This 28-week observational study measured adherence to and acceptability of the diet and nutrition component of an Ornish-type program among patients in a rural southern setting. Ten volunteers followed a very-low-fat (10% of energy), total vegetarian diet and participated in a program of exercise, stress management, and group support. Patients made significant dietary changes and found the diet "acceptable." Three patients consumed less than 10% of energy from fat and two additional patients consumed less than 20% of energy from fat. Eighty-five percent of the patients' meals adhered to a near vegetarian diet. Weight loss ranged from 0.1 to 11.7 kg (0.25 to 26 lb). Lipid values were unchanged. At 12 months, without the benefit of the structured program, one patient reported 100%, six reported 85%, and two reported 50% adherence to the dietary principles. We conclude that motivated patients with coronary artery disease can follow a very-low-fat, near vegetarian diet but experience difficulty without a structured program.