Dr. Dean Ornish: Lessons from a Lifetime of Healing
by Owen
Lipstein
Bill Clinton, Quincy Jones, Deepak Chopra, and Clint
Eastwood all agree: Dr Dean Ornish's latest book, “The Spectrum," is a winner.
After a long and successful career as a physician studying and writing about
heart disease, and showing how lifestyle, mindfulness, and being nice can
actually reverse it, Dr. Ornish has come out with a book outlining the non-diet
diet, encouraging us to do the best we can, and dropping the drama of trendy
weight-loss programs.
There's hope for us yet!
InsideOut: How do you explain such things as the obesity
epidemic or some of the other indifferences to medicine, as you describe them?
Dean Ornish: It's a number of different factors. Part of
what we have learned, and [what] I describe in my book, is that it’s not enough
to give people information. If it were, nobody would smoke. Everybody knows it’s
not good for you, it’s on every package of cigarettes. So we have to work at a
deeper level. The most currently prescribed prescription drugs are the
anti-depressants; the real epidemic is not just obesity, but depression,
loneliness and isolation. Our world has become more fragmented. A generation or
two ago, people knew their neighbors. They had a church or synagogue they went
to regularly. They had a job where they felt secure and stable. They had an
extended family that they saw regularly. Many people have none of those things,
and we pay a price for that.
IO: How does this lead to unhealthy habits?
DO: In our studies we would spend years together, in some
cases, and months together in others, and we would ask them: "Why do you
smoke? Why do you overeat? Why do you drink too much? Why do you work too hard?
Why do you watch so much television? Why do you spend so much time on the
Internet? These behaviors seem so maladaptive to me."
They would say, "Dean, you don't get it. You don't have
a clue. These behaviors are very adaptive, because they help US get through the
day."
Many people overeat to cope with that pain. "It helps my
nerves or numbs my pain," or "When I feel depressed I try to fill
that void with food," or "I use alcohol and drugs to numb the
pain," or "I work too hard to distract myself from those feelings,”
or "I spend too much time watching TV, or DVDs, or on the Internet as
another way of distracting myself from those feelings." So part of the
reason that we've been able to be so successful in motivating people to make
sustainable changes in their lifestyles is that we are not just giving people
information, we're also addressing the deeper issues.
You could also talk about how people don't work on the farm,
and have more video games, and there's more junk food available out there, and
there's some truth to that — but 20 years ago, most people weren't working on a
farm either. Clearly our genes haven't changed in that period of time, but I do
think that people are lonelier than they used to be, and more frightened and
more fragmented.
IO: I thought the way you began your book, with a set of
"Why It [The Spectrum] Works," was particularly interesting, because
it addresses the failures people may feel they've had in their own lives or the
lives of loved ones.
DO: Yes. Part of the reason it works is that I've made a lot
of mistakes over the 30 years of doing this work, and I've learned from them.
One of the mistakes that I've made is one that most doctors make, which is
trying to scare people into changing. You know, "You better change or you
are going to get a heart attack," or "You're going to get lung cancer
if you don't stop smoking," or whatever.
Fear of dying is not really a very sustainable motivator.
When someone's had a heart attack, they'll do anything for about three or four
weeks. Even then, they go back to their old patterns, which causes many doctors
to say, "Gosh, if I can't even get my patients to change after that, how
can you get them to change and just stay healthy?"
IO: Aren't people afraid of being unhealthy? Of dying, even?
DO: Fear is not a great motivator because it's just too
scary by definition. We all know we are going to die. The mortality rate is
still 100 percent, one per person. It's one of the reasons why the appearance
of drugs like Lipitor and other cholesterol-lowering drugs is so I unhelpful.
Two-thirds of the people prescribed these drugs are not taking them four months
later, even though they are usually paid for by someone else, and the side
effects for most people are pretty minimal, if any.
The reason is that you are asked to take a pill to prevent
something really bad from happening years down the road that most people don't
want to think about. They don't make people feel better, so they don't take
them. While a fear of dying is not a good motivator, joy of living is—pleasure,
joy, abundance, ecstasy and freedom are.
[Notice] what I call this moralistic quality — I cheated on
my diet. I ate bad food — feeling, like you are a bad person because you ate
bad food, all the kinds of judgments or moralistic words that we use. Or what I
call these fascist [phrases] like "patient compliance," like we have
to manipulate people and control them to get them to change. And that's not
sustainable either, because even more than being healthy, people want to feel
free and in control. It goes back to "Don't eat the apple." That
didn't work, and that was God talking.
The concept of the spectrum is all about freedom and choice
and abundance, because everything is included. The whole concept of a diet is
[that] if you go on a diet, you are going to go off a diet, because the very
concept of a diet is based on restrictions and what you can't have: Eat this.
Don't eat this. Do this. Don't do that. Go out and exercise. Don't do this.
Don't smoke. As soon as somebody's told they can't have something or they
shouldn't do something, they immediately want to do it. It's just human nature.
IO: Are these observations something that you came up with
all at once, or was it a slow set of aha moments, if you will?
DO: More the latter. They evolved over time. The idea of a
spectrum is that there are no bad foods. There are some foods for you that are
healthier than others, [but] that's very different than calling them good or
bad for you. All foods are included, so there is a sense of abundance. What
really matters is your overall way of eating, so what I've done is categorized
foods from the most healthful to the least healthful and said, "Look, it
doesn't mean you should never indulge yourself, because I do."
In fact, studies show that the people who overall eat the
healthiest are the ones that allow themselves some indulgent foods. Maybe it's
chocolates, but for somebody else it might be something different. All of our
studies have shown that with heart disease, with cancer and with other
illnesses, the degree to which you move in a healthy direction overall, there
is a corresponding benefit. You are going to look better, feel better, lose
weight and gain health. How much you want to move, how quickly you want to move
is really a function of your own needs and desires and preferences and genes.
IO: Talk about gradual changes versus more radical changes,
and your opinion about that.
DO: Part of what we have learned is that there are two basic
strategies that are sustainable. One is more gradual changes, which most people
are aware of. The advantage of that is that it is not that hard. The
disadvantage is that you don't really feel that much better. In the long run,
small gradual changes add up, but in the short run, you don't really feel that
much better. Even though it is counterintuitive, sometimes it is paradoxically
easier to make really big changes in a lot of things at the same time. The
reason is that you feel so much better so quickly, and it comes from your own
experience, not because some doctor or some book told you, but rather [because]…
your brain gets more blood flow.
Part of what we've shown in our studies over the years is
how dynamic your body is, how quickly you can get better or worse depending on
the choices that you make. You don't have to wait very long to see the
benefits. Your brain gets more blood when you eat healthy food and exercise and
manage stress. You can even grow more brain neurons to the point where your
brain gets measurably bigger. You have more energy. You become smarter. Your
skin gets more blood so you don't wrinkle as much. You age less quickly. Your
heart gets more blood. In studies, we have shown that you can actually reverse
heart disease within a few weeks. Your sexual organs get more blood, the same
way Viagra works. There is no point in giving up something that you enjoy
unless you get something back that is even better.
IO: One of the other radical things that you talk about is
generosity and forgiveness, and how they are good for you.
DO: These are not my ideas. These are a part of all
spiritual traditions. What we are learning is that these are behaviors and ways
of being in the world that give us immediate benefits to free us from our
suffering right here and now.
I learned this in the very first study that I did back in
1977 over 30 years ago. I took 10 men and women who had really bad heart
disease, put them in a hotel for a month, and put them on this program. It
happened that one of the patients was this 75-year-old man who was homophobic,
and the other was a 60-something-year-old gay man. The first time they got
together, the [homophobic man] made some kind of slur and the other guy yelled
something equally bad back, and they both got severe chest pain and clutched
their chest [s], and I thought this was going to be the end of our very short
study...
I said, "OK, you two: You are giving the power to give
you chest pains, and maybe even a heart attack and die, to the person that you
hate the most. That's not really smart. Putting aside whatever the so-called
right thing to do is, just from your own self-interest, it's not a smart thing
to do because it's breeding suffering and cramps, and might even kill you, so
for your own selfish reasons — I want you two to be more forgiving and compassionate.”
(I did things that I wouldn't do now, because when you are a medical student
you'll try things that are probably a little silly now.) I asked them if they
would try that, and they said yes. Each day I'd ask them to do something for
each other, like do each other's laundry or whatever. I won't say they became
fast friends, but they never had any more pain and their heart disease
improved.
The most selfish thing we can do is be unselfish, because
that's what frees us from our suffering.
IO: Are you feeling hopeful these days?
DO: I think there is more reason for optimism, and also more
reason for pessimism, than ever. I chair the health advisory boards of PepsiCo,
Safeway, and Google, and work directly with the CEO of McDonald's to make
healthier foods. Early on, they became interested in part because of the
concerns about litigation and legislation and so on, as well as the desire to
do good.
Now they are finding that it's actually good business, so
business has become sustainable at PepsiCo because two-thirds of their revenue
growth is coming from their healthier foods. I helped [McDonald's] develop a
fruit-and-walnut salad that's [made them] the biggest purchaser of apples in
the world. Who would have thought, five years ago? The biggest successes in the
grocery world now are whole foods, [and] so the rise of organic [food]. What
gives me optimism and hope is that there is a tipping point being reached where
people are realizing that we have to address these issues because we're
non-sustainable otherwise — and it's good business to do so.
