Integrating Yoga into Nutrition Therapy

Beverly Price, RD, MA, E-RYT 200, C-IAYT, CEDRD-S

Certified Eating Disorder Specialist

iaedp Approved Supervisor

IAYT Certified Yoga Therapist

Objectives:

Describe three elements of the philosophy of Yoga and how they can be integrated into nutrition therapy sessions.

Discuss three benefits of Yoga for nutrition concerns.

Demonstrate postures that can benefit your clients.

Beverly Price, RD, MA, E-RYT 200, C-IAYT, CEDRD-S

Beverly Price is a certified eating disorder specialist, International Association of Eating Disorder Professionals Foundation (IAEDP) Approved Supervisor and International Association of Yoga Therapists (IAYT) Certified Yoga Therapist recognized for her mindfulness Yoga-based eating disorder recovery programs, along with Yoga training programs in eating disorders for professionals. Beverly has created, cultivated and sold various healthcare businesses. In her career, she has also consulted with healthcare entities who wish to maximize their bottom line.

What is Yoga?

Yoga

Yoga Therapy

What is Yoga Therapy?

Yoga therapy is the application of teachings and practices in a therapeutic context in order to support a consistent yoga practice that will increase self-awareness and engage the client’s energy in the direction of desired goals

Yoga Therapy Requirement

Foundational understanding of yoga theory and practice

Biomedical and psychological foundations

Teaching and therapeutic skills

Yoga therapy tools and their application

Professional practice that includes– Legal

– Regulatory

– Ethical issues pertaining specifically to Yoga therapy

Goals of Yoga Therapy Eliminate, reduce, or manage symptoms

Improve function

Prevent the occurrence or reoccurrence of underlying causes of illness

Improved health and wellbeing

Help clients change their relationship to and identification with their condition

Who Can Provide Yoga Therapy?

Yoga therapists are now certified through a governing and accrediting body

The International Association of Yoga Therapists (IAYT), is recognized as the as the governing body for yoga therapists based on

– Evidenced-based practice and peer reviewed literature

– Standards of practice that differentiate between a Yoga therapist and Yoga teacher are now emerging

Yoga Therapy Assessment

Yoga Therapy Assessment

Application of knowledge on how to synthesize intake, evaluation, observations, and working assessment

Development of an appropriate practice or session strategy for individual clients with eating disorders and substance use disorder

Formulation of group classes, taking into consideration the individual make up and needs of the client

Yoga Therapy Assessment

Assessment is similar to that of any other treatment team member’s preliminary assessment

Collection of information to develop a client-centered, integrated treatment plan.

Yoga Therapy Assessment

Current healthcare information relevant to the work of a Yoga therapist treating the eating disorder and substance use disorder population

Pathologies, co-occurring disorders, drugs, surgical procedures

Evaluation of the physical, energetic, mental, emotional, and spiritual dimensions of well-being

Breath patterns

Posture and movement patterns

Yoga Therapy Treatment Plan

Client-centered recovery plan based on the assessment

Implementation of the Yoga therapy treatment plan

Importance for the client to know and understand why they are engaging in the recommended postures

Communication with treatment team

The Chakras

The Chakras

• Chakra: “Wheel,” “Circle,” or “Wheel of life”

• The chakras are aligned in an ascending column from the base of the spine to the top of the head

• Each chakra is associated with multiple physiological functions

The Chakras

•The body’s chakras parallel two chains of nerve bundles located on each side of the spinal cord.

•Activating these chakras, through Yoga, releases emotional pain imprisoned in the body as physical pain around the spinal cord.

•An interesting parallel may be created with the chakras to incorporate discussion on a physical, emotional and spiritual level as it relates to eating disorder behavior.

First Chakra: Muladhara The Root Chakra - physical vitality, survival

Your right to be here.

Your roots and external messages that form your food beliefs and rituals

How your roots and messages mold your thought processes, including physical health, comfort in your own skin, comfort in your home, comfort in your environment, positive feelings towards your family of origin, sense of safety (security and stability), positive relationship to finances and prosperity, ability to be still, ability to be present in the moment.

Second Chakra: Svadisthana

The Sacral Chakra - desire, including sexual energy

Your right to feel

Your relationship with food and how it parallels every other relationship in your life

Know the different eating cycles and moving toward instinctive eating

The Solar Plexus Chakra - creation of self, perception and projection of self

Your right to self-definition and action.

Issues related to responsibility, self-esteem, and nourishing your body and soul

Nourish your soul and develop your self-worth

Third Chakra: Manipura

Fourth Chakra: Anahata

The Heart Chakra - universal love, compassion, empathy

Your right to love and be loved.

How you use food to deal with emotions and learn to let go of old behaviors

Understanding attachments while learning to let go and move forwards

Letting go of rules, numbing painful emotions, working through emotional barriers

Fifth Chakra: Vishuddha

The Throat Chakra - communication, creative expression

Speaking your truth, freeing your creativity

The power of choice in healing your relationship with food.

Forgiveness and speaking your truths

Turning intentions into actions

Sixth Chakra: Anja

The Brow Chakra - visualization, third eye

Seeing the way – intuition and vision

Learn to use your intuition and insight in making food and related behavior choices in your highest good

Evaluate internal messages in order to trust their own power of choice.

Detaching and observing

Creating your sacred space

Seventh Chakra: Sahasrara

The Crown Chakra - totality of being, spiritual perfection

Self knowledge and understanding

Reconnect with your highest self--wholeness and holiness

Explore the spirituality of food and your spirituality in the healing process

Engaging into life while living in the present moment

Yoga Philosophy Integrated

Chakra 1: Physical

Chakra 2: Connections

Chakra 3:Purpose

Chakra 4: Emotional

Chakra 5: Expression

Chakra 6: Future/hope

Chakra 7: Unity

Physical

Social

Occupational

Emotional

Environmental

Intellectual

Spiritual

Maslow’s Hierarchy of Needs

Yoga Physiology and Benefits

Benefits of Yoga on Bone Health

Weight-bearing exercises improve bone health by stimulating the bones to retain calcium and produce bone mass.

Yoga is a weight-bearing exercise as many of the poses require clients to lift their own body weight.

Decreased cortisol

– Increased bone formation and calcium absorption

Lu,Yi-Hsueh PhD, Rosner, Bernard PhD, Chang, Gregory MD PhD, and Fishman,Loren M. MD.Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss. Top Geriatr Rehabil. 2016 Apr; 32(2): 81–87.

Benefits of Yoga on Heart Disease

Decreased activity of sympathetic nervous system

– Decreased heart rate

– Decreased blood pressure

Herbert Benson, Harvard, Relaxation Response, Research Patient Data Registry, BHI Relaxation Response Resiliency Program (3RP) from 2006 to 2014

Nischala Joy Devi and Dean Ornish Reversing Heart Disease Program:

Flight or fight – decrease activity of the sympathetic nervous system.

Opening the heart.

Benefits of Yoga on Cancer Recovery

Psychosocial issues

Chemotherapy, radiation and immunotherapy

Lymphedema, fatigue, pain, nausea, neuropathy, menopause, osteoporosis, sleep disorders, anxiety

Côté, MD, Andréanne. Effect of yoga on patients with cancer, Our current understanding. Can Fam Physician. 2012 Sep; 58(9): e475–e479.

Benefits of Yoga in Diabetes

• Postures innervating the pancreas

• Increased insulin production in Type II DM

Manikappa, Subhash, Chimkode,Sendil D. Kumaran,V.V., Shivanna, .Kanhere, and Ragunatha. Effect of Yoga on Blood Glucose Levels in Patients with Type 2 Diabetes Mellitus. J Clin Diagn Res. 2015 Apr; 9(4): CC01–CC03.

Benefits of Yoga in GI Disease

Parasympathetic- homeostasis of GI tract

Gut brain axis

Kavuri, Vijaya, Raghuram, Nagarathna, Malamud, Ariel Malamud, and Selvan. Irritable Bowel Syndrome: Yoga as Remedial Therapy. EvidBased Complement Alternat Med. 2015; 2015: 398156.

Benefits of Yoga in Eating Disorder Treatment

Understanding bad habits, self-destructiveness, exploring the mind, growth and transformation as related to habits and addictions.

Increased general self acceptance increased body awareness and acceptance.

Daubenmier, Jennifer J. The relationship of yoga, body awareness and body responsiveness to self-objectification and disordered eating. Psychology of Women Quarterly banner. 2005: May 13.

Benefits of Yoga in Addiction

In recent studies, Yoga has been shown to increase the levels of GABA in the brain by more than 20 percent.

This is important because people dealing with addiction usually exhibit low levels of GABA.

If an activity such as Yoga can increase these levels, even for short periods of time, then people struggling with addiction can more conscientiously focus on their recovery.

Streeter, CC., Gerbarg, PL., Saper, RB., Ciraulo, DA., Brown, RP. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Medical Hypothesis. 2012, 78(5): 571-579.

Benefits of Yoga in Depression and Anxiety

The ability to control irrational thoughts and the increased ability to shift attention at will.

The ability to use mindfulness and positive self affirmations leading to the reduction of unrealistic pessimism often associated with depression and anxiety disorders.

Eastman-Mueller, H., Wilson, T., Jung, AK., Kimura A., and Tarrant, J. iRest yoga nidra in the college campus: changes in stress, depression, worry and mindfulness. Int J Yoga Therap. 2013, (23): 15-24.

Yoga and Mindfulness Research

Studies have discovered that mindfulness can bring out positive emotions and suppress negative emotions and stress.

Practicing mindfulness meditation can boost the immune system and help fight off illness.

Mindfulness helps focus, which can combat distractions and improve attention.

A study that looked at stress reduction showed that mindfulness-based therapy may be useful in altering affective and cognitive processes that underlie multiple clinical issues.

Mindfulness teaches clients to use alternatives to avoidant-based coping and recognize underlying reasons for maladaptive behaviors.

Khanna, Surbhi, MBBS and Greeson, Jeffrey M. Greeson, PhD. A Narrative Review of Yoga and Mindfulness as Complementary Therapies for Addiction. Complement Ther Med. 2013 Jun; 21(3): 244–252.

Benefits of Mindful Yoga Mindful Yoga and meditation can affect the cerebral

cortex, improving focus and awareness.

The cerebral cortex is the center of the brain that is responsible for impulses, irrational thoughts and behaviors.

Activating the cerebral cortex can diminish the impulsivity along with irrational thoughts and behaviors involved in eating behaviors and nutrition

beliefs.

Malcolm Gladwell. Blink: The Power of Thinking Without Thinking. 2005.

Yoga and Eating

Yoga can help delay impulses

Through Yoga, clients may find themselves in postures that are difficult or awkward

Learning to stay within the poses and work through these postures can help the client, who feels an urge binge or practice unhealthy food behaviors, delay acting on this urge

Yoga and Eating

Clients learn to tolerate uncomfortable emotional states without running toward food or drugs for comfort or numbing out by turning away from food

When in various Yoga poses, postures are held for a certain length of time while maintaining the breath

Yoga and Eating

Often, clients tend to want to “run away” from uncomfortable situations and/or ambivalent about MNT

Practicing Yoga can help maintain discipline, help clients to feel and accept uncomfortable emotions and avoid overeating and other impulsive behaviors

Yoga and Eating

For many clients, part of weight homeostasis is learning to tune in to the body's signals of hunger and satiety

By eating only when hungry and stopping when the body is satisfied will result in the body slowly return to its natural weight

Yoga and Eating

Individuals who have attempted to control their weight through dieting are fearful of allowing themselves to decide when and how much to eat

Yoga can help those with weight and food issues trust their body and understand the messages given to them by their own body

Yoga and Eating

The physical discomfort of overeating and under eating becomes more obvious as greater awareness learned in the regular practice of Yoga makes all sensations more apparent

This can make it easier for clients with eating disorders to choose to stop eating before the point of physical discomfort as well as honor hunger and nourish the body

Yoga and Eating

Yoga also emphasizes mindfulness

Clients learn to experience the taste, texture, and other sensual qualities of food

They also learn to begin to make thoughtful vs impulsive choices related to eating behaviors and daily life decisions

Mindful awareness, which emphasizes “observing” vs. “reacting” to daily stresses in life also comes into play for clients who are repulsed by food

Yoga and Eating

Staying present is another important concept learned in Yoga, whereas the mind starts to wander, clients are taught to draw their attention back to the breath

Although many poses are uncomfortable, others are also meant to be enjoyable, thus teaching clients how to engage into life and “let go” of whatever they are holding on to that is hindering them from moving forward in their health

Yoga Benefits

Clients begin to “take their Yoga off the mat” and find their edge in everyday life

Finding their physical edge can help peel away layers to tapping into an emotional and spiritual edge

The Therapeutic Yoga Asana Practice

Lighting

• Dim

• Close all curtains

• Temperature

• Moderate (75-80 degrees)

• No Mirrors!

The Asana Practice

•Theme

•The Edge

•Adjustments

•Moments of Silence

•The Breath

Yoga Adjustments

Physical

Non-physical

Non-verbal cues/body language

Disease Compromised

Gentle hatha

Yin Yoga

May bring up extreme agitation for the client as their work is to be still

Emotions tend to be elicited in these postures, where the client is unable to avoid feeling these emotions based on attachment to their disease

YogaLarger Bodied

Vigorous or slower paced preferences

Identifying risk factors, based on a thorough assessment, hypertension and type II diabetes

If not monitored and managed, this can be a concern in an intense Yoga plan

For the Yoga therapist who practices in a private setting, client self-monitoring of blood pressure and/or blood glucose is crucial with available results guiding the respective day’s Yoga postures

Yoga Larger Bodied

Gastric implications – including gastric balloons

– Slow Hatha with modifications

– Yin Yoga

– Chair Yoga

Yoga for Every Body

Clients needing a faster pace Yoga can be guided through a series of poses, followed by the freedom to “flow on their own”

Clients can then add or delete poses of their choosing

Clients move at their own pace, tap into their breath and feel the movement of their bodies on a much deeper level This type of free flow can also be very empowering

This style of Yoga can help clients begin to break free from the rigidity that often mirrors the history of the “diet” mentality and controlling their disease state.

Yoga in the Community

Gym or studio can be a progression for the client who is higher functioning, weight and risk factor normalized/ managed and who is empowered to understand that not all of the postures and word choices directed by the Yoga teacher are appropriate

These clients are confident enough to take what they need from their Yoga, and not react to inappropriate word choices and nutrition advice.

It is important for a private practitioner and/or comprehensive eating disorder treatment center that offers Yoga to understand the Yoga culture of the community.

Practicing your own Yoga at various studios in order to understand the lay of the land is necessary in order to safely advise clients where to practice Yoga in the community.

Lisa…

“Yoga has helped me make peace with my body. It gives me the courage and strength to challenge my body and the wisdom and kindness to know when to give it rest. Yoga has helped me pay attention to how my body reacts to the choices I make. It nourishes the mindfulness to make better choices and the forgiveness to let go when I make poor decisions.”

In Summary

The Yoga practitioner can observe whether or not the client sinks into the postures, as a metaphor for sinking into their life, or whether they hold back with tension and apprehension.

Often, attachment is the root of the tension that your client may be experiencing physically and emotionally. Yoga therapy can help move your client forward with awareness. However, it is difficult for the client to let go of something, when they don’t know what they are holding onto.

By observing and recording body language, including the resistance the client may be experiencing, the Yoga practitioner can become in tune to what is going on in the moment.

The Yoga therapist can then consult with the treatment team in order to hone the team’s support in helping the client uncover what may be holding them back from participating in their own life.

Your client’s relationship with food parallels all relationships in their lives as well as their relationship with their Yoga mat

Research

Carbaugh, Rebecca J. and Sias, Shari M. Comorbidity of bulimia nervosa and substance abuse: etiologies, treatment issues, and treatment approaches. Journal of Mental Health Counseling. 2010: 125-138.

Eastman-Mueller, H., Wilson, T., Jung, AK., Kimura A., and Tarrant, J. iRest yoga nidra in the college campus: changes in stress, depression, worry and mindfulness. Int J Yoga Therap. 2013, (23): 15-24.

Pacanowski, Carly R., Diers, Lisa, Crosby, Ross D., Neumark-Sztainer, Dianne. Yoga in the Treatment of eating disorders within a residential program: A randomized controlled trial. Eating Disorders. 2017, 37-51.

Reddy Shivani, Dick Alexandra M., Gerber Megan R., and Mitchell Karen. The Effect of a Yoga Intervention on Alcohol and Drug Abuse Risk in Veteran and Civilian Women with Posttraumatic Stress Disorder. The Journal of Alternative and Complementary Medicine. October 2014, 20(10): 750-756.

Root, Tammy L., Poyastro Pinheiro, Andrea, Thorton, Laura, Strober, Fernandez-Aranda, Fernando, Brandt, Harry, Crawford, Steve, Fitcher, Manfred M., Halmi, Katherine A., Johnson, Craig, Kaplan, Allan S., Klump, Kelly L., La Via, Maria et al. Substance Use Disorders in Women with Anorexia Nervosa. International Journal of Eating Disorders. 2010: 14-21.

Streeter, CC., Gerbarg, PL., Saper, RB., Ciraulo, DA., Brown, RP. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Medical Hypothesis. 2012, 78(5): 571-579.

Questions?

Beverly S Price

Phone – (248) 390-4150

Email – Beverly@beverlysprice.com

Website – beverlysprice.com

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