Curated Paper 1: Metabolism, Microbiome, and Ayurveda: The Big Picture

        For millennia, health and medicine have rested on the idea that parts of the body constantly communicate with each other and the environment. This perspective is central to Ayurveda, “The science of life,” and contemporary research likewise recognizes the connections between biological systems. As I continued my research on Ayurveda, one important tenet I came across was Agni (fire), which represents the biological or metabolic fire. Agni drives metabolic processes and, ultimately, health and vitality. This idea started to sound similar to what we know about the microbiome. In Ayurvedic philosophies, Agni governs distinct mechanisms such as ingestion, digestion, absorption, and assimilation. Ayurveda emphasizes that proper digestion is vital to preventing disease, so when Agni becomes imbalanced, it can lead to Ama, a toxic, undigested byproduct. My first impression came as I read about the disruptions of these processes in my microbiology class and our discussion of dysbiosis. Perhaps even more significant than recognizing the interconnected nature of these processes is the idea of utilizing our modern understanding and investigative tools to improve overall individual health. Through my journaling, I noticed that observations and experiences I have had in my own life fit nicely within both the Ayurveda framework and the study of pathology and disease lifecycles.

Which comes first…the chicken or the egg?

At first, you might think this sounds like an opening line to a comedy act, but practitioners of Ayurvedic medicine would argue this is no laughing matter. This paradox is very similar to what we know about the microbiome. I started to wonder whether certain diseases lead to an imbalance in the microbiome, or whether the imbalance in the microbiome leads to the disease.  Research shows that when the microbiome is in a state of equilibrium, it performs essential processes that improve metabolism, immunity, cardiovascular health, and brain health. Conversely, when the microbiome is out of balance, dysbiosis can occur and may contribute to inflammatory and gastrointestinal issues. Growing up on a farm, my parents often credited being around animals and outside with making us so healthy. I didn’t care much about the idea at the time, but as we started our discussion of the microbiome, it made me curious if my childhood environment had any significant influence on my microbiome. For instance,  I come from a long line of farmers, and riding horses and playing in the feedlot were weekly activities. My cousins, however, did not grow up on a farm, and when they would visit, they struggled with hay fever and other allergies. This didn’t make much sense to me at the time, but recent studies refer to this phenomenon as the “farm effect.” An article from Pediatr Allergy Immunol discusses how lipopolysaccharides (LPS), which are bacterial components found in rural environments and farm animals, get tracked into the house and accumulate on bedding. Notably, higher levels of LPS were associated with reduced risk of allergies and asthma. The researchers found more microbial diversity in the children on the farm when compared to children not on a farm. The repeated exposure to bacterial microbes may help train the body's immune system not to overreact to everyday allergens. Notably, the influence of these microbes is particularly influential during early development. 

The idea that there are beneficial bacteria from nature and animals seemed counterintuitive, especially considering the importance these microbes have in early childhood. This raised the question: why is early exposure important for development? Interestingly, beneficial bacteria can be passed through the mother's breast milk to her newborn and can help shape the infant's gut microbiome. When infants digest their mother's breast milk, their gut microbes produce compounds that may influence serotonin signaling, which is important in healthy brain development. What I found most interesting from this connection was that early disruptions of these processes may influence the risk of neurodevelopmental disorders. This research helped me understand how breast milk can greatly influence the development of a healthy gut microbiome and overall health of a growing child. However, I wasn’t sure if these same levers could be pulled when disease has already set in. 

As we began our study of metabolism, I was shocked to learn that one of the most economically and socially devastating metabolic diseases is diabetes. Diabetes is often thought of in terms of type 1, type 2, blood glucose, insulin, and other complications when metabolism is imbalanced. In endocrinology, we learned that removal of the pancreas in animals led to what we know as diabetes, highlighting the pancreas’s role in regulating blood glucose. Before insulin was available, type 1 diabetes was essentially fatal. The discovery of insulin was lifesaving, but as time went on, the cost of insulin started to increase. Recent research emphasizes how the increased cost of insulin has created a barrier to treatment for many individuals with diabetes. An article in Endocrinology and Metabolism Clinics of North America reported that about 25-30% of Americans skip or ration insulin because of its cost. Not only is it a cost concern, but rationing medication increases the risk of complications and developing other diseases. This shows how diabetes is much more than managing a disease, but a debilitating financial obligation. Beyond the individual financial burdens, population studies on diabetes found that glucose-lowering medications and supplies were 17% of the total direct medical costs attributable to diabetes, suggesting most costs came from other diabetes-related healthcare expenses. As a college student, I recognize how even little inconveniences or unexpected financial events alter my budget for necessities. It’s difficult to imagine how different my life would be if managing a chronic illness and its costs weren’t an option. This understanding of diabetes helped me recognize that improving the lives of others requires more than just insulin and other medications. It requires addressing broader socioeconomic barriers and manageable healthcare costs. 

Connection to Ayurveda

        As I thought about these physical and economic imbalances, I started to consider the idea that these burdens may have psychological effects. Chronic psychological stress can significantly influence the gut microbiome, contributing to gastrointestinal and immunological issues. These processes are mediated by what is referred to as the gut-brain axis, through which the brain and gut can communicate through bidirectional signaling. As I investigated the relationship between stress and metabolic health, I found a study that analyzed changes in the microbiome resulting from psychological stress in healthcare workers during COVID-19. This helped me see another angle to metabolic diseases, as they found that severe psychological stress was associated with persistent depletion of some beneficial bacteria. The deficiency of these bacterial species is similar to the gut dysbiosis in inflammatory bowel disease (IBD). Notably, while the psychological symptoms fluctuated, they found that changes in the gut microbiome persisted for six months. Although this study doesn’t investigate individuals with diabetes directly, it made me consider the additional effects of stress and how it connects to broader aspects of health. I found this connection between the gut microbiome and the brain interesting, as this interaction reflects principles rooted in Ayurveda. 

    

        As I studied different areas of the body, I began to see how diet, exercise, socioeconomic factors, and the environment are all connected. I’ve come to learn that Ayurveda goes beyond disease and offers a framework for health and well-being. Blended with modern scientific wisdom, some Ayurvedic practices support restoring balance between metabolic and other biological systems to improve health. 

Curated Paper 1_Kihyun Yu

 

Connecting Ayurveda, Metabolism, Diabetes, and the Microbiome

When I first researched Ayurveda, I learned that it is a traditional medical system from India that looks at the body, mind, lifestyle, and environment as connected. Health, according to Ayurveda, is dependent on the balance of three doshas, which include Vata, Pitta, and Kapha, whereas health disorders result from an imbalance of the above doshas. Nonetheless, I found there was little scientific proof to demonstrate that the three doshas were responsible for causing diseases. Therefore, I concluded that all elements of Ayurveda could not be scientifically accepted as a whole.

My first draft on Ayurveda made use of stress as an example. Apart from affecting one's mental state, stress can affect other bodily functions such as sleep and digestion. Diet, exercise, sleep, and environment were mentioned to play a role in determining a person's health status as well. This is one of the reasons why I think there is scientific validity in the broader concept of Ayurveda. I came up with a hypothesis where stressed individuals will have more issues concerning their sleep and digestive function than non-stressed individuals.

At that point, I mostly understood the idea of balance in a very general way. After learning about metabolism and diabetes, I started to understand balance in the body in a more specific way. One of the key things that made me rethink my previous ideas was the discovery that metabolism goes beyond burning of calories. Metabolism is a series of chemical reactions that facilitate the body in using nutrients to produce energy and maintain homeostasis. The concepts of glycolysis, Krebs cycle, oxidative phosphorylation, and gluconeogenesis were also introduced to us.

One part that caught my attention the most is the regulation of blood glucose levels. Insulin and glucagon have opposing effects, but together they regulate the level of glucose in the blood. Insulin reduces blood glucose levels through decreasing the formation of glucose in the liver and taking up the glucose from the blood by muscles and fats. Glucagon increases blood glucose levels when the body requires additional energy. Diabetes develops when the regulation of glucose levels starts failing. When there is insufficient insulin production, or the cells do not react to it properly, the glucose does not go inside the cells as it should and remains in the bloodstream, resulting in hyperglycemia. At the same time, glucagon will release glucose in the blood, causing even bigger imbalance. One point that I found very interesting is that the blood could be full of glucose and at the same time the cells could not utilize it.

The study of diabetes also made me view diseases in general differently. Before this module, my view of diabetes was mainly focused on the elevated blood glucose level. However, after further understanding, I realized that diabetes does not only have impacts on the blood glucose level but can affect various organs including the liver, muscles, fats, kidneys, the brain, the immune system, the stomach and the gut microbiome. Diabetes also causes oxidative stress as a result of the long period of hyperglycemia.

The next component that helped me develop my ideas was an explanation of diabetes from a sociological perspective. The information provided in “Diabetes: Beyond Biology” talked about low income, unemployment, low education level, and bad living conditions. This information may influence one’s access to proper nutrition, physical activity, and healthcare services. For this reason, I wrote that it is far too simplistic to assume that type 2 diabetes is solely associated with unhealthy decisions made by the individual. Diet and exercise are important, but so is the environment.

Considering this idea in hindsight, I believe that it ties in with an earlier idea of mine that I had on Ayurveda. When writing my paper on Ayurveda, I believed that one’s lifestyle and surroundings influence his or her state of health. This idea was later developed in a more concrete manner when I was reading about diabetes. An individual might be aware of the importance of proper nutrition, exercise, and medical care, yet factors such as income level, occupation, education, and other living conditions may influence the accessibility of these necessities. However, this does not prove my earlier hypothesis regarding Ayurveda; rather, it helped me see the connection between the two papers.

This was emphasized by the economics of the disease. According to the Economic Costs of Diabetes in the U.S. in 2022 paper, the cost of diagnosed diabetes in the United States was estimated at approximately $412.9 billion in 2022. Direct medical costs amounted to $306.6 billion, while indirect costs were valued at $106.3 billion. Individuals with diagnosed diabetes had annual medical expenditures of approximately $19,736, while the medical expenditure was 2.6 times higher compared to those who did not have diabetes. Approximately $12,022 was attributed to diabetes per person annually.

Indirect costs consisted of loss in productivity, disabilities, and early deaths. The statistics revealed to me that diabetes impacts more than the patient who is suffering from the disease. The disease may impact a person’s family members, workplace, and even the larger society. For this reason, prevention and early intervention became an important aspect for me. As noted in my journal, physical activities can help in preventing diabetes, although prevention also requires access to low-cost health care services, good nutrition, knowledge about diabetes, testing, and exercising grounds.

There was also an additional tie to the topic brought out in the journal on the microbiome. Prior to reading this journal article, while I was aware that bacteria existed in the gut, my association with them was only with digestion. The journal showed me how the microbiome is able to have connections with other parts of the body as well.

This immediately brought back Ayurveda to mind as Ayurveda stresses digestion, diet, lifestyle, and balancing of body. While writing about the microbiome in my microbiome journal, I did not want to claim that the study of microbiome validates Ayurveda, instead I noted that the study of microbiome indicates that diet impacts gut bacteria and some specific diets are linked to some specific types of gut bacteria. For me, this was yet another instance where something related to lifestyle also connects to biology of the body.

I also learned that a disruption in the microbiome may be harmful to health. Gut bacteria help with digestion, generates helpful compounds like short-chain fatty acids, and interacts with the immune system. In class, we also found out that an unbalanced or bad microbiome is linked to illnesses like obesity, diabetes, cardiovascular diseases, allergies, and IBD. The fact that we saw diabetes in the list of conditions related to a poor microbiome was fascinating for me because I had studied it previously as a metabolic condition.

Gut-brain axis was definitely the most shocking fact from the chapter on the microbiome. It was fascinating that the gut and the brain can exchange information using such mechanisms as the nervous system, hormones, and the immune system, and changes in gut bacteria influence stress and behavior. Moreover, this information brought back the topic of my research on Ayurveda. The example that I used in that paper was that long-term stress can influence both sleep and digestion. Then, with the help of the microbiome information, I got an additional perspective on the issue of stress and the gut. Nevertheless, I do not think that it proves Ayurveda to be scientifically correct, but it explained to me the reasons for my findings.

Combining all three of these journals helped me look at the term “balance” in a completely new light. At first, while researching Ayurveda, the concept of balance seemed very general and abstract. Metabolism taught me more about homeostasis through insulin, glucagon, and blood glucose regulation. Diabetes revealed what happens when such processes start breaking down, how they affect one’s body overall, and that one’s state of health depends on one’s social surroundings and resource availability. Finally, the microbiome provided me with yet another link between one’s diet, digestion, metabolism, immune system, and even brain function.

I do not think Ayurvedic balance and biological homeostasis are the same thing, and I still agree with what I wrote in my first paper: some parts of Ayurveda need more scientific evidence. I also wrote in my microbiome journal that there is still a lot we do not fully understand about what a “healthy” microbiome actually looks like. Because of this, I think it is important not to take similarities between these topics too far.

However, when reading these articles together, my perception of the field of health care changed somewhat. Previously, I considered individual diseases and body systems in isolation. Diabetes was a blood sugar problem; the microbiome was digestive; and Ayurveda was an entirely separate medical tradition. Now that I’ve reviewed these journals again, it makes more sense why the theme of interconnectedness kept popping up in all three.

In summary, the most significant concept which I have learned as a result of connecting these topics to each other is the fact that health is a product of interaction between many factors at once. Metabolism introduced me to the concepts of regulation within our bodies. Diabetes taught me how one metabolic problem may influence the whole body, as well as create social and economic issues. The topic of microbiome made me realize that digestion goes beyond our consumption of food. Ayurveda became the first topic which made me realize that the body, lifestyle, and environment should be viewed as interconnected entities, although I still think that not all of its concepts require any scientific proof.

Reference

Parker, E. D., et al. (2024). Economic costs of diabetes in the U.S. in 2022. Diabetes Care, 47, 26–43.

Curated Paper 1 - Yun Chung

 Curated Paper 1

Health and illness are the result of the relationships that exist between various parts of the body and a person's everyday life. When I previously considered Ayurveda, I accepted its broad idea that the body, the mind, one's way of life, and the environment are all connected. Looking at metabolism, diabetes, and the microbiome has provided me with more particular methods for looking at these connections. At the same time, these subjects have led me to doubt whether the concept of 'balance' is a clear enough description of health. Precisely what needs to be balanced and how can we tell when that balance has in fact been reached? After bringing my thoughts together, I conclude that an interconnected approach to health is helpful, but it must be backed by specific biological mechanisms and by consideration of individual circumstances.

I was interested in the holistic approach of Ayurveda since I had always held the view that physical and mental health affect one another. Severe stress may lead to physical issues and a physical illness can in turn affect a person's mental state. To me, taking these interrelationships into account is reasonable. Yet, the fact that there is a connection between the mind and the body does not imply that all diseases can be accounted for by emotional distress or by lifestyle choices. It is possible for a person to be mentally healthy yet still have metabolic problems, some of which may be due to genetic factors. Although connections are important, their role may vary from person to person.

That is the reason why, to me, the term "balance" now seems too vague when used alone. It doesn't clearly show which processes are working correctly and which have altered. The aspects of a person's mental health, glucose regulation, and microbial function cannot all be regarded as belonging to a single condition. The issue I have is not with evaluating these factors together, but with supposing that a general statement can account for the details. It is exactly the complexity of disease that appeals to me. Various mechanisms can interact, and in order to understand them a close examination from several different points of view is required.

In the reflection I wrote on Ayurveda, I also separated its general approach from the particular treatments it offers. I can see the value of the emphasis it places on lifestyle and the individual as a whole, even though I remain wary of the idea that natural treatments are always superior. It is possible for someone to put their trust solely in natural cures and thus postpone essential medical treatment. The fact that this point resonated with my later journal entries helped me to realise that a wide-ranging view of health and a careful assessment of the evidence should go hand in hand. Looking at more aspects of a patient's life does not take away the need to decide whether a treatment is effective.

Metabolism served as a clear illustration of the importance of certain mechanisms. Catabolic pathways involve the breakdown of molecules to release energy that can be used, whereas anabolic pathways consume energy in order to build molecules. Glycolysis, the Krebs cycle, oxidative phosphorylation, and gluconeogenesis are examples of pathways that help to show how the body breaks down nutrients and provides fuel. Because of these processes the concept of internal regulation became more specific; rather than just saying the body is balanced or unbalanced, I could begin to ask how energy is obtained, how glucose is regulated, and what occurs when those processes fail to work properly and effectively.

It was diabetes that gave these questions significance. When a person has eaten, insulin causes the tissues to take up glucose and at the same time reduces the amount of glucose that the liver produces. Moreover, insulin signalling causes GLUT4 transporters to be brought to the membranes of muscle and fat cells. While fasting, the liver releases glucose in order to keep blood glucose levels stable. Type 1 diabetes involves the autoimmune destruction of the pancreatic beta cells, while type 2 diabetes involves insulin resistance and a decrease in insulin secretion. The fact that there are these differences shows that diabetes is far more complex than just having an excess of sugar in the blood; it is important to know what specific disruption is present since a general remark about an imbalance does not explain how the disease develops.

The microbiome contributes another aspect to this situation. When I was keeping a microbiome journal, I discovered that microorganisms aid in digestion, metabolism, immune function, and communication between the gut and the brain. The effect of food on the body can be seen both in the nutrients we take in and in the actions of our microbes. For instance, microbial fermentation leads to the production of short-chain fatty acids such as butyrate, which provides energy for the intestinal epithelial cells. As a result, I was able to see a more concrete way of linking nutrition with the notion that health relies on the interactions between various systems.

At the same time, the microbiome helped me to focus on individual differences. Not everyone has the same microbial communities and it doesn't follow that variation must mean someone has a disease. Just as important as the kinds of organisms present is the function of the microbes. Although it is interesting to find associations between microbial differences and conditions like obesity or insulin resistance, such an association does not prove whether those differences cause disease, are a result of disease, or interact with other factors. In a similar way, the findings from germ-free animals cannot be simply transferred to humans. Because of these limitations, I am careful not to assume that one microbial pattern or intervention will mean the same thing to all people.

The fact that the gut-and-brain connection was discussed also provided a biological basis for the mind-body connection which interested me in Ayurveda. The communication between the gut and the brain takes place via neural, hormonal, and immunological pathways. While this reinforces the idea of looking at physical and mental health as a pair, it does not prove that Ayurvedic ideas or any specific treatments have been scientifically validated. As a result of bringing these two areas together, I gained a more specific understanding of what a holistic approach entails: it should prompt us to look at the connections in question while at the same time being careful about what the evidence actually shows.

My metabolism journaling also broadened my view outside biological processes. Parker et al. (2024) estimated that the cost of diagnosed diabetes to the United States in 2022 was $412.9 billion, this amount comprising $306.6 billion in direct medical expenses and $106.3 billion in indirect costs. The indirect costs involved losses due to disability, reduced productivity, and early death. This demonstrated that the effects of diabetes extend to families, workplaces, and society as well as to the individual body. The study also posed a question which I had not before given any serious thought to: what occurs when a person needs treatment but their situation makes it hard to get or keep that treatment?

When I was growing up in South Korea, I never regarded treatment costs as a major obstacle in the same way. That view was due to my familiarity with the Korean health insurance system, even though my own experience doesn't prove that everybody can get medical care without difficulty. It became clearer to me through the nutrition classes and this capstone course in the United States that financial situations can be another barrier to managing a disease. It was disappointing to realize that knowing what would be helpful doesn't mean that a person can afford it or that they can fit it into their daily routine. This realization also made me interested in the roles that different health professionals and community services play in helping to ensure access to care.

Combining this social viewpoint with metabolism and the microbiome has altered the way I consider nutritional advice. Although diet has a biological impact, a person's choice of food also depends on their income, work schedule, the circumstances of their household, and the resources that are available to them. If someone is unable to adhere to a recommended eating pattern they should not be seen as lacking motivation. Knowing what food does within the body is only one aspect of the question; we must also take into account what the individual can actually obtain and prepare.

Since I intend to become a physician, I would like to look at a patient's nutritional state in conjunction with their economic situation and their daily routine. To do this, I would find out what they usually eat, how their schedule influences their meals, and what kind of home circumstances they have. From these answers I could work out the conditions under which a treatment plan would have to function. In the case of difficulties caused by cost or access, I would aim at arranging community support, identifying any available assistance, and finding more affordable ways of making dietary changes. I have also come across such possibilities in my nutrition classes, and this shows how scientific knowledge can be combined with practical support.

To sum up, these reflections have served to deepen my interest in the complexity of disease. Ayurveda enabled me to think about health in a connected way, metabolism explained the importance of particular physiological mechanisms, and the microbiome caused me to discover more relationships and uncertainties. When I learned about the costs of diabetes, this broadened my perspective to include the conditions that affect a person's ability to manage their illness. I realised that in order to take a holistic view of a person it is necessary to have both a detailed knowledge of the biology and an understanding of practical matters. Instead of merely stopping with the idea of 'balance', I now wish to find out what is actually happening, identify which factors are relevant for this individual, and determine what sort of support would make care possible.

Nicholas Davis - Curated Paper 1

Ayurveda is a system of traditional holistic medicine that originated in India. This system looks at the relationship between body, mind, and spirit. This is an official system of medicine in many places that supports a more modern medicine system. I think the interconnectedness of our body and all its processes is fascinating. I think that it makes a lot of sense that the concept of ayurveda has existed for so long.

Most diseases are due to some kind of imbalance in the body, whether that’s among the different levels of substances in your body or between your body and another organism. Microbes, for example, are an essential part of our bodies. The number of microbes in our body outnumbers our own cells by a significant amount. Some people call the relationship between our genome, epigenetics, and the microbiome the hologenome. The microbiome is an essential part of large organisms and is often required for an individual to survive. There are more than 160 different species of bacteria in any given individual. Populations of microbes differ based on location in the body and shift based on different conditions like diet or other factors. Even the placenta is exposed somewhat to bacteria and other microbes, but exposure to most bacteria will occur at birth and after. As we’ve learned more about the balances between our body and other organisms, we understand more about why disease occurs and we could consider it to be a kind of modern ayurveda. This knowledge gives us a more holistic approach to disease treatment.

Another example of this, and one that is especially interesting, is the connection between your gut microbiome and your mental health. They’ve found that various mental health issues can be improved somewhat on the basis of improving gut microbiome health. The microbiome can affect brain function via signal promotion or interference. The population in your gut can contribute to things like depression, anxiety, and even possibly something like Parkinson’s if it becomes unbalanced. 

The microbiome can produce byproducts that can interfere with other signals in the body and create problems like insulin resistance, chronic inflammation, and a lack of satiety. Antibiotics are an example of something besides diet that can completely change the makeup of your microbiome. Some people can see improvements in certain problems with their microbiota when using antibiotics. Genetics can also play a part in diseases relating to the microbiome of the gut. The immune system maintains a homeostasis with the gut microbiome and when the immune system reacts improperly, it can lead to gastrointestinal diseases. 

As development continues from birth, the body can grow with different microbes that can have very different effects. The body uses various signals, chemicals, and conditions to select for microbes normally found in the microbiome. One example is that the intestinal lining uses a lot of oxygen which makes an anoxic environment, which is one of the ideal conditions for normal gut bacteria. The milk of a mother is essential for the development of a baby’s microbiome and immune system. If the microbiome doesn’t develop properly, it can lead to things like malnutrition and disease. Probiotics can help to restore normal function to your microbiome when it’s been put off balance. 

The microbiome has major impacts on many different systems in the body. They have found that obesity can be caused by the microbiome. They took mice that were obese and performed a fecal transplant on mice that didn’t have a microbiome and those mice became obese. Diet is a major determinant for the composition of your microbiome. Certain diets can promote the growth of bacteria that can contribute to many different diseases like atherosclerosis, obesity, and others.

Another major factor in diseases like obesity is metabolism, which is where imbalances within our own body come in. Metabolism is the conversion of energy from ingested material into a usable form for the body. This energy and other molecules associated with the process of metabolism are used to maintain homeostasis and allow for growth and survival of the body. This is accomplished through a combination of catabolic and anabolic processes. Metabolic diseases most commonly have to do with molecules that tend to be less essential for survival, since organisms with metabolic diseases that affect the main processes typically don’t live for very long if they live at all.

Metabolic diseases can arise in three primary ways, genetics, acquired, or dysfunction. One of the most well known metabolic diseases is diabetes, which can be either from genetics, type 1, or acquired, type 2. Treatments for metabolic diseases include dietary restrictions, enzyme replacement therapy, and there are gene therapies emerging that can even cure certain metabolic diseases. Examples other than diabetes of metabolic diseases are galactosemia, phenylketonuria, and Gaucher disease.

Metabolic diseases are all about a loss of balance in the body. Thinking about them through the lens of ayurveda is interesting here because it is the loss of balance caused by whatever metabolic deficiency that causes disease. Metabolism is all about maintaining homeostasis in the body, so when there is a process that doesn’t work like it should, like being unable to properly metabolize phenylalanine for example, then it can throw off the balance the body typically maintains and it causes bad side effects that lead to disease. Diabetes is another great example of a balance of things that are all supposed to be there being thrown off and causing disease.

My sister has had type 1 diabetes since she was around 3 or 4 years old and one of the biggest things I’ve noticed is how inconvenient it is. She had to get used to needles when she was very little because she had it before they had any good insulin pumps, so injections were the only way for her. It’s become much more convenient for her since she can now use a pump, but there are still expenses tied with that. One thing I haven’t noticed, at least lately, is her being unable to do something because she has diabetes, which is good.

My dad and one of my other sisters have prediabetes, which would become type 2 diabetes without management. Their situation is not as inconvenient, but they do use medication to help manage their blood sugar levels. My dad has successfully implemented lifestyle changes that have helped effectively manage his prediabetes as well as some other issues like kidney stones. I’m not sure if his kidney stone issue is a metabolic one, but I do know that he makes two different kinds of kidney stones that each come with their own dietary restrictions to manage them.

Society is often a big contributor to the risk of people in a population developing a metabolic disease like diabetes. Things like city planning, economic status, and other factors of accessibility to healthy lifestyles. Diabetes also has a significant impact on society, especially in terms of cost. Well managed diabetes is very costly to individuals due to insulin costs and a healthy lifestyle is often more expensive for many people. Poorly managed diabetes is even more costly for individuals as well as society itself. 

Diabetes can result in major health issues including complications that can lead to loss of eyesight and amputation of limbs. This is expensive for the person going through it, but it also costs society a lot in things like loss of productivity and payments for the disabilities that result from these conditions. Social determinants tend to lock people into cycles of unhealthy lifestyles that can be very difficult to break. It can be difficult for these patients as well due to stigmas surrounding things like obesity.

Looking at recent figures on the cost of diabetes, diabetes accounts for about 1 in every 4 dollars spent on health care. People with diabetes spend around 4,000 dollars a year out of pocket just for this condition. Numbers tied with diabetes can get somewhat messy as well because of the number of other conditions it can cause. Adding complications like kidney disease, hypertension, and other conditions resulting from diabetes makes those medical bills stack up quickly.

An article called Economic Costs of Diabetes in the U.S. in 2022 from Diabetes Care gives some crazy statistics for just how big of a deal diabetes is on an economic level. Diabetes costs an estimated $412.9 billion with $306.6 billion being direct costs. Indirect costs come from loss of productivity due to disability and premature deaths along with other factors that come with diabetes. On average, people with diabetes pay 2.6 times more money on medical expenses than someone without the disease. They conclude that the cost is an incredible burden on society as a whole. This is a big reason why more effective treatments for diabetes are sought after and why it’s worth spending money to try to fix the problem.

Diabetes has some really interesting and terrible effects on the body. Diabetes can lead to a decrease in flexibility in the walls of arteries and veins, which leads to higher blood pressure because the heart has to work harder to do its job. It can also cause impairment to the immune system’s ability for phagocytosis, which makes fighting diseases more difficult. Proteins can become glucosylated, which can change the shape of the protein and impair its normal function. Blood clotting is more likely to occur, which can lead to deep vein thrombosis, pulmonary embolism, stroke, or heart attack.

These issues and imbalances are just a couple examples among many about why the core idea of ayurveda is so important in health. There are many options that people can take advantage of to improve their health, many of them being lifestyle changes that have proven to be sustainable for those who participate. Focusing on proper diet and physical activity can do a lot to reduce the likelihood of throwing off the many delicate balances your body maintains. My family has benefited from some of these lifestyle changes in their health struggles and the science shows that anyone can.

Curated Paper 1 GD

 In the last several weeks, after learning about Ayurveda, metabolic pathways, diabetes, and the microbiome in humans has most definitely changed the way I think about health and disease. Now, as a biology undergraduate student, I have spent a rather large sum of time studying the different systems of the human body. Often I’ve focused on individual organs, cellular processes, and biochemical pathways. However, the unification of these topics has helped me to recognize that our bodies are very interconnected. If you affect one system, it can have consequences throughout the entire body, whether that means you changed something in glucose regulation, or the microorganisms that live in our digestive tract, or even our environment and lifestyle. I think one of the most interesting connections that I've found while learning these topics is how they relate to the philosophy of Ayurveda. In particular, the emphasis it has on balance and the relationship that the body, mind, and environment have on one another. Now, the traditional explanations that ayurveda has aren’t necessarily supported by our modern science, but I think it still has some particularly interesting similarities between its overall perspective on health and what we actually know about physiological homeostasis. And looking at these topics side by side has helped me to develop new ideas about what balance, as taught by ayurveda, actually means, as well as how different biological systems can influence each other, and how understanding disease requires more than being able to identify one disrupted process.

What is Ayurveda? A traditional system of medicine that originated from India several thousand years ago. Its main philosophy puts emphasis on maintaining balance between the mind, body, and spirit. It also recognizes that lifestyle and environmental factors can impact health. In Ayurveda, people are believed to have different combinations of 3 doshas. They are called vata, pitta, and kapha, and they believe that disease is a disruption of their balance. Now, doshas haven’t been established as biological mechanisms in modern scientific research, but the more broad concept that different bodily systems influence one another is something that I find rather reasonable. In my physiology class, we are always learning about homeostasis and how the body maintains these internal conditions through coordination of multiple organ systems. The nervous, endocrine, immune, and digestive systems are in constant communication with one another, and a disruption in one can most definitely influence the function of several others. I think an interesting comparison between ayurveda and modern biology can be made here without having to necessarily say they are scientifically equivalent. This also made me question a lot about whether health should be understood as just maintaining one specific internal condition or as the body’s ability to constantly and continuously adapt to different circumstances. 

I think one of the best examples of this kind of interconnectedness is metabolism. Even more so when looking at diabetes. During all of my substantial quantity of general biology, physiology, chemistry, and biochemistry classes, I've spent yet an even larger substantial quantity of time learning about glycolysis, gluconeogenesis, glycogenolysis, and the citric acid cycle. Now, when I first learned these, the pathways seemed to me like separate processes that I just needed to understand for my exams. However, while learning about diabetes, it helped me to appreciate how important they are for maintaining normal physiological functions. The body is constantly regulating glucose availability, energy production, and nutrient storage. And hormones such as insulin and glucagon are so critically important to coordinating these processes. In type 1 diabetes, autoimmune attack on pancreatic beta cells makes it so the body produces little, or no insulin. Type 2 diabetes is similar, although insulin can be made, cells become less responsive to insulin, and the pancreas can eventually struggle to make enough insulin to maintain normal blood glucose levels. A disruption such as this can affect multiple metabolic pathways and even eventually impact the cardiovascular, nervous, renal, and several other systems. I think something that stands out a lot to me is how something that involves the regulation of one molecule, glucose, can have such a widespread effect on the body. I think this helps me to recognize that even though we study each metabolic pathway individually, they are all working together to maintain homeostasis.

After learning about all of these metabolic pathways, it made me reflect about my own lifestyle. As a college student, I am constantly juggling classes, studying, work, exercise, and getting sufficient sleep. Finding a balance between these things is difficult. On some particularly busy days, it is often tempting to choose to eat whatever food is quickest or most convenient to make, rather than something that has better nutritional value to me. I think that before I studied metabolism in greater detail, I never really thought about how those decisions influenced the biological processes happening inside my body. I think now, I spend much more time and careful consideration on how nutrition, physical activity, and sleep are affecting my energy regulation and long-term health. I think that even though type 2 diabetes has loads of contributing factors, including genetics, and other circumstances that are outside of a person's control, it is important to maintain healthy habits that can help reduce its risk. I think this ties in nicely with ayurveda’s emphasis on lifestyle and maintaining that balance, since each of the perspectives, ayurvedic and biological, encourage each of us to consider how our everyday choices, behaviors and such influence our health over time. Now, something that I did begin to realize from some of the other topics that we covered is that lifestyle choices are only a part of maintaining health. There are many more biological and environmental influences that we don't always have complete control over.

Another topic that I found interesting was the human microbiome. In many of my biology and immunology classes, we spend a lot of time talking about pathogenic microorganisms, antibiotics, and how the immune system works and how it protects the body from infections. I think that learning about the microbiome challenged this perspective, since it highlights how dependent we are on microorganisms for our normal bodily functions. We have trillions of microorganisms that live on and inside the human body. Many of them contribute to digestion, metabolism, immune regulation, and protection against pathogens. In my immunology class, we talked about how microorganisms can have mutualistic, commensalistic, or pathogenic relationships with their hosts. Some of our beneficial bacteria help break down some otherwise indigestible food components and then make useful metabolites. Others occupy space and compete with potentially harmful organisms. I think learning about this definitely helped me to recognize that maintaining health isn’t just about destroying bad microorganisms, but also about maintaining relationships with the good ones that allow our bodies to function properly. I think its super interesting that organisms that we might normally link with disease are actually essential contributors to our health.

I think something that I found most interesting about the microbiomes is that two different people can have two very different microbial communities. Genetics, diet, medications, age, environment, and lifestyle can all influence what microorganisms we have in our bodies. What this can mean is that there isn’t a ‘gold standard’ for microbiomes that everyone should have, but it's more so that health can depend partly on how well a person's microbial ecosystem is doing within a person's body. If there were to be a significant disruption of this, also called dysbiosis, have been linked to several diseases. I think this made me think a lot about the concept of balance with ayurveda. Initially, I was thinking that the balance of the body was just functioning in a particular healthy state, but my understanding was reformed. If two healthy people can have vastly different microbiomes, then maintaining health certainly means that it does not require that they have identical microbiomes. I think it's much more that biological balance is about someone being able to regulate themselves and adapt to changing circumstances. I think that thinking about it this way makes a much stronger comparison between ayurveda and modern biology, more than just saying they both emphasize balance. 

While I was thinking about how the microbiome changes I was reminded about my experience of moving to Portugal. When I moved there I noticed a lot of differences in how my digestive system felt, and in the moment, I chalked these changes up to mostly stress, sleep schedule differences, or just getting used to a new environment. After we talked about the microbiome, I realized that the changes in my diet and the foods i was eating was influencing my gut microorganisms. Different microbes metabolize different nutrients, which means dietary changes can change the environment in which they live. Although I can't directly state that my microbiome was the culprit for the digestive changes I felt, I can certainly realize how complicated the relationship between diet, environment, and physiology can be. I think this also made me realize that things like antibiotics can also sometimes disrupt beneficial microbial populations in their quest to eliminate the harmful ones. I think that when I look back on my experience I think it is very possible that multiple factors went into my digestive changes rather than just one. 

I think that after reflecting and reviewing these topics from my undergraduate experience has helped me to gain a much broader understanding of what imbalance actually means. Ayurveda has helped me to think more critically throughout this whole process, and I think that revisiting my journals has helped me to appreciate how much more complex health is than simply just the lack of disease. I find that I am thinking more about the relationships between all the different bodily systems. Diabetes shows the importance of metabolic homeostasis, and the microbiome helps us understand our dependence on microbiota. I think that by combining these ideas, it helps realize that metabolism is influenced by microorganisms, and that chronic disease and stress can influence one another, and that biological balance doesn't always look the same for everyone. I think that my personal experience of moving to Portugal, being a college student balancing my responsibilities, and knowing people who live with diabetes has helped me to see these concepts in more real life situations. I would say that by far the biggest lesson that I've taken from these topics is that understanding disease is much more than being able to identify what biological process has gone wrong. It also is about recognizing how the disruption affects the rest of the body, affecting mental well-being, and their ability to function in a society. I think that as I continue to study biology and prepare for med school, i think keeping this broader perspective can help me understand my patients as individuals rather than just a collection of symptoms or medical conditions. 

Curated Paper 1- Balance in All Things

 Balance in All Things

“Calm mind brings inner strength and self-confidence, so that's very important for good health.” - Dalai Lama

Just as the Dalai Lama’s words suggest, the mind and body are very closely linked, and problems with one can seriously impact the other. This idea of interconnectedness is not new. Ayurveda, a traditional medicinal system used in India, has promoted a long and healthy life for generations. It involves using natural elements to battle the root cause of diseases, primarily through restoring balance to the body and creating a healthy lifestyle to ensure this balance is maintained. It aims to maintain harmony and balance in all disciplines of life, including the body, mind, and spirit, through the use of holistic approaches such as changes in diet, use of herbs and spices, meditation, yoga, and more to prevent and treat disease. While holistic practices may not be enough to treat every disease, Western medicine is essential for treating specific diseases. However, only understanding the body through structural or biochemical analysis can sometimes limit our view of health. Studying various topics from metabolism to the microbiome to diabetes, I kept finding the same lesson: the systems of the body and the environment around us are all connected, and our health is dependent on ensuring balance among them.

Our metabolism is a good example of this. It recycles and builds energy through pathways such as glycolysis, pyruvate oxidation, and the Krebs cycle. During a biochemistry class I took over the summer, we went into depth about each of these cycles and how they work together to create homeostasis within multiple systems. There are major detriments that can happen when these cycles don’t function or aren’t regulated properly. A few diseases that occur from enzyme dysregulations are G6PD deficiency, PEPCK deficiency, von Gierke disease, or complex II mutations. Diving deeper into one of these disorders, I was able to learn more about von Gierke disease. Edgar von Gierke, the namesake, was the first to describe the excess glycogen storage in the liver. Von Gierke disease is an autosomal recessive glycogen storage disease resulting in abnormal amounts of glycogen. It is caused by a deficiency of glucose-6-phosphatase activity, mainly in the kidney and liver, leading to hepatomegaly, hypoglycemia, and other long-term conditions. There is no cure, but strict diet and medical treatment can manage it. As we can see, one enzyme malfunctioning causes a domino effect through our whole system, and diet can help to restore the “balance”. This is exactly the kind of approach that Ayurveda emphasizes. 

The same interconnection appears between the immune system, thyroid, and blood sugar. The major histocompatibility complex (MHC) is the major genetic contributor to autoimmune disease susceptibility, and accounts for a large part of genetic risk in conditions like type 1 diabetes and rheumatoid arthritis. The primary function of MHC molecules is to defend against pathogens, but variation on the MHC gene locus on 6p21 is closely connected to autoimmune thyroid disease, including Hashimoto’s thyroiditis, which I have. Thyroid disorders impact metabolic functions including circulating insulin levels, absorption of glucose, and glucose uptake. Hyperthyroidism is linked to glucose intolerance, while hypothyroidism is associated with insulin resistance. Autoimmune thyroid diseases are more common in people with type 1 diabetes, reflecting shared genetic susceptibility. Seemingly separate diseases turn out to be deeply intertwined. 

These conditions can also come with emotional and financial burdens. Between 1990 and 2010 cases of those living with diabetes tripled, and the number of new cases annually doubled. Those adults with diabetes have a 50% higher risk of death than those without, not accounting for the myriad of complications associated with diabetes. In 2022, the American Diabetes Association’s most recent comprehensive US economic analysis found that those with diabetes had an average annual medical expenditure of $19,736, about 2.6 times higher than those without diabetes. This can include payment for insulin, glucose monitors, A1C checks and lab testing, treatment of additional health complications, time away from work, and other costs. These can all create financial hardships for patients and families. The CDC reported approximately $640 billion is used annually for diabetes related costs and accounts for one-quarter of the US health-care spending. We can use this information to better the lives of those around us by investing more in prevention and early intervention, including making insulin and healthy lifestyles more affordable. One of the cheapest ways to deal with diabetes is to prevent it during the pre-diabetic stage. This is where Ayurveda’s message and modern medicine meet: put the body into balance before it becomes severely unbalanced. 

The microbiome may be one of the most important pieces of that balance. A person's microbiome begins developing very early in life. We live with enormous amounts of microorganisms, and scientists are still learning what a “normal” or “healthy” microbiome actually looks like. As I read about this alongside metabolism and diabetes, I began to wonder: if gut microbes influence metabolism and immune function, could microbiome imbalances lead to these chronic conditions? We know that the gut is connected to many different systems in the body, including the immune system and metabolism, and there is also evidence of communication between the gut and the brain. Gut microbiome imbalances have been associated with many health conditions. In addition, Westernized industrialized populations tend to have less diverse gut microbiomes than those in rural settings, and exposure to soil, animals, and other microbes appears to be a contributing factor. Evidence has been found that children who grow up with dogs can have differences in their gut microbiome and may have a lower risk of developing certain allergic diseases. Modern lifestyles have perhaps shifted our relationship with microorganisms in ways we are only beginning to understand. This is where Ayurveda and microbiology, in different ways, point us in the same direction. If a diverse, healthy microbiome helps to prevent metabolic and autoimmune disease, then the preventive lifestyle that Ayurveda promotes may deserve further research.  

The mind is also an essential piece of the puzzle. One paper I found discussed how high subjective well-being can promote better health and longevity, and that positive emotions were related to lower pain and a greater tolerance for pain. This fits into the idea of balance between the mind, spirit, and body. In another class, we discussed physician Ronald Epstein’s observation that when we are less anxious, defensive, and rigid, curiosity flourishes. This promotes the idea that a calm mind can not only improve health but also our learning. It is interesting to me that something as simple as our outlook on life or our situation can make such a difference in our health. I saw a real example of this when I was vacationing in California over the summer; I happened upon a group doing Tai Chi. The instructor explained how he now works with a hospital to help people connect their mind to their body to have a positive effect on their health. Meditation techniques may help to improve this relationship between having a “calm mind” and “good health”. Western medicine is still the default for treatment because of its supporting evidence and research; however, it remains clear that there are many obstacles to overcome in order to deliver the best care for each patient. Ayurveda-based and other holistic approaches can support prevention and patient well-being. 

In the end, our outlook on health should expand to include the mind alongside the body’s systems. Just as balance is an integral part of Ayurveda, there is also balance in how we use it: drawing on the strengths of both Western and holistic approaches can help prevent disease before it begins. 

Curated Paper 1 - Craig Whittaker

  Journaling every day has helped me connect concepts from biology with broader approaches to understanding health. Over the past few weeks, I’ve journaled about ayurveda, metabolism, diabetes, and socioeconomic influences on health. Revisiting these entries has allowed me to recognize connections I had not initially considered. Integrating these topics has given me a more comprehensive understanding of health and disease. It has made me realize that the key to health is the balance between the mind and body. 

To begin with, let’s understand what ayurveda actually is. Ayurveda is an ancient traditional form of medicine whose central dogma is the balance between the body and mind. One of the main principles of ayurveda is the three doshas: Vata, Pitta, and Kapha. The three doshas represent biological energies which must be in balance. It is thought that illness arises when the doshas fall out of balance. Key values of ayurveda are diet and digestion, lifestyle and prevention, and overall balance. We will see how these values relate closely with diabetes, metabolism, and socioeconomic influences on health. 

Ayurveda’s holistic perspective offers a useful way to think about interactions between body systems. Modern healthcare is designed to focus narrowly on individual organ systems or sometimes even just organs. Clinicians often specialize in a specific organ system and often don’t take other organ systems into full account when treating. This can cause serious side effects when the rest of the body is not considered. While we can train clinicians to have a more holistic approach, the problem is deeply rooted in how our healthcare system works. I don’t think that putting the full responsibility on training clinicians will be effective. This issue would have to be solved through a complete restructure.

Ayurveda has changed how I think about balance and the interconnectedness of the body. I always knew that the body is always wanting to reach homeostasis across many processes from studying biochemistry, but I never considered the interconnectedness of the mind and body. A person’s outlook on life has a significant impact on their health. For example, someone with depression might find it difficult to get outside and be active, and if that were to go on for an extended period of time, it could lead to serious health problems such as obesity or diabetes. Not to mention, those problems could cause more depression. Another example could be anxiety. We know that anxiety can cause a myriad of issues, such as hypertension, gastrointestinal distress, irritable bowel syndrome, shortness of breath, a weakened immune system, and much more. All to say, the mind and body are entirely connected.

Now let's bring in metabolism and diabetes. Let’s first dive into metabolism and explore the relationships between anabolism, catabolism, and metabolism. Metabolism is the sum of all reactions that sustain life. Anabolism takes energy from simple molecules to build complex molecules. Catabolism breaks down complex molecules into simpler ones. These processes work together to maintain and sustain the body. When metabolism dysfunctions, a possible outcome is hyperglycemia. Hyperglycemia can damage the endothelium of blood vessels, which can affect blood flow, blood pressure, clotting, and inflammation. Excess glucose can do this through oxidative stress, which is when reactive oxygen species oxidize proteins, lipids, and DNA, affecting blood vessels. Oxidative stress can also reduce nitric oxide availability. Nitric oxide helps blood vessels relax; without it, blood flow can be impaired. Another way is through advanced glycation end products (AGEs). AGEs are formed when glucose attaches to proteins and lipids without enzymatic control in a process called glycation. Over time, AGEs can build up in vessel walls, causing inflammatory signals. One last way hyperglycemia affects blood vessels is simply by thickening and stiffening vessel walls via chronic inflammation and damage to the extracellular matrix.

To explain how one becomes hyperglycemic, we first need to understand how insulin and glucagon work together to balance glucose levels. Insulin works to lower blood glucose by anabolic processes of storing nutrients and constructing large molecules. Glucagon raises blood glucose by extracting stored energy, usually in times of fasting. When the system malfunctions, hyperglycemia, type 1 diabetes, and type 2 diabetes can occur. 

Let’s talk about type 2 diabetes and how genetic predispositions and lifestyle factors play a role. Genetic predisposition can cause someone to have impaired insulin production or insulin resistance. This alone doesn’t guarantee someone will develop diabetes, but rather it means they are more susceptible to diabetes. Lifestyle factors are what can take those genetic predispositions and cause type 2 diabetes to occur. Diet, physical inactivity, excess body fat, poor sleep, stress, and environmental factors can all affect someone's likelihood of developing diabetes. Many of these factors can be out of someone's control and are baked into society. Food access and opportunities for physical activity are huge factors that we ought to take more seriously as a society.

To bring all these ideas back to ayurveda, the key to avoiding these conditions is balance. There needs to be balance metabolically, in diet, in exercise, and in sleep. We can see that when systems fall out of balance, disease occurs. This trend expands across organ systems. We have been using diabetes as an example to demonstrate this, but there are many different ailments that all derive from a lack of balance between systems.

Researching ayurveda, diabetes, and environmental factors for diabetes has made me realize that type 2 diabetes is preventable and the blame should not be placed on the people who are afflicted with it. In society, there is often a stigma around type 2 diabetes, and people are quick to blame the afflicted person, but there are so many factors outside of their control that blame is not fair. This research has solidified my stance that we need to address type 2 diabetes on the social level and not the individual. The system we live in is built to put those at risk in danger.

To expand on the system, let’s dive into the socioeconomics of it all. It is no coincidence that people with type 2 diabetes often are in the lower socioeconomic classes. We have found strong inverse relationships between household income and type 2 diabetes. One of the major reasons for this is disadvantaged environments. Immediate access to fresh food is often limited, and safe spaces for outdoor activity are non-existent. Chronic financial stress causes inflammatory proteins and cortisol in the blood, triggering insulin resistance. Barriers to healthcare are enormous. When it is difficult to put food on the table and pay rent, going in for a check-up is not even in the picture. This causes treatment to be delayed until hospitalization. These delayed treatments cause severe complications that can be fatal. Not to mention, if you are trying to get a job as a person with type 2 diabetes, your odds are much lower. There has been research done on biases towards people with type 2 diabetes. People with type 2 diabetes have lower odds of getting jobs and being promoted. This makes getting out of the lower class and into a safer environment much harder. These biases also make adults conceal their diabetes. This concealment might even make them take their diabetes less seriously because they are in denial that it even exists! There is a quote by W. Edwards Deming: “Every system is perfectly designed to get the results it gets.” In this context, we could say that diabetes being the problem it is today is no accident. This system we live in was designed to keep the lower class down.  We have to address the system to solve these issues. We have to correct these conditions that people in lower socioeconomic classes live in. Diabetes is among the leaders in death causing diseases and has to be taken seriously.

To conclude, ayurveda ties the ideas of holistic health care and balance in the mind and body to prevent diseases. We can use these ideas to build a healthcare system that is better designed to treat the whole body. We can also see connections of balance in how our metabolism works. We can see biologically what goes wrong when systems fall out of balance. Using diabetes as an example, we see that when insulin and glucagon become unbalanced, glucose levels rise or fall, causing a myriad of issues, including type 2 diabetes. We learned that type 2 diabetes requires a genetic predisposition as well as environmental and lifestyle factors. Finally, we learned about how socioeconomic class affects one’s likelihood of developing type 2 diabetes.