yoga for cardio metabolic disorders€¦ · stages of asana: arambha(beginning), sthiti(stability),...

Yoga for Cardio Metabolic Disorders

16thAnnual NAMA (National Ayurvedic Medical Association) Conference, Art of Living Retreat Center, Boone, NC

Ayurveda and Spirituality, April 24-26, 2020

Dilip Sarkar, MD, FACS, C-IAYT, AYT-NAMA, D.Litt (yoga)Associate Professor of Surgery (Retired), Eastern Virginia Medical School

Fellow, American Association of Integrative Medicine (AAIM), American College of Surgeons (ACS)

Past President, Board of Directors, AHA, Hampton Roads, Virginia

Past President, Board of Directors, International Association of Yoga Therapists (IAYT)

Chairman of Board, Life in Yoga Institute

Member, Virginia Governor’s Asian Advisory Board (2003-2018)

Chairman, Center for Integrative Medicine and Yoga, Taksha Institute, Hampton, VA

+1-757-621-7655 dilipsarkarster@gmail.com http://www.dilipsarkar.com

Yoga Therapy for Heart Disease

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Yoga

Philosophy (Yoga Sutra of Patanjali) and Practice (Patanjali Ashtanga Yoga)

Outcome – Self Realization

Health Benefits – Byproduct

Used as Adjuvant Therapy for Chronic Dis-eases

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Yoga Therapy

Adaptation of the yoga practices based on the patient/client

clinical condition

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Ayurvedic Yoga Therapy

Yoga Therapy is Ayurveda

Yoga Therapy is AyurvedicYoga Therapy

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Yoga Therapy

�Evidence based medicine (conventional medicine)

�Practice based evidence (integrative medicine)

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My Book - Bibliography

Books Yoga Therapy Related25 Books

DVD For Healthcare Providers2 DVDs

Website For Yoga Therapy

20 websites

Journal References – only clinical journals from 1957 to 2016

75 articles

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Yoga Therapy for Health and Healing: A Daily Practice (2015)

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Yoga Therapy for Health and Healing: A Daily Practice (2015)

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Cardio Metabolic Disorders is METABOLIC SYNDROME

Component of metabolic syndrome.

Truncal obesity

Heart disease (coronary artery disease)

Diabetes

Hypertension

High cholesterol (dyslipedemia)

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Metabolic Syndrome Pathogenesis

Stress – Insomnia and Sleep Apnea –

Stimulates Limbic System

High Sympathetic Tone (hyper-arousal of Brain)

High Cortisol Level – refined carbohydrate

intake – sugar spike – increase in insulin –

converts sugar to omental fat

Truncal Obesity

Omental Fat Secreting Proinflammatory Molecule

METABOLIC SYNDROME

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Metabolic Syndrome (Cause)

� STRESS (fear of the unknown)

� Brain hyper-arousal by INSOMNIA and SLEEP APNEA

� Activates Emotional Brain, LIMBIC SYSTEM, and its nuclei amygdala, which responds to fear, and the hippocampus, which stores memories

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Yoga TherapyMechanism of Action

� Psycho

Limbic System

� Neuro

Hypothalamus

� Endocrinology

Pituitary Gland

Adrenal Gland

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Psycho-Neuro-Endocrinology

� Limbic system sends a signal to hypothalamus(supraoptic and paraventricular nuclei), the site of our homeostasis through neurotransmitters

� Hypothalamus sends a signal to the autonomic nervous system and pituitary gland

� Pituitary gland, through its adrenal cortical axis, releases hormones, causing altered hormonal homeostasis, which, combined with autonomic nervous system dysfunction, causes metabolic syndrome

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Yoga Therapy is Relaxation Response

Activation of Parasympathetic Tone

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Yoga Therapy is

Relaxation

Response

(Meditation)

Meditation is Medication

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Meditation is Medication

T - TransformationC - Choice (Pills or Yoga Therapy)

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Yoga Therapy

EXPERIANCIAL

You are the creator of your destiny

(TRANSCENDENTAL)SCIENCE

Science beyond science

EXPERIMENTAL

Personal practice

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Body as Computer

� Body - Hardware

� Mind - Software

� Spirit - Programmer

Control Software for Hardware control

� Spiritual and emotional state of mind affect physical health and vice versa

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White Coat Hypertension

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Brain – Heart Connection

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Man with heart dis-ease winning lottery Memorize by heart

Yoga Therapy OutcomeAlan Brand 2013

� 73 years old white male

� Ischemic Cardiomyopathy with EF of 10-20%

� Multiple admission with acute CHF

� Severe CAD, non-operable

� With Yoga practice for six months, EF is 40%.

� EF is based on Peripheral Resistance and Cardiac Output. With reduction of PR and increase in CO the EF gets better.

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Yoga Therapy Outcome Alan Brand 2015

� Now 75 practicing daily Yoga Therapy learned headstand

� Developed increase in baroreceptor sensitivity

� Protecting from sudden change in hemodynamics and acute coronary events.

� On no medication

� Blood work

10.01.2014 03.23.2015

TCL 168 142

HDL 47 64

LDL 99 65

TGL 112 64

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Yoga Therapy OutcomeRobert Minyard 2015

� 76 yr. WM

� 1969 – Surgery (?) VSD

� 1989 - High BP 250/150

� 1998 – Surgery Descending Thoracic Aneurysm

� 2005 – Atrial Fibrillation

� 2006 – CHF

� 2013 – Pacemaker

� Yoga practice for 3 years, Daily at home Balancing Pose & Mudras, 2 hr. Sunday at Temple, 2 hr. Wednesday at Prime Plus

July 11, 2015

TCL: 145 HDL: 54 LDL: 76 TGL: 74

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Yoga Therapy OutcomeRobert Minyard 2016 77 yrs. WM

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Balancing poses improves CVD

1969 – Surgery (?) VSD1989 - High BP 250/1501998 – Surgery Descending Thoracic Aneurysm2005 – Atrial Fibrillation2006 – CHF2013 – Pacemaker

July 11, 2015TCL: 145 HDL: 54 LDL: 76 TGL: 74

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Regular Practice of Yoga

� Increases vagal tone

� Modulates the autonomic nervous system

� Causes rapid shift from sympathetic to parasympathetic activation

� Creates control over the autonomic nervous function

� Increases baroreceptor sensitivity

� Increases heart rate variability

� Improves cardio-respiratory fitness

� Improves quality of life.

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Yoga Therapy for Cardio Metabolic Disorder

Control the mind

� Through deep internal awareness, through

� Relaxation of the physical body (sithilikaran asana)

� Effortless yogic breathing (a slower rate, exhalation longer than inhalation, longer breath holding power)

� Calming down the mind with, savasana (corpse pose), pranayama, meditation, and mantra chanting.

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Start Yoga Therapy: Patients Cardio Metabolic Disorder

Sthiram (still, steady) Sukham (happy, comfortable) Asanam

Stages of Asana: Arambha (beginning), Sthiti (stability), Visharjana (immersion / surrender)

Awareness (no pain, comfortable discomfort)

Relaxation Response (Straight Spine – grounding poses or in a chair, Dhyana Mudra, Eyes Closed –mana sthir, Effortless Breathing - exhalation twice the inhalation, Vibration – om/aum creates same vibration of brain, Harmonic Resonance)

Effortless Pranayam – Vidhi (method), Samaya (timing),

Sankalpa (determination, Siddhi (attainment)

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Yoga Therapy for Cardio Metabolic Disorder

� Reduce truncal obesity through asanas such as mandukasana (frog pose) and slow kapalbhatipranayama (forehead shining breathing)

� Rx for Stress – Relaxation Response (physiological effects of Meditation)

� Rx for Insomnia – Bhramari Pranayama (humming bee)

� Rx for Sleep Apnea – Ujjayi Pranayama (victorious)

� Dinacharya – daily routine

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Rx: Yoga Therapy� One Hour of daily practice:

25 mins. each of Asanas and Pranayama, 10 mins. of Meditation

Pranayama: Effortlessly in stages to target timing

Bhastrika: active inhalation and exhalation (5 mins.)

Kapalbhati: passive inhalation and active exhalation (10-15 mins.)

Anulom-Vilome: alternate nostril breathing (5-10 mins.)

Nadi Suddhi: anulom-vilom with kumbhaka (retention) 10 times

Bhramri: close senses with sound of bee (7-10 times)

Shitali & Shitkari: cooling pranayam

Ujjayi: resistive inhalation

Sankha: resistive exhalation, conch shell breathing

OM / AUM or Udgeeth pranayam:

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Yoga Therapy

Transformation

Not to master the postures, but use the postures in stages for

transformation

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Yoga Therapy

� In stages impossible becomes possible - T.K.V. Desikachar

�With faith impossible becomes possible - Swami Satchitanand

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Primary Prevention

Parents with Hypertension, CAD, Diabetes

Genetic predisposition (high risk)

↓←Yoga Therapy

Genetic suppression

(prevent onset of genetic disease)

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Cleveland Clinic’s Lifestyle 180 program

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Cleveland Clinic’s Lifestyle 180 program

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Cleveland Clinic’s Lifestyle 180 program

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Secondary Prevention

Genetic predisposition (high risk)

↓← Life Style

Genetic expression (clinical disease)

↓←Yoga Therapy

Genetic suppression

(prevent progression or reverse disease)

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Tertiary PreventionGenetic predisposition (high risk)

↓← Life Style

Genetic expression (clinical disease)

↓←Yoga Therapy

Genetic suppression

(prevent progression or reverse disease)

Tertiary – Prevents Complications

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Rehabilitation

Genetic predisposition (high risk)

↓← Life Style

Genetic expression (clinical disease)

↓←Yoga Therapy

Better management of disease

Less pharmaceutical support

Better quality of life

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Positive Proof of Global Warming!

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Yoga Therapy

Mind – Body Hygiene

What will happen if you don’t brush your teeth for a month?

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Yoga Therapy

Yoga Therapy is

“Personalized Lifestyle Changes”

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Yoga Therapy

Lifestyle changes can be better than

drugs

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Yoga Therapy

� Yoga Therapy with other healing modalities can increase healing

synergistically

� Yoga is

TRANSFORMATIVE

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After a two-year visit to the United States, Michelangelo's David

Prakruti / Vikruti

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Origin of

Yoga Therapy

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Tadasana / Mountain Pose

Vrksasana / Tree Pose

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Vajrasana / Thunderbolt PoseSukhasana / Easy Pose

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Bhujangasana / Cobra

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Shalabhasana / Locust Pose

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Adho Mukha Svanasana / Downward Facing Dog, Marjariasana / Cat Pose

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Jathara Parivartanasana /Revolved Abdomen Pose

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Jathara Parivartanasana /Revolved Abdomen Pose

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Upavistha Konasana / Wide angle seated forward bend

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Paschimuttanasana / Seated forward bend, Prasarita Padottanasana / Wide legged forward bend

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Balasana / Child’s Pose

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Supta Baddha Konasana / Reclining bound angle pose

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Naukasana / Boat Pose

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