Changes

The functional trait of such food articles is ''snigdha'' (oily) ''guna'' is ''sneha'' (unctuousness), ''mriduta'' (softness), and ''ardrata'' (malleability, fluidity)<ref> Gothecha Mohanlal., Dr., editor. Guna Parijnana. Jamnagar: Post Graduate Training Center in Ayurveda; 1958. pp. 19–20. </ref>  <ref> Acharya Vaidya Jadavaji Trikamaji, Aachrya Narayana Rama. Sutra Sthana Dalhana. 8 edition. 49. Vol. 1. Chaukhamba Orientalia; 2005. Susruta, ‘Susruta Samhita’ with ‘Nibandha Sangrha’ commentary by Dallhanacharya; p. 12 </ref>. ''Snigdha'' food articles include those derived from lipids and fat molecules. Similarly, ''madhura'' (sweetness) is a property of food substances that possess predominantly sweet taste - not just perceived at the tongue, but also in many parts/tissues along our digestive system. ''Guru'' is the primary property that indicates “heaviness” of a food item, and a ''guru'' food article is heavy to digest and increases bulkiness of the tissues. ''Guru'' is the opposite of ''agni'' and hence delays digestion and metabolism and is used, therefore, in therapies that require nourishment, enhancement of physical strength, etc (''brimhana, agnimaandyakara, upalepa, bala, upachaya'' and ''tarpana''). Finally, ''picchilla'' is sliminess and stickiness, and indicates food items that vitiate ''kapha'' and ''mamsa-meda dhatu'' particularly.  

The functional trait of such food articles is ''snigdha'' (oily) ''guna'' is ''sneha'' (unctuousness), ''mriduta'' (softness), and ''ardrata'' (malleability, fluidity)<ref> Gothecha Mohanlal., Dr., editor. Guna Parijnana. Jamnagar: Post Graduate Training Center in Ayurveda; 1958. pp. 19–20. </ref>  <ref> Acharya Vaidya Jadavaji Trikamaji, Aachrya Narayana Rama. Sutra Sthana Dalhana. 8 edition. 49. Vol. 1. Chaukhamba Orientalia; 2005. Susruta, ‘Susruta Samhita’ with ‘Nibandha Sangrha’ commentary by Dallhanacharya; p. 12 </ref>. ''Snigdha'' food articles include those derived from lipids and fat molecules. Similarly, ''madhura'' (sweetness) is a property of food substances that possess predominantly sweet taste - not just perceived at the tongue, but also in many parts/tissues along our digestive system. ''Guru'' is the primary property that indicates “heaviness” of a food item, and a ''guru'' food article is heavy to digest and increases bulkiness of the tissues. ''Guru'' is the opposite of ''agni'' and hence delays digestion and metabolism and is used, therefore, in therapies that require nourishment, enhancement of physical strength, etc (''brimhana, agnimaandyakara, upalepa, bala, upachaya'' and ''tarpana''). Finally, ''picchilla'' is sliminess and stickiness, and indicates food items that vitiate ''kapha'' and ''mamsa-meda dhatu'' particularly.  

Today’s research is consistent with the above findings of Ayurveda. Researchers acknowledge that taste receptors exist in the upper gastrointestinal tract as well. These receptors are “primarily located in the intestinal brush and enteroendocrine cells, and recognize sugars, D-amino acids, sweet proteins, and artificial sweeteners<ref>Greenfield Jerry R.,  Chisholm Donald J.  How Sweet It Is: Intestinal Sweet Taste Receptors in Type 2 Diabetes. Diabetes. 2013 Oct; 62(10): 3336–3337.</ref>”, per their research. Peptide YY (PYY) exerts its action through NPY receptors by inhibiting gastric motility and increasing water and electrolyte absorption in the colon<ref> Liu C, Aloia T, Adrian T, Newton T, Bilchik A, Zinner M, Ashley S, McFadden D (1996). "Peptide YY: a potential proabsorptive hormone for the treatment of malabsorptive disorders". Am Surg 62 (3): 232–6.Charaka Samhita Sutra Sthana 27/309 </ref>.  PYY may also suppress pancreatic secretion, as it is secreted by neuro-endocrine cells in the ileum and colon in response to a meal, and has been shown to reduce appetite. It works by slowing the gastric emptying, thereby increasing the efficiency of digestion and nutrient absorption after a meal. Considering the effects of sweet food substances, PYY, in certain quantities, helps induce satiety in a person and thus in excess, inhibits appetite. This study clearly suggests the impact of ''madhura rasa'' and ''snigdha'' food substances in creating ''santarpaniya vyadhi'' or increased anabolism. Like GLP -1, GIP is related to metabolism and inflammation.  

Today’s research is consistent with the above findings of Ayurveda. Researchers acknowledge that taste receptors exist in the upper gastrointestinal tract as well. These receptors are “primarily located in the intestinal brush and enteroendocrine cells, and recognize sugars, D-amino acids, sweet proteins, and artificial sweeteners<ref>Greenfield Jerry R.,  Chisholm Donald J.  How Sweet It Is: Intestinal Sweet Taste Receptors in Type 2 Diabetes. Diabetes. 2013 Oct; 62(10): 3336–3337.</ref>”, per their research. Peptide YY (PYY) exerts its action through NPY receptors by inhibiting gastric motility and increasing water and electrolyte absorption in the colon<ref> Liu C, Aloia T, Adrian T, Newton T, Bilchik A, Zinner M, Ashley S, McFadden D (1996). "Peptide YY: a potential proabsorptive hormone for the treatment of malabsorptive disorders". Am Surg 62 (3): 232–6.Charak Samhita Sutra Sthana 27/309 </ref>.  PYY may also suppress pancreatic secretion, as it is secreted by neuro-endocrine cells in the ileum and colon in response to a meal, and has been shown to reduce appetite. It works by slowing the gastric emptying, thereby increasing the efficiency of digestion and nutrient absorption after a meal. Considering the effects of sweet food substances, PYY, in certain quantities, helps induce satiety in a person and thus in excess, inhibits appetite. This study clearly suggests the impact of ''madhura rasa'' and ''snigdha'' food substances in creating ''santarpaniya vyadhi'' or increased anabolism. Like GLP -1, GIP is related to metabolism and inflammation.  

Thus, it can be said that excess of ''madhura, guru, snigdha'' and ''pichchilla'' foods can have inflammatory effect at the molecular level. If the above properties elaborated by Charaka are to be understood, it can be clearly stated that they increase body tissues in volume and delay the digestion of food. This seems to be acceptable and the effect may be mediated through peptide YY. As it delays digestion and increases the nutrient uptake, these food substances lead to ''santarpana''.

Thus, it can be said that excess of ''madhura, guru, snigdha'' and ''pichchilla'' foods can have inflammatory effect at the molecular level. If the above properties elaborated by Charak are to be understood, it can be clearly stated that they increase body tissues in volume and delay the digestion of food. This seems to be acceptable and the effect may be mediated through peptide YY. As it delays digestion and increases the nutrient uptake, these food substances lead to ''santarpana''.

==== II. Impact of age on grains and grain-based food products ====

==== II. Impact of age on grains and grain-based food products ====

The age of food grains helps determine the quality as well as digestibility of food. ''Shuka dhanya'' (monocotyledons) and ''shami dhanya'' (dicotyledons) that are old /aged are easy to digest and are dry in property as compared to new ones<ref>Charaka Samhita Sutra Sthana 27/309 </ref>. ''Nava anna'', or fresh, non-aged rice, millet, etc. increase ''kapha'' and are heavier than old grains. Charaka notes that all new and fresh grains are heavy and induce ''santarpana'', while aged grains are lighter to digest.

The age of food grains helps determine the quality as well as digestibility of food. ''Shuka dhanya'' (monocotyledons) and ''shami dhanya'' (dicotyledons) that are old /aged are easy to digest and are dry in property as compared to new ones<ref>Charak Samhita Sutra Sthana 27/309 </ref>. ''Nava anna'', or fresh, non-aged rice, millet, etc. increase ''kapha'' and are heavier than old grains. Charak notes that all new and fresh grains are heavy and induce ''santarpana'', while aged grains are lighter to digest.

Sharangdhara in Purva Khanda also talks of new and old grains and recommends six to twelve month-old grains to be used. Biochemical changes that help in digestion may be occurring after certain aging of grains. Per researchers (Seguchi, 1993), aging of flour and grains does enhance their functionality as ingredients for cakes and batter. Cereals can be stored for long periods without microbial spoilage. However, biochemical changes also occur during aging. There is great possibility that certain amino acids and phyto chemicals get stabilized in the grain which make them safe for consumption. Eventually, the grain respires, dry matter is lost and functional and nutritional aspects of the grain are altered. Age related changes have great influence on the viscosity of any batter made out of wheat-flour and the water-binding ability of the wheat flour (Shelke et al, 1992). In addition, the starch granule surface protein is found to increase up to three to four times with aging. However, prolonged aging is not recommended (Pomeranz et al, 1968). The moisture content of grains, the storage temperature and relative humidity have been shown to exert dramatic changes in the acidity, pH, free amino nitrogen, crude protein, and protein quality. Significant changes in soluble sugars and amylase contents of the grains have also been reported during storage at elevated temperature<ref> Zia-Ur Rehman, W.H. Shah. Biochemical changes in wheat during storage at three temperatures. Plant Foods for Human Nutrition 54: 109–117, 1999. </ref>.   

Sharangdhara in Purva Khanda also talks of new and old grains and recommends six to twelve month-old grains to be used. Biochemical changes that help in digestion may be occurring after certain aging of grains. Per researchers (Seguchi, 1993), aging of flour and grains does enhance their functionality as ingredients for cakes and batter. Cereals can be stored for long periods without microbial spoilage. However, biochemical changes also occur during aging. There is great possibility that certain amino acids and phyto chemicals get stabilized in the grain which make them safe for consumption. Eventually, the grain respires, dry matter is lost and functional and nutritional aspects of the grain are altered. Age related changes have great influence on the viscosity of any batter made out of wheat-flour and the water-binding ability of the wheat flour (Shelke et al, 1992). In addition, the starch granule surface protein is found to increase up to three to four times with aging. However, prolonged aging is not recommended (Pomeranz et al, 1968). The moisture content of grains, the storage temperature and relative humidity have been shown to exert dramatic changes in the acidity, pH, free amino nitrogen, crude protein, and protein quality. Significant changes in soluble sugars and amylase contents of the grains have also been reported during storage at elevated temperature<ref> Zia-Ur Rehman, W.H. Shah. Biochemical changes in wheat during storage at three temperatures. Plant Foods for Human Nutrition 54: 109–117, 1999. </ref>.   

==== III. Categories of food leading to anabolism ====

==== III. Categories of food leading to anabolism ====

'''''Gorasa''''' (milk and milk products): Over the years, there have been many conflicting views in scientific journals and from nutritionists regarding dairy products and it is often difficult to conclude about their health benefits. Charaka has clearly mentioned in various texts, including this chapter and in [[Prameha Nidana]], that excessive consumption of dairy products, meat, and carbohydrates may lead to many metabolic disorders. It may also create inflammation at a molecular level. Common allergens like casein and gluten create inflammation in the gut. Investigators have correlated higher levels of milk antibodies with rheumatoid arthritis<ref> rheumatoid arthritis </ref> (Arvikar, 2013). Studies suggest (Feskanich D. et al) that cow’s milk could be responsible for an irreversible inability to metabolize blood sugar, and could cause Type I and type II diabetes. This study also suggests that severe disorders such as rheumatoid arthritis, diabetes, heart attacks, multiple sclerosis, and osteoporosis could be attributed to diet rich in milk<ref> Feskanich D. et al. Milk, dietary calcium and bone fractures in women: A 12 year prospective study. Am. J. Public Health 87: 992-997. 1997 </ref>.  

'''''Gorasa''''' (milk and milk products): Over the years, there have been many conflicting views in scientific journals and from nutritionists regarding dairy products and it is often difficult to conclude about their health benefits. Charak has clearly mentioned in various texts, including this chapter and in [[Prameha Nidana]], that excessive consumption of dairy products, meat, and carbohydrates may lead to many metabolic disorders. It may also create inflammation at a molecular level. Common allergens like casein and gluten create inflammation in the gut. Investigators have correlated higher levels of milk antibodies with rheumatoid arthritis<ref> rheumatoid arthritis </ref> (Arvikar, 2013). Studies suggest (Feskanich D. et al) that cow’s milk could be responsible for an irreversible inability to metabolize blood sugar, and could cause Type I and type II diabetes. This study also suggests that severe disorders such as rheumatoid arthritis, diabetes, heart attacks, multiple sclerosis, and osteoporosis could be attributed to diet rich in milk<ref> Feskanich D. et al. Milk, dietary calcium and bone fractures in women: A 12 year prospective study. Am. J. Public Health 87: 992-997. 1997 </ref>.  

Thus, there has been much research concerning dairy products, besides meat and other forms of complex proteins, which shows their excessive consumption in a very unfavourable<ref> Feskanich D. et al. Milk, dietary calcium and bone fractures in women: A 12 year prospective study. Am. J. Public Health 87: 992-997. 1997 </ref>. These types of food have multifold impact on the health of a person. These can change the gut flora leading to disorders of absorption, adversely affecting auto-immunity and production of antibodies. It has been shown by certain researchers that excess of meat and dairy products leads to immune-activation <ref> Hvatum M, Kanerud L, Hällgren R, Brandtzaeg P. The gut-joint axis: cross reactive food antibodies in rheumatoid arthritis. Gut. 2006 Sep;55(9):1240-7. </ref>  <ref> Pattison DJ, Symmons DP, Lunt M, Welch A, Luben R, Bingham SA, Khaw KT, Day NE, Silman AJ. Dietary risk factors for the development of inflammatory polyarthritis: evidence for a role of high level of red meat consumption. Arthritis Rheum. 2004 Dec;50(12):3804-12. </ref>. Excess of meat also has certain enzymatic toxicity which can lead to insulin resistance –a basic pathology of obesity, heart disease and type II diabetes.  

Thus, there has been much research concerning dairy products, besides meat and other forms of complex proteins, which shows their excessive consumption in a very unfavourable<ref> Feskanich D. et al. Milk, dietary calcium and bone fractures in women: A 12 year prospective study. Am. J. Public Health 87: 992-997. 1997 </ref>. These types of food have multifold impact on the health of a person. These can change the gut flora leading to disorders of absorption, adversely affecting auto-immunity and production of antibodies. It has been shown by certain researchers that excess of meat and dairy products leads to immune-activation <ref> Hvatum M, Kanerud L, Hällgren R, Brandtzaeg P. The gut-joint axis: cross reactive food antibodies in rheumatoid arthritis. Gut. 2006 Sep;55(9):1240-7. </ref>  <ref> Pattison DJ, Symmons DP, Lunt M, Welch A, Luben R, Bingham SA, Khaw KT, Day NE, Silman AJ. Dietary risk factors for the development of inflammatory polyarthritis: evidence for a role of high level of red meat consumption. Arthritis Rheum. 2004 Dec;50(12):3804-12. </ref>. Excess of meat also has certain enzymatic toxicity which can lead to insulin resistance –a basic pathology of obesity, heart disease and type II diabetes.  

All the above types of food mentioned herein could explain 57% of the total structural variation in gut microbiota whereas changes in genetics accounted for no more than 12% <ref> Zhang C., Zhang M., Wang S., Han R., Cao Y., Hua W., Mao Y., Zhang X., Pang X., Wei C., et al. Interactions between gut microbiota, host genetics and diet relevant to development of metabolic syndromes in mice. ISME J. 2010;4:232–241. doi: 10.1038/ismej.2009.112. </ref>. This indicates that diet plays a dominant role in shaping gut microbiota and changing key populations may transform healthy gut microbiota into a disease-inducing entity. For example, the western diet, which is high in sugar and fat, causes dysbiosis affecting both host GI tract metabolism and immune homeostasis<ref> Tapiainen T., Ylitalo S., Eerola E., Uhari M. Dynamics of gut colonization and source of intestinal flora in healthy newborn infants. APMIS. 2006;114:812–817. doi: 10.1111/j.1600-0463.2006.apm_488.x. </ref>. Dysbiosis is a very important term that can be helpful in explaining many pathologies mentioned in Ayurvedic literature.

All the above types of food mentioned herein could explain 57% of the total structural variation in gut microbiota whereas changes in genetics accounted for no more than 12% <ref> Zhang C., Zhang M., Wang S., Han R., Cao Y., Hua W., Mao Y., Zhang X., Pang X., Wei C., et al. Interactions between gut microbiota, host genetics and diet relevant to development of metabolic syndromes in mice. ISME J. 2010;4:232–241. doi: 10.1038/ismej.2009.112. </ref>. This indicates that diet plays a dominant role in shaping gut microbiota and changing key populations may transform healthy gut microbiota into a disease-inducing entity. For example, the western diet, which is high in sugar and fat, causes dysbiosis affecting both host GI tract metabolism and immune homeostasis<ref> Tapiainen T., Ylitalo S., Eerola E., Uhari M. Dynamics of gut colonization and source of intestinal flora in healthy newborn infants. APMIS. 2006;114:812–817. doi: 10.1111/j.1600-0463.2006.apm_488.x. </ref>. Dysbiosis is a very important term that can be helpful in explaining many pathologies mentioned in Ayurvedic literature.

Thus, an excessive meat/dairy based diet that has been explained by Charaka starts its dreadful effect from GI tract leading to metabolic disorders. This can be compared with the theory of agni elaborated by Ayurveda scholars and also explains how wrong food exerts its effect on immune system leading to inflammation at molecular level. Chronic inflammation changes the normal mechanism of body and leads to certain dreadful metabolic disorders. Thus, over and undernutrition both lead to certain metabolic diseases mediated through inflammation <ref> Wellen KE, Hotamisligil GS: Inflammation, stress, and diabetes. J Clin Invest 2005, 115:1111-1119. </ref>.

Thus, an excessive meat/dairy based diet that has been explained by Charak starts its dreadful effect from GI tract leading to metabolic disorders. This can be compared with the theory of agni elaborated by Ayurveda scholars and also explains how wrong food exerts its effect on immune system leading to inflammation at molecular level. Chronic inflammation changes the normal mechanism of body and leads to certain dreadful metabolic disorders. Thus, over and undernutrition both lead to certain metabolic diseases mediated through inflammation <ref> Wellen KE, Hotamisligil GS: Inflammation, stress, and diabetes. J Clin Invest 2005, 115:1111-1119. </ref>.

==== IV. Effect of lifestyle on anabolism ====

==== IV. Effect of lifestyle on anabolism ====

Charaka not only explains the adverse effects of bad eating but also explains the ill effects of sedentary behaviour which are the leading cause of metabolic disorders. He explains that those averse to physical or mental activities (exercises), those who are habituated to sleeping during the day and always having the tendency to lying down will end up suffering from various metabolic disorders. Modern researchers have proved this too. Sedentary behaviour refers to low-energy activities that involve energy expenditure (at the level of 1.0–1.5 metabolic equivalent units (METs))<ref> Huang TT, Howarth NC, Lin BH, Roberts SB, McCrory MA: Energy intake and meal portions: associations with BMI percentile in U.S. children. Obes Res 2004, 12:1875-1885 </ref>, and include activities such as lying down, sitting, etc. Individuals could be spending a significant part of their waking hours in sedentary activities<ref> Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.Diabetes Care 2004, 27:1047-1053.  </ref>.   

Charak not only explains the adverse effects of bad eating but also explains the ill effects of sedentary behaviour which are the leading cause of metabolic disorders. He explains that those averse to physical or mental activities (exercises), those who are habituated to sleeping during the day and always having the tendency to lying down will end up suffering from various metabolic disorders. Modern researchers have proved this too. Sedentary behaviour refers to low-energy activities that involve energy expenditure (at the level of 1.0–1.5 metabolic equivalent units (METs))<ref> Huang TT, Howarth NC, Lin BH, Roberts SB, McCrory MA: Energy intake and meal portions: associations with BMI percentile in U.S. children. Obes Res 2004, 12:1875-1885 </ref>, and include activities such as lying down, sitting, etc. Individuals could be spending a significant part of their waking hours in sedentary activities<ref> Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.Diabetes Care 2004, 27:1047-1053.  </ref>.   

Per studies by Lee et al (2001), the association between sedentary behaviour and metabolic health could, to some extent, explain the association between sedentary time and metabolic syndrome <ref> Lee JY, Sohn KH, Rhee SH, Hwang D: Saturated fatty acids, but not unsaturated fatty acids, induce the expression of cyclooxygenase-2 mediated through Toll-like receptor 4.J Biol Chem 2001, 276:16683-16689. </ref>.   

Per studies by Lee et al (2001), the association between sedentary behaviour and metabolic health could, to some extent, explain the association between sedentary time and metabolic syndrome <ref> Lee JY, Sohn KH, Rhee SH, Hwang D: Saturated fatty acids, but not unsaturated fatty acids, induce the expression of cyclooxygenase-2 mediated through Toll-like receptor 4.J Biol Chem 2001, 276:16683-16689. </ref>.   

'''''Kotha''''', as explained, is a decay of tissues due to certain conditions. In the context of ''santarpanajanya vyadhi'', decay usually is seen in diabetic patients caused mostly due to microangiopathy. Involvement of the blood vessels by atherosclerosis leading to ischemia is a significant factor in diabetic foot. Lower extremity peripheral vascular disease (PVD) is the most common factor associated with limb ulceration, gangrene, impaired wound healing and ultimately amputation<ref> Gayle R, Benjamin AL, Gary NG. The burden of diabetic foot ulcers. The American Journal of Surgery 1998Aug 24; 176(Suppl 2A):65-105. </ref>. It mainly occurs due to blood flow changes, occlusive changes, micro angiopathy, and hematological changes. There is marked change in the flow of blood in peripheral vessels. The microcirculation is regulated by neural factors, local reflexes and vasoactive mediators. The initial haemodynamic changes will be increased flow and pressure of capillary blood<ref> Tooke JE. Microvascular hemodynamics in diabetes mellitus. Clin Sci 1986; 70:119-125 </ref> . As the disease progresses, autoregulation is lost and haemodynamic stress results. It could also be due to increased calcification of vessels or AV shunting or hyperosmolarity of blood. It is well documented by high ankle brachial ratio and also Doppler studies. Occlusive changes occur in more than 50% of diabetics having the disease for more than 10 – 15 years<ref> Pyorala K, Laasko M, Vusiitupa M. Diabetes and atherosclerosis, An epidemiologic view. Diabet Methob Rev 1987; 3:463-524 </ref>. It mainly affects arteries below profunda femoris and is characterized by multiple segment involvement. The tibial & peroneal arteries between the knee and the ankle are primarily affected. Dorsalis pedis artery and foot vessels are usually spared. Patients with diabetes have diminished ability to establish collateral circulation especially in arteries around knee.  This disease is more prevalent & accelerated with diabetes mellitus.   

'''''Kotha''''', as explained, is a decay of tissues due to certain conditions. In the context of ''santarpanajanya vyadhi'', decay usually is seen in diabetic patients caused mostly due to microangiopathy. Involvement of the blood vessels by atherosclerosis leading to ischemia is a significant factor in diabetic foot. Lower extremity peripheral vascular disease (PVD) is the most common factor associated with limb ulceration, gangrene, impaired wound healing and ultimately amputation<ref> Gayle R, Benjamin AL, Gary NG. The burden of diabetic foot ulcers. The American Journal of Surgery 1998Aug 24; 176(Suppl 2A):65-105. </ref>. It mainly occurs due to blood flow changes, occlusive changes, micro angiopathy, and hematological changes. There is marked change in the flow of blood in peripheral vessels. The microcirculation is regulated by neural factors, local reflexes and vasoactive mediators. The initial haemodynamic changes will be increased flow and pressure of capillary blood<ref> Tooke JE. Microvascular hemodynamics in diabetes mellitus. Clin Sci 1986; 70:119-125 </ref> . As the disease progresses, autoregulation is lost and haemodynamic stress results. It could also be due to increased calcification of vessels or AV shunting or hyperosmolarity of blood. It is well documented by high ankle brachial ratio and also Doppler studies. Occlusive changes occur in more than 50% of diabetics having the disease for more than 10 – 15 years<ref> Pyorala K, Laasko M, Vusiitupa M. Diabetes and atherosclerosis, An epidemiologic view. Diabet Methob Rev 1987; 3:463-524 </ref>. It mainly affects arteries below profunda femoris and is characterized by multiple segment involvement. The tibial & peroneal arteries between the knee and the ankle are primarily affected. Dorsalis pedis artery and foot vessels are usually spared. Patients with diabetes have diminished ability to establish collateral circulation especially in arteries around knee.  This disease is more prevalent & accelerated with diabetes mellitus.   

'''''Pandu''''' (anemia): It means pallor and is seen in metabolic disorders. Charaka has explained it as a disease as well as complication of other disorders. ''Pandu'' that has been mentioned in ''santarpanajanya'' diseases chapter is ''kapha'' dominant where the causes are elaborated in verses 3 and 4. Two of the most common causes of anemia are due to abnormalities in iron homeostasis: iron-deficiency anemia and anemia of inflammation also known as anemia of chronic disease. The anemia caused due to inflammation is elaborated in this context. It is very interesting to know metabolic disorders like obesity and some complication of diabetes like diabetic nephropathy also lead to pallor and iron deficiency<ref> Karlee et al. Is Obesity Associated with Anaemia of Chronic Disease? A Population-based Study. 2008. Doi: 10.1038/oby.2008.353 </ref>. Along with anaemia, renal parameters also get deranged which may lead to abdominal symptoms like nausea and vomiting, so the word ''arochaka'' is used here adjoining to ''mutrakrichhra'' (urinary disorder)<ref> Mehdi et al. Anemia, Diabetes, and Chronic Kidney Disease. 2009. 32(7): 1320-1326 </ref>. In the latter stages of diabetic or hypertensive nephropathy urinary complaints like oligouria or anuria can occur. If it remains untreated due anaemia and congestion in heart, edema starts developing which has been called as ''shopha''.  

'''''Pandu''''' (anemia): It means pallor and is seen in metabolic disorders. Charak has explained it as a disease as well as complication of other disorders. ''Pandu'' that has been mentioned in ''santarpanajanya'' diseases chapter is ''kapha'' dominant where the causes are elaborated in verses 3 and 4. Two of the most common causes of anemia are due to abnormalities in iron homeostasis: iron-deficiency anemia and anemia of inflammation also known as anemia of chronic disease. The anemia caused due to inflammation is elaborated in this context. It is very interesting to know metabolic disorders like obesity and some complication of diabetes like diabetic nephropathy also lead to pallor and iron deficiency<ref> Karlee et al. Is Obesity Associated with Anaemia of Chronic Disease? A Population-based Study. 2008. Doi: 10.1038/oby.2008.353 </ref>. Along with anaemia, renal parameters also get deranged which may lead to abdominal symptoms like nausea and vomiting, so the word ''arochaka'' is used here adjoining to ''mutrakrichhra'' (urinary disorder)<ref> Mehdi et al. Anemia, Diabetes, and Chronic Kidney Disease. 2009. 32(7): 1320-1326 </ref>. In the latter stages of diabetic or hypertensive nephropathy urinary complaints like oligouria or anuria can occur. If it remains untreated due anaemia and congestion in heart, edema starts developing which has been called as ''shopha''.  

'''''Amaja vyadhi''''':  ''Ama'' is referred to an intermediate bio product of cellular metabolism leading to number of metabolic disorders. Generation of ''ama'' is thought to start with maldigestion or indigestion of food substances when taken in excess which begins in the stomach. It is a very important factor playing a pivotal role in the genesis of any disease. It is clearly stated that there is no disorder devoid of ''ama''. So all the anabolic disorders where ''ama'' is considered as cause are supposed to be under the category of ''ama vyadhis''.   

'''''Amaja vyadhi''''':  ''Ama'' is referred to an intermediate bio product of cellular metabolism leading to number of metabolic disorders. Generation of ''ama'' is thought to start with maldigestion or indigestion of food substances when taken in excess which begins in the stomach. It is a very important factor playing a pivotal role in the genesis of any disease. It is clearly stated that there is no disorder devoid of ''ama''. So all the anabolic disorders where ''ama'' is considered as cause are supposed to be under the category of ''ama vyadhis''.   

'''''Kushtha''''': There are many skin diseases which are related to anabolism. Anabolism leads to discoloration and hyperpigmentation of skin. Majority of obese people show severe hyperpigmentation, which is called as acanthosis nigricans. Simple acne can also be the result of ''santarpanajanya vyadhis''.  Some of the studies<ref> Downing D, Strauss J, Pochi P. Changes in skin surface lipid composition induced by severe caloric restriction in man. Am J Clin Nutr. 1972;25:365–367</ref> had reported, how caloric restriction can change sebum composition. Another study <ref> Adebamowo CA, Spiegelman D, Berkey CS, et al. Milk consumption and acne in teenaged boys. J Am Acad Dermatol. 2008;58:787–793. </ref>linked acne to the consumption of milk.  

'''''Kushtha''''': There are many skin diseases which are related to anabolism. Anabolism leads to discoloration and hyperpigmentation of skin. Majority of obese people show severe hyperpigmentation, which is called as acanthosis nigricans. Simple acne can also be the result of ''santarpanajanya vyadhis''.  Some of the studies<ref> Downing D, Strauss J, Pochi P. Changes in skin surface lipid composition induced by severe caloric restriction in man. Am J Clin Nutr. 1972;25:365–367</ref> had reported, how caloric restriction can change sebum composition. Another study <ref> Adebamowo CA, Spiegelman D, Berkey CS, et al. Milk consumption and acne in teenaged boys. J Am Acad Dermatol. 2008;58:787–793. </ref>linked acne to the consumption of milk.  

'''''Klaibya''''': A person who is unable to have proper sexual intercourse either due to erectile dysfunction or early ejaculation is termed as ''klaibya'' in Ayurveda.''Klaibya'' is described in detail in [[Chikitsa Sthana]] (Chikitsa 30/155) and is mentioned as a complication of either obesity, diabetes or hypertension. While elaborating the properties of ''lashuna'' (garlic) Charaka has explained that ''lashuna'' is important herb in cardiac disorders as well and is useful in ''klaibya''. Looking at its properties on microvessels, ''garlic'' is proven to be a herb which regulates nitric oxide synthesis in the arteries and keeps the lumen of the arteries dilated. Per studies, in cases of hypertensive erectile dysfunction in rats, it has been observed that nitric oxide synthesis in penile artery is lowered<ref> Penson DF et al. Adrenal Control of erectile function and nitric oxide synthase in the rat penis 138(9):3925-32 1997 </ref>. Garlic has positive impact on regulating nitric oxide synthesis<ref> Peyman et al.  Therapeutic Uses and Pharmacological Properties of Garlic, Shallot, and Their Biologically Active Compounds 16(10):1031-1048 2013 </ref>.

'''''Klaibya''''': A person who is unable to have proper sexual intercourse either due to erectile dysfunction or early ejaculation is termed as ''klaibya'' in Ayurveda.''Klaibya'' is described in detail in [[Chikitsa Sthana]] (Chikitsa 30/155) and is mentioned as a complication of either obesity, diabetes or hypertension. While elaborating the properties of ''lashuna'' (garlic) Charak has explained that ''lashuna'' is important herb in cardiac disorders as well and is useful in ''klaibya''. Looking at its properties on microvessels, ''garlic'' is proven to be a herb which regulates nitric oxide synthesis in the arteries and keeps the lumen of the arteries dilated. Per studies, in cases of hypertensive erectile dysfunction in rats, it has been observed that nitric oxide synthesis in penile artery is lowered<ref> Penson DF et al. Adrenal Control of erectile function and nitric oxide synthase in the rat penis 138(9):3925-32 1997 </ref>. Garlic has positive impact on regulating nitric oxide synthesis<ref> Peyman et al.  Therapeutic Uses and Pharmacological Properties of Garlic, Shallot, and Their Biologically Active Compounds 16(10):1031-1048 2013 </ref>.

   

   

The direct effect of obesity on increased risk of erectile dysfunction is well researched, and is often attributable to hormonal imbalance, endothelial dysfunction and insulin resistance.  

The direct effect of obesity on increased risk of erectile dysfunction is well researched, and is often attributable to hormonal imbalance, endothelial dysfunction and insulin resistance.  

'''''Sunthi''''' or ginger (Zinziber officinale): Ginger has ''katu rasa, madhura vipaka'' and ''ushna veerya''. Ginger has been shown to exhibit antioxidant effects. (6)-gingerol appears to be the antioxidant constituent present in ginger, as it was shown to protect HL-60 cells from oxidative stress. Ginger oil has dominative protective effects on DNA damage induced by H2O2. Ginger oil might act as a scavenger of oxygen radical and might be used as an antioxidant<ref> Ma J, Jin X, Yang L and Liu ZL. Diarylheptanoids from the rhizomes of Zingiber officinale. Phytochemistry. 2004;65(8):1137-1143..24 </ref>. In vitro research indicates that gingerols and the related shogaols exhibit cardio depressant properties at low doses and cardiotonic properties at higher doses. Both (6)-shogaol and (6)-gingerol, and the gingerdiones, are reportedly potent enzymatic inhibitors of prostaglandin, thromboxane, and leukotriene biosynthesis. <ref> Shoji N, Iwasa A, Takemoto T, Ishida Y and Ohizumi Y. Cardiotonic principles of ginger (Zingiber officinale Roscoe). </ref> Spiced foods or herbal drinks, containing ginger, have the potential to produce significant effects on metabolic targets, such as satiety, thermogenesis, and fat oxidation thus, useful as anti-obesity agent. Thermogenic ingredients, such as ginger, may be considered as functional agent that could help restore a "positive energy balance" and prevent obesity<ref> Westerterp-Plantenga M, Diepvens K, Joosen AM, Berube-Parent S and Tremblay A. Metabolic effects of spices, teas, and caffeine. Physiol Behav. 8-30-2006;89(1):85-91. </ref>.   

'''''Sunthi''''' or ginger (Zinziber officinale): Ginger has ''katu rasa, madhura vipaka'' and ''ushna veerya''. Ginger has been shown to exhibit antioxidant effects. (6)-gingerol appears to be the antioxidant constituent present in ginger, as it was shown to protect HL-60 cells from oxidative stress. Ginger oil has dominative protective effects on DNA damage induced by H2O2. Ginger oil might act as a scavenger of oxygen radical and might be used as an antioxidant<ref> Ma J, Jin X, Yang L and Liu ZL. Diarylheptanoids from the rhizomes of Zingiber officinale. Phytochemistry. 2004;65(8):1137-1143..24 </ref>. In vitro research indicates that gingerols and the related shogaols exhibit cardio depressant properties at low doses and cardiotonic properties at higher doses. Both (6)-shogaol and (6)-gingerol, and the gingerdiones, are reportedly potent enzymatic inhibitors of prostaglandin, thromboxane, and leukotriene biosynthesis. <ref> Shoji N, Iwasa A, Takemoto T, Ishida Y and Ohizumi Y. Cardiotonic principles of ginger (Zingiber officinale Roscoe). </ref> Spiced foods or herbal drinks, containing ginger, have the potential to produce significant effects on metabolic targets, such as satiety, thermogenesis, and fat oxidation thus, useful as anti-obesity agent. Thermogenic ingredients, such as ginger, may be considered as functional agent that could help restore a "positive energy balance" and prevent obesity<ref> Westerterp-Plantenga M, Diepvens K, Joosen AM, Berube-Parent S and Tremblay A. Metabolic effects of spices, teas, and caffeine. Physiol Behav. 8-30-2006;89(1):85-91. </ref>.   

   

   

'''''Shigru''''' (Moringa olifera): has properties of ''katu, kashaya rasa, ushna veerya'' and ''katu vipaka''. It is widely used in ''santarpaniya vyadhis''. Charaka has also elaborated ''shigru'' to be used in obesity and heart diseases. It exhibits strong hypoglycaemic properties.<ref> Effect of Moringa oleifera Lam. leaves aqueous extract therapy on hyperglycemic rats Dolly Jaiswal, Prashant Kumar Rai, Amit Kumar, Shikha Mehta, Geeta Watal. Journal of Ethnopharmacology 123 (2009) 392–396  </ref> The aqueous, ethanol and ether extracts of moringa oleifera leaves contain compounds that cause reduction in heart rate and relaxation of cardiac muscle and have medical use in management of cardiac conditions like hypertension<ref> Effect of moringa oleifera leaf extracts on the isolated rabbit heart and uterus Ntulume, R. Davis URI: http://hdl.handle.net/10570/308Date: 2010-11. </ref>.  

'''''Shigru''''' (Moringa olifera): has properties of ''katu, kashaya rasa, ushna veerya'' and ''katu vipaka''. It is widely used in ''santarpaniya vyadhis''. Charak has also elaborated ''shigru'' to be used in obesity and heart diseases. It exhibits strong hypoglycaemic properties.<ref> Effect of Moringa oleifera Lam. leaves aqueous extract therapy on hyperglycemic rats Dolly Jaiswal, Prashant Kumar Rai, Amit Kumar, Shikha Mehta, Geeta Watal. Journal of Ethnopharmacology 123 (2009) 392–396  </ref> The aqueous, ethanol and ether extracts of moringa oleifera leaves contain compounds that cause reduction in heart rate and relaxation of cardiac muscle and have medical use in management of cardiac conditions like hypertension<ref> Effect of moringa oleifera leaf extracts on the isolated rabbit heart and uterus Ntulume, R. Davis URI: http://hdl.handle.net/10570/308Date: 2010-11. </ref>.  

   

   

'''''Katukrohini''''' or ''kutaki'' (Picrorrhiza kurroa): ''Kutaki'' has ''tikta rasa, katu vipaka'' and ''sheeta veerya''. It possesses a strong hepatoprotective properties due to phytochemical picroliv and also have a potent antioxidant properties<ref> Phytochemical and Pharmacological Standardisation of Polyherbal Tablets For Hepatoprotective Activity Against Carbon Tetrachloride  </ref>.  It is found to be effective against CCl4 induced hepatic damage in rats, by reversal of increased serum level of SGOT, SGPT, ALP, Cholesterol, Bilirubin and decreases level of total protein which occurs during hepatotoxicit<ref> Induced HepatotoxicityVilas A. Arsul*, R. O. Ganjiwale, P. G. Yeole International Journal of Pharmaceutical Sciences and Drug Research 2010; 2(4): 265-268 </ref>.   

'''''Katukrohini''''' or ''kutaki'' (Picrorrhiza kurroa): ''Kutaki'' has ''tikta rasa, katu vipaka'' and ''sheeta veerya''. It possesses a strong hepatoprotective properties due to phytochemical picroliv and also have a potent antioxidant properties<ref> Phytochemical and Pharmacological Standardisation of Polyherbal Tablets For Hepatoprotective Activity Against Carbon Tetrachloride  </ref>.  It is found to be effective against CCl4 induced hepatic damage in rats, by reversal of increased serum level of SGOT, SGPT, ALP, Cholesterol, Bilirubin and decreases level of total protein which occurs during hepatotoxicit<ref> Induced HepatotoxicityVilas A. Arsul*, R. O. Ganjiwale, P. G. Yeole International Journal of Pharmaceutical Sciences and Drug Research 2010; 2(4): 265-268 </ref>.   

If we observe the food substances, fruits and other edibles which are advised for the management of ''apatarpana'' have high glycemic index. Dates, raisins, and certain fruits mentioned are fast energy giving substances while formulation with sattu are slow energy giving substances.  

If we observe the food substances, fruits and other edibles which are advised for the management of ''apatarpana'' have high glycemic index. Dates, raisins, and certain fruits mentioned are fast energy giving substances while formulation with sattu are slow energy giving substances.  

It is very interesting to note that honey and sattu are used both in ''apatarpana'' and ''santarpaniya vyadhis''. In ''santarpanajanya vyadhis, sattu'' is used along with certain herbs, which are ''tikta'' and ''katu rasa'' dominant. Apart from herbs oil, ghee and honey in prescribed portion is used. While in ''apatarpana'' diseases ''sattu'' has been used along with sugar, alcoholic beverages, honey, oil and ghee. This is the importance of ''samayoga'' (combination) of ''dravyas'' mentioned by Charaka elsewhere. ''Sattu'' when advised with alcoholic beverages or with certain sour substance exerts different nutritional properties.  

It is very interesting to note that honey and sattu are used both in ''apatarpana'' and ''santarpaniya vyadhis''. In ''santarpanajanya vyadhis, sattu'' is used along with certain herbs, which are ''tikta'' and ''katu rasa'' dominant. Apart from herbs oil, ghee and honey in prescribed portion is used. While in ''apatarpana'' diseases ''sattu'' has been used along with sugar, alcoholic beverages, honey, oil and ghee. This is the importance of ''samayoga'' (combination) of ''dravyas'' mentioned by Charak elsewhere. ''Sattu'' when advised with alcoholic beverages or with certain sour substance exerts different nutritional properties.  

When ''sattu'' is given with acidic and fermented substances like alcohol, an enzymetic degradation of phytic acid of ''sattu'' is observed. Such a reduction in phytate may increase the amount of soluble iron, zinc and calcium several folds. This makes the combination of sattu more nutritious as compared to the formulation mentioned in the management of santarpanajanya diseases.       

When ''sattu'' is given with acidic and fermented substances like alcohol, an enzymetic degradation of phytic acid of ''sattu'' is observed. Such a reduction in phytate may increase the amount of soluble iron, zinc and calcium several folds. This makes the combination of sattu more nutritious as compared to the formulation mentioned in the management of santarpanajanya diseases.