Exercies, Yoga and Diet for Diabetes mellitus

Exercise for Diabetes mellitus

Physical Activity for Type 2 Diabetes mellitus

• Because of poor efficacy of insulin, there is inability of glucose to enter into the cell. Therefore, glucose remains high in the blood.
• To make this insulin more efficient, exercise is the best way because the existing even the poorly effective insulin is good enough to transport glucose from the blood into the cells.
• Therefore, when we do the exercise, we go on creating a better gradient without demanding more insulin.
• Exercise helps in reducing obesity and therefore the insulin resistance.
• Exercise is also useful in presenting and delaying diabetes in high risk people.
• Research has shown that moderate physical activity performed regularly for 120-200 minutes per week helps people to prevent diabetes.

Yoga for Diabetes mellitus

• Yoga is the spiritual science of self-realisation. It is an art of healthy living, which focuses on bringing perfect harmony between  body and mind.
• Yoga is popular world-wide because of its spiritual Value, therapeutic credentials, its role in the prevention of disease, promotion of health and management of lifestyle related disorders.
• The word Yoga has two meanings; the first comes from root 'Yujir' or union, the second is derived from different root ‘Yuja' which means ‘Samadhi' - the highest state of mind and the absolute knowledge.
• There are many methods of yoga catering to the needs of different persons in society to bring about the transformation of the individual.
• According to Maharshi Patanjali, Yoga is defined as the process of sublimation of all mental modifications in the mind through a systematic process of yamas (moral doctrines), niyamas (disciplines), āsanas (postures), Prānāgāma (regulated breathing/breath control), pratyahara (introspection/drawing the mind away from perceptible external sensory stimuli), dhãrana (concentration), dhyana (meditation) and finally to attain a state of Samadhi (absorption).
• Attainment of such a contemplative absorptive state has been elucidated to confer a blissful state of mind and body.
• Apart from this ashtanga Yoga, there are many more Yogic methods, which prescribes different practices such as Satkriyas (Six Cleansing Techniques), śithilikarana Vyāyāma (Looseming Exercises), Bandhas and Mudras, Suryanamaskara (Salutations to Sun), Yogic Diet, Karma Yoga (Path of Action), Bhakti Yoga (Path of Devotion), Jnana Yoga (Path of Knowledge) and Raja Yoga (Path of Psychic Control).
• Each step of Yoga not only enlightens the soul but also increases physical strength, endurance, power of mind, establishes emotional stability and social security.
• The practices of Yoga leads to promotion of health, prevention of disease, effective management of all mental disturbances and better understanding of higher level of Consciousness.

Śithilikarana Vyāyāma (Tanaumukt Kriya/Sukshma Vyayama) and Suruanamaskãra

• In this module of Yoga, we have included Sithilikarana Vyayama in the beginning of the one-hour program, which has this exercise effect.
• Though, they resemble to that of exercise, but they are not exercise. They are performed with awareness and breathing.
• These Sithilikarana Vyayama or loosening exercise includes simple trunk movements, which prepares the body with better flexibility to move on to Suryanamaskara. Sithilikarana Vyayama followed by Suryanamaskara offers the workout effect, which is necessary  to burn the calories and transport more glucose from blood to the cells, so that the muscles can utilise this glucose in a healthy way.
• Three important points to remember while doing Sithilikarana Vyāyāma:
1. Rhythmic movement which starts slowly and becomes faster to prepare the body for risk free practice of further Yogic program.
2. Movements combined with breathing and
3. Deep internal awareness of the parts that are stretched or Contracted during practice of a particular vyayama or asana.

Suryanamaskara is a very interesting program which is a bridge between loosening exercise and the yogasana. Suryanamaskara is a combination of 12 postures, but done like an exercise. During Suryanamaskara three important points to be remembered and they are:

1. Suryanamaskara is done initially with fast movements. Then do it slowly. The idea is when we do fast, it will burn out calories involving all the muscles all over the body and then when we move on to the slower pace, we start developing deeper awareness.
2. Combination of breathing with body movements is the most important component, as it promotes concentration and complete body awareness.
3. Suryanamaskära involves mind and emotion through devotion to Sun. In the mind, you have a continuous divine mood that" am offering salutation to the divine source, the Surya, the Sun'. Therefore, in the mood of offering the 'self, our mind gives up stiffness & rigidity and becomes soft and gentle.

Satkriyas-Six Cleansing Techniques

These are cleansing techniques using "external objects. These are 6 types and therefore termed as 'shat'kriyas. Shatkriyas bring control on different reflexes and establish psycho-physiological balance. The main effects of kriyas are:

• Cleansing, activating and revitalizing the organs.
• Tones up the functions of the organs.
• Desensitization.
• Development of deep internal awareness.

Asanas for Type 2 Diabetes Mellitus

• Now coming to yogasanas, in this first module, the very simple but effective asanas have been included.
• Asanas are not  really exercises although they look like exercises.
• They use the body but the principle of using the body movements in yogasana is totally different.
• What is the definition of yogasana?-  It is defined as sthira sukham asanam. Maintained in the final posture for a long time, it should become easy, effortless and enjoyable.
• They do not burn out calories, but help to conserve calories, conserve energy.
• Therefore, it works in harmony with nature and offers rest to the local stretched part of the body.
• So there are three outcomes, which one would like to remember when practising asanas.

There are 3 steps while you do the asanas.

1. Step 1-Prayatna: it means to try to come to the final position; here you have pain, you feel like giving up; with your will power, you are fighting to continue to stretch; you are feeling tired in the process. You are putting lot of effort. So, with full effort, with full prayatna you are trying to reach the final posture ignoring the pain.
2. Now the real effect of yoga starts. So you have made an effort. You have tried your best. You have come to a position which may not be the final position as per the final position in the model. The stretch will go on improving and you will be able to reach the position as recommended by sages. But today when you have reached Your maximum possible range of movement without severe pain, you start doing the next step that Patanjali describes by two words prayatna Saitilya and ananta samapatti. Now effort (prayatna) should go away. While you are maintaining the final position, scan the whole body once from top to bottom. Recognize the parts of the body you are keeping tight or stiff with unnecessary extra effort. Now release the unnecessary extra effort and let go; relax those parts of the body which are held tight. Thus, you relax all other parts of the body, except the part which is stretched to maintain the final position. This makes you feel a lot better;
3. Expansion (ananta samāpatti) : Now focus your mind on the point that is being stretched. Take the example of vakrasana or ardhamatsyendrasana, the spinal twist in sitting position. Here you have twisted the spine; there is one spot in the upper part of the lumbar region where you can really feel the strong stretch. Bring your mind completely focused to this point; no other thoughts in the mind; when you focus intensely on that area (pradesa) of your back where there is enormous amount of strain your mind enters into the state of dhārana. Now, go on releasing the effort involved in that stretched part. This 'let go' is called prayatna Saitilya in the spot where you are focusing your mind.
   Now defocus your mind focus-defocus; Constrict and expand; start experiencing ananta samapatti, a limitless expanded feeling from that point of stretch. Feel the release of the energy blockage in the body structures around. Moving further, observe the whole body and be in this posture with one point being stretched and all other parts completely relaxed. Now allow your mind diffuse into the vast space all around the body; start seeing your body from that vast space all around; this is called ananta samápatti - i.e. to merge in the unlimited expanse. This results in the experience of sukha, the  joy of maintaining in the final posture; thus enjoying the final posture with ease and effortlessness is called sthiram sukham āsanam.
   When you maintain deeply relaxed in this position for a long time it is neither isometric not even isotonic contraction; it offers deeper and deeper rest to each and every part of body including the part that is being stretched. In vakrasana the part that is being stretched is the upper part of lumbar region; your pancreas is seated just under this spot; so your mind is completely focused on the pancreatic area where the insulin producing cells are sitting. Over a period of time, when your concentration and internal awareness improves, you will actually feel the deep rest in the internal organs including the pancreatic cells. We have seen earlier that deep rest to the sick organ is the healer. So consciously bringing the mind to that particular point in the final position of vakrasana and just concentrating on the zone just underneath offers deep rest to your pancreas and fat cells around.
4. Absorption : Now, once you stay in that state, the mind has become so soft, so gentle, so much expanded that you may start losing your body awareness; you become one with the vast space around where your awareness has merged in the non-dual state and that is called ‘ tato dvandva anabhighátah; At that stage, mind becomes so much in tune with that one single universal consciousness that you cannot be affected by the dualities of the life. This is the final experience of an asana. This results in conscious, wakeful relaxation to the nervous system, musculoskeletal system and the endocrine system. Sages say "do not use brutal force to handle your mind and body - na hatat na balať. It is the stretch with awareness followed by slowing down that really works. This is the yogic way for self-mastery through asana that helps your cells do their job better.

Pranayama for Type 2 Diabetes Mellitus

Maharshi Patanjali defines Pranayama as slowing down of breathing 'Tasmin satistvasa prašvasayoh gatirvicchedah Pranayámah’.

• Prānāyāma means mastery over Prāna. What is Prāna? Prāna is that bio-energy, which carries out all functions of the body.
• A quantum of Prana is drawn from the bottom of the spine to be supplied to all parts of the body through the system of nadis and chakras.
• All cells need their Prana to carry out their functions at a basal level.
• When we need to do more work we need more Prāna.
• When we think of doing any work the extra Prana flows to that part which makes the structures in that part work more vigorously for e.g. if we want to run - you decide to run, Prana rushes to limbs - this energy makes the nervous system send down information to muscles - muscles contract using this extra Prana. After the running is over, the Prana flow reduces and the muscles get rest. So increase or decrease of Prana  flow is responsible for all actions.
• Mind controls its flow. lf mind is slow, breathing is slow; if breathing is slow mind becomes slow and rested.
• Mastery over all mental (manah/chitta) and physical activities (Prāna) is health.
• Sickness is uncontrolled excessive Prana during stress, due to increased speed of mind, the habituated drawing of excess Prana results in imbalance and blockages in the nadis disturbing healthy functioning of the chemical processes in the tissues; thus the tissue damage (in annamaya kosa) is due to this excess persistent excessive flow of Prana. So the aim should be to reduce the flow to the sick organ where the Prana is locked up.
• This is achieved by doing cleansing type of breathing practice as in kapalabhati and then go on to Pranayama (slow breathing) - so slow that you are breathing almost at the rate of 1-2 breaths/min.
• Pranayama that refers to slowing down the rate of breathing is a very important tool to develop mastery over the excessive speed of Prāna.
• Several types of Pranayama techniques that may involve fast breathing, sectional breathing, uni-nostril breathing, alternate nostril breathing, with or without breath holding are all meant to achieve mastery over the Prāna and correct the imbalances.

Meditation for Type 2 Diabetes Mellitus

• Yoga is an ancient Indian Science and way of life, which includes the practice of specific postures, regulated breathing, and meditation.
• "Meditation is uninterrupted, spontaneous flow of the mind towards the chosen object'. Meditation has been described as training in awareness, which produces definite changes in perception, attention and cognition.
• The five characteristic features of meditation are
1. single thought,
2. effortlessness
3. awareness
4. slowness and
5. expansiveness.
• Scientific studies on Meditation have shown significant decrease in the amount of oxygen consumed and in breath rate and an increase in breath volume, enhanced cardiac vagal activity, decreased sympathetic nervous activity, reduced anxiety, improved attention, concentration and produces a hypo-metabolic physiological state indicating a greater control over the mind, which helps in the management of Diabetes mellitus.

Diet for Type 2 Diabetes mellitus

• There are three basic components in the lifestyle change for diabetes: diet, exercise and stress management. Diet is altered in such a way as to reduce post-prandial glycaemia and to improve carbohydrate tolerance.
• This is achieved by emphasizing consumption of complex carbohydrates (such as starch) and more of dietary fibre.
• Foods rich in fibre take more time and effort to chew and slow down gastric emptying, which promotes satiety, and limit energy intake and also makes the fecal matter soft and bulky that prevents constipation and promotes easy bowel evacuation.
• Fibre adds to the weight and volume of food but makes only a negligible contribution to energy intake, helps in reducing the obesity, which is one of the risk factors for Diabetes. Also, the fibre content is rich in Yogic Satvik Diet.
• Eating is totally a psychological phenomenon in man due to the development of the higher faculties of awareness and mastery. Sage Bhartruhari says:

āhara midrā bhaya maithunam cha
sāmanyam etat pašubhih narānām
buddhirhi (dharmohi) te shām adhiko viśeshah
buddhiviheenah (dharmeinheenah) paśubhih samānah

Srimat Bhagavadgita describes the Yogic Diet as follows:
Yuktāhāra Vihārasya Yuktacheshtasya Karmasu
Yuktasvapnavabodhasya Yogo Bhavati Duhkhaha

(Gita verse 6:17)

He who is proper at food selection, conduct, sincere in effort, and who is moderate in sleep and wakefulness, attains the state of Yoga, which destroys all the sorrows and miseries (dukhah)

The Bhagavadgita also classifies food into three categories:

• Satvik: Those foods which increase the life, purity, strength, health, happiness and cheerfulness and good appetite are considered Sātuik food. Sātuik foods are mild — neither over cooked nor undercooked and they lead to state of calm and alertness. Satvik foods not only provide nourishment for the body but also add utility to the total system by bringing a perfect, harmonious balance of energy states in the food.
• Rajasik : Food that is bitter, sour, saline, streaming hot, pungent, dry, burning is the Rajasik food. Definitely, these diets create brilliant energy and keep all vigorous men restlessly striving to fulfil their uncontrolled passions and desires.
• Tamasik: The foods which are partially spoiled, which have lost its essence, have been processed for too long, preserved in a way having no spark of life, or which lack the vitality of food are generally considered as Tamasik foods. Energy and vitality are almost absent in such foods.

Yoga talks about the effect of food on the mind and vice versa. Those foods that improve vitality health and maintain good blood glucose  levels are the Satvik foods. Thus, yogic diet is a satvik diet which is in tune with what the modern nutritionists are recommending for diabetics. Sātvik diet is a diet based on foods mentioned in Yoga literature that contains sattva qualitv (guna). In this system of dietary classification, foods that harm the mind or body are considered Tamasik, while those that are stimulating and negative are considered Rajasik. Satvik diet is meant to include food and eating habit that is "pure, healthy, essential, natural, vital, containing energy that enhances longevity, clean and consciously managed". Satvik diet is a regimen that places emphasis on seasonal foods, fruits, nuts, seeds, oils, ripe vegetables, legumes, whole grains, and low calorie diets. Satvik diet is sometimes referred to as yogic diet in modern literature. In ancient and medieval era Yoga literature, the concept discussed is Mitahara, which literally means "moderation in eating".

The Yogic concept of food takes into consideration, the total dimension of human existence. Apart from the atoms and molecules, from which our gross physical body is made of, we all possess Prana, Mind, Intellect, Emotions and Spiritual Dimensions. 'Yoga' is that process by which we can bring in an integration of the entire personality at all these levels. The stamina of the body is to be developed, the Prana should be flown freely, the mind should calm down, the emotions should be stabilized & cultured. In totality the bliss should arise to keep oneself happy and healthy.

A "Balanced Diet' according to Yoga, is the diet which restores balance at all levels. The Yogic diet believes in the concept of Mitahara. This postulates that the final effect of intake of diet depends upon the following three factors:

1. Quality of food: It should be satvik and more akin to the natural form of it.
2. Quantity of food: Half of the stomach should be filled with food, one forth with liquid and the rest one forth should be empty for the free flow of air (gases).
3. State of mind while taking food: While during meals one should be calm and quiet; should relish the food, and not be engaged in any form of intense thinking activity.

Both ancient and modern scientific literature say that simple kitchen based herbs have been found to be highly useful in diabetes control. Some of these herbs have been proven to have hypo-glycaemic and hypo-lipidemic effects. They are from daily kitchen items in India and are easily available. Enhancing awareness about increasing their consumption is the key. Following herbs should be consumed more often by an individual suffering from diabetes:

1. Fenugreek (Methi): both powder and green leaves 2-3 times a day along with regular meals
2. Bitter Gourd (Karella)
3. Turmeric (Haldi)
4. Bitter and Sweet Neem (Mitha aur Kadu Neem)
5. Indian Gooseberry (āmla)
6. Ginger (Adrak)
7. Aloe vera (gwar paatha)

It is a healthy eating plan which is naturally rich in nutrients and low in fat and calories. It insists on moderate eating of healthiest food at regular intervals. The following model can help prepare an individual tailor made diet program:

Recommended vegetables for Diabetes

Source : Yoga based life style module for diabetic