|Year : 2003 | Volume
| Issue : 2 | Page : 57-63
Food allergies--leads from Ayurveda.
D Arora, M Kumar
Universal College of Medical Science, Bhairahawa, Nepal
Universal College of Medical Science, Bhairahawa
Source of Support: None, Conflict of Interest: None
Food allergy being a common health problem needs attention. The experience of Ayurveda can be utilized to accelerate our understanding and management of food allergies and related phenomenon like allergic tension fatigue syndrome, intolerance and indigestion associated with certain foods. Prevention of food allergies by carefully selecting the foods in accordance with the individual's body constitution and seasonal alterations, is considered as the best strategy in Ayurveda. If possible, the concept of prakriti and properties of food as described in Ayurveda, should be interpreted in modern terminology. Moreover, to scientifically validate them, an appropriate correlation with modern concepts is required along with scientific studies on modern parameters. Rasayanas may also prove helpful in the management of food allergies. It is obvious that there, is an urgent need for multidimensional and planned investigations of these Ayurvedic rasayanas in management of food allergies. The clinical acceptability of rasayanas for the treatment of food allergies entirely rests on such studies. Food intolerance and allergies are common health problems which are difficult to diagnose and still more difficult to treat. This problem is well addressed in Ayurveda and guidelines are available for their management. This paper aims to present the Ayurvedic concepts in the management of food intolerance/ allergies and its correlation with the evidences available from modem scientific laboratories. The understanding of this ancient wisdom may prove to be of immense importance in patient care.
Keywords: Food Hypersensitivity, diagnosis,epidemiology,prevention & control,Human, Medicine, Ayurvedic, Prevalence,
|How to cite this article:|
Arora D, Kumar M. Food allergies--leads from Ayurveda. Indian J Med Sci 2003;57:57-63
Food allergy is the term applied to a group of disorders characterized by abnormal or exaggerated immunological response to specific proteins present in the food resulting in a variety of symptoms. This is a very common health problem which is difficult to diagnose and even more difficult to treat. The prevalence of food allergy is the greatest in first few years of life and declines with age. It has been estimated that up to 8% of children younger than 3 years suffer from this problem and it declines with each year of first decade. The prevalence in the adults is reported to be 1.5%. The problem is still more common in adults and children with atopic constitution.
The common food items implicated in food allergy are cow's milk, eggs, chocolates, shellfish, soybean etc. and the problem has a wide range of clinical manifestation of varying severity like gastrointestinal disorders, lip swelling, urticaria, angioedema, eczema, asthma, and anaphylactic shock. The allergic reactions to food can be acute, mediated by IgE antibodies or delayed reactions resulting from non IgE mediated mechanisms. Thus, food allergy appears to have some immunological basis. Food intolerance appears to be similar to food allergy and this involves deficiency of some key enzymes.
Some other problems associated with food are in digestion, allergic tension fatigue syndrome and behavioral problems like hyperactivity in response to dietary substances, however, biological basis of these is not clear. These problems are food specific for a particular individual, i.e. the foods with which intolerance is observed as well as the degree of intolerance, differs from individual to individual. Moreover, the problems faced as a result. also differ amongst the individuals. Thus, these abnormal psychological/ physiological responses of individuals to different foods do not have any immunological or biochemical explanation, at present. Further studies are required for a complete understanding of such food related problems.
| ¤ Ayurvedic concept of food allergy|| |
Food related problems can arise in a normal, healthy person when the dietary intake is not in accordance with the individual's body type, known as prakriti in Ayurveda, climate of the place and seasonal variations. The capacity of digestion is referred to as agni and a deranged agni is another cause of food problems, usually food intolerance leading to chronic disorders. Thus, food related problems can be of acute or chronic nature.,
| ¤ Diagnosing food allergies and allergens|| |
Food allergies are suspected on the basis of presenting symptoms and are confirmed by asking the questions related to the presenting symptoms and the ingestion of food articles. A food article is suspected to be an allergen when symptoms occur after its ingestion, recur on challenge testing and are associated with other well evident features of an allergic reaction, like lip swelling, urticaria, angioedema or anaphylactic shock. It is however: very difficult to single out an allergen as skin prick tests and measurement; of antigenic specific IgE antibody in serum have limited predictive value and double blind placebo controlled food challenges are laborious and not readily available.
So, clinical suspicion and trials of elimination are commonly practiced. Avoidance of certain commonly allergenic food articles is recommended for the first few months by children with any suggestion of atopic constitution.
Similarly in Ayurveda, preliminary diagnosis is made on the basis of presenting symptoms. These along with the non observance of prescribed dietetic codes (ritucharya and dinacharya) arouses a strong suspicion of food intolerance. As laboratory based diagnostic tests are lacking in Ayurveda, diagnosis is confirmed only when the patient improves with the correction of food habits.
| ¤ Management of food allergies|| |
Food allergies are best managed according to the presenting symptoms and prevention is the best strategy for their management. The detection of food allergen itself is the most difficult part of prevention of food allergies. Further, as there are no specific symptoms of food intolernce, the diagnosis of food tolerance and related food problems is difficult to establish. In Ayurveda even the minor ailments related to the digestion are considered very important because if continued for long they are known to cause heart disease, rheumatoid arthritis, renal disorders, pyrexia of unknown origin, epilepsy and several other CNS disorders. The food related problems should be prevented by the regulation of food habits as follows.
(i) Avoiding the foods which cause allergic reactions or intolerance
(ii) Preferentially eating foods in accordance with one's prakriti. In regard to the food related problems special consideration is given to the prakriti of the individual. Prakriti is described as the constitution of the individual which is determined genetically and is influenced by the environmental factors. Thus, biological responses to the food vary with the `prakriti of the person, time, place and season. Depending on the varying combinations of three doshas vata, pitta and kapha, broadly ten classes of prakritis are recognized. viz. predominantly vataj, pittaj, or kaphaj, combinations of two doshas as vatapittaj, vata- kaphaj, pitta-vataj, pittakaphaj, kapha-vataj, kapha-pittaj; (the first dosha being the predominant one) and the combination of all the three doshas. People belonging to a particular prakriti express similar physical, physiological and psychological characteristics and are prone to similar disturbances, including food related problems. Response of the individuals to foods and therefore, the suitability of dietary substances varies in different prakritis. Selection and avoidance of food. substances with due consideration to prakriti helps in maintaining good health and prevention of diseases, particularly the problems of food intolerance and allergies, e.g. fats like ghee and butter and sweets, as they can normalize vata dosha, are more suitable for vatic types, whereas. kaphaj individuals should better avoid fats and sweets, as they can vitiate kapha dosha. Not only the type of food but also the manner in which food is consumed variably affects the doshas. Thus, cold milk is a better option for the vatic individuals and lukewarm milk should be preferred by the kaphaj ones.
The individuals with single doshik type are most prone to diseases as a result of irregular food habits. These, however, respond best to the normalization of dietary habits. The individuals with dual doshik type, particularly the ones which combine the opposite doshas i.e., vata and kapha (vata-kaphaj and kapha-vataj type), are the most difficult to manage. Food tolerance in such body type is affected by the interacting environmental variables. Thus, alteration of food habits in such individuals can result in variable and unpredictable response.,
(iii) Seasonal variations also demand alterations of food habits. The biological responses of the body vary with season and time of the day. In Ayurveda, these variations in biological responses are explained on the basis of alterations in relative proportions of different doshas in response to climatic and geographical variations. Thus, the suitability of an individual to a particular food- item maybe influenced by changes in climate and time of the day and thus, for perfect health, diet should be adjusted according to seasonal changes. The human biological systems have their own rhythm and the research to understand biological rhythms is going on. In Ayurveda, the concept of chronobiology and chronotherapy is well developed. All physiological and pathological phenomena are explained in terms of balance of doshas which is also influenced by the diurnal cycle and climate of the place. This doshik biological clock may be regulated through ritucarya which is explained as dietary and behavioral adjustments according to the seasonal changes. These adjustments aim at health maintenance in all the seasons by maintaining doshik equilibrium by diet, balanced as per seasonal variations. The basis for seasonal adjustments is that the change of seasons leads to an aggravation of different doshas and thus, there are chances of ill-health during the change of seasons. Therefore, anticipating the doshic alterations with seasonal changes, the individuals should try to maintain doshas to normal levels by appropriate dietary adjustments, thereby, preventing diseases. Ritucharya is also useful in bringing back the aggravated doshas to the normal levels by suitable dietary changes. The dietary substances are chosen on the basis of complementarity, i.e. foods with properties similar to aggravated dosas are avoided while choosing the contrary and vice-versa. Thus, problems related to food are minimized e4hen diet is taken in accordance and adjusted as per the prakriti of individual and season.
(iv) Combining the foods to improve tolerance. Diet should be made wholesome by appropriate combination of different foods. A particular dietary item can be made more suitable for an individual by combining it with other food articles, e.g. curd should generally be avoided at night, however, one desirous of eating curd at night can take it with ghee and sugar (C.Su 7/61-62)*. For an individual suffering from habitual constipation, curd with sugar is more useful. On the other hand, salted curd should be preferred by the one suffering from diarrhea.
(v) Combining the foods to reduce intolerance. The suitability of the food is further improved by appropriate processing. Processing can be very simple like heating. churning, steeping and infusing and various properties are imparted to the food by these processes. Food's characteristics can also be modified by keeping for a long duration or in contact with specific utensils and water. Even a simple change of temperature can significantly alter the properties, e.g. lukewarm water improves digestion (by improving the regional blood flow as a result of vasodilatation) and is therefore, useful in fevers, on the other hand, cold water slows down the process of digestion.
(vi) Slowly adapting to the unsuitable food. Food is also made by oaksatmaya. Oaksatmaya is adjustment to a particular diet/ behavior by practice (C.Su 6/49-50). This is the practice of introducing foods which are not suitable and may contain antigenic substances, in small amounts and/or at large intervals, so that these gradually become acceptable. This appears to be similar to the present concept of desensitization.
vii. Adapting with the help of herbs. There are several herbs classified as rasayana, which are traditionally used m the prevention as well as the treatment of allergic disorders including food allergies. These like Bacopa monnieri, Ocimum strncturn, Withania, somnifera, Emblicu ooficinals, Asparagus racemosus are routinely administered to the babies as well as the pregnant and lactating mothers in order to optimize the baby's immune system. The immunomodulator effects of rasayana herbs are being proved in several clinical and experimental studies. However, we still lack well planned studies demonstrating the utility of these drugs in the management of food related problems.
| ¤ INTEGRATING AYURVEDIC KNOWLEDGE IN THE MANAGEMENT OF FOOD ALLERGIES.|| |
Ayurvedic information on food related problems can be well utilized in the management of food allergies. Like most of the other diseases, food intolerance and allergies are easier to prevent than treat. As is clear from the above discussion, this is where Ayurveda can play an important role. First of all, a rational selection and avoidance of food substances with due consideration to prakriti is desirable to avoid the problems of food intolerance and allergies and in maintaining good health. Other factors required to make the food wholesome and suitable are the properties of dietary items, their nutritional values, characteristics of the place, time and season as well as the liking and disliking of the consumer along with his cultural values.
Further, in patients who are already suffering from food intolerance, an appropriate diagnosis should be followed by the identification of the culprit food. As discussed above, the identification of allergen is difficult and it is further difficult to identify the foods causing milder, undefined problems like food intolerance, allergic tension fatigue syndrome with the available technology. At this stage, the experience of Ayurveda can be best incorporated and with the help of a qualified Ayurvedic physician, preferred and restricted foods. (in different seasons, according to the prakriti of the individual) can be listed. Thereafter, a nutritionally balanced diet chart should be prepared out of the preferred food items. One by one inclusion of the restricted foods may further help in pin pointing the antigenic foods. However, it has been found that an inappropriate application of Ayurvedic principles may result in non selective restriction of various food substances, thereby depriving the person of several essential nutrients, this becomes particularly significant in case of a growing child. Such malpractice in the name of Ayurveda compromise the chi;d's nutrition and raise doubts about the validity of Ayurvedic therapeutics. Therefore, it is very important to work out appropriate diet charts on the basis of available information on calorie and nutritional values of foods in terms of protein, carbohydrates and fats. The rational integration of the two systems of medicine can be well exemplified by a diet chart based on the suitability of foods according to the Ayurvedic principles and nutritional values as per information available in modern medicine. For example, as per modern medicine, all the pulses are a rich source of protein with the calorie value of approximately 350 Kcal/ 100 gm. However, as shown in [Table - 1], they have different effects on various doshas. An individual can therefore, include the pulses suitable to his prakriti without compromising with the nutritional value. Similarly, all fats have calorie value of 9 Kcal/ gm. The individuals with vataj and pittaj prakriti should prefer ghee, as it pacifies vata and pitta, whereas, persons with kapaj prakriti (who are usually overweight) should ideally avoid fats and if at all fats are to be included, should prefer oil. Now we know that as they are rich in unsaturated fats, should be preferred over ghee in obese, who usually suffer from hyperlipidaemias, how ghee or saturated fats benefit other prakritis or why different pulses differently affect doshas remains to be explained in modern scientific terminology. The available information can, however, be utilised in the dietary management of diseases. Further, the judicial use of rasayana herbs may also help in better adaptation of the body, thereby, preventing the manifestations of food related problems. However, there is an urgent need for multidimensional and planned investigations of these Ayurvedic rasayanas in management of food allergies. The clinical acceptability of rasayanas for the treatment of food allergies, particularly in neonates and infants and pregnant and lactating mothers entirely rests on such studies.
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[Table - 1]