Āyurveda, diet, and psychosis

Āyurveda, diet, and psychosis

After my recent post on Vegetarianism and Ayurveda, I received a question from a reader, who was curious about why I said that in Āyurveda, there is scant reference to the preferment of a vegetarian diet as a therapeutic tool, except for the disease of unmāda (psychosis). To explain myself better, I want to provide a little background on the disease to provide some more context.

The term unmāda is derived from the Sanskrit root words ud, meaning ‘upwards’, and mad, which refers to the capacity to ‘excite’ or ‘exhilarate’. According to Āyurveda the life force called prāṇa is received by the body not just through the lungs and digestive system, but also through the top of the head. This prāṇic energy descends downwards to guide the formation and maintenance of our bodies, connecting through our feet to the earth, from a state of etheric potentiality to one of physical manifestation. This energetic flow is symbolized by the downward-pointing triangle, representing the feminine principle. In Āyurveda, this downward moving energy relates to a subset of prāṇa (or vāta) called apāna vāyu, that roots itself in your abdomen after your first breath at birth, to become the ‘mother’ prāṇa, regulating all the other subsets of prāṇa.

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It is the downward-moving flow of apāna vāyu that promotes and regulates human consciousness, and a derivation of this pattern can promote disturbances of the mind. In an earlier post on anxiety I made reference to the idea that this condition is in large part caused by unexpressed creative energy. This creative energy is expressed by apāna vāyu, and a failure to properly release this energy over-excites it, causing it to rise upwards and disturb the heart. Although we like to think of the heart as nothing more than a simple pump, in both Āyurveda and Chinese medicine, as well as many other systems of traditional medicine, the heart is the seat of consciousness. By disturbing the function of the heart, the excitation and upward movement of apāna vāyu results in a disturbance to the manovaha srotas which allow for the expression of consciousness by the brain. By aggravating apāna vāyu, the pathology of anxiety in Āyurveda very much relates to the disorder of unmāda, and can even be a cause of a specific type of psychosis, called śokaja unmāda. While overt cases of schizophrenia are only thought to affect about 1% of the population, the prevalence of anxiety in our society appears to be increasing dramatically.

As a disease, psychosis or schizophrenia is a condition that exists independent of culture, religion, or race, and is found all over the world. The signs and symptoms appear to be equally distributed in both men and women, although the condition often appears earlier in men, usually in the late teens to early twenties, whereas for women the condition typically appears somewhat later, in the twenties to early thirties. There are several biological theories to explain the cause of schizophrenia, most built upon the concept that it is caused by physical abnormalities of the brain, and more specifically, neurochemical defects. This includes the idea that schizophrenia relates to a relative dopamine excess, or from the antagonism of NMDA (N-methyl-D-aspartate) receptors in the brain. While both these theories are conveniently structured so as to support the use of powerful antipsychotic drugs, such as as clozapine (which blocks dopamine) and cycloserine (an NMDA receptor agonist), there are other explanations too.

The single-carbon hypothesis is based on the observation that disturbances of the single-carbon folate pathway can lead to schizophrenic symptoms. This metabolic pathway provides carbon groups for a variety of chemical reactions in the brain, including the synthesis of the amino acid methionine. Several studies have shown that methionine metabolism is impaired in most schizophrenic patients, apparently caused by enzyme deficits in the folate pathway. While the relationship that these feature shave to neuronal transmission is entirely clear, it does support the work of practitioners such as Abram Hoffer who used B-vitamins such as folic acid and vitamin B12, that play a key role in methionine metabolism, to successfully treat schizophrenia. Likewise is there good evidence that deficiencies of other nutrients such as essential fatty acids (EPA/DHA), and vitamin D3 may play a role in psychosis.

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According to Caraka (Ci 9), Suśruta (Utt 62), and Vāgbhaṭa (Utt 6), the cause of unmāda (psychosis) is separated into two basic forms: that which arises innately to the body and mind (nijottha unmāda), and that which arises from external factors (āgantu unmāda). That which is arises from external factors is called devādikṛta unmāda, the term ‘deva’ referring to ‘possession’ by the graha (spirits), each type (e.g. deva graha, gandharva graha, yakṣa graha, etc.) exhibiting peculiar behaviors that allow it to be identified. Treatment for this particular form of unmāda comes under the purview of Bhūtavidyā tantra in Āyurveda, which delineates five separate types of treatments, each of which corresponds to a specific sense, i.e. smell (e.g. incense), taste (e.g. food), sight (e.g. yantra), touch (e.g. massage), and hearing (e.g. mantra). While certainly a foreign concept within modern medicine, this type of therapy has nonetheless been shown to have a powerful influence for what appear to be untreatable mental illnesses. In particular, as hereditary Buddhist priests of the Bajracharya lineage, my colleagues in Nepal have been practicing Bhūtavidyā tantra for 800 years, and have a record of their successes over the centuries.

Among those types of unmāda caused by innate factors (nijottha unmāda), there are five types: three for each doṣa, one for a combination of all three doṣa(s) (called sānnipātika), and one type caused by emotional disturbances (śokaja). There are, however, several factors that generally predispose one to become victim to unmāda. This includes failing to observe a proper dietary and lifestyle regimen, indulgence in alcohol and other inebrients, tāntrika practices, and disrespecting “gods, teachers and brahmins”. Certainly altered circadian patterns is a common finding among schizophrenic patients, as is a failure to obtain proper nutrition. Alcohol addiction and powerful psychoactive substances too can disturb the equanimity of the mind, and can lead to psychosis. Suśruta’s warning against improper tāntrika practices is germane, providing insight into the dynamic of a premature kundalini awakening, recently classified in the DSM IV as a “Religious or Spiritual Problem“. Lastly, while disrespecting “gods, teachers and brahmins” seems to be specific to Hindu culture, I believe that this simply refers to behaviors that are actively antagonistic to commonly held social values, leading separation and ostracization, and the emotional and mental stress that results.

Vātaja unmāda is identified when the patient has an unkempt appearance, speaks harshly, demonstrates breathing problems, is a picky eater, and exhibits symptoms of coldness, emaciation, and painful throbbing of the limbs and joints. The patient can often be seen to be clapping their hands repeatedly, singing, dancing, shouting, and wandering about. Patients suffering from pittaja unmāda complain of visual hallucinations, thirst, perspiration, burning sensations, an increase in appetite, and insomnia. They can be observed to retreat from hot or warm things, preferring the cold, shade, wind and water. Patients suffering from kapha unmāda complain of vomiting, poor appetite, aversion to food, lethargy, poor concentration/comprehension, sleepiness, and a desire for warm things. The sānnipātika type displays aspects of all three doṣa(s).

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Śokaja unmāda relates to emotional disturbances, caused from both within and without, both real and imaginary. As I made the point earlier, this type of unmāda relates to severe emotional stress, such as anxiety. In some cases, unmāda relates to the consumption of certain poisons, called viṣaja unmāda, noted by signs such as redness of the eyes, an alteration in perception, loss of bodily control, bluish discolorations, and a loss of consciousness. While considered a type of psychosis, the line of treatment for viṣaja unmāda concerns the specific use of antitoxin remedies described Agada tantra (agada, ‘antidote’), the branch of Āyurveda that concerns the treatment of poisoning.

The treatment for the various types of unmāda depend upon the etiological agent involved. For vātaja unmāda, the primary treatment is snehapāna, ‘oil-drinking’; and abhyaṅga, ‘massage’, followed by svedana (‘steam therapy’), utilizing gentle laxatives beforehand if the patient is constipated. For kapha and pitta unmāda, a course of panca karma is applied, consisting of snehana (oil massage) and svedana (sudation), followed by vamana (therapeutic vomiting), virecana (purgation), and vasti (therapeutic enema). Additional measures for psychosis include śiro virecana (‘head enema’), anjana (eye sales), avapiḍa nasya (nasal medication), dhūma (medicinal smoking), and rakta mokṣaṇa (blood-letting).

In the treatment of unmāda, Caraka, Suśruta and Vāgbhaṭa also mention the utility of aged ghee, called purāna ghṛta, which is stated to alleviate all three doṣa(s). Important herbal formulas mentioned in these texts include Mahākalyāṇa ghṛta, Lasunādya ghṛta, Brāhmi ghṛta, and Phala ghṛta. Individual herbs used in the treatment of unmāda, both internally and/or as incense, include brāhmī (Bacopa monnieri), hiṅgu (Ferula foetida), jaṭāmāṁsī (Nardostachys grandiflora), haridrā (Curcuma longa), guḍūcī (Tinospora cordifolia), vacā (Acorus calamus, śankhapuṣpi (Evolvulus alsinoides), and jyotiṣmatī (Celastrus paniculatus). Śokaja unmāda, or psychosis caused by emotional stress, is also addressed by reversing or ameliorating the underlying emotional state utilizing a variety psychological, behavioral and spiritual techniques.

With regard to the subject of diet, the instructions given by Caraka, Suśruta or Vāgbhaṭa are rather terse, and somewhat open to interpretation. Suśruta clearly states that a barley gruel prepared with the powder of parched barley grains should given to the patient every third day, but that otherwise, the diet should be palatable and appetizing to the patient. For the treatment of unmāda related to the doṣa(s), the application of the graduated diet is important to restore digestion before the application of panca karma, followed by doṣa-specific dietary regimens. While this isn’t specifically stated, this would logically include some animal products – particularly with regard to the treatment of vāta-type psychosis.

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There remains, however, some confusion in both Caraka and Vāgbhaṭa’s writings, with regard to the consumption of meat in the treatment of psychosis. On the one hand, there is clear reference by Caraka to the utility of meat, specifically following the application of rakta mokṣaṇa (blood-letting). Here Caraka states that after treatment, the patient should reside in wind-free location, and eat ghee and meat until satisfied – no doubt to restore the body after such an invasive treatment. A contradiction seems to arise, however, near the end of the section on unmāda, in which both Caraka and Vāgbhaṭa make the exact same statement:

निवृत्तामिषमद्यो यो हिताशी प्रयतः शुचिः|
निजागन्तुभिरुन्मादैः सत्त्ववान् न स युज्यते||९६||

nivṛttāmiṣamadyo yo hitāśī prayataḥ śuciḥ
nijāgantubhirunmādaiḥ sattvavān na sa yujyate

If you look for an interpretation of this verse, it is most frequently it is understood to mean that:

“A person who abstains from eating meat and drinking alcohol, eating only wholesome food, who is disciplined and pure, with a strong will, does not get afflicted by psychosis.”

One problem here is the word used for ‘meat’ (āmiṣa), which while it certainly can mean ‘flesh’, it also means something that we might ‘lust’ or ‘long’ for. Hence, the connotation here isn’t simply a reference to eating meat, but a ‘lust’ for meat. In this regard, lusting for anything disturbs the equanimity of the mind, and is a causative factor in mental illness. Nonetheless, I am well aware that this is my interpretation, and that others will probably disagree. And so if we stick to the conventional interpretation, then it is here in both Caraka and Vāgbhaṭa, but not in Suśruta, that we have this distinction around the role of meat consumption in unmāda. Hence, this is the source of my reference, in my earlier blog on Vegetarianism and Āyurveda, that there was some discrepancy around the use of meat in the treatment of psychosis.

If we peruse other important classical texts, however, such as the Cakradatta or the Bhaiṣajyaratnāvalī, we find specific recipes that call for the use of meat in the treatment of unmāda. The Cakradatta states the uncooked flesh of the sparrow pounded with milk and sugar is useful in unmāda, as is the use of the herbal formula daśamūla in a meat broth (māṃsa rasa). In the Bhaiṣajyaratnāvalī, the author Bhiṣagratna suggests the cooked flesh of the cuckoo bird restores memory and normal conscious in the patient suffering from unmāda.

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So what are we to make of the suggestions found in Caraka and Vāgbhaṭa that eating meat is a cause of psychosis? Considering that no mention of this is made in Suśruta, which in its current form is the oldest of all these texts, it could be that this verse was simply appended to these texts by later commentators. This type of thing is fairly common in Āyurveda and there are often a few different versions of these classical texts, some of which are still hidden away by family traditions. My Bajracharya colleagues in Nepal, for example, have a vast collection of palm leaf manuscripts, including that of the Caraka saṃhitā, that has never been carefully compared and contrasted to the existing sources.

As you can see, my mind struggles with the suggestion found in Caraka and Vāgbhaṭa, because it is contradictory, and, doesn’t conform to my empirical experience. As I stated previously, schizophrenia seems to exist independent of cultural factors such as diet, and is found in both vegetarian and non-vegetarian populations. Over the years, I have helped a number of people suffering from schizophrenia, and because the pathology most frequently involves the primary citation of vāta, a meat-based diet has almost always seemed helped to ‘ground’ the patient. Among the patients I have worked with, some have also been committed life-long vegetarians, contradicting the interpretation of the verse in question, that those who “abstain from eating meat… do not get afflicted by psychosis”.

As my earlier post indicates, the vitamin B12 deficiency commonly found in vegetarian populations is an important factor for the development of psychotic symptoms. Found in 81% of the Indian population, this deficiency leads to a functional folic acid deficiency, impairing the synthesis of S-adenosyl-methionine (SAMe), causing to widespread neurological damage. This is why among the typical symptoms of a vitamin B12 deficiency, such as diminished energy and pernicious anemia, there are often clear indications of mental changes, including depression, psychosis, and dementia. While a vitamin B12 deficiency is certainly not the only cause of unmāda, it can be easily remedied by following a wholesome, balanced diet. And I think we can all agree that this a prerequisite of both physical and mental health, whether you are vegetarian or not.

Vegetarianism and Ayurveda

Vegetarianism and Ayurveda

In my blog last week, I addressed the mistaken belief held by some in the Āyurveda community that sufficient vitamin B12 can be obtained from plant-based foods. Unfortunately, this misperception is just the tip of the iceberg when it comes to the all-pervading belief both within and without the community of Āyurveda, that it is (primarily) a vegetarian-based system. Considering the decades of knowledge that we have accumulated on the very real issue of vitamin B12 deficiency, the notion that vitamin B12 can be obtained in plant foods is really nothing more than wishful-thinking, typically expressed by those who believe that eating meat is morally wrong. Normally, what someone personally believes isn’t my concern, but when this belief obscures the practice of Āyurveda, denies the basic science, and puts the public health at risk, it is important to speak out.

As painful as it may be for some to hear, the very real truth is that Āyurveda is not, and never was, a vegetarian system. There is nothing in any classical text of Āyurveda, including those of the bṛhat trayī (Caraka, Suśruta, Vāgbhaṭa) or the laghu trayī (Mādhava, Śāraṅgadhara, Bhāvaprakāśa), to suggest otherwise. All of these texts and many others not mentioned fully describe the qualities and properties of a multitude of animal products, including their use in the treatment of disease. With regard to the latter, out of the many diseases and syndromes described by Āyurveda, only for the disease of unmāda (psychosis) is a vegetarian diet sometimes prescribed, but not consistently. Otherwise, for every other disease the practical utility of animal products in the diet is described, such as the frequent recommendation of consuming the meat of desert-dwelling animals, as well as the ubiquitous application of māṃsa rasa (non-fatty meat soup).

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Was Vedic culture vegetarian?

Āyurveda is a śāstra, or a teaching within the Vedic tradition, and it is not vegetarian because the ancient Vedic culture itself was not vegetarian. While this may come as a shock to many, in reality, there is so much evidence against the assertion that ancient Vedic culture was vegetarian that to state otherwise borders on the absurd. In his meticulously referenced tome, The Myth of the Holy Cow, Hindu scholar Dr. DN Jha systematically deconstructs the assertion that Vedic civilization was vegetarian. As the title suggests, the author puts forward evidence that ancient Vedic peoples did not elevate the cow in the same way as modern Hindus, making ample reference to their consumption of beef, which was especially valued as a ritual food by the priestly caste (brahmins). This irony was recently brought to light when the state of Maharashtra banned beef consumption, citing the historical importance of vegetarianism in Hindu society. Unfortunately for supporters of this move, it also brought to uncomfortable attention that many traditional brahmin communities continue to eat meat – including beef – as part of an unbroken lineage of practice that extends back thousand of years. As the great Swami Vivekananda said over a hundred years ago, “You will be surprised to know that according to ancient Hindu rites and rituals, a man cannot be a good Hindu who does not eat beef.”

Restoring the proper context for vegetarianism

Whether or not I am able to convince you that Vedic culture was not vegetarian doesn’t concern me: like any debate concerning a topic so vast, it is easy to cherry-pick one fact over another. Certainly there is evidence of vegetarian practices in the Vedic literature, but these relate to ascetic practices, and not general dietary advice. As a form a self-denial and purification, vegetarianism has long been a component of ascetic practices in ancient India. These practices ranged from meditation and yoga, to more severe methods such as plucking the hairs of the body or walking on hot coals – all as a practice to uproot worldly desire and uncover the penultimate truth. The ancientness of these practices including vegetarianism are attested to in the Rāmāyaṇam  when Lord Rāma leaves the comforts of his palace to follow the path of the brahmacarya, or worldly renunciate:

“I shall live in a solitary forest like a sage for fourteen years, leaving off meat and living with roots, fruits and honey”.

– Ayōdhyā Kanda 2-20-29

The association between vegetarianism and Hindu asceticism is undeniable, but it is not an exclusive relationship, and nor was this association meant to inform the practices of everyday society. In the sacred Hindu law book, called the Manusmṛti, vegetarianism is only mentioned as a technique appropriate to the religious-minded, and not as a general practice. And even though the Manusmṛti was compiled almost 2000 years after the end of the Vedic period in India, there is nothing in it – even at its comparatively late date – to suggest that vegetarianism was a requirement for the average Hindu.

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What about ahimsā?

While vegetarianism serves as a form of self-denial, important for penance or ritual purification (as in the story of Rāma), vegetarian practices are also based on the concept of ahimsā, or non-injury. As a specific form of spiritual practice, ahimsā found its greatest expression in the post-Vedic spiritual traditions of the first millennium BCE, including Jainism and Buddhism. By fully embracing the concept of ahimsā, these new spiritual movements clearly distinguished themselves from the Vedic religion, attracting new followers by critiquing the “decadent” practice of ritual animal slaughter.

Between the two, Jainism took the most radical approach to the problem of ahimsā, which in its highest expression involves the practice of sallekhanā, or starving oneself to death. While most assuredly causing the least amount of harm, sallekhanā as a spiritual goal is typically undertaken by very few people. For the vast majority of Jains, the practice ahimsā as it relates to diet allows for the consumption of dairy (as no apparent harm is caused to the cow by milking), as well as the allowance of the aerial parts of any plant as food – but not the roots (which would kill the plant). In contrast, while the practice of ahimsā is a prerequisite to spiritual advancement, simply eating meat isn’t a violation in Buddhist teachings because meat is not a living thing. Unlike Jainism, which views karma as a subtle material essence that attaches to a permanent soul, Buddhist teachings believe karma to be a function of cause and effect that relates more to intent. Thus, the Buddha would eat meat if it were given to him as part of his alms, but in order to uphold the principle of ahimsā, he would refuse to eat the food if knew beforehand that the animal had been specifically slaughtered on his behalf.

Both Buddhism and Jainism grew during the post-Vedic period, but due to its greater flexibility with regard to diet, as well as the fact that it rejected the caste system maintained by both Hindus and Jains, Buddhism became the dominant religious force in India during the later part of the first millennium. The growing and pervasive influence of Buddhism in India meant that its concepts including that of ahimsā indelibly shaped Indian society and later Hindu beliefs. Inspired by the Buddhist teachings on ahimsā, the Emperor Aśoka established a law of the land in the 3rd century BCE, enshrining the rights of animals, banning animal sacrifice, and promoting environmental stewardship. In this regard Aśoka wasn’t advocating for vegetarianism, but for greater thoughtfulness, care and consideration for all living beings.

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Buddhism exerted its influence in India for almost 1000 years, and its emphasis on ahimsā as a practice had a strong influence on the Hindu revivalist movement that emerged with the decline of Buddhism. In the 7th century a Hindu reformer named Ādi Śaṅkara successfully modeled a new version of Hindu teachings that only slightly varied from Buddhism, adding the concept of an eternal god (brahman), but including the same Buddhist emphasis upon ahimsā. Gradually, this revivalist movement became a syncretic religious movement influenced by regional folk traditions, including the bhakti (devotional) movement of South India, to evolve into the dominant form of Hinduism found today in India – called Vaishnavism.

As the Hindu revival emerged during the early medieval period, India began to suffer the first wave of more than a thousand years of foreign invasion, continuing right up until the British left India in 1947. Some scholars have asserted that the ideal of ahimsā was so pervasive in early medieval Indian society that it left the country vulnerable to invasion. Certainly there was a marked difference between the character of the invading forces, whose God justified all-manner of violence and brutality, to the spiritual principles of Indian society, which valued peace, contemplation, and insight.

While there were many Hindus, including the Marathi warrior Śivaji, that attempted to fend off the invaders, the cultural traditions of India were systemically damaged during this period. Now already in decline, foreign invasion meant for Buddhism its complete eradication from India, as the hoards of Turkish and Arab warriors found little resistance from its monasteries and universities. For Hindus, it meant the destruction of a great deal of their cultural heritage, including religious monuments such as the temple at Ayōdhyā, which marked the traditional birthplace of the Hindu god Rāma.

As a response to foreign invasion, the medieval period understandably marks a period of consolidation within Indian culture, and the crystallization of a Hindu orthodoxy and its beliefs. To maintain its religious distinctiveness, and as a way to distinguish Hindus from the non-vegetarian invaders, vegetarianism was elevated as part of the Hindu cultural identity. This crystallization of Hindu teachings, however, had a dramatic impact upon the understanding and sophistication of Āyurveda. In much the same way that the sophisticated medical knowledge inherited from the Greeks and Romans by the Church underwent decline during the Dark Ages in Europe, the preservation of Āyurveda by the Hindu orthodoxy during the medieval period meant that much of the knowledge became theoretical and academic. Rational practices such as surgery almost completely disappeared from Āyurveda during this time, replaced by superstition, and a greater emphasis upon magic-religious techniques to resolve disease. In this way, the vegetarian diet as a hallmark of Hindu culture was not only associated with morality, but served as a kind of talisman against disease.

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On the subject of sattva, rajas, and tamas

One frequent way used to explain the difference between vegetarianism and non-vegetarianism, as well as the practices that comprise the Hindu orthodoxy from those of the non-Hindu, is to reference the concept of triguṇa.  Individually called sattva, rajas, and tamas, the triguṇa represent three distinct, yet interdependent qualitative states, each representing a difference sphere of experience. The origin of this concept is found in Sāṁkhya, a teaching considered by some scholars to be the most ancient of the Vedas. Although the original teachings of Sāṁkhya have been lost to time, it exists in redacted form as a text called the Sāṁkhya-kārikā (3-5th cent. CE), supplemented with a few references to its teachings in the Bhagavad-gītāSāṁkhya is particularly important to the epistemology of Āyurveda, however, and it is in classical texts such as the Caraka saṃhitā that we find the oldest surviving exposition of its teachings.

According to Sāṁkhya, sattva, rajas and tamas relate to three qualities manifest within an individuated being (called ahaṃkāra). Within this temporal state, sattva, rajas and tamas represent different aspects of individuated experience. According to the Sāṁkhya-kārikāsattva is described as “illuminating”, giving rise to pleasure; rajas is “activating”, giving rise to pain; and tamas is “restraining”, which gives rise to delusion. Collectively, these three qualities represent the entire spectrum of experience.

Derived from the root words sat (eternal truth) and tva (thyself), sattva represents the subjective consciousness, which is only experienced in fullness through deep meditation, when the mind is turned inward and away from the compulsions of rāga (desire) and dviṣ (aversion). This is why sattva is said to give pleasure – not the temporal pleasure that fulfills desire – but rather, the bliss that comes from deep spiritual insight (saccidānanda). In contrast, tamas represents the objective, physical world, which includes our bodies, the food we eat, the earth itself, and all the stars in the universe. In Āyurveda  this includes the five elements, and the three doṣa(s) that emanate from them. Between them lies rajas as the “activator”, the quality that binds sattva to tamas, drawing the illuminated consciousness outwards into the inertia of physical reality.

When the teaching of Sāṁkhya became crystalized within the Hindu orthodoxy, the concept of triguṇa became much more literal. Rather than representing the esoteric concept of the illuminated consciousness, sattva became synonymous with “goodness” and “purity”, representing the religious and spiritual values of orthodox Hinduism. Likewise, rajas became associated with “conflict” and “disturbance”, and tamas with “evil” and “contamination”. In this way, when applied to food, that which is vegetarian is automatically considered to be sattvic, whereas non-vegetarian foods are tamasic, and rajasic foods are those which stimulate the desire for tamasic foods. For example, milk and rice – two staples of Indian vegetarian cuisine – are considered “sattvic”, whereas foods like meat, fish and alcohol are considered “tamasic”. Supposed “rajasic” foods include onion, garlic and chili, which all stimulate the appetite for heavier (i.e. tamasic) foods. While this definition may seem to make sense on the basis of its own internal logic, it only does so if one ignores the original teaching of Sāṁkhya and Āyurveda. According to Caraka, the word “sattva” is synonymous with the mind, and if we accept this definition, it cannot be possible for food also to be a product of sattva.

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Each of us must consume food to nourish our bodies, and thus both food and the body relates to the quality of tamas. It is impossible to say that one food is “sattvic” and another is “tamasic”, when in truth, all foods are tamasic, and are eaten precisely for these tamasic qualities, i.e. to nourish and sustain our tamasic bodies. When a tamasic object such as food is elevated to the quality of sattva, we are practicing a subtle form of spiritual materialism, in which object become confused for subject. Since the medieval period in India, Hindu beliefs and practices have frequently reflected this misapprehension, devolving from the symbolic, sacred meaning of objects and the impression this is meant to convey to the mind, to the elevation of these objects as the embodiment of the spiritual experience itself.

When I have raised these issues before, one frequent argument I am met with is that I must be saying that food has no impact upon consciousness. This conclusion, however, similarly reflects the ignorance of someone that doesn’t fully comprehend the interdependent nature of triguṇa. Just because food and mind are not the same thing, it doesn’t mean that food cannot impact the consciousness – obviously it does –  just as anyone who has perhaps eaten too much chili pepper or horseradish can attest to. But this effect is not a unique property of food, as anything within the realm of tamas can impact the mind. How do you feel on a rainy day – a little depressed and sad perhaps? What if you had an argument with someone – do you feel angry? Or what if you won the lottery? Would it change how you feel? There is no denying that tamasic experiences can and do impact the equilibrium of the mind (sattva), but they do so most powerfully when we confuse subject (i.e. the mind) for object (i.e. physical reality). For example, if someone does something we don’t like, and we get angry, is that person the cause of our anger, and thus responsible for it, or is our anger purely an emanation of our consciousness?

Confusing vegetarianism with spirituality

During the Buddha’s lifetime, he had a follower named Devadatta who wanted to change some of the teachings. Specifically, Devadatta believed that the vegetarianism practiced by other religious sects, such as the Jains, should be incorporated into the Buddhist monastic code. While upholding the principle of ahimsā, the Buddha rejected Devadatta’s request, which eventually resulted in his expulsion from the saṃgha.  The reason the Buddha rejected him is because Devdatta was fundamentally confused, wanting to turn the teaching into a cult of materialism that elevated vegetarianism as a spiritual goal, once again, confusing subject for object. Likewise, throughout the spiritual history of India, the great adepts have rejected spiritual distinctions with regard to diet, including Shirdi Sai Baba, who sought to overcome communal politics by embracing a practical and egalitarian approach to food. Consider as well, what the Sikh holy book, called the Guru Granth Sahib, says on the matter:

“The fools argue about flesh and meat, but they know nothing about meditation and spiritual wisdom. What is called meat, and what is called green vegetables? What leads to sin? It was the habit of the gods to kill the rhinoceros, and make a feast of the burnt offering. Those who renounce meat, and hold their noses when sitting near it, devour men at night. They practice hypocrisy, and make a show before other people, but they do not understand anything about meditation or spiritual wisdom. O Nanak, what can be said to the blind people? They cannot answer, or even understand what is said.”

My intent in writing this post has not been to hurt anyone’s feelings. Vegetarianism is an ethical and moral choice, and despite what conclusions might be drawn from my writing, I have a great deal of respect for this choice. I applaud the efforts of animal rights activists, and am fully behind the effort to deconstruct the industrial food model that treats living creatures as nothing more than commodities. But the choice of vegetarianism is just that – a choice – not an imperative. There is nothing in Hinduism or Āyurveda that mandates vegetarianism, despite the fact that almost all college-trained physicians of Āyurveda recommend a vegetarian diet. To this day, physicians will directly contradict or modify the practices of Āyurveda to promulgate the mistaken belief that a vegetarian diet is “healthier”, or is somehow intrinsically better to achieve mental balance. As we can see with the issue I raised with regard to the problem of vitamin B12 deficiency in vegetarian communities, the all-pervasive belief that vegetarianism is superior diet is a kind hubris imposed onto Āyurveda, limiting its practical utility, and causing irrevocable damage to its integrity.

The issue of vegetarianism in Āyurveda is a metaphorical sacred cow that obfuscates its authentic history and practice, and forces it to become nothing more than a pale replica of itself. The reality is that Āyurveda is for everybody, regardless of diet, faith, gender, age, culture, geography, or climate. According to tradition, the knowledge of Āyurveda is built into the very fabric of matter itself, and in this way, is a part of us all – even if we don’t know it. Āyurveda is a system of knowledge that allows you live in concert with dharma, or the natural rhythm of life, no matter where you live: whether its the lush tropics of south India where being a vegetarian is very easy, or the frigid steppes of Tibet, where being a vegetarian isn’t even a possibility. My hope in addressing this issue is to reopen the dialogue around diet, restoring Āyurveda to its proper state: resplendent in its grounded, earthy wisdom.

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’.