1. Introduction to the Nutrition Spectrum Reversal Program
TALKING POINTS:
As you learned through the New Hope New Choices lecture, the research behind this program clearly shows that making changes in how we eat, how we manage our stress, our activity level and our communications with others has the power to heal.
By choosing to join this program, you have taken a major step towards proactively changing your lifestyle.
You have significant control over several of the major risk factors for heart disease.
What we eat is a “modifiable” risk factor; one we have complete control over.
Introduction to the Nutrition Spectrum Reversal Program

2. 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
TALKING POINTS:
The goals for this session are:
To talk about the typical American diet and its impact on our risk for heart disease
To provide an overview of a low fat, plant based eating style and it’s health benefits
To describe the nutrition guidelines and the rationale for each
To introduce you to the Reversal Food Guide Pyramid – a tool for planning enjoyable and nutritionally adequate meals
To describe the process of adjusting to the Nutrition Spectrum Reversal Plan physically and emotionally.
With education, commitment, professional guidance and a little planning, you can be successful in meeting and enjoying the nutrition recommendations for the Dr. Dean Ornish Program for Reversing Heart Disease.

3. What Is the Typical American Diet?
TALKING POINTS:
Let’s begin by taking a look at the typical American diet and what it consists of nutritionally. From here we will look at what the research tells us in terms of how the typical American diet affects our health and risk for heart disease.
The typical diet consists of 38% fat; 45% carbohydrates (2/3 of which is from refined carbohydrates) and 17% protein. A further breakdown of these numbers suggest that the American diet is low in fiber, low in vegetables, low in whole grains, high in refined carbohydrates (i.e. processed foods) and high in animal based proteins and fats.

4. Fat and Animal Protein Sources In the Typical American Diet
TALKING POINTS:
Fat, cholesterol and animal protein are major culprits in contributing to heart disease.
Most of us know that eating too much fat or cholesterol is not recommended. However, many of us are not aware of where these sources come from. Animal protein contains significant amounts of cholesterol, fat and especially saturated fat.

5. 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
TALKING POINTS:
It’s interesting to look at the average consumption of animal proteins for the typical American over a lifetime.
Review and discuss the slide.

6. The Results TALKING POINTS:
The physically “obvious effects” of the SAD American diet and American lifestyle are evident.
Even our pets are overweight!
Since the 1960’s, the percentage of people who are overweight has dramatically increased from 43% to over 60%.

7. 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)
TALKING POINTS:
Review and discuss the slide.

8. What We Eat Impacts Our Health
Coronary artery disease
Stroke
Certain cancers
Diabetes
Hypertension
Overweight and obesity
Osteoporosis
TALKING POINTS:
Review and discuss the slide.
The research evidence is clear. What we choose to eat has a clear relationship to many of the chronic disease states that Americans suffer from.
Major dietary changes are needed to significantly alter the prevalence of heart disease and other chronic diseases like cancer and diabetes.

9. Nutrition and the Formation of Atherosclerotic Plaque
TALKING POINTS:
Autopsy research on children who died from other causes showed the beginning of atherosclerotic plaque formation as early as 2 years of age.
Autopsies on young soldiers (18-19 yrs old) who were killed in the war showed significant artherosclerotic plaque formation. (See references below that document these facts).
Many people do not realize that high fat, high cholesterol food choices year after year are one of the main contributors to the blockage of the arteries. A high level of stress and physical inactivity combined with a poor diet is a recipe for heart disease.
The formation of artherosclerotic plaque does not happen when we get older… it’s a process that can begin at an early age and continue to occur throughout a lifetime. Our lifestyle choices have a dramatic effect on this process.
References:
“Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons aged 6 to 30 years and studied at necropsy” (The Bugalusa Heart Study; J Cardiology 1992)
“Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults” N Eng J Med 1998)
“A nationwide study of atherosclerosis in infants, children and young adults in Japan.(Atherosclerosis, 1988, Aug 72)
“Second nation-wide study of atherosclerosis in infants, children and young adults”. (Atherosclerosis, 2001)

10. The Goals of the Dr. Dean Ornish Program For Reversing Heart Disease
TALKING POINTS:
To slow, stop and/or reverse this process…

11. An Integrated Approach to Reversing Heart Disease
Love & Support Spectrum
Stress Management Spectrum
Nutrition Spectrum
Fitness
Spectrum
TALKING POINTS:
Reversing heart disease requires adherence to all four elements of the Program.
The research suggests that these four elements work in synergy…adherence in one area helps adherence in the others.
Success with the nutrition element leads to:
Achieving a healthy body weight and reducing risk factors (i.e. enhancing self-image and body comfort; making exercise and stress management poses easier; increasing self-confidence and self empowerment to make group support sessions easier)

12. Plant Versus Animal-Based Nutritional Programs
Studies world-wide have shown that populations eating a plant-based, low fat diet have…
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
TALKING POINTS:
As reviewed in the New Hope New Choice lecture given by our Medical Director earlier, studies worldwide have shown that populations who eat a plant based, low fat diet have less chronic disease.
Review and discuss the slide.
REFERENCES: (1) Am. J. of Cardiology, 1998, T. Campbell. (2) American J. of Clinical Nutrition, (3) Lancet.1990; 336; (4) JAMA1998; 280: (5) JAMA. 1995; 274:

13. 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
TALKING POINTS:
Multiple factors in a plant-based diet reduce our risk for heart disease as listed here.
Antioxidants have been shown to decrease the rate of plaque formation.
Folate has been shown to decrease homocysteine, a protein byproduct that is associated with plaque formation.
REFERENCES: (1) ADA, Position Paper on Vegetarian Diets, (2) The Vegetarian Guide, M. Messina, 1996.

14. 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
TALKING POINTS:
The Nutrition Spectrum Reversal Program is a plant based, whole food eating style. It’s low in fat, high in complex carbohydrates and adequate in plant-based protein.
It is also rich in disease fighting nutrients such as phytochemicals, carotenoids and antioxidants.
Compare the pie chart here to the standard American diet pie chart in the beginning of the lecture. Instead of 38% fat, the goal is 10% fat. Instead of 45% refined carbohydrates, the goal is 75% complex carbohydrates. Protein percentages are very similar… the difference is that we will be getting our protein primarily from plant based sources as well as fat-free egg whites and fat-free dairy foods.

15. Nutrition Spectrum Reversal Program Guidelines for Reversing Heart Disease
Fat
Cholesterol
Animal products
Calories
Refined Carbohydrates
Caffeine
Sodium
Alcohol
Soy
Nutrition Supplements
TALKING POINTS:
Getting started with the Nutrition Spectrum Reversal Program requires becoming familiar with the nutrition guidelines. Let’s review each of these guidelines and their rationale.
Making comprehensive changes in our food choices can be easier and more effective than making small changes.
The Lifestyle Heart Trial showed that it is often easier for people to make big changes in diet and lifestyle than to make small ones. People who made big changes began to feel so much better, so quickly that the benefits became clear and the choices worth making.
Participants in the Lifestyle Heart Trial reported a 91% reduction in frequency of chest pain almost immediately after starting the Program. Rapid improvements are a powerful motivator. (Lancet. 1990; 336: )

16. 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.
TALKING POINTS:
The first step to reversing heart disease is to decrease total dietary fat.
Why 10%?
Diets including 20-30% of calories from fat like the American Heart Association diet, have been associated with heart disease progression, not reversal. (The Lancet; Lifestyle Heart Trial, July 1990 Vol 226; JAMA, Dec 16, 1998 – Vol 280, No. 23: JAMA, Sept. 20, 1995 – Vol 274, No. 11,)
All oils and fats contain some saturated fat, the kind of fat that makes heart disease worse. The Nutrition Spectrum Reversal Program minimizes saturated fat by keeping dietary fat very low.
A very low-fat, plant based vegetarian nutritional program is naturally about 10% of fat and nutritionally adequate. The body only needs about a 5-6% intake of fat in the diet to obtain the essential fatty acids.
Emphasis on whole grains, the addition of a full fat soy food each day and the recommended fish oil or flaxseed supplements will ensure plenty of the essential fats, without exceeding the 10% fat guidelines. We will learn more about this later in the lecture.

17. Achieve 10% FAT by: Eliminating: Meat, Poultry, Fish, etc.
ELIMINATE
Achieve 10% FAT by:
Eliminating:
Meat, Poultry, Fish, etc.
Avocados, Olives
Nuts, Seeds
Added Oils/Fats
TALKING POINTS:
To achieve no more than 10% of total calories from fat, added fats (i.e. butter, margarine), oils, nuts, seeds, avocados, coconut and olives must be eliminated. To give you an idea of the rationale for why some foods are excluded, let’s take a look at the percentage of total calories from fat in some basic foods.

18. Hidden Fat and Saturated Fat in Animal Based Products
TALKING POINTS:
All foods listed here come from animal based products. Take a look at the total % of fat in each food and how much of this fat is saturated.
As the red line clearly shows, all foods pictured here are greater than 10% fat and are too high in total fat and saturated fat to meet the reversal guidelines.

19. Hidden Fat and Saturated Fat In Oils and Added Fats
TALKING POINTS:
Here is an example of the types of hidden fat in oils and other assorted fats. All oils contain 100% of their total calories from fat. All oils contain saturated fat, the type of fat that makes heart disease worse. Even canola oil and olive oil contain saturated fat.
As the red line clearly shows, all foods pictured here are greater than 10% fat and are too high in total fat and saturated fat to achieve reversal.

20. Hidden Fat and Saturated Fat In Nuts, Seeds, Avocados
TALKING POINTS:
Here is an example of the hidden fats in nuts, seeds and avocados. All are greater than 70% fat and all contain some degree of saturated fat.
Our red line again shows that all of the foods pictured here are greater than 10% fat and are too high in total fat and saturated fat to achieve reversal.
Olives are not pictured here but they too contain too much fat to be included in the Nutrition Spectrum Reversal Program. Most olives are over 90% fat.

21. Choose Plant-Based Whole Foods
TALKING POINTS:
Here is an example of some plant based whole foods that are included in the Ornish Nutrition Plan. As the red line clearly shows, all foods pictured here fall below the 10% of total calories from fat and are heart-healthy choices upon which to start building your nutritional program.
The Nutrition Spectrum Reversal Program is simple. It is abundant in whole grains, vegetables, fruits, legumes and small amounts of fat free dairy products and egg whites.
Keep a positive attitude about this new way of eating. With all of the major changes in our life, it takes time to adjust and become familiar with all of our options and the health benefits we will receive from doing our best. You will find as the weeks go on, the Nutrition Spectrum Reversal Program will become the easiest element of the entire program.

22. 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.
TALKING POINTS:
Dietary cholesterol is associated with an increased risk of heart disease. This risk is separate from the risk of heart disease and increased dietary fat.
The more dietary cholesterol one eats, the greater the risk of heart disease. This is also true for some individuals who appear to have normal blood cholesterol and blood pressure levels but who have heart disease.
The average American consumes 600 milligrams of cholesterol per day. The 0-10 milligram recommendation on the Nutrition Spectrum Reversal Program allows some fat free dairy products to be eaten to gain the nutritional benefits of dairy foods and to add variety to meals. This scant amount is not thought to significantly influence heart disease reversal.

23. 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 fat-free dairy foods (0 to 2 servings/day)
TALKING POINTS:
Cholesterol is only found in animal products. Therefore, meats, poultry, fish and animal products are eliminated. The exception is fat-free dairy foods and egg whites.
Plant based foods are naturally cholesterol-free.
Some people choose not to eat dairy foods. If all dairy foods were eliminated from the Nutrition Spectrum Reversal Program, dietary cholesterol intake would be zero. Soy foods that meet the guidelines can be used in place of dairy foods.

24. Hidden Sources of Cholesterol In Food
TALKING POINTS:
Here is an example of hidden sources of cholesterol in animal based products. The red line clearly shows that all foods pictured here exceed 10 mg of cholesterol except for egg whites.

25. Cholesterol Content of Dairy Foods
TALKING POINTS:
Here is a comparison of the cholesterol content of regular, low-fat and fat-free dairy foods. The graph indicates that regular and even low fat dairy foods contain too much cholesterol.
Fat- free dairy foods are acceptable since one serving will have 5 milligrams or less of dietary cholesterol.
Fat-free dairy foods still contain cholesterol, so moderation is recommended. This is why fat-free dairy foods are limited to 2 servings per day.

26. Eliminate Animal Products
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
TALKING POINTS:
Animal products contain cholesterol, fat and saturated fat often in high concentrations.
Animal products also contain animal protein and iron, which may increase heart disease risk by creating an environment where fats are more likely to be deposited in the arteries.
Animal products displace the consumption of other food components that protect against heart disease, such as fiber and antioxidant vitamins.
The typical American plate is 2/3 animal protein. You do not need to eat animal products to have enough protein in your diet. Plant proteins alone can provide enough of the essential and non-essential amino acids when caloric intake is adequate and sources of dietary protein are varied. Soy protein has been shown to be equal in nutritional value to proteins of animal origin.
Sources: (1) ADA, Position Statement, Vegetarian Diets, (2) AHA, Position Statement, Vegetarian Diets, 1996.

27. 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
TALKING POINTS:
Egg whites contain protein but no cholesterol and no fat.
Fat-free dairy products contain protein, calcium, riboflavin, vitamin B12 and other nutrients, no fat and only 4-5 milligrams of cholesterol per serving.
Plant based protein sources are cholesterol-free, low in saturated fat and high in fiber and disease fighting compounds.

28. 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
TALKING POINTS:
This is everyone’s favorite nutrition guideline!
A very low-fat, vegetarian nutritional program is naturally lower in calories per bite and higher in fiber, compared to the typical American diet, so most people feel satisfied on fewer calories.
The Nutrition Spectrum Reversal Program helps people to lose weight naturally, gradually and safely without having to calorie-count.
It is a simple but extremely effective approach to eating well and living well.
Fat contains 9 calories per gram. Protein and carbohydrate contain only 4 calories per gram. By simply lowering your intake of fat, you can reduce the amount of calories you consume.
Eating with awareness and portion control is still necessary. It is possible to gain weight on the Dr. Dean Ornish Program for Reversing Heart Disease if calories are in excess of your nutritional needs and calories burned. Even healthy calories, eaten in excess, can lead to weight gain and/or an increase in triglyceride levels.
Excess body fat is related to high blood pressure, elevated serum cholesterol and diabetes. Even moderate increases in fat tissue resulting from excess weight (10%-30%) in young adults and middle-aged persons are linked to coronary artery disease.

29. 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.
TALKING POINTS:
All four elements of the Dr. Dean Ornish Program for Reversing Heart Disease work together to create a healthy balance and to allow abundant eating.

30. Limit Refined Carbohydrates
Angel food cake
Fat-free frozen yogurt
Fat-free sweets
Table sugar
Jelly
Fat-free pudding
Limit to 0 to 2 servings per day
LIMIT
TALKING POINTS:
Refined carbohydrates are primarily processed foods that are high in sugar, high in calories, low in fiber and low in nutrients. A limited amount is included in the Nutrition Spectrum Reversal Program to help add variety and increase long term satisfaction with this eating style.

31. 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
TALKING POINTS:
Refined carbohydrates are:
Absorbed quickly into the blood stream and can lead to blood sugar highs and lows.
Are a source of empty calories
Can elevate triglycerides.
Many contain hydrogenated or partially hydrogenated fats (i.e. crackers, snack foods)
LIMIT

32. 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
TALKING POINTS:
Complex or preferred carbohydrates are nutritionally superior to refined carbohydrates and are associated with:
Slower absorption in the blood stream, leading to more stable blood sugar levels and more constant energy levels
Reduced triglyceride levels
Increased satiety levels with fewer calories
6 servings per day of a whole grain food are recommended over the “white” counterparts.
Populations consuming 60-75% of their total diet from complex carbohydrates have been shown to have a lower prevalence of atherosclerosis.

33. 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.
TALKING POINTS:
Sodium can be included in moderation in the Dr. Dean Ornish Program for Reversing Heart Disease unless your physician has prescribed otherwise.
Small amounts of sodium can add flavor to low fat vegetarian dishes.

34. Naturally Occurring in Foods
Sources Of Sodium
Added at the Table
33%
Naturally Occurring in Foods
34%
Processed Foods
TALKING POINTS:
This chart shows the food sources where most Americans get their sodium. 66% of the sodium in the American diet comes from added salt at the table and the consumption of processed foods.
If you are sodium sensitive, you can easily reduce your sodium intake by taking the saltshaker off the table and by reducing the amount of processed foods you consume.

35. 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.
TALKING POINTS:
Use these strategies to keep the flavor in your food and create enjoyable dishes.
Sodium in recipes can be reduced or eliminated.
LIMIT

36. Caffeine-Free Living
Eliminate caffeinated and decaffeinated coffee, colas, chocolate and cocoa products, regular and decaffeinated teas as well as over-the-counter medications containing caffeine.
Choose grain-based coffee, herbal tea and naturally caffeine-free diet and regular soft drinks.
ELIMINATE
TALKING POINTS:
The Nutrition Spectrum Reversal Programis caffeine free. All sources of caffeine continue to be eliminated on the Nutrition Spectrum Reversal Program, including regular and decaffeinated coffees and teas, chocolate, cocoa, regular or decaffeinated dark colas and over the counter medications containing caffeine.
One exception to this rule is green tea which we will talk about in a few slides from now.
This is the one nutrition guideline where we encourage you to gradually work your way towards achieving a caffeine free way of living.

37. 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”
TALKING POINTS:
Caffeine effects the body in a variety of ways that interfere with the stress management element of the program.
Living “caffeine free” will allow you to gain the most benefit from the Program and truly experience the relaxation response.

38. Caffeine Content of Common Beverages
TALKING POINTS:
This table shows various sources of caffeine in the American diet. Decaffeinated coffee and tea still contain a small amount of caffeine and are not recommended.
Why no decaf? Decaffeinated foods and beverages contain trace amounts of caffeine. This small amount of caffeine has no bearing medically however it may interfere with your stress management practice, specifically meditation and deep relaxation. Trace amount of caffeine can interfere with the mind-body connection.

39. 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
TALKING POINTS:
Eliminating caffeine can be a challenge because of the withdrawal side effects such as headaches. To avoid the effects of caffeine withdrawal, follow the recommendations listed here.
After a few days to a couple of weeks without caffeine, you will find you have much more productive energy. Caffeine does not give you energy but creates a “stress response” that quickly wears off.

40. 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.
TALKING POINTS:
Why is green tea an exception? Evidence from recent studies on tea shows that the health benefits of green tea outweighs the risks for most individuals. Green tea contains a variety of powerful antioxidants called polyphenols, especially the flavonoids such as catechins, which may reduce the risk of many chronic diseases.
Daily limit Guidelines
Although green tea’s caffeine content is lower than that found in coffee, black or oolong tea and caffeinated cola soft drinks it is not caffeine free. For this reason, green tea should be limited to no more than 2 cups per day.
Decaffeinated green tea and other products
Decaffeinated green tea can also be consumed. Choose decaffeinated green tea that has been naturally decaffeinated with the “effervescence” method (uses water and carbon dioxide), which preserves most of the polyphenols present in regular green tea. Other beverages and foods mixed with green tea may contain high amounts of sugar and/or empty calories and should not be consumed.
Individuals with arrhythmias and elevated stress should avoid green tea and other caffeine containing substances. Individuals taking coumadin or other blood thinning medications also need to be aware that green tea may interact with this drug, therefore, it's important to alert participants to this and ask them to have their physician check their INR while taking these so that their coumadin dose can be appropriately titrated.

41. 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
Speak with your doctor about alcohol and possible adverse interactions with medications or medical conditions.
LIMIT
TALKING POINTS:
If you are not currently including alcohol, we do not recommend that you begin. For those who do choose to consume alcohol, the Nutrition Spectrum Reversal Program does include a recommendation for a small amount.
If consumed, 1 serving per day is defined as 1.5 ounces of liquor, 4 ounces of wine or 12 ounces of beer.
It’s not recommended that you save all of your servings per day for the end of the week!

42. The Pros and Cons Beneficial effects: Negative effects:
Moderate amounts may increase HDL cholesterol
Negative effects:
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
TALKING POINTS:
Some research suggests that small amounts of alcohol may increase our good or HDL cholesterol. The negative effects of alcohol outweigh the beneficial effects.
The small amount of alcohol included within the Nutrition Spectrum Reversal Program is not associated with negative effects.

43. 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.
TALKING POINTS:
Several years ago, Dr. Ornish added this guideline to the program to enhance the Nutrition Spectrum Reversal Program with the many benefits of natural soy foods. Full fat soy foods are an excellent source of omega-3 fatty acids.
Omega-3 fatty acids are cardio-protective:
prevent blood clots by decreasing platelet stickiness.
decrease arrhythmias (abnormal heart rhythm) which may cause sudden death
may lower triglycerides
LIMIT

44. What is a Full-Fat Soy Product?
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)
TALKING POINTS:
Full-fat soy foods are defined as:
Greater than 3 grams of fat per serving
Fat is derived naturally from the soybean
No added fat/oil, added by the manufacturer
Examples of full-fat soy foods:
Soymilk (>3 grams)
Tofu (1/2 cup)
Soy nuts, roasted, no added oil (1/4 cup)

45. 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
TALKING POINTS:
Vitamin and mineral supplementation is a part of the Nutrition Spectrum Reversal Program guidelines.
The heart disease research suggests that the omega-3 fatty acids and certain antioxidants provide cardio-protective benefits that warrant the addition of these nutrients to the diet.
Nutrition Supplement Overview and Dosage Recommendations, 2001 provides a review of each supplement recommendation and the associated research. Supplement recommendations are divided into two categories; recommended and optional.

46. 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.
TALKING POINTS:
Active people who consume a variety of grains, fruits and vegetables can obtain adequate nutrition from a balanced low fat vegetarian nutritional program. As added insurance, a multivitamin with no more than 100% Daily Value is recommended with a source of vitamin B12 (24 mcg/day). The multivitamin with minerals should not contain iron unless prescribed by your physicians or you are a female of childbearing age.
The recommended fish oil supplement provides a daily source of the omega-3 fatty acids. Depending on the brand, a one gram capsule of fish oil will contain a certain percentage of EPA and DHA, in addition to other oils, such a vitamin E. The Dr. Dean Ornish Program for Reversing Heart Disease recommends a daily dosage of fish oil supplement that includes approximately 600 mg EPA and 400 mg DHA for both men and women. This dosage is usually found in 2 to 4 grams of fish oil capsules.
Choose a cholesterol free brand. The ingredient label will identify the amount of EPA and DHA in each capsule and whether or not the product contains cholesterol.
Some recent studies suggest that while omega-3 fatty acids may be very beneficial for most people with CAD, a small subset of patients who have chronic congestive heart failure or chronic, severe, recurrent angina should avoid taking these. Participants who are taking omega-3 fatty acids as well as blood thinners such as coumadin or heparin may need to adjust their medication dose and should consult with their physician.
Multivitamin supplements that exceed the Daily Value are not advised or necessary. Iron supplementation is not recommended because of its oxidant properties and lack of health benefit in anyone but woman of childbearing age and those who have iron deficiency secondary to blood loss or bone marrow disorders.
Source: Nutrition Supplement Overview and Dosage Recommendations, 2001

47. Optional Supplements FOLIC ACID 400-1000 mcg/day
VITAMIN E no more than 100 IU/day
If taking a cholesterol-lowering statin medication, check with prescribing MD.
VITAMIN C 1-3 grams/day
SELENIUM mcg/day
TALKING POINTS:
Vitamin E, C, & selenium are dietary antioxidants. Research suggests that certain antioxidants may reduce heart disease risk by inhibiting the oxidation of LDL or the “bad” cholesterol.
Folic acid plays an important role in DNA synthesis. Inadequate folic acid intake leads to impaired DNA synthesis and results in the accumulation of homocysteine, a protein byproduct and an independent risk factor for heart disease. High homocysteine levels may cause injury to the lining of the artery. The typical multivitamin contains 400 mcg/day. The use of folic acid supplements above 1000 mcg/day should be done under physician supervision.
Optional Vitamin and Mineral Supplementation: Dr. Ornish recommends that the above nutrients are obtained from food sources ideally. It is not required that participants take these nutrients in pill form. If dietary records over time suggest intake is low in any of these areas, participants should consult with their MD/RD to see if supplementation is advisable.

48. Food Sources First Vitamin E Vitamin C
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
TALKING POINTS:
Remember choose foods first.
Vitamin E rich food sources: unrefined cereals, wheat germ, grains, some fruits and vegetables.
Vitamin C rich food sources: citrus fruits and juices, red peppers, chili peppers, Brussels sprouts, cauliflower, kale, collards, mustard greens, broccoli, spinach, strawberries.

49. Food Sources First Selenium Folic Acid
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
TALKING POINTS:
Selenium rich food sources: plan foods such as grains and vegetables.
Folic acid rich in food sources: dark green leafy vegetables like kale, spinach, mustard greens, escarole, beans, broccoli, asparagus, orange juice and brewers yeast.

50. 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
TALKING POINTS:
Following the Nutrition Spectrum Reversal Program is easy once you give yourself time to adjust and experiment with all of the new choices and new variety with this eating style.
Over the next 12 weeks, we will eat together and taste a variety of easy recipes and quick meals that meet the guidelines. We will also have a few potluck meals where all of us will share some of the new ideas we have discovered.
All the information that we have discussed today can be found in your Participant Manual. Please read and refer to the information in the Nutrition Section.

51. TALKING POINTS:
Use the Reversal Pyramid as a guide to your daily food choices and as a way to ensure that your needs for protein, vitamins, minerals and trace nutrients are met on the Nutrition Spectrum Reversal Program.
The Ornish Reversal Pyramid is designed to facilitate heart disease reversal unlike the standard USDA guidelines, which have been ineffective in this effort.
The Pyramid is split into various food groups and recommendations are made for serving sizes within each group. We will work with this Pyramid in more detail in future sessions and learn how to use it as an effective tool for planning enjoyable and nutritionally adequate meals.
6 or more servings per day of whole grains are the foundation and the basis of the nutritional program.
5 or more servings per day of fruits and vegetables. The less processed the choice, the more nutritious it is.
2 to 4 servings per day of legumes or egg whites as a protein source. 1 full fat soy food per day is included in this protein intake.
0 to 2 servings of a fat-free dairy choice.
Refined grains are to be limited as much as possible. No specific serving guideline has been designated but should be based on each participant’s medical condition.
Other grains and starches, primarily high in simple carbohydrates should be limited. Individuals with diabetes, elevated triglycerides or elevated body weight often need to further limit or eliminate refined carbohydrates and should work with their RD to customize to their needs. Starchy vegetables are included in the other grain and starch category but are higher in nutrient content than other refined products and should be chosen over simple refined carbohydrates.
Other limitations: 0 to 2 servings of non-fat sweets; 0 to 1 serving of alcoholic beverage

52. 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
TALKING POINTS:
As you begin to follow the Nutrition Spectrum Reversal Program, you may experience a few adjustments.
Short Term: As you increase the fiber in your diet and your GI system adjusts to this new way of eating, it is not uncommon to experience gas/bloating or cramping. Symptoms can be alleviated by increasing your water intake and by using a dietary enzyme like Beano, which helps to prevent gas from forming. As you follow a high fiber diet on a regular basis, your body will adjust and symptoms typically subside.
Some people may experience headaches from caffeine withdrawal but these can be prevented by using the tips we discussed earlier.
Long Term: The positive benefits of the Nutrition Spectrum Reversal Program far outweigh the temporary short-term effects.
INSTRUCTOR: Provide instruction here on the proper use of Beano to achieve maximum results.

53. Adjusting Well to New Feelings
Empowerment and pride
“Road less traveled”
Anger
Fear
Guilt
Inspiration
Excitement
TALKING POINTS:
It is normal to have a variety of feelings about the Nutrition Spectrum Reversal Program. Feelings may range from:
A sense of empowerment/pride in your effort
A feeling like you’re on the road less traveled.
Angry that you will not be including some of your favorite foods
Fear that you will not be able to stick to it
Guilty that you are asking for support from your partner
A sense of inspiration for taking charge of your health
Both the positive and the negative feelings are normal and fine. What is important is that you do not let these feelings divide you from the people close to you. Share all the feeling you have with the people close to you.
Throughout this program we will be learning how to effectively express our feelings and make the requests you need to successfully follow this program.

54. 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
TALKING POINTS:
In addition to today’s lecture, over the next 12 weeks we will be covering other nutrition topics that will help you to succeed in following the Ornish way of life. Upcoming presentations include a grocery store tour, cooking demonstrations, and a discussion on eating out, traveling, and socializing.
During the next 12 weeks, you will also self-monitor your daily food intake to help you stay on track and monitor your progress along the way. Self-monitoring is an effective tool in making major changes in your eating style and is a tool that will help me to give you guidance along the way. Your records will also help me to individualize the Ornish Nutrition Plan to your lifestyle.
I am looking forward to being with you through this discovery process and to assisting you in gaining the skills you will need to make this program work for you.
When making lifestyle changes, the research strongly suggests that those who self-monitor their progress along the way do better than those who do not.

55. Questions TALKING POINTS: A low-fat, plant-based eating style:
Contributes to heart disease reversal
Is a nutritional program that is abundant and familiar
Is a commitment to your health and happiness
Wrap up the session and open up the floor for a question and answer period.
Questions 55