Eating for heart health

Eating for heart health

Dr. Dean Ornish
, creator of a renowned program for reversing cardiac disease, says allowing people to set their own dietary changes is key to better health outcomes in the long run.

CYNTHIA GRABER: This is Cynthia Graber reporting for FutureFood 2050. Cardiovascular disease is the top killer in the world, according to the World Health Organization. More than 7 million people a year die of heart disease, but, says Dr. Dean Ornish, 90 to 95 percent of heart disease can be prevented with lifestyle changes, including dietary changes. Ornish has spent more than four decades demonstrating that these lifestyle changes can reverse even severe heart disease without drugs or surgery. He’s the author of six best-selling books and was named one of the most interesting people by People magazine and one of the seven most powerful teachers in the world by Forbes magazine. He currently writes a monthly column for Newsweek and was appointed by President Obama to a Department of Health and Human Services advisory group on public health. Most recently, his Program for Reversing Heart Disease was one of the first lifestyle programs to be covered by Medicare.

While personalization, I think, is an important trend in medicine, we’re finding that if you in effect give yourself the right raw ingredients, your body can in a sense personalize and extract what it needs in order to begin healing.”
—Dr. Dean Ornish

DEAN ORNISH: The program is, in the most simple form, is eat well, stress less, move more and love more. In more detail, it’s basically a whole foods, plant-based diet, predominantly fruits, vegetables, whole grains, legumes, soy products, ideally in their natural, unrefined forms. It’s also naturally low in refined carbohydrates like sugar and white flour and so on. It includes various simple, like walking a half an hour a day aerobic exercise, an hour a day of yoga and meditation to manage stress, and perhaps most important, more love and support in one’s life.

And so in a very real sense, we’re finding that not to blame but to empower that while genetics plays a role, that even if you’re genetically predisposed to heart disease, if you’re willing to make big enough changes, in most cases you can avoid it or even reverse it. In fact, we did a study that we published a few years ago that found that even our genes are more malleable than we had once realized. We found that after just three months of this program, over 500 genes were changed in terms of their gene expression, and in fact, up-regulating or turning on the genes that protect us, down-regulating or turning off the genes that cause heart disease and, for that matter, diabetes and early prostate cancer, breast cancer, colon cancer and so on. And so while personalization, I think, is an important trend in medicine, we’re finding that if you in effect give yourself the right raw ingredients, your body can in a sense personalize and extract what it needs in order to begin healing.

GRABER: And are there other similar programs that combine dietary changes with lifestyle changes, or how is your approach different from others in the field?

ORNISH: I think what makes our program different is that we have the science to prove that it works. And that we found that the more closely people follow the program, the more improvement that we measured in each of these parameters, whether it was their, the amount of blockages in their arteries, their prostate-specific antigen in terms of prostate cancer, the degree of diabetes they have, even their telomere length. The more you change, the more you improve.

And so I wrote a book called “The Spectrum” a few years ago that was based on this finding that the more you change, the better you get—at any age. Which really surprised me because I had thought that the younger patients who had milder disease would do better, but I was wrong. It turned out it wasn’t so much a function of how old or sick they were, it was mainly a function of their, their adherence. The more you change, the better you get.

And so, you know, part of what I’ve learned is that even more than being healthy, most people want to feel free and in control. And as soon as somebody tells them, you know, eat this and don’t eat that and do this and don’t do that, they often immediately want to do the opposite. It just goes back to the first dietary intervention when God said don’t eat the apple, and that didn’t go so well and that was God talking. So, so what we tell people is to say look, if you’re trying to reverse disease, that’s a pound of cure that really requires intensive changes. That’s why we were the first to show it is that people didn’t go far enough. But in terms of just staying healthy, it’s not all or nothing. And, you know, if you go on a diet, sooner or later you’re gonna go off the diet. And then you have all that anger and shame and guilt and humiliation, all these emotions that really are toxic.

So what I tell people is to say look, you decide how much you want to change. Instead of me telling you, here is what you ought to do, you tell me how much you want to change. How quickly? How many things? We’ll support that degree of change and then we’ll track it. And if that’s enough to accomplish your goals, great. If not, we’ll do more. So it’s a very compassionate approach because it says if you indulge yourself one day, it doesn’t mean you cheated or you’re bad or you failed, you know.

The whole language of behavioral change has this kind of moralistic quality. You know, I cheated on my diet, you know, [and] these are good foods and these are bad foods and once you eat bad foods, you’re a bad person and all the things that, all the kind of negative things that go along with that. So I said look, instead of me saying how much you want you should change, tell me what you’re trying to accomplish. Well, a patient might say I want to lose 10 pounds, or get my cholesterol level down 50 points, or my blood sugar down, or my blood pressure down, whatever it happens to be. I say, great. Where are you on this spectrum of foods? So I categorize foods instead of saying these are good and these are bad, to say, um, food is just food but some foods are healthier for you than others. So group 5 are the least healthy, group 1 are the most healthy, groups 2 through 4 are in the middle. So I say, where are you now? “Well, I’m eating mostly unhealthy group 4 and 5.” Great, how much are you willing to change, not here’s your diet. “Uh, well, I’m not ready to go all the way to being a vegetarian, but I’ll eat less red meat and I’ll eat more, you know, other stuff.” OK, great, how much exercise are you doing? “Well, not enough.” How much are you willing to do? “Well, I’ll walk 20 minutes a day.” OK, how much yoga and meditation are you doing? “Zero.” How much are you willing to do? “Well, I’ll meditate 10 minutes a day.” And how much love and support do you have in your life? “Well, not enough but I’ll make that more of a priority.”

OK, good, and then we’ll support that degree of change. We’ll help them track it. Let’s say after a month they wanted to lose 10 pounds and have lost five, and they wanted to get their cholesterol level down 50 points, it came down 30. I’d say, look, you’re moving in the right direction, now just go a little further. So again, it’s not all or nothing. If you indulge yourself one day, just eat healthier the next and so on. And while I find that’s much more sustainable and much more compassionate because there’s no diet to get on so there’s no diet you can’t fail.

GRABER: I want to talk a little bit about this diet question, um, and that’s where some of the critics I’ve read have come in. And, uh, some critics of your approach say that lumping all meat together, for example, isn’t an accurate portrayal of some of the research going on now, and that while, say, processed meats might be unhealthy, maybe unprocessed meats might not have the same health impacts on our hearts. What’s your response to that?

ORNISH: It’s all red meat. It’s not just processed red meat. It’s associated with an increased risk of all-cause mortality, cardiovascular mortality and increased risk of cancer mortality. And, um, in fact, I wrote an editorial to a paper that Dr. Walter Willett and his group from Harvard School of Public Health wrote that looked at, you know, several hundred thousand uh people and found that, you know, that it’s true that processed meat is worse than regular red meat, but red meat is also associated with a higher risk of, uh, all-cause mortality, cardiovascular mortality and cancer mortality, as well as diabetes mortality.

GRABER: To go back to heart health, what lines of research do you think are important to continue to investigate in terms of the relationship between food and heart health?

ORNISH: Well, I think, you know, although there’s an emerging consensus about what constitutes a healthy diet, I think the emerging consensus is that, uh, these things are not good for you, um, but I think there’s also a growing awareness of how can we best motivate people to make these changes. It’s not so much what changes should people be making but what is the best, uh, way to motivate people to make and maintain these changes.

And that’s part of what we learned over almost 40 years of doing this work. It’s not what I thought when we began doing it. I used to think, you know, that if we scare people enough, that’ll get people to change. Which is what most doctors are taught. And, you know, every package of cigarettes, you know, tries to scare people more and more, and it doesn’t really work. I mean, fear is not a sustainable motivator in any aspect of life. For like four to six weeks after somebody’s had a heart attack, they’ll do pretty much anything that their doctor or nurse tells them to do because fear is a great motivator in the short run. But in the long run, they stop doing it, the denial comes back, and it’s not sustainable.

But what we found is that while fear of dying or fear of something bad happening is not sustainable, joy of living is. And that because these underlying biological mechanisms are so dynamic, when people make big changes in diet and lifestyle, they often feel so much better so quickly, it reframes their reason for making these changes from fear of dying, which is not sustainable, to joy of living, which, which really is.

GRABER: Do you see a role for integrating technology into your program, or in the future, could technology play a larger role in helping people make dietary and lifestyle changes?

ORNISH: I do. I think there’s an incredibly, uh, untapped market for making it fun and sexy and cool and hip and crunchy and convenient for people to eat and live more healthfully. There’s a growing awareness, uh, that what we eat really matters, but most families don’t even cook anymore. You know, it’s kind of a lost art or they don’t have time to do it. So if food manufacturers can find ways of doing it in ways that don’t overly process the food but can preserve the inherent goodness of it, you know, through some of the sous vide and chill technologies, ways of, I think people are really looking for solutions that are as close to the natural form as it can be to make it fun and tasty.

You know, I chaired PepsiCo’s Health Advisory Board for many years until about four or five years ago, and on the first day, so they said these are our fun-for-you foods and these are our good-for-you foods, and I said, well, that’s the whole problem right there. It’s like, why can’t it be good for you, why can’t it be fun for you to eat healthy foods? You know, why can’t we make foods that are, that are fun and tasty and delicious and convenient and beautiful and delicious and, and have them really good for you as well? So I think the real opportunity here, uh, is to come up with technologies that don’t overly process the food, but find ways of keeping it, uh, uh, safe and healthy in chilled forms and forms that are much less processed and can get to people in ways that they can afford and that they can prepare in ways that, uh, that are either pre-prepped or actually ready to eat that can save them the time when they don’t feel like they’re having to sacrifice their health or the quality in the process.

GRABER: That was Dr. Dean Ornish, creator of Dr. Ornish’s Program for Reversing Heart Disease. More information on this subject can be found on I’m Cynthia Graber.

Cynthia Graber

Boston-based radio and print journalist Cynthia Graber received one of the inaugural Food and Farming fellowships from the University of California at Berkeley School of Journalism in 2013. Her radio documentaries have aired on “Scientific American,” “The World,” “Studio 360,” and “Living on Earth,” while her print stories have appeared in media including Fast Company, Slate, BBC Future, and others.

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