9 Mind, Body, and Genome

                                               

          

When Jon Kabat-Zinn first developed MBSR at the University of Massachusetts Medical Center in Worcester, he started slowly, talking one by one to physicians there. He invited them to refer their patients who had to endure chronic conditions like untreatable pain—those considered medical “failures,” because even narcotics didn’t help—or who had to manage lifelong conditions like diabetes or heart disease. Jon never claimed he could cure such diseases. His mission: improve the quality of patients’ lives.

 

Surprisingly, perhaps, Jon met with almost no resistance from physicians. Right from the start, key clinic directors (primary care, pain, orthopedics) were willing to send such patients to what Jon at the time called the Stress Reduction and Relaxation Program, based in a basement room borrowed from the physical therapy department.

 

Jon led sessions there just a few days a week. But as word spread of patients praising the method for making their lives with an incurable condition more bearable, the program flourished and, in 1995, expanded into the Center for Mindfulness in Medicine, Health Care, and Society to house its research, clinical, and professional educational programs. Today hospitals and clinics around the world offer MBSR, one of the fastestgrowing kinds of meditation practice, and by now the approach with the strongest empirical evidence of its benefits. Beyond health care, MBSR has become ubiquitous, spearheading the popular mindfulness movement in psychotherapy, education, and even business.

 

Now taught at most academic medical centers in North America and in many parts of Europe, MBSR offers a standard program that makes it appealing for scientific study. To date there are more than six hundred published studies of the method, revealing a wide variety of benefits—and some instructive caveats.

 

For instance, medicine sometimes falters when it comes to treating chronic pain. Aspirin and other over-the-counter pain medications can have too many side effects to be used daily for years; steroids offer temporary relief but again with sometimes harmful side effects; and opioids have proven too addictive to be used widely. MBSR, however, can help without such drawbacks, since there are usually no negative side effects of mindfulness practice, and if practiced following the eight-week MBSR program, can continue to help people live well with chronic conditions and with stress-related disorders that will not necessarily get better on their own or with conventional medical treatment. A key element for long-term benefit is the continuity of practice, and despite MBSR’s long history, we still have virtually no good information on the extent to which those who have taken an MBSR course continue to engage in formal practice in the years following their initial training.

 

Take debilitating pain in the elderly. One of the most feared impacts of growing old is losing independence due to troubles with mobility from pain in arthritic hips, knees, or spine. In well-designed research with elderly pain sufferers, MBSR proved highly effective both in reducing how much pain people felt and how disabled they became as a result.1 Their lowered pain levels lasted into a six-month follow-up.

 

As in all MBSR programs, participants were urged to continue a daily practice at home. Having a method they can use on their own to ease their pain gave these patients a sense of “self-efficacy,” a feeling that they can control their destiny to some extent. This in itself helps patients live better with pain that won’t go away.

 

When Dutch researchers analyzed dozens of studies on mindfulness as a pain treatment, they concluded this approach was a good alternative to purely medical treatment.2 Even so, no research so far has found that meditation produces clinical improvements in chronic pain by removing the biological cause of the pain—the relief comes in how people relate to their pain.

 

Fibromyalgia offers an instructive case in point. This malady presents a medical mystery: there are no known biological explanations for the chronic pain, fatigue, stiffness, and insomnia that typify this debilitating disorder. The one exception seems to be impairment in regulating heart function (though this, too, is debated). One gold standard study that used MBSR with women who suffered from fibromyalgia failed to find any impact on cardiac activity.3

 

Even so, another well-designed study found that MBSR brought significant improvements in psychological symptoms, such as how much stress fibromyalgia patients felt, and lessened many of their subjective symptoms.4 The more often they used MBSR on their own, the better they did. Still, there was no change in the patients’ physical functioning or in a key stress hormone, cortisol, which stayed at high levels. The patients’ relationship to their pain changed for the better with MBSR—but not the underlying biology causing the pain itself.

 

Should someone with a disorder like chronic pain or fibromyalgia try MBSR, or meditation of any kind? Depends who you ask.

 

Medical researchers, in endless pursuit of definitive outcomes, have one set of criteria; patients have quite another. While doctors may want to see hard data showing medical improvements, patients just want to feel better, especially if there’s little to be done to relieve their clinical condition. From a patient’s viewpoint, then, mindfulness offers a path to relief—even as medical research tells doctors the evidence is not clear when it comes to reversing the biological cause of the pain.

 

Though patients may find relief from pain after they have gone through the eight-week MBSR course, many drop the practice after a while. That may be why several studies have found good results for patients immediately after they take MBSR, but less so in six-month follow-ups. So —as Jon will tell you—the key to a lifetime relatively free from the experience of pain, both physical and emotional, is continuing one’s mindfulness practice day after day in the following months, years, and decades.

 

WHAT THE SKIN REVEALS

 

Our skin offers a surprising window on how stress impacts our health. As a barrier tissue in direct contact with foreign agents from the world around us (as are the gastrointestinal tract and our lungs), the skin is part of the body’s first line of defense against invading germs. Inflammation signals a biological defensive maneuver that walls off infection from healthy tissue so it won’t spread. A red, inflamed patch signals that the skin has attacked a pathogen.

 

The degree of inflammation in the brain and body play a big role in how severe a disease like Alzheimer’s, asthma, or diabetes will be. Stress, though often psychological, worsens inflammation, apparently part of an ancient biological response to warnings of danger that marshals the body’s resources for recovery. (Another signal of that response: how you just want to rest when you get the flu.) While the threats that trigger this response in prehistory were physical, like something that could eat us, these days the triggers are psychological—an angry spouse, a snarky tweet. Yet the body’s reactions are the same, including emotional upset.

 

Human skin has an unusually large number of nerve endings (about five hundred per square inch), each a pathway for the brain to send signals for what’s called “neurogenic,” or brain-caused, inflammation. Skin specialists have long observed that life’s stress can cause neurogenic flare-ups of inflammatory disorders like psoriasis and eczema. This makes the skin an appealing lab for studying how upsets impact our health.

 

Turns out the nerve pathways that let the brain signal the skin to inflame are sensitive to capsaicin, the chemical that makes chilies “hot.” Richie’s lab used this novel fact to create carefully controlled patches of inflammation, to see how stress would increase, or meditation muffle, this reaction. Meanwhile, Melissa Rosenkranz, a scientist in the lab, invented a clever way to assay the chemicals that induce inflammation, by creating artificial (and painless) blisters in the inflamed area that would fill with fluid.

 

The blisters were created in a contraption Melissa built that uses a vacuum system to raise the first layer of skin in small circular areas over the course of forty-five minutes. When done slowly the method is quite painless, hardly noticed by the participants. Tapping that fluid allowed measuring levels of pro-inflammatory cytokines, the type of proteins that directly cause those red patches.

 

Richie’s lab compared a group who were taught MBSR with another who went through HEP (the active control treatment) as they endured the Trier ordeal—a dispiriting job interview, followed by a tough math workout—a sure way to trigger the pandemonium of the stress response.5 More specifically, the brain’s threat radar, the amygdala, signals the HPA axis (that’s the hypothalamic-pituitary-adrenal circuitry, if you must know) to release epinephrine, an important freeze-fight-or-flight brain chemical, along with the stress hormone cortisol, which in turn raises the body’s energy expenditure to respond to the stressor.

 

In addition, in order for the body to ward off bacteria in wounds, proinflammatory cytokines increase blood flow to the area to supply immune products that gobble up foreign substances. The resulting inflammation in turn signals the brain in ways that activate several neural circuits, including the insula and its extensive connections throughout the brain. One of the areas triggered by messages from the insula is the anterior cingulate cortex (ACC), which modulates inflammation and also connects our thoughts and feelings and controls autonomic activity, including heart rate. Richie’s group discovered that when the ACC activates in response to an allergen, people with asthma will have more attacks twenty-four hours later.6

 

 Back to the inflammation study. There were no differences in the two groups’ subjective reports of distress, nor in their levels of the cytokines that trigger inflammation, nor in cortisol, that hormonal precursor of diseases made worse by chronic stress, like diabetes, hardening of the arteries, and asthma.

 

But the MBSR group did better on an unfudgeable test: participants had a significantly smaller patch of inflammation after the stress test, and their skin was more resilient, healing faster. That difference held even four months later.

 

Although the subjective benefits of MBSR, and some of the biological ones, do not seem unique, this impact on inflammation certainly seems to be. Those who engaged in their MBSR practices for thirty-five minutes or more at home daily, compared to those doing HEP, showed a greater decrease in pro-inflammatory cytokines, the proteins that trigger the red patch. This, intriguingly, supports an early finding by Jon Kabat-Zinn and some skin specialists that MBSR can help speed healing from psoriasis, a condition worsened by inflammatory cytokines (but some thirty years on, this remains a study not yet replicated by dermatology researchers).7

 

To get a better idea of how meditation practice might heal such inflammatory conditions, Richie’s lab repeated the stress study using highly experienced (around 9,000 lifetime hours of practice) vipassana meditators.8 Result: the meditators not only found the dreaded Trier test less stressful than did a matched cohort of novices (as we saw in chapter five), but they also had smaller patches of inflammation afterward. Most significant, their levels of the stress hormone cortisol were 13 percent lower than in the controls, a substantial difference that is likely clinically meaningful. And the meditators reported being in better mental health than volunteers matched for age and gender who did not meditate.

 

 Important: these seasoned practitioners were not meditating when these measures were taken—this was a trait effect. Mindfulness practice, it seems, lessens inflammation day to day, not just during meditation itself. The benefits seem to show up even with just four weeks of mindfulness practice (around thirty hours total), as well as with loving-kindness meditation.9 While those new to MBSR had a mild trend toward lower cortisol, a large drop in cortisol under stress seems to kick in at some point with continued practice. Looks like there’s biological confirmation of what meditators say: it gets easier to handle life’s upsets.

 

Constant stress and worry take a toll on our cells, aging them. So do continual distractions and a wandering mind, due to the toxic effects of rumination, where our mind gravitates to troubles in our relationships but never resolves them.

 

David Creswell (whose research we visited in chapter seven) recruited unemployed job seekers—a highly stressed group—and offered them either a three-day intensive program of mindfulness training or a comparable relaxation program.10 Blood samples before and after revealed that the meditators, but not those taking relaxation, had reductions in a key proinflammatory cytokine.

 

And, fMRI scans showed, the greater their increase in connectivity between the prefrontal region and the default areas that generate our inner stream of chat, the greater the reductions in the cytokine. Presumably, putting the brakes on destructive self-talk that floods us with thoughts of hopelessness and depression—understandable in the unemployed—also lowered cytokine levels. How we relate to our gloomy self-talk has a direct impact on our health.

 

HYPERTENSION? RELAX.

 

The moment you woke up today, were you breathing in or breathing out?

 

That hard-to-answer question was put to a retreatant by the late Burmese monk and meditation master Sayadaw U Pandita. It bespeaks the extremely conscientious and precise version of mindfulness he was renowned for teaching.

 

The sayadaw was the direct lineage holder of the great Burmese teacher Mahasi Sayadaw, as well as spiritual guide to Aung San Suu Kyi during her years-long house arrest before she became Burma’s head of government. On his occasional trips to the West, Mahasi Sayadaw had instructed many of the best-known teachers in the vipassana world.

 

Dan had traveled off-season to a rented kids’ summer camp in the high desert of Arizona to spend a few weeks under U Pandita’s guidance. As Dan later wrote in the New York Times Magazine, “The consuming task of my day was to build a precise attention to my breath, noticing every nuance of each inhalation and exhalation: its speed, lightness, coarseness, warmth.”11 The point for Dan: clear the mind, and so, calm the body.

 

While this retreat was one of a series Dan tried to fit into his yearly calendar in the decades after returning from his graduate school sojourns in Asia, it wasn’t just meditation progress he hoped for. Over the fifteen years or so since his last long stay in India, his blood pressure had gotten too high, and Dan hoped this retreat would lower it, at least for a while. His physician had been troubled by readings over 140/90, the lower border of hypertension. And when Dan returned home from retreat, he was pleased to find a reading far below that borderline.

 

The notion that people could lower blood pressure through meditation largely originated with Dr. Herbert Benson, a Harvard Medical School cardiologist. When we were at Harvard, Dr. Benson had just published one of the first studies on the topic showing meditation seemed to help lower blood pressure.

 

Herb, as we know him, served on Dan’s dissertation committee, and was one of the few faculty members anywhere at Harvard sympathetic to meditation studies. As later research on meditation and blood pressure have shown, he was on the right track.

 

Take, for example, a well-designed study of African American men, who are at particularly high risk for hypertension, cardiac and kidney disease.

Just fourteen minutes of mindfulness practice in a group who already suffered from kidney disease lowered the metabolic patterns that, if sustained year after year, lead to these diseases.12

 

The next step, of course, would be to try mindfulness (or some other variety of meditation) with a similar group, but who had not yet developed a full-blown disease, compare them with a matched group who did something like HEP, and follow them for several years to see if meditation headed off the disease (as we would hope—but let’s try this study to see for sure).

 

On the other hand, when we look at a larger set of studies the news here is mixed. In a meta-analysis of eleven clinical studies where patients with conditions like heart failure and ischemic heart disease were randomly assigned to meditation training or a comparison group, results were, in the words of the researchers, “encouraging” but not conclusive.13 As usual, the meta-analysis called for larger and more rigorous studies.

 

There’s a growing body of research here but a meager yield when we look for well-designed studies. Most have randomized wait-list controls, which is good, but usually lack an active control group, which would be best. Only with an active control do we know that the benefits are due to the meditation itself rather than to the “nonspecific” impact of having an encouraging instructor and a supportive group.

 

GENOMICS

 

“It’s just naive,” a grant reviewer bluntly told Richie, to think that one will see changes in how genes are expressed during just one day of meditation. Richie had just received the same negative opinion via a review from the National Institutes of Health rejecting his proposal for that exact study.

 

Some background. After genetic scientists mapped the entire human genome, they realized it wasn’t enough to just know if we had a given gene or not. The real questions: Is that gene expressed? Is it manufacturing the protein for which it is designed? And how much? Where is the “volume control” on the gene set?

 

This meant there was another important step: finding what turns our genes on or off. If we’ve inherited a gene that gives us a susceptibility to a disease like diabetes, we may never develop the malady if, for example, we have a lifelong habit of getting regular exercise and not eating sugar.

 

Sugar turns on the genes for diabetes; exercise turns them off. Sugar and exercise are “epigenetic” influencers, among the many, many factors that control whether or not a gene expresses itself. Epigenetics has become a frontier of genomic studies. And Richie thought meditation just might have epigenetic impacts, “down-regulating” the genes responsible for the inflammatory response. As we’ve seen, meditation seems to do this—but the genetic mechanism for the effect was a complete mystery.

 

Undeterred by the skeptics, his lab went ahead, assaying changes in the expression of key genes before and after a day of meditation in a group of long-term vipassana practitioners (average of about 6,000 lifetime hours).14 They followed a fixed eight-hour schedule of practice sessions throughout the day, and listened to tapes of some inspiring talks and guided practices by Joseph Goldstein.

 

After the day of practice the meditators had a marked “down-regulation” of inflammatory genes—something that had never been seen before in response to a purely mental practice. Such a drop, if sustained over a lifetime, might help combat diseases with onsets marked by chronic lowgrade inflammation. As we’ve said, these include many of the world’s major health problems, ranging from cardiovascular disorders, arthritis, and diabetes to cancer.

 

And this epigenetic impact, remember, was a “naive” idea that countered the then prevailing wisdom in genetic science. Despite assumptions to the contrary, Richie’s group had shown that a mental exercise, meditation, could be a driver of benefits at the level of genes. Genetic science would have to change its assumptions about how the mind can help manage the body.

 

A handful of other studies find that meditation seems to have salutary epigenetic effects. Loneliness, for instance, spurs higher levels of proinflammatory genes; MBSR can not only lower those levels—but also lessen the feeling of being lonely.15 Though these were pilot studies, an epigenetic boost was found in research with two other meditation methods. One is Herb Benson’s “relaxation response,” which has a person silently repeat a chosen word like peace as if it were a mantra.16 The other is “yogic meditation,” where the meditator recites a Sanskrit mantra, at first aloud and then in a whisper, and finally silently, ending with a short deepbreathing relaxation technique.17

 

There are other promising hints for meditation as a force in upgrading our epigenetics. Telomeres are the caps at the end of DNA strands that reflect how long a cell will live. The longer the telomere, the longer the life span of that cell will be.

 

Telomerase is the enzyme that slows the age-related shortening of telomeres; the more telomerase, the better for health and longevity. A metaanalysis of four randomized controlled studies involving a total of 190 meditators found practicing mindfulness was associated with increased telomerase activity.18

 

Cliff Saron’s project found the same effect after three months of intensive practice of mindfulness and compassion meditation.19 The more present to their immediate experience, and the less mind-wandering during concentration sessions, the greater the telomerase benefit. And a promising pilot study found longer telomeres in women who had an average of four years of regular practice of loving-kindness meditation.20

 

Then there’s panchakarma, Sanskrit for “five treatments,” which mixes herbal medicines, massage, dietary changes, and yoga with meditation. This approach has its roots in Ayurvedic medicine, an ancient Indian healing system, and has become an offering at some upscale health resorts in the United States (and at many lower-cost health spas in India, if you’re interested).

 

A group who went through a six-day panchakarma treatment, compared to another group who were just vacationing at the same resort, showed intriguing improvements in a range of sophisticated metabolic measures that reflect both epigenetic changes and actual protein expression.21 This means genes are being directed in beneficial ways.

 

But here’s our problem: while there might be some positive health impacts from panchakarma, the mix of treatments makes it impossible to tell how much any one of them, like meditation, was an active agent. The study used five different kinds of interventions together. Such a mishmash (technically, a confound) makes it impossible to tell if the meditation was the active force, or perhaps some herb in the medicine, or a vegetarian diet, or if something else in that mix accounts for the improvements. Benefits accrue—we just don’t know why.

 

There’s also the gap between showing improvements at the genetic level and proving meditation has biological effects that matter medically. None of these studies makes that further connection.

 

In addition, there’s the issue of what kind of meditation has which physiological impacts. Tania Singer’s group compared concentrating on the breath with loving-kindness and also with mindfulness, looking at how each influenced heart rate and how much effort meditators reported the methods took.22 The breath meditation was the most relaxing, with loving-kindness and mindfulness both boosting heart rate a bit, a sign these take more effort. Richie’s lab had a similar increase in heart rate with highly experienced meditators (more than 30,000 lifetime hours) doing compassion meditation.23

 

While a quicker heartbeat seems a side effect of these warmhearted meditations—a state effect—when it comes to the breath, the trait payoff goes in the other direction. Science has long known that people with problems like anxiety disorders and chronic pain breathe more quickly and less regularly than most folks. And if you’re already breathing fast, you are more likely to trigger a freeze-fight-or-flight reaction when confronting something stressful.

 

But consider what Richie’s lab found when they looked at long-term meditators (9,000 average lifetime hours of practice).24 Comparing each to a nonmeditator of the same age and sex, the meditators were breathing an average 1.6 breaths more slowly. And this was while they were just sitting still, waiting for a cognitive test to start.

 

Over the course of a single day that difference in breath rate translates to more than 2,000 extra breaths for the nonmeditators—and more than 800,000 extra breaths over the course of a year. These extra breaths are physiologically taxing, and can exact a health toll as time goes on.

 

As practice continues and breathing becomes progressively slower, the body adjusts its physiological set point for its respiratory rate accordingly. That’s a good thing. While chronic rapid breathing signifies ongoing anxiety, a slower breath rate indicates reduced autonomic activity, better mood, and salutary health.

 

THE MEDITATOR’S BRAIN

 

You may have heard the good news that meditation thickens key parts of the brain. The first scientific report of this neural benefit came in 2005 from Sara Lazar, an early grad of Mind and Life’s Summer Research Institute, who became a researcher at Harvard Medical School.25

 

Compared with nonmeditators, her group reported, meditators had greater cortical thickness in areas important for sensing inside one’s own body and for attention, specifically the anterior insula and zones of the prefrontal cortex.

 

Sara’s report has been followed by a stream of others, many (but not all) reporting increased size in key parts of meditators’ brains. Less than a decade later (a very short time given how long such research takes to ramp up, execute, analyze, and report), there were enough brain imaging studies of meditators to justify a meta-analysis, where twenty-one studies were combined to see what held up, what did not.26

 

The results: certain areas of the brain seemed to enlarge in meditators, among them:

 

·       The insula, which attunes us to our internal state and powers emotional self-awareness, by enhancing attention to such internal signals.

·       Somatomotor areas, the main cortical hubs for sensing touch and pain, perhaps another benefit of increased bodily awareness.

·       Parts of the prefrontal cortex that operate in paying attention and in meta-awareness, abilities cultivated in almost all forms of meditation.

·       Regions of the cingulate cortex instrumental in self-regulation, another skill practiced in meditation.

·       The orbitofrontal cortex, also part of the circuitry for self-regulation.

 

And the big news about meditation for older folks comes from a study at UCLA that finds meditation slows the usual shrinkage of our brain as we age: at age fifty, longtime meditators’ brains are “younger” by 7.5 years compared to brains of nonmeditators of the same age.27 Bonus: for every year beyond fifty, the brains of practitioners were younger than their peers’ by one month and twenty-two days.

 

Meditation, the researchers conclude, helps preserve the brain by slowing atrophy. While we doubt that brain atrophy actually can be reversed, we have reason to agree it can be slowed.

 

But here’s the trouble with the evidence so far. That finding on meditation and aging brains was a reanalysis of an earlier study done at UCLA that recruited fifty meditators and fifty people matched for age and sex who had never meditated. The research team made careful images of their brains and found meditators showed greater cortical gyrification (the folding at the top of the neocortex) and so had more brain growth.28 The longer the meditator had practiced, the more folding.

 

But as the researchers themselves noted, the findings raise many questions. The specific varieties of meditation practiced among those fifty ranged from vipassana and Zen to kriya and kundalini forms of yoga. These practices can vary greatly in the particular mental skill being deployed by a meditator, for example open presence where anything can come into the mind versus a tight focus on one thing only, or methods that manage breathing versus those that let breathing be natural. Thousands of hours of practice of each of these could well have quite unique impacts, including in neuroplasticity. We don’t know from this study what method results in which change—does every kind of meditation lead to the increases that cause more folding or do just a few account for the bulk of it?

 

This conflation of different kinds of meditation, as though they were all the same (and so have similar brain impacts), pertains also to that metaanalysis. Since the studies included were also a mix of meditation types there’s the dilemma that all but a few of the brain-imaging findings are “cross-sectional”—a one-time image of the brain.

 

The differences could be due to factors like education or exercise, each of which has its own buffering effect on brains. Then there’s self-selection: perhaps people with the brain changes reported in these studies choose to stick with meditation, while others do not—maybe having a bigger insula in the first place makes you like meditation more. Each of these alternate potential causes has nothing to do with meditation.

 

To be fair, the researchers themselves name such drawbacks to their study. But we highlight them here to underline the ways in which a complicated, poorly understood, and tentative scientific finding can radiate out to the general public as an oversimplified message of “meditation builds the brain.” The devil, as the saying has it, is in the details.

 

So now let’s consider some promising results from three studies that looked at how just a little meditation practice seemed to have increased volume in parts of the brain, based on differences found before and after trying the practice.29 Similar results of increases in thickness and the like of appropriate brain areas come from other kinds of mental training like memorization—and neuroplasticity means this is quite possible with meditation.

 

But here’s the big problem with all these studies: they have a very small number of subjects, not enough to reach definitive conclusions. We need many more participants in these studies because of another problem: the brain measures used are relatively squishy, based on statistical analyses of about 300,000 voxels (a voxel is a volume unit, essentially a threedimensional pixel, each a 1 cubic millimeter hunk of neural geography).

 

Odds are, a small portion of these 300,000 analyses will show up as statistically “significant,” when they are actually random, a problem that diminishes as the number of brains being imaged increases. For now, there’s no way to know in these studies if the findings of brain growth are actual or an artifact of the methods used. Another problem: researchers tend to publish their positive findings but not report nonfindings—times they did not find any effect.30

 

Finally, brain measures have become more precise and sophisticated since many of these studies were done. We don’t know if measurements using the newer, more stringent criteria would yield the same findings. Our hunch is that better studies will reveal positive changes in brain structure with meditation, but it’s too early to say. We’re waiting to see.

 

A midcourse correction on meditation and the brain: Richie’s lab tried to repeat Sara Lazar’s findings of cortical thickening by looking at long-term meditators, Westerners with day jobs and a minimum of five years as a practitioner—a group with an average lifetime 9,000 hours of meditation.31 But the thickening Sara had reported did not show up, nor did several other structural changes that had been reported for MBSR.

 

There are many more questions than answers at this point. Some of the answers may come from data being analyzed as we write this, from Tania Singer’s laboratory at the Max Planck Institute for Human Cognitive and Brain Sciences. There they are very carefully and systematically examining changes in cortical thickness associated with three different types of meditation practice (reviewed in chapter six, “Primed for Love”), in a massive study using a rigorous design with a large number of participants practicing over nine months.

 

One of the early findings to emerge from this work: different types of training are associated with different anatomical effects on the brain. For example, a method that emphasizes cognitive empathy and understanding how a person views life events was found to enhance cortical thickness in a specific region of the cortex toward the back of the brain, between the temporal and parietal lobes, known as the temporoparietal junction, or TPJ. In previous research by Tania’s team, the TPJ has been found particularly active when we take another person’s perspective.32

 

That brain change was found only with this method, and not with the others. Such findings underscore the importance for meditation researchers to distinguish among different types of practice, particularly when it comes to pinpointing related changes in the brain.

 

NEUROMYTHOLOGY

 

While we’re spotlighting some of the neuromythology out and about concerning meditation, let’s look at one bit that traces back to Richie’s own research.33 As of this writing, the best-known study from Richie’s lab has 2,813 citations, an astonishing renown for an academic article. Dan was among the first to report on this research, in his book about the meeting in 2000 with the Dalai Lama on destructive emotions, where Richie presented this work in progress.34

 

The research has gone viral outside the academy, reverberating through the echo chamber of big and social media alike. And those bringing mindfulness to companies invariably mention it as “proof” the method will help folks there.

 

Yet that study raises large question marks in the eyes of scientists, especially Richie himself. We’re talking about the time he had Jon KabatZinn teach MBSR to volunteers at a high-stress biotech start-up where people were on the run virtually 24/7.

 

First, some background. For several years Richie pursued data on the ratio of activity in the right versus left prefrontal cortex while people were at rest. More right-side activity than left correlated with negative moods like depression and anxiety; relatively more left-side activity was associated with buoyant moods like energy and enthusiasm.

 

That ratio appeared to predict a person’s day-to-day mood range. For the general population this ratio seemed to fit a bell curve, with most of us in the middle—we have good days and bad days. A very few people are at the extremes of the curve; if toward the left, they bounce back from feeling down, if toward the right they might be clinically anxious or depressed.

 

The study at the biotech start-up seemed to show a remarkable shift in brain function after the meditation training—from tilting toward the right to a leftward pitch, and reporting a switch into a more relaxed state. There were no such changes in a comparison group of workers assigned to a wait list, who were told they would receive the meditation training later.

 

But here’s one major hitch. This research was never replicated, and was designed only as a pilot. We don’t know, for instance, if an active control like HEP would result in similar benefits.

 

While that study was never replicated, others seem to support the finding on the brain ratio and its shift. A German study of patients with recurring episodes of severe depression found their ratio tilted strongly toward the right—which may be a neural marker of the disorder.35 And the same German researchers found that this right-side tilt shifted back toward the left—but only while they were practicing mindfulness, not at normal rest.36

 

The problem: Richie’s lab has not been able to show that this tilt toward left-side activation continues to grow stronger the more you meditate. Richie hit a snag when he started bringing to his lab Olympic-level meditators, Tibetan yogis (more about them in chapter twelve, “Hidden Treasure”). These experts, who had logged off-the-charts hours of meditation, did not show the expected whopping leftward tilt—despite being some of the most optimistic and happy people Richie has ever known.

 

This undermined Richie’s confidence in the measure, which he has discontinued. Richie has no sure sense of why that left/right measure failed to work as expected with the yogis. One possibility: a tilt toward the left may occur at the beginning of meditation practice, but other than a small range of change, the left/right ratio does not budge much. It may reflect temporary pressures or basic temperament but does not seem associated with enduring qualities of well-being or more complex changes in the brain found in those with high levels of meditation experience.

 

Our current thinking holds that in later stages of meditation other mechanisms kick in, so that what changes is your relation to any and all emotions, rather than the ratio of positive to negative ones. With high levels of meditation practice, emotions seem to lose their power to pull us into their melodrama.

 

Another possibility: different branches of meditation have disparate effects, so there may not be a clear line of development that’s continuous from, say, mindfulness in beginners, to long-term vipassana practitioners, to the Tibetan experts assayed in Richie’s lab.

 

And then there’s the question of who teaches mindfulness. As Jon has told us, MBSR teachers vary greatly in expertise, in how much meditation retreat time they have put in, and in their own qualities of being. The biotech company had the benefit of having Jon himself as their teacher— over and above instruction in the MBSR techniques, he has unique gifts in imparting a view of reality that can potentially shift students’ experience in ways that, possibly, might account for a shift in brain asymmetry. We don’t know what the impacts would be if some other, randomly selected, MBSR teacher had come there.

 

THE BOTTOM LINE

 

Back to Dan and the meditation retreat he attended in hopes of lowering his blood pressure. Although he did get a big drop in his blood pressure readings immediately afterward, it’s impossible to know whether it was because of the meditation or a more general “vacation effect,” the relief we all feel when we drop our daily pressures and get away for a while.37

 

Within weeks his blood pressure readings were high again—and stayed that way until an astute physician guessed that he might have one of the few known causes of hypertension, a rare hereditary adrenal disorder. A medication that corrects that metabolic imbalance brought his blood pressure down to stay—while meditation did not.

 

Our questions are simple when it comes to whether meditation leads to better health: What’s true, what’s not, and what’s not known? As we leapt into our survey of the hundreds of studies linking meditation to health effects, we applied strict standards. As is true of all too much meditation research, the methods used in many studies of health impacts fail to clear the highest bar. That left us surprised by how little we can say with certainty, given the great excitement (and, okay, hype) about meditation as a way to boost health.

 

The sounder studies, we found, focus on lessening our psychological distress rather than on curing medical syndromes or looking for underlying biological mechanisms. So, when it comes to a better quality of life for those with chronic diseases, yes to meditation. Such palliative care gets ignored too often in medicine, but it matters enormously to patients.

 

Still, might meditation offer biological relief? Consider the Dalai Lama, now in his eighties, who goes to bed at 7:00 p.m. and gets a full night’s sleep before he awakens around 3:30 for a four-hour stint of spiritual practice, including meditation. Add another hour of practice before he goes to bed and that gives him five hours a day of contemplative time.

 

But painful arthritis in his knees makes going up or down stairs an ordeal —not uncommon for someone in the ninth decade of life. When he was asked if meditation helps medical conditions, he retorted, “If meditation was good for all health problems, I’d be free of pain in my knees.”

 

When it comes to whether meditation does more than offer palliative help, we’re not sure yet—and if so, in what medical conditions?

 

A few years after Richie got that stinging rejection of his plan to measure genetic changes from one day of meditation, he was invited to give the prestigious Stephen E. Straus Lecture at the National Institutes of Health, a yearly talk in honor of the founder of the National Center for Complementary and Integrative Health.38

 

 Richie’s topic, “Change Your Brain by Training Your Mind,” was controversial, to say the least, among the many skeptics on the NIH campus. But, come the day of his talk, the august auditorium at the Clinical Center was packed, with many scientists watching a live stream from their offices—perhaps an augury of the changing status of meditation as a topic for serious research.

 

Richie’s lecture focused on the findings in this area, mainly those from his lab, most of which are described in this book. Richie illuminated the neural, biological, and behavioral changes wrought by meditation, and how they might help maintain health—for instance, in better emotion regulation and sharpened attention. And, as we’ve tried to do here, Richie walked a very careful line between critical rigor and genuine conviction that there is really a “there” there: that meditation has beneficial impacts worthy of serious scientific investigation.

 

At the end of his talk, despite its staid academic tone, Richie received a standing ovation.

 

IN A NUTSHELL

 

None of the many forms of meditation studied here was originally designed to treat illness, at least as we recognize it in the West. Yet today the

scientific literature is replete with studies assessing whether these ancient practices might be useful for treating just such illnesses. MBSR and similar methods can reduce the emotional component of suffering from disease, but not cure those maladies. Yet mindfulness training—even as short as three days—produces a short-term decrease in pro-inflammatory cytokines, the molecules responsible for inflammation. And the more you practice, the lower the level becomes of these pro-inflammatory cytokines. This seems to become a trait effect with extensive practice, with imaging studies finding in meditators at rest lower levels of pro-inflamatory cytokines, along with an increased connectivity between regulatory circuitry and sectors of the brain’s self system, particularly the posterior cingulate cortex.

 

Among experienced meditation practitioners, a daylong period of intensive mindfulness practice down-regulates genes involved in inflammation. The enzyme telomerase, which slows cellular aging, increases after three months of intensive practice of mindfulness and loving-kindness. Finally, long-term meditation may lead to beneficial structural changes in the brain, though current evidence is inconclusive about whether such effects emerge with relatively short-term practice like MBSR, or only become apparent with longer-term practice. All in all, the hints of neural rewiring that undergird altered traits seem scientifically credible, though we await further studies for specifics./.

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