Ayurveda

Purported Benefits, Side Effects & More
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Ayurveda

Purported Benefits, Side Effects & More
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Ayurveda

Common Names

  • Ayurvedic medicine
  • Traditional Indian medicine

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For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.

What is it?

Ayurveda is a medical system that originated in India. Oral formulations, dietary and lifestyle changes, and yoga or meditation are the main components. Herbs such as curcumin have beneficial effects but should be used under supervision. Yoga and meditation help alleviate side effects associated with cancer and its treatments.

Derived from the Sanskrit words “ayur” (life) and “veda” (knowledge), Ayurveda dates back more than 3,000 years. Treatment is tailored to the individual and consists of oral formulations containing herbal, mineral, spice, and animal components; cleansing practices; dietary and lifestyle changes; and improving mental balance through yoga or meditation.

Commonly used herbs in Ayurveda, such as ashwagandha (Withania somnifera), guggul (Commiphora mukul), boswellia (Boswellia serrata), gotu kola (Centella asiatica), curcumin (Curcuma longa), ginger (Zingiber officinale), aloe (Aloe barbadensis), and garlic (Allium sativum), exhibit antioxidant, antimicrobial, immunomodulatory, or anti-inflammatory properties.

Studies in humans however, are quite limited. Some data suggest various Ayurvedic formulations may be helpful for diabetes, knee osteoarthritis, or rheumatoid arthritis. However, additional studies are needed. One study of guggulipid to treat high cholesterol found it may actually raise cholesterol levels. Curcumin is among the most extensively studied, but positive findings on cancer preventive effects are preliminary.

Lifestyle changes and mind-body modalities are also a core component of Ayurveda. Yoga and meditation have been shown to help reduce symptoms associated with cancer and its treatments.

What are the potential uses and benefits?
  • To treat cancer-related symptoms
    Yoga has been shown to improve sleep, mood, and quality of life, and reduce stress in cancer patients both during treatment and throughout survivorship. Meditation has been shown to reduce anxiety, lower blood pressure, and enhance well-being both in the general population and in oncology settings.
  • To treat diabetes
    Several herbs used in Ayurveda have blood glucose-lowering effects, but the clinical evidence for their use is not strong. More studies are needed.
  • To lower high cholesterol
    A study of the herbal medicine guggulipid found it may actually increase cholesterol levels.
  • To treat arthritis
    A few preliminary studies suggest benefit with various Ayurvedic formulations, but additional confirming studies are needed.
What are the side effects?
  • Skin hypersensitivity and rash with guggulipid.
  • Itching, GI discomfort, nausea, oral ulcers and elevated liver enzymes with Ayurvedic formulations in one study.

Case reports

  • Heavy metals, liver toxicity, and arsenic poisoning with various Ayurvedic preparations.
What else do I need to know?

Patient Warnings:

  • Although heavy metals such as lead, gold, and silver are traditionally used in Ayurvedic formulations, the use of lead for its assumed benefit has been a cause of concern. The US Centers for Disease Control and Prevention reported 12 cases of lead poisoning associated with the use of Ayurvedic medications.
  • Improper use of nasal rinsing devices such as Neti Pots have been associated with rare but severe infections. Only distilled or sterile water should be used and these devices must be cleaned properly after each use.

Do Not Take if:

  • You are taking phenytoin: The Ayurvedic syrup shankhapushpi causes decreased blood concentrations of phenytoin.
  • You are taking CYP450 substrate drugs: Several ayurvedic herbs induce or inhibit CYP enzymes, and may reduce effectiveness or increase the risk of side effects of these drugs.
  • You are pregnant or nursing: Adhatoda vasica, an herb often used for respiratory tract ailments, may induce labor or abortion, and other ayurvedic formulations have caused birth defects.

Special Point:

  • Although Ayurveda is available in a few clinics in North America, there is no licensure for practicing Ayurveda in the United States.
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For Healthcare Professionals

Clinical Summary

Derived from the Sanskrit words “ayur” (life) and “veda” (knowledge), Ayurveda originated in India over 3,000 years ago. Treatment is patient-tailored and consists of oral formulations containing herbal, mineral, spice, and animal components, purgatives, dietary and lifestyle changes, and improving mental balance through yoga or meditation. It is available in a few clinics in North America, but there is no licensure for practicing Ayurveda in the United States. Ayurvedic medicinals, which can contain from a few to hundreds of components, are commonly used to treat chronic diseases such as diabetes, rheumatoid arthritis, Parkinson’s disease, acne, obesity, and cancer.

Studies in humans are quite limited, perhaps in part due to the individualized nature of Ayurveda treatment. Preliminary data suggest some benefit of various Ayurvedic formulations for diabetes (46). In an equivalence study, pain reductions and improved function with either of two traditional ayurvedic formulations were comparable to glucosamine and celecoxib for knee osteoarthritis (47). However, additional safety studies are needed. Other preliminary data suggest that an individualized Ayurvedic treatment may be as effective as methotrexate against rheumatoid arthritis (48). A clinical trial of guggulipid for hyperlipidemia found it may actually raise cholesterol levels (3).

A few Ayurvedic herbs are being investigated for their anticancer potential. Curcumin is among the most extensively studied, but positive findings are preliminary.

Lifestyle changes and mind-body modalities are also a core component of Ayurveda. Yoga has been shown to improve sleep, mood, and quality of life, and reduce stress in cancer patients both during treatment and throughout survivorship. The effects of meditation in reducing anxiety, lowering blood pressure, and enhancing well-being both in the general population and in oncology settings have also been confirmed.

Purported Uses and Benefits
  • Arthritis
  • Cancer-related symptoms
  • Diabetes
  • High cholesterol
Mechanism of Action

Ayurveda emphasizes both health maintenance (Svasthavritha), and diagnosis and treatment (Athuravritha). Patients are classified by their prominent dosha, or physical, emotional, and metabolic type, Kapha, Pitta, or Vata, each located in specific organs and associated with two of the five elements (earth, fire, water, air, and ether) and five senses. The doshas represent properties shared by the organs, body, environment, and cosmos. When a patient’s unique state of dosha is out of balance, illness occurs. Therapy is personalized to the individual’s problems and metabolic characteristics to restore balance through diet and lifestyle modifications, medicinals (herbs, spices, metals and/or animal products), breathing exercises, and meditation. Detoxification (panchakarma) occurs before administration of medicines, which includes bloodletting, induced vomiting, and bowel purging. The therapeutic approach seeks to cure disease by reversing the steps that led to it (eg, administering cooling medicines if Pitta, the hot dosha, is predominant) (10).

Maharasnadi Quathar, a medicinal used to treat rheumatoid arthritis, increases antioxidant enzyme activity, decreases TBARS generation, and improves symptoms in human subjects (16). Many of the frequently used herbs, such as ashwagandha (Withania somnifera), guggul (Commiphora mukul), Boswellia (Boswellia serrata), gotu kola (Centella asiatica), curcumin (Curcuma longa), ginger (Zingiber officinale), aloe (Aloe barbadensis), and garlic (Allium sativum), have been studied extensively in vitro and in vivo, and show antioxidant, antitumor, antimicrobial, immunomodulatory, or anti-inflammatory properties. Herbs often used to treat diabetes, Gymnema sylvestre, Momordica charantia, fenugreek (Trigonella foenum-graecum), Coccinia indica, and Pterocarpus marsupium, show hypoglycemic activity in vitro and in vivo. Mucuna pruriens, used in preparations for Parkinson’s disease, contains L-dopa (17). Rasayana herbs, such as ashwagandha, Asparagus racemosus, Emblica officinalis, Piper longum, and Terminalia chebula that are said to promote positive health showed immunostimulant and adaptogenic activities in an animal study (18). Ayurvedic gold preparations (eg, Swarna Bhasma) have antioxidant and restorative effects in animal models of ischemia (19). The herbal mixtures Maharishi Amrit Kalash-4 and -5 have antioxidant properties, inhibit LDL oxidation in vitro, inhibit platelet aggregation, and cause a reduction in aortic arch atheroma in hyperlipidemic rabbits (20).

An in vitro study investigated the activity of extracts from eight plants that are traditionally used as immunomodulators in Ayurvedic medicine against HIV: Allium sativum, Asparagus racemosus, Coleus forskohlii, Emblica officinalis, Glycyrrhiza glabra, Piper longum, Tinospora cordifolia and Withania somnifera (21). The extracts significantly reduced viral production in human lymphoid CEM-GFP cells infected with human immunodeficiency virus (HIV-INL4).

Warnings
  • Although heavy metals such as lead, gold, and silver are traditionally used in Ayurvedic formulations, the use of lead for its assumed benefit has been a cause of concern. The US Centers for Disease Control and Prevention reported 12 cases of lead poisoning associated with the use of Ayurvedic medications (22).
  • Improper use of nasal rinsing devices such as Neti Pots have been associated with rare but severe infections. Only distilled or sterile water should be used and these devices must be cleaned properly after each use (31).
Adverse Reactions

Dermatologic hypersensitivity with guggulipid (3)

Pruritus, epigastric discomfort, nausea, oral ulcers and elevated serum glutamic pyruvic transaminase (SGPT)/alanine aminotransaminase with Ayurvedic formulations in one study (47).

Case reports

  • Lead poisoning, severe GI symptoms, and anemia with Ayurvedic preparations (23) (24) (32) (33) (34) (35) (36) (37) (38) (42).
  • Arsenic poisoning, manifested by hyperkeratosis, neuropathy, splenomegaly and anemia, following use of ayurvedic medications for dermatitis, vitiligo, and diabetes (39).
  • Acute liver injury and death from a formula containing heavy metals and volatile organic compounds (43).
  • Oxytocic and abortifacient effects with Adhatoda vasica, an herb often used for respiratory tract ailments (16) (19) (25) (26) (27) (28) (29).
  • Fatal congenital defects in the fetus with the ingestion of ayurvedic tablets by a pregnant woman. Analysis of the tablets revealed presence of lead, mercury, and arsenic (44).
Herb-Drug Interactions

Phenytoin: The Ayurvedic syrup shankhapushpi causes decreased blood concentrations of phenytoin (49).
CYP 450 enzymes: Guggul induces CYP3A4 activity and may interact with medications that are metabolized by the CYP3A proteins (30).

References
  1. Rasmussen LB, Mikkelsen K, Haugen M, Pripp AH, Førre ØT. Treatment of fibromyalgia at the Maharishi Ayurveda Health Centre in Norway. A six-month follow-up study. Clin Exp Rheumatol. 2009 Sep- Oct;27(5 Suppl 56):S46-50.
  2. Ayurvedic interventions for diabetes mellitus: A systematic review. Evid Rep Technol Assess 2001;41.
  3. Szapary PO, et al. Guggulipid for the treatment of hypercholesterolemia. A randomized controlled trial. JAMA 2003;290(6):765-772.
  4. Singh BB, Vinjamury SP, Der-Martirosian C, Kubik E, et al. Ayurvedic and collateral herbal treatments for hyperlipidemia: A systematic review of randomized controlled trials and quasi-experimental designs. Altern Ther Health Med. 2007 Jul-Aug;13(4):22-8.
  5. Prakash VB, Prakash S, Sharma R, Pal SK. Sustainable effect of Ayurvedic formulations in the treatment of nutritional anemia in adolescent students. J Altern Complement Med. 2010 Feb;16(2):205-11.
  6. Chawla YK, et al. Treatment of dyspepsia with Amalaki (Eblica officinalis Linn.) - an Ayurvedic drug. Indian J Med Res 1982;76(suppl):95-8.
  7. Cohen L, et al. Psychological adjustment and sleep quality in a randomized trial of the effects of a tibetan yoga intervention in patients with lymphoma. Cancer 2004;100(10):2253-60.
  8. Carlson, LE, et al. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology 2004;29:448-74.
  9. Cassileth, BR. The Alternative Medicine Handbook. New York (NY):W. W. Norton & Co;1998.
  10. Chopra A, Doiphode VV. Ayurvedic medicine: Core concept, therapeutic principles, and current relevance. Med Clin N Amer 2002;86:75-89.
  11. Antarkar DS, et al. A double-blind clinical trial of Arogya-wardhani - an Ayurvedic drug - in acute viral hepatitis. Indian J Med Res 1980;72:588-93.
  12. Paranjpe P, Kulkarni PH. Comparative efficacy of four Ayurvedic formulations in the treatment of acne vulgaris: A double-blind randomized placebo-controlled evaluation. J Ethnopharmacol 1995;49:127-32.
  13. Paranjpe P, Patki P, Patwardhan B. Ayurvedic treatment of obesity: A randomized double-blind, placebo-controlled clinical trial. J Ethnopharmacol 1990;29:1-11.
  14. Chopra A. Ayurvedic medicine and arthritis. Rheum Dis Clin N Amer 2000;26:133-43.
  15. Chopra A, et al. Randomized double blind trial of an ayurvedic plant derived formulation for treatment of rheumatoid arthritis. J Rheumatol 2000;27:1365-71.
  16. Thabrew MI, et al. Antioxidant potential of two polyherbal preparations used in Ayurveda for the treatment of rheumatoid arthritis. J Ethnopharmacol 2001;76:285-91.
  17. Nagashayana N, et al. Association of L-DOPA with recovery following Ayurveda medication in Parkinson’s disease. J Neurol Sci 2000;176:124-7.
  18. Rege NN, Thatte UM, Dahanukar SA. Adaptogenic properties of six Rasayana herbs used in ayurvedic medicine. Phytother Res 1999;13:275-91.
  19. Shah ZA, Vohora SB. Antioxidant/restorative effects of calcined gold preparations used in Indian systems of medicine against global and focal models of ischemia. Pharmacol Toxicol 2002;90:254-9.
  20. Sundaram V, et al. Inhibition of low-density lipoprotein oxidation by oral herbal mixtures Maharishi Amrit Kalash-4 and Maharishi Amrit Kalash-5 in hyperlipidemic patients. Am J Med Sci 1997;314:303-9.
  21. Sabde S, Bodiwala HS, Karmase A, et al. Anti-HIV activity of Indian medicinal plants. J Nat Med. 2011 Mar 3.
  22. Lead poisoning associated with ayurvedic medications—five states, 2000-2003. MMWR Morb Mortal Wkly Rep 2004 Jul 9;53(26):582-4
  23. Claeson UP, et al. Adhatoda vasica: A critical review of ethnopharmacological and toxicological data. J Ethnopharmacol 2000;72:1-20.
  24. van Vonderen MG, et al. Severe gastrointestinal symptoms due to lead poisoning from indian traditional medicine. Am J Gastroenterol 2000;95:1591-2.
  25. Ayurvedic interventions for diabetes mellitus: A systematic review. Evid Rep Technol Assess 2001;41.
  26. Ernst E. Adverse effects of herbal drugs in dermatology. Br J Dermatol 2000;143:923-9.
  27. Prpic-Majic D, et al. Lead poisoning associated with the use of ayurvedic metal-mineral tonics. J Toxicol Clin Toxicol 1996;34:417-23.
  28. Spriewald BM, et al. Lead induced anaemia due to traditional Indian medicine: A case report. Occup Environ Med 1999;56:282-3.
  29. Fugh-Berman A. Herb-drug interactions. Lancet 2000;355:134-8.
  30. Dan E, et al. Guggulsterone activates multiple nuclear receptors and induces CYP3A gene expression through the pregnane X receptor. JPET 2004;310:528-535.
  31. Consumer Updates:Is Rinsing Your Sinuses with Neti Pots Safe? U.S. Food Drug Administration. Jan 24, 2017. Accessed February 3, 2021.
  32. Mongolu S, Sharp P. Acute abdominal pain and constipation due to lead poisoning. Acute Med. 2013;12(4):224-6.
  33. Desai A, Staszewski H. Ayurvedic remedy for diabetes as a cause of lead poisoning: A case report. Am J Med. 2012 Oct;125(10):e3-4.
  34. Pierce JM, Estrada CA, Mathews RE Jr. Buyers beware: lead poisoning due to Ayurvedic medicine. J Gen Intern Med. 2012 Oct;27(10):1384-6.
  35. Gunturu KS, Nagarajan P, McPhedran P, Goodman TR, Hodsdon ME, Strout MP. Ayurvedic herbal medicine and lead poisoning. J Hematol Oncol. 2011 Dec 20;4:51.
  36. Centers for Disease Control and Prevention (CDC). Lead poisoning in pregnant women who used Ayurvedic medications from India—New York City, 2011-2012. MMWR Morb Mortal Wkly Rep. 2012 Aug 24;61(33):641-6.
  37. Tsutsui RS, Van Schalkwyk J, Spriggs D. Lead poisoning from Ayurvedic medicines. N Z Med J. 2013 May 10;126(1374):80-3.
  38. Pinto B, Goyal P, Flora SJ, Gill KD, Singh S. Chronic Arsenic Poisoning Following Ayurvedic Medication. J Med Toxicol. 2014 Dec;10(4):395-8.
  39. Kessler CS, Eisenmann C, Oberzaucher F, et al. Ayurvedic versus conventional dietary and lifestyle counseling for mothers with burnout-syndrome: A randomized controlled pilot study including a qualitative evaluation. Complement Ther Med. 2017 Oct;34:57-65.
  40. Amalraj A, Varma K, Jacob J, et al. A Novel Highly Bioavailable Curcumin Formulation Improves Symptoms and Diagnostic Indicators in Rheumatoid Arthritis Patients: A Randomized, Double-Blind, Placebo-Controlled, Two-Dose, Three-Arm, and Parallel-Group Study. J Med Food. 2017 Oct;20(10):1022-1030.
  41. Sharma AK, Basu I, Singh S. Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial. J Altern Complement Med. 2018 Mar;24(3):243-248.
  42. Philips CA, Paramaguru R, Joy AK, Antony KL, Augustine P. Clinical outcomes, histopathological patterns, and chemical analysis of Ayurveda and herbal medicine associated with severe liver injury-A single-center experience from southern India. Indian J Gastroenterol. 2018 Jan;37(1):9-17.
  43. Breyre A, Green-McKenzie J. Case of acute lead toxicity associated with Ayurvedic supplements. BMJ Case Rep. 2016 Jun 30;2016.
  44. Wong A, Dargan P, Koutsogiannis Z, Sokol J, Ramkrishna J, Greene SL. Chronic Ayurvedic medicine use associated with major and fatal congenital abnormalities. Med J Aust. 2015 Dec 14;203(11):443-4.
  45. Lalla JK, Nandedkar SY, Paranjape MH, Talreja NB. Clinical trials of ayurvedic formulations in the treatment of acne vulgaris. J Ethnopharmacol. 2001 Nov;78(1):99-102.
  46. Sridharan K, Mohan R, Ramaratnam S, et al. Ayurvedic treatments for diabetes mellitus. Cochrane Database Syst Rev. Dec 7 2011(12):Cd008288.
  47. Chopra A, Saluja M, Tillu G, et al. Ayurvedic medicine offers a good alternative to glucosamine and celecoxib in the treatment of symptomatic knee osteoarthritis: a randomized, double-blind, controlled equivalence drug trial. Rheumatology (Oxford). Aug 2013;52(8):1408-1417.
  48. Furst DE, Venkatraman MM, McGann M, et al. Double-blind, randomized, controlled, pilot study comparing classic ayurvedic medicine, methotrexate, and their combination in rheumatoid arthritis. J Clin Rheumatol. Jun 2011;17(4):185-192.
  49. Dandekar UP, Chandra RS, Dalvi SS, et al. Analysis of a clinically important interaction between phenytoin and Shankhapushpi, an Ayurvedic preparation. J Ethnopharmacol. Jan 1992;35(3):285-288.
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