Heart disease kills more Americans than all other causes of death combined. Surgical advances have helped to keep many patients alive, and drugs–with their unpleasant side effects–can actually heal clogged arteries. But until this week, there has been no published scientific evidence to confirm the belief that one could reverse heart disease strictly through changes in lifestyle. The current edition of the British medical journal, The Lancet, contains the revolutionary results of a yearlong experiment conducted by Ornish and his colleagues–the program that opened Royall’s artery. Most Americans would look glumly on a future containing more yoga than ice cream, but Ornish’s patients are thriving. At the very least his research should prompt a critical new look at the AMA’s widely recommended guidelines. If his patients continue to do well, Ornish’s work could change the lives of millions.
Even as a medical student at Baylor College of Medicine in Texas, Ornish wondered why doctors considered it standard practice to bypass blocked arteries–literally–rather than attack the causes of heart disease. In a coronary bypass operation, vessels from elsewhere in the body are grafted onto the heart so that blood can circumvent an artery clogged with cholesterol and other deposits. In many cases, however, the new arteries themselves become blocked. With angioplasty, a surgical technique popular since the mid-’80s, a small balloon is inflated in the artery, pushing aside the deposits to permit the flow of blood. But clogging often recurs after angioplasty, too.
Lifestyle factors had long been implicated in the incidence of heart disease, but Ornish found that diet, exercise and stress reduction were being tried on a piecemeal basis only. No researcher had put them all together in a single experiment and measured the effects on the heart. Ornish decided to do just that, on the theory that if people could benefit from one major change in their lives, they could benefit even more by making several.
Forty-eight volunteers participated in the San Francisco-based study. All were patients with severe heart disease. and most had decided against surgery. Ornish divided them randomly into two groups: 28 were put on his experimental regimen, and 20 became a control group, receiving standard medical care and following the AHA recommendations in order to provide a base of comparison. The Ornish group adopted a near-vegetarian diet; the only animal products they could eat were egg whites and one cup daily of nonfat milk or yogurt. They reduced fat intake to 10 percent of total calories and cholesterol to 5 mg a day (the amount in half a tablespoon of light cream). They eliminated caffeine altogether, and those who wished to drink were permitted only two ounces of alcohol a day. To control stress they meditated, did stretching exercises and practiced other relaxation strategies derived from yoga. They spent a minimum of 30 minutes three times a week exercising, usually walking, and met as a support group twice a week.
At the end of a year, most of the experimental group reported that their chest pains had virtually disappeared; for 82 percent of the patients, arterial clogging had reversed. Those who were sickest at the start of the program actually showed the most improvement on the regimen. Compared with the findings from the control group, the results from the experimental group seem even more dramatic. The patients receiving standard care reported an increase in chest pain, and their arterial blockage worsened. Ornish’s conclusion: “Conventional recommendations don’t seem to go far enough. Dietary changes and a 30 percent fat diet may help prevent heart disease in some people, but it may not be enough to reverse blockage.”
Surprisingly, changes in blood cholesterol were not as closely linked to changes in the arteries as conventional medicine would have it. Ornish once had thought that a patient’s arteries would not begin healing until blood cholesterol levels dropped below 180 (200 is considered by most doctors the upper limit for good health). “I was wrong,” he says. “Cholesterol is important, but it’s not the whole story.” As long as his patients stuck with the overall program, their arteries improved. Robert Royall, who suffers from unusually high cholesterol owing to a genetic condition, saw his cholesterol drop from 360 to about 250 on the program. Even so, Ornish was on the verge of prescribing a cholesterol-lowering drug–until he saw the dramatic change in Royall’s arteries.
Should the Ornish regimen be the treatment of choice for heart disease? A growing number of doctors already advocate Ornish’s principles. “To look to physicians for medicines and magic treatment isn’t the only answer,” says Dr. Kerry Stewart, assistant professor of medicine at Johns Hopkins School of Medicine. On the other hand the medical profession is notoriously conservative, and many physicians will wait to see further research. Dr. Basil Rifkind of the National Heart, Lung and Blood Institute notes that Ornish’s is the first controlled clinical trial to show these results.
New lives: Meanwhile, Ornish’s patients are thrilled with their new lives. Werner Hebenstreit, 75, a retired businessman, is the oldest in the group; when he joined the program he could barely cross the street without chest pains. “Now I can hike for six hours in the Grand Tetons at 8,000 feet,” he says. Don Vaupel Jr., 51, a coordinator of graduate studies in psychology at the University of San Francisco, says he used to be fat, sedentary and angry. Now he’s lost 14 inches around the waist and 82 pounds–an achievement the Beverly Hills Diet Weight Watchers, Overeaters Anonymous and his own cayenne pepper-and-lemonade diet couldn’t match.
Group meetings, with gala low-fat buffets prepared by a resident chef, help keep the participants enthusiastic. But the real incentive to continue is the fact that they started to feel better almost immediately, and today they feel great. Ornish thinks even people who aren’t sick will feel better on his program–and avoid heart disease. “Knowing what we know now, I think heart disease can be prevented for a vast majority of Americans without a new drug or breakthrough,” he says.
This fall Random House will publish “Dr. Dean Ornish’s Program for Reversing Heart Disease,” in which Ornish sets out in detail the science, philosophy and especially the diet behind his patients’ success. With its bountiful grains and vegetables, limited protein and scant animal food, the diet is highly un-American. In fact it’s more like the traditional diet of all those countries, including China and Japan, where heart disease is rare. The average American may find it hard to pass up a cheeseburger in favor of a jicama-cucumber salad. But the average American, notes Ornish, is in line for a heart attack.
The virtues of a low-fat diet have been widely publicized for years. Now Americans have to decide which version of that diet will do them the most good.
Heart Association Diet Dean Ornish’s Diet The AHA recommends no more Ornish (above, with than 30 percent of total patients) cuts fat 300mg of cholesterol daily to 10 percent of That means less red meat, of total calories more fish and chicken and and cholesterols to 5 mg. low or nonfat dairy products. the diet consist mostly of fruit, vegetables and grains. Healthy folks can modify the diet if their cholesterol stays at 150.
