DOES LIFESTYLE DISTURBANCE AFFECT DIGESTION: A CLINICAL STUDY

Abstract

In 21st century, non-communicable diseases are prone to kill more people which are result of changing Lifestyle which include unhealthy dietary habits and wrong behavioral pattern. In Ayurveda, Ahara Vidhi (Dietary rules), Vihara (Conducts) etc. are described in detail which can be included under the heading Lifestyle. Agnimandya i.e. Indigestion is a prime important disease. In Ayurveda, it is considered as a root cause for manifestation of all diseases like Diabetes mellitus, Obesity etc. which are amongst top 10 Lifestyle disorders, by disturbing Gut-Brain-Endocrine axis. This study aims at establishment of relationship between disturbances in Lifestyle and manifestation of disease Agnimandya and to frame guideline for its prevention. Survey study was carried out on 33 diagnosed patients of Agnimandya with disturbed Lifestyle which shows that disturbances in Lifestyle such as irregular food habits, irregular sleep pattern affects digestive system and results in pathogenesis of disease Agnimandya. [PUBLICATION ABSTRACT]

Headnote

ABSTRACT

In 21st century, non-communicable diseases are prone to kill more people which are result of changing Lifestyle which include unhealthy dietary habits and wrong behavioral pattern. In Ayurveda, Ahara Vidhi (Dietary rules), Vihara (Conducts) etc. are described in detail which can be included under the heading Lifestyle. Agnimandya i.e. Indigestion is a prime important disease. In Ayurveda, it is considered as a root cause for manifestation of all diseases like Diabetes mellitus, Obesity etc. which are amongst top 10 Lifestyle disorders, by disturbing Gut-Brain-Endocrine axis. This study aims at establishment of relationship between disturbances in Lifestyle and manifestation of disease Agnimandya and to frame guideline for its prevention. Survey study was carried out on 33 diagnosed patients of Agnimandya with disturbed Lifestyle which shows that disturbances in Lifestyle such as irregular food habits, irregular sleep pattern affects digestive system and results in pathogenesis of disease Agnimandya.

KEY WORDS: Lifestyle, Agnimandya, Digestion, Ahara Vidhi, Vihara.

INTRODUCTION

In a major shift of disease pattern, WHO has found that the non communicable diseases are prone to kill more people (i.e. 63%) than communicable diseases. Major risk factors underlying this umbrella, are mainly lifestyle related, such as physical inactivity, unhealthy diet etc. which are preventable. Hence more attention has to be given to prevent such diseases (WHO Health Statistics, 2008).

In classical texts of Ayurveda, there are profound references that indicate a lifespan of 100 years of the people who follow proper diet with proper regimen and have control on their senses. (Brahmanand Tripathi, 2006) Now a days, due to disturbed lifestyle i.e. faulty dietary habits and wrong behavioral pattern, life expectancy have been decreased to 65 years at birth in India (WHO Health Statistics, 2011).

'Lifestyle' means a way in which a person lives or entire activities and conducts by a person during whole day & night regarding its methods, timing, place etc. is called as lifestyle. i.e. how, where and when a person is sleeping, playing, wandering, eating, swimming, walking etc. So, Vihara (Conducts) and Ahara Vidhi (Dietary rules) can be included under the heading Lifestyle. Vihara consists of the conducts given under the heading Dinacharya (Daily regimen), Ritucharya (Seasonal regimen) etc. and Ahara Vidhi consists of the conducts given under the heading Ahara Vidhi Vidhana (Dietetic rules), Bhojanottara Vidhi Vidhana (Conducts after meal) etc. which are described in detail in classics of Ayurveda. Any alteration in these conducts lead to manifestation of diseases. The present study aims to establish the role of disturbed Lifestyle in manifestation of disease Agnimandya and to frame guidelines for Lifestyle modification in healthy individuals to prevent the disease Agnimandya.

Agnimandya (Indigestion) as a cause of other diseases:

Agnimandya is the disease of digestive system with impairment of digestive power. Wrong dietary habits like Adhyashana (Taking food before digestion of previous food), Vishamashana (Intake of improper quantity of food at improper time) and wrong behavioral pattern like Vegadharana which lead to vitiation of Tridoshas independently or together which result in manifestation of disease Agnimandya. In Ayurveda, it is believed that Agnimandya is root cause for all diseases like Prameha, Sthaulya (Brahmanand Tripathi, 2007). In modern sciences also, it has been proved that there exists Gut-Brain-Endocrine axis which involves Ghrelin-Leptin hormones, Insulin, Orexins etc. Disturbance in this axis leads to diseases like Obesity, Diabetes mellitus which are among the top 10 Lifestyle disorders. The causes behind it are improper feeding pattern, disturbed sleep pattern etc (Annette L. Kirchgessner, 2002 & Y Wang, H Yang, 2004).

MATERIALS

Source of Data:

Patients attending O.P.D. of department of Basic Principles, I.P.G.T. & R.A., Gujarat Ayurved University, Jamnagar complaining symptoms of Agnimandya and fulfilling the criteria of inclusion were selected for the present study. An elaborative pro-forma was specially designed for the purpose of incorporating all aspects of the disease and Lifestyle related to disease.

METHODOLOGY

The survey study was conducted on 33 diagnosed cases of Agnimandya. Patients having classical symptoms of Agnimandya i.e. Udaragaurava, Avipaka, Praseka, Aruchi (Ananta Ram Sharma, 2008) were selected for study. Lifestyle assessment was done on the basis of total 24 criteria. Some of them were scored from 0 to 3 and some from (-3) to 3. Overall Lifestyle disturbance was calculated out of total score 108. The clinical trial was approved by the Institutional ethics committee with Ethical clearance approval no. CTRI/2014/02/004420.

Inclusion criteria:

· Patients having the symptoms of Agnimandya as per classics.

· Patients having age between 15-60 years.

Exclusion criteria:

· Patients having age less than 15 years and more than 60 years.

· Patients suffering from any other systemic disease.

· Patient having any established pathology of G.I. Tract.

RESULTS

1) Lack of exercise:

· Lack of exercise and physical inactivity was found in 87.9% patients.

2) Sleep:

· Keeping awake at night (Ratrau jagarana) and day sleep (Divaswapna) both are abnormal patterns of sleep. They were found in 57.9% and 85.1% patients respectively.

3) Suppression of urge of micturition and defecation (Mutra and Purisha Vegadharana):

· It was found in 51.1% patients.

4) Dietary habits:

· Intake of food when previous food is not digested (Adhyashana): Frequency of intake of food was found 4 times/day in 48.2% patients.

· Irregular time of food intake: It was found in 57.2% patients.

· Intake of Non-veg., curd, oily food, milk etc. at night: It was found in 23.8% patients.

· Intake of cold food or cold drinks/cold butter milk with meal: It was found in 30.2% patients.

· Intake of food in more quantity than required (Ati-matra bhojana): It was found in 79.2% patients.

· Watching TV, talking, chatting, phone calls, operating computer during meal: It was found in 90.1% patients.

· Fast Eating: It was found in 28.6% patients.

· Intake of Hard food items: It was found in 10.5% patients.

5) Water drinking habits:

· Intake of large quantity of water after meal: It was found in 90.2% patients.

· Intake of large quantity of water before meal: It was found in 23.5% patients.

· Intake of more quantity of water than thirst (Atyambupana): It was found in 47.8% patients.

Overall assessment of Lifestyle disturbance:

In present study, maximum number of patients i.e. 81.81% was found moderately disturbed Lifestyle. In 12.12% and 6.06% patients were found marked and mild disturbed Lifestyle respectively (Table 1).

DISCUSSION:

Lack of exercise: It is a major cause for vitiation of Kapha (Brahmanand Tripathi, 2006) which hampers the digestion. Lack of exercise/sedentary lifestyle leads to delayed gastric emptying (Campbell J.M.H, G.O. Mitchell, 1928).

Sleep: Effects of Ratrau jagarana and Divaswapna on digestive systems are as follows:

Keeping awake at night:

Due to this, vitiation of Samana Vata (Brahmanand Tripathi, 2007) and Agni (Ananta Ram Sharma, 2008) takes place. In human body, there exists a circadian rhythm in activities of digestive enzymes like maltase, sucrase, trehalase, leucine aminopeptidase, alkaline phosphatase. Wakefulness in night causes disruption in circadian rhythm and disturbance in activities of digestive enzymes which leads to indigestion (Masayuki Saito et al., 1975). Sleep deprivation leads to secretion of Orexigenic hormone ghrelin (a peptide released primarily from the stomach) which is responsible for appetite and reduction in circulating levels of leptin (an adipose tissue- specific hormone) which promotes satiety (Taheri S et al., 2004). Therefore there is tendency of Night-eating which leads to indigestion. Therefore in Night workers/ Shift workers, indigestion is most common.

Daytime sleep:

Daytime sleep leads to vitiation of Kapha and hampers digestive power (Brahmanand Tripathi, 2006). It disrupts the circadian rhythm of digestive enzymes (Charles W. Atwood, 2008). Sleep delays gastric emptying by disrupting gastric myoelectric function (Elsenbruch S. et al., 1999) and there is decrease in secretions of stomach (Banche M., 1950), duodenum and liver (Komarov, Marks, 1958) due to sleep.

Suppression of urge of micturition and defecation (Mutra and Purisha Vegadharana):

Suppression of natural urges leads to vitiation of Apana Vata (Brahmanand Tripathi, 2007) which further leads to vitiation of Samana Vata and hampers digestion (Brahmanand Tripathi, 2006). It has been proved that voluntary suppression of defecation urge delays gastric emptying (Hilda C. Tjeerdsma et al., 1993)

Dietary habits:

Intake of food when previous food is not digested (Adhyashana):

If one takes food before the digestion of the previous meal, the digestive product of the previous food gets mixed up with the product of food taken afterwards. (Brahmanand Tripathi, 2006) In a survey study, it had been concluded that Adhyashana results in the manifestation of disease Agnimandya (Hitesh A. Vyas, R. R. Dwivedi, 2011).

Irregular time of food intake:

It causes vitiation of Agni. Irregular time of food intake disrupts the normal digestive pattern which adhered to a circadian rhythm (Melinda Blackman & Colleen Kvaska, 2010).

Intake of Non-veg., curd, oily food, milk etc. at night:

As stated in Ayurveda, in night there is decrease in the functions of all systems of body (Brahmanand Tripathi, 2006). Sleep reduces the functions of digestive system (Elsenbruch S. et al., 1999; Banche M., 1950; Komarov Marks, 1958). Therefore food items which are difficult to digest (Guru) and sticky (Abhishyandi) e.g. non-veg., curd, milk, (Brahmanand Tripathi, 2006) oily food (Ananta Ram Sharma, 2008) etc. which during the period of night, due to slowness of digestion cannot get properly digested. These improperly digested products, due to its sticky property block the channels and results into indigestion. It has been proved that during the period of sleep in night, digestion process slows down which cannot digests these type of food items properly in night.

Intake of cold food or cold drinks/cold butter milk with meal:

Ushma is one of the Ahara Parinamakara Bhava (Factors helping digestion) (Brahmanand Tripathi, 2006; Anil Avhad, 2013) which is essential for proper digestion of food. It lacks due to intake of cold food items which results in indigestion. In stomach, the digestion goes on best at temperature of about 99°F to 100°F. When temperature lowers to that of atmosphere, the digestion process almost ceases. It renews after addition of caloric. In an experiment by Dr. William Beaumont, ingestion of a single glass of water having temp of 50°F, sufficed to depress heat of stomach upwards by 30°F and normal temperature was regained after half an hour. This fact furnishes a clue to the mischief arising from taking cold food, ices in large quantity, drinking cold water after or during meal (William Beaumont, 1838).

Intake of food in more quantity than required (Ati-matra bhojana):

When food is being taken in more quantity, it cannot be digested properly due to lack of Vayu which is Ahara Parinamaka Bhava (Brahmanand Tripathi, 2006) and also beyond the capacity of digestive system, it cannot digest more food. In an experiment, when very full meal was eaten, digestion proceeded only after a certain length. The remainder of food (for which the stomach was unable to supply juice) began to undergo process of fermentation, just as it does out of stomach under similar circumstances of heat and moisture and hence the acidity, flatulence and oppression are characterized. The undigested food particles act as local irritant same as foreign body and produces inflammatory action on inner coat of stomach which interfere process of digestion and hampers gastric secretions (William Beaumont, 1838).

Watching TV, talking, chatting, phone calls, operating computer during meal:

A person taking food with full concentration, knows about quantity, digestive power etc. Now a days people are busy in TV, Phone calls, Computer, Chatting, Talk and Laugh during meal. Due to this, they can't decide the exact quantity of food needed. In a study, experimental rats were subjected to noise at the time of food intake. It was observed that, food intake of experimental rats (Harald Krebs et al., 1996) was lower and defecation rate of the experimental rats was higher (Narducci F.et al., 1985).

Fast Eating:

It leads to improper placement of food in stomach (Brahmanand Tripathi, 2006). Stomach does not yield readily and willingly to the rapid introduction of successive morsels but contracts upon each in turn, for the express purpose of diffusing it through the cavity and bringing it into contact with as large a surface as possible and thereby impregnating it thoroughly with gastric juice. And consequently when we gulp down food, this adjustment is prevented, the stomach is forcibly distended (William Beaumont, 1838).

Hard food items:

Hard food items take more time to digest (Ananta Ram Sharma, 2008).Gastric juice act more rapidly and powerfully upon the ailments which has loose consistency or liquid in nature. But larger quantity and longer time is needed for digestion of more dense and hard in consistency (William Beaumont, 1838).

Water drinking habits:

Intake of large quantity of water after meal:

Normally, abdominal muscles relax after consumption of food and water to accommodate ingested substances and provide help in digestion. Excessive intake of water after taking meal can result in prolonged abdominal muscle relaxation which in turn can cause indigestion (Ronald Ross Watson & Victor R. Preedy, 2012).

Intake of large quantity of water before meal:

It leads to vitiation of Kapha and produces Agnimandya. (Ananta Ram Sharma, 2008) Intake of water in large amount before meal dilutes the stomach acid, it also stimulates digestive system to prepare from incoming food from stomach. This stimulation causes a dump of very basic digestive enzymes into the lower gastrointestinal tract (American Academy of Orthopaedic Surgeons, 2013).

Intake of more quantity of water than thirst (Atyambupana):

It was found in 47.8% patients. It leads to vitiation of Kapha and produces Agnimandya. (Anant Ram Sharma, 2008)Excess dilution of the gastric content slows down digestion (S Wyard, 1935). Large intake of water produce dilutional hyponatremia (Mary Baumberger, 2004), hypochloremia (Konstantin Monastyrsky, 2005) and acid-base imbalance (American Academy of Orthopaedic Surgeons, 2013) which hampers the function of sodium to transfer of amino acids and glucose from intestinal lumen to intestinal cell and Chloride which is a component of bile, responsible for emulsification of fat (Carol Porth, 2011).

Agnimandya is a disease which involves impairment of Jatharagni i.e. digestive power characterized by symptoms like Udaragaurava, Aruchi, Praseka etc. Factors responsible for manifestation of disease Agnimandya are related to Lifestyle i.e. wrong dietary habits like Adhyashana (Intake of food soon after meal), Ajirnashana (Intake of food when previous food is not digested), Ati-matra bhojana (Intake of excess food), Akala/Atitakala bhojana (Irregular times of food intake), wrong behavioral pattern like Vegadharana (Suppression of natural urges), Ratrau jagarana (Keeping awake at night), Divaswapna (Daytime sleep) and wrong water drinking habits like Atyambupana (Intake of excess water), Intake of large quantity of water before or after meal or in morning after sunrise. These all causes are responsible for impairment of Ahara Parinamakara Bhavas like Ushma, Vayu and disruption of circadian rhythm of digestive enzymes.

Modification of Lifestyle helps to correct the factors which are responsible for proper digestion and Gut-Brain-Endocrine axis. Prevention of disease Agnimandya is most important to prevent major diseases like Diabetes mellitus, Obesity etc.

Recommendations of Lifestyle Modification for Prevention of Agnimandya:

A) Exercise:

· One should do exercise daily. (Brahmanand Tripathi, 2007) It helps digestion. Mild to moderate exercise stimulates gastric emptying (Campbell J.M.H, G.O. Mitchell, 1928) and increases secretions of gastric juice which leads to rapid and healthy digestion (William Beaumont, 1838).

· One should do exercise for half of his capacity i.e. up to creating symptoms like increased rate of respiration, heart rate etc. (Brahmanand Tripathi, 2006) Hyperventilation (U Reinhard, PH Müller, RM Schmülling, 1979), increased heart rate up to 50% Heart Rate Reservoir (HRR) (DM Rotto, CL Stebbins, MP Kaufman, 1989 & David P. Swain, Clinton A. Brawner, 2012) is demarcating line between aerobic and anaerobic exercise. Exercise beyond this limit, leads to anaerobic metabolism and results in accumulation of lactic acid and carbon dioxide which causes pain (Panteleimon Ekkekakis, Eric E Hall, Steven J Petruzzello, 2004).

· Exercise must be done on empty stomach (Brahmanand Tripathi, 2006). It has been proved that exercise reduces mesenteric blood flow (M I Qamar, 1987), Colonic motility (number and amplitude) (Rao S S C, J Leistikow, 1999) and intestinal absorption (John S. Fordtran, B. Saltin, 1987) during exercise.

· One should not do excess exercise i.e. more than half of his capacity (Brahmanand Tripathi, 2007). Prolong exercise leads to diarrhea with or without bleeding, dehydration, hypokalemia, hyperthermia, GI bleeding (Forgoros R N, 1980) due to tissue ischemia (Gaudin C, E Zerath, 1990). Exercise, heat and dehydration disturbs Gut-barrier which has function of thermal tolerance, fluid homeostasis, cardio- vascular regulation and produce ischemic or hypoxic damage to intestinal mucosa leading to increased intestinal permeability leads to endotoxemia, bacteremia and cytokine cascade (Hall D M, 1999). Endotoxins in blood originate from intestine contribute to increased risk of injury and hyperthermia (Gathiram P., 1988).

B) Sleep:

· One should wake up early in the morning before sunrise (Brahmanand Tripathi, 2007).

· One should not sleep after sunrise and in after noon (Brahmanand Tripathi, 2006).

· One should not sleep after meal (Anant Ram Sharma, 2008).

· One should not sleep late at night (Brahmanand Tripathi, 2007).

C) Urges:

· One should not suppress the natural urges like micturation, defecation etc. (Brahmanand Tripathi, 2007).

D) Dietary habits:

· One should take food only when previous food gets digested and there is feeling of hunger (Brahmanand Tripathi, 2007).

· One should take food little less in quantity than hunger or the quantity which will not hamper body functions like walking, sitting, speech, respiration etc. (Brahmanand Tripathi, 2006).

· One should not take non-veg., curd, fatty food or food items which are heavy to digest in dinner (Brahmanand Tripathi, 2006).

· One should always take luke-warm food. One should not take cold food or any type of food items like ice cream, cold drink, juice with/before/immediately after meals (Brahmanand Tripathi, 2006).

· Don't s during meal - watching TV, Computer, chatting, phone calls, tension, talk, laugh (Brahmanand Tripathi, 2006).

· One should not eat too fast (Brahmanand Tripathi, 2006).

· One should not take hard food items in meal (Anant Ram Sharma, 2008).

E) Water drinking habits:

· One should not drink water in more quantity even on thirst (Anant Ram Sharma, 2008).

· One should not drink water before or after meal (Anant Ram Sharma, 2008).

· One should not drink water during meal abruptly. Drink it sip by sip during meal (Brahma Shankara Mishra, Rupalalaji Vaishya, 2012).

· One should not drink water on being hungry (Brahmanand Tripathi, 2007).

CONCLUSION

Lifestyle as per Ayurveda classics helps in maintenance of health and prevention of diseases. Ahara Vidhi, Vihara etc. have been described in detail in Ayurveda which can be included under the heading 'Lifestyle'. Disturbance in Lifestyle as irregular schedules of sleep and diet intake mainly affect the Ahara Parinamakara Bhavas and circadian rhythm which leads to manifestation of disease Agnimandya (Indigestion). It further results in Diabetes mellitus, Obesity etc. which are amongst top 10 lifestyle disorders, due to disturbance in Gut-Brain-Endocrine axis. Lack of exercise, keeping awake at night, daytime sleep, irregular food habits, intake of excess food, improper water drinking habits etc. are the main causative factors for manifestation of disease Agnimandya which are related to Lifestyle. It can be concluded that prevention of the disease Agnimandya by Lifestyle modification plays major role in prevention of major diseases like Diabetes mellitus, Obesity etc.

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Cite this article:

Saylee Deshmukh, M.K.Vyas, Bhushan Sanghavi (2014), DOES LIFESTYLE DISTURBANCE AFFECT DIGESTION: A CLINICAL STUDY, Global J Res. Med. Plants & Indigen. Med., Volume 3(4): 175-183

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Source of Support: Nil Conflict of Interest: None Declared