Gelotology, or the science of laughter, is developing as a complementary field of medicine. Laughter therapy has been shown to have multifaceted physiological and endocrine benefits, and is being used to help manage various chronic diseases. This communication describes some aspects of laughter therapy, and reviews evidence related to its therapeutic potential in diabetes care.
Keywords: Diabetes mellitus, euthymia, euthymic euglycaemia, glycaemic happiness, lifestyle modification, non-pharmacological therapy
Diabetes is a multifactorial syndrome, with various mechanisms contributing to its pathophysiology and progression. The autonomic nervous system not only contributes to insulin resistance, but is affected by uncontrolled hyperglycaemia as well.1,2 Thus, the autonomic nervous system is both a villain, and a victim, on the diabetes battlefield.
Multiple pharmacological therapies have been developed and utilized for the management of diabetes, including those directed to the autonomic system, such as bromocriptine.3 However, no single therapeutic modality is able to provide comprehensive control. The foundation of diabetes care, viz, lifestyle modification, has its own limitations and challenges as well. Hence, there is a need to explore newer methods for glycaemic control.
One such mode of treatment is laughter, or humour. This is not a laughing matter: gelotology,4 or the science of laughter, is developing as a distinct field of medicine. This communication shares evidence and suggests pragmatic ways of incorporating laughter into our daily medical practice.
Laughter is known to upregulate genes related to NK (natural killer) cell activity in diabetes, and thus improve immunity.5 It also modulates the renin-angiotensin system, and offers a way of influencing vascular tone.6 Well-conducted studies have demonstrated a beneficial effect of laughter on post prandial glucose levels.7,8
Various hypotheses have been postulated to explain the mechanism of action of humour. These include the relief theory, incongruity theory and superiority theory. These theories focus on the specific role that humour plays for people in situations such as dealing with misfortune, making sense of rule violations, and bonding with others. Irrespective of the explanation, however, the physiological advantages of laughter seem to be obvious.9
From an endocrine perspective, laughter defuses the “fright, flight, fight” effect of catecholamines, which serve as counterregulatory hormones against insulin. Attenuating the frightening effect of these hormones may help reduce insulin resistance in persons with dysglycaemia.
Laughter yoga has been shown to have psychologically beneficial effects, especially on the aspects of tension–anxiety, and vigour. Adrenocorticotropic hormone and cortisol levels are significantly decreased after four laughter yoga sessions in healthy adults.10
Impact on health
Laughter has been shown to be associated with a lower risk of all- cause mortality and cardiovascular disease in a large population-based study. In the Yamagata study, individuals who laughed more than once a week had lower risk of cardiovascular disease and mortality.11 Similar results are available for persons with diabetes.12 Apart from end points such as cardiovascular disease, laughter also favourably influences softer end points like self- compassion13 and promotes resolution of hyperglycaemia.14
Results suggest that people with either type of diabetes are more inclined toward self-enhancing humour, less inclined toward aggressive humour, and score better on self-defeating humour. Persons with type 1 diabetes tend to be inclined toward affiliative humour as well.14
Based upon current evidence, laughter therapy should be promoted as a part of diabetes self-management education, and of coping skills training. Laughter should be utilized as a therapeutic tool by the diabetes care team, to achieve the goal of euthymic euglycaemia, or glycaemic happiness, not only in their patients, but in themselves as well.15,16 Begin by smiling and laughing yourself: the patient and her/his family will automatically follow suit. Find humour and positivity in adversity: you will automatically find an opportunity to achieve health and happiness.
1. Kalra S, Kalra B, Agrawal N, Kumar S. Dopamine: the forgotten felon in type 2 diabetes. Recent patents on endocrine, metabolic & immune drug discovery. (Journal Discontinued).2011;5:61-5.
2. Feldman EL, Callaghan BC, Pop-Busui R, Zochodne DW, Wright DE, Bennett DL, et al. Diabetic neuropathy. Nat. Rev. Dis. Primers. 2019;5:1-8.
3. Shivaprasad C, Kalra S. Bromocriptine in type 2 diabetes mellitus. Indian J Endocrinol Metab; 2011;15(Suppl1): S17-24.
4. Gonot-Schoupinsky FN, Garip G. Laughter and humour interventions for well-being in older adults: A systematic review and intervention classification. Complement. Ther. Med. 2018; 38:85-91.
5. Hayashi T, Tsujii S, Iburi T, Tamanaha T, Yamagami K, Ishibashi R, et al. Laughter up-regulates the genes related to NK cell activity in diabetes. Biomed. Res. J. 2007;28:281-5.
6. Nasir UM, Iwanaga S, Nabi AH, Urayama O, Hayashi K, Hayashi T, et al. Laughter therapy modulates the parameters of renin-angiotensin system in patients with type 2 diabetes. Int J Mol Med. 2005;16:1077-81.
7. Hayashi K, Hayashi T, Iwanaga S, Kawai K, Ishii H, Murakami K. Laughter lowered the increase in postprandial blood glucose. Diabetes care. 2003;26:1651-2.
8. Čokolič M, Herodež ŠS, Sternad S, Krebs S. The inhibitory effect of laughter yoga on the increase in postprandial blood glucose in type 2 diabetic patients. Diabetol Croat. 2013;42:54-8.
9. Wilkins J, Eisenbraun AJ. Humor theories and the physiological benefits of laughter. Holist. Nurs. Pract.. 2009;23:349-54.
10. Tanaka A, Tokuda N, Ichihara K. Psychological and physiological effects of laughter yoga sessions in Japan: A pilot study. Nurs Health Sci .2018;20:304-12.
11. Sakurada K, Konta T, Watanabe M, Ishizawa K, Ueno Y, Yamashita H, et al. Associations of frequency of laughter with risk of all-cause mortality and cardiovascular disease incidence in a general population: findings from the Yamagata study. J Epidemiol. 2019:JE20180249.
12. Noureldein MH, Eid AA. Homeostatic effect of laughter on diabetic cardiovascular complications: The myth turned to fact. Diabetes Res Clin Pract. 2018; 135:111-9.
13. Ahmadi Z, Bazzazian S, Tajeri B, Rajab A. Laughter Therapy on Self-Compassion and Hyperglycemia in the Elderly with Type 2 Diabetes. MEJDS.Middle Eastern Journal of Disability Studies. 2020; 10:20-.
14. Greene DS, King ND, Coe JB. Diabetes and Humor: A Preliminary Investigation. Diabetes Spectrum. 2020 ;33:175-81.
15. Kalra S, Das AK, Baruah MP, Unnikrishnan AG, Dasgupta A, Shah P, et al. Euthymia in diabetes: clinical evidence and practice-based opinion from an international expert group. Diabetes Therapy. 2019;10:791-804.
16. Kalra S. The President's message, 2019-20 strengthening endocrinology: Towards a sustainable future. Indian J Endocrinol Metab;2020;24:377-80.