The Source of All Things

by Reinhard Friedl

  I wasn’t really worried, though, that I would forget my search for the heart—since it was also engrained in my long-term memory.

  Besides all this, an elastic heart also lifts one’s spirit and subjective sense of well-being, and enhances our social behavior.2 This variability of the heartbeat was the hot lead in my quest to prove that the heart’s physical voice was inextricably linked with our emotions and thoughts.

  * * *

  The elastic heart even reveals something about our capacity to empathize: the more a heart can adapt, the more compassion a person feels.3 This can also be useful for one’s self-care: for example, if you like to eat and raid the fridge at night. A recent academic study proves that people with higher heart rate variability are better able to withstand hunger pangs and reach their dietary goals.4 But does that prove the wisdom of the heart? What even is wisdom?

  A wise person considers the well-being of others, not just personal advantage; they consider the opinions of others, and accept other viewpoints; and they consider the possibility that they don’t know everything, so they seek advice and are able to make compromises. We see the opposite of such wisdom in current world politics. Intelligence alone is by no means enough to make wise decisions. History is full of “brainiacs” who often acted in a selfish and discriminatory fashion. In 2016 a scientific study proved that egotistical points of view stand in the way of wise decision-making and separate us from the signals rising from the heart.5 One hundred and fifty healthy participants were asked to find answers and solutions for problems in areas they were familiar with: health care, education, environmentalism, politics, taxes, and security. They were asked to take either an egotistical point of view or one where they removed themselves from the equation. Simultaneously, their hearts’ ability to adapt was measured. The higher their heart rate variability, the more prominent was their ability to make wise decisions—but only if they adopted an inner perspective in their brains that considered other people’s interests. If, however, they maintained an egotistical point of view, the heart could not do anything and higher heart rate variability could not exert any influence on the wisdom of their decisions. We can only act wisely when an open, adapting heart is connected with an open, sophisticated mind.

  Heartbeat and brainwave

  I had always believed that heartbeat and brainwaves did not have a lot to do with each other. Now I learned that the heart can also make a wave which influences consciousness. The wise heart is not merely a metaphor.

  * * *

  Very recently, the immense importance of breathing to the well-being of our physical heart was revealed. In a study of over 900 patients observed for five years, the survival rate after a stroke was significantly improved by changing heart rate variability through breathing (which is exactly what happens when you chant “OM”). The data can even be consulted to estimate how long patients will survive.6

  Most studies about mortality acknowledge risk factors such as smoking, diabetes, obesity, lack of exercise, elevated levels of blood lipids, and high blood pressure. Today we know that reduced heart rate variability is also an independent risk factor—even one of the most important ones. Frequently it occurs at the beginning, long before an ECG shows anything or a patient’s blood pressure goes “through the roof.” So you have to detect it early. A recent study with more than 20,000 participants observed for between three and a half and fifteen years demonstrates extremely impressively that low heart rate variability increases the risk of cardiovascular disease by 32 to 45 percent.7 And at the very end of a long illness, you will have a patient’s heart that beats barely at all, and inflexibly, the heart rate variability close to zero.

  * * *

  The inner world of those affected becomes poorer and unbalanced. They become prone to stress, hostility, bullying, depression, and anxiety. The stress system, which is regulated sympathetically, becomes hyperactive. If this state continues for a long time, our body’s energy requirements become excessively high, and we use more energy than we have at our disposal. At some stage this overdrive (or should I say overkill?) will lead to early aging, illness, and increased mortality.8 But how can an unspecific trigger such as emotional stress make a heart sick? What are the underlying mechanisms?

  * * *

  Researchers at the renowned Massachusetts General Hospital and the Harvard Medical School proved in 2017 that for human beings the amygdala plays a role in this regard. It is the “wild animal” in the zoo of our emotions, the part of our brain that becomes active when we face danger, fear, or anger. If the amygdala serves continuously and unceasingly as a command post, our bone marrow will produce more and more inflamed cells. This will eventually lead to vascular inflammation and later arteriosclerosis and vascular obliteration. Two hundred and ninety-three people who had never suffered from cardiovascular disease were studied; they were observed for three to seven years. During this time, twenty-two of them suffered strokes, angina pectora, cardiac insufficiency, peripheral vasoconstriction, or apoplexy. Why those twenty-two and not the others? What they all had in common was that PET-CT images had shown their amygdalas to be highly active. It was proven for the first time, and published in one of the world’s most prestigious medical journals, The Lancet, that if our center for anger, stress, and fear in the brain is continuously activated it inflames the whole body and makes heart and blood vessels sick.9

  The study’s authors point out explicitly that so-called stress management (especially the kind that considers our feelings) is essential for the survival of our heart. Antidepressants and tranquilizers are not what is meant here, as their long-term effects are disastrous. Their work is based on blocking different receptors, and patients thus can no longer feel what should be felt. They become deaf inside. It is understandable for patients to wish for such drugs when stress and emotional pain become unbearable. You simply want it to stop. In the short term, tranquilizers may offer a solution—but in the long run the side effects are too serious. A study with over 15,000 patients receiving therapy with antidepressants has demonstrated that in the long term such medication leads to an increased heart rate and further reduction of the heart’s variability.10 Of course, alcohol, drugs, and work (being a workaholic) are not solutions either.

  So what can we do? The good news is: a lot, as nothing is carved in stone in our biological body—many processes are reversible. A healthy diet, quitting smoking, physical activity, losing weight, and consuming less alcohol work wonders. And there is yet another remedy: breathing.

  Research into stress has long searched for something like a “jammed gas pedal:” a reason why we are often stuck in a hyped-up state. Today we know that usually the problem is not the gas pedal but rather a poorly functioning brake. In other words, the lack of relaxation.11 It is the vagus nerve that possesses this brake function; it can relax us, can cool down a hot heart, and increase our heart rate variability. But many patients are simply no longer able to find the brake pedal. Take the case of Mr. Brown …

  The enlightenment

  Mr. Brown came to me to “have his pump checked out.” He was forty-nine, tall, overweight, and I did not have to ask his profession to know that I was dealing with an executive.

  “I’m on several boards,” he informed me without my prompting. “It’s stressful. And I’m approaching the dangerous age now, right?” He didn’t give me time to respond but continued. “My blood pressure is too high, and I might as well tell you straight: I smoke. Can’t stop because of the stress. And as you can see, I’m not exactly slim. But I feel good. Yes, good. But I’m not sure if everything’s okay. Sometimes I feel funny. And last week someone at the firm conked out.” He clapped his hands. “Bang. Gone.” He exhaled noisily and looked at his watch, as if wanting to know how much time he had left. “I should exercise. But when?”

  * * *

  I opened my mouth to ask him a question, but he promptly shot me another one: “How long does the appointment with you take?”

  I could not answ
er that, as I was not yet clear why he had come to me. If the diagnosis was just “strange,” it could have been given by a family doctor, psychiatrist, psychologist, or nutritionist.

  I pondered how long I could stretch the time with him without stressing him out further, and replied: “Half an hour.”

  He sighed deeply. “Okay. Half an hour, okay.”

  “I would suggest—” I began, but he cut me off. “Should I maybe have a blood test?”

  “Yes, we’ll do that too,” I said, although I had something else on my mind first. Patients like Mr. Brown often want something done straightaway so they feel well looked after. Sometimes I hook them up to the ECG machine to calm them down. With Mr. Brown, I wanted to start by listening to his heart. A little grudgingly he took his shirt off, presumably offended that I did not employ more technology for his health.

  “How long will the test results take?” he asked.

  “If you can’t wait around for them, you can call later to get them,” I said.

  “Good, good,” he nodded. He relaxed because I had heard his message that he was a busy man without much time. I, on the other hand, was acting as a sort of messenger for his heart, and what I heard when I put the stethoscope to his chest was worrying. Even more alarming was Mr. Brown’s blood pressure. 185/110 mmHg.

  “I told you so,” my impatient patient said. “It’s always like that when I see a doctor. I have white-coat syndrome.” He tried to laugh. I sensed his fear and started to be a little afraid for him myself. He had a high-blood-pressure crisis.

  “Maybe I will come back tomorrow,” he thought out loud.

  “I can’t let you go like this,” I said calmly. “We’ll do an ECG.”

  He did not object. I had already heard that his heart was too fast, and the rate of 105 beats per minute confirmed this. Fortunately I did not find any signs of a stroke, as I had feared a little that I would. The lab results would confirm this later. I gave him an injection with emergency medication for his far-too-high blood pressure and asked him to remain lying down. “I will have to make a phone call first.”

  “I would like to take a closer look at your heart,” I suggested as an alternative, “and you can also see it on the screen for patients.”

  “Oh really? Okay, then. That’s interesting. I’m rather curious.”

  Together we looked at his heart in the ultrasound—echocardiography, as it is called. At first glance everything worked well, and the valves seemed okay too. They opened and closed impeccably. The walls of the left ventricle were thickened, as is common in patients who have had high blood pressure for years. But somehow the whole heart movement was not “round”—the heart looked as if it were wobbling. Further testing confirmed my suspicion that the left ventricle’s walls were thickened. This heart did not have a problem with exertion and contraction—it was the relaxation that was disturbed.

  * * *

  After half an hour, his systolic blood pressure had gone down to 140 mmHg.

  “So everything’s fine again,” said Mr. Brown.

  “You can’t leave such high blood pressure untreated,” I countered. “It leads to arteriosclerosis, damages the veins, and the risk of a stroke or a heart attack is high.”

  “And what does that mean?”

  “That the worry which brought you here is justified. And that you listened to the voice of your heart.”

  Now he seemed pensive.

  I took a deep breath and then launched into a somewhat different doctor’s talk. “You actually should start taking medication straightaway to reduce the high blood pressure and fast heart rate.”

  Mr. Brown interrupted me. “I won’t take beta blockers. A friend of mine’s taking them, and since he started,” he pointed to his groin, “nothing happens.”

  “And how about you?” I inquired.

  Silence. Finally he cleared his throat. “They’ve got drugs for that nowadays.”

  “Viagra?”

  He nodded.

  “And?”

  “Terrific. But … Viagra doesn’t help my back.”

  “Your back?”

  “Yes, I often have horrific pain in my lower back. Kills the sex drive. Apart from that I sleep badly.”

  I was glad to have asked, because after these confessions it was clear to me that Mr. Brown’s autonomic nervous system was considerably defective. Contraction and exertion were dominant here: in the heart, in the head, and in the back. But not where he most wished for it, between the legs.

  Normally he would be prescribed medication to lower his blood pressure and a sedative or even a mild antidepressant. His risk of heart attack or stroke was very high. But I wanted to try another approach.

  I explained heart rate variability to my patient and that it was possible to influence it without medication, through breathing and relaxation.

  “I’m not the yoga type.”

  “Breathing.” I smiled. “Not gymnastics.”

  He sighed. “Okay.”

  I attached the electrodes to measure his heart rate variability. He became impatient again. “How long will this take?”

  “Twenty minutes.”

  I was not surprised to see that the screen showed a stress curve. I asked Mr. Brown to close his eyes and breathe. He wasn’t able to keep his eyes closed, nor to breathe calmly. I liked him.

  “In that case, let’s breathe together,” I suggested.

  So I sat beside him and breathed with him. Gradually his breathing became slower, his exhalations longer. He was following my lead. I asked him not to say anything, to trust me and just play along. Then I started with a soft “OM.” After a few seconds Mr. Brown joined in, which I was surprised as well as pleased about. But he still couldn’t drop his jokes.

  “Doctor, are we becoming enlightened now?”

  Not as quickly as that, I thought—except maybe in MRI. A recent study examined what happens in the brain when people hear OM. Scientifically, the result was put like this: the blood flow increased in the “left—dorsolateral—middle frontal gyrus,” and in the “right supramarginal gyrus.” Meaning the brain started to light up like a Christmas tree in regions that had to do with empathy and compassion.12 That old acquaintance and relaxation artist the vagus nerve is also involved. Its signals allow the vibrations in the heart to increase, which in turn considerably improves the blood flow in the brain.13

  If we had done an MRI scan of Mr. Brown’s brain right now, it may well have shown “enlightenment.”

  It is interesting that so far no one has examined how immediate, curative, and powerful the chanting and breathing of OM is for our heart. To the best of my knowledge, having searched all relevant databases, this book contains the first reports anywhere in the world about the effects of OM on the heart.

  * * *

  When Mr. Brown opened his eyes twenty minutes later and saw his coherent heart curve, he cried: “Terrific! Can I buy this device somewhere? I would connect it every day.”

  “It’s not about the device. When you next connect it, such a coherent curve may elude you.”

  “OM.” Mr. Brown smiled. How relaxed his face looked now. Not one bit like the stressed executive’s mask at the beginning. I wanted to motivate him a little and explained: “For me, this visualization is a good first step to get in touch with my heart. The OM helps me control my thoughts. It is as if they fly away with every exhalation. And as I am curious, I have tried out many different ways of breathing. None was as effective as OM. The HeartMath device has shown me something I otherwise would perhaps not have believed—how much my feelings, thoughts, and breathing influence each other and how much the heart is able to express all this. The device has also supported me. But it cannot produce any amazing feelings or create a state of deep meditation. It is all about your willingness to relax, to become involved with your heart.”

  “Oh, health is so arduous,” he moaned.

  “Illness is more arduous,” I replied.

  He was silent. He appeared thoughtful, and co
nsiderably calmer. His heart rate had dropped to 80 beats per minute.

  * * *

  If before his appointment he had made any sort of decision already about what to do, he would potentially decide differently now, maybe even wisely. His heart and brain were now joined in relaxation. This would have tangible long-term implications for his health and life expectancy. I am convinced that his risk of a heart attack would drop, and his blood pressure would return permanently to normal. And I have solid scientific reasons for this.

  “So I’m to de-stress and breathe?” Mr. Brown assured himself.

  “Among other things.”

  “And sing?”

  “Can’t hurt.” I smiled.

  “Do I get a prescription?”

  “Yes. I also recommend a dose of conscious breathing at least three times daily before meals.”

  * * *

  And I would like to recommend this to you, too. As best you can, try to get in touch with your innermost heart. Perhaps you can hear your heart a little? It has been with you for so long, longer than you suspect, longer than you can remember. It was already beating three weeks after you were conceived; it is the first organ to develop. Once upon a time, you were only a heart.

  HEARTS IN SYNC

  Not that long ago I was on an emergency rotation to a small town in Mecklenburg. The emergency coordination center told us the patient was thirty-four weeks pregnant. A premature birth was imminent. In big cities there are emergency doctors who specialize in newborns, trained specifically to look after premature babies. I, the “regular” emergency doctor on duty that night, usually treated adults. My driver reckoned: “Probably a false alarm. High-risk pregnancies are really well monitored these days.”