March 4, 2015

Dr. Virender Sodhi, ND, MD (Ayurved) and Research assistant Dr. Anup Mulakaluri, ND, AWC, resident doctor Ayurvedic & Naturopathic Medical Clinic

Introduction:

Diseases like Alzheimer’s disease, dementia, Multiple sclerosis and Parkinson’s are formidable challenges for the aging population. The degeneration of the brain is another chapter in the textbook of modern chronic diseases like heart disease, diabetes, high blood pressure, bowel disease, etc. These are result of our modern lifestyle, environmental exposures and risk factors. Advances in science are helping us to understand the mechanism of these diseases and we are gaining insights for prevention and treatment of neurodegenerative diseases. But, are we really looking at the whole picture or trying to find magic bullet, which never works? In this article we will discuss the burden of these neurodegenerative diseases and Ayurvedic strategies for prevention and treatment.

Prevalence:

The 2011 report on Alzheimer’s Disease Facts and Figures[1] are really scary:

  • An estimated 5.4 million people have Alzheimer’s Disease
  • 14.9 million unpaid caregivers (Family members, friends, and volunteers)
  • $183 billion dollars in annual cost

These figures convey a sense of urgency about the exponentially growing occurrence of dementia in the United States and whole world. Alzheimer’s dementia (AD) is the most common form of dementia in the US and in the world. Parkinson’s disease is another degenerative neurological disease that has been growing in incidence. An estimated one million Americans have Parkinson’s disease (PD).[2] Over 60,000 new cases of PD are diagnosed every year. Multiple sclerosis (MS) is another chronic degenerative disease of the brain growing in incidence rapidly. Currently, about 400,000 Americans are believed to suffer from MS.[3] Although, this number may be far greater due to non-specific presentation of MS. Amyotrophic lateral sclerosis (ALS), often referred to as "Lou Gehrig's Disease," is another progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. Also, 90% cases are not inherited, only 10% are considered familial ALS (FALS). Someone with autosomal dominant FALS has one copy of the gene with a mutation and one copy of the gene without a mutation. A child born to someone with FALS has a 50% chance of inheriting the FALS gene mutation and a 50% chance of inheriting the gene without the mutation. I believe we are all are born with all kinds of genes but expression of genes depends on our life style, environment, toxicity and nutrition. In other words, we all are born with particular hardware and we can write any kind of software to run that hardware. Approximately 5,600 people in the U.S. are diagnosed with ALS each year. The incidence of ALS is two per 100,000 people, and it is estimated that as many as 30,000 Americans may have the disease at any given time.

Causative factors of Neurodegenerative diseases:

Toxic burden of the body:

Studies looking at the causative factors of Alzheimer’s disease, dementia and Parkinson’s disease have found very little evidence for genetic basis. Instead, environmental exposures to chemicals, heavy metals, solvents seem to play a major role. Industrially used dithiocarbamate fungicide, Rotenone pesticide, Manganese, and lead have been directly linked with Parkinson’s disease.[4] Commonly prescribed drug for ADHD, called Addrall or Concerta has amphetamines that are also used as street drug; like heroin. Amphetamine compounds in street drugs have been shown to increase Parkinson’s disease many fold.[5,6] Can you imagine your child on this drug? We have many patients who performed better with nutritional changes, supplements, yoga and mediation. These toxicants are believed to have caused abnormal genetic expression and metabolism in the body that leads to a degenerative process.

Mental and Emotional factors:

The thought process has a profound effect on the activities of the hormones and physiological balance in the body. In my practice, I have observed people who are very critical, rigid, aggressive or angry tend to develop neurodegenerative diseases. Of these, those who have anger and express through harsh words, tend to have more Alzheimer’s like conditions. While those who have anger and keep it stuffed in, have Parkinson’s like conditions. Patients with MS and ALS are often affected by mental and emotional trauma in past or present.

Researchers have also outlined that Parkinson’s disease is more likely to be associated with certain kind of personality.[7,8] These people tend to: be reflective, rigid, stoic, slow-tempered, frugal, orderly, and persistent.[7] All of these characters are exaggerated in a person with Parkinson’s disease. This relationship between personality and disease is attributed to pattern of dopamine expression and tendency for “dopamine-dependent novelty seeking” (which means, seeking new experiences, enjoying life and pleasures). In other words, personality characteristics create a pattern of neurotransmitter expression that may lead to disease later. People who are more open, active, flexible, and emotionally stable are less likely to have these problems.

Inflammation:

Inflammation is now considered one of the major factors in all chronic disease, also increases risk of degenerative brain diseases. On the other hand, inflammation is a very important tool for the body to degrade toxins, fend off infections, and promote healing. When it becomes out of balance – excessive or prolonged low-grade inflammation – it causes tissue damage and accumulation to oxidative waste. The result is further burden on cells and modification of normal genetic expression.

I had good fortune to be speaker on the same stage with Dr. Bharat Aggarwal, known researcher and Professor at The University of Texas M.D. Anderson Cancer Center, Houston,, Texas in the field of inflammation and herbs. He is the person who brought model of TNF (tumor necrosis factor) inflammatory molecule and since then lots of TNF blockers like Remicade, Enbrel, Cimzia, Humira just to name few have been brought in to market for auto-immune diseases like rheumatoid arthritis, psoriasis, Crohn’s disease and ulcerative colitis. He said Virender, “You have concept of Agni (digestive fire) in Ayurvedic medicine, and TNF is Agni in cell, as long as it is in the cell it protects and does all the normal functions to protect it, but once it get out of cell, it destroys the cell with fire and burns it.” He used analogy of fire of cook stove, as long as you can switch on and off the fire under the stove it cooks your food very well, but once it looses the control it burns the whole house.

Accumulation of environmental toxins, exposures to stresses in the womb or after birth, persistent mental and emotional stressors are all causes of increased inflammation in the body, the Agni out of control. When this inflammation goes beyond the body’s capacity to eliminate toxicants; then, chronic degenerative process begins.

Ayurvedic Insights on the Causes of Degeneration:

“Dharyati iti mala” meaning “Excretory products are the basis of whole body”

In Ayurveda, the digestive process is considered central to the development of good quality of tejas (intelligence), Ojas (vitality) and Prana (life-force). The digestive process is a broad term that includes our gross digestion of food, digestion of elements (sugar, amino acids, fats), cellular metabolism, as well as digestion of sensory inputs, thoughts and ideas. The above statement highlights that an important part of digestion is separation and elimination of waste products from the body.

Without proper elimination, the body’s blood vessels, lymph, spinal canal, subtle channels within various organs all become susceptible to accumulation of waste. According to Ayurveda, accumulation and blockage is caused by “Ama” – a form of intermediate waste product. For example, if you do not digest your carbohydrate properly, you may have accumulation of di-sachrides, if you do not digest your proteins you may accumulate ketoles and indoles and if you do not digest properly fats you may accumulate inflammatory arachidonic acid. This intermediate waste product or “Ama” occurs due in-complete processing of waste resulting from weak metabolic function – in turn, causing accumulation and blockage of the route of elimination. Your microbiomes in the gut change and make more toxins than body can handle. We have approximately 33-100 trillion cells and have almost ten-fold bacteria in our body; the large intestine is the main warehouse for these microbes. If the microbiome (Gut-bacteria environment) changes you will develop lots of toxins, and body does not know how to react normally and it reacts violently producing inflammation.

Examples of these intermediate waste products are seen in the neurodegenerative diseases discussed here[4]:

Disease Intermediate waste product
Parkinson’s disease Lewy bodies: eosinophil cells clogged with amyloid-like protein that clogs spaces in the various parts of the brain
Alzheimer’s disease Mis-folded amyloid proteins that form accumulations that block normal neuron interactions.
Multiple sclerosis Degradation of Myelin sheaths that insulate the nerves – produces accumulation of plaque of brain and spinal tissues
MTHFR gene mutation

This deficiency can result in accumulation of the intermediate product, homocysteine – which triggers inflammation and mal-functioning of many mechanisms in the body.

Despite the lack of modern technological tools, Ayurvedic physicians accounted for the accumulation of such intermediate waste products and their toxic effects. Thus, regular daily and seasonal detoxifications were recommended as part of cleansing. Additionally, Ayurvedic Panch Karma was designed to stimulate cellular cleansing for the diseased and healthy individuals.

Ayurvedic Approach to Prevention and Treatment of Degeneration:

Centuries before western medical sciences defined Parkinson’s disease and developed treatments for addressing the neurotransmitter imbalances, Ayurveda had clear description of this disease. Sushruta Samhita, a 6th century BC text, described the symptoms of Parkinson’s disease under the title of “Kampvat” many centuries before Dr. Parkinson. Sushruta recognized the disease as the dysregulation of the air element due to blockage of channels (burning of Sadhak Pit), which resulted in rigidity and movement disorders, as well as mental and emotional disturbance. Sushruta also outlined specific herbal medicine called Macuna prurien (Kapikachu) as a treatment for this disorder. Now we know that Macuna is a source of L-dopa compound, which serves as the basis of modern drugs to treat Parkinson’s disease.

In Ayurvedic Medicine, the foundation of health stands on four pillars: 1) Diet/digestion, 2) Exercise, 3) Sleep/rest, 4) mental/emotional well-being. Let us discuss some specific strategies for prevention and health maintenance:

Health-care from conception:

Conditions in the womb, health of the pregnant mother, and environmental factors of early childhood have a profound impact on health later in life. Charaka Samhita, 2nd century BC text, described pregnant woman as a “Dau Hridya” – one with two hearts. Thus, vigilant care is recommended for the well-being of the delicate new heart. Sage Charaka explains that care of the new life begins before conception, with the preparation of parents to optimize the quality of sperm and egg. Both, mother and father undergo 40 days cleansing program to purify their body, mind, and spirit in preparation of conception. This helps to cut down the toxic burden and allows the purest form of genetic material transfer.

When conception is achieved great care is taken to avoid exposure of the mother to unhealthy environments. The family is instructed to avoid exposing the mother to toxic foods, thoughts and bad news to prevent shock and stress that can negatively affect the child’s health. The family and community together support the mother and baby with nourishing foods and loving care.

Baker Hypothesis:

Baker Hypothesis[4] states that exposures in the mother’s womb and during infancy can have profound impact on the development of chronic diseases later in life. Factors like low birth weight, mother’s dietary intake, mother’s exposure to stress have all been implicated in the development of diseases like heart disease, diabetes, as well as abnormal hormone and neurotransmitter expression. Thus, it is now considered that health-care for the child begins in the womb.

Diet and Digestion:

All parts of the physical body are derived from our food. Therefore, the quality and balance of our bodily tissue directly depends on the quality of our diet and the balance of our nutrition intake.

Healthy diet that is rich in vegetables, fruits, with moderate amounts of protein sources (beans, meat, dairy, nut/seeds, eggs, etc.), and low amount of simple carbohydrates (refined breads, grains, sweets/sugars, etc.) has a very beneficial effect in controlling inflammation in the body.

Digestion is the key to converting good food into good nutrition for the body, while separating out and eliminating the waste. The quality of digestion is based on the health of Agni, the digestive fire. When Agni is balanced and strong it completes the transformation of food into useful nutrients and packages waste for elimination. When Agni is too weak or too strong, it produces intermediate waste products called Ama that accumulates and cause blockages.

Assessment of Agni and state of Ama accumulation are important parameters of health that must be addressed by physicians to prevent development of diseases at the root.

Exercise:

Exercise stimulates break down of fatty tissue that store many environmental toxicants. Exercise also mobilizes of sweat and renewal of musculoskeletal system of the body. The cleansing action of the regular exercise also has a positive effect on the mind by promoting improvement of balance, co-ordination, and attention.[9,10] Exercise also helps to balance neurotransmitter and regulate hormonal functions – which results in improved mood and stress relief.[11,12]

Mental and emotional wellbeing:

Mental and emotional wellbeing: in the modern world, stress is an inherent and overwhelming part of most people’s lives. Unfortunately, our mechanisms of dealing with stress were evolved to deal with rare and occasional stress of a simpler life. Now, the high speed and diversity of experiences are alone stressful for the body and mind.

Ayurveda offers some of the best Spiritual technology for mental and emotional processing and detox. Breathing exercises, pranayama, are exercises that raise our Prana or life-force. These help with increasing oxygenation that has a supportive effect on metabolic and immune activity. Breathing also helps with elimination of CO2 (carbon dioxide) from the body, excess of which results in the accumulation of intermediate waste product of carbonic acid (H2CO3). Proper oxygenation has been demonstrated to benefit in building new blood vessels[13], as well as promote recovery from traumatic brain injury.[14]

Ayurvedic Herbal Support for Cognitive Health:

Herbal medicines are great tools to support normal physiology of the body, to provide essential nutrients, and for correcting certain functional imbalances. Ayurvedic herbal medicine has been successfully used throughout the history for treatment of cognitive diseases. Effectiveness has been confirmed through scientific validation. Here are some powerful herbs that protect the brain and support cognitive function.

Bacopa monnieri, also called Brahmi, is a name synonymous with cognitive support in Ayurvedic medicine. It is traditionally regarded as one of the most useful medhya rasayana, rejuvenators of the mind. It is given to young and old equally because it is non-toxic and wonderfully effective in promoting development and regeneration. In a clinical study on healthy elderly individuals; with average age of 62, Bacopa was given for 12 weeks and compared to effect of placebo.[15] Group receiving Bacopa had significant improvement in attention, cognitive processing, and working memory. In a broader study of all randomized control trials on Bacopa, it was found that the herb can improve all parameters of the analytical frontal lobe of the brain[16] – improvement was seen in 1) remembering number and picture, 2) 3D spatial orientation, 3) learning, 4) attention and concentration, 5) recall and memory, 6) decision making and more.

Bacopa has very unique and powerful healing effects on the brain. Laboratory experiments confirm that administration can help in develop, growth, and healing of neuron.[17] In these studies, the number of connections for a neuron treated with Bacopa increased in dose dependent manner; they were observed to be more than double in some cases. Thus, Bacopa also improves interconnectivity of the brain – making it more resilient to degeneration.

Withania somnifera, Ashwagandha is a popular and very useful Ayurvedic herb. It has been proven effective as an immune supportive, anti-inflammatory, hormone balancing, anti-anxiety, adrenal tonic, and more.[18] Among the cognitive benefits of Ashwagandha, animal studies have demonstrated that this herb can help improve learning capacity and memory retention despite stress. Ashwangandha does this by enhancing acetylcholine (neurotransmitter) mediated communication among neurons of the frontal cortex.[19] The frontal cortex of the brain is the center of our “Executive functions” that are defined as learning, decision making, working memory, etc. – which help us do our work, daily functions, and control unsafe/unhealthy impuses.[20] In Alzheimer’s model mice, treatment with Ashwagandha helped to improve decision making and problem solving, as well as enhanced learning and attention compared to untreated model mice.[19] Levels of functionality were almost restored to normal levels relative to control mice. This study also found that compounds in Ashwagandha helped to enhance or restore neuron inter-connectivity.

Thus, Ashwagandha is a complete and powerful medicine that benefits many conditions and people of all ages.

Centella asiatica, commonly known as Gotu Kola is often juiced fresh or dried to make tea – traditionally consumed in many parts of south Asia. Gotu Kola is also well known to western herbalist tradition. It has been thoroughly studied and dubbed “A Potential Herbal Cure­all”. Gotu Kola has been studied for and proven effective as wound healing, venous supportive, anti-anxiety, anti-depressant, Anti-epileptic, anti-inflammatory, anti-oxidant, as well as supportive for cognitive function in human subjects.[21] Pertinent to our discussion, Gotu Kola has also been found to improve physical performance and health-related quality of life in the elderly.[22] In a clinical study of Elderly individuals with mild cognitive deficiency, Gotu Kola demonstrated significant improvement in cognitive function based on Mini Mental Status exam (MMSE).[23] Gotu Kola provides similar protection among younger and healthy adults as well.[24]

Considering the profound beneficial effect of Gotu Kola on connective tissue seen in variety of research, it is likely that this herb addresses the structural deficiencies that affect function of the aging brain.

Macuna pruriens, also named by its characteristic dark-purple colored “Velvet bean” is a medicine that is specifically used for Parkinson-like diseases encountered in Ayurvedic medicine. It was first described a treatment for “Kampvat” (Ayurvedic equivalent of Parkinson’s disease) in the Sushruta Samhita, written around 6th century BC. Modern science has discovered that some symptoms in Parkinson’s disease are produced by deficiency in dopamine production. Modern drugs like Carbidopa, levodopa, etc. work by supplementing this deficiency. Macuna has been found to be the richest natural source of dopamine precursor compound L-dopa.

In a small study, effectiveness of Macuna was compared to Levodopa/Carbidopa standard drug.[25] It was found that L-dopa in Macuna worked faster and it was effective longer than the conventional drug. Additionally, the herb had fewer side-effects. In another study on Parkinson’s patients, 60 patients were given an open-label sachet of Macuna powder for 6 days per week.[26] In 12 weeks, these individuals demonstrated significant improvement in symptoms. The herb was as effective for those who used it to replace the conventional drugs, as compared to those who used only Macuna for relief.

Besides the direct supplementation of L-dopa, this herb has a positive impact on hormone balance and neurological protection.[27]

Ghee, medicated Ghee, coconut oil, nuts and seeds:

“Your brain is the fattest organ in your body and may consist of at least 60 percent fat.”[28] Fatty acids form important structural components of each nerve cells; fatty membranes also form the blood-brain-barrier that protects the brain and controls what goes in and out. Fatty tissue, by nature, is a good carrier of many subtances; it is also very susceptible to oxidative degeneration. For this reason, Ayurvedic therapies use oils in treatment of most diseases, especially those affecting the brain.

External application and internal consumption of healthy oils replenishes fatty tissue in the body – out with the old, in with the new. Just as oils are good carriers for toxins out of the body, they are also good carriers of medicine. Ghee (clarified butter) is commonly used as a carrier for medicinal herbs like Bacopa m. Generally, ghee has been shown to improve lipid (cholesterol) metabolism in the body – it also has a protective effect against oxidation of lipids in the body.[29] When given as Bacopa-medicated ghee (Brahmi ghritam), it is beneficial for promoting learning and memory in amnesia.[30]

Coconut oil has also been tested for benefits on the degenerating brain. The medium chain triglycerides from the coconut oil have demonstrated benefit of improving memory and attention in Alzheimer’s patients.[31]

Nuts and seeds like almond, pistachio, pecan, cashews, walnuts, sunflower seed, pumpkin seeds, chia seeds, etc. are also a great source of healthy fatty acids. These serve as a great snack in between meals and provide excellent fuel for the brain. Tree nuts have been an important component of Ayurvedic diet – described as beneficial for brain, spinal and bone marrow. In recent years, scientists have tested this claim to find tree nuts are rich in “flavonoids, proanthocyanidins, and phenolic acids, as well as monounsaturated and omega-3 and omega-6 polyunsaturated fatty acids that have the potential to combat age-related brain dysfunction.”[32]

Yoga, breathing exercise and meditation:

Yoga is the science of Spiritual Union – it is spiritual technology developed by ancient yogis of India for the optimization of the body and mind, which permits spiritual realization. Components of the Yogic lifestyle like Yoga postures (asana), breathing exercises (pranayama), and meditation (dhyana) are very beneficial for health.

Yoga asana has excellent benefit for the elderly within 8-12 weeks of practice. In one clinical study, 8-week regular practice of yoga helped to improve executive functions (like attention, working-memory, learning, decision making, etc.) in the elderly patients.[33] Indicating that yoga can improve resilience of the aging brain. A 12-week intervention, helped to improve balance and mobility in the elderly.[34] Furthermore, pranayama (breathing exercises) was observed to reduce stress rapidly during practice. In the long term, pranayama also helped to reduce anxiety, depression, PTSD; while it improved compassion and stress resilience. Overall effect is described as promoting longevity.

Meditation is another powerful ancient technology that can help to develop mental faculties like attention, concentration, memory, co-ordination, problem solving, and decision making.[35,36,37] Meditation is free medicine for the aging brain to help maintain these capabilities.

Kuntsevich, et al. describe that benefit of yoga asana, pranayama, and meditation is derived from helping the mind and body slow down; improving regulatory control of physiology and reducing accumulation of toxicants in the body.[38] Slowing down helps to reduce “noise” (excess activity) in the brain, while promoting mental awareness of the body and mind. It also helps the homeostatic mechanism of the body to balance.

Conclusion:

Many years ago I was invited by University of Washington to lecture on back pain. They had panel of doctors, orthopedic specialist, neurologist, neurosurgeon and physical therapists. When I presented Ayurvedic model of back care, neurosurgeon got very upset. He said, “So you are a physician, psychologist, nutritionist, exercise specialist and massage therapist all in one.” I was really sad to see his tunnel vision he had about the disease and health. It reminded me the story of five blind man and elephant. This particular doctor was so upset at me that he even reported against me to the medical board. Medical investigator came to my clinic and asked for my credentials. I showed him all my credentials and later investigator wrote me a letter, “Dr. Sodhi your medical degree is authentic and sorry for the inconvenience.” I do not blame this doctor but unfortunately our medical training is like that, where we have created tunnel vision doctors and results are in front of us.

We are social animals, if you look at the communities who live longer, and have less neuro-degenerative  disease and live free of other common disease of our society, like people of Okinawa (Japan) Sardinia (Italy) Nicoya (Costa Rica) Icaria (Greece) and among the Seventh-day Adventists in Loma Linda, California, we find some clue to their longevity. All these communities have the following in common.

They live very low stressful life. They eat what they grow. Environment is clean. They do not over indulge in food. Mostly food is plant based. All have the feeling of community and very socially bonded.  Most of them live in extended families. Their wisdom is revered. They have firm belief in consciousness and live very meditative life. They all are very active until they die.

We will never find one magic bullet which will cure all the disease, as disease is multifactorial and treatment have to address all of those factors at mental, emotional, spiritual and physical levels.

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