Ayurvedic Concept of Obesity,Metabolic Syndrome,and Diabetes Mellitus

Introduction

O besity, metabolic syndrome, and diabetes mellitus are increasing to epidemic proportions globally. There are more than 1.5 billion overweight adults worldwide, of which 400 million are clinically obese. Once considered an affliction of affluent societies, overweight and obesity are now dramatically on the rise in low- and middle-income countries, especially in urban areas. In these developing countries it is not unusual to find obesity coexisting with undernutrition. ¹ It is estimated that 25% of the world's adults have metabolic syndrome, ² and there are more than 220 million people worldwide who have diabetes. ³ Nearly 3 million people die annually from diabetes, ⁴ with almost 80% of the deaths occurring in low- and middle-income countries. ³

The global impact of these disorders is immense in terms of human suffering and economic burden. Obesity is a major contributor to the global burden of chronic disease and disability. ⁵ Diabetes and its complications have a significant economic impact on patients and their families, as well as the health care systems and countries involved. ³ The total cost of diabetes in the United States in 2007 (including direct medical costs, disability, work loss, and premature mortality) was $218 billion. ⁶ There is an urgent need for a more effective understanding of these disease processes and their management, including the use of natural strategies that are affordable and efficacious. The healthcare system known as Ayurveda has much to offer in this regard.

Ayurveda

Ayurveda, which translates as the “Science of Life,” is a comprehensive, holistic health care system that originated in the ancient Vedic times of India. Ayurveda's primary emphasis is on prevention of disease and preservation and promotion of health; this system also provides treatment for disease. According to Ayurveda, the human body is composed of five Mahabhutas (basic elements that have the properties of space, air, fire, water, and earth) that combine to form Vata, Pitta, and Kapha, the three psychophysiologic principles known as Doshas (Table 1). The body is regulated by the three Doshas and the three qualities of mind known as the Gunas (Sattva, Rajas, and Tamas).

The Doshas regulate various functions in the body. Vata governs functions associated with movement and communication (e.g. blood flow, nerve conduction, intestinal motility, etc.) Pitta governs functions associated with metabolism, digestion, and transformation (e.g. appetite, endocrine functions, etc.) Kapha governs the structure and cohesion of the body (e.g. strength, stability, weight, etc.) ⁷ The Gunas are mental qualities. Sattva is the creative influence associated with intelligence, purity, and balance. Rajas is the spur to activity. Tamas is the influence of inertia, which results in stability. ⁸

Prakriti is the individual's psychophysiologic constitution and is determined at the time of birth by the individual's Dosha proportions. Each individual has a certain ratio of Vata, Pitta, and Kapha that is unique to him/her. Individuals with a Vata-predominant Prakriti have a light, thin build; perform activity quickly; have a tendency toward dry skin and constipation; have an aversion to cold weather; have a tendency to worry; and sleep lightly. Individuals with a Pitta-predominant Prakriti are moderate in build; perform activity with medium speed; have an aversion to hot weather; have sharp hunger and digestion; prefer cold foods and drinks; have a tendency toward irritability and short temper; and are excellent speakers. Individuals with a Kapha-predominant Prakriti have a solid build and great strength and endurance; are slow and methodical in activity; have oily, smooth skin; have a steady and tranquil personality; sleep long and heavily; have slow digestion and mild hunger; and have a tendency toward greed. ⁹ Current research in the fields of genomics and pharmacogenomics is revealing the possibility of utilizing Prakriti to correlate phenotypes with genotypes in the human population. This would have a significant impact on the field of personalized, predictive medicine. ^{10 –13}

In the body there are also seven Dhatus, which are fundamental principles that support the various bodily tissues; these are Rasa (plasma), Rakta (blood), Mamsa (muscle), Meda (fat), Asthi (bone), Majja (bone marrow), and Shukra (sperm or ovum). There are three metabolic waste products known as Malas, which are Mutra (urine), Purisha (feces), and Sweda (sweat). Energy flow and communication take place through various channels of organization known as Srotas. The spectrum of health and disease depends on the functioning of these various constituents. A state of equilibrium in their functioning results in health and disequilibrium leads to disease.

Obesity, Metabolic Syndrome, and Diabetes Mellitus

Obesity is a state of increased body weight, resulting from adipose tissue accumulation, that is of sufficient magnitude to produce adverse health effects. The body weight is expressed in relation to height as body–mass index (BMI). BMI=(weight in kg)/(height in meters ² ) (Table 2). BMI is closely related to accumulation of body fat. Central or visceral obesity is associated with a much higher risk for several disorders and diseases, including diabetes, hypertension, hypertriglyceridemia, decreased high-density lipoprotein (HDL) cholesterol, proteinuria, osteoarthritis, pancreatitis, gallstones, fatty changes in the liver, nonalcoholic steatohepatitis (NASH), hypoventilation syndrome, and increased risk of stroke and venous thrombosis. ^15,16

The major features of metabolic syndrome, also known as “Syndrome X,” are central obesity, high cholesterol, high triglycerides, low HDL cholesterol, hypertension, insulin resistance, and hyperglycemia. Disorders and diseases associated with metabolic syndrome are cardiovascular disease; type 2 diabetes mellitus; increases in apolipoprotein B, uric acid, prothrombin factors, homocysteine, white blood cell counts, and proinflammatory cytokines; microalbuminuria; fatty liver; NASH; polycystic ovarian disease; and obstructive apnea. ¹⁷

Diabetes mellitus is a chronic disorder of carbohydrate, fat, and protein metabolism, with a relative or absolute deficiency in insulin secretory response resulting in hyperglycemia. Insulin resistance is a major factor in the development of type 2 diabetes, which is seen in obese patients. Complications of diabetes include microangiopathy, retinopathy, nephropathy, neuropathy, and accelerated atherosclerosis. ¹⁵

Obesity, metabolic syndrome, and diabetes mellitus have much in common with Prameha. The Ayurvedic description of the Kapha-predominant and Vata-predominant types of Prameha include features of diabetes mellitus. Description of the Pitta-predominant type of Prameha corresponds more closely to inflammatory, hepatic, and gallbladder complications seen with obesity and metabolic syndrome.

Prameha as a “Lifestyle” Disorder

The etiology, classification, pathogenesis, and management of Prameha are discussed at length and in detail in the Ayurvedic texts. There are three major classical texts of Ayurveda, known as Charaka Samhita, Sushruta Samhita, and Ashtanga Hridaya of Vagbhata; and three minor texts, known as Sarngadhara Samhita, Bhavaprakash Samhita, and Madhava Nidanam. According to Ayurveda, Prameha is one of the significant pathologic conditions brought on by unhealthy diet and lifestyle. Ayurveda places emphasis on dietary and lifestyle recommendations as part of a comprehensive strategy for the prevention and treatment of disease. This strategy extends back to the point of conception, which ideally should be undertaken by parents who are healthy themselves. Ayurveda has recommendations for the course of pregnancy, the care of the newborn child during the lactation period, and from thereon throughout the course of life. The ingestion of a nourishing, balanced diet and optimum physical exercise according to the individual's Prakriti (psychophysiologic constitution) are considered essential for maintaining physical and mental well-being. When one starts to deviate from this natural way of living, he/she becomes susceptible to the “lifestyle” disorders, such as Prameha. Ayurveda has classified Prameha according to several parameters, including etiology, Dosha predominance, physique of the individual, and prognosis.

Conclusions

Obesity, metabolic syndrome, and diabetes mellitus are rampant and increasing to epidemic proportions globally. These disorders take an immense toll on the patients who have them, and have a significant economic impact on patients and their families, as well as the health care systems and countries involved. A new approach to the understanding and management of these disorders is available from the comprehensive, holistic health care system known as Ayurveda. The complex set of disorders identified as Prameha in Ayurveda correlates in many ways with obesity, metabolic syndrome, and diabetes mellitus. The theoretical background and comprehensive set of strategies Ayurveda utilizes to manage Prameha may be valuable in treating these disorders in an efficacious and cost-effective manner.

For further elaboration on the Ayurvedic concept of Prameha, see Sharma H, Chandola HM. “Prameha in Ayurveda—Correlation with Obesity, Metabolic Syndrome, and Diabetes Mellitus: Part 1—Etiology, Classification, Pathogenesis,” in this issue. Part 2 will be in a following issue.