Curated Paper 1 - Derek Baker

The general concept and practice of Ayurveda is a great health-conscious approach that incorporates the body, mind, and environment. Within the continuation of research, we only seem to find more links between the three than evidence to suggest that each works independently. One example that comes to my mind is anecdotal evidence from fecal matter transplant patients. In an effort to restore a healthy gut microbiome through other people's fecal matter, they also found that they had taken on some mental health challenges of the donor. This example shows the complicated nature of the connection between the mind and the body. To me, the promise of Ayurdeva is lost in its specificity. Much like most forms of holistic care and other philosophies the need to make sense of our world through specificities takes away from the bigger picture. 

In my opinion, the best takeaways from Ayurveda are the following: First, the reality of the connection between mind, body, and environment. Second, the focus on balance as a form of preventative care and health. Third and lastly, the idea that the make-up of each of our bodies is unique and as such our care should be as well. Due to its holistic nature, Ayuderva is very difficult to “prove” as effective by modern science. Science strives to make universal generalizations and find consistent patterns, so the concepts of “unique makeup” and “personalized care” are difficult to study and implement. The integral concept of spirit in Ayurdeva also proves the integration of a biomedical and holistic approach to be difficult. 

Regarding the concept of Ayurveda, diabetes is a perfect example of the result of a life lived without balance. To me, diabetes is much more than just a pandemic taking over many of our industrialized countries. Diabetes and its prevalence are a direct reflection of the way life is lived in certain areas and the social structures in place regarding preventative health. 

One of the greatest social determinants of health for diabetes is income and economic status. It is no secret that fast food has been a leading contributor to health problems in the United States. Despite this knowledge, its accessibility and affordability make it seductive enough to entice those who have little time, energy, or income. In fact, as of 2020, the American Diabetes Association claims that neighborhoods with lower income tend to have higher rates of type II diabetes. Like most other chronic diseases diabetes tends to lead to a self-perpetuating maladaptive cycle. Individuals of a lower economic status can’t afford to shop for or eat a diet centered on a variety of organic whole foods. This initial inability to live a healthy lifestyle leads to health problems that compound the difficulty of getting back on track. When diabetes inevitably shows up, more costs incur. Piling medical bills, insulin, time off work, amputations, and cataracts are all expenses that force those of lower socioeconomic status to stay where they are or end up worse off than how they were before. In layman's terms, it is expensive to be poor. 

Another large determinant of diabetes is education. This one strikes particularly close to me as both of my grandparents are diabetic. While both are educators themselves neither has a great understanding of nutrition as a whole. In fact, listening to them talk about their diet and how they perceive food is quite scary. When asked to determine if an item of food was mainly protein, carbs, or fats, potato was ultimately categorized as a protein. In addition, my grandmother will consume boxes of Milk Duds because “they are simple carbs and easier to digest” when she is ill or needs to give her stomach a break. Above all, they reason that “they can consume as much sugar as they want because they have insulin to help regulate thier blood sugar”. 

To us, these takes on diabetic health can be considered comical based on our knowledge and education of macromolecules and nutrition. The scary reality however is that there are many Americans that have the same line of thinking. Those of an older demographic are especially vulnerable to this lack of education because they are so far removed from education itself. While we may feel constantly bombarded by the latest fads in what is considered healthy, a more mature demographic may not have a clue about nor a desire to learn about healthy eating. Besides knowing about nutrition, it is important to realize that general education attainment is also associated with the onset of diabetes. Once again, the American Diabetes Association has also claimed that living in areas with lower education attainment is associated with higher levels of type II diabetes. 

Environmental settings can indeed play a contributing factor to the onset of diabetes. The American Diabetes Association puts out another statistic correlating more single-parent households and crowded living spaces with higher rates of type II diabetes. Once again it is effortless to tie both of these factors to a decrease in time, energy, or income to strive for a healthier lifestyle. In addition, the ADA found that those who live in more rural areas deal with their own unique factors regarding diabetes. Lack of access to parks, gyms, or other areas designated for physical movement can decrease physical activity if it is not a part of their job/ daily life. Access to different goods and services is also found to be in deprivation in rural areas like access to diverse and healthy food sources, physicians (both in quantity and quality), and hospitals. 

When taxpayer dollars are allocated to social infrastructure, it is important to consider preventative measures in addition to curative care. Investing in areas that encourage physical activity, access to a clean diet, and closer healthcare facilities can all be ways to reduce the weight that diabetes has on our nation economically and socially. In addition to focusing on ways to improve our physical health, it can also be beneficial to focus on our mental health as well. The National Library of Medicine published a study finding a correlation between stress and the prevalence of type II diabetes. Those who live in chronically stressful environments subject themselves to larger amounts of cortisol, epinephrine, and norepinephrine in their lifetime. The combination of these three molecules has been shown to increase insulin resistance and lead to the road of chronic illness. It is worth noting that increased cortisol also leads to greater adipose deposits in the body which can compound the complexity of type II diabetes. Furthermore, chronic stress can lead to inflammation that stimulates endothelial dysfunction and once again contributes to the onset of diabetes. 

An additional study published by the National Library of Medicine concluded that there is an inversive relationship between the amount of social support in a person's life and the ability to cope with type II diabetes. When surrounded by a group that provides emotional and instrumental support, patients are more likely to follow through and adhere to their treatment plans and less likely to develop poor mental health that can compound the weight of a preexisting illness. 

Many studies to date support the principles of Ayurveda and highlight the importance of living a balanced life. This balance centers around the interconnectedness of the mind, body, and environment. When we examine diabetes through this lens, the relevance of Ayurvedic teachings becomes evident. The physical aspect is the most straightforward, as it's widely known that poor diet and lack of exercise are major contributors to type II diabetes. However, these imbalances can be further categorized. Environmental factors may include living in areas that hinder healthy eating and physical activity, exposure to stress, low social support, or crowded living conditions. Lastly, mental imbalances often manifest through poor stress management and declining mental health (anxiety and depression), which can both exacerbate the existing condition.

Continuing with this idea that differing components affect one another, we should, in turn, look at the way that diabetes affects society in addition to how society affects diabetes. One of the greatest pillars of society that is feeling the impact of diabetes is that of the healthcare system. On average an American with diabetes will incur around 19,000 dollars worth of medical expenses where around 12,000 dollars of which are directly related to diabetes. This makes this demographic 2.6 times more expensive than the average American when it comes to healthcare expenditures. As a nation, it is estimated that we spend nearly 400 billion dollars, 300 of which are directly related to medical costs, and the other 100 are indirectly related. These indirect costs can manifest as a loss in productivity at work, unemployment, payment for services that can no longer be performed for oneself, and many others. Not to mention all of the money and funding that has gone to research in these areas that could be allocated elsewhere. When it comes to looking at American healthcare expenditures as a whole diabetes accounts for nearly an entire quarter. 

Financial trends are also a great way to portray the projection of diabetes prevalence in our nation. Between 2012 and 2022 healthcare costs for diabetes have increased by nearly 80 million dollars. In addition, that same 10 years showed that spending on insulin tripled from 8 billion dollars to 22.3 billion dollars. From these numbers, we can see that the pandemic of diabetes is not going away any time soon. Our current solutions to the problem should be revised if we want to see any form of change on a national level. As a country that spends so much on healthcare, we should start to ask ourselves if the spending is making a difference. 

The rising dependency of our nation on diabetic treatments and medications has also led to an increase in the cost itself, not just its use. For example, the costs of just insulin itself were found to have increased by 24 percent between 2017 to 2022. While providing adequate healthcare for diabetics is essential, when this demographic begins to represent a larger portion of the population rather than a niche, it opens the door for certain companies to profit from a national health crisis. This allowance of financial capacity gives these groups unchecked lobbying power and influence to keep America sick and continue to fill their pockets. Once again, the lesson of balance reaches not only into the body, mind, and environment but also into the nation’s federal systems. 

Diabetes can also have a profound impact outside of the financial sense. A study published by the National Library of Medicine has found that those with diabetes have an overall worse quality of life when compared to those without chronic illness. Poor physical health can make it difficult to be mobile, feel a sense of energy, and contribute in ways that are found to be meaningful in our own lives. In addition, people with diabetes were also found to have suffered from mental illness at a greater rate than the average. In fact, Type I diabetics experience depression 3 times more often and type II diabetics twice as often. Both the mental and physical impact can lead to social withdrawal in people with diabetes, which once again can further compound poor mental health. 

On a global scale diabetes has further exacerbated income inequality and made it difficult for families to escape poverty. To me, one of the most interesting cases exemplifying this is soda accessibility. In many rural areas and developing countries it is actually easier and cheaper to buy a Coke than it is to have access to clean drinking water. In a Framingham Heart study it was found that those who consumed more than one soft drink became 25 percent more likely to have trouble managing blood sugar levels and 50 percent more likely to develop metabolic syndrome. Putting these two facts together we can see how easy it is for those without the resources to develop diabetes. Now take all the financial, physical, mental, direct, and indirect implications of the disease and place them with people who are trying to make ends meet as it is. 

Overall, diabetes as a chronic illness has deep and hidden connections to seemingly endless aspects of our lives. I have seen its direct impact on my grandparents which has motivated me to live a cleaner lifestyle to avoid where they have ended up. Most Americans have or at least know someone with diabetes, but don’t need to in order to feel its effects. Diabetes has had an immense cultural impact changing the way we think about diet, exercise, and healthcare in general. Not to mention, every tax-paying American has had some portion of their dollars cover the effects of this disease. Hopefully, a more comprehensive and in-depth look at diabetes will cause the introspection needed to create the necessary changes we need to end this pandemic. 

Another profound example of the reality of Ayruveda is found in the complex connections of the human microbiome. The microbiome is one of the most unexplored and leading areas of human health. Recently increased research on this topic has helped us to see, if anything, how little we actually know about the role that our microbiome plays in other aspects of our physical and mental health.

Looking at the complete organismic unit that we are (our body, bacteria, fungi, and other microbes) our human DNA only accounts for about one percent of total DNA makeup. This is significant in the fact that we have been affected by the genome of other organisms for the entirety of our lives, whether to our benefit or our detriment. Though they may not control 99 percent of our biological processes they still play a significant role in our body's function and should be studied in greater depth. That being said, in the concept of Ayurveda we cannot discount the role that the microbiome plays in helping us to maintain balance and homeostasis in our bodies. 

One major role of our microbiome that I can attest to is its role in harmful microbes and pathogens. A study published by the National Library of Medicine stresses the importance of the interplay of infectious disease and our own bacteria. They explain that our preexisting microbiome competes for space, nutrients, and attachment sites to the inner lining of our gastrointestinal tract. They also claim that they contribute to the physical barrier against pathogens by regulating the production of mucus. The importance of the microbiome hits close to me as I learned the consequences firsthand of neglecting it. Last summer I participated in a study abroad trip through the university to Thailand. As part of the preparation I was on a round of antibiotics to help protect against some of the fresh water pathogens we would be exposed to there. The prescription lasted for almost a month. Shortly after I had my wisdom teeth removed and I was placed on yet another round of antibiotics. I ended up getting an infection in my sockets twice after and received more antibiotics to help. I believe that my infection in the first place was largely due to my damaged microbiome and subsequent vulnerability to pathogens. 

One of the more interesting roles that the microbiome plays is in relation to our brain. Extensive communication between our gut and brain occurs via the vagus nerve, enteric nervous system, hormones, and neurotransmitters. Another study published by the National Library of Medicine found that our microbiome can play a significant role in our neurodevelopment, stress responses, mood, cognitive function, and memory. These microbes can even produce neurotransmitters like GABA, serotonin, and dopamine, all very important in the function of our brain. In that same study, it was found that certain neurological disorders such as Parkinson's, Alzheimer's, anxiety, depression, and even autism can all be linked to an imbalance or an overall poor internal microbiome. A separate article published by Nature Briefing found that the microbiome plays a role in the regulation of microglial cells as well. Improper microglial function can lead to neuroinflammation and many other early signs of neurodegenerative diseases, once again all related to poor microbiome maintenance. 

Given these problems that arise from a disruption in the microbiome, we can find rather interesting therapeutic techniques to treat them. FMT is a standard medical procedure that stands for fecal microbiota transplantation. In this procedure, fecal matter from someone with a good microbiome (or a healthy donor), is given to someone else to help rebuild their microbe colonies. This transplant can be done through enemas, oral capsules, and other methods. Originally this treatment was used to treat people with antibiotic resistant CDI (or Clostridioides difficile Infection). It is also being tested through research to see if it is an effective procedure for other microbiome-related issues such as Chron’s disease, IBS (inflammatory bowel disease), chronic constipation, Parkinson’s, diabetes, allergies, autoimmune disorders, and immune regulation for certain cancers. Because the microbiome is so vast and complex research in these areas is slow and the risks are unknown. There is concern about accidentally introducing species that can cause problems not previously thought to be related to the microbiome. As we have not yet determined what constitutes a “healthy” makeup of a microbiome we are left to define “healthy donors” as those who do not present with the disease being treated. 

Overall, it is once again very clear to see that this concept of Ayurveda is more important than we could have previously known. We can see now that an imbalance in our microbiome, (most typically by poor diet) can lead to a myriad of other disorders, affecting our mental health, neurological health, and physical health. Besides the core concept of balance, the microbiome is also evidence of Ayurveda through personalized medicine. According to Ayurveda each of us is inherently a different make up of elements to make us who we are, so our treatment should be different and personal as well. Research into the microbiome is also helping to lead us to an era of personalized medicine through tailored prescriptions, calculating biomarkers for disease susceptibility, and better nutritional recommendations for the patient.