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Preventing Heart Disease: The Role of Bacteria.

Immunologist at the Ontario Cancer Institute in Toronto, Josef Penninger. He recently led a study on the link between bacterial infection and heart disease. The study focused on the chlamydia bacteria which 95% of people are exposed to during their lives. The study suggests that heart disease can be prevented by treatment of antibiotics. The study was reported in the journal Science in February.




Related Topic

Other segments from the episode on May 5, 1999

Fresh Air with Terry Gross, May 5, 1999: Interview with Josef Penninger; Interview with Kilmer McCully; Interview with Dean Ornish; Commentary on coverage of the Kosovo War.


Date: MAY 05, 1999
Time: 12:00
Tran: 050501np.217
Head: Bacterial Infection and the Link to Heart Disease
Sect: News; International
Time: 12:06

TERRY GROSS, HOST: This is FRESH AIR. I'm Terry Gross.

New research about heart disease, the nation's top killer, is challenging some of our assumptions about its causes and leading to new approaches for prevention. Today, we're going to hear from three heart disease researchers.

In February, Dr. Josef Penninger and his colleague announced they had discovered that some forms of heart disease may be caused by a bacterial infection of the heart. This theory fits in with the discovery that some gastrointestinal ulcers are caused by bacteria.

Dr. Penninger is an immunologist at Princess Margaret Hospital, a teaching hospital at the University of Toronto; he's originally from Austria. He found that when the form of bacteria known as chlamydia invades the heart the chlamydia look like proteins that are normally found in the heart. This confuses the immune system.

DR. JOSEF PENNINGER, IMMUNOLOGIST, ONTARIO CANCER INSTITUTE: What we found is that there's a region of chlamydia bacteria which looks very similar to a protein which is present in the hearts of all of our -- of all of us, in all people. And basically our theory is when we have a chlamydia infection of white blood cells start attacking the chlamydia, but since the chlamydia look very similar to our own hearts the white blood cells are basically being fooled enough starting attacking our own heart.

GROSS: So let me see if I understand this correctly, the makeup of the chlamydia bacteria is similar to the makeup of certain proteins in our heart. So our body not only attacks the bacteria it starts attacking our own heart protein.

PENNINGER: Exactly. That's exactly our hypothesis, yes.

GROSS: Is that called an auto immune response where your immune system starts attacking healthy tissue?

PENNINGER: Yes, it's actually -- what we're proposing is that heart disease can be triggered by an auto immune response, similar to what people would believe like in diabetes, multiple sclerosis. So it would be actually identified as a similar mechanism. And we're saying chlamydia is probably the trigger, which basically turns on our white blood cells to attack our own heart muscles.

GROSS: Now, have you found this in typical immune systems or only in overzealous immune systems?

PENNINGER: Actually, what we found is there's a genetic hereditary factor which controls which animal will get heart disease or not. And the reason is because the immune systems of all of us are set up differently, which means my immune system for example will attack a different part of chlamydia than the immune system of another person.

So, the person is in trouble where the immune system attacks the part of chlamydia, which looks exactly like their own heart. So it's essentially, not a really over zealous immune system but it's a hereditary factor which controls how the immune system is reacting against the chlamydia bacteria.

And if now my immune system attacks the part of chlamydia which looks identically like my own heart than I'm in big trouble.

GROSS: Now, is the presence of the chlamydia bacteria the cause of the problem, or do you think that they're a symptom of a larger problem? In other words, are the bacteria there feeding on already diseased arteries?

PENNINGER: Yes, that's a very good question. Because there were already many papers out there who -- which claimed that there's a link between chlamydia infection and heart disease. But nobody could really say now is the chlamydia the trigger of heart disease or is it just sitting there like an innocent bystander? But there's actually nothing to the risk of heart disease.

So what we could actually do is we found the first cause or link that chlamydia is not just sitting there, but they can actually induce heart disease. So we basically can take a part of the chlamydia, put into an animal and they all get heart disease.

So heart disease, meaning they get inflammation around blood vessels, the blood vessel walls are thickening. Some blood vessels are clogging up. So we basically can associate chlamydia infection itself and heart disease. So we can just take a part of chlamydia, put it into an animal and they'll get sick.

GROSS: Any idea how the chlamydia infection starts in the first place?

PENNINGER: Yes, chlamydia are very common bacteria. So it's estimated that all of us will get infected with chlamydia. So there are three different strains of chlamydia, two of which infecting us through the respiratory system, so we get infections of the lungs, a kind of pneumonia sometimes -- a very mild infection.

The third one is actually the most common cause of sexually transmitted disease. So it's estimated that, for example, one in ten women in the United States are infected with the chlamydia (unintelligible). And so normally this chlamydia very often are symptomatic.

So it means they're just sitting around in our body and don't do very much for a long time. And this is the reason why chlamydia (unintelligible) is the most common cause for female infertility in the United States, for example. Three million women are infertile. So this is how we get it.

It's either sexually transmitted or transmitted through the air. So basically you can go into the subway and you can catch chlamydia infections.

GROSS: Now, assuming that further studies prove this link between chlamydia and heart disease, what will the implications be for the prevention and treatment of heart disease?

PENNINGER: Yes, so first I would like to say people always know there are novel risk factors. So we have always been told cholesterol, obesity, diabetes, hypertension are the major risk factors, and this is of course true.

But people always knew 20 to 50 percent of patients with heart disease lacked all those traditional risk factors. So there are all these very healthy people who are jogging and drop dead of a heart attack, and so there was this huge risk factor missing.

And I think these are bacteria. And what the study basically opens up is a mechanism of how bacteria can induce heart disease. And on one hand it's very scary because it means we could just get into the bus and catch a heart attack. On the other hand, it's of course a huge opportunity because if we understand the mechanism we can actually interfere with it.

So what this means concrete for people is first we have to define that this in humans a real risk factor. So we have to define new tests where we say this person is infected with chlamydia, and because of those the immune system has started attacking the heart of this person. So we can make this test.

The other thing is, if this turns out to be a real factor in humans then we can actually kind of vaccinate against it. We can probably start to try to re-program the immune system, and we can tell the immune system to kill the chlamydia infection but leave the heart alone.

GROSS: This seems to fit into a larger pattern that we're starting to see of scientists finding, and being very surprised to find, that bacteria can be causing illnesses that we never thought they were responsible for. Like ulcers seem to be caused -- or some ulcers -- seemed to be caused by a certain bacteria. And that was very surprising to find.

Do you see these two findings as being related?

PENNINGER: Yes. Actually, I think the bacteria will come back to us with a vengeance. So there are now people who are claiming Alzheimer's Disease is actually an infectious disease.

GROSS: Mmm-hmm.

PENNINGER: Some people say schizophrenia is an infectious disease. So some people say you can actually catch gallstones (unintelligible) bacteria. So I think the problem was because I think classical bacteriology where you had to isolate the bacteria, you had to grow it in the laboratory, put it somewhere else and then you would get disease.

And so you could basically establish the proof that his bacteria or virus was responsible for the disease. But with chlamydia, for example, you could never do this. Because for example you cannot really grow out chlamydia in culture, it does not work well.

The same, probably, for bugs or viruses which might cause Alzheimer's Disease. So I think for a long time we were hampered by this classical postulate what we have to do to prove how a disease is happening.

So what I personally find really funny is when I went to medical school 10 years ago, 15 years ago for every disease which we didn't understand was psychosomatic. Our parents were bad for us, so therefore we developed an ulcer or we developed heart disease.

And five years ago, ten years ago, everybody thought it was all genetic diseases, and now all of a sudden bacteria are coming back. So it's quite interesting actually how these things are coming back in cycles.

GROSS: If you're just joining us my guest is Dr. Josef Penninger, a scientist who found a link between the presence of chlamydia bacteria and heart disease. And his study was in mice.

If it does prove to be true that the bacteria chlamydia is linked to heart disease, what does that say about cholesterol? Does that say people wouldn't need to worry about cholesterol anymore, or would those be two different kinds of heart disease?

PENNINGER: That's a very good question. The thing is we have been told now for years -- there is a whole health industry out there which tries to keep us healthy and lower our cholesterol and lower our intake of fat and our intake of salt.

And of course it's very good to stay in good shape. I mean, we are staying and we are running and that's all fine. But there are all these anecdotes of people who are perfectly healthy and dropping dead of the heart attack.

So some recent studies actually show that salt intake or the level of how much salt we take does not really cause heart disease. The same is probably true for cholesterol. So -- and the studies are basically that in the United States the incidence of heart attacks are going down, but the levels of cholesterol have stayed the same.

So if there is a direct correlation between cholesterol levels and heart disease then these two curves should be parallel, but they do not correlate very well. So this is actually one of the reasons why people are really looking for new risk factors, and this is with bacteria coming in and I think we should take it quite seriously.

GROSS: Mmm-hmm. Your research was done in mice. What needs to be done to see if this research carries over to humans?

PENNINGER: Yes. So first we have to establish if the same principle which causes heart disease in mice actually also applies for humans. So we can actually do this because we can put a human immune system into a mouse, we call it humanizing a mouse. And then we can establish the principle of truth, and we just have done this.

And so a paper which will appear soon, and basically we can show now that the same principle which governs heart disease in mice actually works also when you have a human immune system around. But of course it doesn't mean this is the mechanism of how it's happening in humans.

And so what we have to establish is that people who have been infected with chlamydia have actually white blood cells which are attacking the heart -- the heart of the person. And if we have shown this I think then we're fairly confident that this inflammatory process or this mechanism we have established in mice is actually also working in humans.

GROSS: Do you have the green light to keep going? I mean, will you be using human subjects soon?

PENNINGER: We are just a research lab here. We only are one and a half people working on this project.

GROSS: Oh. Oh, wow.

PENNINGER: My post-doctorate fellow and myself. So we really stumbled over this because we were working on a virus infection of the heart muscle. And then we found a protein in the heart muscle and then it just turned out to be similar to chlamydia.

So we personally -- my laboratory, we cannot really move on with this because I just do not have any manpower. But I try of course to set up some collaborations now and give out our peptides to everybody who wants them, so that people and clinicians and big centers can follow up to study now in humans.

GROSS: Now, your research lab is very small, it's you and one other person. What's the next step for you in this research?

PENNINGER: Yes. We actually believe it's not only chlamydia which can lead to heart disease, so we are looking now into other bacteria and actually some viruses and probably also parasites which can cause heart disease. For example, it has been known in several countries there's a very common parasitic infection from (unintelligible) that makes (unintelligible) disease, it's very prevalent.

And people know that 30 percent of infected persons will actually develop chronic heart disease 10, 15 years afterwards. And again, it's postulated, it's an auto immune disease. So we actually found some regions which look very similar.

So I think it's just not just chlamydia which is the trigger but we might be up to some very interesting surprises. So we already pulled out two or three more bacteria which probably can do the same. So this is what we're following up now.

GROSS: Dr. Joseph Penninger is an immunologist at Princess Margaret Hospital in Toronto. Coming up, more research on the prevention of heart disease.

This is FRESH AIR.

This is a rush transcript. This copy may not
be in its final form and may be updated.

Dateline: Terry Gross, Washington, D.C.
Guest: Dr. Josef Penninger
High: Immunologist at the Ontario Cancer Institute in Toronto, Josef Penninger. He recently led a study on the link between bacterial infection and heart disease. The study focused on the chlamydia bacteria which 95 percent of people are exposed to during their lives. The study suggests that heart disease can be prevented by treatment of antibiotics. The study was reported in the journal Science in February.
Spec: Health and Medicine; Diseases; Science; Lifestyle; Culture; Dr. Josef Penninger

Please note, this is not the final feed of record
Copy: Content and programming copyright 1999 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1999 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Bacterial Infection and the Link to Heart Disease

Date: MAY 05, 1999
Time: 12:00
Tran: 050502NP.217
Head: The Cholesterol Theory of Heart Disease
Sect: News; Domestic
Time: 12:20

TERRY GROSS, HOST: Cholesterol clogs the arteries and causes heart disease, right? Well, according to Dr. Kilmer McCully high cholesterol may be a symptom of heart disease rather than a cause. His research shows that the real culprit may be high concentrations of an amino acid found in the blood called homocysteine. And, that homocysteine levels can be controlled by increasing the intake of certain vitamins.

Dr. McCully proposed this theory in 1968. By the end of the '70s his theory had become so unpopular that he lost his funding and his teaching position. But in the past few years several other studies have also found connections between high homocysteine levels and heart disease.

So now Dr. McCully's research is being taken much more seriously. He has a new book explaining his research called "The Heart Revolution." I asked him to describe his theory.

DR. KILMER MCCULLY, AUTHOR, "THE HEART REVOLUTION: THE B VITAMIN BREAKTHROUGH THAT LOWERS HOMOCYSTEINE, CUTS YOUR RISK OF HEART DISEASE, AND PROTECTS YOUR HEALTH": Homocysteine is an amino acid that can build up to abnormally high concentrations in the blood. That is too much of the level becomes too high, and when this happens it -- the amino acid damages these cells and tissues of the arteries causing plaques.

The reason for this buildup is that homocysteine is normally controlled by three important B vitamins: vitamin B6, folic acid and vitamin B12. When these vitamins are either deficient in the diet or not absorbed normally then homocysteine levels can build up and damage the arteries causing plaques.

GROSS: What exactly does homocysteine do in the arteries? How does it wreak the damage?

MCCULLY: Homocysteine affects the cells by damaging the cells and injuring the cells. And then in response to this there is like a healing process where the cells multiply and form a sort of a scarred area which we call a plaque. And during this process cholesterol and lipoproteins are also deposited, particularly over a long period of time.

So homocysteine causes the underlying plaque which then becomes an area where the cholesterol and fats are deposited.

GROSS: Now what is homocysteine supposed to do for us that's good in our bodies?

MCCULLY: You can't live without homocysteine. It's an absolutely essential part of the body. It's required for normal growth. It's required for function of the brain. It's required in many different areas. It also is important in the normal control of growth of cells, and when they become abnormal, as in cancer, there's an abnormality of homocysteine.

There are many many examples of how homocysteine is involved in normal -- the normal processes of the body.

GROSS: The theory that most scientists have subscribed to is the cholesterol theory of arterial sclerosis. That if you eat a lot of foods high in cholesterol they will end up causing plaque in your arteries which will lead to heart disease.

You say that high cholesterol is more of a symptom not a cause of heart disease. What's your take on cholesterol?

MCCULLY: My take is that the cholesterol in the blood is a part of the so-called low-density lipoprotein particle, and we've discovered that this particle carries homocysteine. So when you have a high level of low-density lipoprotein and cholesterol in the body there's more carrier there, and it carries more homocysteine to the walls of the artery were the damage is done.

GROSS: So the cholesterol isn't causing the homocysteine, it's just carrying it.

MCCULLY: That's correct. And for many years it's been assumed that the cholesterol in the diet and the fats in the diet are the cause of the elevated cholesterol in the blood, but this has never really been proven thoroughly. As a matter of fact, high doses of homocysteine, for example, in animals can cause the cholesterol levels to become very high.

GROSS: My guest is Dr. Kilmer McCully, and he is the doctor who has proposed a theory that high levels of the amino acid homocysteine in the blood are responsible for arterial sclerosis. His new book is called "The Heart Revolution."

Now you say that the B vitamins control the level of homocysteine in the body. The less you have of B vitamins, the higher the level of homocysteine and the more prone you will be to arterial sclerosis.

Does that mean that you think everybody should be eating more foods with vitamin B in it?

MCCULLY: Yes. That means that the diet should be improved so that people should be eating foods that are naturally abundant in these important vitamins. These vitamins are widely distributed in fresh foods, but when foods are processed and packaged these sensitive vitamins are lost in large part.

So that I think the most important way to prevent arterial sclerosis is to eat the fresh nutritious foods that contain high levels of these B vitamins.

GROSS: What are the foods that are high in the B vitamins?

MCCULLY: Oh, for example, bananas are loaded with vitamin B6. Legumes like navy beans, for example, or lentils have a lot of folic acid and vitamin B6. Citrus fruits have a lot of folic acid. The classic food for folic acid are leafy green vegetables and salads. These are very good sources of folic acid.

Vitamin B6 is also widely distributed in animal foods as well. For example, fish is very high in vitamin B6. Another example is liver or any fresh meats are high in vitamin B6, but when meats are processed or canned up to 50 percent or even more of vitamin B6 is lost during the processing methods.

GROSS: Dr. Kilmer McCully is the author of "The Heart Revolution." We'll talk more about his research in the second half of the show.

I'm Terry Gross and this is FRESH AIR.


GROSS: This is FRESH AIR. I'm Terry Gross.

Back with Dr. Kilmer McCully. About 30 years ago he came up with the theory that certain forms of heart disease are caused by high levels of homocysteine, an amino acid found in the blood. Dr. McCully's homocysteine theory was very unpopular among medical researchers until recently.

In the past few years several studies have also found connections between homocysteine levels and heart disease.

Now, you first developed your theory about homocysteine as a cause of heart disease through studies that you were doing in 1969. You were researching children who had a rare disease. What was the disease and why were you examining those children?

MCCULLY: The disease is called homocysteine urea (ph). In this disease the amino acid homocysteine is present in the urine. I became interested in this disease because we had a case that had been described in the early '30s of a child who developed a stroke, and I discovered that this child had homocysteine urea.

An analysis of this case and an analysis of a second case with a different form of the homocysteine urea led to the discovery that no matter what the cause of elevated homocysteine, the arteries become damaged and arterial sclerotic plaques result. This was the genesis of the theory in 1968 and '69.

GROSS: So you were finding young children who had hardening of the arteries the way you'd expect to find them in older people, and you thought that the cause of that was the homocysteine.

MCCULLY: That's correct. So then we went on to experiment with animals and cells and biochemical preparations, and we were able to reproduce this disease in rabbits by injecting homocysteine into rabbits.

GROSS: What reaction did you get in the medical and scientific worlds when you introduced this theory?

MCCULLY: The very early reaction, within a year or so of my first paper in 1969, was that of interest among people in the scientific world who were familiar with this area. However, I think it's fair to say that the vast majority of the medical profession ignored the theory or felt that it perhaps applied to these rare hereditary diseases, but really had nothing to do with the disease in the population.

GROSS: So you were -- people viewed you with interest or they ignored you. After a while they got kind of irritated with you.

MCCULLY: Well, I think the problem was that I persisted. I kept publishing papers -- when I did experiments in the laboratory they all worked. Everything worked out. And I kept publishing papers, and paper after paper showing that under different conditions high levels of homocysteine caused arterial sclerosis.

And I called attention to the vitamin connection and I, you know, I explained many of the features of arteriosclerosis in the general population with these observations and experimental models. And the reaction was extraordinary.

About the mid-'70s, around 1975 or 1976, I was denounced by some of the leaders in the cholesterol and lipid fields. They felt that -- I was told that anyone who suggests that a vitamin deficiency has something to do with arteriosclerosis may be guilty of malpractice.

And I was publicly denounced by this and eventually what happened is that my chairman of my department retired and I was out of a job. I was forced out of Harvard and Mass General Hospital because the conventional wisdom couldn't make room for this new approach.

GROSS: Do you think that your theory is gaining more acceptance?

MCCULLY: Yes. Very fortunately, within the last five to ten years a number of large scale human studies have been published from clinics and laboratories throughout the world. These studies have shown that elevated homocysteine levels are a very potent independent risk factor for vascular disease of various types, including coronary heart disease, stroke and cerebral vascular disease and also peripheral vascular disease.

In addition, epidemiological studies have shown that elevation of homocysteine is common in the elderly population and that it leads to narrowing of the arteries and the complications of vascular disease. And finally, just this past year a massive study was published by the Nurses Health Study showing that among 80,000 nurses who were studied for a 14 year period those who consumed low amounts of folic acid and vitamin B6 which control homocysteine had an increased death rate from coronary heart disease, directly proving the underlying theory.

GROSS: So what do you think your status is now in the medical world?

MCCULLY: Well, I'm very gratified that all of these human studies on large-scale worldwide have begun to really offer firm proof for the validity of this homocysteine approach. So I'm very gratified, and it's extremely satisfying to me because when I was a young person this is what I wanted to do with my life.

I wanted to investigate the cause of diseases using my background in chemistry and biochemistry. And this is what's happened. So it's a very filling and gratifying experience.

GROSS: Well, Dr. McCully, I want to thank you very much for talking with us.

MCCULLY: It's been my pleasure.

GROSS: Dr. Kilmer McCully writes about his research into homcysteine and heart disease in his new book, "The Heart Revolution."

Coming up, Dr. Dean Ornish on the connection between emotional health and heart disease.

This is FRESH AIR.

This is a rush transcript. This copy may not
be in its final form and may be updated.

Dateline: Terry Gross, Washington, D.C.
Guest: Dr. Kilmer McCully
High: Dr. Kilmer McCully takes another look at the cholesterol theory of heart disease in his new book, "The Heart Revolution: The B Vitamin Breakthrough that Lowers Homocysteine, Cuts Your Risk of Heart Disease, and Protects Your Health." McCully writes that the real culprit in heart disease is the amino acid homocysteine which is found in the blood. Too much of it can lead to damaged arteries, leaving them susceptible to cholesterol and fat deposits. McCully writes that Vitamin B deficiency leads to too much homocysteine.
Spec: Health and Medicine; Diseases; Science; Lifestyle; Culture; Dr. Kilmer McCully

Please note, this is not the final feed of record
Copy: Content and programming copyright 1999 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1999 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: The Cholesterol Theory of Heart Disease

Date: MAY 05, 1999
Time: 12:00
Tran: 050503NP.217
Head: The Link Between Emotional Health and Heart Disease
Sect: News; Domestic
Time: 12:35

TERRY GROSS, HOST: Dr. Dean Ornish is best-known for research that he says shows that heart disease can be prevented or reversed by switching to a non-fat diet and making appropriate changes in your lifestyle. His latest book, "Love & Survival," explores the connection between emotional health and susceptibility to heart disease.

For example, loneliness and isolation can increase the likelihood of smoking, drinking, overeating and other self-destructive behavior. And according to Ornish, loneliness and isolation increase the likelihood of disease and premature death from all causes by 200 to 500 percent through mechanisms which are not fully understood.

Dr. Ornish's new book presents some of the research into emotional health and heart disease.

Let's look at some of the studies that you refer to in your book, "Love & Survival." Maybe you can tell us about the Harvard "mastery of stress study."

DR. DEAN ORNISH, CLINICAL PROFESSOR OF MEDICINE, UNIVERSITY OF CALIFORNIA, SAN FRANCISCO; AUTHOR, "LOVE & SURVIVAL: 8 PATHWAYS TO INTIMACY AND HEALTH": That was a particularly interesting study because they asked Harvard undergraduates in the 1950s two simple questions: were you close to your mother and were you close to your father when you were growing up.

Forty years later -- that's what so amazing to me about so many of these studies -- 40 years later, those who said no, I wasn't close to my mother and no, I wasn't close my father; all of them, a hundred percent of them, had major illnesses in midlife. But less than half of them who said yes, I was close to both parents and somewhere in between if they were close to one or the other parent.

Now, why should something be so predictive 40 years later? And I think that our first teachers of love and intimacy are our parents. And if you grew up in a family where they didn't know how to do that very well, or on an extreme if they were abusive, either sexually or physically or emotionally abusive, you quickly learned that intimacy is dangerous. That it's not safe to open up to someone else.

And since these aren't skills we really learn much about in our culture, we tend to relate to people as adults much as we did when we were younger. So if we didn't get it when we were younger we're probably not going to get it when we're older. And so to whatever degree that lack of intimacy is predictive of premature death or disease, it's not surprising that those early life experiences are so predictive.

GROSS: Tell us about another of the studies that you find particularly interesting about the connection between your emotional life and emotional connections and your health.

ORNISH: I think one of the most interesting is a study that was done at the University of Texas Medical School of men and women who were about to undergo open heart surgery. And they also asked them two questions, but they were different questions.

They said do you draw strength from your religious faith, whatever that faith might be it didn't matter. And are you a member of a group of people that meet together regularly. It could be a church or synagogue or a civic group, it could even be a bowling league or a Bridge club.

Six months after open heart surgery those who said no to both questions; no, I'm not a member of a group that meets regularly. No, I don't draw strength from my religious strength -- 21 percent of them were dead compared to only three percent who said yes to both questions. And about a fourfold difference in those who said yes to one or the other.

That's a sevenfold difference in mortality. We're not talking about touchy feely kind of stuff here. We're talking death. And not just a little, but a lot.

So to me it illustrates a couple of things. The first is -- first of all, I don't know any surgeons that ask these two questions to their patients, but you can be sure if a drug came out or a new surgical technique that had a sevenfold difference in mortality six months after surgery, you know, every doctor in the country would be doing it.

The second is, you know you're dealing with something very basic and very fundamental when the relatively crude measures of intimacy are so predictive. I mean, let's face it, being a member of a bowling league is not the most intimate of life experiences. And yet even that kind of measure can be so predictive of survival.

And it causes me -- it's really caused me to re-think a lot of my ideas over time as I've done this research on reversing heart disease. That the need for love and intimacy is a basic human need that's as fundamental as eating and sleeping and breathing. And when we don't get that we pay a price.

And the price isn't just in the quality of our lives, it's in the quantity of our lives and how long we live and how likely we are to get sick. And if we understand that -- you know, to me awareness is the first in healing.

And if we become aware -- more aware of how much these things matter then we can make different choices and not see them as a luxury but as something that's very basic and necessary to not only our happiness and our well-being, but even our survival.

GROSS: Dean Ornish, you're best-known for your work with diet. Trying to use diet to reverse heart disease. How did you stumble onto the idea that somebody's emotional life is connected to the health of their heart?

ORNISH: Most people do think -- tend to think of my work as mainly about diet. I mean, it's gotten to the point where I can't go out to dinner without someone either apologizing for what they're eating or commenting on what I'm eating.

But even when I did my first study back in 1977, 22 years ago, I had groups -- I had 10 men and women all of whom had severe heart disease -- this was my first pilot study when I was a medical student. And I put them in a hotel for a month, and I put them on this program of mine which included the diet and exercise and meditation and yoga.

And we met in a support group once an evening that was originally designed to help people stay on the diet and to quit smoking and to follow the exercise and so on. But what became clear to me even back then was that we took his very diverse group of men and women, put them together in a group and unwittingly I had created a community.

And then people began to open up to each and to talk about what was really going on in their lives. And even though these people were so different from each other in the ways that we usually categorize people in terms of, you know, age and race and gender and sexual preference and socioeconomics and all the demographics and so on.

They all began to talk about, almost all of them, how lonely and isolated and what was really happening in their lives. And it became clear to me over time that this wasn't just something that was helping them stay on the other parts of the program, it was one of the most important parts of the program. And certainly one of the most meaningful, both for the patients and for me.

And then later as more research became clear that this intervention was probably as important as the diet and so on not just in terms of helping them stay on it, but it had direct benefits above and beyond that. That I became more and more interested in that.

GROSS: My guest is Dean Ornish, and he is well-known for his research into reversing heart disease through changes in the diet -- a nonfat diet. His new book is called "Love & Survival: 8 Pathways to Intimacy and Health."

Let's talk a little bit about diet. Have you had any changes of heart, so to speak, about the fat-free diet that you suggested is good for the prevention or even the reversal of heart disease?

ORNISH: No, actually I think that there's more evidence than ever that shows this is really the most optimal diet for most people. When you eat a low-fat plant-based diet you're avoiding those substances that cause disease like animal fat, animal protein, saturated fat, cholesterol and so on -- oxidants like iron.

And you're also getting literally thousands of substances that are actually protective: vito-chemicals bioflavinoids, anti-oxidants, carotinoids, retinal's, isoflavoids -- it's a whole alphabet soup of substances that have been shown to have anti-heart disease, anti-cancer, even anti-aging properties.

And with few exceptions these are found in a plant-based diet. The only differences that I've made in my program over the years are a few.

The first is I've always said it's better to avoid simple carbohydrates like sugar and white flour and alcohol, which your body converts to sugar, because they get absorbed quickly. They make you body's blood sugar go up. Your pancreas makes insulin to bring it back down, and the insulin can accelerate the conversion of those calories into fat.

So a lot of books have been coming out saying all carbohydrates are bad. You should eat really healthy foods that won't stimulate an insulin response like sausage and bacon and pork because those won't do that. Well, that's just nutty. I mean, it's a great way to sell books, telling people that those are health foods but they're not.

The distinction to make is between simple and complex carbohydrates. Complex carbohydrates -- fruits and vegetables, and grains and beans in their natural forms -- are high in fiber which slows the absorption so you don't get a rapid spike in blood sugar. You don't provoke an insulin response.

And you're also not getting all the saturated fat and all the other stuff that's in meat. So when you, for example, refine away the fiber in the brand that's in whole wheat flour or brown rice and turn it into white flour or white rice, you're changing a complex carbohydrate into a simple one.

The other thing that I think is worth noting is that some supplements I think are good. And they include some of the antioxidant vitamins, I think folic acid and folate which can reduce homocysteine levels.

But also I think two or three grams a day of fish oil or flaque (ph) seed oil can provide omega-3 fatty acids that can reduce sudden cardiac death by 50 to 70 percent or more, but don't give you the excessive fat and cholesterol that you find in fish or the kinds of things that you find in the Mediterranean diet.

So what those refinements of my program it's pretty much the way that it's been for the last 22 years.

GROSS: Speaking of the Mediterranean diet, I don't know if you saw there was a recent article in "The New York Times" by health writer Jane Brody about the Mediterranean diet. And this is a diet that consists largely of fruits, vegetables, cereals, you know, grains, fish and beans and a fair amount of olive oil.

She wrote, "the most surprising and gastronomically pleasing feature of the dietary scheme that has emerged from research is that diet may not have to be low in fat to protect the heart. Rather than insisting, as Dr. Dean Ornish, that no fat be added to food and that all fat containing animal foods be avoided, advocates of the Mediterranean diet include a fair amount of fat nearly all in the form of oils: olive oil, nut and seed oils and fish oil."

Dean Ornish, what do you think?

ORNISH: Well, I do think that the fruits and vegetables and grains and beans in the Mediterranean diet are protective. But you know what's really protective about the oils in the Mediterranean diet is not the olive oil. I mean, the olive oil people would like you to think that olive oil is good for you. It really isn't. It's not as bad for you as, say, coconut oil or Crisco.

But olive oil has virtually none of the omega-3 fatty acids that are protective, and its higher in the omega-6 that are harmful. It's the small amounts of the omega-3 that are so protective. You only need about three to four grams a day of flaque seed or fish oil. And you can take those in little capsules that come in one grams.

You don't need the excessive amounts that cause problems. Even canola oil at least as some of the omega-3, olive oil has none. So it's despite the olive oil not because of it.

Now, if you're eating olive oil instead of lard or butter you're going to have a lower risk of heart disease, and that's good. But if you actually look at the Mediterranean countries, they have lower risks of heart disease, breast cancer, prostate cancer, colon cancer than countries like the U.S., but not nearly as low as Asian countries like Japan and China.

And so to me, a Mediterranean diet is a better diet, but it's not an optimal diet. An optimal diet would be more like you find in countries where the heart disease and cancer rates are even lower, like in Asia. My colleagues and I are doing the study now to see whether the progression of prostate cancer may be effected through a similar kind of intervention.

And I think we're at a state with respect to prostate and breast cancer and perhaps colon cancer, very similar to where we were with heart disease 22 years ago.

GROSS: You said that, you know, research has found that people in Mediterranean countries and in the East seem to have a lower rate of heart disease than in the United States, and that's in the research largely been attributed to diet.

Do you think that a sense of community and connection might come into play in those cultures as well?

ORNISH: I do, actually. I think that so much has been made of people drinking red wine in France, for example, and maybe that's the cause of them having such lower rates of heart disease. Well, first of all, heart disease is still the number one cause of death in France. It's not like they don't have heart disease.

But I wonder why is it that studies show that people who drink one or two drinks a day live longer than those who don't drink at all or who drink more than that. Well, where else in our culture in the U.S. do people get together, they get a little high, they let their emotional defenses down, they talk about what's going on their lives. I mean, what do we call that? We call that happy hour.

And it may be that the benefits of those who drink moderately are more do to those social factors than to the red wine or to the alcohol per se. And similarly, it may be that in other countries where they have lower rates of heart disease, at least part of the reason may not only be due to the diet but also to these social factors.

On the other hand, a great experiment is now occurring around the world, and that is many of these countries that have had among the lowest rates of heart disease in the world, are beginning to live like Americans and they're are beginning to die like Americans. They're importing our way of eating and they're importing our way of dying.

In Japan, for example, Japanese boys now have cholesterol levels that are as high as American boys. In one generation we're probably going to see them going from one of the lowest to one of the highest rates of heart disease in the world. And it's sad because it's so avoidable.

GROSS: Dr. Dean Ornish, I want to thank you very much for talking with us.

ORNISH: It's my great pleasure.

GROSS: Dr. Dean Ornish is the founder of the Preventive Medicine Research Institute in Sausalito, California and A professor of Medicine that the University of California School of Medicine in San Francisco. His latest book is called "Love & Survival."

This is FRESH AIR.

This is a rush transcript. This copy may not
be in its final form and may be updated.

Dateline: Terry Gross, Washington, D.C.
Guest: Dr. Dean Ornish
High: Dr. Dean Ornish discusses the link between emotional health and prevention and treatment of heart disease. His new book is "Love & Survival: 8 Pathways to Intimacy and Health." Ornish is Clinical Professor of Medicine at the School of Medicine, University of California, San Francisco and founder of the Osher Center for Integrative Medicine.
Spec: Health and Medicine; Diseases; Science; Lifestyle; Culture; Dr. Dean Ornish

Please note, this is not the final feed of record
Copy: Content and programming copyright 1999 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1999 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: The Link Between Emotional Health and Heart Disease

Date: MAY 05, 1999
Time: 12:00
Tran: 050504NP.217
Head: Linguist Geoff Nunberg's Views on the War in Serbia
Sect: News; International
Time: 12:52

TERRY GROSS, HOST: The coverage of the war in Serbia has dominated the news here and in Europe. Our linguist Geoff Nunberg is in Rome and has these thoughts on what he's read in the newspapers and seen on TV there.

GEOFF NUNBERG, LINGUIST: I had dinner this May Day with friends who live on a hilltop near Rimini on the Adriatic coast of Italy. We watched the TV news as it showed the planes taking off from Aviano Air Base on their way to Serbia.

As we went one outside to eat, I was remarking on how far away the war seemed, at which point we heard the very same planes streaking by overhead. My host smiled. "In Italy," he said, "the war is a multimedia presentation."

There's no denying that from here at least the presentation of the war seems to be rife with these contrasts and juxtapositions. The most obvious of course is the nightly news coverage that moves between pictures of the destruction wrought by the bombing raids and pictures of the steams of Kosovari refugees.

But there are others that are equally odd, the way there are in all televised wars. A week or so ago the TV news lead with coverage of the NATO raid that had killed 30 or so civilians in a bombing of a bridge. Then moved on seamlessly to a piece about how Ray Ban sunglasses were going to be sold in Italy for the first time, illustrated with footage of famous Ray Ban wearers like Tom Cruise in "Top Gun."

It's information overload of a particular sort not that we hear too much about the war, but that the words and images we get seem to undercut every effort to organize some coherent story about how we ought to think about what's going on.

It's true that none of this has stopped intellectuals from trying to turn the war into a straightforward moral tale along the lines that people have always used in the past to make wars comprehensible, whether they were for them or against them.

In one widely reprinted article, for example, the French sociologist Jean Bodriar (ph) offered an exquisitely subtle analysis of the hidden motives of the Americans, which would have done honor to anyone in the French Left of the Vietnam period.

"Having won the war with communism and undermined the Asian miracle," he suggested, "the Americans are now worried about the specter of a unified multiethnic Europe. And have contrived the war as a way of bogging the continent down while at the same time allowing Milosevic to do some Muslim bashing that coincides nicely with American interests in the Middle East."

And he adds that European who oppose Milosevic are just playing the American's game. It was a sweeping account that made a place for everything. The sort of thing that Bodriar and his contemporaries describe as a grand narrative.

Indeed, it's exactly the kind of story that they themselves have insisted is no longer possible to tell in the postmodern world. And in that at least they're right. When you watch the TV news it's hard to credit that the whole story is unfolding according to some master plan hatched by some geniuses in the Pentagon -- that's Bodriar's praise not mine.

It may be that the people in the White House and the Pentagon are morally capable of this kind of Machiavellian scheming, but it's pretty clear they're not intellectually capable of bringing it off. That's a characteristic defect of French intellectuals who always want to think that their adversaries are as brilliant as they are. It's more satisfying to accuse them of being malevolent than simply inept.

But the problem is just the same for proponents of the war who have their own great narratives to spin. Susan Sontag had piece in this vein that ran in the "Sunday Times" this week as well as in a number of European papers.

"There are just wars," she says, invoking the specters of Auschwitz and the American Civil War and other struggles against evil.

"There may be civilian casualties in Serbia, but they're trifling compared with the victims of Serbian ethnic cleansing." "And anyway," she says, "those too are the fault of the Milosevic government which has finally brought on Serbia a small portion of the suffering it has inflicted on neighboring peoples."

But, again, when you watch TV it's hard to feel any sense of poetic justice at the sight of all those burned bodies strewn by the bus that NATO bombs hit on that bridge in Serbia. Reading Bodriar and Sontag, I think of something that the Czech writer Karol Chopic (ph) said once, "was there ever anything so terrible that some philosopher wouldn't try to save the world with it."

And for those of us who lack the stern mental rigor of the intellectuals, it can be hard to sustain any of these over arching stories anymore. We look at the images and we read all the words and we can't escape the sense of anguished confusion. That's doubtless why forces on every side have tried to narrow the bandwidth.

Milosevic shuts down the alternative press and radio stations in Serbia. NATO bombs Serbian television. And in Italy, anti-American radicals have been concentrating their attacks not on McDonald's or Coca-Cola, but on Blockbuster Video outlets; several of which were firebombed in Rome and Milan.

It's a sign of the change in mentality when the most powerful symbol of American domination is a company that diffuses images rather than hamburgers or soft drinks. But for us in the West at least they're still too many images and too many words.

It's an article of faith in the information age of course that this is a good thing in the end. That this poliphany of voices and images is what will deliver us from superstition and misunderstanding. That could be true in the end. To paraphrase what Oliver Wendell Holmes said about free speech, may be the answer to information overload is more information overload.

In the meantime though you have the sense that even when it's all up on the screen we're not going to be able to weave it into a single story.

GROSS: Geoff Nunberg is a linguist at the Xerox Palo Alto Research Center.

I'm Terry Gross.

This is a rush transcript. This copy may not
be in its final form and may be updated.

Dateline: Terry Gross, Washington, D.C.
Guest: Geoff Nunberg
High: Linguist Geoff Nunberg reports from Rome where he's been watching the coverage on the NATO bombings and the Kosovar refugees.
Spec: War; Refugees; Europe; Lifestyle; Culture; Geoff Nunberg

Please note, this is not the final feed of record
Copy: Content and programming copyright 1999 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1999 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Linguist Geoff Nunberg's Views on the War in Serbia
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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