Dr. Dean Ornish had a subversive idea: Could severe heart disease be reversed without drugs or surgery? To find out, he asked 22 patients with atherosclerosis to change their diets and lifestyles for one year. A team of filmmakers decided to go along for the ride, trailing four of the patients and their families through a brave new world of clean living. Their fascinating film of Ornish's experiment, "Avoiding the Surgeon's Knife," airs this week as a segment of PBS' "Nova" series.
Ornish, a 38-year-old internist from Sausalito, told Janny Scott that the answer to his original question is yes.
What did you ask the people in the study to do?
We asked them to follow a low-fat, vegetarian diet. Besides diet, we asked them to practice a series of stress management techniques, to walk for half an hour a day or for an hour three times a week and, for those few patients who were still smoking, to stop smoking.
What prompted you to try this?
There was evidence from earlier studies that each of these lifestyle factors play an important role in the development of heart disease. But no one had tried an intensive program that combined all of these lifestyle factors, using tests to see whether people can not only feel better but become better, that their arteries could become less blocked and the blood flow to their heart could improve and the chest pain would diminish.
Was it difficult to get funding?
The major sources of scientific funding were unwilling to support us initially because they thought that nobody would make and maintain lifestyle changes to this degree in a real-world setting, and, even if they did, that heart disease couldn't be reversed. Later on, as we began to demonstrate that people were making and maintaining these changes and that, in fact, they were beginning to improve, then some of the major foundations and, finally, the National Heart, Lung and Blood Institute gave us support to continue.
Is the program too difficult for the average American?
To say that it's too hard for people to do is, to me, a paternalistic and somewhat patronizing attitude. I never tell people they have to change. As a scientist, I'm simply trying to find out, if people change, what happens, and to do the best studies we can to learn that.
But if somebody doesn't want to make changes, then I have no hesitation to prescribe cholesterol-lowering drugs or even to refer them for angioplasty or bypass surgery or whatever it takes--as long as they understand that those approaches really don't address the underlying cause of the problem.
Would the program help people who have no known heart disease?
I think it would. Heart and blood vessel diseases kill more Americans each year than all other diseases combined. And yet I believe that at least 95% of that could be prevented or even reversed.
What I suggest people do is, if they have heart disease, is go on what I call a reversal diet, which is the (low-fat, vegetarian) diet that we serve the patients in our study.
If they don't have heart disease, then they can go on what is called a prevention diet. It's based on simply using your blood cholesterol level as a rough index. If your cholesterol is 150 or less, consistently, then whatever you're eating is probably fine because heart disease is very rare when cholesterol levels are consistently below 150. If it's above 150, you can begin by making moderate changes and whatever you're eating, eat less of it. So if you're eating a 40% fat diet, go to 30%. If that's enough to bring it down below 150, that may be as far as you need to go.
During the course of the documentary, one patient dies. What was your reaction to his death?
Until he died, I wasn't as convinced of the importance of addressing the emotional and even spiritual dimensions of heart disease. But here was someone who did everything right in the usual sense: He got his cholesterol down from 249 to 121, he never smoked, he exercised like crazy. And he died. But he was someone who didn't want to participate in the stress management classes or in the group discussions after the first month. So for me and for the group it was a powerful lesson that it's not enough to just address behaviors like diet and smoking and exercise. We also need to address the factors that underlie those behaviors.
What were your results after the first year?
Eighty-two percent of the patients, 18 of the 22, showed some overall reversal of their atherosclerosis. Three were essentially unchanged. Only one was clearly worse, and he was someone who wasn't adhering at all to the program.
Did you have any control over the documentary?
Absolutely none. It was a big risk, because they began filming on the first day of the study and they filmed all the way through and we had no idea what we'd find. It could have been a documentary about a total failure. What's unique about this film is the viewer can watch the process as it unfolds. To me, the process is always much more interesting than the outcome.
"Avoiding the Surgeon's Knife" airs on "Nova" Tuesday at 7 p.m. on KVCR, 8 p.m. on KCET, 8:10 p.m. on KPBS and on Wednesday at 8 p.m. on KOCE.