By Dr.Hiruni Poornima
Obesity can lead to many other diseases, conditions, and complications such as diabetes, heart disease, stroke, and some types of cancer. Today, our main focus will be diabetes and the Ayurveda approach to it. Diabetes mellitus has gained gigantic disgrace in recent times, as it is fast becoming the world’s largest silent killer. According to International Diabetes Federation (IDF) data, 415 million adults suffer from diabetes mellitus at present, and this number will be 642 million by 2040. The prevalence of diabetes mellitus has increased into epidemic proportions in the South-East Asian region in the past few years. As a developing country, Sri Lanka has a prevalence of diabetes in 6.8-10.8% of its population, the International Diabetes Federation has estimated.
Ayurveda introduces diabetes mellitus as madhumeha. The history of diabetes (madhumeha) can be traced back to 1000 BC Caraka Samhita. Descriptions concerning the disease and its management are available in Ayurvedic literature. These literatures have described the etiological factors, signs and symptoms, complications, treatment plans, and prognosis. Caraka Samhita (1000 BC) and Susruta Samhita (1000-600 BC) defined madhumeha as the disease in which the patient passes frequent urine characterised as astringent and sweet. Ayurveda attributes to the multi-factorial aetiology of diabetes food articles that are tikta (bitter), kashaya rasa (astringent), ushna (hot), laghu (light), and ruksha (dry) qualities; a faulty lifestyle like sleeping during the day, lack of exercise, laziness; faulty dietary habits like eating too much curd, fatty foods, and sweets; mental stress; and genetic factors. Ayurveda describes early symptoms of the disease and they are an accumulation of dirt on the teeth (mouth, eyes, nose, and ears), feeling of burning sensation in the palms and soles, stickiness of the skin all over the body, thirst, sweet taste in the mouth, and sweetness of urine. This disease has two main clinical symptoms and they are polyuria, which is an increase in the frequency of urination, and turbid urine. Other than these two, there are some other signs and symptoms as well. Some of them are excessive thirst, excessive perspiration, dryness of palate and throat, desire for sedentary life, flaccidity of muscles, and bad body odour. These are similar to the signs and symptoms of modern science. In modern science, they are explained as follows; polyuria (excessive urination), polyphagia (excessive hunger), polydipsia (excessive thirst), exhaustion/tiredness, body aches, polyneuritis (numbness/tingling), and visual disturbance. 
Acharya Charaka mentions three types of prognosis conditions. If the disease is diagnosed early, then the condition is curable. But unfortunately, we do not diagnose diabetes mellitus at an early stage. Diabetes can mainly be controlled with palliative measures and if the patient is weak, then the disease becomes incurable or difficult to manage. If the patient is having the genetic component as the causative factor for the disease, then also the condition will become incurable.
According to Ayurveda, the line of treatment of madhumeha is strictly based on an individual’s constitution. It is based on an entire change in the lifestyle of the person; along with medication and diet, the patient is also advised to lead a healthy lifestyle and live an active life. The role of diet is equally or even more important in diabetes to control blood sugar level as well as to prevent complications. Cereals like old rice, rice which crops within 60 days, barley; pulses such as red gram (cajanus cajan), kulattha (horse gram), and mudga (green gram); all types of bitter vegetables, fruits (orange, watermelon, apple, Indian gooseberry); and meat can be added to the diet. But according to Ayurveda, one should start with a light diet and then gradually increase the quantity of food. Hard exercises are prescribed for diabetics and obese persons. This is meant for proper utilisation of the fat and to consume the glucose in the body. Some of the hard, productive exercises prescribed by Acharya Shushruta are fighting games, horse riding, cart riding, and walking. Since Ayurveda originated in India, there are other exercises according to the financial position and also according to their community. Other than these hard exercises, yoga improves metabolism in the body. So diabetics should perform different types of yoga. Yoga will definitely help in managing diabetes mellitus.
With regard to drugs, there are so many drugs and formulas but the main drugs are either bitter (tikta) or astringent (kashaya). The treatment line needs to be planned according to the patient’s condition and this must be done by a qualified Ayurveda doctor.
(The writer has a BAMS [Hons] from the University of Colombo, Msc in Food and Nutrition from the University of Peradeniya [Reading], and a Diploma in Panchakarma)