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Reversing heart disease.


Using sophisticated imaging machines, researchers can now accurately measure the effects of diet and lifestyle on the human heart.

Editor's note: Dr. Dean Ornish is on the faculty at the School of Medicine, University of California, San Francisco, and serves on the staff of the Pacific Presbyterian Medical Center. He comments here on the dietary studies he and his colleagues have been conducting on patients with severe coronary heart disease.

Dr. Ornish, you presented some extraordinary and rather dramatic results of cardiovascular research at the recent national meeting of the American Heart Association in Washington, D.C. What are you finding?

For the last decade, my colleagues and I have been conducting cardiovascular research to determine--for the first time--if severe coronary heart disease can be reversed by comprehensively changing lifestyle, without using cholesterol-lowering drugs or surgery. Our interim data indicate that, for many people, it may.

Hadn't it already been proven that heart disease could be reversed? What's new here?

Although it's been shown in animals that lifestyle can cause or reverse coronary heart disease--in dogs, pigs, rats, monkeys, rabbits, and so on--never before has it been shown that lifestyle changes can reverse coronary heart disease in humans. Various people have speculated on this or claimed that it could, but without scientific proof. In fact, until now the technology for measuring heart disease in living people has not been accurate enough, while in animal studies the animals are sacrified and the blockages in their coronary arteries measured. For humans we've had to use more indirect measures of the amount of coronary artery blockage.

Until recently, the "gold standard" for measuring coronary heart disease severity was coronary angiography, an invasive test in which dye is injected into the coronary arteries while an X-ray movie is made. Unfortunately, even this test is fairly imprecise.

Recently, however, breakthroughs in technology have made it possible to use computers to quantitatively measure the amount of blockage in coronary arteries during angiography, thereby allowing us to measure with confidence even small changes when they occur. An even more exciting test is called a cardiac PET scan, done by a $25 million machine, which now makes it possible to noninvasively measure even early heart disease, often years before it becomes clinically apparent. So, in a real sense, we are using the latest in high-tech, expensive, state-of-the-art medical technology to measure the power of very ancient, inexpensive, and low-tech interventions. And although we tend to think of breakthroughs in medical science as being the latest new drugs or surgical techniques, we are learning that these very simple and low-cost interventions may ultimately prove to be more powerful than drugs and surgery.

That's fascinating. Please describe in more detail what you are finding in your research.

In our current study, patients who have severe coronary heart disease are randomly divided into two groups. One group receives the usual medical care from their doctors, who usually prescribe an exercise program, stopping smoking, and more moderate dietary changes, along the guidelines of the American Heart Association recommendations. The other group undergoes more intensive and comprehensive lifestyle changes, including moderate exercise and stopping smoking, but also a diet that is much lower in fat and cholesterol. These patients are asked to follow a low-fat vegetarian diet with no animal products whatsoever, other than small amounts of nonfat milk or yogurt. Also, they are asked to do one hour each day of stress management techniques, including various stretching, breathing, meditation, imagery, and progressive relaxation exercises derived from integral yoga.

Both groups of patients are tested at the beginning of the study and then one year later, and the two groups are compared. Patients in both groups receive a quantitative coronary angiogram, cardiac PET scan, cholesterol and lipid tests, and other measures.

What are the interim findings?

So far, approximately two-thirds of the research patients have completed the first year and all testing. Almost all of the patients who have comprehensively changed their lifestyles have demonstrated some measurable reversal of coronary artery blockage and improvement in blood flow to the head, whereas the majority of patients who are following their doctor's recommendations are showing some measurable overall worsening of the coronary artery blockage and reduced blood flow to the heart. Also, we are measuring larger reductions in cholesterol levels than have ever been reported without the use of drugs or surgery.

Does this mean that the patients who comprehensively change their lifestyles are cured?

No, but it does mean that most of them are getting better, whereas the patients making more moderate changes are tending to get worse. So our research is telling us several things. First, people are more willing to make comprehensive lifestyle changes than we might have thought, especially if they know the benefits. Second, most people begin to feel better fairly soon after making these changes. For example, most of the patients in our study who had incapacitating angina--chest pain--now find they are able to exercise much more without pain, and most are essentially pain free. Third, people not only begin to feel better, in most cases they are better, and these improvements can be measured. Fourth, conventional recommendations for lifestyle changes may not go far enough, especially for those who already have heart problems.

Many corporations are becoming increasingly concerned about the exponential rise in health-care costs. Does your program have anything to offer in this area?

Yes. Last year, over $7 billion was spent on coronary artery bypass surgery, and increasing sums are being spent on coronary angioplasty. Cholesterol-lowering drugs like lovastatin (Mevacor) cost $2,000 to $3,000 per year, per person. Since there are up to 100 million Americans whose cholesterol levels are too high, placing everyone on cholesterol-lowering drugs like lovastatin would cost $200 to $300 billion per year! In contrast, I am becoming more and more convinced that for many people lifestyle changes alone may ultimately be more effective and more cost-effective.

What are the implications of your work and your findings?

Coronary heart disease still accounts for more deaths each year than all other diseases combined, including accidents, homicides, cancer, and AIDS. If our research continues to show that coronary heart disease can be reversed for most people, then it is not such a leap of faith to say it probably can be prevented for the vast majority of Americans. Forty percent of people who die each year from heart disease did not know they had a heart problem until they died from it--clearly, not the best way to find out. So no matter how good we get at treating heart disease, clearly we need to place more emphasis on prevention of coronary heart disease.

What about the people who don't want to change their lifestyles? What's the matter with taking pills to lower cholesterol, and what's wrong with bypass surgery or coronary angioplasty?

There is nothing wrong with these approaches; it is really a question of what is most effective in the long run. But the problem with all of these approaches to treating heart disease is that they do not address the underlying causes of the problem, so the problem comes back, sometimes very quickly. I first got interested in doing this research when I was a medical student and learning to perform coronary bypass surgery with Dr. Michael DeBakey, the eminent heart surgeon. While it was thrilling to watch him operate, I noticed that many patients were coming back for second and third bypass operations.

More recent studies show that, within five years, half the patients who have had bypass surgery need it again, because the bypassed arteries have themselves clogged up. And newer approaches, like coronary angioplasty, also can be lifesaving, but they are not sufficient for most people. One-third of the blockages dilated by balloon angioplasty have closed up again within six months. And although cholesterol-lowering drugs do help to lower cholesterol levels, they have to be taken for the rest of one's life, often at great expense and with frequent side effects.

So for me bypass surgery became a metaphor--bypassing a problem rather than dealing with the underlying causes, like mopping up the floor around an overflowing sink without also turning off the faucet.

I believe that the body has a great capacity to begin healing itself if given a chance to do so. Unfortunately, we often don't give it that chance. For example, three times a day we may eat more fat and cholesterol than the body can metabolize, so they build up in our arteries. Likewise, we never have a chance to recover from one emotionally stressful episode before we are hit with another. So by reducing the amount of fat and cholesterol in our diets and by learning ways of managing stress more effectively, our bodies can begin going to work on healing themselves.

Does this mean you advise patients not to have bypass surgery or angioplasty and not to take cholesterol-lowering drugs?

Not necessarily. My role is to provide people with accurate information that they can use to make intelligent choices. I try never to tell someone he has to change his lifestyle, because even more than feeling healthy, we all want to feel free to choose. Instead, I give information he can use to make an informed choice. If a person is unable or unwilling to make comprehensive changes in his lifestyle, I may recommend that he take cholesterol-lowering drugs or undergo surgery. And if someone comes into the emergency room complaining of crushing chest pain, I don't feed him vegetables and ask him to meditate--I use whatever invasive procedures and drugs may be necessary to help him survive a life-threatening situation. When he is stable, I inform him of his choices. But until recently we have not had accurate, scientific information upon which to base those decisions.

PHOTO : By looking inside a human heart using Positron Emission Tomography (PET), specialists are

PHOTO : able to detect blockages in their patients' coronary arteries with 98 percent accuracy.

PHOTO : Researchers are using PET scans in order to study the effects of dietary and lifestyle

PHOTO : changes on patients with severe heart disease.

PHOTO : The top PET scans show a heart at "rest" with a normal blood-flow pattern indicated by

PHOTO : white, red, and yellow. The bottom images of the same heart under medically induced

PHOTO : "stress" show a different picture: purple, blue, and green indicate blockages of blood

PHOTO : flow to the heart muscle severe enough to have caused this patient to undergo bypass

PHOTO : surgery. A healthy heart would show the same blood-flow pattern at rest and with stress.
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Title Annotation:Dr. Dean Ornish comments on his dietary studies of coronary heart patients
Publication:Saturday Evening Post
Article Type:interview
Date:Oct 1, 1989
Previous Article:The quick one; Father Brown and the invisible witness.
Next Article:Dolly Parton: here I come again.

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