Patient Care Neurology & Psychiatry - November 2007 - (Page 29)

The Science Healing of Using health-enhancing mechanisms that support the body’s ability to self-heal Mind over BP—or, lessons from a yogi W e underutilize the potential of the mind’s influence on physical aspects of health, more often relying on external influences. Two cases in the medical literature bear witness to the mind’s influence in treating such common conditions as high BP and heart disease. A case study published in Lancet in 1950 described a yogi who was voluntarily buried for 62 hours while his vital signs were continuously monitored. There was no elevation of his BP or signs of stress during this time.1 In another case, 9-hour continuous ECG monitoring of a buried yogi showed significant increase in heart rate (HR) variability, resulting in a sinusoidal pattern which is associated with normal BP 2 In both cases, a meditative process . overrode the fight or flight (sympathetic response) while enhancing parasympathetic parameters associated with heart health. icant variability in the rhythm with the breath, we are assessing HR variability. The more variability we have in our everyday lives, such as exercising, laughing, and dancing, the more stimuli we give to our baroreceptors, which encourages sensitivity. If we spend most of our time sitting motionless in front of a computer screen, our baroreceptors become desensitized and HR variability decreases. (An exception to this rule is slowing the breathing rate to 5 to 6 breaths per minute.) A loss in variability has been associated with higher mortality risk.3,4 In a study of patients with a previous MI, a low HR variability was associated with a higher 1-year mortality rate compared to those with a high HR variability (15% versus 9.5%) even when the patients had identical ejection fractions.5 Heart rate variability HR variability is a measure of the balance between the 2 branches of the autonomic nervous system (ANS)— the sympathetic and the parasympathetic. To oversimplify a complicated process, it can be viewed as the difference between the HR at the peak of inspiration and HR at the peak of exhalation. If the HR goes up to 90 beats per minute (bpm) with inhalation and down to 50 bpm with exhalation, the HR variability is 40. If it goes up to 85 bpm with inhalation and down to 80 bpm with exhalation, the HR variability is 5. High HR variability is desirable and suggests sensitivity of baroreceptors to both internal and external environmental change. When we monitor the fetal HR on a uterine tracing or listen to a child’s heart and notice the signif- DAVID P. RAKEL, MD Director, Integrative Medicine; and Assistant Professor, Department of Family Medicine, University of Wisconsin Medical School, Madison. Dr Rakel is a member of the Patient Care Board of Editors. Positive emotions When compared to negative emotions such as frustration, appreciation—among other positive emotions— is found to enhance HR variability, thus creating a balanced sinusoidal HR pattern. HR variability can be enhanced by exercise, some medications (beta-blockers), smoking cessation, and slowing the breathing rate, in addition to facilitated positive emotion. Controlling our breathing rate has also been found to not only enhance HR variability but also to lower BP 6,7 Biofeedback devices can be used to help train . the body to slow the breath to a rate that enhances baroreceptor sensitivity and lowers BP Studies have . shown that slowing respiratory rate with biofeedback over 8 weeks of treatment results in an average drop in BP of 14 mm Hg systolic and 8 mm Hg diastolic.6,7 The baroreceptors seem to become sensitized to change with a shift toward parasympathetic stimulation when the breathing rate is slowed to 5 to 6 breaths per minute.8 This involves one “in and out” breath every 10 seconds. The yogis who were buried alive used a combination of techniques to maintain a sense of peace and calm in the face of a stressful situation. They first slowed their breathing, which stimulated the para- NOVEMBER 2007 PATIENT CARE NEUROLOGY & PSYCHIATRY 29

Table of Contents Feed for the Digital Edition of Patient Care Neurology & Psychiatry - November 2007

Patient Care Neurology & Psychiatry - November 2007 Contents Research Digest Medicine in the News The 15-Minute Visit Dementia workup and treatment: Do the drugs really work? Help for Your Patients Who Suffer from Specific Phobias Clinical Clips Case & Comment The Science of Healing Classified Advertising

Patient Care Neurology & Psychiatry - November 2007

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