What's love got to do with it? (Dean Ornish, heart specialist, finds that heart disease is reversible without the use of drugs)(Interview) By Suzanne Gerber Vegetarian Times March, 1998 Twenty years ago, when Dean Ornish, M.D., first began to research the effects of a vegetarian diet, yog and meditation on heart disease, many of his peers thought he was a little crazy. "For at least 10 years, I took a lot of flack for even thinking these things were worth investigating," he recalls. Back then, in the late 1970s, the U.S. government and the major medical institutions that funded most clinical studies firmly held the position that it was impossible to reverse heart disease. Even if it were possible, they argued, you could not motivate people enough to change their diet and lifestyle to the necessary degree. "It was a Catch- 22," says Ornish. "Without the funding, we couldn't do the studies to see if it was possible, and without showing that it was feasible, they didn't want to fund it. But I believed it was worth trying and had blind faith that we'd raise the money." Eventually Ornish not only found the money, he proved for the first time that heart disease is, in fact, often reversible, without drugs or surgery. Today Ornish has gone from fringe to mainstream: The federal government's National Institutes of Health has funded his work; most cardiologists are familiar with and supportive of his work; some 40 health insurance companies reimburse patients on his program; and even ultraconservative Medicare is analyzing his program for possible future coverage. In 1984, he founded the nonprofit Preventive Medicine Research Institute in Sausalito, Calif., where he holds the Bucksbaum Chair in Preventive Medicine. A vegetarian for 25 years, he also is a clinical professor of medicine at the University of California, San Francisco's medical school, where he is a founder of the Center for Integrative Medicine. Ornish is a physician consultant to President Clinton, the recipient of numerous national and inter national awards and, according to Life magazine, one of the 50 most influential people of his generation. Up until now, Ornish's published works (scores of medical journal article and four books, including Dr. Dean Ornish's Program for Reversing Heart Disease and Everyday Cooking with Dr. Dean Ornish) have focused on reversing and preventing heart disease. But this month he publishes his fifth book, Love & Survival The Scientific Basis for the Healing Power Intimacy (HarperCollins, 1998), which looks at the factors that Ornish believes to be the most important in premature death and disease. In conjunction with the book's release, he also has taped two hour-long specials for PBS, which will air later this month. And, to help people make the transition to more healthful vegetarian eating, this month he's launching a new line of natural food products, called Advantage\10[TM], which will be available in most natural food store and supermarkets. Vegetarian Times: In your previous four books, you've established the role die and lifestyle play in heart health. How is your new book, Love & Survival, different Dean Ornish: The real epidemic isn't just physical heart disease--it's what I call emotional or spiritual heart disease. In our culture, there's a pervasive sense of isolation and loneliness and alienation. The point of Love & Survival is that isolation is at the too of behavior patterns that often lead to a significantly increased risk of premature death and disease. Heart health is not just about getting our cholesterol down or preventing something bad from happening. It's about finding love and intimacy, which give our lives a sense of joy and meaning. The premise of this book, and my work in general, is that whatever promotes a sense of loneliness and isolation-- from oneself or other people or something spiritual--predisposes us to disease and premature death. Whatever promotes a sense of intimacy is healing. ME: What first tipped you off that love and intimacy might be as important as diet, stress and lifestyle? MF: Throughout my 20 years of research, support groups have always been important, but they were originally designed to help people stay on the other parts of the programs--the diet, for example. But over time, what became clear was that we ended up creating, almost unwittingly, an intentional community, a place where people felt safe enough to let down their defenses and talk about what they were of really feeling and what was really happening in their lives without fear of being judged or made fun of or being given advice on how to fix it. For many people, that sense of being heard and seen and understood was a new experience. In an early group, only one man refused to participate in the group sessions--while everyone else was talking about what was happening in their lives, he'd go to the gym and work out--and he was the only person in that study to die. While one person does not prove anything, his death really got our attention and made it clear that group support might be as important as anything else we were doing--if not more so. Many people had the greatest resistance to this part of the program, and yet once they began the process, they invariably said it was the most meaningful because it filled a basic human need that wasn't being met in other parts of their lives. MG: In the book, you write rather confessionally about your own struggles with intimacy. Was that part of the original plan? MH: I don't think of it as confession so much as sharing. It was the most difficult chapter to write, and I wasn't sure until the very end that I was going to include it. It's so personal, and yet I'm trying to model in the book what I'm suggesting that others do. In my own case, I didn't want to be completely alone, because that felt like nonexistence, yet being too intimate felt overwhelming. My dilemma wasn't unique; many people believe they're the only lonely or depressed ones because it looks like everyone else has it all together. If you don't have anybody to talk to about these issues, it may seem that way. An integral part of intimacy is the ability-- the willingness--to make oneself vulnerable. And the more vulnerable we can make ourselves, the more intimate we can become. In our culture, it's often considered dangerous to be vulnerable because you can get hurt. I've struggled with these very issues in learning to open my own heart and be more intimate. By "open my heart," I mean letting down our emotional defenses. It's not that we shouldn't have emotional defenses- -you don't want to go into a job interview and talk about your deepest secrets--but if you have no one with whom you feel close enough to do that, in effect, those walls will always remain up. And the same walls that protect you can also isolate you. MI: But how can someone who's spent a lifetime building up those walls begin to let them down? MJ: The first step in healing is awareness. So if we understand how much love, intimacy and a feeling of connectedness matter, not only in the quality of our lives but in the quantity, or the length, of them, then we can begin saying, "Well, gee, it may be scary to let down my emotional defenses, but it's worth it." And it's important to remember that this doesn't happen overnight; it's part of a lifelong process. In the book, I go into detail about ways to begin this process: meditation, compassion, altruism, group support, commitment, communication skills, psychotherapy. But the way one goes about doing this is less important than understanding what an important difference love and intimacy make in our lives. When people really get that, they begin to find their own way of incorporating it into their lives. It's funny how the universe works in that way. If you're really hungry, you tend to notice all the restaurants. If you decide you want more love and intimacy in your life, then often spiritual teachers or emotional resources appear, as does a willingness to take risks with your beloved. Forgiveness is another important pathway to learning to open our hearts. It's part of virtually every religious tradition. Forgiveness doesn't wipe the slate clean or mean that all actions are condoned. But it does free us from the anger, guilt, stress and fear that separate us from others and get in the way of true intimacy. When we can confess our darkest secrets to another person and be forgiven, then we can learn to trust them more and begin the difficult process of forgiving ourselves. MK: How many studies on love and intimacy do you cite in the book? ML: Around 200, but there are thousands out there. There's a vast and extensive literature that demonstrates to me beyond question that people who feel lonely and isolated and depressed and hostile have three to five to 10 times the risk of premature death and disease from virtually all causes when compared to those who have love and connection and community in their lives. I don't know anything in medicine--not drugs, not surgery, not diet, not lifestyle, not genetics-- that has a greater across-the-board powerful effect. Cholesterol has a powerful effect on heart disease, for example, but not on premature-birth complications. One of the first studies to really impress me involved Harvard undergraduates in the early 1950s who were simply asked how close they felt to their mothers and fathers. Then, 35 years later, their medical files were checked and detailed histories taken. Those who had said they weren't close to either parent were found to have substantially higher rates of disease--in fact, in this study, 100 percent had major illnesses in midlife compared with only 47 percent of those who felt close to both parents. Another study that fascinated me was done by Dr. David Speigel at Stanford Medical School and published in 1989. Originally he had set out to disprove the notion that psychosocial interventions, like support groups, could prolong the lives of women with breast cancer. In the study, women with metastatic breast cancer were randomly divided into two groups: Both received conventional treatment (surgery, radiation, chemotherapy), but one group also took part in a support group that met for 90 minutes, once a week for a year. Led by a psychiatrist or social worker with breast cancer in remission, the group was encouraged to share their feelings. Five years later, the women who'd been in the support group lived twice as long, on average, as the women who hadn't been. In fact, none of those women were alive after five years. MM: You write that loneliness is the leading cause of death in this country. That's quite a claim. MN: Yes. That these things matter is beyond question. Why they matter is a bit of a mystery. We know they matter to some degree because on a behavioral level, people who feel lonely and depressed and unhappy and isolated are more prone to smoke and overeat, drink too much, work too hard and abuse drugs--such behaviors help them just get through the day. Yet even when these factors are controlled for in studies, people who feel lonely and isolated have much higher rates of premature death and disease from virtually all causes. In the book, I interview a number of eminent scientists, healers, theologians, psychologists and therapists, each of whom provides a fascinating perspective on why love and intimacy matter so much. MO: How do negative emotions "get into" the body? MP: We are constantly learning new pathways through which chronic emotional stress leads to illness. In the case of heart disease, stress can cause your arteries to constrict, it can cause your blood to clot faster, it can make the blockages in your arteries build up more quickly--all of which can lead to chest pain or heart attacks. And yet it's not only through stress that loneliness and isolation affect our health and well- being. A common denominator is energy. Einstein showed that energy and matter are interconvertible. The idea that we are energy systems and that energy affects our bodies in the form of matter is a fundamental concept of most forms of healing yet not in Western medicine. When you wall yourself off emotionally, you may be literally walling yourself off from the source of energy that other people are continually exchanging with each other. It's the life force- -known as qi (pronounced chee) in Chinese medicine; kundalini, Prana or Shakti in yog. There are many things that even in conventional medicine we understand play an important role in disease, even if we don't yet understand the mechanisms underlying them. But it's not necessary to understand them to begin integrating them into our lives. MQ: What was your goal in writing this book? MR: I'm hoping that this book will raise awareness to the extent that people will become willing to take risks and make themselves vulnerable in order to become more intimate. Social change happens one person at a time--it's not something you can legislate. Any kind of change is stressful at first. But once you understand the power of love and intimacy, then the idea of change becomes more appealing. Ultimately, it's not about a fear of dying but the joy of living. It's easy to make fun of these ideas and call them "touchy-feely" or "soft," but in many ways they are the most powerful and most healing. And if the book accomplishes that, even in a small way, then it will have been worth doing. Suzanne Gerber is the senior health editor of Vegetarian Times. MS: What was your goal in writing this book? MT: I'm hoping that this book will raise awareness to the extent that people will become willing to take risks and make themselves vulnerable in order to become more intimate. Social change happens one person at a time--it's not something you can legislate. Any kind of change is stressful at first. But once you understand the power of love and intimacy, then the idea of change becomes more appealing. Ultimately, it's not about a fear of dying but the joy of living. It's easy to make fun of these ideas and call them "touchy-feely" or "soft," but in many ways they are the most powerful and most healing. And if the book accomplishes that, even in a small way, then it will have been worth doing. Suzanne Gerber is the senior health editor of Vegetarian Times. 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