EFFECTS OF LAUGHTER YOGA ON BLOOD GLUCOSE LEVEL IN TYPE 2 DIABETIC PATIENTS
Collection of Lectures (2nd International Congress of laughter; Laughter: Complementary Therapy, May 2012, Slovenia)
Asist. Miro ČOKOLIČ, MD, internist, Department of Internal Medicine, Division of Endocrinology, University clinical centre Maribor,
Dr. Špela STANGLER HERODEŽ, Assistant Professor, Laboratory of Medical genetics, University Medical Centre Maribor,
Simona STERNAD, RN, Department of Internal Medicine, Division of Endocrinology, University clinical centre Maribor
Simona KREBS, RN, International institute for laughter Maribor
Diabetes mellitus is associated with considerable morbidity and mortality of the elderly and is the most prevalent metabolic disease and is one of the significant medical and socio-economical problems all over the world. It is a chronic disease, which needs long clinical observation and constant adherence to medication. Negative emotions such as anxiety, fear, and sorrow are known to be factors that elevate the blood glucose level.
Conversely, positive emotions such as laughter have been reported to modify the levels of neuroendocrine factors involved in negative emotions and to modulate immune function. Our study elucidates the inhibitory effect of laughter on the increase in postprandial blood glucose and suggests the importance of daily opportunities for laughter in patients with diabetes. Laughter therapy can be used as non-pharmacological treatment for the prevention of diabetic microvascular complications.
Key words: laughter yoga, diabetes mellitus, postprandial blood glucose.
A long time ago wise men travelled through India. They usually teach, but instead, they spread laughter. They did not laugh, they laughed during their travels. At first, people observed and after that they started laughing, too. This way they learned about the importance of laughter. There are documents that state that the Greek hospitals were built near the theatres, so that the patients could hear the audience laugh and thus recovered faster. In the 13th century, there were some surgeons who used laughter to distract their patients from the pain caused by the procedure. The history of laughter has its ups and downs. In the 16th century the Puritans banned laughter, they even banned the smile. However, in the other part of the world Martin Luther used the »laughter therapy« for the depressed patients. He advised them not to isolate themselves, but to socialise with their friends, who like parties, make jokes and laugh with them. The idea of laughter yoga is based on the results of research, which proved that our body does not know the difference between the stimulated (fake) laughter or spontaneous laughter. The physiological and biochemical changes in the body are completely the same. In the 80’s, Hunter Doherty »Patch« Adams, the founder of Gesudetheit! Institut, came up with the idea to treat patients with humour, laughter and good mood. He is the initiator of the idea of Clown doctors, who treat in children’s sections. The idea spread all over the world. We have Red noses for this purpose. Norman Kazn wrote an article where he described the procedure of the treatment of his disease. The article was published in an English newspaper in 1976. He was suffering from severe pain and the doctors told him that the probability of healing is very small. He left the hospital and went home. He watched comedies like Candid Camera, Marx Brothers, etc. He realised that 10 minutes of good laugh gives him two hours of good night sleep. This became his daily routine and he repeated the technique until he completely recovered. After he got better, he was determined to bring love, faith, hope, joy and determination into his life as much as possible. In 1995, the Indian cardiologist Madan Kataria decided to bring laughter to humanity as close as possible. He founded Laughter Yoga School. Negative emotions, such as fear and sadness, are known causes for the increase of glucose in the blood . The positive emotions, like laughter, mitigate the neuroendocrine factors involved in negative emotions   and modulate immunity  . A study of the influence of laughter on the blood glucose level of diabetic patients was published in 2006. The study found a significant reduction of the increase of sugar levels after a meal. The cause could be the muscular work because of laughter. Counter regulatory hormones or neuroendocrine system   could also be the cause. Laughter yoga was as beneficial as exercises  in the case of older depressed women. The group, which practiced laughter yoga twice a week for twelve weeks, showed a lowering of blood pressure, reduction of the fat and regulation of level of the blood glucose. Therefore, the laughter yoga is recommended for the diabetics to better long-term regulation of glucose . The study, that took a long time, also found hormonal and genetic changes that have a positive effect on blood glucose levels   Humour also has a positive effect of post-stroke rehabilitation . The syncope is also described  in exaggerated laugher. The problems may arise with KOPB patients .
We created a questionnaire for the purpose of research which evaluated if the laughter yoga influences enthusiasm, positive attitude, better breathing, energy level, mood, ability to laugh for no reason, optimism, stress levels and physical and mental relaxation after the 30-minute workout. The study involved 69 participants, from which 34 were not involved in laughter yoga and 35 were involved. We kindly asked the participants to eat a lighter meal on a day of the research before 10 a.m. We have measured the level of blood glucose at the arrival and after that they are the standard brunch: 30 g black bread (1 PE), 150 g apples (1 PE), 15 g of butter (2.5 PE) and 200 ml of unsweetened tea, a total of 250 Kcal. 90-minute lecture was followed by a 30-minute intense workout. The lecture was intended for the ones who had laughter yoga included in the programme. We measured the level of blood glucose after the finish of workout (120 min). The control group consisted of participants who have only listened to a lecture, and in their case the postprandial (that is after eating a meal) rise in blood glucose level occurred, more specifically from 10.1 to 10.84 mmol/L.
30-minute workout had a positive influence on all the researched parameters and it also reduced the postprandial increase of the blood glucose level in smaller numbers (from 8, 95 to 8, 99 mmol/L). The average level of glucose in blood was not statistically significantly different between the two groups (8, 95 mmol/l in 10,1 mmol/l). After the meal, the participants of the control group had a statistically significant higher level of blood glucose level (10, 84 mmol/l) than the patients who experienced laughter yoga workout (8, 99 mmol/l; p = 0, 01). In particular, well-being, mood, optimism and enthusiasm were increased and improved. There was a slight decrease in the energy, but that is logical, since the laughter needs energy for the muscle workout.
The laughter yoga has proved to be an effective complementary and preventive therapy in reducing postprandial levels of blood glucose. Therefore, it contributes to long-term regulation of diabetes, type 2. Laughter is of preventive, psychological, physiological and therapeutic importance. However, it must be dealt by professionals  . It also has a beneficial influence on depression and insomnia. It is cheap, easily accessible and useful . Therefore, the laughter could be used as non-pharmacological treatment in preventing chronic micro vascular complications of diabetes .
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