PLMI 2014 Thought Leaders Consortium
‘Lifestyle medicine is the right idea at the right time’: Dean Ornish, MD
Dr Ornish has been looking at the impact of lifestyle medicine – using lifestyle as treatment as well as prevention – for about 40 years, and it includes what and how we eat, how we respond to stress, how much exercise we get, and how much love and support we have.
Speaking at the Personalized Lifestyle Medicine Institute’s Thought Leaders Consortium – a high-level, exclusive event that was hosted by Dr Jeffrey Bland and his colleagues in Seattle in late October – Dr Ornish gave a presentation about the “transformative powers of lifestyle changes and love”.
“There’s a convergence of forces: As the limitations of high-tech medicine becoming clear – stents and bypasses don’t really work – the benefits of these low-tech interventions are becoming better documented,” he said.
A favorite analogy of Dr Ornish is that modern medicine spends so much time mopping up the floor next to an overflowing sink without turning off the faucet. “Sometimes you do need to mop up the floor, but if that’s all we do then the problem keeps coming back again.”
“The faucets are the lifestyle choices we make each day.”
And that is the organizing principle for the various approaches, which include lifestyle medicine, functional medicine, personalized medicine, systems biology/P4 medicine, and integrative medicine, he said, and these are all converging in a common way.
The PLMI Thought Leaders Consortium 2014
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“At the root of all of this is the question, ‘what is the cause?’ And if we can get to the bottom of that what we find is that our bodies often have a remarkable capacity to begin healing themselves if you give them a chance to do so.”
The lifestyle changes advocated by Dr Ornish have been shown to have an effect on cardiovascular disease, type-2 diabetes and some cancers, including prostate cancer.
To deepen the understanding of what is happening, genetic analysis of prostate cancer patients revealed that gene expression in 501 genes was beneficially affected in only 3 months (Ornish et al. PNAS, 2008, 105, pp. 8369). “Think about how dynamic this is,” he said.
“Our genes are a predisposition but our genes are not our fate.”
Telomeres and aging
Dr Ornish has also turned his attention to bigger questions, including asking if lifestyle changes can affect aging, and for that he looked at telomeres: DNA sequences at the end of chromosomes that shorten as cells replicate and age.
The aging and lifespan of normal, healthy cells are linked to the so-called telomerase shortening mechanism, which limits cells to a fixed number of divisions. During cell replication, the telomeres function by ensuring the cell's chromosomes do not fuse with each other or rearrange, which can lead to cancer. Prof Elizabeth Blackburn, a telomere pioneer at the University of California San Francisco and 2009 Nobel Prize winner in Physiology or Medicine, likened telomeres to the ends of shoelaces, without which the lace would unravel.
With each replication the telomeres shorten, and when the telomeres are totally consumed, the cells are destroyed (apoptosis). This makes telomeres a good measure of biological age.
Collaboration with Prof Blackburn led to the 2008 publication of results from a “landmark study” in The Lancet Oncology (Ornish et al. Vol. 9, pp. 1048-1057) that reported a significant 30% increase in telomerase activity in the patients' blood cells. This is thought to lengthen telomeres and boost the stability of the chromosomes that is associated with tissue renewal and disease prevention.
A follow-up to that 2008 study published last year in the same journal (The Lancet Oncology, Ornish et al. 2013, Vol. 14, pp. 1112-20) found that, after five years of follow-up, the lifestyle intervention was associated with 10% increases in relative telomere length.
“What this shows is a beginning to reverse aging at a cellular level is a good thing,” he said.
Making it sustainable
While the data may be compelling, getting people to change their lifestyles and maintain those changes is often a much bigger challenge. The traditional medical approach to produce lifestyle changes has been based on fear, said Dr Ornish, but fear is not sustainable. The data shows that two-thirds of people on Lipitor are not taking it a few months after it is first prescribed, he said. “Why not? Well, because they don’t make you feel better.”
“Fun, freedom, pleasure & love ultimately makes sustainable changes,” he said. The lifestyle changes he advocates have people feeling better and quickly, he added, and compliance is excellent as a result, with between 85 and 90% of participants in 60 sites trained by his team.
Focusing on what people eat, Dr Ornish has come up with a series of recommendation to eat optimally:
- Eat mostly plants: fruits, vegetables, whole grains, legumes, and soy products in their natural forms.
- What you include in your diet is as important as what you exclude.
- Eat as close as possible to its natural form, which includes the fiber.
- Reduce the intake of hydrogenated fats, saturated fats, and trans fats. “There’s a study coming out in a few months that shows that saturated fats actually shorten your telomeres,” he noted.
- Reduce intake of sugar and refined carbohydrates. Consume 4 grams of fish oil or equivalent per day.
- And try to eat organic – “It not only tastes better but it doesn’t have the endocrine disruptors,” he said.
“The primary determinant of improvement was the degree of lifestyle change, and the more you change, the better you feel and the more you improve at any age, which I think is empowering.”
“There has been a globalization of illness,” he said. “Countries live like us, eat like us, and they die like us. More people are dying today of chronic diseases worldwide than AIDS, TB and malaria combined. The irony is that the diet they were eating before they started eating like us is the diet we found could prevent and reverse all of these conditions.”
Cost savings
Three-quarters of the $2.8 trillion in health care costs – which is predominantly sick care – are due to chronic disease. Most of these chronic diseases can often be prevented or even reversed by changing diet and lifestyle.
Studies with different health insurance companies have shown that the lifestyle approaches are cost effective and medically effective. “I’ve learned that if it’s not reimbursable it’s not sustainable. Medicare has created a new category to cover our lifestyle program and that has recently been expanded through Medicare Advantage and Medicaid to include type-2 diabetes or early-stage prostate cancer. Other insurance companies are starting to follow this lead.”
“This allows us to reclaim our role as healers and not as technicians.”
