[However, as this article makes clear, some experts have doubts. Bill Moyer's PBS series on Healing and the Mind (1993) has an excellent segment on Ornish's original work, but, of course, it does not scientifically review the literature or reflect recent opinion/studies.]
By GINA KOLATA
It can not be easy to go out to dinner if you are Dr. Dean Ornish. As a best-selling author and developer of a program that promises to reverse heart disease and help people live better, he is recognized everywhere.
Cut the fat and learn to love vegetables, says Dr. Dean Ornish, whose rigid regimen for a healthy- heart also involves yoga, exercise and participating in support groups.
But the real problem with going out to eat, if you are Ornish, is what to order. His diet is not just vegetarian. It also has no added salt, fat or oil. He allows no sugar, no caffeine. It is not easy finding a restaurant that can accommodate him. So, Ornish says, he likes to go to places like the Avenue Grill in Mill Valley, Calif., where the staff members know him and can prepare the food he requires.
One evening last spring, Ornish started with Caesar salad, which he ordered with dressing on the side. When the salad came, he ignored the dressing, along with the Parmesan cheese and croutons that were sprinkled over the lettuce. Ornish's "Caesar salad" was simply a handful of leaves of romaine. His main course was a plate of steamed vegetables surrounding a scoop of plain white rice. No butter. No oil. No salt. Not even any spices. He drank water. No dessert. No coffee.
It hardly seemed like enough. But Ornish, who is far from gaunt, explained his secret. "I eat throughout the day," he said. "I graze."
The diet, however, is only part of Ornish's program. Adherents meditate, practice yoga and exercise. Those who smoke must stop. And they regularly attend support groups and learn to manage stress, and they are encouraged to develop and nourish close personal relationships.
It is an intense commitment, requiring at least 12 hours a week, not counting time to find and prepare the food, according to Ornish's publications, and an iron will during holidays when everyone around is stuffing down calories as if there were no tomorrow.
The program and Ornish's tireless quest to publicize it has turned him into an American phenomenon. He runs the Preventive Medicine Institute in Sausalito, Calif., where he directs weeklong workshops for people who want to start his program. In March, Ornish began endorsing a line of foods that he helped develop, Advantage/10, with the 10 standing for the 10 percent fat in his diet.
Ornish's adherents swear by his program. Victor Karpenko, 76, from Danville, Calif., said he started the program more than 10 years ago. He said he lost 30 pounds and avoided bypass surgery, which, he says, his doctor had recommended. "I feel great," he said.
Jack Brandon, 68, from San Rafael, Calif., said his family pushed him to start the program two years ago because he had had a prostate-cancer scare. Ornish hopes that his program will prevent prostate cancer or, if a man already has it, slow or reverse the tumor's growth. "I'm in love with the program," Brandon said. "I'm in love with Dean, I'm in love with the world."
Ornish also has supporters in academic medicine.
"Fundamentally, he's right," said Dr. Lee Goldman, the chairman of the department of medicine at the University of California in San Francisco. "It makes good sense and we have been very supportive of his program."
Dr. William Fair, the director of the Prostate Diagnostic Center at Memorial Sloan-Kettering Cancer Center in New York, "a believer" in Ornish's program, started it after he contracted colon cancer. Now he is collaborating with Ornish on research into whether the diet can reverse cancer.
Meanwhile, Fair said, "I am into the diet, I take soy proteins and vitamin E. I am into exercise, into yoga."
Dr. Claude Lenfant, director of the National Heart, Lung and Blood Institute, observed that most Americans would not want to follow Ornish's strict regimen. Nor would they need to. However, he said, Ornish's most recent data, published this month in the Journal of the American Medical Association, show that "if one wants to follow this regimen, then it's going to work," by slowing the buildup of plaque in coronary arteries.
But others are not so sure. They question whether research supports Ornish's claims for his program and look askance at his record as an entrepreneur. They wonder if he can be objective about a diet program that has been a major source of income and that he travels so vigorously to promote.
Ornish said that to protect his objectivity, he strives to "make sure I collaborate with people who are the most respected in the field and whose biases are often quite different from mine." He adds that many who look askance at his financial arrangements themselves take money from drug companies for research and lectures while they are studying the companies' drugs.
But Dr. Richard Pasternak, director of preventive cardiology at the Massachusetts General Hospital in Boston said that Ornish's research did not demonstrate anything, because his studies were flawed. "There's virtually no science here, as far as I can tell," Pasternak said.
And Dr. Paul Thompson, the director of preventive cardiology at Hartford Hospital in Connecticut, said, "There does come a point where one starts becoming more of a cheerleader than a scientist."
Though Ornish's curriculum vitae lists scores of speeches, television presentations and the like, it notes only three scientific studies. One involved 10 patients studied for a month. Another involved 48 people, who were studied for a month. It showed, he reported, that people who followed his program had drops in cholesterol levels, less chest pain, and an improvement in heart function.
The third study began with 53 patients who were asked to follow his program and 43 who were asked if they would undergo regular medical assessments while having their usual care. But only 28 intervention and 20 control patients agreed to participate. One of the intervention patients died while exercising, "greatly exceeding his prescribed exercise," Ornish says.
P In a paper published this month in the Journal of the American Medical Association, Ornish and his colleagues reported that after five years, 20 patients remained in the treatment group and 15 in the control group. Those who were in his program, he and his colleagues reported, had slightly wider coronary arteries, on average, and had, he says, "dramatically less" chest pain than those who were left to their own devices.
One problem with these studies, critics said, was their small size. As Thompson put it, "Rarely have so many conclusions been based on so few subjects."
But Ornish said the size of the study was less important than the precision of the results. His measurements of changes in the average diameter of coronary arteries were so precise, he said, that he could see definitive results with just a few patients.
But some researchers said Ornish should look beyond this measurement.
Dr. Robert Eckel, a professor of medicine at the University of Colorado Health Sciences Center in Denver and chairman of the nutrition committee of the American Heart Association noted that Ornish did not show whether people lived longer on his program, or had fewer heart attacks. To see such differences, if they exist, typically requires studies with thousands of patients, followed for years.
Dr. Frank Sacks, a nutrition professor at Harvard Medical School and the Harvard School of Public Health, noted that Ornish found no improvements in the most narrowed parts of his patients' arteries -- where blood clots might be expected to lodge and cause heart attacks. And, he added, Ornish has no evidence that artery-clogging plaque melted away in patients on his program.
Ornish said that what mattered most was blood flow to the heart as well as heart attacks, hospitalizations, bypass surgery, and chest pain. "We found marked improvements in blood flow and two and a half times fewer cardiac events," in patients on his program, he said.
It was almost a matter of happenstance that Ornish found his calling. It happened in 1972 when he dropped out of Rice University in Houston to recover from mononucleosis and what he describes as a suicidal depression. At his parents' home in Dallas, Ornish met Sri Swami Satchidananda, who had been teaching Ornish's older sister to meditate. Ornish asked the swami to help him, too.
"He said, 'Become a vegetarian."' Ornish recalled. "I said, 'Fine."' He said the swami also told him to meditate, practice yoga, exercise and "always do something to help someone." The swami "gave me my program," Ornish said. "I felt better. I felt peaceful."
Inspired by this experience, Ornish began a small study several years later, when he was in medical school at Baylor College of Medicine in Houston. He would see if the program the swami taught him might reverse heart disease.
He found 10 patients. Half chose to follow his program; the others did not. "I taught yoga and led exercise sessions. I taught nutrition," Ornish said. And he led the participants in a support group where, he said, they shared what he describes as their pain and loneliness.
Ornish said the patients who followed his program ended up with lower blood levels of cholesterol, less chest pain and improved heart function. He followed with his one-month study of 48 patients.
He wrote a book, "Stress, Diet & Your Heart" (New American Library) that came out at the end of 1982, just before his 1983 scientific paper describing his findings.
In 1984 he started his Preventive Medicine Institute and began another study to see if he could detect an actual reversal of atherosclerosis in patients who followed his program. He published a paper in 1990 while, that same year, he published a book, "Dr. Dean Ornish's Program for Reversing Heart Disease" (Ballantine Books), which climbed to No. 3 on The New York Times best-seller list.
Now Ornish is hoping that he can show his program can prevent or reverse cancer. And, he says, he would like to see it licensed for use across the United States.
Sacks, for one, questions whether very many patients could stick with the program. "I have extreme skepticism and a lot of experience with patients," he said.
Sacks said he obtained a grant from the National Institutes of Health to study Ornish's program, but he had great trouble recruiting patients.
"We pulled out all the stops. We had a superb staff," Sacks said. But few patients agreed to try the program and they could not stick with it, he said.
Ornish agrees that his program is not for everyone. But, he emphasizes, the program is more than just a medical treatment for heart disease. He follows the diet himself, he says, "because I prefer low-fat foods." And, Ornish adds, the program has other rewards.
"Probably the most important reason that many people smoke or eat too much is because it helps them deal with stress and loneliness and isolation," Ornish said. That is where stress management and support group meetings come in, he said.
Patients adhere to his program, Ornish said, because they have gone
beyond "fear of dying to joy in living."
Copyright 1998 The New York Times Company