Monday, March 23, 1998

The Ticker Picker-Upper

Dr. Dean Ornish calls love a key to a healthier heart

By Julie Vargo

Special Contributor to The Dallas Morning News



Dean Ornish sounds stressed out.

Fresh after his face graced the cover of Newsweek, the country's
heart guru is huffing and puffing his way through a book tour. And
today it's got his pulse pounding.

From a cell phone somewhere in California, he apologizes for calling
late, explaining that he's been locked out of a friend's house where
he is a guest. Or he can't find his key. It's one of those days.

Still, life is a little easier, if busier, for Dr. Ornish these days.

It took a skeptical medical community almost two decades to embrace
Dr. Ornish's ideas on reversing even severe heart disease with yoga,
meditation, diet, and exercise. Now it seems everyone wants to hear
what he has to say.

In his most recent book, Love & Survival: The Scientific Basis for
the Healing Power of Intimacy (Harper Collins, $25), Dr. Ornish turns
his attention to the link between a healthy heart and emotional
vitality.

"I'm not aware of any factors in medicine - not diet, smoking, stress
or surgery - that have a greater impact on our quality of life,
incidence of illness, or death from all causes," says Dr. Ornish, who
grew up in Dallas and will be back in town Thursday and Friday.

"This has always been a part of my work. But most of the focus has
been on my diet. Diet is important, but nothing impacts our health
more than community, connection, love and intimacy. But we don't
value those things in our culture."

Studies highlighted in Dr. Ornish's book provide dramatic evidence of
the dangers of solitary lifestyle.

People who felt lonely and isolated had a 200 percent to 500 percent
higher risk of premature death from all causes when compared with
those who had a sense of connection and community. Mobility has
helped break up the extended families and multigenerational
neighborhoods that created the close-knit communities of the past.

Heart patients who didn't feel loved had a 50 percent more arterial
damage than those who did feel loved. And heart-attack survivors who
lived alone were more than twice as likely to die within a year.

Intimacy is not an easy prescription for many people. It means
becoming vulnerable. Opening up to another person leaves people
feeling unprotected and open to painful emotions.

"We want to kill pain in our culture," Dr. Ornish says. "There are so
many ways to numb pain – smoking, drugs, alcohol, food, working too
much, channel surfing, staying on the Internet.

"But pain is the messenger. If you just kill the pain without
listening to it, it's like clipping the wires to the fire alarm and
going back to sleep without putting out the fire."

The medical community was slow to embrace Dr. Ornish's heart-disease
therapy. But now some insurance companies, realizing the program
could prevent $50,000 bypass operations, pay the costs for Ornish-
model support groups and classes. The Ornish program costs about
$7,500 and is available at 11 hospitals nationwide.

Dr. Ornish, 44, has experienced his own share of emotional setbacks.
A Dallas high school track star, he suffered depression and
contemplated suicide when faced with stiff competition while
attending Rice University in Houston.

"I was trying to be loved for my accomplishments, not who I really
was," he says.

He returned to his parents' home to recuperate. While there, he
altered his life, learning meditation, yoga and vegetarianism from a
swami.

"Suffering and pain is a catalyst for change," says Dr. Ornish, who
finished his college career at the University of Texas at Austin and
Baylor College of Medicine.

"Change is not easy, even good change. The status quo is familiar,"
he says.

Patients have told him that having a heart attack was the best thing
that ever happened to them. "That if they hadn't suffered, they
wouldn't have been able to make changes in their lives that helped
make their relationships better and helped them find inner joy."

Such inner joy, however, has often escaped from Dr. Ornish. He admits
that his accomplishments in medicine did not translate to the love he
so needed.

"I was working, overworking, so hard to distract myself, to numb the
pain," he says. "When I turned 40, I realized I needed to take
another look at myself. I had to face my own shortcomings and
limitations. I'm still working on myself."

Today, Dr. Ornish has all the trappings of success – a string of best-
selling books, a new line of low-fat vegetarian foods.

He also has found emotional fulfillment.

His relationship with his fiancée, Molly Blackwell, "brings me so
much more happiness than any award or accomplishment."

A celebrity in his own right, Dr. Ornish counts President Clinton,
financier Michael Milken and television journalist Bill Moyers as
friends. His past, however, helps pull his present success into focus.

"Those accomplishments don't bring happiness, but they do provide an
opportunity to reach people and possibly help them," Dr. Ornish says.

"What I am learning is that nothing external can bring lasting
happiness and joy. It's not the money or being a best-selling author
or having the cover of Newsweek that makes life meaningful. It's the
love we give and receive and how we grow in wisdom. This is what we
take with us. And that's what is fun and meaningful to me."

The doctor strives to follow his own advice in making the commitment
to one person - a husband, wife, lover, partner, teacher. The process
of commitment is so liberating," he says.

"When I was growing up, monogamy had this repressing feel to it. But
as I got older I saw the power in commitment. When you commit
yourself to one person, you create a sacred, safe place. You become
more intimate and vulnerable and life is more fun.

"And if you aren't having fun, who wants to live to be older anyhow?"

Julie Vargo is a Dallas-area freelance writer.


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Is Love the Best Drug?

Newsweek, March 16,1998

By Geoffrey Cowley and Anne Underwood

Call it the Pennsylvania paradox. Until about 1965, the people of
Roseto, a small town in the eastern part of the state, seemed all but
immune to heart diseases. They smoked as much as the folks in nearby
Bangor. They ate similar food, and they relied on the same doctors
and hospitals. Yet their death rate from heart attacks was
significantly lower. Why? Roseto's most striking distinction was its
tightknit social life. Founded in 1882 by immigrants from southern
Italy, it was full of three-generation households with strong
commitments to church and family. But when those traditions eroded in
the 1960s, so did Roseto's health. By the mid `70s, the residents
were as mobile and anonymous as other Americans – and just as prone
to heart disease. The "Roseto effect" had vanished.

Was social change the culprit? There are now many reasons to think
so. As Dr. Dean Ornish argues in his new book, "Love & Survival: The
Scientific Basis for the Healing Power of Intimacy" (284 pages,
Harper Collins, $25),the quality of our relationships can have
profound effects on our health. Mounting evidence suggests that
people without close, durable ties to family and friends are at high
risk for everything from cancer and heart disease to ulcers and
infections. "Love and intimacy are at the root of what makes us sick
and what makes us well," Ornish declares. "I am not aware of any
other factor in medicine - not diet, not smoking, not exercise - that
has a greater impact." A growing number of specialists are now
striving to tap the healing power of companionship. Unfortunately,
the forces that transformed Roseto are still changing the world.

Thirty years ago, anyone blaming loneliness for physical illness
would have been laughed at. But as scientists studied different
populations, isolation kept emerging as a risk factor. In one study
that inspired many others, California researchers followed 4,700
residents of Alameda County for 10 years, starting in 1965. At the
outset, the participants checked off their key sources of
companionship and estimated the time they devoted to each. Over the
course of the study, the people who reported the least social contact
died at nearly three times the rate of those reporting the most. The
source of companionship didn't much matter - a person without a
romantic partner might get ample support from other sources - but
time spent with others was critical.

Since then, researchers have studied men, women, soldiers and
students from countries all over the world. And the same pattern
keeps emerging. Women who say they feel isolated go on to die of
breast and ovarian cancer at several times the expected rate. College
students who report "strained and cold" relationships with their
parents suffer extraordinary rates of hypertension and heart disease
decades later. Heart-attack survivors who happen to live by
themselves die at twice the rate of those who live with others.
Studies have even found that women with smaller social networks give
birth to smaller babies.

What's going on here? How could something as mushy as "social
support" affect the growth of a tumor or the function of a coronary
artery? For starters, it helps regulate our behavior. People with
commitments to honor are less likely to abuse themselves. They drink
less, eat better and avoid needless risks. Companionship also lets us
share feelings that would otherwise fester. "If you don't talk out
your traumas, you're screwed," says University of Texas psychologist
James Pennebaker. "I think that's the scientific term for it."
Pennebaker has shown that when people regularly talk or even write
about things that are upsetting them, their immune systems perk up
and they require less medical care.

Besides changing our behavior, companionships can modulate our
physiological responses to stress. When study volunteers are ordered
to count down by 17s from a number in the thousands, and to hurry up
about it, most experience significant increases in heart rate and
blood pressure. In a 1990 study, University of Pittsburgh
psychologist Thomas Kamarck asked 39 college-age women to try that
drill twice - once alone, and once accompanied by a friend. Both
tests affected the women's cardiovascular systems. But having a
companion on hand reduced the impact by half.

When you consider what chronic stress can do to us, the long-term
benefits of friendship are not hard to fathom. The stress hormones
(adrenaline, nonadreanaline and cortisol) switch the entire body into
emergency mode. Anything not involved in fighting or fleeing -
digestion, immune function, bone production, sexual function - goes
on hold. "That's exactly what you want if you're a zebra sprinting
out of harm's way," says Stanford biologist Robert Sapolsky. "Three
minutes, no big deal. But if every day is an emergency, you pay a
price." People who lack social support tend to stew in stress
hormones all the time, not just when they're counting down by 17s.
And studies confirm the health effects. When researchers at Carnegie
Mellon University exposed volunteers to a cold virus, the most
isolated got sick four times the rate of those with the most social
ties.

Is there a lesson for doctors in this? Ornish certainly thinks so.
Though he's best known for his dietary edicts, emotional support has
always been central to his program. He believes that by helping
people express their feelings and attend to their relationships, he
can change the chemistry that feeds their illness. Because his
regimen includes so many elements, it's impossible to know whether
his support sessions really affect people's health, but other
clinicians have found that togetherness can help keep people alive.
In one seminal study, Dr. David Spiegel of Stanford followed 86
advanced breast-cancer patients, 50 of whom joined small support
groups as part of their treatment. Four years later, a third of those
receiving the extra social support were still alive. Every one of the
control patients had died.

For those of us who are still healthy, the lesson should be obvious.
It's clear that reaching out to others can help our bodies thrive.
It's equally clear that we're growing more isolated. In 1900, only 5
percent of U.S. households consisted of one person living alone. The
proportion reached 13 percent in 1960, and it stands at 25 percent
today. In his forthcoming book "Bowling Alone" (based on a 1995
article by the same title), author Robert Putnam shows that our
social connections are withering on other levels as well. In 1976,
Americans attended an average of 12 club meetings a year. The current
average is five. Card games, dinner parties and shared family meals
have all followed the same arc. We all have a good excuse - we're too
busy - but we shouldn't be surprised when it catches up with us.

The Price of Loneliness

Many studies have found that isolation is a health hazard. Some
examples:

Women

`Do you feel isolated?' Those who said yes were three-and-a-half
times as likely to die of breast, ovarian or uterine cancer over a 17-
year period

Men

`Does your wife show you her love?' Men who said no suffered 50
percent more angina over a five-year period than those who said yes

Male Medical Students

`Are you close to your parents?' Those who said no were more likely
to develop cancer or mental illness years later

Heart Patients

`Do you feel loved?' Those who felt the least loved had 50 percent
more arterial damage than those who felt the most loved

Unmarried Heart Patients

`Do you have a confidant?' Those who said no were three times as
likely to die within five years

Heart-Attack Survivors

`Do you live alone?' Those who said yes were more than twice as
likely to die within a year