Ayurveda in Medicine: The Imbalance that is Diabetes

     Almost everyone with a scientific background is familiar with the term of homeostasis, and its importance to the body. This mechanism is vital to life, as all living organisms try to reach a balanced, stable state whilst their environment constantly changes (either drastically or minimally). When we talk about homeostasis, we generally think about pH levels, body temperature, fluid balances, etc. which are maintained via physiological processes and pathways. The many different systems in our body are constantly adapting their processes to keep us alive in the various different activities, hardships/injuries, and environments that we find ourselves in. While this state of the physical body being in balance, as a whole is, very important, what if there was more to our well-being than this… and that introduces the concept of Ayurveda.

Ayurveda isn’t a commonly heard word in the Western world, as this word originated thousands of years ago in India. With the Western and Eastern worlds differing in many categories, it is no surprise that many haven’t heard this word, however, it has incredible meaning when broken down into its root words. According to PubMed, in Sanskrit, “Ayur” means life and “veda” means knowledge, so Ayurveda literally means the knowledge of life. The concept of ayurveda is one of Eastern medicine, with a much more holistic approach to the treatment of one’s health. As such, ayurvedic medicine is the practice of balancing one’s mind, body, and spirit to promote good health and wellness. 

That being said, Ayurveda can almost be considered a step back from homeostasis, as it encompasses the entire body and not just the physical processes and components. Humans are more than just an intricate compilation of incredible organs, complex biochemical processes, etc.… our conscious mind with our intelligence, personality, and reasoning combined with our bodies makes each and every individual unique. We all have unique beliefs, ideals, and standards that make us different from one another… but each body has its own unique differences, and flaws, that make us physically different as well. As such, each individual cannot be treated in the same, generic ways for physical, mental, and spiritual matters. The more that we read about Ayurveda and other Eastern medical practices, the more we begin to see major differences in the ways that medicine is conducted in the Western world (for the most part) as compared to the Eastern world.

It is a common stereotype that the general course of medicine in the West is that of treating symptoms, rather than treating patients. This is not always the case in Western medicine, because there are those healthcare providers and individuals who treat in a holistic manner rather than as a general compilation of symptoms and stereotype. In holistic medicine and practices, like ayurveda, the goal is to find the root of what may be causing a person symptoms “X, Y, and Z”, rather than just trying to fix the patient’s symptoms. Now, there isn’t anything wrong with conventional medicine and all that comes with every growing modern medicine… but it has its places, with its ups and downs.

For example, a patient may be suffering from recurrent headaches and goes to see a healthcare provider who prescribes them ibuprofen, or other common medications, in order to help with their symptoms. This may alleviate the symptoms temporarily, but once the ibuprofen has metabolized, the headache returns. Rather than attempting to give the patient the next pain medication on the list, the provider may take a step back, evaluate the patient’s history, and realize that there are stressors in their life that are causing the headaches. With this newfound discovery, the healthcare provider could offer the patient resources to help alleviate stress in their life rather than try another medication to “get them by” for some time. 

While this is just a generic, basic example, it demonstrates how just a slight change in our mindset about diseases that terrorize the body may come about and be treated. The viewpoint of ayurveda and holistic medicine is very important because each of us is different and will react to medications and treatments completely different than another person may. With this basic example in mind, one of the largest, most widespread disruptors of Ayurveda in terms of diseases is that of diabetes mellitus.

This disease occurs when the body cannot manage its level of blood glucose (often called blood sugar), which disrupts many processes. When the body is unable to manage its glucose levels independently, this often results in hyperglycemia, or an elevated blood glucose level. Complications that arise due to hyperglycemia include: an increase in blood pressure, impairment of immune system phagocytosis, neuropathy (nerve damage), and many changes to the body’s response to hemorrhage (to name a few). 

There are two different varieties of diabetes mellitus: type 1 diabetes and type 2 diabetes. There are many differences between the two diseases, however, of the biggest is that type 1 diabetes is a genetic, organ-specific autoimmune disease and type 2 diabetes is life-style related disease which can be prevented. Type 1 is usually a sudden onset of the disease, generally occurring at a young age. Type 2, on the other hand, is usually a gradual onset of the disease and generally occurs in adults. In type 1 diabetes, endogenous insulin is reduced or even absent and in type 2 diabetes, endogenous insulin remains around normal (potentially with some increase or decrease).

Diabetes has many impacts on almost every organ of the body. For example, in type 1 diabetes, there is a decrease in beta-cell function/mass and insulin production (all happening in the pancreas). For the brain, diabetes causes an increased appetite, lessened dopamine surge in the morning, and an increase in sympathetic tone. In the colon, specifically our microbiome, abnormal microbiota (and abnormal function of the microflora) can occur. In the stomach/small intestine, we find an elevated glucose absorption, and, in the kidneys, we see increased glucose reabsorption. In the liver, diabetes causes increased gluconeogenesis, in the muscle we see decreased peripheral uptake of glucose, and in the adipose connective tissue we see increased lipolysis. With diabetes (both type 1 and type 2, but sometimes in different ways) impacting our homeostatic balance, it truly is a serious disease.  This is where Ayurveda begins to come into play in terms of diabetes mellitus, and with so many physical and physiological impacts occurring, one’s mind and spirit also get impacted.

Type 1 diabetes mellitus’ is generally caused by a genetic factor, however, there are also a handful of other situations that it can arise. These include damage or removal of the pancreas, environmental factors, drugs/chemicals/toxins, endocrine diseases, and some viruses/infections. Regardless of the cause, type 1 diabetes results from the damage and death of beta-cells in the pancreas. Think of the beta-cells as factories that produce, store, and ship out the hormone insulin. This hormone is vital to the body in combating hyperglycemia, as it signals a pathway in which cells uptake the sugar from the bloodstream, using it for energy. In the majority of type 1 diabetic cases, the body initiates an autoimmune response, fighting and killing its own beta-cells in the pancreas. As such, hyperglycemia sets in because the insulin factories have been shut down. In order to combat this, one must take insulin from an exogenous source, introducing it to the body so that blood glucose can be taken into the cells. We see many individuals daily who struggle with this disease that we don’t even know have it. When this disease is appropriately managed and cared for, we see them living normal lives. These individuals generally have insulin injections or insulin pumps that help them manage their blood glucose levels.

Type 2 diabetes mellitus’, on the other hand, is not the cause of damage to the beta-cells in the pancreas. Instead, this form of the disease is caused by the body’s cells not responding to insulin (which is called insulin resistance). Because of this, the pancreas produces more insulin in an attempt to get the cells to respond. Over time, the pancreas cannot keep up with the increasing demand of insulin, and type 2 diabetes sets in. The reason that type 2 diabetes is linked to an individual's lifestyle and diet is because when one eats too much glucose, and/or doesn’t exercise to burn the glucose in the cells, blood glucose levels begin to rise. After prolonged elevation, we see insulin resistance set in and blood glucose continuing to rise. Type 2 diabetes is generally accompanied by a large, or obese, body habitus (while type 1 is generally accompanied by a thin or “normal” body habitus). This is one of the biggest issues that we see in the United States of America, as many individuals eat glucose-rich diets, don’t exercise, and do not tend to take the steps necessary to treat their elevating blood glucose levels. Some type 2 diabetics even have to use exogenous insulin, as well as changes to their lifestyle.

While hypoglycemia isn’t the most expected thing to see in a diabetic patient, it can occur. Hypoglycemia is the opposite of hyperglycemia, meaning that it is a result of low levels of blood glucose. Hypoglycemia is generally the result of treating hyperglycemia, and generally an “over-treatment” (in diabetic individuals). I work in the emergency department here in Cedar City and have seen quite a few cases of diabetic hypoglycemia. In most of these cases, the patient either miscalculated the amount of insulin needed or accidentally gave themselves too much insulin. In these patients, I have seen confusion, loss of consciousness, nausea/vomiting, dry mucous membranes, diaphoresis, etc. Generally, hypoglycemia is treated by introducing glucose into the individual’s system, and I have definitely given out a handful of juice boxes to those who are conscious and able to drink. In non-diabetic individuals, hypoglycemia can be a result of decreased food intake. 

On the opposite side of the blood glucose spectrum, when hyperglycemia becomes too high, we see diabetic ketoacidosis. This occurs because the body’s cells are not getting glucose for fuel, so the liver breaks down stored fats in order to produce energy. While in short bursts when needed this isn’t bad, over a prolonged period this can become dangerous. A side product of this fat metabolism is an acid called ketones, which, over an extended period of time build up in the bloodstream to a dangerous level. At this point, the body’s pH is thrown off and requires immediate treatment. In the emergency department when we see patients in DKA, I have found that we generally give fluids, electrolytes, and provide insulin, in an attempt to lower the patient’s blood glucose levels.

With that understanding of diabetes mellitus, we can see just how the use of medications is very important to managing this disease. However, maintaining an Ayurvedic balance of physical, mental, and spiritual well-being has a large role in preventing type II diabetes mellitus. And regardless of the type of diabetes that an individual has, the economic costs, maintenance, etc. can weigh heavy on one’s mind and throw off one’s mental balance. As individuals ensure that they are taking care of themselves in a holistic manner, especially those with impactful diseases, they will not only see a positive increase in their physical health, but also their mental, emotional, and spiritual health.

                                                                        

                                                                       References

Ayurveda. Johns Hopkins Medicine. (2019, December 2). Retrieved September 8, 2022, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/ayurveda#:~:text=Ayurveda%2C%20a%20natural%20system%20of,translates%20to%20knowledge%20of%20life.

How long do insulin vials last & how many you need per month? 4Allfamily. (2022, August 9). Retrieved September 30, 2022, from https://4allfamily.com/blogs/diabetes/how-long-does-a-vial-of-insulin-last

Lad V. (1995). An introduction to Ayurveda. Alternative therapies in health and medicine, 1(3), 57–63. https://pubmed.ncbi.nlm.nih.gov/9419799/#:~:text=Ayurveda%20is%20a%20Sanskrit%20word,became%20the%20science%20of%20life.

Miller, K. (2021, March 20). What is ayurveda? treatments, massage, diet, and more. WebMD. Retrieved September 8, 2022, from https://www.webmd.com/balance/guide/ayurvedic-treatments 

U.S. Department of Health and Human Services. (n.d.). Ayurvedic medicine: In depth. National Center for Complementary and Integrative Health. Retrieved September 8, 2022, from https://www.nccih.nih.gov/health/ayurvedic-medicine-in-depth