LONGEVI TY, REGENERATI ON, AND OPTI MAL HEALTH

Protection throughout the Life Span

The Psychoneuroimmunologic Impact of
Indo-Tibetan Meditative and Yogic Practices
Erin L. Olivo
Columbia University, College of Physicians and Surgeons, New York, New York, USA
The Indo-Tibetan tradition claims that prociency in the suggested longevity practices
of meditation, diet, and physical exercise (yoga), will result in profound anti-aging,
stress-mediating and health enhancing effects. Western biomedical research has begun
to demonstrate that the psychobiological states induced and cultivated by cognitive
behavioral practices which are emblematic of those contained within the Indo-Tibetan
tradition (hypnosis, meditation, visualization, systematic relaxation), indeed do have a
profound impact on the bodys protective and regulatory systems. Although continued
study is necessary, much of the early research illuminating the mechanisms responsi-
ble for the life-span extending and health-enhancing effects of these cognitive behav-
ioral practices points to the importance of their anti-inammatory, anti-stress, and
antioxidant effects as well as their impact in enhancing the production of endogenous
substances that possess general longevity-enhancing, regenerative properties.
Key words: meditation; psychoneuroimmunology; preventative health
Extensive research in the elds of neu-
roendocrinology and psychoneuroimmunol-
ogy (PNI), over the past decade has resulted in
the development of a new paradigm of health,
which has begun to elucidate the multidirec-
tional and multidimensional nature of health
and the stress response. This PNI paradigm,
which begins to illuminate the complex inter-
actions among emotions, the central nervous
system (CNS), and the immune and endocrine
systems, is astoundingly congruous with the
holistic view of health at the center of Ti-
betan medicine and indeed provides a body of
evidence descriptive of the mind-body connec-
tion proposed by this 12-centuries-old healing
tradition which is a continuation of the 2,500-
year-old Indian Buddhist tradition. Indeed, Ti-
betan medicine does not establish (as Western
medicine historically has) a duality between the
Address for correspondence: Erin L. Olivo, Ph.D., M.P.H., Columbia
University, College of Physicians and Surgeons Department of Psychi-
atry, Division of Behavioral Medicine, 1150 St. Nicholas Avenue, New
York, NY 10032. Voice: 917-974-1488. elo4@columbia.edu
mind and the body, but instead, views mind and
body as a single totality in which the somatic
and the psychic interact with one another.
1
The Indo-Tibetan tradition claims that
prociency in the suggested longevity prac-
tices of meditation, diet, and physical exer-
cise (yoga), will result in profound anti-aging,
stress-mediating, and health-enhancing effects.
Western biomedical research has begun to
demonstrate that the psychobiological states in-
duced and cultivated by cognitive behavioral
practices which are emblematic of those con-
tained within the Indo-Tibetan tradition (hyp-
nosis, meditation, visualization, systematic re-
laxation), indeed do have a profound impact on
the bodys protective and regulatory systems.
Although continued study is necessary, much
of the early research illuminating the mecha-
nisms responsible for the life-span extending
and health-enhancing effects of these cognitive
behavioral practices points to the importance of
their anti-inammatory, anti-stress, and antiox-
idant effects as well as their impact inenhancing
the production of endogenous substances that
Longevity, Regeneration, and Optimal Health: Ann. N.Y. Acad. Sci. 1172: 163171 (2009).
doi: 10.1111/j.1749-6632.2009.04415.x
C
2009 New York Academy of Sciences.
163
164 Annals of the New York Academy of Sciences
possess general longevity-enhancing, regenera-
tive properties.
Impact on Immune Function
and Inammatory Process
Aging is characterized by the simultaneous
heightening of baseline inammation and re-
duced antimicrobial effectiveness, and many
investigators now believe that such immunose-
nescence may be in large part responsible for
the fundamental processes of aging itself.
2,3
In-
ammation has been linked to a broad spec-
trum of conditions associated with aging, in-
cluding cardiovascular disease, type II diabetes,
Alzheimers disease, rheumatoid arthritis, and
various cancers.
4
The groundbreaking work of Kevin Tracey
in the area of immune function and inam-
matory processes has set the stage for fur-
ther research into how the cognitive behav-
ioral practices of the Indo-Tibetan tradition
may modulate dangerous inammatory mech-
anisms, while at the same time up-regulate
the bodys innate antimicrobial capacities and
reverse immunosenescence. At the heart of
this action may well lay the interrelation, elu-
cidated by Dr. Tracey and others, between
stress, the inammatory response, and specic
tracts of the CNS. The observation that inam-
matory challenge activates pituitary-dependent
adrenal responses and alters neuronal signal-
ing in the hypothalamus, alerts us to the pres-
ence of a central nervous component of in-
ammatory regulation.
5
The CNS receives
both humoral and neural input from periph-
eral inammatory loci, and in turn exerts
immunomodulatory effects through parasym-
pathetic efferent activityvagus nerve activa-
tion drives acetylcholine release in the liver,
spleen, heart, and GI tract, which effectively
inhibits the release of inammatory cytokines
from tissue macrophages. These linkages work
together in a neural pathway that reex-
ively monitors and adjusts the inammatory
response.
Documentation of this cholinergic anti-
inammatory pathway provides further proof
of the connection between mind and body and
offers guidance in the development of potential
interventions that may target components of
this pathway. For example, Dr. Tracey has sug-
gested that biofeedback, hypnosis, meditation,
and acupuncture may all potentially be used
to regulate autonomic function (through va-
gal activation) and thereby modulate cytokine
release.
5
Indeed, studies of meditation and
meditation-like practices (self-hypnosis, sys-
tematic relaxation, guided imagery, etc.) have
demonstrated a range of anti-inammatory
effects. Reductions in levels of tumor necrosis
factor- (TNF-),
6
interleukin-2 (IL-2),
7
and
interferon- (INF-),
7,8
as well as attenuations
in inammatory responses to a range of
antigens, allergens, and irritants, including
lipopolysaccharide (LPS),
9
histamine,
10
cap-
saicin,
11
Varicella zoster,
12
and ultraviolet B,
13
have all been shown to result from the use of
these cognitive behavioral practices.
Interestingly, practices such as these may
also have import into recent treatment mod-
els of neurodegeneration, which focus on the
use of cholinesterase inhibitors to enhance
acetylcholine-mediated neural transmission.
14
Though the potential impact of Indo-Tibetan
cognitive behavioral practices on age-related
neurodegeneration is discussed in depth below,
at this point it should be noted that this treat-
ment strategy, as well as the association of anti-
cholenergic drug treatment with cognitive de-
cline in the eldery
15
suggest a role for practices
which enhance parasympathetic tone in neu-
roprotection, as acetylcholine is the principle
parasympathetic neurotransmitter.
Resistance to Trauma and Infection
Cognitive behavioral techniques might
not only exert ongoing, chronic anti-
inammatory effects, but also acute anti-
inammatory effects in response to challenges
Olivo: Protection throughout the Life Span 165
or traumas such as burns, surgery, and other
forms of injury.
10,13,16,17,19
In fact, there is a
small but signicant body of research show-
ing that, with training and prociency, an
impressive, even extraordinary level of resis-
tance to stress, inammation, and the as-
sociated tissue damage, is achievable for
practitioners of these cognitive behavioral
techniques.
2027
Enhanced secretion of endogenous mela-
tonin (MT) and dehydroepiandrosterone
(DHEA), as well as of acetylcholine (AcH),
alpha-melanocyte stimulating hormone (alpha-
MSH), and growth hormone (GH), appear
to be signicant components of a neuroen-
docrine response triggered by cognitive be-
havioral practices such as meditation.
2835
The
anti-inammatory and anti-shock properties of
these substances have been established in a
number of clinical and experimental trials.
3645
Interestingly, these substancesespecially MT
and DHEAappear to exert either direct or
indirect antimicrobial actions on a wide range
of disease-causing pathogens, such as West
Nile virus,
46
schistosomiasis,
47
and many oth-
ers. In addition to their overt antimicrobial
actions, these substances also appear capable
of counteracting the inammation-mediated
pathological changes induced by these and
other major infectious diseases, such as
tuberculosis.
48
It is also interesting to note that the cholin-
ergic anti-inammatory pathway identied by
Dr. Tracey and described above is in many ways
isomorphic with the pathway that more gener-
ally mediates stress and relaxation. A number
of studies have shown that animals and hu-
mans subjected to prolonged, heightened stress
can be at considerably greater risk for devel-
oping disease when infected by viruses, bac-
teria, and other pathogens.
4951
This highlights
the interaction between the autonomic nervous
system (and the associated stress response) and
immune modulation, and suggests the possible
role of anti-stress cognitive behavioral practices
in conferring immunity to a host of harmful
pathogens.
Psychological ImpactStress
and Aging
Central to the PNI paradigm(andthe holistic
view maintained within the Indo-Tibetan tra-
dition) is the role of emotions, psyche, and stress
in both the development of disease and the
aging process. Numerous studies have demon-
strated that negative affect, depression, anxiety,
and perceived stress are implicated in the de-
velopment and exacerbation of diseases such as
cancer, cardiovascular disease,
5254
metabolic
syndrome, and multiple sclerosis
55
to name a
few. In addition, several recent controlled stud-
ies have demonstrated that in some popula-
tions, depression can increase risk of death by
as much as four times as compared with non-
depressed controls.
5660
It is only recently that
physiological mechanisms capable of explain-
ing the link between negative affect and mor-
tality have begun to be elucidated. The ground-
breaking research of Dr. Elizabeth Blackburn
and Dr. Elissa Epel has recently demonstrated
an association between the experience of stress
and both telomere lengtha basic indicator
of cellular agingand telomerase activitya
measure of cellular capacity for ongoing repli-
cation.
6163
Researchers have only recently begun to
measure the impact meditation and related
cognitive behavioral practices may have on psy-
chological variables with a focus on symptoms
such as subjective feelings of stress, depression,
anxiety, panic attacks, and chronic pain. While
this body of research is handicapped by small
sample sizes and a relative paucity of controlled
studies, overall, it does appear that preliminary
evidence supports the usefulness of meditation
in decreasing these symptoms.
The majority of research in this area has
been conducted using the mindfulness-based
stress reduction paradigm (MBSR) developed
by Kabat-Zinn.
64
For reviews of the MBSR
literature, more extensive than is possible
here, see Baer
65
and Bishop.
66
However, it is
worth noting that investigations of the MBSR
program have demonstrated its effectiveness in
166 Annals of the New York Academy of Sciences
decreasing stress, anxiety, and depressive symp-
toms in the general population, in the absence
of clinically-dened mood disorder.
6769
Within
clinical samples, MBSR training is capable of
reducing total mood disturbance and stress
symptoms (in a group of cancer patients),
70
and a combined program utilizing cognitive-
behavioral therapy in conjunction with MBSR
has been shown to reduce rates of relapse
among formerly depressed patients.
71
There have been numerous uncontrolled
studies of the impact of meditation on psy-
chological symptoms. Kabat-Zinn
7274
reports
ndings from several studies of his MBSR
program with chronic pain patients that in-
dicate reductions on self-report measures of
present-moment pain, negative body image, in-
hibition of activity by pain symptoms, mood
disturbance, and psychological symptomology
including depression and anxiety. In addition,
in Kabat-Zinns research studying the impact
of MBSR programs on anxiety and panic dis-
order,
75,76
clinically and statistically signicant
post-treatment reductions were found in both
subjective and objective symptoms of anxiety
and depression and these results were main-
tained at the three-year follow-up.
A recent pilot study conducted at Stan-
ford demonstrated that a program of med-
itation and yoga could signicantly impact
the perception of caregiver stress and the re-
lated symptoms of depression and anxiety.
77
It is worth noting that this is exactly the
type of challengeperceived caregiver stress
linked by Blackburn and Epel to telomere
shortening.
Impact on Neuroendocrine Function
The research of Dr. Bruce McEwen and oth-
ers has begun to elucidate the role played by
glucocorticoids (GCs) in the deleterious effects
of stress on health and aging.
78,79
The glu-
cocorticoid cascade hypothesis (established
through investigation in rat models), suggests
that basal levels of glucocorticoids and ACTH
rise with age and that aging is associated with
a loss of sensitivity in the adrenocortical axis to
feedback inhibition, presumably due to degen-
erative changes within the aging brain, specif-
ically in the hippocampal region of the limbic
system.
78
In addition, this model suggests that
cumulative exposure to basal concentrations
of glucocorticoids lead to the degenerative loss
of neurons and GC receptors in the senescent
hippocampus, and that chronic stress, with its
resultant increases in GC concentrations, ac-
celerates this process.
78
The overall results of research in the area
of the neuroendocrinologic impact of cogni-
tive behavioral practices suggest that practices
such as meditation induce a complex neu-
roendocrine response. Research demonstrates
acute declines in several hormones implicated
in the deleterious effects of the stress response
in response to meditation and related prac-
tices, such as cortisol and thyroid stimulating
hormone (TSH).
8083
Additionally, several lon-
gitudinal studies conrm that these effects are
long lasting in subjects who regularly practice
meditation.
In addition to the reduction of the
above-mentioned harmful substances, endoge-
nous neuroendocrine substances with proven
anti-inammatory, anti-stress, and general
longevity-enhancing properties such as MT,
DHEA, and alpha-melanocyte stimulating hor-
mone (alpha-MSH) have all been shown to be
enhanced by cognitive behavioral practices, as
mentioned above.
8488
In the context of this
discussion, it is relevant to note that among the
broad range of protective and regenerative ef-
fects they are found to have on the body, MT
and DHEA both appear to counteract the GC-
mediated deleterious effects of stress.
8991
Impact on Autonomic
FunctionStress and ANS
Since Herbert Bensons description of the
stress response, a substantial body of research
has been devoted to elucidating the role of
the autonomic nervous system in both health
Olivo: Protection throughout the Life Span 167
maintenance and disease processes. A pri-
mary set of ndings of this research impli-
cate increased sympathetic reactivity and de-
creased parasympathetic tone as contributing
factors to the development of cardiovascular
disease.
There has been considerable research in-
vestigating the acute and long-term impact of
meditation on autonomic activity. The over-
all results indicate decreased activation and in-
clude such ndings as decreased spontaneous
electrodermal response (EDR) and decreased
heart rate (HR).
9295
A meta-analysis of 31
studies comparing physiological differences be-
tween Transcendental Meditation (TM) and
rest control groups indicated that those subjects
who had been practicing TM for a long time
exhibited signicantly lower baseline levels of
spontaneous skin resistance responses, respira-
tion rate, heart rate, and plasma lactate prior to
meditation than comparison subjects did prior
to rest.
96
Yet another group of studies investigated the
impact of meditation on recovery from stress-
ful stimulation. Several researchers have re-
ported signicantly faster habituation or return
to baseline (as measured by GSR, EDR, and
HR) after exposure to stressful stimuli in medi-
tators as compared to controls.
97,98
Hemodynamic variables such as systolic and
diastolic blood pressure (SBP, DBP), cardiac
output (CO) and total peripheral resistance
(TPR) have also been a focus of study in re-
gard to how they are impacted by the prac-
tice of meditation. Individuals practicing TM
have been found to have lower resting SBP
and DBP than matched controls.
99101
Because
blood pressure is the product of cardiac out-
put and total peripheral resistance, changes in
these variables have also been studied during
meditation. An investigation of circulation that
utilized dye-dilution and radioactive clearance
methods yielded results that demonstrated a
small but signicant increase in CO (15%) dur-
ing TM. In perhaps the only controlled study
investigating the impact of meditation on TPR,
subjects in the TM group exhibited signi-
cantly decreased TPRand SBP compared with
increases in the eyes-closed relaxation control
group.
100
Conclusions
The Indo-Tibetan tradition maintains that
prociency in meditative and yogic practices
can bring about extraordinary resistance to the
effects of disease, stress, andaging. The research
discussed above demonstrates that there may
be, in fact, a scientic basis for these claims.
Further rigorous research is necessary in order
to prove within the Western scientic paradigm
what the Indo-Tibetans have known to be true
for thousands of years. It is through this re-
search that we will create a common language
embraced by both traditions and thereby truly
achieve the globalization of medicine.
Conicts of Interest
The author declares no conicts of interest.
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