Diabetes : Ayurvedic approach

14th November is the World Diabetes Day. Every one will talk about the disease, in a temper for few days but is that all that we can do to fight with this complicated disease? The Question arises; is it worth just observing a day in the name of diabetes? 

Diabetes and complications related to are causing havoc in the society. You will be stunned by the increase in number of people affected with diabetes. In 2013, according to International Diabetes Federation, an estimated 381 million people had diabetes. Its prevalence is increasing rapidly, and by 2030, this number is estimated to almost double with maximum increase in India . 

Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in the developed countries. The greatest increase in prevalence is, however, expected to occur in Asia and Africa, where most diabetic patients, would probably be found, by 2030. 

By the year 2030 India will become the capital of diabetes.  Diabetes is attacking Indian population like an epidemic. Currently, in India more than 62 million individuals are diagnosed with the disease; which is more than 7.1% of India's Adult Population. An estimate shows that nearly 1 million Indians die due to Diabetes every year. The average age of onset is 42.5 years. According to International Diabetic Foundation, India has more diabetics ( 31.7 million) than any other country in the world, followed  by China ( 20.8 million) and USA (17.7 million).

The high incidence of diabetes is multi-factorial which includes genetic susceptibility plus environmental factors such as obesity, associated with adoption of a high-calorie diet, low-activity lifestyle and urban lifestyle changes. It is a reflection of adopting Western life-style by India's growing middle class. 

This difficult disease, once called adult-onset diabetes, is striking an ever-growing number of adults. Even more alarming fact is that, it's now beginning to show up in teenagers and children.The problems associated diabetes, are even more alarming. Early onset and longer duration of diabetes is responsible for the development of various complications.  

The data which shows number of people affected with complication of diabetes is really horrifying. Diabetes is the leading cause of blindness (due to diabetic retinopathy, 16.6% in those who are suffering from diabetes) and kidney failure (diabetic nephropathy in 21.1% ) among adults.  It causes mild to severe nerve damage (diabetic neuropathy in 24.6%)  that, coupled with diabetes-related circulation problems, often leads to the loss of a leg or foot (leg ulcers 5.5 %). Diabetes increases the risk of heart disease and cardiovascular complications (23.6% of Indian population affected with Diabetes). Poor glucose control is a factor responsible for damage of large and small circulatory vessels which bring about different complications in diabetic patients. 

However, even after knowing these facts & figures about this dreadful disease, which is looming large over the population of India in great numbers, many government and public health planners and health service providers are in inertia and in paralytic state and not in mood  to face this challenge. Even a gold standard test like HBA1C is not available in rural parts of India, which helps in initiation and intensification of insulin therapy in advance stage of the disease and in specific conditions. 

The picture seems to be horrifying and chaotic, but the good news is that type 2 diabetes is largely preventable. About 9 cases in 10 could be avoided by taking several simple steps: keeping weight under control, exercising more, eating a healthy diet, and not smoking.

For implementation of preventive programmes and to reduce the burden that diabetes creates,  Government of India as well as all the stakeholders of the society should take some wise steps. Modern conventional medicine (allopathy) and   Indian Indigenous Science, Ayurveda which puts lots of efforts on prevention of disease should join hands together while addressing the issue like diabetes. 

Emphasis should be given on diabetes detection programme where in population can be subdivided in-

1. Healthy group

2. Pre diabetics and  

3. Diabetics

Healthy group

स्वस्थस्य स्वास्थ्य रक्षणम्।।  or conservation of health of a healthy should be the aim of the medical management. So that rise in number of newly diagnosed diabetics could be kept under check. 

Preventive majors should be taken in healthy individual who are prone to diabetes, those who have family history of diabetes and who are obese. Although genetic predisposition influence development of type 2 diabetes, it can take a back seat if behaviour and lifestyles factors like excess weight, lack of exercise, unhealthy diet and smoking are kept in check.

• Need is to strengthen the early screening pre- diabetes program in pregnant women and in those who have BMI more than 25
• Awareness should be raised among the people, by  educating people about this dreadful disease and it's late complications so that more and more people would adopt healthy lifestyle
• Importance of daily and seasonal regimes mentioned in Ayurveda should be emphasized among the population. Adaptation of Dinacharya and Ritucharya puts you on the way to wellness. 

Ayurveda has given certain dietary guidelines. Following them strictly helps in maintaining health for example-

1. To avoid factors that are responsible in causation of diabetes   

2. To take wholesome and balanced diet. 3. To avoid frequent eating it leads to insulin resistance
4. To  avoid sleeping immediately after having food.  Sleeping after having food, decreases      basal metabolic rate.
5. To  avoid direct sugar and its by-product. It is mentioned as a primer causative factor in causation of diabetes
6. Incorporating cereals like java (barley) and ragi to diet

• Regular exercise like brisk walking and yoga help to prevent diabetes by reducing weight
• Following panchkarma procedures regularly arrests disease process by eliminating toxins that are produced in daily metabolic processes.
• Aachar Rasayan (positive behavioural changes) and regular meditation helps to reduction in mental stress and not allowing your cortisol levels to go haywire
• Rasayan chikitsa- health promoting medicines can be given to boost immune system, to reduce oxidative stress

Pre-diabetics (Patients with border line diabetes)- 
It is a metabolic condition where blood glucose levels are higher than Normal level but not high enough to be classified as diabetes. Pre-diabetes is a critical stage in the development of diabetes, for it is at this point that lifestyle choices can be made to turn it around. Early, decisive action can slow down or even halt the development of type 2 diabetes.

Pre-diabetes can be reversed and type II diabetes can be prevented
*If pre-diabetes stage detected earlyBy making changes in diet
*By adopting appropriate physical exercise
*By reducing stress level

Simply speaking following guidelines for healthy lifestyle,  advocated in Ayurveda will definitely help you to overcome pre diabetes stage

Diabetics -Patients who are labelled to have diabetes-
Type I Diabetes:
This form of diabetes occurs when the immune system attacks and permanently disables the insulin-making cells in the pancreas. This is type 1 diabetes, once called juvenile-onset, or insulin-dependent, diabetes. Roughly 5 to 10 percent of diagnosed diabetes cases are type 1 diabetes wherein treatment with exogenous insulin is must to keep sugar in control and to avoid diabetes related complications.

Type II Diabetes:The other form of diabetes tends to creep up on people, taking years to develop into full-blown diabetes. It begins when muscle and other cells stop responding to insulin's open-up-for-glucose signal. The body responds by making more and more insulin, essentially trying to ram blood sugar into cells. Eventually, the insulin-making cells get exhausted and begin to fail. This is type 2 diabetes.

Type 2 diabetes used to be called adult-onset diabetes, since it was almost unheard of in children. But with the rising rates of childhood obesity, it has become more common in youth, especially among certain ethnic groups.

As a number of diabetic patient is increasing in our country to fight against the diseases combine efforts should be made by the government, clinicians and health care providers and by patients themselves.

• Clinicians may target to facilitate implementation of screening and early detection, therapeutic management and self management and counselling in accordance with national diabetes program and guidelines
• Patient education programs and awareness programs about the complications of diabetes should be organised-Patient education programs to improve quality of life and to live healthier life even with diabetes should be encouraged.
• Regular screening for chronic kidney disease, Heart disease and eye check up for diabetic retinopathy is must to prevent major events like renal failure, heart attack and blindness

Ones patient have diabetes stopping anti diabetic medicines abruptly without consulting his/ her physician is like inviting trouble.  Patient's sugar may shoot up and his system may go haywire and it may end up with critical complications like diabetic ketoacidosos and diabetic coma. Patients should be educated about this. They should strictly adhere to their therapeutic regimen


Ayuerveda also says that pre-diabetes (prameha) is curable but when the disease progresses and converts in diabetes (Madhumeha) becomes non curable or palliable diseases. With adopting proper lifestyle, healthy diet   and medications one can have tight glycaemic control and can live healthy llife despite of he is having diabetes.

• According to Ayurveda the line of treatment of prameha and it's further stage Madhumeha is strictly on individuals constitution. It is based on entirely on modifications in lifestyle, diet, medicines.
• Purification procedures ( panchkarma) should be administered only when they are required and indicated according to one's physique and constitution.
• Hard exercise are prescribed in diabetes and obesity like walking, tracking, digging farming etc.
• Yoga and meditation improves metabolism and reduces oxidative stress and mental stress and definitely help in diabetes

Many Ayurvedic herbal and herbo-mineral formulations are useful to treat diabetes and its long term complications. The drugs of choice which are specially used in prameha or Madhumeha are-

1. Shilajatu 
2. Amalaki + Haridra
3. Triphala
4. Daruharidra + Haridra +Nagarmotha +Triphla 
5. Chandra prabha vati
6. Vasant kusumakar rasa in specific conditions
7. Home remedies like methi seeds, ginger, garlic, holy basil, triphala can achieve good glyceamic control
8. Other medicines like arjun,  , guduchi, gokshur, dhamasa, dashmool, vijaysar, gudmar, bilva, tulasi, jambu etc are effectively used in the treatment of diabetes and it's related complication like CAD, neuropathy, neuropathy. 

These medicines are scientifically proved have anti-diabetic, antioxidant, anti lipidaemic and cardio-protective effect.
Medicinal herbs like gudmar, bilva, vijasar, guduchi etc. lower the levels of blood glucose and glycosylated hemoglobin and increased secretion of insulin from existing pancreatic beta cells of islet of langerhans.
They are found to increases ability to utilize the blood glucose by improving glucose uptake by cells. Also regenerate pancreatic cells and improve function of beta cells.

Thus Ayurveda can help in prevention as well as in diabetes treatment and can be judiciously used in preventing complication of diabetes. Even patients suffering from end stage renal disease can get benefit with Ayurvedic treatment.

So on the occasion of world diabetes day let's join together to defeat monster of diabetes

Medicinal plants: Way to Wellness: Bilva

Bilva : The tree that cure diseases
(Bael tree, Aeglle marmelos )

Since childhood I have witnessed a special relationship between  Bilva tree and Lord Shiva. It is said that lord Shiva is fond of it's leaves (Bilva patra). You can get blessings from Lord Shiva, just by offering Bilva patra with devotion. Hence Bilva tree and Belpatra are of great importance for Hindus.

According to the Skanda Purana, the Bel tree has emerged  from the sweat droplets of Goddess Parvati which fell on the Mandrachal mountain.  Goddess Parvati resides in all parts of Bilva tree in all her forms along with Goddess Laxmi. She resides as Girija in the roots of the tree, as Maheshwari in its trunk, as Dakshayani in its branches, Parvati in its leaves, Katyayani in its fruit and as Gauri in its flowers.

The leaf of  Bel tree is trifoliate which signifies the holy Trinity: Brahma, Vishnu and Shiva. It also signifies the three eyes of Lord Shiva.It's trifoliate shape also signifies the three components or 'gunas' namely the Sattva, Rajas and Tamas. The Sattva guna is the positive energies while the Tamas is the negative forces. It is believed that the centre part of the Bilva leaf has the natural characteristic to attract the Sattva or the positive energy. When someone touches the Belpatra, the positive energies are transferred to him/her. So, it is said that touching the Bilva tree makes you get rid of sins and ailments.

According to ancient text of Ayurveda Bilva tree has great medicinal values and is extremely beneficial for health.

The roots, skin, leaves, fruits ane seeds are being used in medicine to cure various ailments . Bilva is 'sweet', astringent, appetizing and gastric stimulant.

According to Charak Samhita bilva is best among the medicines which binds stools, which enhances function of agni (deepan), and in thoes that alleviates kapha and vata dosha.

Crude extracts different parts (Fruits, seeds, leaves, bark and root) of the bael plant are used to treat various disorders in different Indian traditional systems.
Roots-  are used to cure cardiac malfunction, abdominal pain, fever, urinary troubles.

Leaves- are used as an astringent, laxative, digestive, anti-inflammatory and pain reliever . They are also useful in hearing loss.

The unripe fruit- is also helpful in curing dysentery.

The ripe fruit- is used as an astringent, appetizer, laxative, tonic, restorarative.

Different parts of this plant are used to cure various diseases in folklore medicine. some of it's medicinal properties have been proved with the help of  array of modern tests.

Extracts of Different parts of bilva tree have found useful in different ailmentssuffice for an adult.

Diarrhea and Dysentery-
Bilva possesses antiprotozoal and antibacterial activity against  common pathogens of gastrointestinal tract like Escherichia coli, Salmonella typhi, Salmonella paratyphi, Proteus vulgaris, Streptococcus faecalis, Vibrio cholerae etc. Hence it useful in the treatment of diarrhoea, dysentery and other infections of GIT.
The unripe or half ripe fruit is perhaps, the most effective food remedy for chronic diarrhea and dysentery where there is no fever. Best results are obtained by the use of dried bael or its powder.
The unripe bael can also be baked and taken with jaggery or honey.

Dried powder of Bael fruit is also a valuable remedy for chronic dysenteric conditions characterized by alternate diarrhea and constipation.

Constipation-
Ripe bael fruit is regarded as best of all laxatives. It cleans and tones up the intestines. Its regular use for two or three months helps evacuate even the old accumulated faecal matter from the bowels. Juice of ripe fruit with milk and sugar  or pulp ( about 30 gms) should be taken for best results.

Fevers-
Bael leaf extract possesess anti malarial ( anti protozoal and schizontocidal) activity. Decoction made from the bark of the plant is often used in the cure of malaria.
The juice of bael leaves, with honey, relieves fever and catarrh.

Respiratory Affection-
Bael leaf extract also have anti-allergic and anti-pyretic properties.A medicated oil prepared from bael leaves gives relief from recurrent colds and respiratory affections. The juice of bael leaf, mixed in warm water with a little pepper, is given  as a drink to bring relief from wheezing and respiratory spasm.

Gastro duodenal ulcers-
Gastroduodenal ulcers are very common and irritative in nature. Multiple factors are involved in causation of Gastroduodenal ulcer such as -
- Development of oxidative stress due to unhealthy food habits, unhealthy lifestyles and addition of tobacco, alcohol pan masala, etc
- Decreased blood flow to internal lining ( mucosa) of the stomach and GIT
- Stress, non steroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori infection are the most common causes of ulceration.
All these factors lead to imbalance between repair and regeneration of gastric mucosa lowering gastro protection and play a dominant role in the pathogenesis of ulcer.

Along with other Indian medicinal plants like turmeric and neem, bilva also have shown antiulcer activity. A potent antioxidant compound " luvangetin" is present in bael fruit which inhibit oxidative stress thus shows prominent gastroprotective effect .

An infusion of bael leaves is regarded as an effective food remedy for peptic ulcer. The leaves are soaked overnight in water. This water is strained and taken as a drink in the morning for few weeks. It helps to releive pain and discomfort. Bael leaves are rich in tannins which reduce inflammation and help healing of ulcers.

Diabetese mellitus-
Diabetes mellitus is a common metabolic disease around the world. A large percentage of the global population is suffering from this disorder. Diabetes and its related complications are closely related with oxidative stress of the body. Diabetes is closely inter-linked with cardiovascular as well as renal disorder at advanced stage and creates fatal disease syndromes.

Bael fruits, seeds and leavers all have exhibited hypoglycemic effect in animal as well as in clinical trials. This anti diabetic effect of bilva tree is multidirectional.  The extracts lower the levels of blood glucose and glycosylated hemoglobin and increases secretion of insulin from existing pancreatic beta cells of islet of langerhans. It increases ability to utilize the blood glucose by improving glucose uptake by cells. The leaves extract can also regenerate pancreatic cells and improve function of beta cells.

Taking 15-20 ml leaf extract or munching 10-12 bael leaves for 15 days significantly reduced blood cholesterol levels with blood glucose in diabetic patients.

Antihyperlipidaemic, cardio protective activity-
Higher concentration of blood triglyceride, fatty acid and cholesterol level make blood vessels stiff,  less elastic and inflammed. This condition is known as atherosclerosis. Atherosclerosis    increases the risk of heart diseases like ischemic heart disease, myocardial infarction and cerebro vascular accidents.

Along with your conventional treatment you can take 10-12  bael leaves for prevention and  as adjuvant treatment in above mentioned cardiac diseases.

Extract of bael leaf reduces oxidative stress (lipid peroxidation), and reduces  serum lipid levels. It decreases fat synthesis and decreases fat mobilization from the peripheral depots in to the blood.  Leaf extract activates break down of triglycerides and decreases circulatory level of blood cholesterol by decreasing fat mobilization from peripheral adipose tissues. This extract also potentiates glucose utilization by burning glucose at cellular level.

Antioxidant activity-
Oxidative stress is produced during normal metabolic processes in the body as well as induced by a variety of environmental and chemical factors, oxidative  stress generates various reactive free radicals.  Free radicals are reactive oxygen species which  can damage to macromolecules like DNA, proteins and lipids.

Bael fruit and leaf contains Eugenol and marmesinin which are responsible for such powerful antioxidant activity. Extract of bael leaf scavenges free radicals like hydroperoxides (HP), creatine kinase (CK) and lactate dehydrogenase (LDH) etc. Whereas it activates antioxidant machinery in the body and increases enzymes like glutathione, glutathione peroxidase, glutathione reductase, superoxide dismutase (SOD) and catalase which reduces oxidative stress.

Cancer-
Beal leaf extract shows anti cancer effect in animal studies.   The plant extract exhibits cytotoxicity against tumor cells, arrests cell cancer cells proliferation. It also induces apoptosis (programmed cell death) which may be due to the presence of skimmianine in the leaf.
Hence it can be used in cancer treatment as an adjuvant drug which will be inexpensive and non toxic.
It also possesses Radioprotective activity. Hence it can be used with other anti cancer drugs and radiotherapy to prevent side effects of radiation.

Hope

HOPE

Never indulge in any act that removes the hope from a patient who has a serious illness, after all, that may the only positive thing your patient may have… 

http://www.slideshare.net/mobile/kasinamrao/cpd-ob-gyn-specialist

At 5th Intenational Conference on Translational Cancer Research, 

New Delhi

Apoptosis and miraculous herbs

Apoptosis and Miraculous herbs-

Our body cells are very disciplined and are of highly organised community. The cell number is tightly regulated not simply by controlling the rate of cell division, but also by controlling the rate of cell death. If cells are no longer needed, they commit suicide by activating an intracellular death program. 

This process is of programmed cell death, or Apoptosis.Meaning of apoptosis ( a Greek word ) is “falling off,” as leaves from a tree.

You will be surprise to know the fact that infinite number of cells undergo apoptotic process during one's life span.

For example, in developing feotus, up to half or more of the nerve cells normally die soon after they are formed. Isnt it amazing? But it's a regulatory system of body for cotrolling cell number. 

Just imagine what will happen if cells refuse to die. They will live longer and with the help of other oncogenic factors lead to cancer.  Mutations in certain pro-apototic genes can cause havoc in the bodies defence mechanism but this does not happens always. Bodies immune surveilance is far more powerful and keep all cell under tight control.

Diseases in which apoptosis is implicated as one of the causative factor are cancer, neurodegenerative diseases and auto-immune disorders. The rate on which cancer cells grow depends on rate of  cell division and cell death. Ofcourse in cancer, rate of cell division outgrows rate of cell death. Abnormal apoptotic process can promote development of cancer by either allowing accumulation of cancer cells or by preventing their removal. Apoptosis is found to be an efficient way for preventing malignant transformation because it removes genetically malformed cells.

Apoptosis also have a role in causation of neurodegenerative disorder like Alzheimer's disease . Modulation of apoptotic process may be useful in the treatment. The rate of neurodegenerative disorders have been increased as a result of increases in the census of ageing population. Hence there is a need to find newer solutions for this challenge. 

Exaggerated apoptotic process is also problematic as in AIDS. In AIDS the balance between rate of CD4 ( one type of lymphocyte )death and it's replacement is impaired. Here inhibition of apoptotic process is useful in the treatment. 

Indian medicinal plants which are described to have rasayana properties can be effectively used in such conditions as they can have check on our immune surveillance system. Medicinal plants with Rasayana properties help in slowing down aging process and provides protection against diseases. 

Rasayanas provide long life, ability to remain young and good intellect by enhancing proper uptake of nutrition by body cells thus imparting proper growth and improvement in seven vital tissues.

This can be achieved by multifaceted actions of Rasayana drugs. With their antioxidant, anti-carcinogenic , immunomodulator properties these medicinal plants can activate immune responnsivenes of an individual ( organism). When immune system of body is activated it sets into motion a whole cascade of events that act on different organs and produce different beneficial effects.

Indian medicinal plants also offer prospects for the modulation of the balance between proliferation and apoptosis.A yurvedic medicinal plants have been found to modulate the apoptotic process. For example the plants like Punarnava
(Boerhaavia difussa) and Amruta
( Tinospora cordifolia) have been shown to inhibit apoptotic process by stimulation of macrophage and GM- CSF which activate enzyme protein kinase C and inhibit apoptosis and have potential role in the treatment of AIDS. 

There are number of Rasayana drugs mentioned in Ayurvedic texts like-

1. Haritaki ( terminalia chebula)

2. Amalaki (Publica officinale) 

3.Bala (Sida-condifolia)

4.Ashwagandh (Withania somnifera) 5.Pippali (Piper longum)

6.Brahmi (Bacopa monnieri)
7.Mandukaparni (Centella asiatica) - 8.Guggul (Commiphora mukul) 

9.Bhallataka(Semicarpus anacardium)

10.Punarnava(Boerrhevia diffusa)

11.Shatavari(Asparagus racemoses)

12.Haridra(curcumalong,termeric)

13.Nagavalli ( piper betel,  betel leavef)