Is Shanka Prakshalana Safe?

I’ve been asked that question many times, and up until now Ive only been able to give an answer based on theory and on my professional and personal experience with this colon cleansing technique. (If youre not familiar with shanka prakshalana, see my explanation here.)

By theory, dangerous shifts in blood levels of sodium and potassium could result in serious health consequence. By professional and personal experience, I can say Ive never seen it happen, not in hundreds of trials. Of course, just because I havent seen it, that doesnt mean serious electrolyte shifts won’t occur depending on individual circumstances.

As a physician and a scientist, I’ve wished for a research study documenting the safety of shanka prakshalana, real data to support its safety and efficacy. This week I finally located just such as study, and I am happy to share it with you today.

In 1978, quite a long time ago, a physician on an Air Force Base in the Midwest of the United States, Colonel Clint Chambers, designed a study along with a Texas colleague of his, Gray Carter, to look at the ability of bowel irrigation with salt water to prepare the large intestine for colonoscopy or surgery. They werent yogis, at least as far as I know, and I dont imagine either of them had heard the term shanka prakshalana. They based their trial on the textbook theories of how the sodium ion of common table salt (sodium chloride) traverses the gut wall, and they were aware of two prior studies looking at a similar bowel prep tried due to the same deductive reasoning.

Twenty-three patients were cleansed with a physiological solution of salt water, the exact solution recommended for shanka prakshalana. Its the same 0.9% sodium chloride we put into the veins of dehydrated patients in the hospital, but it was administered either by mouth or by a tube into the stomach.

Electrolytes were measured prior to the ingestion of salt water and immediately thereafter. No significant shifts of sodium or potassium were observed.

Doctors judged the efficacy of warm salt water at thoroughly cleansing the colon. Most of the time they gave an excellent rating, and it was at least satisfactory 95% of the time for all patients in this study, inclusive of another set of 14 patients who were given a little potassium and bicarbonate in their salt solutions. That success rate parallels, or even exceeds, any modern pharmaceutical colon cleanse preparation for colonoscopy.

Dr. Chambers and Dr. Carters results are consistent with a previous study in 1976 in which 37 people were given a plain table salt solution as a colon cleansing preparation. After drinking four liters of physiological saline, none of the patients had significant electrolyte shifts. In 1975, Dr. Crapp (really, Im not making that up) and his colleagues successfully cleaned the colons of 47 people with physiological saline. They didnt report any electrolyte abnormalities either.

So why, you may be asking, if shanka prakshalana is such a safe and effective natural method of colon cleansing, did the medical establishment abandon it in favor of other solutions?

The doctors in the 1978 study gave up on asking the patients to drink salt water after a few of them had a difficult time with the taste and volume of liquid needed. It was too salty to enjoy, and it induced vomiting in two. Instead they moved to placement of a tube that is threaded up the nose, down the back of the throat, and then into the stomach with the liquid infused through it. For some reason, the patients apparently liked that better, although having a tube up your nose is not too fun either.

Subsequent studies revealed the dangers and side effects of nasogastric tube placement, and eventually the whole saline irrigation technique of bowel preparation was deemed intolerable by patients. A pharmaceutical company immediately stepped in to make a solution that works by the same physiological principles of the salt flush without the extreme salty taste. That solution, polyethylene glycol or PEG, is still used for colonoscopy preparations today. Marketing and patient satisfaction with PEG left simple saline flushes to disappear from the conversation. Shanka prakshalanas attempt to become mainstream was thwarted, and its trials have been buried in dusty journals from the 1970s.

So, I am happy to be able to say that shanka prakshalana is a safe method for colon cleansing for most people based both on my professional experience and on the scientific literature. I have never found a case report or study indicating otherwise. Still, a theoretical basis for injury exists, and susceptible people should either avoid its use or exercise extreme caution under the direction and care of their personal physician. Anyone with kidney disease, congestive heart failure, high blood pressure or taking medications for high blood pressure, ischemic heart disease, stomach ulcers or pregnancy is at a higher risk of complications.

Shanka prakshalana should never be done at home alone without at least one family member or buddy to keep an eye out, and the first experience should be done under the care and observation of an experienced practitioner.

If you want a safe and natural method of intestinal cleansing for colonoscopy, discuss salt water flushing with your doctor. Below are the scientific references for the articles mentioned above for you to share with your healthcare team.

References:

  1. Chambers CE, Carter HG. Saline lavage: a rapid, safe, effective method of whole-gut irrigation for bowel preparation. South Med J. 1978 Sep;71(9):1065-6. PDF (162 KB)
  2. Levy AG, Benson JW, Hewlett EL, Herdt JR, Doppman JL, Gordon RS Jr. Saline lavage: a rapid, effective, and acceptable method for cleansing the gastrointestinal tract.Gastroenterology. 1976 Feb;70(2):157-61.
  3. Crapp AR, Tillotson P, Powis SJ, Cooke WT, Alexander-Williams J. Preparation of the bowel by whole-gut irrigation. Lancet. 1975 Dec 20;2(7947):1239-40.

How to Lose Weight with Yoga

At the Yoga Institute in Mumbai, the city formerly and still defiantly called Bombay by many of its residents, I attended a seminar on Yoga for weight management.

The words of the current president, Dr. Jayadeva Yogendra, who is the son of the legendary founder, Shri Yogendra, reflect the inherent wisdom of the discipline.  “Yoga is another word for a way of living, where one gives as much importance to happiness and peace of mind as to one’s material comforts.”

It is through attending to one’s entire way of living, with patience and with hope, that we confront our desires for comfort foods and tame our minds’ tendency to convince us that we’re better off eating Doritos on the couch instead of taking a walk through the timber.

Our minds play a huge role in weight management.  We eat when we’re stressed.  Yoga lowers stress.

We eat for other reasons too and not always just because we’re hungry.  Why do we reach for that piece of chocolate cake after dinner when we’re already full?

Yoga quiets the mind and helps one to reflect with wisdom from a higher perspective, from the witness inside of us who watches everything we do and wants to help us make the best choices.

When it comes to food, Yoga lore makes it clear that the best choice is a wholesome vegetarian diet.  Eat lots of fruits and vegetables with whole grains.  The instructor for the day was emphatic about avoiding the five “whites.”  Eat no refined sugar, no refined white flour, no ghee (clarified butter), no cheese, and drink no milk.

Our attitude towards food should be one of reverence.  What we eat is an offering to the Divine, made at the temple of our bodies.   Keep a food diary of your offerings and reflect of what you’ve been feeding Spirit.

Of course, Yoga is a set of physical exercises as well.  Depending on what style of Yoga you choose, you can burn many calories or hardly any.  For the slower, more meditative styles of Hatha Yoga, the benefit comes from awakening the tissues with their stretch, increasing vitality and energy, and motivating one for more strenuous aerobic exercise.

And here’s one last tip from the teachers at the Yoga Institute.  Performing surya mudra helps to increase metabolism and thereby promotes weight loss.  Place the tip of the ring finger at the base of the thumb, hands resting on the knees or thighs, while sitting quietly with eyes closed for five to fifteen minutes.  According to them, this completes a circuit between the earth and fire energy channels, igniting and burning the elements.

Whether there is a subtle energy effect or not is unclear by western science standards, but for sure taking the time to quiet the mind just before eating will lead to the proper state to eat with reverence and awareness.  Or you can try it after the meal and before that piece of chocolate cake to reflect on whether you REALLY want it as a part of your body after that brief spot on your taste buds.

 

Fasting for Health

Since I last posted about the benefits of fasting for health, more supporting evidence has been found. As these four studies show, there seems to be something important happening when we go for a period of time without calories.

Fasting may lower the risk of heart disease. 200 patients undergoing a cardiac cath to get an angiographic image of the arteries of their heart were asked whether or not they fast occasionally. Those who said they did had a 58% lower risk of having blocked arteries than those who did not. Although this study, presented as an abstract at the recent American College of Cardiology meeting, doesnt prove cause and effect, its an interesting association that may be explained by changes in metabolism that occur with occasional fasting things like levels of growth hormone, an agent that gets released when theres little food intake. Growth hormone triggers the body to burn fat and protect muscle mass. Read about the study here.

Fasting protects the brain and spinal cord. In a model of spinal cord trauma that involves loss of function of the legs, eating every other day, whether initiated before or after injury, promotes re-growth of nerves and the recovery of movement. Simply restricting the usual calories eaten every day to 75% of usual does not have the same effect.  That means its not about the number of calories, its about giving your body a break from the constant ingestion of food. (Jeong MA et al. Intermittent fasting improves functional recovery after rat thoracic contusion spinal cord injury. J. Neurotrauma Mar;28(3):479-92, 2011.)

Fasting can slow aging and ward off dementia. In mice that are genetically programmed to have a shorter lifespan, fasting every other day corrected specific protein deficits in the brain. The replenished proteins are important contributors to brain cell survival and growth.  (Tajes M et al. Neuroprotective role of intermittent fasting in senescence-accelerated mice P8 (SAMP8). Exp Gerontol. Sep;45(9):702-10, 2010.)

Fasting doesn’t interfere with athletic performance. Lots of people around the world fast for religious or cultural reasons. During Ramadan, for example, people fast when the sun shines (often up to 18 hours) every day for one month. Studies of fasting athletes show little evidence of decreased performance. Any effects are quite small and may be related more to sleep deprivation since all eating must occur during night-time hours.  (Maughan RJ, Fallah J, and Coyle EF. The effects of fasting on metabolism and performance. Br J Sports Med. Jun;44(7):490-4, 2010.)

Fasting helps with weight loss. The latest review of existing evidence for the effects of intermittent fasting (IF) indicate it is just as effective as reducing the overall amount of calories eaten on a daily basis when it comes to losing weight. The great part about IF though is that on non-fasting days dieters eat whatever they want without restricting quantity and they dont lose lean muscle mass. That makes limiting calories a lot more enjoyable and healthy. (Varady KA. Intermittent versus daily calorie restriction: which diet regimen is more effective for weight loss? Obes Rev. 2011 Mar 17. doi: 10.1111/j.1467-789X.2011.00873.x.)

I’m a fan of intermittent fasting (IF). Every other evening eat an early dinner, between 5:00 and 6:00 in the evening, then skip breakfast in the morning, and eat lunch around noon. That makes for an 18-hour fast, essentially the window of time needed for our metabolic machinery to reset to maximum efficiency without detrimental effects. An IF schedule such as this fits with the advice of ancient Yoga gurus as written in the Gheranda Samhita.

Ways to deal with a lack of sleep

Before considering the many ways in which to deal with a lack of sleep, first note how this phenomenon expresses itself symptomatically. Also take into account its sources, as well as some of its consequences. These considerations will influence the various ways of dealing with sleep deprivation.

As far as the physical traces of sleeplessness are concerned, look at the skin underneath the eyes. Dark circles, swollen eye bags, thin lines and tiny wrinkles are evidence of it. A person who is not getting enough rest at night may behave in subtle ways like an intoxicated person the next day. Simple hand movements lack in ordinary dexterity. Speech becomes slurred or faltered. The ability to respond to events is retarded. In instances where this deficiency is prolonged, a person always looks tired. Other symptoms include vacant stares, looking vague and distracted, and lacking in concentration. Complaints of muscle and joint aches from constantly repositioning the body in an effort to fall asleep, are not uncommon.

Emotionally, sleep deprivation tends to show up as fatigue and overly fussiness. Mood swings and irritability are also manifested. A loss of interest in life can also be noted. A person may try to catch a nap at all sorts of odd hours during the day. An absence of mental lucidity may surface, as when person says or does incomprehensible things. Forgetting things that are ordinarily remembered is another symptom.

The problem and its symptoms feed into each other in a vicious cycle. Prolonged shortages of proper slumbering time can bring about states of depression. The latter compounds the problem and contributes to the failure to fall asleep. Depressive feelings in turn interferes with normal eating habits. Lacking the will to eat might make a person consume more liquids rich in caffeine or sugar. This does not reduce hunger, but makes the body even more alert, and hence less likely to come to rest. Weight gain or weight loss problems can result. Either a person up during the night consuming food, or is too exhausted to have a decent meal.

There are many reasons why some people go through periods of sleeplessness. External sources could relate to work or the immediate home environment. Being overworked might cause a person to be too tired to get some rest. A conflict ridden home environment producing lots of anxiety and excitement. This predisposes the body to become restless, and makes it harder to come to settle when it is needed. Personality dynamics might contribute to the problem. Short-tempered or highly strung individuals are likely to be more responsible for their own emotional upsets that results in sleeplessness. They might also be using medication to help settle their nerves. This could have adverse effects, however, one of which is sleeplessness.

Interpersonal problems at home or at work can generate high levels of anxiety and stress. If the mind cannot come to rest, the rest struggles to do likewise. When solutions to these problems do not seem immanent, especially where intimate relationships are concerned, sleep deficiency is likely to be more intense. Here the source of the troubles are close by, living and sleeping in the same environment. Not getting adequate slumber time makes an individual prone to feeling vulnerable and on edge, which in turn aggravates relationship conflicts.

The effects or circumstances of the immediate environment in which a person sleeps can result in a lack of decent rest. People who lay down in rooms or spaces that are lit, even slightly, takes longer to fall asleep. Alternatively, they tend to take longer to close their eyes, if at all. Here the normal association between darkness and rest are interrupted, triggering the mind and bodys resistance to sleep. Too much or high levels of noise in an environment where one works or lives can contribute to the issue. The usual silence unconsciously connected with falling asleep gets disrupted. This in turn interferes with sleeping patterns, and upsets the regular biological rhythm of the physical makeup. And of course, individuals may get angry and excited at this, which only exacerbates the problem.

On an interpersonal level, feeling tired and cranky all the time sours interactions with others. Intimate relationships can undergo significant strain when a partner experiences ongoing sleep problems. Afflicted partners may temporarily lose the desire for sexual intimacy, given the levels of exhaustion that inhabits the body. The issue is likely to affect workplace performance. This, in turn, may lead to undesirable relationships in the work environment. Sleep deprived sufferers simply do not have the energy or desire to engage in physically or mentally vigorous activities.

There are some immediate steps to take in securing an adequate nights rest. Get some exercise. It tires the body and makes it more susceptible to calm down. However, bear in mind that exercise also invigorates the body. So, doing this shortly before going to bed is not a smart idea. The body needs some time to return to a state of balance after being energized by exercise. Reading when in bed also helps, provided the subject matter is of the lighter variety. Relaxing in a warm bath tends to relax the muscles, especially after a busy day. If sleep does not come easy, or at all, avoid trying to get some during day. Try sticking to a schedule for going to bed and getting up. It teaches the body a waking and sleeping routine it can become familiar with.

Besides focusing on finding immediate answers to sleeplessness, also take a simultaneous long-range look at both the external and internal sources of the problem. Sometimes it is necessary and possible to make changes in what is generating undue anxiety. Consider altering how the body and mind process daily pockets of stress. For example, people who tend to personalize issues bring undue pressure on themselves. Another persons grumpiness might be due to their personality, and not because someone is responsible for it.

As a parting suggestion, try to stop the problem from getting out of hand. As soon as it makes an appearance, do not take it lightly. Go for medical or psychological help when getting adequate sleep becomes problematic. If not taken care of promptly, it can have adverse consequences for a persons health and well-being. 

How to recognize sleep deprivation symptoms

It is normally fairly easy to recognize sleep deprivation symptoms. Even though the advantage of getting a good night’s sleep are well known, we should also be aware of the the symptoms and consequences of a reduced amount of sleep. It is possible that sleep deprivation symptoms are not immediately obvious, so you should always bear in mind this possibility and look for more hidden signs. If you are not getting enough sleep, you are very likely to experience some, or even all of the following sleep deprivation symptoms.

Sources of sleep deprivation symptoms

There are various sleep deprivation symptoms that people with insufficient sleep may experience. But first, we should make the distinction between chronic and acute sleep deprivation. The chronic variety will occur after a longer period of time with insufficient sleep and is a lot harder to make up. Acute sleep deprivation will appear when you miss sleep for one night, but make it up over the next few nights. These two kinds will, naturally, have different sleep deprivation symptoms. It is not uncommon for people who systematically go without sufficient sleep, such as university students, to seek medical assistance in removing the consequences. Oftentimes it will happen that, after a long period with not enough sleep, the body will get into a state of constant blur, a kind of semi-awake state, which is only one of the common sleep deprivation symptoms.

Common sleep deprivation symptoms

Extensive research has been conducted in order to examine sleep deprivation symptoms. They have been made on subjects who were allowed to sleep only four hours a night, for a period of six nights. The results have been able to identify the most common among them. The sleep deprivation symptoms that were found are the following: the production of only one half of the normal amount of antibodies in the immune system, the rise of the level of stress-induced hormones, activation of the sympathetic nervous system, the rise of blood pressure and faster beating of the heart. These are common sleep deprivation symptoms, but there are others too: people may easily get irritated, they will often be moody, and may also lose their inhibitions. If these initial symptoms are ignored, apathy may ensue, as well as slower speech, weaker memory and reduced ability for multitasking.

Variations of sleep deprivation symptoms

Not all people will react in the same way to the lack of sleep and experience the same sleep deprivation symptoms as a consequence. Every person has different needs for sleep and different reactions to the lack of it. Some people can function normally with only four to six hours of sleep, while others will be incapacitated if they get less than ten. They may experience such sleep deprivation symptoms as arthritis and other conditions which affect the bone system and cause various kinds of pain. The symptoms in women may include significant hormonal shifts, especially the premenstrual syndrome, as well as complications during the pregnancy. The sleep deprivation in teenagers has been proven to be related to their use of drugs, alcohol and tobacco, even when other sleep deprivation symptoms, such as drowsiness, depression or attention problems were not present.

Types of Sleep Disorders

Sleep disorders have various causes. It cannot be overstated how important good night’s sleep is for a person’s health and overall well being. Sleep helps you organism repair and restore its regular functions. However, many people commonly experience various sleep disorders, which can have serious consequences for people’s health. In order to help them get more sleep, many people tend to use drugs, which, in turn, can have serious side-effects. On the other hand, natural medicine may offer less harmful alternatives, adjusted to people’s individual needs. Polls have shown that almost half of adults experience one or more symptoms of insomnia, one of the most common sleep disorders.

Symptoms of sleep disorders

Although recognizing sleep disorders is normally easy and intuitive, we bring some of the most common symptoms that should by all means be taken seriously if they appear. It is important to note here that simply not getting enough sleep does not necessarily mean you have a serious problem. Perhaps it would be good to monitor you sleeping habits and make sure you don’t confuse a temporary issue for a more serious sleep disorder. Some of the symptoms that should be considered are the following: a feeling of irritability during daytime, slower reactions than usual, frequent need for caffeine and/or caffeinated drinks in order to be able to function properly, experiencing difficulties in concentration, feeling tired or even falling asleep when driving, not easily keeping your emotions under control, etc. If you are experiencing some or even all of these symptoms, you may be suffering from one of the sleep disorders.

Common sleep disorders

There are various kinds of sleep disorders and some are more common than others. Unfortunately, physicians today normally don’t have a lot of (or any) training in recognizing such conditions, so they will often go unnoticed and undiagnosed. One of the most common sleep disorders is insomnia, which is a chronic condition in which the person suffering from it has difficulties falling asleep and/or staying asleep, with no other visible causes. Other frequently occurring disorders include: (1) bruxism – condition where a person’s teeth involuntarily grind or clench during sleep; (2) narcolepsy – manifests through excessive sleepiness during daytime, often with falling asleep not willingly and in inappropriate situations; (3) parasomnias – behaviours including unsuitable actions, such as sleep walking. There are many other sleep disorders, but these are most common and easily identifiable ones.

Curing sleep disorders

The easiest way of curing sleep disorders, which many people readily resort to, is taking sleeping pills. However, unless they are carefully prescribed by a competent doctor and taken with caution and according to the prescription, they may cause overdose or dangerous side effects. However, there are some very simple and easy steps you can take that can help you sleep and maybe even resolve some of the more mild sleep disorders: taking a warm bath just before going to sleep, stretching lightly or doing yoga before bedtime, not eating too late, reducing your intake of caffeine and alcohol and avoiding smoking, listening to soft, relaxing music before going to bed, and reserving your bedroom strictly for sleeping and intimacy. Keeping a healthy and relaxed lifestyle can generally reduce, or even remove your sleep disorders.

Identifying stages of sleep

Every good sleep necessarily occurs in five stages of sleep. In order to wake up fully rested and with enough energy to keep you active and productive during the day, you need to get well rested, ideally without disruptions and sudden waking up during the night. If your sleep times are too short, you may not go through all the stages of sleep. This may have consequences for your health because your body will not get enough rest and will not be able to function normally. It is immensely important to get a good night’s sleep because it has many benefits for your health. However, there are also some shorter kinds of sleep, which do not require going through all the stages of sleep because they have a slightly different purpose than “proper” sleep.

Descriptions of stages of sleep

Five stages of sleep have been identified. The first stage is light sleep, where it is possible to drift in and out of sleep and be easily woken up. People often have the feeling of falling during this stage. It usually lasts about five to ten minutes. The second stage takes up about half of the time you spend sleeping. In this stage, the brain activity level is reduced. In the third stage, deep sleep begins. In this stage, slower brain waves, the so-called delta waves, combine with faster waves. The fourth one of the stages of sleep is actually the second stage of deep sleep. The brain makes only delta waves in this stage and that is why people are not easily woken up in this stage. The last stage is known as REM (Rapid Eye Movement) and is the stage in which dreaming occurs. A person is most likely to sweat and breathe deeply and heavily during this stage. All of these stages of sleep in order to feel rested and full of energy.

Stages of sleep in power naps

Power naps work through fewer stages of sleep than “regular” sleeping. The main characteristic of power naps is that they bring maximum rest in a short period of time. Not all stages of sleep are necessary nor is there enough time for all of them to occur. Power naps typically include only the first two: the first stage includes lightly falling into sleep, where breathing slows down and there is some eye and jaw movement. In the second stage, body temperature lowers and muscles relax. Power naps will typically last for 15 to 30 minutes and not include the last three stages of sleep.

Sequence and significance of stages of sleep

Each one of the stages of sleep has its own importance. For example, stage two has enormous benefits for energy restoration and is most important for power naps. During the later stages of sleep, your brain activity will slow down and your muscles will relax. It is important to note that the stages do not appear in a linear way during sleep. When we go to sleep, the stages of sleep appear in a cyclical way – we go through stages 2, 3 and 4 a couple of time before going into REM, and afterwards we return into stage 2 before waking up.