Dr. Swami Shankardevananda Saraswati, MB, BS [Syd]

The heart is a miracle of creation which beats 100,000 times each day, pushing some 10 tons of blood through 60,000 miles of blood vessels (enough to go around the world twice). Yet few of us know how to really look after the heart. The following interview took place between Dr. Swami Shankardevananda and a patient suffering from angina pectoris. He also suffered two heart attacks before seeking yogic advice and a program of asanas and pranayama. It is hoped that this conversation will highlight certain basic points and lead people to a yogic lifestyle, one which will care for this magnificent organ and prevent disease from occurring in the first place or will lead people to yoga as early as possible in their heart disease career. In this way much needless suffering and misery is avoided.

What is coronary heart disease?

Though the heart pumps an enormous amount of blood to the body, it is itself, as a living unit, dependent for its own nutrition on the two small coronary arteries, approximately five inches long and an eighth of an inch in diameter. It is when these arteries become blocked that angina (chest pain) and other troubles start.

You said I have angina, what is that?

Angina pectoris is the chest pain that occurs when the coronary, arteries cannot supply the heart tissue with enough oxygen to fulfil its needs. For an example, during physical exercise or emotional stress, the heart may require as much as 3 to 5 times its normal blood supply. When the coronary arteries are partially blocked by fats and bleed clotting materials, then even a small increase in demand cannot be met. Walking a little faster or moving uphill can cause pain and thus the individual’s life is grossly restricted. Angina can be defined as pain or oppression, occurring in the upper or middle breast bone (centrally located), which is precipitated by effort or emotions and which may persist for a few minutes.

The pain may radiate up into the inside of the arms, neck, jaw, shoulder or back. It can also be brought on by cold weather or overeating and has been described as a feeling of constriction, tightness, crushing, gripping, boring, grinding, squeezing, vicelike pain, and even as simply as a feeling of pressure and discomfort as in indigestion. Angina pain is never sharp or knifelike, as occurs in the more common causes of chest pain, muscular tension or lung disease. Characteristically, angina is relieved by rest and the drug nitro-glycerine taken in tablet form and placed under the tongue. If relief does not occur, the patient has either had a heart attack or is suffering from one of the other causes of chest pain: anxiety, mental tension, emotional upset, digestive problems, lung disease, anemia, thyroid disease, spondylosis (disease of the spinal vertebrae), and so on.

What is the difference between angina and heart attack?

Angina is pain. Heart attack, also called myocardial infarction, coronary thrombosis or coronary occlusion, occurs when the coronary arteries become so blocked that a portion of the tissue dies. This can lead to sudden death or it can be so mild that the individual does not even realise it has occurred until his next general medical check-up when his doctor, taking an electrocardiogram (ECG), finds evidence of its having occurred. The most usual sign of a heart attack is centrally located, severe, gripping chest pain, nausea, and cold sweat. The pain is not relieved by rest or nitro-glycerine and may continue for many hours. A doctor will find signs of shock, fever, pallor, cold clammy skin, weak pulse and low blood pressure. However, the only sure way to determine whether a heart attack has occurred is by taking an ECG.

What is the cause of coronary heart disease?

Coronary heart disease is a long term degenerative process that requires many years to build up before manifesting as chest pain or heart attack. It is possible to see this condition, which is most common in middle age, manifesting even in youth. Many of the American soldiers killed in the Korean war, average age 22 years, exhibited early stages of arterial disease. The causes are thought to be:

1. An aggressively competitive personality, excessive fear, a low resistance to disappointment. For example, many heart attacks occur after some emotional disappointment or ‘heartbreak’. A British team studied 5000 widowers and discovered that more than 200 of them died within 6 months of their partners. Any type of emotional or mental strain or tension increases sympathetic nervous system activity, making the blood stickier, increasing blood pressure and raising the level of fats in the blood.

2. Excess fats in the blood, partly from an excessive dietary intake of saturated fatty acids and partly because of an imbalance in the internal body metabolism. This latter is probably stress induced.

3. Insufficient physical exercise.

4. Cigarettes, alcohol and other toxic substances.

5. Overweight.

6. Hormonal imbalance, especially excessive amounts of testosterone, the male Sex hormone, and excessive thyroid hormones.

7. High blood pressure.

8. Heredity, of both physical and psychological characteristics.

9. Ageing, which is a degenerative process in itself.

10. Certain diseases such as high blood pressure, diabetes and gout are associated with arterial damage.

11. Low fibre diet is associated with an increased fat content in the blood.

12. Soft water, low in magnesium and calcium salts, is related to high blood fat levels, high blood pressure and increased heart rate, especially in the presence of a poor or low fibre diet, devoid of whole grain cereals.

There is still a great deal of debate about the factors causing heart disease and it appears that one or more of them are needed to manifest disease. For example, a study in Finland showed that by reducing the level of saturated fatty acids (especially high in meat and animal products) in the diet, the number of deaths from heart disease diminished. In India, it was found that increasing fibre via Bengal gram (chick peas with the husk intact) reduced the level of arteriosclerosis even in the presence of a high cholesterol diet. A study of twins living in Ireland and America showed that, despite a high fat diet, the Irish side was healthier. This was attributed to the fact that the twin living in Ireland tended to be more easy going and took life less seriously than his American brother, and also usually performed more physical exercise. Another study has shown that workers performing manual labour had 500 percent less heart attacks before the age of 75 years than a sedentary group.

How do doctors treat coronary heart disease?

For simple angina the doctor tries to modify the lifestyle to remove those factors such as smoking, overweight, dietary fat, mental tension, and so on, which lead to arterial disease. At the same time he tries to induce a relaxed attitude to life, and to institute a light, natural and balanced diet with the daily performance of physical exercise within the individual’s limits of tolerance. For more severe angina, drugs such as nitroglycerine, beta-blockers, sorbide nitrate, and perhexiline maleate may be used. Angina can be so severe, however, and so debilitating that the only real solution is to perform bypass surgery in which a new blood vessel is grafted into the heart to bypass the blocked and useless original. However, this is not always successful.

For the heart attack victim, treatment ideally takes place within the emergency ward of a hospital. Drugs such as morphine for pain, lignocaine to keep the heart beating properly, anticoagulants to stop blood clotting, and tranquillisers and sleeping pills to still a busy mind, may be used. The patient is kept warm, well oxygenated and the end of his bed may be raised. The patient is usually confined to bed for 3 to 6 weeks, depending on the severity of the attack and whether complications arise or not. The diet is light, easy to digest and salt-reduced. Laxatives may be used to avoid straining at stool. The whole therapy is aimed at rest and freedom from tension. This is especially important in the critical first 2 days after heart attack when most deaths occur. After 3 or 4 days he is allowed to sit up in bed for a few hours, and is then encouraged to try a few simple exercises and to do some deep breathing. It is in these critical days that yoga could be so useful in speeding up the convalescent process and preventing death.

Rehabilitation continues at home so as to help the heart keep the rest of its blood vessels open and to grow new blood vessels if possible. Light exercise and a light diet help this process.

What is the best diet for heart patients?

The ideal diet for heart disease is one which is fat and sucrose free. If this is impossible replace animal fats with vegetable oils, and sugar with honey. Stop refined and artificially prepared foods and take whole grains, boiled vegetables, pulses, salads, ‘fruits, sprouts and natural produce. A higher fibre diet aids in the correct secretion of body fluids to balance fat digestion and absorption. Above all, eat less and at the correct times for optimal absorption, once in the morning between 10 a.m. and 12 a.m. and once at night, preferably before sunset.

How will I live with a damaged heart? Will I be an invalid all my life? Am I likely to have another heart attack?

The most important point to remember is not to worry if a doctor has told you that you have coronary disease. This fear can cause more trouble than it is worth. The second most important point to remember is that you are only as crippled as you think you are. Many people become frightened when told they have heart disease, or use it as an excuse to get attention and pity. They cripple themselves and through unnecessary worry make their condition worse. Even a heart attack may not be as serious as you think and only a small portion of the heart need be damaged to give a lot of pain. The heart has fantastic recuperative powers, especially if we do not interfere with the process by mental worry, and so on. Take your heart attack as a warning to change your lifestyle and to take up yoga.

Yogis can stop their hearts but can they stop heart disease?

All the research and our experience point to the answer ‘Yes’. One man came to our ashram after having had 5 heart attacks in Australia. He was told the trip to India would kill him. Nevertheless he came, learned yoga, and now he is a swami travelling all over the world and working hard to propagate yoga in hospitals and to people suffering from heart disease. He is totally free from any chest pain.

This seems to indicate that it does not matter if we have had a heart attack or not. The important thing is to halt and reverse the degenerative process. If we can do this then a small scar on the heart is of little consequence. We have many scars on our bodies. Scar tissue is stronger than the original tissue. It is a reminder for us to continue our yogic practice. However, we must be cautious and proceed along the correct path, and for this, both yogic and medical advice is necessary. In this way, we can actually grow new blood vessels, called collaterals, to feed the heart tissues and eventually achieve a cure.

By reversing the degenerative process via meditation, relaxation, pranayama, and light asanas, we can actually start off a process in which the formed blood clot is broken down in a process called fibrinolysis. This is especially so in early cases before calcification and hardening take place. Fibrinolytic activity is reduced during tension and increases during relaxation. Yoga enhances relaxation, and also removes the fundamental cause at the core of our personality which led to heart attack in the first place.

In yoga nidra we use the sankalpa, the power of the resolve and positive thought, to overcome fear and doubt of how we will manage in the world. We develop faith in ourselves, confidence about the future and thereby, better health. Shavasana is a much better alternative to tranquillisers. Apart from this, shavasana, yoga nidra and meditation reduce the work of the heart, and its need for oxygen. They also reduce the level of pain, increase the heart’s capacity to tolerate work and to recover quicker; that is, to slow down faster. The blood becomes less sticky and the cholesterol level decreases. So yoga is the ideal practice for heart patients.

Yoga sadhana can be especially powerful for preventing a crisis situation when we remember that blood tends to clot more quickly at night and that most heart attacks occur in the early hours of the morning. This is the time recommended for yogic practices. Yoga reverses the process which causes clotting and may be the ideal method to combat coronary artery disease.

Where then, do yoga and medicine meet?

The first thing a person who has chest pain should do is to have a full medical examination so as to determine whether he has heart disease or not and so that an appropriate yogic program can be, given. Then commence practicing under expert guidance. Drugs may be required initially but should be discontinued as quickly as possible and as soon as yoga becomes effective.

(Courtesy Yoga Magazine, September, 1980)

Inspired by the work of Udupa and Singh (1972) *1 Tandon has documented the use of yoga in helping people crippled by COAD to live better and more healthful lives. *2 Udupa and Singh have suggested that yoga has beneficial effects on respiratory function in normal persons as after training in hatha yoga they found:

1. Increased vita capacity the amount of air normally inhaled and exhaled.

2. Decreased rate of respiration.

3. increased tolerance to physical stress.

Tandon’s work was with 22 elderly patients with severe GOAD. They were not in an acute stage of their illness; they were enjoying reasonable health at the time of the experiment. They were then randomly allocated to either yoga or physiotherapy and were told not to change their prescribed medication or their smoking habits.

All were measured before starting treatment for :

1. The efficiency of their lungs, by means of blood samples to measure arterial oxygen and carbon dioxide. If the oxygen levels are low it means that the lungs are not providing enough oxygen, and so on.

2. The function of the lungs, by means of measuring the amount of air expired in one minute (FEV I) and the amount of air taken into and out of the lungs (VC- vital capacity).
3. The maximum amount of exercise they can tolerate, by means of an exercise test on a bicycle.

They were then taught either:

1. Physiotherapy, which included relaxation exercise for the respiratory muscles and general exercises for the legs and trunk to increase stamina.

2. Yogic breathing exercises, aimed at encouraging full use of the entire abdominal and thoracic muscles, plus 10 yogic postures designed to produce improvement of respiratory function.

Both groups were trained for 1 hour, 3 times in the first 4 weeks, twice in the next 4 weeks, and once a month thereafter for a total of 9 months. All were encouraged to practice at home and were subjected to monthly testing of their lung function and subjective improvement.

As a result of this experiment it was shown that after the 9 months there was no difference in the arterial blood gas levels or in the lung function. There was, however, a significant change in the ability of the yoga group to handle exercise better, whereas no change occurred in the physiotherapy group. The yoga-trained subjects reported to have:

1. Improved exercises tolerance.

2. Quicker recovery after exertion.

3. Control over an acute attack of shortness of breath without the need to seek medical help.
4. Definite improvement in their overall chest condition. The breathing pattern of the yoga group was changed to a more efficient one. It was deeper and slower as compared with their original condition before the experiment and as compared with the shallow, fast breathing of the physiotherapy group which showed no change in breathing pattern.

Discussion

The importance of these findings is obvious. When we remember that the experiment was performed on a group of elderly and severely affected COAD patients, they become even more impressive and offer greater hope to those less affected but with similar conditions. The effects of the asanas and pranayama on these individuals lives can be expected to be enormous, for the ability to remain independent of medical aid and drugs during an acute attack and to exert oneself more during times of relative good health offer a degree of freedom that many with shortness of breath will envy. For one cannot really understand what a person is going through when the life giving breath is withheld or impeded in its course.

The results of this experiment should encourage others to experiment further, especially with younger and less severely affected individuals. When yoga is accepted into the medical profession as a valuable adjunct, we may see the dawning of an age in which both the doctor and the patient find themselves with an optimistic approach to what was once thought to be irreversible disease.

*
*1. K.N. Udupa& R.H. Singh, “Scientific Basis of Yoga”, Am. Med. Assoc, 220, 1365.
*2. M.K. Tandon, ‘ ‘Adjunct Treatment with Yoga in Chronic Severe Airways Obstruction”, Thorax, 33, 514-517, 1978.

(Courtesy Yoga Magazine, January 1979)