Ayurveda

• How It Works

  Ayurveda is a medical system that originated in India. Oral formulations, dietary and lifestyle changes, and yoga or meditation are the main components. Herbs such as curcumin have beneficial effects but should be used under supervision. Yoga and meditation help alleviate side effects associated with cancer and its treatments.

  Derived from the Sanskrit words “ayur” (life) and “veda” (knowledge), Ayurveda dates back more than 3,000 years. Treatment is tailored to the individual and consists of oral formulations containing herbal, mineral, spice, and animal components; purgatives; dietary and lifestyle changes; and improving mental balance through yoga or meditation.

  Many of the more frequently used herbs, such as ashwagandha (Withania somnifera), guggul (Commiphora mukul), Boswellia (Boswellia serrata), gotu kola (Centella asiatica), curcumin (Curcuma longa), ginger (Zingiber officinale), aloe (Aloe barbadensis), and garlic (Allium sativum), have been studied extensively in vitro and in vivo and show antioxidant, antitumor, antimicrobial, immunomodulatory, or anti-inflammatory properties. Herbs often used to treat diabetes show hypoglycemic activity in vitro and in vivo. Clinical trials confirmed that some Ayurvedic botanical formulations can be used to treat acute viral hepatitis, acne vulgaris, obesity and rheumatoid arthritis. Yoga and meditation have shown benefits in reducing symptoms associated with cancer and its treatments.

• Purported Uses
  • To treat acne
    Certain herbal preparations have been shown to be effective in reducing acne.
  • To prevent and treat cancer
    No scientific evidence supports this use.
  • To treat cancer related symptoms
    Recent studies demonstrate that yoga helps improve sleep pattern in lymphoma patients and also reduces symptoms of stress in breast and prostate cancer patients.
  • To treat heart disease
    There are no data to back this claim.
  • To treat diabetes
    Several herbs used in Ayurveda have blood glucose-lowering effects, but the clinical evidence for their use is not strong.
  • To treat fibromyalgia
    One clinical study found that ayurvedic dietary, herbal, and meditation therapies resulted in a significant improvement of symptoms in patients with fibromyalgia.
  • To lower high cholesterol
    A clinical trial showed that certain herbal preparations could lower blood cholesterol and triglyceride levels in overweight patients.
  • To treat Parkinson’s disease
    A clinical study supports the use of one herbal preparation for improving the functional status of patients with Parkinson’s disease.
  • To treat rheumatoid arthritis
    Although many ayurvedic herbs have anti-inflammatory effects, robust data are lacking to support this claim.
  • For weight loss
    Data from a clinical trial suggest that a few herbal preparations could aid weight loss in overweight patients.
• Patient Warnings
  • Although heavy metals such as lead, gold, and silver are traditionally used in ayurvedic formulations, the use of lead for its assumed benefit has been a cause of concern. The US Centers for Disease Control and Prevention reported 12 cases of lead poisoning associated with the use of Ayurvedic medications.
  • In the last few decades, commercialized meditation regimens have emerged to the concern of many. They often associate meditation with supernatural abilities. Such claims are not based on scientific evidence and should not be confused with meditation practice in Ayurveda.
• Do Not Take If
  • You are taking Phenytoin: The Ayurvedic syrup shankhapushpi causes decreased blood concentrations of phenytoin ⁽²⁷⁾.
  • You are taking drugs that are substrates of Cytochrome P450 enzymes: Several ayurvedic herbs induce or inhibit CYP enzymes, and may reduce effectiveness or increase the risk of side effects of these drugs
• Side Effects
  • Ayurvedic preparations can contain varying amounts of lead and have caused severe gastrointestinal symptoms and anemia due to lead poisoning^.
  • Adhatoda vasica, an herb often used for respiratory tract ailments, is reported to have oxytocic (facilitating childbirth) and abortifacient (causing abortion) effects.
  • Arsenic poisoning, manifested by hyperkeratosis, neuropathy, splenomegaly and anemia, has been reported following use of ayurvedic medications for dermatitis, vitiligo and diabetes.
  • Ayurvedic formulations containing heavy metals and hepatotoxic (toxic to liver) volatile organic compounds can cause acute liver injury and deathIngestion of ayurvedic tablets by a pregnant woman resulted in fatal congenital defects in the fetus. Analysis of the tablets revealed presence of lead (47%), mercury (1.7%) and arsenic (<0.01%) 
• Clinical Summary

  Derived from the Sanskrit words “ayur” (life) and “veda” (knowledge), Ayurveda originated in India over 3,000 years ago. Treatment is patient-tailored and consists of oral formulations containing herbal, mineral, spice, and animal components, purgatives, dietary and lifestyle changes, and improving mental balance through yoga or meditation. It is available in a few clinics in North America, but there is no licensure for practicing Ayurveda in the United States. Ayurvedic medicinals, which can contain from a few to hundreds of components, are commonly used to treat chronic diseases such as diabetes, rheumatoid arthritis, Parkinson’s disease, acne, obesity, and cancer.

  Clinical trials show benefit of various formulations in treating fibromyalgia ⁽¹⁾, diabetes ⁽²⁾, hyperlipidemia ^(3) (4), hypothyroidism ⁽³⁹⁾, anemia ⁽⁵⁾, dyspepsia ⁽⁶⁾, acute viral hepatitis ⁽¹¹⁾, acne vulgaris ^(12) (45), obesity ⁽¹³⁾, and rheumatoid arthritis ^{(14) (15) (40)}. Ayurvedic dietary and lifestyle changes were shown to affect positive outcomes in a randomized study of women with burnout syndrome ⁽⁴¹⁾.

  A few Ayurvedic herbs are being investigated for their anticancer potential. Curcumin is among the extensively studied, and initial findings appear promising. Yoga has been shown to help improve sleep, mood, to reduce stress and to improve quality of life both in cancer patients and survivors. The effects of meditation in reducing anxiety, lowering blood pressure, and enhancing well-being both in general population and in oncology setting have also been confirmed.

• Purported Uses
  • Acne
  • Cancer
  • Cardiovascular disease
  • Depression
  • Diabetes
  • Liver conditions
  • Indigestion
  • Infections
  • Memory loss
  • Parkinson’s disease
  • Rheumatoid arthritis
  • Weight loss
• Mechanism of Action

  Ayurveda emphasizes both health maintenance (Svasthavritha), and diagnosis and treatment (Athuravritha). Patients are classified by their prominent dosha, or physical, emotional, and metabolic type, Kapha, Pitta, or Vata, each located in specific organs and associated with two of the five elements (earth, fire, water, air, and ether) and five senses. The doshas represent properties shared by the organs, body, environment and cosmos. When a patient’s unique state of dosha is out of balance, illness occurs. Therapy is personalized to the individual’s problems and metabolic characteristics to restore balance through diet and lifestyle modifications, medicinals (herbs, spices, metals and/or animal products), breathing exercises, and meditation. Detoxification (panchakarma) occurs before administration of medicines, which includes bloodletting, induced vomiting, and bowel purging. The therapeutic approach seeks to cure disease by reversing the steps that led to it (e.g., administering cooling medicines if Pitta, the hot dosha, is predominant) ⁽¹⁰⁾.

  Maharasnadi Quathar, a medicinal used to treat rheumatoid arthritis, increases antioxidant enzyme activity, decreases TBARS generation, and improves symptoms in human subjects ⁽¹⁶⁾. Many of the frequently used herbs, such as ashwagandha (Withania somnifera), guggul (Commiphora mukul), Boswellia (Boswellia serrata), gotu kola (Centella asiatica), curcumin (Curcuma longa), ginger (Zingiber officinale), aloe (Aloe barbadensis), and garlic (Allium sativum), have been studied extensively in vitro and in vivo, and show antioxidant, antitumor, antimicrobial, immunomodulatory, or anti-inflammatory properties. Herbs often used to treat diabetes, Gymnema sylvestre, Momordica charantia, fenugreek (Trigonella foenum-graecum) Coccinia indica, and Pterocarpus marsupium, show hypoglycemic activity in vitro and in vivo. Mucuna pruriens, used in preparations for Parkinson’s disease, contains L-dopa ⁽¹⁷⁾. Rasayana herbs (said to promote positive health) such as ashwagandha, Asparagus racemosus, Emblica officinalis, Piper longum, and Terminalia chebula showed immunostimulant and adaptogenic activities in an animal study ⁽¹⁸⁾. Ayurvedic gold preparations (e.g., Swarna Bhasma) have antioxidant and restorative effects in animal models of ischemia ⁽¹⁹⁾. The herbal mixtures Maharishi Amrit Kalash-4 and -5 have antioxidant properties, inhibit LDL oxidation in vitro, inhibit platelet aggregation, and cause a reduction in aortic arch atheroma in hyperlipidemic rabbits ⁽²⁰⁾.

  An in vitro study investigated the activity of extracts from eight plants that are traditionaly used as immunomodulators in Ayurvedic medicine against HIV: Allium sativum, Asparagus racemosus, Coleus forskohlii, Emblica officinalis, Glycyrrhiza glabra, Piper longum, Tinospora cordifolia and Withania somnifera ⁽²¹⁾. The extracts significantly reduced viral production in human lymphoid CEM-GFP cells infected with human immunodeficiency virus (HIV-INL4).

• Warnings
  • Although heavy metals such as lead, gold, and silver are traditionally used in ayurvedic formulations, the use of lead for its assumed benefit has been a cause of concern. The US Centers for Disease Control and Prevention reported 12 cases of lead poisoning associated with the use of Ayurvedic medications ⁽²²⁾.
  • In the last few decades, commercialized meditation regimens have emerged to the concern of many. They often associate meditation with supernatural abilities. Such claims are not based on scientific evidence and should not be confused with meditation practice in AyurvedaImproper use of Neti Pots (nasal rinsing devices) has been associated with rare but severe infections. Patients are advised to use only distilled or sterile water in such devices and to clean them properly after use.
• Adverse Reactions
  • Ayurvedic preparations can contain varying amounts of lead and have caused severe gastrointestinal symptoms and anemia due to lead poisoning ^{(23) (24) (32) (33) (34) (35) (36) (37) (38) (42)}.
  • Adhatoda vasica), an herb often used for respiratory tract ailments, was shown to exert oxytocic and abortifacient effects ^{(16) (19) (25) (26) (27) (28) (29)}.
  • Arsenic poisoning, manifested by hyperkeratosis, neuropathy, splenomegaly and anemia, has been reported following use of ayurvedic medications for dermatitis, vitiligo and diabetes ⁽³⁹⁾.
  • Ayurvedic formulations containing heavy metals and hepatotoxic volatile organic compounds can cause acute liver injury and death ⁽⁴³⁾.
  • Ingestion of ayurvedic tablets by a pregnant woman resulted in fatal congenital defects in the fetus. Analysis of the tablets revealed presence of lead (47%), mercury (1.7%) and arsenic (<0.01%) ⁽⁴⁴⁾.
• Herb-Drug Interactions

  Phenytoin: The Ayurvedic syrup shankhapushpi causes decreased blood concentrations of phenytoin ⁽²⁷⁾.
  Cytochrome P450 enzymes: Guggul induces CYP3A4 activity and may interact with medications that are metabolized by the CYP3A proteins ⁽³⁰⁾.

• References

  1. Rasmussen LB, Mikkelsen K, Haugen M, Pripp AH, Førre ØT. Treatment of fibromyalgia at the Maharishi Ayurveda Health Centre in Norway. A six-month follow-up study. Clin Exp Rheumatol. 2009 Sep- Oct;27(5 Suppl 56):S46-50.

  2. Ayurvedic interventions for diabetes mellitus: a systematic review. Evid Rep Technol Assess 2001;41.

  3. Szapary PO, et al. Guggulipid for the treatment of hypercholesterolemia. A randomized controlled trial. JAMA 2003;290(6):765-772.

  4. Singh BB, Vinjamury SP, Der-Martirosian C, Kubik E, et al. Ayurvedic and collateral herbal treatments for hyperlipidemia: a systematic review of randomized controlled trials and quasi-experimental designs. Altern Ther Health Med. 2007 Jul-Aug;13(4):22-8.

  5. Prakash VB, Prakash S, Sharma R, Pal SK. Sustainable effect of Ayurvedic formulations in the treatment of nutritional anemia in adolescent students. J Altern Complement Med. 2010 Feb;16(2):205-11.

  6. Chawla YK, et al. Treatment of dyspepsia with Amalaki (Eblica officinalis Linn.) – an Ayurvedic drug. Indian J Med Res 1982;76(suppl):95-8.

  7. Cohen L, et al. Psychological adjustment and sleep quality in a randomized trial of the effects of a tibetan yoga intervention in patients with lymphoma. Cancer 2004;100(10):2253-60.

  8. Carlson, LE, et al. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology 2004;29:448-74.

  9. Cassileth, BR. The Alternative Medicine Handbook. New York (NY):W. W. Norton & Co;1998.

  10. Chopra A, Doiphode VV. Ayurvedic medicine: core concept, therapeutic principles, and current relevance. Med Clin N Amer 2002;86:75-89.

  11. Antarkar DS, et al. A double-blind clinical trial of Arogya-wardhani – an Ayurvedic drug – in acute viral hepatitis. Indian J Med Res 1980;72:588-93.

  12. Paranjpe P, Kulkarni PH. Comparative efficacy of four Ayurvedic formulations in the treatment of acne vulgaris: a double-blind randomized placebo-controlled evaluation. J Ethnopharmacol 1995;49:127-32.

  13. Paranjpe P, Patki P, Patwardhan B. Ayurvedic treatment of obesity: a randomized double-blind, placebo-controlled clinical trial. J Ethnopharmacol 1990;29:1-11.

  14. Chopra A. Ayurvedic medicine and arthritis. Rheum Dis Clin N Amer 2000;26:133-43.

  15. Chopra A, et al. Randomized double blind trial of an ayurvedic plant derived formulation for treatment of rheumatoid arthritis. J Rheumatol 2000;27:1365-71.

  16. Thabrew MI, et al. Antioxidant potential of two polyherbal preparations used in Ayurveda for the treatment of rheumatoid arthritis. J Ethnopharmacol 2001;76:285-91.

  17. Nagashayana N, et al. Association of L-DOPA with recovery following Ayurveda medication in Parkinson’s disease. J Neurol Sci 2000;176:124-7.

  18. Rege NN, Thatte UM, Dahanukar SA. Adaptogenic properties of six Rasayana herbs used in ayurvedic medicine. Phytother Res 1999;13:275-91.

  19. Shah ZA, Vohora SB. Antioxidant/restorative effects of calcined gold preparations used in Indian systems of medicine against global and focal models of ischemia. Pharmacol Toxicol 2002;90:254-9.

  20. Sundaram V, et al. Inhibition of low-density lipoprotein oxidation by oral herbal mixtures Maharishi Amrit Kalash-4 and Maharishi Amrit Kalash-5 in hyperlipidemic patients. Am J Med Sci 1997;314:303-9.

  21. Sabde S, Bodiwala HS, Karmase A, et al. Anti-HIV activity of Indian medicinal plants. J Nat Med. 2011 Mar 3.

  22. Lead poisoning associated with ayurvedic medications—five states, 2000-2003. MMWR Morb Mortal Wkly Rep 2004 Jul 9;53(26):582-4

  23. Claeson UP, et al. Adhatoda vasica: a critical review of ethnopharmacological and toxicological data. J Ethnopharmacol 2000;72:1-20.

  24. van Vonderen MG, et al. Severe gastrointestinal symptoms due to lead poisoning from indian traditional medicine. Am J Gastroenterol 2000;95:1591-2.

  25. Ayurvedic interventions for diabetes mellitus: a systematic review. Evid Rep Technol Assess 2001;41.

  26. Ernst E. Adverse effects of herbal drugs in dermatology. Br J Dermatol 2000;143:923-9.

  27. Prpic-Majic D, et al. Lead poisoning associated with the use of ayurvedic metal-mineral tonics. J Toxicol Clin Toxicol 1996;34:417-23.

  28. Spriewald BM, et al. Lead induced anaemia due to traditional Indian medicine: a case report. Occup Environ Med 1999;56:282-3.

  29. Fugh-Berman A. Herb-drug interactions. Lancet 2000;355:134-8.

  30. Dan E, et al. Guggulsterone activates multiple nuclear receptors and induces CYP3A gene expression through the pregnane X receptor. JPET 2004;310:528-535.

  31. Consumer Updates:Is Rinsing Your Sinuses with Neti Pots Safe? U.S. Food Drug Administration. Jan 24, 2017. Accessed September 18, 2018.

  32. Mongolu S, Sharp P. Acute abdominal pain and constipation due to lead poisoning. Acute Med. 2013;12(4):224-6.

  33. Desai A, Staszewski H. Ayurvedic remedy for diabetes as a cause of lead poisoning: a case report. Am J Med. 2012 Oct;125(10):e3-4.

  34. Pierce JM, Estrada CA, Mathews RE Jr. Buyers beware: lead poisoning due to Ayurvedic medicine. J Gen Intern Med. 2012 Oct;27(10):1384-6.

  35. Gunturu KS, Nagarajan P, McPhedran P, Goodman TR, Hodsdon ME, Strout MP. Ayurvedic herbal medicine and lead poisoning. J Hematol Oncol. 2011 Dec 20;4:51.

  36. Centers for Disease Control and Prevention (CDC). Lead poisoning in pregnant women who used Ayurvedic medications from India—New York City, 2011-2012. MMWR Morb Mortal Wkly Rep. 2012 Aug 24;61(33):641-6.

  37. Tsutsui RS, Van Schalkwyk J, Spriggs D. Lead poisoning from Ayurvedic medicines. N Z Med J. 2013 May 10;126(1374):80-3.

  38. Pinto B, Goyal P, Flora SJ, Gill KD, Singh S. Chronic Arsenic Poisoning Following Ayurvedic Medication. J Med Toxicol. 2014 Apr 3. [Epub ahead of print]

  39. Kessler CS, Eisenmann C, Oberzaucher F, et al. Ayurvedic versus conventional dietary and lifestyle counseling for mothers with burnout-syndrome: A randomized controlled pilot study including a qualitative evaluation. Complement Ther Med. 2017 Oct;34:57-65.

  40. Amalraj A, Varma K, Jacob J, et al. A Novel Highly Bioavailable Curcumin Formulation Improves Symptoms and Diagnostic Indicators in Rheumatoid Arthritis Patients: A Randomized, Double-Blind, Placebo-Controlled, Two-Dose, Three-Arm, and Parallel-Group Study. J Med Food. 2017 Oct;20(10):1022-1030.

  41. Sharma AK, Basu I, Singh S. Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial. J Altern Complement Med. 2018 Mar;24(3):243-248.

  42. Philips CA, Paramaguru R, Joy AK, Antony KL, Augustine P. Clinical outcomes, histopathological patterns, and chemical analysis of Ayurveda and herbal medicine associated with severe liver injury-A single-center experience from southern India. Indian J Gastroenterol. 2018 Jan;37(1):9-17.

  43. Breyre A, Green-McKenzie J. Case of acute lead toxicity associated with Ayurvedic supplements. BMJ Case Rep. 2016 Jun 30;2016.

  44. Wong A, Dargan P, Koutsogiannis Z, Sokol J, Ramkrishna J, Greene SL. Chronic Ayurvedic medicine use associated with major and fatal congenital abnormalities. Med J Aust. 2015 Dec 14;203(11):443-4.

  45. Lalla JK, Nandedkar SY, Paranjape MH, Talreja NB. Clinical trials of ayurvedic formulations in the treatment of acne vulgaris. J Ethnopharmacol. 2001 Nov;78(1):99-102.