Prakriti (Ayurvedic concept of constitution) and variations in platelet aggregation

A randomized, controlled, comparative, proof-of-concept study to evaluate the efficacy and safety of Nisha-Amalaki capsules in prediabetic patients for preventing progression to diabetes

BACKGROUND

Prediabetes is an intermediate state of hyperglycemia, which acts as a precursor to Diabetes mellitus if left untreated. Nisha (Curcuma longa) and Amalaki (Emblica officinalis) combination has been advocated as drugs of choice to treat the early manifestations of Diabetes mellitus.

OBJECTIVE

This prospective, randomized, single-blind, placebo-controlled, comparative study was planned to assess the efficacy and safety of Nisha-Amalaki capsules in preventing progression to Diabetes mellitus in prediabetic patients when administered for 6 months.

METHODS

The study was conducted on prediabetic participants randomized to receive either Nisha-Amalaki (500 mg) or placebo one capsule twice a day for six months. The effect of study medications on IDRS (Indian Diabetes Risk Score), BMI (Body Mass Index), blood sugar, serum insulin, HOMA-IR (Homeostasis Model Assessment-Estimated Insulin Resistance), HbA1c (glycated hemoglobin), oxidative markers, Ayurvedic symptoms and Quality of Life (QoL) scores was assessed at regular intervals.

RESULTS

58 of the 62 participants enrolled completed the study. Significant fall in IDRS score [p < 0.001], BMI [p < 0.001], fasting, and 2 h post-OGTT sugar, insulin, HbA1c, HOMA-IR, and oxidative stress markers [p < 0.001] was observed in patients receiving Nisha-Amalaki at 6 months. Ayurvedic symptoms and QoL scores also improved at 6 months in the treatment group.

CONCLUSION

Treatment with Nisha-Amalaki capsules improved all study parameters including insulin sensitivity at 6 months as compared to placebo in prediabetic patients. Thus Nisha-Amalaki should be considered as prophylactic therapy in prediabetics to delay progression to diabetes.

A culturally tailored personaliseD nutrition intErvention in South ASIan women at risk of Gestational Diabetes Mellitus (DESI-GDM): a randomised controlled trial protocol

INTRODUCTION

South Asians are more likely to develop gestational diabetes mellitus (GDM) than white Europeans. Diet and lifestyle modifications may prevent GDM and reduce undesirable outcomes in both the mother and offspring. Our study seeks to evaluate the effectiveness and participant acceptability of a culturally tailored, personalised nutrition intervention on the glucose area under the curve (AUC) after a 2-hour 75 g oral glucose tolerance test (OGTT) in pregnant women of South Asian ancestry with GDM risk factors.

METHODS AND ANALYSIS

A total of 190 South Asian pregnant women with at least 2 of the following GDM risk factors-prepregnancy body mass index>23, age>29, poor-quality diet, family history of type 2 diabetes in a first-degree relative or GDM in a previous pregnancy will be enrolled during gestational weeks 12-18, and randomly assigned in a 1:1 ratio to: (1) usual care, plus weekly text messages to encourage walking and paper handouts or (2) a personalised nutrition plan developed and delivered by a culturally congruent dietitian and health coach; and FitBit to track steps. The intervention lasts 6-16 weeks, depending on week of recruitment. The primary outcome is the glucose AUC from a three-sample 75 g OGTT 24-28 weeks' gestation. The secondary outcome is GDM diagnosis, based on Born-in-Bradford criteria (fasting glucose>5.2 mmol/L or 2 hours post load>7.2 mmol/L).

ETHICS AND DISSEMINATION

The study has been approved by the Hamilton Integrated Research Ethics Board (HiREB #10942). Findings will be disseminated among academics and policy-makers through scientific publications along with community-orientated strategies.

TRIAL REGISTRATION NUMBER

NCT03607799.

Using Traditional Typologies to Understand Posture Movement and Cognitive Performance - A cross sectional study

CONTEXT

We employed two classification methods that characterize psycho-somatotype categorization to understand motor and cognitive performance. The Trunk Index produces three somatotypes/body type categories: ectomorphs, mesomorphs, and endomorphs, and Prakriti classifications categorizes people into three categories: Vata, Pitta, and Kapha. Comparing these two categorization methods offers insights into anthropometric measures that combine psychological and physical characteristics to account for motor and cognitive behavior.

AIMS

The present study examined variations in cognitive and motor performances using the two typologies - prakriti and somato body types using cross-sectional study design.

SUBJECTS AND METHODS

The study employed fifty-eight healthy young adults, classified into prakriti (vata, pitta, kapha) and ecto-, meso-, endo-morph body types, to examine their cognitive performance (reaction time [RT] and accuracy), and motor performance (posture stability and posture accuracy) in standing yoga postures.

STATISTICAL ANALYSIS USED

Analysis of covariance was performed to compare the cognitive and postural performance across the three somato and prakriti types after adjusting for age and gender as covariates. Post-hoc analysis of Bonferroni was performed with the consideration of Levene's test. Partial correlations were employed to investigate the correlation between postural stability and cognitive performance measures for each of the prakriti- and somato-body types as well as between the prakriti typology (scores) and trunk index values (adjusting the effects of age and gender as control variables). A P < 0.05 was selected at the statistical significance level. SPSS 26.0 version was used for the analysis.

RESULTS

Cognitive performance was observed to vary in terms of RT across somato- and prakriti body types (P < 0.05). Postural stability and cognitive performance are positively connected only for ectomorph body types (P < 0.05). Variations in motor performance were not significant. Barring ectomorph type, no other somato- and prakriti body types showed significant relationships between postural stability and cognitive performance. Likewise, the association between the features used for prakriti classification, and the trunk index scores showed marginal significance, only for a small subset of physical features of prakriti assessment (P = 0.055) (P1).

CONCLUSIONS

Comparing classifications that use psychophysical attributes might offer insights into understanding variations in measures of motor and cognitive performance in a sample of healthy individuals.

Clinical Prediction of Type 2 Diabetes Mellitus (T2DM) via Anthropometric and Biochemical Variations in Prakriti

Type 2 Diabetes Mellitus (T2DM) is a complicated multifactorial illness involving hereditary and external environmental variables. The symptoms typically appear gradually over a number of years without realizing it. This viewpoint is further supported by the Ayurvedic constitution concept (Prakriti). Prakriti explains the biological variability that is observed in different individuals. This study was conducted a retrospective investigation to examine if there was a link between type 2 diabetes and an individual’s constitution based on anthropometric and biochemical characteristics. Physical and mental characteristics and anthropometric and biochemical markers were used to determine reported cases’ prevailing Dosha Prakriti (constitution). Based on biochemical and anthropometric data, significant differences in Prakriti were found between the case (T2DM patients) and control (person without diabetes) groups. The incidence of numerous secondary problems linked with T2DM patients was also evaluated according to their Prakriti types, which revealed a positive relationship. The three primary contributing parameters, such as waist-hip ratio, postprandial blood sugar, and serum creatinine, were correctly classified all person with or without diabetes subjects to 90.6% of the time, whereas the constitution-wise study classified person with diabetes and without diabetes individuals of Pitta and Kapha Prakriti to 94.3% and 90%, respectively. A discriminant function was created to predict a person with diabetes and without diabetes based on these three contributing factors. The primary contributing biochemical parameters discovered by Prakriti in the current study could be used as a biochemical disease diagnostic for predicting type 2 diabetes susceptibility.

Exploring AyuGenomics approach for understanding COVID-19 predisposition and progression

Recent reports on COVID-19 suggest that, the susceptibility to COVID-19 infection and its progression have a genetic predisposition. Majorly associated genetic variants are found in human leukocyte antigen (HLA), angiotensin convertase enzyme (ACE; rs1799752: ACE2; rs73635825), and transmembrane protease serine 2 (TMPRSS-2; rs12329760) genes. Identifying highly prone population having these variants is imperative for determining COVID-19 therapeutic strategies. Ayurveda (Indian traditional system of medicine) concept of Prakriti holds potential to predict genomic and phenotypic variations. Reported work on Prakriti correlates HLA-DR alleles with three broad phenotypes (Tridosha) described in Ayurveda (AyuGenomics). This is suggestive of differences in immune responses in individuals with specific constitutions. Therefore, the reported studies provide clues for clinically relevant hypotheses to be tested in systematic studies. The proposed approach of Ayurveda-based phenotype screening may offer a way ahead to design customized strategies for management of COVID-19 based on differences in Prakriti, immune response, and drug response. However, this needs clinical evaluation of the relation between Prakriti and genetic or phenotypic variants in COVID-19 prone and resistant populations.

Development of a reliable Dosha self-assessment questionnaire

INTRODUCTION

The Ayurvedic theory of Tri-Dosha offers a unique framework for understanding human differences in health and disease. The Doshas could be readily applied in clinical studies to control for such differences the same way sex, age, height and weight are routinely used except that clinical evaluation is required and methods vary. No open-source questionnaire has been shown to be reliable for self-assessment. Therefore, we undertook this study to develop a reliable Dosha self-assessment questionnaire with characteristics suitable for use in clinical research.

METHODS

A review of published questionnaires and translations of classic Ayurvedic texts along with an analysis of item-total correlations and ANOVAs by Dosha for 735 responses to a 37-item ipsative questionnaire from an Ayurveda products company served as the basis for generating 108 Dosha-specific test items featuring a 7-point Likert scale. We used item-total and inter-item correlations from a convenience sample of 176 individuals to identify the best performing items. We then solicited repeat responses to the resultant 39-item questionnaire (13 for each Dosha) from these and other website visitors and calculated test-retest reliability as the intraclass correlation coefficient for absolute agreement (ICC 2,1) for each Dosha.

RESULTS

The final questionnaire gives normally distributed results. Among 76 self-selected adults, the test-retest reliabilities for Vata, Pitta and Kapha Dosha scores are all above 0.8.

CONCLUSIONS

This study demonstrates that it is possible to quantify the three Doshas with adequate reliability for most clinical studies.

Correlation of body composition parameters and anthropometric somatotypes with Prakriti body types among the Meitei adults of Manipur, India

BACKGROUND

Body composition and types are often considered essential health indicators for lifestyle-related disease. Assessment of body type based on tridosha is regarded as a prerequisite in Ayurveda.

AIM

To correlate body compositions and somatotypes with Prakriti body types.

SUBJECTS AND METHODS

A cross-sectional study on 463 adult individuals was done. Anthropometric and body composition parameters were measured. Heath-Carter somatotypes and Prakriti body types were also determined. Tests of association were calculated. Correlation and concordance analysis was also done to infer the correlation between body composition parameters and Prakriti body types.

RESULTS

Kapha Prakriti have significantly higher body weight, body mass index (BMI), body fat percentage and body fat mass. Vata have the lowest mean values in all body composition parameters with Pitta in the intermediate position compared to the other Prakriti types. There is a strong and positive statistical association between Prakriti body types and body composition parameters, except height. Cohen's Kappa analysis reveals there is a fair concordance between Prakriti body types and somatotype.

CONCLUSIONS

Prakriti assessment can explain an individual's fatness as it correlates with body composition parameters and could be used to predict risk susceptibility to various complex disorders.

Prospective, Randomized, Open-Label, Blinded End Point, Two-Arm, Comparative Clinical Study to Evaluate the Efficacy and Safety of a Fixed Ayurvedic Regimen (FAR) as Add-on to Conventional Treatment in the Management of Mild and Moderate COVID-19 Patients

Background:

The traditional healthcare systems are being avidly looked into in the quest for effective remedies to tackle the menace of COVID-19 pandemic.

Objective:

This was a prospective randomized, controlled open-label, blinded end point (PROBE) study to evaluate the efficacy and safety of a fixed ayurvedic regimen (FAR) as an add-on to conventional treatment/standard of care (SOC) in the management of mild-to-moderate COVID-19 infection.

Methodology:

A total of 68 patients were recruited who consumed either FAR + SOC (n = 35) or SOC only (n = 33) for 28 days. Primary outcomes assessed were mean time required for clinical recovery and proportion of patients showing clinical recovery between the groups. Secondary outcomes assessed included mean time required for testing SARS-CoV-2 negative, change in clinical status on World Health Organization (WHO) ordinal scale, number of days of hospitalization, change in disease progression and requirement of oxygen/intensive care unit admission/ventilator support/rescue medication, health status on WHO quality of life (QOL) BREF and safety on the basis of occurrence of adverse event/serious adverse event (AE/SAE) and changes in laboratory parameters.

Results:

Patients consuming FAR as an add-on SOC showed faster clinical recovery from the day of onset of symptoms by 51.34% (P < 0.05) as compared to SOC group. A higher proportion of patients taking FAR recovered within the first 2 weeks compared to those taking only SOC. It was observed that 5 times more patients recovered within 7 days in FAR group when compared to SOC (P < 0.05) group. An earlier clinical recovery was observed in clinical symptoms such as sore throat, cough, loss of taste and myalgia (P < 0.05). Improvement in postclinical symptoms such as appetite, digestion, stress and anxiety was also obs served to be better with the use of FAR. Requirement of rescue medications such as antipyretics, analgesics and antibiotics was also found to be reduced in the FAR group (P < 0.05). FAR showed a significant improvement in all the assessed domains of QOL. None of the AEs/SAE reported in the study were assessed to be related to the study drugs. Further, FAR did not produce any significant change in the laboratory safety parameters and was assessed to be safe.

Conclusion:

FAR could be an effective and safe add-on ayurvedic regimen to standard of care in the management of mild and moderate COVID-19 patients. CTRI number: CTRI/2020/09/027914.

Ayurgenomics and Modern Medicine

Within the disciplines of modern medicine, P4 medicine is emerging as a new field which focuses on the whole patient. The development of Ayurgenomics could greatly enrich P4 medicine by providing a clear theoretical understanding of the whole patient and a practical application of ancient and modern preventative and therapeutic practices to improve mental and physical health. One of the most difficult challenges today is understanding the ancient concepts of Ayurveda in terms of modern science. To date, a number of researchers have attempted this task, of which one of the most successful outcomes is the creation of the new field of Ayurgenomics. Ayurgenomics integrates concepts in Ayurveda, such as Prakriti, with modern genetics research. It correlates the combination of three doshas, Vata, Pitta and Kapha, with the expression of specific genes and physiological characteristics. It also helps to interpret Ayurveda as an ancient science of epigenetics which assesses the current state of the doshas, and uses specific personalized diet and lifestyle recommendations to improve a patient’s health. This review provides a current update of this emerging field.

Comparative gut microbiome analysis of the Prakriti and Sasang systems reveals functional level similarities in constitutionally similar classes

The traditional medicinal systems (TMS) of India (Prakriti) and Korea (Sasang) classify human individuals based on their constitution determined by the physiological and psychological traits of individuals. Similarities in the constitutions are already found between the classes of Prakriti (Vata, Pitta, and Kapha) and Sasang (TE: Taeeumin, SE: Soeumin, and SY: Soyangin) systems. Gut health is an important aspect of this constitution based classification in TMS. To determine the role of gut microbes in such classifications, we have analyzed the gut microbiome (taxa and imputed functions) in the constitutionally similar Prakriti and Sasang classes. An enrichment of Bacteroides and Prevotella enterotypes is observed in the Sasang and Prakriti samples, respectively. The impact of the constitution is found to be more prominent with respect to the taxa and predicted-functions within the Prakriti classes. Gut microbiome functional-level similarities are found to correlate well with the host phenotypes of the constitutionally similar Prakriti and Sasang classes. An enrichment of carbohydrate and amino-acid metabolism is observed in the Vata and SE classes which may be responsible for meeting with their high energy demands and lean phenotype. The Pitta and SY classes exhibit the high capacity to metabolize toxins. An enrichment of functions responsible for predisposition to obesity and high drug metabolism is observed in the Kapha and TE classes. The contribution of gut adaptive functions is found to correlate with the constitution-based classification in both Prakriti and Sasang systems. The TE class harboured the highest number of biofilm-forming and stress-tolerant microbes thus exhibiting the maximum tolerance of environmental stress. Similarities in the gut microbiota and the resulting disease predisposition patterns are found to exist between the constitutionally matching Prakriti and Sasang classes.

A prospective study to assess the association between genotype, phenotype and Prakriti in individuals on phenytoin monotherapy

Background

Genetic polymorphisms in drug metabolizing enzymes (DMEs) impart distinct drug metabolizing capacity and a unique phenotype to an individual. Phenytoin has large inter-individual variability in metabolism due to polymorphisms in CYP2C9 and CYP2C19. As per Ayurveda, Prakriti imparts a unique phenotype to an individual.

Objective

To assess whether Prakriti can substitute phenotyping [therapeutic drug monitoring (TDM)] and genotyping in individualizing therapy with phenytoin in epilepsy patients.

Methods and materials

This was a cross-sectional study conducted over a period of three years. Prakriti was assessed using standardized and validated software. Polymorphisms in CYP2C9 and CYP2C19 were assessed using Polymerase Chain Reaction (PCR)-Restriction fragment length polymorphism (PCR-RFLP). Plasma concentrations of phenytoin (phenotype) were determined using reverse phase-high performance liquid chromatography (RF-HPLC).

Results

Total 351 patients were enrolled for the study. Kapha vata (KV) (39%) was the predominantly observed Prakriti followed by vata kapha (VK) (20.8%) and vata pitta (VP) (8.83%) among the patients. The CYP2C9 and CYP2C19 genotype distributions were in accordance with Hardy–Weinberg equilibrium. There was no association between Prakriti and genotypes and Prakriti and phenotype (p > 0.05 each). Patients with CYP2C9 *1/*3 genotype were thrice more likely to have toxic plasma concentrations of phenytoin as compared to those with wild-type genotype (*1/*1) (Adjusted odds ratio – 3.36; 95% C.I. 1.61, 7.01). However, no such association was observed between polymorphisms of CYP2C19 and phenotype.

Conclusions

We did not find any association between Prakriti and either phenotype or genotypes suggesting that Prakriti assessment would be of limited utility in individualizing phenytoin therapy in epilepsy patients.

Effect of yoga training on lipid metabolism in industrial workers with reference to body constitution (Prakriti)

INTRODUCTION

The progressive increase in dyslipidemia and physical inactivity are considered to be major risk factors for the onset of non communicable diseases. Awareness of body constitution plays a vital role to regularise optimum health. The present study was planned to evaluate the effect of yoga practices on lipid metabolism with reference to specific body constitution (Prakriti).

METHODS

A self-as-control study was conducted on 36 male healthy volunteers between age group of 30-58 years. Their prakriti analysis was done using standardized, validated questionnaire and were divided into Vata-Pitta (n = 16) and Pitta-Kapha (n = 20) groups. The assessment of lipid profile was done in fasting blood samples before and after 12 weeks of yoga training. Data were analyzed using paired t-test and independent t-test.

RESULTS

After yoga intervention, the result of within group comparison revealed that in Vata-Pitta (V-P) group, significant decrease in the levels of TC, LDL (p < 0.001) and significant increase in HDL (p < 0.01) was observed. While, Pitta-Kapha (P-K) group showed significant decrease in TC (p < 0.001), TG (p < 0.01), LDL (p < 0.001) and VLDL (p < 0.05) levels. Further, the results between groups revealed that P-K group has significantly higher baseline levels of TC, TG and VLDL as compared to V-P group (p < 0.05).

CONCLUSION

The study concludes that yoga practices can effectively regulate lipid metabolism and total body energy expenditure with reference to specific constitutional type (Prakriti) that may act as a tool to assess magnitude of metabolic functions.

Prakriti-based research: Good reporting practices

The recent advances in the fields of genomics, personalized medicine, and Ayurveda have motivated many researchers to look at the relationship between Prakriti (phenotype-based Ayurveda constitution) and various objective biological parameters. As a result, a number of studies reporting such a relationship have made their way into mainstream scholarly journals. However, when it comes to the protocols that these workers follow to identify one's Prakriti, there are several issues that are yet to be resolved. In this communication, we propose a few reporting practices that such workers are required to be encouraged to follow, while submitting their work on Prakriti to scholarly journals. We have arranged this proposal under the following domains that may serve as a preliminary checklist in this context: The textual references, validation process, assessment of characters, scoring pattern, weightage assignment, criterion for expressing the final Prakriti type, and a need to publish the complete Prakriti-determination tool. We advocate that only if the workers in the field adhere to these good reporting practices, one will be able to draw meaningful, generalizable, and applicable interpretations out of such studies. We also suggest that the editors of relevant scholarly journals may recommend these reporting practices while considering such reports for publication.

Dosha brain-types: A neural model of individual differences

This paper explores brain patterns associated with the three categories of regulatory principles of the body, mind, and behavior in Ayurveda, called Vata, Pitta, and Kapha dosha. A growing body of research has reported patterns of blood chemistry, genetic expression, physiological states, and chronic diseases associated with each dosha type. Since metabolic and growth factors are controlled by the nervous system, each dosha type should be associated with patterns of functioning of six major areas of the nervous system: The prefrontal cortex, the reticular activating system, the autonomic nervous system, the enteric nervous system, the limbic system, and the hypothalamus. For instance, the prefrontal cortex, which includes the anterior cingulate, ventral medial, and the dorsal lateral cortices, would exhibit a high range of functioning in the Vata brain-type leading to the possibility of being easily overstimulated. The Vata brain-type performs activity quickly. Learns quickly and forgets quickly. Their fast mind gives them an edge in creative problem solving. The Pitta brain-type reacts strongly to all challenges leading to purposeful and resolute actions. They never give up and are very dynamic and goal oriented. The Kapha brain-type is slow and steady leading to methodical thinking and action. They prefer routine and needs stimulation to get going. A model of dosha brain-types could provide a physiological foundation to understand individual differences. This model could help individualize treatment modalities to address different mental and physical dysfunctions. It also could explain differences in behavior seen in clinical as well as in normal populations.

Genome-wide analysis correlates Ayurveda Prakriti

The practice of Ayurveda, the traditional medicine of India, is based on the concept of three major constitutional types (Vata, Pitta and Kapha) defined as “Prakriti”. To the best of our knowledge, no study has convincingly correlated genomic variations with the classification of Prakriti. In the present study, we performed genome-wide SNP (single nucleotide polymorphism) analysis (Affymetrix, 6.0) of 262 well-classified male individuals (after screening 3416 subjects) belonging to three Prakritis. We found 52 SNPs (p ≤ 1 × 10⁻⁵) were significantly different between Prakritis, without any confounding effect of stratification, after 10⁶ permutations. Principal component analysis (PCA) of these SNPs classified 262 individuals into their respective groups (Vata, Pitta and Kapha) irrespective of their ancestry, which represent its power in categorization. We further validated our finding with 297 Indian population samples with known ancestry. Subsequently, we found that PGM1 correlates with phenotype of Pitta as described in the ancient text of Caraka Samhita, suggesting that the phenotypic classification of India’s traditional medicine has a genetic basis; and its Prakriti-based practice in vogue for many centuries resonates with personalized medicine.

Commonly Used Dietary Supplements on Coagulation Function during Surgery

BACKGROUND

Patients who undergo surgery appear to use dietary supplements significantly more frequently than the general population. Because they contain pharmacologically active compounds, dietary supplements may affect coagulation and platelet function during the perioperative period through direct effects, pharmacodynamic interactions, and pharmacokinetic interactions. However, in this regard, limited studies have been conducted that address the pharmacological interactions of dietary supplements. To avoid possible bleeding risks during surgery, information of potential complications of dietary supplements during perioperative management is important for physicians.

METHODS

Through a systematic database search of all available years, articles were identified in this review if they included dietary supplements and coagulation/platelet function, while special attention was paid to studies published after 1990.

RESULTS

Safety concerns are reported in commercially available dietary supplements. Effects of the most commonly used natural products on blood coagulation and platelet function are systematically reviewed, including 11 herbal medicines (echinacea, ephedra, garlic, ginger, ginkgo, ginseng, green tea, kava, saw palmetto, St John's wort, and valerian) and 4 other dietary supplements (coenzyme Q₁₀, glucosamine and chondroitin sulfate, fish oil, and vitamins). Bleeding risks of garlic, ginkgo, ginseng, green tea, saw palmetto, St John's wort, and fish oil are reported. Cardiovascular instability was observed with ephedra, ginseng, and kava. Pharmacodynamic and pharmacokinetic interactions between dietary supplements and drugs used in the perioperative period are discussed.

CONCLUSIONS

To prevent potential problems associated with the use of dietary supplements, physicians should be familiar with the perioperative effects of commonly used dietary supplements. Since the effects of dietary supplements on coagulation and platelet function are difficult to predict, it is prudent to advise their discontinuation before surgery.

Evaluation of prakṛti and quality-of-life in patients with irritable bowel syndrome

OBJECTIVE

To evaluate the prakṛti of irritable bowel syndrome (IBS) patients and its association with IBS subtypes and quality-of-life (QOL).

METHODOLOGY

IBS patients with the consistent subtype in the last 6 months were recruited. Prakṛti assessment with a 24-item questionnaire was performed and depending on the scores the patients were categorized into vāta predominant, pitta predominant, and kapha predominant prakṛti. QOL was assessed with prevalidated disease-specific 34-item questionnaire scored on a 0-100 scale.

RESULTS

Of 50 IBS patients enrolled, with mean age of 43.5 ± 12.8 years, and male: female as 43:7, 22 patients were of vāta and pitta predominant prakṛti each while six patients had kapha predominant prakṛti. IBS-C was diagnosed in 24 patients, IBS-D in 21, and IBS-M in five patients. In vāta predominant group, IBS-C was found in 13 patients, IBS-D in 8, and IBS-M in 1. In pitta predominant group, IBS-D was found in 13, IBS-C in 6, and IBS-M in 3. In kapha predominant group, IBS-C was found in 5 patients and IBS-M in 1. The median QOL in IBS-C group was 48.897, IBS-D was 38.97, and IBS-M was 66.911. The median QOL score 52.205, 42.27, and 55.51 in vāta, pitta, and kapha predominant group, respectively.

CONCLUSION

Majority of the vāta predominant patients had developed IBS-C, pitta predominant patients had developed IBS-D. QOL was better in pitta predominant individuals of all IBS-disease subtypes. With this, we find that prakṛti examination in IBS helps in detecting the proneness of developing an IBS subtype and predicting their QOL accordingly.

DNA methylation analysis of phenotype specific stratified Indian population

Background

DNA methylation and its perturbations are an established attribute to a wide spectrum of phenotypic variations and disease conditions. Indian traditional system practices personalized medicine through indigenous concept of distinctly descriptive physiological, psychological and anatomical features known as prakriti. Here we attempted to establish DNA methylation differences in these three prakriti phenotypes.

Methods

Following structured and objective measurement of 3416 subjects, whole blood DNA of 147 healthy male individuals belonging to defined prakriti (Vata, Pitta and Kapha) between the age group of 20-30years were subjected to methylated DNA immunoprecipitation (MeDIP) and microarray analysis. After data analysis, prakriti specific signatures were validated through bisulfite DNA sequencing.

Results

Differentially methylated regions in CpG islands and shores were significantly enriched in promoters/UTRs and gene body regions. Phenotypes characterized by higher metabolism (Pitta prakriti) in individuals showed distinct promoter (34) and gene body methylation (204), followed by Vata prakriti which correlates to motion showed DNA methylation in 52 promoters and 139 CpG islands and finally individuals with structural attributes (Kapha prakriti) with 23 and 19 promoters and CpG islands respectively. Bisulfite DNA sequencing of prakriti specific multiple CpG sites in promoters and 5′-UTR such as; LHX1 (Vata prakriti), SOX11 (Pitta prakriti) and CDH22 (Kapha prakriti) were validated. Kapha prakriti specific CDH22 5′-UTR CpG methylation was also found to be associated with higher body mass index (BMI).

Conclusion

Differential DNA methylation signatures in three distinct prakriti phenotypes demonstrate the epigenetic basis of Indian traditional human classification which may have relevance to personalized medicine.

Electronic supplementary material

The online version of this article (doi:10.1186/s12967-015-0506-0) contains supplementary material, which is available to authorized users.

Determinants of prakriti, the human constitution types of Indian traditional medicine and its correlation with contemporary science

Background:

Constitutional type of an individual or prakriti is the basic clinical denominator in Ayurveda, which defines physical, physiological, and psychological traits of an individual and is the template for individualized diet, lifestyle counseling, and treatment. The large number of phenotype description by prakriti determination is based on the knowledge and experience of the assessor, and hence subject to inherent variations and interpretations.

Objective:

In this study we have attempted to relate dominant prakriti attribute to body mass index (BMI) of individuals by assessing an acceptable tool to provide the quantitative measure to the currently qualitative ayurvedic prakriti determination.

Materials and Methods:

The study is cross sectional, multicentered, and prakriti assessment of a total of 3416 subjects was undertaken. Healthy male, nonsmoking, nonalcoholic volunteers between the age group of 20-30 were screened for their prakriti after obtaining written consent to participate in the study. The prakriti was determined on the phenotype description of ayurvedic texts and simultaneously by the use of a computer-aided prakriti assessment tool. Kappa statistical analysis was employed to validate the prakriti assessment and Chi-square, Cramer's V test to determine the relatedness in the dominant prakriti to various attributes.

Results:

We found 80% concordance between ayurvedic physician and software in predicting the prakriti of an individual. The kappa value of 0.77 showed moderate agreement in prakriti assessment. We observed a significant correlations of dominant prakriti to place of birth and BMI with Chi-square, P < 0.01 (Cramer's V-value of 0.156 and 0.368, respectively).

Conclusion:

The present study attempts to integrate knowledge of traditional ayurvedic concepts with the contemporary science. We have demonstrated analysis of prakriti classification and its association with BMI and place of birth with the implications to one of the ways for human classification.

A self-rating scale to measure tridoṣas in children

Background:

Self – rating inventories to assess the Prakṛti (constitution) and personality have been developed and validated for adults. To analyze the effect of personality development programs on Prakṛti of the children, standardized scale is not available. Hence, present study was carried out to develop and standardize Caraka Child Personality inventory (CCPI).

Materials and Methods:

The 77- item CCPI scale was developed on the basis of translation of Sanskrit verses describing vātaja (a), pittaja (b) and kaphaja prakṛti (c) characteristics described in Ayurveda texts and by taking the opinions of 5 Ayurveda experts and psychologists. The scale was administered on children of the age group 8-12 years in New Generation National public school, Bangalore.

Results:

This inventory was named CCPI and showed excellent internal consistency. The Cronbach's alpha for A, B and C scales were 0.54, 0.64 and 0.64 respectively. The Split - Half reliability scores for A, B and C subscales were 0.64. 0.60 and 0.66 respectively. Factor validity coefficient Scores on each item was above 0.4. Scores on vātaja, pittaja and kaphaja scales were inversely correlated. Test-retest reliability scores for A,B and C scales were 0.87,0.88 and 0.89 respectively. The result of CCPI was compared with a parent rating scale Ayurveda Child Personality Inventory (ACPI). Subscales of CCPI correlated significantly highly (above 0.80) with subscales of ACPI which was done for the purpose of cross-validation with respect to ACPI.

Conclusions:

The prakṛti of the children can be measured consistently by this scale. Correlations with ACPI pointed toward concurrent validity.

Prakriti and its associations with metabolism, chronic diseases, and genotypes: Possibilities of new born screening and a lifetime of personalized prevention

Ayurveda is one of the oldest health sciences of the world with concepts of tridosha and prakriti being core philosophies. These core concepts allow implementation of ways for not only personalized medicine and treatment but also personalized prevention. In the light of modern or current science, evidence has surfaced connecting the concepts of tridosha and prakriti with metabolic pathways, chronic diseases, and various genotypes. Such evidence has thrown up insights about the universality of Ayurvedic concepts as well as their apparent association with concepts in current science. This review was undertaken to consolidate the evidence of such associations which exist between prakriti and metabolic systems, chronic diseases, and genotypes with the objective that a case can be made for drawing out the clear linkages that might exist for prakritis being distinct phenotypes representing certain genotypes. A corollary to such discoveries can be the possibility of newborns being screened for their prakriti by genetic testing, which will enable the prevention of various chronic diseases for such children via the implementation of various dietary, lifestyle, and habitual changes, as required, from an early age. This implementation of preventive practices from an early age may result in such children leading healthy, disease-free, more productive lives. Thus, eventually, this can be an opportunity to practice personalized preventive health, which is not a possibility in other systems of medicine especially western systems of medicine. Personalized preventive health is one step further than personalized medicine and is a very novel idea with far-reaching implications.

Interrater reliability of diagnostic methods in traditional Indian ayurvedic medicine

This study assesses the interrater reliability of Ayurvedic pulse (nadi), tongue (jivha), and body constitution (prakriti) assessments. Fifteen registered Ayurvedic doctors with 3-15 years of experience independently examined twenty healthy subjects. Subjects completed self-assessment questionnaires and software analyses for prakriti assessment. Weighted kappa statistics for all 105 pairs of doctors were computed for the pulse, tongue, and prakriti data sets. According to the Landis-Koch scale, the pairwise kappas ranged from poor to slight, slight to fair, and fair to moderate for pulse, tongue, and prakriti assessments, respectively. The average pairwise kappa for pulse, tongue, and prakriti was 0.07, 0.17, and 0.28, respectively. For each data set and pair of doctors, the null hypothesis of random rating was rejected for just twelve pairs of doctors for prakriti, one pair of doctors for pulse examination, and no pairs of doctors for tongue assessment. Thus, the results demonstrate a low level of reliability for all types of assessment made by doctors. There was significant evidence against random rating by software and questionnaire use and by the diagnosis preferred by the majority of doctors. Prakriti assessment appears reliable when questionnaire and software assessment are used, while other diagnostic methods have room for improvement.