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Twenty-five years ago, Dean Ornish, M.D., began investigating whether
comprehensive lifestyle changes could reverse coronary artery disease, the
narrowing of the arteries that can impede even mild physical activity and
significantly increase the risk of heart attack. Although his initial studies
enrolled small numbers of patients, the results showed that lifestyle changes
could do for the arteries what most clinicians thought only drugs and surgery
could accomplish: significantly improve blood flow by literally clearing them of
plaque build up. Dr. Ornish has been telling—preaching—this story ever
since.
Dr. Ornish, founder and president of the nonprofit Preventive Medicine
Research Institute in Sausalito, CA, and clinical professor of medicine at the
University of California, San Francisco, recently made an appearance for a
Cleveland Clinic "Grand Rounds" presentation, where he held court for
an audience of some 200 plus Clinic physicians and clinicians. Dr. Ornish told
his listeners—among them some of the nation’s top cardiologists—that
despite the breakthroughs in heart drugs and technology, despite the
improvements in the understanding of heart function and atherosclerosis
(clogging of the arteries by plaque), management of heart disease today often is
analogous to mopping up a flooded kitchen floor without turning off the faucet
that is causing the problem. In other words, says Dr. Ornish, "we’re not
treating the underlying cause of heart disease."
Increasingly, that underlying cause is a combination of a diet high in
carbohydrates and fat and a lifestyle that allows little time for exercise,
reflection, and relationship building. In fact, the essence of the Ornish
program involves using nutrition, exercise, stress reduction (stress increases
the risk of heart attacks occurring and lowers disease resistance) and building
or maintaining meaningful relationships as a means to achieving optimal
cardiovascular health.
The essence of the Ornish meal plan is a diet high in complex carbohydrates
(whole wheat, brown rice, fruits, vegetables, grains, and legumes in their
natural, unrefined forms) low in fat (sorry Atkins disciples, no bacon, ham and
pork-rind sandwiches), and low in simple carbohydrates (sugar, white flour,
white rice).
Many skeptics
Dr. Ornish is the author of four books, including New York Times’
bestsellers "Dr. Dean Ornish’s Program for Reversing Heart Disease"
and "Eat More, Weigh Less." His quest to promote non-drug and
non-surgical alternatives for management of heart disease, along with several
published studies bolstering his theories, have made him somewhat of a media
celebrity, landing cover stories of his work in US News and World Report,
Time, and Newsweek.
But much of the medical establishment, and perhaps more important, the health
insurance industry, remain skeptical. Although he has convinced some insurers to
back his program (at medical and health centers in California, Illinois,
Nebraska, Pennsylvania, and West Virginia), most do not like the idea of helping
to finance an intervention program they believe patients will not adhere to,
says Dr. Ornish. (Note from Dr. Ornish to insurers: some 70% of patients who go
on cholesterol-lowering drugs quit them within a year.)
The medical profession has long criticized Dr. Ornish because his studies
enrolled far fewer patients than the typical clinical trials used to test new
drugs or medical treatments. In some clinical trials, for instance, hundreds or
thousands of patients might be enrolled. Perhaps the biggest complaint
physicians have against the Ornish program to reverse heart disease, however, is
that it is unrealistic.
Most patients are not capable of making significant and lasting lifestyle
changes or sticking to the Ornish diet, goes the argument, so it would be
clinically irresponsible not to put them on cholesterol-lowering drugs (statins),
high blood pressure agents and other heart drugs that can help manage heart
disease and reduce the risk of heart attacks. But Dr. Ornish argues that the
skepticism simply perpetuates a self-fulfilling prophecy. If physicians have no
faith that their patients can change, they won’t, he says. In fact, says Dr.
Ornish, "People make significant lifestyle changes all the time, and those
who do often feel better about themselves."
It is true—his program to manage severe coronary artery disease requires
significant discipline. But his research shows that the program can reverse
heart disease. He also offers a modified version of the program for people who
do not necessarily need to make drastic diet changes but are interested in
making significant and positive changes to improve health.
"I think the Ornish diets have merit," says Cleveland Clinic
cardiologist Deepak L. Bhatt, M.D., who was on hand for Dr. Ornish’s talk.
"When patients ask me which diet to follow, I recommend one that is low in
fat, low in cholesterol. If they want me to be more specific, I point them to
the Ornish diet." He also believes that the Ornish diets are much safer and
more sensible than the Atkins or South Beach diets, which he characterizes as
"questionable."
Fewer drugs
One of Dr. Ornish’s quests is to reduce the number of people who use drugs
to manage cholesterol levels and heart problems. He says that too often,
patients diagnosed with heart disease start on diet and exercise programs and
make little headway in terms of improving cholesterol levels and losing weight.
But instead of being encouraged to try a more aggressive approach that will
produce impressive results, physicians too often instead prescribe
cholesterol-lowering drugs.
"I have nothing against using drugs to help people get healthy,"
says Dr. Ornish. "They can help save lives. And I don’t try to steer
patients to one treatment plan or another. But I think we should at least offer
patients an option before relegating them to medications that—without
lifestyle changes—they will need the rest of their lives."
Plus, says Dr. Ornish, "Statins don’t make you feel better. Making
positive lifestyle changes do. People are much more likely to make—and
maintain—changes that are life enhancing because that is very empowering.
Taking a statin is not."
Dr. Bhatt agrees with Dr. Ornish, but he says it depends where the patient is
healthwise. "I think it’s always better to avoid medications if you can
do so using appropriate exercise and diet programs," says Dr. Bhatt.
"But in people who have established vascular disease—for instance
patients who have had heart attack, angioplasty or bypass surgery—the
beneficial role of medicine is fairly well established. So while diet and
exercise are important, I wouldn’t withhold proven drugs—statins for example—in
the hope that diet and exercise alone are sufficient."
Dr. Bhatt also notes that statins have potential benefits beyond improving
levels of good and bad cholesterol. For instance, recent studies have shown that
statin use can reduce the risk of heart attack and stroke. Statins may also
reduce levels of c-reactive protein (CRP), a molecule that at high levels is
believed to be a more accurate gauge than cholesterol levels of impending
trouble in the heart’s arteries. Interestingly, says Dr. Bhatt, diet, exercise
and weight loss have also been shown to lower CRP levels.
Fear factor doesn’t help
Given the risks associated with heart disease, it can be tricky for
physicians to try and convince patients to change without underscoring the
potential imminent dangers. But fear, says Dr. Ornish, is a poor motivator.
"If we try to scare patients, they’re not going to listen to us, because
they don’t want to have to think about things like disease and death. Most
people are more concerned about getting through the day than living
longer."
Much more effective, says Dr. Ornish, would be for physicians to make an
effort to get to know an individual beyond the vital signs and facts listed in a
patient chart. Taking an interest in their lives is particularly important if
patients are depressed, says Dr. Ornish. And many of them are depressed,
although they are also unlikely to volunteer that information. But loneliness,
isolation and depression all can impede the body’s ability to maintain health
or fight off disease. People who are depressed also are at greater risk for
death than those who are not.
"If you spend just a few minutes asking your patients about their
lives," Dr. Ornish implores his colleagues, "they will become your
most loyal patients, and much more willing to make significant lifestyle
changes. And if you can address deeper issues, patients are much more likely to
be successful achieving [and maintaining] lifestyle changes."
Combine the strategies
Dr. Bhatt believes patients with heart and vascular disease would benefit
most from combining the Ornish approach with the mainstream approaches. "I
think one compliments the other." It would be a mistake, he says, for a
patient or physician to rely solely on one strategy—diet and exercise versus
medications versus surgical interventions—to manage heart disease. "When
used appropriately," says Dr. Bhatt, "all three are complimentary and
beneficial."
For more about the Dean Ornish, M.D., lifestyle program, visit these
websites:
WebMD
http://my.webmd.com/content/pages/9/3068_9408.htm
The Preventive Medicine Research Institute
http://www.pmri.org/
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