Thursday, January 18, 2018

Reversing Heart Disease with Complementary Medicine

When Dean Ornish entered Baylor College of Medicine in Houston in 1975, it was a leading center of what, at the time, was the hottest new high-tech treatment for heart disease, coronary artery bypass surgery. Surgeons there were winning acclaim for crafting detours around blockages in the arteries that supplied blood to people’s hearts. But bypass surgery did not impress Ornish.

“Bypasses bypassed the problem,” he explains. “They didn’t cure heart disease. They were just very expensive, traumatic band-aids. After a few years, bypasses themselves got blocked, and then people were right back where they started—at high risk for heart attack. If heart disease was an overflowing sink, then bypass surgery was a fancy new mop. Nobody was trying to turn off the faucet.”

However, Ornish was intrigued by curious new findings that were popping up in the medical literature. Beginning in the 1970’s, studies were showing that stress raised cholesterol and blood pressure, both risk factors for heart attack; that meditation, yoga, and exercise lowered blood pressure; and that vegetarian cultures in Africa and Japan, had remarkably little heart disease. Ornish was also intrigued by the work of San Francisco cardiologists Meyer Freidman, M.D., and Ray Rosenman, M.D., who showed that hostile, time-pressured stressed-out Type-A behavior was a risk factor for heart attack (see Box).

To deal with the pressures of medical school, Ornish embraced several alternative lifestyle practices. He meditated, did yoga, and ate a vegetarian diet. They made him feel happier, healthier, and more relaxed. He envisioned a study that would combine moderate exercise with his own his own lifestyle to see if the combination might arrest, or even reverse, heart disease. He took a year off between his second and third years of medical school to pursue his study, and approached cardiologists to find 10 subjects with serious heart disease.

“What’s the name of your study?” one asked.

“The Effects of Yoga, Meditation, and a Vegetarian Diet on Coronary Heart Disease,” Ornish replied.

“Forget it,” the doctor said. “What do I tell my patients—that I’m referring them to a swami? Take my advice: Call it ‘The Effects of Stress Management Techniques and Diet Change on Coronary Heart Disease,’ and I’d be delighted to refer some patients.”

Ornish took the advice and recruited his 10 subjects. For a month, they stopped smoking, took daily walks, learned yoga and meditation, participated in a support group, and ate a vegetarian diet limited to 10 percent of calories from fat (one-quarter of the fat in the average American diet). The diet permitted no red meat, no chicken, no fish, no dairy, no nuts, no chocolate, and no coffee, but all the whole grains, beans, and fresh fruits and vegetables participants could eat, in other words, no calorie restrictions. After only a few days, most of the participants reported decreased chest pain (angina). At the end of the month, many were pain-free. Sophisticated tests showed increased blood flow to their hearts, in other words, some reversal of their heart disease.

Ornish’s results, published in a medical journal in 1979, were greeted with howls of skepticism. Cardiologists dismissed his ultralow-fat diet as impossible for the vast majority of Americans. And they rolled their eyes at the mention of yoga, meditation, exercise, and support group meetings.

In 1980, after graduating from medical school, Dr. Ornish repeated his study. This time, he recruited 48 people with severe heart disease. Half, the control group, were instructed to follow their doctors’ advice. The other half participated in three weeks of yoga, meditation, social support, moderate exercise, an ultra-low-fat diet, and no smoking. By the end of the study, the control group’s heart disease had grown worse. But test group showed a 21 percent drop in cholesterol, a 91 percent reduction in chest pain, a 55 percent improvement in exercise capacity, significantly lower blood pressure, plus reduced anxiety and a greater sense of well-being. Tests showed that their hearts were pumping more normally. The results, published in the Journal of the American Medical Association in 1983, made the medical world sit up and take notice. But critics argued that Ornish’s study involved too few people for too short a time to really mean anything.

So Ornish launched a third larger, longer study. He recruited 43 men and five women. The controls followed standard recommendations for heart disease patients: no smoking, moderate regular exercise, cholesterol-lowering drugs, and a diet containing no more than 30 percent of calories from fat. The treatment group followed the Ornish regimen: no cholesterol drugs, no smoking, moderate exercise (walking for either 30 minutes a day or one hour three days a week), stress management (an hour a day of yoga and meditation), and the strict vegetarian diet with fewer than 10 percent of calories from fat. The treatment group also met twice a week for four hours of group activities: a long walk, yoga, meditation, dinner, and a support group. The people in the treatment group followed the program as best they could, but no one followed it perfectly.

Afer a year, those in the control group reported more chest pain, and showed increased coronary artery blockage. But in the treatment group, frequency of chest pain dropped 91 percent, and 82 percent of the participants showed significant reversal of arterial blockage. Tests showed that in many participants, blood flow to the heart doubled.

Ornish’s program, based entirely on complementary therapies, is the only treatment for heart disease that actually reverses it. The high-tech approaches—drugs, bypass surgery, and angioplasty—are merely band-aids. Today, 40 major health insurers cover the Ornish program and for good reason. It not only works, it’s also cheaper than mainstream care—$3,826 in annual medical costs for Ornish participants vs. $13,927 for people receiving conventional care.

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