Evaluation of diet and life style in the etiopathogenesis of Urdhwaga Amlapitta (non-ulcer dyspepsia).

For a long time, infectious (communicable) diseases were the biggest killer diseases globally. But now, the trend is changing toward increased prevalence of chronic diseases with causative factors mostly related to diet and lifestyle. Among them, Urdhwaga Amlapitta (non-ulcer dyspepsia), a gastrointestinal tract (GIT) disorder, has acquired majority of the share with causative factors like improper diet and habits, stress, spicy irritant food, oily foods, bakery products, etc., A survey study was conducted on 138 patients, irrespective of sex, religion, etc., who had presented with the clinical symptoms of Urdhwaga Amlapitta and attended the OPD of Department of Basic Principles, at I.P.G.T. and R.A., Gujarat Ayurved University, Jamnagar, between February 2009 and June 2010. Information on demography, dietary intake, and lifestyle factors was collected by standard questionnaires. The data revealed that majority of the patients indulged in faulty dietary habits like excess Katu Ahara Sevana (99.3%), Amla Ahara (95.65%), Guru Ahara (90.57%), Snigdha Ahara (86.23%), Viruddha (81.88%), Abhishyandi Ahara (81.88%), Atiushna Ahara (73.9%), Vidahi (51.44%), Pistanna (47.10%), etc., and the data on lifestyle revealed that majority of the patients indulged in Diwasvapna (89.85%), Antarodaka Paanam (81.88%), Chinta (79.71%), etc., This survey study upholds the novel concept of diet and lifestyle of Ayurveda. The data reflects that dietary patterns, lifestyle choices, and physical activities play an important role in the etiopathogenesis of Urdhwaga Amlapitta, and it is important for patients to have access to diet and lifestyle modifications. Currently, research in this area is minimal.

Introduction

From Stone Age to Space Age, food pattern of people has undergone innumerable changes. The changes of course have been always for the better aspect of life, yet most of the diseases are firmly rooted in poor dietary habits due to traditional superstitious beliefs and overpowered logical thinking. None of the existing systems of medicine is the complete answer for all the health problems as all these aim at symptomatic relief rather than a total cure.[1]

Those who take proper diet and drinks live a long life and those not doing so die prematurely. Proper maintenance of the power of digestion also depends upon the intake of proper diet.[2]

Even with the advent of excellent techniques and astonishing advancement in science and technology, the humanity is left with innumerable health problems. Most of the diseases have direct or indirect link with the type of food we consume, our food habits, and lifestyle. 80% of the top ten killing diseases of the world are due to wrong food habits.[3]

In the society, due to improper Ahara (diet) and Vihara (lifestyle), incidences of diseases are increasing in day-to-day life. If proper dietary pattern is not followed by the patient, nobody can cure these diseases.[4]

Main causes for the disease are improper diet, habits, stress, not following Ahara Vidhi Visheshayatana, etc.,[5] Viruddhahara, Asatmya Ahara, stale food, spicy irritant food, oily foods, bakery products, some fast foods, excess consumption of tea and coffee, excess food intake, drinking excess water after meals, freezed products, wine, cigarette smoking during meal, chemical medicines during meal, etc.

Chronic diet-related diseases are on rise around the world due to new lifestyles and eating habits.[6] Gastrointestinal disturbances are increasing and India is no exception to this. Among them, non-ulcer dyspepsia, a gastrointestinal tract (GIT) disorder, acquires majority of the share.[7]

The aim of this study was to evaluate the role of diet and lifestyle factors in the etiopathogenesis of Urdhwaga Amlapitta.

Materials and Methods

Study design and patient selection

The present study was a survey conducted on 138 patients, irrespective of sex, religion etc., who had presented with the clinical symptoms of Urdhwaga Amlapitta and attended the OPD of Department of Basic Principles, I.P.G.T. and R.A., Gujarat Ayurved University, Jamnagar, between February 2009 and June 2010. A detailed proforma was specially designed for the purpose of incorporating all aspects of the demography, dietary intake, lifestyle factors, and disease on Ayurvedic parlance. Informed consent was taken from the patients before including them in the survey study.

Selection of patients

Patients were eligible for the study if they were over 15 years and below 65 years of age, and had classical signs and symptoms of Urdhwaga Amlapitta[8] like Avipaka, Vidaha, Klama, Tiktamlodgara, Hritdaha, Kanthadaha, etc., Patients who had chronicity for more than 5 years and were having organic diseases like gastric ulcer, duodenal ulcer, cancer of stomach, and major illnesses like cardiac diseases, diabetes, etc., were excluded.

Laboratory investigations were carried out before including the patients under the study to rule out any other pathological conditions.

Routine hematological investigations – Hemoglobin (Hb), total count (TC), differential count (DC), erythrocyte sedimentation rate (ESR), packed cell volume (PCV)

Urine examination – Routine and microscopic

Stool examination – Routine and microscopic

Biochemical examination – Fasting blood sugar (FBS), Sr. cholesterol, Sr. triglycerides, high density lipoprotein (HDL), blood urea, Sr. creatinine, serum glutamate pyruvate transaminase (SGPT), serum glutamate oxaloacetate transaminase (SGOT), Sr. total proteins, albumin, globulin, A/G ratio, Sr. alkaline phosphatase, bilirubin (T), bilirubin (D), Sr. uric acid.

Observations

Data of 138 patients surveyed revealed that maximum number of patients (68.83%) were between 25 and 45 years of age, with chronicity of 30 days (74.6%).

81.88% of patients were on regular treatment, while 18.12% were not taking any medication though aware of the disease. 93.48% patients were married and 85% had more than four family members. Majority of the patients (53.62%) had Pitta–Kaphaja Prakruti, 68.8% had Rajasika Prakruti, and 30.43% had Tamasika Prakruti. Symptoms reported include: Amla tikta udgara and Hrit kantha daha (100%), Avipaka (99.27%), Udara shoola (91.30%), Chardi (68.11%), Aruchi (100%), Hrillasa (95.65%), Gaurava (90.57%), Agnimandya (80.43%), Vibandha (78.26%), and Shira shoola in 74.63% of the patients [Figure 1].

Figure 1

Demographic data of 138 patients of Urdhwaga Amlapitta

The data on dietary habits revealed that majority of the patients indulged in Katu Ahara (99.3%), Amla Ahara (95.65%), Vidahi (51.44%), Pistanna (47.10%), Guru Ahara (90.57%), Snigdha Ahara (86.23%), Viruddha (81.88%), Abhishyandi Ahara (81.88%), Rukshanna (31.88%), Dhanya Ahara (71.73%), Atiushna Ahara (73.9%), and non-veg food (44.92%) [Figure 2 and Table 1].

Figure 2

Subjects and their diet and dietary habits

Table 1

Subjects and their diet and dietary habits

The data on lifestyle revealed that majority of the patients indulged in Diwasvapna (89.85%), Vegavidharana (23.18%), Antarodaka Paanam (81.88%), tea/coffee (98%), smoking (23.9%), Pan chewing (54.34%), tobacco chewing (43.47%), and had tension (48.55%), depression (25.36%), anxiety (8.69%), constipation (90.5%), sedentary occupation (47.83%) [Figure 3 and Table 2].

Figure 3

Subjects and their lifestyle modifications

Table 2

Subjects and their lifestyle habits

Discussion

The fast emerging lifestyle diseases in India today inflict heavy burden on the society and is a new national reality. By and large, they are born out of faulty diet and lifestyle modifications. Comprehensive, workable, and cost-effective preventive alternatives are available in Ayurveda, which need recognition and promotion. But prevention of the disease is better than cure, so also Nidana Parivarjana has been suggested as the first line of treatment in almost all the diseases.[9] In the present study, most of the etiological factors were found to be related with the diet and lifestyle. If one does not follow proper dietary habits, his/her Agni will be diminished due to irregularities in the digestion and finally will lead to Urdhwaga Amlapitta.[10] Maximum number of patients, i.e. 68.83%., belonged to the age group between 26 and 45 years. It is the most productive age of one's life, as they struggle for improving their economic status, due to which they suffer from stress and strain. The irregular food and drinking habits in their service might have led to more incidences. This age group also has Pitta dominance. Most of the individuals who were taking dominant Rasa as Katu 99.3%, Amla 90.6%, and Lavana 53.6% were prone to this disease, proving the classical etiological factors for causing and aggravating the disease. 21.72% patients were following Adhyashana. Acharya Charaka has advised to take the food only after the previous meal is digested.[11] Adhyashana causes aggravation of Doshas, and due to insufficient rest to the stomach, the mucus membrane is hampered which will lead to local damage. 43.47% patients were addicted to chewing tobacco, which due to its Ushna, Tikshna, Vyavayi Gunas causes and aggravates the Amlapitta.[12] 90.5% patients were suffering from Krura Kostha which is due to Vata Dosha. These people were more prone to constipation which is also one of the symptoms of Urdhwaga Amlapitta. Stress is a known factor for disturbing the sleep. In this study, more patients reported disturbed sleep followed by Alpanidra.

Conclusion

Urdhwaga Amlapitta is a chronic recurring condition that affects health-related quality of life. As a result of the economic and social burdens of Urdhwaga Amlapitta, it is important for patients to have access to diet and lifestyle modifications. The results of the survey study suggest that unwholesome diet, fast and stressful lifestyle with sedentary habits play an important role in the manifestation of this disease. Currently, research in this area is minimal.