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The Dean Ornish Program

Introduction

The Dean Ornish Program, developed by Dean Ornish, MD, was the first diet and lifestyle program scientifically proven to reverse heart disease. The Ornish diet emphasizes the consumption of whole grains, fruits and vegetables, and severely restricts the consumption of animal products, dietary fat, and refined carbohdyrates. In addition to these dietary recommendations, the Ornish Program involves comprehensive lifestyle changes including moderate aerobic exercise, stress reduction techniques, peer support, smoking cessation, and nutritional supplementation. The Dean Ornish Program has been shown to be beneficial for individuals with heart disease. The Ornish Diet, however, may be too low in calories, essential fatty acids, calcium and vitamin B12 to meet the caloric and nutrient needs of children, adolescents, pregnant and lactating women.

History

Dr. Dean Ornish, M.D., first became interested in conducting research on heart disease in 1975, when he was a medical student at Baylor College of Medicine. As part of his medical training, he had the opportunity to assist cardiovascular surgeons as they performed coronary artery bypass surgery. Although he appreciated the skill and expertise of the physicians, Dr. Ornish soon became disillusiioned with this form of "treatment," as it appeared to simply "bypass" the causes of the disease in search of a temporary fix of the problem. Dr. Ornish began to research the dietary and lifestlye factors that lead to heart disease and to design clinical research trials that would allow him to study the effectiveness of dietary and lifestlye changes as a treatment for heart disease. The results of Dr. Ornish's first clinical trial, the Lifestyle Heart Trial, were published in 1990. In this study, Dr. Ornish's heart patients got healthier simply by adopting new dietary and lifestyle habits. The results of this study were considered revolutionary since, until that point, it was believed that it was impossible to stop the progression of heart disease.

Popularity

Dr. Ornish's dietary and lifestyle recommendations have earned widespread popularity among patients and physicians as a way to prevent and reverse cardiovascular disease. His first book, Dr. Dean Ornish's Program for Reversing Heart Disease, published in 1990, has been a long-standing New York Times bestseller. Dr. Ornish has also written a best-selling weight loss book called Eat More, Weight Less.

Principles

In his best-selling book, Dr. Dean Ornish’s Program for Reversing Heart Disease, Dr. Ornish presents two diets: the Reversal Diet and the Prevention Diet. The Reversal Diet is for people diagnosed with heart disease who want to lower their risk of heart attack and reduce the symptoms of the disease, such as chest pain. The Prevention Diet is recommended for people who do not have heart disease, but whose cholesterol levels are above 150, or for people with a ratio of total cholesterol to HDL (the so-called “good cholesterol”) that is less than 3.0. In practical terms, very little difference exists between the Reversal and Prevention Diets. Dr. Ornish’s dietary recommendations are as follows:

  • Consume 10% of calories as fat, with a ratio of polyunsaturated fat to saturated fat that is greater than 1
  • Consume 70-75% of calories as complex carbohydrates and 15-20% of calories as protein
  • Limit cholesterol intake to less than 5 mg per day
  • Consume whole grains, fruits, vegetables and legumes in unlimited quantities
  • Exclude all meat and dairy products, except egg whites, nonfat milk and nonfat yogurt
  • Eliminate caffeine from the diet and consume sugar, salt, and alcohol in moderation

In addition to these dietary recommendations, the Ornish Program involves comprehensive lifestyle changes including moderate aerobic exercise, stress reduction techniques (such as stretching, meditation, and imagery), peer support, smoking cessation, and nutritional supplementation (with folic acid, vitamin C, vitamin E, vitamin B12, fish oil, flaxseed oil, and selenium).

Research

The dietary principles of the Ornish Program are based on a large body of epidemiological research that indicates that diets high in cholesterol and saturated fat cause blood cholesterol levels and blood pressure to increase, thereby increasing the risk of heart disease. In addition, many research studies have demonstrated that diets low in fat and cholesterol cause blood cholesterol levels and blood pressure to decrease. Dr. Ornish has also published a series of clinical trials that document the effectiveness of his program for reversing heart disease.

In 1990, Dr. Ornish and his colleagues at the University of California at San Francisco School of Medicine published the results of a one-year study called The Lifestyle Heart Trial. This study was the first randomized, controlled clinical trial conducted to determine whether people with heart disease could be motivated to make and sustain comprehensive lifestyle changes and if so, whether regression of coronary atherosclersosis (hardening and narrowing of the arteries) could result from these lifestyle changes alone.

In this study, 28 patients followed the Ornish program (as described in the Principles section above), while a control group of 20 patients followed conventional dietary guidelines for heart disease (including restriction of fat intake to 30% of calories and cholesterol intake to 200-300 mg per day). After one year, the patients in the Ornish program showed a significant overall regression of coronary atherosclerosis (as measured by quantitative coronary arteriography), while, in the control group, atherosclerosis progressed. Patients in the Ornish group reported near complete relief from angina (chest pain), a likely result of increased blood flow to the heart. (Ornish, 1990)
Studies published in 1992 and 1995, which used different diagnostic procedures for measuring the progression and regression of atherosclerosis than those used in the original Lifestyle Heart Trial, also showed the effectiveness of the Ornish Program (Gould and Ornish, 1992 and 1995). It is interesting to note that in each of the studies mentioned above, the amount of regression of atherosclerosis experienced by patients in the Ornish group was associated with the extent of lifestyle change, indicating that although small changes in lifestyle may slow the progression of heart disease, a complete change in lifestyle is required to reverse or halt the disease process.

Dr. Ornish has also proven that his program can dramatically decrease the medical costs associated with heart disease. In 1994, approximately 500,000 coronary artery bypass graft (CABG) operations and approximately 600,000 antioplasties were performed in the United States, at a combined cost of approximately $15.6 billion. In a 1998 study involving 333 patients, 194 of whom followed the Ornish Program and 139 of whom served as the control group, Dr. Ornish attempted to determine if his lifestyle changes could reduce the number of angioplasties and coronary artery bypass surgeries (CABGs) performed during a three year period, thereby reducing medical expenditures among his cardiovascular patients. In the Ornish group, only 31 angioplasties and 26 CABGs were performed, resulting in an average medical cost of $18,119.00 per patient in the control group, including the costs associated with participating in the Ornish program. On the other hand, 89 members of control group underwent angioplasty and 84 underwent bypass surgery, for an average cost per patient of $47,647.00. (Ornish, 1998)

Critics of the Ornish Program caution that low-fat, high-carbohydrate diets tend to lower HDL cholesterol, the so-called "good" cholesterol, and increase triglyceride levels. Low HDL cholesterol levels and high triglyceride levels are believed to increase the risk of heart disease. (Katan, 1997) Critics are also concerned that the Ornish Diet limits fat intake too severely and underemphasizes the importance of essential fatty acids in the prevention of heart disease. In response to concerns about HDL levels, Dr. Ornish suggests that a low HDL level in a person consuming a low-fat, low-cholesterol diet may not confer the same risk for atherosclerosis as the presence of low HDL cholesterol levels in a person consuming a high fat diet. (Ornish, 1998)

Critics of the Ornish Program also argue that the dietary recommendations are unpalatable and too strict, and, as a result, most people, especially those accustomed to eating a typical American diet, find it extremely difficult to follow the diet for an extended period of time. However, the results of two small clinical trials indicate that people can successfully adopt the dietary changes recommended by Ornish. In 1995, Franklin, et. al, conducted a 28-week observational study of ten patients following an Ornish-type program, which included social support, exercise, stress reduction, and a very low fat, vegetarian diet. At 28 weeks, eight patients were consuming less than 30% of calories as fat. Of these eight patients, three were consuming less than 10% of calories as fat. In addition, seven of eight patients reported adherence to the vegetarian diet. At 12 months, without the benefit of a structured program, one patient reported 100%, six reported 85%, and two reported 50% adherence to the dietary principles. (Franklin, 1995) In 1998, Ornish et. al. published a five year follow-up report on the Lifestyle Heart Trial, in which he commented on the ability of the patients in the Lifestyle Heart Trial (a total of 35 patients completed the study) to maintain the dietary and lifestyle changes for five years. Among those participating in the Ornish Program, on average, fat intake decreased from 30% to 8.5%, cholesterol from 211 to 18.6 mg per day, calories from 1950 to 1846 per day, protein from 17% to 15%, and carbohydrate intake increased from 53% to 76.5% from the beginning of the trial to the five year follow up. (Ornish, 1998)

Foods Emphasized

Individuals following the Ornish Program are encouraged to eat whole grains, vegetables, fruits, legumes, and soybean products in unlimited quantities.

Foods Avoided

Individuals following the Ornish Program must avoid all meat and dairy products, except egg whites, nonfat milk, and nonfat yogurt. To adhere to the strict limitation on dietary fat intake, individuals on the Ornish diet must restrict the consumption of plant foods that contain high amounts of fat, including all vegetable oils, nuts, seeds and avocados. All caffeinated beverages must be eliminated, and the consumption of alcoholic beverages is discouraged.

Nutrient Excesses/
Deficiencies

The Ornish Diet may be deficient in calcium, iron, vitamin B12, and essential fatty acids. Dr. Ornish recommends supplementation with these nutrients.

Who Benefits

Research indicates that individuals with existing heart disease can reverse their disease process and reduce their risk of dying from heart disease by following the Ornish Program. This diet is also beneficial for people who want to prevent the onset of heart disease.

Who is Harmed

The Ornish Diet is low in fat and calories and may be deficient in calcium, vitamin B12, and iron. Therefore, this diet is not recommended for individuals with increased caloric and nutrient needs, such as pregnant and lactating women, children, adolescents and the elderly.

Menu Ideas

The following menu ideas are taken from Dr. Dean Ornish’s Program for Reversing Heart Disease, and are representative of the type and quantities of food eaten during the various phases of the diet.

Breakfast

  • Oatmeal with raisins and cinnamon
  • Nonfat milk
  • Grapefruit half
  • Brewed tea

OR

  • Buckwheat pancakes
  • Nonfat yogurt
  • Sliced bananas and kiwi
  • Fresh berries
  • Orange juice

Lunch

  • Black bean chili
  • Toasted corn tortillas
  • Green pea "guacamole"
  • Tossed green sala
  • Fresh fruit

OR

  • Tomato and lentil soup
  • Zucchini salad
  • Bread
  • Fresh fruit

Dinner

  • Spanish chick-pea and garlic soup
  • Linguini with roasted red pepper and herbed tomato sauce
  • Onion confit with croutons
  • Watercress, fennel and orange salad
  • Poached pears

OR

  • Ratatouille
  • Polenta with tomato sauce
  • French lentil salad
  • Tossed green salad
  • Banana bread

Resources

Dr. Ornish has written several books, including:
  • Dr. Dean Ornish's Program for Reversing Heart Disease: The Only System Scientifically Proven to Reverse Heart Disease Without Drugs or Surgery
  • Everyday Cooking With Dr. Dean Ornish: 150 Easy, Low-Fat, High-Flavor Recipes
  • Eat More, Weigh Less: Dr. Dean Ornish's Life Choice Program for Losing Weight Safely While Eating Abundantly

References

  • Franklin TL, Kolasa KM, et al. Adherence to very-low-fat diet by a group of cardiac rehabilitation patients in the rural southeastern United States. Archives of Family Medicine 1995; 4:551-554.
  • Gould LK, Ornish D, et. al. Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification. JAMA 1995; 274(11): 894-901.
  • Gould LK, Ornish D, et. al. Improved stenosis geometry by quantitative coronary arteriography after vigorous risk factor modification. The American Journal of Cardiology 1992; 69(10): 845-853.
  • Katan MB, Grundy SM, Willett WC. Should a low-fat, high-carbohydrate diet be recommended for everyone? Beyond low-fat diets. New England Journal of Medicine 1997; 337:563-6,567.
  • Ornish D. Serum lipids after a low-fat diet. JAMA 1998; 279(17): 1345-1346.
  • Ornish D. Avoiding revascularization with lifestyle changes: The Multicenter Lifestyle Demonstration Project. Am J Cardiol 1998; 82:72T-76T.
  • Ornish D, Brown SE, et al. Can lifestyle changes reverse coronary heart disease. The Lancet 1990; 336: 129-33.
  • Ornish D, et. al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998; 280(23): 2001-2007.

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