Diabetes is a serious disease that affects quality of life and may even shorten a person’s life span. An endocrinologist/diabetologist who manages diabetes would need two things in order to help combat the disease: SKILL AND STRATEGY. Physicians need skills in understanding the intricate balance of this illness in order to prevent complications. They need strategy to customize the management approaches in order to optimize their patient’s endocrine health. With this premise, physicians should use proactive and comprehensive efforts in disease prevention and enhancement of the quality of life. This would mean striving to bring the most cutting edge medical knowledge in practice, while incorporating multidisciplinary and holistic approaches.

One of the holistic and integral traditional medicine in India that is re-emerging is Ayurveda. Ayurveda is a way of life that teaches how to maintain and promote health. Ayurveda treats man as a whole, which is a composition of body, mind and soul. During my interview with Rev. Dr. Jacob Gnalian MD., PhD who is considered the founder of Ayurveda in the Philippines, those who are not familiar with Ayurveda in countries like the Philippines but have heard the term “herbal,” might think that it is the use of a particular herb for a specific physical problem – like lagundi for asthma or some herbs available at the side of Quiapo Church. He emphasizes that Ayurvedic medicine is far from such concepts. This article is the author’s humbling effort to shed light on the possible role of Ayurveda in Diabetes management.

What is Ayurveda?
The term Ayurveda (“ah-yer-vey-duh’) combines two Sanskrit words: ayur, which means life and veda, which means science or “knowledge.” Ayurveda means “the science of life.” It is the world’s oldest form of healthcare which was developed in India some 3000 years before Christ. In Ayurvedic philosophy, people, their health and the universe are all related. Ideally, human beings and nature should be in perfect harmony. “The object of “Ayurveda,” said Susruda, the famous physician some 2600 years ago,” is the restoration to health of those who are afflicted with disease and the preservation of sound health of those who are well!”

Based on this belief, Ayurveda defines the human body as composed of five elements- vayu (air), agni (fire), akasa (ether/ space), prtivi (earth) and jel (water). Each part of the body contains all these elements in different measures; and they generate three essential conditions (doshas) known as Vatta, Pitta and Kapha in the human body either alone or by merging with each other. The doshas govern all biological, psychological and pathophysiological functions in the body, mind and consciousness. They are fundamental to human health, and an imbalance of the doshas brings on illness. Humans are endowed at birth with one of the seven different body types, depending on which dosha or combination of the three basic doshas predominate. A person’s body type is expressed both physically and emotionally.

Air and space/ether represent Vatta. Vata controls muscle and joint movement, breathing and heartbeat. It also controls anxiety, fear, pain and other functions of the nervous system. A person with vatta makeup tends to have a small and thin build.

Fire and water represent Pitta which is thought to control such bodily functions as digestion, metabolism, intelligence and skin color. Pitta governs the emotions of anger, hate and jealousy. A pitta body style is more of a medium and muscular build.

Earth and water represent Kapha. The physical structure of the body and the immune system are governed by Kapha. Emotional responses thought to be controlled by Kapha include calmness, forgiveness, love and greed. The kapha appearance is usually bigger and well-developed. Most people are considered to have combination of doshas, with one type usually being predominant.

What is the background of Diabetes in the Ayurvedic philosophy?
The Indian word for diabetes is “madhumeda,” “madhu” meaning sweet and “mesha” meaning excessive urination. The etiology, symptomatology, pathology and prognosis and principles of diabetes are described in detail by the physician Caraka in Caraka Samhita which dated back around the first century AD. In this literature, madhumeda is defined as the disease in which the patient passes urine characterized as astringent, sweet and rough.

The etiology of madhumeda is multifactorial in Ayurvedic system. Causes may be traced to tendencies inherited at birth or to derangements acquired afterwards. Madhumeda is classified in the group of urination disorders known as prameha. Two types of pramehas are described for diabetes. The first, called sahaja, is thought to be due to a defect in genetic substance, either in the mother or father. This form corresponds to T1 DM, and such patients are often described as thin and are thought to have more serious disease. The second type, apathyanimittaja, is believed to be acquired later in life due to excessive habits, such as overindulgence in food or sweets. This corresponds to adult onset diabetes, and the patients are described as obese.

Ayurveda holds that, if there is predominance of pitta or kapha in persons suffering from madhumeha, their prognosis is better. If there is an excess of vata, madhumeha is said to be incurable.

How can Ayurveda help with Diabetes?
It is well-recognized that important aspects of diabetes management are nutrition, exercise, and emotional harmony. Ayurvedic treatments are centered on the improvement in these three areas of health and well-being. Ayurvedic practitioners will determine his or her primary dosha, or the type of natural forces at work in the body, and the balance of doshas.

According to Ayurveda, diabetes, is primarily a Kapha disorder, or the dosha that governs the physical well-being. Ayurvedic practitioners address diabetes using a multi-pronged approach. First, they address diet modification, eliminating sugar and simple carbohydrates, and emphasizing complex carbohydrates. Protein is limited, since excessive intake can damage the kidneys. Fat is also eliminated because there is often a deficiency of pancreatic enzymes in individuals with diabetes, making fat digestion difficult. At least one attempt has been made in the Indian literature to determine the source of dietary carbohydrate (i,e., lentils vs. wheat) has an impact on diabetes.

Treatment protocols are different for each type of patient based on vitality, constitution and disease etiology. Patients are either obese and strong or lean and weak. Treatment for obese patients begins with cleansing. Lean diabetic patients, however, are considered too frail to undertake radical cleansing; they and other frail diabetic patients customarily undergo milder cleansing procedures. A cleansing program is begun with herbal massages and an herbal steam sauna, and then followed by fasting to cleanse the body. An herbal purge for the liver, pancreas and spleen are conducted. Colon therapy is next, first to cleanse the digestive tract and then to reconstitute the system.

Exercise and diet are important adjuncts to the primary diabetes treatment. Vigorous exercise, however, is contraindicated in lean and weak patients. Instead, severe diabetic patients are advised to perform specific yoga positions that are believed to benefit them in mind and body with the least physical stress. Certain postures are believed to stimulate the endocrine pancreas and improve its function.

Little research has been carried out in other areas of Ayurveda medicine. In the case of diabetes, most of the concentration and certainly research has been conducted on Ayurvedic herbal treatments. Specifically, there are three Ayurveda botanicals that have so far shown promising results: Gurmar (Gymnema sylvestre) can significantly lower glucose levels in the blood making it a potentially ideal form of diabetes treatment. Clinical trials have shown that consumption of gurmar reduces the amount of insulin among T1 DM patients. Mamordica charantia and Tinospora cordifolia both help to prevent rising levels of blood sugar.

Is Ayurveda safe?
Ayurvedic practices such as yoga and mediation can be safe ways to promote health especially in chronic illnesses like diabetes. Ayurvedic herbal medications may trigger allergic reactions or interact with other medicines the patient is taking. Some ayurvedic medicines were found to contain high levels of heavy metals such as lead as reported in some grocery stores in Boston, USA.

What can we learn from Ayurveda?
Ayurveda is a rich and sophisticated form of medicine that is both like and unlike Western medicine. Modern medicine recognized diabetes mellitus about 3 centuries ago, but the real breakthrough in its management came about less than 100 years ago, when insulin was discovered and 50 years ago when oral hypoglycemic agents began to be used. The pioneers of diabetology realized early on, however, that no management strategy could be successful if based on drugs alone. The active participation of the patient was an essential prerequisite for successful therapy.

One of the essential contributions of Ayurveda in the field of diabetes is the Quadruple of Atreya. According to this treatise by Sutrasthana, there are four components necessary to treat diabetes: THE PHYSICIAN, DRUGS, THE PATIENT AND THE ATTENDANTS (family and nurses). All the four components of the quadruple of Atreya have to be equally effective since the chain is as strong as its weakest link. Indeed, there are four attributes which are necessary for each component of the quadruple:

• A good endocrinologist/ diabetologist should have good command over the theory and the practice. He should be quick and efficient in using effective, available drugs in judicious doses and combinations.
• Active support from the “attendants”, who include diabetes educators and family members.
• Effectivity and safety profile of the Medications/Drugs used in diabetes and
• Lastly, the patient should cooperate by giving complete history and concordance with the planned therapeutic regimen.

Educating the diabetic person to achieve empowerment has a positive therapeutic effect on the health of the patient. Patients need to understand that they need to consult their physician about combining an alternative therapy with their conventional treatment. It is ALWAYS not safe to forego their conventional treatment and rely only on an alternative therapy.

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