Science of nutrition in Ayurveda: Need for conceptual framework for scientific validation and mainstreaming

Background The field of nutrition examines the intricate relationship between food and health, whereas dietetics focuses on meal planning for both healthy individuals and those with health concerns. Although it has developed into a comprehensive and structured area of study, modern viewpoints often concentrate on the basic components of the diet. In contrast, Ayurveda offers a broader perspective on dietetics and nutrition, considering various factors such as quality, quantity, food processing methods, the rationale behind food combinations, emotional states, individual nature, and geographical and environmental conditions. These elements are crucial for maintaining health and preventing disease. There is an increasing interest in nutraceuticals, which provide health benefits and serve as alternatives to traditional medicine. Ayurveda addresses the use of foods as health supplements aimed at enhancing quality of life and supporting both preventative and therapeutic measures [Table 1]. Historically, dietetics emerged as a well-established science in ancient India. However, rapid shifts in diet and lifestyle have led to a rise in noncommunicable diseases (NCDs), particularly those associated with lifestyle choices. Ayurvedic principles are vital in both preventing and managing these conditions.Table 1: Prophylactic and therapeutic nutritionA health-promoting regimen is central to Ayurvedic therapeutics, where specific dietary and lifestyle recommendations accompany medicinal treatments. This holistic approach aims to restore balance and overall well-being. Thus, prioritizing diet planning based on Ayurvedic principles can significantly contribute to health promotion, disease prevention, and effective management of health issues.[1] Classification of Foods Classics of Ayurveda classify food into 12 basic categories based on source, preparation method, and utility, such as 1. Shukandhanya (corns with bristles), 2. Shamidhanya (pulses), 3. Mamsa (meat), 4. Shaka (vegetables), 5. Phala (fruits), 6. Harita (salads), 7. Madya (fermented drinks), 8. Ambu (water), 9. Gorasa (milk and milk products), 10. Iksuvikara (products of sugar cane), 11. Krtanna (food preparations), and 12. Aharayogi (accessory food articles). In addition, the convenience of consumption shows how food articles are classified into different forms, as cited in Charaka Samhita and Bhava Prakasha. Acharya Charaka has explained four forms of diet—Asita (eatable), Khadita (masticables), Pita (beverages), and Lidha (lickables). Whereas Bhavaprakasa has explained six forms of diet—Chavya (masticable) as fruits, Cusya (chewable) as sugarcane, Lehya (lickable) as honey, Peya (drinkables) as milk beverages, Bhojya (partially masticable) as rice, and Bhaksya as sweets. Diet plays an important role in keeping the mind healthy, and explicit psycho-pharmacological effects of food led to the classification of food into the following three categories. 1. Satvika diet: an ideal diet containing vegetarian, nonoily, nonspicy components that are congenial to the body and mind. 2. The Rajasika diet is too spicy, hot, sour, and salty; it leads to stimulation of cognitive function. 3. Tamasika diet: too oily, heavy food; reduces mental competence.[2-4] Historical Note and Basic Concept The history of dietetics is as old as civilization. The Vedas (3000-1000 BC) recognized the importance of food nutrition discipline and conducted an understanding of nutrition dynamics and pharmaco-dynamics. Almost all the Upanisadas (3000-1000 BC) of Krsnayajurveda, such as Kathopanishad and Kenopanishd, start with a common version that signifies the universal dietetic regimen prevalent in ancient enlightened civilization. The Ayurvedic text Charaka Samhita proposed diet as a key determinant of health and disease, demonstrating its medico-historical importance. Adding to this, Manusmriti emphasizes food's importance and advocates certain discipline on the part of its user. It further mentions that taking the food with devotion and eagerness gives strength and energy, but on the other hand, dislike or aversion destroys both.[5] Insights on Dietary Discipline The Sanskrit synonyms denoting the human body (viz. Kaya, Deha, and Sharira) are indicative of nutrition dynamics and different metabolic aspects of nutrition as the term “Kaya” represents growth and development by nutrition, “Deha” stands for anabolism, whereas “Sharira” symbolize catabolism. Major classics of Ayurveda delineate the system of eating food covering physiological, social, spiritual, psychological, and environmental aspects. A few of these rules comprise: 1. One should consume food with full eating awareness, that is, “Tanmanabhunjita.” 2. Every country enjoys varied food traditions, as per the region. Hence, one should consider the type of food and quantity according to the habitat for maintaining good health (Desha Satmya). 3. One must take wholesome food in the correct quantity and time to maintain the homeostasis of all three biological humors (Doshas). 4. Ayurveda strongly regards that eating before or after the usual timings of meals is unhealthy or “Swasthyavighatakd” which causes physical and mental illness. 5. Sushruta advises the intake of easily digestible, energetic, soft, and warm food to be taken in proper quantities only when one is hungry. Furthermore, Ayurveda emphasizes achieving optimum benefits from nutrition, viz. longevity, immunity, and mental competence.[4,5] Ayurveda also specifies eight major aspects (Astavidha Ahara Vidhi Visesha Ayatanas) viz. food convention that includes compatibility of dietary components, which are determinant factors for the maintenance of health viz.1. Prakrti—qualitative characteristics of the food, 2. Karana—processing of food, 3. Samyoga—mixing/ combination, 4. Rashi—the quantity, 5. Desha—habitat of the person, 6. Kala—time and seasonal variation, 7. Upayoga Samstha—variable digestibility of different food articles, and 8. Upayokta—the person who takes the food.[5] Food Incompatibility Food with incompatible or contradictory qualities has a toxic effect on the body that aggravates Tridoshas intern, leading to various disorders and also destroys strength, vigor, memory, and immunity. A few contradictory food combinations are 1. Fish or its soup along with milk. 2. Equal quantity of honey with ghee. 3. Milk or milk products with alcoholic beverages. 4. Processed food or cereals with milk. 5. Radish consumed with milk. 6. Lotus stem with honey. Regulation Food Safety and Standards Authority of India [(FSSAI) and D and C Acts Brief Note] The Ministry of Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy(Ayush) has notified the regulations in the official gazette, in consultation with the FSSAI, to recognize India's age-old principles of Ayurveda and the Aahara prepared as per ancient texts and has formulated Food Safety and Standards (Ayurveda Aahara) Regulations, 2022. The “Ayurveda Aahara” is defined in the regulation as food prepared according to the recipes, ingredients, or processes as per the method described in the authoritative books of Ayurveda listed under “Schedule A” of these regulations. FSSAI has also formulated a logo for “Ayurveda Aahara” to create its unique identity for easy identification, and the same was launched by the Minister for Health and Family Welfare on June 7, 2022. Necessity of Scientific Validation for Mainstreaming Ayurvedic principles certainly play an important role in the prevention and management of NCDs. Health-promoting regime (Pathya Vyavastha) is the hallmark of Ayurvedic therapeutics. Specific diet and lifestyle guidelines are always prescribed along with the drugs and therapies to facilitate the restoration of homoeostatic bio-mechanisms (Dhatu-Samyata) and well-being. Therefore, emphasis on diet planning based on Ayurveda principles would certainly help promote health, prevent diseases, and manage them. Ayurveda evolved as a comprehensive healthcare system systematically through scientific experimentations of high order backed by sound and reproducible evidence base and stood the test of time. The holistic approach of Ayurveda poses considerable challenges in research, due to diverse concepts and complex approaches in clinical trial design, diagnosis and therapy, assessment of outcomes of clinical efficacy and drug interactions, and synchronization of Ayurveda and bio-medicine approaches. An appropriate model addressing the above issues would undoubtedly facilitate the design of research plans satisfying the fundamental principles of Ayurveda. Well-designed experimental studies to validate the safety, biological activity, drug interactions, and possible mechanism of action will possibly provide tangible scientific evidence leading to adopting suitable models, research plans, and scientific parameters may provide a clear insight with good translational value. Conclusion and the Way Forward The integration of Ayurvedic principles into nutritional practices offers a unique perspective, emphasizing the alignment of dietary choices with the natural laws governing body and mind. As we move forward, it is essential to consider the specific effects of dietary interventions to achieve optimal health outcomes. These studies should focus on validating the safety, biological activity, and mechanisms of action of Ayurvedic interventions followed by appropriate clinical studies that yield valuable insights with significant translational potential. Key areas for future focus include Mainstreaming Ayurvedic nutritional principles through advocacy for the integration of Ayurveda in clinical nutrition, particularly in secondary and tertiary care Ayush Hospitals. This will further enhance the understanding and application of these principles in health and disease management. Promotion of evidence-based practices by implementing evidence-based approaches, such as antenatal care and Ayurvedic nutritional interventions in pediatrics and geriatrics, can significantly improve health outcomes across various demographics. Development of standardized guidelines to establish standardized Ayurvedic treatment protocols for managing major nutritional issues, such as protein energy malnutrition, will provide clinicians with reliable frameworks for patient care. Innovative dietary solutions such as creation of “ready-to-eat” Ayurvedic dietary supplements and clinical dietetics, including traditional recipes, such as Peya, Manda, and Villepi, can facilitate the practical application of Ayurvedic nutrition in healthcare settings. By focusing on these areas, the potential of Ayurveda can be harnessed to enhance nutritional well-being, ultimately contributing to the overall health of communities and the economic prosperity of nations. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.