Dean Ornish, M.D., is the president and founder of the nonprofit Preventive Medicine Research Institute in Sausalito, California and a Clinical Professor of Medicine at the University of California, San Francisco. He has directed revolutionary research proving, for the first time, that lifestyle changes can often reverse—undo!—the progression of many of the most common and costly chronic diseases and even begin reversing aging at a cellular level.
By Dean Ornish and Anne Ornish, 2019 Published by Ballantine Books, ISBN-10: 052547997X.
Review of “UnDo It! How Simple Lifestyle Changes Can Reverse Most Chronic Diseases”.
Reviewed by George M Jacobs, firstname.lastname@example.org
‘Simple’ appears in the book’s subtitle and is a key word in this book, which starts with a quote attributed to Einstein that only when we understand something well can we explain it in simple language. Indeed, the authors claim their approach is ‘radically simple’. It is not just that Dean and Anne Ornish use simple language in explaining their approach to health but also that they believe simple steps are all that are necessary to enable us to be healthy and to recover our health, even when we are suffering from major chronic diseases, such as diabetes and heart disease.
The Ornish Diet claims to be ‘Radically simple, yet powerfully proven’. And, the authors have the research – research appearing in top journals – some of it done by them, to support their claims about the simplicity and effectiveness of their lifestyle prescriptions. On one hand, their prescriptions are low tech and inexpensive, but on the other hand, their evidence comes from high tech measuring tools and state-of-the-art research methods.
Undo It! proposes a 4-part program summarized in the motto: “Eat Well, Move More, Stress Less, Love More.” Each of these parts can be briefly explained as:
- Eat Well = eat a whole foods plant-based diet. Whole food means less processed, for example, brown rice instead of instant noodles and soy milk instead of ice cream loaded with refined sugar. Plant-based means mostly from plants, for example, beans instead of meat, and plant milks instead of dairy milk.
- Move More = do regular, moderate exercise. Find a sport or other form of exercise you enjoy, so that you will find it easy to exercise regularly.
- Stress Less = find a way to reduce stress. It could be moving away from stress-inducing contexts or changing your perspective on stress-inducing situations, or it could be finding ways to release stress, such as listening to music, exercising, pursuing a hobby, or striving to quiet your mind.
- Love more = build and maintain a support network of family, friends, non-human animals, and community.
Small, slow changes or big, fast changes? For people already suffering from chronic diseases, the Ornishes recommend making quick, big changes. In their experience, baby steps do not bring about sufficiently large health changes to motivate people to continue with the program, at the same time that people are not enjoying the diet and lifestyle changes.
The Ornishes propose a ‘New Unified Theory of Health and Healing.’ Previously, each chronic disease, such as dementia, prostate cancer, Type 2 diabetes, or obesity, was seen as a separate problem, deserving of its own chapter in the textbooks of doctors and other health professionals. Instead, according to Unified Theory, all lifestyle diseases share many of the same causes, and they progress in similar ways. As a result of these commonalities in their origins, the various lifestyle diseases can also be reversed by similar treatments.
Such a unified approach to understanding and overcoming chronic diseases goes against a current trend that seeks to individualize disease treatment. This individualized approach sees everyone as different as to blood type, DNA, family history, etc. However, the evidence presented in Undo It! suggests that, despite the presence of these real differences, Eat Well, Move More, Stress Less, and Love More can be powerfully effective for everyone and for all lifestyle diseases.
The hard copy version of the book is more than 500 pages, but about half of those pages are recipes, and another 50+ pages are devoted to practical tips, such as stretching exercises. As mentioned earlier, most of the book is written in simple, layperson language. Thus, most readers will find the book’s language and length to be easily comprehensible and inviting, at the same time they find the content to be eminently useful.
What follows are brief overviews of UnDo It!’s eight chapters, highlighting points that the reviewer felt to be noteworthy. The book’s authors are easily found on the internet discussing the book, such as they are interviewed on Rich Roll’s vegan podcast: https://www.youtube.com/watch?v=BGcU9wy8_Dw
Chapter 1 – It Works!
For years, plant-based nutrition has talked about lowering the risk of chronic diseases, but the book’s title, UnDo It!, takes this a step further. The authors claim, based on research listed in the back of the book, that their program can not only lower risk but it “can often reverse the progression of many of the most common chronic diseases”, sometimes with and sometimes without drugs and surgery. These chronic diseases include heart disease, type 2 diabetes, prostate cancer, high blood pressure, elevated cholesterol, obesity, early-stage dementia, some autoimmune diseases, and depression. And, the beauty of this program is that, unlike drugs and surgery, Eat Well, Move More, Stress Less, and Love More has no side effects.
The Ornishes are based in the U.S., and one big reason that physicians there previously did not recommend the Ornishes’ lifestyle medicine approach – despite its scientific backing – was that insurance companies would not reimburse the physicians. Instead, pills and procedures were what insurance companies paid for. That is changing. “Medicare and insurance companies are paying for seventy-two hours of training each patient rather than only ten minutes. … The physician acts as ‘quarterback’”. Also involved in these seventy-two hours are exercise physiologists, yoga/meditation teachers, clinical psychologists, social workers, dietitians, and nurses.
Very importantly, patients seem to like the Ornish program: 94% completed the entire seventy-two hours and 85-90% were still following the program a year later. This faithfulness sharply contrasts to the behaviour of patients who, instead of lifestyle modifications, are prescribed cholesterol-lowering drugs and blood pressure medications: “one-third of these prescription are not even filled.” The authors explain why some patients won’t even perform the quick and easy daily act of taking pills, but they will perform the much more time consuming, much more outside-the-box behaviours recommended in their book: the lifestyle changes usually make people feel better.
Chapter 2 – Why It Works: A New Unified Theory of Health and Healing
This chapter begins with a quote from famous science fiction author, Arthur C Clarke, “Like all revolutionary new ideas, the subject has had to pass through three stages, which may be summed up by these reactions: (1) ‘It’s crazy—don’t waste my time.’ (2) ‘It’s possible, but it’s not worth doing.’ (3) ‘I always said it was a good idea.’” This three-stage process seems to be what may be happening in medicine, albeit far too slowly.
Why do Dean and Anne call their perspective a “Unified Theory of Health and Healing”? “The same lifestyle medicine program described in this book has such far-reaching impacts on undoing such a wide range of diverse chronic illnesses.” Their research did not use “one set of life-style changes for reversing prostate cancer, diabetes, and other chronic illnesses. It was the same lifestyle medicine program for reversing all of these. … Also, the more closely people adhered to this program, the more they improved – at any age.”
The rest of the chapter is probably the most complex in the book, as it goes into detail on the various common mechanisms at work in boosting people’s health. These mechanisms include addressing chronic inflammation and immune system dysfunction; chronic emotional stress, depression, overstimulation of the sympathetic nervous system, stress hormones, and lack of sleep; gene expression and sirtuins; telomeres; the microbiome; oxidative stress, cellular metabolism, and apoptosis; angiogenesis; and stasis.
For instance, the section on gene expression addresses the powerful myth that our genes are our inescapable destiny. As Dr Ornish wrote to former U.S. President Clinton who has a family history of heart disease, “Our genes are a predisposition, but our genes are not our fate. … You’re genetically predisposed to having heart disease because it runs in your family, but this just means that you need to make bigger changes to prevent or reverse it than someone else might. Our DNA is not our destiny.”
Chapter 3 – The Lifestyle Medicine Revolution
Dr Ornish was one of the pioneers of lifestyle medicine going back to the previous century. Lifestyle Medicine is an approach to healthcare that emphasizes lifestyle changes in combination with or without pharmaceuticals and surgeries. Key lifestyle changes are those summarized in the Undo It! slogan: Eat Well, Move More, Stress Less, and Love More.
The main part of this chapter looks at the impact Lifestyle Medicine can have on chronic diseases. For example, the chapter reviews research, including some done by Dr Ornish and his colleagues, on the superiority of lifestyle medicine over traditional Western medicine in the prevention, treatment, and reversal of type 2 diabetes. “Many patients with type 2 diabetes may initially need to be on prescribed medication if their blood sugar is very high while they are beginning to make comprehensive lifestyle changes.” Lifestyle medicine may allow doctors to wean patients off these medications, thus freeing them from the medications’ side effects, at the same time the patients benefit from the many other benefits of lifestyle changes.
Chapter 4 – Eat Well
This chapter opens with an Ayurvedic proverb that sounds a bit like Hippocrates’ “Let your food be your medicine”: “When diet is wrong, medicine is of no use. When diet is correct, medicine is on no need.” The chapter’s information is probably well-known to people in and around the vegan/vegetarian community. It can be summarized as advocating a whole food, plant-based diet.
Dr Ornish’s own thinking has evolved a bit on potential inclusion of minimal amounts of animal-based foods: “[T]he best results come from avoiding all animal products. In our earlier studies, we included egg whites and one cup per day of either nonfat yogurt or milk—but you don’t need these for good nutrition, and there is increasing evidence that it may be better to avoid dairy and eggs.”
Somewhat unique for a book on health, UnDo It! also contains in Chapter 4 a section on “What’s Good for You Is Good for Our Planet.” I recently had a chat with a nurse educator who was hesitant to include the climate crisis in her curriculum. I am going to send her the quote Dean uses from the Journal of the American Medical Association, “Health is inextricable linked to climate change.” Dean ties this link between environment and diet to compassion, “to the degree we choose to eat a plant-based diet, we free up tremendous amounts of resources that can benefit many others as well as ourselves. … And when we can act more compassionately, it helps our hearts as well.”
In the remainder of the chapter, Anne provides advice on eating well. I especially like the sections on why we eat and how we eat. Under why we eat, she urges that we ask ourselves, “What do I really need right now? Is it a cookie or a hug that I actually need? Is it chips or an energizing walk? Is it ice cream or some rest?” As to how we eat, Anne advises, “to bring mindful eating to life for yourself, begin by getting centered in your chair and placing both of your feet on the ground. Close your eyes and take three slow, full-body breaths. As you slowly open your eyes, gaze down at your food as you take a moment to feel gratitude.”
Chapter 5 – Move More
This chapter is about exercise. Simple and easy are the watchwords. No need to do much exercise; thirty minutes of moderate exercise most days of the week will suffice. Which kinds exercise to do? Ones you enjoy, because you will do what you enjoy; it will be a playout, not a workout. “In short: do what you enjoy, make it fun, and do it regularly. … It’s not like you need to do one type of exercise to reverse heart disease, another type of exercise to reverse early-stage prostate cancer, or to lower your blood pressure, weight, cholesterol, or blood sugar levels.”
Most of the advantages Dean lists for exercise are well-known. What may be less known are that exercise makes us happier and makes our brain bigger and smarter. He cites research that found, “Those who worked out only once or twice a week said they felt much happier than those who never exercised. Those who worked out thirty minutes a day showed even greater benefits.” Various forms of exercise, even stretching/balancing, were associated with greater happiness. As to exercise’s benefits for our brains, “Exercise causes new neurons to be born, and also new connections between neurons to be made. This allows you to encode or develop new learning and memory and also provides a new vascular (blood vessels) structure. Besides increasing the size of your hippocampus, exercise makes the connections between your neurons work more effectively and also brings more blood flow to your brain.”
Although the book says that any exercise works, the authors recommend that people do three kinds of exercise: aerobic, strengthening, and stretching. I love aerobic exercise, but the other two not so much. Fortunately, Anne offers suggestions accompanied by photos for each of the three types of exercise. Many of these use resistance bands. Anne also recommends yoga.
Chapter 6 – Stress Less
Chronic stress leads to chronic diseases. “It has a direct effect on our health mediated through the sympathetic nervous system, and it plays an important role via affecting each of the other mechanisms described in Chapter 2 (inflammation, etc.).” Fortunately, in Chapter 6, Anne provides 50+ pages of advice on stress reduction.
For example, her suggestions for gentle stretching are:
- Move slowly and consciously, and never strain.
- Pay attention to the area being stretched.
- Stretch to a point before you feel pain, not beyond.
- Always keep your breath natural and through the nose whenever possible.
- Always remember to breathe smoothly and evenly during stretching postures.
- Full-body inhalations and exhalations help you to relax and stretch farther.
- The time you take for relaxing between the poses is as important as the postures themselves.
- Be aware of signs of stress—dizziness, shortness of breath, pain, and agitation.
- Use common sense. If it hurts, stop what you are doing.
- Hold each posture only as long as it feels comfortable.
- The goal is to feel peaceful and relaxed.
Elsewhere, the chapter deals with various forms of meditation, breathing techniques, deep relaxation, guided imagery, yoga postures, and sharing of feelings. Anne also offers responses to reasons people give for not destressing. For instance, here she responds to people who do not enjoy stress reduction activities:
- Try walking meditation.
- During stress reduction activities, play music you enjoy.
- Attend a class for more guidance.
- Do it with a partner.
- Create a nice atmosphere (for example, candles, dim lighting, plants, aromas).
- Determine the part you like and do more of it.
Chapter 7 – Love More
Perhaps this chapter had the most insights for me, with the most ideas that could benefit those working to help themselves and others to Eat Well, Move More, and Stress Less. First off, the guideline to Love More fits well with observations found in other books as to what promotes health and longevity. In Maslow’s Hierarchy of Needs, belongingness constitutes a vital need. Similarly, social networks form a key element in the Blue Zones, places where living to be 100 is not unusual. Plus, relationships provide an essential component of Seligman’s Positive Psychology framework.
Dean’s spiritual teacher, Swami Satchidananda, is quoted as stating, “Peace comes not from doing, but from undoing; not from getting, but from letting go.” People might not be aware that we already have connections to others. Dean states, “We can consciously choose to use these connections with each other in healing ways rather than in harmful ones.” He refers to horizontal intimacy, our connections to other people as well as to other beings, such as nonhuman animals. Dean also talks about vertical intimacy which I’m guessing means transcending our individuality and seeing that we are the world and the world is in us, or as is stated in the quote by the poet Rumi at the start of the chapter, “Do not feel lonely. The entire universe is inside you.”
Other points that stood out in the Love More chapter are:
- The Ornish program structures in a lot of group support, and group members often continue to meet after the seventy-two-hour program has ended.
- A great deal of attention is devoted to establishing well-functioning, supportive groups who communicate about their feelings.
- We can change the psychological effects of the past, which is almost like changing the past itself, because often it is the psychological effects of the past which shape the present and future.
- We should express our gratitude to others and to ourselves. At the same time, we should forgive others and ourselves. In the same vein, apologizing can be a powerful way to repair the past, as long as we bear in mind the words of the philosopher, Benjamin Franklin, “Never ruin an apology with an excuse.”
- An easy means of burnishing our connections with others is by providing them with support. Anne reported one study that found, “stress did not predict mortality risk among individuals who provided support for friends or family members … [but] stress did predict mortality among those who did not provide help to others.”
- Dean discussed which tool is best for convincing people to adhere to the Eat Well, Move More, Stress Less, Love More program: fear or hope. His decades of experience suggest that hope is by far stronger. This is why he and Anne ask a question people have often never been asked before: “Why do you want to live longer?”
Chapter 8 – The Ornish Kitchen/True Love Recipes
The book’s many food and drink recipes cover a wide gamut of meals and cuisines. While the recipes, especially those that involve branded ingredients, would be easier to put together in North America, most harder-to-find ingredients would be easy to substitute for. Also, each recipe comes with Nutrition Facts, including information on calories, calories from fat, cholesterol, sodium, and protein. People may also find the cooking tips to be useful.
To conclude, I enjoyed reading the quotes listed on the book’s covers and early inside pages of book. Undo It! has a very impressive number of such quotes from an impressive array of people, including Beyonce. The quote I liked best is from someone I had never heard of, Jack Hidary, senior adviser to Google X, also known as X Development, which does R&D for Alphabet, Google’s parent company. Hidary wrote, “Dean Ornish is from the future.” Let’s hope that Hidary is right and that many people follow the well-explained, well-researched, powerful advice in this book.