The Ayurveda experience presents Dr. Akil Palanisamy
Contents 1. Preface... 4 2.Introductory Module... 6 Rising incidence of autoimmune disease... 6 Analogy for understanding autoimmune disease... 6 Stage One: Accumulation (Sanchaya)... 7 Stage Two: Aggravation (Prakopa)... 7 Stage Three: Spread (Prasara)... 7 Stage Four: Localization (Sthana Samshraya)... 8 Stage Five: Symptom Manifestation (Vyakti)... 8 Stage Six: Complications/Differentiation (Bheda)... 8 Ayurvedic perspective on pathophysiology of autoimmune disease... 8 3. Treatment of diagnosed autoimmune diseases...13 Diet changes...13 Paleovedic Detox...14 Oil-Pulling...14 The Neti Pot and Nasya...15 Abhyanga...16 Sweating...16 Drinking lots of water...17 Exercise...17 2
Eating detoxifying foods...17 4. Your Immune System...18 Ghee...19 Spices...21 Pranayama...23 The Fight or Flight Reaction...26 Meditation...26 5. Section One Hashimoto s Thyroid Disease...28 6. Section Two - Rheumatoid Arthritis (Ama Vata)...30 7. Section Three - Inflammatory Bowel Disease (Ulcerative Colitis and Crohn's Disease)...31 8. Section Four - Celiac Disease...33 9. Section Five - Eczema and Psoriasis...34 10. Epilogue...35 3
1. Preface Thank you so much for joining me for this course. Before we start, let me tell you a little bit about myself - my background and training... I am a Harvard-trained physician currently practicing integrative medicine, where I combine Ayurveda and Western medicine in my clinical practice with patients in San Francisco. I studied Ayurveda in India at the Arya Vaidya Chikitsalayam in Coimbatore and completed apprenticeship clinical training with my guru, Dr. L. Mahadevan in Derisanamcope, Tamil Nadu at the Sri Sarada Ayurvedic hospital. Dr Mahadevan is an incredible teacher and source of knowledge, and I am so grateful to him for sharing his Ayurvedic wisdom with me. I started out as a basic scientist with a passion for science I completed my undergraduate degree in biochemistry at Harvard, and performed clinical research at Harvard Medical School where I wrote my senior thesis. This was followed by medical school at the University of California, San Francisco, residency training at Stanford University, and fellowship in integrative medicine with Dr. Andrew Weil at the University of Arizona. I am the author of another course with The Ayurveda Experience called Ayurveda and the Paleo Diet. I have a genuine passion for helping people with all conditions but especially with autoimmune disease, because I have seen firsthand how my approach can make a difference in treating and reversing autoimmune disease. Ayurveda is all about self-healing. Your body has the capacity to repair and heal itself, if provides the correct inputs and stimuli, no matter its current state. That is the first point I want to make. Whether you are taking this course in order to learn tools to help your patients, or interested in working on healing yourself, the first thing to remember is that YOU CAN GET BETTER. Many patients come to me and tell me that their doctors had told them that they would never get better. But how could their doctors know? The body has a tremendous ability to heal, often more rapidly and completely than you might expect and that is something that you should never forget. Be sure to share this faith with any patients or 4
clients you are working with, because your belief in their ability to get better is absolutely powerful, and potentially you might be the only person in their life giving them this positive message and selfbelief. I hope that this course will give you the knowledge and understanding to help begin the journey of healing and transformation of autoimmune diseases in your patients and if necessary in yourself. 5
2. Introductory Module First, the definition of autoimmune disease - autoimmune disorders are characterized by the immune system producing antibodies to its own tissues or dhatus, resulting ultimately in damage to the dhatus. Let s discuss the different types of autoimmune disease - there are over 100 different types of autoimmune disease that have been classified. The one thing they have in common is that the immune system is attacking the dhatus. The difference in each disease is which dhatu is affected. For example, if the thyroid is affected, then Hashimoto's thyroid disease is the result. If the joints are attacked, rheumatoid arthritis or lupus can be the result. Which dhatus are specifically affected depends on prakruti, vikruti, khavaigunya (which will be explained later), state of the srotas or channels in the body, genetic predisposition, and other factors. Rising incidence of autoimmune disease Rates of autoimmune disease are skyrocketing, making autoimmune disease the fastest growing category of diseases. For example, rates of type I diabetes have increased by 500% since 1950 in countries that keep careful statistics. Rates of celiac disease, an autoimmune disease exacerbated by exposure to the proteins found in wheat, has also increased by about 500% in the past 50 years. Allergies, asthma, and eczema are rapidly increasing, especially in children. In some countries, food allergy now affects more than 10% of the population. Analogy for understanding autoimmune disease Think of the body as a car, with the immune system controlled by the gas pedal and brake. Autoimmune disease occurs when the gas pedal is pressed all the way down to the floor and the immune system is out of control. Western medication like steroids, methotrexate, etc. suppress the immune system by slamming on the brakes. But the gas pedal is still pressed, meaning that the underlying disease process is still active. The Ayurvedic approach is to take the foot off the gas pedal, by removing the triggers for autoimmune activity. 6
Before we talk specifically about autoimmune disease, let s discuss the process of pathogenesis for all disease according to Ayurveda. This will be reviewed for some of you but perhaps not for everyone. There are 6 stages of samprapti or pathogenesis in Ayurvedic science. Stage One: Accumulation (Sanchaya) Weak, imbalanced Agni and excess of dosha is responsible for such a condition. Here, ama or toxins produced by improper digestion collects in the gastro-intestinal (GI) tract. Typically, toxins resulting from a Kapha imbalance accumulate in the stomach, those associated with a Pitta imbalance collect in the small intestine, and those related to Vata malfunction amass in the colon. Due to the presence of one of these toxins, mild nonspecific & illdefined symptoms may show. Stage Two: Aggravation (Prakopa) The accumulated, stagnant doshas are now `excited by factors as ahara or diet, vihara or conduct & environmental factors such as the seasons, etc. The toxins amass in such a degree to get aggravated or provoked in the site of production in the GI tract. Stage Three: Spread (Prasara) In this stage, the ama accumulated in the GI tract starts overflowing. Generally, up to this stage the damage is fully reversible and restoration of doshic balance can be achieved with proper measures. Or there may be spontaneous prashama (remission) influenced by various external factors like seasonal changes, etc. 7
Stage Four: Localization (Sthana Samshraya) Overflowing toxins migrate, entering and taking refuge in localized, weak or defective dhatus (khavaigunya, a concept which we will talk about later). This eventually leads to malfunction and structural damage. It is here that susceptibilities to infections begin. Stage Five: Symptom Manifestation (Vyakti) Differentiated symptoms first begin to appear from the affected dhatu. This is the stage at which conventional allopathic doctors will make the diagnosis of disease. Fortunately, integrative medicine physicians like myself are trying more and more to catch disease earlier before it gets to this point. The earlier we can catch it, the easier it is to treat. Stage Six: Complications/Differentiation (Bheda) The disease, having taken years or even decades to reach this final stage, becomes chronic. Now that we have reviewed the basic pathogenesis of all diseases, let s look specifically at autoimmune disease. We will begin analyzing autoimmune disease from the Ayurvedic perspective. Ayurvedic perspective on pathophysiology of autoimmune disease The key factors to understand are 5 important elements that we are going to be talking about: Agni - digestive fire Ama - toxins Ojas - the force maintaining cellular immunity Tejas - controller of cellular metabolic activity and intelligence Prana the flow of communication within and between the cells 8
Every person is born with a unique prakruti, or combination of the doshas Vata, Pitta, and Kapha. These are correlated with their more subtle essences as follows: Vata - Prana, the subtle life force that controls all of movement within the body, and also regulates communication within each cell and between different cells. Pitta - Tejas, the subtle essence of fire, responsible for intelligence, understanding and comprehension at the cellular level. Controls metabolism as well as cellular and metabolic transformation. Kapha - Ojas, the fine essence of all the bodily tissues and end product of perfect digestion. Reflects the quality of Agni as well as dietary patterns, lifestyle choices, stress levels, and overall state of consciousness. It is also a measure of the vigor and vitality in a person and helps to control cellular immunity. Balanced immune function depends on optimal function and relationship between ojas, tejas, and prana. When Agni becomes imbalanced, which is always the first step in disease, ama is produced. Ama can be thought of as partially digested food that normally stays in the gut, but when Agni becomes imbalanced and the gut becomes leaky, these poorly processed food particles can enter the bloodstream. These particles have antigens which are foreign proteins. When confronted with a foreign antigen, the immune system produces antibodies, which are Y shaped proteins that identify, bind to, and neutralize the antigen. The immune system does not recognize these toxic Ama particles and creates antibodies to bind them, creating what are called immune complexes, which are toxic Ama in the blood. This toxic Ama then circulates through the body and eventually ends up in the khavaiguna, defective or weak dhatus that are 9
prone to damage. Every person has a different khavaiguna, depending on their prakruti, lifestyle, and genetic factors, which is why the autoimmune process can manifest in over 100 different diseases. IMPORTANT POINT: Where the Ama deposits is also affected by the srotas, channels in the body which affect the circulation. For example, if there is narrowing of the srotas or microcirculation in the kidneys, it s possible that the Ama may deposit in that organ, leading eventually to kidney inflammation or even renal failure. So what happens once the Ama localizes and deposits in a particular dhatu? Ama then enters and settles into the deeper cellular levels of the specific dhatu, where it can alter the functioning of tejas, which determines cellular intelligence. This most commonly occurs when the ama covers the cells and prevents normal function of ojas, tejas, and tejas. When tejas is affected, the body cells lose the ability to recognize each other as part of the body, which is essential for harmonious functioning of the immune system. Thus, there is a breakdown in cellular communication which is the critical first step in the process. Your cells are constantly talking to each other, recognizing themselves as part of yourself and not foreign. When that communication is disrupted, the ongoing recognition fails to take place and a cell that was correctly recognized as self in the past is now labeled as NOT SELF or foreign. This is where the problem begins. Consequently, certain cells signal the immune system to produce antibodies to destroy the neighboring cell, and the autoimmune disease process is initiated. A second pathway to autoimmune disease occurs in people who have a significant family history of autoimmune disease and consequently, a very strong genetic predisposition. This is typically a Vata or Pitta prakruti person who has very high Vata or Pitta. Both 10
Vata and Pitta share a lot of gunas (qualities) with tejas. As you recall, Ayurveda is a qualitative science in which certain basic qualities can affect multiple different forces in the body -- therefore when someone has excessive Vata or Pitta, they may potentially have qualities that predispose them to have overactive tejas. This overactive tejas, or cellular intelligence, can become dysfunctional and directly attack neighboring cells. This is the case of hyperactive tejas directly acting through the immune system to attack ojas in the surrounding cells, and is common in certain autoimmune diseases with a strong genetic component. This is excessively high tejas burning ojas and causing damage, just like fire causes water to evaporate. To review, we have discussed the 2 main mechanisms in Ayurveda for the development of autoimmune disease. Feel free to look back at the past few minutes to review those concepts as I know they are not straightforward. Now we re going to move on to discuss certain other factors that can contribute to autoimmune disease. Other factors that contribute to autoimmune disease include: 1. Genetic predisposition and family history 2. Food sensitivity, poor diet 3. Leaky gut syndrome or increased intestinal permeability 4. Exposure to certain infections 5. Environmental toxins and pollutants 6. Chronic stress often the final event that precipitates or triggers autoimmune disease is a period of significant stress. That could be the final step in the 9 or 10 step process we discussed, which leads to the eventual manifestation of autoimmune disease. An underlying mechanism that is common to almost all autoimmune diseases is leaky gut syndrome, or increased intestinal permeability. This is correlated with imbalances in Agni and the 11
production of Ama, and therefore this must be understood and addressed before one can effectively treat autoimmune disease. Diagnosing and treating Agni imbalances and leaky gut syndrome is the foundation of treating and reversing autoimmune disease. I m going to use some slides next to explain these key concepts to you so let s go ahead and do a deep dive into gut health. Now that we have started with treating and balancing Agni and leaky gut syndrome, we can talk about the other steps in the treatment of autoimmune disease and discuss a few autoimmune diseases in more detail. 12
3. Treatment of diagnosed autoimmune diseases DISCLAIMER: be sure to work with your qualified Ayurvedic practitioner or physician who is supervising and directing your treatment program. This course is educational only and is not intending to diagnose or treat medical problems or conditions. Once you have been diagnosed with an autoimmune disease, the very first step is always healing the gut. This is true even if you have no digestive symptoms whatsoever, because it is not possible to develop an autoimmune disease without some degree of Agni imbalance and leaky gut syndrome. Diet changes The most important step is always eating for your prakruti. In this case, once you have a diagnosed autoimmune disease, it is certainly possible that your vikruti may be quite different. Therefore, it is important to consult with a practitioner to determine which dosha should be a priority for initial treatment. Subsequently, the diet should be tailored to balance of that dosha. The 2 nd step is to perform an elimination diet. Sometimes food sensitivities can play a role in autoimmune disease, both directly by triggering the immune system and indirectly by contributing to leaky gut Syndrome. Therefore I recommend a specific 3-week detoxification program called the paleovedic detox which will help you eliminate the most common food sensitivities such as gluten, dairy, soy, and corn. After the period of elimination, you will then reintroduce the different foods and monitor for reactions. This program helps you to eliminate commonly problematic foods, increase your intake of nutrient-dense healing foods, and begin the process of detoxification. The Paleovedic Detox helps you increase energy, reduce inflammation, burn fat, and begin to reverse autoimmune disease. 13
There is an important reason why the program is twenty-one days, and not longer or shorter. In Ayurvedic medicine, as you know, there are three doshas and seven primary dhatus or tissues. When you undertake a detox intentionally, one tissue level in each dosha is cleansed per day. Therefore, a time period of twenty-one days is ideal for all 7 tissue levels in each of the 3 doshas to be cleared every week, all 7 dhatu levels in one particular dosha are cleared and cleansed. Thus, in Ayurveda, twenty-one days is an ideal amount of time for both physical and mental transformation. Paleovedic Detox The goal of the Paleovedic Detox is to avoid the most allergenic foods and simplify your body s digestive processes to facilitate removal of toxins from your body and healing. The entire regimen is very comprehensive and due to time limitations I cannot go into all the details here. The next area that we are going to be focusing on that s relevant for autoimmune disease is the topic of toxins, which includes industrial chemicals like pesticides, plastic residues, heavy metals such as lead and mercury, air pollutants, and other environmental toxins. We know that the buildup of toxins over many years can contribute to the development of autoimmune disease. The best practice is to prevent this buildup. Optimal daily elimination of malas sweat, urine, and stool is vital for good health in Ayurvedic medicine and there are a few simple, natural and effective daily detoxification practices which we will talk about next. Oil-Pulling Oil-pulling is an ancient Ayurvedic therapy which involves holding oil in the mouth for about ten minutes and then discarding it. In Ayurveda, oil-pulling has been used to strengthen the teeth, gums, and jaws and to prevent tooth decay, gum disease, and bad breath. It is believed that oil-pulling removes toxins from the body and stimulates Agni, or digestive fire. 14
The practice is usually done with either sesame or coconut oil. Basically one takes about a teaspoon of oil into the mouth and swishes and pulls the oil around through one's teeth. After about ten minutes the oil is believed to have drawn up toxins and waste metabolites from the body and should be disposed of. Do not swallow the oil. After spitting, rinse the mouth well with water. The process should be done on an empty stomach. I would recommend starting with about five minutes of practice and slowly increasing to ten and then 15 minutes. The Neti Pot and Nasya The neti pot is a small pot that is designed to help cleanse your nasal passages. Fill the pot with warm water and a small amount of sea salt or Himalayan salt, about an eighth of a teaspoon. I suggest adding six to eight drops of an herbal oil known as nasya oil. This helps counteract the drying effects of the salt and provides additional calming and rejuvenating effects on the mind, in addition to other benefits. Ayurveda considers nasya, or nasal application of oil, to be a therapy in its own right. It is often recommended for conditions such as allergies, chronic rhinitis, sinusitis, dizziness, brain fog, anxiety, and depression. The practice I have described here combines nasya with neti practice in order to save time. Nasya oil can be purchased online from companies such as Banyan Botanicals or the Ayurvedic Institute. To use the neti pot, stand over a sink and lean your head slightly forward and to the right. Put the narrow spout of the pot into your left nostril and slowly allow the water to flow in to your nasal passageways and out your right nostril. It will take some practice. When completed you could have the urge to blow your nose to expel additional mucus. Then tilt your head forward and to the left and insert the spout of the pot into your right nostril and repeat. Only one application in each nostril is necessary. This is especially helpful if you have allergies, sinus issues, nasal congestion, or recurrent upper respiratory infections. 15
Abhyanga Abhyanga is a type of Ayurvedic massage that helps to energize the mind and body, nourish the nervous system, and balance the doshas. It can also help with clearance of toxins. While it is usually performed by trained Ayurvedic practitioners, self-abhyanga can be a valuable part of your daily routine. Different oils are recommended for different body types. Sesame oil is the best for Vata because it has the most warming quality energetically. Coconut oil is cooling and recommended for Pitta. Almond oil is stimulating and good for Kapha types. Sit or stand on a large towel spread on the floor. Use about a cup of warm oil and apply it to your entire body, starting with the head and working downward. After your head, scalp, and neck, apply oil to your shoulders, arms, chest, and abdomen. Finish by applying oil to your legs and feet, giving particular attention to your joints. Use circular movements on the torso and strokes toward the body on the arms and legs. After concluding, rest for a few minutes and then take a shower with lukewarm water. Sweating Take Advantage of Sweating to Detoxify The skin is your largest organ. The skin tends to absorb a fair amount of anything applied topically, which is why it is important to use natural skin-care products. In addition, the skin can be used for detoxification: 1. Sweating is an effective way to release toxins that are stored in the subcutaneous fat layer just underneath our skin. To do this, sweating must result from the body being gradually heated from an external source. Therefore, sweating from exercise does not accomplish as much in terms of detoxification, although exercise has many other benefits. 2. Sweating in a sauna or steam room is effective at releasing stimulating toxin release toxins through the skin. At least fifteen to twenty minutes is necessary to achieve this objective. I recommend starting with one or two sessions per week. 3. If you do not tolerate the heat from a traditional sauna, infrared saunas are a good alternative. These achieve the same benefits in terms of detoxification but do not heat the air around the body. 16
People who are intolerant of traditional saunas often do well with infrared saunas. 4. If you do not have access to any of these, it is also possible to use a bathtub at home. Fill the bathtub with hot water and immerse your body in it for at least fifteen minutes until you feel some sweat on your forehead. You may wish to put a quarter cup of bentonite clay into the water to prevent your body from absorbing any chemicals in the water through your skin. Drinking lots of water It goes without saying that drinking lots of water is indispensable for flushing toxins out of your body. How much water should you drink? The amount varies depending on your height and weight and other factors but you should be consuming enough water to ensure that your urine is completely clear. If your urine is dark or yellow it means you are not drinking enough water. Exercise moves rasa or lymph. The lymphatic system is part of the circulatory system, comprising a network of channels called lymphatic vessels that carry a clear fluid called lymph toward the heart. Keeping a healthy lymphatic system is important for the immune system as well as for removing toxins from the body. Unlike blood, the lymph fluid is not pumped by the heart, but instead relies on muscular contraction and body movement to move the fluid appropriately. Regular aerobic exercise is beneficial not only for cardiovascular health but also for lymphatic drainage. Eating detoxifying foods We talked earlier about detoxifying foods such as beet greens, the leafy tops of beetroot. In addition, cooked cruciferous vegetables like broccoli, cauliflower, and Brussels sprouts are very good for supporting deliver in comparing toxins. 17
4. Your Immune System We know that certain infections can predispose to the development of autoimmune disease so it is important to keep the immune system strong to prevent the development of infections, which can also trigger autoimmune disease in some cases. Therefore restoring the optimal function of the immune system is an essential part of treating autoimmune disease as well. The immune system is correlated with a strong Agni and healthy ojas, the basic essence of Kapha. Basic strategies to maintain a healthy immune system include: 1. Getting adequate sleep 2. Proper dinacharya or daily routine 3. Chyawanprash -- traditional herbal jam based on amalaki which supports healthy immune system function, protects the body against stress, and kindles the digestive fire. One of the most powerful rasayana (formulas for rejuvenation). 4. Ghee - considered medicinal in Ayurveda, helps to build up ojas which is one of the pillars of the immune system. We will talk about ghee in much more detail a little bit later. 5. Vitamin C - important to get adequate food sources of vitamin C including citrus fruits, vegetables, etc. 6. Vitamin D - adequate sun exposure is the best way to ensure shealthy level of vitamin D, which plays an important role in regulating the immune system. If you are deficient you might need a supplement for some time to bring up your levels to a healthy range. 7. Omega-3 fatty acids (EFAs) -- fish and seafood are the best source of omega 3 essential fatty acids. For vegetarians, flax seeds, Chia seeds, walnuts, and hemp seeds also offer excellent sources of omega-3s. The balance between Omega-3 and Omega-6 fatty acids in the body is important for regulating inflammation and immune system. Most people should try to get more omega-3 fats and less omega-6 fats. 18
Ghee For several reasons, I believe that ghee plays an essential role in the Ayurvedic treatment of autoimmune disease. 1. First, we know that ghee stimulates Agni and strengthens digestive fire. As we talked about earlier, imbalances in Agni are prerequisites for and often the first step in the pathogenesis of autoimmune disease. 2. 2 nd, ghee does not contain any lactose or casein. Many people with autoimmune disease have food sensitivities or dairy intolerance. However, they can still tolerate and benefit from ghee because it does not contain those proteins that people usually develop reactions to. 3. 3 rd, ghee helps universally with balancing Pitta and Vata, which are the 2 doshas most commonly implicated in autoimmune conditions. 4. It is helpful for providing lubrication for the connective tissues and joints especially helpful for autoimmune conditions which involved joint inflammation. 5. Ghee dispels blockages in the srotas or microcirculation. We talked earlier about how blockages in the srotas can be one of the reasons why ama localizes in certain dhatus during the pathogenesis of autoimmune disease. 6. Finally, ghee helps with building ojas and vitality. Often people with autoimmune disease complain of fatigue and feeling depleted and this is usually related to low ojas For most people with autoimmune disease, I recommend at least 2 to 3 teaspoons of plain ghee daily, because of all those reasons we talked about. It is actually quite easy to make your own ghee let s talk about how to do this. It s ideal to perform this while you are in a contemplative or meditative state of mind. Making therapeutic ghee can be a really powerful meditation practice. 19
Make Your Own Ghee While ghee is available commercially, it can be expensive, and making your own ghee is relatively easy and fun. To begin, purchase a good quality, organic grass fed butter. You can use either salted or unsalted butter, but I prefer salted butter because unsalted butter can have other ingredients like lactic acid instead of salt. Take 4 4-ounce quarters (total of 16 ounces) of the butter and melt them in a pan uncovered at medium heat. When the butter is fully melted, turn the stove to the lowest possible heat and let the butter simmer. Stir occasionally for the first 5 minutes and continue to simmer for about 30 40 minutes. The butter will make a bubbling, crackling noise and some foam will appear on the top. As it is cooking, particles from the butter will sink to the bottom and form a brownish solid residue. A fragrant smell like freshly made popcorn will fill your kitchen. After 30 40 minutes, when the butter has stopped crackling and bubbling, check to see if the ghee is done - put a drop of water into the ghee. If it s done, the ghee will crackle briefly as the water evaporates, and then stop crackling. Now the ghee is ready. Skim off the foam and discard it. Pour the clear liquid through a strainer into a glass jar and allow it to cool before closing the lid. Ghee has a very long shelf life and should not be refrigerated. Medicated ghee, known as ghrita, is clarified butter in which herbs have been boiled or extracted, and is extremely effective in reducing Pitta. One of the most famous medicated ghee is brahmi ghrita, which contains the herb gotu kola or brahmi. Fennel ghee is extremely effective in cases of high Pitta this can be made by boiling 1 tablespoon of fennel seeds in a mixture of 8 ounces of ghee and 8 ounces of water. Stir this mixture well and then boil over low flame until all the water is evaporated and only the ghrita remains. Shatavari ghee is also very effective for high Pitta and especially beneficial for cases of low ojas in women. This can be made by boiling 1 tablespoon of Shatavari powder or 2 tablespoons of the whole Shatavari root in a mixture of 8 ounces of ghee and 8 ounces 20
of water. Boil over low flame until all the water is evaporated and only the ghrita remains. Work with your practitioner for guidance and advice about using ghrita, or simply use plain ghee which has a lot of benefits as well. Spices Next, it is very important to incorporate spices, because of their multiple benefits for people with autoimmune disease. Ayurveda considers spices to comprise an entire category of medicine. Scientific research has uncovered profound healing effects from spices. The biochemistry and physiology behind these effects is now understood to be mediated by four main mechanisms - antioxidant, anti-inflammatory, blood sugar regulation, and digestive enhancement. First, the spices listed here have unparalleled abilities to protect your body from oxidative stress through their rich array of antioxidants. Let s talk a little bit about why this is important. Oxidative stress is one of the underlying mechanisms behind almost all major diseases and the aging process itself. Oxidative stress is the strain placed on our body as a result of internal processes like metabolism as well as external factors like environmental pollutants, radiation, toxins, etc. Oxidative stress is caused by compounds known as free radicals, molecules that directly damage proteins, DNA, and other components of our cells, and can be quite high when someone is suffering from autoimmune disease and chronic inflammation. Free radicals are also known as reactive oxygen species, or ROS. These molecules are produced in our body all the time as normal by-products of metabolism and other enzyme reactions. In the same way that an apple turns brown when exposed to air, you can think of a similar process of rusting occurring in our cells if they are exposed to excessive free radicals. The main benefit of antioxidants is that they protect our bodies from the damage caused by free radicals, and are therefore one of the main ways in which our body counteracts the effects of oxidative stress. 21
The second key property of spices is their anti-inflammatory effect. Many compounds in spices have the capacity to quiet inflammation, which is the underlying cause of most chronic disease. One of the key mechanisms by which many spices exert their beneficial effect is by blocking a compound known as Nuclear Factor-kappa B (NF-kB), which stimulates the expression of a broad array of inflammatory genes and is linked to multiple chronic diseases including cancer, heart disease, Alzheimer s, and diabetes - phytochemicals from spices such as turmeric (curcumin), red pepper (capsaicin), cloves (eugenol), ginger (gingerol), cumin (anethol), fennel (anethol), rosemary (ursolic acid), and garlic (ajoene and others) have been shown to be effective at inhibiting the activation of NF-kB. Third, there is promising research suggesting that spices can help to maintain healthy blood sugar. In my clinical experience, optimal blood sugar regulation is fundamental to good health, so it s exciting to realize that spices can play a big role in maintaining glycemic and metabolic wellness. Finally, spices are used in Ayurveda to restore a healthy digestive tract and stimulate one s Agni, or digestive fire. We talked earlier about how fundamental this is in treating autoimmune disease. For all these reasons, it is essential to significantly increase your intake of spices when faced with autoimmune disease, specifically the following spices: turmeric, ginger, cinnamon, cumin, fenugreek, clove, fennel, coriander, allspice, black cumin, ajwain, saffron and curry leaf. Chronic inflammation is one of the underlying mechanisms in autoimmune disease, and the spices can have the most powerful effect in providing information naturally without the side effects of prescription drugs. 22
Pranayama The next component of treating autoimmune disease using an Ayurvedic approach is the incorporation of Pranayama. Pranayama is one of the most powerful tools in Ayurveda to harmonize your body, mind, and spirit. Regular practice of pranayama promotes physical well-being, mental clarity, muscle relaxation, stress reduction, reduced anxiety, optimal energy, and cellular regeneration. It is especially beneficial because it can help with restoring optimal balance of the doshas and reducing inflammation. We will cover 3 different approaches to pranayama, which could be useful in different situations. General guidelines: Do not practice pranayama if you are pregnant, have uncontrolled hypertension, or suffer from any other serious medical problems. Do not practice on a full stomach; wait at least 2 hours after meals in order to practice. If at any point you feel lightheaded or dizzy, immediately stop the practice and lie down if you need to. One of the most well-known types of pranayama, Anuloma Viloma or alternate-nostril breathing, is very calming for the mind and body and helps with balancing the doshas. This pranayama would be beneficial for all people with any subtype of autoimmune disease. Here s how to practice: Sit comfortably with your spine erect but relaxed. You can either close your eyes or keep a gentle gaze on a point in front of you. Start by using your right ring finger to cover up your left nostril. Take a deep breath in through your right nostril to a count of 4. Then cover your right nostril with your thumb and hold your breath for a count of 8. Then release your left nostril and exhale to the count of 4. Next, inhale through your left nostril to a count of 4, hold a count of 8, and exhale through your right nostril to a count of 4. You have just completed one cycle. To start, complete around 5 cycles daily and gradually increase up to 10 cycles per day. It can be a powerful practice so if you feel dizzy at any time just stop and take a break. 23
A more activating and stimulating technique is Bhastrika or Bellows Breath. Because it is energizing, this pranayama technique can be practiced when you are feeling a little sluggish or in need of energy boost. This is effective for people with autoimmune disease who are suffering from fatigue, or who have an imbalance in Vata that is pretty significant. To start, sit comfortably with your legs crossed on the floor or on a chair. Begin by taking a few full, deep breaths, lifting up your shoulders and pushing out your abdomen as you breathe in, and expelling the air fully when you breathe out. In this technique, you will be breathing in and out through your nose and not through your mouth. Start the technique by rapidly expelling the breath through your nostrils with your mouth closed, and then breathing in with a complete, deep inhalation through your nostrils while lifting up your shoulders and chest and pushing out your abdomen. The inhalation should be somewhat slow and full taking about 2 seconds; the exhalation is rapid and abrupt. Practice about 20 times which should take about 40 seconds, and then rest for 30 seconds. You have just completed one cycle of Bhastrika. If you feel well, begin another round of 20 rapid exhalations and inhalations over about 40 seconds, followed by a 30 second rest period. Finally, repeat this process to complete your 3rd cycle. Perform no more than 3 cycles per day unless supervised by a trained teacher. Another activating pranayama is Kapala Bhati. This is also a stimulating technique best done in the morning. This is effective for people with autoimmune disease who are suffering from fatigue, or who have an imbalance in Vata that is pretty significant. It is especially important to practice this technique on empty stomach. To start, sit comfortably with your legs crossed on the floor or on a chair. During this technique, your entire focus will be on exhalation through the nose; keep your mouth closed during the exercise. You will not think about breathing in but inhalation will happen automatically. You will be making rapid exhalations originating from your abdominal muscles. To start, rapidly exhale through the nose while pulling in your abdominal muscles, almost as if you were blowing your nose. Immediately repeat and continue performing 24
these rapid exhalations a total of 100 times. If you feel well, rest for 1 minute and perform a 2nd cycle of 100 rapid exhalations. After another minute of rest, you can perform your 3rd and final cycle of 100 exhalations. Perform no more than 3 cycles per day unless supervised by a trained teacher. A more relaxing, cooling technique is Sheetali pranayama. The word Sheetali means cooling in Sanskrit, and this pranayama is designed to calm the mind, cool the body, and reduce tension. You may also notice some cool sensations in your mouth and in your body. This is especially beneficial for reducing excess Pitta and quieting inflammation and overheating in the body. To start, sit comfortably or stand in a relaxed position. This is one of the few pranayamas which can safely be performed standing if the situation requires. You will be inhaling through your mouth and exhaling through your nose. The only difference is that you will be making a roll out of your tongue someone sitting across from you would see a U shape when looking at your tongue. After a few slow deep breaths, begin by inhaling through your mouth while your tongue is rolled into this U shape. Take about 4 seconds to perform the inhalation. Then close your mouth and exhale through your nostrils, taking 4 seconds to release the air. If you are feeling well, you may practice this for a maximum of 5 minutes per session, up to twice per day. We know that stress is often a precipitating factor that can trigger autoimmune disease. Therefore it is important to have a daily mindbody practice that helps reduce stress and also purifies and cleanses all of your nadis (channels). Maintaining good mental and emotional health is crucial for the recovery from autoimmune disease. One important concept to discuss is the fight-or-flight reaction, which is a stress response that is adaptive in the short term but harmful in the long term. The problem is that poor diet, lack of sleep, and emotional stress can cause your body to stay in this fight-or-flight mode chronically, which is insidiously damaging. 25
The Fight or Flight Reaction The fight or flight reaction is the primal response of our nervous system that evolved to keep us alive in the jungle. When under threat, it enabled us to run from danger or fight for our lives. This is activated by the sympathetic nervous system, which is your body s equivalent of a gas pedal. It increases your blood pressure, speeds up your heart, raises blood sugar, and redirects blood away from your digestive tract and internal organs to your muscles so you can take action. In medical school we learned that the sympathetic nervous system is associated with the 4 F s fight, flight, fear, and sex. There is no problem if the sympathetic nervous system is activated for short periods of time, which evolution designed it to do. The problem is that the stress of modern life leads to people being in this state most of the time. This leads to elevated levels of stress hormones such as cortisol that have harmful consequences over time, including raising blood sugar and blood pressure, promoting inflammation, suppressing the immune system, and shutting down digestion. Your body in its wisdom does have a brake to counteract this the parasympathetic nervous system. This enables your body to rest, recover, and regenerate itself. Activation of these pathways helps lower blood pressure, slow your heart rate, boost immune function, and restore digestion. All mind-body techniques have capacity to directly activate your parasympathetic nervous system, which leads to a plethora of health benefits. Meditation The latest research from neuroscience has proven that we can literally change the structures of our brains through meditation and other practices, a concept known as neuroplasticity. For example, MRI studies revealed a significantly larger hippocampus, a region of the brain that is vital for stress management, memory, learning, and mood, and other positive changes in gray matter density after just eight weeks of meditation practice. Moreover, research has shown 26
that meditation can boost your immune system, reduce anxiety, and lower blood pressure. Meditation may improve your focus, attention span, and ability to work under stress. Daily meditation can turn on genes that reduce inflammation, fight cancer, and kill unhealthy cells. Examples of other mind-body techniques besides meditation are yoga, deep breathing, progressive muscle relaxation, guided imagery, and visualization. So far we have talked about dietary changes, The Paleovedic Detox, cleansing and detoxification practices, immune system boosting strategies, the therapeutic use of ghee, incorporating spices for multiple health benefits, performing pranayama, and practicing a mind-body technique. These different components would all be beneficial in any type of autoimmune disease. Now let s take a few different individual conditions and talk about specific personalized treatment for each autoimmune disease. I m going to discuss five autoimmune diseases. Of course, not all of these recommendations may be appropriate for everyone with a particular condition. These are just a starting point and it is important to work with a qualified practitioner to determine what is really optimal for each person. 27
5. Section One Hashimoto s Thyroid Disease This is where the body attacks the thyroid gland leading to lower levels of thyroid hormone. I would like to present a case of a patient with this condition to illustrate my approach: Rhonda was a fifty-four-year-old female who was struggling with obesity, fatigue, and a sluggish thyroid. Her TSH (thyroid stimulating hormone) had been hovering just outside the optimal range for many years, and she had elevated thyroid peroxidase antibodies consistent with Hashimoto s disease, where her immune system was attacking her thyroid. She had a strong aversion to taking medications and was opposed even to taking a natural form of thyroid hormone. She felt like she was too fatigued even to exercise, although she had been very active for most of her life. She was following a gluten-free Paleo diet with a lot of fruits and vegetables and loved dairy products of all kinds including milk, cheese, and yogurt. She explained that she was from Wisconsin, where dairy farming is common, and that s why she loved drinking milk every day. After talking with her I determined that she had excess Kapha as well as very low Agni. I had her follow a Kapha-pacifying diet. Traditionally, Ayurveda recommends eliminating dairy products during such a diet. Even though it was very difficult for her, Rhonda stopped eating dairy products and started following the Kapha meal plan. I also encouraged her to incorporate warming spices into her diet, such as ginger, turmeric, black pepper, and chili. Lastly, I suggested that she begin taking an herbal supplement called Guggulu, which is effective at reducing excess Kapha and is also traditionally used to support healthy thyroid function. After three months, she was excited to report that she had lost fifteen pounds just from changing her diet. Her energy had improved to the point where she was able to start a regular exercise program. As she began exercising, her energy improved 28
further and she lost another ten pounds. After six months, we repeated her thyroid function tests and found that they had normalized. In fact, her thyroid antibodies had returned to normal, indicating that her Hashimoto s disease had been successfully reversed. Other things to consider in Hashimoto s disease include the elimination of gluten because of potential cross-reactivity between gluten and thyroid tissue. Also, consider performing tests for and elimination of other food sensitivities, at least in the beginning. Ashwagandha -- usually not used alone but as part of an herbal formula because it is a very heating herb and can worsen irritability especially if someone already has high Pitta. Also do not use indefinitely because of case reports of hyperthyroidism incurred by prolonged unsupervised use of Ashwagandha. 29
6. Section Two - Rheumatoid Arthritis (Ama Vata) We talked more about the pathophysiology of Ama Vata earlier when we were reviewing the slides about increased intestinal permeability and leaky gut syndrome. Consider performing tests for and elimination of other food sensitivities at least in the beginning -- often dairy products may be problematic in this condition Kaishore guggulu restores healthy tissues and is especially helpful for the joint and musculoskeletal systems. Shatavari as part of a cooling herbal formula which reduces excess Pitta if it is present. Mahanarayana tailam - for topical application to affected joints. Ginger - can reduce inflammation but be careful about excessive heating property especially in patients with high Pitta. 30
7. Section Three - Inflammatory Bowel Disease (Ulcerative Colitis and Crohn's Disease) I would like to present a case to illustrate my approach to treating inflammatory bowel disease: Russell was a thirty-two-year-old male with severe ulcerative colitis, an autoimmune disease in which the body attacked the colon, leading to inflammation and loose stools. Despite being on the antiinflammatory drug mesalamine, he still had elevated levels of C- reactive protein (CRP), a blood marker that indicated persistent inflammation. He was having eight to ten bowel movements per day with blood and mucus in his stools. He had been on a strict Paleo diet for six months, and his diet consisted of eggs, red meat, fermented dairy products, sauerkraut, and a limited number of vegetables. After talking to him I realized that he had excess Pitta, which was manifesting as inflammation in his colon, bloody diarrhea, and a frequent sour taste in his mouth. I realized that the foods that he was eating were all very hot in terms of their qualities and properties. While meat, eggs, and dairy products are wonderful nutrient-dense foods, in his case they were actually not beneficial because of their heating properties. I had him start a modified Paleovedic Detox without meat, eggs, or dairy products. For three weeks he consumed bitter greens such as arugula, spinach, and kale, which have very cooling energetic properties. I also encouraged him to eat khichadi once a day, which he was open to doing even though it contained rice (which is not strictly Paleo by some definitions), because of its soothing effect on the gut. I encouraged him to liberally incorporate turmeric into his cooking. I suggested that he temporarily reduce consumption of sour foods such as sauerkraut because they can potentially aggravate Pitta. Lastly, I suggested that he take a supplement containing Boswellia serrata, an herb that balances Pitta and is often used to reduce inflammation. 31
At a three month follow-up visit, he reported that his symptoms had improved by 80 percent. He was having two to three bowel movements per day and there was no blood or mucus present in his stool. He was no longer experiencing the sour taste in his mouth. After continuing to work with me over the next year, we were able to wean him off the mesalamine and control his symptoms using diet and select supplements. As we can see, the Pitta pacifying diet is absolutely essential in inflammatory bowel disease. Turmeric should be incorporated liberally in both powder and supplemental form. Boswellia reduces excess Pitta. Shatavari as part of a cooling herbal formula which reduces excess Pitta. Aloe vera juice The fundamental role of changes in the intestinal bacteria may need to be addressed with the strategies that we reviewed earlier during the presentation, such as using probiotics, prebiotics, and fermented food to shift the beneficial bacteria in the microbiome. 32
8. Section Four - Celiac Disease Possible remission with the elimination of gluten. Patients with celiac disease are usually found to have other deficiencies including zinc and vitamins like vitamin B12, so it s important to test for these and address deficiencies when they are found. Consider elimination of other food sensitivities at least in the beginning when gut healing is taking place. A digestive healing regimen is very important. Sat isabgol as a fiber source can help with healing the gut and promoting regularity. 33