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Simple and Proven Breakthroughs That Are Changing the World

Dean Ornish, M.D., is one of the greatest medical pioneers in the world. His research has demonstrated—for the first time—that integrative changes in diet and lifestyle can reverse heart disease, turn on health-promoting genes, slow aging, and slow or even reverse early stage prostate cancer. Medicare and many of the largest insurance companies have made his program the first lifestyle-based approach they have ever covered. Chosen by Forbes as “one of the seven most powerful teachers in the world,” Dr. Ornish's work is changing the face of medicine.

Dr. Ornish challenges the myth that you have to choose between what's good for you and what's fun for you. His research proves that better diet can lead to better sex, more energy, and a happier life.

JOHN ROBBINS: Your results have been extraordinary. Patients in your program see their angina reverse or decrease as early as the first few weeks. Blood flow to the heart improves, often in a month or less. After a year, even severely blocked coronary arteries become measurably less blocked. It seems that as the years go by there is even more reversal and more improvement. Have you seen comparative improvements in patients following the more moderate American Heart Association Guidelines or any other program that you know of?

DR. DEAN ORNISH: Moderate changes may be enough to prevent heart disease in some people, but they are usually not enough to reverse it. We were able to show in a scientific way that most traditional recommendations didn't go far enough. The more you change your diet and lifestyle, the more you improve in virtually every way we can measure, whether it is your heart disease improving, your PSA coming down, or your gene expression changing. We found that over 500 genes were changed in just three months, with the up-regulating or turning on of genes that prevent disease, and down-regulating or turning off of genes that help promote disease. Particularly what are called the RAS oncogenes that promote cancers of the prostate, breast, and colon were down-regulated. These processes are much more dynamic than anyone had realized. The more we look, the more we find.

Some people think taking a pill is easy and everyone will do it, but that changing diet and lifestyle is difficult, if not impossible, and hardly anyone will do it. What we're finding is actually the opposite. Adherence to most medications, whether they are cholesterol-lowering drugs or blood pressure pills, is only about 30 percent at three or four months. But we are getting 85–90 percent adherence after a year in Nebraska, Pennsylvania, and West Virginia, even though West Virginia leads the United States in heart disease. The reason is that the pill may not make you feel better, but changing your diet and lifestyle will. The better you feel, the more you want to keep doing it so you get into a virtuous cycle. That is one of the reasons people are continuing to do it—not just to live longer, but to live better.

JOHN ROBBINS: So they enter the program because they have some medical problem that they want to alleviate and they end up changing their life in a way that creates benefits across the board. It seems as though you have found an entry point into people's lives that is healing in a profound sense.

DR. DEAN ORNISH: Well it is, and that is why I love doing this work. You know, we are all going to die of something. The mortality rate is still 100 percent, it is one per person. But the question is not just how long we live, but also how well we live.

There is a belief that you have to choose between what is good for you and what is fun for you. But we're saying you can have both. You can have more fun, have better sex, sleep deeper, enjoy your food more, and not have all those aches and pains.

The ancient swamis, rabbis, priests, monks, and nuns didn't develop techniques like meditation, yoga, and so on to unclog their arteries or lower their blood pressure. But it turns out that they developed some really powerful tools for transformation that are also physiologically healing. I can't tell you how many patients have said things to me like, “Even if I knew I wouldn't live another day longer, I would still make these changes now that I know what they are like because my life is transformed.”

What is most meaningful to me is how we can work with people to use the experience of suffering in whatever way they are feeling it as a catalyst and a doorway for transforming their lives. For some, it is physical suffering, because they have angina or chest pain. For others, it is the suffering of depression or isolation. If we can work at that level, then we find that people are much more likely to make lifestyle choices that are life enhancing rather than ones that are self-destructive.

To me it is really about transformation, and then on a physical level, just about everything we measure tends to get better. We're seeing dramatic improvements in things that were never measured before. We found that even telomerase increased by 30 percent in the first three months.

JOHN ROBBINS: Why it that important?

DR. DEAN ORNISH: Dr. Elizabeth Blackburn won the Nobel Prize in 2009 for her co-discovery of telomerase. Telomerase repairs and lengthens our telomeres, which are the ends of our chromosomes. Telomeres control aging, which in turn controls how long we live. So as your telomeres get shorter, your life gets shorter.

She had done a pioneering study with women who were caregivers of parents with Alzheimer's or kids with autism. The more stress the women reported feeling and the longer they reported feeling that way, the lower their telomerase and the shorter their telomeres were. It made headlines because it was the first study showing that even at the genetic level, chronic stress can actually shorten your life.

What was one of the more interesting findings of this study is that stress is not simply what happens to you, it is how you deal with it. You could have two women who were in very comparable life situations, but one was coping much better than the other. It wasn't the objective measure of stress that determined its effects on telomerase; it was the women's perception of it. So when people learn how to meditate and do yoga and use other methods to manage stress, they can be in the same job or the same family or the same environment and react in different ways.

JOHN ROBBINS: I am hearing two things. I am hearing that your research is showing that the kind of lifestyle changes you recommend actually affect gene expression, turning on disease-preventing genes and turning off genes that promote cancer, heart disease, and other diseases. I am also hearing that there is evidence that these same lifestyle changes have an affect on aging, because they actually impact the telomerase.

DR. DEAN ORNISH: Yes, we found that the telomerase increased by almost 30 percent in just three months, and ours is the only intervention to date that has been shown to do that. We are now looking to see the effects on telomere lengths.

JOHN ROBBINS: That is astounding information and a major breakthrough.

DR. DEAN ORNISH: It is a radically simple idea that when you eat healthier, when you love more, when you manage stress better, when you exercise moderately, and when you don't smoke, you are happier and your life is more fun.

JOHN ROBBINS: You have become primarily known for your nutritional wisdom and research, but you have also written in great depth about the healing power of relationships and intimacy. We live in a culture where loneliness probably kills more people than cigarettes. What are you learning about the connection between relationships and health?

DR. DEAN ORNISH: We get to know each other really well in some of my studies. After a while I asked some of my patients, “Why do you smoke? Why do you overeat and drink too much and work too hard and abuse yourself? These behaviors seem so maladaptive to me.”

They would say: “You don't get it. You don't have a clue. These are adaptive behaviors, because they help us get through the day.”

One patient said, “I've got twenty friends in this package of cigarettes and they are always there for me.”

So it is true that loneliness kills more people than cigarettes, but keep in mind that it is often loneliness that causes people to smoke in the first place. Or they use food to fill the void or alcohol to numb the pain, or they work all the time to distract themselves.

To me, the function of pain is to say, “Hey, listen up. Pay attention. You are doing something that is not in your best interest.” Then we start to say, “Oh, I have a different choice. I can do this instead of that,” and then it comes out of your own experience, not because some authority figure told you.

JOHN ROBBINS: I want to take the example of your friend, former President Bill Clinton. He has had serious health problems for a long time. In 2004 he underwent a quadruple bypass to restore blood flow to his heart. A few years later, there were more problems and he had two stents placed inside one of his coronary arteries that had once again become clogged. After that he made a decision that I think you had probably been encouraging him toward for some time. That decision seems to have transformed his life. He has lost more than twenty-five pounds. The last time I heard from him, he said he was feeling healthier than ever. He may have become the world's most famous vegan. What can you share about President Clinton's health journey and your involvement with it?

DR. DEAN ORNISH: Well I love President Clinton. I think he is an amazing human being. I began working with the Clintons in 1993 when someone arranged for Mrs. Clinton to meet with me. She was interested in the research that we were doing and after showing her the research she said, “Would you work with the chefs who cook for us?” And I said, “Excuse me?” She repeated it and I said, “Of course, I would be honored to.” So I brought in some of the top chefs that we have worked with over the years. We went to the White House and we worked with the chefs who cooked for the President. We also worked with the chefs from Camp David and from Air Force One. It was a great privilege to be able to do that.

I also began working with the President on his own health. He did make some changes in the way he was eating and it did lead to some benefits, but when his bypass clogged up, there was a press conference in which it was announced that it was all in his genes and his diet and lifestyle had nothing to do with the bypass clogging up. So I communicated with him and said, “The friends that I value the most are the ones who tell me what I need to hear, not necessarily what I want to hear. What you need to know is that it is not all in your genes. I say this not to blame you, but to empower you, because if it were all in your genes, you would just be a victim. There is a lot you can do. Again, that is the opportunity. It is not a criticism in any way. It is out of great respect and love.”

I sent President Clinton some of the research and a couple of books that I have written on the topic, and when we met a week or so later, he said that he had decided to do it. I was really happy that he did that because I care about him so much. I was also happy because I think, whatever your politics, when the President of the United States—especially one who was known earlier in his life for eating particularly unhealthfully—makes a choice to eat a lot healthier, that sets a great example for everyone. So, as you say, he may have become the world's most well-known vegan. Whatever other considerable good that he does in the world, he will have added to it substantially by showing that this is possible.

JOHN ROBBINS: I want to share one of my favorite quotes of yours. You said, “I don't understand why asking people to eat a well-balanced, vegetarian diet is considered radical, while it is medically conservative to cut people open and put them on powerful cholesterol-lowering drugs for the rest of their lives.”

DR. DEAN ORNISH: We pay for things that are dangerous, invasive, expensive, and largely ineffective. And we have a hard time believing that simple choices in our lives that we make each day—like what we eat, how we respond to stress, how much love we give each other, and how much we exercise—can make such a powerful difference. But they really do. That is probably our unique contribution: we use these very high tech, expensive, state-of-the-art measures working with first-rate scientists to show how powerful these very simple, low-tech, and low-cost interventions can be. Three-quarters of the 2.8 trillion dollars that we spend each year on health care in the United States is for chronic diseases that can often be prevented or even reversed by simply making these same kinds of changes. In every one of our studies, the more people have changed their diet and lifestyle, the more they have improved.

It is not like there is one diet and lifestyle intervention for heart disease and a different one for prostate cancer and a different one for Type 2 Diabetes and a different one for changing your genes or making your telomeres longer. It is really just to the degree that you move in this direction, we've found there is a corresponding benefit. It is not all or nothing. Being a vegan is too much for some people, so we say, “Okay great. Just do what you can. What matters most is your overall way of eating and living. Foods aren't good or bad, but some are healthier for you than others.” So we have categorized foods from the healthiest (group one) to the least healthful (group five), and groups two through four are intermediate. If you are eating mostly four and five, you are eating mostly unhealthy food.

If you feel like making any changes, of course that is up to you. You can say, “Okay, maybe I will eat a little less four and five and maybe more one through three.” Then you do that and you see if you feel better. If you start to feel better, then maybe you want to make even bigger changes, but again it is coming out of your own experience.

The problem with going on a diet is that when you go on a diet, sooner or later you are likely to go off it. Once you go off it, you may feel like you are a failure. Be compassionate with yourself. Just say, “Directionally I am going to go more towards a plant-based diet because I want to feel better. So if I indulge myself one day, then I will eat healthier the next. If I don't exercise one day, I will do a little more the next. If I don't have time to meditate for an hour, I will do it for a minute.” Just the consistency is more important than anything, and that way you can't fail. It just becomes a way of living in the world rather than just a diet that you go on and off.

JOHN ROBBINS: It reminds me of the old story, The Tortoise and the Hare. Slow and steady wins the race.

DR. DEAN ORNISH: That's true. And it's also true that sometimes people do really well when they make big changes all at once because they feel so much better so quickly, and the effect of their changes is highly visible. For others it is easier to go with slow and steady.

We say, “Here are the risks and the benefits, the costs and the side effects. This is your life, and your responsibility. I am only here to support you and make sure that you have all of the information that you can use to make intelligent choices. I'm here to support whatever you choose to do, whether it is drugs, surgery, lifestyle, or a combination.”

JOHN ROBBINS: You have been engaged in a dialogue with Medicare for a long time that is now bearing fruit. One would hope that if you do good science it is going to change medical practice. But if there isn't reimbursement, then it might not.

DR. DEAN ORNISH: I am grateful for Medicare. They are now covering “Dr. Ornish's Program for Reversing Heart Disease” as a named program in the clinics, hospitals, and physician's offices where we train and certify. Having seen what powerful changes diet and lifestyle can make over the past thirty-five years of studies, it is great to be able to make them available. Reimbursement is an important determinant of medical practice and even medical education.

I learned a painful lesson when we opened a number of sites before we had reimbursement to cover our program. Even though we got excellent clinical outcomes, some of those sites closed down. They didn't close because the treatment wasn't working. They closed because it wasn't reimbursable.

If you change reimbursement, then everything follows. Without that even a thousand studies may not be enough to really change things.

After sixteen years of reviewing our work internally and externally, Medicare agreed to cover it. Now we can make it available to people everywhere, because most other insurance companies are following their lead.

We trained ten hospitals in West Virginia which has been the number one state in the country for heart disease, and 44 hospitals and clinics elsewhere, with many more to come. We trained the St. Vincent de Paul Society homeless clinic in San Francisco in our Spectrum Integrative Medicine Program and they have treated more than 15,000 people through it in the past year and a half. We will be offering our reversing heart disease program there as well which Medicare will reimburse, and then we'll clone it to St. Vincent de Paul homeless clinics throughout the country.

We are in the process of training lots of different people in our program and providing a truly integrative paradigm that incorporates the best of drugs and surgery when they are effective, but also addresses the more fundamental causes of why we get sick.

JOHN ROBBINS: You have become known for advocating a low-fat diet, and yet as you have so often pointed out, low fat is not synonymous with healthy. I have seen studies that purport to measure low-fat diets to see if there are any benefits, but they define “low fat” as an intake barely less than the norm in our culture, and then don't see benefits. There is barely any reduction in fat consumption, so you see barely any results.

DR. DEAN ORNISH: Right, well not only is there barely any reduction in fat, but also they usually put in tons of sugar. I am so sorry that I somehow have gotten this reputation as the low-fat guy. I think it came out of the debates I was in with Dr. Atkins. To me that is the least interesting part of the work that we do.

JOHN ROBBINS: What would you say is the role of fat in an optimally healthy diet?

DR. DEAN ORNISH: It depends. Three or four grams a day of omega-3 fatty acids taken during pregnancy can increase a child's IQ. For adults, they can reduce your risk of sudden cardiac death by up to 80 percent, because they raise the threshold for ventricular fibrillation. They can reduce your risk of prostate or breast cancer. They can help reduce inflammation. They can lower triglycerides. I think that those are good things to have in your diet.

If you are vegan, you can get omega-3 fats from the plankton-based supplements, and if you are not, you can get them from fish oil. I recommend that just about everybody take three or four grams a day of fish oil or the equivalent.

There is a consensus that trans fats are harmful in a number of different ways. There is a lot of controversy about whether saturated fat is harmful or not. I think it is, with the possible exceptions of the saturated fat that you find in chocolate, which, although it is dense in calories, may actually be good for your heart.

Total fat consumption matters in a number of ways, one of which is that fat is the most dense form of calories. Fat has nine calories per gram and protein and carbs have only four. So if you are eating less fat, you are getting fewer calories without having to eat less food. It is the volume of the food that really seems to stimulate satiety more than the caloric density of the food. An easy way to lose weight is to just reduce the amount of fat in your diet, because you are going to be getting the same quantity of food, but it will be less dense in calories, so you are going to be eating fewer of them.

JOHN ROBBINS: How about coconut?

DR. DEAN ORNISH: Coconut is high in saturated fat. I think the jury is out on coconut. I haven't seen enough good evidence either way.

JOHN ROBBINS: Olive oil is frequently touted as a health food and the center of the Mediterranean Diet. At the same time, canola oil is getting a bad reputation in certain circles. What do you think of this controversy?

DR. DEAN ORNISH: One of the main reasons people think that olive oil is good for you is because of the Lyon Study that took place in France. People consuming what was termed a Mediterranean Diet had an 80 percent lower risk of heart attacks than those who didn't. But if you actually looked at what they were eating on this so-called Mediterranean Diet, they were reducing their intake of saturated fats—meat and butter and dairy and so on. And they were eating a diet that was high in canola oil. What makes canola oil beneficial are the omega-3 fatty acids that are high in canola oil but are very low in olive oil. That is what they were eating in the Lyon Study, and so the Mediterranean Diet that was so beneficial was high in canola oil, more than in olive oil.

Now olive oil does have antioxidants. It has some good things. The problem with olive oil is that, like all oils, it is so dense in calories. One tablespoon of olive oil has about fourteen grams of fat. People dip their bread in it and soak up large amounts of oil, thinking it is somehow going to be good for them and not realizing that they are getting a lot of calories.

JOHN ROBBINS: I want to ask you about alcohol. I have always seen you as somebody who wants people to enjoy their life.

DR. DEAN ORNISH: Absolutely. What is the point otherwise?

JOHN ROBBINS: For many people, alcohol is part of their joy in life and their connection with other people. Yet of course, in excess it is addictive and terribly destructive. We are seeing some evidence that moderate alcohol consumption has actual health benefits. What is your take on this?

DR. DEAN ORNISH: I think that you should do things you enjoy. I don't prescribe alcohol. I don't proscribe alcohol. I say if you are going to drink, the studies show that it is best to keep it on average under two drinks a day. Two drinks means two glasses of wine, two cans of beer, two shots of whiskey, or the equivalent.

The studies show that people who drink moderately can derive some benefit. But these are people who like to hang out with their friends after work. They go to a bar or go to a restaurant for happy hour. It's a great place for people to get social support. So it's hard to separate how much of that benefit is due to the social support, and how much is due to moderate alcohol consumption. Rather than trying to sort out the relative parts, I would say they are probably both important. But I wouldn't tell somebody who is not drinking to start. I think that it is important that people feel like they have lots of ways of increasing their social support or managing stress. Some people may sit around drinking, and other people will do it in other ways.

JOHN ROBBINS: Medicine is a business and there are powerful commercial forces involved. There is a lot of money at stake, and the incentives haven't always been aligned with patient well-being.

DR. DEAN ORNISH: I think that is beginning to change with the Affordable Care Act. Now instead of reimbursement by procedure we're seeing reimbursement by diagnosis. When you say, “Here is X amount of dollars to take care of someone who has got heart disease,” then suddenly the doctor might be advising doing fewer procedures and helping people to change their lifestyles.

We all know that lifestyle is important in preventing disease. But now we're seeing lifestyle as a treatment. It can often work as well or even better, at a fraction of the cost, with only good side effects.

There is a convergence of forces that makes this the right idea at the right time. The limitations of high-tech medicine are becoming clear. Stents and angioplasties don't work for stable patients, and the surgery for prostate cancer isn't really necessary most of the time. Meanwhile, the power of these very simple, low-tech, low-cost interventions like lifestyle changes have become increasingly well-documented.

The opportunities are really ripe now for industries to realize that a new paradigm of medical care can be much more sustainable, and even profitable.

Health care costs are reaching a tipping point. They are not financially sustainable for the government nor for many families. Most large businesses are self-insured, and this is coming right off their bottom line. There is a debate between some people who say, “Let's just raise taxes and let the deficit go up,” and other people who say, “No, let's just dismantle or privatize Medicare.”

I say, “If 75% of the $2.8 trillion in health-care costs are for chronic diseases that can often be prevented and even reversed by making comprehensive lifestyle changes, this can be a third alternative. By teaching people how to change their lifestyles, we can make better care available to more people at significantly lower costs—and the only side-effects are good ones.”