limit - The Ornish Spectrum

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Introduction to the Nutrition Spectrum
Reversal Program
Our Goals For This Session
• Discuss the typical American diet and its impact
on heart disease risk
• Provide an overview of a low-fat, plant based
eating style and its health benefits
• Describe the nutrition guidelines and the rationale
• Introduce the Reversal Food Guide Pyramid
• Describe the process of adjusting to the Nutrition
Spectrum Reversal Program
2
What Is the Typical American Diet?
CARB
45%
PROTEIN
17%
FAT
38%
3
Fat and Animal Protein Sources In
the Typical American Diet
4
The Average American Consumes…
•
•
•
•
•
15 cows
12 hogs
900 chickens
12 sheep
1,000 pounds of other assorted animals
– Klaper, Michael MD. A Diet For All Reasons,
1992
5
The Results
6
Even Man’s Best Friend…
• “FDA OKs Pfizer Drug For Obese Dogs” Fri Jan 5,
1:59 PM
– “The Food and Drug Administration said Friday it
approved a Pfizer drug to help manage the weight of
obese dogs. Pfizer will market Slentrol, a liquid formula,
to the estimated 5 percent of U.S. dogs that are 20
percent over their ideal weight. In a statement issued
Friday the FDA says the drug's "mechanism for
producing weight loss is not completely understood," but
seems to cause less fat absorption. Overweight pets are
more likely to develop heart disease, diabetes and joint
problems, according to the government agency.
According to Slentrol's labeling, a veterinarian must
monitor the monthly weight change of a dog on the drug
and adjust the dosage accordingly.” (Cited from
Associated Press)
7
What We Eat Impacts Our Health
•
•
•
•
•
•
•
Coronary artery disease
Stroke
Certain cancers
Diabetes
Hypertension
Overweight and obesity
Osteoporosis
8
Nutrition and the Formation of
Atherosclerotic Plaque
9
The Goals of the Dr. Dean Ornish
Program For Reversing Heart Disease
10
An Integrated Approach to Reversing
Heart Disease
Fitness
Spectrum
Nutrition
Spectrum
Stress
Management
Spectrum
Love & Support
Spectrum
11
Plant Versus Animal-Based Nutritional
Programs
• Studies world-wide have shown that populations
eating a plant-based, low fat diet have…
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–
–
–
–
–
–
Less risk of heart disease
Lower death rates from ischemic heart disease
Less hypertension
Less risk of type 2 diabetes
Fewer intestinal disorders
Less incidence of certain cancers
Less risk for osteoporosis, kidney stones, and
gallstones
12
Factors that Reduce Risk for
Heart Disease
•
•
•
•
•
•
•
Reduced saturated fat and cholesterol intake
Higher fiber and antioxidant intake
Lower heme iron intake and lower iron stores
Lower blood pressure
Decreased tendency to form unwanted blood clots
Reduced blood viscosity
Higher folate intake
13
What is the Nutrition Spectrum Reversal Program?
It is a plant-based, whole-foods eating style that emphasizes…
•
•
•
•
•
•
Whole Grains
Vegetables
Fruits
Legumes and Beans
Soy
Fat-free Dairy/Egg Whites
14
PROTEIN
15%
FAT
10%
CARB
75%
Nutrition Spectrum Reversal Program
Guidelines for Reversing Heart Disease
•
•
•
•
•
•
•
•
•
•
Fat
Cholesterol
Animal products
Calories
Refined Carbohydrates
15
Caffeine
Sodium
Alcohol
Soy
Nutrition Supplements
10% of TOTAL CALORIES from FAT
• Nutritional programs that include 20-30% of
calories from fat, like the American Heart
Association Diet, have been associated with heart
disease progression.
• NO REVERSAL OCCURS.
16
Achieve 10% FAT by:
• Eliminating:
ELIMINATE
– Meat, Poultry, Fish, etc.
– Avocados, Olives
– Nuts, Seeds
– Added Oils/Fats
17
% of Total Calories from Fat
Hidden Fat and Saturated Fat
in Animal Based Products
100
90
TOTAL
SATURATED
80
70
60
50
40
30
20
10
0
CHEESE
BEEF
EGG
PORK
MILK
18
SALMON
VEAL
CHICKEN
SHRIMP
SATURATED
19
TOTAL
B
Pa ut t
l m er
K
Co e rn
e
co
nu l
tO
il
Ca
no
Sa
l
f fl a O
ow
il
er
Su
O
nf
low il
er
O
Co il
rn
O
i
O
liv l
Se e O
il
sa
m
e
So
y b Oil
M
ar ean
ga
rin Oi l
e,
Pe Tub
Co a n
tto ut O
ns
M
ee il
ar
d
ga
O
rin
e, il
St
i ck
La
Be
rd
ef
Ta
llo
w
% Total Calories From Fat
Hidden Fat and Saturated Fat
In Oils and Added Fats
100
90
80
70
60
50
40
30
20
10
0
% Total Calories From Fat
Hidden Fat and Saturated Fat
In Nuts, Seeds, Avocados
100
90
80
70
60
50
40
30
20
10
0
Pecans
Peanuts
Hazelnuts
Walnuts
SATURATED
20
Avocados
TOTAL
Almonds
Sunflower
seeds
Cashews
% Calories From Fat
Choose Plant-Based Whole Foods
100
80
TOTAL
SATURATED
60
40
20
0
ck
es
l
a
l
R
B
ab
t
n
,
ge
ns
ow
e
r
a
V
B
Be
e
ic
ta
s
Pa
le
ar
B
y
ey
n
id
B
lit
at
ils
t
p
e
n
h
,S
Le
W
s
a
e
ed
P
k
c
ra
C
ns
a
e
K
21
u
Fr
it
0-10 mg Cholesterol per Day
• Dietary cholesterol is related to the increased risk
of heart disease.
– This risk is separate from the risk of dietary fat.
• The body makes all the cholesterol it requires.
• Food sources of cholesterol are in excess of what
the body needs.
22
Achieve 0-10 mg Cholesterol
Per Day by:
• Eliminating:
– Meat (all types)
– Poultry (all types)
– Fish (all types)
– Animal products except for egg whites and fatfree dairy foods (0 to 2 servings/day)
23
24
Egg White
Cheese
Milk
Fish
SaLMON
Beef
Chicken
Pork
Veal
Shrimp
Egg Whole
Cholesterol (mg)
Hidden Sources of Cholesterol In
Food
250
200
150
100
50
0
25
Yogurt,
Regular
Yogurt, Low
Fat
Yogurt, Fat
Free
Milk,
Regular
Milk, Low
Fat
Milk, Fat
Free
Cheese,
Regular
Cheese,
Low Fat
Cheese,
Fat Free
Cholesterol (mg)
Cholesterol Content of Dairy Foods
35
30
25
20
15
10
5
0
Eliminate Animal Products
• Animal products:
ELIMINATE
– Contain fat, saturated fat and cholesterol in high
concentrations
– Contain animal protein and iron, which
create an environment that increases heart disease risk
– Reduce the consumption of other food components that
protect against heart disease
• EXCEPTION: Non-fat dairy and egg whites are
allowed with limits
26
Protein Sources
• Choose:
– Egg whites as a source of protein
– Fat-free dairy products (0 to 2 servings/day) for
protein, calcium, riboflavin and vitamin B12
– Plant-based sources for adequate protein
27
Eat Abundantly
• Calories are not restricted unless overweight or
not losing weight (if desired).
• The Nutrition Spectrum – Reversal Program:
–
–
–
–
Is rich in fiber and naturally low in calories per bite
Increases satiety value with fewer calories
Self-regulates calories without calorie counting
Helps to gradually reach and maintain an healthy body
weight
– Promotes eating with awareness and portion control
28
An Integrated Approach
• Regular exercise burns calories and reduces stress.
• Stress management increases awareness of when
you are hungry, how much you eat, and why you eat.
• Group support improves social connections and
communication skills.
• Improved nutrition eliminates high-fat, calorie-dense
foods.
29
Limit Refined Carbohydrates
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Angel food cake
Fat-free frozen yogurt
Fat-free sweets
Table sugar
Jelly
Fat-free pudding
Limit to 0 to 2 servings per day
30
LIMIT
Why limit refined carbohydrates?
• Absorbed quickly into the bloodstream, and
causes swings in blood sugar levels (i.e. highs and
lows)
• Source of empty calories (i.e. weight gain)
• Can elevate triglycerides
• Many contain hydrogenated or partially
hydrogenated fats
LIMIT
31
Replace Refined Carbohydrates with
Complex or “Preferred” Carbohydrates
Instead of:
Choose:
White Rice
Brown Rice
White Bread
100% Whole Wheat Bread
White Pasta
Whole Wheat Pasta
Refined Cereals
Whole Grain Cereals
White Flour
Whole Wheat Flour
32
Moderate Sodium Intake
• Follow your doctor’s recommendation if you are
medically restricted.
• Only about 1/4 of the population is sensitive to
sodium.
– Individuals who are not sodium-sensitive can have
moderate quantities of sodium.
• Salt can add flavor to very low-fat vegetarian
dishes, improving taste and making adherence to
the eating style easier.
33
Sources Of Sodium
Naturally Processed
Added at
Occurring
Foods
the Table
in Foods
33%
34%
34
33%
If Sodium Is Restricted
• Use fresh herbs and spices instead of salt.
• Choose sodium-free spices.
• Use reduced-sodium soy sauces, vegetable broths
and condiments.
• Ask for foods to be prepared without added salt.
• Use fresh lemon juice, other citrus,
flavored vinegars, hot sauce and
wine in cooking to enhance flavor.
LIMIT
35
Caffeine-Free Living
• Eliminate caffeinated and decaffeinated coffee,
colas, chocolate and cocoa products,
regular and decaffeinated teas as well as over-thecounter medications containing caffeine.
• Choose grain-based coffee, herbal tea
and naturally caffeine-free diet
and regular soft drinks.
ELIMINATE
36
Caffeine’s Effect on the Body
• Increases stress hormone levels (epinephrine,
norepinephrine and cortisol)
• Interferes with stress management
• Increases blood pressure
• Increases frequency and severity of irregular heart
beats
• Increases stomach acid
• Acts as a laxative
• Promotes nervousness, restlessness,
• May contribute to a shorter “fuse”
37
38
7 UP
Naturally Caffeine Free Tea
Herbal Tea
Caffeine Free Cola
Chocolate Pudding
Decaffeinated Tea
Green Tea
Chocolate Bar
Diet Cola
Coca-Cola
Mountain Dew
Exedrin
Tea
Jolt, Soft Drink
No-Doz
Expresso
Coffee, Drip
Coffee, Perc.
Caffeine (mg)
Caffeine Content of Common
Beverages
160
120
80
40
0
Withdrawing from Caffeine
• Gradually…
– Take 1-2 weeks to go caffeine free
– Switch to lower caffeine sources
– Reduce intake 1/2 to 1 cup at a time
– Have caffeine-free substitutes available
39
Green Tea: An Exception to the
Caffeine-Free Rule
• Contains powerful antioxidants that may reduce
the risk of chronic disease
• Choose fresh brewed regular or naturally
decaffeinated green tea.
• Limit to no more than 2 cups/day.
• Individuals with arrhythmias, elevated stress
and/or taking certain medications should avoid
green tea.
• Coumadin and other blood thinning medications
may need adjustment.
40
Alcohol In Small Amounts
(But Not Encouraged)
• If consumed at all, limit alcohol to 1 serving/day.
• One serving equals:
– 1.5 ounces liquor
– 4 ounces wine
– 12 ounces beer
LIMIT
• Speak with your doctor about alcohol and possible
adverse interactions with medications or medical
conditions.
41
The Pros and Cons
• Beneficial effects:
– Moderate amounts may increase HDL cholesterol
• Negative effects:
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Direct toxic effect on heart muscle and other organs
Source of “empty” calories
Decreases the body’s ability to burn fat by about 1/3
Inhibits willpower and adherence to the diet
Associated with increased rates of breast cancer and
liver disease
– Associated with increased accidental deaths
42
One Full-Fat Soy Product Per Day
• Source of essential fatty acids (omega-3)
• Isoflavones (plant chemicals unique to soybeans)
have antioxidant properties, which may protect
LDL from oxidation.
• Soy isoflavones have favorable effects on blood
vessel function.
LIMIT
43
What is a Full-Fat Soy Product?
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Greater than 3 grams of fat/serving
Naturally occurring fat derived from the soybean
No added fat/oil
Examples include:
– Soymilk (1 cup; >3 grams of fat)
– Tofu (1/2 cup)
– Dry roasted soy nuts (1/4 cup)
44
Vitamin and Mineral Supplementation
• Added insurance
• Source of omega-3 fatty acids
– Reduce risk of sudden cardiac death, prevent certain
types of arrhythmias, decrease platelet stickiness/blood
clots, decrease triglycerides
• Source of antioxidants
– Help to prevent oxidation of LDL cholesterol, the form of
cholesterol that is most likely to deposit in the arteries
45
Required Supplements
• MULTIVITAMIN 100% Daily Value with Minerals
– With B12 (24 mcg/day or 2.4 mg)
– Without Iron (Unless female of childbearing age)
• OMEGA-3 FATTY ACID SOURCE (Fish Oil
Capsules)
– Approximately 600 mg EPA and 400 mg DHA per day
for both women and men (Dosage typically found in 2 to
4 grams of fish oil capsules per day)
– Choose cholesterol-free fish oil supplements.
46
Optional Supplements
• FOLIC ACID
• VITAMIN E
400-1000 mcg/day
no more than 100 IU/day
– If taking a cholesterol-lowering statin medication, check
with prescribing MD.
• VITAMIN C
• SELENIUM
1-3 grams/day
100-200 mcg/day
47
Food Sources First
• Vitamin E
– Unrefined cereal grains, wheat germ, spinach,
green peas and corn
• Vitamin C
– Fruits and vegetables especially: peppers,
sweet green and red peppers and hot red and
green chili peppers, citrus fruits and juices,
Brussels sprouts, cauliflower, cabbage, kale,
collards, mustard greens, broccoli, spinach and
strawberries
48
Food Sources First
• Selenium
– Plant foods are the major sources of selenium
in most countries; amount depends on soil.
– Primarily found in grains and vegetables.
• Folic Acid
– Dark green leafy vegetables (spinach, kale,
mustard greens, escarole, arugula, beet greens,
bok choy, dandelion greens, radicchio, Swiss
chard), oranges, lentils, pinto beans, garbanzo
beans, asparagus, orange
49
Nutrition Spectrum – Reversal Program:
Summary
• 0% of total calories
from fat
• 0-10 mg cholesterol
• No animal protein
• Eat abundantly
• Limit refined
carbohydrates
•
•
•
•
Sodium in moderation
Caffeine-free living
Alcohol in moderation
1 full-fat soy product
per day
• Nutrition supplements
50
51
Adjusting Well to a New Way of Eating
• Short-term
– Gas/bloating
– Cramping/constipation
– Headaches
• Long-term
– Fewer ups and downs
– Desire to eat more frequently
– Sustained energy throughout the day
– Weight loss
52
Adjusting Well to New Feelings
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Empowerment and pride
“Road less traveled”
Anger
Fear
Guilt
Inspiration
Excitement
53
Upcoming Nutrition Discussions
• Identifying Ornish friendly foods
• Grocery store tour
• Evaluating the Nutrition Spectrum Reversal
Program
• Cooking demonstrations
• An integrated approach to weight management
• Shopping and meal planning
• Eating out, traveling, socializing
• Advanced nutrition: calcium, phytochemicals and
functional foods
54
Questions
55
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