Fat is not the demon

So my patient, Dane, generously volunteered to be on the Dr. Oz show, as I discussed previously.

What we didn't know, nor did the producer who contacted us mention, that Dane would be counseled by low-fat guru Dr. Dean Ornish on a strict low-fat diet. The teaser introduction essentially tells the entire story.

Ironically, that is the exact opposite of the dietary program that I advocate. I rejected the 10% fat diet long ago after I became a type II diabetic, gained 30 lbs, and suffered miserable deterioration of my cholesterol values on this diet. I also witnessed similar results in many hundreds of people, all following a strict low-fat diet. In fact, elimination of wheat--whole, white, or otherwise--along with limitation or elimination of all other grains has been among the most powerful health strategies I have ever witnessed.

I now regret having subjected my patient to this theatrical misinformation. Dane is a smart cookie--That's probably why he was not allowed more than a "yes" or "no" during Dr. Oz's monologue, else Dane might have pitched in about some ideas that would have tripped Oz and Ornish up.

In their defense, if we took 100 Americans all following a typical 21st century diet of fast food, white bread buns, Coca Cola and other soft drinks, chips, barbecue sauce, and French fries, converting to a plant-based, high-carbohydrate, grain-rich diet is indeed an improvement. People will, at first, lose weight and enjoy an initial response. (The occasional person with the Apo E4 genetic pattern, heterozygote or homozygote, may even enjoy long-term benefits, a topic for another day.)

But the majority of people, in my experience, after an initial positive response to an Ornish-like low-fat, high-carbohydrate diet will either plateau (stay overweight, have low HDL, high triglycerides, plenty of small LDL, and high blood sugars) or deteriorate, much as I did.

Thankfully, Dane has been a good sport about this, understanding that this is essentially show business. I believe he understands that the information was all well-intended and, after all, we are all working towards the same goal: reduction of heart disease risk.

By the way, regardless of which diet you follow, it is, in my view, absurd to believe that diet alone will do it. What about vitamin D normalization, thyroid normalization (thyroid disease is incredibly common), omega-3 fatty acids from fish oil, identification of hidden sources of risk (something that is unlikely in Ornish, since small LDL particles skyrocket on a low-fat diet), postprandial glucoses, etc., all the pieces we focus on to gain control over coronary plaque? Eating green peppers and barley soup alone is not going to do it.

Comments (36) -

  • Matt Stone

    4/16/2010 1:09:27 PM |

    You might wanna revise the last statement in parenthesis about a low-carb diet causing small LDL to skyrocket Smile  I assume you meant low-fat.

  • Eloise

    4/16/2010 1:23:10 PM |

    I´ve been a low fat healthy anything victim myself for over 12 years and know exactly that it is a difference to SAD - but as you said only at the beginning. But maybe it´s easier to take those first changing steps into the right direction even if it´s the wrong way.
    Low fat, tons of fruits and whole grains are not the solution.
    Now I´m VLC for over one year, keto the last half got rid of eczema, asthma, mood issues and much more. Laboratory always repeat the tests because they can´t believe it: HDL 199, triglyceride 35. That´s high fat.

  • Dr. John Mitchell

    4/16/2010 1:26:29 PM |

    Dr. D
    You are on the mark with the last paragraph...it's more than one "magic pill" to solve the health problem. The solution appears to be a combination of many aspects of human existence...diet exercise and mental state.
    Eat right, exercise right, and think right...making the right choices for a healthier lifestyle.

  • Anonymous

    4/16/2010 2:08:30 PM |

    (something that is unlikely in Ornish, since small LDL particles skyrocket on a low-carb diet)

    Should this not read either

    "Low-Fat" or "High-Carb" diet?

  • John

    4/16/2010 4:07:42 PM |

    I applaud Dane--I don't know how long I'd be able to contain my frustration if I had to not only watch the Dr. Oz show, but actually receive direct advice from Ornish and Oz about low fat...

  • Chuck

    4/16/2010 4:33:16 PM |

    You mean "skyrocket on a *low fat* diet", right?

  • Anna

    4/16/2010 4:37:00 PM |

    "since small LDL particles skyrocket on a low-carb diet"

    I think this is a typo that was meant to say "high-carb diet", right?  Or perhaps it was large LDL particles skyrocket on a LC diet.

  • Nigel Kinbrum

    4/16/2010 5:31:01 PM |

    "since small LDL particles skyrocket on a low-carb diet"
    I think you meant high-carb diet

  • Anonymous

    4/16/2010 5:56:34 PM |

    I think you have a mistype here:

    (something that is unlikely in Ornish, since small LDL particles skyrocket on a low-carb diet)

  • Anonymous

    4/16/2010 7:38:14 PM |

    Dr. Davis,

    I watched Dr. Oz's show on reversing heart disease and it was interesting to read your comments.  

    Regarding the reversal of heart disease, while I admittedly haven't read your publication, do you have Heart Scans/Calcium Scores, angiograms or PET Scans that show the same results Dr. Oz (and other MDs like Dr. Caldwell Esselstein or K. Lance Gould) that show the same results with your program?  

    Thank you again and look forward to your feedback.

  • Anonymous

    4/16/2010 7:46:00 PM |

    maybe I am reading into this wrong but " (something that is unlikely in Ornish, since small LDL particles skyrocket on a low-carb diet)"

  • Anonymous

    4/16/2010 8:27:32 PM |

    ''something that is unlikely in Ornish, since small LDL particles skyrocket on a low-carb diet''   You surely meant low-fat diet.

  • jd

    4/16/2010 8:45:38 PM |

    Thanks as always.  Please fix third line from bottom, after skyrocket,"low-carb," to help the newbies.

  • pjnoir

    4/16/2010 8:53:34 PM |

    See- it was an AMBUSH. They write the rules and that is that. WE, the low carb HIGH fat diet, community must be the grass roots driving force. We are like Galileo committing hiFat heresy among an antiFat, Whole grain Inquisition. Fight on and screw tv talk shows.

  • Drs. Cynthia and David

    4/16/2010 10:51:34 PM |

    I will be curious to see how this goes down on the Oz show, but am afraid we'll be left wanting to bang our heads on the wall.  Does this mean that Dane did not get a chance to respond at all to their advice or that he must agree to follow their advice (maybe with a  follow up to show improvement, or NOT).

    I agree with you that their diet advice is probably better than what most of their featured patients eat.  And you probably can show improvements to a degree that way in many people.  Just cutting the enormous glycemic load in conjunction with omega-6 rich oils should help a lot.  But that doesn't make it optimal for health.

    What's it going to take to shut up the low fat dogmatists?  A class action lawsuit?

    Why don't you have a show of your own?  I think it would be a good thing.

    BTW, I think you meant to say "small LDL particles skyrocket on a low-FAT diet" in your penultimate sentence.


  • Phil

    4/16/2010 11:32:21 PM |

    Dr. Davis,
    Should the next-to-last sentence read "...small LDL particles skyrocket on a low-fat diet..."?  I thought low-carb diets reduced small LDL.

  • Steve

    4/17/2010 12:42:09 AM |

    Typo should be fat
    "small LDL particles skyrocket on a low-carb diet"

    I've enjoyed reading your blog.

    Other ideas...
    Niacin and phosophorous suppression causal for insulin resistance?


  • Dr. William Davis

    4/17/2010 4:41:10 AM |


    Thanks, all for catching the typo.

    The sentence should have read:

    . . . small LDL particles skyrocket on a low-FAT diet.

    I guess everyone is paying attention!

  • Gys de Jongh

    4/17/2010 8:55:20 AM |

    not every body agrees ....

    Am J Clin Nutr. 2010 Mar;91(3):578-85.

    Lack of suppression of circulating free fatty acids and hypercholesterolemia during weight loss on a high-fat, low-carbohydrate diet.

    BACKGROUND: Little is known about the comparative effect of weight-loss diets on metabolic profiles during dieting. OBJECTIVE: The purpose of this study was to compare the effect of a low-carbohydrate diet (< or =20 g/d) with a high-carbohydrate diet (55% of total energy intake) on fasting and hourly metabolic variables during active weight loss. DESIGN: Healthy, obese adults (n = 32; 22 women, 10 men) were randomly assigned to receive either a carbohydrate-restricted diet [High Fat; mean +/- SD body mass index (BMI; in kg/m(2)): 35.8 +/- 2.9] or a calorie-restricted, low-fat diet (High Carb; BMI: 36.7 +/- 4.6) for 6 wk. A 24-h in-patient feeding study was performed at baseline and after 6 wk. Glucose, insulin, free fatty acids (FFAs), and triglycerides were measured hourly during meals, at regimented times. Remnant lipoprotein cholesterol was measured every 4 h. RESULTS: Patients lost a similar amount of weight in both groups (P = 0.57). There was an absence of any diet treatment effect between groups on fasting triglycerides or on remnant lipoprotein cholesterol, which was the main outcome. Fasting insulin decreased (P = 0.03), and both fasting (P = 0.040) and 24-h FFAs (P < 0.0001) increased within the High Fat group. Twenty-four-hour insulin decreased (P < 0.05 for both groups). Fasting LDL cholesterol decreased in the High Carb group only (P = 0.003). In both groups, the differences in fasting and 24-h FFAs at 6 wk were significantly correlated with the change in LDL cholesterol (fasting FFA: r = 0.41, P = 0.02; 24-h FFA: r = 0.52, P = 0.002). CONCLUSIONS: Weight loss was similar between diets, but only the high-fat diet increased LDL-cholesterol concentrations. This effect was related to the lack of suppression of both fasting and 24-h FFAs.

    PMID: 20107198

  • Fred Hahn

    4/17/2010 2:15:57 PM |

    If I'm correct, the study cited in the comments section fails to reflect LDL particle size. IOW, your total LDL can go up and still result in a superior outcome.

    Also, weight loss isn't the issue - fat loss is. We want to know which group lost the most fat, not weight.

    Additionally, A calorie restricted, low fat diet that places carb intake at only 55% (FAR lower the the USRDA recc's) is still a relatively low carb diet.

  • Lou

    4/17/2010 3:28:45 PM |

    Gys de Jongh,

    I've seen that study before. I can't access to the whole study but did they use NMR lipid test or traditional lipid test? Huge difference! I'd bet the study was flawed.

  • TedHutchinson

    4/17/2010 8:38:20 PM |

    @ Gys de Jongh
    In this study Subjects were told that polyunsaturated fats
    and monounsaturated fats were healthier sources of dietary fatty acids than were saturated fats,

    readers here know Dr Davis makes his recommendations on the basis every effort is made to improve omega 3 status while avoiding omega-6-rich sources like corn oil, vegetable oils, sunflower or safflower oils.

    Similarly New Atkins devotes a lot of time explaining the importance of raising omega 3 while reducing omega 6 sources.

    It is a pity these researchers didn't make similar recommendations.

    I would also like to point out that  in this study, concentrations of LDL cholesterol were estimated by using the Friedewald equation
    You may be interested in Dr Davis's  previous comments on Making Dr. Friedewald an honest man

    The point is that in the context of  high omega3 ~ low omega6 intakes, we would normally expect to see a low carbohydrate diet produce a beneficial effect on triglycerides and free fatty acids without reducing TOTAL cholesterol but this may seriously throw Friedewald off target.

    Without any positive recommendations to address the omega3<>omega6 ratio, the low carb diet used in this research is not a low carb diet that either Atkins proponents or Dr Davis would support.

  • donny

    4/17/2010 11:03:08 PM |


    So how much did the high carb group eat? The abstract only says that calories were restricted, it doesn't say to what extent.

    What was the composition of the weight loss?

    "There was an absence of any diet treatment effect between groups on fasting triglycerides or on remnant lipoprotein cholesterol, which was the main outcome."

    Triglycerides at the same level probably means different things, depending on the overall picture.

    A particular triglyceride level in a high carb diet might be a measure of the continuous production of triglycerides in the liver. In a low carb diet,  triglycerides might be at a similar level, and if this comes alongside a higher level of free fatty acids, those free fatty acids will be in competition for takeup with the triglycerides; so the same level of serum triglycerides could be reached, even though triglyceride production itself might be decidedly lower.

  • marshall

    4/17/2010 11:04:44 PM |


    It would be interesting to see if it was the large, fluffy LDL or the small, dense LDL that increased. Were the high fat diets consisting of a lot of Omega 6 or PUFAs? Or did the high fat come from coconut, grass fed meats, and omega 3 fatty acids?

  • Bobby

    4/18/2010 12:02:18 AM |

    I know lots of folks on a low fat high carb diet who flourish and do not have your experience. I know folks who are on a diet you recommend who also flourish. This whole subject must be more complex than currently understood. Either folks are different or we are missing some variables. The oriental cultures flourish on a high carb diet and they do well (until the SAD influences them).

  • nightrite

    4/18/2010 4:01:27 PM |

    It's not uncommon for LDL to increase with a high-fat diet. This increase however is in the large fluffy LDL subparticles and not in the small, dense type LDL.
    Small LDL is the real "bad guy" in the cholesterol story.

  • Jan-Peter

    4/18/2010 4:26:54 PM |

    I recently had the Berkley Heart panel done and found out I was a 3/4 APO E carrier.  Their recommendation of a 20% low fat diet I found misguided.  Instead I went on a restricted calorie (1,700/day I'm 5' 11") diet consisting of no grains, some limited fruit (mostly berries)and lots of veggies (daily carbs 110g), lean protein (grass fed if red meat) about 125g. And I eat a ratio of fats (80g) mostly from avacado, olive oil, nuts, and yes some saturated (20g).
    The Macro ratio is 46% fat/30 % protein/24% carbs.
    By being high fat I am able to maintain this low calorie diet without feeling depreived.
    After 2 months on this diet I lost 24 pounds my LDL went from 130 to 91, my HDL went from 45 to 54, and my triglycerides from 230 to 94.

    I know there are conflicting studies (Krauss). I would love Dr. D to take on this APO E subject.  I can't believe from an evolutionary standpoint that 20 % of the population can't eat high fat diets, something is wrong with this hypothesis.

  • Norm

    4/18/2010 9:41:03 PM |

    Gys de Jongh, maybe you should read this interpretation of the study on Dr. Eades' blog.

  • Gys de Jongh

    4/19/2010 11:11:00 PM |

    @ TedHutchinson :
    The Friedewald equation works fine in this case because the baseline Trig's were 117 mg/dl

    If Trig's < 100 mg/dl, LDL is over estimated by 12.17 mg/dL or if you have a (very) good lipid panel your LDL might be over estimated by 10% . Nothing to worry about I would say Smile

    The article is free :
    Arch Iran Med. 2008 May;11(3):318-21.
    The impact of low serum triglyceride on LDL-cholesterol estimation.

    PMID: 18426324

  • Gys de Jongh

    4/19/2010 11:17:49 PM |

    Total cholesterol and triglycerides were measured enzymatically with a colorimetric endpoint (Roche Diagnostic Systems, Indianapolis, IN), as were HDL-cholesterol concentrations (Diagnostic Chemicals Ltd, Oxford, CT). LDL cholesterol was calculated from plasma total and HDL cholesterol and triglyceride concentrations

  • Gys de Jongh

    4/19/2010 11:23:07 PM |

    Suggested caloric intakes for women initially were set at 1200–1500 kcal/d, with the higher intakes recommended for those with a BMI > 36. Men were instructed to eat 1500–1800 kcal/d, again with the higher intakes recommended for those with a BMI > 36. Subjects were encouraged to consume about 30% of calories from fat, 15% from protein, and 55% from carbohydrate.

  • Gys de Jongh

    4/19/2010 11:30:30 PM |

    The best "diet" for you depends on what your genes do with the food after you eat it  Smile
    Int J Circumpolar Health. 2007 Dec;66(5):390-400.
    Common variants APOC3, APOA5, APOE and PON1 are associated with variation in plasma lipoprotein traits in Greenlanders.
    OBJECTIVES: We undertook studies of the association between common genomic variations in APOC3, APOA5, APOE and PON1 genes and variation in biochemical phenotypes in a sample of Greenlanders. STUDY DESIGN: Genetic association study of quantitative lipoprotein traits. METHODS: In a sample of 1,310 adult Greenlanders, fasting plasma lipid, lipoprotein and apolipoprotein (apo) concentrations were assessed for association with known functional genomic variants of APOC3, APOA5, APOE and PON1. For significantly associated polymorphisms, between-genotype differences were examined in closer detail. RESULTS: We found that (1) the APOE restriction isotype was associated with variation in plasma total and LDL cholesterol and apo B (all p < .0001); (2) the APOC3 promoter genotype was associated with variation in plasma triglycerides, HDL cholesterol and apo A-I (all p < .002); (3) the APOA5 codon 19 genotype was associated with variation in plasma triglycerides (p = .027); and (4) the PON1 codon 192 genotype was associated with variation in total and LDL cholesterol and apo B (all p < .05). CONCLUSIONS: Taken together, our results suggest that common genetic variations in APOC3, APOA5, APOE and PON1 are associated with significant variation in intermediate traits in plasma lipoprotein metabolism in Greenlanders; the associations are similar to those observed for these variants in other populations.

    PMID: 18274205

  • Gys de Jongh

    4/19/2010 11:35:35 PM |

    High-fat/low-carbohydrate-diet treatment
    Participants in the high-fat condition were instructed to consume a diet that was low in carbohydrate and thus higher in percentage fat and/or protein (13). The central feature of this approach is carbohydrate restriction with unlimited consumption of fat and protein. Subjects were told that polyunsaturated fats and monounsaturated fats were healthier sources of dietary fatty acids than were saturated fats, but it was clear that the primary goal was to limit carbohydrate by whatever means were required. Participants were provided a treatment manual, which described the rationale for a low-carbohydrate diet as well as numerous suggestions for meal plans. The treatment manual for the highcarbohydrate diet plan was modified to make it parallel to the high-fat (low-carbohydrate) recommendations. This substudy took place during the first phase (“induction”) of the intervention. During this phase, participants were instructed to consume ’20 g carbohydrate/d. They were told to eat until full while remaining within the carbohydrate limit.

  • Lou

    4/20/2010 10:38:22 PM |


    What about small LDL particle vs large LDL particle? Did they use vegetable oil? What kind of carbohydrates?

    How do you explain this clincal study - http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=17583796&dopt=AbstractPlus?

    I rapidly lost a lot of viseral fat past month after cutting most of wheat flour based food AND adding more healthy fat like avacado, coconut milk, olive oil, egg yolk and plenty of various meat. I feel better. I tried low fat high carbs diet and it was not sustainable because I go hungry all the time.

    Unless I have full access to that study, I'm going to write it off as flawed misleading study. The author was clearly trying to promote high carbs and low fat diet. I'll have to see where they got grants from to do the study.

  • Catatonic Eyes

    4/22/2010 3:15:12 PM |

    Dr. Davis what brand of fish oil do you recommend? I have been taking Flameout by Biotest but am feeling it may not be the best choice. I am hopeful to find something reasonably priced that works well. When my Vit d tested at nine in December when I was admitted to the hospital, I started taking the NOW brand of Vit d 3 and mid March was at 53.....my new doctor is having me increase my dose as he wants it higher. Any brand recommendations for someone struggling on one income for the family for fish oil? Thanks for all of your articles. I am learning so much and will regain my health in time!

  • wendys

    4/26/2010 9:42:26 PM |

    Did they do a full colesteral work-up and will they show the results if it shows that Dane's numbers got worse instead or better?