Ornish Program

The mantra is that there are no dietary studies in humans that prove a benefit in PCa treatment. This will probably always be the case, because in order to study diet accurately, you have to sequester the participants for long periods. The only long sequesters I know of are the space station and the OJ Simpson trial jury.

However, looking to diet to cure / treat is setting the bar too high, at least in the recurrence setting. All we need there is to lengthen the PSA doubling rate to years, rather than months. In the recurrence setting PSA rises are seldom false positives, almost always mean cancer growth,

Non diet treatments get the quantity of PCa cells down by many orders of magnitude. Perhaps from billions to thousands. In this setting, techniques that delay the path of growth back to billions, is a de-facto cure, if the delay is long enough.

BillyBob@388, asking whether saturated fat is good or bad for your cardiovascular (CV) health is looking for a simplistic answer to a complicated issue.

Saturated fat is not a single entity, and the merits of saturated fatty acids (SFAs) can depend on what you are comparing them with, what foods the fats are in, what dietary pattern these foods are part of, and who is doing the consuming.

This has led to calls to stop emphasizing macronutrients (fat, carbs, protein) in healthy-eating guidelines, and to highlight real food instead. Probably the most highly touted is the Mediterranean dietary pattern which is rich in fruit, vegetables, whole grains, fatty fish, lean meat, oils, nuts and legumes.



halbert, your call for "moderation" is noble, but the reality is that today's society has lost perspective on what "moderation" means...it has become known today as a falacy. Today's thought leaders are emphasizing that moderation in today's terms is not enough. The "MyPlate" guidelines are a long way from today's concept of moderation...for most Americans who unwittingly follow the Standard American Diet (SAD).

Just look at what many people think of as America's favorite meal: hamburger with ketchup on white bread with fries. You couldn't do better if you wanted to try to promote cancer growth: red meat (the #1 food ingredient associated with a wide variety of cancers), grown on corn and soy (which remove the healthy omega-3s that are found in grass-fed meat), and bovine growth hormone (which stimulates all cell growth, including cancer cell growth); french fries: a rare vegetable that does not help slow cancer growth but, on the contrary, stimulates insulin release and thus cell growth, dipped in omega-6 inflammation-promoting oil and fried to increased oxidative stress; white bread: which again stimulates insulin release.

Bottom line...if you one of the 2% who are closely following MyPlate, then you can say you are eating with moderation.

Post Edited (NKinney) : 1/4/2016 12:46:21 PM (GMT-7)

BillyBob@388 said...


Hazard ratio .85 fro highest saturated fat intake vs the lowest? What?

Lots of things to be noted about that study...
Yes, only a .85 HR for "events".... but a discomforting 1.40 HR for "fatal coronary events"

You might go over the study in depth... additionally noting that in the baseline for the Lowest Quartile of saturated fat intake, that group at the beginning of the study... 44.6 participants who had already had heart attacks... compared to 37.4% for the highest quartile group.

Too many other points to notes. It takes more reading than I have time for now to see what that study really shows.
Of note, in the next to last paragraph it says---

" Thus, we cannot exclude that statin treatment may have
influenced the overall findings in this selected cohort of patients
with CAD"

Statin use went up from 67% to 87% during the study in the highest quartile group.

Lots of moving parts

BillyBob@388 said...

Pratoman said...
Bully bob, yes, it's accepted that getting all those numbers down is good. But the thing is, in people with CAD, it has not been shown to reduce mortality, which, after all, is the ultimate endpoint.

Again, what about complex carbs, which have been proven to reduce TGL?
The type of diet you are talking about is basically the Atkins Diet (diet used in different context, we use diet as a way of eating, not a temporary "thing" to lose weight). I can't cite studies, but I recall reading more than once, that the Atkins way of eating, followed strictly, for a long period of time. Can be detrimental to health

@Halbert... Yes, moderation and sensible eating do make sense. But is not enough if you are trying to REVERSE and stop progression of, heart disease.

OK, then, very good, improving all of those numbers has not been shown to reduce mortality. But what about Ornish or some of those links Franklin provided(was that Ornish, or some variation?) Has that been shown to reduce mortality in anything that would be considered long term, large scale studies? Something other than 5 or 6 guys in a study done by someone who pushes that approach? I'm not at all claiming that a Pritikin or Ornish type approach will not indeed reduce mortality and actually reverse disease, they may well. I'm just saying that the burden of proof is actually very high, usually requiring large numbers and placebo and RCT and all that jazz. Not that I require all of that to make a decision, I'm just asking if anything has been "shown" or "proved" with either approach?

Its a good point, and i dont think so. From the reading i have done SO FAR, i think 5 year numbers are the most Ornish has to offer. I think to prove lower mortality, you need longer numbers. I do think i recall reading that he had less "coronary events" over those 5 years.

Cicero2K said...
Hazard ratio .85 fro highest saturated fat intake vs the lowest? What?

eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-i

Yes, eating a low fat diet was mistaken advice, according to the above. Dr. Attia describes a hypothesis, backed up by study results, where CAD is enhanced by low fat diets, not the other way around. .

Part of a Q & A of Peter Attia...
----------------------------------------------------------------
How much fat a day do you eat?

"Fat, for me, makes up 85-90% of my calories, but this is because I consume so many calories per day."
----------------------------------------------------------------

Attia is a interesting character, but I would be very careful in buying into everything he says as it relates to normal people in every day living, let alone CAD patients.

Post Edited (Franklen) : 1/4/2016 5:30:58 PM (GMT-7)

I realize that 'moderation' is an almost meaningless word. that being said, personally, I'm perfectly satisfied with a 6 oz fillet (with or without bacon), a medium baked potato with 1 tablespoon of butter or margarine and no sour cream, and some grilled veggies. I simply can't eat a 12 ounce steak.

Prato, best of luck to you on your efforts to deal with your cardiac issues.

Franklen said...

BillyBob@388 said...


Hazard ratio .85 fro highest saturated fat intake vs the lowest? What?

Lots of things to be noted about that study...
Yes, only a .85 HR for "events".... but a discomforting 1.40 HR for "fatal coronary events"

You might go over the study in depth... additionally noting that in the baseline for the Lowest Quartile of saturated fat intake, that group at the beginning of the study... 44.6 participants who had already had heart attacks... compared to 37.4% for the highest quartile group.

Too many other points to notes. It takes more reading than I have time for now to see what that study really shows.
Of note, in the next to last paragraph it says---

" Thus, we cannot exclude that statin treatment may have
influenced the overall findings in this selected cohort of patients
with CAD"

Statin use went up from 67% to 87% during the study in the highest quartile group.

Lots of moving parts

OK, I found the 1.4 for fatalities, but I think I have to still go with the authors summary of " no associations between SFA intake and risk of coronary events [age- and sex-adjusted HR (95% CI) was 0.85 (0.61, 1.18) for the upper vs. lower SFA quartile] or any secondary endpoint. Estimates were not appreciably changed after multivariate adjustments.
Conclusions: There was no association between dietary intake of SFA and incident coronary events or mortality in patients with established CAD. ".

I don't always accept the authors summary of their own results after I look at the details, and you always need to watch for bias IMO. But in this case, I have to more or less agree with them. Here is why:

1st, they also clarify what the secondary endpoints were for which there were no associations with SFAs: Acute MI, fatal coronary events, and all cause death. ( I can not copy and paste for some reason so I am just paraphrasing and not exactly quoting) So, despite the 1.4 for that one quartile(highest), they are still calling fatal MIs for all quartiles as insignificant.

2: Though the 4th quartile has 1.4 times more fatal MIs than Q1, Q2 is actually lower than Q1 at .92 and Q3 is barely higher at 1.11. So I suspect those 2 results raise some questions about how valid that last # is.

3: total heart attacks were barely higher(1.04) in quartile 2 only, then lower for Q3 and 4., while total coronary events were lower across the board with highest fat being lowest, and all cause deaths were lower for Q2 and 3, nd barely higher for Q4(1.18, multivariate- adjusted for many factors- only 1.02)

4: lastly, fatal MIs adjusted for other illnesses, meds like statins and smoking(multivariate) for q2,3 and 4 was .98,1.13 and 1.29(down from 1.4)

So not being a statistician, I still have no argument with their summary claim, which is that the statisticians correctly feel that the overall results indicate just as they say in the summary "no observed associations to clinical outcomes". In fact, though still insignificant, it seems the majority of end points, especially multivariate adjusted, actually had lower #s with higher fat, with that 1.4 being an outlier, but I could be wrong. And they even go on to say that since there was no association found, this might indicate there is even some protection from increased SFA, at least in subgroups.

Still, thanks for pointing that 1.4 out, that for sure required a closer look!

Post Edited (BillyBob@388) : 1/4/2016 7:48:46 PM (GMT-7)

BillyBob@388 said...
And they even go on to say that since there was no association found, this might indicate there is even some protection from increased SFA, at least in subgroups.

Well, as we all know, there are hundreds of studies showing many things, usually ending by saying that further investigation is needed to confirm results.

But...if you are in a position such as Pratoman or myself, then you have to make choices based on the best available information.
This study used quartiles. The diet that these subject consumed...even in the lowest quartile is nothing like that consumed in the Ornish or Esselstyn.....two of the studies, albeit small by comparison, that showed results for those with existing blockages.
We try to figure out what will work for us going into the future while knowing that each individual is unique.

So look at the "lower fat" quartile used in this study. The fat as a percentage of calories was 25%.
In the Ornish and Esselstyn studies, the goal was under 10%. The range from the lower fat quartile to the high fat quartile was 25% to 37%.... The Ornish study over 5 years was 8.4%
Cholesterol intake in this study ranged from 229mg to 357mg whereas in the Ornish study they averaged 18.6 grams.
In other words, the diets of those who showed the improvement in the Ornish study were eating in a manner that was like on another world compared to what was reported in this study we are discussing.

The comparing the lowest quartile with the highest quartile.... then suggesting that given that observation that the same might hold true, even if comparing it to the Ornish level of diet, is a step too far for me.

I have to eat now. I have to choose the program that offers me the best hope and has some evidence to back it up. If i thought for a moment that eating more fat of all types would offer me a better outcome, I'd change tomorrow.
There are no guarantees and every individual is different. Not unlike when people are choosing treatments for prostate cancer.
One of the problems that some have mentioned here is that we don't have a large 1,800+ size....5 year trial showing that a ultra low fat diet, where the subjects are fairly selected and randomly assigned to a normal or low fat diet. We will never have such a study... In large part because you can't find people who are willing to be assigned to a 10% diet for 5 years. The dropouts would be 90% and the adherence of those who remained would be very poor.
It will never happen yet that is one of the arguments some throw at this dietary very low-fat choice.
I don't think this study we are discussing solved that problem because a 25% fat diet is very close to normal, though I imagine the participants on the lowest quartile were eating a bit like they were trying to be "heart healthy" given that they were already CAD patients and almost half of them (44%) had already had one heart attack.

So, I don't know this study gives us much to go on. More like some nuances in the normal dietary realm as opposed to a comparison of outcomes in a true effort at very low-fat dietary intervention.

I have only one blockage in one spot. I have thus far chosen to not have a stent placed. I may change my mind. I do a significant amount of cardio exercise and experience temporary initial mild angina every time between minutes 3 and about 15- 20... I don't stop my exercise and then it goes away for the most part as I continue.
But the daily exercise angina has not gone away. So perhaps I am halting progression but not reversing anything. Can't run down and get a angiogram every few months.
I have to make a choice on how I eat now.
I can assure you I have read a huge amount of information from hundreds of sources...

I find nothing in the high fat/ low carb message that makes me want to risk going that route.
I find that no one in that huge movement has taken the time to take 100 CAD patients and place them on a high fat diet to see what the outcome will be.
So we end up with studies that keep looking at not-very-low-fat diets compared to normal-fairly high-fat diets, then try to draw some inference that if the line continued on the graph it would show such and such for the very-low fat diets.
Fairly weak ideas result.

I'll keep a open mind as I continue studying the various sources of information. Nothing in the world would be easier than to just revert back to a higher fat diet.
I don't accept all the claims of Ornish, Esselsstyn, McDougall, Fuhrman, T. Colin Campbell, and the dozens of others who make the low-fat case.
But when you end up with everything on the table, you have to make a choice.
Thus far the ultra lower fat, higher complexed carbs, no dairy, lifestyle offers the hope of better results for those looking to do something to improve their odds over years and years.

It may be that at some level of lower fat, you cross a threshold of benefit where things begin to behave differently in your arteries. It may be that 25% is not nearly low enough to achieve such benefits.
Not unlike those on low carbs that finally reach the "promised land" of ketosis.

Much mystery surrounds all of this, compounded by the fact that every individual is unique.
Stanford professor Christopher Gardner is studying just that feature. That different individuals behave differently on various diets. What works for one is the opposite of what achieves results for others.

You lay down your money and place your bets. I'm going the Ornish route until and unless someone comes up with something different for CAD patients that offers more hope.

Post Edited (Franklen) : 1/4/2016 9:31:49 PM (GMT-7)

eatingacademy.com/nutrition/way-exploit-metabolic-quirk-cancer

Not to let this thread die, I would suggest to its readers the above article. It's 1,000 words and gets to the heart of the sugar-metformin-metabolism debate regarding cancer growth.

It also presents a hypothesis for the mechanism, that cancer grows anaerobically, requiring much larger concentration of blood sugar than normal cell metabolism. He presents this as well.

Franklen, good post! But, everyone complains about how long-winded I am, though I can't seem to help myself. But some folks might be wondering if you were trying to take my crown. If so, give up, you don't stand a chance!

But let me clarify that by submitting that Study we have been discussing(Just one more of the many I have submitted on the subject of saturated fat and low versus high carbohydrate) I was by no means trying to say that study at all compared with an Ornish style approach. Obviously it does not. Just as I find that most studies of so-called low carbohydrate approaches, that often do not find very much if any advantage for that approach, rarely are actually low carbohydrate diets in the style of Atkins or Paleo. A majority of those studies over the years have just been somebody's idea of cutting back carbohydrates from 60 or 70% of total calories maybe down to 30 or 40%. Not a chance at all of achieving any of the claimed benefits of low carbohydrate eating.

I had previously put forth the possibility that it was possible that either extreme approach might have some beneficial effects. Though I don't think there's any "might" about it for low carb, relatively high fat eating when it comes to the traditional blood lipids(Except LDL) like TGLs that everybody wants to lower with drugs(or raise in the case of HDL), as well as blood pressure, blood insulin levels and waistline. Study after study confirms the benefits low-carb eating(most especially when it's truly low-carb and not just somewhat lower carb), regardless of the fat consumed. I think all that is pretty well established, now whether or not that also leads to better health is unknown as far as I know.(But they do like to give us drugs to try an match some of those benefits like raising HDL and slashing triglycerides etc.) The other extreme such as Ornish may well also improve all of those parameters, and probably does better with LDL, but I don't think I've seen near as many studies to confirm it.

But no, I am by no means claiming that the results of THIS study or any others I have linked to, prove that increasing saturated fat gives better or even as good as a results for heart health as cutting fat to almost zero. Nope, all this study shows is that the people in this study whose total fat was 25% of energy did no better at all then people whose total fat intake was 37% of total energy(or those with 18 g saturated verses 38g saturated). The AHA says:

Somebody said...
The American Heart Association recommends aiming for a dietary pattern that achieves 5% to 6% of calories from saturated fat. That means, for example, if you need about 2,000 calories a day, no more than 120 of them should come from saturated fats. That’s about 13 grams of saturated fats a day.

Lowest quartile here was 18g, very low to me, but above 13)
Health.gov says:

Somebody said...
Choose a diet that provides no more than 30 percent of total calories from fat.

Lowest here was 25%, but as you said, way less than that might be needed.

Actually, everybody in the study was reasonably low fat by my standards. But whether 25% total fat calories or 37%, it helped not at all in this group. If anything, the higher fat did better overall even if insignificantly. But maybe if they cut it down even drastically further, it might help. But as you pointed out in your post, is going to be very difficult to ever have a large group, long-term study on that question, because it is extremely difficult to get most people to eat a diet that is that low in fat. Most of us find that to be extreme deprivation. Of course, we can also feel deprived by giving up pasta and desserts. But in my experience, if you ever get into ketosis, usually after a few days, most all cravings disappear. At least until you decide to step off of that diet and take that first bite of chocolate pie.

Post Edited (BillyBob@388) : 1/5/2016 12:46:58 PM (GMT-7)

Cicero2K said...
The mantra is that there are no dietary studies in humans that prove a benefit in PCa treatment. This will probably always be the case, because in order to study diet accurately, you have to sequester the participants for long periods. The only long sequesters I know of are the space station and the OJ Simpson trial jury.

However, looking to diet to cure / treat is setting the bar too high, at least in the recurrence setting. All we need there is to lengthen the PSA doubling rate to years, rather than months. In the recurrence setting PSA rises are seldom false positives, almost always mean cancer growth,

Non diet treatments get the quantity of PCa cells down by many orders of magnitude. Perhaps from billions to thousands. In this setting, techniques that delay the path of growth back to billions, is a de-facto cure, if the delay is long enough.

Many cancers including pc seems to depend on an amino-azid that can be found in high levels in meat, fish, eggs etc..

Arne52 said...
https://www.ted.com/talks/william_li#t-851333

Very interesting!

BillyBob,

Thanks for posting the article!

I currently eat two oat bran muffins a day. Based on my recipe, and the numbers I found on line, I figure I get about 4.4 grams of beta-glucan per day from the oat bran ..... guess I'll try eating three to get to 6 grams.

There is about 3 times as much beta-glucan in oat bran than there is in oatmeal.

A caution .... eating this much bran does have a side effect ... for me it is a positive .... absolutely no constipation .... unless I am traveling and can not get oat bran .... then!?!?

www.pathway27.eu/topstory/beta-glucan/

Post Edited (RCS) : 1/13/2016 4:37:33 PM (GMT-7)