That means many patients - if willing to make tough sacrifices involving diet and exercise - can stop or reverse their own heart disease, the USA's leading killer.

The new finding, out today in the Journal of the American Medical Association, proves for the first time that blocked arteries can be opened enough to avoid surgery when patients adhere to a low-fat diet, stop smoking, lose weight, exercise and reduce stress, says Dean Ornish of the Preventive Medicine Research Institute in Sausalito, Calif.

But his program is not easy. It involves eating a 10%-fat diet - no meat, no fish, no chicken, no nuts. It also requires practicing meditation and stress-reducing techniques based on yoga, exercising a minimum of an hour three times a week and participating in group support sessions.

In the study, which tested the program in 48 patients, Ornish and former skeptic K. Lance Gould, University of Texas Medical School, Houston, used high-tech imaging techniques to show changes in heart artery blockages over four years.

"The results show with cholesterol-lowering and a low-fat diet, blood flow improves in patients, and in the control group it gets worse," says Gould. "I see a lot of patients who've been told they need surgery to save their lives, but they would do just as well with reversal treatment. That doesn't make me too popular, but that's what the science says."

Other key studies since the 1980s also show small decreases in blockages can be achieved by combining lifestyle changes with daily doses of cholesterol-lowering drugs.

When Ornish's study is taken in context with those of cholesterol-lowering drugs, experts estimate anywhere from 40% to 90% of people with heart disease may avoid or at least delay surgery or angioplasty.

"We found a strong correlation between adherence and outcome: The more people changed, the better they got," says Ornish, whose study began in 1986. "It wasn't a function of how old . . . or how sick they were (but) primarily a function of how much they changed their lifestyle."

The diet and lifestyle changes made by patients in the new study were developed by Ornish, who has converted thousands of heart bypass surgery candidates into vegetarian, yoga- practicing health enthusiasts.

Victor Karpenko opted for Ornish's method 10 years ago after his doctor told him he needed bypass surgery. His chest pain disappeared in a month. Today he hikes and climbs the equivalent of 130 floors on the Stairmaster three days a week.

"It's such a miraculous change in my physical condition from not being able to walk to going to the High Sierras at 8,000 feet with 45 pounds on my back. I'm tireless from following this regimen," says Karpenko, 73, of Danville, Calif. The changes in Karpenko's heart are the focus of the new JAMA study - and of excitement among experts.

"Dean has done a remarkable job," says Daniel Steinberg of the University of California, San Diego, who led the effort in the early '80s to get people to lower their cholesterol. "He uses his powers of persuasion to do what we would all like to see done. It is very hard to get people to be as Spartan as that," he says.

But Steinberg says it's unclear whether all of the components of Ornish's program are necessary to reverse blockages. So far, scientists believe the most important aspect is lowering cholesterol dramatically.

Still, if patients can be motivated to make the additional lifestyle changes, they clearly benefit.

"This is a beautiful demonstration of the synergy with which you can attack (heart disease) on all fronts, and a beautiful example of how physicians should do it," Steinberg says.

Ornish's program is taught in retreats operated by his non- profit institute. It also is the subject of his best-selling books, Dr. Dean Ornish's Program for Reversing Heart Disease and Eat More Weigh Less.

In 1990, Ornish and Gould first published a study showing that, after one year, 82% of patients who adhered to Ornish's regimen had arteries that showed some reversal or change in their blockages. Patients in a control group, who followed American Heart Association guidelines of a 30%-fat diet, got worse.

The study captured the attention of the medical community and was immediately controversial. It contained only a small number of patients, so doctors said the findings might not bear up in a larger study. Doctors also argued that patients would never go along with the diet and lifestyle changes necessary to reverse heart disease.

By 1992, however, the program caught the eye of Ken McDonough, then medical director at the Mutual of Omaha insurance company.

With bypass procedures costing $50,000 each, Ornish's program at $5,000 to $6,000 per patient appeared to offer an economic alternative.

A pilot program to test it in the real world was begun at Immanuel Medical Center in Omaha and the insurer agreed to pay the bills.

Mutual of Omaha found that of the patients motivated enough to try the program, 90% stuck with it. And of those patients, bypass surgery and angioplasty was avoided in 75% to 80%. The insurer saved $5 for every $1 spent on Ornish's program.

Meanwhile, Gould has developed his own program that combines a 10% low-fat diet with cholesterol-lowering drugs. (Ornish does prescribe drugs for some patients.)

Says Gould: It's "both life-saving and contributes to symptom-free activity and that's a real advance."

Antonio Gotto, chairman of medicine at Baylor Medical College, is conducting a new study with Gould to determine its effectiveness.

But Gotto says the current research is important. "They got a lot of bang for a little buck, a lot of change in blood flow to the heart muscle. But can this kind of program be exported and used widely? It's a lot more complicated than taking a pill or following a moderate diet."

Last month, Blue Cross and Blue Shield of California accepted the program as a standard benefit at hospitals where it is available.

B. Greg Brown, University of Washington, who led one of the landmark studies of cholesterol-lowering drugs, says regardless of which method is used, anything that cuts cholesterol significantly is effective.

Patients can be dramatically helped "without any side effects, really. This puts the convincing nail in the coffin" of heart disease.

Original printed in USA today
September 20, 1995