Right after a massive heart attack, my cardiologist put me on the Ornish Program. Yes, my total cholesterol dropped, but so did my HDL (good cholesterol). My LDL (bad cholesterol) increased. Most alarmingly, in less than a month, my triglycerides more than doubled! My cardiologist had no explanation for this phenomenon. So, I ate even less fat (down to 5% of total calories). My blood chemistry did not improve.
Fortunately, I changed cardiologists and found that for about 25% of the population the low-fat diet of Ornish's approach actually triggers worse heart disease. This group has an inherited condition that causes small-particle LDL syndrome, a deadly condition that at least triples heart attack risk. (Patients with this condition are said to have Pattern B LDL subclass.) Even the staid American Heart Association last year recognized that for these patients, it is better to change the types of fat a patient eats (switching from saturated fats to monounsaturated fats) rather than drastically reducing fat intake.
Ornish ignores this phenomenon with the comment that some patients don't respond to his treatment. Not responding and getting worse are very different things. I would think that Ornish would at least avail himself of the advanced cholesterol testing that would identify patients who have genetically-caused small-particle LDL syndrome BEFORE treating them with a low-fat diet.
The rabid, no-fat-low-fat mantra may work for some patients, but for those who "don't respond", it is deadly, as proven by several scientific studies. In fact, two recent studies by the University of California at Berkeley showed that even normal men (who did not have heart disease and who did not have small-particle LDL syndrome) began producing large amounts of small LDL particles when put on a low-fat diet. 41% of the test group converted to the deadly disease state in six weeks, thus tripling their heart attack risk.
For those with these inherited killer genes, a completely different approach is necessary. But most important, it's necessary to first use advanced cholesterol testing (sometimes called cholesterol subclass testing) to find out if a patient has the genetically-induced form of heart disease that responds badly to a low-fat diet. This testing is different than the oft-given cholesterol panel that shows HDL and LDL. Such panels are highly inaccurate in determining the presence of small-particle LDL syndrome.
Without advanced cholesterol testing, both heart patients and normal individuals who adopt a low-fat diet are playing Russian Roulette. The good news is that for those who have small-particle LDL syndrome, proper treatment can reverse coronary blockage without drugs or surgery. I know. I have this disease and after I got worse with Ornish's diet, my cardiologist and I watched my coronary blockage melt away with an approach that is totally different from what Ornish recommends.