Yoga has a great potential in preventing and managing chronic diseases and Yogic lifestyle can make an appreciable contribution to improvement of health of our masses. Yoga has the potential to prevent progression of the disease and if started early, maybe even effecta cure (Bhavanani, 2013). Basic Yogic principles that are used in management of DM include: 1. Psychological reconditioning and development of appropriate attitudessuch as yama-niyama, chaturbhavana, pratipakshabhavanametc 2. Stress management through counseling, jathis (loosening techniques), asanas (postures), kriyas(systematic rational breath-body coordination movements) and pranayama (breath-energy harmonizing techniques). 3. Helping utilizing the glucose better through physical activity such as surya namaskar, asanas, kriyas, pranayama etc 4. Relaxation, visualization and contemplative practices to induce a sense of inner calmness and wellbeing.

1. Enhancing Management of
T2 DM Through Yoga
Yogacharya
Dr. ANANDA BALAYOGI BHAVANANI
MBBS, ADY, DSM, DPC, PGDFH, PGDY, MD (Alt Med), FIAY, C-IAYT
Deputy Director
Centre for Yoga Education, Therapy and Research (CYTER),
Sri Balaji Vidyapeeth, Puducherry.
www. sbvu.ac.in/ahs/yoga

2. SBV AIM HIGH’s
Centre for Yoga Therapy, Education
and Research (CYTER)
Salutogenesis, our focus!

3. SBV AIM HIGH’s
Centre for Yoga Therapy, Education
and Research (CYTER)
Salutogenesis, our focus!

4. SBV AIM HIGH’s
Centre for Yoga Therapy, Education
and Research (CYTER)
Salutogenesis, our focus!

5. Salutogenesis, our Focus
• Moving from pathogenesis, the focus on disease
towards salutogenesis, the focus on health!
• Under SBV AIM HIGH (Academy of Integrative
Medicine for Holistic Intervention towards General
Health), Faculty of Allied Health Sciences, CYTER is
striding forward on an innovative path of promoting
holistic health for one and all.
Pathogenesis
Salutogenesis

6. Bridging the experiential wisdom of Yoga with
empirical modern medical science.
Yoga is usually found in Physical Edu
& Sports deptts of universities
We at CYTER, have it in a medical
institution since 2010
– quality of life enhancing benefits
for ~ 29,000 patients
– educating future Yoga therapists
(PGDYT, M.Phil, PhD),
– creating awareness amongst
medical, dental and nursing
students & professionals
– scientifically researching Yoga,
– 53 publications & 4 CMEs

7. “அண்டத்தில் உள்
ப�ண்ட; ப�ண்டத்தி
உள்ளேத அண்;
அண்ட�ம் ப�ண்ட
ஒன்ேற அறிந்�தா
பார்க்�ம்ேப”
- சட்ைட�ன� சித்
That which lies in the macrocosm,
lies in the microcosm.
That which lies in the microcosm
lies in the macrocosm.
When we understand truly,
both are indeed one.
- Sattaimuni Siddhar

8. Introduction
• Yoga is probably the best lifestyle ever designed
• Effective in stress induced, lifestyle disorders.
• Even a short lifestyle modification program based on
Yoga reduces risk factors for cardiovascular disease
and DM within a period of 9 days (Bijlani, 2005)
• Yogic practices may have a role in prevention and
management of diabetes & in co-morbid conditions
like hypertension and dyslipidemia (Sahay, 2007).
• Adjunct Yoga therapy may help obtain benefits at
lower doses, reducing side effects of medicines –
enhancing metabolic control & patient compliance.

9. • Increased insulin sensitivity & attenuation of –ve
relationship between weight /WC & insulin sensitivity
associated with long term Yoga practice (Chaya, 2008).
• A systematic review (32 articles from 1980-2007)
found Yoga interventions effective in reducing weight,
BP, glucose level & high cholesterol (Yang 2007)
• Improved nerve conduction (Malhothra, 2002) and
biochemical profile (Lorenzo, 2008) in diabetics.
• With no appreciable side effects & multiple collateral
benefits, Yoga is safe, simple, & can be practiced by
even ill, elderly /disabled pts (Innes &Vincent, 2007).
• Being safe, simple & economical, it should be
considered beneficial adjuvant in DM (Jain, 1993).

10. • A comprehensive review by Innes & Vincent (2007)
found beneficial changes in several risk indices,
including
– glucose tolerance, insulin sensitivity, lipid profile,
anthropometric characteristics, blood pressure,
oxidative stress, coagulation profiles, sympathetic
activation and pulmonary function, ……. as well as
– improvement in specific clinical outcomes.
• Suggested Yoga may improve risk profiles in adults
with Type 2 DM &
• May have promise for prevention and management
of cardiovascular complications in this population.

11. WHAT IS YOGA ?
• A mindful way of life
• Union (Yuj) of
– Body, emotions and mind
– Jivatma with Paramatma
• Skill in action
• Stilling the whirlpools of the mind
• Harmony of thought, word and deed
• Equanimity of mind (samatwam)
• Conscious evolution

12. ASHTANGA YOGA
Eight limbs of Patanjali’s Ashtanga Yoga
• Yama - morality for daily living
• Niyama - ethics for the self
• Asana - firm & comfortable posture
• Pranayama - control of the vital energy
• Pratyahara - sensory withdrawal
• Dharana - one pointed concentration
• Dhyana - state of meditation
• Samadhi - absorption/ oneness

14. ADVANTAGES OF YOGA
Wholistic:
• Preventive, promotive, rehabilitative, curative (?)
• Science, philosophy, art
• Involves body, mind, spirit
• Desirable +ve “side benefits”
• Simultaneous improvement in health and control
of other conditions
• Relief from stress - the main cause of Adhija
Vyadhi (psychosomatic disorders)

15. What is health?
“samadoshah samaagnishcha samadhaatu
malakriyah prasanna atmendriyamanah
swasthityabhidheeyate”
Health is a dynamic balance of the elements and
humors, normal metabolic activity and efficient
elimination coupled with a tranquil mind, senses
and contented self.
–Sushruta Samhita, Sutrasthanam, 15:41

16. • Yoga enables attain and maintain a dynamic
sukha sthanam - a dynamic sense of physical,
mental and spiritual well being.
• Yoga helps cultivation of positive health through
three integral steps *:
1. Cultivation of correct psychological attitudes,
2. Reconditioning of neuro-muscular and neuro-
glandular system – in fact, the whole body –
enabling it to withstand stress and strain better,
3. Laying great emphasis on appropriate diet
conducive to such a peak state of health, and
encouraging natural processes of elimination
through various processes of shuddhi.
* Swami Kuvalayananda & Vinekar S.K. Yogic Therapy (1963)

17. Yoga places great importance on a proper and healthy
lifestyle whose main components are:
 Achar – healthy physical activities & exercise
 Vichar – right thoughts and right attitude towards life
that are vital for wellbeing.
 Ahar – healthy, nourishing diet with adequate intake
of fresh water; balanced intake of fresh food, green
salads, sprouts, unrefined cereals & fresh fruits.
Satwic diet, prepared & served with love & affection.
 Vihar – proper recreational activities to relax body
and mind are essential for good health.

18. THE
YOGIC
CONCEPT
OF
ORIGIN
OF
DISEASE
-
Yoga
Vashishta

20. Perceived
Stimulus

21. PSYCHO-NEURO-IMMUNO-ENDOCRINOLOGICAL
CORRELATES OF STRESS, ILLNESS & HEALTH
NERVOUS
SYSTEM
ENDOCRINE
SYSTEM
IMMUNE
SYSTEM
MENTAL & PHYSICAL ILLNESS

22. PSYCHO-NEURO-IMMUNO-ENDOCRINOLOGICAL
CORRELATES OF STRESS, ILLNESS & HEALTH
NERVOUS
SYSTEM
ENDOCRINE
SYSTEM
IMMUNE
SYSTEM
HEALTH & WELLNESS

23. Illness to Wellness,
the choice is ultimately
ours & ours alone !

24. Yoga intervention:
Pathway 1
↓ Perceived stress
↓ Activation/reactivity
of sympathoadrenal
system and HPA axis
Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2 diabetes
mellitus: A systematic review. eCAM 2007; 4: 469-86.
Postulated mechanisms of yoga in diabetes mellitus

25. Yoga intervention:
Pathway 2
Vagal
stimulation
↓
Parasympathetic
activation
Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2 diabetes
mellitus: A systematic review. eCAM 2007; 4: 469-86.
Postulated mechanisms of yoga in diabetes mellitus

26. Yoga intervention:
Pathway 2
Yoga intervention:
Pathway 1
↓ Inflammatory cytokines
↓ Heart rate, blood pressure
Reduced risk for:
Type 2 diabetes and its complications
Improved coagulation
/ fibrinolytic profile
↓ Oxidative stress
↑ Endothelial function
Enhanced metabolic and
psychological profile
↑ Insulin sensitivity
↑ Glucose tolerance
Improved lipid profile
↓ Visceral adiposity
Improved mood
↓ Perceived stress
↓ Activation/reactivity
of sympathoadrenal
system and HPA axis
Vagal
stimulation
↓
Parasympathetic
activation
Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2 diabetes
mellitus: A systematic review. eCAM 2007; 4: 469-86.
Postulated mechanisms of yoga in diabetes mellitus

27. All aspects of human psycho-
physiological functioning improved
When the breath is steady,
emotions become more balanced
When the body is stilled, the mind
starts to calm down
Conscious focus on the present
moment-the NOW
Integration breath pattern with
coordinated smooth body
movements

29. Basic Yogic principles used in
management of DM
• Psychological reconditioning and development of
appropriate attitudes such as yama-niyama,
chaturbhavana, pratipaksha bhavanam etc
• Stress management through counseling, jathis
(loosening techniques), asanas (postures), kriyas
(breath-body coordination movements) and
pranayama (breath-energy harmonizing techniques).
• Helping use glucose better through physical activity:
surya namaskar, asanas, kriyas, pranayama etc
• Relaxation, visualization and contemplative practices
to induce a sense of inner calmness and wellbeing.

30. Kriya
Asana
Meditation
Pranayama
Relaxation
Yoga therapy practices
30

31. Recommended practices that are modified
as per individual needs & /abilities.
Counseling of yogic lifestyle, diet and attitudes
• Jathis & Kriyas (loosening & breath body coordination practices )
• Suryanamaskar
• Tala asana
• Trikona asana
• Parshvakona asana
• Veera asana
• Pawanmukta asana
• Nava asana
• Ardhamatsyendra/ vakra
• Viparitakarani
• Agnisara kriya
• Kapalbhati
• Chandra nadi pranayama
• Bhramari pranayama
• Pranava pranayama & dhyana
• AUM Japa with Mudras
• Kaya kriya
• Marmanasthanam kriya

33. Uninostril / alternate nostril
pranayamas
Suryanadi asana Chandranadi asana

34. Whooshing tensions away-nasarga
mukha bhastrika

35. Tension relaxation coupling: Spanda
nishpanda

36. Chakra MeditationChakra dhyana
Inhale
Exhale

37. References:
• Bhavanani AB. Yoga Chikitsa: The application of Yoga as a therapy. Pondicherry, India: Dhivyananda
Creations, 2013.
• Bijlani RL, Vempati RP, Yadav RK, et al. A brief but comprehensive lifestyle education program
based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus. J Altern
Complement Med 2005; 11:267–74.
• Chaya MS, Ramakrishnan G, Shastry S, et al. Insulin sensitivity and cardiac autonomic function in
young male practitioners of yoga. Natl Med J India 2008; 21:217–21.
• Gordon LA, Morrison EY, McGrowder DA, et al. Effect of exercise therapy on lipid profile and
oxidative stress indicators in patients with type 2 diabetes.BMC Complementary and Alternative
Medicine 2008; 8: 21.
• Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2
diabetes mellitus: A systematic review. Evid Based Complement Alternat Med 2007; 4: 469–86.
• Jain SC, Uppal A, Bhatnagar SO, Talukdar B. A study of response pattern of non-insulin dependent
diabetics to yoga therapy. Diabetes Res ClinPract 1993; 19: 69–74.
• Madanmohan, Bhavanani AB, Dayanidy G, Sanjay Z, Basavaraddi IV. Effect of yoga therapy on
reaction time, biochemical parameters and wellness score of peri and post-menopausal diabetic
patients. International Journal of Yoga 2012; 5: 10-15.
• Malhotra V, Singh S, Tandon OP, Madhu SV, Prasad A, Sharma SB. Effect of Yoga asanas on nerve
conduction in type 2 diabetes. Indian J Physiol Pharmacol 2002; 46: 298-306.
• Sahay BK. Role of yoga in diabetes. J Assoc Physicians India 2007; 55:121–6.
• Yang K. A Review of yoga programs for four leading risk factors of chronic diseases. Evid Based
Complement Alternat Med 2007; 4: 487–91.

38. Accredited with ‘A’ grade by NAAC