The Joy of Living Versus the Fear of Dying

Cardiovascular disease kills more people worldwide than everything else combined, said Dean Ornish, MD, cardiologist and clinical professor of medicine at the University of California in San Francisco. Dr Ornish is well known for his lifestyle-driven approach to the control of cardiovascular disease. Depending on the extent of personalized lifestyle changes, disease progression can be stopped and even reversed.

A correlation between cardiovascular disease and depression has been suspected for some time, and now scientific evidence is accumulating, which demonstrates that, indeed, there is a link. However, the relationship is much more complex than previously believed. Although the onset of depression after a cardiac event can be expected, recent findings indicate that major depression, which precedes any evidence of cardiovascular disease, can predict future disease and cardiac death.¹

Several sessions on the correlation of cardiovascular disease and depression were presented at the recent American Psychiatric Association meeting in San Francisco; one of the highlights was the lecture by Dr Ornish. There are many pharmacological treatments for depression that are reasonably safe and effective for patients with cardiac diseases, but perhaps the approach that has the fewest adverse effects is that of Dr Ornish. In his presentation, Dr Ornish reviewed the benefits of simple lifestyle changes, which are evident not only in medical conditions but can extend to neuropsychiatric disorders as well-some of the latest clinical findings suggest that comprehensive lifestyle changes can make a difference on neurogenesis and genetics.

Dr Ornish’s approach is based on pleasure rather than fear. Simple lifestyle changes-diet, excersise, meditation-can make a huge difference. Stress is reduced, health is improved, and thus life becomes more enjoyable. And, it is a spectrum of change-even the smallest change can make a difference in a person’s physical and/or mental health. For instance, just a few minutes a day of yoga or meditation can made a big difference in a person’s well-being. However, the bigger and more comprehensive the changes, the better the outcomes: moderate changes give moderate benefits, bigger changes provide greater benefits (eg, coming off medication). The more lifestyle changes that people make, the better they feel physically and mentally.

The risk factors for cardiovascular disease are depression, hostility, and chronic anger. With lifestyle changes, all 3 decrease. Once the lifestyle changes are implemented, the benefits accrue quickly because the mechanisms are so dynamic. However, according to Dr Ornish, motivating a patient for sustainable change in behavior cannot be accomplished through threats: fear is not sustainable because eventually it gets boring. Replacing the fear of dying with the joy of living is the motivation for sustained lifestyle changes.

Lifestyle changes may also be implicated in genetics. Findings from a recent pilot study undertaken by Dr Ornish and colleagues² suggest that lifestyle changes promote increased telomerase activity, which translates into telomere maintenance capacity in human immune system cells. Telomeres are found at the ends of chromosomes that control how long we live: longer telomeres increase life expectancy. Larger randomized controlled trials are needed to confirm these findings.

The benefits of lifestyle changes are not just physical, improvements to mental health have also been found. Brain imaging studies show neurological changes that result from the comprehensive lifestyle changes approach developed by Dr Ornish. Before the advent of the new brain imaging techniques, it was believed that neurogenesis did not occur in the adult brain. However, findings from recent brain studies suggest that adult hypocampal neurogenesis does occur.³ Dr Ornish provided an example: Brain size increased in subjects who walked 3 hours a week for 3 months because of the growth of neurons in the prefrontal cortex.⁴ The prefrontal cortex is the area of the brain responsible for cognitive behavior/executive function, including making choices between right and wrong or good and bad, and governing social control. If results of further studies are positive, the implications for mental health could be significant.

Dr Ornish closed with the caveat that in order to implement the comprehensive lifestyle changes, we need health care reform that bases payment on effective evidence-based treatment rather than status quo reimbursement. He said that change of reimbursement for treatment is the driver to diet and lifestyle changes. Health policy should reflect the medical- and cost-effectiveness of comprehensive lifestyle changes.

References:

References

1. Lett HS, Blumenthal JA, Babyak MA, et al. Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosom Med. 2004;66:305-315.
2. Ornish D, Lin J, Daubenmier J, et al. Increased telomerase activity and comprehensive lifestyle changes: a pilot study [published correction appears in Lancet Oncol. 2008;9:1124]. Lancet Oncol. 2008;9:1048-1057.
3. Lee E, Son H. Adult hippocampal neurogenesis and related neurotropic factors. BMB Rep. 2009;42:239-244.
4. Ornish D. The power of personalized lifestyle changes. Presented at: the American Psychiatric Association Annual Meeting; May 16-21, 2009; San Francisco.