Recently there has been several write ups in both conventional and social media about a new area of health science research called Ayurgenomics. Ayurgenomics is supposed to help in smoothly integrating tridosha concept of Ayurveda with modern science. There are even claims that tridosha concept has been validated by modern science using genetic studies. Being a science enthusiast and a practicing medical doctor I was deeply interested and decided to have a close look.
What is Ayurgenomics?
The website of India’s Central Government run CSIR-Institute of Genomics & Integrative Biology has a section titled Ayurgenomics. It says :
In Ayurveda texts, though the principles of phenotypes in health and disease states are extremely well described, they are not readily decipherable and hence its potential has not been appreciated by modern genomic researchers. According to Ayurveda individual’s basic constitution (Prakriti) describes its predisposition and prognosis to disease status and also the treatment for disease and lifestyle regime.
In Genomics, individual’s basic constitution is decided by its genetic makeup which indirectly reflects the levels of various biochemical parameters in individual which states its Health status. We aimed at establishment of high correlation of Prakriti with genomic signatures by isolating DNA, RNA and Plasma from the blood sample. It is anticipated that this approach of Ayurgenomics would allow development of surrogate methods for cost effective screening of predisposed individuals in the population. This would result in development of an integrative approach to systems biology for disease and health state.1
The above concept is explained further by Ayurgenomics researchers like this:
“The three Doshas, i.e., Vata, Pitta, and Kapha, work in harmony to create a state of good health in an individual while also regulating each other. An individual’s basic constitution, Prakriti, is described to be a consequence of the relative proportion of Vata, Pitta, and Kapha”.
The phenotypic diversity in a population, according to Ayurveda, is a consequence of a continuum of relative proportions of Doshas. Although no two individuals can be identical, ancient texts have categorized the baseline phenotypic variability into seven possible constitutional types, namely, Vataja (V), Pittaja (P), Kaphaja (K), Vata-Pittaja (VP), Pitta-Kaphaja (PK), Vata- Kaphaja (VK), and Vata-Pitta-Kaphaja (VPK). Among these, the first three, which have predominance of one of the three doshas, are considered as extremes, exhibiting readily recognizable phenotypes, and are more predisposed to specific diseases.2
In a more simple language this concept of Ayurgenomics can be explained like this. Ayurveda is supposed to divide normal healthy people according to predominance of doshas. It is supposed to determine three things in an individual:
- predisposition to diseases
- Prognosis if having a disease and
- treatment response
Genetics has determined that a person’s body constitution is decided by the genetic makeup. Ayurgenomics aim to show high correlation between genetic factors and Prakriti system of classification of people and thus they claim it will validate the Ayurvedic concept. This they hope will help in finding markers for cost effective screening of individuals predisposed to certain diseases. They also hope to find easy methods to know which type of patients will respond to different types of therapies.
Before we go deep into these claims, let us see what is this Prakriti system of classification.
Tridosha and Prakriti
The central concept of Ayurvedic medicine is the theory that health exists when there is a balance between three fundamental bodily humours or doshas called Vata, Pitta and Kapha. Together these three doshas determine the physiological balance and constitution of the individual which is called as Prakriti in Ayurveda.
But can a person with a loss of balance between doshas be called normal individual?
According to Charaka Samhita if a person is having predominance of one dosha it is unnatural and hence the word prakriti cannot be used. At the same time the Samhita is also mentioning some other physicians who think it can be used:
Some say “there are no persons having all the 3 doshas in equilibrium because of the use of unbalanced food, thus some are having Vata constitution, some Pitta constitution and others Kapha constitution.”
This statement not correct. Why? Because the physicians take the person having balanced V, P and K as healthy, health is normalcy and for the same object therapeutic measures are applied. Hence there are (person having prakrti as) balanced V, P and K but there are no prakrtis (constitution) like V, P or K. Because of predominance of certain dosha in person the respective dosha prakrti of the same is said, but as there can’t be normalcy in imbalanced doshas they can’t be taken as prakrti. The concerned person can only be said as Vattala, Pittala or Kaphaja because they are in the state of abnormalcy.”3
Thus it seems Ayurgenomics researchers are in a way going against the principles expounded by Charaka Samhita .
Prakriti classification in Ayurvedic texts
Ayurveda texts classify vata, pitta and kapha predominant body constitution using a lot of parameters. (See figure below)4
We can see that almost all the features mentioned for classification of humans into vata, pitta and kapha Prakriti are vague and subjective .
Prakriti in Ayurgenomics studies
Since ancient text books were very vague and subjective I was very much interested in finding out how Ayurgenomics researchers determined Prakriti in an objective manner suitable for modern day research. All the papers on the subject has mentioned that Prakriti was determined by Ayusoft software and/or examination by experienced senior Ayurvedic doctors. Both the software and clinicians relied on a set of questions. Following is an example of such a set of questions used for all studies in Ayurgenomics.5
When we look closely at the set of questions used to classify people to different prakritis, we realise that most of them are very subjective and the answers may depend on the whims and fancies of the interviewer or interviewee.
As no values are given that can define terms, how can one objectively say whether the person examined is proportionate/disproportionate, has symmetry/asymmetry, has skin thick/thin etc? How are terms like healing power, memorising, recalling, digestive power etc defined? How to differentiate between deep and sound sleep, regular and irregular thirst etc are anybody’s guess. This method of Prakriti classification by such set of questions used in a series of widely publicised Ayurgenomics studies can only be called highly subjective with very low chance of repeatability.
Low chance of repeatability
This low chance of repeatability was proved by their own studies. In the paper titled Genome-wide analysis correlates Ayurveda Prakriti6 they tried to get healthy adult males between 20-30 years with 60% predominance of one dosha and concordance through 3 stages of analysis by 3 different analysts. Out of 3416 males studied they could get such a concordance only in 971 persons (28%).
Omission of females
The GWAS paper mentioned above did not include females. The authors explain why women were not included like this:
we have excluded female subjects from this study to minimize the confounding variations. …….. hormonal fluctuations result in numerous physical and psychological disturbances, which occur in the premenstrual and menstrual phases. These elicitable and visible features can confound or obscure the Prakriti assessment process.
Then why women who are not in premenstrual or menstrual phase were not included? Authors give a silly and very conservative explanation, not at all apt for scientific research:
Although the Ayurvedic physicians routinely enquire about the menstrual habits of patients while assessing the Prakriti, it would have been difficult for us to make similar enquiries to young, healthy women who volunteered to join this study
Actually the omission of females was deliberate because it was still difficult to get concordance and significant results because of their experience in an earlier study7. Thus when females are excluded only about 14% of general population had a predominance of one Prakriti and concordance with all investigators.
Can a study which represents just 14% of general population determine surrogate methods for cost effective screening of predisposed individuals in the population?
Prakriti disease predisposition and prognosis
The notion that Prakriti system of classification can determine predisposition and prognosis to disease status and also the treatment for disease and lifestyle regime is just a hypothesis. Nobody has proved that hypothesis yet though it is easily testable.
When I looked through the Ayurgenomics studies, I saw that one of the study actually tested that hypothesis.
In the paper titled Potential of Ayurgenomics Approach in Complex Trait Research: Leads from a Pilot Study on Rheumatoid Arthritis8 they had compared the incidence of Rheumatoid arthritis in people with different Prakritis determined by the above set of questions. They found that 86% of those with Rheumatoid Arthritis had either pitta or kapha Prakriti. People with vata prakrthi seems to have the least predilection for Ama vata (Rheumatoid Arthritis). This is in stark contrast to the claim in classic Ayurvedic texts that Ama vata is more common is vata Prakriti group.
Thus it seems at least this study as a part of Ayurgenomics disproves the claims of tridosha hypothesis.
Does Ayurgenomics validate tridosha hypothesis?
So does Ayurgenomics integrate tridosha concept of Ayurveda with that of modern science?
The answer has to be no as the hypothesis of relationship between tri doshas and diseases is yet to be proven to be true.
What are these doshas? In which part of the body and in what form it exists? How it can be quantified? No answers has come out. The tragedy is nobody is doing any study to prove or disprove it.
Pitta and metabolism – grasping at straws?
The authors of the study Genome-wide analysis correlates Ayurveda Prakriti, claim that:
We found PGM1 gene associated with the Pitta phenotype. In Ayurveda, characteristics of Pitta include digestion, metabolism and energy production. Interestingly, we found PGM1 gene is in the center of many metabolic pathways i.e. glycolysis or gluconeogenesis (hsa00010); pentose phosphate pathway (hsa00030); galactose metabolism (hsa00052); purine metabolism (hsa00230) and; starch and sucrose metabolism (hsa00500) (Figure S7). Our finding suggests that the function of the gene directly correlates with the role of Pitta in metabolism as described in Ayurvedic literature.6
They conclude in the abstract of the paper like this:
Subsequently, we found that PGM1 correlates with phenotype of Pitta as described in the ancient text of Caraka Samhita, suggesting that the phenotypic classification of India’s traditional medicine has a genetic basis; and its Prakriti-based practice in vogue for many centuries resonates with personalized medicine.
This is a grossly false statement. Author of the ancient text Caraka Samhita do not know what is PGM1. So how can that text say PGM1 correlates with Pitta?
As per Charaka Samhita the function of Pitta are:
“vision, digestion, heat, hunger, thirst, softness in body, complexion, lustre, cheerfulness and intellect prowess, exhilaration, clarity “9
As per that ancient text the diseases of alimentary canal correlating with excess of pitta are:
hyper- acidity, burning in the stomach and esophagus, internal burning, burning in scapular region, foul smell in body,, jaundice, bitterness in mouth, bloody smell from mouth, foetid smell from mouth, excessive thirst, loss of contentment, stomatitis, inflammation in throat etc10
There is no mention that Pitta is associated with metabolism. Pitta was supposed to be associated with digestion but that is an entirely different process . To say that the vague mention of heat correlates with metabolism is an over-reading. Also among the organs where Pitta is supposed to be located liver, the prime organ of metabolism is never mentioned.
So how can the authors claim that “Our finding suggests that the function of the gene directly correlates with the role of Pitta in metabolism as described in Ayurvedic literature“?
Does Ayurgenomics prove anything?
So what did all those studies on Ayurgenomics did prove?
They have shown that there is an association between presence of certain single nucleotide polymorphisms (minor changes in genes ) and a person ‘s phenotype. A phenotype is the composite of an organism’s observable characteristics or traits. A phenotype results from the expression of an organism’s genes as well as the influence of environmental factors and the interactions between the two. So the fact they have shown, the changes in genes (SNPs ) influence a person’s phenotype, is well known to science.
Will it help in finding markers for cost effective screening of individuals predisposed to certain diseases? For that it has to be proved that people of certain prakrthi (body constitution ) is predisposed to certain diseases. Say for example excess of pitta is supposed to produced hyper acidity . So we can compare people who are supposed to have pitta predominance and those who do not have pitta predominance and find out the level of Hydrochloric acid in stomach and the incidence of peptic ulcer . If a correlation was found it has to be repeated a few times in different settings to really prove the correlation. Without proving it there is no point in thinking about cost effective screening for markers.
A bigger problem in such a research is the difficulty to find out objectively those people with pitta predominance. The repeatability of dividing people into three prakrthi types using the subjective questionnaire used in Ayurgenomics study is questionable . The authors could get a consensus on prakrthi predominance only in about 14% of population they studied.
The Indian government funded Ayurgenomics studies are based on weak science. No attempt is being made to know about the structure, site of occurrence, properties of doshas that are supposed to determine health and diseases. No attempt is being made to prove the primary hypothesis of Prakriti concept that excess of certain doshas produces certain diseases. They are not trying to come out with an objective tool for measuring the prakriti.The fact that genotype influences phenotype is not a new discovery and do not add anything to science. The whole exercise can be considered as a part of a hyper nationalist revivalist agenda to confuse people so as to make it appear that ancient Indian Ayurvedic concepts are based on Science.
- ACS Chem. Biol. 2011, 6, 875–880
- Charaka Samhita – Vimana sthana 6: 13-19
- Journal of Translational Medicine 2008, 6:48
- Journal of Translational Medicine 2008, 6:48 -Addl file 2
- Scientific Reports 5, Article number: 15786 (2015)
- Journal of Translational Medicine 2008, 6:48 -Fig 2
- PLoS ONE 7(9): e45752. doi:10.1371/journal.pone.0045752
- Charaka Samhita – Suthrasthana 12-11, Su18-50
- Charaka Samhita –Suthrasthana 20-14