Will the Ornish Diet Help You?

This very low fat diet has the potential to prevent or even reverse heart disease, and may improve other health conditions, too.

The Ornish Diet is referred to as a lifestyle intervention program, meaning it’s not just about food. The combined positive effect of good nutrition, stress management, moderate exercise, and social support are the foundations of the program started by Dean Ornish, MD, clinical professor of medicine at the University of California, San Francisco. Wondering what would happen if people addressed the underlying factors of heart disease rather than bypassing the problem (literally and figuratively) with drugs and surgery, Ornish began his research in 1977 while in medical school. 

In 1984 Ornish founded the non-profit Preventive Medicine Research Institute (PMRI) in Sausalito, Calif. Ornish and his colleagues at PMRI, in collaboration with the University of California, San Francisco, and other academic institutions have conducted a series of studies designed to show how improvements in diet and lifestyle can have a significant positive effect in a relatively short amount of time.

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Nutritionally, Ornish advocates achieving health by what he calls the Spectrum approach. He says that going on a diet implies that at some point you are going to go off a diet. “In contrast, the Spectrum approach is all about freedom and choice. There is no diet to get on and no diet to get off. Nothing is forbidden,” it states on his website.

Ornish has categorized food into a spectrum ranging from the most healthful (Group 1) to the least healthful (Group 5). How much you eat from each group depends on your goals. If you are in good health and trying to stay that way, you may not need to make many changes. However, if you are trying to reverse heart disease, you will likely need to make much more significant changes.

In his 2007 book “The Spectrum,” and on his website, Ornish lays out the foods in each group. You are directed to find your place on the Spectrum based on how you currently eat most of the time. “Then, according to your own needs and preferences, decide how far, and how quickly, you want to move in a more healthful direction,” he states. In general, the farther and faster you move toward the Group 1 end of the spectrum, the more benefits you’ll see and the faster they will happen.

Groups 1 and 2 are completely vegetarian but allow egg whites and low-fat dairy products. There is also virtually no fat in Group 1 with the exception of fish oil supplements and non-stick cooking spray. On the other hand, calories are unrestricted unless you’re trying to lose weight, and then you are advised to use portion control to achieve your goals.

The diet emphasizes eating organic, locally sourced, whole foods, “as close as possible to their original state.” Ornish has created an eight-level food pyramid as a guide:

1. The foundation of the diet is vegetables and unrefined whole grains “in abundance”
2. Unprocessed fruits and legumes, including soy, also in abundance
3. Nuts, avocadoes, and plant oils; canola is preferred to olive oil because of its higher omega-3 fatty acid content
4. Egg whites and fish, particularly those high in omega-3s (salmon, mackerel, halibut)
5. Non-fat dairy or calcium supplements
6. Sugar, refined carbohydrates, and occasionally alcohol
7. Lean poultry
8. Red meat, butter, and trans-fatty acids; everything at this level should be avoided

The first two levels of the pyramid, with the addition of 1 to 2 servings per day of egg whites and non-fat dairy products, characterize the stricter version of the Ornish diet, which is meant for people wanting to reverse heart disease. Healthy people who want to prevent disease or achieve and maintain weight loss can add the upper layers of the pyramid.

One of the criticisms of this diet is that it may be hard to stick to over time. However, if you have heart disease that may lead to poor quality of life, dependence on drugs, possible surgery, or even death, the more restrictive version of this diet may be an attractive alternative.

Additionally, a diet made up primarily of fresh fruits and vegetables, legumes (beans, peas, lentils, and soy), and whole grains provides nutrition rich in healthy carbohydrates, protein, fiber, vitamins, minerals, and “an immense variety of disease fighting chemicals found only in plant foods (phytochemicals).”

In addition to making better food choices, Ornish advocates regular, moderate exercise, stress management and reduction, and a supportive environment of family and friends. All of these interventions have been shown to improve risk factors that can lead to disease.

Ornish’s research over more than 30 years has demonstrated these approaches to be effective. However, the diet is not without controversy. Some critics argue that the diet is too dependent on carbohydrates, and recently carbs have come under fire for their role in obesity and type 2 diabetes. However, the carbs that contribute to these diseases tend to be from products made with refined grains, and those containing high amounts of sugar, not the complex carbs advocated in Ornish’s diet.

Another criticism is that numerous studies have shown that other types of diets, for example, low carbohydrate and Mediterranean, have also been effective at improving cholesterol profiles and glycemic control. Other studies have shown little difference in outcomes when comparing several types of diets, including Ornish.

For people who have a significant amount of weight to lose, a critical component of a successful weight-loss program is support and intensive nutritional counseling. One benefit of the Dr. Dean Ornish Program for Reversing Heart Disease is this kind of support. The program consists of 18 four-hour sessions with a small group of people who all have the goal of reversing heart disease. According to the site, it’s the first integrative lifestyle program for reversing heart disease and other chronic conditions that is covered by Medicare. It is also covered by a number of private insurers. However, it isn’t widely available.

If you have heart disease or are at risk for developing it, the Ornish program may be worth a look. If you have health concerns, consult with your doctor about the best diet and lifestyle modifications for your specific needs. If you are serious about improving your health, making a commitment to a good diet a healthy lifestyle may be all that’s required.