"The Heart of the Matter"

brought to you by NEMA - The National Emergency Medicine Assoc.

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Transcripts: 511-1 to 511-5

Week: 511.1 Guest: Dean Ornish, M.D. Topic: Reversing Heart Disease- Part One Host: Richard Roeder Producer: Ed Graham

NEMA: : This is a five part series on reversing heart disease with Dr. Dean Ornish, author of Reversing Heart Disease, Eat More, Weigh Less and his newest book "Everyday Cooking With Dr. Dean Ornish".

NEMA: Dr. Ornish, one of the things that I like the most about your approach to heart disease is how fully you encompass issues of diet, exercise and even the psycho-spiritual dimensions of life but let's start our discussion with the dietary aspect of heart disease. Why does dietary fat have adverse effects on the cardiovascular system?

ORNISH: Your body converts dietary fat, especially saturated fat, into cholesterol and dietary fat also makes your blood clot faster. In the little blood clots that can form, they also contribute to heart disease and especially to heart attacks. Even a single meal that's high in fat and cholesterol can cause your arteries to constrict and your blood to clot more quickly. In the simple terms, heart disease is really a disease of excess - too much fat, too much cholesterol, too much stress, too many cigarettes - and we really haven't evolved quickly enough to deal with the excessive, for example, fat and cholesterol that we find in the modern diet. The major problem for the last several hundred thousand years has been getting enough fat and enough cholesterol. It's only recently in the last century that we've had the technology that's enabled us to transport and to preserve meat and fat and to eat as much of it as we do and to be able to afford it. And in simple terms, if you eat more fat and cholesterol than your body can get rid of, it has to go somewhere so it tends to end up in your arteries.

NEMA: There was a time not so long ago when the majority of doctors would argue, and I'm talking about as recently as even 10, 15 years ago, that the majority of doctors would argue that once there was arterial damage from cholesterol it was permanent. Is the concept of reversibility now relatively widely accepted or are you sort of standing out in the field by yourself still?

ORNISH: No. You're right. 19 years ago, almost 20 years ago when I began doing this work, the idea that the progression of heart disease could be reversible was thought to be impossible by most doctors and it was even difficult to get funding to do this research because they said it's impossible to reverse it. Why should we waste our money and then I'd say yes, but without doing the research we can't really show that it's possible. So it was a "catch 22." But I think now, not only because of my work but the work of many other people, and not only using diet and lifestyle but cholesterol-lowering drugs or even intestinal bypass surgery have been shown to stop or reverse the progression of heart disease in many patients. And so the idea that was so radical when I began doing this work is now pretty mainstream.

ROEDER: Okay. But still there were doctors a little bit more recently that would say okay, maybe you can stop the progression of this disease but the rare individual was the one who said it can actually be reversed. Is that relatively well accepted now?

ORNISH: I think the reversibility of heart disease is now accepted by most doctors. The skepticism that now remains is how practical is this? When I first began doing this, I thought not only was it the skepticism that heart disease was reversible. There was also skepticism that nobody could follow the program even well enough to test it. They'd say, you know, I can't even get my patients to cut back on eating less red meat. You'd expect them to give it up completely and exercise and quit smoking and meditate and do all these things. Forget it. There's no way. But then we were able to show that these patients in our study by and large were able to do it. They did get better. They were able to reverse the progression of their disease on the average.

ROEDER: Join me for part two on reversing heart disease with Dr. Dean Ornish.


Week: 511.2 Guest: Dean Ornish, M.D. Topic: Reversing Heart Disease- Part Two Host: Richard Roeder Producer: Ed Graham

NEMA: This is part two in a five part series on reversing heart disease with Dr. Dean Ornish whose most recent book is called Everyday Cooking With Dr. Dan Ornish. I asked Dr. Ornish about the difficulty in getting patients to comply with his low fat diet.

ORNISH: What we've done to address that is to set up through our nonprofit institute a demonstration network of eight hospitals in different parts of the country. We're not in Peoria but we're close. We're in Omaha. We're in Des Moines. We're at Harvard. We're at New York's Beth Israel Hospital. We're in South Carolina where one of the cardiologists said "Gravy is a beverage." We're in Broward General Hospital in Fort Lauderdale. We're at Scripps in La Jolla and we're at Mount Diablo Hospital near San Francisco in Concord. And we've been doing this for about two years in the oldest cities' hospitals and so far we're finding that 90% of the patients who otherwise might have had a bypass or angioplasty have been able to change their lifestyle well enough to follow this program and to avoid having the operations that they otherwise were eligible for. Mutual of Omaha was the first major insurance company to pay for this and they're now finding that for every dollar that they've spent, they've saved almost six. Immediately. Because instead of paying $50,000 or $60,000 for a bypass, they pay a fraction of that to teach people how to change their lifestyle. So we're finding that for many people, it is practical and what our studies seem to show are that the more people change, the better they get. It's not really a function of how old they are or how sick they are. Primarily it's a function of how much they were willing to change. And that's really a very hopeful message to give people.

NEMA: You have written about blood pressure medications and not all of the news is good for a lot of different reasons. Would you just touch on that a little bit.

ORNISH: I think that any drug has potential side effects, both known and unknown, and whether it's blood pressure medications or cholesterol lowering drugs or other kinds of medications, most of them really don't address the underlying cause of the problem. Like bypass surgery, it doesn't really address the underlying cause. You're literally bypassing the problem and I often use the example of the analogy that it's like mopping up the floor on a sink that's overflowing without also turning off the faucet. The problem keeps coming back again and you have to take these drugs because they don't address the underlying cause. You have to take them for the rest of your life usually in ever increasing dosages and they can be expensive and they have side effects, as I mentioned. I think that it's not that the drugs have no benefits. I just don't think they're the best first choice and even when they're needed, it's also important, whether drugs or surgery, it's important also to address the underlying cause of the problem. And what we find in our work is that the need for medications and the need for surgery is often reduced in many patients and even those patients who are taking medications of various types under their doctor's supervision often are able to reduce or in some cases even to get off their medication completely. So instead of having to take something for the rest of their lives, many times patients are able to get off some of these medications.

NEMA: What are the basic principles of your heart disease reversal diet?

ORNISH: The basic principle is that your body has a great capacity to begin healing itself if you give it a chance to. If three times a day you eat more fat and cholesterol than your body can get rid of as we talked about, you're eating more than your body can remove so it tends to build up in your arteries. If it's the arteries in your heart, it can lead to a heart attack. If it's in your neck, it can lead to a stroke. If it's in your kidneys, it can lead to high blood pressure or kidney disease and so on.

NEMA: Join me for part three on reversing heart disease with Dr. Dean Ornish.


Week: 511.3 Guest: Dean Ornish, M.D. Topic: Reversing Heart Disease- Part Three Host: Richard Roeder Producer: Ed Graham

NEMA : This is part three in a five part series on reversing heart disease with Dr. Dean Ornish whose most recent book is called "Everyday Cooking With Dr. Dean Ornish". I asked Dr. Ornish about the basic principles of his diet.

ORNISH: The basic principle is to stop what's causing the problem, to not just bypass it but to treat the cause and for many people, the cause is too much fat and too much cholesterol. So a plant-based diet which is really what I recommend, fruits, vegetables, grains, beans, nonfat dairy and egg whites gives you all of the protein but it doesn't give you the excess amounts of fat and cholesterol that can lead to problems. In addition, they're just more and more reasons why a plant-based diet is healthful. Cholesterol is only found in animal products. They also tend to be high in both total fat and in saturated fat. Animal products are high in iron that may oxidize cholesterol to a form that makes it more dangerous, more likely to be taken up into your arteries whereas it's low in a plant-based diet and yet a plant-based diet is high in the anti-oxidants that help to prevent that. There's really no fiber in meat which is high in a plant-based diet. There's a study that just came out in Journal of the AMA today showing that people who ate a high-fiber diet had 35% less deaths from heart disease than those who ate a lower-fiber diet. And there are new classes of chemicals called carotenoids and bioflavinoids any phytochemicals and so on that cannot only help to prevent heart disease but may have a role in slowing the aging process and preventing many forms of the most common forms of cancer. So what we learn is more and more reasons why a low fat, plant-based diet is really the most healthful way to eat.

NEMA : Another important dimension of your program is exercise. How vital a role is exercise in restoring your cardiovascular health?

ORNISH: Exercise is an important role. It's just not enough. Many people have the idea that as long as they're exercising, they can go out and have a cheeseburger and burn it off by just running. Well, it doesn't work that way. In fact you might even be putting yourself at higher risk by doing that and other people have this idea that if you don't run three to five miles three times a week, you know, why bother? Just roll over in bed. It doesn't do any good. The good news is that modern exercise has a lot of benefits. Just walking for an hour three times a week or even just 20 or 30 minutes a day and not even all that fast and not even necessarily all at once. You know, just doing little things like parking further away. I mean like when I go to the gym I still find myself getting irritated if all the parking spaces near the gym are taken so I have to walk a little farther to the gym before I go in and work out. It's pretty silly. But still that's just human nature. But what studies show is that walking 20 or 30 minutes a day can cut premature death in half. It gives you most of the health benefits without the risks. If you want to do more, that's great but what people should know is that if you're going to exercise at a higher level, you should do it on a consistent basis. What gets people into trouble is when they become weekend warriors, when they do nothing all week and then they shovel snow on weekends or play full court basketball or really exercise too much. The point is to try to do it on a consistent and a regular basis at whatever level you're comfortable.

NEMA : In your book Reversing Heart Disease, you talk a great deal about emotions and the tension of the quest for more, bigger, faster and you're very honest, surprisingly honest about some intimate details of your own history with depression and self-doubt. How big is the role of emotion in heart disease?

ORNISH: I think the role of emotion is becoming increasingly documented but it's been clear to me for a long time just because of my own personal experiences, as you've talked about.

NEMA : Join me for part four on reversing heart disease with Dr. Dean Ornish.


Week: 511.4 Guest: Dean Ornish, M.D. Topic: Reversing Heart Disease- Part Four Host: Richard Roeder Producer: Ed Graham

ROEDER: This is part four in a five part series on reversing heart disease with Dr. Dean Ornish, whose most recent book is called "Everyday Cooking With Dr. Dean Ornish". I asked Dr. Ornish about stress and heart disease.

ORNISH: It's easy to measure cholesterol or blood pressure and things like that and in science, doctors tend to believe what they can measure. It's harder to measure things like feelings and emotions but I think they have a role in two ways. One is that your brain and your heart are connected. There are direct connections between your brain and the arteries all over your body including the ones in your heart and during times of emotional stress, those connections can cause your arteries to constrict. Stress hormones like adrenaline can make your blood clot faster. Studies of monkeys even show that the plaque builds up twice as fast in the arteries even when they're on the same diet if you compare the group of monkeys stressed to those that aren't stressed, even if they're genetically the same. So there's something about stress that can accelerate the progression of plaque or build-up in your arteries. And finally stress can cause the heart to beat irregularly and can even lead to sudden death. Stress also plays an important role because of its effect on our behaviors. Many people smoke when they're under stress. They overeat. They work too hard. They drink too much. They take other drugs as a way of dealing with emotional stress and loneliness and depression and isolation which I think are really the epidemic in our culture. It's not just physical heart disease. It's what I call emotional and spiritual heart disease and the idea is that if we don't work at a deeper level of what really motivates people and not just focus on their behaviors or give them health information and think that that's really going to do it for most people, we really need to work at a deeper level because what patients tell me is - you know, I'd ask them "Why do you do these things?" - and they'd say "'Cause you don't get it. You think that these behaviors are maladaptive. They're not maladaptive. They're very adaptive because they help us get through the day." And for many people, just getting through the day is more important than worrying about living to be 86 instead of 85, which doesn't really motivate most people unless maybe you're 85 and not even then many times. Because telling somebody who's lonely and depressed and isolated that they're going to live longer if they just quit smoking or change their diet or even take their medication doesn't really motivate most people because who wants to live longer if you're unhappy and these behaviors that seem maladaptive to us as doctors are very adaptive to patients because like one patient told me "I've got 20 friends in this package 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 they use food to fill the void or they use alcohol to numb the pain or other drugs. Or like many of us, they work too hard to distract themselves from their pain. And we have lots of ways in our culture for distracting or numbing or killing the pain but in my approach, the idea is to say hey, pain is a messenger. It's there for a reason and killing the pain without also addressing the cause is just another form of bypass. It's like clipping the wires to a fire alarm while your house burns down and go back to sleep and think you've really corrected the problem when the problem wasn't the alarm. It was the fire. And pain can be a catalyst for helping us to transform our lives because it can open our hearts. It can get our attention and it can also make it easier to change because let's face it, it's hard to make changes. It's stressful to change your life in major ways but if you're in enough pain and you stop trying to cope with it and numb the pain, you can start to say things like well, it's going to be hard to change but it's got to be better than this. Let's give it a try.

ROEDER: Join me for part five on reversing heart disease with Dr. Dean Ornish.


Week: 511.5 Guest: Dean Ornish, M.D. Topic: Reversing Heart Disease- Part Five Host: Richard Roeder Producer: Ed Graham

NEMA : This is part five in a five part series on reversing heart disease with Dr. Dean Ornish whose books include Reversing Heart Disease, Eat More, Weigh Less and his newest book "Everyday Cooking With Dr. Dean Ornish".

NEMA : You have produced a of recipes to support your dietary recommendations. One of the most fascinating ideas, I've sort of always fantasized about it myself and you did it in your book Eat More, Weigh Less and I'd like you to talk about the concept behind how you put that together, and you've also published a book very recently called "Everyday Cooking With Dr. Dean Ornish". First touch on the first book and then explain a little bit about what you've done with the second one.

ORNISH: Well, Eat More, Weigh Less was designed to be another doorway for people. If I wrote a book on how to prevent heart disease and cancer and lots of bad things, it never would have made it to number one on the New York Times bestseller list and not that many people would have read it or benefited from it and having seen what a powerful difference these simple changes can make in people lives, I really wanted to find a way to make it more widely available to people and it is true. You can eat more and weigh less and a lot of people who wouldn't be so interested in preventing something bad in the future are interested in losing weight. And most approaches to losing weight don't work for very long. But when we looked at the data from our study, what we found was that the average patient lost 25 pounds in the first year and we weren't even trying to get them to lose weight. And we said gee, how come our patients were able to lose so much weight and keep it off and we're not even trying to get them to do that and all these weight loss programs, that's their main goal and most of them don't work. Most weight loss diets don't because they're based on deprivation - counting calories, restricting portion sizes. Sooner or later, people get tired of feeling hungry and deprived. They get off the diet. They gain the weight back and then they blame themselves because they think they didn't have enough discipline or will power or motivation when the real problem is just that they were going about it in the wrong way. If you change the type of food, you don't really have to be as concerned with the amount of food. You can eat whenever you're hungry. You can eat until you're full and you can lose weight and you can do it simply and safely and easily. So that was the reason for writing the Eat More, Weigh Less book - to show people that there really is a better way to do this. The "Everyday Cooking With Dr. Dean Ornish", book that just came out is designed to make it really easy for people to eat this way. In my earlier books, I wanted to show how gourmet the foods could be, how good they could taste and what I found was that the best way to make low fat foods good was to work with a great chef even if they weren't known for low fat cooking and say "Work within these guidelines," and then found that the food could be delicious and beautifully presented as well as being healthful because great chefs know how to make great food even if they're not known for cooking that way. But sometimes the ingredients were hard to find, the recipes took a while to make or they were complex and because we had done these eight hospital programs like people from Mercy Hospital in Des Moines or Emanuel Hospital in Omaha or Richland Memorial Hospital in Columbia, South Carolina or even at Beth Israel in New York would say things like either they don't have time to make these recipes like in New York or in places like the Midwest, they'd say "What are chanterelles and where the hell can I find chanterelles anyway?" And so I wanted to make foods that were easy to find, familiar to people, familiar comfort foods with easy to find ingredients that really you can make very quickly. I've also been working with ConAgra, the large frozen food company that makes Healthy Choice frozen dinners and they've come out with a new line of frozen dinners called Life Choice when you don't even have time to make simple recipes. You can just put them in the oven or microwave them and there you have it. And there's a toll free number in the front of my books that if people call, they'll FedEx them anywhere in the country. They're not in the supermarkets.

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