Dr. Dean Ornish's Program for Reversing Heart Disease: The Only System Scientifically Proven to Reverse Heart Disease Without Drugs or Surgery

For the past 24 years, the non-profit Preventive Medicine Research Institute and the University of California, San Francisco, School of Medicine have conducted research scientifically proving, for the first time, that the progression of even severe coronary heart disease can begin to reverse by making comprehensive changes in diet and lifestyle, without drugs or surgery. These studies have been published in leading peer-reviewed journals such as the Journal of the AMA, The Lancet, the American Journal of Cardiology, New England Journal of Medicine, Circulation, and others.

Mr. Bayan alleges that the diet we have proven to be so beneficial is "dangerous" for some patients because both HDL and LDL may decrease and triglycerides may increase. HDL and triglycerides are only potential risk factors for heart disease, they are not diseases. When we measured the actual severity of heart disease using state-of-the-art measures such as computer-analyzed coronary arteriography and cardiac PET scans, patients showed continued improvement over time, even in patients like Mr. Bayan whose HDL decreased or triglycerides increased. Also, cardiac events were 2.5 times lower in the group who followed the program compared to the control group who made more moderate changes in diet (30% fat, 200 mg cholesterol). [reference: JAMA. 1998;280:2001-2007.] Clearly, lowering HDL by changing diet did not harm these patients. LDL cholesterol decreased by an average of almost 40% during the first year, and none of the patients who adhered to the diet showed an increase in LDL.

As Dr. Connor wrote in the New England Journal of Medicine, "There are no data showing that the physiologic reduction of HDL cholesterol levels with a low-fat diet is detrimental. Diet-induced lowering of HDL cholesterol does not confer the same risk of atherosclerosis as do low HDL cholesterol levels in Americans consuming a high-fat diet." [ref: N Engl J Med. 1997;337(8).]

It is true that one can eat an unhealthful low-fat diet if it is high in simple carbohydrates such as sugar, white flour, alcohol, and many popular fat-free desserts. Such a diet may cause a shift to the more harmful pattern B LDL subclass that Mr. Bayan mentions.

But this is not the diet we recommend for reversing heart disease. Other studies have shown that a diet high in fruits, vegetables, grains, beans, and other complex carbohydrates (which is the diet we recommend) actually cause a shift AWAY from the pattern B LDL subclass to more beneficial patterns [ref: Kenney JJ, et al. Very-low-fat diets do not necessarily promote small, dense LDL particles. American Journal of Clinical Nutrition. 1999;70(3):423-5.]

Patients whose triglycerides increase are counseled to be even more mindful in reducing their intake of simple carbohydrates and increasing their exercise. Also, for many years we have recommended that patients take 3 grams/day of fish oil, which also helps to lower triglycerides. In the Multicenter Lifestyle Demonstration Project, we found that triglyceride levels, which initially increased slightly but not significantly, then fell significantly in years two and three. [ref: American Journal of Cardiology. 1998;82:72T-76T.] Almost 80% of people who were eligible for bypass surgery or angioplasty were able to safely avoid it by making these diet and lifestyle changes instead.

We respect the work of Dr. Robert Superko and often refer patients to his lipid laboratory for testing. Again, we have found that patients with small dense LDL also show reversal of heart disease on the program recommend.

The program that we recommend includes a reversal diet for those with heart disease and the prevention diet for others. The prevention diet may be higher in fat and cholesterol than the reversal diet and is tailored to the needs of the individual rather than offering one diet for everyone. The prevention diet may include some oils, fish and other animal products for some people.

Switching from saturated fats to monosaturated fats is better, but for reversing heart disease or lowering cholesterol it is better to avoid all oils other than fish oils. Olive oil is 100% total fat and 14% saturated fat. The more olive oil you consume, the more saturated fat you consume, the higher your plasma cholesterol. The studies showing that olive oil lowers cholesterol are only when substituted in equal amounts for butter or oils that are higher in saturated fat. Also, olive oil has almost none of the beneficial omega-3 fatty acids.

The bottom line is this: patients in our studies with severe heart disease reported a 91% reduction in angina (chest pain) within one month, and most became pain-free. They not only felt better, they were better. We measured improved blood flow within one month as measured by thallium scans and radionuclide ventriculograms, reversal of coronary artery blockages (atherosclerosis) within one year, even more reversal after five years, and 2.5 times fewer cardiac events (e.g., heart attacks). It works.


I like the program but I'm concerned and confused.   March 29, 2001
R. Donaldson (United States)
152 out of 170 found this review helpful

My husband, who is a physician, and has a family history of heart disease, and I, an RN, began diligently following the reversal diet of the Ornish program in January, incorporating the recommended supplements, exercise and meditation. Since then, in a period of two months, he has lost 30 pounds, his cholesterol, and LDL have significantly improved, his HDL has not, and his already high Triglycerides have risen significantly by 30%. The previous post by the Ornish group states: "HDL and Triglycerides are only potential risk factors for heart disease, they are not diseases" If they are potential risk factors..then my concern is that my husband may still be high risk since he still has the potential risk factors. The Ornish group also states in it's post, "It is true that one can eat an unhealthful low-fat diet if it is high in simple carbohydrates.... Such a diet may cause a shift to the more harmful pattern B LDL subclass that Mr. Bayan mentions" We have been following the Ornish reversal diet/program diligently and have seen " a shift to the more harmful pattern B LDL subclass that Mr. Bayan mentions" They also state that "Patients whose triglycerides increase are counseled to be even more mindful in reducing their intake of simple carbohydrates and increasing their exercise." We have not been eating simple carbohydrates, "such as sugar, white flour, alcohol, and many popular fat-free desserts", and my husband has been exercising almost every day. They also state: "Also, for many years we have recommended that patients take 3 grams/day of fish oil, which also helps to lower triglycerides" We have been taking 3 grams/day of fish oil, along with the other recommended supplements, and his triglycerides rose 30%.

I must confess I am confused, and while I do believe the Ornish program may work for some people, I am concerned about the safety of this program for my husband specifically. We are going to pursue the cholesterol subclass testing mentioned by Mr. Bayan. I have also posted several questions to the Ornish website about my concerns...but have not received any feedback n this phenomenon as of yet, or reassurance that these test results are not something to be concerned about. We plan to work with our cardiologist on exploring what we can do to lower his triglycerides and raise his HDL, since poor levels of both are still considered "potential risk factors" I do not wish to "discourage some people from making changes in diet and lifestyle that we have proven to be lifesaving", because I do believe for some folks the Ornish program may be just the ticket. My question, until I do more reading and have more information, is whether it could be risky for some who may not respond the same way. Until I have more information and answers to my questions, I cannot whole-heartedly know if it's for everyone. And I would certainly advise folks who are interested in trying this program, to do so with medical supervision, as is advised by the Ornish group. Just as a side note..I have really enjoyed eating the Ornish reversal diet. We have both very much enjoyed the recipes, the meditation, yoga and exercise. I like the total comprehensive approach dealing with the whole person. I've also lost 25 pounds on this program..and for that reason alone, would very much like to continue with it, as I have more to lose. I have not yet had my cholesterol re-tested but plan to soon. Still..we have some home-work to do to figure out why my husbands triglycerides and HDL are not responding, what we can do about it, and to figure out whether it's even a problem that they're not. As we have both been otherwise delighted with this program, we are both very disappointed to get caught on this snag.


Some Good Advice, but Lots of Dietary Errors   June 20, 2002
Stephen Byrnes (Honolulu, HI United States)
99 out of 149 found this review helpful

Dr. Ornish's book claims to be based on "the only scientifically-proven plan for reversing heart disease." While several of his suggestions are sound and probably account for the improvements in some of his patients, the dietary advice in the book is abysmal and should not be followed.

The first section of the book concerns itself with several case histories and is quite interesting--everyone loves a story.

The second section deals with the lifestyle changes Ornish believes will prevent and reverse heart disease. Chapters 7, 8, and 9 concern themselves with getting in touch with your emotions, your interpersonal relationships, and your relationship to a Higher Power. Chapters 11 and 12 deal with quitting smoking and exercising more. All of these things are certainly helpful in regaining and maintaining one's health.

It is in chapter 10 where the advice goes bad. This chapter concerns itself with diet. There are so many errors in it that it is difficult to know where to begin but a brief synopsis will be attempted.

Dr. Ornish says that there are two diets presented in the chapter: the Reversal Diet and the Prevention Diet. The Reversal Diet is for treating and reversing heart disease, while the Prevention Diet is for, well, prevention of heart disease. Ornish says that, "Both diets will substantially reduce your risk of developing other degenerative diseases, including obesity, high blood pressure, stroke, osteoporosis, diabetes, gallstones, and cancers of the colon, breast, and prostate." (P. 254) Ornish also claims that the diets will help you "to enjoy life more."

Of course, the diet he recommends is an ultra-low-fat regime that is almost 100% vegan. On page 256, he says that the Reversal Diet is "very low in fat and cholesterol," containing less than 10% calories from fat. The diet also excludes foods high in saturated fats such as "avocados, nuts, and seeds." Egg whites and nonfat dairy products are allowed. The bulk of the diet is made up of complex carbohydrates, fruits, and vegetables.

Dr. Ornish's advice shows his lack of knowledge about lipids (fats and oils) and research has not borne out his claims about low-fat diets being good for heart disease. In the first place, avocados, nuts, and seeds are not "high in saturated fats" as he claims. Their fat content is mostly from oleic acid, a monounsaturated fatty acid, and linoleic acid, a polyunsaturated fatty acid. Very little of the fat content of nuts, seeds, and avocados comes from saturated fatty acids (see MG Enig "Know Your Fats," Bethesda Press, 2001, 291-2). Additionally, a comprehensive review of the available trials has shown the ineffectiveness of low-fat/cholesterol diets in both treating and preventing heart disease (L Corr and M Oliver. Eur Heart J, 1997, 18:18-22; (b) G Taubes. Science 2001 Mar 30 291:5513 2536-45). In fact, such diets actually INCREASE risk factors for heart disease (DM Dreon and others. Amer J Clin Nutr, 1999, 69:411-8; F. Jeppesen and others. Am Jnl Clin Nutr, 1997; 65:1027-1033).

Furthermore, vegetarian diets do not protect against heart disease. A study of vegans showed that vegan females had higher rates of heart disease than non-vegan females (Ellis, Path, Montegriffo. Amer J Clin Nutr, 1970, 32:249-255). Vegetarians in India suffer from high rates of coronary artery disease--higher than meat-eating Indians (EA Enas. J Indian Med Assoc 2000 Nov;98(11):694-5, 697-702; SL Malhotra. Brit Hrt J, 29:895-905, 1967). Some studies have also shown that vegetarians have higher homocysteine levels than non-vegetarians and homocysteine is a known cause of heart disease ((a) Herrmann, Schorr, Purschwitz, Rassoul, Richter. Clin Chem, 2001, 47(6):1094-10; (b) D Mazzano and others. Thromb Res 2000 Nov 100:153-60).

The high carbohydrate diet Ornish recommends will drive insulin levels up and keep them elevated. Hyperinsulinemia is also another probable cause of heart disease (I. Zavaroni and others. New Eng J Med, 1989, Mar 16, 320:11:702-6).

Ornish makes a lot of other bizarre claims in this chapter--all without any supporting documentation. For example, he mistakenly says that, "Sugar is not very strongly linked with coronary heart disease; the real culprits are saturated fats and cholesterol." (P. 257). This statement directly contradicts meticulous research on sugar and heart disease (J Yudkin. Lancet 1:296-297, 1971). Additionally, careful reviews have shown that saturated fats and cholesterol do NOT cause heart disease (U Ravnskov. The Cholesterol Myths. New Trends Publishing, 2001).

Ornish claims that excess dietary protein causes osteoporosis when actually such notions have been shown to be false--when protein is consumed as real meat as opposed to isolated amino acids ((a) H Spencer and L Kramer. J Nutr, 1986, 116:316-319; (b) Amer J Clin Nutr, 1983, 924-929; (c) J Nutr, 1988, 118(6):657-60).

On page 267, Ornish says that, "Many anthropologists believe that our ancestor's were primarily vegetarian." No supporting references to the "many anthropologists" are given. This statement also flies in the face of accepted nutritional anthropological data which clearly shows that humans evolved as omnivores and that meat and animal foods made up a significant part of our forebears' diet (HL Abrams. J Appl Nutr, 1979, 31:1,2:43-59).

On page 268, Ornish claims that "as early as 1900 two thrids of the protein in the typical American diet came from plant foods." Again, no supporting references are made for this untrue statement. Did he look at any cookbooks from that time? If he did, he'd see lots of recipes for meat, fish, shellfish, and wild game. Recipes invariably included butter, cream, or lard as well--at a time when heart disease was rare!

And on and on it goes. If you'd like to read what dietary factors figure into heart disease, you should look into my book "Diet & Heart Disease: Its NOT What You Think," Kilmer McCully's "The Heart Revolution," and Christian Allan's "Life Without Bread." For a thorough debunking of Dr. Ornish's dubious claims, see Uffe Ravnskov's "The Cholesterol Myths." All of these book are available off of amazon.com and would be better investments of your money.


The hysteria over dietary fat gone too far!   February 18, 2002
92 out of 112 found this review helpful

Ever consider the pitfalls of self treatment? I wish I had.
WARNING: Pregnant or nursing women, infants, children or the elderly, and those with insulin dependent diabetes should not use this diet.

For many of us baby boomers our first experience in fat reduction was in high school. We never worried about heart disease. We woke up every morning only too find we had another big pimple on our face. Back then one of the recommendations to clear up acne was the avoidance of high fat foods such as French fries, hamburgers and milk shakes, the staples of the teenage diet. But the home medical guides at the time (and our parents and doctors) cautioned not to completely eliminate or severely reduce fat intake. Back then, when common sense prevailed; fat was recognized as an essential nutrient, needed for the assimilation of fat-soluble vitamins. But now the nearly complete elimination of fat is the latest health fad. But is this fad safe?

If you have diagnosed heart disease or unusually high cholesterol you may want to try this program, but only with the approval and close supervision of your physician. To be safe and effective you must follow the program exactly as outlined including exercise.
If you only have some weight to lose, have slightly elevated cholesterol or slightly elevated blood pressure this program may actually not be safe for you, especially if you put off the exercise. When you give up fat and a major portion of protein you have a heavily carbohydrate-laden diet. If you are overweight and carry most of your fat in your belly - typically called beer belly - have high blood pressure and high triglycerides, you may have a condition called Metabolic Syndrome, sometimes referred to as Syndrome-X. Often times a high carbohydrate diet makes this condition worse. It has been shown to increase triglycerides as much as 70 percent.
As Rebecca Donaldson points out in her review, she is still concerned about her husband. This diet can cause a significant lowering of HDL good cholesterol along with a significant rise in triglycerides. Although the LDL is also lowered, in some people the LDL shifts to a smaller more dangerous pattern B LDL. (If you are in an HMO you will probably never have cholesterol sub class testing).
High triglycerides are an important risk factor for heart disease. They are just as significant as high cholesterol. The Ornish group points out low HDL and high triglycerides are only potential risk factors for heart disease, they are not diseases. But that is true of high cholesterol. Why is one risk factor important if their program lowers it but not important if their program raises it? What do others have to say? Why does the American Heart Association specifically caution against very low fat diets? According to a study reported in 1997 in the journal Circulation, triglyceride levels alone could predict the risk of heart attack as well as more commonly used LDL and HDL cholesterol levels. Those with high triglycerides alone had a 3-fold increase in risk for heart attack. People with the highest ratio of Triglycerides / HDL had a 16 times the risk of heart attack as those with the lowest ratio. The report by the Harvard lead author showed the HDL/Triglycerides ratio was a more accurate predictor of heart attack risk than standard HDL/LDL cholesterol tests. (If your triglycerides are more than twice your HDL cholestererol or a ratio of 2.0 you are at increased risk for heart attack irregardless of your total cholesterol level). Another report in the March 1998 issue of Circulation showed that high triglycerides alone were a strong risk factor for heart attack among middle-aged and elderly men, independent of other factors such as total cholesterol levels. Another report in the December 11, 2001 issue of Circulation shows that high triglycerides, above 200 mg/dl, increased the risk for stroke by 30%.
The Ornish group says: "for many years we have recommended that patients take 3 grams a day of fish oil, which also helps to lower triglycerides." (I thought they weren't concerned about triglycerides). An entire book on the diligent avoidance of all fat, but then the suggestion to take 3 grams of fish oil a day. What would you rather have the fish oil capsules or a nice salmon dinner?

What about the dangers of cholesterol too low? We have been led to believe that the lower the cholesterol the better. But other studies have shown men with low cholesterol are much more prone to depression, suicide and death by all other causes including accidents. The truth is that low fat diets have never been shown to lower the over all rate of death. You may lower your risk of heart disease but at the same time increase your risk of death from other causes at the same or higher rate. Despite the claims of the link between high fat intake and cancer, very low fat diets have been shown to significantly increase the risk of breast cancer in women.

Most experts who have reviewed the studies published by Ornish, point out the study was not double blind, used a very small sampling of individuals hand picked by Ornish, and addressed multiple risk factors, including fat and cholesterol intake, exercise, weight reduction, stress reduction, meditation and cessation of smoking. Which one of these factors actually produced the results? The severe reduction in total fat intake also severely reduces intake of saturated fat, trans fat, and polyunsaturated vegetable oils. But there is growing evidence that trans fat and too much polyunsaturated fat causes heart disease and may even be worse than saturated fat.

To avoid heart disease, exercise, lose weight and eat sensibly. Use a moderate amount of fat such as olive oil. Include fish; nuts, especially walnuts and almonds and avocados in your diet every week. Don't be too afraid of a little butter occasionally. Don't fry at high heat. Don't fry using polyunsaturated vegetable oils such as corn oil or safflower oil. If you are over 40 you will remember these oils were highly promoted 25 years ago, about as much or more than olive oil is now. But now the current recommendation is to keep these oils at less than 10% of calories. I would avoid them completely. The only links between fat and cancer has been frying with these highly polyunsaturated vegetable oils. Olive oil has been used for 5,000 years. Corn oil is a recent invention. Avoid trans fatty acids (anything were the label says partially hydrogenated); avoid deep fried foods, and limit sugar and simple carbohydrates. Too many people think that a low fat muffin is healthy. But too much sugar is also bad for your heart. There is little difference between muffins and cake except if it is for breakfast you call it a muffin.

I don't have any of those fancy abbreviations at the end of my name. I am a victim of low fat diets, which caused high triglycerides and high fasting glucose. I suspect it was the high fasting glucose combined with the inability to assimilate and use vitamin A that caused near blindness from cataracts in both eyes by age 46 which had to be surgically repaired. (Cataracts before age 70 are extremely rare). I also developed severe acid reflux during this time even though low fat diets are claimed as a treatment for acid reflux. Since giving up on this approach I have lowered my blood pressure, lowered my risk factors for heart disease, lowered my weight without hunger, lowered my triglycerides to 63, raised my HDL to over 40 for the first time in years. Although my total cholesterol has increased the ratio has improved to what is considered a very low risk ratio. When my total cholesterol was below 160 my ratio was in the high-risk range. And most important I am in a much better mood now. I might actually keep my job.


It worked for me!!!   February 27, 2002
56 out of 59 found this review helpful

When my doctor suggested cholesterol lowering drugs last year, I decided that 34years old was too soon to start taking drugs. My cholesterol was 266 (& that's after cutting out most red meat and pork fat -and no hamburgers). I was motivated to try to improve the health of my arteries and heart. I want to be around for my ten year old's retirement party!

I followed Dr Ornish's diet program for 6 month's then had my cholesterol levels tested again. Everything improved: cholesterol down to 210, triglycerides went from 389 to 217 and my ratio improved 24%. I never skipped a meal. I never went hungry. Secondary benefit: I lost 14 pounds and two inches around my waist without trying. I did not exercise enough so I am trying to increase my exercise now. I probably exercised an average of once a week.

By the way, Dr Ornish included a chart that demanded that you eat at least a certain amount of fat in your daily diet. I liked that the book is filled with studies by major US universities. This is not 600 pages of rambling prose but a how to book to reverse heart disease. If you want someone to hold your hand, call your Mom. If you want a "How to Reverse Your Heart Disease" manual, buy this book. ... Stop reading reviews and buy, read and try it.