Prediabetic and type 2 diabetes – Effect of Ayurveda intervention, lifestyle modification and Yoga

Type 2 diabetes is a lifestyle-related disorder that affects around 422 million individuals in India.Physical inactivity, faulty diet, sedentary lifestyle habits and stress are the major risk factors of noninsulin-dependent diabetes. The main aim of the management of diabetes is to lower the blood glucose level either by intervention of medicine or by improving behavior of diet and lifestyle.Ayurveda emphasized on the management of Prameha through diet and lifestyle modification (which can be correlated to diabetes).Studies have also shown the effectiveness of Ayurveda intervention in the management of type 2 diabetes.

Global report on diabetes (2016) by the WHO and the National Health Policy (2017) emphasized on the integrated management of NCDs. Keeping in view the strength of AYUSH systems for the prevention and management of NCDs by promoting healthy lifestyle.

The objective of this study was to analyze the effect of Ayurveda intervention, lifestyle modification and Yoga in the management of type 2 diabetes.

Enrolled patients were distributed in two cohorts: pre-diabetic, i.e., Cohort A and type 2 diabetic, i.e. Cohort B. Each cohort was further divided into two groups, i.e. A1 and A2 and B1 and B2 as follows:

Group A1 was advised for lifestyle modification and Yoga

Group A2 was given Ayurveda medication, lifestyle modification and Yoga

Group B1 was advised for lifestyle modification and Yoga along with allopathic medication

Group B2 was given Ayurveda medication, lifestyle modification and Yoga along with allopathic medication.

Cohorts A and B: Patients of either sex aged between 30 and 60 years and those who are willing to give written informed consent were included.

Cohorts A and B: Known cases of HIV positive; type 1 diabetic individuals; patients having a history of cardiovascular diseases such as bundle branch block, transient ischemic attack, uncontrolled hypertension and stroke; patients who have undergone recent or significant abdominal surgery (e.g., gastrectomy) during the past 6 months; patients on corticosteroids and hormonal treatment; pregnant and lactating mothers and patients having any major systemic illness were excluded.

Keeping in view of classical texts and various research studies, the Mamajjaka capsule (powdered dried whole plant of Enicostemma littorale Blume) 1 g, Amalaki Churna (powdered dried fruit of Emblica officinalis Gaertn.) 3 g and Guduchi Churna (powdered dried stem of Tinospora cordifolia (Willd.) Miers.) 3 g twice a day after meals with lukewarm water were administered for the management of type 2 diabetes. The medicines were procured from Good Manufacturing Practices (GMP) certified Ayurvedic pharmaceutical companies as per pharmacopoeial standards. The medicines were prescribed for 6 months.

The list of common allopathic medications prescribed by the allopathic physicians for type 2 diabetic patients in the study contains chlorpropamide, tolbutamide, glibenclamide, glibornuride, tolazamide, glipizide, gliclazide and metformin.

The details of the advocacy on diet and lifestyles on diabetes are shown in bellow link 

A list of selected Asana/Kriya/Pranayama was advocated under the supervision of Yoga experts for practice by enrolled patients depending on the age and severity of disease, as mentioned in the bellow link 

Discussion

The trial drugs, i.e., Mamajjaka, Amalaki and Guduchi were found effective in controlling FBS and PPBS levels in type 2 diabetic individuals. Mamajjaka is a folklore drug which has been practiced since long time for the management of Prameha in India. Various studies have documented the potential role of Mamajjaka in controlling blood sugar levels.It possesses Bitter Taste (Tikta Rasa) which is known to help in stimulating metabolism.

Amalaki and Guduchi are documented in the Ayurvedic Pharmacopoeia of India to possess anti-diabetic activity.Further, Amalaki and Guduchi impart rejuvenating (Rasayana) effect that causes improvement in digestive functions and metabolism, thus enhancing glucose uptake by the cells. Amalaki is a rich source of Vitamin C and amino acids and possesses immune-modulatory effect and antioxidant activity.Studies reported that Guduchi enhances glucose tolerance and lowers the blood glucose level. It possesses antioxidant activity.

Lifestyle modification contributes to the effect of Ayurveda medications as proper diet, abstinence of substance abuses such as tobacco and alcohol and management of daily routines will remove the causative factors of disease and help in preventing progression of disease.

Yoga has been practiced since ancient times to manage the physiology of the body. This not only improves the flexibility but also improves the function of both endocrines and exocrine glands of the body. Various studies have reported that Yoga has a positive impact in the management of type 2 diabetes. Different Asanas such as Surya Namaskara and Tadasana help in insulin production and improve digestive fire. Cleansing process in Yoga Kriya like Kapalnbhati and Agnisara stimulates pancreatic cells and improves their efficiency.

Subjective symptoms of type 2 diabetes, i.e. polyuria, polydipsia, polyphagia, blurred vision, and weakness showed improvement in all the groups. This was possibly due to elimination of causative factors through lifestyle modification and improvement in physiology through Yogic practices. Further, pharmacological intervention controls the blood sugar levels and thus, relief in subjective symptoms was observed. Few patients felt improvement in vision which may be due to retinopathy changes which are nonreversible. Fewer people perceived an improvement in non-healing ulcer. This is possibly because of requirement of localized treatment of the ulcer tissue.

On comparing the P values of the four groups in FBS, it was observed that though lifestyle and Yoga have a positive impact over the disease management, the groups having medical intervention in the form of Ayurveda or allopathic medicine, i.e. groups A2, B1 and B2 performed better than group A1. This implies that lifestyle and Yoga can prevent disease progression through removal of causative and aggravating factors, but pharmacological intervention is required to manage the disease. Yoga regulates eating pattern and leads to medication adherence.Diet plays an important role in the management of every disease as medicine is effective only in the presence of proper diet.

Similarly, groups having Ayurveda medication, i.e., groups A2 and B2 showed better treatment outcome than group B1 which is having allopathic medicine along with lifestyle and Yoga in diseased cases. This signifies that type 2 diabetic patients responded better to Ayurveda medications, i.e., Mamajjaka, Amalaki and Guduchi in the current study. The reasons for better response may be multi-modal action of Ayurveda medications which not only relieve the symptoms but also stimulate the glands, rejuvenate the cells, and improve the uptake of glucose in the body and may probably increase insulin sensitivity. Similar observations were also observed during analysis of PPBS levels.

This highlights the importance of management of type 2 diabetes through integrative approach with Ayurveda medications that help to correct the vitiated Dosha and help in improving metabolism as reflected through the laboratory parameters and subjective parameters. Thus, Ayurveda intervention exhibits potential for integrative management along with lifestyle modifications, Yoga and allopathic anti-diabetic agents.

The acceptance of Ayurveda intervention was overwhelming among population as depicted by large proportion of participants in groups A2 and B2, where Ayurveda medication was prescribed. Further, a number of participants in the groups without Ayurveda medications were very less. The reason may be the inclination of individuals for pharmacological treatment of type 2 diabetes mellitus.

Conclusion

The study reveals that Ayurveda intervention, i.e. Mamajjaka Churna (1 g), Amalaki Churna (3 g) and Guduchi Churna (3 g) two times/day effectively controls blood sugar level in pre-diabetic and type 2 diabetic patients and improves the disease management with lifestyle modification and Yogasana as well as with allopathic treatment.

Source ( For detailed text and original source ): http://www.ayujournal.org/article.asp?issn=0974-8520;year=2019;volume=40;issue=1;spage=8;epage=15;aulast=Sharma