diabetes

Mindfulness and meditation for diabetes management

wildmind meditation newsDavid Mendosa, Mendosa.com: Last night my thoughts returned again and again to a missing package. The sender had written me that my order had been delivered, but I hadn’t received it. I tried and tried to suppress that thought and to get back to sleep. Finally, meditation helped.

This was for me a painful example of what psychologists call “thought suppression.” Like many people, I have experienced thought suppression lots of times. But I don’t remember having read about this concept before starting to prepare this article, which reviews a new study of how meditation and mindfulness can help people with diabetes and …

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Mindful eating helps with lowering weight and reducing blood sugar

Eating mindfully is just as effective as adhering to nutrition-based guidelines in reducing weight and blood sugar levels in adults with Type 2 diabetes, a new study at Ohio State University suggests.

In a comparison study of the effectiveness of the two types of behavioral interventions, participants lost about the same amount of weight – an average of between 3 1/2 and 6 pounds – and lowered their long-term blood sugar levels significantly after three months.

One treatment group followed an established diabetes self-management education program, with a strong emphasis on nutrition information. The other group was trained in mindful meditation and a mindful approach to food selection and eating. Both interventions, involving weekly group meetings, also recommended physical activity.

“The more traditional education program includes general information about diabetes, but with more emphasis on nutrition and food choice: What are different types of carbohydrates and fats and how many am I supposed to have? What should I look for when I read a food label? What are healthy options when dining out? That was the traditional diabetes education program,” said Carla Miller, associate professor of human nutrition at Ohio State University and lead author of the study.

“We compared it to an intervention where mindful meditation was applied specifically to eating and food choices. This intervention group did not receive specific nutrition goals. We said we want you to really tune into your body before you eat. Take a few minutes to assess how hungry you are and make conscious choices about how much you’re eating. Stop eating when you’re full.

“We studied two very different approaches, and we found they both worked. This means people with diabetes have choices when it comes to eating a healthy diet,” Miller said.

The research is published in the November issue of the Journal of the Academy of Nutrition and Dietetics.

Participants were adults between age 35 and 65 years and had been diagnosed with Type 2 diabetes for at least one year. To be eligible, they had to have a body mass index, a measure of weight relative to height, of 27 or more, indicating they were overweight, and a hemoglobin A1c (HbA1c) reading of at least 7 percent. HbA1c measures blood glucose levels in the previous two to three months; normal HbA1c is 5.6 percent or lower.

Study participants were randomly assigned to a treatment group. Twenty-seven completed the mindful eating program, and 25 completed the traditional diabetes self-management program called “Smart Choices.” Each intervention involved eight weekly and two biweekly 2 ½-hour sessions with trained facilitators.

Trainers of the mindfulness program encouraged participants to cultivate “inner wisdom,” or mindful awareness related to eating, and “outer wisdom,” which referred to personal knowledge of optimal nutrition choices for people with diabetes. Each session included guided meditation oriented toward participants’ experiences and emotions associated with food. Participants received CDs for help with home meditation practice.

“We have so many environmental cues to eat in America that we’ve tuned out our normal physiological signals to eat. Being mindful means stopping long enough to become aware of these physiological cues,” Miller said. “We also tried to generate awareness, staying in the moment, and living and eating in response to hunger instead of habits and unconscious eating.”

The mindful intervention also included basic information about what is known as medical nutrition therapy: the relationships among calories consumed, carbohydrate and fat intake, weight regulation and high blood sugar.

In contrast, the Smart Choices program focused specifically on the condition of diabetes itself, including factors that can lead to the diagnosis, common complications (which include heart disease, kidney and nerve damage, eye problems and stroke), the importance of blood sugar control, and appropriate food choices when blood sugar levels spike. Every session included a medical nutrition therapy discussion such as calorie-intake goals, percentages of carbohydrates and fats in an ideal diet, and portion control. Many sessions included a 15- to 20-minute walk to further emphasize the recommendation for regular physical activity. Problem-solving regarding choosing healthy foods in high-risk situations, such as the holidays, were a focus of the program.

The interventions took place over three months. Researchers assessed participants’ health measures and dietary habits immediately after the programs concluded and then again three months later at the study’s end.

Miller said that because nutrition education is particularly important to people with a new diabetes diagnosis, she sees the mindful meditation and eating option as a potential supplement to basic diabetes education that patients need.

She also said that participants adapted well to the concept of mindfulness even though it is generally considered an alternative health practice.

“One of the things we were evaluating was how well this was accepted by people who had no experience with it. It was very well accepted by participants in that group,” she said. “And this tells us that people with diabetes have choices.

“The fact that both interventions were equally effective suggests that we should let people choose. If mindful meditation is appealing and people think that approach is effective, then it very well could be the best choice for them.”

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Mindfulness meditation: a new way to help diabetics?

Research is showing a certain type of meditation may help people suffering from diabetes. This stress reduction works in many different ways and provides calming strategies as well as ways to discipline the mind.

“There is little research on this process when it comes to this treatment of diabetes,” Joseph B. Nelson, MA, LP, CST, told Ivanhoe. He defines mindfulness as “intentional awareness of each moment; non judgmental; internal and external awareness.” Nelson stresses mindfulness is not about relaxing; rather, it is about becoming fully awake and aware. In addition, Nelson said, “Mindfulness is not meditation; it’s a way to live.”

Nelson believes through mindfulness-based stress reduction (MBSR), people with diabetes will be able to relieve stress and anxiety. At the 2010 American Diabetes Association Conference, Nelson talked about a pilot study that was conducted on diabetic patients. He said through the practice of MBSR, patients showed lower blood pressure levels as well as reduced stress, anxiety, and depression.

Nelson presents seven attitudes that are taught during mindfulness meditation. They are: Be non-judgmental, have patience, use a beginner’s mind, trust (yourself and your environment), be non-striving (do not try to make something happen, concentrate on the present moment at hand), accept what you are given, and lastly, let go.

Through self-calming strategies and skills, such as using breathing as an anchor, practicing the seven attitudes previously mentioned and being self-aware of your internal dialogue (your triggers), you will be able to calm down and rid yourself of any other stressors and anxieties in your life. In addition, Nelson says it’s important to discipline the mind by not getting carried away with trivial things.

Nelson firmly believes that MBSR practices will decrease depression, anxiety, fears, and eating disorders (common among diabetic patients). By practicing mindful meditation, patients are able to decide what is important to stress over and what is not. The key is being honest with yourself and allowing your mind to relax, according to Nelson.

[via Ivanhoe.com]
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The flexible approach (Sydney Morning Herald, Australia)

Jacqueline Maley, Sydney Morning Herald, Australia: Celebrities have embraced it. Bookstores are bursting with literature about it, and converts evangelise about its benefits. The practice of yoga has taken off in the West, 5000 or so years after the philosophy was codified by the Indian scholar Patanjali.

Although many students of yoga report myriad benefits to their physical and mental health, it has yet to be embraced by mainstream medicine as a valid form of treatment.

But Dr Craig Hassed, a senior lecturer in the department of general practice at Monash University, says yoga is “one of the most, if not the most, comprehensive approach to lifestyle management of all the traditional healing systems”.

Yoga is an effective tool in maintaining the mind/body balance, which is integral to general health, he says.

“Positive emotional states are associated with greater resistance to disease, better recovery from illness and a better ability to cope with illness,” he explains.

On the other hand, he says, negative emotional states have been proven to lead to a lower resistance to infection and higher risk of illnesses, such as heart disease, auto-immune disorders and inflammatory arthritis…

As proof of yoga’s benefits, Hassed points to a pivotal 1990 study by Dr Dean Ornish in the United States. Ornish tracked two groups of heart disease patients over a period of five years. The first group took medication only, and the second group took medication and also adopted a lifestyle based on yoga principles – incorporating exercise, meditation, diet and relaxation.

The five-year follow-up study, published in the Journal of the American Medical Association in 1997, showed the medication-only group had experienced 2 times as many “major cardiac events” (ie heart attack or death) as the yoga-lifestyle group.

“He was the first person to prove heart disease is reversible,” Hassed says.

And he did it using yoga principles.

Professor Avni Sali, the foundation head of the Graduate School of Integrative Medicine at Swinburne University in Melbourne, believes the “stillness”, or meditation part of yoga, usually practised after postures have been completed, is the most beneficial part of the yoga program.

Sali has conducted studies to show yoga meditation can reduce levels in the blood of the stress hormone cortisol.

“If your stress hormones are down and your immune system is working better, you are less likely, theoretically, to get cancer,” he says.

Hassed says the reduction in stress levels, by means such as meditation, can also assist in controlling diabetes, which can be exacerbated by stress. He emphasises, however, yoga can never be a replacement for insulin.

Yoga can also be useful for treating adult diabetes.

“[Type 2] diabetes is very much an illness of modern Western lifestyle, so yoga is a powerful intervention for lifestyle diabetes,” he says.

Yoga meditation is also the basis of research conducted by Dr Ramesh Manocha, a research fellow at the Natural Therapies Unit at the Royal Hospital for Women in Randwick.

Manocha focused on sahaja yoga, a method of meditation developed by Shrimataji Nirmala Devi in India in the 1970s.

He has just finished a seven-year doctoral research project “aimed at the answering the question: does meditation work in any way – body, mind, spirit, whatever?”

“You have this discrepancy,” Manocha explains, “the public has a very positive perception about meditation but when you actually look at the scientific literature, the scientific literature doesn’t agree.”

He set out to investigate the discrepancy by taking about 60 people with severe asthma and randomly allocating them to two treatment groups. One group underwent a standard, government-approved stress management program, involving counselling, breathing techniques and relaxation. The other group were taught sahaja yoga techniques.

The findings, published in the medical journal Thorax, were that the emotional state of the sahaja group – measured using psycho-metric questionnaires – was two times better than that of the stress management group.

The sahaja group also demonstrated significantly lesser degree of irritation in the lungs. The other group showed no change.

“There was significant evidence indicating that the actual physical disease was . . . influenced, and it wasn’t just the participants’ subjective impressions which were changing,” he says.

At the Sydney Menopause Centre, Manocha has also used sahaja to treat a group of women suffering hot flushes. The women had about a 70 per cent reduction in their hot flushes over eight weeks, he says.

Last year, he tried the technique on a group of children with Attention Deficit Hyperactivity Disorder.

“In six weeks, we had them sitting down for 20 minutes at a time and relating better to their friends and family,” he says. Three of the children were able to stop their medication after attending the clinic.

Dr Luis Vitetta, the deputy head and director of research at Swinburne’s Graduate School of Integrative Medicine, supervised another study involving yoga and children. One group of children was given reading to do and the other was led through yoga exercises.

There was a reduction in anxious mood in the yoga group, but measurements of cortisol levels in the children were inconclusive.

Vitetta says this only serves to show that yoga is not a quick fix. “You need to do yoga over a long period of time,” he says. “You don’t take yoga as you take a pill.”

Practised over long periods, there is some evidence yoga can help people with cancer, anxiety, depression, Vitetta says. It can even help you quit smoking, by “teaching people a unity of mind and body”.

“Yoga exists in the domain of mind/body medicine,” he says. “The mind/body connection is at the centre of health, whether you want to believe it or not.”

But doctors admit the benefits of yoga are not always taken seriously, especially when it comes to meditation and “mental stillness”.

Hassed says although yoga is becoming more widely accepted as a form of therapy, there is still very little about yoga in medical education. “Relative to its potential health benefits and a growing body of research, it seems to be under-represented in the health care system,” he says.

He argues governments should take notice of yoga, if not for the sake of patients, then for the cost savings it delivers.

During Ornish’s yoga/heart disease project, Hassed says an insurance company worked out that $83,000 was saved per patient, three years after they began the yoga treatment.

Avni believes it is the holistic nature of yoga which prevents it from gaining due recognition. That, and the fact that it receives minimal research funding, because there is no “product” and hence no pharmaceutical company, associated with yoga.

“You can’t put yoga in a bottle and sell it,” he says. “It’s the responsibility of the government to fund it.”
What is yoga

Yoga is a Hindu discipline and philosophy that has been practised in India for more than 5000 years. In the West, “yoga” is used to refer to the exercises only, but yoga is actually an entire lifestyle system, involving meditation, diet and good works. It was codified in the second century in a book called the Yoga Sutras.

HATHA

The generic term for the physical postures and exercise part of the entire yoga philosophy. Hatha is also describe a gentle, traditional style of yoga.

BIKRAM

Also called “hot” yoga, conducted in rooms heated to 38 degrees or more to aid muscle stretching. It is very dynamic and involves the repetition of 26 set asanas, or poses. Not for beginners.

ASHTANGA

A very physical form of “power”, yoga based on the original texts of Patanjali, the founder of yoga. Ashtanga is physically demanding, involving fast movement and breathing.

IYENGAR

Focuses on ideal body alignment and posture. It is rigorous but gentle. Practitioners use props such as straps and wooden blocks to aid flexibility.
Roma’s a picture of health

Roma Blair spent three years in a Japanese prison camp in the Dutch East Indies in World War II. In that time, she gave birth with no doctor present, was given stitches without an anaesthetic and contracted two types of dysentery. Sometimes, she coughed up worms.

After the war, Blair was living in South Africa when her doctor referred her to a local yoga swami to help her with her ongoing health problems.

“I was nervous and in pain,” she says. “I was a very sick lady, but I’m very, very healthy today,” she says.

Blair believes yoga cured her. She was so impressed that when she returned to Australia in 1957, she established the Roma Blair yoga clubs in Sydney.

From 1959, she began filming yoga exercise shows for Channel Nine and featured in magazine lift-outs.

In 1966, she went to India and was made the first female Australian swami by Swami Satyananada.

Since then Blair, 80, has published six books on yoga, made two videos and four records.

Swarmi Sarasvati is also one of the longest-practising yoga experts in in Australia.

Sarasvati practises what she calls “complete lifestyle yoga” which is an integrated yoga, combining meditation, physical exercise and karma yoga (self reflection and doing good works).

She believes yoga can be useful in treating a range of illnesses, from stress-related complaints such as headache, insomnia and heart problems, to breathing difficulties and people with musculoskeletal pain.

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