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Influence of pranayamas and yoga-asanas on serum insulin, blood glucose and lipid profile in type 2 diabetes

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Abstract

A distinguishable feature of type 2 diabetes besides hyperglycemia and deranged lipid profile is an impaired insulin secretion, peripheral insulin resistance and obesity which has become a major health concern worldwide. India with an estimated 31million diabetics in 2000 and 79mllions by the yr 2030 has the highest number of type 2 diabetics in the world. In this study, we aimed to see if yoga-asanas and pranayamas have any influence in modifying certain biochemical parameters. Sixty patients of uncomplicated type 2 diabetes (age 35-60 yrs of 1-10 yrs duration) were divided into two groups: Group 1 (n=30): performed yoga along with the conventional hypoglycemic medicines and group 2 (n=30): patients who only received conventional medicines. Duration of the study was 45 days. Basal recordings of blood glucose (fasting and post-prandial), lipid profile and serum insulin were taken at the time of recruitment and the second reading after forty five days. Results showed a significant improvement in all the biochemical parameters in group 1 while group 2 showed significant improvement in only few parameters, thus suggesting a beneficial effect of yoga regimen on these parameters in diabetic patients.
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Indian Journal of Clinical Biochemistry, 2008 / 23 (4) 365-368
INFLUENCE OF PRANAYAMAS AND YOGA-ASANAS ON SERUM INSULIN, BLOOD
GLUCOSE AND LIPID PROFILE IN TYPE 2 DIABETES
Savita Singh, Tenzin Kyizom, K P Singh*, O P Tandon and S V Madhu*
Departments of Physiology and *Medicine, University College of Medical Sciences & GTB Hospital, Dilshad Garden, Delhi
ABSTRACT
A distinguishable feature of type 2 diabetes besides hyperglycemia and deranged lipid profile is an impaired
insulin secretion, peripheral insulin resistance and obesity which has become a major health concern worldwide.
India with an estimated 31million diabetics in 2000 and 79mllions by the yr 2030 has the highest number of
type 2 diabetics in the world. In this study, we aimed to see if yoga-asanas and pranayamas have any influence
in modifying certain biochemical parameters. Sixty patients of uncomplicated type 2 diabetes (age 35-60 yrs
of 1-10 yrs duration) were divided into two groups: Group 1 (n=30): performed yoga along with the conventional
hypoglycemic medicines and group 2 (n=30): patients who only received conventional medicines. Duration of
the study was 45 days. Basal recordings of blood glucose (fasting and post-prandial), lipid profile and serum
insulin were taken at the time of recruitment and the second reading after forty five days. Results showed a
significant improvement in all the biochemical parameters in group 1 while group 2 showed significant
improvement in only few parameters, thus suggesting a beneficial effect of yoga regimen on these parameters
in diabetic patients.
KEY WORDS
Pranayama and yoga-asana, Diabetes mellitus, Insulin resistance, Lipid profile, Blood glucose.
Address for Correspondence :
Prof. Savita Singh,
Department of Physiology,
UCMS and GTB Hospital,
Dilshad Garden, Delhi- 95
E-mail: tenkyiz5@yahoo.com
INTRODUCTION
Diabetes mellitus (DM) comprises a group of metabolic
disorders that share the common phenotype of hyperglycemia,
polydipsia, polyuria and hyperphagia. Added metabolic
dysregulation in the form of deranged lipid profile, impaired
insulin secretion and insulin resistance is a feature of type 2
diabetes. Most patients are obese when they develop diabetes
and the obesity is becoming a major health hazard worldwide.
The incidence of type 2 diabetes is also increasing with the
increase in age, physical inactivity and sedentary lifestyle (1).
Its strong familial predisposition makes the situation even
worse with the result that children and adolescents now present
with juvenile diabetes (2,3).
Yoga, a vedic science has been applied in the field of
therapeutics in modern times. Yoga has given patients the
hope to reduce medication besides slowing the progression
of the disease. Yoga employs stable postures or asanas and
breath control or pranayama (4). It has already proven its mettle
in the improvement of oxidative stress
as well as in improving
the glycaemic status of diabetics through neuroendocrinal
mechanism (5). The 45 days study was undertaken to see if
yoga-asanas and pranayamas have any influence on the blood
glucose, lipid profile and serum insulin level of patients of
uncomplicated type 2 diabetes.
MATERIALS AND METHODS
The study was conducted in the departments of Physiology &
Medicine, UCMS, Delhi. Sixty patients of type 2 DM in the
age-group of 35-60 yrs with diabetes of 1-10 yrs duration were
recruited from diabetic clinic of Guru Teg Bahadur Hospital,
Delhi. Patients of nephropathy, retinopathy (proliferative) and
coronary artery disease or any other complications of diabetes
were excluded. The patients were divided into two groups of
30 patients each. Group 1 practised yoga along with the
conventional medicines while group 2 continued with the
Indian Journal of Clinical Biochemistry, 2008 / 23 (4)
366
conventional medicines. The dose of the medicines remained
constant throughout the study period. The clearance from the
Ethical committee of the college was obtained and an informed
written consent was taken from all the patients after the
procedure was explained to them.
Group 1 patients were taught pranayama and yoga-asana by
a yoga expert (Table 1). During this study period, the subjects
were initially called continuously for five days and then once
every week for follow up and compliance, total time for
performing yoga being 45 minutes every day for forty five days.
Fasting and post prandial blood glucose levels, lipid profile
and serum insulin levels by Mercodia insulin ELISA (Enzyme
Linked Immunosorbent Assay) kit were assessed before and
after forty five days in both the groups. The data were
statistically analysed using repeated measures analysis of
variance (ANOVA) followed by Tukey’s test at 5% level of
significance.
RESULTS
The study showed a decrease in BMI (Body Mass Index) and
a significant decrease in the weight in group 1 patients
(Table 2). A significant decrease in blood sugar (Table 3) ,serum
insulin level (Table 4) and an improvement in lipid profiles
(Table 3) was also observed in group 1 while group 2 patients
showed increase in the weight and non-significant
improvement in other parameters.
DISCUSSION
Following 45 days of yoga-asanas and pranayamas, significant
reduction in the blood sugar was achieved in group 1 (Table 3)
while group 2 although showing a reduction didn’t show
significant change. Various yoga-asanas may be directly
rejuvenating cells of pancreas as a result of which there may
be increase in utilization and metabolism of glucose in the
peripheral tissues, liver and adipose tissues through enzymatic
process (6). Sahay et al (7) reported a decrease in the drug
requirements by some of the patients in his study. Singh S et
al (8) also observed the similar findings in their study.
Jain et al (9) found that there was significant reduction in
Table 1: Name and duration of various pranayamas & yoga-
asanas included in yogic exercises
S.No. Name Duration
1. Bhastrika- pranayama 3-5 mins per day
2. Kapal- bhati 5-10mins per day
3. Anulom-viloma 5-10 mins per day
4. Bhramari 5 times a day
5. Udgit-Om Uccharan 5 times a day
6. Surya namakar 3-7 turns of each, the pose being
maintained for ten seconds adding
each turn,every fortnight
7. Tadasana ¼ minute to one minute for adding
¼ minute per week.
8. Trikona-asana ¼ minute to one minute for each
side, adding ¼ minute per week
9. Pashimottanasana ¼ minute to one minute for each
side, adding ¼ minute per week
10. Bhujangasana 3-7 turns of each, the pose being
maintained for ten seconds adding
one turn each, every fortnight
11. Shavasana 2- 5 minutes, adding 1 minute per
week
Table 2 : Weight and BMI in both the groups before and
after 45 days of study (Mean ± SD)
WT (kg) BMI(Kg/m
2
)
GROUP 1 Before 63.20 ± 4.45 26.12 ± 1.54
After 60.60 ± 4.65* 24.59 ± 1.39
GROUP 2 Before 63.17 ± 4.67 25.83 ± 1.77
After 64.03 ± 5.10* 26.05 ± 2.13
*p < 0.05
Table 3: Glucose & lipid profile ( mg/dl) in both groups before and after 45 days (Mean±SD)
Glucose (fasting) Glucose(PP) TC TG HDL LDL VLDL
GROUP 1
Before 172.87±45.55 260.50±78.60 185.60±45.86 162.93±79.21 36.23±8.05 118.90±41.70 32.20±16.56
After 133.77±38.77** 198.90±63.68** 169.37±37.14* 137.37±58.78* 39.23±6.23* 104.30±40.25* 27.03±13.03*
GROUP 2
Before 174.40±36.91 260.27±51.43 187.40±45.44 163.77±41.44 36.57±4.82 120.0±53.37 29.80±11.98
After 167.40±37.32 250.23±48.57 182.90±47.66 157.93±38.44 37.27±5.49 116.37±46.30 27.13±9.39
*p < 0.05; **p <0.001
367
hyperglycemia with decrease in oral hypoglycemic drugs for
maintenance of normoglycemia in response to yoga therapy.
These findings suggest improvement in the insulin sensitivity
following yogic exercises.
The present study also shows a significant decrease in Total
Cholesterol (TC), triglycerides (TG), low density lipoprotein
(LDL) and very low density lipoprotein (VLDL) with a significant
increase in high density lipoprotein (HDL) level from its initial
value after forty five days of yoga-asanas and pranayamas in
group 1 while showing insignificant decrease in group 2
(Table 3). The parameters were taken only twice -once at the
time of recruitment and other at the end of 45 days, therefore
the trend of reduction cannot be commented upon. At the same
time, it is also difficult to exactly quantify how many patients
have benefited by pranayama because it differed from
parameter to parameter. For example, only 25 patients showed
improvement in HDL by 13.66%, 20 patients had reduction in
VLDL by 25.80% , 22 patients had reduction in LDL by 20.91%,
26 patients in TG by 18.18%, 29 patients in TC by 8.83% and
reduction in blood glucose (fasting and post-prandial) by
22.61% and 23.64% respectively. The decrease in lipid profile
seen in this study is in agreement with the earlier studies.
Sahay et al
(7) and Bijlani et al (10) reported a significant
reduction in free fatty acids, LDL, VLDL and an increase in
HDL. The improvement in the lipid profile after yoga could be
due to increased hepatic lipase and lipoprotein lipase at cellular
level, which affects the metabolism of lipoprotein and thus
increase uptake of triglycerides by adipose tissues (11, 12).
These changes suggest improvement in the insulin sensitivity
following yogic exercises. The patients in both the groups
belonged to the same socio-economic background. So it won’t
be wrong to assume their dietary habits were similar.
Hypoglycemic drugs like glibenclamide and metformin were
the drugs prescribed to most of these patients. We also
encouraged patients to include vegetarian diet and stressed
on the importance of regular meal timings since some studies
suggest that plant protein may be hypocholesterolemic (13).
Supplementation of vegetarian diets and dietary fibres is also
known to augment the activity of these metabolic enzymes
further.
Type 2 diabetes in contrast to type 1 diabetes is associated
with an increased plasma insulin concentration
(hyperinsulinemia). This occurs as a compensatory response
by the pancreatic β-cells for the decrease in carbohydrate
utilization and storage and the resultant increase in blood
glucose. However, even the increased levels of insulin are
not sufficient to maintain normal glucose regulation because
of the greatly diminished insulin sensitivity of the peripheral
tissues, a condition referred to as insulin resistance. Enzyme
Linked Immunosorbent Assay (ELISA) for insulin estimation
in fifteen patients showed hyperinsulinemia (Table 4).The
serum insulin levels came back to normal value after forty five
days of yoga-asanas. The beneficial effect on the insulin
kinetics may be by improving the sensitivity of the target tissues
thus decreasing insulin resistance and consequently,
increasing peripheral utilization of glucose. Sahay et al (7)
observed a significant increase in insulin sensitivity and
decrease in insulin resistance by reporting a significant rise in
the number of insulin receptors following yogic-intervention.
They also suggested a shift of the peak level of the insulin
level to the left with normalization of insulin/ glucagon (I/G)
ratio with a reduction in free fatty acid levels. A short lifestyle
modification and stress management education program leads
to favourable metabolic effects as also studied by Bijlani et al
(10) within a period of 9 days. Yoga also reduces oxidative
stress and improves day to day performance (14). Significant
reduction in the weight and noticeable decrease in Body Mass
Index (BMI) following forty five days of yoga-asana was also
observed in our study (Table 2). The average reduction in
weight was 2.26kg per person and BMI was 1.2kg/m
2
per
person. For the reason cited above, the trend of reduction of
both weight and BMI cannot be commented upon. However,
out of 30 patients in the yoga group, 3 patients didn’t show
any change in the weight while the rest 27 had 4.56% reduction
in weight and 26 patients had 6.69% reduction in BMI. Sahay
et al (7) have also reported a significant decrease in the body
fat and increase in lean body mass in type 2 diabetics after
yogic intervention. Yoga helps in the redistribution of fat by
reduction of fat from waist, thus changing from central obesity
to peripheral obesity due to change in insulin resistance. A
significant reduction in the skin fold thickness in normal healthy
volunteers was also reported in his study. Besides these,
following yoga-asanas and pranayamas, many patients
reported a feeling of well being, more relaxed and satisfied,
and a sense of relief from anxiety. They were more alert and
active which could be due to release of opiods and altered
adrenocortical activity
(15). Yoga-asanas with its change in
posture and controlled breathing in pranayama influences
mental status of an individual allaying apprehension, stress
and brings about feelings of well being and hormonal balance.
Table 4: S. Insulin levels (mU/L) in both groups (Mean±SD)
S. Insulin
GROUP 1 Before 31.47±17.28
After 22.42±13.80*
GROUP 2 Before 32.20±16.18
After 30.18±15.10
*p < 0.05
Influence of Pranayamas and Yoga-Asanas
Indian Journal of Clinical Biochemistry, 2008 / 23 (4)
368
Sense of well being seen in those practicing yoga is also
believed to be due to endogenous secretion of melatonin (16).
Although improvements were seen in all the parameters in
group 2 but none were significant. This may be because they
were already taking the same drugs since many years. When
combined with yoga (group1), these parameters show
significant improvement. Thus, it is not wrong to conclude that
diabetes can be better controlled if yoga can also be
simultaneously administered along with the conventional
medicines . From the beneficial effects of yoga on diabetes
as seen in this study, it may be assumed that adoption of
yoga on long term basis would bring proper control of blood
sugar, lipid profile and insulin levels in diabetes. However,
further extensive and long term studies need to be done to
prove this and to understand the basic mechanisms involved.
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