Diet DoubleDare: Eat More, Weigh Less

An article by Dean Ornish, M.D.


Eat More, Weigh Less may sound too good to be true, but in his book by the same title, Dean Ornish, MD, says you can lose weight and be healthy without counting fat grams or calories. Find out which foods fit into his plan and which ones are no-no's.

The opinions expressed herein are the guest's alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Thank you for joining us today, Dr. Ornish. There has been so much discussion of your healthy lifestyle plan -- it almost seems wrong to call it a diet. Yet there seems to be confusion. Can you please explain the difference between the reversal diet and your eating plan for those who don't have heart disease?

Ornish: Yes. The old thing about an ounce of prevention is true. It takes more to reverse diseases like heart disease than it does to prevent them. The reason no one has scientifically proven before us that heart disease is reversible is because they didn't go far enough. To prevent disease though, is much easier. There is a spectrum of food choices based on how efficiently your body can metabolize or get rid of dietary fat and cholesterol. In part, this is genetically determined.

On one end of spectrum are those so efficient at metabolizing fat and cholesterol in their diet, it almost does not matter what they eat. These people are so efficient that they can eat almost anything and not get heart disease. Everyone knows someone who is 90 years old and eats eggs for breakfast and a steak for lunch making you wonder if diet is not important. Look what they are eating and they are not gaining weight. However, everyone else eating that rich of a diet and were not so efficient in metabolizing didn't make it to 90. That's who you are left with. On the other end of the spectrum are those with heart disease or high cholesterol levels. In general, people who have heart disease are not very efficient at getting rid of fat and cholesterol in their diet. The good news is this: Even if you're not very efficient at metabolizing fat and cholesterol, if you reduce your intake sufficiently, you are no longer eating more than your body can get rid of, thereby allowing your heart to begin healing itself. In our research, we demonstrated this healing can occur much more quickly than once realized.

So, how can you customize a diet just right for you? If your total cholesterol is 150 or less, or your LDL is less than 95, either you are not eating much fat and cholesterol, or your body is very good at metabolizing it. Either way your risk of heart disease is quite low and whatever you are eating is probably fine, at least as far as your heart is concerned. If it's above 150 then begin reducing the amount of fat and cholesterol in your diet. If you are eating four cheeseburgers a day, try eating two a day. If you are eating three eggs a day, try one egg a day. Instead of eating red meat, eat more fish and chicken. If those changes are enough to bring cholesterol down to target ranges, then that may be all you need to do. If not, then you can progressively reduce the amount of fat and cholesterol in the diet until you reach the target ranges. It's not all or nothing. For more information on how to do this, please consult my book, Dr. Dean Ornish's Program for Reversing Heart Disease.

Member: How do I fit this diet into my "crammed with activity" life; in other words, not enough time to prepare and also on a limited budget.

Ornish: I wrote a book entitled Everyday Cooking with Dr. Dean Ornish for just this purpose. In my earlier books, the recipes were gourmet, from top chefs. The meals were delicious and often complicated and took a long time to prepare. The Everyday Cooking book has menus that even I can prepare, with ingredients easy to find and recipes that don't take very long to make. Also there are a number of recipes on our site at WebMD. If you go to www.ornish.com you will also find a shortcut to our site at WebMD.

Moderator: We have about 150 Dr. Ornish-recommended recipes on our Ornish website.

Member: What makes your diet plan better than other popular ones out there?

Ornish: Because it is scientifically proven. For the past 25 years, I have directed a series of scientific studies proving that the diet and lifestyle program I recommend can reverse the progression of even severe heart disease, as well as help in losing weight and keeping it off.

After one year, the average person lost 25 pounds and kept off much of that weight five years later. Also, we found a 40% reduction in LDL [bad] cholesterol without using cholesterol-lowering drugs.

The reason that I spent so much time in research even though it is often difficult and expensive is that science is a powerful tool for helping people sort out conflicting claims. Nowhere are the claims more conflicting than in the area of diet. Unlike other diets such as the high-protein diets, we have published our findings in leading medical journals, demonstrating that this approach is both safe and effective. When you go from a high-fat, high-animal-protein diet, to a low-fat, whole-foods diet low in animal products, you get a double benefit. You reduce your intake of disease-promoting substances: cholesterol, saturated fat, and oxidants, while increasing your intake of disease protecting substances. With few exceptions, these substances that have anti-cancer, anti-heart disease and even anti-aging properties are found in fruits, vegetables, grains, and soy products. So, it's not only what you "exclude" but also what you "include" that's important.

Member: I am under the impression from my reading that the issue is saturated fat and other "good" fats -- like olive oil and fat in fish -- which change when heated in cooking and that these good fats unchanged are not damaging to the health of the heart and may even add to the health of the heart. What are your feelings about this?

Ornish: You are right. Fish oil is rich in omega 3 fatty acids that can reduce sudden cardiac death by 50-80%. These omega 3 fatty acids have other benefits as well. They can reduce your triglyceride levels, decrease arthritis inflammation, and reduce the incidence of heart attacks. You only need 3-4 grams per day to provide these protective benefits. More provides no additional benefits, but just extra fat. I take fish oil capsules that are available in most health-food stores and pharmacies that come in 1-gram capsules. You can also get fish oil by eating salmon, mackerel, halibut, and other deep-water fishes, but you also get a lot of extra fat and cholesterol you may not need, and all too often, mercury and other toxic substances.

If you don't have heart disease, eating these fish a few days per week might be fine, but if you are trying to reverse heart disease, you should avoid them and take the capsules instead. Some evidence suggests fish oil may reduce the risk of breast and prostate cancer as well. So if you remember nothing else from today's chat, consider taking fish-oil capsules. While fish oil and flaxseed oil provide beneficial omega 3 fatty acids, olive oil is not really a "good fat." In studies showing the beneficial effects of the Mediterranean diet, it is because of increased consumption of fish and consuming olive oil instead of butter, lard, and other fats which are much more toxic. Olive oil has virtually none of the protective omega 3 fatty acids. Studies show olive oil only helps reduce cholesterol when substituted for butter, lard, palm oil, and so on. In short, olive oil is not good for your heart. It is less harmful.

Does that mean you should not ever eat olive oil? Of course not. But if you have heart disease, avoid olive oil because it's 14% saturated fat and 100% total fat. So, more olive oil consumed, then the higher your cholesterol goes. If you are trying to prevent heart disease, some olive oil may be fine. From a weight-loss standpoint, olive oils are 100% fat. The easiest way to lose weight is to eat less fat and sugar. Fat has 9 calories per gram whereas protein and carbohydrates have only 4. When you eat less fat you eat fewer calories without having to eat less food. Some think that olive oil is good for them and pour it all over their food not realizing they are consuming a lot of extra, unneeded calories. One tablespoon of any oil has 14 grams of fat, and 14 grams of fat times 9 calories per gram is 126 calories. One scoop of premium ice cream has about 16 grams of fat. So, putting 2 tablespoons of olive oil on pasta or salad has about the same number of calories as two scoops of ice cream. No one would do that and expect to lose weight.

So in summary, if you exclude as much as possible all oils other than small amounts of fish oil and flaxseed oil, it is one of the easiest ways to lose weight and lower cholesterol.

Member: Can you reverse heart disease by just taking these fish oil capsules alone without changing your eating habits?

Ornish: No. But you can reduce your incidence of sudden cardiac death since the fish oil stabilizes the electrical system in your heart.

Member: If we follow your plan six days a week, can we still prevent heart disease if we are at the lower efficient end of the spectrum?

Ornish: It depends on what you do on the seventh day. You can try that, and check your cholesterol levels. If they are in target, that's all you need to do. If not, consider making bigger changes.

Member: Is the prevention diet appropriate for pre-teens or children with a weight problem?

Ornish: Yes, if they have a weight problem. Diabetes has increased by 70% in the last 10 years in 30-year-olds. And childhood obesity is of epidemic proportions. Young children need calories to grow, but if overweight, they are getting too many. In addition to too much fat, many Americans eat too much sugar and simple carbohydrates. When you eat too much sugar and simple carbohydrates, you get a double whammy. You get a lot of calories that don't fill you up because you have removed fiber and bran and you are more likely to convert those calories into fat. Simple carbohydrates include sugar, white flour, white rice, and alcohol that your body converts into sugar. These get absorbed quickly into your blood stream, causing your blood sugar to zoom up. When your blood sugar zooms up your pancreas makes insulin to bring it back down and insulin also accelerates the conversion of calories into fat, causing you to gain weight. The goal is not to go from simple carbohydrates to sausage, pork rinds, and bacon; but rather go from simple to complex carbohydrates, or whole foods (brown rice, whole wheat flour, beans, and fruits and vegetables).

Fiber, in turn, slows the absorption of foods, preventing the rapid rise in blood sugar that provokes an insulin response. Also when you eat foods high in fiber, you get full before you get too many calories. And the food you are eating is less dense in calories because it's low in fat. The high-protein diets are based on a half-truth, which is that too many in this country eat too many simple carbohydrates. The goal is not to go from simple carbohydrates to sausage, but to go from simple carbohydrates to whole foods. You then get the benefits of a high-protein diet in terms of reducing intake of simple carbohydrates, but instead of mortgaging your health in the process you are enhancing it.

I would love to be able to tell you eating steak and cheese will reverse heart disease but it does not. There is no mystery in how to lose weight. You burn more calories or consume fewer calories. You can burn by exercising or consume fewer calories in two ways: you eat less food, which is why all diets work in the short run because when you eat less food you are eating fewer calories, but the problem is you get hungry when you eat less food and sooner or later you get off of the diet and often blame yourself for not having enough discipline, willpower, or motivation. The real problem is you were going about it in the wrong way. The other way to eat fewer calories is to eat foods less dense in calories -- in other words, less fat. As mentioned earlier, eating less fat means you consume fewer calories because the food is less dense in calories. In this way, you eat when hungry and until you are full. You can lose weight and keep it off without hunger and deprivation. In short, you really can eat more and weigh less if you know what to eat.

Member: What is the average weight loss one can expect if following your plan?

Ornish: The average person in our studies lost 25 pounds in the first year. You may be able to lose weight more quickly on other plans, but you'll gain it back. Slow but steady wins the race. In our experience, people who need to lose more weight in the first year, can. And keep it off. It's better to lose weight more slowly and more lasting because you are less likely to provoke other problems like gallbladder disease.

Member: Is it safe to follow your eating plan while breastfeeding? I'm trying to lose weight and my baby is 4 1/2 months old.

Ornish: I would recommend women breastfeeding not try to lose weight because you are eating for two. There will be plenty of time to lose weight when your baby has weaned himself or herself.

Member: I read that diets too low in fat cause your body to go into "starvation" mode and store fat, is this true?

Ornish: When you reduce intake of calories by eating less food, your body thinks you are starving and your metabolism may decrease. For the past 100,000 years or so the major problem has been getting enough calories. Our bodies have evolved dealing with starvation and famine by burning calories more slowly during those times. As a result, if you just reduce the amount of food in your diet by eating one-third less, you will lose weight at first, but your metabolism slows by one-third, since your body thinks you are starving. Your body then will not lose weight. In my approach, when you eat less fat you don't have to reduce the amount of food so your metabolism does not slow down which is why it's easier to lose weight and keep it off.

Member: I just read a [piece] by Dr. Cordain on the Paloe diet and he makes a strong case to add a reasonable percentage of very lean protein -- fish (northern waters like salmon, mackerel, etc.) and naturally fed range chicken, turkey, and game animals along with unprocessed fruits, veggies, and grains as the diet for life. Recommends a fat percentage over 30% and gives a lot of seemingly cogent data both current cultural/societal and historic data re optimum health based on this diet. It leaves me quite confused. Your thoughts please?

Ornish: In our research we have proven the diet I recommend can reverse even severe coronary heart disease, and more quickly than once realized. Medicare is now paying for 1,800 patients to go through our program in hospitals and other sites we have trained because it works. For a listing of sites, go to www.ornish.com. It is better to eat free-range chicken and wild game because it's lower in fat. If you have heart disease, it's better to avoid even these. Remember those with heart disease are less efficient in metabolizing fat and cholesterol, so even these low sources of fat may still be too high for them.

Member: I have been doing your diet for a year and a half and I feel great. My question is regarding infants. I would like my kids to follow this diet, is it safe for them? What about milk? Can I substitute dairy for soy, rice, or almond milk? I am worried about allergies, colic reactions, lactose reaction, etc.

Ornish: Sure. We have a 16-month-old son, so that's close to my heart. Infants and children need more calories to grow. The very reasons a low-fat diet is great for adults -- foods lower in calories -- don't work for infants and children who need calories to grow. If the child is overweight, they may benefit from a moderate reduction in calories as described in the Prevention Diet, but only until they lose the excess weight. Finally, with rare exceptions, infants should be breastfed. Nothing takes the place of mother's milk for bonding and nutrients that breast milk provides. Cow's milk is for cows. I recommend a soy-based formula once an infant has been weaned because of the food allergies that you indicated.

Member: I am having trouble convincing my three teenage boys to consider fruits and veggies a snack. They are body builders, not overweight, but they want to gain weight. I think they are better thinner since we have a lot of heart disease in the men on both sides. I guess the supermarkets and people around them are giving them a different message. It is very difficult for me not to eat the things they bring home!

Ornish: The whole point of being a teenager is to do the opposite of what your parents tell you, so it's not surprising you are meeting resistance to your suggestions. The best way to gain is to work out and lift weights. Their performance will improve eating a healthy diet. Telling a teenager they will get a heart attack when 70 instead of 80 will not motivate them, and often doesn't motivate those who are 70. It's more effective to emphasize the short-term gains from eating a healthy diet, like looking better, smelling better, feeling better, and even tasting better. Your body exudes toxic waste through breath, perspiration, and bowels. When you eat a healthier diet, you and your loved ones may notice a difference in these areas.

Moderator: We are almost out of time. Before we wrap up for today, do you have any final comments for us?

Ornish: Having seen what a powerful difference changes in diet and lifestyle can make, I want to make the information more widely available so many can benefit. I appreciate the opportunity to work with WebMD. Please come visit our site at www.ornish.com and here at WebMD for a variety of resources and information, tools and techniques that may be helpful. Thank you so much for the opportunity to be of service.

For more information, visit Dr. Ornish's website.

Note: This article was taken from WebMD.

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