Saturday, November 29, 2008

New Frontiers of Mind-Body Medicine Research

It's Hard to Believe What's Being Discovered

In this article, I explore the cutting edge of neuroscience and mind-body health. What scientists and researchers, with their new tools and techniques of evaluation and analysis, have discovered recently may leave you stunned. They certainly have (or at least should have) implications for amount of time we spend taking care of ourselves through wellness programs - and maybe even our choice of lifestyles. First, however, I'll review a couple crucial topics that will provide a background for understanding what the researchers have uncovered. If you already have an understanding of the concepts of stress and the relaxation response, skip down to "The New Frontiers of Mind-Body Medicine Research" section.

Stress and Chronic Stress

In 2008, it's almost become cliché to discuss the levels of stress we feel. Everyone seems to be stressed out because of one issue or another. The topic is constantly in the press. An economy in the dumps and getting worse. Two wars. Lay-offs. Housing foreclosures. Working longer hours. Indeed, a Google search on the word "stress" (without any related terms, like "stress symptoms," etc.) yields almost two hundred million results on the Internet (related to websites, news articles, products, blogs, videos posted on the popular site YouTube, etc.)! Stress currently appears to be ubiquitous in the US.

Many situations and life events create stress and anxiety - and therefore the "fight or flight" response. This response, a complex process of reactions in the body, is developed in every mammal and prepares it to fight or flee during actual situations of danger, such as when one of our ancestors was being chased by a saber toothed tiger. Now that's stressful! Our brain reacts to these situations by pulling blood to the large muscles of our body so we can react. Heart rate, blood pressure, and breathing speed up. We get a rush of adrenaline. All of these changes enable us to fight better or run faster.

However, we rarely face actual situations like these anymore, but in terms of the stress response, our brain cannot differentiate between being attacked and being late for a crucial meeting that could make or break a career. All of these same functions occur, so we feel "stressed out." People who live with goals that are difficult to reach or are just plain unrealistic will almost inevitably face chronic stress. If people can't obtain the "stuff" they want, they may be constantly anxious.

The biological processes of the long-term stress response are beyond the scope of this article. However, ongoing stress affects virtually every system in the body, including the endocrine and immune systems. Our bodies try to adapt, but eventually stress will likely have a negative impact on our health. Our immune systems can be compromised. We may experience high blood sugar and increased bad (LDL) cholesterol.

Here is a laundry list - established by medical research - of several health conditions that can worsen (or even appear) under conditions of constant mental stress: asthma, depression, heart disease, compromise of the immune system, high blood pressure, sexual problems, diabetes, obesity, itching, hives, gastrointestinal problems (ulcers, colitis, irritable bowel syndrome), reduced resistance to viruses and bacterial infections, arthritis, and many, many other conditions.

It's no wonder why the well-respected non-profit American Institute of Stress (AIS) notes that between 75 to 90 % of visits to primary care physicians are for stress-related complaints.

The Antidotes – The Relaxation Response or Major Lifestyle Changes

Humans have been using relaxation exercises, such as meditation and chanting, for thousands of years. Before the 1970's, most people in the West likely associated meditation with the Beatles' phase when they visited the founder of the Transcendental Meditation (TM) movement, Maharishi Mahesh Yogi, in India and became followers (and then created a large, if somewhat faddish, movement in the early 1970's, though there are still many practitioners of TM). TM is simple: a person meditates 20 minutes twice a day repeating a secret Sanskrit word, or "mantra". Through this practice, the Maharishi promised followers happiness and a sense of calm.

Meditation's role in mainstream healthcare in the West at the time? Zilch.

To Western medicine, the mind and the body were completely separate entities and treated as such. Then came Herbert Benson, MD, of Harvard Medical School. He started researching the physiological effects of TM and began publishing scientific papers on the topic, adding mainstream legitimacy to the topic and technique. He created the term "the relaxation response," which described the state of complete relaxation and calm created by meditating. He wrote a book on the topic, also called the Relaxation Response (1975), which describes the exercise in a secular manner and how to elicit a state of relaxation.

Benson's instructions included sitting comfortably in a chair, closing one's eyes, relaxing one's muscles, and saying a word, such as "one," over and over while breathing through the nose for between 10 and 20 minutes.(1) This state of relaxation can also be achieved by numerous other exercises, such as prayer, yoga, jogging, tai chi, progressive muscle relaxation, and repetitive exercises. The relaxation response is a state of deep rest that creates physiological changes that counteract the stress response.

Since Dr. Benson's initial research paper, published in 1971, he has been the author or co-author of 11 books and 180 scientific publications demonstrating the benefits of the relaxation response in treating a variety of illnesses. Between Dr. Benson, his team and many other researchers around the world, thousands of medical studies have been published, establishing the effectiveness of stress management exercises in the treatment of the following conditions, which represent a similar list described above as diseases or conditions negatively affected by stress.

Hypertension
Chronic Pain
Insomnia
Anxiety and Depression
Migraines and Headaches
Self-esteem in Young People
Immune System-Related Conditions
PMS
Heart Disease
Digestive Conditions
Rheumatoid Arthritis
Among Others

That is a summary of the last 40 or so years of research on the mind-body effect, often combined with other wellness techniques, like eating well and adequate physical exercise. With the published research has come some acceptance of such approaches in mainstream healthcare, but most visits to your family doctor still won't include advice on meditation or relaxation exercises. You may have to visit a yoga studio or purchase a meditation CD or video lesson.
Another option, of course, is to seek and adopt a completely ego- and stress-free lifestyle, like the one espoused and explained by Eckhart Tolle, author of "A New Earth," to millions of people in a groundbreaking online 10 part learning program sponsored by Oprah Winfrey. Good luck if you choose that option and you're not willing to move to a monastery. The fact is, virtually all of us will live in an environment that offers us a host of events and situations throughout our lives that provoke feelings of stress and anxiety, for some on an ongoing basis.

The New Frontiers of Mind-Body Medicine Research

So medical research has demonstrated that relaxation techniques can improve health. But what's going on these days in research labs armed with new, sophisticated testing tools? Some of the latest findings, using emerging technologies like sophisticated imaging of the brain and an understanding of the human genome, are truly remarkable.

1. The relaxation response can influence the expression of stress-related genes.

How can a simple relaxation exercise, twenty or so minutes per day, result in the improvement of so many medical conditions and their symptoms? The answer comes from Herbert Benson, MD (yes, the same one), his team at the Benson-Henry Institute for Mind-Body Medicine and the Genomics Center at Beth Israel Deaconess Medical Center (BIDMC). It now appears that a practicing exercises that elicit a deep state of relaxation can actually influence the activation patterns of genes associated with the body's reaction to stress.(2)

The team published a study this past July that found "how changing the activity of the mind [such as through relaxation] can alter the way basic genetic instructions are implemented," says Benson.

The team studied whether specific genes were activated or repressed during the relaxation response by testing blood samples and using cutting edge testing techniques, such as "gene ontology" and "gene set enrichment." The study demonstrated that relaxation response exercises altered the expression of genes related to various processes, such as inflammation, programmed cell death and how the body handles free radicals, molecules that can damage tissues and cells if not appropriately neutralized. The study noted that changes in gene expression resulting from eliciting the relaxation response may be related to long-term physiological effects. The authors hope the study will stimulate interest in more research related to specific diseases. Twenty-first century genomics meets a simple exercise that is thousands of years old.

2. Meditation may be able to change your brain function, a rewiring of sorts.

Can thinking change the brain? In other words, can mental experiences actually alter our physical gray matter? This is the concept of "neuroplasticity," a new scientific field that studies the strengthening or expansion of circuits in the brain that are used often - and by the shrinking of those that are used rarely. The Dalai Lama himself mentioned this possibility to neurosurgeons with whom he visited in the 1990's, a notion initially dismissed by the doctors.
The Dalai Lama and neuroscientist Richard Davidson of the University of Wisconsin, Madison later teamed up to test this possibility. Professor Davidson traveled to Dharamsala, the Dalai Lama's home, to compare brain activity in study participants who were new meditators to that of Buddhist monks who had spent more than 10,000 hours meditating. The exercise in the study involved "compassion meditation," a mental exercise focused on generating a feeling of loving-kindness towards all.

Brain scans showed a significant difference between the experienced meditators and the novices. The monks showed a large increase in gamma waves, high level brain activity associated with consciousness. The novice meditators showed a slight increase in gamma activity, but much less than that of the monks. Gamma wave activity is a sign of brain activity that comprises a complex network of circuits in the brain, associated with high level mental activity. According to the study, the monks' gamma activity was off the charts, at levels that hadn't been reported before.
The areas of the brain that are involved with positive emotions, reactions to the sight of suffering, and movement (to help someone in need of aid) were full of activity in the monks' brains. The study, published in the Proceeding of the National Academy of Sciences, noted that changes in the brain likely can be produced by mental training since the most experienced meditators demonstrated such profound activity.(3)

3. Chronic stress may make the brain and body age faster

If you have read any of the recent popular books related to healthy- or anti-aging, you no doubt have a sense that stress management should be a crucial component of your wellness program. You may have heard the "common knowledge" that stress can make someone age faster and also know people who fit that profile perfectly.

We now may understand why that is, according to recent medical research. Stress can increase the pace of physical aging. In 2004, researchers discovered that chronic stress (or, more specifically, a lack of stress resilience or coping) can age individual immune cells. They focused on a part of the chromosome called a "telomere," the end cap portion. Telomeres are the part of our DNA that control aging. They also protect the tip of the DNA from damage. As we age, when a cell divides, telomeres in the cell get a bit shorter. Eventually, the telomere becomes too short and the cell can no longer divide. End of cell life. That's why, for example, we lose muscle strength as we get older.

The report, which was published in the Proceedings of the National Academy of Sciences, studied the telomeres and stress levels of healthy, pre-menopausal women who were mothers taking care of chronically ill children. They found that the immune cells of highly stressed women had aged by an extra ten years, though the researchers did not know the exact mechanism of how this occurs. (4)

Additionally, as discussed, chronic stress affects the immune and endocrine systems. This is related to that fact that stress produces stress-related hormones, such as cortisol, and eventually can lead to adrenal fatigue. As people get older, the brain may lose its ability to regulate these hormones, so seniors who are stressed actually produce more of them. A recent study demonstrated that excess cortisol over the years can actually damage the part of the brain that stores memories, the "hippocampus." Chronic stress in our senior years, then, may result in poor memory and impaired cognitive function. (5)

Conclusion

The field of mind-body medicine has always been a fascinating one, and is only getting more interesting as new technology allows us to conduct research never before possible. The outcomes of this new generation of research are "mind blowing" but teach us the importance of stress management and offer lessons for our system of healthcare. Finally, it makes this author wonder what we have yet to learn.

Sources
(1) Benson, Herbert, MD. The Relaxation Response. HarperTorch: New York, 1975. 162-163. (2) Massachusetts General Hospital. "Relaxation Response Can Influence Expression Of Stress-related Genes." ScienceDaily 3 July 2008. 8 November 2008 . (3) Lutz, Antoine, et al. Proc Natl Acad Sci U S A. 2004 Nov 16;101(46):16369-73 as mentioned in Begley, Sharon. How Thinking Can Change the Brain, Wall Street Journal. Jan 20, 2007. (4) Epel ES, et al. Proc Natl Acad Sci U S A. 2004 Dec 7;101(49):17312-5. (5) University of California San Francisco. Aging, the stress response, cortisol, and cognitive function. 2004, as discussed in Woolston, Chris. Stress and Aging. Consumer Health Interactive, Jan 29, 2008.