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It’s a common question.

Ornish Lifestyle Medicine (Intensive Cardiac Rehabilitation) is the only diet and lifestyle program that has been scientifically proven to reverse heart disease without drugs and surgery. A series of randomized controlled trials published in leading peer-reviewed journal over the last thirty-seven years have clearly demonstrated that a very low-fat, whole food, vegetarian lifestyle can reverse the progression of even severe coronary heart disease, type 2 diabetes, hypercholesterolemia, high blood pressure, and early-stage prostate cancer.

If you choose beans or lentils as your protein, you’ll allow the healthy bacteria in your gut to flourish

It has also been shown that the very same vegetarian diet and lifestyle can change your genes, turning on protective genes and turning off genes that promote inflammation, oxidative stress, and oncogenes that promote prostate cancer, breast cancer, and colon cancer, over 500 genes in only 3 months. In addition, these lifestyle changes lengthen telomeres, the ends of our chromosomes that regulate aging, thereby beginning to reverse aging at a cellular level.

This research did not include fish as part of the lifestyle approach that was shown to reverse disease, and is therefore not recommended. Other approaches that include fish such as the Mediterranean diet and research such as the PREDIMED study published in 2013 have shown reduction in cardiovascular disease, but not reversal of the disease. Fish may be lower in saturated fat, yet it still contains a significant amount of cholesterol that for some people can lead to elevated cholesterol and heart disease.

Ornish Diet: No TMAO

ʺThe vegetarian approach that is recommended as part of Ornish Lifestyle Medicine is low in saturated fat and cholesterol. By eliminating animal protein, including fish, you are also avoiding other substances that we are just now discovering that can lead to heart disease.

A 2013 study published in Nature Medicine, and other studies, for example, demonstrate similar findings. The studies show that a substance called carnitine present in animal foods such as red meat, dairy and fish is metabolized by certain gut bacteria, which increases a substance called TMAO that poses risk for heart disease, kidney disease, and prostate cancer. The way it happens is that certain gut bacteria metabolize the carnitine to a toxic substance called trimethylamine. Trimethylamine then gets oxidized in our liver to TMAO (trimethylamine-n-oxide), which then circulates throughout our bloodstream. Elevated levels of TMAO increases the buildup of plaque in the arteries, increasing risk of heart disease.

Ornish Diet: High in Fiber and Other Cardio-Protective Substances

The reversal vegetarian approach is high in fiber that can reduce cholesterol and is packed with hundreds of substances that promote health and healing. These health-promoting substances include phytochemicals such as flavonoids, carotenoids, retinols, isoflavones, genestein, lycopene; all of which are protective against heart disease and have anti-cancer and anti-aging properties.

Fish is often touted as a healthy choice primarily because it is lower in fat than meat and some species contain omega 3s, which are beneficial for heart and cognitive health, immune function, and the ability to lower oxidative stress and inflammation. Some studies have shown a positive association of fish intake on cardiovascular disease, which is often linked with an increase in omega 3s and a decrease in saturated fat when fish is substituted for meat. Many people who follow the Ornish diet to lose weight and improve their health do include it.

The Benefits of Plant Protein and Fiber

But for those trying to reverse disease, it’s important to know that fish doesn’t have health-promoting fiber and can crowd out the nutrient-dense plants foods, which are packed with these cardio-protective antioxidants and health-promoting phytochemicals. If instead, you choose beans or lentils as your protein, you also nourish yourself with fiber and allow the healthy good bacteria in our gut to flourish. To learn how the Ornish Lifestyle Medicine works to balance the composition of our gut flora and prevent diseases including heart disease, diabetes, and kidney disease, we recommend our Ornish Living article, The Gut Heart Connection.

A Guide to Plant Proteins


Fish and Toxins

Even though fish does provide protein, this protein also comes with cholesterol and toxins. The health effects of fish consumption remains a topic of debate in the media and among health organizations primarily because exposure to mercury, a heavy metal present in some fish species, as well as other toxins such as PCBs and dioxins.

Researchers have closely examined the potential health effects of chronic low-level mercury exposure from even modest fish consumption. This is of especially high concern for children and pregnant women. A 2016 study released by the Environmental Working Group, a non-profit, non-partisan organization dedicated to protecting human health and the environment, studied the mercury levels in women who ate fish or seafood at least twice a week. They found almost 30 percent more mercury in their bodies than considered safe by Environmental Protection Agency. This study has brought attention to stricter government guidelines around fish for women during pregnancy.

Mercury can have toxic effects on the nervous, digestive and immune systems, and on the lungs, kidneys, skin and eyes, according to the World Health Organization. Certain other contaminants sometimes found in fish, such as dioxins and PCBs, have been linked to some cancers and reproductive problems.

For many who are still confused about the health effects of fish, the question may become whether eating fish is worth it for the Omega 3s or whether it’s just a just a healthier substitution for high cholesterol meat and saturated fat? Swapping fish for meat is like switching to a lower nicotine cigarette to decrease risk of the risk of lung cancer. It is a step in the right direction, but why not take a bigger leap and swap meat for plant proteins such high fiber, nutrient dense legumes and cardio-protective soy foods that clearly make the biggest impact on your health in a multitude of ways.

What’s holding you back from making the switch to a plant-based diet?

Contributed by

Carra Richling
Registered Dietitian

Eat well, be well!

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