YOGA & AYURVEDA FOR CARDIOMETABOLIC DISORDERSERIN KOEHLER, RN, YOGA INSTRUCTION, AYURVEDA & LIFESTYLE COACHING

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CARDIO METABOLIC DISORDERS

• Cluster of interrelated metabolic risk factors

• Abdominal Obesity

• Hypertension (high blood pressure)

• Insulin Resistance/Diabetes

• High Cholesterol

• Leading up to Coronary Artery Disease

• Arteriosclerosis (hardening of vessels with decreased compliance)

• Atherosclerosis (plaque formation within vessels)

• Angina (chest pain)

• Myocardial Infarction (heart attack - portion of heart becomes unoxygenated relative to occluded cardiac vessel)

ORIGINS OF CARDIOMETABOLIC DISORDERS

• Prakruti (Lifestyle Tendencies)

• Genes (physiologic map)

• Family History (conditioning)

• Karma

VATA KAPHA PRAKRUTI

• “Vata Kapha group had higher number of patients with cardiovascular risk disease than other groups. There are significantly higher number of subjects of DM, HTN and dyslipidemia in Vata Kapha type indicating VK is common in these conditions.

•More than half of patients (62.3%) were of Vata Kapha type and it was more prevalent compared to other prakriti; VK>VP>PK>K.

• It may be concluded that as there is dominance of Vata Kapha Prakriti and there is strong correlation with risk factors, insulin resistance, cytokine (IL6) and inflammatory markers. But IL6, TNF alpha and hsCRP is positively correlated with Kapha group also. Hence, identifying an individual with Vata Kapha and Kapha Prakriti will help in taking precautionary measures for future risk of cardiovascular disease.”

J Ayurveda Integr Med. 2012 Jul-Sep; 3(3): 150–157. Association of constitutional type of Ayurveda with cardiovascular risk factors, inflammatory markers and insulin resistance. Namita P. Mahalle, Mohan V. Kulkarni,1 Narendra M. Pendse,2 and Sadanand S. Naik

ORIGINS OF CARDIOMETABOLIC DISORDERS

• Vikruti

• Stress Management

• Smoking

• Diet (what we eat and how we eat)

• Exercise/Sedentary Lifestyle

• Inflammation

• Age

VATA KAPHA VIKRUTI

• Mind is moving too much (overwhelm, anxiety, insomnia)

• Body is not moving enough (in an intentional/productive way)

• Cellular metabolism becomes altered (Pitta/Agni)

• Need to reverse this imbalance

• Massive inflammatory effects may ensue

DEVELOPMENT OF DISEASE

• Physiologic disease occurs when forces interfere with natural biorhythms

• Movement away from natural rhythms aggravates the doshas and disrupts Agni (digestive fire) resulting in decreased metabolic efficiency and altered prana flow

• Doshas accumulate and overflow instead of alleviating, leaving their primary homes within the digestive system, and relocating typically following the path of least resistance

VATA {ETHER & AIR}

• Drives movement and circulation (throughout the body, the nervous system, the heart and all organ systems/tissues)

• Excess creates anxiety, fear, overwhelm, insomnia, lack of healthy routines

• Excess creates cold, hardening, dehydration, and degradation of tissues (arteriosclerosis/hypertension)

• Excess also results in disorderly movement

• electrical conduction (nervous system/heart)

• flow of fluids (turbulence/friction - circulation)

PITTA {FIRE & WATER}

• Drives digestion and metabolism (not only relative to food but also on the cellular level, organ level, and mental level)

• Excess creates anger, resentment and heated emotions

• In excess creates heat and inflammation of tissues

• Systemic inflammation

• Liver malfunctioning (high blood sugar/cholesterol)

• Pancreas is taxed (diabetes)

• Blood vessel integrity compromised (rakta upadhatu)

KAPHA {WATER & EARTH}

• Maintains structure, stability, and lubrication

• In excess creates stagnation of flow and accumulation of tissue

• Obesity

• Fluid Retention

• Diabetes

• Atherosclerosis (plaque build-up/increased aggregation of cells)

• Conditions of Congestive Heart Failure

OBESITY

• Vitiation of Kapha dosha

• Accumulation of Medas dhatu (fat tissue)

• Often pushed into excess by Vata dosha

• Stress

• Food Choices

• Sedentary Lifestyle (calories in > calories out)

• Endocrine disorders (hypothyroid, polycystic ovarian syndrome, Cushing’s)

MEDAS DHATU {WATER & EARTH}

• Water element = fat nourishes

• Earth element = fat stabilizes

• Healthy Medas

• Body is properly lubricated with a good balance of flexibility and stability

• skin, joints, digestion, respiratory health, cellular integrity

• Mind is stable, calm, loving – Sattva

• Rasa reserves

PHYSIOLOGIC EFFECTS OF OBESITY

• Disrupted Prana flow as channels become obstructed

• Inflammation

• High blood pressure (hypertension)

• Impaired glucose tolerance and type-2 diabetes

• High triglycerides, high LDL cholesterol and total cholesterol, low HDL cholesterol

• Atrial Fibrillation

STRESS AND FAT

The brain has the ability to selectively activate the fight, flight, or defeat responses.

• The “fight” or “flight” stress responses cause the heart to beat faster and harder as well as release more free fatty acids into the blood

• The “defeat” response stress pathway can lead to enhanced lipogenesis (fat creation), visceral obesity (deep abdominal obesity), breakdown of tissues, and suppression of the immune system

• Christine A. Maglione-Garves, Len Kravitz, Ph.D., and Suzanne Schneider, Ph.D. Cortisol Connection: Tips on Managing Stress and Weight. https://www.unm.edu/~lkravitz/Article%20folder/stresscortisol.html

VISCERAL OBESITY

• Abdominal fat—particularly visceral or ectopic adiposity—and insulin resistance are the main contributors to elevated cardiometabolic risk.  Abdominal obesity results in an increase in circulating free fatty acids, an increase in cytokines that promote inflammation and hypertension, and a reduction of adipokines which normally regulate both glucose and lipid metabolism. These changes are important factors in the development of insulin resistance, dyslipidemia, and an inflammatory and prothrombotic state—pivotal factors in the development of both atherosclerosis and type 2 diabetes.

• Chatterjee A, Harris SB, Leiter LA, Fitchett DH, Teoh H, Bhattacharyya OK; Cardiometabolic Risk Working Group (Canadian). Can Fam Physician.  Managing cardiometabolic risk in primary care: summary of the 2011 consensus statement. 2012 Apr; 58(4):389-93, e196-201.

INCORPORATE MINDFUL EATING PRACTICESASAP

• Eat relative to hunger cues

• Sit down to eat in a calm and aesthetic setting

• Eat slowly and chew the food properly

• Avoid eating while doing activities (including driving, walking, talking, working...) as this is likely to cause gas, bloating, indigestion and heaviness

• Ancient fasting technique (12 hours overnight)

BLOOD PRESSURE

• Pressure = Flow x Resistance

• Regulated by

• Vascular System

• Nervous System

• Kidneys (less fluid volume triggers Renin Angiotensin Aldosterone system > results in water retention and vasoconstriction > to raise blood pressure)

VASCULAR FUNCTION

• https://watchlearnlive.heart.org/index.php?moduleSelect=bpanat

HYPERTENSION

• <120/80 considered normal

• Commonly asymptomatic

• May have occasional symptoms such as headaches, dizziness, or nose bleeds

• About 75 million American adults (32%) have high blood pressure—that’s 1 in every 3 adults (cdc.gov)

• High blood pressure costs the nation $48.6 billion each year. This total includes the cost of health care services, medications to treat high blood pressure, and missed days of work (cdc.gov)

HYPERTENSION AND DOSHAS

• Vata

• stress/sympathetic overstimulation

• hardening of vessels

• Pitta

• typically occurs with underlying Vata and/or Kapha)

• sympathetic overstimulation

• vasospasm 

• Kapha

• excess fluid

• cholesterol deposits in vessels

INSULIN RESISTANCE

• Positive feedback cycles perpetuate the disorder

• In the liver, insulin resistance is selective in that insulin fails to suppress glucose production from non-carbohydrate sources, but continues to stimulate fatty acid synthesis

• In adipose (fat) tissue, insulin resistance is manifested as impaired glucose transport, as well as impaired inhibition of fat breakdown

• Hardy OT, Czech MP, Corvera S. What causes the insulin resistance underlying obesity?. Curr Opin Endocrinol Diabetes Obes. 2012;19(2):81–87. doi:10.1097/MED.0b013e3283514e13

DIABETES TYPE II

• Insulin Resistance (cells don’t respond normally to insulin) 

• The pancreas creates more insulin to try to get cells to respond

• Blood sugar rises as the pancreas can’t keep up with the demands

• Type II Diabetes is considered a disease of Kapha vitiation

DIABETES COMPLICATIONS

• Vascular disease (damage to lining of arteries/poor systemic circulation)

• Skin ulceration, poor wound healing, amputations

• Visual Loss

• Kidney disease (adding to hypertension component)/Kidney Failure

• Increased cholesterol

LIPID PROFILE

• Cholesterol

• Primarily produced by the liver

• External sources come from animal products

• Cholesterol is necessary for building key components in the body

• Cell Membranes, Hormones, Skin Health, Vitamin D, Bile Acids (which digest fat)

• Triglycerides

• Fats which travel throughout the blood stream

• Serve as the body’s energy stores

LIPOPROTEINS

• Cholesterol needs to attach to proteins to travel throughout circulation

• HDL = high density lipoprotein

• “good cholesterol”

• helps remove excess cholesterol from circulation

• LDL = low density lipoprotein

• “bad cholesterol”

• deposits cholesterol into arteries

ENDOTHELIAL DYSFUNCTION

• The endothelium = layer of endothelial cells which line blood vessels, lymphatic vessels, and heart chambers

• Vata invades Rasa creating turbulence and friction against vessel lining

• In this way Vata invades Rhakta dhatu creating new space within the lining

• This process adds to decreased compliance of vessel (arteriosclerosis) and hypertension

• Newly vacant space creates a site for deposition of cholesterol and plaque formation (atherosclerosis)

CORONARY ARTERY DISEASE

• Most common type of heart disease

• Caused by plaque buildup in the wall of the arteries that supply blood to the heart (coronary arteries)

• Plaque is made up of cholesterol deposits and other cellular debris (Kapha accumulation)

• Plaque buildup causes the inside of the arteries to narrow over time

• This process is called atherosclerosis

• Atherosclerosis is largely recognized as a chronic inflammatory disorder and coronary artery disease is its common manifestation.

FORMATION OF CORONARY ARTERY DISEASE

• https://watchlearnlive.heart.org/?moduleSelect=chlcad

MYOCARDIAL INFARCTION

• Result of Coronary Artery Disease

• Plaque in a vessel may partially or more fully occlude blood flow

• Plaque in a vessel may rupture stimulating clot formation

• Occlusion of one or more cardiac vessels cuts off blood supply to the portion of the heart, sometimes creating irreparable damage, may result in death

• May be precipitated by incidence of Angina

TREATING CARDIOMETABOLIC DISEASE WESTERN MEDICINE

• Diet (low fat, low sodium, increased plant based)

• Exercise

• Controlling water retention with medication (Kapha - diuretics)

• Controlling blood pressure and heart rate with medication

• Control diabetes/blood sugar (antihyperglycemics, insulin)

• Control cholesterol & clot aggregation with medication (baby aspirin, statins)

• Stent placement for vessel repair (minimally invasive/outpatient/short stay)

• Bypass surgery for vessel repair & valve replacement (inpatient/longer recovery)

TREATING CARDIOMETABOLIC DISEASEGOALS

• Restore Agni (digestion and elimination)

• Reestablish healthy Prana flow

• Cultivate Sattva (with foods, activities, environments, relationships…)

• Return towards greater harmony with natural rhythms

TREATING CARDIOMETABOLIC DISEASEDETOX

• Detox as tolerated (regain sense of taste – rasa)

• Diet (dosha appropriate/more plant based)

• Herbs (dosha appropriate)

• Body Therapies

• Yoga & Pranayama

• Regain connection between body and mind

• Bhakti – assess where one’s devotion lies/surrender to devotion of one’s higher self

• Meditation (mental detox – restore aberrations in consciousness)

TREATING CARDIOMETABOLIC DISEASECREATING NEW NORMALS

• Diet (dosha appropriate, increase prana in foods, primarily plant based diet, decrease sugar, eliminate snacking, incorporate basic practices of “mindful eating”)

• Herbs (dosha appropriate)

• Exercise (rejuvenative/proactive/maintenance)

• Yoga & Pranayama (breath awareness/self awareness)

• Lifestyle (aim towards greater stress management/meditation)

TREATING CARDIOMETABOLIC DISEASEEMPOWERMENT

• “Counseling consists of instilling a more powerful and positive spirit in the client, who is often weighed down by the stress, responsibility, and complexity of life.”

• The Art of Science of Vedic Counseling. David Frawley, Suhas Kshirsagar

• In this population, this perception of weight has translated into excess physical tissue in the body.

• Uplift the spirit with positive feedback

“PREVENT TROUBLE BEFORE IT ARISES”~ TAO TE CHING VERSE 64

• Ayurveda is a form of individualized preventative medicine

• Screening (Western)

• Cardio Metabolic Risk Assessment

• Visceral Fat Assessment

• Know your family history

• Know your Prakruti (VK high risk)

• Lifestyle counseling/programs for families/high risk groups

• Insurance coverage for lifestyle counseling (evidence based medicine)

REFERENCES• Ana Valeria B. Castro, Cathryn M. Kolka, Stella P. Kim,  and Richard N. Bergman.. Arq Bras Endocrinol Metabol. 2014 Aug; 58(6):

600–609. Obesity, insulin resistance and comorbidities – Mechanisms of association.

• Michael P. Czech. Nat Med. 2017 Jul 11; 23(7): 804–814. Insulin action and resistance in obesity and type 2 diabetes.

• Valter Lubrano and Silvana Balzan. World J Exp Med. 2015 Feb 20; 5(1): 21–32. Consolidated and emerging inflammatory markers in coronary artery disease.

• Omura-Ohata, Y., Son, C., Makino, H. et al. Efficacy of visceral fat estimation by dual bioelectrical impedance analysis in detecting cardiovascular risk factors in patients with type 2 diabetes. Cardiovasc Diabetol 18, 137 (2019).

• Vishal & Lambiase, Pier. (2019). Obesity and Atrial Fibrillation: Epidemiology, Pathophysiology and Novel Therapeutic Opportunities. Arrhythmia & Electrophysiology Review.

• Julie C. Wang, Martin Bennett. (2012). Aging and Atherosclerosis: Mechanisms, Functional Consequences, and Potential Therapeutics for Cellular Senescence. Circulation Research.

• https://www.ayurvedacollege.com/Ayurveda/medas-dhatu-closer-look-fat-ayurvedic-perspective

• ClevendClinic.org

• Heart.org

• MayoClinic.org