Appetite And Digestion In Diabetic Patients – An Ayurveda Perspective

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

A quote from Master Vagbhata tells that ‘all the diseases have their origin from low metabolic fire, especially the abdominal diseases’. Here we have to consider ‘low metabolic fire’ as ‘imbalances in the digestive mechanism’. This includes sluggish, severe and perverted digestion. Most systemic diseases will have an associated ‘imbalanced digestive fire’ component at the beginning or in the process of the disease. Prameha is not an exception.

Polyphagia i.e. excessive appetite is one of the 3 ‘P’s of the ‘diabetic symptom triad’. The other two ‘P’s are polyuria i.e. excessive urination and polydipsia i.e. excessive thirst.
Read – Excessive Thirst – Ayurvedic Understanding And Treatment

In my clinical experience I have not seen these ‘clinical symptom triad’ existing together as a theoretical rule in most patients. At least one or the other will be missing. Or the patient will miss out telling these symptoms unless asked for. May be when all three are present it makes the diagnosis of diabetes almost confirmed.

But as an Ayurveda physician my observance will be always towards the ‘agni – the digestive fire’ of all my patients. I will never lose out on taking a detailed history of patient’s appetite, digestion and excretion especially in metabolic disorders like diabetes. I have seen diabetic patients have varying forms of appetite and digestion capacity. I have seen patients with severe and also sluggish appetite, some with moderate appetite. The digestion in diabetic patients too is variable. Sometimes it is good, sometimes it is bad and many times unpredictable. The bowel movements too will be in accordance to appetite and capacity to digest foods.

Prameha is correlated to diabetes mellitus. A subtype of prameha i.e. madhumeha is precisely correlated with diabetes by many experts. On the outlook all 20 kinds of prameha look like different pathological manifestations seen in urine. Ayurveda has taken urine as a criterion to access and diagnose various stages and presentations of diabetes.
Read – Loss of appetite: Anorexia: Ayurvedic Understanding And Treatment

Kapha and mandagni at the onset of diabetes

All pramehas are caused due to imbalance of kapha. This includes vata and pitta types of prameha too. Thus at the origin of diabetes there is predominant influence of kapha. Here kapha influences the digestive fire. So naturally there is manda agni i.e. sluggish fire. Consequentially there is weak digestion at gut and tissue level. Lot of ama is formed and put into circulation. Therefore this type of indigestion is called ama ajirna. There is lot of stagnation of fluids and unwanted metabolites in the body cells. The dampness created in the body will further weaken the fire.

These events are applicable in everyone suffering from diabetes but predominantly occur in those of kapha constitution.

Urine is an excreta belonging to kapha category. Therefore in kapha diabetics along with less appetite and weak digestion, there will be excessive formation and excretion of urine. Consequentially there will be increased thirst. The person might drink more water or fluids. This will further lessen the digestive fire and cause related events.
Read – Relationship Between Doshas And Digestive Fire

Principles of intervention – these conditions shall be treated skillfully as per persisting condition –

• On lines of treating kaphaja prameha i.e. kapha type of diabetes
• On lines of treating agnimandya and ama ajirna i.e. weak digestive fire and related indigestion leading to formation of excessive ama
• By administering appetite and digestion enhancing medicines
• By implementing kapha expelling treatments like emesis and herbal powder massages as and when needed
• Kapha combating diet protocol
• Promoting regular exercise and activities
• Promoting weight loss in obese diabetics
• Medicines shall be administered in the form of herbal powders and decoctions
  Read – 50 Great Decoctions Explained By Master Charaka – Maha Kashaya

Pitta and tikshnagni in the progressive stage of the diabetes

Pitta type of prameha vis-à-vis diabetes should be understood as an independent entity from diagnostic and treatment perspective. In pitta diabetics there will be increased metabolism and digestive fire i.e. tikshnagni. The digestion too will be quick and fast. In fact there will be burnout of food and its essence. As a result there will be severe hunger. This can be correlated to polyphagia explained in modern texts.
Read – Understand Pitta Dosha By Its Functions

I just want to add my views on this. The appetite and digestion patterns in pitta type of diabetes might develop as a feedback to sluggish appetite and weak digestion in kapha diabetes. The disease begins with weak digestion and sluggish fire in the stomach. Since more ama and less nutrition are formed, there is a feedback on the tissue fires. The tissue fires get intensified when they don’t get the needed nutrition. This manifests in the form of polyphagia. There may be quick reversal in kapha body types due to abundant kapha in their system. In pitta and vata constitution, pitta predominance might continue.

The person may also feel low appetite sometimes in spite of pitta being high. This is because of ama or kapha association with pitta. Low appetite can also occur in low pitta conditions caused due to high kapha. Destruction of fat tissue occurs in this case to provide energy to the cells. This can be compared to ketoacidosis, a threatening complication of diabetes.
Read – Medo Dhatu: Fat Tissue, As Explained In Ayurveda

Principles of intervention – these conditions shall be treated as per condition from the below mentioned options –

• On lines of treating pittaja prameha i.e. pitta type of diabetes
• On lines of treating tikshnagni and vidagdha ajirna i.e. intense digestive fire and related indigestion leading to burnout of food and deficit formation of nutritive juices
• By implementing pitta and heat expelling treatments like purgation as and when needed
• Pitta combating diet protocol
• Medicines shall be administered in the form of medicated ghee after the ama has been digested
  Read – Diseases Due To Pathological Fat Tissue – Meda Pradoshaja Rogas

Vata and vishamagni in the established stage of the diabetes

Vata type of prameha vis-à-vis diabetes is also an independent entity as said in pitta type. But it can also develop sequentially following the predominance of kapha and then pitta initially. In vata type diabetics there will be variable and unpredictable, erratic metabolism and digestive fire i.e. vishamagni. The digestion too will be erratic, sometimes good and sometimes bad. As a result there will be variable hunger following the digestion pattern.
Read – Vata Dosha – Mastermind Behind All Body And Mind Activities

In vata type of diabetes there will be excessive loss of tissues and ojas, the essence of all tissues. The body will be thin out. Thin / non-obese diabetics fall into this group. The nutrition to the tissues will be less. There will be excessive coldness and dryness in the body and tissues. The tissue fire too will be erratic. Madhumeha wherein there is excessive elimination of urine resembling honey is a sub-type of vata diabetes.

The appetite and digestion patterns in vata type of diabetes might develop as an effect of excessive burnout of tissues in pitta type diabetes. Excessive destruction of tissues leads to increase in vata. This vitiated vata causes vata type of diabetes.

As such in pitta type of diabetes the nutrition to the tissues is low. The tissue fire is also high and causes tissue burn outs. This forms a suitable backdrop for vata to get vitiated. Vata diabetes is also caused due to its independent causes. Polyphagia and polydipsia still persists. Things get more severe if vata diabetics are also vata body types.
Read – Vata Body Type From Structural, Functional Mental And Social Viewpoint

Principles of intervention – these conditions shall be treated as per condition from the below mentioned options –

• On lines of treating vataja prameha i.e. vata type of diabetes
• On lines of treating vishamagni and vistabdha ajirna i.e. erratic digestive fire and related indigestion leading to inconsistent digestion of food
• By implementing vata and heat balancing treatments like enema and oleation as and when needed
• Vata combating diet protocol
• Medicines shall be administered in the form of medicated ghee or oil after the ama has been digested
• Interventions to increase and maintain ideal weight is the key
• Rasayanas shall be used as and when needed to prevent tissue damage and to promote their health

Impact of treating appetite and digestion imbalances occurring in Diabetes Mellitus in an Ayurveda way

• By addressing the appetite imbalances and various kinds of indigestion in Diabetes Mellitus we will address the root cause of the disease i.e. imbalance of digestive fire.
• By this the actions and functions of all the doshas will come to balance.
• When the digestion improves ama is not formed.
• The food is digested properly and nutrition juices are formed in rich quality and quantity.
• These juices put into circulation will nourish and replenish the damaged tissues. The tissues gain strength.
• As a result the strength, endurance and immunity of the system will be restored.
• The organ and tissue health will get back to optimum levels.
• General health is established and the patient starts feeling better.
• The progression of the diseases halts.
• If the age and immunity of the patient is good enough and if the case is acute one, greater cure can be seen.
  Read – Immunity In Ayurveda: Concept, Diet, Herbs, Medicines, Exercise

Limitations

It is very important to look at the ‘appetite and digestion patterns’ and their ‘variability’ while treating diabetes mellitus. But we should not totally rely on these factors. This is one of the strategies for handling cases of diabetes mellitus in an Ayurveda way, but it is not all.

A proper and fractional study, analysis and diagnosis of the stage and dosha involvement in diabetes mellitus are needed. This forms the foundation for comprehensive treatment. Along with balancing the digestive fire disease modifying medicines should be used.
Read – How To Know That Your Digestion System Is Working Fine?

Quality, quantity and timing of food should be reasonable and sensible. It should be in accordance with the appetite and hunger. Maintenance of the digestive fire and optimum health is the secret of keeping diabetes under control.

Large scale variations in appetite and digestion patterns shall be brought to the notice of the doctor.

With ageing and in chronic conditions the change of patterns of appetite and digestion would be fixed and stubborn. Keeping an eye on these aspects and trying good interventions too might not yield great results.
Read – Ayurvedic Home Remedy To Improve Digestion

Popular herbal remedies for correcting indigestion and appetite imbalances in diabetes mellitus

In my clinical experience I have seen that most of the times the disease specific medications mentioned in the classics themselves help in correction of metabolic errors. The same medicines correct indigestion and appetite imbalances while addressing the disease. Below mentioned are few important formulations which serve this purpose.

• Nishakatakadi Kashayam
• Kathakakhadiradi Kashayam
• Varanadi Kashayam
• Tiktakam Kashayam
• Guggulutiktakam Kashayam
• Ayaskriti
• Jambavasava
• Lodhrasava
• Dhanwantaram Ghritam
• Trikantakadi Ghritam
• Guggulutiktakam Ghritam
• Tiktakam Ghritam
• Varanadi Ghritam
• Vanga Bhasma

What modern science has to say?

Polyphagia is an important symptom of diabetes mellitus. The other way, diabetes mellitus is one of the chief causes of excessive hunger. It means excessive hunger or increased appetite. It is associated with both high and low blood sugar levels.

Increased hunger and hyperglycemia

When the blood glucose levels are abnormally high in uncontrolled diabetes, the glucose cannot enter the cells. This happens due to lack of insulin or insulin resistance. As a consequence, your body doesn’t convert the food you eat into energy. Lack of hunger causes increased appetite. Eating food will not get rid of the hunger. This will in fact add to the already high glucose levels. Exercise will help stimulate insulin production and reduce blood sugar levels. If this condition persists you might have to speak to your doctor.

Read about Hyperglycemia and Ayurveda

Increased hunger and hypoglycemia

Abnormally low blood glucose can also cause increased appetite. When blood glucose falls below normal levels, the body responds by releasing stored glucose from the liver. This will cause excessive hunger. Diabetics on medication like insulin or sulfonylureas are at risk of developing severe forms of hypoglycemia. They should eat something sweet as soon as they go hypoglycemic.

Read about Diabetes Hunger and food cravings, methods of dealing with it

Polyphagia is excessive hunger that doesn’t go away by simply eating more food or even by eating more regularly than normal. You need to consult a doctor if you have sudden increase in appetite which doesn’t go away after eating food. You should do this if this episode occurs frequently.

Some observations and tips related to managing low appetite in diabetes

Difficulties with eating are often associated with diabetes or as the side effects of treatment.

It is not appropriate to reduce fat, salt and sugar intake for every diabetic. Poor oral health, effects of some drugs on digestive system, limited mobility and dexterity can all cause discomfort associated with eating.

In loss of appetite

Though you do not feel like eating, you need to eat and drink as much and as often as possible. This gives your body with needed nutrients and helps you to recover.

• You may try to eat small amounts frequently
• Try eating in a small plate. A full big plate of food can make you feel over facing and put you off eating.
• Aim at taking six small meals or nourishing snacks each day rather than 3 big meals.

Follow your hunger and time of hunger – try to eat good when you feel hunger. Example, if you feel good appetite at mornings try eating cooked breakfast in good quantity at that time. If you feel soft consistency foods are easier to manage, have them. They require less effort to chew.
Read – Importance Of Diet (Pathya) For Specific Diseases

Enrich your food – Make your food as nourishing as possible. If you cannot eat solid foods, compensate it with nourishing drink. Ayurveda too has included lighter foods like peya i.e. different types of gruel and tarpana i.e. nourishing drinks as ideal foods in diabetics.

• If you have lost weight and if your appetite is low, you need to enrich your food with inclusion of milk, dairy products and fats.
• Limit sugars as much as possible.
• Eat foods you love rather than being too harsh and restrictive on self. Example – taking jam with toast is better than not taking toast at all.
• Milk and dairy may add energy and protein to your food. Use full-fat dairy products like full cream milk and full fat yogurt in place of low fat varieties. Non dairy milk alternatives such as soya, almond, rice or oat milks may be used alternatively.
• Replace cups of tea and glasses of water with milky drinks such as hot chocolate, malted milk and milk coffee. Lattes, cappuccinos and flat white coffee too are welcome. They may be tried between meals and at supper time.
• Fruits and vegetables – are filling. You can take small portions of these foods when your appetite is low.
  Read – Lifestyle Tips For Healthy People And Patients In Ayurveda

Enjoy what you eat – Food has strong relationship with your mind. Enjoy what you eat and relax while eating. Take time to chew your food well.

Short walk before a meal – or just a few breaths of fresh air may relax you and enhance your appetite and interest towards the food.

It is important to keep balanced meals – Meals should include bread, cereal, potato, pasta or rice, chapatti, yam, sweet potato, fruits and vegetables, meat, fish or milk and dairy foods.

Read – Loss of appetite is dangerous for diabetics

Loss of appetite – can be caused due to complications of diabetes

Undiagnosed diabetes – Having loss of appetite especially in undiagnosed cases of diabetes will open up problems. Loss of appetite for few weeks or more will cause malnutrition. If this is not addressed, diabetes can damage your eyes, nerves and kidneys. It can also cause circulatory problems, stroke or heart attack.
Read – Treatment For Diseases Of Over And Under Nourishment – Charaka Sutra 23

Ketoacidosis – If hyperglycemia is untreated, diabetic ketoacidosis occurs as a complication. High levels of ketones build up in the blood and urine. The cells are unable to use glucose as fuel in the absence of insulin. Now the body breaks down the fat for energy. This produces ketones. One of the symptoms of ketoacidosis is loss of appetite. This can be high kapha-low pitta condition.

Gastroparesis – high blood sugar may damage the vagus nerve over a period of time. This causes slow movement of food down the digestive tract. The muscles of the GI tract will not be capable of moving the food easily out of the stomach into the intestines. Loss of appetite is one of the symptoms of gastroparesis associated with diabetes mellitus. This can be a high kapha-low vata prameha condition.

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