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=== Introduction ===

== Introduction ==

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In the series of chapters described for management principles, the present chapter describes two most commonly observed conditions in society viz. ''santarpana'' (over-nutrition) and ''apatarpana'' (undernutrition). It is sequenced after ''langhana'' and ''brimhana'' therapies. The present chapter enlists causes and diseases due to over-nutrition and under-nutrition and their management through diet and medicaments. It is a blend of nutraceutical food supplements with medicaments. Complications arising due to sedentary lifestyle and over-nutritive diet are also enlisted in the chapter with diseases caused due to undernutrition/ malnourishment and their management with simple dietary preparations. The pharmacological effect of herbs used in management are elaborated in detail as well.  

In the series of chapters described for management principles, the present chapter describes two most commonly observed conditions in society viz. ''santarpana'' (over-nutrition) and ''apatarpana'' (undernutrition). It is sequenced after ''langhana'' and ''brimhana'' therapies. The present chapter enlists causes and diseases due to over-nutrition and under-nutrition and their management through diet and medicaments. It is a blend of nutraceutical food supplements with medicaments. Complications arising due to sedentary lifestyle and over-nutritive diet are also enlisted in the chapter with diseases caused due to undernutrition/ malnourishment and their management with simple dietary preparations. The pharmacological effect of herbs used in management are elaborated in detail as well.  

''Santarpana'' (overnutrition) leads to vitiation of ''kapha dosha and meda dhatu'' and various obstructive pathologies, whereas ''apatarpana'' (undernutrition) leads to ''vata-pitta dosha'' vitiation and various degenerative pathologies. This concept has been emphasized in this chapter.

''Santarpana'' (overnutrition) leads to vitiation of ''kapha dosha and meda dhatu'' and various obstructive pathologies, whereas ''apatarpana'' (undernutrition) leads to ''vata-pitta dosha'' vitiation and various degenerative pathologies. This concept has been emphasized in this chapter.

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===Sanskrit text, Transliteration and English Translation===

==Sanskrit text, Transliteration and English Translation==

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Lord Atreya said, “Now we will discuss in detail the chapter about santarpana.” [1-2]

Now I will explain the chapter on Over-nutrition, under-nutrition and its disorders. Thus said Lord Atreya. [1-2]

==== Causes of ''santarpana'' induced diseases ====

=== Causes of ''santarpana'' induced diseases ===

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==== List of ''santarpana'' induced diseases ====

=== List of ''santarpana'' induced diseases ===

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==== Management of ''santarpana''-induced diseases ====

=== Management of ''santarpana''-induced diseases ===

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==== Indications ====

=== Indications ===

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==== Diseases due to ''apatarpana''(under-nutrition) and their treatment ====

=== Diseases due to ''apatarpana''(under-nutrition) and their treatment ===

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==== Management of diseases due to undernutrition====

=== Management of diseases due to undernutrition===

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Sweet and sour ''mantha'' prepared from water with or without unctuous substances refreshes instantly and gives stability, good complexion and strength. [39]

Sweet and sour ''mantha'' prepared from water with or without unctuous substances refreshes instantly and gives stability, good complexion and strength. [39]

==== Summary ====

=== Summary ===

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Diseases caused due to overnutrition and undernutrition, along with their treatment, have been described in this chapter. [40]

Diseases caused due to overnutrition and undernutrition, along with their treatment, have been described in this chapter. [40]

=== ''Tattva Vimarsha'' / Fundamental Principles ===

== Tattva Vimarsha (Fundamental Principles) ==

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1. Intake of calorie rich and excessive food and nutrition with little or no physical exercise, results in increased body tissues. This contributes to causing diseases such as metabolic syndrome. These conditions are managed by purification therapies leading to reduction (''langhana''), and prescribing a regimen of physical exercise, appropriate dietary changes, fomentation and reducing drugs.  

1. Intake of calorie rich and excessive food and nutrition with little or no physical exercise, results in increased body tissues. This contributes to causing diseases such as metabolic syndrome. These conditions are managed by purification therapies leading to reduction (''langhana''), and prescribing a regimen of physical exercise, appropriate dietary changes, fomentation and reducing drugs.  

2. Excessive physical and/or mental activities without adequate nutrition causes nutritional deficiency diseases like wasting and psychosis. Treatment is high calorie but less filling diet, rest, medicated oil enema and massage. In cases of acute weight loss, nutrition should be given immediately while in the case of chronic loss, the process should be gradual but prolonged.

2. Excessive physical and/or mental activities without adequate nutrition causes nutritional deficiency diseases like wasting and psychosis. Treatment is high calorie but less filling diet, rest, medicated oil enema and massage. In cases of acute weight loss, nutrition should be given immediately while in the case of chronic loss, the process should be gradual but prolonged.

   

   

=== ''Vidhi Vimarsha'' / Applied Inferences===

== Vidhi Vimarsha(Applied Inferences)==

The word ''santarpana'' means the act of satiating, restoration or refreshing. In this context, the term is used for overeating or overnutrition. Dietary items that are ''prithvi'' and ''apa mahabhuta'' dominant lead to ''santarpana''. Quality, quantity, and age of certain food items can cause alteration in the digestabilibty of the food. For example, aged food grains are light to digest than new food grains. Therefore, the new food grains tend to increase weight, and same quantity of aged food grains do not increase weight. What changes occur in aging of the grains and their mechanism of action needs to be studied.  

The word ''santarpana'' means the act of satiating, restoration or refreshing. In this context, the term is used for overeating or overnutrition. Dietary items that are ''prithvi'' and ''apa mahabhuta'' dominant lead to ''santarpana''. Quality, quantity, and age of certain food items can cause alteration in the digestabilibty of the food. For example, aged food grains are light to digest than new food grains. Therefore, the new food grains tend to increase weight, and same quantity of aged food grains do not increase weight. What changes occur in aging of the grains and their mechanism of action needs to be studied.  

==== I. Properties of ''Santarpanakarak'' food articles ====

=== I. Properties of ''Santarpanakarak'' food articles ===

   

   

Unctuous (''snigdha''), sweet (''madhura''), heavy to digest (''guru''), and slimy (''pichhilla'') foods predominantly have ''prithvi'' and ''apa mahabhutas'', leading to an increase in ''kapha'' and ''rasa dhatu''.  

Unctuous (''snigdha''), sweet (''madhura''), heavy to digest (''guru''), and slimy (''pichhilla'') foods predominantly have ''prithvi'' and ''apa mahabhutas'', leading to an increase in ''kapha'' and ''rasa dhatu''.  

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''.

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>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.

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.

Ageing of wine solely depends on its storage and oxidation of the wine. Normally new wines contain about .02 - .03% acetic acid. This is reduced in aged wine if it is packed properly.  This physico-chemical change in aged wine, change in taste and aroma modify its pharmacological effects. Increase in its antioxidant properties and change in Anthocyanin tannin complex makes wine more effective after age. There is also a possibility that chemical process in ageing of wine may also change the molecular size of tannins which might become more bio-available after consumption.

Ageing of wine solely depends on its storage and oxidation of the wine. Normally new wines contain about .02 - .03% acetic acid. This is reduced in aged wine if it is packed properly.  This physico-chemical change in aged wine, change in taste and aroma modify its pharmacological effects. Increase in its antioxidant properties and change in Anthocyanin tannin complex makes wine more effective after age. There is also a possibility that chemical process in ageing of wine may also change the molecular size of tannins which might become more bio-available after consumption.

==== 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. 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>.  

'''''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, 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>.

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 ===

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>.   

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>.   

Exercise and fasting has a very positive effect on anabolic disorders. Exercise results in reduction in fasting blood glucose, which replicates previous beneficial effects of exercise interventions in type II diabetes<ref> D. E. Kelley and B. H. Goodpaster, “Effects of exercise on glucose homeostasis in type 2 diabetes mellitus,” Medicine and Science in Sports and Exercise, vol. 33, no. 6, supplement, pp. S495–S501, 2001.</ref>.   

Exercise and fasting has a very positive effect on anabolic disorders. Exercise results in reduction in fasting blood glucose, which replicates previous beneficial effects of exercise interventions in type II diabetes<ref> D. E. Kelley and B. H. Goodpaster, “Effects of exercise on glucose homeostasis in type 2 diabetes mellitus,” Medicine and Science in Sports and Exercise, vol. 33, no. 6, supplement, pp. S495–S501, 2001.</ref>.   

   

   

==== Fasting ====

=== Fasting ===

That fasting and CR (calorie restriction) makes an organism’s metabolic process more efficient, enhancing the organism’s age, is a well-researched subject. Clive McCay at Cornell had published, in 1937, that a 33% caloric restriction resulted in a 50% increase in the maximum lifespan of a rat. Similar experiments were done on organisms such as yeasts, mosquitoes, flies, protozoa, roundworms, fish, etc. Many decades later, the National Institute of Aging (NIA) and the universities of Maryland and Wisconsin tried to study the impact of CR on aging using primates (squirrel and rhesus monkeys). The NIA Primate CR study indicated that CR monkeys “demonstrated an improved metabolic profile”, though they also concluded that the effects of CR in long-lived animals are complex and depend on a variety of factors besides caloric restriction<ref> Mattison et al Impact of caloric restriction on health and survival in rhesus monkeys: the NIA study. Nature 2012 Sep 13: 489(7415):10.1038 </ref>.

That fasting and CR (calorie restriction) makes an organism’s metabolic process more efficient, enhancing the organism’s age, is a well-researched subject. Clive McCay at Cornell had published, in 1937, that a 33% caloric restriction resulted in a 50% increase in the maximum lifespan of a rat. Similar experiments were done on organisms such as yeasts, mosquitoes, flies, protozoa, roundworms, fish, etc. Many decades later, the National Institute of Aging (NIA) and the universities of Maryland and Wisconsin tried to study the impact of CR on aging using primates (squirrel and rhesus monkeys). The NIA Primate CR study indicated that CR monkeys “demonstrated an improved metabolic profile”, though they also concluded that the effects of CR in long-lived animals are complex and depend on a variety of factors besides caloric restriction<ref> Mattison et al Impact of caloric restriction on health and survival in rhesus monkeys: the NIA study. Nature 2012 Sep 13: 489(7415):10.1038 </ref>.

==== Herbs used in management of ''santarpanajanya'' diseases ====

=== Herbs used in management of ''santarpanajanya'' diseases ===

While treating ''santarpanajanya vyadhis'' like ''sthulata'' (obesity) and ''madhumeha'' (diabetes), consumption of ''dravyas'' that have ''guru'' and ''ruksha'' properties is advised. Along with medicines, the diet must also be ''ruksha''. For skin ailments, applying powders of medicinal plants all over the body which can provide relief from ''kandu'' (itching) and ''kotha'' (pre-gangrenous condition) are advised. So the food must be ''guru'' and ''apatarpaka'', i.e., it should induce catabolic activities. Applying these powders on the lesions may improve blood circulation which may consequently improve the increased hydroxylysine and glucose disaccharide content, decrease in proteoglycan and heparin sulfate and decrease in lysine content towards the lesion. The effects of honey, a food rich in antioxidants, on diseases such as cancer, coronary diseases, inflammatory disorders, and aging, has helped it gain lot of attention among nutritionists<ref> Jaganathan et al. Antiproliferative Effects of Honey and of Its Polyphenols: A Review. 2009 Journal of Biomedicine and Biotechnology. Article ID 830616</ref>.  Properties of honey are ''ruksha, guru,'' and ''kashaya''. Food and medicine having these properties enhance ''akasha'' and ''vayu mahabhuta'' which tends the person towards ''apatarpana''.  

While treating ''santarpanajanya vyadhis'' like ''sthulata'' (obesity) and ''madhumeha'' (diabetes), consumption of ''dravyas'' that have ''guru'' and ''ruksha'' properties is advised. Along with medicines, the diet must also be ''ruksha''. For skin ailments, applying powders of medicinal plants all over the body which can provide relief from ''kandu'' (itching) and ''kotha'' (pre-gangrenous condition) are advised. So the food must be ''guru'' and ''apatarpaka'', i.e., it should induce catabolic activities. Applying these powders on the lesions may improve blood circulation which may consequently improve the increased hydroxylysine and glucose disaccharide content, decrease in proteoglycan and heparin sulfate and decrease in lysine content towards the lesion. The effects of honey, a food rich in antioxidants, on diseases such as cancer, coronary diseases, inflammatory disorders, and aging, has helped it gain lot of attention among nutritionists<ref> Jaganathan et al. Antiproliferative Effects of Honey and of Its Polyphenols: A Review. 2009 Journal of Biomedicine and Biotechnology. Article ID 830616</ref>.  Properties of honey are ''ruksha, guru,'' and ''kashaya''. Food and medicine having these properties enhance ''akasha'' and ''vayu mahabhuta'' which tends the person towards ''apatarpana''.  

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==== Table 1: Concise information about herbs used in management of ''santarpaniya'' diseases ====  

=== Table 1: Concise information about herbs used in management of ''santarpaniya'' diseases ===  

{| class="wikitable"

{| class="wikitable"

! Name !! Latin name !! Family !! ''Rasa'' !! ''Veerya'' !! ''Vipaka''

! Name !! Latin name !! Family !! ''Rasa'' !! ''Veerya'' !! ''Vipaka''

Over-nutrition and disorders induced by it leads to immune activation or susceptibility to inflammatory diseases, such as diabetes while under nutrition results in immune suppression or susceptibility to infection. Over-nutrition (prolonged intake of high fat/sugar diets) and infection lead to chronic and acute inflammation through nutrient and pathogen sensing systems, respectively<ref> Wellen KE, Hotamisligil GS: Inflammation, stress, and diabetes. J Clin Invest 2005, 115:1111-1119. </ref>

Over-nutrition and disorders induced by it leads to immune activation or susceptibility to inflammatory diseases, such as diabetes while under nutrition results in immune suppression or susceptibility to infection. Over-nutrition (prolonged intake of high fat/sugar diets) and infection lead to chronic and acute inflammation through nutrient and pathogen sensing systems, respectively<ref> Wellen KE, Hotamisligil GS: Inflammation, stress, and diabetes. J Clin Invest 2005, 115:1111-1119. </ref>

==== List of research works done as post graduate and post doctoral level on obeisty, dyslipidemia, hyperlipidemia ====

=== List of research works done as post graduate and post doctoral level on obeisty, dyslipidemia, hyperlipidemia ===

About 42 research works are found on the subject of hyperlipidaemia with various aspects like aetiopathogenesis and management. Some important work on hyperlipidaemia and hypercholesterolaemia are as follows:

About 42 research works are found on the subject of hyperlipidaemia with various aspects like aetiopathogenesis and management. Some important work on hyperlipidaemia and hypercholesterolaemia are as follows:

#Mudigoudar Yoshadha S (2000) : The efficacy of Pippalyadi Guggulu in Medoroga (w.s.r. to its hypolipidaemic effect).

#Mudigoudar Yoshadha S (2000) : The efficacy of Pippalyadi Guggulu in Medoroga (w.s.r. to its hypolipidaemic effect).

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=== References===

== References==

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