Exploring Ayurvedic Knowledge on Food and Health for Providing Innovative Solutions to Contemporary Healthcare

In Silico Approaches to Polyherbal Synergy: Protocol for a Scoping Review

BACKGROUND

According to the World Health Organization, more than 80% of the world's population relies on traditional medicine. Traditional medicine is typically based on the use of single herbal drugs or polyherbal formulations (PHFs) to manage diseases. However, the probable mode of action of these formulations is not well studied or documented. Over the past few decades, computational methods have been used to study the molecular mechanism of phytochemicals in single herbal drugs. However, the in silico methods applied to study PHFs remain unclear.

OBJECTIVE

The aim of this protocol is to develop a search strategy for a scoping review to map the in silico approaches applied in understanding the activity of PHFs used as traditional medicines worldwide.

METHODS

The scoping review will be conducted based on the methodology developed by Arksey and O'Malley and the recommendations of the Joanna Briggs Institute (JBI). A set of predetermined keywords will be used to identify the relevant studies from five databases: PubMed, Embase, Science Direct, Web of Science, and Google Scholar. Two independent reviewers will conduct the search to yield a list of relevant studies based on the inclusion and exclusion criteria. Mendeley version 1.19.8 will be used to remove duplicate citations, and title and abstract screening will be performed with Rayyan software. The JBI System for the Unified Management, Assessment, and Review of Information tool will be used for data extraction. The scoping review will be reported based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines.

RESULTS

Based on the core areas of the scoping review, a 3-step search strategy was developed. The initial search produced 3865 studies. After applying filters, 875 studies were short-listed for further review. Keywords were further refined to yield more relevant studies on the topic.

CONCLUSIONS

The findings are expected to determine the extent of the knowledge gap in the applications of computational methods in PHFs for any traditional medicine across the world. The study can provide answers to open research questions related to the phytochemical identification of PHFs, criteria for target identification, strategies applied for in silico studies, software used, and challenges in adopting in silico methods for understanding the mechanisms of action of PHFs. This study can thus provide a better understanding of the application and types of in silico methods for investigating PHFs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/56646.

In vitro and in silico studies of the potential cytotoxic, antioxidant, and HMG CoA reductase inhibitory effects of chitin from Indonesia mangrove crab (Scylla serrata) shells

This study aimed to characterize chitin extracted from Indonesia mangrove crab (Scylla serrata) shells, as well as to assess its in vitro cytotoxic, antioxidant, and HMG CoA reductase inhibitory potentials. In silico molecular docking, molecular dynamic, and ADMET prediction analyses were also carried out. Chitin was extracted from mangrove crab shells using deproteination and demineralization processes, Scanning Electron Microscopy (SEM) and Fourier Transform Infrared (FTIR) characterization are then performed. The MTT method was further tested in a study of cell viability, while in vitro method was used to assess HMG CoA reductase inhibitory and antioxidant activities. The extracted chitin was found to have a moderate level of cytotoxic and antioxidant activities. In vitro studies showed that it has an IC50 of 36,65 ± 0,082 μg/mL as an HMG CoA reductase inhibitor, and decreased enzyme activity by 68.733 % at 100 μg/mL as a concentration. Furthermore, in the in silico study, chitin showed a strong affinity to several targets, including HMG CoA reductase, HMG synthase, LDL receptor, PPAR-alfa, and HCAR-2 with binding energies of -5.7; -5.8; -3.6; -5.6; -4.6 kcal/mol, respectively. Based on the ADMET properties, it had non-toxic molecules, which were absorbed and distributed across the blood-brain barrier. The molecular dynamics (MD) simulation also showed that it remained stable in the active sites of HMG CoA reductase receptor for 100 ns. These results indicated that chitin from Indonesian mangrove crab shells can be used to develop more potent HMG CoA reductase inhibitor with antioxidant and cytotoxic activities for effective dyslipidemia therapy.

Health and demographic indicators of selected districts of India: An impact of Swasthya Rakshan Programme (SRP)

Swasthya Rakshan Programme (SRP) provides health care services through Ayurveda, an initiative of the Government of India that aims to survey and create alertness of essential health appliances to ameliorate society from its grassroots level. The present study aimed to survey the prevailing health standards of residents in certain districts of India and to record the prevalence of diseases among them according to their living conditions, food habits, lifestyle, education, occupation and other socio-economic status. Data was collected through a community-based cross-sectional survey conducted from April 2018 to March 2019 in 22 Districts of 19 states in India. A stratified multi-stage sampling design was adopted for the survey. Documentation of demographic profile, food habits, lifestyle, hygiene status, and existing health conditions was assessed. A pre-designed semi-structured questionnaire was used for the collection of the data. Before initiating the programme, written consent was obtained. In this study, from 162 selected villages/colonies/areas, a total of 562,913 population and 81,651 households were surveyed. Sixty-nine thousand three hundred nineteen patients were cared for various ailments through health camps. The study found that the most prevalent disease in the concerned population was 'Sandhivata' (Osteo-arthritis), that is, 43.0%, followed by 'Dourbalya' (Debility), that is, 11.7%. The study includes insightful analyses of comprehensive demographic and health indicators classified by various socio-economic categories. The collected data regarding the prevalence of diseases with their sociodemographic correlations may provide a better understanding of the locality and thus may help in all future health endeavours.

The Brief History of Complementary, Alternative, and Integrative Medicine Terminology and the Development and Creation of an Operational Definition

The definition of complementary, alternative, and integrative medicine (CAIM) remains dynamic and complex despite a steady increase in the popularity/usage of CAIM therapies across the globe. A lack of consistency in how these terms are defined remains a challenge for researchers, clinicians, and national and international organizations (e.g., World Health Organization, National Center for Complementary and Integrative Health) alike. In the present article, we provide a brief history of the use of these terminologies, and then outline the process we took to develop and create an operational definition of complementary, alternative, and integrative medicine. Our operational definition is the first to be informed by a systematic search of four quality-assessed information resource types, ultimately yielding 604 unique CAIM therapies. We then developed a single search string for the most common bibliographic databases using the finalized operational definition list of CAIM therapies. These CAIM therapies were searched against the Therapeutic Research Center's "Natural Medicines" database for all 604 therapies, whereby each item's scientific name and/or synonym was included as a keyword or phrase in the search string. While the current definition is not without limitations and ongoing debates still surround the field, this work is arguably a steppingstone towards enabling increased collaboration and communication amongst healthcare clinicians, researchers, and the public. This operational definition provides a foundation for developing well-coordinated research efforts that will assist in the acceptance and understanding of this field, while also focusing on adopting knowledge translation techniques and efforts for further research advancement and use.

Patient-reported outcomes of ayurveda consultation in relation to clinical practice data

BACKGROUND

Clinical practice characteristics and patient-reported outcomes for Ayurveda have not been adequately studied.

METHODS

From January 2 thru February 28, 2022, all clients first seen during the 9-year period ending December 31, 2021, were solicited to respond to a web-based 34-item questionnaire containing 5 items targeting their general experience, 7 focusing on specific results, and 22 examining the implementation and impact of common Ayurvedic recommendations. These data were combined with practice data to develop linear regression models for the main outcome variables to assess improvement and the drivers of change.

RESULTS

170 responses were received from 252 eligible clients: an overall response rate of 67%. Test-retest data for 57 respondents gave a reliability coefficient of 0.83 [0.69-0.91]. The outcomes of consultation were independent of the mode of interaction (in-person vs. telehealth) and whether pulse diagnosis information was available. 85% were at least Satisfied with their overall consultation experience. The mean difference in health from before consultation to the survey was 1.2 [1.0-1.4] on a 7-point scale. 61% reported Much to Exceptional benefit. On average, 63% rated themselves as at least Somewhat Better in terms of physical well-being, emotional well-being, sleep, digestion, bowel function, fitness and energy. These findings were buttressed by clinically significant changes on 4 clinical assessment questionnaires among 60 clients. Engaging in follow-up and adopting recommendations were associated with better outcomes.

CONCLUSIONS

Consultation with a practitioner of Ayurveda may provide substantial probability of durable holistic health benefit and improvement in chronic conditions with minimal risk of harm.

Ayurveda, yoga, and acupuncture therapies in alleviating the symptom score among patients with spinal cord injury - A systematic review

BACKGROUND

Spinal cord injury (SCI) is the leading cause of motor and sensory abnormalities due to damage caused to any part of the spinal cord resulting from trauma, disease, or degeneration. Most of the disability caused will be irreversible with various systemic manifestations. Hence, management of SCI focuses on minimising disability, diminishing limitations due to impairment, and improving quality of life, emotional, and psychological aspects.

AIM

This review is aimed at describing Ayurveda, Yoga, and Acupuncture therapies in the management of SCI as individual and integrated approaches for alleviating the symptom score in patients with SCI.

METHODS

The data was collected from six databases, including PubMed Central, the Cochrane Library, Google Scholar, Scopus, MEDLINE, and Grey Literature. The subjects in these studies were between the ages group 21-70 years and had been previously diagnosed with SCI and its clinical presentation. The interventions used in the selected studies incorporate Ayurveda (medicinal system of longevity) herbal medications, Panchakarma (five methods) treatment, diet, and yoga (mind-body medicine) therapy. Full-text publications in English, and research designs such as randomised controlled trials, case studies, review articles and cohort studies were included. Letter to the editor, study protocol, animal trials, and in vitro studies were excluded.

RESULTS

216 records were identified using keywords such as spinal cord injury, Äyurveda, Acupuncture, païca karma, rehabilitation, and yoga. After applying inclusion and exclusion criteria, 28 articles were selected for synthesis, which contain 12 case studies, 12 literature review articles, 2 randomised controlled trials, 1 cohort study, and 1 meta-analysis.

CONCLUSION

The integration of Ayurveda management, including Panchakarmatherapy and Ayurveda medications, with other alternative therapies like Acupuncture, Yoga, and Rehabilitation improved muscle strength, quality of life, range of motion, and neuronal function, and reduced depression, stress, and pain with symptom scores.

Assessment of Chronic Toxicity of an Ayurvedic Herbo-Metallic Formulation Rasaraj Rasa in Wistar Rats

Objectives

This study aimed to assess the adverse effects of Rasaraj Rasa tablets after repeated oral administration for 180 days in Wistar rats.

Methods

Wistar rats were divided into five groups, of which three were treated with 54, 162, and 270 mg/kg body weight of Rasaraj Rasa, respectively, which correspond to one, three, and five times the proposed human therapeutic dose, for 180 days consecutively. The fifth group (satellite) also received 270 mg/kg body weight of Rasaraj Rasa for 180 days. Body weight and food intake were measured weekly. At the end of the study, all rats were sacrificed, and their blood, serum, and organs were collected and examined using hematology, serum biochemistry, gross pathology, and histopathology tests. In contrast, the satellite group was kept for 4 weeks after treatment.

Results

No significant treatment-related toxicological findings were observed in the clinical features, body weight, laboratory findings, and pathological findings of the high-dose treated groups, when compared to those of the control group.

Conclusion

The no-observed-adverse-effect-level for Rasaraj Rasa in Wistar rats is set at 270 mg/kg body weight.

Can Guduchi (Tinospora cordifolia), a well-known ayurvedic hepato-protectant cause liver damage?

Ayurveda is a centuries old traditional medicine practiced in India even today. There are certain safe medicinal plants with well-established medicinal properties both in clinical practice as well as in modern scientific publications. Guduchi or Tinospora cordifolia (Willd.) Miers (Menispermaceae), is one such medicinal plant that has well known anti-inflammatory, immune-modulatory and other safe therapeutic applications including hepato-protection, because of which it was recommended by the Ministry of AYUSH, Government of India to be used in COVID-19 care. Therefore, Aabha Nagral's article "Herbal Immune Booster-Induced Liver Injury in the COVID-19 Pandemic-a Case Series," published in 2021, was unanticipated. The article recounted histologically documented clinical cases of six patients who developed drug-induced autoimmune-like hepatitis after reported consumption of Guduchi or Guduchi containing formulations during the COVID-19 pandemic. Since the Ayurveda practitioners vouch by the safety of T. cordifolia (TC), it was felt that the story needed to be further scrutinized. This article reviews the botanical entities, the substitutes and adulterants of species used as Guduchi, their pharmacological and toxicological properties. While the authentic botanical entity of Guduchi is TC, Tinospora sinensis and Tinospora crispa are also commonly traded in the Indian subcontinent as Guduchi or Giloy. Among these species, T. crispa is known to induce heapto-toxicity. In Nagral's article, there were variations in the reported six cases in terms of patient history and TC/TC product consumption. More importantly, the botanical authenticity of the consumed products was not investigated. A review of published literature indicates that it is unlikely that the authentic TC could have induced autoimmune-like hepatitis of the patients. It is probable that a wrong species was self-administered by the patients. It is worth following up with the cases (patients), to investigate details of the products, so that other consumers do not suffer. Nagral's article however does highlight the serious issue of adulteration in herbal markets and the need for establishing a robust pharmacovigilant system in India.

S, Patel AB, Chen ZS. An Ayurgenomics Approach: Prakriti-Based Drug Discovery and Development for Personalized Care

Originating in ancient India, Ayurveda is an alternative medicinal approach that provides substantial evidence for a theoretical-level analysis of all aspects of life. Unlike modern medicine, Ayurveda is based upon tridoshas (Vata, pitta, and Kapha) and Prakriti. On the other hand, the research of all the genes involved at the proteomics, metabolomics, and transcriptome levels are referred to as genomics. Geoclimatic regions (deshanupatini), familial characteristics (kulanupatini), and ethnicity (jatiprasakta) have all been shown to affect phenotypic variability. The combination of genomics with Ayurveda known as ayurgenomics provided new insights into tridosha that may pave the way for precision medicine (personalized medicine). Through successful coordination of “omics,” Prakriti-based treatments can help change the existing situation in health care. Prakriti refers to an individual’s behavioral trait, which is established at the moment of birth and cannot be fully altered during one’s existence. Ayurvedic methodologies are based on three Prakriti aspects: aushadhi (medication), vihara (lifestyle), and ahara (diet). A foundation of Prakriti-based medicine, preventative medicine, and improvement of life quality with longevity can be accomplished through these ayurvedic characteristics. In this perspective, we try to understand prakriti’s use in personalized medicine, and how to integrate it with programs for drug development and discovery.

Hot and Cold Theory: Evidence in Nutrition

Ancient scholars across cultures have postulated that by being less potent versions of herbs, food plays a substantive role in the maintenance of health and treatment of disease. A commonality among these traditional medical systems is in relation to the 'heating' and 'cooling' properties of foods. In this chapter, 'hot' and 'cold' classifications of foods are explored, along with ways to optimize health and combat disease. Scientific evaluations of 'hot' and 'cold' properties are also reviewed in relation to chemical compositions and physiological impacts. A broad scoping Google Scholar search was conducted to identify relevant articles. Scientific evaluations were heterogeneous and of mixed quality. Nonetheless some evidence supported the traditional 'hot' and 'cold' classifications. Overall, 'heating' foods were associated with metabolism and sympathetic nervous system enhancement via increased proportions of caffeine, carbohydrate, protein, fat, and calories; as well as greater oxidation potential; vasodilatory and pro-inflammatory effects; and higher acidity and aromatic compound content. 'Cooling' foods were contrastly found to be higher in water, fiber, alkalinity, and aliphatic compounds; as well as associated with anti-inflammatory, and detoxification (elimination) processes. With the potential to specifically tailor diets to suit individual needs, further high-quality research to substantiate traditional food classifications is warranted.

¿Qué es la medicina alternativa, complementaria e integrativa?

El concepto de medicina alternativa fue creado por la medicina occidental para identificar prácticas médicas diferentes a la medicina convencional, tales como la medicina tradicional china y acupuntura, homeopatía, terapia neural, medicina osteopática y quiropráctica, medicina ayurveda y la medicina tradicional indígena, que también tienen fundamentos filosóficos, científicos y terapéuticos. Desafortunadamente, con el tiempo se estableció la creencia de que la medicina alternativa comprende todas las prácticas médicas que no son parte de la medicina convencional, lo que ha causado muchas inexactitudes y controversias. La medicina surgió como necesidad de auto preservación del ser humano y que considera a la salud como bienestar completo y a la enfermedad, como pérdida de esta condición. A lo largo de su evolución han emergido diversas racionalidades y algunas de ellas se han convertido en sistemas médicos. La medicina convencional se estructuró en Occidente, fundamentada en racionalidades médicas existentes para la época y enfocada en modificar la enfermedad, lo que resultó en marcadas diferencias conceptuales con sistemas de tratamiento ya existentes que se centraban en el individuo y en modificar los procesos de la enfermedad. Todos los sistemas médicos han generado un impacto en diversos campos sociales. Asimismo, han surgido tendencias y estrategias de integración de la medicina convencional con otros sistemas médicos comoLa electroacupuntura de Voll, la homotoxicología, el balance polar electromagnético, la antroposofía, la sintergética y la biofotónica. Actualmente se considera que el objetivo de la medicina es integrar y complementar conocimientos de diferentes racionalidades médicas dentro del concepto de una sola medicina. Teniendo en cuenta lo anterior, el objetivo del presente artículo es clarificar los conceptos de las diferentes formas de medicina, plantear algunas definiciones al respecto, y proponer una definición de medicina alternativa, complementaria e integrativa.

"Ethno-microbiology" of ethnic Indian fermented foods and alcoholic beverages

The concept of "ethno-microbiology" is to understand the indigenous knowledge of the Indian people for production of culturally and organoleptically acceptable fermented foods by natural fermentation. About 1000 types of common, uncommon, rare, exotic and artisan fermented foods and beverages are prepared and consumed in different geographical regions by multi-ethnic communities in India. Indian fermented foods are mostly acidic and some are alkaline, along with various types of alcoholic beverages. A colossal diversity of microorganisms comprising bacteria mostly belongs to phylum Firmicutes, filamentous moulds and enzyme- and alcohol-producing yeasts under phyla Ascomycota and Mucoromycota, and few bacteriophages and archaea have been reported from Indian fermented foods. Some microorganisms associated with fermented foods have functionalities and health promoting benefits. "Ethno-microbiology" of ethnic Indian people has exhibited the proper utilisation of substrates either singly or in combination such as fermented cereal-legume mixture (idli, dosa and dhokla) in South and West India, sticky fermented soybean food (kinema and related foods), fermented perishable leafy vegetable (gundruk and related foods), fermented bamboo shoots (soibum and related foods) and fermented fish (ngari and others) in North East India, and fermented meat and sausage-like products in the Indian Himalayas, fermented coconut beverage (toddy) in coastal regions, and various types of naturally fermented milk products (dahi and related products) in different regions of India. This review has also highlighted the "ethno-microbiology" knowledge of the people involving the consortia of essential microorganisms in traditionally prepared amylolytic starters for production of cereal-based alcoholic beverages. The novelty of this review is the interpretation of ethno-microbiological knowledge innovated by ethnic Indian people on the use of beneficial microorganisms for food fermentation to obtain the desired fermented food products for consumption.

Medicalisation and Ayurveda: the need for pluralism and balance in global health systems

The current global economic and biomedical perspectives contribute content, strategy, and values to global health systems, like objectification and competition, which encourage the medicalisation of the system. Medicalisation overlooks our interdependence with other beings, the environment and biosphere. In contrast, ancient health traditions like Ayurveda, derived from Asian cultures, provide knowledge of the human being's composition of five basic states of nature that need to remain in constant equilibrium to ensure health (Svasthya). Asian health traditions encourage values like vulnerability and respect to facilitate an inherent relationship with the internal and external environment. The recent pandemic has revealed the fragile vulnerability in this nexus and the consequences to human health and well-being when that equilibrium is disturbed. Serious deliberations and discussions are needed between the modern economic and the Asian frameworks for healthcare which result in two different approaches to health and to health systems. This debate may encourage the creation of a philosophy and structure for a new global pluralistic health system more aligned to nature. These deliberations need to encourage the discussion of Svasthya (health), Soukhya (sustainable happiness), and the inner and outer ecological landscapes experienced by human beings that can be understood through mindful self-awareness. Global health systems need to evolve in the direction of a different, pluralistic philosophy of health that encourages a 'population's self-reliance in health' through an intimate and integrated connection with nature.

Sickle cell disease in India: a scoping review from a health systems perspective to identify an agenda for research and action

INTRODUCTION

Sickle cell disease (SCD) disproportionately impacts Adivasi (tribal) communities in India. Current research has focused on epidemiological and biomedical aspects but there has been scarce research on social determinants and health systems aspects. Given its fragmented distribution, resources and programmes have emerged in west and central India. This scoping review seeks to identify geographical and evidence gaps for action on SCD from a health systems lens.

METHODS

We followed a scoping review protocol, using Google Scholar and PubMed for published literature. Keywords used included sickle cell anaemia/disease, health systems, tribal and India. We used Google search for grey literature. We compiled a list of 55 records (of which 35 were retained), with about half pertaining directly to India and others relevant to similar settings. Results were organised and analysed using the WHO health systems framework to identify geographical and evidence gaps.

RESULTS

We found substantial literature on biomedical and clinical aspects of SCD but little on the design and implementation of programmes in community and Adivasi-specific contexts as well as on social determinants of SCD. There were regional gaps in knowledge in southern and northeast India. Wherever community-based programmes exist, they have originated in civil society initiatives and relatively limited state-led primary healthcare-based efforts pointing to weak agenda setting.

CONCLUSION

Both research and action on SCD especially among tribal populations need immediate attention. While geospatial epidemiology has been well understood, gaps remain in context-specific knowledge for action in several parts, as well as evidence gaps across several health system building blocks, including governance and financing of care. Despite publication of a draft policy, delayed adoption and lapses in implementation have limited the response largely to local communities and non-governmental organisations.

Withania somnifera (L.) Dunal: Opportunity for Clinical Repurposing in COVID-19 Management

As the COVID-19 pandemic is progressing, the therapeutic gaps in conventional management have highlighted the need for the integration of traditional knowledge systems with modern medicine. Ayurvedic medicines, especially Ashwagandha (Withania somnifera (L.) Dunal, WS), may be beneficial in the management of COVID-19. WS is a widely prescribed Ayurvedic botanical known as an immunomodulatory, antiviral, anti-inflammatory, and adaptogenic agent. The chemical profile and pharmacological activities of WS have been extensively reported. Several clinical studies have reported its safety for use in humans. This review presents a research synthesis of in silico, in vitro, in vivo, and clinical studies on Withania somnifera (L.) Dunal (WS) and discusses its potential for prophylaxis and management of COVID-19. We have collated the data from studies on WS that focused on viral infections (HIV, HSV, H1N1 influenza, etc.) and noncommunicable diseases (hypertension, diabetes, cancer, etc.). The experimental literature indicates that WS has the potential for 1) maintaining immune homeostasis, 2) regulating inflammation, 3) suppressing pro-inflammatory cytokines, 4) organ protection (nervous system, heart, lung, liver, and kidney), and 5) anti-stress, antihypertensive, and antidiabetic activities. Using these trends, the review presents a triangulation of Ayurveda wisdom, pharmacological properties, and COVID-19 pathophysiology ranging from viral entry to end-stage acute respiratory distress syndrome (ARDS). The review proposes WS as a potential therapeutic adjuvant for various stages of COVID-19 management. WS may also have beneficial effects on comorbidities associated with the COVID-19. However, systematic studies are needed to realize the potential of WS for improving clinical outcome of patients with COVID-19.

What are the challenges for antibiotic stewardship at the community level? An analysis of the drivers of antibiotic provision by informal healthcare providers in rural India

In many low- and middle-income countries, providers without formal training are an important source of antibiotics, but may provide these inappropriately, contributing to the rising burden of drug resistant infections. Informal providers (IPs) who practise allopathic medicine are part of India's pluralistic health system legacy. They outnumber formal providers but operate in a policy environment of unclear legitimacy, creating unique challenges for antibiotic stewardship. Using a systems approach we analysed the multiple intrinsic (provider specific) and extrinsic (community, health and regulatory system and pharmaceutical industry) drivers of antibiotic provision by IPs in rural West Bengal, to inform the design of community stewardship interventions. We surveyed 291 IPs in randomly selected village clusters in two contrasting districts and conducted in-depth interviews with 30 IPs and 17 key informants including pharmaceutical sales representatives, managers and wholesalers/retailers; medically qualified private and public doctors and health and regulatory officials. Eight focus group discussions were conducted with community members. We found a mosaic or bricolage of informal practices conducted by IPs, qualified doctors and industry stakeholders that sustained private enterprise and supplemented the weak public health sector. IPs' intrinsic drivers included misconceptions about the therapeutic necessity of antibiotics, and direct and indirect economic benefits, though antibiotics were not the most profitable category of drug sales. Private doctors were a key source of IPs' learning, often in exchange for referrals. IPs constituted a substantial market for local and global pharmaceutical companies that adopted aggressive business strategies to exploit less-saturated rural markets. Paradoxically, the top-down nature of regulations produced a regulatory impasse wherein regulators were reluctant to enforce heavy sanctions for illegal sales, fearing an adverse impact on rural healthcare, but could not implement enabling strategies to improve antibiotic provision due to legal barriers. We discuss the implications for a multi-stakeholder antibiotic stewardship strategy in this setting.

Identification of Molecular Network Associated with Neuroprotective Effects of Yashtimadhu (Glycyrrhiza glabra L.) by Quantitative Proteomics of Rotenone-Induced Parkinson's Disease Model

Parkinson's disease (PD) is a progressive neurodegenerative disorder, whose treatment with modern therapeutics leads to a plethora of side effects with prolonged usage. Therefore, the management of PD with complementary and alternative medicine is often pursued. In the Ayurveda system of alternative medicine, Yashtimadhu choorna, a Medhya Rasayana (nootropic), prepared from the dried roots of Glycyrrhiza glabra L. (licorice), is prescribed for the management of PD with a favorable outcome. We pursued to understand the neuroprotective effects of Yashtimadhu choorna against a rotenone-induced cellular model of PD using differentiated IMR-32 cells. Cotreatment with Yashtimadhu choorna extract rescued rotenone-induced apoptosis and hyperphosphorylation of ERK-1/2. Quantitative proteomic analysis of six peptide fractions from independent biological replicates acquired 1,561,169 mass spectra, which when searched resulted in 565,008 peptide-spectrum matches mapping to 30,554 unique peptides that belonged to 4864 human proteins. Proteins commonly identified in biological replicates and >4 PSMs were considered for further analysis, leading to a refined set of 3720 proteins. Rotenone treatment differentially altered 144 proteins (fold ≥1.25 or ≤0.8), involved in mitochondrial, endoplasmic reticulum, and autophagy functions. Cotreatment with Yashtimadhu choorna extract rescued 84 proteins from the effect of rotenone and an additional regulation of 4 proteins. Network analysis highlighted the interaction of proteins and pathways regulated by them, which can be targeted for neuroprotection. Validation of proteomics data highlighted that Yashtimadhu confers neuroprotection by preventing mitochondrial oxidative stress and apoptosis. This discovery will pave the way for understanding the molecular action of Ayurveda drugs and developing novel therapeutics for PD.

Pomegranate Juice Enhances Iron Dialysability and Assimilation in In-Vitro Cell Free and Cell-Based Models

Despite concerted programmatic efforts iron deficiency anemia (IDA) continues to be a global health problem. Per Ayurveda, an Indian Traditional Medical System, natural plant materials such as pomegranate juice (PJ) is indicated as a food supplement to manage IDA. We hypothesized that pomegranate could play a role in improving absorption and assimilation of iron. A cell free in vitro model simulating the gastric and intestinal digestive processes coupled with cell based (Caco-2 and HepG2) models were used to assess iron (FeSO₄ form) dialysability in the presence of PJ. Iron assimilation into cells was measured in terms of the cellular ferritin content. PJ (containing ~13 mg/100 ml natural ascorbic acid equivalent) increased the dialysability of iron by >3 fold when compared to control in the cell free model. An equivalent concentration of ascorbic acid alone increased it only by 1.6-fold. PJ increased the iron uptake in Caco2 cells by ~6-fold and ferritin content by 30% when compared to the ascorbic acid control. Similarly, PJ enhanced the iron uptake in HepG2 cells by ~3 fold and iron assimilation by about 50%. This study establishes a scientific evidence for Ayurveda's claim of using pomegranate in the management of IDA by facilitating iron absorption and assimilation. It provides a simple solution for addressing the global problem of IDA. Synergistic action of multiple phytochemicals, over and above ascorbic acid, in PJ may be responsible for improving iron bioavailability.

Which Is a Good Diet-Veg or Non-veg? Faith-Based Vegetarianism for Protection From Obesity-a Myth or Actuality?

INTRODUCTION

India ranks first among nations with the largest population of vegetarians, and 40% of Asian Indians are vegetarian. There seems to occur a "nutrition transition" among vegetarians in India with a decline in the consumption of whole plant food content and replacement with processed foods, fried foods, and refined carbohydrates. This study evaluates the association between the consumption of a vegetarian diet and the prevalence of morbid obesity necessitating bariatric surgery in Asian Indians.

MATERIAL AND METHODS

This is a retrospective cohort study analyzing records of 235 Indian patients suffering from morbid obesity and who underwent bariatric surgery at our center through the years 2015 to 2017. Pearson's chi-square test for independence of attributes was applied to analyze the difference between a number of vegetarians versus non-vegetarians undergoing bariatric surgery.

RESULTS

The difference in the number of vegetarians versus non-vegetarians undergoing bariatric surgery was not significant for years 2015 and 2017, but the number was numerically higher for vegetarians. The difference was significantly higher for vegetarians in the year 2016. The difference in female vegetarians versus female non-vegetarians undergoing bariatric surgery was not significant for the year 2017 but was significantly higher for vegetarians during the years 2015 and 2016. The difference in male vegetarians versus non-vegetarians undergoing bariatric surgery was not significant for all the years.

CONCLUSION

In an Asian Indian cohort, we found that vegetarian dietary patterns were associated with a higher incidence of morbid obesity culminating in bariatric surgery. Our study is a myth breaker that all vegetarian diets are healthy diets. Our findings can be utilized to discourage refined and processed food consumption and promote healthy vegetarian food choices.

Dietary Protein Deficit and Deregulated Autophagy: A New Clinico-diagnostic Perspective in Pathogenesis of Early Aging, Skin, and Hair Disorders

Background:

Diet has an important role to play in the well-being of human body.

Aims:

The study intends to establish the “hypothesis of conscious, selective, and self-destruction i.e., deregulated autophagy of skin and hair in low dietary protein scenario” by determining the facial profile, clinical presentation, and histopathological correlation of deficient protein intake and missing of meals in a tertiary care aesthetic skin institute.

Methods:

A total of 98 patients of skin- and hair-related complaints were enrolled in the study and a histopathological correlation was established by skin and scalp biopsies in high and low protein groups.

Results:

A significant number of subjects (68.4%) were taking less than half of the recommended daily allowance of proteins and faced problems like hair fall, acne, pigmentation, vitiligo, hirsutism, melasma, and premature aging. Subjects missing breakfast were found to have hypothyroidism, diffuse hairfall, autoimmune disorders like vitiligo, lichen planus, and alopecia areata. Histopathological images from submental area showed loose and fragmented collagen in high carbohydrate group in comparison to high protein group where thick, uniformly stained collagen bundles were found in dermis. Histopathology of scalp tissue showed chronic perifollicular inflammatory infiltrate and fibrosis in high carbohydrate group which was absent in histopathology specimen of high protein group. Patients taking early and nutrient-rich breakfast had higher mean protein intakes and less severe skin and hair problems suggesting a role of circadian rhythm as well.

Conclusion:

Dietary protein adequacy and early breakfast have significant role in preventing self-destruction or deregulated autophagy in trichology and cosmetic dermatology and may prevent various autoimmune, inflammatory, and metabolic diseases.

Ayurveda and medicalisation today: The loss of important knowledge and practice in health?

Ayurveda translates as 'life science'. Its knowledge is not limited to medicine, cure or therapy and is for laypersons, households, communities, as well as for physicians. Throughout its evolutionary history, Ayurveda and Local Health Traditions have reciprocally influenced each other. In modern times, the influence of biomedicine on Ayurveda is leading to its medicalisation. Over the past century, the introduction and perspective of biomedicine into India has made the human being an object for positive knowledge, a being who can be understood with scientific reason and can be governed and controlled through medical knowledge. This paper explores how this shift towards medicalisation is affecting the knowledge, teaching, and practice of Ayurveda. It examines the impact and contribution of processes like standardisation, professionalisation, bio-medicalisation and pharmaceuticalisation on Ayurveda education, knowledge, practice and policies. To maintain health and wellbeing Ayurveda's ancient knowledge and practice needs to be applied at individual, community and health care provider levels and not be limited to the medical system. The current over medicalisation of society is a potential threat to human health and well-being. Ayurveda and LHT knowledge can provide essential teachings and practices to counter-balance this current trend through encouraging a population's self-reliance in its health.

Vegetarian Diet and Cardiometabolic Risk among Asian Indians in the United States

Research studies have shown that plant-based diets confer cardiovascular and metabolic health benefits. Asian Indians (AIs) in the US (who have often followed plant-based diets) have elevated risk for chronic diseases such as diabetes, metabolic syndrome, and obesity suggesting ethnic vulnerability that imply genetic and/or lifestyle causative links. This study explored the association between this ethnic group and diabetes, obesity, and metabolic syndrome after controlling for demographics, acculturation, family history of diabetes, and lifestyle and clinical risk factors. The sample comprised of 1038 randomly selected adult AIs in seven US sites. Prevalence and metabolic syndrome was estimated, and obesity was calculated using the WHO Asian criteria. Multivariate analysis included multinomial logistic regression. The mean age and length of residency in the US were 47 and 18.5 years, respectively. The majority of respondents were vegetarians (62%) and educated. A vegetarian lifestyle was associated with females, food label users, respondents with poor/fair current health status, less acculturated, and those who reported their diet had not changed after coming to the US. Vegetarian status was a protective factor and lowered the risk for diabetes but not for metabolic syndrome and obesity in the regression model. Results provide a firm basis for educational programs.