Yoga in Health and Disease

Today yoga attracts people primarily as an easy way to good health. But yoga is neither easy, nor was it designed primarily for health. The fact that yogis are generally in good health is because the yogic lifestyle includes physical activity, a balanced diet and mental peace - all ingredients for good health. But health is a byproduct of yoga, not its goal.

Yoga as treatment

Till recently, in modern medicine yoga was considered adjunct therapy borrowed from an alien system. But during the last few decades, yoga has got incorporated into modern medicine itself. The integration has been the result of several convergent developments. First, the diseases of modern civilization such as obesity, hyper-tension, coronary artery disease and diabetes are rooted in a faulty lifestyle. This realization stimulated the search for good lifestyles. Yoga is one of the best lifestyles ever devised by mankind. Second, psychological stress is a major contributor to the diseases of modern civilization.

This discovery stimulated the search for strategies for overcoming stress. Yoga provides a new way of looking at life. Hence, everything remaining the same, the person starts feeling better. A method based not on changing the circumstances but on changing our attitude to circumstances is potentially infallible. Finally, the emergence of psychoneuroimmunology (PNI) has provided a solid scientific foundation for the mind-body relationship. While stress, anger and hostility or relaxation, peace, love and intimacy may be difficult to measure, their effects on cytokine levels or NK cell activity can be quantified. Science demands quantifiable evidence. By providing evidence for the effect of emotions on quantifiable biological features of great relevance to health and disease, PNI has acted as a bridge between ancient wisdom and modern science. The evidence generated by, PNI has made modern medicine accept relaxation, peace, love, hope and joy as therapeutic tools. That is how systems like yoga which promote positive feelings have also become a part of scientific medicine.

Mind-body medicine has now come of age, and is a potent instrument for influencing the mind positively. But our consciousness being rooted in the physical, yoga is still considered most useful where the yogic postures and diet play a major role in recovery. Based on this traditional thinking, given below is a list of disease for which yoga is most frequently used in modern medicine.

Orthopedic Problems

Yogasanas have been used for orthopedic problems such as cervical spondylosis and backache, which would benefit from strengthening of specific groups of muscles or from improvement of posture. Asanas for relaxation have been used for conditions requiring relief from muscle spasm.

Hypertension

Meditation has been shown to reduce systolic and diastolic blood Pressure of hypertensive patients in several studies.

Coronary heart disease

Dean Ornish and his colleagues reported in 1990 that long term changes in lifestyle involving yogic exercises, stress reduction technique and fat-free vegetarian diet led to angiographically -demonstrable reduction in coronary stenosis in patients having coronary heart disease. Following this report there have been other similar studies with comparable results.

Diabetes Mellitus

Yoga has also been widely recommended for diabetes. Some of the earliest studies on the subject are those of Sahay and his colleagues. They deliberately dissected yoga into small components and studied each separately. among the alternatives which reduced fasting and postprandial blood glucose were Pranayama, dhanurasana + ardhamatsyendrasana, halasana + vajrasana, and naukasana + bhuj angasana. Further analysis revealed that dhanurasana was the most effective asana for diabetes. A combination of mudra and salabhasana was ineffective, and actually produced a non-significant rise in fasting blood glucose in their study on 5 subjects. This part of the study has often been Cited as evidence for mudra and salabhasana being harmful for diabetes. The small number of subjects, and the statistically non-significant rise in blood glucose, make such a conclusion unwarranted. That is why it is important to read research reports critically.

Following Sahay's studies there have also been some other studies indicating that yogic exercises and relaxation improve glycaemic control in diabetes, especially if the pretreatment fasting blood glucose is less than 250 mg/dL.

Bronchial Asthma

Dr. Nagendra and Dr. Nagarathna from the Vivekananda Kendra Yoga Research Foundation, Bangalore, have conducted controlled trials on large series of patients having bronchial asthma. Their studies indicate that a 2 to 4 week course in the theory of yoga and selected yogic practices reduces the frequency of asthmatic attacks, reduces the requirement for medication, and increases the peak expiratory flow rate.

Psychological Disorders

People, especially in India, have prevented and treated psychological disturbances for centuries using some aspects of yoga, of the Gita. But yoga has also been used professionally for stress reduction as well as for treatment of psychological disorders.

For stress reduction, shavasana, meditation and adoption of a yogic attitude are particularly helpful. Other asanas and pranayama can also contribute to mental relaxation.

The basic attitudes to be transmitted by the counselor to the client are:

a. Happiness is conducive to recovery.

b. Happiness does not depend on external circumstances.

c.  Opening oneself to a higher Will can achieve the apparently impossible.

d.  Illness can be in opportunity for spiritual growth For treatment of psychiatric disorders, the yogic technique resembles other forms of counseling in that its basic principles also are:

a. to give the patient a better insight into the problem, and

b. to use this knowledge for recovery.

But yogic therapy differs in that the insight is not based on the ego of the person but on his spiritual Self. Secondly, the control acquired by the patient does not consist predominantly of efforts to change circumstances and to change others. Instead, the patient tries to change his way of looking at circumstances and people. In other words, the patient, instead of learning to control circumstances, learns how to gain liberation from circumstances. This approach works very well because our ability to change circumstances and people is very limited. On the other hand, the freedom to look at things the way we like is unlimited, and nobody can take it away from us. This approach is recognized also by modern psychology as a valid approach and is called cognitive reappraisal. Thus the difference between approaches favoured by yoga and by modern psychology is one of degree rather than kind. Using yoga is applied psychology is useful not only in the management of psychological disorders but also where a psychological problem manifests as a physical disorder, such as insomnia, tension headache or irritable bowel.

It is interesting that some psychiatrists like Dr. M. Scott Peck, trained primarily in modern scientific medicine, have finally arrived at the conclusion that a psychological problem can be treated best by helping the patient grow spiritually.

How does Yoga work ?

Although yoga works, we do not always know how it works. The mystery may be partly because yoga also utilizes the healing power of positive emotions. The mind-body relationship is now widely accepted, and there is considerable objective evidence supporting it. But positive emotions often cannot be quantified, and their specific contribution to amelioration of disease cannot always be demonstrated in physiological or biochemical terms. One exception to this general statement is the strong evidence that has been collected in favor of the effect of emotions on immunocompetence. The evidence has been collected from human studies, animal studies, as well as studies at cellular level. The underlying mechanisms have also been worked out to a remarkable degree. The result is that now the nervous system, endocrine system and immune system are considered an intimately interlinked supersystem. Cells in all the three systems secrete many chemicals in common, and each of the three systems has receptors for chemicals secreted by the other two. Effect of emotions on immune functions explains the favorable effect of positive emotions not only on infections, autoimmune diseases and allergies, but also cancer, atherosclerosis and diabetes because these diseases have also been shown to have immunological components in their etiology. Some of the more obvious explanations for the therapeutic effects of yoga are given below.

The favorable effects of yoga in orthopedic problems are simple to explain. For example, asanas which strengthen back muscles understandably relieve backache. Increase in flexibility and decrease in body weight resulting from the asanas ameliorate pain in knee joints.

Loss of weight and physical exercise also improve glucose tolerance, which in turn helps diabetes. Some dietary changes, and stress reduction, often associated with yoga, may also contribute to the improvement in glucose tolerance. Similar factors also contribute to the favorable influence on coronary heart disease.

In essential hypertension the baroreflex sensitivity is reduced. It has been shown by Selvamurthy and his colleagues that a set of selected asanas return this sensitivity towards normal. Associated with the return of baroreflex sensitivity is a fall in blood pressure towards normal.

Stress reduction and the favorable effect of positive emotions on the immune response possibly contribute to the beneficial results of yoga in bronchial asthma. In addition, asthma also benefits from the effects of yogic exercises on respiratory function.

A wider Role

How much role yoga has in health and disease depends on what one understands by yoga, and what one expects.

If yoga is viewed comprehensively as a foundation of peace and joy, it has extensive, and potentially all-pervasive, applications in medicine ranging from primary prevention to care of the terminally ill.

Prevention

A person whose daily life is based on yoga eats only what is good for the body and in the right amount, takes regular exercise, sleeps well for the right duration, and enjoys profound equanimity. He keeps away from smoking and other harmful practices because they do not tempt him. Therefore, on one hand, he does not challenge his body unduly, and on the other, he is doing everything physical and emotional to strengthen the capacity of the body to fight disease. Hence he unlikely to fall ill.

Self-healing

If illness does occur, a person practicing yoga is likely to recover fast with minimal external assistance because his self-healing mechanisms are in very good shape. Self healing is not confined to self-limiting acute infectious diseases such as common cold. It has now been shown to occur even in cancer and chronic degenerative disease such as coronary heart disease.

In the course of treating cancer patients, Bernie Siegel, a cancer surgeon, realized that a few patients who defined all statistics and went on to live far beyond anybody's expectations were neither cases of wrong diagnosis nor random miracles but had a consistent personality profile.

These exceptional patients had immense love for their fellow beings, were peaceful by disposition, and had the courage to face their diagnosis positively. They had accepted their fate gracefully, and decided to use what remained of their life creatively and meaningfully, taking care to do things they had always wanted to do but somehow had not got down to doing. Interestingly, in case of such patients not only what remained of their life became more meaningful, the remainder also got longer. Further, Bernie Siegel found that while to some patients such behavior came naturally, many more influenced in that direction and the change seemed to help heal their disease, and more importantly, their life.

The explanation resides in psychoneuroimmunology. It is well-known that in infectious diseases, even after an appropriate antibiotic has been used, the very last germ in the body is eliminated only by the immune system. Similarly, in case of cancer, the immune system firstly plays a role in prevention by weeding out cancer cells at early stages of development through immunological surveillance. Secondly, if there is a cancer which has been tackled by surgery irradiation and chemotherapy, a few cancer cells are invariably lurking somewhere in the body (minimal residual disease). These cells can be eliminated only by the immune system. The strengthening of the immune system by positive emotions seems to facilitate this process.

After a few preliminary studies which were received with scepticism, Dean Ornish finally made headlines when he published the results of a one-year follow-up of patients having coronary heart disease who had participated in a randomized controlled trial of a lifestyle modification programme. This was the first study in which it was shown that lifestyle modification could lead to angiographically detectable reduction in coronary stenosis. It might be argued that lifestyle modification includes physical measures such as dietary restriction, physical exercise and giving up smoking. But Dean Ornish's programme was based on principles of yoga, and his aim was that the patient should adopt these physical measures because he wants to, not because he has to. That is where the psychological element of yoga comes in. The fact that the psychological element is important is suggested by the fact that there have been a few studies in which physical measures have been prescribed to patients without paying any attention to their psychology. In some such studies, the patients who did exactly what they were told got worse; in fact, the patients who took a few liberties here and there fared better. The reason seems to be that if a patient eats fruits and vegetables while his mind is dwelling on omelettes and cutlets, the stress caused by missing the 'delicacies' does more harm than the good resulting from eating right. With the yogic attitude, the Spartan lifestyle becomes, in itself, a fountain of joy rather than an ordeal to be tolerated for the sake of recovery from disease. The disease assumes the character of a turning point which gives the patient an opportunity to get introduced to a lifestyle far more enjoyable than any he had imagined possible. That is why patients in Dean Ornish's programme did better than in those in which physical measures were prescribed in isolation. In Dean Ornish's programme, the yogic attitude was reinforced by meditation and group support; the other psychological approaches used in his programme were imagery and autosuggestion. That is why Dean Ornish prefers to call his programme 'Open Your Heart' programme: the patient is encouraged to open his heart to himself, to his fellow beings, and to a Higher force. In short, the psychological consequences of yoga not only promote self-healing by themselves, they also promote cheerful acceptance of the physical measures conducive to healing. This approach has relevance to a wide variety of chronic illnesses, specially obesity, diabetes and bronchial asthma.

Relief of Symptoms

The impact of psychological changes brought about by yoga extends also to unpleasant symptoms such as pain. Pain is the commonest symptom of disease. Norman Cousins found though his own experience that ten minutes of laughter gave him freedom from pain or two hours. In view of recent knowledge, this seems to be due to release of endorphins in the brain. Endorpmosae released not only by laughter but also by exercise and meditation. This is much better than pain killers given by the doctor as pills or injections. The comparison has been made very vividly and philosophically by Dr. Deepak Chopra when he says that the chemicals, such as pain killers, released in the body represent an enormous amount of intelligence, or know-how. The chemical is released at just the right place, in just the right amount, and is associated with a synchronized increase in the number of receptors for the chemical only in the cells where its action is desired. ln contrast, a drug injected by the doctor, even when similar to the endogenous chemical, is usually administered in much larger doses, circulates all over the body, and acts indiscriminately everywhere. While the endogenous chemical is part of an orchestra, and sings a melodious tune to a receptive audience, the drug shouts at all cells of the body. The result is that while there may be relief of symptoms due to some action at appropriate sites, there are also several undesirable side effects due to action at inappropriate sites. The overall conclusion arrived at by Deepak Chopra is that the best pharmacy resides within the body.

Absence of Misery

We have seen above that the salubrious psychological effects of yoga reduce the possibility of illness. However, if illness does occur the same psychological effects assist self-healing and relieve symptoms. No wonder, yogis do not fall ill very often, and usually live long. However, there is still no guarantee that a yogi cannot get an incurable or painful disease. What yoga does guarantee is that even when afflicted with an incurable or painful disease, the person is not miserable. The freedom to refuse to be miserable is one freedom that nobody can take away from us. And yoga gives us that freedom by enabling us to look at events in a new light.

Thus yoga reduces the possibility of falling ill. If illness does occur, it promotes recovery and minimizes symptoms. If even that fails, as it sometimes must, the person is not miserable, no matter what. Can anybody dare ask for more?

Conclusion

The term 'yoga', as commonly applied in medicine, is a misnomer. It is frequently used for referring to only a few techniques such as asanas, Pranayama and meditation. Techniques are a part-time activity without any obligatory influence on the rest of daily life. On the other hand yoga is a full-time spiritual quest which should influence the motive and quality of every activity performed in the course of the day. A typical report on medical effects of yoga runs somewhat like this; 10 patients having high blood pressure were trained in yoga (20 asanas, pranayama and meditation) for 1 hour per day for 1 week and asked to continue the practices at home. After 6 months their blood pressure showed a significant fall. 'Yoga is a discipline into which aspiring individuals are inducted, or trained. Yoga is not synonymous with asanas, pranayama and meditation. Yoga is not a part-time activity needing only 1 hour per day. Progress in yoga cannot be measured in terms of a fall in blood pressure. There is one important conclusion, however, which may be drawn from such research studies. If so little performed so half-heartedly can do some good, how much more might possibly be accomplished if yoga became a way of life.

Question and Problem

Why is it necessary to bring yoga, or any spiritual discipline, into the treatment of lifestyle diseases? Is it not enough to advise the right diet adequate physical activity, quitting smoking, and meditation or any other relaxation technique?

Answer and Solution

The reason why bringing in a spiritual discipline helps is that doing so is likely to transform the patient's attitude to life. Along with the physical performance or renunciation of something, the spirit in which it is done also counts. For example, physical exercise can be done in at least two ways - one, out of fear of disease and- death; and two, as an enjoyable activity Similarly, a desirable diet can be eaten in at least two ways - one, with the mind dwelling on the forbidden foods; and two, liking what one is eating better than the alternatives. Finally, smoking may be given up out of fear of cancer, or because one no longer feels the need to smoke. In short, each of these entirely desirable practices can be a source of stress or a fountain of joy. Further, if adhering to the dietary and other lifestyle prescriptions has added to the stresses of an already stressful life, mechanical performance of meditation for twenty minutes a day cannot help much. Hence what is needed is an all-encompassing transformation so that the individual is thrilled by the discovery of a new way of living which he had earlier not even imagined. That makes a tremendous difference because the harm caused by stress may far exceed the benefit gained from a strict but grudging adherence to the prescriptions. This is not just conjecture or common sense: it is supported by several studies - basic and clinical. The yogic attitude makes desirable activities enjoyable by taking away the preoccupation with sensory pleasures.

Courtesy from - Understanding Medical Physiology (IIIrd Edition)