handouts fahri saatcioglu

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Breathwork and effects on the immune system, brain function, and behaviour

Fahri Saatcioglu, Ph.D.University of Oslo

Oslo, Norway

Summary1. Sympathetic tone is increased during times of stress. It seems that in many of us there is a chronic overactivity of the SNS.

2. Ample evidence exists for a strong and consistentassociation of acute and chronic psychological stress withvarious diseases, such as hypertension and insulin resistance, ischaemia, arrhythmia, and cancer.

3. Interventions derived from spiritual traditions, such as yoga, act, at least in part, by directly influencing the breath and the functioning of the ANS.

4. Breath is therefore a unique medium to affect the ANS and other aspects of the physiology, from molecular to systemic levels, to increase health and wellness.

What We Spend – and What it is Worth

• U.S. has spent nearly $2,3 trillion on health care in 2007 – approx. 16% of GDP, more than any other major expenditure and more per capita than anywhere else in the world. It is projected that thepercentage will reach 20 percent by 2016.

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Chronic diseases account for 75% of the $1.4 trillion spent on health care in the US

$245 billionan average of $1,066 per person

1980

$1.4 trillionan average of $5,039 per person

2001

Mensah: www.nga.org/Files/ppt/0412academyMensah.ppt#21Heffler et al. Health Affairs, March/April 2002.

$2.8 trillionan average of $9,216 per person

2011

We Face an Epidemic of Unparalleled Proportions

• Noncommunicable diseases cause 86% of deaths and 77% of the disease burden in the WHO European Region.

• One-third of the years of potential life lost before age 65 is due to chronic disease.

• Four chronic diseases—heart disease, cancer, stroke, and diabetes—cause almost two-thirds of all deaths each year.

Mensah: www.nga.org/Files/ppt/0412academyMensah.ppt#18

• U.S. uses more expensive specialty services – by far –than elsewhere, but studies show more care doesn’t necessarily mean better health.

416

158 157130

94 86 73

0

100

200

300

400

500

UnitedStates

Canada(2001)

France(2001)

Australia OECDMedian

NewZealand

UnitedKingdom

Percutaneous transluminal coronary angioplasty interventions per 100,000 population in 2002

What We Spend – and What it is Worth

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Life Expectancy by Health Care Spending

US spends more on health care than any other country in the world, but it does not translate into better health.

Walter C. Willet MD MPHProfessor of MedicineChairman of the Department of NutritionHarvard School of Public Health

• Moderately easily achieved lifestyle intervention* results in 82% reduction risk of coronary artery disease…. This is much more important than Statins.

*No cigarette smoking, moderate physical activity and easy diet changes

+Reduction of psychological stress!

“Honest doc--if I had known I was gonna live this long, I’d have taken better care of myself…”

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"There are two classes of diseases—bodily and mental. Each arises from the other, and neither can exist without the other. Thus mental disorders arise from physical ones, and likewise physical disorders arise from mental ones."

--Ancient epic Mahabarata

"The biggest mistake physicians make is attempting to cure the body without curing the mind. The mind and the body are one."

--Plato, ca 400 B.C.

“I would rather know the person who has the disease rather than the disease the person has!"

--Hippocrates, the father of modern medicine, ca 400 B.C.

Stress, Emotions, Individual characteristics

Nervous System Endocrine System

Immune System

Breakdown

Psychoneuroimmunology (PNI)

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Stress-induced hormonal alterations are associated with significant clinical effects, such as:

• An increased susceptibility to viral infections• Activation of latent viral infections• Onset and exacerbation of autoimmune diseases• Progression of atherosclerotic heart disease and myocardial infarctions• Stroke• Depression

►In a prospective study over 15 yrs of 1800 middle aged men, hostility and anger increasedCHD and all cause mortality by 50% and 42%, respectively (Schekelle et al., 1983).

PNI, Selected findings

►In a prospective study of 2832 people, depression and extreme hopelessness wereassociated with an increased risk of ischemicheart disease, 55 and 110%, respectively(Anda et al., 1993).

Cardiovascular Disease

►In 2428 men over six years, moderately and highly hopeless men were at significantly increased risk of all-cause and cause-specific mortality relative to men with low hopelessness scores (Everson et al., 1996).


►Psychosocial treatment significantly increasedlife expectancy in a cohort of metastatic breastcancer patients (Spiegel et al, 1989).

Cancer

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►In 602 men, over six years, depressive affects were associated with significantly greater mortality (Mayne et al., 1996).


►Faster progression to AIDS was related to stressful life events, denial coping, low socialsupport, and increased cortisol (Leserman et al, 2000).

HIV/AIDS

PNAS 2003, vol. 100, p. 9090

An example of stress associateddysregulation of the PNI axis

► This was a longitudinal (6-year) community study thatassessed the relationship between chronic stress and IL-6 production in 119 men and women who were caregiving for a spouse with dementia and 106 noncaregivers, with a meanage at study entry of 70.58 (SD 8.03).

► Recent medical literature has highlighted a spectrum of age-associated diseases whose onset and course may be influencedby proinflammatory cytokines, including cardiovascular disease, osteoporosis, arthritis, type 2 diabetes, certain cancers, Alzheimer’s disease, periodontal disease, and functional decline.

► For example, the link to cardiovascular disease, the leadingcause of death, is intriguing as IL-6 plays a central role in promoting the production of C-reactive protein (CRP), an important risk factor for myocardial infarction.


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► Over the course of the study, caregivers' average rate ofincrease in IL-6 was about four times as large as that of non-caregivers. Furthermore, caregivers consistently reportedsignificantly more stress and loneliness compared with controls.

Pred

icte

dIL

-6 (L

og10

, pg/

ml)

0.0

1.0

0.5

55 60 65 70 75 80 85 90 95

Caregivers p<0.001Controls p<0212

Age


► These findings have notable implications for morbidity and mortality.

► These data provide important evidence of a key mechanismthrough which chronic stressors may have potent healthconsequences for older adults, accelerating risk of a hostof age-related diseases.


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►Stress management skills

How to handle stress?

►Yoga, meditation, breathwork

►Time management

►Exercise

►Diet

►Prayer

►Massage therapy

►etc.

Summary

2. In traditional ’spiritual’ exercises, such as meditation, yoga, Qigong, etc., a major component of the effects elicited may be due to changes in respiration rate and/or patterns.

1. One of the most effective means to relieve stress is through breathing exercises derived from yoga.

3. Yogic breathing exercises may directly influence the functioning of the ANS.

►’’Of all the techniques that I have investigatedfor reducing stress and increasing relaxation, it is breathwork that I have found to be most time-efficient, the most cost-effective, and the one thatmost promotes increased wellness and optimal health.’’

Andrew Weil, M.D.Director, Arizona Center for Integrative MedicineUniversity of ArizonaAuthor, ’Spontaneous Healing’

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► Slow controlled breathing is coincident with important modifications of cardiovascular function, including a marked enhancement of respiratory sinus arrhythmia and a reduction in blood pressure.

Slow breathing, heart rate and hypertension

Hirsch JA, Bishop B. 1993Am J Physiol Heart Circ Physiol.

► Slow controlled breathing is normally accompanied by a potentiation of the influences of both heart rate and blood pressure on arterial baroreceptors. Radaelli et al. 2004

Am J Hypert

► Slow breathing, either controlled or occurring naturally, is a hallmark of most traditional practices that are employed to increase health and well-being.

Slow breathing and traditional practices

British Medical Journal, 2001

Dipartimento di Medicina Interna, U. of Pavia, Pavia; Departimento di Medicina Interna, Unita Ospedaliera S

Maria Nuova, Florence

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1. Reduced heart rate variability and baroreflexsensitivity are powerful and independent predictors of poor prognosis in heart disease.

Effect of breath on cardiovascularfunction, some background

2. Slow breathing enhances heart rate variability and baroreflex sensitivity by synchronizing inherent cardiovascular rhythms.

1. Recitation of the rosary, and also of some yoga mantras (type of meditation), slowed respiration to almost exactly 6/min, and enhanced heart rate variability and baroreflex sensitivity.

Bernardi et al., BMJ 2001

4. Thus, the rosary or yoga mantra chanting may be viewed as a health practice!

3. This even resulted in rhythmic fluctuations in cerebral blood flow, which might directly influence central nervous system oscillations.

2. This frequency (6/min) coincides with the subjects' spontaneous Mayer wave frequency and thus enhanced this cardio-vascular oscillation by synchronising sympathetic and vagal outflow.

Bernardi et al., BMJ 2001

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Somatic vs. Autonomic Nervous System

• Voluntary• Skeletal muscle• Single efferent neuron• Axon terminals release

acetylcholine • Always excitatory• Controlled by the

cerebrum

• Involuntary • Smooth, cardiac muscle;

glands• Multiple efferent neurons• Axon terminals release

acetylcholine or norepinephrine

• Can be excitatory or inhibitory

• Controlled by the homeostatic centers in the brain – pons, hypothalamus, medulla oblongata

Somatic Autonomic

Antagonistic control in the ANS

Is meditation effective against hypertension?

Anderson et al., Am J Hyp 2008Meta-analysis of 9 studies

4.7 mm Hg declineon average (95% CI)

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3.2 mm Hg declineon average (95% CI)

The regular practice of meditation has the potential to reduce both systolic and diastolic blood pressure that are clinically meaningful.



► Thus, slow breathing may be used to attenuate the sympathetic overactivity that characterizes several conditions in health and disease.

Radaelli et al. 2004Am J Hypert

Slow breathing, heart rate and hypertension

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Neural mechanisms involved in reflex control of cardiovascular function

1. Baroreceptorsblood pressure

2. ChemoreceptorspH, [gases]

Electroencephalographic (EEG) studies of meditative states have been conducted for almost 50 years. While there is no clear consensus about the underlying neurophysiological changes from meditation practice, reliable meditation-related EEG frequency effects, as well as EEG coherence and ERP component changes, have been observed.

Meditation and brain activity

Cahn and Polich, 2006Psychological Bulletin

► Long-term Buddhist meditation practitioners had sustained electroencephalographic high-amplitude gamma-band oscillations and phase-synchrony during meditation. These electroencephalogrampatterns differed from those of controls, in particular over lateral frontoparietal electrodes.

Buddhist meditation and brain activity

Davidson et al., 2004PNAS

►The subjects were eight long-term Buddhist practitioners and 10 healthy student volunteers. Buddhist practitioners underwent mental trainingin the same Tibetan traditions for 10,000 to 50,000 h over time periods ranging from 15 to 40 years.

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Davidson et al., 2004PNAS

Increased gamma power during Buddhist meditation

Color code: Percentage of subjects thathad an increase in gamma activity during Meditation.

Cont. Meditaters

►Different meditation practices may have different effects on the EEG with the general finding of power increases in theta and alpha bands and overall frequency slowing.

Meditation and brain activity

Cahn and Polich, 2006Psychological Bulletin

►Neuroimaging results indicate that frontal and prefrontal areas are generally activated. Prospective longitudinal assessments are required.

► For example, one of the hallmarks of the TM technique is the rapid onset and maintenance of high levels of short- and long-range EEG coherence, in alpha, theta and gamma frequencies, especially in the prefrontal cortex.

Meditation experience is associated with increased cortical thickness

► Hypothesis: Since meditation practice is associated with altered resting EEG patterns, suggestive of long lasting changes in brain activity, it is possible that meditation practice might also be associated with changes in the brain’s physical structure.► Magnetic resonance imaging was used to assess cortical thickness in 20 participants with extensive insight meditation experience, which involves focused attention to internal experiences.

► Brain regions associated with attention, introspection and sensory processing were thicker in meditation participants than matched controls, including the prefrontal cortex and right anterior insula. Differences in prefrontal cortical thickness were most pronounced in older participants, suggesting that meditation might offset age-related cortical thinning.

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1. Insula2. Brodmann area 9/103. Somatosensory cortex4. Auditory cortex

Meditation experience is associated with increased cortical thickness

Lazar et al., 2006Neuroreport

5000+ year-old system of health promotion, one of the first to recognize the impact of mind and emotions as being pivotal/significant in the restoration and maintenance of vibrant health.

The Yogic Science of Breath:

"Breath and mind are linked like body and mind. Breath sorts out the imbalances in the mind and the body. It’s the secret of life we have forgotten."

--Sri Sri Ravi Shankar

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► Yoga-classical, hatha yoga

Art of Living practices

► Ujjayi (victory) breath, pranayama

► Bhastrika (bellows breath) - forced rapid breathing

► Stress-management and self-development program derived from the Yogic Science of Breath

Sudarshan Kriya (SK)

► Precise physiological procedure utilizing distinct rhythms or patterns of breath

► Taught by certified instructors uniformly around the world, so far to over 2 million people in more than 140 countries

Scientific Research on SK&P

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► Melancholic depressives (n=45) randomized into 3 groups. A) Electroconvulsive therapy (ECT), B) Imipramine (IMN), C) SKY.

Antidepressant effect of SKY in Melancholia(Janakiramaiah et al., 2000)

► Significant reductions in depression were observed for all groups (as measured by BDI and HRSD).

HR

SD S

core

Assessment week1 2 3 4

ECT (n=15)IMN (n=15)SKY (n=15)

Antidepressant effect of SKY

BD

I Sco

re

Assessment week1 2 3 4

ECT (n=15)IMN (n=15)SKY (n=15)

Antidepressant effect of SKY

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► IMN and SKY were comparable

Antidepressant effect of SKY in Melancholia(Janakiramaiah et al., 2000)

► SKY is a potential alternative to current standard antidepressant treatments.

-absence of unwanted side effects-self-empowering-cost-effective

Stress relief in healthy people throughSK&P?

t=0Pre-test

HAD, LOT, SE, PANAS

and PAI

Days 1-6 Intervention Home practice

t=6 wksPost-testHAD, LOT,

SE

Group 1: SK&P, daily practice (n=48)Group 2: Sitting w/eyes closed, <=15 min/day (n=55)

EDN

Kjellgren et al., 2007BMC Complement Altern Med

4,5

2,5

3,0

3,5

4,0

SK&PCont

Pre-test Post-test

Rel

ativ

e D

epre

ssio

n(H

AD

)

*

*

*P=0.001

Depression

Decreased anxiety and depression through SK&P

1

5

8

Rel

ativ

e A

nxie

ty(H

AD

)

SK&PCont

Pre-test Post-test

P<0.001*

*

*

Anxiety

4

3

2

6

7

9


19

Rel

ativ

e St

ress

(SE

)

2,8

2,0

2,2

2,4

2,6

SK&PCont

Pre-test Post-test

P=0.003**

*

Stress

Decreased stress and increased optimismthrough SK&P

25

0

10

20

SK&PCont

Pre-test Post-test

Rel

ativ

e O

ptim

ism P=0.002*

**

Optimism


40

0

10

20

30

Control SK&P

Exp

erie

nce

ofA

ltere

dSt

ates

ofC

onsc

ious

ness

(ED

N)

**

*

P<0.001

Experience of altered states of consciousnessduring SK&P


►Kill virally infectedand tumor cells

Natural Killer (NK) cells

►Prevent tumor growth and metastases

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►Kill virally infected and tumor cells

Natural Killer (NK) cells

►Prevent tumor growthand metastases

►NK cell toxicity is down-regulated by stress

►NK-activating cytokineproduction 25-fold lowerin medical students taking exams (e.g. Glaser et al, 1986)

► NK cells significantly higher in SKY practitioners compared with normal and cancer patients (p<0.001).

Increase in NK cells through SKY

Flowcytometry: NK Cells

0

5

10

15

20

25

30

Control AOL Cancer patients

% o

f cel

ls

p<0.001

N=63 N=17 N=17

Kochupillai et al., 2005Ann N Y Acad Sci.

► Cancer patients in remission, left either untreated(n=6) or practiced SKY (n=21) for a period of 6 months. NK cells significantly higher in SKY group compared with control patients (p<0.05).

Increase in NK cells through SKYin cancer patients

0 1 12 240

5

10

15

20

Rel

ativ

e N

K c

elln

umbe

r

SKYCont

Sampling time (weeks)

Kochupillai et al., 2005Ann N Y Acad Sci.

► Similar results obtainedthrough use of Nishino breathwork, derived from martial arts/Qigong (Kimura et al. 2005, J Alt Com Med).

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►Decreased levels of the ’stress’ hormonecortisol.

Other findings/ongoing studies on SK&P

► Decreased levels of blood cholesterol.

►Increased levels of the ’wellness’ hormoneprolactin.

► Decreased levels of PTSD symptoms.

► Possible effects of SK&P on respiratory function. ► Possible effects of SK&P on gene expression.

►In EEG, increased alpha waves, interspersedwith beta waves.

► For details: www.aolresearch.org

►As exemplified by the yogic breathing exercises, the subjective reports of increased health, vitality, well-being, and peace of mind through ‘meditative’practices are supported by research findings, which suggest an overall strengthening of the mind/body system at all levels.

SUMMARY

►Further studies are certainly needed; however, these practices provide a possibility for powerful health restoration and promotion effects. Therefore, they could be incorporated into the current medical practice as a preventive and adjunct regimen.

►Integrative medicine has been defined as healing-oriented medicine that takes account of the whole person (body,mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeuticrelationship and makes use of all appropriatetherapies, both conventional and alternative.

►Integrative medicine embraces the concerns of the public and medical profession for more effective, compassionate, patient-centered medicine. Recently,the number of medical schools providingeducation related to integrative medicine has grownrapidly.

The need for integrative medicine

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Some Centers for Integrative Medicine in the US academic institutions

Focus Altern Complement Ther 2007; 12: 21

Hospital-based integrative medicine in the Netherlandsvan Duijn RM1, Georgiou M, Koolen R, von Rosenstiel I

Slotervaart Hospital, Amsterdam, Louwesweg 6, 1066 EC, the Netherlands

Integrative Medicine in the Netherlands?

“Then you should do yogic breathing!”

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Partnerships needed!

handouts fahri saatcioglu

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