Adhyashan: A Key Factor in Insulin Resistance

Dr. Amit Nakanekar, MD (Ayu.), Ph.D., Assistant Professor, Department of Kaychikitsa, Government Ayurveda College, Nagpur

Insulin resistance is the phenomenon by which the cell inhibits the entry of insulin molecules inside the cell. This is responsible for defective insulin action. For many hormones in the body, the two types of the phenomenon are- resistance and assistance. Resistance will oppose the entry of a particular molecule inside the cell, while assistance will provide entry of molecule inside the cell by some receptor mechanism. Therefore, to understand this concept it is very important to know how insulin resistance can happen inside the body. Impairment of insulin signal transduction enzymes, proteins leads to insulin resistance. Insulin resistance at the level of hepatocytes increases blood glucose level which leads to decreased uptake of glucose at the adipose tissue level and skeletal muscle level^{. [1]}

Ayurveda concept of digestion is nicely explained by Charaka in Grahanichikitsa Addhyaya. Agni (metabolic power) is Addhisthan (site) for digestion. Agni is situated in Grahani above the umbilicus. The function of Grahani is to hold the food till it gets digested and release this food after digestion. ^[2]

If the Agni is weak, indigested food moves in to forward direction without proper digestion. There are three types of defective eating, all these three types of defective eating can create diseases that are difficult to treat. These defective types of eating are Adhyashan, Vishamashan, and Samashan which means it is a mixture of a healthy and unhealthy diet. When healthy and unhealthy diet both are mixed together and eaten is called as Samashan. Pathya and Apathya diet mixed together causes diseases. Vishamashan means taking more or less food than the requirement, also taken at inappropriate timings. Food is taken at inappropriate timings that is before the feeling of hunger or not taking food in spite of it. Adhyashan means eating before the digestion of a meal, eating again in a very short time after the meals. ^[3]

Food consists of Six Rasas (Madhura-sweet, Amla-sour, Lavana,Katu , Tikta, Kashay). During digestion, food has to pass through the phases of digestion namely Madhur, Amla, and Katu Avasthapak. Every Rasa turns to be Madhur Rasa in the first AvasthaPak (Madhur avasthapak -1^st stage of digestion) and it increases the Kapha. If food intake is done before the end of the first Avasthapak, the duration of Madhur Avasthapak will be prolonged^{. [4]} If it continued like this, the whole body will be exposed to Madhurata (Sweetness-increased blood sugar level) for a longer duration. It will show the symptoms of Madhur Rasa Ati Yoga (symptoms of excessive intake of sweet). These are Sthaulya(obesity), Agnisad, Guruta(Heaviness in the body), Alasaka (excessive indigested food), Atinidra(excessive sleep), Shwas(Respiratory diseases), Prameha(Diabetes), Galroga(Throat diseases), Visangyata, Alasya, Galagand(Goitre), Arbuda(tumor), Gandamala(Thyroiditis), Udarda, Kasa(Cough), Krimi(worm infestation).^[5]

Diagnostic features of insulin resistance are hyperinsulinemia, hyperglycemia or normoglycemia, and anti-insulin antibodies. The effect of insulin resistance manifests on the heart, brain, kidney, blood vessels, and many more organs. ^[6]

Physiologically basal insulin secretion level is maintained at 10 μU /ml. It is secreted in two phases after meals. Phase 1 Active Phase or 1^st phase of glucose-stimulated insulin secretion, influences fasting to feeding duration. In this phase, it works by inhibition of glucose production by hepatocytes, reduced lipolysis, decreased intake of glucose by adipose tissue.1^st phase of insulin secretion is quick and 2^nd phase is slow and gradually increasing. The second phase which is a passive phase of insulin secretion also inhibits glucose production by hepatocytes up to a lesser extent, but most importantly it increases the utilization of glucose by peripheral tissue. Graph 1 shows the phases of insulin secretion.^[7]

Graph 1: Phases of insulin secretion after a meal

 Adhyashan includes eating before the digestion of a meal, eating again in a very short time after the meals. This means 1^st phase of insulin secretion repeatedly occurs before the completion of the second phase of insulin secretion. This cycle goes on repeatedly causing insulin resistance. Graph 2 shows the effect of Adhyashan on insulin secretion phases. Adhyashan has some role in the development of insulin resistance and its mechanisms can be correlated with disturbance in phases of insulin secretion leading to insulin resistance.

Graph 2:Possible effect of Adhyashan on insulin secretion phases

References:

1. Yaribeygi, H., Farrokhi, F. R., Butler, A. E., & Sahebkar, A. (2019). Insulin resistance: Review of the underlying molecular mechanisms. Journal of cellular physiology, 234(6), 8152–8161. https://doi.org/10.1002/jcp.27603
2. Tripathi B., editor. Charak Samhita; Varanasi.1^sted. Chikitsasthan, Grahani Chikitsa Addhyaya, chapter 15, verse 6, 57 Chaukhamba Surbharti Prakashan; 2013
3. Sharma S., editor. Ashtang sangraha Samhita; Varanasi.1^sted. Sutrasthan, Annapanviddhi adhyaya, chapter 10, verse 27 Chaukhamba Surbharti Series; 2016
4. Tripathi B., editor. Charak Samhita; Varanasi.1^sted. Chikitsasthan, Grahani Chikitsa Adhyay, chapter 15, verse 9, 10 Chaukhamba Surbharti Prakashan; 2013
5. Tripathi B., editor. Charak Samhita; Varanasi.1^sted. Sutrasthan, Aatreyabhadrakapyiaya Adhyaya, chapter 26, verse 41 Chaukhamba Surbharti Prakashan; 2013
6. Di Pino A, DeFronzo RA. Insulin Resistance and Atherosclerosis: Implications for Insulin-Sensitizing Agents. Endocr Rev. 2019; 40(6):1447-1467. doi:10.1210/er.2018-00141
7. Park SY, Gautier JF, Chon S. Assessment of Insulin Secretion and Insulin Resistance in Human. Diabetes Metab J. 2021; 45(5):641-654. doi:10.4093/dmj.2021.0220