Integrative Yoga Therapy: A Data-Driven Approach to Diabetes Management

Diabetes mellitus, a chronic metabolic disorder, has reached epidemic proportions globally. Conventional treatments, while effective, often come with side effects. This has led to a growing interest in complementary therapies, especially yoga, which offers a holistic approach to health.

Type 2 diabetes is a common lifestyle disorder caused by insulin resistance with relative or absolute insulin deficiency, resulting in chronic hyperglycemia and various cardiovascular complications. Globally, according to the International Diabetes Federation diabetes atlas (eighth edition, 2017), in 2017 there were roughly 425 million people with diabetes, a figure that is projected to increase to 629 million by 2045. Sedentary habits and unhealthy dietary patterns are the major risk factors for the development of various lifestyle disorders, including diabetes. Psychological stress also increases the risk and severity of diabetes. Lack of physical activity was found to increase the risk of diabetes by 3 times and the risk of coronary artery disease by 2.4 times.

Dietary control and exercise are established treatment modalities in patients with type 2 diabetes and other lifestyle disorders, including obesity, hypertension, and dyslipidemia. Urbanization, the intake of calorie-rich food, use of various machines, less open space for exercise, a busy modern lifestyle, and lack of motivation reduce the likelihood of adherence to dietary control and exercise as a management option in people with diabetes. Moreover, individuals with diabetes have a reduced capacity to engage in exercise because of overweight, physical unfitness, sedentary lifestyle, limited joint mobility, and other diabetes-related complications, including cardiovascular disease, peripheral neuropathy, and diabetic foot problems. Several studies have shown that poor adherence to diet and exercise programs were major limitations in the implementation of non-pharmacological treatments of diabetes.

Yoga therapy is relevant for wellness, as well as for illness. The latest scientific evidence suggests the potential role of yoga-based lifestyle modifications in the management of type 2 diabetes and its associated risk factors. It is suggested that psychoneuro-endocrine and immune mechanisms have holistic effects in diabetes control. Parasympathetic activation and the associated anti-stress mechanisms improve patients’ overall metabolic and psychological profiles, increase insulin sensitivity, and improve glucose tolerance and lipid metabolism. Yoga practices such as cleansing processes, asanas, pranayama, mudras, bandhas, meditation, mindfulness, and relaxation are known to reduce blood glucose levels and to help in the management of comorbid disease conditions associated with type 2 diabetes mellitus, resulting in significant positive clinical outcomes.

Yoga: More Than Just Poses

Yoga, often misunderstood as mere physical exercise, encompasses a comprehensive system of practices including physical postures (asanas), breathing exercises (pranayama), meditation, and relaxation techniques. When integrated into diabetes management, it becomes a powerful tool for improving overall well-being.

MECHANISM OF BENEFITS AND EVIDENCE FROM CLINICAL TRIALS

Yoga is based on the principle that the mind and body are intimately related. It improves flexibility, muscle strength, blood circulation, and oxygen uptake. Yoga exhibits many health benefits, such as improving physical fitness, relaxation, and awareness of self. Various lifestyle disorders, including diabetes, can be effectively addressed by the practice of yoga, given acceptably high levels of adherence. Yoga practice improves an individual’s discipline regarding food and exercise, thereby helping to modify patient-related reluctance that results in the underutilization of exercise as a treatment modality.

Diabetes is a chronic metabolic disease that adversely affects quality of life. Psychological stress and negative mood have a bidirectional effect on the control of diabetes. Stress increases the risk and severity of diabetes by stimulating the hypothalami-pituitary-adrenal (HPA) and sympathetic axes and parasympathetic withdrawal, resulting in increases in the levels of cortisol, epinephrine, norepinephrine, growth hormone, glucagon, catecholamines, prolactin, leptin, and neuropeptide Y. Chronic activation of the HPA axis is associated with poor control of diabetes and complications such as diabetic neuropathy. An increased level of inflammatory cytokines results in insulin resistance in patients with type 2 diabetes. Chronic psychological stress can result in insulin resistance, hypertension, and an increased risk of cardiovascular events. Yoga effectively reduces stress, thereby helping in control of diabetes. Yoga practice in healthy volunteers was found to result in increases in wellness; reductions in stress, depression, and anxiety; improvements in the physical, psychological, and social domains and total quality of life; a feeling of balance; and a new outlook on life. Yoga practice results in significant improvements in the scores of various psychological assessments, including satisfaction and worry. Yoga also results in improvements in physical activity, behavioral changes, and dietary practices, in addition to its effects on relaxation and stress management.

Abdominal stretching during yoga exercises is believed to result in the regeneration of pancreatic cells. The various postures during yoga practice help to improve the sensitivity of cells to glucose, thereby improving insulin secretion, and increase the blood supply to the muscle and muscle relaxation, thereby improving glucose uptake. Improvements in hormonal homeostasis also improve glycemic control in people with diabetes mellitus. Yoga therapy also results in immunomodulator by reducing pro-inflammatory responses and improving immune function.

The various health benefits of yoga therapy are related to changes in the level of various hormones and neurotransmitters: joy and euphoria during yoga therapy are due to an increase in endorphin, serotonin, and dopamine levels; improvements in arousal are due to increased arginine-vasopressin levels, which reduce the gamma-aminobutyric acid (GABA)-ergic inhibition of the supra optic area of the hypothalamus; its calming effect is due to melatonin; the ecstatic and blissful feelings that arise during yoga are due to lateral hypothalami stimulation; and the decrease in spatial orientation and out-of-body experiences during meditation are due to decreased levels of GABA and increased levels of N-acetylaspartylglutamate and 5-methoxydimethyl tryptamine (from pineal enzymes).

Yoga practice is thought to have “beyond the drug action” which refers to the potential to induce stem cell trafficking from the bone marrow to the peripheral blood, which may lead to tissue regeneration by replacement and recruitment of cells differentiated from the stem cells. However, this mechanism needs to be further explored.

Yoga asana also modulate gene expression and increase muscle activity, strength, endurance, flexibility, and balance, resulting in favorable effects on body weight, adiposity, dyslipidemia, and insulin resistance.

Yoga reduces oxidative stress, as demonstrated by reductions in serum malondialdehyde, interleukin 6, and leptin levels, and improvements in adiponectin levels. Yoga therapy increases the number of insulin receptors and increases the proportion of receptor binding in patients with diabetes. It improves insulin kinetics by reducing fasting insulin levels, shifting the peak insulin level to the left, and by normalizing the insulin-to-glucose ratio. It also reduces levels of free fatty acids, indirectly indicating improved insulin sensitivity or reduced insulin resistance. Yoga and various breathing exercises were found to lead to improvements on lung function tests. Yoga improves cell-mediated immunity, as demonstrated by improvements in the lymphocyte migration test in people with type 2 diabetes.

Yoga also prevents the development of diabetes in high-risk individuals. It was found to improve symptom scores in people with diabetes. It also results in reduction of fasting blood sugar, postprandial blood sugar, hemoglobin A1c, and anti-diabetic drug requirements, suggesting improved glycemic control. Yoga therapy results in a reduction in body weight, body mass index, the waist-to-hip ratio, body fat percentage, body fat mass, and skin fold thickness, thereby increasing lean body weight.

Yoga reduces levels of triglycerides, low density lipoprotein cholesterol, and free fatty acids, and improves high density lipoprotein cholesterol levels. It induces discipline regarding food and exercise. The regular practice of yoga improves exercise tolerance, and it has been shown that yoga improved performance on the treadmill test from eight metabolic equivalents (METS) to 12 METS and resulted in the postponement of the anaerobic threshold. Some studies have shown that there were reductions in both systolic and diastolic blood pressure in persons practicing yoga.

The regular practice of yoga reduces the risk of diabetes-related complications. Cardiac autonomic dysfunction is believed to be a cause of sudden death in patients with diabetes mellitus. Clinical studies have shown that regular yoga practice improved cardiac autonomic function independently of glycemic control and reduced the risk of cardiovascular events. Yoga therapy also stabilizes the coagulation profile, thereby improving nerve conduction and cognitive function in patients with diabetes.

The Science Behind Yoga and Diabetes

Blood Sugar Control: Research indicates that regular yoga practice can significantly lower blood glucose levels. Studies have shown reductions in fasting blood sugar and HbA1c (a marker of long-term blood sugar control) among diabetic patients.
Weight Management: Obesity is a major risk factor for type 2 diabetes. Yoga has been shown to aid in weight loss and maintenance by increasing metabolic rate and reducing appetite.
Reduced Stress: Diabetes is often accompanied by stress, which can exacerbate the condition. Yoga's relaxation techniques have been proven to lower cortisol levels, the stress hormone, leading to improved blood sugar control.
Improved Cardiovascular Health: Heart disease is a common complication of diabetes. Yoga has been linked to reduced blood pressure, cholesterol levels, and risk of heart attack.
Enhanced Quality of Life: Beyond physical benefits, yoga improves mental health, reduces anxiety and depression, and enhances overall quality of life for people with diabetes.

The Integrative Approach

The true power of yoga lies in its holistic approach. It addresses not just the physical symptoms of diabetes but also the psychological and emotional aspects. By combining physical postures, breathing exercises, and meditation, yoga helps individuals develop a deeper connection with their bodies and minds, leading to better self-management of their condition.

While more research is needed to fully understand the mechanisms behind yoga’s benefits, the existing evidence strongly supports its role as a complementary therapy for diabetes. By incorporating yoga into a comprehensive diabetes management plan, individuals can experience improved health outcomes and a better quality of life.

Adapted from NCBI ArticlePMC6145966