This month I have been busy with more yoga teacher training, concentrating on Yoga in Healthcare. We have delved into the evidence behind the benefits and mechanisms of Yoga in many populations and disease states. Now, I would love to share some of that information with my readers.
I was assigned the topic of Diabetes so I will start there. This is a good place to start given the Epidemic of Diabetes occurring right now in our country. People with Diabetes are at very high risk for many complications, including heart disease (the #1 cause of death in diabetics), vascular disease, stroke, kidney failure, neuropathy (loss of sensation in their limbs), and retinopathy (visual disturbances). Diabetes is also linked to elevated risk for other chronic conditions, including depression, chronic liver disease and dementia.
The word “Diabetes” is Greek for “siphon” or “passing through”, referring to the excessive urination that can occur when diabetes is out of control. The word “Mellitus” is Latin for “sweet”. Thus, Diabetes Mellitus is characterized by hyperglycemia, excess sugar in blood and urine.
There are two main types of diabetes: Type 1 and Type 2. Type 1 develops when the immune system destroys pancreatic beta cells – the only cells in the body that make insulin, a hormone that controls blood sugar. People with type 1 diabetes need to receive regular insulin via injection or pump. Type 1 diabetes usually strikes children and young adults and accounts for roughly 5% of diabetes in the adult population.
The other 95% of diagnosed diabetes cases in the US adult population is of Type 2, which is believed to be caused by a combination of genetics and environmental factors (think diet, lack of exercise, obesity, and chronic stress). It usually starts as insulin resistance, where cells cannot use insulin properly, and eventually, the pancreas loses its ability to make it.
Some startling statistics:
- Prevalence: In 2015, 30 million Americans, or 9.4% of the population, had diabetes.
- New Cases: 1.5 million Americans are diagnosed with diabetes every year.
- Prediabetes: In 2015, 86 million Americans age 18 and older (1 in 3!) had prediabetes.
Prediabetes is defined as elevated blood Glucose (sugar) that is not high enough to be classified as Diabetes. A Fasting Blood Glucose (FBG) greater than 126 is diagnostic of diabetes. Prediabetetics have a FBG of 100-125 and are at high risk of developing full-blown Type 2 Diabetes Mellitus.
- It is the single most costly chronic disease nationwide. Total cost in medical bills and lost work and wages due to diabetes and related complications is at $245 billion, up from $174 billion in 2010.
This global epidemic is largely fueled by lifestyle factors, in particular, poor nutrition, sedentary lifestyle, and related obesity, impaired sleep, depression, chronic stress and smoking.
The good news is that lifestyle changes can alter the course of this disease, resulting in lower rates of complications and can prevent the progression from prediabetes to Type 2 Diabetes. The American Diabetic Association states “Lifestyle management is a fundamental aspect of diabetes care and includes diabetes self-management education and support (DSMES), medical nutrition therapy (MNT), physical activity, smoking cessation counseling, and psychosocial care”. Lifestyle changes, however, are not easy. They do not come in a pill and they do not produce rapid results. But the evidence is strong that proper nutrition, regular exercise, and stress management are effective in the management of diabetes.
EXERCISE
Physical activity is a key element in the prevention and management of type 2 diabetes. It is now well established that participation in regular physical activity improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life!! Unfortunately, only 39% of adults with diabetes are physically active compared with 58% of other American adults.
For persons with Type 2 Diabetes, it is recommended that aerobic exercise of moderate intensity be performed at least 3 days/week (ideally 5) for a minimum of 150 minutes/week with at least 2 nonconsecutive days of resistance exercise training to experience the benefits. It’s as simple as walking. Make it a fun family affair and bring along your furry companion too.
NUTRITION FOR DIABETES
For many individuals with diabetes, the most challenging part of managing their disease is knowing what to eat. There is not a one-size-fits-all eating pattern for individuals with diabetes, and both the American Diabetes Association and Diabetes UK advocate individualized meal planning (much like Ayurveda recommendations). There is strong evidence that suggests eating certain foods can help reduce the risk of Type 2 diabetes, can manage blood glucose levels in people with Type 2 diabetes, and reduce the risk of cardiovascular disease in people with diabetes. These suggested foods include vegetables, fruits, whole grains, nuts and legumes, i.e. a Plant-Based Diet. Eating less red and processed meat, refined carbohydrates and sugar-sweetened beverages is also highly recommended.
STRESS AND DIABETES
There is increasing interest in the role of Stress in Diabetes. Chronic or recurrent real or perceived stress results in the frequent or sustained release of cortisol, which leads to elevated levels of Blood Glucose. Furthermore, Oxidative stress has been strongly implicated in the development of T2 Diabetes and diabetes-related complications. Small studies have shown a reduction in markers of oxidative stress with yoga practice. Yoga’s health benefits stem largely from this reduction in stress, both at the subjective and, seemingly, at the cellular level.
YOGA
Yoga is a Mind-Body practice that has many health benefits including aiding in the management of Diabetes. The rationale for yoga comes from, I believe, not just one element, but the combination of physical movement, emphasis on breath, deep relaxation and meditation. There have been several studies looking at the effects of yoga in adults with Type 2 Diabetes. These studies showed significant improvements in fasting blood glucose (FBG), cholesterol, weight and other markers of diabetes compared with “usual care”, brisk walking or group education. Down-regulation of the Sympathetic Nervous System and the Stress Response leads to decreased cortisol levels resulting in improved glucose levels.
So, what would I recommend: A healthy lifestyle incorporating all of these elements, especially regular physical activity, a plant-based diet and yoga. As a mind-body-spirit practice, Yoga works at many levels incorporating physical movement, stress management and a sense of well-being. I would recommend a yoga class that involves the elements of movement, breathwork, and meditation.