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Dr. Dean Ornish vs. Dr. Mark Hyman: When Diet Experts Disagree

I had a call yesterday with a potential Gene Food investor here in Jackson Hole. About 5 minutes into the call, she told me she wasn’t sure why anyone would need a personalized nutrition platform. “After all, it’s pretty simple, eat a mostly plant based diet and follow the advice of leaders like Dr. Mark Hyman. That would solve nutrition if only people knew.”

This is a common point of view – that there are a handful of health wizards out there who have the protocol to fix all of us.

Nutrition is not one size fits all

However, my experience in the nutrition world over the last 5 years has taught me that there is no absolute correct protocol for all of us.

One of the reasons I founded Gene Food was to create a system to help people find a diet and lifestyle that works best for them, not for someone else. People who have never struggled with diet or food sensitivity have a hard time understanding how desperate it can feel to get on the wrong side of your health and know it’s linked in some way to food.

And here’s the problem for those of us looking for answers: the best diet gurus disagree.

What better way to illustrate this point than to examine the contrasting advice on nutrition from two of the brightest minds in the business: Dr. Dean Ornish and Dr. Mark Hyman.

Both Dr. Ornish and Dr. Hyman enjoy loyal followings, and deservedly so. Dr. Hyman is the Head of Strategy and Innovation of the Cleveland Clinic Center for Functional Medicine and a multiple time NY Times best selling author. Dr. Ornish is also a multiple time NY Times best seller and has famously published a randomized, controlled study that reversed heart disease in some subjects who were placed on his lifestyle medicine protocols.

No one can doubt the credentials of either of these men, and yet they have a long standing personal rivalry and advocate for entirely opposite styles of eating.

Let’s examine their competing perspectives on dietary fat, cholesterol, and some other issues related to food choice.

Dr. Ornish vs. Dr. Hyman on Nutrition

Nutrition issue:Dr. MarkDr. Ornish
EggsYes, part of a heart healthy dietNo, causes heart disease due to cholesterol and TMAO
Saturated fatYes, no proof of a link to heart diseaseNo, ample evidence of heart disease risk
FishYes, good source of omega 3 fatty acidsNo, too much cholesterol and fat, contributes to heart disease risk
MeatIn moderation including red meat.Never.
Refined carbsNoNo
AlcoholVery small amountsVery small amounts

Dr. Dean Ornish on saturated fat

Dr. Ornish’ position on saturated fat is clear: saturated fats cause heart disease.

Dean Ornish is a long standing advocate of plant based diets and argues that diets higher in saturated fat have been shown to increase the risk of heart disease significantly. To quote Dr. Ornish’s website discussing a British Medical Journal Report on saturated fat:

If you actually look at the raw data in the report (they didn’t even put this in the abstract) there was a highly significant correlation between the intake of saturated fat and total mortality, cardiovascular mortality, diabetes, etc.

Dr. Mark Hyman on saturated fat

Now to Dr. Hyman, who concludes, based on the same British Medical Journal report that saturated fat doesn’t cause heart disease, and that, in fact, higher saturated fat diets lowered the risk of stroke.

Saturated fat is not linked to heart disease in the absence of refined (starchy) carbs and sugar, and in the presence of omega 3 fats. And review after review after independent review of the research shows that there seems to be no link between saturated fats and heart disease. In fact, a recent large review of the research found that the higher the saturated fat intake, the lower the risk of stroke.

Dr. Dean Ornish on eggs

Dr. Dean Ornish and many of his more Vegan leaning colleagues like my friend Dr. Joel Kahn will tell you that eating eggs increases your risk for heart disease, and they have some compelling research on their side. In addition to cholesterol absorption, which varies from person to person, Dr. Ornish is opposed to eating eggs because of a compound called TMAO most of us have never heard of.

When we eat eggs, the bacteria in our microbiome can turn the choline in eggs into TMAO which the New England Journal of Medicine and some others medical journals have linked to an increased risk for heart disease.

Dr. Mark Hyman on eggs

You know this was coming, Dr. Mark takes the opposite approach from Dr. Ornish to eating eggs and both men claim they are on the side of “the science.”

Consider this Facebook video on eggs from Dr. Hyman. His position is that eating eggs can be part of a heart healthy diet and that we needn’t concern ourselves with egg white omelets any longer. As we discussed in our podcast episode on eggs, Dr,. Hyman has research on his side as well. A large study that appeared in The American Journal of Clinical Nutrition found no increased risk for heart disease when eating eggs everyday in moderation.

Confused yet?

Maybe things aren’t quite as simple as my investor friend wants to believe? Sure, Dr. Mark Hyman is a true expert and an excellent physician, but so is Dr. Ornish.

They are making arguments about nutrition that directly conflict with one another. How is the person at home, with a job, a family, and a social life, supposed to navigate this mess?

They won’t be able to and will instead throw their hands up in desperation with an “everything in moderation” mantra thrown in for good measure. Heck, even former President Bill Clinton has consulted both Ornish and Hyman, he’s just as confused as the rest of us!

Using personalized nutrition to resolve the diet wars

As the table included as the outset of this post details, there is some common ground to be found between Dr. Ornish and Dr. Hyman. Both eschew junk food, processed grain, and loads of oil in the diet. Both men believe in stress management, loving relationships and time spent in nature.

However, there is no denying that their viewpoints on saturated fat, cholesterol, eating meat and dairy, and even fish, are diametrically opposed.

What if both Dr. Hyman and Dr. Ornish were both right, but for some people?

In other words, what if there was a system that could help steer some of us towards an Ornish protocol, while others would pursue a Dr. Hyman style Pegan diet?

For example, Dr. Hyman discourages his readers from eating oatmeal because it has the potential to spike blood sugar, and we know that repeated fluctuations in blood sugar contribute to inflammation. However, a large study out of King’s College London, called the Predict-1 study, looked at hundreds of identical twins to determine the degree to which genetic factors influence blood glucose after a meal. The researchers found that 50% of post-meal (also called post-prandial) spikes in blood sugar were determined by genetics.

This points towards a future where we personalize the approach to diet and blood sugar rather than blanket recommendations that everyone should avoid eating grains.

Similarly, there are credible studies from some of our best scientists demonstrating that TMAO is bad for heart health. However, there is also ongoing microbiome research aimed at identifying and neutralizing TMA producing strains of bacteria. It could be that some of us should avoid eggs because of the state of our microbiome, while others can eat eggs in moderation without producing dangerous amounts of TMAO. Further, some of us absorb more cholesterol than others. People who have been identified as cholesterol “hyper-absorbers” may want to limit eggs as recommended by Dr. Ornish, while others who absorb very little cholesterol may be better off following Dr. Hyman, especially if they fall in the camp of people genetically predisposed to elevated blood sugar. I discussed many of these issues when I interviewed world renowned lipid expert Dr. Tom Dayspring about diet and heart disease on the Gene Food Podcast. Dr. Dayspring is an advocate of personalizing all protocols from pharmaceutical to lifestyle.

In sum, the science of personalized nutrition has arrived and its only going to get better from here. Rather than assuming everyone can follow an Ornish or a Hyman diet protocol, we must instead get the proper diagnostic tests out to the general public, especially to underserved communities, disadvantaged communities, and communities of color. Labs like Boston Heart Diagnostics run Cholesterol Balance Tests that can help people determine whether they absorb, or make, large amounts of cholesterol in response to diet, or whether they can be more liberal with dietary fat as Dr. Hyman suggests.

The key is to empower people with the latest science rather than assuming we are all the same.

John O'Connor

John O'Connor is the founder of Gene Food, a nutrigenomic startup helping people all over the world personalize nutrition. John is the host of the Gene Food Podcast and a health coach trained at Duke's Integrative Medicine Program. Read his full bio here.

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