Uniting Body, Mind, and Spirit

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I gathered my legs underneath me to get off the floor, like a minute-old foal finding out what her body is for. Emotionally, I was flying. And, unexpectedly, I had been crying. I had discovered how to live inside my body with gentleness.

How did this happen? At the beginning of a one-on-one therapeutic yoga session, my instructor pointed out that I was breathing only into my upper chest in fight-or-flight style, as if I didn’t feel safe. I closed my eyes and allowed my belly to rise and fall gently with my breaths. My instructor then encouraged me to explore the images that came to mind. At first, I saw the annoying pain in my right shoulder as a sharp, metal plate — and then, suddenly, I began to feel long-forgotten grief and loneliness from a relative’s suicide. While I lay motionless and listened to an internal voice say that the death was not my fault, my stiff hips and shoulders actually moved, like doors pushed ajar by the wind. My right hip felt open and bursting with light, my shoulders as if they had melted and dripped down my spine.

I was thunderstruck, and delighted. I had reached a new level of understanding about yoga, my body, and my life, and all I had to do to get there was breathe.

The experience described here may sound dramatic, but it is in fact commonplace within the context of a therapeutic yoga session. Therapeutic, or restorative, yoga is a new form gaining popularity among medical practitioners such as physical therapists and nurses. It is a combination of gentle traditional yoga, guided meditation, breath work, and hands-on healing. Practitioners create an environment where students feel safe enough to deeply sense the emotions held in the body. The images that come to mind during guided meditation can lead to insights about what makes a person feel the way he does.

These days, it’s not uncommon for diabetes care providers to encourage people with diabetes to use yoga for stress management. Yoga provides this benefit and much more; it is a practice that enhances health through a heightened awareness of the body–mind connection.

Only through doing yoga is it possible to understand all that it has to offer. Yoga is not straightforward exercise. “You may get fit through yoga,” says Arturo Peal, a certified yoga therapist at Yoga Soup in Santa Barbara, California, “but make the intention of going to yoga to feel more of yourself, bring peace to your life and your heart, and radiate that out to your family. That’s what yoga is.”

The evolution of yoga

Yoga began as a spiritual practice thousands of years ago in India. Yoga asanas, or postures, were done to prepare the body for meditation. However, the postures are only one “limb” of eight areas of learning in yoga: The others are yamas (restraints), niyamas (observances), pranayama (breathing), pratyahara (withdrawal of senses), dharana (concentration), dhyani (meditation), and samadhi (absorption). Self-observation, personal ethics, and a state of awareness called “mindfulness” are all part of yoga.

As yoga moved West and evolved into dozens of different styles — some far removed from the original spirit — the American fitness industry began to market yoga as a quick route to increased flexibility and a sculpted physique. Classes that emphasize these goals are not hard to find at gyms or even at some yoga studios. However, this approach to yoga is not desired by or suitable for everyone. People with diabetes who have complications, limitations, or additional chronic illness; have had amputations; or experience pain and stiffness are more likely to find physical and emotional relief through the practice of restorative yoga, which may or may not be offered in a gym setting.

Restorative yoga differs in form, but not in spirit, from the yoga practiced in the East. Restorative yoga emphasizes “being” rather than “doing.” Students settle gently into position and remain in only a few poses for long, restful periods of time. Props like pillows and blankets are often used to support the body. Classes are designed to be nurturing and nonjudgmental, so that even the very inflexible can feel comfortable and experience deep relaxation. Students are encouraged to work only within the range that feels right for their bodies, no matter how large or small that range may be. Once a sense of ease is found in restful poses, more active poses can be pursued gradually.

Andrea Gonzales, a student in Peal’s class who has experienced back problems, enjoys restorative yoga because it “feels safer.” Gonzales says that on several occasions, she has become teary in class because relaxing and stretching feel so good.

What the research says

In 2005, a study published in the Journal of the American Board of Family Practice Medicine reviewed 70 separate pieces of research probing the relationship between yoga and both cardiovascular disease and insulin resistance syndromes, including Type 2 diabetes. The review determined that yoga may be instrumental in improving the core indicators associated with both. Improvements were evident in glucose tolerance, insulin sensitivity, lipid profiles, and blood pressure.

How does yoga have all of these positive effects? Researchers speculate that yoga activates the “relaxation response,” a term coined by Dr. Herbert Benson, Director Emeritus of the Benson–Henry Institute for Mind Body Medicine at Massachusetts General Hospital, to describe the effects of meditation on the nervous system. Heart rate, blood pressure, and breathing slow down, and brain waves become slow and smooth, replacing the choppy, agitated brain activity that occurs under stress. As the vascular system relaxes, uptake of oxygen increases, allowing more oxygen and nutrients to reach tiny capillaries within tissues. The relaxation response also boosts immune function and counters the negative effects of stress-induced adrenaline and cortisol, which can include high blood glucose.

A report by physicians in Delhi, India, in 2005 found that when 20 study subjects with Type 2 diabetes practiced specific yoga asanas for 40 days under the instruction of a yoga expert, they experienced significant decreases in fasting and after-meal blood glucose and in waist-to-hip ratio, or tummy bulge. The study concluded that yoga asanas were an effective adjunct to diet and drugs in diabetes management.

Of special interest to those with neuropathy, in 2002 the same team of physicians studied people with Type 2 diabetes who had mild neuropathy. Slight improvement in nerve function occurred after 40 days of yoga asanas for 30–40 minutes per day, while in a control group that performed light walking, nerve function deteriorated. The asanas used in this study include some that require diligence and attention rather than exertion, such as tadasana, or mountain pose, in which a person stands on both feet with his palms together in front of his heart; and shavasana, or corpse pose, practiced lying flat on the floor while bringing awareness to the body and systematically visualizing every internal organ as relaxed.

Caring for emotions with yoga

Many people with diabetes frequently feel guilt related to their blood glucose control, weight, blood pressure, or cholesterol, as well as anger or sadness due to the challenges of coping with diabetes. The experience of receiving yoga instruction in a supportive atmosphere free of judgment can provide a much-needed respite from these feelings.

Naomi Kingery, a teen with diabetes in Simi Valley, California, who became a yoga teacher with the dream of helping other teens, knows the impact that yoga can have on emotional well-being. “When you’re breathing deep, you’re focused,” she says. “You aren’t thinking about needles or blood sugar; you’re enjoying being in the moment.” Kingery is particularly passionate about the “relaxation pose,” in which students lie on their backs with their eyes closed: “For these few minutes, you completely let go of the world, which is so important for us diabetics, because our minds never stop.”

For people with diabetes who live with eating disorders such as anorexia or binge eating, yoga can provide an opportunity to uncover the emotional roots of these conditions. The idea of sitting quietly with your own thoughts and feelings can be intimidating, but it’s worth putting up with the initial discomfort if experiencing and identifying your true feelings lessens their power and leads to personal insight.

Setting realistic expectations

Ann Bartlett, who has had diabetes for 37 years, believes that yoga, as part of a variety of conventional and unconventional medicine practices, has kept her complication-free. “I own a wellness center and was encouraged to open it because my clients see me as ‘healthy to the core.’ Most never knew I had diabetes,” she says.

Beginners to yoga should not, however, expect sudden improvement in their fitness level or diabetes control or even expect classes to feel like a workout. According to Charles Matkin, a New York City yoga expert, those who come to yoga expecting vigorous exercise are likely to push themselves in the wrong direction. “Learn your stillness first,” Matkin says, “then fire it up.”

What is stillness? Words fall short, but Buddhist monk Tarthang Tulku may have described it best as “brief tranquil moments when the senses are relaxed and responsive…and the blessing of healing and knowledge flows forth.” Stillness, in yoga, is also the ability to let go of struggle and find ease in activity.

Another reason to start slowly is that yoga postures that look easy can be surprisingly rigorous. Serious injury can result in those who push too far, too fast. In a handful of extreme cases, abdominal hemorrhage has occurred from the “breath of fire,” and serious neck injury has resulted from headstands.

People with diabetes, especially, should make sure that their yoga-related goals are reasonable ones. A Google search of the words “yoga and diabetes” reveals thousands of excited claims that yoga can do everything for diabetes from preventing it to curing it completely. Although many people are able to make significant changes in their health that reduce the need for drugs or otherwise assist with diabetes management, even this should generally not be the goal of yoga for beginners.

Yoga offers people with diabetes an opportunity to connect with their own bodies with appreciation, acceptance, and gratitude and to experience the self as healed. Students often find that with this new awareness, they are willing to embrace diabetes self-management chores with new appreciation and acceptance. By rushing to get dramatic benefits from yoga right away, students might miss the real point of it. Yoga is in all cases, of course, never a substitute for medical care, but rather an integrative practice to be used in conjunction with your self-care regimen.

Special care and caution

In a person with diabetes, long-term glycosylation, or binding with glucose, of proteins can occur in almost any part of the body. Glycosylation damages nerves and tiny blood vessels and causes damaged collagen to accumulate in both the skin and the delicate structures surrounding joints. Seen more commonly in people with long-standing Type 1 diabetes, but also possible in those with Type 2, such changes in connective tissue can cause adhesions that result in unusually stiff shoulders, hips, knees, feet, or hands. People with muscle pain, joint pain or stiffness, decreased range of joint movement, swelling or deformities, or conditions such as frozen shoulder or carpal tunnel syndrome will need to pay careful attention to their bodies and remain cautious as they gauge what feels comfortable.

Peal advises students who hope to overcome limitations or recover from injuries to log the duration of the various poses they attempt, discovering the threshold where comfortableness begins to wane, and then to gently increase their efforts. “You want to avoid huge setbacks, and have tiny ones,” Peal says. “Stress the body just enough so that it makes changes that are helpful. The threshold will move up, but if you crash through it, it will move down.”

People who have complications involving the feet, such as neuropathy, Charcot foot, or even amputation of a toe, part of the foot, or a limb, can still practice yoga. In fact, yoga may be especially valuable for these people as a gentle form of physical activity that enhances feelings of well-being, while other forms of exercise can be problematic or impossible. The key is to know that almost every posture can be modified to make it comfortable, even for people who have difficulty balancing. Postures can still be effective when performed leaning against a wall, holding onto or seated in a chair, or using pillows and blankets for support.

Getting started

Books, DVDs, Web sites, and classes are readily available for people interested in yoga, but few such resources exist specifically for people with diabetes. Two that do are the videos Healing Yoga for Aches and Pains and Healing Yoga for Common Conditions, produced by Matkin and his wife Lisa. (See “Yoga Resources” for information on where to purchase these videos.) Although the titles were changed for broader appeal, this set was originally developed specifically for people with diabetes, and it provides a thoughtful, gentle introduction.

Because the practice of yoga is so diverse, beginners should start the search for classes and teachers with honest self-reflection and a few questions. Question 1: What do I want? Yoga can offer stretching, strengthening, better balance, stress reduction, spiritual practice, emotional balance, or a vigorous cardio workout. Decide which elements are most important, and discuss these with prospective teachers. Question 2: What is my current physical and emotional state? Be honest. People who are initially couch potatoes will need to start slowly, and those who are very stressed may need individual work to learn to breathe correctly. Question 3: Can the prospective teacher completely accept my current state and help me take the next step? If not, find a teacher who can. Compassionate yoga teachers strive to match the yoga to the student, not the other way around. Modifying poses for ability level is essential. “There are a few poses where I cringe” at the original versions, says Peal. “Maybe for one in a hundred bodies that could be good, but for some, the amount of stress that is put on the ligaments is just a no.”

Matkin recommends that people with diabetes, and especially those with diabetes-related complications, start with a class in a medical setting or with individual instruction. The yoga industry lacks a national credential system or uniform standards, so instructors and classes should be selected with care. Look for instructors who have the most hours of training, as well as outside training in disciplines such as nursing, physical therapy, anatomy, and kinesiology. But most of all, “Find a teacher who cares,” Matkin advises.

What can first-time yoga students expect from a yoga class? There are huge differences in styles and approaches to yoga, and one class experience may be dramatically different from another. In many if not most classes, the instructor describes the postures to be done and also demonstrates them, so that new students can both listen and watch to learn and follow along. The names of postures and other practices may be given in English or Sanskrit, and often an instructor will use both terms. Some instructors may routinely suggest alternative postures for people with physical limitations; others may only make suggestions if asked.

Some classes include breathing exercises, and pranayama, or the art of breathing in yoga, may at first seem downright weird, especially with more experienced students making strange noises upon exhalation. Many new students feel awkward until they learn to do yoga breath correctly and to enjoy the deep relaxation that follows. Many classes include a meditation, which can also be very relaxing.

It is vital to keep an open mind; overcoming a feeling of awkwardness about an activity can, in fact, be one of the most freeing experiences. However, if a class seems to move too quickly or to consist mainly of postures you feel are too difficult for you, it’s probably a good idea to try another class to find a better fit.

If you’d like to explore yoga but aren’t yet ready for classes, pull tidbits from books and DVDs that you feel fit your personal needs. When using DVDs at home, watch the whole DVD first and take time to get familiar with the routine before trying to keep up with it. Sit quietly and breathe during poses that are uncomfortable, or do a favorite pose instead.

People with diabetes may at times have trouble finding the motivation to perform self-care, and the stress or guilt that ensues can lead to a negative outlook. Yoga can counter this, helping to fulfill both physical and emotional needs for people with diabetes. If done within your limits, it may feel so good that you can’t wait to do more. Learning yoga is like learning to live with diabetes: It asks you to commit to taking the best possible care of your body, and to seek help in this endeavor. People are waiting to help you learn to live in your body with gentleness.

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