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Brad Smith2
If you don't believe in freedom of speech for all
10:07 PM on 06/03/2011
Cholesterol is needed in your body, it's part of every cell you have. The whole good/bad thing is wrong. So is the low fat diet. Your brain needs fat to function, without fat you will get depressed and not even be able to think well. A diet high in carbs creates a need for more and more insulin. The insulin is needed to convert the sugars that are not used in carbs into fat in the body. Then the fat must be broken down, but it doesn't happen because you get hungry and eat because the quick fix of carbs into sugar is faster but then you add fat as well. It's a cycle that repeats itself over and over. This is the true cause of obesity and heart disease in this nation. Low fat High Carb diets are not a good thing. When you consume fat you don't need the insulin and it actually keeps your body filled with energy for much longer so your body doesn't crave more food. Going on a high fat low carb diet will actually help people loose weight as long as they keep their intake of calories down and get at least some exercise.
Optimistic Pessimist
06:57 PM on 06/03/2011
Hey, isn't it free donut day?
05:49 PM on 06/03/2011
That was very insightful. I've read a bit about cholesterol and have blogged about it, but didn't clearly understand the HDL issue till now.

That said, Dr. Ornish's post focused on HDL confusion, in particular, but there's much more for the lay person to know about cholesterol. Lots of myths out there, so consider reading the "12 Myths About Cholesterol":
07:41 AM on 06/04/2011
Okay, I read it. Those "12 myths" are baloney. They're not even prominent beliefs of anyone. They add nothing to knowledge, and in fact a couple of them are flat out wrong and others are just your opinion of what might be right but which there is no reason to believe.

You don't understand what the purpose of the 300 mg level is. It is not to say what one can "safely" take in. There is no safe level of cholesterol consumption, and we have no dietary need for it at all:

"The report doesn't set maximum levels for saturated fat, cholesterol, or trans fatty acids, as increased risk exists at levels above zero, however the recommendation is to eat as little as possible while consuming a diet adequate in important other essential nutrients." [Since we can consume a diet adequate in nutrients without cholesterol in the diet at all, that means: No cholesterol.]

"Given the capability of all tissues to synthesize sufficient amounts of cholestero l for their metabolic and structural needs, there is no evidence for a biological requiremen t for dietary cholestero l. Therefore, neither an Adequate Intake nor a Recommende d Dietary Allowance is set for cholestero l." Dietary Reference Intakes for Energy, Carbohydra te, Fiber, Fat, Fatty Acids, Cholestero l, Protein, and Amino Acids (Macronutr ients), http://boo /openbook. php?record _id=10490
01:46 AM on 06/05/2011
According to the Mayo Clinic:

"...high-density lipoprotein (HDL), or the "good," cholesterol. HDL cholesterol helps sweep up low-density lipoprotein (LDL), or the "bad," cholesterol, in your bloodstream."

I would take from this, and from the article to which all these comments are attached, that not all cholesterol is the same.
05:48 PM on 06/03/2011
I've read posts that say saturated fat is good and saturated fat is bad; that a mainly plant based diet is the best and that a meat based diet is best. The vegans and vegetarians who began including animal based protein to their diets who began feeling better and the the people who who became vegans and vegetarians who felt better and more energized. And the studies and the statistics. The problem is that all these studies suggest that one way of eating is good for everyone. What all these comments tell me is that different ways of eating are good for different people. We're all individuals and too many health professionals including the nutritionists want to reduce the human race to one way of eating. Your comments reflect this reality: those who say THEIR way of eating is the only way for everyone are missing the point; that we are individuals and our bodies respond differently to different diets. For one person it may be mainly plant based protein and for another mainly animal based. Reductionism is good only if it reflects this reality. As for me, I eat mainly a plant based diet and I feel wonderful on it. My husband eats meat and thrives; I would never suggest he eat the way I eat because he would feel like c***. "To each his own" as my mother would say. Paying attention to what your own body is telling you is the way to go.
12:43 AM on 06/04/2011
I couldn't agree with you more. I have not eaten red meat since age 15 (more than 30 years). My husband, on the other hand, eats beef whenever possible. Since we live in Israel, beef is very expensive, so "whenever possible" is about once a week. I always thought this was just a matter of taste, until my second pregnancy. In my first and third pregnancies I made sure to eat chicken a few times a week to keep up my protein intake, but in my second pregnancy I *craved* it. I didn't go back to eating red meat, but I ate poultry just about every day - and continued to until I weaned my son. He, like my husband, eats meat whenever possible. My first and third children, like me, eat it only occasionally.
Despite my semi-vegetarian diet and being a woman, my hemoglobin is consistently higher than my husband's. He also takes B-12 supplements -- when he doesn't, he is fatigued and short-tempered. The year we were in the US and he ate beef 3-4 times a week, he actually lost weight, because he was not hungry all the time. In other words, my body does not need meat to keep it healthy, and my husband's does. The diet proposed here is perfect for me, but would prevent him from functioning.
Cat guardians for Obama/Biden and all Democats
07:55 PM on 06/04/2011
Totally agree with the two of you but I think most people are not that in touch with their bodies or how they feel and therefore really do not know what to ear.
05:44 PM on 06/03/2011
There's more to this than Dr. Ornish claims. Gary Taubes, in his book "Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control, and Disease" discusses a little known discovery by Ronald Strauss, a lipid metabolism specialist, of "pattern A" and "pattern B" LDLs. What these are would take more space than I'm allotted. Quoting Taubes: "...On a diet that Krauss calls the 'average American diet.' with 35 percent of the calories from fat, one in three men will have the atherogenic pattern B profile. ... On a diet of only 10 percent fat, of the kind advocated by the diet doctors Nathan Pritikin and Dean Ornish, two out of every three men will have small, dense LDL and, as a result, a predicted threefold higher risk of heart disease. ..."
11:07 AM on 06/04/2011
Great blog debunking pretty much most of what Gary Taubes says or has written. Taubes crafty writing skills don't disguise a well picked cherry tree. Also a great blog exposing the dark side of low carb/high fat diets from a low carber.
09:18 PM on 06/05/2011
Perhaps you might want to read a book that summarizes and supports what Gary has written and translates it into a primer for physicians with suggestions on how to help their patients adopt this lifestyle.
"The Art and Science of Low-Carbohydrate Living." The authors are well-credentialed and highly respected researchers in the field of nutrition and metabolism. They include clear physiological explanations for why it is carbohydrates, not fat, that cause the "diseases of civilization" and obesity.
05:39 PM on 06/03/2011
Cholesteral is bad/cholesterol is good, coffee is bad/coffee is good, alcohol is bad/alcohol is good, beef is bad/beef is good.....every one of these studies is a joke because they are inconclusive.
Smoking cigarettes causes lung disease and cancer and many people have died prematurely because if it. That's been proven time and time again, therefore it's conclusive.
07:35 AM on 06/05/2011
Yeah it seems that every few months there is some new study that confirms or refutes some food or supplement as being healthy or unhealthy....
05:01 PM on 06/05/2011
I believe the only time we have ever heard "beef is good" for you it was coming from the National Cattlemen's Beef Association, a rich lobbyists' group...
04:46 PM on 06/03/2011
Dr. Dean, How about taking fish oil supplements to raise HDL for someone already on a healthy vegetarian diet for many years. Helpful or unnecessary? Family doc is recommending it. LDL is fine.
04:42 PM on 06/03/2011
My stepfather has always derided my siblings and me for following low-carb diets. Last summer, when we were visiting my mother, he made a big show of eating cereal with skim milk and fruit while we enjoyed our egg frittata. A month later, guess who had a quadruple-bypass?
04:39 PM on 06/03/2011
my doctor said i would be dead in 5yrs. if i didnt change my eating habits, and take cholesterol lowering drugs wich made me ill, he said stop smoking, eating meat, stress, so here i am my wife is 35, and im 66, and have a 5 year old son. the only thing i have changed was my doctor, and added a 4th wife. my doctor died of an heart attack, i lived 25yrs. longer then he said i would........
05:45 PM on 06/03/2011
If you're one-in-a-million, then good for you. But that's irrelevant to the other 999,999.

Most of us, by definition, cluster around the averages of things and so need to be cognizant about what works and doesn't work for most people.
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09:55 PM on 06/03/2011
" wife is 35." What an odd thing to say.
03:45 PM on 06/03/2011
The problem with these claims is in the interpretation of the research. The lifestyle intervention that improved CVD outcomes was multi-faceted. It was not just low-fat. It was vegetarian, lower in sugar and lowered the GI of the carbs. It involved exercise and smoking cessation plus "stress management". If we assume that the results are correct (the cohort size was small and there has been little in the way of confirmatory studies) then we must consider the various possibilities in terms of cause. Smoking cessation is huge. Cutting sugar is another big one. Also, cutting down on fat would mean a big reduction in omega-6, another important factor. I note in the five-year follow-up data, that the HDL was not different between the intervention and control groups so I am not sure why there is such a big emphasis on the role of HDL in all this. It would appear to me that the combined effect of the intervention would be powerfully anti-inflammatory. We know from the JUPITER study that this is how statins reduce CVD risk. The result may have had little to do with how much fat was eaten.

Bottom line - when you argue the benefits of any intervention, it really hinges on what you are comparing it to. In this case, "usual care" was obviously not ideal. How about another trial that compares this miracle lifestyle intervention to a very low-carb/high fat diet? Now that would be really interesting.
04:39 PM on 06/03/2011
I remember reading a number of years ago about a study in Germany that placed cardiac patients on a program of exercise, biofeedback, stress reduction therapy, etc. very similar to the Ornish program but the patients did not change their diets. The result in terms of improvements to cardiac markers was identical to the results of the Ornish plan. In other words: it wasn't the diet.
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Science is the antidote to the poison of religion
03:40 PM on 06/03/2011
Yes, there is such thing as stress-induced cholesterol and yes, your genes play an important part in that too. Which means you can do everything right and still have high LDL.
Mark from atlanta
Unity through Diversity.
03:29 PM on 06/03/2011
Most MDs I know believe ornish's plan is good, but do not recommend it to their patients because they do not think they have the will power to follow through. A plant-based diet, daily exercise and meditation do not seem to fit into the mainstream American lifestyle, unfortunately.
03:11 PM on 06/03/2011
Thanks for the cutting edge reminders Dean!

And you're one of the few MDs who is wise enough to add that bit of final advise: meditate and love more. You are reminding the world of what it once new: that our behavior and emotions affect our health as much as anything else we "put into our bodies."
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The dream shall never die - Ted Kennedy
03:01 PM on 06/03/2011
So eating right and exercising is good for the heart. Must be one of those new fad things.