Dean Ornish

What Dean says, topic by topic

Vitamin B12

Asked about B12 in a 2019 webinar with John McDougall, Ornish said it matters mainly for people who are fully vegan, since in his view the vitamin comes only from animal foods¹. He added that the body keeps a reserve lasting five to seven years, so a shortfall is unlikely in the short run, and said vegans should still supplement¹.

The Ornish program’s site says B12 may be missing entirely from a low-fat vegan diet and points to fortified cereals and nutritional yeast². It also notes that the body absorbs only a small part of a large oral dose, about 10 mcg out of 500 mcg in healthy people³.

What all the experts say about vitamin B12

Vitamin D

In the same 2019 webinar Ornish said he takes a little vitamin D, around 1,000 units a day⁴. McDougall answered that recent trials, among them the VITAL study published in January 2019, had found little benefit from vitamin D or omega-3 pills⁵.

The program’s site prefers sunlight to food as a source. It says ten minutes of summer sun gives as much vitamin D as about thirty glasses of milk⁶, and that 10 to 15 minutes in summer sun yields roughly 3,000 to 5,000 IU⁷.

What all the experts say about vitamin D

Omega-3 fats

In the 2019 webinar Ornish granted that newer studies had made omega-3 look less useful than once thought, but said he still sees a role in keeping the heart’s rhythm steady⁸. He said he takes 3 grams a day from plankton, and named fish oil or flaxseed oil as the alternatives for people who are not vegan⁸.

In an online column signed by Ornish (reader comments date from 2015), he named a fish oil brand, saying he had no financial tie to it and that it removes mercury, PCBs and dioxin⁹. For vegans he pointed to plankton-based capsules carrying both DHA and EPA⁹.

By 2022, talking about his book Undo It!, he described the program as more vegan than before and said omega-3s can come from algae instead of fish¹⁰.

What all the experts say about omega-3 fats

Oil

The Ornish program caps fat at 10% of calories, which it reaches by adding no fats, oils, avocados, coconut or olives¹¹.

It is less absolute than the no-oil camp in practice. Its guidelines allow low-fat packaged foods now and then, which may hold small amounts of olive or canola oil¹², and a 2014 program recipe video lightly sprays or wipes the pan with olive oil¹³.

Ornish applies the rule when eating out. In the 2019 webinar he said he asks restaurants for the freshest vegetables, cooked with no oil, butter or salt¹⁴.

What all the experts say about oil

Protein

In a 2014 interview Ornish argued that the low-carb debate misses the source of the protein¹⁵. He cited a study from that year in which diets high in animal protein (plant protein did not count) went with about 75% higher early mortality, four times the cancer deaths and five times the diabetes¹⁵.

A column under his name on the program’s site (comments from 2016) makes the same point and adds that more plant protein was not linked to higher risk and even looked protective¹⁶. Answering a reader in 2016, a program dietitian cited the official allowance of 0.8 grams per kilogram and called it generous for most people¹⁷.

In 2022 he also made an environmental case, saying meat protein takes about 14 times the resources of plant protein¹⁸.

What all the experts say about protein

Calcium, dairy and bones

In a Charlie Rose interview (posted 2011) Ornish listed nonfat dairy among the foods of his reversal diet, beside fruit, vegetables, grains, beans and soy¹⁹. The program’s 2022 guidelines still listed nonfat dairy as optional, up to two servings a day, with soy milk encouraged instead²⁰.

Asked in 2019 why the program had included skim milk, he said a cup of nonfat milk or yogurt was an early concession so the diet would not seem too extreme, and that his later studies, on prostate cancer and Alzheimer’s, left it out²¹.

On bones, the program’s site describes osteoporosis as a balance between calcium taken in and calcium lost²². It says diets heavy in meat and dairy push more calcium out in the urine, and that salt raises that loss too²²²³.

What all the experts say about calcium, dairy and bones

Calorie density

Ornish explains weight mostly through how dense food is in calories. In a 2012 talk he said fat carries 9 calories per gram against 4 for protein and carbohydrate, so a lower-fat diet lets people eat the same amount of food for far fewer calories²⁴.

He makes a parallel point about fiber. In the same talk he said whole foods such as apples fill people up before they overeat, while sugar and white flour can be eaten almost without limit²⁵. On NBC’s Today show that year he called this eating less fat without eating less food²⁶.

What all the experts say about calorie density

Nuts, seeds and avocado

The program’s 2022 guidelines add no avocados and allow nuts only in small portions, because they are so concentrated in fat¹¹²⁷.

An article on the program’s site says the reversal program now allows a limited amount of certain nuts and seeds²⁸. They count within its low-fat servings, where one serving holds 3 grams of fat or less: about 5 almonds, one walnut or 5 teaspoons of ground flax²⁹.

What all the experts say about nuts, seeds and avocado

Soy

Soy foods have been part of Ornish’s diet description for years: he named soy products among its main foods in the Charlie Rose interview posted in 2011¹⁹ and again in a 2012 TV segment³⁰.

An article on the program’s site, written with Ornish’s input, addresses fears about plant estrogens³¹. It says they bind the estrogen receptor only weakly and may even block it at low levels, and the program suggests one to two servings of soy a day³¹.

What all the experts say about soy

Salt

Salt is not a major theme for Ornish. The reversal guidelines on his Spectrum program pages (archived 2011) asked only for moderate use of salt, unless a doctor says otherwise³². When he eats out, he said in the 2019 webinar, he asks for fresh vegetables cooked with no oil, butter or salt¹⁴.

What all the experts say about salt

Sugar

On NBC’s Today show in 2012 Ornish said he agreed with Robert Atkins that Americans eat too many refined carbohydrates, such as sugar and white flour, which he said raise blood sugar quickly without filling people up³³. He parted ways with Atkins on the fix: whole fruits, vegetables, grains and legumes rather than bacon and sausage³⁴.

In a 2014 interview he again drew the line between sugar and refined flour on one side and whole grains on the other³⁵. In the 2019 webinar he said fiber in whole grains slows absorption and avoids sharp sugar swings³⁶, and cited US food supply data showing Americans eating more sugar, fat, meat and calories every decade since 1950³⁷.

What all the experts say about sugar

Supplements

Ornish’s list of supplements has changed over the years. In a 1999 Fresh Air interview he backed some antioxidant vitamins, folic acid to bring down homocysteine, and 2 to 3 grams daily of fish or flaxseed oil, which he said could cut sudden cardiac death by half or more³⁸.

His reversal guidelines (archived 2011) listed a low-dose multivitamin and mineral with B12, fish oil and, if a physician advises it, calcium; antioxidant vitamins and folic acid were left optional³⁹.

In the 2019 webinar he said supplements help when used with judgment, as an addition to good food rather than a substitute⁸. He listed his own: omega-3s, magnesium, curcumin because Alzheimer’s runs in his family, a little vitamin C and a multivitamin with no iron⁴⁰. McDougall replied that recent trials had found little benefit from omega-3 and vitamin D pills⁵.

What all the experts say about supplements

Iron

Ornish treats extra iron as something to limit rather than a nutrient to chase. In the 1999 Fresh Air interview he counted iron among the oxidants that a low-fat plant diet helps people avoid⁴¹. His reversal guidelines (archived 2011) called for a multivitamin without iron for people not of childbearing age³⁹, and in 2019 he said the multivitamin he takes has none⁴⁰.

What all the experts say about iron

Fish and eggs

In the Charlie Rose interview (posted 2011) Ornish said that swapping some red meat for fish and chicken barely moves cholesterol⁴². In 2022 he made the same contrast: the milder heart diets of the past, with more fish and chicken and about four eggs a week, only slowed artery clogging, while his more intensive program aimed to stop or reverse it⁴³.

The program’s site explains that fish was not part of the lifestyle shown to reverse heart disease, so it does not recommend it⁴⁴. It adds that fish protein arrives with cholesterol and pollutants⁴⁵. Its 2022 guidelines still allowed egg whites⁴⁶.

What all the experts say about fish and eggs

Fiber

Fiber is the heart of Ornish’s line between good and bad carbohydrates. In 1999 he said the fiber in whole fruits, vegetables, grains and beans slows absorption, so blood sugar does not spike and insulin is not provoked; milling brown rice or whole wheat into white strips that fiber and bran away⁴⁷. On NBC’s Today show (segment posted 2012) he added that fiber fills people up before they take in too many calories⁴⁸, and he repeated the point in the 2019 webinar³⁶.

In a 2014 column for people with type 2 diabetes he advised eating whole fruit instead of drinking juice, because fiber slows the passage of food from the gut into the blood⁴⁹.

What all the experts say about fiber

Fruit

Ornish places fruit among the most healthful foods and stresses eating it whole. His 2014 column for people with diabetes preferred whole fruit to fruit juice⁴⁹. In a 2012 talk he used apples to show how fiber limits eating, since people feel full long before the calories add up²⁵. In a 2014 program video he said blueberries can even make people smarter⁵⁰.

What all the experts say about fruit

Whole grains, bread and flour

Ornish draws a sharp line between whole and refined grains. In 1999 he said that removing the fiber and bran from whole wheat flour or brown rice turns a complex carbohydrate into a simple one⁴⁷. In the Charlie Rose interview (posted 2011) he said he had eaten oatmeal for breakfast, and that pasta is fine alongside other high-fiber foods, as long as grains are whole rather than white flour⁵¹.

In his 2008 reply to readers of the New York Times TierneyLab blog he cited the Nurses’ Health Study, in which women who ate more whole grains had less coronary heart disease⁵².

What all the experts say about whole grains, bread and flour

Meat

There is no meat in Ornish’s reversal diet, as he told Charlie Rose (posted 2011)⁵³. On the Today show (segment posted 2012) he said red meat can raise the risk of breast, prostate and colon cancer and of heart disease, and that people are healthier the more they avoid it⁵⁴. In 2014 he cited Harvard cohort analyses linking red meat to higher death rates overall and from heart disease and cancer⁵⁵.

For people who do eat red meat, his Spectrum pages (archived 2011) place it in the least healthful food group and suggest organically raised, humanely slaughtered animals, noting that feedlot meat has more fat and cholesterol than grass-fed⁵⁶.

He also makes an environmental and ethical case. In 2022 he linked livestock to global warming¹⁸ and to clearing of the Amazon, while saying people need not become vegan: even one meatless day a week gives food choices meaning⁵⁷.

What all the experts say about meat

Low-fat eating

Ornish is often called the low-fat doctor, but his Spectrum Q&A says that label was never quite right: he recommends less total fat, very little of the bad fats and enough omega-3⁵⁸. For reversing heart disease the program keeps fat near 10% of calories, which a 2014 program video put at about 25 grams a day from plant foods⁵⁹.

He does not ask everyone to go that far. In the Charlie Rose interview (posted 2011) he said he advises a more moderate diet for people without heart disease, while adding that most people would be better off eating less fat⁶⁰. Asked on Fresh Air in 1999 whether he had changed his mind about very low-fat eating, he said the evidence for it was stronger than ever⁶¹.

He often criticizes trials that label a diet low-fat when fat barely changes. In 2008 he noted that the low-fat group in a much-cited low-carb trial went from about 31% to 30% of calories from fat⁶², and in 2014 he made the same objection to a study comparing a 35% fat diet with a 30% one⁶³.

What all the experts say about low-fat eating

Saturated fat

In his 2008 TierneyLab reply Ornish disputed Gary Taubes’s claim that a large low-carb trial cleared saturated fat. He said saturated fat in the Atkins group rose by less than a gram a day, too little to prove anything⁶⁴, and cited a crossover study in which blood flow worsened on an Atkins diet, more so as saturated and total fat intake rose⁶⁵.

In a 2014 program video he said red meats and saturated fats harm the brain as well as the heart⁶⁶. His Spectrum pages (archived 2011) explain why he ranks bad fats below refined carbs: eating healthy foods with them does less to offset their harm⁶⁷.

What all the experts say about saturated fat

Cholesterol

In a 2012 program video Ornish said the body makes all the cholesterol it needs, so people need none from food⁶⁸. Those willing to make bigger changes, he said, lowered cholesterol by almost 40% on average, close to what drugs achieve⁶⁹; in 2008 he tied that figure to a randomized trial at 10% fat with no cholesterol-lowering drugs⁷⁰.

He explains differences between people through genetics. In the Charlie Rose interview (posted 2011) he said people vary in how well they clear fat and cholesterol, and those with heart disease tend to clear it poorly, so a small cut in intake still leaves more than their bodies can handle⁷¹.

On HDL he argues that higher is not always better. A 2014 column compares HDL to garbage trucks hauling cholesterol away, so a rich diet can raise HDL and a low-fat diet can lower it without harm⁷². He does prescribe statins, he said in 2019, for patients who do not want to change their diet⁷³.

What all the experts say about cholesterol

Carbohydrates and low-carb diets

Ornish has argued with low-carb advocates since his debates with Robert Atkins. He agrees with them that refined carbs do harm, but in a 2014 interview he said the low-carb revival sells by telling people that bacon, sausage and red meat are good for them⁷⁴. He added that low-carb studies track risk factors rather than the arteries, and that when arteries were measured on high-protein, low-carb diets, blockages grew⁷⁵.

In his 2008 TierneyLab reply he said only two published studies had measured heart health on an Atkins diet, both finding worse blood flow, and that none showed it reverses heart disease⁷⁶.

What all the experts say about carbohydrates and low-carb diets

Coffee, tea and caffeine

The reversal guidelines on his Spectrum pages (archived 2011) removed all caffeine, including regular and decaf coffee and tea, chocolate and cocoa, on the grounds that caffeine interferes with meditation and relaxation⁷⁷. Green tea was the exception, limited to two cups a day, for its antioxidant polyphenols⁷⁸.

What all the experts say about coffee, tea and caffeine

Alcohol

Ornish groups alcohol with sugar and white flour as a simple carbohydrate the body turns into sugar, as he said on Fresh Air in 1999⁷⁹. His 2014 column on high triglycerides lists alcohol among the refined carbs to avoid⁸⁰.

In the same 1999 interview he questioned the red wine story, suggesting moderate drinkers may live longer because of the social side of drinking together rather than the wine itself⁸¹. His reversal guidelines (archived 2011) allowed one drink a day but did not encourage it⁸².

What all the experts say about alcohol

Chocolate

Ornish says he eats a little dark chocolate almost every day; his book The Spectrum opens with that habit, presented as enjoying his diet rather than cheating on it⁸³. In a 2014 program video he described picking the darkest, richest chocolate and letting a small piece melt slowly, for a lot of pleasure from few calories⁸⁴.

His Spectrum pages (archived 2011) say a little dark chocolate daily may lower blood pressure, while a lot of it brings sugar, calories and saturated fat⁸⁵. The stricter reversal guidelines on the same pages removed chocolate and cocoa along with other sources of caffeine⁷⁷.

What all the experts say about chocolate

Juicing and smoothies

His view of juice depends on the juice. In the 2014 column for people with diabetes he advised skipping fruit juices in favor of the whole fruit, whose fiber slows the rise in blood sugar⁴⁹. In the 2014 nutrition video, though, he cited one of his own studies suggesting that a daily glass of pomegranate juice may start to reverse heart disease within a few months⁵⁰.

What all the experts say about juicing and smoothies

Mediterranean diet

Asked on Fresh Air in 1999 about the Mediterranean diet, Ornish credited its fruits, vegetables, grains and beans but not its olive oil⁸⁶. He said olive oil has almost no omega-3 and more omega-6, that Mediterranean countries have less heart disease and cancer than the US but more than Japan or China, and called the diet better but not optimal⁸⁷.

In 2008 he wrote that the Atkins, Mediterranean and low-fat diets each have some benefits, and that an ideal diet takes omega-3s from the Mediterranean pattern while staying low in saturated fat and high in plant foods⁸⁸.

What all the experts say about mediterranean diet

Weight loss

In a 2012 talk Ornish said the average participant in his research lost 24 pounds in the first year and still had half of that off five years later, although weight loss was not the program’s aim⁸⁹. He added that many people overeat when stressed, lonely or depressed, so the program works on those causes too⁹⁰.

On the Today show (segment posted 2012) he said people can lose weight on diets heavy in red meat and fat, but at a cost to their health, just as they can on amphetamines or cigarettes⁹¹. In 2008 he set his trial’s 24-pound first-year loss against the 10 pounds reported in a major low-carb trial⁹².

What all the experts say about weight loss

Cravings and food addiction

Ornish sees overeating as a way of coping. In 2022 he recalled asking his patients why they smoked, overate or drank, and hearing that these habits help them bear loneliness and depression; one told him “fat coats my nerves”⁹³.

So he puts little faith in information or willpower alone. His Spectrum Q&A presents the program as resting on love rather than willpower, with nothing forbidden⁹⁴, and in a 2014 program video he warned that labeling foods good or bad leads people to feel bad and give up⁹⁵. At a 2019 conference he said food addictions lose their hold once people find something more compelling, such as feeling better or living for their family⁹⁶.

What all the experts say about cravings and food addiction

Exercise

Ornish’s rule is that the best exercise is one you enjoy, because then you keep doing it, as he said in a 2014 program video⁹⁷ and a 2014 column⁹⁸. He favors moderate activity: in the video he said a mile walked burns no fewer calories than a mile run, and suggested about 30 minutes a day, or an hour three times a week, for people in the heart program⁹⁹.

His Spectrum Q&A cites the Women’s Health Study, in which brisk walking for 60 to 90 minutes a week halved deaths from heart attack and stroke, and says exercise may even help the brain grow new cells¹⁰⁰. For people with heart disease, his column suggests asking a doctor for a safe exercise prescription based on a treadmill test⁹⁸.

What all the experts say about exercise

Heart disease

Heart disease is where Ornish’s work began. In 2022 he recalled his first study, run in 1977 while he was a medical student: ten patients with severe heart disease spent a month in a hotel on his program, and eight showed better blood flow to the heart¹⁰¹.

In a 2012 program video he said heart disease could be prevented in 95 to 99% of people¹⁰², and said that in his research blood flow to the heart improved within a month, chest pain fell by over 90%, and blockages shrank after a year and further after five¹⁰³. His 2008 TierneyLab reply added that 99% of patients stopped or reversed their disease, with two and a half times fewer cardiac events¹⁰⁴.

He doubts procedures for stable patients. In 2014 he cited an analysis of eight randomized trials finding that stents and angioplasty, outside of an actual heart attack, did not prolong life or prevent heart attacks¹⁰⁵, a point he repeated in 2022¹⁰⁶.

What all the experts say about heart disease

High blood pressure

In a 2012 program video Ornish compared blood pressure pills to mopping the floor around an overflowing sink without turning off the tap: they are prescribed for life because the cause is left alone¹⁰⁷. He said high blood pressure mostly stems from diet, stress, activity and social support, and that with enough change many people can reduce or stop their medication under their doctor’s supervision¹⁰⁸.

What all the experts say about high blood pressure

Diabetes

In a 2012 program video Ornish called type 2 diabetes an epidemic that is preventable or even reversible for most people¹⁰⁹. He argued that lifestyle can work better than drugs because the body adjusts blood sugar minute by minute, which a pill taken a few times a day cannot match¹¹⁰, and said bigger changes make it more likely that medication can be cut or stopped under a doctor’s care¹¹¹.

In a 2014 interview he said that lowering blood sugar with drugs prevents complications less well than lowering it through diet and lifestyle, and that bringing HbA1c under 7 that way can prevent them¹¹². A 2014 column cites program data from more than a thousand people with type 2 diabetes who moved their HbA1c from above 7 to below it, and says no extra fat or animal protein is needed, only fewer sugars and refined carbs¹¹³.

What all the experts say about diabetes

Cancer

Ornish’s cancer research centers on early prostate cancer. On Good Morning America (posted 2011) he described a trial with urologists Peter Carroll and William Fair: 93 men with biopsy-proven prostate cancer who had chosen not to be treated were randomly split, and after a year PSA fell in the group on a vegan diet with exercise, yoga, meditation and a support group, while it rose in the other group¹¹⁴. Serum from the men who changed slowed the growth of prostate tumor cells in the lab by 70%, against 9% in the comparison group¹¹⁵.

He stressed on the same show that the study did not show standard treatment to be unnecessary, and that people being treated may still gain from changing diet and lifestyle¹¹⁶. In a 2012 program video he said most men die with prostate cancer rather than from it, and that surgery and radiation often leave men impotent or incontinent without clear proof of longer life¹¹⁷; in 2019 he cited trials in which men with early disease who went untreated survived about as long as men given surgery or radiation¹¹⁸.

In the Charlie Rose interview (posted 2011) he said Japan has a fraction of US prostate cancer rates, which climb when people move to the US, and cited animal studies in which prostate tumors stopped growing or shrank on a low-fat diet¹¹⁹.

What all the experts say about cancer

Dementia and the brain

Ornish’s mother died of Alzheimer’s, and he has said he carries one copy of the APOE4 gene¹²⁰. In 2019 he said he had just started a randomized trial with UCSF neurologist Bruce Miller and others to test whether his lifestyle program can reverse early Alzheimer’s¹²¹. Halfway through, in 2022, he said gentler programs such as the FINGER study had slowed decline, and his theory was that a more intensive one might stop or reverse it, though he could not yet share results¹²².

He argues the same mechanisms drive heart disease and dementia, so what helps the heart helps the brain¹²³. At a 2019 conference he added that loneliness may feed a downward spiral in Alzheimer’s, as forgetful people withdraw and lose contact with others¹²⁴. In a 2014 program video he said red meats and saturated fats harm the parts of the brain that control memory⁶⁶.

What all the experts say about dementia and the brain

Longevity and aging

Ornish reports that his program may slow aging at the level of the cell. His book The Spectrum describes a study in which telomerase, the enzyme that repairs the ends of chromosomes, rose significantly after three months on his program¹²⁵. In the 2019 webinar he said a later study with Nobel laureate Elizabeth Blackburn found the telomeres themselves grew longer, which The Lancet described as reversing aging in cells¹²⁶.

He gives social ties as much weight as diet. In the same webinar he said his book Love and Survival reviewed studies showing that lonely, depressed and isolated people are three to ten times more likely to fall ill and die early¹²⁷.

What all the experts say about longevity and aging

Each small number links to its reference at the bottom of the page: the video at the exact second, or the page where it was said.