Wednesday, November 9, 2011

The Dean Ornish Program; Does It Really Work?

The other day I was getting ready to leave work and I noticed a guy looking at the pamphlets and handouts on my desk. Whenever I see customers looking at the information on my desk I go up and introduce myself. The man asked if I could help him find foods that were less than 10% fat. Right away I thought he was referring to the Daily Value (10% of the Daily Value for fat), and I thought "this will be easy....". I soon realized he meant less than 10% of the total calories. Yikes. That's difficult. I soon found out this man was following the Dean Ornish program.

When following this program the key is to look at the calories from fat (listed next to the total calories), and make sure they are 10% or less of the total calories. Obviously high fat foods, such as the almonds below, would not make the cut (150 total calories, 120 from fat, so almost 100% of the calories in these almonds are from fat.)

Nut, legume, and seed butters such as the soy butter below would not make the cut either.

What about a popcorn snack that is given a name that signifies "health", such as the popcorn snack below (sorry, can't give brand names on my blog, boo)? The total calories is 120, but the calories from fat is 20, which is almost 20%. Failure. On this diet you'd have to pop your own popcorn, with very little oil.

And what about fish? The fish below is orange roughy, which is a lighter white fish. Sadly the calories from fat make up more than 10% of the total calories, so this is out too.

What about this sports bar, below? Nope, too much fat.

And you better believe that salad dressings are not allowed, unless they are fat free (fat free and also loaded with sugar and sodium......).

Have we finally found something we can eat? I think so! Cereal. The calories from fat are about 5%, so this is allowed.

You can read more about the Dean Ornish Program here (source: WHFoods) and here (source: WebMD). Dean Ornish's website does provide a very detailed list of the foods you can eat on this plan, which is helpful (it includes hummus made without oil or tahini. Yuck).

In short, these are the foods to emphasize and avoid on this program (source);

Individuals following the Ornish Program are encouraged to eat whole grains, vegetables, fruits, legumes, and soybean products in unlimited quantities.

Individuals following the Ornish Program must avoid all meat and dairy products, except egg whites, nonfat milk, and nonfat yogurt. To adhere to the strict limitation on dietary fat intake, individuals on the Ornish diet must restrict the consumption of plant foods that contain high amounts of fat, including all vegetable oils, nuts, seeds and avocados. All caffeinated beverages must be eliminated, and the consumption of alcoholic beverages is discouraged.

His website provides a food pyramid that is very helpful, and it indicates that fish such as salmon and mackerel are allowed on occasion, as well as healthy oils, nuts, and flaxseed. So lots of grains and fresh fruits and veggies, and a few almonds, every now and then.

If you check out his website you will see he does provide some of his clinical research. I find it strange, however, that he only provides one heart disease study, and it's weak, at best. There weren't many people in the study, most of them were males, and the control group (the group not following the plan) was simply asked to follow the recommendations of their doctor (why not an RD? The control group should at least be somewhat realistic). The results of the experimental group's labs and cardiac events were compared to the control group at 1 and 5 years. There was a "greater improvement with the experimental group as compared with the control group". Well, no crap! This study would have been much more valid had he added a third group; a "high fat" group, or a "high protein" group. If the Dean Ornish (experimental) group had done better after 5 years compared to a control, a high fat, and a high protein group, then perhaps this study would have effectively convinced me of the benefits of this program.

I'm sure there is other evidence to support this (although I could not find it, in regards to heart health), but what about evidence that suggests that carbohydrates are really what's making us so unhealthy? According to the book Good Calories, Bad Calories carbohydrates are mainly to blame for the obesity epidemic. Gary Taubes, the author of this book, provides pages and pages of research that suggests carbohydrates are mainly to blame for obesity, diabetes, heart disease, and some other chronic diseases. In his book, he writes;

On a diet of 10% fat, two out of every three men will have small, dense LDL and, as a result, a predicted threefold higher risk of heart disease. The same pattern holds true in women and in children, but the percentages with small, dense LDL are lower. Some research suggests that the more saturated fat in the diet, the larger and fluffier the LDL-a beneficial effect.

Did you know that when you get labs from your doctor, which indicate your LDL levels ("bad cholesterol") it's really just telling you how much cholesterol is packed into your LDL particles? More and more research is saying that the better test is one that measures the size of your LDL particles. Smaller and more dense LDL seems to be worse than larger and fluffier LDL.

And what about the Mediterranean diet? This diet has been shown over and over again to have a beneficial effect on heart health, and it's 25-35% fat. Enough said.

Who is to say that the intense restrictions of the Dean Ornish plan aren't what really makes the person following the plan "healthier"? You can't really eat out at restaurants, and you can't eat at other people's house for dinner (or any other meal) without being a major burden. You are restricted from the gravitational pull that is our "unhealthy eating environment". You are shielded from society's ability to grab your appetite and rouse it all day long with food photos and smells and noises. While you still may see those pictures and hear those noises and smell those smells, you can't have them, so they don't really effect you (and if they do effect you still, you probably won't be able to follow this plan for too long).

I'm not saying that I disagree with the Dean Ornish program, but to me it just sounds like another strict diet plan that "works" because you end up eating less crap and you have less food from which to choose (read Lauren's post about "Boring Yourself Thin") If you make anyone actually stop and think about every single thing they put in their mouth (such as with this diet) they are going to most likely eat healthier. The man I was talking to at work left with a cart full of brown rice, figs, and canned beans. As this man said, "these are my staple foods, because most everything else has too much fat".

QUESTION: Have you read about Dean Ornish? What are your thoughts?

The Chicago Tribune recently published this great article about fat. Check it out if you're unsure about good vs. bad fats, and their sources.


  1. While I respect Dean Ornish I had never heard the details of his plan. this is funny considering I look into all plans clients list as previous diets. This seems a good way to cut calories but haven't we learned about fat free diets? Blech unsatisfying, sugar-full and I would think short lived.

  2. I'm sure Dean Ornish has good intentions...and I have had a client on this diet when she was waiting to have gall bladder surgery (if she ate fat, she had a gall bladder "attack")....but I'd be a little worried about someone being on this long term.
    Fat makes up our cell's our primary source of fuel for daily activities (unless we train our bodies to use glucose...and then we've also trained our insulin production into overdrive). It also plays roles in hormone balance---I used to try and "clean" my diet as much as possible (for health reasons) that led to eat less fat and more produce. The funny health problems got worse over 3 years, and when I finally adopted a more traditional diet (with higher fat intake) health issues went away. Not saying everyone would have the same experience...I do believe we all have different needs.
    So I don't know if it's "bad" either...but I probably wouldn't recommend it to anyone!

  3. Thanks for sharing this. I have never heard about the Dean Ornsih plan but it sounds pretty awful to be honest. I don't know if I could deal with that much restriction in my diet and I generally have pretty strong willpower when I want to.

    I think a big problem with this would be eating things that aren't pre-packaged foods with labels that tell you the nutrition facts. How would you even know what the % of fat is? You'd have to do some research...something that I wouldn't want to do every time I picked up my fork to eat.

  4. I have borderline high LDL levels - it's genetic because I eat a very healthy diet.

    I don't think I would like such a restrictive diet though. I am trying to eat even healthier than before my latest cholesterol screening and see what kind of difference it makes.

  5. I think the Dean Ornish program is good for short-time periods to help people get their cholesterol levels in check and to drive them to start consciously thinking about what they put in their body. From there, they can be more lenient, but still keep that awareness when choosing food items. Definitely not something I'd want to do in the long run (um, not nut butter!?), but Ornish has helped a lot of people.

  6. i really do not think i could get by without things like nut butter or fatty fish !

  7. The first time I heard about the Ornish Diet was a few days ago via Yahoo's homepage in an article titled "Best diets for healthy eating". Based on the scorecard, the lowest score it received was 2 stars out of 5 because it is hard to follow and it is not a cheap diet (food-wise). I agree it seems very restrictive but it's effective on a short term basis. Anyway, I loved this post because it provided insight into what a Supermarket Dietician does. Your client came to you with a 'diet regime' in mind and sought your help in the food selection process. I'm intrigued by that fact. Where I'm from most dietician's are primarily clinical with few being community based.

  8. I haven't heard about that diet but it sounds rediculous to me. I don't know what's the rational for that, but fat is not bad at all.
    I think you said once before, if you just put anyone in any kind of diet, either low fat, low carb, low protein, the fact that you're limiting its food choices, he/she will lose weight no matter what type of diet you follow. You're absolutely right Gina!

  9. I haven't heard about that diet but it sounds rediculous to me. I don't know what's the rational for that, but fat is not bad at all.
    I think you said once before, if you just put anyone in any kind of diet, either low fat, low carb, low protein, the fact that you're limiting its food choices, he/she will lose weight no matter what type of diet you follow. You're absolutely right Gina!

  10. Wow, that's a VERY low amount of fat. I try to limit the fat I eat to less than 20%, but that's of everything I am eating at the time so if I have salmon with some rice, it usually balances out. I only do this because my stomach does not handle fat well and I was told by my doctor AROUND 20% or less is a good thing to aim for- by no means do I analyze everything but if I am trying a new snack with nutrition info on it I'll glance and just ballpark it.

    I really only do this for my stomach and don't think it's part of an overall "healthy" diet. I think someone who eats healthy fish and olive oil is probably significantly healthier than some of the crap you can find thats 10% or less of fat. Like you said, probably the biggest difference is in their overall change in unhealthy habits like eating out frequently.

  11. This is the doctor from Forks over Knives, right? I loved the movie, but have heard critiques of it since I saw it...the fat issue is the main one.

    I'm personally a huge fan of healthy fats, but I have heard that a major alternative treatment for cancer is calorie restriction...maybe the minimization of fat is really a way to minimize calories without feeling as deprived? And reducing calories is sometimes a problem for people with heart disease...

    Interesting write up!

  12. Hi Gina!

    My dad was actually a subject in one of the Dean Ornish studies. He followed the Dean Ornish program religious for a year I believe it was. The program also is a lot more than just the food portion of it... exercise is a huge part as well as stress relief -- in the program he did, they focused on yoga.

    Anyway, when my dad went in for a recatherization, he did not need to be stented and of course this made himself and his doctors very proud.

    Now that he's not an official "subject" anymore, he has incorporated some healthy fat fish into his diet. He still avoids meat and drinks soy milk instead of cows. I even have seen him eat a cookie since being in the study, but that's a rare occasion.

    Just wanted to give you a success story in your comments!

  13. oh where to start! love your posts as always. So heard of it yes, I described it in my Obesity and Weight Mgmt class... I don't think diets are bad ideas but they always eliminate foods somehow- their purpose right?! I don't think that anyone that "needs" to lose weight and "go on a diet" should focus their energy on eliminating foods or focusing on < 10% fat because as you so nicely point out - salmon, almonds, fish -- these are healthy foods that are rarely allowed if at all!

    It does help encourage an individual to pay attention to a label, calculate, think about what they are eating and keep faith that <10% fat will work.

    I also discussed the importance of small LDL vs. just more LDL and put that as a test question. Most of them got it wrong - RD's no less - I think it is because the main focus has been high or low in terms of cholesterol... not small vs big so great job on that!

    thirsty thursday

  14. I remember reading about the Dean Ornish diet about 10 years ago. It seemed quite restrictive to me back then. Also, with all the research about carbohydrates and fats, I'm not so sure that restricting fat that much is the answer or is healthy. I also agree with you that when you put so many foods off limits, those who follow the diet will be successful because there isn't really much to eat and they have to totally change how, where and what they eat. I wonder how many people stay on it long term...

  15. great post gina and very informative! i just think it is too long in fat and like you said you probably end up eating too much sugar if you choose fat free items. have a great day!

  16. What a great post Gina! I'm definitely familiar with The Dean Ornish diet, and I have heard reports of success, however, like said that could be because of many different factors (switching to a healthier diet, calorie restriction, cutting out processed foods, etc.). So much more research, I agree, on the health benefits of a Mediterranean diet, and SO much more pleasurable to follow too!

  17. I hate to see that so many people think a low-fat heart-healthy diet like Ornish's has to be "restrictive" and tasteless. Quite the contrary! I've opened my horizons to SO MANY new foods since starting a plant-based diet several years ago. I don't worry too much about fats as long as my total cholesterol stays under 150 and I'm getting them mostly from whole-food sources. (I'm also young and have never had heart disease, although I did have a total cholesterol of 260 before I went plant-based.) You should check out the Engine2 Diet--here's their facebook page:
    They have a big community of low-fat plant-based eaters who are loving what they eat and how they feel.

  18. Hi Gina,
    Great job as usual; keep up the good work! Hope all is well.

    Warm regards,

  19. I thought you could eat all the 100% whole wheat bread you want on Dean's diet? How is that restrictive? I understand no fat, but there are no calories to count, therefore allowing you to eat all the bread you want. Please tell me that all that bread is bad for you, because I can live without all the fat, but I think I am addicted to bread.