Nourishing Agni on a Mental Level

Tending to agni (digestive fire) within the subtle realms

For thousands of years, the medicine of Ayurveda has prioritized agni as an important aspect of health and well-being. Modern medicine is now confirming the truth of what Ayurveda has been saying for thousands of years—digestive health is a key factor in our ability to feel well in our mind-body dynamic. We tend to think of digestion in relationship to the physical body, but digestion actually happens on the mental and emotional levels, as well as being a part of our ability (or lack thereof) to process and release experiences, beliefs, and emotions. If we are to step more fully into our wholeness and truth (svastha), then we are going to have to digest, move through, and release limited mindsets and experiences we hold on to.

What is health from an Ayurvedic perspective? 

Let’s back up and take a look at how Ayurveda defines health. In Ayurveda, to be in a state of health is not simply to experience the absence of disease. To define health in those terms is to reduce the totality of what we are to just the physical dimension of our being. The word for health in Ayurveda is svastha, meaning to be situated in oneself or content in oneself. This definition encompasses not just the bodily factors but also our senses, mind, and spirit—conveying a holistic understanding of health. Therefore, we are being guided by Ayurveda to tend to our whole being to nurture health, which means taking care of the digestive fire not just within the physical sheath but also the mental and emotional sheaths.

So why is agni important to health? 

According to one of the ancient texts on Ayurveda, the Charaka Samhita, a person is as old as their agni. “Agni is necessary for the normal process of digestion, and the subtle energy of agni transforms the lifeless molecules of food, water, and air into the consciousness of the cell.” Agni also exists within the mental and emotional body, helping to transform our experiences through the five senses so that they may be processed and then released. Within the realms of mind and emotions, agni transforms the sensory experience into understanding. Right understanding leads to great discernment (buddhi) and wisdom, which ultimately fuel the path of self-realization as it relates to Ayurveda’s sister science Yoga.

What happens when agni is impaired?

When the digestive fire becomes vitiated due to an imbalance in the three doshas, or bodily humors, our food or experiences may not be broken down completely, and as a result, nutrients are not absorbed efficiently, beliefs and emotions get stuck inside us, and the cycle of intake, digestion, and release is hindered. This situation can lead to an accumulation of metabolic waste (ama) in the body—physical, mental, emotional, and/or energetic. Ama is sticky, heavy, and foul, and clogs the channels (srotas) of the body, thus impeding the flow of prana (life force energy) and ultimately causing our health to deteriorate from the inside out. When prana can’t flow freely, the intelligence of the body is disrupted, which leads to confusion in the mind-body dynamic. This can result in excess heat—inflammation, stagnant water (water retention), stuck earth (lethargy), chaotic air (dryness and lack of focus), and so on. On a more subtle level, this can result in frazzled energy that may manifest as fear and anxiety, anger, self-centeredness, and a judgmental mindset, as well as lead to over-attachment, lack of motivation, and depression. All these different possibilities prevent our true nature from shining forth and hold us back from experiencing a deep sense of well-being.

But tending to agni is not just for the sake of the physical human experience. 

We must remember that Ayurveda is Yoga’s sister science, and Yoga is the experience and practice of oneness, wholeness, and dissolution of mental activity into the self. It is our ultimate purpose from the spiritual perspective. While Ayurveda describes a plethora of food recommendations and herbal protocols to support individual constitutions, manage seasonal changes, correct doshic imbalances, and optimize the health of agni, we must also remember that attending to our physical needs can only take us so far if we don’t engage the other aspects of our being—mind, wisdom, and spirit. And I have found that this level of practice usually requires simplicity, presence, and intention. 

Three simple practices to sustain agni that nourishes your mind, emotions, and energy: 

1. Put away the screens during mealtime—when our mind is inundated by scrolling, reading, analyzing, and engaging with a screen, energy is redirected from the digestive system to whatever we are looking at. But we want energy going to the digestive process to support agni, so focus on one thing during mealtime, your meal. Eat slowly and savor the array of tastes, colors, and textures.

2. Sit down at the table to eat—for the same reason mentioned above. When we are walking, talking, driving, etc. while eating, energy is dispersed among these other activities and not focused on the digestive process. Not to mention, this can be aggravating to the vata dosha, which can lead to a host of problems, including gas, bloating, dryness in the colon, and poor digestion. Carve out time in your busy day that’s dedicated exclusively to meals, and set an intention to eat in a way that nourishes your entire being.

3. Light a candle when possible—the fire element is the essence of agni, and to physically bring fire into your mealtime environment is a subtle way of strengthening your inner fire. It also brings a sense of sacredness to mealtime, which truly exemplifies its nature. Eating is a time when we consume gifts from the earth as nourishment for our vessel, thus allowing ourselves to have a human experience. When we fail to see life through this unifying lens of gratitude, we miss out on a good portion of accessible medicine and forget that Ayurveda is just is not just medicine for the physical body but also a healing salve for inner states of disconnection from our spiritual essence.

4. Upon waking first thing in the morning, look at the morning sun and imagine your body infused with its radiant light and that radiant light nourishing the agnis of your entire being. Ask yourself this: How am I doing (from a judgment-free zone)? And then follow up with this question: What will feel nourishing for today? And incorporate the answers into your day.

5. At the end of each day, take time to reflect on what felt supportive of your whole being and what didn’t, again with no judgment. And then offer up these experiences to something bigger than yourself either through journaling, meditation, mantra, movement, or any practice that allows you to release and let go. Imagine the experiences of the day dissolving back into the cosmic ocean from which they arose.

 Sometimes it’s in the simple practices we find profound healing.

about the author

Ashlyn Miller is a Student, Teacher, Ayurveda Yoga Counselor, and Intuitive Medicine Guide. She is the founder of Inner Woven Wellness LLC, a portal for wellbeing & spirituality that offers educational experiences in Ayurveda, Yoga, and Earth-based practices. Ashlyn supports people in embracing their True nature and highest sense of Self through holistic medicine and spirituality, encouraging an intimate, nourishing relationship with life.

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National Ayurvedic Medical Association 2021 Annual Conference Report

by Baba Lou Haber

The 17th Annual Conference of the National Ayurvedic Medical Association (NAMA) brought together online 45 experts whose presentations centered on Ayurveda as evidenced-based and integrative medicine. The conference demonstrated how practitioners are harnessing scientific research to validate classical Ayurvedic approaches, growing expertise in disciplines of emerging importance such as microbiome research and genomics, and building bridges with Western medicine.

Integrative Medicine Defined

Among the first presenters was Victoria Maizes, MD, executive director and professor of medicine at the University of Arizona Andrew Weil Center for Integrative Medicine. Maizes offered a definition of integrative medicine as “healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle” and “emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies.”

An internationally recognized leader in integrative medicine, Maizes began with an alarming statistic from JAMA: Even though 70% of deaths in the United States are due to behavioral and environmental factors, only 1%–3% of healthcare dollars are spent on disease prevention, compared to 97%–99% spent on medical care and biomedical research. She emphasized how “something is missing from our healthcare systems, and we believe that we can do a better job taking care of our patients through integrative medicine.”

Innovative Integrative Approaches

That spirit of advancing a better way to improve healthcare and foster wellness was abundantly evident throughout the NAMA conference. Presentation topics included evidenced-based approaches to healing leaky-gut syndrome (in which an unhealthy gut lining allows undigested food and toxins to leak into the bloodstream); innovative therapies to address gastrointestinal tumors; Ayurvedic approaches to mitochondrial diseases and disorders (which occur when mitochondria fail to produce sufficient energy for the body to properly function); and Ayurvedic prevention and treatment of gynecological disorders.

Among the presenters on yoga were Susan Bass, AP- and AYT-NAMA, E-RYT 500, C-IAYT, a certified Ayurvedic practitioner and Ayurvedic yoga therapist who founded the Sarasvati Institute of Ayurveda & Yoga Therapy and the Sarasvati Mission. “Ayurveda excels at digestion and detoxification, so it is about improving the quality of blood,” noted Bass. “That’s why Ayurveda and yoga are exponentially more effective when practiced together, because who cares if you have the blood moving around the body when it is of poor quality and does not nourish the cells and the organs?”

Bass led two sessions. The first examined the beneficial role of yoga in reducing stress and improving mental health. In her second presentation, Bass brought together asana, pranayama, mudra (gestures), and marma (vital body junction points) therapy to address vishama agni (irregular/weak metabolism), the type of digestive imbalance caused by excess vata (air/wind).

A Deeper Understanding of “Evidence”

Bhushan Patwardhan, PhD, national research professor at the Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, provided an overview of Ayurveda as an evidenced-based science. He emphasized that Ayurveda and yoga require a different approach to research and a fresh look at what constitutes evidence, given that they have an entirely different framework than Western medicine.

According to Patwardhan, the integration of Ayurveda and modern medicine will entail an “epistemological transformation process” in which Ayurveda as a holistic, experiential, and natural approach will need to be more fully appreciated and understood by medical practitioners and the medical research community.

A New Paradigm to Foster and Sustain Health and Wellness

In her presentation “Biodiversity Is Health; Biodiversity Is Sustainability,” Vandana Shiva, PhD, likewise emphasized the critical importance of a paradigm shift—one to a more holistic understanding of health that includes our interconnectedness with all species and the entire planet.

“The paradigm we have today is one that doesn’t work with whole systems,” said Shiva, a researcher and eco-feminist food-sovereignty activist who founded the Research Foundation for Science, Technology, and Ecology in Dehradun, India. In contrast, Shiva noted, Ayurveda teaches us that health is about balance. “The body is not little fragments and parts; the body is a non-separable whole interacting non-separably with the world and the biodiversity around us,” she said.

Shiva ended her talk with a call to action. “If there is one thing we can take forward from ecology, from biodiversity, from Ayurveda, it is our interconnectedness,” she said. “We are one, and we can be interconnected through health and regeneration, or through disease and degeneration. [E]ach of us should cultivate the will and determination and the hope that the regeneration part is what we will evolve.”

A Look at COVID-19

NAMA additionally offered a post conference event providing perspectives from conventional medicine and Ayurveda on COVID-19. The presentation, by Dhaval Dhru, MD, and Mimi Guarneri, MD, included a survey of preliminary research looking at promising results of both integrative and Ayurvedic treatments of the virus.

Throughout the conference, NAMA encouraged attendee donations to help the people of India during the country’s COVID-19 crisis through such organizations as Sewa International USA (www.sewausa.org).

Mark Your Calendars

Planning is already underway for NAMA’s next annual conference. The 2022 gathering will be a special event where participants will hopefully again meet in person. The theme of the conference, to be held in Tucson, Arizona, April 22–24, is “Ayurveda for Family Health.”

Originally published in Yoga Therapy Today, a publication of the International Association of Yoga Therapists (www.iayt.org). Shared with permission.

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About the Author

Baba Lou Haber has written for CBS News, served as a communications executive for several companies and public agencies, and is a Cicero Award–winning speechwriter. He is currently studying to be an Ayurvedic Health Counselor. Baba Lou also serves as a member of NAMA’s Communications Committee.

Integrating Ayurveda and Allopathic Medicine: An Interview with Charles Elder, MD, MPH

Internist, researcher, noted author, and NAMA member Dr. Charles Elder has expertise in both conventional and complementary medicine. He recently spoke with Baba Lou Haber, a member of the NAMA Communications Committee, to offer insights on how NAMA members can work collaboratively with allopathic practitioners. Read their conversation below.

Baba Lou Haber: Let’s start with how you became interested in Ayurveda.

Dr. Charles Elder: My journey actually began when I was admitted to medical school right out of high school. I was accepted to Boston University’s combined BA/MD program. I was only 17 and new to Boston, having been raised in northeast Ohio. To relieve the stress of it all I started a meditation practice at the greater Boston Transcendental Meditation Center and began practicing yoga as well. So I went through medical training meditating the whole time, which shaped my thinking. For example, if there was a patient suffering from anxiety for whom we were prescribing Valium, it struck me as bizarre that we were not suggesting meditation to help him.

I did my residency in Internal Medicine at the University of Michigan, where I met my wife, Leslie, who was also a resident. She also had a meditation practice and already had some interest in Ayurveda. Together we went on a weekend meditation retreat where one of the speakers was Dr. Hari Sharma, who is an outstanding scientist. He gave a talk describing the antioxidant and antineoplastic properties of some of the traditional Ayurvedic formulas that he was studying in his lab. I found the whole thing mindboggling.

Baba Lou Haber: What a gift to have discovered Ayurveda at the beginning of your medical career! How were you able to integrate it into your practice?

Dr. Charles Elder: When we finished our residencies 30 years ago, Leslie and I moved to Portland, Oregon. I started working as a primary care doctor at Kaiser Permanente, where I still am. For the first 10 years or so I was just working hard being an internist, and it was a busy time. My wife and I had to balance career and family, as well as pay off student loans. But we also made time to take short courses in Ayurveda for physicians offered by Maharishi University, and we incorporated what we learned into our own lives.

About six or eight years into my job, I started getting frustrated because I had patients coming in with problems such as chronic pain, functional bowel disorder, anxiety, depression – problems where allopathic medicine can be weak. I knew I had all these tools in these areas, but could not use them, which was problematic. Eventually I wrote a proposal and got permission from Kaiser Permanente to do some innovative Ayurvedic consultations with patients who had these conditions. I detailed what I was going to offer and the metrics that would measure outcomes. The reviews after working with about a dozen patients were so positive that the pilot initiative ended up getting expanded to a Kaiser Permanente referral-based clinic, where I have since been doing integrative Ayurvedic consultations.

Baba Lou Haber: How have you continued to spread the word about Ayurveda beyond your clinic in Portland?

Dr. Charles Elder: In 2000 I did a part-time sabbatical at the Kaiser Permanente Center for Health Research, where there was a group of researchers interested in integrative medicine. That opened the door for me to begin research at the Center focused on how complementary medicine can improve mainstream medical care.

And in 2017 I took a second sabbatical during which Leslie and I wrote a book entitled Picture of Health to help people incorporate Ayurveda into their lifestyles. We use it as a manual for people who come to our clinic, and it also is designed to be a guide that people in conventional medicine can digest and assimilate.

Baba Lou Haber: Your story speaks to the importance of collaboration between Ayurvedic and allopathic practitioners.

Dr. Charles Elder: The potential for collaboration is enormous, and we need to make the most of it through relationship building around areas of mutual interest. There is so much common ground and so many things we can talk about in Ayurveda.

Take, for example, functional bowel disorders. Allopathic doctors in general are not great with what we call irritable bowel syndrome because it is abdominal pain and digestive complaints that we cannot explain. In so many words, that is the description and diagnosis. But the area of digestive disorders is one in which Ayurveda is very rich, and people can make a lot of progress seeing a NAMACB board certified practitioner. There are gastroenterologists out there who would love to have a competent, trustworthy person that could help these patients with diet and lifestyle.

Chronic pain is another example where Ayurveda can help patients make a lot of progress. Many times, not always, but many times, mind-body techniques, diet, daily routine, exercise, and yoga can a make huge difference in alleviating chronic pain.

There are many other areas – for example, high blood pressure, high cholesterol, depression, and menopausal disorders – where allopathic doctors need help and there is space for dialogue. So identifying and building relationships in those areas through dialogue can be extremely powerful.  

Baba Lou Haber: From my personal experience, not every doctor in conventional medicine is open to a conversation about Ayurveda. Are you being overly optimistic?

Dr. Charles Elder: Keep in mind that, in large part, training for allopathic doctors is focused on procedures and drugs, and their knowledge in other areas may be limited. Some doctors are more evolved and open to a conversation than others.

Remember also that different doctors will have sensitivities about different things. So you don’t want to jump right in talking about bastis and vamana, which are for a later discussion. And when you start prescribing herbs, be a little sensitive to where some doctors are coming from, because some have misconceptions. I would not necessarily talk about herbal supplements on a “first date.” As for me, I feel that if someone is getting herbs from a trained and certified practitioner, I don’t worry about it. On the other hand, if a patient just grabbed them off the shelf, I may be more concerned.

Baba Lou Haber: And what would you say to an Ayurvedic practitioner or student who looks with skepticism at for-profit companies within the healthcare industry?

Dr. Charles Elder: Let’s focus on people. I honestly believe that 99.9999 percent of healthcare practitioners want the patient to get better. With the well-being of the patient at the center of the discussion, everyone can get on the same page.

Baba Lou Haber: Tactically speaking, what is the best way for an Ayurvedic doctor to build bridges with allopathic doctors?

Dr. Charles Elder: That is a great question. How do you reach out to people? Get out there and network – that would be my approach. I think giving public talks is a good idea. Also, advertising in medical publications in a very targeted way. And if you can get into integrative medicine circles, good. Find institutions in your area that can serve as meeting grounds for people on both sides. Here in Portland, for example, there is a big integrative medicine community in which people can reach out if they are looking to collaborate. And there are a number of medical schools that have fellowship and research programs that may provide networking opportunities.

Of course, it is important to develop relationships with the right people. A lot of that can be personal chemistry. The good news is that, from what I see, the allopathic community is much more open these days than it used to be. The wisdom and science behind Ayurveda is so powerful – doctors are seeing that and taking notice.

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About the Author

Charles R. Elder MD, MPH, FACP, received his MD and MPH degrees from Boston University School of Medicine and completed residency training in internal medicine at the University of Michigan hospitals. He has served as a primary care internist at Kaiser Permanente Northwest (KPNW) for 30 years and has been the physician lead for the complementary and integrative medicine program at KPNW for 20 years. In this capacity, Dr. Elder offers a referral-based integrative Ayurvedic clinic, advising patients in the areas of diet, exercise, herbal medicine, mind-body practices, and other complementary medicine modalities. Dr. Elder holds a Senior Investigator appointment at the Kaiser Permanente Center for Health Research, where he has served as principal or co-investigator on a range of federally funded studies evaluating mind-body and other complementary medicine interventions in the setting of chronic disease management. Dr. Elder has an adjunct faculty appointment at Maharishi International University, where he serves as a course instructor for the online MS in Ayurveda program.

Baba Lou Haber is the chair of the NAMA Articles and Interviews Subcommittee. He has written for CBS News, served as an executive in the communications functions for several companies and public agencies, and is a Cicero Award-winning speechwriter. A certified yoga instructor (RYT 200), he is currently studying to be an Ayurvedic Health Counselor. Baba Lou is a graduate of Swarthmore College and Brooklyn Law School.

The Dangers of Self-Medicating with Herbs

by Manju Kolli

Before I had the joy of becoming an Ayurvedic Practitioner, I trained and served as a clinical pharmacist. My experience in pharmacy, spanning more than 15 years, has both informed and enriched my perspective on the Ayurvedic practice I have built.   

As a pharmacist, one of the most alarming and challenging trends I have witnessed is the surge in sales of over-the-counter (OTC) drugs, particularly those designed to alleviate symptoms of a range of increasingly common chronic illnesses. The growing use of OTC medications has been further fueled by their affordability, as well as by a rise in the number of prescription drugs that are now available over the counter.   

Abuse and overuse of OTC medications can have serious consequences. The dangers from misuse of certain OTC painkillers, cough medicines, antihistamines, antacids, and laxatives, for example, are well documented within the medical community, and there is growing public awareness of the perils as well. 

We are now seeing rising sales of herbal supplements, the market for which is currently valued in the multibillion dollar range and continuing to grow as increasing numbers of consumers seek natural remedies, both to prevent disease and to address chronic conditions. Additionally, the COVID-19 crisis is prompting many wellness consumers to look to supplements, including herbs, to boost their immune system.

Given my overlapping backgrounds in pharmacy and Ayurveda, I am acutely aware of the dangers of potential misuse of herbal supplements by consumers who may be self-medicating. This concern is shared by Ayurvedic and allopathic doctors alike. A friend who is a nephrologist even made a personal appeal to me to help save people’s kidneys by warning them of the dangers that lie in the misuse of herbal supplements.

The Science of Herbs

Although those of Indian origin tend to see Ayurveda as grandma’s wisdom-infused medicine, the reality is that Ayurveda is highly scientific in its approach to health and wellness. The well-developed rationales and principles underlying this approach and the logical treatment protocols it comprises have withstood the test of time. 

Foundational to Ayurveda is the understanding that we all have a distinct blueprint at birth. As we mature, age, and go through life’s varied experiences and challenges, the natural balance of our original constitution (prakruti) changes and can be pushed out of balance. This imbalanced state (vikruti) is heavily influenced by our dietary and lifestyle choices. 

Since a person responds to external triggers according to their particular prakruti, one person’s medicine can be another’s poison. This insight is true for most herbs just as it is true for most drugs.

Also essential to the proper use of herbs is a clear understanding of the Ayurvedic principle Karya Karana Bhava, which holds that no event occurs in creation without a cause. Simply put, there is a cause behind each and every disease. Ayurveda’s wisdom is used to address that cause in order to maintain health, prevent disease, and restore balance. 

Let us look at the common problem of indigestion. One study cited by the National Institute of Health estimates that one in four Americans suffers from it. 

There are many causes of indigestion. I have grouped together some common causes according to the dosha they can aggravate:

1. Excessive or high-impact physical activity or insufficient food consumption, aggravating vata

2. Spicy, salty, or sour foods, or excessive anger, aggravating pitta

3. An extremely sedentary lifestyle or consumption of too many sweet and heavy foods, aggravating kapha 

Trikatu (which comprises dry ginger, black pepper, and pippali) can be very helpful in curing indigestion, as well as the bloating it can cause; however, it is only truly applicable to one of the three scenarios listed above.

In the first scenario, indigestion is likely to have resulted from insufficient digestive fire because of a loss of tissue strength, with the influence of vata’s predominantly dry and light properties. Trikatu will increase these depleting qualities, due to its own inherent dry and light properties, which, in turn, will aggravate the indigestion.

In the second scenario, indigestion results from excessive pitta, and trikatu will likewise aggravate indigestion and pitta due to its hot potency.

In the third scenario, however, trikatu is indicated as an appropriate pacifying remedy. 

Here are some other examples of commonly available herbs that are subject to misuse: 

Tulsi is known for helping with cold and cough symptoms. If, however, a cough is due to depletion, and it is dry, tulsi will increase the dryness and depletion and could aggravate the cough.

Ashwagandha is frequently used to treat depression, help with fertility, and increase muscle mass. If a client’s symptoms are due to excess accumulation of ama (undigested food in the body), however, ashwagandha will only worsen the condition. 

Triphala is definitely an amazingly versatile herbal medicine that can help in many scenarios, but long-term use of it can create a harmful dryness in mucosal linings. 

Neem can help with diabetes by removing excess accumulation of mucus. Yet if neem is overused after it achieves the desired action, vata gets aggravated, creating an imbalance.

Even ghee, one of the most widely advocated superfoods in Ayurveda, can be misused. If a person is suffering from insufficient digestive fire (mandagni) and excessive mucus, ghee can further dampen digestion and exacerbate the problem. 

These are but a few examples of why it is essential to understand the nature of both the prakruti and the vikruti of clients, as well as the pathological road map of their disease manifestation, before prescribing herbal treatments. It is also important to use the optimal delivery method, including the Karya Karana Bhava, that will efficiently and effectively deliver the right herb to the right site and body system. 

As these examples illustrate, well-meaning friends can naively advocate for an herb that has worked very well for them but can be harmful for someone else. In contrast, a knowledgeable Ayurvedic Practitioner can help clients find and correctly use herbal supplements that are right for them.

Our Role in Educating the Public

As Ayurvedic Practitioners, we play a critical role in protecting public health. Here are three suggestions for increasing awareness of the benefits of herbal supplements and the dangers of self-medicating:

1. Ask your clients to reach out to you with any questions rather than try to self-medicate based on advice from friends or information they find on the internet.

2. Offer free talks in public venues, such as virtual or live forums hosted by local libraries.

3. Author articles for local newspapers to educate your community.

The increasing popularity of herbal supplements and remedies represents a potential turning point in public awareness and medical community acceptance of Ayurveda as a credible pathway to health and wellness. It is up to us as practitioners and students of Ayurveda to help people understand that herbs and herbal supplements must be used appropriately.

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About the Author

Manju Kolli is an Ayurvedic Practitioner based in California’s Bay Area, where she is the founding director of Ayurhitam, an Ayurvedic wellness clinic. Manju has more than 15 years of experience serving as an allopathic clinical pharmacist at the long-term care pharmacy PharMerica. A NAMA-recognized Ayurvedic Practitioner, she also teaches Ayurveda and has expertise in women’s and children’s health, gut problems, skin conditions, mental health, and allergies.

Research and Clinical Practice Highlight

with Clayton Bell M.D.

My name is Clayton Bell, and I am an Integrative Medicine physician and Assistant Clinical Professor in the Department of Family Medicine at the University of Tennessee Medical Center.  My current clinical practice as an Integrative Medicine physician combines cutting-edge, evidence-based Orthomolecular-Functional Medicine with the subtle yet powerful healing insights of Ayurveda. 

Personalized wellness plans are created for each patient based on their prakruti, vikruti, and current medical conditions.  Heavy emphasis is placed upon Lifestyle Medicine treatments and “miracles” often abound in the healing response.  Patients and fellow healthcare providers are often amazed to discover what happens when one brings the various aspects of their life (physical, psychological, emotional, spiritual) into balance.  To help expand this clinical knowledge, I am actively teaching Ayurvedic techniques to rotating medical students, residents, and providing Grand Rounds to various medical departments throughout the hospital as well. Combining the science of Western medicine and the wisdom of Eastern medicine creates the highest level of patient care possible.

Ayurveda began capturing my passion and professional curiosity three years ago during my Integrative Medicine Fellowship at the University of Kansas Medical Center. For my fellowship thesis, I wanted to scientifically validate if the various Ayurvedic prakruti (Vata, Pitta, Kapha) were truly biostatistically correlated with Integrative and Western Medicine diagnosis.  Through researching both national and international peer-reviewed journals, many articles began to emerge linking specific prakruti to various biomarkers and genomic patterns.  However, nowhere could I find where any researchers had ever biostatistically validated these most foundational theorems regarding prakruti and various disease states.  

Our research study participants were patients of the KU Integrative Medicine Clinic. Eligibility criteria included adult patients ages 21 and older with no language barriers and the ability to give consent. Approximately 150 participants were screened, 129 were enrolled with 119 successfully completing both the Mind-Body Survey and the Medical History Form. The Mind-Body Survey consisted of 10 self-assessment questions pertaining to specific physical and psychological characteristics. This survey was adapted from The Chopra Center’s Prakruti Patient Intake Form and provided quantitative subscores for each Ayurvedic dosha (Vata, Pitta, Kapha). Participants were also given a Medical History Form to determine active, past, or lack of history for 47 common integrative medicine diagnoses. Biostatistical analysis was analyzed to determine positive and inverse correlations between prakruti and specific disease diagnosis.

Based on our findings, we have discovered multiple statistically significant positive and inverse correlations between prakruti and self-reported medical diagnosis. Vata was associated with anxiety (r = .22, p = .02) and sleep disorders (r = .25, p = .01), whereas Kapha appeared to be protective from anxiety (r = –.31, p = .001) and sleep disorders (r = –.19, p = .04) as well as osteoporosis (r = –.22, p = .02), hyperthyroidism (r = –.24, p = .01) and environmental allergies (r = –.19, p = .04). However, Kapha was statistically associated with obesity (r = .32, p = .001) and overweight (r = .32, p = .001), whereas Vata was protective from obesity (r = –.19, p = .05) and overweight (r = –.39, p < .001). Vata was also statistically correlated with constipation (r = .19, p = .04), depression (r = .22, p = .02), irritable bowel syndrome (r = .26, p = .01), and panic attacks (r = .29, p = .002). Vata was inversely correlated with hypertension (r = –.22, p = .02) and solid organ cancers (r = –.25, p = .01). No statistical associations were found for Pitta.

We were very excited to discover the positive and inverse correlations, which verified the ancient Ayurvedic teachings and our research was published in the Ayurveda Journal of Health—an incredible experience! I learned so much through the entire research and publication process and highly recommend others to do the same.  Our research and many other current publications are validating Ayurveda as an incredibly useful and pragmatic medical system.  To learn more, see the Ayurveda Journal of Health 2017 Summer edition and read our article: Ancient Wisdom: Can Ayurvedic Prakruti Provide Invaluable Insights into Integrative Medicine?

Remember, as a NAMA member you have a subscription discount to the Journal. Check your Member Discounts from the NAMA Member Center.

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ABOUT THE AUTHOR

Dr. Clayton Bell, M.D., is an Integrative Medicine physician and Assistant Clinical at the University of Tennessee Medical Center.  He utilizes evidence-based Orthomolecular Functional Medicine and the ancient wisdom of Ayurveda to create personalized wellness plans for each patient.  

NAMA Responds to Issue of Heavy Metal Toxicity

National Ayurvedic Medical Association (USA)
Ayurvedic Practitioners Association (UK)
Verband Europäischer Ayurveda-Mediziner und -Therapeuten (Germany)

Joint Response to the August 2008 JAMA Article

A study conducted “to determine the prevalence of Ayurvedic medicines available via the Internet containing detectable lead, mercury, or arsenic” has concluded that “one-fifth of both US-manufactured and Indian-manufactured Ayurvedic medicines purchased via the Internet contain detectable lead, mercury, or arsenic.” The article can be found in the August 27 issue of JAMA, the Journal of the American Medical Association (Vol 300, No.8 p915) titled “Lead, Mercury, and Arsenic in US- and Indian-Manufactured Ayurvedic Medicines Sold via the Internet.”

The National Ayurvedic Medical Association (NAMA), Ayurvedic Practitioners Association (APA) and Verband Europäischer Ayurveda-Mediziner und -Therapeuten (VEAT) welcome all efforts to enhance quality and safety of Ayurvedic products but recommend that this study be interpreted with caution. We recognize and support the need for effective quality control in the use of all Ayurvedic products and promote the use of suppliers who use Good Manufacturing Practices. We agree that there is clearly a challenge with heavy metals throughout the food chain as a whole.

“Metals,” “heavy metals” and “toxic metals” are all terms used for a group of elements which include lead, mercury, arsenic and others that are known or suspected to cause toxicity in certain forms and at certain doses. The detectable presence of these elements in dietary products and food or water is not the same as toxicity. These elements are present in many of our everyday foods and as shown in this study, Ayurvedic dietary supplements. In the case of foods and herbal products their presence can occur because: 1) they are naturally occurring in the soil, water and air, 2) from pollution as a result of human activity where in both cases theses elements are taken up by the plants, 3) from contamination in the manufacturing process, and 4) these elements are intentionally added. Toxicity is the result of too much of the specific form of metal being ingested over time.

In the U.S, there is no current national law precisely regulating the amount of lead, mercury and arsenic in dietary supplements. There are various opinions on what the maximum safe daily limits for lead, mercury and arsenic in dietary supplements should be. For example, four authorities are, mentioned in the JAMA article and their limits vary considerably. They are: the California Safe Drinking Water and Toxic Enforcement Act (California Proposition 65) that gives a maximum level of 0.5 μg /day for lead as a reproductive toxin; The American National Standards Institute (ANSI)/National Sanitation Foundation (NSF) International Dietary Supplement Standard 173 that gives a maximum level for lead at 20 μg /day, mercury at 20 μg /day and arsenic at 10 μg /day; the US Environmental Protection Agency (USEPA) that gives a maximum level of 21 μg /day for inorganic mercury and 21 μg /day for inorganic arsenic for a 70 kg adult; and The Food and Agricultural Organization / World Health Organization Joint Expert Committee on Food Additives (FAO/WHO) that give total dietary intake maximum levels of 250 μg /day for lead, 50 μg /day for mercury and 150 μg /day for arsenic for a 70 kg adult. In the absence of specific standards it is difficult for the dietary supplement industry and Ayurvedic community to know what limits to meet. NAMA, APA and VEAT welcome government guidelines for the industry. [μg = mcg = micrograms or one millionth of a gram = 0.000001 sometimes referred to as ppm or parts per million -- mg = milligrams or one thousandth of a gram = 0.001]

The JAMA article states that “one-fifth of both US-manufactured and Indian-manufactured Ayurvedic medicines purchased via the Internet contain detectable lead, mercury, or arsenic.” However, as discussed above, the simple presence of any of these elements does not in and of itself translate to toxicity. This “one-fifth” (or 20%) was based simply on whether lead, mercury or arsenic was able to be detected in the product, not the specific forms of these metals that are of concern and without consideration of the resulting daily dose. More importantly, all these products were said to “cause ingestions exceeding at least 1 regulatory standard.” The “regulatory standard” with the lowest levels is California’s Proposition 65, with a maximum level of 0.5 μg /day; the lowest by far of all of the limits cited in the article and one that does not take into consideration naturally occurring lead. It is important to note that California Proposition 65 is not a regulation prohibiting sales of these products, but rather requires a specific warning to the consumer if a product contains these elements above its limits. If a different analysis were done using the daily dose limits of ANSI/NSF, USEPA and FAO/WHO, we would find that the percentage of products containing heavy metals and resulting in daily doses above their recommended amounts is approximately 8% of total products, not the 20% stated in the article.

There is one more important issue to consider. Among the products tested, there were some traditional Ayurvedic products that intentionally contain specially prepared forms of lead, mercury and or arsenic. Although these products have been in use in India for hundreds of years with claims of efficacy and safety, they have not been proven by modern medical science to be either safe or effective. NAMA, APA and VEAT recommend that practitioners and consumers should avoid the use of products in which lead, mercury and or arsenic have been intentionally added until these products are better understood by modern science and medicine, and there are clear guidelines both from within the Ayurvedic community and national laws. Finally, if we were to count only those products that do not have lead, mercury or arsenic intentionally added but would still result in daily doses above the authorities other than California Proposition 65, we find about 5%, not “one fifth” 20%.

In order to adequately and effectively meet the existing challenge of heavy metal contamination in Ayurvedic products, NAMA, APA and VEAT make the following recommendations:

1.  That government and industry establish sound, scientific daily dose limits for lead, mercury and arsenic in all dietary supplements and establish Good Manufacturing Practices that all manufacturers demonstrate compliance through independent third-party testing using validated preparation and testing methodologies, not just for Ayurvedic products and dietary supplements but also for conventional foods.

2. That manufacturers, marketers, practitioners and consumers of herbal products stop importing, manufacturing, distributing, selling, recommending and using any product for which lead, mercury or arsenic have been intentionally added until such time as modern western science and medicine have proven the safety of such products.

3. We support those companies who adhere to the points in these recommendations, Good Manufacturing Practices, quality control and who are members of one or more recognized industry associations that are committed to safety and quality.

4. Until such time as government and industry can agree upon and establish scientifically sound daily dose limits for lead, mercury and arsenic, we recommend that manufacturers and practitioners adhere to any government regulations currently in existence and at a minimum follow the lower of the guidelines established by ANSI/NSF and FAO/WHO which are currently 20 μg /day for lead, 14 μg /day for mercury and 10 μg /day for arsenic. Consumers must make their own decisions on what is safe for them based on sound scientific, medical and expert advice according to their own personal situation.

NAMA-APA-VEAT Joint Response to JAMA Article on Heavy Metals in Ayurvedic Medicines - September 2008