Published in JHH17.2 – Mind-body self-care

A meditating medic

While practising as a GP in the Welsh Valleys I treated an 80-year-old male ex-miner who was suffering from chronic pain. He had never heard of meditation, but when I suggested it he was keen to try anything that might help him. So I wrote out a prescription for six weeks of daily meditations that he could listen to on my Youtube channel. When he returned for his review appointment he was full of enthusiasm for the course of treatment: his pain levels had improved significantly and I was able to reduce his repeat prescription for analgesics.

I’m often asked how well my meditation advice is received by patients. What I’ve learned, though, is not to assume who will or won’t be open to trying mind–body/lifestyle medicine tools. When I first started tentatively discussing meditation with patients, I would try to guess who might be interested and who wouldn’t
be. Treating patients like the ex-miner soon made me realise that I was bringing my own judgements to the table, so I began offering meditation prescriptions as standard to all patients. No matter what the complaint or symptoms, there is always a meditation that can bring some benefit – and won’t cause harm. Visualisation encourages patients to develop a mindset of recovery and helps them set future health goals. From tonsillitis to cancer, I now always offer advice about using meditation as part of the management plan, as well as advice on incorporating exercise, nutrition and sleep. Meditation has become an essential part of my toolkit, both as part of my routine practice and for me personally. Anyone and everyone can benefit, from children to the elderly.

Crucially, it is the one health measure that is not dependent on money. I’ve practiced in some of the most deprived areas of Wales – areas where advice to eat more healthily and take more exercise is met with barriers such as not being able to afford fresh food or trainers. Meditation can be done anywhere, and does not need special equipment. Those who use the free meditations I offer on my YouTube channel report positive changes in their health after following a meditation practice. Their feedback suggests that meditation is helping them to start feeling better, both emotionally and physically.

From a personal point of view, regular meditation means I no longer feel like a stressed-out GP. I can be totally present in my consultations, and I genuinely enjoy working. I am also able to fully immerse myself in family time; I feel in complete control of my work/life balance for the first time in my working life.

But where is the evidence to support what I’m seeing every day in my practice?

Where’s the evidence for meditation?

Back in 2012, a six-week course of mindfulness meditation was offered to breast cancer patients at UCLA Medical Center, Los Angeles, as part of a randomised controlled trial. After the trial, the participants reported that their stress levels and depressive symptoms were reduced; they felt less tired, and their sleep quality and menopausal symptoms had improved.

The doctors administering the trial also saw a reduction in stress and inflammation responses within the body, including a significant reduction in pro inflammatory gene expression, as well as activity of the proinflammatory transcription factor NF-kB. (Bower et al, 2015).

First made popular in the 1970s, the healing powers of meditation have definitely caught the interest of the scientific community in recent years. There’s increasing evidence to support the use of meditation to improve both physical and mental health, sparking considerable excitement as more and more evidence of its benefits is recognised. But what exactly are the benefits? And what’s the scientific basis for using meditation as part of everyday healthcare?

One central fact is emerging: meditation has a measurable beneficial effect on both the brain and the body, as well as enhancing a sense of wellbeing and purpose in life. The UCLA trial might have been the first trial to demonstrate the effect of meditation in cancer patients, but numerous other studies over the past decade have shown the health benefits of meditation to be widereaching.

This is your brain in meditation

Our brainwaves change depending on our thoughts, feelings and activity. Delta waves are slow, low-frequency brainwaves, associated with deep, dreamless sleep. Theta waves are also known as creativity waves. They are highly active in 2 to 5-year-olds, the age at which we are most imaginative. In adults, they are seen in deep relaxation, meditation and dreaming. Alpha waves are seen to be present in relaxed wakefulness and during meditative states Beta waves indicate awake, alert consciousness; these are fast waves, and the more stressed we become, the more intense these beta waves get. Gamma waves are the fastest brainwaves, allowing information to pass between different brain areas at the same time, for the rapid processing of information.

As a person meditates, we can see the brainwaves slow down and the alpha waves increase. As a deeper state of meditation is reached there is an increase in theta waves (Cahn, 2006). The enhanced levels of alpha and theta waves signifies relaxed alertness and brain-states thought to be conducive to better mental
health (Lomas et al, 2015). Not only does meditation alter our brainwaves, numerous studies show that it can actually alter the structure of the brain itself (Fox
et al, 2014).

Meditation has been found to increase neuroplasticity – the development of new neurons in the brain in response to experiences (Davidson, 2015). MRI studies show that there are modifications in the areas involved in selfreferential processes, as well as the areas associated with attention, executive function and memory (Boccia et al, 2015). During meditation, regional cerebral blood flow is enhanced to areas of the brain responsible for executive function (Khalsa et al, 2009).

These physiological and structural changes can therefore have a positive impact on conditions associated with reduced brain function. For example, meditation has been shown to slow brain atrophy (Last et al, 2017) and to increase cortical thickness (Lazar et al, 2005). After meditation there is better emotional regulation with reduced amygdala (fear centre) reactivity (Kral et al, 2018), and it has been shown to increase grey matter in the frontal and hippocampal areas of the brain. These changes result in an enhanced ability to experience positive emotions, find emotional stability and improved memory (Luders et al, 2009).

Studies have shown that meditation can ease symptoms of anxiety, and reduce high blood pressure and insomnia. It has been shown to help relieve symptoms of irritable bowel syndrome and flare-ups in people who have had ulcerative colitis. I have seen many cases of patients showing significant symptom improvement from conditions such as IBS, fibromyalgia, heart failure, insomnia and stress.

Anti-ageing and immunity: meditation for general health and wellbeing

The benefits of meditation are also seen right down at the cellular level. Practising meditation may have significant anti-ageing effects. The enzyme telomerase is linked with improved cell longevity, by maintaining the telomeres that protect the ends of our chromosomes. Telomeres, however, inevitably grow shorter as a result of cell replication and ageing. Meditation results in significantly greater activity of the enzyme, which essentially means we do not age as quickly or become prone to disease so early. A trial measuring the effects of a three-month meditation retreat on the activity of telomerase confirmed significantly greater activity in retreat participants (Jacobs et al, 2011). A 2018 study found that meditation could impact on the progression of Alzheimers, suggesting that longterm meditation might help preserve brain structure and function from progressive, age-related decline (Chetelat et al, 2018).

Meditation can improve immune system function, and potentially increase our resistance to infectious disease. It has even been shown to be better than exercise in its ability to improve immunity to the cold virus (Obasi et al, 2013). It reduces the stress response (Pace et al, 2009), and causes changes in select immune system biomarkers (Black and Slavich, 2016). In a trial comparing an eightweek course of mindfulness meditation to that of health education talks, meditators showed a significant reduction in blood pressure (Ponte Marquez et al, 2018). Following a study of more than 400 trials, The American Heart Association affirmed that in view of meditation’s potential for reducing cardiovascular disease risk, and low risk of harm, it can be added to patient management programs (Levine et al, 2017)

Meditation and pain management

The over-use of drugs for pain relief carries a range of health and social risks, including dependency. Research has shown that various non-drug methods for pain relief (such as attentional control) can directly affect the opioid receptors in the brain. Brain imaging studies have shown us that mindfulness meditation also activates similar brain areas to those activated by the use of drugs (opioids) in pain management. But newer studies suggest that meditation does not simply block opioid receptors.

Researchers in a 2016 National Center for Complementary and Integrative Health (NCCIH) funded study showed that its effects are not blocked by naloxone (Zeidan et al, 2016). We don’t yet fully understand the exact biological mechanism at work here, but the NCCIH study gives compelling evidence for the benefits of using meditation as pain relief.

Rest and digest: meditation and stress

Clearly, stress has a significant negative effect on the British economy. Roughly half a million people in the UK were recorded as suffering from work-related stress, depression or anxiety in 2018–19. This caused 12.8 million working days to be lost. But it also has a serious impact on our health and wellbeing as individuals: stress increases the risk of mental health problems and is a risk factor for many physical diseases.

Meditation can reduce stress, anxiety and depression, improve quality of life and increases subjective wellbeing. By focusing the mind on gratitude and bringing perspective to fluctuating feelings it reduces psychological distress and emotional reactivity, encouraging us to look for the positives and learn from difficult experiences and change health-harming behaviours (Keng et al, 2011). In 2012 a systematic review and meta-analysis of 47 trials with a total of 3,320 participants examined the effect of meditation programmes on psychological stress and wellbeing (Goyal et al, 2014). The review found that anxiety and depressive symptoms were reduced after eight weeks of meditation; stress and distress lessened, and there were improvements in the mental health component of health-related quality of life. The researchers concluded that clinicians should be prepared to talk with their patients about the role that a meditation programme could have in addressing psychological stress.

Stress leads to an increase in stress hormones such as cortisol and adrenaline. These hormones serve a useful function in an emergency by temporarily improving our performance (and therefore likelihood of survival) in dangerous situations. They do this by increasing our heart rate and blood pressure, keeping our brain alert and reducing unnecessary functions such as digestion. However, these days the ‘dangers’ are no longer physical, yet the same stress response when unrelieved leads the sympathetic nervous system to be continually activated. This persistent stress response eventually leads to health breakdown. But even before it produces cellular damage persistent stress underlies various kinds of somatic dysfunction – insomnia, fatigue, muscle ache, tremor and IBS (to name but a few).

In the 1970s, when meditation saw a surge in popularity, Herbert Benson was the first to show how it triggers a measurable ‘relaxation response’, neutralising
the sympathetic nervous system’s fight or flight response by activating the parasympathetic nervous system’s rest and digest response. This not only lowers the breathing rate, blood pressure and heart rate, and encourages healing and digestion, but also reduces perceived stress, anxiety and depression and improves quality of life (Benson and Klipper, 1976).

Some additional benefits

I have found that after adding a mind–body element to my consultations several patients reported that the management plan felt more personalised and that they felt more cared for. So it appears that including this in treatment plans can have a positive impact on patients, even before they experience their first meditation.

People who meditate regularly say they feel a deeper connection to their surroundings and in their relationships with others. They may sometimes sense feelings of oneness, increased sense of purpose in life and greater self-actualisation. In my own experience, as a greater understanding and awareness of one’s thinking develops, thoughts can be steered into more constructive patterns. And, as the capacity for love and compassion deepen, we may learn to be more fully present and able to experience more fully an enriched and more expansive life.

Meditation, mind–body medicine and the Covid-19 crisis

This pandemic has wrought so much destruction, yet also some unexpected opportunities for us to retreat, pause, breathe and reconnect to one another and to what’s truly important. As lead medic for our Covid-19 field hospitals in the South Wales valleys I see possibilities for bringing elements of mind–body medicine and social prescribing into secondary care settings where more patients can benefit from this holistic care model. Recovering Covid-19 patients will need a holistic rehabilitation programme to help them manage reduced cardiopulmonary fitness, improve nutrition, and find ways of reducing anxiety, which is likely to be high following infection. During admission to the field hospital I will be encouraging daily meditation in the morning or for sleep preparation, and there will be a holistic events programme of Qi Gong, chair yoga and singing. My hope is that these mind–body medicine techniques will aid recovery by improving breath control and, through stress-reduction, better sleep and emotional stability.

I really do encourage everyone to develop a meditation practice. Though it’s a skill that calls for some practise, given time its amazing healing potential will surely unfold.

References

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