Preventing the Diseases of Aging

Welcome to The First Word from AARP, a series of conversations with the experts, exclusively for AARP members. Today on The First Word, Dean Ornish on how to prevent the most common diseases of aging.

BL: Hello. I’m Bob Love, editor-in-chief of AARP The Magazine and the AARP Bulletin. Welcome back to The First Word from AARP, an interview series exclusively for our members.

Each of us wants to live a longer, healthier life. Today’s guest has developed a program designed to help us do exactly that.

You may have — probably have — heard of Dr. Dean Ornish, whose diet program to reverse heart disease has been world renowned since the 1990s. Today Dr. Ornish is back with a fuller and more holistic lifestyle approach that he says can not only reduce your risk of cardiovascular disease, but of cancer, Alzheimer’s and more.

Dr. Ornish outlines his program in his new book titled Undo It. And he’s here to tell us about the four essential components of staying healthy for life. Dean, thank you very much for joining us today.

DO: It’s great to see you, Bob. Thanks for including me.

BL: Let’s begin by identifying some of the diseases we’re trying to prevent. What are the common diseases associated with aging that are proven to be linked to lifestyle and diet?

DO: A very good question. Well, I wrote this book because for the last, as you indicated, over 40 years, I’ve directed a series of studies showing that simple changes in lifestyle, which are basically a whole foods plant-based diet that is both low in fat and sugar, moderate exercise like walking half an hour a day, various stress management techniques including meditation and yoga, and what we call psychosocial support, which is really love, intimacy and community. To reduce it to its essence, eat well, move more, stress less, love more. Boom, that’s it!

 The more diseases we study and the more mechanisms we look at, the more scientific evidence we have to show how powerful these simple lifestyle changes are and how quickly people can get better.

We tend to think of advances in medicine as being a new drug, a new laser or something really high tech and expensive. I think our unique contribution has been to use these very high-tech, expensive, state-of-the-art scientific measures to prove how powerful these very simple and low-tech and low-cost interventions can be.

In a series of studies published in the leading peer-reviewed medical and scientific journals, we showed for the first time that these same lifestyle changes could reverse even severe coronary heart disease, type 2 diabetes, high blood pressure, high cholesterol, obesity, early-stage prostate cancer and probably, by extension, early-stage breast cancer.

We did a study with Craig Venter, who was the first to decode the human genome, showing that when you change your lifestyle, it actually changes your genes. It turns on the good genes and turns off the bad genes. Over 500 genes were changed in only three months.

And we did a study with Dr. Elizabeth Blackburn, who got the Nobel Prize for discovering telomeres, which as you know are the ends of our chromosomes that control how long we live. As we get older, our telomeres get shorter, and as our telomeres get shorter, our lives get shorter. We found we could actually lengthen them. When we published this in the Lancet, the editors called it reversing aging at a cellular level.

We are now doing, as you indicated, the first randomized trial to see if these same lifestyle changes may even reverse the progression of early-stage Alzheimer’s disease, which we can talk about more later. I think we’re at a place with Alzheimer’s very reminiscent of where we were 40 years ago when we started doing studies on heart disease.

What was interesting to me, Bob, was that I was trained like all doctors to view each of these different diseases as different diseases, different diagnoses and different treatments. Like all doctors. But I’ve found over the years that these same lifestyle changes could reverse and therefore prevent all of these conditions.

I began to realize that the reason for that is that they are the same disease manifesting and masquerading in different forms because they all share the same underlying biological mechanisms, things like chronic inflammation, oxidative stress, changes in the sympathetic nervous system, overstimulation in the microbiome, angiogenesis, gene expression, telomeres and so on.

Each of these mechanisms in turn is directly influenced by what we eat, how we respond to stress, how much exercise we get and how much love and support we have. I’m continually amazed at how dynamic these underlying biological mechanisms are and how quickly you can get better or worse depending on what you do.

And so I present in this new book what I call a unifying theory, that they’re really the same disease and that’s why it’s the same lifestyle intervention. It kind of radically simplifies it.

BL: That is a radical statement, isn’t it, to say that they’re pretty much the same disease?

DO: It is a radical statement. I thought that I would be getting a lot of criticism from my colleagues in the medical world, but they all say, “You’re right.” It’s one of those great ideas — great not in the sense of how great I am, but great in the sense that it ties so many things together. It’s one of those ideas where you think surely someone must have thought of it before. The most interesting ideas are the ones that seem obvious, but yet no one really talked about it before.

The reason why I think that’s important is that with all this interest in personalized medicine — if you’re talking about a targeted immunotherapy for melanoma or pancreatic cancer, it’s awesome. But for the vast majority of chronic diseases, it’s not like you need one set of diet and lifestyle recommendations for reversing heart disease or preventing it or diabetes or prostate cancer or whatever it is. It’s the same for all of them. And to the degree you make these changes, there is a corresponding benefit. And so that radically simplifies it.

BL: Not to put too fine of a point on it, but it’s a unified field theory of therapy for the major chronic diseases associated with aging.

DO: Exactly.

BL: Where is your Nobel Prize?

DO: I don’t know. Call Stockholm for me, please.

BL: Stockholm on the line!

 Let’s start with cardiology.

DO: By the way, Einstein used to talk about a unified field theory, as you know. I open the book with one of my favorite quotes of his, which is, “If you can’t make it simple, you don’t understand it well enough.” I think there’s a lot of truth to that.

BL: Absolutely. Let’s go back to your first area of inquiry, which is cardiology. What’s changed during your time as a doctor in the last 30 or 40 years? What is notable in the changing of cardiac disease? We know that people don’t die from it as much as they used to. Is that fair to say?

DO: Well, that was fair until recently. It’s starting to go up again.

When I started doing this work, I got interested in part because I was learning how to do bypass surgery with Dr. Michael DeBakey, who was one of the pioneers who invented heart surgery. It was really dramatic. There was an Aztec quality to exposing someone’s beating heart and all that.

But after a while, it was disheartening in every sense of the word because we would cut people open, bypass their clogged arteries, tell them they were cured and more often than not, they would go home and eat junk food, not manage stress, smoke cigarettes, not exercise and so on.

And often, the new bypasses would clog up and we would have to cut them open again, sometimes two or three times. For me, that became the metaphor that we are literally and figuratively bypassing the problem without also treating the cause.

When I lecture, I often show a cartoon I had drawn many years ago of doctors busily mopping up the floor around the sink that is overflowing but nobody is turning off the faucet.

Even today, when people get put on drugs to lower their cholesterol or their blood pressure or their blood sugar — you know, there are 60 million people on cholesterol-lowering drugs in the U.S. alone, that’s 1 out of 4 people — they say, “Doctor, how long do I have to take these drugs?” The doctor usually says, “Forever.”

How long do you have to mop up the floor for the sink that’s overflowing? Forever. Why don’t we turn off the faucet?

 What I’ve been continually impressed by is that when we can treat the cause, which to a much larger degree than we had once realized are these lifestyle choices, our bodies often have a remarkable capacity to begin healing, and much more quickly than we had once thought. Even people with severe heart disease who literally can’t walk across the street without getting chest pain or make love with their spouse or play with their kids or go back to work, usually in a few weeks are pain free and they can do all those things.

They may be put on medications that they’re told they have to take forever, and under their doctor’s supervision they can often reduce or even get off these medications. They start to feel like, “Oh, I’m really getting better.”

For someone who can’t do all these things and suddenly you can now do them, it changes the whole dynamic from preventing something bad from happening years down the road to feeling good now.

Doctors say, “I can get my patients to take their cholesterol-lowering statins and things like that but there is no way they’re going to change their lifestyle.” And yet two-thirds of people who are prescribed statins are not taking them after just four to six months even though they’re of proven value in people who have heart disease. Twenty percent of those prescriptions never even get filled.

We’ve been training hospitals and clinics and physician groups around the country because Medicare created a new benefit category to cover my program, and most of the major insurance companies are as well.

We’re getting bigger changes in lifestyle, better clinical outcomes, bigger cost savings and better adherence than anyone has ever shown. That seems so counterintuitive. Taking a pill should be easy and everyone will do it, but changing lifestyle is really hard and yet, we’re finding much better results in people getting motivated to change their lifestyle. The reason is that the pill doesn’t make you feel better, but the lifestyle changes do.

The pill is really fear-based, and fear is not really a sustainable motivator. I think we’re finding that in the political world these days as well. The doctor usually says, “Take this pill to lower your cholesterol or your blood pressure. It’s not going to make you feel better. Hopefully, it won’t make you feel worse. It’s to prevent something really awful like a heart attack or stroke from happening years down the road that you don’t want to think about it,” so people stop thinking about it. So they stop doing it.

When you change your lifestyle, most people feel so much better so quickly. It reframes the reason for making these changes from fear of dying or fear of something really bad happening to joy and pleasure and love and feeling good. And that’s really what makes it sustainable.

BL: The bonus of doing things your way is that people actually feel good, whereas when you take a pill, it does its job but you’re not getting any extra joy from it.

DO: No, and oftentimes it makes you feel worse.

The other thing that has changed in cardiology, to go back to question, is that when I was a medical student in the late ’70s and early ’80s, bypass surgery and then later stents were all the rage. We spent at one point over $100 billion a year on these two operations, and yet the randomized trials have now shown conclusively that unless you’re in the middle of having a heart attack, which most people aren’t, neither bypass surgery nor stents really prolong life, prevent heart attacks or even reduce chest pain. They’re dangerous, invasive, expensive and largely ineffective, and yet these very simple lifestyle changes can actually not only prevent but even reverse even severe heart disease in most people.

I think our unique contribution has been to use these very high-tech, expensive, state-of-the-art scientific measures to prove how powerful these very simple, low-tech, low-cost and often ancient interventions can be. People think, Diet and lifestyle, that’s boring. How powerful could that be? Well, pretty damn powerful.

One of the people I wrote about in Chapter 1 of the book, we now have over a dozen people like him, was a doctor himself. He had such severe heart disease that he was told that the only thing that could save his life was to get a new heart, to have a heart transplant.

While waiting for a donor, he went through our program at UCLA, one of these Medicare-covered programs, to get in better shape for the surgery. After nine weeks, his heart improved so much, he didn’t need the heart transplant. What’s the more radical intervention here, a heart transplant or eat well, move more, stress less, love more?

And by the way, a heart transplant is like $1.5 ­million per person plus a lifetime of immunosuppressant therapies. We found that these same lifestyle changes could actually cut health care costs in half in the first year.

BL: Do you find that people do not go in with both feet until their backs are against the wall and they’ve got heart disease?

DO: Often that’s the case, and even then people don’t do it because their doctors don’t tell them to do it. They say, “We know you can’t change. Just take this pill. That will take care of it.”

Fear can be a great motivator for about a month or so. If someone has had a heart attack or an emergency room visit or chest pain or been recently diagnosed with a life-threatening condition, they’ll do pretty much anything their doctor or nurse says for a month or two, but then they stop because fear is not a sustainable motivator. It will get your attention, but what makes you sustain is that you feel so much better and a sense of love and connection and community really make a difference.

BL: I want to go back to term that you use early in the conversation called “telomeres.” Am I correct in thinking that this is genetic material and that what you’re talking about is actually, through the lengthening of this little squiggly thing, making people on a cellular level increasing life span? Is that right?

DO: Yes.

BL: Explain that to us.

DO: Thank you for the question. Telomeres are sometimes likened to the plastic tips on the ends of your shoelaces that keep your shoelaces from unraveling. Actually, they are the tip of your DNA. They keep your DNA from unraveling. As we get older, the DNA replicates over and over again and as it replicates, each time the telomeres get a little shorter. As the telomeres get shorter, our lives get shorter and the risk of premature death from pretty much all of these diseases we’ve been talking about goes up in proportion to that.

Dr. Blackburn, who got the Nobel Prize for discovering telomeres, did a study with Elissa Epel where she found that women who were under chronic emotional stress because they were caregivers of either parents with Alzheimer’s or kids with autism, the more stress they felt and the longer they felt that way, the shorter their telomeres were. When they looked at the high-stress versus the low-stress women, they found there was a 9- to 17-year shortening of the life span in the high-stress women compared to the low-stress. That’s pretty depressing.

But what was even more interesting to me was not that the stress could shorten your telomeres, but that it was the women’s perception of the stress that determined its effect on them. You could have two women in very similar life situations, but the one who is coping with it and doing all the things I write about in our new book: They were meditating, they were exercising, they were eating healthy, they had love and support. And so you can buffer or mitigate the effects of that.

You can be in the same job, the same family, and react in very different ways that protect you from the harmful effects of stress. Ironically, you can often accomplish even more without getting stressed or sick in the process when you do that.

BL: You mentioned a few minutes ago that success in cardiac interventions has recently tailed off a little bit. People are actually getting cardiac disease or dying from it more frequently. Talk to us about that. What’s happening?

DO: What’s happening, I think, is that diets are getting worse. Seventy percent of America is now overweight or obese. We’re not exercising. We’re playing video games. We’re watching TV.

A lot of middle America is stressed out. Prosperity has passed them by. There is a lot of anger and discontent in our country, and for good reason, because a lot of people feel like the system is rigged against them economically and, to a large degree, it often is.

You have a combination of feeling stressed and the breakdown of the social networks that used to give us a sense of connection to the community.

You know Bob, there has been a radical shift in our culture in the last 50 years from what your parents and mine and certainly our grandparents had. Fifty or 60 years ago, most people had an extended family they saw regularly. They had a neighborhood with two or three generations of people where they grew up together and they saw each other. They had a job that felt secure that they had been at for 10 years or more. They had a church or a synagogue or a mosque or a club that they went to regularly. Many people today don’t have any of those.

You may say, “Well, so what?” Well, it turns out that study after study, many of which I wrote about in the new book called Undo It, has shown that people who are lonely and depressed are three to 10 times more likely to get sick and die prematurely from all causes when compared to those who have a sense of love and connection and community.

I don’t know anything in medicine that has that big an impact. I think part of the reason for that is that when you grow up in a family with two or three generations of people, they know you. They don’t just know your Facebook profile or your bio sketch, they know where you messed up. They know when you got arrested or whatever it was. And you know that they know, and they know that you know that they know, and they’re still there for you. There’s something primal about the need for being seen.

In that wonderful movie that James Cameron did called Avatar, there is that scene, “I see you. I see all of you. Not just your good side.”

One of the studies I cite in the Undo It book is the more time you spend on Facebook, the more depressed you are. Why is that? Because it’s not a real, authentic intimacy. People don’t post their demons and their dark side and their failures on Facebook. It just looks like everybody has this perfect life but you. Whereas when you grow up in a family with two or three generations of people, they really know you.

I think that in our support groups what we do when we work with people with chronic diseases, it’s not just helping people stay on the diet or exercising or running tips or running shoes or whatever, it’s creating a safe place where people can let down their emotional defenses and just be open and authentic with each other without fear that someone is going to abuse you or criticize you or judge you or laugh at you. It’s just to be there fully present with you.

To me, part of the value of science is to show us how much these things matter so we can make different choices.

I think one of the great things about AARP is that it’s one of the largest communities in the world, and when you can bring people together the way that you do, virtually with this show, for example, or at your annual meetings or through your magazine, which reaches more people than anyone, it’s healing.

Even the word “healing” comes from the root “to make whole.” Yoga comes from Sanskrit “to yoke, to unite, union.” These are really old ideas that we’re rediscovering.

BL: This is part of your theory of good health and long life, the intersocial connections, relationships. But it starts with, I would imagine, diet. Should we talk a little bit about diet and what a good diet looks like today?

DO: Sure. I think there is an increasing convergence of what is an optimal diet. It goes something like this: basically, mostly plants. Fruits, vegetables, whole grains, legumes, soy products in their natural form as close to nature as you can get are really the optimal way of eating for most people, low in fat and low in sugar. It has hundreds of thousands of substances that are protective and it’s low in the ones that cause you to get sick. So many studies have shown that when you go from a meat-based diet to a plant-based diet, you really get a double benefit. You’re not only not doing the things that cause you to get sick, but there are hundreds of thousands of protective substances that keep you healthy.

I’m in town to go to the premiere of this wonderful new movie that James Cameron and Louie Psihoyos and James Wilks and  Joseph Pace made called The Game Changers. When people think about a plant-based diet, the biggest misconception is where do you get your protein. I’m not going to get my protein.

BL: We’re going to talk about that.

DO: “You’re kind of a wimp.” “Am I going to live longer or is it just going to seem longer?” and all those clichés.

James Cameron, he and his wife Suzie went on a plant-based diet about 10 years ago. In addition to making amazing films like Terminator and Titanic and Avatar, he’s an explorer. And he learned that more global warming was caused by livestock consumption than all forms of transportation combined. So he went on a plant-based diet initially for environmental reasons, and then he had so much energy, he’s actually now making Avatars 2, 3 and 4 at the same time, and he’s in his mid-60s, sleeping on the floor of the studio. I actually visited the set. It’s an amazing set.

The film is about elite athletes who raised their games and became Olympic medalists, NFL champions, martial artists, heavyweight boxing champions and so on by going on a plant-based diet. It made them stronger and more successful. It turns out that the Roman gladiators were plant-based. Their survival literally depended on that.

Also, there is a wonderful scene in the movie. A lot of people as they get older have problems with erectile dysfunction. He has this great scene with three athletes in their mid-20s, and he feeds them a single meat-based meal, and it’s grass-fed beef, organic chicken and pork.

Then Aaron Spitz, the urologist, measured the frequency and hardness of erections they get when they sleep at night. It’s a normal male function that your body gets erections when you sleep.

Then they did the same thing the next night, this time with a single plant-based meal and they measured them. They found that after the plant-based meal, they had 300 to 500 percent more frequent erections and 10 to 15 percent harder erections than after the single meat-based meal, just one meal!

 Also, your brain is getting more blood, your skin is getting more blood, you look younger, you can actually grow some new brain neurons. Your brain can actually get bigger in just a few weeks, particularly the part of your brain called the hippocampus that controls memory. Your heart gets more blood. You can reverse heart disease. Your sexual organs get more blood.

It reframes the reason for making lifestyle changes from fear of dying or fear of something bad happening to joy of living. What you gain is so much more than you give up and how quickly you can feel better.

BL: So why hasn’t this caught on any more than it has? Clearly, we’ve been moving in this direction as a people, although it’s hard to eat an entirely plant-based diet, isn’t it?

DO: Well, it doesn’t have to be entirely plant-based if you’re just trying to stay healthy. It’s the ounce of prevention and pound of cure.

 One of the interesting findings we found in all of our studies was that, I thought, incorrectly as it turned out, that the younger people who had less severe disease would do better, but it turned out that it wasn’t how old or how sick they were, the only thing that mattered was how much they changed their lifestyle at any age — which is great for AARP members; it’s never too late. The more you change, the better you feel, and the more you change, the better you are in every way we can measure using very high-tech state of the art measures. Whether it’s the amount of blockages in the arteries in your heart or the size of a prostate tumor or the length of your telomeres or the number of genes that get turned off and on, the more you change, the better you get.

Now I find that a very empowering thing. If you don’t have a life-threatening condition, it’s not all or nothing. Just have a meatless Monday and the more you change, you start to make the connection. When you eat one way you feel good, but when you eat another way you don’t feel as good, not years down the road, but hours down the road.

Everyone has had the experience of having a big Thanksgiving or holiday pig-out and you want to take a nap a couple hours later because your brain is literally getting less oxygen and less blood.

BL: We were told it was the tryptophan in the turkey.

DO: Well, there is some of that, but that’s not really what’s going on. When you eat a lot of this stuff, whether it’s turkey or not, you’re going to be sleepy.

When you make these changes, to the degree you make them, you’re going to feel better, look better, lose weight, gain health, all the things that really matter to people.

Now if you’re trying to reverse a life-threatening condition, that’s a different story. That’s the pound of cure. That’s what the Undo It book is really about. The reason we were the first to show that you can reverse all these different conditions when everyone thought that was impossible is that it takes a lot. People didn’t go far enough. We’re finding that most of these diseases can be reversed.

 We’re in the middle now of doing the first randomized trial to see whether these same lifestyle changes may reverse the progression of early-stage Alzheimer’s disease. My mom died of Alzheimer’s, so I have a particular interest in this. I know a lot of your listeners in AARP have interest in that. People are more afraid of Alzheimer’s than pretty much anything because when you lose your memories, you lose everything. As you know, there are no highly effective drugs either for treating it or for preventing it, unlike heart disease. It’s really in a class by itself. All the billions of dollars they’ve spent on these blockbuster drugs have failed.

I think we’re at a place with Alzheimer’s that is very reminiscent of where we were with heart disease 40 years ago. First of all, the mechanisms are the same that we talked about like chronic inflammation, oxidative stress, changes in the microbiomes and so on. The less intensive interventions like the MIND Study and the FINGER Study and others show that the less intensive interventions can slow the rate at which you get worse. We think a more intensive intervention might actually reverse it.

 We’re going to find out. It’s the first randomized trial. We’re in the middle of it now. It’s too early to say anything, but I’m hopeful that we’ll be able to show that.

BL: And when will the results likely be forthcoming?

DO: Probably another year or so, we’ll know, have a much better idea.

BL: This is also a pretty radical thing you're saying is that you can either treat or reverse Alzheimer's or dementia conditions by lifestyle changes.

DO: Well, we don't know that, but that's what we want to find out.

BL: We’re going to find out.

DO: We're going to find out. But other studies show that non‑Alzheimer’s dementia, making these lifestyle changes actually people often do get better. And so I find that a very empowering information to give people ,and that's why I appreciate so much the chance to share this information with your listeners, because having seen what a powerful difference these lifestyle changes can make and how quickly people can get better and often, again under their doctor's supervision, reduce or get off these medications that they were told they'd have to take forever, which all have bad side effects. The only side effects of lifestyle changes are good ones.

BL: Do you think there's too much treatment of markers like cholesterol or blood pressure, or are we doing it the right way?

DO: Well, I mean, in our studies we weren't just looking at surrogate markers like blood pressure and cholesterol. We were actually looking at the underlying disease process. We used quantitative arteriography to look at the blockages in the arteries of the heart, a cardiac positron emission tomography, or PET scans, to look at blood flow, cardiac events and so on. So we know that people are actually —‑ not just the risk factors are getting better, the underlying disease is getting better. But those tests are often invasive, and so people look at surrogate markers as kind of an index of whether or not people are getting better.

 And I think part of the value is if you tell somebody you're at risk for disease, they don't generally think it's going to happen to them. But if you show them they actually have early disease and if you don't do anything, it's likely to get worse, but if you're willing to make bigger changes, you can stop or reverse it, that can be a very powerful motivator.

BL: In terms of a plant-based diet, we know that a lot of our members or our demographic are not getting enough protein in their diet as it is. So how do you address the problem of getting protein in a plant-based diet?

DO: Well, one of the things in this Game Changers movie said, “I want to be as strong as an ox.” They say, “Well, eat what an ox eats, which is plants.” The protein all comes from plants, which really ultimately comes from the sun and photosynthesis. So you can eat the plants directly or you can eat them using the middleman of the animal, but that's where it all comes from. And so you can get all the protein you need on a plant-based diet. What you don't get are the saturated fat and the TMAO and the other things that are the toxic substances that you find in meat and animal protein.

 In fact, having been in all these various diet wars with Dr. Atkins and others, the fat guy versus carbs debate, it turns out the latest thinking is that the animal protein itself is actually toxic. The same protein that people think is so beneficial, when you get it from an animal, is actually harmful because it promotes inflammation. And there was a study that was done in a journal called Cell Metabolism where they found that people who ate a lot of animal protein had a 75 percent increased risk of premature death from all causes and a 400 to 500 percent increased risk from heart disease, prostate, breast, colon cancer and so on.

 And so most people are getting too much protein, especially the animal protein. But the plant-based proteins, not only are they not harmful, they're actually protective. And so when you go from a meat-based diet to a plant-based diet, and I grew up in Texas eating meat all the time. But when I changed my diet when I was 19, I felt so much better so quickly that I thought, OK, these are choices worth making. Again, not to prevent something bad from happening, but because I feel so much better.

 And there are bodybuilders in this Game Changers film. You know,  Arnold Schwarzenegger's in there. He says, “Look, I know this world better than anybody.” And he kept talking about meat makes you strong. And they have this clip where I think Sylvester Stallone hits Arnold Schwarzenegger and he goes, “Oh man, you punch like a vegetarian,” you know. Well, it turns out the gladiators were vegetarian. That's what makes them strong. And one of the protagonists in this Game Changers film won the mixed martial artists national champion. The NFL Titans won their first championship in 14 years when they went meatless. It's the plants that actually give you the protein that makes you strong.

BL: I remember Sugar Ray Leonard was the first, in my lifetime, the first boxer of any repute to say, “I renounce meat and I'm going to go on this.”

DO: Great name for someone renouncing meat, right?

BL: Well, he did take up carbs.

DO: But Edwin Moses or Carl Lewis, they had their best, personal best, when they were 40 years old when they went on a plant-based diet.

BL: So what about you? What did you eat for breakfast and lunch today? What is your dinner likely to be? How does the paragon of this plant-based diet eat?

DO: It's really, breakfast is easy because I think I had — and, you know, I'm traveling. So I just had a bowl of oatmeal made with water and a big bowl of blueberries on top. Because blueberries, as you know, increase cognitive function.

BL: But no milk, no milk on your oatmeal.

DO: I didn't put any milk on there. I asked for a little side of soy milk. They didn't have any. So I just ate it plain. It was fine. And for lunch and dinner, it can be a salad. It can be, there's so many plant-based restaurants here. I had a lunch at Candle Cafe here which is not far from here, which has a wonderful, a whole menu of plant-based things. But if you go into any restaurant, even if they're not known for plant-based cooking, any good restaurant, you say, “Hey, can you ask the chef to make me a plate of vegetables? Just lightly steam it” or whatever you like, with as little oil and butter and salt as possible. You don't have to draw attention to yourself. You don't have to make a big deal about it. And then when the people you went to dinner with look at your plate and they go, “I didn't see that on the menu. That looks better when I got. I'll have what he's having,” like in When Harry Met Sally….

BL: Yeah, yeah. Are the other plant-based proteins that you mentioned almost entirely soy based?

DO: Oh, no.

BL: Tell me more.

DO: Almost all plants have some protein in them.

BL: Like quinoa has protein.

DO: Quinoa is a complete protein. Now, the reason why people think that animal-based proteins are better is because they have all the amino acids in them. Amino acids are like the alphabet, that they form the building blocks that make protein, and your body can make all but a few of them.

 But it turns out that, for example, rice may have all but one amino acid and beans have all but another one, you put them together, you get a complete protein. It used to be thought you had to have them at the same meal. You just have them the same, like, week and your body will figure it out. So it's really simple to eat this way and you don't have to go to a lot of trouble to do it.

BL: So let's move from diet to exercise. How much do you like people to do? What kind of exercise do you recommend for (a) a healthy life or for (b) reversing disease?

DO: Well, it kind of goes back to this unifying theory. It's not like there's one kind of exercise for this disease and a different one for that. It’s just exercise. And the best kind of exercise is the one that you like. Because if you like it, you'll do it. There's generally aerobic exercise, like walking. Walking half an hour a day is a good thing for most people. It doesn’t even have to be all at once. If you can build it into your routine, like take the stairs instead of the elevator. I used to get annoyed when I’d go to the gym and I couldn't find a parking place nearby. I said, well, this is ridiculous. Just deliberately park farther away, which makes it easier to find a spot anyway. So there's aerobic. There's strength training, like resistance training, like with weights, or you can just buy a rubber band, one of these big bands for like $5 that stretches. And there's some exercises in the book that describe that. And then there are stretching exercises, which are yoga-type stretching, which is good. So some combination of all those. But the main thing is to try to do what you like because then you're more likely to do it.

BL: I guess some think that the fitness industry has hijacked the entire conversation about exercise. It's become too complicated, too trendy, too expensive. You’ve got to go buy the clothes, the yoga pants and all this stuff. How should an older person go about getting into fitness if they haven't been exercising in a long time or their mobility is slightly compromised?

DO: Yes.

BL: Tell us, like, how do we start?

DO: Well, there's an old saying that a journey of a thousand miles begins with a single step. And I think you're right. The fitness industry has been hijacked, the yoga industry as well. It's like you have to buy your special yoga pad and yoga pants and all this kind of stuff. And a lot of older people get intimidated because they have all these beautiful people, men and women, doing yoga or exercising at a gym. It's like, “I don't want to, like, go there and look like I don't fit in there,” you know?

But it's simple, really. That's why I wrote this book. Because in my experience, people, if I asked you about journalism, with your amazing background at Rolling Stone and AARP and so on, you could reduce it, put it on an index card and tell me what was most important. Because you know so much about it, you can reduce it down to its essence.

 And this has been my whole professional life for over 40 years. So, as I say, eat well, move more, stress less, love more. So from the move more, if you like it, you'll do it. So walk for 20 or 30 minutes a day. If you can do it with your friend, even better. Then you get the social support. Or Paul Dudley White, who was John F. Kennedy's cardiologist, said, “Walk your dog whether you have one or not.” Just get out and do something. You don't have to draw attention to yourself. You don't have to pay anyone. I mean, you don't need any special equipment, just a pair of shoes. And resistance training, you can buy some weights, but you can just take a pound of groceries and just take the bag and do some curls with it. I mean, these are very simple things that really make a big difference. And what the studies all show is that a little goes a long way. Just doing something every day makes a huge difference.

BL: Well put. You focus a lot on stress management in your book and in your program. So what are the mechanics? How does reducing stress prevent the diseases associated with aging?

DO: Well, stress affects all of our organ systems. When you're depressed, your immune system is depressed. When your stressed, your immune system doesn't work as well. Your hormones don't work as well. Your arteries constrict. Your blood clots faster. This is actually part of an adaptive response that during times of stress, if you're walking along in the jungle and the saber-toothed tiger jumps out at you, you want your arteries to constrict and your blood to clot so if it bites you, you don't bleed as much.

 But in modern times, these stresses are so much more chronic that the arteries in your heart can construct or the ones that go to your brain can constrict, which can cause a heart attack or a stroke. So it's not that we're built wrong. It's just that we're not used to dealing with the chronic, relentless stress that is so much a part of modern life.

 But to me, the more interesting question is why do we feel stressed in the first place? And I studied for many years with an ecumenical spiritual teacher. And people would say, “What are you, a Hindu?” And he'd say, “No, I'm an undo.” Which is where the title of the book really came from. Although my favorite key on the computer has always been the undo button. I thought, Wouldn't it be nice if we had an undo button in our lives?

BL: Ironically, it's the opposite of the Nike slogan, too: Just do it.

DO: Yeah, that's right. Well, it was an homage to that as well. And he would say our nature is to be happy and healthy and peaceful. Everything in our culture, particularly the whole advertising industry, says just the opposite: You buy this thing, then you'll be happy, if you get this thing. And so people think, Gosh, if only I had more whatever. A lot of people say, “I'm really feeling lonely and stressed and isolated and I must be lacking something and unloved or unlovable. If only I had more” — whatever, you fill in the blank — more money, more power, more beauty, more accomplishment or the usual things in our culture. “If only I had more money or power or whatever, then I'd be happy. Then people would love me. Then I wouldn't feel so stressed. Then I could love myself.” Once you set up that view of the world, however it turns out, you generally feel stressed. Because until you get it, you feel stressed.

 And we know from that study I talked about with the women taking care of parents with Alzheimer's or kids with autism, the stress doesn't just come from what you do, but how you react to what you do, which in turn is really a function of how we see and perceive the world. And so if you perceive the world as thinking, I've got to get this to be happy and lovable, then the stresses go way up. And then if someone else gets it and you don't, then they go really up. And then it kind of reinforces this misperception that we live in this very hostile, dog‑eat‑dog world, and the more you get, the less there is for me. And you've got to get it while you can and all that.

But even if you get it, it's very seductive. Because in the moment it's like, “Ah, now I do feel good. Now I’m, you know.” But invariably, it doesn't last. It’s soon followed by either “Now what?” One patient said, “I can't even enjoy the view from the mountain I've climbed. I'm already looking over the next one.” Or “So what? Big deal.” It doesn't really provide that lasting sense of meaning. And so they say, “Well, the letdown that comes from accomplishing the goal is so great, I always make sure I've got a dozen projects going at the same time. I can immediately shift my attention to something else.”

Now what this teacher told me, he said that these techniques that we call stress management techniques were not developed by the ancient swamis and rabbis and priests and monks and nuns and so on to manage stress or unclog your arteries or perform better in sports, although it can help you do all those things. They're really powerful tools for transformation, to quiet down our mind and body, to experience more of an inner sense of peace and well-being and to realize that's really our natural state.

And so when I'm feeling anxious or worried, to remind myself why am I feeling that way? It's usually because I think I have to do or get something so I don't feel so anxious. Instead of saying, “What am I doing that's disturbing that?” Because I can stop doing that. So at the end of a meditation, for example, when I'm feeling more peaceful, to remind myself that the meditation didn't bring me that sense of peace, but rather it was already there. At least for the moment, I wasn't disturbing.

And then the question shifts from how can I get what I think I need to be happy and peaceful to how can I stop disturbing what's already there? And that may sound like just a lot of semantic parsing of words, but the implications are profound. Because if it's out there, then everyone who has something I think I need has power over me. If it's me, then I can change that. Not to blame, but to empower myself. When I was 19 I almost committed suicide because I was so profoundly depressed and felt totally unlovable and stupid and worthless as a human being. And I thought, Now that I'm in a school with a bunch of really smart kids, it's just a matter of time before — it was my first year of college — they figure out what a mistake they made in letting me in. And I came about as close to doing that as a person can.

But fortunately, I ran myself down so much that I got a bad case of infectious mononucleosis. I didn't have the energy to get out of bed. My parents saw what a wreck I was. I went home to Dallas to get well enough to kill myself, as crazy as that sounds. Meanwhile, this teacher came — and there's an old saying, when the student is ready, the teacher appears. And in walks this guy with long saffron robes, kind of a caricature of what Central Casting’s idea of what a swami should look like. And he started off by saying, “Nothing can bring you lasting happiness.” Which I'd already figured out, which is part of the reason I was so depressed and I really felt stupid. I felt like even if I was able to get all this stuff, it wouldn’t matter anyway. But I looked at him and said, well, you look like — he was radiant and I was ready to do myself in. I said, “What am I missing?” He went on to say, “Nothing can bring that to you, but you have it already.” And not being mindful of that, and perhaps the ultimate irony, we run after all these things that we think will bring us what we could have already if we just stopped doing that.

BL: But you’re a famous cardiologist and a Type A personality. Are you still anxious? Do you still fight that every day or depressed?

DO: I'm not a cardiologist. I'm an internist. But, of course, I mean, I’m human. But I’ve learned that when I have those feelings of feeling — I never get as depressed as I was then. I have blue moments like everyone does or I get stressed out at times. But when I feel stressed, that's my reminder to say, “What am I doing that's causing me to get stressed as opposed to how come I can't get what I think I need?” And that's a huge difference, because, again, I can do something about that.

BL: Do you think stress is different for older people? I mean, now you've experienced it and you've been mindful of it as a young person and as an older person. Do you think it's a different beast? Or is it the same?

DO: I don't think it's different. I think that older people deal with a sense of isolation, especially when their kids grow up or a spouse dies or whatever. Yeah, there’s a lot to that, but a lot of younger people are dealing with those same issues as well. I certainly felt that same sense of isolation. I think it's across lines.

 he other thing that I’ve found to be very powerful is at the end of the meditation, when I'm feeling more peaceful, we all have an inner guide, the still, small voice within, the inner guru, the inner whatever you want to call it. It's the voice that speaks very clearly but quietly. It gets drowned out by the chatter of everyday life. And I've learned that that's the voice — I’ve learned to trust that voice.

And so at the end of a meditation, I ask that voice to identify itself. I'll say, “Hello.” And it'll say, “Hello.” As crazy as that sounds, everyone has that. You can do that, too, if you're listening to this. And I ask the same question each time. I ask, “What am I not paying attention to that I need to pay attention to?” And I just listen and it will tell me. And all of the studies that we've done, which had never been done before, really came from listening to that voice and kind of reverse engineering or things in my life.

And you mentioned type A behavior or, like, talking fast or being productive or multitasking. Those are not harmful to your health. What's harmful, as it turns out, is this one component of what used to be called type A behavior, which is the chronic hostility and anger. That's the most toxic emotion. So there's a saying, when you point your finger at someone, there are three fingers pointing back at you. You know, when you're angry with someone else, it affects you. And conversely, all these great spiritual truths of love and forgiveness and compassion and altruism and service are what free us from that suffering. And so if I'm forgiving somebody, it doesn't condone or excuse what they did, but it frees me from the suffering.

When Nelson Mandela in his long walk to freedom after being in jail for 16 years, he was asked, “Do you hate your jailers?” He said, “Well, they took away the best years of my life. But if I hate them, then I'm still in prison in my heart.” I love that quote.

BL: Yeah, fantastic. Well, Dean, we've covered almost everything we'd like to in this first session. I'd like to ask you any final words of wisdom or hope for our audience. I mean, you've told us so much. What would be one last thing you'd like to leave our readers and our members with?

DO: Well, first let me thank you and AARP for the amazing work that you do and the community that you're creating, which I really think is a healing community. Bringing people together is healing. And I would just say to understand how these very simple changes in lifestyle can have such a powerful impact on our lives, how quickly you can feel better when you make them. And that all these great spiritual truths of, you know, this is a love-based program. Because we don't usually talk about love in medicine. It's one of those four-letter words that we don't talk about. And yet to me, it's really the key to everything. Love and meaning.

When Victor Franco wrote his classic book Man's Search for Meaning about concentration camp survivors in World War II, it wasn't the strongest and healthiest. It was the ones that had the strongest sense of meaning and purpose: “I have to survive so that I can” — whatever.

So ask yourself what is it that brings meaning and purpose in your life. For many people, it would be, like, “I want to watch my kids grow up. I want to dance at their wedding.” Whatever it happens to be for you, if you can get in touch with that sense of meaning and purpose, everything else follows from that.

BL: Terrific, Dean. Thank you so much. We're out of time today. We really learned a lot from the conversation. For more advice on healthy living and managing chronic conditions, please visit aarp.org/health. This is also a good moment to remind our listeners that AARP makes a wide range of carefully chosen discounts available to members. Each is designed to create real value in key areas of your life, including travel, dining, entertainment, shopping and more. Go to aarp.org/ benefits to learn more. We hope you enjoyed this episode of The First Word. I know I did. Until next time, this is Bob Love wishing you good health and a wonderful week ahead.