DEAN ORNISH: Right, well not only is there barely any reduction in fat, but also they usually put in tons of sugar. I am so sorry that I somehow have gotten this reputation as the low-fat guy. I think it came out of the debates I was in with Dr. Atkins. To me that is the least interesting part of the work that we do.
JOHN ROBBINS: What would you say is the role of fat in an optimally healthy diet?
DR. DEAN ORNISH: It depends. Three or four grams a day of omega-3 fatty acids taken during pregnancy can increase a child's IQ. For adults, they can reduce your risk of sudden cardiac death by up to 80 percent, because they raise the threshold for ventricular fibrillation. They can reduce your risk of prostate or breast cancer. They can help reduce inflammation. They can lower triglycerides. I think that those are good things to have in your diet.
If you are vegan, you can get omega-3 fats from the plankton-based supplements, and if you are not, you can get them from fish oil. I recommend that just about everybody take three or four grams a day of fish oil or the equivalent.
There is a consensus that trans fats are harmful in a number of different ways. There is a lot of controversy about whether saturated fat is harmful or not. I think it is, with the possible exceptions of the saturated fat that you find in chocolate, which, although it is dense in calories, may actually be good for your heart.
Total fat consumption matters in a number of ways, one of which is that fat is the most dense form of calories. Fat has nine calories per gram and protein and carbs have only four. So if you are eating less fat, you are getting fewer calories without having to eat less food. It is the volume of the food that really seems to stimulate satiety more than the caloric density of the food. An easy way to lose weight is to just reduce the amount of fat in your diet, because you are going to be getting the same quantity of food, but it will be less dense in calories, so you are going to be eating fewer of them.
JOHN ROBBINS: How about coconut?
DR. DEAN ORNISH: Coconut is high in saturated fat. I think the jury is out on coconut. I haven't seen enough good evidence either way.
JOHN ROBBINS: Olive oil is frequently touted as a health food and the center of the Mediterranean Diet. At the same time, canola oil is getting a bad reputation in certain circles. What do you think of this controversy?
DR. DEAN ORNISH: One of the main reasons people think that olive oil is good for you is because of the Lyon Study that took place in France. People consuming what was termed a Mediterranean Diet had an 80 percent lower risk of heart attacks than those who didn't. But if you actually looked at what they were eating on this so-called Mediterranean Diet, they were reducing their intake of saturated fats—meat and butter and dairy and so on. And they were eating a diet that was high in canola oil. What makes canola oil beneficial are the omega-3 fatty acids that are high in canola oil but are very low in olive oil. That is what they were eating in the Lyon Study, and so the Mediterranean Diet that was so beneficial was high in canola oil, more than in olive oil.
Now olive oil does have antioxidants. It has some good things. The problem with olive oil is that, like all oils, it is so dense in calories. One tablespoon of olive oil has about fourteen grams of fat. People dip their bread in it and soak up large amounts of oil, thinking it is somehow going to be good for them and not realizing that they are getting a lot of calories.
JOHN ROBBINS: I want to ask you about alcohol. I have always seen you as somebody who wants people to enjoy their life.
DR. DEAN ORNISH: Absolutely. What is the point otherwise?
JOHN ROBBINS: For many people, alcohol is part of their joy in life and their connection with other people. Yet of course, in excess it is addictive and terribly destructive. We are seeing some evidence that moderate alcohol consumption has actual health benefits. What is your take on this?
DR. DEAN ORNISH: I think that you should do things you enjoy. I don't prescribe alcohol. I don't proscribe alcohol. I say if you are going to drink, the studies show that it is best to keep it on average under two drinks a day. Two drinks means two glasses of wine, two cans of beer, two shots of whiskey, or the equivalent.
The studies show that people who drink moderately can derive some benefit. But these are people who like to hang out with their friends after work. They go to a bar or go to a restaurant for happy hour. It's a great place for people to get social support. So it's hard to separate how much of that benefit is due to the social support, and how much is due to moderate alcohol consumption. Rather than trying to sort out the relative parts, I would say they are probably both important. But I wouldn't tell somebody who is not drinking to start. I think that it is important that people feel like they have lots of ways of increasing their social support or managing stress. Some people may sit around drinking, and other people will do it in other ways.
JOHN ROBBINS: Medicine is a business and there are powerful commercial forces involved. There is a lot of money at stake, and the incentives haven't always been aligned with patient well-being.
DR. DEAN ORNISH: I think that is beginning to change with the Affordable Care Act. Now instead of reimbursement by procedure we're seeing reimbursement by diagnosis. When you say, “Here is X amount of dollars to take care of someone who has got heart disease,” then suddenly the doctor might be advising doing fewer procedures and helping people to change their lifestyles.
We all know that lifestyle is important in preventing disease. But now we're seeing lifestyle as a treatment. It can often work as well or even better, at a fraction of the cost, with only good side effects.
There is a convergence of forces that makes this the right idea at the right time. The limitations of high-tech medicine are becoming clear. Stents and angioplasties don't work for stable patients, and the surgery for prostate cancer isn't really necessary most of the time. Meanwhile, the power of these very simple, low-tech, low-cost interventions like lifestyle changes have become increasingly well-documented.
The opportunities are really ripe now for industries to realize that a new paradigm of medical care can be much more sustainable, and even profitable.
Health care costs are reaching a tipping point. They are not financially sustainable for the government nor for many families. Most large businesses are self-insured, and this is coming right off their bottom line. There is a debate between some people who say, “Let's just raise taxes and let the deficit go up,” and other people who say, “No, let's just dismantle or privatize Medicare.”
I say, “If 75% of the $2.8 trillion in health-care costs are for chronic diseases that can often be prevented and even reversed by making comprehensive lifestyle changes, this can be a third alternative. By teaching people how to change their lifestyles, we can make better care available to more people at significantly lower costs—and the only side-effects are good ones.”
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Caldwell Esselstyn, M.D.
You Can Prevent and Cure Heart Disease. Period.
Caldwell Esselstyn, M.D., is author of the bestselling book, Prevent and Reverse Heart Disease. Drawing on the insights from his decades of rigorous research and more than 150 scientific papers, Dr. Esselstyn explains, with irrefutable, scientific evidence, how we can literally end the heart disease epidemic forever by changing what we eat. His work is featured in the extraordinarily popular documentary, Forks Over Knives.
Do you or anyone you know suffer from heart disease? It's the leading killer in the world. Would you like to know Dr. Esselstyn's simple and life-saving prescription?
JOHN ROBBINS: You conducted a study that rocked the medical world. You have said that patients in your study who were compliant, and 95 percent of them were, became virtually heart-attack proof. That is strong language, and your research seems to support it. Yet the idea for