Mainstream medicine is opening to the benefits of a plant-based diet and lifestyle changes as a prescription for better health and decreased heart disease. You’ll be happy to see these recommendations are in alignment with what you are doing as part of creating your own healthy ageless body and building your ageless lifestyle after 50.
In this guest blog, Dean Ornish, MD, founder of the University of California San Francisco’s Preventive Medicine Research Institute and the eponymous diet, argues that lifestyle change — including but not limited to diet — is good medicine.
Recently, Kim A. Williams, MD, incoming president of the American College of Cardiology, posted a blog describing why he’s now consuming a plant-based diet. After a week, it’s still the no. 1 most-read cardiovascular article on MedPage Today. I admire Williams for his courage and leadership.
In response to the many comments that followed, the editors of MedPage Today asked me to provide a perspective.
The most influential trend in medicine today, growing exponentially, is the emerging field of what is known as “lifestyle medicine” — lifestyle as treatment, not just prevention.
We tend to think of advances in medicine as a new drug, laser, or surgical device, something high-tech and expensive. Yet, the simple choices we make in what we eat and how we live have a powerful influence on our health and well-being.
For the past 37 years, my colleagues and I at the nonprofit Preventive Medicine Research Institute and the University of California San Francisco School of Medicine, in collaboration with leading academic centers, have conducted a series of randomized, controlled trials and demonstration projects showing that comprehensive lifestyle changes alone often can reverse the progression of coronary heart disease and several other chronic diseases.
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- A whole foods, plant-based diet (naturally low in fat and sugar)
- stress management techniques (including yoga and meditation)
- Moderate exercise (such as walking)
- Social support and community (love and intimacy)
In our research, we’ve used high-tech, expensive, state-of-the-art scientific measures to prove the power of these simple, low-tech, and low-cost interventions.
In 1979, we published a pilot study showing that these comprehensive lifestyle changes improved myocardial perfusion after only 30 days. There was a 90% reduction in frequency of angina during this time.
In 1983, we published the first randomized, controlled trial showing that these comprehensive lifestyle changes could begin to reverse heart disease as measured by exercise radionuclide ventriculography after only 24 days. We measured improvements both in the ejection fraction response and improved regional wall motion as compared with the randomized, control group. There was a 91% reduction in frequency of angina.
In 1990, we published the Lifestyle Heart Trial, the first randomized, controlled trial showing that lifestyle changes alone can reverse the progression of even severe coronary heart disease. There was even more reversal after 5 years than after 1 year and 2.5 times fewer cardiac events.
Using cardiac PET scans to measure myocardial perfusion, 99% of the patients were able to stop or reverse the progression of their heart disease, and there was a 300% improvement in myocardial perfusion. We found a 40% reduction in LDL cholesterol in the Lifestyle Heart Trial after 1 year, and none of these patients was taking cholesterol-lowering drugs.
Although the sample sizes of these studies were small, there were statistically significant differences in all of the above measures. It is a common belief that the larger the number of patients, the more valid a study is. However, the number of patients is only one of many factors that determine the quality of a study. Judging a study by the number of patients is like judging a book by the number of pages.
In our studies, we ask smaller groups of people to make much bigger changes in lifestyle and provide them enough support to enable them to do so. And because the degree of these lifestyle changes is much higher than a control group is likely to make on their own, and the intervention is potent, it becomes easier to show statistically significant differences even though the number of patients is smaller.
As Attilio Maseri, MD, an internationally known and respected cardiologist, wrote:
“Very large trials with broad inclusion criteria raise grounds for concern for practicing physicians and for the economics of healthcare. The first is the fact that the larger the number of patients that have to be included in a trial in order to prove a statistically significant benefit, the greater the uncertainty about the reason why the beneficial effects of the treatment cannot be detected in a smaller trial.”
My colleagues and I conducted a demonstration project of 333 patients from four academic medical centers and four community hospitals. These patients were eligible for revascularization and chose to make these comprehensive lifestyle changes instead. We found that almost 80% were able to avoid surgery by making these comprehensive lifestyle changes.
In another demonstration project of 2,974 patients, Highmark Blue Cross Blue Shield provided this lifestyle program in 24 hospitals and clinics in West Virginia, Nebraska, and Pennsylvania. They found statistically significant and clinically significant improvement in all metrics, with 85% to 90% adherence to this lifestyle program after 1 year.
Overall healthcare costs were reduced by 50% in the first year. Reductions in healthcare costs were particularly striking in those who incurred the highest costs in the preceding year. There were four times as many patients in the control group who incurred health claims costs in excess of $25,000 than in those who went through our lifestyle program.
We also published the first randomized, controlled trial showing that these lifestyle changes may slow, stop, or even reverse the progression of early-stage prostate cancer.
Changing lifestyle changes your genes — we found that these comprehensive lifestyle changes caused beneficial changes in expression of 501 genes in just 3 months. Downregulated genes included those promoting inflammation, oxidative stress, and the RAS oncogenes that promote breast cancer, prostate cancer, and colon cancer.
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Often, patients say, “Oh, I’ve just got bad genes, there’s nothing I can do about it.” However, when they learn that changing lifestyle may beneficially change gene expression in so many genes so quickly, it can be very motivating. Not to blame, but to empower.
We also measured a 30% increase in telomerase after only 3 months of making these comprehensive lifestyle changes in these patients. After 5 years, we published the first study showing that these lifestyle changes may lengthen telomeres, the ends of our chromosomes that control aging.
In evaluating studies of different diets, it’s important to look at actual measures of disease rather than only risk factors, which can be misleading. A review article by Steven Smith in the New England Journal of Medicine made this point very effectively. Although changes in traditional risk factors were not greatly different when comparing three different diets,what happened in their arteries was very different.
On a whole foods, plant-based diet, there was little, if any, atherosclerosis. On a typical Standard American Diet, there was moderate atherosclerosis. On a high-fat, high-animal protein, low-carbohydrate diet, there was substantial coronary atherosclerosis.
What I found most interesting about this study is that these changes in coronary atherosclerosis were not necessarily reflected in changes in traditional risk factors such as LDL or HDL cholesterol. They were mediated by nontraditional risk factors such as changes in endothelial progenitor cells and degree of inflammation.
I am not aware of any study published in a peer-reviewed journal, even an uncontrolled study, showing that a high-fat, high-protein, low-carbohydrate diet can reverse the progression of coronary atherosclerosis or improve blood to the heart as measured directly using cardiac PET scans or even thallium scans.
The Mediterranean diet is better than the Standard American Diet, but the PREDIMED study did not show a reduction in cardiac events, only in stroke rates.
More than 75% of the $2.8 trillion in annual U.S. healthcare costs (mostly sick-care costs) are from chronic diseases, which can often be prevented and even reversed by eating a plant-based diet, at a fraction of the costs — and the only side-effects are good ones.
For example, in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, patients who adhered to healthy dietary principles (low meat consumption and high intake of fruits, vegetables, and whole-grain bread), never smoked, were not overweight, and had at least 30 minutes a day of physical activity had a 78% lower overall risk of developing a chronic disease. This included a 93% reduced risk of diabetes, an 81% lower risk of heart attacks, a 50% reduction in risk of stroke, and a 36% overall reduction in risk of cancer, compared with participants without these healthy factors.
A recent study found that animal protein dramatically increases the risk of premature death independent of fat and carbohydrates. In a study of over 6,000 people, those ages 50 to 65 who reported eating diets high in animal protein had a 75% increase in overall mortality, a 400% increase in cancer deaths, and a 500% increase in type 2 diabetes during the following 18 years.
The Harvard Health Professionals Study and the Harvard Nurses Health Study followed more than 37,000 men and 83,000 women for almost 3 million person-years. They found that that consumption of both processed and unprocessed red meat is associated with an increased risk of premature mortality from all causes as well as from cardiovascular disease, cancer, and type 2 diabetes.
After 16 years of review, CMS began providing Medicare coverage for “Dr. Ornish’s Program for Reversing Heart Disease” in a new benefit category, intensive cardiac rehabilitation.
One of the most interesting findings in all of our studies was this: the more people changed their diet and lifestyle, the more they improved in a variety of metrics. At any age. For example, we found a statistically significant dose-response relationship between the degree of lifestyle changes and the degree of improvement in coronary atherosclerosis, in changes in prostate cancer, and in telomere length.
It’s not all or nothing. You have a spectrum of choices.
Ornish disclosed lecture honoraria and consulting with Healthways.