Comments on the Fat Summit, Day 4

Published 2.1.2016
Mark Hyman MD hosted a series of conversations with others about dietary fat in the diet last week. Hyman's main point is to sell his new book, Eat Fat, Get Thin: Why the Fat We Eat Is the Key to Sustained Weight Loss and Vibrant Health.

I only listened to two talks on Day 4, well actually 1.5 talks. I didn't make through the conversation with Christiane Northrup, MD. The title of the talk was, "How to Eat like a Ageless Goddess," which is not — surprisingly— the name of a book she's written. The second conversation was with Dean Ornish, MD. As always, what follows is not a overview or summary of the talk, but rather notes and commentary I wrote as I listened.

Christiane Northrup MD

I've never heard of this woman, but decided to listen because I was hopeful there might be something of interest for a "woman of a certain age." Do people use that phrase any more?
She ate a variety of different ways, including a macrobiotic vegetarian diet. If sounds like she didn't really focus on finding a way of eating that she could adhere to, she just moved from fad diet to fad diet.
Eventually realized that protein is satiating.
She tried the Atkins Diet after menopause, but it didn't work. Atkins told her that it was because she was menopausal. I don't remember the Atkins diet being age limited, but certainly it fails for a lot of people.
Shortly after her own diet history we delve into the insulin theory of weight loss, which simply is not supported by the facts.
Nor does the pancreas "get tired." What it gets is riddled with fat that then disrupts its function. I'm not certain anyone in this summit is aware of Dr Roy Taylor MD's research at Newcastle University.
She acknowledges that some people do thrive on low fat diets, but that eating more fat makes women feel better and improves hair, skin and nails. No actual studies supporting this idea are cited.
It is not necessary to eat a bar of butter to avoid "white knuckling it." Pastry in the morning means you’re hungry at 4 PM? What happened to eating lunch?
She says eat medjool dates rather than chocolate, frankly I'd like the option to eat both.
CICO doesn't work unless you have the diet correct. Well no kidding. The most important thing for any diet is ADHERENCE. If you have a way of eating that you can adhere to without eating more than you expend, then there is no "white knuckling" and counting calories is less important too.
It's not news that different people have different diet preferences.
Prednisone does not cause osteoporosis because "it make you crave sugar." WTF?
I quit the talk early because she started in on the woo that is Wheat Belly.

Dean Ornish, MD

This was one of the most interesting conversations in the entire summit.
Ornish may be best known as the doctor who debated Robert Atkins, but Ornish claims that he is tired of the low fat vs low carb wars.
Ornish has clearly read and understood the literature in depth, much more so than Hyman. When challenged he had thoughtful and considered responses, even if he wasn't always convincing. Hyman and he agree on about 90% of things.
Ornish has unbent a bit, now says that his very low fat diet is necessary only for people with heart disease. His is the only diet (what about Esselstyn's diet work— which is also extremely low fat) that has reversed heart disease. And yes it involves more than eating correctly. He says he used to be defensive about this, but now he isn't. Stress relief and community support are just as important as the diet. Medicare now pays for his program.
Ornish's personal tale includes depression and suicidal thoughts, which a Swami helped him recover from. This is why there's a strong Eastern medicine influence in his program.
Ornish still thinks that saturated fats are bad, though his program now includes a moderate amount of seeds and nuts because the data there is pretty clear that those are healthy.
The amount of total fat and sat fat makes a difference, at least in his results. People who eat more sat fat and cholesterol do worse. He points out that the studies that show fat and cholesterol studies were done by the egg board. Adding more eggs to a bad diet doesn’t make a difference. adding an egg to a vegan diet makes a big difference.
Ornish brings up the 2015 Hall study that not only disproved Taubes' insulin weight gain theory, but also showed that low fat was a better bet to lose weight than high fat or low carb. But he also says the reductionism isn't helpful.
Ornish cites a cell Metabolism Article showed that people who eat a lot of animal protein have a 75% increased risk of premature death (all causes) and a 400-500% increased risk of premature death from CVD and cancer. Hyman pointed out hat there are studies saying the opposite. So Ornish pointed out that okay, replacing refined carbs with fat might improve things, but even better is to replace refined carbs with whole, unrefined carbs rather than fat. Hyman jumps in and says we don’t know that. He brings up the 2015 Willett Ludwig study that looked at 53 randomized control studies of 1 year or more. Looked at low fat vs high fat low car and LCHF was better for weight loss. Ornish says they replaced refined carbs with fat, and that the low fat diet wasn’t truly low fat. This was the exchange that made me realize that Ornish has not only read the literature, he's studied it and comprehended it. When challenged, he can speak with authority because he's done the work. In far too many cases (Nina Teicholz was a glaring example) the presenters only had a surface understanding of the studies they cited.
In a nutshell, 30 minutes walk, do yoga, have more love, and eat more fruits and vegetables and whole grains with little to no animal products is what Ornish teaches.
LCHF has NOT shown an improvement in blood flow or a reversal of CVD. Hyman was tap dancing at this point because he didn't have detailed enough knowledge of the data to argue.
Ornish noted that when someone has heart disease, you need to be more conservative in what you jtell them to do. His program works, low carb high fat (LCHF) has NOT been shown to reverse heart disease. Apparently Ornish tried to get Gary Taubes to fund a study that would look it at reversing heart disease with LCHF, but Taubes wasn't interested.
Marker improvement isn't the benchmark, Ornish says, it's increased blood flow through arteries and removal of blockages.
Eventually Ornish admitted that it's not too much fat or too many carbs that is the problem, IT'S TOO MUCH FOOD.
Ornish won't be budged from his view that it's better to replace refined carbs with unrefined carbs rather than fat— even if it's plant fat. He thinks animal fats are to be avoided, period. If you don’t have heart disease, then you can experiment. But if you want to reverse heart disease, then Ornish has the evidence that his plan works.
Ornish's latest book is The Spectrum: A Scientifically Proven Program to Feel Better, Live Longer, Lose Weight, and Gain Health.

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