chronic stress

  • A Practical Guide to Treating Stress and Anxiety

    A Practical Guide to Treating Stress and Anxiety Jacob Teitelbaum MD

    Stress is a funny word. Loaded with the emotional bias of being a “bad” thing, the word stress can be quite deceiving, making it harder to handle than it needs to be. So we will offer a new way to look at it—and very effective ways to address it.

    As the healing arts grows, it is important to remember that there are four key domains in healing:

    1. Biochemistry. This includes herbals, nutrition and medications.
    2. Structural. Including areas such as manipulation, surgery, breathing, exercise, and ergonomics.
    3. Biophysics. For example, Acupuncture, Chakra work, Yoga, and NAET.
    4. Mind-Body-Spirit. Understanding how the body is a metaphor for what is occurring at a deeper level. For most illnesses, including anxiety and even cancer, complete healing is unlikely to occur unless this is also attended to.

    You will find that healing occurs best when all four of these areas are addressed. No individual healer is likely to have complete expertise in all of these areas. As our new healthcare system evolves, and the current one heads to extinction, it is good to see health practitioners from diverse backgrounds communicating and working together more.

    So let's look at how a Comprehensive Medicine approach works when addressing anxiety and stress. I will focus predominantly on mind-body and biochemical aspects, as these are where my expertise is.

    Treating Mind-Body Issues
    Stress is not inherently good or bad. In fact, stress can be used to force flowers to bloom, and this analogy applies to people as well. The problem is when stress becomes chronic, and is no longer enjoyable. This then contributes to chronic elevation of the stress hormone cortisol, directly triggering anxiety. As the excessive stress becomes chronic, cortisol levels then go too low—ironically also triggering anxiety by causing recurrent bouts of low blood sugar.

    A simple way to tell if stress is healthy? Simply check in to see how it feels. If it feels good, it is healthy. What is enjoyable can vary markedly from person to person. For example I enjoyed the stress of skydiving, while for my wife it would feel awful.

    A Novel Treatment
    The key stress antidote? Check in to see how things feel. This is so important, that I am being purposely redundant. Learn to say NO to things that feel bad. Leave your brain out of it. Our brain is the product of our societal and family training. It simply feeds back to us what we were taught that we should do to make others happy. Our feelings, on the other hand, tap into our own personal authenticity. So choose to focus on, and do, those things that feel good. Once you've determined what feels good, then your mind can figure out how to make it happen.

    And yes, it is OK to simply choose to focus on what feels good in life, without being in constant battle mode against things you don't like. Like food choices at a buffet, we don't have to protest for the removal of those foods we don't choose to eat. Simply ignore them and pick those things you like. You will find that the rest will soon stop appearing in your life. This is part of how I suspect “free will” works. Our focus is like the remote control on our TV. What we focus on keeps showing up on our screen. This is why our constant “Wars on…” just seem to create more of what we are attacking.

    Is it truly OK to do what feels good? Some will make the argument that “Heroin feels good, and perhaps also smacking that person who makes me angry over the head with a two-byfour.” This is why we add two caveats:

    1. Don't hurt others.
    2. Ask yourself “How is that working out for me?”

    Doing this, people will find their anxiety is often coming from their choosing what they think they should do over what feels good (i.e. doing what others want, instead of what is authentic to them). Notice if you are constantly feeling, “I should do this, or I should do that.” This is euphemistically called “Shoulding on yourself.” I invite you to change that toxic behavior.

    If hyperventilation is present, one will usually have buried feelings that are bubbling to the surface during periods of relative calm. Counseling to help them learn to feel their feelings helps over time. Also, as panic attacks often leave people feeling like they are going to die, understanding that the symptoms are not dangerous helps. Simply being told this may not be enough to reassure you though. You can confirm hyperventilation is the cause by breathing rapidly for up to 30–60 seconds and seeing how it amplifies your symptoms. Unfortunately, this can also precipitate a full-blown panic attack, so be forewarned, and pick a safe time and place to do this test!

    My e-book, “Three Steps to Happiness—Healing through Joy,” can help guide you through the mind-body healing process.

    Balance The Biochemistry
    Begin with ruling out and treating overt issues, including:

    1. Overactive thyroid. Consider this if your Free T4 thyroid test is even in the upper 20th percentile of the normal range.
    2. Low progesterone (women). Progesterone is like our body's natural Valium. Consider this if anxiety is worse around menses and ovulation.
    3. Low testosterone (men). Consider if testosterone levels are in the lower quarter of the normal range.
    4. Adrenal fatigue—caused by drops in blood sugar. A key tip-off? Irritability and anxiety that triggers sugar cravings and improves after eating.

    Also optimize nutrient status, especially magnesium and B vitamins. Instead of blood testing, which is of questionable value here, I simply recommend (for most people—whether or not they have anxiety) a high potency multi powder called the Energy Revitalization System (by Enzymatic Therapy). With this, one drink replaces well over 35 pills, optimizing levels of most nutrients. Also have the person decrease sugar and caffeine intake to see if this helps.

    Herbals can also be very helpful. For example, there is a unique extract, which can be as effective as Xanax, but is very safe. This special extract stimulates one of the most abundant neuroreceptors in the body, the cannabinoid receptors. Many of you may recognize this as the marijuana receptor, and in fact many people use cannabis to self-medicate for their anxiety. But what if you could get the benefits without the sedation and side effects?

    The good news is that now you can. Recent research showed that a special extract of the roots of the narrow leafed coneflower (Echinacea angustifoliae) was more effective than the tranquilizer Librium, with none of the side effects. It also worked quickly, with effects building with continued use. This is not the same component used for immune enhancement, and isn't found at needed levels in standard Echinacea. It is available though as AnxioCalm (by EuroPharma—20 mg per tablet).

    Let's look at a few studies of this unique extract.
    A study published in the March 2012 issue of Phytotherapy Research included 33 volunteers. All experienced anxiety, assessed using the validated State-Trait Anxiety Inventory (STAI). The extract decreased STAI scores within three days, an effect that remained stable for the duration of the treatment (seven days) and for the two weeks that followed treatment. There were no dropouts and no side effects.

    Another study looked at higher dosages (40 mg 2 x day) in a multi-center, placebo-controlled, double-blind Phase II study involving 26 volunteers diagnosed with generalized anxiety disorder (GAD). Over a three week period, the number of severely anxious patients (HADS-A scores larger than 11) decreased from 11 to zero!

    So I begin with two tablets of AnxioCalm 2x day for severe anxiety. After three weeks, the dose can often be dropped to one 20 mg tablet twice a day. It can also simply be used as needed, and serves as an excellent sleep aid.

    Other helpful herbals include valerian, passion flower, hops, theanine, and lemon balm. These can be found in a combination called the “Revitalizing Sleep Formula,” which helps anxiety during the day and sleep at night. I personally use both AnxioCalm and the Revitalizing Sleep Formula at night to ensure 8–9 hours of deep sleep.

    The smell of lavender oil is also calming, and a small drop on the upper lip, or even having a lavender bouquet in one's room, can be helpful.

    Structural And Biophysics
    Simply going for regular walks in the sunshine, and doing yoga, tai chi, and meditation can be very helpful. A technique called centering can help people feel that they are in the calm “eye of the cyclone” when panic attacks hit. In addition, it is helpful to explore a technique called Butyko breathing, which can be very helpful for anxiety and hyperventilation.

    For PTSD or old emotional traumas, a technique called EFT (Emotional Freedom Technique) can give near miraculous benefits in as little as 20 minutes (see EFT.Mercola.com). It may seem odd, but try it and you'll be amazed. Releasing old traumas through a simple “trembling” technique is also helpful, and the person can do it on their own. It is easy and simple instructions can be found in the book Waking the Tiger.

    By having the entire healing arts toolkit available, and not just using the “medical hammer,” anxiety can now be effectively treated!
  • L-Theanine: Nature’s Chill Pill

    Virtually everyone has stress. In fact, According to the Stress in America™ survey by the American Psychological Association,1 39 percent of respondents said their stress increased over the past year, and 44 percent said that their stress had increased over the past five years. The question is, how well do you handle your stress, how does it affect your life, and what can you do about it? The same Stress in America survey indicates the following percentage of Americans is only fair or poor at:

    • Preventing themselves from becoming stressed (44 percent)
    • Managing or reducing stress once experienced (39 percent)
    • Recovering fully or recharging after they’ve been stressed (31 percent)

    The ramifications of chronic stress include increases in illness, including headaches, heart disease, immune deficiencies and digestive problems. To a large extent, this appears to be due to an increased production of stress hormones and decreased immune function.2

    So what can be done to help control stress and reduce its ill effects? The answer is really multifaceted and may include a program of diet, exercise, stress-management techniques such as yoga, and even psychological counseling. In addition, when stress rears its ugly head, nature’s chill pill, L-theanine may be able to help.

    L-THEANINE’S MECHANISM OF ACTION
    Asian cultures have often used teas for relaxation effects. The relaxing effect is, at least in part, caused by the presence of a neurologically active amino acid, L-theanine (gamma-ethyl-amino- L-glutamic acid). Tea has the reputation of having less caffeine than coffee but it is the L-theanine in the tea that lessens the stimulant effect of caffeine on the human nervous system. In the brain, L-theanine increases both serotonin and dopamine production3, and possibly GABA as well.4

    Evidence from human electroencephalograph (EEG) studies show that it also significantly increases brain activity in the alpha frequency band which indicates that it relaxes the mind without inducing drowsiness. Alpha activity is also known to play an important role in critical aspects of attention. Research indicates that L-theanine has a significant effect on improving mental alertness while promoting relaxation.5

    L-THEANINE AND RELAXATION
    According to Mason, two small human studies6 showed that within 30–40 minutes of consuming 50 or 200 mg of L-theanine there is an increase of alpha wave activity/electrical signals produced by the brain. The perceived relaxation effect in the subjects coincided with the detection of alpha waves. This shows that L-theanine fosters a state of alert relaxation, which is consistent with the fact that anxious people have fewer or smaller alpha waves.

    The journal Human Psychopharmacology Clinical and Experimental published a double-blind placebo-controlled study7 in which sixteen healthy volunteers received 200 mg L-theanine, a pharmaceutical anxiolytic or placebo. The results showed that L-theanine induced feelings of tranquility in the volunteers.

    L-THEANINE, STRESS AND ANXIETY
    The journal Biological Psychology published a double-blind, placebo-controlled study8 in which twelve participants underwent four separate trials: one in which they took L-theanine at the start of an experimental, stress-inducing procedure, one in which they took L-theanine midway, and two control trials in which they either took a placebo or nothing. The results showed that L-theanine intake resulted in a reduction in some physiological indicators of stress within 15 minutes, compared to the placebo or control condition. Moreover, analyses of heart rate variability indicated that reductions in heart rate were likely attributable to a reduction of sympathetic nervous activation, suggesting that L-theanine had anti-stress effects via the inhibition of cortical neuron excitation.

    Similarly, a placebo-controlled study9 conducted with pharmacy students found that L-theanine (200 mg, twice a day, after breakfast and lunch) was effective at suppressing the initial stress response of students.

    The Journal of Physiological Anthropology published a placebo- controlled study10 in which 14 participants took either L-theanine + placebo, caffeine + placebo, or placebo only (L-theanine 200 mg, caffeine 100 mg) while performing mental tasks and physiological activities under conditions of physical or psychological stress. The results showed that L-theanine significantly reduced anxiety and reduced the blood-pressure increase in high-stress-response adults. Caffeine tended to have a similar but smaller inhibition of the blood-pressure increases caused by the mental tasks.

    The Journal of Functional Foods published a double-blind, placebo-controlled study11 in which 18 normal healthy subjects were divided into two groups referred to as high anxiety propensity group and the minimal anxiety propensity group. Both groups received 200 mg L-theanine and placebo (at different times)(200 mg/100 ml water) and placebo (100 ml water) in a double-blind repeated measurement design protocol. When tested at 15–60 minutes after consumption, results showed significantly enhanced activity of alpha bands, descending heart rate, elevated visual attentional performance, and improved reaction time response among high anxiety propensity subjects compared to a placebo. However, no significant differences were noticed among subjects with a minimal anxiety propensity.

    L-THEANINE AND MENTAL FOCUS
    The journal Neuropharmacology published a double-blind, randomized, cross-over study12 in which 27 participants received 100 mg L-theanine, 50 mg caffeine, a combination of the two, or a placebo. The results were that L-theanine and caffeine each significantly reduced error rates during a sustained attention task. It was noted that the combination of L-theanine and caffeine did not confer any additional benefits over either compound alone.

    Another study13 examined “sensory gating.” Sensory gating describes the processes of filtering out redundant or unnecessary stimuli in the brain from all possible environmental stimuli. Being able to do this is obviously beneficial when you’re trying to focus on a mental task. In the study, L-theanine was given to 14 healthy subjects, and tests were conducted 90 minutes later. The results were that 200 mg and 400 mg significantly improved sensory gating.

    CONCLUSION
    Research shows that L-theanine is effective at helping to promote relaxation while reducing feelings of stress and anxiety. Furthermore, this amino acid is even helpful in promoting mental focus. Truly, L-theanine is nature’s chill pill.

    References
    1. American Psychological Association. Stress in America™: Our Health at Risk. Released January 11, 2012. 78 pgs.
    2. Head KA, Kelly GS. Nutrients and botanicals for treatment of stress: adrenal fatigue, neurotransmitter imbalance, anxiety, and restless sleep. Altern Med Rev. 2009 Jun;14(2):114–40.
    3. L-Theanine monograph. Alternative Medicine Review 2005;10(2):136-8.
    4. Lu K, Gray MA, Oliver C, et al. The acute effects of L-theanine in comparison with alprazolam on anticipatory anxiety in humans. Hum Psychopharmacol Clin Exp 2004;19:457–65.
    5. Nobre AC, Rao A, Owen GN. L-theanine, a natural constituent in tea, and its effect on mental state. Asia Pac J Clin Nutr 2008;17 Suppl 1:167–8.
    6. Mason,R. 200 mg of Zen. Alternative & Complementary Therapies 2001; 7(2):91–95.
    7. Ibid. Lu K, Gray MA, Oliver C, et al.
    8. Kimura K, Ozeki M, Juneja LR, Ohira H. L-Theanine reduces psychological and physiological stress responses. Biol Psychol 2007;74(1):39–45
    9. Unno K, Tanida N, Ishii N, et al. Anti-stress effect of theanine on students during pharmacy practice: positive correlation among salivary á-amylase activity, trait anxiety and subjective stress. Pharmacol Biochem Behav. 2013 Oct;111:128–35.
    10. Yoto A, Motoki M, Murao S, Yokogoshi H. Effects of L-theanine or caffeine intake on changes in blood pressure under physical and psychological stresses. J Physiol Anthropol. 2012 Oct 29;31:28.
    11. Higashyama A, Htay HH, Ozeki M, Juneja LR, Kapoor MP. Effects of l-theanine on attention and reaction time response. Journal of Functional Foods. 2011;3(3):171–8.
    12. Foxe JJ, Morie KP, Laud PJ, Rowson MJ, de Bruin EA, Kelly SP. Assessing the effects of caffeine and theanine on the maintenance of vigilance during a sustained attention task. Neuropharmacology. 2012 Jun;62(7):2320–7.
    13. Ota M, Wakabayashi C, Matsuo J, et al. Effect of L-theanine on sensorimotor gating in healthy human subjects. Psychiatry Clin Neurosci. 2014 May;68(5):337–43.
  • Meditation, Stress, and Aging

    Meditation, Stress, and Aging Dallas Clouatre PhD

    Meditation, yoga, tai chi and other practices often are mentioned in passing as being good for health. However, it is surprising how little medical research has been devoted to testing such claims. Perhaps equally surprising is that until recently little work had been undertaken to quantify the impact of stress on aging. Of course, people often talk about reducing stress and note that too much stress is not good for us, but how much is too much and what, exactly, is the impact on the length of life? It took the interest of a Nobel Prize Winner finally to direct research at medical schools towards these questions. A paper by Epel and Blackburn on the impact of stress on the length of telomeres, a direct cellular measure of successful aging, only appeared in the Proceedings of the National Academy of Sciences in December 2004.1 More than a decade later, meditation has begun to be accepted as a low cost /no cost approach to health benefits.

    Stress and Adrenal Fatigue

    In medical circles, two syndromes often are discussed with regard to what laymen consider to be the consequences of stress. The first is adrenal insufficiency. Adrenal insufficiency is a condition in which the adrenal glands do not produce adequate amounts of steroid hormones, primarily cortisol; it also may include impaired production of aldosterone (a mineralocorticoid), which regulates sodium conservation, potassium secretion, and water retention. Craving for salt or salty foods due to the urinary losses of sodium is common. Adrenal insufficiency is a medical condition that requires intervention beyond dietary supplements.

    Adrenal fatigue occupies a bit of a nether world in many medical circles, meaning that allopathic medicine is not quite sure that it is real. According to the Mayo Clinic, adrenal fatigue is a term often applied to a collection of nonspecific symptoms, such as body aches, fatigue, nervousness, sleep disturbances and digestive problems. However, it also is used as a catch-all for the exhaustion caused by placing demands upon the body that are beyond its normal recovery capacity. Very important in this picture is cortisol, a hormone manufactured in the adrenals, but also exhibits a metabolism that is regulated strongly in various peripheral tissues, such as in fat stores.

    The counter-regulatory or "stress" hormone cortisol plays crucial everyday roles in the regulation of blood sugar levels, inflammation and the circadian rhythm. Cortisol should be relatively low late in the day as we unwind and prepare for sleep and should rise quite significantly starting an hour or two before waking. The circadian pattern of cortisol release generally is considerably more important than is its total 24-hour level.

    Acute demands outside the normal range and chronic stress alter this picture. Recurrent increases in stress levels, both from psychological and physiological sources, can result in excess cortisol production or alterations in cortisol release timing leading to a disrupted homeostasis and directly affecting the hypothalamic-pituitary-adrenal (HPA) axis, the nervous system, and an array of other body systems.

    Immediate responses to stress
    Typical acute phase reactions to stress are increases in heart and respiratory rates, elevations in blood pressure and blood sugar, and a general increase in cellular metabolism.

    Post-stress reactions
    Those in good health, especially younger individuals, quickly recovery equilibrium. However, stress in excess of immediate recovery capacity can lead to bouts of hyperglycemia, fatigue, insomnia, irritability, anxiety, etc.

    Poor recovery from stress
    Chronic stress disrupts the normal equilibrium of the body. Chronic elevations of cortisol and the neurotransmitters epinephrine and norepinephrine initially cause people to feel energetic, yet unable to rest. Indeed, there is increasing dysregulation of an array of hormonal systems, including growth hormone, glucocorticoids, adrenocorticotropic hormone (ACTH), mineral corticoids, angiotensin, and others. Ultimately a number of vicious cycles can be set in motion. These include set points involving mineral corticoids and insulin. One example of this is a cycle involving blood sugar, insulin and cortisol:

    chronic ↑ blood sugar => ↑ insulin + ↑ leptin => insulin resistance + leptin resistance => ↑ cortisol => ↑ blood sugar

    Depending on the individual's starting constitution and habits, this can lead to elevations of blood sugar and lipids, water retention, mood swings, a loss of lean tissue followed by a gain in fat tissue, generalized fatigue and other symptoms.

    The goal of any program aimed at controlling stress and reducing adrenal fatigue is to promote adaptation. One classic way of thinking about this issue is to consider the medical concept of allostasis, the process of achieving stability, or homeostasis, through physiological or behavioral changes. This can be carried out by means of alterations in HPA axis hormones, the autonomic nervous system, cytokines, or a number of other systems, and is generally adaptive in the short term. This adaptation calls upon mediators such as adrenalin, cortisol and other chemical messengers with the obvious corollary of increasing demands on precursor substrates and the production of downstream metabolites.

    Repeated episodes of allostasis increase allostatic load. This means that repeated episodes of stress increase the demands that are placed on the body. Even the body's attempts at rebalancing can lead to cumulative damaging effects. The burden of the level of responses required either repeatedly or chronically itself becomes an insult (stressor) in its own right.2,3

    Meditation, Stress and Telomeres
    The pioneering work of Epel and Blackburn linked perceived stress to shorter telomeres in healthy women as well as in Alzheimerfs caregivers, victims of domestic abuse and earlylife trauma, and people with major depression and posttraumatic stress disorder. Telomeres are a repeating DNA (deoxyribonucleic acid) sequence that "caps" or shields the ends of the chromosomes each time that cells divide and the DNA is copied. With successive cell divisions, the protective caps wear down. Blackburn received a Nobel Prize for discovering an enzyme called telomerase that can protect and rebuild telomeres. This enzyme slows the slide towards telomeres becoming too short to protect the chromosomes and leading to a loss of the ability of cells to divide. The length of telomeres thus is one measure of how many cycles the cells have left, a measure of aging. The key finding regarding stress and aging is that stress and our ability to cope with stress strongly affect telomere length. Subsequent work in other labs revealed that the stress hormone cortisol reduces the activity of telomerase. Oxidative stress and inflammation—the physiological fallout of stress—appear to erode telomeres directly.4,5

    There are various ways of attempting to control stress its negative effects, including exercise, social support groups, eating advice, and so forth. One of the most successful in trials is meditation. As reported in an excellent 2104 BBC review,6

    In one ambitious project, Blackburn and her colleagues sent participants to meditate at the Shambhala mountain retreat in northern Colorado. Those who completed a three-month-long course had 30 percent higher levels of telomerase than a similar group on a waiting list. A pilot study of dementia caregivers, carried out with UCLA's Irwin and published in 2013, found that volunteers who did an ancient chanting meditation called Kirtan Kriya, 12 minutes a day for eight weeks, had significantly higher telomerase activity than a control group who listened to relaxing music. And a collaboration with UCSF physician and self-help guru Dean Ornish, also published in 2013, found that men with low-risk prostate cancer who undertook comprehensive lifestyle changes, including meditation, kept their telomerase activity higher than similar men in a control group and had slightly longer telomeres after five years.

    Western style research thus increasingly is validating meditation as a tool for combatting known markers for aging. The next issue is whether meditation improves individual conditions, such as high blood pressure and high blood sugar.

    Meditation and Specific Conditions
    Telomere length and the production of telomerase to regenerate telomeres are indirect measurements of health. Impacts on these markers can suggest anti-aging benefits, but true clinical findings involve endpoints, not markers, i.e., were subjects followed long enough to demonstrate an actual increase in longevity? With long-lived animals such as human beings, this type of follow-through is difficult. However, meditation has been tested in regard to specific medical conditions, including blood pressure, blood sugar and mental aging. Results have been positive in all three.

    Blood Pressure
    Although statistical reviews typically have found that clinically meaningful changes in health related to blood pressure usually take place only when systolic blood pressure (SBP, the upper figure) exceeds 140 and diastolic blood pressure (DBP) exceeds 90, in recent years increasing attention has been paid to the category of prehypertension. Nearly 60 million Americans have blood pressure (BP) in the prehypertensive range (SBP of 120– 139 and/or DBP of 80–89). These numbers do not yet warrant medication, yet may signal that changes in diet, exercise and other habits should be undertaken to prevent the emergence of the clinical condition that does require treatment.

    Mindfulness-based stress reduction (MBSR) is a change in habits that has been tested under controlled conditions. In a trial published in 2013, it involved body scanning exercises, sitting meditation and yoga exercises performed in eight supervised group sessions totaling 2½ hours per week. Subjects also were encouraged to practice at home. The trial examined 56 men and women averaging 50.3 years of age with BP in the prehypertensive range randomized to eight weeks of either MBSR or active control conditioning consisting of progressive muscle relaxation training (PMR) (the control arm).7

    Patients in the MBSR group exhibited significant reductions in blood pressure measurements; systolic blood pressure decreased by an average of 4.8 millimeters of mercury (mm Hg) compared to 0.7 mm Hg with the control group, which did not receive the mindfulness intervention. Diastolic blood pressure also was lower in the mindfulness-based intervention group with a reduction of 1.9 mm Hg compared to an increase of 1.2 mm Hg in the control group.

    Blood Sugar
    As is true of blood pressure, in free-living populations meditation and other mind-body practices long have been associated with better body mass index and blood sugar regulation.8 Nevertheless, without prospective clinical trials, such benefits cannot be definitively claimed to be due to any given factor. Over the last handful of years, studies have gone some way towards remedying this issue.

    In 2015, the Endocrine Society presented information on the effects of MBSR on fasting blood glucose in overweight and obese women. The NIH National Center for Complementary and Alternative Medicine (NCCAM) and the NIH National Center for Research Resources and the National Center for Advancing Translational Sciences funded the study.9 A pilot randomized controlled trial of 86 overweight or obese women (similar in age and body mass index) tracked eight weeks of either MBSR or health education control (HEC) with tests of fasting blood work and completed questionnaires at baseline, eight weeks and then at 16 weeks. The MBSR group's mindfulness scores significantly increased and its perceived stress scores significantly decreased compared to the HEC group's scores. Fasting glucose dropped significantly and quality of life improved significantly in the MBSR group, but not in the HEC group. Other measures were similar between the two groups.

    Results with the MBSR intervention were good with regard to blood sugar just as with blood pressure. A different form of meditation may be even more successful. Traditional Buddhist walking meditation in a 2016 trial improved not only fasting blood glucose and blood pressure, but also glycosylated hemoglobin (HbA1c, a measure of long term blood sugar control) and other factors above the results found with walking alone in diabetic test groups.10 Twenty-three type 2 diabetics were split into two groups that performed a 12-week exercise program that consisted of walking on the treadmill at an exercise intensity of 50–70 percent maximum heart rate for 30 min/session, 3 times/week. In the Buddhism-based walking meditation exercise (WM) training program, the participants performed walking on the treadmill while concentrating on foot stepping by voiced "Budd" and "Dha" with each footstep that contacted the floor to practice mindfulness while walking.

    Both arms in this trial improved. After 12 weeks, maximal oxygen consumption increased and fasting blood glucose level decreased significantly in both groups. In contrast, walking meditation exceeded simple treadmill exercise in other areas. There were significant decreases in HbA1c and both systolic and diastolic blood pressure only in the WM group. Again, arterial stiffness was improved only in the WM group and blood cortisol levels were reduced only in the WM group.

    Brain Aging
    Another area, one that concerns all of us who are getting a bit older, is brain aging. Observational studies and a number of studies have indicated that meditation can exert a positive influence, yet the question of "how" remains poorly determined. Does it involve telomeres, inflammation, stress regulation, macroscopic brain anatomy or other mechanisms? Answers suitable to the Western allopathic medical model only now are beginning to be uncovered.

    A review published in 2017 attempts to survey the relevant issues.11 It judges that "preliminary evidence for possible age-defying effects of meditation mostly stems from cross-sectional studies and/or from using indirect markers associated with aging. In contrast, controlled longitudinal studies between meditation and diminished brain aging are still missing." Nevertheless, "[w]ithout a doubt, the accumulating scientific evidence is very encouraging, especially given that meditation is relatively easy to integrate in everyone's every-day life."

    Conclusions
    A philosophical person—a lover of wisdom—indulges his appetites neither too much nor too little, but just enough to lay them to sleep and prevent them from interfering with higher activities. He collects himself in meditation to pursue spiritual investigations, seeking and discovering unrealized realities of the past, present, and future. Through identifying with his Higher Self in meditation he avoids being the victim of fantastic and uncivilized vagaries and most effectively attains Truth.

    Plato, Commonwealth 9, 571d12

    We tend to think of meditation as an "Eastern" tradition, but, in fact, very similar practices existed in the ancient Greco-Roman world until the closure of the Platonic Academy in 529 AD by Justinian I. A major goal of meditation is to attain inner balance neither by indulging the passions nor by stifling them. Many different techniques exist. Overall, the goal of classic meditation exercises was and remains spiritual benefit. Modern research has discovered that even those not directly interested in religious or philosophical paths can obtain quite real and tangible benefits from meditative practices. These benefits include stress reduction, a balancing of blood pressure and blood sugar and, perhaps, greater longevity.

    References:

    1. Epel ES, Blackburn EH, Lin J, Dhabhar FS, Adler NE, Morrow JD, Cawthon RM. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA. 2004 Dec 7;101(49):17312–5.
    2. McEwen BS, Seeman T. Protective and damaging effects of mediators of stress. Elaborating and testing the concepts of allostasis and allostatic load. Ann N Y Acad Sci. 1999;896:30–47.
    3. McEwen BS. Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol. 2008 Apr 7;583(2–3):174–85.
    4. Marchant J. Can Meditation Help Prevent the Effects of Aging? July 1, 2014. http://www.bbc.com/future/story/20140701-canmeditation- delay-ageing
    5. Epel E, Daubenmier J, Moskowitz JT, Folkman S, Blackburn E. Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres. Ann N Y Acad Sci. 2009 Aug;1172:34–53.
    6. Marchant (op. cit.)
    7. Hughes JW, Fresco DM, Myerscough R, van Dulmen MH, Carlson LE, Josephson R. Randomized controlled trial of mindfulness-based stress reduction for prehypertension. Psychosom Med. 2013 Oct;75(8):721–8.
    8. Younge JO, Leening MJ, Tiemeier H, Franco OH, Kiefte-de Jong J, Hofman A, Roos-Hesselink JW, Hunink MG. Association Between Mind-Body Practice and Cardiometabolic Risk Factors: The Rotterdam Study. Psychosom Med. 2015 Sep;77(7):775–83.
    9. The Endocrine Society. "Stress reduction may reduce fasting glucose in overweight and obese women." ScienceDaily, 6 March 2015. www.sciencedaily.com/releases/2015/03/150306181815.htm
    10. Gainey A, Himathongkam T, Tanaka H, Suksom D. Effects of Buddhist walking meditation on glycemic control and vascular function in patients with type 2 diabetes. Complement Ther Med. 2016 Jun;26:92–7.
    11. Kurth F, Cherbuin N, Luders E. Promising Links between Meditation and Reduced (Brain) Aging: An Attempt to Bridge Some Gaps between the Alleged Fountain of Youth and the Youth of the Field. Front Psychol. 2017 May 30;8:860.
    12. An admittedly idiosyncratic, yet helpful translation found at http://www.hermes-press.com/meditation0.htm