Dr. Dean Ornish is considered the father of lifestyle medicine, pioneering programs that can reverse life-threatening illness with a combination of a plant-based diet, moderate exercise, meditation and therapy. Dean and I have known each other for over 40 years, dating back to our time together at Massachusetts General Hospital. Then, Dean’s ideas were considered outlandish. Today, we’re finding they may be the key to treating even our most challenging diseases like Alzheimer’s. Dean is a cardiologist, the founder of the Preventive Medicine Research Institute, and a bestselling author. I haven’t been able to put down his latest book, “UnDo It! How Simple Lifestyle Changes Can Reverse Most Chronic Diseases,” which he coauthored with his wife Anne.
Dean Ornish: And so, when you change all of these things, the blood flow improves even before the blockages have a chance to reverse. We found in just three and a half weeks, there was a 400% improvement in blood flow to the heart as measured by PET scans. But over a longer period of time after a year, even severely blocked arteries became measurably less clogged. And over five years, there was even more improvement than after one year.
Bill Frist: You’re listening to A Second Opinion, your trusted source engaging at the intersection of policy, medicine, and innovation, and rethinking American health. Dr. Dean Ornish is considered by many to be the father of lifestyle medicine, pioneering programs that have been proven to reverse life-threatening illness with a four point plan. Eat a plant-based diet. Move more. Stress less and love more.
Dean and I have known each other for about four decades, dating back to our time together as interns at Massachusetts General Hospital. Then, Dean’s ideas were considered a bit out there, a bit on the edge. Today, they are mainstream. Today, they are fact. We’re finding they may be fundamental to treating even our most challenging diseases such as Alzheimer’s. Dean is a cardiologist, the founder of the Preventive Medicine Research Institute, and he is a best-selling author.
You will absolutely love his latest book where he puts it altogether with a unifying principle, the title, Undo It! How Simple Lifestyle Changes Can Reverse Most Chronic Diseases, which he coauthored with his wonderful wife. And I’m your host, Senator Bill Frist. Welcome to A Second Opinion. Dean Ornish, it’s been 40 years that we’ve known each other in different capacities. I want to get to that shortly. But for our listeners and for our viewers, let’s just start right in.
You have a 40-year history of being the pioneer. And probably the better word is, the father of lifestyle medicine. How did you earn that moniker? And I know well how you did through the peer-reviewed literature and all, but what does it mean, the father of lifestyle medicine?
Dean Ornish: Well, first, thanks for having me on your podcast. It’s great to have an excuse to spend this much time talking together. I got interested in doing this. Lifestyle medicine is a field where we use lifestyle changes not only to help prevent disease, which we all know, but to treat and often even reverse it. And I think our unique contribution has been to use these very high tech expensive state-of-the-art scientific measures to prove the power of these very simple and low tech and low cost interventions.
We often think that it has to be a new drug, a new laser, something really high tech and expensive to be powerful. But these simple lifestyle changes, a whole foods plant-based diet that’s low in fat and sugar, moderate exercise for half an hour a day like walking, and some strength training, various stress management techniques like meditation, and what we call social support, or to reduce it to its essence, to eat well and move more, stress less and love more.
The more diseases we study and the more underlying mechanisms we look at, the more scientific evidence we have of how powerful these simple changes are, how wide and reaching they can be, and how quickly we can measure improvements in ways that really matter to people.
Bill Frist: The four components that you put together, the one that you add uniquely to what is basically common sense, and I say that recognizing, and we’ll talk more about it, the sophistication, the peer review, the long journey that you have put in to document from a scientific standpoint. But the fourth component that of the more social connectedness, isolation, and you summarized it frequently under love, L-O-V-E.
And where did come from? And how did you first incorporate that into the other four, that one of the four?
Dean Ornish: Yeah, good question. Well, love is one of those four letter words we don’t talk much about in medicine. Even in cardiology or cardiac surgery, the heart is that symbol of love. And study after study have shown that people who are lonely and depressed are three to 10 times more likely to get sick and die prematurely from virtually all causes than compared to those who have a sense of love and connection to community. And I don’t know anything in medicine that has that far reaching an impact.
And in part, it’s because it affects our behaviors. In doing these studies, we spent a lot of time with the study participants. And I get to ask them like, “Teach me something. Why do you smoke? Why do you overeat? Why do you drink too much? Why do you abuse substances? Why do you spend so much time on videogames? Why do you use opioids?” These behaviors seem so maladaptive to me. And they look at me and they go, “They’re not maladaptive. You don’t get it. You don’t have a clue.
These behaviors are very adaptive because they help us deal with our pain, our loneliness, our depression.” I think that the real data epidemic or pandemic in our culture, and then so much of the world, is the breakdown of the social networks that used to give people a sense of love and family, and connection, and church, and synagogue and intimacy with each other. Fifty years ago, most people had an extended family that they grew up with.
They had a neighborhood with two, three generations of people that they grew up with. They had a church or a synagogue, or a mosque, or something that they went to on a regular basis. And today, many people have a job that felt secure that they’d been out for 10 years or more. And today, many people don’t have any of those things, and we pay a real price for that. And when people say things like… I mean, we’ve learned that information is important, but it’s not usually sufficient to motivate most people to change their behavior.
I mean, if it were, nobody would smoke. It’s not like I’d say, “Hey. Bill, I want you to quit smoking. Did you know it’s bad for you?” And you go, “Ghee, I didn’t know that, I’ll quit today.” And it’s like, everybody knows. It’s on every pack of cigarettes. But people say things to me like, “I’ve got 20 friends in this pack of cigarettes and they’re always there for me, and nobody else is. You’re going to take away my 20 friends? What are you going to give me?
Or food fills that void or fat calms my nerves and numbs the pain, or alcohol, or opioids, or other drugs numb the pain, or videogames numb the pain. They distract me or working all the time is something we’ve all used to distract ourselves from pain.” And so, I’ve learned that the information is important, but we need to work at a deeper level. And when we work at that level, then we find that people are much more likely to make and maintain lifestyle choices that are life-enhancing than ones that are self-destructive.
Bill Frist: I have with me, and for those who are watching this, to the viewers, I have in my hands here a book. And my wife, the love of my life, is a little bit upset with you. Because for the last three nights, I’ve stayed up till about 2:00 in the morning reading your book. And the book is Dean Ornish and Anne Ornish, we’ll come back to that. And the book is Undo it! How Simple Lifestyle Changes Can Reverse Most Chronic Diseases.
And then, that brings me, and you have this circle here. Is there a central organizing pieces that you’ve had over the last 40 years that you’ve continued to refine and develop, and build the very best sort of the scientific background and proof purpose? How do you summarize that central organizing principle?
Dean Ornish: Yeah. It’s this unifying theory that we presented the book. With all this interest in personalized medicine, it wasn’t over the 43 years of doing these studies, it wasn’t like there was one set of diet and lifestyle recommendations for reversing heart disease and other one for diabetes, et cetera. It was the same for all of them. And so, that got me thinking like, “Why is that?” And then, it hit me like, “Oh.”
Because you and I, and all the doctors were taught to view heart disease and type 2 diabetes, and proxy cancer, and hypertension and so on, is different diseases, different diagnoses and different treatments. But what we’re learning is that they’re really, to me, and what the radical idea that we present in this book, is that they’re really the same disease more than we thought manifesting and masquerading in different forums.
And I say that because they all share the same underlying biological mechanisms. Things like chronic inflammation, changes in immune function, and oxidative stress, and telomere length, and gene expression, and angiogenesis, and apoptosis, and so on. And each one of these, in turn, is a direct function of what we eat, how we respond to stress, how much exercise we get, and how much love and support we have.
And it’s one of the reasons why for example as you know, you often find the same patient will have what are called comorbidities. They’ll have high blood pressure and be overweight, and have high cholesterol, and have type 2 diabetes, and have heart disease. Or why entire cultures like in China 50 or 60 years ago, they had such low rates of all these chronic diseases. And then, when they start to eat like us and live like us, they started to die like us.
And now that heart disease and type 2 diabetes killed more people around the world than a sodium malaria combined. And so, when we look at it that way, it radically simplifies what we tell people. And it also helps us to see that if you’re trying to reverse disease, it’s like the pound of cure. It takes a lot. That’s why we found these same lifestyle changes. I got interested in doing this work when I was a medical student at Baylor College of Medicine in Houston, and I was at Michael DeBakey’s surgical service, who I’m sure you probably knew.
And we cut people open. We bypass their clogged arteries. He’d tell them they were cured. And more often than not, they go home and do the same things that have caused the problem in the first place, eat junk food and not manage stress, not exercise, and so on. And then, we come back. And then, we cut them open again, sometimes, multiple times. And so, for me, that became a metaphor. They were literally bypassing the problem without also treating the cause.
When I lecture sometimes, I had a cartoon drawn many years ago of doctors busily mopping up the floor and a sink that’s overflowing, but no one’s turning off the faucet. Now, bypass surgery and stance, and so on, can be life-saving in a crisis, but they don’t really treat the underlying cause. Sometimes, you didn’t need to mop the floor. Drugs and surgery have their place. But we also need to treat the underlying cause.
And by the way, just as an aside because you knew him, Dr. DeBakey was really ruthless to his students. And he’d say, “What year are you, son?” I said, “I’m starting my third year.” He goes, “Damn. It’ll be so much harder to buzz you out of here with these weird ideas you have.” And he’d stick you with a needle if you didn’t move your hand fast enough out of the field, that thing. And about four or five years ago, I got this call from him.
And he said, “Hey, Dean. This is Mike DeBakey.” And as you know, he had this distinctive Louisiana accent, and I knew it was him. And I hadn’t heard from him in decades. And he said, “You know those ideas that used to give me such a hard time about 30 years ago, 40 years ago? I said, “Oh yeah, I remember very well.” He said, “That’s what’s kept me alive all these years.”
Bill Frist: I love it. I love it. I love it. For our listeners, Dr. DeBakey, just like you are that pioneered the father of lifestyle medicine, he very much is of cardiac surgery, my field, and the large vessel vascular surgery. But that’s very interesting, but take us a little bit further through that. Because you’re not just arresting cardiac disease. And again, we’ll come back, because as you said, it’s multifactorial in all of these other chronic diseases.
But going back to my field, cardiac disease and Dr. DeBakey, you’re not only stopping it or slowing it down. But your program is reversing it, and that’s unheard of. Or it’s not now, but it was 10, 15 years ago. Tell us about that.
Dean Ornish: Well, this was back in 1977. I was a second year medical student, third year medical student. I decided to take off a year. And one of the nice things about being in Texas is they’ll let you do things they wouldn’t let you do at Harvard, for example. It’s like, “Oh, you have this weird idea? Go for it. It won’t work, but you’ll learn something. So, we’ll support it.” The Chief of Cardiology, Robert Miller, and [Tony Gada], who was the chief of medicine at the time, donated to testing.
I went to every hotel in Houston, and the last one gave us 10 rooms for a month. And so, I put 10 men and women who had severe heart disease and who hadn’t had surgery, and they got better. And they not only felt better but they were better. We found that eight of the 10 people showed improvement in their blood flow to the heart as measured by thallium scan, which was a new test at the time. It was also my first experience that when you’re doing something that everybody thinks is impossible, it gets held to a different standard.
People say, “Oh, that’s impossible. The tests must be wrong.” And I said, “Well, these are the tests we use to send people to surgery every day. You did the test. We analyze it. Why are they no longer good?” “Well, it must be. You can’t be true. So, you didn’t have a randomized control group.” I said, “Well, that’s true. But eight of the 10 people got better. How often do you see that?” “Well, that’s beside the point. You didn’t have randomized control groups.”
So, I went back to school, finished medical school. Then, did a second study. This time, we did have a randomized control group, replicated that, published in The Journal of the American Medical Association. And then, went on to Boston to do my medical residency. And so, everything that we’ve done over the last 40 years, people thought it was impossible. And that, to me, is what the whole point of research, is to redefine what’s possible.
And by doing so, we can give at this point millions of people new hope and new choices, and empower them with things that they can do to begin healing themselves.
Bill Frist: And so, with the heart disease, so I’ve done hundreds, thousands of heart operations in my life. And I’m like Dr. DeBakey in the sense that we bypass. We jump around the lesion. The lesion stays there at the blockage in the vessel itself. But what you have proven is that through your program, and I’d like for you to describe the discipline behind your program, that blockage actually begins to go away, melt?
Dean Ornish: That’s right.
Bill Frist: To me, being a cardiac surgeon when you first presented it, I said, “No way. No way.” But explain that to our listeners.
Dean Ornish: Well, we used quantitative arteriography to measure the blockages and cardiac PET scans to measure blood flow in the most definitive study called the Lifestyle Heart Trial, which we also published in JAMA after I moved here from Boston in 1984. And our bodies have a remarkable capacity to begin healing if we simply stopped doing what’s causing the problem. It’s also been found that we used to think that the more severely blocked an artery was, the more likely it was to cause a heart attack.
And so, the blockages that that surgery was generally done around lesions or blockages that were 50% or greater. But we now know that it’s actually that those are the blockages that tend to cause angina or chest pain because the supply can’t keep up with the demand. The blockages keep the blood flow from getting to the heart where it needs to feed itself. But it turns out it’s the 20% to 30% blockages that actually are more likely to cause death because they can go from 20% to 30%.
You can get bleeding into the lining of an artery called plaque hemorrhage, and it goes suddenly to 100% blocked, or a blood clot can come and clog in there. There’s also as you know, your body can grow its own bypasses, and they’re called collaterals. And they tend to be much smaller in diameter than the epicardia or the big arteries that feed the heart. And they tend to get clogged up with fat and sludging, and small little blood clots, microthrombi, and others.
And so, when you change all of these things, the blood flow improves even before the blockages have a chance to reverse. We found in just three and a half weeks, there was a 400% improvement in blood flow to the heart as measured by PET scans. But over a longer period of time after a year, even severely blocked arteries became measurably less clogged. And over five years, there was even more improvement than after one year.
And so, when you make these changes, as to the degree that you make them, your body continues to improve. But the reason we were first approved that you could actually reverse heart disease, is that most people didn’t go far enough. I mean, I’d love to be able to tell people the moderate changes can reverse disease, but they generally don’t. There may be enough to prevent it but not to reverse it. The ounce of prevention and pound of cure.
So, we asked people to make what some people would call, really extreme changes, to follow a plant-based diet, fruits, vegetables, whole grains, legumes, soy products, very low in fat, very low in sugar, very low in refined carbs. The old joke is, am I going to live longer? Is it just going to seem longer if I eat that way? But eat food that’s delicious as well as being nutritious. Meditation and stress management for an hour a day, half an hour a day of exercise, and participating in a support group.
And in the support group, it wasn’t just to help people stay on the diet. It was really to create a safe environment much as when you grow up in a family, an extended family or a neighborhood with two or three generations of people, they really know you. They don’t just know your Facebook profile. There’s a study that I cite in the new book that the more time you spend on Facebook, the more depressed you are.
Because it looks like, it’s not authentic intimacy. It looks like everybody has this perfect life. “Here I am in front of the Eiffel Tower. Here I am and my kids are doing great.” It doesn’t show people posting, “Here’s my kid addicted to drugs or here’s the problems I’m having in my marriage,” or whatever. When you grew up 50 years ago in an extended family, they know you. They don’t just know your good stuff. They know your demons. They know your darkness.
And you know that they know, and they know that you know that they know, and they’re still there for you. And there’s just something very primal about being seen in that way, words and all. And so, in our support groups, I stumbled into this. We create a safe environment in which people are encouraged to talk about what’s really going on in their lives without fear that someone’s going to judge them or criticize them, or reject them.
And it’s incredibly powerful because many people have no one that they can do that with. And being able to do that in a supportive environment is the part of the program people generally have the most apprehension about or the most skepticism about it. And yet, invariably, it’s what they feel the most powerful aspect of it. And it’s the reason why we’re getting unprecedented levels of adherence. Now, we’ve been training hospitals.
Medicare, as you know, is now covering our program, in part, thanks to you when you were the Senate majority leader. But we had 20 members of the Senate from the most Liberal Democrats, the most Conservative Republicans, and 30 or 40 members of the House, the heads of the AARP, and most other organizations took 16 years, but we finally were able to do that.
Bill Frist: It does demonstrate that by parties, it does occur-
Dean Ornish: That’s right.
Bill Frist: … and wealth and well-being can bring people together. But go a little bit further in terms of the program. How many weeks is it? You said it’s a very disciplined program. And then, we’ll come to the adherence. A year later, are people still on it or is it just too tough? Because it’s counterintuitive. The tougher you have made or more disciplined, you’ve made the program that is guaranteed as, number one, higher or compliance.
And then, a year later, that compliance is still there. So, tell us a little bit more about that.
Dean Ornish: Yeah, it is encouraging. That was back I think when people talked to each other, Republicans and Democrats. So, these are just human issues. We had Bill Clinton, he was president, and Newt Gingrich, who’s the Speaker of the House came together. It’s one of the few things that they came together around. You came together with Harry Reid or whoever was the Democratic instructor at the time. And we’ve put our differences aside.
And so, these are things that can benefit everyone, and I’m deeply grateful for that. It didn’t take us 16 years, but my persistence is probably my best and my worst quality. But it did, and now that Medicare is paying for it and is covering it in all 50 states, BlueCross BlueShield, Anthem, most of the major insurance companies are paying for it.
Bill Frist: So, what are they covering? First of all, it’s a great story, and only you could have pulled it off to have the government reimburse for it. A lifestyle was the first lifestyle reimbursement by Medicare ever in the history. And then, to have the commercial payers, you mentioned two, but most of the commercial payers now pay for your particular lifestyle program. They’ve paid for some others as well. But yours was the first and the one that is most commonly reimbursed.
What are they actually reimbursing?
Dean Ornish: Good question. Well, thank you for your kind comments. And again, thank you for your support back then. It means the world to me, and your friendship. So, what they’re paying for is 72 hours of training. Traditional cardiac rehab is just an hour of exercise, 36 different times. This includes the hour of exercise when people come for four hours to get an hour of X, supervised exercise. In our support group like we were talking about, an hour of a group meal with a lecture, and an hour of stress management.
They do that twice a week for nine weeks for a total of 72 hours. Or they can come to a retreat for 12 days, six hours a day to get the 72 hours, and they’re reimbursing it at a high enough level to make it financially viable. Now, just to digress a moment, through my nonprofit Preventive Medicine Research Institute in the early ’90s, we trained 53 hospitals and clinics around the country, and it worked. We got bigger changes in lifestyle, better clinical outcomes, bigger cost savings, better adherence anyone ever shown that a number of the sites closed it down because we didn’t have the reimbursement.
And that was the painful lesson that doesn’t matter how good it is clinically, if it’s not reimbursable, it’s not sustainable. And that’s why we ended up spending 16 years of Medicare, but now it is. And so, we’ve been training hospitals and clinics around the country. And we’re getting those same outcomes. Excuse me, 94% of the people finished all 72 hours of training. And a year later, 85% to 90% of the people are still following it, and that’s not just in places like UCLA in Los Angeles, but in South Bend, Indiana or in Salinas, Arkansas, or some places that people would think would be really challenging.
And that’s, as you say, it’s counterintuitive. And that’s much higher than people do it for just traditional cardiac rehab, which is just exercise and a whole lot easier. And the question is, why is that? And what we’ve learned is that, to the degree you make these lifestyle changes, you benefit. You feel better. Your angina tends to go away. And for someone who can’t walk across the street without getting chest pain or make love with their spouse, or play with their kids, or go back to work without pain.
And within a few weeks, they can do all of those things. Then, they say, “I like eating junk food but not that much, because what I gain is so much more than what I give up.” And not years later, it’s not about living to be 86 instead of 85. That doesn’t really motivate most people when they’re 85. It’s about, “Wow, I can do things I couldn’t do before.” One of the examples I cited in the new book is a guy named Dr. Robert Treuherz, who’s an internal medicine doc.
And he had such a massive heart attack that he was told that the only thing that could save his life would be a new heart, a heart transplant. And so, he went through our programs, our nine-week program at UCLA, our reversal program, to get in better shape for the surgery. But he improved so much, his heart, again, is pumping so much better, his ejection fraction, the percentage of heart as you know that it pumps on his feet, went from 11% to 15%, to 30%.
Now, he couldn’t literally get out of bed or walk, even walk a few steps without getting angina. Now, he’s chopping wood. He’s working full-time. He’s doing all those things and didn’t need the heart transplant, which is the ultimate high tech low tech contrast. What’s the more radical intervention, your heart transplant or be well, move more, stress less and love more? So our bodies really have this amazing capacity.
And if what you get is more than what you give up, if your chest pain goes away, you think more clearly. Your brain can grow some new brain neurons through a process of neurogenesis. Your brain can get bigger in just a few months. Your skin gets more blood. You look younger. Your heart gets blood flow. Your sexual organs get more blood flow in the same way that drugs like Viagra work. And for all of these reasons, for many people, what they… and many people are told that once you get put on medications to lower your blood pressure, your cholesterol or your blood sugar, and they say, “Doctor, how long do I have to take these?”
The doctor usually says, “Forever.” It’s like, “How long do I have to mop up that floor on the sink that’s overflowing?” “Forever.” “Well, why don’t I just turn off the faucet?” And the faucet, because to a much larger degree than we had realized, are the lifestyle choices. And again, I want to make sure that people who are listening, don’t make any changes in your medication without your doctor’s approval.
But you’ll find that if you really follow this program, your blood pressure may get so low. Your blood sugar may get so low. Your cholesterol levels is so low that your doctor is able to reduce or often discontinue many of these medications that people were told they’d have to take forever, and may be able to avoid surgery that they thought they wouldn’t be able to do.
Bill Frist: Again, the book, Undo it!, by Dean Ornish and Anne Ornish, is an unbelievable book, and it is complete. As I said, it’s kept me up for the last three nights just because I love it. I love it so much. Throughout the book and throughout our relationship over the last 30 years, you’ve always stressed the importance of being able to prove to do the controlled trial, the blinded trial, the science of it. You are among the most published people that I know when I’ve spent 20 years in academic medicine publishing a lot.
But you’ve always published in peer-reviewed journals, and there are a lot of lifestyle books out there when you go into a library, and you can find them, and you can pick them up. The thing that distinguishes yours is this relentless commitment to prove to science, to analysis, to documentation. And then, having that affirmed by your peers, other scientists. Many of whom started off as doubters. A lot of cardiac surgeons said, “You’re going to run me out of business.
I’m not going to endorse you.” So, you’ve come over huge barriers, but talk a little bit about the importance of having that substantiation through the scientific literature.
Dean Ornish: Well, that’s true. And by the way, a number of cardiac surgeons recommend the book, because they say, “If I’m going to operate on you, I don’t want you to come back. Because every time we have to redo it, it’s a lot harder with all the scar tissue and adhesions, and so on.” But yeah, I’m a scientist, and it’s hard doing these studies. It’s hard to raise money for them. People generally don’t want to support a study if everybody thinks it’s impossible.
It’s like, “Why should we waste our money?” And I said, “Well, that’s what makes it interesting.” Without the funding, you can’t prove it works. And if I don’t think it’s going to work, I don’t want to fund it. So, it’s always a struggle. But as you said, we’ve published in The Journal of the AMA, The New England Journal of Medicine, The Journal of the American College of Cardiology, The Lancet, Circulation, all of the major journals.
Because to me, that’s the whole point of science, is to help people say, “Is this true or not? What works? What doesn’t? For whom? And under what circumstances?” And so, it’s really hard to do it, but I think it’s worth doing, because if we show that something does work like reversing heart disease and then we can get it out to people, then we can empower people with information that can really give them new hope and new choices.
So, after we did the reversing heart disease studies and we showed that these same lifestyle changes can reverse type 2 diabetes, high blood pressure, high cholesterol. We did the first randomized trial with Peter Carroll, who’s the chair of urology at UCSF, and Will Fair, when he was the chair of urology at Memorial Sloan-Kettering Cancer Center. We always try to work with the top people in the field. Because then, it has more credibility and it makes it easier to get published.
And we showed it for the first time that these same lifestyle changes could slow, stop, and even reverse the progression of men who had early stage prostate cancer, which is particularly important now that there are two randomized trials published in The New England Journal, showing that only one out of 50 men who has early stage prostate cancer actually benefits from the surgery or the radiation.
The others often end up either impotent or incontinent, or both for no real benefit. But if the choice is between doing nothing and doing something, those guys want to do something once they’ve been diagnosed with prostate cancer. We can give people a third alternative now. You show these same lifestyle change of gene expression in a study we did with Craig Venter, as you know, was the first study called the human genome.
We found that over 500 genes were changed in just three months. And in fact, turning on or upregulated with good genes and downregulating or turning off the bad ones, particularly the genes that cause these same mechanisms that are part of this unifying theory of the genes that control chronic inflammation, oxidative stress, changes in the microbiome and telomeres, and gene expression and so on.
Bill Frist: You’ve written about telomeres and you have documented it. And so, tell us what a telomere is. We’re all looking for the fountains of youth in some way. And if you change lifestyle as you have laid out in those four points, tell us a little bit about the impact it has on telomeres. And tell us, what is a telomere?
Dean Ornish: Good question. Telomeres are, as you know, are the ends of our chromosomes that regulate how long we live. They regulate cellular aging. They are sometimes likened to the classic tip on the end of a shoelace that keeps your shoelace from unraveling. They keep our DNA from unraveling. And as we get older, as they keep replicating, they tend to get shorter and shorter. And as our telomeres get shorter, our lives get shorter.
And the risk of premature death from a wide variety of conditions from heart disease to diabetes to the most prostate, breast, colon cancer, even Alzheimer’s, are directly linked to the length of our telomeres. So, Elizabeth Blackburn, who got the Nobel Prize for discovering telomeres, had published a paper with Elissa Epel showing that women who were under chronic emotional stress because they were taking care of kids with autism.
The more stress they felt and the longer they felt that way, the shorter their telomeres were. Now, when they compared the high stress and the low stress women, they found that the stress women had nine to 17 years shortening of their lifespan based on the shorter of their telomeres. Big deal. But what was even more interesting to me was that it wasn’t an objective measure of stress. You could have two women and very similar life situations.
But it was how they were perceiving the stress, and those that were meditating and eating healthy, and exercising, and had love and support could buffer the effects of that stress. And so, it didn’t affect them as much. So, I had lunch with them. I said, “If bad things make your telomeres shorter, maybe good things can make them longer.” So, we did a study together, and we published this in The Lancet. And we found that after just three months, the telomerase, the enzyme that repairs and lengthens telomeres, increased by 30%.
And over a five-year period, we found for the first time, that any intervention could actually lengthen telomeres. Whereas, compared to the control group, they got shorter. And when The Lancet editors published this, they sent out a press release, and they called it, reversing aging at a cellular level. So, again, it’s just another example. It was the same lifestyle program that can do all of these different things. We’re now in the process of doing the first randomized trial to see if these same lifestyle changes may be able to reverse Alzheimer’s.
And I think we’re in a place with Alzheimer’s, it’s very reminiscent of where we were 43 years ago where we did our first study on heart disease. In other words, the same biological mechanisms are in play, less intensive lifestyle interventions like the finger study and the mind study that came out a few years ago, showed that they could slow down the rate at which you got worse. Whereas, all the drug trials, they spent billions of dollars looking for the magic bullet drug, and none of them have really worked.
The lifestyle changes could at least slow down the rate at which how people worse. My pieces, my radical theory, again, is that if less intensive interventions can slow it down, maybe more intensive interventions can reverse it, just like what we found with these other diseases like heart disease and others. So, we’re midway through the trial. I can’t really talk about the benefits, except to say that I’m cautiously optimistic that this will work. And if it does work, and it’s still a big if, people are more afraid of Alzheimer’s than any other disease.
Because when you lose your memories, you lose everything. My mom died of it. She was brilliant. It was really tragic to see her beautiful mind decay. And so, I have a personal interest in this. I have one of the Alzheimer’s genes, the APOE genes. And so, when James Watson of Watson and Crick who discovered DNA, was one of the first to get his genome sequence, he said, “I want to know everything except the APOE gene. Because why would I want to know if I have a disease that I can’t do anything about?”
Whereas, now, if we can show that we could reverse it, then, it’ll be a much smaller step to show we can prevent it. And then, with all the new tests that are coming out to diagnose Alzheimer’s, some of them, 20 years before they become clinically apparent, that’ll give people a lot of runway to say, “Okay, I’m going to start making these lifestyle changes because I don’t want to get that, and it’ll improve my life in so many other ways. And the only side effects are good ones.”
Bill Frist: Dean, for something like you started with the heart. You demonstrated that, and you’ve gone disease by disease, organ by organ. And now, you’ve come with this unifying theory, a hypothesis that it all is coming down to this basic mechanism. And now, you’re doing the Alzheimer’s. You’re entering into some promising early data. How long will it take to something like that take to demonstrate? Is it a year or five years?
Or do you set the foundation and other research people pick it up? When do you think you’ll start getting some definitive data from these studies?
Dean Ornish: We’ll probably have the study finished in another year and a half or so. But the intervention is only we’re taking people, we’re taking 100 men and women who have early Alzheimer’s, randomly divided into two groups. Half of them get the program for 20 weeks, and half don’t, three times a week. And by the way, they’ve been coming in-person three times a week. But we’re finding, by necessity, we’ve now been doing it all virtually.
And so, we’ve learned, and I didn’t think this was going to work. I mean, like I said, we have to try, because what else can we do with the coronavirus and everything? And so, we’ve been meeting three times a week virtually for four hours at a time. So, you get an hour of stress management virtually and an hour of exercise class virtually, an hour of support group virtually, an hour of a group meeting virtually.
These are people who’ve actually never met each other in real life. And it’s working. We’re getting just as good outcomes virtually as we had in-person, which makes it, the implications, if this does work, to be able to scale this worldwide at a fraction of the cost, are really profound. And if there is a silver lining to the coronavirus, this might be it. So, we test people in the beginning. We test them after 20 weeks.
After 20 weeks, the control group crosses over. They get it for 20 weeks. And then, we test both groups again at 40 weeks. And then, now, we’ll test them again after an initial 40 weeks. But speaking of the coronavirus, I think so much of the emphasis has been on avoiding it, which of course is important through sequestering people at home and wearing masks, and gloves, and handwashing, and so on.
That’s important of course, but the other half of the equation is how our body interacts with the coronavirus. And you can’t always avoid it. But not everybody who is exposed to it gets it. Not everybody who gets it dies from it. We have asymptomatic to mild, to really severe cases. And so, our immune function is one of the things that these same lifestyle changes can help boost as well. One study that’s probably worth mentioning getting back to where we started with love, is Sheldon Cohen did a study published in The Journal of the AMA, which surprised me, where he… this is in the early ’90s.
I don’t know how he got this from the human studies committee or got people to volunteer for it. But they actually dripped rhinovirus and coronavirus, a less invasive one than the one that we’re dealing with now, into volunteer’s noses. You can pay us to be in the study. But anyway, 100% of them got infected. But not everybody that got infected developed the signs and symptoms of a cold. And they found that those that had six or more social contacts, meaning, a phone call or a visit from a friend, it could just be a phone call.
Over a two-week period compared to those that had two or fewer, those that had six or more interactions with a friend, were 4.2 times less likely to actually get sick than those that didn’t, even though they were all infected. And so, it’s not just running into the wrong bug, it’s how our body interacts with it. And these same lifestyle changes that can help prevent and reverse heart disease and diabetes, and prostate, and probably breast cancer, and hopefully Alzheimer’s, are also ones that boost our immune function as well.
Bill Frist: I think the coronavirus is radically changing our lives in ways at this point, we don’t even know totally what it is. But I think just in our conversation today, we’ve talked about isolation, loneliness. And the treatment today, before we have antivirals, which hopefully will change here in a few weeks and a vaccine, which hopefully will change within a year, is social distancing. What tricks of the trade have you developed over the last few months to encourage people to get outside of being alone?
Because a lot of people are listening and sheltering now. But also, a lot of people aren’t fortunate enough to have wonderful spouses or children. And they’re probably listening to us and saying, “Well, now, what things can I do and get out?” In your book, you have a whole chapter on this. And so, I’ll encourage people to read the book. But share with our listeners and our viewers some of the tricks of the trade.
Dean Ornish: Yeah, thank you. And my wife, Anne, as brilliant as she’s beautiful, has a whole section to probably half the book on things that people can do. And as we talked about when we started, the social isolation itself makes you three to 10 times more likely to get sick and die prematurely from pretty much everything. Unless you buffer that by reaching out to other people. And these technologies, they can isolate us.
We’ve all seen pictures of people at their family table, and they’re all on their iPhone. Nobody’s talking to each other. But they can also bring this together, just like we’re having this conversation. Pick up the phone. Send a meal over to a friend. Volunteer if you can’t, to help other people. Anything that takes you out of the sense of being alone and isolated, and connecting with other people, either literally or virtually, is healing.
Even the word healing comes from the root, to make whole. Yoga comes from the Sanskrit, meaning, to yoke, to unite, to bring together. These are really old ideas that we’re rediscovering.
Bill Frist: The disciplined more radical way of addressing these four issues, you’ve been a champion of, and I understand that the compliance in the short-term, or they sticking with it, is because if I just start adjusting my diet a little bit, I don’t really feel a lot better a month later or two months later, or six months later. But if I adjust my diet to a plant-based diet and incorporate the other three factors with your lifestyle plan, I feel better in a week or maybe a few days, or two weeks.
So, that’s enough to keep me going. But what about it a year or two years? Are people able to maintain this fairly disciplined, fairly strict four point plan?
Dean Ornish: Yeah. Well, the conventional wisdom has always been that small, gradual changes are easy, and big, rapid ones are hard. But sometimes, even though it’s counterintuitive, it’s just the opposite. That when you make small changes, you don’t really feel that much better as you indicated. But you still have the hassle of not being able to do and eat everything you want. So, in some ways, you get the worst of both worlds.
But when you make big changes all at once, most people feel so much better so quickly in ways that really matter. We talked about the chest pain going away for example. There’s a wonderful film called The Game Changers that came out that James Cameron, the legendary director did, along with Louie Psihoyos who got an Academy Award for his first documentary. And by the way, Louie’s doing a documentary on our Alzheimer study.
And James Cameron went on a plant-based diet about 12 years ago, because in addition to being an amazing filmmaker, he’s an explorer. And he learned that more global warming was caused by livestock consumption than all forms of transportation combined. So, he went on a plant-based diet mainly for the environment and began to feel so much better. He’s in his early 60s. He’s making Avatars two, three and four at the same time now.
He’s got so much energy that he really became a proponent of this. So, he made this film with James Wilks and others that focused on elite athletes who raised their game when they went on a plant-based diet and became mixed martial artist national champions, and bodybuilders. And Arnold Schwarzenegger is in there talking about why he’s on a plant-based diet. But there’s this one great scene in there of these three guys in their mid-20s. And they feed them a single meat-based meal.
And at night, they measure the frequency and hardness of erections they have when they sleep, which as you know, is a normal guy function. And then, they did the same thing a day later and gave them a single plant-based meal, and did the same thing again. And by the way, the meat-based meal was organic and grass-fed beef and all that stuff. After the single meal, the plant-based meal, all three guys had 300% to 500% more frequent erections and 10% to 15% harder erections than after the single meat-based meal.
In fact, the film crew went on a plant-based diet after shooting this film. Again, it’s a graphic example of how dynamic these mechanisms are. How much you gain for many people is so much more than what you give up. And as you know, being a cardiac surgeon, if you have problems with erections, you probably have problems with your heart as well, because if your sexual organs aren’t getting enough blood flow, chances are, your heart and your brain aren’t either. Because it’s the same mechanisms that affect all of these things.
And it shows how quickly you can get better. And then, it reframes the reason for change from fear of dying, which is not sustainable to joy and love, and pleasure, and feeling that we truly are.
Bill Frist: It does. I mean, that story does. It’s a cute story that grabs your attention. But also, it really does reflect what’s going on medically, the inflammatory process, blood vessels throughout the body itself. And also, the immediacy of it, which was the surprising thing to me that it can have that much of immediate effect after those diets.
Dean Ornish: And by the way, I would encourage people who are watching this, try for a week. And you’ll feel so much better. And then, it comes out of your own experience. They don’t have to be this diet wars. It’s like, “Oh, I get it. What I gain is more than what I give up.” And by the way, it’s not all or nothing. If you’re trying to reverse a life-threatening condition, it really is all or nothing. That’s what it takes to reverse disease.
But if you’re just trying to stay healthy and lose a few pounds, I wrote a book 10 years ago called, The Spectrum, which was based on the finding in all of our studies that the more you change, the more you improve, and everyone we can measure. Including even telomere length or gene expression, or the amount of blockages in your arteries. And so, it’s the ounce of prevention, a pound of cure. What matters most is your overall way of eating and living, unless you have a chronic disease.
And the more you change, the more you improve. But if you indulge yourself one day, it doesn’t mean you cheated or you failed. Just eat healthier the next. You don’t have time to walk five miles one day, do a little more than next. You don’t have time to meditate for an hour? Do it for a minute. The more you do it, the more you improve, the better you feel. And the more you’ll want to keep doing it.
Bill Frist: I love that commonsense approach. And in the book, you talked very much about that, and the guilt that comes, and you’ve written about that. I think it was in the same book from 10 years ago when people go on diets and everybody listening to us. I’ll bet you, everybody has gone on a diet in the last six months of some sort. And the guilt that people feel after that and not coming through. And you worked through that both in the book and tell people, “No, it’s not the best approach. And if you do this four point plan, you avoid that.”
Dean Ornish: That’s right.
Bill Frist: Let’s close. So, we’ve known each other for probably 40 years. And first of all, it’s passed… and looking back, it’s embarrassing, but that’s all right, not feeling good. You’re looking good.
Dean Ornish: I still look pretty good from ’96 then, I think.
Bill Frist: But we were at Mass General together. And then, I guess it was me, surgery, you, medicine. And then, I guess after that, it was really you come into Washington when I was in the United States Senate, and I was focusing on health and healthcare. So, again, with that crossing in the past, we came early on. And then, 10 years later, you really did what I thought would be impossible, just because it’s so hard, and that is to get the CMS, the Medicare reimbursement and the code itself for lifestyle.
What did we call that, comprehensive lifestyle? What was it called?
Dean Ornish: Yeah. Well, it’s called Dr. Dean Ornish’s Program for Reversing Heart Disease under a new category called Intensive Cardiac Rehabilitation.
Bill Frist: Yeah, we’ve had a great history together. And to be able to continue that today and being able to share, again, just a fantastic book, Undo It! How Simple Lifestyle Changes Can Reverse Most Chronic Diseases, stress less, love more, eat well, move more, more straightforward discipline principles. Really, thank you for everything you’re doing for humanity and being a great model for scientists, for clinicians who do want to make an impact beyond just the patients they’re taken care of.
But domestically, globally, which is clearly what you’re accomplishing. Thank you.
Dean Ornish: Well, I want to say that we wouldn’t have the medical coverage or being very modest. You were the Senate majority leader at the time, and working with Mark McClellan and others who really made a big difference. But more than that, I treasure our friendship, and I just really appreciate the chance to be with you today. So, thank you.
Bill Frist: Good. Dean, thank you very much, and I look forward to continuing this conversation with you many, many times. Thank you very much.
Dean Ornish: Next time.
Bill Frist: This episode of A Second Opinion was produced by Todd Schlosser, the Motus Creative Group and Snapshot Interactive. You can subscribe to A Second Opinion on Apple Podcasts, Spotify, or wherever you are listening right now. You can also watch our interviews on YouTube and on our website. And be sure to rate and review A Second Opinion so we can continue to bring you great content. You can get more information about the show, its guest, and sponsors at asecondopinionpodcast.com.
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