In Chapter 8 we discussed the ancient Yoga philosophy that breath equals life. Here in the West, many of us would be more likely to say that food equals life. In our culture, the enjoyment of food is a top priority, far more important than its nutritional value. Major celebrations are centered around eating. Fast-food joints and swanky restaurants are everywhere. Our pantries and freezers are stocked to the brim, and still we want our pizza delivered in half an hour or less. So when something goes wrong with our body's ability to efficiently process the food we eat, it can be enormously distressing.
I met Alicia, a thirty-eight-year-old artist and mother, at the Esalen Institute in Big Sur, California, while I was teaching a weekend Yoga seminar. Fifteen minutes before our class began, she was already in the room pacing the floor and expressing numerous worries about the difficulty of the class. I invited her to sit for a few minutes and get acquainted.
She explained that she had suffered from numerous digestive problems since becoming a mother seven years earlier. She had been hospitalized several times with irritable bowel syndrome (IBS) and frequently experienced acid reflux. Much to her disappointment, I recommended against the group class until I could spend some time with her, since several Yoga postures are problematic for IBS and acid reflux. We met twice more that weekend and I learned that Alicia had used a great deal of medication to treat her symptoms but had never considered trying to get to the cause of her ailments. I arranged some counseling referrals near her home and created a conservative Yoga program for her to practice on her own, similar to the one in this chapter for IBS and acid reflux. The program emphasizes calming the nervous system, gently massaging the intestines and stomach, and increasing circulation to the area. We avoided any inverted postures, prone postures (lying on the belly), or postures that put pressure on the abdominal area. When she returned home, Alicia started psychotherapy and nutritional counseling, and began practicing her Yoga routine regularly. I taught her what to avoid in a group class and how to substitute postures she could do for ones that were inappropriate for her conditions. After three months, Alicia told me that the combination of Yoga, diet, and counseling have reduced her suffering dramatically. She is elated that her IBS and acid reflux have calmed down, saying, “I'm much less anxious on a daily basis, and even my friends have noticed a difference in my moods and temperament.”
Digestive ailments such as Alicia's can be awful to deal with and difficult to talk about. Sometimes it seems easier to take a bunch of medicine and hope for the best, rather than find a way to really solve the problem. But Yoga has a long tradition of healing these disorders. In fact, Yoga philosophy contends that the abdomen is the seat of sickness and wellness; therefore many of the postures of Yoga were designed specifically to enhance abdominal health.
The Yogis' view of the significance of the digestive system is also reflected in the ancient Sanskrit word for food, anna,which has two seemingly opposite meanings: “that which nourishes you” or “that which lives on you, or kills you.”1If you suffer from digestive ailments, you know exactly how both meanings can be true. While these disorders are not necessarily caused by food, they can change your experience of eating from gratifying to unpleasant or even downright dangerous.
The digestive system consists of approximately thirty-three feet of plumbing that begins at your mouth and ends at your rectum. The best way to understand it is to take a journey through it from the point of view of a piece of food. The food enters your mouth, where digestive juices from saliva begin to break it down into more usable molecules to provide nutritients to your organs and cells. Your teeth mash up the food to make it easier to swallow and more readily available to the salivary enzymes. You then swallow the food, and it travels down the esophagus with the help of gravity and peristalsis. (Peristalsis is a contracting motion that occurs all along the digestive tract to help move food along.) The food lands in your stomach where various digestive juices break it down further. The stomach pushes the food into the duodenum, which is the beginning of the small intestine. In the stomach and duodenum, the acid is highly concentrated. Therefore these regions are the most common areas for ulcers and acid-related problems. As the food passes through the duodenum, your pancreas delivers its special digestive enzymes which help process sugars. Your liver also sends a unique chemical called bile, which is used for fat digestion. (The gallbladder stores the bile and can deliver it into the small intestine, but since your liver can do this without the gallbladder, the gallbladder is not an essential organ.)
The food continues to move along the long narrow tube that we call the small intestine. While there, the essential nutrients of the food get absorbed into the bloodstream and pass through the liver for detoxification. The sugars, carbohydrates, proteins, and fats are absorbed into the bloodstream through the small intestine, to be transferred throughout the body via the circulatory system. Whatever food does not get absorbed into the bloodstream will pass into the large intestine, which has a larger diameter than the small intestine but is significantly shorter. The job of the large intestine, also called the colon or the bowels, is to remove the extra water out of the remaining waste products so that your bowel movements will not be excessively watery. This helps your body conserve water and produce a formed stool. Both within the medical community and without, you often see the terms digestive system, intestines, and bowels used synonymously.
The most common gastrointestinal disorder is IBS. Approximately one out of six Americans experience it, and a quarter of them see a physician because of their symptoms. Though it can affect just about anybody the most common sufferers are between the ages of fifteen and forty-five, with females being affected more than males.2
IBS is a disorder of the intestines that leads to crampy pain, gassiness, bloating, and changes in bowel habits. IBS can cause you to have constipation, diarrhea, or alternate between the two. Through the years, this disorder has been called by many names, such as colitis, mucous colitis, spastic colon, and spastic bowel. These are all laypeople's terms for IBS, but none of them is really accurate. IBS can cause a great deal of suffering and anxiety, but it does not cause permanent harm to the intestines and does not lead to any serious illness. Doctors call it a functional disorder because there is no inflammation or sign of disease when the intestines are examined. It is not to be confused with ulcerative colitis, however, which is a different disorder that is more severe and involves inflammation in the colon.3
In healthy people, eating causes contractions of the colon, which may cause an urge to have a bowel movement within an hour after a meal. (This is called the gas-trocolic reflex.) In people with IBS, the urge often comes sooner and with a vengeance—accompanied by cramps and diarrhea.
Certain medicines and foods may trigger intestinal spasms in some sufferers of IBS. Sometimes the spasm leads to constipation. Chocolate, milk products, and large amounts of alcohol are frequent offenders. Caffeine may cause loose stools in healthy people, but it is more likely to affect those with IBS.
Before changing your diet, it is a good idea to keep a journal, noting which foods or patterns of eating seem to cause distress. You may want to consult a registered dietitian, who can help you make changes in your diet. And be sure to discuss your findings with your doctor.
Researchers have found that women with IBS may have more symptoms during their menstrual periods, suggesting that reproductive hormones can increase IBS symptoms. Other contributing factors may include inadequate time on the toilet to relax the bowels and lack of exercise.4Most people with IBS are able to control their symptoms through diet, exercise, stress management, and medication prescribed by their physician.
Gastroesophageal reflux disease (GERD) is the medical term for what we commonly call heartburn or acid indigestion. More than sixty million American adults experience heartburn at least once a month, and about twenty-five million adults suffer from it daily. Although GERD can be uncomfortable to the point of limiting daily activities and productivity, it is rarely life threatening.5
Gastroesophageal reflux literally means “the return of the stomach's contents back up into the esophagus.” The disorder affects the lower esophageal sphincter (LES)—the muscle connecting the esophagus with the stomach. In normal digestion, the LES opens to allow food to pass into the stomach, and closes to prevent food and acidic stomach juices from flowing back into the esophagus. Reflux occurs when the LES is weak or relaxes inappropriately, allowing the stomach's contents to flow back up.
Sri Mishra, M.D., associate professor of neurology at the University of Southern California School of Medicine and a Yoga expert, says he attributes digestive problems such as GERD to the “hurry, worry, and curry” syndrome. In other words: stress, anxiety, and the wrong foods. Doctors recommend lifestyle and dietary changes for most people with GERD. Certain foods and beverages, including chocolate, fried or fatty foods, coffee, and alcoholic beverages may open the LES, causing reflux and heartburn. In addition, some foods can irritate a damaged esophageal lining, such as citrus fruits and juices, tomato products, and pepper. All of these problem foods should be avoided. Decreasing the size of portions at mealtime may also help control symptoms. Always avoid lying down immediately after eating any meal or snack. Eating meals at least two to three hours before bedtime may lessen reflux by allowing the acid in the stomach to decrease and the stomach to empty before going to bed.
Studies show that cigarette smoking weakens the LES. Therefore, stopping smoking is an important way to reduce GERD symptoms. In addition, being overweight often worsens symptoms, and many overweight people find relief when they lose weight.
Stress is a major contributor to heartburn. People usually find that when they reduce their stress through Yoga postures and relaxation techniques, their heartburn decreases. The right Yoga postures can also soothe the abdominal area and help prevent GERD.
According to the Bihar School of Yoga, the solution to digestive problems lies in elevating the eating process from a mechanical habit to a conscious and pleasurable act, in which moderate quantities of simple pure food are eaten with full awareness. This is an ideal unlikely to be met at all times, especially in our fast-paced, eat-on-the-run society. Fortunately, even a small improvement in your diet, combined with a Yoga practice and some stress relief, will likely improve your digestive problems.
Roger was a 42-year-old money manager with a high-profile, high-maintenance client base—and a high-stress, fast-track lifestyle to go with it. He burned the candle at both ends, and ate indiscriminately. He dealt with his chronic symptoms of heartburn by consuming massive amounts of over-the-counter antacids. Because he remained slender regardless of his diet, he rationalized that he did not need to exercise and bragged that he never saw a doctor. His wife asked him to try Yoga but he was too busy and was sure he didn't need it.
One afternoon, after a weekend of little sleep, a lot of spicy food, and the loss of one of his major clients, his heartburn got so bad that his medications did not help and he feared he was having a heart attack. He described the pain as though “someone was shoving the heel of their foot into his heart.” Because he had no doctor to call, his wife took him to a crowded emergency room where he truly thought he was going to die. After being treated with stronger medications and subjected to numerous tests, he was assured that he was not having a heart attack. The treating doctor cautioned Roger, however, that unless he wanted to repeat this ordeal, he had to change his diet and lifestyle, and recommended Yoga. This time he listened. Referred by his wife and one of his clients, he came to me for Yoga therapy. He felt tremendous improvement after only one session in which he learned a routine similar to the one in this chapter. He went home with it on audiotape and the suggestions that he avoid spicy foods and stop eating at least three hours before sleeping. Happily, Roger made a quick turn-around. After three months he was off of his medicines completely and much calmer in his work and home life.
The ancient Yogis use the image of agni— Sanskrit for “fire”—to understand the power of digestion. In this theory digestive disorders reflect some imbalance in the internal fire. With GERD and IBS, the digestive fire is too strong, and these are called hyperagni conditions.6
When using Yoga to treat hyperagni conditions, such as heartburn and irritable bowel syndrome, we need to soothe the digestive system, not strain it. Dr. Mishra encourages gentle folding and twisting postures for heartburn and IBS. He also recommends relaxation and meditation for these ailments, since stress is such a large factor.
If you take a group Yoga class, be sure you are with a qualified instructor.
Talk with the instructor before the class, to learn which postures you may need to avoid.
Try to establish the habit of early morning evacuation of the bowels. It is best to wait until after breakfast, when the gastrocolic reflex should aid the process of evacuation.
Improve your diet, making sure to include plenty of fiber and fluids and staying away from foods that seem to aggravate your condition.
Do regular cardiovascular exercise such as brisk walking, swimming, or cycling, but not right after eating. Your circulation is needed to digest your food, and should not be competing with the muscles during exercise.
Try to develop self-awareness while eating, a fundamental Yoga practice.
Be regular with meal times and eat slowly. Try to extract maximum pleasure from each morsel rather than unconsciously stuffing yourself.
Don't eat when you are anxious or tense.
Practice the Yoga therapy routine from this chapter. Start with two or three days a week, working toward five or six days a week.
Avoid foods and beverages that affect the LES or irritate the esophagus lining, including fried and fatty foods, chocolate, alcohol, coffee, citrus fruits and juices, and tomato products. (Some people with heartburn can tolerate these foods. Use your own judgment and pass up the ones that activate your symptoms.)
Lose a few pounds if you are overweight.
Don't smoke.
Avoid lying down for two to three hours after eating.
Yoga for Irritable Bowel Syndrome and Heartburn
This program is similar to the one I gave to Alicia for her IBS and heartburn. It takes approximately fifteen minutes and should be practiced using Focused Breathing. Try to inhale and exhale through your nose, pausing briefly after the inhalation and the exhalation. Ideally, practice the routine twice a day until your condition improves, then practice it once a day. When you feel your condition has subsided, you may cut down to three times a week.
Supported Easy Posture
This opening posture increases the flexibility of your hips and spine, and prepares you for more advanced sitting postures. A blanket adds comfort and supports the natural curves of your spine.
Sit on the floor with a folded blanket under your hips for comfort. Cross your legs at your ankles, left leg on top, right leg on the bottom. (Alternate from day to day.)
Press your palms down on the floor while you move each foot toward the opposite knee as far as possible. Ideally, your right foot will be underneath your left knee, and your left foot underneath your right knee, but don't force it.
Bring your head and spine up nice and tall with a slight lift in your chest until your ear, shoulder, and hip are in vertical alignment. Place your hands comfortably on your knees with your elbows bent. Stay in this posture for 8 to 10 breaths.
This exercise gently compresses and stretches your abdomen. The use of the soft sounds ah and ma soothe your belly The sequence also relaxes and gently stretches your lower and upper back, neck, and shoulders.
Kneel upright with your knees at hip width and your arms at your sides.
As you inhale, raise your arms from the front up and overhead until your arms and ears are in alignment and your palms are facing in.
Exhale, using the sound ah as you bend forward, moving your hips back toward your heels and placing your head, arms, and palms on the floor. Sit back only as far as comfortable.
As you inhale, move your chest and head forward, gently arching your back, and raise your head slightly.
As you exhale, use the sound ma and sit back again as in Step 3.
As you inhale, raise up to the upright kneeling position with your arms overhead as in Step 1. Repeat Steps 1 to 5 in a continuous flow 4 to 6 times. Be sure to use the sounds ah and ma on the exhale.
This posture gently compresses and twists your stomach and intestines, promoting better circulation.
Sit sideways on a chair with the chair back to your right, feet flat on the floor, and heels directly below the knees.
Exhale, turn to the right, and grasp the sides of the chair back with your hands. If your feet are not comfortably on the floor, place a folded blanket or a phone book under them.
As you inhale, bring your back up tall, as if you were trying to touch the ceiling with the top of your spine.
As you exhale, twist your torso and head farther to the right.
Return to the starting position. Repeat the twist, gradually twisting farther with each exhalation for 3 breaths, but do not go beyond your comfort zone. On the last repetition, hold the twist for 4 to 6 breaths.
Repeat the same sequence on the opposite side.
Sitting Fold
This posture gently compresses and stretches your abdominal area. It also gives a nice stretch to your hips and lower back.
Sit sideways on a chair with the chair back to your left, feet flat on the floor. Place your heels directly below your knees. Put your hands on your thighs with your fingers facing forward, near your knees.
As you exhale, bend forward from your hips and slide your hands forward and down your legs. Hang your head and arms down and relax briefly in the folded position.
As you inhale, roll your torso, head, and arms back up to the initial seated position.
Repeat slowly 4 to 6 times.
This twist gently compresses and twists your stomach and your intestines, promoting better circulation.
Lie flat on your back with your knees bent and feet on the floor at hip width. Move your arms out from your sides in a T, aligned with the tops of your shoulders, palms down.
As you exhale, slowly lower your bent legs to the right side; then turn your head to the left. It is important to keep your head on the floor.
As you inhale, bring your bent legs back to the middle. Exhale, while slowly lowering your bent legs to the left side. Turn your head to the right.
Alternating sides, repeat slowly 3 times to each side. Hold the last twist to each side for 6 to 8 breaths. Return your feet to the floor in the bent knee position.
Knees to Chest
This gentle stretch compresses your stomach and your intestines and relieves abdominal gas. It also compensates your lower back after a twisting posture.
Lie on your back with your knees bent, feet on the floor at hip width. Bring your bent knees toward your chest and hold on to the top of your shins, just below your knees, one hand on each knee. If you are having knee problems, hold the backs of your thighs, under your knees.
As you exhale, draw your knees toward your chest. As you inhale, move your knees a few inches away from your chest, rolling your hips to the floor.
Repeat 3 times, and then stay in the most folded position for 6 to 8 breaths.
Corpse (Supported) with Belly Breathing
This is the classic posture for relaxation of the body and mind. It gives a gentle opening to your chest and brings circulation to the gastric area and reduces acidity.
Lie flat on your back with your arms at your sides, palms up. Place blankets under your upper back to gently open your chest. Place blankets or pillows under your head and neck for support. Cover your eyes if you like. If the supported position doesn't feel right to you, lie flat on your back in the classic Corpse.
Practice Belly Breathing, gradually increasing the length of your exhalation until you reach your comfortable maximum. Repeat for 8 to 10 breaths.
Relaxation or Meditation
Stay in the Corpse (Supported) position.
Practice Yoga Nidra or Focused Meditation for at least five minutes.
Breathing Break
Once per day, use Victorious Breath or Belly Breathing with long exhalation for three to five minutes.