Obesity: A risk factor for Heart diseases, Ayurveda, Modern Views

Article by Dr Raghuram Y.S. MD (Ay)
Obesity has become an epidemic which in most of the cases is difficult to conquer. The number of cases of people getting and looking obese has been regularly increasing to alarming proportions. This also includes childhood obesity. Thanks to the modernization of life which is devoid of time for exercising and has scope for all forms of stress and junk eating.

Man has become a victim of civilization. Obesity clinics and sophisticated gymnasiums and body trimming garages have been on a rise and minting big money because people are desperate to get back their body dimensions and configurations, in a state of believing and trusting anything and anyone rather than themselves! Many times it is too late before people start working over selves.

Being fat or overweight is a social curse and embarrassment for many. Many obese people and kids are bullied and develop suicidal thoughts. It is not only a disease related to increase in body calculations; obesity also puts our life in trouble by pulling us into the vicinity of a wide array of complications. Almost all the tissues and organs of the body are put under the stress of the accumulating bad fat in the body.

Many organs suffer an irreversible damage many times. Heart is often a soft target and victim of obesity. ‘Heart’ over a period of time loses its competence to work in its normal limits and satisfy the needs of the body. This anatomical damage of the heart and failure of the heart to work as an efficient pump takes us closer to many complications including death!!

Ayurveda has mentioned ‘ati sthula’ – a person who is too obese (fat / over weight) under the category of Ashtau Nindita’s – 8 categories of people who are socially unfit.

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We already know that the ‘heart is under trouble’ in those who are obese and or overweight. In this article I have tried to deal this topic i.e. ‘Obesity as a risk factor or predisposing factor for serious heart ailments’ with an Ayurvedic perspective.

Before going into a comparative study between the ancient Ayurvedic concepts and modern day concepts in relation to ‘Obesity or overweight being a risk factor for cardiac disorders’, I shall touch upon a few words which will be repeatedly used throughout the context of this article.

The below mentioned (described) Ayurvedic terms generally describe the modern day concepts of obesity / overweight conditions:

obesity complications

Medoroga: Fat metabolism disorder
Medo Roga means disease (diseases or symptom complex) which is manifested due to pathological increase in quantity of fat tissue in the body (Meda=fat, Roga=disease). This explains Medo Roga as a syndrome rather than a disease or a complaint. This term covers all the symptoms and complications which occur due to the disturbances in fat metabolism. This is more-over a pathological definition of fat related pathology in terms of physiological disturbances.

Sthoulya- Obesity
Sthoulya means obese or looking obese (bulky / busty). This moreover looks like an anatomical description of the disease. Sthoulya may or may not have progressed to the level of causing severe damages in the body, enough to be called as a disease but may be a warning sign that the body tissues and organs are under danger. The body dimensions in this condition will be blown out of proportions. This seems to be a predisposing stage earlier to Medo Roga

Note – All those who have Medo Roga (diseases caused due to disturbance in fat metabolism) need not look Sthula (anatomically obese).

Medo Vriddhi:
This term indicates ‘pathological increase of fat’ with a simultaneous depletion of other tissues. This is a background for development of serious fat related disorders in the body. The term looks almost similar to Medo Roga. The difference is – Medo Vriddhi is a condition in which the fat tissue has been increasing gradually following which the person starts looking stout and obese (Sthoulya) on the backdrop of which the accumulated fat in the body causes serious morbidity by causing serious tissue and organ damage involving the morbid Dosha’s along with it (Medo Roga).

The other term which I will keep using in this article is Hridroga / Hrudroga.

Hridroga:
Hridroga is a word made up of 2 terms – Hrid=Heart and Roga=Disease. Thus Hridroga or Hrudroga means heart diseases or cardiovascular ailments or CVD (Cardiovascular diseases / disorders) or a symptom complex indicating anatomical damage and physiological disturbances related to the heart as an organ. The term Hridroga engulfs a wide array of diseases. There are many aetiological (causative) factors which cause Hridroga. But in this article I will be just touching upon obesity as a causative factor for heart diseases.

What is the relationship between Medoroga / Sthoulya (Obesity) and Hridroga (Cardiovascular Diseases)?
Obesity and Cardiac Disorders can very frequently be encountered as independent diseases in the modern era. Each disease independently carries the privilege of producing life threatening damages in the body. But when they get connected with each other in a cause and effect relationship, they form a lethal combination. Obesity and Heart diseases (CVD) may be considered as 2 sides of the same coin because they are very often considered and practically evidenced as inter-related ailments.

If you are over-weight or obese…well….you may be highly prone to get a heart disease!!!!

Medoroga / Sthoulya (Obesity) is considered as one of the important modifiable risk factors of Coronary Artery Disease (CAD). A positive correlation has been established between obesity, plasma cholesterol concentration, familial hyperlipidemia (excess bad fat in the blood stream) and physical inactivity and prevalence of morbidity (the relative incidence of a particular disease) and death from coronary disease.

Note – Coronary arteries are the blood vessels which supply blood and nutrition to the heart

Similarly severe obesity may increase the work load over the heart leading to excessive cardiac output which in-turn may event in Cardiac Hypertrophy (hypertrophy=enlargement of organ or tissues owing to the abnormal increase in the size of its cells), Cardiac Dilatation (heart being stretched beyond normal dimensions) and Abnormal Ventricular Function (ventricle=lower chambers of the heart).

Ayurveda Perspective:
The words ‘Sthoulya and Medoroga’ as available in textual references of Ayurvedic literature may be considered to be related terminologies to the modern words of Obesity, Hypercholesterolemia and Hyperlipidemia etc.

Note –
Hypercholesterolemia – Excess of Cholesterol (Bad Fat) in the blood stream
Hyperlipidemia – Abnormally high concentration of fat or lipids in the blood

Thus the terms Sthoulya and Medoroga cover a wide array of medical conditions explained in Modern medicine like Hypercholesterolemia and Hyperlipidemia apart from covering obesity and overweight conditions.

Similarly a limited reference of cardiac related disorders is available in the explanation of Hridroga. But the cardiac manifestations (heart related symptoms or symptoms indicating dysfunctions of heart) secondary to other systemic disorders have been given different terminologies like Hritshoola, Hritpeeda, Hridgraha, Hridayaashuddi, Hridishoonyata etc. That means to tell that Hridroga also occurs as a secondary manifestation as a complication or symptom of some other disease. The pathological state of heart in different systemic diseases have been given different terms in different contexts. These terms indicate the nature of pathology or the heart is undergoing as related to the primary disease. Ex. Hritshoola (heart pain), Hrit peeda (heart pain), Hrid graham (stiffness or feeling of catch in the region of heart), Hridayashuddhi (an awkward feeling in the region of heart), Hridayashoonyata (a feeling of emptiness in the region of heart) etc are the different terms which explain different manifestations of heart related illness, secondary to some primary illness. But in this article I shall limit Hridroga to CAD or CVD’s caused as an effect of Medo Roga or Sthoulya.

The references indicating relationship of Sthoulya or Medoroga as a causative or risk factor of Hridaya Sambandhi Vikaras (Heart related diseases) cannot be directly obtained from the classics.

But the terminologies explained in the below mentioned chapters or contexts indirectly points towards the possible cardiac manifestations (caused as an effect of errors of fat metabolism or obesity). The terms should be understood by analysing them with the aid of anumana (inference). The contexts are –
Medoroga Prakarana (chapter covering Medoroga or disease manifested due to errors of fat metabolism) of Madhava Nidana text (Chapter 34) and
Ashtounindhita Adhyaya (chapter explaining 8 types of socially unfit people) of Charaka Samhita (Sutra Sthana Chapter 21)

In these chapters we can find some terms like Ayukshaya (decrease in life span), Ashaktaha-sarvakarmasu (inefficiency in doing all kinds of works), Alpaprana (deterioration of life), Nashayatyashu-Jeevitham (quickly takes away the life), Kshudra-Shwasa (dyspnoea or short of breath), Pushyanti Anye Na Dhatavaha (lack of nourishment of other tissues) etc. All these terms point out towards anatomical damage and failure of heart as a pump (physiological breakdown) as an effect of stress created on it by increased fat in the body and also due to errors of fat metabolism and obesity.

Now let us try to make a comparative study of Ayurvedic concepts and modern concepts of obesity. In the process, we shall try to learn how similarly or differently they have tried to establish a link between obesity and heart diseases. To do this, I have tried to put forth analysed view of certain Ayurvedic terms related to obesity in a language of simple understanding. I have also compared them to the terms used in modern cardiology to give a better understanding. By doing so, I have tried to prove that Obesity is a risk factor for heart diseases and Ayurveda was probably the first science to document it!

Obesity – A risk factor for heart diseases, a comparative study of terminologies:
मेदसा आवृत मार्गत्वात् पुष्यन्ति अन्ये न धतवह।
मेदस्तु चीयते तस्मात् अशक्तः सर्व कर्मसु॥
क्षुद्र श्वास तृषा मोह स्वप्न क्रथन सादनैः।
युक्तः क्षुत् स्वेद दौर्गन्ध्यैः अल्प प्राणो अल्प मैथुनः॥(मा.नि.३४/२,३)
मेदस्यतीव संवृद्दे सहसा एव अनिलादयः।
विकारान् दारुणान् कृत्वा नाशयत्याशु जीवितम्॥(मा.नि.३४/८)
Medasaa aavruta maargatvaat pushyanti anye na dhaatavaha
Medastu cheeyate tasmaat ashaktaha sarva karmasu
Kshudra shvaasa trushaa moha svapna krathana saadanaihi
Yuktaha kshut sveda daurgandhyaihi alpa praano alpa maithunaha (Ref – Madhava Nidanam 34/2,3)

Meaning – When the pathways and channels in the body get clogged by morbid fat, the other tissues of the body get deprived of the nutrition and elements which they need to build and maintain selves. When this fat increases over a period of time and accumulates in all the passages leading to depletion of tissues (as the fat tissue takes away the bulk of nutrition), the person becomes incapable of doing any kind of work. He suffers from short of breath, thirst, unconsciousness, sleep, intermittent dyspnoea, laxity and weakness of the body parts, excessive hunger, excessive sweating, foul smell from the body, decreased life expectancy and lowered sexual drive.

Medasya ateeva savrudde sahasaa eva anilaadayaha
Vikaaraan daarunaan krutvaa naashayati aashu jeevitam (Ref – Madhava Nidanam – 34/8)
Meaning – When the morbid fat blocks all the pathways of the body, the dosha’s immediately get aggravated. The vitiated doshas cause severe life threatening complications and take away the life in quick time.

Medasavrita Margatvat –
Term split: Medasa – fat, Avrita – masked or enveloped or blocked, Marga – passages, channels
Thus the term Medasavrita Margatvat means ‘the passages or routes or channels blocked by the morbid fat’
The pathologically increased Meda or fat obstructs different margas (pathways) or srotas’s (channels of transportation of nutrition and other essential body and tissue building components) in the body. Such obstruction caused by morbid fat mainly in Rasa-Raktadi Srotas (channels concerned to transportation of nutrition and blood i.e. blood vessels) point towards pathological conditions like atherosclerosis and hyperlipidemia. Both these conditions in turn lead into the formation of CAD’s (Coronary artery diseases)

Pushyanti Anye Na Dhaatavaha (Under Nourishment of other Dhatus) –
Term split – Pushyanti – get nourished, Anye – other, Na – not, Dhatavaha – tissues
Thus Pushyanti anye na dhatavaha means ‘the other tissues are not nourished or are under-nourished’

The Meda (fat) gains an abnormal increase by consumption of food and activities (meda vriddhikara aharas and viharas) which tend to increase the fat content of the body. The increased fat tends to cause blocks (avarodha) in all the marga’s (passages) and srotas’s (channels and micro channels, cells) of the body. Blockage at various levels in the body leads to deficient supply of nutrients and other requirements (needed for tissue building and functioning) to the other dhatus. This further leads to qualitative and quantitative depletion of all the tissues (other than fat tissue).

At the same time there is excessive accumulation of only meda snatching away all the nutrients which should otherwise have gone to nourish the other tissues (dhatus). This produces a functional overload over the heart which tries to compensate the requirements of other tissues. This chain of events may lead to many a cardiac manifestations like hypertrophy (enlargement of organ or tissues owing to the abnormal increase in the size of its cells), dilatation of the heart (heart being stretched beyond normal dimensions), hypertension (increase in blood pressure) etc which occur as an effect of functional overload.

The Hridaya and its Dasha Dhamani’s being the Moola Sthana’s for Rasavaha Srotas and Rasa in turn is involved in Preenana Karma, the nutritional demands of other dhatus are met with only in the normal functioning of Hridaya and Rasavaha Srotas. The Medas poses to be a major obstacle in this process and leads to imbalanced nutrition when it clogs the Rasavaha Srotas and impairs the smooth functioning of the heart.

Note:
Dasha Dhamani’s – 10 Great blood vessels getting their origin from Heart which in turn give off many branches
Moola Sthana – Place of origin
Rasavaha Srotas – The Channels carrying and transporting Rasa Dhatu (which is in the process of transformation) to the site of requirement
Rasa – The first tissue formed from the essence of our food according to Ayurveda which further takes part in a cycle in which other tissues are formed consecutively
Preenana Karma – Function of Nutrition

Medastu Cheeyate –
Term split – Medastu – The fat, Cheeyate – accumulates
Thus Medastu cheeyate means ‘the fat accumulates’. It indicates and explains the mechanism of accumulation of morbid and unwanted fat tissue in undesired places like passages and channels of circulation in the body.
It indicates the impending atherosclerosis and plaques in the blood vessels which form a risk factor for the CVD’s. Atherosclerosis in coronary vessels may cause IHD (Ischemic Heart Disease)

Note –
Atherosclerosis – A disease of the arteries (blood vessels) characterized by the deposition of plaques of fatty material on its inner wall

Plaques – A sticky deposit
Ischemic Heart Disease (IHD) – It is the most common type of heart disease and cause of heart attacks. (Also called Coronary heart disease, Coronary arterial disease, atherosclerotic heart disease). This is caused due to less blood supply to heart and its muscles.

Ashaktaha Sarva Karmasu (Inability to do any work), Dourbalya (Extreme weakness, Loss of strength) & Javoparodha (Breathlessness) –
The person suffering from Medoroga or Sthoulya will suffer from loss of strength and energy and will be unable to perform the daily routine activities. This mechanism probably points towards the exercise intolerance due to the functional overload produced by excess fat and fat induced blocks over the heart, which in turn functions to meet the metabolic needs of excessive adipose tissue, to metabolize and mobilize the excessive fat. This hyper-functioning of the heart may lead to hypertrophy and dilatation of the heart and abnormal ventricular function, pulmonary congestion (filling in excess of blood or any other fluid in the lungs), peripheral oedema (swelling of tissues especially in the lower limbs / legs due to accumulation of excessive watery fluids) and exercise intolerance.

Kshudra Shwasa –
Term split – Kshudra – short, Shwasa – breath, Thus Kshudra Shwasa means shortness of breath (Dyspnoea, Difficulty in breathing)
Dyspnoea (difficult or laboured breathing) on mild exertion may also be due to functional over load over the heart and lungs produced by excessive fat, as the hyper-functioning heart may cause pulmonary congestion.

Alpaprana (Decreased Life expectancy and Hypoxia)
Term split –
Aplaprana = Alpa – less or decreased, Prana – life, Thus Alpaprana means a decreased life expectancy which also reflects a condition called Hypoxia (less amount of oxygen reaching the tissues)

The person suffering from Sthoulya or Medoroga will have Alpaprana i.e. decreased life expectancy and Hypoxia, which cannot be caused by the meagre increase of Medas. The abnormal increase in Medas producing hypercholesterolemia, hyperlipidemia, atherosclerosis etc. may in turn produce cardiac manifestation’s like cardiac dilatation, ventricular hypertrophy etc. The consequence of one or more of these conditions will be hypoxia, nutritional impairment, hypertension, renal insufficiency (deficient excretion of wastes from kidneys) etc.

This chain of events may cause a threat to the life and may be responsible for decreased life expectancy. Here, the hypoxia caused due to multiple blocks caused by morbid fat exerting a functional burden on heart and lungs in the process will cause decreased life expectancy as a whole as well as that of each and every cell.

Hridaya is a place (sthana) for ojus (essence or active principles of all the tissues). The sroto-avarodha (blockage of body channels) caused by meda (fat) in medoroga may cause depletion of Dhatus (tissues) and hence result in ojokshaya (depletion of ojus). Since depletion of ojus reflects a gross depletion in the quantity and quality of all the tissues, ojo kshaya may be considered as a predisposing factor for Dourbalya (weakness), Ashaktata (inability to do any type of work), Alpaprana (decreased life expectancy) and Javoparodha (breathlessness).

Vikaaraan Daarunaan Kritva Naashayatyaashu Jeevitham
Term split –
Vikaaraan – diseases or disorders, Daarunaan (complicated or troublesome), Kritva (does), Naashayati (destroys) aashu (quickly), Jeevitam (life)
Thus ‘Vikaaraan daarunaan kritva naashayati aashu jeevitam’ means ‘it causes complicated disorders quickly leading to loss of life i.e. death’
This explains that the meda (fat) is responsible for manifestation of life threatening disorders in the body. Accumulation of excessive morbid fat in the body passages leads to imbalanced supply of nutrients and building elements to the tissues. Deprivation of nutrition leads to cell damage consequentially leading to tissue depletion. Amidst all these pathological background, the dosha’s – Vata, Pitta and Kapha get aggravated and start destructive activities in the body. The immunity starts deteriorating. The overall effect leads to the manifestation of life threatening disorders which can ultimately end up in death.

Obesity is generally responsible for hypertension, which in turn may cause hypertensive cardiac diseases. The patients of hypertensive heart disease have advanced coronary atherosclerosis and may develop progressive IHD. Weight reduction seems to reduce the systolic BP significantly. As a result of atherosclerosis and hypertension there is an increased risk of MI (Myocardial Infarction) and stroke in obese individuals, thus producing a threat to life.

Note –
Hypertensive Cardiac Diseases – Heart Diseases caused due to raised Blood Pressure
Systolic – The phase of the heartbeat when the muscles of the heart contract and pump the blood from its chambers into the arteries
Myocardial Infarction (MI) – Destruction of Heart tissues due to the deficit blood supply to the muscles of the heart. (Another name for Heart Attack)
Stroke – a sudden disabling attack or loss of consciousness caused by an interruption in the flow of blood to the brain, especially through thrombosis

Atherosclerosis in coronary vessels may cause IHD. Myocardial ischaemia may event in MI, chronic IHD etc. MI in turn may cause arrhythmias, Congestive Cardiac Failure (CCF), Cardiogenic shock, thrombo-embolism, cardiac aneurysm, pericarditis etc. all of which may be life threatening.

Acute coronary syndromes i.e. acute myocardial infarction, unstable angina and ischaemic death are often precipitated by fixed coronary atheromatous plaques

Obesity causes hyperinsulinaemia and Non Insulin Dependent Diabetes Mellitus (NIDDM) or Type 2 Diabetes which are responsible to produce hypertension which in turn is responsible for heart diseases.

Obesity is related to hypo-ventilation syndrome which events in polycythaemia and eventually right sided heart failure

Note –
Myocardial ischaemia – Less blood supply to the muscles of the heart
Arrhythmias – Fast/slow, Regular/irregular heart beat – disturbance in the rhythm of the heartbeat
Congestive Cardiac Failure (CCF) – Heart failure, failure of the heart in the function of pumping blood, not meeting with the demand of the body’s requirements
Cardiogenic shock – shock caused by cardiac (heart) arrest
Thrombo-embolism – obstruction of a blood vessel by a blood clot
Aneurysm – Excessive localized enlargement of an artery caused by weakening of the arterial wall
Pericarditis – Inflammation (swelling) of outer layers of the heart
Unstable angina – condition in which the heart does not get enough blood and oxygen supply. It may lead to heart attack. Angina is a type of chest discomfort or pain due to poor blood flow through the blood vessels (coronary) of the heart muscles (myocardium). It may present as a chest pain also.
Atheromatous – degeneration of the arterial walls due to accumulated fatty deposits and scar tissues obstructing blood supply
Hyperinsulinaemia – excessive level of insulin circulating in the blood than expected in relativity to the level of glucose
Non insulin dependent diabetes mellitus (NIDDM) – It is also called Type2 Diabetes or adult-onset diabetes. In this, the body either resists the effect of insulin – a hormone that regulates movement of sugars into the cells or do not produce enough insulin to maintain a normal glucose level
Hypoventilation syndrome – Also called Pickwickian Syndrome. In this, the severely overweight people fail to breath rapidly enough or deeply enough, resulting in low blood oxygen levels and high blood carbon dioxide levels.
Polycythaemia – abnormal increase of haemoglobin in the blood

I have discussed these terminologies which reflect the effect of obesity and errors of fat metabolism on the heart. When we try to connect each term and form a web of them, the pathology and pathogenesis leading from accumulation of fat to damage of heart is clearly seen and understood. Actually Ayurvedic texts have explained all the terms together and have narrated the events in chronological order. But for convenience of understanding and correlation with the terminologies of modern medical science, I have split the terms and have handled them as separate sub-topics.

Ayurveda has accepted Medoroga or Sthoulya as a Santarpanottha Vyadhi (disease caused due to over nutrition). Obesity is also included in nutritional disorders in modern medical science.

Hridroga has not been told to be caused by Santarpana (saturation or over-nutrition). But it has been included under the indications of Langhana (lightening therapies). This probably indicates the relationship of Hridroga with Santarpana or Santarpanottha Sthoulya (obesity caused due to over nutrition), which again is curable by Langhana or Apatarpana Chikitsa (depleting nutrition or causing starvation, which is a form of treatment). Hridaya Shuddhi (feeling of lightness in the region of heart or head) is one of the symptoms of Samyak Langhana (Properly done lightening therapy).

Langhana or Lightening therapy is an indication in obesity. When Langhana or lightening therapy is done in a proper way, it brings about lightness in the region of heart (which was not there when the person was obese). This also reflects that the heart starts functioning normally after the burden on it has been relieved as an effect of reduction of weight through well planned therapies for obesity. This shows the relationship between obesity and heart ailments. Read more about Langhana therapy

All the above said factors indicate the probable relation of obesity with CVD as a risk factor. It also shows us that the ancient Ayurvedic science of medicine knew that obesity and errors of metabolism, apart from causing many health related problems, damage the heart leading to life threatening complications.

Few Tips to keep the heart safe from fat (Preventive and Therapeutic):
Keep away from over eating
Get indulged in regular daily exercises (Physical and Mental activities) and avoid sedentary life style.
Avoid calorie rich diets and the diets derived from carbohydrates and fats (Medhya-Fat rich and fat enhancing food, Shleshmala ahara-foods which cause vitiation of kapha in the body which in turn causes Obesity and CVD, Madhura anna rasa-Foods and drinks rich in sweet taste, Sneha-Oil rich foods etc)
Therapeutic starvation – Only water, no caloric drink with vitamin mineral and protein supplements in very obese (Langhana, Apatarpana etc)

Undergoing Panchakarma therapies (Ayurveda cleansing and detoxifying therapies), Yoga and Naturopathy will surely help. Among Panchakarma therapies – Vamana (therapeutic emesis), Virechana (therapeutic purgation) and Vasti (medicated enemas) are highly beneficial in reducing weight and thus aiding in recovery from fat induced heart ailments.
Udwarthanam (powder massage done in the reverse direction of traditional massage) is a widely practised Ayurvedic treatment highly effective in weight reduction.

Monitoring stress, dealing with conditions like Depression etc is essential. Soothing Ayurvedic massages (Abhyanga), pouring of medicated liquids over the head (shirodhara) and body (sarvanga dhara) in streams etc treatments along with meditation and Yoga are good inclusions in weight management programmes and cardiac protective treatments. Releasing the heart from the clutches of morbid fat is the key.

Hridaya being a sthana for ojus, the sroto-avarodha caused by meda in medoroga may cause depletion of dhatus and hence ojokshaya (depletion of ojus) which may be a causative factor for dourbalya, ashaktata, alpaprana and javoparodha

Just before finish,
If your body is regularly gaining or losing something, do not ignore. It may be an early sign to indicate that a foundation for a serious life threatening disorder is being laid in the body. You need to have your body proportions close to accurate if not perfect to keep away from wide array of diseases, especially dangerous ailments related to heart and circulation. Regularly following the above mentioned tips religiously can minimise fat in the body, thus reducing the risk of CVD’s which in turn improvise the life expectancy of an individual.

“Control, Avoid and Expel Bad Fat-Protect your Heart” should be the thought for the modern world, the principles being alike in Ayurveda and the present day medical sciences

Click to Consult Dr Raghuram Y.S. MD (Ayu)


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Comments

  1. dreamh11 says:

    Very informative article.

  2. This is great article i liked it a lot i will suggest to my friends and family members

  3. This is good article i will suggest to my friends and family members

  4. Dr. G S Lavekar says:

    Dr. Hebbar and your team, Congratulations, almost all articles are excellent, very much useful for Academicians, Therapist and Researchers; your contribution is worth and praising.

    • Dr J V Hebbar MD(Ayu) says:

      Dear Dr G S Lavekar sir, many thanks for your kind words of appreciation and encouragement 🙂

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