Category Archives: vegetarian

The new dietary guidelines, a major improvement

The new Dietary Guidelines for Americans (DGA) represent a major improvement over previous guidelines. The storm of criticism registered by some “experts” and quoted by the media is NOT based on valid evidence. There has been excessive and irrational criticism over inverting the food pyramid, with animal sources of protein on the top. Until now recommendations for daily protein intake have been based upon estimates to avoid protein deficiency rather than optimization. The recommendations for 1.2-1.6 grams per kilogram bodyweight per day (up from 0.8 g/kg/day) is supported by data on muscle building, muscle maintenance and bone health (when combined with resistance exercise), especially for elderly individuals.

Unfortunately, the 10% restriction on saturated fat remains, but the guidelines appropriately state that there is a lack of evidence to keep that restriction at 10% of caloric intake. The controversy over saturated fat remains despite meta-analyses of randomized controlled clinical trials that conclude that restriction of saturated fat has not been found to improve cardiovascular, metabolic, or cancer outcomes.

I doubt that those critical of the new DGA have read the 416-page appendices that document scientific references and explanations for each of the dietary recommendations. That’s right, 416 pages of narrative and scientific references are in the appendices of the DGA.

If you go here, you can download 4 documents including the Scientific Foundation Appendices (416 pages), the Scientific Foundation for DGA (90 pages), The Daily Servings Guide (3 pages) and the DGA (10 pages)

Here is an excerpt that is very useful.

How can you identify highly processed foods? Highly processed foods tend to have: 1. Refined grains and/or added sugars 2. Refined fats and oils 3. Long, complicated ingredient lists including chemical additives (e.g., artificial sweeteners, flavor enhancers, artificial colors, and emulsifiers). Examples are provided in Figures 4.3 and 5.8.

And a good explanation for why refined grains (any food made with flour) causes rapid and high blood sugar responses.

Refined Grains and Starches are Sugar • Refined grains are highly purified sources of starch. • Starches are long chains of glucose—a form of sugar. • During chewing and digestion, enzymes rapidly break down starch into glucose, raising blood sugar much like table sugar does. • Refined grain foods—white bread, crackers, breakfast cereals, chips, pastries, and pasta—can therefore act metabolically like sugar, delivering fast-absorbing carbohydrates with few nutrients or fiber to slow absorption. Take-home message: Refined grains are sugar in disguise. Choose whole grains, beans, or vegetables instead.

The following two graphics demonstrate the results of previous dietary guidelines that demonized healthy fats and animal sources of protein. The first shows the rise in obesity and diabetes but does not address the insulin resistance that evolves over decades before crossing the arbitrary threshold of diabetes, wreaking metabolic havoc long before diabetes occurs. The second graphic reveals how Americans consume 60% or more caloric intake in the form of refined carbohydrates (equivalent to sugar)

The following graphic displays the difference between minimally processed, moderately processed and highly processed foods according to the NOVA classification system (a system I will discuss and criticize in future posts). For now, suffice it to say that a simpler and more practical definition of “processed food” would include any food with one or more of the following: added sugar, artificial sweeteners, refined starch especially flour made from grains, refined “vegetable” oils, emulsifiers, artificial coloring, preservatives, and other additives found to disrupt the microbiome, intestinal barrier function or cause cancer. This graphic importantly covers the issue of food packaging which can contribute to the consumption of micro plastics, phthalates and PFAs

I have consistently advocated for a diet that consists of free-range meat, poultry, eggs, seafood (low mercury varieties), organic vegetables, fruits, nuts, seeds, an ancestral or paleo diet. The new DGA go a long way to produce evidence-based recommendations to help Americans eat healthy food. I continue to advocate for getting fiber from vegetables and fruits, eliminating grains, for reasons previously discussed but if you want to eat grains and are not gluten sensitive or suffer from celiac disease, consume the grains as a whole food, not in a food made from flour. “Whole grain bread” is not a whole grain food, nor is “whole grain” pasta. Once flour is made from grains the cellular components are destroyed producing a product with a glycemic index akin to sugar with the resultant metabolic disturbance which over the long run leads to insulin resistance, obesity and chronic disease.

If you want to consume dairy it makes much more sense to consume full fat fermented dairy foods instead of the low-fat dairy products advocated by prior DGA. The new DGA go into great detail to describe the nutrient deficiencies associated with vegan and vegetarian diets unless specific supplements are consumed. Specific recommendations for pregnant and breast-feeding mothers cover most important points as do age specific recommendations for infants and children. The importance of choline could have received a little more attention (best sources include eggs and liver). The importance of marine omega-3 fats (EPA, DHA, DPA) received adequate attention.

Overall, I consider the 2026 DGA a major improvement compared to previous iterations which ignored a large body of nutritional science.

The following references support my position on SFA and properly raised and prepared animal protein.

https://pubmed.ncbi.nlm.nih.gov/32562735/

Astrup A, Magkos F, Bier DM, Brenna JT, de Oliveira Otto MC, Hill JO, King JC, Mente A, Ordovas JM, Volek JS, Yusuf S, Krauss RM. Saturated Fats and Health: A Reassessment and Proposal for Food-Based Recommendations: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Aug 18;76(7):844-857. doi: 10.1016/j.jacc.2020.05.077. Epub 2020 Jun 17. PMID: 32562735.

Reimara Valk, James Hammill, Jonas Grip, Saturated fat: villain and bogeyman in the development of cardiovascular disease?, European Journal of Preventive Cardiology, Volume 29, Issue 18, December 2022, Pages 2312–2321, https://doi.org/10.1093/eurjpc/zwac194

Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study Dehghan, MahshidDiaz, R et al. The Lancet, Volume 390, Issue 10107, 2050 – 2062

https://pubmed.ncbi.nlm.nih.gov/36216940/

Lescinsky H, Afshin A, Ashbaugh C, Bisignano C, Brauer M, Ferrara G, Hay SI, He J, Iannucci V, Marczak LB, McLaughlin SA, Mullany EC, Parent MC, Serfes AL, Sorensen RJD, Aravkin AY, Zheng P, Murray CJL. Health effects associated with consumption of unprocessed red meat: a Burden of Proof study. Nat Med. 2022 Oct;28(10):2075-2082. doi: 10.1038/s41591-022-01968-z. Epub 2022 Oct 10. PMID: 36216940; PMCID: PMC9556326.

Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis Renata Micha ¹, Sarah K Wallace, Dariush Mozaffarian, Circulation CIRCULATIONAHA.109.924977. Epub 2010 May 17. https://pubmed.ncbi.nlm.nih.gov/20479151/

Unprocessed Red Meat and Processed Meat Consumption: Dietary Guideline Recommendations from the Nutritional Recommendations (NutriRECS) Consortium Bradley C. Johnston, PhD, Dena Zeraatkar, Msc, et. al. Ann Intern Med 2019: 1:756-764 doi: 10.7326/M19-1621

Reduction of Red and Processed Meat Intake and Cancer Mortality and Incidence A Systematic Review and Meta-analysis of Cohort Studies Mi Ah Han, MD, PhD; Dena Zeraatkar, MSc; et. al., Ann Intern Med. 2019;171:711-720. doi:10.7326/M19-0699

Patterns of Red and Processed Meat Consumption and Risk for Cardiometabolic and Cancer Outcomes A Systematic Review and Meta-analysis of Cohort Studies Robin W.M. Vernooij, PhD*; Dena Zeraatkar, MSc Ann Intern Med.2019;171:732-741. doi:10.7326/M19-1583

Red and Processed Meat Consumption and Risk for All-Cause Mortality and Cardiometabolic OutcomesA Systematic Review and Meta-analysis of Cohort Studies Dena Zeraatkar, MSc, Mi Ah Han MD, PhD, et. al, Annals of Internal Medicine 1 October 2019: 171-710 doi: 10.7326/M19-0655

Effect of Lower Versus Higher Red Meat Intake on Cardiometabolic and Cancer Outcomes

A Systematic Review of Randomized Trials Dena Zeraatkar, MSc, Bradley C Johnston, PhD, et. al. Ann Intern Med. 2019;171:721-731. doi:10.7326/M19-https://doi.org/10.7326/M19-0622

E, Lavie CJ, Hill JO. The Failure to Measure Dietary Intake Engendered a Fictional Discourse on Diet-Disease Relations. Front Nutr. 2018 Nov 13;5:105. doi: 10.3389/fnut.2018.00105. PMID: 30483510 Archer; PMCID: PMC6243202.

Archer E, Hand GA, Blair SN (2013) Validity of U.S. Nutritional Surveillance: National Health and Nutrition Examination Survey Caloric Energy Intake Data, 1971–2010. PLoS ONE 8(10): e76632. https://doi.org/10.1371/journal.pone.0076632

O’Connor, Lauren E., et al. “Effects of total red meat intake on glycemic control and inflammatory biomarkers: a meta-analysis of randomized controlled trials.” Advances in Nutrition 12.1 (2021): 115-127.

Kiani AK, Dhuli K, Donato K, Aquilanti B, Velluti V, Matera G, Iaconelli A, Connelly ST, Bellinato F, Gisondi P, Bertelli M. Main nutritional deficiencies. J Prev Med Hyg 2022;63(suppl.3):E93-E101.https://doi.org/10.15167/2421-4248/jpmh2022.63.2S3.2752

Bailey RL, West KP Jr, Black RE. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab. 2015;66 Suppl 2:22-33. doi: 10.1159/000371618. Epub 2015 Jun 2. PMID: 26045325.

Global, regional and national burdens of common micronutrient deficiencies from 1990 to 2019: A secondary trend analysis based on the Global Burden of Disease 2019 study. Zu Han et. al., eClinicalMedicine, February 11, 2022 https://doi.org/10.1016/j.eclinm.2022.101299

Sean R. Lynch, Why Nutritional Iron Deficiency Persists as a Worldwide Problem, The Journal of Nutrition, Volume 141, Issue 4, April 2011, Pages 763S–768S, https://doi.org/10.3945/jn.110.130609

Meat supplementation improves growth, cognitive, and behavioral outcomes in Kenyan children , J Nutr. 2007 Apr;137(4):1119-23.

Animal source foods have a positive impact on the primary school test scores of Kenyan schoolchildren in a cluster-randomised, controlled feeding intervention trial – PubMed (nih.gov), Hulett JL, Weiss RE, Bwibo NO, Galal OM, Drorbaugh N, Neumann CG.Br J Nutr. 2014 Mar 14;111(5):875-86. doi: 10.1017/S0007114513003310. Epub 2013 Oct 30.PMID: 24168874 Clinical Trial.

Meat supplementation increases arm muscle area in Kenyan schoolchildren – PubMed (nih.gov), Br J Nutr. 2013 Apr 14;109(7):1230-40. doi: 10.1017/S0007114512003121. Epub 2012 Aug 2.PMID: 22856533 Clinical Trial.

School snacks decrease morbidity in Kenyan schoolchildren: a cluster randomized, controlled feeding intervention trial.

Neumann CG, Bwibo NO, Jiang L, Weiss RE.Public Health Nutr. 2013 Sep;16(9):1593-604. doi: 10.1017/S1368980013000876. Epub 2013 Mar 28.PMID: 23537728

Effects of animal source foods, with emphasis on milk, in the diet of children in low-income countries.

Allen LH, Dror DK.Nestle Nutr Workshop Ser Pediatr Program. 2011;67:113-30. doi: 10.1159/000325579. Epub 2011 Feb 16.PMID: 21335994

https://www.bmj.com/content/351/bmj.h4962

The scientific report guiding the US dietary guidelines: is it scientific?

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4962 (Published 23 September 2015)

https://pmc.ncbi.nlm.nih.gov/articles/PMC9794145/

Teicholz N. A short history of saturated fat: the making and unmaking of a scientific consensus. Curr Opin Endocrinol Diabetes Obes. 2023 Feb 1;30(1):65-71. doi: 10.1097/MED.0000000000000791. Epub 2022 Dec 8. Erratum in: Curr Opin Endocrinol Diabetes Obes. 2025 Aug 1;32(4):166. doi: 10.1097/01.med.0001118356.22843.75. PMID: 36477384; PMCID: PMC9794145.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

Red Meat and Health, another round of nonsense

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Again, another biased article claims to demonstrate the dangers of red meat. There are so many problems with the author’s analysis and conclusions it is hard to know where to begin. Rather than go through the nitty gritty here, just head on over to this analysis to read another debunking of the same litany of bad science.

https://www.globalfoodjustice.org/nutrition/does-the-global-meat-trade-lead-to-poor-health

In the context of the COVID 19 pandemic I will close with the usual summary.

Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
Get plenty of sleep (without adequate sleep your immune system does not work well )
Follow good sleep habits
Exercise, especially out of doors in a green space, supports the immune system
Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml. (read this Open Letter)
Eat an anti-inflammatory diet rich in micronutrients.
Practice stress reduction like meditation and yoga which improves the immune system
Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Doctor Bob

Nutrition and Lifestyle vs Pandemic

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Earlier this year I gave 2 presentations on this topic at the (virtual) annual meeting of Physicians and Ancestral Health, a physician organization dedicated to incorporating evolutionary biology and lifestyle recommendations into the practice of medicine. Here is the first slide:

And here are some very important references:

Please note that this lecture was given before the delta variant arrived so the data applies to the pre-delta period.

MI= Myocardial Infarction (heart attack with loss of muscle), PE=Pulmonary Embolus, DVT= Blood Clots in legs, SIRS= Systemic Inflammatory Response Syndrome

I will skip several of the slides and get to the nutritional immunology and other lifestyle factors.

This slide shows many lifestyle factors that interact with the immune system. The “12% metabolic health” refers to a study demonstrating that only 12% of American adults are metabolically healthy, which will be explained later. Dysbiosis refers to an imbalance in gut bacteria favoring inflammation and immune compromise. The rest should be self explanatory but discussed in detail later in this series.

Here is the very busy slide that summarizes nutritional immunology:

w3/w6 refers to the omega 3 to omega 6 ratio in the diet, ROS= Reactive oxygen species (oxidative stress), CH: carbohydrates; GALT: gut-associated lymphoid
tissue; GPRs: G-protein-coupled receptors; FA: fatty acids; GI/GL: glycemic index/load; RAR/RXR:
retinoic acid receptor/retinoid X receptor; SCFA: short-chain fatty acids; TF: transcription factors; VDR:
vitamin D receptor.

Key points in this slide:

Omega 3 fats from fatty fish fight inflammation, excess omega 6 fats from refined “vegetable oils” (corn, soy, cotton seed, sunflower seed, safflower, etc.) contribute to inflammation and blood clots, contributing to cytokine storm and bradykinin storm.
Vitamin D interferes with the virus at multiple points.
Adequate iron (Fe) from meat and seafood is essential for immune function (Iron from plant sources is much less bioavailable compared to meat and seafood.)
Adequate complete protein (not available from vegan diets) is essential for immune function.
Zinc and selenium (both found in seafood and meat) are essential for multiple protective pathways in the immune system (enhancing response to infection and mitigating excessive inflammatory response as cofactors for antioxidant enzymes)
Sugar and high glycemic foods cause inflammation, high blood sugars suppress the immune system
Dietary fiber supports a healthy gut microbiome which in turn suppresses inflammation and provides the gut lining with SFAs (gut epithelium requires SFAs for energy and function, gut barrier function needs SFAs)
Phenolic compounds in colorful vegetables and berries modulate multiple essential immune pathways that can inhibit viral replication.
Carotenoids, phenolics support several vital immune pathways.
Omega 3 fats are the building blocks of chemicals that help resolve inflammation and mitigate against cytokine storm and bradykinin storm.
Multiple vitamins and phenolics support our internal anti-oxidant system.
To get a balanced protein intake we should eat “nose to tail”. Include connective tissue (home made bone broth is a great source) and organ meats (from grass fed/finished ruminants) in addition to muscle meat.

Here is another busy slide that presents more detail, note the reference at the bottom of the slide to read more.

Sorry for the small print but you can see the blow up on line by going here.

http://A Review of Micronutrients and the Immune System-Working …

So does the “Standard American Diet” meet these nutritional needs to support a healthy immune system?

The % above represent the % of American adults with intakes BELOW the EAR (Estimated Average Requirement) for various vitamins and minerals. But note the definition of EAR:

“nutrient intake value that is estimated to meet the requirement of half the healthy individuals to avoid symptoms of a clinical or subclinical deficiency” (NOT OPTIMAL LEVELS for immune function)

Note also that this study did not consider omega-3s, phytonutrients, flavonoids, polyphenols, fiber, etc., all of which are essential to a robust immune response to any virus including SARS CoV-2.

With regards to omega 3 vs omega 6 fats:

Omega 3 fats (EPA and DHA) found in seafood fights inflammation, blood clots. DHA and EPA are the building blocks of SPMs which help RESOLVE INFLAMMATION (MITIGATE CYTOKINE STORM)

We will return to this topic in my next post. We are just scratching the surface of a complex system.

In the context of the COVID 19 pandemic I will close with the usual summary.

Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
Get plenty of sleep (without adequate sleep your immune system does not work well )
Follow good sleep habits
Exercise, especially out of doors in a green space, supports the immune system
Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml. (read this Open Letter)
Eat an anti-inflammatory diet rich in micronutrients.
Practice stress reduction like meditation and yoga which improves the immune system
Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
If you are over age 12 and eligible for vaccination, consider protecting yourself and your neighbor with vaccination.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Doctor Bob

Three Major Threats to Global Health

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Our world faces three major threats.

Global Warming
Daily loss of nutrient rich top soil with desertification of arable land
COVID-19 pandemic

The first two threats are intimately related to each other. As the climate and our oceans warm and seas rise, the ecologic and economic consequences will be profound. Species are threatened and become extinct, biodiversity which sustains the global ecology and global economy diminishes on a daily basis. Loss of trees and native plants accelerates global warming. Melting of the polar ice caps and mountain glaciers results in less reflectance of solar energy back into space and more absorption of solar energy by the planet, producing a positive feedback loop that is cooking our planet.

Warming climate combined with loss of habitat (especially loss of rainforests) has produced a non-sustainable advance that has already caused tens of thousands of insect species to become extinct. Loss of insects, at the base of the food chain, and loss of essential microbes in our soil, threaten all species on earth, including humans.

Mono-agriculture has produced quantitative and qualitative loss of topsoil and arable land. Soil is a living organism. Arable land requires not just nutrient rich topsoil but also a diverse abundance of microorganisms that support agriculture, native plants, and the entire food chain. Ditto the effects on the health of our oceans, seas, rivers, streams and lakes.

There has been a pseudo-scientific movement away from raising animals as a food source. We have been told that only a vegetarian or vegan diet can sustain the planet. Nothing can be further from the truth!

Creation rather than destruction of arable land requires animal waste. Feeding the world with health-supporting food will require animal and plant foods. Sustainable agriculture requires animals and their poop.

To be blunt, the future of the world’s food supply and arable fertile land depends upon the poop of wild and domestic animals, the elimination of Monoagriculture, GMOs, Roundup-ready crops, and deforestation as well as addressing the threat of global warming.

How many news headlines, films, books and friends of yours say that beef is the unhealthiest and environmentally destructive foods you could be eating? Have you cut down on your meat consumption or feel frustrated about the vilification of meat, something humans have eaten for millions of years?

The most pivotal food and environment book of 2020 is coming soon!

My friends Diana Rodgers and Robb Wolf have been trying to get the word out for years about the importance of sustainability when it comes to diet, and have just finished a new book (due out July 14) and documentary film (slated for Fall release) that addresses this complex, yet critically important topic.

What is Sacred Cow?

Beef is framed as the most environmentally destructive and least healthy of foods, but while many argue that greatly reducing, or even eliminating it from our diets, Sacred Cow takes a more critical look at the assumptions and misinformation presented about meat – and has the science to back it up!

Where can you get it?

Sacred Cow is available now for pre-order everywhere books are sold. They’re also offering over $200 in pre-order incentives, including a free sneak peek preview link to the film Sacred Cow! Click here for more info.

After spending years analyzing the science, the book presents a solid case that:

Meat and animal fat are essential for our bodies
A sustainable food system cannot exist without animals
A vegan diet may destroy more life than sustainable cattle farming
Regenerative cattle ranching is one of our best tools at mitigating climate change

Sacred Cow proposes a new way to look at sustainable diets. The book takes a deep dive into the nutritional claims against meat, why cattle raised well are actually good for the environment, and address the ethical considerations surrounding killing animals for food. The truth is, you cannot have life without death, and eliminating animals from our food system could cause more harm than good.

But even if this way of raising animals is better than our current system, surely you can’t feed the world this way, right? Yep, they tackle that too!

Order it today and get all of your questions about the impacts of eating and raising meat answered in one place.

Have a great week!

PS – Don’t forget to order Sacred Cow today to take advantage of their valuable pre-order incentives and the preview link to the film. Receipts must be submitted to sacredcow.info/book by July 14th!

In the context of the COVID 19 pandemic I will close with the usual summary.

Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
Get plenty of sleep (without adequate sleep your immune system does not work well )
Follow good sleep habits
Exercise, especially out of doors in a green space, supports the immune system
Get some sunshine and make sure you have adequate Vitamin D levels.
Eat an anti-inflammatory diet rich in micronutrients.
Practice stress reduction like meditation and yoga which improves the immune system
Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Doctor Bob

The Ornish Low Fat Vegetarian Diet, does it work?

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Dr. Dean Ornish has done wonderful research in the area of cardiovascular disease and lifestyle intervention. His study on comprehensive lifestyle intervention (1) is often quoted to support a low fat vegetarian diet as treatment for cardiovascular disease. But his “Intensive lifestyle changes for reversal of coronary heart disease” included several components that would be expected to improve health and decrease cardiovascular risk independent of a vegetarian diet as will be discussed below.

Let’s review what this study did.

48 patients with diagnosed moderate to severe coronary artery disease were randomized to one of two treatment groups, an “intensive lifestyle change” (ILC) group or a “usual-care” (UC) control group. 28 patients were allocated randomly to the ILC group and 20 were allocated to the UC group. Out of 48 patients starting the study only 35 completed the study, 20 out of 28 in the ILC group completed the study and 15 out of 20 in the UC group completed the study.

The intensive lifestyle change group followed this program:

10% fat whole foods vegetarian diet
daily aerobic exercise
stress management training (training in and daily performance of meditation and/or yoga)
smoke cessation (they quit smoking)
group psychosocial support (3 hour group therapy sessions)

At the start of the study only one patient in the ILC group was smoking and she quit. We do not know how many smokers were in the UC group or how many quit. (I consider that a deficiency of this study. Because smoking is such a significant determinant of cardiovascular outcome, details of smoking at start and end of the study for both groups should have been reported)

At the end of five years the intensive lifestyle change group demonstrated an average 3.1% absolute reduction in the coronary artery blockage as measured by coronary arteriograms (or to put it another way, the diameter of the blocked coronary arteries increased by 3.1%). The usual care group (receiving cholesterol lowering statin drugs) showed an average 2.3% absolute increase in the coronary artery blockage (2.3% reduction in diameter). These are not huge changes or differences but they were measurable and statistically significant.

Twenty five total “cardiac events” occurred in the 28 patients randomized to the intensive lifestyle change group over the five years and 45 cardiac events occurred in the 20 patients randomized to the “usual care” group (receiving cholesterol lowering statin drugs). But this was due to differences in the number of hospitalizations and angioplasties. There was no statistically significant difference in the number of deaths, heart attacks or coronary artery bypass surgeries.

By the end of the study 2 patients in the ILC group had died compared to 1 death in the usual care group but as mentioned above, this difference was not statistically significant. We do not know how many deaths occurred in the 8 patients who dropped out of the treatment group or in the 5 patients who dropped out of the usual care group, nor do we know any of the other outcomes for the drop-out patients.

So there were no lives saved by the intensive lifestyle change program and no reduction in the number of heart attacks. In fact the ILC group had 2 deaths compared to 1 in the usual care group.

What does this all mean and why has the Ornish Diet attracted so much attention.?

First, I would suggest that the demonstrated benefits (reductions in the number of angioplasties and hospitalizations) are likely explained by the following parts of the lifestyle changes.

stress reduction training and implementation (meditation and yoga)
elimination of manufactured trans-fats from the diet
elimination of unhealthy pro-inflammatory excess omega six fats (vegetable oils) from the diet
elimination/reduction of processed carbohydrates and sugar.

Although the intensive lifestyle intervention included regular exercise the data show no significant difference in times per week or hours per week of exercise at the end of the study between the two groups.

The big difference was in stress management. The ILC group averaged practicing meditation and/or yoga 5 times per week (48 minutes per day) versus less that once per week (8 minutes per day) in the usual care group.

Stress reduction is a major issue in any disease and in particular in cardiovascular disease.

Several studies have demonstrated that the daily practice of meditation improves immune function, increases telomerase activity, reduces inflammatory markers, and reduces circulating stress hormones (cortisol and epinephrine) independent of dietary changes.
Meditation has also been observed to improve “endothelial function”, the ability of the cells that line arteries to respond to changes in demand. (2,3,4,5,6,7)

Here is a press release from the American Heart Association 13 November 2012. (8)

“African Americans with heart disease who practiced Transcendental Meditation regularly were 48 percent less likely to have a heart attack, stroke or die from all causes compared with African Americans who attended a health education class over more than five years, according to new research published in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes.

Those practicing meditation also lowered their blood pressure and reported less stress and anger. And the more regularly patients meditated, the greater their survival, said researchers who conducted the study at the Medical College of Wisconsin in Milwaukee.”

I believe the major benefit of the interventional program was from the stress reduction and the elimination of three major dietary sources of trouble (trans-fats, excess omega 6 fats from processed-refined vegetable oils, and refined carbohydrates-sugar)

I have already discussed in other posts the problems associated with excess omega 6 fats and refined carbohydrates-sugar relative to cardiovascular risk. (9,10,11)

There is little controversy that elimination/reduction in trans-fats produces benefit. (12,13,14)

All three of these changes were essential to the whole foods approach of the intervention group.

I have also discussed the lack of data to support the contention that saturated fat from animal sources of protein contributes to cardiovascular disease. (15, 16))

I remain a strong proponent of a whole foods diet that includes a variety and abundance of organic vegetables and fruits, nuts, pastured grass-fed meat, fresh wild seafood, free-range organic poultry and eggs from that kind of poultry. This diet represents the foods we have evolved to eat, free from added sugar, hormones, antibiotics, pesticides. This dietary approach also produces a healthy balance of omega 6 to omega 3 fatty acid as well as a significant improvement in the ratio of potassium to sodium.

Stress reduction should be an essential part of our lives and data on this aspect of health will be discussed in future posts. References for this discussion appear below.

Peace,

BOB Hansen MD

REFERENCES:

1. JAMA Network | JAMA | Intensive Lifestyle Changes for Reversal of Coronary Heart Disease

2. Intensive meditation training, immune cell telomerase activity, and psychological mediators.

3. Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres.

4. A pilot study of yogic meditation for family dementia caregivers with depressive symptoms: effects on mental health, cognition, and telomerase activity.

5. Meditation Improves Endothelial Function in Metabolic Syndrome, American Psychosomatic Society (APS) 69th Annual Scientific Meeting: Abstract 1639. Presented March 10, 2011.

6. Alterations in brain and immune function produced by mindfulness meditation.

7. Adrenocortical activity during meditation.

8. Meditation may reduce death, heart attack and stroke in heart patients | American Heart Association

9. Polyunsaturated fat, Saturated fat and the AHA

10, Lose weight, control blood sugar, reduce inflammation

11. Sugar, a serious addiction

12. The negative effects of hydrogenated trans fats and what to do about them.

13. Trans fats in America: a review of their use… [J Am Diet Assoc. 2010] – PubMed – NCBI

14. FDA to Ban Trans Fats in Foods – US News and World Report

15. saturated fat | Practical Evolutionary Health

16. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease.