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updated 3/2/2004 6:59:15 PM ET 2004-03-02T23:59:15

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

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Heart disease doesn't get the media attention that many other conditions get, but it's the No. 1 health threat to women, by far. But the good news is, heart disease can be prevented, and even reversed. We discussed women's heart health, including diet, stress, love, and the effects of menopause, with Dr. Dean Ornish.

Moderator: Welcome back to WebMD Live Dr. Ornish. This is heart health month. Why the emphasis on women and heart disease?

Ornish: February is heart month. Many women don't realize that heart disease is as common in women as in men. In fact, heart and blood vessel diseases kill more women than all other diseases COMBINED. That's the bad news.

Women had been told to take HRT (hormone replacement therapy) to reduce the risk of cardiovascular disease even though it was known that it increased the risk of breast cancer and uterine cancer. The rationale was that heart disease was more common, so the net effect would be worth it. Yet most women would be unwilling to trade heart disease for cancer.

Our research and that of others indicates that women can reverse heart disease easier than men, whether through diet and lifestyle or lipid-lowering drugs, or both. Women who undergo revascularization with bypass surgery or angioplasty generally don't do as well as men, so this is yet another reason why women may benefit from diet and lifestyle changes.

And these changes in diet and lifestyle can also help prevent breast cancer, osteoporosis, diabetes, hypertension, arthritis, colon cancer, and obesity, and the only side effects are good ones.

Member question: Is your diet as effective for women as it is for men, especially postmenopausal women?

Ornish: As I mentioned above, women can reverse heart disease even easier than men, whether through diet and lifestyle, statin drugs, or both. So these changes in diet and lifestyle are especially beneficial in postmenopausal women.

Moderator: Let's talk about some of the lifestyle changes you recommend for heart health. You were talking about meditation last week on Oprah. How does that fit into your plan for heart-healthy life style changes?

Ornish: Meditation is a powerful means of reducing stress, but it is much more than that. Meditation is the practice and process of paying attention and focusing your awareness. When you meditate, a number of desirable things begin to happen -- slowly, at first, and deepening over time. Meditation is simple in concept but difficult to master. Fortunately, you don't have to master mediation to benefit from it. You just have to practice. No one ever really masters it completely, but even a few steps down that road can make a meaningful difference. It is the process of meditation that makes it so beneficial, not how well you perform.

In most forms of meditation, you repeat a sound, or a phrase, or a verse from a prayer, over and over and over again. It can be a sacred object such as rosary beads or a picture or icon. It can be a favorite prayer. It can be secular. It can be anything. Or, you can simply observe your breathing: in and out, over and over.

Certain sounds have been found to be very soothing, and they are very similar in different cultures. These sounds are often translated to mean "peace," like shalom or om or amen or salaam or ameen. If you are more comfortable with a secular meditation, you can repeat the word one. A mother or father humming to their baby has an intuitive understanding that a humming sound is very peaceful. It also helps you to focus. These sounds usually begin with an "o" or an "ah" and ends with an "m" or an "n". For example, or "ommmmmmmmmm" or "amennnnnnnnnnnnnnnnnnn" or "shalommmmmmmmm" or "onnnnnnnnnnnnne" or whatever word you are comfortable with. Inhale; say the word during your out breath, emphasizing and focusing on the humming sound; inhale, and continue. The sound can be repeated out loud or silently, although many people find that concentration is easier when you say it out loud.

When you focus your mind, a number of good things begin to happen. First, you get better at concentrating, so whatever you do, you do better. Second, on a sensual level, when you pay attention to something, you enjoy it more fully. Food, sex, music, art, massage, anything sensual becomes more pleasurable when you pay attention to it. Also, your mind begins to quiet down and you can begin to experience more of an inner sense of peace and joy and well-being. And you realize that this is our natural state until we disturb it, so it's very empowering. Because when we feel stressed, we can stop blaming others and focus on what we can do about it.

Like most things in life, getting started is the hardest part, so if I meditate for one minute, chances are I'm going to continue doing it for longer. But even a minute of meditation has benefits. Have you ever listened to a song on the radio in the morning and found yourself humming it later in the day? Similarly, on a subconscious level, you continue meditating throughout the day. The consistency is even more important than the duration.

Member question: How do you go about learning meditation and is one form better than another?

Ornish: You can meditate in whatever way is most comfortable for you. There are two basic types: those in which you repeat a sound or phrase or prayer, sometimes called "mantra meditation." You can do this while sitting or walking.

Some people find it easier to do meditations that are more active when they are feeling distracted. For example, you can do a walking meditation, in which you repeat a sound or phrase while walking slowly. Or you can do tai chi, or you can dance. Whatever it is that you do with awareness and focus becomes a meditation.

There is another kind of meditation called "mindfulness meditation" during which you do not repeat anything. Instead, you just observe whatever comes up in each moment, without judgment. You just watch your thoughts bubble up without getting caught up in the emotion or the content of the thoughts, and then you watch the next one. You see them as events in the field of awareness. You just focus on watching your thoughts go by, without judgment, rather than repeating a sound. Meditation by repeating a sound and mindfulness meditation both help to bring our awareness into the present moment.

The consistency of meditation is more important than the duration. Meditating for even a few minutes a day has great benefits.

For more resources, please go to my site at WebMD, Dean Ornish, MD's Lifestyle Program -- a shortcut to it is ornish.com. Also, the oprah.com site has information on our show last week in which I did a chocolate meditation with Oprah.

Moderator: What is a chocolate meditation?

Ornish: You can make eating a form of mindfulness meditation. When you pay attention to what you're eating, you enjoy it more fully, so less food can provide even more sensual gratification. Close your eyes when you put a bite of food in your mouth; savor the texture, the flavor, the temperature. Involve as many of your senses as you can. Even a single bite can be exquisitely satisfying and sensual. Experiment with a ripe piece of fruit, or a small piece of high-quality chocolate. Notice how the flavors change and linger as the food goes down your throat.

I love chocolate, so I try to find the richest, darkest chocolate. I stop what I'm doing, look at the chocolate, smell it, savor it, and let it melt in my mouth. Notice how the flavors change as it melts and goes down your throat. You can take several minutes with a single piece of chocolate, and it can be exquisitely satisfying. Oprah and I did this on the "After the Show" show, which is online at her site.

You can also eat in a mindless way, as I have done on many occasions. If I'm eating while reading or watching TV or talking with someone, and I'm focusing on that instead of the food, I can go through an entire meal, look down at the empty plate, and wonder, "Who ate that?" because I didn't even taste the food.

Meditation can bring you into the present. I'd rather have a small piece of high-quality chocolate eaten with awareness than a pound of everyday chocolate.

Member question: How does this help your heart? Just by calming you down? I have a job and teenaged children. I find it very difficult to relax.

Ornish: Even a minute a day of meditation has great benefit, as it makes your fuse longer. Things just don't bother you as much. The consistency of practice is even more important than the duration. Even a few minutes per day of meditation, for example, have lasting benefits. It can give you greater equanimity, helping to even out the highs and lows. As several people have described to me, "I used to have a short fuse and I'd blow up at the slightest provocation. Now, my fuse is longer. Things just don't seem to bother me as much. So, now, I can accomplish even more without getting as stressed in the process." You can be in the same job, same family, and not be as affected, not as stressed.

Stress makes your arteries constrict and your blood clot faster which, in turn, can precipitate a heart attack in some people. It also causes blockages to form in your arteries more readily. And it makes you gain weight, because stress hormones cause you to gain weight.

So there are many, many health benefits to regular meditation. My book, Dr. Dean Ornish's Program for Reversing Heart Disease, gives many examples of how to meditate, as does my site at WebMD.

Member question: Can working out be an effective de-stressing tool or not since it increases heart rate?

Ornish: Exercise is a good way of releasing stress, but it's not a substitute for the type of meditation we described. Doing both is best. Fitness and health are not the same thing. More exercise promotes better fitness -- for example, how long and how far you can run -- but not necessarily better health. Here's some good news: several studies have now shown that walking just 20 to 30 minutes per day may reduce premature death rates by 50 percent or more in both women and men.

And it doesn't have to be all that fast, or even all at once. Moderate exercise provides much of the health benefits of more intensive exercise but with a lower risk of injury or sudden cardiac death during exercise. The greatest reduction in premature death is between those who walk and those who don't do anything. From a fitness standpoint, more is better, but only if you do it on a regular basis. What gets people in trouble is when they are weekend warriors -- being sedentary six days a week and exercising intensively (i.e., shoveling snow, playing basketball) on the seventh.

You can incorporate exercise into your daily routine -- park a block or two away from where you're going, take the stairs a flight or two. Even better is to walk with a friend, lover, or pet, and then you get a double-benefit: exercise plus emotional support. One of the best ways of beginning to exercise is to use a pedometer. Just 10,000 extra steps a day can help keep you from gaining weight. For more information, go to America on the Move, or www.aom.com.

Moderator: One of the other components of your program is social support. How does this apply to women in particular?

Ornish: A real epidemic in our culture is not only obesity and heart disease but also loneliness and depression. Study after study have shown that people who feel lonely, isolated, and depressed are many times more likely to get sick and die prematurely than those who are not.

I am not aware of any other factor in medicine -- not diet, not smoking, not exercise, not stress, not genetics, not drugs, not surgery -- that has a greater impact on our quality of life, incidence of illness, and premature death from all causes.

I wrote a book, Love & Survival, which talks about these issues in more detail. Awareness is the first step in healing. We all know that diet, exercise, and smoking are important factors in health and well-being, but many people are not aware how important love and relationships are. When we understand that the time we spend with our friends and family is essential to our health, then we can view these as important to our survival, not just luxuries.

Member question: Do you think prayer has any role in heart health? I don't mean praying for a healthy heart. But when I pray, it relaxes me and makes me feel connected to something larger. It certainly reduces my stress levels.

Ornish: Many studies are beginning to document the healing power of prayer. The type of prayer seems less important than the process. Anything that helps you feel connected to something larger than yourself is healing.

Even the word "heal" comes from the root, "to make whole." This is why intimacy is healing -- anything that connects you with something or someone outside your separate self is healing. Prayer, compassion, love, and altruism, are all powerful pathways to feeling that sense of connection and community.

In a real sense, science is beginning to re-discover the spiritual truths that have been around for thousands of years. I'm referring here to spirituality. Unfortunately, religion is often used to divide people rather than to find common ground.

This experience of interconnectedness is part of spiritual traditions and the perennial wisdom in virtually all religions and cultures. Albert Einstein wrote, "A human being is a part of the whole that we call the universe, a part limited in time and space. He experiences himself, his thoughts and feelings, as something separated from the rest -- a kind of optical illusion of his consciousness."

One of the most powerfully healing experiences is to realize that on one level we're separate. On one level, we are alone, separate, apart from everyone and everything; on another level, we are the Self in different disguises, different names and forms, a part of everyone and everything. Many religions proclaim as a fundamental truth, "The Lord is One."

That experience is powerful, and goes beyond "stress management" to a root of suffering and illness.

Member question: How does menopause affect a woman's heart health?

Ornish: Before a woman goes through menopause, she has a lower risk of heart disease. After menopause, her risk increases to that of a man. A major reason for this may be the endogenous estrogen, but another may be the menstruation itself.

Iron is an oxidant, and the only way to reduce iron stores in your body is to bleed. So, if you're not menstruating, consider donating blood on a regular basis, which has the added healing value of altruism. I'm not a big advocate of hormone replacement therapy (HRT), since the evidence is weak that it reduces cardiac risk but clearly increases the risk of cancer.

Moderator: So what are your recommendations for postmenopausal women who want to remain heart healthy?

Ornish: The program that I write about is of particular benefit to postmenopausal women to prevent and even reverse heart disease. As we discussed earlier, it can also help prevent a number of other illnesses as well. Just as important is that you'll feel so much better.

I want to emphasize that you have a spectrum of choices. For example, the diet for staying healthy is a spectrum of choices -- to the degree that you reduce your intake of saturated fat, animal protein, and simple carbs and focus more on complex carbs such as whole grains, fruits, vegetables, legumes, and soy products, you'll feel better, lose weight, and gain health.

Member question: What is the connection between genetics and heart disease? My mother's family has a very strong history of heart disease, especially in the women. I'd like NOT to carry on this particular family tradition.

Ornish: Your genes are a predisposition, not a death sentence. If you have a strong family history, then you may need to make bigger changes in diet and lifestyle than someone else. The good news is that if you're willing to do so, then you don't have to suffer that way. For example, studies indicate that it is desirable to reduce your LDL cholesterol below 90 mg/dl. You can begin by making moderate changes in diet and lifestyle. If that's enough to accomplish this goal, great; if not, then continue to make bigger changes until you reach this goal. If necessary, consider going on a statin drug in addition to lifestyle changes.

Moderator: We have discussed three of the four components of your program: stress reduction, social connection, and exercise. Now let's focus the fourth part of your program: diet and nutrition.

Ornish: There are two versions of the diet I recommend. The "reversal diet" is designed for people who have diagnosed coronary heart disease or with high cholesterol levels. This diet is a whole foods vegetarian diet high in complex carbohydrates, low in simple carbohydrates (e.g., sugar, concentrated sweeteners, alcohol, and white flour), and very low in fat (approximately 10 percent of calories). Those few plant-based foods that are high in fat are excluded, including all oils (other than 3 grams per day of flax seed oil or fish oil to provide additional omega-3 fatty acids), nuts, and avocados. The diet consists primarily of fruits, vegetables, grains, and beans (including soy-based foods) supplemented by moderate amounts of non-fat dairy and egg whites. Patients with high triglycerides are especially encouraged to limit their intake of simple sugars and alcohol.

The "prevention diet" is customized to meet your needs. It is based on the idea that there is a genetic variability in how efficiently (or inefficiently) someone can metabolize dietary saturated fat and cholesterol. Some people are so efficient at metabolizing dietary fat and cholesterol that it almost doesn't matter what they eat. Those are the people who live to be 90 and talk about the 12 eggs they eat for breakfast and the steak for lunch and the cheeseburger for dinner. People like that may cause you to question if diet even has a role in heart disease, but everyone else who was eating that rich a diet and who wasn't so efficient at getting rid of the fat and cholesterol never made it to 90. It's a selected group.

So -- if your total cholesterol is consistently less than 150 mg/dl or if your ratio of total cholesterol to HDL is consistently less than 4.0, or your LDL is less than 90, then either you are not eating very much saturated fat and cholesterol or you are very efficient at getting rid of it. Either way, your risk of heart disease is low, and you may not need to make any changes in diet, at least from a cardiac standpoint (there are other good reasons for changing diet, such as losing weight and reducing your risk of many forms of cancer and other illnesses). If not, then you can begin making moderate changes -- eat less fat and cholesterol. If that is enough to bring your cholesterol values into this range, then that may be all you need to do. If not, progressively reduce your intake of fat and cholesterol until you achieve these values or until you are on the reversal diet.

As more mechanisms for understanding heart disease become clearer, this provides even more evidence why this diet is so healthful.

For example, homocysteine is a substance that increases your risk of heart disease because it increases inflammation. Meat protein increases homocysteine levels whereas folate found in whole grains and green leafy vegetables decreases it.

Member question: You stated in your book that fish oils raise your cholesterol level; now you say they are good for you. Do they raise cholesterol levels or not?

Ornish: I've been recommending fish oil for many, many years. My mentor at Harvard Medical School, Dr. Alexander Leaf, did some of the pioneering work showing that the omega-3 fatty acids found in fish oil can reduce the risk of a heart attack and sudden cardiac death by 50-80 percent or more.

What I was trying to say is that you don't need much of it. Just 3 grams per day provides all the protective benefits; more just gives extra fat and cholesterol that you don't need.

Also, you can purchase fish oil capsules in which the mercury, dioxin, PCB's, and other toxic substances have been removed, which are often high in the fish (salmon, mackerel, halibut) that have the omega-3 fatty acids. So you get the benefits without the toxicities or the extra fat and cholesterol.

The omega-3 fatty acids help reduce the risk of breast cancer in women and prostate cancer in men, as well as the inflammation of arthritis. FYI, olive oil has almost none of the omega-3 fatty acids, which is why it may not be the best choice.

Member question: My wife's cholesterol readings are: Total = 249, HDL = 101, LDL = 132 and triglycerides = 78. Does the high HDL overcome the high total?

Ornish: It may. I would suggest one of the ultra-fast CT scans ("Heart Scan") just to make sure. It's not foolproof but provides an additional level of reassurance if her calcium score is low.

Member question: Do you recommend a specific vitamin? Is there any multivitamin particularly for people with heart disease? Do you have a recipe book out?

Ornish: I prefer not to recommend specific brands, but there is a web site, www.consumerlab.com, that tests most of the major brands to see if what's on the label reflects what's really in the vitamins. Also, I recommend taking a multivitamin without iron if you're a man or postmenopausal woman, as iron is an oxidant.

Most people benefit from 200 mcg/day of selenium, which may reduce cancer substantially. These studies are being replicated, but the costs and risks are so low and the potential benefits so high it may be worth considering.

One study showed that people on statin drugs may do worse when they take vitamins (in terms of arteries getting clogged more quickly), so if you're taking a stain drug you may want to discuss this with your doctor. More information on vitamins is on my site at WebMD.

Member question: Is extra virgin coconut oil as safe or heart healthy as articles are have been stating?

Ornish: I'm not a big fan of coconut oil since it is highly saturated and may raise cholesterol levels.

Member question: Have there been studies done on women taking aspirin for heart disease? Or just on men? What do they show?

Ornish: It depends. The reason aspirin may lower the risk of a heart attack is because it helps prevent blood clots from forming. Most heart attacks occur when a blood clot forms and lodges in an artery that's already partially clogged with cholesterol and other plaque. Many doctors prescribe aspirin because it helps to keep your blood from clotting inside your coronary arteries, thereby reducing your risk of a heart attack. Unfortunately, aspirin also keeps your blood from clotting where you want it to clot -- like in your brain and in your stomach -- so studies show that you may lower your risk of a heart attack but increase your risk of a hemorrhagic stroke (bleeding in your brain) or gastrointestinal bleeding.

To me, the more interesting question is not, "What drugs can we give to keep the blood from clotting?" but, rather, "Why is your blood clotting where it's not supposed to?" Emotional stress makes your blood clot faster, because stress hormones such as epinephrine and norepinephrine make your blood clot faster. This mechanism is supposed to protect you -- so if you get bitten by a saber-toothed tiger or get wounded in battle, then you don't bleed as much because your blood clots faster. Unfortunately, in modern times, the stresses are so much more chronic that the stress hormones are circulating for much of the day. As a result, the mechanisms that are supposed to protect you may actually kill you by causing a heart attack from a blood clot. Nicotine in cigarettes makes your blood clot faster. So does even a single meal that is high in fat and cholesterol.

So, when you quit smoking, practice stress management techniques, and change your diet, then you reduce the likelihood of having a blood clot form where you don't want it to be (like in your coronary arteries) without reducing the ability of your blood to clot where you do want it to (like your brain and stomach).

Some people are at high risk for a blood clot forming, so for them the benefits of aspirin may outweigh the risks. These include people who recently underwent bypass surgery or angioplasty, those with a decreased cardiac ejection fraction, atrial fibrillation, a ventricular aneurysm, and so on. Also, if a person is not interested in changing diet and lifestyle, then the benefits of taking an aspirin may outweigh the risks. But I am cautious about recommending that everyone over the age of 40 take an aspirin regardless of circumstances. For men and women.

Member question: I am a 39-year-old mother of three and suffered a heart attack last week. They put in a stent and sent me on my way. What now? I have three children and work as a nurse practitioner. I need to live a long life but having this heart attack at such a young age, I am scared.

Ornish: I'm so sorry that you've had such a difficult time recently. The good news is that there is no reason you ever need to have another heart attack -- if you're willing to make big enough changes in your diet and lifestyle.

Many people find that they will make changes on behalf of their children that they might not make if it were just for them. And, as you know, your children really need you. So, use that as a motivator to make the changes in diet and lifestyle that I describe in my book, Dr. Dean Ornish's Program for Reversing Heart Disease and on my site at WebMD.

Find a doctor who supports you in these changes and is also up-to-date on the latest drug treatments as well. My colleagues and I at the nonprofit Preventive Medicine Research Institute have trained hospitals in different parts of the country, and Medicare is paying for people to go through our program as part of a demonstration project. We hope that this will be a benefit available to all Americans in the not-so-distant future. A listing of these hospitals is available on my site at WebMD or by calling the Institute at (415) 332-2525.

Moderator: We are almost out of time. Do you have any final words for us, Dr. Ornish?

Ornish: The choices we make in our lives each day -- what we eat, how we respond to stress, whether or not we smoke, how much we exercise, and the quality of our relationships -- have a powerful determinant on our health and well-being. Begin by making either small changes that anyone can accomplish or big changes that will allow you experience very quickly how much better you feel and how much your weight and cholesterol and blood pressure can decrease. I hope this has been useful, and I am grateful for the opportunity to be of service.

Moderator: We are out of time. Thanks to Dr. Dean Ornish, for being with us today. For more information, please read Dr. Dean Ornish's Program for Reversing Heart Disease. And please visit Dean Ornish, MD's Lifestyle Program on WebMD, as well as his message board, Heart Healthy Living: Dean Ornish, MD.

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