REVERSING HEART DISEASE: Dean Ornish, M.D.

The Rice Paper: Healing Stories; Fall 1995; Editor: Luz Rodriguez Arpan

A three-year study conducted by a team of doctors led by Dean Ornish, M.D., has demonstrated that lifestyle changes can not only arrest but also actually reverse the ravages of heart disease. The main components of the program followed by study participants were a low-fat diet, stress management techniques and exercise.            

Patients with severe heart disease were randomly divided into two groups. One group followed Dr. Ornish's. program, while the patients in the other group were asked to follow their doctors' advice: to make some dietary changes (eat less red meat, more fish and chicken, margarine instead of butter, and no more than three eggs per week), to exercise moderately and to quit smoking. Both groups were tested at the beginning of the study and at yearly intervals for three years.

After only one year, the majority (82%) of the patients who followed Dr. Ornish's program showed some measurable average reversal of their coronary artery blockages. In contrast, the majority of the heart patients in the comparison group who were following their doctors' advice became measurably worse during the same interval. These results were confirmed by subsequent yearly testing. The study group continued to improve, the comparison group continued to worsen. On the basis of this data, Dr. Ornish concluded that ". . . for people who have heart disease, conventional recommendations for changing lifestyle may not go far enough."

At the core of the Ornish program for reversing heart disease is the diet followed by the patients in the study, which Dr. Ornish has named the Reversal Diet. The difference between this diet and the typical American Diet can be summarized as follows:

TYPICAL AMERICAN DIET

40% to 50% fat (mostly saturated)

25% to 35% carbohydrate

25% protein

400 to 500 milligrams cholesterol per day

REVERSAL DIET

10% fat (mostly polyunsaturated or monounsaturated)

70% to 75% carbohydrate

15% to 20% protein

5 milligrams cholesterol per day

In making this comparison, two things became clear. First, the Reversal Diet consists primarily of complex carbohydrates, also known as starches. Vegetarian foods in their natural form are primarily complex carbohydrates, for example, grains, beans, vegetables, fruits and so on. Complex carbohydrates are very filling. In contrast, simple carbohydrates such as alcohol, honey and sugar are "empty" calories - that is, calories without any nutritional value - so it's easy to eat a lot of calories without being aware of it.

Because of this principle, the Reversal Diet limits (but does not eliminate the use of sugar and alcohol. Sugar is not strongly linked with coronary heart disease; the real culprits are saturated fats and cholesterol, but sugar is often found in combination with foods that are high in saturated fat and cholesterol (i.e. cake, ice cream).

Second, the Reversal Diet has somewhat less protein than the typical American diet. All of us have been taught the importance of getting enough protein, often equating it with good nutrition. Dr. Ornish states, however, that in the United States, most people (rich or poor) eat too much protein - at least twice as much as they need. Too much protein, like too little protein, can be harmful. Animals that are fed high-protein diets die sooner than animals given the same number of calories but with less protein. Excess protein can lead to bone demineralization and osteoporosis. In animal studies, even a low-fat diet that is high in protein can promote the formation of coronary artery blockages.

Protein is formed from building blocks called amino acids. There twenty-two different kinds, of amino acids  which can combine to form billions of varieties of proteins. The human body can make thirteen of these protein building blocks, while the other nine must be supplied by the diet. Plant foods provide the same amino acids that animal foods do. The protein that comes from eating a T-bone steak is exactly the same quality as the protein that comes from a meal of rice and beans. But when you eat a steak, you're also consuming excessive fat and cholesterol.

Unlike animal products, no single plant source contains all of the essential amino acids, but amino acid requirements can be met by eating a variety of foods. A meal of rice and beans provides a complete protein, no different from the protein found in eggs or meat.

According to Dr. Ornish, you don't have to be a scientist or nutritionist to combine foods properly. His rule is: just eat any grains and any legumes sometime during the day. The ideal proportion is two-thirds grains and one-third legumes.

Here are some examples of a complete protein:

rice with beans *  tacos with beans

tofu with rice *  pasta a fagioli (pasta and beans)

Hopping John (black-eyed peas and rice)

Boston baked beans and brown bread

The Reversal Diet is vegetarian because cholesterol is only found animal products, including meats, poultry, fish, and dairy. Vegetarian foods are cholesterol free and, with rare exceptions, are low in saturated fat

What can you eat on the Reveral Diet? Here are some examples:

ANIMAL PRODUCTS

egg whites, non-fat milk or yogurt (1 cup per day)

WHOLE GRAINS

amaranth, barley, buckwheat, bulgur, corn, millet, oats, quinoa, rice, rye, sorghum, wheat.

LEGUMES

azuki beans, black beans, black-eyed peas, brown beans, chick-peas (garbanzos), Great Northern beans, kidney beans, lentils, mung beans, navy beans, peas, pinto beans, red Mexican beans, soybeans (includes miso, tempeh and tofu), split peas

VEGETABLES AND FRUITS

All vegetables and fruits except avacodos, coconuts and olives.

BEVERAGES

club soda, fruit juices (all kinds), grain coffees, herbal teas, mineral water, vegetable juices (all kinds)

No oils (except in very small quantities), nuts, seeds, chocolate or other cocoa products are permitted on the Reversal Diet.

This diet may seem restrictive to some, but as Dr. Ornish points out: "Halfway measures aren't enough to reverse coronary heart disease for the majority of people. Most of the people in the control groups of our research were eating a 30% fat 'low-fat, low-cholesterol' diet along the guidelines of the American Heart Association or National Cholesterol Education Project - less red meat, more fish, chicken with the skin removed, etc. - yet the majority of these patients got worse, not better."

For those who do not have heart disease but wish to prevent it, Dr. Ornish has one cardinal rule: keep your cholesterol level below 150. If your cholesterol level is above that, start restricting your daily fat intake by eliminating such high fat foods as meats, ice cream, butter, eggs, nuts, cheese and oils. Moderate dietary changes will be enough to bring cholesterol levels down for some people, whereas others will find that more comprehensive changes are required.

In addition to the Reversal Diet, the patients in the Ornish study also learned a variety of stress management techniques, meditation, visualization, and progressive relaxation practices. These techniques were included in the study because Dr. Ornish believes they address one of the fundamental problems, which predisposes an individual to illness - isolation from one's feelings and inner self.

Another personal difficulty addressed by the Ornish study was isolation from others as a root cause of stress leading to heart disease. In order to decrease isolation, the participants in the study formed a support group, which met twice a week. At these meetings group members were taught, communication skills and discussed their progress with the program as well as current problems.

Exercise was another lifestyle change made by the patients in the study. Walking was chosen as the preferred form of exercise because it provided health benefits along with the lowest risk of injury or sudden cardiac death. The study members were asked to walk for thirty minutes every day or for an hour every other day.

Because the Ornish study included so many lifestyle changes, it is impossible to assess the relative contribution of each component of the program. That is, it is unknown how much an individual's improvement was to the changes in diet, how much because of the stress management techniques, how much due to group support, and so on. Whatever the proportional merit of each factor, however, the end result is that the patients in the study reversed their condition and demonstrated that there viable alternatives to drugs and surgery in the battle against heart disease.

 This article was based on Dr. Ornish's Program for Reversing Heart Disease, New York: Random House, 1990. In his book Dr. Ornish states: "This program is an adjunct to, not a substitute for, conventional medical therapy. If you have a coronary heart disease or other health problems please consult your physician before beginning this program."

"The Rice Paper" wishes to thank Dr. Ornish for permission to use excerpts from his book.