Ep 67: Dr. Dean Ornish – Lifestyle Changes and the Reversal of Alzheimer’s Symptoms (part 2)

Lifestyle interventions like diet and exercise can reduce the risk of developing dementia. A recent study by Dr. Dean Ornish, Founder and President of The Preventative Medicine Research Institute, suggests actual reversal of Alzheimer’s symptoms without medication. In part 2, host Meryl Comer and Dr. Ornish further discuss the findings of his study published in Alzheimer’s Research & Therapy. Listen as they talk about the success of his nine-week Medicare-covered program for heart disease, which could be adapted for Alzheimer's patients. You won’t want to miss this episode that gives hope for those with cognitive decline. 

Transcript

Dr. Dean Ornish (00:01):

The whole language of behavioral change has this moralistic quality. You know, once you call foods good or bad, it's a very small step to saying, I'm a bad person 'cause I eat bad food. You know, I cheated on my diet. All these words are very judgmental and shaming and ultimately counterproductive. And 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, eat this and do this and don't do that and don't smoke and don't eat cheeseburgers, 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.

Introduction (00:32):

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 (00:48):

This is Brainstorm. And I'm Meryl Comer. Our guest is Dr. Dean Ornish, founder and president of the Preventative Medicine Research Institute, who refocused his research deploying many of the same lifestyle strategies used for heart disease to see if similar success might be possible for early Alzheimer's patients. He described the study and the need for early diagnosis.

Dr. Dean Ornish (01:15):

It's important to give people a sense of real hope. Unlike leading into your brain or swelling of your brain, the only side effects of lifestyle changes are good ones. You know, your heart disease gets better, your diabetes, your prostate cancer, your cholesterol, your blood sugar, et cetera, your weight. So Sanjay Gupta filmed our very first cohort five and a half years ago and Chichi Erba was one of the patients in that. And then it came back five years later, filmed her again. And that was a huge risk for us 'cause we had no idea if this was going to work or not, but I figured if it did work, that would be really important. And if it didn't, that would be important for people to know too. So either way I thought it would be worth doing. But it was great because when he filmed her again, she's been following it almost a hundred percent for the last five years.

Dr. Dean Ornish (01:53):

So it shows people that she can do it. And she's a Sicilian Italian love breaded, veal cutlets and really unhealthy foods. And it's like, if she can do it, maybe I can do it. And her husband did it right along with her and he is like 90 something and still doing well. And he said she's doing better today than she was when she started. Five years later. Our study was only 20 weeks long. We'll be publishing the 40 week findings later this year, but after five years it's only one person. But to show that one person for five years can follow it, really big change in her lifestyle and continues to actually feel anything be better five years later, I think is also very inspiring to people. And when Sanjay saw her after five years, she goes, Chiche, you look better than you did five years ago. She said, well, you know, I feel better and I'm thinking more clearly than I did five years ago. And he said to what do you attribute that he, she said, well, this lifestyle program,

Meryl Comer (02:36):

Dr. Ornish, unfortunately there are not enough neurologists and your prescribed lifestyle changes for heart have been shown to modulate a number of independent risk factors from Alzheimer's, from high blood pressure to diabetes. So why not recruit cardiologists to diagnose?

Dr. Dean Ornish (02:55):

Well, I think it's a great idea. It's not the diet, it's the diet is one of four components. It's a whole foods plant-based diet, very low in fat and sugar and refined carbs. That's essentially a vegan diet. Fruits, vegetables, whole grains, legumes, soy products as close as possible to how they come in nature. Some supplements, moderate exercise an hour three times a week or half an hour a day. Both aerobic and some strength training. Usually just walking meditation. Another yoga based stress management techniques and support groups who are spending more time with your friends and family and loved ones undo it. Book begins with one of my favorite quotes attributed to Albert Einstein. If you can't explain it simply, you don't understand it well enough. So to reduce it to its essence to eat well, move more, stress less and love more. That's really the intervention.

Dr. Dean Ornish (03:35):

Now you indicated that like about half of dementia is Alzheimer's, but most of it is vascular dementia. And you know what's good for your heart is good for your brain in part because atherosclerosis is a diffuse process. It doesn't just occur in your heart. I mean it's one of the reasons why men who have erectile dysfunction are getting less blood flow to their sexual organs is one of the barometers. It's one of the first markers that they may have blockages in the arteries of their heart or their brain because it's a diffuse process. And so I think cardiologists, internists, primary care doctors in general are a good place to begin because if anything vascular dementia responds even better and more quickly than Alzheimer's. Not a randomized trial we've done, but anecdotally we've seen this. And if you know you're starting to forget stuff or you're older, you have a family member who does get 'em a copy of the Undo It book, go to our website@ornish.com or just say, I'm going to do these things on my own.

Dr. Dean Ornish (04:21):

You know, because they don't cost anything really. This is essentially a third world diet. Whether or not your doctor recommends this. If these are things that you're concerned about, you're starting to forget things like where did I put my keys and where does my wallet and you know, that kind of stuff. Begin making these changes. First of all, if you can often improve cognition and function in people who have diagnosed early Alzheimer's, my guess is it probably works even better to help prevent it. And there are a lot of new tests coming out where using ai, artificial intelligence, sometimes 10 years before someone becomes clinically apparent, they may have early Alzheimer's disease. But a lot of people say, why would I want to know if I'm likely to get something that's so terrible that I can't do anything about? But clearly if we can show improvement in people who already have early disease, these lifestyle changes probably work even better to help prevent it.

Dr. Dean Ornish (05:02):

You know, I'm on the nutrition working group at the American College of Cardiology. We published a paper a few years ago that the average doctor, internist or family doctor gets four hours of nutrition training a year in medical school a year. And the average cardiology fellow in four years of fellowship gets none. So we're trained to use drugs in surgery, we're reimbursed to use drugs in surgery and that's why we use drugs in surgery. You know, the only tool you have is a hammer. You see everything as a nail. As Abraham Maslow once said, and that's why I spent so many years to work with CMS to get Medicare to cover our program for people with heart disease. 'cause I knew that if you change reimbursement then it's available to people who otherwise wouldn't have it. And if you change reimbursement, you change medical practice and even medical education. And I'm hoping that Medicare ultimately will reimburse the same program for people who have early Alzheimer's disease because it's exactly the same program that they're already reimbursing. All they have to do is broaden the inclusion criteria.

Meryl Comer (05:50):

Describe how the current Medicare sponsored heart program works.

Dr. Dean Ornish (05:54):

Our program is nine weeks long that Medicare is paying for and Aetna and Blue Shield and some others. People come twice a week, four hours at a time for nine weeks. Each four hour session they get an hour of exercise, an hour of meditation, an hour of a support group, and an hour of a lecture. The support group isn't just helping people stay on the diet. We create a safe place where people really connect deeply. So when they finish their nine weeks, 93% of the people complete all 72 hours, which is unheard of, especially when you talk about like statins where only two thirds of people are not taking 'em after just three months. But also 85% of the people are still meeting virtually on their own because they form such tight bonds with each other, which you can do just as well through Zoom. Can

Meryl Comer (06:31):

You address the issue of equity and social determinants of health that may limit access to the kinds of healthy plant-based diets that you prescribe?

Dr. Dean Ornish (06:42):

Yeah, I mean their zip code is one of the most potent determinants of your health. And ironically, this is a third world diet. I consulted years ago with some of the major food companies to try to get them to make healthier versions of their foods. Consulted with McDonald's to get them to cook their french fries and granola oil instead of beef tallow and reduce the amount of sodium. They didn't tell anybody about it 'cause they were afraid that people wouldn't think they'd tasted a good, but it tasted just as good. Even incremental change on that scale is worth doing. And the reason I designed this study in such a way where it doesn't cost anything to do this, costs less to eat fruits and vegetables. You can go to co-op and you know, get rice and beans and vegetables. You know, it's less expensive than meat.

Dr. Dean Ornish (07:16):

Unfortunately a lot of people live in food deserts where there are no co-ops, there are no grocery stores really, there are only fast food restaurants and liquor stores. And that's why it's so great now that we can work with people in their homes that Medicare is covering this. I didn't want this just to be concierge medicine. If you've got Medicare and heart disease, chances are you're eligible for our program, which we can do in your home. We actually send you the first two weeks of meals for free as part of what Medicare is reimbursing, so that while you're learning how to cook and shop and eat out and so on, you can eat just the food we give you for two weeks. And again, because these biological mechanisms are so dynamic, most people start to feel so much better, particularly if they have angina, the angina tends to go away and they go, oh okay, this is really cool.

Dr. Dean Ornish (07:54):

I really want to keep doing this. 'cause It's not just about living longer, it's about feeling better. You know, I don't have my angina, I can do things I couldn't do before. That's a choice worth making for many people. So I designed this in such a way that it reduces health disparities in health inequities because now everybody has access to it wherever you live. And you don't have to drive somewhere, you don't have to take off work, you don't have to get childcare. You can do it from the comfort of your own home. And for many people that makes all the difference. I was suicidally depressed when I was in college and what I learned that just like I could take all the meaning out of my life, I could imbue my life with meaning by doing acts of service.

Meryl Comer (08:25):

Dr. Ornish talked to us about the issue of falling off the wagon when trying to strictly adhere to these lifestyle changes if we hope to be successful in slowing Alzheimer's disease.

Dr. Dean Ornish (08:37):

What I've learned in this process of doing this for more than 45 years is that the whole language of behavioral change has this moralistic quality. You know, once you call foods good or bad, it's a very small step to saying I'm a bad person 'cause I eat bad food. You know, I cheated on my diet. All these words are very judgmental and shaming and ultimately counterproductive. And 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, 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.

Dr. Dean Ornish (09:11):

So I've just learned that even more than being healthy, people want to feel free and in control. You decide how much you want to change and to what degree. And if you get off the program, get on the program, you know it's up to you. There's no shame, there's no guilt, there's no pressure, there's no any of that stuff. It's just you decide what's best for you. Now what we have learned over the years is that to get reversal and including the most recent study, we actually did a correlation like how much adherence did people need to have to our lifestyle intervention to stop or improve the progression of their disease? And it turned out a lot that didn't surprise me. That's why we were the first to show in all these different studies, 'cause most people didn't go far enough. And what matters most is your overall way of eating and living.

Dr. Dean Ornish (09:46):

So if you indulge yourself one day, eat healthier the next, you don't have time to exercise one day, do a little more than next. If you don't have time to meditate for an hour, do it for a minute. Whatever you do, there's a corresponding benefit. And then it takes away all the sense of control. 'cause You decide how much you want to do, how often to what degree. And we found that the more you do, the more you improve. But to get reversal, you really have to make close to a hundred percent adherence to the program. Whether or not you choose to do that is up to you. But that's what it takes.

Meryl Comer (10:12):

Have you found any difference between men and women and their ability to adhere to strict lifestyle changes?

Dr. Dean Ornish (10:20):

No. Not men, not gender, not age, not ethnicity, not socioeconomics, not demographics. 20 years ago we put this program at the St. Vincent de Paul homeless shelter and over 10,000 homeless people went through it just to show this isn't just for rich white people. You know, anybody can do this. Whether or not you choose to, it's really up to you. Like I say, sometimes big changes are easier than small ones because you feel so much better so quickly. Whether it's you want your memory to come back or improve or you want your chest pain to go away in the case of heart disease or you want to just feel better or reduce or get off of medications under your doctor's supervision to control your cholesterol or blood pressure or blood sugar that you might've been told you have to take forever for any of those reasons. Sometimes big changes are easier.

Meryl Comer (10:57):

Researchers say that Alzheimer's disease begins years before diagnosis. Doesn't matter when you start adopting these lifestyle changes,

Dr. Dean Ornish (11:06):

Clearly the sooner you start the better and the less you probably have to change. When I started doing this work, I thought the younger people who had less severe disease would do better in the case of heart disease. But I was completely wrong. In our lifestyle, heart trial, the most definitive randomized trial, we found the oldest guy who was 86 when he started in 91 when he finished actually showed more reversal of his heart disease than anybody. But he was very disciplined and followed the program more than a hundred percent. We found the primary determinant of improvement wasn't how old or how sick they were, but how much they changed their lifestyle. Alzheimer's is different. I think there does come a point of no return where you've done so much damage to the brain that it's never going to get better. But if the earlier you start it, and these were people had early dementia or mild cognitive impairment, mostly had early dementia is not too late for most people. For some people it is, but for most of them it isn't. But clearly the sooner you start, the more effective it's going to be and the less you probably have to change.

Meryl Comer (11:53):

The fear of getting Alzheimer's is palpable by age 65, 1 in 10 have dementia at age 85, 50% have dementia. And each day approximately 2000 people move from mild to moderate stages of the disease. So there's a real imperative to find a way to slow disease progression. What conversation should we be having?

Dr. Dean Ornish (12:16):

I've spent so much of my years doing these studies and particularly this one, which was the most challenging but the most rewarding. But in the case of Alzheimer's, none of the drugs can do better than slow down the rate at which you get worse. And if you're told you're only going to get worse, even if it's more slowly, it's still a devastating diagnosis. And you know, the suicide rate three months after people have a a diagnosis of Alzheimer's is seven times more than the general population because people lose hope. You know, hope is everything. I was suicidally depressed when I was in college. I almost committed suicide when I was 19. I actually came about as close to doing it as you can. I just got lucky and I didn't. One of my favorite movies is it's a wonderful Life. You know, with Jimmy Stewart, I feel like if there's a hell, it would've been like if I had committed suicide to see what my life could have been like had I not done that.

Dr. Dean Ornish (12:56):

I learned how devastating I could take all the hope out of my life. Who cares? So what big deal? Nothing matters. You know, why bother all those kind of existential angst? I was 19 at the time. But that's what happens when many people get diagnosed with Alzheimer's. They get their hope taken away and that's devastating. So while we can't guarantee that people are going to get better, not everybody get better, but a lot of people do. 73% of the people you stopped or improved their cognition and function during the 20 weeks of the study. And we're hoping to find that continuous over time that can give people real hope as opposed to false despair. You know, people say, oh, you shouldn't give people false hope. Well this is real hope not guarantees not everybody's going to get better, but that's a whole lot better than saying that almost everybody's going to get worse over time.

Dr. Dean Ornish (13:34):

Which we can now say there's more we can do that can give people real hope. Despair can be a downward spiral. Hope can be an upward spiral. You know, you start to say, oh, okay, well gosh, maybe I can do something about this. Let me try this weird stuff. You know, let me go on this plant-based diet. Let me start meditating. Let me start exercising. Let me spend more time with my friends and family. Instead of seeing that as a luxury that you do after you do all the important stuff, that spending time with your friends and family is the important stuff, you know? And the only side effects are good one. So why not do that? Yeah, well you're not having your cheeseburgers every day. But what's more important, you know, for many people having a sense of hope and empowerment and at least the chance that maybe their cognition may at least stop getting worse and in many cases get better. Those are choices worth making for many people. And now we can tell people what we couldn't tell them before. And that's why I do these studies is they're really hard. That's hard to raise money. I'm very grateful to George Denberg for helping give us some of the initial funding when this was just a wild idea to many people.

Meryl Comer (14:26):

Dr. Ornish, are you looking to expand your cohort and push the study beyond 20 weeks?

Dr. Dean Ornish (14:32):

We have data on over 15,000 people who have gone through our cardiac program. We hope to be able to do that for Alzheimer's. People say, oh, you've only had a small number of people. You only had 51 people in your study. Isn't that just a pilot study? Well, no. The point of any study is to say, is this a real finding or is this a chance finding? Well, how do you show something that's statistically significant, less than 5% due to chance? Well, either you've got big changes that are consistent in smaller groups of people or smaller changes with more noise in larger groups of people. If you can show that statistical significance in a smaller group of people, that just means your intervention is that much more potent. And there's less noise in the measurement by analogy. If you were looking at the effects of penicillin on pneumococcal pneumonia in 1950 before there was drug resistance and you had 50 people in 25, you gave the penicillin in 25, you didn't, you don't need a thousand people to know that something's happening.

Dr. Dean Ornish (15:20):

'Cause Most of the people who got the penicillin to get better and a lot of people wouldn't, who didn't? It's not as generalizable. That's a separate question. We didn't have as much ethnic diversity in our group as we would've liked, even though we tried really hard to get that. We need larger studies to be able to make them more generalizable. But in terms of the outcome, did people actually get better in their cognition and these other measures? The fact that three of the four measures were statistically significant, even though there was a relatively smaller group of people, just means the intervention is that much more potent. It doesn't mean that it's pilot study or that it's not really relevant yet.

Meryl Comer (15:51):

Dr. Ornish, what was the turning point in your career when your lifestyle interventions became more broadly adopted and mainstream?

Dr. Dean Ornish (15:59):

Well, it's really lifestyle medicine. I'm known as the father of lifestyle medicine. And lifestyle medicine is using lifestyle changes not only to prevent disease, which we've known forever, but to treat and often reverse its progression or improve outcomes. And I've been doing this now for close to 50 years. At the time people thought, what are you doing? But I think there's a convergence of forces that finally make this the right idea at the right time. Drugs and surgery, when used appropriately can be lifesaving. We've all benefited from that, but they have limitations. 86% of the almost $4 trillion that we spent last year for healthcare, which is primarily sick here, are for treating chronic diseases that are largely preventable and often even reversible by making more intensive lifestyle changes at a fraction of the cost and with only good side effects. For example, stents in stable patients don't prolong life, don't prevent heart attacks.

Dr. Dean Ornish (16:46):

And there was one study called the orbital study that was done in the Lancet in, in England, where they actually put fake stents, sham stents in half the people in a randomized trial and found their reduction in Ang was the same as those who had real stents. So it may not even reduce angina. And yet we spend billions of dollars on these interventions that are often dangerous, invasive, expensive, and often ineffective. The fact that this convergence of forces the limitations of drugs and surgery, the costs are unsustainable. And at the same time, the power of lifestyle changes not only in our studies, but others are showing this as well. Sometimes as a, an alternative to drugs and surgery, sometimes in synergy with them. I'm hoping that studies will be done that show that in people with early stage Alzheimer's, that you know, using drugs plus lifestyle may be more powerful than either alone. Just like we often have statins and lifestyle changes in people who have coronary heart disease. They're not mutually exclusive. So I think that for all these reasons, lifestyle medicine now is mainstream.

Meryl Comer (17:37):

Our guest has been Dr. Dean Ornish, founder and president of the Preventative Medicine Research Institute. That's it for this edition. I'm Meryl Comer. Thank you for brainstorming with us on 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.

Speaker 2 (18:24):

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