We conclude this chapter by looking at the approach I use when discussing lifestyle changes with my heart patients. I call it the "Good, Better, Best Approach." First, the "best" approach is the lifestyle program that has been clearly shown to be the most healthful: a total vegetarian diet--the ideal diet--in addition to smoking cessation, caffeine avoidance, regular exercise, emotional support, and stress control.
There will be some people that for one reason or another feel that they cannot--or choose not to--get on the best program. For them we can offer the "better" approach. The better approach would be somewhere between the National Cholesterol Education Program Diet and the best approach. For those who elect not to follow either approach, there is the "good approach," which is to follow the National Cholesterol Education Program or a similar diet. The content of these three diets is shown in Figure 24: Three Choices of Diet: Good, Better, or Best.
The patients are informed of the level of expected results from following each option. Those who only succeed in meeting the "good" diet, which is the NCEP's strictest recommendations: 200 mg cholesterol intake per day, and 30 percent or less calories of total fat (with not more than seven percent saturated fat), will likely experience progression of heart disease rather than regression, especially if they are not on chronic cholesterol-lowering medication. However, if their previous diet was much worse than this, they may slow the rate of progression. But the odds are good that the future eventually holds surgery or angioplasty, if not a heart attack. When one needs to jump across a chasm, a half jump just does not do the job.
