Moderators: JeffN, carolve, Heather McDougall
MikeyG wrote: This discussion also reminded me of Dr. Gardner's 2007 A-to-Z Diet study, where patients on an "Ornish" diet were only able to keep dietary fat to 29.8% vs. the recommended 10%. So the failure of the "Ornish" diet was thought to be due to the fact that the dietary guidelines were not adhered to, which we often see in studies that claim a LFWFPB dietary pattern failed to produce positive health effects.
MikeyG wrote:Dr. Ornish seems to believe that high levels of compliance on a low-fat, plant-based diet are largely due to the participants feeling better through their healthier dietary choices.
MikeyG wrote:Thus, it appears that the low levels of compliance/adherence we see outside of the studies done by the WFPB researchers may be a result of the low-fat, WFPB diets being inadequately prescribed and adopted by the study participants, since LFWFPB leaders seem to find patients willing to adhere to the diets simply by experiencing the positive benefits of doing so.
MikeyG wrote:However, as you have pointed out, long-term compliance may be difficult due to our toxic food environment, and accurately measuring and reporting adherence/compliance can vary significantly based on our definition of these terms.
MikeyG wrote:As it appears that a large majority of our research funding is directed toward the minutiae, if you had the choice, where would you like to see that funding directed instead? If Jeff Novick were the new tsar of all our public research funds, what types of studies do you feel would be the most beneficial to furthering the science? As we already have a wealth of peer-reviewed, published, scientific evidence suggesting that a LFWFPB dietary pattern is incredibly important for optimal health, should we now be studying how best to improve compliance/adherence over the long-term?
MikeyG wrote:Or, at this point, would the money be better spent attempting to create the infrastructure necessary for implementation of the LFWFPB dietary pattern and optimally healthy lifestyle, as the research seems to have already done well to establish the value of these interventions and patterns?
JeffN wrote:More to follow on what I think the key factors are, why we see 70-90% in some of the studies but not in the real world and why Dr Esselstyn had such a high success rate in his first study.
Adherence is the key factor upon which arrest and reversal therapy depends. Four techniques were used to promote adherence and reinforce the plant-based diet:
(1) At enrollment, treatment objectives were discussed in an in-depth, 60- to 90-minute interview with each participant and spouse.
(2) Patient adherence and lipid results were monitored through biweekiy visits for the first 5 years. Such immediate recognition in achieving lipid goals is critical reinforcement and provides the patient with real-time proof of success. Visits became monthly during the second 5-year period and have been quarterly for the past 2 years.
(3) Throughout the first year I called each patient on the evening of the clinic visit to review the lipid profile and any needed dietary or medication adjustments.
(4) Several times a year a group meeting was held at my home or the home of a participant to review treatment objectives, exchange menus, and socialize.
Continued frequent patient encounters appear critical to teach dietary knowledge and reinforce new habits. Patients reported that their physician's commitment to the same diet was additional motivation.
http://www.pmri.org/publications/1953.pdf
"They say, women completing the follow-up were younger and more likely to be employed. Men completing the follow-up were more likely to have a history of PTCA (Stent) and a family history of CAD, were more often previous smokers, consumed less alcohol, were living with someone, and cohabitating men tended to have their partner participate. Men who completed the program also expressed greater self-efficacy toward adherence to the program components. There were no other statistically significant differences in demo- graphic, medical, or psychosocial characteristics between those who completed the follow-up and those who did not."
"Self-Efficacy Enhancement
Self-efficacy, a component of social cognitive theory, describes an individual's perception regarding his/her abilities to carry out actions necessary to perform certain behaviors (eg, making changes in diet or lifestyle).20 Perceived self-efficacy is a major determinant of performance independent of an individual's actual underlying skill.20 The strength of perceived self-efficacy is particularly important, as individuals are more likely to both initiate a behavior and continue their efforts until success is achieved if their perceived self-efficacy is higher.20 Thus enhancement of an individual's perceived self-efficacy can be incorporated into interventions to improve the likelihood of successful behavior change. Bandura's theory suggests 4 sources of self-efficacy that can be drawn on and incorporated into intervention strategies to enhance self-efficacy.82 The source with the greatest potential for increasing self-efficacy, mastery experiences, entails having a person successfully achieve a goal that is reasonable and proximal; for example, substituting fruit for a high-calorie dessert or being able to walk 1 mile. A second source, vicarious experience, consists of the individual witnessing someone who is similar in capability successfully perform the desired task; for example, observing patients exercise and improve their physical function in cardiac rehabilitation or watching a nonprofessional prepare a healthy meal. A third source, verbal persuasion, entails the provider persuading the person that he/she believes in the person's capability to perform the task. This is the weakest source for improving self-efficacy, but can be implemented via telephone or other electronic modes. The fourth source, physiological feedback, entails interpreting to the individual the meaning of different symptoms associated with behavior change. Examples include explaining that experiencing fewer symptoms with exertion is related to regular participation in a physical activity program or that feeling less fatigued or more comfortable is related to weight loss.20 An extensive body of evidence indicates that self-efficacy influences behavior change across all the behavior domains related to CVD risk reduction.83–92 Self-efficacy enhancements were incorporated into the interventions of several of the studies that yielded favorable outcomes."
Of the 22 participants, 5 dropped out within 2 years, and 17 maintained the diet
11 of whom completed a mean of 5.5 years of follow-up.
Disease was clinically arrested in all 11 participants, and none had new infarctions. Among the 11 remaining patients after 10 years, six continued the diet and had no further coronary events, whereas the five dropouts who resumed their pre-study diet reported 10 coronary events.
Six nonadherent patients were released within the first 12 to 18 months of the study, and they returned to standard care. By 1998, these patients, who initially had levels of angiographic and clinical disease equivalent to those of the adherent patients, had sustained 13 new cardiac events. The remaining 18 patients adhered to the study diet and medication for 5 years.
At 5 years, 11 of these patients underwent angiographic analysis by the percent stenosis method, which demonstrated disease arrest in all 11 (100%) and regression in 8 (73%).14
During the 7 years since the conclusion of the 5-year study, all but 1 patient have continued to adhere to the prescribed diet and medication. Today, 12 years after study inception, the mean total cholesterol of the patients is 145 mgldl (Table I).
MikeyG wrote:However, I wonder if the "I just don't care what anyone else thinks of me," perspective that the highly compliant individual expressed could have some pitfalls.
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