Introduction
About 422 million people worldwide have diabetes. The majority of people having diabetes are living in low and middle income countries. 1.5 million Deaths are directly attributed to diabetes each year. Number of cases and the prevalence of diabetes are steadily increasing over the past few decades. According to WHO, The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014. The global prevalence of diabetes among adults over 18 years of age rose from 4.7% in 1980 to 8.5% in 2014. Between 2000 and 2016 there was 5% increase in premature mortality from diabetes. Although the modern science in advanced day by day, and there is invention of new anti-diabetic drugs every year, the prevalence and mortality is increasing day by day. Diabetes is the seventh leading cause of death before age of 70 years in 2016.A healthy diet, regular physical activity maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes. Diabetes is a metabolic disorder or a lifestyle disease. According to Ayurveda diabetes is a stage of Prameh. Causes of diabetes are more and more related to diet and lifestyle. In this article I had overlooked some food forms which are major causative factors of this increasing prevalence of diabetes1.
Materials and Methods
Internet browsing, Ayurveda text is major source of knowledge.
Prameh
In prameh, kapha, pitta, mamsa and meda are excessively increased, which ultimately diminishes digestive fire. Undigested food product called aama is produced, which leads to produce tissues and waste products with aama [sama dhatu and sama mala]. This metabolic disorder leads to accumulate kleda, bad water content in body. Normal vata motion is not allowed, so vata get vitiated. Oja, the most pure form of shukra is separated from tissues because of diminished digestive fire, kleda, aama and produced and excreted out from body through ureter, so we can see the patient with pale face, loss of appetite, loose body tissue, excessive thirst, and weakness. As in prameha, three dosha are vitiated, tissue involvement is more, it hampers patient’s quality and length of life. Major cause of prameha is diet and behavior.1, 2, 3, 4
Diet
The diet which diminishes digestive fire, vitiates three dosha, vitiated blood, mamsa, meda, and increses bad water content in body are major culprits to cause prameha.1, 2, 3
According to rasa5, 6, 7
Sweet-more sweet rasa food is heavy and unctuous by nature, which leads to vitiation of kapha, increases bad kapha and meda. This ultimately diminishes digestive fire and then diminishes tissue digestive fire, increases aama in tissues. Patient has symptoms of laziness, heaviness in body dyspnea, sweat, urine becomes sweet.
Sour-excess use of sour food leads to increase kapha and pitta. Because of hot nature of sour taste, bad water content in body increases, body tissue get loosen, kapha and meda liquefies. This increased bad water content, which is expelled out by body through urine; it prevents wound healing, and blood gets vitiated.
Salt-Excessive use of salt taste causes blood and bone marrow- majja vitiation and because of its hotness kapha also get liquefied. It causes thirst, and wrinkles.
Pungent-it is hot, potent increases kapha and causes blood and majja vitiation.
Bitter, Astringent- more use of these 2 rasa, because of dryness and coldness, vata gets vitiated, patient becomes weak, thin. His skin becomes lusterless.
According to quality of food8
Heavy- nourishes all tissues, especially mamsa (muscle), meda (fat), asthi (bone) and shukra. If more heavy food is consumed with cold and oily food then it causes vitiation of rasa dhatu, kapha increases, mamsa, meda, get vitiated, increased. If this heavy food is consumed with oily and sticky food, majja and shukra also get vitiated to cause body heaviness.
Unctuous- snigdha- kleda-bad water content in body increased. Fluffiness increased. As mamsa, meda, majja and shukra are oily tissue.when this snigdha is consumed with hot and liquid food it causes blood vitiation.
Picchil-sticky-meda, majja, shukra, oja, lymph get vitiated. Sticky food material like cheese are with water and earth quality, so they have capacity to coat. Patient shows symptoms of tangled hair, heavy voice with unclear words, skin becomes oilier, soft. Mala excretion and formation is more, so more waste material formed in eyes, ear, and nose.
Liquid- more liquid intake tend to diminish digestive fire. Excess water content in body increases, more kleda is formed. Tissue tone decreased.
If hot, liquid and potent hot food is consumed pitta becomes vitiated, causes more sweat, and body has typical pitta smell (visra gandha). Also patient complains palmo-planter burning.
If heavy and oily food is consumed with dry, cold and light food then it causes dyspnea and numbness in hands and legs.
According to food products9, 6, 7
Dhanya varga- cereals-new grains- heavy, sour, abhishyandi, vitiates all three dosha, mamsa and majja get vitiated so continuous intake must be avoided. Some variety of rice is cold, sticky, oily, heavy and its after digestion effects sour which are major causes of prameha. Black gram, sesame, new peas are abhishyandi in nature, increases more and more stickiness in body.
Milk products- buffalo milk is cold, unctuous, increases bad water content-kleda in body. It diminishes digestive fire it induces sleep. If more buffalo milk is consumed rasa and mamsa are vitiated. If milk is consumed without boiling it becomes very heavy for digestion. If the milk products which are prepared by more and more boiling and reducing milk are very heavy for digestion. Mamsa and meda are increased with its consumption. Curd is sour, heavy, and hot increases kapha, and pitta. Half curdled milk is abhishyandi, increases tridosha, kleda and burning in body. Urine excretion is increased, rasa, meda get vitiated. Clarified butter or ghee is rasayana-tissue nourishing by nature. More comsumption of ghee increases oiliness in body, more fat is nourished. Kapha is increased and also majja, shukra and rasa get increased, causes loose tissue, butter also increases fat.
Sugar cane variety-sugar cane is heavy, unctuous, nourishing with sweet taste and after effect is also sweet. It increases kapha and urine excretion. Sugarcane juice is sweet, unctuous, cold, laxative and increases kapha. Sugarcane juice extracted with machine is heavy for digestion, causes constipation and burning because of rasa and blood vitiation. Sugarcane juice nourishes mamsa and meda. Kakvi is prepared by boiling sugarcane juice, so it is very heavy for digestion, abhishyandi by nature and kapha and kleda increasing, it has tendency to increase urine output. Kakvi causes vitiation of muscle tissue. Sugar is sweet by taste and after digestion, so nourishes fat. Jiggery if not cleaned vitiates brain tissue, blood and fat tissue. It nourishes fat but because of hot nature pitta and blood get vitiated.
Mamsavarga- meat variety- meat of animals living in water, broiler chicken, fish, seafood, pig are heavy, unctuous, hot by nature. It increases kapha and pitta, vitiates mamsa, meda, and shukra, increases kleda, so strictly prohibited for prameha.
Madyavarga- Hard drinks- heavy, abhishyandi, increases all three dosha, after digestion effect is sour, causes blood and fat vitiation.
Shakvarga- Green, leafy, vegetables are heavy for digestion, constipating, blood vitiating so must be avoided especially in rainy season.
Payas- milk and rice are cooked together to prepare payas. It is very heavy for digestion, also increases kapha.
Krushara- it is prepared by cooking sesame, rice, back gram, so it is very heavy for digestion.
Contradictory food products- viruddhanna-
It causes brain tissue damage. It vitiates all three dosha, but are unable to expel it out of the body. For example, avoid eating milk and salt or fruits or curd together.
Hot, sour, salt, pungent, kshar- pickle, papad, chivada, chatni causes- blood, shukra, udak tissue vitiation causes pitta prameha.
Astringent, pungent, bitter, dry, light, cold food like corn, chickpea, and beetle nut causes vataja prameh.
Heavy, left-over food, frozen food, hampers digestive fire
Diet methods- To take food before the previous food is digested, to take contradictory food together, bad and good food together, and to eat without appetite, all these bad diet practices hamper digestive fire. Fasting increases vata, reduces tissue nourishment, thereby causes vataj prameh.
Diet as prameh treatment10, 3, 11
To expel kleda from body, roasted barley, wheat, pop up grains can be used.
Barley is dry, astringent, absorbs liquid, kleda from body. It’s after digestion effect is pungent. It reduces fat and kapha, pitta from body. It clears urine. It increases appetite, brings stability in body tissue. You can prepare many recipes from it according to dosha prominence. Ragi, green gram, red gram, old rice, sesame, mustard, jamun, bitter vegetables, honey, and roasted meat, small grains are light for digestion, dry by nature, so good for diabetes. Wood apple is sweet, sour and astringent, absorbs kleda from body, antipoisonous, it helps to reduce dyspnoea, cough, excessive thirst, vomiting etc. Indian blackberry or Jamun is helpful for pittaj prameha and should be avoided by vataja prameha. Bitter vegetables helps in dosha digestion, ignites digestive fire, constipating, absorbs kleda, so helps in prameh. Honey is kapha pitta absorbing, tissue nourishing, increases appetite and digestion and also increases tissue tone. Honey is dry by nature, so absorbs kleda, bad water content in tissues, thereby tissue nourishment is achieved. Pop up grains, pulses helps in tissue nourishment. Roasted meat nourishes muscle tissue, but if it is consumed with wet gravy, it does not help in nourishment, instead increases kleda.
Discussion
Pameha is a disease of liquefied kapha. All three doshas are involved later on. Diminished digestive fire, tissue fire, reduced tissue nourishment, tone, increased kleda, are major factors. To tackle these problems with Ayurveda, there by preventing patient to land up in diabetes means madhumeha is major role of proper ayurvda diet plan.
To eat Heavy, unctuous, sour, salty diet at a same time, are major causes of prameha.
To take sweet rasa in excess quantity leads to kapha vitiation, blood vitiation and thus causes amlameha and shonitmeha. Salt in excess quantity leads to kapha and pitta vitiation to cause lavanmeha, manjisthameha. Pungent in excess quantity leads to blood and majja vitiation. Bitter and astringent rasa in excess quantity prevents tissue nourishment, and patient becomes very weak. Heavy, unctuous, sticky, liquid qualities directly increases and vitiates kapha dosha. In diet, new grains, rice, milk products, sugarcane variety are very heavy for digestion, diminishes digestive fire, kapha vitiating, thereby bad for prameha. Meat variety, especially sea food, hard drinks are hot and liquid, thereby increases bad kleda in body. A green leafy vegetable, contradictory food products diminishes digestive fire and increases dosha. Food intake by proper method as told by Charaka, is very important to protect digestive fire.
In prameha treatment, Diet plays major role. We must advice food which is light for digestion, tissue nourishing, dosha pacifying. Barley has major role in prameha treatment. It is magic grain, it reduces kleda, meda and kapha. It increases appetite, light for digestion, but it should be avoided in vataja prameha. Honey is very helpful in prameha by reducing fat and kapha and by nourishing tissues. Small grains like ragi, small millet, grams, pop up grains, are light for digestion and also reduces kleda. Wood apple, Indian black berry, and bitter vegetables, are helpful to reduce kleda in body.
We can manage diabetes with the help of proper diet plan.
Conclusion
Diabetes is a disease of new era. Day by day its prevalence is increasing. Improper food and behavior habit are major cause of prameha. We can prevent prameha to progress in madhumeha-diabetes by following proper diet plan as per Ayurveda. We must avoid excess intake of heavy, unctuous, liquid, oily, hot, spicy food. More intake of sweet, sour, salt, pungent, should be avoided, new grains, rice, milk products, sugarcane variety are very heavy for digestion, diminishes digestive fire, kapha vitiating, thereby bad for prameha. Meat variety, especially sea food, hard drinks are hot and liquid, thereby increases bad kleda in body. A green leafy vegetable, contradictory food product diminishes digestive fire and causes blood vitiation.
We can treat prameh with diet plan. This diet should be according to obese and thin patient. Barley-yava, honey, small grains, pop up food, bitter veetables, Indian berry, are good for prameha especially obese. Wood apple, tandoor meat, timely intake of food, old honey, alcohol prepared from sugarcane, oil, ghee are recommended for thin prameha patient.
Clinical trials to prove these conclusions are necessary.
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