|Anyone seeking information about diet and nutrition quickly discovers that there are countless nutrition books and websites, each with a different set of rules and regulations. For the average person sincerely desiring dependable information, this presents a major dilemma: whom do you trust?
With nutrition, as with many things in life, it is helpful to start with the assumption that many roads can lead to the desired destination. Since there are healthy people following diets that differ substantially from one another, it follows logically that no single set of guidelines must be rigidly adhered to by all people seeking good health. Fortunately, we have choices.
Having choices, however, does not mean that we can eat and drink all manner of junk food in cavalier fashion, trusting that everything will turn out fine. Some people can follow a grease-filled, vegetable-free diet, yet live to be 90 and never develop heart disease. Others can smoke two packs of cigarettes a day and never get lung cancer or asthma. These people are the exceptions. For the vast majority, such courses of action can have grave consequences.
Health research in recent years has repeatedly turned conventional wisdom upside down. Time and again, ideas condemned as nonsense by the medical establishment have appeared in learned medical journals a couple of decades later, hailed as exciting new discoveries. Perhaps the most dramatic example is the role of diet and nutrition in cancer prevention. Scoffed at for years as a fantasy, the preventive role of a healthful diet is now heartily endorsed by the National Institutes of Health's National Cancer Institute (which now estimates that at least 35% of cancers have nutritional causes)1,2 the American Cancer Society (which advises everyone to "eat a healthy diet with an emphasis on plant sources") and all other major health science institutions.
Groundbreaking research by Dean Ornish, MD, published in the Journal of the American Medical Association3-9 and The Lancet,10,11 has demonstrated that heart disease can be reversed through a combination of a very low-fat, whole foods vegetarian diet along with exercise and stress reduction practices. No other non-drug, non-surgical method, including the reduced-fat-plus-exercise regime that is still the standard of care in conventional medicine, has ever been shown to reverse heart disease. At best, they just slow its advance. If a pharmaceutical drug achieved the dramatic results seen in the Ornish program, it would be malpractice for any physician to fail to prescribe it.
In certain key respects, the natural foods approach has become the recognized standard, though like many standards it is applied too seldom. In the mid-1970s, the United States Senate Select Committee on Nutrition, led by Senators George McGovern and Robert Dole surveyed the field, reviewed the scientific literature, and then endorsed many of the long-held principles of the natural nutrition movement. In its landmark report, this committee advised eating more whole grains, more vegetables and fruits, less salt and sugar, less meat, and less fat in general. The United States Department of Agriculture Dietary Guidelines, which have gone through several revisions since then, largely codified the ideas advanced in the Senate report. Though they do not go as far as some of us would prefer, they are nevertheless a major step in the right direction.
When this pattern of a whole foods, plant-centered diet truly becomes the norm, our society as a whole will be much healthier as a result. If, in addition, the entire population were to stop smoking, keep alcoholic beverages and caffeine intake to a modest level, and exercise regularly, the effects would be truly revolutionary. These simple recommendations have been repeated so often in recent years that they have become a kind of health cliché. Yet most people I've seen as patients ignore at least a few of them and some people's diets seem tailor-made for self-destruction.
Here, briefly, are the cornerstones of a healthy diet: eat whole, unprocessed foods (primarily plants) including vegetables and fruits, whole grains, beans and legumes, nuts and seeds. Keep overall fat content to a minimum and include a substantial amount of fiber from sources like beans, whole grains, vegetables and fruits. If you choose to eat meat, it should be relatively low in fat and not high in quantity. You also need adequate calcium intake, either from dairy products (a controversial issue we will address in a future issue of this newsletter), plant sources such as kale, broccoli, and soybeans, calcium-fortified foods, or calcium supplements. In addition, some form of omega-3 fatty acids (from fish, flax seeds, walnuts, or supplements) is needed. These dietary recommendations are consistent with guidelines of the various branches of the National Institutes of Health and major advocacy organizations such as the American Cancer Society, American Heart Association and American Diabetes Association. Thirty five years ago, these groups did not endorse this dietary approach. They do now.
Fortunately, no one needs a doctor's prescription in order to eat a healthy diet. Well-informed health professionals can be very helpful partners as you make a transition, but success depends mainly on your own willingness to make healthy changes and sustain them over time. People who choose not to change unhealthy habits stand a good chance of severely handicapping their chances to achieve optimal health. To the extent that a society collectively ignores this information, as is still the case in much of contemporary America, it is choosing illness over health.
Today is as good a day as any to think deeply about your health and what you can do to improve it. All steps in the right direction, small or large, deserve encouragement. To a very large extent, your health future is in your own hands.
- National Cancer Institute. Cancer rates and risks. Washington, DC, 1985.
- Doll R, Peto R. The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today. J Natl Canc Inst 1981;66:1191-308.
- Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. Dec 16 1998;280(23):2001-2007.
- Ornish D. Serum lipids after a low-fat diet. JAMA. May 6 1998;279(17):1345-1346.
- Ornish D. Dietary fat and ischemic stroke. JAMA. Apr 15 1998;279(15):1172; author reply 1172-1173.
- Gould KL, Ornish D, Scherwitz L, et al. Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification. JAMA. Sep 20 1995;274(11):894-901.
- Ornish D. What if Americans ate less fat? JAMA. Jan 15 1992;267(3):362; author reply 363-364.
- Sacks FM, Ornish D, Rosner B, McLanahan S, Castelli WP, Kass EH. Plasma lipoprotein levels in vegetarians. The effect of ingestion of fats from dairy products. JAMA. Sep 13 1985;254(10):1337-1341.
- Ornish D, Scherwitz LW, Doody RS, et al. Effects of stress management training and dietary changes in treating ischemic heart disease. JAMA. Jan 7 1983;249(1):54-59.
- Ornish D, Brown SE, Scherwitz LW, et al. Lifestyle changes and heart disease. Lancet. 1990;336(8717):741-742.
- Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. Jul 21 1990;336(8708):129-133.