Tuesday, November 20, 2012

Naturopathy and Yoga in Cancer Management

In the Post Tea session, Dr. Ibrahim Nagnor of Kidwai introduced the delegates to Dr. Raghavendra Rao M. BNYS, Ph.D. Sr. Scientist, Clinical Research and Head CAM Program, HCG Enterprises Ltd., Bangalore and later to Dr. Nagarathna Raghuram MD, MRCP, FRCP Dean, Division of Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore. The well renowned resource persons of their fields, these two experts presented their views on NATUROPATHY, MANAGEMENT OF CANCER THROUGH YOGA: CONCEPTUAL BASIS AND PRACTICES and ROLE OF YOGA IN INTEGRATIVE ONCOLOGY: AN EVIDENCE BASED APPROACH
Dr. Raghavendra is a recipient of Dr. Sushila Thacker Prakruti Mandir Prize for the best paper in the field of Yoga, Naturopathy and Natural Health by Association of Physiologists and Pharmacologists of India in December 2002.
He started his talk with brief introduction to Naturopathy which deals with the natural healing power of nature and human body. Naturopathy states that within every human cell there is a healing energy which maintains the wellness of both the mind and body, and it is this healing energy that gives us the ability to heal and maintain wellness of our body. According to naturopathy, the main cause of our illness is that we do not live cordially with nature, but often go against it. Our busy routines, restlessness, eating junk food, changing the life style often, stress, depression, sedentary or extremely hectic activities, lack of close companionships and many other factors contribute generously to the problems of people nowadays.
Naturopathy has formulated a method of expelling toxins from our body to heal it through fasting. The healing power of naturopathy is opposite to the harsh effects of chemicals, which is gentle, non-invasive as well as effective.
In naturopathy, the therapeutic methods of herbal medicine, food and nutrition, homeopathy, hydrotherapy, yoga and exercise, healthy lifestyle and proper mental attitude are all combined effectively to diagnose and treat the cause of the disease whereas most of the other therapies simply treat the symptoms and manifestation of the disease while ignoring the cause of it. Starting from preventive methods, naturopaths are efficient in handling even advanced, chronic and debilitating diseases.
Dr. Raghavendra next touched on the
fast growing area of research known as neuroimmunomodulation which explores the way in which the nervous system interacts with the immune system via neural, hormonal, and paracrine actions. Basic investigations consider all neural and humoral interactions from molecular genetics through cell regulation to integrative systems of the body. He deftly explained how neuroimmunomodulation through Yoga can help in survival of people diagnosed with cancer.
Without the will power and proper attitude to fight cancer, you can almost assume the battle to be lost even with best of treatments. Therefore it is important to bring in the fighting spirit in the patient.
Chronic is known to promote tumor cell growth in people in addition to other negative health outcomes including the formation of gastric ulcers, and heart disease. Stress activates the sympathetic nervous system, which will be further implicated in the regulation of metastatic processes. A chronically activated sympathetic nervous system is capable of promoting metastasis via macrophage activity.
The next topic was how depression is a predictor of disease progression and mortality in cancer patients. It is strongly believed now that depressive symptoms and major depressive disorder predict disease progression and mortality in cancer patients and the associated risk was significant through studies conducted.
Cancer cells are located in a very complex microenvironment together with stromal components that participate to enhance oxidative stress to promote tumor progression. Oxidants influence the DNA mutational potential, intracellular signaling pathways controlling cell proliferation and survival and cell motility and invasiveness as well as control the reactivity of stromal components that is fundamental for cancer development and dissemination, inflammation, tissue repair, and de novo angiogenesis.
 Yoga can lower stress acutely and may adjust stress mechanisms in the long run, possibly conferring survival benefit to cancer patients. The release of stress hormones, in particular the glucocorticoid cortisol, is a key component of homeostasis in mammals. Yoga not only lowers cortisol levels, in addition it improves the quality of the circadian rhythm by restoring the "flatter" cortisol curves to a more normal undulating pattern. This may be a key mechanism in yoga's beneficial effect on outcomes in cancer patients.  
Dr. Raghavendra spoke extensively on psychologic stress and tumor biology in course of his lecture. Studies conducted on stress in cancer patients have focused on the relationship between stress and the immune system. Instead of merely weakening the entire immune system, as was believed to be the case years ago, chronic stress actually deregulates the immune system by suppressing the immunological processes that protect the body from viruses and malignancy (e.g., cellular immunity) and promoting the processes that make the body vulnerable to autoimmune disease and cancer progression.
He also gave brief introduction to mind body programs and how yoga helps.
In the battle of cancer, more than the disease itself, but the discomfort and side effects brought on by chemotherapy, surgery and radiation can be tough to deal with. All the left over from the surgery like the scar tissue, loss of vital organs, weakness, nausea, hair loss and infinite side effects of chemotherapy and the after math of loss of healthy tissue from radiation; all can leave the patient exhausted and with less enthusiasm for life.
Yoga can step in here and help the survivors strengthen their bodies and deal with the discomfort arising from the symptoms of cancer or side effects of cancer treatment, both during and after the treatment. Yoga has been successfully proven to be one of the best methods to combat the physical onslaught of cancer and cancer treatment on our bodies. The not so demanding gentle yoga postures can help in clearing out the toxins which gets accumulated in the body due to cancer treatment.  The yoga postures stimulate muscles, increase blood flow and create balance in the hormones which helps in purifying the body. The deep, methodical breathing process of Yoga increases the flow of oxygen rich red blood cells to the vital parts of the body, which not only provides rejuvenates the tired cells but again contributes in clearing out the toxins.
The stage was then taken over Dr. Nagarathna, who has MBBS and M.D. (Gen Medicine) degrees from India and MRCP from UK. Presently she is working as a Consulting Physician & Yoga Therapy Consultant with Swami Vivekananda Yoga Research Foundation (VYASA) and Suhruda Polyclinic, Bangalore.
Dr. Nagarathna has done research and brought out papers on physiological and psychological effects of yoga practices, studies on medication and altered states of consciousness, clinical studies on therapeutic applications of yoga, stress management and management systems, yoga research in education for total personality development, yoga research for rehabilitation.  She has presented research papers in national and international conferences and has successfully received accolades for her contribution to the field of Yoga. Dr. Nagarathna has several awards to her credit including the “Doctor’s Day Award” by IMA, Bangalore.  She is a Member of the Royal College of Physicians, Fellow of International College of Angiology, US, Life Member of Association of Physicians of India, Member of Third World Organization for Women in Science, Third World Academy of Sciences, Trieste, Italy, Member of American Society for the Psychical Research (ASPR). She worked as Assistant Surgeon, Children Unit, Vani Vilas Hospital, Bangalore, Senior House Officer, Department of Geriatric Medicine Poole Hospital, Middlesborough, Cleveland, UK.
According to Dr.Nagarathna, cancer is a psychosomatic disease, a disease which involves both mind and body. Some physical diseases are thought to be particularly prone to be made worse by mental factors such as stress and anxiety and cancer is one of them. The current mental state of the patient going through cancer can highly affect how bad cancer is progressing in his/her body.
Yoga slows down all the process taking place in body and reduces speed. Yoga reduces cortisol levels ,a steroid hormone produced by the adrenal gland which is released in response to stress and low level of blood glucocorticoids. Yoga also helps in reducing tumour necrosis factor.
Dr. Nagarathna went on to elaborate on the functioning of the Annamaya Kosha. Annamaya (physical, matter) kosha is the layer where our physical sensations are felt and all our elements and minerals come together as the material body. Yoga postures operate at the Annamaya kosha level and remove the physical symptoms of ailments. 
The next topic Dr.Nagarathna touched up was about the diet and cancer and the benefits of following a yogic diet along with the yoga therapy.  A yogic diet ideally follows a sattvic or pure food diet. A balance of fresh fruit, vegetables, cooked whole grains, milk, legumes, nuts and seeds, using a combination of both raw and cooked foods. These food are light, simple and supply all the necessary nutrients required by the body without increasing toxins. They increase physical and mental vitality making it easier to experience clarity, lightness and peace of mind. Rajasic foods are prepared with much oil and spice. They create heaviness and restlessness in the mind. Meat and fish are classified under these. Onion and garlic are also under this group as they increase desire. Tamasic foods are foods that are old and stale. They lower the energy and cause laziness. They include foods that are not cooked properly or chewed well and processed foods. Stale, processed and frozen foods have lost their pranic energy. If we try to eat only sattvic foods as much as possible we can slowly change the body chemistry, renewing the digestive system and taking away any strain. Ideally we should eat foods that take minimum energy to digest, so that the remaining energy can be used for more productive uses.
Dr. Nagarathna also spoke about the Manomaya (mental, or mind) kosha which is the sheath where our emotions, thinking, feelings and desires are grouped together. During the dream-state this kosha brings together many aspects of the mind. It is also where the ego can create obstacles, and psychosomatic factors causing physical illness begin their journey into the body’s cell structure resulting in a breakdown of tissue. Yoga Sutras, is facilitated through dharana (concentration exercises) and dhyana (meditation, or spiritual contemplation). These practices may ultimately lead to Samadhi (or super-consciousness).
 The yoga therapy and yoga asanas contribute a lot to the well being of a cancer survivor. Dr. Nagarathna says,”when you maintain in the final posture of the asana, concentrate intensely on the internal changes at the site of stretch; relax all unnecessary muscle contractions by passing your mind through the whole body; focus again on the point of stretch; start relaxing the point that is stretched (called prayatna saithilya); now move on to defocus by imagining the pain of the stretch diffusing away like a drop of ink that spreads into the surrounding pool of water. (Called Ananta Samapatti). The asanas that are selected should be those which improve the digestion (Pavanamuktasana, Vakrasana, Paschmatanasana, parivritta-trikonasana); and the asanas that would give a mild stretch to the affected part of the body. For example Vakrasana and Bhujangasana in breast cancer, Ardha-Cakrasana for throat cancer, Ardhasirsasna for head and neck cancer etc. In these postures Prayatna Shaithilya and anantha samapatti with deep internal awareness helps in giving very deep rest to the fighter cells that are in large number in the site”.
Pranayama and PET - the violent surge of Prana which has caused the aggressive multiplication of the cells, has to be controlled by slow deep abdominal breathing and all other breathing practice which is the essential step to move on to PET (Pranic Energization Technique). The slow breathing is the vehicle to become aware of the subtle energy that makes you breath. Once this is achieved you will move on to reduce the surges of prana in PET.
Meditation techniques - meditation on OM, Cyclic meditation and  MSRT (Mind Sound Resonance technique) are all very subtle methods to directly handle the violence in the conscious and subconscious layers of the mind.In MEMT (Mind Emotion Management  Technique)you will understand and open up a lot of the hidden emotional suppressions in the Pandora's Box of the subconscious mind. Systematic regular practice of devotion and surrender to the divine with full faith invokes enormous strength into your White Blood Cells.
VISAK (Vignana Sadhana Kaushala) is another technique for Notional Correction. This takes you into the knowledge from the upanisads which reveal the trick to be happy and be contented under all circumstances be it a difficult family or job or business situation; you will learn to exercise the complete freedom within. To realize the truth "Stress is speed, bliss is silence" is the key.  This correction helps you to reset your life style completely. No person or no situation can now affect you as you now know the trick of non-reaction and inner joy.
ANAMS (Anandamrita Sinchana), is the trick to overcome the fear of death by a systematic analysis and training. The eight steps of ANAMS puts you in the state of absolute fearless state which you know is the most important factor that helps you to cure yourself as in the example of Ian Gowler. Dr. Ian Gawler OAM. Ian is well known as a pioneer in Mind-Body Medicine and therapeutic meditation. He is a long-term cancer survivor and an articulate advocate for a healthy lifestyle. To accept and face death, you need to walk through the thick psychological barrier that stops you from imaging that you would die.
Benefits of Yoga therapy for patients going through cancer treatments can be as follows:
·         Reduced side effects during chemotherapy (CT) and radio therapy (RT)
·         Lesser degree of anxiety and depression in yoga group as compared to non-yoga group
·         Better quality of life
·         Lesser immune system damage due to CT and RT
·         Increase in Natural Killer cell count in yoga group    
Dr.Nagarathna also narrated a story of Dr. Tarayama from Japan who was an invitee for the international holistic health conference in 1991 and 2003 held in Bangalore where she had met him. Tarayama was an executive of a big company; developed abdominal pain; seen by the experts; found to have advanced cancer in 1984; the lump could not be removed completely as it had advanced too far; he was told that he may not survive more than a few weeks; but he survived himself and is now helping large number of cancer patients in his beautiful nursing home in Japan. Last year when he came to our centre, I asked him ' Sir please tell us what happened in your mind when you were told that you have advanced disease?
He said I was depressed. I even cried to my wife as to how the family would cope after I go away. But she gave me the confidence and said “Do not worry about us, we care for your well being”. These words triggered something deep within me. The fear went away. I prepared to die fearlessly. I started doing many things. I resigned my job, settled my financial issues, wanted to enjoy the remaining short period of my life; went to a monastery in Fuji mountains; walked up and down the hill daily; gave up meat and fish eating; drank wheat grass juice and other fresh juices; meditated on Sun God and I felt better and better every day. My disease disappeared completely. Scanning of my abdomen showed that there was no sign of cancer in my body anymore.
I asked Tarayama what is your message for cancer patients. He said "LOVE THY CANCER CELLS!" Thus we have seen how self healing is possible through the example of a cancer survivor like, Tarayama.
Emotional management is very important in managing cancer. According to Yoga therapy, the root cause of Stress induced ailments is the imbalance at the Manomaya Kosa. Amplified likes and dislikes at the manomaya kosa results in distressful emotional surges called 'Aadhi'. The life style gets disturbed because of long standing uncontrolled surges of stressful reactions like intense desire (Kama), anger (Krodha), fear (Bhaya), jealousy (Matsarya) etc., and these agitations cause violent fluctuations in the flow of prana in the 'nadis' which are said to be the channels distributed all over the body through their branching system. Each and every cell in the body, the components of annamaya kosa, requires right quota of its pranic energy to carry on its biochemical processes in an efficient way. The example is that of uninterrupted power supply necessary for every electrical gadget in right quantities. Just as these equipments would fail if there is any irregularity in the power supply, human organ systems fail to function if they do not get the right quantum of prana. Thus the disturbances in the Manomaya kosa percolate into physical body (Annamaya Kosa) through disturbed prana flows. Hence the management of these stress induced ailments should correct imbalances at all these levels (physical, prana and mind) and help the patient establish himself in his Vijnanamaya and Anandamaya Kosa which is the state of freedom from illness. Hence Yoga techniques are offered at all these levels, to correct the imbalances through a set of yoga practices which have been termed as integrated approach of yoga therapy.
The Paper presented by the experts:
Advances in cancer treatment have markedly improved survival with more people having to endure cancer symptoms longer than ever before. Persons with cancer experience a range of symptoms related to both the disease and its treatment. This causes severe psychological distress and coupled with cancer related intrusive thoughts, can exacerbate symptoms in cancer patients. Most of these symptoms also have a psychological and emotional component that effect the way it is perceived and felt by the cancer patients and can impact neuro-endocrine and immune stress responses thus impacting survival outcomes in these patients. Integrative oncology encompasses a holistic care using a multidisciplinary approach to improve quality of life and well being in cancer patients by reducing their distress and painful experience of cancer and its treatment related symptoms. This is facilitated by helping cancer patients allay their fears and concerns of disease and distress and cope with them effectively through mind body approaches that involves cognitive restructuring and relaxation. Yoga is an ancient mind body intervention that has found beneficial effects in reducing psychological distress and improving quality of life in cancer patients. Our experience since last 13 years with yoga intervention in breast cancer patients has shown yoga to reduce affective states, perceived stress, treatment related distress and toxicity, modulate antitumor and anti-inflammatory immune responses, reduce genotoxic stress during radiation and normalize diurnal salivary cortisol rhythms. Results from 4 RCTs in breast cancer patients comparing yoga with supportive care will be discussed. The basic principles underlying mechanism of action of yoga in oncology and philosophical basis for the same will be discussed.

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