Effects of Yoga for Diabetes Management
Yoga practices such as cleansing processes, asanas, pranayama, mudras, bandha, meditation, mindfulness, and relaxation are known to reduce blood glucose levels and to help in the management of type 2 diabetes mellitus.
Yoga reduces levels of triglycerides, low density lipoprotein cholesterol, and free fatty acids, and improves high density lipoprotein cholesterol levels. It induces discipline regarding food and exercise. The regular practice of yoga reduces the risk of diabetes-related complications. Cardiac autonomic dysfunction is believed to be a cause of sudden death in patients with diabetes mellitus. Clinical studies have shown that regular yoga practice improved cardiac autonomic function independently of glycemic control and reduced the risk of cardiovascular events.
The classical ancient texts Hatha Yoga Pradipika and Gheranda Samhita describe purification/cleansing practices known as shatkarmas. Of these, the practices of vaman dhauti (stomach cleansing with induced vomiting), kapalbhati (frontal brain purification, which is a breathing technique with forceful exhalations and automatic inhalations), and shankhaprakshalana (intestinal cleansing) help to increase the production of insulin and to control blood glucose levels. Regular internal cleansing enhances the functional capacity of the organs.
A study showed that vaman dhauti practice (emetic therapy) caused a marked reduction in blood sugar levels. It is believed to increase glucose uptake, minimize insulin resistance, and promote the function of insulin by reducing levels of circulating free fatty acids in the body. The abdominal pressure created during exhalation in kapalbhati improves the efficiency of β-cells of the pancreas. Shankhaprakshalana is the process of cleansing the intestinal tract by practicing a set of yoga postures and drinking lukewarm water with salt in between. This sequence is repeated till only water is evacuate ed.
The level of blood glucose falls significantly with this intestinal cleansing process. It has been claimed that this practice increases insulin production and helps in the control of diabetes. Agnisar kriya (stimulation of the digestive fire) involves pulling the abdomen in (uddiyan bandha) and snapping it backwards and forwards while holding the breath. The ‘vacuum’ effect of this action massages the internal organs and increase blood flow to the area. It boosts metabolism and facilitates the proper functioning of the abdominal organs . This practice is recommended for the management of diabetes.
Surya namaskar involves a series of dynamic yoga postures performed in a specific sequence. A brisk surya namaskar performed in an energetic way increases cellular requirements for oxygen and glucose. To meet these requirements, insulin production is stimulated through brain signalling.
In a study, a yoga intervention consisting of 25 minutes of surya namaskar along with other yoga postures and a deep relaxation technique in perimenopausal women resulted in a significant decrease in diastolic blood pressure and hip circumference, and beneficial effects on glycemic outcomes.
Asanas emphasize the relationship of body, mind, and awareness, focusing on the synchronization of breathing and movement. They involve stretching/twisting movements and relaxation. The key to performing a yoga posture is that it should be performed with stability and comfort. Seated postures such as ardhamatsyendrasan, yoga mudra, and mandukasan improve pancreatic function. Asanas with forward bends massage and pressurize the pancreas and stimulate the secretion of insulin. Twisting poses, such as vakrasan and ardhamatsyendrasan (seated spinal twist) squeeze the intestines and massage them to prevent the stagnation of colonic contents.
For therapeutic benefits, the poses need to be maintained for approximately 30 seconds to 1 minute, depending on individual capacity, and the duration may be gradually increased. A study showed that yoga postures had a positive effect on glucose utilization and fat redistribution in individuals with type 2 diabetes. In patients with diabetes, pancreatic cells may be rejuvenated and pancreatic β-cell sensitivity may be increased by the alternating abdominal contractions and relaxations involved in yoga practice. Improved blood supply to muscles may enhance insulin receptor expression in the muscles, causing increased glucoseuptake..Dhanurasana and ardhamatsayendrasana, halasana, vajrasana, bhujangasana, and naukasana are also found to be very effective
It is suggested that as little as 10 minutes of the yoga intervention combined with standard medical care could improve metabolic health significantly.
Pranayama is controlled or regulated yogic breathing practice. The slow breathing technique in pranayama causes comprehensive changes in body physiology by controlling the autonomic nervous system; it regularizes the rate and pattern of breathing and regulates the heart rate and its variability.
Slow pranayamas, such as anulom vilom (alternate nostril breathing), chandranadi (left nostril breathing), sitkari (cooling breaths), and bhramari (humming bee breath) augment cerebral blood flow and oxygenation, thereby improving the neuronal activities of the brain centres, including those present in the limbic areas, hypothalamus, and medulla, Anulom vilom pranayama (alternate nostril breathing) has been shown to yield significant improvements in components of health-related fitness (i.e., cardiorespiratory endurance, flexibility, and percentage of body fat).
The vibrations created in bhramari prayanama (humming bee breath) have a soothing and calming effect on the mind and could play a vital role in improving mental and physical health. Right nostril breathing is believed to have a sympathetic stimulating effect and may be recommended in people with diabetes. Bhastrika pranayama (bellow-breathing) is a powerful and energetic pranayama referred to as “the breath of fire.” It helps in the regulation of the pineal, pituitary, and adrenal glands, which play an important role in the regulation of metabolism .
Bandha refers to a hold, tightening, or lock. It constricts a certain part of the body and re-directs the flow of blood and lymph to other parts. Asanas or pranayama may be combined with bandhas.
Uddiyan bandha (abdominal lock), which involves creating negative pressure in the abdomen and contracting the abdominal area, may have a therapeutic effect in the management of diabetes. It is believed that the negative pressure created in the abdominal cavity may improve pancreatic function.
Scientific analyses have shown that chanting “Aum” is based on the physics of sound, vibrations, and resonance, and has a positive influence on health. Chanting the “Aum” mantra results in stabilization of the brain, removal of negative thoughts, and increase of energy, and mental improvements and relaxation of the body take place within minutes of practice. Pranava pranayama (chanting “Aum”) in the supine posture produces an integrated relaxation response, which may have clinical significance in the management of hypertension and diabetes .Evaluation of the immediate effects of the mind-sound resonance technique in people with type 2 diabetes showed its potential role in enhancing cognitive function.
Meditation has been shown to cause physiological changes in the brain. Meditators experience beneficial psychological effects, such as faster reactions to stimuli, and are less prone to various forms of stress . The mental stability attained through the practice of meditation helps diabetes patients.. Visualization and concentration on the pancreas during meditation has positive effects on sugar levels and is recommended in the management of diabetes. Mindfulness practice is advocated for better sleep, greater relaxation, and more accepting approaches to illness and the illness experience in people with diabetes and coronary heart disease .
Yoga nidra (conscious, dynamic, psychic sleep) is a comprehensive, profound relaxation technique for removing physical, mental, and emotional tensions.
Yoga Mudras are a combination of subtle physical movements that alter mood, attitude and perception, and deepen awareness and concentration. Some hasta mudras (hand gestures), such as linga mudra, surya mudra, and prana mudra, are believed to be helpful for diabetes. Regular practice of these mudras boosts metabolic rates, promotes weight loss, and reduces sugar levels. Certain other mudras, such as apan mudra and gyan mudra, are recommended for diabetes patients for deep relaxation and eliminating stress. However, their individual effects have not been evaluated in scientific studies.
Yoga should be learned under the guidance of a qualified yoga professional. There are many different styles of yoga, and while many are safe, some can be strenuous and may not be appropriate for everyone. Fast-paced yoga practice and vigorous exercises in extreme temperature conditions, as in hot or Bikram yoga, are not recommended for individuals with diabetes, cardiovascular disease, or who are at risk of complications. A relatively safe yoga style suitable for an individual's requirements should be practised. Beginners should avoid extreme practices. Patients taking medication to control diabetes should carefully monitor their bodies' reactions to any new fitness activity.
Overlooking the warning signals of pain and discomfort while performing yoga practice may result in serious injury. Yoga practitioners should never push themselves beyond their physical capacity. Yoga practices are generally recommended on an empty stomach, but those taking treatments for diabetes may take light snacks to prevent hypoglycaemia. Inverted poses such as sarvangasan and sheershasan cause blood to rush or pool into the head and upper body, which may lead to a risk of retinal detachment or bleeding; such poses should be avoided in patients with diabetes or practiced with utmost care. Balancing poses should be practiced carefully to avoid traumatic injuries.
Yoga poses must be practiced slowly, without any sudden jerky movements and without pushing beyond one's limits. Complications of diabetes, such as autonomic neuropathy, may cause dizziness when sitting or standing abruptly because of a sudden drop in blood pressure. Individuals with diabetes are advised to enter and come out of poses slowly, pausing for a breath or two if required while practicing the pose.
Yoga is based on the principle that the mind and body are intimately related. It improves flexibility, muscle strength, blood circulation, and oxygen intake. Yoga exhibits many health benefits, such as improving physical fitness, relaxation, and awareness of self. Various lifestyle disorders, including diabetes, can be effectively addressed by the practice of yoga, given acceptably high levels of adherence. Yoga practice improves an individual's discipline regarding food and exercise, thereby helping to modify patient-related reluctance that results in the under utilization of exercise as a treatment modality.