Ep 66: Dr. Dean Ornish - Lifestyle Changes and the Reversal of Alzheimer’s Symptoms (part 1)

Imagine being able to fight the effects of Alzheimer’s through changes to the way you live your daily life. Dr. Dean Ornish sits down with host Meryl Comer to discuss the findings of his study published in Alzheimer’s Research & Therapy. Lifestyle interventions like diet and exercise not only can reduce the risk of developing dementia, but this study also suggests actual reversal of Alzheimer’s symptoms without medication. Listen to Dr. Ornish’s approach that is adding to the treatment options and giving hope, as well as a roadmap, in the fight against cognitive decline.

Transcript

Dr. Dean Ornish (00:00):

Being able to tell many people that they can often stop the progression of disease, at least during these 20 weeks, and in many cases, over 40% of the patients showed improvement. That can give many people new hope and new choices. Not false hope, but real hope as opposed to false despair. <Laugh>, you know, if you tell everybody they're going to get worse, now we know that may not necessarily be the case.

Opening (00:21):

Welcome to BrainStorm by UsAgainstAlzheimer's, a patient-centered nonprofit organization. Your host, Meryl Comer, is a co-founder, 24 year caregiver and Emmy Award-winning journalist and the author of the New York Times bestseller, Slow Dancing With a Stranger.

Meryl Comer (00:39):

This is BrainStorm and I'm Meryl Comer. By 2030, just six years from now, there'll be over 78 million people living worldwide with dementia. Alzheimer's disease accounts for 50 to 60% of all dementias. So imagine being able to fight the effects of Alzheimer's, not with a pill, but by making changes to the way you live your daily life. That's what Dr. Dean Ornish, founder and president of the Preventative Medicine Research Institute set out to research and the results are now in. Welcome, Dr. Ornish. Thank you for joining us.

Dr. Dean Ornish (01:16):

Thank you, Meryl. It's great to be here.

Meryl Comer (01:18):

Dr. Ornish, your research and professional reputation for the last 40 years has been based on demonstrating the use of lifestyle changes to reverse severe coronary heart disease without drug or surgery. We all know the saying, what's good for the heart is good for the brain, but why take on Alzheimer's?

Dr. Dean Ornish (01:37):

Well, a lot of reasons. The first is that people tend to talk about Alzheimer's today, the way they talked about heart disease 45 years ago. When I started doing research there at that time it was thought that once you had heart disease, the best you could hope for was to slow down the rate at which you got worse. Much as how people view Alzheimer's today. We found then that if people made bigger changes in lifestyle and several at the same time, that the progression of heart disease could often be reversed instead of getting worse and worse over time, many people got better and better. And I think these findings then gave many people new hope and new choices at that time. The idea that heart disease could be reversed was considered a radical concept, but now it's become mainstream like so many things and it's not just heart disease.

Dr. Dean Ornish (02:14):

We found that type two diabetes, high blood pressure, high cholesterol, that many people when they're put on drugs to lower their blood sugar, their blood pressure, their blood cholesterol levels were told. When the patient says, doctor, how long do I have to take these? The doctor usually says, forever. I had a cartoon drawn many years ago of doctors busily mopping up the floor around a sink that's overflowing, but nobody's reaching over to turn off the faucet. It's like, how long do I have to mop up the floor? Like forever? Well, why don't we turn off the faucet? And the faucet are the underlying cause of so many of these chronic diseases are the lifestyle choices that we make each day.

Meryl Comer (02:44):

Dr. Ornish, what other links have you uncovered between certain chronic diseases and lifestyle choices?

Dr. Dean Ornish (02:51):

We found these same lifestyle changes in a randomized control trial with Peter Carroll, the chair of urology at University of California San Francisco, where I'm a clinical professor of medicine and Bill Fair when he was the chair of urology at Memorial Sloan Kettering Cancer Center. These same lifestyle changes could often slow stop and in some cases reverse the progression of men with early stage prostate cancer. We did a study with Craig Venter who was one of the first to decode the human genome, and we found that when you change your lifestyle in these ways, that it changes your gene expression. In fact, turning on the good genes to keep us healthy, turning off the ones that cause us to get sick. And we found that with Dr. Elizabeth Blackburn, who got the Nobel Prize for discovering telomeres, the ends of our chromosomes that regulate cellular aging. We showed for the first time that we could lengthen telomeres, which we published in the Lancet Oncology, affecting aging at a cellular level. So to me, Alzheimer's was the next logical progression of that.

Meryl Comer (03:38):

Was your interest in examining lifestyle choices related to preventing Alzheimer's disease, academic or personal?

Dr. Dean Ornish (03:46):

I had a personal interest in that 'cause my mom died of it. All of her siblings died of it. Her mother, my grandmother died of it. I have one of the a p OE four genes from it risk for it. It's devastating because I saw this in my mom and her siblings and certainly in all the patients that I've worked with now in the study in the last five and a half years is you tell people, I'm sorry, it can only get worse. Maybe we can slow it down a little bit. Get your affairs in order. There's not much we can do beyond that. And if there's anything you want to do, do it soon. 'cause You don't have that much time and you know when you lose your memory, you should lose everything. It's almost like the brain starts to shut down as an adaptive response to such devastating news and it just goes downward, spiral.

Dr. Dean Ornish (04:18):

And then of course your world starts to shrink. You don't want to go out. You often take your driver's license away so your world shrinks even more. It's harsher being able to tell many people that they can often stop the progression of disease, at least during these 20 weeks. And in many cases, over 40% of the patients showed improvement. That can give many people new hope and new choices. Not false hope, but real hope as opposed to false despair. <Laugh>, you know, if you tell everybody they're going to get worse. Now we know that may not necessarily be the case. We just published a few days ago, the first randomized trial showing that these same lifestyle changes showed overall improvement in cognition and function in the intervention group. Whereas they got worse in the control group. These improvements occurred in a dose response relationship. In other words, the more closely they followed this lifestyle program, the more they improved

Meryl Comer (05:03):

Dr. Ornish in your book, undo It, written with your wife Ann, you suggest the same lifestyle changes can benefit and often reverse the progression of most common and costly chronic diseases. What are the practical implications for individuals at risk of Alzheimer's disease and for healthcare providers?

Dr. Dean Ornish (05:23):

The answer is because they're not as different as we thought. They all share the same underlying biological mechanism. That's why what's good for your heart is good for your brain. Things like chronic inflammation, oxidative stress changes in the microbiome in telomeres and gene expression, angiogenesis, apoptosis over simulation of the sympathetic nervous system during times of chronic stress immune function. And each of these biological mechanisms in turn is directly influenced by what we eat, how we respond to stress, how much exercise we get, and how much love and social support we have. And so it radically simplifies. It's not, here's your heart disease diet and here's your Alzheimer's diet and here's your type two diabetes diet and here's your high blood pressure diet and here's your high cholesterol diet and here's your weight loss diet and here's your prostate cancer diet or breast cancer. It's the same for all of these because they all share these mechanisms which are very dynamic in both directions.

Dr. Dean Ornish (06:08):

You can get better quickly and you can get worse quickly depending on what you're doing, indirect proportion to the degree of change. So it was in that context, in that milieu, we decided that, let's find out what's true for Alzheimer's. In some respects, this was the hardest study we've ever done, and not the least of which is 'cause covid happened in the middle of it, but also it's the most meaningful because at least with these other conditions, there were other treatments that had significant benefit, but they spent billions of dollars on finding the right Alzheimer's drug. In the last 20 years, only two have been approved for many years. Amyloid was the known of Alzheimer's, that if you had amyloid, you had Alzheimer's, and if you didn't, you didn't. And that was the whole story. All the ones I just mentioned before that underlie all these other disease, chronic inflammation and so on, also affect Alzheimer's.

Dr. Dean Ornish (06:48):

And there was a dose response correlation between the degree of change in lifestyle and not only the degree of change in all four of the measures of cognitive function, the same ones that are used in FDA drug trials, but also in the degree of change in this biomarker in the a beta 42 40 ratio. In many respects, not every patient got better. We found that overall using one of the most important tests called the clinical global impression of change, 73% of the patients stopped or improved their function. Whereas in the control group, 68% of them got worse. Not every patient got better, but many of them did.

Meryl Comer (07:17):

Dr Ornish, $14 billion are spent annually on brain supplements, a barometer of how much Alzheimer's disease is feared. When you talk about your randomized control clinical trials, what does that mean and what were the outcomes?

Dr. Dean Ornish (07:33):

In any clinical trial, whether you're looking at a lifestyle intervention or a drug or a surgical operation or a device, you're always asking the same question, is this a real finding or is this due to chance? If there's less than a 5% likelihood that it's due to chance, then it's what's called statistically significant. Everyone's heard that term that means your P value. The probability is less than 0.05, means there's less than a 5% likelihood that these findings are due to chance. And that's what we found in three of the four measures of cognitive function. There was a statistically significant difference between the intervention group and the control group. And the fourth one, it was borderline to the 0.053 level. So these findings, I think, can really give many people new hope and new choices. And the reason why you do a randomized control group is that there are always factors that you may not know about that might affect the course of the disease. And so if you randomly assign people to a group that gets the intervention lifestyle in this case or the group that is just told, just do whatever you normally do. If there are other factors, then the idea is that they're going to be randomly distributed so that it's not going to affect one group more than the other. So if you do show differences that it's likely due to the intervention rather than due to random chance.

Meryl Comer (08:35):

Dr. Ornish, with all your experience, when a potential patient walks in to see you, can you tell whether they're really a good candidate for your intensive lifestyle interventions?

Dr. Dean Ornish (08:46):

We had very strict criteria for who we selected for the study. These were people who had either mild cognitive impairment or early dementia. Most of them had early dementia. They had a MOCA score of 18 or higher, and they also had Alzheimer's diagnosed using the usual criteria. It's interesting. Years ago we did a study to try to determine what are the best predictors of who's going to do well in making lifestyle changes, whether it's for heart disease or for anything. And we found that three questions were the most likely predictors. One is, do you think this intervention will help you? The second was, do you think you can do it? And the third was, have you ever made a commitment to do anything that you've been able to follow? And if people were able to say yes to those questions, chances are they would do it.

Dr. Dean Ornish (09:24):

Now, we've learned over the years that fear is not really a, a sustainable motivator for most people. And that's how most doctors, certainly how I used to try to scare people into changing, put that cigarette down, you're going to get lung cancer, put that cheeseburger down, you're going to get a heart attack. And I just found that fear is a great motivator for like a month or two and then it stops because fear is not sustainable because we all know we're going to die someday, right? Mortality rate's still a hundred percent. It's one per person. So we don't think about it most of the time 'cause it's too scary. Now, if you've had a heart attack or a diagnosis of Alzheimer's or something, you think about it a lot. But even then, only for a month or two, it's too hard to get through the day if you're thinking about it all the time.

Meryl Comer (09:58):

So if fear is not really a sustainable motivator, what is

Dr. Dean Ornish (10:03):

Joy and love and pleasure and feeling good? And because these biological mechanisms are so dynamic when you make big changes in lifestyle that a lot of things at the same time, it's often easier to make big changes and a lot of things at the same time than just to make small changes. Even though that goes against the conventional wisdom. You know, people think, well, I can't even get my patients to take their statins for their heart disease. You know, the studies show that only two thirds of people prescribe Lipitor and other statins are not taking them just a few months later. And that's just taking a pill once a day for most people, doesn't have many side effects and usually someone else is paying for it. And it's a proven value in helping to prevent heart disease. So why is that? Well, the answer is really simple.

Dr. Dean Ornish (10:38):

The statins, they don't make you feel better. It's like, take this pill today to prevent something really awful from happening years down the road, like a heart attack or stroke that you don't want to think about. So people stop thinking about it so they stop taking their medicine. But when you change your lifestyle, in the case of heart disease, most people feel so much better so quickly it reframes the reason for making these changes from fear of dying, which is not sustainable to joy of living, which is, so in the case of heart disease, many people have chest pain or angina. They can't do most things because they get chest pain. And usually within two or three weeks their pain goes away or is markedly less. And so they can do things they couldn't do before. They can make love with their spouse, they can play with their kids, they can go back to work, they can do all the things that make life worth doing. And they say things like, I like eating cheeseburgers, but not that much. I like being able to do all these other things even more. So what I gain is so much more than what I give up in ways that are really meaningful and happens very quickly. That's what really enables people to make it.

Meryl Comer (11:30):

Dr. Ornish, why is participation in a support group part of your prescribed lifestyle interventions? Is it because misery loves company?

Dr. Dean Ornish (11:38):

People tend to think that support groups are just to help in our program or to just to help people stay on the diet and exercise and meditation. But they're really a, a powerful intervention in their own right. Study after study have shown that people who feel lonely and depressed and isolated, which I think is the real pandemic in our culture with the breakdown of the social networks that used to give people a sense of connection and community, that people who feel that way lonely and isolated, 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. People say, well, we've got the internet, we can stay connected that way. But one of the studies that Ann and I, my wife and I talk about in the Undo It book is that the more time you spend on Facebook, the more depressed you are.

Dr. Dean Ornish (12:14):

And why is that? Because it's not an authentic intimacy when you grow up in an extended family or a neighborhood where you get to know each other and people watch you grow up. They don't just know your good stuff. They know where you messed up, you know when you got depressed or you got busted or whatever. You broke that window and you know that they know and they know that you know, that they know and they're still there for you. And there's just something really powerful about, I see you like James Cameron talked about in Avatar, which is really a, an old African proverb. I see all of you, not just your Facebook profile. Whereas on Facebook, that's why all you see it looks like everybody has this perfect life, but you, you know, and that just makes people more depressed. So our support groups are really designed around creating a safe place where people can talk openly and authentically about what's really going on in their lives, which is especially important for Alzheimer's patients who tend to withdraw and are very isolated and their spouses don't really want to talk about it. Sometimes it's a secret. Putting people in a safe environment where they can talk about what's really going on in their lives for both the partners as well as the patients, is really an important part of the intervention without fear of being judged or criticized or given glib advice on how to make things better.

Meryl Comer (13:15):

Our guest has been Dr. Dean Ornish, known as the Father of Lifestyle Medicine. In part two of our conversation, we discussed the need for early diagnosis and the response to the CNN documentary with Dr. Sanjay Gupta, who has the disease in his family.

Dr. Dean Ornish (13:32):

Part of what I've learned is that even more than being healthy, people want to feel free and in control. And as soon as I tell somebody, you know, eat this and do this and don't do that, and don't smoke and don't eat cheeseburger, they immediately want to do the opposite. It goes back to the first dietary intervention when God said, don't eat the apple. And that didn't go so well and that was God talking. And apples are good for you. So I've just learned that you know even more than him being healthy, people want to feel free and in control.

Meryl Comer (13:53):

That's it for this edition. I'm Meryl Comer. Thank you for brainstorming with us. When brainstorm, we interview top experts in dementia research and brain health, but we know you are the experts on the Alzheimer's journey, which is why we invite your participation in our a-list. By joining and taking periodic surveys, you're helping inform healthcare providers, policy makers, and other leaders in the field about your experience and what matters most to you. It only takes a few minutes of your time. Join the A-list and see how it feels to be heard.

Closing (14:32):

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