It's not every day that you hear a medical doctor suggest that lifestyle changes can be a form of treatment that can reverse -- not just help prevent -- many of the most common and costly chronic diseases, including heart disease, prostate cancer and Type 2 diabetes.
But that is exactly the message -- hard-earned through 35 years of scientific research -- that Dean Ornish, M.D., best-selling author and HuffPost's medical editor, communicated in his recent keynote address at the Integrative Healthcare Symposium in New York. If the numerous standing ovations were any indication, it was also a message that resonated with the attendees, which included conference speaker (and HuffPost blogger) Dr. Mark Hyman.
"Seventy five percent of the $2.7 trillion in health care costs, which are really 'sick care' costs, are from chronic diseases that can be largely prevented, or even reversed, through simply changing diet and lifestyle," Ornish told HuffPost in an interview after his address.
According to the doctor, prostate cancer is one clear example: Since most prostate cancers are slow-growing, most men are more likely to die with prostate cancer than from it, he said.
Because of this, the U.S. Preventive Services Task Force recently recommended against screening for the disease because men who are found to have prostate cancer have so much pressure to "cut it out before it spreads" even though recent studies in the New England Journal of Medicine have shown that only 1 of 49 men who are treated for prostate cancer live longer, yet the treatments leave many men impotent, incontinent, or both.
"There's a third alternative between doing nothing and undergoing treatments like prostate surgery that don't prolong life and have these terrible side-effects, and that's to support people in changing their lifestyle," he said. "It's an aggressive, non-surgical, non-pharmacological intervention, not just 'watchful waiting.'"
"My colleagues and I at the non-profit Preventive Medicine Research Institute conducted a randomized controlled trial in collaboration with Dr. Peter Carroll [chair of urology, UCSF] and the late Dr. William Fair [chair of urology, Memorial Sloan-Kettering Cancer Center] showing that comprehensive lifestyle changes may slow, stop, or even reverse the progression of early-stage prostate cancer -- and the only side-effects are good ones," he said.
Patients who choose to make comprehensive lifestyle changes in lieu of surgery should be carefully monitored so that they can have surgery or other treatments if the tumor continues to grow.
Dr. Ornish's research also showed, for the first time, that these same comprehensive lifestyle changes can reverse the progression of even severe coronary heart disease and reduce cardiac events. In contrast, studies have shown that angioplasties and stents do not prolong life or prevent heart attacks in stable patients, which make up the vast majority of patients who undergo these procedures.
In his lecture, Dr. Ornish reported that half of Americans will have Type 2 diabetes or be prediabetic by 2020 at a cost to the U.S. health care system of $3.35 trillion if current trends go on unabated. The complications of Type 2 diabetes -- heart disease, blindness, nerve damage, kidney damage, amputations and impotence -- can be prevented in most people when they reduce their blood sugar (hemoglobin A1C) below 7.0 by changing lifestyle.
Last year, Dr. Ornish and his colleagues published a report summarizing the outcomes of almost 3,000 patients in 24 hospital sites that they trained to execute their unique lifestyle change program in West Virginia, Pennsylvania and Nebraska. This program reduced blood sugar (hemoglobin A1C) from above 7.0 to below 7.0 after 12 weeks and also after one year, thereby preventing the complications and costs of Type 2 diabetes.
In contrast, two recent studies in the New England Journal of Medicine showed that lowering blood sugar using medications does not prevent the complications of Type 2 diabetes.
Dr. Ornish advocates integrative medicine -- empowering patients to take control of their health and lifestyles -- and using drugs and surgery when appropriate.
Mutual of Omaha found that they saved almost $30,000 per patient in the first year when they went through Dr. Ornish's program. Highmark Blue Cross Blue Shield found that patients with heart disease or diabetes cut their overall costs by 50 percent in the first year and by 20 to 30 percent in years two and three when they went through his program.
The overarching principle of Dr. Ornish's approach is to treat the underlying causes of chronic diseases rather than literally or figuratively bypassing them. "These causes are primarily the lifestyle choices we make each day -- what we eat, how we respond to stress, whether or not we smoke, how much exercise we do, and how much love and support we have."
After 16 years of internal and external review, Medicare agreed last year to cover "Dr. Ornish's Program for Reversing Heart Disease" in hospitals, clinics and physician offices trained the doctor and his colleagues.
"This is a game-changer, because reimbursement is such a powerful determinant of medical practice," Ornish said. "We are grateful to Medicare for making it possible for physicians and other health professionals to create sustainable models of health care that empower people to change their lives for the better."
There is a heated debate going on in Washington between many Republicans who want to privatize or dismantle Medicare and many Democrats who want to just raise taxes or let the deficit go up, Ornish told HuffPost. "There is a third alternative: if we treat the underlying lifestyle causes of chronic diseases, it's not only more medically effective, it's also more cost effective -- better health at lower costs," he explained.
In Dr. Ornish's program, the physician is quarterback, providing overall guidance. The 72 hours of training for patients are provided in 18 four-hour sessions: one hour of exercise supervised by an exercise physiologist, one hour of stress management training with a certified yoga and meditation teacher, one hour of a group meal with a lecture by a nurse or registered dietitian and one hour of a support group led by a clinical psychologist in which a powerful community is created.
The million-dollar question, of course, is how to motivate patients to make lasting changes in their lifestyle.
Fear, he said, does not work. "We all know we're going to die one day, but who wants to think about it?" he said. "What's sustainable is joy, pleasure and freedom."
He continued, "Because the biological mechanisms that affect our health and well-being are so dynamic, when people change their diet and lifestyle, they usually feel so much better, so quickly, it reframes the reason for changing from fear of dying to joy of living. Also, the support that patients give each other is a powerful motivator."
The success has been measurable, according to the team's findings. Adherence to the program has been 85 to 90 percent at all sites, with significant reductions in all measures, including weight, blood pressure, LDL-cholesterol, depression and hostility. Further, that change appears designed to last. As Ornish explained, "When we work at that level, we find that people are much more likely to make and maintain lifestyle choices that are life-enhancing than self-destructive."
They found that over 500 genes were changed just three months after beginning Dr. Ornish's program. In his lecture, he described how this program down-regulated (turned off) oncogenes that promote breast cancer, prostate cancer and colon cancer.
Another of Ornish's key precepts is the need to begin healing what he sees as an "epidemic of depression and loneliness in this country" due to the breakdown of the social networks that used to give people a sense of connection and community.
"Part of the value of science is to raise our awareness," he explained. "People who are lonely and depressed are three to 10 times more likely to get sick and die prematurely than those who have a strong sense of love and community. I don't know any other single factor that affects our health -- for better and for worse -- to such a strong degree."
He argued that change results when we understand that the time we spend with our friends, family and loved ones "is not just a luxury to do once we've done the important stuff -- it is the important stuff."
According to Dr. Ornish, the need for love and intimacy is as powerful as the need for food and water and a vital part of overall health.
"When most people think about my work, they think about diet. To me, diet has always been the least interesting part of it," he told HuffPost. "It's really about helping people use the experience of suffering -- both the physical suffering and psychosocial suffering, which is often harder to measure, but often more meaningful -- as a catalyst for transforming their lives for the better. It's a conspiracy of love."
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