Dean Ornish, M.D. at TEDxSF (7 Billion Well)

Dean Ornish, M.D. at TEDxSF (7 Billion Well)

October 9, 2019 99 By Stanley Isaacs


Translator: Tanya Cushman
Reviewer: Peter van de Ven It’s great to be here today. I want to thank all the organizers
for the chance to be here today and particularly Kunal. You know, we tend to think
of advances in medicine as being a new drug, a new laser,
something really high-tech and expensive, and we often have a hard time believing
that the simple choices we make each day can make such a powerful
difference, but they do. And in our work, we’re using high-tech,
expensive, state-of-the-art measures to prove the power of these very simple
and low-tech and low-cost interventions. And since this a conference on global
health, I wanted to begin with that. Many people don’t know that more people are dying today
in most parts of the world from heart disease, diabetes
and other chronic conditions than AIDS, tuberculosis
and malaria combined, and what’s happening is it’s drawing
and diverting a lot of resources away from things
that really do need drugs, like AIDS, TB and malaria, to things that can be
largely prevented and even reversed through simply changing
diet and lifestyle. And what’s happening is that countries are
beginning to eat like us and live like us and all too often die like us. And the irony is that the diet we found that can reverse and even prevent
most of these conditions is the way that most of these countries
were eating before they began to copy us. So this is still
the steep part of the curve, so intervention now
can make a powerful difference. And what’s personally sustainable
is globally sustainable; what’s good for you is good
for the planet, and here’s why. You know, it’s so easy to get overwhelmed
by all the crises that are facing us now: the energy crisis, the global-warming crisis and the health-care crisis. It’s like, what can I do as one person? But something as simple
as what we choose to eat every day can make a difference. In the energy crisis, for example, 20% of the fossil fuel
that we burn each day goes to make processed foods, which, themselves,
are not so great for us. It takes 10 times more energy
to eat higher on the food chain; when you’re eating meat
as opposed to a plant-based diet, it takes ten times more resources
to make that possible. Michael Pollan calculated
that a quarter-pounder with cheese takes 26 ounces of petroleum
and leaves a 13-pound carbon footprint, which is equivalent
to burning seven pounds of coal. So the next time you’re having a burger,
imagine you’re eating 7 pounds of coal in terms of its impact on the planet. So, does it mean
you should never eat meat? No. But even if you just have
a meatless Monday, know that it’s investing
meaning in our actions, as Adam was saying before, is part of what makes them powerful
and makes them sustainable. From a global-warming [perspective], many people are surprised to learn
that livestock consumption accounts for more global warming
than all forms of transportation combined. You know, it’s responsible for 18% of
the total world greenhouse gas emissions compared to the entire
global transportation system that’s only responsible for 13% of that. Livestock is responsible for even more
of the most toxic parts of the gases. Methane, for example, from cow farts is 23 times more toxic to the ozone layer
than even carbon dioxide. And nitrous oxide is almost 300 times
more toxic to the ozone layer than – let me see if I can get
this slide back up – than CO2. So these simple changes
can make a powerful difference in not only how long we live
but also how well we live. From the standpoint of eating meat, again, what’s good
for the planet is good for you; what’s bad for the planet is bad for you. Eating meat – a number
of studies have come out showing that red meat consumption increases total cardiac mortality,
cancer mortality and all-cause mortality. I like this cartoon – it’s cows
going off to the slaughterhouse saying, “My only consolation is that
by eating us, they’re killing themselves.” (Laughter) From a health crisis – you know,
three-quarters of the 2.8 trillion dollars that we spend each year
on healthcare costs, which are really, for
the most part, sick-care costs, are for chronic diseases that we can
largely prevent or even reverse simply by changing diet and lifestyle. This is just one of many studies
that showed in large numbers of people, walking a half-hour a day, not smoking, eating a reasonably healthy diet
and keeping a healthy weight prevented 93% of diabetes,
81% of heart attacks and so on. And these are probably underestimations –
it’s probably more than that. Well, how do we treat
heart disease in the USA? Generally, with a lot of drugs
and surgery and money. We spend 60 billion dollars
on angioplasties and stents in the last year we have data on them. You say, “It’s a lot of money,
but think of all the lives it saves.” Except that it doesn’t. The latest randomized trials –
a total of 8 of them – were reviewed recently
in the Archives of Internal Medicine. They found that unless
you’re having a heart attack, which most people getting
angioplasties and stents are not, they don’t prolong life, prevent
heart attacks or even reduce angina. And so the same is true
for bypass surgery. Unless you’re the one or two percent
of people who has the most severe disease, they don’t prolong life
or prevent heart attacks. That’s 100 billion dollars
for two operations that are dangerous, invasive,
expensive and largely ineffective. The cartoon says, “I can operate
or you can go on a strict diet.” He says, “Well, you better operate because
my insurance doesn’t cover a strict diet.” That’s the problem; with all this talk
about evidence-based medicine, reimbursement is really
a much more powerful determinant of how we practice medicine. Now, you find the same patterns
with prostrate cancer. The New England Journal of Medicine
had two major studies. They showed that only 1 out of 49 men who was treated for prostate cancer
with surgery or radiation actually lives longer because of it. The other 48 tend to become
either impotent or incontinent or both. So you take a guy who’s often
in the prime of life, 50s or 60s, find out they have
early-stage prostate cancer, scare the hell out of them. They end up having an operation
that doesn’t really help them, but it maims them
in the most personal ways – now they’re wearing diapers
and can’t have sex – for no benefit. But the alternative is to say let’s just do watchful waiting,
under a sword of Damocles, for something bad to happen, and that’s not very good. So the U.S. Preventive Services Task Force recently recommended maybe we shouldn’t
even screen them for prostate cancer because it’s too hard to know that you
have it and “not do anything about it.” But here again is a third alternative,
as I will show you, when you change your diet and lifestyle, you can slow, stop or reverse the progression
of early-stage prostate cancer without having to do that. Now diabetes is another issue. Type II diabetes is a global
epidemic; it’s a pandemic. Already, a third of Americans
are diabetic or prediabetic. In the next eight years,
it’s estimated to be half of Americans, at a cost of 3.3 trillion dollars – clearly not sustainable. Now, it turns out that lifestyle changes are actually better than drugs
at preventing diabetes. This was a major study that was
in the New England Journal ten years ago. It showed that lifestyle actually worked
better than a drug to prevent diabetes. But lifestyle changes are also better
than drugs at treating diabetes. This was in the New England Journal
a year and a half ago. They had two drugs to lower blood sugar; they found it didn’t work nearly as well
to prevent the complications of diabetes as doing it through lifestyle. And the complications
of diabetes are pretty awful: heart attacks, strokes, amputations, blindness, kidney failure and so on. But if you get someone’s blood sugar down
through diet and lifestyle, you can prevent all
of these complications, both the human cost
as well as the economic cost. And my colleagues and I at the nonprofit
Preventive Medicine Research Institute have trained about 55 hospitals
and clinics around the country, including 24 in West Virginia,
Nebraska and Pennsylvania, and we’ve found that in looking
at large numbers of patients, we could get their blood sugar down to a level that we can prevent
all these costs and complications simply by changing diet and lifestyle and at a fraction of the cost, and the only side effects are good ones. So what are we doing? Well, it’s what we eat,
how we respond to stress, how much we exercise we get –
just walking a half-hour every day – and how much love and intimacy
and social support we have. But this really goes back
to a very radical concept – radical in the sense of getting
to the root of something – which is what is the cause? And we spend so much time in medicine mopping up the floor
around the sink that’s overflowing without also turning off the faucet. And it’s a simple idea,
but it’s a powerful one. Because if we can treat
the cause, what we find – the cause, by the way, are the lifestyle choices that we make
each day, for the most part. Otherwise the doctor says,
“Take these cholesterol-lowering drugs, take these blood pressure pills, take these pills
for lowering your blood sugar.” “How long do I have
to take them?” “Forever.” It’s like how long do I have
to mop up the floor? Well, forever. Why don’t we just turn off the faucet? Why don’t we treat the underlying cause, and when we do that, we find that our bodies have
a remarkable capacity, in most cases, to begin healing, and much more quickly
than we had once realized because these biological mechanisms are exquisitely sensitive
and highly dynamic. And it’s not just lifestyle as prevention,
but it’s also lifestyle as treatment. Now, I began doing this work 35 years ago
when I was a medical student, and I took ten men and women
with bad heart disease, put them in a hotel for a month, and we used what was then a new test
called thallium to measure blood flow. And you can see around
ten o’clock there, in the upper left, there’s a black area where
their blood flow should be going. A month later, in the same patient
in the same area, you can see there’s
much more blood going there. But we only had ten patients,
no control group. So I went back to school,
finished medical school, and before starting my internship,
did a second study. This time we had a randomized
control group for comparison, and we found that the people
who made these changes got better; those who didn’t got worse. The differences were highly significant. We published it in the journal of the AMA. Went to Boston, finished medical training,
moved to San Francisco in 1984, began the lifestyle heart trial. We used quantitative arteriography
to measure the blockages. In the upper left, where the arrow is, is a narrowing in a main artery
that feeds the heart, because it’s clogged. Just a year later, it’s wider. And because the blood flow is
a fourth-power function of the diameter, the actual blood to the heart
was increased by 200-300%, which we measured using
what are called cardiac PET scans. The lower left picture is the beginning:
blue and black is no blood flow. A year later, lower right – it’s orange
and white – it’s maximal blood flow. You can see these are dramatic changes. And what we found overall
is that the control group, who made more moderate changes – got worse after one year
and even worse after five years – that’s what usually happens. But instead of getting worse and worse, these patients actually showed
some reversal after one year and even more after five years. This is the first time that was shown. Now, to put a human face on this,
I just want to show you a one-minute clip from a new documentary
called “Escape Fire,” that came out last month
in theaters around the country. It’s available on iTunes
and Amazon and so on. And the filmmakers
want this to be to medicine what “An Inconvenient Truth
was to global warming. So, take a look. (Video) 25 years ago, I had
five restaurants in San Francisco. It was a great life. I smoked six cigars a day. Ten cups of coffee. A lot of wine. It was wonderful. And I had a massive heart attack. I was in the hospital for two weeks. I could hardly just about
walk three steps, and I’d have to stop and rest. I was popping 20 or 30 nitrols a day. But then Dean Ornish
was starting his program to see if he could reverse heart disease
through lifestyle change. And he went to my doctor
and asked if he could approach me. He told Dean, “How long is the program?” He said it was a year. And my doctor told him
he wouldn’t recommend taking me, because he didn’t think
I would live the year. So he figured I was going to die
because I was in such bad shape. And now, 25 years later,
and I’m in pretty good shape. Dean Ornish: His doctor, unfortunately,
passed away in the meantime. (Laughter) But you know, this is a guy
who hasn’t had chest pain now in 25 years, who couldn’t walk across the street. It’s why I’m so passionate
about this work; it’s the kind of thing
we see all the time, in thousands and thousands of patients. So we wondered if maybe
this could help prostate cancer too. So we did a study in collaboration
with Dr. Peter Carroll, the Chair of Urology here at UCSF, and the late Dr. Bill Fair,
who, at the time, was the Chair of Urology
at Sloan-Kettering in New York. And we took men who had
biopsy-proven prostate cancer but had elected not to be treated
for reasons unrelated to this study so that we could divide them
randomly into two groups, ask one group to make these
lifestyle changes, but not the other, and see what happened without being confounded by the usual
chemo and radiation and surgery. We found the PSA levels –
a marker for prostate cancer – went up or got worse
in the no-change group, went down or got better
in the group that did. These differences were highly significant and were in direct proportion
to the degree of change in lifestyle, the same we saw in heart disease: the more
people change, the more they improve. We looked at the effects
when adding their serum to a standard line of prostate
tumor cells growing in tissue culture, the tumor growth
was inhibited 70% versus 9%. And one of the coolest slides: the more people changed lifestyle,
the more it directly inhibited the growth of prostate tumors
growing in tissue culture. Through John Kurhanewicz’s lab, here at UCSF, we did MR spectroscopy
showing the tumor activity, in red here, was diminishing
in this patient after a year as well as the PSA going down. So taken as a whole, this is the first,
and still only, randomized trial showing that the progression
of men with early-stage prostate cancer can be slowed and stopped
and often even reversed simply by making changes
in diet and lifestyle. So we wonder what some of the mechanisms
might be to help explain that. And we found that gene expression
was changed in over 500 genes in just three months. And in fact, turning on or up-regulating
the good genes that protect us, down-regulating the bad genes that cause
inflammation and oxidative stress and also the RAS oncogenes that promote
prostate, breast and colon cancer were down-regulated or turned off –
hundreds of them in just three months. This is what’s called a heat map: you can see on the right
are the oncogenes, and red is mostly turned on. Three months later,
green is mostly turned off. It’s amazingly powerful. We did a study with
Dr. Elizabeth Blackburn, who won the Nobel Prize
for discovering telomerase, which is an enzyme that repairs
and lengthens damaged telomeres – the ends of our chromosomes
that control how long we live – and also Dr. Elissa Epel,
who’ll be presenting later today. What we found was that the telomerase
could increase by 30% in just 3 months, and no study has shown that. And we’re about to publish
the five-year follow up and show that the telomeres
themselves actually get longer when you make these changes. It will be the first study
to show that too. If this was a new drug
that could lengthen your telomeres, it’d be a multi-billion drug overnight, but it’s the same lifestyle changes
that do all these things. It’s not like there’s one for diabetes,
one for heart disease and so on. And we found, again,
the more lifestyle changes people made, the longer their telomeres got. We also found that angiogenesis changes. This is the first study to show that. We found that we could down-regulate VEGF, which tumors secrete to cause
blood vessels to grow and feed them. Drugs like Avastin
and Nexavar inhibit VEGF, but they cost $100,000 a year,
per person, to take. This is, again, for free;
it’s just the same lifestyle changes. So, the more we look,
the more mechanisms we can invoke to explain why these changes are
so powerful and make such a difference. Our genes are our predisposition,
but our genes are not our fate. I found that very empowering. We also found that this was not only
medically effective but cost effective. Mutual of Omaha found they save
$30,000 per patient in the first year. Highmark Blue Cross Blue Shield found they
could cut costs by 50% in the first year and by an additional 20 to 30%
in years two and three. And finally, a year and a half ago,
after 16 years of review, Medicare agreed to cover our program,
which was a real game changer because, again, reimbursement is such a primary
determinant of medical practice; you change reimbursement, you change
medical practice, even medical education. So we’re in the process now of training
hospitals and clinics around the country. If you’re interested in learning more
about our work, go to our website. Or if you’re interested in being trained. Our role – our goal is to –
we train a team of six people: a doctor, a nurse,
a stress management specialist – essentially a yoga-mediation teacher – an exercise physiologist,
a dietitian and a psychologist who work together as a team
with the doctor as quarterback. And it enables us to reclaim our world
as healers and not simply as technicians. Vinod Khosla, speaking later today,
was quoted on a controversial statement that we doctors are going to be replaced
by an iPhone app before too long. And if all we are are just a collection
of algorithms, then that’s true. But we’re more than that; it allows us to get
re-enchanted with medicine and to reclaim our role
as healers and not just technicians. We train the St. Vincent de Paul
homeless shelter here in San Francisco. They’re over 20,000 patients who’ve gone
through our clinic in the last 1.5 years, and now with the Medicare
reimbursement, it’s financially stable, and we can now clone this
around the country without needing ongoing
philanthropy to support them. But the other big epidemic besides
heart disease, obesity and diabetes is depression and loneliness. Study after study has shown
that people who feel lonely and depressed are many times more likely
to get sick and die prematurely than those who have a sense
of love, connection and community. We found we could cut
depressions scores in half simply by changing diet and lifestyle – comparable or even better
than what you get with antidepressants. And you know, because there’s been
a breakdown of the social networks that used to give us a sense
of connection and community; many people don’t have
a job that feels secure, a neighborhood with several
generations of neighbors living together, an extended family or even
a nuclear family that you see regularly. These things affect
the quality of our lives, but they actually affect our survival. And Nick Christakis’s work found that
these social networks were so powerful that if your friends are obese,
you’re 45% more likely to be obese. If your friends’ friends are obese, 25%. If your friends’ friends’ friends are
obese, 10%, even if you’ve never met them. And you can see this with other behaviors
as well; that’s how powerful these are. The last thing I want to say is that
anything that creates a sense of trust leads to intimacy,
leads to healing and meaning. The word “healing” comes
from “to make whole.” “Yoga” – “to yoke, to unite,
to bring together.” These are old ideas
that we are rediscovering. And you find this as part
of all spiritual traditions: altruism, compassion,
forgiveness and love – not to get some external reward
in the next lifetime, but that’s what frees us from our isolation, and our depression
and our suffering here and now. My dad died a few months ago; my mom had a stroke,
a debilitating stroke, soon after; my dog of 14 years got bit
on the nose by a rattlesnake – all this in the last
few months – and died. You know, life is short
and life is precious. And what I’m most interested in
is not simply unclogging arteries or showing all these kinds of things –
as interesting as they are. We’re all going to die. The mortality rate is still 100%;
it’s one per person. (Laughter) I got profoundly and suicidally
depressed when I was in college. That was my doorway into this area. For someone else, it might be
a heart attack or a stroke. But, you know, change is hard,
as Adam mentioned earlier. But when you’re in enough pain, suddenly the idea of change
becomes more interesting. And what I find I’m most passionate about,
what I find most interesting is how we can use
the experience of suffering as a doorway for transforming
our lives and finding meaning, and then we can often get curing,
but we can always get healing. Thank you so much. (Applause)