Dean Ornish, one of the few giants in nutrition science who
dare count on a healthy diet to prevent and treat heart disease and other chronic
diseases and founder of the Ornish diet, published an commentary March 6 on
Newsweek.com to dispute the claim by Stanford researchers that the Atkins diet
beats the Ornish diet when it comes to weight loss.
This Ornish is not an ordinary M.D. who counts on
prescription drugs and medical instruments to make a living.
He actually formulated a dietary regimen that
helps people cure heart disease.
people may think heart disease is cureless. But he has proved that his Ornish
diet and lifestyle program, which is now covered by some health insurance
plans, can stop or reverse the progression of coronary artery blockage in 99%
News media reported that a
study showed pre-menopausal women on Atkins lost on average 10 pounds after one
year compared to four to six pounds in those on other diet plans.
Even better, the Atkins diet followers
experienced an increase in the level of good cholesterol, indicating Atkins is
good for the heart according to the common nutritionists' belief.
The study was published in the current issue
Ornish found that the conclusion made by the authors that
“Women assigned to follow the Atkins diet, which had the lowest carbohydrate
intake, lost more weight and experienced more favorable overall metabolic
effects at 12 months than those assigned to follow the Zone, Ornish, or LEARN
diets” is false.
He said that the authors actually say in the context of
their report that there was no significant difference in weight loss between
the Atkins and Ornish or LEARN diets after one year.
He cited the study to say that Atkins
followers lost more weight only when it was compared to the Zone diet.
Ornish said that the current study was flawed because first
most participants could not follow Ornish diet, which requires that dietary fat be limited to 10% of the total calories.
Instead, those on the Ornish diet in the study reduced their fat intake only
to 30% from 35% in a typical American diet after one year.
The second reason to say that the study was flawed is that
when people strictly followed an Ornish diet, the dieters experienced drastic
improvements. Ornish said a randomized controlled trial published earlier in
JAMA already demonstrated that the study subjects lost 25 pounds after one year
and better yet, half of the lost weight did not come back even after fiver
That trial also showed that the Ornish
diet reduced LDL cholesterol, the bad cholesterol by 40% without resorting to
any drug, which was not seen in those on the Atkins diet in the current study.
Early studies also found, according to Ornish, that some
patients had coronary heart disease reversed only one month after they used the
Ornish diet and more people experienced the same effect after one year and five
How well people adhere to the
Ornish diet determines how much of the benefit they can gain from the
Those who adhered well to the diet
were 2.5 times less likely to have cardiac events such as heart attack and 99%
patients stopped or reversed their heart disease.
The Ornish diet is better than the Atkins diet when it
comes to the protection against heart disease.
Many trials on the Ornish diet directly measured the effect of the
artery blockage, not cholesterols.
Ornish said just because something raises the level of good cholesterol
does not mean it is healthy. He said that good cholesterol is raised to
clear saturated fat and cholesterol from a diet. That explains why the new
study found that those on the Atkins experienced a slight increase in good
cholesterol because they have too much saturated fat and cdietary cholesterol to deal with.
Unfortunately, these people
did not experience any decrease in bad cholesterol while studies have
demonstrated that the Ornish diet reduces the bad cholesterol in patients.
Previous studies have shown the Ornish diet and lifestyle
program could also reverse progression of prostate cancer and diabetes while the Atkins
diet has been proved to worsen heart disease, Ornish said.
It has been proved for a long time that the Atkins diet can
help weight loss, say in a time frame of six months.
But the lost weight may come back soon. The
current study acknowledged that after one year, the average weight loss was
smaller than that at six months.
All nutritionists have or should have concerns over the Atkins
High fat diet is in no way a
The high fat
and often low carbohydrate diet contain little of certain essential vitamins and
minerals, which can lead to nutrition deficiencies easily.
many other adverse effects associated with this diet have been reported.
It is easy to follow the Atkins diet.
But there is likely a consequence the
followers need to face.
the full commentary, visit
Why I Disagree With
following is an article detailing the problems associated with low carbohydrate
diets including Atkin's diet. Republished from http://www.atkinsdietalert.org/advisory.html
Health Risks of Low-Carbohydrate Diets
Recent media reports have publicized the short-term weight loss that
sometimes occurs with the use of low-carbohydrate weight-loss diets. Some of
these reports have distorted medical facts and have ignored the potential risks
of such diets. Past experience with the fen-phen drug combination and other
weight-loss regimens has shown that some people may disregard even serious
long-term health risks in hopes of short-term weight loss.
The American Heart Association,1,2 American Dietetic Association,3
and the American Kidney Fund4 have all published statements warning
about the various dangers associated with low-carbohydrate, high-protein diets.
We would like to notify you of (1) the potential risks from the long-term
use of low-carbohydrate, high-protein diets, (2) currently circulating
misunderstandings and deceptive statements made in support of such diets, and
(3) the establishment of a registry for individuals who feel they may have been
harmed as a result of following a low-carbohydrate, high-protein diet.
What is a Low-Carbohydrate Diet?
The theory behind low-carbohydrate diets is that if dieters avoid foods
containing carbohydrate—that is, starches or sugars—they will shed pounds. Such
diets eliminate or dramatically restrict the intake of fruit, fruit juice,
starchy vegetables, beans, bread, rice, cereals, pasta and other grain
products, and all other foods containing carbohydrate, leaving a limited diet
of foods that contain primarily fat and protein: meat, cheese, nonstarchy
vegetables, and very little else. As the diet proceeds, the carbohydrate
restriction relaxes somewhat, but fatty, high-protein foods continue to
dominate the dieter’s plate.
Despite anecdotal accounts of seemingly dramatic weight loss, the effect of
low-carbohydrate diets on body weight is similar to that of other
weight-reduction diets. In research studies at the University of Pennsylvania
and at the Philadelphia Veterans Affairs Medical Center, the average
participant lost weight during the first six months on a low-carbohydrate diet,
but regained some of this weight during the next six months so that the net
weight loss after one year (15.8 pounds in the University of Pennsylvania study
and 11.2 pounds in the VA study) was not significantly different from that seen
with other diets used for comparison.5,6 This degree of weight loss
is not greater than that which occurs with programs using low-fat, vegetarian
diets. In Dean Ornish’s program for reversing heart disease, for example, a
combination of a low-fat, vegetarian diet and exercise led to an average weight
loss of 22 pounds in the first year, along with dramatic reductions in
cholesterol levels and reversal of existing heart disease.7 Five
years later, much of that benefit had been retained.8 Studies of
whether weight loss from low-carbohydrate diets is maintained for more than one
year have not been performed.
In a one-year clinical trial reported in JAMA in 2005, researchers randomly
assigned 160 overweight individuals to one of four popular diets. Participants
assigned to the Atkins diet lost 2.1 kilograms, while Weight Watchers dieters
lost 3.0 kilograms, Zone dieters lost 3.2 kilograms, and dieters following the
Ornish program lost 3.3 kilograms.9
A review of 107 research studies on various low-carbohydrate, high-protein
weight-loss diets concluded that weight loss on these diets is not due to any
special effect of restricting carbohydrate; rather, weight loss depended on the
extent to which the dieters’ caloric intake fell and how long they continued
with their regimens.10 Other reports have also found calorie
reduction to be the most important factor in weight loss, with no special
weight-loss advantage from the restriction of carbohydrates.11,12
A review on the safety of low-carbohydrate diets notes that Atkins-type
diets are at a greater risk for being nutritionally inadequate and raise the
issue of potential long-term health effects.13
Some low-carbohydrate diet books, such as those promoting the Atkins diet,
describe how a diet devoid of carbohydrate forces the body to turn to other
fuels for energy. That means getting energy from fats and protein in the diet
or from body fat. When fats in the diet or in body fat are used for energy,
they produce compounds called ketones, and low-carbohydrate dieters sometimes
check for the presence of ketones in their urine as a sign that they have
managed to eliminate carbohydrate. It turns out, however, that, in controlled
trials, the degree of ketosis does not appear to influence weight-loss speed.12
Low-carbohydrate diets typically include quantities of cholesterol, fat,
saturated fat, and protein that exceed the recommended safe limits set by the
National Academy of Sciences, and are often low in fiber and other important
dietary constituents.11 The Nutrition Committee of the Council on
Nutrition, Physical Activity, and Metabolism of the American Heart Association
states, “High-protein diets are not recommended because they restrict healthful
foods that provide essential nutrients and do not provide the variety of foods
needed to adequately meet nutritional needs. Individuals who follow these diets
are therefore at risk for compromised vitamin and mineral intake, as well as
potential cardiac, renal, bone, and liver abnormalities overall.” 1
A nutrient analysis is presented below for the sample menus for the three
stages of the Atkins diet as described in Dr. Atkins' New Diet Revolution (M.
Evans & Co., 1999), pp. 257-259, using Nutritionist V., Version 2.0, for
Windows 98 (First DataBank, Inc., Hearst Corporation, San Bruno, CA). The menus
analyzed were as follows:
Typical Induction Menu
Bacon slices, 4 slices
Coffee, decaf, 8 ounces
Scrambled eggs, 2
Bacon cheeseburger, no bun
Bacon, 2 slices
American cheese, 1 ounce
Ground beef patty, 6 ounces
Small tossed salad, no dressing
Shrimp cocktail, 3 ounces
Mustard, 1 teaspoon
Mayonnaise, 1 tablespoon
Clear consommé, 1 cup
T-bone steak, 6 ounces
Sugar-free Jell-O, 1 cup
Whipped cream, 1 tablespoon
Typical Ongoing Weight Loss Menu
Cheddar cheese, 2 ounces
Bell peppers, 1 tablespoon
Onion, 1 tablespoon
Ham bits, 1/10 cup
Butter, 1 tablespoon
Tomato juice, 3 ounces
Crispbread, 2 carbo grams (1/4 slice)
Tea, decaf, 8 ounces
Chef's salad with ham, cheese, and egg with zero-carb dressing
Iced herbal tea, 8 ounces
Subway seafood salad, 1 item
Poached salmon, 6 ounces
Boiled cabbage, 2/3 cup
Strawberries, 1 cup
4 tablespoons cream
Typical Maintenance Menu
Gruyere and spinach omelet:
Gruyere cheese, 2 ounces
Spinach, 1 cup cooked
Butter, 1 tablespoon
Crispbread, 4 carbo grams (1 slice)
Coffee, decaf, 8 ounces
Roast chicken, 6 ounces
Broccoli, 2/3 cup, steamed
Creamy garlic dressing
French onion soup, 1 cup
Salad with tomato, onion, carrots
Oil and vinegar dressing
Asparagus, 1 cup
Baked potato, 1 small with sour cream (2 tablespoons) and chives
Veal chops, 1 serving
Fruit compote, 1+ cups (generous cup)
Wine spritzer, 16 ounces
Nutrient Analysis of
Atkins Sample Diets
Protein, g (% energy)
Carbohydrate, g (% energy)
Fat, g (% energy)
Alcohol, g (% energy)
Saturated fat, g
Calcium, mg (% DV)
Iron, mg (% DV)
Vitamin C (% DV)
Vitamin A, RE (% DV)
Folate, µg (% DV)
Vitamin B-12, 5g (% DV)
Thiamin, mg (% DV)
*% Daily values are based on a 2000-kcal diet
deriving 30% of total energy from fat (10% each from saturated,
monounsaturated, and polyunsaturated fats), and 15% total energy from protein.
In addition to having very high protein content and low carbohydrate
content, the menus at all three stages are very high in saturated fat and
cholesterol. The menus are also low in fiber. In addition, these sample menus
do not reach Daily Values for calcium and iron. The Induction menu does not
meet the Daily Values for vitamin C, vitamin A, folate, and thiamin. The Weight
Loss menu is low on folate and thiamin.
No published studies have addressed the long-term effects of
low-carbohydrate diets. The longest studies have followed dieters for only 12
months, which is not sufficient to assess whether dieters are at risk for the
problems seen in studies of general populations consuming large amounts of
meat, fatty dairy products, and the cholesterol, saturated fat, and animal
protein they contain. However, long-term studies of the general population
following a variety of diets and short-term studies of individuals on
low-carbohydrate diets raise important concerns, which are outlined below:
Colon cancer is one of the most
common forms of cancer in North America and
and is among the leading causes of cancer-related mortality. Long-term daily
intake of meat, particularly red meat, such as beef, pork, or lamb (as is
common in Western countries), is associated with approximately a three-fold increased
risk of colon cancer.14,15
The 1997 report of the World Cancer Research Fund and American Institute for
Cancer Research, entitled Food, Nutrition, and the Prevention of Cancer,
concluded that, based on available evidence, diets high in red meat are
probable contributors to colon cancer risk. Studies of large populations
published in subsequent years arrived at similar conclusions.16 In
addition, meat-heavy diets are often low in dietary fiber, which protects
against cancer.17 Low-carbohydrate diets typically include red meats
among their foods recommended for daily consumption, but no studies have yet
been conducted to see whether low-carbohydrate dieters do indeed have the same
increased long-term cancer risk seen with other populations eating meat-heavy
2. Heart disease. Generally speaking, weight loss
tends to reduce cholesterol levels, while saturated fat and cholesterol tend to
raise them.18,19 Consequently, the effect on cholesterol levels of a
low-carbohydrate weight-loss diet that includes saturated fat and cholesterol
can vary from person to person.5,20-23 In some studies, about 30% of
people on low-carbohydrate diets showed an increase in cholesterol levels,
despite their weight loss.21,23
In a low-carbohydrate diet study conducted at
University, funded by the
for Complementary Medicine, LDL (“bad”) cholesterol levels fell in 29 of the 41
study completers, as would be expected from weight loss along with the various
supplements used in the study. However, LDL levels rose in 12 participants by
an average of 18 mg/dl (the increases ranged from 4 to 53 mg/dl). One
participant had an LDL increase from 123 mg/dl to 225 mg/dl (normal LDL values
are typically described as <100 mg/dl, although some investigators have called
for lower limits). The participant was then treated with a
“cholesterol-lowering nutritional supplement,” and the LDL dropped to 176
mg/dl, which is still far above recommended levels.21 In a
subsequent Duke University study, two low-carbohydrate diet participants
dropped out of the study because of elevated serum lipid levels (one had an
increase in LDL cholesterol from 182 mg/dl to 219 mg/dl in four weeks; the
second had an increase from 184 mg/dl to 283 mg/dl in three months), and a
third developed chest pain and was subsequently diagnosed with coronary heart
disease. In 30 percent of participants, LDL cholesterol increased by more than
10 percent.23 The effect of the diet on HDL (“good”) cholesterol
levels is not consistent.5,6,20
We recommend caution when reading favorable press accounts of the effect of
low-carbohydrate diets on cholesterol levels. The two
studies cited above are sometimes cited as evidence that low-carbohydrate diets
reduce LDL (“bad”) cholesterol and increase HDL (“good”) cholesterol. However,
these studies did not test a low-carbohydrate diet alone. Rather they tested
the diet along with regular exercise and various nutritional supplements,
including flax oil, borage oil, fish oil, vitamin E, chromium picolinate, and a
“multivitamin formula” containing niacin, vitamin C, and other nutrients.
Exercise and supplements would be expected to influence cholesterol levels on
their own, apart from the effects of the diet.21,23
One particular danger of the press promotion of low-carbohydrate diets is
the suggestion that meats and dairy products that are high in saturated fat and
cholesterol do not pose the risks that scientists have long said they do.
However, abundant evidence shows the risks of such foods.19 In fact,
some evidence suggests that even a single fatty meal (e.g., a ham-and-cheese
sandwich, whole milk, and ice cream) may adversely affect the compliance of
arteries, increasing the risk of heart attacks after meals.24
Low-carbohydrate diet promoters have argued that the risks of diets high in
saturated fat and cholesterol may be disregarded when the diet is also very low
in carbohydrate. However, no long-term studies have tested this conjecture.
Furthermore, a study of nearly 30,000 women followed for 15 years found that
coronary heart disease death was associated with intakes of red meat and dairy
products when substituted for servings of carbohydrates. Coronary heart disease
death was significantly reduced when animal protein was replaced with vegetable
protein, leading the authors to conclude that "Long-term adherence to
high-protein diets, without discrimination toward protein source, may have
potentially adverse health consequences."33
3. Impaired kidney function. Studies of the Atkins
diet and other low-carbohydrate, high-protein diets have not been of sufficient
duration to evaluate their potential to affect kidney function. However, reason
for concern comes from studies of the general population, in which diets high
in animal protein are associated with reduced kidney function over time.
Harvard researchers reported that animal protein intake is associated with
decline in kidney function, based on observations in 1,624 women participating
in the Nurses’ Health Study.24 The good news is that the damage to
the kidneys was found only in those who already had reduced kidney function at
the study’s outset. The bad news is that as many as one in four adults in the
may already have reduced kidney function, and the percentage is considerably
higher for those over forty or who have hypertension. Mild kidney impairment is
also found in approximately 40% of individuals with diabetes.25 This
suggests that many people who have kidney problems are unaware of that fact and
do not realize that high-protein diets may put them at risk for further
deterioration. The kidney-damaging effect was seen only with animal protein.
Plant protein had no harmful effect.24
of Family Physicians notes that high animal protein intake is largely
responsible for the high prevalence of kidney stones in the
and other developed countries and recommends protein restriction for the
prevention of recurrent kidney stones.26
4. Complications of diabetes. In diabetes, kidney
and heart problems are particularly common. The use of diets that may further
tax the kidneys and may reduce arterial compliance is not recommended.
No studies of low-carbohydrate diets have been of sufficient duration to
assess their potential long-term effects on individuals with diabetes. Because
controlling blood cholesterol levels and protecting kidney function are
essential for individuals with diabetes, health authorities recommend choosing
diets that are rich in vegetables and fruits, while limiting saturated fat,
cholesterol, and animal protein.27
5. Osteoporosis. High intake of animal protein is
known to encourage urinary calcium losses and has been shown to be associated
with increased fracture risk in research studies involving various populations.28,29
Two studies have examined the effects of low-carbohydrate diets on calcium
losses. A Duke University study showed that urinary calcium losses rose
significantly in individuals following a low-carbohydrate, high animal-protein
diet for six months.15 Similarly, the loss of calcium was
demonstrated in a low-carbohydrate diet study at the University of Texas. In
the maintenance phase of the diet, urinary calcium losses were 55% higher than
normal. The researchers concluded that the diet presents a marked acid load to
the kidney, increases the risk for kidney stones, and may increase the risk for
bone loss.30 No studies of low-carbohydrate, high-protein diets have
yet been of sufficient duration to measure long-term bone loss.
6. Other adverse effects. The following adverse effects were noted in
a six-month study of a low-carbohydrate diet, in addition to the effects on
cholesterol levels noted above:23
Bad breath 38%
Muscle cramps 35%
General weakness 25%
Misunderstandings and Deceptive Statements
Some individuals may be confused or misled about important dietary issues
based on the following inaccurate claims:
“High-protein diets cause dramatic weight loss.”
The weight loss typically occurring with high-protein diets—approximately 11-16
pounds over the course of a year5,6—is not significantly different
from that seen with other weight-reduction regimens or with low-fat, vegetarian
“Fatty foods must not be fattening, because fat intake fell during
the 1980s, just as
obesity epidemic began.”
Some news stories have encouraged the public to discount health warnings about
the amount of fat (especially saturated fat) in the diet, suggesting that fat
intake declined during the 1980s, an era during which obesity became more
common. However, food surveys from the National Center for Health Statistics
from 1980 to 1991 show that daily per capita fat intake did not drop during
that period. For adults, fat intake averaged 81 grams in 1980 and was
essentially unchanged in 1991. While the American public added sodas and other
non-fat foods to the diet, forcing the percentage of calories from fat to
decline slightly, the actual amount of fat in the American diet did not drop at
all. What did change was portion size. A report in the
Journal of the
American Medical Association confirmed that meal sizes have steadily risen
over recent decades.31
A notable contributor to fat and calorie intake in recent years is cheese
consumption. Per capita cheese consumption rose from 15 pounds in 1975 to more
than 30 pounds in 1999. Typical cheeses derive approximately 70 percent of
energy from fat and are a significant source of dietary cholesterol.
“Fat and cholesterol have nothing to do with heart problems.”
Abundant scientific evidence establishes that dietary fat and cholesterol are
associated with increased cardiovascular disease risk.19
Nonetheless, some popular-press articles have incorrectly suggested that
evidence supporting this relationship is weak and inconsistent.
In addition, the late diet-book author Robert Atkins claimed in interviews
that, despite his having followed a fatty, high-cholesterol diet for decades,
he did not have artery blockages. The net result may be that dieters believe
they can safely disregard well-established contributors to heart disease. After
Dr. Atkins’ death, his widow and his personal physician revealed that Dr.
Atkins had indeed had coronary artery blockages, although they have maintained
that these blockages had nothing to do with his death.
“Meat doesn't boost insulin; only carbohydrates do that, and that's
why they make people fat.”
Popular books and news stories have encouraged individuals to avoid
carbohydrate-rich foods, suggesting that high-protein foods will not stimulate
insulin release. However, contrary to this popular myth, proteins stimulate
insulin release, just as carbohydrates do. Clinical studies indicate that beef
and cheese cause a bigger insulin release than pasta, and fish produces a bigger
insulin release than popcorn.32
Also, it is important to realize that different carbohydrate-rich foods have
very different effects. Most cause a gradual, temporary, and safe rise in blood
sugar after meals. Beans, green leafy vegetables, and most fruits are in this
healthful category. The main exceptions are large baking potatoes, white bread,
and sugary foods, which can cause an overly rapid rise in blood sugar.
“People who eat the most carbohydrates tend to gain the most
Popular diet books point out that cutting out carbohydrate-containing foods may
lead to temporary weight loss. This fact has been misinterpreted as suggesting
that carbohydrate-rich foods are the cause of obesity. In epidemiological
studies and clinical trials, the reverse has been shown to be true. Many people
Asia consume large amounts of
carbohydrate in the form of rice, noodles, and vegetables and generally have
lower body weights than Americans—including Asian Americans—who eat large
amounts of meat, dairy products, and fried foods. Similarly, vegetarians, who
generally follow diets rich in carbohydrates, typically have significantly
lower body weights than omnivores.
High-Protein Diet Registry Established
In order to assist patients and consulting clinicians, the Physicians
Committee for Responsible Medicine has established a registry for individuals
who have begun low-carbohydrate, high-protein diets or who may have been
prescribed them by practitioners. Individuals signing onto the registry may
report their experience with such diets.
St Jeor ST,
Prewitt TE, Bovee V, Bazzarre T, Eckel RH; Nutrition Committee of the Council
on Nutrition, Physical Activity, and Metabolism of the American Heart
Association. Dietary protein and weight reduction: a statement for health care
professionals from the Nutrition Committee of the Council on Nutrition,
Physical Activity, and Metabolism of the American Heart Association.
2. American Heart Association Web site,
http://www.americanheart.org/presenter.jhtml?identifier=11234 (accessed March
3. American Dietetic Association Web site, http://www.webdietitians.org/Print/92_nfs0200b.cfm
(accessed March 17, 2004).
4. American Kidney Fund Web site,
http://184.108.40.206/AboutAKF/Newsroom_020425.htm (accessed March 17, 2004.)
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6. Stern L, Iqbal N, Seshadri P, et al. The effects of low-carbohdrate versus
conventional weight loss diets in severely obese adults: one-year follow-up of
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low-carbohydrate diets: a systematic review. JAMA 2003;289:1837-1850.
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correlation to health, nutrition, and obesity. J Am Diet Assoc.
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a very low carbohydrate diet and a calorie-restricted low fat diet on body
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dietary animal protein and hip fracture: a hypothesis. Calcif Tissue Int
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propensity, and calcium metabolism. Am J Kidney Dis 2002;40:265-74.
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demand generated by 1000-kJ portions of common foods. Am J Clin Nutr
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