Assessing the Two Versions of the Diet Dean Ornish, MD, Recommends
"Prevention" vs. "Reversal" Diet Guidelines

By Anne Pearce

In a real sense, each person has a spectrum of choices each day in what they eat. Viewing dietary choices as a spectrum avoids the feelings of restriction and deprivation that are often associated with "going on a diet."

There are two versions of the diet that Dean Ornish, MD, recommends. The Reversal Diet and the Prevention Diet are based on the idea that some people need to make bigger changes than others. The old saying that "an ounce of prevention is worth a pound of cure" is really true.

The "reversal diet" is designed for people who have diagnosed heart disease or with high cholesterol levels. It has been scientifically proved to reverse heart disease and may be beneficial for many other illnesses as well.

The "prevention diet" is customized according to your health risks and health goals. Ornish bases this scale on the idea that there is a genetic variability in how efficiently (or inefficiently) someone can metabolize dietary saturated fat and cholesterol.

Some people are so efficient at metabolizing dietary fat and cholesterol that it almost doesn't matter what they eat. Those are the people who live to be 90 and talk about the 12 eggs they eat for breakfast and the steak for lunch and the cheeseburger for dinner. People like that may cause you to question if diet even has a role in heart disease, but everyone else who was eating that rich a diet and who wasn't so efficient at getting rid of the fat and cholesterol never made it to 90. It's a selected group.

First, decide how much change you want to make and how much change you need to make. Remember, it's not all or nothing -- the more heart healthy your diet and lifestyle is, the more benefit and overall sense of wellness you'll experience.

The "reversal" diet is a whole foods vegetarian diet high in complex carbohydrates, low in simple carbohydrates (e.g. sugar, concentrated sweeteners, alcohol, white flour), and very low in fat (approximately 10% of calories). Those few plant-based foods that are high in fat are excluded, including all oils (other than 3 grams per day of flaxseed oil or fish oil to provide additional omega-3 fatty acids), nuts, and avocados. The diet consists primarily of fruits, vegetables, grains, and beans (including soy-based foods) supplemented by moderate amounts of nonfat dairy and egg whites. Patients with high triglycerides and/or diabetes are especially encouraged to limit their intake of simple sugars and alcohol. As a rule of thumb, try to include foods in your diet that have less than three grams of fat per serving while avoiding saturated fat and sugar.

The "prevention" diet is customized according to your cholesterol profile, genetic disposition, weight, age, and any other health risks and health goals you have. Ornish's data show that if your total cholesterol is consistently less than 150 or if your ratio of total cholesterol to HDL is consistently less than 4.0, then either you are not eating very much saturated fat and cholesterol or you are very efficient at getting rid of it. Either way, your risk of heart disease is low, and you may not need to make any changes in diet, at least from a cardiac standpoint. There are other good reasons for changing diet, such as losing weight, reducing your risk of obesity, and many forms of cancer and other chronic diseases. If not, then you can begin making moderate changes -- eat less fat and cholesterol. If that is enough to bring your cholesterol values into this range, then that may be all you need to do. If not, progressively reduce your intake of fat and cholesterol until you achieve these values or until you are on the reversal diet.

Guidelines for both versions of Ornish's diet emphasize reducing your intake of high fat, high animal protein foods, such as red meat, pork, bacon, ice cream, etc., and increasing your consumption of complex carbohydrates, including fruits, vegetables, and whole grains in their natural forms, legumes, nonfat dairy, soy products, and egg whites. These foods are also low in total fat, low in saturated fat, and low in sugar and other simple carbohydrates. It's wise to eat fewer simple carbohydrates, since these give you a double-whammy: a lot of calories that don't fill you up while provoking an insulin response that is more likely to convert those calories into fat. Another easy way to consume fewer calories is to eat less fat, because fat has nine calories/gram whereas protein and carbohydrates have only four. So when you eat less fat, you consume fewer calories without having to eat less food.

If your cholesterol profile is within the target range and you don't have heart disease, you may experiment by making certain allowances and modifications to the "reversal" guidelines. Just eat less fat and cholesterol than you're currently eating and see what happens. For example, if you're eating a 60% fat diet, go to 50% and check your cholesterol levels. If that's enough to bring into the target guidelines, then that's all you may need to do. If not, then further restrict your intake of dietary fat and cholesterol until you reach the desired goals.

You may include moderate amounts of fish, skinless chicken, avocados, nuts, and seeds. However, if you are working toward losing weight and sustaining a healthier, target weight, these allowances could also be sources of unwanted calories and fat. Remember to keep your meals balanced and varied so as to keep your diet both interesting and delicious. If you follow the program outlined here, you are likely to reach a more naturally healthy weight than on a high-protein diet, your cholesterol levels may come down even more, and you will feel better, look better, TASTE better (yes, taste better), and SMELL better. Try some Sample Menus.

The concept of a spectrum empowers people with information they can use to customize a diet and lifestyle program just right for them. So if someone who wants to lose a few pounds wants to indulge themselves one day, they might choose to eat a little more from the healthier end of the spectrum the next day.

"Good fats" provide the omega-3 fatty acids. These can be found in high concentrations in both fish oil and flaxseed oil -- 3 grams a day is all you need. The omega-3 fatty acids have many benefits. Fish oils are believed to protect blood vessel walls from the harmful effects of LDL cholesterol, including a reduction in sudden cardiac death of more than 50%-80% in some studies. Since the fish that are in omega-3 fatty acids also may be high in mercury, cholesterol, and fat, these provide the benefits of fish without the potential concerns.

Some studies suggest that flaxseed oil may promote prostate cancer growth whereas fish oil may inhibit it. These studies are not definitive but they are worrisome, so until the data are sorted out, it may be wiser to take fish oil if you're a man.

For the past 26 years, Ornish's findings from scientific studies in diet and lifestyle have been published in leading peer-reviewed medical journals. Our goal is to give you the tools and resources you need to make and maintain diet and lifestyle changes to the degree that you want to and need to. You may want to consider ways to share a healthy diet and lifestyle with those you love; it certainly makes it more fun, not to mention worthwhile!

Ornish's approach to diet and lifestyle empowers the individual and is based on freedom of choice and personal responsibility. To the degree you move toward that end of the spectrum, you feel better, lose weight, and gain health.