Bulimia nervosa: Ayurveda Understanding

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

Bulimia nervosa or bulimia is not only a serious eating disorder, but is also a potentially life-threatening disorder. Patients with this condition experience binge eating episodes. They eat large amounts of food in a single sitting and often eat secretly. Following this, they suffer from feelings of guilt and shame. This consequently leads to purging behaviours like vomiting or misuse of laxatives to eliminate the consumed calories.

People suffering from bulimia are preoccupied with their body shape and weight. They judge themselves very harshly. Effective and timely treatment and counselling will help improve self-esteem, promote healthier eating habits and mitigate severe complications.

Symptoms of Bulimia include persistent fear of gaining weight and consequent adaptation of unhealthy methods to lose weight, episodes of binge eating, loss of control in eating food, indulgence in purging behaviours, engaging in extreme exercise to prevent weight gain, misuse of medications like laxatives, emetics or enemas, alternating between binge eating and fasting, using dietary or herbal supplements for losing weight and feeling extremely dissatisfied with their body shape and weight.

Bulimia Nervosa: Ayurveda Understanding

There is no condition explained in Ayurveda which can be exactly correlated with Bulimia Nervosa.

But we will try to draw some inferences from Ayurveda references and match up with the explanation of Bulimia Nervosa hypothetically.

Manasika Roga / Mano Dosha

Herein the person binge eats, wherein he or she eats large amounts of food, often in secret. So, one cannot control over food is the key point to look at. They also have feelings of guilt and shame followed by forcible purging behaviours. This condition is also connected to self-perception and people judge themselves for their body weight and shape and flaws therein. The basic thing we need to see here is that it is all a ‘mind thing’.

The mind is not analysing so as to what and how much and at what time it is right and sufficient to eat. The judgment of mind over the food requirements and limitations are lost. These people eat and then feel guilty and find remedies for that which will create awkward and untoward problems and complications. So, when they are eating, they do not feel it is wrong, they are trying food to compensate for something. Food is an attraction and illusion at that particular point of time. They only realize after the act. These fluctuations in thought process and judgment are also related to deviation of memory of good and bad things and the ability to discriminate between them being masked.

So, we see these people are mentally disturbed. Hence this Bulimia Nervosa can be classified grossly under manasika roga.

The ‘Manovaha Srotas’ Link

Since manas is involved, the manovaha srotas – the channels and pathways of mind are definitely involved. The imbalances of raja and sattva qualities of mind and deterioration of sattva quality can be inferred.

Hridaya is one of the roots of manovaha srotas. Though Hridaya means heart, it also contextually means ‘the brain’ – which is the seat of consciousness, mind, thoughts, decision making and memory.

The manovaha srotas also includes the dasha dhamanis – which are the channels through which the sensory and motor information and the thought processes flow.

We can also see that the functions of the mind are also imbalanced and displaced here. When the person eats, there is no –

– Indriyabhigraha – control of the mind over the senses or sense organs
– Svasya nigraha – control over self
– Uha – understanding
– Vichara – thought process which is right situationally

Usually it should be ‘think and act’, these people ‘act and think or worry’.

There are also errors occurring in the subjects of the mind in Bulimia Nervosa, including –

– Chintya – thinking
– Vicharya – analysing
– Uhyam – guessing
– Dhyeya – concentration / focus
– Sankalpam – decision or determination

The ‘Ati Santarpana’

The main issue of Bulimia Nervosa is ‘uncontrolled eating’. This leads to excessive nutrition beyond the point of need or saturation. Basically, we see it as ‘ati santarpana’. All diseases including obesity / weight gain etc which branch out from ati santarpana will be considered as ‘ati santarpanotta rogas’ i.e. diseases caused due to excessive and undesired nutrition. The effects of bulimia nervosa, immaterial of what causes it, is ati santarpana.

Ati Santarpana – excessive / binge eating in Bulimia Nervosa puts the patient at risk of developing diabetes. Ati santarpana / ati ashana leads to medo roga / medo vriddhi, medovaha sroto dushti and medo pradoshaja rogas. Prameha – diabetes is one among the diseases caused due to contamination of fata related channels or diseases caused due to errors of fat metabolism.

Santarpanottha Vikaras and Bulimia Nervosa

Among the diseases or symptoms mentioned as being caused by ati santarpana i.e. overnutrition or excessive eating, the below mentioned have also been mentioned amongst the complications or risk factors of bulimia nervosa –

– Prameha – diabetes has been mentioned among the complications of bulimia nervosa
– Pandu – anemia,
– Kushta – skin diseases / dry skin,
– Ama pradoshaja rogas – severe gastrointestinal problems like irritable bowel syndrome (mentioned as complication of bulimia),
– Ati sthoulya – obesity / excessive weight gain,
– Klaibya – sterility or infertility

Atyashana

Binge eating is one of the main symptoms of Bulimia Nervosa. We call that as ‘atyashana’ or ‘ati ashana’ in Ayurveda. This is one of the eating disorders as per Ayurveda. This leads to agnimandya – weakness of digestive fire and power and subsequent formation of ama. Also an increase of kapha and meda occurs which leads to weight gain. The consciousness which gets ignited as a consequence will push the person to obsessively adopt methods and measures to lose weight.

Medo Roga

The fat which gets increased due to binge eating and subsequent agnimandya, would block all the channels of the body and deplete nutrition to all the tissues. This condition is called medo roga – errors of fat metabolism and dreadful symptoms branching from it. The person might get stuck in a vicious cycle of fasting, food restrictions and binge eating.

Sthoulya

Obesity or weight gain in bulimia nervosa is due to errors of fat metabolism caused due to non-calculative binge eating and consequent deposition of fat in untoward ways and in untoward places of the body.

The rajo and tamo guna link

There are mood swings and depression in bulimia nervosa patients and they may occur due to the increase of tamo guna of the mind and fluctuation between rajo guna and tamo guna. The feelings of guilt are also due to aroused rajas and tamas qualities of mind.

The Grahani Link

Bulimia Nervosa has a relationship with mental health issues including depression, anxiety, substance misuse etc, which are in fact the triggers of the mentioned condition also. When we see through a condition ‘Vataja Grahani’ an intestinal disorder explained in Ayurveda, the patient, among many symptoms would have kshut – severe hunger, griddhih sarva rasanam – desire to eat foods having all the tastes (like all or any foods, as in binge eating) and manasah sadanam – depression – a condition resembling bulimia nervosa.

A high prevalence of ‘Irritable Bowel Syndrome’ (IBS), a gastrointestinal complication, is noted among Bulimia Nervosa patients. IBS is correlated with Grahani. Krishata – emaciation has been mentioned among the symptoms of Vataja Grahani. This may be the result of the patient trying unusual methods of losing weight, excessive consumption of vata aggravating foods and activities or a combination of both.

Panchakarma Apachara

We have the concept of Panchakarma Apachara i.e. erroneous and injudicious use of purification / detox therapies mentioned in some contexts in Ayurveda, as amongst etiological factors of kushta – skin diseases, which can cause serious health issues. We see that many people rush into Ayurveda hospitals and demand for Panchakarma therapies to put down weight and get rid of obesity and weight gain issues. Many do it even without consent of a doctor or a proper prescription. Bulimia Nervosa patients would also do this for getting proper and frequent purging or emesis. The doctor’s rule is very crucial here.

The ’Unmada and graha dosha’ Connection

The word Unmada is generally correlated with psychosis or insanity. But the term / condition unmada is a huge umbrella term under which many patterns and variants of minor to major to complicated to idiopathic conditions of mental imbalances and disorders get included. Bulimia Nervosa may not exactly fit into the description of unmada, but it might not be wrong to do so. The patterns of eating without method or limits and binge eating is found as a symptom in some kinds of unmada. Same is the case of graha dosha – affliction by demons and supernatural entities or malevolent and unfavourable planets. Unmada is also a manasika roga – mental disorder. These abnormal eating habits are found mainly in Bhuta unmada conditions – special types of unmada wherein the person is afflicted by Bhuta – supernatural forces.

Example –

– In a type of Bhuta Unmada i.e. Unmada caused by Deva Shatru or Danava i.e. demon one of the symptoms is ‘santushto na bhavati cha annapana jataih’ i.e. the person is not satisfied in spite of consuming large quantities of food and drinks.

– In yet another type of Bhuta Unmada i.e. Unmada caused by Pitru Graha – spirits of ancestors, it is mentioned ‘mamsepsu tila guda payasabhikamah tad bhakto bhavati’ i.e. the person has too much inclination towards frequent and excessive consumption of foods prepared from meat, sesame, jaggery and also sweet dishes.

– Similarly, a person afflicted by Sarpa Graha – a type of Bhuta Unmada, the person is greedy for eating food products prepared with jaggery, honey, milk and sweet diseases as said – ‘guda madhu dugdha payasepsu’.

– Bahvashi – ‘eating in excess’ is one of the symptoms of a person afflicted by Pisacha Graha – one more kind of Bhuta Unmada.

We also need to see that these persons also have other psychological symptoms along with eating patterns similar to Bulimia Nervosa.

Asatmya Indriyartha Sannikarsha, Prajnaparadha, Kala Parinama

Improper coordination between sense organs and their respective sense objects, intellectual blasphemy (committing mistakes or sins in a state of consciousness and awareness) and impact of transforming time – are considered as the chief causes of almost all the diseases. All these are involved in the pathogenesis of Bulimia Nervosa also.

Dhee Dhrti Smriti

The abnormal deviation and imbalance of dhee – intelligence, dhriti – courage / decision making power and smriti – memory is the key event in any mental disorder, and so also in Bulimia Nervosa.

Ajirna, Anatmavantah and Bulimia Nervosa

In the context of Ajirna – indigestion there is a verse which explains – ‘When a person who does not have self-control consumes food in excess and abnormal quantities and also keeps eating anything and everything without taking quantity of food into consideration, just like an animal, will suffer from ajirna – indigestion, which is the root cause of many diseases’. Here, the explanation of ‘eating without control’ resembles the explanation of Bulimia Nervosa. All the other systemic diseases and complications which occur in Bulimia Nervosa are due to consequent indigestion and accumulation of wastes and fat in the body.

Conclusion

Below mentioned is the DSM-5 Criteria for diagnosing Bulimia Nervosa –

– Recurrent binge eating.
– Regular purging through vomiting, excessive exercise, misuse of laxatives, or fasting.
– Self-worth derived from weight and body shape.
– Binge eating and purging occurring at least once a week for three months.
– Absence of anorexia nervosa.

These symptoms as such are not explained in a bunch anywhere in Ayurveda nor any condition which resembles Bulimia Nervosa closely. The explanation given in this article is only my perspective and should be seen as hypothetical.

Ayurveda Treatment options for Bulimia Nervosa

Depending on the hypothetical presentation that I have given in this article about Bulimia Nervosa Understanding from Ayurveda perspective after having considered various aspects from Ayurveda basics and as per my understanding, I would tell that the treatment principles and protocols too should be made taking into consideration the above explained aspects. The approach should be skilful, situational and strategical.

Nidana Parivarjana

Following the basic principles of treating any disease in Ayurveda, the first and foremost rule will be avoidance of causative factors or anything which triggers.

Mano Chikitsa, Sattvavajaya Chikitsa

Since the mind is mainly involved in this condition, the mind needs to be treated. The three principles are applicable here also –

– Dhee – manipulating the basic intelligence of the individual which has deviated or perverted,

– Dhairya – instilling confidence and courage in the individuals – counselling, psychotherapy

– Atmadi Vijnana – making the person to realize the importance of ‘self’ and ‘self-care’ and also regarding what is good and what not

The components of mind functions i.e. indriyabhigraha, svasya nigraha, uha and vichara too should be worked upon. The person should be trained in terms of proper Chintana and Vicharana, and also to indulge in meaningful and proper Uha, Dhyeya and Sankalpa.

Sattvavajaya Chikitsa which is similar to psychotherapy is an important tool in treating conditions like Bulimia Nervosa wherein the physician should try to conquer the mind of the patient by counselling and other useful measures.

Apatarpana and Langhana

Since this condition is caused due to santarpana – over nutrition, the opposite measures should be adopted i.e. apatarpana chikitsa – therapies and medicines which might deplete the body of those accumulated extra calories. Likewise, langhana measures too should be advocated in the treatment protocol – anything which brings about lightness in the body. Therapies like udwarthana, vamana, virechana and vasti, and measures like therapeutic fasting, indulgence in regular exercise, walking in early morning sunlight etc should be considered as and when needed, as per the skilful decisions of the doctor.

Daiva Vyapashraya

Divine or belief therapies come in handy when other treatments or approaches fail or will help as support therapy in Bulimia Nervosa.

Other principles

Bulimia Nervosa shall be treated on the principles of treatment of below mentioned conditions –

– Medo Roga
– Sthoulya
– Grahani Roga
– Unmada
– Bhuta Unmada
– Graha Roga
– Chittodvega
– Teekshna and Vishama Agni
– Vidagdha and Vishtabda Ajirna
– Vata Vyadhi

As per the presentation of Bulimia nervosa as connected to these disorders – the diet, medicines and therapies should be planned accordingly.

Also,

The person should be trained to control his or her senses so that they do not make excessive or perverted contact i.e. ati or mithya yoga with the sense objects, mainly of darshanendriya i.e. sense organ of sight or eye and jihvendriya i.e. sense organ of smell or nose, the main reasons for eating more food or binge eating.

The deviations or perversions of dhi, dhrti and smriti should be identified and addressed promptly. This will prevent the person from committing mistakes in a state of consciousness i.e. prajnaparadha. By addressing these two aspects, one can prevent the effect of time which may, going ahead, cause many complications which are difficult to handle.