Yoga as Preventive Medicine Psychological and Physiological Mechanisms

Yoga as Preventive Medicine

Psychological and Physiological Mechanisms

“When health is absent, wisdom cannot reveal itself, art cannot manifest, strength cannot fight, wealth becomes useless, and

intelligence cannot be applied.” ― Herophilus

Overview

• Lifestyle and Disease• The mechanisms that underpin relationship between lifestyle and

disease• Yogic mechanisms which act as a preventive medicine.

Noncommunicable Diseases, Country Profiles, World Health Organization, 2011

It is well established that NCDs are the leading cause of death in the world, responsible for 63% of the 57 million deaths that occurred in 2008. The majority of these deaths - 36 million - were attributed to cardiovascular diseases and diabetes, cancers and chronic respiratory diseases.

In most middle- and high-income countries NCDs were responsible for more deaths than all other causes of death combined, with almost all high-income countries reporting the proportion of NCD deaths to total deaths to be more than 70%.

Non-communicable Diseases (NCDs)

Global status report on noncommunicable diseases 2010 World Health Organization

…NCDs will be responsible for a significantly increased total number of deaths in the next decade. NCD deaths are projected to increase by 15% globally between 2010 and 2020 (to 44 million deaths).

Non-Communicable Diseases (NCDs)

Major Contributory Factors

• Stress• Poor Habits• Isolation

British Statistics

• 2012-2013 61% of the population reported anxiety the day before

• From 1993-2007 anxiety and depression increased by 2.3%

Office for National Statistics United Kingdom 2011

Autonomic Nervous System

Sympathetic• Fight and flight• Anabolic• Meets immediate survival needs• Helps to mobilize energy

Parasympathetic• Relaxation• Catabolic• Meets long-term well-being

needs• Involved in restoration of energy

Cellular Effects of Sympathetic Activation

• Systematic arousal increases rate of cellular respiration• Cells break down glucose with the help of oxygen to produce energy• Carbon-Dioxide and Free Radicals are byproducts• Free Radical Damage cells• CO2 is necessary for healthy focusing-high levels are dangerous and

lead to blood acidosis.

Consequences of High Levels of CO2

• Activates chemoreflex-Increases breathing rate to expel excess CO2• Chemoreflex stimulates sympathetic activation• Increased breath rate correlates with reduced oxygen consumption• Oxygen resources are used for breaking glucose• Excess O2 is has important functions• Excess O2 involved in processes that degrade free radicals, chronic

sympathetic arousal = no oxygen surplus.• Free radicals damage cells

Consequences of Free Radicals in Cells

• Upregulation of genes involved in inflammatory response• Downregulation of genes that help to reduce the damage caused by

oxidative stress• Upregulation of genes that contribute to stress related diseases

Long-term Conseqeunces of Increased Cellular Respiration

• Reduced awareness of bodily needs• Increased probability of inflammatory diseases• Increased probability of Artheroscolersis• Reduces positive prognosis in cancer patients• Exercaberation of respiratory disorders• Contributes to and excercbates diabetes• Contributes to an exercabates GI conditions

Stress and Cortisol

• The hippocampus is extremely sensitive to high levels of cortisol

• Chronically elevated cortisol levels damages hippocampus

• Reduced neurogenesis• Cortisol inhibits bones from laying down

new minerals and increases resorption rates

• Increases break down of collagen• As a steroid hormone cortisol enters the

cellular nucleus and interacts with transcription factors that influence gene expression

Consequences of Chronically Elevated Cortisol

• Enhanced tendency for osteoporosis• Reduced hippocampal volume is feature of Alzheimer's• Greater appearance of aging• Upgrading of genes that contribute to stress related diseases

Stress and Sleep

• Chronic Sympathetic arousal compromises ability to fall asleep and stay asleep• Ruminations Sympathetic arousal• Stressed brain = beta brain waves. Sleep requires alpha and then theta waves• Cortisol is released in union with ciradian rhythms, high levels of stress

undermine this rhythm• Cortisol levels are high at night when they should be low• Cortisol inhibits melatonin, which is released at night to stimulate sleep• When rhythm is off, cortisol may be released too early we wake before we are rested

• Chronic taxing of the HPA-axis may compromise cortisol levels-chronic experience of exhaustion.

Low Term Consequences of Poor Sleep

• Contributes to Alzheimer's, for those who have a genetic pre-disposition

• Inhibits neurogenesis• Contributes to mental health disorders• Reduces immune function

Habits

Contributing Factors to Bad Habits

• Lack of Awareness• Stress• Ethos of impulsivity feed by society

Stress and Poor Habits

• High levels of stress are correlated with behaviors that undermine health

• Smoking • Drinking• Poor eating habits• Increased sedentary lifestyle –

lack of exercise

Smoking

• “In the UK, tobacco consumption is now recognized as the single greatest cause of preventable illness and early death with smoking-related disease responsible for more than 107,000 deaths in 2007. It is estimated that 86 per cent of lung cancer deaths in the UK are caused by smoking” (Office for National Statistics 2011)

Alcohol Consumption

• Stress increases alcohol consumption1

• Alcohol is commonly used as mode to reduce stress• 37% of men and 29% of women the UK population drank more than 4

units in the last week2

• 20% of men and 13% percent of women binge drank in the last week2

1Keyes, K.M.; Hatzenbuehler, M.L.; Grant, B.F.; and Hasin, D.S. Stress and alcohol: Epidemiologic evidence. Alcohol Research: Current Reviews 34(4):391–400, 2012.2Office of International Statistics 2009

Long-Term Consequences of Alcohol Misuse

• “Alcohol has been identified as a causal factor in more than 60 medical conditions including mouth, throat, stomach, liver and breast cancers; hypertensive disease (high blood pressure); cirrhosis; and depression” (Office for National Statistics 2011)

• Alcohol use is correlated with decreases vagal tone. Decreased vagal tone is associated with:

• Anxiety• Heart-disease• Poor sleep• Poor emotional resilience

Stress and Diet

• Stress is correlated with hyperphagia and hypophagia1

• For those who are emotional eaters stress increases intake of sweet and sugary foods2

• Women who are highly stressed show preference for high-fat and sweet food3

1Greeno CG, Wing RR. Stress-induced eating. Psychol Bull 1994; 115:444–642Gibson, E. L. (2006). Emotional influences on food choice: sensory, physiological and psychological pathways. Physiology & Behavior, 89, 53–61.

3Summar The relationship between stress, dietary restraint, and food preferences in women; Appetite 52 (2009) 437–444

Consequences of Poor Diet

• Malnutrition• Reduced transport of tryptophan to the brain, necessary for serotonin

production• Reduction of precursor elements for neurotransmitter production• Lack of essential nutrients and vitamins for healthy functioning

• Inflammation• Increased blood sugars levels• Insulin resistance

Long-term Consequences of Poor Diet

• Heart Disease• Hypertension• Cognitive Decline• Osteoporosis• Diabetes• Obesity• Anxiety and depression

“Let food be thy medicine and medicine be thy food” ― Hippocrates

Sedentary Habits

• Length of work days are increasing• Many people work all day in front of a

computer-in the past much of work was physically oriented

• Technological advances are creating reduced interest in physical and outdoor activities

• In UK and USA sedentary lifestyle is the most prevalent risk factor for chronic diseases.

• 95 percent of both populations do not meet physical activity guidelines

Joint Health Surveys Unit (National Centre for Social Research and UCL Department of Epidemiology and Public Health). Health Survey for England—2008: Physical Activity Fitness. The NHS Information Centre, Leeds, UK, 2009.

Long-Term Consequences of Sedentary Life Style

• Increased risk of heart disease• Increased risk for hypertension• Increased risk for diabetes• Increased risk for osteoporosis• Reduced muscle tone• Reduced flexibility

Long-Term Consequence of Sedentary Habits

•Each decade after the age of 20 flexibility decreases by 15% with the greatest loss in lower back and hamstring flexibility-if we do not engage in physical activity

• Increases the likelihood of lower back pain •Reduced physical activity weakens muscles necessary for balance, including core muscles •According to the Center for Disease Control 2014, one out of three adults over the age of 65 falls each year•Falls in the elderly contribute to morbidity and are a contributing factor in reduced life expectancy.

Bell Relationships of age and sex with range of motion of seventeen joint actions in humans. 1981Can J Appl Sport Sci. Dec;6(4):202-6.

Isolation

Contributing Factors

• High paced work schedules• Increased population• Breakdown of family structures• Value on self-achievement vs. community• Heightened focus on self vs community

Long-term Consequences

• Poor Social Bonds• Reduced positive prognosis when hospitalized for illness• Increased risk of heart attack• Increased risk of mental health conditions• Social and economic conditions that undermine well-being of many

citizens

Yoga as Preventive Medicine

“Each patient carries his own doctor inside him.” ― Norman Cousins

From: Characteristics of yoga users: results of a national survey, Birdee GS, Legedza AT, Saper RB, Bertisch SM, Eisenberg DM, Phillips RS, Journal of General Internal Medicine. 23:1653-8, 2008.

Most yoga users (58%, n=1381) felt that yoga was animportant part of maintaining their health and well-being.

Contributing Factors to Stress Reduction

• Deep slow breathing practices, common to yoga, reduces sympathetic arousal and increases parasympathetic activation.

• Various meditative practices of yoga increase parasympathetic activation.

• Long holds in stretch oriented asanas enhance relaxation.• Greater parasympathetic activation enhances sleep quality.• Mindful attention taught in yoga classes, reduces rumination.• Balance between sympathetic and parasympathetic practices

increases physiological resiliency to stress.

Vagal Tone

• Parasympathetic activation is correlated with greater vagal tone:

• Increases resiliency to stress• Enhances cardiac functioning• Associated with elevated GABA Levels• Improves digestion• Inhibits release of inflammatory proteins• Increased heart rate variability

Stress Reduction-Cellular Level

• Reduced consumption of O2• Increased surplus of O2• Upregulation of genes that reverse oxidative stress damage-cellular

restoration• Increased levels of telomerase

Yoga Stress and Sleep

From: Subjective sleep quality and hormonal modulation in long-term yoga practitioners,Vera FM, Manzaneque JM, Maldonado EF, Carranque GA, Rodriguez FM, Blanca MJ, Morell M, Biological Psychology 81:164-8, 2009.

Sleep in Elderly Yoga Practitioners

From: Impact of long term Yoga practice on sleep quality and quality of life in the elderly,Bankar MA, Chaudhari SK, Chaudhari KD, Journal of Ayurveda and Integrative Medicine, 4:28-32, 2013.

Yoga and Sleep

Cortisol Reduction

• Slow breathing reduces cortisol levels• Yoga reduces cortisol levels• Yoga practice increases BDNF (indicator of hippocampal

neurogenesis)

Cortisol

Naveen.The influence of Hatha yoga as an add-on treatment in major depression on hypothalamic-pituitary-adrenal-axis activity: A randomized trial.  2014 Mar 11. J Psychiatr Res

Contributing Factors to Improved Habits

• Greater awareness of body and mind• Reduced stressed• Community of others with positive habits• Improved energy levels• Transformation in world view

Research on Yoga and Better Habits

From: National survey of yoga practitioners: mental and physical health benefits, Ross A, Friedmann E, Bevans M, Thomas S, Complementary Therapies Medicine, 21:313-23, 2013.

From: National survey of yoga practitioners: mental and physical health benefits, Ross A, Friedmann E, Bevans M, Thomas S, Complementary Therapies Medicine, 21:313-23, 2013.

Yoga Practice AssociationsResearch on Yoga and Better Habits

Perceptions of Yoga on Health

From: National survey of yoga practitioners: mental and physical health benefits, Ross A, Friedmann E, Bevans M, Thomas S, Complementary Therapies Medicine, 21:313-23, 2013.

Yoga and Well-Being

From: The effects of yoga on psychosocial variables and exercise adherence: a randomized, controlled pilot study, Bryan S, Pinto Zipp G, Parasher R, Alternative Therapies in Health and Medicine, 18:50-9, 2012.

.

“The acute-feeling responses to the yoga classes were favorable and may have been a key con-tributor to participants' improved perceptions of ability, which may have further fostered adherence.” “The participants reported an increased self-awareness as a result of their experience.”

Research on Yoga and Better Habits

Medications in Yoga Practitioners

From: Increased Hatha yoga experience predicts lower body mass index and reduced medication use in women over 45 years, Moliver N, Mika E, Chartrand M, Burrus S, Haussmann R, Khalsa S, International Journal of Yoga, 4:77-86, 2011.

Research on Yoga and Better Habits

Yoga Reduces Experience of Isolation

• Often done in a community setting• Philosophy expresses connectedness of all things• Philosophy expresses connection to forces greater than the self• Enhances mindfulness and reduces rumination-self-focused thinking• Is correlated with kindness towards others

Yoga Enhances Connectedness in MDD

• N=12 (women) 8-week gentle yoga intervention.• Findings

• Women's experience of depression involved stress, ruminations, and isolation.

• Their experiences of yoga were that it served as a self-care technique for the stress and ruminative aspects of depression and that it served as a relational technique, facilitating connectedness and shared experiences in a safe environment.

Kinser, Bourguignon, Taylor, Steeves "A feeling of connectedness": perspectives on a gentle yoga intervention for women with major depression Issues Ment Health Nurs. 2013 Jun;34(6):402-11.

Meditation & the Default Mode Network

From: Mind wandering and attention during focused meditation: A fine-grained temporal analysis of fluctuating cognitive states, Hasenkamp W, Wilson-Mendenhall CD, Duncan E, Barsalou LW, Neuroimage, 59:750-60, 2012.

dorsolateral prefrontal cortex

default network mode regions

Community and Well-Being

• Healthy social bonds are correlated with greater HRV and overall health.

• For those who have been hospitalized due to a life threatening illness, survival is much higher when a caregiver is present.

• Men who experienced myocardial infarction are more likely to survive if they have healthy interpersonal relationships (Ruberman 1984)

• Various studies show that when all other factors are controlled for, mortality rates are lower in those with healthy social bonds.

Roseto Effect

• In 1961, Dr. Wolf noted Roseto, PA had low rates of MI for men between the ages of 55-64, a high risk period.

• Men over 65 had a death rate of 1% compared to the national average of 2%.

• Residents smoked, drank, and ate greasy, heavy food.

• Wolf’s Hypothesis The very strong social networks acted as a physiological shield.

• Later-community became more Americanized - social bonds broke down – MI rates increased

Yoga’s Overall Effect on Well-Being

Medications in Yoga Practitioners

From: Increased Hatha yoga experience predicts lower body mass index and reduced medication use in women over 45 years, Moliver N, Mika E, Chartrand M, Burrus S, Haussmann R, Khalsa S, International Journal of Yoga, 4:77-86, 2011.

Yoga Practice Associations

From: Frequency of yoga practice predicts health: results of a national survey of yoga practitioners, Ross A, Friedmann E, Bevans M, Thomas S, Evidence Based Complementary and Alternative Medicine, 983258, 2012.

Conclusions

• Current life style choices increase potential of chronic disease.• Stress, poor, sleep, poor diet, smoking, consuming alcohol, sedentary

lifestyle, and break down of community interact and undermine well-being and health.

• The traditional eight limb practice of yoga provides• Stress relief• Increases awareness• Supports better habits• Enhances community

Conclusions

• A yogic lifestyles combines the main elements that promote health and well-being

• Research reveals that yoga Practice is an expensive and comprehensive way to reduce incidences of NCD’s.