Book Review: Research-Based Regimen Highlights How to Reverse Chronic Disease

Dean Ornish, MD has been at the forefront of lifestyle medicine for 40 years. The unusual title of “Undo It! How Simple Lifestyle Changes Can Reverse Most Chronic Diseases,” written by Ornish and his wife Anne Ornish, reflects Ornish’s approach to undoing things that cause progression of chronic disease.

The book is the culmination of decades of research on how to halt and reverse chronic disease. To document the effectiveness of the lifestyle medicine program, the research incorporates scientifically vetted measures to asses end point changes in chronic disease. The treatment protocol focuses on diet and exercise, as well as deep relaxation and breathing techniques like yoga. The healing power of intimacy and social support is likewise a mainstay of a whole-person lifestyle medicine approach. This represents a radical departure from how conventional medicine views chronic disease and how managed care treats such conditions. Moreover, “Undo It!”, and the research that supports it, is a foundational stone of the emerging field of lifestyle medicine.

According to the American College of Lifestyle Medicine, “Lifestyle Medicine involves the use of evidence-based lifestyle therapeutic approaches, such as a predominantly whole food, plant-based diet, regular physical activity, adequate sleep, stress management, avoidance of risky substance use, and other non-drug modalities, to prevent, treat, and, oftentimes, reverse the lifestyle-related, chronic disease that's all too prevalent.”

The book is a 528-page how-to-do-it manual that bears directly on the future of American healthcare, particularly chronic care, and what individuals can to do to take charge of their health and enjoy fuller lives. It is a manifesto that challenges prevailing healthcare assumptions and practices that focus on “curative” medicine, too often at the expense of disease prevention and health promotion.

The Ornishes explain how to live healthier lives by incorporating 4 disarmingly simple tenets into daily life: eat well, move more, stress less, and love more. These maxims constitute the heart of the book and each tenet is supported through 200 pages of examples and peer-reviewed research (245 footnotes). Additional chapters include 75 recipes for healthy eating, 2 weeks of daily meal plans, what to stock in the kitchen to support better nutrition, including snacks, and a guide to packaged and frozen foods. It is an exhaustive treatment on the what, how, and whys of healthy living even when faced with a chronic disease. The guidelines are encouraging, simply stated and decidedly nonmedical sounding. However, they go right to the heart of healing, which is the essence of effective treatment and what matters most to patients.

The book is valuable for anyone wanting better health by making changes in lifestyle. However, the most striking message is that US healthcare is on the wrong track and that lifestyle medicine is the most practical, and least expensive, strategy for responding to the tsunami of chronic disease. American medicine is not equipped to deal with the needs of an aging population with multiple chronic conditions and the fact that 2 in 3 adults are overweight or obese.¹ More than 86% of US healthcare costs ($3.3 trillion) are attributed to chronic disease.² This is unsustainable in terms of cost as well as diminished health status and decreased productivity (activities of daily living, business expense, lost wages). The current delivery system and medical business model are ill equipped to change the trajectory of chronic disease in the United States.

The Ornishes contend that many of the most common and debilitating chronic diseases can be slowed, stopped, and even reversed by following their 9-week lifestyle medicine program. Their studies assessed the benefits of lifestyle change first on coronary heart disease and then prostate cancer, which showed a reduction of oncogene activity (genes that have the potential to cause cancer) and lengthening of telomeres (caps that protect chromosomes from deterioration). Larger scale studies also showed lifestyle medicine benefits for diabetes, high cholesterol, hypertension, and weight loss.

The lifestyle medicine methodology rests on the synergy of 4 components working together:

A whole-foods plant-based diet, primarily fruits, vegetables, whole grains, legumes, and unprocessed soy products. What is included in your diet is just as important as what is excluded. The authors wrote that plant-based foods have thousands of protective factors with anticancer, anti—heart disease, and antiaging properties. The Ornishes say to consume “good carbs” and “good protein” while avoiding sugar, white flour, and white rice (“bad carbs”). Patients should also include 3 grams of “good fats” (omega-3 fatty acids) every day and reduce total intake of fat, and especially “bad fats,” such as trans fats, saturated fats, and partially hydrogenated fats. In other words, an optimal way of eating is low in fat and low in refined carbohydrates, as well as low in animal products. The authors do not mince words about healthy eating.

Moderate exercise, such as walking and strength training. For example, walking 20 minutes a day can cut premature death by 20% to 30% according to Ornish. Research is cited that shows exercise is positively linked to happiness. Moreover, men and women performing resistance exercise training had fewer symptoms of depression, whether or not they were depressed at the beginning of the study, according to the Ornishes. Twenty pages of illustrations are included for resistance band exercises.

Stress management, such as meditation and gentle yoga. Chronic stress is one of the most important mechanisms underlying numerous chronic diseases. It can increase inflammation in the brain and can lead to depression, which, in turn, can lead to and exacerbate depression. The book concludes that 1 hour a day of stress reduction has a powerful impact that can stop or undo a variety of chronic illnesses. Again, detailed instructions are provided on gentle stretching in different positions, breathing techniques, different forms of meditation, guided imagery, and deep relaxation. One of the most important parts of the prescription calls for deep-healing techniques, such as sharing feelings, taking care of a pet, and digital detoxing. Unplugging can have a powerful effect on the nervous system.

Love, social support and intimacy with an emphasis on feelings of love, connection, and community. Love and intimacy are healing, while loneliness and isolation are deadly. The authors point out that people who feel lonely, depressed, and isolated are 3 to 10 times more likely get sick and die prematurely from virtually all causes. Listening with empathy is a key to communication and connection and a building block of the lifestyle medicine program. The book recommends 5 daily practices that foster connection with others: smile and laugh freely, express gratitude, embrace forgiveness which is freeing, support and serve others, and participate in a support group. As Ornish wisely notes: “Compassion naturally flows when the divisions which separate us from one another begin to fade.”

The Ornish prescription aims to create a new paradigm by providing better care to more people at lower cost. It sets out to “undo” a wide range of chronic diseases and unhealthy lifestyle habits. The authors strongly believe that their lifestyle medicine program applies to all chronic diseases because they share many common underlying biological causes, mechanisms, and clinical pathways. People with heart disease, for example, also have high blood pressure, type 2 diabetes, elevated cholesterol levels, and obesity.

The guiding principle of the lifestyle medicine program is based on addressing the underlying causes of illnesses on multiple levels simultaneously. To illustrate: when a patient receives multiple heart bypasses, it is a clear that the underlying cause is being bypassed. The bigger picture is to prevent chronic illnesses in the first place—a major failing of the medical system and medical education.

“Undo It!” challenges providers, payers, and policy makers to fundamentally rethink what works and what does not for addressing what ills patients, particularly those with chronic disease. More of the same medicine will not improve population health status which continues to deteriorate despite extraordinary levels of private and public investment in medical care.

The Ornishes propose a sweeping re-set of how we view and manage disease. “Undo It!” serves as a comprehensive field guide and a call to action for the majority of Americans who contend every day with the debilitating effects of chronic disease. Whether people are highly committed to reversing their disease or interested in slowing their disease, the Ornish lifestyle medicine program offers a research-based behavioral regimen that is long overdue.

References

1. Overweight & Obesity Statistics. National Institute of Diabetes and Digestive and Kidney DIseases website. niddk.nih.gov/health-information/health-statistics/overweight-obesity. Published August 2017. Accessed October 2, 2019.

2. Health and Economic Costs of Chronic Diseases. CDC website. cdc.gov/chronicdisease/about/costs/index.htm. Accessed October 2, 2019.