A Laugh A Day Keeps the Doctor Away

Learn about connection between the body, mind, spirit and health

(RxWiki News) Could laughter really be one of the best medicines?

The connection between the body, mind and spirit has been the subject of conventional scientific inquiry for some 20 years. The notion that psychosocial and societal considerations have a role in maintaining health and preventing disease became crystallized as a result of the experiences of a layman, Norman Cousins.

In the 1970s, Cousins, then a writer and magazine editor of the popular Saturday Review, was diagnosed with an autoimmune disease. He theorized that if stress could worsen his condition, as some evidence suggested at the time, then positive emotions could improve his health. As a result, he prescribed himself, with the approval of his doctor, a regimen of humorous videos and shows such as Candid Camera.

Ultimately, the disease went into remission. Cousins wrote a paper published in the New England Journal of Medicine along with a book about his experience, Anatomy of an Illness: A Patient’s Perspective, published in 1979. The book became a best seller and led to the investigation of a new field, known then as whole person care or integrative medicine and now known as lifestyle medicine.


The unscientific foundation laid down by Cousins was taken up by many medical researchers, including the academic medical researcher Dr. Lee Berk in the 1980s. In earlier work, Berk and his colleagues discovered that the anticipation of "mirthful laughter" had surprising and significant effects. Two hormones--beta-endorphins, the family of chemicals that elevates mood, and human growth hormone, which helps with optimizing immunity--increased by 27 percent and 87 percent, respectively, in study subjects who anticipated watching a humorous video. There was no such increase among the control group who did not anticipate watching the humorous film.

In another study, the researchers found the same anticipation of mirthful laughter reduced the levels of three detrimental stress hormones. Cortisol, termed "the steroid stress hormone"; epinephrine, better known as adrenaline, and dopac, the major catabolite of dopamine, were reduced 39, 70 and 38 percent, respectively. These results were statistically significant compared to the control group. Chronically released high levels of these stress hormones can be detremential to the immune system.

Dr. Berk has paired with Stanley Tan, M.D., Ph.D., an endocrinologist and diabetes specialist at Oak Crest Health Research Institute in Loma Linda, California, to examine the effect of mirthful laughter on individuals with diabetes. They found that mirthful laughter, as a preventive adjunct therapy in diabetes care, raised good cholesterol and lowered inflammation. The researchers presented their findings at the American Physiological Society's annual meeting in April 2009.

The Study

A group of 20 high-risk diabetes patients with high blood pressure and elevated cholesterol were divided into two groups: Group C (control) and Group L (laughter). Both groups were started on standard medications for diabetes (glipizide, thiazolidinedione, metformin), high blood pressure (ACE inhibitor or angiotensin receptor blocker) and elevated cholesterol (statins).

The researchers followed both groups for 12 months, testing their blood for the stress hormones epinephrine and norepinephrine, high-density lipoproteins (HDL or "good" cholesterol), certain inflammatory cytokines that help speed up the accumulation of plaque in the heart and C-reactive proteins, a marker of inflammation and heart disease. Group L viewed self-selected humor for 30 minutes in addition to the standard therapies described above.


The patients in Group L had lower epinephrine and norepinephrine levels by the second month, suggesting lower stress levels. They had increased HDL cholesterol. The laughter group also had lower levels of the inflammatory cytokines and C-reactive proteins, indicating lower levels of inflammation.

At the end of one year, the research team saw significant improvement in Group L:  HDL cholesterol had risen by 26 percent, but Group C had only risen 3 percent. Harmful C-reactive proteins decreased 66 percent in the laughter group versus 26 percent for the control group.


The study suggests that adding an adjunct therapeutic mirthful laughter prescription to standard diabetes care may lower stress and inflammatory response and increase good cholesterol levels.

The authors conclude that mirthful laughter may thus lower the risk of heart disease associated with diabetes and metabolic syndrome. Further studies need to be done to expand and elucidate these findings.

In describing himself as a "hardcore medical clinician and scientist," Dr. Berk says, "The best clinicians understand that there is an intrinsic physiological intervention brought about by positive emotions such as mirthful laughter, optimism and hope. Lifestyle choices have a significant impact on health and disease, and these are choices...we and the patient exercise control relative to prevention and treatment."

Donna Krupa

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Review Date: 
October 1, 2010