In a towering Victorian house, 40 heads bow.
"Lord, make us grateful for the many friends we've made in this program as we try to reverse our heart disease. . . . Amen!"
Seconds later, the crowd of heart patients is swigging cider and digging into bowls of bean soup, then tasting a spicy casserole of cabbage, barley and apple, and munching tossed salad and steamed vegetables. Dessert is a pastry of tart berries stuffed into fat-free phyllo dough.
These diners, once so seriously ill that they needed heart surgery, are doing what science said was impossible a few years ago. They're turning back the clock on their bodies, reversing the course of a disease that has been the nation's leading killer for most of this century.
A California physician, Dr. Dean Ornish, stunned the medical world in the 1980s by showing that lifestyle changes can -- at least in some cases -- reverse heart disease.
But Dr. Ornish catered to upscale Californians paying thousands of dollars a week to learn gourmet vegetarian cooking, yoga and how to get in touch with their feelings. Critics called his approach costly and elitist and said it'd never play in Peoria.
And while it isn't playing verbatim in Baltimore, area cardiac rehabilitation and heart disease prevention programs combine some of the approaches used by Dr. Ornish. They encourage patients to eat a low-fat diet and make lifestyle changes such as increasing exercise, stopping smoking and managing stress -- in addition to taking their medication if necessary. Followed carefully, physicians say, such regimens may sometimes provide alternatives to balloon angioplasty, bypass surgery and other invasive procedures.
Fifteen miles southwest of Detroit, Dr. Joseph Rogers of Trenton, Mich., is making the Ornish program work -- and for much less than Dr. Ornish charges. Dr. Rogers collects $20 a week from the patients who participate in his Downriver Reversal Team. They gather for weekly, four-hour meetings of exercise, yoga, vegetarian dinners and group discussions, held in a turn-of-the-century mansion down the street from a steel mill.
At the end of the first year, changes are dramatic:
* Fitness levels, measured by treadmill tests, are up 13 percent.
* Average weights? Down nearly 10 pounds; one woman shed 43.
* Average cholesterols are down eight points; one patient dropped 125.
* And, most important, scans of their hearts show that blockages are shrinking. Gradually, their disease is simply going away.
"Our challenge was to see if this could be applied to the average [person], and make it inexpensive and not so outlandish that people are intimidated by it," Dr. Rogers explains.
Two of his patients had been scheduled for bypass surgery but canceled to join his group. Others had endured surgery, only to face the sentence imposed on most heart patients -- a likely return of symptoms, perhaps even a heart attack. Many were saddled with shortness of breath and chest pain. All had shared a chilling fear of the future.
But all believed in Dr. Rogers and his gospel of healing through healthier living.
The cornerstone of Dr. Ornish's reversal programs is vegetarian dieting with a strict limit on fat: no more than 10 percent. That rules out even broiled chicken and fish. But his most recent book, "Eat More, Weigh Less," includes 250 low-fat recipes contributed by some of the nation's best-known chefs.
Science pooh-poohed Nathan Pritikin when he made similar claims. It took Dr. Ornish's studies to get doctors to listen -- even if many are dubious of some of his claims.
Dr. Ornish's reversal results, based on a small sample, have yet to be duplicated by other studies, according to the American Heart Association. Although cardiologists agree that programs to prevent or reverse heart disease are most effective if they combine various approaches and medications, they wonder if patients can reverse heart disease through a more lenient regimen than the one designed by Dr. Ornish. For example, the American Heart Association's diet recommends that 30 percent of a person's calories come from fat, 10 percent of which should be saturated fat.
"Part of the problem with reversal programs is that a number of people have jumped to the conclusion that Ornish's program is the only way to reverse heart disease," says Dr. Michael Miller, director of preventive cardiology and assistant professor of medicine at the University of Maryland Medical Center.
"And most people also have a gross misconception of what it means to reverse heart disease; they think it means the vessel is cleaned out completely. Although it happens to a much smaller extent -- one can achieve a 3 percent to 5 percent reduction, which is important -- if someone has a 90 percent blockage, it's fair to say this program will not reduce it to 30 percent or 40 percent.
"Ornish gives an ideal approach, but it's not practical for most people. . . . Most people can stick to an American Heart Association diet, which is a low-fat diet but which occasionally permits some red meat and a hot dog if you go to the ballpark."
Peter Kwiterovich, director of lipid research at Johns Hopkins Medical Institutions, says each heart patient should have extensive blood chemistry tests before deciding on any particular diet. He agrees that a diet with only 10 percent fat will probably help adult patients with coronary atherosclerosis.
No one has uncovered any danger to limiting fat to 10 percent of a diet, says Baltimore nutrition consultant Colleen Pierre.
"When I hear doctors talk about this diet, they just always say, 'Nobody can stick to this.' Having severe angina is a great motivator about changing something in a way that can give you relief. Many Americans are not interested in doing a diet that severe for something that might happen down the road, but for people who are really suffering from heart disease, I think this diet is a real possibility."
With the support of Mutual of Omaha, Dean Ornish's program is being tested in hospital centers in New York, Des Moines and Omaha.
In July, the giant medical insurer announced a $100,000 grant to a reversal program in Omaha, saying it "could save as much as $58,000 per patient" over drugs and surgery. A recent review of reversal programs nationwide found a 54 percent reduction in "coronary events" -- heart attacks, chest pain and emergency room visits.
In Detroit, Dr. Rogers has enlisted a dietitian and chef to dim his patients' memories of grease and meat.
"People think Ornish food is icky. They should come here and eat with us!" exclaims Alta Prince, 54, of Brownstown Township, Mich.
A homemaker with two sons, she switched to a typical heart-healthy diet of chicken and fish seven years ago after a heart attack. "But I was still getting chest pain when I walked. I couldn't vacuum," she says. Not anymore. "Now I feel great, right through the day."
Dr. Rogers also signed on exercise physiologists and yoga teachers who pump up pulse rates and then relax minds and muscles. Most patients, even those strapped for cash, have purchased treadmills for workouts.
Group discussions vent feelings, airing frustrations before they well up. "Most cardiac patients are somewhat volatile," says Dr. Rogers. Studies show that stress, social isolation and hostility are linked to heart disease and shorter life spans.
Says dietitian Gerry Krag, who leads group discussions: "We can't tell exactly what will help which patient the most. But we think all of it helps."