I came across one funny story. Once, lord Ganesh was suffering from excessive urination. He had caught disease called Prameha (Diabetes). To get rid of Prameha, lord Shiva, his father formulated one medicine called as “Shiva Gutika.” Ganesha took that maedicine, ate leaves of kapittha phala  (elephant’s fruit) and got rid of Prameha. This story is described in one of the ancient Ayurvedic textbooks (REF). Disease Prameha is a condition described in Ayurveda, whose causes, signs, symptoms, manifestation coincide with the current ideas of diabetes, which we see today. We can say that Lord ganesha was suffering from diabetes. Whether it is just a story or truth, it was interesting to know why Lord Ganesh caught diabetes? As we see in modern days, who is prone for diabetes? A person 1, who is overweight

2. who has big belly (in scientific language, it is called as central obesity)
3. who overeats and consumes large amount of carbohydrates, especially sweets
4. , who leads sedentary lifestyle
5. , who has lot of mental stress and brain work
6. current research also points to short and fat people, who are more likely to get diabetes.

Lord Ganesh just fits in above criteria. Ganesha has big belly, that is why he is called as Lambodara. He likes sweets in the form of modakas and laddus. He was eating with elephants head (Gajaanana), which naturally caused overeating but his rest of the body was like a human. So, the digestive system and pancreas (a gland, which secretes insulin to control blood sugar levels) had its own limitations. He seemed to avoid physical activity. So, when the time came for Prithvi Pradakshina (going round the earth along the equator), his brother Kartikeya did it. But he made his parents Shiva and Parvati to sit in the centre and went around them to complete pradakshina. As we all know, Ganesha is worshipped as a god of intellect (Buddhidevata). He comes under class of intelligentia, who has lot of brainy work. If we look at these symbols, we can realize why Ganesha must have caught diabetes. Ganesha’s story gives us insight to look at this disease. It also indicates the line of treatment in terms of diet, physical activity and medicine and mentions that Ganesha got rid of disease (reversal of the condition…..hurrey!) Atharva veda  (…..), one of the four Vedas describes the disease Aasraavam meaning polyuria (excessive urination). Charak samhita, an Ayurvedic textbook, (written in 1500 BC – 200 AD), which is followed by Ayurvedic fraternity even today, substantially describes disease Prameha (Diabetes). Sushrut samhita, the another textbook of Ayurveda, which is dedicated to surgery (1000BC), also describes Prameha and its complications like carbuncles, abscess and nonhealing wounds, which needs surgical interventions.  Next to these, Ashtang Sangraha (…..), astanga Hridaya samhita (…….), Yog ratnakar(…….), Bhavprakash (…….)compiled the information given in Charak and Sushrut with few timely additions of medicines. Ayurveda, the Indian system of medicine is based on above knowledge, which certainly can throw light on today’s problems. Don’t think that ‘ancient is outdated’. It can be applied even today and guides us to lead healthy life which is the mission of this science “maintain the health of healthy person, help the unhealthy person to get rid of his disease”. In this series of articles, we are going to see the applied aspect of Ayurveda, which will help us understand how to deal with diabetes. How to prevent it. How to manage it. How to control it. What lifestyle changes (other than those we know today), we need to make. What type of diet will help us keep fit, control our diabetes and prevent the complications. And lastly, how to prevent diabetes in ourselves and in coming generations. Diabetes patients are exponentially rising the world over, India being the capital of Diabetes. Advances in modern therapy are certainly offering better management tools day by day. But, they have got their own limitations. Its time to dig up our ancient medicinal system and traditions, which are time proven and which have kept our forefathers healthy and long lived with minimal use of medicines and supplements. Not only for us, but for the coming generations, we will have to go back to certain age old good practices, if at all, we believe in Genetics and Epigenetics.

As we saw in our previous article, Prameha is a disease described in Ayurveda, which we can relate to Diabetes. If we look into the disease Prameha and its description available in ancient Ayurvedic textbooks (Charak, Sushrut, Vagbhat etc.), we realize that the concept of “Prameha”  covers broad spectrum of this condition from pre pre pre diabetic stage to end stage diabetes along with its complications. Let’s see how. The Sanskrit word Prameha means a disease, in which a person prominently urinates. In a broad sense, Charak says that, a person, who frequently passes plenty of turbid urine, is said to have Prameha. So, there are three signs which should be present at a time. They are 1. Passing large amount of urine 2. At more number of times  3. Urine should be turbid.  As per Ayurveda, normal frequency of urination is supposed to be six times a day. Frequency more than six times a day is supposed to be excessive urination (whether it is due to Prameha or anything else).  Now a days, We are advised to drink larger quantities of water for keeping ourselves fit…(?).! So, we pee more than six times a day. If we drink water, only when we are thirsty and drink that much quantity, which will quench our thirst, means as per body demands and not as per our smart (?) knowledge, and still we have to pee more number of times, then, we can call it as excessive urine frequency. Increased frequency is always seen, when we suffer from urinary Tract Infection. But in this condition, we frequently pass smaller quantities of urine with agonizing pain and burning sensation. Whereas, in Diabetes, large amount of urine is passed without any pain. The usual colour and appearance of urine is pale yellow and clear. But, in Prameha, urine appearance is turbid. So, in Ayurveda, Prameha is defined as FREQUENTLY passing LARGE amount of TURBID urine. This is the main differentiating symptom of PRAMEHA. Why does a person frequently has to pass large amount of turbid urine? Certainly, there is some disturbance in the body.  Some of the constituents, which body cannot accommodate within it, looks at them as a toxic waste, have to be thrown out of the body. Which are these body constituents? They are either generated inside the body in excess, are water soluble or can easily get mixed with water and find their way out along with urine. As a result, they add to the quantity of urine, change the urine appearance from clear to turbid. What do these toxic wastes come from? To get the answer to this question, we go to our proverbs, notions in our culture. Anything, which we think as “good” is “bad” in excess quantities, when it crosses its limits. Too much of food, luxury, wealth, exercise etc. are as bad as the poison. Same thing applies to the body. Too much of “good food” (especially fats and carbohydrates), if put inside the body (which generally nourishes our body), it will get accumulated. If we don’t utilize them through physical and mental activity, they will get accumulated as toxic waste. Then what is the correct quantity of food? It will defer from person to person. It is not just the quantity of food, but also the quality, which has effects on our body. Coming back to our definition of Prameha, it is the disease which is expressed through changed nature of urination. Ayurved describes the causes of Prameha, types of Prameha, who is prone for it, its symptoms occurring much before the disease (in medical term, they are called as prodromal signs and symptoms), stages of disease development and its complications. It is also said that, if we can diagnose the earlier stages, reversal is possible. In the growing epidemic of diabetes, it is necessary for all of us to understand, what is it, That Ayurveda emphasizes. With the help of modern science, we are able to control blood sugar and manage diabetes and some type of emergencies occurring  during its course to a certain extent. But still, there is a long way to go. The medicines, which can control blood sugar levels fail after certain time period and we have to increase their doses or go on adding different drugs. We have to lifelong use cholesterol lowering drugs and blood thinning agents and blood pressure lowering drugs and vitamin supplements and….the list go on increasing. In such a scenario, if we can have holistic approach of the treatment, which will take care of all these conditions, it will certainly minimize the number of drugs and doses we need to take to manage our diabetes.For this, let’s try to understand, how the disease was managed by our forefathers, two thousand years ago. It can give us different perspective to look at the disease.

Now we have identified diabetes as Prameha in Ayurvedic language. If we see, what disturbance takes place in Prameha, which causes excessive urination, the curser points to body fats and its wear and tear. Yes.  Ayurved has given prime importance to body fats (and not carbohydrates) as a causative factor in developing this disease. Let’s see how. Once a upon a time, when I was an undergraduate student (say in 1990), when I was taught about disease Prameha, when I looked at it through the perspective of modern science, it was really hard to accept Ayurvedic concepts of Prameha and link them to Diabetes. It was a time, when modern science has been looked as superior to all the medical science and all other pathies were secondary. Ayurveda was not an exception. Modern concept of diabetes, insulin secreted by pancreas and its role etc. were proven concepts. Use of insulin and drugs stimulating insulin secretion were seen lowering down the blood sugar and minimize the symptoms. Ayurvedic concepts were far from our reach causing confusion due to our mindset. I have seen people laughing at Ayurvedic physicians, who tried to put Ayurvedic concept of Prameha in medical conferences on diabetes. In fact, most of the Ayurvedic physicians  were also not clear  about the ideas. When the limitations of modern antidiabetic treatment were apparent and more and more research started happening in the modern science, body fats started gaining attraction. Research threw light on the role of fats in the development of diabetes, which actually threw light on the Ayurvedic concepts. We could read Ayurveda in between the lines. It gave different perspective to look at Prameha. Ayurvedic concepts of fats and Prameha were far more different, practical, applied and deep. The aim of this article series is to take those concepts to society, which will help controlling this epidemic. Coming back to our title, Ayurveda has given importance to body fats and its wear and tear (in medical language, it is called as fat metabolism), body composition etc. Ayurveda considers basic seven type of tissues which built the body. Fats are one of them. They are known as Meda (fats)dhaatu. Meda dhatu, in normal condition (physiological state), has got its own functions in the body such as offerinf lubrication and cushioning to the body ailments. Optimium quantities of fats are necessary for proper functioning of cells to systems of the body.  Derangement of  medadhatu and its system of wear and tear (deranged fat metabolism),  is the basic cause of Prameha. And Prameha is one of the manifestations of deranged fat metabolism. Now, who has got deranged fats? Ayurveda describes certain body types, which are said to have deranged fats. These body types are: excessively fat, excessively thin, excessively tall, excessively short, excessively fair, excessively dark complexion and those having excessive body hair or no body hair at all. The point is though they are said to have deranged fats, they may not necessarily catch Prameha. Observational studies in modern science have shown that, obesity (higher weight in kgs for a given height as measured by body mass index), especially central obesity (having big belly), adiposity (thick skin folds of waist, back and arms, where the fats are deposited),  are associated with risk factors of diabetes (blood sugar levels, insulin levels, cholesterol and triglyceride levels etc). In one pilot Ayurvedic study, Short stature, having excessive body hair were also associated with these risk factors. Secondly, those who have prodromal signs and symptoms of Prameha (and they may not have disease Prameha) have deranged fat metabolism. These prodromal signs of prameha are listed in Ayurveda.  These signs and symptoms are present much before the actual manifestation of Prameha. So, it can be hypothesized that, those who have the signs of deranged fat metabolism may be prone for diabetes. Coming to body composition types. Excessively fat is prone for diabetes. That is understood. But as per Ayurveda, excessively thin person also has deranged fats. Excessive tallness or shortness, fatness or thinness, having excessive body hair and no body hair at all are the disorders of endocrine system and hormones in the body. Diabetes also is a disease of endocrine pancreas. It is noteworthy that, Ayurveda has linked these conditions to fat system i.e. medadhaatu. Ayurveda has given standard body measurements for a human body. If I measure my height using my own fingers (average breadth of my middle fingers is equal to one unit to measure my own body parts), it should be 84, my ears, nose, forehead, neck should be 4 fingers in length and so on. One study has been carried out in Pune, in which such body measurements were taken using finger unit of each participant to measure his own body parts like facial structures and  limbs. If a person had smaller or larger measurements than the reference  body measurements described in Ayurvedic textbooks, they had comparatively more amount of  fats in the body measured as weight, waist circumference, skin fold thicknesses and actual body fat percentage measured on DEXA machiene. Similarly, other signs of deranged fats that is prodromal signs and symptoms of Prameha, were also associated with modern markers of adiposity and diabetes. Fat metabolism is gaining attraction of medical researchers since just a last one and half decade. Treatment strategies are changing to certain extent accordingly. Whereas, whole understanding of Prameha and its management in Ayurveda is based on deranged fats. Its approach  to look at the disease, its steps of development, causes, treatment strategies and diet are different and special. We, the common people, need to understand them for controlling this epidemic of Diabetes.

As per the theory of modern science, Diabetes is the condition occurring due to defects in insulin. Let’s understand, what this insulin is. In our tummy, there are many soft organs like stomach, liver spleen, intestines, gall bladder etc. We also have one gland, called pancreas (3 to 4 inch in length) situated near initial part of small intestine. This pancreas secretes pancreatic juice, which helps in the process of digestion of food in the gastro-intestinal tract. Pancreas has a narrow end known as tail of pancreas. In this part, there are islands of specific cells, which secrete the hormone insulin. They are known as beta cells of islets of Langerhans. And this part of pancreas, is known as endocrine organ. The food, what we eat, is digested in gastrointestinal tract with the help of various types of digestive juices. Sugar, protein and fat molecules are released from complex structure of food and they are converted into simple form to get absorbed into the blood circulation. Through blood circulation, they reach various body organs like muscles and brain and other tissues. Sugar, which is absorbed in the blood enters inside the cells of various tissues with the help of insulin. When, there is no insulin or less amount of insulin secreted by beta cells of tail of  pancreas, sugar partially enter or cannot enter inside the cell to provide energy to the tissues. It remains in the blood. Many a times, insulin is there, but it is inefficient to carry out its function. So, blood sugar remains in the blood even in the presence of insulin. When, blood sugar raised beyond the threshold, body tries to throw it out of the body through urine. For throwing out the sugar, body has to pass larger quantities of urine frequently. This we call it as diabetes mellitus (passing sweet urine). When there is complete deficiency of insulin, we call it as Type I diabetes, which requires insulin injections. When the insulin is not working properly, we call it as Type II diabetes, which initially can be managed with medicinal pills, but may require insulin in later stages. It was supposed that, Type I or insulin dependent Diabetes occurs in children and type II or non insulin dependent diabetes occurs in fatty person and in old age. But this is no more true. Type II Diabetes, which was supposed to be the diabetes of the adults is now seen at quite earlier age as early as age 20, and even at 10! Let’s now see the Ayurvedic perspective. Ayurveda believes in TRIDOSHAs, vaata (kinetic energy required for all body movements during respiration, blood circulation, locomotion, excretion etc.),  pitta (Thermal energy, responsible for digestion and transformation, complexion, vision etc.) and Kafa (potential energy responsible for body building, keeping the body elements intact and lubricated for their optimal functioning). These three doshas control the functioning of seven tissues “saptadhaatu”. Those are rasa (plasma), rakta (blood), mansa (muscle tissue), meda (Fats), asthi (bones), majja (brain and nervous tissue) and shukra (reproductive system). Body is in harmony, when tridoshas are in balanced state. Our daily food, lifestyle, seasons, age has temporary effects on this balance of tridoshas.   Eg, kafa dosha is expressed as saliva, lubricant fluids present in lungs, joints, around the heart, brain etc. It  increases after eating cold, sour, sweet, liquid type of food like fruits, fruit juices, curd, buffalo’s milk etc. It is  prominent in the childhood.  Pitta dosha is expressed as intellect, anger, boldness, adventurous and conquering nature. It increases due to hot, spicy and pungent food.  It is prominent in the youth. Vaata dosha is expressed as lung movements when we breathe, beating of heart, blood circulation, movements of joints when we walk or do any physical activity including speech or excretory functions.  It is responsible for dryness in the body, aging disorders like tremors, weight loss, reduced strength etc. Vaata dosha increases due to excessive exercise, starvation, chronic diseases, raw and fatless diets etc.It is prominent in old age. We need optimum amount of fats to control vaatadosha, nourish kafadosha and stimulate pittadosha for its functioning. In Prameha, body looses the balance of these Tridoshas. Due to our food and lifestyle, excessive fats get deposited and accumulated in the body.In the presence of accumulated body fats, If we frequently eat a particular diet which increases and vitiates kafa dosha, then body fats  are vitiated and give rise to a type of Prameha which is called as kafaja Prameha (Prameha originating from vitiated kafadosha). . If we frequently eat a particular diet which increases and vitiates pitta dosha, then body fats  are vitiated and give rise to a type of Prameha which is called as pittaja Prameha (Prameha originating from vitiated pittadosha). Similarly, vitiated vaatadosha causes vaataja Prameha. Like this, there are three pathways through which disease developes in the body. The purpose of this theoretical description is to understand that the causes and line of treatment of each Prameha type is different. We need to understand  Prameha type first before following diet, lifestyle and the medicines. The complications of Prameha occurring in each Prameha type also vary from each other. In the successive articles, we are going to see each Prameha type, their causes, symptoms etc. in details.

We have now linked Diabetes Mellitus with the disease Prameha due to the similarity of symptoms, causes etc. Similarity is that, it presents itself as increased quantity and frequency of urination, increased thirst etc. Fatness, physical inactivity, consumption of sweets and fatty diet are the causes. Patient has to exercise and control his diet to control or get rid of the disease. We all know about this. But, there is something more Ayurveda has mentioned, which is also interesting. Causes of Prameha: Ayurveda describes causes of Prameha in general and then as per each type in particular. In general, any type of food or lifestyle, which increases kafadosha and meda (body fats) and watery waste product in the body thrown out as urine, if consumed frequently, in large quantities and consistently for a longer time will cause Prameha. What are these food or lifestyle?

1. Long hours of sitting at one place in a relaxation mode (Physical inactivity poor activity) : If you are sitting on a stool or working chair actively doing some work, getting up several times, taking out some files from the cupboard, or for doctors, getting up from chair to examine his patients, will not come under this category. But, imagine a big shop owner (seth ji) sitting in his revolving chair or on his mattress at the cash counter from morning , when the shop opens till the lunch time, and the from evening till night. Imagine an IT Professional or programmer sitting for long hours in front of the computer. Imagine any middle aged house wife, sitting on a sofa with a TV remote in hand and changing the channels. These long hours of inactive sitting is the causative factor mentioned first in the list of causes.
2. Long hours of peaceful sleep: All of us need 7-8 hours sleep daily, which makes us rejuvenated, active and prepares us to take workload the very next day. When I say peaceful sleep on the comfortable bed and that is for long hours, means more than 8 hours, it differentiates dozing while sitting in the chair or while travelling or while listening to boring speech. Ayurveda says that, if you sleep less at night, say for 2 hour, you should make it up during the day time, by sleeping for half of the time period which you missed at night, that is for 1 hour. Long hours of sleep is a cause of Prameha. Now imagine a person, who enjoys his night parties or watches TV or works till late night say around 2.00 Am. And then he goes to sleep till 10.00 AM in the morning. Means, he sleeps for virtually 8 hours. But if we apply above logic, won’t you call it excessive sleep? His sleeping pattern is also changing his body rhydm and physiological functions and metabolism and……what not? Excessive sleeping increases kafa dosha in the body, increases body fats and watery waste product, which will add to the urine volume too.
3. Daytime sleep: Now let’s apply above logic again. A person regularly doing night shift at his work place, sleeps during the day time for more than 5 hours a day, won’t you call as excessive sleep? In addition to it, he will be eating all his meals during the day plus eating extra or at least tea or coffee during his night duty. This situation will serve as a causative factor for Prameha in the long learn.

There is one more twist. If a person sleeps in the afternoon after taking his lunch, that also is supposed to be a cause of Prameha. Taking a nice heavy lunch in the afternoon and then to have nice 1 hour to 1 ½ hour sleep is our favorite weekend activity. Now, imagine a situation, where a person at home having a long nap daily after his lunch. Increased kafa dosha, increased deposition of meda and….prone to Prameha.

4. Poor physical activity: It is needless to say that poor physical work, no exercise will deposit more amounts of fats, responsible for reduced muscle tone and causes diabetes in long learn. Rather, physical exercise is a first line of treatment for diabetes. There is no alternative for physical exercise in terms of diet and medicines. As per Ayurvedic theory, poor physical activity will cause accumulation of kafadosha and deposition of medadhatu in the body, which are responsible to cause Prameha. Ayurveda also advises on what type of exercise should be done to treat and get rid of Prameha.

So, we can say that, moderate physical activity and appropriate sleeping pattern should be crucial part of our lifestyle. Are we able to follow these simple norms? If answer is yes, we can taking steps to avoid diabetes in future. If the answer is no, better be prepared to take pills lifelong. Choice is ours! In the next article, we will see few more causes of Prameha related to diet.

Treatment of Diabetes is mainly focused on lowering down of BSL with oral antidiabetic tablets, insulin and the food, which has low glycemic index ( means the food which won’t create hike in BSL levels beyond expected limits. Many upcoming therapies including diet therapy are focusing on cutting down the carbohydrates, total restriction of fats, milk products and non vegetarian food, increasing the amount of proteins in the diet through pulses and soy products and intake of higher amount of fibers through vegetable, fruits etc….somewhat known as vegan diet. The effect of the diabetes medicines and diet is lowering of blood sugar levels, reduction in the drug doses or even sometime the patient can be totally off medicine……..which is now considered as Reversal of Diabetes. But, does the diabetes only mean “Rise in BSL levels beyond the defined cutoffs?” I think this is partially true. Rise in BSL levels is one of the manifestations of Diabetes pathology. Actually, there is a sequence of events occur during the diabetes development. Fat or adipose tissue metabolism is deranged. Excess fat deposition in the body including muscle tissue, liver etc. Blood vessels, nerves, retina of the eyes, kidneys and feet are affected. Delayed wound healing is experienced. All these complications are observed in few patients even when BSL levels are under control. This means pathology of the disease is not always fully controlled even after controlling the BSLs with medicines or diet. We need to think something extra. Ayurveda, an ancient Indian medical science gives insight to look at diabetes. It has described disease Prameha, whose causes, signs and symptoms coincide with the current ideas of diabetes. Ayurveda describes that Prameha is the disease developed due to derangement in body fats (irrespective of that, whether person appears fat or thin). The main imbalance is in Kafa dosha (body humor resembling potential energy, lubricating fluids in the body) and Pitta dosha (body humor resembling thermal energy, responsible for digestion and transformation). When kafa and pitta dosha are vitiated and also cause imbalance in Vaatadosha (the third body humor resembling kinetic energy of the body, responsible for movements, locomotion, nerve conduction etc), disease development starts. These vitiated doshas unite with deranged adipose tissue (body fats), muscle tissue, disturb fluid and water balance in the body.  Subsequently, other body constituents such as blood, reproductive tissue and its ailments, lymph, nervous tissue, plasma etc. are also affected in Prameha giving rise to a variety of symptoms and signs. Holistic treatment of Prameha includes balancing kafa and pitta dosha and correction of deranged fat, muscles and other tissues. Dr. Shirodkar’s special dietary food products, which are helpful in obesity, pre diabetes, diabetes, cholesterol, heart disease and other associated problems have been developed in view of breaking Prameha pathology, balancing doshas and correcting deranged tissues. The selection of cereals, pulses and spices as well as their processing is based on Ayurvedic guidelines for the treatment of Prameha. They aim at balancing kafa and pitta dosha. They help in reducing excessive and deranged body fats. They help reduce the symptoms like excessive thirst, frequent urination, constipation. They help wound healing (which is helpful in non healing ulcers). They help digestion, tissue metabolism. They can be used by even healthy individuals. They provide energy, nourishment, stability, voice and complexion. Dr. Shirodkar’s special dietary food products are developed using Ayurvedic guideline and through research project funded by government of India. They are standardized and tested for palatability, acceptability, nutritional values and shelf life. They have been used by hundreds of healthy individuals and diabetic patients. They have been shown to help reduce fat mass in obese individuals. In diabetic patients, they help in reducing BSL levels due to their low glycemic load and low glycemic index. But, in non diabetic patients, normal BSL are maintained. These products also help in bringing down cholesterol values. Along with health and nutrition, these products provide taste and satiety, reduce hunger pangs and also alleviate the symptoms related to Diabetes.