Critical Appraisal of Medical Nutrition Therapy in Ayurveda for Diabetes Mellitus

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International Journal of Medical and Pharmaceutical Sciences

International Journal of Medical and Pharmaceutical Sciences (IJMPS) Vol 2 issue 2 www.ijmps.com

Page 6

IJMPS Vol 02 issue 02

Category: Review

Received on: 31/12/11

Revised on: 23/01/12

Accepted on: 10/02/12

ABSTRACT

Diabetes mellitus is a disease as old as humanity and is one of the major problems in clinical practice

even today. To tackle this disease, the physician should identify a target level of glycaemic control for

each patient and provide the patient with the educational and pharmacologic resources necessary to

achieve this level. The first line of therapy in a patient with suspected type 2 Diabetes involves advice

about dietary and life style modification. This can help achieve adequate glycaemic control in

approximately 50% of the patients; while anti diabetic drugs will be required in 20% to 30% and insulin

in the rest. Thus, patient education should be viewed as a continuing process with regular visits for

reinforcement. Amongst all the available therapies for diabetes mellitus, Ayurveda is the oldest.

Ayurvedic approach towards diabetes and all other diseases is that they are caused by doshic imbalance.

Still, the speciality in the management of Diabetes (prameha) through Ayurvedic approach is that it has

described the complete change of life style for the patients along with dietary modifications and drugs. In

Ayurveda, the management of any disease (including prameha) is based on the individuals constitution or

Prakriti and the line of treatment chosen according to the individuals strengths (bala) assessed by the

various parameters of rogi pariksha and the strength of the disease (roga bala). These points are analyzed

by observing the following various parameters such as Charakokta dashavidha pariksha, Sushrutokta

dwadashavidha pariksha etc to name a few i.e. prakriti, vikriti, satwa, satmya, ahara etc.. Based on these

factors, the management is individualized for each patient with drugs, diets and life style modification.

Thus, it is attributed the combined use of these three factors described in Ayurveda, will produce very

significant metabolic advantages for the prevention and treatment of diabetes and its complications.

CRITICAL APPRAISAL OF MEDICAL NUTRITION

THERAPY IN AYURVEDA FOR DIABETES MELLITUS

Gupta Archana, Byadgi P.S.

Department of Vikriti Vigyan, Faculty of Ayurveda, Institute of Medical

Sciences, Banaras Hindu University, Varanasi

Corresponding author E-mail: [email protected]





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Keywords – type 2 diabetes

(prameha/madhumeha), doshic imbalance,

fibric diet, life style modification, Yava,

Barley, amalaki, mudga

INTRODUCTION

The first line of therapy in a patient with

suspected type 2 Diabetes involves advice

about dietary and life style modification. This

can help achieve adequate glycaemic control

in approximately 50% of the patients; while

anti diabetic drugs will be required in 20% to

30% and insulin in the rest. Thus, patient

education should be viewed as a continuing

process with regular visits for reinforcement

(1)

.Thousands of years ago, Ayruveda hasdiscussed, about diabetes & clearly defined it.

DM was known to by the name Asrava

(Prameha)/Madhumeha, since Indian

civilization which started from Vedic period.

In spite of advances in modern sciences,

Diabetes has been a global problem. WHO

has projected that 346 million people

worldwide have diabetes. In 2004, an

estimated 3.4 million people died from

consequences of high blood sugar. More than80% of diabetes deaths occur in low- and

middle-income countries. Death due to

diabetes will double between 2005 and 2030.

Healthy diet, regular physical activity,

maintaining a normal body weight and

avoiding tobacco use can prevent or delay the

onset of type 2 diabetes (10). In Ayurveda,

madhumeha is also included as a Maharoga

(major disease) that means this disease affects

all parts of the body & the physiology of each

cell. It also disturbs five sheaths of the body-

annamaya kosha[Food sheath], pranamaya

kosha[Energy sheath], manomaya

sheath[Mind sheath], vijnana maya

kosha[Intellectual sheath], and anandamaya

kosha[Bliss sheath](3)

. In Ayruvedic texts, the

full description about Prameha has been

described by Charaka Samhita, Sushruta

Samhita, Astanga Sangraha & Hrudaya,

Hareeta Samhita. Prameha defined as a group

of Urinary disorders, which are characterized

by profuse urination with several abnormal

qualities. These are classified into twenty

types. According to the predominance of

doshas (three humours that governs the human

body), they are classified as follows: Vataja

Prameha – Four subtypes, Pittaja Prameha – six

subtypes, Kaphaja Prameha – ten subtypes. The

fundamental principal of Ayurveda states that

to keep the normal state of functioning of the

body, these three doshas (V, P, K) must be

present in a proper balance within the body. If

even one of doshas is vitiated, than it can lead

to diseases, and Prameha is one of them. In

Charaka Samhita, another classification of

Prameha has been described, as of 2 types:

Sahaja: due to genetic factors, can becompared with type 1 DM, mostly seen in lean

individuals and Apathya Nimittaja: due to

unwholesome diet & life style, can be

compared with type 2 DM, mostly seen in

obese individuals.

ETIO – PATHOGENESIS

The word Prameha refers to the dilution of

everything in the body, not only urine. The

two main cause of Prameha are lack of

exercise and excessive consumption of foodhaving Ushna, Snigdha & Guru Nature, that

increases Kapha, Medhas & Mootra, which are

the major factors for Prameha: Yashcha

kinchith vidhiranyepi sleshma medho moothra

samjananam sa sarva: nidana vishesha(4).

Diabetes, when considered according to

Ayurveda, is a kaphaja metabolic disorder in

which there is diminished functioning of agni

leading to a tendency toward high blood sugar.

Its unique assessments states that the disease

occurs when toxins get accumulated in the

tissues and causes circulation blockage. In

charaka samhita the causes of Prameha have

been described as follows: Asyasukham-

Svapnasukham dadini

Gramyaudakanooparsah payamsi

Navannapanam gudavaikrutamcha

pramehahetuh kaphakruccha sarvam(5) .

Asyasukha means happiness of tongue, i.e.

mostly eaten food is sweets, salty & sour in

taste. According to Ayurveda healthy food





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should contain all the six tastes viz: sweet

(madhura), sour (amla), salty (lavana), bitter

(tikta), pungent (katu), and astringent

(kashaya) But if only one taste like sweet is

prominent in the diet, it can increase kapha &

medas (fat) and causes prameha. The term

Swapnasukham refers to the day time sleeping

immediately after meals for more than 30 min

&sleeping more at night. It also means that not

living an active life with good amount of

exercise & sports. The type of food & drinks

likely to precipitate the prameha have been

mentioned in all the classical Ayurvedic texts

as everyday consuming yoghurt & other milk

products in large quantity; excessive use of the

meat of pig, fish, buffalo, beef ; Fresh grains(non-aged rice, millet, wheat etc); Fresh wine

(it causes heaviness & imbalances the

tridoshas whereas old wines promote

circulation in the body and increases

digestion). Hence, in this fast modern world,

most people do not bother about the specific

details for the consumption of new rice and

other cereals, with the result being the

increasing number of diabetics in the world. In

Ayurveda there is lot of information availableregarding the food materials. Traditionally,

people in the various part of world consumed

one year old grains and never consumed fresh

grains unless during drought. This was

because they were aware about the fact that it

predisposes them to prameha. The description

of this acquired form of prameha; refers to as

Apathyanimittaja prameha(6), which is very

similar to that of type 2 diabetes. Thus, we

found that these factors (dietary, life-style,

psychologic) which are briefly listed below are

responsible for the onset of prameha:-dietary

factors- excessive consumption of food that

are heavy to digest like cold, sweet, sour,

unctuous(oily), liquid & slimy foods; life style

factors – excessive sedentary life style,

excessive sleeping, sleeping during the day

time, leak of exercise & laziness; phychologic

factors – Excessive stress, disturbance in

mental health caused by extremes of phyche

such as depression (Vishada) and bipolar

disorders; Another important etiological factor

is related to the Prakriti of body, which is the

psychophysiologic constitution of an

individual & is determined at the time of birth

by the individuals dosha proportions. The

Prakriti of an individual plays an important

role in progression & prognosis of the diseases

and response to treatment. The doshic

manifestation of the disease process is also

affected with the predominant doshas in the

individual Prakriti. In a study conducted on

Prakriti & diabetes mellitus, it was

hypothesized that the progression of disease is

test in diabetic patients with kaphaja Prakriti

(i.e. Prakriti in which kapha dosha is the

dominant) and vataja Prakriti also has quick progression. These values are moderate in the

case of patients with pittaja Prakriti.

Ayurvedic Management of Diabetes

The drastic disease diabetes can be controlled

by giving comprehensive attention to 3

aspects. They are Ahara (Diet), Vihara (life

style modifications) and Aushadha (medicine).

The role of Ahara & Vihara are equally or

even more important in diabetes to control

blood sugar level as well as to preventcomplications of this disease. In a patient with

suspected type 2 diabetes mellitus, the first

line of therapy involves advice about dietary

& life style modifications. It has been

observed that exercising increased the bodies

sensitively to insulin, thus controlling blood

sugar elevations.

AHARA (DIET): - In a diabetic patient,

always a balanced diet should be maintained

and the intake of food products which are

having katu, tikta & kashaya tastes should be

increased because these are generally

considered good. A balanced diet which is

ideal for diabetes are low in fat, carbohydrates

and cholesterol. The foods having high

glycemic index like potatos, junk food like

pasta & while bread, which are rich in

carbohydrates, must be avoided because they

easily enter into the blood stream and get

converted to glucose very fast. The intake of

fast food, bakery items & calorie rich soft





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drinks give remarkable rise to blood glucose

level which stimulated the beta cells of

pancreas of secrete more insulin. As the

person ages, the capacity of production of

insulin comes down. Insulin resistance is

associated with dyslipidimias, obesity &

sedentary daily routine. A resistance to

insulins action lead to hyperglycemia &

associated symptoms. In an attempt to

overcome the resistance to insulin, the

pancreas is stimulated to release large amount

of insulin. As the person ages the islets of

langerhans cannot keep up pace with increased

insulin secretion and the person becomes

hyperglycemic. Hyperglycemia is itself toxic

to beta cells of pancreas which further reduceinsulin secretion. So in the diabetic patients

such diet is preferred which is having low

glycemic index. Person should try eating 4 – 5

small meals in a day rather than three large

meals and drink at least 8 glasses of water a

day to flush out those harmful toxins from the

body and to keep healthy. In all Ayurvedic

classics, the group of pathya Ahara dravyas are

described in detail & they cover all the food

group noted in the following table;Cereals – Yava, Barley {Chenopodium

Album}, Godhooma(Wheat), Shyamaka,

Kodrava, Bajara

Pulses – Mudga {Green gram}, Chanaka

{Gram}.

Vegetables – Tikta shakas, Methika,

Nimba{Azadirachta Indica},

Karavella{Momordica charantia}, Patola

{Trichosanthas Anguina}, Rasona{Garlic},

Udmbara{Ficus racemosa},Broccoli, Beans,

Asparagus, Green leafy vegetables.

Fruits – Jambu {Black berry}, Syzygium

cumini, Tala phala {Borassus flabellifer},

Kharjura {Phoenix sylvestris}, Kamala

{Nelumbo nucifera}, Utpala {Nymphoea

Stellata}, oranges, pears,apples.

Flesh – Harina – Deer flesh, Shashaka – Rabbit,

Birds like Kapotha, Titira

Liquor, Old sura {Old wine}.

Oils – Mustard, Ingudi {Balanitis aegypotiaca}.

Life Style Modifications (Vihara):- Life style

contributes a lot in health and disease. DM is a

disease which is positively interlinked with

lifestyle. A study shows that a person with

high levels of physical activity, a healthy diet,

no smoking habits , and alcohol consumption

in moderation had an 82% lower rate of

diabetes. Obesity & physical inactivity has

been found to contribute to approximately

55% of cases of type 2 diabetes. An Ancient

Indian life style consists different cultural and

religious activities and daily regimens

responsible for loss of extra calories taken by

an individual. In Sushruta Samhita(6)

, about

treatment it is written that a type 2 DM patient

should walk barefoot for 800 miles in a year(AV. 3.5 km/day) or do heavy work like

digging a well etc. Physical exercise results in

lightness in the body, stability of the organs,

increased pain endurance, balances the doshas

by normalizing the metabolism. Yogic

postures and Pranayama (breathing exercise)

also play an important role in control of DM.

Ayurvedic life style consists of various health

promoting & protective measures.

Maintenance of a healthy life by one’s ownright action is called “Swasthavritta” which

literally means” the regime of obideing in

one’s own nature”. According to Ayurveda

one should observe certain disciplines or

duties to achieve a healthy and happy life.

Some of them are – daily regimen

(Dinacharya), seasonal regims (ritucharya),

precautionary observance in sexual activity

(brahmacharya), rules of conduct for the

wellbeing of oneself and the society

(sadavritta), rules for taking food (ahara

vidhi), precautionary measures against

untimely old age (rasayana & vajikarana),

conduct & practice to achieve self realization

(naisthiki chikitsa). Ayurveda outlines

practices to be done on a daily basis as

indication of timely sleep & rise, regular light

exercise which makes the body proportionate

in shape & improves function of agni which is

responsible to balance the doshas of body.





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In this manner, Ayurveda is not only restricted

to drugs for the treatment of diabetes but takes

a much broader perspective.

Ausadha (Drugs): - In Ayurveda, herbs are

mentioned which help to control the increased

blood sugar include(7) – Amla(Phyllanthus

emblica), Triphala(Fruitsof haritaki, vibhitaki,

amalak), Asana(Pterocarpus marsupium),

Guduchi (Tinospora cardifolia),

Arjuna(Terminalia arjuna),

Methika(Trigonaella foenugraecum),

Haridra(Curcuma Longa), Khadira(Acacia

catechu), Musta(Cyperus rotendus),

Aristaka(Azadirachta indica),

Gokshura(Tribulus terrestris),

Saptarangi(Casearia esculenta), Karela(Momardica charantia),

Bhunimba(Andrographis paniculata),

Meshashrungi(Gymnema sylvestrae),

Jambu(Syzygum cumini), Daruharidra

(Berberis aristata), Mamajjaka(Enicostemma

littorale), Shilajith, Guggul etc. The various

combinations of these drugs are used for the

management of diabetes mellitus.

CONCLUSIONThe world health organization (WHO) states

that about 346 million people worldwide

suffer from diabetes. Ayurveda has a major

role to play in this scenario because it offers

natural remedies and treatments with no side

effects. The most common problem in a

diabetic patient is general body weakness and

a deterioration of the major organs as eyes,

kidneys etc. in due course of time inspite of

good glycaemic control by the modern

medicines. Ayurveda can have its role here,

because it has still not been assessed that what

effect do these Ayurvedic medicines and life

style management have an these long term

complications. Although studies have been

carried out on various Ayurvedic regimens for

the management of diabetes in different parts

of the country which have given very positive

results, no such long term study on incidence

of complications after Ayurvedic management

has been conducted but in the need of the

hour. It is further stressed here that Ayurveda

addresses the individual as a whole and its

management therapy is also based on the same

principle of overall improvement of the

individual. This is the reason why thousands

of years back they understood the implication

of lifestyle modification in this disease and

envisaged it along with ahara and aushadha.

This holistic approach of Ayurveda for the

management of Diabetes demonstrates the in

depth and scientific knowledge of this science

which should be practiced in the field to reap

benefits to large number of people suffering

from this dreaded disease.

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Medicine, edited by Nicki R. colledge,

Brain R. walker, Stuart H.Ralston;

Churchill Livingstone Elesevier; 21st

edition.

2. Ayurvedic Concept of Diabetes Mellitus

(www.diabetesmellitus-

information.com/Ayurveda-diabetes

mellitus.htm) 17 nov 2010

3.

Ayurvedic Management of DiabetesMellitus; Dr CS Krishna Kumar, Chief

Physician, Nagarjuna Ayurvedic Group,

Kalayanthani,Thodupuzha, email:

[email protected]:Dr K Krishnan

Namboodiri, Chief Physician, Nagarjuna

Ayurvedic Centre, Kalady, Okkal –

683550, email: [email protected] .

4. Byadgi P.S. Prameha, In

Parameswarappa’s Ayurvediya Vikriti-

Vijnana & Roga vijana, Volume 2,

Reprint. Varanasi, India: Chowkhamba

Prakasan; 2009; 355.

5. Agnivesha. Prameha chikitsa, In Acharya

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(Charaka and Dridhabala with

Chakrapani), Reprint. Varansi, India:

Chowkhamba Prakahsan; 2007; 242.

6. Sushruta. Pramehachikitsum, In

Ayurveda-Tattva Sandipika. Susruta

Samhita (by Kaviraja Ambikadutta

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Shastri), Reprint. Varanasi, India:

Chowkhamba Prakahsan; 2007; 62.

7. Diabetes Mellitus in Ayurveda, ancient

diagnostic methods, it’s treatment in

Ayurveda & lifestyle (ayurvedasara-dr

shivakumar

blog,,ayurvedasara.com/content)

8. American Journal of Clinical Nutrition,

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American Society for Clinical Nutrition

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10. Diabetes, World Health Organization

http://www.who.int/mediacentre/factsheets

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http://www.ajcn.org/misc/terms.shtml

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Critical Appraisal of Medical Nutrition Therapy in Ayurveda for Diabetes Mellitus

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