by Alakananda Devi (Alakananda Ma), M.B., B.S. (Lond.)
According to the latest medical research, optimal blood sugar levels should be significantly lower than the so-called "normal" range, "shifting the entire population glycaemia curve to the left." (Editorial, BMJ 2001; 322:5-6). It is essential for us as Ayurvedic practitioners to be abreast of these current understandings, so that we can apply the correct chikitsa to prevent serious illnesses in our clients.
In an important article in The Lancet, (2006 Nov 11; 368(9548):1651-9) the authors note that "Cardiovascular mortality risk increases continuously with blood glucose, from concentrations well below conventional thresholds used to define diabetes." They further note that, "Higher-than-optimum blood glucose is a leading cause of cardiovascular mortality in most world regions." In fact, high blood sugar is linked, worldwide, to 3,160,000 deaths each year.
Traditionally, the ADA has held fasting blood glucose of less than 100mg/dL as "normal". Yet the Lancet study showed that risk started to increase at 4.9mmol, or 88.2mg/dL; a number that would pass as very normal on a blood sugar test. An Israeli study published in the New England Journal of Medicine in 2005 followed healthy, non-diabetic Israeli soldiers for an average of over five years. Co-author Dr. Iris Shai noted that, "What we found was that men with fasting blood glucose levels at the high end of normal - between 95 to 99 mg/dl - had about three times the risk of developing type 2 diabetes as men with blood sugar levels under 81 mg/dl." Furthermore, "If you combine those high end levels with other factors like obesity or high triglycerides, the risk is even higher."
I have found it helpful to look at blood glucose levels in three segments, explaining carefully to clients where they fall on the spectrum and enlisting their support in achieving optimal levels even after their doctor may have told them everything is "fine." A standard for diagnosis of diabetes is fasting blood glucose of 126mg/dL or above, on more that one test and accompanied by symptoms of diabetes. Those who have fasting blood glucose of 100-125mg/dL are typically said to be pre-diabetic. They may have symptoms such as overweight or obesity, high cholesterol and high blood pressure. While with these two groups the diagnosis is pretty clear cut, it is important to consider the third group, those who have peri-diabetes. These individuals have fasting blood sugar in the range of 86-99mg/dL. In addition, they may have a family history of diabetes, as well as sugar cravings, and abdominal weight gain.
Once we have segmented our group in terms of how close they are to developing diabetes per se, we of course need to further segment in terms of tridosha. A peri-diabetic vata may be of fairly normal weight, yet with a little pot belly indicating build up of hard fat intra-abdominally. They may have an erratic eating pattern that focuses around refined sugar. A typical day for this individual might look like this. Skips breakfast, has some black coffee in the car on the way to work. 11a.m-- gets a Snickers Bar from the vending machine. Lunch--has a salad. Four p.m. more refined sugar snacks or perhaps a diet soda. After dinner, they may consume chips, popcorn or cookies throughout the evening. The peri-diabetic pitta, on the other hand, is overweight or borderline obese. They crave breads, chocolate and sweets throughout the day and eat ice cream after dinner. They experience tikshnagni which is worsened every time they consume a refined sugar or refined carbohydrate. The more sugar they eat, the hungrier they become, leading to an uncontrollable urge to continue snacking. They experience irritability in relation to any delay in their meals. Their blood pressure is elevated to 130-85 or above and their cholesterol is moderately elevated. As for the peri-diabetic kapha--this individual is typically obese, eats a lot of desserts, and craves carbohydrates although they feel sleepy after consuming them. They try to lighten their diet by skipping breakfast only to end up consuming large amounts of high calorie foods calories during and after dinner. Their blood pressure may be 140/90 or higher and their cholesterol and triglycerides are elevated. Although different strategies are needed for each in terms of chikitsa, it is worth noting that the vata under-eater, the pitta overeater and the kapha food addict all face an increased risk of heart disease, macular degeneration and cancer.
Although Ayurvedic care will be of immense value at any point in the spectrum of diabetes, it is in the peri-diabetic group that Ayurvedic care can make a world of difference. At this stage, we have the opportunity to intervene at the earlier stages of the kriya kala process; whereas by the time pre-diabetes or diabetes is medically diagnosed the disease has already progressed to the vyakti and bheda stages, with significant irreversible damage.
Diet, exercise and lifestyle changes are universally recommended for diabetes. In addition, Ayurveda offers valuable herbal remedies to help maintain blood sugar at an optimal level.
In terms of diet, the most important area to address is breakfast. A skipped or sugary breakfast sets off negative hormonal cascades for the remainder of the day. For the vata who skips breakfast, cascades of adrenalin and noradrenalin lead to reduced appetite for wholesome full meals and craving for sugary snacks. For the pitta who has sugar puffs for breakfast, the day starts with excess insulin production leading to increased tikshnagni and craving for carbohydrates. For the kapha who skips breakfast, elevated cortisol levels lead to compulsive overeating and weight gain. The best plan for any peri-diabetic person is to avoid the sweet breakfast. Kitcheri can be an excellent breakfast for vata and pitta, while vegetable soup starts the day well for kapha. For clients who eat eggs, scrambled eggs (for vata) or egg white omelet with vegetables (for pitta and kapha) can be a great way to introduce protein at breakfast while keeping an aura of familiarity in terms of breakfast foods. The other important point regarding diet is to keep things light at night, avoiding dense starches in the pitta time of the evening from six to ten p.m. Vegetable soup is a good light dinner which helps keep the fasting blood sugar regulated. Refined sugars and refined starches should of course be eliminated from the diet, a process which will become easier once Ayurvedic herbs begin to balance the sense of taste and reduce cravings for starches and sugars.
Asana has been shown to improve blood sugar levels in patients on the diabetes spectrum. A peer reviewed study in Nepal Medical College Journal. (2005 Dec; 7(2):145-7-- Malhotra V,Singh S, Tandon OP, Sharma SB. ), showed, "significant decrease in fasting glucose levels from basal 208.3 +/- 20.0 to 171.7 +/- 19.5 mg/dl and one hour postprandial blood glucose levels decreased from 295.3 +/- 22.0 to 269.7 +/- 19.9 mg/dl". The asana programme also improved abdominal obesity in these subjects, with a significant change in waist-hip ratio. Asanas used in this study were Surya Namaskar, Trikonasana, Tadasana, Sukhasana, Padmasana, Bhastrika Pranayama, Paschimottanasana, Ardhmatsyendrasana, Pavanmuktasana, Bhujangasana, Vajrasana, Dhanurasana and Shavasana.
In terms of herbal remedies, Ayurveda has much to offer for this situation. For peri-diabetes, it is especially important to address the postprandial blood sugar rise. Although these individuals may have a seemingly normal fasting blood sugar, they do not have a normal glucose tolerance, and develop abnormal blood sugar levels after eating. Turmeric is an important home remedy to address this situation. One 00 capsule of turmeric can be taken fifteen minutes before eating to help smooth the blood sugar curve. For craving for sugar and breads, Mahasudarshan is extremely valuable. Pitta and kapha can take half a teaspoon in the morning on an empty stomach, with honey as anupan, for six weeks. Vata may be able to take a quarter teaspoon daily for a month, to help with sugar cravings. If libido becomes an issue, Mahasudarshan should be discontinued. Bibhitaki is an important herb for elevated blood sugar, especially for Kapha, and can be taken half a teaspoon at bed time steeped for ten minutes in boiling water. Bibhitaki will also help protect the eyesight from the impact of above optimal blood sugar. For pitta peri-diabetes, Amlaki can be used in the same way. Amlaki will also help to normalize raised cholesterol, another complication of peridiabetes. (Effect of the Indian gooseberry (amla) on serum cholesterol levels in men aged 35-55 years. Eur J Clin Nutr. 1988 Nov;42(11):939-44.) Alternatively Triphala can be used for any of the three doshas and has been shown in animal studies to have a significant adntidiabetic effect (Anti-diabetic activity of medicinal plants and its relationship with their antioxidant property.J Ethnopharmacol. 2002 Jul;81(2):155-60. )
Neem is another herb valuable for lowering blood sugar in pitta and kapha. Both clinical trials and animal studies have shown that use of neem can lower insulin requirements for type II diabetics. This seems to be because A. indica leaf extract blocks significantly the inhibitory effect of serotonin on insulin secretion mediated by glucose..( JEthnophamacol 1999 Nov 30;67(3):373-6). Neem can be taken along with turmeric, before meals, or used in a blood sugar lowering formula. However, it may be quite unsuitable for vata due to being light, dry, cold and extremely bitter. Bhumyamlaki has been shown in numerous studies to be hypoglycemic, and can also be taken half a teaspoon at bed time steeped for ten minutes. It will be especially valuable where there is a history of alcoholism or other liver damage preceding the onset of peri-diabetes. It has a cold virya and light energy and is best for pitta and kapha.
Shardunika is famed for its action in diabetes although we should note that neem has been shown to be superior to shardunika in terms of blood sugar lowering activity.(J Ethnophamacol 1999 Nov 30;67(3):367-72.) The activity of these two herbs is quite different in that neem works on insulin resistance and Shardunika works on enhancing insulin production and regenerating the beta calls of the islets of Langerhans in the pancreas. (Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin-dependent diabetes mellitus patients. Baskaran K, Kizar Ahamath B, Radha Shanmugasundaram K, Shanmugasundaram ER. 1990 Oct;30(3):295-300). Shardunika also contains saponins that temporarily destroy the ability to perceive the sweet taste, and in addition has glycosides that inhibit glucose absorption. Shardunika is beneficial for all three doshas although in massive doses it could stimulate pitta due to heating virya. Various studies and my own personal experience have demonstrated that persons with type II diabetes can permanently get off many of their antihyperglycemic drugs and also get off the Shardunika too, after some time. In other words, the effect is curative rather than palliative.
Sweet Ease contains a blend of herbs that support normal blood sugar through a variety of modes of action. It is especially valuable for pitta and kapha individuals who have peri- or pre-diabetes.
Working with the peri-diabetic vata could be quite difficult were it not for the demonstrated blood sugar lowering effect of Tulsi. (J Ethnophamacol 1999 Nov 30;67(3):367-72.). By drinking Tulsi tea several times daily, taking Turmeric before meals and Triphala at bedtime, as well as following the indicated diet modifications and asanas, vata should do quite well despite their inability to take neem, the star antihyperglycemic herb.
With an array of proven herbal remedies as well as deep knowledge of dietary issues and yoga therapy, Ayurveda can have a huge impact on the longevity and wellbeing of anyone with elevated blood sugar. Above all, by noting the different needs of the doshic types in terms of suitable chikitsa, we are able to tailor the regimen to the person rather than simply to the condition. All products mentioned in this article are available from www.banyanbotanicals.com.
Alakananda Devi (Alakananda Ma) is director of Alandi Ayurvedic Clinic in Boulder, Colorado, and principal teacher of Alandi School of Ayurveda, a traditional ayurvedic school and apprenticeship program. She can be reached at 303-786-7437 or by email at: firstname.lastname@example.org.