Abstract
With the rise in diabetes, healthcare costs are exponential, and quality of life is diminishing. Finding a cost effective, low risk, self-care tool is key in reducing the negative byproducts of this disease. The purpose of this paper is to examine the relationship the ancient practice of qigong has with various symptoms and contributors to diabetes. In reviewing three literature reviews and four empirical studies, it is clear that qigong has benefits on insulin and glucose levels, and possibly weight, psychological wellbeing, and other health markers. Conclusively qigong and diabetes requires further research that yields more efficacious conclusions that the medical community can use.
Introduction
With a price tag of 245 billion dollars, the cost of diabetes is taking a toll not just on bank accounts, but is diminishing the quality of life for adults and children suffering from the disease. The American Diabetes Association reports that the largest medical costs are due to inpatient care and prescription medications to treat complications such as cardiovascular disease and depression (The Cost of Diabetes, n.d.). The need for diabetes patients to play a role in their own self-care is critical to treating this disease, however many diabetes patients struggle to engage in exercise which is a critical part of healing. Finding solutions that are realistic, affordable, and sustainable are critical to reducing the burden on society.
Diabetes is a growing issue not just in the United States, but across the globe. People with Type II diabetes are not properly managing insulin, resulting in imbalanced glucose levels (Type 2, n.d.) that can be managed with weight loss, stress management, improved blood pressure, and improved lipid metabolism (Fardet & Boirie, 2013). With no effective cure from conventional medicine, turning to the practice of qigong and tai chi within Traditional Chinese Medicine is a plausibly effective, economical, and low risk method of beneficially treating diabetic populations. Unlike conventional medicine, which seeks to treat acute symptoms, qigong is a multilayered practice that can impact both the physiological and psychological contributors and symptoms of the disease.
Research Question
This paper provides an overview of the available research on how qigong or tai chi can positively impact the imbalances that contribute to diabetes as well as the symptoms of patients with diabetes.
· Is qigong/tai chi beneficial in the treatment of obesity and diabetics?
Premise of Qi Gong in Traditional Chinese Medicine
Traditional Chinese Medicine (TCM) seeks health and well being through keeping energy, or qi, free-flowing throughout the body. Disease, or dis-ease is caused when the energy is stuck or blocked (Chen, Tianjun, Haibo, and Zhongpeng, 2009). Within the TCM system there are various healing practices that promote the flow of qi. Acupuncture being one of the most accepted forms of TCM practices in the United States, is a way of promoting the flow of energy and releasing stagnation in the energy pathways to increase wellness (Kawakita and Okada, 2014). Acupuncture requires a trained practitioner to apply the needles, making it a somewhat passive form of healing.
Self-care being one of the core principals of New Medicine highlights the importance of the individual being able to take action on their own to manage personal well being and chronic illness (Gordon, 1990). Qigong is the quintessential self-care practice as it can be done individually or in groups, is gentle, and costs very little. Qigong is the foundation of tai chi and both practices help the body balance through “psychosomatic maneuvering techniques or skill that integrate breathing, mind, and body posture into oneness” (Chen et al, 2009). The practices are intended to unify the mind, body and spirit through “cultivating energy” in circular, unforced relaxed movements (Horowitz, 2014).
Liu, Miller, and Brown (2009) suggest that for a population that is hesitant to exercise, qigong is a less intimidating method of movement than Western forms. Additionally, “qigong activates large muscle groups, which is likely to enhance glucose disposal and it has strong focus on relaxation and controlled breathing which may have important effects in terms of stress reduction” (p.432). Many of the studies to be discussed in this paper find that even if other measures are inconclusive, glucose levels are consistently improved with a qigong intervention.
Traditional Chinese Medicine and Diabetes
Chen, et al, (2009) describes how TCM’s perspective on diabetes provides a framework for the justification of qigong’s ability to treat the disease. Diabetes is considered a result of qi imbalance in an internal subsystem and different blockages produce different symptoms. There are three distinct imbalanced organs of the body that correlate with onset diabetes: (1) Too much fire in the lung, which causes thirst, frequent urination, and negative moods. (2) Too much fire in the stomach from a high fat, high sugar diet which causes weight loss and food cravings. (3) Weak kidneys, which depletes the body of essential fluids, energy and results in waist pain, leg pain, waning vision, and memory loss. According to TCM, the qigong therapy must be aimed at the specific sites that originate the disease so that it can be restored, allowing qi to flow freely so as to cure or prevent further illness. Oftentimes TCM accompanies qigong therapy with external therapies such as herbs and acupuncture (Chen et al, 2009), however this paper will solely focus on the impact qigong and tai chi therapy has on diabetes.
Methods
Articles reviewed were found using electronic searches in Google scholar, CINHAL, Mary Ann Liebert, and Science Direct. The search terms used included: diabetes, type II diabetes, obesity, qigong, tai chi, insulin, and Traditional Chinese Medicine. The literature spans from 2007 to 2014 and includes empirical studies that relate to the impact of qigong or tai chi on diabetes, as well as three reviews of the role of qigong on the health of diabetic patients.
A Look into Published Reviews: Cautious Optimism
The table below summarizes the findings from literature reviews completed between 2007-2013 on qigong’s impact on diabetes. The commonality amongst the reviews is that it that a qigong intervention can have an impact on metabolic symptoms, but because of the limitations of the studies, it is hard to draw firm conclusions.
Chen et al (2009) conducted the most extensive review by reviewing three types of studies: qigong as self-practice, qigong plus external qigong, and qigong with other TCM therapies. For the sake of consistency in this paper, the first scenario is most relevant. In the review of qigong as self-care, the authors examine 17 studies and provide hopeful data for people seeking relief from metabolic symptoms in diabetics, namely improved insulin levels, glucose levels, cholesterol, and triglycerides. One study indicated 3 months of intense qigong practice could alleviate symptoms in 95% of patients, and 76% in another study. The authors also found that in two longitudinal studies with two-year follow-ups, 16 out of 52 patients were completely cured. The studies reviewed arguably have no clinical validity because of a lack of control groups and randomization, however they do have positive implications. The authors suggest that with the findings, an ongoing qigong practice is important to for diabetics to maintain health long-term.
In another literature review of qigong and its affect on diabetes, Freire and Alves (2013), have similar findings to Chen et al (2009). Unlike the previous review discussed, the authors were limited to English written journal articles. Considering the origin of qigong, it is not surprising that much of the literature is written in Chinese. Despite their limiting criteria, the authors reviewed five articles, not all with randomized control trials, and found that plasma glucose levels improved after qigong therapy intervention. Even more promising is that in one randomized control trial, improved glucose levels were greater in qigong groups than in other exercise intervention groups. The authors point out that the existing data is hopeful but not significant enough to make any strong claims. There is enough reason to conduct larger, longer, randomized control trials to truly understand in what capacity qigong can help diabetics.
In the third literature review, Liu, Miller, and Brown (2007) reached similar conclusions as the previous authors discussed above. “Although qigong has beneficial effects on some of the metabolic risk factors for type 2 diabetes, methodological limitations make it difficult to draw firm conclusions about the benefits reported” (p.427). In 2011, Liu and his colleges responded to this need by conducting a randomized controlled study looking at how qigong can help control diabetes (to be discussed further below). Liu, Miller and Brown’s (2007) review is the first to asses both Chinese and English language studies, revealing again, the most consistent finding is that blood glucose levels improve with a qigong intervention.
Review of Empirical Studies
The table below summarizes four studies that looked at various components of diabetes. Three of the studies investigate physiological diabetic symptoms and how they are impacted by qigong and one measured the psychological effects that qigong has on the diabetic patient. That the studies, with the exception of Gates and Mick (2010) were set up as randomized control trials, provides the medical community with methodologically sound results that had been missing in the years leading up to these studies.
Qigong’s Impact on Insulin and Glucose Levels
Qigong utilizes large muscle groups that promote an uptake of glucose in the muscles, lowering the levels in the blood. Liu, Miller, Burton, Chang, and Brown (2011) conducted a randomized control trial with 41 participants with elevated glucose levels. They found favorable and significant results in the qigong group over the usual medical care control group. This finding suggests that qigong is activating more use of muscles than the traditional methods of diabetes management. Gates and Mick (2010) cited a pilot study by Liu et al as reason to believe that qigong could improve glucose and insulin levels in rural women suffering from type II diabetes, however their findings demonstrate no immediate improvement on these values. Gates and Mick’s study only had 10 participants, lacked a control group or consistency in how many sessions of qigong were conducted.
Qigong’s Impact on Weight, Strength, and Waist Circumference
Considering how important weight loss and muscle development are for the improvement of type II diabetes, it is surprising that only one study yielded in the literature search measured weight, strength and waist circumference. Liu et al (2011) used a linear regression analyses to show that significant differences exists between the qigong and the control group, in favor of the qigong group. The measured improvements are body weight (p<.01), waist circumference (p<.01) and leg strength (p<.01). Weight loss and muscle use is associated with improvements in insulin resistance, which begs to ask the question if the weight loss or the practice of qigong itself is the mechanism that improves the insulin and glucose levels of diabetics.
Qigong’s Impact on Cholesterol Levels
Despite the limitations of Gates and Mick’s (2010) study, they do cite that participant’s HDL levels decreased and LDL increased, indicating that qigong, (or perhaps simply being enrolled in a study), could improve cholesterol levels in diabetics. Lam, Dennis, and Diamond (2008) looked at the effectiveness of tai chi on 53 patients in a randomized control trial and found that while there are improvements in cholesterol levels from baseline measurements, there are no statistically significant difference between the tai chi and the wait list group.
Qigong’s Impact on Stress, Depression, and Healthiness
The most significant finding from Gates and Mick (2010) is the improved score on perceived healthiness of the participants. Using the Leddy Healthiness Scale (LHS), the researchers measured perceived personal involvement and ability to create healthy changes needed for improved well-being. The pre to post-test scores on the small number of participants are near statistical significance, which implies that qigong can trigger a patient to engage in the many lifestyle changes needed to manage or cure diabetes. Perhaps this explains why cholesterol levels may decrease; a cascade of healthy behaviors such as cooking at home, reducing fast food, etc., following a qigong or tai chi practice lead to improved HDL and LDL levels.
Putiri, Lovejoy, Gillham, Sasagaw, Bradley, and Sun (2012) conducted a randomized controlled trial assessing the impact qigong has on depression and stress in diabetics. The study found that compared to a progressive resistance training group (PRT), the qigong group decreased their perceived stress scores by 29.4% and depression score by 14.3%, versus 18.6% and 50% in the PRT group, respectively. The standard care group had no changes in their scores. For the purpose of this paper, the interesting data lies in the statistically significant reduction of stress over the other groups. There are multiple potential factors that play a role in reducing stress. One possibility is in Gates and Mick’s (2010) findings that patient’s increase in perceived healthiness contributes to decreasing stress. Another possibility is that the design of the qigong moves are promoting self-awareness and harmonizing the mind and body parts that need attention through “liver-excess-energy-releasing exercise; a pancreas-empowering exercise; and a liver and pancreas-harmonizing exercise” (Putiri et al, 2012, p.31). Understanding why the reduction in depression was significant in the PRT group over the qigong group would be worth future inquiry.
Conclusion
As a mind-body practitioner, qigong therapy has a hopeful and useful place in diabetes treatment, even with the limited existing literature. The studies are small, but the more recent trials are randomized offering data that is clinically significant. Considering that qigong is not invasive, with little to no downside other than time invested, a qigong intervention is recommended for type II diabetics, especially with the sedentary and older population.
In examining the existing reviews and studies of qigong’s impact on type II diabetes, the potential mechanisms or reasons why patients experience weight loss, reduced stress, depression, cholesterol and glucose levels seem to be multifactorial and difficult to prove in a randomized control study. The existing literature points to the biochemical metabolic changes that happen as muscle groups are engaged, but without bigger studies that examine weight loss, and take into account medications, it is hard to decipher if improved metabolic symptoms, stress and depression levels are a result of moving from a sedentary state to movement, or because of the actual design of qigong, or something else in the patient’s lifestyle.
Additionally, it is not clear if the specific sequence, duration and intensity of the practice are a variable in yielding positive results. What is known is that qigong has been practiced for thousands of years in the East and is part of a holistic system that seeks to balance the flow of energy through the body and mind in a way that pharmaceuticals do not. As the body of research grows and improves hopefully conventional medicine will begin to prescribe qigong sequences that are advantageous for people suffering from diabetes.
References
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Gates, D., Mick, D. (2010). Qigong: an innovative intervention for rural women at risk for type 2 diabetes. Holistic Nursing Practice, 24(6), 345-354. doi:10.1097/HNP.0b013e3181fbb832
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