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.

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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.

Ayurveda and vitamin B12

Ayurveda and vitamin B12

This past week I received a newsletter from a notable physician of Ayurveda that frequently travels from his home in India, to share his knowledge of Ayurveda to the world. I have met and worked with this fellow, and respect both his knowledge and experience in the field of Ayurveda. In his newsletter I noticed a post on the subject of vitamin B12, and it caught my eye, because I have long been aware that India has a very high rate of vitamin B12 deficiency.  Much to my disappointment, however, the post was little more than a collection of mistruths about vegetarian sources of vitamin B12, and a diatribe against non-vegetarian practices. Needless to say, I was both disappointed and a little disturbed that a respected physician could write such a biased piece, particularly when trying to promote himself to a global audience. But in truth I am not surprised, because his perspective is all too prevalent among physicians in India these days, who have chosen to forfeit the integrity of Ayurveda in favor of political correctness.

Can Vitamin B12 be found in plants?

In his newsletter, this physician claimed that Vitamin B12 could be easily obtained from plant sources, and cited examples including plant foods such as moringa (drumstick), papaya, barley, walnut, and wheat germ. The assertion that Vitamin B12 can be obtained from plants is one that I have seen made many times over the years, typically spoken by neophyte or otherwise uneducated vegetarians and vegans. The original source of this assertion isn’t important, as it has now become a meme within the vegetarian community. What is more important is to understand that this notion is dead wrong.

moringa As wonderful as it is, Moringa fruit does not contain vitamin B12.

The reason why plants do not contain vitamin B12 is because the ability to synthesize it is only found in bacteria and certain genera within the archaea. Despite its limited production within these microorganisms, vitamin B12 remains an essential nutrient for all animals, and the only way for this vital nutrient to move up and through the food web is if one animal eats another. It may come as a surprise to learn that even ‘vegetarian’ animals such as cows are thus also insectivores, consuming a significant volume of insects with each mouthful of fresh green grass they take. And lucky for the cows, who need vitamin B12 just as much as we do, many insects happen to be a good dietary source (for B12, as well as other nutrients). 

In the human diet, vitamin B12 is only found in any significant quantity within animal foods. For vegetarians, this includes dairy products, as well as eggs (if they eat them), but neither of these foods contain particularly high quantities. This is why it is fundamentally important that these foods remain an important part of vegetarian dietary practices. For example, swiss cheese is among the highest vegetarian sources of vitamin B12 at about 3.3μg per 100 gram serving, whereas something like cooked clams contains almost 100μg per serving. Likewise, other seafoods and organs meats such as liver contain significantly high quantities of vitamin B12, meaning that it is a lot easier to maintain optimal vitamin B12 levels when eating a non-vegetarian diet.

Why is vitamin B12 important?

Vitamin B12 is a crucial nutrient that functions as a cofactor in two important enzymes, one of which is methionine synthase. This enzyme functions to transfer a methyl group from 5-methyltetrahydrofolate (5-THF) to homocysteine, regenerating tetrahydrofolate (THF) and also methionine in the process. THF is one the active forms of folic acid in the body, and plays a key role in many reactions, particularly in the metabolism of amino acids and nucleic acids. Methionine is an essential sulfur-based amino acid that also plays a number of key roles in the body including the synthesis of S-adenosyl-methionine (SAMe), required for the synthesis of the myelin sheath that protects the nervous system. A deficiency of vitamin B12 thus creates a functional folic acid deficiency, and impairs the synthesis of S-adenosyl-methionine (SAMe), leading to widespread neurological damage. A deficiency of vitamin B12 also impairs the regeneration methionine from homocysteine, resulting in the accumulation of homocysteine, which is a significant risk factor in the development of a wide range of diseases, including thrombosis, psychiatric illness, fractures, cardiovascular disease, and kidney disease.

vitaminB12_mom Many infants and new mothers in India are at significant risk of vitamin B12 deficiency.

According to the latest research, upwards of 81% of the urban Indian population suffer from a vitamin B12 deficiency. This deficiency syndrome can range from a gross deficiency causing overt clinical symptoms, to subclinical deficiencies that can look a lot like other diseases. Signs and symptoms of a vitamin B12 deficiency include:

  • diminished energy
  • exercise tolerance and fatigue
  • shortness of breath
  • palpitations
  • pernicious anemia
  • numbness and tingling
  • tinnitus
  • mouth/tongue sores
  • vision problems
  • mental changes: irritability, depression, psychosis, dementia

If you are a vegetarian and have any of these symptoms, even in a mild form, please make sure that you’re taking sufficient amounts of vitamin B12 and folic acid.

Why is vitamin B12 deficiency so prevalent in India?

Whether vegetarian by choice or through poverty, the reason why so many people in India suffer from a vitamin B12 deficiency is because most do not consume a sufficient volume of animal products in their diet on a daily basis. For many Indians, the every day diet consists primarily of a cereal grain such as rice or wheat, eaten with pulses such as chana, mung, urad, and toor. In previous generations, these grains and legumes were processed and only partially refined, leaving on some of the outer hull and thereby increasing the fiber content. In modern India, however, all these cereals and legumes are now for the most part industrially refined and thus stripped of this extra fiber. While this fiber itself does not contain vitamin B12, ensuring that we have adequate fiber in the diet means that we can at least produce a tiny bit from the bacterial synthesis that occurs in our colon. To be sure, feeding the gut bacteria this extra fiber isn’t enough to maintain vitamin B12 levels alone, but when your diet puts you at risk of deficiency, every little bit helps. 

dhenki
The dhenki is traditionally used in Indian villages to partially mill cereals such as rice.

Consuming this extra fiber, however, creates problems that aren’t on the radar of most nutritional experts who recommend a high-fiber diet. All seeds, including grains or legumes, contain a variety of plant toxins that are synthesized by the plant to discourage predation. Some of these ‘toxins’ induce inflammatory or hypersensitivity reactions, whereas others function as anti-nutritient factors, such as protease-inhibitors that impair gastric function. In the case of the latter, impaired gastric function can play havoc with vitamin B12 absorption, which occurs in the upper digestive tract, after it is attached to a glycoprotein called intrinsic factor that is released by the parietal cells found in the gastric mucosa. In traditional Indian cuisine, many grains and cereals were fermented before preparation, such as sourdough roti, or the steamed fermented rice cakes called ‘idli’ that are common in south India. That sad truth of it, however, is that a few generations of Indians raised on refined cereals and legumes means that most people have pretty much forgotten traditional methods of food preparation. In a casual survey of Indian physicians I know, very few fully appreciate just how dramatically the modern Indian diet has been altered from its traditional forebear, with its excess of refined sugar, refined cereals, and refined oils. And unfortunately, even fewer actually know what to do about it.

Sorting through the confusion

I think that as physicians, practitioners and healers, we all have a responsibility to maintain the authenticity of whatever tradition we uphold. Oftentimes this means that we need to leave our personal and religious beliefs at the door. With regard to Ayurveda, it means that we need to fully comprehend the entire scope and practice as described in the ancient shastras, and not apply a partial perspective that ignores the whole. Likewise, this same responsibility applies in order to correctly represent whatever perspective we lay claim to. To be sure, the ancient Indians knew nothing about vitamin B12, but if we follow the classical teaching on diet, which includes both plant and animal foods, we probably don’t even need to consider it. But if we wish to bend Ayurveda to our biased perspective and use science in our defense, it is equally important that we get the science right. 

In my next blog post, I will address the philosophical underpinnings of the assertion that Ayurveda is a vegetarian system, and in particular, the confusion around the terms ‘sattva’, ‘rajas’, and ‘tamas’.