Late in the year 2001, the U.S. Centers for Disease Control and Prevention (CDC) released a report that should have been front-page news. It was an alarming account of the dramatic and parallel rise in the incidence of both obesity and diabetes. Calling these two health concerns “twin epidemics,” CDC Director Dr. Jeffrey P. Koplan warned, “If we continue on this course for the next decade, the public health implications in terms of both disease and health care costs are staggering.”1 Dr. Koplan called on the health-care industry, along with schools and communities, to intensify efforts to prevent and treat these epidemics. Maybe the most striking aspect of the report was the admission that both diabetes and obesity are largely preventable through proper diet and exercise, yet over 60 percent of Americans are overweight and about fifteen million of us have diabetes. This means that more than half of the population is affected, and many people will die prematurely owing to their own unhealthy lifestyles.
Diabetes is a disease of the endocrine system, the system in our bodies responsible for producing and distributing hormones. It is caused by a lack of insulin, a hormone produced by the pancreas, or the ineffective action of insulin in the body. In type 1 diabetes, the pancreas stops producing insulin and the person with this condition must take insulin daily to stay alive. In type 2 diabetes, the pancreas is still producing insulin but the body is resistant to the insulin and does not use it effectively. In both types of diabetes, the lack of insulin activity results in high blood sugars and all the complications of diabetes.
Persons with type 1 diabetes always need to take insulin. In addition, proper diet, exercise, and weight control are an important part of controlling the diabetes and preventing complications. The major complications of diabetes are eye disease, foot problems, heart disease, and kidney problems.
Type 2 diabetes can often be treated by proper diet, exercise, and weight control alone. When lifestyle changes don't work well enough to bring the blood sugar under control, oral medications are prescribed. Some persons with type 2 diabetes will need to take insulin when the oral medications are not working adequately. One of the biggest risk factors for type 2 diabetes is obesity, which is caused by a complex relationship of genetics and behavior. Obesity can be partially caused by endocrine system problems, such as incorrect levels of thyroid hormones, insulin, or sex hormones. For this reason, we are covering obesity here along with the endocrine system. Keep in mind that most people who are overweight do not have a problem with their endocrine system; but if their weight problem continues, it's possible they eventually will have an endocrine problem—diabetes.
The endocrine system is made up of glands throughout the body that secrete hormones—chemical messengers that regulate bodily processes such as growth, metabolism, and sexual development. The endocrine system keeps our body in balance through the function of hormones. The master gland is the hypothalamus, a tiny cluster of brain cells that receives messages from the body and transmits signals to the pituitary gland. The pituitary gland makes hormones in answer to the body's needs. These pituitary hormones signal other endocrine organs, such as the adrenal gland, thyroid gland, ovaries, and testes, to produce the hormones needed for good health. The ovaries (in females) and testes (in males) receive the messages from the pituitary and in turn produce the sex hormones—estrogen and progesterone in women, testosterone in men.
The pancreas is another gland that affects digestion. It lies behind the stomach. This gland secretes digestive juices that break down fats, carbohydrates, proteins, and acids. Within the pancreas are specialized cells that secrete hormones— glucagon and insulin—that together regulate the level of glucose in the blood. If the pancreas fails to produce insulin or secretes it in low quantities, the result is diabetes.
In diabetes, your body does not properly produce or use insulin, a hormone needed to convert sugar, starches, and other food into energy needed for daily life. Type 1, in which patients require daily insulin injections to stay alive, makes up only 5 to 10 percent of diabetes cases. Type 2 diabetes is much more common. It is type 2 diabetes that the CDC reports is nearing epidemic proportions, and doctors believe it is due to the rise in obesity, sedentary lifestyles, and unhealthy diets.2
Controlling your diet is crucial when you have diabetes. Lowering fats, sugar, and alcohol and eating healthy amounts of whole grains, vegetables, and protein are the general guidelines. The book Diabetes Meal Planning Made Easy: How to Put the Food Pyramid to Work for Your Busy Lifestyle,sanctioned by the American Diabetes Association, shows you how to create a nutritional plan that works (see Resource Guide).
Exercise is one of the best ways to improve your health if you are diabetic, helping you lose weight and normalize blood sugar. However, you need to be careful about your blood sugar during exercise. It helps to have eaten relatively recently before exercising and to test your blood before and after exercise, especially if you take insulin. Most important, exercise should be done regularly, several days a week.
If you have obesity and diabetes simultaneously, healthy weight loss through diet and exercise can cause type 2 diabetes to disappear entirely. If you are steadily losing weight and staying healthy, be sure to get tested regularly by your doctor. Your diabetic medications will probably be lowered and may eventually be completely discontinued. If you have type 2 diabetes, be sure to read Yoga for Type 2 Diabetes and Obesity.
Being overweight is a disheartening predicament that over half of Americans find themselves in. Doctors now determine whether and how much a person is overweight by figuring his or her body mass index (BMI). This measure is the ratio of your height to your weight (see Appendix C). Percentage of body fat is another reliable indicator of whether or not you are at a healthy weight, and some experts believe it may be a more accurate gauge than BMI.3 One advantage of BMI is that it's easy to figure on your own with the help of a calculator, whereas you may not be able to get an accurate body fat percentage without seeking professional help. The bottom line is that weight, body fat, and BMI are all good tools for helping you determine where you lie on the healthy-weight spectrum. You should use them to help in your self-evaluation, but also consider how you feel, how many illnesses you tend to get, your energy levels, and how you look in the mirror.
Obesity has immense health risks. Heart disease, high blood pressure, stroke, and diabetes vastly increase with obesity, and the musculoskeletal system can be affected, most commonly by lower back pain, knee pain, arthritis, and carpal tunnel syndrome.
The best way to approach obesity is through a threefold plan of attack: Get your diet under control, find the amount and types of exercise that work for you, and find strategies that can help you maintain your resolve. These may include stress management, nutritional counseling, keeping a journal of your eating and exercise patterns, psychotherapy, accountability to another person, and mind–body practices that can increase your self-awareness and sense of personal power. See the Resource Guide for some diet book recommendations. If you are seriously overweight, be sure to read Yoga for Type 2 Diabetes and Obesity.
The key to controlling body weight and diabetes is lifestyle. We all need to develop the discipline to exercise regularly and choose healthy foods. One of the greatest benefits of Yoga is that it helps you develop self-control. As you practice Yoga, you become more skilled at concentrating, and you learn to manage your thought processes. This can increase your willpower to make changes, even if they are difficult or unpleasant, such as cutting back on sweets.
People are often waylaid from their best intentions for diet and exercise by stress. Once you have a regular and reliable means of controlling stress, you can count on more success with your self-discipline. As we've discussed throughout this book, Yoga is one of the most effective stress busters available. Yoga is also known for increasing general feelings of well-being. When you're happy and content, it is easier to make choices that contribute to your health rather than your momentary pleasure.
Controlling stress can also have very concrete benefits in controlling diabetes. A landmark study of people with diabetes released in 2002 showed that stress-management techniques, including relaxation and breathing exercises, can significantly reduce the average glucose level, the important factor in diabetes. The effect was so great that the researchers compared it to the change they would expect to see from some diabetes-control drugs, and they concluded that “Managing stress can significantly improve a patient's control of their diabetes.”4
Yoga is an ideal form of exercise if you are overweight. It is gentle and doesn't push you beyond your limits. It can be successfully practiced even by overweight individuals who may have given up on exercise because it was too difficult. Yoga does not strain the heart and when carefully practiced, has a very low risk of injury.
For people with diabetes, Yoga is a healthy form of exercise because it does not burn calories and bring down blood sugars as rapidly as more vigorous exercise such as jogging or aerobics. Because Yoga is usually done indoors in places where there is access to food or drinks, it is more likely that you will have some food available for treatment if your blood sugar should drop drastically.
Lydia was 46 and had been healthy all her life, but at age 42 she went through a difficult divorce and a long bout of depression. She gave up exercise and gradually her diet deteriorated, leading her to put on weight. Eventually her doctor diagnosed type 2 diabetes and obesity, put her on medication, and advised her to improve her diet. Her symptoms improved but she still suffered from fatigue, depression, and irritability, so Lydia's physician referred her to me. I worked closely with Lydia on her diet, increasing whole grains, beans, and vegetables and reducing fats, sweets, and alcohol. For exercise, she began walking regularly and practicing a daily Yoga routine similar to the one in this chapter. Her symptoms improved after only two weeks, and after three months she had lost sixteen pounds and her glucose levels had significantly decreased, so her doctor cut her medication dose in half. Lydia may continue to need medication for her diabetes, but she is much healthier and reports feeling great.
Being overweight can take a major toll on our self-esteem, reminding us of our perceived failures and lack of ability to change. One of the greatest advantages of Yoga is that it helps you see yourself in a different way. You can leave behind your disappointing image of yourself to discover your inner strength and the ability to make real changes in your life. Yoga is a gentle way to bring a balanced attitude to all aspects of life. If you commit to a regular practice and embrace all the principles of Yoga as explained in this book, you can achieve permanent weight loss, decrease or eliminate symptoms of diabetes, and rebuild your self-esteem to embrace life with confidence.
Be informed about diabetes and/or obesity by reading books and accessing reliable information on the World Wide Web.
Do some type of moderate aerobic exercise for at least twenty minutes, three to four times per week. Depending on your fitness level, you may want to start with walking, swimming, or cycling. Find an exercise you truly enjoy to increase your chances of keeping it up.
Create a diet plan that works for you, referring to reliable sources and experimenting until you feel you're in a good groove. Avoid fasting or extreme fad diets.
Choose a diet with plenty of grain products, vegetables, and fruits and that's low in fats and sugars.
Make it a habit to sit down while eating. Eat slowly, savoring each bite.
Do not eat while distracted by television, crime-filled newspapers, or a stressful conversation.
Maintain regular sleep habits, getting seven to eight hours each night, a crucial component in protecting your overall health.
If your BMI is 30 or higher, be sure to seek medical care and be aware of any health issues you may be facing due to obesity.
Keep a journal of your food intake and exercise for a couple of weeks, as a reality check. Use that information to determine what you might need to modify.
Consider therapy or an accountability program in which you report periodically to a counselor or nutritionist to discuss your progress.
Take proactive steps to reduce the stress in your life.
Integrate meditation into your schedule, following the guidelines given in Chapter 5.
Practice the appropriate Yoga therapy routine from this chapter. Start with two or three days a week, working toward five to six days a week.
For Diabetes
Time your exercise according to your meals and insulin. Generally, you want to exercise one to two hours after a meal.
Be prepared to treat low blood sugar. Always carry juice, nondiet soft drink, glucose gel, raisins, or another fast-acting source of sugar. If you feel a reaction coming on, stop, test, and treat it right away.
Be careful of your feet when you exercise or practice Yoga. You should not exercise in bare feet (except in a pool) and should use socks and appropriate footwear.
If you drink alcoholic beverages, have no more than a drink or two, a few times a week. Never drink to intoxication.
Enlist the help of a registered dietitian who has experience working with people who have diabetes. To find a registered dietitian near you, contact the American Diabetes Association.
Yoga for Type 2 Diabetes and Obesity
This routine is similar to the one I created for Lydia. It takes about twenty minutes, and should be practiced using Belly Breathing or Focused Breathing Part Two. Inhale and exhale through the nose slowly with a slight pause after both the inhale and the exhale. Ideally practice twice a day until you are within your healthy weight range or your diabetes is under control. Then you can practice once a day.
Seated Posture
This basic posture will used throughout the routine.
Sit comfortably in an armless chair, bringing your body slightly away from the back rest.
Let your arms hang down by your sides. Place your feet evenly on the floor at hip width. If your feet do not touch the floor, place a folded blanket or a phone book under them. Your thighs should be parallel to the floor with your knees and hips bent at approximately a 90 degree angle.
Place your hands on your thighs with your fingers toward your knees. Bring your back up nice and tall, and gently pull your head back until your ears, shoulders, and hip sockets are in alignment. Do not force anything beyond your comfort level.
Hold for 8 to 10 breaths.
This simple arm movement gently stretches the muscles of the upper and lower back. It also promotes circulation to your neck and shoulders.
Start in the Seated Posture.
Let your arms hang at your sides, palms turned back. Look straight ahead.
As you inhale, raise your right arm forward and up overhead until it is vertical.
As you exhale, bring your right arm down to the starting position.
As you inhale, raise your left arm forward and up overhead. Exhale on the return.
Repeat 4 to 6 times, alternating arms.
Wing and Prayer
This simple movement gently works your upper back and opens up your chest.
Start in the Seated Posture
As you exhale, join your palms in the prayer position, thumbs at the breastbone.
As you inhale, separate your hands and stretch your arms like wings to the sides at shoulder height. Your wrists stay flexed, your fingers pointing toward the ceiling and your palms facing away from you. Look straight ahead.
As you exhale, join the palms again at the breastbone.
Repeat 4 to 6 times.
This gentle twisting motion tones the abdomen and rejuvenates the spine.
Caution: Move carefully and slowly while executing a twist. If you experience any pain or discomfort, leave the twist out of your routine until you can check with your health-care professional.
Sit sideways on a chair with the chair back to your right, feet flat on the floor, and heels directly below your 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 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; then return to the starting position.
Repeat the same sequence on the opposite side.
Standing Forward Bend with Chair
This movement stretches the backside of your body, including upper and lower back, neck, and hamstrings.
Stand with your feet hip-width apart, arm's distance from the seat of a chair. Keep the spine tall but relaxed. Let your arms hang at your sides, palms turned inward toward your legs. Look straight ahead.
As you inhale, raise your arms to the front, up and overhead.
As you exhale, slowly bend forward from the hips, bringing your arms, hands, torso, and head forward and down until the palms touch the front edge of the chair. Slightly bend your knees.
As you inhale, return to the upright position, keeping your arms raised.
Repeat 3 times. Then stay in Step 3 in the forward bend position for 6 to 8 breaths. Slowly return to the upright position.
This posture helps improve your overall balance and stability.
Start on your hands and knees with the heels of your hands directly below your shoulders, your knees at hip width.
As you exhale, slowly slide your right hand forward and your left leg backward as far as they will go on the ground. Pause briefly.
As you inhale, raise your right hand and left leg up as high as you feel comfortable, or until they are both parallel to the floor. As you exhale, bring them both down to the floor, keeping them in the extended position.
Repeat the lifting motion 3 times; then hold in the lifted position for 4 to 6 breaths.
Repeat the sequence with your left arm and right leg.
Lying Leg and Arm Raise with Bent Legs
This exercise gently stretches the hamstrings and the upper and lower back, while toning the abdomen.
Lie on your back with your arms at your sides. Bend both knees and bring them toward your chest.
As you inhale, slowly bring your arms straight up and back, while raising your legs. Keep going until your arms are touching the ground behind you, and your legs are straight up, with the knees slightly bent.
As you exhale, return to the starting position.
Repeat 6 to 8 times.
This posture promotes circulation to the neck and shoulders, and strengthens the back, shoulders, hips, and thighs.
Lie on your back, bend your knees, and place your feet on the floor at hip width.
Relax your arms at your sides, palms down.
As you inhale, use your abdominal muscles to raise your hips halfway up. Pause. Then lift your hips as high as you feel comfortable. Do not go past halfway if it causes you any back pain.
As you exhale, bring your hips back to the floor.
Repeat 6 to 8 times, remembering to pause halfway up.
Bent-Leg Corpse
This is the classic posture for relaxation, with bent legs to support your back.
Lie on your back with your arms at your sides, palms up. Place pillows or rolled blankets under your knees for comfort.
Bend your knees with your feet flat on the floor, at hip width. If your head tilts back or your throat is tense, use a pillow or folded blanket under your head. Stay in this position for 6 to 8 breaths.
Relax with your eyes closed.
This technique helps to create balance and harmony in your system. It is described in detail. Do 10 to 12 cycles, sitting comfortably in a chair or on the floor.
Meditation
Remain seated comfortably in a chair or on the floor.
Use Focused, Open-Ended, or Mantra Meditation for at least 5 minutes.
Breathing Break
Once per day, take a break to practice Alternate Nostril Breathing for five to ten minutes.
Affirmation
You may want to compose your own affirmation that applies directly to your situation. Repeat your affirmation upon rising and on retiring at night; before all meals; and whenever you start to have cravings, negative thoughts, or fears throughout the day. If you like, you can use the following affirmation: “Every day, in every way, I grow stronger, with my body, breath, and mind.”