Role of diet and lifestyle in the management of Madhumeha (Diabetes Mellitus).

From ancient to modern times, the perspective to visualize the management of Madhumeha (DM) has shifted from holistic to drug oriented. Therefore, until a few years ago, the revival of the holistic approach, the Ayurvedic diet, and lifestyle were not being much focused. This research work was planned to evaluate the extra effects of Ayurvedic Ahara and Vihara in the management of Madhumeha and to project them socially. A total of 30 patients were selected and divided into two groups. Group A was treated with Ayurvedic Ahara and Vihara with Varadi Kwatha and group B was treated with only Varadi Kwatha for 8 weeks. The study showed highly significant results in most of the parameters in both the groups. However, further trials with increased number of patients are needed to support the current observations.

Introduction

Since a long time, Ayurveda has been emphasizing more on the importance of diet and lifestyle in the maintenance of health, according to which a healthy man is referred as “he who indulges daily in healthy diet and lifestyle activities, who discriminates between wholesome and unwholesome and acts accordingly, who is not attached too much to the worldly affairs, who develops the habit of charity, considering all as equal, is truthful, pardoning, and keeping company of good persons becomes free from diseases.”[1]

It is also said that in both the conditions, viz. health and disease, the wholesomeness and the unwholesomeness is a prime factor to be thought about, as without proper diet, the use of any drug is futile.[2]

As said earlier, the consideration of Ayurveda with lifestyle also has to be given due emphasis for the maintenance of the standards of health. In this segment, the entrainment and entertainment of the mind also plays a vital role, as no human activity takes place without the indulgence and proper setting of the mind. Hence, the planning of lifestyle in accordance with the day-to-day requirement of a person by giving due importance to the entrainment and entertainment of the mind is quite crucial.

Reviewing the current practices of diet and lifestyle including the mode of food preparation, raw materials, food combinations and food timings, timings of work and rest, types of work, the modes of entertainment and recreation, surrounding environment, Yoga such as Asanas (postures), Pranayama (bioenergy boosting techniques), Surya Namaskara (sun salutation), Agnisara (bioenergy detoxification), prayer, etc., is really in a state where it is very essential to focus if the tranquility, sanctity, and fruitfulness of human life is to be maintained.

Amongst the many dreadful conditions arising because of modern-day living, Diabetes Mellitus (DM) is a giant disease considered as one of the archenemies of the humankind caused by improper diet and lifestyle. It is often referred to as a “silent killer.” Diabetes and its complications pose a major threat to public health resources throughout the world. Looking at its gravity, the World Health Organization (WHO)[3] has taken up a close vigilance and survey about this problem the world over.

The WHO's statement on primary health care program states that there is a “collective failure to deliver in line with these values which is painful and deserves our greatest attention.”[4] Also, there is “an inability of health services to deliver the level of national coverage that meets the stated demand and changing needs.”[5] This scientific holistic work inspired from Ayurveda with a special focus on diet and lifestyle [Table 1] can seriously contribute into the DM management and primary health care program.

Table 1

Special plan of Ayurvedic diet and lifestyle

Taking these facts into consideration, the present study was undertaken to evaluate the effect of Ayurvedic diet and lifestyle with Varadi Kwatha in Madhumeha (DM).

Materials and Methods

Patients

For the present study, 30 diagnosed patients of Madhumeha (DM type 2) from the Outdoor Patient Department of Basic Principles, Institute for Post Graduate Teaching and Research in Ayurveda, Jamnagar were registered on the basis of signs and symptoms of Madhumeha as per Ayurvedic classics and modern medicine.

Inclusion criteria

Patients of either sex in the age group of 30-65 years

Both obese and non-obese patients

Patients showing classical signs and symptoms of Madhumeha as below were included in the study.

Prabhuta Mutrata, Avila Mutrata,[6] Pipasadhikya,[7] Alasya with Utsahahani,[8] Kshudhadhikya/Mahashanama,[9] Pindikodveshthana,[7] Karapadatala Daha,[10] Karapadatala Suptata,[8] Swedadhikya,[11] Gala Talu Shosha,[8] Daurbalya,[12] Shrama Shwasa,[11] Shula, Alasya/Utsahahani,[10] Klaibya,[11] Nidradhikya and Purishabadhdhata.[13]

Criteria for diagnosis of DM by American Diabetic Association:[14]

Patients having random blood sugar level >200 mg/dl or

Fasting blood sugar (FBS) >126 mg/dl up to 375 mg/dl or

Postprandial blood sugar (PPBS) >200 mg/dl up to 500 mg/dl.

Exclusion criteria

Patients with juvenile diabetes

Patients less than 30 years and more than 65 years

Emergency cases in DM

Patients having insulin-dependent DM (IDDM) and receiving insulin (type 1)

Excessive blood glucose: FBS > 375 mg/dl and PPBS > 500 mg/dl

Chronic complications (microvascular and macrovascular).

Grouping

The registered 30 patients were divided into two groups:

Group A – Ayurvedic diet and lifestyle + Varadi Kwatha (n = 6)

Group B – Varadi Kwatha (n = 24).

Posology

Group A

Patients in group A were treated with Varadi Kwatha[15] [Table 2] and instructed to follow diet and lifestyle plan as provided in Table 1. Varadi Kwatha (decoction) was administered in a dose of 24 ml twice a day in the morning and evening on empty stomach (before food) for 8 weeks.

Table 2

Ingredients of Varadi Kwatha

Group B

Patients in group B were treated only with Varadi Kwatha. It was administered in a dose of 24 ml twice a day in the morning and evening on empty stomach (before food) for 8 weeks.

Criteria for assessment

Objective parameters

The following parameters were assessed objectively:

FBS level, PPBS level, fasting urine sugar, serum triglyceride, serum cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL), very low density lipoprotein (VLDL), serum creatinine, and HbA1c

Subjective parameters

Assessment of overall effect of therapy:

Observations

Among the registered patients, 100% were married, 90% were vegetarians, 70% were above the age of 50 years, and 73% belonged to middle socio-economic class. In dietary habits, 83.33% patients were indulging in milk products, 73.33% were taking Guru Ahara, and 70% were taking Madhura Rasatmaka Ahara. 86.67% of the patients were having Chinta (worry), 73.33% were doing Shayya Swapna Prasanga (comfortable sitting and rest), 83.33% were not doing Vyayama (no exercises), and 80% were doing Divaswapna (day sleep).

Pipasadhikya was seen in 70% of the patients, Daurbalya in 86.67%, Prabhuta Mutrata in 73.33%, and Klaibya in 86.67% of patients.

Results

Effect of therapies on subjective parameters

Prabhuta Mutrata was relieved in 100% of patients in group A and 81% in group B. Avila Mutrata was relieved in 100% of group A patients and 86% of group B patients. Relief in Kshudhadhikya was seen in 100% in both the groups. Relief in Karapadatala Daha and Karapadatala Suptata was seen in 75% patients of group A and 81% patients of group B. In Swedadhikya, there was a relief of 75% in group A and 86.65% in group B; in Galatalushosha, a relief of 100% was observed in group A and 76% in group B; in Daurbalya, it was 86% in group A and 78% in group B, whereas in Pindikovestana, it was seen in 75% of group A and 71% of group B. In Pipasadhikya, 100% relief was seen in group A and 84% in group B; in Shula, it was 100% in group A and 74% in group B; in Klaibya, it was 90% in group A and 76% in group B; in Nidradhikya, 86% relief was observed in group B; and in Purishabadhdhata, 100% relief was seen in both the groups [Tables 3 and 4].

Table 3

Effect of therapy on symptoms of Madhumeha in Group A

Table 4

Effect of therapy on symptoms of Madhumeha in group B

In group A, statistically highly significant results were observed in Prabhuta Mutrata (P < 0.001) and Klaibya (P < 0.01), while significant results (P < 0.05) were observed in Pipasadhikya, Kshudhadhikya/Mahashanama, Abhyavaran Shakti, Gala Talu Shosha, Daurbalya, Shrama Shwasa, Shula, Alasya/Utsahahani, and Purishabaddhata [Table 3].

The effect of Varadi Kwatha in patients of group B was found to be statistically highly significant in Prabhuta Mutrata, Avila Mutrata, Pipasadhikya, Pindikoveshtena, Karapadatala Daha, Karapadatala Suptata, Swedadhikya, Galatalushosha, Daurbalya, Shrama Shwasa, Shula, Alasya/Utsahahani, Klaibya, Nidradhikya, and Purishabaddhata [Table 4].

Effect of therapies on objective parameters

In group A, statistically significant (P < 0.05) results were observed in FBS, PPBS, fasting urine sugar, HDL cholesterol, and HbA1c, while insignificant results were observed in serum triglyceride, serum cholesterol, serum creatinine, LDL, and VLDL [Table 5].

Table 5

Effect of therapy on biochemical parameters in group A

In group B, highly significant results were obtained in FBS (P < 0.001) and PPBS (P < 0.01). Significant results (P < 0.05) were obtained in serum triglyceride, serum cholesterol, and VLDL, while insignificant results were obtained in fasting urine sugar, HDL cholesterol, serum creatinine, and LDL [Table 6].

Table 6

Effect of therapy on biochemical parameters in group B

Overall effect of therapy

In group A, 4 (66.67%) patients showed moderate improvement, 1 (16.67%) patient showed mild improvement, and 1 (16.67%) patient showed no improvement. In group B, 17 (70.83%) patients showed moderate improvement, 6 (25%) patients showed mild improvement, and 1 (4.17%) patient showed no improvement [Table 7].

Table 7

Overall effect of therapies

Discussion

For Prabhuta Mutrata, in both the groups, the results [Tables 3 and 4] were statistically highly significant (P < 0.001) as Ahara and Vihara with Varadi Kwatha may help to regulate the Udakavaha and Medovaha Srotas, and thus, will have an impact on the Mutravaha Srotas. Therefore, it helps in regulating the water balancing system of the body.

With regard to Klaibya also, in both the groups, the results were highly significant (P < 0.01 and P < 0.001, respectively, in groups A and B), as the Varadi Kwatha, with lifestyle practices such as Pranayams, exercise, fasting, etc., helps in rectifying Srotorodha and, thus, generating Ruchi, Utsaha, and Bala in life and for enjoyment of sex.

The effects of the therapy on FBS and PPBS were statistically significant (P < 0.05) in groups B and A. With respect to fasting urine sugar, the result was significant (P < 0.05) in group A. This could be attributed to lifestyle modifications like Padagamanam, exercises, Asanas, fasting, etc., and the selected light diet which helped to enhance blood circulation and the metabolism of glucose, whereas in group B, the result was insignificant due to absence of Ayurvedic diet and lifestyle modifications.

The effects on the symptoms Pipasaadhikya and Galatalu Shosha were statistically highly significant (P < 0.001) in group B. Possibly, Varadi Kwatha helps to utilize the unspent glucose in the blood and relieves the accumulated Kapha and channelizes the Vayu properly due to Tikta Rasa which is Akasha and Vayu Mahabhoota. Thus, it helps to regulate the Udakavaha and Medovaha Srotas and, therefore, regulates the water balancing system of the body and mouth dryness, while in group A the result was significant as the number of patients was less.

In relation to Kshudhadhikya and Abhyavarana Shakti, the result was statistically significant in group A due to lifestyle practices like Padagamanama, exercises, Asanas, fasting, etc., and the selected light diet helps to enhance the power of Agni (metabolism), while in group B, the result was insignificant.

In Daurbalya also, the result was statistically significant in group A as the Varadi Kwatha helps to utilize the unspent glucose in the blood to release energy. The Ayurvedic diet and lifestyle treatment as mentioned above helps to regulate the Agni. The Pranayamas have helped in increasing the energy level by enhancing the Agni (metabolic activities) and Prana (bio energy) thus enhancing Bala (energy). The lifestyle schedule through Asanas relieves the accumulated Kapha and channelizes the Vayu properly.

In Shrama Shwasa, the results obtained were highly significant and significant in group A and group B, respectively. This was due to the effect of Varadi Kwatha in both the groups as it is Tikta (bitter) and Kashaya Rasa (astringent taste) predominantly with Kaphaghna property, which is expected to clear the Pranavahasrotasas (channels carrying the prana). The Pranayama in group A helps to strengthen the respiratory organs and Vyayama helps to systematically strengthen the body capacity; therefore, the result was highly significant in group A.

In the symptom Shula, the results obtained were significant and highly significant in group A and group B, respectively. In patients of Madhumeha, Shula occurs due to craving and lack of glucose entry to the body tissues. In this case, Varadi Kwatha, being predominantly Tikta and Kashaya Rasa and Kaphagna property is expected to clear the srotasas (channels) and facilitates the entry of glucose (nutrition) to generate Bala (vitality) and curbs Shula (tissue damage) and Suptata.

The results obtained were significant and highly significant in group A and group B, respectively, in Alasya with Utsahahani because the Tikta and Kashaya Rasa with Laghu and Ruksha Gunas of Varadi Kwatha in both the groups relieve the accumulated Kapha, channelize the Vayu properly, and rectify the Alasya of whole body and mind. The lifestyle program including Asanas, Pranayama, and listening to Mantras helped in regaining the physical, mental, and spiritual health of the patients in group A.

In Purishabadhdata, the results obtained were significant and highly significant in group A and group B, respectively, as Haritaki in Varadi Kwatha has Anulomanaka nature, thus facilitating the bowel evacuation.

In group A, the extra treatment through Ayurvedic diet and lifestyle treatment relieved the accumulated Kapha, rectified Guruta and Snigdhata, and channelized the Vayu properly with enhancement in Agni Bala, and therefore, significant results were obtained in HDL cholesterol, while in group B, the result was insignificant.

The effect on HbA1c in group A was statistically significant (P < 0.05) as the treatment techniques through lifestyle changes like Padagamanama, exercises, Asanas, fasting, etc., and the selected diet plan helped to enhance blood circulation and the metabolism of glucose, while in group B, this test was not done.

In group B, the results obtained in the symptoms like Daurblaya, Shrama Shwasa, Shula, Alasya with Utsahahani were highly significant as compared to the results observed in group A due to more number of patients.

Conclusion

The specially prepared Ayurvedic diet and lifestyle plan in the present study has all the potential to be used as a standard Ayurvedic model protocol for Madhumeha (DM) patients. According to the effect of therapy, Varadi Kwatha with Ayurvedic Ahara and Vihara (group A) has proved to be a better remedy than only Varadi Kwatha (group B) by relieving most of the cardinal symptoms as well as improving the biochemical parameters. Thus, it can be used to help to correct the condition of Madhumeha (DM). The effect of Ayurvedic diet and lifestyle plan along with Varadi Kwatha can be further studied on a large number of patients to substantiate the results of the present study.