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Bill Klaproth (Host): If you have had a cardiac event or have risk factors for cardiovascular disease, both the American Heart Association and the American College of Cardiology have recognized cardiac rehabilitation as an important component of cardiac care. Here to talk with us about an integrative approach to cardiac rehab to Dr. Mark P. Wexman, a cardiologist at MarinHealth Cardiovascular Medicine | A UCSF Health Clinic. Thank you for your time. We appreciate it. You help get the Ornish Lifestyle Medicine Program named after Dr. Dean Ornish, the first and only program of its kind in northern California as an option for patients of MarinHealth. First off, can you tell us who is Dr. Dean Ornish?

Dr. Mark P. Wexman (Guest): I can. Good day. Dean Ornish has been a local treasure and friend for many years. He has been a leading physician advocate for lifestyle research and lifestyle medicine, how it impacts cardiovascular disease and actually has done some research in prostate cancer and other illnesses as well. Dean, over the last 20 years, has been a very vocal advocate of lifestyle programs and accomplished what many of us out on the front lines thought was not possible and that was to get Medicare and insurance companies to value prevention based services and reimburse them well enough to get those incorporated into the medical regimen of patients and not just reimburse for the medicines and the technology. Dean has been a strong advocate of that and his program is something that our practice has endorsed and believes is helpful to the outcomes that we want for our patients.

Bill: Obviously, you’ve been touched by this program and felt it important to bring to Marin Country.

Dr. Wexman: We did. We had a program not under Dr. Ornish’s name, but with many of the same attributes over about 18 years and it was supported locally and we switched over the Dr. Ornish’s program earlier this year and we’re going through delivering that program now to very grateful patients who are interested in more than the passive approach to their heart problems – “I'm just going to take this pill” or “I'm going to go see my doctor” or “I’ll get a procedure done” – but rather they know that the more they engage in the process of helping themselves, the better their outcome from heart disease will be. Those are the patients that Dr. Ornish provides a kick start for and gives us an opportunity through his program to give them a structure that they can really succeed with.

Bill: You mentioned lifestyle and prevention based. What are some of the premises of this program? Can you share some of the details of it?

Dr. Wexman: I would suggest that the program has four pillars that it sits on. The first is the nutrition – what we choose to eat, what we put into our bodies – has a very significant effect on what our metabolism does and our health. We know that using our body and having exercise as part of a regular lifestyle is quite important. We know that the world is a very crazy place and that having ways of dealing with the chronic stresses of our current world, and also reduce risk from heart disease. One might think of chronic stress, anxiety and depression, isolation and hostility being similar to risk factors of smoking, diabetes or high cholesterol – they also need to be attended to. Finally, we try to give people a place to make emotional connections through a group process to deal with the vulnerability and the fears that come up when somebody has a life threatening illness like heart disease.

To summarize quickly, we believe you have to move your body to exercise, we believe that a plant based low saturated fat diet is the healthy place to start, we believe that learning stress reducing techniques – such as yoga and meditation – are important, and having an emotional structure that allows you to learn from the life threatening illness and come out on the other side stronger in your broken plan is very valuable to our patients. That’s the four pillars of the Ornish Lifestyle Medicine Program. I would add one more, and that is that there's an educational component that comes across. Our patients learn the language of medicine. They understand the physiology and the pathology of what's happened to them, and because of that, they better interact and, I believe, get more out of their doctors.

Bill: All of that makes wonderful sense. Can you talk about the results that it generates over a traditional approach?

Dr. Wexman: Absolutely. In traditional approaches to regression of cardiovascular disease, western medical approaches have just lowering a little bit of saturated fat and telling people to get a little bit more activity don’t result in stabilization and generally result in progression of vascular disease. In Dean’s early studies, he was able to compare those people who did a program like I described against those who were following the typical advice and, in fact, the results were dramatically different. There was improved in blood flow, there was a reduction in degree of narrowing in arteries in the people who were in the active lifestyle program, and there was generally progression in the others. We also recognize that medicines are part of this.

This program is not to the exclusion of western medicine, but I believe complements it. The more the patient does, the less the doctor needs to do with pharmacology or with procedures, so the more effective the patient is in controlling their own metabolism and their own lifestyle, the better the results that they get. Mortality outcomes studies are improved with this type of lifestyle program. The quality of life is probably the most dramatic thing that I see is different in people who participate in this program. They go from being worried and vulnerable and depressed and isolated and overweight and with bad habits to much more vital, much more loving, much more engaged people, and I think they have a better family life, they have a better interaction with the medical community and their outcomes for both longevity and avoiding heart attacks and avoiding surgeries and avoiding procedures are enhanced with this type of lifestyle medicine.

Bill: Those are the type of results you want to see, and you just mentioned the more the patient does, so I take it someone really needs to be committed to this program to get the most out of it.

Dr. Wexman: I think this is an experiential program. This is not where if you just learned some information and know the right answers that you're going to get the results you want. I think you have to apply it. The good news is anything worth doing is worth doing imperfectly. You're not going to be perfect in stress reduction, perfect in your diet, perfect in your exercise or perfect in your emotional world, but we can move to a much healthier place. Yes, patients have to be engaged and involved. They have to be willing to make changes. If you do more of what you’ve previously done, you get more of what you already have. If patients have had heart attacks or bypass surgery or procedures, they don’t want more. The opportunity to make a change in one’s behaviors that really advances their outcomes and their quality of life, it sounds very difficult because when my mother and father wanted to show that they loved me, they took me out for a fancier dinner and a bigger piece of beef and some more Eastern European cooking – all of which can be hazardous to your health. They love me, but that wasn’t the best way to help me be healthy.

Nowadays, I think we can show love with food and still be a lot more compassionate to maintain good health and this is not a diet about what I'm deprived of – this is developing a new sense of flavor and taste and excitement around food and activity and stress reduction leading to a more satisfactory enjoyable life. It’s not punishment. It may seem like deprivation because I'm used to the mashed potatoes, gravy, spare ribs and fettuccini alfredo, but you could do quite well without that and substitute remarkably interesting tastes and recipes. Dr. Ornish did a great job in his books and in the program of providing recipes from some very talents chefs that can turn bland vegetables into an exciting dinner. I think that’s what people can experience when they try it and it’s a matter of adopting. If you're not perfect at it, you can back on. If you’ve stepped off the path, you learn to get back on as quickly as you can. Those people who have studied in Dean’s work and in other published data, we’re not perfect either, and yet they can almost get perfect terrific results with imperfect behavior because they're striving for the right things and doing it constantly.

Bill: It’s important and you said that lifestyle change for life is very important. Lastly, who is a good candidate for the Ornish Lifestyle Medicine Program?

Dr. Wexman: The Ornish Lifestyle Medicine Program has been geared to and has insurance benefits for people who have angina – meaning cardiac symptoms of chest pain – people who have had a heart attack, people who have had an angioplasty or a stent within the last year or people who have had bypass surgery within the last year and people who have had certain types of valve surgery are also candidates on most insurances. We also have a segment of the population that wants to do the program for its prevention benefit. In other words, they may know that they’ve got a strong family history or they have early vascular disease but don’t have ongoing symptoms or have not had significant events, and the program is open to those people as well, although they don’t have the insurance benefits in most cases for the program.

Bill: Very good. Thank you so much for talking to us today about the Ornish Lifestyle Medicine Program. For more information about the program in Marin County, you can visit marinhealthcare.org/ornish. Once again, if you want more information on the Ornish Lifestyle Medicine Program, visit marinhealthcare.org/ornish. This the healing podcast brought to you by MarinHealth. I'm Bill Klaproth. Thanks for listening.