ON THE ISSUE OF DIETARY FAT

A REACTION TO DR. DEAN ORNISH AND THE PRITIKIN CENTER

By Stephen Byrnes, PhD, RNCP, Grad. Dip. Nat.( drbyrnes@powerhealth.net )

Predictably, Gary Taubes' NYT article "What If Its All Been a Big Fat Lie?" generated a hornet's nest of coverage around the world, but particularly in the USA. Unfortunately, the essential message of the article got quickly twisted by the Spin Doctors of Modern Medicine to suit their own agenda.

For example, the popular American show 20/20 ran its lead story on the article shortly after it appeared in print. The report started out alright, detailing how the American low-fat dietary guidelines were decided on by lawyers, not physicians or nutritionists, but then things went sour- -FAST.

Despite the report stating that fat was now good, once again, the "saturated animal fats" were branded as "The Bad Fats" along with the TFAs (trans-fatty acids). The "Good Fats" were all of the politically-correct ones: olive oil, sesame oil, flax oil, and canola oil. Canola oil? Ai!! (see "The Great Con-ola http://www.westonaprice.org/know_your_fats/conola.html)

The 20/20 report also kept stating that it was REFINED carbohydrates that were harmful but that complex carbohydrates like whole grains were OK. However, the fact is that, except for a few vitamins and minerals and some fiber, "a carb is a carb is a carb" because they ALL are converted in the body to glucose. I don't think Gary Taubes meant to imply in his article that it was not OK to eat a bowl of pasta, but perfectly fine to eat a big bowl of brown rice instead. The 20/20 show even had Taubes at the end of the piece saying, "I'm going to continue eating a low-carb diet."

For the grand finale, after the piece was over, the show had Barbara Walters and her co-host discussing the recent Duke University study on the Atkins Diet and how the subjects lost weight and had improved blood lipid profiles. It, of course, is common knowledge that the Atkins Diet is heavy on animal fats, the supposed "bad" ones fingered by the show - but this was not mentioned by the hosts.

Other responses to Gary's article include this very good one by MSNBC correspondent Josh Mankiewicz:
http://www.msnbc.com/modules/exports/ct_email.asp?/news/780727.asp

Angry Responses from the Low-Fat Gurus

The low-fat camp was, of course, horrified at the attention Gary Taubes’ article got and responded in kind.

For Dr. Dean Ornish's response, in the form of an Op-Ed piece in the New York Times, entitled "A Diet Rich in Partial Truths." (You may have to register for free with the NY Times to read this.) http://www.nytimes.com/2002/07/13/opinion/13ORNI.html

And the Pritikin Center also responded. http://biz.yahoo.com/prnews/020711/flth013_1.html

When you read the responses from Ornish and Pritikin, there are several things to keep in mind, as I will now discuss.

Complex and Refined Grains - Is There Much of a Difference?

Both responses, like the 20/20 report, try to finger refined carbs (and not complex carbs) as the villains due to their deleterious effects on insulin levels. For example, the Pritikin Center states:

But any Glycemic Index Food Table will quickly show this to be a lie. The Glycemic Index is a measure of how fast blood sugar responds two hours after a certain food is ingested in comparison to the way it responds two hours after an equal amount of glucose is ingested. The higher the Glycemic Index, the faster the spike in blood sugar and insulin. Consider the following chart comparing the Glycemic Index of some refined carbs with some complex carbs:

On the low end of the glycemic index are some legumes like lentils and (gasp!) ice cream and whole milk! If you follow the advice of Ornish and the Pritikin Center, its actually better to eat ice cream than it is to eat brown rice!

On the Effectiveness of the Ornish Diet

Dr. Ornish's claims about the effectiveness of his program are questionable. He implies that the benefits of his program are from his very low-fat, high-complex carb diet.

However, it is a fact that his program combines lifestyle changes like smoking cessation, weight loss, exercise, and meditation along with the diet. The diet was never studied on its own by Dr. Ornish's team. So the "million dollar question" is this:

How do you know which factor (or combination of factors) produced the benefits in Dr. Ornish's patients?

The same things can be said of the Pritikin Plan: The diet was never studied in isolation of the other components of the program.

Conflicting Results on the Ornish/Pritikin Diets

When the Pritikin and Ornish diets were studied by other groups, however, very different results were obtained as a medical doctor colleague of mine explained. I've reprinted some of the pertinent parts of his comments:

"Until Knopp and his associates did so (JAMA 1997), the Pritikin diet was not studied alone and without exercise, stress reduction, and other components of a comprehensive approach such as Pritikin's and Ornish's. Knopp's study clearly demonstrated that, despite the assistance of spousal education and support, the lowest fat group could not tolerate such a low fat diet. They found that as percentage of fat was lowered below 30%, traditional lipid profile risk factors clearly worsened in direct relation to the degree of lowering of percentage of dietary fat.

The weight loss registry is not really a trial, and it shows that, yes, a very small percentage of folks can keep weight off with a low fat diet if they also exercise vigorously for about 90 minutes per day. What kinds of folks do you think sign up for a weight registry? I'm guessing not predominantly the dismal failures. Is this supposed to be scientific evidence?

Why do the Pritikin folks not cite the numerous studies suggesting glycemic load's association with elevated CRP [C-Reactive Protein] and other risk factors for diabetes and CHD? The jury is still out re insoluble fiber's usefulness and it would seem that soluble fiber's general usefulness is likely due to its slowing of carbohydrate absorption and glycemic index of meals. This is probably not as important in a diet that is low-carb to begin with. So, according to the Pritikin folks, I am to conclude that large amounts of insulin are bad, that highly refined carbs elicit large spikes, but large amounts of less refined carbs, which also yield a net large amount of insulin, are OK. Could someone please explain how that works?"

Even more stinging is this analysis of the Pritikin Center's study by another colleague:

"This article cites the following study http://www.uchsc.edu/nutrition/nwcr.htm from the National Control Registry that shows that a low-fat diet works. Oh yeah! It works, but why and how? It works when women eat an average of 1,300 calories per day for the entire five years in order to "maintain" their weight. Yes I said, "Maintenance" was 1,300 calories a day PLUS vigorous exercise. How much exercise? Enough to burn 400 calories per day. But ooooh nooooo, it's not the low calories and huge amounts of exercise that are keeping these people thin. We are supposed to believe that it is the heaven-sent, decreed by almighty God himself, low-fat diet! So how much could men eat to maintain weight? Men averaged 1,600 calories per day on this high carbohydrate low fat diet. They also exercised off 400 calories per day. Does anyone see any hypocrisy here?"

The Pritikin Center’s Misinformation Campaign

In its press release, the Pritikin Center concludes by claiming that:

Well, readers of my newsletter http://www.powerhealth.net/subscribe.htm should know that this "huge body of research" is NOT so huge and that naturally saturated fats do NOT clog arteries. For more on this, see my book Diet & Heart Disease: Its NOT What You Think http://www.powerhealth.net/books.htm or Uffe Ravnskov's book The Cholesterol Myths http://www.ravnskov.nu/cholesterol.htm.