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AYURVEDAThe Ultimate Lifestyle Medicine
NAMA 2015
Siri Chand Kaur Khalsa MD [email protected]
NATURE AND NURTURE
¡ Health destiny is malleable ! Complex array of the “genes” are born with and how the
genes are tuned on and off in the body
! In ancient models, it was known that health was the product of many elements and balance was on ongoing process
¡ In modern era, many medical institutions and health insurance companies are turning towards the model that l ifestyle choices do matter ! CEO Aetna is promoting Mindfulness and yoga after
debilitating accident
Overview ① What is it?
② How does it relate to Ayurveda?
EPIGENETICS
¡ Definition ! “Epi” = on or above
! “Genetics” = study of genes
¡ Hardware/Software ! Genes = hardware
! Software = proteins and cellular messenger
! ”Histones”
EPIGENETICS: WHAT IS IT?
Alcohol Research: Current Reviews, Volume 35, Number 1, 2013.
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¡ Epigenetic Mechanisms ! DNA Methylation
! Biochemical process that attaches a methyl group to a specific spot on DNA
! Acts to lock genes in the “off” position.
! Histone Modification ! DNA wraps around proteins called histones to condense itself
! Histones can be modified and turn genes both on and off
! MicroRNA Alterations ! Some small non-coding RNAs, called microRNAs (miRNAs), silence
the expression of genes
! After they have been transcribed or during the process of transcription
EPIGENETICS: WHAT IS IT?
Alcohol Research: Current Reviews, Volume 35, Number 1, 2013.
EPIGENETIC REGULATION
Hou L et al. Int. J. Epidemiol. 2011;ije.dyr154
Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2011; all rights reserved.
TELOMERES
Ludlow et al. Biomed Res Int. 2013;2013:601368 . Shammas Curr Opin Clin Nutr Metab Care. Jan 2011; 14(1): 28–34.
¡ Telomeres shorten with: ! Each cell division
! Increasing chronological age
! Lifestyle choices
¡ Short telomeres have been associated with a range of age related diseases (Shammas, 2013)
TELOMERES & EPIGENETICS
¡ Lifestyle choices
! Impact telomerase action and telomere length
! Impact epigenetic regulators
! Histone methyltransferases
! DNA methyltransferases
! Determine oxidative stress
¡ Loss of the histone methyltransferases and DNA methyltransferases correlates with loss of telomere-length control, and telomere shortening to a critical length affects the epigenetic status of telomeres and subtelomeres (Blasco, 2007)
Blasco. Nature Reviews Genetics 8, 299-309 (April 2007) |
Riya R. Kanherkar, Front Cell Dev Biol. 2014; 2: 49.
AYURVEDIC FOUNDATIONS
Ṛtucaryā�Panchakarma �
Rasayana �Tanmātrā Chikitsā�Śamana Chikitsā�
Dinacaryā Adhyāya �
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Dinacaryā AdhyāyaDaily RoutinePractice of attuning the lifestyle to an individual’s current state and needs in such a way that health and vitality are promoted.
DINACARYĀ ADHYĀYA
¡ The heal thy person should get up dur ing brāhma muhū r ta( 3 am to 6 am) to protect h i s l i fe .
¡ E l iminate ur ine and feces (pay attent ion to urges)
¡ Clean teeth wi th twig of area, nyagrodha, khadi ra, karañja, kakubha (ast r ingent , b i t ter, pungent) ; the twigs are the s i ze of the t ip of the f inger in th ickness and 12 añgulās in length and teeth should be c leaned wi thout hur t ing the gums. AH. Sū 2 :2-3 ! Excluded form this group are persons suffering from indigestion, vomiting, dyspnea, cough, fever, facial paralysis,
thirst, ulcerations of the mouth, diseases of the heart, eyes, head and ears should not make use of the toothbrush (use powder instead) AH. Sū 2:4
¡ Añjana (col ly r ium to the eyes) ! Sauvīrāñjana is good for eyes as daily slave (ore of antimony sulphide mixed with botanicals)
! The eye is full of tedious (light) an has risk of troubles especially from śleṣman (kappa); hence rasāñjana (decoction of dāruharidrā ( Berberus aristāta) should be used once a week to drain out kappa AH. Sū 2:5
¡ Afterwards the person should make use of navana (nasal drops) , gaṇḍūṣa (mouth garg le) , dhūma ( inhalat ion of smoke) , and tāmbū la (chewing of bete l leaves) AH. Sū 2 :6
¡ Tāmbū la i s har mfu l to those suf fer ing f rom wounds, b leedings d i seases , dryness and redness of the eyes , poison ing, unconsciousness , intox icat ion f rom consumpt ion. AH. Sū 2 :7
DINACARYĀ ADHYĀYA
¡ Abhyañga (Oil Massage) ¡ Abhyañga should be per formed daily, it wards off old
age, exertion and aggravation of vāta; bestows good vision, nourishment to the body, long life, good sleep, good and strong healthy skin. It should be done specifically to the head, ears and feet.
¡ It should be avoided by persons suffering from aggravation of kappa, who have just undergone purificatory therapies, and who are suffering form indigestion. AH. Sū 2:8-9
DINACARYĀ ADHYĀYA
¡ Vyāyāma (Phys ical exercise)
¡ L ightness of the body, abi l i ty to do hard work, keen digest ion, deplet ion of fat , s table and developed phys ique ar i se f rom Vyāyāma (phys ical exercise) AH. Sū 2 :10
! Persons suffering from disease of vita; pitta; children and the aged and those having indigestion should avoid it.
! Persons who are strong and who indulge in fatty foods (daily); in cold season and spring (season) should exercise to half of their strength and capacity(appearance of perspiration on forehead, nose, sti l l , joints of the l imbs and feeling of dryness of the mouth); while others in other season should do it mildly. AH. Sū 2:11
! After doing it (exercise) all part of the body should be massaged comfortably. AH. Sū 2:12
! Thirst, emaciation, sever dyspnea, bleeding disorders, exhaustion, feeling of debil ity, cough, fever and vomiting are caused by excess exercise AH. Sū 2:13
! Those who indulge in much of physical exercise, keeping awake at night (loss of sleep), walking long distances, sexual intercourse, too much of laughing, speaking and such other strenuous activities perish, just as a l ion after vanquishing an elephant. AH. Sū 2:14
DINACARYĀ ADHYĀYA
¡ Udvartana (massage)
¡ Massaging the body with soft, fragrant powders mit igates kappa, l iquefies fat, produces stabil ity (compactness, strength) of the body parts and excellence of the skin AH. Sū 2:15
¡ Snāna (bath) ! Snāna (bath) improves appetite, sexual vigor, span of life, valor and
strength, removes itching, dirt, exhaustion, sweat, stupor, thirst and bring sensation of the skin. AH 2:16
! Pouring warm water over the body bestows strength but the same over the head, makes for loss of strength of the hair and eyes. AH 2:17
! Bath is contra-indicated for those suffering from facial paralysis, diseases of the eyes, mouth and ears, diarrhea, flatulence, pīnasa (discharge of foul smelling liquid form the nose), indigestion and those who have just taken food. AH 2:18
DINACARYĀ ADHYĀYA
¡ Sadv ṛ t ta (good conduct)
! Person should take food after digestion (of the previous meal), that which is suitable and
in l imited quantity; urges of the body should not be init iated prematurely by force,
should not be engaged in other works when the urges are patent, not do anything
(administration of drugs, therapies, etc) without treating the curable diseases AH. Sū
2:19
! All human activit ies are meant for the happiness of all the l iving beings; such happiness
is based on dharma (righteousness, r ight moral conduct); hence every person should
adopt r ightness always. AH. Sū 2:20
! Friends should be served with affection and good deeds (beneficial acts) whereas others
(foes, wicked persons) should be kept at a distance. AH. Sū 2:21
¡ Hiṁsā (caus ing harm), s teyā ( s teal ing, robbing), anyathākāma (unlawful
sexual act iv i ty) , paiśunya (abus ive speech), an ṛ ta vacana (scolding),
saṁbhinna ā lāpa (speech caus ing unrest , d issens ion), vyāpāda (quarrel) ,
abhidyā ( jealousy) and d ṛgviparyayā ( f inding fault/complain ing about
scr ipture, e lders , teachers) - these ten s ins pertain ing to the body, speech
and mind should be avoided. AH. Sū 2 :21-22
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DINACARYĀ ADHYĀYA
¡ Sadv ṛ t ta (good conduct)
! Person should take food after digestion (of the previous meal), that which is suitable and
in l imited quantity; urges of the body should not be init iated prematurely by force,
should not be engaged in other works when the urges are patent, not do anything
(administration of drugs, therapies, etc) without treating the curable diseases AH. Sū
2:19
! All human activit ies are meant for the happiness of all the l iving beings; such happiness
is based on dharma (righteousness, r ight moral conduct); hence every person should
adopt r ightness always. AH. Sū 2:20
! Friends should be served with affection and good deeds (beneficial acts) whereas others
(foes, wicked persons) should be kept at a distance. AH. Sū 2:21
¡ Hiṁsā (caus ing harm), s teyā ( s teal ing, robbing), anyathākāma (unlawful
sexual act iv i ty) , paiśunya (abus ive speech), an ṛ ta vacana (scolding),
saṁbhinna ā lāpa (speech caus ing unrest , d issens ion), vyāpāda (quarrel) ,
abhidyā ( jealousy) and d ṛgviparyayā ( f inding fault/complain ing about
scr ipture, e lders , teachers) - these ten s ins pertain ing to the body, speech
and mind should be avoided. AH. Sū 2 :21-22
ŚAMANA CHIKITSA
¡ Treatments that lead to palliation, pacification or neutralization to doshas
¡ Dīpana: kindling agni
¡ Pāchana: burning ama
¡ Kshut nigraha: fasting
¡ Trut nigraha: observing thirst
¡ Vyāyāma: exercise
¡ Ātapa seva: bathing in sunlight
¡ Maruta seva: sitting in fresh air
Lad, Vasant. Textbook of Ayurveda. Fundamental Principles. Vol 3. 2012. Ayurvedic Press p132 AH. Sū 14:6-6.5
TANMĀTRĀ CHIKITSĀ
¡ Sensory pathways of our inner pharmacy ¡ Shabda(Sound)
! Speech, Counseling, Music, mantra
¡ Sparsha (Touch) ! Massage, OMT, Polarity, Acupuncture, Lepana, Mudra, Hugs,
Realtionships
¡ Rūpa (Form) ! Color, Gemstones, Crystals, Trataka Meditation, Yantra
¡ Rasa (Taste) -6 tastes found in all food, drink, botanicals ¡ Gandha (odor)
! Aromatherapy, essential oils, insence
¡ Pū jā ! Spiritual ceremony for self healing and meditation (Dhyāna)
Lad, Vasant. Textbook of Ayurveda. Fundamental Principles. Vol 3. 2012. Ayurvedic Press p 253
NATURE
¡ Benefits of spending time in Nature ! Research in Japan (Park, 2010)
! Physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing)
! Spending time in a forest environment (vs city) results in: ! Lower concentrations of cortisol
! Lower pulse rate
! Lower blood pressure
! Greater parasympathetic nerve activity
! Lower sympathetic nerve activity
! Epigenetic modulation of cellular pathways
¡ Nature can be a source of motivation for maintaining physical activity and reducing stress (Calogiuri, 2014)
Park et al. Environ Health Prev Med. 2010 Jan;15(1):18-26 Calogiuri, BMC Public Health. 2014 Aug 24;14:873
EXERCISE
¡ Exercise may reduce the rate of age-associated telomere shortening
¡ Systemic review of l iterature: 23 studies (Ludlow, 2013) ! Positive impact
! Association with more physical activity and longer telomeres
! Differences in telomere length equated to about 10 years of biological age difference in active subjects (Cherkas, 2008)
! No change – perhaps from style of data collection
! U shape has been observed in studies with extremes of minimal exercise and strenuous exercise for extended time ! The “right” amount probably varies by individual
¡ Benefits seen even at 5 minutes (Lee, 2014)
Ludlow et al. Biomed Res Int. 2013;2013:601368. Cherkas, Arch Intern Med. 2008 Jan 28; 168(2):154-8 Lee et al J Am Coll Cardiol. 2014 Aug 5;64(5):472-81
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SLEEP
¡ International Agency for Research on Cancer 2007:
! In animals there was ‘sufficient experimental evidence’ for the
carcinogenicity of light during the daily dark period but
‘limited evidence’ for the carcinogenicity of shift work that
involves night work in humans, resulting in an overall
classification that ‘shift work that involves circadian disruption
as ‘probable carcinogenic to humans’ (group 2A) (Straif, 2007)
Straif et al. Lancet Oncol. 2007 Dec; 8(12):1065-6.
SLEEP
¡ Disruption in circadian rhythms impacts genome
! Epigenetic effect mediated by hypomethylation of DNA
! Wide variety of genes impacted, including those related to
circadian rhythms (Bhatti, 2014)
¡ Long term shift work
! Promoter hypomethylation of CLOCK and hypermethylation of
CRY2 (Zhu, 2011)
! Hypermethylation in the CLOCK promoter reduced the risk of
breast cancer (Hoffman, 2010)
Bhatti et al Chronobiol Int. 2014 Sep 4:1-10 Zhu et al, Chronobiology international 2011;28(10):852-861 Hoffman et al. Cancer Res. 2010 Feb 15;70(4):1459-68.
¡ Effects of proper s leep on the body: ! Sukha(happiness),
pushti(nourishment), bala(strength), vrishata, jnana(knowledge), jeevita(life)
¡ Effects of less s leep on the body: ! Dukha(unhappiness),
Karshyata(emaciation), Abala(weakness), Kleebata(impotant), Ajnana(impaired knowledge or unwise), Destroys the l ife
¡ “Dependent on s leep is happiness and misery, corpulence and leanness, st rength and weakness, potency and impotency, intel lect and non-intel lect, l i fe and death. S leep undertaken unt imely, excess ively and negatively takes away happiness and l i fe l ike the other death-night. S leep, i f undertaken proper ly, provides happiness and l i fe l ike the f lashed true knowledge provided to a Yogini .”
CS, Sū . 21/36-38
NIDRA (SLEEP)
http://www.vedicsociety.org/nidra-a-361.html
CIRCADIAN RHYTHMS
¡ Circadian disruption is an independent cancer risk factor for humans ! Link to breast, ovarian, lung, pancreatic, prostate, colorectal and endometrial
cancers, non-Hodgkin's lymphoma (NHL), osteosarcoma, acute myeloid leukemia (AML), head and neck squamous cell carcinoma, and hepatocellular carcinoma (Fu, 2013)
¡ Circadian disruption is associated with poor prognosis and early mortality of cancer patients (Fu, 2013)
! Number of years doing shift work
! Frequency of rotating work schedules
! Number of hours per week working at night among night-shift workers
¡ Breast cancer patients circadian genes identif ied
! Low levels of CLOCK methylation
! High levels of CRY2 methylation which may lead to decreased gene expression (Hoffman, 2010)
Fu et al, Prog Mol Biol Transl Sci. 2013; 119: 221–282 . Hoffman et al. Cancer Res. 2010 Feb 15;70(4):1459-68.
MINDFULNESS/MEDITATION
“Mindfulness meditation is a form of attentional control training by which individuals first develop the ability to direct and maintain attention towards a chosen object. To this end, mindfulness practice requires skills involved in monitoring the focus of attention and in detecting distraction, disengaging attention from the source of distraction, and flexibly (re)directing and engaging attention to the intended object. In addition to this training of attention, mindfulness meditation cultivates the skill to maintain a non-judgmental, open presence to the present moment. This form of meta-awareness consists of non-reactively monitoring the content of experience from moment-to-moment without being carried away by thoughts, emotions, or perceptions”
-Richie Davidson
MacCoon et al. PLoS One. 2014 Jun 23;9(6):e9755
MEDITATION & BREAST CANCER
! Breast cancer survivors identified with distress & diagnosis of stage I to III cancer who had completed treatment at least 3 months prior participated in mindfulness-based cancer recovery (MBCR) focused on training in mindfulness meditation/Hatha yoga or supportive-expressive group therapy (SET) vs control with no intervention
! Telomere length in the intervention groups (MBCR & SET) was maintained whereas it was found to decrease for control participants (Carlson, 2014)
! Improved psychological outcomes in intervention groups (Carlson, 2013)
Carlson et al. Cancer. 2014 Nov 3. doi: 10.1002/cncr.29063 Carlson et al. J Clin Oncol. 2013 Sep 1;31(25):3119-26
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MINDFULNESS & EPIGENETICS
¡ Experiment ! Mindfulness meditation in experienced subjects vs control group of
subjects with no meditation experience who engaged in leisure activities in the same environment
! Measured expression of circadian, chromatin modulatory and
inflammatory genes in peripheral blood mononuclear cells (PBMC)
¡ At baseline al l the epigenetic regulatory enzymes and inflammatory genes analyzed were the same
¡ Epigenetics effects on experimental group of meditators:
! Reduced expression of histone deacetylase genes (HDAC 2, 3 and 9)
! Alterations in global modification of histones (H4ac; H3K4me3)
! Decreased expression of pro-inflammatory genes (RIPK2 and COX2)
! Expression of RIPK2 and HDAC2 genes was associated with a faster cortisol recovery
Kaliman et al. Psychoneuroendocrinology. 2014 Feb;40:96-107
EPIGENETIC DIET (HARDY, 2011) Epigenetic diet compounds
Food source Epigenetic function
EC, ECG, EGC and EGCG
Green Tea DNMT and HAT inhibitor, modulates miRNA
Resveratrol Grapes, peanuts, mulberries, cranberries, blueberries
DNMT and HDAC inhibitor
Curcumin Turmeric, curry DNMT inhibitor and miRNA modulator
Genistein Soybeans, fava beans DNMT and HDAC inhibitor, enhances HATs, modulates miRNA
Isothiocyanates, sulforaphane
Broccoli, cabbage, kale, watercress
DNMT and HDAC inhibitor
Selenium Brazilian nuts, chicken, game meat, beef
DNMT and HDAC inhibitor
Alcohol Alcoholic beverages High consumption increases promoter hypermethylation
0.0% 100.0% 200.0%
Vitamin E mg Vitamin D mcg Folic Acid mcg
Potassium mg Choline mg
Vitamin A mcg Magnesium mg Vitamin K mcg Vitamin C mg
Calcium mg Zinc mg
Thiamine mg Copper mg Sodium mg
Vitamin B6 mg Niacin mg
Riboflavin mg Iron mg
Phosphorus mg Selenium mcg
Vitamin B12 mcg
% Female
% Male
Average Dai ly Amer ican Intake of Nut r ients : Percentage of IOM RDA in Men and Woman (non-pregnant) aged 31-50. NOT ADEQUATE!
Based on IOM RDA U.S. Department of Agriculture, Agricultural Research Service. 2012. Nutrient Intakes from Food: Mean Amounts Consumed per Individual, by Gender and Age, What We Eat in America, NHANES 2009-2010. Available: www.ars.usda.gov/ba/bhnrc/fsrg.
¡ Awareness (Lad, 2002) ! Each cell is a center of awareness
¡ Governor ! Of digestion, assimilation and
transformation of matter into energy
¡ Nutrition ! Of all body tissues ! Neutralization of toxins in tissues
¡ Intell igence ! Cellular intelligence, cellular
selectivity and choice.
“A man is as old as his agni”
AYURVEDA: AGNI
Lad, Vasant. Textbook of Ayurveda. Fundamental Principles. Vol 1. 2002. Ayurvedic Press p79-85
MICROBIOME
¡ Microbiome and cancer ! Bacterial species have been identified as initiating GI
malignancies
! Influence is actually turning out to also be systemic
! Microbiota contributions to cancer susceptibility (Huller, 2014): ! Fermentation of dietary fibers and resistant starch
! Metabolism of xenobiotics ! Beneficial or detrimental (drugs, diet, carcinogens, etc.)
! Renewal of gut epithelial cells and mucosal integrity
! Impact to system immune system
Huller et al Cancer Treat Res. 2014;159:377-99.
MICROBIOME & EPIGENETICS
¡ Microbial metabolites of diet are epigenetic activators of gene expression (Huller, 2014)
! Microbial metabolites influence epigenetics via:
! Altering the pool of compounds available for cellular processes
! Directly inhibiting enzymes involved in epigenetic pathways
! Colonic epithelium is directly exposed to these metabolites
! Metabolite actions are also being elucidated systemically
Huller et al Cancer J. 2014 May-Jun;20(3):170-5 Matsumoto et al. PLoS ONE 2011;6(8):e23652.
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MICROBIOME & EPIGENETICS
¡ Microbial metabolites of diet are epigenetic activators of gene expression (Huller, 2014)
! Microbial metabolites influence epigenetics via:
! Altering the pool of compounds available for cellular processes
! Directly inhibiting enzymes involved in epigenetic pathways
! Colonic epithelium is directly exposed to these metabolites
! Probiotic strain Bifidobacterium animalis subsp. lactis (LKM512) increased intestinal luminal polyamines and it was found to increase longevity in mice following probiotic treatment (Matsumoto, 2011)
! Metabolite actions are also being elucidated systemically
Huller et al Cancer J. 2014 May-Jun;20(3):170-5 Matsumoto et al. PLoS ONE 2011;6(8):e23652.
ADD FERMENTED FOODS
38
! Kimchi
! Fermented cabbage Korean dish
! Lacto-fermented vegetables
! Sauerkraut
! Antipesto
! Kefir- fermented drink
! Yoghurt (Lassi – drink with spices taken after meals)
! Raw Vinegar
! Poi
! Miso
STRESS
¡ Women exposed to stress in their daily life (relative to control group) (Epel, 2004): ! Evidence of increased oxidative pressure
! Reduced telomerase activity
! Shorter telomeres in peripheral blood mononuclear cells
! Difference in telomere length in these two groups of women was equivalent to 10 years of life
¡ More stress = less telomerase activity ¡ Glucocorticoid resistance observed in splenic
macrophages of mice under stress is thought to be mediated by DNA methylation and miRNA (Jung, 2015)
Epel et al Proc Natl Acad Sci U S A. 2004 Dec 7; 101(49):17312-5 . Jung et al. . Brain Behav Immun. 2015 Feb;44:195-206.
STRESS
¡ Epigenetic effect of stress ! Glucocorticoid resistance observed in splenic macrophages
of mice under stress is thought to be mediated by DNA methylation and miRNA (Jung, 2015)
¡ Women exposed to stress in their daily life (relative to control group) (Epel, 2004):
! Difference in telomere length in these two groups of women was equivalent to 10 years of life
! More stress = less telomerase activity
Epel et al Proc Natl Acad Sci U S A. 2004 Dec 7; 101(49):17312-5 . Jung et al. . Brain Behav Immun. 2015 Feb;44:195-206.
EFFECT OF TRAUMA
¡ Traumatic stress such as seen in PTSD has duel impact (Boks, 2015)
! Lowers “epigenetic age” via DNA methylation profiles
! Afghanistan veterans had an “older epigenetic age”
! Shortens telomeres which results in premature “aging”
¡ Examining epigenetics ! Serves for prediction of response to treatment and prognosis
of outcome (Roth, 2014, Sipahi, 2014)
! “Pre-existing epigenetic states” predispose to PTSD
! Histone modifications and microRNAs changes AFTER TRAUMA
Boks et al. Psychoneuroendocrinology. 2015 Jan;51:506-12. Sipahi Psychol Med. 2014 Nov;44(15):3165-79. Roth. Front Psychiatry. 2014 Jul 31;5:93
EFFECT OF TRAUMA
¡ Traumatic stress such as seen in PTSD has an impact on aging at the cellular level (Boks, 2015) ! Shortens telomeres which results in premature “aging”
! Lowers “epigenetic age” via DNA methylation profiles ! Afghanistan veterans with trauma had “older epigenetic
age”
¡ Quantifying DNA methylation ! Pre-existing epigenetic states differentiate individuals
who are resilient versus susceptible to PTSD (Sipahi, 2014)
! Serves for prediction of response to treatment and prognosis of outcome (Roth, 2014)
! Histone modifications and microRNAs changes emerging Boks et al. Psychoneuroendocrinology. 2015 Jan;51:506-12. Sipahi Psychol Med. 2014 Nov;44(15):3165-79. Roth. Front Psychiatry. 2014 Jul 31;5:93
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TRANSGENERATIONAL TRAUMA
¡ Transgenerational transmission of trauma (Kellermann, 2013) ! Children of Holocaust survivors,
! Offspring of other PTSD parents are also vulnerable
! Descendants of ! War veterans
! Survivors of war trauma
! Childhood sexual abuse
! Refugees
! Torture victims
¡ Transmission continues beyond the great grandchildren
¡ Difficult to create model for understanding ! Epigenetics includes hereditary and environmental factors is a
new proposed inclusive mechanism Kellerman al. J Psychiatry Relat Sci. 2013;50(1):33-9.
¡ Longer telomeres are found in healthier and happier people (Blackburn, 2005)
¡ Mindfulness meditation techniques (Epel, 2009) ! Shift cognitive appraisals from
threat to challenge
! Decrease ruminative thought
! Reduce stress arousal
! Promote telomere maintenance(Epel, 2009)
HAPPINESS
Blackburn FEBS Lett. 2005 Feb 7;579(4):859-62 Epel et al. Ann N Y Acad Sci. 2009 Aug;1172:34-53.
COMPASSION
“Compassion is a mind free from hatred. When there are no negative emotions in our minds, then we are automatically at peace. Compassion is the wish that others not suffer, as well as having the urge to help end the suffering of others. Cultivating compassion is a source of peace and harmony in the heart and mind.”
– Richie Davidson
¡ Compassion is l ike a muscle – it must be taught and exercised in order to have it
¡ Compassion versus empathy ! Empathy drains energy. Compassion strengthens it.
BENEFITS OF MEDITATION
¡ Compassion and caring for others increases telomerase which elongates telomeres and promotes longevity
! 3-month trial of intensive concentrative and compassion-oriented meditation found 30% significantly higher telomerase activity as compared with the control group (Jacobs, 2011)
¡ Job that require hands-on care of dementia patients can lead to caregiver dissatisfaction and physiologic changes related to stress
! In a study of dementia caregivers, the meditation group showed a 43% increase in telomerase activity when compared with a relaxation “control group” (Lavretsky, 2012)
Jacobs et al. Psychoneuroendocrinology 2011;36:664–81. Lavretskyet al Int J Geriatr Psychiatry. 2012 Mar 11
CHANGE YOUR BRAIN BY TRAINING YOU MIND
¡ Neuroplasticity
! Our brains respond to experience
! We all have the ability to actually change our brains through training
¡ Epigenetics
! Contemplative practices can change gene expression
¡ Bi-directional communication between mind/brain and body
! Psychological well-being is related to levels of physical health
¡ Innate basic goodness
! Most contemplative practices teach that human beings are
inherently good
! Preference for pro-social behavior or altruistic choices
! Infants show a preference for altruistic behavior over selfish behavior
http://depts.washington.edu/ccfwb/content/change-your-brain-transforming-your-mind
TRIPHALA AS ANTI-OXIDANT
Carlsen et al. Nutr J. 2010 Jan 22;9:3. doi: 10.1186/1475-2891-9-3.
706.25
2.5
1.45
47.5
48.32
4.76
Triphala
Amla
Ginseng Radix
Cascara Sagrada
Bilberries
Blackberries
Antioxidant content in mmol/100g
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SAUNA
¡ To investigate the association of frequency and duration of sauna bathing with the risk of sudden cardiac death (SCD), fatal coronary heart disease (CHD), fatal cardiovascular disease (CVD), and all-cause mortality, a prospective cohort study of a population-based sample ! 2315 middle-aged (age range, 42-60 years) men from Eastern
Finland from March 1, 1984, through December 31, 1989.
¡ Increased frequency of sauna bathing is associated with a reduced risk of SCD, CHD, CVD, and all-cause mortality
Laukkanen et al. AMA Intern Med. 2015 Feb 23. doi: 10.1001/jamainternmed.2014.8187
CHANGING INDIVIDUAL HEALTH
0
25
50
75
100
Month 1 Month 2 Month 3 Month 4 Month 5 Month 6
Unhealthy Habits Healthy Habits ¡ Daily habits exist that do not promote health
¡ Bringing awareness to patients about potential detrimental effects of daily choices is essential
¡ Rate of telomere shortening is accelerated when cells are exposed to genotoxic stress (Trusina, 2014)
ELIMINATION PLAN
Trusina BMC Syst Biol. 2014 Mar 1;8:27
ILLNESS IN AYURVEDA
¡ According to Caraka, all i l lnesses can be attributed either to: ! Endogenous factors (nija) (i.e. an imbalance of the three
humors (dosa
! Exogenous factors (agantu)
! Violations of good sense (prajnaparadha) ! (Car 4.1.1.98, 116 – 117).
WEISS Ancient Science of Life, Vol No. VI No. 3 January 1987, Pages 129 – 134 KARMA AND AYURVEDA*
PRAJNAPARADHA
¡ Lifestyle of person ! Cumulative process with his/her physical capacity coordinated with
psychological functioning, displayed in the form of habits, behavior, dietary and living pattern based on his own training sought from childhood, and mimicries he gained from his immediate companions including parents, siblings, peers, etc.
¡ When init iation, control, and co-ordination are disturbed, it leads to the derangement of l i festyle and results in any l i festyle disorder
¡ Ayurveda narrated this phenomenon as ‘Prajnaparadha’ ( intel lectual blasphemy) ! One of the three basic causes of any disease
! Improper actions as an impact of Prajnaparadha are root causes of various diseases
! Habit of suppression of any natural urge is a result of Prajnaparadha and enlisted as a cause of nearly 50% of the diseases.
Chandola. Ayu. 2012 Jul-Sep; 33(3): 327.
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Induction of cancer through changes in cel l cycle
- Init iat ion -Promotion -Progression
INCREASED OXIDATIVE STRESS
http://commons.wikimedia.org/wiki/User:Kelvinsong
Reactive oxygen species (ROS) and their role in the development of human cancer.
Klaunig J E et al. Toxicol Pathol 2009;38:96-109
Copyright © by Society of Toxicologic Pathology
Food Based
¡ Non-Nutritive Sweeteners
¡ Carrageenan ¡ Teflon ¡ MSG ¡ Bovine GH ¡ Antibiotics ¡ Food preservatives ¡ Food dyes ¡ Alcohol ¡ Trans Fat
Environmental (Hou, 2011)
¡ Metals ¡ Pesticides ¡ Herbicides ¡ BPA/thalates ¡ Flame retardants ¡ Dioxin ¡ DES ¡ Chlorine ??
TOXINS
Hou et al. Int J Epidemiol. 2012 Feb;41(1):79-105
NONNUTRITIVE SWEETENERS
¡ Non-caloric artificial sweeteners (NAS) ! Aspartame, neotame, saccharin, sucralose, stevia
! Affect gut bacteria ! Splenda (sucralose) reduced beneficial rat fecal microflora (Abou-
Donia MB, 2008)
! Mice consuming artificial sweeteners developed glucose intolerance and modified gut bacteria (Suez, 2014)
! May increase appetite for sweet foods, promote overeating, and lead to weight gain (Bellisle, 2008)
¡ FDA on safety of NNS
¡ NCI and safety of NNS ! Possibility of aspartame link to development of lymphoma and
leukemia (Schernhammer, 2012) Abou-Donia et al. J Toxicol Environ Health A. 2008;71(21) 1415-29. Suez et al Nature. 2014 Sep 17. doi: 10.1038/nature13793 . Am J Clin Bellisle et al. Eur J Clin Nutr. 2007 Jun;61(6):691-700. Schernhammer, Nutr. 2012 Dec;96(6):1419-28.
NONNUTRITIVE SWEETENERS
¡ FDA on safety of NNS
¡ ADA and AHA position statement on NNS
¡ NCI and safety of NNS ! “All on market have been tested and no clear link to
cancer”
! Possibility of aspartame link to development of lymphoma and leukemia (Schernhammer, 2012)
59 Schernhammer, Nutr. 2012 Dec;96(6):1419-28.
FOOD ADDITIVES
¡ MSG (Monosodium Glutamate) ! Glutamic acid, yeast extract, hydrolyzed protein, sodium
caseinate can exacerbate fibromyalgia and IBS (Holton, 2012)
¡ Food Preservatives ! Benzoates, monoglycerides, diglycerides, nitrates,
nitrites, and sulfites are linked to chronic pain conditions. (Sun-Edelstein, 2009)
¡ Teflon ! Pots, microwave popcorn, fast-food packaging
! Don’t preheat nonstick cookware or bake with it
60 .Holton KF et al, Clin Exp Rheumatol. 2012 Jul 4 Sun-Edelstein C, et al Clin J Pain. 2009 Jun;25(5):446-52.
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FOOD ADDITIVES
¡ Bisphenol A (BPA), Phthalates ! Plastic bottles, lining canned foods
¡ Carrageenan ! in non-dairy milks may irritate IBS symptoms
and lead to chronic inflammatory diseases of the bowel (Qin, 2012; Tobacman, 2001)
¡ Food Dyes ! Blue #1 and #2, yellow #5 and 6, red #40,
Yellow #6 have raised specific health concerns, after research showed they can cause behavioral problems, cancer, birth defects, and other health problems in laboratory animals and are banned in Norway and Austria and EU strong warning
61 Qin World J Gastroenterol. 2012 Apr 21;18(15):1708-22 Tobacman JK. Environ Health Perspect. 2001 Oct;109(10):983-94
REDUCING TOXINS
¡ Remove All Food Additives and Non Calorie Sweeteners ! Trial off for 6weeks off and assess health symptoms
¡ Use glass containers for storage
¡ Cook with cast iron for non-stick option
¡ Learn canning/freezing techniques for food storage
¡ Use dry legumes: soak and pressure cook
¡ Consider organic stevia as replacement sparingly
¡ Make your own nut milk
¡ Use only fresh organic spices (local grown when possible)
¡ Air popped popcorn
FOOD EXPOSURE
¡ Genetic Modification and Herbicide/Pesticide exposure ! Direct effects (Grover, 2014):
! Antibiotic resistance genes used as markers in GM crops could be transferred to microbiome (Nederwood, 2004)
! Cry1Ab protein (a Bt toxin) and glyphosate metabolites detected in pregnant woman, their fetuses and non-pregnant woman (Aris, 2011)
¡ Epigenetic Effects
! Further studies of epigenetic mechanisms in disease pathogenesis, their relationships with environmental exposures and the pathways associated with the disease phenotype may help develop preventive and therapeutic strategies (Hou, 2012).
Grover et al. J Fam Med Primary Care 2014;3:188-90 Netherwood et al. Nat Biotechnol 2004;22:204-9 Aris et al, 2011 May;31(4):528-33. doi: 10.1016/j.reprotox Hou et al. Int J Epidemiol. 2012 Feb;41(1):79-105
FOOD EXPOSURE
¡ Epigenetic Effects ! Studies of epigenetic mechanisms in disease pathogenesis in
relation environmental exposures are needed is needed (Hou, 2012).
! Arsenic, nickel, cadmium and BPA disrupt DNA methylation and histone acetylation (Kanherkar, 2014)
¡ Genetic Modification and Herbicide/Pesticide exposure ! Direct effects (Grover, 2014):
! Antibiotic resistance genes used as markers in GM crops could be transferred to microbiome (Nederwood, 2004)
! Cry1Ab protein (a Bt toxin) and glyphosate metabolites detected in pregnant woman, their fetuses and non-pregnant woman (Aris, 2011) Grover et al. J Fam Med Primary Care 2014;3:188-90
Netherwood et al. Nat Biotechnol 2004;22:204-9 Aris et al, 2011 May;31(4):528-33. doi: 10.1016/j.reprotox Hou et al. Int J Epidemiol. 2012 Feb;41(1):79-105
POSITION STATEMENT
¡ American Academy of Environmental Medicine
! Physicians to educate their patients, the medical community, and the public to avoid GM foods when possible and provide educational materials concerning GM foods and health risks.
! Physicians to consider the possible role of GM foods
in the disease processes of the patients they treat and to document any changes in patient health when changing from GM food to non-GM food.
http://www.aaemonline.org/gmopost.html
¡ Roundup (containing glyphosphate)caused the following in the rat model (ElShenawy, 2009):
! Reduced antioxidant status with lower hepatic glutathione
! Induced oxidative stress with higher serum lipid peroxidation
! Increased serum nitric oxide and TNF-α
! Proposed to modulate microbiome negatively(Samsel, 2013)
HERBICIDES IN FOOD
El Shenawy. Environ Toxicol Pharmacol. 2009 Nov;28(3):379-85. Jasper et al Interdiscip Toxicol. 2012 Sep;5(3):133-40. Samsel et al. Interdiscip Toxicol. 2013 Dec;6(4):159-84.
Jasper, 2012
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AVOID The Dirty Dozen
¡ Apples ¡ Strawberry ¡ Grapes ¡ Celery ¡ Peaches ¡ Spinach ¡ Sweet bell peppers ¡ Nectarines (imported) ¡ Cucumbers ¡ Cherry tomatoes ¡ Snap peas ¡ Potatoes
FOCUS The Clean Fifteen ¡ Avocado ¡ Sweet corn ¡ Pineapple ¡ Cabbage ¡ Frozen sweet peas ¡ Onions ¡ Asparagus ¡ Mangos ¡ Papaya ¡ Kiwi ¡ Eggplant ¡ Grapefruit ¡ Cantaloupe ¡ Caulif lower
EWG 2014 GUIDE
http://www.ewg.org/foodnews/list.php
REDUCING TOXINS
¡ Go ORGANIC
¡ Remove All Food Additives and Non Calorie Sweeteners
¡ Use glass containers for storage
¡ Cook with cast iron for non-stick option
¡ Learn canning/freezing techniques for food storage
¡ Use dry legumes: soak and pressure cook
¡ Consider organic stevia as replacement sparingly
¡ Make your own nut milk
¡ Use only fresh organic spices
¡ Air popped popcorn
¡ Reduce exposure in home and personal care products
COMPREHENSIVE MODEL: ORNISH
¡ A whole foods, plant-based diet (naturally low in fat and sugar)
¡ Stress management techniques (including yoga and meditation)
¡ Moderate exercise (such as walking)
¡ Social support and community (love and intimacy)
¡ Results
! 3 months: 30% increase in peripheral blood mononuclear cell (PBMC) telomerase activity (Ornish, 2008)
! 5 years: increases in relative telomere length IN PBMC after 5 years of follow-up, compared with controls (Ornish, 2014)
Ornish et al. Lancet Oncol. 2008 Nov;9(11):1048-57. Ornish et al. Lancet Oncol. 2013 Oct;14(11):1112-20.
CREATING HEALTHY HABITS
“We suggest that professionals could consider providing habit-formation advice as a way to promote long-term behavior change among patients.”
¡ ‘Initiation phase’: new behavior and the context in which it wil l be done are selected
¡ ‘Learning phase’: behavior is repeated in the chosen context to strengthen the context-behavior association
¡ ‘Stability phase: habit has formed and its strength has plateaued, so that it persists over time with minimal effort or deliberation
Gardner, et al Br J Gen Pract. 2012 Dec; 62(605): 664–666.
CREATING HEALTHY HABITS
Make a new healthy habit
¡ Decide on a goal that you would l ike to achieve for your health.
¡ Choose a simple action that wil l get you towards your goal which you can do on a daily basis.
¡ Plan when and where you wil l do your chosen action. Be consistent: choose a t ime and place that you encounter every day of the week.
¡ Every t ime you encounter that t ime and place, do the action.
¡ I t wi l l get easier with t ime, and within 10 weeks you should f ind you are doing it automatically without even having to think about it.
¡ Congratulations, you’ve made a healthy habit! ! My goal (e.g. ‘to eat more fruit and vegetables’) _____________
! My plan (e.g. ‘I will add greens to my soups’) _________________
! (When and where) __________ I will ___________________________
Gardner, et al Br J Gen Pract. 2012 Dec; 62(605): 664–666.
A Y U R V E D AThe Ultimate Lifestyle Medicine
Thank you to all my teachers, Dr Vasant Lad,
SS Haribhajan Yoji Bhajan,
Sangeet Kaur Khlasa
"Document provided to and used by NAMA with permission from: Siri Chand Khalsa."
SELF-CAREROUTINE
©Siri Chand Kaur Khalsa
1
PITTA LIFESTYLE SUGGESTIONS5 to support vitality & health
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3
4
5
Exercise
Sleep
Diet
Self- Care
Yoga
learn to SURRENDER
©Siri Chand Kaur Khalsa
VATA LIFESTYLE SUGGESTIONS5 to support vitality & health
1
2
3
4
5
Exercise
Sleep
Diet
Yoga5
establish a ROUTINE
©Siri Chand Kaur Khalsa
Self- Care
KAPHA LIFESTYLE SUGGESTIONS5 to support vitality & health
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2
3
4
5
Exercise
Sleep
Diet
Self Care
Yoga
©Siri Chand Kaur Khalsa
challenge YOURSELF
Elements of Ayurvedic Daily Self Care20 to support vitality & health
©Siri Chand Kaur Khalsa
1. Wake Up Before the Sun Rises2. Gratitude; Offer Prayers3. Clean the Face, Mouth and Eyes4. Drink Warm Water in the Morning5. Evacuation6. Gargling7. Chewing8. Nasal Drops9. Ear Drops10. Apply Oil to Head & Body11. Bathing12. Dressing13. Essential Oils14. Exercise/Yoga15. Pranayama16. Meditation17. Nourishing Meals18. Hydration19. Community 20. Restfull sleep
