For years it was thought that bed rest was the best medicine for heart attacks. Then, in the 1950s, the idea of getting patients to move around -- at least a little -- after an attack became the norm. The 1970s featured highly monitored exercise programs. By the 1990s, the idea became more radical: Patients suffering from coronary artery disease could reverse the condition through diet, exercise and lifestyle changes, without the aid of drugs.
Dean Ornish led the 1990 study that found that a plant-based diet, mild exercise, stress reduction and social support could reduce coronary artery blockages. The study pointed toward a rethinking of the treatment of heart disease through what was called a "diet breakthrough." Over the years, the evidence has mounted linking these lifestyle factors to improved heart health.
While Ornish's research offered results, his program was not immediately embraced by all health insurers. He worked for 16 years with the Centers for Medicare and Medicaid Services to create in 2010 a new coverage category called intensive cardiac rehabilitation (ICR), which focuses on comprehensive lifestyle changes.
Since then, Medicare has reimbursed costs for Ornish's Program for Reversing Heart Disease, a 72-hour ICR for people who have had heart attacks, chest pain, heart valve repair, coronary artery bypass, heart or lung bypass, or coronary angioplasty or stenting. (Medicare also pays for ICR programs created by the Pritikin Longevity Center and by the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital.)
In an interview, Ornish discussed the current thinking on reversing heart disease. Here is an edited transcript of the conversation.
Q: Let's start by defining heart disease.
A: Coronary heart disease is when the heart can't feed itself. The heart pumps blood to the body, but it first pumps blood to feed itself through coronary arteries. Over time, if they get clogged, then the heart can't pump enough blood to feed itself. Blood carries oxygen, and oxygen is fuel for the heart. If the heart doesn't get enough oxygen, in the short term it can cause angina or chest pain. Over a longer period of time, everything downstream may die and turn into scar tissue; that's what we commonly refer to as a heart attack. If it's a small area, you live; if it's a big area, you don't.
When someone has a heart attack, the artery may constrict, due to intense emotional stress, a high fat meal, intense exercise. . . . During times of emotional stress, your arteries are supposed to constrict and your blood is supposed to clot faster. We're really designed to or evolved to deal with acute stresses. You walk into the jungle, the saber-toothed tiger jumps out and either you run or you kill the tiger or the tiger eats you, but one way or another, it's over. Modern times, these same stresses are so chronic that the mechanisms that are supposed to protect you could kill you.
Q: How does your program help reverse this?
A: Beginning in 1977, we began publishing a series of clinical research trials, showing for the first time that instead of getting worse and worse, most people could get better and better, if they were willing to make comprehensive changes in diet and lifestyle that went beyond what most (doctors) had been recommending until then. And these include a whole-foods, plant-based diet that's naturally low in both fat and in sugar and refined carbohydrates; a series of stress management techniques including yoga and meditation; moderate exercise; and what we call psychosocial support, which is another way of saying love and intimacy and community.
Q: What's been learned about reversing heart disease?
A: The more people change, the more they improve, at any age, in terms of the amount of blockages in their arteries. The more closely they followed our program, the more improvement they showed.
What I've learned is what enables people to make sustainable changes in their lifestyle is not fear of dying, it's joy of living. Most people for four to six weeks after they've had a heart attack, they'll do pretty much anything that their doctor or nurse advises them to do, but then the fear goes away, the denial comes back and they stop doing it. Whereas when you change your lifestyle . . . most people find they feel so much better so quickly that it reframes the reasons for making these changes. . . . They say, "You know, I like eating cheeseburgers, but not that much. Because what I gain is so much more than what I give up."