In the 1970s, Nathan Pritikin created the ultra-low-fat Pritikin diet based on unprocessed
or minimally processed straight-from-nature foods like fruits, vegetables,
and legumes. Dean Ornish and Caldwell Esselstyn, Jr. are among the physicians
who have conducted pioneering and careful clinical trials of similar diets that demonstrated that a lifestyle intervention based on diet could usually halt the progression of coronary heart disease and even reverse it.

The Ornish program lifestyle modifications include:
• Whole-foods, plant-based diet (naturally low in fat and sugar)
• Stress management techniques (including yoga and meditation)
• Moderate exercise (such as walking)
• Social support and community (love and intimacy)

The ULF diet that Ornish and Esselstyn and others advocate features “beans and
greens.” It limits fat intake to 10% to 15% of total calories, avoids saturated and
trans-fats, meat, oils, refined grains and refined grain products, minimizes non-fat
dairy or eliminates dairy, eliminates added sugars, seafood (in some versions), and
most processed foods—typically they are high in added fat, sugar and salt.
The diet consists mainly of natural unrefined plant-based foods, including fruits, vegetables,
legumes, whole grains, soy, and cereals. Their whole-food plant-based diet is high
in fiber and low in rapidly absorbed added sugars, so it has a low glycemic index.

Ornish emphasizes that a very-low-fat diet that is high in refined carbohydrates like
sugar, white flour, white rice, and pasta, increases harmful LDL-C and triglycerides
and that replacing fat in the diet with “low-fat” foods that are high in sugar and other
refined carbohydrates will not decrease and may increase cardiovascular risk.

Beginning in 1977, Ornish studied patients with heart disease and symptoms like
angina and coronary artery disease that was documented by angiograms. As described
in his book The Spectrum, the participants who adopted his program had
more than a 90% reduction in the frequency of angina after a few weeks, on average
a 40% reduction in LDL-C, and improved blood flow to the heart as shown by quantitative coronary arteriography and heart muscle perfusion studies with positron emission tomography (PET scans). A follow-up study of Ornish’s Lifestyle
Heart Trial published in the JAMA showed that after five years, there was more
regression of coronary atherosclerosis in the experimental treatment group but a
continuing progression of coronary disease in the control group.

A study among coronary heart disease patients who were eligible for revascularization
found that nearly 80% of the patients who chose the Ornish program were
able to avoid surgery.263 A similar larger study found that after 12 weeks on the
Ornish program, average LDL-C decreased by 17.6%, total cholesterol by 14.9%,
triglycerides by 10.6%, BMI by 6.6%, and functional exercise capacity as measured
by METs (metabolic equivalents) improved by 22.2%. According to Ornish,
“Over and over, I’ve seen patients with coronary heart disease so severe that
they can’t walk across the street or work or play with their kids or make love or do
much of anything without getting severe chest pain become pain-free after only a
few weeks of making these diet and lifestyle changes.”

Some observers of the Ornish program are somewhat skeptical of the impact of the
stringent diet requirements because exercise and stress management are also a feature
of the program. Ornish has evaluated the relative impact of each of the features
of his program, diet, stress management, and exercise. His study found that
reduced dietary fat intake was the only predictor related to lower LDL-C, and that
management of stress was related to a decrease in triglycerides and total cholesterol.
Ornish stated that “I’m not aware of any studies showing that walking and stress
management techniques alone can reverse heart disease.”

This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel.