Module on “Scope of diet, lifestyle and Rasayana in Geriatric care” By- Dr. Mangalagowri V Rao

DIET, LIFESTYLE AND RASAYANA IN GERIATRIC CARE

Introduction

The geriatric care includes components like prevention management of physiological, psychological and physical ailments arising due to the old age. As the age advances the medicines need to be administered with care. Hence, diet and lifestyle management along with Rasayana medicines helps in the geriatric care.

In the old age problems like neurological and psychological manifestation like dementia, parkinson’s disease, stroke, transient ischemic attack, dizziness, syncope, depression, delirium, hearing and visual impairments, gait and balance problems, sleep disorders, rheumatic conditions like osteoarthritis, rheumatoid arthritis, genito-urinary problems like benign prostatic hyperplasia, sexual dysfunction, cardiovascular problems like congestive cardiac failure, atrial fibrillation, hypertension, endocrinal ailments like diabetes mellitus, lung infections, electrolyte disturbances, GIT problems like constipation, malnutrition, fractures etc. are common.

Prevention and management of geriatric problems with different Rasayanas

The basic principle is maintaining the Agni, for adequate digestion, assimilation and metabolism. The management of Vatavriddhi and strengthening of respiratory and cardiovascular system are the other measures in management of geriatric conditions. The suitable diet, lifestyle and medicine should be advocated keeping in view the factors like Dosha, Dushya, Agni, Srotas, srotodushti prakara and specific avastha.

• Chyavanaprasha Rasayana as mentioned in Ashtanga Hridaya is ideal for prevention of Jara (Oldage) and cure of Jarajanitavikaras (diseases commonly occurring in elderly). The indications are cough (kasa), dyspnoea (Shvasa), fever (Jvara), Shosha (emaciation), Hridroga (cardiac problems), Vatashonita (gout), mutra and shukradosha (urinary and reproductive organ problems), abnormal voice (Vaisvarya), improves intellect, memory, lusture, vatanulomana (alleviation of Vata), strength to sense organs, Agnivardhana (enhances digestive fire).
• Juice of Indian gooseberry (Amalaki/Emblica officinalis) with honey, sugar candy and ghee, if licked destroys old age
• Vidanga (Embelia ribes), Bhallataka (Semicarpus anacardium), Nagara (Gingiber officnale) if taken along with ghee, and honey the person will successfully check the flow of river of ailments due to old age and gets

Role of Medhya Rasayanas in psychological and psychosomatic issues

Various old age issues like dementia, depression, sleep disorders, hypertension etc. can be managed well with the Medhya Rasayanas as well as diet. Yogic practices also are very helpful in addressing issues and bringing about healthy ageing.

• Yashtimadhu (Glycerrhiza glabra)
• Manduka Parni (Centella Asiatica)
• Guduchi (Tinospora cardifolia)
• Shankha Pushpi (Convolvulus pluricaulis)
• Ashwagandha (Withania Somnifera)
• Kushmanda (Binincasa hispida)

Mode of action: The mental calmness and improvement in memory can be brought about by regular intake of Medhya Rasayana (Ca.Ci.1/1/7) and constant practice of Yoga, since childhood help in reduction of aggressive behavior, improve adjustment and transform mental state positively. Beneficial effects of C. pluricaulis were seen on the patients of anxiety neurosis by modification of GABA system at the level of the synthesis of GABA mediators, release or reuptake or metabolism. Pharmacological studies shown hypotensive and tranquilizing effects. Induces a feeling of calmness and peace, good sleep and relieves anxiety, stresses, mental fatigue, producing a significant reduction in the level of anxiety, neuroticism arising due to various levels of stresses. Guduchi has antidepressant-like effect by interaction with α₁-adrenoceptors, dopamine D₂-receptors, serotonergic and GABA_B receptors, hence increasing the levels of norepinephrine, dopamine and serotonin; and decreasing the levels of GABA in brains of mice. Licorice is known to have multiple pharmacological actions including adrenocorticoid-like activity hence helpful in anxiety and aggressive behavior. For mental weakness and for improving memory, Mandukaparni powder of dried leaves in small dose is given with milk. Methanol and ethyl acetate extracts as well as the pure asiaticoside of Mandukaparni , shows anxiolytic activity.

• वाराही कंदम आर्द्रार्द्रां क्षीरेण क्षीरपः पिबेत मांसं निरन्ना मांसं च क्षीरान्नादो जराम जायेत (AshtangaHridaya, Uttara Tanra, 39/105)
• Fresh Varahikanda and Ardraka (ginger) with milk and meat with milk helps to conquer. (Ashtanga Hridaya, Uttara Tanra, 39/105)
• सवितुः समुदाय  काले प्रसति  सलिलस्य  विवेदस्युः  | रोगा जरा  परिमुक्तो  जीवेद् वत्सर शतम सग्राम (Bhavaprakasha 5/317)

Intake of 1 prasriti of water daily at the time of sunrise will prevent the diseases of old age (Bhavaprakasha, Purvardha 5/317)

• या नोपरुन्ध्यादाहारमेकं मात्रा जरांप्रति| षष्टिकः पयसा चात्र जीर्णे भोजनमिष्यते||Cha. Chi. 1/53

Shashtika (Variety of rice) with Payas (milk) and the food that can be digested easily specially benefit the elderly ((Charaka Samhita, Chikitsa sthana 1/53)

• Licking of honey with juice of Bijapuradala (Citrus medica leaves) alleviates vata and induces good sleep [47], which is the most common problem in old age. (Bhavaprakasha Vidyotini tika, Purvardha, 5/316,)
• पूर्वोक्तेन विधानेन लोहैश्चूर्णीकृतैः सह| तत् पीतं पयसा दद्याद्दीर्घमायु सुखान्वितम्||५२||

जराव्याधिप्रशमनं देहदार्ढ्यकरं परम्| मेधास्मृतिकरं धन्यं क्षीराशी तत् प्रयोजयेत्||Cha. Chi.1/3/52-53||

As previously explained the Loha bhasma is taken with milk will enhance longevity and health. This destroys old age, strengthens body, and enhances intellect and memory. One should be on milk diet Rasayana therapy.

Osteoporosis (Asthi dhatu Kshaya due to ageing)

• Pathya: Finger millet (Ragi), Cow’s milk (Godugdha), Cow’s ghee, Brinjal (Vrintaka), intake of betel leaves with calcium oxide (churna) devoid of tobacco, gingili seeds (Tila), Piper longum (Pippali), poppy seeds (Khas khas), Amaranth, agastya (sesbinia grandiflora), mustard (Sarshapa) leaves
• Apathya: Tea, coffee, alcohol, fried items, eggs, refined carbohydrates, white flour and sugar from the diet.

Vatahara Ahara

• Pathya: wheat (Godhuma), finger millet (Madhulika), Vajranna (jowar), Mudga (green gram), Kulattha (Horse gram), Mulaka patra (Radish leaves), Putiha (Mint), Methika (Fenugreek), Patola (Snake gourd), Bimbi (Kovai), Urumana (Almonds), seva (Apple), Kharjura (dates), Ananasa (Pineapple), Lichi (Lichi), Naranga (Orange), Mishtanimbuka (Sweet lime), Dadima (pomegranate), Matulunga (Citrus medica), Ardraka (ginger), Lashuna (Garlic), Palandu(Onion)

Shosha

• Pathya: Shali (Rice), Shashthika (Variety of rice), Godhuma (wheat), Yava (Barley), Mudga (green gram), Chanaka (Bengal gram), Shigru ( drum stick), Kharjura (dates), Parushaka (Citrus medica), Draksha (grapes), Dugdha (milk), Ghrita (ghee), Jangala mamsa (flesh of terrestrial animal), Ajamamsa (goat’s meat), Kambalika, Shadava, Veshavara, gooseberry, dates, Narikela (coconut), paraval
• Apathya: Dry food, Vishamashana (taking food at irregular interval), beetle leaves, Tarabuja (watermelon), horse gram, black gram, garlic, vetragra (tender shoot), asfoetida, sour, pungent, astringent taste, leafy vegetable, alkali, Viruddha ahara (contradictory foods), bimbi (Kovai), bitter gourd

  Svarabheda

• Pathya: Rakta shali (Red rice), Yava (Barley), Hamsa (swan flesh), wild cock flesh (Vanakukkuta mamsa), Balamulaka, Draksha, Matulunga (Citrus medica), Lashuna, Lavanardraka, Haridra, Tambula (Beetle leaves), Maricha (pepper), Sarpi(ghee)
• Apathya: Amakapittha (sour kapittha),, Jambu (Jamun), Naranga (Orange), Tinduka, Sheeta ahara

Certain general dietary tips for elderly

• CVDs, hypertension, diabetes mellitus, cancers, pneumonia, tuberculosis and dyslipidaemia are commonest problems among geriatric population.
• The increased cholesterol levels result in atherosclerosis producing CVDs. It can be related to one of the kaphananatmaja vyadhi Dhamani Pratichaya resulting from faulty lifestyle and dietary habits.
• The research conducted by Dr. Philip Frost from University of California shows that maintenance of blood cholesterol less than 185 mg/dl in elderly people reduce the chances of coronary heart disease by 23-30%.
• The diet accounts for only 25 to 30 % of the total cholesterol in your body. As per Harvard pathologist Dr. Kilmer McCully the high levels of homocysteine are risk factor for vascular diseases, especially obstruction of carotid artery obstruction. The studies conducted by Washington University show that low levels of Folic acid contribute to homocysteine imbalance, because folic acid breaks down homocysteine which is taken out from the blood stream. Daily requirement of folic acid is 400 mcg in diet. Beans, green leafy vegetables, and citrus fruits are good sources of folic acid.
• As per Ayurveda intake of heavy and non-nourishing diet is advocated for management of Medovikaras like sthaulya (Obesity). The research in Finland and the USA has found a direct correlation between fibre intake and cholesterol levels.
• 25 to 30 grams dietary fibre per day is advocated by the American Heart Association. Use of whole grains instead of white refined flour would increase consumption of the dietary fibre. The grains like barley, bajra etc. have complex carbohydrates which are more beneficial.
• Constipation and accompanied problems like gas, bloating, headaches etc. are common in old age. They are also benefited by high fibre intake.
• Calcium rich foods are also good. The potassium and calcium rich foods help in alleviating Hypertension and are Vatahara Dietary changes can reduce systolic pressure by an average of 11.4 mm and diastolic pressure by an average of 5.5 mm. Such results are as good as or even better than those achieved through pharmaceutical drugs and possess the added benefit of no adverse side-effects.
• The maintenance of sodium and potassium levels is highly essential while managing hypertension. Potassium rich foods like oats, rice, raw leafy vegetables, garlic, onions, broccoli, celery, watermelons, squash, parsley, and cucumber should be included in the diet.
• Increased intake fruits and vegetable enhances antioxidant levels and improved cognitive performance in healthy subjects. Progression of thickening of carotid intima media is slower on adequate intake of vitamin C in diet among elderly men.

Yoga- As rejuvenator

• In Shavasana steady, smooth, fine and deep breathing was maintained without any jerky movements of the body which soothes the nerves and calms the mind.
• The Pranayamas act on the pranic level (Pranamaya kosha) and restore the harmony to the flow of prana removing the blocks in the nadi produced due to stress, anxiety etc.
• Regular practice of Anuloma Viloma Pranayama helps to increase oxygen supply throughout the body, making one feel calm and peaceful, relieving stress, fever, it improves blood circulation, transforms negative thoughts in to positive thoughts and stimulates Ajnachakra. The brain centers are stimulated to work to their optimum capacity.
• Bhramari Pranayama helps in relieving stress, insomnia and tension, alleviating emotions like anger, anxiety. Probably by the vibrations during Bhramari Pranayma, the cerebral cortex sends impulses directly to the hypothalamus, which controls the Pituitary gland. The resonance of the brain’s metaphysical thinking is taken out and this enhances capacity of brain. Further, the humming sound enhances concentration of the mind. This produces a positive effect on mind and body especially nervous system. The mind becomes calm and peaceful. Thus helps in mental tension, agitation, high blood pressure, and heart disease etc.
• Dhyana acts on the manomaya Kosha and help in channalising the thoughts and focusing on a single thought which lead to the equilibrial state of mind.

Conclusion

• Agni, Vata, and Prakriti are the factors responsible for ageing a natural disease. The best treatment for natural diseases is Rasayana or rejuvenation.
• If the natural disease occurs before the time or premature ageing, that can be counteracted with the help of treatment according to the aggravated Doshas.
• Rejuvenation in the form of diet like milk, Indian gooseberries, pomegranate etc. is ideal in old age.

Links for further Reading

1.   https://jamanetwork.com/journals/jama/article-abstract/399267 (A Prospective Study of Plasma Homocyst(e)ine and Risk of Myocardial Infarction in US Physicians)

2. https://www.cdc.gov/ncbddd/folicacid/about.html#:~:text=CDC%20urges%20all%20women%20of,and%20spine%20(spina%20bifida) (Folic acid)
3. https://en.wikipedia.org/wiki/Geriatrics
4. https://en.wikipedia.org/wiki/Geriatric_care_management
5. https://www.ahajournals.org/doi/full/10.1161/01.cir.94.7.1795 (A Statement for Health Professionals From the Nutrition Committee, American Heart Association)
6. https://pubmed.ncbi.nlm.nih.gov/10524397/ (Position of the American Dietetic Association: functional foods)
7. https://pubmed.ncbi.nlm.nih.gov/33026154/ (The PREVIEW intervention study: Results from a 3-year randomized 2 x 2 factorial multinational trial investigating the role of protein, glycaemic index and physical activity for prevention of type 2 diabetes)
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944202/ (A Pilot Study Providing Evidence for a Relationship between a Composite Lifestyle Score and Risk of Higher Carotid Intima-Media Thickness: Is There a Link to Oxidative Stress?)
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372138/ (Cross-sectional associations between dietary intake and carotid intima media thickness in type 2 diabetes: baseline data from a randomised trial)
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616644/ (Carotenoids and Markers of Oxidative Stress in Human Observational Studies and Intervention Trials: Implications for Chronic Diseases)