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Yoga & the Mindful Neuron

#Yoga #Mindfulness #Brain #Behaviour #Neuropsychiatry

As World Yoga Day 2021 dawns, it could not have come at a more relevant time. For over a year, our world has been gripped within the jaws of a pandemic that comes in waves and disrupts our lives at will. It is a time when much of humanity is paralysed into inaction, by fear of an invisible enemy. Indeed, never before has Yoga and its modern offshoot, mindfulness, been so relevant. When one considers the term Yoga, one often thinks of it as being a physical discipline with mental effects; the adoption of postures in order to achieve a state of mental calmness and equanimity.

Modern science tells us that Yoga is not just about postures and mental states; it has substantive effects on the human brain, indeed effects that one is able to study on dynamic brain imaging such as functional Magnetic Resonance Imaging (fMRI).


Yoga is one of many important mindfulness traditions, perhaps the most ancient, from across the globe. Yoga which originated in India is derived from the Sanskrit word “Yuj” and means “Union”, indeed a method of spiritual union. In the Patanjali’s Yoga Sutra, the ancient and definitive treatise, it follows eight aspects or limbs- yamas (abstinence from immoral behaviour), niyamas (self-discipline), asana (physical postures), pranayama (breath control), pratyahara (sensory withdrawal), dharana (concentration, dhyana (meditation) and samadhi (pure consciousness). Let us focus on the breath, prana, which indeed is the focus of most modern mindfulness practices. Pranayama is the yogic practice of focussing on one’s breath and is meant to elevate “prana Shakti” or “life energies”. To be able “to restrain and control” one’s breathing is a very key element of the pranayama practice which is the fourth of eight limbs in the Ashtanga Yoga mentioned in the Yoga Sutras of Patanjali. Indeed, this focus on the breath is as old as The Buddha who incorporated it into his enlightenment discovery, with little success, at least initially.

And, the focus on the breath is very much part of the modern secular mindfulness practice, techniques such as Mindfulness Based Stress Reduction developed by Jon Kabat-Zinn, having made it integral practice.


Today, we think of mindfulness as secular, process driven and science based. Yet, Yoga, Tai Chi, the many martial arts traditions in the East, native traditions in the Middle-East, Africa, Latin America and among the “Indian tribes” in North America have incorporated practices that lead to “the thing called mindfulness”. At an extended University of Leiden online course that I attended, the instructor Prof. Chris de Goto described mindfulness “as a consciousness discipline that exists in the interface between science & spirituality, a kind of mental praxis”. 


Yoga, therefore, is not just a “body-mind” exercise. Indeed, when things were normal and we medical professionals could meet, we the Buddhi Clinic and Trimed Therapy team had a conclave of experts across disciplines, discussing impact of these traditions on the brain and mind. In that Buddhi immersion, presenting a series of studies about Yoga conducted at NIMHANS, Prof. Gangadhar pointed out that there were positive biological and healthcare (including psychological) outcomes with its practice. Dr. Naveen Vishveshvariah of Yogakshema presented a number of research studies both those in which he was involved and others conducted and published from around the globe, that showed structured yoga practice having impact on a range of molecular, biochemical and neurophysiological parameters under study. In a review in the “Frontiers of Integrative Neuroscience”, van Aalst and colleagues* examined 34 international peer reviewed studies of Yoga using Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET), or Single Photon Emission Computed Tomography (SPECT), all of which incorporate dynamic brain imaging. They found 11 morphological (structural) and 26 functional studies, including 3 studies that were both structural and functional.

https://www.linkedin.com/pulse/learning-promise-integrative-medicine-ennapadam-s-krishnamoorthy/

Apart from increased grey matter volumes in the insula and hippocampus, key structures for memory, emotions and behaviour, they were able to demonstrate increased activation in the pre-frontal cortex and functional connectivity changes within the Default Mode Network. 


Their findings mirror modern mindfulness research from around the globe, with increasing evidence that mindful states, whatever their origin, have a profound effect on the brain, memory & emotions in particular. 


Which then brings us to where the brain-mind -body connection originates from. Behold the Kundalini, that ancient concept of unlimited reserve power seated in the nucleus of every form of existence. Kundalini is conceptualised as being associated with and coiling itself around the bindu (the point of utmost sensitivity); while in its uncoiled, manifested form, it exhibits nada (the continuum of utmost sensitivity). The mystic 3 coils and a half of kundalini are thought to be the basic disposition of kala (the fundamental, the evolvent principle). Kundalini is a cosmic principle; it is seated principally at the “Base Centre” called muladhara.

When aroused the kundalini ascends along the path of Susumna (the yogic channel of life) and is the nature of ejection not projection (what the source loses, the receiver gains).

The susmna and cakras are not thought to be grossly anatomical, in that certain nerve pathways and ganglia are not to be taken as their “physical and physiological basis.” The cakra is considered to be a subtler more potent apparatus, yantram, that controls the economy of our whole being, physical, vital, conscious. 

Thus what does Yoga or indeed any mindfulness practice done well, evoke? Wherein does this mind body connection lie? Well consider this! You are walking down a forest path one dark and lonely evening. You come across a wild animal, say a cheetah. What happens? You are perplexed and frozen, your pupils dilate, nostrils flare, muscles tense, heart beats fast and becomes almost audible (palpitations), you start shaking, sweating and feel short of breath, you perceive a need to empty your bladder (or do so involuntarily), you feel as if you have run a mile. In short, unbeknown to you, your nervous system prepares you to fight or flee. This is the work of your Autonomic Nervous System, nerve pathways that exercise control over our everyday involuntary actions, even as we think and make important (voluntary) decisions, to talk, walk, climb, eat and so on.

This autonomous part of your nervous system (hence autonomic), which connects body and mind, is what is influenced by Yoga and mindfulness practice. 

And be aware, it is intimately connected with the deep recesses of our brain, the oldest parts of our mammalian brains, the Limbic system, composed of the hippocampus, amygdala, insula, all of which have a role to play in memory and emotion. And the decisions, to fight or flee, to be aggressive or passive, are derived from the prefrontal cortex, to which the limbic system is intimately linked.

Thus, our ancients probably got it spot on when they described the kundalini and the practise of Yoga. When we practice Yoga, we influence the Autonomic Nervous System and through it the brain, thereby bringing about physiological changes, heart rate, blood pressure, breathing; mental changes, a reduction in anxiety and enhancement of mood and motivation; cognitive changes, improved attention and focus, enhanced memory and quite naturally behavioural changes, behaviour being the quintessential expression of emotion.

It falls upon us, therefore, to celebrate our ancients, who deduced all this without fancy brain imaging, neurophysiology and neuropsychology; who created perhaps India’s greatest export to the world, one that influences “the mindful neuron”! 

* June van Aalst, Jenny Ceccarini & Koen van Laere. What has neuroimaging taught us on the neurobiology of Yoga? A review. Frontiers in Integrative Neuroscience, 2020; 14: 34

Dr. Ennapadam S Krishnamoorthy
MBBS, MD, DCN (Lond), PhD (Lond), FRCP (Lond, Edin, Glas), MAMS (India)
Founder: Buddhi Clinic 

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Featured Founders Blog

Buddhi Clinic: Leading the Way in Integrated Care for the Brain and Mind

In today’s fast-paced world, a large section of the population is denied the opportunity to manage chronic diseases through a wellness, holistic and healing-oriented approach.

Dr. Ennapadam S Krishnamoorthy

The burden of chronic disorders is largely attributed to the perils of modern medicine that prioritises cure through prescription drugs instead of focusing on the entire continuum of human healthcare engagement: rejuvenation, restoration and rehabilitation. The end result: an unhealthy ageing population.This is where India’s ancient and holistic Ayurvedic system as a viable form of alternative medicine comes in. It is about time medical practitioners harnessed the full potential of Ayurveda as it’s based on a strong foundation of scientific research, much like modern medicine’s tenets. 

In recent years, a growing body of research points to integrated medical treatments—a combination of complementary (alternative) and modern (allopathic) medicine—gaining popularity. While modern medicine’s thrust is on cure, integrative medicine focuses on disease prevention, comfort and care.

However, despite the marked shift in patients’ preference for alternative forms of healing, I observed a deficit of innovation in therapies that are based on integrative medicine. This is where Buddhi Clinic’s genesis and my entrepreneurial journey can be traced. 

I realised there was no other healthcare outfit in the world that provides a unique 360° evaluation of body, brain and mind through an integrated approach. At Buddhi, we take a holistic approach to diagnose a medical condition that combines the scientific rigour of modern medicine’s diagnosis and drug treatments with the therapeutic benefits of ancient healing traditions. 

In essence, my long-term vision for our healthcare startup that was founded as a project in 2009 and company in 2013, is to make complementary and alternative medicine (CAM) gain acceptance as mainstream therapies. From my experience, I realised this would be possible only by seamlessly integrating them with modern medicine. 

Let me tell you how this is done at Buddhi Clinic.

A Game-Changer in Brain and Mind Integrated Therapy

We are the pioneers and innovators of integrated care for the brain and mind. What sets Buddhi Clinic apart from the rest is that we don’t follow a cookie-cutter approach to diagnosis and treatment. Our raison d’être lies in being able to provide unique personalised treatment strategies for patients that is managed by interdisciplinary process-driven programmes. 

Since several neurological and mental health disorders and disability are longstanding issues, patients need continuous and comprehensive care. Thus, we strive to offer a better quality of daily life to our patients by curating a range of therapeutic solutions based on considerable clinical and empirical research, and our team’s extensive experience.

Buddhi Clinic’s focus is on neurology and mental health rehabilitation and therapy. We have also created a range of interventions for pain, mental health, lifestyle and disablement conditions. 

While our diagnostic approach and internal treatments are allopathic, we also rely on traditional healing therapies to restore the equilibrium of your brain and mind interface. Buddhi Clinic’s seamlessly integrated approach offers 14 non-pharmacological treatment modalities that are an amalgamation of modern science and ancient wisdom.

We offer treatment programmes for each condition customised for children, adults and the elderly. These include: Ayurveda, Acupuncture, Acupressure, Naturopathy- water, mud, aroma and magnet treatments; Reflexology and Yoga; and Rehabilitation therapies – speech, neurodevelopmental, physiotherapy and a range of specialized psychological therapies. We have also curated treatment combinations for Psychology – CBT, CRT, Behavioural, JPMR, ERP, EMDR; and Neuromodulation or brain stimulation (a full house of treatments). 

Empowering the Patient Based on the McDonalds Model”

One of the guiding principles behind founding Buddhi is respecting and understanding patient preferences and engaging patients in shared decision-making. Towards this end, we perceive our startup to be the McDonald’s of “Brain and Mind Care and Rehabilitation”. 

Similar to how a customer can curate his meal in a McDonald’s outlet, Buddhi Clinic, too, offers patients the choice to curate integrated treatment programmes tailored to their specific needs. This is called the “choice model” and is better suited for mild impairment and chronic or progressive health conditions. In such situations, we give patients the choice and flexibility to select a combination of modern and ancient interventions rather than rely on a single medical treatment, procedure and therapy. It is our belief that for best treatment outcomes, the patient should be in control of his own decisions regarding his healthcare options.

That said, our team also draws up a “prescription model” when the patient suffers from a chronic condition and requires continuous restoration and rehabilitation.

Crucially, at Buddhi Clinic, we adopt a holistic approach to healing our patients and focus on their overall wellness and recovery that goes beyond cure. We think different—not just about illness or disablement but also about ability and enablement. 

Research and Innovation Led Approach

Nothing fulfils me more than making sustained efforts to give our patients a better quality of life. Our patient-focused approach includes continuously monitoring their progress and offering them quality pre-treatment, mid-treatment and end-of-treatment assessments. 

Over the years, we have delivered quality healthcare to over 10,000 patients who have received an excess of 1,00,000 interventions. Our success stories that cover conditions such as autism, epilepsy, depression, Parkinson’s disease and dementia, among others, are documented as detailed case studies in ‘Buddhi Books’. The books are aimed at fostering the spirit of research and continuous learning to enable children, adults and elders achieve a better quality of daily life.

Buddhi Clinic also endeavors to offer innovative products and services to enhance the integrated approach to long-term brain and mind care. For instance, we use Transcranial Magnetic Stimulation (TMS) to treat neurological and psychiatric disorders. Transcranial Direct Current Stimulation (tDCS) and transcutaneous auricular Vagus Nerve Stimulation (taVNS) are also the Neuromodulation innovations we bring in. While the former two, rTMS and tDCS stimulate specific brain pathways for specific conditions and outcomes, the latter tAVNS stimulates the auricular (ear lobe) branch of the vagus nerve (ABVN), an easily accessible target that innervates the human autonomic nervous system. Like this, there are other innovations in the pipeline that we hope will lead to paradigm disruption in this space.

Building a Service-Oriented Approach

In order to create a healing environment based on holistic principles, we aim to continue to provide personalised and meaningful patient experiences at competitive rates. Since today’s patients have greater discernment, patient satisfaction is paramount to us. Our service-oriented approach helps us deliver, on an average, 10-20% more therapy to each paying client, apart from serving the disadvantaged at low cost or free of cost.

In the coming years, it is our goal to collaborate with doctors and diverse talents in the healthcare sector to serve populations beyond Chennai and India. Our objective is to demonstrate our capability as pioneers and leaders in integrated care with a brain and mind focus. 

One of my key learnings as a healthcare entrepreneur has been that it’s not enough to achieve a robust bottom line growth. It is equally important to sustain it by creating impact at scale through a committed patient-focused approach.

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COVID-19 Featured

Did you know? Covid-19 vaccination can also be associated with unexplained neurological symptoms!!

Recently Mrs. R aged about 55 years consulted us with a range of symptoms that closely followed the first dose of vaccination for Covid-19. They included

  • Pricking and pulling pain in the hands and feet
  • Pain in the neck and shoulders
  • Altered sensation in the soles, feels roughness in them.
  • Pulling pain in the back of the knees and legs
  • Palpitations on exertion.
  • Disturbed sleep

She had visited her family doctor and an orthopaedic surgeon and was diagnosed as having cervical and lumbar spondylosis and carpal tunnel syndrome. When it became apparent to us that her symptoms had followed vaccination, she having not considered this piece of information important in her earlier consultations, we proceeded to carry out our comprehensive 360* evaluation at Buddhi Clinic. Mrs. R met our team- physician, physical therapist, psychologist and electrophysiologist and was evaluated for a neuropathy as well as dysautonomia.

Lo and behold we discovered evidence of both a peripheral neuropathy (responsible for the pain in her hands and feet and altered sensation in her soles) as well as clinical autonomic dysfunction (Postural Orthostatic Tachycardia Syndrome being the diagnostic indicator) contributing to fatigue, palpitations and sleep dysfunction. There was also considerable health related anxiety about her new and unusual symptoms. A working diagnosis of “post vaccination neuropathy and clinical autonomic dysfunction” was made and Mrs. R inducted into our comprehensive care program. From a drug perspective we used pregabalin (a nerve membrane stabilising agent and weak anti-epileptic drug that helps with both neuropathy and dysautonomia), nortryptyline (a conventional antidepressant with anti-pain and anxiety relieving/ sleep promoting effects) and baclofen (for muscle spasm identified in clinical evaluation). 

She started also on our comprehensive care (non-drug therapy) program with our Mobility & CAM labs. The mobility lab team delivered manual and electrotherapy treatments for pain/ dysasthesia and a comprehensive exercise therapy program for dysautonomia. The CAM lab team delivered focal abhyangam with Sahachadhari thailam and kizhi together with acupressure, reflexology and mud therapy sessions. 

After 15 hours of each treatment paradigm Mrs. R was reviewed in our case conference, with the following outcomes. 

Mobility Lab:

  • Muscle spasm and pain in the neck and shoulders has reduced completely – the Visual Analogue Scale scores were- Pre therapy-8, Mid therapy-4, End therapy-0
  • Mild pain in the right brachioradialis continues with a Visual Analogue Scale Score of 2
  • Altered sensation in the hands and feet has reduced by 50% but tends to fluctuate, being present on and off
  • Grip, grasp and fine motor skills are improving

CAM Lab: 

  • Pricking and pulling pain in the legs improved
  • Her metabolism improved and she perceives overall wellness in her daily functions
  • Sleeps 5 hours fitfully but would like that to return to her customary 7 hours  
  • The self-application (assisted by family) of lepam (herbal paste) in both palms and soles is helping her; when her night time symptoms are bothersome she has learnt to apply ice packs to the dysasthetic areas and is able to sleep
  • Abnormal sensation in palms continues to fluctuate

Summary:

A vaccination is nothing but a minor and contained infection inducer, designed to help people develop immunity. Not just COVID-19 vaccination, but all vaccinations can induce some adverse effects, unexplained neurological and neuropsychiatric symptoms not being uncommon. The temporal relationship between the de novo symptoms that Mrs. R developed, detailed by our comprehensive evaluation and targeted testing, confirmed for us new onset peripheral neuropathy and dysautonomia. As is our practice in Buddhi Clinic we combined modern drug treatment with the wisdom of convention (physiotherapy) and ancient traditions (Ayurveda and Naturopathy) to give Mrs. R much needed relief. Mrs. R continues in a step down program combining weekly clinic visits with our “Do it Yourself” (DIY) Buddhi kits and is on the pathway towards complete recovery. She discovered Buddhi Clinic and in her we have evolved the pathway to helping people with post-vaccination neurological symptoms.