Heart Rate Variability in the Acupuncture Clinic

Hi all.
Here is my abstract I'm submitting for an Acupuncture Research Conference in the fall. I hope they accept it. If so, I'll have a poster presentation, the lowest rung of a research presentation, but they're fun to do. Wish me luck! (Other research, on same topic of course, here.)

Heart Rate Variability Analysis in the Acupuncture Clinic: Correlation with Clinical Outcomes

Kristen Sparrow, MD

Private Practice

San Francisco, California

Background: Heart Rate Variability (HRV) analysis is a non-invasive method of assessing autonomic tone and has been studied in conjunction with acupuncture in a number of contexts. Poor health outcomes such as impaired immunity, lowered pain thresholds, mood disorders, and even accelerated aging accompany chronic stress. Acupuncture has been shown to lower sympathetic tone and enhance vagal activity, i.e decrease the stress reponse.

In contrast to the research setting, there are time and efficiency constraints in the private acupuncture practice. In addition there can be monitoring artifacts which make frequency and time domain HRV analysis impractical and unreliable. The author hypothesizes that analysis using nonlinear analysis in addition to the aforementioned analysis methods will give a more sensitive and dependable evaluation of the patients’ autonomic state and show a more consistent correlation with clinical outcomes.

Objectives:

1. Assess the feasibility of evaluating HRV across time, frequency and nonlinear domains in the acupuncture clinic setting.

2. To compare intra-treatment HRV response in patients who have positive treatment outcomes to those who do not.

Design, Setting, and Patients: Case study of 20 patients presenting to a private acupuncture clinic, representing 80 treatment sessions.

Intervention: All patients received body acupuncture prescribed by the tenets of Traditional Chinese Medicine. HRV data was collected after needle placement for 20 minutes using J and J Engineering I 330 2 Biofeedback Device. . HRV data were analyzed after each treatment.

Main Outcome Measure: Patients were assessed by symptom resolution. Their HRV data were compared for the time frames “a” (60 sec to 360 sec) and “b” (360 sec to 660 sec) using Kubios shareware for the following:

1. Time series: pnn50 %

2. Frequency Domain: FFT (LFR/HFR) ratios and HFR%

3. Nonlinear results: Poincaré Plots (SD1/SD2) and Sample entropy

Results:

Patients who responded to their acupuncture treatment tended to exhibit a decrease in LFR/HFR in the segment “a,” compared to “b” by at least 30% and/or an increase from “a” to “b” in the nonlinear measurement SD1/SD2 by at least 20%.

Non-responders, or patients who were aggravated by a particular treatment tended to show no change or an increase in their LFR/HFR from “a” to “b” and a decrease in their SD1/SD2 from “a” to “b.”

Conclusions: In this study the correlation between increased HRV suggesting vagal enhancement during acupuncture treatment and positive response to acupuncture was supported. Use of nonlinear analysis in addition to frequency domain measures added to the sensitivity of HRV outcome measures.

Blackburn, a few more quotes from the Atlantic

A month ago, I posted some discussion from the Atlantic Magazine (here) about Alternative Medicine. I didn't excerpt this particular section at the time, but will now since it's pertinent to yesterday's post (here) about telomeres and Dr. Elizabeth Blackburn. She is quoted below. (I would only take slight issue with the claim that she has "no skin in the game," since she now has a for profit company offering telomere testing, but that's small potatoes compared to Big Pharma and the Medical Device industry.) (For more information about my practice please click here.)

You might think the weight of the clinical evidence would close the case on alternative medicine, at least in the eyes of mainstream physicians and scientists who aren’t in a position to make a buck on it. Yet many extremely well-credentialed scientists and physicians with no skin in the game take issue with the black-and-white view espoused by Salzberg and other critics. And on balance, the medical community seems to be growing more open to alternative medicine’s possibilities, not less.

That’s in large part because mainstream medicine itself is failing. “Modern medicine was formed around successes in fighting infectious disease,” says Elizabeth Blackburn, a biologist at the University of California at San Francisco and a Nobel laureate. “Infectious agents were the big sources of disease and mortality, up until the last century. We could find out what the agent was in a sick patient and attack the agent medically.” To a large degree, the medical infrastructure we have today was designed with infectious agents in mind. Physician training and practices, hospitals, the pharmaceutical industry, and health insurance all were built around the model of running tests on sick patients to determine which drug or surgical procedure would best deal with some discrete offending agent. The system works very well for that original purpose, against even the most challenging of these agents—as the taming of the AIDS virus attests.

But medicine’s triumph over infectious disease brought to the fore the so-called chronic, complex diseases—heart disease, cancer, diabetes, Alzheimer’s, and other illnesses without a clear causal agent. Now that we live longer, these typically late-developing diseases have become by far our biggest killers. Heart disease, prostate cancer, breast cancer, diabetes, obesity, and other chronic diseases now account for three-quarters of our health-care spending. “We face an entirely different set of big medical challenges today,” says Blackburn. “But we haven’t rethought the way we fight illness.” That is, the medical establishment still waits for us to develop some sign of one of these illnesses, then seeks to treat us with drugs and surgery. ...
The medical community knows perfectly well what sort of patient-care model would work better against complex diseases than the infectious-disease-inspired approach we’ve inherited. That would be one that doesn’t wait for diseases to take firm hold and then vainly try to manage them with drugs, but that rather focuses on lowering the risk that these diseases will take hold in the first place. “We need to prevent and slow the onset of these diseases,” says Blackburn. “And we know there are ways to do that.” Aside from getting people to stop smoking, the three most effective ways, according to almost any doctor you’d care to speak with, are the promotion of a healthy diet, encouragement of more exercise, and measures to reduce stress.

Acupuncture has been shown in countless studies to reduce stress. So beyond the principle "First Do No Harm," I would add, "Get your acupuncture!" And, yes, in full disclosure, I also have "skin in the game."

Telomeres, Aging and Astragalus

Dr. Elizabeth Blackburn, recent Nobel Prize Winner from UCSF, published groundbreaking work on telomeres, proteins at the end of chromosomes, and how they are a measure of aging. A recent post on the effects of stress on certain chronic diseases is here. This article in the San Francisco Chronicle discusses a new company which will allow telomere testing to the public. There are many topics I would love to riff on about this whole topic, but the main reason I needed to bring this to your attention is a paragraph at the end, where her partner Harvey "Harley offers astragalus root extract, meant to stimulate telomere growth, to any takers." I can't tell you how amazing this is to me. I've been giving Astragalus to my patients, especially the formula Astra Essence from Health Concerns, ever since I set up my practice in 1998. It is a longevity formula and I take it religiously every day. I had no idea it had been implicated with telomere growth. The ancients really knew what they were doing. Astonishing. I'll try to dig up more on the science for later posts. (I'm linking to the whole article so you have context.) (For more info about my practice, please click here.) (For more information about acupuncture and stress please click here.)

Telome Health of Menlo Park tests age of DNA


Nellie Bowles, Chronicle Staff Writer

Monday, July 11, 2011
Lab scientist Saker Karimi (left) and biochemist Cal Harl... Longevity marker Telomeres are the necessary "cap" or end... Nobel laureate Elizabeth Blackburn helped found Telome He... More...

In 1989, biochemist Cal Harley took DNA samples of his entire family, from his 9-year-old daughter to his 74-year-old father.

Before Thanksgiving dinner 20 years later, he repeated the test.

Not only did the family look older (some taller, others grayer), but so did their DNA. Looking at the length of their telomeres, the tiny protective caps on the ends of DNA, Harley could see they had aged, becoming shorter. While his daughter's telomeres were just a little shorter, Harley's had been shrinking drastically.

"I was experiencing accelerated aging," Harley says, shaking his head. "I started exercising after that. And I realized this could be more than just fun with the family. So I called up Liz." Liz happens to be Nobel laureate Elizabeth Blackburn, the UCSF biologist who discovered the telomere and an old colleague of Harley's. "She's hesitant about mixing science and industry, but this was a matter of public health," Harley says.

Thus was born Telome Health Inc., founded by Harley and Blackburn, along with "deal man" CEO Dan Hunt, UCSF social psychologist Elissa Epel and UCSF biologist Jue Lin. The Menlo Park company provides telomere analyses for $199, making it the first to offer affordable, accessible telomere testing for the public.
Consumer-friendly test

Harley knew well that traditional genome science had failed in its grand goal of using DNA to determine everything from personality to disease risk. Scientists, so focused on the individual nucleotides that make up our genetic code, missed something larger: The way we treat our genes may be more important than what those genes might be.

Enter the humble telomere. Once cast aside in textbooks and by genome coders as "junk DNA," these delicate noncoding strings that dangle off the DNA can show how we've lived - how hard we've been drinking, how much we've been eating, smoking and stressing out.

Telomeres shorten each time our cells duplicate, shedding tiny nucleotides off their tips until they become stubby and frayed, and we die. Several studies have shown or suggested that if we lose weight, take Omega-3s or meditate, the telomere shortening process can slow down. Some small observational studies suggest telomeres can even lengthen.

Now, only three years after their discovery, telomere tests may become part of every regular doctor appointment from birth to well-predicted death.

"We want it to be like getting your cholesterol checked," says Blackburn, with her thick Tasmanian accent, "only it's of course much better."

The test is simple and consumer friendly: Ask your doctor to order the test, and a package will be delivered to your doorstep. Spit in the company-provided vial and mail it back to the lab. Two weeks later, you'll receive your TeloAge (your telomere's length compared to that of the general population) and HealthSpan (the number of healthy years you have left), along with a sleek graph showing your projected decline.

Morbid but, for many, fascinating.
2 markets for testing

Many Americans are obsessed with self-monitoring and pseudoscience, clinging to the heart-rate monitor of their Ellipticals, running to the click of a pedometer, watching an agile Dr. Mehmet Oz chastise the obese with elaborate mock-ups of what their organs surely look like. Men's Health magazine, with a worldwide circulation of 15 million, once ran a cancer probability calculator next to sex tips.

In another era, telomeres might have been studied more thoroughly before scientists rolled out what they bill as a stopwatch on your life. But the work on telomeres transpired in San Francisco, not Cambridge, and with Silicon Valley's influence, things move quickly.

At Telome Health Inc.'s Menlo Park office, the atmosphere is jovial. CEO Hunt sees two markets for telomere testing. First, for physicians with seriously ill patients, to determine whether a medical intervention would be worthwhile - in other words, to see if a patient is near death. The second market is for the curious private consumer, and the company plans to eventually sell the kit directly to individuals.

The ideal routine, Blackburn says, is to test every three months to see how rapidly telomeres are shortening and whether the rate is increasing or decreasing.

Some experts are worried, however, that Telome Health Inc. is marketing telomere tests to the public too soon.

"As a matter of overall public benefit, I'm not sure I see that they add societal value," says UC Berkeley bioethicist David Winickoff.

Bruce Ames and Kathleen Collins, aging experts in the department of biochemistry and molecular biology at UC Berkeley, are cautiously optimistic.

"My own suspicion is that telomeres shorten faster with bad nutrition. Americans are eating this god-awful diet," Ames says. "But giving out TeloAge? Seems a little premature. ... Whether or not telomeres actually lengthen has still not definitively been shown."

"But if people had waited to circulate aspirin," Collins counters, "a lot of people would be dead."
Insurance worries

Harley believes that any new information about health is always useful, though he is concerned that life insurance companies might take advantage of the telomere test results to increase premiums. That, he says, "would be a deep perversion of our technology."

In Telome headquarters, Harley offers astragalus root extract, meant to stimulate telomere growth, to any takers. He hasn't managed to lengthen his telomeres yet, but with running and weight loss, he says he has slowed their shrinking. "It's not easy knowing my telomeres are short," Harley leans back in his chair and sighs, "but it's good to know."

Toll From Stress: Links to Parkinson's and other Diseases

From Scientific American Mind,( www.ScientificAmerican.com/mind) an article about brain disorders result from a complex interaction between our genes and the environments to which we are exposed. A set of recent studies has just uncovered an important environmental instigator of neurodegenerative disease: stress. It goes on to say that stress has been shown to have an adverse effects on numerous psychological condition The idea that stress may figure into neurodegenerative disease, is relatively new. The research was done on rats and monkeys, but the implications for human disease are pretty clear.
Their Fast Facts:
1. A recent wave of research has unveiled an important environmental player in the genesis of neurodegenerative disease: Stress
2. Pairs of identical twins developed Alzheimer's disease in concert only 40% of the time, showing that factors other than genetics must contribute to the disorder.
3. Stress seems to impede the ability of certain brain cells to recover from insults, triggering aor aggravating the symptoms of disorders such as Parkinson's.

We know from the work of Dr. Elizabeth Blackburn that telomeres show increased cellular aging in patient populations with increased stress, so it is not too surprising that Alzheimer's would be influenced by increased stress levels also.
As readers of this blog know, stress is my particular area of interest especially using acupuncture as a mitigator of the stress response. (I have a page on my website here.)
Be Smart! Relax! And get your acupuncture! (As well as exercise, meditation etc..._
(For information about my practice, please click here.)