f you are one of the millions of Americans diagnosed with heart disease each year, there are a number of ways to fight back. For example, you can modify your diet, take prescription drugs, stop smoking, or take nutritional supplements. But there's one more weapon in your arsenal against heart disease, and it's all in your mind.
Managing stress and anger is an important skill in reducing your risk of heart disease. Below, cardiologist Dr. Nate Lebowitz and alternative medicine expert Dr. Sam Benjamin discuss the reasons why a calm heart may also be a healthier heart, and share some methods for achieving this state of mind.
What is the relationship between stress and the human heart?
NATE LEBOWITZ, MD: We've found that the mind plays a powerful role in the coronary arteries, and in the rhythms of the heart as well. There's clear evidence that people who are the so-called Type-A personality (people who are feel constant time pressure, are extreme perfectionists, are easily hostile, among other things) are at much higher risk of developing coronary heart disease.
What does the body release when it is under stress?
NATE LEBOWITZ, MD: It's actually adrenaline, or nor-epinephrine and epinephrine. These are the fight or flight hormones, and they are adaptive for when we had to run away from predators. These hormones speed up the heart rate, increase the blood pressure, and constrict the arteries. In animal models, animals that are under chronic physiologic stress develop heart disease.
SAM BENJAMIN, MD: These hormones also effect many different parts of the immune system, in many different parts of the body. This is important because one possible cause of some kinds of heart disease may relate to immune system dysfunction, and even the possibility that certain bacteria increase the amount of disease. So stress can make a dangerous difference in many different ways.
It's scary to think that you might be contributing to your own illness by virtue of your personality type. What can people do to thwart the Type-A urge, if that's what they've got?
NATE LEBOWITZ, MD: It's not easy, but it can be altered. It does take effort, it does take some learning and some training. The concept of "just relax" does not work. You need to learn. Stress reduction classes, yoga, massage, tai chi have all been shown to have very beneficial effects on the true physiology-the measurable levels of adrenaline, the function of our arteries-and therefore clearly have health benefits.
SAM BENJAMIN, MD: Intentionality. That's a very important issue. Having a positive attitude makes a difference. And when Mommy said, years ago, "Don't get upset; it's going to get you sick", she was absolutely right. And that's a very important point.
We're learning more and more that if we fix something in our mind, there's a physiologic, a biochemical apparatus, that helps us meet the time frame we've set in our minds. Our intentions, our optimism, make a difference. And there are numerous studies to support this contention.
NATE LEBOWITZ, MD: I would add that social supports have been shown to be very, very beneficial. Humans were made to be social animals. People that have loving families, friendship networks, even pets, have been shown to do better with exactly the same disease state than people who are loners, who do not have these social supports.
Can you describe guided visual imagery and how it is used as a stress reduction tool?
SAM BENJAMIN, MD: Guided visual imagery is a method that encourages people to summon up visual images that represent their disease. It is primarily done with a certified instructor.
For instance, I had a patient who was diabetic and had heart disease, with associated chest pain. They were being medically treated very appropriately, yet they continued to be symptomatic. Using guided visual imagery, this patient imagined that the heart disease and diabetes were like a ball and chain around their chest. And when they imaged that, and began to unravel the ball and chain, their symptoms got substantially better-physiologically there was some sign of improvement, and a decreased need for drugs.
Aromatherapy is another technique used in stress reduction. Could you describe how it is useful?
SAM BENJAMIN, MD: Memories of smells can oftentimes summon up certain immunologic responses in the body, as well as relaxation states. Aromas stimulate the limbic system in the brain, resulting in a substantial change.
One of the most interesting mind/body approaches in this realm has to do with prayer. And it's not necessarily the patient who needs to do the praying, but there have been some studies done about people who are prayed for, and perhaps they don't even realize they're being prayed for.
Tell me a little bit about that.
NATE LEBOWITZ, MD: It's called intercessory prayer. This is one of the most potentially intriguing, and yet unknowable, areas. In a couple of good studies, patients where shown to improve with prayer.
And, to reiterate, the patients didn't know they were being prayed for.
NATE LEBOWITZ, MD: That's right. It seems to have been completely blinded. The patients didn't know, and yet they clearly did do better.
That is an intriguing notion. How does that make you feel as a physician, to know that there are things that can't be measured, can't be tested?
NATE LEBOWITZ, MD: I think, if I was purely a scientist, I would be incredibly uncomfortable with that. But I chose to go into a mix of science and humanities called medicine, and you have to be comfortable, to some degree, with uncertainty. Because you just don't know. You have to take your best shot, and combine science with art, with a bedside manner, and try to combine the best tools that will really help the patient.
So there's clearly uncertainty, and you have to be comfortable with it to some degree. It's not easy. But, clearly, there are a million things we don't know, and you have to do your best.
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