Yogacharya Dr Ananda Balayogi Bhavanani's invited presentation on "Enhancing Management of metabolic syndrome and Type 2 diabetes mellitus through Yoga" at Samanvaya – 2018, a National Conference on ‘Integrative Diabetology – Present Trend in Diabetes Care’ organised by Sri Devaraj Urs Academy of Higher Education & Research, Kolar, Karnataka (SDUAHER), to update the recent trends in the field of integrative medicine and its integration with conventional care.

1. Enhancing Management of
MetS and T2DM
Through Yoga
Yogacharya
Dr. ANANDA BALAYOGI BHAVANANI
MBBS, ADY, DSM, DPC, PGDFH, PGDY, MD (Alt Med), FIAY, C-IAYT
Director
Centre for Yoga Education, Therapy and Research (CYTER),
Sri Balaji Vidyapeeth, Puducherry. www. sbvu.ac.in

2. SRI BALAJI VIDYAPEETH
(Deemed University Accredited with “A” Grade by NAAC)
Ranked 72 in NIRF 2018
Centre for Yoga Therapy, Education
and Research (CYTER)
Salutogenesis, our focus!

3. 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 ~ 47000 patients
– educating future Yoga therapists
(PGDYT, M.Phil, PhD),
– creating awareness amongst
medical, dental and nursing
students & professionals
– scientifically researching Yoga,
– 77 publications & 6 CMEs.
– IDY celebrations since 2015

4. Salutogenesis, our Focus
• Moving from pathogenesis, the focus on disease
towards salutogenesis, the focus on health!
• CYTER is striding forward on an innovative path of
promoting holistic health for one and all.
www.sbvu.ac.in

5. 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 & DM within a period of 9 days. (Bijlani,2005)
• Yoga may have a role in prevention &
management of MetS as evidenced by previous
reports.
(Bethe,2008;Joel,2011;Kim,2013;Alka,2014;Caren,2015;Parco,2015;Sohl,2016)

6. • Being safe, simple & economical, it should be
considered beneficial adjuvant in DM. (Jain,1993)
• Adjunct Yoga therapy may help (Bhavanani,2013)
– obtain benefits at lower doses,
– reducing side effects of medicines
– enhancing metabolic control &
– patient compliance.

7. • Enhanced insulin sensitivity & attenuation of –ve
relationship between weight /WC & insulin sensitivity
associated with long term Yoga practice. (Chaya,2008)
• 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)
& biochemical
profile (Lorenzo,2008)
in diabetics.
• With no appreciable side effects and multiple
collateral benefits, Yoga is safe, simple to learn and
can be practiced by even ill, elderly /disabled patients.
(Innes&Vincent,2007)

8. • A comprehensive review by Innes & Vincent (2007)
found
beneficial changes in several risk indices, including
– glucose tolerance, insulin sensitivity, lipid profile,
anthropometric characteristics, BP, oxidative
stress, coagulation profiles, sympathetic activation
and pulmonary function, ……. as well as
– improvement in specific clinical outcomes.
• Holger et al (2016)
concluded that Yoga can be
preliminarily considered as a safe and effective
intervention for reducing Wc and SP in individuals
with MetS who are not adhering to conventional
forms of exercise.

9. Metabolic Syndrome
Obesity
Elevated BP
Hyperglycemia
INSULIN
RESISTANCE
Dyslipidemia
The modern
pandemic????

10. Diagnostic Criteria For Metabolic SyndromeDiagnostic Criteria For Metabolic Syndrome
According to guidelines from National Heart, Lung, and Blood
Institute (NHLBI) and American Heart Association (AHA), Metabolic
syndrome is diagnosed when a patient has at least 3 of the following 5
conditions:
1. Fasting glucose ≥100 mg/dL (or receiving drug therapy for
hyperglycemia)
2. Blood pressure ≥130/85 mm Hg (or receiving drug therapy for
hypertension)
3. Triglycerides ≥150 mg/dL (or receiving drug therapy for
hypertriglyceridemia)
4. HDL-C <40 mg/dL in men or <50 mg/dL in women (or receiving drug
therapy for reduced HDL-C)
5. Waist circumference ≥102 cm (40 in) in men or ≥88 cm (35 in) in
women; if Asian American, ≥90 cm (35 in) in men or ≥80 cm (32 in) in
women

11. A chubby baby may not be a healthy baby!!!
Obesity starts young!!

12. If you eat junk food………..
You just end up
becoming junk!!

13. Eat healthy……………
be healthy!!!!!

15. Responsibility for our health,
………..…… always starts with us!

16. So, then
what about the
role of Yoga?

17. WHAT IS YOGA ?
• A mindful way of life
• Union (Yuj) of
– Body, emotions and mind
– Jivatma with Paramatma
• Skill in action
• Harmony of thought, word and deed
• Conscious evolution through choice
based actions

18. 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

20. And not merely the absence of disease.And not merely the absence of disease.
Definition of Health (WHO)Definition of Health (WHO)
Health is a
dynamic
state of
complete…
Health is a
dynamic
state of
complete…

22. “Yoga therapy is the process of
empowering individuals to
progress toward improved health
and wellbeing through the
application of the teachings and
practices of Yoga”. – IAYT

23. Aim of Yoga Therapy Protocol
Normalize
• Body Weight
• Adiposity,
• Blood pressure
• Blood sugar
• Lipid profile
• Autonomic balance
Reduce
Insulin
Resistance
Enhance
Quality of Life
Empowering the
individual to take charge
of their own health.

24. Mechanism
Sympathetic
Activity
Parasympathetic
Activity
Body Weight,
Blood Pressure,
Blood Sugar,
Insulin Resistance
Dyslipidemia
Diet + Jathis, Kriyas, Suryanamaskar, Twisting (Standing, Sitting, Lying down),
Shat Kriyas, Pranayama, Relaxation, Meditation.

25. 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)

26. • 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)

27. 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.
 Vyavahar – healthy relationships

30. Perceived
Stimulus
Perceived
Stimulus

33. Mental
Agitations
Mental
Agitations
Haphazard
Flow of
Prana
Haphazard
Flow of
Prana
Unstable
Nadis
Unstable
Nadis
Hypo-cellular
activity
(Ajeeranatvam)
Hypo-cellular
activity
(Ajeeranatvam)
Hyper-cellular
activity
(Ateejeeranatvam)
Hyper-cellular
activity
(Ateejeeranatvam)
Altered cellular
activity
(Kujeeranatvam)
Altered cellular
activity
(Kujeeranatvam)
VYAADHI
Physical
Ailments
VYAADHI
Physical
Ailments
Yogic understanding of Psychosomatic DisordersYogic understanding of Psychosomatic Disorders
AADHIAADHI
Manomaya
Kosha
Manomaya
Kosha Annamaya KoshaAnnamaya Kosha
Pranamaya
Kosha
Pranamaya
Kosha

34. PSYCHO-NEURO-IMMUNO-ENDOCRINOLOGICAL
CORRELATES OF STRESS, ILLNESS & HEALTH
NERVOUS
SYSTEM
ENDOCRINE
SYSTEM
IMMUNE
SYSTEM
MENTAL & PHYSICAL ILLNESS
-ve
STRESS
StressStress
response
response

35. PSYCHO-NEURO-IMMUNO-ENDOCRINOLOGICAL
CORRELATES OF STRESS, ILLNESS & HEALTH
NERVOUS
SYSTEM
ENDOCRINE
SYSTEM
IMMUNE
SYSTEM
+ve
YOGA
HEALTH & WELLNESS
Relaxation
Relaxation
response
response

36. Stress
respons
e
RelaxationRelaxation
responseresponse
Yoga
Yoga
Illness to Wellness,
the choice is ultimately
ours & ours alone !

38. Impact of stress on hypothalamic–pituitary–adrenal
(HPA) axis and sympathetic NS.
* Yoga has been shown to have significant beneficial effects in these
Sengupta P. Health Impacts of Yoga and Pranayama: A State-of-the-Art Review. Int J Prev Med 2012; 3:444–58.

39. Stress management through Yoga
• Dr W Selvamurthy gave a beautiful
message at SBV recently. He said:
Yoga enables and empowers
individuals to
– Modify their perceptions of the stressors,
– Optimise their responses to them, and
– Efficiently release the pent up stresses.
• We can think of it as a 3-in-1 action!!

40. 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

41. MechanismsofYoga
MechanismsofYoga

44. Basic Yogic principles used in
management of MetS and 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).
• Enhance insulin sensitivity through physical activity:
surya namaskar, asanas, kriyas, pranayama etc
• Relaxation, visualization and contemplative practices
to induce a sense of inner calmness and wellbeing.

45. Yoga therapy protocol for Met S and T2DM
Diet:
• Avoid refined food stuffs and junk foods.
• Take lots of green vegetables salads, bitter gourd and neem.
• Maintain good hydration.
• Regular small meals
• Less amount of salt intake in foods.
• Garlic and Onion help to reduce the blood pressure
• Avoid pickles , papads , meats
• Choose complex carbohydrates and lots of dietary fiber
• Perform Vajrasana for 5 min after meals to help digestion

46. Asana
Meditation
Pranayama
Relaxation
Yoga therapy practicesYoga therapy practices
46

47. 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

49. Uninostril / alternate nostril
pranayamas
Suryanadi asana Chandranadi asana

50. Whooshing tensions away-nasarga
mukha bhastrika

51. Tension relaxation coupling: Spanda
nishpanda

52. Chakra MeditationChakra dhyanaChakra dhyana
Inhale
Exhale

53. In conclusion…..
• Yoga has infinite possibilities of solutions for the
problems being faced by modern humankind.
• We however want it to be a miracle pill, that we take
only once - immediate loss of all problems!
• Yoga is a w-holistic science and must be learnt and
practiced with a holistic view.
• Dedicated practice of Yoga as a way of life is a
panacea for psychosomatic, stress related disorders.
• Helps us regain our birthright of natural health,
wellbeing and universal happiness.

54. An Integrated Approach
• The need of the modern age is an integrated
approach towards therapy utilizing Yoga in
coordination & collaboration with other systems of
medicine such as Allopathy, Ayurveda, Siddha and
Naturopathy
• Physiotherapy, osteopathy and chiropractic practices
may be used with the Yoga if needed
• Advise on diet and life style is very important
• Adoption of right attitudes through Yogic counseling

55. “Health and happiness
are your birthright.
Learn and live Yoga
for then you will
know true health and
happiness”
Yogamaharishi
Dr Swami Gitananda Giri
Guru Maharaj
(1907-1993)
Founder:
ICYER at Ananda Ashram,
Pondicherry, India.

56. 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.

57. Thank You!Thank You!