Listening to the Heart

It just may be one of the ironies of the heart. In this age of high-tech medicine it now appears that one of the most effective strategies in caring for the heart is to listen to what it is saying. This is the opinion of several leading cardiologists and the finding of many recent studies. And interestingly, this awareness echoes what Taoist sages and traditional Chinese medicine (TCM) practitioners have advocated throughout the ages.

The standard Western medicine risk factors for cardiovascular disease, which together with coronary artery disease affects some 70 million Americans, continue as predictors. These include non-modifiable factors such as age, gender, race, and genetic background, as well as modifiable ones such as smoking, obesity or being overweight, diabetes, high blood pressure, high cholesterol levels, and a sedentary lifestyle. Yet there is mounting scientific evidence that an individual's emotional state—how he or she truly feels in their heart of hearts—is a very strong predictor of cardiac problems. And now in the West it is becoming clear that stress, depression, grief, and anger all take their toll on the heart.

The reality of this concept is not lost on Dr. Mehmet Oz, director of the Cardiovascular Institute at Columbia University Medical Center and attending surgeon at New York-Presbyterian Hospital/Columbia University Medical Center. Treating hundreds of heart patients yearly, Dr. Oz has for years supported the "new science" paradigm, viewing heart health as interconnected with the mind and emotions. "Many Americans don't realize that at the end of the day they are the world experts on their bodies," says Dr. Oz. "They need to study their body, to become students of how that remarkable organ works—the heart in particular because it really is the window into the soul of the body. We can measure things like heart rate and blood pressure, but you as a patient can sense intuitively how your heart is doing."

For cardiologist Dr. Mimi Guarneri, founder and medical director of the Scripps Center for Integrative Medicine and attending physician in cardiovascular disease at the Scripps Clinic in La Jolla, California, "each heart has its own biography, language, and method of revealing its truth if we know how to listen." In her book, The Heart Speaks, she tells of her discovery of the emotional and spiritual components of heart disease through working with her patients and how awareness of these key factors was absent from her training as a physician.

The Healing Hearts program at the Scripps Center is modeled on Dr. Dean Ornish's groundbreaking work in reversing coronary disease without drugs or surgery. Studying alongside the famous surgeon Dr. Michael DeBakey in the mid-1970s, Dr. Ornish became increasingly aware that while the then-new heart surgeries were technically impressive, restoring patients to a state of temporary functionality, in his words, they "bypassed the underlying causes of the problem." Patients were simply returning to their previous lifestyles, which had caused their heart problems in the first place. Integral to his Opening Your Heart program was the understanding that "physical heart disease may be the final manifestation of years of abuse that first begins in the psyche and spirit." Dr. Guarneri states it this way: "Suppressed emotions, or ones we are unconscious of, don't just simmer on the back burner indefinitely; they manifest themselves on a physical level and are reflected in our bodies as physical symptoms."

So how do our emotions contribute to create the symptoms related to heart problems? Many studies provide an interesting window on this process from the Western point of view. Stress is something of a generic term—what is stressful to one person may not be to another. But when present, its levels—and its destructive effects in the body—can now be accurately measured. Stress triggers the production of hormones like adrenaline, which increases heart rate and blood pressure and raises cholesterol levels. Over time, these states can cause inflammation and damage blood vessels. One study at the Mayo Clinic determined that one of the strongest indicators of future cardiac events was psychological stress. Is it coincidental that the most common time for heart attacks to occur is Monday morning?

Depression is also a very strong predictor of heart problems. From the Western perspective it can alter heart rhythm and the clotting ability of blood and cause a rise in insulin as well as triglyceride and cholesterol levels. Factors like depression and anxiety were shown in a University of Washington study to be more reliable predictors of a patient's physical damage than the degree of coronary artery disease—even when artery blockage was as high as 70 percent. And a study at Duke University Medical Center has proved that depression increases the risk of ischemia (reduced blood flow to the heart) whenever mental stress is experienced. These findings dovetail with TCM's understanding that the Heart organ network controls the emotions and therefore an imbalance of the emotions can directly affect the heart. Similarly anger, grief, and loneliness can foretell coronary trouble. Dr. Oz points out that those who live alone are especially at risk, observing that, "At the end of the day, if your heart doesn't have a good reason to keep beating, it doesn't."

Many of the new heart treatment programs use complementary therapies. Dr. Oz has pioneered an approach to health care that combines the very latest in Western medical technology with a variety of complementary modalities such as yoga, acupuncture and Qigong, and massage. These programs have shown promising success. The NIH-funded Smart Heart trial at Duke University has demonstrated the greater efficacy (not to mention the cost-effectiveness) of stress management training and exercise in preventing future cardiac events versus routine cardiac care (including the use of pharmaceutical drugs). This is the first study that indicates stress reduction can actually reduce the risk of heart problems by having positive effects on physiological determinants of cardiovascular health. Understanding this concept, TCM has always prescribed forms such as Qigong and Taiji, which use gentle movements and postures as a way to reduce stress and build energy.

East or West, fundamentally the question becomes, is it possible to have arteries that are open and a heart that functions well if the mind and spirit are clogged by problematic emotions? Can one really have abundant health if the heart is not peaceful or open in a spiritual sense? Chronic "negative" emotional states can be accurate indicators of physical heart problems, yet often they are also signs of deeper, underlying issues that we may need to become aware of and address. In this sense, symptoms accompanying health difficulties can be seen as a valuable teacher. They reveal what we need to see about ourselves. But we have to be willing to look and listen, and then act on what we discover. And while a range of help and guidance are now available, essentially only we can do this for ourselves. Aptly drawing upon the very workings of the heart, Dr. Oz comments, "I'll leave you with an analogy of the heart: The human heart, this wonderful muscle that squeezes and twists the blood out as it leaves to go to the aorta, the tube that carries the blood to the rest of the body, the first thing the heart does when it pumps the blood out is feed itself."

Dr. Mehmet Oz is one of many cutting-edge practitioners who have presented at the Building Bridges conference. Dr. Oz's ideas expressed in this article were excerpted from his keynote address at this yearly symposium, which brings together both Western and Eastern medical experience and viewpoints. Visit www.tcmconference.org or call 1.888.TCM.6909 for more information.