ENHANCING MANAGEMENT OF TYPE 2 DIABETES THROUGH YOGA

Enhancing Management of T2 DM Through Yoga

Yogacharya Dr. ANANDA BALAYOGI BHAVANANI

MBBS, ADY, DSM, DPC, PGDFH, PGDY, MD (Alt Med), FIAY, C-IAYT

Deputy DirectorCentre for Yoga Education, Therapy and Research (CYTER),

Sri Balaji Vidyapeeth, Puducherry.www. sbvu.ac.in/ahs/yoga

SBV AIM HIGH’sCentre for Yoga Therapy, Education

and Research (CYTER)

Salutogenesis, our focus!

SBV AIM HIGH’sCentre for Yoga Therapy, Education

and Research (CYTER)

Salutogenesis, our focus!

SBV AIM HIGH’sCentre for Yoga Therapy, Education

and Research (CYTER)

Salutogenesis, our focus!

Salutogenesis, our Focus• Moving from pathogenesis, the focus on disease

towards salutogenesis, the focus on health!

• Under SBV AIM HIGH (Academy of IntegrativeMedicine for Holistic Intervention towards GeneralHealth), Faculty of Allied Health Sciences, CYTER isstriding forward on an innovative path of promotingholistic health for one and all.

Pathogenesis

Salutogenesis

Bridging the experiential wisdom of Yoga with empirical modern medical science.

Yoga is usually found in Physical Edu& Sports deptts of universitiesWe at CYTER, have it in a medical institution since 2010

– quality of life enhancing benefits for ~ 29,000 patients

– educating future Yoga therapists (PGDYT, M.Phil, PhD),

– creating awareness amongst medical, dental and nursing students & professionals

– scientifically researching Yoga, – 53 publications & 4 CMEs

“அண்டத்தில் உதிப�ண்ட;ிப�ண்டத்தில் உதிஅண்ட;ிஅண்டடிப�ண்டடிஒனஉேிஅே்ிநத�னிப�ர்கடஉப�உத”

- சட்்ட�னிச்டதர

That which lies in the macrocosm, lies in the microcosm.

That which lies in the microcosm lies in the macrocosm.

When we understand truly, both are indeed one.- Sattaimuni Siddhar

Introduction• Yoga is probably the best lifestyle ever designed• Effective in stress induced, lifestyle disorders.• Even a short lifestyle modification program based on

Yoga reduces risk factors for cardiovascular diseaseand DM within a period of 9 days (Bijlani, 2005)

• Yogic practices may have a role in prevention andmanagement of diabetes & in co-morbid conditionslike hypertension and dyslipidemia (Sahay, 2007).

• Adjunct Yoga therapy may help obtain benefits atlower doses, reducing side effects of medicines –enhancing metabolic control & patient compliance.

• Increased insulin sensitivity & attenuation of –verelationship between weight /WC & insulin sensitivityassociated with long term Yoga practice (Chaya, 2008).

• A systematic review (32 articles from 1980-2007)found Yoga interventions effective in reducing weight,BP, glucose level & high cholesterol (Yang 2007)

• Improved nerve conduction (Malhothra, 2002) andbiochemical profile (Lorenzo, 2008) in diabetics.

• With no appreciable side effects & multiple collateralbenefits, Yoga is safe, simple, & can be practiced byeven ill, elderly /disabled pts (Innes &Vincent, 2007).

• Being safe, simple & economical, it should beconsidered beneficial adjuvant in DM (Jain, 1993).

• A comprehensive review by Innes & Vincent (2007)found beneficial changes in several risk indices,including– glucose tolerance, insulin sensitivity, lipid profile,

anthropometric characteristics, blood pressure,oxidative stress, coagulation profiles, sympatheticactivation and pulmonary function, ……. as well as

– improvement in specific clinical outcomes.• Suggested Yoga may improve risk profiles in adults

with Type 2 DM &• May have promise for prevention and management

of cardiovascular complications in this population.

WHAT IS YOGA ?• A mindful way of life• Union (Yuj) of

– Body, emotions and mind– Jivatma with Paramatma

• Skill in action• Stilling the whirlpools of the mind• Harmony of thought, word and deed• Equanimity of mind (samatwam)• Conscious evolution

ASHTANGA YOGAEight limbs of Patanjali’s Ashtanga Yoga

• Yama - morality for daily living• Niyama - ethics for the self• Asana - firm & comfortable posture• Pranayama - control of the vital energy• Pratyahara - sensory withdrawal• Dharana - one pointed concentration• Dhyana - state of meditation• Samadhi - absorption/ oneness

ADVANTAGES OF YOGA

Wholistic:• Preventive, promotive, rehabilitative, curative (?) • Science, philosophy, art• Involves body, mind, spirit• Desirable +ve “side benefits”• Simultaneous improvement in health and control

of other conditions • Relief from stress - the main cause of Adhija

Vyadhi (psychosomatic disorders)

What is health?

“samadoshah samaagnishcha samadhaatumalakriyah prasanna atmendriyamanah

swasthityabhidheeyate”Health is a dynamic balance of the elements andhumors, normal metabolic activity and efficientelimination coupled with a tranquil mind, sensesand contented self.

–Sushruta Samhita, Sutrasthanam, 15:41

• Yoga enables attain and maintain a dynamicsukha sthanam - a dynamic sense of physical,mental and spiritual well being.

• Yoga helps cultivation of positive health throughthree integral steps *:1. Cultivation of correct psychological attitudes,2. Reconditioning of neuro-muscular and neuro-

glandular system – in fact, the whole body –enabling it to withstand stress and strain better,

3. Laying great emphasis on appropriate dietconducive to such a peak state of health, andencouraging natural processes of eliminationthrough various processes of shuddhi.

* Swami Kuvalayananda & Vinekar S.K. Yogic Therapy (1963)

Yoga places great importance on a proper and healthylifestyle whose main components are:

Achar – healthy physical activities & exercise

Vichar – right thoughts and right attitude towards lifethat are vital for wellbeing.

Ahar – healthy, nourishing diet with adequate intakeof fresh water; balanced intake of fresh food, greensalads, sprouts, unrefined cereals & fresh fruits.Satwic diet, prepared & served with love & affection.

Vihar – proper recreational activities to relax bodyand mind are essential for good health.

THEYOGIC

CONCEPT OF

ORIGIN OF

DISEASE-

Yoga Vashishta

Perceived Stimulus

PSYCHO-NEURO-IMMUNO-ENDOCRINOLOGICAL CORRELATES OF STRESS, ILLNESS & HEALTH

NERVOUSSYSTEM

ENDOCRINESYSTEM

IMMUNESYSTEM

MENTAL & PHYSICAL ILLNESS

PSYCHO-NEURO-IMMUNO-ENDOCRINOLOGICAL CORRELATES OF STRESS, ILLNESS & HEALTH

NERVOUSSYSTEM

ENDOCRINESYSTEM

IMMUNESYSTEM

HEALTH & WELLNESS

Illness to Wellness, the choice is ultimately

ours & ours alone !

Yoga intervention:Pathway 1

↓ Perceived stress↓Activation/reactivity

of sympathoadrenalsystem and HPA axis

Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2 diabetesmellitus: A systematic review. eCAM 2007; 4: 469-86.

Postulated mechanisms of yoga in diabetes mellitus

Yoga intervention:Pathway 2

Vagalstimulation

↓Parasympathetic

activation

Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2 diabetesmellitus: A systematic review. eCAM 2007; 4: 469-86.

Postulated mechanisms of yoga in diabetes mellitus

Yoga intervention:Pathway 2

Yoga intervention:Pathway 1

↓ Inflammatory cytokines↓ Heart rate, blood pressure

Reduced risk for:Type 2 diabetes and its complications

Improved coagulation / fibrinolytic profile↓ Oxidative stress

↑ Endothelial function

Enhanced metabolic and psychological profile↑ Insulin sensitivity↑ Glucose tolerance

Improved lipid profile↓ Visceral adiposity

Improved mood

↓ Perceived stress↓Activation/reactivity

of sympathoadrenalsystem and HPA axis

Vagalstimulation

↓Parasympathetic

activation

Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2 diabetesmellitus: A systematic review. eCAM 2007; 4: 469-86.

Postulated mechanisms of yoga in diabetes mellitus

All aspects of human psycho-physiological functioning improved

When the breath is steady, emotions become more balanced

When the body is stilled, the mind starts to calm down

Conscious focus on the present moment-the NOW

Integration breath pattern with coordinated smooth body

movements

Basic Yogic principles used in management of DM

• Psychological reconditioning and development ofappropriate attitudes such as yama-niyama,chaturbhavana, pratipaksha bhavanam etc

• Stress management through counseling, jathis(loosening techniques), asanas (postures), kriyas(breath-body coordination movements) andpranayama (breath-energy harmonizing techniques).

• Helping use glucose better through physical activity:surya namaskar, asanas, kriyas, pranayama etc

• Relaxation, visualization and contemplative practicesto induce a sense of inner calmness and wellbeing.

Kriya

Asana

Meditation

Pranayama

Relaxation

Yoga therapy practices

30

Recommended practices that are modified as per individual needs & /abilities.

Counseling of yogic lifestyle, diet and attitudes

• Jathis & Kriyas (loosening & breath body coordination practices )• Suryanamaskar• Tala asana• Trikona asana • Parshvakona asana• Veera asana• Pawanmukta asana• Nava asana• Ardhamatsyendra/ vakra• Viparitakarani

• Agnisara kriya• Kapalbhati• Chandra nadi pranayama• Bhramari pranayama • Pranava pranayama & dhyana• AUM Japa with Mudras• Kaya kriya• Marmanasthanam kriya

Uninostril / alternate nostril pranayamas

Suryanadi asana Chandranadi asana

Whooshing tensions away-nasarga mukha bhastrika

Tension relaxation coupling: Spanda nishpanda

Chakra MeditationChakra dhyana

Inha

leExhale

References:• Bhavanani AB. Yoga Chikitsa: The application of Yoga as a therapy. Pondicherry, India: Dhivyananda

Creations, 2013.• Bijlani RL, Vempati RP, Yadav RK, et al. A brief but comprehensive lifestyle education program

based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus. J AlternComplement Med 2005; 11:267–74.

• Chaya MS, Ramakrishnan G, Shastry S, et al. Insulin sensitivity and cardiac autonomic function in young male practitioners of yoga. Natl Med J India 2008; 21:217–21.

• Gordon LA, Morrison EY, McGrowder DA, et al. Effect of exercise therapy on lipid profile and oxidative stress indicators in patients with type 2 diabetes.BMC Complementary and Alternative Medicine 2008; 8: 21.

• Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: A systematic review. Evid Based Complement Alternat Med 2007; 4: 469–86.

• Jain SC, Uppal A, Bhatnagar SO, Talukdar B. A study of response pattern of non-insulin dependent diabetics to yoga therapy. Diabetes Res ClinPract 1993; 19: 69–74.

• Madanmohan, Bhavanani AB, Dayanidy G, Sanjay Z, Basavaraddi IV. Effect of yoga therapy on reaction time, biochemical parameters and wellness score of peri and post-menopausal diabetic patients. International Journal of Yoga 2012; 5: 10-15.

• Malhotra V, Singh S, Tandon OP, Madhu SV, Prasad A, Sharma SB. Effect of Yoga asanas on nerve conduction in type 2 diabetes. Indian J Physiol Pharmacol 2002; 46: 298-306.

• Sahay BK. Role of yoga in diabetes. J Assoc Physicians India 2007; 55:121–6. • Yang K. A Review of yoga programs for four leading risk factors of chronic diseases. Evid Based

Complement Alternat Med 2007; 4: 487–91.

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