SELF-CARE:  The Missing Link in Health-Care

A critical element is missing in the national debate on health-care reform. Politicians, medical experts and insurance executives struggle to formulate an affordable health-care system, but overlook the simplest, least expensive, yet most profound ingredient in the equation: Self-Care. The most effective way to reduce health-care costs is to reduce the demand for medical services. How? By acquainting people with attractive alternatives to old, unhealthy habits that create disease.

The U.S. Centers for Disease Control and Prevention in Atlanta, Georgia report that the key factors influencing an individual's state of health have not changed significantly over the past twenty years. Quality of medical care accounts for only 10%. Heredity accounts for 18% and environment 19%. But everyday lifestyle choices contribute an impressive 53%. The decisions people routinely make about their daily lives are by far the greatest factor in determining their wellness. The meaning of these statistics is crystal clear. If people could be introduced to some essential, basic information and be motivated to make more skillful choices, they'd experience better health and, as a consequence, lower health-care costs.

Mind-body medicine pioneer Herbert Benson, M.D. of the Harvard Medical School claims that maintaining good health is analogous to building a three-legged stool. One leg is pharmaceuticals. The second leg is surgery and medical procedures. And the third leg is Self-Care. "Health and well-being," Dr. Benson insists, "is balanced and optimal only when all three legs of the stool are in place."

The present health-care system is broken and bankrupting the nation because our society assumes that heart disease, cancer, diabetes and most of the chronic diseases that plague us are simply the natural breakdown of the human body. But that is just not true. The body strives to maintain good health. It is the mind that sabotages and overburdens the body by making poor decisions that serve short-term pleasure or convenience and undermine long-term health.

Human beings are not merely physical bodies. We are breathing and thinking beings also--living with complex thoughts, desires and emotions. Yoga Science views the body as a covering outside the mind, and the mind as a covering outside the center of consciousness (the soul). To experience health and well-being, we must properly care for and feed the body, regulate our breath, coordinate the functions of our mind and base all our actions on the inner intuitive wisdom of our spirit, as reflected by the conscience (buddhi).

Our individual achievement of optimal health does not begin with a lower health insurance premium. First and foremost, human wellness requires a reliable blueprint for mind-body self-care. With active and discriminating participation in our own health management, we can form a healing partnership with our physicians--and stop working against our own best interests.

The basis of every effective mind-body self-care program is meditation. The word meditation is derived from the Latin mederi, meaning to heal. The words medicine, medical and medicate come from the same root word. Mederi implies a sense of attending to or paying attention to something in order to facilitate well being. In meditation, you sit quietly and ask the mind to let go of its everyday tendencies to think, analyze, remember, solve problems, and focus on past events or on expectations of the future. Meditation increases theta waves (the electrical waves that appear in the brain just before one falls asleep) while the meditating person remains alert and focused. This experience creates a sense of calm awareness that allows a meditator to overcome the body's natural "fight or flight" stress response to perceived external danger or irritation. This, in turn, slows down the mind's rapid series of thoughts and feelings, and replaces that mental activity with a calm, inner awareness and attention. As a consequence of this quiet, effortless, one-pointed focus of attention, the body and mind both become rejuvenated. By maintaining a daily meditation practice, stress, fear, depression, fatigue, high blood pressure and addictions are all diminished and the body is free to function to its healthy potential.

Mind-body medicine is an approach to healing that uses the power of thoughts and emotions to positively influence physical health. As Hippocrates wrote, "The natural healing force within each one of us is the greatest force in getting well." Yoga Science, the world's oldest holistic mind-body medicine, presents a comprehensive and time-honored program for staying well.

While phrases such as "mind over matter" have been around for years, only recently have scientists found solid clinical evidence that mind-body techniques of meditation and hatha yoga actually do combat disease and promote health. Here are a few of the most recent findings.

• Educator Robert Schneider, M.D., of the Institute for Natural Medicine and Prevention, recently announced the results of a new study which found that patients with high blood pressure who meditated regularly had a 23% lower death rate from all causes and a 30% lower rate of cardiovascular disease mortality (such as heart attacks and strokes) than did similar patients in a control group.
  
  

• NaturalNews.com recently reported on two important new studies. The first, published in Diabetes Research and Clinical Practice, found that yoga postures and meditation improve blood pressure, blood sugar and triglyceride levels and reduced waist circumference. In the second study, the University of Karlstad, Sweden researchers concluded that the daily yogic breathing practices of pranayama significantly lowered levels of anxiety, depression and stress in those individuals participating.
  
  

• A pilot study in the Arab Emirates revealed that as little as 12 sessions of meditation and hatha yoga significantly improved the conditions of rheumatoid arthritis (RA) patients. Out of a total of 47 patients enrolled in the study, 26 undertook Yoga sessions, while a control group of 21 remained on regular treatment. Some patients in the yoga group were able to decrease or discontinue RA medications. The study was funded by the Emirates Arthritis Foundation.
  
  

• According to Dr. Amit Sood, director of research at the Mayo Clinic College of Medicine, both meditation and hatha yoga are used in their complementary medicine program. Meditation is used to treat anxiety and high blood pressure and to help people quit smoking without medication. Mayo reports their studies have found that meditation helps patients cope with epilepsy, premenstrual syndrome, menopausal symptoms, autoimmune disease and the anxiety experienced during cancer treatment. When Mayo Clinic patients used yoga, it was found to be effective for stress relief, lower back pain, carpal tunnel syndrome, osteoarthritis, anxiety and depression. Patients with heart disease and diabetes who practiced yoga breathing techniques and postures had significant improvement in total cholesterol and blood sugar levels.
  
  

• Research conducted by Dr. David Eisenberg and his colleagues at Harvard Medical School has recently concluded that meditation is the most beneficial of therapeutic alternatives. And it's no wonder, when you consider the growing body of medical evidence. Focusing the mind continuously on one thought, phrase or prayer for a period of time naturally leads to a "relaxation response," changes in the body that are deeply restorative and which accelerate the healing process. These beneficial changes include reductions in heart rate, blood pressure, respiratory rate, oxygen consumption, perspiration and muscle tension, as well as an improvement in immune function.
  
  

• For the first time, meditation has been shown to produce lasting beneficial changes in immune-system function, according to Dr. Richard J. Davidson of the University of Wisconsin. The study, which looked at a group of 25 biotech workers who underwent an eight-week meditation training program, is the latest in a growing body of research into the mind-body connection. Toward the end of the eight-week study, flu shots were given to the employees and a group of 16 other employees who did not receive meditation training. When researchers checked for antibodies to the vaccine at one month and two-month intervals, the meditators had significantly higher levels than the non-meditators. On average, the meditators had a 5 percent increase in antibodies, but some had increases of up to 25 percent.
  

Other clinical studies document the positive effect of meditation on mood and symptoms in people with a variety of conditions (such as high blood pressure, irritable bowel syndrome, and cancer) as well as an improved quality of life. Researchers have found that particular stress hormones are associated with specific unhealthy emotions. For example, stress related to hostility and anxiety can result in disruptions in heart and immune function. Similarly, depression and distress may diminish the body's natural capacity to heal. In contrast, emotional expression that encourages openness and active coping with problems helps stabilize the immune system.

Research indicates that the inability to skillfully deal with stress and emotions leads to inappropriate lifestyle choices and illness. According to internist Steele Belok, M.D., staff physician at Mt. Auburn Hospital in Cambridge, Massachusetts, and a clinical instructor of medicine at Harvard Medical School, "Twenty percent of Americans have an anxiety disorder. Stress arises when a person has trouble coping with the demands placed on them. When people are unable to cope, the resultant anxiety leads them to self-medicate in various ways such as food, TV, alcohol, cigarettes, drugs, and coffee." However, these methods are short-sighted because they depress the body's natural immune system. What results is a vicious cycle of stress and debilitating emotions, where the less a person is able to cope, the more he or she improperly self-medicates. These actions further worsen the ability to cope and cause even more poor lifestyle choices as some measure of compensation. This vicious, habitual cycle of stress and harmful lifestyle choices inevitably leads to disease and higher health-care costs.

Take obesity for example. Much obesity is a function of lifestyle choice, and it's not just dangerous, it's expensive. New research shows medical spending averages $1,400 more a year for an obese person than for someone whose weight is normal. Overall obesity-related health spending has reached $147 billion, double what it was just a decade ago, according to a study published by the journal Health Affairs.

But there is a way to cut short this vicious cycle of stress. One goal of meditation is to activate the relaxation response and reduce the stress response. When you are relaxed, the levels of hormones related to stress are reduced and your immune system is more efficient.

Mind-body techniques such as meditation, diaphragmatic breathing and yoga postures are helpful for many conditions because they promote relaxation, improve coping skills, reduce tension and pain, and lessen the need for medication. For example, many mind-body techniques are used successfully (along with medication) to treat acute pain. Symptoms of anxiety and depression also respond well to mind-body techniques.

Because they improve coping skills and give a feeling of control over symptoms, Yoga Science mind-body techniques are being used to help treat many diseases beyond those already mentioned. These include: asthma, coronary heart disease, cancer (and the pain and nausea/vomiting related to chemotherapy), insomnia, diabetes, stomach and intestinal disorders (including indigestion, irritable bowel syndrome, constipation, diarrhea, ulcerative colitis, heartburn and Crohn's disease), fibromyalgia and menopausal symptoms such as hot flashes, depression, and irritability.

But personal health is not the only area in our lives affected by poor lifestyle choices. According to the U.S. Bureau of Labor, American business and industry loses over $300 billion dollars annually due to the devastating effects of stress in the workplace. Worse, none of the widely used programs to combat stress are doing the job. So health-care costs, loss of productivity, and morale problems continue to escalate--especially during the current economic recession. According to the American Institute of Stress, research indicates that meditation is the most effective solution to the problem of job stress and the only program shown to significantly and reliably develop creativity and intelligence while increasing productivity.

In every culture and society, all over the world, people are educated in the skills needed to function and survive in that culture--how to talk, think, work, and investigate the objects and experiences of the external world. We learn science, technology and business practices in order to succeed in the world, but no one teaches us to understand or attend to those habit patterns that motivate actions that cause dis-ease. Instead, we merely learn to assimilate the goals, fashions and values of our society, without really examining and knowing ourselves first, within and without. This leaves us ignorant of our own inner intuitive wisdom and leaves us dependent on the advice and suggestions of others.

The take-home message from all this is simple. You are the architect of your life and you determine your destiny. For over 6,000 years Yoga Science has provided tools to help human beings learn the art of healthy living. Yoga Science is an holistic mind-body medicine that provides the skills and motivation to change old, debilitating habits into new healthy habits that enhance well-being and reduce health-care costs. Regardless of your age, if you practice Yoga Science as mind-body medicine you can cut health costs dramatically by boosting the immune system, facilitating clarity of thought, helping focus attention, increasing energy and productivity, enhancing problem solving capabilities and strengthening and healing relationships. As part of a complete daily wellness program, meditation and an easy-gentle yoga practice can improve mental, emotional and physical well being and give you the necessary skills to become an active partner with your physicians in maintaining health and vitality at a fraction of the current cost.

You can live in an optimal state of balance and healthfulness--if you simply learn to make living in that state a priority and unite the intuitive wisdom of the spirit with the healing power of your mind.

Leonard is a philosopher, educator, author and founder of the American Meditation Institute.

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CME Accreditation:  THE STUDY 
BETH NETTER, M.D.

In support of the American Meditation Institute's accreditation process for continuing medical education for physicians (through the Albany Medical College) I conducted a retrospective interview-based case study with people who had previously participated in Leonard Perlmutter's Heart and Science of Yoga™ course.

In conducting this study the goal was two-fold: To determine the "real" health benefits experienced by course participants, and if physicians ever recommend these sorts of health modalities as part of the patient's therapeutic care plan.

We discovered that: 

1. Meditation, breathing, yoga and life structure information created significant, positive, and life-enhancing physical, mental, emotional, and spiritual changes. 
   

2. Prior to the course, none of the participants' doctors had recommended this course (nor any such mind-body practices) to help treat the specific cardiac, respiratory, digestive, endocrine, or mental disease each participant was experiencing.
   

3. Even though participants/patients reported significant benefits from the course, their physicians still did not solicit additional information in order to refer other patients --often because they were unclear as to what the course actually offered.
   

I have personally taken this course, utilized the practices in daily life and referred numerous patients to the class. Even with an existing personal and professional appreciation for the effectiveness of these practices, I found the results quite impressive.

The study found that positive changes included improvements in blood pressure, cholesterol levels, relationships, and stress management. Myriad disorders, previously unsuccessfully treated with other forms of medicine, were either improved or fully healed, including digestive, cardiac, sleep, respiratory, and depression-related illnesses. Participants' quality of life and overall wellness were significantly enhanced.

The practices learned led to these reproducible, long-term health-promoting benefits: lowered blood pressure, lowered heart rate, reduced cholesterol levels, decreased chest pain, diminished or extinguished acute and chronic pain, weight loss, increased breathing capacity, increased exercise capacity, improved quality and quantity of sleep, improved energy levels, increased creative capacity, diminishment of migraines, significant reductions in stress and fear, elimination of irritable bowel syndrome and a general sense of happiness and optimism in all facets of life for every participant.

The following are a few statements obtained from this study:

Participant #2: "Before the course I was out of shape physically and mentally. Physically I had high cholesterol around 230, was out of shape and had poor eating habits. I had been an athlete. I went to the hospital thinking I was having a heart attack but it was indigestion. It was the wake-up call that helped me start the meditation course. I was resisting the cholesterol-lowering medication my doctor wanted me to take. Mentally I was mildly depressed. After the course my cholesterol went from 230 to 160s, my heart rate went down from 80s to 50s, and my blood pressure went from 140/90 to 110/70."

Participant # 13: "My symptoms of Irritable Bowel Syndrome and panic attacks decreased after the course. I went through menopause without any issues." 

Participant #14: "My migraines diminished, my cholesterol went down, and I significantly reduced my blood pressure medication."

From these findings, it is clear that the health and well being of physicians and their patients will benefit from this course.

Beth Netter, MD is an holistic physician practicing mind-body medicine at the Center for Integrative Health & Healing in Delmar, NY. She is chair of AMI's Continuing Medical Education Committee.

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They intended to put us out of business. The year was 1978 and representatives from the American Medical Association were on their way to confront our doctors and inspect our clinic. It was the first step in a messy legal process of pressing a lawsuit and shutting us down.

I had recently joined the staff at the Center for Holistic Medicine, located just north of Chicago. We were the only full service holistic center in the American Midwest at the time, and it seemed the AMA was determined to kill the radical new movement we represented. We were offering something practically unprecedented: a proactive approach to health that emphasized preventive medicine, while treating common medical complaints, not with drugs or surgery when those could be avoided, but with yoga postures and cardiovascular exercise, meditation, biofeedback and stress reduction techniques, nutritional adjustments, natural supplements, and homeopathic remedies.

In the eyes of the medical establishment we were obviously quacks playing on the naivete of a gullible public. But we were a real threat: our physicians were regularly invited on local television and radio programs, which generated tremendous public excitement. We were even featured on the Phil Donahue Show, as popular in that era as Oprah is today. When our doctors lectured at the center, which they did frequently, the hall was packed. Dr. Rudolph M. Ballentine, the director of our clinic, had written a bestseller called "Diet and Nutrition" that was revolutionizing the public's understanding of good eating habits.

The atmosphere in the clinic was tense as the two representatives from the AMA stepped brusquely into the reception area. Dr. Ballentine himself seemed remarkably at ease, considering how much trouble might just have walked in the door. Watching him handle the inspectors with confidence and calmness reminded me to bring my awareness to my breath till my nerves settled down. Focusing on the breath is an old trick yogis have used from time immemorial to help them maintain equanimity in spite of anything happening in the external environment. Activating certain nerves in the nasal cavity by shifting one's consciousness to the breathing process has a measurable effect on the brain, relaxing and balancing its reactions.

What the gentlemen from the AMA didn't know was that much of the burgeoning holistic health movement had actually originated with yoga adepts in the Himalayas. Dean Ornish-whose ideas about a role of a healthful diet in preventing and treating heart disease became hugely influential-was himself a student of Swami Satchitananda. Deepak Chopra had been a conventional endocrinologist till he met Maharishi Mahesh Yogi. Dr. Ballentine and the other doctors at our clinic were taught by Swami Rama.

All three of these well known yoga masters were based in the Rishikesh area in the foothills of the Himalayas. When they arrived in the U.S. in the late 60s and early 70s, they brought with them the sophisticated knowledge of the yoga tradition about the physical and subtle bodies and the mind. They also imported an understanding of herbs gleaned from India's own Ayurvedic medical tradition, as well as an appreciation for homeopathy. (Since homeopathy is a tremendously effective yet amazingly inexpensive way to treat disease, it is widely used in India.) In addition, the original stress reduction techniques employed in holistic medicine were borrowed directly from yogic pranayama ("breath control") exercises and visualization practices.

If our critics from the AMA believed we'd be easily vulnerable to attack, they were breathtakingly mistaken. When he founded our clinic, Swami Rama had anticipated just this sort of confrontation, and had planned ahead. All the doctors he brought onto our staff had medical degrees from top medical institutions including Duke University and the University of Minnesota. They were all steeped in cutting edge scientific research and could back up any claim they made with numerous references to the latest medical literature.

I went about my business that day teaching our patients systematic relaxation exercises, as well as yoga postures specifically tailored to their health concerns. I recommended cooking classes where they could learn to prepare high protein, whole grain-based meals and fresh vegetable dishes-a skill many Americans, raised on fast foods and frozen dinners, had never developed. I showed them how to rinse out their nasal cavity, to help alleviate colds and allergies. The patients looked up, startled, when they heard shouting coming from Dr. Ballentine's office-it was our visitors, accusing our group of physicians of misleading the public. In their best judgment we were snake oil pedlars, and our patients could be seriously harmed if they ignored standard medical protocols, following our advice instead.

Through the walls we could barely hear Dr. Ballentine's calm, measured response. He was trying to help them see the practice of medicine from a wider perspective. The holistic view was different from conventional wisdom, but that didn't necessarily mean it was wrong. It just required thinking about disease and wellness in a fresh and fair way.

There was much at stake that day for the entire holistic health movement. But there was also a great deal on the line for the medical establishment. They were distributors for the ubiquitous pills produced by pharmaceutical companies which subsidize most medical research (today these companies earn some 300 billion dollars a year). If patients began taking control of their own health, preventing or delaying the onset of major diseases-and treating common medical complaints, when possible, with home remedies or inexpensive alternatives to medication-these companies stood to loose enormous amounts of income. Since the discovery of antibiotics, with their nearly miraculous ability to cure numerous serious illnesses, most doctors had put their faith unreservedly in drugs. Prescription medications had saved tens of thousands of lives, so this wasn't an unreasonable response. It was only when the drug industry used its enormous influence to push alternative forms of therapy out of the picture that I started to feel uncomfortable with its power.

But there was an even larger issue involved here. For decades, in Western culture physicians had been in charge of their patients' health. People got sick; it was the doctor's job to cure them. The idea that patients were in part if not entirely responsible for their own well-being was unheard of, irrational, revolutionary, and potentially dangerous. Only doctors had the background and the credentials to make medical recommendations. And only allopathy, conventional Western treatment aimed at suppressing symptoms of illness, had the seal of approval from authoritative medical groups like the AMA, insurance purveyors, and the U.S. government. Any other form of treatment, including time-tested Indian and Chinese healing traditions, was deeply suspect. Even the most successful Ayurvedic specialist, who had spent as much time mastering his subject in India as any internist in the U.S., could not legally practice medicine in this country.

For over 2000 years Ayurvedic physicians in India had been teaching that many of our physical maladies are caused by our own unbalanced actions and attitudes. If we want to maintain our health, we need to eat a diet based on living foods, not over-processed lifeless ones. There should be ample physical activity, and our spines should remain supple. We also need to recognize our constitutional type and adjust our food and exercise to accommodate it. A kapha type (somewhat heavy and perhaps physically lethargic) may benefit from hot foods, a pitta type with a much higher metabolism may suffer from them. An herb used to treat a problem in a pitta constitution may be harmful to someone who is primarily kapha. Western medications on the other hand are one-size-fits-all. Evidence for damaging effects to specific body types washes out in large scale statistical studies funded by drug manufacturers.

Vaidyas, traditional physicians in India, also emphasized the importance of our thoughts and attitudes. Positive thoughts enhance physical vibrancy, and make physical challenges easier to bear when they do arise. Living in a respectful and harmonious manner with our family and neighbors also improves longevity, according to this ancient tradition of medical wisdom. Ideas like these might as well have been voodoo to Western doctors in the 70s.

The holistic movement challenged the authority of conventional Western physicians and drug therapies. Power is painful to let go of, and we could see that discomfort on the faces of the AMA inspectors. They expected anarchy, not improved health, if patients started playing a larger role in directing their own care. They were not bad people, they were simply so committed to their own point of view that it was difficult for them to understand that other perspectives might also be legitimate.

In a sense, the doctors at the Center for Holistic Medicine were anarchists. They actually explained to patients that taking antibiotics for colds and other problems caused by viruses, not bacteria, was completely medically useless. In fact, this could contribute to building a tolerance toward antibiotics so that if you contracted a serious bacterial infection and actually needed a drug, it might no longer work effectively for you. In the 1970s and 80s, you weren't supposed to tell patients that. The physician's job was to prescribe, not to educate.

In the late 70s a battle had been engaged between old ways of thinking and a new wave of medical understanding. When the two AMA representatives walked out of Dr. Ballentine's office, I knew from the expression on their faces that we had won. For every accusation they could level at our new way of thinking, our doctors had clear, well-researched responses that stopped our critics in mid-sentence. Sitting in Dr. Ballentine's office that day, they'd caught a glimpse of an unexpected future in which doctors not only treated patients but also empowered them to live vigorous, healthful lives.

Indeed, a small but important victory had been won. The lawsuit was quietly dropped, and holistic centers similar to ours began springing up around the country.

Recently I was put on hold while phoning my HMO to schedule a check-up. A tape started playing, inviting me and any other Kaiser Permanente patient who might be calling, to attend classes offered at our local Kaiser hospital on stress reduction techniques, hatha yoga, and healthful food preparation. Since I was manager at the holistic clinic, wondering whether the medical powers-that-be would close us down, an entire generation has grown up taking holistic ideas completely for granted. What was revolutionary in the 70s is largely the norm today. There's still some distance to go: Kaiser offers acupuncture now, but homeopathy hasn't taken root there yet.

What is flourishing now though, is the realization by physicians and patients alike that each of us must actively participate in our health-care, exercising, watching what we eat, and managing our negative emotions. Our doctor can't do this for us, nor can any medication. We are the architects of our own health. It's good to know the doctor is there, but it's good to know too that we have the power to live healthful, balanced lives, if we only choose to do so.

Linda Johnsen, M.S. is a regular contributor to Transformation and author of "Meditation is Boring," and seven other books on spiritual life currently available at the AMI bookstore.

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