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Issue #36 (October 2017)

From the Editor

Volume 1

Back in NERD 28v2, we covered a meta-analysis examining mindfulness-based interventions’ effect on weight loss. Recently, mindfulness has made the headlines again. In late September, the American Heart Association (AHA) released a scientific statement on meditation’s role in reducing cardiovascular disease risk. Most of the news articles I saw covering this statement had the same theme: they suggested that meditation could lower the risk of heart disease, and that more research is needed. While that’s not a completely inaccurate summary of the findings, it lacks nuance and, more importantly, it doesn’t describe the AHA’s reasoning behind the scientific statement.

So, how did the AHA come to craft their scientific statement? Quite a bit of work went into it. It’s the result of a systematic review of the literature to date on meditation’s effect on cardiovascular risk factors (like smoking and high blood pressure) and actual cardiovascular events (like stroke or heart attacks). They intentionally excluded interventions like tai chi and yoga, which mix meditative aspects with physical exercise, making it harder to estimate the effects of meditation alone. Although the authors didn’t synthesize the information quantitatively using a meta-analysis, their results still offer quite a bit of insight into the state of the science on the matter. And so far, the state of it ain’t great.

One of the main points the scientific statement emphasizes is that “the overall quality and, in some cases, quantity of study data are modest.” In short, the AHA found that the strongest evidence of meditation’s efficacy was in three areas: neurobiology, psychology, and smoking cessation. Meditation seems to reduce stress and contribute to long-standing brain changes, leading the authors to conclude that it’s biologically plausible that it could reduce cardiovascular disease risk. And smoking is a major risk factor, so interventions that improve people’s chances of quitting would likely lower disease risk.

Besides those three areas, though, the AHA noted that the evidence for meditation’s efficacy tends to be weak, contradictory, or lacking entirely. This dearth of consistent, quality evidence exists for many risk factors (e.g., hypertension) and hard clinical endpoints (such as death). Yet, the authors state that “meditation may be considered as an adjunct” to evidence-based treatment conforming to standard guidelines. The reason they suggest this is because it’s plausible that it may work, and it’s relatively low-cost and low-risk.

So, the main takeaway here is that meditation shows promise and plausibility as an adjunct therapy for cardiovascular disease. But there’s a lot more work to be done before it can be said that meditation actually lowers risk.

Gregory Lopez, MA, PharmD
Editor-in-chief, Nutrition Examination Research Digest

Volume 2

In the last volume of the NERD, I used my editorial soapbox to talk about the American Heart Association’s recent scientific statement on mindfulness for the prevention of cardiovascular disease. Well, mindfulness is in the news again. This time, though, the news is more foreboding, since what’s making headlines is a paper published in Perspectives on Psychological Science whose thesis, very roughly, is that the claims surrounding mindfulness-based interventions are overhyped.

As a person who tries (but often fails) to go on meditation retreats yearly and who’s been to a few scientific seminars on mindfulness, I agree. I would only point out that overhyping in and of itself seems to happen quite broadly in science nowadays, partially due to media reporting, partially to misinterpretations of otherwise solid findings, and sometimes due to poor methodology. In the past few years, I’ve seen claims of overhyping in everything from social psychology research to drug therapies to surgery. And, given our raison d'être here at Examine.com, it goes without saying that overhyping also can extend into the fields of nutrition and nutritional supplementation.

However, the main thrust of the paper isn’t just a general claim of overhype. That, in itself, wouldn’t be particularly interesting. Instead, one of its purposes is to explain the problems in the literature that are specific to mindfulness research. The main one being that there’s no solid agreement of what “mindfulness” actually is in the first place.

Glimmers of this can be seen in our review of a meta-analysis for mindfulness-based interventions for weight loss back in NERD 28v2. In that study, several methodologies that were mindfulness-like, from a talk therapy called Acceptance and Commitment Therapy to “multifaceted mindfulness approaches”, were reviewed. Since “mindfulness” means many different things, this means that several different approaches are being tested throughout the literature. Furthermore, that makes whether someone was successfully “mindful” or not during the intervention very hard to measure. So, if you see a headline that claims that mindfulness works for X, you should ask immediately which type of “mindfulness” is being talked about.

The authors talk about many other issues with mindfulness research, but since I only have a page, I want to highlight one other one: adverse effects. I wanted to squeeze this into my comment about the AHA statement, since their recommendation for mindfulness in part comes from its relative lack of harm. But… only one page! Anyway, the authors state that less than 25% of research papers looking at mindfulness even bother assessing adverse effects, and that this could lead to underestimating mindfulness’ potential harm. Speaking from personal experience, many meditation retreats also acknowledge that there could be problems with mindfulness, since they ask retreatants upon registration to report physical and psychological problems that may be an issue during the retreat.

While mindfulness shows promise in some areas, as one of the authors also admitted in an interview, it may have some peril as well. So, as usual: mind the hype.

Gregory Lopez, MA, PharmD
Editor-in-chief, Nutrition Examination Research Digest

See other articles in Issue #36 (October 2017) of Study Deep Dives.