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Enhancing Management of metabolic syndrome and Type 2 diabetes mellitus through Yoga

Yogacharya Dr Ananda Balayogi Bhavanani's invited presentation on "Enhancing Management of metabolic syndrome and Type 2 diabetes mellitus through Yoga" at Samanvaya – 2018, a National Conference on ‘Integrative Diabetology – Present Trend in Diabetes Care’ organised by Sri Devaraj Urs Academy of Higher Education & Research, Kolar, Karnataka (SDUAHER), to update the recent trends in the field of integrative medicine and its integration with conventional care.

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Enhancing Management of metabolic syndrome and Type 2 diabetes mellitus through Yoga

  1. 1. Enhancing Management of MetS and T2DM Through Yoga Yogacharya Dr. ANANDA BALAYOGI BHAVANANI MBBS, ADY, DSM, DPC, PGDFH, PGDY, MD (Alt Med), FIAY, C-IAYT Director Centre for Yoga Education, Therapy and Research (CYTER), Sri Balaji Vidyapeeth, Puducherry. www.
  2. 2. SRI BALAJI VIDYAPEETH (Deemed University Accredited with “A” Grade by NAAC) Ranked 72 in NIRF 2018 Centre for Yoga Therapy, Education and Research (CYTER) Salutogenesis, our focus!
  3. 3. Bridging the experiential wisdom of Yoga with empirical modern medical science. Yoga is usually found in Physical Edu & Sports deptts of universities We at CYTER, have it in a medical institution since 2010 – quality of life enhancing benefits for ~ 47000 patients – educating future Yoga therapists (PGDYT, M.Phil, PhD), – creating awareness amongst medical, dental and nursing students & professionals – scientifically researching Yoga, – 77 publications & 6 CMEs. – IDY celebrations since 2015
  4. 4. Salutogenesis, our Focus • Moving from pathogenesis, the focus on disease towards salutogenesis, the focus on health! • CYTER is striding forward on an innovative path of promoting holistic health for one and all.
  5. 5. 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 disease & DM within a period of 9 days. (Bijlani,2005) • Yoga may have a role in prevention & management of MetS as evidenced by previous reports. (Bethe,2008;Joel,2011;Kim,2013;Alka,2014;Caren,2015;Parco,2015;Sohl,2016)
  6. 6. • Being safe, simple & economical, it should be considered beneficial adjuvant in DM. (Jain,1993) • Adjunct Yoga therapy may help (Bhavanani,2013) – obtain benefits at lower doses, – reducing side effects of medicines – enhancing metabolic control & – patient compliance.
  7. 7. • Enhanced insulin sensitivity & attenuation of –ve relationship between weight /WC & insulin sensitivity associated with long term Yoga practice. (Chaya,2008) • 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) & biochemical profile (Lorenzo,2008) in diabetics. • With no appreciable side effects and multiple collateral benefits, Yoga is safe, simple to learn and can be practiced by even ill, elderly /disabled patients. (Innes&Vincent,2007)
  8. 8. • A comprehensive review by Innes & Vincent (2007) found beneficial changes in several risk indices, including – glucose tolerance, insulin sensitivity, lipid profile, anthropometric characteristics, BP, oxidative stress, coagulation profiles, sympathetic activation and pulmonary function, ……. as well as – improvement in specific clinical outcomes. • Holger et al (2016) concluded that Yoga can be preliminarily considered as a safe and effective intervention for reducing Wc and SP in individuals with MetS who are not adhering to conventional forms of exercise.
  9. 9. Metabolic Syndrome Obesity Elevated BP Hyperglycemia INSULIN RESISTANCE Dyslipidemia The modern pandemic????
  10. 10. Diagnostic Criteria For Metabolic SyndromeDiagnostic Criteria For Metabolic Syndrome According to guidelines from National Heart, Lung, and Blood Institute (NHLBI) and American Heart Association (AHA), Metabolic syndrome is diagnosed when a patient has at least 3 of the following 5 conditions: 1. Fasting glucose ≥100 mg/dL (or receiving drug therapy for hyperglycemia) 2. Blood pressure ≥130/85 mm Hg (or receiving drug therapy for hypertension) 3. Triglycerides ≥150 mg/dL (or receiving drug therapy for hypertriglyceridemia) 4. HDL-C <40 mg/dL in men or <50 mg/dL in women (or receiving drug therapy for reduced HDL-C) 5. Waist circumference ≥102 cm (40 in) in men or ≥88 cm (35 in) in women; if Asian American, ≥90 cm (35 in) in men or ≥80 cm (32 in) in women
  11. 11. A chubby baby may not be a healthy baby!!! Obesity starts young!!
  12. 12. If you eat junk food……….. You just end up becoming junk!!
  13. 13. Eat healthy…………… be healthy!!!!!
  14. 14. Responsibility for our health, ………..…… always starts with us!
  15. 15. So, then what about the role of Yoga?
  16. 16. WHAT IS YOGA ? • A mindful way of life • Union (Yuj) of – Body, emotions and mind – Jivatma with Paramatma • Skill in action • Harmony of thought, word and deed • Conscious evolution through choice based actions
  17. 17. ASHTANGA YOGA Eight 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
  18. 18. And not merely the absence of disease.And not merely the absence of disease. Definition of Health (WHO)Definition of Health (WHO) Health is a dynamic state of complete… Health is a dynamic state of complete…
  19. 19. “Yoga therapy is the process of empowering individuals to progress toward improved health and wellbeing through the application of the teachings and practices of Yoga”. – IAYT
  20. 20. Aim of Yoga Therapy Protocol Normalize • Body Weight • Adiposity, • Blood pressure • Blood sugar • Lipid profile • Autonomic balance Reduce Insulin Resistance Enhance Quality of Life Empowering the individual to take charge of their own health.
  21. 21. Mechanism Sympathetic Activity Parasympathetic Activity Body Weight, Blood Pressure, Blood Sugar, Insulin Resistance Dyslipidemia Diet + Jathis, Kriyas, Suryanamaskar, Twisting (Standing, Sitting, Lying down), Shat Kriyas, Pranayama, Relaxation, Meditation.
  22. 22. 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)
  23. 23. • Yoga enables attain and maintain a dynamic sukha sthanam - a dynamic sense of physical, mental and spiritual well being. • Yoga helps cultivation of positive health through three 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 diet conducive to such a peak state of health, and encouraging natural processes of elimination through various processes of shuddhi. * Swami Kuvalayananda & Vinekar S.K. Yogic Therapy (1963)
  24. 24. Yoga places great importance on a proper and healthy lifestyle whose main components are:  Achar – healthy physical activities & exercise  Vichar – right thoughts and right attitude towards life that are vital for wellbeing.  Ahar – healthy, nourishing diet with adequate intake of fresh water; balanced intake of fresh food, green salads, sprouts, unrefined cereals & fresh fruits. Satwic diet, prepared & served with love & affection.  Vihar – proper recreational activities to relax body and mind are essential for good health.  Vyavahar – healthy relationships
  25. 25. Perceived Stimulus Perceived Stimulus
  26. 26. Mental Agitations Mental Agitations Haphazard Flow of Prana Haphazard Flow of Prana Unstable Nadis Unstable Nadis Hypo-cellular activity (Ajeeranatvam) Hypo-cellular activity (Ajeeranatvam) Hyper-cellular activity (Ateejeeranatvam) Hyper-cellular activity (Ateejeeranatvam) Altered cellular activity (Kujeeranatvam) Altered cellular activity (Kujeeranatvam) VYAADHI Physical Ailments VYAADHI Physical Ailments Yogic understanding of Psychosomatic DisordersYogic understanding of Psychosomatic Disorders AADHIAADHI Manomaya Kosha Manomaya Kosha Annamaya KoshaAnnamaya Kosha Pranamaya Kosha Pranamaya Kosha
  29. 29. Stress respons e RelaxationRelaxation responseresponse Yoga Yoga Illness to Wellness, the choice is ultimately ours & ours alone !
  30. 30. Impact of stress on hypothalamic–pituitary–adrenal (HPA) axis and sympathetic NS. * Yoga has been shown to have significant beneficial effects in these Sengupta P. Health Impacts of Yoga and Pranayama: A State-of-the-Art Review. Int J Prev Med 2012; 3:444–58.
  31. 31. Stress management through Yoga • Dr W Selvamurthy gave a beautiful message at SBV recently. He said: Yoga enables and empowers individuals to – Modify their perceptions of the stressors, – Optimise their responses to them, and – Efficiently release the pent up stresses. • We can think of it as a 3-in-1 action!!
  32. 32. Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: A systematic review. eCAM 2007; 4: 469-86. Postulated mechanisms of yoga in diabetes mellitus
  33. 33. MechanismsofYoga MechanismsofYoga
  34. 34. Basic Yogic principles used in management of MetS and DM • Psychological reconditioning and development of appropriate attitudes such as yama-niyama, chaturbhavana, pratipaksha bhavanam etc • Stress management through counseling, jathis (loosening techniques), asanas (postures), kriyas (breath-body coordination movements) and pranayama (breath-energy harmonizing techniques). • Enhance insulin sensitivity through physical activity: surya namaskar, asanas, kriyas, pranayama etc • Relaxation, visualization and contemplative practices to induce a sense of inner calmness and wellbeing.
  35. 35. Yoga therapy protocol for Met S and T2DM Diet: • Avoid refined food stuffs and junk foods. • Take lots of green vegetables salads, bitter gourd and neem. • Maintain good hydration. • Regular small meals • Less amount of salt intake in foods. • Garlic and Onion help to reduce the blood pressure • Avoid pickles , papads , meats • Choose complex carbohydrates and lots of dietary fiber • Perform Vajrasana for 5 min after meals to help digestion
  36. 36. Asana Meditation Pranayama Relaxation Yoga therapy practicesYoga therapy practices 46
  37. 37. 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
  38. 38. Uninostril / alternate nostril pranayamas Suryanadi asana Chandranadi asana
  39. 39. Whooshing tensions away-nasarga mukha bhastrika
  40. 40. Tension relaxation coupling: Spanda nishpanda
  41. 41. Chakra MeditationChakra dhyanaChakra dhyana Inhale Exhale
  42. 42. In conclusion….. • Yoga has infinite possibilities of solutions for the problems being faced by modern humankind. • We however want it to be a miracle pill, that we take only once - immediate loss of all problems! • Yoga is a w-holistic science and must be learnt and practiced with a holistic view. • Dedicated practice of Yoga as a way of life is a panacea for psychosomatic, stress related disorders. • Helps us regain our birthright of natural health, wellbeing and universal happiness.
  43. 43. An Integrated Approach • The need of the modern age is an integrated approach towards therapy utilizing Yoga in coordination & collaboration with other systems of medicine such as Allopathy, Ayurveda, Siddha and Naturopathy • Physiotherapy, osteopathy and chiropractic practices may be used with the Yoga if needed • Advise on diet and life style is very important • Adoption of right attitudes through Yogic counseling
  44. 44. “Health and happiness are your birthright. Learn and live Yoga for then you will know true health and happiness” Yogamaharishi Dr Swami Gitananda Giri Guru Maharaj (1907-1993) Founder: ICYER at Ananda Ashram, Pondicherry, India.
  45. 45. 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 Altern Complement 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.
  46. 46. Thank You!Thank You!