To the Editor: The study by Dr Dansinger and colleagues1 suggests that all 4 diets (Atkins, Ornish, Weight Watchers, and Zone) are comparable because the changes in risk factors for coronary heart disease (CHD) are similar. I believe that this would not be a proper conclusion because the study did not distinguish between cardiovascular risk factors and direct measures of cardiovascular disease.
In a randomized controlled trial measuring the effects of the Ornish diet,2 which is a very low-fat diet that predominantly consists of fruits, vegetables, unrefined carbohydrates (ie, whole grains), and legumes, the progression of CHD was reversed as measured by quantitative coronary arteriography, with more regression of CHD after 5 years than after 1 year, and there were 2.5 times fewer cardiac events. These patients lost a mean of 24 lb in year 1 and had kept off more than half that weight 5 years later. Another study3 showed halting or regression of CHD in the majority of the patients, as measured by cardiac positron emission tomographic scans. A third study4 showed improvement as measured by radionuclide ventriculography, with a 91% decrease in frequency of angina in the first 3 weeks.
In contrast, no study has shown that an Atkins, Zone, or Weight Watchers diet can stop or reverse the progression of CHD. The only study of the Atkins diet that examined measures of cardiovascular disease rather than risk factors showed that myocardial perfusion worsened with an Atkins diet but improved with a low-fat diet.5 These findings are consistent with a large amount of data from epidemiological studies, animal research, and randomized controlled trials linking the intake of a diet high in animal fat and protein with the incidence of CHD.6 Serial coronary arteriographic studies of 30% fat diets that are similar to Weight Watchers and Zone diets, such as the American Heart Association and National Cholesterol Education Program diets, show continued progression of CHD.6 Finally, patients assigned to the Ornish diet in the study by Dansinger et al had the greatest reductions in weight, body mass index, total cholesterol, low-density lipoprotein cholesterol, blood glucose, and C-reactive protein after 1 year when compared with the other 3 diets.
Financial Disclosure: Dr Ornish writes books and gives lectures for which he receives payment.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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