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Befriend the Body

Yoga can help ease the challenges of living with an autoimmune disorder.

By Catherine Guthrie

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In 1996, Hillary Rubin was living her dream of working in New York's fashion industry, when a troubling numbness in her legs sent her to the doctor. A battery of tests led to a diagnosis of multiple sclerosis, an autoimmune disorder that can damage the central nervous system. The leading cause of disability among young adults, MS can impair balance, mobility, and even vision. The diagnosis led Rubin to begin looking for complementary therapies, including yoga, to support her health even before she began the drug therapy prescribed by her doctors.

Since those early days of anger and confusion, Rubin's yoga practice has allowed her to transcend the physical and psychological challenges of MS, which has no cure. Now a full-time certified Anusara Yoga teacher living in Los Angeles, Rubin, 37, is symptom free without medication. The numbness in her legs—at one point so severe she was fearful of collapsing—hasn't come back. Although she's used a variety of alternative modalities to corral her symptoms, including acupuncture and dietary changes, yoga has been her mainstay—the anchor that not only keeps her symptoms at bay but also helps her make peace with an uncertain future. "Thanks to yoga, I see the blessings in life's challenges," she says.

The War Within

Rubin is just one of 10 million Americans coping with an autoimmune disorder—an umbrella term for more than 80 conditions, including MS, rheumatoid arthritis, lupus, and Graves' disease. An autoimmune disease occurs when the immune system turns on the very thing it is designed to protect: the body. "The immune system misidentifies normal cells as invaders, but they're not," says Loren Fishman, MD, the co-author of Yoga and Multiple Sclerosis and a professor at Columbia University's College of Physicians and Surgeons. "These normal cells may be part of your joints, as in the case of rheumatoid arthritis; part of your connective tissue, such as in lupus; or part of your nerves, in MS."

Until about 50 years ago, the idea of the body attacking itself was considered ludicrous. "People didn't think it could happen, because the idea was so counterintuitive," says Noel Rose, MD, PhD, and director of the Center for Autoimmune Disease Research at Johns Hopkins University's Bloomberg School of Public Health and School of Medicine in Baltimore. "Now, of course, we realize that the immune system's ability to distinguish between what is self and what is not self is far from perfect."

Autoimmune disorders can be tricky to diagnose and onerous to treat. No part of the body is beyond their reach, from the skin to the joints to the blood. Typically, medical care falls to a physician trained to treat the organ in question (a dermatologist for psoriasis, for example, or a rheumatologist for rheumatoid arthritis). But autoimmune disorders often travel in twos and threes, attacking different organs and systems simultaneously, meaning that patients often see different specialists for treatment. This scattershot approach can fragment care and lower its quality. So a movement is under way among autoimmune experts to shift from a focus on each disorder's idiosyncrasies to a focus on their commonalities, says Rose. "We need to start thinking of autoimmune diseases as a single category, like cancer or infectious diseases."

Among autoimmune disorders' shared traits is a propensity to strike women more often than men. More than 75 percent of people with autoimmune disorders are female, making these diseases the third-leading cause of chronic illness among women in the United States. Why women are more vulnerable is not well understood, but some experts think the complexity of women's immune systems plays a role. A woman's body distinguishes "self" from "nonself" differently from the way a man's does because it's biologically designed to carry a baby. "Females are capable of a genetic feat that nothing else on Earth comes close to," says Fishman. "The immune system—so ready to attack outsiders—somehow leaves those embryonic cells alone."

Genes also play a role. Researchers have identified a cluster of genes that creates a predisposition for autoimmunity. Although genetic testing is available for a smattering of autoimmune disorders, its usefulness is debatable, since the mere presence of a gene doesn't mean it will ever activate a disease. Instead, a combination of genetic and environmental factors is needed to trigger the onset.

Tending to Body and Mind

Autoimmunity is a complex health issue, and treatment requires a nuanced approach coordinated by health care professionals. Although it is not a magic bullet, yoga can address some of the shared challenges, both physical and mental. According to Fishman, moderate exercise like yoga gives you a sense of calm and well-being that lowers the body's production of physical and mental stressors that compromise the immune system.

On a physical level, studies show that yoga stimulates the parasympathetic nervous system (the calming influence), which reduces the body's stress response. This can have a profound effect on the immune system. Furthermore, new studies show that moderate exercise can quell inflammation in the body, which is common with autoimmune disease. That's because the immune system sends out its army of white blood cells, but without a battle to fight, they inflame nearby tissue.

Still, reining in an autoimmune disease is hardly a simple matter of relaxing or getting regular exercise. Specialists do, however agree on one thing: Yoga can help ease the considerable psychological challenges of living with a chronic condition. "One of yoga's most important gifts is an inner connection to the reality that you are not your diagnosis," says Gary Kraftsow, founder and director of the American Viniyoga Institute. "People suffering from autoimmune disorders need to shift their fixation away from the body to something that is deeper, something that is unchanging. No matter whether you're happy or sad, in pain or not in pain, with or without a diagnosis, there is something unchanging in each of us, and that is fundamentally our awareness."

Kelly McGonigal, a health psychologist at Stanford University and the author of Yoga for Pain Relief, sees a need for a similar shift in her work with people dealing with autoimmune disorders. "A big part of yoga and meditation practice is learning how to choose the focus of your attention," she says. "Choosing what sensations in the body are worth attending to, and how to let go of the rest."

That was the case for Kate Porter. In 2000, pervasive pain rendered her unable to walk without support and kept her housebound for nearly four years. Eventually, the diagnosis was lupus, an autoimmune disorder characterized by an inflammation of the connective tissue. A mixture of pain relievers and anti-inflammatories got her back on her feet, but it wasn't until she discovered yoga that she made peace with her body. "Yoga helped me regain and maintain my health," she says. "But it also taught me to accept that sometimes I can only do a tiny bit of what I'd like to do, that ' perfect' is the very best you can do on a particular day." Today, Porter, 33, is a certified yoga instructor teaching a blend of hatha, vinyasa, and Iyengar yoga near her home in Singapore. She still has pain, which varies in intensity from week to week, and still takes pain relievers and anti-inflammatories, but she feels that her yoga practice is the best medicine. "Without exercise, my pain increases intensely and alarmingly quickly," she says. "What makes yoga ideal is the multitude of variations and modifications of poses that makes them accessible regardless of my body's restrictions."

Living in the Moment

Yoga's emphasis on being in the moment is especially helpful for people dealing with the ups and downs of living with an autoimmune disorder. "There are times when the symptoms are quite minimal," says McGonigal, "but there are other times when they clobber you. You have to adapt to both. Yoga is about learning how to be with your body and notice what it needs and is capable of in this moment. That process translates really well into learning how to manage a chronic illness."

Yoga's physical and mental benefits for autoimmunity were illustrated by a small study published in the medical journal Alternative Therapies. Twenty women with rheumatoid arthritis enrolled in the study. Half the women did nothing. The other half took a 10-week hatha yoga course. Those women met with an instructor three times a week for 75 minutes. Each class began with 5 minutes of breathing exercises, moved through a series of traditional asanas, and ended with a short meditation. After 10 weeks, the women in the yoga group not only reported better balance and functioning and less pain but also experienced less depression than those in the control group.

McGonigal wonders whether the women's mood improved because yoga helped them reconnect with their bodies in a meaningful way. "With autoimmune disorders, there can be a sense of betrayal, because the body is literally attacking itself," she says. "Learning how to relate to the body in a compassionate way can be very healing." Regardless of how the improvements came about, Pamela Bosch, the lead author and a professor of physical therapy at the Arizona School of Health Sciences, in Mesa, was pleased with the results of the study. "These were women who'd been battling their disease for 20-plus years, and within 10 weeks yoga made a huge difference in their day-to-day lives."

Rubin sees her yoga practice as a means to keep her well and healthy, whether it's her mind or her body or both that need attention. "My practice of meditation and yoga is a place where I get clear and heal," she says. "Just stopping in the midst of a practice to breathe and focus gets to the real part of what is happening for me. Yoga has given me a single-pointed awareness that I can come back to in any stressful situation, and that, for me, is the secret to staying balanced."

A Journey Back to Health

One woman's inspiring tale of healing.

Hillary Rubin discovered yoga in her chiropractor's office. That's where she first saw the book Light on Yoga, B. K. S. Iyengar's definitive text. As she turned the pages, gazing on the black-and-white photos of a young Iyengar twisted into seemingly impossible poses, she felt inexplicably drawn to the practice. With her curiosity sparked, she sought out her first yoga class. Her timing was fortuitous. A few months later, the complaint she'd presented to her chiropractor—a feeling of pins and needles in her feet—had spread to her left hand, arm, and chest. After seeking numerous medical opinions, she was diagnosed with multiple sclerosis. Only 24 years old, she spiraled into a black hole of denial, depression, and anger. "I was mad at God. I blamed everyone and, ultimately, myself," she says. "I felt like a failure." Yoga offered a tool by which she could find peace in her body.

Rubin sampled different teachers and styles before finding an instructor whose words sank into her psyche like fishhooks. "I would do two classes back to back and drink in the words from my teacher that reset the negative talk in my mind, which was causing more pain than any diagnosis could," she says. "Being told that I mattered in the world, that my expression made a difference, and that there was more to me than my diagnosis, inspired me to return to my mat again and again." She didn't know it at the time, but her teacher's heartfelt approach was grounded in the words, themes, and philosophy of Anusara, a style of yoga founded by John Friend.

During those early days, Rubin didn't let the numbness and tingling in her hands and feet keep her from doing yoga. Instead, she approached the mat with respect and an awareness of her limitations, such as needing to rest in Child's Pose if the room got too hot, and a willingness to excavate the emotions beneath her fear and sadness. "Yoga helped me realize I was feeling victimized by my diagnosis," she says. "I decided to turn the tables and take responsibility for my own health."

Rubin explored a bounty of complementary and alternative healing traditions, everything from Ayurveda to acupuncture to saying affirmations. Slowly, gradually, as she turned her attention inward, her symptoms retreated and she weaned herself from medication. Today, 14 years after her initial diagnosis, Rubin, now 38, is symptom and medication free, which isn't necessarily typical. She credits her paradigm shift from fear toward empowerment for reshaping her life. "Through yoga I've learned how to listen to my body and care for it with love and devotion," she says. "I tend to my body just like I would a vintage car. My breath is the fuel, and my practice is my tune-up."

Rubin reserves two hours each morning for self-care. During that time she may meditate, practice yoga (a mixture of restorative, therapeutic, and challenging asanas, depending on the day), take a hike, or write in her journal. "I may even sleep a little bit more," she says. "Some days are more energetic than others; I just listen and do what my body asks for."

Although she weaves many modalities into her healing, yoga is her foundation. "My asana practice opens up the energy flow in my body," she says. "It brings me insights, deepens my creativity, and sharpens my intuition. It makes me realize that being in my body is truly a gift."

Catherine Guthrie is a freelance writer and yoga instructor in Bloomington, Indiana.
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