Insights from Ayurveda?

In my last post I was asking about how we could get insight into whether there is a ‘type’ of person that is more likely to suffer from MND.  I wondered whether there might be insights from traditional forms of medicine, such as Ayurveda, that type people according to physical and mental attributes and use that typing to understand the origin of and treat their disease.

I should make it clear here that I’m not asking for, or expecting, any insights into treating MND with Ayurveda.  As far as I know, by the time MND manifests and somebody has symptoms, there are currently no treatments – from any medical tradition – that can reverse the disease’s devastating trend.

But back to the idea of types.  Ayurveda is a several thousand year-old medical tradition that takes a very holistic perspective – humans are not ‘linear beings’ and their spiritual and physical evolution is happening at the same time.  To get some first insights into Ayurveda beyond what I could find on the web I spoke to a friend of mine, who used to work in the Western medical system (in cancer care) but is now a yoga teacher and training as an Ayurvedic practioner in New Mexico.  She studies with Vasant Lad, who was one of the first people to bring Ayurveda to the West.

She introduced me to the idea of Ayurvedic doshas – which I had previously only encountered on products in the Body Shop – which are shorthand for a combination of qualities that tend to cluster together.  There are three dosha types – Vata, Kapha and Pitta – each with different attributes, and the dosha constitution ('prakriti' in Sanskrit)you have when you are born will generally be with you for life.  Most people will have a dominant dosha (either Vata, Kapha or Pitta), many will be di-doshic (two doshas of equal strength, and the third of lesser strength) and there are a very few people who are tri-doshic (with all doshas having equal strength). Everybody has all doshas present in their bodies, it’s just the relative amount of each that differs.  It will also be generally consistent through all of your body systems – skin, digestion, circulation etc – although the exception (of course!) is the mind (or heart-brain as it is known in Ayurveda), which can have a different dosha profile to the rest of your body.

MND is described on sites promoting Ayurvedic treatment as associated with Vata imbalance.  According to Vasant Lad’s description, Vata is the ‘subtle energy associated with movement — composed of space and air, and governs breathing, blinking, muscle and tissue movement, pulsation of the heart, and all movements in the cytoplasm and cell membranes. In balance, vata promotes creativity and flexibility. Out of balance, vata produces fear and anxiety’. I asked my friend if MND being attributed to a Vata imbalance means it only shows up in ‘Vata-type’ people, but a vata disease can develop in any dosha type.  And Vata imbalance is also cited as the origin of Parkinson’s and other neurological disorders.  Furthermore, it could be the other doshas acting to ‘push’ Vata out of balance.  It’s just a question of where (i.e. in which part of which system) the imbalance will show up.

This led us to discuss the idea of a ‘weak link’ – something that everyone has and is an easy entry point for disease (khavaigunya). This could stem from childhood illness or injury, or something inherited – either genetically or behaviourally.  I know this meant something to my mum.  When she was about 30, an Indian taxi driver – who claimed intuitive powers - told her that her weakness was in her nervous system.  She took him very seriously at the time but didn’t think much about what he said until she was diagnosed with ALS.  Is there any way he could have seen a ‘weak link’ in her nervous system from the short time he was with her?  It’s impossible to say.

As usual, I feel full of questions.  My scientific mind would like to interrogate the Ayurvedic approach further.  It feels frustrating to me that if there is a medical system that has brought insights to many millions of people over thousands of years that it’s not part of mainstream thinking in the West.  I wonder what the distribution is of people across dosha types, and whether there are an infinite number of different dosha combinations that all occur with equal frequency.  In my geeky moments I wonder what it would look like if you could measure all of the different dosha compositions and plot them on a three-dimensional graph.  And I wonder what it would reveal if we could analyse and record dosha compositions at the beginning of life and then follow that cohort of people through to see what diseases they go on to develop.  Would it be random, or would we see associations of particular diseases with particular dosha profiles?  I’m sure it’s the latter, but it’s hard to know.  But this would be one of the few ways I can think of to test the explanatory, and predictive, power of Ayurveda.  So what would it take to get that kind of approach included in some of our largest cohort studies, like the Children of the 90's study in Bristol?

But if any disease can occur in any dosha type, then in the case of MND it might not be possible, or helpful, to associate the illness with any particular dosha composition.  I imagine any Ayurvedic practitioner would say that they work more with the person in front of them, and less with abstract concepts.  But it would be interesting to talk to Ayurvedic doctors who have seen a number of patients with MND and to hear what they think.

I wonder whether the complexities of the Ayurvedic approach might be telling us what the Western medical approach tells us too - it’s complicated.  There are lots of different potential ways and reasons someone might develop MND.  And it’s likely going to be a different story for everyone.

The MND 'type'?

A question that has piqued my curiosity for some time is whether we can say anything about the 'type' of people who get MND.  'Type' could include elements of people's personality, but it could be any traits that are more likely to be associated with people that have MND than those who don't develop the disease. Given that about 90% of cases of MND seem to arise spontaneously in the population (that is there is no family history of the disease), then it would be extremely helpful for early diagnosis and possibly intervention if we knew which people would be most likely to go on and develop MND.

Of course, this would never be an exact science, and we have to be cautious about looking for easy patterns.  If learning about MND teaches us anything it is that there are likely a huge variety of reasons why someone develops this disease.  Those could be any combination of genetic background, developmental, environmental, or lifestyle factors, and likely the interaction of all of them over time.  We can't afford to narrow our view to exclude people that don't conform to a stereotype, but equally, a rigorous understanding of type might give us some predictive power, an insight into the mechanism of the disease, or a better grasp of which treatments might bring benefit.

So if there is a 'type' of person that is more likely to develop MND, what kinds of ways could we approach learning about that?

We have the epidemiological data: 1-2 people in every 100,000 will develop MND in any year, and the average age of onset is 57 years.  Slightly more men than women develop ALS, but the proportions even out in older patients.  There seem to be some populations where MND occurs more frequently than we would expect, and one well-known example is in top division Italian football players.  But building up a more insightful picture is really difficult because MND is rare, and so requires big populations to be confident that any increased incidence is not just due to chance, or because of some specific but unusual reason.

This information feels frustratingly crude.

More recently, we are starting to build up a picture of the kinds of things people with MND are exposed to in their lives.  In one US study, MND was more frequently associated with people who had exposures to fertilisers and pesticides, and this has been found - although not consistently - in other studies as well.  Questionnaire-based methods have shown that MND sufferers have higher levels of work and leisure physical activity, and Dutch researchers recently found that increased leisure time physical activity was correlated with an increased risk of MND.  The hypothesis is not that the physical activity causes MND, but that the type of people that favour physical activity are also the people that are more likely to go on and develop the illness.

These are some tantalising clues.

We have the experiences of people who work closely with MND sufferers.  Physicians see hundreds of patients with MND, and some will speculate - with due caveats - about the traits they feel they see more often.  The archetype is someone slim who has led an active life - a 'go-er and do-er', and had little illness to date.  I was really struck by a paragraph that echoes this in the excellent and moving memoir - Rowing Without Oars - by Ulla-Carin Lindquist:

"Who is your typical patient?" I ask Nurse Margaretha.
Her reply comes straightway: "Well-educated, highly intelligent, with great integrity.  Seldom overweight or careless with themselves.  Often sporty.  Eighty per cent of my patients are what one usually calls type-A individuals.  They are high achievers with integrity who make huge demands on themselves."

I recognise all of those features in my mum.  Which is not to say it's true - this is the MND type - but it is interesting.

But it seems to me we need to go much deeper.  We know people come in different shapes and sizes, with different personalities and dispositions.  What we don't understand is how those features relate to illness and wellbeing.  I wonder if there are traditions, other than the Western medical tradition, that are more comfortable with 'typing' people.  I'm thinking of systems such as Ayurveda and Traditional Chinese Medicine.  It might seem a bit far-fetched, but I'm going to investigate.  I'll let you know what I find out!