have been extraordinary. Patients in your program see their angina reverse or decrease as early as the first few weeks. Blood flow to the heart improves, often in a month or less. After a year, even severely blocked coronary arteries become measurably less blocked. It seems that as the years go by there is even more reversal and more improvement. Have you seen comparative improvements in patients following the more moderate American Heart Association Guidelines or any other program that you know of?
DR. DEAN ORNISH: Moderate changes may be enough to prevent heart disease in some people, but they are usually not enough to reverse it. We were able to show in a scientific way that most traditional recommendations didn't go far enough. The more you change your diet and lifestyle, the more you improve in virtually every way we can measure, whether it is your heart disease improving, your PSA coming down, or your gene expression changing. We found that over 500 genes were changed in just three months, with the up-regulating or turning on of genes that prevent disease, and down-regulating or turning off of genes that help promote disease. Particularly what are called the RAS oncogenes that promote cancers of the prostate, breast, and colon were down-regulated. These processes are much more dynamic than anyone had realized. The more we look, the more we find.
Some people think taking a pill is easy and everyone will do it, but that changing diet and lifestyle is difficult, if not impossible, and hardly anyone will do it. What we're finding is actually the opposite. Adherence to most medications, whether they are cholesterol-lowering drugs or blood pressure pills, is only about 30 percent at three or four months. But we are getting 85–90 percent adherence after a year in Nebraska, Pennsylvania, and West Virginia, even though West Virginia leads the United States in heart disease. The reason is that the pill may not make you feel better, but changing your diet and lifestyle will. The better you feel, the more you want to keep doing it so you get into a virtuous cycle. That is one of the reasons people are continuing to do it—not just to live longer, but to live better.
JOHN ROBBINS: So they enter the program because they have some medical problem that they want to alleviate and they end up changing their life in a way that creates benefits across the board. It seems as though you have found an entry point into people's lives that is healing in a profound sense.
DR. DEAN ORNISH: Well it is, and that is why I love doing this work. You know, we are all going to die of something. The mortality rate is still 100 percent, it is one per person. But the question is not just how long we live, but also how well we live.
There is a belief that you have to choose between what is good for you and what is fun for you. But we're saying you can have both. You can have more fun, have better sex, sleep deeper, enjoy your food more, and not have all those aches and pains.
The ancient swamis, rabbis, priests, monks, and nuns didn't develop techniques like meditation, yoga, and so on to unclog their arteries or lower their blood pressure. But it turns out that they developed some really powerful tools for transformation that are also physiologically healing. I can't tell you how many patients have said things to me like, “Even if I knew I wouldn't live another day longer, I would still make these changes now that I know what they are like because my life is transformed.”
What is most meaningful to me is how we can work with people to use the experience of suffering in whatever way they are feeling it as a catalyst and a doorway for transforming their lives. For some, it is physical suffering, because they have angina or chest pain. For others, it is the suffering of depression or isolation. If we can work at that level, then we find that people are much more likely to make lifestyle choices that are life enhancing rather than ones that are self-destructive.
To me it is really about transformation, and then on a physical level, just about everything we measure tends to get better. We're seeing dramatic improvements in things that were never measured before. We found that even telomerase increased by 30 percent in the first three months.
JOHN ROBBINS: Why it that important?
DR. DEAN ORNISH: Dr. Elizabeth Blackburn won the Nobel Prize in 2009 for her co-discovery of telomerase. Telomerase repairs and lengthens our telomeres, which are the ends of our chromosomes. Telomeres control aging, which in turn controls how long we live. So as your telomeres get shorter, your life gets shorter.
She had done a pioneering study with women who were caregivers of parents with Alzheimer's or kids with autism. The more stress the women reported feeling and the longer they reported feeling that way, the lower their telomerase and the shorter their telomeres were. It made headlines because it was the first study showing that even at the genetic level, chronic stress can actually shorten your life.
What was one of the more interesting findings of this study is that stress is not simply what happens to you, it is how you deal with it. You could have two women who were in very comparable life situations, but one was coping much better than the other. It wasn't the objective measure of stress that determined its effects on telomerase; it was the women's perception of it. So when people learn how to meditate and do yoga and use other methods to manage stress, they can be in the same job or the same family or the same environment and react in different ways.
JOHN ROBBINS: I am hearing two things. I am hearing that your research is showing that the kind of lifestyle changes you recommend actually affect gene expression, turning on disease-preventing genes and turning off genes that promote cancer, heart disease, and other diseases. I am also hearing that there is evidence that these same lifestyle changes have an affect on aging, because they actually impact the telomerase.
DR. DEAN ORNISH: Yes, we found that the telomerase increased by almost 30 percent in just three months, and ours is the only intervention to date that has been shown to do that. We are now looking to see the effects on telomere lengths.
JOHN ROBBINS: That is astounding information and a major breakthrough.
DR. DEAN ORNISH: It is a radically simple idea that when you eat healthier, when you love more, when you manage stress better, when you exercise moderately, and when you don't smoke, you are happier and your life is more fun.
JOHN ROBBINS: You have become primarily known for your nutritional wisdom and research, but you have also written in great depth about the healing power of relationships and intimacy. We live in a culture where loneliness probably kills more people than cigarettes. What are you learning about the connection between relationships and health?
DR. DEAN ORNISH: We get to know each other really well in some of my studies. After a while I asked some of my patients, “Why do you smoke? Why do you overeat and drink too much and work too hard and abuse yourself? These behaviors seem so maladaptive to me.”
They would say: “You don't get it. You don't have a clue. These are adaptive behaviors, because they help us get through the day.”
One patient said, “I've got twenty friends in this package of cigarettes and they are always there for me.”
So it is true that loneliness kills more people than cigarettes, but keep in mind that it is often loneliness that causes people to smoke in the first place. Or they use food to fill the void or alcohol to numb the pain, or they work all the time to distract themselves.
To me, the function of pain is to say, “Hey, listen up. Pay attention. You are doing something that is not in your best interest.” Then we start to say, “Oh, I have a different choice. I can do this instead of that,” and then it comes out of your own experience, not because some authority figure told you.
JOHN ROBBINS: I want to take the example of your friend, former President Bill Clinton. He has had serious health problems for a long time. In 2004 he underwent a quadruple bypass to restore blood flow to his heart. A few years later, there were more problems and he had two stents placed inside one of his coronary arteries that had once again become clogged. After that he made a decision that I think you had probably been encouraging him toward for some time. That decision seems to have transformed his life. He has lost more than twenty-five pounds. The last