Health: YOGA - for a better you !
One of my good friends Anita K Patel, MD, FAAP (@yoga_doc_md) is a Pediatric Critical Care Attending at Children’s National Medical Center and an Assistant Professor of Pediatrics at GW School of Medicine and Health Science. She is also a 500-hr registered yoga teacher. Here, she is sharing the wisdom behind Yoga for our self-development.
Through medical school, residency and fellowship I was drawn to the extreme – in chaos I found calm. However, this draw to extreme highs and even lower lows wreaked havoc on my emotional well-being. This mentality is what causes over 10%-12% of physicians to pursue addictive substances, 300-400 deaths per year by suicide, depression rates of 27-30%, and divorce rates 10-20% higher than the general population.
I was one of the lucky ones. I found yoga in the middle of my pediatric critical care fellowship at Columbia. I started by taking a few classes here and there – suddenly I felt like I had found my “off switch” that had eluded me until that time in my life.
The change was subtle, but sweet. Rather than building energy and releasing it in quick bursts, I found a gradual, but enduring relief from the internal chaos. I just wanted a break, what I received was liberation. My experience is not unique. There is some science to back the emotional and physical benefits of yoga that so many of us are lucky to experience, but even the most prestigious yoga researchers will admit, science can’t prove ALL the benefits we experience from practicing yoga, but below I will try! 
Relaxation of the autonomic nervous system – also termed self-regulation: the ability of human beings to control their internal state both physiologically and psychologically. This phenomenon was first discovered by scientists in the 1950’s who spent a year traveling through India studying advanced yoga practitioners .
Up-regulation of “positive” life-prolonging genes (including up-regulation of antiviral immunoglobulin response), and down-regulation of genes promoting bodily stress, inflammation, aging, and disease promotion. The Benson-Henry Institute for Mind-Body Medicine and UCLA have both pioneered research supporting this theory [3,4].
Improvement in attention and response to external stress. Functional MRI (fMRI) studies on both long and short-term meditators versus non-meditators as controls have proven that the act of meditating actually ENGAGES the attention networks in a person’s brain. By the act of neural plasticity, or the ability of the brain to change its structure in response to behavior or activity, underlies this incredible effect of a regular yoga and meditation practice [5,6,7].
Psychiatric Health. Preliminary studies have shown that regular practitioners of yoga and meditation actually have a significantly reduced incidence of psychiatric, seizure, and mood disorders 
Now that we know all of the incredible benefits of yoga, how does one start? Am I suggesting that you go become a yoga teacher? NO! For me, yoga became a lifestyle – but it doesn’t have to be all consuming. Below I will list a few easy ways to gradually incorporate yoga and breath-work into your life.
1) DON’T GIVE UP BEFORE THE MIRACLE HAPPENS! What I mean by this is give yoga a real chance. This doesn’t mean taking one class, and giving up. My recommendation is start small. Start with 20-30 minutes 3x/week for one month. If you can find a studio nearby, start taking classes. If you don’t have time to make it to a studio, you STILL have many options!! www.Yogaglo.com, www.omstars.com, and YOUTUBE are your friends. The first two websites are paid websites (this is not sponsored at all) that always have a trial period so you can try before you buy for a few weeks. Youtube is free – but clearly there are many teachers, so below I will list a few I love:
Cosmic Kids Yoga (for yoga with your kids!)
Yoga with Adriene (she has a great 30 day yoga series if you want structure)
Elena Brower (she has great classes on both yoga and meditation, and has many classes on yogaglo)
2) CHOOSE THE RIGHT CLASS! We ALL have different personalities and fitness types – and perusing your local yoga classes may seem daunting at first, so hopefully my explanations will help to demystify the nomenclature and help you choose the best class for YOU. One other important piece of advice is go early to class, introduce yourself to the yoga teacher and tell him or her that you are a beginner. That almost always causes them to pay more attention to you, and provide modifications and alternate poses as you need them.
ASHTANGA: Ashtanga is based on ancient yoga teachings, popularized and brought to the West by K. Pattabhi Jois in the 1970s. It's a rigorous style of yoga that always follows a specific sequence of postures, and similar to vinyasa yoga each pose is accompanied to the breath. This is NOT for the beginner. I practice this – and it is generally practiced in a room in which every person is following the same sequence at their own pace. Unless the class says “led” but the title – you will not have a yoga teacher telling you each pose to do. You advance in the practice once your teacher believes you have mastered the pose you are currently on.
BIKRAM (hot yoga): 30 years ago, Bikram Choudhury developed this school of yoga where classes are held in artificially heated rooms. You will sweat through a series of 26 poses. Due to the extreme heat, don't forget to bring a water bottle! Although the heat can be hard the first few times – it actually really helped me when I first started yoga as I was incredibly unflexible, and the heat helped to warm up my joints!
HATHA: Hatha yoga is a generic term that refers to any type of yoga that teaches physical postures. Nearly every type of yoga class taught in the West is Hatha yoga. When a class is marketed as Hatha, it generally means the class will be slightly slower, and less of a cardiovascular workout than others.
IYENGAR: Iyengar yoga was developed and popularized by B.K.S. Iyengar as a very exact and meticulous style of yoga with a specific focus on alignment in a pose. Iyengar often uses multiple props to help in alignment. This is often similar to Hatha in that it is less of a sweat-inducin work out, and more focused on perfection each posture you are guided into during class.
RESTORATIVE (Yin): Restorative yoga is a perfect way relax and RESTORE. During a restorative class – the focus is on being guided into relaxing yoga postures than you can hold for 5-10 minutes at a time with the helpf of props and walls. I have often felt more rested and relaxed after one of these classes than I ever felt after a full nights sleep or mid-day nap.
VINYASA: Vinyasa classes are notable for constant movement and impeccable sequences that smoothly transition from posture to posture accompanied by constant breathwork. Most Vinyasa classes will get your heart pumping and feel like an excellent cardiovascular workout. Vinyasa classes are my favorite because they combine the mind-body benefits of yoga with a killer work out!
3) SUN SALUTATIONS! If you still feel intimidated by yoga, focus on the foundation of almost every yoga class you will attend, the sun salutations! This circles back to my original suggestion of 20 minutes of yoga 3x/week. If you can’t fit a yoga class into your schedule, go on you tube, search sun salutation (Eddie Stern has my favorite sun salutation video), and start practicing them! This will give you a perfect introduction into yoga, and will also take some of the anxiety away when you finally attend your first yoga class as you will know what everyone else is doing in the beginning of the class (almost every yoga class starts with several sun salutations!)
4) Keep your eye on your own matt! This is an important one guys. After reading this – my hope is each and every one of you takes a yoga class! My biggest advice is keep your focus on your own practice and the teacher. I know that when I first started yoga and could barely touch my knees in a forward fold, I felt incredible discouraged when I looked at the clearly advanced yogis doing handstands and complex poses with ease. It made me want to walk out of the class, but luckily I didn’t. Remember we are all beginners at some point in time, so focus on yourself – focus on the reason WHY you took that yoga class and the incredible benefits you know will come if you stick with the practice.
5) Ask for modifications! Its Ok if you can’t do the pose the in person or online yoga instructor gives you. MODIFY it. Use blocks if you can’t put your hands on the ground, use the wall for balancing poses, and listen for modifications in the instructions. Most yoga teachers will always give you a beginners modification – don’t hesitate to use it! The worst think you can do for your body, and the easiest way to quickly give up, is to push yourself into advanced poses. I STILL can’t do a full split. I always use my hands, a blanket or blocks to help me – and I’ve been doing yoga for over 4 years now!
6) Eat like a yogi! Do not go to your yoga class on a full stomach. Do not eat a big meal within 2 hours of taking your yoga class. And if you are hungry before class, keep it light and choose some fruit and/or nuts to fuel your practice without weighing you down. Also – drinking heavily or eating a big greasy meal the night before your yoga class will make you feel weighted down during the practice. Try to prepare ahead. As I said, yoga is so much more than a practice, it can be an entire lifestyle if you allow it to be!
Above are just a few tips on how to incorporate yoga into your life. Let me share where I am today as a direct result of my yoga practice. I process rather than purge the experiences that accompany each day in the pediatric intensive care unit. I am present, for myself and for my patients. My loved ones do not have to fear the intermittent, albeit extreme explosions of emotion that I was previously prone to. I am a yogi, having completed a 500-hour yoga teacher training at Atmananda Studio amidst my pediatric critical care fellowship at Columbia. And the fact is, we are ALL yogis on the inside – sometimes it just takes a little patience and practice to bring the inner yogi out. I am always here for you as a resource (@yoga_doc_md) – know that you aren’t alone.
The Sanskrit translation of the word Yoga is Union. I have born witness to the beautiful union of medicine and yoga in my own life – both sustaining and lifesaving in their own unique ways.
 Chandratreya S. Yoga: An evidence-based therapy. J Midlife Health. 2011;2(1):3-4. doi:10.4103/0976-7800.83251
 Cramer H, Lauche R, Langhorst J, Dobos G, Paul A. Quality of life and mental health in patients with chronic diseases who regularly practice yoga and those who do not: a case-control study. Evid Based Complement Alternat Med. 2013;2013:702914. doi:10.1155/2013/702914
 Ram A, Banerjee B, Hosakote VS, Rao RM, Nagarathna R. Comparison of lymphocyte apoptotic index and qualitative DNA damage in yoga practitioners and breast cancer patients: A pilot study. Int J Yoga. 2013;6(1):20-25. doi:10.4103/0973-6131.105938
 Vijayaraghava A, Doreswamy V, Narasipur OS, Kunnavil R, Srinivasamurthy N. Effect of Yoga Practice on Levels of Inflammatory Markers After Moderate and Strenuous Exercise. J Clin Diagn Res. 2015;9(6):CC08-12. doi:10.7860/JCDR/2015/12851.6021
 Mishra S, Singh S, Moheb N, Khosa S, Trikamji B. Changes in functional magnetic resonance imaging with Yogic meditation: A pilot study. AYU (An Int Q J Res Ayurveda). 2017;38(2):108. doi:10.4103/ayu.AYU_34_17
 Gothe NP, Hayes JM, Temali C, Damoiseaux JS. Differences in Brain Structure and Function Among Yoga Practitioners and Controls. Front Integr Neurosci. 2018;12:26. doi:10.3389/fnint.2018.00026
 Dodich A, Zollo M, Crespi C, et al. Short-term Sahaja Yoga meditation training modulates brain structure and spontaneous activity in the executive control network. Brain Behav. November 2018:e01159. doi:10.1002/brb3.1159
 Mishra S, Singh P, Bunch S, Zhang R. The therapeutic value of yoga in neurological disorders. Ann Indian Acad Neurol. 2012;15(4):247. doi:10.4103/0972-2327.104328