Yoga as Preventive Medicine Psychological and Physiological Mechanisms

1. Yoga as Preventive MedicinePsychological 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

2. Overview • Lifestyle and Disease • The mechanisms that underpin relationship between lifestyle and disease • Yogic mechanisms which act as a preventive medicine.

3. Non-communicable Diseases (NCDs) 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%. Noncommunicable Diseases, Country Profiles, World Health Organization, 2011

4. Non-Communicable Diseases (NCDs) …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). Global status report on noncommunicable diseases 2010 World Health Organization

6. Major Contributory Factors • Stress • Poor Habits • Isolation

8. 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

9. Autonomic Nervous System Sympathetic Parasympathetic Relaxation Catabolic Meets long-term well-being needs Involved in restoration of energy • Fight and flight • Anabolic • Meets immediate survival needs • Helps to mobilize energy

10. 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.

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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.

17. 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

18. Habits

19. Contributing Factors to Bad Habits • Lack of Awareness • Stress • Ethos of impulsivity feed by society

20. 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

21. 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)

22. 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

23. 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

24. 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; 115:444–64 2Gibson, 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

25. 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

26. 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

27. 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.

28. 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

29. 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. 1981 Can J Appl Sport Sci.  Dec;6(4):202-6.

30. Isolation

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

32. 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

33. Yoga as Preventive Medicine “Each patient carries his own doctor inside him.” ― Norman Cousins

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

36. 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.

37. 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

38. 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

39. 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.

40. Yoga and Sleep 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.

41. Cortisol Reduction • Slow breathing reduces cortisol levels • Yoga reduces cortisol levels • Yoga practice increases BDNF (indicator of hippocampal neurogenesis)

42. 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

43. 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

44. 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.

45. Research on Yoga and Better Habits Yoga Practice Associations 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.

46. Yoga and Well-Being 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.

47. Research on Yoga and Better Habits “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.” 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. .

48. 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.

49. 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

50. 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.