Major changes in diet, lifestyle reverse heart disease in 5-year study

By Brenda C. Coleman, AP Medical writer Copyright 1998 Associated Press December 16, 1998

More than two-thirds of heart patients stuck with the radical heart-treatment regimen of Dr. Dean Ornish for at least five years and their heart health steadily improved on his ultra-lowfat diet, he and his colleagues reported today.

But heart patients who were assigned to conventional care - a moderately low fat diet and, in some cases, cholesterol-lowering drugs - steadily worsened over the same five-year period in the study, the researchers reported in the Journal of the American Medical Association.

With no cholesterol-lowering drugs, Ornish's 28 patients suffered half the rate of heart attacks and other adverse heart "events" such as bypass operations and angioplasty procedures, the study found. Twenty of the 28 completed all five years of follow-up.

The American Heart Association, however, remains skeptical of Ornish's approach, questioning whether most Americans could maintain the drastic dietary and lifestyle changes he advocates.

Experts in the medical establishment also say there is no proof that the dramatic improvements he produced could occur in the population at large - all ages and races, and both sexes. His patients were all men.

Ornish's regimen calls for a vegetarian diet that limits fat to no more than 10 percent of total calories. It also requires smoking cessation, regular exercise, stress-management training and support meetings. The only subject in his study who smoked quit when the study started.

The study and similar others, however, do not make clear which aspects of Ornish's program work, said Dr. Robert H. Eckel, chairman of the heart association's nutrition committee.

"We need to create recommendations that can be followed by the general public," he said. Too little evidence exists "to recommend that Americans as a whole embrace this highly involved lifestyle."

The results are useful, but studies are needed involving thousands of patients before public health recommendations can be made, he said.

The AHA stuck by its recommendation that no more than 30 percent of dietary calories be consumed in fat - triple the proportion in Ornish's program. "Almost everyone can live with the American Heart Association's eating plan," Eckel said.

But for most people, the AHA guidelines are too moderate to stop heart disease from worsening, Ornish said Tuesday from Sausalito, Calif., where he directs the nonprofit Preventive Medicine Institute.

"It probably worsens more slowly than if you did nothing, but it still gets worse," said Ornish, a Harvard-trained internist and professor of medicine at the University of California, San Francisco.

According to the Ornish study, patients' episodes of chest pain decreased in frequency by 72 percent, while such episodes decreased 36 percent in the conventional-care group.

The total number of heart events among Ornish's 28 patients was 25, compared with 45 among the 20 members of the conventional-care group.

The Ornish patients suffered two heart deaths, two nonfatal heart attacks, two bypass surgeries and eight angioplasties. Blockage of coronary arteries decreased by 3.1 percentage points over five years.

The conventional-care group suffered one heart death, four nonfatal heart attacks, five bypass surgeries and 14 angioplasties. Artery blockage increased by 11.8 percentage points over five years.

The conventional-care group reduced its dietary fat from 30 percent to 25 percent, while the study group reduced fat intake from 30 percent to 8.5 percent.

An expert not involved in the research, Linda Van Horn, professor of preventive medicine at Northwestern University Medical School, applauded Ornish's findings but agreed they are too preliminary to form the basis for sweeping public health guidelines.

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