The Graduated Diet

The Graduated Diet

The ‘graduated diet’, or sansarjana krama in Sanskrit, is a measure utilized in Ayurveda to rekindle the digestive fire (agni). It is used for the purpose of amapachana: to enhance digestion and the processing of wastes, and remove the metabolic and immunological detritus (ama) that is generated with poor digestion.

The graduated diet can be utilized in a variety of situations, including whenever digestion is weak and in the treatment of diseases such as fever (jwara). The process of ‘rekindling’ the digestive fire (agni) is analogous to starting a fire in a wood stove, enkindling the agni with easily digestible foods as one would a fire with paper or kindling. Once the fire is established, in the form of a strong appetite, progressively denser and more energy-rich foods are introduced in a graduated fashion to feed the digestive fire, but never so much as to cause it to smolder or be extinguished.

How much to eat?
The graduated diet isn’t designed to provide a maximal source of energy. It is by nature a light diet, meant to encourage a strong appetite and to enhance metabolism. As such, it is important to limit physical and mental activity during this period, so there is more energy available for digestion.

The idea behind the graduated diet is to tease your appetite with small amounts of easily digestible foods. The amount of food recommended in this post is for a medium-sized adult, and should be adjusted accordingly. While having a strong appetite is a good thing, being constantly famished is not, so make sure to eat enough to satisfy your needs.

While on the graduated diet, try to eat mindfully and not too fast, and listen to what your stomach is telling you, rather than your tongue. As the saying goes, “control your tongue, control your life.”

Meal times
In Ayurveda, there are two basic times to eat a meal: once before noon (breakfast), and again before the sun sets (dinner). As such, the graduated diet follows this basic scheme of two meals a day consisting of breakfast and dinner. During the graduated diet specifically, snacks are not allowed, but ginger tea and room temperature water may be drunk freely. During this regimen, it is important to consume at least a liter of water on a daily basis.

Cautions and contraindications
While the graduated diet does contain nutrients and hence food energy, in the initial phases especially, the meals are quite small and will not provide enough energy for everyday activities. This means that during the first few days especially, you should plan to take time off of work, lighten your responsibilities, and significantly reduce your activity level. This is not a recommendation to ignore or take lightly! Please avoid driving or traveling during the graduated diet.

If you are diabetic, hypoglycemic, or are taking pharmaceutical drugs, the graduated diet may be contraindicated, so please check with your health care provider before undertaking this regimen.

The Components of the Graduated Diet

The basic components of the graduated diet include rice, mung bean, ginger root, salt, ghee, spice powder, fermented food, and meat soup. Apart from these items, one useful piece of equipment is a pressure cooker. Let’s explore all of these in some detail.

White basmati (left), red matta rice (right)

Rice
For the graduated diet, I suggest using either white basmati rice, or a partially milled red rice (red matta rice) that cooks in the same amount of time. Generally speaking, use one-half cup of dry rice per meal, per person. Thus, to make enough rice for one person for an entire day, use one cup of rice.

To prepare the rice, rinse in cold water to remove any foreign particles, and let it soak overnight in water. The next day, drain the rice, add the required amount of water, bring to a boil, and then simmer.

There are three basic types of rice preparations used in the graduated diet, called peya, vilepi, and odana. Each type of rice preparation is made with different amounts of water, as follows:

  • peya is prepared with one part rice and eight parts water;
  • vilepi is prepared with one part rice and four parts water;
  • odana is prepared with one part rice and two parts water.

To make enough peya for an entire day, use one cup of rice per person, and mix with eight cups water. Bring to a boil and simmer, partially covered with a lid, and stir periodically. When peya is ready, it should have the appearance of a thin porridge.

To make enough vilepi for an entire day, use one cup of rice per person, and mix with four cups water. Like the peya, bring this to a boil, reduce to a simmer, and partially cover the pot with a lid, stirring periodically. When vilepi is ready, it should have the appearance of a thick porridge.

To make enough odana for an entire day, use one cup of rice per person, and mix with two cups water. Bring this to a boil and simmer, covered with a lid. When odana is ready, the rice should be soft, moist, and firm, with no water left in the pot.

Mung beans, split and washed

Mung bean soup
For the purpose of the graduated diet, mung bean soup refers to washed, split yellow mung beans that have had their skins removed. Of all the beans mung bean is generally easiest to digest, and among the different types of mung, the washed/split mung bean is best for weak digestion. For a medium-framed individual, use ¼ cup of the dry beans, per meal. Thus to prepare enough mung bean soup for an entire day, use ½ cup per person.

To prepare the beans, soak them overnight in water, drain, and then add fourteen (14) times the amount of fresh water. For both meals for a single person, this would be equal to ½ cup of mung bean to seven cups water. To this mixture add a few thin slices of ginger root, bring to a boil, simmer, and cook uncovered until the beans are very soft and look blown apart. Stir frequently during cooking especially as it is coming to boil to prevent burning, and continue to stir periodically thereafter.

There are two types of mung bean soup: one that is unflavored and unsalted (akrita yusha) and another that is flavored with salt, spices and served with some fermented foods (krita yusha). When preparing akrita yusha do not add any salt, but with the krita yusha you can add ½ teaspoon of salt per person, per day.

Ginger root, fresh

Ginger root
Although technically a rhizome, or an underground stem, fresh ginger root (adrak) is an excellent medicine to prevent the gas-promoting property of any legume it’s cooked with, and is generally helpful for digestion. A few slices of fresh ginger root in water brought to a boil and then simmered makes for a pleasant, digestive-enhancing tea to drink throughout the day during the graduated diet.

Sendha namak, or pink salt

Salt
Generally this refers to sendha namak, also known as pink salt, or Himalayan pink salt. You can also use kala namak, or black salt, which is more warming in nature, as well as rich in both iron and sulfur, and is very helpful digestion is especially weak. Sea salt is a fine substitute for either pink or black salt, and over the long term, may be a preferred source of salt due to its natural iodine content.

Ghee, clarified butter

Ghee
Ghee refers to the pure oil extracted from unsalted, fermented (i.e. cultured) butter, sometimes known as ‘European’ or ‘Old-fashioned’ butter. The quality of the ghee will only be as good as that of the milk, and thus butter obtained from grass-fed cow milk is best. Cultured butter is made by fermenting the cream that naturally separates from fresh cow’s milk, and is very different from the bland, centrifuged ‘creamery’ butter that most people eat nowadays. Mostly notably, ghee made from creamery butter lacks the agni-giving property displayed by that made from cultured butter. Among the different fats, properly made ghee is perhaps best for digestion, but too much too soon will weaken digestion and promote ama, so use cautiously. In the graduated diet, use 1-2 teaspoons of ghee when stir-frying one tablespoon of the spice powder.

A chunk of raw Hing from Afghanistan.

Spice powder
In the graduated diet, the spice powder is a mixture (masala) of culinary herbs that have digestive-enhancing properties, called dipana-pachana in Ayurveda. One useful masala is the powdered herbal formula Hingwastak churna, which is easy to find at Indian grocery stores or online. This formula contains a stinky, garlic-smelling resin called hing (asafoetida) as its most potent ingredient. Hing is not only good for digestion, it helps to ease spasm and colic, and inhibits the activity of disease-causing bacteria and parasites. Hingwastak churna also contains trikatu (i.e. ginger, pippali, black pepper), as well cumin seed, nigella seed, ajwain seed, and pink salt.

While Hingwastak churna is a good choice, there are other herbs to consider too, particularly if the odor of the hing seems unpleasant, or if the formula seems too spicy. Less pungent and milder herbs to consider include the seeds of coriander (dhaniya), cumin (jeera), fenugreek (methi), fennel (sonf), caraway, and dill.

Use the spice mixture or masala by stir-frying one tablespoon of the freshly ground herbal powder in 1-2 teaspoons of ghee at medium heat for 1-2 minutes (do not burn), and use this to flavor both the mung bean and meat soups (krita yusha and mansa rasa).

Carrot pickle, before adding the brine

Fermented foods
Fermented foods refer to live culture vegetable pickles, which contain beneficial lactic acid bacteria that are essential to maintain good digestive health. A fermented food in the graduated diet can be any lacto-fermented pickle prepared without spices, made from any vegetable including carrot, cauliflower, daikon, or cabbage. This does not include any ferments made with fruit, sugar, or grains such as miso, tamari, kombucha, or alcohol. To get the best effect, make sure that the pickles are sufficiently aged (2-4 weeks, depending on season).

Meat soup, mansa rasa

Meat soup
Called mansa rasa (‘meat juice’) in Ayurveda, meat soup is a stated requirement for the traditional practice of sansarjana karma, but can be avoided in vegetarians. To make mansa rasa, fry one pound (half kilogram) of boney meat (e.g. goat, mutton, skinless chicken back) in one tablespoon of ghee, along with one tablespoon minced fresh ginger, one minced onion, minced celery (2-3 stalks), and one tablespoon of your chosen spice mixture. Add 12 cups of water, bring to a boil, secure the lid, and cook at a medium-simmer until the meat is falling off the bone. When done, strain the soup from the meat, and scoop off the fat. Initially, serve just the soup for the first meal of mansa rasa. If it is well-digested, small pieces of the cooked meat can be gradually added into the soup.

An example of a modern pressure cooker

Pressure cooker
A modern pressure cooker is an exceptionally useful piece of equipment that in my opinion should be in every kitchen. It is a wise investment, saving in both preparation time and dramatically reducing the energy cost of cooking. In former times, a failing rubber gasket might cause a pressure cooker to explode, and hence their bad reputation, but nowadays modern pressure cookers have long-lived silicone gaskets, and are very safe.

In ancient times, pressure cookers were big pots with very heavy thick lids, something that today would be a little unwieldy to use. The most practical and best-wearing pressure cookers are made of stainless steel, whereas cookers made with softer, more reactive metals such as aluminum – an established neurotoxin – releases metallic ions into the food during cooking. For regular use, a large and a small pressure cooker together is a versatile combination to feed several people quickly.

A pressure cooker is a quick way to make peya in under 30 minutes, whereas with a regular pot it might take up to two hours. Likewise, using a pressure cooker to prepare the mung bean soup saves about the same amount of time. Pressure cookers are especially useful to make the meat soup, which takes about 60-90 minutes, but up to 8-12 hours in a regular pot without pressure.

Implementation of the Graduated Diet

The graduated diet can be applied over a three, five, or seven day period, for a mild, moderate, or strong effect. It may be continued for even longer periods of time, although generally speaking, the graduated diet is not meant to be taken long term. In some cases it may be necessary to go backwards in the diet (i.e. simpler foods) if digestion is getting worse, and sometimes modifications may be required based on individual needs.

The five phases of the graduated diet
In Ayurveda there are five phases of the graduated diet, beginning with peya and ending with mansa rasa. Vegetarians, however, can avoid this last phase of the diet, and continue with krita yusha.

The graduated diet can be applied over a three, five, or seven day period, depending on the desired effect. A three day graduated diet has a mild effect, and is better for mild conditions, where digestion is only a little weak, and there is only a little ama. A five day graduated diet has a moderate effect, indicated when digestion is moderately impaired, with a moderate accumulation of ama. The seven day graduated diet is indicated for long-standing digestive weakness and a profound accumulation of ama. Each of these regimens is be applied as followed:

[table]Strength,Phase 1,Phase 2,Phase 3,Phase 4,Phase 5
Mild,Day 1 breakfast,Day 1 dinner, Day 2 breakfast, Day 2 dinner, Day 3 breakfast Day 3 dinner
Moderate,Day 1 breakfast Day 1 dinner,Day 2 breakfast Day 2 dinner,Day 3 breakfast Day 3 dinner,Day 4 breakfast Day 4 dinner,Day 5 breakfast Day 5 dinner
Strong,Day 1 breakfast Day 1 dinner Day 2 breakfast,Day 2 dinner Day 3 breakfast Day 3 dinner,Day 4 breakfast Day 4 dinner Day 5 breakfast,Day 5 dinner Day 6 breakfast Day 6 dinner, Day 7 breakfast Day 7 dinner
,,,,
[/table]

  • Phase 1: peya
    During this phase, only a thin rice porridge (peya) is eaten, prepared by cooking one part rice in eight parts water, without salt.
  • Phase 2: vilepi
    During this phase, only a thick rice porridge (vilepi) is eaten, prepared by cooking one part rice in four parts water, without salt.
  • Phase 3: akrita yusha
    During this phase, the rice is prepared as odana, prepared by cooking one part rice in two parts water, without salt. Taken with this rice is an unflavored mung bean soup (akrita yusha), prepared by cooking one part mung bean in fourteen parts water, without salt.
  • Phase 4: krita yusha
    This phase is identical to phase three, except that the mung bean soup is prepared with a little salt during cooking, and after it is ready, mixed with the spice powder that has been stir-fried in ghee. During this phase, a small amount of live culture vegetable pickle (2-3 tbsp) can be consumed with each meal.
  • Phase 5: mansa rasa
    For the final phase of the graduated diet, meat soup is eaten with odana (steamed rice, prepared at a 1:2), along with some fermented foods. Like the preparation of krita yusha, the stir-fried spice powder can be added to the soup, along with a little salt.

Coming off the Graduated Diet

After the graduated diet has been completed, succeeding meals are drawn from the same types of foods, so that as the process of graduation continues, and the graduated diet serves as the basic structure of the every day diet. After completing the graduated diet, the portion size may increase proportional to an increase in appetite and energy requirements.

Adding vegetables
As one comes off of the graduated diet, vegetables can be added back to every day meals. This includes both non-starchy and starchy vegetables. Non-starchy vegetables include leafy greens such as bok choy, chard, kale, cabbage, and collards, as well as green beans, zucchini, peas, and asparagus. When preparing non-starchy vegetables, use methods such as steaming or stir-frying, cooking until tender but maintaining the brilliant color of the vegetables. Starchy vegetables include carrot, rutabaga, winter squash, sweet potato, daikon, and parsnip. To prepare these dense, starchy foods, methods such as boiling, steaming or baking are optimal, cook them until tender and not crunchy.

Urad dal (black gram), split and washed

Increasing variety
After reintroducing vegetables successfully, other foods can be added back to the diet. For example, try mixing the mung beans with washed/split black gram (urad dal, kali dal), or trying a different legume altogether, such as washed/split red lentils (masoor dal) or washed/split garbanzo beans (chana dal). You can also vary the types of grains as well, substituting basmati and partially-milled red rice with safe alternatives such as quinoa, buckwheat, short grain brown rice, or wild rice. If whole cereals or legumes take on any significant role in the diet, they should be fermented during preparation to reduce the high levels of natural plant chemicals in these foods that actively inhibit digestion.

The issue of fatty foods
After the graduated diet is complete, slowly introduce more fatty foods into the diet. Although fat has been much maligned in recent years – a trend that now appears to be reversing – Ayurveda has long stated that the consumption of healthy, fatty foods is an important element to promote youthfulness and long life.

The problem with fat is that among the macronutrients it is the hardest to digest — and if digestion is weak — its consumption is most likely to result in the production of ama. Many people avoid eating fat because they can’t digest it well, but as the ability to digest fatty food diminishes, the entire body and especially the brain and nervous system becomes dry and deficient, promoting disease and aging. When digestion is strong, most people find that they function best when eating heavy, dense, fatty foods on a regular basis. These foods supply a dense source of nourishment that is slowly oxidized, nourishing the body and stabilizing the nervous system. Such heavy foods should be consumed during the early portion of the day – when digestion is strongest – saving lighter burning carbohydrate-rich food towards the end of the day.

Using the analogy of a wood stove, dense fuels like cherry, birch or fir are known to generate a lot of heat for a long time, something that might be added to the stove in the morning to keep the house warm during the day. But come evening, unless its really cold, it’s unnecessary to build a big fire when it’s time to go to sleep. In this same way do heavy, fatty foods eaten earlier in the day provide a more stable and prolonged supply of energy. Likewise, carbohydrate foods are best eaten when digestion and metabolic activity is decreased, towards the end of the day. This allows these lighter fuels to be burned at a slower metabolic rate, avoiding the peak and valley effect when carbohydrates are rapidly digested.

For vegetarians, fatty foods such as eggs and dairy should be introduced back into the diet. For example, fresh yogurt with a little honey can be taken in the morning on an empty stomach, or a cup of hot milk before bed. Unripened cheeses such as panir, cottage cheese, and feta cheese can also be introduced back into the diet, eaten with meals. In order to avoid inflammation, dairy products should come from A2 milk (e.g. Desi, or “Indian” cow), but if this is not available, goat, sheep, or water buffalo dairy can be used instead.

For non-vegetarians, prepare most or all of your meat by stewing, braising, or poaching methods. Grilling, roasting and baking, which cooks meat by drying it out, also makes it harder to digest by damaging both fats and proteins, resulting in the production of cancer-causing heterocyclic amines, lipotoxins, and glycotoxins.

To maintain proper digestion avoid eating raw and cold foods such as salads and ice water. Digestion requires a significant expenditure of energy, and raw foods require more energy for digestion, and many of these foods contain components that are inherently indigestible or even toxic. Physically cold foods such as ice cream, cold smoothies, and ice water serve to shock the digestive tract, forcing blood and circulation away from the epithelial surface, inhibiting chemical digestion and nutrient absorption.

Understanding all these factors, try to avoid extremes, listen to your body, and work towards maintaining a diet that is built upon this model of a graduated approach. Even with the best of diets, the reality of our constantly changing world means that digestion is affected regardless. Stress, infection, climate, and aging are only a few of the factors that affect digestive health, and are sometimes unavoidable. What the graduated diet provides for is a model of eating that allows you to adapt to the natural waxing and waning that happens with any fire, both resetting and fine-tuning your digestive fire whenever its required.

What is Paleo-Ayurveda?

What is Paleo-Ayurveda?

Several weeks ago I was asked to do an interview on the subject of the “Paleo-Ayurveda” diet. I guess as one of the few in the Āyurveda community that utilizes the Paleolithic diet as a therapeutic tool, and also as someone who is outspoken on the issue of vegetarianism, it made sense in the interviewer’s mind to combine these modalities. Unfortunately, due to my busy schedule, I was never able to follow through on the interview, and so I will address my thoughts on this now.

For decades now I have been inspired by the teachings of Āyurveda. As a therapeutic tool there is no modality that speaks to me as clearly, but it is not the only modality that I employ in my practice. My background also includes training in Western and Chinese herbal medicine, as well as clinical nutrition. This diversity is reflected in my practice, in which I make use of a large range of medicines, from hand-made herbal pills (guṭikā and vaṭī) that I import from Nepal, to ethanol-based tinctures and percolations; from Chinese herbal granules, decoctions and syrups, to local, wildcrafted remedies that I make myself. Likewise, I am also trained in physiology, pathology, and clinical nutrition, and weave these elements into my practice as well, as do many of my respected colleagues.

IMG_0329 (1)

Traditional herbal pills from Piyushabarshi Aushadhalaya, Nepal

While I do utilize Āyurveda as my primary modality, it may seem at first glance that I practice a kind of eclectic, syncretic approach to medicine. In all my studies and areas of research, however, I have made sure to understand each modality on its merits, and in its own context. I have thus avoided mixing and matching modalities, conflating a concept understood in one system, with a concept that forms the basis of another. Too often I see practitioners with only a smattering of training in one system, hook their newfound knowledge up to another modality they only partly understand, to create a syncretic approach that is often quite thin in substance. There is a long history of this in the West, for example, when ancient concepts such as yoga and the chakras were adopted by New Age enthusiasts, but without the benefit of really understanding the context or practice. A book such as the Energetics of Western Herbs is a good example of this, which isn’t rooted in any particular tradition, and lacks the necessary empiricism to make the text all that useful.

When I graduated from herb college all those years ago, the prevailing bias within my training was that a vegetarian diet was the best diet. It probably didn’t help that the dean of the college was an avowed vegan, but truth be told, there has long been a strong bias within the natural healing community that a vegetarian diet is better for you. Fortified with this bias, when I began to practice 20 years ago, I dutifully recommended to all my patients that they become vegetarian. And I continued this for at least a couple years, until it became very clear that a vegetarian diet wasn’t helping a large number of my patients, and in some cases – particularly for metabolic and autoimmune disease – was actually making them worse.

At this point, I began to investigate other dietary modalities to resolve the problems I was encountering. Being a vegetarian myself, and also seeing issues in my own health, I began to ask myself “what exactly am I supposed to eat”? The most logical place for me to start was an inquiry into the original human diet, and thus I embarked on a nutritional-anthropological journey that led to my discovery of a significant amount of research on what is proverbially called the “stone-age” or “paleolithic” diet.

Paleolithic cave paintings from Bhimbetka, Madhya Pradesh, India (c. 28,000 BCE)

In short, the Paleolithic diet reflects the original diet of our ancestors, before the first humans began to become dependent on agriculture some 9000 years ago. Scouring the literature, I came across clear evidence showing that the incidence and prevalence of chronic disease in agrarian populations was dramatically higher than in those few remaining groups that maintained this ancient diet. Bolstered by this research, I began to suggest to my patients that they cut out all agricultural staples, including cereal grains, legumes, and dairy products, as well as the “usual suspects” that characterize the Standard American Diet (SAD), such as refined sugar, fats, and salt.

Within 6-8 weeks I would uniformly note clinical improvement in patients suffering from metabolic issues including obesity and diabetes, as well as autoimmune disease such as ankylosing spondylitis and rheumatoid arthritis. Patients with cardiovascular problems, such as hypertension and hyperlipidemia, would also note that their condition tended to normalize and disappear within three months. I recall the case of one patient, who not only suffered from hypertension and hyperlipidemia, but had been recently diagnosed with glaucoma. Three months of dietary changes and treatment, and these conditions literally disappeared, much to the shock of the ophthalmologist. Of course, because I have always believed in the multi-factoral nature of disease, such changes were also accompanied by lifestyle measures, such as regular exercise (e.g. walking 45-60 min daily), the use of medicinal herbs, and key nutritional supplements. Nonetheless, without the dietary changes, as my previous experience demonstrates, sustainable therapeutic changes might not have been achieved.

I have been employing the Paleolithic diet in my clinical practice now since 1998, and have found it to be exceptionally useful in many cases. I have also followed this diet on a personal basis to one degree or another for most of this time since, and have also noted dramatic differences in my health when I do. Empirically, and on the basis of anthropological and medical research, I think that this diet makes a very strong case for itself, and it has been gratifying to see that more and more people are finding the same success in restoring their health, as I myself have experienced.

What has been less than gratifying is to see is the Paleolithic diet becoming a kind of fad, which like the Atkins diet or raw food veganism, is employed with very little understanding or experience. Partly this is because the Paleolithic diet challenges the dietary assumptions of the last 75 years within medicine, and thus vested interests cast aspersions upon it, leading to ignorance and confusion. But the primary issue, for me, have been the green-horned enthusiasts that have literally made a business out of the Paleolithic diet. Thus advocates with perhaps a better grasp of marketing than science, including celebrity chefs, have mis-framed and mischaracterized the benefits of the diet. The response has been increasing skepticism and acceptance of the Paleolithic diet within the mainstream, such that it now seems – like all passing fads – destined to fade away into the oblivion of history. But hopefully I speak too soon…

bansky_caveman

Oh well, back to the tried and true…?

Perhaps, tongue-in-cheek, I am envious that I didn’t cash in on the Paleolithic band-wagon. After all, I was using the diet some ten years before it began to become popular. But quite honestly, it never occurred to me, and I have no regrets. In good faith, I cannot unilaterally support join Team Paleolithic. This is because I know very well that the diet doesn’t work all the time, and that there are some people for whom this diet is not a good idea at all. And the reason I know this, is because I also employ Āyurveda.

According to its proponents, the Paleolithic diet should be good for everyone. After all, it is what we all used to eat, right? But very clearly, as I have seen in my practice, the Paleolithic diet doesn’t work for everyone, and can produce some major problems. But for what seems to be an irreconcilable contradiction among the paleo-proponents, because I also utilize a system like Āyurveda, I can see exactly how the Paleolithic diet causes problems. Stepping out of the paleo-paradigm allows me to see it more clearly, and this is useful: not only because it can inform how to modulate the diet in certain cases, but also because it provides guidance as to when this diet might be contraindicated. In light of this, the term “Paleo-Ayurveda” is a misnomer. It is term that demonstrates its own ignorance, that somehow we could take Āyurveda and blend it with the Paleolithic diet, and arrive at a syncretic system that is better than both. They are entirely distinct and separate considerations that must be understood on their own merits.

When it comes to comparing Āyurveda and the Paleolithic diet, it’s not like either approach is dealing with a fundamentally different object of concern. After all, food is food – no? Thus, there is obviously some overlap between these systems, and there is a way to also explain and harness the benefits of the Paleolithic diet within the context on Āyurveda. With its emphasis on animal fats and proteins, the Paleolithic diet maintains all the qualities of a vāta-reducing diet in Āyurveda. In this way, perhaps it is no surprise that the Paleolithic diet is beneficial in many different diseases characterized by the involvement of vāta, such as neurodegenerative disorders and autoimmune disease. According to the Caraka saṃhitā, almost 60% of the diseases described in Āyurveda involve vāta as the primary etiological agent. Thus, it is easy to see why so many people find therapeutic benefit in this diet.

The problem not typically appreciated by paleo-proponents is that the Paleolithic diet can be very difficult to digest. Knowing this, measures can be taken to make the diet lighter, such as emphasizing soups and stews, rather than grilled, fried, or roasted meat. The amount of fat, meat and animal products too can be reduced, in favor of more vegetables – which by my measure – should account for at least 50-60% of the total volume of food eaten everyday on this diet. Remember: Paleolithic peoples lived all over the globe, in a huge variety of environments, and thus there is a diverse range of foods and practices, and not all of these are based on animal products. The addition too of herbs and spices can also be very helpful to promote good digestion, but sometimes this is not enough.

If we regard what Āyurveda states, while 60% of disease is linked to vāta, the remaining diseases are associated with pitta (inflammation) and kapha (congestion). As such, a vāta-reducing diet would make no sense for these conditions, and because the qualities of the Paleolithic diet directly antagonize pitta and kapha, it can actually make things much worse. This is apart from the fact that the Paleolithic diet is much harder to digest, which can affect anyone who suffers from weak digestion – regardless of the nature of the primary complaint. As anyone trained in Āyurveda knows, the role of digestion is fundamental to health, and improperly digested foods generate a by-product called ama. While this ama isn’t so much a material substance as an effect, it can be clearly identified, with symptoms such as a feeling of heaviness, mucus congestion, swelling, lethargy, and circulatory problems.

The 80 syndromes of vātaCaraka saṃhitā, Sū 20:11

In such cases where āma can be seen, all fatty foods are removed from the diet, and the patient is given the easiest and simplest food to eat. The method to restore digestion and shed āma is called saṃsarjana krama in Āyurveda, also known as the graduated diet. This diet begins with the simplest foods to digest, such as a thin rice soup. Simple carbohydrate foods like rice soup are the easiest foods to assimilate, reflected in the composition of human breast milk, which contains mostly simple sugars that are easily digested by a newborn’s digestive system. Following rice soup are more complex foods, such as kitchari (rice and mung bean soup), and then finally a non-fatty meat broth called māṃsa rasa. At this point, the regimen is complete, and the patient can return to normal foods, slowing increasing the amount fat in the diet until it is being consumed at the optimal level (which is certainly much higher for almost everyone, than the low-fat diet recommendations of modern nutrition).

In summation, there is no such thing as Paleo-Ayurveda: it’s just an annoying marketing term formulated by people that have no idea what they are talking about. A lot of people do benefit from following a Paleolithic diet, and in consideration of the higher levels of fat found in this diet, we can also consider it a vāta-reducing diet. But if you have weak digestion, active inflammatory and congestive conditions, then you might want to approach this diet with some caution, or at the least, under the guidance of an expert.

Let them eat salt!

Let them eat salt!

If you have been keeping abreast of the news lately, you might have come across a news story that highlighted a recent study published in the New England Journal of Medicine (NEJM), which found that salt consumption wasn’t associated with an increase in systolic blood pressure in either men or women, after controlling for factors like age (1). Given that health authorities have been saying for years that salt increases the risk of hypertension, these recent findings are another wrench in works for low-salt proponents.

This is not to say that very high salt consumption is safe. There is good evidence that reducing salt intake from 9-12 g per day, in large part from eating junk food and prepackaged foods, to less than 7 g per day, does promote a significant fall in systolic blood pressure (2). The problem is getting a handle on what exactly this means, particularly when these same changes seem to have no effect on lipid levels, and the risk of dying from cardiovascular disease is at best weakly associated with high salt consumption (15% increase in risk). Once again, as I addressed in an earlier blog, we need to make sure that we don’t confuse our objectives, and remember that hypertension isn’t so much a disease as it is as diagnostic sign. Just because we can alter the findings of one diagnostic sign through various interventions, doesn’t necessarily mean that we have altered the course of the disease. It is really just another example of failing to see the forest for the trees.

Despite these rather unconvincing findings, authorities continue to suggest that we’re consuming too much salt, with the US Food as Drug Administration (FDA) suggesting that we consume less than 2.3 grams per day, and the American Heart Association (AHA) going even further by recommending that we consume no more than 1.5 grams. After all, if eating too much salt is a bad thing, dramatically reducing our consumption must therefore be a good thing – right?

Nope.

In another recent study published by the NEJM (3), researchers compared the health outcomes of patients that followed the very low sodium diet recommended by the FDA and AHA, consuming less than 3 g per day, and found that they had a higher risk of death or cardiovascular than those who consumed more than 7 grams per day:

salt_deaths

Shocked? You shouldn’t be, because it’s not the first time we’ve seen these kind of results. A study published in the Journal of the American Medical Association (JAMA) in 2011 found much the same thing, after following 3,681 people for almost a decade that were eating either a low, moderate, or high salt diet (4). And while researchers again found that excessive salt intake was associated with an increase in systolic high blood pressure, they found that a low-sodium diet was significantly associated with higher mortality from cardiovascular causes:

According to the USDA and Health Canada, the average North American consumes only about 3.4 g of salt on a daily basis, which according to the latest research, suggests that most of us are consuming salt at the low end of the spectrum. Personally, I found these results surprising, especially considering just how much prepared and packaged food we eat, which is notorious for containing the high levels of salt which appeals to our tastebuds, activates our appetite centre, and stimulates impulse purchases. But it seems that even with what is still perceived as relatively high salt consumption, most of us are eating salt within a range that is associated with the least risk. Besides which, we’re talking about very small differences in risk, regardless of how much salt we eat. There are far bigger fish to fry, for example, when we compare the effects of eating too much salt, to the consumption of a high carbohydrate diet, which increases the risk of diabetes by 44% and the risk of CVD by 25% (5).

In Āyurveda, salt is a flavor that is an essential part of the diet, and to help maintain good health. Salt stimulates the appetite, promotes the flow of glandular secretions, and assists with the assimilation and absorption of food. It is described as viṣyañdī, meaning that it promotes tissue secretion, and sūkṣma, because salt opens the channels and promotes the easy passage of the feces, making it helpful in constipation. Salty flavor is hot, heavy and wet in quality, and helps to reduce and balance vāta, the component of the humoral theory in Āyurveda that is most closely associated with function of the nervous system. Sodium accounts for almost half the osmolarity of the extracellular fluid, playing a key role in conducting electrical impulses throughout the body.  With excessive sweating or diarrhea, the loss of sodium and other electrolytes disrupts the function of the nervous system, leading to issues including nausea and vomiting, headache, mental dysfunction, fatigue, irritability, weakness, cramping, seizures, and loss of consciousness. Often people will think to drink water when they’re dehydrated, but without the addition of electrolytes such as sodium, the water will go right through them and the problem will likely get worse. Although medical organizations like to suggest oral rehydration packets loaded with sugar to restore electrolytes, research has shown that a traditional Āyurvedic salted rice soup (e.g. peya) is far more effective (6).

While I am an advocate for consuming salt, like anything, there is a down-side too. Apart from the overt effects of hypernatremia, which is almost impossible to achieve from dietary consumption, the excessive consumption of salt irritates the mucous membranes, and can lead to inflammation. In a similar fashion, excessive salt weakens digestion and promotes congestion, leading to a feeling of heaviness and lethargy. In this way, salt consumption is limited in kapha (congestive) and pitta (inflammatory) conditions in Āyurveda, but even with these contraindications, it is never eliminated entirely.

Perhaps the most important issue to consider when it comes to salt is the source. Most commercial sources of table salt are prepared from pure sodium chloride, to which various ingredients are added, including anti-caking agents (e.g. sodium aluminosilicate), and if the salt has been iodized, the addition of alkalis (e.g. sodium carbonate) and stabilizers (e.g. dextrose, sodium thiosulfate). I don’t recommend this salt for a number of reasons. Apart from the synthetic anti-caking agents and other additives, pure sodium chloride is a highly refined product, as pure NaCl doesn’t exist in nature. Typically derived from either marine sources (e.g. sea salt), or mined from prehistoric salt deposits (e.g. rock salt), natural salts contain a diversity of nutrients including calcium, magnesium and potassium, as well as a host of trace minerals. The net effect is that these natural salts moderate the direct influence of sodium in the body, and because salt craving can often be a sign of a mineral deficiency, helps to address the root cause of nutrient imbalances.

In Āyurveda, there are five basic groups of salt, called the pañca lavaṇa:

• saindhava lavaṇa
• sauvarcala lavaṇa
• viḍa lavaṇa
• sāmudra lavaṇa
• audbhida lavaṇa

Consumed not just as a flavor or condiment, the pañca lavaṇa are viewed as therapeutic agents, used singly or in combination, found in many different formulas used both internally and topically, such as Bhāskaralavaṇa cūrṇa and Saindhavādi taila.

Jamts Davs
Saindhava lavaṇa is considered to be the best among salts, mined for thousands of years at the feet of the Himalayas in the Sindh region of the subcontinent. It is derived from the ancient Tethys Sea that at one time separated the subcontinent from Asia. Also known as pink salt, sendha namak or Himlayan salt, saindhava is a light-colored rock salt with a mild taste and sweetish-salty flavor. Saindhava is stated to alleviate all three doṣāḥ (doshas), enkindle digestion, restore electrolytes, benefit the eyes, reduce burning sensations, and enhance fertility.

Sauvarcala lavaṇa is another type of rock salt mined in the Sindh regions and elsewhere, but contains significantly higher levels of iron sulfide, providing for its blackish-red color and characteristic sulfurous odor. Also known as black salt, kala namak, sonchal or sanchal, sauvarcala is considered best for digestion and to balance vāta.

Viḍa lavaṇa is an artificially-prepared salt, made by boiling the powders of saindhava, Āmalakī, Harītakī and sarjakṣāra (sodium carbonate) in water until it is completely evaporated. Naturally rich in ammonium chloride, viḍa is black in color, and possesses an alkaline, salty flavor. It is used to correct kapha and vāta, reducing heaviness in the chest and promoting good digestion, and the proper excretion of feces and gas. Viḍa lavaṇa is generally not used for dietary purposes.

Sāmudra lavaṇa is unrefined sea salt, prepared by evaporating off the moisture from seawater. It is made all over the world, and is differentiated from refined salt by containing a high density of trace minerals, giving it a greyish, rather than pure white appearance. It has a mildly warming energy, and acts to enhance digestion, reducing vāta and the expulsion of flatus, and is only slightly aggravating to pitta and kapha when consumed in larger amounts.

Audbhida lavaṇa is a type of salt that is collected and purified from the soil by calcination, and is rich in sodium bicarbonate. It has an alkaline taste and action, and is considered to be difficult to digest, greasy in quality, cold in energy and acts to reduce vāta. It is used therapeutically, but is generally not added to food.

My take on E3 Live during pregnancy

My take on E3 Live during pregnancy

Several months ago a patient in her first trimester of pregnancy asked me about a new product called E3Live® BrainON®, and was wondering if this product was safe her to take. Many of her friends were taking it, and she was wondering about a convincing testimonial from an Evita Ramparte on the E3Live® website.

I went through my entire pregnancy drinking E3Live® Enhanced with BrainON, which kept my mind alert, awake and positive. I gave birth to [a] very healthy baby boy. I am breastfeeding, and I believe it is thanks to E3Live® that I have plenty of milk and no post-partum depression. We’re in good spirits and good health. Besides, I have already lost all the weight I gained in pregnancy! As a wellness journalist, I am often asked whether E3 is safe for pregnant and nursing moms. On the bottle, it’s written: ‘Consult your physician.’ Unfortunately, few physicians know about this beautiful gift of Nature. Naturally, they are afraid to recommend something they have not studied.

That’s quite an endorsement, which might allay the concern of any pregnant mom, but it’s also pre-emptive shot-across-the bow against any rational critique of this product. It’s like Ms. Ramparte is telling us that E3Live® BrainON® is something so unique and so different, that science truly cannot understand it’s virtue and benefits, that it lies beyond any kind of logical explanation. But taking a look at the ingredients, I don’t see anything heretofore unknown to science. In fact, I see something rather concerning – especially for my pregnant patient.

According to the website, E3Live® BrainON® is stated on the website to contain “Organic, liquid fresh-frozen AFA algae (Aphanizomenon flos aquae) with BrainON®, an organic AFA extract of Phenylethylamine (PEA).” Let’s examine these two ingredients in detail:

Aphanizomenon flos aquae

The first ingredient, Aphanizomenon flos aquae (AFA), is a blue-green algae or cyanobacteria, that used to be sold under the trade name “Super Blue-Green Algae®” in the early 1990s when I was training as a herbalist. I recall that it was popular among some of the students, and lots of people were talking about it: not surprising given that it was sold as part of an MLM scheme. But I felt wary of this product, just like I did with grapefruit seed extract, which was also becoming popular at the time. Among its most vociferous adherents in my class was a young woman who claimed to have stacks of research papers on SBGA® – unfortunately, she only lasted a few months before having to bow out due to sickness. It was a short time later that we learned of major problems with AFA, as detailed by John M. McPartland (DO) in the Townsend Letter for Doctors:

“A. flos-aquae also produces hepatotoxins and neurotoxins. Some of these are carcinogenic.(6b) Others are acutely lethal. The LD50 of one hepatotoxin, microcystin-LR is a mere 50 µg/kg, compared to cyanide’s LD50 of 10,000 µg/kg.(7) Neurotoxins produced by A. flos-aquae include neosaxitoxin and anatoxin.(8) Anatoxin is a chemical cousin to cocaine. Anatoxins may be the reason why people eating blue-green algae sometimes feel energized. Some people also describe being addicted to blue-green algae. Animals are known to develop a fatal attraction to mats of blue-green algae washed up on shorelines.(9) Anatoxins are neurotoxins and eventually destroy brain cells.(10) And contrary to claims by Cell Tech, toxins have been found in A. flos-aquae coming from Klamath Lake.(6,11,12) Cell Tech reportedly tests their algae for these toxins. But in 1984 batches of blue green algae distributed by Cell Tech were found to be toxic and seized by the FDA.”

While Super Blue-Green Algae® is no longer available, it has been reinvented in products such as E3Live® BrainON®, which uses the same species of cyanobacteria that Dr. McPartland refers to in his article. And while the company that makes it, Klamath Algae Products Inc., claims that it is safe, and has many testimonials to back it up, they don’t publish the actual level of these hepatotoxins and neurotoxins in their product. I contacted the company in April of 2013, and asked them for these details, because I was concerned for my pregnant patient. When I first called, the customer service representative hadn’t any clue what I was asking for, but reassured me that E3Live® BrainON® was a great product. Later, I received an email from an E3Live® rep, who forwarded me first a simple monograph, but when pressed for actual data, sent me a “certificate of analysis”:

CofA_E3Live_2013This “certificate of analysis” isn’t helpful of course, because it is just an example. Again, I wrote E3Live® again for the actual data, but as of yet I have not heard back from the E3Live® rep. As you can see in the analysis they provided, E3Live® states that they test for microcystin, a toxic peptide that is highly toxic to the liver. The regulatory limit for microcystin established by the Oregon Health Division and the Oregon Department of Agriculture is 0.1 micrograms per gram. Microcystin levels above this limit thus represent a risk to the consumer, and the higher the levels, the greater the risk.

Most retail products containing Aphanizomenon flos aquae are sourced from Klamath Lake, in Oregon. Locals to the area are well aware of frequent public health notices, warning recreational users about the danger of algal blooms in Oregon, which is well established to cause a variety of health issues including diarrhea, cramping, vomiting, fainting, numbness, dizziness, tingling and paralysis. Under the current regulations, however, AFA has received an exemption from the Oregon Health Authority:

Aphanizomenon flos-aquae (AFA) is a species of cyanobacteria commonly found in Oregon’s fresh waters. Although some studies have shown this species to produce toxins in other parts of the world, subsequent evaluations of that work show that the species either was or likely was misidentified. For the purpose of issuing public health advisories, AFA is excluded from calculation of combined cell counts of toxigenic species.

While this seems to provide some reassurance, and perhaps reflects the influence of a powerful stakeholder, other research continues to identify problems with products containing AFA. In 2008, the Universität Konstanz in southern Germany found microcystin levels that exceeded the safety level of 1 microgram microcystin per gram in 10 out of 16 samples of AFA sourced from Klamath Lake. In a more recent study in Italy, an analysis of 17 different brands of AFA-containing products were found to be “contaminated by highly variable levels of microcystins (MC-LR and MC-LA congeners), up to 5.2 μg MC-LR equivalents per gram product”. In the WHO’s Guidelines For Drinking-water Quality (3rd ed.) (p. 280), naturally-occuring toxins in Aphanizomenon species include not just peptides like microcystins, but alkaloids such as anatoxin-A, the saxitoxins, and cylindrospermopsin, none of which are listed in the “certificate of analysis” from E3Live®. But it starts to get even worse. Although E3Live® BrainON® is supposedly safe for pregnancy, another study has showed that AFA contains high levels of retinoic acid, a well-established reproductive toxin (teratogen) that promotes birth defects of the nervous system, skeleton, heart, thymus, and urogenital system, in all types of vertebrates, including humans. And even after you remove all these toxins, in study of 259 people using a detoxified extract of Aphanizomenon flos aquae, AFA still caused an allergic reaction in 12% of the population. If you are offering advice to a pregnant woman, does any of this sound safe to you?

Phenylethylamine

The product information for E3Live® BrainON® also states that it contains phenylethylamine (PEA), a monoamine alkaloid that naturally occurs in the brain, acting both as a neuromodulator and neurotransmitter. Similar to amphetamine in action, PEA is synthesized in the brain from the amino acid phenylalanine, and stimulates the release of norepinephrine and dopamine, just like cocaine and methamphetamine. In this way, PEA is a “feel-good” substance when secreted in the brain. In their marketing, the manufacturer claims that E3Live® BrainON® contains a natural-sourced PEA, and on the surface, I didn’t find this too surprising. PEA is found in a variety of plants such as cacao bean, and at one time, was a proposed as a mechanism for the mood-enhancing effects of chocolate. While I searched extensively for published research on the natural occurrence of PEA in Aphanizomenon flos-aquae, the only reference I could find was a patent filed in 2009, and a questionable wikipedia citation. The patent refers to a propriety product trademarked as Phycomin® for which no other information is given, nor can be found anywhere on the internet including PubMed, stating that it is concentrated PEA-extract derived from Aphanizomenon flos-aquae. Interestingly enough, however, this patent doesn’t call for using AFA as a source for PEA, but just pure phenylethylamine itself, which anyone can buy at a bulk nutrition shop for next to nothing compared E3Live® BrainON®.

But what about the phenylethylamine added to E3Live®, as the BrainON® component – does it do what the marketing claims? Does it “promote mood balance and enhanced focus”? Unfortunately, an oral dosage of phenylethylamine has at most a very temporary effect in normal individuals. This is due to the presence of a natural enzyme in the body called monamine oxidase (MAO-B), which rapidly breaks down any oral dose of PEA into it’s constituent components. Research pharmacologist Alexander Shulgin states that PEA taken orally in doses up to 1600 mg has no effect, but sensitive individuals may indeed experience a temporary high. Several years ago, researchers thought that phenylethylamine was responsible for the mood altering effects of chocolate, but this was eventually dismissed. To elicit any kind of sustained effect, PEA must be taken with a MAO inhibitor, such as selegiline, deprenyl or Syrian Rue (Peganum harmala), and when this happens, PEA can become a seriously addictive drug. According to the “certificate of analysis” provided above, E3Live® BrainON® contains 1 g of PEA per 100 g of the product, and thus a typical 2-4 gram daily dose of E3Live® BrainON® only contains 200-400 mg of phenylethylamine. Although the PEA in E3Live® BrainON® will have little to no stimulatory effect in healthy individuals, in those taking taking antidepressants or MAO inhibitors, as well as those suffering from schizo-affective disorders in which MAO may be diminished, it could be that a large dose of E3Live® BrainON® could be strong enough to have serious side-effects and/or cause psychosis. Unfortunately, I don’t see this warning stated anywhere on the E3Live® website.

While PEA may have been added to E3Live® BrainON® to boost the claim that it has cognitive benefits, the “rush” that consumers sometimes experience with this product could be something else altogether. As John M. McPartland noted above in his Townsend Letter article, one of the toxins found in Aphanizomenon flos-aquae not apparently tested for in E3Live® BrainON® is anatoxin, which is structurally similar to cocaine and has similar stimulatory effects upon catecholamine secretion as phenylethylamine. Unlike phenylethylamine, however, anatoxin is directly toxic to neurons, and in high doses causes respiratory failure. Unfortunately, the effect of chronic administration of anatoxin isn’t known. Thus while the PEA issue seems to me to be no more than deception, I cannot in good faith recommend to anyone that they ingest neurotoxins to get a “rush”.

The bottom line

Based on the evidence, I can’t recommend to my pregnant patient that she takes this product, and I would council all pregnant women to avoid it as well – even if we just consider the high retinoic acid content. As well, due to its potential neurotoxic effects, I also suggest that children and the elderly avoid this product as well. While I am open to the idea that AFA, like other algae such as Chlorella, might be beneficial for human consumption, I am worried that the levels of hepatotoxins and neurotoxins might be too high in E3Live® products. The only way to resolve this issue is for E3Live® BrainON® to actively publish their testing data and guarantee the safety of this product for regular human consumption.