go on and off.
JOHN ROBBINS: It reminds me of the old story, The Tortoise and the Hare. Slow and steady wins the race.
DR. DEAN ORNISH: That's true. And it's also true that sometimes people do really well when they make big changes all at once because they feel so much better so quickly, and the effect of their changes is highly visible. For others it is easier to go with slow and steady.
We say, “Here are the risks and the benefits, the costs and the side effects. This is your life, and your responsibility. I am only here to support you and make sure that you have all of the information that you can use to make intelligent choices. I'm here to support whatever you choose to do, whether it is drugs, surgery, lifestyle, or a combination.”
JOHN ROBBINS: You have been engaged in a dialogue with Medicare for a long time that is now bearing fruit. One would hope that if you do good science it is going to change medical practice. But if there isn't reimbursement, then it might not.
DR. DEAN ORNISH: I am grateful for Medicare. They are now covering “Dr. Ornish's Program for Reversing Heart Disease” as a named program in the clinics, hospitals, and physician's offices where we train and certify. Having seen what powerful changes diet and lifestyle can make over the past thirty-five years of studies, it is great to be able to make them available. Reimbursement is an important determinant of medical practice and even medical education.
I learned a painful lesson when we opened a number of sites before we had reimbursement to cover our program. Even though we got excellent clinical outcomes, some of those sites closed down. They didn't close because the treatment wasn't working. They closed because it wasn't reimbursable.
If you change reimbursement, then everything follows. Without that even a thousand studies may not be enough to really change things.
After sixteen years of reviewing our work internally and externally, Medicare agreed to cover it. Now we can make it available to people everywhere, because most other insurance companies are following their lead.
We trained ten hospitals in West Virginia which has been the number one state in the country for heart disease, and 44 hospitals and clinics elsewhere, with many more to come. We trained the St. Vincent de Paul Society homeless clinic in San Francisco in our Spectrum Integrative Medicine Program and they have treated more than 15,000 people through it in the past year and a half. We will be offering our reversing heart disease program there as well which Medicare will reimburse, and then we'll clone it to St. Vincent de Paul homeless clinics throughout the country.
We are in the process of training lots of different people in our program and providing a truly integrative paradigm that incorporates the best of drugs and surgery when they are effective, but also addresses the more fundamental causes of why we get sick.
JOHN ROBBINS: You have become known for advocating a low-fat diet, and yet as you have so often pointed out, low fat is not synonymous with healthy. I have seen studies that purport to measure low-fat diets to see if there are any benefits, but they define “low fat” as an intake barely less than the norm in our culture, and then don't see benefits. There is barely any reduction in fat consumption, so you see barely any results.
DR. 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.
