Health Benefits of Yoga for Anorexia Nervosa ​

It is widely agreed that the translation of the word “yoga” is union. The mental and physical components of a yoga practice lead to a harmonized union of the mind and body. Yoga has been seen as a highly prioritized form of healing in the eastern culture, where many people turn to prescriptions from yogis to heal many medical conditions along with relaxing the mind to achieve optimal health. When addressing the health benefits that yoga provides both areas are equally important. There is one psychiatric condition with the highest mortality rate due to it’s accompanying physical symptoms. This happens to be the eating disorder called Anorexia Nervosa (AN). AN is when one restricts their food intake, inducing self starvation, while maintaining a dangerously low weight. This illness impacts a person’s mental and physical well being. Physically damage can happen to the digestive system, thyroid, heart, kidneys, reproductive system, and bones, all stemming from malnourishment. Mental symptoms include depression, anxiety, and obsessive compulsive behaviors. People with AN generally report feeling lost, empty, and disconnected from the world and themselves. Taking these facts into consideration, it is reasonable that the highly therapeutic aspects of yoga would lead to healing and promote health in those struggling with AN. It can be a valuable tool towards healing on the physical, mental, and spiritual level. In the recovery from AN much importance is placed on physical healing with the reasoning that if one does not have a healthy functioning body there is no opportunity for life in the simplest form. This is where the physical asanas can provide much needed benefits. In many cases hunger is denied to the point where it is no longer felt. The digestive system loses strength and does not function properly, leading to conditions such as chronic constipation and stomach pain (Dryden-Edwards ,“Anorexia Nervosa“). The most common postures that provide relief to digestive problems are Leg Raise and Wind Relieving, while Locusts and Bow also have the tendency to increase appetite (Das 80-84, 87-88, 94-95). In addition, breathing exercises such as Uddiyana Bandha and Nauli can strengthen the abdominal organs and stimulate the removal of waste products in a natural way (Vishnu-devananda 37) which reduces the need for stimulants such as laxatives that can become addictive with this population. The endocrine system, whose major organ is the thyroid, can also be healed through yoga. The thyroid tends to slow down with starvation in order to preserve energy. The thyroid produces fewer amounts of various hormones that can cause a decrease in heart rate, metabolism, and body temperature. As hormone production is affected, many females will experience amenorrhea, and males experience low testosterone ( Schulman, “Anorexia Nervosa: An Endocrine Problem). Beneficial postures that regulate the thyroid and hormone production include Fish, Hare, and Plow (Dass 131, 152, 167). A health issue of great importance that affects those with AN is cardiac malfunctions. AN is associated with a slow heart rate and arrhythmias as the work capacity of the heart is reduced. Yoga tends to provide a way to work the heart muscles in a gentle fashion that does not include high intensity and stress. Yoga focus on slow controlled muscle movements in combination with deep breathing which provides an increase in circulation and intake of oxygen. This results in more blood flow to the heart, stretching fibers with stronger contractions. The end result is a stronger heartbeat (Vishnu-devananda 47). In addition, a study has found that the energy expenditure in calories due to cardiac output from yoga in moderation does not lead to a decrease in the weight of a person with AN. This is important since weight loss would not promote recovery in this population. Therefore, yoga can provide health benefits through working the heart without a negative effect on weight, making it a great tool for recovery (Carei, Fyfe-Johnson, Breuner, & Marshall 346-351). Those with AN are at a high risk for Osteoporosis due to a lack of calcium and Vitamin D in the diet from malnutrition. In this state the body feds upon itself and muscle and tissues are destroyed in an attempt to provide the body, mostly the heart, with fuel to function. Bones are one of those tissues that are depleted in this process. Those with AN tend to experience a significant reduction in bone density. One way of reversing the effects of a loss of bone mass is through weight bearing exercises. Yoga is a weight bearing exercise since the body holds its weight against gravity producing positive stress on the bone leading to new bone growth. An advantage in this is that no stress is put directly on joints, causing cartilage damage. Warrior poses, Downward Dog , Cobra and Bridge are common postures that produce such bone strengthening benefits (Fishman 244-250). Health is not just about the physical body. AN has a large impact of the brain and mind. The mind can be what leads a person to using an eating disorder to cope with stress, but the results of starvation can worsen or even cause symptoms of depression, anxiety, and emotional dysregulation, keeping a sufferer in a vicious cycle. Therefore addressing mental issues is essential to recovery. Since yoga creates health in the mind as well as the body, this makes it an essential tool for recovery from AN. The mind of an Anorexic can be bombarded with anxious thoughts about life in general. AN is a disease of control. In the majority of cases one feels out of control of an aspect of their life and clings to regimented control over food and exercise for a sense of security. One can also use starvation as a way to numb emotions that feel out of control. This control and anxious thinking needs to be targeted as the mind is overrun with thoughts about food and exercise to avoid thinking about life situations. Therefore, an experience like yoga that leads to gaining control over the mind and anxious thoughts, mainly through the practice of pranayama breathing, is healing. The slow steady breathing in yoga activates the parasympathetic nervous system, which sends a signal to the brain with neurotransmitters for it to relax and reduce anxiety. In AN the mind runs out of control as the ego is specifically affected. The ego begins to look towards achievement, control, performance, and appearance to find self worth and identity ( Costin & Kelly 3). This leads to a perfectionist mentality where one has deep body dissatisfaction. In many cases the preexisting perfectionist mentality is an underlying issue that led to the development of AN. Yoga offers a time, place, and experience for people to learn to accept their bodies. Yoga requires one to be aware not of what the body looks like in the postures, but what the body can do and what it feels like. Yoga classes encourage students to only go as deep into postures as they are able, and modifications are temporary until new physical achievements are made. Students learn to recognize that the body has limits. As a result, more respect for the body is developed. Anorexics are better able to listen to their bodies and honor hunger cues that were ignored in the past. This respect spills over into taking better care for the body off the mat as well with proper nutrition and rest ( Haynie 1). The ending posture Savasana is one of the most healing elements of yoga for the Anorexic mind. This is because the body has to be still. A large majority of Anorexics suffer from exercise addiction, sometimes obsessively moving the body as much as possible in order to burn calories. Stillness is then associated with the fear that it will be promoting weight gain. In Savasana a student has the ability to challenge this fear and practice the art of stillness. The stillness is not just a physical difficulty, but a mental one as well. Constant movement and “doing” interferes with mindfulness and having a still mind that is in the present moment. There is often a fear of being in the present moment with the discomfort from emotions or thoughts about the body or aspects of life that seem uncontrollable. In Savasana one’s mind is still allowing thoughts and emotions to come and go without judgment. Savasana requires the practice of tolerating the physical and mental discomfort of stillness. Studies of those with eating disorders participating in yoga have shown that the increased ability to be still on the mat is linked to focus off the mat in others areas of life ( Costing & Kelly 8). Therefore the effects of yoga are carried outside the class, promoting lasting health benefits. The mind body connection that yoga provides those with AN is essential to recovery. It is widely agreed among professionals that AN is a disease of the mind and body. One uses disordered eating behaviors and weight loss methods to escape emotions and discomfort. As David Emerson explains, trauma sensitive yoga can bridge the body and mind disconnect. Those with AN are not able to appropriately experience interoception which is awareness of the physiological condition of the body and the feeling and sensation of a conscious self. Trauma Sensitive Yoga is evidenced to help students become aware of physiological changes in the body through awareness and attunement to the body. It is learned that these changes are connected to emotions, such as discomfort or fear. Yoga postures and breathing techniques are learned to alter the physiological responses and making the emotional and mental discomfort more tolerable. Students learn that when certain emotions are experienced a choice can be made in how to respond. This opens the doorway to using healthy ways to cope other than the automatic response to use harmful eating disordered behaviors (Costin & Kelly 44-45). Lastly, to reach full health from AN through yoga the spiritual benefits must be included. When one’s mind and body are disconnected there is also a disconnect between the person and their true self. AN is similar to an addiction. It overtakes a person’s true nature. The person acts in compulsive, irrational, and deceptive ways, that are out of balance. When the disorder is at it’s worst the sufferer is no longer in control of their actions, the disorder is. The person begins acting as the eating disorder demands versus what the real self desires. Many Anorexics in recovery report feeling a loss of sense of self and empty. The eight limbs of yoga leads one with AN to develop non-violence to the self , as well as compassion and self acceptance. This helps the person become more at peace and connected with the inner self, therefore allowing the opportunity to be connected with the spiritual aspects of something grater than the self. Yoga philosophy provides a way to answer the question of “who am I without my eating disorder” for Anorexics. The meditative aspects of yoga train one to become more mindful of emotions, pleasure, and even pain. Powerful meditation of connecting to the breath and mantras helps a person clear their mind of intrusive thoughts of what a person “should” do that prevent one from acting in an authentic way that reflects choices and actions coming from the heart. As one is more aware of the true self and connected, connection to others and a force greater than the self is more possible. Those suffering from AN need healing on every level. The bridge between the mind and body has to be built. The philosophy and practice that yoga offers makes it an essential tool to recovery. Health benefits are experienced on the physical, mental, and spiritual level. Each area of health benefits the other, breaking the unhealthy mind and body cycle that those with AN get stuck in. To promote healthy recovery from AN each area has to be addressed. Yoga is an answer to pure, whole healing of the mind, body and soul. Works Cited Carei, T.R., Fyfe, Johnson, A.L., Breuner, C.C., & Marshall, M.A. “Randomized Controlled Clinical trial of Yoga in the Treatment of Eating Disorders.” Journal of Adolescent Health., vol.46, no.4, 2010, 346-351. doi:10.1016/j.jadohealth.2009.08.007. Costin and Kelly. Yoga and Eating Disorders: Ancient Haling for Modern Illness. Routledge, 2016, New York. Das, P.S. Yoga panacea: A book of Holistic Medicine for Holistic Healing. Indian Publishing House, 2016, West Bengal, India. Dryden-Edwards,Roxanne MD. “Anorexia Nervosa.” MedicineNet.com, 8 March 2016, http://www.medicinenet.com/anorexia_nervosa/article.htm. Accessed 30 Sept. 2017. Fishman, L.M. “Yoga for Osteoporosis: A Pilot Study.” Topics in Geriatric Rehabilitation, vol. 25, no.3, 2009, 244-250. doi: 10.1097/TGR.0b013e3181b02dd6. Haynie, D. Yoga: A New Way to Fight Anorexia and Bulimia. Columbia U, 13 Feb. 2007, http://jscms.jrn.columbia.edu/cns/2007-02-13/haynie-yogatherapy.html. Accessed 1 Oct. 2017. Schulman, R. “Anorexia Nervosa: An Endocrine Problem?” EmpowerYourHealth.org, https://www.empoweryourhealth.org/magazine/vol3_issue3/Anorexia-Nervosa-An-Endocrine-Problem. Accessed 06 Oct 2017. Vishnu-devnanda, Swami. The Complete Illustrated Book of Yoga. Three Rivers Press, 1988, New York.