Dr. Bray Links

Saturday, January 14, 2017

Dean Ornish in Defense of the Dietary Fat - Heart Disease Link

Dr Ornish: We still have the only randomized controlled trial[1] showing that lifestyle changes can actually reverse the progression of coronary heart disease. We showed this using radionuclide ventriculography to measure the ejection fraction response from rest and peak exercise in our study published in JAMA in 1983. The Lifestyle Heart trial 1-year data published in the Lancet,[2] and the 5-year data published in JAMA,[3] showed that the percent diameter stenosis improved in the people who went through our program, and it got worse in the control group.

We also found that cardiac PET scans[4]—and these were all performed and blindly analyzed by independent observers—showed a 300% improvement in blood flow to the heart in the intervention group compared with the randomized control group, and they had 2.5 times fewer cardiac events.[3] We found a dose-response correlation at both 1 year[2] and 5 years[3] between the degree of adherence to both the lifestyle program as a whole and the diet, in terms of cholesterol milligrams and fat grams consumed, and changes in the arteries. These things make a difference. The burden of proof is on others to show that a higher-fat diet can reverse the progression of heart disease.

That said, this is a work in progress. I have been doing work in this field for 39 years, and as new science comes, we modify accordingly. For example, when I did my internship and residency at Harvard Medical School and the Mass General Hospital, the chief of medicine at the time, Dr Alexander Leaf, was my mentor. He had done a lot of the pioneering work with fish oil[5] and convinced me back then that we should add fish oil to our diet, which we have been doing ever since. Given the preponderance of evidence on the benefits of seeds and nuts, we have added those in small quantities this year.


  1. Ornish D, Scherwitz LW, Doody RS, et al. Effects of stress management training and dietary changes in treating ischemic heart disease. JAMA. 1983;249:54-59. Abstract
  2. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990;336:129-133. Abstract
  3. Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280:2001-2007. Abstract
  4. Gould KL, Ornish D, Scherwitz L, et al. Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification. JAMA. 1995;274:894-901. Abstract
  5. Leaf A. Cardiovascular effects of fish oils. Beyond the platelet. Circulation. 1990;82:624-628. Abstract

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