The Sweetness of Life

A Mind-Body Approach to Diabetes
By Sheila Patel, MD

Part of truly appreciating our human experience is enjoying the sweetness of life—a perfectly ripe peach, a fresh slice of homemade bread, or a scoop of chocolate ice cream. However, at a time when we have access to the world’s rich variety of sweet delicacies more than ever before, the number of people with difficulties metabolizing sugar in their bloodstream soars. This condition, commonly known as diabetes, is reaching epidemic proportions in many countries.

Although medical science has made great advancements in the treatment of acute diseases, infectious illnesses, trauma, and other life-threatening conditions, we are seeing a dramatic rise in chronic diseases, including diabetes. According to the most recent report from the Centers for Disease Control and Prevention (CDC), the number of people in the US diagnosed with diabetes rose from 1.5 million in 1958 to 18.8 million in 2010. Diabetes is the seventh leading cause of death in the US and is a major cause of heart disease, stroke, kidney disease, lower limb amputation, and blindness. Data from international studies show that the number of people with diabetes worldwide in 2011 reached 366 million. In addition, there are more individuals who do not meet the criteria for the diagnosis of diabetes, but have a have dysfunction classified as pre-diabetes.

A recent study reported that elevations in blood sugar could occur up to 10 years before the actual diagnosis of diabetes is made. This presents an opportunity to intervene with dietary and lifestyle changes that can prevent the condition from reaching dangerous levels.

Ayurveda is an ancient healing system that originated in India thousands of years ago. It addresses health in a holistic way—acknowledging the connection between mind, body, and spirit. Ayurveda offers valuable wisdom and guidance that can help us listen to the signals of our body, notice the first signs that we’re getting out of balance, and make the necessary changes to reverse the imbalances. Current science and research confirms that these ancient recommendations have basis for their actions and can be a useful addition to our current recommendations for prevention and treatment of diabetes.

By taking a fresh look at the ancient and comprehensive knowledge base of Ayurveda, we can better treat and manage this complex disease. We can also expand our potential to develop treatment strategies that combine ancient wisdom with modern medicine.

What Is Diabetes?

The current medical understanding of diabetes mellitus is that it is a group of related diseases in which the body is unable to regulate the amount of sugar, specifically glucose, in the blood. Glucose provides our body and mind with vital energy. It is the main source of energy for our cells and the main source of fuel for our brain.

In a healthy individual, several hormones, including insulin, regulate blood glucose levels, allowing glucose to be used for fuel. However, in people with diabetes, the body either does not make enough insulin (type 1 diabetes), or is not able to use it well (type 2 diabetes). In some cases of diabetes, the body is both unable to produce enough insulin and unable to use it efficiently. When the body is unable to efficiently incorporate glucose from the blood into the cells where it is needed, glucose stays in the blood, where it can cause serious problems. In addition, cells don’t receive the energy they need to function properly. In all forms of diabetes, high blood-sugar levels increase risk for other serious health problems, both acute and chronic.

An Ayurvedic Perspective

One of the earliest references to the disease we recognize today as diabetes appears in the Atharvaveda, one of the four Vedas (sacred texts) that originated in India, around 1,500 to 1,000 BC. The traditional comprehensive healing system of Ayurveda was developed from material that is found in these ancient texts.

In Ayurveda, diabetes is referred to as madhumeha, a Sanskrit term that directly translates as “sweet urine” disease. When our blood-sugar levels rise above a certain threshold, it can be detected in urine. The ancient description of this disease includes an appreciation for the changes in several body tissues that take place due to imbalances in metabolism. The term for this in Sanskrit is dhatupaka janya vikruti.

The cause, symptoms, prognosis, and management of diabetes were also described in detail in the Vedic texts thousands of years ago. Ayurveda recognizes the multifactorial nature of diabetes, making reference to mind-body tendencies inherited at birth (doshas), as well as accumulated imbalances of potentially all three of the doshas (Vata, Pitta, and Kapha). These doshas represent patterns of thinking and/or patterns of physical characteristics that can make someone more prone to certain diseases.

In addition, under certain circumstances, any of these mind-body energies can accumulate, lead to an imbalance, and eventually disease. Imbalances in these doshas govern what physical or emotional disturbances will manifest. Although Ayurvedic terminology may differ from our modern scientific language, the underlying explanations of the causes of diabetes, and subsequent treatments, are quite similar.

The Different Types of Diabetes

Ayurveda also identifies different types of diabetes, including a form known in Sanskrit as apathyanimittaja that tends to occur later in life and whose contributing factors include excessive sleep, overindulgence in food and sweets, and a lack of physical activity. This description correlates well with our modern medical understanding of type 2 diabetes. Current scientific research has found that the risk factors for type 2 diabetes include a high-fat diet, high alcohol intake, being overweight, and a sedentary lifestyle.

A Closer Look at Type 2 Diabetes

Type 2 diabetes used to be a disease that occurred mainly in adults, but is now rising dramatically in children and adolescents—a population that is much more sedentary and overweight than previous generations. Obesity is a major risk factor for developing type 2 diabetes, as well as making it more difficult to control. The fundamental causes of obesity worldwide are a shift in diet towards increased intake of energy-dense foods that are high in fat and sugars but low in vitamins, minerals and other healthy micronutrients, as well as decreased levels of physical activity.

From an Ayurvedic perspective, type 2 diabetes is primarily an imbalance, or excess, of the Kapha dosha, which consists of the earth and water elements, or “heavier” elements. Kapha governs the physical structure of our body as well as several metabolic processes that control energy usage. When it builds to excess, it can manifest in weight gain, lethargy, allergies, and resistance to change. These are all manifestations of excess “earth” and “water” in our physiology. Ayurveda identifies an excessive appetite, especially for sweet food, as a causative factor in the development of type 2 diabetes. However, overeating is sometimes provoked by an imbalance in the Vata dosha (primarily “air” and “space”), which can easily become aggravated. Vata dosha governs movement in our physiology, whether it is thoughts in the mind or movement in our physical organ systems. When people with Vata imbalances in the mind (stress and/or anxiety) overeat to soothe themselves, Kapha can in turn become imbalanced in the body and, over time, contribute to the development of type 2 diabetes.

Our Diet, Our Health

Since Ayurveda considers diabetes mainly an excess of Kapha dosha, it recommends a Kapha-pacifying (or Kapha-balancing) diet to keep diabetes under control. This reduces the “earth” and “water” in the physiology while increasing the lighter elements of “air” and “space.” The Ayurvedic classification of food, before there were laboratories to examine the biochemical structure of food, includes six tastes. Each taste category has predominant energies or elements. The “heavier” foods are primarily made up of earth and water, and the “lighter” foods are made up of air, space, or fire. The Ayurvedic guidelines include eating more foods that are bitter, astringent, or pungent in taste (lighter foods) and decreasing consumption of foods that are categorized as sweet, sour, or salty (heavier foods).

Keep in mind that an Ayurvedic dietary prescription takes many factors into account, such as age, body constitution, season, and other environmental and social factors, so a consultation with a trained practitioner is necessary to make specific individual recommendations. Here are some recommendations to balance Kapha:

>> Eat foods that have a balancing effect upon the dominant dosha or that will pacify (balance) a dosha that has become excessive or aggravated. Because Kapha is heavy, oily, and cold, favor foods that are light, dry, or warm.

>> Reduce your intake of dairy, which tends to increase Kapha. You can use small amounts of ghee (a clarified form of butter), low-fat milk, and low-fat yogurt.

>> Drink hot ginger tea with meals to stimulate slow digestion, which is typical with Kapha excess. Drink two to three cups of ginger tea daily.

>> All beans are good for Kapha types except for soybeans and tofu, which should be eaten in moderation.

>> Favor lighter fruits such as apples, pears, pomegranates, cranberries, and apricots. Reduce heavier fruits like bananas, pineapples, and figs.

>> Grains: Favor barley, corn, millet, buckwheat, and rye. Use less refined oats, rice, and wheat.

>> All spices except salt are pacifying to Kapha. Use pungent spices like pepper, cayenne, mustard seed, and ginger freely in your diet.

The Ayurvedic perspective on balancing Kapha is consistent with Western medicine’s current understanding of the proper diet for diabetes, which recommends minimizing simple carbohydrates, fats, and other “heavy” foods while increasing “lighter” foods such as beans (as the main protein source), whole grains, and lighter fruits and vegetables. On further inspection, this diet is consistent with a lower glycemic diet that is often recommended to manage diabetes.

In addition to specific dietary recommendations, Ayurveda recommends to eat only when hungry and not to overeat. Another Ayurvedic recommendation is to sit down to eat slowly. This allows one to place full attention to the signals the body sends. When we listen to the true signals of our body’s hunger level, we tend to decrease our total caloric intake and feel more satisfied with the food we have eaten.

Recent Research on Various Foods and Diabetes

Current Western medical studies have shown that the intake of whole grain, as opposed to refined grains, is inversely associated with risk of developing type 2 diabetes. Researchers think that this effect is due to improved insulin sensitivity, or an improved ability of the body to use insulin after the intake of whole grains. There are a large variety of whole grains, many of which we are not familiar with in our current Western diets. Examples of whole grains are brown rice, quinoa, millet, amaranth, barley, rye, oatmeal, and sprouted bread.

There is also evidence that supports the beneficial effects of a diet high in legumes, fruits, and vegetables in the prevention and management of diabetes. Like whole grains, these foods tend to be high in fiber and prevent the rapid release of glucose into the blood, allowing the body to efficiently metabolize the sugar as opposed to storing it in the form of fat. Some studies have also suggested that frequent consumption of processed meat may increase the risk of type 2 diabetes. Processed meat contains many pro-inflammatory chemicals that can contribute to a chronic state of inflammation in the body. This in turn increases risk of diabetes.

Our current understanding of diabetes includes a growing appreciation of chronic inflammation as a risk factor for type 2 diabetes. Inflammation leads to insulin resistance in the cells and impaired beta-cell function in the pancreas where insulin is produced in the body. Chronic inflammation has also been shown to stimulate areas of the brain involved in hunger level, and may actually increase our appetite. An increased intake of whole grains and dietary fiber has been shown to decrease inflammation in the body. In addition, a diet high in saturated animal fats has been shown to increase our inflammatory response. Eating a diet rich in anti-inflammatories, especially through whole grains and vegetables, is beneficial in control and prevention of diabetes. The role of chronic inflammation in the development and control of type 2 diabetes is an ongoing area of research and we are likely to find more mechanisms in the future by which inflammation leads to poor blood sugar control.

Many people are able to manage their diabetes with dietary changes, especially when these changes are made early on in the progression of the disease. In fact, when early intervention is made with diet, people with pre-diabetes can prevent development of the disease itself.

Get Moving

Both Ayurveda and modern medicine recognize a lack of physical exercise as one of the lifestyle factors that contributes to the development and progression of diabetes. Any type of physical activity helps lower blood glucose, and aerobic exercise in particular improves the functioning of insulin, allowing glucose to enter the cells where it is needed and keeping the level in the blood normal. For these reasons, being active and maintaining a healthy body weight is important in the treatment and prevention of diabetes.

From an Ayurvedic perspective, increasing physical activity helps reduce excess Kapha dosha in the body that manifests as excess weight. However, vigorous exercise is not always recommended. In diabetic individuals who are frail or thin (where obesity does not play as much of a role), or are suffering from other medical issues, professional guidance on a proper exercise regimen is recommended.

Yoga for Body-Centered Awareness and Balance

Yogastah kuru karmani is a Vedic saying that can be translated as “established in union, perform action.” The practice of yoga establishes this union-union of body, mind, and spirit, out of which true healing occurs. Often, once people begin a regular yoga practice, they notice that they start to perform spontaneous right action and make choices that are more aligned with good health. They begin to exercise more and choose the proper foods with less struggle and effort. Ayurveda recommends a regular yoga practice for maintenance of health and is especially useful for people dealing with diabetes, as any exercise and movement reduces excess Kapha dosha.

There have been several studies published in the last few years that document the benefits of yoga for management of type 2 diabetes. One recent study published in 2011 in the journal Diabetes Care found an improvement in blood-sugar control in a group of patients that practiced yoga three times per week for three months in addition to their regular medical care. Another group received routine medical care only and did not see a great improvement in blood sugar. The yoga group also had a reduced body mass index. In other recent studies, patients who practiced yoga also showed elevated levels of circulating antioxidants, decreased levels of pro-inflammatory chemicals, and increased levels of certain anti-inflammatory chemicals. In addition, these benefits increased with the length and regularity of yoga practice.

From an Ayurvedic perspective, there are specific yoga postures that offer the greatest benefits with the least amount of stress. All exercise should be practiced mindfully with attention to the signals the body sends. Yoga can be practiced by anyone and consultation with an experienced yoga instructor may be beneficial when beginning. Some useful poses include:

>> Sun Salutation series

>> Seated forward bend (paschimotta nasana)

>> Tree pose (vrksasana)

>> Warrior I and II (virabhadrasana I and II)

>> Extended side angle (utthita parsvakonasana)

>> Bridge pose (setu bandha sarvangasana)

>> Alligator twist (jathara parivartasana)

>> Relaxation pose (savasana)

Try These Activities

Here are other examples of exercise you can incorporate into a daily routine for prevention and control of diabetes:

>> Take a brisk walk

>> Participate in a yoga, tai chi, or qigong class

>> Go dancing

>> Take an aerobics class

>> Swim or do water aerobics

>> Go for a bike ride or use a stationary bike indoors

For most people, it’s best to aim for moderate exercise for a total of thirty minutes a day, at least five days a week. If you are trying to lose weight, you may want to exercise more than thirty minutes a day. Start out slowly and gradually increase the intensity of exercise. Start with a simple brisk, daily walk. It can have an immediate effect on lowering blood sugar, so watch blood sugar levels closely if you begin a new exercise program.

Medicinal Herbs and Spices

Ayurveda identifies many herbs and spices that can be used to treat diabetes. We have only begun to identify some of the beneficial actions of these natural medicines from a scientific perspective. There are currently over 1,200 species of plants that have known glucose-lowering effects. Here are a few:

Gymnema Sylvestre This plant has been used to treat diabetes for more than 2,000 years. It is a woody, climbing vine common in central and southern India. Ayurvedic practitioners referred to this plant as gurmar, or “sugar destroyer.” Gymnema sylvestre was traditionally used in many forms, either by chewing the leaves, taking it as a powder, or preparing it with water as a beverage. The herb has been shown to bind to the same receptors on the tongue as sugar, thereby blocking the taste of sugar. By doing this, it reduces our taste and craving for sugar. These same receptors exist in our small intestine and gymnema can block the uptake of sugar after we ingest it. From an Ayurvedic perspective, gymnema contains astringent and bitter tastes, which reduce Kapha.

In addition, this herb has various effects on the metabolism of sugar. There has been extensive research on gymnema sylvestre animal studies and has been found to stimulate insulin secretion, increase the effects of circulating insulin, and decrease blood-glucose levels. Gymnema sylvestre also seems to increase the sensitivity of the tissue to insulin, which helps the body use glucose for energy. It has also been shown to have a protective effect on the pancreas—the organ that produces and secretes insulin. There have been several studies that confirm these glucose-lowering effects in humans.

The active components that have so far been identified are characterized as gymnemic acids. This herb also contains other beneficial phytochemicals such as glycosides and saponins. Many chemicals responsible for gymnema’s effects on sugar metabolism remain to be characterized. A typical dose of gymnema is 200 to 400 mg twice daily in the extract form.

Trigonella Foenum-graecum Commonly known as fenugreek, this herb is cultivated throughout the world as a spice. In Sanskrit it is also called methi. In Ayurveda, the seed is used to treat diabetes when prepared as a drink or when the powder or seed is mixed into curry or bread. Ayurveda classifies the taste of fenugreek as bitter, thus reducing Kapha.

Fenugreek seeds are high in fiber and several components of the seed have been identified as having direct glucose-lowering effects. Fenugreek also contains other healthy phytochemicals, such as saponins and alkaloids, which decrease inflammation.

Human studies have shown that daily use of fenugreek seeds can decrease insulin resistance and improve blood sugar control as it delays absorption of glucose from the gastrointestinal tract by slowing gastric emptying. This also results in an increased sense of satiety, or fullness, which may help decrease the total number of calories ingested. The recommended dose of fenugreek for diabetes is 10 to 15 grams daily. Fenugreek seeds or ground powder can also be added directly to foods as a spice. Mild side effects may include diarrhea or stomach upset, and may interact with certain medications, such as warfarin.

Cinnamon This fragrant spice is used in cooking all over the world and has received much attention recently as a sugar-lowering substance. From an Ayurvedic perspective, cinnamon has a pungent and sweet taste, so it should be used in moderation to balance Kapha.

Cinnamon has been shown in many animal studies to mimic the effects of insulin by improving glucose uptake into cells and making our body more sensitive to the effects of insulin. Cinnamon improves the body’s ability to use insulin in multiple ways; it stimulates insulin receptors on the cells and acts directly on our DNA to “turn off” genes responsible for deactivating cellular insulin receptors. These actions make it much easier for cells to take up glucose, thus reducing blood sugar levels.

Including cinnamon in a meal that is high in carbohydrates reduces the rise of glucose in the blood after eating. For example, you could add just one teaspoon of cinnamon to a cup of rice pudding to allow the body to metabolize the healthy carbohydrate more efficiently. A typical dose of cinnamon for diabetics is one to six grams daily. One teaspoon contains approximately 4.75 grams. It is necessary to be aware that cinnamon contains coumarin, a substance that can thin the blood.

Although some human studies show mixed results on blood-glucose levels, it is a healthy additive to the diet, especially when used in combination with a carbohydrate-rich meal or snack.

Turmeric This popular Indian spice has a long history of use as an anti-inflammatory. Due to the connection between inflammation and diabetes, it is being studied in the prevention and treatment of diabetes. Many of the beneficial medicinal effects of turmeric are related to the active ingredient curcumin. In Ayurveda, turmeric has pungent, bitter, and astringent tastes, which all reduce Kapha.

A 2011 animal study published in Food and Chemical Toxicology found that the effects of turmeric are similar to a commonly prescribed diabetes medication—increased insulin sensitivity and reduced blood-sugar levels. The consumption of turmeric also resulted in a significant decline in body weight, fat content, and blood sugar. However, further research is needed to confirm these effects in humans.

Current research reveals no significant side effects from using turmeric at the recommended dose—a typical dose may range from one to five grams daily, depending on need. Apart from taking curcumin as a capsule, practical uses include adding ½ teaspoon to a cup of hot water to drink as a tea. The flavor blends well with ginger, cardamom, or honey. A ½ teaspoon of turmeric can also be added to soups or sautéed vegetables.

Beneficial Foods

Several foods have been used traditionally as a remedy for diabetes and have shown to decrease blood-glucose levels. For example, bitter goard, or karela, is widely used to treat diabetes in many traditional healing systems. It is thought to work by decreasing absorption of glucose from the intestine, stimulating insulin secretion, and increasing uptake of glucose into muscle cells. Used as a food in the Indian diet, there have been no reported toxicities.

Another gourd that has been shown to have glucose-lowering effects is ivy goard, or kanduri. The juice of this food contains an enzyme humans naturally produce that breaks down sugars. Extracts of the root and leaf lowers blood-sugar levels in animals, too.

Several studies show that eating almonds with a carbohydrate significantly lowers the release of sugar into the blood, similar to the addition of cinnamon to a meal. Try adding a handful of almonds to a salad, oatmeal, or cereal.

Remember that starting any sort of supplement or new food can have a significant effect on blood sugar. This can be especially true if a person already takes medication for diabetes as some supplements enhance the effects of medication. Check blood-sugar levels frequently and discuss the inclusion of supplements with your medical provider. There may be interactions with medications that need to be addressed. Also, integrate herbal supplements, new foods, and/or spices slowly until you know what effect they have on blood sugar.

In combination with modern diabetes medications, these supplements may be the most beneficial treatment for many individuals. To incorporate useful herbs and spices into the diet as part of a complete mind-body program provides a balanced, healthy approach to the prevention and management of diabetes.

Meditation

Meditation has always been essential in any Ayurvedic treatment plan and is fast becoming an accepted practice in managing many health conditions. There have been numerous studies on meditation over the last several decades that document the beneficial effects of meditation. By connecting to our essential nature, quieting the activity of the mind, and calming the body, we create health at a deeply fundamental level.

There are small studies that have documented the direct blood-sugar-lowering effects of meditation. It is felt that this is mediated through the inhibition of our “fight-or-flight” mechanisms (sympathetic nervous system) and activation of our natural relaxation pathways (parasympathetic nervous system).

Meditation is an effective practice for stress management. Stress plays a significant role in the development and control of diabetes. When we face situations we perceive as stressful, whether they are physical or emotional, the body goes into the fight-or-flight mode and increases the production of stress hormones such as cortisol and adrenaline that raise our blood sugar. Chronic stress can lead to insulin resistance, which elevates blood-sugar levels. With regular meditation, stress hormones decrease, resulting in better blood-sugar control. In addition, there is a large body of evidence that confirms meditation decreases inflammatory markers in our physiology. By decreasing inflammation in the body, the risk of developing diabetes decreases and the control of blood sugar improves in patients with diabetes. Decrease in chronic inflammation also reduces the risk of many of the severe complications that can occur from diabetes.

The Healing Power of Deep Sleep

Studies confirm that improper sleep contributes to poor blood-sugar control, therefore establishing proper sleep is particularly important for people with diabetes. Many studies have demonstrated the beneficial effects of meditation on sleep. With inadequate sleep, chronic hormonal imbalances occur that can subsequently lead to impaired blood-sugar control. Not only does meditation help with falling asleep and maintaining sleep, but the quality of sleep is better.

We have seen the clinical health benefits of meditation in patients who come to the Chopra Center. Often a regular meditation practice allows people to sleep properly for the first time in decades, thus allowing their hormones, including those that regulate blood sugar, to return to their natural balance and function effectively.

The key to fully enjoying the “sweetness” of life is a balanced, holistic approach that encompasses our body, mind, heart, and spirit. This can be accomplished by incorporating ancient wisdom practices with modern science. Neither needs to be excluded. By nurturing our wholeness and health, we can not only prevent or effectively manage diabetes, but we can also experience expanded happiness, fulfillment, and wellbeing.

Sheila Patel, MD, is a board-certified family physician and Medical Director of the Chopra Center. Her areas of expertise include diabetes, heart disease, hypertension, stress reduction, and many others.