in response to Peter's low fat story

[Guest guest]

http://www.msnbc.msn.com/id/11225530/site/newsweek/from/RL.4/

The Facts About Fat

In his debut column, our nutrition expert explains why all low-fat diets are not

the same

Live Talk: Dean Ornish on Dieting

• Noted nutrition expert Dr. Dean Ornish joined us for a Live Talk on the

latest diet news, Thursday, Feb. 16. Read the transcript.

 

 

WEB EXCLUSIVE

Special to Newsweek

Updated: 6:07 p.m. ET Feb. 7, 2006

Feb. 7, 2006 - The Journal of the American Medical Association on Tuesday

reported the results of the Women's Health Initiative dietary modification

study, which followed nearly 49,000 middle-aged women for more than eight years,

comparing those on a regular diet to those on a low-fat diet. The women in the

dietary change group were asked to eat less fat and more fruits, vegetables, and

whole grains each day to see if it could help prevent heart disease and cancer.

The women in the comparison group were not asked to change their diets.

 

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What did researchers find? According to the study: Low-fat diets don't protect

against heart disease, or stroke, or breast cancer, or colon cancer.

 

OK, so maybe you're a little confused? A little crazed? You're not alone.

 

For many years, doctors (like me) have been telling you about the benefits of a

low-fat diet. It's as American as apple pie (well, maybe that's the wrong

metaphor...). So you may be thinking now, “You mean all those doughnuts and

butter that I didn't eat were for nothing? Those doctors can't make up their

minds! From now on, I'll eat what I want, take my Lipitor and forget about

it.â€

 

With a large number of women in a randomized controlled trial in a major

peer-reviewed journal, these findings must be true. Right?

 

Well, no--not exactly. The investigators acknowledged that the study had some

serious limitations. These include:

 

The study participants did not reduce their dietary fat very much--29 percent of

their diet was comprised of fat, not the study's goal of 20 percent. Even this

may be an overestimation, since it's very common for people to report that

they're following a diet better than they really are.

They did not increase their consumption of fruits and vegetables very much.

The comparison group also reduced its consumption of fat almost as much and

increased its consumption of fruits and vegetables, making it harder to show

between-group differences. Neither group significantly changed its consumption

of grains.

As a result, LDL-cholesterol ( " bad cholesterol " ) decreased only 2.6 percent more

in the low-fat diet group than in the comparison group, hardly any difference at

all. Blood pressure decreased hardly at all in either group, by only about 2

percent in both groups.

The study did not last long enough to expect to see a difference in preventing

cancer.

 

Also, this study didn't distinguish between fats that are beneficial and ones

that are harmful. The omega-3 fatty acids found in salmon, mackerel, halibut,

walnuts, and flax may reduce your risk of a heart attack by 50 percent or more,

according to several studies. Only 3 grams a day of fish oil provide these

benefits. Some studies suggest that omega-3 fatty acids may also reduce your

risk of some types of cancer, although more research is needed. The fatty acids

have been shown to help reduce inflammation, which may be an important factor in

both heart disease and cancer.

The real lesson of the Women’s Health Initiative study is this: if you don't

change much, you don't improve much. Small changes in diet don't have much

effect on preventing heart disease and cancer in those at high risk.

 

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Here's the good news: in this study, the risk of a heart attack was reduced in

the subgroup of patients who consumed the lowest amount of saturated fat, trans

fat, and the highest amount of fruits and vegetables.

 

This finding is consistent with many other studies showing that the majority of

people with heart disease who make only moderate reductions in dietary fat and

cholesterol show continued worsening of their coronary artery disease. However,

bigger changes in diet and lifestyle may prevent heart attacks in almost

everyone.

 

Last year, for example, the landmark INTERHEART study of almost 30,000 men and

women in 52 countries found that nine factors related to diet and lifestyle

accounted for 94 percent of the risk of a heart attack in women and 90 percent

of the risk of a heart attack in men. This was seen in all geographic regions

and in every racial and ethnic group worldwide.

 

In addition to preventing disease, your body often has a remarkable capacity to

begin healing itself if you give it a chance to do so. My colleagues and I

documented that most people who already have coronary heart disease can reverse

its progression just by making intensive changes in diet and lifestyle, without

drugs or surgery. These include a diet much lower in saturated fat and trans

fatty acids and high in fruits, vegetables, whole grains, legumes, and soy

products, as well as moderate exercise, stress management techniques (such as

yoga and meditation), and support groups. These studies used the latest in

high-tech, state-of-the-art measures to prove the power of simple, low-cost, and

low-tech lifestyle changes. Also, these patients showed a 40 percent average

reduction in LDL-cholesterol after one year without cholesterol-lowering drugs.

 

In our research, we found that the more people changed their diet and lifestyle,

the more their heart disease reversed. But in order to get heart disease to

reverse, they needed to make bigger changes in diet and lifestyle than were seen

in the Women's Health Initiative study.

 

More intensive changes in diet and lifestyle also may affect cancer as well as

heart disease. Last year, we published a randomized controlled trial showing

that more intensive changes in diet and lifestyle stopped or reversed the

progression of prostate cancer when compared with a randomized control group.

As in our earlier cardiac studies, the more people changed their diet and

lifestyle, the more they improved. Even severely blocked coronary arteries

became measurably less blocked after one year and showed even more improvement

after five years in direct proportion to the degree of change in diet and

lifestyle. Similarly, there was a direct correlation between the degree of diet

and lifestyle change and the changes in PSA and in the inhibition of prostate

tumor growth

What's true for prostate cancer is likely to be true for breast cancer as well.

In the Women's Health Initiative, the incidence of breast cancer was 9 percent

lower in the study group than the comparison group, although not enough to be

statistically significant. But a study reported last year by Rowan T.

Chlebowski at the American Society for Clinical Oncology found that women who

reduced their dietary fat intake to only 20 percent (about 33 grams of fat per

day) reduced their risk of breast cancer recurrence by 42 percent after five

years when compared with a randomized comparison group who consumed 51 grams of

fat per day. However, this effect was only seen in estrogen-negative breast

cancer. Another study from the Harvard Nurses' Health Study published last year

reported that walking at least three hours per week significantly reduced the

risk of death from breast cancer.

 

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Fat is only part of the story. What we include in our diets is at least as

important as what we exclude. There are at least a thousand substances that

have health benefits-phytochemicals, bioflavonoids, carotenoids, retinols,

isoflavones, genistein, lycopene, and so on. With few exceptions, these

beneficial substances are found in fruits, vegetables, whole grains, legumes,

and soy products.

 

You have a wide spectrum of dietary choices; it's not all or nothing. If you go

on a diet and feel constrained, you are more likely to drop it. But if you see

your food choices each day as part of a spectrum, then you are more likely to

feel free and empowered.

 

If you indulge yourself one day, you can eat more healthfully the next. If

you're a couch potato one day, exercise a little more the next. Then, you're

less likely to feel restricted. Studies have shown that those who eat the

healthiest diets are the ones that allow themselves some indulgences.

 

Not everyone needs to make bigger changes in diet and lifestyle. If you're at

high risk or are trying to reverse heart disease or prevent the recurrence of

cancer, then you probably need to make bigger changes in diet and lifestyle than

someone who just wants to lose a few pounds and is otherwise healthy (and needs

only the proverbial " ounce of prevention " ). If you just want to lower your

cholesterol or blood pressure, you can begin by making moderate changes in diet

and lifestyle. If that's enough to achieve your goals, great; if not, then

consider making bigger changes.

 

It’s not just about living longer, but also about living better. These are

diet and lifestyle changes that make you feel good.

 

Dr. Dean Ornish is founder and president of the non-profit Preventive Medicine

Research Institute and a clinical professor of medicine at the University of

California, San Francisco. He is the author of several books, including the New

York Times' bestsellers " Eat More, Weight Less " and " Love & Survival. "

 

For more information, please go to ww.ornish.com or ww.pmri.org.

 

 

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