Program Reverses Heart Disease -- Two Northwest Doctors Say 3-Part Approach Makes It Hard To Tell What Caused Reversal

A San Francisco researcher's widely publicized lifestyle program for reversing heart disease is getting mixed reviews from two noted Northwest heart experts, one of them in Seattle.

They don't question Dr. Dean Ornish's artery-clearing results. But they say it's impossible to tell just what caused them: the strict, low-fat diet, the exercise or the stress-reduction parts of his program - or a combination.

For years, health authorities have been telling us how to reduce our risk of heart disease, through diet, weight control, non-smoking, etc.

But they haven't offered much hope for actually reversing the disease - the nation's leading killer - once it sets in.

Ornish, a physician and medical researcher at the University of California, San Francisco, says his program does just that. Most of the heart patients who followed his plan for a year in a controlled study saw their chest pains virtually disappear and their clogged arteries begin to clear, Ornish reported.

His findings, published last summer in The Lancet, a British medical journal, have drawn national publicity and the attention of heart experts across the country. The American Heart Association has said Ornish's study provides ``encouraging indications'' that coronary artery blockages are ``reversible through drastic diet and lifestyle interventions.''

Now, Ornish has written a thick new book for laymen, ``Dr. Dean Ornish's Program for Reversing Heart Disease.'' In it are recipes, exercises, patients' personal stories and a hefty dose of his own lifestyle philosophy.

This is a program for the truly dedicated.

Ornish's Reversal Diet for people with heart disease allows a mere 10 percent of total calories to come from fat - far lower than the 30 percent the American Heart Association recommends for healthy Americans. Ornish calls for only 5 milligrams of cholesterol intake daily, versus the AHA's recommended 300-milligram maximum for people without heart disease.

Ornish's diet uses no oil at all in any of its recipes, even salad dressing, nor is there any meat, fish or poultry. The only animal products allowed are egg whites and non-fat dairy products. Mainly it's a diet of vegetables, grains and dried beans. He also offers a less-stringent prevention diet.

But diet is just part of Ornish's program. He also calls for moderate exercise and for stress reduction through yoga and meditation. In other words, a sweeping lifestyle change.

``We found that overall adherence to lifestyle changes was most associated with reversal of (heart) disease,'' the tall, lanky Ornish said recently while in Seattle to promote his book.

In his study, 18 of 22 patients (82 percent) who stuck to his experimental program for a year saw their coronary arteries become less clogged with fatty deposits - as measured by computer-analyzed coronary angiogram.

They also reported an average of 91 percent fewer bouts of angina, or chest pain.

In contrast, among the 19 members of the control group receiving usual care, chest-pain frequency increased more than 2 1/2 times. Also, 10 members of this group (53 percent) saw their artery blockages worsen overall, while eight improved and one stayed the same.

Dr. Greg Brown, heart researcher at the University of Washington medical school, does not quibble with Ornish's results. ``I think he's probably right in that his program caused improvement to the arteries,'' and the artery changes appear to have been objectively measured, he said.

But exactly why the arteries improved isn't clear, he said. Ornish credits exercise and stress reduction as well as diet. But Brown thinks that by including all three lifestyle elements in the study, it was not possible to tell which one caused the artery changes. Brown leans toward diet, based on other studies.

``Maybe (exercise) does improve the arteries, but there haven't been any good studies,'' Brown said. ``For him to change three things (in one study) and say all three of those things are necessary is bad science and a form of evangelism.''

But Ornish says the patients who made the greatest overall lifestyle changes showed the biggest improvement - supporting the three-pronged approach.

Brown questioned Ornish's conclusion that lowering blood cholesterol, while helping improve heart health, isn't as important as once thought.

``He's making remarkably sweeping conclusions with one of the smallest studies that have been done,'' Brown said. He said other studies have shown a direct correlation between lowering LDL cholesterol (the so-called ``bad cholesterol'') and reducing artery blockages.

Brown also said there were inaccuracies in Ornish's comments about Brown's own research. In his book, Ornish says artery blockages worsened in most of the patients who received cholesterol-lowering drugs in Brown's recent study. Brown says the opposite occurred: Arteries improved in the majority of drug-treated patients.

Well-known heart researcher Dr. William Connor, of Oregon Health Sciences University in Portland, said he ``wouldn't deny that stress reduction is important. . . . I happen to be an advocate of yoga myself. I think it's worthy of study.''

But, like Brown, Connor did not think Ornish's study proved whether it was diet, exercise and stress reduction combined, or just one of them, that improved the patients' arteries.

Perhaps they improved only because the exercise, yoga and twice-weekly group meetings motivated them to stick to the strict diet, he said.

``It's a very rigid, very strict approach. . . . It involves a great deal of time to carry out,'' Connor said. Yet he said he personally ``would consider it'' if he had life-threatening heart disease.

Brown noted that one of the patients in Ornish's study died before completing the year-long program - an outcome Ornish attributed to overzealous exercising in an unsupervised gym.

Ornish says his program is not a substitute for conventional medical therapy, and that anyone with coronary heart disease should consult a physician before beginning the program.

The American Heart Association is still recommending a 30-percent-fat diet (with one-third of the fat the saturated kind) for healthy Americans - that is, people without diagnosed coronary artery disease. It includes a maximum 300 milligrams of cholesterol intake daily.

The AHA suggests a more restrictive diet - with less saturated fat and cholesterol - for people with high cholesterol levels or known artery disease. The AHA emphasizes that these people should be under a doctor's care.