Thursday, March 13, 2008

Note To Dr. Dean Ornish: We DON'T All Agree About What Is Considered Healthy

Agreement and civility are mutually exclusive of one another

It's been a few weeks since I was given the unique opportunity to speak with low-fat diet guru Dr. Dean Ornish to discuss his new book entitled The Spectrum. Now that all four parts of the interview has been aired on my podcast show, I'd like to offer a postscript expressing my thoughts about what was said during the interview by Dr. Ornish.

Anyone who has not listened to the 100-minute interview, here are the direct links to each segment for your convenience. It's pretty fascinating stuff and quite confrontational at times, so give it a listen if you haven't already done so:

- My Second Interview with Dr. Dean Ornish
- Dean Ornish, Jimmy Moore Debate 'The Spectrum'
- Does Dean Ornish Now Support A Low-Carb Diet?
- Whatever You Do, Don't Call Dean Ornish A Low-Fat Vegetarian

Before I share my opinions about the interview itself, let me give you some background about how this came about. In early 2006, I decided on a whim that I wanted to try to get an interview with Dr. Dean Ornish to talk with him about his dietary philosophy. My modus operandi was nothing more than to hear what the man had to say about what he believes regarding diet, health, and nutrition.

I initiated contact with him through every means I knew to reach Dr. Ornish and was pleasantly surprised to hear back from him within a couple of months about setting up the interview. This was only about a year after I started my blog and many months before I had my own podcast show. In fact, I wasn't even sure how I was gonna record the interview since I didn't have ANY equipment to make it happen.

As it turns out, in the summer of that year Dr. Ornish got married to his wife Anne and our interview was delayed until October. It was a long time coming, but we finally made it happen and you can read all about it with the transcripts of that interview here, here, here, and here and even listen to the raw audio footage I taped using a digital recorder and a speaker phone by clicking here and here. I even wrote this post-interview challenge to Dr. Ornish and low-fat advocates to pursue those areas of common beliefs to help those who struggle with weight and health issues understand some of the basics of what is generally accepted by everyone as healthy.

Fast forward to early 2008 and this time around Dr. Ornish contacted me to see if I'd like to interview him again to talk about his new book. He explained that he wrote The Spectrum because he was inspired by our previous interview and those areas where we agreed. I was excited to hear that this man who had based his entire career on advocating a high-carb, low-fat, vegetarian diet was open to the possibility of finding merit in other nutritional approaches that run counter to what he has always believed. I honestly held out hope that The Spectrum would show progress in the way Dr. Ornish now thought about livin' la vida low-carb.

Unfortunately, that was not to be.

I will give him credit that the ideals espoused in his book are definitely a step forward in attempting to forge some common ground among those who advocate a low-fat or a low-carb diet, but it didn't take long to see that what Dr. Ornish believed was on the healthy end of the "spectrum" of food choices was the same old high-carb, low-fat vegetarian choices and the foods on the least healthy end were the more fatty, meat-based choices. In other words, not much has changed at all!

While our interview was indeed a cordial one because I am not the kind of person who seeks to rip the throat out of someone I am speaking with, I wasn't going to let Dr. Ornish dominate the conversation tee-totally as I did by design with my first interview. This time around I challenged him where I thought we disagreed as he requested upfront before our interview even began. Boy did I ever!

Let me tell you, though, it was quite nauseating for Dr. Ornish to implore a strategy designed to make it seem like we all agreed when in fact we didn't. You'll notice quite often during our interview, he made references like "we all agree" or "we're not in disagreement about" prior to making a point. The first couple of times he did that, I was only casually listening to what he had to say next. But when it became a habitual part of his communication strategy, my ears perked up every single time he did that.

You don't know how tempted I was to say back to him, "Oh, so since we all agree on what a healthy diet looks like, then that must mean you think a high-saturated fat, low-carbohydrate nutritional plan is needed to bring about improvements in weight and health. After all, we're not in disagreement about this at all, are we?" Dr. Ornish would have crapped in his pants if I actually said that and it would have been snarky for me to do so. That said, he KEPT on doing it and I finally had to call his bluff on it. When I did, he seemed to get perturbed with me and contend that I'm making this a "low-carb versus low-fat" thing.

And that's another issue I had with Dr. Ornish during our interview. Every single time I brought up a question about carbohydrate or fat intake, he'd use this excuse that he's not interested in the "diet wars" which he declared as over and done with now. How convenient for you, Dr. Ornish! While you say you no longer want to engage in the macronutrient debate (which is obviously not true as evidenced by this attack by you against the Atkins diet in March 2007), the fact is you have built your entire reputation on the high-carb, low-fat, vegetarian diet. It's what you will always be remembered for--good, bad or ugly.

While it's nice that you finally agree with low-carb advocates that refined carbohydrates are not as healthy as you once believed they were, even that's not entirely true based on your placement of this category of foods in the moderately healthy part of your "spectrum." What's up with that? Sure, you say that if they are eaten by themselves they should be considered among the least healthy, but that caveat is NOT explained in your book. And, I'm sorry, but eating more fiber with those carbohydrates will NOT significantly slow the blood sugar rise and insulin response in the body as you claim. It would send me into a sugar rush tailspin that would take days to recover from!

And that's another issue of contention I had with Dr. Ornish. While I can appreciate his insistence on looking at the data and the science behind what he recommends, it seems he quite conveniently neglects all the preponderance of the evidence that has come out in recent years regarding a high-fat, controlled-carbohydrate dietary approach. Every researcher he cited you'll notice was his "friend." People like Dr. David Ludwig, a low-carb researcher interested in issues involving childhood health (I recently reviewed his fabulous book Ending the Food Fight), are considered by Dr. Ornish to be on his side of the health debate. But something tells me this "friend" he cites would have something to say about being associated with the high-carb, low-fat, vegetarian diet that runs directly counter to what his research is showing him about a healthy diet.

Then, when I mentioned the name of Gary Taubes and his brilliant book Good Calories, Bad Calories, you would have thought I had just cursed his grandmother! Oh the vitriol that came out of Dr. Ornish's mouth about Gary Taubes was enough to see exactly who he is and what he's about. It very clearly showed me he was uninterested in the evidence and simply stuck on his own monopolistic viewpoints.

When I asked if he had read the Taubes book, you'll notice Dr. Ornish never really answered that question. He said it was on his desk, but that doesn't mean he read it. The disrespect he showed Gary Taubes by claiming he was "just a journalist" put his snobby, elitist attitude on full display for everyone to see. So, does it disqualify Gary Taubes from conducting over six years of research with 150 pages of references in his book because he's not a researcher with an MD or PhD behind his name, Dr. Ornish?

I think not.

I don't have those credentials either, Dr. Ornish, so why would you waste your time on a nothing blogger like me since obviously you look at me in a similar light as you do Gary Taubes? This is why low-carb supporters continue to be skeptical of any changes in you, Dr. Ornish--we don't see any evidence that you're different in either your message or the manner in which you communicate it. It's just more and more of the same old stuff that's been repackaged to seem different. But it's not.

Then there's the issue of people like me who have been highly successful at losing weight on a diet that runs absolutely opposite of what Dr. Ornish has been promoting his whole life. When I asked him about that, he skirted the question rather quickly and moved into talking about all his research about low-fat diets again. Ummm, that wasn't the question, sir. HOW DO YOU EXPLAIN JIMMY MOORE and others who have been successful at not just losing weight on low-carb, but keeping it off over the long-term? It's not a difficult question to answer and I'd STILL love to hear what he has to say about it.

Dr. Dean Ornish is very good at creating diversions from the difficult questions. If he wasn't involved in the health industry, then I'm sure one of the major political parties would LOVE to have him run for office since he can wiggle and maneuver his way out of all the tight circumstances. It's no doubt something he has to do nowadays in light of all the evidence that keeps pouring in from the research community shooting down every single theory he has ever held about a healthy diet.

That's fine that he declares his diet is the only one to be proven to "reverse heart disease" but I'm not buying it. To state as you have your entire career that the healthiest way to eat is a high-carb, low-fat, vegetarian diet is not only false, but completely misleading to a nation full of people who deserve better than that, Dr. Ornish. There should be just as much emphasis on the negative role of carbohydrate in your "spectrum" and not just the refined carbs. Even some whole grains are detrimental to the health of those who are especially insulin resistant--and it's a lot more people than you're willing to admit are out there, my friend.

I'm sure this blog post will be reason enough for Dean Ornish to never want to do another interview with me again, but that's no concern for me right now. I had to speak the truth and the truth is I couldn't remain silent about the continued lies he is sharing with people about his failed dietary philosophy. Get with the times already, Dr. Ornish. Whether you like it or not, livin' la vida low-carb IS mainstream now and here to stay. It's not low-carb versus low-fat--it's what works for the individual. Your refusal to even acknowledge that a low-carb program will work for some gets to the very heart of the matter.

Even I am the first to admit that low-carb will not work for everyone, but it's an option that should at least be promoted by health groups and tried by people who have struggled on a high-carb, low-fat diet as I did for most of my life before going on the Atkins diet in 2004. My mantra is for people to find the proven and effective plan that works for them, follow that plan exactly as prescribed by the author, and then keep doing that plan for the rest of their life. If that's an Ornish-styled low-fat diet, then I say GO FOR IT. But if it's an Atkins-styled low-carb diet, then that should be something you should openly encourage people to follow, too.

Now that's something we ALL agree about anyway, right Dr. Ornish?

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Blogger joshv said...

I have to say, I listened to all four interviews, and I think Ornish really did get the better of you, at least from a debating standpoint. You bring up some good points here in this post, but I felt like you were reading from scripted questions in your interview, and didn't effectively adapt to his wily rhetoric.

Ultimately though, Ornish has a rhetorical style that I think is almost impossible to debate. He won't answer tough questions. He'll give non-answers that sound like answers, he'll try to build consensus where there is none. The guy really ought to be a politician.

3/14/2008 12:13 AM  
Anonymous Anonymous said...

My take on the interviews, which I enjoyed a lot, was that you were both trying to get along, you by treating him respectfully even when you didn't agree, and he by trying to emphasize points of agreement and minimize points of disagreement.

You kept irritating him by labeling him based on his views of thirty years ago, and he kept annoying you by pretending that he agreed with you about things that you really don't agree on.

I would have liked it better if he had admitted that low carb is an amazingly effective way to lose weight, and if you had admitted that we really don't know yet what the long term health effects of eating a lot of saturated fat are, but neither of you were up for that.

You're kind of caught in a bind, as you genuinely want a dialogue with people that don't agree with you, but you also hate it when people disagree, for example basically calling with you, case in point calling Ornish a liar in your blog piece today, which doesn't exactly lead to more dialogue.

It's worth keeping in mind that Ornish has been telling people for 30 years to quit eating sugar and flour, and forgiving him when he takes Taubes's name in vain, I actually thought he didn't read the book, just maybe some sections.

It's interesting to me that William Davis (heart scan blog) says Ornish, not being a cardiologist, misinterpreted his artery scan data, and that plaque didn't really decrease in Ornish's studies. I would love to know what other cardiologists think of Davis's view on that.

Peter Silverman

3/14/2008 10:10 AM  
Blogger Jimmy Moore said...

Well, considering the man has been doing this for over three decades and has all the medical degrees and experience about his low-fat diet compared with someone like me who has been blogging for less than three years without the benefit of any medical or nutritional training, I don't think I did that poorly, Josh. :D But I do appreciate your comments.

Yes, I had a few questions for him, but when I attempted to engage him on points where we disagreed, he went on his high horse and started chiding me for making this a "low-carb versus low-fat" thing or made his infamous "well, we're not in disagreement about that." It was quite frustrating because he couldn't simply answer a question straight.

You'll notice when I asked him about Fred Hahn's "slow burn" style of lifting weights, he stammered and stuttered. Why? Because he got off of his template and had to actually think about an answer before giving it. VERY TELLING!

While I may not have slammed it back at Dean Ornish during our interview, again, that's not my style. I give guests on my podcast show the same respect that I would expect them to give me. As I stated, respect and civility are mutually exclusive of one another. You can disagree without being disagreeable and that's my motto.

You know what would be fun, but it would NEVER happen. Dr. Ornish should be debated by the great Dr. Mike Eades. It very nearly happened once before, as , but Ornish bailed. If he were genuinely interested in debating someone with a similar background from a different nutritional perspective, then Dr. Eades would be the one.

How about it, Dr. Ornish?

3/14/2008 10:15 AM  
Blogger Tom Bunnell (TB)--TB said...

Dr. Ornish, unbeknownst to himself, is migrating with the classic 'where my bread is buttered' peoples syndrome.

We all do this quite naturally and without knowing that we are doing it to protect and provide for ourselves and our families and our reputations! It's human instinct!

Just like these heads of big tobacco in the video clip, he is not lying or distorting the truth in any way. He is saying and telling it exactly as he sees it and as he genuinely believes and perceives things to be.(We should add) As he genuinely believes and perceives things to be 'as they reflect to his own personal being'!

We each want the biggest, juiciest piece of the pie or the whole pie if we can get it!

The 'chiefs' and the 'counsels' then weigh all of these issues like we are doing right here right now, and as the commission did 'after' the tobacco hearings and determine what the 'real' truth is!

3/14/2008 10:25 AM  
Blogger Jimmy Moore said...

THANKS Peter. Good analysis overall, but I would only dissent slightly on one point. I don't mind people disagreeing with me, but I do mind when someone disagrees and basically gives no reason for the disagreement. That's what happened with Dr. Ornish during my interview and I called him on it in my post-interview blog today. Is it unreasonable for me to want him to answer the questions as stated? I don't think so. And yet he didn't.

Had he simply stated that a low-carb way of eating works for helping people lose weight and get healthy as has been proven time and time again in the research lab and in real life, then that would have been a major breakthrough. Otherwise, he's just still promoting the same thing he did thirty years ago. Read the book and see what I mean, Peter.

On the saturated fat front, you'll be pleased to know I will be attending a conference in Phoenix next month with all the latest research on saturated fat and it will surprise a lot of people. I've highlighted some of it here previously, but it's not as damning as we have been led to believe--especially in the reduction or absence of carbs.

Dr. Davis is indeed a rebel and I'd LOVE to see what ORNISH has to say about the heart scan data, too. :D

THANK YOU as always for your comments, Peter. I really appreciate it.

3/14/2008 10:42 AM  
Anonymous Anonymous said...

Re: Ornish debating Mike Eades, Ornish would be foolish. Unlike you and Ornish, when Eades doesn't like someone's views he starts calling them names, "idiots" and "pimps" being his two favorites. Would you debate, say, a low fat advocate who is into serious insulting of people who don't agree with him?

Re: Ornish's book, I did read it.
What has changed in his view is:
a. much more emphasis now on how bad refined carbs are for you. b. Less insistence on there only being only one right diet, namely less than 10% fat, but rather a spectrum of reasonable choices.

Both of you are trying to find common ground, but the biggest stumbling block is on the long term health effects of eating lots of saturated fat. It certainly isn't clear to me who's right about that, but time will tell.

3/14/2008 11:12 AM  
Blogger Tom Bunnell (TB)--TB said...

oops! I meant to send this one!

3/14/2008 11:19 AM  
Blogger Jimmy Moore said...

THANKS again, Peter! While Ornish may agree that refined carbs are harmful in lip service, I still can't get past him putting them in Group 3 as a moderately healthy food to consume. HUH? This is just plain loopy to me based on all we know about refined carbohydrate. I still contend not much has changed about him.

3/14/2008 11:38 AM  
Blogger Tara said...

I think Dr. Ornish's low fat diet must have gone to his head because he doesn't make any sense - a low-fat diet does NOT agree with the Atkins diet.
Given that the brain is pretty much made of fat, it looks like his is starving.

3/14/2008 12:46 PM  
Blogger Dave said...

Ornish (along with just about everybody in the health and nutrition field) is firmly caught in confirmation bias. He should read "Mistakes Were Made (but not by me)" by Carol Tavris and Elliot Aronson. For instance, one wonders what Ornish would have to say about this study showing that progression of atherosclerosis was inversely related with saturated fat intake in postmenopausal women. Rather than weigh it properly, I suspect he dismissed it entirely, because it was disconfirming of his beliefs. The scientific method demands you consider all of the available evidence, and understand how it contributes to your belief in different hypotheses.

I think key evidence that is nearly always ignored (probably because many dietary "experts" are largely ignorant of said evidence) comes from detailed knowledge of metabolism at the molecular and cellular level. This was one of Taubes' key points: any hypothesis about the health effects of a given nutrional program need to be reconciled with what is known about human metabolism, the hormonal responses to various foods, etc. because this stuff can be measured and understood in highly controlled experiments. It may not tell the whole story, but it tends to be a very solid piece, especially compared to evidence from epidemiological and other observational studies.

Take glycation damage, for instance. Sugars interact with proteins (and fats) through a chain of reactions, resulting in what are known as advanced glycation endproducts (or AGE). These damaged proteins are functionally and structurally modified (meaning they can't do their intended jobs), and increase oxidative stress in the body. The body "knows" this, expressing a specific receptor (RAGE) which, when activated by AGE, induce an inflammatory response, presumably in an effort to clear out the damaged material before it causes too many problems.

Glycation is a difficult issue to avoid if you're promoting a high-carbohydrate diet. The more digestible carbs you eat, the greater potential for glycation damage. It's just basic chemistry. To avoid this issue, you would need to hypothesize some mechanism by which the body tolerates some level of carbohydrate intake, e.g. that doubling carbohydrate intake doesn't result in a corresponding increase in the generation of AGE; or you might argue that glycation is the lesser evil from several alternatives, and thus carbohydrate is the most healthy energy nutrient. But you need some proof to back that up.

Let's apply the same analysis to saturated fat. Saturated fat is chemically pretty stable, and tends not to react with other things. Most notably it resists oxidation, and does not react with proteins as sugars do. As far as I've been able to determine, saturated fats don't really exert much effect on anything (e.g. hormones), beyond their role in cell membrane rigidity and permeability. Indeed, when your body stores fat, it prefers to store it as saturated fat, and thus that saturated fat is an important fuel between meals. It's very likely that the evolutionary choice to store and utilize energy in this form was made for a good reason, one which enhances the survival characteristics of the organism.

So there's basically no molecular/cellular evidence that consumption of saturated fat has negative health effects (if I'm missing something, please fill me in). Now there are lots of hypotheses of how saturated fats lead to health problems, e.g. by interfering with cholesterol metabolism. But these remain hypotheetical, to my knowledge having little supporting experimental proof.

By contrast, polyunsaturated fats are easily oxidized, and measurably increase oxidative stress. Basic chemistry strikes again.

I'd be happy to debate Dr. Ornish. I have a Ph.D., so am properly "credentialed". And I promise not to call him names. But I would make him answer some of these fundamental questions linking his hypotheses of what constitutes a healthy diet with what is known about human metabolism, and probe the depth of his knowledge on these topics. This sort of debate is the foundation of scientific advancement, and those who avoid such debate clearly have interests outside of the pursuit of scientific truth.

3/14/2008 1:12 PM  
Blogger Matt Reiner said...

You missed a golden opportunity with the Inuit question, as there are many studies out there proving the excellent overall health of indigenous socities that consume/comsumed large quantities of fat and animal products. I haven't seen any on low-fat vegetarian civilizations, have you? As humans, we evolved from meat-eaters. Period. I'd like to see Dean's take on that.

Ornish is a tough person to debate with. I saw him use the same "we all agree on" technique with Gary Taubes a few years back.

3/14/2008 8:01 PM  
Blogger Jimmy Moore said...

THANKS, Matt, but I DID ask Ornish about the Inuit people. His answer was that we have evolved to eat the diet we have today--namely a low-fat vegetarian diet. When I responded that our early ancestors ate a mostly high-fat, moderate protein, nearly zero carb diet, he said that was then and this is now. So he did respond.

3/15/2008 11:00 AM  
Blogger Tom Bunnell (TB)--TB said...

I believe he said that 'they' (Inuit) evolved to eat that way! And then he added that 'we' have evolved to eat the diet we have today. -- namely a low-fat vegetarian diet as you stated.

3/15/2008 2:25 PM  
Blogger Kevin M. said...

That was great, Dave, where are the clear-thinking, common-sense people like you in the medical feild? All co- opted and compromised, apparently. Ornish is a remnant of a prior phase of American culture, kind of like Ralph Nader, that is why he won't change his veiw and is not open to new information. He may be willing to debate with a layperson because, like most medics, he relies more on his presumed authority as a doctor than on actual evidence to support his contentions. The real question raised by low-carb and being debated here is the legitimacy, or lack thereof, of the current medical science profession. We need scientists of integrity such as Dave to speak up in support of responsible, meaningful research. But considering that we are challenging and changing the direction of the entire nutritional understanding of modern medical science, it may be understandable that it may take a few decades. It's incomprehensible how the greatest medical science system in history allowed itself to get into such a state of error to begin with.

3/15/2008 6:00 PM  
Blogger Matt Reiner said...

One of the studies folks like Ornish like to base their low-fat vegaetarian credentials on is T. Colin Campbell's "The China Study," which is still selling well on

I first read this book in 2005 and, as a result, went vegetarian for two years (I did eat some seafood, however). I then began to challenge Campbell's work when I realized how much soy products disagreed with me and my difficulty keeping my weight down. The most disturbing thing I've found about this so-called "monumental" study is that carbohydrates, not animal protein, actually had a higher correlation to sickness and disease among the Chinese Campbell studied! If anyone else here has read the book, they might also notice how little of the book is dedicated to the study itself.

So as I said in my earlier post, we have plenty of studies to back us up. Now we need a stronger voice. Thank you, Jimmy, for giving us one.

3/15/2008 8:15 PM  
Blogger Didirina said...

Speaking of studies, that absolutely stupid one that was done by the University of Maryland last fall has reared its ugly head again. The latest Prevention magazine has cited it in an article entitled, "The Worst Diet For Your Heart: Discover the truth about the Atkins diet" by Cynthia Sass, RD.! It's on their website, too. And even worse, the magazine has another article in the same issue that promotes the Pritikin diet for healing diabetes! I thought Prevention was making progress here (there have been a few success stories with Atkins, and their new Flat Belly diet advocates more fat than usual), but it's glaringly apparent that science and evidence is to be glossed over as it has been to date. In this same issue, some of the breakfast smoothies have more than 40 grams of carbs in each serving!

3/15/2008 11:36 PM  
Blogger Dave said...

Chris Masterjohn does a nice job of critiquing "The China Study" here: Be sure to read Campbell's response, and Masterjohn's rebuttal as well.

Loren Cordain also debated Campbell in written form, and pretty much handed him his head. This is a long read (ignore the editorial at the start), but worth looking at if you want to see the difference between how scientific evidence should be evaluated (Cordain) vs. hand-waving and "philosophy" (Campbell). Read "The Protein Debate" here:

Some further commentary on Cordain/Campbell here:

3/16/2008 3:18 PM  
Blogger Carl said...

I listened to one of the podcast. I don't think that I could stand to listen to anymore. My immediate impression was; this guy's a nut! Not only is he a nut he's dangerous. He is putting people on the road to a heart attack not preventing it. Diabetes is only a milestone on your trip to having heart disease and a heart attack. A diabetic has the same risk of a heart attack as someone who has already had one.

I am diabetic and have suffered with the disease for a long time. Controlling diabetes for me turned out to be very simple. No thanks to bad medical advice from my so called expert doctors and the American Diabetes Association. My doctors were specialist ( Endocrinologist ). Not one of them told me the most important thing for me to do to control diabetes was to lose weight! These doctors only want to write prescriptions. It took me years to figure out how to control my diabetes. The answer was on almost every page of Dr Robert Atkins book. I now call this book my diabetes bible. The solution is very simple and logical. Don't put anything into your mouth that will cause your blood sugar to rise. A sugar spike is the common term for this. This sugar spike causes insulin to be dumped into your blood by the pancreas. Insulin is a very destructive powerful hormone. Insulin destroys your carder vascular system. The combination of insulin and the liver produces fat in your body. Eating fat does not make you fat. Eating fat is good for you. Eating carbohydrates makes you fat! You can not produce and store fat in your body without insulin. This is the bases of Dr Robert Atkins wonderful diet; insulin control! Eating fat does not cause a insulin response. This is why living the low carb lifestyle is not only the best way to lose weight. It is also the best treatment for diabetes. The Ornish diet will cause disease and death.

3/17/2008 7:10 AM  
Anonymous Anonymous said...

People have asked for the list of 8 people who have allegedly reversed their heart disease, but Ornish has used his fast talking diversions to change the subject.

9/15/2008 5:20 AM  

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