De-Stress Using Yoga and Meditation, with Dr. Marianela Lavena

Hello and welcome to the Five Journeys podcast. We are really excited to have Dr. Marinella Lavana.

We are absolutely delighted to have Dr. Lavana here today. She's a board certified family doctor who currently works at Five Journeys with us. How privileged are we? For the past 15 years, Dr. Lavaina has been teaching and recommending mindfulness meditation and yog as part of her therapeutic plan for patients. She's trained with some of the top minds in mindfulness meditation and mindfulness based stress reduction at the Herbert Benson Mind Body Medicine Institute and Harvard, to name drop a few. And yoga and meditation have been an important part of Marianela's own healing journey and that's why she's so passionate about it. So we asked her here today to talk about it because everyone wants to know about it. So I'm gonna jump in with the first question, which is what's the real deal behind meditation and yoga success? Like, is it, is it all just hype? That's what I want. Inquiring minds want to know.

That's a good question. So when I recommend it to my patients and when I recommend it to friends and what I always say that when you are practicing yoga, when you're practicing meditation, maybe some days you feel bliss and relaxation and some days you don't feel anything when you practice yoga or meditation. But then there's a lot of studies. One was done by the University of Massachusetts, the mbsr, where a group of students were scanned, they scanned their brains with functional MRIs before starting practicing meditation. And eight weeks after practicing only 10 minutes every day. And what it showed that after those eight weeks, you don't have to meditate all your life to get changes in your brain. After those eight weeks, the prefrontal cortex, the medial prefrontal cortex, that is the part of the brain that is more evolved and is more connected with a sense of peace, happiness, creativity gets bigger and your amygdala and limbic system that is in the back base of the brain shrinks. So maybe you're not feeling anything. Maybe you know, when you're meditating, you're thinking, I should be doing something else. This is not going to work. But it works. It works because it's, you're rewiring your brain, something called neuroplasticity. For example, when you want to learn how to play the piano or how to drive, you practice, practice, practice, practice, practice. And after a few months, you're just playing the piano with your eyes closed or driving and you are thinking about.

Something else, hopefully with your eyes open.

With the eyes open, hopefully. But it's your brain learning. So that's why when I recommend mindfulness, I tell people you don't have to use mindfulness or yoga when you're stress only you have to practice off stage. So, for example, if you have to, if you want to participate on a plate and you have your lines and you're going to practice them and practice them and practice them, on the day of the play, you're going to say your lines and it's going to look beautiful. Well, the same happens with anxiety, stress and meditation. If you practice every day, coming back to the present moment, filling your breath, you know, phrases, oh, you know, I don't have to believe my thoughts. Whatever you like to practice or yoga, the day you have a stressful situation, your limbic system or your amygdala is not going to hijack you. You're going to be able to relax and use your moribula plane, your prefrontal cortex.

Cool. So one thing I want to come back to is just you said mbsr, and I know, I want to make sure that people know what that is. That's mindfulness based stress reduction. And that was originally based on Jon Kabat Zinn's work. I just want to have that baseline.

I thought you were going to talk about neuroplasticity because when she said that, you got all excited.

Well, I do, but I want to back up and just get some baseline. But what I actually want to know was, is there a difference between yoga and meditation? Seems like you're lumping them together. Is the benefit the same? Is it different? How would you describe it?

That's a good question. So first, the MBSR, Yes. Was founded by John Kabat Zin at the UMass Hospital. And he uses the definition that mindfulness meditation is paying attention to the present moment without judgment, is bringing your attention to this present moment. And he's done a lot of studies about meditation and what's the difference between yoga and meditation. So, for example, I think they have the same benefits because when you are practicing yoga, you're moving your attention from your thoughts, worry thoughts to your body, body and to proprioception. You're feeling your hands on the floor, you're feeling your breathing, so you're working on that proprioception. And there's a lot of studies showing that when we work on bringing the attention to our bodies, we are making our medial prefrontal cortex bigger. So there's a study, there's a doctor in Harvard University, his name is Dr. Bessel. Dandelcock, he did study work with two groups of patients. One group with depression, one group was taking Prozac, this was like 40 years ago. And the other group was practicing yoga only 10 to 12 minutes a day. The group that was practicing yoga after 2, 3 months, the depression and the anxiety was much better than the other group and it got sustained in time. So I think it depends on your personality and what you like. I love meditating, I love yoga, I love tapping Tai chi. I try to practice a little bit of everything. But if you're, if you're meditating and you're sitting and it's making you anxious and you have problems with breathing and you have asthma and paying attention to your breath, it's making you more anxious. So try movement, try tapping or yoga or tai chi or any movement. So with the movement you're doing, you're getting the same effect and you're working on the same part of the brain.

That's really cool.

In fact. Yeah, sorry, with, with Tai chi and qigong and slow movement, when you work on proprioception, when you're moving, for example, your hand really slow, you're. You're paying a lot of attention and you stimulate the insula too. That is connected with all this self regulation too. So very interesting.

Okay, so how would someone go about figuring out what's best for them? Is there one you recommend people start with or is it. Here's your pick list. Pick something and then if that doesn't work, try something else. How do they get into it?

So for example, if I see a patient that is very overwhelmed with a lot of anxiety and, and when I tell them about meditation, they open their eyes and they're like, well, I'm not gonna do that. I recommend movement. And if not, if. Usually what I do is give them a list with like some meditations, some like qigong exercises, chair yoga, and tell them to just try them and pick the ones that they like. And it depends on what you're going through. For example, if you're going through a lot of pain, doing like a full yoga class is not going to be a good idea. But tai chi, qigong or theory yoga are more gentle.

How long until people really start to notice any difference from whatever modality they pick?

I think that after four to six weeks you start feeling the, the benefits. Once in a yoga class, it was like one of the students was like 70 or 75, and I was in my yoga class. And when we finish, we were like sharing and doing the, you know, the typical share and, and he said this was before I was a yoga fanatic. He said that if you practice yoga three times a week, it helps your body, it helps your. Your mind, but if you practice yoga every day, it changes your life. I was like, what? Really? No. So I started because of what. Because of what he said at practice. Started practice, like, he's 75. I was like, I don't know, 22. I was like, I'm gonna practice every day. And it did change my life.

And what. Why?

That was my question.

So when. When I was younger, When I was 16, 17, I started having lots of migraines and lots of anxiety. I went through medical school with, like, trying. Going to neurologist because I had this bad migraines and, you know, anxiety. He would tell me, go exercise. I'm like, I'm in medical school. I don't. I can't. That's not possible. I'm sorry. So until I, you know, I started practicing yoga and I would practice for two or three weeks, and I didn't have a migraine. I was like, look at that. And I would stop and I would get a migraine and anxiety. And so I changed my life. And with the yoga teacher, we used to do 40 days of yoga and meditation and clean eating. And so I was like, oh, I'm gonna do this. I can't do this. So I was like, this is amazing. I don't have a migraine. I don't have to take the zometryptan anymore. So that's why I'm a new person.

So when you do recommend to patients, what do you actually see? What difference does it actually make that you've seen?

Yeah, so I've seen a lot of patients benefit from yoga or meditations from migraines to, like, for example, one of my patients with two little ones, one like 2 year old and like a 4 year old, and she was like, having migraines and taking Topamax injections, you name it, all the treatments for migraines. And I recommend. I told her, like, maybe you could do like a yoga video. Like Yoga with Adrian. That's, you know, it's a really good one. And she started practicing, and I saw her four months later, she didn't have migraines, and she's been taking medicines and trying injections and. And she was amaz. I was like, I'm practicing yoga. My kids are like, running around. And I'm like, just with those 20 minutes every day, I heal my pain.

Can you say a little more about anxiety and Depression. Because I think that that's really something a lot of people are struggling with lately, especially the last year and a half. Yeah. And we try not to have it be too Covid. Focused, but there's been a huge increase. And can you say more about. Specifically for anxiety and then depression, how does the practice interrupt the rat wheel of the feelings?

That's a great question. That's a great question. And then when I read a lot about. And I took a training with Dr. Basil Vandelkok, he's specialized in depression and PTSD and anxiety. And it's very interesting the changes you get in the brain when you. When you practice yoga or meditation. So what he explains that I, I sometimes, when I. When I have time, I explain to my patients that, for example, with anxiety. Let's start with anxiety. When you are having anxiety, you start telling yourself, this is not rational. It's just. It's just like, you know, a problem, you're just late, or this is just your kid having a tantrum. You don't need. Do you need to be anxious? This is not rational. You need to calm down. So that's the dorsolateral prefrontal cortex that is in the sides of the brain. The dorsolateral prefrontal cortex is not connected with the amygdala and the limbic system. So you cannot talk yourself out of an anxiety attack. You cannot tell yourself this is. This is not rational. So he. And I love that. It's like when he. When you talk to your. To your patients and you tell them, oh, your life is good, your family is healthy, you don't have any problems. Don't anxious. Like, that's nonsense. You. You're not gonna. You're not gonna understand why you're anxious. So by practicing yoga meditation every day, at least five minutes, at least three minutes, saying, like, okay, today my intention is to be calm and to be happy and to be joyful. And that's my meditation. And I take a deep breath and I feel my heart. So whatever it is, if you do it every day, you are making this prefrontal cortex, medial prefrontal cortex bigger. That medial prefrontal cortex is connected with the amygdala, and that's the part of the brain that regulates your anxiety. Sometimes it's, you know, one example that Dr. Vessel Vandal Koch gave in. One of the trainings was like, for example, we're here in this big meeting, and there's a bomb. Boom. So if your medial prefrontal cortex is very small, your amygdala is not very regulated. Maybe you have three kids here in the meeting. You're going to just rush out of there and you're going to run, fight, flight, freeze. You're going to be safe. You're going to be outside, and your kids, maybe they're still inside, because what you activated there is your alarm system, your amygdala, and your prefrontal cortex is offline. So you can think if it's safe for the kids or not. You're just escaping, rushing out. If your prefrontal cortex is big, you just take a deep breath. This is just. Okay, I'm going to get the kids out. Get them out. Come in. I'm going to help people. I'm going to. So you're not. You're not hijacked by your amygdala. So this is with anxiety and the same with depression.

We. Mary, I just want to stop you because I want to make sure that that's really clear. Anxiety is not a rational event, and you can't talk yourself out of it. And when you're meditating or doing yoga, does tai chi and qigong or any type of other movement also apply? Like, this is also making the prefrontal cortex larger and more developed.

Okay.

So any modality that qualifies is going to make your ability to think and function in something traumatic or crisis oriented or stressful more effective.

Is that. Yes.

Did I get that right?

Yes. Correct. Yeah. You're working on the same medial prefrontal cortex and to. You're more regulated. You're more regulated. And maybe you've been meditating for six weeks and, and it happens sometimes to, to my patients that when we do the, the mindfulness group meetings or classes that they're like, oh, I don't see any changes. And then maybe six weeks later, they're like, I drop a plate. And instead of like, start cursing or saying like, how stupid I am, I was like, oh, well, you know, it's just a plate. I was like, oh, my gosh, that changed me. I'm really changing. So maybe it's some subtle things that you notice, but it does change your mind.

Okay.

Yeah. I want to actually emphasize that because I notice in general as a human being, we want to be better yesterday. Like, everybody wants to be better yesterday. And when I, when, after our initial visit, when I see patients back two or three times later back, I ask how they're doing, and the majority of people say they're doing about the same, they're no better. And then we go back to the initial visit and talk about their symptoms that they saw. And they're at least a lot of times at least 20 to 40% better. But people don't acknowledge it because we all want to be better yesterday.

Well, it's also the absence of a problem is very hard to remember when it's gone or better. So that's why people forget it's not there. You're not present to it, you're not experiencing it. It's gone. So I think it's just gone.

Right. So I think that yoga, meditation work on a very subtle level that a lot of people don't appreciate until an event like dropping your plate or something happens, because otherwise it's just their life. And life is very complex and not delicate.

I'm busy. Okay, so now let's transition then to the depression part that I didn't let you go into because I was just so struck by the fact that you can't talk yourself out of anxiety.

Yes. Yeah. So. Well, depression is. It's very similar. I think that there's mainly the studies. The. I think it's. The explanation is very similar. But mainly it's the studies. The studies that have been done with functional MRIs and neuroplasticity. And of course, sometimes with depression, there's other things. And in functional medicine, we know that maybe it's not just your ideas or your PTSD or all you went through. There's some food sensitivities or there's some toxicity in your body that you have also to work on. I'm reading a book that it's about a girl that is talking her story about how she, she. She gets into functional medicine and she gets very upset because she's upset with all the yogis and the meditation teachers that she's been following because. And she says you can meditate yourself out of mercury poisoning or you can. So it's true. It's true. It's very helpful. But of course we have to see the person as a whole. And maybe you have a really high gluten sensitivity or. So I think it's very helpful. And for some people, it's transforming just what they needed. And they're not depressed anymore or they're not anxious anymore. I've never, ever had anxiety again. And. And if you ask my husband that, he met me when I was 17, he can tell you I'm a different person. But in depression is the same. It's like the same mechanisms. And I think that this subtle changes. And there's doctor, her name is. Or psychiatrist, her Name is Martian Linenham. She has a program that is called Dialectic dbt. And what she uses is she uses mindfulness to give her patients with PTSD and depression. She works with suicidal patients to give them tools to have how to go through all that. And when she talks, she says, I've been practicing psychiatry since I was in, like, I don't know, my 20s. And I've seen a lot of patients with PTSD and depression. And I see that patients that go through very traumatic events and they, their lives is destroyed and they can't get out of that hole and they can recover. And I see patients that they're really in a really bad spot and they start thriving and they start feeling better and their lives get better. And those patients usually use a lot of the mindfulness tools.

So when you're looking at depression, are there types of depression that typically respond better? Like, would a seasonal depression respond better, or are there stratifications for how it's approached that they have any data on that?

No, it's all, it's all one lump. Yeah. It's good for, I think, all types of depression.

Yeah. And I want to kind of emphasize, Dr. Lavaina, what you were saying, that anxiety depression, on the one hand, can be treated very effectively with yoga or meditation. On the other hand, there could be biochemical issues. There could be mercury poisoning or heavy metal toxicity. There could be gluten sensitivity. There could be a lot of other things. Or even just as the posture, talking about how they're standing and sitting and et cetera, so forth. Just that could be. If your head is hunched forward, you can very much feel depressed and anxious. And yoga can help with that.

Obviously, we can't have an episode without talking about Amy Cuddy. We just can't.

This is so important. Yeah, it's true.

So it's definitely not a one size fits all approach, which is what you're saying. And this is a major part of it is if you can't stay present, if you can't feel your body, you may get anxious. That cycle may be repeating. So it's huge. Cool.

Yeah. And I think that one of the things that John Kabat Zin says in his training is like that sometimes we are always like, or all of us may, we are always rushing. We have to take the kids to school and go to work and finish the project and do this and do that, and, and, and some people, they get to their 70s, they're 70 years old, they're 80, and they, they've been rushing all their lives, and they haven't been paying attention to their loved ones or their needs or the. So being in automatic pilot all your life is. It could be really sad. So I think that that's something that we can tell our patients that just practicing at least one minute a day, being here in the present moment, filling your body, asking yourself, do I have anxiety today? Am I have tension? Like, what's going on? What do I need? I think that's super important for our lives because if not, we are rushing and rushing and rushing to the finish line. That is death. And then we get there. So I think that's something that I always like from John Kabat, saying that we don't need to be, we have to be, or from Thich Nhat Hanh. He says that the best gift that you can give your family, yourself, your friends, your patients is being present, listening and being there. Maybe you're not talking, but you are there and you're present.

Very cool.

Yeah, it is very cool. I want to know how do yoga, meditation and other movement practices play within the functional medicine approach? Do you start with them? Do you finish with them? Is it alongside? How do you weave it in?

That's a good question. So usually I start listening to the patient and we go through all the. We start with all the recommendations and, you know, biochemicals, functional medicine. We can talk about diet, supplements, sleep. But I feel. Finish all my. All my visits with, like, you can have the best diet with the best diet and, like, follow everything we tell you. You can take all the supplements, you can sleep, have a really good sleep routine. But if you don't work on your stress and your spirituality, your connection with your. With your. You can call it higher self, you can call it. With your. If you don't get connected with yourself and work with stress reduction or yoga or any of these practices, or it could be painting. It doesn't have to be yoga or meditation. It could be painting. One of my patients this morning, he told me that he's into working with wood and he's carving and he's doing all these things and it's super relaxing. So it could be anything that brings you to the present moment. Music. So what I was going to. So if you're not going to do that, if you're going to be very stressed and rushing, keep it like the same lifestyle. Don't waste your money. Don't waste your money in all these supplements, you know, because your body doesn't heal. When we are in the stress response, in the sympathetic mode, the Most important for our body is to survive, to get the blood to our muscles, to. To our brain to survive. But in the parasympathetic mode, vagal tone that we call it, when your body is relaxed, you rest, digest and you heal. So if you want to heal your body, you have to give your body some rest.

Right. And putting it into kind of the five journeys perspective. It's really important to exercise the body. And the studies are showing now that it's just as important to exercise the mind. If you don't exercise the mind through meditation or these other practices, just exercising the body is not enough, like you said, or just sleeping is not enough, or you can take all the supplements in the world, but you have to exercise the mind and stay present and sharp and be here.

Now I have a question I'd like to go back to, which is you've mentioned it a couple times. Neuroplasticity. What do you mean by that? What difference does it make? Why is it important for people?

Oh, that's a good question. I love neuroplasticity. So one of the trainings that I took was in neurofeedback. And so, for example, when you are studying or when you want to learn something, and you repeat it and repeat it and repeat it and repeat it, so you're generating new connections in your neurons when you are doing something a lot of times. So the, this muscle memory. Yeah. The scientific explanation is that when you're doing that several times, you're creating these new connections between two neurons. Or more. A lot more. But the interesting thing that if when you're creating those connections and you've been doing it for so long, there's some proteins that bind the two neurons together. And so you created a memory. So maybe, for example, with riding a bike, maybe you were riding a bike like all your childhood, and then for 10, 20 years you don't ride a bike. Then you get on a bike and you ride the bike because those proteins, those synapses are so, so stable. So the same happens with this, with mindfulness meditation. So every day you go back to your breath, you go back to filling your body. You tell yourself that you are important, that you're lovable, that you love yourself, that. So then you start believing that, that you are worth it and you are good and you, you know. So I think that that's very interesting about neuroplasticity because I have a lot of people and I thought it myself. Oh, my, my grandma, my mom had anxiety, so I'm anxious and that's the way it is. It's just genetics. And I'm not going to change my brain. It doesn't matter if you are 10, if you're 20, if you are 85, we can change our brains. There's neuroplasticity. There's a lot of studies with that. There's studies with patients that had strokes that the good side, the side that they can still use, they do an exercise of putting it to not use it and start using the site that was affected by the stroke and they start generating new connections in the brain. It's very interesting and I think that it's very, it gives us a lot of hope because sometimes when we, we think it's the way it is and we can change it, we, we can change our brain. And what I tell my patients in, in our visits when there's depression involved or anxiety is like, you can train your brain to play the piano. Yes. You can train your brain to drive. Do you drive? Yes. You can train your brain for happiness.

Yeah. How important is that? That's really important. So where do you start? What are the good resources that we can. That our audience would. You would recommend to our audience as like a place to start? Is there apps that are the.

That's a good question. Yeah. So. And I can then give you the list of my favorite meditations and sites and all that. But yes, using an app is really, it's a good way to go. Calm Headspace Insight Timer. So there's, there's a bunch of apps that you can do and that's easy because it's in your phone and you can maybe if you feel anxious or you want to do like a three minute meditation at lunch, you can listen to that. I use it with my kids too Calm. They listen to meditations at night. And so I think it's a very, very good app. Calm is a good app. That's the one we use. Then there's a lot of good teachers. Well, John Kabat Zin, that we already. And there's a lot in YouTube with all these teachers. Jon Kabat Zinn, Tara Brack, she's a mindfulness teacher. She's a Buddhist psychologist. I think she has amazing meditations. So that could be another good name. Lots of. In my classes and my group visits, what I use a lot is Meditations of Christopher Girmer and Christine Neff. I don't know if you've heard of them, they do the Self Compassion Mindfulness meditation. They have a program the Self Compassion and Antara Brack always says that with mindfulness you have. It's like a bird with two wings. You have the paying attention. Oh, yes. We have to pay attention to the breath and to the body and to the thoughts. So awareness is one wing and the other wing is. One is paying attention and the other wing is befriending and doing something. So if you just pay attention. Well, yeah, I'm paying attention to my breath. That is fast today. And. But if you pay attention and then you hold yourself with kindness, it's, it's going to be. It works a lot better if you put some self compassion into the mindfulness meditation. So attending and befriending, that's what she calls, calls it. And Christine Neff and Christopher Garmer, they had done a lot of studies with depression and anxiety and they compared just mindfulness meditation and mindfulness meditation with self compassion. The rates of recovery with this with self compassion trainings are double. Like, much, much better. It's. They have a lot of good meditations about self compassion and, and I can list them and we can give you a list of meditations.

Perfect. Thank you so much. This has been unbelievable. I know. I've learned a lot.

Yeah. I want to go back and do my Tai chi practice now. I haven't done it in a while.

It's fun. Thank you. Thank you for having me. Yeah, it's been, it's been great to talk with you.

Thank you for joining us, Dr. Marianella Lavana, on the Five Journeys podcast.

Thank you.

Thank you.