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Dean Ornish, M.D

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Dean Ornish, M.D 10/25/19 The Transformative Power of Lifestyle Medicine Dean Ornish, M.D. Founder & President Preventive Medicine Research Institute Clinical Professor of Medicine University of California, San Francisco 1 2 1 10/25/19 Optimal Lifestyle Program Whole foods plant- based diet naturally low in fat & refined carbohydrates Stress management Moderate exercise Psychosocial support 3 4 2 10/25/19 Lifestyle Medicine= lifestyle as treatment to reverse disease as well as to prevent it. 5 Reversing Chronic Diseases Reversing even severe coronary heart disease Reversing early-stage prostate cancer Reversing type 2 diabetes Reversing hypertension Reversing autoimmune diseases Reversing hyperlipidemia Reversing obesity Reversing cellular aging (lengthening telomeres) Changing gene expression 6 3 10/25/19 Same diet and lifestyle program for all of these improvements. 7 New Unifying Theory The reason that these same lifestyle changes can reverse the progression of so many different chronic diseases is that they are different manifestations of the same underlying biological mechanisms. 8 4 10/25/19 Shared Underlying Mechanisms Chronic inflammation Chronic sympathetic nervous system stimulation Microbiome & TMAO Oxidative stress Apoptosis Angiogenesis Gene expression Telomeres Immune System 9 Each of these lifestyle interventions affects each of these biological mechanisms. 10 5 10/25/19 11 12 6 10/25/19 Awareness is the first step in healing. 13 14 7 10/25/19 What is the cause? 15 16 8 10/25/19 Your body often has a remarkable capacity to begin healing itself if you give it a chance to do so— and quickly. 17 “Impossible” 18 9 10/25/19 Can Lifestyle Changes Reverse Heart Disease? 19 Ornish D, Gotto AM, Miller RR, et al. Clinical Research. 1979;27:720A. 20 10 10/25/19 21 There was a 91% reduction in the frequency of angina in 24 days. --Ornish D, et al. JAMA.. 1983 Jan 7;249(1):54-9. 22 11 10/25/19 Lifestyle Heart Trial Men and women with moderate to severe coronary heart disease were randomly assigned to intensive lifestyle changes or to usual care Major endpoints = quantitative coronary arteriography, cardiac PET, and cardiac events Ornish D et al. Lancet. 1990; 336:129 & JAMA. 1998;280:2001. 23 Lifestyle Heart Trial % Diameter Stenosis: Quantitative Coronary Arteriography 52% 50% 48% 46% 44% 42% 40% 38% Control 36% Treatment Baseline (n.s.) 1 year (P<.02) 5 years (P<.001) Ornish D et al. Lancet. 1990; 336:129 & JAMA. 1998;280:2001. 24 12 10/25/19 Lifestyle Heart Trial None of the experimental group patients took lipid-lowering drugs; more than 50% of the control group patients began taking them during the study. Progression was significantly greater in control group patients not taking lipid- lowering drugs (40.7 to 59.7%) than those who were (45.7 to 51.7%). Ornish D et al. Lancet. 1990; 336:129 & JAMA. 1998;280:2001. 25 There was a 40% reduction in LDL-cholesterol in the first year without cholesterol- lowering drugs. --Ornish D et al. JAMA. 1998;280:2001. 26 13 10/25/19 There was a 400% improvement in coronary blood measured by cardiac PET scans after 5 years. --Gould KL, Ornish D, et al. JAMA. 1995;274:894-901. 27 28 14 10/25/19 99% of patients stopped or reversed their heart disease as measured by cardiac PET scans after 5 years. In contrast, 45% of controls got worse, 50% showed no change, and only 5% improved (p = 0.03). --Gould KL, Ornish D, et al. JAMA. 1995;274:894-901. 29 Adherence and Change in Coronary Atherosclerosis after Five Years 6% US 3% 1% 0% 0% -3% -6% -7% -9% Low (<56%) Intermediate (56–88%) High (>88%) Ornish D et al. JAMA. 1998;280:2001 30 15 10/25/19 Lifestyle Heart Trial There were 2.5 times as many cardiac events in the control group as in the lifestyle group after five years. 31 32 16 10/25/19 33 Can Lifestyle Changes Reverse Prostate Cancer? 34 17 10/25/19 Principal Investigators: Dean Ornish, M.D. Peter Carroll, M.D. William Fair, M.D. Chairman and Professor, Dept. of Urologic Surgery Clinical Professor of Chairman and Professor, Dept. Medicine, UCSF of Urology, UCSF Memorial Sloan-Kettering Cancer Center 35 Patient Selection Criteria 93 men with biopsy-proven prostate cancer, PSA 4–10, Gleason <7 All patients chose to do watchful waiting for reasons unrelated to this study Randomly assigned to intensive cardiac rehabilitation or usual care 36 18 10/25/19 Changes in PSA 6.80 6.74 6.55 6.36 6.30 6.23 6.05 5.98 P=0.002 5.80 Baseline 12 Months Control (n=41) Ex perim ental (n=43) Ornish D et al. Journal of Urology. 2005;174:1065 37 Degree of Lifestyle Change and Changes in PSA 7% 8% US 4% 2% 1% -1% -3% -6% -5% P=0.001 Low (<48%) Intermediate (48–88%) High (>88%) Ornish D et al. Journal of Urology. 2005;174:1065 38 19 10/25/19 Change in Prostate Tumor Growth (LNCaP) 0% -16% -9% -32% -48% -64% -70% -80% t=6.9, P=.000 %F BS Control Ex perim ental Ornish D et al. Journal of Urology. 2005;174:1065 39 Degree of Lifestyle Change and Inhibition of LNCaP Tumor Growth 0% -8% -20% -40% -39% -60% -72% -80% P=0.0001 Low (<48%) Intermediate (48–88%) High (>88%) Baseline-12m Change in LNCAP Cell Growth Ornish D et al. Journal of Urology. 2005;174:1065 40 20 10/25/19 Baseline 1 year later PSA—6.4 ng/ml PSA—4.5 ng/ml 41 None of the experimental group patients but six control group patients had conventional treatment during the first year. Ornish D et al. Journal of Urology. 2005;174:1065 42 21 10/25/19 A high-fat diet increases metastasis of prostate cancer whereas a low-fat plant-based diet inhibits it. M. Chen et al. Nat Genet. 2018 Jan 15, 2018. 43 In the Physicians Health Study, men who ate mostly a Western diet had a 250% higher risk of prostate cancer-related death—and a 67% increased risk of death from any cause. In contrast, men who ate mostly a whole foods plant-based diet had a 36% lower risk of death from all causes. Yang M. et al. Cancer Prevention Research, June 2015 DOI: 10.1158/1940-6207. 44 22 10/25/19 Can Lifestyle Changes Reverse Type 2 Diabetes? 45 Over half of Americans have diabetes or pre-diabetes: 12-14% have type 2 diabetes 40% have pre-diabetes source: JAMA. 2015 Sep 8;314(10):1021-9. 46 23 10/25/19 47 Lifestyle changes can be better than drugs at preventing diabetes 48 24 10/25/19 Cumulative Incidence of Diabetes Diabetes Prevention Program Research Group, N Engl J Med 2002;346:393-403 49 Epic Study In 23,000 people, exercising 3.5 hours a week, not smoking, eating a healthy diet, and keeping a healthy weight prevented 93% of diabetes, 81% of heart attacks, 50% of strokes and 36% of all cancers. EPIC study, Arch Intern Med. 2009;169(15):1355-1362. 50 25 10/25/19 Lifestyle changes can be better than drugs at treating diabetes 51 Tight Control of Diabetes with Drugs sts and offers uncertain benefits in return. Clinicians should prioritize supporting well Montori VM et al. Ann Intern Med. 2009;150:803-808. 52 26 10/25/19 A plant-based dietary intervention improves beta-cell function and insulin resistance in overweight results in a randomized, controlled trial after 16 weeks. Kahleova H, Tura A, Hill M, Holubkov R, Barnard ND. Nutrients, Feb 9, 2018 53 Complications of diabetes include heart disease, blindness, amputations, kidney damage, impotence American Diabetes Association 54 27 10/25/19 The complications of diabetes can be prevented when hemoglobin A1C is reduced below 7.0% with lifestyle. American Diabetes Association 55 In 786 men and women who went through our lifestyle program at 24 hospitals in Nebraska, West Virginia, & Pennsylvania, HgbA1c decreased from 7.4 to 6.6% after 12 weeks (p<0.005) and to 6.9% after 1 year (p<0.005). Silberman A et al, Am J Health Promot 2010;24[4]:260–266. 56 28 10/25/19 can lifestyle changes beneficially affect gene expression? 57 Gene expression in 501 genes was beneficially affected in only 3 months Ornish et al. Proc Nat Acad Sci USA 2008; 105: 8369. J. Craig Venter = Communicating Editor 58 29 10/25/19 RAS family oncogenes (RAN, RAB14, RAB8A) that promote prostate cancer and breast cancer were downregulated. Ornish et al. Proc Nat Acad Sci USA 2008; 105: 8369. J. Craig Venter = Communicating Editor 59 change in genes linked with breast cancer and prostate cancer (red = turned on green = turned off) Ornish et al. Proc Nat Acad Sci USA 2008; 105: 8369. J. Craig Venter = Communicating Editor 60 30 10/25/19 Our Genes are Not our Fate Genes can double the risk of heart disease, but a good lifestyle cuts it in half. Healthy lifestyles lower risk of heart disease regardless of genes. Khera AV, Fuster V, et al. N Engl J Med Nov 16, 2016 61 62 31 10/25/19 Control 8 weeks of Long-term group meditation meditation Downregulated Genes: Upregulated Genes: Dusek JA et al, PLoS One 2008;3(7): e2576. 63 Can Lifestyle Changes Reverse Cellular Aging? 64 32 10/25/19 Telomerase increased 30% in only 3 months Telomerase Activity (Ln) 2.4 P < 0.05 (two tailed) 2.3 2.2 2.1 2 1.9 1.8 1.7 1.6 1.5 Baseline 3 Months 1 SEM Ornish D et al.
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