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Dr Dean Ornish with manna for the massesMar 28, 2012 10:05 EDT
Dr Dean Ornish, tall, fit, and lithe, is perhaps the world's best-known life coach. He not only preaches radical change in the arena of coronary heart disease prevention, but he insists he can reverse it as well. "Thirty-five years of work have proven that low-tech measures can provide high-tech benefit," he stated. "The fear of dying is not a sustainable motivator. Information is not enough! It must be fun! The essential ingredients of freedom, pleasure, and love must be included."
Dr Ornish ran rapid-fire through a series of slides that in strong pictorial fashion drove his points home. He is a man in a hurry because there is a lot to tell and a lot to change in a short amount of time. Among his first slides is that of a sink running over with water feverishly attended by minions mopping in futility. He means to send the subliminal message that we spend inordinate amounts of time "mopping up the floor but we don't turn off the faucet." This was no subtle hint at his belief that the futilities of modern medical therapy fail in comparison to the benefits of sweeping lifestyle change. He demonstrated improvements in myocardial perfusion and regional wall motion after dietary changes and exercise were implemented. There were more benefits shown with cardiac PET studies. "Even modest improvements in stenosis can significantly improve perfusion." I drank the Kool-Aid with enthusiasm, though it was sweetened only with stevia or honey, I'm sure.
The dynamic Ornish presentation was chock-full of illustrations as well as statistics. There was the impressive testimonial of one of the success stories of an average everyday American male, who says, "I am no longer using a cane or a wheelchair. In November of 2001, I had to ride one of those scooters through Wal-Mart . . . and I didn't like it. Now, I no longer take my diabetic medications. My total number of meds has now been reduced by 75%. I could not go to the mailbox without chest pain. Now I am walking at least two miles per day, and I ride a stationary bike 10 miles per day." As his testimonial comes to an end, Dr Ornish interjects, "This is not a best-case scenario, it's the average-case scenario."
Next there were data from 93 patients with prostate cancer who implemented his program and demonstrated a positive impact on PSA, LNCaP levels, and MRA studies, all of which suggested a reduction in tumor activity at one year. "What are some of the mechanisms?" he asked. "Gene expression," he answers. "We know there are over 500 genes that can be affected. We know there are oncogenes that promote breast cancer and prostate cancer. You can do a lot." He laments that so many individuals indicate they are powerless because they believe "it's all in the genes," but Dr Ornish knows better. He's seen "telomerase levels increase by as much as 30% in three months," insisting that "our genes are not our fate."
Dr Ornish then covered the potential for neuron growth stimulation. "Remember how as med students you were taught if you went on a weekend binge, you lost neurons and those neurons were not replaceable?" he asked. "Well, you can actually grow neurons, and your brain can actually get bigger. Walking for three hours per week for just three months causes neurogenesis," he said. "Chocolate, tea, blueberries, frequent sex, alcohol in moderation, and stress management" can also grow neurons. He quipped that these successes to date were demonstrated mostly in mice, "because humans weren't interested in studies that required the cohorts to be celibate and then sacrificed along with the controls at the end of the study." Another giddy chuckle rose from the audience.
The next slide is that of a gorgeous man, coal-black hair, strong square-set jaw, and the epitome of virility dressed in a cowboy hat and a leather vest. "Half of men who smoke have erectile dysfunction," he said, and indeed this cowboy was smoking a flaccid cigarette, as wilted as a Dali clock dangling from his lips. The next slide is that of a crusty old fortuneteller with the caption, "I give smokers a discount because there isn't as much to tell." The audience laughed again.
"If you go on a diet, you are likely to go off a diet," Dr. Ornish went on. "Our plan is radically simple. . . . It begins with you. You decide how much to change. You keep track of your own progress. The more you change your way of eating and living, the better you get, and the more things you change, the better you feel and then the healthier you are. You get the idea," he said encouragingly.
"So what is the optimal way of eating?" I asked Dr. Ornish in an interview after the program, "and how does your diet vary from the Mediterranean diet?" I confessed to him, tongue in cheek that I had always thought of Ornish followers as emaciated unhappy folks, wobbling from one place to the other, weak, pale, and hungry. He smiled and politely let me get me get away with it. "Well, I recommend less animal protein. Perhaps a cup per day of nonfat yogurt or nonfat milk instead," he replied.
The Ornish diet is similar to the Mediterranean diet in several ways. He recommends mostly plants, fruits, legumes, whole grains, and soy, but he directs 4 g per day of fish oil or its equivalent. "Always count calories, remember that organic is better, and choose quality over quantity" he urged in today's talk. "Reduce the total intake of fat, sugar, and refined carbs. Remember, refined carbs accelerate conversion of calories to fat and produce inflammation, which plays a role in the development of so many chronic diseases. High-protein low-carb diets lower the number of endothelial progenitor cells and double the level of nonesterified fatty acids," he added.
The diet and life style guru then projects a gloomy future, quoting what many of us already know; more than half of Americans will have diabetes or be prediabetic in the next eight years at a cost of $8 billion to the US. He also pointed out that in trials, "metformin did not do as well as lifestyle changes in diabetic management, so the trick is to cure it," and cure it as well as prevent it, we can. One study he quoted included 23 000 patients who by exercising 3.5 hour per week, avoiding smoking, eating healthily, and maintaining a normal weight prevented the development of diabetes in 93% of its cohorts.
Dr Ornish wants to be all things to all people in the wellness world, so he ventured into the world of carbon footprints and green living. "Our food choices affect the energy crisis," he says. "Of the fossil fuels we burn, 20% go to produce processed food. It takes 10 times more energy to eat higher on the food chain." Quarter-pounders apparently require 26 oz of petroleum and 17 pounds of coal per burger to produce. "I went to McDonald's and got them to put salads on the menu, but unfortunately, the price of the food does not reflect the cost to society. Just look at the cost of a $7 salad and compare that with a 99-cent hamburger," he said.
The next slide depicted a large elderly person listening to his doctor. The doctor says, "We can operate or you can go on a strict diet." The patient replies, "You better operate, doctor, my insurance doesn't cover a strict diet." Continuing the rapid-fire delivery required by time constraints, he stated that of 4000 men and women from 24 sites studied, adherence to his diet was still at 85% to 90% at one year. "That's powerful," he concludes. He contributes his success to support groups, which meet "an unmet need for connection." "Humans are touchy-feely," he points out.
Dr Ornish seems to have a lot to brag about. He claims that 96% of his patients with coronary disease report improvement in angina severity. Improvements in depression scores best those of SSRIs. Hostility scores substantially drop and overall quality of life indicators improve. No longer do his patients ask the question, "Am I going to live longer, or is it just going to seem longer?" he quips.
And it's not just the lay public that is paying attention to Dr Ornish. Besides his impact on the fast-food industry with the McDonald's menu improvements, Medicare began covering his program for reversing heart disease under intensive cardiac rehab with a team approach. "Physicians like it because it's not just reimbursable, it sustainable," he said. He assisted the St Vincent de Paul homeless shelters, which "no longer have to depend so much upon third-party payers to care for that high-risk population. The real epidemic there is loneliness, depression, and isolation, all of which increase mortality by three to seven times," he said.
Dr Ornish thinks the things that work best to make us all happier are altruism, forgiveness, compassion, and love. "I am most interested in transformation. Those things make relationships better and are essential sources of peace, joy, and well-being," he concluded.
"Behold I will rain bread from heaven for you; let the people go forth and gather what is sufficient for every day." —Exodus 16:4