Mood and Food Nutritional Psychiatry Meets Ayurveda By Penelope Diamanti

 Acknowledgements

I offer my deepest gratitude to my teachers, my teachers’ teachers
and all the saints, sages, and students, who have preserved
and shared the wisdom of Ayurveda through the ages.
Among my own teachers Rod Stryker introduced me to Ayurveda and 
Drs. Vasant Lad, David Frawley, Robert Svoboda, and John Douillard, 
Maya Tiwari, Light Miller, Claudia Welch, and Jessica Ferrol
helped prepare me through their books and workshops for my
studies at the California College of Ayurveda with
Dr. Mark Halpern and Mary Thompson.
 

Abstract

I review the extent of anxiety and depression, the impact of pharmacological treatments and their side effects, and advances in Western medicine as it gradually comes to the understanding that body and mind are connected and that what we eat does affect mental health.  I identify some ways Ayurveda’s time-tested understanding of the body/mind relationship relative to food can help treat and prevent anxiety and depression. Learning to recognize the differences in constitution (“dosha”) and understanding the different needs of each through Ayurveda can help reduce inconclusive results that occur when doshic differences are not understood in the clinical trial process. Ayurveda’s nutritional guidelines with dosha specific food recommendations could streamline and accelerate research that currently seems to lack focus due to the absence a theoretical/philosophical framework.  Guided by Ayurveda, future research on the interaction between diet and mental emotional/health could advance Western medicine’s understanding in this field, and help people affected by mental illness, while simultaneously  “proving” the truth of Ayurveda through rigorous testing, thus benefitting both disciplines and bringing us closer to a truly integrative approach to mental and physical health and wellness.

Introduction – Scope of the issues

According to the Centers for Disease Control approximately 25% of adults in the United States suffer a mental illness, and nearly half will develop at least one mental illness during their lifetime. The most common mental illnesses in adults are anxiety and mood disorders. 7, 10, 11, 12, 26 Generalized Anxiety Disorder, or GAD is the term used to describe the condition. The NIH explains the symptoms as follows: 

“People with GAD can’t seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They can’t relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes.” 5

The publication gives some typical examples: “I’d feel keyed up and unable to relax. At times it would come and go, and at times it would be constant... There were times I’d wake up wired in the middle of the night. I had trouble concentrating… My heart would race or pound. And that would make me worry more. I was always imagining things were worse than they really were. When I got a stomachache, I’d think it was an ulcer…I was worried all the time about everything. It didn't matter that there were no signs of problems, I just got upset…I couldn't keep my mind focused at work…” 5

The report goes on to state: “…no one knows for sure why some people have it [GAD] while others don't. Researchers have found that several parts of the brain are involved in fear and anxiety. By learning more about fear and anxiety in the brain, scientists may be able to create better treatments.”5

Anyone familiar with Ayurveda immediately recognizes the above symptoms as classic “Vata dosha” imbalance, and that the initial cause is “Vata” vitiating diet and lifestyle. Ayurveda also has a toolbox of foods, herbs, and therapies to help, as will be explained.

Treatment and Side Effects

In western medicine, however, the treatments usually come in the form of pills: anti-anxiety medications or antidepressants. A quick search for current and recent clinical trials related to GAD brought up 471 results, almost all of them drug related.9 This despite the fact that the NIH acknowledges the dangers:  “These medications may cause side effects such as headache, nausea, or difficulty sleeping… they may be risky for some, especially children, teens, and young adults… antidepressants may cause some people to have suicidal thoughts or make suicide attempts. Anyone taking antidepressants should be monitored closely… Long term [more than 4 weeks] use of benzodiazepines [anti-anxiety medications] for GAD should be avoided… Benzodiazepines should be used with extreme caution in the elderly due to the risk for excessive sedation, confusion, and risk for falls and fractures.”5

But the recommended monitoring and limits on use are not happening amid increasing prescriptions for anxiety and depression medicines. Fewer than one-third of Americans taking one antidepressant medication, and less than half of those on multiple antidepressants, have seen a mental health practitioner in the past year, and nearly 10% of people over the age of 12 with no current anti-depressant symptoms continue taking antidepressants.1 Once children and adults are started on these drugs, they frequently continue taking them without supervision, for long periods of time, despite side effects, and even after symptoms have resolved. 

In addition to the dangers alluded to by the NIH report cited above, anti-anxiety and anti-depressant medications (mostly benzodiazepines, selective seratonin reuptake inhibitors and serotonin-norepinepherine reuptake inhibitors) have a variety of additional undesirable side effects including: drowsiness, confusion, dizziness, blurred vision, weakness, lack of coordination, slurred speech, dry mouth, excessive sweating, difficulty urinating, constipation, sexual problems including erectile dysfunction, loss of appetite, and difficulty breathing.15, 26 Aside from the discomfort that may lead users to discontinue taking their medications26, or to seek relief with additional drugs, many of these side effects pose risks for driving, operating equipment, and/or other daily activities. 

Yet, according to the Centers for Disease Control antidepressants are the third most common prescription drug taken by Americans of all ages, and the rate is increasing dramatically. From 1988-1994 through 2005-2008 antidepressant prescriptions in the United States, among all ages, increased nearly 400%.1 

Women take more antidepressants than men1 and are more likely than men to die of overdoses on medicines prescribed for mental health conditions.  Antidepressants and benzodiazepines (including Alprazolam, Diazapam, Lorazapam, Mirtazapine, Xanax, Valium, Versed, Halcion, Ativan, Librium and more) send more women than men to emergency departments, and rates increased fivefold between 1999 and 2010.3 Mental health drugs can be especially dangerous when mixed with prescription painkillers and/or alcohol.2 In 2010 there were nearly a million (943,365) emergency room visits by women for drug overdoses with benzodiazepines ranking right behind cocaine and heroin as the responsible agents. In the same year 15,232 women died of drug overdoses.  According to the CDC “The prominent involvement of psychotherapeutic drugs, such as benzodiazepines, among overdoses provides insight for prevention opportunities.”3

Alternatives – Insights and Invitations from Nutritional Psychiatry

As an increasing number of patients and doctors are starting to look for better solutions, Ayurveda has much to offer. Yoga asana, and meditation, as well as other stress management techniques, along with cognitive behavior therapy have already been proven to help. More recently the connection between food and mood has been getting attention, both in the popular press, and among a segment of the medical community.

A quick search on Amazon for books about “food and mood” turns up more than 30 self-help titles on the subject. On the professional/academic front, The International Society for Nutritional Psychiatry Research (ISNPR) was founded in 2013 to “To support scientifically rigorous research into nutritional approaches to the prevention and treatment of mental disorders and their comorbidities.” Their website (http://www.isnpr.org/) also states: 

“The field of nutritional psychiatry is rapidly developing and involves researchers from around the world from the fields of nutrition, mental health, population health and epidemiology. It is envisaged that this society be open to all whom may have an interest in this field, no matter what their discipline.”

Publications by ISNPR members clearly support what Ayurveda teaches regarding the link between diet and mental health. A 2010 article by Felice Jacka, PhD, et al. in the American Journal of Psychiatry reports that a “dietary pattern characterized by vegetables, fruit, meat, fish, and whole grains was associated with lower odds for major depression or dysthymia and for anxiety disorders. A "western" diet of processed or fried foods, refined grains, sugary products, and beer was associated with a higher GHQ-12 [General Health Question-naire used to measure psychological symptoms] score…These results demonstrate an association between habitual diet quality and the high-prevalence mental disorders…”4

Eva Shelhub, Alan Logan and Alison Bested show a willingness to learn from longstanding traditions in their 2014 paper, “Fermented foods, microbiota, and mental health: ancient practice meets nutritional psychiatry”, in the Journal of Physical Anthropology. The abstract states:  “As our knowledge of the human microbiome increases, including its connection to mental health (for example, anxiety and depression), it is becoming increasingly clear that there are untold connections between our resident microbes and many aspects of physiology…Here, we argue that the consumption of fermented foods may be particularly relevant to the emerging research linking traditional dietary practices and positive mental health.”8

Jacka and other ISNPR members remind us that: “Prevention strategies have made a major contribution to the considerable successes in reductions in cardiovascular disease and cancer mortality seen in recent decades. However, in the field of psychiatry, similar population-level initiatives in the prevention of common mental disorders, depression and anxiety, are noticeably lacking.” They call for public health funding for campaigns to educate people about the mental health benefits of a healthy diet, pointing out that such efforts would save money in the long run. 2, 30, 31, 36, 38, 39

J. Sarris, writing in Lancet Psychiatry unequivocally agrees: “Psychiatry is at an important juncture, with the current pharmacologically focused model having achieved modest benefits in addressing the burden of poor mental health worldwide. Although the determinants of mental health are complex, the emerging and compelling evidence for nutrition as a crucial factor in the high prevalence and incidence of mental disorders suggests that diet is as important to psychiatry as it is to cardiology, endocrinology, and gastroenterology… We advocate recognition of diet and nutrition as central determinants of both physical and mental health.”27 

Snapshots of the Evolution of Western Medicine

It has taken several centuries Western medicine to arrive at the conclusion that diet affects health as Dr. Kulteet Chaudhary explained through a quick history of Western medicine during her 2013 presentation to the National Ayurvedic Medical Association (NAMA) conference in Albuquerque, NM14 

The microscope enabled Antonie van Leeuwenhoek to first observe bacteria and other microorganisms in 1676, but it was not until the 1860 and several cholera epidemics later, that Louis Pasteur was able to convince the at least some members of the medical profession that bacteria cause disease. It took nearly another 20 years before bacteriology and germ theory became widely accepted, but once embraced, they became gospel. Missionaries and colonizers spread “scientific medicine” throughout the world, usually denigrating indigenous healing traditions in the process. In India for example, Ayurveda was largely driven underground during British rule. 

The ability to see inside the body and monitor bodily functions began with x-rays and the electrocardiogram during the First World War and has proceeded steadily so that we can now monitor the activity of the brain in real time with functional MRIs and follow food through the digestive tract with micro-cameras. The age of miracle medicines such as antibacterial sulfa drugs and penicillin arrived in time for the Second World War. Next, the World Health Organization, founded in 1948 as a UN agency to improve global health, pioneered a successful international effort to eradicate infectious diseases with vaccines. Francis Crick and James Watson published their seminal article on the structure of DNA in 1953 and the race to sequence the entire human genome was soon underway. By this time every medical student was inculcated with the dogma that diseases are caused by viruses, bacteria, and that “genetic determinism” condemns anyone with genetic abnormalities to suffer the consequences regardless of diet and lifestyle, which to this day remain almost completely absent from medical school curricula.14, 28

There’s just one problem with this premise: even a casual observer can see that not everyone inheriting a genetic marker, or coming in contact with infectious agents, gets sick. And as the communicable diseases around the world were eliminated it is becoming increasingly clear that most of our contemporary health challenges are caused by diet and lifestyle. Furthermore, coronary artery disease, heart attack, stroke, diabetes and some cancers, which until recently had only plagued high-income countries, are being exported around the world along with our poor diet and lifestyle habits. According to an NIH report on disease control priorities in developing countries: “These striking changes in rates within countries over time and among migrating populations indicate that the primary determinants of these diseases are not genetic, but environmental factors, including diet and lifestyle.” Unfortunately, as Dr. Chaudhary also reported at the NAMA Conference, while the NIH admits that 2/3 of all deaths in the US are due to diseases caused by diet and lifestyle only 0.08% of their $30.9 billion budget is devoted to diet and lifestyle.14

Western medicine seems to find it so much easier and more profitable to work with chemistry and technology, and despite undeniably important advances in these fields, the segregation between body and mind has until recently been rigidly maintained. Dr. Candace Pert, internationally recognized pharmacologist, who was instrumental in starting to break down that wall, summed up the situation on her website (candacepert.com): “Most psychologists treat the mind as disembodied, a phenomenon with little or no connection to the physical body. Conversely most physicians treat the body with no regard to the mind or the emotions. But the body and the mind are not separate, and we cannot treat one without the other.” Pert published over 250 research articles during her tenure at Johns Hopkins, as Chief of Brain Biochemistry, Clinical Research at the National Institutes of Mental Health (NIMH) and as a professor at Georgetown School of Medicine in Washington DC.  Her 1997 book, Molecules of Emotion: The Scientific Basis Behind Mind-Body Medicine brought the “pioneering” work in body/mind medicine to the attention of the general public.  Ayurveda, however, has been well aware of this connection for 5000 years.

Research Connecting Diet and Mental Health

Current research on the relationship between diet and mental health disorders listed with PubMed (www.pubmed.com) reveals a multitude of studies that appear to be tackling the food/mood question quite randomly. One camp looks at individual vitamins, minerals, amino acids and metabolites as well as probiotics, and nutrient categories such as fats for their correlation with mental health or disease. Gluten, dairy and other common allergens are also explored.18, 19, 20, 21, 23, 25,26, 28,  31 

Another group, summarized here by R. S. Opie’s research, prefers the whole foods approach: “Five key dietary recommendations for the prevention of depression emerged from current published evidence. These comprise: a) follow 'traditional' dietary patterns, such as the Mediterranean, Norwegian, or Japanese diet; b) increase consumption of fruits, vegetables, legumes, wholegrain cereals, nuts, and seeds; c) include a high consumption of foods rich in omega-3 polyunsaturated fatty acids; d) replace unhealthy foods with wholesome nutritious foods; e) limit your intake of processed-foods, 'fast' foods, commercial bakery goods, and sweets… It is imperative to remain mindful of any protective effects that are likely to come from the cumulative and synergic effect of nutrients that comprise the whole-diet, rather than from the effects of individual nutrients or single foods.”32 This advice strongly resembles an Ayurvedic textbook, yet Ayurvedic nutritional guidelines, though universally applicable and adaptable, were not included among the healthy diets listed.

Although the Western scientific community is apparently oblivious to the existence of Ayurveda, their research seems to be leading them directly toward this ancient wisdom.  Researchers are, however, sometimes frustrated by inconclusive results and cite the need for more work, while seeming unsure of what to try. Specifically, they seem to lack a theoretical or philosophical framework for their investigations. Also missing is the understanding that different constitutional types are either helped or harmed by different ingredients. Thus, if subjects for clinical trials are recruited without regard to constitution the results inevitably will show benefit for some, and detriment to others, leaving researchers who do not understand the relevant Ayurvedic principles confused.22, 33,  37 

How Can Ayurveda Help?

In his keynote address at the NAMA Conference of 2015 in Long Beach CA, Dr. John Douillard applauded the scientific advances that have finally given Western medicine the tools to validate what Ayurveda has been teaching all along. Epigenetics trumps genetics: diet and lifestyle, not the mere presence of genetic markers, determine whether or not we get sick. Butter, ghee, and other healthy fats are, not just not bad for us, but absolutely necessary for brain health, and Ayurvedic advice to stay in tune with natural rhythms is now starting to be understood in the “new” science of Circadian Medicine. 

Dr. John Douillard: “Ayurveda has finally arrived…What Ayurveda did thousands of years ago is actually pointing the direction for modern researchers to discover Ayurveda…[Modern] Scientists study nature, except they have no rhyme or reason or logic to figure out what they should be studying.  Ayurveda just sits and waits, patiently thousands of years, for modern science to begin to discover and prove the truths of Ayurveda… What is happening in modern science is so exciting. Everything [that Western medicine believed] is being flipped upside down. For 60 years we were told that cholesterol was bad for us… They took saturated fats out of our diets, so what do we crave? Sugar!...Now we have an epidemic of blood sugar issues… People get exhausted, anxious, depressed, when the body’s under this much stress, the body stores fat, carves sugar, we have a culture that’s overweight, can’t stabilize their mood, can’t sleep through the night…”15 He mentions another “new frontier” that modern science is excited about: “Circadian Medicine or Chronobiology” the recent “discoveries” that our physical, mental rhythms repeat through the 24 hours cycle of light and dark and profoundly affecting digestion and metabolism, hormone releases, body temperature, sleep/wake cycles, and much more, with clear implications for the plague of lifestyle disorders we suffer: obesity, diabetes, insomnia, depression, and other mental and physical conditions. Early Ayurvedic texts recognized the importance of staying in tune with the daily (“dinacarya”) and seasonal (“rtu carya”) rhythms.51, 52

Dr. Douillard continues: “…when you have something that’s been tested for thousands of years [Ayurveda] and you have science behind it, that is something that any logical mind would accept…That you can take to the bank. The only problem is that the Western scientists don’t know that they are actually studying Ayurveda.” He issues a call to action: “Our responsibility is to tell them: Hello – that’s an Ayurvedic thing that you are studying! We know these things. What we practice is now [finally] being well documented and it’s time we stand strong and let people know that Ayurveda is a real true science…”15

The ISNPR’s open invitation to help heal and prevent mental disease through nutrition is a good place to start collaborating with Western science in a joint effort to reduce mental and emotional suffering as well as the dangers of drugs currently prescribed to treat these disorders, while at the same time helping everyone achieve better physical as well as mental health. 

Very Basic Overview of Ayurvedic Fundamentals

Ayurvedic diagnostic protocols begin with determining the balance of elements and their qualities in the individual. The Ayurvedic treatment plan is summed up with the admonition that the doctor must understand the [elemental] nature, of the patient, of the disease, and of the proposed cure in order to be able to reverse the condition. 56

Ayurveda recognizes that each individual is unique. One size cure does not fit all. Foods, therapies, medicines, or activities that can help heal one person, or condition, will aggravate another. To distinguish between substance that will aggravate rather than alleviate symptoms, we must start with the most basic components:

Ayurveda recognizes five basic elements, or building blocks, of all matter. These are present, to a greater or lesser degree, in all animate and inanimate objects. The elements are: ether, air, fire, water and earth. These are best understood as states of matter, or as the universal principles inherent in the element. Earth is the solid state and represents the essence of solidity, density, stability, etc. Water is the liquid state, the essence of fluidity, etc.42

Ayurveda endows each of these elements with qualities drawn from 20 pairs of opposites. The dominant qualities of each element are, sorted from densest to most subtle, as follows: Earth is heavy, hard, rough, dense, dry, cold. Water is moist, cold, heavy, flowing, soft and smooth. Fire is hot, dry, light, sharp, subtle, and flowing. Air is cold, dry, light, subtle, flowing, rough and clear. Ether is subtle, dry, light, cold, subtle, clear and flowing.13

Just as Western medicine classifies human body types as endomorphic, mesomorphic or ectomorphic, Ayurveda also classifies individuals as predominantly “Vata dosha” (mostly air and either), “Pitta dosha” (mostly fire with some water) or “Kapha dosha” type (earth and water). 13 The Ayurvedic constitutions, however, describe not only the body, but also the mental/emotional nature of the person. 13 Both body and mind are influenced by the qualities of the elements dominant in a particular person.  Just the chemical compounds in a mineral define its attributes, or as the ingredients flavor - or alter the chemistry of - a recipe, so the elements carry their dominant attributes to the individual. Ayurveda understands each of us to have our own unique proportions of the five elements and all the teachings of Ayurveda are designed to help us maintain this equilibrium.46

The constitutions can be grouped generically into three main types (Vata, Pitta, and Kapha),  that can then be combined to create seven more.13 Here is a snapshot of what each type looks like in a balanced state. 

A brief look at a balanced Vata individual reveals a small or slender person, who is, however, not undernourished. This flexible person moves fluidly and gracefully.  Their bones, face, fingers and feet tend to be long and narrow.  Vata eyes and other facial features tend to be small, or irregular. Their personality is gregarious and vivacious. They’re full of enthusiasm, creativity, energy, and willingness to try almost anything. A balanced Vata’s mind is clear, alert, intelligent, pursues many interests, and communicates effectively.13,57

Balanced Pitta individuals have a moderate physique, as well as strong digestion, good vision, and ruddy complexions. They tend to have angular faces and penetrating deep-set eyes. Temperamentally balanced Pittas show intelligence, insight, courage, discipline and wisdom. They lead effectively with determination, decision-making and organizational skills backed up by clear, persuasive communication.  They hold strong beliefs, but remain open to new information, often profiting from ideas Vatas can’t manifest due to lack of focus.13,57

A balanced Kapha constitution presents a more stocky endomorphic shape with a rounder face and larger eyes, nose, lips and teeth, as well as thick hair. They tend have shorter bones, noticeable in the fingers, and carry more weight – initially muscle, that can turn to fat if they don’t exercise.  Kind, nurturing, calm and stable describe the balanced Kapha personality. Their movements, digestion, speech and thought tend to be slower than the other two types, but the stay the course as responsible and reliable parents, friends, caretakers, managers. 13,57

The next important concept in Auyurveda is that “Like increases like.” This means that as the elemental qualities already present in the constitutional type are increased by the qualities of foods consumed, the environments inhabited, etc., imbalance (always due to excess) develops. By contrast, applying opposite qualities brings relief.13, 47

For example, Vata is dominated by the cold, light, mobile, and dry qualities of ether and air. When predominantly Vata constitution individuals are exposed to cold, dry windy climates and/or eat too much dry, cold, rough food (such as salads, crackers, chips, etc.), these influences become excessive, throwing Vata out of balance.55, 13, 57

When this happens Vatas types typically suffer from conditions of excess dryness such as dry skin and hair, cracking joints, hoarse voices, and dry colons leading to constipation. They may become mentally and physically overly mobile leading to worry, anxiety, overwhelm and exhaustion leading ultimately to a type of depression caused by depletion.54 Along the way a variety of symptoms can manifest, including tics, tremors, insomnia, and/or incessant talking. Vata tendency toward mood swings, indecisiveness and impulsive actions, such as changing jobs, friends, homes, etc. becomes exaggerated. Projects are started, but not finished; focus, productivity, and relationships suffer. 57

When intense Pitta constitutional types get overheated or over-stimulated in hot weather, by competition, or through the consumption of spicy, salty, or oily foods, alcohol, stimulants, or smoking, their fire gets exacerbated. This can explode externally as anger, jealousy, or judgmental criticism, or internally as acid indigestion, loose stools, ulcers, hot rashes, fevers, high blood pressure, or eyestrain, 54, 55 yet they often refuse to slow down. Pitta out-of-balance intensity manifests as workaholism, fanaticism, and obsessions that can damage relationships, careers, and overall health. 57

Too much coolness, moisture, heavy food, and/or sedentary habits can push Kapha constitution out of balance in the direction of lethargy, complacency, obesity, and depression rooted in sentimental attachment to the past. Watery sinus and lung congestion or excess salivation plague out-of-balance Kaphas along with paleness, lassitude, weight gain and edema.54, 55 Stubbornness, attachment and depression characterize Kapha’s mental out-of-balance tendencies. Attachment to friends or relatives can lead to overprotectiveness, possessiveness or subtle manipulation. Attachment to objects can escalate into greed or hoarding, while attachment to ideas that reject change, can keep them stuck and sad.57

From these descriptions it becomes easy to see how disregarding constitutions can hinder research by generating inconclusive results. For example both Vata types and Kapha types might suffer from depression, but Vata type depression is the result of long-term over-activity leading to exhaustion and is best treated with warm, moist, heavy foods and rest. Kapha depression, on the other hand, is the result of too much inactivity, excess sleep, complacency or melancholic longing for the past, and is best treated with a lighter, spicier diet, and exercise. If a mixed group is given one diet, only some of the people will benefit. Sorting the group by constitution and/or imbalance and treating each group with appropriate foods should result in more conclusive results, more anxiety or depression alleviated, and validation of Ayurvedic principles: a win-win-win situation.

Western medicine has long experience conducting rigorous clinical trials and thus the methodologies already exist for incorporating Ayurvedic principles into these efforts. For example body mass index and other biological metrics can be used to help identify Vata, Pitta, or Kapha dominant types. Saliva can be tested for cortisol or other components to identify stress levels after exposure to dietary or environmental stimuli.21 Sequencing of the human genome has even made it possible to study the underlying mechanisms for diet-health relationships, with the hope that “…in the near future dietary advice (and possibly tailored food products) for promoting optimal health could be provided on an individual basis, in relation to genotype and lifestyle.”30

Many of the studies cited in this paper use various standardized questionnaires to define or quantify mental states, for example the State-Trait Anxiety Inventory, Profile of Mood States, Food Frequency Questionnaires, GHQ-12, etc.21, 24 Ayurvedic practitioners and educators have also developed checklists to help determine the state of doshic balance or imbalance for the benefit of those who do not have the expertise to make these determinations based on the pulse.58 Finally, the extensive food lists, time-tested through centuries of experience provide enough dietary options to keep legions graduate students and post docs busy testing hypotheses in clinical trials.58

Unlike the Mediterranean, Norwegian or Japanese diets which rely heavily on foods from a particular region, the exhaustive Ayurvedic food lists61 contain enough ingredients so trails can be conducted anywhere in the world with foods familiar to the inhabitants.58 Researchers no longer have to wonder what foods might mitigate a condition. Ayurveda already knows, but validating the experience in standardized trials is lacking.  The science behind the food lists leads us back to the elements and their connection to taste.58 In the simplest expression of this phenomenon it can be said that sweet, sour and salty tastes pacify Vata dosha; sweet, bitter, and astringent tastes pacify Pitta dosha; and pungent bitter and astringent tastes pacify Kapha dosha.48, 58 But, it must immediately be noted that “sweet” in Ayurveda does not refer to candy and sugar, but rather to such substances as grains, diary, and even meat – substances that are nourishing and build tissue.58 Researchers who are not prepared to delve deeper into Ayurveda should stick with the foods lists when designing experiments.  Ayurvedic texts spend a great deal of time discussing the qualities of various foods their effects on the Vata, Pitta, or Kapha body/mind.53

As the Caraka Samhita, one of Ayurveda’s early texts, points out, food is fundamental: “Of all the factors for the maintenance of positive health [mental and physical] food taken in proper quantity occupies the most important position…”49, 50 Dr. David Frawley explains in his book Ayurvedic Healing: “Wrong diet is the main physical cause of disease. By correcting the diet, we eliminate the fundamental causes of disease [physical and mental]. In its constitutional approach, Ayurveda emphasizes the correct diet for the individual as the basis for health.”17 But this is just the beginning. The science is further refined in many ways, among some of the more important and likely to be of interest to Western researchers are: 

Food preparation matters: for example soups and salads both combine a multitude of healthy vegetable nutrients, but Ayurveda teaches that the warm moist soups and stews are much more beneficial for Vata constitutions, while Pitta constitutions can often tolerate, and Kapha constitutions actually benefit from the colder, rougher, more astringent qualities of salads. Meal timing, eating environment, and habits also factor in.58

Next, the “Gunas” describe an individual’s state of consciousness along the spectrum from “Tamas” (ignorance, darkness) through “Rajas” (movement, disturbance, upheaval) to “Sattva” (peace, clarity, contentment).  Combined with the basic constitutions the gunas can express as follows: A typical Sattvic Vata is enthusiastic, inspired, artistic, possibly a gifted healer. A Rajasic Vata is full of worry, anxiety, insecurity, ungrounded, undecided, and yet hyperactive. Tamasic Vata presents as secretive, paranoid, self-destructive, and/or addicted. Sattvic Pitta is perceptive with traits often seen in spiritual teachers. Rajasic Pitta displays anger, resentment, jealousy or aggression. Tamasic Pitta is vindictive and violent.  Sattvic Kapha is unconditionally loving, faithful, nurturing, patient and compassionate. Rajasic Kapha appears as materialistic, greedy, controlling, stubborn or attached. Tamasic Kapha is lethargic, apathetic, dull, and depressed.59 

These gunas can combine to create recognizable mental/emotional states or disorders. For example, Tamasic Rajas could describe the kind of dark violence in action that leads to mass shootings. Whereas Rajasic Sattva could describe someone like Mahatma Gandhi who through enlightened example, and largely passive action, changed the world. In addition to identifying the foods that pacify individual constitutions, sophisticated Ayurvedic foods lists61 also identify which foods have sattvic, rajasic or tamasic effects so this information could provide additional opportunities for testing in clinical trials.

On an even more refined level Ayurveda recognizes three subtle counterparts of Vata, Pitta, and Kapha dosha. In order these forces that affect the mind and emotions are: “Prana” the subtle version of Vata, “Tejas” the subtle expression of Pitta and “Ojas” the subtle manifestation of Kapha. It may be some time before medical technology can detect or monitor these forces, but carful observation can see their effects in their balanced, excess, or deficient states.60 

Balanced prana gives healthy enthusiasm for life, excess prana presents as overly excitable and distracted, while deficient prana shows loss of enthusiasm and motivation. Healthy tejas enhances clarity, an open mind and ability for unbiased analysis. Excess tejas brings angry criticism and cynicism, while deficient tejas leaves the individual impressionable, lacking the ability to discriminate between truth and deception. Healthy ojas gives good mental stamina and emotional equilibrium, but in excess can result in complacency or apathy. Deficient ojas leads to quick mental fatigue and loss of mental stability.60

Case studies are another way of looking at the effects of various treatments by delving deeper into the evolution of disorders/imbalances and their treatment.29 Ayurvedic case studies routinely document the effects of diet, but also of herbal therapies, lifestyle modifications, oil therapies, other sensory therapies, and much more beyond the scope of this paper. For more on all the aspects of Ayurveda mentioned above, these references are particularly helpful for those serious students or medical professionals:6, 42, 43, 44, 45 

Conclusion

Having developed increasingly refined ways of analyzing the body and its functions, and having now recognized the connection between body and mind, at least some branches of Western medicine seem ready and willing to learn from Ayurveda. As Ayurveda continues to grow in the West, Ayurvedic practitioners are also ready and willing to help guide research, beginning with the important issues in Nutritional Psychiatry. In communities around the country, Ayurvedic practitioners could also participate in the public health outreach programs about healthy diet that psychiatric professionals are calling for to deal with the epidemics of anxiety, depression and the related drug use and abuse. In such joint efforts Western science will benefit from the long experience of Ayurveda, while Ayurveda stands to gain valuable recognition when sufficient rigorous trials document its efficacy.  As lack of such documented evidence has long been used as a reason for excluding Ayurvedic theory and practice from serious consideration by Western medical professionals, collaborating with Nutritional Psychiatry may help open other doors for Ayurveda to help in the many other areas where unhealthy diet and lifestyle cause disease. With its emphasis on relatively low cost and high level of patient contact, education, and involvement in the healing process Ayurveda has much to offer motivated patients, as it becomes a valued partner to overburdened public and private healthcare systems

References

1. L. A. Pratt, D. J. Brody, Q. Gu,  “Antidepressant use in persons aged 12 and over:
United States, 2005–2008.” National Center for Health Statistics Data Brief 76 (2011): 1-8 http://www.ncbi.nlm.nih.gov/pubmed/22617183

2. F. N. Jacka, “Prevention of common mental disorders: what we can learn from those who have gone before and where do we go next?” The Australian and New Zealand Journal of Psychiatry 2013 Oct; 47(10): 920-9 http://www.ncbi.nlm.nih.gov/pubmed/23798717

3. Centers for Disease Control and Prevention, CDC Staff. Overdoses of Prescription Opioid Pain Relievers and Other Drugs Among Women – United States , 1999-2010 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6226a3.htm  

4. Felice N. Jacka et al. “Association of Western and Traditional Diets with Depression and Anxiety in Women” American Journal of Psychiatry Volume 167, Issue 3 (March 2010) :305-311 http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2009.09060881 

5. National Institute of Mental Health, NIH Staff, Generalized Anxiety Disorder (GAD) http://www.nimh.nih.gov/health/topics/generalized-anxiety-disorder-gad/index.shtml 

6. Lad, Vasant, Textbooks of Ayurveda, Volumes 1, 2, and 3. (Albuquerque: Ayurvedic Press, 2002, 2006, 2012)

 7. William C. Reeves, et al “Mental illness surveillance Among Adults in the United States” Morbidity and Mortality Weekly Report, September 2, 2011/60(03);1-32 http://www.cdc.gov/mmwr/preview/mmwrhtml/su6003a1.htm?s_cid=su6003a1_w  

8. Eva M Selhub, Alan C Logan, and Alison C Bested, “Fermented foods, microbiota, and mental health: ancient practice meets nutritional psychiatry” Journal of Physiological Anthropology 33 (2014): 2 http://www.jphysiolanthropol.com/content/pdf/1880-6805-33-2.pdf  

9. National Institutes of Health, NIH Staff, ClinicalTrials.gov Search of GAD https://www.clinicaltrials.gov/ct2/resultsterm=GAD&Search=Search

10.  R. C. Kessler, et al,  “Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication” Archives of General Psychiatry 2005;62:593-602. 

11. R. C. Kessler et al,   “Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication.” Archives of General Psychiatry 2005;62:617--709. 

12. R. C. Kessler et al. “The prevalence and correlates of serious mental illness (SMI) in the National Comorbidity Survey Replication” in Manderscheid RW, Berry JT, eds. Mental health, United States, 2004.  Rockville, MD: Substance Abuse and Mental Health Services Administration; 2006. DHHS Pub no. (SMA)-06-4195.

13. Marc Halpern Principles of Ayurvedic Medicine (Nevada City, CA: California College of Ayurveda 2012) 47-59

14. Keynote address at 2013 NAMA Conference by Kulreet Chaudhary “Modern Ayurveda: The Science of Immortality” http://backcountryrecording.com/collections/nama-2013/products/key-4-modern-ayurveda-the-science-of-immortality-by-kulreet-chaudhary

15. Mayo Clinic, Mayo Clinic Staff, Diseases and Conditions: Depression http://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20044970

16. John Douillard Keynote at NAMA Conference 2015 http://lifespa.com/?s=Nama+keynote

17. David Frawley, Ayurvedic Healing (Twin Lakes, Wisconsin: Lotus Press, 2000) 79

18. C. P. Mueller et al. “Brain membrane lipids in major depression and anxiety disorders” Biochimica et Biophysica Acta 2015 Aug: 1851(8): 1052-65 http://www.ncbi.nlm.nih.gov/pubmed/25542508

19. T. Murphy, G.P. Dias, and S. Thuret, “Effects of diet on brain plasticity in human and animal studies: mind the gap” Neural Plasticity 2014:563160 http://www.ncbi.nlm.nih.gov/pubmed/24900924

20. A. M. Haagensen, et al, “High fat, low carbohydrate diet limit fear and aggression in Göttingen minipigs” Plos One Journal 2014 Apr16:9(4):e93821 http://www.ncbi.nlm.nih.gov/pubmed/24740321

21. N. Jaatinen, et al, “Effects of daily intake of yoghurt enriched with bioactive components on chronic stress responses: a double-blinded randomized controlled trial” International Journal of Food Sciences and Nutrition, 2014 Jun;65(4):507-14 http://www.ncbi.nlm.nih.gov/pubmed/24490888

22. L. F. Marti, “Dietary interventions in children with autism spectrum disorders – an update review of the research evidence” Current Clinical Pharmacology  2014; 9(4):335-49 http://www.ncbi.nlm.nih.gov/pubmed/24050740

23. P. Psaltopoulou, et al, “Mediterranean diet, stroke, cognitive, impairment, and depression: A meta- analysis ” Annals of Neurology 2013 Oct; 74(4):580-91 http://www.ncbi.nlm.nih.gov/pubmed/23720230

Adherence to a Mediterranean diet may contribute to the prevention of a series of brain diseases; this may be of special value given the aging of Western societies.

24. G. E. Crichton, “Mediterranean diet adherence and self-reported psychological functioning in an Australian sample” Appetite 2013 Nov; 70:53-9 http://www.ncbi.nlm.nih.gov/pubmed/23831151

25. S. Akhondzadeh, et al, “Nutrients for treatment and prevention of mental health disorders” The Psychiatric Clinics of North America 2013 Mar; 36(1): 25-36 http://www.ncbi.nlm.nih.gov/pubmed/23538074

26. S. E. Lakhan and K. F. Vieira, “Nutritional therapies for mental disorders” Nutrition Journal 2008 Jan 21; 7:2 http://www.ncbi.nlm.nih.gov/pubmed/18208598

27. J. Sarris, et al, “Nutritional medicine as mainstream in psychiatry” Lancet Psychiatry 2015 Mar; 2(3):271-4 http://www.ncbi.nlm.nih.gov/pubmed/26359904

28. M. Miller, “Diet and Psychological Health” Alternative Therapies in Health and Medicine 1996 Sept; 2(5):40-8 http://www.ncbi.nlm.nih.gov/pubmed/8795935

29. M. Miller, “Diet and psychological health: a case study” Alternative Therapies in Health and Medicine, 1998 Mar; 4(20): 54-8 http://www.ncbi.nlm.nih.gov/pubmed/9682512

30. S. J. Fairweather-Tait, “Human nutrition and food research: opportunities and challenges in the post-genomic era” Philosophical Transactions of the Royal Society of London, Series B, Biological Sciences 2003 Oct 29; 358(1438):1709-27 http://www.ncbi.nlm.nih.gov/pubmed/14561328

31. W. R. Bidlack, “Interrelationships of food, nutrition, diet and health: the National Association of State Universities and Land Grant Colleges White Paper, Journal of the American College of Nutrition. 1996 Oct; 15 (5)) 422-33 http://www.ncbi.nlm.nih.gov/pubmed/8892167

32. R. S. Opie, et al, “Dietary recommendations for the prevention of depression”  Nutritional Neuroscience, 2015 Aug 28 [epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/26317148

33. M. Kingsbury, et al, “Associations between fruit and vegetable consumption and depressive symptoms: evidence from a national Canadian longitudinal study” Journal of Epidemiology and Community Health 2015 Aug 26, pii:jech-2015-205858  http://www.ncbi.nlm.nih.gov/pubmed/26311898

34. A. O’Neil, et al, “Relationship between diet and mental health in children and adolescents: a systematic overview” American Journal of Public Health 2014 Oct:104(10):31-42 http://www.ncbi.nlm.nih.gov/pubmed/25208008

35. A. C. Logan and F. N Jacka, “Nutritional Psychiatry Research: an emerging discipline and its intersection with global urbanization, environmental challenges and the evolutionary mismatch” Journal of Physiological Anthropology 2014 Jul; 33:22 http://www.ncbi.nlm.nih.gov/pubmed/25060574

36. F. N. Jacka, et al, “Food policies for physical and mental health” BMC Psychiatry 2014 May 9; 14:132 http://www.ncbi.nlm.nih.gov/pubmed/24884515

37. S. E. Quirk et al,  “Association between diet quality, dietary patterns and depression in adults: a systematic review” BMC Psychiatry 2013 Jun 27;13:175  http://www.ncbi.nlm.nih.gov/pubmed/23802679

38. A. C. Hayley, et al, “The relationship between excessive daytime sleepiness and depressive and anxiety disorders in women.” The Australian and New Zealand Journal of Psychiatry 2013 Aug: 47(8): 772-8 http://www.ncbi.nlm.nih.gov/pubmed/23677847

39. F. N. Jacka, “Moving toward a population health approach to the primary prevention of common mental disorders” BMC Medicine 2012 Nov 27; 10:149 http://www.ncbi.nlm.nih.gov/pubmed/23186355

40. F. N. Jacka, “A prospective study of diet quality and mental health in adolescents” PLoSOne 2011;6(9):e24805 http://www.ncbi.nlm.nih.gov/pubmed/21957462

41. L. J. Williams et al, “Lifetime psychiatric disorders and body composition: a population based study” Journal of Affective Disorders 2009 Nov; 118(1-3):173-9 http://www.ncbi.nlm.nih.gov/pubmed/19249106

42. David Frawley, Ayurvedic Healing for Health Care Professionals (Nevada City: California College of Ayurveda, 2012)

43. David Frawley Ayurveda and the Mind (Twin Lakes, WI: Lotus Press, 1997) pp 20-22

44. Frank J. Ninivaggi, Ayurveda, A comprehensive guide to traditional Indian medicine for the West (New York: Rowman and Littlefield, 2010)

45. Robert E. Svoboda., Ayurveda: Life, health and longevity (Albuquerque: Ayurvedic Press, 2004)

46. Bhagwan Dash, et al, Caraka Samhita (Varanasi: Chowkhamba Sanskrit Series Office, 2009) Vol. 1, p39 (Ch. 1, verse 53)

47. Baghwan Dash, et al, Caraka Samhita (Varanasi: Chowkhamba Sanskrit Series Office, 2009) Vol. 1, page 43 (Ch. 1, verses 56-61)

48. Bhagwan Dash, et al, Caraka Samhita (Varanasi: Chowkhamba Sanskrit Series Office, 2009) Vol. 1, page 46 (Ch 1, verse 66)

49. Bhagwan Dash, et al, Caraka Samhita (Varanasi: Chowkhamba Sanskrit Series Office, 2009) Vol. 1, page 46 (Ch. 5, verses 1-2)

50. Bhagwan Dash, et al, Caraka Samhita (Varanasi: Chowkhamba Sanskrit Series Office, 2009) Vol. 1, page 130 (Ch. 6, verses 1-2)

51. Murthy, Srikantha K. R. Ashtanga Hridayam (Varanasi: Chowkhamba Krishnadas Academy, 2010. Vol. 1, Ch. 2pages 22-32.

52. Srikantha K. R. Murthy, Ashtanga Hridayam (Varanasi: Chowkhamba Krishnadas Academy, 2010. Vol. 1, Ch. 3, pages 33-44.

53. Srikantha K. R. Murthy, Ashtanga Hridayam (Varanasi: Chowkhamba Krishnadas Academy, 2010. Vol. 1, Ch. 6, pages 74-108.

54. Srikantha K. R. Murthy, Ashtanga Hridayam (Varanasi: Chowkhamba Krishnadas Academy, 2010. Vol. 1, Ch. 11, page 156.

55. Srikantha K. R. Murthy, Ashtanga Hridayam (Varanasi: Chowkhamba Krishnadas Academy, 2010. Vol. 2, Ch. 1, page 8.

56. Marc Halpern, Clinical Ayurvedic Medicine (Nevada City, CA: California College of Ayurveda 2012) xiv

57. Marc Halpern, Principles of Ayurvedic Medicine (Nevada City, CA: California College of Ayuveda 2012) 181-190

58. Ibid 251-275

59. Ibid 191-198

60. Ibid 232-239

61. Vasant Lad, Textbook of Ayurveda, fundamental principles (Albuquerque, NM: The Ayurvedic Press 2002) 294-297