The document discusses stress, its types (eustress and distress), stages (alarm, resistance, exhaustion), physiology involving the sympathetic-adreno-medullary axis and hypothalamus-pituitary-adrenal axis. It then covers stress-related disorders like depression and diabetes, their symptoms, diagnosis, relation to stress, and management using yoga and naturopathy. It also discusses lifestyle-related disorders like obesity and their prevention and management with yoga and naturopathy case studies provided as examples.

1. RELEVANCE OF YOGA ALONG
WITH NATUROPATHY IN THE
PREVENTION AND
MANAGEMENT OF STRESS-
RELATED/LIFESTYLE-RELATED
DISORDERS
BY-DR KALLOL PANDEY

2. What is stress ?
• Stress can be defined as a state of worry or mental tension
caused by a difficult situation. Stress is a natural human
response that prompts us to address challenges and threats in
our lives.
• Everyone experiences stress to some degree.
• The way we respond to stress, however, makes a big difference
to our overall well-being.

3. TYPES OF STRESS
• RICHARD LAZARUS divided stress into :-
EUSTRESS
DISTRESS

5. • EUSTRESS STRESS :
• Enchances function ( physical or mental ) such as through strength
training or challenging work .
• DISTRESS STRESS :
• Persistent stress that is not resolved through coping or adaptation
may lead to escape anxiety or withdrawal depression behaviour.

6. EUSTRESS OR POSITIVE STRESS
1.Eustress or positive stress, has the following
characteristics:
• Motivates ,focuses energy
• Is short-term
• Is perceived as within our coping abilities
• Feels exciting
• Improves performance

7. DISTRESS OR NEGATIVE STRESS
2. DISTRESS or negative stress , has the following
characteristics:
• Causes anxiety or concern
• Can be short or long term
• Is perceived as outside of our coping abilities
• Feels unpleasant
• Decreases performance
• Can lead to mental and physical problems

8. STAGES OF STRESS

9. STAGE 1:- ALARM
• The body stress response is a state of alarm .
• During this stage adrenaline will be produced in order to
bring about the fight or flight response .
• Activation of HPA axis producing cortisol .

10. STAGE 2: RESISTANCE
• If the stressor persists.
• Necessary to attempt means of coping with stress .
• The body begins to try to adapt , to the strains or demand of
the environment .
• The body cannot keep this up , so its resources are gradually
depleted.

11. STAGE 3 : EXHAUSTION
• All the body resources are depleted .
• The body is unable to maintain normal function .
• At this point the initial ANS symptoms may reappear –
1. Sweating 2.Raised Heart Rate

12. IF STAGE THREE IS EXTENDED:
• Long term damage may result as the capacity of the adrenal
gland.
• The immune system is impaired and resulting in decompensation.
• The result can manifest itself in illness such as :-
Ulcers, depression or cardiovascular problems.

13. PHYSIOLOGY OF STRESS

23. MECHANISM
• Any physical or psychological stimuli that disrupt homeostasis
result in a stress response.
• The stimuli are called stressors and physiological and behavioral
changes in response to exposure to stressors constitute the stress
response.
• A stress response is mediated by a complex interplay of nervous,
endocrine, and immune mechanisms that involves activation of
the sympathetic-adreno-medullar (SAM) axis, the hypothalamus-
pituitary-adrenal (HPA) axis, and immune system.

24. • The physiology of stress response has two components;
• a slow response, mediated by the HPA axis,
• and a fast response, mediated by the SAM axis

25. FAST RESPONSE
• The fast response due to activation of SAM results in increased
secretion of norepinephrine(NE) and epinephrine(E) from the
adrenal medulla into the circulation and increased secretion of NE
from the sympathetic nerves and thus result in elevated levels of
NE in the brain.
• The released E and NE interact with α- adrenergic and β-
adrenergic receptors, present in the central nervous system and
on the cell membrane of smooth muscles, and other organs
throughout the body.

26. • The norepinephrine(NE) and epinephrine(E), once released,
• bind to specific membrane-bound G-protein receptors to initiate
an intracellular cAMP signaling pathway that rapidly activates
cellular responses.

27. • Activation of these receptors results in, contraction of smooth and
cardiac muscles cells leading to vasoconstriction, increased blood
pressure, heart rate, cardiac output, skeletal muscle blood
flow, increased sodium retention, increased glucose levels (due
to glycogenolysis and gluconeogenesis), lipolysis, increased oxygen
consumption, and thermogenesis.
• It also leads to reduced intestinal motility, cutaneous
vasoconstriction, bronchiolar dilatation. In addition, SAM
activation cases behavioral activation (enhanced arousal,
alertness, vigilance, cognition, focused attention, and analgesia).

28. SLOW RESPONSE
• The slow response is due to activation of the HPA axis resulting in
the release of Corticotropin-releasing hormone (CRH) from the
paraventricular nucleus of the hypothalamus into the circulation.
• The CRH released from the hypothalamus acts on two receptors;
CRH-R1 and CRH-R2.CRH-R1 is widely expressed in the brain in
mammals.
• . It is the key receptor for the stress-induced ACTH release from
the anterior pituitary. CRH-R2 is expressed primarily in peripheral
tissues including skeletal muscles, gastrointestinal tract, and
heart, as well as in subcortical structures of the brain.

29. • Cortisol releasing hormone binding protein CRH-BP binds with CRH with a
higher affinity than CRH to its receptors. CRH-BP gets expressed in the
liver, pituitary gland, brain, and placenta.
• The role of CRH-BP as a controller of the bioavailability of CRH has
support by studies finding 40 to 60% of CRH in the brain is bound by CRH-
BP.
• In exposure to stress, the expression of CRH-BP increases in a time-
dependent fashion, which is thought to be a negative feedback
mechanism to decrease the interaction of CRH with CRH-R1. Serum
cortisol level describes the body's total cortisol level, of which 80% is
bound to cortisol binding globulin (CBG) and 10% is bound to albumin.
Unbound cortisol is biologically active.

30. • The released CRH then stimulates the anterior pituitary gland to
release adrenocorticotrophin hormone (ACTH) into the
bloodstream.
• ACTH stimulates the adrenal cortex to secrete glucocorticoid
hormones, such as cortisol, into the circulation. Cortisol's inactive
form, cortisone, is catalyzed to its active form, cortisol, by 11
beta-hydroxysteroid dehydrogenases.

31. • The HPA axis is regulated by pituitary adenylate cyclase-activating
polypeptide (PACAP).
• PACAP may play a role in the production of CRH and have a
modulatory role in multiple levels of the HPA axis. Evidence also
points to PACAP's involvement in the autonomic response to stress
through increased secretion of catecholamines. The PACAP
receptors are G-protein coupled and PACAP-R1 is the most
abundant in both central and peripheral tissues. PACAP may also
modulate estrogen's role in the potentiation of the acute stress
response.

32. • Once CRH is released, it binds with cortisol releasing
hormone binding protein (CRH-BP) because CRH has a higher
affinity for CRH-BP than for its receptors.
• CRH-BP gets expressed in the liver, pituitary gland, brain, and
placenta.
• The role of CRH-BP as a controller of the bioavailability of CRH has
support by studies finding 40 to 60% of CRH in the brain is bound
by CRH-BP

33. • In exposure to stress, the expression of CRH-BP increases in a
time-dependent fashion, which is thought to be a negative
feedback mechanism to decrease the interaction of CRH with CRH-
R1.
• Serum cortisol level describes the body's total cortisol level, of
which 80% is bound to cortisol binding globulin (CBG) and 10% is
bound to albumin. Unbound cortisol is biologically active.

34. STRESS/LIFESTYLE RELATED DISORDER
STRESS RELATED
DISORDERS
LIFESTYLE RELATED
DISORDERS
STRESS & LIFESTYLE
RELATED DISORDERS
DEPRESSION TYPE-2 DIABETES OBESITY
ANXIETY OBESITY DIABETES
HEART DISEASE HYPERTENSION HYPERTENSION
HEADACHES CORONARY ARTERY DISEASE HEART DISEASES
GASTROINTESTINAL
DISEASES
COPD
ACCELERATED AGING PCOS
CANCER

35. STRESS RELATED DISORDERS
• Studies have found many health problems related to stress. Stress
seems to worsen or increase the risk of conditions like obesity,
heart disease, Alzheimer's disease, diabetes, depression,
gastrointestinal problems, and asthma.

36. DEPRESSION
• Depression is a mood disorder that causes a persistent feeling of
sadness and loss of interest. The American Psychiatric
Association’s Diagnostic Statistical Manual of Mental Disorders,
Fifth Edition (DSM-5) classifies the depressive disorders into:
1. Disruptive mood dysregulation disorder
2. Major depressive disorder
3. Persistent depressive disorder (dysthymia)
4. Premenstrual dysphoric disorder
5. Depressive disorder due to another medical condition

37. DIAGNOSIS
• These are the 9 symptoms listed in the DSM-5. Five must be
present to make the diagnosis (one of the symptoms should be
depressed mood or loss of interest or pleasure):
1. Sleep disturbance
2. Interest/pleasure reduction
3. Guilt feelings or thoughts of worthlessness
4. Energy changes/fatigue
5. Concentration/attention impairment
6. Appetite/weight changes
7. Psychomotor disturbances
8. Suicidal thoughts
9. Depressed mood

38. STRESS AND DEPRESSION

39. PREVENTION

40. MANAGEMENT
MANAGEMENT OF
DEPRESSION
ANTIDEPRESSANTS PSYCHOTHERAPY

41. ANTIDEPRESSANTS
• The more commonly used medications are from the following
classes:
• ●Selective serotonin reuptake inhibitors (SSRIs)
• ●Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• ●Atypical antidepressants
• ●Serotonin modulators

42. TITLE AUTHOR /
YEAR
PARAMETER INTERVENTION RESULT
Yoga and Naturopathy
intervention for reducing
anxiety and depression of
Covid-19 patients – A pilot
study
R. Jenefer
Jerrin, S.
Theebika
Year-2021
Jun 1
HADS
CAS
Yoga and Naturopathic
intervention was given for
60 min a day for two weeks
in the morning between
7.30am and 8.30am. The
details of the interventions
are presented in. Qualified
Yoga and Naturopathy
doctors gave the
intervention with personal
protective equipment (PPE)
kits during the intervention.
In addition, this
intervention was also
shared to the patients in the
form of an E module
(video) for better self-
learning and practice. A log
book was maintained to
note the timing and
duration of practice per day
After the intervention
there is significant
reduction in
HADS-Anxiety
HADS-Depression
CAS score.

44. DIABETES
• Diabetes mellitus is a group of metabolic disorders in which a
person has high blood sugar , either because the body does not
produce enough insulin, or because cells do not respond to the
insulin that is produced.
• FBS- 126mg/dL
• OGTT- >200mg/dL

45. SYMPTOMS

46. STRESS AND DIABETES RELATION

47. PREVENTION

48. MANAGEMENT

49. YOGA AND NATUROPAHY MANAGEMENT
• TILTLE - Effect of an Integrated Naturopathy and Yoga Program on
Long-Term Glycemic Control in Type 2 Diabetes Mellitus Patients:
A Prospective Cohort Study
• AUTHOR – Srinivas Bairy, M Raghavendra Rao
• INTERVENTION - Naturopathy and yoga-based lifestyle
intervention In this group, the participants were enrolled in a 3-
month residential naturopathy intervention program comprising
diet, yoga, hydriatic treatments, massage, and didactic and
interactive lectures on lifestyle modification and type 2 diabetes
mellitus self-management.

50. • Patients underwent a structured routine which involved physical activity,
yoga program with asanas, pranayama, meditation and relaxation, calorie
restriction, and salt-restricted diet.
• The diet prescribed was a low glycemic index, low-salt high-fiber plant-
based diet containing whole grains, legumes, vegetables, and fruits with
no added oil, sugar, or salt.
• They also underwent short intermittent juice fasting with calorie
restriction over 3–4 days a month. They had to undergo a structured
routine of hydriatic treatments such as hip bath, immersion bath, jets,
sprays, douche, and mud and steam bath apart from partial and full-body
Swedish massages. The goal of treatment was weight reduction if
overweight, stress reduction, and dietary intervention to manage glycemic
index.
• The patients were in this facility for a period of 3 months and were
supervised by doctors and diabetologists over the course of their
intervention. The oral antidiabetic medication was constantly monitored
and tapered based on their blood glucose and HbA1c levels.

51. • CONTROL INTERVENTION - The control group received
conventional antidiabetic treatment as per the standard
guidelines. The pharmacological management of type 2 diabetes
mellitus patients included both oral hypoglycemic agents,
parenteral insulin, and other medicines to manage their comorbid
conditions and supportive care. The control group also received a
diabetes self-management program by a diabetes educator during
their hospital visits.
• They were also counselled on the diet and physical activity by a
clinical nutritionist. Both HbA1c levels, blood glucose, and other
biochemical tests were routinely conducted and monitored. Dose
escalation or tapering was done based on these levels by a
diabetologist.

52. CONCLUSION
The results suggest benefit with an intensive residential
naturopathy-based lifestyle intervention program.
Randomized controlled trials are needed to further validate
the findings.

53. TITLE AUTHOR /
YEAR
PARAMETER INTERVENTION RESULT
A yoga intervention for
type 2 diabetes risk
reduction: a pilot
randomized controlled
trial
Kelly A
McDermott,
Mohan
Raghavendr
a Rao
YEAR-01
JULY 2014
• weight,wa
is
circumfere
ne BMI
• FBG,
• PPBG,
• blood
pressure,
cholestero
l
The yoga group attended a
day long (eight hour) group
counseling session on
healthy lifestyle changes
with topics on healthy diet,
increasing physical activity
and smoking cessation.
Participants in the
intervention group were
then asked to attend at
least three, and up to six,
yoga classes per week over
the eight weeks of the
study.
The control group attended
the same day long (eight
hour) group counseling
session on lifestyle changes
with their spouses. The
control group was asked to
do 30 minutes of walking
significant decrease in
weight, BMI and waist
circumference in the yoga
group compared to the
walking control, however
we did not see a decrease
in FBG, PPBG, insulin,
insulin resistance, blood
pressure, or cholesterol.

54. OBESITY
• Obesity is defined as having a body mass index (BMI) greater
than or equal to 30 kg/m2. BMI is your weight (in kgs) divided by
a square of your height (in meters).

55. SEVERAL FACTORS RESPONSIBLE FOR OBESITY
• BEHAVIORAL AND LIFESTYLE FACTORS
• MENTAL ILLNESS
• GENETICS
• STRESS

56. STRESS AND OBESITY

57. • There is a strong inter-relationship between activation of the
hypothalamo-pituitary-adrenal axis and energy homeostasis.
Patients with abdominal obesity have elevated cortisol levels.
• Furthermore, stress and glucocorticoids act to control both food
intake and energy expenditure. In particular, glucocorticoids are
known to increase the consumption of foods enriched in fat and
sugar. It is well-known that, in all species, the cortisol response to
stress or adrenocorticotropin is highly variable.
• It has now emerged that cortisol responsiveness is an important
determinant in the metabolic sequelae to stress.

58. LIFESTYLE AND OBESITY

59. PREVENTION

60. TITLE AUTHOR /
YEAR
PARAMETER INTERVENTION CONCLUSION
Integrated Yoga and
Naturopathy module
in management of
Metabolic Syndrome:
A case report
Swathi
Gowda, Sriloy
Mohanty,
YEAR-2017
Mar 16
• BMI
• LIPID
PROFILE
• BLOOD
PRESSURE
The IYN protocol was
planned. The
naturopathic therapies
included a combination
of therapeutic fasting
and calorie restricted
diet, hydrotherapy, mud
therapy and
manipulative therapies,
with a focus on the
detoxification. The
integrated yoga program
was designed
including asanas, pranay
ama, meditation,
relaxation
techniques, kriyas,
educative lectures and
yoga based counselling
sessions
The case report shows
remarkable changes in
MetS status that
improved the quality of
life following a 6 week
IYN intervention. The
change was sustainable
for 12 weeks through
simple lifestyle
modifications.
Considering the effects
achieved in this case,
IYN could be used as a
safe and beneficial
intervention to integrate
into the management of
MetS

62. GH pack–Gastro-Hepatic Pack, IRR–Infrared rays.
One-week Treatment protocol was repeated every week.
Note: The Naturopathy therapies were repeated on a weekly basis.

63. HYPERTENSION
• Hypertension (high blood pressure) is when the pressure in your blood vessels is
too high (140/90 mmHg or higher). It is common but can be serious if not
treated.
• People with high blood pressure may not feel symptoms. The only way to know
is to get your blood pressure checked.
• Things that increase the risk of having high blood pressure include:
• older age
• genetics
• being overweight or obese
• not being physically active
• high-salt diet
• drinking too much alcohol

64. SYMPTOMS

65. STRESS AND HYPERTENSION

66. LIFESTYLE AND HYPERTENSION

67. PREVENTION

68. MANAGEMENT

69. TITLE AUTHOR INTERVENTION CONCLUSION
Effect of Integrative
Naturopathy and
Yoga in a Patient
with Rheumatoid
Arthritis Associated
with Type 2 Diabetes
and Hypertension
Mooventhan, Geetha
Shetty
The treatments such
as Naturopathy (60 –
90 min.), Yoga (60
min.), and
acupuncture (30
min.) were given
daily for 10-days
along with the
patient's prescription
medicines (except
Diclofenac sodium).
A detail of
intervention is given
in. Data assessments
were done before
and after
intervention.
Result of our study
suggests, INYT may
be considered as an
adjuvant to
conventional
medicine in patient
with RA associated
with type-2 diabetes
and essential
hypertension

72. MIGRAINE
• A migraine is a headache that can cause severe throbbing pain or a
pulsing sensation, usually on one side of the head .
• It's often accompanied by nausea,
• vomiting, and
• extreme sensitivity to light and sound.
• For some people, a warning symptom known as an aura occurs before or
with the headache. An aura can include visual disturbances, such as
flashes of light or blind spots, or other disturbances.
• REFERENCE:-https://www.who.int/news-room/fact-sheets/detail/headache-disorders

73. TYPES OF HEADACHE

74. SYMPTOMS OF MIGRAINE

75. TITLE AUTHOR / YEAR PARAMETER INTERVENTION RESULT
Effect of Yoga on
migraine: A
comprehensive study
using clinical profile
and cardiac
autonomic functions
Ravikiran
Kisan, MU Sujan
headache
impact test
Migraine patients
receiving conventional
care and Yoga therapy
had received Yoga
therapy along with
conventional care.
Patients were scheduled
to visit for 30 sessions
(5 days a week for 6
weeks) of Yoga. They
were asked to maintain
headache diary for the
full duration of the
study and was verified
during Yoga session. The
Yoga intervention
consisted of a daily
practice of loosening
exercises, breathing
exercises, asanas or
postures done with
awareness and
significant clinical
improvement in both groups.
Headache frequency and
intensity were reduced more
in Yoga with conventional care
than the conventional care
group alone. Furthermore,
Yoga therapy enhanced the
vagal tone and decreased the
sympathetic drive, hence
improving the cardiac
autonomic balance. Thus, Yoga
therapy can be effectively
incorporated as an adjuvant
therapy in migraine patients.

77. TITLE AUTHOR /
YEAR
PARAMETER INTERVENTION RESULT
Prevention of Chronic
Migraine Attacks with
Acupuncture and Vamana
Dhauti (Yogic Therapeutic
Self-Induced Emesis)
Interventions.
Naveen
Gowrapura
Halappa
Year-2019
Jan
Visual
Analog Scale
ranging from
0 to 10
53-year-old male
presented with chronic
migraine with aura. He
was treated for acute
symptoms for 10 days with
the following acupuncture
points at the EM 6
(Qiuhou), ST 8 (Touwei),
GB-8 (Shuaigu), LI 4
(Hegu), and ST 44
(Neiting). In addition,
Vamana Dhauti (VD) (self-
induced emesis) was
taught once followed by
VD practice once a week
as part of a long-term
follow-up for 10 years.
Results suggest that
acupuncture is beneficial to
reduce the acute symptoms
of migraine and the possible
frequency of migraine
attacks. However, VD has
shown to be beneficial in
reducing the frequency of
migraine attacks over a
period of time and
eventually led to the
complete cessation of
migraine attacks