The Share Guide: In the book you mention the concepts of love, intimacy and meaning--those are essential to your work. You say that they are the least understood, as well as the most important.

Dr. Dean Ornish: Yes, they are. In science we tend to focus on what we can measure, even though what we can measure may not necessarily be what is meaningful. Not everything that is meaningful is measurable. We tend to focus on cholesterol and blood pressure, things we can more easily measure even though that may not necessarily be what's most important. There is a wide body of evidence showing that people who feel lonely and depressed and isolated are 3-7 times more likely to get sick and die prematurely than those who have a sense of love and connection in the community. I don't know of anything in medicine that has a more powerful impact across the board, not just with heart disease but also with most other illnesses. Researchers found in one study, for example, that by asking people about to go through open heart surgery (both men and women) two simple questions, the answers were powerful predictors of who was likely to survive six months later. Researchers asked:1) "Do you draw strength from your faith?" Whatever that faith was did not matter. 2) "Are you a member of a group that gets together on a regular basis?" It could be church or synagogue, civic group or bowling league. What they found, to me, was mind boggling: those who said "No" to those two questions, 21% had died within six months of the open heart surgery. This is compared to only 3% of those who said "Yes" to those questions, a seven-fold difference in mortality. Those who said "Yes" to one of the two questions had about a four-fold difference in mortality. I don't know anything else that is so powerfully predictive, and yet most surgeons don't bother to ask these questions to their patients because they don't realize how important they are. You know you are dealing with something very powerful when these relatively crude measures of love and intimacy are so powerfully predictive of survival (just a few months later, or sometimes decades later). A bowling league is not the most intimate of life experiences, and yet look what a difference it makes in these people.

The Share Guide: Because of social bonding?

Dr. Dean Ornish: Yes. When I talk about intimacy, I don't just mean sexual or romantic intimacy, although those are nice forms of intimacy. Intimacy is anything that takes us out of the experience of feeling separate. Someone or something other than ourselves. It could be a lover, a friend, a relative, a community member; it could be a pet. It could be a spiritual or transcendent experience-- feeling like a part of everything as opposed to feeling apart from everything. There are many pathways to intimacy. I outline eight in the book. These are just eight of many, but eight that have been helpful to me in my own life as well as in the lives of many other people with whom I've worked with over the years.

The Share Guide: It does make sense to me. If you have a life threatening illness, and you have no one to recover for except yourself, the urge to get well and move on may not be as great.

Dr. Dean Ornish: That's part of it. That these things matter is clear. Why they matter is a bit of a mystery, and in the final chapter of my book I interview 24 different people and ask them all the same question, "Why do you think isolation is such a powerful predictor of illness and suffering, while intimacy is powerfully healing?" They all started in different places within their own frame of reference, but they ended up in a place that was very similar. In most systems of healing other than Western medicine, there is a concept of vital energy, sometimes called chi, qi, prana, shakti, or kundalini, and the idea that we are all interconnected at some level. You can cut yourself off from that interconnectedness through putting up walls, emotional defenses for example. Not that you shouldn't have some defenses, but if they are always up and you have no one you trust enough to open up to, then those same walls that you think are protecting you are also isolating you.

The Share Guide: It takes energy to keep defenses up.

Dr. Ornish: Yes, it takes energy to keep them up, but more importantly it is cutting you off from the energy that is already there between you and the rest of the world. It is a little like walking into a room that has lots of windows and it's a bright sunny day outside but you can close all the windows and shades and make the room dark. It is still bright outside but you have just cut yourself off from the source of light. Again, it's not that we shouldn't have emotional defenses, but if you have no one to feel safe enough with to let them down, then they are always up. The paradox is in the name of protecting us they are actually isolating us. Isolation itself threatens our survival. The very thing that we think we are doing that's protecting us is the very thing that may be harming or maybe even killing us. Part of the value of science is to help raise the level of awareness to how much these things really matter. If we can understand how much they matter, then we can make different choices. There has been a radical shift in our culture in the last 50 years with the breakdown of the social network. You can give people a sense of connection and community. These things affect the quality of our lives--and our survival. They also affect our behaviors. People that are lonely and depressed and isolated are much more likely to smoke, to overeat, to drink too much, to work too hard, to abuse drugs, to spend too much time on the internet, to watch too much television, and so on. So it's not enough to just give people information and expect them to change. We have to work at a deeper level.

The Share Guide: I agree. If a person wants to make lifestyle changes it isn't necessarily easy. If you have a family to change for as well as yourself it is definitely a support group.

Dr. Ornish: There is that, too. That's important.

The Share Guide: Reading your book Love & Survival has made me thankful that I have a family.

Dr. Ornish: You should be! In working with people over the years I ask them why do you smoke, or overeat, or drink too much, or work too hard, or do drugs, or spend too much time watching television or on the internet. These behaviors seem so maladaptive to me. They say, "You don't get it, these behaviors aren't maladaptive, they are very adaptive because they help me get through the day." For many people, just getting through the day is the most important thing. One woman said, "I have 20 friends in this one package of cigarettes. They are always there for me. Nobody else is. You want to take away my twenty friends? What are you going to give me instead?" People may use food to fill the void, or alcohol or other drugs to numb the pain. They work too hard to distract themselves from the pain, or watch too much television. We have lots of ways of numbing, killing, bypassing or distracting ourselves from pain. The pain isn't the problem, it's a messenger. It is saying, "Listen up, pay attention, you are not doing something that is in your best interest." If we just try to numb pain or kill it or bypass it without listening to it, then it is a little like clipping the wires to a fire alarm, and then going back to sleep while your house keeps burning down. The problem is still there and it just gets worse.

The Share Guide: So pain is a good signal?

Dr. Ornish: Pain can be a powerful catalyst for transformation. We know change isn't easy. If you are in enough pain and the strategies for numbing, killing or bypassing it aren't working that well, then sometimes the idea of change becomes more appealing. You think, well, it might be hard to change but boy, I am in so much pain I am ready to try just about anything. When people make these changes, and they see how much better they feel and how quickly it happens, they look back on the suffering itself as a blessing in disguise. They say things like "Having a heart attack was the best thing that ever happened to me. It made such a powerful difference in my life. Had I not gone through that experience I never would have changed."

The Share Guide: What do you mean when you say in your book, "Healing and curing are not the same. Disease and illness are not the same. Pain and suffering are not the same."

Dr. Ornish: Pain is a physiological process of your nerves transmitting information. Suffering is the experience of that. We've all had times when the same level of external stimulation may be perceived as much more painful than at other times. So we can't always control pain, but our experience of pain is something that is often affected by the amount of support that we have. The same is true for disease and illness. Disease is the physiological process. Illness is the experience of that. With illness, while no one searches for that or wants it, there can often be a transformative quality about it. Not that you would ever go up to somebody suffering and say, "Oh what a great opportunity you have to transform because you are sick." The proper response to that would be a punch in the nose! We don't look for suffering, but it's there. How we deal with it is something that we have much more control over than we might realize. The same is true for healing and curing. Curing is the physiological process of getting better. Healing is the process of becoming more whole. They often go together. My colleagues and I at the non-profit Preventive Medical Research Institute have shown over the years that you can often reverse the progression of heart disease much more quickly than what we once realized.

We can use high-tech, state-of-the-art measures to prove the power of very low-tech and low-cost interventions. We can show that there is actually an improvement in the underlying disease process. If you talk to the patients who go through our study, they'll say they first got interested because they wanted to get cured, but they stayed interested because of the healing end of it. They will say things like, "I am not as concerned that my arteries are more opened, because I am more open. In other words, my relationships are better, my capacity to love myself and others is greatly improved. I am learning to quiet down in my mind and body so that I can re-experience inner sources of peace and joy and well-being." Again, not that anyone looks for pain or illness or suffering or disease, but they can be powerfully transformative. These aren't things I was trained to look for in my Western medical training. Even if the disease doesn't get better physiologically, there can still be healing that occurs. Even in death there can be healing, in terms of the level of intimacy and inner peace that people have the potential to discover during these vulnerable moments.

The Share Guide: There's a quote in your book from The Broken Heart by Dr. Lynch that says "There is a biological basis for a need to form loving human relationships."

Dr. Ornish: That's true. That is how we've been able to survive as a species for so many years. I think we ignore these fundamental human needs at our own peril. The need for love is a basic human need that's as fundamental as eating and breathing and sleeping. We don't generally realize how important these things are. We think that the time that we spend with our loved ones is what we do after we've done all the important stuff. We don't necessarily realize that it's the other way around. You work long hours, travel a lot and maybe spend a few precious minutes with your spouse or kids when you come home from work. It's like a luxury and yet we don't realize it's a basic fundamental human need. Here again, that's part of the value of science, which can help us understand and raise the level of awareness of how much these things matter so that at least we know we have a real choice there, and we're not just blundering into things out of ignorance.

The Share Guide: As I read your book I repeatedly kept thinking of John Lennon's phrase, "All you need is love." It seems that applies on so many levels from politics and taking care of the environment to our own bodies. You even mention that the binding of hydrogen and oxygen into water is all about unity.

Dr. Ornish: In one sense that's true. Even the electrons dancing around, some people would say, are molecules making love, but I think we also need to deal with things on a very practical level as well. Part of the research that we are doing is trying to show that these approaches are both medically effective and even cost effective. If I went to an insurance company or Medicare and said, "I want these people to open their heart," they would show me the door! But if I say, "Here are the arteriograms and the cardiac catscans, etc. all showing reversibility of heart disease. For every dollar you are spending (whether it's Mutual of Omaha or Blue Cross/Blue Shield or whatever company), we're saving several more immediately, they say, "Oh that's really great! Tell us more, and maybe we'll cover it." More than 40 insurance companies are paying for this program and Medicare recently agreed to begin a demonstration project where they're going to cover 1,800 patients who go through the program in the sites where we train.

The Share Guide: I know that 40 insurance companies have heard of your program, but I thought that was related to your low-fat diet. This work is also part of the overall program?

Dr. Ornish: That's right. It's more than just the low fat diet. It's a whole foods/ plant-based low fat diet. There's a lot of misconceptions about diet. Such as Atkins and other high-protein diets. I end up debating them on regular occasions.

The Share Guide: Would you like to give an overview of your program?

Dr. Ornish: The program is a low fat, whole foods, plant-based diet which includes fruits, vegetables, grains, beans, non-fat dairy, soy products, egg whites, and we've added oil, 3 or 4 grams a day of fish oil and flax seed oil. There's also moderate exercise, walking 30 to 60 minutes three times a week, stopping smoking, and a variety of stress managing techniques such as yoga, meditation, stretching, breathing, relaxation techniques and so on. There are also support groups for reversing heart disease. Plus some supplements and vitamins. These are all listed on my web site. (Go to Ornish.com which is part of WebMD) The web site covers all the elements of the program: how to stay on the program, the recipes, the vitamin and supplements I recommend--they're all there and it's all for free. I feel good about that because having really seen what a powerful difference changes in diet and lifestyle can make, it really provides an opportunity for us to make a difference.

The Share Guide: This might seem like a silly question, but I sometimes wonder how do you know you're healthy? I have been rather health-conscious since college, have no known health problems, and don't even go get checkups. Now I'm in my mid 40's. Should we be getting regular checkups if we feel like we don't have anything wrong with us?

Dr. Ornish: That's a hard question to answer in general because it just depends. There's some newer technologies like Dr. Harvey Eisenberg is doing in Orange County, California which can help you; basically it's a total body scan. There may be some value in that because if you find you have early-stage diseases then it can be a powerful motivator in doing something about it.

The Share Guide: Yes, something could be going wrong even if you think you're eating enough tofu.