Newly Updated Ornish Reversal Program Guidelines

[JeffN]

Has Dr Ornish gone nuts?

In Health
Jeff


Dr Ornish Has Updated The Ornish Reversal Program Dietary Guidelines

https://www.ornish.com/proven-program/nutrition/

Our program of lifestyle medicine has been scientifically proven to reverse the progression of even severe coronary heart disease, type 2 diabetes, hypercholesterolemia, and high blood pressure as well as to slow, stop, or even reverse the progression of early-stage prostate cancer in a series of randomized controlled trials published in leading peer-reviewed journals.

As a science-based program, we continue to stay up-to-date with the most relevant validated research in the areas of lifestyle medicine. Here are a few recent updates to our program’s dietary guidelines.

[geo]

I don't know if he's gone nuts, but is it still valid to change his diet and then still say that it will do everything it previously did with out doing more studies?

I certainly understand the desire to make the diet more flexible and that if followed strictly the changes may have little to no impact, but shame on him to make claims for the old diet that were quite legitimate and then without further testing, on his part, ascribe the same claims to the new changes.

[pundit999]

Jeff:

Will it be better advice to avoid nuts but include 1-3 teaspoons of ground Flax, similar to what Dr Esselstyn advises?

[JeffN]

My above comment was tongue-in-cheek.

I don't think the science has changed in regard to nuts as explained in my last thread on nuts.

viewtopic.php?f=22&t=40295

The change from Dr Ornish is supposed to be based in science. The new recommendation can't be based on any nutrient(s) as not all the choices (or the amounts recommended) supply anywhere near the same level of any nutrient(s) that may be of benefit. So, outside of adding a few nuts for taste, crunch or texture, where is the known benefit (& science) of adding so few nuts/seeds. Some observational studies? Some randomized controlled studies where they used much more (~2 oz per day) then he is recommending and for which the results, when put in proper context, were unremarkable.

At the amounts he is recommending, this makes them not into a super food, but a super miracle food.

I agree they should have always been allowed but to suddenly allow three peanuts or a walnut?

I haven't changed my mind nor am I changing anything till the science changes.

And as pointed out, if your evidence supports a very specific program on what is included or not, and you change the program, the existing evidence for the original program no longer applies to the new changes. Where is the study that compared the old reversal program without any nuts/seeds versus the new reversal program with nuts/seeds?

As Dr Ornish himself said...

http://www.medscape.com/viewarticle/862903

“Now, it is entirely possible that perhaps a somewhat higher-fat diet, if it is plant-based fats, might work as well, and those are studies worth doing. If that turns out to be true, I will modify our dietary guidelines accordingly. But fat is not the whole story”

This has not happened yet. No one has done this study and the truth is, till it is done, we can’t say what is being said about the reversal program. HIs evidence is based on his original program. He now needs new evidence on the new program with nuts/seeds.

AFAIK, having worked together with Dr Esselstyn him for five years, he recommends up to 2 tablespoons of flaxseed a day. His recommendation, which is for flax or chia only, is based on omega 3's, which makes sense.

From his FAQ

http://www.dresselstyn.com/site/faq/

"Flax seed meal is well tolerated and supplies a bonus of omega 3 using 1 or 2 tablespoons on cereal daily. Avoid flax seed oil."

What is best is to follow the principles and guidelines as recommended, applying them to yourself and your situation and make sure your diet is calorie adequate, satiating and nutrient sufficient.

Nutrients are required. Foods are only sources of nutrients. I don't think any one specific food is required

My guidelines have always "allowed" for 1-2 servings per day depending on the person and the situation as explained in my thread on nuts and in my DVD on nuts.

In Health
Jeff

[JeffN]

This recently came up in a discussion with one of the WFPB doctors, who used this as evidence for the use of nuts and a higher fat WFPB diet, so I wanted to clarify this...

From Dr Ornish's website

ʺThe addition of nuts and seeds does not change the Ornish Lifestyle Medicine, but enhances them to include additional choices. The current guidelines continue to prescribe zero to three servings of low-fat foods. The select nuts and seeds serving sizes will be listed in the low-fat food group.

Example: One low-fat food-serving (≤ 3 gm fat) equals:

5 almonds
9 pistachios
1 whole walnut
3 pecan halves
2 cashews
6 peanuts (no shell)
2.5 tsp flax seeds, ground
2 tsp chia seeds or sunflower seeds, shelled
1.5 tsp pumpkin seeds

And

https://www.ornish.com/proven-program/nutrition/


"No more than 10% of calories are from fat. This is achieved by not adding any fats, oils, 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, soy foods — and small amounts of nuts & seeds.”

"Nuts are allowed in small amounts. To maintain the low-fat goal of 10 % of calories from fat, servings sizes for nuts are limited since they are very concentrated in fat.”

So, this is not a liberal endorsement of an ounce (or more) of nuts a day (as some are implying). The revised recommendation with the nuts for the Ornish reversal program remains, "No more than 10% of calories are from fat." In addition, he allows 3 servings a day from the low fat group, which included the nuts, and a serving must have no more than 3 gm fat which means a serving is around 6-7 grams or .2 oz. If all three low fat servings came from nuts, that would be around 18-21 grams or about .6 oz.

In Health
Jeff