In 1990, cardiologist Dean Ornish published the book, Dr. Dean Ornish’s Program for Reversing Heart Disease. In this book, Dr. Ornish presents his research showing for the first time that heart disease can be reversed with lifestyle modifications and without medications. A pretty revolutionary body of evidence considering heart disease is the number one killer of Americans. However, one can’t help but wonder, if this book, with all its fantastic scientific evidence, was published almost 18 years ago, why is heart disease still the number one killer of Americans?

The answer is an unfortunate combination of a simple concept and a challenging plan.

The Design

The main focus of this diet has never been weight loss, although, Dr. Ornish points out this is a positive side effect. I am even reluctant to call this program “a diet” being that it is only 1 of the 4 components that led to the study results showing the reversal in heart disease. The 4 components are:

1. Stress Management
2. Diet
3. Smoking Cessation
4. Exercise

Stress Management

The stress management portion focuses on stretching, relaxation, meditation, communication, and intimacy. Research is available showing that decreasing stress does indeed decrease the risk factors associated with a fatal heart attack. After reviewing these studies, I am hesitant to cite their findings due to the fact that stress is subjective. Therefore, it is difficult to isolate, measure, and compare. This makes for unreliable scientific results.

However, I cannot discredit the advice given by Dr. Ornish to include these strategies for stress management and ultimately a healthier lifestyle. Unlike medications and supplements, getting a hug and relaxing a bit carry no harmful side effects (do beware of the big bear hug)!

Smoking Cessation/Exercise

The smoking cessation and exercise portions need little explaining since they have time and time again been included in many instructions for healthy living. So let’s get to the meat and potatoes of this program, or in this case, the beans and potatoes!

The Diet

That’s right, this is a vegetarian diet. The whole design of the diet breaks down like this:

• Less than 10% Calories from fat and very little saturated fat (the fat that increases cholesterol and clogs arteries)
  -Exclude all animal products, fish, oils, avocados, and nuts
  -Include non-fat milk/yogurt and egg whites
• Less than 5mg Cholesterol
• High Fiber
• Less than 2oz Alcohol per day
• No caffeine, stimulants, or MSG’s
• No restrictions in portion sizes or total Calories consumed

Considering that the American Heart Association along with the American Dietetic Association recommend up to 30% calories come from fat and fish be included at least 3 times per week, I had many concerns with the nutritional adequacy of this seemingly restrictive diet.

Concern #1: Protein Deficiency

The concern for lack of protein comes not from the thought that the diet is low in protein-rich foods (exclusion of animal products), but that the diet lacks “complete proteins.” All proteins are composed of various amino acids. Our bodies are able to make some, but not all amino acids. The ones we cannot make are called “essential,” and need to be consumed in the diet. “Complete proteins” contain all the essential amino acids, and are found exclusively in animal products.

This does not mean that a person who eliminates animal products cannot get essential amino acids. Plant proteins (beans, rice, potatoes, etc) provide different amino acids and when consumed together make complete proteins. These are called “complementary proteins.” I was quite pleased that Dr. Ornish not only explained this process in his book, but also provided a number of examples of combinations for guidance. Be advised that properly combining plant proteins takes a bit more time and planning, but the benefits may very well be worth the troubles.

Concern #2: Essential Fatty Acid Deficiency:

Like the essential amino acids, there are also some fatty acids that the body cannot produce, and must be consumed in the diet. Most notable are omega-3 fatty acids, which are abundant in much of the fish we consume. Omega-3 fatty acids have been shown to have very beneficial health effects, including a decrease in the risk for heart disease when consumed regularly. Therefore, it is hard to believe that Dr. Ornish recommends a diet void of all fish.

He addresses this concern by recommending supplementation with fish oil capsules. In doing so, one can obtain the recommended amount of omega-3's without eating fat. The problems with getting omega-3’s via a pill are the same problems with getting any nutrient in pill form:

1. Supplements are not regulated and therefore, can be contaminated.
2. There are many components in food that help our bodies utilize nutrients in beneficial ways. When you consume only one nutrient in a pill form, you cannot be guaranteed the same benefits shown when consuming whole foods.

To Dr. Ornish’s defense, he also recommends plant sources of omega-3’s (flaxseed, beans, vegetables). However, please note that to match the amount of omega-3’s provided by fish, one must consume a large quantity of these plant sources.

Concern #3: Elimination of “Good” Fats

Every time I sop up olive oil with my French bread, I praise myself for doing something good for my body! The same goes for the avocado on my sandwich and the handfuls of nuts during the football game. That’s because these foods contain monounsaturated fats, which have been found to be healthier than saturated fats.

The flaw in the proceeding sentence is that the word “healthier” does not mean “healthy.” It’s like smoking crack because it is not as bad as shooting heroin. As much as it pains me to say, the fat in olives, avocados, and nuts are not good for you, they are just not as bad as the fats in meat, creams, and butter. This is especially true for people looking to lose weight since these fats provide the same number of calories as the fats in steak and butter. They just will not clog your arteries as fast.

Concern #4: Vitamin/Mineral Deficiency

Any diet that recommends the addition of vitamin supplementation is admitting it is flawed. The vitamins and minerals that concerned me the most as being inadequate on this diet are:

1. Vitamin B-12: Only found in animal products and fortified grains (usually refined grains, which are discouraged on this diet)
2. Vitamin D: A study published by the American Dietetic Association evaluated the nutrient adequacy of a very low-fat vegan diet and found that the consumption of vitamin D was less than adequate.
3. Iron: Our bodies utilize the iron provided by animal products more efficiently than the iron in plant foods.

Dr. Ornish recommends a multivitamin with added vitamin B-12 and iron (for those menstruating or anemic). He appropriately suggests that vitamin D needs can be met with the serving of non-fat milk/yogurt allowed (not included in the vegan diet studied) and adequate sunlight (our bodies make vitamin D from sun exposure). He also recommends additional vitamin C consumption, either in food or supplement form, to enhance the absorption of iron provided in plant foods.

Concern #5: Decreased “Good” Cholesterol

A study published in the 2005 Journal of the American Medical Association showed that people who followed the Ornish diet had a decrease in their HDL (good) cholesterol after 2, 6, and 12 months of following the diet. This was especially concerning considering that the people who followed the Atkins diet (the polar opposite of the Ornish diet) had an increase in their HDL. Dr. Ornish does an excellent job at clarifying these confusing results and dispelling the idea that a meat and butter diet is good for your heart.

Turns out that HDL is good because it removes LDL (bad) cholesterol from the blood. When the levels of LDL are decreased, the body needs less HDL to do its job, and therefore, makes less of that too. In the aforementioned study, LDL was significantly decreased on the Ornish diet when compared to the Atkins diet. Think of LDL as a mess, and HDL like a maid. It would be great to have 6 maids to clean your house. But if you don’t have a big mess, why shell out the cash for 6 maids, when 2 can get the same job done.

Concern #6: No Portion Control & Low Fat Intake = Overeating and Weight Gain

It is hard to criticize a diet for its flaws in appropriate weight-loss strategies when the diet does not claim to be for weight loss. Therefore, if weight loss is your main objective, this may not be the diet for you. Fat makes us feel full and satisfied. Severely restricting fat can lead to frequent hunger and overeating. Dr. Ornish admits that this was a frequent complaint of his subjects.

He suggests that this can be overcome by not restricting portions of the “allowed” foods. Carbohydrates and protein provide less than half the calories per gram as fat, therefore, can be consumed in greater quantities while maintaining a constant calorie intake. This theory seems reasonable, but the numbers show otherwise. In the October 2007 issue of the Journal of the American Dietetic Association, a study was published that compared 10 popular diets. The Ornish diet, being the most restrictive in fat intake, was #4 when it came to the most calories consumed. Again, not the ideal situation for weight loss.

Concern #7: Longevity of Diet

Diets that eliminate entire food groups are often very hard to follow for an extended amount of time. This seems to hold true with the Ornish diet. In the same 2005 article from the Journal of the American Medical Association showing a decrease in HDL, this was made evident. Less than half of the participants on the Ornish diet remained in the study for a full 12 months.

Final Thought

Even though this diet has some shortcomings, I do not discredit the benefits shown in those who have followed this program. When followed properly, this diet can have very favorable results when it comes to heart health. For those solely looking to lose weight, the work this diet entails will not be worth your efforts.

Sources

http://www.webmd.com/diet/ornish-diet-what-it-is
http://www.everydiet.org/diet/ornish-diet
http://www.dietsinreview.com/diets/Ornish_Diet/
http://www.medicinenet.com/script/main/art.asp?articlekey=47141