Qs & As – Dr Ramesh R. Varier – Senior Physician – Ayurveda
… however if detected in the very early stage, these diseases can very well be reversed completely’
Dr Varier was here recently in the context of a medical conference on “Ayurveda for today’s healthcare needs” organised by the Global Rainbow Foundation (Founder- President: Prof Armoogum Parsuramen). He runs an Ayurvedic Hospital in Chennai where the philosophy is one of holistic care, about which he throws some light in this interview. He also comments on some of the challenges facing Ayurvedic medicine, such as people’s choice of Allopathic medicine as a first line of treatment, the reasons for the lag of regulatory mechanisms in the control of quality and efficacy of Ayurvedic medicines and how they are being addressed, resource allocation for research in Ayurveda etc. However, he is confident that Ayurvedic medicine will have an increasing role to play given that many allopathic drugs are associated with side effects.
* It seems most people who go for traditional medicines such as Ayurveda, acupuncture, homeopathy do so only when allopathic treatment has not met their expectations or has failed. Why is that so?
There are several reasons for this phenomenon. One of the most important reasons is that Allopathic medicine is the most widely available one and it is also effective in quickly providing relief to the patients. There is continuous research on massive scale being conducted in allopathic medicine and drugs and surgical approaches to previously incurable conditions are being brought out. This creates a very positive image about the Allopathic system of medicine. Most people also want to get back to their routine as quickly as possible and since they believe Allopathy is capable of delivering quick relief they tend to seek Allopathy as the first line treatment and only when it fails to provide relief or when the side effects become intolerable, they seek other alternative therapies. However, with the growing awareness among the educated public about the potential adverse effects of most allopathic medicines, there is a surge in the tendency to seek alternate therapies as first line therapy in places where Ayurvedic professionals and products are available, and if it fails to provide relief, or if they are told by their alternative medicine practitioners about the inadequacies of their system in dealing with the specific problem, they do go to Allopathic medicine. This trend is particularly seen in the developed countries and among the health conscious and rich people the world over.
* The conditions in which Ayurvedic medicines are thought to be prepared and the presence of allegedly toxic levels of heavy metals in some medicines have been used to scare people away from Ayurveda. Is there any basis to these allegations?
Ayurvedic medicines have been largely produced in India. As it was the national system of medicine, it was universally used and was not under strict guidelines and there had been no pressure on the part of the manufacturers to upgrade their facilities in earlier times. However over the years, the Government of India has taken up the issue of ensuring quality standards for Ayurvedic medicines quite seriously, and has made GMP (Good manufacturing practices) mandatory for Ayurvedic manufacturing facilities as well. This move has greatly improved the state of manufacturing of Ayurvedic medicines. Now there are several excellent manufacturing facilities for Ayurveda in tune with WHO guidelines, and the quality control procedures have also been greatly improved and standardised in the country. The issue relating to heavy metals is much more complicated. Heavy metals are not always adulterants in Ayurvedic medicines. Though the oldest three classical textbooks of Ayurveda, Charaka Samhita, Sushruta Samhita and Ashtanga hrudaya do not use the heavy metals as part of their pharmacopoeia, they were later introduced as ingredients in medicines, with specific processing techniques and quality control procedures to enable safe and effective use of these substances for medical purposes. If prepared properly, the metal-based preparations become nano particles and then do not follow the properties of their normal metals. However the standardisation of the process and quality control to ensure that the products confirm to the prescribed standards has not been there. Further, the safety of the properly prepared products has also not yet been established at an International level, through studies complying with international norms and publications in peer reviewed high impact journals.
Ayurvedic medicines do not find a place as medicines in most parts of the world. However they are being shipped from India as dietary supplements, along with the metal-based preparations included as such. However, the heavy metal-based products are definitely not to be considered as dietary supplements for use other than under strict medical supervision, even in Ayurveda. This is the major cause of the hue and cry about heavy metals in Ayurvedic products. Extrapolating this problem to the entire spectrum of Ayurvedic products is probably not justifiable.
* Billions of dollars are poured into modern research labs every year for the development of new medicines, new treatments and technologies in the field of allopathic medicine, resulting in better treatment and improved health for millions of people. What happens for Ayurveda? Are Ayurvedic therapies and practices being constantly improved?
Currently, Ayurveda is practised and used by a very miniscule minority of the population compared to the universal use of allopathic medicine. So naturally the resources available for the development of Allopathic medicine in terms of capital, manpower, etc are also vastly greater. However, interest in Ayurveda is growing all over the world and more and more research to validate the efficacy of the products is taking place lately. New product development has always been happening in the field of Ayurveda since time immemorial and the pharmacopoeia has been continuously growing. Treatment protocols and methods have also been evolving with time. However the size of the industry and the scale of operations and geographical spread is so small that the impact is not seen to be significant. With more and more patronisation by the educated public and the realisation of the benefits of Ayurveda by governments of several countries, it will reach a tipping point and the resource allocation to Ayurveda will grow exponentially in the time to come and then we will witness its tangible contribution to global healthcare.
* What does Ayurveda do in terms of treatment that is not possible with Allopathic medicine and has this been scientifically proven?
Ayurveda is not a panacea. It is a very holistic system of medicine which looks at all factors causing diseases and recommends an approach to treatment which is very concerned about the fact that no harm should be caused in the process of treatment. Having said that, Ayurveda as a system is not averse to the use of anything to treat a disease, but advocates the use of the mildest intervention that is capable of curing and controlling the disease. Moreover, it believes in going to the root cause of the problem and addressing it.
Ayurveda embodies some very effective concepts of treatment like detoxification and anti-degeneration, which are unique. The therapeutic use of several herbs has been understood, and a very effective way of combining them to create individualised and unique therapeutic effects has been developed. These are some of the unique strengths of Ayurveda. It also has the potential to be combined with Allopathic treatment where necessary. These factors bestow some unique strength to Ayurveda in handling some diseases not responding to allopathic treatment. However, it does not mean that Ayurveda can cure all diseases not curable in Allopathy. Ayurveda also categorises diseases into easily curable, controllable, surgically curable and incurable diseases.
As Ayurveda has always been practised as a personal system of medicine and the relationship of the doctor with the patient was based on trust, there was neither the question of making claims, nor was there the need to prove the efficacy of Ayurveda till recent times. Now there is this new phenomenon of making claims about efficacy, both as a stand-alone method and in comparison to the other known treatments. This has given rise to the need for validation.
The task of validating all the products and treatments for their efficacy is a very daunting one and requires immense resources. Private organisations and the Government are trying to put their best efforts at validating the efficacy and safety of Ayurvedic medicines. Lately, there have been some very good studies that have been published in high impact journals pertaining to the efficacy of Ayurvedic herbs, preparations and treatment methods in alleviating health problems. There is still a long way to go to gain critical mass and a massive capital outlay will be required to reach this level of proof building.
* How about the treatment of today’s so-called diseases of affluence: Type 2 diabetes, asthma, coronary heart disease, cancer, kidney failure, etc? Are they curable with Ayurveda and has this been proved conclusively?
Ayurveda does not promise a magical cure for these diseases. However if detected in the very early stage, these diseases can very well be reversed completely if one follows systematic Ayurvedic treatment comprising of diet, appropriate lifestyle changes, Ayurvedic herbal remedies and therapies where needed. If the condition crosses a certain threshold, a complete reversal is not possible. Diabetes type 2 and coronary heart disease have been proven to be reversible with strict diet and lifestyle interventions even by modern scientists like Dr Dean Ornish. The proof building process in Ayurveda is only in its infancy and will take time as I mentioned earlier.
* Does ayurveda work for weight loss?
Ayurveda has described a treatment protocol to help people lose weight. However a lot of it is in the hands of the patient. No weight management program will be successful unless the patient is able to maintain the recommended diet and lifestyle modification. However, Ayurveda also says that for an obese patient to lose weight and maintain the lost weight status over a long period of time is very difficult.
Ayurveda also categorises people into various constitutional types and says that people with a kapha prakruti will find it extremely difficult to lose and maintain low weight while pitta persons could do so with effort and Vata persons can easily achieve weight loss. It is best not to put on weight beyond a certain extent. However, Ayurveda can help patients who are very committed and motivated to reduce and keep their weight under control.
* Are there any side effects of Ayurvedic medicines and how long do they generally take to work?
Most of the Ayurvedic medicines are very safe for even long term use. However people can have allergies, abdominal upsets etc to even the mildest forms of food. So it is not right to say that Ayurvedic medicines are completely free form side effects. The concept in Ayurveda is that anything that is very powerful will also be potentially harmful.
However, the choice of the medicine will depend upon the condition, If a problem can be solved with mild intervention like diet or lifestyle modification, it is the safest. Ayurvedic herbs are more powerful than food but less powerful than isolated pure chemical components or drugs. There are some very toxic plants as well. They are known to be toxic and are administered with proper care and precautions in some specific conditions which warrant their use and not in all conditions.
The duration of treatment will also depend upon the nature of the problem. There are conditions like flatulence and acidity which will respond within minutes of administration of the medicine and there are conditions where the patent will have to consume medicines lifelong.
* Is It OK to take Ayurvedic and allopathic or homeopathic medicines simultaneously?
There is not enough scientific understanding about this subject. The question of how one drug interacts with another is studied in allopathic medicine but the potential interaction between say 5-10 drugs that are often prescribed to a patient is not yet studied properly or reported. So it is not a question of whether Allopathic drug will interact with Ayurvedic medicines or not, it is more a question of how many medicines whether from the same system or other systems could interact with each other.
However from our practical experience we do not experience any problem when patients are administered Ayurvedic medicines along with allopathic medicines which they take for other health conditions. There are thousands of patients who are getting treated simultaneously by Allopathic and Ayurvedic doctors for different or same problems and both doctors do not see anything significantly unexpected, happening to the patients.
* People are increasingly getting exposed to what are being posted or circulated on social networks like Facebook, Twitter, Instagram, etc., about the dos for a healthier lifestyle, about the “amazing benefits” of, for example, cider vinegar, taking cold baths, etc., — and contradictory views the next day. How does one make out which one is fact or fiction and which health tip to adopt?
It is becoming extremely difficult for anyone to actually understand which of the circulated information is true. Even scientific publications publish diametrically opposite findings about the same issue. However most of the confusion is because of the different contexts in which the conclusions are drawn or experienced. The generalisation of anything as good or bad is the culprit. Nothing is good or bad for everyone. For example, food high in calorific value or one with a high glycaemic index is generally spoken about as very bad.
However it is the ideal diet for a person with extreme exhaustion or energy malnutrition. So Ayurveda insists that everything is appropriate or inappropriate with respect to the context of the person involved, his age, his state of health, his activity level, the place where he lives, the climatic condition and a host of other factors. So generalised statements about good and bad are more often likely to be misleading unless they are clearly articulated with respect to the context in which they apply.
* In terms of practical advice for healthy living, what does Ayurveda prescribe to everybody from the time that one gets up in the morning till one gets back to bed at night? What are the do’s and don’ts?
Ayurveda prescribes a number of routine practices to be followed daily to maintain health and longevity. Of them, the first and foremost one, is to wake up early in the morning, by around 4.30 AM. This is mentioned as the most important step towards longevity.
In addition to the routine of brushing, bowel cleansing etc, a course comprising of Anjana (application of a herbal paste in the eye), followed by Nasya (instilling two drops of a medicated oil – Anu tailam in the nostrils), Kabala (gargling with oil, honey etc according to a person’s constitution) and Dhooma (inhaling smoke from burning a herb dipped in ghee) is advocated on a daily basis to preserve the health of the sense organs. Application of oil on the body and head, followed by exercise and then a bath is recommended. It is after this that one is advised to take food.
Exercise is to be performed in tune with one’s capacity. A person is advised to exercise up to half his maximum capacity. The practice of applying oil is meant to enhance peripheral circulation, reduce stress and improve para-sympathetic tone in the body. It has a great effect in slowing down degeneration and stress-related issues. It is also very good to keep the skin supple.
Sleep is another very important aspect of health and has to be aligned with the circadian rhythm. Our body-clock actually follows the sun and so it works best if we follow the pattern of the sun. So, going to bed early, is another great thing one can do to preserve health.
Some of the other important instructions to prevent diseases and maintain health are 1) to undergo periodic detoxification, because we all accumulate toxins in the system however careful we are with our food, 2) To follow specific lifestyle and diet changes in tune with the climatic changes, for example to drink more water and to avoid excessive exposure to sun in summer, 3) to not suppress the natural urges in the body like the feeling of going to toilet, to urinate etc. Withholding these natural urges over time could lead to serious neurological problems, 4) to follow a righteous life in tune with the norms of the society and without harming anyone 5 ) to consume anti-degenerative herbs like Amla (Phyllanthus embellica), Triphala (The three herbal fruits), and formulations like Chyavanaprasam, Brahma rasayanam, Agasthya Rasayanam etc according to the the needs of each individual. 6) To maintain the mind is a state of peace and happiness through increasing the sattvic qualities (non-violence, truthfulness, cleanliness, intelligence etc) in a person and reducing the rajasic (aggression, lust, greed, jealousy etc) and tamasic (inertia, ignorance, filthiness etc) qualities. However the ultimate state of health is mentioned as that when one becomes a realised soul.
Diet is another very vast subject and is dealt with in detail in Ayurveda. Some of the salient points are:
One has to eat in alignment with a variety of factors to achieve optimal health. He has to consider his age, state of health, time of the, the properties of the product he is consuming, the way it is processed, the items with which it is combined, the place from which it is procured with respect to the place of birth of the person and what one is used to for generations and so on. So Ayurveda says that trans-cultural eating can be quite harmful to the body as the body takes generations to get adapted to a particular diet pattern.
There is also the concept of what to drink along with each type of food item. One is supposed to eat solids so as to feel half full, drink water to fill one fourth of the stomach and one fourth is to be free. If heavy to digest items are taken, one is to eat not more than half the quantity required to feel satisfied and if easy to digest food is taken, one can eat till short of feeling very full. Sweet items are to be eaten first and then only the other items are to be taken. This is very important as a person will feel full earlier when a sweet is taken first and so will not overeat.
Water is ideally to be taken warm and in small quantities between morsels of food. If one takes water before eating food he can lose weight, as his appetite will reduce and if water is taken after meal he is likely to put on weight as one doesn’t realise that he has had enough food until he is too full. The list is endless. It is best to have a personal consultation with qualified Ayurvedic physicians to get personalised advice on the most appropriate diet for each person and in each condition.