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The Emerging Importance of Psychoneuroimmunology: Dr Michelle Woolhouse and Professor Craig Hassed

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The Emerging Importance of Psychoneuroimmunology: Dr Michelle Woolhouse and Professor Craig Hassed

“Everything that you do to help your mental and emotional health is a positive investment in your immunity.”
 
In this episode, Dr Michelle Woolhouse and Professor Craig Hassed discuss the psychoneuroimmunology (PNI), including how the immune system and the brain talk to each other, the impact of trauma and stress on the immune system, and how mindfulness and meditation affects our DNA and longevity. 

Covered in this episode

[00:54] Welcoming Professor Craig Hassed
[01:44] The discovery of psychoneuroimmunology
[04:57] How the immune system and the brain talk to each other
[08:31] Flow on effects from positive changes
[11:11] Psychoneuroimmunology, the gut microbiome, and mental health
[17:55] How structural changes to the brain improve immunity 
[21:48] Meditation and memory
[24:25] How trauma affects the body and our DNA
[30:56] The effects of mindfulness on DNA and longevity
[37:07] Emotional regulation and reduced inflammation
[40:41] Thanking Craig and closing remarks


Resources discussed in this episode

Professor Craig Hassed
Craig's book: The Essence of Health
Monash Centre for Consciousness and Contemplative Studies
Meditation Australia
Study: Behaviorally conditioned immunosuppression (Ader & Cohen, 1975)
Food & Mood Centre at Deakin University
Study: The Effects of Meditation on Grey Matter Atrophy and Neurodegeneration: A Systematic Review (Last, Tufts, Ager, 2017)

Michelle: Hi, and welcome to FX Medicine where we bring you the latest in evidence-based integrative, functional, and complementary medicine. I'm Dr Michelle Woolhouse, and joining us on the line today is Professor Craig Hassad

Craig is the founding director of education at the Monash Centre for Consciousness and Contemplative Studies. Craig is renowned for being a pioneer in the use of mindfulness meditation within the medical world and beyond. He's been a meditation teacher for more than 30 years and was the founding president of Meditation Australia

He's with us today to discuss psychoneuroimmunology, a term that may be unfamiliar to many, but it is the term that we will learn underpins the important area of mind-body medicine. 

Welcome to FX Medicine, Craig. How are you?

Craig: Hi, Michelle. It's great to be with you again.

Michelle: Psychoneuroimmunology isn't a term that has gone viral yet, but for me, it was the most profoundly inspiring discovery in my whole medicine journey. It used to be considered a pseudoscience. So Craig, what is psychoneuroimmunology, and what does it mean for our understanding of whole-person medicine?

Craig: Well, I guess, Michelle, it's all in the name, really. Psycho, the mind, neuro, through the nervous system, immunology, talks to the immune system. So, whatever goes on in our mind has effects in the brain, and that talks to the rest of the body, including the immune cells, and change how they function, and therefore, have massive implications for health. Because it was thought that the immune system is just a bunch of cells going around doing their own thing, and yes, immune cells talk to other immune cells and so on, but in the mid-'70s, there were some interesting discoveries that really quite surprised people. 

For example, Robert Ader, who pretty much is the father of modern science of psychoneuroimmunology. They were doing studies looking at the effects of chemo on mice, the immune cells, and they were trying to use this to work out what doses were safe or not safe for humans. And they were giving them this very controlled diet, including this saccharine water, which would give the taste of being sweet but not provide any calories. So it was a very controlled diet. And they were dosing them with chemo and so on. 

Then, on occasion, they'd just give them the saccharine water but not the chemo. And they noticed that the immune system of the mice behaved as if it just got another dose of the chemotherapy, and went into quite profound immunosuppression again. And they said, "Wait, did somebody gives the chemo by mistake?"

Michelle: Wow.

Craig: And they thought, "What happens if we give the chemo again?" And the immune system would crash again. And they said, "Wait a sec, the mouse is associating the taste of the saccharine water with the chemo and having an effect on the immune system? This is classical conditioning."

Michelle: It's classical Pavlov's. Yeah. Amazing.

Craig: So they started to look closely at immune cells and lymph glands, and they thought, "Well, let's stain them up and look for nerve fibres." And sure enough, they found nerve fibres all the way through lymph glands and in other lymphoid tissue around the body. And they said, "Well, it wouldn't be there unless the central nervous system was communicating with the immune system." And then they started looking for neurotransmitter receptors on the surface of white blood cells and they were finding them all. And they said, "Well, there's something going on there." And that's really where the whole story began. It took off from there.

Michelle: And so what was so fascinating to me when I first started learning about this was that there's a bidirectional communication between the immune system and the brain, and the brain and the immune system. And that was just mind-blowing to me because, in my health education, it was always this top-down heavy response to the body. So the brain was the governor, but yet we now know that the immune system talks back to the brain. Tell us about that.

Craig: Yeah. Well, that's right because these immune cells actually send out hormones and neurotransmitters and so on, that talk back to the brain, particularly the prefrontal cortex, which is interesting. So we found that that's a very important area of the brain for regulating the immune system, but also the limbic system. 

So emotions are very central in the regulation of immunity. And it's not surprising because any health professional who's ever listened to a patient has heard from them about how, "Well, when I get stressed or get very angry or going through a difficult time, my inflammatory condition flares up or my pain gets worse," and so on. And patients have been telling us for a long time, and that should have given us pause for consideration, but...

Michelle: That's right.

Craig: ...science sometimes takes a long, long time to catch up to the obvious.

Michelle: Yeah. But it is absolutely profound. We know, in terms of pain medicine, how profound the stress response is. But I think sometimes when we're looking at the physical aspects of people's issues, like inflammation, that we don't make that connection so easily.

Craig: We now realise that the whole process is much more nuanced than we thought. So if we say, "Oh, well, we now know that, say, significant stress will suppress immune resistance to infections, viruses, and so on. And if one gets an infection, it will be more severe.” So, that’s one thing, but wait a second, the inflammation gets worse at the same time. So, it suppresses immunity, but we get more inflammation. Now, that doesn't make sense unless we now know that there's a thing called immune dysregulation. 

So we get the worst of both worlds with poor mental health. Because it's not just stress, the whole poor mental health, including anger, significant anger, and so these significant and especially chronic effects on our emotional state will dysregulate the immune system. So we get less resistance, but we get more inflammation. 

When you flip that the other way...that's the negative side of the story. And if ever you find yourself talking to a patient about this, and by the time you finish telling them all this information, they'll be feeling stressed, anxious, and depressed.

Michelle: That’s right. Exactly. It’s true.

Craig: So you very quickly got to start giving the positive side of the story, that is everything that you do to help your mental and emotional health is a positive investment in your immunity. So it'll have an immune re-regulating effect. So it'll boost your resistance, but at the same time, it will have an anti-inflammatory effect, which is a win-win situation.

Michelle: I noticed in your book...I was just rereading it. I went to have a look at it as I was preparing for this podcast and all of my highlighting had faded, so I had to go and re-highlight it. It was a bit long ago when I first came across your amazing book, Essence of Health. But you had a term in there which I loved, which was called a “brain renovation.” And I guess we could call it an “immune system renovation” where, by using a lot of these positivity mechanisms, that we can then go and really enhance our immune system, or enhance our stress resilience, or enhance our mental health.

Craig: Yes, that's right. And because all of these systems are interconnected, and the approach to medical education, probably less so in training complementary medicine practitioners because the holistic model is much more fully adopted in that. But in medicine, there was this systemic approach to the body and to education, and, "Oh, let's learn about the immune system. Let's learn about the gut. Let's learn about the immune system." So all of these systems, the nervous system, were taught and then practised in medicine as if are independent things. And that's like, well, you're in a city like Melbourne or Sydney or somewhere else, and that's like saying, "Well, the traffic is independent. The circulation's independent from industry that's producing stuff." Everything in a city is interrelated.

Michelle: Interconnected. Well, we saw with that COVID, how interconnected our infrastructure is.

Craig: Yeah. You can't affect one part of it without having flow-on effects to everything else. So this is a total fabrication in the mind of modern medicine that, unfortunately, has persisted for, well, decades, perhaps generations.

Michelle: Yeah.

Craig: And so it has to be dismantled again, and actually come back to the obvious, and that all of these systems are interrelated. And every time you make a positive investment in one way, it has positive flow-on effects in the other. And that's the really optimistic sign or message, I suppose, from a therapeutic perspective.

Michelle: Well, absolutely. And I think so much research has gone on for the last decade with regards to the gut biome, and the gut being the second brain. And all of this incredible information has come through our symbiotic relationship to bacteria. 

And I think one of the profound aspects of that was that we know that most of our immune system lives inside our gut. And so then that further extrapolates the importance of this holistic picture. 
What do we know about psychoneuroimmunology and gut health and the gut biome? What's the latest on that?

Craig: Well, look, it's just really opening up, that we realise if we don't have a good diet, for example, and we're having lots of things like antibiotics and a lot of processed foods and various stuff. So if we have a negative impact on the gut biome, the microbiome then...that has effects on the absorption, and how leaky the gut is, things get through, and has implications for allergies and immunity. And so, again, it's like a really new...well, it's not really new because people have been talking about this for a few decades now as well.

Michelle: Yeah. We're a bit slow.

Craig: We’re a bit stymied in medicine, trying to catch up. Look, I've been in medical education for 33 years now, and I'd like to say we're so much at the cutting edge, but so much of the time, actually, we're lagging behind. And so, we're just starting to realise that a healthy gut is a really important foundation for health of other systems as well. And that's...

Michelle: But that's bidirectional too, isn't it?

Craig: Yeah.

Michelle: It's like with the health of the brain and the health of our emotions impact so significantly on the gut and the gut biome.

Craig: Well, that's right. And that's been recognised for a bit longer as well, in that if you get very extremely nervous prior to exams and so on, people would often say they get queasy in the stomach. And we realised from early research on the fight or flight response that that has implications for gut motility. 

So a lot of symptoms that people experience when they're very stressed centre on the gut. But we're now realising that this is a two-way thing as well, that the health of the gut can have implications also, not just for the health of our immunity, but also for our mental health as well. Because this chronic inflammation that's set up through very poor gut health has significant implications. 

And mental health is important. Everybody has been talking about the importance of serotonin for mood and so on. And serotonin's important, the chemical, there's no doubt about it. But serotonin is not the only thing affected in depression. And so inflammation's an important part of that as well because proinflammatory cytokines...So these chemicals, mediators of the immune response, when a lot of those are being produced, they actually act on the central nervous system to produce what's called the sickness response. And so, for example, if you've got the flu, these cytokines will have effects on the brain that...

Michelle: They shut you down a bit.

Craig: You've got no motivation, you've got no energy.

Michelle: Yeah.

Craig: And it's like nature's way of saying, "Go to bed."

Michelle: Rest. Yeah, rest.

Craig: "I'm going to put you to bed, and I'm not going to make you want to feel like doing anything else." And so you go to bed and you rest and recuperate, and then a few days later you get out of bed and, hopefully, are all right again.

Michelle: That's so fascinating because we get so many people in our clinics that come with this pervasive sense of fatigue and lack of apathy and motivation. And yet we really think about the role of our cytokine inflammatory storm for that regard. This opens up our possibility of thinking along those lines for people that come in, that we haven't found any other functional reasons for why they are fatigued.

Craig: Well, that's right. And so it's not like it's going to be the explanation for fatigue for every patient, but for a significant proportion, it will be. 

And so, in depression, for example, because of the effects of allostatic load — and we can talk more about that in a moment if you'd like to — but these cytokines that are a part of that. A lot of the symptoms associated with depression in relation to appetite and energy and motivation, they got nothing to do with serotonin. They’ve got to do with these cytokines and the sickness response and also with those main pathways, and so on. And so we just think, "Oh, it's a serotonin thing." That's a very convenient explanation. And thinking of, "Oh, we're just going to prescribe antidepressants." But that's only going to touch a small part of the effects of depression.

And so when you actually take a much broader approach, and we're now starting to realise that diet and improved gut health is an important part of the recovery from depression for a significant proportion of people. The Food & Mood Center at Deakin University have done a lot of fantastic work. And they're not the only people in the world that are doing this, but realising that dietary interventions, healthy diet, is an antidepressant.

Michelle: Amazing.

Craig: And one of the important explanations for that is probably because of these effects on inflammation, as is exercise an antidepressant, as is getting some regular sunlight an antidepressant, as is sleeping well. So I've always thought myself, since my teenage years, that all of these things are interrelated. The very common first law of ecology was that everything is related to everything else. And I think that figures why we're thinking about health as well.

Michelle: We've got all these amazing techniques that have come in the last couple of decades. For example, MRI has really changed the way that we see the function of the brain. Well, functionally, MRI has changed that as well. And that's made a profound difference between seeing the role of letting go of stress, or things like mindfulness meditation or transcendental meditation on the actual structural MRI changes of the brain. 

Tell us a little bit about that because you mentioned before about the prefrontal cortex and the limbic system being involved and heavily attached to the immune system and the immune response.

Craig: Yeah. It's interesting. Again, one of the other things that have been taught for a few generations, which is now being untaught slowly, is that the brain produces all its cells and wires itself by late childhood. And then essentially, the adult brain doesn't do anything other than lose brain cells over time and gets clogged up with amyloid...

Michelle: It's not a very uplifting story.

Craig: No. So, we got the brain, and we poured it in reinforced concrete and said it doesn't change. Well, that's just ridiculous. Now we know, of course, it does change. And so every time we think something, do something, or react in a certain way, the brain and certain circuits are active, other circuits are not active. And when you activate circuits, you reinforce connections, and indeed, new brain cells, even in the adult brain. It's a neurogenesis. 

So, if you learn to play the piano, or if you want to become a London taxi driver and you've got to develop the knowledge, that is learn all the streets of London and so on, then if you measure your brain 12 months later, the brain will have changed, not just functionally, but anatomically. Grey matter thickness in those areas of the brain that have been stimulated will grow. And the memory circuits and spatiotemporal circuits of the brain, executive functioning areas of the brain, areas of the brain that serve with finger movements if you learn the piano.

So, point is that the brain is plastic, not just neuroplasticity, but neurogenesis as well, new brain cells. And now, from a meditation point of view, this is a workout for the brain, especially the attentional circuits of the brain. The cingulate gyrus and also the insula. And there are a number of areas of the brain that are getting a workout when we practice meditation. And those areas of the brain that get the workout are slightly different from one form of meditation to another depending on what kind of meditation a person's practising. 

But if you take mindfulness, where most of the research is, then that literally changes the grey matter density in some important areas of the brain, especially the attentional circuits. Now, attention is so important for, say, memory. A lot of people worry about their memory. "Oh, I've got a terrible memory. I can't remember stuff." And it's not the memory. It's the attention.

Michelle: Yeah, that's right.

Craig: If the person's not paying attention, the memory circuits are offline.

Michelle: That's right.

Craig: And if they continually don't pay attention, then the memory circuits are continually offline. And that's our way of telling the brain, "I don't need those circuits. I'm not using them." So the brain will prune them back through disuse. Like a muscle that's not being used, it wastes away. A bone that's not being used, gets osteoporosis because the body says, "You don't need that, well, I'll just dismantle it."

Michelle: It's such a great way of thinking about it because I know a lot of people are worried about their memory. And recently in clinic, I really noticed more and more people, even at younger ages, are actually complaining about memory and cognitive impairment and foggy brain. And that was never discussed 20 years ago. That whole concept of foggy brain didn't exist 20 years ago. And now it's like even in the medical software, they've got a tick box that says foggy brain. 

Craig: Yeah.

Michelle: And I think really thinking about how empowered we are to be able to actually make our brain denser. Because it doesn't...I was reading a study, Richard Davidson's study of looking at beginner meditations. And they had quite profound changes within about, was it eight weeks of doing a beginner meditation course? It's not like you have to be a serious monk for four hours a day to see these changes. It doesn't take as long as what people actually think it does, which is so inspiring too.

Craig: Yes, that's right. So after six or eight weeks of practising these skills, and the person's not practising memory tasks. The person's practising attention through meditation, but the memory circuits will change. Also, the emotion regulation circuits change. Also the areas of the brain associated with interoception. That is your ability to be in touch with your body change, the ability to switch attention, the ability to process information. 

So a lot of executive functioning circuits get a workout through the practice of meditation. And this, of course, has flow-on effects into the person's day-to-day life. "Oh, I'm working better. I'm making...

Michelle: Yeah. Performance.

Craig: ...better decisions.

Michelle: That's right.

Craig: I'm processing information better. I'm getting less emotionally reactive than I used to."

Michelle: They lose their keys less.

Craig: Yes, that's right. Just even in simple ways, a person walking away from their car to the office, for example, and how far to the office, "Did I lock my car or not?"

Michelle: Yeah, that's right. It would save so much time.

Craig: Well, that's right. Will I keep walking or will I go back and check? And then there's this internal agitation, go back and check. But we did it on automatic pilot because the mind was already thinking about the stuff we've got to do at work. So in that one second that that little button on the key ring was being pressed, we weren't paying attention, so it doesn't register in memory. 

It's interesting when we've known for a long time that...well, the last 15, 20 years, that meditation practices change the brain and generate new brain cells and slow the loss of brain cells. So by about the age of 50, one recent study was showing that people who practised these skills regularly, their brains are about 7-and-a-half years younger than people who don't. Which, I don't know which side of 50 many of our listeners will be under.

Michelle: Whoa. I’m just under.

Craig: I can assure you that it becomes a more and more attractive option all the time.

Michelle: It sure does.

Craig: And mind you, if you practise too much meditation, you wind up with the brain of a 5-year-old, which is probably not quite so good for anyone.

Michelle: So there's a point, there’s like a sweet spot. I want to be 21.

Craig: You go ahead and do it. Don't overdo it.

Michelle: There's a lot of talk about holding our trauma and emotions in the body now. And there's a whole new way of discussing trauma like through the vagus nerve plays a role and the parasympathetic nervous system. What does all that mean? What do you think they mean by holding the trauma in your body? And does that change the way we think about emotional well-being in that whole-person care?

Craig: Yes. This is an interesting and important area, but I think it's a very difficult one to be precise about in the way that we might like to be. So, it would be hard to say that, for example...and it depends. Psychologically, on a deep level, a person might express certain symptoms, even unconsciously, associated with past trauma with particular areas of the body. It's very hard to join all the dots from a psychological-emotional experience, and then all of the biochemical and neurological pathways that mean that that, therefore, expresses itself in those particular symptoms in that part of the body. It's hard to join all those dots and to be 100% sure about that. That doesn't mean, of course, that it's not, it just means that that's a very difficult thing to prove.

Michelle: Yeah. It's so nuanced and abstract.

Craig: But we certainly know that psychological events from past experience can have significant effects in the body, and even in our DNA. So if you look at, say, people who might have been two generations removed or one generation removed from Holocaust survivors, the people that went through the Holocaust, an extraordinarily stressful situation, and that had effects on the DNA, their chromosomes, especially the segments of chromosomes that regulate the stress response.

Michelle: Interesting.

Craig: So, it was like people coming away from that situation, there were epigenetic changes to the chromosome segments that regulate the stress response. But what they've found is that those changes can be handed on to the next generation and the next generation.

Michelle: That's incredible.

Craig: Which is interesting. Other things have gone back many more generations from that, perhaps even three or four. It's very hard to keep going back because we don't have the data from hundreds of years ago. But the lifestyle that your grandparents or great grandparents led, for better or for worse, is expressing itself in your DNA now, through epigenetic changes. 

Not changes in the makeup of your DNA, changes in the way that your DNA functions and expresses itself because of all of the things around the DNA that are turning on and turning off particular chromosomes or segments of chromosomes. So these kinds of traumas, even from a generation or two back, can have flow-on effects even through generations. So in a way, is it nature or nurture, for the next generation to have problems? Well, it's probably both...

Michelle: Both.

Craig: ...like with everything.

Michelle: Yeah.

Craig: That it's nature, what we're born with, but it's also nurture, the environment that we're brought up in. And so, I think it's always going to be a combination of those two things. So, it's held in the body, but it even seems to be held in the DNA. 

It was interesting, animal studies you can do that you can't really do on humans. They looked at giving, again, a conditioned response in mice. So they would give them the smell of orange blossom, and at the same time, they would give them a little electric shock. So they’d do that a few times so that the mouse quite quickly related the smell of the orange blossom to an electric shock. So when it was presented with the orange blossom smell by itself, it would start shaking as if it was about to receive a shock. And then they got those male mice to reproduce. 

So the next generation comes along, and then they expose the next generation to orange blossom. They've never been shocked, but they'll just give them a smell of the orange blossom, and the mouse starts shaking, having a quite extreme stress response...

Michelle: Oh, my goodness.

Craig: ...even though they've never been shocked or never been classically conditioned.

Michelle: That is unbelievable, isn't it? Wow.

Craig: We don't know the implications for all this. If we were landing on a continent, it's like we've just landed on the shore, and we've got this vast continent to explore, and we've only seen about a few square meters of it. This is...

Michelle: It's so incredible. Uncharted, all this.

Craig: ...unexplored territory.

Michelle: I've heard you talk many times, but you talk also about the role of mindfulness on telomeres and longevity, and cancer protection as well. So this isn't just on our immunity to protect us from viruses or bacteria or inflammation. It can even go as far as having influences on our risk of cancer. Tell us about the links and what the science is saying about the role of telomeres and, say, mindfulness, or other forms of meditation.

Craig: Yeah. Well, there are lots of dots still to join, but what's been done, and mainly through the work of Elizabeth Blackburn who won the Nobel Prize for discovering telomeres, she's an Australian scientist working in the States, and she and her main colleague in this area of research, Elissa Epel, they were looking at the effects of significant chronic stress, poor mental health, anger and hostility. And these things are actually having an effect of shortening telomeres. 

Now, for those listeners who are new to understanding about telomeres, if you imagine your chromosomes as long, coiled up molecules of DNA, on the end of the chromosomes are these little caps called telomeres, and they stop the DNA from unravelling a little bit like the plastic bits on the end of shoelaces stop shoelaces from unravelling. And then as we age and every time our cells divide, those telomeres are getting whittled away at end shorter and shorter. And as they get shorter, the DNA starts to unravel and mutate and get damaged and essentially they've found that the shorter the telomeres, the older we are, and the bigger the risk of the illnesses that we associate with ageing, like cancer and heart disease and dementia. So, big implications for health.

Although, I've just told the story as if it's one-dimensional but we know that there are subtle different variations of that story. But that's the overall story. We're still trying to work out the whole...well, I'm saying we, I'm not one of the researchers in this area. But the scientific community is still trying to work it out, the full story. 

So, for example, one of the first studies was looking at women who were carers for children with major chronic conditions. And they found that by their late 30s, the women were 9 to 17 years older as far as their DNA was concerned compared to women who were mothers of children but without chronic conditions. So, just the effects of carer stress could be that significant.

Michelle: Yeah. Which is so significant.

Craig: And you know how people who've been through the wringer in their life had...And mind you, I should say as well, in that study, it depended on how well or poorly the women were coping with those demands. Because women who were in that situation that were coping well emotionally, compared to the women who were coping poorly emotionally with that situation, the women who were coping poorly were 9 to 17 years older as far as their DNA was concerned. 

Michelle: Well that’s important because it gives you…

Craig: And so, it wasn't the situation as much as how...

Michelle: Yeah, the coping.

Craig: ...people cope with it. Anger and hostility, particularly from men, are associated with shorter telomeres, much more so than for women. Anger and hostility is much more a male problem. Mind you, male anger and hostility can cause massive problems for everybody involved with the men, but it particularly affects males. So that's the negative side of the story. And unhealthy lifestyle, short telomeres, etc. 
But some of the interesting research since 2000 and the early 2010s has found that the practice of meditation actually switches on the telomerase. That's the repair enzyme...

Michelle: That's incredible.

Craig: ...that repairs and renovates the telomeres, if you like. So if that telomerase is working, then the telomeres don't shorten nearly so fast. And so that will start to happen within a week of a person learning and practising meditation regularly.

Michelle: That's incredible.

Craig: But if you follow over the longer term, what it translates into is longer telomeres. And so, for example, women with breast cancer who were taught and practised mindfulness regularly, then their telomeres stopped shortening compared to the women that had breast cancer and who were not practising mindfulness. And, of course, the psychological stress associated with that is significant. The study on middle-aged men who not only learned mindfulness practice but also took up a healthy lifestyle, what they found was that they started to regrow telomeres. And so that is a genetic version of a reversal of the ageing process. 

Now, mind you, we don't have long-term studies following people over decades to be 100% sure that those people will live for 2 years, or 5 years, or 10 years longer. All we know is that the signposts are pointing in that direction of greater longevity, and probably via a number of different mechanisms. But on the genetic level, it looks like it slows down, and possibly even with healthy lifestyle, reverses the ageing process. At least to an extent. You can't do that forever.

Michelle: Yeah. Unfortunately.

Craig: The telomeres are going to shorten sooner or later. And telomeres are not the only thing that is an important time post for ageing.

Michelle: But there are so many incredible factors that you've just spoken about. Emotional regulation and the ability to perform better, to have confidence in our skills, to have less anger and hostility. So the positive effects of meditation are absolutely profound. And so then the side effects of that is the potential for longevity and less ageing, and all of these, less inflammation.

Craig: Yeah. Well, and if I can add a footnote to what I was saying before and to pick up on some of the things you're saying. Noticing that meditation has these effects from a genetic level physiologically, neurologically, etc. doesn't mean if you meditate, we'll never get cancer, or if we've got cancer, we just need to meditate and it'll go away. 

What we're talking about is that it can help to take some of the wind out of the sails of the chronic conditions and do some things to help to support the body's own natural resistance. And so it can help to shift a balance more in our own favour, but it needs to be taken in conjunction with all of the other treatments and everything else that might be necessary for that condition, or to help the person to cope with that condition emotionally, or to cope with the symptoms associated with the condition or the treatment. So it's not like just meditate and everything will go away. So it's a really important potential adjunct in the management of these conditions.

But those questions you were mentioning before, like asking people, particularly for men, about anger and hostility, is very important because if somebody says...And to actually try and quantify how often and how angry somebody gets because that could be a really important part of the management of their heart disease. And so, for example, if somebody gets really, really angry, then within the next two hours, depending on their other cardiovascular risk factors, they're eight to nine times more likely to have a heart attack in the following two hours than they would be if they hadn't gotten angry. That is, it can be a trigger for acute events. Or another study was looking at how often somebody gets angry and looking at their other risk factors. And what they found was for people who got angry about, say, 5 times a day, and that could be just in the traffic, and something happens at home, etc., so 5 times a day, and if they got high cardiac risk factors, there was, what was it, 657 extra cases of cardiovascular disease per 10,000 people per year.

Michelle: Gee.

Craig: That's a lot. That's a lot of increase.

Michelle: That's a lot.

Craig: That's over and above what you would expect when controlling for their other risk factors. So that's a lot. So if you ask them, "How often do you get angry, really angry?" And that may be a really important part of the management factors that we're...

Michelle: And a really important doorway into an opportunity to explore a whole new way of helping reduce down the risk and helping to support their life, and helping really to work towards optimising their health, whether they've got these chronic diseases or not. 

Craig, I have to thank you so much for joining us today to discuss this incredible concept, really, that I don't think gets enough airplay. We've learned about the role of stress and mindfulness on epigenetic changes, on our immune function, the role of emotional regulation on health, and thickening our prefrontal cortex so that we can become more productive and optimised and have these incredible forward-thinking planning skills. I love the concept of holism and whole-person care, and this interconnection with ourselves, and the whole of life, really. 

So it's not just about us being all interconnected, but it's ourselves being interconnected to each other and to the community, and to the world, and to the land, and ecology as you mentioned before as well. And so it was just a pleasure speaking to you today.

Craig: Well, it's been a pleasure as well for me, Michelle. So, I hope it's been useful for all the listeners. And perhaps I haven't said anything like good mental health, the importance of healthy lifestyle and diet, perhaps none of this is new, but maybe a lot of the modern research is just giving people more and more reason to have good faith in putting those things into effect in their lives.

Michelle: Yeah. Thanks, everyone, for listening today. Don't forget that you can find all the show notes, transcripts, and other resources from today's episode on the FX Medicine website. I'm Dr Michelle Woolhouse, and thanks for joining us. See you next time.


About Professor Craig Hassed

Professor Craig Hassed OAM has been working within the Faculty of Medicine at Monash University since 1989. Now he also teaches into a number of other faculties, is coordinator of mindfulness programs across Monash and is the founding Director of Education at the Monash Centre for Consciousness and Contemplative Studies. His teaching, research and clinical interests include mindfulness, mind-body medicine, lifestyle medicine, integrative medicine and medical ethics. Craig developed and integrated into the Monash medical curriculum the world-first mindfulness-based healthy lifestyle course called the Health Enhancement Program and has collaborated with Australian and international universities helping them to integrate similar content.

He has authored over 100 papers in peer-reviewed journals and has published 14 books and 16 book chapters. Craig is regularly invited to speak and run courses in Australia and overseas in health, educational, government and corporate contexts. He was the founding president and patron of Meditation Australia, is a Smiling Mind ambassador and a regular media commentator featuring in the documentaries, The Connection, and My Year of Living Mindfully. He co-authored with Richard Chambers two free Mindfulness MOOCs (massive open online courses) in collaboration with Monash University and FutureLearn, both of which are rated by Class Central as the two leading online mindfulness courses globally and among the 10 top online courses for any subject in the world. In 2019 Craig was awarded the Medal of the Order of Australia (OAM) for services to Medicine.


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Michelle Woolhouse
MBBS, FRACGP, ACNEM, FASLM, Grad Dip. Mind-Body Med Dr Michelle Woolhouse is an integrative specialist GP. Her philosophy is that health addresses the whole spectrum of a person’s life: emotional, physical, mental, spiritual and environmental. Dr Woolhouse has an in-depth understanding of the underlying cause of diseases and in the healing principles of the body from an energetic, biochemical , psycho-spiritual and relational level. In addition to her medical degree from Monash University in 1996, and her fellowship with the Royal Australian College of General Practitioner’s (RACGP), she also has post graduate qualifications from Swinburne University in Nutritional Medicine and Mind-Body Medicine, as well as training in hypnotherapy, acupuncture, and various meditation techniques. She was the founder and medical director of Whole Medicine, the second largest integrative medicine clinic in Victoria, from 2009 to 2020. Dr Woolhouse is co-founder and co-host of the award-winning health podcast, The Good Doctors, and is currently the medical director of Australia largest wellness platform and soon to launch online wellness support program, called vive.ly. Her number one piece of advice to patients is: everything in moderation even moderation. She loves surfing, watching her children grow up, yoga and walking in nature.