Obesity or Sthaulya is the most common nutritional disorder in the present era. It has reached epidemic proportions globally with more than 1 billion adults overweight – atleast 300 million of them clinically obese – is a major contributor to the global burden of chronic diseases and disability.
Childhood obesity is also on rise. An estimated 22 million children under five are estimated to be overweight worldwide. The prevalence of obese children aged 6 -11 years is becoming a global problem and increasingly extending into the developing world.
Sthaulya – In Ayurveda , Sthaulya or obesity is considered as one of eight condemned human constitutions.
Sthaulya according to Ayurveda is – when a person is having excessive and abnormal increase of medodhatu ( fat tissue ) along with mamsadhatu ( muscle tissue ) and results in pendulous appearance of buttocks, belly, breasts and whose increased bulk mass is not equal to a corresponding increase in energy.
Obesity – Excess deposition of adipose tissue in the body is known as obesity. It exists when body weight is 120% above the ideal weight.
Hina Sthaulya (Overweight)
Madhyama Sthaulya (Obesity class 1& 2)
Adhika Sthaulya (Severe or Morbid Obese)
Mainly faulty diet and sedantary lifestyle. It can be classified into
Physical activity should be increased. Research shows that exercise for 10 – 15 minutes at a stretch for 4 – 5 times a day is beneficial than doing exercise for 30 -40 minutes at a stretch. Optimum time to prevent obesity is during age 5 – 10 years.
Yoga is beneficial in controlling obesity. Nadi shodhan pranayam , meditation and asanas mainly surya namaskar (Sun Salutations), paschimottanasana (Posterior Stretch Posture), suptapavanmuktasana (Lying wind release Posture ), bhujangasana (Cobra Posture), katichakrasana (Lumbar – Wheel Posture) etc help one’s body and mind to stick to the conviction and to work with firm determination.
Diabetes is the most common medical complication of pregnancy and it has increased about 40% . The increasing prevalence of Type 2 Diabetes in general and younger people in particular has led to an increasing number of pregnancies with this complication .
Women can be separated into :
– those who were known to have Diabetes before pregnancy – Pregestational or Overt
– those diagnosed during pregnancy – Gestational .
There is keen interest in events that precedes Diabetes which includes the mini environment of the uterus , where it is believed that early imprinting can have effects later in life ( Saudek 2002) . For example in utero exposure to maternal hyperglycemia leads to fetal hyperinsulinemia , causing an increase in fetal fat cells, which leads to obesity and insulin resistance in childhood . This in turn leads to impaired glucose tolerance and Diabetes in adulthood . Thus a cycle of fetal exposure to Diabetes leading to childhood obesity and glucose intolerance is set in motion .
GESTATIONAL DIABETES MELLITUS :
Gestational Diabetes Mellitus is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy . An alternative explanation is that Gestational Diabetes is Type 2 Diabetes unmasked or discovered during pregnancy .
Risk Factors :
a) Positive family history of Diabetes
b) Having a previous birth of an overweight baby of 4 kg or more
c) Previous stillbirth
d) Unexplained perinatal loss
e) Presence of polyhydramnios ( excessive amniotic fluid ) or recurrent vaginal infection in present pregnancy
f) Persistent glycosuria
g) Age over 30 years
i) Ethnic groups ( East Asian , Pacific Island)
The method employed is by using 50 gm oral glucose challenge test without regard to time of day or last meal , between 24 – 28 weeks of pregnancy . A plasma glucose value of 140 mg percent or that of whole blood of 130 mg percent at 1 hour is considered as cut off point for consideration of a 100 gm ( WHO – 75 gm ) glucose tolerance test .
a) Increased perinatal loss is associated with fasting hyperglycemia . Fetal anomalies are not increased due to the absence of metabolic disturbance during organogenesis in early pregnancy.
b) Increased incidence of Macrosomia ( Fetal Macrosomia is defined as infants whose birth weight exceeds 4500 gm) .
d) Birth trauma
e) Recurrence of GDM in subsequent pregnancies is about 50 %
OVERT DIABETES :
A patient with symptoms of Diabetes Mellitus ( increased urination , increased thirst , weight loss ) and random plasma glucose concentration of 200 mg / dl or more is considered overt diabetic . The condition may be pre existing or detected for the first time during present pregnancy .
According to American Diabetic Association , diagnosis is positive if
a) The fasting plasma glucose exceeds 126 mg / dl
b) The 2 hour post glucose ( 75 gm ) value exceeds 200 mg / dl
Patients with poor glycemic control and vascular disease are at increased risk of complication of IUD , IUGR , Pre eclampsia and Ketoacidosis .
During Pregnancy :
Preterm Labour ( 20% )
Infection – Urinary tract infection and vulvo vaginitis
Increased incidence of Pre eclampsia ( 25 % )
Polyhydramnios ( 25 – 50% )
During Labour :
Prolongation of labour due to big baby
Fetal Macrosomia – With good Diabetic control , incidence of Macrosomia is markedly reduced .
Congenital Malformation – It is related to the severity of Diabetes affecting organogenesis , in the first trimester ( both in Type 1 and Type 2 Diabetes ) .
Hypoglycemia ( < 37mg / dl )
Respiratory distress syndrome
In Ayurveda Madhumeha disease can be correlated with Diabetes Mellitus . Though there is no direct reference of Gestational Diabetes but GarbhaVriddhi is described as a complication .
Garbha Vriddhi : In Garbha Vriddhi , there is excessive increase in size of abdomen and perspiration . Labour is difficult .
This can be understood as Overweight fetus or Macrosomia .
Ayurveda helps in limiting the maternal and fetal complications . Herbs are helpful as a supportive treatment along with the modern medicine under supervision .
Generally beneficial , congenial , purifying and suppressive dietetics and mode of life , not causing loss of doshas and dhatus but capable of decreasing the increased doshas and dhatus should be used .
Though the most appropriate diet for women with Gestational Diabetes has not been established , it is suggested that obese women with a body mass index greater than 30 kg / m2 may benefit from a 30 – 33 % caloric restriction .
This should be monitored with weekly tests for ketonuria because maternal ketonemia has been linked with impaired psychomotor development in the offspring .
Physical Activity : Physical activity during pregnancy reduces the risk of Gestational Diabetes .Resistance exercise helps avoid insulin therapy in overweight women with Gestational Diabetes .
Pranayam and Yogasana is beneficial .
Herbs : Tinospora cordifolia , Holarrhena antidysenterica , Rubia cordifolia , Emblica officinale , Boerhavia diffusa , Withania somnifera , Tribulis terrestris , Hemidesmus indica etc can be given under supervision .
Breast milk is the best nutrition a mother can give to her child . Feeding the child is the most satisfying and fulfilling experience for a mother . The child should be breastfed exclusively for first six months after birth . But when amount of breast milk decreases or is inadequate , it becomes very distressing.
Ayurveda describes decreased breast milk as ‘ Stanya Kshaya’ i.e Stanya means breast milk and Kshaya means decrease.
Absence or faulty secretion of breast milk following childbirth is called ‘Agalactia’ or ‘Agalactorrhoea’ .
The decreased secretion may occur from beginning and continue through entire period of lactation or it may be normal initially and decrease gradually .
Causes ( According to Ayurveda ):
* Anger , grief , fear , absence of affection for the child . * Fasting , intake of dry or non – oleaginous edibles and fluids. * Excessive exercise , emaciation , inadequate sleep and rest. * Excessive use of purifying measures. * Pregnancy during lactation.
* Sore nipples. * Smoking and alcohol consumption. * Taking oral contraceptives. * Providing other feeds in between breast feeding.
Motherhood is a special and joyous moment in every woman’s life. But this is possible if her health is taken care of during postnatal period.
The postnatal period or Puerperium is called ‘Sutika kala” and woman is called ‘Sutika’ in Ayurveda. A woman is called ‘Sutika’ only after the placenta is expelled during labour. The duration of ‘Sutikakala’ is usually 1-1/2 month (45 days).
Great emphasis has been laid on post natal care i.e. Sutika Paricharya , as during this period she restores her health and strength. Ayurveda compares the condition of woman after childbirth with that of a pot filled with oil up to brim. If the pot becomes unstable, the oil spills. So, if proper care is not taken during postnatal period , her health deteriorates.
Importance of Post Natal Care (Sutika Paricharya)
* To bring the woman’s health status to the pre pregnant state, as due to growth of the baby and the pain & blood loss during delivery, there is weakness & loss of vital elements from the body.
* To prevent the complaints during Sutika kala such as
1. UTI 2. Backache 3. Loss of appetite 4. Thirst 5. Anxiety 6. Anger 7. Disturbed sleep 8. Depression, etc.
Post Natal Care (Sutika Paricharya)
* She should be given Ghee (clarified butter) or Til oil (Sesamum) mixed with Panchkola according to her digestive power.
* After digestion of the above mixture give her rice gruel or milk medicated with panchkola or Vidharigandhadi Gana (i.e mixture of Shatavari,Gokshur,Punarnava,Bala etc.)
* Along with this give ‘Gudodaka’ or jaggery water for 5-7 days.
* After 7th day give her strength giving and easily digestible food e.g. sixty day rice, meat soup of forest dwelling animals, etc.
On World Tuberculosis Day , let’s focus on the role of Ayurveda in combating Tuberculosis .
Tuberculosis can be correlated with Yakshma or Rajyakshma in Ayurveda .In Rajyakshma , dhatukshaya ( loss of essence of tissues ) is the main reason of pathogenesis and can affect any organ .
TB of female genital tract is common amongst all the communities where pulmonary or other forms of extra genital tuberculosis are prevalent and this despite early recognition and effective treatment of such lesions .
It follows that genital tuberculosis is nearly always secondary to a focus elsewhere in the body but spread takes place at a very early stage of disease – usually in adolescence or early maturity .
Thus by the time lesion is found , which can be at any age , the primary has often healed and is inconspicuous .
How it spreads :
The tubercle bacilli reach the genital tract by one of the following mechanisms:
Bloodstream : The primary focus being most often situated in the lungs , lymph nodes , urinary tract , bones and joints – in that order .
Descending : In this type the infection reaches pelvic organs by direct or lymphatic spread from infected adjacent organs such as peritoneum , bowel etc .
Ascending : There is a theoretical possibility that a few cases of Tuberculosis of vulva and vagina and of primary tuberculosis of cervix are explained by – children sitting unclothed where others have spat or coughed and in adults having coitus with a male suffering from urogenital tuberculosis .
Any part of the genital tract can be affected but the common sites are fallopian tubes and the endometrium . Tubes are involved in atleast 90% of cases .
Clinical features :
a) This is often a silent disease . It may be present for 20 or more years without producing any symptoms , the woman remaining in apparently excellent health .
The presence of Pelvic Tuberculosis is most often revealed by the investigation of childlessness and therefore is usually discovered in women aged 20 – 40 years .
c) Ectopic pregnancy
d) Menstrual disorders
e) Pain in lower abdomen
f) General disturbances : Malaise , loss of weight , night sweats , pyrexia ,are only seen during an unusually active phase of disease .
General : It is important to improve the patients natural resistance to the disease by paying attention to the diet and general well being . Until infection is controlled , husband should use condom to prevent possibility of contracting urogenital tuberculosis .
Medicine : The treatment of Pelvic Tuberculosis is similar to that of Pulmonary Tuberculosis.
Ayurvedic Management :
Panchakarma ( Purification measures ) should be done according to condition of the patient .
Diet : Rice ,wheat ,barley ,green gram, horse gram, pomegranate , raisins , tamarind , long pepper , dry ginger , coriander , cinnamon , small cardamom , garlic , bishop’s weed , freshly prepared butter , goat’s milk , honey , candy sugar ( mishri) can be taken .
World Kidney Day aims to raise awareness of the importance of our kidneys to our overall health and reduce the frequency and impact of kidney disease and its associated health problems worldwide .
This year’s focus is on Acute Kidney Attack ( earlier called Acute Renal Failure ) .
Although some diseases of the kidney and urinary tract may be associated with pregnancy by chance , pregnancy induced changes may predispose to the development of renal tract disorders . Acute Kidney Attack is a life threatening complication of pregnancy .
Causes of Acute Kidney Attack during pregnancy
A) Early pregnancy : Hyperemesis gravidarum ( Severe Vomitting )
B) Late pregnancy : Pregnancy induced hypertension (PIH),Pre eclampsia
Antepartum haemorrhage (bleeding during pregnancy)
Post partum haemorrhage ( bleeding after delivery )
UTI ( Urinary tract infection ) : It is the most common cause of renal disease and ranges from asymptomatic bacteriuria to pyelonephritis .
Oliguria is an important sign of acutely impaired renal function .
According to Ayurveda , it is considered as Mutra apravrittijanya roga .
Prevention through Ayurveda :
a) Garbhini Paricharya ( Ayurvedic Antenatal Regimen ) should be initiated as soon as pregnancy is confirmed .
b) Herbs which can be taken under supervision are – Amla ( gooseberry ) , Punarnava (Boerhavia diffusa ) , Chandan ( Santalum album ) , Ushir ( Vetiveria zizinioides ) , Bala ( Sida cordifolia ) ,Shatavari ( Asparagus racemosus ) , Gokshur ( Tribulus terrestris ) etc .
c) Diet : Eatables which can be included are – Cucumber , Pumpkin , Pomegranate , Fennel , Small cardamom , Coconut water , Buttermilk , Sugarcane juice , Raisins , Mishri ( candy sugar ) , Coriander , Water chestnut ( Singhara ) etc.
As the physiological status is altered during pregnancy , significant changes both in structure and function take place in urinary tract . So special care for even minor complaints should be taken .
‘Pregnancy should be by Choice, not by Chance’ – this statement holds true for having a healthy progeny and safe pregnancy. As the ultimate constitution of an individual is determined by the chromosomes of sperm and ovum destined to unite and form zygote from which organism develops, the health status of both the partners is very important for conception.
Ayurveda describes that as proper season, fertile field, water and good quality seeds are essential for good crop, similarly the normal menstrual cycle, healthy female reproductive system, proper maternal nutrition and healthy sperm and ovum are requisite for conception and healthy child.
The regimen followed during pre pregnancy period to achieve conception is called ”Garbhadhan Vidhi”.
Specific guidelines have been laid in Ayurveda for Pre pregnancy or Pre conception care.
Suitable partner for marriage
Should not belong to the same family or caste.
Should not suffer from infectious diseases including sexually transmitted diseases.
Should not have anatomical anomalies.
Should be healthy.
Factors vital for conception
Healthy uterus, cervix and vaginal canal without vitiation of doshas.
Normal menstrual cycle and healthy ovum.
Equipoise Vata dosha or neurotransmission, hormonal and regulatory mechanism of the body .
Both the partners should be psychologically happy and mature, as happy mood is essential for achievement of conception .
Regimen for couple
Panchkarma (Purification Measures): The couple should be purified with oleation, sudation, emesis, purgation, enema. After this, they are brought to normal physiological status with dietetics . These are meant to cleanse the body of accumulated toxins .
For Male: Ghrita (clarified butter) and milk medicated with anabolic herbs are given to improve the quality of sperms. Herbs such as Ashwagandha (Withania somniferum) , Gokshur (Tribulus terrestris) , Musali (Curculigo orchioides), Kaunchbeej (Mucuna pruriens), Shilajeet (Asphaltum), drugs of Shukrajanan (Spermatopoietic) group should be taken for 4 – 6 months prior to conception. Diet should be healthy and balanced.
For Female: Sesamum oil and Black gram should be taken along with the balanced diet. Sesamum seeds possess excellent antioxidant property. They are a good source of zinc which in turn is important for the formation of folic acid. Herbs such as Shatavari (Asparagus racemosus), Vidarikand (Pueraria tuberosa ) , Mulethi (Glycerrhiza glabra), Bala (Abutilon indicum), Amalaki (Phyllanthus emblica), drugs of Prajasthapana (Procreants) group should be taken.