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
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2 izd`fra vuqigR;
3 ;Fkk dkya tjka xPNfr
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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