A conversation between Dr. Dean Ornish of Preventive Medicine Research Institute and David Kirkpatrick.
Below is an excerpt of their interview, but the full transcript is accessible here.
David Kirkpatrick: So, this is really great to have you at the end of the day, Dean, and I think that there were a number of elements in the preceding session that are pertinent—
Dean Ornish: Or impertinent.
Kirkpatrick: Impertinent but pertinent to what you have to say because in you’re thinking so interestingly about health. You run the Preventive Medicine Research Institute at UCSF. You’re a professor of medicine there. You’ve been researching for many years about how lifestyle changes can really affect a wide range of health outcomes and you’ve written all these books which I’ll just name a few of. The most recent one The Spectrum, Love and Survival, Eat More, Weigh Less, Dr. Dean Ornish’s Program for Reversing Heart Disease. All of those bestsellers you were on various White House commissions for various Presidents. You’ve turned Steve Jobs into a vegan. I mean, you’ve done a lot of amazing things.
Ornish: But I did not kill Steve Jobs.
Kirkpatrick: You’re not being blamed for that. So, anyway, I’m very eager to hear your thoughts about this whole question of how do we make people healthier? I know you’ve been giving a lot of thought even in some new ways that have to do with the media environment we’re in. So have I started off by saying enough to give you a chance to start talking?
Ornish: Sure. First, thanks for including me today. It’s a great conference. I’ve been doing this work for 40 years. It’s my passion. We helped create a new field called lifestyle medicine which is using lifestyle changes not only prevent disease but actually to treat and even reverse it. So in a series of randomized trials and demonstration projects we’re able to show for the first time that simple lifestyle changes: eat well, whole foods/plant-based diet, various exercise, including walking, stress-management techniques, including yoga and meditation, and maybe most important, we’ll talk more about this, love and support. Or, eat well, move more, stress less, love more, can actually reverse the progression of most of the diseases we look at, and the more underlying biological mechanisms we study, the more reasons we have to show why these simple changes are so powerful, and how quickly people can get better.
So we began with heart disease which showed that could be reversed, even severe heart disease, diabetes, early-stage prostate cancer, by extension breast cancer, high cholesterol, high blood pressure, obesity. When you change your lifestyle, it changes your genes, turns on the good genes, turns off the bad genes, particularly downregulating what are called the oncogenes that promote prostate, breast, and colon cancer. It’s just amazing how quickly you can show improvement. We did study and published it with Craig Venter in the Proceedings of the National Academy of Sciences.
We did a study with Elizabeth Blackburn who got the Nobel Prize for discovering telomerase, the role of telomeres, the ends of our chromosomes that regulate how love we live. She found that as you get older, your telomeres get shorter. As your telomeres get shorter, your life gets shorter, and the risk of premature death from pretty much everything goes up proportionate to that. We still have the only controlled study showing that any intervention, in this case, these same lifestyle changes, can actually lengthen telomeres.
With all of this talk about personalized diets and personalized lifestyle interventions and precision medicine, I think that’s great if you’re talking about targeting a special new immunotherapy for pancreatic cancer type, cell type, but for most of these chronic diseases, it’s wasn’t like one there was one set of diet and lifestyle recommendations for reversing heart disease, a different one for diabetes or prostate or whatever. It was the same for all of them and the more you change, the more you improve at any age. I think in part because a lot of these chronic conditions share underlying disease pathways like chronic inflammation, oxidative stress, and so on, and they manifest in different ways. So, the longer I do this work, the simpler it becomes.
Kirkpatrick: Well, that’s a great thing in some ways. It certainly makes things simple.
Ornish: Steve Jobs used to always say he was more proud of what he left out of the iPhone than what he put into it. When you really understand something, when you make it your life you can really—I mean, people don’t know anything about it can make it simple and people who spend their whole lives doing it can make it simple.
Kirkpatrick: Well, the good thing is that we kind of know what we should do.
Ornish: And there is a real convergence of agreement about that.
Kirkpatrick: But the weird thing is we don’t do what we should do.
Ornish: Not always.
Kirkpatrick: Well, the majority of us, 75% of Americans are obese or something like that, just to name one statistic. I know one of the reasons you wanted to speak at this conference was because you’ve been giving a lot of thought to the media environment and the kind of digitized landscape in which we live and the phone addiction that we are all prey to, almost literally everyone, and how it dovetails with what you’ve learned so talk a little bit about how you’re thinking about that.
Ornish: Well, if information were enough for people to change then nobody would smoke. It’s not like I’d say, “Hey, David, smoking is bad for you,” and you go, “Oh, I didn’t know that. I’ll quit today.” Everybody knows that. It’s on every package of cigarettes. It’s not enough to give people information. It’s not enough just to focus on their behavior.
We have to work at a deeper level. Really the essence of all of my work in a sentence is to treat the cause. If you say, “Why do people smoke?” or, for that matter, overeat, as you indicated or drink too much, or take opioids, or work too hard, or spend too much time playing video games, or whatever it happens to be.
I’ve asked the people in our studies, “Teach me something. Why do you do these things? They seem so maladaptive to me,” and they kind of say, “You don’t get it. You don’t have a clue,” they’d say. “These are very adaptive. They help us deal with our pain, our loneliness, our depression.”
There’s been a radical shift in our culture in the past 50 years with the breakdown of the social networks that used to give people a sense of connection and community, and what I’m learning is that anything that brings us together is healing. Even the word “healing” comes from the route “to make whole.” Yoga from the Sanskrit to yoke, to unite, to bring together. These are really old ideas that we’re rediscovering. Fifty years ago people had extended families they saw regularly for the most part. They had a neighborhood with two or three generations of people that grew up together. They had a church or synagogue they went to regularly. They had a job that felt secure that they’d been at for 10 years or more.
Many people now don’t have any of those things and we pay a price for that. I wrote a book about this in 1998 called “Love and Survival” that reviewed what hundreds were then and now literally thousands of studies that show that people who are lonely and depressed are three to ten times more likely to get sick and die prematurely than those who have a sense of love and connection and community.
I don’t know anything in medicine that has that powerful an impact. They say things like, “I’ve got 20 friends and this pack of cigarettes and they are always there for me. Are you going to take away my 20 friends? What are you going to give me?” Or they say, “Food fills that void” or a well-known food writer said, “Fat coats my nerves and numbs the pain,” or alcohol or opioids or alcohol numbs the pain or other drugs numb the pain or video games numb the pain, or, as many of us have found, working all the time numbs the pain.
We have lots of ways of dealing with our pain but if you just try to numb or bypass literally or figuratively the pain, you’re just killing the messenger. It’s like clipping the wires to a fire alarm and going back to sleep while your house burns. You know you’ve just killed the messenger.
Our approach is to help people use the experience of their suffering as a doorway for transforming their lives in ways that go beyond just risk factor reduction.
Fear is not a good motivator. In the short run, fear is a great motivator. People do anything for a month or so after they’ve had a heart attack, but in politics as we’re finding now or in health, it’s not sustainable. Fear is not a sustainable motivator but joy and pleasure are and because these underlying biological mechanisms are so dynamic, when you make big enough changes in diet and lifestyle most people feel so much better so quickly, and the love and support they get is so important, that it reframes the reason for making these changes from fear of dying, which is not sustainable, to joy and pleasure and freedom and feeling good, which are.