Ayurvedic Principles of Upavasa and Fasting for Diabetic Patients

The underlying principle of Ayurveda, the oldest known medical science in the world, is holistic health that is centered on natural methods of prevention and cure. Ayurveda stresses that there are three pillars of good health – spiritual, psychological and physical – that have to be in harmony for all-round well-being of a person.

Ayurveda states that every person is born with a particular Prakriti that is the result of the interactions between the tridoshas – Vata, Pitta and Kapha. The digestive fire or agni, which is the natural fire in the body, plays a vital role in metabolic functions such as digestion, immunity, sensory perception, mental alertness which helps the body perform its role effectively. In addition to agni, Ayurveda also considers the role of Ojas (important energy generated after the digestive process) and Ama (toxins) as important for good health.

Accumulation of ama, weakened agni, reduced Ojas and imbalanced tridoshas are the root causes of diseases. When the agni is strong, ama is weak resulting in strong immunity. On the other hand when the agni is low, the ama is increased which causes imbalances in the body. The primary cause of diseases is rooted in a malfunctioning digestive system.

To restore balance and rejuvenate the body, the first step that Ayurveda recommends is eliminating ama or metabolic toxins from the body. Fasting or Upvasa is one of the detoxification techniques mentioned in Ayurveda.

Ayurveda and principles of fasting

Ayurveda says that when an individual fasts, they are essentially practicing the 5th element of ashtanga yoga known as Pratyahara or withdrawal of senses. Upvasa or fasting is withdrawal of food for specific periods of time, undertaken under the supervision of an experienced Ayurvedic Vaidya.

According to Ayurveda fasting empowers the body to restore itself-mending capacities. Upvasa or fasting is a powerful method of igniting the digestive fire or agni and burning away all the accumulated ama or toxins to help combat illnesses.

Ayurveda generally advocates short-term fasting (long term fasting can be harmful to health) around similar time (every week or some days in a month) depending on a person’s body type (body type of a person is determined by age/vaya, digestive fire/agni, season/kala and dosha) and detoxification/purifying requirements. Vata, Pitta and Kapha depict the physical doshas whereas Satva, Rajas and Tamas represent the mental doshas. Any vitiation of these doshas results in diseases.

Gorging on food before and after fasting is not at all recommended. Instead, easy to digest, light, liquid foods should be eaten after a fast. Ayurveda does not advocate completely giving up food or zero fasting as it overloads the agni but supports consuming light foods that are suitable for that person’s dosha type.

Although the process of fasting can result in some loss of body weight, the main aim of fasting is to remove metabolic toxins, waste matter and excess body fats. Ayurveda also does not consider overeating as the only factor for weight issues. Weight issues are also related to the proper functioning of the digestive system.

Benefits of fasting

• Strengthens the jatharagni or the digestive fire which helps speed up the metabolism in the body
• Helps execrate ama or toxins
• Boosts immunity and improves the digestive system
• Promotes mental clarity and feeling of lightness in the body (reduces bloating)
• Assists weight loss (although only overeating is not the only reason for weight gain and thus fasting (when done in a systematic manner under supervision of a medical professional) is only one of the ways to reduce body weight
• Improves heart health by controlling cholesterol levels as well as triglycerides
• Helps control blood pressure
• Enhances brain function and restores a sense of calmness
• Helps maintain healthy sleep cycle
• Improves complexion and slow down the aging process
• Increases the secretion of the growth hormone serotonin
• For diabetics or pre-diabetics, reduces insulin resistance (beneficial for Type II diabetes) and also helps control blood sugar
Revitalizes the body and boosts natural energy levels

Langhan Chikitsa

Diabetes is a chronic metabolic condition where either the body is unable to produce enough insulin (type I diabetes) in the pancreas or not able to effectively use the insulin (type II diabetes or insulin resistance) it does make, this results in excess blood sugar in the body.

Ayurveda considers diabetes as a lifestyle disease often brought on by extreme use of guru/ heavy, madhura/sweet, snigdha/oily, shita/cold ahara or diet as well as vihar or lifestyle habits like alashya/sedentary or lazy, adhyasana/eating food before the previous meal has been digested (this is actually one of the main reasons for diabetes/Prameha), vishamashan/not having a set timing for meals etc. Incorrect dietary and lifestyle habits can result in excessive body fat or adiposopathy. Adiposopathy can then lead to various metabolic diseases including diabetes/Prameha.

As per Ayurveda, Langhan upakarma is an effective treatment in controlling excessive body fats. Langhan is derived from the Sanskrit word langha which means fasting or Upvasa. Langhan, one of the six basic treatment practices in Ayurveda, is therapeutic fasting or therapy intended to reduce abnormally increased body fats, accumulation of ama/toxins, balance vitiated doshas (vata, pitta, kapha) and lighten the body components to maintain equilibrium.

Langhan is a part of Apatarpana chikitsa (where oral food intake is restricted) is administered by diet, medicines or activities that have properties such as laghu/lightness, ushna/hot, tikshna/intense, vishada/cleansing, ruksha/dryness, sukshma/minute, khara/rough, sara/fluid, kathin/hard in order to reduce fats.

Out of the Panchamahabhutas or 5 core elements, Agni/fire, Vayu/wind, and Akash/space are the elements that play a vital role in Langhan therapy.

Langhan chikitsa is a type of shamana chikitsa (pacifying) procedure. Langhan therapy is always prescribed after assessment of strength/bala of the individual and severity of disease. It is administered for specific duration and in specific dose as per the health conditions of the patient under the supervision of a qualified Ayurvedic Vaidya.

Langhan stimulates the digestive fire or agni, normalizes the dosha, brings about lightness in the body thus maintaining healthy hunger, thirst, strength and is thus recommended in the early stages of disorders that arise from kapha dosha vitiation, ama accumulation such as Diabetes mellitus/Prameha etc.

Intermittent fasting for diabetics

Western medicine does not recommend fasting for diabetics, but Ayurveda takes a slightly different approach. Ayurveda has equally emphasized the importance of prevention as that of cure. So, in addition to dietary adaptations and herbal supplements, Ayurveda also considers intermittent fasting (Langhan/Upvasa or supervised fasting) as a means to regulate blood sugar levels and lower the risk of diabetes.

Intermittent fasting involves fasting for 14-16 hours, then eating within an 8–10-hour period (if a person has dinner by 8pm then their next meal will be lunch between 12-2 pm the next day). Drinking water during the fasting period is permitted. Also, eating food high in nutritional value, in regular proportions is recommended during the 8–10-hour period.

Intermittent fasting has its roots in the Ayurvedic system of eating twice (or at the most thrice) a day, once after sunrise (increased digestive capacity) and once before sunset (to avoid aggravating the pitta dosha that is active after sunset).

Studies have shown that alternate day fasting as well as intermittent fasting for diabetics helps reduce insulin resistance. This improved insulin sensitivity means that the glucose in the blood is absorbed with more efficiency, thus helping regulate the blood sugar levels in the body.

Of course, the results will depend on age, gender, health condition, prevailing illnesses, type of fast. It is strongly recommended that any type of fasting for diabetic patients must be undertaken only under the supervision of trained Ayurvedic Vaidya’s or medical doctors.

Ayurvedic diet for diabetes

Ayurveda refers to diabetes as Prameha and chronic insulin dependent type II diabetes/diabetes mellitus as Madhumeha (sweet urine). Ayurveda considers poor diet (foods that increase the Kapha dosha, meda/fats as well as excessive intake of dry (Ruksha), bitter (Tikta) and astringent (Kashaya) foods) and lifestyle as the main causes of diabetes. It states that Type II diabetes is a largely preventable disease that can be achieved through Ayurevdic Pathya Ahara or wholesome diet (which is suitable for all dhatus/tissues) and Pathya Vihara or wholesome, healthy lifestyle habits. The quantity and quality of diet for a diabetic patient should be based on the agni bala or digestive strength.

The Ayurvedic Pathya Ahara for diabetes, although not as useful in lowering blood sugar levels as insulin, works as a nutritional supplement and a therapeutic agent that not only improves the quality of life but also acts as a useful complement to insulin or other existing diabetes medicines in managing the disease.

Recommended Pathya/diet for Prameha rogi/diabetic patients

• Ayurveda strongly advises a fiber rich diet as fiber is absorbed in the small intestine and reaches the large intestine in an almost unchanged state. Fiber content slows the movement of food and decreases blood sugar levels, helps improve digestion, and the ability of the cells to receive and utilize insulin.
• Vegetable and fruit fibers reduce the risk of diabetes, delay sugar digestion and absorption, improve the insulin sensitivity and glucose utilization and relieve constipation. Also, fruits, vegetables and spices are rich in micronutrients and influence metabolic functions and also provide vital vitamins, minerals, and phytonutrients that ensure a balanced diet which are necessary to control diabetes.
• Ayurveda recommends a high intake of cereals rich in fiber such as yava/barley, wheat/godhuma, kulith/horse gram, toor dal, adhaki/red gram, mugda/moong/green gram.
• Bitter (bitter foods delay absorption and thus prevent increase of blood sugar levels after meals) and astringent leafy vegetables that are rich in fiber content such as tanduleyaka/chouli/amaranthus, patola or dodka, methi/fenugreek, karela/bitter gourd etc.
• Spices have some anti-diabetic effects and are useful for short term blood glucose decrease and long-term improved glucose tolerance and are recommended as part of the daily diet of diabetic patients. Asafetida/hing, methi/fenugreek seeds, cumin seeds, curry leaves, ocimum, rock salt, turmeric, cinnamon, mustard, garlic, onion, ginger, coriander, maricha/pepper etc.
• Fruits such as guava, jambu/rose apple, amalaki/Indian gooseberry, orange, watermelon, apple are recommended but fruits that have natural high sugar content such as bananas, mangoes, chikoo, grapes need to be avoided
• Use oils such as nikumba (helps reduce vata), sarshapa/mustard, atasi/alasi/flax seeds, ingudi/desert date
• Ayurveda suggests that a contraindicated diet or Apathya needs to be avoided by diabetic patients. Alcohols like Sauveera, Sukta, Maireya and Sura, milk products (cream, cheese, curd/dahi, cream etc.), oily/fried items (poori, parathas etc.), ghee, sugarcane juice or sugar, jaggery/gud, grain cakes/Pishtha, sour substances, sweet drinks/Panakas, and meats of domestic, aquatic and swamp animals should be avoided
• Avoid simple carbohydrates such as sugar, jam, cakes etc. as these carbs can be broken down easily and spike blood sugar levels. Also, fatty foods, salt, alcohol, caffeine and refined foods (white sugar, white flour, white bread, pastries, etc.) should be avoided as they have a high glycemic index and can increase blood sugar levels

Tips for fasting for diabetics

• Don’t start any fast before consulting your Ayurvedic Vaidya. They will determine your dosha, the status of blood sugar levels and other medical parameters before recommending if a fast is good for you or not
• Make sure if you are fasting, then the last meal is not later than 8 pm
• Don’t eat fried foods while breaking a fast, instead consume salads, or dry fruits such as dates or fruits with less sugar content (avocados, grapefruit, watermelon, strawberries etc.)
• Make sure the intake of salt and sugar is proper on the day of fasting to avoid any water retention
• Make sure you get enough sleep on the day of fasting (at least 7 hours)

The main reason behind fasting as per Ayurveda, for diabetic patients as well as non-diabetics, is to give the digestive fire or agni a rest so that it can be revitalized and support a robust digestive system. The other reason is to let the agni get rid of ama of toxins/waste matter that accumulate in the body leading to low energy (Ojas) and low immunity.

But Ayurveda does not advocate long fasting nor zero fasting. These can cause dosha imbalance and cause harm rather than any benefit. Ayurvedic Vaidya’s mostly recommend a mild fast once a week to cleanse the body internally. But again this depends on the person’s body type (age, gender, medical complications etc.).