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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.
Accredited with ‘A’ grade by NAAC