The Dangers of Cardiovascular Disease

Cardiovascular disease (CVD) is currently the leading cause of death worldwide, accounting for approximately 30% of all deaths.[1] Whereas CVD used to be understood in terms of conditions (like atrial fibrillation or hypertension) or events (like myocardial infarction or angina), it is now seen as a "broad spectrum of illnesses comprising hypertension, atherosclerosis, heart disease, stroke, peripheral vascular disease, and aortic vascular disease and their associated complication."[2] Not only is CVD the leading cause of death worldwide, it is also one of the leading causes of morbidity and disability as people along the continuum are living in compromised bodies.

The medical understanding of CVD has expanded greatly in the past few years. Doctors and researchers now describe "CVD as a chain of events initiated by several risk factors such as dyslipidemia, hypertension, diabetes mellitus, smoking and obesity”[3] which are known to promote oxidative stress and to cause endothelial dysfunction, initiating a cascade of events.[4] Yoga has the potential to act at several levels of this chain of pathophysiological events.[5]

Treatment, therapy and rehabilitation for and of CVD are diverse, ranging from surgical, pharmaceutical and lifestyle changes. While surgical and pharmaceutical treatments continue to save and prolong lives, doctors and researchers have learned much more about how patient’s choices and care for themselves can be effective in prevention of and rehabilitation after CVD events, as well as increasing quality of life for CVD survivors. Yoga therapies are important parts of lifestyle choices and care.

It is generally acknowledged that the vast majority of CVD, at all stages along the continuum, is caused by lifestyle choices. The Lifestyle Heart Trial,[6] a study conducted by Dean Ornish and a team of doctors and researchers, was the first and remains one of the most robust studies regarding the ability of lifestyle changes to slow and even reverse heart disease. That randomized clinical trial, conducted from 1986 to 1992 measured changes in blood fat profiles, angina episodes, and changes in coronary artery percent diameter stenosis between groups of patients that followed intensive lifestyle changes - a 10% fat, whole foods, vegetarian diet; aerobic exercise; stress management training; smoking cessation; and group psychosocial support — and a control group. Yoga was part of the stress management component of the program.

The study showed that the patients in the lifestyle changes group had a 37.2% reduction in low-density lipoprotein (LDL) cholesterol levels and a 91% reduction in the frequency of anginal episodes. Average percent diameter stenosis regressed from 40.0% at baseline to 37.8%.[7] The yoga in the Dean Ornish study was designed by Nischala Devi. The protocol she created for these patients included deep relaxation at several stages throughout each yoga session, not just at the end. The practice used for the trial can be found on Devi’s audio recording Relax, Move & Heal.[8] The effectiveness of yoga as a rehabilitative therapy or treatment for CVD was not able to be determined by this study as it was one component among several in the therapy protocol. However, the study did show that heart disease is indeed reversible to some extent and that healing and health can be in one’s own hands.

Many have focused on the other parts of this study - the low fat diet, smoking cessation, aerobic exercise -- for prevention, treatment and rehabilitation of heart disease. However, people who adhere to these components of a healthy lifestyle can find themselves with CVD, which indicates that there is more nuance to cardiovascular health. For example, Deane Delmas, a 72-year-old social worker from Texas, saw her lifestyle as extremely healthy when she had her cardiac event leading to an angioplasty. She ate a healthy diet and was a long distance runner competing in marathons. She seemed to already being doing everything to take care of her health and her heart. She said "After I got back on my feet again, I began to look at my schedule. It was all assertive, aggressive—lifting weights, brisk walking, and the like. Something was missing.”[9]

It turns out how you are with and in your body matters especially to cardiovascular health and rehabilitation. The Western world has a colloquially identified a personality type called Type A, which refers to people who are “high strung, “ aggressive,” “achievement oriented,” “hard-driving.” These people are always “on,” don’t sleep enough, drink a lot of caffeine, are intense and have a sense of urgency about time. There are many ways to describe this “personality type.” In an Ayurvedic view these people are pittas or have excessive pitta dosha. They are fiery and intense and without balance. These personality traits and emotional dispositions have been strongly linked through multiple studies to heart attacks.[10]

The characteristics of Type A or excessive pitta dosha people are those of stress. Stress, very generally, is our response to environmental and psychosocial situations. Researchers have sought to be more specific about “normal” response to stress and stress responses that are “ abnormal" because they contribute to disease. The term allostatic load refers this kind of “abnormal" stress response.[11] "When the brain perceives an experience as stressful, physiologic and behavioral responses are initiated leading to allostasis and adaptation. Over time, allostatic load can accumulate, and the overexposure to neural, endocrine, and immune stress mediators can have adverse effects on various organ systems, leading to disease.”[12] Allopathic load is more than stress or even chronic stress; it "sets into motion adaptive processes that alter the structure and function of a variety of cells and tissues.”[13]

There is increasing evidence from clinical trials that the “mechanism of action by which yoga therapy helps patients with heart failure is likely due to autonomic nervous system modulation. It has been well established that in patients with heart failure there is sympathetic overdrive … yoga therapy facilitates the balancing of sympathetic and parasympathetic nervous systems”.[14] Vascular surgeon Dilip Sarkar states that “yoga therapy for cardiovascular disease is primarily targeted to control the mind through deep internal awareness. This is achieved through relaxation of the physical body, effortless yogic breathing, and calming down the mind with prolonged savasana, pranayama, deep meditation, and mantra chanting.”[15] Nischala Devi states, “we are trying to reverse the behavioral patterns of overachieving and pushing beyond limits.”[16] Yoga seems to be an ideal intervention and rehabilitative therapy for addressing the stress, anger, and intense life orientation that are proven CVD risk factors.

The yoga protocols - or routines - used in treating CVD vary. The yoga is often, but not always, performed in a chair. The sequences focus on joint-freeing (neck, shoulders, wrists, ankles, hips), moving with the breath, gentle forward and backward bends, gentle inversion (viparita karani), deep relaxation (savasana), pranayama (slow breathing with the exhalation longer than the inhalation, possibly chaining OM on exhalation), and alternate nostril breathing (nadi shodhana). These yoga practices can intervene at virtually any stage along the CVD continuum and are particularly important for anyone already identified as being on the continuum or in cardiac rehabilitation after a cardiac event.

References:

1 Khalsa, S.B.S., Cohen, L., McCall, T., & Telles, S., (Eds.). (2016, 2017). The Principles and Practice of Yoga in Health Care. United Kingdom. Handspring Publishing. P. 277

2 Khalsa, p. 277

3 Khalsa, p. 277, referencing Dzau, V.J., Antman, E.M., Black, H.R., Hayes, D.L., Manson, J.E., Plutzky, J., … Stevenson, W. (2006). The cardiovascular disease continuum validated: clinical evidence of improved patient outcomes: Part I: Pathophysiology and clinical trial evidence (risk factory through stable coronary artery disease). Circulation, 114(25), 2850-2870.

4 Khalsa, p. 277

5 Khalsa, p. 278

6 Ornish, Dean, et al. (1999). Intensive Lifestyle Changes for Reversal of Coronary Heart Disease. Journal of the American Medical Association. 280 (23). 2001-7

7 Ornish, p.2001

8 McCall, T., (2007). Yoga as Medicine: The Yogic Prescription for Health and Healing.New York, New York. Bantam Books.pp. 342-3

9 Barrett, J., Heart to Heart. (2007). Retrieved from https://www.yogajournal.com/lifestyle/heart-to-heart

10 McCall, p.377

11 University of California Medical Center (UCSFMC) Research Notebook on SES & Health: Allostatic Load Notebook. (2009).. Retrieved from https://macses.ucsf.edu/research/allostatic/allostatic.php

12 UCSFMC

13 UCSFMC

14 Khalsa, p. 285 referencing Kishi, T. (2012). Heart failure as an autonomic nervous system dysfunction. Journal of Cardiology, 59(2), 117-122.

15 Khalsa, p. 295

16 Khalsa, p. 295
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Deb McDermott is a first-year student in Yoga Therapy at Prema Yoga Institute. She has been a Yoga teacher for 20 years and recently completed a 40-hour training on Trauma Center Trauma Sensitive Yoga (TCTSY) with David Emerson and Jenn Turner.

Nose Ahead of Stress ANB – The Insider’s Life Hack

“Alternate Nostril Breathing” – mistakenly called “alternative nostril breathing” by some news sites – is an old and reliable way of managing stress. It is traditionally known in Sanskrit as Nadi Shodhana. ‘Nadi’ translates to channel or flow and ‘shodhana’ means cleaning or purifying. It can take as little as 2 minutes, but no more than 15, to manage hormones, stress, feelings of anxiety and depression.

Here’s how PYI’s Mindfulness teacher, Karen Nourizideh teaches it:

Nadi Shodhana (Alternate Nostril Breathing)

Purifies the body and stills the mind, brings oxygen to both hemispheres of the brain.

Place the right-hand index and middle fingers between the eyebrow center, the right thumb closes off the right nostril.

Inhale through the left, count “Inhale 1, Inhale 2, Inhale 3”.

Close off the left nostril with the right-hand ring finger, exhale through the right, count “Exhale 1, exhale 2, exhale 3”, inhale through the right nostril, close off the right nostril, exhale through the left for 3 count, inhale thru the left through 3 count, close off the left, exhale through the right, etc.  End on the left side exhalation.  Practice at least 10 rounds.

Nadi Shodhana has immediate effect on cardiovascular, pulmonary and higher functions of the brain.  Nadi-shodhana pranayama practice for 20 minutes showed statistically significant difference in Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Reaction Time (RT) and Peak Expiratory Flow Rate (PEFR).*

*Subbalakshmi NK, Saxena SK, Urmimala Urban JAD, Immediate effect of nadishodhana pranayama on some selected parameters of cardiovascular, pulmonary and higher functions of the brain. Thai Journal of Physiological Sciences, 18(2):10-6, 2005.

(“Just Breathe” photo by Robin Benzrihem.)
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Author:
Dana Slamp with additional writing by Carolyn Davis.

Dana Slamp is the Founder of Prema Yoga Institute, and considers herself a lifelong student. She's grateful for the expert faculty of PYI, and the extended PYI family of #premapeeps. Danaslamp.com

5 Yoga Tips to Transform Old Habits

It’s the middle of January, deadly freezing, and a time when that New Year’s resolution starts to dissolve away – just when we need our tenacity the most!

We’re sharing advice from the philosophy of yoga below, along with some expert tips to follow your intention (funny, they sound a lot alike!)

1. Combat the Kapha Season

This is the kapha season – or “earth” season – in the Ayurvedic calendar.  At a time when you dearly want to stay inside, you’re meditative or contemplative practice will benefit. Take time to explore – especially in these days around the lunar eclipse. 

The downside is that the kapha season can bring us a little too low – there’s a tendency towards depression, weight gain, and inactivity.  Combat this by getting to class!  This is the one time of year where hot yoga (but not too hot) is truly therapeutic.  Vinyasa and Ashtanga are great choices as well – keep moving once a day, favor warm cooked foods, and get as much of sun as you can.
 
2. Replacement Therapy?  The Sutras Say it Works

Charles Duhigg, the author of “The Power of Habit,” recommends identifying the triggers to your old habit – which can be from time, location, people, emotion, or ritual.  Once you find your trigger, you can intercept your pattern by taking an entirely new one.  The Yoga Sutras state that: 
 
“2.33 When disturbed by negative thoughts, opposite (positive) ones should be thought of. This is Pratipaksha Bhavana.”
 
Next time you wanna reach for the cigarette, the phone, or the remote, try replacing that pattern with a positive one.  Of course, the Sutras concern themselves primarily with thought.  But as the thought always precedes the action (even if primal or subconscious), try to dig a little deeper into why you have been keeping that habit.  Leading to the next step…
 
3. Get to the Root Cause

Many are taught that absolutely everybody has an objective, even if that objective is subconscious, and that every action – however negative – has some positive reward.  Getting to the root cause is critical.  We recommend journaling – sitting down and just downloading any “whys” of your old habits on paper.  You can even burn this paper as a mental and ritualistic way of discarding your old reward system.  Then, circle back to step 2, asking yourself, How can I get that reward in a healthy way?

The Sutras also say that ignorance is the root of all suffering.  Use your inquiry of “why” to dig deeper for a more lasting result.
 
4. Find your Support System

Have you ever heard about the study that says that you’re only as healthy as your 5 closest friends?  Pay attention to whom you are spending your time with, and what you are up to.  Yoga class, a yoga training, or a meditation group are a great way to meet like-minded people who support your new intention.
 
5. Plan to Fail…But Celebrate Anyway

Odds are that not every day of January is going to be full of love & light for you, with 100% clean eating, pure thoughts, depressant/stimulant free, and full of yoga & cardio classes.  Experts recommend cultivating a recovery plan for those not-so-stellar days.  A go-to plan is to schedule in my positive behavior, marking on your calendar when and where you will follow through with healthy habits (especially after a day that involved –say, half a cake & Hulu binging). Whether you manage your tasks with a calendar or a checklist, be sure your new habits are on it.

In a great article on resolutions, the New York Times highlighted that small celebrations are a successful way to support your change.  Celebrating is a form of reward and personal affirmation – and can be as simple as telling a friend about your success & taking in their compliments & support.  

The most effective everyday celebrations are emotional – give yourself a pat on the back every time you follow through with a good intention (or discard an old habit).  This is how we bring out the shy, new patterns, and say goodbye to the old routine.
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Author:
Dana Slamp with additional writing by Carolyn Davis.

Dana Slamp is the Founder of Prema Yoga Institute, and considers herself a lifelong student. She's grateful for the expert faculty of PYI, and the extended PYI family of #premapeeps. Danaslamp.com