Recently, Dr. Dean Ornish, a senior student of Swami Satchidananda and a pioneer in lifestyle medicine, was interviewed by plant-based diet guru John Robbins as part of the 2019 Food Revolution Summit sponsored by the Food Revolution Network. Here is a transcript of this interview, which highlights Dr. Ornish’s most recent research in relation to reversing Alzehimer’s Disease and his latest theory that most chronic illnesses share the same underlying causes, and how diet, Yoga, meditation, and social support are able to turn on good genes and turn off bad genes.

Ocean Robbins: This is Ocean Robbins and I am joined by my dad and colleague John Robbins in welcoming our guest, Dr. Dean Ornish. Dean Ornish MD is founder of the Preventive Medicine Research Institute, clinical professor of medicine at UCSF and author of multiple bestselling books including his latest written with his partner Anne Ornish, Undo It: How Simple Lifestyle Changes Can Reverse Most Chronic Diseases. Dr. Ornish’s 40 years of research, has scientifically proven that the lifestyle changes he recommends can improve heart disease, type two diabetes, prostate cancer, and lengthen telomeres which begins to reverse aging on a cellular level. The Ornish program was the first lifestyle-based program to be covered in the history of Medicare. Dr. Ornish has been recognized by Life magazine as one of the 50 most influential members of his generation and by Forbes as one of the seven most powerful teachers in the world. My Dad and I both consider Dr. Ornish to be a treasured friend and he’s one of the great leaders of our times. Dean, we’re so glad to have this time with you. And now for the interview, I’m going to hand it over to my dad, John Robbins.

John Robbins: Well, thank you Ocean and thank you Dean for being with us once again.

Dean Ornish:  I’m honored to be here and I feel like I should be quit now after such a nice introduction.

John:              Well it’s well deserved and Ocean referred to your program, Dr. Ornish Program for Reversing Heart Disease being now covered by Medicare and Medicaid. And this is the first time that Medicare or Medicaid has ever provided coverage for a lifestyle medicine intervention to reverse heart disease. But it doesn’t stop there because many commercial insurance companies now are also covering your program. And what’s remarkable is that some of these are covering it not only for reversing heart disease, but also for reversing type two diabetes, high blood pressure, obesity, elevated cholesterol levels. It’s amazing to me how these same lifestyle changes that you’ve shown so convincingly can reverse heart disease, can also reverse so many different chronic diseases.

Dean:             Well, it’s true and I appreciate what you’re saying. You know, in the 1990s, my colleagues and I, at our nonprofit Preventive Medicine Research Institute, trained about 53 hospitals and clinics around the country, some of the most prestigious academic medical centers, community hospitals and we got it, all of them. Bigger changes in lifestyle, better clinical outcomes, bigger cost savings, better adherence than anyone had ever published before. But it was distressing because the number of the sites, a few of them anyway, closed down because we didn’t have the insurance and Medicare reimbursement. And so a painful lesson for me was that it’s not enough to have good science, it’s not enough to have a good clinically effective program. As the rappers would say, “It’s all about the Benjamins.” It’s all about the reimbursement. And so we were going insurance company by insurance company and several were covering it, but I realized that most people don’t go into the insurance world because they’re entrepreneurial or visionary.

So I thought, well, if Medicare would pay for it, then that would really be a game changer. And because I’d been working with Bill Clinton when he was president and Newt Gingrich when he was speaker of the house, even though our politics are very different, these are issues that really transcend politics. And they were both very supportive and we had numerous members of the Senate, the House, all the major health organizations, but it still took us 16 years to get Medicare to do it. But they did. And I’ve always remained grateful to CMS for doing that because when you change reimbursement, it changes not only medical practice but even medical education. And so now we’ve been doing the same thing— training hospitals and clinics and physician groups. And as you indicate, now that Medicare is covering it, most of the major insurance companies are covering and in all 50 states. And Blue cross/Blue Shield and others are covering it as well. And again, we’re finding that it’s working. One of the nice things about doing something for 40 years is that you can make a lot of mistakes along the way. And I learned a lot and grew in wisdom by doing that. And so, just by virtue of the fact that we’ve been doing it so long, we’re getting these amazing couple of outcomes, but more importantly, we’re really trying to create a whole new paradigm of healthcare rather than sick care.

John:              Healthcare rather than sick care. That’s a pivotal shift. Most of what modern medicine does, I think would be more accurately called disease management. One of the many things I appreciate about your work, Dean, that you’ve been doing for so many years, is that you’re leading the way to true healthcare. I mean, you’re a pioneer in developing the field that’s now being called lifestyle medicine and lifestyle medicine goes beyond the proven power of a healthy lifestyle to prevent many diseases.

Prevention is really important, but you’re demonstrating that these simple yet powerful lifestyle changes can be a form of treatment; that they can reliably reverse diseases that otherwise often prove fatal. Now you’ve conducted and you’ve published studies showing that the lifestyle changes you advocate are able to revers, to undo as you put it, heart disease, type two diabetes, high blood pressure, depression, obesity, and many other chronic diseases. Now, in recent years, working with Dr. Peter Carroll, the chair of the Department of Urology at the University of California, San Francisco, you conducted the first randomized trial showing these same lifestyle changes could slow stop and even reverse the progression of early stage prostate cancer in men and by extension breast cancer in women and you publish that study with truly one of the great luminaries and understanding the human genome.

Dean:             We published that with Craig Venter, who first coded the human genome. During the proceedings of the National Academy of Science we said we found that over 500 genes were changed in all the three months—upregulating and turning on the good genes and downregulating or turning off the genes that tend to cause all these chronic conditions. We then did a study with Elizabeth Blackburn, where we found these same lifestyle changes could actually lengthen telomeres, the ends of our chromosomes that regulate how long we live. And when the Lancet published this, they sent out a press release worldwide and they called it reversing aging at a cellular level. And we just began a few months ago, the first randomized trial to see if we could reverse the progression of men and women who have early stage Alzheimer’s disease. And our preliminary data are very encouraging.

John:              Well that sounds fabulous. Can you tell us a little bit about your new book that you’ve written with your wife, Anne?

Dean:             The new book that Anne and I wrote called Undoing It, is based on this new unifying theory that we’re putting forth, which is that although as a doctor I was trained to view all these different diseases as being very different from each other—that heart disease is different than prostate cancer or diabetes for example—but the theory that we’re putting forth is that they’re really not different. They’re really the same disease manifesting in different ways and they all are manifestations of the same disordered underlying biological mechanisms.

Things like chronic inflammation, oxidative stress, changes in things we talked about in gene expression and telomeres and angiogenesis and the microbiome and so on. And how one of these mechanisms in turn is affected by what we eat, how we respond to stress, how much exercise we get and how much love and support we have or to reduce it to its essence, which is really what the book is designed to do: to eat well, move more stress less and love more. Boom. That’s it. And the more diseases we study and the more underlying mechanisms that we look at, the more evidence we have to show why these simple changes are so powerful and how quickly we can show improvements.

John:              Well, most physicians today are still trained to think of heart disease and diabetes and prostate cancer and other chronic illnesses as being fundamentally different from each other. They entail different diagnostic categories. They’re thought of as distinctly different diseases. They’re treated by different specialists. It seems to me that one of the most important implications of your work is that it’s suggesting that we should stop seeing chronic diseases as being fundamentally different from each other. Dean, should we begin instead to see them as diverse manifestations and expressions of similar underlying biological mechanisms, all of which are powerfully affected by the lifestyle choices we make every day?

Dean:             Yes. That’s really the theory in a nutshell, and it seems so obvious now, although to be honest, the best theories are those that people say, “Yeah, that’s obvious,” except no one’s said it before. I mean, look at 50 or 60 years ago in China and Japan, they had a fraction of these chronic diseases that we have in this country, but their genes have the same diversity that we have here. And so, but there they have a fairly homogeneous wholefoods plant based diet. And they tended to exercise and have strong social ties. They had love and support. And when those got disrupted when they moved to this country—or even in their countries—and started to eat like us and live like us all too, they often now die like us.

And the incidents of those chronic diseases that we have here is now getting to those countries. And it’s one of the reasons why they found the same what are called comorbidities. You know, people generally have more than one of these diseases. At the same time, most people who have heart disease may also have high cholesterol, high blood pressure, type two diabetes and so on, because they all travel along the same mechanisms. You know, if you’re talking about, a targeted immunotherapy for pancreatic or melanoma, that’s awesome. But for the vast majority of chronic diseases, they’re all caused by these same mechanisms. And so we found that we are healthier with a whole foods plant based diet that’s naturally low in fat and sugar, various stress management techniques, including meditation and Yoga, walking or whatever kind of aerobic and strength training and stretching exercises you do, and what we call psychosocial support, or love and intimacy. And, that’s the same program we’ve been doing for 40 years. The more diseases we studied, the more evidence we have published in all the leading peer reviewed and medical and scientific journals that it works.

John:              What continues to amaze me is that it seems like the more diseases you study and the more underlying biological mechanisms that you research, then the more scientific evidence you have to explain why these simple lifestyle changes are so powerful.

Dean:             It’s true and sometimes the simplicity of it can actually be hard for people to really understand. It’s like, you know, we think it has to be complicated and high tech and expensive to be powerful. And I guess our unique contribution has been to use these very high tech expensive state of the art scientific measures to prove how powerful these very simple and low tech and low costs and often ancient interventions can be.

John:              You mentioned a moment ago that you’ve begun a randomized trial to see if your program can reverse the progression of early stage Alzheimer’s disease and that the results so far are encouraging. Can you tell us more about that?

Dean:             Yeah, I think we’re at a place with Alzheimer’s disease, similar to where we were with heart disease 40 years ago when I did my first study back in 1977. In other words, there’s every reason to think it’s going to work, but no one’s really done it  in a randomized trial. And we’re working with the top people in these different disciplines and we hope to show that. And by the way, it’s personal for me because my mom died of Alzheimer’s. She had a master’s degree in journalism that she got when she was like 17 or 18 years old. When she got Alzheimer’s, it was just so devastating to all of us to see such a brilliant mind just slowly degenerate. And so I have a personal interest in this as well.

So we’re taking men and women who have early Alzheimer’s, randomly divided into two groups, putting half of them through this program and half of them not. And then comparing them and then we’ll cross over the control group and they’ll get it too and we’ll compare them again. So I’m cautiously optimistic, but since there are no good drugs either for treating it or for preventing it, if we can show that we can actually reverse it, then clearly we will be able to prevent it. And I think that will give literally millions of people new hope and new choices. I think what distinguishes our work is that we always do good science on things before we recommend them. It’s why Medicare decided to cover our program. Because, to me, the whole point of science is to try to sort out what’s true and what isn’t and what’s real and what’s not. And so everything that we’ve written about in our new book is, although it’s written in a very simple way, it has lots and lots of scientific references to support all of those statements that we make.

John:              It’s a beautiful book. I’ve been reading it and enjoying it and, and being inspired by it. You wrote it with your wife and this is the first, I think, book of your many great books that is co-written with somebody and this one is with your wife. What’s that about for you? What’s the meaning of that for you?

Dean:             Well, what level do you want to talk about that?

John:              Whatever you want.

Dean:             Well, I’ll talk about it on several levels. First of all, Anne and I have been working together for over 20 years and we’ve been married for much of that time. Anyway, she developed the whole learning management system for all of the training that we’re doing for these Medicare-covered hospitals and clinics and physician groups. It’s a brilliant combination of synthesizing all of our work and to kind of 18 turnkey sessions complete with video and PowerPoints and evidence and all of that lecture notes and so on. And so when we did this book together, I thought, this is a chance for her to have her kind of coming out for people to really see how amazing she is. But more than that, we really complement each other in ways that are synergistic.

Just kind of like you and Ocean do that, I tend to be more of the hardcore science part. Whereas she has advanced training and Yoga, meditation, and in healing of a different number of different modalities. She was on the cover of Yoga Journal 10 years ago. I tended to say the why and she tends to show how, and it’s a nice thing and it worked out well and we, we have different sections, so the publisher wanted us to kind of mesh our voices together, but we wanted to have each one of us have our own distinctive voice. So I think it works better that way. I’d be curious to know what you think. And it also was a really wonderful experience except for the chapter on love where we had a big fight!

John:              Really?

Dean:             Well, mainly because I think I want it to be a little more self-disclosing about our personal life and she felt uncomfortable doing, it was not an angry fight. It was just more of a difference of opinion. But the irony was not lost on us. But, it was actually a beautiful thing.

John:              Well I think the ability to have healthy disagreements and to work them through so you arrive at some kind of a step or process or decision, or a way to proceed that’s better than either of you would have come up with on your own, is a sign of a healthy relationship.

Dean:             It’s true. It’s true.

John:              In the book you talk about inflammation a lot and inflammation is clearly chronic inflammation. I’m talking about not an acute inflammation, which has a role in a lot of healing situations, but chronic inflammation underlies a lot of the chronic diseases of our times. Can you talk a little bit about the role of chronic inflammation in prostate cancer, in diabetes and heart disease, in the many chronic illnesses that your program is so successful in reversing and in preventing?

Dean:             You know, one of the underlying themes of the book is that the same mechanisms that we’ve evolved to help us survive in a key situation can actually be harmful or even lethal. And chronically stimulating the fight or flight response is an example of that. If you are walking along in the jungle and a saber tooth tiger jumps out at you, you want your arteries to constrict and you want your muscles to tense up, to help give you more body armor. You want your blood to clot faster and your arteries to constrict so you don’t bleed as quickly. You want your heart to go pounding and your eyes to dilate, so you see better and so on, but then the harm is over: you kill the tiger, the tiger eats you, or you run away. But one way or other it’s over.

But in modern times, those mechanisms are so chronically activated that for example, it’s not just the arteries in your arms and legs, that constrict—it’s ones in your heart. It’s not just blood clots that can form if you get bitten in your arm, but in your arteries of your heart or in your brain that can cause a heart attack or stroke as in the same entity. The chronically tense muscles can cause back pain and chronic other conditions like that. And the same is true of chronic inflammation that we know that an unhealthy diet, particularly one that’s high in protein and fat and refined carbs, as well as not exercising and to be under chronic stress and being isolated and depressed—it’s one of those that can increase chronic inflammation or as a healthy diet, moderate exercise, stress management and love and intimacy will decrease it. So in the short run, inflammation is a really powerful way of your body healing itself. When it’s injured, whether it’s through an invasion of bacteria or viruses, or whether it’s getting injured, or whatever. And it allows infections in wounds to heal and toxins to be eliminated but these same inflammation that can be healing in the short run can be deadly when it’s chronically activated because it’s just another example of too much of a good thing.

John:              When it’s chronic, when it lasts for years, then inflammation plays an important role in the development of just about every major chronic disease including heart disease, type two diabetes, dementia, autoimmune diseases, cancer, and depression. Dean, what happens in our arteries when there’s chronic inflammation?

Dean:             In your arteries, chronic inflammation injures the lining of your arteries. It’s kind of like I’m putting a Band-Aid on an injury and then putting a Band-Aid on top of that. And so over time that can lead to blocked arteries or atherosclerosis and also, inflammation makes those plaques unstable. So it’s actually the 20 to 30 percent of blockages that are more likely to cause a heart attacks than in the 90 percent ones because at the time an artery is 90 percent clogged, that’s fairly stable and it has a network of blood vessels called collaterals around it. But if you have a 20 or 30 percent blockage that is inflamed, the plaque can cause arterial rupture, that’s called catastrophic progression, which is as bad as it sounds. It can go from 30 to 100 percent all at once in your brain. Chronic inflammation can lead to, and I don’t like sounding depressing, but can lead to Alzheimer’s disease or the buildup of what’s called amyloid plaque and what are called tower neurofibrillary tangles in your brain, that kind of short circuit the neurons and causes them to degenerate and not to be able to communicate with each other and your joints. Chronic inflammation can lead to arthritis and affect your pancreas. It can lead to type two diabetes. The genes that promote prostate, breast, and colon cancer do so in part by causing inflammation at every stage when the cancers grow.

So it’s just one example of many of these things that caused all these different diseases. Chronic inflammation is one overstimulation of the sympathetic nervous system, which causes the chronic stress we’ve talked about. Changes in the microbiome and what’s called oxidative stress and angiogenesis and gene expression and telomeres and immune function. Every one of these plays a role in these same variety of diseases and every one of them is affected by all of these: move more, stress less, and love more.

John:              Well, you just mentioned the microbiome and I’m aware of a study that compared the microbiome of people eating a vegan diet, eating a vegetarian diet, and eating a typical American diet, an omnivorous American diet. And the researchers found that those who were eating the typical American diet had a higher proportion of those types of microbes that are associated with chronic inflammation and insulin resistance and cardiovascular disease. Now we have over a hundred trillion organisms growing inside our bodies. And this is what is now known as the microbiome. How does the lifestyle changes and in particular, how does the diet that you advocate affect the microbiome?

Dean:             Before I answer your question, I just want to comment on something. I was trained as a doctor to view microbes as kind of the enemy. We used terms like, the “therapeutic armamentarium,” this kind of whole language of warfare. But, most of these organisms actually live in a symbiotic relationship with us. They’re actually essential to our health and they keep us healthy in lots of different ways. They were kind of like a coral reef. We have all these different life forms living together. They’ve kind of evolved with us over a period of thousands and thousands of years, whether it’s in your skin, mouth, nose, and they have a profound impact on our health for better and for worse.

Your microbiome contains more than a hundred times as many genes as we have in our own genes. And these genes can generate a variety of proteins and these proteins acts as switches—they can turn on and turn off the processes in our neurotransmitters and hormones for better for worse—we’ve found that in just 12 days, when people went into our program. We haven’t published this yet. There were significant changes in the microbiome, getting away from the harmful ones to the ones that are healing. You know, even a single course of antibiotics can change your microbiome to such a large degree that may take a year for it to kind of get back to normal if you don’t make any big changes in your lifestyle.

John:              Dean, as you described, the importance of the microbiome to our health and the fact that antibiotics can disrupt the microbiome. I’m also wanting to add that antibiotics have saved many lives and when rightly used, they are among the miracles of Western medicine. But today most of them are not being rightly used. More than 80 percent of the antibiotics made in the United States are not given to people suffering from bacterial infections or given to people to prevent bacterial infections. Instead, they’re used as feed additives in factory farms and today’s industrial meat producers do this because it enables the animals to survive and to gain weight. Under the grotesquely cruel and filthy conditions in which these animals are forced to live in factory farms. And I hate to say it, but people who eat modern meat today have misery on their menu because of the brutal and intensely inhumane conditions that are made possible in part by the use of hormones and other drugs and antibiotics.

Dean:             And because of this, a lot of infections were beginning to emerge, which we don’t even have good drugs for. It also is another good reason for eating a plant-based. John, you and I have written about this a lot. This is causing drug resistant bacteria to emerge that can actually spread from animals to humans. And almost a half million people in the US alone get sick every year by antibiotic resistant foodborne bacteria. And also these antibiotics that we feed animals are often frequently found in the meat you buy at the grocery, which further contributes to antibiotic resistance. Not to mention the fact that, as you know, we both have written about it, it takes 10 to 14 times more resources to make a pound of meat-based protein than plant-based protein. So it’s so easy to feel overwhelmed. Like what can I do as one person about global warming or feeding the hungry?

And what I’m learning is that what enables people to make sustainable changes in their diet and lifestyle is not fear. It’s joy and pleasure and meaning. Like when we connect a sense of what we eat to a sense of meaning and purpose. For example, if I say, okay, I’m choosing not to eat meat in this particular meal, because it’s going to free up resources to help the planet heal and it’s going to free up resources to feed the hungry, then I have used those choices with meaning. You know, there’s a wonderful film that James Cameron just came out with called Game Changers. He and his wife Susie became vegan about eight or nine years ago, mainly for environmental reasons. And then he found you felt so much better.

He’s now making Avatar two, three, and four at the same time I visited their set. It’s amazing how much energy he has and he’s in his mid-sixties now. He decided to make a film to try to motivate people to get away from this idea that vegans are wimps and you don’t get enough protein and all that kind of stuff. And focusing on elite athletes who became vegan and whose games elevated and became world class champions when they became vegan. Everyone from mixed martial artists, Olympians to NFL players and so on. And they told me that the film crew became vegan after shooting that, and so it reframes the whole idea of making changes in diet and lifestyle. You know, the fear approach, which is really not sustainable, but joy and pleasure and feeling good and love and meaning are the things that really make these changes sustainable. That’s a better message then, “You’re going to die if you don’t make these changes,” you know?

John:              A lot of us were raised to believe that animal protein is superior to plant protein. It’s the gold standard. We were told it’s the only truly complete protein we were told and some of us are still being told that. We do on the other hand, have compelling evidence that animal protein dramatically increases the risk of premature death. There was one study very recently, over 6,000 people, middle-aged people. They were from 50 to 65 years of age and the study found that those whose diets were high in animal protein had a 75 percent increase in overall mortality and a 400 percent increase in cancer deaths and a 500 percent increase in type two diabetes during the 18 years that the study was carried on. Now you’re familiar with that study?

Dean:             Yeah, I cited in my book.

John:              Well, it seems that those whose diets were high in plant proteins substantially reduced their risk of premature death in every one of the categories that were being examined. And yet many people today still believe that it’s hard to get enough good protein on a plant-based diet. It seems to me that is one of the obstacles in our society to taking the steps.

Dean:             You know, I’m a veteran of all the fat versus carb debates. I ended up getting stuck with being known as the low fat guy and it’s never been just about fat. It’s not even just about fat and carbs, it’s about animal protein, because there’s more and more evidence showing that animal protein is really highly inflammatory. And inflammation, as we’ve been talking about is one of the underlying mechanisms. But you’re going to get plenty of protein on a plant-based diet. If you have a rice and beans, that’s a complete protein and it’s no different from the protein that you find in an egg or a steak or anything else. And you’re not getting the animal protein that’s inflammatory and all of a saturated fat and cholesterol and now antibiotics and sulphates that can cause you to get sick.

And it used to be believed that you have to get them all in the same meal and now we know that you don’t have to, not even necessarily in the same day—your body stores and recycles amino acid. So as long as you’re getting a reasonably good variety of foods, including legumes and enough calories to maintain your weight, you’ll get plenty of protein. You know, all plants contain protein. So rice and beans or rice and tofu, barley and lentils, and some plant based foods themselves are complete protein there, like quinoa. And so it’s really a prevailing myth that you don’t get enough protein on a meat-based diet. And in fact, most people get too much protein, which has its own set of problems in terms of inflammation and kidney disease and other things like that.

And the related prevailing myth that you need meat to be strong. But again, as we’ve been talking about, the word’s getting out among world class athletes that eating a whole food plant-based diet actually makes you stronger. The world’s strongest man is one a plant-based diet.

And remember, my spiritual teacher is Swami Satchidananda. He used to like to make puns. When people asked, “Are you a Hindu?” He would say, “No, I’m an undo.” It was just part of the reason why we call the book, Undo It. He’d always say, “You don’t think you’re going to be strong enough on a plant-based diet. Go ask Mr. Elephant because elephants eat more plant-based, and they’re among the strongest creatures on the planet.” Or, gorillas, or this guy named Patrick, who is a vegan, who broke the world record for the most, carried weight that was carried by a human being when he hauled over 1200 pounds over 10 yards across the stage. And Arnold Schwarzenegger, another very well-known bodybuilder, is featured in the Game Changers film. And he said, “I know this world of bodybuilding very well and I can tell you that I’m stronger now than I was when I was eating meat.”

John:              Well back to inflammation for a moment. Does animal protein increase the production of blood chemicals that promote chronic inflammation?

Dean:             Animal protein does and increase chronic inflammation. There are switches called histones and non-histones and methylation that basically turn genes off and on. So these switches are proteins that do that—for better and for worse. And there’s enzymes that wrap around your DNA, around these histone proteins, as a way of turning off the harmful genes. Think of them as anti-aging proteins. And so the more we kind of drill into this, we begin to understand how the proteins in the plant-based diet tend to turn on the good genes and turn off the bad genes. And that’s what we found in the study that we published with Craig Venter where we found that over 500 genes were changed in just three months. You know, turning on the good genes and turning off the bad genes, and particularly, down-regulating what are called the Ras oncogenes that promote prostate, breast and colon cancer. But other studies have shown that just for example, that meditation alone actually changes your genes. They tested non-meditators, people taught to meditate for eight weeks, and more advanced meditators. And they found that same kind of dose response that you find with diet, that the more you meditate, the more it changes your genes. And likewise, up-regulates the good genes and turns off the bad genes.

And so, you know, we have to eat. It’s just a question of what. But meditation is something that is more optional. And so it’s easy for people to say, “I’ve got so much to do. Why would I want to just sit with my eyes closed and do nothing? How much good could that do?” Well, when they learned that hundreds of genes can be changed in eight weeks—probably even shorter—just from meditating they realize how powerful it is.

John:              A lot of people today still believe that the only way to change your genes is to change your parents, which is of course impossible. But believing this way, many people think that if they have bad genes, there’s nothing they can do about it. You mentioned earlier that your mom died of Alzheimer’s. My mother did also. And there is a possibility that you and I carry the APO E4 gene that makes us more likely to have Alzheimer’s. There’s a possibility we don’t, we don’t know that unless we get tested, but whether or not we have that gene inclination, the lifestyles that we live, the food choices that we make, the way we practice our lives has an enormous impact on our likelihood of getting Alzheimer’s, much greater impact in fact, then that gene—if we have it—that inclines us more towards Alzheimer’s. I think the role that genes play while real and strong in some diseases like hemophilia, but for the vast majority of diseases is actually more minor than we have thought. And the role that our lifestyle choices and the food that we eat plays is actually much, much more dramatic and powerful than we’ve realized.

Dean:             Well, it’s true. You know James Watson—Watson and Crick who famously decoded the structure of DNA for the first time and he got the Nobel Prize for that and he was one of the first people to get his genome sequenced—famously said, “I want to know everything except the APO E4 gene, the one that increases the risk of Alzheimer’s.” He says, “Why would I want to know about something that I can’t do anything about?” That’s why we’re doing this research because, I really know now from our own work and other people’s work, that our genes are a predisposition but our genes are not our fate.

John:              The genes are not our fate. James Watson thought there was nothing he could do about it if he had the APO E4 gene. But your work and the work of Dale Bredesen and others is showing us today that a healthy diet and a healthy lifestyle can in fact prevent most cases of Alzheimer’s. And in those few instances that can’t be prevented, a healthy diet and healthy lifestyle can still delay the onset of the condition for 10 to 15 years, which is no small thing.

Now, Dean, you’ve been working with former US president, Bill Clinton for many years and I seem to remember that one of his cardiologists said that Clinton’s heart problems were entirely genetic and had nothing to do with what he was eating. When did you start working with Clinton?

Dean:             I’ve been working with President Clinton since 1993 when Hillary asked me to train the chefs who cooked for them at the White House, Camp David, and Air Force One. Then I later became one of his consulting physicians. When his bypass was clogged up one of his cardiologist held a press conference and said, “Oh, it’s all in his genes. His diet lifestyle had nothing to do with it.” Having worked with them for many years, I knew it had everything to do with it. So I sent President Clinton an email and I said, “Look, the friends that I value the most are the ones who tell me what I need to hear, not what I want to hear. And you need to know it’s not all in your genes. And I say that not to blame you, but to empower you because if it were all in your genes, then you’d be a victim and you’re not a victim, you’re one of the most powerful men on the planet.” And I figured either I’ll never hear from him again or maybe I would. It was a few days later when we met and he went on a plant-based diet, which he’s been doing now for nine years and he hasn’t changed. He has fish once a week as a concession to what Hillary wanted him to do, but for the other 20 meals a week, he’s eating plant-based and he’s doing great. And so I think that’s really important.

Again, not to blame, but to empower by knowing. Not only my mom had Alzheimer’s, but all of her siblings ended up with it. So I’m quite sure I have the gene and someday I’ll get around to test it, but I do believe that again, our genes are a predisposition but our genes are not our fate. What I’ve found, and I know you guys have found in your life’s work as well, is to show that this is the way to live a life that’s really fun and sensual and pleasurable and that when you choose not to do something that you otherwise could do—whether it’s not eating certain foods, for example, you could say, “Well, I’m deprived.” Or you can say, “Well, I’m choosing not to do something because what I gain is so much more than what I give up, and quickly. Because these underlying biological mechanisms are so dynamic that when you really make big changes in your lifestyle, as I write about in this book, you feel so much better so quickly. Then it reframes the reason for making these changes from fear of dying to the joy of living.

John:              In your program, depression scores are cut in half. There are a lot of people today suffering from depression and not having answers. The medications that are prescribed have side effects. They help a few people, they don’t help everybody by any means. Your program, all of the side effects are positive. What is it about the Ornish program and, in particular, about the diet that you advocate that is helpful to depression? Is it eating fruits and vegetables? Is it not eating the bad stuff, the sugar and the refined carbs and the processed meats and so forth? Do you have any sense of what it is in your program? I know it’s the whole program, but for people who are depressed, they sometimes need just like one thing they can do to start themselves. One step they can take that will get them on a path that will, if it can cut through depression scores in half, hallelujah.

Dean:             Yeah. Well, it is actually the whole program and it’s each part of it that plays an important role. There’s evidence to show that exercise can help with depression, that social support and love reduce depression, that a plant-based diet reduces depression, that meditation and Yoga reduce depression. But there’s a synergy that it’s more than just additive. There’s a synergy that when you do all of these at the same time, and paradoxically, it may seem like it’s easy to just to do one thing, but it’s actually sometimes easier to do all of them and it’s actually sometime easier to make big changes than small ones—even though that’s counterintuitive. Because if you just changed a little bit, you get kind of the hassle and deprivation from not being able to do and eat everything you want, but you’re not really making changes big enough to feel that much better.

But if you start to meditate and exercise and spend more time with your friends and family and loved ones and eat healthier, most people find that their spirits lift. You know, again, because these mechanisms are so dynamic, you don’t have to wait long to feel better. And telling somebody who’s lonely and depressed that they’re going to live longer if they just changed their diet or quit smoking or meditate or whatever, they look at you and they say, “Excuse me. You don’t get it. I don’t know if I want to live longer. I’m just, I’m just trying to get through the day.” I learned that not only from my own experience, but later when I was working with patients and we’d lived together for a month at a time in our earlier residential studies. And I’d say, “You know, teach me something. Why do you smoke? Why do you overeat? Why do you drink too much? Why do you work too hard? Why do you abuse substances? These behaviors seems so maladaptive to me and they’d look at me. “They’d say, “They’re not maladaptive. You don’t get it. They’re very adaptive. They help us deal with our loneliness, our depression, our pain.” I’ve had patients say things like, “I’ve got 20 friends in his pack of cigarettes and they’re always there for me. You’re going to take away my 20 friends? What are you going to give me?” Or food fills that void. A well-known food writer told me, “Fat coats my nerves and numbs the pain.” Or, we have an opioid epidemic now numbing the pain, or alcohol, or other drugs that numb the pain, or video games, or surfing the web, or working all the time. We have lots of ways of dealing with that pain, but the overarching theme of all of the work that Anne and I have been doing is to ask a very simple question which is, “What is the cost?” And if we can work at that level, then the healing can be so much more powerful.

John:              Yes, and then the healing can be so much more powerful. One of the causes I think of the profound levels of illness in our society today as well as the poor diet that’s all around us is the breakdown of our sense of community. There are a lot of lonely people out there, people who feel deeply disconnected from others. And when you feel that way, you’re going to be more susceptible to drugs and alcohol and other addictions. Now, it’s one of the reasons we put on these summits to help people connect with likeminded folks. Dean, what do you see happening in our social networks that might be contributing to the diseases of our times?

Dean:             It’s that radical disruption in our social networks that we’ve talked about in our previous discussions—that 50 years ago, most people had an extended family they saw regularly. A neighborhood with two or three generations of people, a job that felt secure, where you’ve really gotten to know your coworkers who had been there for a decade or more. A church, or synagogue, or a club that you went to regularly. And many people, they don’t have any of those. And virtual communities are not the same. You know, one of the studies that I cite in our new book is that the more time you spend on Facebook, the more depressed you are. Why is that? Because it looks like it’s not an authentic intimacy. Intimacy is all about connecting in an authentic and a real way.

And when you grow up in a family with two or three generations of people, they don’t just know your Facebook profile or your perfect life or your biosketch and all those nice things you said about me when you introduced me at the beginning of the show. They know your demons and your darkness and where you messed up and you know that they know and they know that you know, and they’re still there for you. And there’s something really primal about the human need we have for authentic connection with each other. Because you go on Facebook, it looks like everybody’s got this perfect life but you, and that’s not how it really is. Whereas in a support group that we have when we’re working with people in our reversing heart disease and other programs, it’s not about just helping people stay on the diet or types of running shoes. It’s about creating the safe environment where people can let down their emotional defenses and talk openly and authentically about what’s really going on in their lives, focusing on their feelings. Because it’s our feelings that really connect us and it’s incredibly meaningful. It’s the part of our program that people know the least about, often have apprehension about and yet is invariably the most meaningful because, to me, anything that brings people together is healing. When you change your lifestyle, again, because this mechanisms are so dynamic, you feel so much better so quickly in the ways that are most meaningful, that’s what makes it sustainable along with the sense of meaning and a sense of pleasure that that brings.

John:              Well, Dean, you’re a pioneer in this revolutionary field of lifestyle medicine and you’ve shown and you’ve proven that using a healthy diet and these other simple lifestyle shifts can prevent and reverse not just heart disease. Although that alone would be spectacular, but also type two diabetes, prostate cancer, high blood pressure, depression, weight gain, possibly Alzheimer’s now and a host of other chronic diseases. And I consider it a privilege to be your friend and colleague.

Dean:             Me too.

John:              Thank you. I have so much appreciation for what you’ve done, what you’re doing, what you and Anne are doing now. And on behalf of Ocean and myself and everyone involved in the Food Revolution, I want to thank you for your outstanding work, your deep commitment to the healing of all of our lives and our world and of course for being with us today.

Dean:             Well, right back to you both. And for all of you who are listening, deep appreciation. I hope this has been useful. And thank you for continuing to raise awareness in so many people, making such a meaningful difference in their lives as well as in ours, and much love to you both.

Ocean:            Thank you Dean and we’ve been talking here with Dr. Dean Ornish and founder of the Preventive Medicine Research Institute and author of seven bestsellers, including the latest with his wife Anne, Undo It. Being a world renowned leader in the movement for human health and also for human happiness. We’re so grateful for the lives you’re touching and for your science-driven inquiry, and for that deep part and the wisdom that imbues all you do. It’s a privilege to be your friend and to be your colleague. And we thank you so much for your partnership and leadership in the Food Revolution.

Dean:             God bless you both. Thank you.