May 3, 2021 | 75 minutes, 43 seconds
In This Article
Podcast Show Notes
In this episode of the Ayurveda Meets Modern Science podcast, host John Douillard, DC, CAP, interviews author and yoga therapist Evan Soroka (also find her on Instagram, Youtube, & Facebook) about yoga and Ayurveda for diabetes, including bringing the simple and sacred into diabetes care, pranayama techniques for change, and the act of self-care as self-love. Soroka is the author of Yoga Therapy for Diabetes, which is about approaching living with diabetes from a multidimensional perspective.
Thriving with diabetes is not impossible, but it requires work. For many, the weight of diabetes carries a heavy burden, reducing physical longevity, mental health, and quality of life.
One of the biggest challenges people with diabetes face is upholding diabetes management requirements. Of the 34 million1 people living with diabetes in the US today, only about 40% of type 2s2 and 21% of type 1s are meeting the recommended blood glucose levels despite treatment innovations.3
Diabetes is a highly personalized disease that requires intense monitoring and decision-making skills on the part of the individual. They must be their own best advocate. But this has consequences, too. Like with anything close to us, especially a disease, it becomes difficult to see a separation. We think we are the disease and, as such, lose autonomy.
Education about long-term risks, recommendations about diet, exercise, and blood glucose mitigation is part of the standard of care. Still, there are not sufficiently dynamic or applicable strategies to help transform perception and behavior. And there is little guidance about how to manage the technical details without losing your autonomy or sense of self outside of being diabetic.
Diabetes Support with Yoga and Ayurveda
What makes the ancient practices of yoga therapy (yoga cikitsa) and Ayurveda specialized for diabetes and ironically innovative is how they provide a method through which people can simultaneously see their disease and link to positive and self-referential sources of support.
By teaching people how to view diabetes through the lens of Ayurveda and yoga, we awaken a new vantage point. People can understand what gets thrown out of balance and the underlying causes behind those imbalances. Awareness breeds empowerment through action.
It starts with simple intervention strategies to feel better in real-time. When people feel better, they do better. Daily sadhana (practice) transforms the ordinary into an extraordinary mechanism for protection, prevention, and longevity, helping to manage the stress of having this disease.
Why Diabetes is Stressful
Diabetes is stressful and will always be stressful. Stress is one part-real, one part perceived. There is an actual, physical stress of what high and low blood sugars do to the body. There is the mental stress of trying to keep everything in “control” while simultaneously navigating life. There is the stress of letting go of an old life and accepting a new way of living. Stress can be detrimental, increasing risk, or it can be an asset, increasing resilience.
It is no secret that stress wreaks havoc on a person’s metabolic profile, increasing insulin resistance, oxidative stress, and obesity and making glycemic control nearly impossible.4 Chronic stress increases inflammation, blood pressure, and heart rate and further perpetuates a vicious cycle of hyperglycemia, oxidative stress, obesity, poor sleep, and disturbed mood, heightening emotional reactivity and perpetuating negative coping behaviors.
Stress damages our stress responses, blunting cortisol production, increasing anxiety and heightening the risk for mental health disorders like diabetes distress, eating and sleep disorders, generalized anxiety disorder and depression.
Studies show that psychiatric disturbances negatively impact metabolic control and quality of life. People with diabetes are at an increased risk of developing anxiety and depressive disorders than non-diabetic populations.5
Daily yoga and Ayurveda practices and self-care routines reduce the impact of stress.
Ayurveda and Diabetes
Ayurveda is a sacred science of daily rituals, helping us to live in alignment with nature, understand what throws us out of balance, and learn how to re-establish it. It teaches us the way of transition, or the science of health.
According to Ayurveda, all disease originates in the gut,6 so the answer to disease prevention and healing starts by building back the digestive fire of agni and restoring the protective prowess of ojas, the vital essence.
Diet is a considerable subsect of diabetes care and an area where many falter. It is no wonder. Many are told to abstain from certain foods, and like anything, if you’re told you can’t have something, it makes you want it more.
Ayurvedic rituals teach more mindful forms of eating other than “right” eating. They teach you how to slow down and observe transitions—the transition between each bite of food, each meal, the change of blood sugars after meals, between meals, and everywhere in between.
With Ayurveda, it is all about balance. By learning Ayurvedic principles like the doshas, understanding one’s constitution and dinacharya, eating seasonally and according to the day’s rhythm, one can glean wisdom on the nature of balance and imbalance, making small shifts for large gains.
A significant problem for people with diabetes is the health of their digestive system. The microbiome comprises the bacteria in our stomach and digestive tract and works closely with the immune system to stave off inflammation and disease.7
An Ayurvedic-inspired diet help promote digestion by eating well-balanced, nutrient-dense meals. People with type 1 diabetes, a vata disease, benefit from warming, spiced food that won’t require too much energy to digest. For people with type 2 diabetes, typically a kapha condition, reducing heavy fats and oils combined with walking after meals will quicken digestion.
Organizing the largest meal of the day during the midday—the pitta time of day—helps reduce sluggish digestion and hyperglycemia at night. Exercising in the morning during the kapha time of day, on an empty stomach, allows people with type 1 diabetes to minimize the risk of hypoglycemia, and can help type 2s with weight loss, improved glucose metabolism, and cutting down on insulin resistance.8
Yoga and Diabetes
The starting point of yoga is self-awareness. Yoga postures improve proprioceptive and interoceptive awareness, anchoring you into the present. People feel their bodies, move their bodies and understanding the connection between sensations with actions, thoughts, mood and blood sugar levels.
Yoga and, in particular, breathing practices, or pranayamas are the most powerful way to restore autonomic balance after a blood sugar swing. For example, if someone is hyperglycemic, working with the inhale and then the exhale can help balance the nervous system, especially if the high is from chronic stress.
Slow-breathing practices and hyperoxia, or a state of saturated oxygen intake, have been shown to improve the health of the autonomic nervous system and arterial function in type 1 diabetes.9 Regular yoga has been shown to decrease the hyperactivity of the HPA axis and sympatho-adrenal system, which regulate stress response, while increasing the activation of the parasympathetic nervous system and vagal tone in type 2 diabetes,10 leading to an improved metabolic profile, reduced stress, and improved physical function and executive decision making skills.11 Similar benefits appear in type 1 diabetes, but are yet to be scientifically proven.”
Consistently regulating the nervous system with yoga regenerates the body’s adaptive stress responses—important both for metabolic function and mental health. Ultimately we want to train the body and mind to be adaptive to stress to improve the body’s autonomic responses and promote executive function.
The result of regular self-administered practice is self-efficacy. When a person knows that they can make themselves feel better, they are less identified with their disease and more empowered to live their lives co-existing with diabetes.
Pranayama and Diabetes
We need to be able to turn on our stress responses as readily as turn them off. Some breathing practices are calming and soothing, like abdominal diaphragmatic breathing and lengthening the exhale. Other practices are more stimulating like kapalabhati—a quick exhale derived by snapping back the belly and then relaxing it. Some breathing is nourishing and internalizing like increasing the inhale and the hold after the inhale. Some is balancing like nadi shodhana, an alternate nostril breath.
The benefit of breath work is achieved when we can execute it without tension. But when we’re stressed or taxed, the resistance shows up in the breath. So we learn to train it. One strategy I recommend to train either the inhale or the exhale is something called viloma krama, a two-part or three-part exhale breath. In this technique you divide your inhale (anuloma krama) or exhale into segments with an equal pause in between.
Working with the inhale can be helpful for mental hyperactivity, and working with the exhale helps to calm and soothe the nervous system, an excellent strategy when there is depletion of any kind.
A Breathing Practice for Diabetes
Try this pranayama for extending your exhale and calming your nervous system:
- Begin to deepen and lengthen your breath, breathing in and out at an equal rate.
- Exhale three seconds by contracting the navel.
- Pause for three seconds.
- Exhale another three seconds.
- Pause three seconds.
- Exhale for three seconds, to a comfortable empty.
- Pause three seconds.
- Then inhale slowly without tension. Repeat a minimum of six times.
Diabetes and Self-Care
The act of self-care is self-love. Years ago, I traveled in Japan and was most impressed by how the Japanese bring the sacred into everyday life, transforming even the most mundane tasks into meaningful experiences. Everything was performed reverentially, from wrapping a gift to flipping a chicken kabob or using a public restroom. It is this appreciation that we need to bring to our daily treatment of diabetes.
If we look far back enough to the source of all actions, we will find a motivation—it goes back to the paradigm of love versus fear.
I ask my students with diabetes to consider why they are practicing self-care. Is it to check off a box, receive a gold star from their doctor, or is it because they recognize that their life is sacred?
When a person starts to feel better, they do better. They recognize that their life is a gift.
Like attracts like.
People with diabetes are more positively motivated by intrinsic factors like feeling energetic and vibrant versus extrinsic motivators like a blood glucose level or a doctor’s praise.12 This transition does not happen in a vacuum; it is progressive and slow, taking time to reconstruct itself within each person. This is why we need simple, practical strategies that can easily be conducted throughout the day.
You don’t have to move into a remote cave and start meditating all day to benefit from the simple, subtle beauty that yoga and Ayurvedic practice bring to life. A daily ritual, a breathing practice, a walk after a meal, a pause before a bite can be the first step and a lasting anchor into the present moment.
When we are present, we are clear. When we are clear, we have intention. Intention transforms behavior. Behavior is our link to freedom.
You may be reading this with diabetes or know someone who has diabetes and wonder, well, what’s the next step? I’ll tell you that after 23 years with diabetes myself that the starting point is now. Dive into yourself. You are the sacred. It is in every moment, from this breathe, this finger poke, this day we derive meaning from our lives and in turn, self-create health.
We have an opportunity at all times. Diabetes is challenging, yes. But it is so much sweeter when living with it as a companion rather than an adversary.
Evan Soroka, E-RYT 500, C-IAYT, has lived with type 1 diabetes since adolescence. She is the founder of Soroka Yoga Therapy in Aspen, Colorado, and author of Yoga Therapy for Diabetes. Evan is a featured yoga therapist for Yoga International and runs online programs for diabetes.