Thursday, January 17, 2008

Dean Ornish’s new book, The Spectrum

Most of us know that our lifestyles have a major impact on our health. In his new book, The Spectrum, Dean Ornish, M.D. demonstrates that not only do improvements in lifestyle – diet, exercise and stress reduction – make us feel better, we can actually prevent and reverse chronic diseases. Dr. Ornish shows through his own research and that of others that reversal of heart disease, cancer and diabetes, among others, is possible without surgery and medications. For example, the Interheart Study of 30,000 individuals from around the world conducted by Canadian scientists demonstrates that heart disease is almost completely preventable with lifestyle changes.

What a deal! Improvements in lifestyle can make us much healthier without medical intervention or exorbitant costs, and with no side effects.

Many lifestyle books, especially diet books that push the Adkins Diet or South Beach Diet, base recommendations on anecdotes, personal experiences and testimonials, but very little solid research. Dr. Ornish's recommendations are based upon three decades of research, much of which has been published in peer reviewed medical and scientific journals such as the Journal of the American Medical Association, Circulation, and the New England Medical Journal.

Big Changes, Big Results

If you were to read Dr. Ornish's other books, you might conclude that he is pushing a very restrictive vegan diet as the only way to achieve desirable results. In The Spectrum he clarifies this issue. Ornlish says that each of us is different. We have different health status and different goals. Whether it be diet, exercise or stress reduction, Ornish's three-legged lifestyle stool, we each have a spectrum of choices to achieve our desired results. A person who has heart disease should make the most aggressive changes. Someone who is basically healthy and may want to reduce weight and/or cholesterol might make less aggressive changes.

However, whether we are healthy or trying to recover from a serious illness, Dr. Ornish proposes that the biggest results come from making the most aggressive changes. I know from my own experience that a low fat vegan diet, which is at the extreme end of the Ornish diet spectrum, has produced extremely rewarding results. Since adopting this way of eating, which reduces fat to about 10% of daily calories, my weight as stabilized at 30 pounds less than before I started the diet, my blood pressure has stabilized in the healthy range, and my cholesterol has dropped 60 points.

A System Driven by Money

Ornish argues that Medicare and health insurers should reimburse health providers for helping patients achieve lifestyle changes. Indeed, he has succeeded in convincing Medicare to add his program to their reimbursement and has successfully convinced other insurers to do the same. Nevertheless, the failure of doctors to promote healthy lifestyles remains largely a result of an insurance system that rewards treatment by drugs, medical procedures and surgery rather than changes in diet, exercise and stress reduction. Ornish predicts that the growing costs of health care will force the system to refocus on prevention.

Making Hard Changes

Another reason why physicians spend little time discussing lifestyle changes with their patients is the belief that changes in diet and exercise are too difficult for most people. Ornish disputes this and argues that by making lifestyle changes flexible, simple and rewarding many people will take the plunge. He demonstrates through his and his colleagues work at the Preventive Medicine Research Institute and the University of California that giving patients an array of options and then reinforcing those choices with positive results can sustain long term change. Ornish advises us to make small, gradual changes or big, rapid changes to create sustainable transformations in your diet and lifestyle. His approach caters to individual variation in motivation, goals, and life situation.

General Guidelines

Although his approach is flexible, Ornish does provide some simple guidelines – consume some Omega 3 (good fats) every day, avoid bad fats such as trans fats and saturated fats, choose complex rather than simple carbs, choose foods that are nutrient dense, choose quality of quantity and eat less salt. He also provides guidelines for introducing healthy exercise and stress reduction approaches to our lives.

The Ornish system is very flexible and simple under the theory, I assume, that the important goal is to get people focused on the importance of lifestyle and to get them started. Once started, the positive results will be reinforcing of more aggressive changes, if those changes are needed for optimal health.

The Spectrum is loaded with useful tools such as Ornish's comprehensive chart that rates foods along a dimension of most healthy (Group 1) to least healthy (Group 2). The book also contains some great recipes from Art Smith, a famous gourmet chef. For anyone interested in a very user-friendly guide to making healthy lifestyle changes, this book is for you.


UTV said...

just for your info, I recall Dr. Fuhrman saying on a DVD that 10% of calories from fat is too low

UTV said...

Wait hold that comment!
After reading the posts on McDougall's forum (mostly by Jeff N) I can see what a minefield of confusing information it has become since. So it would seem 10% is fine. I wonder if Dr Fuhrman has changed his line on this - in ETL he roughly recommends 10%, then later during his "the importance of fats" talk he explicitly says 10% is too low, now what does he say? Presumably he agrees with Jeff N's (well-thought-out) views that actually 10% and even lower is good?