Figure 1: A family heirloom. The author\’s great-grandfather kept a diary of Ayurvedic treatments.
Abstract
Traditional treatments, although not yet widely acknowledged in modern medical settings, are gradually attracting new attention from the scientific community. The increasing understanding of the gut microbiome aligns particularly well with Ayurvedic approaches. This paper aims to explore areas in which traditional medical treatments may be combined with modern medical approaches to effectively nullify many of the shortcomings of either system. The goal is to raise awareness of the credibility of traditional treatments and how they can be used to significantly improve quality of life.
Introduction
Ayurveda is a holistic approach to medicine and healthcare that began in the Indian subcontinent at least 2,000 years ago. As a rather complex system, Ayurveda encompasses multiple aspects of health. Also, Ayurveda differentiates medical care according to distinct body types, thus making personalized medicine a cornerstone of the system. Despite its long history, relatively few modern clinical studies have tested Ayurvedic approaches.
It is common to hear Ayurvedic physicians refer to the gut as the “second brain”. One of the main pillars of Ayurvedic medical theory is that the health of one’s gut is essential to the health of the rest of the body. This theory is backed by modern studies that show that changes in the composition of the microbiota increase the likelihood of various diseases.[1]
The microbiome refers to the massive colony of bacteria that populates the human gut. In recent times, researchers in the West have turned increased attention to the sheer scale and variety of these bacteria and have observed a clear link between an individual’s health and gut microbiota.[2] What has also come to light are the ways in which diet, lifestyle and other factors can influence the make-up of this microbiome.
Studies show that to maintain a healthy microbiome, one must adhere to a diet that is high in fiber, free of processed foods and mostly plant-based.[3] This is in line with the type of diet Ayurvedic physicians have recommended for thousands of years. Even Western recommendations that do not refer to the microbiota tend to align with Ayurvedic suggestions. For example, nutritionists in Europe and North America have begun to promote turmeric for its anti-inflammatory properties,[4] whereas turmeric has always been a staple of Ayurvedic medicine and diet.
In addition, Ayurvedic preparations are emerging as a possible treatment for milder bacterial infections, where the use of antibiotics may cause side effects and the development of antibiotic resistance. For instance, methicillin-resistant Staphylococcus aureus (MRSA) is becoming increasingly common due to overuse of antibiotics, and treating mild S. aureus infections with Ayurvedic preparations may reduce the number of instances of MRSA and other antibiotic-resistant bacteria.[5]
This paper explores selected areas in which ancient Ayurvedic knowledge aligns with emerging scientific evidence and outlines the potential benefits of integrating Ayurvedic traditions into modern medicine.
Figure 2: The script of this diary is Malayalam, the language of the southern Indian state of Kerala, where Ayurveda was developed.
Literature Review and Discussion
Correlation of the Microbiome and Lifestyle Diseases
An increasing body of evidence suggests that the gut microbiome is a key factor in an individual’s health. As certain ‘lifestyle diseases’ have become more commonplace, correlations with microbiota size and diversity have been observed.
Irritable Bowel Syndrome
One prominent example is irritable bowel syndrome (IBS), a chronic condition in which patients suffer from diarrhoea, abdominal pain, cramping, constipation, and other gastrointestinal symptoms. IBS cases have risen dramatically, with roughly 11% of people worldwide suffering from it as of 2014.[6] In fact, IBS cases tend to increase in a country when it becomes more “Westernized” with regards to diet and other lifestyle changes. The reason for this is not known.[7]
Studies have shown that IBS patients often have an altered microbiota in comparison to healthy individuals; IBS patients tend to have higher Firmicutes: Bacteroidetes ratios.[8] However, it is notable that IBS is not necessarily caused by a single species, but rather altered ratios of bacterial species as a result of an initial trigger.
The trigger is usually some kind of stomach bug, which is subsequently treated with antibiotics. When the patient continues to experience symptoms even after the infection is treated, this is theorized to be a result of the antibiotics upsetting the makeup of the gut microbiome.
As further indication of an altered microbiota population being the cause of IBS, experimental microbial treatments in the form of fecal transplants have been shown to be up to 60% effective at permanently curing IBS.[9] In addition, probiotics have been proven to be effective at managing IBS symptoms.
Allergies
Increasing empirical evidence has shown a significant inverse correlation[10] between rising rates of individuals with allergies and a decreasing number of individuals with the Helicobacter pylori bacteria present in their gastrointestinal tracts. In mice, an H. pylori colonization has been proven to protect against allergic asthma, and H. pylori colonization of children has been proven to boost immunity.[1]
It has been theorised that this decrease in individuals with H. pylori is the result of decreasing mother-to-child microbiota transmissions.[11] This is in turn due to modern birthing procedures, such as C-sections or sterile practices intended to protect the child from infection.
Obesity
Emerging theories link microbiota populations to obesity, which leads to an increased risk of other conditions such as diabetes or heart disease. One possible reason is the impact of the microbiota population on the absorption of calories. Microbe-free mice have been proven to be resistant to obesity even if fed a high-fat diet, as they lack the fermenting bacteria which process complex polysaccharides. Colonizing the same microbe-free mice with the enterotype (the specific microbial makeup of an individual’s microbiome) of a normal mouse resulted in a significant increase in weight and subsequently obesity when fed a high-fat diet, proving the significance of microbiota of populations in food absorption.[1]
Another possible reason has to do with leptin, a hormone necessary for the regulation of appetite and food intake. In mice, changes in bacteria population have influenced the regulation of leptin. Transferring the enterotype from mice with low leptin levels to wild mice resulted in the wild mice becoming obese [1].
IBS, allergies, and obesity are only a few examples of how microbiotal imbalance can negatively affect one\’s health.
How Modern Lifestyle Affects the Microbiome
Research has found a clear link between rising instances of certain diseases and an overall decrease in microbiota health. As science uncovers the vulnerability of the microbiome, as well as the connection between small changes and substantial consequences, questions emerge: How is lifestyle connected to such a sizeable increase in diseases such as asthma? What approaches can help avoid these diseases?
Childbirth and Infant Care
Colonization by microbes starts with the mother passing on her microbes to the baby during natural birth. The mother continues to contribute to the building of a robust microbiota by passing on oligosaccharides through breastfeeding, which promotes the growth of bacteria such as Lactobacillus and Bifidobacterium.[12]
Modern birthing methods have limited the transmission of microbes from mother to child. C-sections are on the rise, with rates across the world increasing from 6% in 1990 to 21% today in 2020. In Brazil, more than 80% of births in private hospitals are C-sections, with the vast majority of them being done unnecessarily.[13] A 2008 study showed that babies born by C-section had lower gut bacterial counts than those delivered naturally.[11] Bottle-feeding in place of breastfeeding has also been proven to have a negative impact on the immune system and increase the risk of allergies and infections in early life.[14]
Asthma and allergies have become increasingly common over the last few decades, and according to the Centers for Disease Control and Prevention (CDC), 25 million Americans had asthma in 2009, compared with 20 million in 2001.[15] This correlation between the increase in the frequency of asthma and the decrease in natural births and breastfeeding suggests that higher numbers of bacteria in the gut may help decrease the risk of diseases like asthma which are caused by an increased immune response. The increase in asthma cases would align with the theory that microbiome health in developed and developing countries has been negatively impacted over the last few decades. Despite the large amounts of evidence, it is still unclear exactly how allergies may be a result of lower microbiota diversity.
Exercise
Exercise has been proven to positively impact gut microbiota, with a 2014 study showing that athletes have a greater gut microbiota diversity.[16] The effect of insufficient exercise on the microbiota could explain increases in microbiota-linked diseases such as IBS in developing countries as individuals transition away from physically intensive jobs such as farming and towards a service-oriented economy that often comes with more sedentary work.
Diet
Diet is perhaps the biggest factor influencing the composition of gut microbiota. A bidirectional relationship between diet and enterotype has been proven; by eating certain foods, one’s microbiota will adapt to suit that diet. A 2011 study showed that “microbiome composition changed detectably within 24 hours of initiating a high-fat/low-fiber or low-fat/high-fiber diet”.[17]
Western-style diets high in fat and low in fiber tend to be associated with large numbers of Bacteroides whereas traditional plant-based diets common in rural Africa and South America tend to have large numbers of Prevotella. Children in Western countries tended to have low Bacteroidetes: Firmicutes ratios, a feature common in obese people. Native Africans, who have a diet low in animal products, tend to have a more diverse microbiota than African- or European-Americans, who consume a Western diet.[2]
Another example of how traditional diets are better for the microbiome is the consumption of curd. For thousands of years, Ayurvedic physicians have promoted the use of curd (or yogurt as it is called in the West), a natural probiotic. Typical diets in parts of South India where Ayurveda has historically been practiced tend to consume homemade curd daily.
Curd naturally contains probiotics due to the starter culture required, which includes significant Bifidobacteria and Lactobacillus populations that improve gut microbiota composition. The effect of these bacteria has been proven, by numerous studies exploring the benefits of curd and other probiotics. A 2007 study showed that when constipation-predominant IBS patients consumed fermented milk (a probiotic product similar to curd), they experienced a decrease in discomfort, a decrease in bloating and an increase in stool frequency.[18] A 2019 study showed that fermented milk consumption was associated with higher levels of Bifidobacterium and that yogurt consumption was associated with higher levels of Streptococcus thermophilus.[19]
In recent times, yogurt has become increasingly popular throughout North America and Europe. However, most large commercial brands pasteurize their product, which unfortunately kills a majority of the live bacteria it contains (though some brands add probiotics after pasteurization). Many products also contain sugar, artificial colours and/or artificial flavors to mask the tangy, sour taste of yogurt.
Traditionally, curd has been homemade, unsweetened and unpasteurized, and although these are still available on the market, factory-made curd is becoming more popular in India due to lifestyle changes.
Ayurvedic Remedies and Potential Antibacterial Effectiveness
Armenian Bole
A common Ayurvedic remedy for dysentery and diarrhoea is a mixture known as Padikaara Chendooram, a fine powder made from dehydrated alum and Armenian bole, a reddish clay. Armenian bole, also known as bole armeniac, is a common ingredient in traditional medicines all over the world. In fact, in the 17th century, English physician Thomas Cogan recommended a tonic containing bole armeniac designed to prevent the drinker from catching plague.[20] The fact that dysentery is usually caused by bacteria suggests that Armenian bole may have antibiotic-like properties that make it useful against bacterial infections.
Figure 3: Armenian bole, traditionally used to color pottery, also has medicinal purposes.
However, while antibiotics can cause diarrhoea, nausea and abdominal pain, remedies containing Armenian bole do not have any known side effects. It is known that many of the side effects of antibiotics are due to disruptions in the stomach microbiota caused by the death of beneficial bacteria, which appears to be why side effects commonly relate to the stomach. The properties of Armenian bole have yet to be researched, but since it has been used against infections without the risk of side effects, it can be theorized that Armenian bole does not disrupt the delicate composition of the gut microbiota. Once again, it must be stated that there are very few scientific studies about Armenian bole, and the reason for its effectiveness is not yet understood.
Mastic
Another ingredient in Dr Cogan’s anti-plague tonic was mastic, a resin obtained from the mastic tree. Mastic is also used in Ayurveda to treat ulcers, gastritis and inflammatory bowel disease. It is also said that it has antacid and anti-inflammatory properties. Ulcers are often caused by an H. Pylori infection and were until recently attributed to diet. Ulcers are often treated with “triple therapy”, with the drugs Pantoprazole, Amoxicillin and Clarithromycin being taken in tandem.[21] While this treatment is considered the most effective weapon against H. Pylori infections, it often results in adverse side effects and contributes to the problem of antibiotic resistant bacteria.
Figure 4: The mastic tree (Pistacia lentiscus) produces a medicinally useful resin.
A 2009 study showed that taking 3.15 grams of mastic gum a day for 14 days was nearly 50% as effective as triple therapy,[21] with no side effects or risk of antibiotic resistance, providing some credibility to its use in Ayurvedic and European traditional medicine. Physicians using mastic claim that taking it for a longer period increases the success rate, but there are no clinical trials supporting this.
Mastic may also be effective against other bacteria, which may have led to its inclusion in Dr Cogan’s anti-plague tonic. However, there are very few scientific studies about the use of mastic against bacteria other than H. pylori.
Herbal preparations
Reinforcing the theory that certain traditional medicines can be used in place of antibiotics, a 2011 study showed that Ayurvedic herbal preparations were effective antibacterial agents against E. Coli and certain Salmonella bacteria, among others. One herbal preparation, Hareetaki Churna, has even been proven effective against MRSA in laboratory conditions.[22] Ayurvedic treatments include hundreds of various herbs, taken alone or in combination. Currently there is a dearth of clinical studies on the effectiveness of these treatments.
Potential for Clinical Use of Natural Therapies
An argument for using these natural antibacterial remedies would be to alleviate the growing issue of antibiotic-resistant bacteria. Doctors sometimes needlessly prescribe antibiotics for even the most minor illnesses, a practice which may cause more harm than good. Side effects are common, and antibiotics are sometimes prescribed for conditions that may not even have been caused by bacteria, which can lead to the development of dangerous antibiotic-resistant bacteria.
Using natural remedies for milder illnesses and reserving antibiotics for severe ailments could potentially reduce the prevalence of antibiotic-resistant bacteria. The use of remedies like mastic or Armenian bole for less serious illnesses in otherwise healthy individuals would carry minimal risk, since in the event that they are ineffective doctors can prescribe antibiotics if necessary. It must be said that individuals with weaker immune systems should ideally be prescribed the more effective treatment, which is often antibiotics.
A shift to natural medicines would undoubtedly raise questions about safety, but on the contrary, such a move could possibly be safer if handled with caution since they decrease the chance that the user will be infected by antibiotic-resistant bacteria or experience unpleasant side effects that are sometimes worse than the original infection.
Conclusion
Modern microbiota theory affirms certain time-tested, ancient medical approaches such as Ayurveda. Traditional approaches offer benefits, such as minimal side effects and the avoidance of antibiotic resistance. Ayurvedic medicines in particular are worthy of more studies to determine how they could be integrated into modern healthcare.
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[20] Cogan, Thomas. The Haven of Health. 4th edition. London: printed by Anne Griffin, 1636. Digital archive: https://archive.org/details/havenofhealthchi00coga/page/n5/mode/2up?q=bole
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Figure References
Figure 1: Author’s personal photo.
Figure 2: Author’s personal photo.
Figure 3: “File:Armenian bole.jpg”. Wikipedia Commons. Accessed on October 8, 2020. https://commons.wikimedia.org/wiki/File:Armenian_bole.jpg
Figure 4: “Mastic Tree”. Encyclopedia Brittanica. Accessed on August 18, 2020. https://www.britannica.com/topic/mastic#/media/1/368769/114624
About the Author
Naveen David, age 17, is in 12th standard at Indus International School Bangalore. As the son of an American mother and an Indian father, he has a foot in two different worlds. His connection to traditional medicine stems from the legacy of his great-grandfather, who lived in the state of Kerala (the birthplace of Ayurveda) and was an expert in Ayurvedic treatment.