Friday Q&A: Baxter, Are Backbends and Flow Sequences Stimulating or Relaxing?

Judi Friedman, Age 52, photographed by Robert Sturman

Q: Nina asked me what I thought about the recent conversation that she and Ram had via email (see Are Backbends Stimulating or Relaxing?) and I couldn’t help but chime in! So here is what I, Baxter, have to say about the effect of more intense poses and practices on the response of the Autonomic Nervous System and therefore on vagal tone:

A: Nina, I agree with your anecdotal observations as well as your theoretical ponderings (and on a few things, with Ram, too). And my reasons are multiple: 

1. Some students are going to be more challenged by advanced back bends and aerobic flow classes due to a) musculoskeletal issues that make backbends harder for their bodies to do, and b)aerobic fitness levels that are not equal to the intensity of the flow class they are taking. These situations are going to trigger the Sympathetic Nervous System (SNS) branch of the Autonomic Nervous System. 
2. All the other reasons Ram mentions could contribute to increased stress response in a person, thus triggering the Fight or Flight response of the SNS too. And, of course, I agree with his initial statement of the underlying goals of yoga. 
3. As you postulate, abnormal breathing patterns, such as restricted breath in backbends or the tendency to inhale and hold the breath momentarily when doing difficult or unfamiliar poses could also stimulate the SNS. 
4. I also agree that not all yoga practices are designed to quiet and calm the mind exclusively. As you rightly note, in the Hatha Yoga tradition, there is the idea of “firing the vessel,” as with pottery, to strengthen it and make it resilient under the challenges of the deeper levels of mental practices of yoga as one moves towards states like samadhi. So, at times, we want to stimulate the SNS, too, but not right before bedtime!

Nina wrote back: "I’d like to add that I wasn’t saying that backbends and/or flow don’t reduce stress by releasing held muscle tension! I was just saying that I did not believe that they actually triggered the Relaxation Response, which is something very specific. There is a difference between being in a pose and triggering the Relaxation Response in that pose (for example, Viparita Karani) and doing a lot of exercise and then feeling less stressed AFTER the exercise session."

To which I’m adding: Nina, this is a good point. In the moment of practicing, practices like deep, challenging backbends and strong flow practices will likely trigger the Sympathetic branch of the nervous system. If this is a strong enough stimulation, it could be challenging to calm the system during the course of practice. Vickie Russell Bell has a good sequencing way of balancing things out in her evening classes where she provides adequate time to cool the nervous system down. This will ideally allow the practitioner to shift the nervous system to the Parasympathetic side of things, so the entire system can have a greater chance to quiet and calm both body and mind. A big challenge today is that many yoga classes don’t provide adequate cool-down time, often only leaving 4-5 minutes at the end of class for Savasana. This is not likely going to induce the Relaxation Response, which Herbert Benson, MD, noted comes on between 7-10 minutes. 

And this is certainly not a black or white issue. There are some fit and flexible students who will remain relatively neurologically calm doing the proposed back bend and flow practices, and will likely wonder what all the fuss of over!

—Baxter

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The Value of Not Doing

by Richard Rosen

Enso by Torei Enji

I recently discovered in my files an interview I did with Richard Rosen in 2008 for a book I never wrote that was going to be all about Savasana (great idea, right?). As he always does, Richard had some wonderful things to say, so with his permission, I’m going to share them with you today. Because my questions weren’t particularly compelling and what Richard said was so beautiful, I’ve edited and reorganized the interview at tiny bit so it reads as a single statement. Thank you, Richard. —Nina

In my early years as a yoga student, I really didn’t understand Savasana, I thought it was a waste of time. I sort of tended to either cut it short or skip it completely. And I think a lot of classes—a lot of teachers—still tend to do that. They don’t really give time to Savasana in their classes. As I got older as a yoga student I began to appreciate the value of the practice at the end of a yoga session, and I spent 15 to 20 minutes in Savasana at the end of a practice, which is a good chunk of time relative to the rest of my practice.

Teachers want you to feel like you’re doing something. And a lot of people don’t understand or appreciate the value of not doing. But a lot of traditional yoga is just that. The idea is that you’re already doing something that is interfering with your self awareness, your self understanding. And that rather than doing something to fix it, what’s really necessary is to undo what’s getting in the way, which means a need for a surrender, a letting go. To a certain extent that’s what you get a taste of in Savasana. It’s just stopping doing, and letting what’s being interfered with come out. 

What comes out for me is, like Popeye says, “I am what I am.” I just get a feeling that I’m closer to myself. At my stage of yoga development, I feel very keenly that there’s a separation, that I don’t really know who or what I truly am, and that when I perform Savasana well that I get a clearer sense of the underlying truth of myself, the underlying being.

It’s a contrast to the way I usually feel, which is sort of there’s a lot going on in my head and I’m not exactly aware of the present, I’m not connected to the sounds around me, I’m not connected my breath, I’m connected to anything that’s really happening in the moment. There’s always a distraction of some kind. I’m thinking about this or that. I’m thinking about what I have to do. And so there’s a lack of presence. Whereas the experience of Savasana is a clearing away of all of that static. Like in the old days when the analog radios would have dial—a little bar that would move up a down a range of stations—and you would turn it. In between stations you would get a hissing sound, and as you approached a station the music or sound would come in more clearly. I also think of yoga asanas as being like tuners, where as you approach the essence of the pose, say, the static begins to diminish.

I think there’s a lot of static in the brain that interferes with your connections to your surroundings. It’s a distraction in a way. It’s like you’re trying to concentrate on something and somebody’s playing music outside. It takes you away from the direct perception of what’s going on. In Savasana, at least momentarily, that’s turned down, quieted. So I think the way I would describe my experience of a well-performed Savasana is that the dial gets a little bit closer to where the station actually is and the interference goes away and the music of the self comes in more clearly.

When I come out of a well-performed Savasana, I feel very quiet. My senses are more receptive. I feel more expansive. I feel bigger. Physically I feel taller. And when I walk out of my practice room after a well-performed Savasana, I feel more in tune with my surroundings. Colors are brighter. Sounds are clearer. I feel more alive.

Richard Rosen is a yoga teacher and writer from Berkeley, California. He is President of the board of the Yoga Dana Foundation, which supports Northern California teachers bringing yoga to under-served communities. Richard has written three books for Shambhala: The Yoga of Breath: A Step-by-Step Guide to Pranayama (2002), Pranayama: Beyond the Fundamentals (2006), and Original Yoga: Rediscovering Traditional Practices of Hatha Yoga (2012). He also recorded a 7-disc set of instructional CDs for Shambhala titled The Practice of Pranayama: An In-Depth Guide to the Yoga of Breath (2010). For more information about Richard and the workshops he teaches internationally, see http://www.richardrosenyoga.com/. 

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Are Backbends Stimulating or Relaxing?

by Nina

Margann Green, Age 77

Did anyone besides me notice that in his post Yoga Practices to Optimize Vagal Tone, Ram said included both backbends and flow sequences as asanas that trigger the Relaxation Response? 

Before I published that article, I queried him about that. Because both from my own person experience and from what I’ve learned from various teachers, I’ve always believed that backbends and flow sequences, especially done rapidly, were actually highly stimulating, even causing insomnia in people who practice them in evening classes (see Yoga and Your Emotions). And I always considered those two types of asana as something to avoid when I was feeling highly anxious, and when I’m not, I always finish a sequence that includes those poses with some nice long calming poses and practices to balance myself. 

But Ram, it turned out, had a very different perspective on this issue, and that led us to have a very interesting little email discussion about this topic. In the end, I decided that it would be a good idea to share the exchange with you. This will not only allow you to see a bit of what our blog is like “behind the scenes,” but you may also wish to join in the discussion by adding your own comments.  

Nina: I’m confused by the following statement. "All of the above sequences have a quieting effect on the nervous system, encouraging a shift from Fight or Flight mode to Rest and Digest mode- hallmark of an optimally functioning vagus nerve.” This doesn’t really apply to all the poses and sequences you mentioned, right? Can I say EXCEPT flow sequences, standing poses, and active backbends?

Ram: Reg your query, all the sequences I mentioned (flow, active backbends and inversions), optimizes the vagal tone, switch on the parasympathetic nervous system and move the individual to a Rest and Digest mode. Let me know if I need to change it again to make it more clear.  

Nina: Well, I really wonder about that. It seems like some challenging poses, such as backbends, etc. and maybe flow sequences, are actually stressful and so can trigger Fight or Flight. That’s why people often can’t sleep at night after a backbend or flow class just before bed. At least that is my understanding of how the asana practice isn’t always relaxing.  

Ram: Very interesting opinion, Nina. I guess we can argue about this without reaching a satisfying explanation. 

Yoga (asanas + all the other angas) is a means to achieve enlightenment (knowing one’s true nature, awareness, intuition, clarity etc). Physical and mental stress can cloud the mind and so over the years Yoga was adopted to relieve physical and mental stress. If yoga truly relieves stress, then why should anyone experience stress after doing a yoga pose be it a backbend or sun salutation? I have never ever felt stressed out after doing yoga (even after attempting several challenging poses like in Ashtanga or Bikram); exhaustion yes, but not mental stress. 

In my opinion, the mental stress is not from the yoga poses but it is primarily due to the individual’s own demeanor before going to the mat. I can think of several possible reasons:

1. The individual continues to harbor disharmonious impressions while doing Yoga
2. The individual was not able to let go of the emotional turbulence even while doing the asanas
3. The individual got mentally challenged by the neighbors who were more agile
4. The individual did not like the particular teacher and was mentally upset
5. The individual did not appreciate the corrections from the teacher
6. The individual did not appreciate the neighbors who were sweating or breathing heavily. 

 All the above and others that I cannot think of right now can stress out an individual. So it is not asanas per se but the individual’s outlook and attitude.

I am not sure you will agree, but this has been my experience when teaching in the class. I do not want to put the blame on Yoga, at least not yet.  

Nina: Well, I will leave your post as is. But this is an interesting discussion that we should continue to have. 

I am not alone in my thoughts that some yoga asanas are stimulating rather than relaxing (perhaps “stress” is the wrong word, though I think others would agree with me in that they stimulate the sympathetic nervous system, just as some pranayma practices do). This is especially true for active backbends. (Recently at a class with Vickie Russell Bell, she said she always finishes the backbend section of her nighttime classes with a least a half an hour of relaxation, so people won’t go home and have trouble sleeping.) 

When I first started studying yoga, I had no idea why certain poses like Viparita Karani were so relaxing. But I experienced them as such. Later I learned from Roger Cole about baroreceptors and inversions. Likewise, I (and many others) have experienced backbends as highly stimulating. Many people talk about how they cause insomnia. We don’t have an explanation for this, but isn’t it possible than something physiological is going on that is causing this? For example, flexing the neck quiets the nervous system because of the baroreceptors. What does extending the neck, which we do in most backbends, cause? Or, Rodney Yee's theory was that exposing your vulnerable organs (the opposite of what animals on all fours do) triggers a bit of fear response. Maybe one day there will be a study on this. But for now, I’m sticking with my anecdotal experience and that of several of my teachers.

To me this is not “blaming” yoga; it is just another aspect of the asana practice. I think of the asanas as being developed to “fortify” the body for meditation, pranayma, and other spiritual practices, not to relieve stress. And backbends are an important part of a balanced asana practice to create a strong, healthy body. 

I agree with you, however, that the attitude with one approaches a yoga poses, perhaps one that you fear or dislike, could also contribute to its effects.

Ram did not respond to that message, so I guess he was still not convinced or was just busy with work, as he does have a full-time job after all! Then, yesterday, I was practicing Dhanurasana, and I noticed my heart racing after. It’s hard to breathe in this pose for me, as it is in many backbends. My breath speeds up for sure. Maybe my inhalations are longer. So I was wondering if the stuff Baxter taught me about pranayama and the nervous system (how longer inhalations are stimulating—see Pranayama: A Powerful Key to Your Nervous System) might apply to backbends as well and, likewise, flow, if it is rapid and challenging (like Ashtanga, which I have tried). That’s my latest theory of why backbends, flow sequences and other physically challenging poses do not trigger the Relaxation Response.

But as I told Ram, we can agree to disagree as there is no scientific study of this as far as we both know.

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Can Yoga Help Diabetes?

by Baxter

Musa paradisiaca by Maria Sibylla Merian

After reading Nina’s post False Claims Harm Yoga, I got interested in finding the scientifically grounded information about how yoga can assist in the treatment of diabetes. One of the first studies that popped up was a recent study in China called Effects of 1-year yoga on cardiovascular risk factors in middle-aged and older adults with metabolic syndrome: a randomized trial. that looked at a one-year practice of yoga and its affect on metabolic syndrome, which has as one of its factors for developing heart disease the presence of elevated blood sugar levels, or hyperglycemia. (The presence of hyperglycemia could mean the person with metabolic syndrome has diabetes.)The paper mentions that many of the lab values the researchers followed did improve over the course of the study, including waist circumference. They did not specifically mention a reduction on blood sugar levels, however. 

Curious about what reputable websites on diabetes management might be recommending, I found this article from the Joslin Diabetes Center’s website (a Harvard-affiliated center), written by two of their staff Clinical Exercise Specialists, who say, when discussing the benefits of yoga:

“In addition, some reports suggest that because yoga can decrease stress, it may be helpful in controlling glucose levels in people with either Type 1 or 2 diabetes.”

At this center, they have an exercise program that has recently added gentle yoga to the tools they use, and they say: 

“Joslin's Why Wait? Program is a one-of-a-kind program that was created to address the unique weight-loss and weight-control needs of people with type 1 and 2 diabetes. The newest addition to the program is a gentle yoga practice that emphasizes the importance of the body-mind connection, and introduces participants to various forms of yoga.”

Hmmm, no mention of stopping your normal treatment and only doing yoga to treat and or heal diabetes. And although there have been quite a large number of studies looking at yoga and type 2 diabetes, this NIH sponsored review article Yoga Practice for the Management of Type II Diabetes Mellitus in Adults: A systematic review tried to tease out those studies that meet our modern criteria for well designed studies. Only five qualified, with a combined total of 363 participants. They did find the following short-term benefits:

Fasting Plasma Glucose Levels: Four studies provided results on FPG. These studies provided favorable results for the intervention in lowering FPG.

Glycolated Hemoglobin: This blood test is used routinely to monitor the overall average sugar levels in the blood over a more extended period of time. Three of the included studies reported the value of HbA1c. The mean differences indicated that the intervention lowered the level of the HbA1c. However, the results were only statistically significant in the one study.

Cholesterol Effect: Three of the included trials reported an effect on lowering cholesterol level, including increasing HDL and lowering Triglycerides (both directions of change considered beneficial for heart health).

Weight and Body Mass Index: There was minimal drop in one study that was not statistically significant.

Diabetes-Related Complications: Only one study looked at this, and looked at nerve conduction rates in the arms of participants (would be related to the development of peripheral neuropathy in DM), and showed a small statistically insignificant change. 

The authors concluded there is some evidence from well-designed studies (the give reviewed here) that there are some short-term benefits from yoga (listed above). They could not make any comments on the long-term benefits of doing yoga, as the studies did not address this important consideration. They noted lots of quality issues even with the five studies they were able to include in their review of all the yoga and diabetes research that had taken place through 2007. And due to the results, they concluded:

“A definitive recommendation for physicians to encourage their patients to practice yoga cannot be reached at the present.”

“The important recommendation that can be drawn from this systematic review is the need for well-designed large randomized clinical trials to assess the effectiveness of yoga on diabetes type II.”

As we have noted about so many other reviews of studies, we have a ways to go with yoga research! But I feel if we expand the overall benefits of yoga for things like stress management, there is certainly no contraindication for someone with diabetes starting yoga, and lots of potential positive benefits on overall health and well-being.  

The Takeaway

Just to be clear, dear readers, I personally do believe that yoga can be beneficial for diabetes. For example, diabetics can develop numbness in their extremities, which often affects balance and increases the risk of falls. So working on balance poses and circulation practices could lessen the chances of falls as well as help maintain better heart health and circulation, which might slow down this negative consequence of diabetes. Similarly, the mindfulness of yoga could improve dietary habits, allowing the person with diabetes to make better food choices, which could improve blood sugar control and even help with weight loss, which is particularly helpful in type 2 diabetes. 

But what I cannot say is that yoga will always or even usually do these things for sure, because we have not studied them closely yet. That does not mean that someone with diabetes can not safely start yoga and add it to what they are already doing to improve their health. And our friend Melitta, who has type 1 diabetes, has already testified about the benefits that stress management provides for someone with diabetics or anyone else living with a chronic disease (see Aging, Diabetes and Yoga).

And to provide some support to Nina’s assertions that the untrue promotion of yoga as a substitute for medical treatment and lifestyle interventions is dangerous, I'll add that none of the researchers even hinted that yoga replace modern treatment, let alone “heal” diabetes! type 1 diabetes is not curable, and those with type 2 can eventually gain control of normalizing blood sugar levels to healthier ranges with a combination of medical tools and lifestyle practices, but when these tools are skipped or stopped, the symptoms and problems of diabetes will once again show up. 

My take: For people with a new or established diagnosis of type 1 or 2 diabetes, certainly add yoga to your health regime to see if it helps your diabetes specifically over time. And then let us know what you discover! 

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Balance Pose of the Week: Baby In & Out of The Tub

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Friday Q&A: Organ Prolapse and Intra-Abdominal Pressure

White Rose by Melina Meza

Today’s question was left as a comment on our post Organ Prolapse and Yoga, which was written by guest contributor Shelly Prosko. Rather than just leaving a short answer in the comments section, Shelly decided to write long, more thorough answer that we could share with all our readers. Thank you, Shelly!

Q: Thanks for the more nuanced understanding of this issue. Could you help me understand why uddiyana bandha increases IAP (intra-abdominal pressure)? My experience and theoretical understanding suggest that is would decrease pressure because a) the diaphragm is rising, thus relieving pressure on the abdomen, b) the pelvic floor will slightly life if it is relaxed during uddiyana, a sign of decreased pressure, c) the lungs are at less than atmospheric pressure, which should drop general fluid pressure in the torso. Am I missing something?

A: Thanks for your thoughtful and wonderful observation, insight, and question. It gives me an opportunity to more thoroughly explore this topic, and gives me a chance to better explain my perspective about re-evaluating the use of uddiyana bandha for prolapse.

You said, "the diaphragm is rising, thus relieving pressure on the abdomen". Well, yes, the diaphragm ascends on exhalation, but that doesn't automatically decrease intra-abdominal pressure (IAP). If abdominal muscles are engaging such that it increases pressure in the system (the abdominal cavity being the hydraulic part of the piston system), the intra-abdominal pressure may not necessarily be reduced at the end of exhalation, when the diaphragm is elevated.

You also said, "the pelvic floor will slightly life (lift) if it is relaxed during uddiyana, a sign of decreased pressure." I agree for the most part. If the pelvic floor and abdominals are truly relaxed and they draw upward/inwards during uddiyana bandha, one would assume the intra-abdominal pressure has reduced, resulting in a passive lifting effect of the abdominal and pelvic organs. However, it's a challenge to know if the pelvic floor is completely passively lifting or actually actively lifting without EMG, US, or internal manual palpation.

This is where I feel I need to clarify my perspective and explain my experience (personal and clinical) with uddiyana bandha. I am by no means a bandha expert. I understand there are different interpretations and teachings of uddiyana bandha, depending on lineage. Some of these may potentially increase intra-abdominal pressure, others may decrease intra-abdominal pressure, depending on how it is taught and understood.

Here is my translation and understanding of how uddiyana bandha is supposed to be performed (please feel free to add/clarify from your knowledge): After a full exhalation, breath is retained. The intercostals and perhaps even some accessory muscles of respiration are supposed to then be engaged to expand the rib cage, therefore increasing volume in the thoracic cavity which will create reduced intra-thoracic pressure. This, in turn, is supposed to pull up the respiratory diaphragm because of the vacuum created, which in turn is supposed to passively “suck” the abdominal organs up higher. One would assume the same for pelvic organs.

Although even though the “abdominal lock” is supposed to be a passive indrawing/lifting of the abdomen, I believe it is rarely taught or performed (in our western mainstream yoga culture) this way. Even the way we've translated it as the “abdominal lift” can be confusing. To me—and I know many others—this implies that the primary action is to “lift or pull in the abdomen” Instead, maybe we should call it “rib cage vacuum.”

But I've seen videos, books, and teachers give instructions to "pull the abdomen in." If that is the case, then potential is there to incorrectly use surrounding trunk/abdominal muscles to move the abdomen, increasing intra-abdominal pressure, which may be unfavorable for someone with prolapse. (I sure would love to do a study though!)

So, I do feel that people suffering from organ prolapse should re-evaluate their use of uddiyana bandha if they are performing it, particularly if they are performing this bandha regularly, thinking it should help, but they are getting worse (which I've witnessed). In retrospect, I would have re-worded my statement: "precaution with advanced yoga methods such as uddiyana bandha, as this could potentially increase intra-abdominal pressure if not performed correctly."

Finally, reader, I think you're onto something. There is actually a relatively new approach to treating reproductive organ prolapse that is gaining popularity in the pelvic health world called hypopressives. From photos/videos, it looks interestingly similar to uddiyana bandha. Research is still in its infancy, but perhaps there is actually some therapeutic value in uddiyana bandha for reproductive organ prolapse! 

Thanks for opening up this conversation and providing me with this opportunity to expand on this topic. Hope this helps clarify my article.

—Shelly

Disclaimer: This article is not meant to diagnose, treat or act as medical advice. Please consult your health care provider for clearance and guidance before following or participating in these activities. 

Shelly Prosko is a Physical Therapist, Yoga Therapist and a Certified Pilates Instructor. She received her Physical Therapy degree at the University of Saskatchewan, Canada in 1998, her Yoga Therapist training through Professional Yoga Therapy Studies in North Carolina and her Pilates certification through Professional Health and Fitness Institute in Maryland. 

Since 1998, Shelly has been integrating yoga principles and methods into her physical therapy treatments. She has treated a wide variety of musculoskeletal, neurological and cardiorespiratory  conditions while working in private orthopaedic clinics and long term care facilities across Canada and the United States.


Currently, Shelly resides in Sylvan Lake, AB and travels across Canada and the United States offering specialty Physio-Yoga Therapy workshops, classes, private sessions, lecturing at University and College programs as adjunct faculty of Professional Yoga Therapy Studies, teaching at YTT’s and actively promoting the integration of medical therapeutic yoga into our current healthcare system. She believes that bridging the gap between Western and Eastern healthcare philosophies is essential in order to achieve optimal health. Her treatments are individually based and are a unique blend of both approaches. Please visit www.physioyoga.ca for more information about Shelly’s mission and services, and to read a variety of testimonials of how PYT has profoundly influenced many people’s lives.

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What if We Could Weed Out Avidya (Ignorance)?

by Baxter

Constellation Awakening at Dawn by Joan Miro

In her post Ignorance About Ignorance, Nina did a lovely job discussing avidya, a key concept in yoga philosophy that has everyday ramifications for us. In a nutshell, the yogis of old noticed that our everyday unrestrained mind was the underlying culprit not only of our present psychological suffering, but also of our ability to reach many desirable goals regarding health, well-being, and spiritual growth.

Their cure for this was to gain control of the fluctuations, whirls, or cycling of our minds and thoughts (see Thoughts About Quieting the Mind). But they noted that there were obstacles to clear out of the way if we want to make any progress in achieving our goals, and the giant at the doorway to our success is this thing called “avidya,” which Nina so astutely pointed out can mean both ignorance (just plain not knowing something true and real) and misapprehension (having a mistaken understanding of the way things are). 

There are entire fields of knowledge that I am entirely ignorant about, such as quantum physics or jet propulsion engineering, as well as huge pieces of personal history I don’t know about for even some of my closest friends. And although I might still operate in the world on a daily basis without too much trouble or suffering due to these particular areas of ignorance, there are other times where my ignorance does contribute to my suffering and the suffering of others.

To illustrate this, here is little story Nina shared with me that shows how lack of knowledge directly contributed to the suffering of a young woman who was dealing with bouts of anxiety. The young woman’s mother told Nina, “Well, I guess, anxiety just comes and goes.” Nina’s friend and her daughter seemed to feel that the daughter was at the mercy of some emotion that took her over periodically and that there was nothing she could do to change that. But, of course, we now know that there are things you can do to manage anxiety. Through a combination of educating yourself and making some lifestyle changes, you can empower yourself to deal more effectively with stressful situations and hopefully reduce the levels of stress and/or anxiety. Once Nina’s friend learned all this about anxiety, she was able to start taking steps to help her daughter, instead of just feeling helpless.

And when it comes to misapprehension, I do fall into the trap of mistaken understanding all the time, as I—and I suspect you do, too!—tend to make a lot of incorrect assumptions about other people and situations that may not be based in reality at all. These assumptions can often lead to all sorts of difficulties, misunderstandings, hurt feelings, etc., both for me and for others. At its most serious extreme, I can’t help but think about the recent spate of unnecessary killings of young black Americans by local law enforcement based on blatantly false assumptions, such as they were brandishing a weapon that turned out to be a toy gun, or assuming someone is a criminal based on a hooded sweatshirt and the color of their skin. 

Ignorance and misapprehension happen on a personal level regularly, and also happen on a societal level around issues of gender, sexual orientation, race, ethnicity, religion, and so on. And the resulting behaviors and responses in action and policy are often misguided and destructive both individuals and to large groups of people. What if we could weed out this avidya? Would this lead to less psychological suffering and a more peaceful world? The ancient yogis said yes to the first and probably to the second. And our yoga practices, when performed regularly, are the practical way to uncovering these inaccurate perceptions of the world around us, especially the more refined practices like pranayama, concentration, and meditation.

I certainly love to apply yoga philosophy to practical everyday situations to make it relevant and helpful for my own life and my student’s lives as well. But it is also worth noting that the concept of avidya originally applied more specifically to the relationship of ignorance and misapprehension to yoga concepts. This means you would eliminate avidya by studying to scriptures to learn more about how the mind works, what the other obstacles are to quieting the mind, and which practices in life and in meditation would be helpful for moving beyond those obstacles. For example, learning about the yamas and niyamas can be helpful for living a more harmonious life, which in turn will help quiet the mind, eventually leading to the deeper experiences of yoga, such as identifying with the connectedness and inseparability of the individual with the divine.

If you want to learn more about avidya and its outgrowth obstacles known as the klesas, consider reading more about them in a translation and commentary of Patanjali’s Yoga Sutras, such as those by BKS Iyengar or TKV Desikachar. I often find it helpful to compare two different commentaries, as individual commentators can have unique takes on the same Sanskrit words and concepts. Nina has written briefly about the klesas in her post The Pains Which Are To Come.

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Yoga Practices to Optimize Vagal Tone

by Ram

Maria Schilt, Age 64

In my earlier post on vagal tone Vagal Tone and Yoga, I described the vagus nerve and the wide-ranging tasks it regulates, including heart rate, breathing, respiration and digestion, peristalsis of gut, small intestine and colon, sweating, muscle movements in the mouth, speech, and hearing. The vagus nerve, which is the 10th cranial nerve and the largest of the cranial nerves, starts at the base of the skull and extends all the way down to the heart, lungs, digestive tract, and other abdominal organs, and transmits information between the brain and these internal organs. 

People with optimal vagal tone are more resilient under stress and can easily shift from an excited state to a relaxed state and vice versa without getting unduly perturbed. These individuals tend to have good resistance power and are healthier. In contrast, a low vagal tone is linked to inflammation, emotional stress, negative moods, and heart attacks. People with low vagal tone are easily disturbed, have weak digestion, and frequently suffer from physical, mental and emotional instability. Thus, an optimal vagal tone is linked to physical and psychological well-being while an under-performing vagal tone is linked to sickness, negative moods, depression, and heart issues.

Since the vagal tone defines the functional status of the vagus nerve, it may seem obvious, then, that people with an optimally active vagal tone switch on the parasympathetic nervous system and exhibit “feel good and cool attitude” as opposed to individuals with a low vagal tone who exhibit an increased activity of the sympathetic nervous system and are basically in a stress or Fight or Flight mode (see Heart Health and Yoga: An Overview). Better prognosis of the health status can be predicted by the strength of the vagal tone especially in people who are recovering from chronic diseases. However, vagal tone is not static; it keeps fluctuating based on our activities, lifestyle, and moods. We all need to strive to increase the activity of the vagal nerve to optimal levels and sustain that optimal tone. Today’s write up is about yoga practices that keep the vagal tone optimally functioning.  

Asanas and Vagal Tone

Since the vagus nerve innervates the chest, any kind of practices or activities that influence the energy flow through the vagus nerve will have a profound effect on the respiration and circulation. Yoga asanas coupled with the breath stimulate electrical and mechanical activities in the body. The electric activity is reflected in the vagus nerve stimulus that initiates in the brain and travels deep down to the organs for mechanical actions to be initiated. The mechanical action is in the form of: 

• contraction and relaxation of most if not all of the skeletal muscles of the body
• rapid flow of blood and lymph through the arteries and lymph glands respectively
• pumping action of the heart
• smooth venous return

Furthermore, yoga practices sustain the vagal tone and encourage a shift from Fight or Flight Response to Relaxation mode. 

Gentle or full inversions, a flow sequence that involves moving into each asana from Sun Salutations (Surya Namaskara), and gentle backbends all optimize the vagal tone, gradually warm up the body and the cardiovascular system, and strengthen and stretch the connective tissue and muscles that line the abdomen thus facilitating more efficient flow of blood.   

Inverted Poses. These poses use gravity (the heart is superior to the head) to control the blood pressure. In addition to full inversions, such as Headstand and Shoulderstand (Sarvangasana), there are several “partial” and” gentle” inversions that are as effective at stress reduction as full inversions (see All About Supported Inversions). Classic examples are Legs Up the Wall pose (Viparita karani) and Supported Bridge pose (Setu Bandha sarvangasana). The relaxation achieved with these partial/gentle inversions is similar to that achieved from restorative poses.  

Flow Sequences. These sequences involve moving into an asana from Sun Salutations. Such a sequence cultivates agility, benefits the heart, stretches the muscles, and facilitates the blood flow (Cultivating Agility with Yoga). Thus, flow sequences are invigorating, and can be highly stimulating (a sign of optimal vagal tone) especially if the individual is feeling dull, depressed or lethargic.

Backbends. These poses also help relieve sluggishness, dullness, and lethargy (a sign of improved vagal tone). Standing poses could be modified to include a backbend as in Mountain pose (Tadasana) with the arms raised overhead into a slight backbend. From here, exhale, bring the arms down to the floor and initiate your Sun Salutations. Even a resting pose like Savasana could be modified such that the torso is supported by a bolster or stack of blankets, thus opening the chest and also allow the back to be in a slight backbend.

All of the above sequences have a quieting effect on the nervous system, encouraging a shift from Fight or Flight mode to Rest and Digest mode, a hallmark of an optimally functioning vagus nerve.

Pranayama and Vagal Tone

While we do not have a control over the autonomic nervous system, through pranayama (breath practices), we can make a shift from Fight or Flight mode to Rest and Digest. Remember, you can voluntarily alter your breathing, and this is the key to modify the energy flow through the vagus nerve and thereby alter the nervous system as well. This is a technique you can use in times of acute stress. In this case, pranayama practice should involve longer exhalations than inhalations, for example, a one-second inhalation and a two-second exhalation (see Pranayama: A Powerful Key to Your Nervous System) to calm down that stress response. Additionally, humming on the exhalation as in Bhramari Pranayama (see Pranayama for Everyone: Brahmari Breath), or a slow exhalation as in Sitali breath (see Yoga for Menopause: Managing Hot Flashes) will slow down the rapid heart rate as well. This decreased heart rate sends a message to the brain that circumstances are more peaceful, and this stimulates the parasympathetic portion of the autonomic nervous system to allow the individual to calm/ rest, recover, and heal in the Rest and Digest mode. So pranayama practices that lengthen the exhalation are excellent to optimize the vagal tone.

If your inhalations and exhalations are the same length, for example, by intentionally taking a three-second inhalation and a three-second exhalation or by practicing alternate nostril breathing, you are affecting the vagal tone very subtly depending on your current state (Balancing Your Nervous System with Alternate Nostril Breathing). So this practice is good to sustain the optimal vagal tone that will harness the mind in the present moment without having a strong effect on the nervous system.

Take Home Message: Start the day by taking a few deep breaths and do not forget your daily asana practice. Your vagal tone will be happy, and your body and brain will thank you for it!

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Take Your Time: Results from Yoga Practice

by Nina

Unfurling Squash Blossom by Melina Meza

Because my post yesterday False Claims Harm Yoga discussed how misleading and/or false claims about yoga can cause serious harm, I decided to rerun an old article of mine about how results from yoga practice take time. In addition to making false claims about the power of certain yoga poses and practices, some of the articles we see out there imply that results are quick and easy (for example, the article about six poses to "heal" diabetes claimed that a month of practice might be all that was necessary). A couple of years ago I addressed this very issue after I read a New York Times article about how exercise can help us sleep better. My original post follows. —Nina

It's a running joke in our family that when Brad gets impatient with me—because I often do various household tasks a bit slower than he does—he says to me, "Take your time!" He swears that Bill Murray said this repeatedly in the movie "Caddy Shack," but when we watched it again recently, no one actually ever uttered that line. Regardless, I always reply, "You take your time." 

But many worthwhile things really do take time. For example, if you want to cook a really good meal instead of eating fast food, you need to shop for fresh ingredients and prepare everything from scratch. And if you want to turn a new acquaintance into a close friend, you need to spend a lot of time together, getting to know and trust each other. The same is true for seeing results from yoga practice. Obviously, one Downward-Facing Dog pose doesn't instantly make your arms stronger, though with regular practice, it definitely will increase your strength. And it also seems obvious that if you want to reduce your stress levels, you'll need to practice stress management regularly over a period of time.

So it was very interesting for me to hear about a recent study at the Feinberg School of Medicine, Northwestern University, that looked at the effect of exercise on insomnia. One of the findings as reported by Gretchen Reynolds in the New York Times post How Exercise Can Help Us Sleep Better was:

"After the first two months of their exercise program, the exercising volunteers (all of them women) were sleeping no better than at the start of the study. Only after four months of the program had their insomnia improved."

Yes, it took four whole months of regular exercising to bring improvements. That's quite a bit of time, don't you think? The women in this study were not practicing yoga for exercise, but it's likely that using yoga as a form of exercise to help with insomnia (something I definitely recommend) might take a similar amount of time. And it also makes sense to me that if you are practicing yoga for insomnia (see Yoga for Insomnia, Part 1) by using stress management techniques, you should also give that some time (though some people report that doing breath practices in the middle of the night produces immediate results). So be patient.

In general, the time you invest in your yoga practice—whether you are practicing for your physical, emotional, or spiritual wellbeing—is what brings the payoffs. After all, yoga sutra 1.14 tells us that equanimity is attained only through steady, dedicated, attentive practice:

Long, uninterrupted, alert practice is the firm foundation for restraining the fluctuations of the mind. —trans. by B.K.S. Iyengar 

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False Claims Harm Yoga

by Nina

Spectacled Caiman with a False Coral Snake by Maria Sibylla Merian

Just a little rant today. Someone who shall remain nameless shared a link on Facebook to an article titled 6 Yoga Asanas for Healing Diabetes Naturally. The comments on the post were all positive. Isn’t this wonderful!

Are you kidding me? First of all, they don’t distinguish between Type 1 and Type 2 diabetes. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to produce energy. If you have Type 1, you will die without insulin. So while you can use yoga to help manage the stress of living with this chronic disease, there is no “healing” from that disease, not with yoga nor with western medicine. See Aging, Yoga and Diabetes: Stereotypes That Are Truly Dangerous for information about someone who suffered as a result of the confusion between these Type 1 diabetes (which is what she really had) and Type 2 (which is what she was initially diagnosed as having, just because of her age). 

The far more common type 2 diabetes occurs when the body becomes resistant to insulin or doesn't make enough insulin, often as a result of obesity. It is possible that yoga could help with this form of diabetes by helping you reduce stress, change your diet, and lose weight, but going off your medication to use yoga for healing “naturally” instead would be a really bad idea.

Still, I gritted my teeth and went to check out the article itself, just to see what it was they were claiming and what those magical six asanas were. After a very short intro that defined what diabetes is (without making the important distinction between the two types), the article claimed:  

“A newly diagnosed diabetic has excellent prospects of completely controlling and correcting his/her condition if he/she adopts yogic practices and lifestyle under expert guidance. The yogic treatment of diabetes is directed to the underlying causes of the disease as well as to its symptoms.”

Well, that’s pretty scary as far as I’m concerned because it seems to imply you should forgo western medicine if you have diabetes (type 2 we can only assume) and that you should just do yoga instead. And, although they mention “expert guidance,” they never say what kind of expert (I hope they don’t mean a yoga teacher).

This is followed by information on a program:

"The “Go Yogic” diabetes management programme will at least require one month for the initial period of training. However with proper medical collaboration this objective can be safely achieved. The “Go Yogic” diabetes management programme and progress will wary for each individual. This programme should be considered absolute for all the diabetics’ patients."

Well, at least they’re mentioning “medical collaboration,” whatever that is. But the claim that the program should be considered “absolute” for all diabetics is, again, extremely misleading and irresponsible. Finally, the article ends with instructions for doing six poses, with no explanation of what effects those poses (and practices) would actually have on a person with diabetes (or an anyone for that matter). Cause I know you want to see it, here's the list:

• Shashank Asana (Hare Pose)
• Yoga Mudra Asana (Psyhic Union Pose)
• Ardhamatsendr Asana (Half Spinal Twist)
• Pachimottan Asana (Posterior Stretching Pose)
• Bhujang Asana (Cobra Pose)
• Suryabheda Pranayama (Vital stimulating break)

So that’s what is making me angry this morning. Because the truth is, we do think that yoga is a powerful tool for helping with almost any medical conditions, including diabetes (see 5 Ways Yoga Can Affect Your Health). But false claims about “six poses that heal” like this—and, boy, we see these everywhere—are not only dangerous for people reading the article, as they might be led to seriously compromise their health, but are doing yoga a huge disservice. Click bait about yoga that simplifies, misleads, and downright lies is only going to make people distrust yoga's legitimate benefits. 

(Yes, I did leave some explanatory comments on the Facebook post.)

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Balance Pose of the Week: In & Out of the Tub

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Friday Q&A: Epilepsy and Yoga

Inside a Flower by Melina Meza

Q: Our son (29 years old) has just experienced his second tonic-clonic seizure (formerly known as grand mal). The first was almost 2 years ago when he was living in NYC where he started taking anti-convulsive medication. This last one happened last week - much to the terror of his wife. All is fine now, but it has caused me to look deeply epilepsy; nutrition, medications, exercise, etc etc. Have you run across any links in your yoga explorations?

A: This is a great question, and it turns out quite a few people in the US have seizures and a diagnosis of epilepsy. Before we get to yoga’s potential role in addressing this question, let’s begin with some background info. 

Epilepsy is a disorder of the brain that is characterized by recurring seizures. A seizure is a brief, temporary disturbance in the electrical activity of the brain. A seizure is therefore a symptom of epilepsy. How large a problem is epilepsy? According to the World Health Organization:

"Approximately 50 million people currently live with epilepsy worldwide. The estimated proportion of the general population with active epilepsy (i.e. continuing seizures or with the need for treatment) at a given time is between 4 and 10 per 1000 people. However, some studies in low- and middle-income countries suggest that the proportion is much higher, between 7 and 14 per 1000 people.

Globally, an estimated 2.4 million people are diagnosed with epilepsy each year. In high-income countries, annual new cases are between 30 and 50 per 100 000 people in the general population. In low- and middle-income countries, this figure can be up to two times higher.” 

So, you can see, epilepsy is more common than some might imagine. Do we know what causes epilepsy? For better or worse, in 70% of people with epilepsy, the cause is unknown. In the other 30%, the most common causes include head trauma, infection of the brain tissue, brain tumor, stroke, heredity, or a prenatal disturbance of brain development.

About Seizures

All of our brain functions, including feeling, seeing, thinking, and moving our muscles, depend on electrical signals passed between the nerve cells of the brain. In a healthy brain, these electrical signals ebb and flow in a way that allows for all of our brain functions to work uninterrupted. A seizure occurs when too many nerve cells in the brain “fire” too quickly, causing what is commonly referred to as an “electrical storm.” 

Observation of those with epilepsy has identified a number of things that can trigger seizures, but keep in mind this varies quite a bit from person to person. The list below is pretty inclusive, but there may be other triggers not listed. The asterisks represent areas where yoga could be helpful in some way:

• Flashing or bright lights
• Lack of sleep *
• Stress *
• Overstimulation *
• Fever
• Heavy alcohol use *
• Hyperventilation *
• Menstrual cycle/hormonal changes *
• Dehydration *
• Certain medications/missed medications
• Nutritional deficiencies 

There are different kinds of seizures that those with epilepsy experience. A “generalized seizure,” which was previously called a “grand mal” seizure, involves the entire brain and a loss of consciousness. The variation of generalized seizure known as “tonic-clonic” is characterized by rhythmic jerking of muscles, and is the most dramatic form of seizure to witness. There is another variety of the generalized seizure known as an “absence” seizure, which is characterized by a brief loss of consciousness. Seizures that only involve part of the brain and may or may not include loss of consciousness are known as “partial seizures.” The presentation and symptoms of those seizures is related to the part of the brain affected.

How Yoga Can Help  

Typical Western treatment of epilepsy involves prescribing antiepileptic drugs. This is helpful in many cases; however, according to an NIH review paper Yoga for epilepsy:

“25-40% of patients on these medications have uncontrolled seizures, experience adverse effect from medication, suffer from stigmatization and have a higher degree of psychiatric disorders as compared with people with other chronic illnesses.” 

Therefore, there is a need to look to other therapies that might improve the situation for these people. What has research shown us about the use of yoga for epilepsy? The paper mentioned one study of yoga for epilepsy that used a simple form of meditation, which resulted in reduced seizures. The effect of meditation was attributed to a reduction in the level of stress, as evidenced by changes in skin resistance and levels of blood lactate and urinary vanillylmandelic acid (signs of stress that are measurable).

The paper also reviewed two other studies that were unblinded (not as good as blinded), randomized controlled trials (RCTs) with a total of 50 participants (adults) with refractory epilepsy (not responding adequately to medications). They compared “classical Indian yoga” (they did not go into detail about what all that included) to control groups who received no intervention or interventions such as yoga‐mimicking exercises or Acceptance and Commitment Therapy. Those in both arms of the study were continued on their antiepileptic drugs. The objectives of the review were to assess whether people with Epilepsy who treated with yoga: a) have a greater probability of becoming seizure free, b) have a significant reduction in the frequency or duration of seizures or both, and c) have a better quality of life. 

What did they find? Turned out that the yoga intervention was better when compared with no intervention or interventions other than yoga (postural exercises mimicking yoga—don’t you love it, fake yoga!). There was no difference between yoga and Acceptance and Commitment Therapy, a kind of psychological therapy that sound a lot like the cultivation of equanimity (see 7 Ways to Cultivate Equanimity with Yoga), which we have discussed before. The reviewers did not go into detail about the three objectives above. And they also said they could not make any clear conclusions about yoga’s role in treating epilepsy, due to the usual problems: the small number of studies, the small sample sizes, and the un-blinded nature of these studies. They did emphasize that yoga can only be an add‐on to antiepileptic drugs at the present time and cannot be used as the sole method of intervention. So, if you start practicing yoga, don’t stop your meds. 

All that said, I still think that starting a yoga practice under the tutelage of an experienced teacher at a level approviate for the student with epilepsy would be a reasonable thing to try. Yoga can affect many of the triggers of seizures from the list above, most obviously, stress and sleep problems, as well as increasing body awareness that could reduce the tendency to become dehydrated, overstimulated, or hyperventilated. And we have mentioned before that yoga may help in increasing self-awareness of the effects of unhealthy habits and addictions, so it could influence alcohol use as well (see Overcoming Addiction with Yoga). These impacts alone may prove beneficial in reducing the frequency of seizures and improve the lives of many with seizures.  And at the very least, a regular yoga practice that is focused on stress management would help someone with epilepsy deal with the stress of having this medical condition.

A special thanks to the Oakland Cerebral Palsy Center for a recent presentation on Epilepsy and Seizures for those of us who teach yoga there! 

—Baxter

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