Can yoga prevent heart disease ?



Heart diseases are the leading cause of mortality and disability throughout the world and their incidence is increasing in developing countries especially India. The reason for this rapid increase in heart diseases is unhealthy life styles consisting of high fad diet, lack of exercise, mental stress and tobacco consumption.  


Yoga is not merely a few postures (Asanas) but a holistic life style which includes all components of healthy life style like low fat vegetarian diet (satvik diet), tobacco avoidance, physical exercise and stress management and therefore has the potentiality to prevent heart disease. But is there scientific evidence? 


Scientific evidence 


Many research studies have documented the usefulness of yoga in the treatment of various lifestyle related diseases especially cardiovascular disease. A brief summary of scientific evidence is presented below. 



  • Control of heart disease risk factors: Several studies suggest that regular yoga practices can significantly improve coronary heart disease risk factors as lipid profile, body weight and blood pressure (1-3). Schimdt et al reported a significant improvement in the levels of blood pressure, LDL cholesterol and body mass index after 3 months residential training consisting of vegetarian diet and Kriya yoga (2). In another randomized controlled study, Mahajan et al(3) showed similar reductions in the Interventional group practicing yoga.

  • Regression of coronary artery disease: Three controlled studies (4-6) utilizing coronary angiography have demonstrated that yoga practices with low fat vegetarian diet caused significant regression of coronary obstructions in comparison to the usual care control group. In addition the need for interventional procedure was significantly reduced. LDL cholesterol, triglycerides, body weight, angina and exercise induced ischemia were significantly reduced in the yoga groups. All three studies reported excellent compliance.

  • Yoga and Hypertension: Several controlled and uncontrolled studies have shown the long term usefulness of yoga in the treatment of hypertension (2,7-9) Shavasana (Corpse posture) was shown to lower blood pressure significantly in earlier studies (1). In a randomized trial, yoga was found to be equally effective as antihypertensive therapy over a 11 week period (2). One randomized controlled study demonstrated that yoga is capable of producing a long term beneficial effect in the treatment of hypertension (7). The mechanism of reduction of blood pressure has been considered to be restoration of baroreceptor sensitivity by yoga (8-10).

  • Other benefits of yoga: Yoga has also been shown to improve various pulmonary cerebral, mental and metabolic physiologic functions, producing beneficial effects on the cardiovascular status. Some of the beneficial effects include better breath holding capacity, improved tidal volume and vital capacity, improvement in physical fitness (11), reduction in anxiety (12) and improved sugar levels among patients with diabetes. Ana association between increased cerebral blood flow and transcendental meditation (TM) has also been shown (14).

  • A unique phase of relaxation: referred to as ‘the fourt state of consciousness’ (the other three being waking, dreaming, sleeping) has been described during TM (13, 14). This state is characterized by not only the usual change seen in deep relaxation such as reduced cortisol and plasma lactate levels, decreased muscle and red cell metabolism and reduced breath rate but also by an increased alpha brain wave activity and a distinctive pattern of enhanced cerebral blood flow. Regular yoga practice has also been shown to have positive effects on mood and emotional well being (15). Improved muscle strength and relaxation response have also been reported (15, 16).





To conclude: Yoga is a holistic life style intervention which includes all components of healthy life style like stress management, low fat vegetarian diet (Satvik diet), tobacco cessation and physical exercise. Several scientific studies have shown that yoga can control risk factors for coronary heart disease, can lower high blood pressure, elevated blood sugar, can improve emotional well being and induce relaxation. Many studies suggest that yoga can retard the progression of advanced coronary atherosclerosis and even reverse it. Though most of the studies are small and large trials are needed to confirm the findings, yet in view of the existing knowledge, it appears appropriate to incorporate yoga for prevention and management of certain heart diseases and also for leading a stress free, happy life. 


References 



  • Raub et al: Psychophysiologic effects of yoga on musculoskeletal and cardiopulmonary function, a literature review J. Altern Complement. Med 8:797,2003

  • Schimdt T et al: Changes in cardiovascular factors and hormones during comprehensive residential three months. Kriya yoga training and vegetarian nutrition. Acta Physiol Pharmacol 42:205,1998

  • Mahajan AS et al, Lipid profiles of coronary risk subjects following yogic life style intervention. Indian Heart J 51:37,1999

  • Ornish D et al Can lifestyle changes reverse coronary heart disease? The lifestyle heart trial Lancet 336.129,1990

  • Manchanda S.C et al Retardation of coronary atherosclerosis with yoga life style intervention. J. Assoc.Physc, India 48:687,2000

  • Gupta, S et al. Reversal of coronary heart disease by Rajyoga. Vegetarianism and exercise. Worlds conference on Clinical Cardiology and Preventive Cardiology, Mount Abu, India, September, 2006

  • Patel C Twelve month follow up of yoga and biofeedback in the management of hypertension Lancet 1.62,1975

  • Marugesan E et al: Effort of selected yoga practices on the management of hypertension 44:207:2000

  • Selvamurthy W et al: A new physiological approach to control essential hypertension Indian J. Physiol Pharmacol 42:205,1999

  • Bernardi L et al Slow breathing increases arterial baroreceptor sensitivity in patients with chronic hear failure Circulation 105:143,2002

  • Bensen H The Physiology of Meditation Sci Am 226,84,1972

  • Fenwick P.B. et al: Metabolic and EEG changes during transcendental meditation: an explanation Biol Psychol 5:101,1977

  • Jevning R Wilson AF Behavioural increase of blood flow: Complement Med 7:359:2001

  • Sharma H, Clark C. for Ayurveda. Medicine and research in Maharishi Ayurveda ist Ed. Philadelphia, Churchill Livingstone 1998

  • Ananda S. The complete book of yoga: Harmony of body and mind. Ist ed, Delhi, India. Orient Paperbacks, 1981 (reprinted 2001)

  • Alternative medicine- Expanding Horizons, A report to the NIH or alternative medical System and Practices in the USA, 1992


Life style and heart disease



Heart diseases are the leading killer of mankind global. Initially the epidemic of heart diseases started in the West where it has started to decline but these diseases are now rapidly increasing in the developing countries like India. It has been predicted that deaths due to coronary heart disease (CHD) will double in India in the next 20-years. Studies on immigrant Indians from UK, USA, Singapore and South Africa have demonstrated that Indians are about 2-4 times more susceptible to get CHD as compared to the native population.


What are the causes of this rapidly increasing epidemic in India? Well, there appear to be three main reasons: First are the demographic factors (increased life span), second are the lifestyle changes, “diet, exercise, tobacco, stress” and third are the genetic factors. However, the most important reason appears to be life style changes. It has been observed that our diet has changed (to high fat, low fiber, fast food habits), physical exercise has decreased, rapid urbanization has caused mental stress and tobacco consumption unfortunately, has increased (unlike in US where smoking has markedly reduced). How do these alterations in life style cause coronary heart disease?


Diet


Diet has a close relation to several diseases like hypertension, diabetes, obesity, dyslipidemia (increased cholesterol) which are all risk factors for CHD. Increased fat consumption especially from fat foods causes obesity. High intake of cholesterol (found only in animal products like egg, meat and milk) and saturated fats (found in butter, ghee, milk, cream and coconut oil) increase blood cholesterol and are harmful for the heart. However, mono saturated and polyunsaturated fats (especially n-3 type) have lower cholesterol and are heart healthy. An oil with low saturated fats, high mono saturated fats and n3 polyunsaturated fats like mustard, rapeseed, canola, olive or soyabean is considered good for the heart. Fruits and vegetables are rich source of fiber, antioxidants and phytochemicals which lower risk of CHD. Several plant foods like oatbran, soya, gram, psyllium husk (isabgol), garlic etc have been shown to reduce cholesterol. Hence, a vegetarian diet of cereals, fruits and vegetables is ideal for prevention of heart disease.


Physical exercise


Regular physical exercise (like brisk walking for 30 minutes daily, jogging, cycling, swimming etc) lower obesity, cholesterol levels, high blood pressure and diabetes and hence should be performed daily to reduce heart disease. Physical exercise is also good for the lungs, bones, and joints and the whole body. So it is rightly said that “regular physical exercise not only adds years to life but puts life to years”.


Tobacco consumption


Any type of tobacco consumption (smoking cigarettes, biris, hooka, cigaer or chewing tobacco in zarda, pan masalas etc) can cause several diseases like heart attacks at a young age, cancer of lungs, mouth, throat, bronchitis, blockage of arteries of legs and feet etc. Tobacco was responsible for 3 million deaths globally in 1996 and by 2020 it is estimated that about 8 million people will die mostly in the developing countries. In India, the deaths attributable to tobacco use are predicted to increase from 1.4% to 13 % by 2020.


Mental stress


Due to rapid urbanization and rapid pace of life, mental and psycho social stress has markedly increased in modern times. Several stressors like lack of social support, depression, anger, hostility etc have been shown to be risk factors for CHD. Relaxation techniques especially yoga can reduce the risk of CHD and several other stress related diseases.

Yoga is not merely few postures or asaas but a holistic way of life which includes all components of healthy life style like low fat vegetarian diet, tobacco avoidance, physical exercise and stress management. Recent scientific studies by Deam Ornish in USA and Manchanda from India have shown that yoga lifestyle is of extreme benefit in patients with a heart disease. Yoga lifestyle lowers cholesterol, improve angina and even reverses the blockages in coronary arteries apart from reducing stress. Yoga life style appears to be holistic and cost effective approach to tackle the growing menace of coronary heart disease by improving life style.


In conclusion, the rapidly increasing epidemic of heart disease in India appears to be related to unhealthy life style diet, regular exercise, tobacco avoidance and stress management should be able to prevent coronary heart disease to a large extent. Yoga life style appears to be a holistic approach for healthy life style and should be adapted to control the growing menace of heart disease in India and elsewhere.