Yoga Put to the Test for IBS, Inflammatory Bowel, Menopause, and Osteoporosis

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A study using sham acupuncture underscores the necessity of controlling for expectancy effects.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Yoga as therapy: when is it helpful? As you’ve seen over the last few videos, the scientific literature on yoga is limited in scope and quality. I’ve talked about the long list of issues that plague so many of the yoga trials, but let’s continue down the list of conditions to get a sense of the best available balance of evidence. For example, yoga as a therapy for irritable bowel syndrome. Evidence from randomized controlled trials found that yoga beat out drugs, and was equally effective as moderate intensity walking––so, whichever form of exercise you prefer.

What about yoga for inflammatory bowel disease? Since stress can be a trigger, might yoga help? In a trial of yoga as an add-on therapy for adolescents with inflammatory bowel disease, it didn’t seem to help at all. But in a trial of yoga vs written self-care advice for adults with ulcerative colitis, 12 weeks of yoga induced a stronger increase in quality of life, and also reduced disease activity––even three months after the study ended. Here’s the graphs for quality of life and disease activity. Now, the so-called self-care group was really just handed a couple general self-care books. So, the two treatments—yoga vs. self-care—were not matched at all for time intensity, feeling part of a group, or for therapist contact—each of which are likely to have the “yoga” arm more likely to nonspecifically improve quality of life. So, yes; yoga might be effective for improving quality of life in ulcerative colitis. However, the benefits may be no different to other group exercise, for example. Indeed, there have been 11 human studies on the influence of moderate exercise programs upon disease activity in chronic inflammatory bowel disease, and all 11 report benefit in terms of reduced disease activity.

Using passive controls doesn’t account for expectancy effects, attention given to the study subjects, the time spent, the investment that the participants put in. Here’s an excellent example of why having more active control groups is so important. This details a series of studies on nonpharmacological interventions for menopausal hot flashes. For example, randomized to eight weeks of acupuncture, eight weeks of sham acupuncture, or nothing––just usual care. Sham acupuncture is where they still stick needles in you, but shallowly, and not in traditional acupuncture points.

There was also a study of 10 weeks of yoga classes, or the attention control, health and wellness education classes, which lasted just as long as the yoga, and were done in the same kind of group social setting. Here’s what they found. The hot flashes in the usual care group, the passive control where they didn’t do anything special, stayed pretty stable. But the real acupuncture worked way better. But so did the sham acupuncture. Here’s the yoga, and here’s the health and wellness classes control group. So, yoga and acupuncture both worked just as well. But so did the nonyoga and fake acupuncture. There just appeared to be a general placebo effect such that women in all five intervention groups benefited simply by being in a study. That’s why it’s always better to have the control groups do something, so you can have some confidence that at least some of the effect of your intervention is real.

But hey, at least they had control groups. This study: “Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss” caused quite a stir. We know that when it comes to bone health; it’s use it or lose it. Exercise early and exercise often. Physical activity is a widely-accessible, low-cost, and highly modifiable contributor to bone health. Exercise transmits forces through the skeleton, generating signals that are detected by your bone building cells. This is why the National Osteoporosis Foundation, International Osteoporosis Foundation, and other agencies recommend weight-bearing exercises for the prevention of osteoporosis. These include high-impact exercises, such as jumping, aerobics, and running, as well as lower impact exercises, such as walking and weight training, to create those mechanical signals that spark bone growth. Lower impact activities, such as yoga are generally not considered bone-building. That’s why the results of this study were so surprising.

It was a study of Internet-recruited volunteers comparing bone mineral density changes before and after yoga. The researchers devised a 12-minute DVD of 12 yoga poses that they believed would stimulate increased bone density in the spine and both parts of the hip. Here are the dozen poses. And, they appeared to get a benefit in the spine, but not the hip. But in the end, out of the 741 patients recruited at the beginning, only a few dozen actually sent in their bone scans as instructed. So, that’s only like 5 percent. You can totally imagine how those who got positive results were more likely to send them in, and the others that failed just kind of slunk away. So, I don’t consider this convincing evidence.

The authors had the attitude of what do you have to lose? The side effects of yoga are all good; so, why not give it a try? What you have to lose is the opportunity to do higher impact exercise that has more decisive evidence of bone benefit.

And, all the side effects are not necessarily good. There have been vertebral compression fractures associated with yoga. In this series of nine cases from the Mayo Clinic they describe spinal compression fractures occurring a month to years after initiating yoga-associated spinal flexion exercises. Both scientific and media reports continue to advertise yoga as a bone-protective activity. But there’s need for selectivity in yoga poses in populations at increased fracture risk. Here’s the yoga poses they recommend, and these are the ones they encourage people at risk to avoid. And four of the nine patients developed a fracture in the setting of a normal or near-normal BMD. So, maybe everyone should be careful with those. Yoga-related injuries are not uncommon, resulting in thousands of emergency room visits a year, and approximately 5 percent of those are coming in with fractures. I’ll try to put that injury rate in context, comparing yoga to other physical activities in my final video of the yoga series, next.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Yoga as therapy: when is it helpful? As you’ve seen over the last few videos, the scientific literature on yoga is limited in scope and quality. I’ve talked about the long list of issues that plague so many of the yoga trials, but let’s continue down the list of conditions to get a sense of the best available balance of evidence. For example, yoga as a therapy for irritable bowel syndrome. Evidence from randomized controlled trials found that yoga beat out drugs, and was equally effective as moderate intensity walking––so, whichever form of exercise you prefer.

What about yoga for inflammatory bowel disease? Since stress can be a trigger, might yoga help? In a trial of yoga as an add-on therapy for adolescents with inflammatory bowel disease, it didn’t seem to help at all. But in a trial of yoga vs written self-care advice for adults with ulcerative colitis, 12 weeks of yoga induced a stronger increase in quality of life, and also reduced disease activity––even three months after the study ended. Here’s the graphs for quality of life and disease activity. Now, the so-called self-care group was really just handed a couple general self-care books. So, the two treatments—yoga vs. self-care—were not matched at all for time intensity, feeling part of a group, or for therapist contact—each of which are likely to have the “yoga” arm more likely to nonspecifically improve quality of life. So, yes; yoga might be effective for improving quality of life in ulcerative colitis. However, the benefits may be no different to other group exercise, for example. Indeed, there have been 11 human studies on the influence of moderate exercise programs upon disease activity in chronic inflammatory bowel disease, and all 11 report benefit in terms of reduced disease activity.

Using passive controls doesn’t account for expectancy effects, attention given to the study subjects, the time spent, the investment that the participants put in. Here’s an excellent example of why having more active control groups is so important. This details a series of studies on nonpharmacological interventions for menopausal hot flashes. For example, randomized to eight weeks of acupuncture, eight weeks of sham acupuncture, or nothing––just usual care. Sham acupuncture is where they still stick needles in you, but shallowly, and not in traditional acupuncture points.

There was also a study of 10 weeks of yoga classes, or the attention control, health and wellness education classes, which lasted just as long as the yoga, and were done in the same kind of group social setting. Here’s what they found. The hot flashes in the usual care group, the passive control where they didn’t do anything special, stayed pretty stable. But the real acupuncture worked way better. But so did the sham acupuncture. Here’s the yoga, and here’s the health and wellness classes control group. So, yoga and acupuncture both worked just as well. But so did the nonyoga and fake acupuncture. There just appeared to be a general placebo effect such that women in all five intervention groups benefited simply by being in a study. That’s why it’s always better to have the control groups do something, so you can have some confidence that at least some of the effect of your intervention is real.

But hey, at least they had control groups. This study: “Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss” caused quite a stir. We know that when it comes to bone health; it’s use it or lose it. Exercise early and exercise often. Physical activity is a widely-accessible, low-cost, and highly modifiable contributor to bone health. Exercise transmits forces through the skeleton, generating signals that are detected by your bone building cells. This is why the National Osteoporosis Foundation, International Osteoporosis Foundation, and other agencies recommend weight-bearing exercises for the prevention of osteoporosis. These include high-impact exercises, such as jumping, aerobics, and running, as well as lower impact exercises, such as walking and weight training, to create those mechanical signals that spark bone growth. Lower impact activities, such as yoga are generally not considered bone-building. That’s why the results of this study were so surprising.

It was a study of Internet-recruited volunteers comparing bone mineral density changes before and after yoga. The researchers devised a 12-minute DVD of 12 yoga poses that they believed would stimulate increased bone density in the spine and both parts of the hip. Here are the dozen poses. And, they appeared to get a benefit in the spine, but not the hip. But in the end, out of the 741 patients recruited at the beginning, only a few dozen actually sent in their bone scans as instructed. So, that’s only like 5 percent. You can totally imagine how those who got positive results were more likely to send them in, and the others that failed just kind of slunk away. So, I don’t consider this convincing evidence.

The authors had the attitude of what do you have to lose? The side effects of yoga are all good; so, why not give it a try? What you have to lose is the opportunity to do higher impact exercise that has more decisive evidence of bone benefit.

And, all the side effects are not necessarily good. There have been vertebral compression fractures associated with yoga. In this series of nine cases from the Mayo Clinic they describe spinal compression fractures occurring a month to years after initiating yoga-associated spinal flexion exercises. Both scientific and media reports continue to advertise yoga as a bone-protective activity. But there’s need for selectivity in yoga poses in populations at increased fracture risk. Here’s the yoga poses they recommend, and these are the ones they encourage people at risk to avoid. And four of the nine patients developed a fracture in the setting of a normal or near-normal BMD. So, maybe everyone should be careful with those. Yoga-related injuries are not uncommon, resulting in thousands of emergency room visits a year, and approximately 5 percent of those are coming in with fractures. I’ll try to put that injury rate in context, comparing yoga to other physical activities in my final video of the yoga series, next.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Doctor's Note

This is the fifth video in a six-part series on yoga. The first four: 

The series rounds out with The Side Effects of Yoga, coming up next.

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