CV Health and Prevention: An Ayurvedic Approach
Virender Sodhi, ND, MD (Ayurveda)
Anup Mulakaluri, ND, AWC
According to Ayurvedic medicine, the heart chakra lies at the center of the 7 chakras. It holds the emotional functions of love, confidence, and trust, as well as deep connection and compassion; its highest function is expression of self-love and unconditional love. It serves as the seat of the life-force, the Prana. When out of balance, an individual experiences fear or vulnerability, loss of confidence, anxiety, emotional distress, and dependency.The word “courage” is derived from the latin word “cor,” which means heart. The heart calls on us to be courageous, because through the heart we feel our most vulnerable experiences of love, connection, generosity, empathy, compassion, etc. We all know the blessing of “living in someone’s heart,” the generosity of someone’s “kind heart,” the healing power of a “compassionate heart.” All of these are real experiences that reach far beyond the physical activity of the heart, to emotional and spiritual functions of the heart. This is the mystical way our ancestors viewed the heart and its power.
The functions of the physical heart are simple but profound…While it distributes this nutrient-rich and oxygen-rich blood throughout the body, the heart pump also facilitates the circulation of messenger molecules throughout the body. Thus, the pulse of the heart helps to harmonize physiological activity and promote health.
The Problem of Heart Disease
Cardiovascular disease (CVD) is the leading cause of death in the United States, accounting for 1 of 4 deaths per year.1 Every year 700 000 Americans suffer heart attacks, of which 515 000 are first-timers.2 Management of CVD had already placed a direct annual burden of $272.5 billion on the economy in 2010. This is projected to increase to $818.1 billion in direct costs by 2030.3
As the leading cause of chronic illness and death in the United States, heart disease raises some poignant considerations regarding our culture. High blood pressure, high LDL-cholesterol, and smoking are 3 key risk factors for heart disease. About half of Americans (49%) have at least 1 of these 3 risk factors, high blood pressure being the most prevalent.4 Other medical conditions and lifestyles that promote heart disease include:
- Overweight and obesity
- Poor diet
- Physical inactivity
- Excessive alcohol use
Excepting poor diet, all of the above are conditions of excess that can be treated through modifiable factors like diet and lifestyle interventions. Despite this, the main focus of the medical community is to find a magic bullet without adequately considering the role of nutrition, exercise, and stress reduction. Despite the arsenal of drugs and heroic surgical procedures, heart disease is still the leading cause of death. Ironically, iatrogenesis (including pharmaceutical and hospital errors) is the third leading cause of death in the United States.5
Ayurveda describes 3 conditions that can lead to imbalance and heart disease:
Excess: Excessive consumption (food, etc); excess stress; attachment; ignorance, etc
Deficiency: Nutritional deficiency; lack of relaxation and play; weak digestion
Inappropriate combinations: Refers to combinations of time/activity and diet (eg, eating cold foods in cold weather, or combining sweet and sour tastes)
Examples of all of these are widespread across our culture. These root causes must be addressed first in the course of treatment.
The appearance of heart disease is a late sign of long-standing imbalances such as hypertension, high cholesterol, diabetes, obesity, low-grade inflammation, and inactivity. The majority of these individuals would have been able to prevent disease by following preventive measurements.
Primary Prevention of Heart Disease: Healing the Emotional Heart
As discussed before, the heart chakra is the seat of compassion, serenity, harmony, and wisdom. It is considered the balancing point of the chakra system, where the energies of our lower survival instincts are brought into refinement to meet the frequency of higher chakra centers. Heart is described as the site of “Mano-vyapara,” – activity of the mind.6 Heart is intimately affected by our emotional experiences, and thus informs the brain. This essential knowledge is now being elucidated through research studies.
Each heartbeat causes a pulse of cardiac hormones that can have harmonizing or disharmonizing effects on alpha waves in the brain.7 The rate and volume of these pulses are affected by heart-rate variability, which in turn is affected by physiological, emotional, and environmental factors. Negative emotions (eg, frustration) can cause an erratic heart rhythm, whereas shifting to positive states (eg, gratitude, compassion) results in a smooth, sine-wave-like pattern of heart rhythm. Moreover, both dissonance and harmony are expressed in the activity of the brain as a consequence of variability in heart rate.8
Generally, the brain receives feedback from visceral organs, including the heart, and the autonomic nervous system. Deviations from baseline help the brain in interpreting and understanding one’s state of mind.9 This has been explained as follows: “When we sense a mismatch between our actual heart rate and the habituated heart rate, we generate a feeling (e.g., excitement or anxiety, if heart rate is accelerated). The specific feeling experienced may reflect the nature of the mismatch.”10
Connection between emotional stress and heart disease (a “broken heart”) continues to be clarified through recent studies. In an observational study of 63 469 women, depression increased the risk of fatal coronary heart disease (CHD) by 50%, and doubled the risk of sudden cardiac death.11 Similar correlations have also been found with anxiety,12 and negative emotions such as anger.13 “Cardiac stunning,” related to sudden emotional stress, has been associated to with supra-physiologic activation of the sympathetic nervous system, with plasma catecholamines and stress-related neuropeptides levels several times higher than patients with myocardial infarction. These levels remained markedly elevated even a week after the event.14
Chronic physiologic effects of emotional distress include the following:
Nervous system activity: Biochemical imbalances in neurotransmitter and hormones associated with emotional stress may affect the neurological activity of the entire body.15
Enhanced platelet activity: When associated with depression, this contributes to elevated risk of ischemic heart disease (IHD) and other arterial plaque-related diseases.16,17
Chronic low-grade inflammation: This is also a shared feature of emotional distress and cardiovascular disease.18,19
Benefits of Meditation
Meditation is considered one of the foundational practices of mental and emotional self-care in Ayurvedic medicine. The key to meditation is to use the natural qualities of the mind to develop emotional freedom and objective insights regarding challenging experiences. This is achieved through the practice of mindfulness. The application of mindfulness has demonstrated psychological and physical benefits. Here is a short list:
Anxiety and depression: Mindfulness promotes awareness of mental/emotional triggers, also improves self-monitoring of negative affect to help prevent recurrence of these mood disorders.20,21
Mindfulness-based stress reduction relieves or prevents adverse physiologic effects of emotional disturbance by promoting better coping strategies; thus, the practice provides benefits in both physical and mental health.22
Among children with attention-deficit/hyperactivity disorder (ADHD), mindfulness promotes impulse-control, self-directed action, and improved capacity for “self-transcendence” – the relationship of self to the greater universe.23 Mindfulness training was shown to improve executive function in 7 to 9-year-olds, enhancing capacity for attention and shifting focus between tasks.24
Self-monitoring promotes fewer errors while performing tasks, and leads to better problem-solving, lower error-related negativity, and more emotional acceptance. Thus, the practice promotes self-compassion and compassion towards others.25
As an important tool to stimulate self-analysis, reflection, and compassion, the practice of mindfulness has been recommended to law students, lawyers, and mediators for aiding conflict resolution.26 In non-meditating populations, mindfulness is correlated with improved happiness through the cultivation of self-compassion.27 The result was improved capacity “to recognize, manage, and resolve day-to-day problems, which promotes a healthy mind.”
The practice of meditation promotes freedom from emotional reactivity by modulating sympathetic nervous system discharge in response to negative emotion. With practice, one can cultivate improved executive function, problem-solving, self-monitoring, and compassion. The overall effect is greater resilience to emotional distress.
Benefits of Diet
Ayurvedic theory of nourishment and tissue-building follows the model of a step-fountain. From the digested food, bodily tissues are nourished, built, and healed in a step-wise fashion. According to this model, nutritious plasma (rasa) and healthy blood (rakta) constitute the basis of nourishing the cardiovascular tissue that is part of the muscle tissue (mamsa). Therefore, a plant-based diet, due to its nutritious and cleansing qualities, appears to be one of the best preventive strategies (Table 1).
“Cardiodiabesity” is a combination of obesity, diabetes, and heart disease. In a review on the relationship between the Mediterranean diet and cardiodiabesity, 33 of 37 studies demonstrated a significant reduction in the risk of cardiodiabesity among individuals adhering to a Mediterranean-type diet.28
Among 180 000 Seventh Day Adventists (SDA), a vegetarian diet contributed to a 24% reduction in risk of IHD (heart attacks); a 34% reduction in risk of cerebrovascular disease (stroke); and a 35% reduction of death by heart disease.29
It is important to note that the excellent results seen in the SDA studies are more than a result of a healthy diet; individuals in the SDA group also have the support of community and a spiritual practice. Ayurveda philosophy of “Vishwa kam, kutumb kam,” which means “the whole Universe is my family,” resonates with this SDA approach. It teaches us that community and spiritual practice support a sense of belonging and emotional peace. These serve as medicine for the heart, just like food.
Benefits of Yoga and Breathing Exercises
The practice of yoga and breathing exercises is correlated to improvements in physical strength, energy, and stress relief.30 A review of studies demonstrated that yoga in healthy individuals resulted in reductions of blood pressure, total cholesterol, and LDL-C, and improvements in HDL-C.31
Furthermore, yoga intervention has demonstrated benefit of reducing cardiovascular inflammation.32 Building on prior positive research, a study is currently in process that is examining the cardiovascular, metabolic, mood, and cognitive effects of a 12-week yoga therapy program (including 2 group classes and 1 home session per week), in post-cardiac rehabilitation patients.33
For additional physical activity, walking is an efficient form of exercise with a low risk of injury. In a review of studies including over 295 000 participants, 30 minutes per day of brisk walking, 5 times weekly, reduced the risk of CHD by 19%.34
Rauwolfia serpentina is a powerful parasympathomimetic that helps to breaks sympathetic dominance in the cardiovascular system.35 Reserpine is its best known alkaloid, proven to be as effective as first-line anti-hypertensives.36 Using the whole herb provides a more balanced and safer action.
Terminalia arjuna is the primary cardiotonic of the Ayurvedic tradition. It has been shown to improve exercise tolerance and quality of life, and to reverse the severity of congestive heart failure (NY Heart Association’s class II & III).37 The herb has negative chronotropic and positive ionotropic effects, as well as provides antioxidant action to protect the cardiac muscle from toxicity and injury.38,39
Inula racemosa is an herb with similar actions as Arjuna, ie, reducing heart rate and improving stroke volume.40 Given to patients with IHD and chest pain, 90 minutes before exercise, Inula prevented exercise-induced ECG abnormality in all cases.41 Improvement is seen with reduction of chest pain and improvement in dyspnea.42
Curcuma longa was shown in 6 clinical trials to reduce (via its curcuminoids) C-reactive protein by an average of 6.44 mg/L, depending on bioavailability of the compound.43 Curcumin also effectively inhibits phospholipase, lipoxygenases, cyclooxygenases, thromboxane, prostaglandins, TNF-alpha, and interleukin-12 as part of its anti-inflammatory activity.44
Heart disease is an alarming consequence of an unhealthy culture. For too long, we have confused having material excess with personal success. If we look at nature, all animals live an active life; they collect and eat the food they need, and rarely have issues with obesity or chronic disease. Our bodies have evolved in similar living conditions as animals in nature; therefore, straying too far from our own nature leads us into existential troubles.
Fortunately, nature is the most powerful and formidable ally. Adhering to nature’s laws can help us to align our body with its natural healing wisdom. Our healing journey can be simple, efficient, and powerful at once by following this wisdom.
Table 1. The Ayurvedic and Naturopathic Medical Clinic (ANMC)’s Dietary Guidelines
|Vegetables (seasonal, organic): 4-6 servings/day|
|Fruits: 1-2 servings/day|
|Protein: beans, nuts & seeds, moderate amount of chicken, turkey, lamb, etc|
|Oils: 1-2 tbsp raw oil, usually poured over foods; never fried|
|Low-glycemic grains: amaranth, millet, quinoa, buckwheat are preferred|
|Variety in all food groups is essential, as this allows the widest spectrum of nutrients|
Table 2. Herbal Protocols Used at ANMC
|Hypertension||Rauwolfia-Arjuna-Tribulus formula (1 cap at night to start; 1 cap in the morning as well, if needed)|
|Cardiac tonic (for CHD, CHF, etc)||Arjuna-Inula formula, along with coconut-MCT-bound curcumin formula (1 cap TID)|
|Systemic inflammation||Coconut-MCT/curcumin powder (2.5 grams BID)|
(CHD = coronary heart disease; CHF = congestive heart failure; MCT = medium-chain triglycerides)
Virender Sodhi, ND, MD (Ayurveda), received his ND degree from Bastyr University in 1988, and went on to became one of the first to integrate the medical sciences of Ayurveda and Naturopathy. He has continued to integrate the best of both sciences in his practice for over 26 years. Having completed a fellowship in Integrative Oncology in 2012, oncology has become an important part of his primary care practice. Dr Sodhi is the CEO of Ayush herbs Inc, and Medical Director at the Ayurvedic Naturopathic Medical Clinic in Bellevue, WA. He has recently published his first book: Ayurvedic Herbs: Comprehensive Guide to Ayurvedic Healing Solutions.
Anup Mulakaluri, ND, AWC, graduated from the naturopathic program at Bastyr University in 2013; he then completed 1 year of Ayurvedic and Naturopathic residency under the mentorship of Dr Virender Sodhi in 2015. Dr Mulakaluri has also completed training as an Ayurvedic wellness counselor and has had advanced study in Ayurvedic psychology from Lokmanya Tilak University, in Pune, India. Dr Anup is the founder of Natural Rhythms Integrative Medicine. Read more at: www.naturalrhythmsim.com.
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