Curated Paper 1: Ayurveda, Diabetes, and the Microbiome - Jessica Munro

Curated Paper 1

A capstone class is a course designed to do just as the name suggests, to cap everything learned in a major’s core required courses and develop an overarching connection and understanding between the different specified areas of study within. Capstones designed to implement intensive writing specifically encourage students to become more aware of their own thinking and understanding of the material, which facilitates a desire to reflect and learn more. I anticipated this capstone course to be very helpful in finding a purpose for the knowledge I have gained over the past few years. Without reflection and implication, the knowledge feels lifeless and unproductive, but a deeper interaction with the content itself inspires further action, either with a deeper appreciation or with deeper investigation. Thus far, this capstone has shown me the importance of approaching disease from an ayurveda perspective to form connections between logical reasoning, personal experience, and explorational curiosity.

Ayurveda represents the idea that there is a balance between the body and its internal and external influences. This suggests that a connection must exist between the functioning of the body and those things it interacts with, whether within the body itself or in its environment. Where a balance is maintained, a state like homeostasis is achieved where functioning is sustainable and undisturbed. Yet should either internal or external influences begin to have a larger or lesser impact on the body, the delicate balance is no longer maintained and the body inevitably experiences consequences as a result. 

From the perspective of ayurveda ideology, the body is comprised not just of organ systems, but of relationships that form a functionality. Structure, measurable physiological parameters, biochemistry, and mental and emotional health are just a few of the many things contributing to the relationships that define the body’s functionality. Thus, when one of these things is adversely affected, an ayurveda approach to medicine suggests that functionality is lost in one way or another, ultimately causing disease. I think this perspective is generally a valid way of approaching very complex problems from a more simplistic view point. A disturbance to any of the key relationship aspects from an internal source, such as an overactive immune response or a genetic mutation, could disturb the balance and cause a loss of function that leads to disease. From this perspective, external influences can also have a huge impact and disrupt the balance and thus functionality of the body. While reflecting on my personal experiences and previous knowledge, expanding upon the provided materials with further research has shown me that the body’s metabolism provides an exemplary look at the balance and connectedness described by ayurveda. 

Metabolism is a word that describes the entire sum of chemical reactions taking place in a cell, representing the exchange between both building molecules for the cell’s use, and breaking them down for energy or reuse. The flow of energy in a cell can be described by pathways, with reactants being transformed into products in a continuous sequence for the cell to extract and then use its energy for growth and reproduction. In order to maintain this continuous sequence of reactions in the cell, metabolic pathways are highly regulated to control the formation and use of metabolites based on the cell’s needs and resources. Due to the controlled nature of these processes, any disturbance could cause an imbalance that disrupts the flow of metabolites through the pathway and greatly affects the proper functioning of the cell.

Diabetes is an excellent example of the effects of an imbalance in the body’s metabolic pathways on cell function, other organ systems, the body as a whole, and even society and the economy on a larger scale. Type 1 (DM1) and type 2 (DM2) diabetes develop due to different malfunctions in the regulation of blood glucose levels. DM1 is a complex trait, showing an increased risk of developing the disease with mutations present in several different genes. These anomalies elicit an autoimmune response, causing the body to destroy the β-cells in the pancreas responsible for making insulin. A lack of insulin ultimately results in the body’s inability to properly uptake glucose from the bloodstream. DM2 results in similar effects that lead to the same outcomes as with DM1, though the causation is very different. Being overweight or obese can cause the body to develop a resistance to insulin, meaning that the insulin cell receptors are no longer properly responsive to the presence of insulin and thus the cell is unable to initiate the uptake of glucose as normal. As a result, cell function is affected in a very similar way to DM1 and both types of diabetes require continuous monitoring to help adjust abnormally high blood glucose levels.

The lack of energy uptake has immediate effects on cell functioning, making the disease very difficult to regulate properly. While no one in my family has had to deal with diabetes, I know several people with the DM1 disease that manage their symptoms in different ways. One of my high school friends grew tired of measuring her glucose levels by pricking her finger, so she opted for a more permanent device to be inserted on her upper right arm. This allows her to monitor her diabetes more closely, accurately, and conveniently because the device is continuously collecting data and assisting her in regulating her condition by actively measuring her blood glucose levels. Another boy I knew from school managed his diabetes completely differently, opting to be accompanied by a service dog that was trained to monitor his glucose levels by smell. When the dog became aware of abnormally high glucose levels, she would lick the boy’s hand to notify him and he would correct it with insulin. 

From the perspective of an ayurveda mindset, this glucose/insulin imbalance is the source of a disease that develops over time and causes other systems of the body to experience adverse effects as well. Phagocytosis, the process by which the body captures and eliminates foreign matter, is impaired and thus the body’s ability to fight infections is reduced. Damage to endothelial tissue may also result, causing increased incidences of dental cavities, gum disease, cataracts, and even skin conditions. With the dysfunction of systems and the individual organs within them comes the development of symptoms affecting the body as a whole. Individuals with diabetes may experience feelings of excessive thirst or increased hunger, unexplained weight loss, and fatigue or blurred vision. Those with diabetes may also notice cuts or sores healing more slowly, or a numbness in the hands or feet. Another important symptom is frequent urination, or vaginal yeast infections in females. All of these symptoms can be traced back to a dysfunction in one or more of the body’s systems due to an imbalance at the cellular level resulting from the lack of glucose uptake. 

Looking beyond the impacts of diabetes on the body, and an individual, and taking a closer look at the costs of diabetes provides some astounding insights into the financial and economic impacts of the disease. Treatment options include a wide range of effectivity, side effects, risks, and costs for the patient, making the choice of a plan more difficult because the financial burden may be more impactful to patients than the actual benefits of a certain treatment plan. The costs associated with treatment of the disease and its side effects or related health complications also takes a large toll on the nation’s economy. The extensive costs of patient care and treatment are largely covered by national health programs, with estimated billions of dollars spent in the totality of treatments for those with diabetes. I think these limitations are unfortunate, and perhaps the best way to avoid them is to encourage patients to take control of their own health by managing their diabetes with a greater emphasis on lifestyle changes. Creating less of a dependency on more intervening treatment options may allow them to become more attainable for those that would benefit most, while indirectly benefiting those that can make more simple adjustments. Advocating for the health of the nation as a whole may also limit the development of diabetes and prediabetes, limiting the necessity of care to those who would receive the most benefit. 

Learning about metabolism through the lens of diabetes was a unique experience because I was able to take the knowledge I had gained and spread it to other areas of my life. I incorporated my understanding from past biology and chemistry courses and applied that familiarity to a new area by writing about information that satisfied my own curiosity and love for learning. I found connections between the material and my personal observations, seeing both the impacts in my past and the potential impacts on the future on a larger scale. The writing process made me excited to learn more, so I took a deeper dive into the next topic sure to coincide with the ideas of ayurveda connectedness, balance, and bodily functioning: the human microbiome.

The word microbiome encompasses all of the microorganisms that collectively inhabit the human body, whether that be on the surface or more internally in organs or lining tissues. This broad term includes all species of bacteria, viruses, fungi, archaea, and even eukaryotes living on or in the body, while the gut microbiome is more specific to the microorganisms inhabiting the gastrointestinal tract. The gut microbiome behaves almost as its own organ, with unique metabolic activity as well as distinct immune responses that give this microbiome a unique and relatively large impact on the rest of the body. The amount of microbial cells in the gut is substantially large, with estimates as high as 5,000 species representing 100 trillion microbes, and the gut in particular contains the largest and most diverse microbiome of the body, thus having the opportunity to make the largest impact on the body’s health and proper functioning. 

Gut bacteria are involved in a wide range of processes in the human body, assisting with basic metabolic pathways and producing their own byproducts used by the host. The human body and the gut’s microbiome exist in a symbiotic relationship. The host provides optimal habitat conditions, including an ideal environment, protection, resources, nutrients, and other essentials that aid in the success of these microorganisms. Meanwhile, the host is able to receive benefits when the bacteria help harvest energy from food, maintain the balance of beneficial and harmful bacteria, and produce other useful products including serotonin, vitamin K, and other enzymes and vitamins used as neurotransmitters or in metabolic and immunological pathways. While maintaining a balance between beneficial and harmful microbes in the gut is essential to the body’s proper functioning, it has been shown that having a wider diversity in the gut microbiota is a more advantageous composition that appears to be healthier than possessing a smaller range of diversity. 

The body’s microbiome begins its development in the fetus during gestation, with the next most influential change occurring when a vaginal delivery provides exposure to the mother’s vaginal microbes. A similar change occurs in the gut microbiome with breastfeeding as the mother’s microbes are introduced to the newborn’s GI tract for the benefit of establishing a healthy microbiome for the baby. The gut microbiome tends to develop until about the age of 2, when it more closely resembles its final adult pattern. There are a wide range of factors that impact the body’s microbiome, particularly in the gut, including anything from diet and lifestyle choices to genetic and environmental factors. Long-term diets sustained with consistent food groups are often associated with a complement of microbes that are appropriate for the specific nutritional needs and availability of the diet. Diets high in animal protein and fat can be differentiated microbially from those that consist of higher levels of carbohydrates or fiber. This allows for the gut microbiota to significantly expand the metabolic capabilities of the host by acting as a primary source of chemical digestion in the GI tract. Other lifestyle factors such as age, ethnicity, physical health and activity levels, and even mental and emotional health, can impact the composition, diversity, and amount of microbes present in the human gut. 

The symbiotic relationship between a human host and their microbiome exists in a very delicate balance. The body’s immune system employs mechanisms to maintain this balance by carefully regulating the relationship between beneficial and harmful microbes. However, if the balance is lost, it can have huge impacts on the body. A few years ago, my sister experienced the effects of an imbalance in her gut microbiome. She saw periods of symptoms fluctuating between healthy and normal, to sick with very frequent vomiting. After a few weeks of these recurrent symptoms with no improvement, she visited the doctor and found out it was an H. pylori infection in her stomach, and she was given antibiotics to treat the infection. My sister was also advised to eat probiotic yogurts and other food products for a few weeks after her infection was gone to help replenish her gut microbes. She recovered well and has not had any issues since, but it definitely opened my eyes to the reality of the gut microbiome. Many people who have an H. pylori infection never experience symptoms or adverse health effects and have no need for treatment, and it is not well understood why others suffer from a more intense illness. 

The impacts and delicate balance of the gut fall in line with ayurveda thinking, which suggests that the state of the body and mind are connected to illness and the development of disease. If the harmful microbes become more prominent and are able to overpower the beneficial microbes, the body suffers drastic consequences as the symbiotic relationship is disturbed. Digestive health, hormone regulation, and other cellular processes can be impacted, leading to disruptions in the body’s normal functioning that may result in the development of disease or illness. An ayurveda approach insists that the source of a disturbance could be as small as the microbes on and within the body, and an imbalance in their regulation could have drastic effects that impact the body’s function on the organism as a whole. Similarly, ayurveda also encompasses the idea that the source of a disturbance may be as small as a glucose molecule, where its lack of uptake in the cell creates disturbances that impact the body on an organism level, and even beyond to reach society and across the globe. Looking at specific diseases layer by layer from the perspective of ayurveda connectedness has been a very rewarding experience that has made me both appreciative and excited for my capstone class.