Promoting Personalized Medicine through Yoga-Based Lifestyle

Personalized medicine is an emerging field of thought which considers therapeutic approaches based on individual characteristics to achieve precise clinical outcomes.[1] The modern medical system is driven and supported by the pharmaceutical approach, which aims at generalizing the results of clinical studies conducted on a population sample. However, attempts are being made to recognize individual biological differences to develop customized treatment protocols to achieve desired clinical outcomes and minimize probable failures.

Precision medicine is a similar terminology that explores the unique mechanisms that determine diseases and the most appropriate strategies to prevent and cure them, considering each human being unique.[2] Unfortunately, the premise within which precision medicine is getting developed is limited as it is based on the modern medical understanding of human biology. In contrast, traditional medical understanding is much deeper and more personalized.

Considering the advancement in medical research, the World Health Organization aimed to achieve health for all by 2000. Although the focus was on making primary health care accessible to everyone, the surge in noncommunicable diseases (NCDs) changed the policymakers' perception of embracing integrative medicine as the future of the health-care delivery system. Today, NCDs are considered the most feared health condition (responsible for 71% of all deaths) and the main threat to the sustainability of health systems.[3]

Yoga-based lifestyle acts as a common denominator for both modern and traditional medicine as it bridges the concepts of lifestyle medicine of the modern day and holistic medicine of ancient times to provide the most comprehensive approach to understanding health and disease and their management. The key differentiator between traditional medicine and modern medicine is the specialized approach used to treat an individual based on personalized indicators, which are not only physical but also psychological in nature.

Yoga is commonly referred to as an ancient Indian tradition and science. Sage Patanjali, through his Yoga sutras, proposed a systematic and progressive approach for an individual's evolution from the grosser to subtle planes of being.[4] The process starts with basic tenets of ethical and moral code of conduct (Yamas and Niyamas) which plays a significant role today in nurturing an individual's lifestyle. Hence, the techniques include most gross to subtle, ranging from physical postures to meditation. However, in recent years, Yoga has become synonymous with physical postures and their variations. Hence, either postures or meditation dominates yoga sessions the world over.

The classical approach, as described by Swami Vivekananda, provides four different methods (Raja Yoga, Bhakthi Yoga, Karma Yoga and Jnana Yoga) to reach the same goal, which is self-realization. He said, “Use any one or all of them.” Unfortunately, the terminologies taken from classical texts, such as Astanga Yoga and Hatha Yoga, have been misrepresented recently, with significant emphasis on asanas. This asana-centric approach has resulted in students and practitioners being deprived of the more extensive benefits of Yoga, which aims at attaining balance in physical, mental, emotional, and spiritual planes of being. Hence, it is essential to incorporate the basic principles and techniques of Yoga which aims at disciplining and reforming an individual's lifestyle while developing a curriculum for educational programs and therapeutic modules for disease management and used as a basis for research and development.

Due to the lack of regulations and standards in Yoga training and the available freedom for the teachers and therapists to design such training protocols, the participants are deprived of appropriate Yoga practices which are conventionally rooted and scientifically validated.

Multiple factors can be considered while designing personalized Yoga programs in health and disease. In the case of healthy individuals, the factors include: (i) age and gender, (ii) personality types, (iii) body constitution, and (iv) individual goals. Whereas in individuals with health problems, the factors include: (i) personality types, (ii) body constitution, (iii) severity of disease, (iv) existing comorbid conditions, and (v) contraindications and limitations.

While several factors mentioned above are self-explanatory, the two eastern concepts (Gunas and Prakriti) are briefly described to illustrate their importance in personalized diagnosis and treatment. Based on the philosophy of Yoga, Individuals are classified into three categories based on their Gunas (personality types). The three qualities/tendencies, i.e., Satvik (balanced), Tamasik (inertia), and Rajasik (activity), which are present in different combinations, determine an individual's dominant personality. These, in general, are considered functional entities (states), which can become inherent qualities (states) and subsequently convert them into an individual's identity based on the dominant quality.[4]

Similarly, Ayurveda classifies an individual based on Prakriti (body constitution). The three body humors, i.e., Vata, Pitta, and Kapha, are present in different permutations and combinations, resulting in one being dominant (pravara), one moderate (madhyama), and the other least (avara).[5] This classification also utilizes other factors such as Gunas (mentioned above) and Panchamahabhutas (five elements, i.e., earth, water, air, fire, and ether) to derive an individual's Prakriti.

Hence, it is essential to consider both Gunas and Prakriti of an individual, irrespective of the situation (health and disease), to personalize their Yoga practice for aiming at desired benefits.

Gunas and Prakriti directly impact the four cardinal verticals of lifestyle, i.e., physical exercise, diet, habits (including sleep), and mental stress. Yoga-based lifestyle caters to each one of these verticals and utilizes various techniques to re-establish a healthy lifestyle. An individual's uniqueness shall be considered an opportunity while developing Yoga protocols. Integrating the modern medical knowledge of genotyping and phenotyping with the traditional medical principles of Prakriti and Gunas is essential before identifying lifestyle measures to manage NCDs. The same is true in managing various chronic diseases, including cancer.

Hence, personalized medicine plays a vital role in both health and disease. This new approach also raises several questions on the current gold standards of research methodology used in clinical trials, which promotes generalizability but not personalizability. Hence, there is a need for a paradigm shift in comprehensively understanding a human being integrating the best of the east (ancient traditional knowledge base) with the best of the west (modern scientific research) with novel methodologies.