This blog post originally appeared on Mindful.Org
Imagine being poked by a thermal probe that heats a small area of your skin to 120.2 degrees Fahrenheit. Ouch.
Now imagine trying mindfulness meditation, and having that probe touch your skin again. Painful, you’d think. Not as much.
Researchers at the Wake Forest Baptist Medical Center found that the brains of meditators respond differently to pain—a huge finding, given the continued skepticism regarding the benefits of mindfulness meditation as an effective treatment for pain with unique mechanisms above and beyond providing a placebo effect.
The research is even more poignant given that pain is one of the most pervasive, debilitating, and expensive health problems faced by approximately 100 million Americans. Until recently, the go-to treatment has been opioid medications, which have a high side-effect profile, and are highly addictive. More and more, doctors and patients alike are looking toward non-pharmacological ways to supplement current treatment options to help reduce pain and the toll it takes on quality of life.
Mindfulness as a Treatment for Pain
As mindfulness meditation is being introduced into the mainstream to help combat pain, many questions are surfacing about whether it really helps, and the exact mechanisms by which it might provide some benefit.
Jon Kabat-Zinn, the pioneer who brought mindfulness to the West as a possible psychological intervention, was the first to study the connection between mindfulness meditation and pain. In his 1985 study, 90 chronic pain patients were trained in Mindfulness-Based Stress Reduction (MBSR). Results indicated statistically significant reductions in measures of present-moment pain, negative body image, inhibition of activity by pain, mood disturbance, and psychological symptomatology, including anxiety and depression. Additionally, pain-related drug utilization was reduced. Since that study, there have been many more with similar findings.
The mechanisms behind how mindfulness reduces pain proposed in these studies continue to include mindfulness meditation’s ability to provide pain relief by cultivating the ability to parse between the objective sensory dimension of pain, and the more subjective judgement that we attach to the pain that constructs the way we experience it.
Pain is a complex phenomenon, mainly due to it being a multi-dimensional and subjective experience that consists of sensory, affective, and cognitive elements. Meaning, when we first experience a sensation of pain, we begin to judge it as bad and as something we want to immediately eradicate. Then, we start to conspire ways to escape the pain, to find any solution we can come up with, all the while continuing to judge our pain as negative. The subjective judgement we add inflates the pain, making the experience of it far more noxious than the sensory experience alone.
Mindfulness meditation can be used as a tool to create more awareness of the sensation of pain itself, without the judgment or resistance, and the affective and cognitive evaluation that we often project upon it. When we impose a litany of negativity upon our pain, it only becomes worse, and potentially elicits other difficulties including depression and anxiety.When we become more aware of what we are actually experiencing, without the overlay of our judgment, the overall perception of pain is reduced.
Kabat-Zinn articulated this well in The Mindful Solution to Pain. He writes, “From the perspective of mindfulness, nothing needs fixing. Nothing needs to be forced to stop, or change, or go away.” Kabat-Zinn is making the case for awareness of a sensation, without the overlay of our thoughts, in order to elicit healing. He goes on to say “…It is only awareness itself that can balance out all of our various inflammations of thought and the emotional agitations and distortions that accompany the frequent storms that blow through the mind, especially in the face of a chronic pain condition.”
While focusing on the sensory experience of pain could sound counterproductive, it actually provides a pathway to pain relief that is different than the traditional pharmacologic interventions that aim to quell the sensation of pain immediately.
Mindfulness Meditation and Possible Mechanisms of Pain Relief
With the advent of modern imaging techniques such as the functional magnetic resonance imaging (fMRI), neuroscientists are finding changes in the brain that are in sync with Kabat-Zinn’s proposed mechanisms.
- The brains of meditators respond differently to pain: Grant et al. (2011) used functional and structural MRI to ascertain the brain mechanisms involved in mindfulness-related pain reduction. They found that during pain, meditators (albeit in a non-meditative state while being studied) had increased activation in areas associated with processing the actual sensory experience of pain (including primary and secondary somatosensory areas, insula, thalamus, and mid-cingulate cortex). They also found decreased activity in regions involved in emotion, memory, and appraisal (including medial pre-frontal cortex (mPFC), orbital frontal cortex (OFC), amygdala, caudate, and hippocampus).
- Activation of different neural pathway than a placebo: Zeidan et al.’s most recent (2015) study found mostly consistent results and went a step further and accomplished the feat of proving that mindfulness meditation has a different neural pathway than, and reduces pain intensity above and beyond, placebo. In this study, relative to other comparison groups, mindfulness meditation was associated with decreased activity in the brain area called the thalamus. This possibly reflects the inability of sensory information from reaching areas of the brain associated with thinking and evaluation.
Despite the increased elucidation of neural mechanism related to mindfulness-related pain reduction, and its viability as an additional tool doctor’s can “prescribe,” questions still remain. There are many conflicting studies that seem to indicate that mechanisms may vary based on a meditator’s expertise level, as well as a meditator’s engagement in Focused Attention (FA) vs. Receptive Attention (RA) also called Open Monitoring. Findings also differ by stimulus type (heat vs. laser), and diverse experimental directives. Additionally, more research is needed to parse between mindfulness’s ability to reduce both acute and chronic pain.
While mindfulness meditation is not the end all be all panacea for pain, there is enough evidence to indicate that mindfulness practice does in fact lead to reductions in pain intensity and unpleasantness, even more so than placebo. The proof is even in the brain circuitry. In this way, it can be a safe addition to treatment options that have heretofore mostly included highly addictive opioids.
Mindfulness Practice for Pain Relief: The Body Scan Meditation
So how can we put this theory and research into actionable guidance for our own lives? One of the most effective mindfulness practices with regards to pain reduction is the body scan technique, which provides us with the ability to identify physical discomfort in different parts of the body.
The body scan can allow us to use our bodies to experience present-centered, non-judgmental awareness. We can learn to be aware of whatever sensation arises in our bodies, particularly the painful ones, and then we learn to notice the difference between the direct experience of these sensations and the indirect perceptions that we add on to that experience.
The body scan allows us to non-judgmentally identify what we are feeling and where we are feeling it as we narrow our focus on each detailed part of our body. Yet, we also begin to train our minds to broaden our focus away from the intricate body parts to a broader and more spacious awareness of the body as it exists as a whole, with different co-existing parts and sensations. A greater understanding of what our body endures allows us the opportunity to see what it feels, accept it, and cultivate compassion for it, without immediately judging it or trying to escape it.
I invite you to take the time to try a guided body scan meditation. In this practice, I guide you through an 18-minute body scan. It is my hope that together we can work toward a more mindful approach to pain relief.
This blog post originally appeared in The Huffington Post.
Less might sometimes be more, but two brains are most definitely better than one! How extraordinary then that research continues to confirm a second brain that resides in our guts.
Yes, our gut has its own neural network, the enteric nervous system (ENS). Our ENS doesn’t wax philosophical or make executive decisions like the gray shiny mound in our skulls. Yet, in a miraculously orchestrated symphony of hormones, neurotransmitters, and electrical impulses, both of our “brains” communicate back and forth.
This connection is actually what accounts for those proverbial butterflies in our stomach and has vast implications on our overall health and wellness. Changes in the diversity of the trillions of bacteria that reside in our gut (called the gut microbiota) can impact upon our mental state. And on the flip side, psycho-social factors, including the way we think and feel, have been implicated in gut problems.
Given my personal experience with SIBO, and professional experience with hundreds of women suffering from depression, anxiety, and GI difficulties, I enjoy teaching about how to live what I like to call a “Two-Brain Lifestyle.”
Here are four ways to begin your two-brain lifestyle journey:
“Diet is a central issue when it comes to preserving our gastrointestinal health, because by eating and digesting we literally feed our gut microbiota, and thus influence its diversity and composition.” –– Professor Francisco Guarner (University Hospital Valld’Hebron, Barcelona, Spain)
There is more and more research linking diets to both our gut and brain health. Certain diets elicit a healthier bacterial balance. Overall, and generally speaking, a diet rich in whole, unprocessed, unadulterated, and non-genetically modified foods help to maintain a proper pathogenic gut bacteria ratio. More specifically, the following are key recommendations:
A. Probiotic Intake:
Probiotics can be found in foods such as yogurt, or kimchi, and can also be taken in supplement form. Among other benefits, probiotics keep the bacterial ecosystem in our gut healthy, which in turn helps keep us healthy overall.
The positive impact of probiotics on gut flora has been widely studied in the last few years. In a 2013 study in Gastroenterology, 12 of 25 healthy women ate a cup of yogurt twice a day for four weeks. The rest of the women ingested no yogurt. All women had pre and post brain scans while being asked to respond to a series of images depicting different facial expressions. Results indicated that the women who ate yogurt were calmer when shown various emotions than the control group. Showing that the yogurt changed the subjects’ gut microbiota, which also modified their brain chemistry.
This means probiotics are potential game changers when treating anxiety and mood difficulties.
B. Low Sugar/Low Simple Carb Diet:
It is hard to say this, given that a love for chocolate has a special place in many of our lives, but excess sugar upsets the balance in the gut by nurturing more pathogenic bacteria, which leads to increased systemic inflammation. And inflammation is a major player in the inception of chronic disease, including mental health difficulties — no good!
In a recent study, researchers fed a group of mice a diet high in sugar and then tested their mental and physical function. The sugar diet negatively impacted the mice’s gut microbiota, impaired their cognitive flexibility, and ability to efficiently adapt to changing situations. The change in gut bacteria also negatively affected the mice’s long-term and short-term memory.
Basically, sugar makes you forgetful and possibly impairs adaptability, but don’t fret, the chocolate craving can still be met: The darker the chocolate, the less sugar. Also, if you don’t want to cut sugar completely out of your diet, eating less overall can still improve wellness.
2. Physical Exercise:
Ever feel like vomiting when you are scheduled for a job interview? That is just a crude reflection of how stress negatively impacts many aspects of our gut, but give exercise a try, it’s a well-known stress-buster!
A 2014 study found that rugby players not only have more diverse microbiota, but also a high amount of a particular bacterial species associated with decreased rates of obesity and metabolic diseases. While the study didn’t separate the effects of exercise, stress, and diet, it certainly provides evidence for exercise’s possible beneficial impact on gut microbiota diversity.
Our gut microbiota talk to the brain and impact how we think and feel, and, the way we think and feel has a profound impact upon the gut. Therefore, negative thinking styles and certain emotional states can disrupt gut functioning and even lead to dysfunction and disease.
Cognitive Behavioral Therapy (CBT) is a type of therapy geared toward identifying and reframing negative and counterproductive thought patterns. In a 2003 study of patients with IBS, a significant number reported less pain, bloating, and diarrhea after 12 weeks of CBT. Stands to reason that therapy should be part of a thorough treatment plan for chronic gut upset!
4. Relaxation and Stress-Reduction Exercises:
Studies have shown that stress puts us at risk for dysbiosis, a shift away from healthy gut diversity. This then strips us of a defense against infectious disease, which can potentially wreak havoc on the Central Nervous System (CNS).
Beyond utilizing exercise, which we already talked about, stress reduction and relaxation techniques, such as meditation, help bring the gut environment back to homeostasis. In a recent study from Harvard University affiliates, forty-eight patients with either IBS or Inflammatory Bowel Disease (IBD) took a 9-week session that included meditation training. The results showed reduced pain, improved symptoms, stress reduction, and a decrease in inflammatory processes.
Go with your gut
Just as the best way to boost our brain is by maintaining impeccable gut health vis-a-vis the content of our diet, so too, it might be impossible to heal a distressed gut without considering the impact of stress and our emotions.
So just remember, you are what you eat, and you are what you think, and there are ways to do both more mindfully.
This blog post originally appeared on Mindful.Org
The brain is the grand conductor of the symphony of our selves. The brain leads mind and body, and the brain heeds mind and body. The brain plays a role in every thought, feeling, and body sensation we experience. That includes every twitch, every blink, every strum of a guitar, and even every orgasm. That also includes every dream, passion, fear, joy, and deepest desire.
Every memory you consolidated last night while you slept, each micro-movement used to brush your teeth this morning, every smoothie you tasted, step you took, daydream you pondered, daydream you snapped out of, work you intently focused upon, yawn you took, anxiety you felt, drop in blood sugar you experienced, was a manifestation of lots of talking. A plethora of dialogue went on inside of you today, and you need to know it.
Quick Brain Basics:
The brain and the spinal cord make up the nervous system, composed of billions of nerve cells (i.e. neurons) that speak back and forth between the brain and body. What’s the conversation like? Well, the nervous system is at least bilingual, and speaks both electrically and chemically. When neurons (the brain’s cells) are stimulated, an electrical impulse, called an action potential, is created. This eventually leads to the transmission of chemical substances called neurotransmitters, like norepinephrine, dopamine and serotonin, which we know play a huge role in our mood functioning, among a lot of other things.
Why is it so important to know how much chatter the brain is doing? Because to be mindful of the orchestration of our internal states (some in reaction to the external) is to be mindful of the essentiality of nourishing our brains.
The latest scientific research shows that neuroplasticity, the idea that new neurons can be created, makes it very possible for lifestyle to play a big role in maintaining and improving brain function. Of course, as always, nature and nurture dance an exquisite but complex dance, and so there is never one solution or one cause and effect paradigm when it comes to your wellness. Yet, there is something each of us can do to help our brains stay vital:
1. Reduce your stress levels by practicing mindfulness meditation.
Although stress is a temporarily adaptive response to a threat, when it is chronic it becomes maladaptive and can wreak havoc on the central nervous system (CNS). Stress-reduction and relaxation techniques are important for a healthy brain. A widely used relaxation-inducing technique is meditation. Mindfulness meditation has been shown to be particularly effective. Studies have indicated that the amygdala, known as our brain’s “fight or flight” center and the seat of our fearful and anxious emotions, decreases in brain cell volume after mindfulness practice. Mindfulness meditation has been shown to help ease psychological stresses like anxiety, depression, and pain. Research is still parsing out the exact mechanisms, but many agree that on a cognitive level, mindfulness’s ability to cultivate attention on purpose, in the present moment, and non-judgmentally, helps reduce the stress elicited by past and/or future oriented thinking.
2. Get your blood pumping through exercise.
Exercise is a life force, and there are many reasons why it is a crucial part of basic brain hygiene. One reason is that exercise actually raises serotonin levels (most antidepressants focus on the production of serotonin). That’s just the tip of the iceberg though with regards to exercise’s benefits, which is why it is always in my top three recommendations to clients who want to thrive cognitively as they age.
3. Use it, so you don’t lose it, by engaging in mental stimulation.
Lifelong students have the right idea when it comes to staving off age-related brain decline. Continued learning actually promotes brain health, and might actually create new neural connections. This kind of neuroplasticity is a handy defense against future cell loss. So in essence, taking a stab at a crossword puzzle, or enrolling in a continuing education course can help build cognitive reserves. The biggest bang for the brain are tasks that are challenging, varied, and novel.
4. Nourish your body and brain with balanced nutrition.
Our brain’s health is dependent on our many lifestyle choices that mediate gut health, including most notably diet i.e., reduction of excess sugar and refined carbohydrates, and increased pre and probiotic intake. Poor gut health, elicited by dysbiosis (a shift away from “normal” gut microbiota diversity), may contribute to disease, and has been implicated in neurological and neuropsychiatric disorders like multiple sclerosis, autistic spectrum disorders, Parkinson’s disease, and even Alzheimer’s disease. Further, there is now research that suggests that depression and anxiety are mediated by poor gut health as well.
5. Stay positively connected to yourself and others by socializing.
Joining a community center, or even a meet-up group adventure is actually an investment in your future. Research continues to support the positive impact of social interaction on the brain. So much so, that studies even go so far as indicating that social interaction is a key to warding off dementia, including the Alzheimer’s. Even basic exchanges with people keep our brains stimulated as it searches for thoughts and a way to organize them into appropriate communication bytes. Also, let’s not forget that being part of a social network often elicits healthy behaviors, most notably joining a walking group, or engaging in other group exercise. So, keep your friends and family close to help maintain cognitive processes.
This blog post originally appeared on Mindful.Org
Running half-marathons barefoot in the snow. Climbing mountains while wearing only shorts. Standing in a cylinder filled with 700 kilograms of ice cubes.
Self-proclaimed “Iceman” Wim Hof, claims that he can do all of these things by influencing his autonomic nervous system (ANS) through concentration and meditation. The “Wim Hof Method,” is an intensive meditative practice that includes focused concentration, cold water therapy, and breathing techniques. Until recently, the idea that anyone could influence their autonomic nervous system was thought impossible given its assumed “involuntary” nature. The ANS is the system that controls all of our internal organs and regulates body functions like digestion, blood flow, and pupil dilation.
Our brains also use the ANS to communicate to our immune system, which might explain another of the Iceman’s recent feats: suppressing his immune response after being dosed with an endotoxin (a bacteria), which in most people leads to flu-like symptoms and high levels of inflammation in the body. When researchers looked at the Iceman’s inflammatory markers after being exposed, they discovered the markers were low, and his immune response was 50% lower than other healthy volunteers. Basically, he showed very few signs of infection.
Hof is definitely a statistical outlier, though one recent study followed students trained in his method. Apparently, they replicated Hof’s results and experienced no symptoms after being injected with Escherichia coli, a bacteria that normally induces violent sickness.
So, outlier though he may be, researchers are intrigued by the mounting evidence showing that mindfulness has a positive impact on our immune system.
The Floating Brain: Our Best Defense
The immune system is one of the most critical purveyors of our physical wellness. It’s our defense system, our armed forces that work to protect us from foreign invaders like viruses or bacteria. It is so precisely designed that it can distinguish between harmful unwanted pathogens and our own healthy cells and tissue.
It is so wise that the immune system has even been referred to as our “floating brain,” aptly named for its ability to communicate with the brain through chemical messages that float around inside our body. This means that if our immune system is weakened, perhaps as a result of chronic stress or invading pathogens, our whole body system won’t operate as usual. When our immune system struggles, it’s like a welcome sign for infection and disease.
Mindfulness and the Immune System
Beyond the Iceman’s superhuman experiences, there is increasing evidence that mindfulness meditation does impact our immune system.
A recent and groundbreaking review looked at 20 randomized control trials examining the effects of mindfulness meditation on the immune system. In reviewing the research, the authors found that mindfulness meditation:
- Reduced markers of inflammation, high levels of which are often correlated with decreased immune functioning and disease.
- Increased number of CD-4 cells, which are the immune system’s helper cells that are involved in sending signals to other cells telling them to destroy infections.
- Increased telomerase cell activity, the cells that help promote the stability of chromosomes and prevent their deterioration (telomerase deterioration leads to cancer and premature aging).
These results need to be replicated with more rigorous methodology, but they are promising, and potentially pave the way for using mindfulness-based techniques to boost the immune system, enhancing our defense against infection and disease.
And this isn’t the only study showing positive results. In another eight-week study, researchers at UCLA had 50 HIV-positive men meditate daily for 30-45 minutes. Doctors found that, compared with a control group, the more training sessions the men attended the higher their CD-4 cell count at the conclusion of the study (remember, CD-4 cells are the immune system’s helper cells). This study links mindfulness with a slowing down in CD-4 cell count drop, which is associated with healthier immune system functioning.
Richard Davidson, esteemed professor at the University of Wisconsin-Madison, also conducted a study investigating whether mindfulness meditation could alter brain and immune function.
In his study, people were injected with the flu vaccine and were either part of a group receiving mindfulness training or a control group. After eight weeks, the mindfulness group showed greater levels of antibodies available to respond to, and prevent, potential illness.
Mindfulness Meditation and Possible Mechanisms of Increased Immunity
It’s tempting to get carried away by the implications of the research suggesting that mindfulness can help improve immune functioning. However, the question still remains as to the exact mechanisms involved in the mindfulness-immune system connection. Ask any researcher and they’ll tell you they don’t know yet. Some possibilities have been suggested, and it is likely that a convergence of all of these play a role. Here I present three possible ideas:
- Decreased Stress, Increased Emotional Regulation: It has been confirmed through research that what we think and feel impacts our immune system via chemical messages from the brain. Therefore, stress, negative thinking styles, and certain emotional states can have a negative impact upon our immune system, creating an environment increasingly susceptible to disease. Mindfulness’s mechanisms toward greater well-being are complex and multifold, but practice is implicated in decreased stress, decreased rumination, and increased ability to deal with difficult emotions. In this way, practicing mindfulness might stave off impaired immunity.
- Targeted Brain/Immune System Communication: Another link between mindfulness and the immune system is mindfulness’s direct impact upon brain structures responsible for talking to the immune system. More specifically, research indicates that mindfulness meditation increases activity in the prefrontal cortex, right anterior insula, and right hippocampus, the areas of the brain acting as our immune system’s command center. When these parts are stimulated through mindfulness, the immune system functions more effectively.
- Activation of the Second Brain (the Gut): Mindfulness can boost immunity via the gut microbiota. As per a previous article I wrote here on Mindful, the human body is comprised of trillions of micro-organisms, most of which reside in the gut, which are called the gut microbiota. It turns out that the gut microbiota are key players in the development and maintenance of the immune system; the bacteria in the body that helps distinguish between intruder/foreign microbes vs. those that are endogenous. Studies have shown that stress tips our microbial balance, putting us at risk for dysbiosis, (a shift away from “normal” gut microbiota diversity), stripping us of one of our prime defenses against infectious disease, not to mention the cascade of reactions that ensue, which potentially wreak havoc on the central nervous system (CNS). Mindfulness-based stress reduction impacts our immune system by helping to maintain healthy gut microbiota diversity that is often upset by stress.
No matter the exact mechanisms, there is viable evidence that practicing mindfulness meditation helps boost our defense against disease, and fosters wellness. And while we are a long way from this becoming a mainstream treatment practice—given possible egregious side effects if not done properly and the fact that very few of us can be an Iceman—this research paves the way for the addition of a new wellness adage: “Meditation each day keeps the doctor away.”
I’ve been writing recently about the profound connection between the brain and our gut! Most of my writing was intellectual, sometimes metaphorical, maybe a bit poetic, and also humbly instructional (i.e., the way mindful eating fosters health vis a vis this connection).
Today, here is part of my own journey with #AlimentaryAngst, the story that sparked my personal and professional quest to help heal mind through body, and body through mind.
Thank you to Further Food for publishing this and thank you for all the support. I hope this resonates-ultimately, that is why I’m putting THIS forth! What has YOUR journey been like? Comment below with your thoughts, I look forward to responding to each one.
To Thriving, xo, Dr. Jen
This blog post originally appeared on Further Food.
Let’s rewind. February 2013, I noticed that I’d become more bloated than usual after a hearty meal. I experienced a feeling of pressure in my stomach, as well as visceral pain, both of which converged to create a really uncomfortable experience. I also had GERD, and my heart felt fiery. My xiphoid process felt irritated. I was a hot digestive mess.
As uncomfortable as it was, I kept my cool. It was only a few weeks later, when I looked down towards the floor and couldn’t see my own feet, that I gasped with every ounce of guttural energy I had in reserve. I looked six months pregnant.
I used my hands to cradle my inflamed belly and I cried. I cried for so many reasons: the pain, the discomfort, the cruel joke of hearing my biological clock tick so loud I thought I’d go deaf. I only looked pregnant, but wasn’t. Was this some kind of phantom pregnancy? Was that even a thing? Was I about to be catapulted into psychological stardom with my new discovery? This faux-preggers state was characterized by the undoubted lack of a fetus, but a great yearning for one, and a belly the size of six-month gestational equivalence.
I went to the doctor. Gave her a history, which was mostly sparse, except for the few things I seem to always be relaying to doctors. I felt lethargic and tired all the time, and I couldn’t seem to ever get enough sleep. I never woke up feeling rested. Overall, I’m healthy, and thankfully so, but there’s health and then there’s “HEALTH.” The difference is the same as that between surviving and thriving. I prefer to do the latter.
My diagnosis: Small intestinal bacterial overgrowth (SIBO), which had nonchalantly decided to go camping in my gut, like a pesky parasite sucking the life out of every ounce of normal flora to be found. Camping: as in pitching tents, and starting fires, and sleeping in the dark hollows of my alimentary organs.
The road to wellness began with self-compassion. Then, I changed my diet, and embarked on a journey consisting of many lifestyle changes. This was both extraordinarily cathartic and vulnerable to write. Yet, as a mind-body-brain wellness advocate I truly think it is incumbent upon me to share my journey. Why? Well, because my journey is what catapulted me towards the process of researching, reading, conversing, asking, anything I could about the topic. Gut health became a focus of not only my own, but of my practice with my patients.
I am blown away by the connection between mind, body, brain and gut. In fact, the gut is so powerful, and exerts so much impact upon our daily lives, that it’s even been dubbed the second brain. For me, knowing there is a real live brain in my gut makes me think twice about what I put in it, and I’ve never felt better.
Check out my next post on Further Food-I’m going to keep it raw and real, but will get much more technical and science-y about the importance of gut health.