Professor Eric Loucks, director of Brown's Mindfulness Center, joins host Megan Hall to discuss how practicing mindfulness can have measurable, positive health outcomes. His recent paper in JAMA Network Open looks at how an eight-week mindfulness course, focusing on the Dietary Approaches to Stop Hypertension (DASH) diet, moved the needle on cardiovascular health.

Narration 0:02

Welcome to Humans in Public Health. I'm Megan Hall.

In the past few years, the field of public health has become more visible than ever before, but it's always played a crucial role in our daily lives.

Each month we talk to a person who makes this work possible. Today, Professor Eric Loucks.

Eric Loucks says there’s a good reason why so many people have turned to these practices.

As the director of Brown University’s Mindfulness Center, he’s researching whether meditation and other mindful exercises can improve cardiovascular health.

And so far, the evidence is promising. He published a new study this month showing that a mindfulness program helped participants stick to a heart-healthy diet.

Megan Hall 1:04

Eric Loucks, such a pleasure to have you in the studio today. Thanks for joining me.

Eric Loucks 1:06

Yeah, my pleasure. Great to be here.

Megan Hall 1:09

So in this moment, where mindfulness is so popular, what is it? Is it a fad? Is it some sort of spiritual practice? Is it a medical intervention? Or is it all of those things?

Eric Loucks 1:22

I would say all and more. For a while, I was worried it was a fad. But it's, hanging on there. And I think the scientific studies are helping it hold up in Western societies, that really look to the scientific method to really test it and see if it's replicated with high quality methods. It can be a spiritual practice, but it can also just be a tool that can be adapted to someone without a spiritual practice to just help them become more aware and to help see the truth

Megan Hall 1:51

So how do you define mindfulness? How do you explain it to people when you're talking about what you do at the center?

Eric Loucks 1:58

Yeah, one of the most common definitions is that mindfulness is the awareness that comes from paying attention, on purpose, in the present moment, non judgmentally. And so it sort of has two components there. One is like present moment awareness of like our thoughts or emotions, our physical sensations. But it's not just awareness of them. It's the quality of the awareness so that it's non judgmental, there's curiosity there, gentleness, friendliness. And then another piece of mindfulness definitions often has an element of remembering to it, or in other words, remembering to bring our wisdom into this present moment. So wherever we get our wisdom from, whether it's from some religious tradition, or a friend or book that we read, or wisdom from our own personal experience, it doesn't really matter that we have it unless we bring it right here right now.

Megan Hall 2:43

I understand you've been practicing mindfulness since you were 23. What brought you to the practice?

Eric Loucks 2:48

Yeah, I- my mom's second cousin, married a Tibetan who became the Foreign Affairs Minister of the Dalai Lama's government in exile.

Megan Hall 2:58

Whoa.

Eric Loucks 3:00

And he was a really interesting guy who just had a way about him that drew my curiosity. He was very grounded and playful, and happy. And so he’d drawn my curiosity. I didn't think that much about it until he went off to go work with the Dalai Lama. I was like, Who is this guy? and who's the Dalai Lama? And so I started to read books by him and then in my early 20s, I was just looking around at people who I really respected, like Martin Luther King Jr., or Mahatma Gandhi, or the Dalai Lama. And most of them had a strong spiritual practice. And I was like, there's gotta be, there's probably something to that. Just to help live a happy, healthy life. And so I was kind of, you know, not thinking about that too much. I was in college so I started to explore different wisdom traditions and Buddhism resonated with me, … and so I started practicing, in a Buddhist tradition, led by Thich Nhat Hanh who is a Zen master.

Narration: 3:51

Eric continued his mindfulness practice and at the same time, he started an academic career researching how social factors like trauma and loneliness can affect cardiovascular health. But he kept those interests separate.

Megan 4:05

You were practicing mindfulness in a silo? And then on the other side, you were studying cardiovascular health?

Eric Loucks 4:11

Yeah, this was like 13 years ago, so, mindfulness research was kind of just kind of like emerging at that point. And I had silos, I was like, that's my, personal life.

Narration: 4:22

Eric Loucks 4:24

I had a big study funded by the NIH, in the New England family studies, a cohort of people that have been following since they're in their mom's wombs. At that point, they're in their mid 40s. And I decided to put in a mindfulness questionnaire because I was the principal investigator, and I could

Megan Hall 4:38

You were like, I'm gonna break down that silo right now.

Eric Loucks 4:40

Yeah, just check it out. It's like high risk, high reward.

It was the mindful attention awareness scale. So it was a validated questionnaire that measures people's mindfulness levels, and we ended up finding that it predicted fat distribution in the body, body mass index, smoking, physical activity, overall cardiovascular health, so it was like, wow, there seems to be a signal.

Narration: 5:01

Eric wondered, what if mindfulness training had a specific goal in mind, like improving cardiovascular health? So, he got certified to teach a popular mindfulness program called Mindfulness Based Stress Reduction…

Eric Loucks 5:14

and then started to adapt it. So that yes, can we train ourselves up in mindfulness skills like self awareness and attention control and emotion regulation? But can we actually direct it towards the things that impact cardiovascular disease? In our case, hypertension.

Narration: 5:29

Eric’s latest research, a study released in JAMA Network Open, looked into the effectiveness of a program he ran through the Center: an 8 week course aimed at reducing participants’ blood pressure.

Eric Loucks 5:40

We needed to identify one health behavior as our primary outcome that we felt we could move. And so we named adherence to the DASH diet as our primary outcome. DASH diet stands for Dietary Approaches to Stop Hypertension, it's the most evidence based diet to bring blood pressure down. It's kind of like a Mediterranean diet, but lower salt and a bit more Americanized. So we named that as the primary outcome, although we're also giving them, you know, information on physical activity and alcohol consumption, all that other stuff.

Narration: 6:06

The study found that six months after the program, participants were not only more likely to be sticking to that healthy diet than a control group, but they also had more overall self awareness. Eric says being self aware can affect someone’s eating habits too.

Eric Loucks 6:21

You can imagine, say someone who has something sweet to eat, you know, that they might get a sugar high, and then a sugar crash, and then maybe craving for the next sweet item. And so the self awareness will help us notice, if we're having that sugar high, which maybe is kind of fun. also help us notice if we're having a sugar crash, which is less fun.

Narration: 6:39

Eric helps participants develop these abilities with exercises that work directly with foods.

Eric Loucks 6:44

You know we bring into class, like foods that are sweet and savory. And we have them under like a clean towel. And then we unveil them and invite people to notice their thoughts and emotions, physical sensations, as they see these items that they're about to be invited to eat. And we invite them to choose something that's going to be kind of challenging. And so some people are like, “Yeah, it's free food. Awesome. I'm so excited.” And then other people are like, “Yeah, I know I'm gonna eat that whole brownie. I know, I'm gonna regret it. but I know, I'm gonna do it anyway.” And so you just get to hear the diversity of people's emotions, thoughts, as they, you know, explore these different things and then, we share it as eating, and then even afterwards, like 20 minutes afterwards, we check in with them and just by people to share what's been experienced.

Megan Hall 7:31

So how do you get people to make healthy choices like eat less of those potato chips? If you're supposed to be non judgmental, if you're supposed to be like, I'm eating this potato chip? And it's delicious!

Eric Loucks 7:42

Yeah, judgment is like, this is bad

Megan Hall 7:45

Right.

Eric Loucks 7:46

Or this is wrong. And so, say, with a potato chip. You know, can we be there with potato chip, and just notice how we feel. And for some of us, it's gonna be fine, you know, we ate a big salad for lunch. And for others of us, you know, there's certain ingredients of potato chips that actually activate craving. And so if that's the case, so that we then crave more food, or drinks, or more potato chips, or whatever, then the discernment can come in. And discernment can be a little different than judgment. So it's like this is harming me, I'm less happy or less healthy.

Megan 8:22

I think some people will be surprised that you do exercises like that, because usually when you think of mindfulness, you think I gotta meditate for 45 minutes. And so we're just meditating… meditating. So what's the full scope of what you're doing with these participants?

Eric Loucks 8:36

Yeah. I mean, we're doing that stuff too. So, you know, they're getting pretty solid foundational training, like in mindfulness meditation. In this program, it was actually recommended 45 minutes a day. And, you know, sometimes they're doing body scans or being aware of each and every part of the body.

And then what we do is we then take that solid training in like self awareness, and attention control and emotional regulation, then direct it towards the relationships with the things that drive blood pressure: their relationship with their diet, or with their physical activity, their alcohol consumption, or their medication use. And in doing so, we're hoping that we're boosting effects compared to just taking general mindfulness training. And so that's the idea behind it is you have all that mindfulness training, but then direct it to the things that we know influence blood pressure, can it make the effects even larger?

Megan Hall 9:19

So being specific about where you're pointing that mindfulness makes a difference?

Eric Loucks 9:24

Yeah, like I was involved as a mindfulness teacher for a study on asthma. And participants were just getting generalized mindfulness training, it was actually Mindfulness Based Stress Reduction. And it may be that stress can trigger asthma, but all these other things can also trigger asthma, like exposure to dust, and all this all this stuff. And so we had some participants in the class just wondering why they were there. Like, I have asthma, I get stressed, but I don't think my asthma is caused by stress, I think it's caused by the environment that I live in. And a lot of them would drop out.

So with our program, everybody there has high blood pressure. And immediately on the first day, we're talking about hypertension, the drivers of it and the whole theoretical framework of how mindfulness could help bring blood pressure down. And then they go through specific modules where they're setting goals and really understanding how self awareness of their relationship with, you know, the things that drive blood pressure, whether it's alcohol, or physical activity, or medication adherence can improve their blood pressure. So people have no doubt why they're there. And it was neat to see people's experiences.

What do you say to critics that say, no amount of meditation, or mindfulness training will change that you have to work three jobs to pay your bills, or that you, have a spouse and you're their caretaker and your life is just full of stress, or you don't have access to healthy foods?

Yeah, it’s like if you're living in a high crime area, or can't afford housing or healthy foods, or working so many jobs, what do you do? And we provided a mindfulness training program at a community college, like a college of opportunity with a lot of first generation students. A lot of people are working multiple jobs with kids while getting a college degree. And what we found there was a lot of people took the training, and just brought it into day to day life, like walking to work, brushing their teeth. One person's like putting on their leggings, you know, in the morning, whatever it is just can we bring mindfulness training to like that of what we're already doing.

What does it mean that you now have research that shows that mindfulness has a direct impact, in this case on improving people's diets? Like what does that do for your center, or for your goals at the center?

Yeah, I think part of my major research agenda is to bring mindfulness into cardiovascular health. And so in many ways, a lot of the research is on the mental health aspects of mindfulness. But the behavioral health aspects are potentially profound.

So this is a pretty solid study, over 200 participants, randomized controlled trial, blinded everybody that we could go to the Data Analyst and people doing the assessments and, you know, pre registered or primary outcomes. So to have the paper come out and JAMA Network open, that's really solid journal, that's complemented by another large paper that came out in the Journal of the American Heart Association just six months ago, showing the blood pressure outcomes. It's like, it's nice. It's a lot of work that is nice when it turns out the way it's currently turning out. It could go either way! You know, I try to just publish what we find, and you know, just like with mindfulness, we're trying to find the truth. So I don't want to waste anybody's time if mindfulness isn't impacting diet or blood pressure, self awareness, but if it is, then there's beauty in that too.

Great. Well Eric Loucks, thanks for coming in today. Really appreciate it.

My pleasure. Thank you.

Eric Loucks is an associate professor of epidemiology, medicine, and behavioral and social sciences at the Brown University School of Public Health. He also serves as director of the Mindfulness Center at Brown University.

To learn more about his work, or participate in a mindfulness program at the center, go to brown.edu/public-health/mindfulness.

Humans in Public Health is a monthly podcast brought to you by Brown University School of Public Health. This episode was produced by Nat Hardy and recorded at the Podcast studio at CIC Providence.

I'm Megan Hall. Talk to you next month.