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{{#seo:

{{#seo:

|title=Obesity and Metabolic Syndrome  

|title=Obesity and Metabolic Syndrome  

|type=article

|type=article

}}

}}

{{Infobox

{{Infobox

|title =  Contributors

|title =  Contributors

|label3 = Reviewer  

|label3 = Reviewer  

|data3 = Basisht G.²

|data3 = [[Gopal Basisht|Basisht G.]]²

|label4 = Editors

|label4 = Editors

|data4 = Deole Y.S.², Aneesh E.G.², Basisht G. ²  

|data4 = [[Yogesh Deole|Deole Y.S.]]², Aneesh E.G.², [[Gopal Basisht|Basisht G.]]²  

|label5 = Affiliations

|label5 = Affiliations

|label6 = Correspondence email:

|label6 = Correspondence email:

|data6 = carakasamhita@gmail.com

|data6 = jeevanrekha1996@rediffmail.com, carakasamhita@gmail.com

 

|label7 = Date of first publication:

|label8 = Date of first publication:

|data7 = June 09, 2021

|data8 = June 09, 2021

|label8 = DOI

|label9 = DOI

|data8 = Under process

|data9 = 10.47468/CSNE.2021.e01.s09.060

}}  

}}  

'''Principles of Diagnosis and Management of Metabolic syndrome and Obesity in Ayurveda'''

'''Principles of Diagnosis and Management of Metabolic syndrome and Obesity in Ayurveda'''

 

<p style="text-align:justify;">This article is based on lecture delivered by Dr. Mukund Sabnis in Prof.M.S.Baghel Memorial Lecture Series on May 09, 2021.The video lecture can be accessed on the link of [https://fb.watch/8l93wbtQXx/ facebook page.]

This article is based on lecture delivered by Dr. Mukund Sabnis in Prof.M.S.Baghel Memorial Lecture Series on May 09, 2021.

<br/>

 

<div style='text-align:justify;'>

Metabolic syndrome is a group of several cardiovascular risk factors like insulin resistance, obesity, atherogenic dyslipidemia and hypertension. These conditions are interrelated and share underlying mediators, mechanisms and pathways. There has been recent controversy about its definition and its utility. Metabolic syndrome is not an ultimate diagnosis.  Metabolic syndrome is a subgroup of patients with shared pathophysiology who are at high risk of developing cardiovascular disease and type 2 diabetes. Pathophysiology and disease pathogenesis can be better understood by observing the clinical features of metabolic syndrome and their interrelation.

Metabolic syndrome is a group of several cardiovascular risk factors like insulin resistance, obesity, atherogenic dyslipidemia and hypertension. These conditions are interrelated and share underlying mediators, mechanisms and pathways. There has been recent controversy about its definition and its utility. Metabolic syndrome is not an ultimate diagnosis.  Metabolic syndrome is a subgroup of patients with shared pathophysiology who are at high risk of developing cardiovascular disease and type 2 diabetes. Pathophysiology and disease pathogenesis can be better understood by observing the clinical features of metabolic syndrome and their interrelation.

 

[[Ayurveda]] has a vast scope in the management of metabolic syndrome. Clubbing of modern medicine concepts with Ayurveda is essential for this. The pathophysiology of metabolic syndrome shall be clubbed with disorders due to overnutrition (santarpanajanya vyadhi) in [[Ayurveda]].  [Cha.Sa. [[Sutra Sthana]] 23/3-5]

[[Ayurveda]] has a vast scope in the management of metabolic syndrome. Clubbing of modern medicine concepts with Ayurveda is essential for this. The pathophysiology of metabolic syndrome shall be clubbed with disorders due to overnutrition (santarpanajanya vyadhi) in [[Ayurveda]].  [Cha.Sa. [[Sutra Sthana]] 23/3-5] </p>

==Definition==

==Definition==

The type of body frame of a patient with metabolic syndrome should be considered. As per [[Ayurveda]] obese (sthula), lean (krisha) and medium (madhyama) are the three types of body frames. [Su.Sa. Sutra Shtana 35/33] These are the  physiological variations of body frame. As per blood parameters, a thin-built person can also be obese. They are called thin obese patients. There the patient is having adipose tissue ([[meda dhatu]]) vitiation. At the same time, an obese patient may not require any treatment because of excellent adipose tissue quality (meda sara). The management also varies according to body frames. Bringing Ayurvedic and modern concepts about metabolic syndrome can make the treatment easy.

The type of body frame of a patient with metabolic syndrome should be considered. As per [[Ayurveda]] obese (sthula), lean (krisha) and medium (madhyama) are the three types of body frames. [Su.Sa. Sutra Shtana 35/33] These are the  physiological variations of body frame. As per blood parameters, a thin-built person can also be obese. They are called thin obese patients. There the patient is having adipose tissue ([[meda dhatu]]) vitiation. At the same time, an obese patient may not require any treatment because of excellent adipose tissue quality (meda sara). The management also varies according to body frames. Bringing Ayurvedic and modern concepts about metabolic syndrome can make the treatment easy.

==Quality of body tissues (dhatu sarata)==

===Quality of body tissues (dhatu sarata)===

   

   

Sarata means the optimum quality of body tissues. It is one of the assessment parameters to check the health of tissues. Physician may sometimes make a wrong judgement by just looking at the patient. A patient having corpulent or a big physique may not be strong or healthy. On the other hand,  it is observed that some persons having small body and leanness are strong, like the tiny ants carrying a big load. This is why the optimum quality of tissues ([[dhatu]] sarata) shall be examined before understanding a patient's strength. [Cha.Sa. [[Vimana Sthana]] 8/115]

Sarata means the optimum quality of body tissues. It is one of the assessment parameters to check the health of tissues. Physician may sometimes make a wrong judgement by just looking at the patient. A patient having corpulent or a big physique may not be strong or healthy. On the other hand,  it is observed that some persons having small body and leanness are strong, like the tiny ants carrying a big load. This is why the optimum quality of tissues ([[dhatu]] sarata) shall be examined before understanding a patient's strength. [Cha.Sa. [[Vimana Sthana]] 8/115]

Quality of tissue (sarata) and blood parameters should be assessed before treating a patient. The biomarkers used in modern medical practice are insufficient and often inappropriate to decide the patient's diagnosis, prognosis, and treatment. The same is true while applying them in diagnostic and research of [[Ayurveda]] perspectives.

Quality of tissue (sarata) and blood parameters should be assessed before treating a patient. The biomarkers used in modern medical practice are insufficient and often inappropriate to decide the patient's diagnosis, prognosis, and treatment. The same is true while applying them in diagnostic and research of [[Ayurveda]] perspectives.

In most of the researches in obesity, weight is considered as the main parameter. However, it is a very superficial parameter. Weight reduction to make the obese person thin is a primary goal in general practice. However, the most crucial concern in treating an obese person is not to make the person thin but to transform an unhealthy obese person to a healthy obese person. [Su.Sa. Sutra Sthana 35/34] If the person has adipose tissue with optimum quality (meda sara), it is challenging to reduce weight. Similarly, in hyperhomocysteinemia, one should see whether the patient is with optimal quality of blood tissue (rakta sara), before treating the person. So while treating obesity and metabolic syndrome through [[Ayurveda]], the targets should be different, and the biomarkers should be more specific.  

In most of the researches in obesity, weight is considered as the main parameter. However, it is a very superficial parameter. Weight reduction to make the obese person thin is a primary goal in general practice. However, the most crucial concern in treating an obese person is not to make the person thin but to transform an unhealthy obese person to a healthy obese person. [Su.Sa. Sutra Sthana 35/34] If the person has adipose tissue with optimum quality (meda sara), it is challenging to reduce weight. Similarly, in hyperhomocysteinemia, one should see whether the patient is with optimal quality of blood tissue (rakta sara), before treating the person. So while treating obesity and metabolic syndrome through [[Ayurveda]], the targets should be different, and the biomarkers should be more specific.

==Selection of biomarker==

===Selection of biomarker===

The selection of biomarker depends on the type of disorder and drug used for therapy. The correct selection of biomarker sheds light on the mode of action of that particular drug.  The medicines described for the treatment of obesity vary in their mode of action. The different medicines for reducing body tissues (lekhana) act differently. Some medicines work on fatty liver; some on skeletal muscles; some have insulin sensitizing action; and some have anti oxidant activities specific to the adipose tissue ([[meda dhatu]]). So depending on the underlying pathology and drug, the biomarker should be selected. If we suspect inflammatory involvement, then the best biomarker is either Adiponectin or high sensitive c reactive protein (HSCRP). Adiponectin level suggests the presence of inflammation, tendency of atherogenesis, or presence of insulin resistance at the cellular level. In different types of metabolic disorders like hypercholesterolemia, hyperhomocysteinemia etc. the specific biomarker should be selected.

The selection of biomarker depends on the type of disorder and drug used for therapy. The correct selection of biomarker sheds light on the mode of action of that particular drug.  The medicines described for the treatment of obesity vary in their mode of action. The different medicines for reducing body tissues (lekhana) act differently. Some medicines work on fatty liver; some on skeletal muscles; some have insulin sensitizing action; and some have anti oxidant activities specific to the adipose tissue ([[meda dhatu]]). So depending on the underlying pathology and drug, the biomarker should be selected. If we suspect inflammatory involvement, then the best biomarker is either Adiponectin or high sensitive c reactive protein (HSCRP). Adiponectin level suggests the presence of inflammation, tendency of atherogenesis, or presence of insulin resistance at the cellular level. In different types of metabolic disorders like hypercholesterolemia, hyperhomocysteinemia etc. the specific biomarker should be selected.

In fatty liver, in the first stage, insulin resistance is observed at the hepatocytes. There is a reduction in fatty oxidation; increase in fatty acid influx into liver; increased lipogenesis and increased triglycerides. The second stage is lipid peroxidation. So the management should target lipid peroxidation, TNF-alpha, cytokine cascade, reducing the liquid/slimy content (kleda), correcting the metabolism ([[agni]]) etc.

In fatty liver, in the first stage, insulin resistance is observed at the hepatocytes. There is a reduction in fatty oxidation; increase in fatty acid influx into liver; increased lipogenesis and increased triglycerides. The second stage is lipid peroxidation. So the management should target lipid peroxidation, TNF-alpha, cytokine cascade, reducing the liquid/slimy content (kleda), correcting the metabolism ([[agni]]) etc.

Ayurvedic interventions considerably control the hormones - adiponectin and leptin secreted by adipose tissue. The treatment creates insulin sensitivity and reduces inflammation at adipocyte level. Adiponectin is inversely proportional to obesity. If weight is more, adiponectin level is less and vice versa. However, in people having optimum [[meda]] (meda sara), adiponectin level increases with weight.  

Ayurvedic interventions considerably control the hormones - adiponectin and leptin secreted by adipose tissue. The treatment creates insulin sensitivity and reduces inflammation at adipocyte level. Adiponectin is inversely proportional to obesity. If weight is more, adiponectin level is less and vice versa. However, in people having optimum [[meda dhatu]] (meda sara), adiponectin level increases with weight.

=== Effect of therapeutic enema ( [[basti]]) as a treatment in obesity===

=== Effect of therapeutic enema ( [[basti]]) as a treatment in obesity===

   

   

'''A:''' Bhutagni works like a vehicle. Bhutagni carries the fuel (food) to the tissues ([[dhatu]]). The fuel is filled in a vehicle (body gut) only when it is empty (hungry state). If we overfill the tank (gut) beyond its capacity, it leads to engine dysfunction (agni vaishamya). Likewise, when there is excess body fluid (kleda) formation, aap bhutagni becomes less. In this condition, the diet control and medicines advised should work on aap mahabhutaagni. The water intake must be restricted. The astringent medicines should be given as they have kledashoshana (drying) and [[stambhana]] (obstructing) property.

'''A:''' Bhutagni works like a vehicle. Bhutagni carries the fuel (food) to the tissues ([[dhatu]]). The fuel is filled in a vehicle (body gut) only when it is empty (hungry state). If we overfill the tank (gut) beyond its capacity, it leads to engine dysfunction (agni vaishamya). Likewise, when there is excess body fluid (kleda) formation, aap bhutagni becomes less. In this condition, the diet control and medicines advised should work on aap mahabhutaagni. The water intake must be restricted. The astringent medicines should be given as they have kledashoshana (drying) and [[stambhana]] (obstructing) property.

</div>

<big>'''Link to video lecture:  https://fb.watch/8l93wbtQXx/'''</big>

 

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