Why Eat Plant-Based & Low Fat? Just Look at the Picture!
All that matters is what's happening inside of the the arteries.
The traditional intermediate risk-factors of cholesterol, weight-loss, blood pressure, HDL & LDL don't always tell the whole story--which is why promoters of the high-protein high-fat low-carbohydrate diets, like Atkins & Gary Taubes, think their (HPLC) diet works--while all along, unbeknownst to them, it promotes plaque & atherosclerosis.
If you're eating a diet that's high in animal protein, high in fat, and low in healthy carbs--your weight & lipid numbers might even be looking good--but your arteries are not!
The high-fat high-protein low-carbohydrate diets cannot produce the circulating endothelial progenitor cells (EPCs) that are needed to repair damaged blood vessel walls & improve endothelial function.
And the HPLC diet doubles the nonesterified fatty acids (NEFAs) which promote inflammation & atherosclerosis. If you think high-protein-low-carb is good--think again!
And it's all about what's going on inside of the arteries--not just the lipid numbers! A low-fat high-unrefined-carbohydrate diet increases those endothelial progenitator cells--and keeps the artery walls healthy, flexible, and atherosclerosis-resistant. Read more in the PNAS "Vascular effects of a low-carbohydrate high-protein diet"
Full disclosure: the graphic is from an animal model study.
--My paraphrasing of both Dr. Dean Ornish's comments on the graphic & Smith's N Engl J Med article--
If you received this post via email, click here to get to the web version with all the links.
What a week this has been! I've had a chance to hear Dr. Dean Ornish (twice), Dr. David Katz of Yale, Dr. Ezekiel Emanuel of NIH, and Dr. Joshual Sharfstein. All national healthcare experts--all saying the same thing--in four different ways:
Change Your Lifestyle & Change Your Health.
Our Western diet is killing us and our children.
This younger generation will likely be the first generation to not live as long as their parents.
93% of diabetes, 81% of heart disease, and 60% of cancer could vanish with diet, exercise, weight loss, smoking cessation.
When the Cleveland Clinic, the top hospital for cardiac care in the U.S., invites Dr. Dean Ornish to speak about reversing heart disease, diabetes, hypertension, and prostate cancer with low-tech lifestyle changes--you know that the no-oil plant-based Esselstyn-style diet is getting closer to going mainstream!
And on May 11, Dr. Caldwell Esselstyn, Jr. is also scheduled to speak at the Cleveland Clinic Wellness Grand Rounds! That comes right after his April 27th (this Wednesday) appearance on Dr. Oz's Show along with Dr. T. Colin Campbell and Dr. Neal Barnard. Click here for more info.
Looks like plant-based & low-fat is starting to seem commonplace these days. Dr. Neal Barnard--another plant-based disease-reversal pioneer--is currently speaking around the country, promoting his latest science-based book, too. Definitely one that I recommend. Wendy, at Healthy Girl's Kitchen heard him speak on Tuesday night and she does a terrific job of summarizing his lecture. Part l and Part II. Thank you, Wendy!
Sorry for the "non-commercial" interruption--now back to the post: Since most of you didn't have the chance to attend Dr. Ornish's lecture--here's what you would have heard....
Dr. Dean Ornish on the Power of Personalized Lifestyle Changes
For 34 years Ornish has been directing clinical trials proving that major lifestyle changes--without medications or procedures--can prevent or reverse heart disease, type 2 diabetes, hypertension, and early prostate cancer.
He's got the data and the high-tech measurements to back up his claims that a very low-fat vegetarian diet, along with exercise, stress reduction (meditation/yoga), & social support really work--and their effects are synergistic & additive.
The lecture hall was filled with health professionals & support staff.
Ornish Goes Mainstream with Medicare. Could this be a game-changer?
In August 2010, Medicare approved both the Ornish & Pritikin comprehensive lifestyle disease-reversal programs for reimbursement. As Ornish says, "If we can change reimbursement--we'll change the practice of medicine!" Reimbursement to prevent chronic diseases? Money well-spent.
So What Is the Ornish Approach?
Participants in Ornish's clinical trials always followed a very low-fat, vegetarian diet, closely bordering on vegan. That's what reversed their heart disease, type 2 diabetes, hypertension, and early prostate cancer. But he carefully side-stepped discussing the diet specifics in this lecture.
Maybe he was mum about the details of his diet because these days he doesn't want to scare people away by demanding that they follow a super strict low-fat vegetarian diet. And, he hates the word DIET!
Lately, he's offering more of a Spectrum of food choices--you choose how strict you want your diet to be--based on your health and your risk factors. To get the details, I had to go to his website. Click here
Here's the deal. When it comes to reversing heart disease--even Ornish says, you need to go mostly plant-based & very low fat. If you're healthy--and without risk factors or excess weight, you can be a little more indulgent.
But wait a second. I've read the research studies. I've heard Dr. Esselstyn speak. I've heard Dr. Steven Nissen speak--the head of Cardiovascular Medicine at the Cleveland Clinic. If you're eating a typical Western diet--you either have heart disease or you're on the way to getting it! Who's left?
Ornish Food Plan to Reverse Heart Disease
- Fat--No more than 10% of calories are from fat. This is achieved by not adding any fats, oils, seeds, nuts, avocados, coconut and olives to a mostly plant-based diet. The 10% of calories from fat comes from fat that occurs naturally in grains, vegetables, fruit, beans, legumes and soy foods.
- Cholesterol-- No more than 10 milligrams of cholesterol per day. To meet this goal, non-fat dairy products are limited to 2 servings per day. Non-fat dairy products are optional. Soy products can be used instead of dairy products because they are cholesterol free.
- Primarily Plant-Based--no meat, poultry, fish, or products made from these foods. Non-fat dairy foods (no more than 2 servings/day) and egg whites are included.
- Calories--Unrestricted unless weight loss is desired. Small frequent meals spread throughout the day help avoid hunger and keep energy levels constant. Portion control will assist in reaching and maintaining a healthy body weight and controlling blood sugar levels.
- Sugar--Permitted in moderation. No more than 2 servings/day including non-fat sweets. A serving is equivalent to 1 tablespoon or 12 grams of sugar.
Ornish's Spectrum of Food Choices
Heart Disease Reversal Sticks to the Bottom 2 Levels
Ornish's Spectrum Diet is based on one's health, genetics, and risk factors. If you've got risk factors or health problems--you're on the strictest plan. Young & healthy--he's a little more lenient.
"The Spectrum has no rules, no forbidden foods, no guilt -- just a blueprint for determining where you fall on the continuum, and encouragement to make healthful changes.
What matters most is your overall way of eating. I am not saying that you should never consume foods from Group 5-the top of the pyramid (unless you have a serious health condition). If you indulge yourself one day by eating foods from Group 4 or 5, spend a little more time in Groups 1 and 2 the next day.
If you get on a diet, chances are you’ll get off a diet. Sooner or later. For most people, being on a diet—any diet—is not sustainable."
But the further you move toward the healthier end, the more likely you are to look and feel better.
Bottom-line: It's a DOSE RESPONSE RELATIONSHIP! The better your program/diet adherence--the better your health!
Look, I understand Ornish's soft-pedal approach--but, I prefer the Esselstyn's "Just Stick to the Program 100%" approach. Why fool around with half measures? Give me too much leeway--and I'm sliding down that slippery slope!
If you commit yourself to just follow the program (Esselstyn or Ornish) 100% for one month--you'll lose weight, you'll feel great, your energy will improve, and you'll be motivated to continue. With half-measures you just aren't going to see the same results!
Program Basics--click here for the details:
- Diet: mostly vegetarian, no added oil, no nuts, no-fat dairy & egg whites are allowed, whole grains, fruit, vegetables, beans & legumes. But, Ornish, also offers a Spectrum (as his book is called) of choices for people who are healthy, or aren't quite ready to follow a super strict diet--including small amounts of "safe" fish, like wild salmon.
- Exercise: at least thirty minutes a day--but Ornish will forgive you if you skip a day or do less. Click here for details.
- Meditation/Stress reduction Click here for program details. Don't have 20 minutes to meditate? Try it for 5 minutes.
- The Importance of Social networks/close relationships: depression & loneliness impair health. Group support is needed to sustain lifestyle changes. Click here for details.
In Ornish's experience, all these elements are key to preventing & reversing disease. The body has a remarkable power to heal itself with diet and exercise, but stress, depression, and loneliness all have powerful negative effects on health. Depression increases mortality by 3 to 10 times.
The Fear Factor Fails - What Motivates Us to Change?
Ornish's viewpoint: No one makes long-lasting lifestyle changes based on the fear of a future disease. That's why he says only 30-40% of people stay on statins. But, what about me? Fear worked for me. I made major lifestyle changes after seeing my parents suffering after ischemic strokes.
According to Ornish, no one is thrilled to stay on statins, diabetes or blood pressure meds for the rest of their lives--in the hopes that they'll avoid a future heart attack or stroke. And let's face it, these drugs usually don't do a thing to make us feel better, look better, feel happier, or lose weight. And all drugs come with side effects.
Ornish's favorite cartoon is of men madly mopping up a wet floor without bothering to turn off the running faucet that's making the sink overflow. Change your diet, start to exercise, find a way to reduce stress--and it's like turning off the faucet--actually treating the causes of disease.
After 34 years in the diet-exercise-meditation-disease-reversal business, Ornish has figured out what motivates people to make serious lifestyle changes. He knows that information alone isn't sufficient to get people to change.
Joy (from feeling healthy), freedom (to choose the changes), & pleasure (from real food & good health) are the real hooks that get people to make changes--and to continue on with them.
No one wants to give up something they like (cheeseburgers & ice-cream)--if there's no pay back--and if it doesn't come quickly!
It's only when you start to see positive changes in your body, like weight loss, energy, reduced pain, less stress, and you're able to cut your meds--that you realize your health is in your own hands. Just ask these folks who are following Dr. Esselstyn's diet, or my friend Neal.
Creating guilt, fear, threats of non-compliance, or being told, "Do this--or else!"--usually backfire.
The Joy & Pleasure Pay-Offs:
- Benefits of Exercise. Walking 3 hours a week helps to grow brain cells--it's called neurogenesis, baby! Within 3 months of exercise the brain's size actually increases. Read more here.
- Benefits of Meditation. Within 8 weeks of starting to meditate, stress is reduced, cortisol levels drop (the stress hormone), pain lessens, nitric oxide increases (you heard right), the genes responsible for stress & aging are down-regulated, and oxidative stress is also reduced. Stay tuned for an upcoming post on the benefits of meditation.
- How You Look. Your skin improves because a plant-based diet along with exercise increases blood flow & slows aging.
- Sex Life. As your sexual organs get more blood flow--sexual function improves--and erectile function improves.
- Heart Health. As the heart gets more blood--heart disease is reduced--perfusion improves.
- It's All Good. You feel better, you look better, you think better, your energy improves---and because you see change quickly--you're motivated to continue. Convinced?
So how hard is it to make these lifestyle big changes?
Here's how Ornish explains it. He asked the lecture hall audience a couple of questions.
"How many of you have one child?" Lots of hands go up.
"Did your life change?" Lots of nods & chuckles.
"And how many of you had a second one?" Lots of hands go up.
"Did you forget how much your life changed?" Lots of laughter.
You can change your lifestyle, and it will bring joy & pleasure. You do get used to it! I did.
Our palates are malleable. Notice how people easily change from drinking whole milk to skim milk to almond/soy/rice milk? And if you grow up eating healthy foods, you prefer them.
Just Show Me the Evidence
I'm all about the research data. Did I hear anything new from Dr. Ornish? Not really--and if you're a long-time blog reader you've already heard most of this. But, it still motivates & inspires me to to hear it again. It helps me to stay the course!
One Patient's Experience--one year after starting the Ornish program
Dr. Ornish assured us that this man's experience wasn't anything exceptional--but the norm.
- After 7 weeks his angina disappeared
- Lost 50 pounds in one year
- His ejection fraction went from 46% to 61%, into the normal range.
- Triglycerides went from 819 (?? not sure if I got this one right) to 93
- Total cholesterol went from 243 to 110
- HDLs went from 27 to 38
- PSA went down
- No longer using a cane or the (humiliating) wheelchair he needed to use at Walmart
- Off the diabetes medications
- His total medication use was reduced by 75%
- No longer gets chest pains just walking to the mail box
- He now rides his stationary bike 8-10 miles a day & walks 2 miles a day
- The best part of the program? Improvements in his quality-of-life. His fear of dying has been replaced with the joy of living.
Ornish's Pearl: The most adherent patients see the most improvements
The red squares on the left represent the prostate cancer genes. After 3 months of lifestyle interventons, they were down-regulated, showing up as green.
This prostate cancer study demonstrated how our lifestyle choices can literally change our genes.
Ornish recruited 30 men with low-risk prostate cancer tumors, and for 3 months put them on a low-fat (10%) plant-based diet, had them exercise for 30 minutes a day--6 days a week, and participate in stress management sessions with yoga, stretching, and meditation for 60 minutes a day.
Before the intervention, their cancer genes are red--three months later, the cancer genes are turned off, and show green. The men literally "turned off" the RAS family of genes--these are the ones that promote the growth of breast, colon and prostate cancer.
Yes, they turned off cancer genes with lifestyle changes.
And it gets even better--the also "turned on" the GSTM-1 genes--the protein-producing genes that cause breast, colon, and prostate cancer cells to commit suicide.
They turned off the genes that promote cancer--and turned on the genes that promote its death.
Additional changes seen in Ornish's prostate cancer study participants:
- 70% of cancer tumor progression was stopped or reversed in the group who followed a plant-based diet, exercised, & meditated or practiced yoga for stress relief.
- PSAs were reduced
- Dose-response relationship--the men who were the most compliant achieved the most beneficial effects.
- 30% increase in telomere length--a measure of longevity. After only 3 months, 24 out of 30 men showed significant increases in their telomerase levels. Click here to read about the study. No drug is able to achieve this effect. (my note: omega-3s however, do! click here)
Emerging Consensus of What to Eat--According to Ornish
- Mostly plant-based--but Ornish does includes no-fat dairy & egg whites
- Calories do count (nuts, seeds, avocados are all high in calories!)
- Ornish now recommends fish oil--4 grams/a day or the equivalent--a new addition to his plan. He thinks fish oil is better than eating fish, because right now there are no "safe" fish, and when the oil is removed, it can be molecularly distilled to remove any mercury or PCBs. If you do eat fish--choose wild salmon.
- Organic produce is better
- Reduce fat. Total fat does matter. It promotes inflammation and atherosclerosis. For heart disease reversal, limit fat to 10% or less of calories.
- Reduce sugar & refined carbohydrates
- Increase fiber--it will fill you up. Move from bad carbohydrates to the good carbohydrates to prevent chronic insulin surges. Refined carbs accelerate the conversion of calories into fat & promote chronic inflammation.
- Forget about olive oil! And by the way--the Lyon Study used canola oil--not olive oil--and that's the study everyone cites to promote the benefits of olive oil. They used canola because they couldn't disguise the taste of olive oil. Read more about the negatives of olive oil here.
- Reduce sodium.
- According to Ornish, although there have been multiple studies on the health benefits of nuts--whether or not they are beneficial for heart patients will require more study!
- When it comes to calcium, there's a balance between intake & excretion. Too much animal protein causes calcium excretion.
Why Lifestyle Improvements Save Money & Trump Procedures & Pharmaceuticals
- Participants in Ornish's programs reduce their LDL by 40% without the use of statins--with none of the side effects of statins.
- The EPIC Healthy Living Study showed that 93% of type 2 diabetes & 81% of myocardial infarctions can be prevented through lifestyle changes. Click here.
- 75% of our $2.5 trillion "sick care" costs are due to chronic diseases that are preventable. Read more here: Dr. Michael Roizen's Straight Talk About Chronic Disease - Lifestyle Changes Can Control Them and Bring Health Care Costs Down. Roizen's Thirteen Pearls of Wellness.
- Angioplasties & bypasses don't prolong life--diet does. They will get you out of a crisis or stop angina. Read the COURAGE Trial results here.
The Ornish Program Approved for Medicare in August 2010
Getting Medicare approval for any new program, procedure, or diagnostic tool is tough. It took Ornish 7 years to finally get approval for his program.
Bottom Line: Ornish's program saves money! On average, his patients lose 20 pounds, improve their quality of life, get their blood pressure back to normal without drugs, lower their cholesterol, and get off of diabetes medications--while helping to prevent future coronary events.
According to Ornish, getting Medicare on board with prevention & reimbursing for lifestyle changes is a major step in changing the practice of medicine.