By Gabrielle Kaplan-Mayer
Popular images of yoga often show a sinewy person folded, pretzel-like, into a joint-defying pose, perhaps while balancing on one leg, to boot. While impressive, such images often scare people away from the very practice they are promoting or celebrating, namely yoga. That’s unfortunate, because yoga has benefits for everyone, no matter how flexible or sinewy.
Yoga’s benefits are not just physical, although regular practice can dramatically increase flexibility, strength, stamina, and balance. The word yoga comes from the Sanskrit word for “yoke” or “union,” and the practice of yoga emphasizes the integration of physical and mental health through performing various postures (asanas), breathing exercises (pranayama), and sometimes meditation and chanting. That combination can help calm the mind, reduce mental stress, and enhance mental focus. Yoga also has a spiritual component; how much that aspect is emphasized in a yoga class depends on the instructor and the class setting.
Part of what makes yoga suitable for anyone, regardless of physical condition, is its philosophy of “being in the moment.” On a physical level, that means doing the postures to the best of your ability, whatever that is. If you can stand on one foot and hold the other above your head, that’s fine. If you can stand on one foot and hold the other only an inch off the ground, that’s fine, too. Being in the moment also means not comparing yourself to others or even to yourself at a different time. It means doing the best you can at this moment.
On a mental level, “being in the moment” encourages you to focus on the sensations in your body – particularly the sensation of breathing – at this very minute and to allow yourself not to think about the past or the future. For many people, this isn’t easy, but the benefits of practicing this type of meditation can include feeling more relaxed and being able to deal with life stresses more effectively.
Any practice that enhances physical fitness and helps with stress reduction has special value for people with diabetes. Physical activity burns glucose in the short term and also builds muscle, which is the body’s glucose-burning “engine.” The more muscle you have, the more glucose you burn, even at rest. Regular aerobic activity (the type that gets your heart rate and breathing rate going for an extended period of time) also reduces the risk of high blood pressure and heart disease, both of which commonly occur in people who have diabetes. How much of an aerobic workout you get from doing yoga depends on the type of yoga you do and the intensity at which you practice, but the flexibility, agility, and strength you gain from doing any type of yoga will increase your ability to engage in other forms of aerobic exercise.
Stress reduction is often an unaddressed element of diabetes self-management, but uncontrolled stress can disrupt even the most diligent efforts at maintaining tight blood glucose control. Besides taking an emotional toll, stress causes a physiological response in the body, prompting the release of “fight or flight” stress hormones into the blood. Because these hormones spur the release of stored glucose or fat into the bloodstream, stress can cause elevated blood glucose if you don’t have enough insulin in your system at the time. If you don’t realize what is causing your blood glucose to run high, you may, in turn, feel even more stressed.
While Eastern cultures have long recognized yoga’s healing benefits, Western medicine is just catching on. Some American medical schools are starting to teach yoga and meditation as a means of stress reduction, and well-known cardiologist Dean Ornish, MD, now prescribes yoga, along with diet and exercise, as part of his plan for preventing and reversing heart disease. Studies have shown that yoga can help reduce high blood pressure (which can be partly stress-induced). It can also help reverse depression, which is more common among people with diabetes than the general population.
Exactly how yoga may relieve depression is not known, but it may work in several ways at once. According to Beryl Herrin, a yoga instructor based in Philadelphia, “Yoga gets energy moving in the body. It gives you breath awareness, which helps you to stay in the moment, rather than be consumed with worries.” Exercise is known to naturally increase your brain’s “feel-good” chemicals, and meditation, it seems, can have the same effect. Studies show that the increase in slower-frequency alpha and theta brain waves (both of which are associated with a state of relaxation) that occurs during and after yoga meditation corresponds with an increase in dopamine, a chemical that produces feelings of pleasure and satisfaction. And yoga may also help relieve depression simply by burning glucose, since high blood glucose itself can contribute to feelings of depression. However, yoga alone cannot treat major depression; people experiencing severe depression should seek professional help.
There are many types and styles of yoga, some accentuating the physical component of yoga, others its spiritual or calming aspects. Hatha yoga is considered the “basic” yoga style and the root of most other variations. Combining physical poses and breathing exercises to increase body awareness, fitness, and flexibility, a beginner hatha yoga class is a good option for people trying yoga for the first time. Beginners and people with physical limitations might also look for classes labeled “gentle yoga,” in which classical hatha postures are modified so that students can proceed comfortably at their own pace and level of ability.
For people who already have some degree of fitness, ashtanga yoga may be a good choice. Students perform a series of postures in quick succession to get a rigorous aerobic workout while increasing strength and flexibility. Sometimes called power yoga, this style is catching on in gyms and health clubs.
Another popular style is iyengar, a slower, more technique-focused method that uses props such as belts, blocks, and chairs to help students achieve precise alignment in breathing exercises and poses. Poses are usually held much longer than in other types of yoga. The use of props allows students at all levels to progress safely and comfortably, although some people may find this style too exacting.
Kundalini yoga focuses more on the meditative side of yoga. Kundalini incorporates Sanskrit chanting, muscular contractions, meditation, and guided visualization to tap into a dormant energy force (pictured as a coiled serpent, the kundalini) at the base of the spine.
Integrative yoga therapy (not to be confused with integral yoga, which is described here) is practiced in some hospitals and rehabilitation centers as a complement to standard Western medicine. Tailored to the individual, it uses yoga exercises to strengthen the mind—body connection and help people meet specific goals such as pain management, weight loss, recovery from surgery, smoking cessation, or spiritual growth.
Prenatal yoga classes allow pregnant women to move in ways that are safe and nurturing for both them and their growing babies. For women with diabetes, who are under pressure to keep blood glucose in extremely tight control to avoid birth defects in the baby and complications for themselves, the calming effects of doing yoga can be at least as important as the physical benefits. “Pregnancy was up there with the greatest challenges of my life,” says Becky Rosen, 33, who has had Type 1 diabetes for 15 years. “During my first pregnancy, I was extremely exhausted and would get consumed with worries if my blood sugar went out of the really tight range. The second time around, a friend introduced me to prenatal yoga. I was so much calmer as a result. Even 10 minutes of breathing and stretching exercises in the morning helped me feel more grounded and less stressed.”
These are just a few of the types of yoga classes that you may find in your area. In some areas, you may also find classes in “chair yoga” for people in wheelchairs or people who have trouble moving or working comfortably on the floor. Sometimes, there are special classes for couples or classes just for people who are overweight.
To find the right yoga class for you, start by asking around for personal recommendations. Mention that you’re looking for a yoga class in casual conversation; you’ll probably be surprised by how many coworkers, friends, and acquaintances do or have done yoga and can either recommend or steer you away from certain classes or instructors. Beyond that, see what your community has to offer. Most metropolitan areas have a number of yoga studios. If you live in a small town or suburban area, try your local YMCA, health clubs, or community centers for yoga classes.
As you examine your options, think about what you’d like to get out of the class. Are you looking for an aerobic workout? Or would you prefer more gentle stretching and breath awareness exercises? Class brochures or listings should give some indication of the difficulty level (gentle, beginner, moderate, or advanced) and focus of the class, but if it’s not clear, call and ask. You may even want to speak directly with the teacher about the style of yoga he’ll be teaching and whether the class would be a good match for someone at your fitness level. A good teacher will be willing to talk about the class and to point you in the right direction, even if it means referring you to another teacher.
If you’re still not ready to sign up, ask about observing a class or even taking a trial class to see if you like it. If you have never done yoga or meditation before, you may find some of the exercises new and even a little strange at first, but you shouldn’t feel embarrassed or highly uncomfortable. Most classes try to welcome and encourage newcomers. However, says Beryl Herrin, “If you try a yoga class, and it doesn’t feel right or the teacher isn’t really inspiring, don’t give up on yoga; just look for another class.”
There are some other practical matters to consider before signing up for any yoga class. Cost is one of them. Some private studios charge a lot more for classes than, say, the local rec center. But you may be willing to pay a little bit more if the private studio offers smaller class sizes, meaning you’ll get more individual attention, or if you want to study with a particular teacher who has an excellent reputation. You also want to find out about the length of class and how often it meets. While on average yoga classes go for about an hour, some may be longer and others shorter. Some centers allow you to drop in or pay as you go, while others require you to sign up for a given number of sessions.
If you can’t find a yoga class that suits you in your area, or if you’d prefer beginning at home, yoga videos offer an excellent – and inexpensive – alternative to live instruction. You may be able to find yoga videos at your public library or local video rental store, or you can try browsing Internet yoga sites and online bookstores and reading reviews of yoga videos to find one that sounds right for you. (One place to get started on the Internet: www.yogajournal.com.)
At home or in class, dress for yoga in loose or stretchy, comfortable clothing that allows you to move easily. You may want to wear some layers, such as a leotard with a light sweatshirt over it, because some parts of class may be very active and get you sweating, while others are fairly stationary, leading you to cool down quickly.
Most yoga classes require you to bring a sticky mat (available for purchase online at www.gaiam.com and www.yoga.com, among others, at some yoga centers, and at some health-food stores for about $20—$25), and a few styles of yoga, such as iyengar, may also require additional props such as special ropes and blocks. Some yoga studios have sticky mats to borrow if you forget to bring your own or haven’t purchased one yet, but since most yoga exercises are done barefoot, you run the risk of picking up a foot fungus if you use the communal mats.
People who have diabetes are often admonished never to go barefoot except in the bath or in bed. However, many yoga poses are difficult to perform or hold while wearing shoes or socks. If this is a problem for you, ask your yoga teacher about alternatives such as wearing nonslip socks. People with existing foot problems may also want to consult their health-care provider before doing yoga poses that put pressure on the feet. If you shower in a public locker room after yoga class, be sure to wear shower sandals or slippers to protect your feet, both from foot fungus and from any objects that may have fallen onto the floor.
Don’t be shy about letting your yoga instructor know that you have diabetes. It may be necessary, especially when you’re first starting out, to check your blood glucose during class. Be sure to always bring your blood glucose meter and glucose tablets with you to class; you may be surprised by how much even a gentle class may get your heart rate going from time to time, and if that happens, your blood glucose may drop. Don’t hesitate to stop at any time during class to check your blood glucose.
To see how yoga affects your blood glucose level, you may want to follow the example of James O’Keefe, who has Type 2 diabetes and takes insulin. When he first began yoga classes, he checked his blood glucose level before, during, and after class for several weeks to look for a pattern. “I knew how to cut back on my insulin during aerobic exercise,” O’Keefe said, “but it took me some time to figure out how yoga was affecting my blood sugar. It was interesting, because my sugar wouldn’t drop during class, but it would stay lower than usual for a few hours afterward.”
Just like other forms of exercise, yoga may necessitate an adjustment of insulin doses, meals, or snacks. A general rule in yoga is that it’s best not to practice on a full stomach. “I explain to my students that doing yoga on a full stomach just makes it harder and less comfortable to move, because the body is putting so much energy into digestion,” says Beryl Herrin. Depending on how yoga affects your blood glucose, though, you may find that you need to eat some form of carbohydrate 15—30 minutes before doing yoga. If so, Herrin recommends that you choose something on the lighter side, such as a few whole wheat crackers, that will keep your blood glucose up but won’t weigh you down. “If you need to bring a few crackers or a light snack along to class, go ahead. It’s better to stop and eat or drink something if you need to than to not try doing yoga at all,” she says.
Because your body functions best when it’s well hydrated, be sure to drink water before and after class, and bring a bottle of water to class with you if you sweat a lot or tend to get thirsty.
Perhaps the most important thing – for people with or without diabetes – to remember is to be gentle with yourself when you begin. Don’t push or strain to get into a posture. Yoga is about the union of your mind and body; it doesn’t matter what the person on the mat in front of you can do. “When I first started yoga, I pushed myself a lot,” James O’Keefe recalls. “Yet it was when I wasn’t trying to look good – when I just focused on breathing and stretching – that I could hold the asanas [postures] much better.”
You’ll feel better and lower your risk of injury and soreness if you take it easy at first and gradually work your muscles up to the state of a more experienced yoga student. “Listen to your own inner teacher,” recommends Beryl Herrin. “You know intuitively how much energy to use and when to go easy.”
Once you get started practicing yoga, you’ll discover that its benefits aren’t limited only to class time. Yoga’s benefits are long-lasting, and yoga techniques are accessible at any time. The next time you feel your heart racing because you’re angry or anxious about something, start to take deep, gentle breaths and see how it helps to calm you down. When you’re stiff from sitting in front of your computer all day, get up and do some simple stretches. Standing in line at the grocery store, note whether you’re holding any of your muscles tightly; if so, gently release them. Not only will practicing these yoga techniques make you feel better, but you also may find that by reducing your stress level, they help you keep your blood glucose in better control, too. Yoga – building connections between mind and body – is a great tool for anyone trying to successfully manage his diabetes.
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