November 26, 1990 12:00 PM

As a young medical student at Baylor College of Medicine, Dean Ornish watched the eminent heart specialist Dr. Michael DeBakey perfect his technique for coronary-bypass surgery. While DeBakey’s procedure was greeted as a stunning medical breakthrough, Ornish noticed that many patients were returning for a second, and sometimes a third, operation—their bypasses having clogged up. “For me,” says Ornish, 37, “bypass surgery was like cutting the wires on a fire alarm without putting out the fire. It did not address the underlying cause of the problem.”

Today the outspoken physician offers his own therapy in the best-selling Dr. Dean Ornish’s Program for Reversing Heart Disease. Based on a one-year San Francisco study of 48 patients (now extended to four years by the National Institutes of Health), Ornish’s program prescribes not radical surgery but a total change in lifestyle. It advocates a low-fat, vegetarian diet, moderate exercise and stress-management techniques derived largely from yoga. According to Ornish, almost all of the 22 patients in his study group who followed his directions reported almost immediate relief from pain. “Eighty-two percent showed some overall reversal of their coronary-artery blockages,” says Ornish, “and not just the flow improved, but the blockages actually began to reverse.”

Ornish’s own life has been nearly as dramatic as the results of his study. In his second year of college, a bout with depression left him so suicidal that only the fact that he was bedridden kept him from taking his own life. That episode led to the yoga and meditation he has incorporated in his program. He has cut out all meats and most fats but admits to an occasional teaspoon of the “richest, darkest, highest-in-butterfat ice cream I can find.” Now living in Sausalito, Calif., Ornish recently discussed his program with correspondent Dianna Waggoner.

What causes a heart attack?

The heart doesn’t get enough blood flow. If the deprivation is temporary, you have chest pain. But if it’s prolonged, then part of your heart dies.

What prevents the heart from getting enough blood?

For years it has been known that cholesterol and other deposits can build up in the lining of the arteries like rust in a pipe. This process begins in childhood and progresses slowly over decades. Cholesterol and fat are not bad in themselves. We just eat too much. Nicotine damages the lining of the arteries, which can lead to blockages as well. Emotional stress, and nicotine again, can also cause the arteries to constrict and the blood to clot faster. The bad news is that these responses can be activated very quickly.

But you maintain that even after an attack, the patient can reverse arterial blockages and improve blood flow to the heart.

Yes. If you change those lifestyle factors that caused the problems to your heart in the first place, you can often show improvement very quickly. That’s where our plan comes in. It involves a low-fat, vegetarian diet. It also includes an hour three times a week of moderate exercise—walking is sufficient for most people—and an hour a day of stress-management techniques. And those people who smoke need to stop.

How strict is the diet you prescribe?

It’s strict on content but not on quantity. Instead of counting calories and feeling deprived and hungry, you can eat virtually as much as you want, within the guidelines, and still come down to your ideal body weight. The objective is to reduce animal fats by concentrating on vegetables, fruits, beans and grains. The conventional recommendations don’t seem to go far enough to reverse heart disease. The 30 percent fat diet recommended by the American Heart Association—skinless chicken, fish, three eggs per week and red meat only occasionally—is what the comparison group in our study was eating, and the majority showed overall worsening of their arterial blockages.

Stress has eluded scientific measurement. How do you define it?

I believe that stress ultimately comes from a perception of isolation—isolation from one’s own feelings, isolation from other people, and isolation from something spiritual.

What’s the connection between stress and heart disease?

We know there are direct connections between your brain and your heart and that chronic stress contributes to heart disease. In addition we know that during times of stress the arteries in your heart can constrict within seconds and that blood clots faster. Both conditions tend to reduce blood flow to your heart. In some cases this can lead to a heart attack. Also, stress causes steroid hormones to circulate, causing blockages potentially damaging to your heart to build up over a period of years.

How do the stress-management techniques help people to cope better?

The program that we have worked out involves various stretching, breathing, meditation, visualization and relaxation techniques, many of them derived from yoga. When you use these techniques, your threshold for what causes you to feel stress goes up. People in our study describe this by saying things like, “I used to have a short fuse, and I’d explode easily, but now my fuse is longer.” Your work may not change, your home environment may not change, but your reaction to them changes. So it does not create the same level of stress.

It’s well established that exercise strengthens the heart, but how much is enough?

People used to think that you had to run five miles a day, but now we know that walking 20 minutes a day—even doing some gardening, but regularly—gives you most of the health benefits without the risks of more intensive exercise. Designing a program is easy. The key is doing it on a regular basis.

Are surgery and drugs ever helpful for people with heart disease?

I think drugs and surgery have their place, and I use them in a crisis. If you came into the emergency room with crushing chest pain, I wouldn’t tell you to meditate and eat broccoli. But once you’ve survived the crisis, we can begin to ask, “How did you end up in this situation, and what can you do to keep it from recurring?”

If you only deal with the problem on a superficial, physical level, then the same problem often comes back or you get a whole new set of problems. Knowing what we now know, I’m convinced that heart disease is completely preventable for the vast majority of people.

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