Ornish Update: Intense Program Has Immediate Results and a Few Surprise Barriers.By Hollis Bass, RDWhen Dean Ornish, MD, published results of the Life-style Heart Trial in the early 90’s, dietitians were impressed but skeptical. Impressed by results showing a reversal of heart disease in subjects who maintained life-styles changes. Skeptical because we had always emphasized small, gradual changes in the treatment of heart disease. With many patients reluctant to make even small changes, such as switching to skim milk, was it realistic to expect them to so drastically modify their daily routines? Would the Ornish program work in the “real world”?To answer this question, Ornish and his Preventive Medicine Research Institute (PMRI) studied heart patients participating in year-long outpatient programs at eight hospital sites around the country. While final data is not yet available, preliminary results show significant improvement in risk factors such as LDL (“bad”) cholesterol and body fat, as well as a significant decrease in angina.In talking to several dietitians around the country, here is what they are saying about their experience with the program:Diane McIlhon, RD, LD, Coordinator of the Ornish Program at the Iowa Heart Center in Des Moines, notices quick improvement in her patients. “It’s impressive to see people having their chest pain improved after just a couple of weeks,” said McIlhon. Since 1994, 200 people, ranging in age from 30 to 80 years have completed the Des Moines program.While you might think giving up meat, fats and oils is the main obstacle, the diet is not usually the hardest component to follow, according to McIlhon. “The diet actually becomes the easiest part because it is concrete,” she said. “Often the stress management is the hardest to maintain because it is a true life-style change.” She explains that participants practice at least one hour of stress management daily, using yoga with stretching, breathing, and progressive relaxation. “Sitting quietly for an hour a day is not a part of our culture,” McIlhon adds.Colleen Wracker, RD, Nutrition Specialist at Richland Memorial Hospital’s Ornish Program in Columbia, SC, adds that the significant time commitment and family support are other issues participants face. In terms of the dietary restrictions, Wracker notes that “one of the biggest challenges for my patients is giving up caffeine.” Even decaf coffees and teas are excluded because the small amount of caffeine still present could affect stress levels.Despite these challenges, McIlhon and Wracker report compliance during the program. Difficult times come after patients graduate. In Des Moines, 75 out of 200 graduates continue to meet for support and activities such as exercise and yoga.Jan Waters, RD, CDE, who teaches at PMRI’s week-long retreats in California, integrates the program components into her teaching and counseling as a Nutrition Specialist at Pacific Care HMO in Las Vegas. “People with heart disease and other chronic diseases need to be aware of the impact other things have on their state of wellness,” said Waters. This may well be the most “real world” approach to the Ornish program.What is the Ornish Diet?• No animal products except egg whites and nonfat dairy products• No more than 10 percent of total calories from fat• No more than 10 mg. dietary cholesterol per day• Approximately 15 percent total calories from protein• Approximately 75 percent total calories from complex carbohydrates• Restricted salt intake for: hypertension, heart failure or kidney disease• Less than two ounces alcohol per day• No caffeineTips for using the Ornish Components in your practice:1. Give it a try... live Ornish-style for one week. RDs who teach at official Ornish sites attend a week-long retreat side by side with other participants. Learn first hand how it feels to make major lifestyle changes.2. Be flexible... offer your patients choices. Small, gradual dietary changes or immediate, comprehensive lifestyle changes. Given the opportunity and motivation, some patients will choose the Ornish-style method.3. Keep an open mind... remember that dietary changes are only one part of a healthy life-style. Less stress and  more exercise might help more than giving up a favorite dessert.4. Foster group support. Find ways to increase participation and interaction between patients in your classes. Learn to facilitate group discussion instead of lecturing.5.Emphasize the link between stress and disease. Ask a mental health professional to speak to your classes or to give you a primer on stress management techniques.6. Provide easy and cost-efficient recipes for plant-based meals. Cooking classes are a great way to show meat-eaters how to prepare delicious vegetarian dishes.7. Include the patient’s family. Committed spouses or significant others are vital to success.8. Discuss the Ornish components with physicians and other members of the healthcare team. Let them know they can send their motivated patients to you.9. Refer to Dr. Dean Ornish’s Program for Reversing Heart Disease (Random House/Ballantine)