Can Yoga Help Diabetes?

by Baxter

Musa paradisiaca by Maria Sibylla Merian

After reading Nina’s post False Claims Harm Yoga, I got interested in finding the scientifically grounded information about how yoga can assist in the treatment of diabetes. One of the first studies that popped up was a recent study in China called Effects of 1-year yoga on cardiovascular risk factors in middle-aged and older adults with metabolic syndrome: a randomized trial. that looked at a one-year practice of yoga and its affect on metabolic syndrome, which has as one of its factors for developing heart disease the presence of elevated blood sugar levels, or hyperglycemia. (The presence of hyperglycemia could mean the person with metabolic syndrome has diabetes.)The paper mentions that many of the lab values the researchers followed did improve over the course of the study, including waist circumference. They did not specifically mention a reduction on blood sugar levels, however. 

Curious about what reputable websites on diabetes management might be recommending, I found this article from the Joslin Diabetes Center’s website (a Harvard-affiliated center), written by two of their staff Clinical Exercise Specialists, who say, when discussing the benefits of yoga:

“In addition, some reports suggest that because yoga can decrease stress, it may be helpful in controlling glucose levels in people with either Type 1 or 2 diabetes.”

At this center, they have an exercise program that has recently added gentle yoga to the tools they use, and they say: 

“Joslin's Why Wait? Program is a one-of-a-kind program that was created to address the unique weight-loss and weight-control needs of people with type 1 and 2 diabetes. The newest addition to the program is a gentle yoga practice that emphasizes the importance of the body-mind connection, and introduces participants to various forms of yoga.”

Hmmm, no mention of stopping your normal treatment and only doing yoga to treat and or heal diabetes. And although there have been quite a large number of studies looking at yoga and type 2 diabetes, this NIH sponsored review article Yoga Practice for the Management of Type II Diabetes Mellitus in Adults: A systematic review tried to tease out those studies that meet our modern criteria for well designed studies. Only five qualified, with a combined total of 363 participants. They did find the following short-term benefits:

Fasting Plasma Glucose Levels: Four studies provided results on FPG. These studies provided favorable results for the intervention in lowering FPG.

Glycolated Hemoglobin: This blood test is used routinely to monitor the overall average sugar levels in the blood over a more extended period of time. Three of the included studies reported the value of HbA1c. The mean differences indicated that the intervention lowered the level of the HbA1c. However, the results were only statistically significant in the one study.

Cholesterol Effect: Three of the included trials reported an effect on lowering cholesterol level, including increasing HDL and lowering Triglycerides (both directions of change considered beneficial for heart health).

Weight and Body Mass Index: There was minimal drop in one study that was not statistically significant.

Diabetes-Related Complications: Only one study looked at this, and looked at nerve conduction rates in the arms of participants (would be related to the development of peripheral neuropathy in DM), and showed a small statistically insignificant change. 

The authors concluded there is some evidence from well-designed studies (the give reviewed here) that there are some short-term benefits from yoga (listed above). They could not make any comments on the long-term benefits of doing yoga, as the studies did not address this important consideration. They noted lots of quality issues even with the five studies they were able to include in their review of all the yoga and diabetes research that had taken place through 2007. And due to the results, they concluded:

“A definitive recommendation for physicians to encourage their patients to practice yoga cannot be reached at the present.”

“The important recommendation that can be drawn from this systematic review is the need for well-designed large randomized clinical trials to assess the effectiveness of yoga on diabetes type II.”

As we have noted about so many other reviews of studies, we have a ways to go with yoga research! But I feel if we expand the overall benefits of yoga for things like stress management, there is certainly no contraindication for someone with diabetes starting yoga, and lots of potential positive benefits on overall health and well-being.  

The Takeaway

Just to be clear, dear readers, I personally do believe that yoga can be beneficial for diabetes. For example, diabetics can develop numbness in their extremities, which often affects balance and increases the risk of falls. So working on balance poses and circulation practices could lessen the chances of falls as well as help maintain better heart health and circulation, which might slow down this negative consequence of diabetes. Similarly, the mindfulness of yoga could improve dietary habits, allowing the person with diabetes to make better food choices, which could improve blood sugar control and even help with weight loss, which is particularly helpful in type 2 diabetes. 

But what I cannot say is that yoga will always or even usually do these things for sure, because we have not studied them closely yet. That does not mean that someone with diabetes can not safely start yoga and add it to what they are already doing to improve their health. And our friend Melitta, who has type 1 diabetes, has already testified about the benefits that stress management provides for someone with diabetics or anyone else living with a chronic disease (see Aging, Diabetes and Yoga).

And to provide some support to Nina’s assertions that the untrue promotion of yoga as a substitute for medical treatment and lifestyle interventions is dangerous, I'll add that none of the researchers even hinted that yoga replace modern treatment, let alone “heal” diabetes! type 1 diabetes is not curable, and those with type 2 can eventually gain control of normalizing blood sugar levels to healthier ranges with a combination of medical tools and lifestyle practices, but when these tools are skipped or stopped, the symptoms and problems of diabetes will once again show up. 

My take: For people with a new or established diagnosis of type 1 or 2 diabetes, certainly add yoga to your health regime to see if it helps your diabetes specifically over time. And then let us know what you discover! 

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False Claims Harm Yoga

by Nina

Spectacled Caiman with a False Coral Snake by Maria Sibylla Merian

Just a little rant today. Someone who shall remain nameless shared a link on Facebook to an article titled 6 Yoga Asanas for Healing Diabetes Naturally. The comments on the post were all positive. Isn’t this wonderful!

Are you kidding me? First of all, they don’t distinguish between Type 1 and Type 2 diabetes. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to produce energy. If you have Type 1, you will die without insulin. So while you can use yoga to help manage the stress of living with this chronic disease, there is no “healing” from that disease, not with yoga nor with western medicine. See Aging, Yoga and Diabetes: Stereotypes That Are Truly Dangerous for information about someone who suffered as a result of the confusion between these Type 1 diabetes (which is what she really had) and Type 2 (which is what she was initially diagnosed as having, just because of her age). 

The far more common type 2 diabetes occurs when the body becomes resistant to insulin or doesn't make enough insulin, often as a result of obesity. It is possible that yoga could help with this form of diabetes by helping you reduce stress, change your diet, and lose weight, but going off your medication to use yoga for healing “naturally” instead would be a really bad idea.

Still, I gritted my teeth and went to check out the article itself, just to see what it was they were claiming and what those magical six asanas were. After a very short intro that defined what diabetes is (without making the important distinction between the two types), the article claimed:  

“A newly diagnosed diabetic has excellent prospects of completely controlling and correcting his/her condition if he/she adopts yogic practices and lifestyle under expert guidance. The yogic treatment of diabetes is directed to the underlying causes of the disease as well as to its symptoms.”

Well, that’s pretty scary as far as I’m concerned because it seems to imply you should forgo western medicine if you have diabetes (type 2 we can only assume) and that you should just do yoga instead. And, although they mention “expert guidance,” they never say what kind of expert (I hope they don’t mean a yoga teacher).

This is followed by information on a program:

"The “Go Yogic” diabetes management programme will at least require one month for the initial period of training. However with proper medical collaboration this objective can be safely achieved. The “Go Yogic” diabetes management programme and progress will wary for each individual. This programme should be considered absolute for all the diabetics’ patients."

Well, at least they’re mentioning “medical collaboration,” whatever that is. But the claim that the program should be considered “absolute” for all diabetics is, again, extremely misleading and irresponsible. Finally, the article ends with instructions for doing six poses, with no explanation of what effects those poses (and practices) would actually have on a person with diabetes (or an anyone for that matter). Cause I know you want to see it, here's the list:

• Shashank Asana (Hare Pose)
• Yoga Mudra Asana (Psyhic Union Pose)
• Ardhamatsendr Asana (Half Spinal Twist)
• Pachimottan Asana (Posterior Stretching Pose)
• Bhujang Asana (Cobra Pose)
• Suryabheda Pranayama (Vital stimulating break)

So that’s what is making me angry this morning. Because the truth is, we do think that yoga is a powerful tool for helping with almost any medical conditions, including diabetes (see 5 Ways Yoga Can Affect Your Health). But false claims about “six poses that heal” like this—and, boy, we see these everywhere—are not only dangerous for people reading the article, as they might be led to seriously compromise their health, but are doing yoga a huge disservice. Click bait about yoga that simplifies, misleads, and downright lies is only going to make people distrust yoga's legitimate benefits. 

(Yes, I did leave some explanatory comments on the Facebook post.)

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Yoga's Healing Powers

by Ram

Morning Glory by Melina Meza

Undoubtedly, all of us who do yoga as part of our daily routine have experienced its benefits, either at the physical, mental, or emotional level or at all levels. We all agree that it is relaxing, it is calming, and above all it has helped us in our flexibility and strength. Additionally, for some of us, yoga has helped in the healing of the heart, brain, gut, colon, kidney, hips, spine, and so forth. And all the anecdotal reports of the benefits that people have raved about are now being proved by empirical findings. In one of the largest studies of health benefits of yoga, it appears that yoga can reduce inflammation, the body's attempt at self-protection. Before I describe the study, let me briefly discuss inflammation and its positive versus negative health effects.

Inflammation is part of your body's defense response; the objective is to remove damaged cells, harmful irritants, or toxic pathogens from the body and initiate a healing response. While inflammation is not infection, an infection itself caused by bacteria, virus, or fungus can trigger an inflammatory process. Inflammation has a high beneficial value. For example, if you develop a viral infection or if your back sustains a severe blow, inflammation sets in to care and protect the injured tissue. The classical signs of inflammation are pain, heat, redness, and fluid accumulation (swelling). Other signs include: fever, chills, fatigue/loss of energy, muscle aches, headaches, and loss of appetite. All these signs are the body’s defensive strategies were activated to ward off the damage and heal the injured area. These defensive strategies are carried out by an arsenal of molecules that fight the invaders. The molecules include but are not limited to: leukocytes, macrophages, dendritic cells, mast cells, bradykinin, histamine, interleukins, and TNF, among others. Thus, the inflammatory process is akin to a country’s defense system involving several units of entities of increasing specificity that culminate in the removal of invaders and promote healing of any damaged tissue. In a perfect setting, the inflammatory process occurs just as it should: releasing defense/pro-inflammatory molecules when needed and then turning them off when the threat has been sufficiently addressed.

Now imagine if this body’s strong defense system turns awry and the defending molecules take on their own body’s system (akin to a coup). That would be the negative aspects seen in chronic inflammation, which are characterized by a defense response that is aberrant, out of control, and not completely turned off. Just like a constant, slow-burning fire, in chronic inflammation the defense/pro-inflammatory molecules continue to be present in the body even when they are not needed and the body operates as if it is constantly under attack. Thus, chronic inflammation draws on your body’s energy and resources, which can with time result in bodily damage. Additionally, when this system goes out of control, it self-perpetuates and triggers disease conditions, such as, atherosclerosis (inflammation in blood vessels), diabetes (inflammation in pancreatic tissue), arthritis (inflammation in bones and joints), celiac disease (inflammation in digestive system), fibromyalgia, and neuralgia (inflammation in limbs, muscles and nerves), among others. It is as though the body’s defense system fails to distinguish its own self, making the body vulnerable to attacks from its own defense team. The causes of chronic inflammation are numerous and include age, genetic predisposition, smoking, environmental stressors, allergens, chronic stress (both physical and mental), poor foods (sugary, processed, or fast food), and hormonal imbalance, among others.

But there’s good news for those of us who have a regular yoga practice. Several studies now report that a regular yoga practice:

1. suppresses inflammation
2. lowers the level of several pro-inflammatory molecules in the body
3. reduces a subset of pro-inflammatory molecules called cytokines, thereby relieving severe pain associated with the inflamed tissue

More specifically, studies report that yoga reduces inflammation in patients with cardiovascular problems and also improves levels of glucose and insulin in diabetic patients. There are also reports demonstrating yoga’s role in curbing inflammation that may serve as a panacea for people recovering from cancer. It turns out that following several rounds of radiation and/or chemotherapy cancer survivors suffer from persistent and debilitating fatigue for months or even years. Scientists believe that the cancer treatment procedures trigger an inflammatory process that fails to turn off. In addition to the weakness and pain from the cancer therapy procedures, these patients now suffer from inflammation that draws on the body’s resources, resulting in chronic fatigue. It is estimated that about a third of breast cancer survivors suffer from inflammation and chronic fatigue for several years after they complete treatment.

In a recent paper published in the Journal of Clinical Oncology Yoga’s Impact on Inflammation, Mood, and Fatigue in Breast Cancer Survivors: A Randomized Controlled Trial, researchers looked at 200 breast cancer survivors who had completed all the breast cancer treatments. The randomized, controlled trial involved only yoga novices. The yoga group practiced yoga twice a week for 12 weeks with take-home DVDs to practice at home. The control group was wait-listed to receive the same yoga sessions after the completion of the trial. The group that had practiced yoga for three months reported less fatigue and higher levels of vitality three months after the treatment had ended. The yoga group also reported significantly improved sleep. Additionally, three cytokine proteins in the blood that are markers for inflammation were all lowered by 10 to 15 percent. The novelty of the study was that it offered biological evidence of the benefits of yoga in addition to people's own reports of how they felt.

Cancer treatment leaves patients with high levels of stress, fatigue, and insomnia, which may trigger inflammation that in turn triggers tissue damage, leaving the patients completely debilitated and in a downward spiral. As we are now well aware, yoga reduces stress and fatigue (see Stress, Your Health, and Yoga ) and helps people to sleep better (see Sleep: A Pillar of Life), all of which may ultimately block the inflammatory process thus providing immense benefits to the cancer survivors. I guess you would agree with me that you cannot find a better, cheaper, and effective therapy for combating inflammation!

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Aging, Diabetes and Yoga: Stereotypes That Are Truly Dangerous

by Melitta Rorty

Tracks by Brad Gibson

When most people think of diabetes, they think of diabetes associated with obesity (particularly abdominal obesity) and older age. When the mass media uses the term diabetes, it almost always is in reference to Type 2 diabetes, but never stated as such. Yet fully 20-25% of all cases of diabetes are Type 1 diabetes, formerly called juvenile diabetes, which is an autoimmune disease that can occur at any age, including in the elderly, and which requires exogenous insulin for survival.

The stereotypes, widely held both by the general public and medical doctors, are that Type 1 diabetes is strictly a childhood disease and Type 2 diabetes is a consequence of older age and obesity. A particular danger for those who acquire Type 1 diabetes as adults is that they will be misdiagnosed as having Type 2 diabetes, an altogether different disease with different genetics, causes, treatments, and potential cures. The consequences of misdiagnosis are extreme:  rapid onset of diabetic complications and even death.  Fully 10% of people diagnosed with Type 2 diabetes have the autoantibody markers for Type 1 autoimmune diabetes and have been misdiagnosed; that equates to millions of people in the United States alone who are misdiagnosed.

I, myself, experienced the harsh reality of misdiagnosis. In 1995, at the age of 35, I was hospitalized in diabetic ketoacidosis (DKA), but because of my age, I was misdiagnosed as having Type 2 diabetes (by an endocrinologist who is a medical school professor), despite having zero risk factors for Type 2 diabetes. I was removed from life-saving intravenous (IV) insulin and released from the hospital, treated only with oral medications for Type 2 diabetes, a disease that I do not have.  Thankfully, I remained misdiagnosed for only about a week, because in that time I read all the literature about diabetes that was provided to me at the hospital, and realized that the symptoms I had (extreme weight loss, diabetic ketoacidosis, blood glucose 7 times normal, massive ketones in urine) were that of Type 1 diabetes and not Type 2 diabetes. When I confronted the endocrinologist who (mis)diagnosed me, to his credit he admitted he had made a mistake and apologized. Then he changed my diagnosis to Type 1 diabetes and put me on exogenous insulin. Since that time, I have come to know hundreds of others who have been similarly misdiagnosed, and I have worked diligently to dispel the myth that Type 1 autoimmune diabetes is a childhood disease.

Sadly, not much has changed since 1995 and misdiagnosis is still extremely common today, in spite of widely available diagnostic tests that can assist with obtaining a correct diagnosis.  As stated in a recent Wall Street Journal article on the problem of misdiagnosis,

"Most of my [adult Type 1 patients] have been misdiagnosed as having Type 2," says Robin Goland, co-director of the Naomi Berrie Diabetes Center at Columbia University Medical Center in New York. "Once the right diagnosis is made the patient feels much, much better, but they are distrustful of doctors and who could blame them?"

In the United States, a medical doctor faces no repercussions if he/she misdiagnosis a person as having Type 2 diabetes when in reality the person has adult-onset Type 1 diabetes. The governing bodies (the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus; the American Association of Clinical Endocrinologists) describe the different diseases that fall under the umbrella term “diabetes,” but they do not identify any protocols for differentiating amongst the different diseases. So there is no requirement to diagnose, classify, and appropriately treat the different diseases that fall under the term “diabetes.” If there were a standard or guideline, doctors would be held accountable to the minimum standard of care:  anything less would be malpractice. From my perspective, the lack of guidelines appears to be about limiting medical liability, not about enhancing patient care and saving lives.

If you or someone you care about has been diagnosed with diabetes and for any reason you suspect it may not be Type 2 diabetes, request that your doctor run autoantibody tests and the c-peptide test. Dr. Lou Philipson, Director of the Kovler Diabetes Center (University of Chicago) says:

“What I teach is that it is always important to ask oneself why a given patient has diabetes and what kind they have [Type 1, Type 2, or another form of diabetes]. Do not assume. If you have doubts, get another opinion, or get a referral to a see a specialist. Persistence can be life-saving.”

How does all this relate to yoga and healthy aging? I started practicing yoga six months before my first symptoms of diabetes. When I was newly diagnosed, I was in extreme despair—I thought my life was ruined. But yoga saved my life then by allowing me some space and freedom from constant thoughts about my disease. And yoga continues to save my life today by helping me stay calm and focused despite the daily grind of self-care that those of us with Type 1 diabetes must do. I recommend yoga to anyone who has to live with the stress of chronic illness.

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