Metabolic Syndrome and Its Management Through Ayurveda and Yoga

Abstract

An average 230 million peoples all over the world are suffering from metabolic disease. In the present scenario Metabolic Syndrome (MS) is increasing to an epidemic globally, which mainly consist of Hyperglycemia, Dyslipidemia and obesity. This MS can lead to life threatening major risk factors such as CAD, CKD and NAFLD etc. There is an urgent need to understand the complex etio-pathogenesis and to introduce an efficacious management of MS. The Ayurveda describe the two main concepts of diseases first one which is related to over-nutrition and second one related to under-nutrition. The disease MS is supposed to be the outcome of over nutrition due to defective tissue metabolism. Till now the management of MS is limited only up to the use of drugs that correct dyslipidemia, blood pressure and hyperglycemia. In this regard the Ayurveda based line of management with the help of diet, yoga, meditation and with the use of natural herbs, can establish a mile stone in the management of MS. The present work is an effort to understand the etiopathogenesis of MS and to establish an effective line of management of MS in Ayurveda. It may also enlighten the path for future researchers on the same.

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IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 6 Ver. XI (June 2016), PP 36-41
www.iosrjournals.org
DOI: 10.9790/0853-1506113641 www.iosrjournals.org 36 | Page
Metabolic Syndrome and Its Management Through
Ayurveda and Yoga
Dr Jaspreet singh1 Dr A.K.Pandey2
1(Assistant Professor Department of Kayachikitsa (Ayurvedic medicine), Quadra Institute of Ayurveda and
Hospital, Roorkee, Uttarakhand, India)
2(Associate Professor Department of Kayachikitsa, (Ayurvedic medicine), Faculty of Ayurveda, Institute of
Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India)
Abstract:- An average 230 million peoples all over the world are suffering from metabolic disease. In the
present scenario Metabolic Syndrome (MS) is increasing to an epidemic globally, which mainly consist of
Hyperglycemia, Dyslipidemia and obesity. This MS can lead to life threatening major risk factors such as CAD,
CKD and NAFLD etc. There is an urgent need to understand the complex etio-pathogenesis and to introduce an
efficacious management of MS. The Ayurveda describe the two main concepts of diseases first one which is
related to over-nutrition and second one related to under-nutrition. The disease MS is supposed to be the
outcome of over nutrition due to defective tissue metabolism. Till now the management of MS is limited only up
to the use of drugs that correct dyslipidemia, blood pressure and hyperglycemia. In this regard the Ayurveda
based line of management with the help of diet, yoga, meditation and with the use of natural herbs, can
establish a mile stone in the management of MS. The present work is an effort to understand the etio-
pathogenesis of MS and to establish an effective line of management of MS in Ayurveda. It may also enlighten
the path for future researchers on the same.
Keywords:– Dyslipidemia, Hyperglycemia, Insulin resistance, Metabolic Syndrome, obesity.
I. Introduction
In recent years MS is gaining too much importance by the physicians and researchers worldwide,
because of its complex etio-pathogenesis, clinical presentation, management and major complications. The MS
consists of various components which are result of defective metabolism and increases the risk of Coronary
Artery diseases (CAD) and Diabetes Mellitus (DM) (1). The pathogenesis of MS is complex but central obesity
seems to be a key factor to develop MS. It is a major health hazard in the developed countries and gradually
accruing its place in developing countries too, which leads to other hazardous complications such as CAD,
CKD, NAFLD and PCOD etc (2). Initially MS was known as Syndrome X or Insulin Resistance syndrome (3).
Syndrome X was the name proposed by Reaven (1988) in a lecture of the American Diabetes Association (4).
According to Reaven, Syndrome X was a group of associated conditions that were important in the
development of coronary artery disease and he included hyper-insulinemia, glucose intolerance, hyperglycemia,
elevated low density lipoprotein cholesterol and hypertension in the syndrome..
In 1998 World Health Organization has introduced the original definition of MS (5). The main
components of MS include an increased blood pressure, increased triglyceride levels, increased blood glucose
levels, Central obesity and Decrease High density lipoprotein (HDL)(6). The Metabolic syndrome is common in
adult populations all over the world and the incidence of MS in the Indian subcontinent is increasing rapidly.
The sedentary life style and unhealthy food habits contributes a lot in rising rates of obesity, which is a major
contributor to develop MS (7). The prevalence and severity of obesity in children is rising Worldwide and it is an
alarming and initiating feature of MS in younger population (8). The unhealthy and high caloric diet along with
sedentary life style causes central obesity (9). The central obesity increases the risk of insulin resistance by the
release of abundant FFA in the circulation which occupies insulin receptors and causes Pre diabetic or
hyperglycemic state which in turn leads to metabolic syndrome (10). If this pre diabetic state or full pledged
diabetic stage is ignored, condition of metabolic syndrome emerges (11). Over a period of time if not cured this
condition of MS may transform in to other major and hazardous cardio vascular and other complications (12).
This transformation of this in to major and hazardous cardio vascular and other complications depends up on
the degree of risk factors which are associated the clinical condition (13).
Thus the Metabolic syndrome provides many challenges to government and healthcare providers from
birth to death. The recent data reflects that increased industrialization worldwide is associated with rising rates
of obesity, which is anticipated to increase prevalence of the MS dramatically, especially as the population ages.
Moreover the rising prevalence and severity of obesity in children is initiating feature of MS in younger
population.

Metabolic Syndrome and Its Management Through Ayurveda and Yoga
DOI: 10.9790/0853-1506113641 www.iosrjournals.org 37 | Page
The purpose of the present work is to introduce an effective and safe Ayurveda based line of
management of MS as well as to introduce other preventive measures such as yoga and meditation for
metabolic syndrome and to prevent its life threatening major metabolic complications
II. Definition of Metabolic Syndrome
2.1The National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III) in 2004 by the
presence of 3 or more, out of these 5 criteria‟s-
1- Waist circumference >102 cm in males >88 cm in females
2- Hyper Triglyceridemia; Triglyceride >150 mg/dl or specific medication.
3- Low HDL cholesterol; <40 mg/dl in males <50 mg/dl in females or specific medication.
4- Hypertension; Blood pressure>130/85 mm/Hg or specific medication.
5- Fasting plasma glucose >100 mg/dl or specific medication or previously diagnosed Type2 DM.
2.2 The International Diabetes Foundation (IDF) in 2005 has defined MS, by the presence of 2 or more, out of
these 4 criteria‟s-
1-Fasting Triglyceride > 150 mg/dl or specific medication
2-HDL cholesterol <40 mg/dl in males <50 mg/dl in females or specific medication.
3-Blood pressure >130/85 mm/Hg or prevous diagnosis or specific medication.
4-Fasting Plasma Glucose > 100mg/dl or previous diagnosed Type2 DM or specific medication.
2.3 The American Heart Association (AHA) in 2005 has defined MS, by the presence of 3 or more, out of these
5 criteria‟s-
1- Waist circumference >102 cms.
2- Hyper Triglyceridemia; Triglyceride >150 mg/dl or specific medication.
3- Low HDL cholesterol; <40 mg/dl or specific medication.
4- Hypertension; Blood pressure>130/85 mm/Hg or specific medication.
5- Fasting plasma glucose >100 mg/dl or specific medication.
2.4 The American Association of Clinical Endocrinologists (AACE) in 2003 has defined MS, by the presence-
Impaired Fasting Glucose i.e. IFG (FBS 110-126mg/dl), Impaired Glucose Tolerance i.e. IGT (PPBS >140-199
mg/dl) + 2 out of these criteria‟s-
1- BMI >25 Kg/m2
2- Hyper Triglyceridemia; Triglyceride >150 mg/dl or specific medication.
3- Low HDL cholesterol; <40 mg/dl or specific medication.
4- Hypertension; Blood pressure>130/85 mm/Hg or specific medication.
2.5 The European Group for the study of Insulin Resistance (EGIR) in 1999 has defined MS, by the
presence- Insulin Resistance or Hyperinsulinemia + 2 or More of these criteria‟s-
1- Waist circumference >90 cm in males
>80 cm in females
2- Hyper Triglyceridemia; Triglyceride >175 mg/dl or specific medication.
3- Low HDL cholesterol; <40 mg/dl or specific medication.
4- Hypertension; Blood pressure>140/90 mm/Hg or specific medication.
5- Fasting plasma glucose >110 mg/dl or specific medication.
2.6 The World Health Organization (WHO) in 1998 has defined MS, by the presence of- Diabetes Mellitus
or Impaired Glucose Tolerance i.e. IGT (PPBS >140-199 mg/dl) or Insulin Resistance + 2 or More of these
criteria‟s-
1. BMI >30 Kg/m2 or Waist Hip ratio >0.90 in males
>0.85 in females
2- Hyper Triglyceridemia; Triglyceride >150 mg/dl or specific medication.
3- Low HDL cholesterol; <35 mg/dl in males
< 39 mg/dl in females or specific medication.
4- Hypertension; Blood pressure>140/90 mm/Hg or specific medication.
5- Urinary Albumin excretion > 20 µg/min
III. AYURVEDIC CONCEPT OF MS
The classical Ayurvedic texts have vividly described Santarpanjanya Vikaras (Comprise of diseases due
to over nutrition and defective tissue metabolism). Ayurveda mainly focus upon conservation of health rather
than disease eradication. It presumes that improper dietary habits and deranged functions of different sets of
Agni (Metabolic fire) give rise to formation of Ama (reactive antigenic factor). Since last few decades, the
conventional system of medicine is focusing on the concept of metabolic syndrome, which seems very similar
to the concept of Santarpanjanya Vikaras of Ayurveda.

Metabolic Syndrome and Its Management Through Ayurveda and Yoga
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Various factors in the body cause disturbances in the production of Medadhatu (Lipids) prime of them
are Medodhatvagni (Lipid metabolic process). In this whole process the quantity (amount and proportion) and
quality (contents) of Medadhatu (Lipids) are also disturbed by the same. When Medadhatu (Lipids) interacts
with preformed form of Ama (reactive antigenic factor), it changes and alters the quality and quality of fatty
tissues including cholesterol. The interaction of Ama (reactive antigenic factor) with fatty tissues is known as
Sama Medadhatu (unhealthy and bad lipids). This form of Ama (reactive antigenic factor), when circulates all
over the body may lead to blockade of micro-channels and precipitate antigenic reactions and generate series of
inflammatory events in the body. If such categories of Ama (reactive antigenic factor) interact with Medadhatu
(Lipids), it may lead to a variety of metabolic disorders.
3.1Samprapti ghataka (Pathological factors) of Metabolic Syndrome
3.1.1 Doaa - It is a kapha predominant vyadhi but involvement of vata and pitta cannot be neglected. So,
collaboration of three Doaas propagates the process of pathogenesis of MS.
Kapha- It plays an important role at the time of accumulation of Amadosa. Most of the symptoms of MS come
under the category of Kaphavyaidhi i.e. Central obesity, Hyperglycemia and Dyslipidemia etc.
Pitta- In the patients of MS, pittaja lakshanas are very less but most of them have Tikshagni. Srotosanga due to
medovridhi and potentiate Samana Vayu to stimulate the jatharagni so, most of the persons have good appetite.
It plays role in the stage of vitiation and localization of Ama dosas.
Vata- Vata can create two situations in the body.
1.The state of Avrita Vata which provocates the Agni and ultimately increasing the demand for the food
(Abhyavaharana shakti) and absorbs the nutrients.
2-Inactiveness of Vyana vayu. Vyana vayu is responsible for proper circulation and distribution of Dhatus.
Due to, Sanga in srotasa, the nutrients cannot be carried by Vyana vayu to their respective Dhatus. Hence,
involvement of Samana vayu can be clearly postulated with the evidence of Agni sandhuksana and improper
distribution of fat in the body proves the involvement of Vyana vayu.
3.1.2 Dusya - Without Dosadusya sammurchchhana disease process is not possible. In the pathogenesis of MS,
the excessive production of abnormal Medadhatu (Visceral adipose tissue) occurs, which ultimately leads to
Insulin resistance, Hyperglycemia and Atherosclerotic changes etc. Rasa, Rakta Mamsa, Meda, Majja and sukra
dhatu are to be seen Dusya in MS. Among these Rasa, Mamsa and Meda are the pradhana Dusya in the
pathogenesis of MS.
3.1.3 Agni - Due to Dhatvagni mandata there is excessive formation of Abnormal Visceral adipose tissue.
Which causes release of excess FFA, which mimics insulin molecule and causes Insulin resistance by
downstream regulation of the insulin receptors.
3.1.4 Srotasa –In MS, the main srotasa involved are Rasavaha, Raktavaha, Mamsavaha and Medovaha srotasa
along with the involvement of other Srotasa. The srotasadusti in Rasavaha, Mamsavaha and Medovaha srotasa
plays key role in the pathogenesis of MS.
Avyayama, excessive intake of Madhura Dravya and sedentary life styles are vitiating factors for Medovaha
srotasadusti as mentioned in Caraka Samhita. It indicates the clear involvement of Medovaha Srotasa along
with Rasavaha Srotasa. Atisveda and Daurgandhya indicate the involvement of svedavaha srotasa. Presence of
Atipipasa indicates the involvement of Udakavaha srotasa. In the pathogenesis of MS, increased fat deposition
inside the muscle (vasa) indicates the involvement of Mamsavaha Srotasa.
3.1.5 Srotodusti - In the pathogenesis of MS, Srotosanga and Vimarga gamana are initial defect in Srotasa
followed by Atipravritti.
3.1.6 Udbhava sthana - Amasayottha vyadhi
3.1.7 Vyakta sthana – Udara, Spika, stana and Gala pradesa
3.1.8 Sanchar sthana – Sarvasarira by Rasa and Raktavaha srotasa
3.1.9 Svabhava – Chirkari
3.1.10 Sadhyasadhyata - Krichha sadhya vyadhi
IV. Flow Diagram Of Pathogenesis Of Ms

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V. Ayurvedic Approach to the Management Of Ms
Samshodhana (Eleminative therapy) and Samshamana (Palliative therapy) therapy are the important therapeutic
measures described in Ayurveda for the management of various diseases. In which Samshodhana measures hits
the root cause of disease. Under Samshodhana therapy, Procedures like Mridu Virecana (light purgation),
Shodhana Vasti (medicated enema) and Ruksha udvartana (gentle rubbing of skin with dry substances) may be
found clinically effective in cases of MS. Vamana (induced vomiting by use of ayurveda drugs) therapy can be
planned with caution in case of MS.
Under pacificatory measures the below described guidelines may be helpful in preventing and treating the cases
of Metabolic Syndrome-
5.1 Nidana parivarjana (Root cuse elimination) - Nidana parivarjana is”To avoid the risk factors”. Nidana
parivarjana is considered as the main therapy in the management of various diseases as described in Ayurveda.
Excess intake of carbohydrate and fat leads to abnormal visceral adiposity, which initiates cytokines-mediated
pro-inflammatory process and causes excess formation of FFAs, which occupies the insulin receptors and in
turn leads to Insulin resistance and other defective metabolism. Hence, Snigdha (oily), Guru (heavy), Pichhila
(unctous) Ahara, Madyapana (alcohal intake) as well as Atiasan (over eating behaviour), Avayayam (Sedentary
life styles) etc. Should be avoided by the patients of metabolic syndrome.
5.2 Yoga and Asana - According to medical scientist‟s yoga therapy is successful because of the balance
created in the nervous and endocrine system which directly influences all systems and organs of the body.
Yogasans have often been thought of as a form of exercise. They are not exercises, but techniques which place
the physical body in position that cultivate awareness, relaxation, concentration and meditation. Important
Yogasans are Dhanurasana, Halasana, Matsyasana, Yogamudrasana,, Utkatasana, Vajrasana, Siddha
yoniasana, Padasana, Makarasana, shavasana, Pavanamuktasana, Padotthanasana.
5.3 Meditative Exercise - In this regards Yogasana, pranayama, such as Anuloma-Viloma, Bhastrika,
Kapalabhati and Trataka are helpful to check the mental stressors. But these should be advice only after
evaluating cardiac functions of the patients.
5.4 Agni Promoting (Drugs correcting metabolic process) drugs - such as Chitrakadi Vati, Trikatu Churna,
and Pippali Churna etc.
5.5 Ojas Promoting (Immunity enhancer) drugs - such as Guduci, Amalaki, Haridra, and Silajatu etc.

Metabolic Syndrome and Its Management Through Ayurveda and Yoga
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5.6 Compound formulations– Important compound preparations such as- Puskarabramhi guggulu,
Medohara guggulu, Punarnavadi guggulu, Triphaladi guggulu, Nisamlaki Churna, Amritadi guggulu and
Sapragandha ghanavati are found to be helpful.
5.7 Single drug – Like
Puukaramula (Inula racemosa) (14, 15)
Guggulu (Commiphora mukul) (16)
Kustha (Saussurea lappa) (17)
Meshshringi (Gymnema sylvestre) (18)
Vrikshamla (Garcinia indica)
Rasona (Allium sativum) (19)
Sunthi (Zingiber officinale)
Haridra (Curcuma longa)
Arjuna (Terminalia arjuna) (20)
Guduchi (Tinospora cardiofolia) (21)
Amla (Emblica officinalis) (22)
VI. Conclusion
The present research work has been undertaken with aims to laid down scientific overview on
Metabolic syndrome as per conventional and Ayurvedic parlance. Beside this, it also aims to introduce an
Ayurveda based line of management in the cases of metabolic syndrome. The conventional review reveals that
medical men knew the clinical entity of metabolic syndrome since last decades. The incidence of MS is
alarmingly increasing in developed as well as developing countries including India. The observed fact is that the
exact mechanism of complex pathways of MS is not yet completely known but high calorie diet, faulty lifestyle,
stressors, central obesity, endocrine disorders, aging along with genetic factors contribute a lot in the path
physiology of MS. It is believed that adipocytes of visceral fat increases plasma level of TNF-alpha and alters
the level of others substances (adiponectin, leptin, resistin, PAI-1 etc) which plays a series of event of chronic
inflammation that may lead to increased risk of developing hypertension, atherosclerosis, diabetes. The
emerging concept of MS is strikingly resemblance with over-nutritional (Santarpanjanya Vikaras) disorders,
which include Sthaulya/Medoroga (Obesity/Dyslipidemia), Prameha (Diabetes), Hridroga (Cardiac diseases)
of Ayurveda. Thus on the basis of present research work, it can be concluded that Metabolic syndrome is well
defined and still evolving etiopathogenesis in biomedical sciences is as such not described in Ayurvedic
classics, but it may be considered as the Meda (Lipids) dominant disorder have strong resemblance with
Prameha (Diabetes) and sthulya/Medoroga (Obesity/Dyslipidemia). The conventional management of
metabolic syndrome is still not very satisfactory and the current strategy of prevention and treatment of
metabolic syndrome is rapidly changing. Hence many investigators in this field are inclined to undertake
scientific study in treatment development from Ayurvedic resources.
Acknowledgement
Authors are thankful to Honorable Padam Shree Professor R. H. Singh, Emeritus Professor, Depatment of
Kayachikitsa, Institute of Medical Sciences, B.H.U, Varanasi, Uttar Pradesh, India.
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