Health for Life MD: Mind Over Matter

Health for Life MD: Mind Over Matter

Readers sent us their mind-body questions. We asked a Harvard psychologist for some answers

WEB EXCLUSIVE
Newsweek, September 19, 2004

Earlier this month, you wrote to us with queries about the connection between mind and body. We handed them over to Alice D. Domar, Ph.D., director of the Mind/Body Center for Women’s Health at Boston IVF. Here are her responses to some of those questions, including those excerpted in the Sept. 27 issue of NEWSWEEK.

Chicago: Since mid-June, I've had persistent low-grade pain on the left side of my neck and upper back. I've started seeing a chiropractor periodically and am doing the at-home exercises he recommends. I also do yoga 2-3 times a week, and have practiced yoga for three years. I have a stressful, demanding job that I'm becoming increasingly unhappy with. Is it possible that my stress and unhappiness at my job can override the benefits from my chiropractor and my yoga practice? Can a job actually be unhealthy for you?
Alice Domar: Yes, and yes. As much as we would like to think that no matter how tough life gets, wonderful activities like yoga can conquer all, that is often not the case. Yoga can do a lot in terms of strengthening, toning and relaxing but it may not be enough if your job is really getting to you. You didn't say what kind of work-up you have had to make sure that chiropractic care is indeed the best treatment for you, but you might want to check in with your primary-care physician since the pain isn't getting better. He or she may recommend further tests and the solution may range from getting a new pillow and/or sleeping in a different position to physical therapy to continuing with your chiropractor. Recent research does show that job stress leads to a whole host of physical and psychological symptoms, so you might want to rethink your job situation, as well. Can you look for another one? Is there a way to make your current job more palatable? Sometimes we are in situations that are making us sick but we don't take the time to think about how to change things.

Kangwon Province, South Korea: Does a positive attitude boost the immune system to fight cancer and other diseases? I have known a lot of cancer survivors who have attributed their recovery to a positive outlook and trust in divine powers.
This is a really good question and is probably one of the most-asked question about cancer. The research to date has not provided a clear answer. A study by David Spiegel, M.D., in the late-'80s indicated that women with breast cancer who participated in a support group not only were less anxious and depressed but lived twice as long as women who did not participate. Some subsequent research replicated the emotional benefits of groups, but not the survival advantage, while other studies also showed that patients who participated in psychological interventions lived longer. A very recent study (about a week ago!) indicated that indeed psychological therapy was associated with improved immune function. However, there is no definitive evidence that a positive attitude per se can fight off cancer. Pessimists can survive and some optimists do not. My advice to cancer patients is to seek out the support you need and want and not worry that your attitude will truly impact your life span.

Caloocan City, Philippines: My weight is 160 pounds. According to the charts, I am around 15 to 20 pounds overweight. But I am muscular, I lift heavy weights. My waistline is 31 inches. Can I be heavier because I am muscular? I see athletes who are overweight. Is it all right to be overweight if you are muscular?
Muscle indeed weighs more than fat so anyone who lifts weights may well be fit but heavier than the charts suggest you should be. And a study that came out recently showed that being sedentary and thin is worse for you than being fit and overweight. I would suggest examining your eating habits: are you eating lots of fruits, veggies, whole grains and lean meats? If you have solid eating habits and your primary-care physician is satisfied with your weight in terms of your muscle mass, you are most likely in good shape.

Upland, Calif.: I used to get that endorphin kick after my workouts, but no more. Is that proof or refutation of the mind-body connection?
Good question! Actually, a recent study indicated that the early research showing that people get an endorphin high during and after exercise may have been flawed. It raised the question of whether there is an endorphin high after all. That is totally contrary to the experience of many athletes—and to my own personal experience (of course, a study about 10 years ago put into question the existence of PMS, and we all know that must exist!). I would venture a guess that if you no longer get the same satisfaction from your exercise regimen it may be because your body has gotten used to the level of exercise and you might want to push yourself a bit more and see what happens.

Brasilia, Brazil: How much can fitness be responsible for satisfaction and well-being? Can aerobic exercises cure diseases like some cancers?
In my opinion, exercise comes pretty close to the ideal health promoter. If we could develop a pill that does everything exercise does (decrease the risk of heart disease, decrease the risk of certain cancers such as breast, colon and bladder, improve the immune system, decrease the risk of osteoporosis and decrease symptoms of anxiety and depression, to name a few), the whole world would be popping such a pill on a daily basis. Especially if the pill, like exercise, was free and had no side effects. So yes, fitness can definitely contribute to satisfaction and well-being. But no, I don't think we can go so far as to say that it can cure diseases like some cancers. However, patients with diseases such as AIDS and cancer who exercise do have stronger immune systems than patients who don't exercise.

Lakewood, Colo.: I'm pretty substantially overweight, by 60 pounds or so. Every time I lose a few pounds—enough for people to notice and comment on—I seem to lose my focus. Before I know it, I'm back to my old habits, even if my diet had been going really well. I can't help but think there's a connection. What do you say?
I say you are right in that the fact that people comment and compliment you may be a powerful force. In fact, just a few months ago, a new study came out that followed a group of people who were dieting as they lost weight and, unfortunately for most of them, as they gained it back. What the study showed was that as people lost weight, they attracted a lot of good attention (as in comments like: “You look fabulous!”). However, as time went on, the comments decreased in frequency and with the lack of attention, most of the dieting behavior stopped and the weight came back on. It seems that the work of dieting is worth it if people notice and make a fuss over you, but as they get used to the new you and the compliments stop, the effort may just not feel justified. The key to successful dieting may well be to try to make it more dependent on what you think and feel, rather than depending on the comments of others.

Abingdon, Va.: How does the mind-body connection work to reduce the recurrence of breast cancer? (Especially breast cancer that is receptor negative.) And how can you get the mind and body connected?
The mind-body connection can work in a lot of different ways. The goal for any cancer patient is to have an optimal immune system. There are numerous mind-body skills that are associated with improved immune function, including relaxation techniques, exercise, good nutrition, and social support. Relaxation techniques include everything from meditation to progressive muscle relaxation to imagery. The key to integrating relaxation techniques into your life is to try out several techniques and see which one or ones feel comfortable and effective for you.
The easiest way to start is with guidance; either purchase a tape/CD or go to a class. Next is exercise; adopting an exercise routine does not have to mean sweating it out in an aerobics class. Simply putting on a pair of sneakers and walking is an ideal way to start. You might only make it around half the block at first but if you slowly add distance, it will make a difference in your health. Good nutrition is a must for cancer survivors, especially as so many lose weight after surgery and during chemotherapy. Don't feel overwhelmed by suddenly making your diet ideal. There are three easy pieces of advice I had been told by nutritionists. First, balance your plate so instead of it being half meat, one-fourth starch and one-fourth vegetable, try making it half vegetable and one-fourth meat and one-fourth starch. Second, add as many colors as you can. The most healthful fruits and vegetables tend to be colorful. And finally, make three simple changes. Substitute whole grain bread for white, use brown rice instead of white, and when you make a salad, throw in lots of interesting things such as dried cranberries, grapes, different kinds of nuts, etc. Finally, seek out others who can provide support to you and to whom you can give support. Friends are crucial. In one study on breast cancer patients, the women who had numerous close friends were less likely to die than those who had few or no close friends. If you try any or all of these approaches, you will be happier and healthier.

Atlanta: I have been suffering some constipation and have also been feeling particularly moody even though I’ve gotten plenty of rest. Could the two be connected?
The two could be connected but in more ways than one. My advice is to get checked out by your primary-care physician to make sure there is no physical cause. Thyroid conditions can cause both constipation and mood changes so before we assume that this is a mind-body thing, let's make sure it is not a purely physical thing. If your doctor finds no physical cause, there are several things which could be going on. Stress can contribute to constipation so the two could be connected. Also, when people are feeling sad or depressed, they tend to move around less and eat poorly, which can cause constipation. Assuming that your doctor finds nothing physically wrong with you, I would recommend several approaches including exercise, making sure you drink plenty of water and eats lots of fruits and vegetables, and addressing what is going on in your life that may be contributing to your moodiness. Has anything changed lately? Are you in your 40s and experiencing perimenopause, which can actually cause hot flashes at night that can make you moody by day? Have you ever experienced this kind of moodiness before and if so, what helped you then? Finding a good therapist can help address these issues and cognitive-behavioral approaches can help treat the moodiness.

Austin, Texas: I am 57 years old and divorced. I left my husband two years ago to pursue a spiritual path. I was fairly healthy, enthusiastic and very excited to be free to follow my dreams of becoming a Native American Sundancer and Kundalini Yoga teacher. My brother, 48 years old, became ill within three months and was dying with cancer and wanted me there. I lived in hospitals and nursing homes for the following six months, being at his side 24/7, which was a blessing beyond explanation. I had done the same for my mother in 1990, except that she was at home. Anyway, something changed within me. Since that time, I have developed rheumatoid arthritis, lupus and chronic obstructive pulmonary disease. I could care not less if I get up in the mornings, and nothing I seem to do can restore my enthusiasm for life and my dreams. I know that there has to be a mind-body connection here, but I just cannot seem to break the code. Do you have any suggestions for me?
I would tend to agree with you that there is a mind-body connection here. Losing a close relative can cause all sorts of physical and psychological problems. My first guess is that you may be depressed. There are numerous symptoms of depression and the focus for diagnosis used to be what were called "vegetative signs" such as not being able to get out of bed, changes in appetite, etc. However, recently there has been more attention paid to changes in mood. Some of the more common symptoms are feeling hopeless about the future and not enjoying things you used to enjoy. That does sound similar to what you are describing. It is very common to experience symptoms of depression as part of a grief reaction. And depression is associated with decreases in immune function as well as a host of other physical ailments. In addition, rheumatoid arthritis and lupus are both autoimmune diseases which tend to worsen under conditions of stress. The good news is that you have a history of being a healthy, upbeat person and you clearly have an expertise in techniques such as yoga which can decrease stress levels. I would suggest that you also pursue treatment for your depressive symptoms. What I recommend to my patients is to start with antidepressant medication to get you over the hump, and then quickly start cognitive-behavior therapy (CBT). Research shows that the combination of these two treatments can get you healthy quickly and the CBT skills can keep you that way.

New York: I have minor headaches, dizziness and neck discomfort on and off all the time, especially when I'm anxious. I've had blood tests and even an MRI, which are normal. I try to relax and breathe and yet I often feel very debilitated by this. Any suggestions? I'm tired of going to doctors and suffering each day with this.
I don't blame you. Pain is exhausting and it is discouraging not to know why you feel so lousy all the time. Normally, if I have a patient with your symptoms, I make them see a physician for a complete work-up to make sure there is no physical cause. But since you have already done this, it makes sense to assume that mind-body techniques are a logical next step. The good thing about a mind-body approach is that the techniques involve minimal investment of time or money and they have no side-effects. And the worst thing that can happen is that don't help. But they usually do offer relief, both physically and psychologically. Since you report that the symptoms are worst when you are anxious, treating your anxiety is a logical first step. You might want to keep a diary for a week or so of your symptoms to see if there are any triggers. For example, if you find the symptoms are worst when driving, then learning to decrease anxiety while driving would help. Other common triggers of symptoms like yours can be work situations (such as confrontations with your boss or presenting before your colleagues), family members who "push your buttons," and even physical situations such as lifting groceries or sitting on the floor, or poor posture. Once you identify when you feel your worst and what might make you feel that way, you can concentrate on relieving your symptoms. Relaxation techniques would be a good place to start. Relaxing and breathing, as you are already doing, are a good start, but I would advise a more formal regular practice. Research shows that when you practice a regular relaxation technique, within a few weeks you experience a "carry-over" effect so you feel better throughout the day, not just while relaxing. Try hatha yoga, meditation, autogenic training, or imagery, and I wouldn't be surprised if you felt better within weeks.

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