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Summary

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Sixty patients with  Diabetes 2, and 20 healthy people underwent scientific study for 3 months. The effect of  yoga  has been studied on parameters such as weight,  cholesterol level,  blood sugar  and the  serum fructosamine. Following practice, a significant decrease in  blood sugar,  fructosamine  and  cholesterol level  in patients with  Diabetes 2  has been observed.

Foreword

the  yoga  is an ancient Indian system of exercises and way of life, which gives a positive impact on healthy people, as well as people with health problems.

Stress plays an important role, affecting the health of people, including people suffering from  diabetes 2. Stress stimulates the production of stress hormones by the adrenal cortex - which, in turn, increases the  blood glucose level  (Bijlaniand, Manchanda, 1984). Obesity also plays an important role in  pathogenesis of diabetes 2. Therefore the  yoga, which effectively reduces the effects of stress, helps control physical condition, including diseases such as diabetes.

Sahay (Sahay, 1986) demonstrated that  asanas  as  Dhanurasana  and  Ardha Matsyendrasana, practiced for some time, can control the  diabetes 2. These two postures are simple to perform, and they significantly reduce the  blood glucose level  after meals or  with an empty stomach. They help maintain good health, reduce the amount of medication needed, and the number of complications such as infection and ketosis.

The serum concentration of fructosamine in the blood reflects the  fasting blood glucose level  during the last three weeks before the exercises. The  glycated protein  is also used as a measure - (glycosylated serum protein), which is an indicator of diabetes control. The normal fructosamine level is below 2 mmol/l. If the level of fructosamine is increased and the patient has a normal blood glucose level, it is assumed that during the last three months he had glucose fluctuations outside the normal range.

This study was conducted to examine the effectiveness of  yoga poses  for people with  diabetes 2.

Methods and materials

The control group: 20 people of different ages and genders  without diabetes  were chosen as a control group. We studied their  plasma glucose and fructosamine levels. All followed a vegetarian diet.

The group of patients with  diabetes  : 60 patients, attending a diabetic clinic, were chosen to complete this group. The selection criteria were as follows:

1. patients with a  fasting blood sugar  of 126 mg/dL or more, and the post-meal level of 200 mg/dL or more (The Expert Committee, 1997)

2. in all patients the  diabetes  was diagnosed 1-2 years ago.

3. the patients had not practiced exercises. During the study, no other exercise, except  asanas, was practiced.
    

The groups of 60 diabetic patients were divided into three groups :

• Group 1  : exercising only the  yoga-therapy  - 20 people

• Group 2  : exercising the  yoga-therapy  plus a diet - 20 people

• Group 3  : only diet - 20 people
   

Diet  : All patients, by default, adhered to a vegetarian, sugar-free diet. Special measures have been taken regarding groups 2 and 3, where the diet has been developed in detail, on the following points:

• Calorie level: 1600-2500 calories recommended to take, depending on age, sex, weight and type of activity.

• The percentage of the meal was:

  • 55% for complex carbohydrates and grains

  • 35% for protein

  • and 10% fat.
     

The level of glucose in plasma was determined by the method  GOD-POD  (Miskiewicz 1973 Carey 1974). the  serum cholesterol  was checked by the method of  Leffler and McDonalds  (1963), the  serum fructosamine  was controlled by the Johnson method (1982).
 

The levels of  glucose, cholesterol and fructosamine  were studied monthly for three months.

Asanas  : Dhanurasana, Ardha Matsyendrasana, Sirsasana. Those  asanas  were practiced regularly, morning and evening for 2-5 minutes for each asana, followed by  Savasana  for 20 minutes.

Statistical analyzes  : All data are presented as the mean and one standard deviation. Factor "t" was used to detect the differences between the control group and the yoga group. The difference p<0.05 was considered statistically significant.

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Results

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The study involved 32 men and 28 women. 20 healthy people of the same age and sex were also tested. All patients were between 40 and 70 years old.
 

The control group  :

• The average level of  glucose  was 78.8 + -20.17 mg/dL (4.33 mmol/L) 
  and the average level of  fructosamine  was 1.71 mmol/L + - 0.608.
   

Study groups: glucose levels  :

• Group 1  :  only used the  yoga therapy. 
  The average level of  glucose  was 173.05 + -39.54 mg/dL (9.61  mmol/L) 
  after three months it became 132.94 + -40.16 mg/dL (7.33  mmol/L). 
  The level of  fructosamine  was from  3.00  +-0.495mg/l at start
  at the end of three months it was equal to  2.62  mmol / l + - 0608.

• Group 2  : used the  yoga-therapy  and a strict diet
  The level of  glucose  was 232.91 + -55.30 mg/dL (12.8  mmol/L)
  after three months it became 152.75 + -34.2 mg/dL (8.44  mmol/L) 
  The level of  fructosamine  was from  3.00  +-0.495mg/l at start 
  at the end of three months it was equal to   2.29  +-0.528mg/L.

• Group 3  : Followed a strict diet and did not practice  yoga 
  The level of  glucose  was 163.72 + -24.92 mg/dL (9.05  mmol/L) 
  after three months it became 151.54 + -35.45 mg/dL(8.38  mmol/L) 
  the level of  glucosamine serum  2.82  mmol/l + -0.453 
  fell until  2.78  mmol / L + - at the end of the study.
   

cholesterol level  :

• Group 1  : had practiced only the  yoga therapy. 
  The average level was 222.23 + -53.32 mg/dL  (12.3  mmol/L)
  after three months it decreased to 203.88 mg/dL (11.27  mmol/L)

• Group 2  : had practiced  yoga-therapy  and a strict diet
  The mean level was 253.67 + -49.10 mg/dL  (14.05  mmol/L)
  after three months it dropped to  203.80mg + -37.21mg/dL  (11.27  mmol/L)

• Group 3  : followed a strict diet and did not practice it  yoga
  The average level was 220.54 + -56.07 (12.22  mmol/L)
  after three months it fell to 220.54 mg/dL (12.22  mmol/L - the same level)
   

weight loss  :

• Group 1  : had only practiced  yoga-therapy
  he went from  65.57  +/- 12.15 kg at  63.29  +/- 10.96kg

• Group 2  : had practiced  yoga-therapy  and a strict diet
  he went from  58.70  +/- 11.26kg  to  56.70  +/- 10.77kg

• Group 3  : followed a strict diet and did not practice it  yoga
  he went from  67.18  +/- 8.75 to  66.13  kg +/- 9.49 kg
   

Discussion

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the  non-insulinodependant diabetes  (diabetes II) is a multifactorial disease. In addition to genetic data, obesity and physical inactivity, stress is an important cause, caused by conflicts and dissatisfaction in life. Most patients talked about emotional conflict for 2-3 years before the development of diabetes. Under the influence of stressful conditions pancreatic beta-cells are activated by the following factors  (Bijlani et al., 1984, Ward et al., 1984):
 

• During the  stress, the generation of catecholamines from the adrenal glands increases, which activates adenylate cyclase, leading to intracellular accumulation of AMP  cyclic (adenosine monophosphate), resulting by the  release of insulin.
   

• At a  chronic stress  an increase in the  production of adrenocorticotropic hormone, which leads to elevated levels of corticosteroids, which then causes hyperglycemia.
   

• Permanent emotional stress leads to  increased hormonal levels  in children and adults. The combined effects of any or all of these elements lead to hyperglycemia, which, in turn, leads to the production of insulin. In addition stress leads to the destruction of pancreatic beta-cells, which accelerates the development of diabetes in adults (Wardetal., 1984).
   

• Regular yoga practice for three months has been noted to improve biochemical parameters. Much research has been conducted to study the effect of yoga on diabetes (Udupa et al., 1973, Rugmini et al, 1973). Early studies analyzed the effect of  pranayama  and  asanas  on the body, and the results showed a positive effect.  BK Sahay  (Sahay BK et al., 1986) found in their research that  Dhanurasanaet  Ardha Matsyendrasana  were most effective in controlling fasting blood glucose and postprandial blood glucose.
   

• We found in our study that those who practiced  yoga  only (Group 1) recorded a significant decrease in  fasting glucose level. The average level of  fructosamine, which is a measure of blood sugar control for 3 to 4 weeks, also decreased due to the  yoga practice. And so, our study confirms the above mentioned Udupi (Udupa et al.) and Rugminiet (Rugminiet et al.) study.
   

• We have also found that where the practice of  yoga  alone, or yoga combined with a strict diet, a significant and clear reduction in the  serum glucose and fructosamine  has been observed. In the 20 cases where only the diet was used, a slight drop in the levels of  glucose and fructosamine  has been observed. Therefore, this study confirmed the benefits of  yoga in diabetes control.
   

• In our study, a reduction in body weight was observed in all groups (1,2,3). On the other hand the  cholesterol  decreased only in groups practicing  yoga. These observations correspond to the study of Santa Joseph (1981). Therefore, it is obvious that the  yoga therapy  plays a role in reducing  cholesterol level  and weight loss. Food also plays an important role.
   

• The exact mechanisms by which  yoga poses  help in the treatment of diabetes remain unknown.

However, we know that the  yoga practice  relieves stress, which reduces the production of regulating hormones  such as the  cortisone. A fact which also does not require proof is that the  yoga  has a positive effect on  kinetics of insulin, which prevents beta-cell depletion (Blumenthal et al., 1991). 

the  yoga  participates in the gradual change of balance in the direction of  parasympathetic dominance, following the reduction of sympathetic activity. This modulation of the autonomic nervous system can lead to positive effects due to the influence of  yoga practice  on autonomic functions (Leo, 1970), but also by the limbic system and the higher centers of the central nervous system (Anand et al., 1961).

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Authors: Khare, KC, Jane Deepak (Mimamsa Yoga, January 1999)
Translated by: Aleksei Papin