Dean Ornish, M.D.: ‘We Have to Work at a Deeper Level’

At yesterday’s CEO Plenary, Dean Ornish, M.D., accepted the APA’s inaugural Viswanathan Family Lifestyle Medicine and Psychiatry Award—recognizing him for decades of pioneering, innovative work in preventive medicine. In an accompanying lecture he called “A Unified Theory of Lifestyle Medicine,” Ornish explained how lifestyle changes can prevent, treat, and even reverse all manner of disorders, mental just as much as physical. Here are five takeaways from his remarks, edited for length and clarity:

1. Everything is lifestyle: To me, lifestyle medicine is the most interesting trend in medicine today—which is using lifestyle changes not only to prevent disease but to treat and often reverse it. It’s gone from nothing to being one of the fastest-growing fields in medicine. In our program, it includes a whole foods, plant-based diet that’s low in fat and refined carbs; meditation and other yoga-based stress-management techniques; moderate exercise; and what we call “psychosocial support,” or support groups.

One of my favorite quotes is attributed to Einstein: “If you can’t explain it simply, you don’t understand it well enough.” So, to reduce it to its essence, it’s: Eat well, move more, stress less, and love more. That’s it.

After doing this for so many years, I think there’s a convergence of forces that finally make this the right idea at the right time. The limitations of drugs and surgery are becoming clear. The costs are unsustainable, and the power of intensive lifestyle changes are becoming increasingly well documented.

2. Reversing Alzheimer’s: The most recent study that we published last summer is “Can lifestyle changes slow, stop, or even reverse the progression of early-stage Alzheimer’s disease?” Since most of you are psychiatrists who deal with Alzheimer’s, you know how devastating this disease can be. My mom died of it. I have one of the only four [known risk] genes for it, and so I have a particular interest in this.

Now, we know that biological mechanisms are common to all these different conditions. That’s why what’s good for your heart is good for your brain. So, we did a randomized control trial: Can lifestyle changes change the course of Alzheimer’s disease using four standard measures of cognition and function that are used in FDA drug trials? And we found that 42% of the patients actually got better in just 20 weeks, and 71% either stopped or reversed the progression of their disease. In the usual peer control group, none of the patients got better. A third were unchanged, and two-thirds got worse, just during those 20 weeks.

As you know, it’s a progressive disease, and we found that there was statistically significant correlation between the degree of lifestyle change and the degree of change in all four measures of cognition and function.

3. A particular interest in depression: When you give people a sense of control, when they start to feel a sense of agency and efficacy in their lives, when you create a support group that is really not just helping people stay on their diet but really creating a safe place for people to let down their emotional defenses and talk openly and authentically about what's really going on in their lives—then their depression scores begin to lift.

I have a particular interest in depression, because I almost committed suicide when I was 19. I was able to take all the meaning out of life, and then later, I learned I could imbue my life with meaning by doing acts of service.

4. Joy of living vs. fear of dying: The real epidemic is not just heart disease or Alzheimer’s or diabetes. It’s loneliness and depression, with the breakdown of the social networks that used to give people that sense of love and connection with community. Fifty years ago, 60 years ago, when I was growing up, we had an extended family. We had a neighborhood where we knew our neighbors; we all grew up together. We had a church or synagogue, a mosque, a club. Today, many people don’t have any of those things.

Study after study shows that people who are lonely and depressed are three to 10 times more likely to get sick and die prematurely than those who have a sense of love and connection and community, in part because it affects our behavior. So, young people say, “I’ve got 20 friends in this pack of cigarettes, and they’re always there for me. Nobody else is.” Have you ever heard patients say things like that? Or food fills that void, or alcohol numbs our pain, or fentanyl numbs our pain, or working all the time distracts me from my pain, or video games numb our pain.

It’s not enough to give information. We have to work at a deeper level. If we can help people, for example, use meditation to quiet down their mind and body and experience more of an inner sense of peace and well-being, to have a sense of support groups and really recreate that sense of community, then they’re much more likely to choose lifestyle choices that are life-enhancing than ones that are self-destructive. I’ve just found that joy of living is much better motivating than fear of dying.

5. How physicians can avoid burnout: To which organ does your heart pump blood? The brain? Nope. The heart pumps blood to itself through the coronary arteries, so it can then pump blood to the rest of the body. Is that a selfish act? Well, not really, because if it doesn’t, we die. If we’re on an airplane, they say, “If the oxygen mask come down, put it on yourself first, and then on your kid.”

The most unselfish thing we can do is to take care of ourselves. It's like that quote from the Talmud: “If I am not for myself, who will be for me? And being for myself, what am I?” If you take care of yourself, so that you can then make a difference in the world and help others, then that’s the most unselfish thing you can do. Otherwise, we don’t become very good examples. ■