METABOLIC SYNDROME- An Ayurvedic Approach by Prof. Satyendra Ojha

METABOLIC SYNDROME- A AYURVEDIC APPROACH

Metabolic Syndrome is a disorder of energy utilization and storage. It increases the risk of developing cardiovascular disease and diabetes mellitus.

Metabolic Syndrome is diagnosed by a concurrence of two out of five of the following conditions:

1.   Abdominal (Central) Obesity

2.   Hypertension

3.   Hyperglycemia

4.   Hypertriglyceridemia

5.   Low level of HDL

DEFINATION

Metabolic Syndrome is the one which fulfills two or more of the following criteria:

1.   Central Obesity:

Waist circumference more than 102 cm (40 in.) in males                                   Waist circumference more than 88 cm (35 in.) in females

2.   Dyslipidemia:

Serum Triglycerides more than 150 mg/dL

3.   Dyslipidemia:

HDL levels less than 40 mg/dL in males

HDL levels less than 50 mg/dL in females

4.   Blood Pressure:

greater than 130/85 mm of Hg or use of medication for Hypertension

5.   Hyperglycaemia:

Elevated fasting plasma glucose levels equal or more than 110 mg/dL or use of medication for hyperglycaemia

SYNONYMS OF METABOLIC SYNDROME

1.   Insulin Resistance Syndrome

2.   Syndrome X

3.   Cardiometabolic Syndrome

4.   Reaven’s Syndrome

5.   CHAOS( in Australia)

Considering the above definition one can compare the metabolic syndrome to Sthaulya pathogenesis as mentioned in ASTONINDITYA ADHYAYA.

Charak explained that on basis of sharir as ADHIKARAN SWAROOP eight diseases are classified and among this eight ATISTHAULYA and ATIKRUSHA are given utmost importance.

Being Atisthaulya has ASTHADOSHA as stated below:

1.   AAYUSHYA HRASA

2.   DAURBALYA

3.   DAURGANDHYA

4.   JAVOPARODHA

5.   SWEDABADA

6.   KSUDHA ATIMATRAM

7.   ATI PIPASA

8.   KRUCHA VYAVAYATA

If one understands this 8 dosha explained by Charak it is clear that Atisthaulya cannot be restricted to obesity as a single disease but a syndrome which creates the platform for such disease which will reduce life span, reduce the functional capacity, bring about weakness and increase the morbidity and mortality rate

AETIOLOGY:

Charak in Rasayan Adhyaya, Samunthaniya Pada has elaborated about GRAMYA AAHAR chosen by the society was not successful in making inroads in community health. Sedentary lifestyle was responsible for less physical activity which became the cause of preventable disease. Similar hetus are also been explained in relation to sthaulya. Modern also explains that a combination of excessive food energy intake and a lack of physical activity are responsible for metabolic syndrome.

1.   Bija Swabhavat: ‘sthula matapitrujanya bhavat’

Obesity or metabolic syndrome often runs in families. This may be due to a combination of shared genetic, environmental and lifestyle factors. This has been explained by Charak in astoninditiya adhyaya by using the words ‘tasya hi ittyadi’

Chakrapani comments as ‘Samprati sthulasya sadarana api aaharat medojan aaha’ i.e. in a person with family history a normal diet also has a tendency for increasing meda dhatu.

The most common inherited risk characteristics (hypertension, hyperlipidaemia, diabetes) are polygenic.

Genetics: obesity is the result of interplay between genetic and environmental factors. Polymorphisms in various genes controlling appetite and metabolism predispose to obesity when sufficient food energy is present

Obesity is a major feature in several syndromes, such as Prader-Willi syndrome, Bardet-Biedl syndrome, Cohen syndrome, and MOMO syndrome. The greatest risk factor for child obesity is the obesity of both parents.

2.   KLINNA, GURU, ADHYASANA, PISHTANNA, ABHISYANDI AAHAR and AVYAYAMA are source for extra calories.

3.   ABHISYANDI AAHAR: Fast food can also be defined as any food that contributes little or no nutrient value to the diet, but instead provides excess calories and fat. Some of these foods that are of little nutritional value and often high in fat, sugar, and calories. Common foods include salted snack foods, gum, candy, sweet desserts, fried fast food, and carbonated beverages.

4.   GURU, PISHTANNA, VISTAMBI AAHAR : Trans Fatty Acids render plasma lipid profile even more atherogenic than saturated fatty acids by not only elevating LDL cholesterol but also by decreasing HDL cholesterol. It includes

a.   Deep fried fast food

b.   Cake mixes

c.   Cereal and energy bars

d.   Chips, Crackers, Whipped toppings

e.   Packed cookies and candy

f.    Packed doughnuts, pies and cake

5.   SNIGDHA AAHAR : Dietary fat has long been implicated as a driver of insulin resistance. Large quantities of saturated, monounsaturated and polyunsaturated (omega-6) fats all appear to be harmful. Being insensitive to insulin is still positively correlated with fat intake, and negatively correlated with dietary fiber intake, but both these factors are also correlated with excess body weight.

6.      Fat consumption induces very little energy expenditure as most is stored. ‘MEDA EVA UPACHIYATE’

7.   Extra food energy comes from an increase in carbohydrate consumption rather than fat consumption. The primary sources of these extra carbohydrates are sweetened beverages and potato chips.

8.   Shushka shaka, shushka mansa, teel taila and ruksha content have low nutrition value.

9.   VIDAGDHA AAHAR (over cooking) destroys folic acid from leafy vegetables.

10.  VARUNYAS CHA SEVANAT: Alcohol is antagonist to folic acid. Rakta and medodustikara effect has been explained by our acharyas.

11.  Dried fruits are rich in concentrated fructose. This increases the sugar levels in these fruits. Some of the dried fruits known to contain high levels of fructose include dates, figs, apples, pineapples and raisins.

12.  MADHUR AAHAR: Foods that have been prepared commercially can have high fructose levels. Even products that are not sweet may contain fructose as an ingredient. Some processed products rich in fructose include condiments and ketchup, sweet pickles, soups, breakfast cereals, frozen foods, boxed dinner, canned foods, crackers and breads. Commercially prepared foods like pastries and chocolate contain very high levels of fructose.

13.  Vitamin D deficiency is also associated with insulin resistance. Thus indulging in food habits having low vitamin D contents can lead to metabolic syndrome.

14.                Leptin is a hormone that regulates long-term energy balance in many mammals. An important role of leptin is long-term inhibition of appetite in response to formation of body fat. If the regulation fails diet increases. (VIKARA VIGHAT ABHAVA)

15.                ‘TAN MANA BHUNJIT’: In both children and adults, there is an association between television viewing time and the risk of obesity. An increased rate of childhood obesity with increased media exposure, with rates increasing proportionally to time spent watching television.

16.  DIVA SWAP {Day sleeping}, indulging in excessive exercise and sex increase oxidation process and release oxidants and free radicals.

17.                PSYCOLOGICAL FACTORS such as BHAYA, KRODHA, LOBHA, SHOKA, MOHA can contribute to Metabolic Syndrome by disrupting the hormonal balance of the hypothalamic pituitary adrenal axis which increases high cortisol levels resulting in raising glucose and insulin levels which in-turn causes insulin mediated effects on adipose tissue ultimately promoting visceral adiposity, insulin resistance, dyslipidemia and hypertension and osteoporosis. Ca. Vi. 2 /9 explains that psychological factors are cause for ama visha although matravat aahar is taken.

                               

                                                                                              

   DIAGNOSIS CRITERIA:

1.       WEIGHT

2.       WAIST CIRCUMFERENCE

3.       BMI

4.       BLOOD PRESSURE

5.       LIPID PROFILE

6.       FASTING BLOOD GLUCOSE LEVEL

7.       GLUCOSE TOLERANCE TESTING

8.       FASTING INSULIN LEVELS

9.       HORMONAL ASSAY IN PCOS

10.     HISTORY FOR OBSTRUCTIVE SLEEP APNEA

11.        FAMILY HISTORY FOR CVD & DM

TREATMENT:

A.  NIDAN PARIVARJAN

Metabolic Syndrome is a lifestyle disorder which needs to be changed on priority basis.

Obesity being main cause reduction of body weight is essential.

Gramya Aahar, fast food, trans fatty food, saturated fatty food should be strictly avoided, with low sugar intake and regular exercise.

Aaharatmak

1        vkgkjek=k iqujfXucykisf{k.kh

2    izd`fra vuqigR;

3    ;Fkk dkya tjka xPNfr

4    vkgkjek=k     loZ xzgifjxzg 

5  vkgkj izd`fr vuq#i f}fo/k izdkj

   xq# → u vfXu lU/kq{k.k] vfrek=a nks”kofUr

   y?kq → vfXulU/kq{k.k] LoHkkokfu vYi nks”kkf.k

6 nzO; vis{k;k f=HkkxlkSfgR;e/kZlkSfgR;a ok xq#.kkeqifn’;rs ukfrlkSfgR;eXus;qZDR;FkZe~ y?kwukefi

7 ek=kor~ v’kue~ vuqigR; cyo.kZlq[kk;q”kk

8    xq# fi”Ve; u [kknsr~ ek=ka cqHkqf{kr

9    ‘kw”d ekal] ‘kq”d ‘kkd] ‘kkyqd] fcl] d`’k ekal] dwfpZd] fdykV] ‘kkSdj] xO;] ekfg”k ekal] eRL;] nf/k] ek”k] ;od u ‘khy;sr~&

vfgr vkgkj lsou & /kkrq la?kkr uk’k;fr

10   “kf”Vd ‘kkfy] ewX/k] lSa/ko] vkeydh] ;o] vUrfj{k ty] lfiZ] tkaxy ekal] e/kq vH;kl;sr~A

11   vkgkj vkpkj ps”Vklq lq[kkFkhZ izsR; psg pA

   ija iz;Ruefr”Bsncqf/neku fgrlsousA

                        p-lw-7@60

12   vfgrkgkjksi;ksx% iquO;kZf/kfufeRrfefrA

                        p-lw-25@30

13   fojksf/k vUuiku fu”ks/k → vke nks”k dkjd

14   vkgkjfo/kh fo’ks”kk;ru

Prudent Diet:-

-         Varied eating pattern should be followed

-         Preference to fish, chicken, low fat dairy products

-         Salt & alcohol intake should be moderate

-         Consume more unrefined carbohydrates such as grains product.

-         Antioxidants like amalaki, lemons, spinach, turnip leaves, watermelon, sweet potatoes, carrots, tomatoes, pumpkin, wheat grass juice, oranges, guava, should be added in diet.

Diet should include:   

Fenugreek or Methi
Fenugreek seeds are a rich source of constituents known as steroidal saponins that help to reduce the body’s absorption of cholesterol coming in through the fat-rich foods we eat.
Saponins have a role to play in reducing the body’s production of cholesterol.
Flaxseed or Alsi
Is a rich source of omega-3 fatty acids that has a protective action on heart health.
These seeds also contain a lot of fiber and this binds with cholesterol, preventing its absorption.
The regular use of flaxseed is said to prevent the arteries from hardening due to the deposition of cholesterol
 It also helps reduce the risk of coronary artery disease and hypertension.
Flaxseeds also have the effect of increasing the concentrations of apolipoprotein A1 which goes to form HDL cholesterol.
Garlic
Garlic reduces LDL cholesterol.
Prevents a rise of blood pressure
Avoids the deposition of plaque on the walls of arteries, reducing chances of heart attack and stroke.
Garlic contains sulphurous compounds that act as antioxidants and also help with expansion of the blood vessels, keeping blood pressure at a normal level.
Onions
Onion contains a constituent called quercetin that is known to be a strong antioxidant; this means it can prevent the damaging effects of free radicals on human tissues.
Researchers have linked quercetin of onions with increased levels of HDL cholesterol as well as low levels of LDL cholesterol.
Nuts
Nuts such as almonds, pistachios, hazelnuts and walnuts are rich in polyunsaturated fatty acids that help to keep the arteries healthy.
However, eat them in raw form without adding salt or sugar or you will add to the calorie content.
Fish
Certain species of fish are a storehouse of the healthy omega-3 fatty acids that reduce LDL cholesterol and protect the heart.
Herring, salmon, mackerel, sardines, halibut and lake trout are good sources of these fatty acids that also help increase HDL cholesterol.

Mung - Its polysaccharides composition enhances enzyme activity, serum lipoprotein LDL levels of TG hydrolysis to reach curative effect of lowering blood fat

- It contains globulin and polysaccharides, it can promote animal cholesterol in liver bile acid, accerelate decomposed into bile salts in the bile secreted and reduce absorption of cholesterol small intestine.

Yava (Hordeum vulgare) – It lowers LDL and total cholesterol levels.  Study shows it has beneficial effect on lipid metabolism and bowel function.

Maricha (Piper nigrum) – Piper nigrum can increase absorption of selenium vit. B and beta carotene and curcumin as well as other nutrients. It has antioxidant properties.

Patola (Trichosanthes dioca) – Water extract shows it reduces fasting blood glucose, pp blood glucose, aspirate amino transferase, alanine amino transferase, alkaline phosphatase, creatinine, urine sugar and  urine protein

It has antioxidant potential and anti-inflammatory activity.

Karvellaka (Momordica charantia) – It reduces liver secretion of Apolipoprotein B the primary lipoprotein of LDL and also reduces Apoliporotein C the primary lipoprotein of VLDL and increase expression of apolipoprotein A-1 the primary component of HDL. It also stimulate insulin secretion from pancrectic b cells.

Kulatha (Dolichos biflorus) – It has antioxidant activity, hydroxyl radical scavenjing reduces lipid peroxidation. It has hypolipidemic activity and lowers blood sugar level.

Ushira (Vetiveria zizanioides) – It shows antioxidant properties. It scavenges free radicals.

Banana (Musa paradisiaca) – contain dietary fibre, high amount of essential minerals, potassium, vit. A, B1, B2 & C. It has soluble fiber which binds with bile salt and may reduce blood cholesterol levels

Kusmanda (Benincasa hispida) – antioxidant property, scavenging free radicals

Dadima (Punica granatum) – antioxidant, protect body from free radicals. It reduces LDL and increase HDL

Shampaka Shaka (Aragvad patra) - It reduces blood sugar level and has antioxidant activity and also reduces blood and liver total lipids

Mulak (Rapharus sativus) – improve blood circulation. It lowers plasma levels of total cholesterol, TG, phospholipids. It also shows hypoglycemic activity.

Eranda taila (Ricinus communis) - Ricinoleic acid exerts anti-inflammatory effects.

Draksha (Vitis vinifera) - study shows it relieves symptoms of chronic venous insufficiency, arteriosclerosis and high blood pressure, alleviate inflammatory conditions and is cardioprotective. They reduce fragility of blood vessel.

Oats and Beans

Oats are a rich source of fiber and a compound called beta glucan; these act together to bring about a reduction in the levels of LDL cholesterol.

Beans also contain a large amount of fiber and can help to reduce the quantity as well as the rate of cholesterol absorption from the diet.
Diet should be such that it must be guru but should have apatarpan effect. Oats, flakes, honey, butter milk  have such role.

VIHARATMAK  (PHYSICAL ACTIVITY) 

·       O;k;ke fuR; lsou

‘kjhjps”Vk ;k ps”Vk LFkS;kZFkkZ cyof/kZuhA

nsgO;k;kela[;krk ek=;k rka lekpjsr~AA

                      p-lw-7@32

·       vfrO;k;ke fu”ks/k

·       O;k;kegkL;Hkk”;k/oxzkE;/keZiztkxjku~ A

uksfprkufi lsosr cqf/nekufrek=;k AA

                      p-lw-7@34

-          Avoid Smoking

-          Prevent stress

-          Follow aachar rasayan

Ø  Daily exercise should be for 60-90 min.

Ø  Gardening, cycling, swimming, brisk walking and doing housecleaning.

Ø  Vyayam should be ardhashakti but regular and preferably in early morning.

PANCHKARMA

Ø  Ruksha Sweda

Ø  Tikshna Basti but to be avoided in CVD, Vaitaran basti can be done. Triphala , Dashamula, Gomutra, Honey, Saindhav

Ø  Vaman and Virechan can be carried out depending on anubandh of dosha and considering the bala of rugna but avoid in CVD.

MEDICINES

Ø  Drugs acting on amashit meda or medovaha srotas

1.   Maricha

2.   Chitrak

3.   Daruharidra

4.   Rason

5.   Tulsi

6.   Vacha

7.   Pushkarmoola

8.   Punarnava

9.   Shilajeet

10. Triphala

11.  Amruta

12.  Musta

13.  Pippali

14.  Kutki

15. Drugs explained in Urustamba, staulya and santarpanotha vyadhi chikitsa can be chosen.

Drugs acting on Rasa Raktavaha srotas

1.   Amalaki

2.   Haritaki

3.   Punarnava

4.   Shatavari

5.   Shalparni

6.   Sariva

7.   Manjista

8.   Shilajeeta

9.   Amrita

10.  Yastimadhu

11.  Patola

12.  Kutki

13.  Vidanga

14.  Laksha

Drugs acting on Vata dosha

1.   Dashamoola

2.   Haritaki

3.   Rason

4.   Guggulu

5.   Punarnava

6.   Shalparni

7.   Shatavari

8.   Pushkarmoola

9.   Deodaru

10. Mirigashringa

11. Nagbala

Drugs acting on Prameha

1.   Triphala

2.   Gudmar

3.   Asana

4.   Guduchi

5.   Kiratikta

6.   Kutki

7.   Patola

8.   Nimba

9.   Haridra

10.Gokshur

11.Chitrak

12.Shilajeet

Drugs having mutrala effect so reducing the HTN & Renal Pathology

1.   Punarnava

2.   Gokshur

3.   Musta

4.   Ushir

5.   Dashmula

6.   Varun

7.   Pashan bheda

8.   Brahmi

9.   Padmak

10. Pundarik

11. Madhuk

Drugs having Hridya Effect usefull in CVD

1.   Arjun

2.   Brahmi

3.   Tulsi

4.   Guggulu

5.   Punarnava

6.   Rason

7.   Shatawari

8.   Amalaki

9.   Yastimadhu

Drugs acting on grathita rakta in cases of thrombosis

1.   Kamalkshar

2.   Darbha

3.   Kusta

4.   Paravatashakrit

5.   Mrunal

6.   Palash kshar

7.   Priyangu kshar

8.   Utpalnal kshar

9.   Asana

Role of katu rasa pradhan dravya should be studied since Charak says it has shonita sanghata bhinnati action.

Drugs having Medhya action

1.   Brahmi

2.   Sankhapuspi

3.   Jatamanshi

4.   Guduchi

5.   Yastimadhu

6.   Shatawari

7.   Haritaki

8.   Brahmarasayan

Kalpa

1.   Mahasudarshan Churna

2.   Mahatiktak Contents

3.   Navayas Loha

4.   Medohar Guggulu

5.   Varunadi Kwath

6.   Ayaskriti

******************************************************

Prof. Satyendra Narayan Ojha  

MD PhD

(Kayachikitsa)
Director

Yashwant Ayu. College & P.G.Training&Research Center 

Kodoli, Kolhapur, Maharashtra, India.

Mobile No.- +91 9822177155     

email: drsnojha@rediffmail.com