Chapter 1 It Works! If you can't explain it simply, you don't understand it well enough. --­attributed to Albert Einstein Our favorite key on the computer is the undo button. Click!--­a fresh start. We've often thought, "Wouldn't it be nice if there were an undo button for our health as well?" Well, now there is! This is the era of lifestyle medicine: that is, using simple yet powerful lifestyle changes to reverse--­undo!--­the progression of the most common chronic diseases as well as to help prevent them. For more than four decades, one of us (Dean) has directed a series of randomized controlled trials and demonstration projects proving, for the first time, that the radically simple lifestyle medicine program described in this book can often reverse the progression of many of the most common chronic diseases. It can be undertaken in combination with drugs and surgery, or sometimes as an alternative to them. We continue to be amazed and inspired that the more diseases we study, and the more underlying biological mechanisms we research, the more new reasons and scientific evidence we have to explain why these simple lifestyle changes are so powerful, how transformative and far-­ranging their effects can be, and how quickly people can show significant and measurable improvements--­often in just a few weeks or even less. We are excited that our research and the studies of other investigators are proving that many of the most common and debilitating chronic diseases and even much of the damage of aging at a cellular level can often be slowed, stopped, or even reversed by this lifestyle medicine program. These include: *    Reversing even severe coronary heart disease *    Reversing type 2 diabetes *    Reversing, slowing, or stopping the progression of early-­stage non-aggressive prostate cancer *    Reversing high blood pressure *    Reversing elevated cholesterol levels *    Reversing obesity *    Reversing some types of early-­stage dementia *    Reversing some autoimmune conditions *    Reversing emotional depression and anxiety Our studies have been published in the leading peer-­reviewed medical and scientific journals and presented at the most well-­respected physician conferences. No other lifestyle program has this level of scientific evidence on reversing these chronic diseases. This is one reason why a panel of independent experts from U.S. News & World Report rated "The Ornish Diet" as "#1 for Heart Health" in 2011, 2012, 2013, 2014, 2015, 2016, and 2017. Awareness is the first step in healing, and science is a powerful tool for raising awareness. Our peer-­reviewed research findings provide the credibility to help overcome what is often the biggest obstacle: skepticism that such simple lifestyle changes can have such powerful, far-­reaching measurable improvements--­and how fast you can feel better. In that spirit, we are including this information not to boast but (hopefully) to inspire and empower, to rise above the noise and misinformation that are so prevalent. We've used high-­tech, state-­of-­the-­art scientific measures to prove the power of this low-­tech lifestyle medicine intervention. The science may motivate you to get started; the extraordinary benefits you are likely to quickly experience are what make it sustainable. Radically Simple, Yet Powerfully Proven We learned from Steve Jobs that people who have spent their lives deeply understanding something complex can make it really simple for others to learn. When you really know a subject, you can reduce it down to the essence of what's most important. For example, Steve said that he was more proud of what he left out of the iPhone than what he included. Although the underlying technology is highly complex, there is an elegant Zen simplicity in its design that makes it extraordinarily powerful and intuitively easy to use because it is based on a deep understanding of what is most important and what really matters--­and what doesn't. You don't even need a user manual. He and Jony Ive applied this same ethos to the ecosystem of all Apple products they created, which made it the most valuable and emulated company in the world. In that spirit, this book represents the quintessence of what we've learned about the power of lifestyle medicine. We emphasize the research that we have conducted rather than a comprehensive review of the scientific literature. We've included only what's most essential, and we hope you find it to be useful. We have shown, time and time again, that this lifestyle medicine program often works to reverse and help prevent many of the most common chronic diseases for most people. We've consistently achieved bigger changes in lifestyle, better clinical outcomes, larger cost savings, and greater adherence than have ever been reported. If you carefully follow the lifestyle changes we describe in this book, there's a good chance it may be effective for you as well. Here It Is, Why It Works, and How You Can Do It Our program has four major components, each a healing modality on its own and synergistic when done together: *    A whole-­foods, plant-­based diet, naturally low in animal protein, fat, sugar, and refined carbohydrates and high in flavor--­primarily fruits, vegetables, whole grains, legumes, and soy products in their natural, unprocessed forms. The principles of eating this way are simple and clear. We outline these in Chapter 4 and offer amazingly delicious recipes in Chapter 8. *    Moderate exercise, such as walking and strength training. Do what you enjoy--­if you like it, you'll do it. Chapter 5 shows why and how a little exercise goes a very long way. *    Stress management. Chapter 6 introduces you to techniques (including meditation and gentle yoga) that can enable you to do more and stress less. *    Love, social support, and intimacy. People who feel lonely, depressed, and isolated are three to ten times more likely to get sick and die prematurely from virtually all causes when compared to those who have strong feelings of love, connection and community. Chapter 7 describes how we can transform isolation into healing. In short: eat well, move more, stress less, love more. That's it. Boom! This book is based directly on the scientifically proven nine-­week lifestyle medicine program that we have implemented in hospitals, physician groups, health systems, and clinics across the country. We've proven this lifestyle medicine program works exceptionally well in the real world. We have clinical outcomes data from tens of thousands of diverse patients who have gone through this program at a continually growing number of sites throughout the country and from millions of people who have made these lifestyle changes from my earlier books. It is both effective and achievable. The lessons we've learned from this extensive experience form the basis and structure of this book. In 2010, after sixteen years of comprehensive review, I appreciate that the Centers for Medicare and Medicaid Services (CMS) created a new benefit category, "intensive cardiac rehabilitation," to begin providing Medicare coverage for "Dr. Ornish's Program for Reversing Heart Disease." This was the first time that CMS provided Medicare coverage for a lifestyle medicine intervention to reverse heart disease. This had the strong bipartisan personal support of both Bill Clinton when he was president of the United States and Newt Gingrich when he was speaker of the House, as well as leading members of the U.S. Senate and House of Representatives across the political spectrum. Other supporters included the director of the National Heart, Lung, and Blood Institute of the National Institutes of Health, the head of the AARP, and leading physicians and scientists across the country. This was an important recognition of the value of lifestyle medicine as one of the few areas that transcend our increasingly polarized and dysfunctional political environment. Many commercial insurance companies are now also covering our lifestyle medicine program. Some of these are covering it not only for reversing heart disease but also for reversing type 2 diabetes, high blood pressure, obesity, and elevated cholesterol levels. This was a game-­changer, as reimbursement directly affects both medical practice and even medical education. Now it is sustainable for physicians and other healthcare professionals to offer our lifestyle medicine program. We're helping to create a new paradigm of healthcare at a time when it is so badly needed by providing better care to more people at lower cost. Most physicians spend only about ten minutes with a patient at an office visit. This is often frustrating for both doctors and patients, since there is insufficient time to talk about what matters most: what's going on in their lives with respect to their diet, exercise, sources of stress, their marriage, their kids, their work, their friends, their finances, their home, and their spiritual life. In our new lifestyle medicine paradigm, Medicare and insurance companies are paying for seventy-­two hours of training each patient rather than only ten minutes. This new paradigm of lifestyle medicine allows physicians to leverage their time in meaningful ways by using a multidisciplinary team approach. The physician acts as "quarterback" and he or she provides oversight for the intervention, divided into eighteen 4-­hour sessions offered twice per week for nine weeks or for a twelve-­day immersion retreat with six hours of classes per day. Each session is as follows: *    One hour of supervised exercise, led by an exercise physiologist *    One hour of stress management, led by a certified yoga/meditation teacher *    One hour of a support group, led by a licensed clinical psychologist or social worker *    One hour of a group meal and a lecture by a registered dietitian and nurse In addition to being medically effective, our approach is also cost-­effective. It turns out that only 5 percent of patients account for 50-­80 percent of all healthcare costs. These are people who have chronic diseases--­and heart disease is the most expensive condition in terms of total healthcare spending. In a demonstration project, Mutual of Omaha found that almost 80 percent of people who were eligible for bypass surgery or a stent were able to safely avoid it by going through our lifestyle medicine program instead--­saving almost $30,000 per patient in the first year. In a second demonstration project, Highmark Blue Cross Blue Shield found that our lifestyle medicine program cut overall healthcare costs by 50 percent in the first year, and these cost savings were sustained for at least three years. And only 1 percent of these patients who went through our program incurred claims costs in excess of $25,000 after the first year, compared to 4 percent of control group patients--­a threefold difference in costs. For more information and to find a program near you or to attend an immersion retreat, please go to www.ornish.com. Here's an especially dramatic example of how powerful this lifestyle medicine program can be. Robert Treuherz, M.D., is a specialist in internal medicine who had such a massive heart attack that he was told the damage to his heart was so great that he needed a heart transplant to survive. While waiting for a donor heart to become available, he went through our lifestyle medicine program at the UCLA Medical Center to get in better shape for this surgery. Nine weeks later, he improved so dramatically that he no longer needs a heart transplant! Here's his story, along with the perspective of his wife, Claudia: Dr. Robert Treuherz: I'm a sixty-­one‑year‑old internal medicine doctor who was also trained in critical care medicine at one of the most well-­respected medical centers in New York. Yet I never received any training in nutrition or other lifestyle changes. I thought meditation and yoga were woo-­woo--­I didn't take them seriously. Also, I had a very male‑oriented perception of what love and affection meant, without a more mature outlook like one eventually develops. I was enjoying robust good health, living and practicing medicine in Lake Arrowhead at 6,000 feet. I was a ski instructor and was in the ski patrol in college. When my wife, Claudia, and I would ski, we'd have four kids between us and I could ski them into the ground without running out of breath. Then on October 29, 2015, I had a massive heart attack. I had severe blockages in my coronary arteries which resulted in a drop in my ejection fraction to only 11 percent. [The ejection fraction is the percentage of blood that the heart pumps with each beat. Normally, this is at least 50 percent--­i.e., a healthy heart pumps half of its volume or more with each beat.] They put in a stent to try to open one of the main arteries that was 100 percent clogged. The first two weeks after that happened, I was given no prognosis. I mean that in the most literal, concrete way possible. I was told, my wife was told, my mom was told, my family was told, "Say goodbye. That's it! You're done. You're not going to get out of here alive." It was a violent paradigm change. All of a sudden, my whole reality was altered. I managed to survive the first two weeks, then got transferred to another facility, where an angiogram was repeated. They found a complete occlusion of the stent. About twelve hours later, I had a full cardiac arrest. When I came to, ten to twelve hours later, I was intubated because I had literally died. I came out of this dark void, which was so unsettling. My love for my wife and family pulled me out of it. Maybe it's to be here to help other people get an opportunity to go through this program. My vital capacity when I came out of this was close to zero. I was having chest pain anytime I walked more than a few steps. I couldn't go up the stairs to my bedroom unless one of my sons carried me upstairs. Excerpted from Undo It!: How Simple Lifestyle Changes Can Reverse Most Chronic Diseases by Dean Ornish, Anne Ornish All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.