What Foods Are Included in a Heart-Healthy Diet?

Below is a table where I have done my best to compare the daily diets and lifestyles proven to reduce and reverse heart disease researched by Dr. Caldwell Esselstyn, Jr., and Dr. Dean Ornish. You will notice that their recommendations are not identical but that they are very similar. My hope is that you will use this summary as a starting point. Then you can work with your healthcare providers to develop a dietary plan that’s efficacious for you based on information from Dr. Ornish’s website; Dr Esselstyn’s book, Prevent and Reverse Heart Disease, and his website.

Food Dr. Essylstyn’s Program to Prevent and Reverse Heart Disease Dr. Ornish’s Proven Lifestyle Reversal Program
Meat, poultry, fish None None
Eggs None Egg whites allowed, no yolks
Dairy None 2 servings maximum of non-fat dairy
Milk and yogurt Non-dairy only Non-dairy or nonfat milk
Cheese None Nonfat only
Oil None See Note 1
Seeds 1-2 tablespoons of ground flax or chia seeds plus a small amount of seeds, like what is baked into breads or crackers. Small quantities; See Note 1
Nuts Chestnuts only; See Note 3 Small quantities; See Note 1
Fruits Yes Yes
Vegetables Yes Yes
Beans, peas and lentils Yes Yes
Tofu Lower fat varieties Yes
Tempeh Yes Yes
Fruit juice None  
Whole grains Yes Yes
Whole grain breads and pasta Yes  Yes
Refined grains and sugar See Note 2. No more than 2 servings a day, about 100 calories for women and 150 for men
Alcohol Yes At most 1.5 ounces liquor, 4 ounces of wine or 12 ounces of beer
Fats None None
Oils None None
Avocados None None
Coconut None None
Olives Not mentioned specifically. None
Coffee Decaf only 1 cup caffeinated or 2 cups of decaf
Tea Yes (the amount of caffeine in tea is lower than in coffee) 2 cups black or green
Multi-vitamin Not necessary if eating lots of leafy green vegetables Yes – low dose and without iron, unless you are a female of childbearing age
B-12 supplement Yes Yes
Fish oil supplement No. Instead eat 1-2 tablespoons of flax seed meal or chia seeds and several servings of leafy greens. Yes
Other supplements Vitamin D if blood tests indicate Consult your physician about calcium
Exercise, stress management, and love and support Not included in program Part of program
Note 1: See: https://www.ornish.com/proven-program/nutrition/.
Note 2: In his book, Dr. Esselstyn allowed sugar, though recommended desserts be limited to special occasions only. Since the publication of his book, and based on newer research, he has changed his opinion. On his website, he currently recommends you not eat any form of sugar (including honey, molasses, corn syrup, maple syrup, etcetera), especially if your triglyceride levels are elevated.
Note 3: Dr. Esselstyn recommends against eating nuts unless you don’t have heart disease, and, without taking cholesterol lowering drugs, your cholesterol is below 150 and your LDL is under 80. Similarly, he recommends against eating avocados.

We follow the advice of Dr. Esselstyn rather than that of Dr. Ornish. This is in part due to research which shows that the gut microbiota of people who eat animal protein convert the lecithin, choline and carnitine from these sources into TMA, trimethylamine. After entering one’s bloodstream, TMA is converted to TMAO, trimethylamine-n-oxide, in the liver. TMAO has been implicated in vascular disease. For this reason, we don’t eat the egg whites and skim milk allowed in Dr. Ornish’s program.

Besides these two programs, I should also mention that Dr. Joel Fuhrman is another physician who recommends a vegan diet for heart disease. However, his diet includes plant foods like nuts and avocados, making it higher in saturated and other fats than the diets of Drs. Esselstyn and Ornish. Another difference is that he recommends limiting daily servings of whole grains. For more information, you can buy his book, The End of Heart Disease, or check it out of your local library.

My concern about Dr. Fuhrman’s recommendations is that although he presents many cases of individuals who successfully use his program, he does not appear to have studied a group of people with heart disease for much longer than a year. I don’t want in any way to reduce the importance of Dr. Fuhrman’s contributions to the study of diet and heart disease. However, he hasn’t provided extensive, long-term evidence to support his diet recommendations, and Drs. Esselstyn and Ornish have.

Again, please work with your healthcare professionals to determine the program that is best suited for you.