Linking Heart & Brain Health To Dementia Risk

Dean Ornish, MD

Thank you for that kind introduction, and I am so appreciative of the chance to be with you here today and to share what we are learning with the people who are also joining us. To me, awareness is always the first step in healing. Thank you for allowing me to help increase that level of awareness. We tend to think of advances in medicine as being a new drug, a laser, or something high-tech and expensive. We often have a hard time believing that the simple choices that we make in our lives each day—as you indicated—what we eat, how we respond to stress, how much exercise we get, and how much love and support we have—can be such powerful influences on our health and well-being. But they are.  

Derived from your important work, and you are the author of many bestselling books. I think our unique contribution has been to use these very high-tech, expensive, state-of-the-art scientific measures to prove how powerful these very simple, low-tech, and low-cost interventions can be. 

To answer your question, lifestyle certainly affects the numbers. Most doctors are trained to use drugs in surgery. We are trained to use drugs in surgery. We are reimbursed for to use of drugs in surgery. not surprising. That is how most poor doctors practice medicine, and certainly, drugs and surgery can be lifesaving when used appropriately. We have all benefited from them, but they do not usually address the more fundamental clauses of chronic diseases, which are often mostly the lifestyle choices that we make every day. 

The Undo It book that you mentioned that I co-authored with my wife and partner of 27 years, Anne Ornish, puts forth this, what I think is a radical, unifying theory that we found over the last 30 years—actually, 45 years now. It is hard to believe I am doing these clinical trials—that these same lifestyle changes could affect so many of the most common and costly chronic diseases. We showed, as you mentioned, for the first time that even severe heart disease could often begin to reverse. At the time, it was thought, much as people view Alzheimer’s today, that once you had heart disease, the best you could do was to slow down the rate at which you got worse, to get worse more slowly if you will. We found that if you make bigger changes in a lot of things at the same time, you could often get better and better instead of worse and worse. With an ounce of prevention and a pound of cure, it is harder to reverse a chronic disease. That is why no one had shown it before in randomized trials because they did not go far enough. But to stay healthy, you probably do not have to make such big changes to prevent or reverse diseases. But we found that these same lifestyle changes could often reverse type 2 diabetes, high blood pressure, high cholesterol, and obesity. When you change your lifestyle, it changes your genes. We found over 500 genes were changed in just three months, and, by turning on the genes that keep us healthy and turning off the genes that cause us to get sick, we did a study.

We did that with Craig Venter, who was one of the first to decode the human genome and lives in San Diego, where you live. We did a study with Elizabeth Blackburn 14 years ago, who got the Nobel Prize for discovering telomeres, the ends of our chromosomes that regulate aging. We found that we could lengthen telomeres for the first time using any interventions with the same lifestyle changes, and when we published this, The Lancet editors called it the first study showing that lifestyle changes may reverse aging at a cellular level. As you mentioned, we are now in the middle of doing the first randomized trial to see whether these same lifestyle changes reverse early-stage Alzheimer’s disease. The reason why these same lifestyle changes can affect so many different chronic diseases is that they are not so different. They all share the same underlying biological mechanisms: chronic inflammation, oxidative stress, changes in the microbiome in telomeres and gene expression and immune function, overstimulation of the sympathetic nervous system, changes in TMAO levels, and so on.

Each of these mechanisms in turn is directly influenced by what we eat, how we respond to stress, how much exercise we get, and how much love and social support we have, or, to reduce it to its essence, to eat well, move more, stress less, and love more. We also show that these same lifestyle changes are not only medically effective but also cost-effective. We did a study with Mutual of Omaha, and they found that almost 80% of people who otherwise would have had a central bypass, with their doctor’s permission and approval, were able to change their lifestyle and go on our program as a direct alternative. They found they saved almost $30,000 per patient in the first year. We did a study with Highmark Blue Cross Blue Shield, where they found they cut their costs in half in the first year.

Then, after many years of review, as you mentioned in the introduction, Medicare created a new benefit category to cover our program. I thought when we first published our papers in the leading peer-reviewed journals, The Lancet, the Journal of the American Medical Association, the New England Journal of Medicine, and so on, that that would change medical practice and, to some degree, a dip, but not nearly as much as I had hoped. I realized that it is not enough to have good science. You have to have good reimbursement. if we change reimbursement, ultimately we change medical practice and even medical education. I had no idea it would take 16 years. But after 16 years, Medicare created a new benefit category to cover our Reversing Heart Disease Program called Intensive Cardiac Rehab. We began training hospitals, clinics, and physician groups around the country, and it worked. We were seeing bigger lifestyle changes, better clinical outcomes, bigger cost savings, and better adherence than anyone had ever shown. But you had to live near one of the hospitals or clinics that were offering the program. Then, when COVID hit, if anything good came out of it, it was learning that we could do the same program virtually through Zoom as well as doing it in person. I had thought incorrectly that it was too high touch to be done by Zoom, but we had to do it by Zoom, and we found that worked just as well. Then Medicare began covering our program by doing it by Zoom in real time in people’s homes rather than going to a hospital, clinic, or doctor’s office. 

Now we can work with people wherever they live. They did not have to live near one of the hospitals or clinics offering our program. That, in turn, helps reduce health disparities and health inequities and makes them available to people, and four times as many people will offer, we will take a program when it is offered to them in their homes. Even if they live near a hospital, they do not want to have to take off from work and drive there and get into a small room and be exposed to COVID and all that. It is working better for everyone. Ultimately, we can do this even in other countries. It is a new paradigm of health care rather than sick care that empowers people to make these lifestyle changes in ways that, as a result of their work, can be truly transformative. That is what gets me out of bed every day.

Joel Fuhrman, MD

It is so cool. Is there any? Doctors use these numbers as specific risks as if your risk is proportional to your LDL cholesterol or your blood pressure. But what about what do you have? We know that lifestyle, medicine, and lifestyle changes make such a big factor bigger than the numbers do. But is there any way of measuring or quantifying adherence to the program or their lifestyle and quantifying the lifestyle benefit they are getting to counter any risks they have? In other words, how do you measure that?

Dean Ornish, MD

Well, the numbers are important, but they are not the whole story, as you indicated. On average, we found a 40% reduction in LDL cholesterol through a lifestyle change that is comparable to what you get with drugs. But without the costs and side effects. But as someone said to me, I have heart disease. I have no interest in changing my lifestyle. I tell them, you should be on these drugs. Because they have benefits for people who have heart disease, but they may not necessarily be the best first choice for people. The same cardiologist who, before, used to think that a cholesterol level of 280 was normal because that was average as opposed to normal. We are now talking about getting your LDL cholesterol down to 20 or 30, which always concerns me a little bit. I do not know what potential side effects there might be from getting it down that low through drugs. But cholesterol is not a bad thing. Your body makes it. It is one of the things that your body needs as a building block for sex hormones, nerve myelin sheets, and things like that. It is precisely because your body must always make all that you need. The dietary requirement for cholesterol is zero, but it may be that you can get it too low through drugs, although those are questions that we do not know the answer to, and whether people who only want to make modern lifestyle changes may need to add drugs to get the benefit of getting a reversal of disease that may or may not moderate changes generally do not go far enough to preserve reverse heart disease in most people. 

But, whether they are the best lifestyle or whether people should go directly to drugs, I think is something that the patient and the doctor need to work out on their own. The nice thing is that the numbers do improve as well when you change your lifestyle. But there is some other evidence that independent of the effect on the numbers, just the amount of saturated fat and cholesterol that you intake has an impact on your arteries, and the more dynamic these mechanisms are, the more quickly you can get better or worse. We generally find that for most people with angina, there is a 91% reduction in the frequency of angina, usually within the first three or four weeks. For someone who can, for example, work without getting chest pain, walk across the street, be with their spouse, play with their kids, or do all the things that make life worth living. They are essentially pain-free after a few weeks of not experiencing chest pain. It reframes the reason for making lifestyle changes from fear of dying, a heart attack, or something bad happening to joy, pleasure, love, and feeling good. In other words, what you gain is so much more than what you give up in terms of how much better you feel. 

For many people, those are choices worth making. Again, not to live longer, but to live better and to feel better. The paradox is that we tend to think that asking people to make small, gradual changes is pretty easy. But asking to make big changes and a lot of things at the same time is difficult, if not impossible. Yet in studies that compare our intensive cardiac rehab program with regular cardiac rehab, which just exercises alone, more people, 93% of the people finish the intensive compared to only 60% that they do the exercise alone, even though we are asking people to do a lot more because, again, your outcomes are better, your LDL comes down more, your cholesterol, your blood pressure, your hemoglobin A1C, and your depression scores we found come down almost 50%, even more than with any depressants. Your exercise capacity increases by 40 to 50%. Your angina or chest pain goes away by 91%. Most people become pain-free. 

Again, if people fear is not a sustainable motivator, for a month or so after someone’s had a heart attack, I will do pretty much anything that their doctor asks. But even then, it is hard to sustain that. But pleasure, joy, and feeling good are. Not only does it make you feel better, but the support groups that we provide are also important because they help people create a sense of community, love, connection, and care for each other. The real epidemic is not just heart disease, diabetes, cancer, or whatever. It is loneliness, depression, and isolation, which COVID only intensified with the breakdown of the social networks that used to give people that sense of love, connection, and community. We find that after people in our program are in 18 four-hour sessions, it is twice a week for 4 hours at a time for nine weeks, they get an hour of exercise, an hour of a support group, an hour of meditation and yoga, and an hour of a lecture. But after 72 hours, most people continue to meet among themselves, sometimes for decades, because it is so meaningful to have that group interaction. 

Joel Fuhrman, MD

It comprehensively affects their emotional life. It is not just talking about nutritional science, that is me. I also think that I agree that the more aggressive changes not only make people feel better and see the results, but they also stop taking addictive substances that keep triggering their desire to binge. It is giving an alcoholic more alcohol. Sometimes people eat junk food, processed foods, and unhealthy foods. It just triggers them to want more of them. They find it easier to stay in the program when they are more adherent to it. 

Dean Ornish, MD

That is true. They are engineered to be that way. But the paradox is that when you make big changes, your tastebuds change, too. Everyone’s had the experience of not everyone, but a lot of people have had the experience of, say, eating less salt. At first, the food tastes like it needs more solidity than it tastes fine. You go out to dinner, and suddenly the same food tastes too salty. 

People begin to prefer healthier foods. They say it tastes better for them. Likewise, when people get put on medications to lower their cholesterol, their blood pressure, or their blood sugar, and they say, doctor, how long do I have to take this? What does the doctor usually say? Forever. 

I used to show a cartoon of doctors busily mopping up a floor around the sink that is overflowing and no one’s turning off a faucet. How long do I tell you to mop up the floor? Forever. Why don’t we just turn off the faucet? Well, what continually impresses me, as Joel and I know you have seen, too, is that our bodies often have this remarkable capacity to begin healing much more quickly than we had once realized. When we can treat the underlying cause, which more often than not is these lifestyle choices that we make every day, If people do need drugs, then they can generally take fewer lower doses of them than they might otherwise.

Joel Fuhrman, MD

Let us shift to this relationship between heart disease and Alzheimer’s, and then whether you think that Alzheimer’s is in its early stages or is as reversible or is reversible, or stops the progression compared to the findings that you have proven in heart disease.

Dean Ornish, MD

Well, I think we are at a place with Alzheimer’s that is very reminiscent of where we were when I started doing research on heart disease, and back in 1977, 46 years ago, it was hard to believe it had been that long. When I was a medical student. At that time, it was thought that once you had heart disease, the best you could hope to do by changing your lifestyle would be to slow down the rate at which you got worse. That is how people view Alzheimer’s today. We know what is good for your heart is good for your brain. We know that these diseases share a lot of the same underlying biological mechanisms. The ones we have been talking about. 

My hypothesis was, and by the way, I have a personal interest in Alzheimer’s because my mom died of it. All of her siblings and I have one of the APOE-4 genes for it. A lot of people do not even want to know if they are at risk for it because they say, Why would I want to know if I cannot do anything about it? It is just going to make me crazy. We are doing this randomized trial to see whether the more intensive lifestyle changes might slow, stop, and perhaps even reverse the progression of early-stage Alzheimer’s disease. We are still in the middle of finalizing the results, so I cannot talk about it, and no journal will publish it. But stay tuned. We will have some interesting things to report within a few months.

Joel Fuhrman, MD

Sounds good. Besides the lifestyle changes, are there any specific interventions you might add for a person who has heart disease and Alzheimer’s compared to the Heart Disease Lifestyle Reversal program, or are there any supplemental or any differences in the recommendations? 

Dean Ornish, MD

Not really. I think we do recommend supplements, such as a good multivitamin. Curcumin is anti-inflammatory. Some of the omega-3 fatty acids are anti-inflammatory. Glutathione can help with cognitive function. Some of the things in Lion’s Mane that Paul Stamets makes can have been linked to some improved improvements. What I am also just thinking about is that I think some of the key ones are, but again, I think they are not limited to Alzheimer’s or heart disease because these biological mechanisms affect so many different diseases. These same supplements can be beneficial for a wide variety of conditions as well. Either way, if someone is watching this and they have heart disease and they are interested in learning more about what we are doing, particularly since Medicare and many insurance companies are paying for the whole thing, just go to Ornish.com, and it will tell you more about what we are doing and whether or not you might be eligible for it.

Joel Fuhrman, MD

Fantastic. Okay. What about people who are interested in learning more about your program for reversing Alzheimer’s? Listen. Go to Dr Ornish.com and do some research there as well.

Dean Ornish, MD

Just Ornish.com or PMRI.org. It stands for Preventive Medicine Research Institute and talks about the research on Alzheimer’s disease in more detail, but the program is the same. Even though Medicare is not covering it for Alzheimer’s, hopefully, one day they might, people can pay for it out of pocket and still get the same program or just get it from reading one of my books. It is the same intervention for both conditions.

Joel Fuhrman, MD

Okay, let us just pause here for a minute. We are going to continue in a few minutes. 

Thanks so much for joining us today, everybody. If you found our conversation insightful and engaging, of course, and you are a summit purchaser, stay right here, because we are going to dive a little deeper with Dr. Ornish into this discussion. If you are not, you can click on the button below to the side and get access to further information. If you are watching this, thanks for being a member of this program and this community. Let us continue. We could talk for five or ten more minutes if we could. I heard your message, and you have a lot of experience and wisdom in understanding the difficulty people have in making the change to a healthy lifestyle. A lot of people hear you; they have heard programs, and they just do not do it for some reason. With all your decades of experience, what are the major emotional, psychological, and social impediments to people wanting to go in and join this type of successful dietary intervention to reverse the progression of serious diseases?

Dean Ornish, MD

Well, I think a lot of it goes back to what we said earlier: that the real pandemic is not just heart disease, type 2 diabetes, prostate, breast cancer, colon cancer, Alzheimer’s, etc.; it is loneliness, depression, and isolation. I was suicidal and profoundly depressed when I was in college. That is how I got interested in doing this as my life’s work because these same approaches helped me so much at the time. 50 years ago, most people had a community; they had an extended family that they saw regularly. They had a neighborhood with two or three generations of people that grew up together. They had a church, synagogue, mosque, club, or something. They went to places regularly where they got to know people. They had a job that felt secure, that they would be out for a decade or more, and they got to know their coworkers. Today, many people do not have any of those things. Social media is not the same thing. One of the studies that my wife Anne and I cite in our Undo It book is that, the more time you spend on Facebook, for example, the more depressed you are. Why is that? Because true intimacy is where they know you. It is an avatar, I see you. I see all of you, not just your Facebook profile or, if you go on to Facebook, it looks like everybody has this perfect life. But, you know, it is here. Here we are in front of the Eiffel Tower. Here are my perfect, two-and-a-half kids and all of those things. 

Whereas, in real life, when you grow up in an extended family or a neighborhood with three generations of people, they do not just know where you have done well. They know where you messed up. They know where you got busted, that time you failed, or whatever. That they know, and they know that they know, and they are still there. For me, there is just something primal about feeling fully seen, words and all, and being accepted. In our support groups, we try to recreate that by creating a safe environment that feels safe to let down your emotional defenses and to talk openly and authentically about what is going on in your life without fear that someone is going to judge you, reject you, try to change you, or give you glib advice on how to fix it, and so on. But just to be there and to bring up what somebody might say, I might look like the perfect father, but my kid’s heroin use is more extreme, for example. Somebody else will say, My kid’s got problems, too. 

Suddenly, it does not change the fact that you have these problems, but now it does not feel like you are so alone in dealing with them. It is so meaningful for people that it is the part of our program that people often have the most questions, skepticism, or even apprehension about. But almost invariably, it is the most meaningful because you can only be intimate with somebody to the degree that you can open your heart and figuratively, be emotionally vulnerable, and you can only do that to the degree that you feel safe. By creating a safe environment, what goes into the group stays in the group. People are trained to communicate with each other in ways that talk about what they are authentically feeling. They do not feel judgments or attacks toward the other person. It is so meaningful. Anything that creates a sense of intimacy is healing. Even the word healing comes from the root to make whole. Yoga is from the Sanskrit to yuj to unite and union. These are old ideas that we are rediscovering. I wrote a book about this back in 1998 called Love and Survival that revealed what were then hundreds. By now, tens of thousands of studies show that people who are lonely and depressed are 3–10 times more likely to get sick and die prematurely than those who have a sense of love and connection in the community.

I do not know anything that has that impact. Vivek Murthy, the surgeon general, who is a longtime friend, is making this the signature part of his tenure to help raise awareness about that. When you are saying, Why do people who know better, why is it so hard for them to eat healthier or, stop playing some of the video games or stop drinking so much alcohol or other drugs or whatever? I asked people in our studies, What do you think? Why are you doing these things? They seem so maladaptive. They replied that they were not maladaptive. They are very adaptive. They help us deal with our pain, our loneliness, our depression, and our isolation. 

I have had patients who probably have tubes. I have 20 friends in this pack of cigarettes, and they are always there for me. Nobody else says You are going to take away my 20 friends. What are you going to give me? Or food fills that void, or that coats my nerves and numbs the pain, or alcohol numbs the pain, or fentanyl numbs the pain. We have this, the opioid epidemic, other drugs that numb the pain, or video games that numb the pain are working all the time. Is it a more socially acceptable way of distracting yourself from pain? But the pain is not the problem. The pain’s the messenger. It is saying, Hey, listen up. Hey, attention, you are not doing something that is in your best interest. 

My spiritual teacher used to say, If I give you a hot pot to hold if it is hot enough, you will let it go. It is the pain that becomes the messenger. to say, Hey, when you are tired of being in enough pain for me that my mind was depressed, and for someone else, it might be a heart attack or it might be Alzheimer’s or whatever it is. But suddenly, the idea of change becomes more appealing. Part of the reason why I spent so much of my adult life doing these research, scientific, randomized trials, and research studies is that they are hard to do and hard to get funding for because most people do not want to fund a study if they think it is impossible. It is a catch-22; without the funding, you cannot show it is going to work, and they do not think it is worth anyone funding it. 

We just have to generally raise the money as we go along, which is a stressful way to do anything but get it properly done and published in the leading journals. As we have done and working with leading collaborators around the country, it can help redefine what’s possible, and that in turn can give many people new hope into choices that they did not have before. For me, it is not about just giving information. If that were enough, nobody would smoke. It is not something people do not know is bad for them. We have to work not just at the informational level or the other behavioral level, but at a deeper level, which often is the pain that people are experiencing. 

When we work at that level and help people, for example, use meditation to quiet down their minds or to rediscover inner sources of peace, joy, and well-being, then they can often go back and make an accomplice even more without getting sick in the process. They are much more likely to make and maintain lifestyle choices that are life-enhancing than self-destructive ones. If we can deal with that more primal cause of the pain that they are experiencing more often than not,

Joel Fuhrman, MD

As I understand it, you have a very comprehensive way of looking at it. That includes the way people see the world, its meditation, wisdom, training, social interaction, and nutrition, all married together in a whole program that will make people more compliant and willing to stay with it. Then they start to see the benefits in there, and they get emotional benefits, psychological benefits, more peace with themselves, less fear, and seeing all of it. They, and I, think it makes it doable and then maintainable for the rest of their lives. Very important.

Dean Ornish, MD

Under their doctor’s supervision, as I am sure you found, many people can reduce and sometimes get off of medications that they were told they would have to take for the rest of their lives. The paradox is that sometimes when you make big changes in a lot of things at the same time, it changes the reason for making the changes, preventing something bad from happening years down the road that most people do not want to think about, like a heart attack or a stroke. What I gained quickly, within days or two weeks, is so much more than what I am giving up. My chest pain is going away in many cases. Then I can make love with my spouse, and I can play with my kids. I can do all the things that make life worth living that I could not do before. Yes, I eat junk food, but not that much because what I gain is so much more. That is what makes it sustainable.

Joel Fuhrman, MD

Yes. Terrific. Well, thanks for all your decades of work and the wisdom that you are putting forth here for the people, and listeners here.

Dean Ornish, MD

Back at you and you as well.

Joel Fuhrman, MD

Thank you. I hope everybody enjoyed this interview, and best of luck and health to all.

Dean Ornish, MD

See, and if you are interested in learning more about our work, just go to Ornish.com; it is all there for free.

Joel Fuhrman, MD

Thank you so much, Dr. Ornish.

Dean Ornish, MD

Thank you so much. Dr. Fuhrman.