Part II: CLINICAL RESEARCH ON THE BENEFITS
OF YOGA PRACTICE ON DIABETES
Many studies have reported the
beneficial effect of the practice of yoga on diabetes. (10,11,12,13,14,
15,16, 17, 18, 19). Some studies have mentioned up to 65 percent
beneficial effect of yogic therapy for diabetes. (11,13,15, 19)
K.N. Udupa has even mentioned 5 cases of juvenile diabetes who
were completely controlled by yogic treatment. (17) All of these
studies have emphasized the possible mechanism of the yogic practices
1. Direct influence on pancreatic
secretion by rejuvenation of the pancreatic cells, through alternate
abdominal contractions and relaxation, during asanas (yogic postures
which produce relaxation) and breathing exercises.
2. Reduction in blood sugar
due to muscular exercise involved in the asanas.
S.A.A. Ramaiah's study conducted
in Washington, D.C. compared the effects of walking, treadmill,
static cycling, Amarantha Kokkuasana (Sitting crane), Nindra Kokkuasana
(Standing crane) and Vil asana (Bow pose, rocking, especially
side to side). The most effective were found to be the latter.
it was concluded that the direct stimulation of the pancreas by
the postures rejuvenated its capacity to produce insulin.
Several studies have focused
upon why the practice of yoga has been more successful than other
forms of exercise. M.V. Bhole (20) and K.N. Udupa (18) have measured
the effects of yoga on mental stresses. Muhammad (13) has shown
the differences between physical exercises and yoga. He has reported
how doing the yogic practices without exertion has more benefits.
The mechanism of yogic practices
and other exercises is very different. (21) Yogic practices are
supposed to change one's attitude towards the situations of life,
by developing mental relaxation and balance. One study focused
on the practice of the postures in a slow, smooth and non-exerting
manner. (22) The postures were maintained comfortably and easily
for a length of time and the patients were taught to focus on
breathing or on some infinitely vast object like the sky or the
ocean while doing the yoga posture. Two thirds of the patients
were significantly benefitted by this treatment. The others also
A number of institutions in
India offer treatment programs for diabetes (23,24,25,26) Participants
generally stay for between two to five weeks, and follow a program
of instruction and practice of yoga asanas for at least an hour
in the morning and the evening, dietary control, meditation and
breathing exercises. They generally become subjects in on going
Table 2: RECOMMENDATIONS REGARDING THE
PRACTICE OF YOGA BY DIABETICS
1. The patient must learn to
control and his or her self of diabetes in a wholistic manner,
at all levels of your being: physical, emotional, mental, intellectual
and spiritual, recognizing the effects of stress, emotional imbalance,
and dietary and living habits on the disease condition.
2. Before beginning a program,
measure ones exercise toleration. Start with simple movements
and positions before progressing gradually to complicated postures.
3. Throughout the program, monitor
glucose levels and under the supervision of a physician, and take
appropriate medicinal dosages as and when required. After several
weeks one may be able to reduce such dosages.
4. Practice in the morning and
the evening for 40 to 60 minutes the recommended series of postures
according to ones capacity. Practice before meals, but after consuming
5. Avoid exertion, that is heavy
muscular activity. Perform the movements slowly and smoothly,
stretching the limbs and joints, and gently compressing the abdomen,
without straining. Maintain the postures for a comfortable length
of time. The maintenance period of postures should be increased
gradually from 5 seconds to one minute, or even longer depending
upon the posture and capacity of the patient.
6. Focus on the breath during
the maintenance period of the posture, with the eyes closed or
focused on one point, as a means of learning to focus the mind
and to manage stress and tension in the body.
7. Perform the Shavasana, or
complete peace relax pose on the back, systematically relaxing
all of the parts of the body, at the end of the session, or after
completing several postures, if one begins to feel fatigued.
8.The following postures have
been found to be effective in the control and cure of diabetes
(sanskrit names; the english and tamil names are in parentheses):
Dhanurasana (Bow pose, Vilasana),
Paschimottanasana (Sitting crane, Amarntha kokkuasana), Padangusthansana
(Standing crane, Nindra kokkuasana), Bhujangasana (Serpent pose,
Paambuasana), Sarvangasana (Shoulder stand), Ardha-matsyendrasana
(Spinal twist), Halasana (Plough pose, Kalapoy asana), Yoga mudrasana
(Yogic Symbol pose), Supta Vajrasana (Sitting pose of Firmness),
Chakrasana (Wheel pose), Shalabhasana (Grasshopper pose, Vittelasana).
9. The practice of Udiyana bandam,
or the abdominal squeeze has also been fouund to be useful. (22)
10. Regulate the diet throughout
the program. Avoid simple sugars such as white sugar, honey, glucose
and sweets. And eat complex carbohydrates such as wheat, oatmeal,
buckwheat, corn, brown rice and beans. Avoid processed food and
eat foods with lots of fibre and nutrients.
11. Obese patients can start
with different asanas, cleansing processes, bhastrika pranayama
and relaxation. Lean and thin patients should start with relaxation
and pranayama, and practice in a relaxed manner.(20)
12. Meditation practices have
been shown to help the endocrine glands through relaxation of
the sympathetic nervous system. (27)
Since the writing of this article in 1998, there
have been several studies which pertain to this topic.
Regarding the effects of Yoga and Diabetes:
1. In 2007, K.E. Innes and H.K.
Vincent performed a comprehensive literature search using four
computerized English and Indian scientific databases. The search
was restricted to original studies (1970-2006) that evaluated
the metabolic and clinical effects of yoga in adults with Type
II, non-insulin dependent diabetes. Studies targeting clinical
populations with cardiovascular disorders that included adults
with comorbid DM were also evaluated. Data were extracted regarding
study design, setting, target population, intervention, comparison
group or condition, outcome assessment, data analysis and presentation,
follow-up, and key results, and the quality of each study was
evaluated according to specific predetermined criteria. They identified
25 eligible studies, including 15 uncontrolled trials, 6 non-randomized
controlled trials and 4 randomized controlled trials (RCTs). Overall,
they concluded that these studies suggest beneficial changes in
several risk indices, including glucose tolerance and insulin
sensitivity, lipid profiles, anthropometric characteristics, blood
pressure, oxidative stress, coagulation profiles, sympathetic
activation and pulmonary function, as well as improvement in specific
clinical outcomes. They also concluded that Yoga may improve risk
profiles in adults with Type II, and may have promise for the
prevention and management of cardiovascular complications in this
population. However, the limitations characterizing most studies
preclude drawing firm conclusions. Additional high-quality RCTs
are needed to confirm and further elucidate the effects of standardized
yoga programs in populations with Type II. (28)
2. Another study by K.E. Innes
and G. Alexander examined the social context of physical activity.
Findings from the review indicate that yoga has a positive short-term
effect on multiple diabetes-related outcomes; however, long-term
effects of yoga therapy on diabetes management remain unclear.
The context of the social environment, including interpersonal
relationships, community characteristics, and discrimination,
influences the adoption and maintenance of health behaviors such
as physical activity, including yoga practice. Further research
is necessary to determine the extent of this influence. (29)
3. Recent research in India
continues to support the beneficial effects of Yoga on diabetes:
In a New Delhi study of 149
Type II diabetics, sixty-nine percent of the respondents showed
a fair to good response to yoga therapy. The study authors concluded
that yoga was a simple and economical therapy useful for non-insulin
dependent diabetics. (30)
In another study from New Delhi
on diabetes, researchers tried to find out if yoga asanas (postures)
could help diabetes by releasing insulin from the pancreas. Twenty
healthy young volunteers were given four sets of yoga postures
to perform. The asanas given were:
1) Dhanurasana (bow pose)
Matsyendrasana (seated twist)
2) Halasana (plow pose)
Vajrasana (thunderbolt pose)
3) Naukasana (boat pose)
Bhujangasana (cobra pose)
4) Setubandhasana (bridge pose)
Pavanamuktasana (wind relieving pose)
Each volunteer performed the
above sets in random order for five days with a two day interval
between consecutive sets of asanas. Based on blood test results,
the authors found that performance of yoga postures led to improved
"sensitivity of the b-Cells of the pancreas to the glucose signal."
They concluded that this improvement in insulin sensitivity was
due to the cumulative effect of the volunteers performing the
In a 2005 study, 20 patients
with type 2 diabetes were put on a 40 day yoga routine taught
by an expert yoga teacher. The postures performed were: Surya
Namaskar (sun salutation), Trikonasana (triangle pose), Tadasana
(mountain pose), Sukhasana (easy pose), Padmasana (lotus pose),
Bhastrika Pranayama (breathing exercise), Pashimottanasana (posterior
stretch), Ardhmatsyendrasana (half spinal twist), Pawanmuktasana
(joint freeing series), Bhujangasana (cobra pose), Vajrasana (thunderbolt
pose), Dhanurasana (bow pose), Shavasana (corpse pose).
At the end of the 40 days of
of performing the asanas, on average the study participants had
a decrease in fasting glucose levels, a significant decrease in
waist-hip ratio and beneficial changes in insulin levels. (32)
4. In a recent systematic review,
Badr Aljasir, Maggie Bryson and Bandar Al-shehri examined five
randomized controlled clinical trials (RCTs) with a total of 363
participants comparing yoga practice with other type of intervention
or with regular practice or both. Each study was assessed for
quality by two independent reviewers. Mean difference was used
for summarizing the effect of each study outcomes with 95% confidence
intervals. Pooling of the studies did not take place due to the
wide clinical variation between the studies. Publication bias
was assessed by statistical methods. Five trials with 363 participants
met the inclusion criteria with medium to high risk of bias and
different intervention characteristics. The authors concluded
that the studies’ results show improvement in outcomes among patients
with diabetes type II. These improvements were mainly among short
term or immediate diabetes outcomes and not all were statistically
significant. The results were inconclusive and not significant
for the long-term outcomes. No adverse effects were reported in
any of the included studies. Short-term benefits for patients
with diabetes may be achieved from practicing yoga. They recommended
that further research is needed in this area. Factors like quality
of the trials and other methodological issues should be improved
by large randomized control trials with allocation concealment
to assess the effectiveness of yoga on diabetes type II. A definitive
recommendation for physicians to encourage their patients to practice
yoga cannot be reached at present according to the authors.
5. The United States National
Center for Complementary and Alternative Medicine (NCCAM) has
completed a four year study "Yoga for Treating People at Risk
for Diabetes or With Both HIV and Depression." The results are
not yet published. All participant patients practiced specific
yoga asanas 3 to 6 days a week for three months, in the study
from 2004 to March 2007. It was conducted at the Swami Vivekananda
Yoga Anusandhana Samsthana (SVAYSA) in Bangalore, India by Frederick
Hecht, M.D. of the University of California at San Francisco Positive
Western medical research has
focused upon diabetes as only a physical disorder, requiring only
physical modalities of intervention. It has been able to confirm
that regular physical exercise does have some beneficial effects
in diabetics of both types, and that in those who are genetically
predisposed to type 2, it could prevent its development. Western
studies have recommended exercise of moderate intensity, as a
means to adopt a regular diet and insulin dosage, or to control
body weight and improve circulation. Research in India has recognized
it as a psychosomatic disorder with causative factors being sedentary
habits, physical, emotional and mental stress. Many studies there
have confirmed that the practice of the postures can rejuvenate
the insulin producing cells in the pancreas of diabetics of both
types, and that doing the postures in a relaxed manner, without
exertion, yogic meditation and breathing help most patients to
control the causes of diabetes.
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