In this episode of The Dr. Hedberg Show, I interview Sara Lewis in a discussion about the health benefits of yoga.
If you struggle with pain, fatigue, depression, anxiety, insomnia, gut issues, or have adverse childhood experiences, this is one episode you should really listen to.
Sara spent 25 years providing program management expertise to international public health projects in South America, Eastern Europe, Africa and South Asia. The work included directing, managing and planning projects in maternal, newborn, child health and nutrition. After her career in public health, Sara began a second career as a Holistic Health Coach and Yoga Instructor. As a Health Coach, she helps clients discover the benefits of using food as medicine and making small lifestyle changes that have big impacts. She has been practicing yoga for over 15 years and teaching since 2014. Her passion for cooking and food led her to yoga when she began studying the connection between mindfulness and stress eating. Sara teaches both vinyasa flow and yin/restorative classes. Her yin classes include pranayama (breath work) and deep relaxation. When she’s not on the mat or working with clients, Sara can be found in the kitchen fermenting foods, experimenting with locally sourced ingredients from the farmers market or out exploring the hills of Western NC on a bicycle.
Dr. Hedberg: Well, welcome everyone to “The Dr. Hedberg Show.” This is Dr. Hedberg and I’m excited today to have my good friend and colleague Sara Lewis on and we’re gonna be talking about yoga. So I’ve known Sara for quite a while and she’s actually my yoga teacher and she’s also a health coach. So Sara, welcome to the show.
Sara: Thank you Dr. Hedberg, great to be here.
Dr. Hedberg: So why don’t we just start off by you filling everyone in on your background and what you do and what you’ve been working on lately?
Sara: Sure. So I had a career in international public health for about 25 years and I traveled all over the world. I was in Latin America, South Asia, Eastern Europe, and Africa. And I worked mostly in maternal/child healthcare and nutrition and it was a very gratifying career, but at the same time, it was very stressful with all that travel. And so I looked for support from the health coach and I got so much from my health coach that I decided to become one myself. And one of the healing modes that my health coach suggested was to increase my yoga practice and that led me to become a yoga instructor in addition to the health coaching.
So now I have a business called Simply Sara Wellness and Yoga, and I teach about six classes a week at the Waynesville, North Carolina Yoga Center and I provide health coaching to individuals and group clients. So sometimes people will say to me, “Well, what is health coaching?” Health coaching is similar to a personal trainer, but I focus on food and nutrition and lifestyle. So if you came to me and you said, “Sara, I need help with insomnia or my IBS, or I want to prevent type two diabetes because it runs in my family,” then I would work with you to create short-term and long-term goals and I would support you and I would challenge you. I’d probably gave you some homework. I’d wanna know about your life’s ambitions and your fears. I’d probably ask you what you had to eat today. But health coaching is much bigger than food and nutrition. It’s about finding balance in your life and feeling your best.
Dr. Hedberg: Excellent. So I’ve been doing yoga for many years. It’s been very beneficial. Some of our listeners are probably already doing yoga or have done it so far. And even those who have been doing it, they might not really know the background of it. So for those who have never done it before and don’t really know about it, can you just kind of break down the basics of yoga and where it comes from?
Sara: Sure. So the word “yoga” is an ancient Sanskrit language word and it means “yoke” or “union.” And yoga began in India about 5,000 years ago as a comprehensive system for wellbeing. So it wasn’t really an exercise program. And there are multiple branches of yoga, but there’s only one that uses poses or asanas and that’s called Hatha yoga and that’s typically what we practiced in the U.S., Hatha yoga. So in addition to these various branches of yoga, there’s also a lot of different styles of physical yoga. So you’ve probably heard of Iyengar, Ashtanga, yin yoga, but all of these different styles work towards improving your quality of life and relieving stress and improving mental clarity.
Dr. Hedberg: And one of the ones you listed here as the Bikram yoga, is that the very hot yoga?
Sara: Yes. That’s hot yoga. It’s usually practiced at between 90 to 105 degrees temperature.
Dr. Hedberg: Yeah. I’ve seen, you know, quite a few patients who have done that or try to, seems to be a little bit too traumatic actually for some people who are under a lot of stress. You add in the intensity of the yoga and then all of the extra heat and it just seems to be a little bit too much for some people. Have you seen that?
Sara: Yes, I would agree with that. I think for some people it can be too much. It depends on your personality and it depends on the studio. Some studios keep the heat very high, others not quite so much. Depends on the teacher as well. You really need a good introduction about what you’re getting into. You need to be careful about drinking a lot of water and not going too deep. Sometimes you can go into a pose a little too deep for your body.
Dr. Hedberg: So when a lot of people think about yoga, they think about flexibility. Someone who is extremely flexible, you know, when you look at some of the different yoga poses, people might look at it and think, wow, I don’t think I could ever get into that position. So can you just talk a little bit about how yoga can improve flexibility and what people should be thinking about as far as how to improve their flexibility?
Sara: Sure. So I always tell my new students that during their first class, they probably won’t be able to touch their toes when they’re bending forward in a forward fold. That it’s really never about touching your toes. As we say, it’s about what you learned on the way down to touching your toes. And so if you stick to it and you have a regular practice, you will notice that you start to loosen up and your hamstrings will gradually loosen and you will eventually be able to touch your toes and bend your knees as much as you need to. So flexibility is really the ability to move your muscles and joints through their complete range, which is something that you’re born with. So if you think about a baby and how easy it is for them to reach their feet while they’re lying on their back or how toddlers just sort of squat down there.
As we age, we start to lose that flexibility and that’s especially true if you sit a lot or if you’re sedentary, so your bones and your joints and your ligaments kind of settle in if you don’t challenge them. And that’s the beauty of having a yoga practice because you noticed that as you start to become more flexible that your aches and pains might even start to disappear. So if you have tight hips, for example, you’re gonna put strain on your knee joints. And then also, for example, if you have tight hamstrings, it’s gonna affect your lumbar spine and that can cause you back pain. But once you start to move and get that flexibility, then your aches and pains will start to disappear.
Dr. Hedberg: Right. So pain is pain, and chronic pain, it’s actually the number one reason why Americans go to the doctor. So it’s an area in medicine that has really failed the population if we look at the current opioid addiction epidemic and how pain is approached. So yoga can definitely relieve pain. Can you talk a little more about how yoga can help with pain?
Sara: Exactly, right. So yoga is particularly helpful for back pain. And as you mentioned, that’s a big issue here. Back pain is one of the main issues that we have in our society. There was a study that was conducted at Boston University School of medicine that found that yoga was just as effective as physical therapy for improving back pain. They have a beautiful curriculum that I’ve used in my class before. It’s called Back to Health. And so one of the reasons that that back pain is relieved with yoga practice is because we focus on diaphragmatic breathing. So the diaphragm muscle is positioned in the middle of the torso from the nipple to the navel. And when you use that diaphragmatic breathing, then you’re really using all of that, the…I’m sorry, if you don’t use the diaphragm, then you’re losing the strength and the other muscles take over, your back muscles take over and they can tighten up. But when you use your diaphragm, then you’re actually strengthening it and strengthening that whole core area. So if you were to right now, say, put one hand on your belly and one hand behind you, and your listeners could do this too, and just take a really deep, deep inhale and then notice how both of your hands are expanding or moving. And that’s using your entire, your diaphragm. So then there…I’m sorry, go ahead.
Dr. Hedberg: No. Was there anything else you wanted to add there to pain?
Sara: Right. So there’s some other studies that show that yoga poses or meditation or combining both the yoga poses and the meditation can reduce chronic pain in people who have, for example, arthritis or fibromyalgia or other conditions. And their mood starts to improve through a regular yoga practice. And so then they don’t need as much medication to relieve the pain.
Dr. Hedberg: So many of our listeners work sitting at a desk all day. They might have developed bad posture, bad habits. And so along with pain reduction and improved flexibility, can you talk about how yoga could improve posture?
Sara: Yes. I am a huge proponent of proper posture. And I often teach tips from Esther Gokhale posture methods. She wrote a book called “8 Steps to a Pain-Free Back.” Esther is a biochemist and an acupuncturist and she spent years researching back pain and looked at different cultures around the world. And so I’ve used her techniques to work with my students on alignment and foundation. Poor posture can cause a lot of different issues: backaches, neck aches, joint aches. So for example, when you’re sitting, you mentioned that we sit a lot in our society, and you slump and you tuck your tailbone under while you’re sitting, then it takes out the normal curvature in your lower spine. And that’s not good because it puts strain and stress on the muscles in your low back.
In addition to sitting, we also work on computers, we’re texting, we put a lot of strain on our neck, on our spine. And so for example, your head is as heavy as a bowling ball and it’s big and round. And so if you think about if you’re texting and you move your head forward just an inch or so, then you’re really straining the muscles in your neck and you can create poor posture. So if you work on your posture and you get your head balanced directly over your spine then it takes much, much less work for your neck and your back muscles to support it.
Dr. Hedberg: Right. Exactly. So a lot of people, you know, they exercise, but most of the exercise I think people are doing doesn’t necessarily focus on balance. And that’s really an important thing that I think people tend to forget about. So in yoga, there’s definitely some poses and things like that that help with balance. So can you talk a little bit more about that?
Sara: Sure. So if you practice yoga regularly, then it will increase your proprioception, and that is the ability to feel what your body is doing and where it is in space. If you have bad posture or you have dysfunctional movement patterns, then you probably have poor proprioception and that can be linked to knee problems and back pain. So what yoga does is it challenges your balance. And a lot of the poses that we do, we’ll have you stand on one leg or, say, on one knee and then lifting the opposite arm. And these are static poses so that you do them when you’re standing still or, you know, just not moving around. But one of the keys to balance is mastering transition. So most falls in life happen when you’re moving. So for example, if you’re walking or climbing or coming down stairs and a regular yoga practice is gonna help strengthen those muscles that are needed for those transitional movements and it also helps your motor skills.
Dr. Hedberg: So one of the things that I talk a lot about with patients is stress and adrenal stress and also, you know, adverse childhood experiences and how that affects stress when we’re adults. So one of the things that I…I have a list of recommendations for people who have a lot of adverse childhood experiences or who’ve experienced a lot of stress, and one of those things is yoga. So can you talk a little bit about yoga and, you know, cortisol, the adrenals, and stress?
Sara: Right. Very good point. So normally the adrenal glands secrete cortisol in response to a crisis and that will temporarily boost your immune function. But the problem is that if your cortisol levels stay high, even after that crisis passes, then it’s not good for your immune system, as you know. So excessive cortisol is linked with depression and osteoporosis and insulin resistance and it can even cause food-seeking behavior. That really interests me as a health coach. So that’s when you’re upset and you’re stressed or angry. But what happens is when you practice yoga, it helps lower the cortisol level and, you know, reduces stress and affects your nervous system in a good way.
So the “Indian Journal of Psychiatry” published a study a few years ago that showed that yoga significantly reduced blood cortisol levels in depressed patients. It was a small study but they did have a control group and they looked at those who practiced yoga and compared them with an antidepressant medication and found that the yoga was just as effective.
Dr. Hedberg: Excellent. Yeah, we’ve known for years the research on exercise and depression. So yoga, I’m sure there’s effects going on in the brain and the rest of the body, probably serotonin levels and things like that. So have you read anything on serotonin and yoga?
Sara: Yes, absolutely. So about 95% of the serotonin in our bodies is produced in the gut, as you know. So the changes in the serotonin levels affect the gut as well as the brain, and as we say in yoga, it’s all connected. So when you’re practicing yoga, you’re affecting the nervous system. And there is a study that shows that the serotonin levels actually have increased from doing yoga. So increasing that is linked with feeling better, your mood improves, you actually feel happier, and then, of course, it affects your immune system too.
Dr. Hedberg: So sleep is really one of those bedrock things that we have to talk about with everyone. You know, one of the things that I’ve learned in 15 years of practice is that unless sleep is optimal, you’re just not going to get the results that you’re looking for. So we’ve talked about mood and stress and cortisol and serotonin and things like that. But what about sleep and yoga? Do you have anything to add as to how yoga might help people sleep better?
Sara: Yes, this is a big one. So for me personally, I struggle with getting good sleep sometimes. And in fact, I pulled up your article the other day, one of your articles on sleep to read it again, just as a nice reminder. And in addition to all those things like turning off the TV at night and making sure you’re not working on your computer, you know, after 7:00 or 8:00 at night, there’s other things you can do. And yoga is especially restorative, and again, practices are especially helpful for encouraging deep sleep.
So these practices help calm your mind and your body and they put you in a very relaxed state because they’re relaxing the nervous system. So the poses are held for a little bit longer and it’s allowing you to go inward and be more introspective and really focus on your breath. And it’s very meditative, those two practices, yin yoga and restorative yoga. In addition, there’s Nidra yoga. Nidra yoga doesn’t actually use a lot of poses. It’s more a meditative, guided relaxation practice.
Dr. Hedberg: So osteoporosis, bone health, this is a big issue in the U.S. And when it comes to bone health, we’re really looking at chronic inflammation and some other things that come into play like hormones, exercise and things like that. So I have written before about the bone-muscle unit and they’re kind of one and the more we can load them, the healthier we can make the bones. So can you talk a little bit about how yoga could improve bone health?
Sara: Yes. So our bones are constantly being renewed. The entire human skeleton is thought to be replaced about every 10 years or so. And active forms of yoga or weight-bearing exercise has been proven to strengthen the bones, as you point out. So for example, one very popular asana, or pose, in a flow yoga is called adho mukha śvānāsana, or downward-facing dog. And this helps strengthen your wrist, your arms, your ankles, because basically, your entire skeletal system is…you’re lifting your own weight, supporting it. And essentially, any weight-bearing exercise is making tiny, tiny breaks and the bone. And so when the bone grows back together, it makes it stronger. And when I work with new yoga students to help them learn proper alignment in downward-facing dog, for example, I do that because sometimes they’ll complain of wrist pain if they’re not used to putting their weight on their wrist and their arms. So they might lean forward too much or they might round their shoulders and really they need to press away.
And also, yoga can help reduce falls. So for example, as we age, fractures are a big issue from falling. But fewer than one in three hip fractures are actually due to bone fragility or osteoporosis. Really, the fractures are triggered by falls and the falls are triggered by impaired balance. So instead of asking, do you have osteoporosis, a better question might be, do you have impaired balance? Because that is a better predictor of whether or not you’re going to fracture something.
Dr. Hedberg: Right. Right. The other advantage to yoga is that it can be very low intensity. So even elderly people with osteoporosis, even severe osteoporosis could still participate in yoga, couldn’t they?
Sara: Absolutely, yes.
Dr. Hedberg: Excellent. So, you know, I talk a lot with patients about the breath, you know, making sure they’re breathing. I always try and get people to at least consider doing some kind of meditation practice and working on their breath. And so in yoga, the breath is a big part of it. Can you talk about some of the different breathing techniques in yoga and how it can help people?
Sara: Yes. So your listeners might be familiar with the word pranayama, which means controlled breathing. Prana means breath or life force in Sanskrit, and most styles of yoga practice some sort of pranayama. Controlled breathing can be very powerful. It reduces stress and anxiety and it helps you sleep better. And one of the exercises that I like to teach is called the 4-7-8 breath. And this exercise can be done anywhere and I think it’s especially helpful if you have trouble falling asleep.
So the way it works is you start by just taking an exhale and getting all of the breath out of your body. And then you close your mouth and you inhale through your nose counting to four. And then you hold your breath for a count of seven. And then you exhale completely through your mouth by making a whoosh sound to a count of eight. So that would be one cycle, and then you repeat that for a total of four breaths. If you’re not used to holding your breath, you might feel a little bit dizzy at first. But the more you practice it, the longer you can make it. So you’re counting might a little bit longer. And Dr. Andrew Weil has a great YouTube video showing this breathing technique.
Dr. Hedberg: Excellent. So it’s four seconds in, holding for seven seconds, and then you exhale through the mouth for eight seconds, making like a whoosh-like sound.
Sara: Correct. Yes. Very relaxing.
Dr. Hedberg: And how many cycles did you say was recommended of that?
Sara: Four times.
Dr. Hedberg: Four times.
Dr. Hedberg: Right.
Sara: Dr. Weil says don’t do it any more than four at first when you’re first getting used to it.
Dr. Hedberg: Okay. So there must be some more changes. You know, obviously we’d see reduced stress with breathing and we would see a reduction in metabolic acidosis. Anything else you can think of that could affect health in a positive way?
Sara: Yes. Actually, there’s lots of studies on breathing. And one in particular that I was interested in, I heard at a conference a couple of years ago, Dr. Sundar Balasubramanian who is at the Medical University of South Carolina did some research on breathing and he found that breathing affected the immune system. So what they did was they took…the researchers had 20 healthy adults and they divided them into 2 groups. And they asked one group to do 2 sets of 10-minute breathing exercises and then the other group was told to just read a text of their choice. So they basically were just relaxing for the 20 minutes. And then they looked at their saliva during various intervals during the exercises and they found that the group that was doing the breathing exercises had significantly lower levels of three cytokines that are associated with inflammation and stress. So it helped reduce inflammation and stress and improve the immune system.
Dr. Hedberg: Excellent. So I did mention this earlier about, you know, can the elderly with osteoporosis do yoga? So are there any people who shouldn’t do yoga and are there any age or physical limitations?
Sara: Basically, not that I know of, as long as you’re breathing and you can move a few of your body parts, then you can practice yoga. My mother who is almost 90 practices tear yoga, for example, and loves it. And I’ve had students in my class over 80, so. And, of course, there’s yoga for children, there’s prenatal yoga, there’s a yoga style for everybody and every type. I think it’s important for students to find a teacher and a style that resonates with them. And I think one of the really important things is that you create a regular practice if possible, daily, if possible, if you want to really see the health benefits,
Dr. Hedberg: Right. So let’s say there’s someone out there listening and they just don’t have access to any local yoga studios, is there any way that anyone can learn it, say, online or a book or are there any resources you’re aware of?
Sara: Yeah, so there’s lots and lots, there’s especially some great YouTube videos online. There’s lots of wonderful books. Yes, it’s readily available everywhere. You can create a home practice. There’s DVDs. Yes.
Dr. Hedberg: Great. Anything else you’d like to add to what we’ve talked about today?
Sara: Yes. I just wanna say that, you know, everything is connected. And so if you’re just beginning a yoga practice, one of the things that might happen is that you might just start to be aware of your body. You might become more aware of how you’re breathing, or you might become more aware of that little pain you had in your hip, or you might become more aware of your posture, and you might start standing up taller and you might start sleeping better. And somebody might even come up to you and say, “Hey, what are you doing? You look like 10 years younger, what’s going on?” So there’s so many different benefits that we didn’t even talk about half of them here. So a yoga practice emphasizes that awareness and emphasizes that everything is connected, your body, your mind, and your spirit.
Dr. Hedberg: Well, this has been really excellent, Sara, I appreciate you coming on. Is there anywhere that you would like people to find you online?
Sara: Yes, I have Facebook page and Instagram, it’s Simply Sarah Wellness and Yoga.
Dr. Hedberg: Okay, great. Great.
Sara: Thank you, Dr Hedberg, I appreciate it.
Dr. Hedberg: Oh yeah, yeah. Thank you for sharing this. I’m hoping that some of our listeners who aren’t doing yoga will try it out and get into it. And again, I do wanna emphasize if you have a high ACE score, adverse childhood experiences score, yoga is something that I highly recommend that you take. And for those of you who have done yoga before, this could be a reminder to get back into it. And like you said, it’s really important to incorporate it into your life rather than just doing bits and pieces of it for short periods of time. So for all the listeners, go to drhedberg.com. and under the article section, I’ll have a transcript of what we talked about today as well as some helpful links for some resources if you do wanna get into yoga. So take care, everyone. Thanks for tuning in and we’ll talk to you next time.