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Ayurvedic philosophy sees  diabetes as more than a mere medical condition; it is  a disruption in the delicate balance of life forces—kapha, pitta and vata—that govern our body’s vital processes. This imbalance, whether inherited or influenced by lifestyle, mirrors the onset and progression of Prameha, akin to diabetes mellitus.

Within Ayurvedic texts like Sushruta Samhita and Charaka Samhita, we encounter a detailed classification of Prameha, distinguishing between hereditary and acquired types. The parallels between Apathyanimittaja Prameha and type 2 diabetes are striking, especially in the trigger outlined in ancient Ayurvedic texts. These triggers encompass dietary habits—such as excessive consumption of certain foods—and lifestyle choices like sedentary behaviour and lack of physical activity. Moreover, Ayurveda acknowledges the impact of psychological factors, including stress, in precipitating Prameha.

In essence, Ayurveda enriches our understanding of diabetes by recognizing its multifaceted onset and progression. It reminds us that beyond clinical manifestations, individuals contend with a complex interplay of genetic predispositions, lifestyle choices, and emotional well- being. Through  Ayurvedic wisdom, we gain insights into holistic approaches to managing diabetes and a deeper appreciation for the interconnectedness of our physical, mental, and emotional health.

Managing diabetes: 

The Ayurveda way

Ayurveda takes a deeply personal approach to treatment, recognizing the uniqueness of each individual’s constitution and the presentation of their disease. Through herbal formulations,  dietary adjustments, and lifestyle modifications, Ayurvedic management for conditions like Prameha focuses on tailoring treatment to the individual’s needs. This approach resonates with the core principles of Ayurveda, which prioritize customization and holistic well-being.

In managing type 2 diabetes, the holistic approach embraces the idea of health as a delicate balance between the physical, emotional and spiritual aspects of life. Nutrition plays a crucial role, emphasizing whole, nutrient-rich foods to stabilize blood sugar levels and  promote overall health. Exercise becomes a cornerstone for improving insulin sensitivity and managing weight, encouraging enjoyable activities like walking or yoga. Stress management techniques, such as mindfulness and deep breathing, help to reduce cortisol levels and foster relaxation. Quality sleep is prioritized for its role in hormonal regulation, with an emphasis on establishing consistent routines and creating a peaceful sleep environment. Additionally,  social support networks provide invaluable encouragement and understanding throughout the journey.

As modern research delves into the effectiveness and safety of Ayurvedic interventions for diabetes, promising results emerge. Herbs and formulations prescribed in Ayurveda show potential for hypoglycemic, antioxidant, and insulin-sensitizing effects, offering new avenues for integrative diabetes care. By blending traditional wisdom with contemporary scientific insights, Ayurveda offers a holistic approach to managing diabetes, addressing both symptoms and underlying imbalances with compassion and understanding.

Conventional conundrums: Navigating the limitations of mainstream diabetes care Metformin, primarily effective alongside insulin, reduces hepatic glucose output and enhances insulin-mediated glucose utilization in peripheral tissues. Despite its numerous health benefits, metformin encounters challenges regarding patient adherence and tolerability.

Research indicates that only about half of patients continue metformin long-term, with over 20% failing to reach glycemic targets on metformin alone. Moreover, more than 30% experience gastrointestinal side effects, affecting tolerability. To address these issues, low initial doses and extended-release formulations are recommended. Metformin treatment also impacts the gut microbiome, altering species levels. Additionally, studies reveal a 42% secondary failure rate with metformin among patients, with an average yearly failure rate of 17%.

New therapeutic options for T2DM encompass insulin supplementation (ranging from short to ultra-long-acting), biguanides (inhibiting gluconeogenesis and acting as insulin sensitizers), sulfonylureas and meglitinides (stimulating insulin secretion), alpha-glucosidase inhibitors (preventing carbohydrate digestion), thiazolidinediones (acting as insulin sensitizers), SGLT2 inhibitors (blocking glucose reabsorption in the kidney), DPP-4 inhibitors (inhibiting glucagon release and increasing insulin secretion), and GLP1R agonists (increasing insulin secretion and inhibiting glucagon secretion). Combinations such as metformin-SGLT2 inhibitors-DPP4 inhibitors are increasingly used.

Modern drugs like GLP-1 receptor agonists, DPP4 inhibitors, and SGLT2 inhibitors are gaining traction in T2DM management.

Despite their proven benefits, these options have limitations. Sulfonylureas exhibit a 50% secondary failure rate within 40 months for patients with A1C levels between 7.0% to 7.9%.

Combination therapies like metformin-sulfonylurea and metformin-thiazolidinedione result in 41.5% secondary failure. Comparative studies on insulin-OHA regimens show no significant differences in hypoglycemic events. SGLT-2 inhibitors are linked to genital infections, amputations, and ketoacidosis, while GLP-1 receptor agonists may cause severe gastrointestinal events. Non-steroidal MRAs may lead to hyperkalemia requiring hospitalization, and tirzepatide may result in severe gastrointestinal events. Metformin, alpha- glucosidase inhibitors, and other agents are associated with severe gastrointestinal events and gut dysbiosis as well.

In Ayurveda, a plethora of herbs offer targeted support for diabetes-related mechanisms.  Allium sativum, for instance, inhibits DPP-4 enzymes, while Salacia chinensis and Salacia reticulata impede glucosidase activity. Gymnema Sylvestre boosts insulin secretion, and Embilica officinalis not only enhances insulin secretion but also reduces inflammation.

Terminalia belarica, Terminalia chebula, Tinospora cordifolia, Tinospora crispa, and Trigonella foenum graceum help alleviate insulin resistance. Additionally, Citrullis colocynthis, Zingiber officinale Rosc, Boerhaavia diffusa, Berberis aristata, and Caesalpinia bonducella stimulate insulin secretion. Swertia punicea, Curcuma longa, and Cinnamomum cassia aid in reducing insulin resistance. Nigella sativa and Pterocarpus marsupium support insulin secretion, while Syzygium jambo enhances glucose uptake.

From Gut to Glucose: Exploring Diabetes through Microbiome Lens 

Metformin, an antidiabetic drug, has been associated with increased abundance of Escherichia species in the gut microbiota, contributing to intestinal discomfort. α-glucosidase inhibitors, while aiming to reduce blood sugar levels, may see reduced efficacy due to the enrichment of Blaubia obeum in the gut. Additionally, the use of DPP4 inhibitors can lead to an increase in the abundance of the phylum Firmicutes and Bacteroidetes, potentially inducing gut dysbiosis.

Moreover, herbs like Acacia, Chrysopogon zizanioides, and Cuminum cyminum target reducing gut inflammation. Several herbs, including Allium sativum, Curcuma longa, and Terminalia belirica, work to modulate gut dysbiosis and decrease inflammation. Cassia fistula, Murraya Koenigii, Piper nigrum, and Trachyspermum ammi act as prebiotics, offering dual benefits of reducing gut inflammation. Tinospora cordifolia, Trigonella Foenum, and Tribulus terrestris exhibit prebiotic properties while mitigating gut inflammation. Lastly,  Zingiber officinale serves as a prebiotic, aiding in reducing gut inflammation while supporting overall digestive health.

In essence, the holistic management of type 2 diabetes, blending Ayurvedic principles with modern science, offers hope and support to those living with the condition. Ayurveda’s personalized strategies, which consider the unique needs of each individual, aim to restore balance not only in the body but also in the mind and spirit. By integrating herbal interventions and lifestyle adjustments, Ayurveda provides a comprehensive framework for diabetes care, addressing both the physical symptoms and the emotional challenges that come with the condition. Understanding the gut’s role in diabetes opens new avenues for intervention, emphasizing the importance of holistic approaches in diabetes management.

Embracing these holistic approaches can not only lead to improved health outcomes but also foster a sense of empowerment and well-being in those managing type 2 diabetes.

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