Drama with the Dr. Oz Show

A producer from the Dr. Oz show recently contacted my office. They asked whether we could supply them with a volunteer patient from either my practice or the Track Your Plaque program who would be willing to appear on the show and discuss heart disease prevention. They needed someone to commit within 24 hours.

Despite the short notice, we identified a volunteer. He flew to New York the following week where he was interviewed along with several other men and women, all of whom had heart disease (heart attacks, stents, etc.). However, as this young man is very slender and follows most of the Track Your Plaque principles (e.g., vitamin D and omega-3 fatty acid supplementation; no wheat, cornstarch, or sugars, no restriction of fat, etc.), he apparently received less attention than the overweight, I-know-nothing-about-diet interviewees.

Then there was an odd turn of events: Dr. Dean Ornish, apparently a friend of Dr. Oz, will be providing the dietary counseling. The producer had made no mention of Dr. Ornish.

Now that's an odd collision of philosophies: Our Track Your Plaque version of low-carb with the guru of low-fat, Dr. Ornish.

The following week, Dr. Ornish called me and graciously asked whether I was okay with this. I'm not sure just how much he knew about the philosophy I advocate, nor how much I have bashed his program as a destructive approach to diet, nor whether he knew that I gained 30 lbs on the Ornish diet, along with a drop in HDL to 27 mg/dl, increased triglycerides to 350 mg/dl, and type II diabetes that I've talked about on this blog and the Track Your Plaque book and website. I suspect he knew little to none of this.

Anyway, I tried to diplomatically explain that my patient's cause for coronary plaque was small LDL particles that he expressed despite his very slender build, likely from excessive carbohydrates, controlled with carbohydrate restriction. Dr. Ornish maintained his usual arguments: Grains are good, provided they are whole grains, heart disease is "reversed" with his diet program, etc. (I didn't want to challenge him in a phone call and tell him that he never actually reversed coronary plaque, but just reversed endothelial dysfunction. But, as Dr. Ornish is not a cardiologist, I wasn't sure how far his understanding of these issues went.)

We agreed to disagree. This leaves my poor patient in an odd position: Being asked by Dr. Ornish and the Dr. Oz show to follow a low-fat program for the sake of entertainment, or adhering to the advice we follow that has so far served him well, given his small LDL particle size tendencies.

We'll see where this little drama leads.

Comments (27) -

  • preserve

    4/11/2010 2:10:12 PM |

    This can be very educational.  We can find out the effects of Dr. Ornish's diet, directly prescribed by him.  This provides a pretty comparison test.

  • Anne

    4/11/2010 3:12:55 PM |

    If I had been the person flown to NYC for the show and was told they wanted me to follow the Ornish plan, I would have told them "No way." and walked out.

    I tried the Ornish diet when I first started having problems with CAD and multiple stents. I found the diet very difficult and it left me hungry. I did the meditation too.  I don't know what my lipid levels were at that time. I then went to the AHA diet that caused my triglycerides, cholesterol and weight to all rise and the answer was to get on statins and I went on to have bypass.

    In 2008 I started following a TYP lifestyle plan. Here is what happened http://heartscanblog.blogspot.com/2009/06/beating-heart-association-diet-is.html

  • Ned Kock

    4/11/2010 3:54:15 PM |

    Interesting, particularly the involvement of Dr. Ornish. Dr. Oz seems to be changing his tone lately - less critical of fats or more of refined carbs.

    By the way, you mentioned several times on your blog that the  Friedewald equation is very imprecise, providing a fictitious measure of LDL, particularly as TGs go down.

    What is your opinion of the Iranian equation? It seems to be more precise for those with low TGs, and maybe more precise in general, as its parameters were estimated through multiple linear regression:

    http://healthcorrelator.blogspot.com/2010/04/friedewald-and-iranian-equations.html

    Of course, a VAP or equivalent test would be better, but a lot of people would like to have a more precise number based on their standard lipid profile results.

  • JD

    4/11/2010 3:57:26 PM |

    Dr. Oz's wife Lisa is a vegetarian and IIRC a producer of his radio show. Dr. Oz has been quoted as saying that "everything he knows about nutrition he learned from his wife". Given his source of nutrition education I am not surprised he is on good terms with Dr. Ornish. As Dr. Eades says, "Jesus wept".

  • Mark

    4/11/2010 4:06:06 PM |

    Subjects on Dr. Oz are chosen w/entertainment value in mind.  Dr. Oz consistently gives contradicting advice at different times aimed at large audiences with the air that one size fits all. I will stay with my individualized TYP approach and leave him and his advice to entertain the masses.

  • Alcinda (Cindy) Moore

    4/11/2010 5:25:48 PM |

    If it was me, no contest. I'd stick with you! I am not a fan or Oz....and can't stand Ornish!

  • Rantin' Rog

    4/11/2010 5:31:38 PM |

    While I don't agree with Ornish, I think this is an exciting development.  Maybe he will learn something from your patient!  Any common ground and exchange of ideas is a good thing.

  • Brett

    4/11/2010 9:08:37 PM |

    Why didn't Oz or Ornish simply invite you, Dr. Davis, to be on the show? You're (cough) down with the low-fat program, right?

  • pjnoir

    4/12/2010 2:13:45 AM |

    AMBUSH. Low FAT will always win the debate because they set the facts- its just like Alice in Wonderland. Nothing good can come of this. I saw Doc OZ pour some cooking oil in his hand and say to a women- see,image this running through your veins. If thats the case- Id hate to see what Oatmeal looks like in those veins. And don't get me started on DO.

  • Gina

    4/12/2010 4:17:48 AM |

    This is the reason I turned my TV off for good over 9 years ago!
    Oz and Ornish and entertainment...why do people believe every word theses guys say? Oh maybe because Oprha says they're the best. Good God, with a computer and internet available to almost anyone who can view a TV why don't they ask some questions and do some research. Oh maybe because this is all in the name of entertainment.
    Keep up the great work Doc. I love the blog!

  • Dr. William Davis

    4/12/2010 11:31:47 AM |

    I remind myself that Dr. Ornish et al are all trying to work towards the same goal: reduction of heart disease risk. It's just that we disagree on how we get there. I think his heart is in the right place, but I worry that he perpetuates a message that is outdated and, in many cases, destructive.

    Ned--

    The "Iranian equation" is definitely an improvement, despite being nothing more than a manipulation of numbers. However, it does not uncover the hidden sources of risk that are NOT expressed by the basic lipid numbers, no matter how much you massage them.

  • Peter

    4/12/2010 11:47:49 AM |

    I don't think your disagreements with Ornish are as black and white as you suggest: he has been telling people for thirty years to stop eating sugar and other refined carbohydrates, he thinks well enough of heart scans to have one himself (scored zero), and both you and he choose whole foods over processed foods in a heartbeat (that was a joke about heartbeat.) This is not to say that your views are the same.

  • Dr. William Davis

    4/12/2010 11:58:05 AM |

    I agree, Peter.

    While the differences are fundamental, there is perhaps 70% overlap. And we are indeed aiming for the same goal.

  • George

    4/12/2010 5:03:09 PM |

    Dr. Davis, Hopefully something good will come from this. I would love to see status updates of what develops here. Beginning/Ending lipid profiles, what changes your volunteer makes in their diet based on Ornish, etc. Very, very interesting, looking forward to see what happens. Do we know when this will possibly air?

  • Anonymous

    4/12/2010 5:38:02 PM |

    pjnoir is correct.  It is an ambush.

    Ornish is not 'growing', and Oz is not about to admit he's been wrong all this time.

    You are about to be mocked and held up as a quack.

    It is a shame that they have the megaphone and you don't, but that is our perverted medical/money/fame/power system.

  • Health Test Dummy

    4/12/2010 8:07:33 PM |

    Not that I think these types of doctors are 'dumb', per-say, however, it angers me as to their 'ignorance'. I have absolutely the highest respect for all doctors who search for the 'proactive' solution. I think anyone who sticks with the 'lemmings-style' mantra, in regards to science, is only asking for humiliation and self-destruction down the road. The Ansel Keys-inspired lipid hypothesis, I believe, has been absolutely shot down by CORRECT scientific methods for analyzing it's true health benefits. Throwing together some generalized 'meta-analysis' and touting it as 'truth' for the past 50 years shows us just how 'lemming-like' we truly are as a society. This information is a type of regurgitated (telephone game) bit of information that sticks to everything like glue, due to bad media and doctors who refuse to proactively search for alternative solutions based on true scientific formulas (have we all forgotten the 7th grade science class teachings of 'control group' and other forms of scientific analysis?).

    Anyway, it blows my mind. Meanwhile, I will continue to be mocked and viewed upon by my peers as 'weird' or 'out there', whilst they are all 10% + bodyfat % above me.

  • John

    4/12/2010 9:45:40 PM |

    I can vouch for the wisdom of Dr. Davis, I recently switched cardiologists to one that would listen to me about how I changed my diet since November of last year alas with the recommendations on this website I was so fortunate to come across.

    In November  
    Total Cholesterol 295
    LDL 191
    HDL 56
    TG 235
    I was immediately put on 5 mg of Crestor daily.

    Now today... after changing my diet (no wheat, no HFCS, low carbs) ( I cheat every once in awhile  but rarely, sushi with rice is my weakness..but one meal a week if at all) and still take the Crestor... after getting bloodwork from new cardiologist.

    New Numbers
    Total Cholesterol 200
    LDL 121
    HDL 61
    TG 90

    And the best part... I dropped 27 lbs and dropped a pants size...not bad for a 45 year old guy. At 6'4" and 209 pounds I'm ecstatic. Goal weight is 195 lbs that I was 15 years ago when I got married.

    Best thing is... my new cardiologist told me to take the 5 mg of Crestor EVERY OTHER DAY NOW... very happy about that. He said what you're doing with your diet and some exercise is reaping positive changes. He finished with we'll see you in 6 months to reevaluate your progress and go from there. Obviously my goal is to get off the statin for good and I think I can accomplish that with eating the Dr. Davis way.

    Thanks for the great advice you give Dr. Davis.

  • Lou

    4/13/2010 12:01:39 AM |

    Hope your patient is well prepared to provide information why she/he is doing all of that that you had him/her doing. Hope it turns out well for your patient and you.

  • Dr. William Davis

    4/13/2010 1:45:20 AM |

    I'm told that the Dr. Oz show featuring our patient will be aired Wednesday, April 14th.

    I'm not too worried about any bad press it might create. I have always been confident that the truth will win out.

  • Rob

    4/13/2010 9:37:38 PM |

    That is unfortunate. It would have been a great study, but unfortunately Dean Ornish's diet has no evidence to support it is healthy. I would politely refuse to have anything to do with that low-fat diet crap.

    http://productreviewratings.com/2010/02/fat-and-cholesterol-are-good-for-you/

  • Anonymous

    4/14/2010 5:08:46 PM |

    I just checked my Tivo and found this particular Dr. Oz show will be aired on WFLD in Chicago on April 14th at 4:00 pm and then once again on April 15th at 10:00 am.

    David

  • kdhartt

    4/15/2010 1:10:21 AM |

    Just watched it. Fish oil made the cut, not pills even, but something to have with your salad. 30 min exercise. Some yoga for stress. Impressive animations of arteries and plaque and rupture. A lot of low-fat dogma. I must say I learned nothing.

  • rhc

    4/15/2010 3:17:18 AM |

    I just watched the show and I must say it was VERY convincing since Dr. Oz had photos of the improved arteries of two of the patients. In addition, one of Dr. Ornish's original patients  who had been on the heart transplant list 25 years ago was also there - looking quite radiant and healthy. They showed pictures of his heart before and after as well.

    It is all so confusing to me since both sides have their 'proof' and scientific evidence. And let's face it most people will believe the benefits of 'lowfat' over 'highfat' any day.

    Dr. Davis could you please explain your answer to Dr. Ornish:
    “(I didn't want to challenge him in a phone call and tell him that he never actually reversed coronary plaque, but just reversed endothelial dysfunction. But, as Dr. Ornish is not a cardiologist, I wasn't sure how far his understanding of these issues went.)”

    I have no medical training, so forgive my ignorance, but it seems to me that if a diet reverses heart disease it doesn’t matter wether it is by reversing plaque or by reversing a dysfunction – the end result is what counts…doesn't it?

  • Anonymous

    4/15/2010 4:27:47 PM |

    Well I watched the show and couldnt tell which guest was the one that Dr D recommended.
    But certainly heart disease reversal was the predominate theme. Interesting graphics were used to explain plaque build up and blockage. But nothing on the components of cholesteral or small LDL. Nothing about blood sugar monitoring. On reversal startegies, weight control and exercise were trotted out as important elements ... not particularly new or enlightening. But when it came to diet there was almost a whole hearted endorsement of carbs ... oatmeal with plenty of fruit for breakfast, whole grain bread, rice etc.   Curiously fish oils where mentioned only briefly (almost in passing), and there was nothng on Vitamin D or Niacin.
    Not even statins (pro or con) were mentioned.

    All in all not at all informative! ... perhaps even misleading by what was not said ... a very poor performance imho.

  • Dr. William Davis

    4/15/2010 6:36:25 PM |

    I've so far only been able to view some of the introductory dietary comments, the "whole wheat cereal for breakfast" and "low-fat granola bar" for a snack.

    That little bit made me shudder. It brought back memories of all the low-fat blunders we made 15 years ago until we saw that substantial numbers of people were made pre-diabetic or diabetic with this routine.

  • kdhartt

    4/15/2010 10:46:31 PM |

    There was a 70% carbs, 10% fat pie chart. Must do to reverse heart disease. Nutritious meal (for six) portrayed as a death wish. Ornish as god. Not our cup of tea.

  • Anonymous

    4/16/2010 6:37:28 AM |

    Hey, at least they didn't attack you, Dr. D.  That's what I was thinking would happen.

Loading
What to Eat: The diet is defined by small LDL

What to Eat: The diet is defined by small LDL

I approach diet from the perspective of small LDL particles.

Small LDL particles have exploded in frequency and severity in Americans. It is not at all uncommon to see 70% or more small LDL particles (i.e., 70% of total LDL particle number or Apo B) on lipoprotein testing. (I saw two people today who began with over 95% small LDL.)

Small LDL particles are:
--More likely to persist in the bloodstream longer than large LDL particles.
--More likely to adhere to components of atherosclerotic plaque.
--More likely to gain entry to plaque.
--More likely to be taken up by inflammatory white blood cells which, in turn, become the mast cells that fill coronary plaque.
--More likely to be oxidized.
--More likely to be glycated (8-fold more likely than large)

To add insult to injury, foods that trigger small LDL formation--i.e., carbohydrates--also cause high postprandial blood sugars. High postprandial blood sugars, in turn, glycate small LDL. That combination of events accelerates 1) plaque growth, 2) plaque instability, and 3) aging.

So carbohydrates trigger this sequence, carbohydrates of all stripes and colors. Not just "white" carbohydrates, but ALL carbohydrates. It's all a matter of degree and quantity. So, yes, even quinoa, bulghur, and sorghum trigger this process. I've only recently appreciated just how bad oats and oatmeal are in this regard--really bad.

Foods that trigger small LDL also trigger higher blood sugars; foods that trigger higher blood sugars also trigger small LDL. Small LDL and blood sugar are two different things, but they track each other very closely.

So, in the Track Your Plaque approach to diet, we craft diet based on these simple principles:

1) Eliminate wheat, cornstarch, and sugars--These are the most flagrant triggers of small LDL, blood sugar, and, therefore, LDL glycation.
2) The inclusion of other carbohydrates, such as oatmeal, quinoa, rye, etc. depends on individual sensitivity. Individual sensitivity is best gauged by assessing one-hour postprandial glucose.

Stay tuned for more in this series. Also, Track Your Plaque Members: We will be having an in-depth webinar detailing more on thees principles in the next couple of weeks.

Comments (15) -

  • Anonymous

    4/9/2010 8:44:03 PM |

    How ia ApoB test used to know small LDL? Particle count exams aren't available in my area but ApoB is. So I'd like to know how to read this test.

    thankyou

  • Dana Law

    4/10/2010 12:45:03 AM |

    Dr. Davis,
    Please give us an eating plan.  You rant about people making lousy decisions with food.  We need some direction.  What are you eating?  Please tell us.  I find this part the most difficult.  I know I've improved in my quality of food.  Three times a day I need to make the best choices.  It's like being married to a nymphomaniac. You have to have to satisfy the healthy needs of your body, everyday!
    I believe you know what you are talking about.  You've improved our lives but tell us, please, what you are doing personally, day by day, to make those LDL particles small.  
    Sincerely,
    Dana Law
    San Diego, Ca
    P.S. This is a rant.  We need your help.

  • Taylor

    4/10/2010 5:48:55 AM |

    Love your blog, sir. I've been reading up over the last couple weeks--one question I couldn't find answered, though, was which glucose monitor you'd personally recommend? There are a lot of them out there on the market and I'm completely at a loss for how to tell them apart!

    Thanks for all the important work you do.

    --T.

  • ET

    4/10/2010 11:04:36 AM |

    For me, reducing carbs to <90g/day did little to improve my small, dense LDL.  My LDL particle number was over 2,000 and my small, dense LDL >1,600.  Increasing my saturated fat intake and niacin dropped my small, dense LDL to <120 in less than a year.

  • JC

    4/10/2010 11:26:38 AM |

    Many of those who live in the "green zones" have a high carb diet and yet live long healthy lives.Maybe the type of carb really is important.

  • Peter

    4/10/2010 11:47:32 AM |

    Re: the cultures that eat high carb but have low rates of diabetes (Japan) do they have low post-prandial scores and low small LDL particles despite lots of rice or corn and beans?

    I'm wondering why some very high carb cultures have so little obesity, heart disease, and diabetes.

  • Lou

    4/10/2010 2:09:54 PM |

    For people who are confused of what to eat, etc - check out Whole Health Source website. Very helpful.  Check out diabetes and diet under LABELS on the right side that Stephan explains in more details why, how, what, etc works.

    If there's a diet book that you can buy from a bookstore, Paleo Diet would probably be the best but it's not perfect. It says to avoid but it's perfectly fine and even the author changed his mind and it's fine to consume them.

    Free The Animal website has helpful information on how to make dinners.

    Dana Law, there's not need to eat 3 times a day. It's not really required. You can have two very nutritional meal with high amount of fat and feel satisfied for a long time, preferably break fast and dinner with maybe handful of snack like pecan, almond, walnut. That's pretty much how I eat. We're not programmed to eat that often anyway. That's how blood sugar stays low.

    JC and Peter, you need to be more specific... are we talking about percentage of meal high in carbs or total amount of carbs? Two entirely different things. We eat way more carbs than those people, I bet. I'd have to travel to those places to see that myself because I don't believe anything media tells us.

  • Paula

    4/11/2010 12:25:10 AM |

    Dana,
    Dr. Davis's "eating plan" is available to Track Your Plaque members.  I've been a member for over a year, and I can't tell you how much I've learned.  Check out the website at trackyourplaque.com and sign up!

  • Anonymous

    4/11/2010 7:35:20 AM |

    Dana, stop your ranting.  Your air of entitlement is annoying.  The fact that Dr. Davis graciously gives of his time to post some of his insights and advice does not make him a servant at your beck and call.

  • Anonymous

    4/11/2010 1:30:51 PM |

    ET, thanks for your post.  Some folks get carried away with Paleolithic diet or nothing. For those of us who prefer to limit our meat consumption, 2-3grms/day Niacin is a must.

    Dr D is always solid about whether his information is anecdotal or based on clinical trials.  If you would like additional supporting evidence for Niacin and its effects on LDL particle size, check out lipdsonline.org and search "niacin"

    " As in previous studies, niacin therapy had no significant effect on LDL cholesterol concentrations; however, after 3 months of treatment the number of small and medium sized LDL cholesterol particles was significantly decreased in those given niacin compared with those given placebo"

    Trevor

  • Tom

    4/11/2010 2:35:58 PM |

    I agree that I find it pathetic that someone would rant on a free website and some of the very best information available anywhere.  Please stop it now.

    Other posters who are asking about meters, etc:  please review the prior blogs that are listed alphabetically on the left.  Jeez folks, make some effort will you?

    Tom C.

  • Gina

    4/12/2010 4:28:27 AM |

    Yeah! So good to hear you speak out re the quinoa, oats and other carbs. Seems I can get clients to consider letting go of wheat (surprising) but  they now think quinoa is the nectar of the gods. 15 years ago I had a hard time selling even a handful of quinoa and now it is the sweetheart of grains. go figure...oh yet  again it is about who is pushing the stuff. You suppose Ornish is involved ;)
    Great post yet again Doc!

  • Anonymous

    4/12/2010 6:45:36 PM |

    I don't see what is wrong with Dana's post..... maybe we are just a tad more relaxed, those of us who don't eat too much meat Smile
    Trevor

  • April

    4/13/2010 4:42:17 AM |

    yes,I agree that a diet high on carbohydrates and sugar makes people obese and increases the risk for them to be diabetic.

  • Anonymous

    6/26/2010 6:36:17 PM |

    Do any of the home cholesterol meters (Cholesetch , Cardiochek, etc.) measure LDL particle number (i.e. small dense vs. the large not-so-dangerous kind)?

    Would be nice to conveniently measure real ldl once a day!

Loading