meditation and inflammation

Mindfulness training may assuage early-life trauma

wildmind meditation newsThaddeus Pace, Scientific American:

We live in an increasingly stressful world. There’s an aspirational sense things should improve with time, witness the U.S. War on Poverty or the U.N. Millennium Development Goals. But in the last 50 years, many risks, perceived and real, have grown worse: extreme weather, violent conflict, economic dislocation, poverty (especially for children), abuse and domestic violence. Traumatic and chronic stress affects millions. Many become sick and marginalized because of it; others manage to survive and thrive. What explains the difference?

“Resilience” is a popular answer these days. But it’s a buzzword in danger of losing its meaning through overuse. As the need for resilience grows, it’s important to be specific about the term. A new white paper, “The Human Dimensions of Resilience,” of which I’m a co-author, reviews relevant research and proposes evidence-based ways of defining and building resilience. Published by the Garrison Institute, a non-profit that promotes “contemplative” solutions to social and environmental concerns, the paper is intended to advance conversations about our wellbeing.

Science views resilience as part of the response to stress. Not all stress is bad; short stressors can inspire outstanding performance. But extreme or acute stress can be traumatizing and damaging. When physiological responses to stress like cortisol, adrenaline and inflammation persist even after a stressor has ended, they can undermine mental and physical health. Unchecked behavioral responses to stress can lead to sleep and diet problems. Besides PTSD, exposure to chronic and/or traumatic stress can also lead to other serious conditions including heart disease, hypertension, type 2 diabetes, anxiety, depression and cognitive problems – maybe even DNA damage.

Traumatic stress can undermine and shorten peoples’ lives, especially if they’re exposed before age 18. They’re more likely to have lower achievement and wellness, and experience more illness. “Early life adversity”–experiencing abuse or household dysfunction during childhood–correlates not only with more psychological problems, but also with elevated inflammatory markers like C-reactive protein or higher insulin levels that persist into adulthood. Studies show a strong, graded relationship between early life adversity and risk factors for the leading causes of death in adults.

Resilience can mitigate those effects. Extraordinarily resilient people can thrive in adversity and use difficult experiences as opportunities for growth. But resilience isn’t an inscrutable, innate personality trait you’re either born with or not. It’s likely a spectrum of qualities that people possess in varying degrees that help them survive challenges, shut off aspects of stress response when they’re no longer needed, and return to a pre-stressor, baseline state. As such, resilience is something we should be able to analyze and teach, and anyone should be able to learn.

Studies show contemplative practices such as mindfulness meditation, compassion training, yoga, etc. can reduce harmful impacts of stress, and they can be helpful in building resilience. However, recent media coverage gushing over how contemplative practices like mindfulness make you happier, healthier, sharper and richer spreads confusion about how those practices work.

Contemplative practices weren’t invented to fight cancer or boost performance, but rather to tackle big issues like living purposefully and facing death with equanimity. One fundamental skill they build is attention, the simple act of consciously choosing what to focus on instead of letting the mind wander. Having strong attention is an important component of resilience, because it develops a sense of agency and choice in directing one’s thoughts and influencing one’s inner landscape – a powerful counterweight to the sense of helplessness or passivity that traumatic stress can produce.

Colleagues and I recently studied teenagers in foster care in Georgia who were exposed to early life adversity. They were taught a form of meditation called Cognitively Based Compassion Training. After six weeks, the kids who really practiced not only reported feeling better and coping better with anger and stress (“At school, someone threw M&M’s at me and I ignored him. Normally I would have thrown things back and been negative.”). Pre- and post- saliva testing also showed their C-reactive protein levels dropped, which means they actually had less inflammation in their bodies. That suggests increased resilience, because it shows some better functioning and movement back toward baseline.

We recently launched a similar Cognitively Based Compassion Training program in Arizona. The next horizon for research is determining whether kids in such programs perform better in school and generally thrive. Failure to thrive–not taking advantage of the opportunities that arise in life and work–is a symptom of traumatization. Effective resilience building should be able to ameliorate it.

If contemplative practice can help accomplish that for these kids, imagine what it might do for people working in fields with high trauma exposure and burnout risk, like first responders or humanitarian aid and relief workers. For example the Garrison Institute’s Contemplative-Based Resilience Training program designs trainings for aid workers that incorporate meditation, yoga and other contemplative techniques to help them cope with stress, avoid burnout, and thrive in their work. It hypothesizes that more resilient individuals make for more resilient communities, but how and why that’s the case is a subject for another blog.

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Experienced practitioners reap genetic changes after a day of mindfulness meditation

wildmind meditation newsNational Center for Complementary and Alternative Medicine (NCCAM): Results of a recent study cofunded by NCCAM suggest that one day of intense mindfulness by experienced meditators led to biological changes including expression of certain genes that play roles in inflammation and pain. Anti-inflammatory and pain-relieving drugs have similar effects on these genes. Findings from the study appear in the journal Psychoneuroendocrinology.

Mindfulness meditation practices are a form of training that focuses attention on breathing to develop increased awareness of the present. The study, conducted in 40 participants, focused on gaining more knowledge about molecular and genetic effects of this type of meditation and also on testing the feasibility of the study approach for future work.

Researchers divided participants into two groups. The first (active) group, which consisted of 19 people who had practiced daily meditation for at least 3 years, performed 8 hours of intensive mindfulness practice during one day. The other group, a control group of 21 people who had no experience with meditation, spent 8 hours performing quiet leisure activities in the same setting as the meditators. The researchers took blood samples before and after both interventions and analyzed them for certain biological factors, including the expression of various genes important in the regulatory processes for inflammation, circadian rhythms (which refer to the body’s internal “clock”), or histones (proteins in cells that attach to DNA). Researchers also took samples of participants’ saliva to determine the levels of the hormone cortisol as an indicator of recovery time after participants took a test that put them under acute stress.

The investigators found no significant differences between the active and control groups in these biological factors at the study’s start. However, after the interventions, the meditators showed some changes not seen in the control group. These included reduced expression levels of certain genes related to inflammation and histones. The reduced levels for two of these genes were associated with faster recovery from the stress test. No significant differences occurred between groups with respect to circadian genes.

The researchers suggested that their findings may offer a possible mechanism for explaining beneficial effects from meditation on inflammatory disorders, and an avenue for future research in chronic inflammatory conditions.

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Yoga reduces inflammation response

UCLA study helps caregivers of people with dementia

Six months ago, researchers at UCLA published a study that showed using a specific type of yoga to engage in a brief, simple daily meditation reduced the stress levels of people who care for those stricken by Alzheimer’s and dementia. Now they know why.

As previously reported, practicing a certain form of chanting yogic meditation for just 12 minutes daily for eight weeks led to a reduction in the biological mechanisms responsible for an increase in the immune system’s inflammation response. Inflammation, if constantly activated, can contribute to a multitude of chronic health problems.

Reporting in the current online edition of the journal Psychoneuroendocrinology, Dr. Helen Lavretsky, senior author and a professor of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior, and colleagues found in their work with 45 family dementia caregivers that 68 of their genes responded differently after Kirtan Kriya Meditation (KKM), resulting in reduced inflammation.

Caregivers are the unsung heroes for their yeoman’s work in taking care of loved ones that have been stricken with Alzheimer’s and other forms of dementia, said Lavretsky, who also directs UCLA’s Late-Life Depression, Stress and Wellness Research Program. But caring for a frail or demented family member can be a significant life stressor. Older adult caregivers report higher levels of stress and depression and lower levels of satisfaction, vigor and life in general. Moreover, caregivers show higher levels of the biological markers of inflammation. Family members in particular are often considered to be at risk of stress-related disease and general health decline.

As the U.S. population continues to age over the next two decades, Lavretsky noted, the prevalence of dementia and the number of family caregivers who provide support to these loved ones will increase dramatically. Currently, at least five million Americans provide care for someone with dementia.

“We know that chronic stress places caregivers at a higher risk for developing depression,” she said “On average, the incidence and prevalence of clinical depression in family dementia caregivers approaches 50 percent. Caregivers are also twice as likely to report high levels of emotional distress.” What’s more, many caregivers tend to be older themselves, leading to what Lavretsky calls an “impaired resilience” to stress and an increased rate of cardiovascular disease and mortality.

Research has suggested for some time that psychosocial interventions like meditation reduce the adverse effects of caregiver stress on physical and mental health. However, the pathways by which such psychosocial interventions impact biological processes are poorly understood.

In the study, the participants were randomized into two groups. The meditation group was taught the 12-minute yogic practice that included Kirtan Kriya, which was performed every day at the same time for eight weeks. The other group was asked to relax in a quiet place with their eyes closed while listening to instrumental music on a relaxation CD, also for 12 minutes daily for eight weeks. Blood samples were taken at the beginning of the study and again at the end of the eight weeks.

“The goal of the study was to determine if meditation might alter the activity of inflammatory and antiviral proteins that shape immune cell gene expression,” said Lavretsky. “Our analysis showed a reduced activity of those proteins linked directly to increased inflammation.

“This is encouraging news. Caregivers often don’t have the time, energy, or contacts that could bring them a little relief from the stress of taking care of a loved one with dementia, so practicing a brief form of yogic meditation, which is easy to learn, is a useful too.”

Lavretsky is a member of UCLA’s recently launched Alzheimer’s and Dementia Care Program, which provides comprehensive, coordinated care as well as resources and support to patients and their caregivers. Lavretsky has incorporated yoga practice into the caregiver program.

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Meditation improves endothelial function in metabolic syndrome

wildmind meditation news

(From a press release) Meditation may help improve endothelial function in patients with metabolic syndrome, potentially reducing cardiovascular risk, new research suggests.

Presented here at the American Psychosomatic Society 69th Annual Scientific Meeting, a randomized trial in a group of African American patients with metabolic syndrome showed significant improvement in endothelial function in those randomly assigned to a year-long meditation program compared with their counterparts who underwent a program of health education alone.

“We found there was a significant difference between the consciously resting meditation group and the health education group in the flow-mediated dilation, which measures endothelial function,” principal investigator Kofi Kondwani, PhD, National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia, told Medscape Medical News.

A risk factor for coronary heart disease, the clinical manifestations of metabolic syndrome include hypertension, hyperglycemia, high triglycerides, reduced high-density lipoprotein, and abdominal obesity. A diagnosis of metabolic syndrome is contingent on an individual having three or more of these risk factors.

According to the investigators, the etiology of metabolic syndrome is complex, but psychological stress appears to play a role, possibly through overactivation of stress hormones. They also note that endothelial dysfunction, which is also influenced by stress, is a major consequence of metabolic syndrome.

In addition, metabolic syndrome is a major health concern in the African American population — particularly among African American women — and is increasing in prevalence, paralleling the US obesity epidemic.

Particular Problem for African Americans

According to Dr. Kondwani, it has been shown that meditation can be effective in reducing psychological stress and improving some cardiovascular risk factors. However, he added, whether it can improve endothelial function in the setting of metabolic syndrome is unknown.

He noted that although metabolic syndrome and cardiovascular disease are important health issues in general, the major health disparities that exist in the African American population make it a particular concern in this population.

“If we could find some simple, easy, cost-effective approach to reduce some of these risk factors — whether it is blood pressure or endothelial function — that could be adopted in the community on a large scale we may be able to have a positive impact on the health of African Americans,” he said.

A joint initiative between Morehouse Medical School and Emory University, the study randomly assigned 65 African American patients age 30 to 65 to undergo consciously resting meditation (CRM) (n = 32), a 12-month meditation program developed by Dr. Kondwani, or a 12-month health education program (n = 33). At study outset there were no significant differences in demographic characteristics or cardiovascular risk factors between the 2 groups.

The CRM group received three 90-minute sessions of initial instructor-led training. They returned once a week for the following 3 weeks, then once every 2 weeks for 2 months, and finally once per month for the remainder of the study. In the interim they were assigned “home rest” assignments that involved meditating for 15 to 20 minutes twice a day.

Improvements in Blood Pressure, Weight, Triglycerides

The study’s primary outcome measure was endothelial function assessed by brachial artery flow-mediated dilation (FMD) at baseline and 6 and 12 months. A secondary outcome was arterial stiffness, measured by pulse-wave velocity.

Trend tests were performed to assess changes in outcome measures and metabolic syndrome factors across the 3 study time points. The investigators found that FMD significantly improved from baseline in the CRM group (2.10 ± 0.79; P = .009) but that improvement was smaller in the health education group (1.36 ± 0.80; P = .09). Dr. Kondwani said there was no difference in arterial stiffness in the groups.

The researchers also found favorable and statistically significant trends in 3 metabolic syndrome risk factors in the CRM group but not in the health education group: diastolic blood pressure (change, -6.24 ± 2.75 mm Hg; P = .03), weight (-2.52 ± 1.16 kg; P = .03), and triglyceride levels (-32 ± 15 mg/dL; P = .04).

Dr. Kondwani also pointed out that certain psychological factors, including some measures of depression, significantly improved in both study groups. This indicates that “that just because an intervention has an impact on patients’ psychological well-being doesn’t necessarily mean it is going to change their physiology.”

These findings, he added, suggest that physicians should not hesitate to encourage their patients to learn meditation. “It will not hurt and invariably it will help. They also shouldn’t get hung up on the type of meditation. It’s highly likely that even if patients weren’t trained in meditative practice but just sat quietly for 20 minutes twice a day there would be benefit,” said Dr. Kondwani.

Dr. Kondwani said that his group hopes to replicate the study’s findings in a larger trial with 150 participants in each arm.

“Wonderful” Form of Stress Management

Commenting on the study for Medscape Medical News, Lorenzo Cohen, PhD, a professor in the Department of Behavioral Science and director of the Integrative Medicine Program at M.D. Anderson Cancer Center in Houston, Texas, said it is well known that psychological stress has a profound effect on many biological functions.

“In our work we know that stress can directly impact certain cancer-related biological systems. We believe it is very important to provide different forms of stress management to patients to help relieve the psychological stress they experience due to life-threatening illness and that one wonderful form of stress management is meditation,” Dr. Cohen said in an interview.

He added that it was not surprising to him that meditation had a positive effect on endothelial function or other measures of metabolic syndrome.

“We know that metabolic syndrome is related to inflammatory processes and we know that stress can increase inflammatory processes. We also know of course that meditation decreases these processes so it would make sense that it has the potential to be a useful adjunct to the treatment of this syndrome,” said Dr. Cohen.

Dr. Cohen noted that in recent years meditation has gained a great deal of acceptance by the medical community and patients alike and is widely accessible.

Ideally, he said, it is useful to have an instructor teach patients how to meditate in order to optimize practice. However, he added, the tools of the information age, including Web-based programs and audio materials, can also be “quite useful.”

He said in his experience there has been some resistance among patients because of a belief that meditation is associated with religion. However, he added, once they are informed that it is taught in a secular manner, this concern is assuaged.

Dr. Kondwani reports he is the founder of Consciously Resting Meditation.

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of metabolic syndrome is complex, but psychological stress appears to play a role, possibly through overactivation of stress hormones. They also note that endothelial dysfunction, which is also influenced by stress, is a major consequence of metabolic syndrome.

In addition, metabolic syndrome is a major health concern in the African American population — particularly among African American women — and is increasing in prevalence, paralleling the US obesity epidemic.

Particular Problem for African Americans

According to Dr. Kondwani, it has been shown that meditation can be effective in reducing psychological stress and improving some cardiovascular risk factors. However, he added, whether it can improve endothelial function in the setting of metabolic syndrome is unknown.

He noted that although metabolic syndrome and cardiovascular disease are important health issues in general, the major health disparities that exist in the African American population make it a particular concern in this population.

“If we could find some simple, easy, cost-effective approach to reduce some of these risk factors — whether it is blood pressure or endothelial function — that could be adopted in the community on a large scale we may be able to have a positive impact on the health of African Americans,” he said.

A joint initiative between Morehouse Medical School and Emory University, the study randomly assigned 65 African American patients age 30 to 65 to undergo consciously resting meditation (CRM) (n = 32), a 12-month meditation program developed by Dr. Kondwani, or a 12-month health education program (n = 33). At study outset there were no significant differences in demographic characteristics or cardiovascular risk factors between the 2 groups.

The CRM group received three 90-minute sessions of initial instructor-led training. They returned once a week for the following 3 weeks, then once every 2 weeks for 2 months, and finally once per month for the remainder of the study. In the interim they were assigned “home rest” assignments that involved meditating for 15 to 20 minutes twice a day.

Improvements in Blood Pressure, Weight, Triglycerides

The study’s primary outcome measure was endothelial function assessed by brachial artery flow-mediated dilation (FMD) at baseline and 6 and 12 months. A secondary outcome was arterial stiffness, measured by pulse-wave velocity.

Trend tests were performed to assess changes in outcome measures and metabolic syndrome factors across the 3 study time points. The investigators found that FMD significantly improved from baseline in the CRM group (2.10 ± 0.79; P = .009) but that improvement was smaller in the health education group (1.36 ± 0.80; P = .09). Dr. Kondwani said there was no difference in arterial stiffness in the groups.

The researchers also found favorable and statistically significant trends in 3 metabolic syndrome risk factors in the CRM group but not in the health education group: diastolic blood pressure (change, -6.24 ± 2.75 mm Hg; P = .03), weight (-2.52 ± 1.16 kg; P = .03), and triglyceride levels (-32 ± 15 mg/dL; P = .04).

Dr. Kondwani also pointed out that certain psychological factors, including some measures of depression, significantly improved in both study groups. This indicates that “that just because an intervention has an impact on patients’ psychological well-being doesn’t necessarily mean it is going to change their physiology.”

These findings, he added, suggest that physicians should not hesitate to encourage their patients to learn meditation. “It will not hurt and invariably it will help. They also shouldn’t get hung up on the type of meditation. It’s highly likely that even if patients weren’t trained in meditative practice but just sat quietly for 20 minutes twice a day there would be benefit, “said Dr. Kondwani.

Dr. Kondwani said that his group hopes to replicate the study’s findings in a larger trial with 150 participants in each arm.

“Wonderful” Form of Stress Management

Commenting on the study for Medscape Medical News, Lorenzo Cohen, PhD, a professor in the Department of Behavioral Science and director of the Integrative Medicine Program at M.D. Anderson Cancer Center in Houston, Texas, said it is well known that psychological stress has a profound effect on many biological functions.

“In our work we know that stress can directly impact certain cancer-related biological systems. We believe it is very important to provide different forms of stress management to patients to help relieve the psychological stress they experience due to life-threatening illness and that one wonderful form of stress management is meditation,” Dr. Cohen said in an interview.

He added that it was not surprising to him that meditation had a positive effect on endothelial function or other measures of metabolic syndrome.

“We know that metabolic syndrome is related to inflammatory processes and we know that stress can increase inflammatory processes. We also know of course that meditation decreases these processes so it would make sense that it has the potential to be a useful adjunct to the treatment of this syndrome,” said Dr. Cohen.

Dr. Cohen noted that in recent years meditation has gained a great deal of acceptance by the medical community and patients alike and is widely accessible.

Ideally, he said, it is useful to have an instructor teach patients how to meditate in order to optimize practice. However, he added, the tools of the information age, including Web-based programs and audio materials, can also be “quite useful.”

He said in his experience there has been some resistance among patients because of a belief that meditation is associated with religion. However, he added, once they are informed that it is taught in a secular manner, this concern is assuaged.

Dr. Kondwani has disclosed no relevant financial relationships.

American Psychosomatic Society (APS) 69th Annual Scientific Meeting: Abstract 1639. Presented March 10, 2011.

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Monkey mind, ganja, inflammation, and commuting

News reporting on meditation is always going to be a mixed bag, with practical and serious articles interspersed with pieces in a more flippant mood. The latter style is perfectly exemplified by an extraordinarily silly column by Denise Malloy of Montana’s Bozeman Chronicle. In “Monkeying Around with Meditation” Malloy tells us that five minutes of meditation (done by following instructions from a book) was enough to make her skeptical about the proven health benefits of meditation, as well as its potential to bring about inner peace. To be fair, the writer’s tone tends more toward self-mockery than to mockery of meditation itself. But her article made me want to send her a meditation CD.

And then there are the stories that are serious but cover subject that are “out there.” David Silverberg of Toronto’s Globe and Mail writes about “Ganja Yoga.” This is new to me, but apparently some people believe that a toke of marijuana before a yoga session will help you stretch, open up to new philosophical perspectives, and even, according to one class participant, “Marijuana quells those voices in your mind.”

Representing the “serious article on a serious topic,” Live Science reports on a study showing that women who had practiced yoga regularly for at least two years had lower levels of inflammation in their bodies than did women who only recently took up the activity. And all without the aid of inhaled substances. The mechanisms that reduce inflammation may include deep breathing (which reduces stress), greater awareness of one’s feelings, and also the fact of exercising, which has been shown to reduce inflammation.

Finally, Brian Glaser of Baristanet (a news publication we’d hitherto been unaware of) has a nice piece on using the morning commute as an opportunity to meditation. Meditation teacher Susan Morton is quoted as saying,

“When your train or bus get stuck, the first thing that arises is that the mind makes judgments and you have frustrations. You can take the opportunity to observe how stressed out you become through the stories your mind tells you about what’s happening.”

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