Feb. 5, 2001 -- If you're serious about reducing your heart attack risk, it can seem like a full-time job. You need to eat right: easy on the fat, fried foods, and red meat. You should exercise regularly, including plenty of cardiovascular conditioning. And you must control stress. It's quite a tall order.
Now comes another suggestion that's easier to follow: Don't forget to laugh.
Laughter is being called the latest weapon in the fight against heart disease, ever since University of Maryland researchers reported at an American Heart Association meeting in November that heart-healthy people are more likely than those with heart disease to laugh frequently and heartily, and to use humor to smooth over awkward situations. There's even hope, the scientists say, for cranky people who rarely laugh and for those without a sense of humor: They can learn.
In the study, Michael Miller, MD, director of the Center for Preventive Cardiology at the University of Maryland Medical Center, Baltimore, and his colleagues asked 150 people who had suffered heart attacks or undergone heart bypass surgery for their reactions to situations such as arriving at a party to find someone wearing identical clothing, or having a drink spilled on them by a waiter. They compared the responses -- and especially their tendency to laugh -- to those from 150 healthy control subjects (matched for age) without heart problems.
Turns out that the healthy people were more likely to laugh often and to use humor to get out of uncomfortable situations. Those with heart disease, on the other hand, were 40% less likely to laugh in those situations.
The value of a laugh
Exactly how laughter may protect the heart isn't entirely understood, says Miller. But some evidence suggests that the effects of a chortle, snicker, or guffaw include reduction in stress hormones such as cortisol, and reduction in blood pressure. That in turn may reduce heart disease risk. It is known that mental stress can impair the endothelium, the protective barrier lining the blood vessels, Miller says.
Besides those physiological effects, Miller says, there may be additional mechanisms to explain why laughter is good for your heart and your health. He hopes to discover more during his next study, scheduled to start in the spring.
The setting in which you laugh may be important, says Adam N. Clark, MD, a fellow in cardiology at the University of Virginia, Charlottesville, and a co-author of the study. Usually, you laugh in a group or with at least one other person (although Clark is quick to point out there's nothing wrong with a good belly laugh when you're by yourself). But the social aspect of laughing may be a plus, Clark says, because isolation can be associated with depression.
A short history of therapeutic laughter
The concept of laughter being good medicine isn't new, of course. It was mentioned in the Old Testament. ("A merry heart doeth good like a medicine, but a broken spirit drieth the bones." Proverbs 17:22.)
And it's been more than two decades since the late magazine editor Norman Cousins published his 1979 "Anatomy of an Illness," in which he describes how he was diagnosed with ankylosing spondylitis, a painful rheumatic disease, and how he managed it partly by watching funny videos. Now there's more scientific evidence to buttress Cousins' intuition.
What a good laugh can do
Lee Berk, DrPh, a pioneer in laughter studies, says laughter has been found to decrease or attenuate cortisol and other "distress" hormones, although not everyone agrees. And laughter may improve the immune system, adds Berk, associate director of the Center of Neuroimmunology at Loma Linda University School of Medicine and associate professor of health promotion and education in the university's School of Public Health.
In his oft-quoted study, published in the American Journal of the Medical Sciences in December 1989, he found that laughter is a good kind of stress: It reduces blood levels of cortisol, epinephrine, and other substances. Increased cortisol and epinephrine levels tend to suppress the immune system, so decreasing their levels is believed to be beneficial.
Laughter may go a long way to reducing pain, too. At UCLA, a five-year program called UCLA/Rx Laughter, in which researchers are studying the effects humorous videos have on young patients' perception of pain, is entering its second year, funded in part by TV's Comedy Central.
Laughter also may help a patient who already has had a heart attack, Berk says. In a study he and his colleagues presented at the 4th International Conference on Preventive Cardiology in 1997, 24 cardiac rehabilitation patients who watched a 30-minute funny video each day for a year had fewer heart attacks than 24 cardiac patients who did not watch such videos. In the video-watching group, only two had subsequent heart attacks, compared to 10 in the other group.
It would be easy enough to add laughter to a traditional cardiac rehabilitation program, says Veronica Polverari, RN, board certified in holistic nursing and manager of cardiac rehabilitation services for Santa Monica-UCLA Medical Center. Currently, many programs include lifestyle modifications such as having people watch what they eat and exercise more. Adding advice on how to laugh more would be simple, Polverari says.
Learning the art of laughter
Laughing more often and seeing humor in stressful situations can be learned. Larry Wilde, a former standup comedian who founded the Carmel (Calif.) Institute of Humor, makes a living as a motivational humorist, teaching people to laugh. At 72, he says he is free of heart disease.
Wilde hosts laughter-boosting conferences for corporations, associations, and healthcare providers. He also has a web site that offers mini lessons. Among the titles: Up Your Laugh Quotient ("Embrace the notion that humor is not incompatible with dignity and stature.") Wilde uses his own sense of humor to make others laugh: On the phone with a reporter, he says, "Why don't you come to dinner?' Told that the reporter lives more than 300 miles away, he isn't fazed. "We'll send down a jet." Which, of course, makes the reporter laugh.)
You also can improve your sense of humor on your own, Miller says:
- Place a photo of a family event that makes you smile or laugh, or a clipping of a magazine or newspaper cartoon that made you giggle, in plain view.
- Realize that humor is subjective. Figure out what you think is funny and expose yourself to it. "My wife thinks Seinfeld is funny," Miller says. "I don't. I think The Honeymooners is funny, but my wife doesn't."
- Consider gathering a group of friends and engaging in an activity that no one excels at. It could be ice-skating, tennis, or basketball. The point, Miller says, is that if everyone is equally bad, you'll soon be laughing at yourselves.
Finally, for Valentine's Day: Buy your loved one a funny video instead of artery-clogging chocolates.