Cardiovascular diseases

Medoroga / Sthoulya (Obesity) – A Risk Factor for Hridroga (Cardiovascular Diseases)-An Ayurveda Perspective

Medoroga / Sthoulya: The terms (diseases) Sthoulya or Medoroga explained in Ayurveda can be simulated with the modern day disease Obesity (Weight Gain).  There are other terms like Medo Vriddhi etc which fall into the category of Obesity. I shall discuss the meanings of all these terms in the forth-coming articles and also about how different are they or how similar are they to each other. In this context we shall discuss the term Medoroga or Sthoulya wrt Obesity.

Hridroga: Similarly I shall discuss the term Hridroga wrt Cardiovascular Diseases (CVD) though the term engulfs a wide array of diseases.

What is the relationship between Medoroga / Sthoulya (Obesity) and Hridroga (Cardiovascular Diseases)?

Obesity and Cardiac Disorders can very frequently be encountered in the modern era. They 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 Artery1 Disease (CAD). A positive correlation has been established between obesity, plasma cholesterol concentration, familial hyperlipidemia and physical inactivity and prevalence of morbidity2 and death from coronary disease.

Similarly excessive obesity may increase the work load over the heart leading to excessive cardiac output which in-turn may event in Cardiac3 Hypertrophy4, Cardiac Dilatation5 and Abnormal Ventricular6 Function.

Ayurveda Perspective:

The classical 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, Hypercholesterolemia7 and Hyperlipidemia8 etc.

Similarly a limited reference of cardiac related disorders is available in the explanation of Hridroga but the cardiac manifestations in systemic disorders have been given different terminologies like Hritshoola, Hritpeeda, Hridgraha, Hridayaashuddi, Hridishoonyata etc.

But the references indicating relationship of Sthoulya or Medoroga as a causative or risk factor of Hridaya Sambandhi Vikaras cannot be directly obtained from the classics. But the terminologies explained in Medoroga Prakarana of Madhava Nidana text and Ashtounindhita Adhyaya of Charaka Samhita viz Ayukshaya, Ashaktaha-sarvakarmasu, Alpaprana, Nashayatyashu-Jeevitham, Kshudra-Shwasa, Pushyanti Anye Na Dhatavaha etc will indirectly point towards the possible Cardiac Manifestations which could be understood only by Anumana (inference).

Comparative Analysis of the Ayurvedic and Modern concepts of Obesity (Medoroga/Sthoulya) – As a Risk Factor for Cardio-Vascular Diseases (Hridroga)

Medasavrita Margatvat

  • The Meda or fat obstructing the margas or different srotas in the body i.e. Rasa-Raktadi Srotas, point towards the atherosclerosis and hyperlipidemia which in turn may lead into the formation of CAD’s

Pushyanti Anye Na Dhaatavaha (Under Nourishment of other Dhatus)

  • The Meda(fat) which has gained an abnormal increase by consumption of meda vriddhikara aharas and viharas9 tend to cause avarodha11 in all the margas or Srotas’s10 which leads to deficient supply of nutrients and requirements to the other dhatus12 which in turn leads to their qualitative and quantitative depletion. At the same time there is excessive accumulation of only meda snatching away all the nutrients. 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, dilatation of the heart, hypertension13
  • The Hridaya and its Dasha Dhamani’s14 being the Moola Sthana’s15 for Rasavaha Srotas16 and Rasa17 in turn is involved in Preenana Karma18, 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.

Medastu Cheeyate (The fat accumulates)

  • It indicates the impending atherosclerosis19 and plaques20 in the blood vessels which form a risk factor for the CVD’s. Atherosclerosis in coronary vessels may cause IHD (Ischemic Heart Disease21)

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 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 congestion22, peripheral oedema23 and exercise intolerance.

Kshudra Shwasa (Dyspnoea, Difficulty in breathing)

  • Dyspnoea24 (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)

  • The person suffering from Sthoulya will have Alpapranae. 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. leading to hypoxia25, nutritional impairment, hypertension, renal insufficiency26 etc. This chain of events may cause a threat to the life and may be responsible for decreased life expectancy.
  • Hridaya being a sthana (place) for ojus27 the sroto-avarodha28 caused by meda (fat) in medoroga may cause depletion of Dhatus (tissues) and hence ojokshaya (depletion of ojus) which may be a causative factor for Dourbalya, Ashaktata, Alpaprana and Javoparodha.

Vikaaraan Dhaarunaan Kritva Naashayatyaashu Jeevitham (Causes complicated disorders and quickly causes death)

This explains that the meda (fat) is responsible for manifestation of life threatening disorders in the body.

  • Obesity is generally responsible for hypertension, which in turn may cause hypertensive cardiac diseases29. The patients of hypertensive heart disease have advanced coronary atherosclerosis and may develop progressive IHD. Weight reduction seems to reduce the systolic30 BP significantly. As a result of atherosclerosis and hypertension there is an increased risk of MI (Myocardial Infarction31) and stroke32 in obese individuals, thus producing a threat to life.
  • Atherosclerosis in coronary vessels may cause IHD. Myocardial ischaemia33 may event in MI, chronic IHD MI in turn may cause arrhythmias34, Congestive Cardiac Failure35 (CCF), Cardiogenic shock36, thrombo-embolism37, cardiac aneurysm38, pericarditis39 etc. all of which may be life threatening.
  • Acute coronary syndromese. acute myocardial infarction, unstable angina40 and ischaemic death are often precipitated by fixed coronary atheromatous41 plaques
  • Obesity causes hyperinsulinaemia42 and Non Insulin Dependent Diabetes Mellitus (NIDDM)43or Type2 Diabetes which are responsible to produce hypertension which in turn is responsible for heart diseases.
  • Obesity is related to hypo-ventilation syndrome44 which events in polycythaemia45 and eventually right sided heart failure

Ayurveda has accepted Medoroga or Sthoulya as a Santarpanottha Vyadhi46, so as to the obesity being included in nutritional disorders in modern medical science. Though Hridroga has not been told to be caused by Santarpana47, it has been included under the indications of Langhana48 which probably may indicate the relationship of Hridroga with Santarpana or Santarpanottha Sthoulya49, which again is curable by Langhana or Apatarpana Chikitsa50. Hridaya Shuddhi51 or feeling of comfort in the heart (chest) is one of the lakshanas of Samyak Langhana52.

All the above said factors indicate the probable relation of obesity with CVD as a risk factor

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
  • Monitoring stress, dealing with conditions like Depression etc are essential

Hridaya being a sthana for ojus, the sroto-avarodha caused by meda in medoroga may cause depletion of dhatus and hence ojokshaya53 which may be a causative factor for dourbalya, ashaktata, alpaprana and javoparodha

To conclude….

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 and also will have a global impact

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

Dictionary

  1. Coronary Artery-Blood vessels nourishing the heart
  2. Morbidity-The relative incidence of a particular disease
  3. Cardiac-Relating to Heart
  4. Hypertrophy-The enlargement of an organ or tissue from the increase of size of its cells
  5. Dilatation-Getting stretched beyond normal dimensions
  6. Ventricular-Relating to Ventricle, the lower chambers of the heart
  7. Hypercholesterolemia-Excess of Cholesterol (Bad Fat) in the blood stream
  8. Hyperlipidemia-Abnormally high concentration of fat or lipids in the blood
  9. Meda vriddhikara aharas and viharas – Food and activities which cause increase in fat
  10. Srotas’s – Channels or duct system or conduction system of the body/mind
  11. Avarodha – Blockage / Obstruction
  12. Dhatu’s – Tissues
  13. Hypertension – Abnormally High Blood Pressure
  14. Dasha Dhamani’s – 10 Great blood vessels getting their origin from Heart which in turn give off many branches
  15. Moola Sthana – Place of origin
  16. Rasavaha Srotas – The Channels carrying and transporting Rasa Dhatu (which is in the process of transformation) to the site of requirement
  17. 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
  18. Preenana Karma – Function of Nutrition
  19. Atherosclerosis – A disease of the arteries (blood vessels) characterized by the deposition of plaques of fatty material on its inner wall
  20. Plaques – A sticky deposit
  21. Ischemic Heart Disease (IHD) – 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.
  22. Pulmonary Congestion – Filling in excess of blood or any other fluid in the lungs
  23. Swelling of tissues especially in the lower limbs (legs) due to accumulation of excessive watery fluids
  24. Dyspnoea – Difficult or laboured breathing
  25. Hypoxia – Less amount of oxygen reaching the tissues
  26. Renal insufficiency – Deficient excretion of wastes from kidneys
  27. Ojus – Essence or active principles of dhatus
  28. Sroto-Avarodha – Blockage of body channels
  29. Hypertensive Cardiac Diseases – Heart Diseases caused due to raised Blood Pressure
  30. Systolic – The phase of the heartbeat when the muscles of the heart contract and pumps the blood from its chambers into the arteries
  31. Myocardial Infarction (MI) – Destruction of Heart tissues due to the deficit blood supply to the muscles of the heart. (Another name for Heart Attack)
  32. Stroke – a sudden disabling attack or loss of consciousness caused by an interruption in the flow of blood to the brain, especially through thrombosis
  33. Myocardial ischaemia – Less blood supply to the muscles of the heart
  34. Arrhythmias – Fast/slow, Regular/Irregular heart beat – Disturbance in the rhythm of heartbeat
  35. Congestive Cardiac Failure (CCF) – Heart failure, failure of heart in the function of pumping blood, not meeting with the demand of the body’s requirements
  36. Cardiogenic Shock – Shock caused by cardiac (heart) arrest
  37. Thrombo-embolism – Obstruction of a blood vessel by a blood clot
  38. Aneurysm – Excessive localized enlargement of an artery caused by weakening of the arterial wall
  39. Pericarditis – Inflammation (swelling) of outer layers of the heart
  40. Unstable angina – Condition in which 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.
  41. Atheromatous – Degeneration of arterial walls due to accumulated fatty deposits and scar tissues obstructing blood supply
  42. Hyperinsulinaemia – Excessive level of insulin circulating in the blood than expected in relativity to the level of glucose
  43. Non Insulin Dependent Diabetes Mellitus (NIDDM) – 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
  44. Hypoventilation syndrome – Also called Pickwickian Syndrome. In this the severely overweight people fail to breathe rapidly enough or deeply enough, resulting in low blood oxygen levels and high blood carbon dioxide levels
  45. Polycythaemia – Abnormal increase of haemoglobin in the blood
  46. Santarpanottha Vyadhi – Diseases caused due to over-nutrition
  47. Santarpana – Over-Nutrition
  48. Langhana – Lightening therapies
  49. Santarpanottha Sthoulya – Obesity caused due to over-nutrition
  50. Apatarpana – Less nutrition / Starvation
  51. Hridaya Shuddhi – Feeling of lightness in the region of heart or chest
  52. Samyak Langhana – Signs and symptoms of the Lightening therapy having administered properly
  53. Ojokshaya – Decrease in Ojus

Pictures courtesy (with thanks):

http://www.bbc.co.uk/science/0/21702372

http://hrprofessionalsmagazine.com/how-to-weigh-in-obesity-in-employment-decisions/

http://nypost.com/2013/09/30/obesity-up-25-percent-in-nyc/

Dr Raghuram Y.S.

MD(Ay), Ayurvedic Rheumatology

Consultant Ayurvedic Physician

Speciality: Joint and Spine care

Bengaluru, Karnataka, India

Ph: +91-9480071422

Email: drraghuramys@gmail.com

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