Changes

==[[Panchamahabhuta]] composition==

==[[Panchamahabhuta]] composition==

   

   

The [[agni]], [[vayu]] and [[akasha]] [[mahabhuta]] play predominant and vital role in mechanism of langhana therapy. [A.S. Sutra Sthana 24/3]<ref name== Sangraha> Vridha Vagbhata, Ashtanga Sangraha. Edited by Shivaprasad Sharma. 3rd ed. Varanasi: Chaukhamba sanskrit series office;2012.</ref>

The [[agni]], [[vayu]] and [[akasha]] [[mahabhuta]] play predominant and vital role in mechanism of langhana therapy. [A.S. Sutra Sthana 24/3]<ref name= Sangraha> Vridha Vagbhata, Ashtanga Sangraha. Edited by Shivaprasad Sharma. 3rd ed. Varanasi: Chaukhamba sanskrit series office;2012.</ref>

==Methods of langhana therapy==

==Methods of langhana therapy==

I. '''Purifying (shodhana) procedures'''

I. '''Purifying (shodhana) procedures'''

II. '''Pacifying (shamana) procedures''' [A.Hr. Sutra Sthana 14/4]<ref name== Hridaya > Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>

II. '''Pacifying (shamana) procedures''' [A.Hr. Sutra Sthana 14/4]<ref name= Hridaya > Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>

===Purifying (shodhana) procedures===

===Purifying (shodhana) procedures===

11.Exposure to sunlight (atapa)

11.Exposure to sunlight (atapa)

12.Exposure to wind/breathing exercises(maruta) [A.Hr. Sutra Sthana 14/6-7]<ref name==Hridaya/>

12.Exposure to wind/breathing exercises(maruta) [A.Hr. Sutra Sthana 14/6-7]<ref name=Hridaya/>

Bloodletting (asravisruti) and appetizers ([[deepana]]) are excluded from langhana therapy by Charaka.[Cha.Sa.[[Sutra Sthana]] 22/18]

Bloodletting (asravisruti) and appetizers ([[deepana]]) are excluded from langhana therapy by Charaka.[Cha.Sa.[[Sutra Sthana]] 22/18]

*Excess body discharges  

*Excess body discharges  

*Those who had undergone nourishing therapies. [Cha.Sa.[[Sutra Sthana]] 22/24]

*Those who had undergone nourishing therapies. [Cha.Sa.[[Sutra Sthana]] 22/24]

*In state of accumulation of undigested/toxic biological waste ([[ama]]) [Su.Sa.UttaraSthana 40/34]<ref name== Susruta> Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>

*In state of accumulation of undigested/toxic biological waste ([[ama]]) [Su.Sa.UttaraSthana 40/34]<ref name= Susruta> Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>

*In state of nutritive fluid ([[rasa dhatu]]) associated with [[ama]] [Cha.Sa.[[Chikitsa Sthana]] 15/75]

*In state of nutritive fluid ([[rasa dhatu]]) associated with [[ama]] [Cha.Sa.[[Chikitsa Sthana]] 15/75]

*As a part of post therapeutic regimen after therapeutic emesis ([[vamana]]) and therapeutic purgation ([[virechana]]) where digestive power is weak.  

*As a part of post therapeutic regimen after therapeutic emesis ([[vamana]]) and therapeutic purgation ([[virechana]]) where digestive power is weak.  

*In diseases like [[jwara]], stiffness of thighs (urustambha), herpes (visarpa), abscess (vidradhi), splenic diseases(pleeha), obesity (sthaulya), diseases of head, throat and eyes [A.S.Sutra Sthana 24/10]<ref name==Sangraha/> skin disorders (kushtha), urinary disorders (prameha). [Cha.Sa.[[Sutra Sthana]] 22/24]  

*In diseases like [[jwara]], stiffness of thighs (urustambha), herpes (visarpa), abscess (vidradhi), splenic diseases(pleeha), obesity (sthaulya), diseases of head, throat and eyes [A.S.Sutra Sthana 24/10]<ref name=Sangraha/> skin disorders (kushtha), urinary disorders (prameha). [Cha.Sa.[[Sutra Sthana]] 22/24]  

===Specific indications===

===Specific indications===

*Obstruction of [[vata]] by morbidities  

*Obstruction of [[vata]] by morbidities  

*Those who have good physical strength and bulky stature. [Cha.Sa.[[Sutra Sthana]] 22/19]

*Those who have good physical strength and bulky stature. [Cha.Sa.[[Sutra Sthana]] 22/19]

*Jwara, vomiting, diarrhea, cardiac complaints, constipation, heaviness, belching, nausea etc. [A.Hr. Sutra Sthana 14/12]<ref name==Hridaya/>

*Jwara, vomiting, diarrhea, cardiac complaints, constipation, heaviness, belching, nausea etc. [A.Hr. Sutra Sthana 14/12]<ref name=Hridaya/>

====Digestive measures ([[pachana]])====

====Digestive measures ([[pachana]])====

*Mild diseases [Cha.Sa.[[Sutra Sthana]] 22/22]

*Mild diseases [Cha.Sa.[[Sutra Sthana]] 22/22]

*Restricted intake of liquid or water results in pacification of [[kapha]] and [[pitta]] [[dosha]] due to depletion of their source i.e. [[jala mahabhuta]].  

*Restricted intake of liquid or water results in pacification of [[kapha]] and [[pitta]] [[dosha]] due to depletion of their source i.e. [[jala mahabhuta]].  

*By restriction of food, the [[agni]] (digestion and metabolism) is improved first and it hastens the process of normalizing [[dosha]] equilibrium. [A.Hr.Chikitsa Sthana 10/91]<ref name==Hridaya/>

*By restriction of food, the [[agni]] (digestion and metabolism) is improved first and it hastens the process of normalizing [[dosha]] equilibrium. [A.Hr.Chikitsa Sthana 10/91]<ref name=Hridaya/>

====Physical exercise ([[vyayama]]), exposure to sunlight (aatapa) and exposure to wind/breathing exercise (maruta)====

====Physical exercise ([[vyayama]]), exposure to sunlight (aatapa) and exposure to wind/breathing exercise (maruta)====

*[[Vata]] predominant conditions  

*[[Vata]] predominant conditions  

*Conditions of fear, anger, grief and physical exertion [Cha.Sa.[[Chikitsa Sthana]] 3/139]  

*Conditions of fear, anger, grief and physical exertion [Cha.Sa.[[Chikitsa Sthana]] 3/139]  

*Jwara with excess dominance of [[pitta]] [[dosha]] [A.S.Chikitsa Sthana 1/13]<ref name==Sangraha/>

*Jwara with excess dominance of [[pitta]] [[dosha]] [A.S.Chikitsa Sthana 1/13]<ref name=Sangraha/>

*Jwara due to exogenous causes (agantujaj wara) and chronic stage (jeerna jwara) [A.S.Chikitsa Sthana 1/17]<ref name==Sangraha/>

*Jwara due to exogenous causes (agantujaj wara) and chronic stage (jeerna jwara) [A.S.Chikitsa Sthana 1/17]<ref name=Sangraha/>

==Assessment of therapy==

==Assessment of therapy==

*Reappearance of taste, hunger and thirst  

*Reappearance of taste, hunger and thirst  

*Feeling of wellbeing [Cha.Sa.[[Sutra Sthana]] 22/34-35]

*Feeling of wellbeing [Cha.Sa.[[Sutra Sthana]] 22/34-35]

*Intolerance to hunger and thirst [Su.Sa. Uttara Sthana 39/105]<ref name==Susruta/>

*Intolerance to hunger and thirst [Su.Sa. Uttara Sthana 39/105]<ref name=Susruta/>

*Clarity of sense organs [A.Hr. Sutra Sthana 14/17]<ref name==Hridaya/>

*Clarity of sense organs [A.Hr. Sutra Sthana 14/17]<ref name=Hridaya/>

===Features of excessive administration of langhana===

===Features of excessive administration of langhana===

*Loss of sleep

*Loss of sleep

*Delirium

*Delirium

*Depletion and non-elimination of feces and urine [A.Hr. Sutra Sthana 14/29-30]<ref name==Hridaya/>

*Depletion and non-elimination of feces and urine [A.Hr. Sutra Sthana 14/29-30]<ref name=Hridaya/>

*Occurrence of secondary disease like dyspnea [Su.Sa.Uttara Sthana. 39/106]<ref name==Susruta/>

*Occurrence of secondary disease like dyspnea [Su.Sa.Uttara Sthana. 39/106]<ref name=Susruta/>

==Untoward effects of improper follow up of langhana therapy==

==Untoward effects of improper follow up of langhana therapy==

==Benefits==

==Benefits==

   

   

Langhana leads to pacification of [[dosha]], improves strength of digestive power ([[agni]]), lightness in body promotes healthy state, hunger, thirst, desire for food, strength and vigor. [A.S.Chikitsa Sthana 1/3]<ref name==Sangraha/>

Langhana leads to pacification of [[dosha]], improves strength of digestive power ([[agni]]), lightness in body promotes healthy state, hunger, thirst, desire for food, strength and vigor. [A.S.Chikitsa Sthana 1/3]<ref name=Sangraha/>

===Importance in diagnosis===

===Importance in diagnosis===

===Importance in preservation of health and prevention===

===Importance in preservation of health and prevention===

Langhana therapy is more indicated in winter season (shishira and hemanta) to maintain equilibrium. [Cha.Sa.[[Sutra Sthana]] 22/24][A.Hr. Sutra Sthana 14/11]<ref name==Hridaya/> In case of accumulation of toxic biological waste ([[ama]]) and in obese persons, lightening therapy (langhana) should be done daily. [A.Hr. Sutra Sthana 14/10-11]<ref name==Hridaya/> The seasonal purification procedures play vital role in preservation of health and prevention of disease.

Langhana therapy is more indicated in winter season (shishira and hemanta) to maintain equilibrium. [Cha.Sa.[[Sutra Sthana]] 22/24][A.Hr. Sutra Sthana 14/11]<ref name=Hridaya/> In case of accumulation of toxic biological waste ([[ama]]) and in obese persons, lightening therapy (langhana) should be done daily. [A.Hr. Sutra Sthana 14/10-11]<ref name=Hridaya/> The seasonal purification procedures play vital role in preservation of health and prevention of disease.

===Importance in management of disease===

===Importance in management of disease===

   

   

Langhana therapies especially fasting is the first line of therapy in many disorders. It is advocated in the initial stage of following diseases.

Langhana therapies especially fasting is the first line of therapy in many disorders. It is advocated in the initial stage of following diseases.

*[[Jwara]] [Cha.Sa.[[Chikitsa Sthana]] 3/139] can be treated with only fasting (langhana) [Cha.Sa.[[Nidana Sthana]] 8/31] if it is associated with toxic metabolic waste ([[ama]]) or during the predominance of [[kapha]] or [[kapha]] and [[pitta]] [[dosha]]. [Cha.Sa.[[Chikitsa Sthana]] 3/284] The [[kapha]] predominant stage of chronic intermittent pattern of [[jwara]] can also be managed through reducing (langhana) therapies. [Cha.Sa.[[Chikitsa Sthana]] 3/295] The patients who are unsuitable for oleation and purificatory therapies are treated by langhana therapies.  [Su.Sa.Uttara Sthana 39/99]<ref name==Susruta/>

*[[Jwara]] [Cha.Sa.[[Chikitsa Sthana]] 3/139] can be treated with only fasting (langhana) [Cha.Sa.[[Nidana Sthana]] 8/31] if it is associated with toxic metabolic waste ([[ama]]) or during the predominance of [[kapha]] or [[kapha]] and [[pitta]] [[dosha]]. [Cha.Sa.[[Chikitsa Sthana]] 3/284] The [[kapha]] predominant stage of chronic intermittent pattern of [[jwara]] can also be managed through reducing (langhana) therapies. [Cha.Sa.[[Chikitsa Sthana]] 3/295] The patients who are unsuitable for oleation and purificatory therapies are treated by langhana therapies.  [Su.Sa.Uttara Sthana 39/99]<ref name=Susruta/>

*Bleeding disorders (raktapitta) especially through the upper orifices (eyes, mouth and nose) as it is associated with [[pitta]] along with toxic biological waste (same [[pitta]]) and [[kapha]][[dosha]]. [Cha.Sa.[[Chikitsa Sthana]] 4/30]

*Bleeding disorders (raktapitta) especially through the upper orifices (eyes, mouth and nose) as it is associated with [[pitta]] along with toxic biological waste (same [[pitta]]) and [[kapha]][[dosha]]. [Cha.Sa.[[Chikitsa Sthana]] 4/30]

*Abdominal tumors (gulma) caused due to [[kapha]][[dosha]]. [Cha.Sa.[[Chikitsa Sthana]] 5/49]

*Abdominal tumors (gulma) caused due to [[kapha]][[dosha]]. [Cha.Sa.[[Chikitsa Sthana]] 5/49]

*Bleeding hemorrhoids with [[kapha]] and [[pitta]] aggravation [Cha.Sa.[[Chikitsa Sthana]] 14/176], Diabetes mellitus (prameha) caused by [[kapha]] [Cha.Sa.[[Chikitsa Sthana]] 6/25], ulcers with [[kapha]] predominance [Cha.Sa.[[Chikitsa Sthana]] 25/16], rhinitis of [[kapha]] origin (kaphaja pinasa) associated with heaviness and anorexia [Cha.Sa.[[Chikitsa Sthana]] 26/149], Cardiac disorders [Cha.Sa.[[Chikitsa Sthana]] 26/100] and diseases caused by the suppression of urge of vomiting. [Cha.Sa.[[Sutra Sthana]] 7/15]  

*Bleeding hemorrhoids with [[kapha]] and [[pitta]] aggravation [Cha.Sa.[[Chikitsa Sthana]] 14/176], Diabetes mellitus (prameha) caused by [[kapha]] [Cha.Sa.[[Chikitsa Sthana]] 6/25], ulcers with [[kapha]] predominance [Cha.Sa.[[Chikitsa Sthana]] 25/16], rhinitis of [[kapha]] origin (kaphaja pinasa) associated with heaviness and anorexia [Cha.Sa.[[Chikitsa Sthana]] 26/149], Cardiac disorders [Cha.Sa.[[Chikitsa Sthana]] 26/100] and diseases caused by the suppression of urge of vomiting. [Cha.Sa.[[Sutra Sthana]] 7/15]  

*Mild aggravated [[dosha]] should be managed by fasting therapy (langhana) in case of diarrhea. [Cha.Sa.[[Chikitsa Sthana]] 19/19]

*Mild aggravated [[dosha]] should be managed by fasting therapy (langhana) in case of diarrhea. [Cha.Sa.[[Chikitsa Sthana]] 19/19]

*In the prodormal stage of all varieties of erysipelas (visarpa). [A.S.Chikitsa Sthana 20/2]<ref name==Sangraha/> If erysipelas (visarpa) is caused with [[dosha]] in the state of incomplete transformation ([[ama]]) and is located in thorax and upper body parts ([[kapha]]sthana), fasting therapy (langhana) is beneficial. [Cha.Sa.[[Chikitsa Sthana]] 21/44]  

*In the prodormal stage of all varieties of erysipelas (visarpa). [A.S.Chikitsa Sthana 20/2]<ref name=Sangraha/> If erysipelas (visarpa) is caused with [[dosha]] in the state of incomplete transformation ([[ama]]) and is located in thorax and upper body parts ([[kapha]]sthana), fasting therapy (langhana) is beneficial. [Cha.Sa.[[Chikitsa Sthana]] 21/44]  

*Fissure in ano if associated with [[ama]]. [Cha.Sa.[[Siddhi Sthana]] 6/63]  

*Fissure in ano if associated with [[ama]]. [Cha.Sa.[[Siddhi Sthana]] 6/63]  

*Indigestion caused due to [[ama]] (amajeerna). [Su.Sa.Sutra Sthana. 46/505]<ref name==Susruta/>  

*Indigestion caused due to [[ama]] (amajeerna). [Su.Sa.Sutra Sthana. 46/505]<ref name=Susruta/>  

*Bloating in upper abdomen (anaha) caused by improperly digested food/product of improper digestion ([[ama]]), associated with stiffness in cardiac region, diseases of head and heaviness, retention of belching, common cold should be treated with fasting therapy (langhana). [Cha.Sa.[[Chikitsa Sthana]] 26/26]

*Bloating in upper abdomen (anaha) caused by improperly digested food/product of improper digestion ([[ama]]), associated with stiffness in cardiac region, diseases of head and heaviness, retention of belching, common cold should be treated with fasting therapy (langhana). [Cha.Sa.[[Chikitsa Sthana]] 26/26]

When a person follows fasting, the energy is derived by utilization of blood glucose. After that, glycogen stored in hepatocytes is utilized for energy. This also accelerates the breakdown of adipose tissue i.e. lipolysis. Thus, more fatty acids and glycerol are formed and released into blood. At the same time the other cells may produce ketones. The fatty acids are transported into hepatocytes, get metabolized and produce ketones beta-OHB and acetoacetate. This induces mitochondrial biogenesis.

When a person follows fasting, the energy is derived by utilization of blood glucose. After that, glycogen stored in hepatocytes is utilized for energy. This also accelerates the breakdown of adipose tissue i.e. lipolysis. Thus, more fatty acids and glycerol are formed and released into blood. At the same time the other cells may produce ketones. The fatty acids are transported into hepatocytes, get metabolized and produce ketones beta-OHB and acetoacetate. This induces mitochondrial biogenesis.

The ketones thus produced are transported into cells with high metabolic activity such as neurons, muscles etc., becomes acetyl coenzyme A. It enters the tricarboxylic acid (TCA) cycle where ATP is generated. Thus, during fasting, primary energy source of the body shifts from glucose to fatty acids and ketones.<ref name==Antonsd>Anton SD, Moehl K, Donahoo WT, Marosi K, Lee SA, Mainous AG 3rd, Leeuwenburgh C, Mattson MP. Flipping the Metabolic Switch: Understanding and Applying the Health Benefits of Fasting. Obesity (Silver Spring). 2018 Feb;26(2):254-268. doi: 10.1002/oby.22065. Epub 2017 Oct 31. PMID: 29086496; PMCID: PMC5783752.</ref>

The ketones thus produced are transported into cells with high metabolic activity such as neurons, muscles etc., becomes acetyl coenzyme A. It enters the tricarboxylic acid (TCA) cycle where ATP is generated. Thus, during fasting, primary energy source of the body shifts from glucose to fatty acids and ketones.<ref name=Antonsd>Anton SD, Moehl K, Donahoo WT, Marosi K, Lee SA, Mainous AG 3rd, Leeuwenburgh C, Mattson MP. Flipping the Metabolic Switch: Understanding and Applying the Health Benefits of Fasting. Obesity (Silver Spring). 2018 Feb;26(2):254-268. doi: 10.1002/oby.22065. Epub 2017 Oct 31. PMID: 29086496; PMCID: PMC5783752.</ref>

The ultimate beneficial effect of fasting is reduction in adipose tissue ([[meda dhatu]]) and [[kapha]][[dosha]].

The ultimate beneficial effect of fasting is reduction in adipose tissue ([[meda dhatu]]) and [[kapha]][[dosha]].

Fasting therapy results in significant reduction in weight and body mass index (BMI). In a study conducted on 44 healthy individuals, short-term fasting therapy is compared with low calorie diet. Significant reduction in weight and Leptin levels were achieved through fasting than low calorie diet. Increased beta-oxidation is observed during fasting.<ref>Shetty P, Dinesh S, Halappa NG, Rajany T. Comparing the effects of short-term fasting therapy and low-calorie diet on anthropometric and leptin measures among obese or overweight persons: Randomized controlled trial. Ancient Sci Life 2018;37:133-40.</ref>

Fasting therapy results in significant reduction in weight and body mass index (BMI). In a study conducted on 44 healthy individuals, short-term fasting therapy is compared with low calorie diet. Significant reduction in weight and Leptin levels were achieved through fasting than low calorie diet. Increased beta-oxidation is observed during fasting.<ref>Shetty P, Dinesh S, Halappa NG, Rajany T. Comparing the effects of short-term fasting therapy and low-calorie diet on anthropometric and leptin measures among obese or overweight persons: Randomized controlled trial. Ancient Sci Life 2018;37:133-40.</ref>

Average life span is increased by 30%, when the rats were maintained on alternate day fasting. Plasma glucose, insulin and leptin levels were low for the rats maintained on fasting. Ketone and adiponectin levels were more. Inflammatory markers were found to be reduced in liver of rats kept on time restricted feeding. The normal decline in muscle mass during ageing is found to be prevented by caloric restriction in mice. Fasting stimulates autophagy in muscles. Cardiovascular stress adaptations were noted in rats kept on alternate day fasting. It also increases brain derived neurotrophic factor which plays a major role in synaptic plasticity and neurogenesis.<ref name==Antonsd/>

Average life span is increased by 30%, when the rats were maintained on alternate day fasting. Plasma glucose, insulin and leptin levels were low for the rats maintained on fasting. Ketone and adiponectin levels were more. Inflammatory markers were found to be reduced in liver of rats kept on time restricted feeding. The normal decline in muscle mass during ageing is found to be prevented by caloric restriction in mice. Fasting stimulates autophagy in muscles. Cardiovascular stress adaptations were noted in rats kept on alternate day fasting. It also increases brain derived neurotrophic factor which plays a major role in synaptic plasticity and neurogenesis.<ref name=Antonsd/>

===Relevance of fasting (upawasa) and autophagy===

===Relevance of fasting (upawasa) and autophagy===

Ayurveda advised taking meals in proper quantity, at proper time and with proper methods (ahara vidhi) for preservation of health. A group of researchers observed kaalabhojana (optimal food at proper time) has additional health benefits over time restricted feeding. Kalabhojanam does not mean that food can be taken at will during the 24 hours. It must be in coherence with daily regimen (dinacharya) and sleep-wake timings as per day-night cycle. Consuming food just once a day is the best strategy [Cha.Sa. [[Sutra Sthana]] 25/40] and will automatically have a longer fasting period. The second meal shall be in accordance [[agni]] and sleep cycle. Thus, the feeding time must remain restricted during morning to evening (i.e., a maximum of 12-hour eating window during day and thus a minimum 12-hour gap during night), and not during the night. Thus, it extends the window between evening meal and morning meal. This may vary as per the digestion capacity and body constitution of individual.<ref>Prakash NP et.al. Prevention of metabolic risks by Kalabhojanam strategy of Ayurveda.Annals of Ayurvedic Medicine 2020; 9(2):116-129.</ref> The personified langhana therapies can be more beneficial as per the guidelines described above after consideration of body constitution, state of [[dosha]], strength of individual and digestion capacity. These guidelines, if followed while prescribing fasting strategies can yield more health benefits.

Ayurveda advised taking meals in proper quantity, at proper time and with proper methods (ahara vidhi) for preservation of health. A group of researchers observed kaalabhojana (optimal food at proper time) has additional health benefits over time restricted feeding. Kalabhojanam does not mean that food can be taken at will during the 24 hours. It must be in coherence with daily regimen (dinacharya) and sleep-wake timings as per day-night cycle. Consuming food just once a day is the best strategy [Cha.Sa. [[Sutra Sthana]] 25/40] and will automatically have a longer fasting period. The second meal shall be in accordance [[agni]] and sleep cycle. Thus, the feeding time must remain restricted during morning to evening (i.e., a maximum of 12-hour eating window during day and thus a minimum 12-hour gap during night), and not during the night. Thus, it extends the window between evening meal and morning meal. This may vary as per the digestion capacity and body constitution of individual.<ref>Prakash NP et.al. Prevention of metabolic risks by Kalabhojanam strategy of Ayurveda.Annals of Ayurvedic Medicine 2020; 9(2):116-129.</ref> The personified langhana therapies can be more beneficial as per the guidelines described above after consideration of body constitution, state of [[dosha]], strength of individual and digestion capacity. These guidelines, if followed while prescribing fasting strategies can yield more health benefits.

   

   

Fasting is beneficial in metabolic syndrome by decreasing fasting glucose, fasting insulin and insulin resistance. It also reduces the cardiovascular risk factors like total cholesterol, LDL, triglycerides etc. In diabetic patients improved insulin sensitivity and glucose tolerance was reported immediately after a fast.<ref name==Antonsd/>

Fasting is beneficial in metabolic syndrome by decreasing fasting glucose, fasting insulin and insulin resistance. It also reduces the cardiovascular risk factors like total cholesterol, LDL, triglycerides etc. In diabetic patients improved insulin sensitivity and glucose tolerance was reported immediately after a fast.<ref name=Antonsd/>

== List of theses ==

== List of theses ==