Today's Daily Tip
With my eyes closed and my muscles melting into the table beneath me, I'm only vaguely aware of the four hands gently working warm sesame oil over my body. The rhythmic motion of the massage lulls my busy mind, and for a moment I feel completely content. I let out a deep sigh of surrender. This is one of the sweetest moments of an ayurveda">Ayurvedic panchakarma (a profound detoxification process) and is something of a reward for the four weeks I spent on a restrictive diet and lifestyle program. I worked hard to prepare my body and mind for this week at an Ayurvedic healing center and am enjoying the effortlessness of the experience when suddenly—without warning or the usual knot in my throat—I break into a steady flow of tears.
Still, I feel at peace. This kind of response to the panchakarma experience, I'm later told, is common and is considered part of the therapeutic process that Ayurveda, India's 5,000-year-old holistic approach to medicine, encourages. The tears bring relief and a felt sense of acceptance of my story—the story that's brought me here to Boulder, Colorado, in search of healing.
I was 19, in my second year of college in Boston, far from family and friends. Like many students, I studied hard, worked several part-time jobs, stayed up late, and lived off of the cafeteria salad bar and first-date dinners. Halfway through the fall semester, I realized that I was alarmingly tired. Walking a few blocks was exhausting, and climbing the two flights of stairs to my dorm room left me winded. A few weeks later, while at a friend's apartment putting on my costume before a Halloween party, I stood in front of a full-length mirror for the first time in months and saw a gaunt whisper of a girl looking back.
A Difficult Diagnosis
The next day the doctor at the campus clinic told me I had a severe case of ketoacidosis, a life-threatening but reversible condition that occurs when you've maintained a very high level of sugar in the blood for several days. I had been feeling off since September. After noting that my blood sugar measured in the high 600s (70 to 120 is considered normal), the doctor said he was surprised that I'd been able to walk into the clinic at all.
I spent the next few weeks in a hospital, where I was diagnosed with type 1 diabetes, an autoimmune disease that causes the pancreas to cease insulin production. Without insulin, a hormone that allows the body to store and use glucose for energy, sugar builds up in the blood. With that comes the risk of ketoacidosis, which, prior to the discovery of insulin injections, was inevitably fatal. Even with insulin injections, however, diabetics may endure a long list of possible complications—such as kidney disease, blindness, and nerve damage that can lead to amputation. I had grown up knowing what the disease could do to someone. My dad had been diagnosed before he entered high school. By his late 40's, his left foot had to be amputated, he depended on twice-weekly dialysis, and he had undergone a kidney transplant. He died of complications from the disease when I was five.
Gripped by the memory of my dad, and eager to please everyone around me, I was determined to be the perfect patient, doing all that my doctors asked of me: I checked my blood sugars several times a day with a finger-prick test, counted carbohydrates (when digested, carbs turn into glucose, or sugar), and injected large amounts of insulin into my arms, thighs, stomach, and buttocks in the morning, at meals, and before bed. But during those first two years, my blood-sugar levels bounced up and down erratically, and it soon became clear that my doctors were simply guessing about how big or small my doses should be. Too much insulin before yoga, for example, and my sugars would dangerously bottom out to nearly hypoglycemic coma levels, leaving me pale, soaked in sweat, twitching, and close to passing out. A quick swig of orange juice would bring my blood sugars back up in 10 minutes, but often I'd find I had drunk too much, and my sugars were high again. What's more, my doctors insisted that I could be doing better than I was.
Before long, I gave up. I stopped trying to get it right, and I stopped talking about diabetes altogether, quickly changing the subject if someone asked me about it. I disengaged from my out-of-control body and got used to occasional high blood sugars, which are often accompanied by strong mood swings, sweating, lack of concentration, and dizziness. I did a finger-prick test maybe every other day, let most insulin shots slide, and satisfied my sweet tooth daily. For a while, the disease slipped to the back of my mind and I felt normal again.
When The Honeymoon is Over
Ignoring diabetes was actually pretty easy at that time. I've since learned that I was probably in what's called a honeymoon phase, during which time the pancreas continues to produce a small amount of insulin. But underneath my deep denial of the disease, I was suffering from depression. No one seemed to notice anything during those first three years of honeymooning, and even my quarterly blood tests appeared relatively normal. (Called an A1C, this test measures a person's average blood-glucose levels—not the constant swings between sugar highs and lows.)
And then, without warning, sometime after I graduated and moved to San Francisco, the honeymoon was over: Suddenly my A1Cs showed higher and higher blood-sugar averages. I begrudgingly started regular finger-prick tests and multiple injections again—up to 10 insulin shots a day. But my blood sugars and moods still yo-yoed. I knew that if this continued, in a few years I would find myself suffering from many of the complications my dad went through. I needed help.
About this time, I began reading about Ayurveda, yoga's sister science and a system of healing that examines a person's physical, emotional, and spiritual nature to treat the whole self. It was obvious that what I was doing wasn't working, and the idea of treating diabetes holistically sounded appealing. So with a deep breath—and after another two years of procrastination—I took the plunge. I knew that I needed to change from the inside out. I needed a soul-healing, habit-changing, life-transforming Ayurvedic makeover.
Full disclosure: As motivated as I was, I probably wouldn't have gone for a full Ayurvedic treatment if I hadn't joined the staff of Yoga Journal and gotten an assignment to write this story. The assignment paid for the treatment and gave me the time I needed to do it. Knowing now how it has changed my life, I can't believe I hadn't made it a priority sooner.
After consulting with my endocrinologist and getting her OK, I interviewed various practitioners before choosing to work with John Douillard, an Ayurvedic doctor who received his training in India, holds a PhD in Ayurvedic medicine from the Open International University, and co-directed Deepak Chopra's Ayurvedic center for eight years, before opening his LifeSpa in Boulder.
Credentials aside, I trusted Douillard after meeting him and sensing that he genuinely cared about me, my goals, and my emotional well-being. This enabled me to relax and give honest answers to the questions he asked as he put together a behavioral, mental, emotional, physical, and performance profile to determine my prakriti (constitution). (When you go for an Ayurvedic -consultation, expect the practitioner to ask about everything from your sleep schedule and diet to how you handle difficult situations and what weather you enjoy the most.) Because I trusted him and felt he understood me, I trusted his analysis of my constitution: kapha-pitta.
Without Just Cause
No one knows exactly why one person develops type 1 diabetes and another doesn't. Having a genetic predisposition, as I do, might have something to do with it. According to the American Diabetes Association, a man with type 1 diabetes has a 1 in 17 chance of passing it on to his child; a woman with type 1 diabetes has a 1 in 25 chance of passing it on to her child if the child is born before the woman turns 25. After that, the risk is 1 in 100. Most agree, however, that it is impossible to prevent, unlike the more rampant type 2 diabetes, which can often be prevented or even reversed with exercise, stress reduction, and lowered caloric intake.
The underlying cause of type 1, according to Ayurvedic thought, is a kapha imbalance. Kapha is one of three doshas, or elements, that make up your constitution: vata (associated with air and coolness); pitta (associated with fire and heat); kapha (associated with earth, water, and stability). "Type 1 diabetes usually starts as a kapha imbalance during childhood, which is the kapha time of life," says Douillard. "If the diet is bad, and a child eats lots of kapha-producing foods like sugar, kapha energy can build up in the stomach, which puts a lot of stress on the pancreas. It also congests the bile duct, where the pancreas secretes insulin. When this happens, a secondary imbalance occurs in the pitta dosha."
Unbalanced pitta, says Douillard, compromises the liver, puts more pressure on the kidneys, and directs kapha into the bile duct, again causing the pancreas to malfunction. All of this can go on for years and is often exacerbated by stress that starts in childhood. "In Ayurveda, stress is thought to be the cause of 80 percent of disease," says Douillard. "When under stress, the adrenal glands produce an excess of stress-fighting hormones that are toxic, acidic, and compromise lymphatic drainage. Without good drainage, kapha backs up in the stomach, small intestine, kidneys, and finally, the pancreas." The toxins are eventually stored in fat and lead to disease, such as diabetes.
The key components in an Ayurvedic regimen for type 1, then, are reducing stress and treating the dosha imbalances, with the aim of stabilizing blood sugars and minimizing complications. "In Ayurveda, we're trying to unravel the stressors present in the body," says Douillard. "By taking stress off, we'll hopefully reset the cells in the pancreas."
In Good Hands
John Douillard warned me early on that going the Ayurvedic route was not going to be a quick fix. He designed an aggressive six-month plan that included a month of treatment called purvakarma, or preparatory actions, to ready me for a week of detox and restoration called panchakarma, or five actions, at Douillard's LifeSpa. When Douillard did his initial consultation, he noted that all three of my doshas were out of balance. Vata was the most significantly out of balance at the time, so we addressed it first before treating the pitta and kapha components of diabetes.
The purvakarma began with some easy first steps that included a new sleep schedule that had me going to bed by 10 p.m. and waking at dawn, taking herbs (amalaki, gurmar, and neem) with every meal, and following simple dietary guidelines that required me to eat seasonal whole foods. Every few days I'd check in with Douillard over the phone and by email to see if we needed to make changes or adjustments.
I dutifully swallowed the herbs, even though they made me nauseous at first. (After two weeks, my body got used to them.) They certainly proved worthwhile—I monitored my blood sugars carefully and saw them become incredibly stable (no extreme highs or lows) in the first 10 days. After two weeks, we knew the herbs were working, so Douillard added a few more, plus some new dietary guidelines: Make the most of three square meals—no between-meal snacks—taking 20 minutes to eat at a table in a relaxed and undistracted manner. Dine at regular times; avoid sugar, rice, and potatoes; and eat more leafy greens, fenugreek, and turmeric with boiled milk. Enjoy dessert and small portions of fish or lean red meat at lunchtime, but in moderation.
These changes were a bit more difficult to incorporate. I was already eating a well-balanced diet, but I hadn't had a glass of milk in years—I've never been a big fan of the stuff. Perhaps the biggest challenge was sitting down to a quiet meal, free of any music, newspapers, or television. At first, it was just plain boring, but eventually I found joy in tasting and really savoring each bite with the idea that it was medicine. Over the next two weeks, I saw my sugars not only stabilize but also decrease, on average, by about 50 points. That meant I could lower my insulin doses by about 25 percent. I was elated. I was so pleased with these results that I actually looked forward to the herbs and happily ate according to Douillard's prescription. And for the first time, I really began to tune in to and feel the subtle changes occurring in my body.
My moods, I noticed, also seemed to level out, which made it easier to answer questions from my friends, family, and co-workers about all these herbs, skipping morning pastries, and this thing called Ayurveda. Answering their questions got me talking about diabetes again. For the first time, I wasn't trying to run away from my disease. A new feeling of peace and acceptance was present.
Habits That Heal
The fourth week of my purvakarma included an at-home cleansing program to prepare me for the panchakarma in Boulder. I rose before dawn, doing a preshower sesame oil massage called abhyanga and scraping my tongue to remove any ama (partially digested material that builds up overnight and is considered toxic). Breakfast started with a few spoonfuls of ghee (clarified butter), my herbal tea mixture, and foods from a long list Douillard gave me. I mostly ate oatmeal, kitchari (rice and lentils), and hearty vegetable soups. Except for the morning ghee, the diet was fat free, which left me feeling hungry and tired. Douillard suggested I drink plenty of hot water throughout the day, but I was still craving fats and protein. It was probably the strictest, most frustrating part of the whole experience, and I had to keep reminding myself that this regime wouldn't be forever. By the fifth day, my skin was noticeably brighter, and somehow, my hunger went away. The night before my flight to Colorado, I took the recommended castor oil to cleanse my digestive system, and left for the airport just after the laxative effect wore off.
By the time that I landed, I was feeling weak. But I was looking forward to my treatments—a lot of warm oil, steam baths, and massage. Done right, says Douillard, panchakarma is the ultimate restart button—detoxing and burning fat, thus releasing toxins and stored emotions, and bringing about a state of clarity and calm. "It allows the body and mind to drop into deep relaxation," says Douillard. "At this level, we can cleanse toxins stored in the body's tissues as fat—to release deeply held stress."
Which brings me back to the tears. As I lay covered in oil on the table on my first day at LifeSpa, enjoying the shirodhara that followed the four-handed abhyanga, my mind circled around memories of how difficult the past few years had been. Some of the thoughts that came up had to do with diabetes; others, with my family and friends. By the time it was over, I was exhausted but optimistic and ready to head to the big bed awaiting me at the hotel down the street.
Self-inquiry is a big part of panchakarma. By midway through the second day—after more oil, more steam, more massage—I was journaling like a mad woman. Emotions were releasing, and I cried a lot. Thankfully, I met with Douillard almost every day to adjust my herbs, do a pulse diagnosis, and talk about what was coming up during my treatments, in my journaling, and in my dreams.
One night, about halfway through the week, I dreamt of my father, a first for me. It was nothing special—just a few minutes of him joking around with a grown-up me and handing me his favorite items from his old toolbox. It's a relationship I've always imagined, even fantasized about, but have never experienced. When I awoke, I cried, and the loss I had been carrying around with me felt noticeably lighter. In the afternoon, Douillard reassured me that the emotional outpouring was quite common during panchakarma. It was during our sessions that I was able to understand these intense emotions and the stories associated with them as part of my grief and then, quite naturally, let them go. I was beginning to feel whole again.
For the rest of the week, I was covered in the sesame oil Douillard's staff applied to my body each day. I wore a bandana over my hair and hung out in old pajamas that wouldn't suffer from oil stains. I woke up every day around 7 a.m., still covered in oil, to do the asana sequence, pPranayama, and meditation Douillard prescribed. I continued my mostly kitchari diet and, after my morning treatments, would head straight back to the hotel to journal and, once again, do the yoga practices for several hours until dinner. Then I took a bath and had an enema called a basti, resisted turning on the TV, and fell asleep before 9 p.m.—every single day.
To say that my days were repetitive is an understatement. I could have easily gone stir-crazy, but, for the most part, I found myself quiet and content to be in my room, next to the fire, just enjoying the idea that my only job for this week was to take care of myself. Emotions and memories continued to come and go. I felt, I observed, and I let go of feelings—especially those of remorse and resentment about my disease. My mind became very still and clear, like a mountain lake, and there was a feeling of starting fresh. On the fifth day, I got really happy—about everything. I took a short walk and almost burst with joy when I stopped to talk to a man and his dog on the sidewalk.
During my final days of panchakarma, I felt incredibly energized, excited to go home, and get back to the everyday life. Douillard said this anxiousness was typical but that the next 48 hours were crucial in finishing the detox and stimulating lymph movement. So I waited patiently some more, staying relaxed and open to the final treatments.
The transition back to normal life was jarring. While I was grateful to incorporate fat and proteins back into my diet, I found the world around me dizzying and loud—especially in the Denver airport, where travelers screamed into cell phones and flat screens blasted the news of the world I had been retreating from. But by my fourth full day home, a new rhythm set in, one that's slower than before and that hasn't changed much since.
When I returned home after the panchakarma, my blood-sugar levels continued to normalize. Two subsequent A1C tests revealed that my blood-glucose average has dropped nearly 100 points, and I am now out of the danger zone. You might even call me healthy. When my endocrinologist saw the results, she hugged me. Admittedly, the numbers could always be better and my blood-sugar levels are still not perfect, but I've learned to let that go, too. Instead, they are steady, in tight control, and I now require half as much insulin as I was taking before I started my Ayurvedic makeover.
A Fine Balance
It has been nearly a year since my panchakarma. My sugars have stabilized dramatically, making it easier for my endocrinologist and me to determine my insulin doses. And I'm more aware of sugar lows and highs as well as any feelings that come up surrounding my relationship with diabetes. Herbs are more of a weekly affair to keep my digestion healthy, I sometimes turn on the TV or radio during dinner, and I let myself sleep in on most weekends and special occasions. But I've continued with Douillard's dietary recommendations, meditation, asana, pranayama practices, and a few self-care treatments. We check in every once in a while by email, and I hope to do another panchakarma someday. After all, Ayurveda is something you commit to and live by for good health.
I've also lost a little weight. I note this not because I intended to, but because I feel stronger than ever. I think this might just be my ideal weight for using insulin to process energy. I also feel lighter energetically and emotionally. My yoga practice has become savory; my menstrual cycle is now regulated; and I've managed to avoid most colds and flus since I got back.
But most of all, I've found balance in my whole life, which has also made it that much easier to continue with an Ayurvedic lifestyle. It's been a happy ending to this chapter of my story. Before, when it came to diabetes—and a lot of other personal things—I was afraid to look directly at the present and most certainly avoided peering into the future, fearful of what I might find in store. Instead, I dwelled on my personal and medical past and all of the stress that came with it. Today, now free of that stress, I have a kind of courage that's allowed me to stay present with whatever comes up: the occasional low blood-sugar levels, the daily insulin shots, and anything else that might have thrown me for a loop before.
Also, the idea of being normal no longer carries the same weight it used to. Instead, there's a celebration of my unique nature, which just happens to include diabetes. With that, I'm a calmer, much more at-ease woman who's better equipped, physically and emotionally, to handle whatever plot line unfolds next. And I'm certainly looking forward to it.
Lauren Ladoceour is Yoga Journal's associate editor. After writing this article, she checked her blood sugar; it was a healthy 116.