Reverse heart disease naturally

Living proof that positive lifestyle changes can be strong medicine

It's a handsome group, the 30 men and women gathering in a meeting room on the San Francisco waterfront this Tuesday evening. Most look fit and slender, and they chatter exuberantly as they come in from a brisk walk in the sunset shadow of the Golden Gate Bridge.

Heart disease is the last thing you'd think of if you met these people anywhere else, but they're here as participants in Dr. Dean Ornish's famous heart-disease-reversal program. Bob Finnell, 53, with flashing dark eyes and erect posture, cuts a trim figure in his white running suit. "You should have seen me before I lost the 40 pounds," he laughs. He credits his weight loss to the program's vegetarian diet, and his officer's bearing to the yoga he's learned here. More important, blockages in six of his eight blocked heart arteries have diminished since he began the regimen.

At 75, Werner Hebenstreit is the oldest, but he neither looks nor moves his age--he's the group's fastest walker. Four years ago, Werner's angina slowed him down so much that he couldn't make it across a city street before the light flashed to "Don't Walk." Now he and his wife Eva enjoy six-hour mountain hikes. Blood flow to his heart has increased by more than 36 percent. "Sometimes I don't believe it myself!" As the evening goes on, there will be more testimonials like these. This diverse assortment of heart patients--businessmen, a minister, an engineer and a contractor--didn't improve their health through cholesterol-lowering medication or bypass surgery.

Instead, they (and often, their spouses) undertook a completely new way of life, including moderate exercise, a very-low-fat vegetarian diet, yoga, and other stress-reduction practices, along with biweekly group therapy.

Their new lifestyle was prescribed by Dean Ornish, M.D., an assistant clinical professor of medicine at the University of California, San Francisco, and at Pacific Presbyterian Medical Center. Dr. Ornish's new ground-breaking research and second book, Dr. Dean Ornish's Program for Reversing Heart Disease (Random House, 1990), will be published in late June.

With these patients as evidence, Dr. Ornish's research suggests that diet and behavior changes can significantly reverse coronary blockages in just one year. His work is helping to change the way we think about heart disease. Just a few years ago, many authorities doubted whether blockages could be systematically reversed at all. But more recently, studies have shown that atherosclerosis (blocked arteries leading to the heart) can be diminished using medication.

"Dr. Ornish's work is very significant because he has achieved with diet and relaxation the same kinds of results other researchers have achieved with powerful cholesterol-lowering drugs," says Prevention advisor William Castelli, M.D., medical director of the Framingham Heart Study. "But the measures he uses are nontoxic, and you can do them forever."

The catch: Reversing heart disease requires major lifestyle changes, not the least of which involves dropping total fat intake to a meager 10 percent of calories. That's why some physicians wonder about the practicality of the plan. "For those who do it, it works," comments Claude Lenfant, M.D., director of the National Heart, Lung and Blood Institute. "But there is a question about whether the public will accept this kind of regimen; I understand it's pretty tough."

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Yet the participants we met insisted that adapting the new health habits wasn't so tough. What's more, they told Prevention, they felt and looked so much better so quickly that the sacrifices were worth it. Bob Finnell jokes to a visitor, "As time has gone on, some of the visitors to our program look like the heart patients, and we look like potential astronauts."

It's true.

To understand the Ornish program, you have to understand a little bit about Dean Ornish himself. He's young, but at 36, he's already had nearly two decades of experience with the lifestyle he recommends. In college, he was a stressed-out pre-med student, so nervous that he found himself afraid of failing a crucial organic-chemistry class. He realized that he needed to change his life dramatically. So he took up yoga, meditation and a vegetarian diet. "I had a lot more energy, I could think better, I felt better." He went on to graduate as class valedictorian.

In medical school at Baylor College of Medicine, in Houston, he became interested in whether the same lifestyle could benefit people with heart disease. Different studies had indicated that, for example, stress raises cholesterol; that meditation lowers blood pressure (at least temporarily); that high-strung, hard-driving behavior might harm the heart, and that vegetarian diets are associated with low risk of heart disease. But no one had put all the lifestyle factors together into one program.

So he did it. First as a medical student, and then during a residency at the Harvard-affiliated Massachusetts General Hospital. There he conducted small studies that suggested heart patients felt better and had improved heart function and blood flow when they kept to a vegetarian diet, did moderate exercise and practiced yoga, meditation and other stress-reduction techniques. He based his first book, Stress, Diet, and Your Heart (New American Library/Signet Books, 1983), on this research.

About five years ago, Dr. Ornish began recruiting people for a larger study that would use the newest technology to show the precise effects of the regimen on the heart. He located people with high degrees of atherosclerosis who had either refused or who for medical reasons could not undergo coronary bypass to open their blockages. Many had survived one or more heart attacks.

The patients--43 men and 5 women--were divided into two groups. The "treatment" group was instructed to go on a strict vegetarian diet deriving fewer than 10 percent of calories from fat. They were to stop smoking, do an hour of yoga and meditation daily and exercise moderately (which usually meant walking) for at least one hour, three days a week, or 30 minutes every day. The members of the treatment group also made a commitment to attend an introductory week-long retreat and to meet twice a week, for four hours of group activities. During these meetings, they'd walk, participate in stress-management workshops, eat dinner and engage in group therapy sessions led by Dr. Ornish. The program provided unlimited lunches and dinners to take home.

Meanwhile, the control group was advised to follow the standard AHA lifestyle prescription for heart health. That is, reduce their fat intake to under 30 percent of calories, stop smoking and exercise moderately. None of the patients in the treatment group used cholesterol-lowering drugs, although some people in the control group did.

The patients in both groups were queried regarding their diet, exercise and stress-management practices at six-month intervals. (Few people in either group smoked.) Their progress was assessed annually, using quantitative angiography (an x-ray movie of the heart's arteries), and ultrasophisticated PET (positron emission tomography) scanning, which accurately shows blood flow through the heart.

As of November 1989, all the participants had completed one year of the program (and some had followed it for as long as four years). The one-year results, which Dr. Ornish announced at the American Heart Association meeting in New Orleans last fall, made banner headlines nationwide. There was usable data on 41 of the 48 patients (22 in the treatment group and 19 in the control group).

In the treatment group, 82 percent had some reversal of coronary blockages. One got significantly worse "and he didn't follow the program very well," says Dr. Ornish. Three stayed about the same.

The blockage reductions--on the order of 5 percent--were small but significant, Dr. Ornish explains, because even small changes in blockages can have an enormous effect on the amount of blood the heart receives. (A 5 percent regression can mean a 100 percent improvement in blood flow--and, in some cases, even more.) "As a result, people began to feel better very quickly," says Dr. Ornish.

In the control group, however, the results were much less dramatic. While those who adhered to the AHA program fared better than those who didn't, they did not experience the striking reversals seen in the treatment group. At best, the men's disease appeared to progress at a slower rate.

In men, at least, these results suggest that to reverse heart disease you may have to go beyond the AHA recommendations, says Dr. Ornish. (For some reason, all the women--even those in the control group--showed some reversal in heart disease. But Dr. Ornish cautions that it's too early to draw conclusions since only five women participated in the study.)

Another interesting result: The more severe the disease, the more dramatic the improvement on Dr. Ornish's program. The patient with the worst heart disease, Bob Finnell, enjoyed the most clearing of his arteries. He was also among the most compliant.

And the better that people followed the program, the more reversal they had, Dr. Ornish notes.

All this should come as good news to people with atherosclerosis. "It's a program that worked for almost everyone in our study who followed it," says Dr. Ornish. "Apparently, it's never too late to begin making lifestyle changes. And the more lifestyle changes you make, the more improvement you're likely to show."

But how do you motivate people to change completely what they eat, how they spend their leisure, even how they think? They may be Californians, but most of the Ornish patients and their spouses (who were encouraged to participate) cheerfully admit that stuff like yoga and meditation wasn't on their agendas. "I never thought I'd be doing this," says Joe Cecena, 61, a retired government executive who'd suffered two heart attacks. "I thought yoga was strictly for females. I thought it was their exercise, it wasn't for me. Running or waterskiing or something like that was for me. Now, I don't feel right if I don't do my yoga and meditation every day."

What happened to change their minds?

Dr. Ornish believes that there's a psychological component to heart disease. He's observed that heart patients often feel isolated and inadequate--"a sense of not having enough or being enough." In some people, these feelings of inadequacy lead to hostility, he says. He points out that the latest research on type-A behavior suggests that hostility may be the most poisonous trait for the heart.

That's why group therapy, in which the members talk about their frustrations and learn to listen and open up to others, is central to the program. "One of the real values of the group is you can show parts of yourself that you think are going to cause you to be rejected, and you find you're accepted," says Dr. Ornish. "Then real intimacy can happen. And where there's intimacy there's healing, because you relieve some of the chronic stress and isolation that comes from having to hide who you really are."

Werner Hebenstreit says that opening up to the group changed his personality and his marriage, and helped him deal with anger and stress.

Werner's first heart attack came at 65, and his second six years later. Yet both his diet and his exercise were exemplary: He was a vegetarian and an active outdoorsman leading Sierra Club expeditions. But his life had always been stressful. "I always felt I had to earn a lot of money.

"I was a typical type-A personality: ambitious, time-conscious, very serious, easily on the defensive. I had a short fuse, as they say.

"I was always a loner," he adds. "If I did join groups, I had to run them. In the Sierra Club, I always had to be the leader. People did things the way I wanted or there was trouble."

He was able to stay active after his first heart attack, but the second, at 71, left him feeling like an invalid. Even though he could still work, "I did everything in slow motion. I took 14 tablets of all different colors every day, with all the blasted side effects. I was mad at the world, and mad at myself, too."

Communications with his wife broke down. "I was short-tempered when I came home. I didn't want to be bothered with her questions. 'Don't ask me!' I'd yell at her."

When Dr. Ornish telephoned to invite him to apply for the program, Eva answered the phone--but Werner refused to take the call. "I said, 'Dammit, tell him I don't want to talk to doctors! I've had enough of doctors!'" But he finally agreed to meet Dr. Ornish, and in short order volunteered for the program.

"It was the first positive thing that came along," Eva recalls. "This was the glimmer of hope that you grab for."

How soon did he start to feel better? "Perhaps it's wishful thinking, but I felt different after the week-long retreat," Werner says. "My cholesterol even went down a little in that time." His angina soon vanished. He didn't need his rainbow of pills, either, "except for a baby aspirin every other day." After one year, blood flow to his heart improved by 20 percent. His cholesterol dropped from a preprogram high of 305 to its current 135. "Incredible? Yes, most doctors don't even believe me, but it's documented," he says. Today, he has no physical restrictions at all--and he and his wife spent their last vacation hiking in the Grand Teton mountains.

The vegetarian diet wasn't much different from what he ate before (he had to cut out cheese and fish). But what was really new for Werner was a better way of relating to people and dealing with frustrations, taught by psychologists. "I learned to loosen up and talk about my feelings, which wasn't easy for me. I learned not to take offense easily." After four years of meeting twice a week, he says, "The group is my extended family."

He also developed a trick for coping with frustrations; he'd write down every negative thought on a pad that he carried with him. "On good days there would be 23 entries. "

Identifying the negative thoughts helped him learn to dismiss them. "Now, when I'm frustrated, I start to laugh. I was a typical type-A when I came to the program. Now I'm a C-minus type. I'm a lot more easygoing."

Best of all is the improvement in his marriage. "Now we're partners," he says. Eva smiles at him. "I confirm," she says.

What's nearly as striking as the fitness of the participants is their grace as they go about their 70-minute yoga routine, including the 12 postures of the sun salutation. While visitors totter, the group members move smoothly, unswayed even by the tenuous angle position: hands and toes on the floor, buttocks aloft.

It's rare to find a cardiac rehabilitation program that teaches yoga. Yet, interestingly, Dr. Ornish's data shows that the amount of time spent doing yoga was correlated with reductions in coronary blockages just as changes in diet or exercise.

The slow stretching and breathing techniques relax muscles, says Dr. Ornish, and promote feelings of peace. Yoga taught in his program ranges from simple stretches, deep three-part breathing and progressive muscle relaxation, to more esoteric practices like alternate nostril breathing and chanting. Chanting produces a calming effect, just as singing does, Dr. Ornish says. "We show people how to adapt these practices to fit their own cultural and belief systems," he adds.

Yoga is Bob Finnell's favorite part of the program. A couple of times a week he takes an outside yoga class. That means he often does 90 minutes of yoga a day.

If today Bob is a "yogaholic," it has a lot to do with the fact that up until four years ago he was a workaholic. As the president of a $30-million-a-year nonprofit organization, he worked 12-hour days, ate two dinners a night if he was attending two evening functions, arrived at the last minute for airplanes, collected speeding tickets, lost his temper and never, ever walked the 20 minutes it would take to get from his apartment to his office on foot. "I didn't even realize I was sedentary."

At 48, while hiking in Yosemite National Park, he collapsed--then stood up and walked three miles back to the car. A few weeks later, in a doctor's office, he discovered that he'd had a heart attack. Two of the three major arteries to his heart were completely blocked, and one was three-quarters blocked. His condition was very serious. "Three of four cardiologists looked at my heart and said, 'You need an immediate bypass or you'll be dead in six months,"' says Bob Finnell.

But when he was told he had a 1 in 20 chance of not surviving the operation, Bob refused. Then he was recruited for the Ornish program. "That was over four years ago," he recalls proudly.

When he began the program, he focused mainly on the diet, doing only the minimum walking and half-hour of yoga stretches.

"I was scared of exercise," he says. "At first, I couldn't touch my toes. I couldn't do any of the inverted yoga positions, like a shoulder stand or a headstand." After six months, he began taking other yoga classes. And he noticed good things happening. For one thing, waking up felt different. "You have to understand, when I used to wake up in the morning, it was like opening an old creaky barn door. I would unhinge my elbows and knees, take a hot shower to loosen up, and in the old days, drink coffee to get going.

"But after I started doing more yoga, I started waking up refreshed, like I'd been up for three hours. My joints weren't creaky and my head was clear."

His posture had been poor. "I was hunched over a desk, a typewriter, a computer for 20 years, and I had these muscles in the front that were shortened, and in my back that were lengthened. Over time, yoga stretched my muscles."

Most important, says Bob, "It gave me confidence in my body. It gave me a sense of control and a tool to do something about it."

While Bob still has serious heart disease and cannot return to fulltime work, he's very active. In addition to yoga, he walks for an hour (about four miles) a day, five days a week. Last February, he flew to Africa for a two-month visit. The plaque buildup in six of his eight blocked arteries has diminished, significantly improving blood flow to his heart (see Bob Finnell's PET scans, page 61). "That's irrefutable. You can see the pictures. It also confirms the way I feel," he says.

There are other markers of progress, too. "My weight was in the 180s. Now it's in the 140s. My cholesterol is in the 110s and the 120s, down from 235 at the time of my heart attack. There's no question in my mind that if I'd only done the other parts of the program, I wouldn't be feeling as well as I do. Yoga made the difference for me."

Meditation may help reduce stress. But its benefits go deeper. "At the end of a meditation, you are feeling more peaceful, stronger and happier," says Dr. Ornish.

Joe Cecena wasn't sure he'd be able to do it, but now relies on the feeling of peace that meditation gives him to get through the stresses of his life.

If anyone needed stress relief, it was Joe. His first heart attack hit in 1983, when he was 54. "I was working for the State of California, in the unemployment office, with 13 people under me. It was stress, stress, stress.

"Then my father-in-law passed away, and I had to take care of his financial affairs. Soon after that, my own father had a stroke. Finally, my daughter, who had a drug problem, took off and left us with two grandchildren to raise." Nonetheless, after a month of recovery, he returned to work. "The whole ball of wax started again. I did go on the American Heart Association diet, skinning chicken, eating fish. I lost some weight--not as much as I wanted--and I gained it back." He carried more than 230 pounds on his 5'11" frame.

In 1985, Joe was stricken with another heart attack, then a third a few days later, in the hospital. "They told me that the blocked arteries were behind my heart and I couldn't have a bypass because I'd only have a 50-50 chance of surviving the operation. I couldn't walk anywhere without pain."

His wife, Anita, remembers this as a terrifying time. "After they told us Joe couldn't have a bypass, I used to look at him when he was asleep, you know, to see if he was still breathing . . . if he was still alive."

Then, two years ago, Joe was offered a place in the Ornish program. Today he is so enthusiastic about it that he apologizes for sounding like a preacher, but it's understandable. "I lost 54 pounds in the first six months of the program. My cholesterol started at 244; now it's down to 172. Last year I found out my blockages are clearing out.

"Now, I'm very active," adds Joe. I walk four miles every morning. Oh, and I just finished painting the house, inside and out."

Visualization (a form of meditation), he says, has helped him enormously. The program's visualization and yoga instructor, Mary Dale Scheller, M.S.W., worked with him to find a focus (an image to concentrate on while visualizing), a focus that Joe personally found calming and uplifting. For him, the image that worked had to do with experiencing himself enjoying his favorite recreation: snorkeling.

"I handle stress beautifully now with meditation and visualization. When I get pressure from the grandchildren--this one wants to use the telephone, the other wants to go somewhere, and I have my own things to do--I go into another room, sit on the floor in the cross-legged position, dose my eyes and meditate on the motion of waves. I visualize myself underwater in Cancun, snorkeling, or looking at a lake or the ocean. When I get up I feel like a new man.

For his wife, Anita, the relief is immeasurable. "Now I have a lot of peace of mind because I know Joe can be healthy."

"The first week I couldn't stand the food, and I lost about a pound a day," recalls Jim Keith, 60, a carpenter and kitchen remodeler, who ultimately lost 50 pounds on the program. "Then my taste buds started to change. I came to kind of enjoy it."

"If I could change my life, anyone could: I was a real meat-and-potatoes man," says Dwayne Butler, 54. He lost 80 pounds after a year on the program.

The list of prohibited foods on the Ornish regimen may appear daunting to some. Although calorie intake is unlimited, the food selection isn't. No more meat or fish. No nuts. No chocolate. No coffee. (See Dr. Ornish's Intensive Healing Diet, page 67.)

But Eva and Werner Hebenstreit took it upon themselves to demonstrate to Prevention that a meal prepared in accordance with the stringent guidelines can be delicious, satisfying--even exciting. In the middle of a vigorous day showing a visitor around San Francisco (during which they proved their reputation as rapid and tireless walkers), the Hebenstreits served a memorable lunch. There was a brown-rice-and-pea salad--the rice had been cooked in vegetable broth and seasoned with vinegar, mustard and dill pickles. A scarlet cole slaw, made from red cabbage, with a tasty base of nonfat yogurt, mustard, wine vinegar and oregano. A basket of San Francisco's famous Tassajara bread and dark German bread, both store-bought.

Then there were the two highlights of the meal. First, the "potato spears": thick wedges of potato, baked at 450 degrees for about 20 minutes, until they've puffed up golden, dipped in salsa. And finally, the "banana ice," a dessert Eva whips up on the spot. She whirls a couple of cut-up, frozen bananas in the food processor with a dollop of yogurt, a splash of apple juice and some nonsugared berry jam. The results are as creamy-sweet as any premium ice cream. "Have more!" Eva urges. Why not? After all, it contains virtually no fat. "We eat well," Eva says. "We don't feel deprived at all," Werner chimes in. "As you can see, we can eat ourselves silly."

It's true, adds Eva, vegetarian cooking is more time-consuming. "You have to wash and cut vegetables. But we cook for a few days ahead, and you can find shortcuts," says Eva. "Besides, look at all the time we save not going to doctors' offices."

Dr. Ornish refuses to say that any one aspect of the program is more effective than any other. "I believe that the lifestyle changes, like meditation and yoga, are as important as the dietary ones." One of the key lessons of his experiment, he says, is that habits can change quickly and completely. "In some ways it's easier to make big changes than little ones. That's because if you make comprehensive changes, you begin to feel so much better so soon. We don't tell people, 'Do this because you'll live longer.' We say, 'Do this because you'll live better, you'll enjoy life more.'

"If a person is unwilling to give up their steak and cheeseburgers, then I'll prescribe the cholesterol-lowering drugs," adds Dr. Ornish. But there are problems with these drugs, he notes. First the expense--as much as $2,000 a year. Second, there's a risk of side effects, which can range from cataracts to liver damage. Surgical options, such as heart bypass or angioplasty, may be the best choice for some people but are becoming more controversial. Evidence shows that arteries often reclog within months of the procedures.

"The point to me is that it's much safer and more rational to reestablish heart health through lifestyle changes if possible," he says. "Yet doctors always tell me, 'Your program is so radical!' Isn't it ironic that it's considered radical to exercise, relax and eat a heart-healthy diet and conservative to take potent drugs?

"Cardiovascular disease kills more people than any other disease in America, more than all other diseases combined. Yet, I'm convinced it can be prevented, and often it can be reversed. For people who already have heart disease, if they're willing to make these changes, they might never need a bypass, drugs or angioplasty."

There's one more surprise in store for a visitor to the Ornish program. It's that many of the spouses stick to the regimen almost as religiously as the participants. They leave their jobs early on Tuesdays and Thursdays to be on the San Francisco waterfront at 5 p.m. sharp. They've said farewell to cappuccino, and learned to love caffeine-free teas and grain beverages. They walk daily, they sit in meditation, stretch with yoga. Why?

"I feel healthy doing this," says Phyllis Cardozo, sitting on an exercise mat beside her husband, John, a heart patient. "I was never very athletic, but it feels good to take a walk after work. I love the yoga; my mom is all bent over, and I see the need to do it. Best of all, the group therapy has allowed us to go deeper into our feelings, and it's improved our relationship.

"I don't do this program just for John," she laughs. "I'm much too selfish. I do it for myself." '

PHOTO (COLOR): A man exercising

PHOTO (COLOR): Reaching the top: Werner Hebenstreit, angina eased, now takes six-hour hikes.

PHOTO (COLOR): Flat out relaxed: Yoga sessions with Dr. Ornish, front center, destress body and mind.

PHOTO (COLOR): Shopping for heart health: Bob Finnell, center, gets some pointer from his nutritionist, right. walks precede biweekly get-togethers.

PHOTO (COLOR): Bob Finnell's mending heart: After just one year on the Ornish program, Bob's heart is getting significantly more blood, as shown by the dramatic increase in yellow and red areas on the second PET Scan.

CARTOON: 'Honey, don't start another mile.'


By Cathy Perlmutter

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