Curated Paper 1 Adam Porter

 Ayurveda has roots that trace back to India 5000 years ago. It is still widely practiced in India encompassing almost 80 percent of their total healthcare system. Its basic tenets describe a relationship between the mind, body and spirit, three basic energies, and the guiding principle that balance is the most important aspect of health. 

Ayurveda teaches that the mind, body and spirit are interconnected and that many ailments can be traced back to a disconnect or imbalance in the relationship between them. This is especially true of the role of the gut and diet. Although not fully understood, this ancient understanding of the connection between the gut and the body is leading to potentially groundbreaking studies in many fields. One of these intriguing studies is the potential treatment of major depressive disorder by helping restore the body's microbiome with a fecal matter transplant. 

Although Ayurveda as a clinical practice has some faults, such as the use of heavy metals in treatment, its overarching philosophy of balance and interconnectedness holds great value in modern medicine.  

Balance and interconnectedness are demonstrated in several common and complex topics including metabolism, diabetes and the microbiome. 

The metabolic pathways for even the most simple organisms can be widely varied and complex. While learning and memorizing the Krebs cycle for the MCAT I was amazed by its complexity. Thinking about how this cycle is just a small part of a much more complex set of metabolic pathways specific to one of many types of organisms is staggering. During metabolism all metabolites and ions involved are tightly controlled and regulated in how they are processed, stored or secreted. One key example of this is the human body’s blood glucose level and its influence on whether or not incoming glucose is taken into cells or turned into glycogen in the liver. 

Metabolism has to be so tightly regulated because the concentrations of the metabolites need to be so tightly controlled in the body. If the blood’s concentration of any one ion gets out of balance then the effects can disrupt the electrical systems or fluid movement within the body. This idea becomes extremely important in healthcare. One critical example of this is the regulation of calcium and potassium in the body. If the body has too high or too low a concentration of one of these then it can cause cardiac arrhythmia and even cardiac arrest. The delicate balance of the body’s metabolism is protected by several mechanisms because of its importance. These are through filtration in the kidneys as well as regulation of hormones such as glucagon and insulin. 

One clear example of an imbalance that can cause cascading health failures and reaches far in our communities is diabetes. My experience with diabetes has largely been in two settings. The first is working in EMS. I have responded to many people who let their blood sugar drop too low which has led to confusion and weakness, unconsciousness and even cardiac arrest. We often treat this in an acute setting with administration of IV glucose followed with oral intake of complex carbohydrates and proteins. 

My other experience is as a medical scribe for a family practice physician. In this setting we more often dealt with chronic hyperglycemia associated with type two diabetes. This became dangerous to patients as it interfered with their circulation to body parts such as their hands, feet, legs, genitals and eyes. This was treated most commonly through medications such as insulin and metformin, lifestyle changes, and amputation of necrotic tissue. The cascade of direct and critical effects of something as simple as a glucose imbalance can cause life altering and life threatening consequences. The surprisingly narrow normal range for blood glucose is 70-100 mg/dl which reinforces the importance of strict regulation in our metabolism. 

I find the juxtaposition between type one and type two diabetes intriguing. Type one diabetes is caused by malfunction in the pancreas leading to an underproduction of the powerful hormone insulin. This generally leads to acute hyper or hypoglycemia. Both of these are generally corrected quickly and simply with either insulin or sugar intake. Type one diabetes is generally a larger problem for families, schools and individuals during the early to teenage years of the affected person as they aren’t yet practiced with balancing caloric intake with insulin self administration and ensuring that they get the adequate caloric intake each day. Type two diabetes is most often the byproduct of an unhealthy lifestyle and an unhealthy relationship with food. It is associated with a cellular insulin resistance and leads to chronic hyperglycemia which causes most of the symptoms that we associate with diabetes. The latter is the cause of the most widespread societal and economic consequences. 

  The idea that glucagon and insulin are antagonistic reinforces the motif of balance and ayurveda that is constantly present in the study of disease and human health. An over or underproduction of either of these hormones can lead to a cascade of consequences that can have critical acute and chronic consequences. 

  The economic effects of a population that are living with diabetes can be devastating. The disease itself is expensive to treat with medications like insulin, metformin and statin drugs costing hundreds of dollars a month. The other costs are the complications of diabetes. Renal disease, amputations and post operative care, strokes and heart attacks lead as some of the most expensive procedures and recurring treatments made necessary by the disease course of uncontrolled diabetes. The majority of these procedures for type two diabetics are paid for by Medicare so the economic impacts of all are felt by all American taxpayers. What is essentially glucose imbalance costs the United States over 245 billion dollars a year. These costs not only affect the healthcare industry but affect the whole country through reduced productivity, premature death and inflated medical insurance premiums. Other costs that are harder to calculate may be related to things such as reduced quality of life, increased instances of mental illness and decreased productivity of family and loved ones. 

I recently read an interesting article on how Alzheimer’s disease and diabetes are closely related. This article went as far as to say that Alzheimer’s disease could be aptly described as type three diabetes. Alzheimer’s disease does feature some neuronic insulin resistance. Their thought process was that this resistance significantly added to the building up of amyloid and tau plaques in the brain. I don’t believe that this mechanism has been fully explained or explored but there is a documented 81 percent of Alzheimer’s patients that have been diagnosed with type two diabetes.

Many people’s difficulties in overcoming diabetes are due to the strong effects that upbringing, social environment, and living conditions can have on health. The imbalances caused by diabetes are best treated by lifestyle changes such as increased exercise and a balanced diet which give the body the tools it needs to restore balance. Although this is the best treatment it is also the most difficult for many people to start, especially when taking medication seems like a proverbial magic bullet. 

Another aspect of health where balance is critical is the microbiome. The microbiome involves the microorganisms, specifically bacteria, that inhabit the human digestive tract, skin and mucous membranes. The microbiome is something that has become a topic of public interest in more recent years. Mostly these conversations involve talking about probiotics to improve gut health or how dangerous antibiotics can be to the gut microbiome. In the introduction to this topic it was mentioned that a person’s gut microbiome can be determined by where a person is living, who they are living with, and by their diet. It was also very interesting to learn that the microbiome is largely affected by the bacteria that each of us is exposed to following birth. 

The correct amount and composition of microorganisms in the body can be important to a number of different bodily functions. An imbalance in the gut’s microbiome can cause a lack of sufficient or quality sleep. This can then cause a greater imbalance in the microbiome. This cycle continues to worsen both the microbiome and sleep patterns, worsening the quality of life for the person. The direct connection between the quality of our sleep and the makeup of our gut’s microbiome solidifies the intricate and complex connections between different processes in the body.

The microbiome has implications for other major body systems as well. Including the cardiovascular system. We understand a large amount of the risk factors for heart disease including genetic factors, poor diet, lack of physical activity, and diabetes. The metabolites formed by various members of the microbiome can contribute to and warn of impending cardiovascular disease. One specific metabolite contributes to atherosclerosis which increases the risk of myocardial infarctions and strokes, the other metabolite can help to lower blood pressure. This shows that the concentration of the different microorganisms that create these metabolites can change the health outcomes in people’s lives. 

Our understanding of the microbiome and its connections to the other systems of the body is in its infancy. The microbiome affects our immune, cardiovascular, and neurological systems in ways that we do not fully understand. As we continue to learn about the intricate connections between body, mind and spirit we will hopefully find greater tools to help people to live longer and happier lives.