'What is the cause?': Dr. Dean Ornish on helping patients with heart disease through diet & lifestyle
Dr. Dean Ornish has accomplished a lot. He went to Harvard and started his own non-profit, the Preventive Medicine Research Institute. He’s written more than a handful of books. But after interviewing him this past summer, it seemed to me the most important part of his career was (and continues to be) helping patients get to the root of their problems. He said he was curious about the main causes of heart disease at the beginning of his career because of the amount of people who would come back again and again for by-pass surgery without addressing or fixing the underlying issues, like stress, depression or unhealthy eating habits.
As it turns out, the surgery was just the tip of the iceberg. But at the time, Ornish’s approach of telling patients to eat better, exercise more and focus on mental health was new—and not widely accepted. Ornish disrupted the medical field by promoting lifestyle changes, rather than pushing for multiple (and sometimes ineffective) surgeries or other quick fixes.
“There was a lot of criticism,” Ornish told me when we spoke in late April, when I was interviewing him for a Lifestyles Magazine article. (It’s not available for reading online, but you can check it out here.)
I wanted to share a bit more from the interview because he had a lot of inspirational and real things to say that didn’t make it into the piece. His early life was particularly fascinating, with an unexpected start as a photographer for publications like Rolling Stone and Esquire. And then decided to secure his path into medicine after Life Magazine photographer Philippe Halsman told him taking photos was “a terrible life.” Here’s more from Dr. Ornish on his philosophy on health, happiness and how he dealt with early struggles.
What was your first job?
I was an entrepreneur from an early age. I was doing magic shows for kids birthday parties then I became a photographer. I went to work for the leading portrait photographer in Dallas and from the ages of 12 to 14 was his apprentice. He sold me some of his equipment and I opened my own portrait studio when I was 14 and did family portraits and weddings. And then became a stringer photographer for Rolling Stone and Texas Monthly and Esquire and Newsweek so I got to go to all the rock concerts for free, which is great.
What did you learn from your time as a photographer that you took with you into the medical field?
When I went to University of Texas of Austin for college I studied with one of the best photographers of the 20th century, a guy named Garry Winogrand. (He did) a very different kind of photography. Instead of trying to manipulate the images to make people look better than they are, which you do in portraiture, he’d go around and take things as they were.
Part of what he taught me was to try to see things without preconceptions, with what other people would call beginner’s mind. The difference between innovation and imitation is to be able to see things in a new way.
Why did you study and research heart disease?
When I was a medical student, I did my course surgery rotation with Michael DeBakey, one of the pioneers of open-heart surgery. He was one of the people who really helped invent bypass surgery. So we would cut people open, we’d bypass their clogged arteries, basically tell them they were cured—and more often than not they’d go home and do all the things that caused the problem in the first place. They’d eat junk food. Not manage stress. Not exercise. Smoke cigarettes. More often than not, as a result of that, the new bypasses would clog up. They’d come back. We’d cut them open and bypass the bypass, sometimes two or three times.
For me, bypass surgery became a metaphor for an incomplete approach. We were literally bypassing the problem. We were treating it as the underlying cause.
What about your own experiences made you realize mental health is equally as important as physical health?
When I was a medical student, I had become profoundly and suicidally depressed because for a variety of reasons, which I wrote about in both the Dr. Dean Ornish’s Program for Heart Disease book as well as the Love and Survival books.
I studied with…a spiritual teacher called Swami Satchidananda. his is back in 1977, 1978. I was a second-year medical student. One of the things I learned from him was always to ask ‘What is the cause? And what is the cause of that?’ instead of literally or figuratively bypassing the cause. When I apply that same perspective to bypass surgery, I say, ‘Gosh, we’re bypassing the problem. The problem keeps coming back. What if we treated the cause?’
There were all these studies showing that dogs and cats and pigs and rabbits and monkeys—you could cause them to get heart disease if you put them on a high-fat, high-animal protein diet. You could make them smoke and not let them exercise and put them in emotional stress. You could reverse if you change those things so I thought why should people be any different? They said, ‘Oh no, no. That’s impossible.’
And I said, ‘Let’s find out.’
Can you dish some details about your time at the White House?
In 1993, shortly after President Clinton took office, a mutual friend introduced me to Hillary Clinton and we met in the West Wing of the White House and she was interested in the research we were doing, showing that we could reverse heart disease. At the end of the presentation—she’s very smart and she totally understood it—she said, ‘Would you be willing to train the chefs to cook for us?’ And I said, ‘Excuse me? Say that again.’ She repeated it and I said, ‘Of course, I’d be honoured to.’
One of the things I’d learned along the way was the best way to make healthy food taste good was to work with great chefs, even if they’re not known for cooking healthy foods. Shortly after that, a few months later, President Clinton asked me if I would be one of his consulting physicians...so I was one of his only non-military doctors. I did that for several years as well. I became a consultant to him for his own health.
President Obama, years later, appointed me to the White House Advisory group on prevention, health promotion and integrated and public health. I was advising him through that.
And you’re also a professor?
I’ve been a clinical professor of medicine at UCSF (University of California, San Francisco) shortly after I came here in 1984. At first, I was teaching on the wards, and I realized other people can do that as well or better than I can. The way I teach now is to have people come and do rotations with us so they can see something which they don’t ordinarily see. This is how we can train physicians and other healthcare professionals to work with their patients...in this new field which I pioneered, which is called lifestyle medicine—which is to use lifestyle changes not only to help prevent disease, but actually to treat it and often reverse it. To me, lifestyle medicine is the most exciting field in medicine today. It’s tidal wave that hasn’t even begun to crash. You see it everywhere.
Why do you think your teachings and research are more accepted now?
There’s a convergence of forces after doing this work for four decades: the right idea at the right time. On the one hand, the limitations of drugs and surgery are becoming increasingly clear. And I want to say...that surgery can be life-saving when used appropriately and we’ve all been the beneficiaries of that—but for treating chronic diseases, they don’t generally address the underlying causes.
When I lecture, I usually show a cartoon of doctors busily mopping up the floor and the sink is overflowing because no one’s turning off the faucet. It’s like, how long can you mop the floor? Forever.
When we put people on medications to lower their cholesterol, their blood pressure, their diabetes, blood sugar, and they say, ‘Doctor, how long do I have to take these?’ What does the doctor usually say? Forever. How long do we mop up the floor? Well, why don’t we turn off the faucet.
To a much larger degree than we had once realized, the faucet is the lifestyle choices that we make each day. What I continually am impressed by, and often amazed by, is—I’ve been doing this work for so long—the more diseases we study and the more underlying biological mechanisms we look at, the more reasons we have to explain why these changes are so powerful and how quickly people can get better.
We spent tens of billions of dollars on angioplasties and stents each year that are essentially ineffective. And we now know simple lifestyle changes can actually reverse heart disease and much more quickly than we once realized. Within a few days to a few weeks, most people with chest pain become essentially pain-free. For someone who can’t work or make love with their spouse or play with their kids or walk across the street without getting chest pain before the light changes, and within a few weeks they can do all of those things, they usually say, ‘Oh, I like eating junk food but not that much. What I gain is so much more than what I give up.’ That’s what makes it sustainable.
Why is it more important to be motivated by positivity when implementing lifestyle changes?
We learned that efforts that try to motivate people out of fear are not sustainable. What is sustainable is joy and pleasure and freedom and love. Instead of saying, ‘Take this pill (it’s not going to make you feel better but hopefully it won’t make you feel worse) to prevent something really awful from happening years down the road, like a heart attack or stroke’ that you don’t want to think about, so you don’t think about it.
When you make big changes in your lifestyle, most people feel so much better so quickly. It reframes the reasons from making those changes from fear of dying, which is not sustainable, to joy and love and pleasure, which are. We’re getting much better adherence to a much more intensive intervention because what you gain is so much more than what you give up, and how quickly you can experience those benefits in ways that are measurable.
What should people know if they want to start making changes?
What we try to do is help people use the experience of suffering as a doorway or a catalyst for transforming their lives because change is hard, but if you’re in enough pain, suddenly the idea of change becomes more appealing and part of the value of doing forty years of research is that it helps raise awareness. Awareness is the first step in healing.
After doing this for forty years, I still love doing it. It gets me out of bed every day because I was suicidal, depressed when I was in college. These approaches are what helped me transform that so in many ways I feel like I’ve been living on borrowed time since then. It’s what’s given me the courage to do things I might not have otherwise done. Like, ‘How bad could it be? I’ll learn something,’—and having come through that crisis, I decided that however long I live, I’d rather have regrets about what I did than what I didn’t do. If you do something and it doesn’t work then there’s value in that. You learn something very powerful. There’s a lot of wisdom that comes from making mistakes and learning from them. If you never do it, you just wonder, you have regrets. That’s my philosophy that served me pretty well most of the time.
Dr. Ornish’s latest book Undo It is coming in January 2019. It’s about getting to the cause of the problem and enabling people to “re-experience inner sources of peace and joy and wellbeing.”
This interview has been edited for clarity and condensed.