International Day of Yoga 2024 — Q&A + discussion w/ Dr. Abha Rajbhandari and Dr. Jonathan Rosenthal

Welcome everyone. I'm so happy that you're all here, and I'm so excited to talk to Dr. Alba Rajapandari as usual. So I'll— do you want to introduce each other?

Introduce ourselves or each other?

Each other for fun.

I feel like I'll mess it up.

Okay, we can introduce ourselves. So I just have to say this, we do this every year. It's kind of our annual tradition now, which is really nice. We're a little bit late for it, but it is in celebration of International Day of Yoga. And we are both really interested in science and how studying yoga helps us improve how we practice yoga, how we share yoga with others, how we advocate for yoga. And so to celebrate yoga and the Day of Yoga worldwide, we like to talk about science and add that to the, the whole. View of it.

Yeah.

So, Abba, do you want to introduce yourself first?

Sure. Hi, everyone. Yeah, we we've done this for five years now. Yeah, it's amazing to be able to share this, and in a in a way, yoga day is every day. So yeah, it's really you know even though we're doing it late, I think it's good, right? Sometimes happens on one day. But anyways, thank you all for joining. My name is Abba Rajpandari. I'm an assistant professor in the departments of psychiatry and neuroscience at Icahn School of Medicine at Mount Sinai, and I study brain-body communication in relationship to stressors in my lab. And then outside of lab, I'm very passionate about bringing philosophy of yoga, practice of yoga, and the science of yoga all together. So yeah, I'm really excited.

Um, but also teaches classes about the philosophy of yoga, which everyone should check out. They're really cool.

Thank you. Yeah, I'm gonna do it now more, but thank you. Yeah, and I'll turn it over to Jonathan.

Awesome. So I'm Jonathan and I am unemployed now, but I am a neurologist, which means that I'm a physician who specializes in diseases of the nervous system, like stroke and epilepsy and multiple sclerosis. And I'm a subspecialist in clinical neurophysiology, which most people haven't heard of. I hadn't heard of it. And basically what I do is I use electricity to diagnose disorders of the nervous system. And I just finished my fellowship, which I'm really excited about. So I did my med school and residency at NYU School of Medicine, and I just finished my fellowship at Weill Cornell School of Medicine, both in New York City. And I am going to be doing intraoperative monitoring after this. Yeah, which I haven't talked to you about, Abha, but basically what I'm going to be doing is I, during procedures where the brain and the spine is being operated on, we will have electrodes like all over the scalp, all over muscles and nerves, and we'll be able to shock and record to make sure that pathways through the spine are still working.

Wow.

And be able to, it actually changes surgery. So You know, the goal of surgery is to get whatever is causing the problem out without causing any more problems. So we are able to tell when problems are happening so that someone doesn't wake up, you know, unable to move their legs or something.

Oh, wow. That's exciting. Yeah, I, I guess, you know, 'cause you had been so busy with finishing up and then after yoga day or after, you know, March, I think it had gotten a little busy.

Yeah.

So how, Wanting to catch up with you, but that's really exciting to hear.

Yeah, thank you. And I'm very passionate about yoga. I think yoga has the potential to change everyone's life. And I really do think that yoga is for everyone. And I can cite a study at some point today when we're talking about why I think that in an evidence-based way. And then yeah, I, I really want to advocate for yoga out in the world.

Yeah. Amazing. And also like whoever is here and then we can remind please post, pose questions. We're just gonna go with the flow. We have some questions ready, some areas, and couple of questions also came up, and I think very relevant lately. But if you have any other questions, please feel free to post that here. And so, should, to get us started, should we start on some of the questions that were posed? I think one was in the area, which, which is something I'm also interested in. You know, we live in a very Stressful time in the world right now with so many things, you know, work-wise, other things-wise. And so this question has come up for me also many times, you know, in other classes, but it's related to burnout. Like, how can yoga help with burnout? And if so, you know, how does it help? So yeah, as a physi— you know, as a doctor, like, how, what do you have any experiences? You're also a teacher, you know, practitioner. And then as well as well studied, right, in some of the research?

I think it's a really cool question. I think burnout is everywhere. Like, I think every industry is struggling with burnout, especially after COVID. And I think I'm sure people have encountered so many conversations about burnout right now. But for anyone who's experienced burnout, you're like, let's stop talking about it. Like, let's do something about it. And I'm going to share a sentiment that a lot of people feel, especially in the medical world. So burnout rates in medicine are insanely high, like across all fields of medicine, like, you know, not just among physicians either, like the nurses, the respiratory therapists, like the transporters, the people who do the stocking of supplies, like everyone really feels it. And I think it, there are core features of it, like people feel like a lack of autonomy, a lack of fulfillment, like they're not doing something with purpose and meaning. And so the experience of burnout is so prevalent and common that I think when people hear like, oh, why don't you just do yoga? Or why don't you just do this to make it better? They are immediately insulted. It's like, the problem's not me. And you know what? I actually honestly agree with that sentiment. I don't have any evidence to back up my claim for that, but I really do think that for a lot of things with burnout, there need to be system changes. Systemic changes.

Mm-hmm.

But at the same time, I can't argue with data, right? Like, the data are the data. So the data are that yoga really does help with burnout, and it helps with multiple domains of burnout. So it helps people feel more fulfilled in their work, it reduces comorbid symptoms of anxiety and depression, it improves sleep. And so I think all of that together really does suggest that yoga could play a role. But I don't think that that's a reason for corporate, you know, corporate powers to be like, everyone should just do yoga and we don't have to change anything. Yeah.

Right. That same, I think, goes for student burnout, like, you know, in grad school and postdocs, even in, you know, in our system of academia, we see that too. So yeah, this is something I think across, like you said, across the board, right? There is this aspect of burnout, I guess, because of high demands, you know, not well organized. Yeah, like the systemic changes for sure. But in terms of like the evidence you were talking about that shows what, what are the areas that you're finding? I, I found some too that it specifically helps in. Yeah.

So I think there's, I don't have one paper pulled up right now, but I've come across so many papers on yoga for burnout over the years. A lot of them tend to be really low quality studies, like pilot studies. And they're often done in like a nursing school population or an early career nursing population. There are a few that have been published in resident physicians. I know Sapir Kalsa did one of those.

Mm-hmm.

And they pretty much invariably show benefit. But I think if we were to think about, can we extrapolate from really high quality studies that there's improvement? And, you know, one of the other features of One of the overlaps with burnout is a lot of people feel traumatic, like traumatized a bit by some of their work, especially in the healthcare field. And, you know, also in research, like people who work with animals and are kind of sacrificing animals probably feel a bit of trauma from that. And we know that yoga has tremendous benefit in a trauma population. I was actually just looking at this study before this about yoga for the prevention of the development of PTSD. And they applied it in a firefighter and police population.

Yeah.

And the idea was, you know, they were just gonna follow over, I forget how long they did it, but it was, they followed over time after a yoga intervention to see how likely people were to develop PTSD. Obviously their days are filled with, you know, very stressful, life-threatening events all the time.

Mm-hmm.

And the, it was a randomized controlled trial. There was a yoga group and a control group, and the yoga group had a lower incidence of PTSD. So there definitely are protective effects too. So even people who aren't currently burnt out are going to have potentially protection.

Yeah, that makes sense. Yeah. And you're right, like there were so many studies, right? And some are based on like philosophy of yoga, practice of yoga, many things. Like there was even this article on like the Bhagavad Gita of how, you know, how not to attach to the aspect of the, you the end result and just doing the job. And in some ways that also can help physicians and doctors and many other professionals, right, in terms of burnout. But really interesting, there were aspects like you touched on already, but quality, overall quality of life. And I think that goes with being able to manage stress, I think, a little bit better. And I think what I'm noticing is also Sometimes, you know, when we, especially beginner practitioners of yoga, when we say to assign like a time for practicing, right? Like 30 minutes in the morning, that's what the science shows, right? Like 20 minutes or at least 2 times 20 minutes is good for health. But sometimes that itself can become a stressor when you're not able to do it, right? So if you're doing like night shifts or not able to dedicate that time, then you feel like you're missing out or you're not adding that. And so interestingly, there is, you know, a way, which is something I've been advocating also about, is like micro moments and transition times as times to practice, right? Breathing practices, for example, right? Like those are the times that can be done, which can allow like breaking down, you know, probably those 20 minutes, and I don't think there's studies done on this, into smaller chunks. smaller chunks, and especially any moment going from one moment to another, noticing how we're breathing, noticing, you know, how our heart rate is, all of those things then can actually may have an impact. I think they should do some study like that looking at, you know, combined effect of yoga, you know, in these 2 chunks of 20 minutes or 30 minutes, which is known as this dose response, right? That helps. But also these smaller bits, right? All the time in a way practicing. And then, you know, aspects of emotional regulation, physiology, like heart rate, breathing, all of these things are some of these papers sort of show that there are beneficial effects, right? So really interesting.

I really love your answer. I, so, you know, my teacher gave me this practice a really long time ago because I said I was busy. And it was hard for me to practice. And he said, all you have to do is put your hand in Gyan Mudra, put it down by your waist while you're walking, keep your eyes low, don't look around too much, control your senses as you walk. And, you know, obviously don't get into a car accident or anything as you're walking, but, but just control your attention while you're walking. And I was like, wow, that is such a good idea.

Yeah.

Yeah.

I've been practicing that a lot because, you know, in my profession I have to write research grants all the time, right? And so there is this stressor, you know, when grants fail or like, you know, there are these moments where I'm intensely focused on writing and I noticed myself, right? Obviously. But then I've been talking to a few other people in this kind of intense situations. And in those moments, right? Like what you said, like even going to the bathroom in a way can be that walking meditation in a way, right? Like you're noticing like when you get up, Or, you know, when you're standing and walking and doing something like that, change or transition is a great moment to actually practice and notice all aspects of our breathing, heart rate, and then change it, right, for the better. So yeah, I think the teachers knew, right? That's why yoga is all the time. It's not just like in these chunks of moments, but all the time we're practicing it. So really nice.

That's really interesting. I also don't see studies structured that way. Like, I usually see the studies structured as an hour-long, like a 30 to 60 minute intervention, 2 to 3 times a week. And it's like, you're, you're so right. Like it, it actually probably shouldn't be that. Like maybe it would be even more effective if, if we did it this way in the studies.

Especially like, you know, for certain things you might need those, but then noticing your breath or altering your breath or doing some like anulom vilom, alternate nostril breathing or brownberry or bee breathing doesn't require you to actually, you know, go to a place or be somewhere that anywhere, right? Like in, in your own environment situation. And so I think that's very effective.

Yeah.

We have several questions. We do.

Yeah. Felipe asked the first one. Hi, Felipe. It's good to see you. He says, what do you guys think are the best online databases for academic research about yoga? I have a few.

What do you think? Obviously PubMed, right, is the one, but sometimes I know the hindrance can be, you know, getting some of these articles because of the paywall. So in that case, I mean, Google Scholar is the next one, but I don't know, do you have any others? Those are my 2 go-tos.

Yeah, those are my 2 go-tos as well. And I also, if I'm having a hard time getting a paper and I don't want to log into an academic site because it takes too long to get the paper, there's this one I really shouldn't talk about because it's probably illegal, but it's called Sci-Hub. And they like have kind of stolen a lot of papers and they make them available for free because they're like anti-paywall. But if you just like Google Sci-Hub, you'll find it. But the, if you want to find one specifically about yoga and you don't really want to have to search through all of the medical or biomedical research databases, you can go to the Yoga Alliance. They have a whole repository of studies and they include the PDF. And then I think NCCIH. Post some, post some studies on their website as well. So that's the National Center for Complementary and Integrative Health. It's a branch of the NIH. And so, yeah, I'm looking right now and they have studies that you can find.

Oh, that's awesome. I didn't know they posted studies. They usually do like summaries of all the research on yoga that's coming out and where the science shows most beneficial effects and things like that. It's a good one, right? nccih.nih.gov. Yes. Um, have a lot of like summary if you want to know, right, certain areas. But also it seems like they have papers, which I didn't know. So that's good to know.

Yeah. And we had one other question, which is a big one. How does yoga help with anxiety and depression? What is the science?

Yeah, there's a lot we did. I mean, for the Neuro Yoga Conference, right, we've done aspects of, you know, covered aspects of this. But actually those are the areas like stress, depression, PTSD, anxiety-related disorders are actually the areas that have a lot of research that has been done, right? And so to break it down, I think there's a lot of areas and, you know, we have to talk about a lot of times, you know, how much yoga, what kind of yoga, like what is the necessary element of this yoga practice that helps with anxiety? And so I think from, we've talked about this a lot of times, right? And one of the most important part is meditation for sure, right? So even, even if there is asana practice and if there is 5 minutes, 10 minutes, 20 minutes of meditation, the meditation practice seems to be most of the studies seems to be the most important part of managing stress, pain, or not pain, stress, depression, anxiety. And then furthermore, there are also aspects like, you know, indexes of depression that have been shown to be reduced, right? After, before yoga practice, after yoga practice, in beginners versus short-term practitioners versus long-term practitioners. They've done like comparison studies on those. And then also aspects like these physiological changes, right? Like heart rate, breathing, especially panic disorders and PTSD. There's a lot of studies done on those looking at alterations in blood pressure, heart rate, breathing, which are shown to be more like normalized or homeostatic balance like is restored in some of these patients. Yeah, so those are the ones that are coming up right now. But there is a lot, lot of science, you know, backing up even in case of like, you know, dependence on substances because of anxiety and these conditions, even alcohol or smoking and other types of substance abuses are also have beneficial effects because of these aspects of anxiety, stress, and depression management, right? From what I remember from the studies.

Yeah. I think this is the area where we probably have the most, maybe not the most, but among the most evidence. You know, there are over 15,000 studies published on yoga. 1,500 of them are randomized controlled trials. So about 10% of them. Not that they're all high quality, but, you know, if I had to estimate how many are anxiety and depression, it's a lot of those. And so the, if we think about neuroscience as existing at so many levels, like behavior, structure of the brain, physiology of the brain, like neurotransmitters, like we have evidence at every single one of those levels that yoga seems to make a difference in the mood and stress regulation. Yeah.

Oh yeah, I remembered also like the activity of the brain itself, right? Like using functional imaging of the brain areas like connectivity, especially between brain areas that are important for regulating emotions like the amygdala, you know, activity has been shown to go down. Prefrontal cortex that's associated with decision-making, you know, more management of our, you know, toning down the amygdala, that activity seems to go up, you know, things. So there's a lot of, at that many different levels, right? Behavior, physiology, brain structure itself, in some cases levels of cortisol in the blood.

Yeah.

Yeah. Many, many studies on that.

And even you said structure, but even to say it just a little more like in detail, like you can see changes. So people with depression often will have smaller hippocampi, and people with anxiety will typically have bigger amygdala, amygdalae. And the, if you look at studies on yoga, they, they weren't necessarily in a population with depression and anxiety at baseline, but in a healthy control population, people who practiced yoga had bigger hippocampi, smaller amygdalae, like And, and there's this great review paper. I forget the first author, but I think it's from like 2018 or something. And it's a summary of all the neuroimaging evidence on yoga. And I think that's a really good place to start to look at this.

Yeah, definitely. I think there's another question. Aurora, has there been a study or research studies done which is related to women's physiological effects on cortisol levels? Yeah, I think this relates to this question we just— about stress and anxiety. But I think this also, maybe we can tackle this because there was a question from another person about if there are effects of yoga on hormonal balance, fertility as well. And so somewhat it relates to that. I think cortisol obviously is really a stress hormone, right? So that, that there are actually studies to answer that question, but then kind of segueing into, you know, women's Health question. There's also, there was also a question about the fertility, I guess PCOS, polycystic ovarian syndrome, as well as other aspects. And there are a few studies, right?

Yeah. I think this is a really interesting question. You know, I'm hesitant to say too much because when I hear a question like, does yoga help with women with high cortisol? I wonder if this person has high cortisol and they're kind of asking for their specific situation. So just to caution that, like there are diseases where Cortisol is produced excessively, and it's not a result of stress. Like, it's actually a result of almost kind of like a tumor, and it, it needs to be like tested, and you have to like look for that. And that those cells are just producing too much cortisol even without the brain telling them to. So it's like if someone has that disease, that's totally different. I don't think yoga is gonna treat that. You know, that, that's like separate.

And then one thing to add, because cortisol levels fluctuate throughout the day, right? So in the morning, there's very high cortisol levels versus other times of the day. So sometimes cortisol studies have that also, right? A problem where, you know, when it's measured is also can make a difference in terms of how high it is. Yeah.

But there are meta-analyses looking at cortisol levels as a result of stress. And they, you know, they measure it at the same time every day to try to eliminate a source of variation. And they show reduction in cortisol. And this isn't because yoga is affecting the cortisol-producing cells or something. It's really affecting the stress networks of the brain. So how the brain is determining that something is stressful and that resources need to be mobilized for it.

Yeah.

So that— I think the evidence on cortisol is really strong just because the evidence on yoga for stress in general is really strong. Yeah.

And that's a good Mm-hmm.

Yeah. Like if you go around to yoga classes and ask people, why do you practice yoga? The vast majority will be like, for stress.

Yeah, that's true.

Right.

It's like especially in big cities.

Yeah. And, and then in terms of other hormones, I think this is a really, really interesting question. We, we were just talking about this, Abha and I, over text quickly, cuz we were both looking this up and I had never really thought about it before. So I was just kind of searching like yoga and testosterone, yoga and estrogen, yoga and just different hormones that I think people would be interested in. And what I found really interesting is, so, you know, you might say like, oh, yoga increases this hormone or decreases this hormone, right?

Mm-hmm.

But it doesn't seem to always be the case. So take testosterone for example. So the papers that I found on testosterone were in men, yoga seems to increase testosterone.

Mm-hmm.

Okay, cool. So yoga increases testosterone, you might say, right?

Right.

But then if you look at women with PCOS, Who typically have an elevated level of testosterone, that's like part of the syndrome of PCOS, it actually reduces testosterone.

So there's a sex difference.

Yeah. And maybe it's even a disease difference. So maybe it's like really in PCOS, it's just decreasing testosterone. I'm not sure. I didn't see anywhere they tested testosterone in a female population, but it's, it, a female population without PCOS, I should say. But the, it just comes back to this idea for me that Yoga kind of brings things towards a median. Like, it kind of moves things towards where they are. I don't want to say supposed to be because that sounds too not scientific, but I think everyone knows what I mean. Like, you know, if things are too high, they come lower. If things are too low, they come higher. And it's the same way with stress. Like, if you think about people who come to yoga and maybe are actually not feeling any ambition or motivation or fulfillment, They can do yoga and actually feel a lot more of that. Whereas people who are like way too driven and who are like completely overwhelmed and doing way too many things, they do yoga and they have less of that.

Oh yeah, that's so such an interesting way to look at it. So overall, you know, in a way it's like management of life, right? Lifestyle that yoga has an effect on, and it's multiple systems. You know, like when you brought up the hormones, you know, same with immune regulation, right? Immune regulation can either go up or down. It depends on what kind of cytokines associated with the immune functions, because in certain cases stress actually increases certain ones, in other cases it decreases. And then same with yoga, right? And certain ones are increased. And so we can't say like this increase, like you said, right, with the hormones also means this. But rather, I think, yeah, it's bringing, I think, maybe to that equilibrium or that homeostasis, that balance.

Yeah.

way of these various systems in our body, right? Like the autonomic nervous system, the lymphatic, the immune, all of these systems maybe come to a balance, you know, in a way because of this practice.

Yeah.

For, and on an individual basis because everybody comes with their own history, lived experiences, trauma, all kinds of things. But then in a way, everybody, you know, has a beneficial effect, right? Like if someone has pain, if someone has anxiety, if someone has some other effect, but then yoga has effects on all of those, which is really interesting, right? So it's not like one particular way that it was helping in everything, but then it's hard to pinpoint. That's why some of the yoga studies are so difficult, right?

Yeah.

To empirically test because what exactly is it changing is very hard to measure.

Yeah. And I think, you know, I don't think either of us are saying that it's a panacea, but it really does seem to help. Like, it really helps with so many things.

Yeah.

So many different patient populations and even people who are well and don't necessarily have a disease, but are just trying to like feel better globally. Yeah.

Well, yeah, we should add that because, you know, we're not saying it's a replacement for, you know, medications, pharmacological, or even therapy, right? I think It's not a replacement for those, but it acts as a complementary or adjunct sort of way of managing, you know, these symptoms or circumstances. You know, if for example, blood pressure, you know, obviously you have to take the medicine, but then it can maybe help with other aspect of managing health and wellbeing. Yeah.

Right.

Really important to emphasize, right? You know, it's not that takes over. Even therapy, for example, is needed for some people. And then yoga may help with balancing, you know, aspects.

Yeah, I'm developing this controversial opinion that many, many, many of the people who pursue therapy for anxiety and depression would probably do better with yoga, but I can't back that claim up, so I'm not going to argue it right now. But this is, I think, an opportunity to bring up a paper that I really wanted to bring up.

Mm-hmm.

I'm really interested in this one. It was— it's called a randomized controlled preference trial. And what they did is they had I forget how many people it was, but it was hundreds of people and maybe 300, and they randomized them to either being able to choose yoga or the control group and the control group with cognitive behavioral therapy, or they were forced to do yoga or the, or cognitive behavioral therapy. So in one circumstance, it was like, oh, what's your preference? Would you rather do yoga? Would you rather do CBT? And people did what they preferred. And then in the other one, it was like, I don't care what you wanna do. Does— you're just gonna do what we tell you to do.

And the, and really quickly though, you, when you say yoga, it included asana, meditation, pranayama.

Exactly. And relaxation. Exactly. And so the, you know, the hypothesis I think that all of us would have is if you're forced to do yoga and you don't like it, it will not work as well, right? It worked just as well, even if they were in the group where they were forced to do yoga and they didn't want to do it.

Oh, interesting. That's so interesting.

It's so interesting to me. And it was a population of older adults, and they were measuring mostly mood symptoms, right? So it's not replicating every single outcome that's been studied in yoga, like pain and sleep and this and that, right? But I think it probably is generalizable. Like, I think it is the case that yoga probably does have these effects For everyone, even if people don't like it. And I think that's just such a helpful thing to bring out into the world. Like, it doesn't matter if you like it or not.

Yeah, it's just like something to add for sure, right? And then again, you know, yoga doesn't mean just doing the postures and asana because it includes, you know, all of these other aspects, right? So, which is, you know, breathing practices, pranayama practices, as well as especially meditation, right? Meditation, she seems to be the most important component of doing yoga practice, which also from like an autonomic nervous system perspective, right? Like for example, certain asana postures actually increase sympathetic activity, but then if you do the whole yoga practice, there are other counter postures or asana which then also activate the parasympathetic nervous system, bringing again, you know, that aspect of equilibrium and balance. And same with Even pranayama, right? Like pranayama can, certain ones can be sympathetic activators, whereas other ones can be parasympathetic, which again, bringing it together when you do the whole practice, then it balances, right? So I think that is the aspect of yoga, right? As a whole, it allows balancing of our many different systems of our body and physiology and, and I guess you know, deep, I guess, aspect of our mind, right? Which then the outlook itself, which is also shown in cancer patients and many others, right? Like just the outlook towards life changes in so many ways. Yeah.

Yeah. And so much so that yoga is currently in 3 National Cancer Society guidelines. So, and I wanted to add, you know, the point you made about meditation being the most important. I feel like every year people always are asking And we ask ourselves and each other too, like, what are the necessary and sufficient components of yoga? And I'm finally starting to see studies trying to answer that. So most recently I saw this meta-analysis where they were, it was for knee osteoarthritis.

Mm-hmm.

And by the way, I was thinking of this study and I just started pressing on my knee. Like, does my knee hurt? So weird. But the, the, what they did was they took randomized controlled trials that were done for yoga interventions for knee osteoarthritis. They looked at the ones that were effective and they looked at the ones that were not effective. And then they compared in the methods section what was done as yoga. And obviously this isn't a perfect study, right? Like the study could be ineffective for so many reasons. It could be that the intervention was actually fine. But the, I think the idea of it is, is good. It's like a good start to try to answer this question. And what they really found was even for knee osteoarthritis, the key component that kind of separated out these studies was probably meditation and breathing. So, so the asanas alone are kind of not enough.

Oh yeah, there, there are some of those studies we had looked at, right? Where they compared aerobic exercise versus asana and then asana plus meditation. And the meditation was the one where they had the most beneficial effect on you know, some of these scales or measures of depression, rumination, and many other aspects. So really interesting, right?

Yeah, 100%. And it's also— I, it came up in a few papers I was looking at about yoga and memory too, where meditation— so yoga interventions with meditation were more effective for memory outcomes. Yeah. And it kind of makes— it just makes sense. Like, it, it, if you do yoga with meditation, you, you experience it very differently. And The other one that I think is really interesting is when they do yoga compared to sham yoga. So usually sham yoga is where people do postures that kind of mimic yoga postures, but without any guidance on, you know, focusing on your breath, directing the attention inward, controlling the senses.

There's a study on that?

Yes. Yes. And yoga is more effective than sham yoga.

Oh, very interesting. Yeah. Okay. I would love to look at that.

Yeah. If you just search jam yoga, you'll find all the ones that, that had that. It was pretty cool to read about.

That's so interesting because in the internet, right, people sometimes— I know like people who just want to like copy a posture and then try to just do that, you know, in kind of an unregulated way rather than, you know, all the aspects of yoga. Like even before you do a, you know, headstand or something else, you have to preparatory asana, right, to be able to do that. But then There are people who just want to, you know, do the one asana that looks very cool. And so very unregulated, right? Like your sympathetic activation is probably really high and, you know, the focus is totally on something that's also from a, you know, at the level of like dopamine or some other hormone or neurotransmitter, like things are going a little haywire. So that's very interesting. I'm interested to look at that study.

Yeah.

Compared like sham yoga versus real yoga.

Yeah, I'll try to find it and send it to you.

Very interesting. Any other questions? Oh, there was related to what you shared about the osteoarthritis. I think there was a question on pain management. I think it relates to that. And I was actually looking at the NCCIH website and they list, you know, the— all these studies are not the ones that I've looked at, but they do list that there are scientific evidence on specific types of pain that yoga helps with. And the list, these are the ones like migraine, tension-type headaches, pain associated with knee osteoarthritis, that is actually one of them, and low back pain is where they see, I guess, scientific evidence. And then many other areas of pain management is where, you know, there's ongoing studies right now, but Mostly it's showing beneficial effects. I'm blanking on this. There was a documentary, I think, on this as well, looking at how pain and aspects of addiction, you know, all of that can be helped with, especially meditation, right? How that was like a key factor in many of these outcomes. And it makes sense, right? Like pain itself is an interesting thing from a brain's perspective, right? Like how the brain senses pain. can depend on distractions, right? Like, so when there is pain and if there is a distraction, you can kind of not experience the pain. Or you can also alter the way how you sort of, you know, like a volume key, you can tone down the volume of the pain, right? So pain in that sense also yoga seems to help. So it's really interesting. I don't know if you—

I was, I have a few cool things. So the first is yoga has level B evidence in migraine, which is like pretty high. And then for the knee osteoarthritis, it has really good evidence, but the studies have been less good for hip osteoarthritis. But I don't know, we'll see how that plays out. And then I want to talk a little bit more about pain. This is so interesting. So I can't recreate this for anyone, so you'll just have to take my word for it.

Sure.

But Everyone's experienced visual illusions where you like look at something and it looks like what it's not, you know, like you see like the vase and it has 2 faces and you kind of like go back and forth.

Yeah.

There are actually pain illusions as well. So there's this famous experiment where they take like these metal rods in parallel and then ones that are perpendicular like this. And the ones like this are hot, and the ones like this are cold. And if you put that on the skin— and they're not hot like on their own they would burn, and they're not cold like on their own they would hurt. But if you put them together like that, it actually tricks the pain receptors, and it causes intense pain.

Really?

Which is super interesting, right? So it's kind of like a pain illusion. It's like the face in the vase. I think what that really tells you is, you know, pain is supposed to be a measure of harm to tissues so that we get away from whatever is harming the tissue, right?

Right.

Um, at least in theory, like, but, but it's not always. And so that, I think that that gives a really good example of how the pain sensing and processing mechanisms can fail and cause unnecessary pain.

Yeah.

And this is so much of what people, you know, it's the most common complaint in, in medicine. The reason people present to doctors is pain. Low back pain is the single number one cause that people present to doctors for. And so what's really interesting about pain is whenever there's, let's say there is tissue damage at first, if it goes on long enough and people develop really bad coping habits about it, You can actually— it's called centralizing the pain. And it means that instead of the pain being a response to the receptors in the skin or the tissue, it's actually coming from the brain itself. It's like there's signaling changes in the brain resulting in this chronic pain.

Yeah.

And yoga interventions have been done on many different pain syndromes, as we were just talking about. And the fact that it works for so many of them Really makes me think it probably has some effects on centralization.

Hmm.

But I can't prove that right now. I'm trying to think if I have any studies that give me evidence towards that claim, but I have to think a little bit more about it. And the other thing about it is the, like you were talking about with the addiction.

Hmm.

A lot of pain syndromes result in addiction later as people become, you know, they get pain medications and then become addicted to them. And it actually worsens the pain because then when you don't have the pain medication, now it's like so much worse. And yoga has a lot of, not a lot, but a pretty good amount of evidence as an adjunctive treatment in addiction. So yeah, it makes sense that for a lot of pain syndromes, it would be helpful. Yeah.

I'm actually blanking on the movie's name or the documentary's name. But there was a documentary on this, on, you know, following a patient. who was, I think, on opioids because of pain and then was addicted, and then how meditation practice helped. You know, if I find it, I'll have to share on my story or something. But I think it was really, it was, there was a premiere of this documentary, which was kind of eye-opening on that level. But yeah, same with, I think it's like the aspect of perception in that way, right? Like how the brain is sensing the pain can probably be— be altered, it seems like, you know, from the evidence that's out there with yoga practice. And when I, when I, or you were saying yoga, right? Like it seems the meditation component, especially with pain, is the most important part.

Totally.

Mm-hmm. Yeah. I think there was one question here and maybe more related to you. What, what would you tell to the doctors that want to start to investigate how yoga can be connected to healthcare? I think, right, in many places, as especially some aspects of yoga as that adjunct or complementary approach to healthcare, but I don't know. Do you have especially—

I have so many things to say. I think it's, I think it's really important and it's worth pursuing. And I think anyone who wants to contribute to the enormously exploding exponentially body of literature on yoga. They should. And I just think it's, it's, we have to, to all think about how to get funding and resources and do it in a way where it gets, you know, it's a high quality study. 'Cause there's a, there's so much low quality stuff that has come out that we really need to hold it to a high standard.

Sure.

The research. And that's, I, I think the skeptics are already changing their mind, but I think the, it's gonna be even more convincing and make it into more guidelines when there are very well, well-designed, high-powered studies published.

Yeah. And well-controlled, right? That's the other issue. There's not very well-controlled studies, you know, where, you know, yoga practice versus some other things are not well measured. And this is why a lot of times people who are, you know, who want empirical evidence of yoga are not convinced by the studies that come out because of this power issue. You know, well-powered meanings like not enough samples or people that have been studied, or there are not very good controls, right? And so that raises the question, is it really doing anything or is it a placebo effect, right? A lot of times people raise these questions, which, you know, we know from certain areas there are much more concrete evidence, like For example, stress and anxiety disorders, pain, and some of these other aspects that are much more stronger studies. But then there are areas where it's a little iffy, right?

100%. And I also think that we need to find ways to include everyone in yoga studies, like just get all types of people into yoga studies. And, you know, a lot of times there are exclusion criteria. Like, you know, couldn't— basically based on physical characteristics, like, you know, disabilities or something. Not necessarily disabilities, but they're like, you know, must be able to come to the center and do this class with these postures. And it's like, yeah, well, maybe we should have yoga that even they can do. And we should know that it works for them too.

Yeah, yeah. And especially, you know, like if you're looking at people from like underprivileged, low income, you know, those kinds of areas. There's also like, you can see like studies, you know, that are done in, you know, exclusionary in that sort of way. Yeah. So I think that's, there are a lot of things just like in overall science, right? Like overall there are so many areas where a lot of times there's no women that are measured, right? Like that's a big thing already.

In yoga literature, it's the opposite.

More women, but less men. Yeah. Yeah. And all kinds of other things, right? That controlled, well, well done. I mean, you know, people raise questions about how much of yoga. I think now we're getting much more clarity on that with some of these studies that are coming out that are well done. But yeah, there are a lot of other questions, right? Remaining. And there's ongoing studies.

And so for, I guess the last thing to say to anyone who's interested in pursuing it is. Find a really good mentor and run with it. And, and don't give up. It's going to be a really slow process and you might not have any fruits of your labor for years, but you just have to accept that and do it patiently and lovingly.

That sounds good. Yeah. Awesome. All right. This was amazing. I feel like the time went by so fast and I think a few other things we didn't even get to cover, but we'll save it. And actually, this is great for the NeuroYoga conference that Jonathan hosts every year. You know, there, I think there are some topics, right, that could be good for that so far not covered.

Yes.

Right.

So far I'm thinking TBI, something related to hormones. So I think the hormone thing was super interesting and related. And then I don't know what the third topic will be yet, but still thinking about it. So if anyone has any suggestions, send me a message.

Yeah. Awesome. So, so much thank you to everyone who joined us. Really appreciate all the questions and being there and hopefully we'll do it again soon. But thank you all.

Thank you, everyone. Bye, Ada. See you soon.