Dean Ornish, MD: Creating a New Paradigm of Healthcare vs Sickcare

welcome to the plant pure summit 2016 co-sponsored by plant pure foods calm our guests is Dean Ornish MD dr. Ornish is the founder and president of the nonprofit preventive medicine Research Institute and clinical professor of medicine at UCSF for over 39 years dr. Ornish has directed clinical research demonstrating for the first time the comprehensive lifestyle changes may begin to reverse coronary heart disease without drugs or surgery in 2010 Medicare agreed to provide coverage for his program the first time that it has covered a program of lifestyle changes he is the author of six national best-selling books and was chosen by Life magazine as one of the 50 most influential members of this generation dr. Ornish it is a real pleasure and honor to have you here thank you so glad to be here great so what was the spark of inspiration that got you started 39 years ago on your research well at the time I was a second year medical student at Baylor College of Medicine in Houston and learning how to do bypass surgery with Michael DeBakey one of the pioneers in heart surgery we cut people open we bypass their clogged arteries who tell them they were cured and more often than not they would go home and do all the things that had caused the problem in the first place no eat junk food not manage stress not exercise and so on and more often than not their bypasses would then clog up and we'd cut them open again sometimes multiple times so for me bypass surgery became a metaphor of an incomplete approach that we were literally or figuratively bypassing the problem without also treating the underlying cause which to a large degree are the lifestyle choices that we make so I decided to I that was when people actually went to things called libraries and uh pulled out Journal after Journal and realized that there was good scientific evidence that you could cause heart disease to her in dogs and cats and pigs and rabbits and monkeys but you could reverse it if you change those same things that it caused it which was what we eat how we respond to stress how much exercise you get how much support we have no and so I developed the program and saying well what if we put people on a Whole Foods plant-based diet that's naturally low in both fat and sugar I had them do yoga meditation to manage stress moderately exercises in the form of walking and have more loving supportive eyes or in short to eat well move more stress less and love more what would happen and so over a series of no 39 almost 40 years we were using these very high-tech state-of-the-art scientific measures to prove how powerful these very simple and low tech and low-cost interventions can be and how dynamic these underlying biological mechanisms are so how quickly you can feel better or for that matter worse depending on what you do in the beginning what sort of resistance did you get from the medical establishment about the research you were doing well one of the nice things about going to medical school in Texas it has really more of a pioneering Esau's you know you got a crazy idea you know you learn something from it maybe it will work but you know hey go for it so they the chief of Cardiology donated all the tests and referred patients to me as a second-year medical student so I did my first study then I did a second randomized trial between medical school and starting my internship and residency I went to Boston to Harvard Medical School and the Massachusetts General Hospital finished my residency fellowship there and then was going to do a third study there and realize that you know that things were so much more hierarchical than that in the Harvard system it would have been much more challenging to do that you need to work in someone else's lab until you're 40 and then maybe they'll let you do your own work so I moved to San Francisco began the third study and you know anytime you're doing something that is just disruptive which this was and challenging the conventional wisdom which this did it's met with resistance and and in part that's good because medicine is inherently conservative you know you want to really see does something work before it's embraced or covered by insurance or Medicare or things like that and so but it was also we were held to a higher standard and we often still are when you're doing something that doesn't fit within conventional guidelines and you know especially the early studies it's like well how do you know they would have got better anyway well have you ever seen patients get better well no but it's theoretically possible you didn't have a randomized control group in your first time thing that's true so then we did a second study that had a randomized control group and so on so it is held to a higher standard but at this point I think it's become mainstream after 16 years of review both external and internal CMS decided to create a new benefit category to provide Medicare coverage for our program for reversing heart disease that's a real game-changer because you know I think if we just did good science that would change medical practice and some degree it did but if you change reimbursement you change medical practice and even medical education and once men take care cover something most of the other insurance companies do as well and that makes it both attractive to doctors to provide programs like what we're doing because it's reimbursable so that means they can make a living doing it it's not the doctors are only interested in making money and where most people go into medicine because they really want to help people but if you're trained to use drugs and surgery and you're only reimbursed to use drugs and surgery that's what you tend to do now we're creating a new paradigm of health care rather than just sick here so our program is 72 hours long you know most doctors you know you're in a managed care environment you spend maybe eight or ten minutes with a patient it's profoundly unsatisfying about the doctors and the patient you don't really have time to talk about much of anything other than go through a quick problem list to a quick physical exam write a prescription usually for a statin or other medication and they're out the door it's not fun for the doctor or the patient and it is frankly one of the reasons why so many doctors are wanting to leave the profession or you know not recommending medicine as a career for their sons or daughters it's not fun practicing if you only have a few minutes so we don't have 72 hours but the doctor doesn't really spend most of his or her time doing that they're more the quarterback or the coach they're the other five personnel it's the doctor the nurse the stress management instructor which is a certified yoga meditation teacher exercise physiologist registered dietician and psychologists and we divide this 72 hours of training that Medicare and most other insurance companies are reimbursing into eighteen four-hour sessions so it's an hour of supervised exercise like you find in a traditional cardiac rehab program but also an hour of yoga meditation an hour of a group meal with a lecture and an hour of what we call a support group but it's really much more of a safe community where people can let down their emotional defenses and talk openly and authentically about what's really going on in their lives it's a really powerful thing and it's why we're getting bigger changes in lifestyle better clinical outcomes better patient engagement and even larger clock savings than anyone's ever shown before and even though the program is only nine weeks long people come twice a week for four hours at a time usually from five to nine pm if they work or during the day if they don't and then they continue to meet on their own and yet we're getting 85 to 90 percent adherence after a year to the program that's only nine weeks long you know by comparison half to two-thirds of people who are prescribed you know statins like lipitor are not taking them after just four to six months so this idea that most doctors have those patients they'll take their medication but there's no way they're going to change your lifestyle is really the opposite of what we're finding and the reason is is that the statins don't make you feel better but the lifestyle changes do and most people find that their angina goes away or gets markedly better there think more clearly they have more energy they need less sleep we found that these same lifestyle changes that can reverse heart disease can reverse early slow stop reverse the progression of men but early-stage prostate cancer if you have type 2 diabetes and you or you have high blood pressure or high cholesterol levels chances are your doctor said here take these pills and they say well how long do I have to take these they say forever you know it's like I show a cartoon of doctors mopping up a floor around the sink is overflowing it's like how long back them off of the floor like forever well why do we just turn off the faucet and to a large degree the faucet or the lifestyle choices that we make each day so we find that under their doctor's supervision they can reduce or off and get off of these medications completely or at least greatly reduce them that they had thought they'd have to be taking forever we found that when you change your lifestyle it changes your genes turning on the good genes turning off the bad genes over 500 genes in three months we found that even lengthens telomeres of our chromosomes that control how long we live that control the aging process at a cellular level we find that the same lifestyle changes inhibit angiogenesis that keep blood vessels to grow to feed tumors when through this process we can inhibit and down regulate that so the more mechanisms we look at the more reasons we have to explain why these simple changes in diet and lifestyle are so powerful how quickly they can occur and how they're sustainable over the long run both because they're reimbursable and people feel so much better so quickly and really refrains the reason for making these changes from fear of dying or fear of a heart attack or fear something bad happening which is not sustainable to joy and pleasure and feeling good and and freely choosing to do that that's an amazing change in the whole paradigm of how medicine usually works and it's tremendously positive I think very constructive clearly and you had a tremendous amount of success with it and a huge amount of influence and which has been profound frankly thank you what role does plant-based nutrition play in your program well as I indicated it's the that's the diet that people are asked to consume is a plant they hold foods plant-based diet predominantly Thursday shovels whole grains legumes soy products in their natural unrefined form organic whenever possible because it not only does it have fewer the insecticides than that are indican disruptors but it tastes better it tastes better you're more likely to continue doing it it's also low in refined carbs and sugar there's a debate going on now that so many people's out low fat is that it's all sugar well it's not all anything people like to be reductionistic it's not all sad it's not all sugar in fact there's more and more evidence coming out that plant protein in itself is beneficial whereas animal protein is harmful independent of this whole fat versus carbs name and there's also there's a study that came out by Emmy weeks and a more recent one that was in from the Harvard School of Public Health that people that you know goes from process red me to check in to fish and so on that as you go down there the risk goes down proportionately independent of the whole fat versus carbs name and even from the fat versus carbs seeing a lot of them you know prevailing media these days are saying oh you know Americans have been totally less fat they're eating less fat there's out of than ever low fat is that you know it's all sugar well went to the US Department of Agriculture database which tracks the entire food supply of what the entire population has been eating every decade since 1950 because what people tell you they're eating whether actually eating isn't always true and so I said one of what's really happened I know Americans been totally less fat but what have we actually been eating and every decade since 1950 we've been eating more fat more sugar more meat and more calories so not surprisingly we're fat or not because we're eating too little fat or too too little meat but because we're eating too much of every day and you know it's unfortunate because you know a lot of people want to believe that saturated fat is good for you or butter is good for you and if you actually I mean there was one article in the British Medical Journal that I think just epitomized this disconnect between the perception and the reality and even the abstract said saturated fat was not associated with any with heart disease with diabetes with cancer with premature death from all causes when you look at the adjusted scores but when they adjust the statistics they will adjust like excreting they'll just force a saturated fat or you know or and they'll say well for though if they're looking at saturated fat they'll adjust for cholesterol or they're just for animal protein which because they're all linked if you just for one you're kind of obscuring the relationship with the other but then they also present the data what they call the unadjusted the raw date which Jimmy are always more accurate because once you start to adjust things you introduce potential for bias and confounding when you look at the actual raw data they found in that same article that there was a highly statistically significant correlation between saturated fat intake and all of these things premature deaths from all causes cardiovascular disease cancer type 2 diabetes etc he didn't even make its way into the abstract and so and yet the headlines were butters back you know more success rate that isn't harmful there was an article that came out just a couple of weeks ago that dr. Mazda firing did in JAMA internal medicine they the same point butter is not linked with cardiovascular disease so that's the headline you see butters you know butters back butters an attack that was the title of the thing his butter back of their article you know is on the cover of Time magazine butters back and yet if you actually look at that very paper what it showed was that intake of butter was significantly correlated with premature deaths from all causes it wasn't correlated with cardiovascular disease per se and then lots of the reasons that when you do want to call meta analyses and you push together lots of different studies you introduce a lot of noise because the methodologies are different you don't know how actor if they weren't getting dive information for people if you ask people you know if use a food frequency questionnaire and say during the past year or what have you been eating I mean most you look at it remember they know yesterday there's a lot of noise the more noise there is the harder it is to see a significant relationship so the fact that you don't find a significant relationship between say butter and taking cardiovascular disease doesn't mean that it's not harmful especially if you find that butter intake is significantly associated with premature death from all causes it just means that there was so much noise or maybe the sample size wasn't big enough that they weren't able to show significant differences so unfortunately there's a lot of confusion around this but there is a really growing consensus about what constitutes a an optimal way of eating David Katz and Walter Willett held a conference in Boston last year where they brought together leading experts in nutrition from across the spectrum from the Paleo to the vegan and we all agreed that in an optimal diet is primarily a plant-based diet you know fruits vegetables whole grains legumes floor products whether or not you can add small amounts of meat you know is some debate and it probably depends on the individual if you're trying to reverse the seeds we clearly found more you change the more you improve at any age so the pound of cure to trying to reverse disease I think requires people to be as strict as possible and we found a dose-response correlation between the adherence to the diet overall and changes in their arteries in both one year and in five years and an exciting we're down to publish with them a significant correlation between dietary fat and dietary cholesterol intake and changes in their arteries as well so there's a lot of confusion but I think that you know media like controversy they like to highlight the confusion they like to you know magazines are hurting the newspapers are hurting if they can come up with something controversial and tells people what they want to hear it's like Donald Trump you know the circulation even it may not necessarily be what people need to be hearing so how much of this confusion do you think is just confusion and how much of it could be deliberate Distortion oh I don't know I I can't I've learned not to ascribe motivations to people so I can't really comment on that okay so when did your work start to gain greater acceptance among the medical mainstream well I don't know I mean it's been growing since the very first study but I think of what was considered the most this study was when we published our we'd already done two pilot study of ten people back in 1977 and we published in JAMA in 1983 a randomized trial of 48 people just looking at the effects after one month but the most definitive study was called the lifestyle heart trial published in The Lancet in 1992 premier international medical journal where we showed using quantitative arteriography that there was significant reversal of disease after one year in the experimental group who made these lifestyle changes whereas the randomized control group got worse we followed that we got then a support from the National Institute of Health for the National Heart Lung and Blood Institute to extend the study for four more years a total of five years and found that there was even more reversal after five years than after one year even less blockage in the coronary arteries in the group that went through this program whereas the randomized control group showed even more progression after five years and after one year and none of the experimental group patients were taking statins during that time you could need to do this study now as everybody would be on these cholesterol-lowering drugs so we're able to show that without cholesterol drugs most people were able to reverse the progression of their heart disease in the control group none of them were taking the drugs at the beginning but half of them got put on those drugs during this study and comparing those who were taking the drugs and those who weren't in the control group the drugs did slow down the rate at which people got worse but they weren't enough to stop a reverse it and yet in an experimental group even without the drugs they were able to reverse now one school of thought is well why not do both and you know maybe get even more reversal but on the other hand if you can show a reversal for most people and get their LDL s down below 90 without drugs then you know why if subject people to the cost of side effects of that so that's an open question that I think we need more research to show so do you know about how many patients have successfully reversed their heart disease using your program by now well I don't know I mean from my books alone they're probably hundreds of thousands if not millions but we actually did a demonstration project that we published in the American Journal of Health Promotion call almost 4,000 patients at 24 sites in West Virginia Nebraska and Pennsylvania for the more challenging parts of the country West Virginia is the number one in the country in heart disease the last 20 years and we showed again bigger changes in lifestyle better clinical outcomes larger cost savings that anyone's ever shown we did a demonstration project with neutral Omaha where we showed in eight different sites we showed similar they showed most people are able to safely avoid having bypass surgery angioplasty through stents and they saved an average of almost thirty season almost $30,000 per patient that's a little topsy-turvy you know I mean I remember earlier discussions of Medicare and the head of Medicare at the time said what we have to do we have to do a literature review and get clearance from the the chief of the National Heart Lung and Blood Institute of NIH said it's safe for other people to you know walk that it's a tea vegetables and quit smoking and yet they would pay for stents and angioplasties which the randomized control trials have all show the same thing that stable patients which are most of whom we're getting them they don't work they don't prolong life they don't prevent heart attacks and so on so we've been paying for things that have been through Medicare and other insurance companies that are you know dangerous invasive expensive and ineffective and yet something as simple as changing lifestyle took a 16 years of review but they are now paying for and we're in immensely grateful for that because as I said earlier if it's reimbursable its sustainable and now it's the whole field of lifestyle medicine lifestyle to treat in Reverse chronic conditions and not just now for that it is now I think the most exciting field in medicine today and having the reimbursement now makes it practical for many people to do this and so I'm working with a company called share care with Jeff Arnold who started WebMD and dr. oz and others so we're training hospitals and clinics around the country and soon we'll be training individual practitioners so if anyone's watching this who's a you know a physician and nurse yoga teacher exercise physiologist dietitian or psychologist and once you get trained and certified in our program so that then they can go to group said that they're offering it and also it's a good credential they have now go to our website orange comm it's all there and we're really working together to create a not only a new paradigm of health care but a way of practicing medicine that allows the doctor to really leverage his or her time most of that 72 hours is done under their auspices in other did their direction but they can be seeing other patients I just need to be in the building but they're not actually spending a huge amount of their time so allows them to go back to the roots of why most of us went into medicine in the first place you know the spiritual basis of medicine you know because I mentioned it's not fun to have to see any patient every eight to ten minutes but we could really work with people and help them spend time with it about the things that really matter that are the most important determinants of our health what we eat and show people new ways of eating and a cook has a shop at an you know basic nutrition and what how these things affect our health for veteran for works you know to create a support group that feels safe for people to let down their emotional defenses and talk openly and authentically about what's going on in their lives which many people don't have that you know I wrote a book earlier called love and survival that was based on what were then hundreds of now thousands of studies that people are lonely and depressed or three to ten times more likely to get sick and die prematurely than those who have a sense of love and connection community so we show people how they can recreate that because many people don't have you know an extended family or even a nuclear family they see regularly or a job that feels secure or a neighborhood that they grew up and appear so neighbors there so by creating this new paradigm of health care it's not only more transformative for patients who can use the experience of suffering as a catalyst or as a doorway for really transforming their lives but it's really fun practicing medicine in health care this way because we can really help people use the information that we've all learned to transform their lives for the better I always won just on causing their arteries I have to tell you all the the doctors that I've interviewed about this who are using plant-based nutrition now are saying all saying the same thing how much more satisfying it is I'm a doorman it is to be a doctor when they're actually making people better rather than just sort of palliating the problem so congratulations to you and it must it must make you feel really give you a great sense of satisfaction personally to be able to do these kinds of things well I think that's why we're here is to help each other and to learn and to grow and and to help people understand that when you're suffering there's usually a reason for that it's not a punishment it's like hey let's enough pay attention you know you're not doing something that's in your best interest and here's what you can do and how quickly you can feel better I mean I mean even now I've been doing this work for close to 40 years and I get letters all the time and emails I got one just a few days ago from someone who went through our program in at UCLA and well actually two one was in the LAPD and five weeks after he started he showed significant reversal of one of his plaques in just five weeks another guy was on the heart transplant list and after nine weeks improved so much he didn't need a heart transplant anymore you know that's a million dollars in savings but more than that it's like what's the moment at achill intervention here you don't have a heart transplant it's like the ultimate high tech low tech comparison so hearing people saying you know I couldn't walk across the street before getting chest pain I couldn't make love with my spouse I couldn't play with my kids I could work and within a few weeks they can essentially do all those things it's incredibly meaningful not only for the patient but for those of us who do this work and I feel deeply grateful it's really sacred work in that way it's fantastic what was the process like for getting Medicare to approve your program well I have a 501 C 3 nonprofit Institute that I started in 1984 when I moved here to San Francisco from Boston called the preventive medicine research institute and here that we began training of 53 hospitals and clinics around the country and we did it all on a non-profit basis you know people just paid our expenses and we same thing bigger changes in lifestyle better clinical outcomes larger cost savings and yeah a number of those sites closed down because we didn't have reimbursement and they all said the same thing that's des program we've ever had and we're closing it down because we can't afford to lose money so that was the painful lesson for me that if it's not reimbursable it's very hard to make it sustainable unless you want to do like concierge medicine and I didn't just want this to be for you know affluent people I wanted this to be for everyone so um I we're going insurance company by insurance company and that's very challenging and most people don't go into the insurance world because they're entrepreneurial or or innovative in that way there are some notable exceptions you know Mark Bertolini at Edna's certainly one and the people at neutral Omaha when we began working with them and then in the early 90s were but generally that's hard so I figured if we get Medicare if we could Medicare if we could achieve Medicare coverage then most of the other insurance companies would follow suit and so I began a dialogue with them and it was challenging you know because they they said oh well if we pay for this program everyone who's got a crystal ball and a pyramid is going to want Medicare coverage and I brought with me the medical director and chief medical officer meets with almost alone we're not exactly a radical insurance company we're mutual Velma oh we pay for this because it's got years of randomized control trial data showing that it's it works it's safe and effective and I said I will know what I'll do it and I brought with me dr. Richard Collins with the top line was the chief of cardiology at the hospital Nebraska Regent Emmanuel Medical Center and he said look I'm an interventional cardiologist I make my living doing stents and 90% of the people that I would have put a stent and were able to avoid it by going on this program and said and if someone do it and so I have been working with President Clinton since 1993 when Hillary Clinton asked me to train the chef's to cook for them at the White House in Camp David and Air Force One and the Navy mess and so on and then later asked me to consult with with with them and with him when he would have his annual physical as a naval hospital I'd come in for that and so on and also on Newt Gingrich when he was speaker the house came to one of our retreats with a family member who had some health issues and they and they got better so we had the president knighted States and the Speaker of the House who were completely office in this political spectrum and both came together in sort of our work we had 20 members of the Senate 30 members of the House heads of ARP and all the major health organizations and it just took a long time and you know again on the other hand I talked to someone recently who has a lot of experience with Medicare Utley they said 16 years only 16 years ago wise governmental bureaucracies move slowly and understandably so because you know there's a lot at stake when they cover something it really makes a huge difference and I again I remain grateful to them for for covering our program because it has made a huge difference and Anela it enables us to work with people across the socio-economic spectrum we even trained them the same instead of a homeless shelter in San Francisco years ago with dr. Lee listen Thal the workings me and over 30,000 homeless people have been through this so this isn't just for a half though and educated people this is for everyone and ironically you know the diet that we found that can then in Reverse so many of these chronic conditions is the way that people were eating in the third-world countries before they started a copy our diet and now they're starting to eat like us and live like us and also often die like us and it's really going back to what they were doing before and really you know saying copy our successes but don't copy our mistakes well it's it's great that you got them to move in only 16 years but that is a tremendous breakthrough clearly and a hugely important seems to me they created that they created a new benefit category called intensive cardiac rehabilitation again which will pay now for 72 hours of training and recently they're actually providing an additional incentive fundings for people to be referred to both regular cardiac rehab and intensive care rehab traditional cardiac rehab is just exercise which has clearly some benefit so it doesn't go far enough to reverse it intensive cardiac rehab because it has the stress management a more intensive diet plant-based diet and the social support provides the additional intervention that can actually reverse the progression of disease well it's a fantastic progress and this the breakthrough with Medicare is just ethical what what do you see is the main problems with our healthcare system today well it's changing and I think as we move traditionally in a fee-for-service environment there are a lot of perverse incentives and on other words the more and apply C's instance you do for example the more money you make which is why the interventional cardiologists who were so critical of bypass surgeons for doing bypass surgery for so many years when before they did randomized trials and of course randomized trials found that there's a very small percentage of people whose lives are prolonged by by having bypass surgery you know embraced it and began doing it I remember there was an editorial in the New England Journal Medicine that Eugene brown Laval he was the chief of cardiology at Harvard at the time wrote saying you know we've opened Pandora's box you know the genies out of the bottle because now everyone's doing it maybe it's going to take his turn out to be decades before they started to do randomized trials and then they found it now if you're in the middle of having a heart attack of staunton an angioplasty can be by advance can be life-saving but for most people who are stable they don't work but took decades to be able to show that in part because of the way that medicine is being reimbursed as we move into the era of bundled payments under Obamacare whatever you think about it it's really turning all the incentives on their ear because they're saying here's X amount of dollars to take care of this group of patients and you doctor or the hospital the clinic is to keep its leftover so the fewer procedures you do the more money is left but obviously if you if someone needs something you don't do it and they end up in the hospital that comes out of your pot of money as well so lifestyle medicine approaches which to be more effective at lower cost are perfect for this kind of economic environment that we're moving it because people not only receive reimbursement on the front end who are offering our program through Medicare and other insurance companies but they also get to participate in the savings on the back end so I'm optimistic that we're moving in a much better direction now well that's very good news the and you see a plant based nutrition playing a greater role in in the future in preventive health care well clearly obviously I do and you know there's a lot of talk about personalized medicine and and yet while we're finding is that it was the same diet lifestyle intervention in all of our studies the same one reverse heart disease diabetes prostate cancer people lost an average of 24 pounds in the first year they you know their telomeres got longer their genes began to down regulating the harmful genes upregulating or turning on the good genes to the degree that made these lifestyle changes and dietary change so now there's always room for personalization if someone's got you know if they're gluten sensitive then you can you know become aware of that or you know there are little things around the edges to me that they're not it's basically the same diet it's almost as though if you present someone the right raw ingredients they can extract what they need in order to begin healing and it's not all or nothing you know for reversing disease that's the pound of care you really do need to do the whole thing but I wrote a book called the spectrum that was based on the finding that the more you change the more you improve and it's not all or nothing so if you're not ready to follow a plant-based diet 100 of the time to the degree to do it you're going to look better feel better this is weight gain help all the things that people want but it's not all or nothing and I think that's important because people tend to get rigid especially in the plant-based vegan world it's like you're on the bus or you're off the bus you know you're good person you're bad person and I think we need to be more flexible about that because many people are not willing to make such a big change many people are especially if they're sick but many people aren't and if you make them feel bad because they're not pure enough then I think it's really bad for you and for them and so I said look if you go on a diet chances are going to go off a diet because designs are all about what you can't have what you must do and sooner or later if you go off and then you'd have all these toxic emotions of shame and guilt and anger and humiliation which really are bad for you I mean the whole language of diet lifestyle often has this judgemental moralistic quality you know I these are bad foods and once you call some foods bad or good it's a small step to say I'm a bad person because I bad food and then you have all those toxic emotions or I cheated on my diet you know I mean I can't go out to dinner I'm sure you have the same experience without someone either apologising for what they're eating or commenting what I'm eating and I have to say you know I'm not the food finger forgiving but still there's all that stuff so I said look let's just let's leave all that stuff behind what matters most is your overall way of eating and living so if you indulge yourself one day it doesn't mean you're bad or you cheated or you failed he'd help you the next you don't have time to exercise one day do a little more the next you know time to do yoga meditation for an hour do it for a minute whatever you do there's a corresponding benefit I think the consistency is more important than how long you do it anyway so it's a much more compassionate approach because you can't fail there's no diet to get on so there's no diet to get off now what I did do is to say foods are not good or bad but some foods are healthier than others so the Whole Foods plant-based foods I categorize with the healthiest group one you know process red meats and you know sugar would be group five and group students through four would be in the middle and again if you're trying to you're not sick because you want to lose a few pounds or get your cholesterol down a bit of your blood pressure down a bit say okay what are you eating now well I'm eating mostly unhealthy Group four five how much are you willing to change not here's your diet because once I put diet then I'm in this manipulative dance for them where I'm trying to get them to change and one of the lessons I've learned and even more than being healthy people to feel free and in control and as soon as I say you know eat this and don't eat that and do this and don't do that they want to do just the opposite and sometimes when I lecture I'll joke that this goes back to the first dietary intervention when God said don't eat the Apple and that didn't work so well and that was God talking so I don't know people to do say look because even more than being health if you want to feel free and in control so I say what are you eating now you mostly on healthy good for thought how much are you willing to change not here's what you should be doing oh no one's ever asked me that before I don't know Ollie less good four and five more one and three great how much exercise you did I well not that much how much are you willing to do oh I don't know I'll walk 20 minutes every other day great how much you know the meditation you're doing zero but I'll meditate five minutes a day okay how much love and support do you have not enough but I'll make that more of a priority to spend more times of my time with my friends and family so then we'll track and will support that degree of change and let's say their goal was to lose 10 pounds and they lost 5 after a month or they wanted to get their LDL down 20 points and it came down 10 say look you're on the right track I'll just go a little further in that spectrum and probably get the rest of the way and I just find that so much more effective and strategically of helping motivate people to make changes if they don't have to reverse their conditions I I couldn't agree more it's really I think important to be inclusive rather than exclusive and not to shake a finger in people's faces and not be judgmental so clearly it so definitely the way to go so what are your hopes for the evolution of our health care system let's say over the next 10 to 20 years well I think it's already happening you know I think the rise of lifestyle medicine and plant-based diets is thrilling to me because as more and more people begin making these changes in their own lives and see how much better they feel as more and more doctors do that in their own lives and also with their support their patients to do it as reimbursement becomes more widely available for these kinds of interventions it really is creating a whole new paradigm of health care and it empowers people you know drugs and surgery have their place they can be life-saving that's rather than the beneficiary you know when I had a pneumonia years ago and and the antibiotics were you know probably life-saving for me I have great respect for in surgery but they have their place there not everything and when we can you use them when they're appropriate and integrate the best of traditional and non-traditional approaches into lifestyle medicine especially plant-based diets to the degree people are willing to follow them I think that over the next 10 to 20 years we're going to see a blossoming of this field and I may be optimistic but I've been doing this a long time and I think our time has finally come our time is now that's great so in your opinion have we reached that tipping point we have definitely reset the tipping point especially when Medicare begin covering our program that was a tipping point but it's more than that I think there's enough physicians and other healthcare professionals who are practicing medicine of this way of educating people about the power of this and of course is the whole environmental aspect to this as global warming becomes more and more of a threat I used to have discussions with Al Gore about this and I said you know it's great to drive a small car and use for Austin lights but more global running by livestock consumption than all forms of transportation combined and and so I was thrilled when he a few years ago became a vegan himself even though he's a counter with mention so I think as people realized that what we put in our mouth is each day is meaningful and if it's meaningful that it's sustainable because it not only makes a difference in our lives but through our example through our kids they tend to copy what we're doing you know it affects global warming and takes up to 10 times more resources to eat a meat-based side than a plant-based side a lot of hungry people in the world there's enough to feed everyone if more people are willing to do that and maybe you're not going to be a vegetarian or whatever but if you say I'm going to meatless Monday whatever you do there's a corresponding benefit to not only you but lots of other people into the planet itself and use those choices with meaning and what are meaningful them they're sustainable dr. you're truly one of the great pioneers in this whole field you know and we all a huge that of thanks to you and I thank you for taking the time to be part of this summit and for agreeing to be interviewed and taking valuable time out of your day uh if you say what you're doing and getting the word out I mean awareness is always the first step in healing and you're really making an important difference in raising awareness and I salute you for that and as I mentioned earlier if people want more information about our work everything on our website is free just go to Ornish comm or our NIH comm it's all there so thank you so much and keep up your great work thank you very much doctor


  1. AMAZING interview. Thank you for uploading and sharing this to the world. I hope this video will reach more people and will disrupt the meat industry.

  2. This is the message that will ultimately move the needle.

  3. Dr. Ornish is a very wise man. Good thing I can go back and review what he says on this video; he's so full of great info. I love this video. I've been doing a whole food, plant based diet for so long that he's not telling me anything new but, gives it more detail. I'm so grateful that he is willing to continue to teach this life saving information and keep spreading it to corporations and medical institutes. His research helps us to explain to others, why we do this. Thank you for bringing this to us.

  4. nutrition is not medical's pple own job,grow gardens spin clothes

  5. post professional s era,,,P.P.E. let pple do self sufficient wisdom..return to Matriarcal village

  6. Diet Prevents Polio Dr Benjamin Sandler,,sugar n germs epidemic s,,do ecoatkins

  7. ecoatkins lo Carb…works..

  8. Nathan Pritikin is my hero.

  9. dr talks so fast

  10. Thank you to both of you!

  11. Nathan Pritikin did the proof of concept and pointed the way.

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