The quest for good health is turning inward. Increasingly, the medical profession is promoting the notion that a person's spiritual well-being may be as important a factor in long-term health as are diet and exercise.

The value of spiritual health has been recognized by certain health-care professionals for some time, but now it has become a widely accepted area of medical study. A search in the Medline database of medical journal articles shows more than 600 papers dealing with the issues of spirituality and health. The Harvard University Medical School's department of continuing education recently hosted a conference on spirituality and healing.

In these instances, spiritual activity is broadly defined -- moving beyond religion to include meditation or even just relaxation exercises and calming experiences. In the fall, Alternative Therapies in Health and Medicine published a small study highlighting the role spiritual well-being may play in the reversal of heart disease. In it, North Carolina physician Edwin Morris reviewed a well-known heart disease study that found participants who made significant lifestyle changes, including regular meditation along with diet and exercise, posted a reversal in heart disease, unlike the group that didn't make such changes.

Morris tracked down 14 members of the original Dean Ornish study and gave them a widely used questionnaire to assess each individual's spiritual well-being. Questions focused on issues such as a person's sense of meaning and purpose, level of materialism, altruism and idealism, and feelings about things considered sacred or tragic.

In the study, Morris found that, on average, the group with the highest reversal of heart disease also scored 24 percent higher on the spirituality scale. Some scored as much as 50 percent higher. Because the highly spiritual patients also had adopted other lifestyle changes, including diet and exercise, it is impossible to know how much of a factor spiritual health had on physical health. Also, the study size was too small to be conclusive.

The spiritual chasm between the two groups is so significant, however, the study strongly suggests that spiritual well-being plays a profound role in physical health. "You don't know the cause and effect, but what you do know is the spirituality scores correlated with a reversal of disease," says Morris, medical director of the Franklin Cardiac Rehabilitation Program in Franklin, N.C.

One explanation for the health benefits of spirituality and religion involves the body's ability to manage stress. Stress is a well-documented culprit in heart disease, insomnia, hypertension, depression, chronic pain and sexual dysfunction, among other health problems. Stress triggers a biological response that includes the release of adrenaline and other chemicals.

The body also can evoke a relaxation response that triggers a variety of chemical and body changes, including decreased brain activity and lower blood pressure and heart rate. The response can be evoked by repetitive thoughts during meditation, breathing exercises, repetitive movements used in martial arts, or repetitive prayer.

A study in Brain Research Review found that the relaxation response as well as the placebo effect -- in which patients report improvement despite taking only a placebo -- are both linked to the body's production of nitric oxide, which controls other chemical changes. A May 2000 study in the medical journal Neuroreport used magnetic resonance imaging to document the effects of meditation on the part of the brain involved in attention and control of the autonomic nervous system.

Doctors recommend that patients, particularly those with significant health problems, find a daily spiritual activity such as meditation, yoga or prayer. Job satisfaction, volunteer work or time spent enjoying nature also can be beneficial. "Anything that helps you connect to other people is an important factor, as is anything that enhances the sense of mission or purpose in your life," Morris says.

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