WELCOME

MEDOVIKARA

(DYSLIPIDAEMIA)by

ANUPAMA.S.PILLAI

Under the guidance of

Dr. A.SHAHUL HAMEED M.D (Ay)

Assistant professor

Dept.of Dravyagunavijnanam

Nidana Beeja dushti

Ahara

Excess intake of food having madhurarasa , seetha virya , snigdha-guru-pichila

gunas.

Atisampoorana

Virudha ahara (produce utklesha)

Vihara

Avyayama,Divaswapna ,Avyavaya

Manasika karanas

Harsha nithyatwa ,Achintanat

Rupa (Astanga sangraha)

“pramehapoorvarupai

stoulya upadravaischa anyairapi

sleshma rakta mamsa

vikaraprayairmeda:”

• sweda ,anga gandha ,anga sithilata,desire in sayya asana swapna ,upadehain hrit-netra-jihwa-sravana, kesa-nakhaativridhi,seetha priyatwam ,gala talusosha ,kara pada daha

Pramehapoorvarupa

• Ayushohrasa,javauparodha,krichravyavaya-ta ,dourbalya ,dourgandhya ,atikshud,atipipasa

Stoulya upadrava

• stoulya ,alasya ,srota pidhana,moorcha , swasa ,kasa,agnisada

Sleshma vikara

• kusta , visarpa , pitaka ,asrigdara,gulma vidradhi , pleeha roga ,tamapravesa , agninasa , vata rakta , rakta pitta

Rakta vikara

• gala ganda , arbuda,grandhi , gourava in sphig-gala-oshta-bahu-udara-uru-jangha ,talu-jihwa-kanta roga

Mamsa vikara

Beeja dushti kapha medokara ahara vihara

kledabhavena krita- kapha

ahararasa

medodhatw- margava-

agnimandya rodha

ama & malasanchaya

malarupa medodhatuvridhi

Vatarogas (margavarodha)

Prameha

Pitaka

Vidradhi

Urustambha

Bhagandara

Udara

Jwara

Sahaja variety (beeja dushti ) :

Asadhya

Others :

yapya

(controlled by pathyaaharavihara)

Principle : guru apatarpana (A.S)

Oushadha : tikshna , ushna ,ruksha, chedi.

Ahara : kapha-vata -medoharakulatha , yavaka , yava ,syamaka,mudga etc.

Pana : mastu ,takra,madhoodaka,arishta

Vihara : chinta , vyayama , vyavaya , jagaranaudwartana.

“Any of a heterogenous group of fats and fat-like substances ,including fatty acids , neutral fats ,waxes and steroids which are water insoluble and soluble in nonpolar solvents.”

Classification simple

compound

derived

complex

Simple

Lipids

Compound

Lipids

Derived

lipids

Complex

lipids

Esters of

fatty acids

with

glycerol/other

higher

alcohols.

Lipids contain

compounds in

addition to alcohols

& fatty acids.

Compounds

which are

derived from

lipids /

precursors of

lipids.

Lipids

complexed to

other

compounds.

True fats

(Triglycerid

es)

Waxes

Phospholipids

Glycolipids

Sulpholipids

Fatty acids

Steroids

Prostaglandins

Terpenes

Dolichols

Squalene .

Proteolipids

lipoproteins

Serves as an efficient energy source.

As thermal insulator.

Carries fat soluble vitamins.

Constitute large content of nervous tissues.

Structural constituent of cell membrane

Fat transport

Hormone synthesis

Non polar lipids act as electrical insulators.

Belong to the class of organic acids (esters )

formed by the reaction of an alcohol (water

soluble)with an organic acid (fatty acid).

Classification of fatty acids.

1.based on length of carbon chain

-short , medium , & long.

2.number of double bonds :

- saturated & unsaturated

3.essentiality in diet

- essential , non-essenntial

Saturated fatty acids

only single bonds between carbon atoms.

solid at room temperature.

Eg. butyric acid, palmitic acid.

Unsaturated fatty acids contain double bond between carbon

atoms.

liquid at room temperature.

Eg. Oleic acid,linoleic acid,linolenic acid

Dietary fats are classified into two types:

1. Saturated fats

2. Unsaturated fats.

1. Monounsaturated fats.

2. Polyunsaturated fats.

3.Trans fats.

Type of fat Sources Functions

Saturated Full fat milk ,cheese ,cream, butter, commercially baked biscuits ,

pastries, deep fried fast foods

coconut oil and palm oil, fatty meat

blood cholesterol , the risk of

atherosclerosis and CHD

Monounsatu

rated

Oils ( olive and peanut

oils),nuts(cashews,almonds and

peanuts)

blood cholesterol & risk of CHD.

Polyunsatur

ated

Fruits and vegetables , vegetable

oils

Nuts , lean meat fish and sea

foods

1.blood cholesterol and

triglycerides

2.risk ofCHD.

3.risk of obesity.

4.platelet aggregation

5.inflammation throughout the

body.

Trans fats Milk , cheese and beef. Low density lipoproteins and thereby increase the risk of

atherosclerosis , CHD.

Plasma lipids : cholesterol

triglycerides

phospholipids

non esterified fatty acids.

Plasma lipoprotiens : chylomicrons

VLDL, IDL ,LDL ,HDL

Apolipoprotiens

Enzymes participating in lipoprotein metabolism

Lipolytic enzymes , lipoprotein lipase , hepatic lipase,& lecithin cholesterol acyltransferace (LCAT)

Cholesterol

An exclusive product of animal metabolism.

An unsaturated steroid alcohol (contain no fatty acid but exhibit some physical and chemical characteristics of fat . Hence considered as a fat from a dietary point of view.)

An important structural component of cell plasma membranes.

A precursor of biosynthesis of bile acids,vitamin D3 & steroid hormones.

Synthesised by all nucleated cells other than CNS of the body

TRIGLYCERIDES

Esters of glycerol & 3 different fatty acids .

Constitute about 95% of adipose tissue.

Main form of lipid storage in man.

PHOSPHOLIPIDS

Forms biomolecular layer of every

cellwall

Behaves as surface acting agents in

circulation.

Lipoproteins Functions

VLDL Transports triglycerides from

liver to adipose tissue.

IDL Transports triglycerides ,cholesterol and

phospholipids from liver to peripheral tissue.

LDL Transports cholesterol and phospholipids from

liver to tissues and organs like heart.

HDL Transports cholesterol and phospholipids from

tissues and organs like heart back to liver.

Chylomicrons Transports triglycerides of dietary origin,

cholesterol , phospholipids .

LIPOPROTEINS

Several specific protein found in protein

moeity of lipoproteins .

Apolipoprotiens Major protein

component of

A HDL

B LDL,VLDL

C VLDL

E HDL & VLDL

Area Juice Enzyme Substrate End Product

Mouth Saliva Lingual lipase Triglycerides Fatty acid and 1,2-

di acyl glycerol

Stomach Gastric juice Gastric lipase(weak) Triglycerides Fatty acids and

glycerol

Small intestine Pancreatic juice Pancreatic lipase Triglycerides Monoglycerides

fatty acids

Cholesterol ester

hydrolase

Cholesterol ester Free cholesterol

and fatty acid

Phospholipase A Phospholipids Lysophospholipids

Phospholipase B Lysophospholipids Phosphorylcholine

Free fatty acids

Succus entericus Intestinal lipase Triglycerides Fatty acids and

glycerol (weak

action)

Digestion of lipids

The lipids are stored in adipose tissue

( neutral fat or tissue fat )and liver

mainly stored as triglycerides

Free fatty acids are transported in the blood

in combination with albumin.

Other lipids are transported in blood in the

form of lipoproteins.

This aspect can be considered under two

headings:

Major

Minor

Transport of FFA & triglycerides

Two phases

Exogenous

Endogenous

LIVERINTESTINE EXTRA-HEPATIC

TISSUE

Dietary fatBile Acids

Cholesterol

Chylomicrons

VLDL IDL LDL

HDL

Lipoprotein lipase

Free fatty acids adipose

tissue

Lipoprotein lipase

Free fatty acids adipose

tissue

LCAT

LDL

LDL-R

LIVERINTESTINE EXTRA-HEPATIC

TISSUE

Dietary fatBile Acids

Cholesterol

Chylomicrons

VLDL IDL LDL

HDL

Lipoprotein lipase

Free fatty acids adipose

tissue

Lipoprotein lipase

Free fatty acids adipose

tissue

LCAT

LDL

LDL-R

Constituted by

Absorption

Synthesis

Transport cholesterol

Utilisation

Excretion

Body derives cholesterol by

diet

synthesis

Absorption

dietary cholesterol reaches liver through

chylomicron remnants.

Factors influencing absorption

Accelerated by : bile acids & salts.

saturated fatty acids in food

Interfered by : plant sterols like ß sitosterol

Presence of dihydro

cholesterol in intestine.

Main site liver

Also in all nucleated cells except CNS.

Synthesised mainly from Acetyl CoA

Regulated by :

a high dietary cholesterol

LDL cholesterol decrease

Glucagon : decrease

insulin & thyroid hormone : increase

the action of regulatory enzyme HMG CoA reductase

In two routes

1. Excretory routes via neutral sterols.

20% of cholesterol metabolised is

converted to dihydro cholesterol ,7-dehydro

cholesterol , coprosterol (neutral sterols)

2.Route of formation of bile acids.

80% of cholesterol metabolised

converted by liver tissues to bile acids.

lipid stored as triglycerides

3 fatty acids glycerol

ß oxidation glycerose

acetyl co A oxidation

gluconeogenesis

ketone bodies

Bile acids are important end product of

cholesterol metabolism.

Very little cholesterol metabolised is

excreted as sterols in faeces.

Practically no cholesterol is excreted in urine.

Cholesterol is utilised for the synthesis of

other compounds which are structurally

related - steroids.

Lipids Desirable

levels

Borderline Abnormal

levels

Total cholesterol

240

LDL cholesterol

160

HDL cholesterol

>60 40-60

Abnormal fraction of circulating Lipids or Lipoprotein

Classifications

based on

1. pattern observed in electrophoresis & plasma TGL and cholesterol levels (Fredrickson type classification)

2. pattern of abnormality observed on blood testing.

3. Causes

Type Blood picture Clinical sequale

Type 1 chylomicrons &

plasma TGL

Eruptive xanthomas ,

Pancreatitis

Type 2a LDL

CHD2b LDL ,VLDL

Type 3 plasma TGL &

cholesterol

CHD & PVD

(peripheral vascular

disease ).

Type 4 VLDL & TGL CHD & DM

Type 5 chylomicrons , VLDL &

plasma TGL

Pancreatitis

Hyperlipidaemia

1. Mixed Hyperlipidaemia

increase in total cholesterol

triglycerides

decrease in HDL-cholesterol

2. Hypertriglyceridaemia

increase in triglycerides

3. Hypercholesterolaemia

increase in total cholesterol

in LDL cholesterol

Primary

Due to inborn errors of

metabolism

Secondary : due to

Excess dietary fat intake

Obesity

Diabetes mellitus

Hypothyroidism

Pancreatitis

Nephrotic syndrome

Coronary heart disease

Atherosclerosis →thrombosis→episodes of

unstable angina→ MI →sudden death.

Aneurism ( atrophy of arterial intima )

Hypertension

Cerebrovascular events

Pancreatitis

1.Dietary management

Eat low fat food,

Adequate fibre in the diet

Moderate alcohol consumption.

Drink more water

Decrease consumption of oily fish

Adequate fresh fruits & vegetables

Thank you