Authors: Sarbere Preeti, Sarbere Laxminarayan, Mandole Rahul and Khan Sadik

Madhavbaug Cardiac Clinic Jatpura, India

Corresponding Author: Sarbere Preeti, Madhavbaug Cardiac Clinic Jatpura, India; E-mail: drprretisarbare@gmail.com

Background: Cardiovascular disease, which is on the rise worldwide and has several factors, including poor diet and lifestyle choices, is particularly common in developing nations. The traditional medicinal system of Ayurveda provides treatments for various illnesses, including critical ones. Panchakarma is a purification procedure that improves immunity, lowers stress levels along with other health benefits. This study sought to determine the role of Ayurvedic aahar (diet) and panchakarma therapy in stabilizing low-grade atherosclerotic plaque in individuals with known coronary artery disease (CAD).

Aim: To study the effect of the Ayurveda aahar (diet) and Ischemia Reversal Program(IRP) panchakarma therapy in the treatment of low-grade atherosclerotic plaque in individuals with known coronary artery disease (CAD).

Methods: A total of 16 patients suffering from low-grade atherosclerotic plaque with known CAD were enrolled in the study. All the patients were administrated with IRP and a reversed diet kit for 90 days with regular follow-ups. The primary endpoint was the change in total Soft Plaque compared to the baseline. The secondary endpoint was to improve total atheroma plaque volume, Low-density lipoprotein (LDL), triglyceride, weight, and Met Value.

Results: It was observed that the patients showed a -22.12% change in soft plaque followed by a -20.87% change in Total atheroma volume (TAV). Additionally, significant improvement in values of body weight, body mass index (BMI), abdominal girth (ABG), heart rate, Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Met Value, Vo₂ Max and reduction of dependence on allopathic medications were seen after the 90 days of treatment.

Conclusion: Panchakarma and Ayurveda aahar were effective in reducing Total Soft Plaque, TAV along with BMI, ABG, HR, SBP, DBP, lipid profile, Met value, and VO₂ Max were significantly improved.

Keywords: Panchakarma; Ayurveda Aahar; Atherosclerotic Plaque; Coronary Artery Disease

Cardiovascular diseases (CVD) are now the leading cause of death and disability in industrialized countries. The fact that only developing countries account for three-quarters of these fatalities is concerning. Even though CVD-related mortality is down in developed countries, it is still an issue in developing countries like India, exacerbating the problem [1]. The acute coronary syndromes of unstable angina, myocardial infarction, and sudden death are mostly brought on by plaque disintegration with superimposed thrombosis [2]. The way CVDs are treated has changed significantly during the past 30 years. Three main preventative strategies-drug therapies, lifestyle change, and stress management therapies-have been developed as a result of attention to primary and secondary prevention of cardiovascular disease and its associated risk factors. Even after all of these efforts, up to half of individuals with diagnosed CVD experienced repeated cardiac episodes [3]. One of four significant risk factors has reportedly been found in the majority of people with established CVD. These four major risk factors are obesity, hypertension, hyperlipidemia, and diabetes [4]. The majority of therapy methods emphasize lowering these significant risk factors. Drug therapy is frequently used to treat diabetes, hyperlipidemia, and lower hypertension. Healthy eating, increased exercise, weight management, quitting smoking, and drinking alcohol in moderation are all examples of lifestyle modification therapy. Techniques for stress reduction include methods to lessen or eliminate its effects. Altering one's way of life and lowering stress treatments are designated as "primordial prevention," assisting with primary and secondary CVD prevention efforts [5]. Drug interventions proposed to slow the development of atherosclerosis include statins, -blockers, ACE inhibitors, antithrombotic, effective estrogen usage, and antioxidants [6]. Harmful side effects and medication interactions complicate drug therapy. However, the CVD epidemic has not been stopped by these therapeutic options. Classical Ayurvedic writings discuss many therapeutic modalities for enhancing the functional ability and quality of life in patients with cardiovascular disorders. In India, Ayurveda is a recognized form of conventional medicine. Numerous studies have additionally shown the value of panchakarma therapy in the treatment of a wide range of illnesses. Five steps make up the Ayurvedic panchakarma therapy, which is known to remove harmful toxins from the body and provide the patient with the most potential health benefit. There is not enough systematic scientific data to support it, despite the fact that Ayurveda practitioners successfully use it in practice.

Thus, this study is designed to evaluate the efficacy of Ayurveda Aahar and panchakarma therapy in stabilizing low-grade atherosclerotic plaque in known coronary artery disease (CAD).

This is an observational study of 16 patients suffering from CAD of any gender and age who had attended the outpatient department of Madhavbaug clinic, Chandrapur between March 2020 and March 2022 for 90 days. Patients with unstable angina, post coronary artery bypass graft (CABG), heart failure with reduced ejection fraction (HFrEF), and chronic kidney disease (CKD) were excluded from the study.

Basic demographics for all the patients were recorded.

Intervention

All the patients were administrated with Ischemia Reversal Program (IRP) [6], which includes panchakarma treatment and a reverse diet kit [8].

The IRP therapy consists of three steps namely Snehana, Swedana, and Basti. Snehana is an oleation method that involves oil massage with Sesame and Lavender oil. Swedana is a Thermal vasodilation in which passive heat therapy is done by Dashmoola (group of ten herbal roots) with steam at <40 degrees Celsius. And lastly, Basti is a per rectal drug administration. It is a decoction therapy of medicated herbs (Tribulus terrestris, Curcuma longa, Phyllanthus emblica) administered to the patient by the rectal route.

All patients received a diet specially created for CAD patients and consisting of low calories, low carbs, moderate fat, high antioxidant capacity, moderate protein, enriched with vitamin C, and boosted with vitamin E. The diet was administrated for 90 days with regular follow-ups.

The current study used a pre-and post-test experimental design for patients with CAD to evaluate the effects of Madhavbaug's reverse diet kit, a kit that was created with scientific precision. The diet box included pre-portioned, prepared foods that could be cooked right away to meet the daily needs for breakfast, lunch, supper, soup, and early morning diet. High Oxidative Radical Absorption Capacity (ORAC) units, or 64,000 per day, were included in the reverse kit diet meal. Normal subjects need 12000 ORAC units per day, while standard food only has a 3000-4000 ORAC value per serving. The reverse diet kit is created specifically to support the patient's active antioxidant system. The kit's additional benefit over other recommended diets up to this point is that it enables the patient to attain the desired energy deficit. The patient was given a daily diet of 1000 calories so that they would be in a calorie deficit and eventually use body fat to fulfill their daily calorie needs of 1500 calories, which reduced their visceral obesity.

The effect of the reverse diet kit and IRP panchakarma therapy was studied on 16 patients with low-grade atherosclerotic plaque in known CAD. Following the screening procedure, it was determined that 16 patients were eligible for trial inclusion. Out of 16 patients, 14 patients (87.5 %) were male. The mean age of the patients is 60.88 ± 11.74. Table 1 shows the changes in basic demographic parameters noticed in the patients before and after the treatment.

Table 1: Demographic and Plaque Characteristics.

It was observed that after the treatment the patients showed -20.87% and -22.12% changes in Total atheroma volume (TAV) and soft plaque respectively. The basic body parameters such as weight, Body mass index (BMI), abdominal girth (ABG), and heart rate (HR) showed -9.61%, -9.42%, -7.91%, and 1.27% changes after 90 days of the treatment. The Systolic blood pressure (SBP) and Diastolic blood pressure (DBP) showed -3.62% and -2.17% respectively changes in values. The lipid profile also showed significant changes after the treatment. Low-density lipoprotein (LDL), High-density lipoprotein (HDL), triglycerides, and total cholesterol showed 1.60%, 3.76%, -20.82% and 2.27% respectively changes. Also, the Met value changed by 55% and VO₂ Max changed by 52.95% after the treatment [Figure 1]. Overall -39.39% change in medicines was observed in the patients after the treatment.

It has been discovered that inflammation plays a key role in both the beginning and the development of atherosclerosis, which ultimately results in cardiovascular events like CHD [8] If the process of inflammation is interrupted over time, the atheroma that develops when an inflamed coronary tries to heal itself may disappear, but there is a chronic phase of inflammation that results in progressive atherosclerosis. Despite recent therapeutic advancements, the prevention of atherosclerotic vascular disease remains crucial [9]. The main goal of atherosclerosis research has been to slow plaque progression. According to several investigations, switching from a high-cholesterol to a low-cholesterol diet may cause plaque regression as evidenced by a smaller plaque area [10]. As a result, we have here described how to treat coronary atherosclerosis using panchakarma therapy in addition to ayurveda aahar.

Here, the benefits of reversed diet and IRP panchakarma therapy were examined in patients with low-grade atherosclerotic plaque and known CAD. Both insulin resistance and anabolic insulin growth can be prevented and treated with the low-calorie reverse diet. Panchakarma therapy may enhance blood supply to the myocardium and hence lessen angina symptoms, patients with CAD may see a significant improvement in quality of life [8].

A significant improvement was seen in weight, BMI, ABG, HR, SBP, and DBP of all the patients after 90 days of the treatment. One predictive indicator for heart disease patients is SBP. Since lower SBP lessens the afterload on the ventricles and enhances endothelial function, it is linked to a better prognosis in heart disease [11]. The lipid profile also showed noteworthy changes after the treatment. As cholesterol is transported from peripheral cells to the liver to be processed, the risk of CAD and severe coronary events is reduced. HDL plays a crucial role in this process. The soft plaque and TAV were reduced to a greater extent after the treatment. This study has shown the importance of the fundamental Ayurvedic principle in the stabilization and regression of atherosclerotic plaque. Nitric oxide can be released from the endothelium with the use of Phyllanthrus emblica, curcumin, and other decoctions used for IRP. It may also have anti-inflammatory and antioxidant properties. By generating coronary vasodilation, this action may enhance coronary circulation [12].

The maximum amount of oxygen that may be used when exercising is measured by VO₂ max. Diastolic dysfunction in CAD patients results in lower VO₂ max, clinically showing a decreased ability for work or exercise [11]. IRP and reversed diet kit helped to improve the Met value and VO₂ Max of all the patients after the treatment.

The heavy reliance of CAD patients on traditional allopathic medications drives up the cost of healthcare in economically struggling nations like India. Additionally, these medications' worsening side effects result in lower adherence, which makes the situation even worse [13]. In light of this, we examined changes in patients' reliance on allopathic medicine using IRP and dietary changes. After 90 days, there was a noticeable decrease in dependence on allopathic medicines, along with a rise in the number of patients who stopped taking allopathic medications.

We recommend additional research with a larger sample size despite all of these notable positive outcomes of IRP treatment and ayurveda aahar so that the findings of our study can be confirmed and applied to broader populations.

After panchakarma and ayurveda aahar, Total Soft Plaque, TAV, along with that BMI, ABG, HR, SBP, DBP, lipid profile, Met value, and VO₂ Max were significantly improved. Additionally, the patients’ dependence on allopathic drugs was noticeably lessened. The results of our study indicate that patients with low-grade atherosclerotic plaque in known CAD may benefit from IRP Panchakarma treatment in combination with a reverse diet kit.

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