DR. DEAN ORNISH: Well I love President Clinton. I think he is an amazing human being. I began working with the Clintons in 1993 when someone arranged for Mrs. Clinton to meet with me. She was interested in the research that we were doing and after showing her the research she said, “Would you work with the chefs who cook for us?” And I said, “Excuse me?” She repeated it and I said, “Of course, I would be honored to.” So I brought in some of the top chefs that we have worked with over the years. We went to the White House and we worked with the chefs who cooked for the President. We also worked with the chefs from Camp David and from Air Force One. It was a great privilege to be able to do that.
I also began working with the President on his own health. He did make some changes in the way he was eating and it did lead to some benefits, but when his bypass clogged up, there was a press conference in which it was announced that it was all in his genes and his diet and lifestyle had nothing to do with the bypass clogging up. So I communicated with him and said, “The friends that I value the most are the ones who tell me what I need to hear, not necessarily what I want to hear. What you need to know is that it is not all in your genes. I say this not to blame you, but to empower you, because if it were all in your genes, you would just be a victim. There is a lot you can do. Again, that is the opportunity. It is not a criticism in any way. It is out of great respect and love.”
I sent President Clinton some of the research and a couple of books that I have written on the topic, and when we met a week or so later, he said that he had decided to do it. I was really happy that he did that because I care about him so much. I was also happy because I think, whatever your politics, when the President of the United States—especially one who was known earlier in his life for eating particularly unhealthfully—makes a choice to eat a lot healthier, that sets a great example for everyone. So, as you say, he may have become the world's most well-known vegan. Whatever other considerable good that he does in the world, he will have added to it substantially by showing that this is possible.
JOHN ROBBINS: I want to share one of my favorite quotes of yours. You said, “I don't understand why asking people to eat a well-balanced, vegetarian diet is considered radical, while it is medically conservative to cut people open and put them on powerful cholesterol-lowering drugs for the rest of their lives.”
DR. DEAN ORNISH: We pay for things that are dangerous, invasive, expensive, and largely ineffective. And we have a hard time believing that simple choices in our lives that we make each day—like what we eat, how we respond to stress, how much love we give each other, and how much we exercise—can make such a powerful difference. But they really do. That is probably our unique contribution: we use these very high tech, expensive, state-of-the-art measures working with first-rate scientists to show how powerful these very simple, low-tech, and low-cost interventions can be. Three-quarters of the 2.8 trillion dollars that we spend each year on health care in the United States is for chronic diseases that can often be prevented or even reversed by simply making these same kinds of changes. In every one of our studies, the more people have changed their diet and lifestyle, the more they have improved.
It is not like there is one diet and lifestyle intervention for heart disease and a different one for prostate cancer and a different one for Type 2 Diabetes and a different one for changing your genes or making your telomeres longer. It is really just to the degree that you move in this direction, we've found there is a corresponding benefit. It is not all or nothing. Being a vegan is too much for some people, so we say, “Okay great. Just do what you can. What matters most is your overall way of eating and living. Foods aren't good or bad, but some are healthier for you than others.” So we have categorized foods from the healthiest (group one) to the least healthful (group five), and groups two through four are intermediate. If you are eating mostly four and five, you are eating mostly unhealthy food.
If you feel like making any changes, of course that is up to you. You can say, “Okay, maybe I will eat a little less four and five and maybe more one through three.” Then you do that and you see if you feel better. If you start to feel better, then maybe you want to make even bigger changes, but again it is coming out of your own experience.
The problem with going on a diet is that when you go on a diet, sooner or later you are likely to go off it. Once you go off it, you may feel like you are a failure. Be compassionate with yourself. Just say, “Directionally I am going to go more towards a plant-based diet because I want to feel better. So if I indulge myself one day, then I will eat healthier the next. If I don't exercise one day, I will do a little more the next. If I don't have time to meditate for an hour, I will do it for a minute.” Just the consistency is more important than anything, and that way you can't fail. It just becomes a way of living in the world rather than just a diet that you go on and off.
JOHN ROBBINS: It reminds me of the old story, The Tortoise and the Hare. Slow and steady wins the race.
DR. DEAN ORNISH: That's true. And it's also true that sometimes people do really well when they make big changes all at once because they feel so much better so quickly, and the effect of their changes is highly visible. For others it is easier to go with slow and steady.
We say, “Here are the risks and the benefits, the costs and the side effects. This is your life, and your responsibility. I am only here to support you and make sure that you have all of the information that you can use to make intelligent choices. I'm here to support whatever you choose to do, whether it is drugs, surgery, lifestyle, or a combination.”
JOHN ROBBINS: You have been engaged in a dialogue with Medicare for a long time that is now bearing fruit. One would hope that if you do good science it is going to change medical practice. But if there isn't reimbursement, then it might not.
DR. DEAN ORNISH: I am grateful for Medicare. They are now covering “Dr. Ornish's Program for Reversing Heart Disease” as a named program in the clinics, hospitals, and physician's offices where we train and certify. Having seen what powerful changes diet and lifestyle can make over the past thirty-five years of studies, it is great to be able to make them available. Reimbursement is an important determinant of medical practice and even medical education.
I learned a painful lesson when we opened a number of sites before we had reimbursement to cover our program. Even though we got excellent clinical outcomes, some of those sites closed down. They didn't close because the treatment wasn't working. They closed because it wasn't reimbursable.
If you change reimbursement, then everything follows. Without that even a thousand studies may not be enough to really change things.
After sixteen years of reviewing our work internally and externally, Medicare agreed to cover it. Now we can make it available to people everywhere, because most other insurance companies are following their lead.
We trained ten hospitals in West Virginia which has been the number one state in the country for heart disease, and 44 hospitals and clinics elsewhere, with many more to come. We trained the St. Vincent de Paul Society homeless clinic in San Francisco in our Spectrum Integrative Medicine Program and they have treated more than 15,000 people through it in the past year and a half. We will be offering our reversing heart disease program there as well which Medicare will reimburse, and then we'll clone it to St. Vincent de Paul homeless clinics throughout the country.
We are in the process of training lots of different people in our program and providing a truly integrative paradigm that incorporates the best of drugs and surgery when they are effective, but also addresses the more fundamental causes of why we get sick.
JOHN ROBBINS: You have become known for advocating a low-fat diet, and yet as you have so often pointed out, low fat is not synonymous with healthy. I have seen studies that purport to measure low-fat diets to see if there are any benefits, but they define “low fat” as an intake barely less than the norm in our culture, and then don't see benefits. There is barely any reduction in fat consumption, so you see barely any results.
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