18 October 2021

Coming out of lockdown – 6 tips from a spiritual perspective

Six lockdowns, a world record 263 days; who in Melbourne is not ready for our latest and hopefully last lockdown to end this Friday? But I hear of widespread apprehension as people everywhere emerge from their own lockdowns and engage with a post-pandemic society. 

So this week, a different perspective. 

Six tips from a spiritual viewpoint on how to make the most of this brave new world, but first

Thought for the day

To our human meaning and purpose. 

As history unfolded and civilizations and cultures developed 

So did different religions, 

Each one of them giving birth 

To unique insights and perceptions about this silent mystery. 

And common to all these Traditions 

Is the existence of a practice of silence 

That takes us beyond words, 

That takes us from the mind to the heart,

To the way of pure attention and the way of pure being, 

Meditation. 

Laurence Freeman - Benedictine monk

Lockdown seems to have worn many people down. Or is that most? The cost has been great – financial, emotional, mental; it may well have challenged many people’s spiritual views and values. 

Yet emerging into the post-pandemic world carries its own challenges - there is still plenty of virus around. 

Coming to grips with who is vaccinated and who is not and how that affects family, friends, business, sport, leisure and entertainment; not to mention gaining access to a vaccination certificate if your IT skills are limited! 

So much uncertainty about the future – even more than normal and heavily compounded by the over-arching environmental clouds.

So what will be helpful. What do the wisdom traditions have to offer in times like these? 

Spirituality is of course different to religiosity. Spirituality is to do with everyone’s inner journey. That process of turning our attention from the outer, material world of “doing”, to the inner realm of meaning, purpose, values and “being”.

Here then are 6 tips from a fresh perspective; the spiritual perspective – based upon what are called in Buddhism the 6 paramitas. Now again, to be clear, these suggestions do come from a particular tradition, but they come free of dogma and could be well described as the fruit of mind science; form when people study the mind and find whatever anyone from ant tradition could find, verify and use to good effect in their life.

Paramita translates as 'transcendent perfection'. The 6 paramitas are actions we are encouraged to develop and take into daily life in a non-egocentric or self-less manner. While they are key practices Buddhists train in on the path to enlightenment, transcendent also means more simply - transcending the ego-based self. For this reason, these techniques and principles can be used by anyone of any or now particular faith.

Here they are, the 6 paramitas with their Sanskrit translations, 

a simple descriptor and a brief guide…

As the great Tibetan teacher Chogyam Trungpa said 'Transcendental' does not refer to some external reality, but rather to the way in which we conduct our lives and perceive the world—either in an egocentric or a non-egocentric way. The six paramitas are concerned with the effort to step out of the egocentric mentality.”

So how does this translate into a post-pandemic world and the process of emerging and re-engaging?

1. Generosity (dāna) : to cultivate the attitude of generosity

Easy enough in theory, but the challenge? It starts with your self. Be generous with your self, then it is easier with others. Give yourself time and space. Recognise any fears you may have. Deliberate. Consider what you need amidst these challenging times; what will help you? Do it! Who supports you? Seek them out. How to protect yourself without becoming paranoid? How best to practice self care? Make a plan; be clear on where you will go and what you will do.

Then be generous towards others. Remember what we have all been through – tough times… People may not be at the best as they emerge. 

Giving your time to others, even more, giving your attention to others is a gift indeed. And sharing a meal works well too!

2. Discipline – sometimes described as morality (śīla) : refraining from harm

A bogey for some. But here is the point; real discipline is not imposed, it comes from personal kindness. Generosity quite naturally leads on to transcendent discipline. With generosity building, you become gentler with yourself, and in the process become more self-less. That is real Self care. 

And with that, it not only becomes easier to do those things that are good for you; you become increasingly averse to harming others. This sort of discipline develops consistency in avoiding harm and in generating good actions.

3. Patience (kṣānti) : the ability not to be perturbed by anything

Out of discipline comes stability; the powerful emotions like anger, greed and jealousy begin to diminish. There is less reactivity, a growing sense of self control that is increasingly effortless. While a sense of gentle personal inner strength begins to manifest, there is also a reduction in aggression and defensiveness; an open-ness that feels comfortable and fulfilling.

4. Diligence – sometimes described as vigor (vīrya) : to find joy in what is virtuous, positive or wholesome

Maybe the secret here is a growing sense of gratitude. As the previous 3 paramitas begin to take shape in one’s life, there is now an increasing sense of gratitude which coincides with a genuine joy in this very life. With joy, applying one’s self comes naturally; we find it increasingly attractive – and easy - to do what works and feels good in our lives. What a delight!

5. Meditative concentration (dhyāna) : not to be distracted

As life progresses, meditation becomes more compelling. Meditation is at the heart of the inner journey, the reliable pathway to real self-discovery. And yes meditation is more than just practicing formally. As we progress, it rapidly informs how we live; indeed, it becomes our way of living.

6. Wisdom (prajñā) : the perfect discrimination of all phenomena

As we meditate consistently, inevitably we come to know our selves better, and we come to know the truth of the world and people around about us. We move from the intellect to wisdom and this wisdom, knows what to do and when to do it. As we develop the 6 paramitas and they actually begin to blossom in our lives, this wisdom guides us with clarity and confidence. 


Now, we have spoken here of the 6 paramitas, 

but it is said many rivers flow into the one ocean. 


The ocean here is the ocean of wisdom, 

transcendental wisdom and many traditions lead into it. 



May a simple knowledge of these 6 paramitas be of some use in the ongoing journey as we emerge from lockdown and re-engage with our families, friends, colleagues, and our wider communities…

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04 October 2021

Mobile phones, 5G, radiation damage and cancer risk – an update for this, the 400th post

How often are you using your mobile phone, the time slips by and then you feel the warmth around your ear? “Oh my God! Am I giving myself cancer?” Ever worried? Well, to mark this 400th post, let us go Out on a Limb once more and examine the latest evidence; who that evidence comes from, how credible it is, and what is the most likely truth in this controversial matter, but first


    Thought for the day

       Both the Observer and the Observed 

       Are merging aspects of one whole reality 

       Which is invisible and unanalysable.


                 David Bohm – theoretical physicist


Mobile phones...

Biggest health risk? Almost certainly driving while using one. Biggest health benefit? Almost certainly providing reliable communication in emergencies and therefore saving many lives. 

But what of cancer? 

Do mobile phones increase our risk of developing brain cancers in particular?

Sadly, the answer depends upon who you ask. 

I say sadly because we commonly turn to science for evidence, and yet, that evidence we know is skewed depending upon who pays for the research – particularly when multi-billion industries are involved. 


Drug studies sponsored by Big Pharma have about 4x the odds of a positive conclusion compared to independent researchers. Yet this is a modest bias when compared to studies on the health effects of second-hand smoke; studies funded by the tobacco industry have 88x the odds of reaching a “not harmful” conclusion!

So what about mobile phone research? Most independently funded studies show an effect while most of the industry-funded studies do not. The bias? Not toooo bad – industry-funded studies have about 10x fewer odds of finding an adverse effect from cell phone use. 

How then does this show up in what you might read? Here are some examples 

From the USA FDA 

To date, there is no consistent or credible scientific evidence of health problems caused by the exposure to radio frequency energy emitted by cell phones 

And this from Cancer Council WA – under the heading of Cancer Myth 

Mobile phones are in widespread use and so it is important to continue to investigate and monitor any potential public health impact. Although there remains some uncertainty, current scientific evidence indicates that a link between typical mobile phone use or mobile base stations and cancer is unlikely. There is inconsistent evidence to suggest that very heavy users of mobile phones may have a slightly increased risk of cancer.

What are we dealing with here? 

In a major article published in 2020, concerned scientists had this to say

An important factor may be the influence on politicians by individuals and organizations with inborn conflicts of interests (COIs) and their own agenda in supporting the no-risk paradigm. The International Commission on Non-Ionizing Radiation Protection (ICNIRP) has repeatedly ignored scientific evidence on adverse effects of RF radiation to humans and the environment. Their guidelines for exposure are based solely on the thermal (heating) paradigm. The large amount of peer-reviewed science on non-thermal effects has been ignored in all ICNIRP evaluations. Additionally, ICNIRP has successfully maintained their obsolete guidelines worldwide.

Hardell L, Carlberg M. Health risks from radiofrequency radiation, including 5G, should be assessed by experts with no conflicts of interest. Oncol Lett. 2020;20(4):15. doi:10.3892/ol.2020.11876

What about 5G?
 The same authors continue…

The fifth generation, 5G, of radiofrequency (RF) radiation is about to be implemented globally without investigating the risks to human health and the environment. This has created debate among concerned individuals in numerous countries. 

In an appeal to the European Union (EU) in September 2017, currently endorsed by >390 scientists and medical doctors, a moratorium on 5G deployment was requested until proper scientific evaluation of potential negative consequences has been conducted. This request has not been acknowledged by the EU. 

The evaluation of RF radiation health risks from 5G technology is ignored in a report by a government expert group in Switzerland and a recent publication from The International Commission on Non-Ionizing Radiation Protection. 

Conflicts of interest and ties to the industry seem to have contributed to the biased reports. The lack of proper unbiased risk evaluation of the 5G technology places populations at risk. Furthermore, there seems to be a cartel of individuals monopolizing evaluation committees, thus reinforcing the no-risk paradigm. 

We believe that this activity should qualify as scientific misconduct.

So in whom may we trust?

The International Agency for Research on Cancer (IARC) is the specialized cancer agency of the World Health Organization. It is recognised as the authority when deciding what is and is not carcinogenic. The IARC identifies 5 categories: Group 1 carcinogens are agents that we know with the highest level of certainty do cause cancer in human beings, Group 2A probably cause cancer, Group 2B possibly cause cancer, Group 3 : not sure, and Group 4 probably do not cause cancer.

In 2011 the IARC evaluated cancer risks from radiofrequency (RF) radiation. Human epidemiological studies gave evidence of increased risk for glioma and acoustic neuroma. 

RF radiation was classified as Group 2B, a possible human carcinogen. 

Further epidemiological, animal and mechanistic studies have strengthened the association. 

Why no action – or at least cautions?

In spite of the findings, in most countries little or nothing has been done to reduce exposure and educate people on health hazards from RF radiation. On the contrary, ambient levels have increased. In 2014 the WHO launched a draft of a Monograph on RF fields and health for public comments. 

It turned out that five of the six members of the Core Group in charge of the draft are affiliated with International Commission on Non-Ionizing Radiation Protection (ICNIRP), an industry loyal NGO, and thus have a serious conflict of interest. Just as by ICNIRP, evaluation of non-thermal biological effects from RF radiation are dismissed as scientific evidence of adverse health effects in the Monograph. 

This has provoked many comments sent to the WHO. However, at a meeting in 2017 it was stated that the WHO has no intention to change the Core Group.

Hardell L. World Health Organization, radiofrequency radiation and health - a hard nut to crack (Review). Int J Oncol. 2017;51(2):405-413. doi:10.3892/ijo.2017.4046

Recent research – there have been many papers published!

As examples, this 2017 systematic review reported a 33% increase in brain tumours with long-term use.

Prasad M et al. Mobile phone use and risk of brain tumours: a systematic review of association between study quality, source of funding, and research outcomes. Neurol Sci. 2017 May;38(5):797-810. 

This study, also from 2017 demonstrated 46% higher odds for tumours on the phone side of the head. Significantly, both these reviews included the industry-funded studies that have been accused of bias and underestimating the risk, however, in fairness they do note the available data they used to reach their conclusions is still rather flimsy. 

Yang M et al, Mobile phone use and glioma risk: A systematic review and meta-analysis. PLoS One. 2017 May 4;12(5):e0175136. doi: 10.1371/journal.pone.0175136. 

Despite – or because of this, some scientists are pushing hard to have the IARC reclassify cell phones as probable carcinogens or even elevate them all the way up into Group 1, at least for brain cancer and acoustic neuroma. 

As individuals, what to do?

There is no doubt mobiles have many obvious benefits and risks. Their effect on our relationships and way of doing business is enormous, and again, some effects we could call good, some bad.

In context, my clear sense is the cancer risks are real but quite small. Take the risk of developing brain cancer… Current statistics suggest there is a 1 in 161 (or 0.62%) risk of being diagnosed with brain cancer by the age of 85. Even if mobile phones were to double your risk to 1 in 80, that is still quite small. Way less than the risk associated with using a mobile while driving. Researchers at Monash University’s Accident Research Centre say driver distraction causes about 16% of fatal crashes, with only 7% of those distractions being mobiles (a statistic I find surprisingly low).

Still, it does make sense to minimise cancer risk wherever possible and there are things we can do

 1. Provide distance

Radiation intensity drops off exponentially with distance, so the further the phone is from your head the better. 

This is considered particularly important for children. 

Use a speaker phone (this is what I do whenever possible) or a hands free set (including Bluetooth). It is said this reduces any risks by around 100 fold.

2. Be patient

Fun fact – the few moments when your phone first connects to a new call, is when the emissions are high. So wait for a moment when taking a call before placing the phone near your head.

What about texting?

There is no evidence of finger cancer, so no obvious problem.

What about “protection devices”?


Most have been shown not only to be useless but to partially block the signals and so cause the phone to boost its emission. Better avoided.

What about Public Health messaging and business risks for employers?

Will requiring employees to use mobile phones ever have the same legal issues as requiring employees to work amidst passive tobacco smoke? Good question! 

This is discussed in the risk analysis literature. “From a public health perspective, it might be reasonable to provide cell phone users with voluntary precautionary recommendations for their mobile phone handling in order to enable them to make informed decisions”. But they say there is still “scientific uncertainty” and we need caution not to “foster inappropriate fears.” 

In the current situation, whether health authorities chose to inform the public about precautionary possibilities seems like more of a political decision than one based upon science. 

And personally, if I was an employer requiring staff to use mobile phones frequently, I would be concerned.

Summary


Use your mobile when necessary. 

Question yourself regularly – is it necessary? 

Keep the phone as far from your head as practical. 

Do not use the mobile while driving. Or eating. Or while talking face to face with anyone you value.

Enjoy…


20 September 2021

In praise of mentors – and a tribute to a footballing legend

There are many things to adapt to as one becomes older. Speaking personally, one surprise has been the size of the hole left by outliving significant elders. However, with the losses has come an even greater appreciation for the genuine mentors who have blessed, informed and enriched my life in so many ways. 

With my AFL football team - Melbourne - a real prospect to win its first Grand Final in 57 years, it feels appropriate to share something of the remarkable life of a Club legend who was a mentor, and to enthuse about seeking out and maintaining relationships with mentors if you do not have them already, but first

     Thought for the Day


The Buddha is not going to project you to Buddhahood, 

As if throwing a stone. 

He is not going to purify you, 

As if washing a dirty cloth, 

Nor is he going to cure you of ignorance, 

Like a doctor administering medicine to a passive patient. 

Having attained full enlightenment himself, 

He is showing you the path, 

And it is up to you to follow it or not. 

It is up to you now 

To practice these teachings 

And experience their results.

                Dilgo Khyentse Rinpoche


Close friend of my father, Godfather to my elder sister, father of 2 sons I attended school with and one daughter, local doctor in outer Melbourne at the one family practice for life, footballer, incredibly decent human being and powerful influence in my own life for good – Dr Donald Cordner. 

Our families grew up together and we visited regularly. But imagine this – it speaks to the modesty of the man – not until around the age of 30 did I come to know Donald had won a Brownlow Medal in 1946 (best and fairest in the competition) and that he served on the Melbourne Football Club’s Board and as President of the Melbourne Cricket Club. He never spoke of his considerable accomplishments.

Also, for those who watched the pageant and tasteful ceremony of this year's Brownlow presentation as a major event on television, consider this. In 1946, Donald was advised by mail he had won the Brownlow. He was summoned to a Board meeting at VFL House (it was V for Victoria in those days not Australian FL) where he waited half an hour on his own in an ante room. The Chair then said "Player Cordner, you have been awarded this year's Brownlow Medal", handed over the medal, shook his hand and sent him on his way. No media, no fuss; that was it!

As a teenager whose mother had died at 12, Donald was a point of reference. Whenever we visited, whenever we met, he greeted me with warm-hearted affection and importantly, with interest. He always took time to enquire what was happening in my life and was full of encouragement for whatever interested me. He was always asking challenging, sometimes provocative questions; stimulating analysis and reflection. One of his habits was to throw puzzles at his children and their visitors; he was fun as well as comforting. 

Along with his equally remarkable wife, Moyle (from whose presence I also derived great benefit) Donald provided a real model of what a long-term successful marriage could look like.

When my cancer appeared in 1975, my father was living overseas. It was Donald who came to the Hospital and helped arrange the best care and steer me through the difficult choices that led to my leg being amputated. Again, his inner strength and calm was steadying.

As the years went on and my work shifted from the veterinary world towards that of medicine, Donald was happy to discuss issues and provide insight. From time to time we would meet at the MCG, discuss the footy, usually lament the parlous state of Melbourne’s performances, touch on the news of the day, the progress in my life and work. Those meetings were always like a tonic.


Sadly, Donald died in 2009 aged 87.

With Melbourne playing in the 2021 Grand Final, 

Donald would be thrilled. 

I think of him and feel so fortunate to have had this man in my life.


The message? 


Mentors play a key role in life. Elders are important and warrant close relationships, but mentors go to the next level. Some mentors drop into your lap, some you need to seek out. Either way, whether young or older, make the effort; actively build a relationship with one or preferably more mentors. And as you advance in age, experience and wisdom, consider who you might be able to mentor. Pay it forward…


       And of course 


            - Melbourne for premiers!!!





06 September 2021

COVID, antivaxxers and tolerance – breaking the silence

This is a blog about tolerance and what sort of society we all want to live in. No doubt we all want peace and harmony, but is that because we want everyone to agree with us and be like us? Or because we encourage diversity and make an effort to understand, tolerate and even welcome it?

Currently, medical and media opinions are vehemently pro-vaccination. In my opinion they have good grounds for this stance, yet I am disturbed by how many seem intent on ridiculing and shaming those opposed – the antivaxxers, even those slow on the uptake. This tends to polarise people, create entrenched defensive/aggressive positions, take people to extremes and create what is now close to a taboo around even discussing the topic. 

The last blog on vaccinations stirred a good deal of response, including an old friend who shared their own diary-like writings aimed at helping clarify their decision not to be vaccinated at this point in time.

Choosing not to be vaccinated for COVID seems somewhat perilous. No doubt there are many reasons people chose not to be vaccinated, yet currently it seems very difficult to have a measured conversation about why. Tolerance may be in short supply.

Clearly the conclusions this friend has come to are not the same as mine, however, they are well thought out, clearly expressed, may surprise you, and warrant consideration and understanding. 

So how do you respond to someone who has a strongly opposed view to your own? Who is different to you? Is there any curiosity to attempt to understand them? Their point of view? Or is there a rapid and emotion move towards derision? Do you consider yourself to be tolerant, but then feel free to be hard on anti-vaxxers and those who support Trump – as examples of exceptions we all might hold to…

In the interest of being open and of breaking any potential silence or taboo; in the interest of challenging tolerance and commitments to understanding, here are my friend’s reflections, but first



   Thought for the day

 Ultimately, happiness comes down to choosing between 

 The discomfort of becoming aware of your mental afflictions 

 And the discomfort of being ruled by them.

                             Mingyur Rinpoche





Reflections from a friend   who asked to remain anonymous - a further indication of the difficulty expressing these views publicly…

In January this year I reviewed my position re COVID vaccinations and came to the position that I would not get vaccinated but that I would leave the door open and see how the situation unfolds. Time has moved on and a new situation presents itself. I feel it time to review my position.

What is new? We now have ready availability of vaccines and subsequent pressure from the government and media for people to get vaccinated.

Also, potentially severe restrictions are emerging for non-vaccinated people. 

This includes likely expected pressure and victimisation of non-vaccinated people from the wider public. 

My expectation is that life will become very difficult and restricted for non-vaccinated people.

How does this influence my position re COVID vaccination? 

On the one hand it would be so easy to just give in, make an appointment and have this vaccination over and done with and life could continue as usual – fairly straightforward. In addition to that I could do a bit more specific healing meditation around the actual vaccination event and the impact on the body, as a friend of mine suggests and ‘end-of-story’. Let life go on without avoidable government pressure/punishment and potentially ugly peer pressure and the fear surrounding all of that. 

So what is holding me back from this fairly straightforward process?

There is a strong inner voice active in me telling me to not accept this vaccination for myself. 

The inner voice is based on the following points:

1. I have reservations about the lack of a spiritual awareness in mainstream science and in medicine particularly. The human body is commonly regarded as a ‘complicated machine’ devoid of a spiritual dimension. In my worldview there are 2 vital dimensions - spirit and matter. For me, very clearly spirit is primary and matter secondary. 

From that perspective I evaluate very carefully what allopathic/mainstream medicine offerings are acceptable to me or not. In case of COVID vaccination; that is not acceptable to me at this point in time.

2. I am very particular about what I accept going into my body or being done to my body in the form of drugs, vaccines, medical treatments and foods. There is a particular emphasis for me to avoid genetically engineered/manipulated DNA substances wherever possible.

3. I maintain a healthy immune system through a very healthy lifestyle and I trust my immune system to be able to handle viruses.

4. I am not afraid of death. I accept my destiny. If I get COVID or other viruses I will do my best to recover from it. However, if it is my destiny to die from a viral infection, so be it.

5. In the mainstream narrative of the so-called COVID pandemic, the COVID virus is seen as the primary enemy and warlike measures have unfolded worldwide to ‘beat the enemy’. 

Following explanations of credible virology experts in the field there are millions of different viruses around and we could not exist without the viral dimension. 

The challenge is to find a way to co-exist with the viruses and on one level strengthen the immune system to cope with the health effects of some viruses like COVID. 

On another level there needs to be a clearer recognition how the treatment and exploitation of the earth, animals and plants as spirit-less commodities has contributed to conditions whereby viruses jump from animals to humans for instance and interfere with human health. I suggest the root causes should be addressed as a matter of urgency to work towards a sustainable future for all living beings.

6. I spent a lot of time reading/listening/watching the ‘experts’ in the field arguing for and against the current COVID vaccinations and the severity of the so-called COVID pandemic over the last 18 months. I cannot claim to know the truth; as a matter of fact I realised that no amount of research will lead me to the point of ‘knowing the truth’. However, all the information I could take in from the experts in the fields from different camps, leaves me with serious question marks over the validity, accuracy, robustness of the ‘main narrative’ promoted relentlessly by the so-called mainstream leading medical organisations, the mainstream media and the governments at all levels. 

For me the ‘mainstream narrative’ leaves me with too much doubt, too many question marks. And for me this puts serious reservations over the real motives for the relentless, unprecedented push for people to get vaccinated. Too much doubt remains for me which prevents me from trusting the ‘main narrative’. Based on all that I cannot just take the simple way out and get vaccinated. 

The opposition of my ‘inner voice’ to the COVID vaccinations for myself is also strongly linked to my
spiritual beliefs. 

It feels that I am at a major inner crossroad with the vaccination question with potentially serious long term consequences one way or the other. 

Of greatest importance for me at this crossroad is to make my decision based on a state of spiritual ‘Presence’. 

To avoid making decisions based on fear or hatred or anger or ‘becoming a martyr’ which would be related to my ‘pain body’ and driven by my ‘lower ego’. Instead I want to make my crucial decision out of freedom, guided by my ‘I am’, the ‘Deep I’.

The best I can do at this very moment is to listen to my ‘inner voice’ to the best of my capability. This voice is clear for me at the moment and that is to not take the vaccinations at this point in time. 

My firm intention is to do my best to be able to look into the future without fear and anxiety and to strive to have complete peace of soul and tranquillity of mind. And in the given moment to hopefully be able to make decisions out of full ‘Presence’.

I strongly believe in basic ‘human rights’ and one of the most fundamental human right for me is that of ‘informed consent’. At this stage I clearly do not consent to the COVID vaccination.

I fully respect the rights of other people including friends, partner, family members, colleagues to arrive at
their own decision re the COVID vaccination and I respect their choices. 

I also accept my responsibility towards the health of fellow human beings and I will apply appropriate self-isolation measures if I ever do show any relevant symptoms.


RELATED BLOG

How to have a COVID vaccine that is effective and side-effect free






23 August 2021

How to have a COVID vaccination that is side-effect free and effective

Don’t you just love a good coincidence. Recently had my first COVID vaccine - Pfizer variety – and no side effects. This “coincided” with doing a series of simple mind exercises that all you meditators would relate to easily – and may find helpful.

So having resisted writing about vaccines to date, this week, what are the side-effects, how often do they occur and how might you minimise them; and a special point - are symptoms necessary to achieve good levels of immunity? 

Maybe if you or someone you care for is still to be vaccinated you can experience it symptom free and effective, but first 

     Thought for the day

Our problems, both personal and global, seem so complicated, 

And at an intellectual level, they are. 

But the real root of our problems lies at a different level, 

Simpler but more intractable 

– in our anger, self-interest, fear, greed 

– and only at that deeper level can real transformation occur. 

We can think up clever policies and make grand pronouncements, 

But if in our hearts we are really not moved by the suffering of others, 

Then nothing will really change.




Simply put, real change happens in the heart, 

And there the future of our world will be decided. 

                   HH The Dalai Lama


Please be clear, what follows is not a PhD, rather my own summarised investigations. Reference articles have direct links to the original papers.

Everyone is encouraged to make further investigations themselves and consult your doctors when making medical decisions.


WHAT ARE THE COVID VACCINE SIDE-EFFECTS and HOW OFTEN DO THEY OCCUR?

1. Pfizer has less side-effects than AstraZeneca according to The Lancet.

Vaccine side-effects and SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study app in the UK: a prospective observational study. 

Menni C et al. The Lancet, 2021: Vol 21, issue 7, P939-949.

2. What are Pfizer’s side effects?

In this study of Healthcare Workers - who were regarded as highly likely to provide accurate feedback - injection site pain was recorded by 89.8%, fatigue 62.2%, headache 45.6%, muscle pain 37.1%, and chills 33.9%. 

Thirteen percent reported at least one oral side effect; the most common of which was blisters (36%), followed by halitosis (25.4%), ulcers (14%), bleeding gingiva (11.4%), and white/red plaque (10.5%).

All the general side effects were more prevalent among those under 43 years old.


3. How long do Pfizer side-effects last?

The study found 45.1% of the above symptoms lasted for 1 day, while 35.8% lasted for 3 days, 9.4% lasted for 5 days, 5.3% lasted for one week, 3% lasted for over a week, and 1.4% for over a month. 

Riad A et al. Prevalence of COVID-19 Vaccine Side Effects among Healthcare Workers in the Czech Republic. J Clin Med. 2021;10(7):1428. Published 2021 Apr 1. doi:10.3390/jcm10071428


4.What about severe side effects?

Side effects that required medical intervention were reported by only 1.3% of this study group (not sure if this number may have been somewhat reduced as this was a group of health workers and they may have self-treated; but anyway, severe side-effects can be taken to be small). 

Elsewhere, The European Medicines Agency has estimated that the risk of cerebral venous thrombosis after the AstraZeneca vaccine is 5.0 (4.3 to 5.8) per million people. Evaluating the risk of thrombosis in Pfizer is not easy, but seems less than AstraZeneca, while the risk of myocarditis or other major heart issues is real but rare and still being clarified.

DO YOU NEED TO GET SIDE-EFFECTS FOR THE VACCINE TO WORK?

There seems to be a popular myth that greater side-effects indicate a greater immune response from your body and hence, point to better protection.

Happily, the evidence does not support this. In fact, the evidence indicates the level of immunity is relatively independent of the level of side-effects according to research published in JAMA Internal Medicine. “Overall, the findings suggest that regardless of vaccine reactions or prior SARS-CoV-2 infection, either spike mRNA vaccine will provide a robust spike antibody response.”

Debes AK, Xiao S, Colantuoni E, et al. Association of Vaccine Type and Prior SARS-CoV-2 Infection With Symptoms and Antibody Measurements Following Vaccination Among Health Care Workers. JAMA Intern Med. Published online August 16, 2021. doi:10.1001/jamainternmed.2021.4580

So it seems OK to do what you can to minimise or avoid side-effects altogether.

SO WHY GET VACCINATED NOW?

Put simply, the vaccines work, the side-effects are now shown to be minimal and my guess is it will not be long before the unvaccinated will be restricted in what they can access.

While thorough research is yet to be published, a Public Health England analysis (in a preprint that has not yet been peer-reviewed) showed at least two vaccines to be effective against Delta. 

The Pfizer-BioNTech vaccine was 88% effective against symptomatic disease and 96% effective against Delta, while Oxford-AstraZeneca was 60% effective against symptomatic disease and 93% effective against hospitalization. 

The studies tracked participants who were fully vaccinated with both recommended doses.

It seems for the maximum protection from a two-dose vaccine like Pfizer, you must get both shots and then wait the recommended two-week period for those shots to take full effect.

MAYBE SOME PERSONAL CONTEXT IS USEFUL 

When the COVID vaccines first appeared, they did come as a triumph of modern medicine and science. However, they did come with new technology; they inject mRNA and DNA that tricks our immune system into thinking it is being invaded by the actual virus; and causes it to mount an immunological reaction to it.

Given Australia had low rates of infection when the vaccines first appeared, I felt happy to wait and see if this new vaccination method had any unforeseen side-effects. 

Normally, most vaccine side-effects surface within a few months of introduction – to date there has not been an exception to this that I know of; particularly when millions are receiving the vaccines. 

So the risk of significant side-effects years down the track feels pretty remote to me. The evidence for this is pretty solid.

But then came the Delta variant, infections broke out again and it is becoming clear the chance of returning to zero cases is slim; not impossible, but slim. 

Also, even with 80% vaccination rates there will still be significant Delta outbreaks, and the likelihood of needing vaccination to travel and go to major events is highly probable. 

Not to mention the civic duty of contributing to increased herd immunity.

So, putting that all together, next thing was to research the vaccines available – Pfizer and Astra-Zeneca and decide which is preferable. This is a personal preference, however, I did troll through published research in journals like the Lancet and JAMA rather than the internet. In short, and based upon some of what is summarised above, I opted for Pfizer. 

Then, being over 60, I needed to find someone willing to give it to me. This was helped by having a dodgy medical history, and a local GP clinic obliged.

SO WHAT MIGHT HELP AVOID VACCINE SIDE-EFFECTS? What did I do?

In essence, it was all about using the 3 Principles of Positive Thinking and the art and science of Mind-Body Medicine

1. First Principle – Have a clear goal

Having done the research and contemplated the facts, I became clear… now was the time to be vaccinated and Pfizer was my vaccine of choice. 

But more than this, my strong intention was to gain excellent immunity – have the vaccine do its job well – and avoid side effects (I had researched and found good immunity is possible without side-effects).


2. Second principle – Do whatever it takes

i) Get organised – I found a local clinic that could administer Pfizer (well actually Ruth did that for me!)

ii) I made sure the day of the vaccination and the day after could be light on for activity.

iii) In preparation, during meditation and in my mind, I welcomed the vaccine as something that would do me good, strengthen my immune system and protect me from COVID. This was like talking to my body, explaining what was about to happen and reinforcing the benefit. I told the body emphatically there was no need for side-effects; what it was about to receive was all for our good. I had a very strong intention…

3. Third Principle – enjoy doing it

i) While sitting in the waiting room – for 1.25 hours!! – I had plenty of time to reinforce the welcome, relax and be primed for the injection.

ii) The injection was painless, I smiled, thanked the nurse and went home to lie down, relax and meditate. This involved a combination of deep relaxation, the letting go of meditation, and the active process of affirming the benefits and lack of side-effects with some imagery to that effect. 

iii) The last step was repeated over several days.

AND THE RESULT?

To be complete, on first returning home, I did have a strong sensation around my kidneys. I told myself this was just a sensation probably not related to the vaccination, and it passed within a couple of minutes. Apart from that I had no side-effects whatsoever. No injection site pain, no headache, no fatigue, no muscle pain, no sweats, nausea or mouth issues. Nothing.

SO WAS I JUST LUCKY?


Could be, but then it is nice to attempt something and have it work. Every time something like this happens it builds confidence in the Mind-Body connection, and who knows when we might really need that? 

Anyway, if there is something here you find helpful, good luck. 

May you and all you care for stay healthy and well.


RESOURCES

1. To read more about Mind-Body Medicine and how to apply it, You Can Conquer Cancer

2. For more on healing, try the downloads from our webstore

3. If you are not already connected, check out the meditation app I have helped develop : Allevi8

4. Finally, there are these 2 blogs that elaborate 5 principles you can learn and apply to accelerate the healing of any condition.

Accelerated healing – Part 1

Accelerated healing - Part 2



16 August 2021

Transforming lockdown in just 4 do-able steps

From what I am hearing, this latest round of lockdowns in Australia seems to be hitting many people far harder than the earlier ones. Previously, it was tough, very tough for some, but the lockdowns had the sense of being manageable. Seems like we may have reached a collective tipping point. 

So what to do? This week 4 simple, practical tips – all very do-able, especially for you meditators whether lapsed or current practitioners, or maybe 5, but first 


                 Thought for the day

                      Train your mind

                      As you would your dog

                     And the results

                     Will be wonderful

                                Rabbi Laibl Wolf


Transforming lockdown 

1. Practice meditation with a deep relaxation edge – just 10 – 20 minutes a day

We are in lockdown. Who has not got 10 – 20 minutes a day to regain this sense of profound physical and inner balance? That is all it takes to let go of tension, regain clarity and poise. At the same time, with the deep relaxation, we avert any risk of gathering a stress-related illness through the lockdown.

Recommendation

Just 10 – 20 minutes a day.

If you have not already, download the free Allevi8 app and listen to the Daily Practice daily!

Join the community of meditators who gather for the free Monday night group meditation sessions on Zoom – led by the great group of meditation teachers that also provide the individual meditation mentoring service for those who would like personalised teaching and support to practice.


2. Exercise most days – ideally daily

Again, this is ideal for your body and to get out in fresher air for a while.

Recommendation

Exercise at your own level. 

If you are fit, then go for it. 

If you need to be more reserved, the ideal level of exercise is one where you can keep up a conversation while doing it, and where you feel better at the end when compared to when you started.


3. Make a determined effort to generous of spirit – all the time

Recognise not everyone is coping so well. Some are really struggling with livelihoods at risk, families under great pressure. 

Recommendation

As much as possible, cut some slack; but more, do your best to be understanding, tolerant – and nice!




4. Practice gratitude – to you self and others – all the time

There are quite a few grumpy people around at present. Lots of glass half full stuff going on. Lots of fear, apprehension, anxiety; lots of genuine concern.

Recommendation

Again, as much as possible, recognise this is a time to look for the things we can be grateful for. This is very easy once you make the determination to do it. 

Everyone you meet or interact with has something they do that can be acknowledged, highlighted and serve as a source of gratitude. 

Same with our selves. Be generous of spirit, give emphasis to what you are doing well, go gentle on the touchy bits and acknowledge all the things that do warrant your own gratitude. 

Develop an attitude of gratitude…


FINALLY 

I hope not many others of you are Melbourne AFL supporters like me! After years of being very ordinary, here we are with our team top of the table in the middle of a pandemic lockdown. May not get to see any live finals. May not get to see a live grand final.

So if you think things are bad…

NOW, before some get too verbal, cut some slack… Maybe what really helps with transformation is

NUMBER 5

Develop, or maintain a sense of humour!!!


02 August 2021

PTSD, Mindfulness and meditation - what the research says

Did you know a cancer diagnosis is a very common cause of Posttraumatic Stress Disorder (PTSD)? Most will be aware PTSD is associated with major conflict like war or extreme personal trauma, yet it can also follow on from significant psychological distress. This is something I witnessed very commonly during decades of work helping people affected by cancer. In my opinion, and the research supports this view, well over 50% of people joining our groups came suffering from PTSD – and it also affected many of their partners and carers. Yet both our residential and non-residential programs seemed to clear it altogether.

So this week, what exactly is PTSD, and what have mindfulness and meditation to offer, but first

      Thought for the day

In the woods, we return to reason and faith. 

There I feel that nothing can befall me in life,

—no disgrace, no calamity, (leaving me my eyes,) 

Which nature cannot repair. 

Standing on the bare ground,

—my head bathed by the blithe air, 

And uplifted into infinite space,

—all mean egotism vanishes. 

I become a transparent eye-ball; 

I am nothing; I see all; 

The currents of the Universal Being circulate through me; 

I am part or particle of God.

                      Ralph Waldo Emerson


1. SPEAKING PERSONALLY

My own introduction to meditation and PTSD was through Dr Ainslie Meares. Dr Meares was a psychiatrist who helped survivors of World War 2 with what in those days was called “shell shock”. He found hypnotherapy useful, became a world authority and then moved on to become a leading pioneer in the use of therapeutic meditation; helping many people to use intense meditation as an adjunct to healing a wide range of conditions.

Having drawn heavily upon Dr Meares’ meditation techniques during my own recovery from a very difficult cancer, in 1981 I went on to develop what was probably the world’s first lifestyle-based cancer self help group. Meditation was at the heart of what we offered.

Now, most people when they first came to those groups seemed to be in severe distress. In the early eighties we had no name for it, but as the years went on, it was clear that well over half those in our groups were in fact suffering from PTSD. What was wonderful was that after attending either a 10 day residential program or 12 week non-residential program, nearly everyone was free of their PTSD symptoms. 

It remains one of the major regrets of my working life we were never able gather the funding or support to conduct a proper research trial on those groups’ effectiveness with PTSD. My sense is there was more to these consistent recoveries than "just" the mind techniques we taught, but they were very much at the heart of it. 

Anyway, here we are in current times when PTSD is a well-recognised and common issue besetting many people. Any event that involves a threat to life or a serious injury has the potential to be traumatic. This includes natural disaster, war, a serious accident, physical or sexual assault. And yes, strong psychological trauma like the diagnosis of cancer can also lead to PTSD.


2. THE SCOPE OF THIS LITERATURE REVIEW

This literature review aims to present key evidence regarding what mindfulness and meditation can offer to those affected by PTSD. Then, given the times we are in, it also examines the evidence base for online mindfulness and meditation programs. 

Quite a large body of research has been published in this field, but not surprisingly, it varies in quality. Therefore, while not exhaustive, this review aims to reproduce key research (using many direct quotes from that research) that investigates the efficacy of mindfulness and meditation for people affected by PTSD. 

This review includes direct hyper-links to the original scholarly articles as published. 


3. INTRODUCTION  

Stress affects us all differently; some people experience stress as a positive challenge, for others it leads to unwelcome distress. For a large number of people affected by significant trauma, that distress extends into the chronic and debilitating condition now known as Posttraumatic Stress Disorder (PTSD). 

Posttraumatic stress disorder (PTSD) affects the lives of 7-8% of adults in the U.S. 

In Australia, in any given year it is estimated around 4.4% of the population will be suffering from PTSD and around 5 - 10% of the population will suffer from PTSD sometime during their life. 

PTSD is a commons and devastating disorder. 

Although several interventions demonstrate clinical effectiveness for treating PTSD, many patients continue to have residual symptoms and ask for a variety of treatment options.

Both pharmacological and psychological interventions are used in the treatment of PTSD.

Despite empirical support of effectiveness, these interventions have high rates of incompletion (up to 50%) and many patients, both veterans and civilians, continue to have residual symptoms and seek more options.

For this prevalent and devastating disorder, the poor completion rates and relatively poor remission rates of existing, standard PTSD interventions suggest that new, complementary and integrative interventions, whether adjunctive or stand-alone, are likely warranted. Further, both patients and providers have voiced desires for the availability of more PTSD treatment options.

Meditation-based approaches are among the most popular complementary approaches for health promotion used by adults in both the U.S.A. and Australia. Meditation practices have elements of exposure, cognitive change, attentional control, self-management, relaxation, and acceptance, all of which are pertinent to the symptoms of PTSD.


3. WHAT IS PTSD? – with gratitude to Phoenix Australia 

Posttraumatic Stress Disorder (PTSD) is a set of reactions that can develop after someone has been through a traumatic event. 

Most people will experience at least one of these types of events during their lives. In the first days and weeks after a traumatic event, people often experience strong feelings of fear, sadness, guilt, anger, or grief. Generally, these feelings will resolve on their own, and with the support of family and friends, the person recovers. However, if the distress continues, it may mean that the person has developed PTSD or another mental health condition. 

A person with PTSD has four main types of difficulty: 

Re-living the traumatic event – through unwanted memories, vivid nightmares, flashbacks, or intense reactions such as heart palpitations or panic when reminded of the event. 

Feeling wound up – having trouble sleeping or concentrating, feeling angry or irritable, taking risks, becoming easily startled, or constantly being on the look-out for danger. 

Avoiding reminders of the event – activities, places, people, thoughts or feelings that bring back memories of the trauma. 

Negative thoughts and feelings – feeling afraid, angry, guilty, flat, or numb a lot of the time, losing interest in day-to-day activities, feeling cut off from friends and family. 

It is not unusual for people with PTSD to experience other mental health problems like depression or anxiety. Some people may develop a habit of using alcohol or drugs as a way of coping.


4. STANDARD TREATMENT

Almost everyone who goes through a traumatic event will be emotionally affected in some way. For some, the effects can be long lasting. If you are still experiencing problems two weeks after a traumatic event, it is worth talking to your GP or a mental health professional to assess how you are going and to see if treatment would be helpful. 

Effective treatments for posttraumatic stress disorder (PTSD) are available, and include counselling, medication, or a combination of both. These treatments can work even if your traumatic experience was a long time ago.


5. WHAT MINDFULNESS AND MEDITATION OFFER TO PEOPLE AFFECTED BY PTSD 

– A research-based overview

A recent major review observed mindfulness-based treatments of PTSD have emerged as promising adjunctive or alternative intervention approaches. 

The authors reviewed the literature on PTSD treatment studies, including approaches such as mindfulness-based stress reduction, mindfulness-based cognitive therapy and metta mindfulness, and found low attrition with medium to large effect sizes. 

This review examined the convergence between neurobiological models of PTSD and neuroimaging findings in the mindfulness literature, where mindfulness interventions may target emotional under- and overmodulation, both of which are critical features of PTSD symptomatology. Recent emerging work indicates that mindfulness-based treatments may also be effective in restoring connectivity between large-scale brain networks among individuals with PTSD, including connectivity between the default mode network and the central executive and salience networks. 

Future directions, including further identification of the neurobiological mechanisms of mindfulness interventions in patients with PTSD and direct comparison of these interventions to first-line treatments for PTSD are discussed.

Boyd JE et al. Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence. J Psychiatry Neurosci. 2018;43(1):7-25. doi:10.1503/jpn.170021

6. PTSD IN SPECIFIC SETTINGS

Posttraumatic Stress Disorder (PTSD) can be defined by the inability to recover from a traumatic event. A common misconception is that PTSD can only develop in circumstances of war or acute physical trauma. However, the diagnostic criteria of PTSD were adjusted in the Diagnostic Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) to include the diagnosis and treatment of a life-threatening illness, such as cancer, as a traumatic stressor that can result in PTSD. Here we examine PTSD in specific contexts.

i) PTSD and cancer

It is not unusual or surprising that many people experience a diagnosis of cancer as sudden, catastrophic, and/or life-threatening. Cancer-related PTSD (CR-PTSD) is often claimed to affect around 50% of those diagnosed with cancer. CR-PTSD can negatively affect a person’s psychosocial and physical well-being during treatment and into survivorship. Unfortunately, CR-PTSD often goes undiagnosed and, consequentially, untreated. 

This study reflects the commonly held view; it found the prevalence of distress amongst people with cancer was 76% and the incidence of PTSD was 55%.

Pranjic N et al. Distress and PTSD in patients with cancer: cohort study case. Mater Sociomed. 2016 Feb;28(1):12-6. doi: 10.5455/msm.2016.28.12-16. 


This next 2019 article provides a general overview of PTSD with cancer as the traumatic event in order to define CR-PTSD, and reviews the growing pool of literature on this topic, including prevalence, risk factors, characterization, and treatment of CR-PTSD. The purpose of this article is to spread awareness of this relatively newly defined and commonly missed disorder among patients with cancer to clinicians and patients alike.

Leano A et al. Are we missing PTSD in our patients with cancer? Part I. Can Oncol Nurs J. 2019;29(2):141-146. Published 2019 Apr 1.

ii) Mindfulness, PTSD and the military - systematic review and meta-analysis of the benefits 

Military veterans report high rates of psychiatric and physical health symptoms that may be amenable to mindfulness-based interventions (MBIs). However, inconsistent prior findings and questions of fit between MBIs and military culture highlight the need for a systematic evaluation of this literature.

The authors searched five databases and found 20 randomized controlled trials (RCTs) testing MBIs in military veterans to include in their analysis. The findings? MBIs were superior to non-specific controls (e.g., waitlist, attentional placebos) on measures of posttraumatic stress disorder (PTSD), depression, general psychological symptoms (i.e., aggregated across symptom domains), quality of life / functioning, and mindfulness but not physical health. At follow-up (mean length = 3.19 months), MBIs continued to outperform non-specific controls on general psychological symptoms, but not PTSD.

The author’s concluded MBIs may improve psychological symptoms and quality of life / functioning in veterans. Questionable acceptability and few high-quality studies support the need for rigorous RCTs, potentially adapted to veterans.

Goldberg SB et al. Efficacy and acceptability of mindfulness-based interventions for military veterans: A systematic review and meta-analysis. J Psychosom Res. 2020 Nov;138:110232. 

iii) Mindfulness use for PTSD in children

We all know many children are exposed to adverse experiences. The evidence is clear - such adverse childhood exposures may result in stress and trauma, which are associated with increased morbidity and mortality into adulthood. 

In general populations and trauma-exposed adults, mindfulness interventions have demonstrated reduced depression and anxiety, reduced trauma-related symptoms, enhanced coping and mood, and improved quality of life. Studies in children and youth also demonstrate that mindfulness interventions improve mental, behavioural, and physical outcomes. 

Taken together, this research suggests that high-quality, structured mindfulness instruction may mitigate the negative effects of stress and trauma related to adverse childhood exposures, improving short- and long-term outcomes, and potentially reducing poor health outcomes in adulthood. Future work is needed to optimize implementation of youth-based mindfulness programs and to study long-term outcomes into adulthood.

Ortiz R, Sibinga EM. The Role of Mindfulness in Reducing the Adverse Effects of Childhood Stress and Trauma. Children (Basel). 2017;4(3):16. Published 2017 Feb 28. doi:10.3390/children4030016


7. META-ANALYSES AND MAJOR REVIEWS – Mindfulness, meditation and PTSD

i) 2016 review finds positive but statistically weak benefits

This systematic review and meta-analysis synthesized evidence from randomized controlled trials of meditation interventions to provide estimates of their efficacy and safety in treating adults diagnosed with posttraumatic stress disorder (PTSD). Outcomes of interest included PTSD symptoms, depression, anxiety, health-related quality of life, functional status, and adverse events.

In total, 10 trials on meditation interventions for PTSD with 643 participants met inclusion criteria. Across interventions, adjunctive meditation interventions of mindfulness-based stress reduction, yoga, and the mantra repetition program improve PTSD and depression symptoms compared with control groups, but the findings are based on low and moderate quality of evidence. Effects were positive but not statistically significant for quality of life and anxiety, and no studies addressed functional status. 

The authors concluded meditation appears to be effective for PTSD and depression symptoms, but in order to increase confidence in findings, more high-quality studies are needed on meditation as adjunctive treatment with PTSD-diagnosed participant samples large enough to detect statistical differences in outcomes.

Hilton L et al. Meditation for posttraumatic stress: Systematic review and meta-analysis. Psychol Trauma. 2017 Jul;9(4):453-460. 

ii) 2017 Meta-analysis finds meditation offers significant help

In this 2017 meta-analysis, 19 randomized control trials with data on 1,173 participants were reviewed. A random effects model yielded statistically significant positive effects in the small to medium range. Interestingly, the study revealed no appreciable differences between intervention types, study population, outcome measures, or control condition. 

The authors concluded these findings suggest meditation (and yoga) are promising complementary approaches in the treatment of PTSD among adults and warrant further study.

Gallegos AM et al. Meditation and yoga for posttraumatic stress disorder: A meta-analytic review of randomized controlled trials. Clin Psychol Rev. 2017;58:115-124. 


8. SOME CAUTIONS RE MINDFULNESS and PTSD

While mindfulness has much to offer, there are some cautions and this article from Smiling Minds is worth reading if you are taking up that specific practice…

Mindfulness and traumatic stress - best practice guidelines. Catherin Morey-Nase, March 2021, Smiling Mind Blog.

Author's note : In my own experience, starting any mindfulness or meditation-based practice with deep relaxation as in the Progressive Muscle Relaxation, significantly mitigates any potential adverse effects. As such, I highly recommend this practice.


9. ONLINE MINDFULNESS AND MEDITATION PROGRAMS FOR PEOPLE WITH PTSD

i) Online programs and their benefits – a meta-analysis

The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size.

For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions. 

The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.

Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114  

ii) App use improves mental health

Previous research has shown one in five Australians (21%) have taken time off work in the past 12 months due to feeling stressed, anxious, depressed or mentally unhealthy. Workers who took part in this 30 day app trial were assessed over 12 months and reported fewer depressive symptoms while scores for workplace performance, resilience and wellbeing had improved.

“This is the first time researchers have ever been able to achieve reductions in depression incidence using an app alone,” claimed the lead author Dr Mark Deady.

Reference : Click here


PART D  :   CONCLUSION

There is a solid evidence base for mindfulness and meditation being used to help people affected by PTSD. These same interventions can play a part in reducing associated symptoms of PTSD such as anxiety and depression, as well as assist in recovery. 

Also, there is good evidence online mindfulness - based programs have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.



20 July 2021

Diabetes, relaxation, mindfulness and meditation – what the research says

Diabetes is a major global healthcare problem and its prevalence is increasing rapidly. Like other chronic, degenerative diseases, diabetes is closely related to lifestyle. So what does mindfulness and meditation have to offer those affected by diabetes? What does the research say? 

In short, the answer is Yes; the evidence demonstrates these practises improve both quality of life and disease progression for both type 1 and type 2 diabetes. So this week we review and summarise that evidence, but first

       Thought for the day

What am I in the eyes of most people—a nonentity, an eccentric or an unpleasant person—somebody who has no position in society and will never have; in short, the lowest of the low. 

All right, then—even if that were absolutely true, then I should one day like to show by my work what such an eccentric, such a nobody, has in his heart. That is my ambition, based less on resentment than on love in spite of everything, based more on a feeling of serenity than on passion. 

Though I am often in the depths of misery, there is still calmness, pure harmony and music inside me. I see paintings or drawings in the poorest cottages, in the dirtiest corners. And my mind is driven towards these things with an irresistible momentum.


                           Vincent van Gogh


Diabetes is a chronic, metabolic, multifaceted health problem and is a common cause of death and disability. It has significant effects not only on the body but also on the mind and social functioning of those affected. Peoples' quality of life, wellbeing, and social relationship can be profoundly affected by diabetes and its side effects.

Diabetes is a complex medical condition whose management requires a diversified approach. This can include drug therapy, diabetes education programs, adherence to medical treatment and active participation in a therapeutic lifestyle program featuring dietary change, exercise and stress management.

THE SCOPE OF THIS LITERATURE REVIEW

This literature review aims to bring together research investigating what mindfulness and meditation can offer to those affected by diabetes. Then, given the times we are in, it also examines the evidence base for online mindfulness and meditation programs. 

Diabetes is a generic word used to describe different conditions, so the review includes definitions of the different types of diabetes. However, this review does focus on diabetes mellitus type 1 and 2.

Quite a large body of research has been published in this field, but not surprisingly, it varies in quality. Therefore, while not exhaustive, this review aims to reproduce key research (using many direct quotes from that research) that investigates the efficacy of mindfulness and meditation for people affected by diabetes. 

This review includes direct hyper-links to the original scholarly articles as published. 


PART A  :  DIABETES – MELLITUS OR INSIPIDUS? TYPE 1 OR 2? THE DEFINITIONS…

1. DIABETES INSIPIDUS

Diabetes Insipidus (DI) is quite distinct from Diabetes Mellitus. In brief, Diabetes Insipidus is a condition characterized by large amounts of urine (up to 20 litres per day) and increased thirst. Extreme urination continues throughout the day and the night. In children, DI can interfere with appetite, eating, weight gain and growth. Adults with untreated DI may remain healthy for decades as long as enough water is consumed to offset the urinary losses. However, there is a continuous risk of dehydration and loss of potassium. 

This condition is not specifically addressed in this review.

2. DIABETES MELLITUS (DM), commonly known as just diabetes, is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time.

Symptoms often include frequent urination, increased thirst, and increased appetite. Left untreated, DM can cause many health complications and result in an early death – see below.

There are 3 main types of Diabetes Mellitus, plus some uncommon ones

i) Type 1 Diabetes (T1D)

T1D results from the failure of the pancreas to produce enough insulin (the hormone that  regulates blood sugar) due to loss of beta cells. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The loss of beta cells is caused by an autoimmune response whose cause is unknown. T1D management requires the use of insulin injections, although there is growing evidence lifestyle factors can reduce the dosage needed.

ii) Type 2 Diabetes (T2D)

T2D begins with insulin resistance, a condition in which cells in the body fail to respond to insulin properly. As the disease progresses, a lack of insulin may also develop. This form was previously referred to as "non-insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". 

The most common cause of T2D is a combination of excess body weight and lack of exercise.

Prevention and treatment of type 2 diabetes involves adopting a healthy lifestyle based upon maintaining a healthy diet, exercising regularly, avoiding the use of tobacco and utilizing stress management techniques. Care needs to be taken to control blood pressure, along with maintaining proper foot and eye care. Medications such as insulin sensitizers and injections of insulin may be required. Weight loss surgery can sometimes provide an effective measure for those dealing with obesity.

       Pre-Type 2 Diabetes

Pre-diabetes describes a condition in which blood glucose levels are higher than normal, although not high enough to be diagnosed with type 2 diabetes. Pre-diabetes has no signs or symptoms. People with pre-diabetes have a higher risk of developing T2D and cardiovascular (heart and circulation) disease. Two million Australians have pre-diabetes and are at high-risk of developing T2D. Risk factors for pre-diabetes are similar to those for T2D.

Treatment of pre-diabetes involves the same lifestyle changes that are recommended for people diagnosed with T2D. For most, this will include regular physical activity, healthy eating and if necessary losing weight. People with pre-diabetes are also at increased risk of heart disease, so controlling blood pressure and blood cholesterol and triglycerides is also important.

Without sustained lifestyle changes, including healthy eating, increased activity and losing weight, approximately one in three people with pre-diabetes will go on to develop T2D.

iii) Gestational diabetes occurs when pregnant women without a previous history of diabetes develop high blood sugar levels. The majority of women with gestational diabetes have a healthy pregnancy, normal delivery and a healthy baby. 

The cause? The need for insulin in pregnancy is 2 to 3 times higher than normal. For women with underlying insulin resistance, the body may not be able to cope with the extra demand for insulin production and the blood glucose levels will be higher resulting in gestational diabetes being diagnosed.

When the pregnancy is over, blood glucose levels usually return to normal and the gestational diabetes disappears. However, this insulin resistance increases the risk of developing T2D in later life for both the mother and the child, so monitoring may well be advised and maintaining a healthy lifestyle is a logical choice.

The treatment is a healthy eating plan, regular physical activity and monitoring and maintaining blood glucose levels

iv) Uncommon Causes of Diabetes

There are some rare forms of diabetes such as the genetic condition Maturity Onset Diabetes of the Young (MODY), while some diseases such as cystic fibrosis and chronic pancreatitis can lead to diabetes.


PART B  :  THE CONTEXT - WHAT IS THE IMPACT OF DIABETES?

1. HOW MANY PEOPLE ARE AFFECTED?

Diabetes is the 7th leading cause of death globally. In 2019, diabetes resulted in approximately 4.2 million deaths. As of 2019, an estimated 463 million people had diabetes worldwide (8.8% of the adult population). In Australia, around 1.8 million people are diagnosed with diabetes. T2D makes up about 85% of the cases and T1D around 10%. Rates for T1D and T2D are similar in women and men. 

The data suggests rates are rising rapidly and will continue to rise.  Large numbers of people are affected by silent, undiagnosed T2D which may be damaging their bodies. An estimated 2 million Australians are at high risk of developing T2D and are already showing early signs of the condition.

2. WHAT ARE THE RISKS?

Many seem to regard diabetes as a mere inconvenience; something you can live with easily enough. However, the facts are stark. 

While diabetes can be managed well, the potential for very unwelcome complications are high and they are the same for type 1 and type 2 diabetes. 

According to Diabetes Australia, diabetes mellitus:

Is the leading cause of blindness in working age adults

Is a leading cause of kidney failure and dialysis

Increases the risk of heart attacks and stroke by up to four times

Is a major cause of limb amputations

Affects mental health as well as physical health. Depression, anxiety and distress occur in more than 30% of all people with diabetes. Cognitive impairment is a serious risk.

Overall, DM more than doubles the risk of an early death

Early diagnosis, optimal treatment and effective ongoing support and management reduce the risk of diabetes-related complications.

3. WHAT ARE THE FINANCIAL COSTS?

The global economic cost of diabetes-related health expenditure in 2017 was estimated at US$727 billion. In the United States, diabetes cost nearly US$327 billion in 2017. Medical expenditures among people with diabetes are about 2.3 times higher than average. 

4. WHAT CAUSES DIABETES?

Type 2 diabetes is a chronic degenerative disease closely related to lifestyle factors. Happily, its successful management is significantly affected by lifestyle changes. According to Diabetes Australia, T2D is one of the major consequences of the obesity epidemic. The combination of massive changes to diet and the food supply, combined with massive changes to physical activity with more sedentary work and less activity, means most populations are seeing more T2D. 


PART C  :  WHAT DOES MEDITATION AND MINDFULNESS HAVE TO OFFER DIABETES?

What the science says - a research based summary

Mindfulness-based Interventions (MBIs) can be seen as preventive and complementary interventions in DM, particularly for the relief of symptoms related to depression and anxiety in diabetic patients and also in the management of other factors, including mindful eating, physical exercises and treatment adherence. Mindfulness seems to have beneficial effects on all aspects of diabetes, including incidence, control and complications. 

Medina WL et al. Effects of Mindfulness on Diabetes Mellitus: Rationale and Overview. Curr Diabetes Rev. 2017;13(2):141-147. 

What common sense says

The mind controls what we eat and drink, along with how much we exercise. If we want to take charge of what we eat and drink, we will benefit from taking charge of what – and how – we think. This is the beauty of mindfulness and meditation; these 2 practices help us to take more control over our own thoughts, our habits and our way of living. Of necessity, they must form the basis of any therapeutic lifestyle program. And they are easy to learn, easy to practice, can be done anywhere – and once they are learnt, are entirely free – we can do them for ourselves! And as a side effect, mindfulness and meditation reliably lead to inner peace and contentment…


1. META-ANALYSES and REVIEWS – DIABETES, MINDFULNESS AND MEDITATION

i) Meditation and mindfulness lead to wide-ranging benefits 

This study analysed 154 articles examining the potential contribution of mindfulness and meditation to those affected by diabetes. The articles spanned from 1984 to 2017. The review concluded the practice of meditation is associated with reduction in stress and negative emotions and improvements in patient attitude, health-related behaviour and coping skills. There is increased parasympathetic activity with reduction in sympathetic vascular tone, stress hormones and inflammatory markers. Additionally, several studies evaluated the role of mindfulness-based stress reduction in diabetic individuals and demonstrated modest improvements in body weight, glycaemic control and blood pressure. 

The summary?

Mindfulness meditation-based intervention can lead to improvements across all domains of holistic care – biological, psychological and social. 

Meditation strategies can be useful adjunctive techniques to lifestyle modification and pharmacological management of diabetes and help improve patient wellbeing.

Priya G, Kalra S. Mind-Body Interactions and Mindfulness Meditation in Diabetes. Eur Endocrinol. 2018;14(1):35-41. doi:10.17925/EE.2018.14.1.35

ii) Mindfulness-based interventions reduce diabetes distress

This meta-analysis examined the evidence and determined the factors influencing the effect of mindfulness-based interventions (MBI) on diabetes distress. A systematic search of nine databases was conducted and randomized controlled trials of MBIs for adults with diabetes that evaluated the effect of the interventions on diabetes distress were retrieved. A total of 10 articles, consisting of eight studies with 649 participants, were included. 

The summary? MBIs improve outcomes in adults with diabetes who have elevated diabetes distress at baseline, using mindfulness-based stress reduction therapy, using a group format to deliver the intervention, and assigning home practice. MBIs improve diabetes distress significantly more at long-term follow-up compared with short-term follow-up. MBIs could be considered as an adjunct treatment in adults with diabetes to reduce diabetes distress.

Guo J et al. Factors influencing the effect of mindfulness-based interventions on diabetes distress: a meta-analysis. BMJ Open Diabetes Res Care. 2019 Dec 11;7(1)

iii) Mindfulness reduces physiological and psychological symptoms in T1D and T2D

This systematic review examined research published in 5 databases. Eleven studies satisfied the inclusion criteria and they demonstrated Mindfulness-based intervention effectiveness for physiological outcomes (glycaemic control and blood pressure) was mixed. Mindfulness-based interventions appear to have psychological benefits reducing depression, anxiety and distress symptoms across several studies. Some studies’ short-term follow-up periods may not have allowed sufficient time to observe physiological changes or illustrate Mindfulness-based interventions’ potential long-term efficacy. More long-term studies that include a consistent, standardised set of outcome measures are required.

Noordali F., Cumming J., Thompson J. L. Effectiveness of mindfulness-based interventions on physiological and psychological complications in adults with diabetes: a systematic review. Journal of Health Psychology. 2017;22(8):965–983. doi: 10.1177/1359105315620293. [PubMed] 


2. INDIVIDUAL RESEARCH PAPERS

i) Mindfulness meditation improves glycemic control and mental health 

Stress and mental illnesses adversely affect glycemic control. In most patients, a multidisciplinary approach including physical activity, healthy diet, and stress management is required for glycemic control. Mindfulness-based stress reduction (MBSR) is a structured group program that reduces emotional distress through self-awareness and assuming the responsibility for individual choices, and results in increased effective health behaviours. This randomized clinical trial study involved 108 patients with T2D randomised into a 12 weeks MBSR program or routine care. 

The means of haemoglobin A1C (HbA1C), fasting blood sugar (FBS), and depression, anxiety, and stress scores improved significantly after intervention in the MBSR group. Except FBS levels, all outcome variable scores' mean change was significant between the two groups.

Conclusions? In general, this study revealed that mindfulness meditation could be helpful in improving the quality of mental health and lowering glycemic control indices in patients with T2D.

Nikkhah Ravari O, Mousavi SZ, Babak A. Evaluation of the Effects of 12 Weeks Mindfulness-Based Stress Reduction on Glycemic Control and Mental Health Indices in Women with Diabetes Mellitus Type 2. Adv Biomed Res. 2020 Oct 30;9:61.

ii) MBSR demonstrates a remarkable improvement on emotional wellbeing and glycemic control 

Sixty patients with T2D were recruited for this outpatient-based randomized controlled trial. The intervention group participated in 8 sessions of MBSR, and the control group continued treatment as usual. All the assessments were performed at baseline and after 8 weeks and 3 months as follow-up.

In comparison with the control group, the MBSR intervention group showed a significant reduction on all outcome measures including FBS, HbA1C, Hamilton Anxiety Rating Scale (HARS), and Hamilton Depression Rating Scale (HDRS) scores.

The researchers concluded MBSR had a remarkable improvement on emotional wellbeing and glycemic control of patients with T2D.

Armani Kian A et al. The Impact of Mindfulness-Based Stress Reduction on Emotional Wellbeing and Glycemic Control of Patients with Type 2 Diabetes Mellitus. J Diabetes Res. 2018;2018:1986820. 

iii) Innate mindfulness associated with less obesity, less diabetes

Dispositional mindfulness, or trait mindfulness refers to an individual’s innate capacity to pay and maintain attention to present-moment experiences with an open and nonjudgmental attitude. (Brown & Ryan, 2003).

This study examined 399 people with median age 47 years from the New England Family Study, a prospective birth cohort. Dispositional mindfulness was assessed using the Mindful Attention Awareness Scale (MAAS).

The conclusions? People with high versus low MAAS scores were significantly more likely to have normal plasma glucose levels and were not significantly associated with T2D when adjusted for age, sex, race/ethnicity, family history of diabetes and childhood socioeconomic status. 

Mediation analyses provided evidence of mediation via obesity and sense of control, where indirect effects were prevalence ratios.

The authors concluded dispositional mindfulness may be associated with better glucose regulation, in part because of a lower likelihood of obesity and greater sense of control among participants with higher levels of mindfulness. They suggest findings need to be replicated by prospective studies to establish causality and to evaluate potential implications for mindfulness-based interventions to reduce risk of T2D.

Loucks EB et al. Associations of Mindfulness with Glucose Regulation and Diabetes. Am J Health Behav. 2016;40(2):258-267. doi:10.5993/AJHB.40.2.11

iv) Mindfulness and yoga improve quality of life

Many studies reveal the incidence of depression and anxiety is higher among patients with T2D. This study examined an 8 session group mindfulness-based stress reduction program that included conscious yoga. The data demonstrated a significant difference between experimental and control groups in terms of the quality of life level. The mindfulness-based stress reduction program was associated with a significantly increase in the quality of life in the participants of the experimental group. 

The authors concluded the result of this study suggests mindfulness-based stress reduction program can be an appropriate therapeutic method for improving quality of life in patients with T2D.

Rahmani Set al. Examining the effectiveness of mindfulness-based stress reduction program and conscious yoga on quality of life in patients with diabetes type 2. Iranian Journal of Diabetes and Obesity. 2014;6(4):168–175. 

v) More mindfulness, less stress and depression, better quality of life

Twenty to forty percent of outpatients with diabetes are affected by emotional distress. This study of 139 outpatients examined the effectiveness of group therapy with Mindfulness-Based Cognitive Therapy (MBCT), relative to usual care with regard to reducing emotional distress and improving health-related quality of life and glycemic control.

The results? Compared with control, MBCT was more effective in reducing stress, depressive symptoms, and anxiety and more effective in improving quality of life. No significant effect was detected on HbA(1c) or diabetes-specific distress, although patients with elevated diabetes distress in the MBCT group tended to show a decrease in diabetes distress  compared with the control group.

van Son J et al. The effects of a mindfulness-based intervention on emotional distress, quality of life, and HbA1c in outpatients with diabetes (DiaMind): a randomized controlled trial. Diabetes Care. 2013;36(4):823–830. doi: 10.2337/dc12-1477.

vi) More meditation, less worry

This pilot tested a six-week meditation and mindfulness intervention in people (n = 40) with diabetes mellitus and coronary heart disease. The intervention was highly acceptable, with 90% completing ≥5 sessions. Meditation and mindfulness skills led to improved sleep, greater relaxation, and more-accepting approaches to illness and illness experience. At the end of the six-week meditation course, worry, and thought suppression were significantly reduced. 

Keyworth C et al. A mixed-methods pilot study of the acceptability and effectiveness of a brief meditation and mindfulness intervention for people with diabetes and coronary heart disease. Behav Med. 2014;40(2):53-64. 

vii) Mindfulness in adolescents – well accepted; reduces depression and insulin resistance

This study explored a brief mindfulness-based intervention (MBI) on clinical outcomes in adolescents at-risk for T2D. Participants were 12–17yo girls with overweight/obesity, elevated depression symptoms, and T2D family history participating in a randomized, controlled pilot trial of a six-session MBI vs. cognitive-behavioural therapy (CBT) group. 

The results? One-year retention was 71% in MBI; 81% in CBT. At 1-year, depression decreased and IR decreased in adolescents randomized to MBI compared to those in CBT. There were no significant between-condition differences in mindfulness, adiposity, or BMI.

The authors concluded One-year outcomes from this randomized, controlled pilot trial suggest that brief MBI may reduce depression and insulin resistance in at-risk adolescents. They suggested replication and exploration of mechanisms within the context of a larger clinical trial are necessary.

Shomaker LB et al. One-Year Follow-Up of a Randomized Controlled Trial Piloting a Mindfulness-Based Group Intervention for Adolescent Insulin Resistance. Front. Psychol., 08 May 2019 

viii)  Mindfulness meditation shows even greater diabetes related pain reduction than Progressive Relaxation (PR)

Chronic pain, the most common complication of diabetes, is treated with medication often to no avail. This study compared the use of mindfulness meditation (MM) and PR to reduce chronic pain in 109 older females with diabetes. 

Groups MM and PM experienced significant reduction in average daily pain compared to baseline (28.7% and 39.7%, respectively). Group MM had more significant reduction of pain compared to control. Groups MM and PM showed significant improvement in patients’ impression at study end. In Group MM, patient satisfaction scores increased significantly by week 12. 

The authors concluded Integrative therapies such as mindfulness meditation can be part of a comprehensive pain management plan. Benefits include reduction of pain-related medication consumption, better treatment outcomes, improvement in comorbid conditions such as anxiety and depression as well as no risk of addiction or abuse.

Hussain N, Said ASA. Mindfulness-Based Meditation Versus Progressive Relaxation Meditation: Impact on Chronic Pain in Older Female Patients With Diabetic Neuropathy. Journal of Evidence-Based Integrative Medicine. January 2019. doi:10.1177/2515690X19876599

ix) Mindfulness Meditation improves glycaemic control and quality of life in T1D

While Mindfulness Meditation (MM) is known to improve glycemic control and enhance the quality of life (QoL) in T2D patients, to date the role of meditation in T1D has not been studied extensively. Therefore, this randomised study of 32 people examined the effect of MM on the glycemic control and QoL in people living with T1D. 

The results? Significant improvement was recorded in the glycemic control and quality of life of the patients practicing MM. Also, the authors concluded MM certainly plays an important role in attaining peace of mind and helps patients to channel their energy in a positive direction. 

Shukla R, et al. Mindfulness Meditation as Adjunctive Therapy to Improve the Glycemic Care and Quality of Life in Patients with Type 1 Diabetes. Medical Sciences. 2021; 9(2):33. 

x) Mindfulness offers help to T1D in adolescents

This small study examined the acceptability and feasibility of Mindfulness-Based Stress Reduction (MBSR) to reduce stress and improve illness management among urban, older adolescents, and young adults with poorly controlled T1D.

The results? Satisfaction with MBSR was high based on both quantitative and qualitative data. Preliminary evidence was found to suggest that MBSR reduced stress and improved blood glucose levels. The authors suggested additional testing in adequately powered controlled clinical trials appears warranted.

Deborah A. Ellis, et al. (2018) Feasibility of Mindfulness-Based Stress Reduction for older adolescents and young adults with poorly controlled type 1 diabetes, Health Psychology and Behavioral Medicine, 6:1, 1-14.

3. ONLINE MINDFULNESS AND MEDITATION PROGRAMS FOR PEOPLE WITH DIABETES

i) Online programs and their benefits – a meta-analysis

The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size.

For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions. 

The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.

Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114  

ii) App use improves mental health

Previous research has shown one in five Australians (21%) have taken time off work in the past 12 months due to feeling stressed, anxious, depressed or mentally unhealthy. Workers who took part in this 30 day app trial were assessed over 12 months and reported fewer depressive symptoms while scores for workplace performance, resilience and wellbeing had improved.

“This is the first time researchers have ever been able to achieve reductions in depression incidence using an app alone,” claimed the lead author Dr Mark Deady.


PART D  :   CONCLUSION

There is a solid evidence base for mindfulness and meditation being used to help people affected by diabetes. Both the cause and management of diabetes are directly related to lifestyle factors and the evidence is clear that regular mindfulness and meditation is associated with a healthier lifestyle. These same interventions can play a part in prevention and they can reduce the associated symptoms of diabetes such as stress, anxiety and depression, as well as assist in recovery. 

Also, there is good evidence online mindfulness - based programs have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.


MORRESEARCH SUMMARIES

This review summary of the research evidence for the use of mindfulness and meditation with diabetes, will appear on the Allevi8 website where similar reviews can be found for cancer, MS, Stroke, heart disease, dementia, pain management, sleep disorders, mental health and emotional health. 

Go to Allevi8.net