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METABOLIC SYNDROME- AYURVEDIC APPROACH

Prof. Dr. Satyendra Narayan Ojha , MD (KC ) , PhD ( Ayurveda)


Director, post graduate studies, Yashwant Ayurveda College post graduate teaching and research center ,
Kodoli , Kolhapur , Maharashtra

Metabolic Syndrome is a disorder of energy utilization and storage. It


increases the risk of developing cardiovascular disease and diabetes
mellitus.
Metabolic Syndrome is diagnosed by a concurrence of two out of five of the
following conditions:
1.
2.
3.
4.
5.

Abdominal (Central) Obesity


Hypertension
Hyperglycemia
Hypertriglyceridemia
Low level of HDL

DEFINITION
Metabolic Syndrome is the one which fulfills two or more of the following
criteria:
1. Central Obesity:
Waist circumference more than 102 cm (40 in.) in males
Waist circumference more than 88 cm (35 in.) in females
2. Dyslipidemia:
Serum Triglycerides more than 150 mg/dL
3. Dyslipidemia:
HDL levels less than 40 mg/dL in males
HDL levels less than 50 mg/dL in females
4. Blood Pressure:
greater than 130/85 mm of Hg or use of medication for Hypertension
5. Hyperglycaemia:
Elevated fasting plasma glucose levels equal or more than 110 mg/dL
or use of medication for hyperglycaemia
SYNONYMS OF METABOLIC SYNDROME
1. Insulin Resistance Syndrome
2. Syndrome X
3. Cardiometabolic Syndrome

4. Reavens Syndrome
5. CHAOS( in Australia)
Considering the above definition one can compare the metabolic syndrome
to Sthaulya pathogenesis as mentioned in ASTONINDITYA ADHYAYA.
Charak explained that on basis of sharir as ADHIKARAN SWAROOP eight
diseases are classified and among this eight ATISTHAULYA and ATIKRUSHA
are given utmost importance.
Being Atisthaulya has ASTHADOSHA as stated below:
1.
2.
3.
4.
5.
6.
7.
8.

AAYUSHYA HRASA
DAURBALYA
DAURGANDHYA
JAVOPARODHA
SWEDABADA
KSUDHA ATIMATRAM
ATI PIPASA
KRUCHA VYAVAYATA

If one understands this 8 dosha explained by Charak it is clear that


Atisthaulya cannot be restricted to obesity as a single disease but a
syndrome which creates the platform for such disease which will reduce life
span, reduce the functional capacity, bring about weakness and increase the
morbidity and mortality rate
AETIOLOGY:
Charak in Rasayan Adhyaya, Samunthaniya Pada has elaborated about
GRAMYA AAHAR chosen by the society was not successful in making inroads
in community health. Sedentary lifestyle was responsible for less physical
activity which became the cause of preventable disease. Similar hetus are
also been explained in relation to sthaulya. Modern also explains that a
combination of excessive food energy intake and a lack of physical activity
are responsible for metabolic syndrome.
1. Bija Swabhavat: sthula matapitrujanya bhavat
Obesity or metabolic syndrome often runs in families. This may be due
to a combination of shared genetic, environmental and lifestyle

factors. This has been explained by Charak in astoninditiya adhyaya by


using the words tasya hi ittyadi
Chakrapani comments as Samprati sthulasya sadarana api aaharat
medojan aaha i.e. in a person with family history a normal diet also
has a tendency for increasing meda dhatu.
The most common inherited risk characteristics (hypertension,
hyperlipidaemia, diabetes) are polygenic.

Genetics: obesity is the result of interplay between genetic and


environmental factors. Polymorphisms in various genes controlling
appetite and metabolism predispose to obesity when sufficient food
energy is present
Obesity is a major feature in several syndromes, such as Prader-Willi
syndrome, Bardet-Biedl syndrome, Cohen syndrome, and MOMO
syndrome. The greatest risk factor for child obesity is the obesity of
both parents.
2. KLINNA, GURU, ADHYASANA, PISHTANNA, ABHISYANDI AAHAR and
AVYAYAMA are source for extra calories.
3. ABHISYANDI AAHAR: Fast food can also be defined as any food that
contributes little or no nutrient value to the diet, but instead provides
excess calories and fat. Some of these foods that are of little
nutritional value and often high in fat, sugar, and calories. Common
foods include salted snack foods, gum, candy, sweet desserts, fried
fast food, and carbonated beverages.
4. GURU, PISHTANNA, VISTAMBI AAHAR : Trans Fatty Acids render
plasma lipid profile even more atherogenic than saturated fatty acids
by not only elevating LDL cholesterol but also by decreasing HDL
cholesterol. It includes
a. Deep fried fast food
b. Cake mixes
c. Cereal and energy bars
d. Chips, Crackers, Whipped toppings
e. Packed cookies and candy
f. Packed doughnuts, pies and cake

5. SNIGDHA AAHAR : Dietary fat has long been implicated as a driver


of insulin resistance. Large quantities of saturated, monounsaturated
and polyunsaturated (omega-6) fats all appear to be harmful. Being
insensitive to insulin is still positively correlated with fat intake, and
negatively correlated with dietary fiber intake, but both these factors
are also correlated with excess body weight.
6. Fat consumption induces very little energy expenditure as most is
stored. MEDA EVA UPACHIYATE
7. Extra food energy comes from an increase in carbohydrate
consumption rather than fat consumption. The primary sources of
these extra carbohydrates are sweetened beverages and potato chips.
8. Shushka shaka, shushka mansa, teel taila and ruksha content have
low nutrition value.
9. VIDAGDHA AAHAR (over cooking) destroys folic acid from leafy
vegetables.
10. VARUNYAS CHA SEVANAT: Alcohol is antagonist to folic acid. Rakta
and medodustikara effect has been explained by our acharyas.
11. Dried fruits are rich in concentrated fructose. This increases the sugar
levels in these fruits. Some of the dried fruits known to contain high
levels of fructose include dates, figs, apples, pineapples and raisins.
12. MADHUR AAHAR: Foods that have been prepared commercially can
have high fructose levels. Even products that are not sweet may
contain fructose as an ingredient. Some processed products rich in
fructose include condiments and ketchup, sweet pickles, soups,
breakfast cereals, frozen foods, boxed dinner, canned foods, crackers
and breads. Commercially prepared foods like pastries and chocolate
contain very high levels of fructose.
13. Vitamin D deficiency is also associated with insulin resistance. Thus
indulging in food habits having low vitamin D contents can lead to
metabolic syndrome.
14.
Leptin is a hormone that regulates long-term energy balance in
many mammals. An important role of leptin is long-term inhibition of

appetite in response to formation of body fat. If the regulation fails diet


increases. (VIKARA VIGHAT ABHAVA)
15.
TAN MANA BHUNJIT: In both children and adults, there is an
association between television viewing time and the risk of obesity. An
increased rate of childhood obesity with increased media exposure,
with rates increasing proportionally to time spent watching television.
16. DIVA SWAP {Day sleeping}, indulging in excessive exercise and sex
increase oxidation process and release oxidants and free radicals.
17.
PSYCOLOGICAL FACTORS such as BHAYA, KRODHA, LOBHA,
SHOKA, MOHA can contribute to Metabolic Syndrome by disrupting the
hormonal balance of the hypothalamic pituitary adrenal axis which
increases high cortisol levels resulting in raising glucose and insulin
levels which in-turn causes insulin mediated effects on adipose tissue
ultimately promoting visceral adiposity, insulin resistance, dyslipidemia
and hypertension and osteoporosis. Ca. Vi. 2 /9 explains that
psychological factors are cause for ama visha although matravat aahar
is taken.

PATHOGENESIS
The pathogenesis may be understood by the flow chart as given below
GURU, SNIGDHA, PISTANNA,
ABHISYANDHI, SANTARPANOTHA AAHAR

BIJA DOSHA
MEDA UTPADAK
BIJA AVAYAVA
DOSHA

CHOLESTEROL
ENRICHED
DIET
PRITHVI + AAP MAHABHUT PRADHAN
KAPHA

JATHARAGNI MANDYATA
BHUTAGNI MANDYATA
(PRITHVI + AAP BHUTAGNI)

MEDOVAHA
SROTO DUSTI

MEDAGNI
DUSTI

MEDOPOSHAK
RASABHAG DUSTI

DHATWAGNI MANDYATA
(MEDAGNI)

ATIMATRA MEDASWINO MEDA EVA UPACHIYATE NA TATHA ITARE DHATAWA

ALTERED PERMEABILITY OF SROTAS


ALTERED RATIO BETWEEN DRAVATA AND GHANATA

MEDASWITA
(CENTRAL OBESITY)
SUBSTRATE AVAILABILITY
INSULIN RESISTANCY

IL-6
TNF
ANTILYPOLYTIC EFFECT OF INSULIN
(VIKARA VIGHAT ABHAVA)
ABUNDANCE OF CIRCULATING FREE FATTY ACIDS (FFA)
(APACHITA MEDA/ SAMA MEDA)

INCREASED LIPOLYSIS

INCREASED FFA
EFFECT ON LIVER

EFFECT ON MUSCLE

INSULIN SENSITIVITY IN MUSCLE


NON ALCOHOLIC
FATTY LIVER DISEASE

TRIGLYCERIDES
VLDL, LDL,HDL
GLUCOSE

KLEDA MANSABHYAM

SANSARGA GACHATI

INSULIN MEDIATED
GLUCOSE INTAKE
END STAGE
LIVER DISEASE

HEPATO
CELLULAR
CARCINOMA

ACCUMULATION OF
TG IN SKELETAL &
CARDIAC MUSCLE
KLEDA MANSAYO
PRAMAN VRIDHI
MANSA DAURBALYA
GLUCOSE
JAVOPARODHA
CONCENTRATION

LIPOPROTEIN
LIPASE
(VIKAR VIGHAT ABHAVA)

MUTRAVAHA SROTAS

GLYCOSURIA

ALONGWITH
CYTOKINES

GURUNHI
MUKHANI AASADYA
(OSMOTIC DIURESIS)
PRABHUT AAVILA MUTRATA
(POLYUREA)
DIABETES MELLITES
(MADHUMEHA)
PANCREATIC
INSULIN

HEPATIC PRODUCTION
OF C-REACTIVE PROTEIN
INSULIN SENSITIZING
CYTOKINE ADIPONECTIN
ANTI INFLAMATORY
EFFECT

HEPATIC PRODUCTION
HYPERINSULINEMIA
OF FIBRINOGEN &
ADIPOCYTES PRODUCTION
OF PLASMINOGEN ACTIVATOR INHIBITOR 1
Na REABSORPTION
SYMPHATHETIC
NERVOUS ACTIVITY
PROTHROMBIC
STAGE

+ FFA
(PRATIGHAT)
HYPERTENSION
SAMA MEDA VATADINAM RODHAKAM

RHEOLOGICAL FORCES (VYAN VAYU)

CONTRIBUTES

INJURY TO VESSEL WALL (SROTAS UPAGHAT)


THROMBUS
(GRATHIT RAKTA)
FORMATION

OBESITY+HTN +
CIRCULATINGCYTOKINES+
INSULIN RESISTANCE

ASYMMETRIC
DIMETHYLARGININE
(AN ENDOGENOUS
INHIBITOR OF NO)

PREVENTS VASODILATATION
OBSTRUCTIVE SLEEP APNEA

CARDIO VASCULAR DISEASE


ISCHEMIC STROKE
.
(HYPERINSULINEMIA)

ALTERED RENAL
TUBULAR ABSORPTION
ALTERED ENDOTHELIAL
RENAL PATHOLOGY

OVARIES PRODUCE
EXCESSIVE AMOUNT OF
MALE HORMONES
(ANDROGENS IN PARTICULAR
TESTESTERONE)

HYPERANDROGENISM

MICROALBUMINURIA
REABSORPTION
OF URIC ACID
FROM
RENAL TUBULE

POLYCYSTIC OVARIAN
SYNDROME (PCOS)

HYPERURICEMIA

DIAGNOSIS CRITERIA:
1.
WEIGHT
2.
WAIST CIRCUMFERENCE
3.
BMI
4.
BLOOD PRESSURE
5.
LIPID PROFILE
6.
FASTING BLOOD GLUCOSE LEVEL
7.
GLUCOSE TOLERANCE TESTING
8.
FASTING INSULIN LEVELS
9.
HORMONAL ASSAY IN PCOS
10. MEDICAL HISTORY FOR OBSTRUCTIVE SLEEP APNEA
11. FAMILY HISTORY FOR CVD & DM

TREATMENT:
A. NIDAN PARIVARJAN
Metabolic Syndrome is a lifestyle disorder which needs to be changed
on priority basis.
Obesity being main cause reduction of body weight is essential.
Gramya Aahar, fast food, trans fatty food, saturated fatty food should
be strictly avoided, with low sugar intake and regular exercise.

Aaharatmak ; eating pattern should be followed


- Preference to fish, chicken, low fat dairy products
- Salt & alcohol intake should be moderate
- Consume more unrefined carbohydrates such as grains product.
- Antioxidants like amalaki, lemons, spinach, turnip leaves, watermelon,
sweet potatoes, carrots, tomatoes, pumpkin, wheat grass juice, oranges,
guava, should be added in diet.
Diet should include:
Fenugreek or Methi

Fenugreek seeds are a rich source of constituents known as steroidal


saponins that help to reduce the bodys absorption of cholesterol coming in
through the fat-rich foods we eat.

Saponins have a role to play in reducing the bodys production of


cholesterol.
Flaxseed or Alsi
Is a rich source of omega-3 fatty acids that has a protective action on heart
health.
These seeds also contain a lot of fiber and this binds with cholesterol,
preventing its absorption.
The regular use of flaxseed is said to prevent the arteries from hardening
due to the deposition of cholesterol
It also helps reduce the risk of coronary artery disease and hypertension.
Flaxseeds also have the effect of increasing the
apolipoprotein A1 which goes to form HDL cholesterol.

concentrations

of

Garlic
Garlic reduces LDL cholesterol.
Prevents a rise of blood pressure
Avoids the deposition of plaque on the walls of arteries, reducing chances of
heart attack and stroke.
Garlic contains sulphurous compounds that act as antioxidants and also help
with expansion of the blood vessels, keeping blood pressure at a normal
level.
Onions
Onion contains a constituent called quercetin that is known to be a strong
antioxidant; this means it can prevent the damaging effects of free radicals
on human tissues.
Researchers have linked quercetin of onions with increased levels of HDL
cholesterol as well as low levels of LDL cholesterol.

Nuts

Nuts such as almonds, pistachios, hazelnuts and walnuts are rich in


polyunsaturated fatty acids that help to keep the arteries healthy.
However, eat them in raw form without adding salt or sugar or you
will add to the calorie content.
Fish
Certain species of fish are a storehouse of the healthy omega-3 fatty acids
that reduce LDL cholesterol and protect the heart.
Herring, salmon, mackerel, sardines, halibut and lake trout are good sources
of these fatty acids that also help increase HDL cholesterol.
Mung - Its polysaccharides composition enhances enzyme activity, serum
lipoprotein LDL levels of TG hydrolysis to reach curative effect of lowering
blood fat
- It contains globulin and polysaccharides, it can promote animal cholesterol
in liver bile acid, accerelate decomposed into bile salts in the bile secreted
and reduce absorption of cholesterol small intestine.
Yava (Hordeum vulgare) It lowers LDL and total cholesterol levels.
Study shows it has beneficial effect on lipid metabolism and bowel function.
Maricha (Piper nigrum) Piper nigrum can increase absorption of
selenium vit. B and beta carotene and curcumin as well as other nutrients. It
has antioxidant properties.
Patola (Trichosanthes dioca) Water extract shows it reduces fasting
blood glucose, pp blood glucose, aspirate amino transferase, alanine amino
transferase, alkaline phosphatase, creatinine, urine sugar and urine protein
It has antioxidant potential and anti-inflammatory activity.
Karvellaka (Momordica charantia) It reduces liver secretion of
Apolipoprotein

the

primary

lipoprotein

of

LDL

and

also

reduces

Apoliporotein C the primary lipoprotein of VLDL and increase expression of

apolipoprotein A-1 the primary component of HDL. It also stimulate insulin


secretion from pancrectic cells.
Kulatha (Dolichos biflorus) It has antioxidant activity, hydroxyl radical
scavenjing reduces lipid peroxidation. It has hypolipidemic activity and
lowers blood sugar level.
Ushira (Vetiveria zizanioides) It shows antioxidant properties. It
scavenges free radicals.
Banana (Musa paradisiaca) contain dietary fibre, high amount of
essential minerals, potassium, vit. A, B1, B2 & C. It has soluble fiber which
binds with bile salt and may reduce blood cholesterol levels
Kusmanda (Benincasa hispida) antioxidant property, scavenging free
radicals
Dadima (Punica granatum) antioxidant, protect body from free radicals.
It reduces LDL and increase HDL
Shampaka Shaka (Aragvad patra) - It reduces blood sugar level and has
antioxidant activity and also reduces blood and liver total lipids
Mulak (Rapharus sativus) improve blood circulation. It lowers plasma
levels of total cholesterol, TG, phospholipids. It also shows hypoglycemic
activity.
Eranda

taila

(Ricinus

communis)

Ricinoleic

acid

exerts

anti-

inflammatory effects.
Draksha (Vitis vinifera) - study shows it relieves symptoms of chronic
venous insufficiency, arteriosclerosis and high blood pressure, alleviate
inflammatory conditions and is cardioprotective. They reduce fragility of
blood vessel.
Oats and Beans
Oats are a rich source of fiber and a compound called beta glucan; these act
together to bring about a reduction in the levels of LDL cholesterol.

Beans also contain a large amount of fiber and can help to reduce the
quantity as well as the rate of cholesterol absorption from the diet.
Diet should be such that it must be guru but should have apatarpan
effect. Oats, flakes, honey, butter milk have such role.
VIHARATMAK (PHYSICAL ACTIVITY)
-

Avoid Smoking
Prevent stress
Follow aachar rasayan

Daily exercise should be for 60-90 min.


Gardening, cycling, swimming, brisk walking and doing housecleaning.
Vyayam should be ardhashakti but regular and preferably in early
morning.
PANCHKARMA
Ruksha Sweda
Tikshna Basti but to be avoided in CVD, Vaitaran basti can be done.
Triphala , Dashamula, Gomutra, Honey, Saindhav
Vaman and Virechan can be carried out depending on anubandh of
dosha and considering the bala of rugna but avoid in CVD.
MEDICINES
Drugs acting on amashit meda or medovaha srotas
1. Maricha
2. Chitrak
3. Daruharidra
4. Rason
5. Tulsi
6. Vacha
7. Pushkarmoola
8. Punarnava
9. Shilajeet
10.

Triphala

11.

Amruta

12.

Musta

13.

Pippali

14.

Kutki

15.

Drugs explained in Urustamba, staulya and santarpanotha

vyadhi chikitsa can be chosen.


Drugs acting on Rasa Raktavaha srotas
1. Amalaki
2. Haritaki
3. Punarnava
4. Shatavari
5. Shalparni
6. Sariva
7. Manjista
8. Shilajeeta
9. Amrita
10. Yastimadhu
11.

Patola

12.

Kutki

13.

Vidanga

14.

Laksha

Drugs acting on Vata dosha


1. Dashamoola
2. Haritaki
3. Rason
4. Guggulu
5. Punarnava
6. Shalparni
7. Shatavari

8. Pushkarmoola
9. Deodaru
10.

Mirigashringa

11.

Nagbala

Drugs acting on Prameha


1. Triphala
2. Gudmar
3. Asana
4. Guduchi
5. Kiratikta
6. Kutki
7. Patola
8. Nimba
9. Haridra
10.

Gokshur

11.

Chitrak

12.

Shilajeet

Drugs having mutrala effect so reducing the HTN & Renal Pathology
1. Punarnava
2. Gokshur
3. Musta
4. Ushir
5. Dashmula
6. Varun
7. Pashan bheda
8. Brahmi

9. Padmak
10.

Pundarik

11.

Madhuk

Drugs having Hridya Effect usefull in CVD


1. Arjun
2. Brahmi
3. Tulsi
4. Guggulu
5. Punarnava
6. Rason
7. Shatawari
8. Amalaki
9. Yastimadhu
Drugs acting on grathita rakta in cases of thrombosis
1. Kamalkshar
2. Darbha
3. Kusta
4. Paravatashakrit
5. Mrunal
6. Palash kshar
7. Priyangu kshar
8. Utpalnal kshar
9. Asana
Role of katu rasa pradhan dravya should be studied since Charak
says it has shonita sanghata bhinnati action.

Drugs having Medhya action


1. Brahmi
2. Sankhapuspi
3. Jatamanshi
4. Guduchi
5. Yastimadhu
6. Shatawari
7. Haritaki
8. Brahmarasayan
Kalpa
1. Mahasudarshan Churna
2. Mahatiktak Contents
3. Navayas Loha
4. Medohar Guggulu
5. Varunadi Kwath
6. Ayaskriti