Transcendental Meditation and Prevention of Cardiovascular Disease
Transcendental Meditation and Prevention of Cardiovascular Disease
By Jane Kattapong, MD
"Well, now that we have seen each other," said the Unicorn, "if you believe in me, I’ll believe in you. Is that a bargain?"
Lewis Carroll, Through the Looking-GlassCardiovascular disease (CVD), including coronary heart disease and stroke, is the leading cause of death worldwide.1 Globally, death rates for CVD have been increasing.1
Traditional Western medicine has emphasized pharmacological and interventional treatment to address physical illness. These treatments generally entail the use of tangible pills and devices. Can something we cannot see or touch prevent cardiovascular disease?
Mind-body medicine (MBM) is a field of medicine that addresses the intimate relationship and influences of mind and body upon each other. The earliest acknowledgement of the validity of influences of the mind upon the body in Western medicine practice was the acceptance of the placebo effect.2 Rather than administering externally generated treatments, MBM utilizes the unseen influences of the mind upon physical disease processes.
MBM Association
One MBM therapy is meditation. Meditation has been defined as "the self-regulation of attention."2 In general, the practice of meditation is subdivided into two different techniques: concentration meditation and mindfulness meditation. Concentration meditation encompasses transcendental meditation (TM) and the relaxation response. Mindfulness meditation encompasses mindfulness-based stress reduction programs, such as those at Tufts University in Boston. According to Pandya et al, "Meditation ¼ tries to concentrate the mind without tension and creates very peaceful and calm mental status. It is one of the few ways to achieve a state of superconsciousness or self-realization."3
Basis and Proposed Benefits
TM is based on traditional Indian vedic philosophy. TM was developed and brought to the United States by Maharishi Mahesh Yogi in the 1960s. The TM technique is taught in the United States through Maharishi Vedic Universities/schools and affiliates and costs about $1,200.4 According to the Maharishi Mahesh Yogi, "Transcendental meditation opens the awareness to the infinite reservoir of energy, creativity, and intelligence that lies deep within everyone ¼ . By enlivening this most basic level of life, transcendental meditation is that one simple procedure which can raise the life of every individual and every society to its full dignity, in which problems are absent and perfect health, happiness, and a rapid pace of progress are natural features of life."5
Mechanism of Action
Many effects on physiological parameters have been reported in the TM medical literature. (See Table.) These effects include decreased respiratory rate, decreased skin conductance, decreased total peripheral resistance, increased alpha-wave activity on EEG, increased frontal and occipital lobe blood flow, alterations of hormone levels (including adrenocorticotropic hormone, cortisol, growth hormone, thyroid-stimulating hormone, dehydroepiandrosterone sulfate, prolactin, epinephrine, norepinephrine, and beta-endorphins), decreased serum lipid peroxides, decreased beta-receptor sensitivity, decreased erythrocyte glycolysis, and decreased serum lactate.6,7
Specifically regarding CVD risk, TM is believed to have a beneficial effect upon risk factors including hypercholesterolemia, blood pressure, and tobacco use.8
| Table |
|
Proposed physiological changes associated |
|
• Decreased respiratory rate • Decreased skin conductance • Decreased total peripheral resistance • Increased alpha-wave activity on EEG • Increased frontal and occipital lobe blood flow • Alterations of hormone levels • Decreased serum lipid peroxide • Decreased beta-receptor sensitivity • Decreased erythrocyte glycolysis • Decreased serum lactate |
Clinical Studies
One randomized, controlled trial examined the effects of regular TM practice on carotid atherosclerosis.9 In this study, carotid intima-media thickness (IMT) was used as an indicator for coronary atherosclerosis.
The study was designed to compare the effects of TM as a stress-reduction intervention with a heart disease education group in African-American subjects. One hundred thirty-eight patients (men and women) were enrolled. All subjects identified themselves as African-American, resided in Los Angeles, and had hypertension. Exclusion criteria included history of complications related to cardiovascular disease or other serious illness. Baseline evaluations included carotid ultrasound to determine IMT. IMT was defined as the distance between the intima-lumen and media-adventitia interfaces at end diastole. Blood pressure, weight, and lipids were determined as secondary outcome measures.
Patients were randomly assigned to either a TM intervention or a CVD risk factor prevention education program. TM was performed as developed by Maharishi Vedic Medicine.10 The goals of performing TM involve inducing less active thinking processes and creating a state of "restful alertness."11
In the TM group, subjects were asked to practice meditation techniques for 20 minutes twice a day while sitting comfortably; in the health education group, patients were asked to dedicate 20 minutes twice a day to any leisure activity, such as reading or exercising. The intervention period was seven months.
In comparison to the health education group, the TM group showed a significant decrease in carotid atherosclerosis (P = 0.038). The TM group averaged a decrease of 0.098 mm vs. an increase of 0.05 mm in the control group.
A second small controlled trial examined effects of TM on cardiac signs and symptoms in patients with cardiac syndrome X.12 Cardiac syndrome X is a term used to categorize patients with angina, positive exercise stress testing, and normal coronary angiograms. Although these patients generally have a good prognosis with respect to event-free survival, they may remain symptomatic despite medical management.12 Proposed mechanisms contributing to symptoms include anxiety and increased sympathetic activation.
In this trial of TM in cardiac syndrome X patients, nine postmenopausal women with a mean age of 56 years longitudinally served as their own controls. Data were collected regarding cardiovascular status prior to the intervention and three months later. After baseline data were collected, the patients received a three-month training course in TM. After the training period, significant beneficial effects were found, using two-tailed t tests, in time to ST-segment depression on the standard Bruce protocol, maximum ST-segment depression on the standard Bruce protocol, frequency of chest pain episodes, and quality of life.12 A positive correlation was found in quality of life and regularity of TM practice.
Other studies have demonstrated beneficial effects of TM on high blood pressure and hypercholesterolemia;13,14 however, these studies have important methodological flaws or have not been reproducible.
Clinical Study Limitations
Several limitations of these studies exist. Study sizes generally were small. There was little provision for determining whether patients actually practiced TM as instructed. The randomized controlled trial described only a specific demographic group; it is unclear if findings in African Americans would be applicable to other groups. Further well-designed studies are necessary to definitively examine the effect of TM on CVD risk.
Other Health Effects
Other studies have addressed health effects of TM. Beth Roth, a nurse practitioner and mindfulness meditation consultant, and Tae-Wool Stanley, a nurse practitioner, conducted a retrospective cross-sectional study of patients who had completed a mindfulness-based stress reduction community intervention.15 They recorded the number of and reason for health care visits for 47 patients involved in the program, and found that patients had a significant decrease in the number of chronic care visits after completing the program.
In addition, other positive health effects have been proposed. These include beneficial effects on stress, risk of violent death, risk of coronary heart disease, mood disturbances, cancer survival rates, and psychosomatic symptomatology.3,12,16,17 However, few well-designed studies have been completed to evaluate the effects of TM on these conditions.
Adverse Effects
Little in the way of side effects of TM have been reported. Of potential concern, however, is delaying other, efficacious treatment while TM is being utilized.18 To minimize risks associated with a delay in effective treatment, conventional treatments and TM can be initiated simultaneously.
Conclusion
Few well-designed controlled clinical trials have examined the effects of TM on cardiovascular risk. The Castillo-Richmond et al study suggests that TM, as a stress reduction technique, has beneficial effects on CVD risk reduction. The cost of this intervention is limited to the resources required to provide instruction and follow-up of the technique. Once patients have received adequate instruction, practice of this technique is virtually cost-free. Side effects of TM have not been reported.
Recommendation
Although TM cannot be advocated as a substitute for traditional pharmacologic and interventional treatments for CVD risk reduction, this technique certainly appears to be a useful adjunct. TM is a simple, inexpensive intervention that may prevent CVD. This is an intervention that we do not have to see to believe, and can be recommended to patients who are at risk. Although cost effectiveness studies have not been undertaken, TM appears to be worth believing—or at least, examining.
Dr. Kattapong is a board-certified neurologist and a principal in MediCat Consulting, a health services consulting firm in Tucson, AZ.
References
1. Beaglehole R, et al. Cardiovascular diseases: Causes, surveillance and prevention. Int J Epidemiol 2001; 30(Suppl 1):S1-S4.
2. Barrows KA, Jacobs BP. Mind-body medicine: An introduction and review of the literature. Med Clin North Am 2002;86:11-31.
3. Pandya DP, et al. Mind-body therapy in the management and prevention of coronary disease. Complement Ther 1999;25:283-293.
4. Forker AD. Transcendental meditation and hypertension. Altern Med Alert 2001;4:61-65.
5. The Transcendental Meditation Program of Maharishi Mahesh Yogi. Available at: www.tm.org/main_pages/tm_descrip.html.
6. Jevning R, et al. The physiology of meditation: A review. A wakeful hypometabolic integrated response. Neurosci Biobehav Rev 1992;16:415-424.
7. Infante JR, et al. Catecholamine levels in practitioners of the transcendental meditation technique. Physiol Behav 2001;72:141-146.
8. Calderon R, et al. Stress, stress reduction and hyper-cholesterolemia in African Americans: A review. Ethn Dis 1999;9:451-462.
9. Castillo-Richmond A, et al. Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans. Stroke 2000;31:568-573.
10. Nader T. Human Physiology—Expression of Veda and the Vedic Literature. Vlodrop, Holland: Maharishi University Press; 1995.
11. Wallace R K, et al. A wakeful hypometabolic physiologic state. Am J Physiol 1971;221:795-799.
12. Cunningham C, et al. Effects of transcendental meditation on symptoms and electrocardiographic changes in patients with cardiac syndrome X. Am J Cardiol 2000;85:653-655.
13. Schneider DH, et al. A randomized controlled trial of stress reduction for hypertension in older African Americans. Hypertension 1995;26:820-827.
14. Cooper MJ, Aygen MM. A relaxation technique in the management of hypercholesterolemia. J Human Stress 1979;5:24-27.
15. Roth B, Stanley T. Mindfulness-based stress reduction and healthcare utilization in the inner city: Preliminary findings. Altern Ther 2000;39:481-486.
16. Buselli EF, Stuart EM. Influence of psychosocial factors and biopsychosocial interventions on outcomes after myocardial infarction. J Cardiovasc Nurs 1999;13:60-72.
17. Cunningham AJ, et al. Association of involvement in psychological self-regulation with longer survival in patients with metastatic cancer: An exploratory study. Adv Mind-Body Med 2000;16:276-294.
18. Benor DJ. Energy medicine for the internist. Med Clin North Am 2002;86:105-125.
Kattapong J. Transcendental meditation and prevention of cardiovascular disease. Altern Med Alert 2002;5:81-83.Subscribe Now for Access
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