by Albert Cilia-Vincenti

This series explores Dean Ornish’s 30-year research experience into healing and disease reversal by dietary and lifestyle changes. He is a California University Professor of Medicine in San Francisco.  This instalment begins to explain why his programme works, whilst others prove to be unsustainable.

Dean Ornish claims that when people make the diet and lifestyle changes recommended in his programme, most of them find that they feel so much better so quickly that it reframes the reason for changing one’s habits from fear of dying to joy of living. Joy and love are powerful sustainable motivators, but fear and deprivation are not.

Ornish contends that depending on how much you move in a healthy direction along this range, you’re likely to look better, feel better, lose weight and gain health. People have different needs, goals and preferences. What matters most is one’s overall eating and living habits. One may indulge in food one day and eat more healthily the next. One can be a couch potato one day and exercise a little more the next. Consistency is more important than duration. This way one is less likely to feel restricted. Studies show that people who eat most healthy are those who allow themselves some indulgencies.

If one is trying to reverse heart disease or prevent cancer recurrence, one may need bigger changes in diet and lifestyle than someone who just wants to lower his/her cholesterol level a few points or lose a few kilograms. If one has a strong family history, or if genetic testing shows one to be at higher risk, this can be a powerful motivator to make bigger dietary and lifestyle changes than one might otherwise make. It may also be possible to tailor drug therapy more effectively.

Many people have hypercholesterolaemia. You may initially advise them to follow a diet. For some, that’s sufficient to lower their cholesterol adequately, but not for most. Then you usually prescribe cholesterol-lowering drugs, in many instances for the rest of their life. In Ornish’s experience, most people can make progressively bigger dietary and lifestyle changes to achieve their goals, often without medication. How much you want to change is up to you. If you don’t have a serious illness, such as coronary heart disease, it usually doesn’t matter if you indulge yourself occasionally but, if you do have heart disease, even a single meal high in saturated fat may increase the risk of chest pain or even a heart attack.

Even more than feeling healthy, most people want to feel free and in control. Telling people to “eat this and don’t eat that” or “don’t smoke” don’t work, at least not for long, because human nature being what it is, they would want to do the opposite. Nobody wants to feel controlled or treated like a child. People need to feel empowered and in control, so that they can feel free to make healthy choices that are sustainable. They need to understand the reasons for eating this way, which is better than telling them “because I said so”. If you go on a diet and lifestyle programme and feel constrained, you’re likely to go off it sooner or later. Offering a range of choices is much more effective, because you feel free. If you see your food and lifestyle choices each day as part of a range, as a way of living, you are more likely to feel empowered and to be successful.

The language of behavioural modifications (like “cheating on a diet”) often has a moralistic quality to it that turns people off. It’s a small step away from thinking of foods as ‘good’ or ‘bad’ to seeing yourself as a ‘good person’ or a ‘bad person’ if you eat them. However, although we often project moral qualities onto it, food is just food. In the short term, one might be pressured into changing his/her diet, but sooner or later, one will rebel. Ornish’s programme is therefore not trying to get you to do anything, but is only sharing information that one can use to make informed and intelligent choices.

How one eats is as important as what one eats. If a person is concentrating on television, reading or having a heated conversation while eating, he/she can go through an entire meal without tasting the food – having all the calories and none of the pleasure. On the other hand if that person concentrates on what he/she is eating, smaller food portions can be exquisitely satisfying. A calorie is a calorie in terms of its effect on one’s weight, but not in terms of how much pleasure it provides. Paying attention to what one is eating will also make one notice how different foods affect him/her. This will help to identify those foods which affect negatively the general well-being of the concerned person.

Bibliography

Hill JO, Wyatt HR, Reed GW, Peters JC. Obesity and the environment: Where do we go from here?  Science 2003; 299(5608): 853-5.