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Yoga for Cardio Metabolic Disorders
16thAnnual NAMA (National Ayurvedic Medical Association) Conference, Art of Living Retreat Center, Boone, NC
Ayurveda and Spirituality, April 24-26, 2020
Dilip Sarkar, MD, FACS, C-IAYT, AYT-NAMA, D.Litt (yoga)Associate Professor of Surgery (Retired), Eastern Virginia Medical School
Fellow, American Association of Integrative Medicine (AAIM), American College of Surgeons (ACS)
Past President, Board of Directors, AHA, Hampton Roads, Virginia
Past President, Board of Directors, International Association of Yoga Therapists (IAYT)
Chairman of Board, Life in Yoga Institute
Member, Virginia Governor’s Asian Advisory Board (2003-2018)
Chairman, Center for Integrative Medicine and Yoga, Taksha Institute, Hampton, VA
+1-757-621-7655 [email protected] http://www.dilipsarkar.com
Yoga Therapy for Heart Disease
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Yoga
Philosophy (Yoga Sutra of Patanjali) and Practice (Patanjali Ashtanga Yoga)
Outcome – Self Realization
Health Benefits – Byproduct
Used as Adjuvant Therapy for Chronic Dis-eases
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Yoga Therapy
Adaptation of the yoga practices based on the patient/client
clinical condition
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Ayurvedic Yoga Therapy
Yoga Therapy is Ayurveda
Yoga Therapy is AyurvedicYoga Therapy
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Yoga Therapy
�Evidence based medicine (conventional medicine)
�Practice based evidence (integrative medicine)
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My Book - Bibliography
Books Yoga Therapy Related25 Books
DVD For Healthcare Providers2 DVDs
Website For Yoga Therapy
20 websites
Journal References – only clinical journals from 1957 to 2016
75 articles
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Yoga Therapy for Health and Healing: A Daily Practice (2015)
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Yoga Therapy for Health and Healing: A Daily Practice (2015)
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Cardio Metabolic Disorders is METABOLIC SYNDROME
Component of metabolic syndrome.
Truncal obesity
Heart disease (coronary artery disease)
Diabetes
Hypertension
High cholesterol (dyslipedemia)
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Metabolic Syndrome Pathogenesis
Stress – Insomnia and Sleep Apnea –
Stimulates Limbic System
High Sympathetic Tone (hyper-arousal of Brain)
High Cortisol Level – refined carbohydrate
intake – sugar spike – increase in insulin –
converts sugar to omental fat
Truncal Obesity
Omental Fat Secreting Proinflammatory Molecule
METABOLIC SYNDROME
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Metabolic Syndrome (Cause)
� STRESS (fear of the unknown)
� Brain hyper-arousal by INSOMNIA and SLEEP APNEA
� Activates Emotional Brain, LIMBIC SYSTEM, and its nuclei amygdala, which responds to fear, and the hippocampus, which stores memories
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Yoga TherapyMechanism of Action
� Psycho
Limbic System
� Neuro
Hypothalamus
� Endocrinology
Pituitary Gland
Adrenal Gland
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Psycho-Neuro-Endocrinology
� Limbic system sends a signal to hypothalamus(supraoptic and paraventricular nuclei), the site of our homeostasis through neurotransmitters
� Hypothalamus sends a signal to the autonomic nervous system and pituitary gland
� Pituitary gland, through its adrenal cortical axis, releases hormones, causing altered hormonal homeostasis, which, combined with autonomic nervous system dysfunction, causes metabolic syndrome
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4/12/20Yoga for Cardio Metabolic Disorders Dilip Sarkar, MD, FACS, D.Litt (yoga)
Yoga Therapy is Relaxation Response
Activation of Parasympathetic Tone
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Yoga Therapy is
Relaxation
Response
(Meditation)
Meditation is Medication
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Meditation is Medication
T - TransformationC - Choice (Pills or Yoga Therapy)
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Yoga Therapy
EXPERIANCIAL
You are the creator of your destiny
(TRANSCENDENTAL)SCIENCE
Science beyond science
EXPERIMENTAL
Personal practice
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Body as Computer
� Body - Hardware
� Mind - Software
� Spirit - Programmer
Control Software for Hardware control
� Spiritual and emotional state of mind affect physical health and vice versa
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White Coat Hypertension
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Brain – Heart Connection
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Man with heart dis-ease winning lottery Memorize by heart
Yoga Therapy OutcomeAlan Brand 2013
� 73 years old white male
� Ischemic Cardiomyopathy with EF of 10-20%
� Multiple admission with acute CHF
� Severe CAD, non-operable
� With Yoga practice for six months, EF is 40%.
� EF is based on Peripheral Resistance and Cardiac Output. With reduction of PR and increase in CO the EF gets better.
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Yoga Therapy Outcome Alan Brand 2015
� Now 75 practicing daily Yoga Therapy learned headstand
� Developed increase in baroreceptor sensitivity
� Protecting from sudden change in hemodynamics and acute coronary events.
� On no medication
� Blood work
10.01.2014 03.23.2015
TCL 168 142
HDL 47 64
LDL 99 65
TGL 112 64
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Yoga Therapy OutcomeRobert Minyard 2015
� 76 yr. WM
� 1969 – Surgery (?) VSD
� 1989 - High BP 250/150
� 1998 – Surgery Descending Thoracic Aneurysm
� 2005 – Atrial Fibrillation
� 2006 – CHF
� 2013 – Pacemaker
� Yoga practice for 3 years, Daily at home Balancing Pose & Mudras, 2 hr. Sunday at Temple, 2 hr. Wednesday at Prime Plus
July 11, 2015
TCL: 145 HDL: 54 LDL: 76 TGL: 74
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Yoga Therapy OutcomeRobert Minyard 2016 77 yrs. WM
4/12/20Yoga for Cardio Metabolic Disorders Dilip Sarkar, MD, FACS, D.Litt (yoga)
Balancing poses improves CVD
1969 – Surgery (?) VSD1989 - High BP 250/1501998 – Surgery Descending Thoracic Aneurysm2005 – Atrial Fibrillation2006 – CHF2013 – Pacemaker
July 11, 2015TCL: 145 HDL: 54 LDL: 76 TGL: 74
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Regular Practice of Yoga
� Increases vagal tone
� Modulates the autonomic nervous system
� Causes rapid shift from sympathetic to parasympathetic activation
� Creates control over the autonomic nervous function
� Increases baroreceptor sensitivity
� Increases heart rate variability
� Improves cardio-respiratory fitness
� Improves quality of life.
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Yoga Therapy for Cardio Metabolic Disorder
Control the mind
� Through deep internal awareness, through
� Relaxation of the physical body (sithilikaran asana)
� Effortless yogic breathing (a slower rate, exhalation longer than inhalation, longer breath holding power)
� Calming down the mind with, savasana (corpse pose), pranayama, meditation, and mantra chanting.
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Start Yoga Therapy: Patients Cardio Metabolic Disorder
Sthiram (still, steady) Sukham (happy, comfortable) Asanam
Stages of Asana: Arambha (beginning), Sthiti (stability), Visharjana (immersion / surrender)
Awareness (no pain, comfortable discomfort)
Relaxation Response (Straight Spine – grounding poses or in a chair, Dhyana Mudra, Eyes Closed –mana sthir, Effortless Breathing - exhalation twice the inhalation, Vibration – om/aum creates same vibration of brain, Harmonic Resonance)
Effortless Pranayam – Vidhi (method), Samaya (timing),
Sankalpa (determination, Siddhi (attainment)
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Yoga Therapy for Cardio Metabolic Disorder
� Reduce truncal obesity through asanas such as mandukasana (frog pose) and slow kapalbhatipranayama (forehead shining breathing)
� Rx for Stress – Relaxation Response (physiological effects of Meditation)
� Rx for Insomnia – Bhramari Pranayama (humming bee)
� Rx for Sleep Apnea – Ujjayi Pranayama (victorious)
� Dinacharya – daily routine
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Rx: Yoga Therapy� One Hour of daily practice:
25 mins. each of Asanas and Pranayama, 10 mins. of Meditation
Pranayama: Effortlessly in stages to target timing
Bhastrika: active inhalation and exhalation (5 mins.)
Kapalbhati: passive inhalation and active exhalation (10-15 mins.)
Anulom-Vilome: alternate nostril breathing (5-10 mins.)
Nadi Suddhi: anulom-vilom with kumbhaka (retention) 10 times
Bhramri: close senses with sound of bee (7-10 times)
Shitali & Shitkari: cooling pranayam
Ujjayi: resistive inhalation
Sankha: resistive exhalation, conch shell breathing
OM / AUM or Udgeeth pranayam:
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Yoga Therapy
Transformation
Not to master the postures, but use the postures in stages for
transformation
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Yoga Therapy
� In stages impossible becomes possible - T.K.V. Desikachar
�With faith impossible becomes possible - Swami Satchitanand
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Primary Prevention
Parents with Hypertension, CAD, Diabetes
Genetic predisposition (high risk)
↓←Yoga Therapy
Genetic suppression
(prevent onset of genetic disease)
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Cleveland Clinic’s Lifestyle 180 program
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Cleveland Clinic’s Lifestyle 180 program
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Cleveland Clinic’s Lifestyle 180 program
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Secondary Prevention
Genetic predisposition (high risk)
↓← Life Style
Genetic expression (clinical disease)
↓←Yoga Therapy
Genetic suppression
(prevent progression or reverse disease)
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Tertiary PreventionGenetic predisposition (high risk)
↓← Life Style
Genetic expression (clinical disease)
↓←Yoga Therapy
Genetic suppression
(prevent progression or reverse disease)
Tertiary – Prevents Complications
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Rehabilitation
Genetic predisposition (high risk)
↓← Life Style
Genetic expression (clinical disease)
↓←Yoga Therapy
Better management of disease
Less pharmaceutical support
Better quality of life
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Positive Proof of Global Warming!
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Yoga Therapy
Mind – Body Hygiene
What will happen if you don’t brush your teeth for a month?
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Yoga Therapy
Yoga Therapy is
“Personalized Lifestyle Changes”
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Yoga Therapy
Lifestyle changes can be better than
drugs
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Yoga Therapy
� Yoga Therapy with other healing modalities can increase healing
synergistically
� Yoga is
TRANSFORMATIVE
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After a two-year visit to the United States, Michelangelo's David
Prakruti / Vikruti
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Origin of
Yoga Therapy
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Tadasana / Mountain Pose
Vrksasana / Tree Pose
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Vajrasana / Thunderbolt PoseSukhasana / Easy Pose
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Bhujangasana / Cobra
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Shalabhasana / Locust Pose
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Adho Mukha Svanasana / Downward Facing Dog, Marjariasana / Cat Pose
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Jathara Parivartanasana /Revolved Abdomen Pose
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Jathara Parivartanasana /Revolved Abdomen Pose
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Upavistha Konasana / Wide angle seated forward bend
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Paschimuttanasana / Seated forward bend, Prasarita Padottanasana / Wide legged forward bend
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Balasana / Child’s Pose
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Supta Baddha Konasana / Reclining bound angle pose
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Naukasana / Boat Pose
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