Diabetes mellitus, Ayurveda, and yoga.

Abstract

223 Diabetes mellitus (DM) is an ancient disease. The ancient Indian medical system, Ayurveda, which is based on scientific principals, described diabetes under the name Madhumeha (excretion of sweet urine). Madhumeha is largely described under the broad heading of Prameha. The word Prameha means, “passing of excess urine, both in quantity and frequency.” Ayurveda considers DM in three stages; early (Kaphaja prameha), acute (Pittaja prameha), and chronic (Vataja prameha). In the strict Ayurvedic definition, Madhumeha actually refers to the terminal stage of the disease and is said to be incurable because of the advancement of the disease and improper early management. However, the term Madhumeha has become popular and is referred to all stages of DM in the common literature. Ayurveda was first to recognize the two major forms of DM, the genetic form (Sahaja prameha) can be compared to the insulin-dependent DM, and the acquired (Apathyanimittaja prameha) form that is considered to occur at a later stage of life and is comparable to non-insulin–dependent DM or type 2 DM. In the later form, the role of improper diet, lifestyle, and psychic factors were recognized as causative. The dietary factors that influenced Apathyanimittaja prameha or adult-onset DM in Ayurveda are: frequent and excessive eating of sugary, acidic, and salty foods, fresh grains, certain animal flesh, and fresh wine. Supporting this ancient knowledge, several current studies have shown that diet has one of the contributing factors in the etiology of type 2 DM (Mokdad et al., 2001; Nielsen and Popkin, 2003). Ayurveda recommends that one third of our stomachs should be for food, one third for water, and the remaining third should be empty promoting caloric control to prevent obesity and a host of complications as a result of it. Ayurvedic frequency of food consumption is to eat only when one feels hungry, usually not more than two meals per day with no snacking. The increase in consumption of unwholesome food could be another factor in the etiology of non-insulin–dependent diabetes and this has always been discouraged in Ayurvedic medicine. Ayurveda further added that excess consumption of wholesome food is as bad as little consumption of unwholesome food. Under lifestyle that influenced Apathyanimittaja prameha or adult-onset DM in Ayurveda, was the lack of exercise, overindulgence in sleep, sedentary habits, lack of cleanliness, and suppression of natural urges. Current studies have confirmed that there is increased risk of developing type 2 DM from lack or exercise and sedentary lifestyle (Hu et al., 2001). Under lifestyle that influenced Apathyanimittaja prameha or adult-onset DM in Ayurveda was the role of stress as a psychic factor that leads to neuroendocrine changes. Ayurveda recognized the impact of emotional changes on diabetes. Ayurveda considers emotions as psychophysiologic phenomenon effecting automatic responses (through adrenaline and glucocorticoids) that may result in hyperglycemia/hypoglycemia and thus, impact DM. Yoga, the ancient Indian approach to stress control and exercise, promotes physical exercise, mental discipline, and voluntary control of autonomic nervous system (at its highest peak of attainment) is gaining increasing popularity in the West as a form of exercise and as a stress control technique. Yoga practice includes muscles stretching, breathing exercises, behavioral modification, and diet control through mental discipline. Because it is established that control of stress and exercise have a positive therapeutic benefit in DM management, it is no surprise that the yogic principles and practice has an impact in the management of DM. These benefits are summarized by Somani et al (1995). Studies have shown that incorporation of yoga in the management of DM has resulted in reduction in the dosage of hypoglycemic agents and insulin, control over weight, increased glucose tolerance, and reduction in hyperglycemia. It also resulted in the reduction in increased blood lipids. Yoga practice discourages overeating and overindulgence through mental discipline. While no known effective prevention or delay of the development of diabetic peripheral neuropathy other than possibly effective control of the disease exists, yoga practice in patients with diabetic neu-