It has been 15 years since Dean Ornish published his data showing a 3 per cent reduction in the plaques seen by coronary angiograms on a select group of patients who followed his Ornish diet and “lifestyle” plan. To be exact: the 28 patients who followed his plan had a 1.75% decrease in atherosclerotic plaque after one year and 3.1% decrease after five years. With the control group there was an increase of 2.3% in one year and 11.8% at five years.
In 15 years no one has reproduced that data. No one. Still, from one old paper Dean Ornish has made a career; first being the anti-Atkins, and riding the anti-cholesterol, low-fat band wagon with the same religious fervor as Keyes did thirty years before. Ornish has since become the lead health-blogger for Huffington Post, has influenced Bill Clinton – turning him into a vegan, and is favorably mentioned by Dr. Oz. Ornish then did a few experiments with prostate cancer and aging (telomere length)- to who his lifestyle is good for everything from cancer to aging.
The difficulty is this: science has caught up with him, and we know a lot more about how atherosclerotic plaques form. We know that dietary lipids and their carriers are far less important that what the body makes. We know that the dietary component is far more related to the trigycerides – and triglycerides are raised much more by the grains and pastas that Ornish preaches on (in his trial, the “Ornish lifestyle” patients had a rise in their triglycerides).
What Ornish and his crew call a landmark paper, would not be accepted by the same journals today for a number of reasons:
(a) No one compares angiograms – a two-dimensional photograph of an artery – because they can be manipulated so easily and interpreted differently from one experienced radiologist or cardiologist to another. Depending on the angle you take the angiogram from, you can show a reduction in plaque by varying the recorder by a few degrees. Today intra-vascular ultrasound is the test of choice – this gives us a three dimensional view of the artery, from within the artery. The recent article in The New England Journal of Medicine, comparing lipid medications and their long-term effect on atherosclerotic plaque, is the most accurate measurement of plaque and its formation.
(b) We know about the science of lipids, plaque formation, and how we can manipulate those to provide a better answer for atherosclerosis that does not involve severe manipulations of a diet. For example, it appears it is the carrier proteins that cause the damage to the arteries – and more carrier proteins are made in response to certain stimuli (triglycerides being one).
(c ) There were deep and troubling issues with the groups of patients serving as controls. For example, we do not know how many pack-years of smoking were in one group or the other. This is not a minor flaw, as science understands the highly inflammatory changes that are made with smoking as opposed to those made with hyperlipidemia.
(d) Lipid lowering drugs were used in some, and not others – however, the drugs today are far better, and more targeted than before.
Personality, the willingness to believe in your hypothesis no matter what science says, and the desire by the public to see “natural” leads to a great career in politics and entertainment but when it comes to science—not so much.
While his article appears comprehensive, much like the Titanic- it is full of holes that would sink it. Still, people follow Dr. Ornish’s teachings, believing that the changes he advocates will reduce heart disease, cancer, and provide better aging. Odd how the claims of a lifestyle giving benefit to heart disease, cancer, and aging consistently comes up with junk science. The only product Ornish sells are his books, speaking engagements, and his groovy clinic.
A video blog about this is at YourDoctorsOrders.com
Terry Simpson started out life as a basic scientist and decided he preferred people to petri dishes. He is a surgeon in Phoenix, authored several books, and has his musings on YourDoctorsOrders.com (among other blogs) His view of the world became altered in the 1980's in conversations with of a patient who was undergoing treatment in Seattle - Carl Sagan.