Dean Ornish, M.D. at TEDxSF (7 Billion Well)

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Translator: Tanya Cushman Reviewer: Peter van de Ven It's great to be here today. I want to thank all the organizers for the chance to be here today and particularly Kunal. You know, we tend to think of advances in medicine as being a new drug, a new laser, something really high-tech and expensive, and we often have a hard time believing that the simple choices we make each day can make such a powerful difference, but they do. And in our work, we're using high-tech, expensive, state-of-the-art measures to prove the power of these very simple and low-tech and low-cost interventions. And since this a conference on global health, I wanted to begin with that. Many people don't know that more people are dying today in most parts of the world from heart disease, diabetes and other chronic conditions than AIDS, tuberculosis and malaria combined, and what's happening is it's drawing and diverting a lot of resources away from things that really do need drugs, like AIDS, TB and malaria, to things that can be largely prevented and even reversed through simply changing diet and lifestyle. And what's happening is that countries are beginning to eat like us and live like us and all too often die like us. And the irony is that the diet we found that can reverse and even prevent most of these conditions is the way that most of these countries were eating before they began to copy us. So this is still the steep part of the curve, so intervention now can make a powerful difference. And what's personally sustainable is globally sustainable; what's good for you is good for the planet, and here's why. You know, it's so easy to get overwhelmed by all the crises that are facing us now: the energy crisis, the global-warming crisis and the health-care crisis. It's like, what can I do as one person? But something as simple as what we choose to eat every day can make a difference. In the energy crisis, for example, 20% of the fossil fuel that we burn each day goes to make processed foods, which, themselves, are not so great for us. It takes 10 times more energy to eat higher on the food chain; when you're eating meat as opposed to a plant-based diet, it takes ten times more resources to make that possible. Michael Pollan calculated that a quarter-pounder with cheese takes 26 ounces of petroleum and leaves a 13-pound carbon footprint, which is equivalent to burning seven pounds of coal. So the next time you're having a burger, imagine you're eating 7 pounds of coal in terms of its impact on the planet. So, does it mean you should never eat meat? No. But even if you just have a meatless Monday, know that it's investing meaning in our actions, as Adam was saying before, is part of what makes them powerful and makes them sustainable. From a global-warming [perspective], many people are surprised to learn that livestock consumption accounts for more global warming than all forms of transportation combined. You know, it's responsible for 18% of the total world greenhouse gas emissions compared to the entire global transportation system that's only responsible for 13% of that. Livestock is responsible for even more of the most toxic parts of the gases. Methane, for example, from cow farts is 23 times more toxic to the ozone layer than even carbon dioxide. And nitrous oxide is almost 300 times more toxic to the ozone layer than - let me see if I can get this slide back up - than CO2. So these simple changes can make a powerful difference in not only how long we live but also how well we live. From the standpoint of eating meat, again, what's good for the planet is good for you; what's bad for the planet is bad for you. Eating meat - a number of studies have come out showing that red meat consumption increases total cardiac mortality, cancer mortality and all-cause mortality. I like this cartoon - it's cows going off to the slaughterhouse saying, "My only consolation is that by eating us, they're killing themselves." (Laughter) From a health crisis - you know, three-quarters of the 2.8 trillion dollars that we spend each year on healthcare costs, which are really, for the most part, sick-care costs, are for chronic diseases that we can largely prevent or even reverse simply by changing diet and lifestyle. This is just one of many studies that showed in large numbers of people, walking a half-hour a day, not smoking, eating a reasonably healthy diet and keeping a healthy weight prevented 93% of diabetes, 81% of heart attacks and so on. And these are probably underestimations - it's probably more than that. Well, how do we treat heart disease in the USA? Generally, with a lot of drugs and surgery and money. We spend 60 billion dollars on angioplasties and stents in the last year we have data on them. You say, "It's a lot of money, but think of all the lives it saves." Except that it doesn't. The latest randomized trials - a total of 8 of them - were reviewed recently in the Archives of Internal Medicine. They found that unless you're having a heart attack, which most people getting angioplasties and stents are not, they don't prolong life, prevent heart attacks or even reduce angina. And so the same is true for bypass surgery. Unless you're the one or two percent of people who has the most severe disease, they don't prolong life or prevent heart attacks. That's 100 billion dollars for two operations that are dangerous, invasive, expensive and largely ineffective. The cartoon says, "I can operate or you can go on a strict diet." He says, "Well, you better operate because my insurance doesn't cover a strict diet." That's the problem; with all this talk about evidence-based medicine, reimbursement is really a much more powerful determinant of how we practice medicine. Now, you find the same patterns with prostrate cancer. The New England Journal of Medicine had two major studies. They showed that only 1 out of 49 men who was treated for prostate cancer with surgery or radiation actually lives longer because of it. The other 48 tend to become either impotent or incontinent or both. So you take a guy who's often in the prime of life, 50s or 60s, find out they have early-stage prostate cancer, scare the hell out of them. They end up having an operation that doesn't really help them, but it maims them in the most personal ways - now they're wearing diapers and can't have sex - for no benefit. But the alternative is to say let's just do watchful waiting, under a sword of Damocles, for something bad to happen, and that's not very good. So the U.S. Preventive Services Task Force recently recommended maybe we shouldn't even screen them for prostate cancer because it's too hard to know that you have it and "not do anything about it." But here again is a third alternative, as I will show you, when you change your diet and lifestyle, you can slow, stop or reverse the progression of early-stage prostate cancer without having to do that. Now diabetes is another issue. Type II diabetes is a global epidemic; it's a pandemic. Already, a third of Americans are diabetic or prediabetic. In the next eight years, it's estimated to be half of Americans, at a cost of 3.3 trillion dollars - clearly not sustainable. Now, it turns out that lifestyle changes are actually better than drugs at preventing diabetes. This was a major study that was in the New England Journal ten years ago. It showed that lifestyle actually worked better than a drug to prevent diabetes. But lifestyle changes are also better than drugs at treating diabetes. This was in the New England Journal a year and a half ago. They had two drugs to lower blood sugar; they found it didn't work nearly as well to prevent the complications of diabetes as doing it through lifestyle. And the complications of diabetes are pretty awful: heart attacks, strokes, amputations, blindness, kidney failure and so on. But if you get someone's blood sugar down through diet and lifestyle, you can prevent all of these complications, both the human cost as well as the economic cost. And my colleagues and I at the nonprofit Preventive Medicine Research Institute have trained about 55 hospitals and clinics around the country, including 24 in West Virginia, Nebraska and Pennsylvania, and we've found that in looking at large numbers of patients, we could get their blood sugar down to a level that we can prevent all these costs and complications simply by changing diet and lifestyle and at a fraction of the cost, and the only side effects are good ones. So what are we doing? Well, it's what we eat, how we respond to stress, how much we exercise we get - just walking a half-hour every day - and how much love and intimacy and social support we have. But this really goes back to a very radical concept - radical in the sense of getting to the root of something - which is what is the cause? And we spend so much time in medicine mopping up the floor around the sink that's overflowing without also turning off the faucet. And it's a simple idea, but it's a powerful one. Because if we can treat the cause, what we find - the cause, by the way, are the lifestyle choices that we make each day, for the most part. Otherwise the doctor says, "Take these cholesterol-lowering drugs, take these blood pressure pills, take these pills for lowering your blood sugar." "How long do I have to take them?" "Forever." It's like how long do I have to mop up the floor? Well, forever. Why don't we just turn off the faucet? Why don't we treat the underlying cause, and when we do that, we find that our bodies have a remarkable capacity, in most cases, to begin healing, and much more quickly than we had once realized because these biological mechanisms are exquisitely sensitive and highly dynamic. And it's not just lifestyle as prevention, but it's also lifestyle as treatment. Now, I began doing this work 35 years ago when I was a medical student, and I took ten men and women with bad heart disease, put them in a hotel for a month, and we used what was then a new test called thallium to measure blood flow. And you can see around ten o'clock there, in the upper left, there's a black area where their blood flow should be going. A month later, in the same patient in the same area, you can see there's much more blood going there. But we only had ten patients, no control group. So I went back to school, finished medical school, and before starting my internship, did a second study. This time we had a randomized control group for comparison, and we found that the people who made these changes got better; those who didn't got worse. The differences were highly significant. We published it in the journal of the AMA. Went to Boston, finished medical training, moved to San Francisco in 1984, began the lifestyle heart trial. We used quantitative arteriography to measure the blockages. In the upper left, where the arrow is, is a narrowing in a main artery that feeds the heart, because it's clogged. Just a year later, it's wider. And because the blood flow is a fourth-power function of the diameter, the actual blood to the heart was increased by 200-300%, which we measured using what are called cardiac PET scans. The lower left picture is the beginning: blue and black is no blood flow. A year later, lower right - it's orange and white - it's maximal blood flow. You can see these are dramatic changes. And what we found overall is that the control group, who made more moderate changes - got worse after one year and even worse after five years - that's what usually happens. But instead of getting worse and worse, these patients actually showed some reversal after one year and even more after five years. This is the first time that was shown. Now, to put a human face on this, I just want to show you a one-minute clip from a new documentary called "Escape Fire," that came out last month in theaters around the country. It's available on iTunes and Amazon and so on. And the filmmakers want this to be to medicine what "An Inconvenient Truth" was to global warming. So, take a look. (Video) 25 years ago, I had five restaurants in San Francisco. It was a great life. I smoked six cigars a day. Ten cups of coffee. A lot of wine. It was wonderful. And I had a massive heart attack. I was in the hospital for two weeks. I could hardly just about walk three steps, and I'd have to stop and rest. I was popping 20 or 30 nitrols a day. But then Dean Ornish was starting his program to see if he could reverse heart disease through lifestyle change. And he went to my doctor and asked if he could approach me. He told Dean, "How long is the program?" He said it was a year. And my doctor told him he wouldn't recommend taking me, because he didn't think I would live the year. So he figured I was going to die because I was in such bad shape. And now, 25 years later, and I'm in pretty good shape. Dean Ornish: His doctor, unfortunately, passed away in the meantime. (Laughter) But you know, this is a guy who hasn't had chest pain now in 25 years, who couldn't walk across the street. It's why I'm so passionate about this work; it's the kind of thing we see all the time, in thousands and thousands of patients. So we wondered if maybe this could help prostate cancer too. So we did a study in collaboration with Dr. Peter Carroll, the Chair of Urology here at UCSF, and the late Dr. Bill Fair, who, at the time, was the Chair of Urology at Sloan-Kettering in New York. And we took men who had biopsy-proven prostate cancer but had elected not to be treated for reasons unrelated to this study so that we could divide them randomly into two groups, ask one group to make these lifestyle changes, but not the other, and see what happened without being confounded by the usual chemo and radiation and surgery. We found the PSA levels - a marker for prostate cancer - went up or got worse in the no-change group, went down or got better in the group that did. These differences were highly significant and were in direct proportion to the degree of change in lifestyle, the same we saw in heart disease: the more people change, the more they improve. We looked at the effects when adding their serum to a standard line of prostate tumor cells growing in tissue culture, the tumor growth was inhibited 70% versus 9%. And one of the coolest slides: the more people changed lifestyle, the more it directly inhibited the growth of prostate tumors growing in tissue culture. Through John Kurhanewicz's lab, here at UCSF, we did MR spectroscopy showing the tumor activity, in red here, was diminishing in this patient after a year as well as the PSA going down. So taken as a whole, this is the first, and still only, randomized trial showing that the progression of men with early-stage prostate cancer can be slowed and stopped and often even reversed simply by making changes in diet and lifestyle. So we wonder what some of the mechanisms might be to help explain that. And we found that gene expression was changed in over 500 genes in just three months. And in fact, turning on or up-regulating the good genes that protect us, down-regulating the bad genes that cause inflammation and oxidative stress and also the RAS oncogenes that promote prostate, breast and colon cancer were down-regulated or turned off - hundreds of them in just three months. This is what's called a heat map: you can see on the right are the oncogenes, and red is mostly turned on. Three months later, green is mostly turned off. It's amazingly powerful. We did a study with Dr. Elizabeth Blackburn, who won the Nobel Prize for discovering telomerase, which is an enzyme that repairs and lengthens damaged telomeres - the ends of our chromosomes that control how long we live - and also Dr. Elissa Epel, who'll be presenting later today. What we found was that the telomerase could increase by 30% in just 3 months, and no study has shown that. And we're about to publish the five-year follow up and show that the telomeres themselves actually get longer when you make these changes. It will be the first study to show that too. If this was a new drug that could lengthen your telomeres, it'd be a multi-billion drug overnight, but it's the same lifestyle changes that do all these things. It's not like there's one for diabetes, one for heart disease and so on. And we found, again, the more lifestyle changes people made, the longer their telomeres got. We also found that angiogenesis changes. This is the first study to show that. We found that we could down-regulate VEGF, which tumors secrete to cause blood vessels to grow and feed them. Drugs like Avastin and Nexavar inhibit VEGF, but they cost $100,000 a year, per person, to take. This is, again, for free; it's just the same lifestyle changes. So, the more we look, the more mechanisms we can invoke to explain why these changes are so powerful and make such a difference. Our genes are our predisposition, but our genes are not our fate. I found that very empowering. We also found that this was not only medically effective but cost effective. Mutual of Omaha found they save $30,000 per patient in the first year. Highmark Blue Cross Blue Shield found they could cut costs by 50% in the first year and by an additional 20 to 30% in years two and three. And finally, a year and a half ago, after 16 years of review, Medicare agreed to cover our program, which was a real game changer because, again, reimbursement is such a primary determinant of medical practice; you change reimbursement, you change medical practice, even medical education. So we're in the process now of training hospitals and clinics around the country. If you're interested in learning more about our work, go to our website. Or if you're interested in being trained. Our role - our goal is to - we train a team of six people: a doctor, a nurse, a stress management specialist - essentially a yoga-mediation teacher - an exercise physiologist, a dietitian and a psychologist who work together as a team with the doctor as quarterback. And it enables us to reclaim our world as healers and not simply as technicians. Vinod Khosla, speaking later today, was quoted on a controversial statement that we doctors are going to be replaced by an iPhone app before too long. And if all we are are just a collection of algorithms, then that's true. But we're more than that; it allows us to get re-enchanted with medicine and to reclaim our role as healers and not just technicians. We train the St. Vincent de Paul homeless shelter here in San Francisco. They're over 20,000 patients who've gone through our clinic in the last 1.5 years, and now with the Medicare reimbursement, it's financially stable, and we can now clone this around the country without needing ongoing philanthropy to support them. But the other big epidemic besides heart disease, obesity and diabetes is depression and loneliness. Study after study has shown that people who feel lonely and depressed are many times more likely to get sick and die prematurely than those who have a sense of love, connection and community. We found we could cut depressions scores in half simply by changing diet and lifestyle - comparable or even better than what you get with antidepressants. And you know, because there's been a breakdown of the social networks that used to give us a sense of connection and community; many people don't have a job that feels secure, a neighborhood with several generations of neighbors living together, an extended family or even a nuclear family that you see regularly. These things affect the quality of our lives, but they actually affect our survival. And Nick Christakis's work found that these social networks were so powerful that if your friends are obese, you're 45% more likely to be obese. If your friends' friends are obese, 25%. If your friends' friends' friends are obese, 10%, even if you've never met them. And you can see this with other behaviors as well; that's how powerful these are. The last thing I want to say is that anything that creates a sense of trust leads to intimacy, leads to healing and meaning. The word "healing" comes from "to make whole." "Yoga" - "to yoke, to unite, to bring together." These are old ideas that we are rediscovering. And you find this as part of all spiritual traditions: altruism, compassion, forgiveness and love - not to get some external reward in the next lifetime, but that's what frees us from our isolation, and our depression and our suffering here and now. My dad died a few months ago; my mom had a stroke, a debilitating stroke, soon after; my dog of 14 years got bit on the nose by a rattlesnake - all this in the last few months - and died. You know, life is short and life is precious. And what I'm most interested in is not simply unclogging arteries or showing all these kinds of things - as interesting as they are. We're all going to die. The mortality rate is still 100%; it's one per person. (Laughter) I got profoundly and suicidally depressed when I was in college. That was my doorway into this area. For someone else, it might be a heart attack or a stroke. But, you know, change is hard, as Adam mentioned earlier. But when you're in enough pain, suddenly the idea of change becomes more interesting. And what I find I'm most passionate about, what I find most interesting is how we can use the experience of suffering as a doorway for transforming our lives and finding meaning, and then we can often get curing, but we can always get healing. Thank you so much. (Applause)
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Channel: TEDx Talks
Views: 230,948
Rating: 4.8625078 out of 5
Keywords: tedx talk, tedx talks, ted, ted talk, ted x, ted talks, tedx
Id: QYmInK5xo6g
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Length: 20min 3sec (1203 seconds)
Published: Sat Nov 17 2012
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So you posted this just so that you could rage? Go start /r/paleozealots or something and post there instead.

👍︎︎ 1 👤︎︎ u/grapekayak 📅︎︎ Nov 21 2012 🗫︎ replies
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