A Holistic Approach to Heart Disease


By Timothy McCall, MD  |  

When former president Bill Clinton mentioned in a CNN interview that he’d adopted a near-vegan diet for the sake of his heart’s health, the media went wild. Once known for his love of hamburgers and junk food, Clinton—who had bypass surgery in 2004 and an angioplasty in 2010 to remove blockages from a clogged artery—was not a likely candidate for dietary asceticism. But he was persuaded to make the radical change by an extensive review of the scientific evidence. And if you’re concerned about heart health, it’s food for thought that you, too, may want to consider.

Clinton learned that in 1986, several hundred people with heart disease participating in a trial by heart-health guru Dean Ornish, MD, began following a plant-based diet as part of a lifestyle program that included walking, social support, and yoga practice—and 82 percent of them experienced a reduction in arterial blockages after one year. And just like many of the participants in the Ornish program, the former president experienced an unexpected but welcome side effect of his own diet: within months, he’d lost 24 pounds, returning to his high-school weight.

Heart disease kills far more people than any other illness, more than all forms of cancer combined. Here are a few surprising things you should know about cardiac health—and simple things you can do to keep your heart healthy and strong for years to come.

Beat by Beat

Clearly, our culture is concerned with heart health. Statins (pharmaceuticals like Lipitor and Pravachol designed to prevent a build-up of “bad” LDL cholesterol in the coronary arteries) have become the most-prescribed class of drugs in the world. For a man like Clinton, who already has heart disease, statins not only impressively lower LDL cholesterol and the risk of heart attack but, according to some studies, increase life expectancy among men as well. However, such longevity benefits may not materialize for people who don’t already have heart disease, and not a single study has found that statins increase the life expectancy of women.

Though you won’t hear any TV commercials suggesting that you “ask your doctor about healthy lifestyle changes,” the fact remains that after a quarter of a century and billions of dollars in research, a holistic approach to heart disease still works better than drugs for most people.

When Dr. Ornish, who is the founder of the nonprofit Preventive Medicine Research Institute in Sausalito, California (and is on Yoga Journal’s advisory board), invited his first heart disease patients to start his program in 1977, some had symptoms so severe that their regular doctors had recommended immediate bypass surgery. Yet without surgery, and without the statins and other cholesterol-lowering medications that most members of the control group took, his patients improved, and symptoms like chest pain began to lessen almost immediately.

Not only did their heart disease improve, but so did their weight, blood pressure, blood sugar, and markers of inflammation. The program was the first intervention of any kind documented to reverse heart disease—that is, to reduce the size of blockages in the coronary arteries—without drugs or surgery.

“When people make these comprehensive lifestyle changes,” Ornish says, “most of them are able to reduce or even discontinue medications under their doctor’s supervision.”

Even more exciting, recent research on Ornish’s program is revealing that dozens of disease-preventing genes are getting down-regulated, or switched on, in program participants, while hundreds of bad genes—including some that are linked to heart disease, inflammation, and even cancer—are getting up-regulated, or deactivated. Another recent study found beneficial effects on telomeres, special DNA sequences at the end of chromosomes that affect the rate of aging (as your telomeres get longer, your life gets longer), suggesting that his program slows cellular aging. “Even drugs haven’t been shown to do this,” Ornish says.

It’s easy to get caught up in the latest scientific findings—the promising new drug, the life-saving surgery, the break-through insights into the complex relationship between cholesterol and heart disease—but if you’re willing to dig a little deeper, you’ll discover that ancient yogic teachings on diet and lifestyle reflect a practical wisdom that modern medicine is gradually validating.

One of the strengths of a holistic approach to heart disease is that it doesn’t reject reductionist tools like drugs or surgery when necessary. But if you take the holistic route, you are simply less likely to need them. Here’s what you need to know.

What To Eat

Diet is clearly a cornerstone of the holistic approach to heart health, and both Ornish and Caldwell Esselstyn Jr., MD, of the Cleveland Clinic, whom Clinton credited with inspiring his lifestyle changes, encourage a low-fat, vegetarian diet. Ornish originally learned the basics of this diet from his spiritual teacher, Swami Satchidananda, the founder of Integral Yoga. Years later, Ornish began testing the diet’s benefits on heart disease patients, with great success.

Today, he recommends the following:

  • A wide variety of vegetables, fruits, whole grains, and legumes
  • Natural, unrefined soy foods (think miso and tempeh, not products with soy protein isolate or hydrolyzed soy protein)
  • No more than one cup per day of nonfat dairy products (like skim milk)
  • 3 to 4 grams per day of omega-3 fats (derived from algae or from fish oil that has been purified of toxins)
Why Yoga Helps

As Ornish explains, “Chronic emotional stress makes plaque build up twice as fast in the coronary arteries that feed the heart. Stress also causes the coronary arteries to constrict, reducing blood flow to the heart. It makes the platelets stickier and more likely to form blood clots that may precipitate a heart attack.” Yoga is perhaps the most effective stress-reduction method ever invented. If you want to keep your heart healthy, incorporate these tips into your practice:

  • Do a yogic relaxation for at least a few minutes every day. Research suggests it can increase your resiliency to stress—and, by extension, to heart disease.
  • Balance your emotions with a regular yoga practice. Studies suggest that yoga helps diffuse emotions such as anger, hostility, and impatience that are linked to heart attacks.
  • Combat loneliness, another risk factor for heart disease, by becoming part of a community. A recent study suggests that people with spiritual practices who meet regularly in a group live longer and have fewer heart attacks.
  • Offer service (karma yoga) to those less fortunate than yourself—whether that means volunteering in a food pantry, or teaching a free yoga class in a retirement community. According to the yoga tradition, there is no better way to open your heart.
The New Heart-Smart Workout

Although conventional medicine often recommends heart-pounding aerobic workouts for cardiac health, there is evidence that less-intense exercise provides major benefits.

  • Don’t overexercise; recent studies suggest that extreme exercise, like running 10 miles if that’s not your norm, may actually promote inflammation.
  • Get 20 to 30 minutes of slow to moderate walking daily, Ornish recommends.
  • Practice gentle asanas—such as Ardha Matsyendrasana (Half Lord of the Fishes Pose);Bhujangasana (Cobra Pose) with the chest just barely lifted; brief, modified Salamba Sarvangasana (Supported Shoulderstand) with your feet on the wall; and Savasana (Corpse Pose), easy pranayama exercises such as three-part breathing, and meditation even a few minutes per day, Ornish says, can make a huge difference.
Dr. Timothy McCall is Yoga Journal’s medical editor and the author of Yoga as Medicine.