Laughter remains good
medicine
Friday, April 17, 2009
The connection between the body, mind and spirit has
been the subject of conventional scientific inquiry for some 20
years. The notion that psychosocial and societal considerations
have a role in maintaining health and preventing disease became
crystallized as a result of the experiences of a layman, Norman
Cousins. In the 1970s, Cousins, then a writer and magazine editor
of the popular Saturday Review, was diagnosed with an autoimmune
disease. He theorized that if stress could worsen his condition, as
some evidence suggested at the time, then positive emotions could
improve his health. As a result, he prescribed himself, with the
approval of his doctor, a regimen of humorous videos and shows like
Candid Camera©. Ultimately, the disease went into remission and
Cousins wrote a paper that was published in the New England Journal
of Medicine and a book about his experience, Anatomy of an Illness:
A Patient's Perspective, which was published in 1979. The book
became a best seller and led to the investigation of a new field,
known then as whole-person care or integrative medicine and now,
lifestyle medicine.
The unscientific foundation that was laid down by Cousins was taken
up by many medical researchers including the academic medical
researcher Dr. Lee Berk in the l980s. In earlier work, Berk and his
colleagues discovered that the anticipation of "mirthful laughter"
had surprising and significant effects. Two hormones –
beta-endorphins (the family of chemicals that elevates mood state)
and human growth hormone (HGH; which helps with optimizing
immunity) – increased by 27% and 87 % respectively in study
subjects who anticipated watching a humorous video. There was no
such increase among the control group who did not anticipate
watching the humorous film. In another study, they found that the
same anticipation of mirthful laughter reduced the levels of three
detrimental stress hormones. Cortisol (termed "the steroid stress
hormone"), epinephrine (also known as adrenaline) and dopac, (the
major catabolite of dopamine), were reduced 39, 70 and 38%,
respectively (statistically significant compared to the control
group). Chronically released high levels of these stress hormones
can be detremential to the immune system.
Lee Berk, DrPH, MPH, a preventive care specialist and
psychoneuroimmunologist, of Loma Linda University, Loma Linda, CA,
has paired with Stanley Tan, MD, PhD an endocrinologist and
diabetes specialist at Oak Crest Health Research Institute, Loma
Linda, CA, to examine the effect of "mirthful laughter" on
individuals with diabetes. Diabetes is a metabolic syndrome
characterized by the risk of heart attack, blindness and other
neurological, immune and blood vessel complications. They found
that mirthful laughter, as a preventive adjunct therapy in diabetes
care, raised good cholesterol and lowered inflammation. The
researchers will present their findings entitled Mirthful Laughter,
As Adjunct Therapy in Diabetic Care, Increases HDL Cholesterol and
Attenuates Inflammatory Cytokines and hs-CRP and Possible CVD Risk.
They will present the findings at the 122nd Annual Meeting of the
American Physiological Society (APS; www.the-aps.org/press),
which is part of the Experimental Biology 2009 scientific
conference. The meeting will be held April 18-22, 2009 in New
Orleans.
A group of 20 high-risk diabetic patients with hypertension and
hyperlipidemia were divided into two groups: Group C (control) and
Group L (laughter). Both groups were started on standard
medications for diabetes (glipizide, TZD, metformin), hypertension
(ACE inhibitor or ARB)) and hyperlipidemia (statins). The
researchers followed both groups for 12 months, testing their blood
for the stress hormones epinephrine and norepinephrine; HDL
cholesterol; inflammatory cytokines TNF-α IFN-γ and IL-6, which
contribute to the acceleration of atherosclerosis and C-reactive
proteins (hs-CRP), a marker of inflammation and cardiovascular
disease. Group L viewed self-selected humor for 30 minutes in
addition to the standard therapies described above.
The patients in the laughter group (Group L) had lower epinephrine
and norepinephrine levels by the second month, suggesting lower
stress levels. They had increased HDL (good) cholesterol. The
laughter group also had lower levels of TNF-α, IFN-γ, IL-6 and
hs-CRP levels, indicating lower levels of inflammation.
At the end of one year, the research team saw significant
improvement in Group L: HDL cholesterol had risen by 26 percent in
Group L (laughter), and only 3 percent in the Group C (control).
Harmful C-reactive proteins decreased 66 % in the laughter group
vs. 26 percent for the control group.
The study suggests that the addition of an adjunct therapeutic
mirthful laughter Rx (a potential modulator of positive mood state)
to standard diabetes care may lower stress and inflammatory
response and increase "good" cholesterol levels. The authors
conclude that mirthful laughter may thus lower the risk of
cardiovascular disease associated with diabetes mellitus and
metabolic syndrome. Further studies need to be done to expand and
elucidate these findings.
In describing himself as a "hardcore medical clinician and
scientist," Dr. Berk says, "the best clinicians understand that
there is an intrinsic physiological intervention brought about by
positive emotions such as mirthful laughter, optimism and hope.
Lifestyle choices have a significant impact on health and disease
and these are choices which we and the patient exercise control
relative to prevention and treatment."