Nutrition past – nutrition today: prescientific origins of nutrition and dietetics

Nutrition past – nutrition today: prescientific origins of nutrition and dietetics – part 1 : The Nutritional-Dietary Legacy of India

Louis E. Grivetti

Throughout the prescientific era, ancient physicians and practitioners observed what people ate and noted associations between diet and illness. Such nonscientific observations, from prehistoric times into the 18th century, formed the basis for the modern sciences of nutrition and dietetics. Humans have procured food, selected diets and formulated food patterns for more than two million years. Cooking, however, probably does not predate 500,000 B.C. The earliest writings with descriptions of food and human food-related practices stem from ancient Egypt and date only to 3200 B.C. Compared to the antiquity of Homo sapiens and to the discoveries of fire and writing, the sciences of nutrition and dietetics are recent as both emerged barely 200 years ago after the pioneering work of Lavoisier.

The great antiquity of humans and the recent development of scientific nutrition and dietetics raises several interesting questions. What did the ancients eat and were they well nourished? How did preliterate peoples select their diets and formulate their food patterns? What dietary and nutrition principles were noted, recorded and followed in the prescientific era? How different or similar were these principles from modern 20th century practices based upon scientific knowledge?

The study of ancient nutrition and dietetics, called paleo- or historical-nutrition, draws upon a wide variety of data sources. These range from identification and analysis of foods present in the stomach and intestinal contents of ancient mummies, laboratory examination of human skeletal remains, description of food-related art objects to ancient written texts. The oldest surviving documents that record and describe human nutrition and dietetics are from ancient India. Subsequent historical accounts from China and different Mediterranean cultures provide additional valuable prescientific nutrition and dietary information.

Although spatially separated by vast distances, prescientific medical practitioners in India, China and the Mediterranean considered disease and treated illness in a strikingly similar manner. Indigenous diseases in each region were assigned distinctive temperature attributes, whether hot or cold, based upon the observed symptoms and physiological effects upon the body. Similarly, all available foods were classified as to their apparent or potential heating or cooling properties. Practitioners treated disease by diet and assigned foods from the category opposite to that of the disease: cooling foods for a hot illness, warming foods for cold. This prescientific approach to healing, common to ancient India, China, and the Mediterranean, was known in antiquity by the Latin term, contraris contrariia, meaning treatment by opposites. It is better known today by its English term: allopathy. ALLOPATHY: A MODERN CHALLENGE TO NUTRITION EDUCATORS Allopathy, one of several medical-nutritional healing systems that have developed historically, originated in ancient India perhaps 4000 years ago. From India this form of medical practice subsequently spread eastward to China and westward into the Mediterranean region. While born in antiquity, allopathy is widely practiced today by millions in the 20th century. Allopathic principles are followed in north Africa, throughout Asia and by countless citizens of Mediterranean Europe. It is widely practiced today throughout Central and South America and the Caribbean where it probably was introduced after colonial contact in the 16th century.(1)

Allopathy, too, has a rich legacy in North America for it is practiced widely within Asian, Hispanic and European immigrant communities. It flourished throughout colonial America, whether at British, (1) There exists credible evidence from surviving Aztec herbals that allopathy may have been practiced in Central America before the arrival of Cortez in 1517 A.D. French, or Spanish settlements, and was challenged by scientific medical-nutrition only in the mid 19th century after pioneering work and demonstration of the germ-theory origin of disease by Louis Pasteur.

In the United States of America today, allopathy exists side by side with the scientific practice of nutrition and dietetics. While the Western’ scientific model for healing dominates most medical care in America today, allopathy remains the medical treatment of choice for millions of citizens who represent a wide range of ethnic groups in both urban and rural America. Allopathic nutrition-dietary principles, representing a broad spectrum of social, cultural and economic origins and practices, are followed on college campuses and are used by blue collar workers on the automobile assembly lines of Detroit, by Louisiana coastal fisherman and by countless other Americans.

Widespread acceptance and use of allopathy as an alternative to scientific nutrition in the United States presents a modern challenge to science-trained laboratory nutritionists, dietitians and community nutrition educators. Millions of intelligent Americans enrolled in local, state and national nutrition programs reject science as the basis for their medical and nutritional information. They turn, instead, to nonscientific allopathic practices. Yet most dietitians design nutrition education materials based only upon scientific principles that reflect decades of laboratory research. Such materials, when used in nutrition counseling sessions attended by clients who do not believe in science, lead to miscommunication. Science-trained nutrition educators become frustrated when scientific data, RDAs or U.S. Dietary guidelines are ignored, disputed or disregarded by their clients. Sometimes educators perceive some ethnic clients through the narrow perspective of the THREE-U’s, that is, they are “uneducated,” “ungrateful” and “unresponsive” to proper nutrition education. Clients who follow allopathy, in turn, want nutrition information but cannot understand why the information provided is so useless to them and their families. When such conditions of cross-cultural misunderstanding and miscommunication exist, counseling sessions become “dialogues of the deaf,” where educators trained in science who wish to communicate cannot-and clients who wish to learn are unable to do so. GLOSSARY: AYURVEDIC NUTRITION-DIETETIC TERMS Agni: digestion; digestive fire Ahrayogi: condiment food-group Akasa: ether element Ama: slimy residue Amassia: stomach Ambucarin: meat food-group Amla: sour taste Anubandha: human mind Anupa: meat food-group Apastamba: Dharma-Sutra text Apo: water without taste Appu: water element Arivu: wisdom Asthi: bone Atman: human soul Ayurveda: life knowledge (medical system) Baudhayana: one of the Dharma-Sutra dietary code texts Bhumisaya: meat food-group Bhuta: element Caraka-Samhita: principal Ayurvedic medicine source document Desa: growth Dhari: body structure Dharma-Sutra: religious texts Dhatu: organ feeder Dosa: humor Dravay: body structure components Gautama: one of the Dharma-Sutra dietary code texts Ghee: clarified butter Gorasa: milk food-group Grinni: spleen (the place of bile) Harita: salad green food-group Hetu: behavioral, cultural, environmental signs Iksu: sweetener food-group Jala: rain water food-group Jangla: meat food-group Jivita: sense organs Kala: time Kanmavishaya: five activities Kapha: water humor Karana: knowledge, mind, passion to possess, and will Karmenthriyam: five activity centers Kashaya: astringent taste Katu: pungent taste Killa: unusable food component Krtanna: combination dish food-group Kulmassa: boiled spiced grain Lavadya Viskira: meat food-group Lavana: salt taste Linga: clinical signs and symptoms Madhura: sweet taste Madya: alcoholic beverage food-group Majja: bone marrow Mansa: flesh Manu: one of the Dharma-Sutra dietary codes Meda: fat Molasa: large intestine Nityaga: human mind Ojas: life force Panaka: date syrup Parigraha: quantity of food consumed Peri: the five body parts Peshi: muscle tissue Phala: fruit food-group Pitta: fire humor Prakrti: nature Prasada: usable food component Prasaha: meat food-group Pratuda: meat food-group Prithive: earth element Pukassia: perfected digestion Pulan: the five senses Raka: blood Rasa: taste Rasi: quality Rasyani: blood vessels Saindhava: rock salt Saka: vegetable food-group Samidhanya: legume food-group Samyoga: combination Sarvagraha: quantity of food consumed Sukadhanya: grain food-group Sukra: semen Tejas: life liquid Thathwa: the thirty essentials Theyu: fire element Tikta: bitter taste Triskandha: the three foundation components of Ayurvedic

medicine Upasaya: appropriate medical/dietary treatment Upayogasamstha: dietary rules Upayodta: consumer Varisaya: meat food-group Vasishtha: one of the Dharma-Sutra dietary code texts Vayu: wind/air element; air humor Yavasuka: alkali from barley hulls Part One: Legacy of India Food is the vital breath of living beings; this is why people rush to food. Complexion, cheerfulness, good voice, life, imagination, happiness, contentment, corpulence, strength, and intellect-all these are dependent on food. A wholesome diet is needed for maintenance of [the body]; obesity and leanness are particularly caused by sleep and diet. Food having gone to the stomach and having been digested there fully, its mature product thereafter reaches all the organs through blood vessels.

Caraka-Samhita(2) (ca. 1500 B.C.) INTRODUCTION Roots of the Indian allopathic nutrition and dietetic system are shrouded in mythology. Central to Indian belief is the tenet that eternal knowledge, the study of life or ayurveda, passed from the Creator (Brahma) to humans, whereupon it was incorporated into medical treatment. Thereafter, the traditional healing system of India was called Ayurvedic medicine. The Ayurvedic nutrition-dietary system, born in antiquity and practiced today by millions, is based upon three concepts (triskandha): 1) the recognition and evaluation of clinical signs and symptoms, 2) the acknowledgement that behavior and environment influences health or disease and 3) the belief that proper food and diet restores health. (2) The Caraka-Samhita document, or Caraka’s Hymm of Praise, dates to at least 1500 B.C., and probably dates much earlier in oral tradition form. The Caraka-Samhita manuscript was transcribed sometime after 1500 B.C. but before 600 B.C. The version examined was redacted (compiled and annotated) by the physician Drdhabala, who lived during the 4th century A.D. Caraka, the presumed author of the text, may have been an actual person, or the term may have been applied to members of an ancient healing caste, possibly to groups of regional practitioners.

Food and dietetics play central roles in Ayurvedic medicine. Health is considered the normal human condition and results when the body remains in balance.’ Illness, conversely, is the state of ‘imbalance’ and reveals itself through specific physical signs. Health is compromised when one or more of the following factors exhibit signs of “imbalance”: 1) elements (bhutas), 2) humors (dosas), 3) organ feeders (dhatus) and 4) tastes (rasas). The definition and dietary role of each factor within the allopathic Ayurvedic medical-nutrition system are considered in turn. THE FIVE ELEMENTS All plants and animals contain five elements (bhutas) in different proportions. The relative proportions of each determine the shape and attributes of each respective life form. In the Ayurvedic system each of the five elements is assigned different functions and qualities or attributes.

Earth (prithive) forms bone, hair, muscle, skin and blood vessels. Its qualities include attributes of hardness, odor, sound, taste and visibility.

Water (appu) forms blood, phlegm and semen and controls urine excretion. Its designated qualities are cold, light, softness, sound, tangibility, taste, visibility and weight.

Fire (theyu) arouses appetite, stimulates hunger and deep sleep, heightens fear and alerts thirst. The qualities of fire are beauty, color, goodness, hot, lightness, movement, passion, sound, strength, tangibility and valor.

Air/wind (vayu) arouses mental consciousness, brings about happiness and regulates body movements. Its qualities parallel those of water and fire in regard to lightness, movement and tangibility; it is also designated by touch. Ether (akasa) causes passion to rise, love to emanate, and triggers other emotions of anger, animosity, fear, hatred and shame. The qualities of ether are infinite and encompass human goodness and understanding. THE THREE HUMORS The ancient Indian Ayurvedic system also is humoral, based upon the prescientific concept that body fluids or secretions in specific proportions of balance determine health. A triad of three humors (dosas) is identified; their management is called tridosa therapy.

Air (vayu) controls the central and sympathetic nervous system. It is characterized as active, cold, dry, fine, light, mobile, nonslimy, sharp, subtle and rough. Its primary home is the stomach and navel. Normal functions of air humor include muscle tissue formation and distribution, respiration control, fluid circulation and waste excretion. When air humor dominates, body extremities become cool, dry and hard, and the tongue darkens. If excessive, air humor causes anorexia, arthritis, colic, diarrhea, fever, rheumatism and generalized pain and weakness. Restoration of air humor balance requires increased dietary intake of acidic, salty and sweet foods.

Fire (pitta) drives metabolism and digestion (agni) and serves as the source of body heat. It is characterized as bitter, hot, light, liquid, mobile, oily, pungent, sharp, sour and yellow. Its principal home lies between the heart and navel. Primary functions of fire humor regulate appetite, arouse thirst, produce and maintain proper body color and separate food into useable (prasada) and excreted components (killa). Related functions of fire humor maintain heartbeat, eyesight and intelligence. When aggravated, or stimulated unduly, fire humor makes the body acidic, fiery and pungent. Excessive fire humor produces anemia, cachexia, deafness, delirium, diarrhea, dryness, fainting, fever, indigestion, jaundice, nausea, tremor, vertigo, vomiting and generalized weakness. Reduction of fire humor slows digestion and forms slimy residues (ama) inside the body, said to retard transmission of nourishment to specific body organs. Dietary treatment to restore fire humor balance is to prescribe astringent, bitter and sweet foods.

Water humor (kapha) regulates body heat and produces body fluids. It is characterized as cold, heavy, immobile, oily, slimy, soft, sweet, viscous and white. The primary home of water humor is an ill-defined area above the chest, with a secondary home in the stomach. Normal functions of water humor spread mucous secretions, lubricate joints, provide luster to skin and develop limb firmness. When water humor is aggravated the body becomes cold, heavy, moist, numb, soft and sweet. Diseases that result include anorexia, asthma, bronchitis, cough, drowsiness, emaciation, fainting, fever, pneumonia, ulcers and vomiting. Water humor balance is restored through increased intake of astringent, bitter and pungent foods. THE SEVEN FEEDERS Ayurvedic medicine holds that human life (ayus) has four components: 1) structure (dhari), 2) sense organs Vivita), 3) mind (nityaga), and 4) self (anubandha). Body structure, our concern here, has ten components or substances (dravays). Three of the ten components are without form and said to be undifferentiated, that is, not vital to survival: life force (ojas), life liquid (tejas) and human soul (atman/ jiva). The seven differentiated, vital components are: 1) organic juice (rasa), 2) blood (raka), 3) flesh (mamsa), 4) fat (medas), 5) bone (asthi), 6) marrow (majja) and 7) semen (sukra). Each of the seven vital components must receive nourishment from a dhatu or specific organ feeder.

In Ayurvedic medicine-nutrition practice, established more than 3500 years ago, the processes of digestion, organ-feeding and nutrient assimilation were described:

Food reaches the stomach (amassia)

by means of air [humor]; food

is softened and mixed with water

[humor] in the stomach and becomes

red and sweet; navel air

increases fire [humor] and the resulting

heat digests food in the

stomach; food becomes frothy

and sour, then passes to the place

of bile (grinni) where it is mixed;

food then becomes pungent and

passes to the place where digestion

is perfected (pukassia) and

impurities separated; impure

fluids enter the bladder while

solid impurities with the help of

air [humor] pass into the large

intestine (malosia); the pure part

of digested food is the color of

milk; it is sent to the heart by

vessels (rasyani) where it is mixed

with blood.

During repletion each vital body organ is nourished by its respective feeder (dhatu) in a precise sequence of successive “cookings” or digestions:

Organic juice (rasa) circulates nutrients

extracted from food. Basic

rasa is cold, sweet and white. This

nutritive fluid, transported by organic

juice, enters the spleen and

liver, whereupon, it is “cooked”

and turned red by fire [humor],

then transformed into blood….

Blood (raka) circulates, energizes

the body and subsequently is

“cooked” by internal fire [humor]

and transformed into flesh. . . .

Flesh (mamsa) provides mass to

the body and is ‘cooked’ further

by internal fire [humor] and

thickened by body air [humor] to

produce muscle tissue (peshi);

further “cooking” transforms

flesh into fat. . . . Fat (meda)

lubricates the body and further

“cooking” forms bone. . . . Bone

(osthi) supports the body and further

cooking” produces marrow.

. . .Marrow (majja) fills empty

bone spaces and produces glistening

skin; further cooking” of

marrow forms semen…. Semen

(sakra) is produced [by] both

males and females. It is the reproductive

fluid of males while the

semen of females, when mixed

with blood, becomes menstrual

discharge. The semen produced

by pregnant women is diverted

to breast tissue where it forms

milk. THE SIX TASTES The Ayurvedic medical-nutrition system identifies six tastes, each with specific attributes, characteristics and functions. While each of the six tastes (rasas) is present in every plant and animal, only one taste dominates. The taste of a specific food is determined by different proportions of the five elements. Taste begins as undifferentiated, unflavored water (apo) generated in the sky that falls to earth, flows over rocks and soil, absorbs the five elements, is assimilated by plants or drunk by animals and incorporated into living tissue. Taste attributes vary because of differences in season, age of the life form and its geographical habitat.

Sweet taste (madhura) dominates water humor and is characterized as cold and heavy. Sweet foods increase virility and life-span, promote strength and wound healing in emaciated persons, increase human milk secretion, improve eyesight and reduce thirst and body heat. Such foods are considered especially beneficial to children, adults and the infirm. Overconsumption of sweet foods reduces wind and fire humors. When eaten to excess sweet foods cause anorexia, conjunctivitis, cough, goiter, mucous coatings in the arteries, bladder and throat and ultimately result in obesity and vomiting. Sour taste (amla) dominates earth humor and controls digestion. Such foods are characterized as fatty, hot and light. Consumption promotes appetite, body bulk and facilitates digestion. Sour foods are viewed as energy sources and said to awaken the mind; they exert a warming effect upon the body. Sour foods counter wind humor and at the same time promote fire humor and bile secretion. Such foods are laxative and semen reducing. if consumed to excess, however, they cause burning sensations in the chest, heart and throat, generalized swelling, hot-cold tooth sensitivity, increased thirst and wound suppuration.

Salt taste (lavana) dominates water humor and influences digestion. Salty foods are characterized as fatty, heavy and hot. They moisten and relax the intestines. Such foods neutralize fire humor and bile production and counter water humor and phlegm secretion. Salty foods promote perspiration. When eaten to excess, however, they cause body hair to turn prematurely gray or white and overuse leads to untimely baldness. Excessive intake of salty foods also causes fainting, gastritis, leprosy, loosened teeth, increased thirst, wrinkled skin and damaged sense organs.

Pungent taste (katu) dominates air humor and digestion. Such foods are characterized as hot, light and rough. Their intake promotes appetite, clears the sense organs, reduces edema and increases perspiration. Eating pungent foods reduces milk production in lactating women. Excessive intake leads to reduction in body fat and improved intelligence, but eventually external and internal beauty and strength is destroyed. Overuse reduces sexual potency, produces confusion, fainting, giddiness, leads to a sense of darkness [depression?] and results in tremors.

Bitter taste (tikta) dominates air humor and ether element. Bitter foods are characterized as cold, light and rough. They are used to alleviate fainting, itching and leprosy. Consumption promotes appetite, cools the body, firms skin and muscle, reduces fever and thirst, absorbs excessive body moisture and facilitates fluid excretion. Excessive intake, however, adversely affects wind humor and causes emaciation, giddiness, headache, malaise, mental confusion and loss of strength.

Astringent taste (kashaya) dominates air humor and earth element. Such foods are characterized as cold, rough and moderately light. They facilitate wound healing and soften the skin. If consumed to excess, however, astringent foods stiffen the body, cause abdominal swelling and reduce urine-fecal elimination. Overuse causes convulsions, emaciation, facial paralysis, heart pain, malaise and thirst.

Humoral balance is achieved by management of the six tastes; the six tastes, in turn, are balanced through proper dietary selection. When consumed in proper combination, three tastes increase aggravate) one humor, while three different tastes decrease (pacify) the same humor. Air humor, for example, is aggravated by astringent, bitter and pungent foods, but pacified by salty, sour and sweet items. Fire humor, in turn, is aggravated by pungent, salty and sour foods, but pacified by astringent, bitter and sweet products. Water humor is aggravated by salty, sour and sweet items, but pacified by astringent, bitter and pungent foods.

By selecting wholesome foods balanced for the six tastes, the humors are balanced, and health results. It follows that over- or under-consumption of specific foods, or incautious selection of dietary combinations leads to ‘imbalance’ and illness. It is to this issue of dietary balance and disease management that we now turn. DIETARY MANAGEMENT OF DISEASE Hundreds of diseases were recognized in antiquity and identified by ancient Ayurvedic practitioners. All diseases were grouped into three categories: 1) innate, 2) exogenous and 3) psychic. Innate diseases were believed to be caused by ‘imbalance’ in one or more of the seven organ feeders (dhatus). Exogenous illness, in contrast, were perceived to be due to imbalances of the five elements (bhutas) or the three humors (dosas). Psychic diseases were thought not to be caused by “imbalances” of elements, humors or organ feeders but resulted when desires remained unfulfilled.

Management of innate and exogenous diseases was based upon detailed observation of the client and diagnostic questioning. A diagnosis was made and the patient was treated by selection of wholesome, nourishing foods. What constituted wholesome, nourishing foods in Ayurvedic medicine in antiquity (and today) had a distinctly religious basis. Wholesome Food. Wholesome food is defined by Hindu religious precepts. More than 220 foods or food-related behaviors are characterized as unwholesome and prohibited. Indian food prohibitions are outlined in religious texts called the Dharma-Sutra.(3) When summarized, the ancient dietary codes of India may be set within six general categories of taboos directed toward: 1) human professions, behavioral traits and social conditions that determine who may have access to and receive food, 2) religious rituals that define food purity, 3) consumer responsibilities and proper behavior when confronted with uncooked, stale or sour (fermented) foods, 4) inappropriate human eating behaviors, 5) inappropriate animal behaviors or morphological characteristics that compromise food purity and 6) specific forbidden plants, birds, fish, reptiles, mammals, dairy products and beverages (Table 1).

Balancing and countering this wide range of unwholesome, prohibited foods are more than 110 specific dietary codes that define suitable, appropriate foods that are allowed and considered to be religiously wholesome. Some of these dietary codes state or describe how unwholesome foods can be “repurified” under specific circumstances (3) The Dharma-Sutra texts (law codes) stem from the 6th century B.C. This rich literature contains numerous references to food and the ancient Indian religious dietary codes are published under five specific titles: Apastamba, 1896; Baudhayana, 1882; Gautama, 1896; Manu, 1896; and Vasishtha, 1882. and rendered acceptable (Table 2). One generous tenet states that during times of famine, or if one’s life is in danger, survival is paramount and one should eat to live. Under such conditions, all religious dietary prohibitions are relaxed; previously profane, defiling foods then may be consumed, after being “touched once with gold or fire,” Especially interesting are religious texts revealing that the ancient Hindus were not vegetarians, but ate beef; the shift away from beef occurred after the rise of Buddhism in the 5th century B.C. The Thirty Essentials. Ayruvedic practitioners systematically observe and evaluate their clients using six categories of information. Each of these six categories, in turn, contains five defined topics. The six categories and five topics collectively are called the thirty essentials (thathwas). Practitioners are required to master and demonstrate knowledge of: 1) the elements (bhutas): air, earth, ether, fire and water; 2) parts of the body (peri): ear, eye, nose, tongue and trunk; 3) the senses (pulan): sight, smell, sound, taste and touch; 4) the body activity centers (karmenthriyam): anus/urethra, stomach, hand, mouth, foot and reproductive organs; and 5) activities at the body centers (kanmavishaya): excretion, give-take, motion, pleasure and speech; and 6) aspects of human thought, specifically the subtle components of knowledge, mind, passion to possess and will (collectively called karanam) and the fifth component, integration, that leads to arivu or wisdom. The Small Quadruple. Having evaluated the client for the thirty essentials, Ayurvedic practitioners proceed with diagnosis and examine “imbalances” of elements (bhutas), humors (dosas), organ feeders (dhatus), or tastes (rasas). Healers are schooled to understand illness and its treatment in terms of disease etiology, symptomology, classification, relationship of diseased organs to other body parts, as well as its severity and timing (seasonality and the patient’s age). The medical-nutritional diagnostic framework used is based upon four factors, each with four components. This multiple of 4 x 4 is called the small quadruple and represents roles played by the: 1) physician and physician’s characteristics: a) cleanliness, b) dexterity, c) excellence in theoretical knowledge and d) extensive practical experience; 2) attendant and attendant’s characteristics: a) cleanliness, b) dexterity, c) loyalty and d) knowledge; 3) healing drug(s)-food(s) selected and their characteristics: a) abundance, b) normal composition, c) effectiveness and d) different pharmaceutical forms; and 4) patient and patient’s: a) ability to provide accurate information, b) exhibit fearlessness, c) recall accurately and d) ability to obey the physician’s advice.

While the Ayruvedic medical-dietetic system holds that persons who eat wholesome foods should not become diseased, practitioners recognize that disease occurs even when wholesome food regularly is consumed. Such instances include intellectual error, as when a person eats wholesome foods but during the wrong season. It is axiomatic that diet may be improved or worsened because of factors unrelated to food. Such causative factors are said to be external in nature. Attention to aesthetics, in turn, leads to dietary improvement; therefore, suitable dining locations are encouraged and aesthetic food presentation is recommended. Diets based upon wholesome foods, however, may become poor or non-nutritious if culturally inappropriate food combinations are consumed, if the potency of different healing drugs and foods is misjudged or errors are made regarding quantity of food ingested, whether too much or too little food is consumed. It follows that diseases caused by imbalances of elements, humors, organ feeders or tastes may be mild or severe, acute or chronic depending upon such dietary errors of improper food selection, general condition and physical state of the body and the age of the patient. The Twelve Food Groups. The Ayurvedic dietary tradition defines twelve food groups (Table 3). The twelve represent groupings of life forms that are categorized as immobile (plants) or mobile (animals), set within four descriptive food categories: foods that are drunk, chewed, eaten or licked. Potentially, each wholesome food has ten characteristics and may be categorized as: hot or cold, heavy or light, unctuous or rough, dull or sharp, stable or mobile, soft or hard, non-slimy or slimy, smooth or coarse, small or large and viscous or liquid.

Therapeutic food combinations selected by Ayurvedic practitioners are in accord with the principle of opposites (contraris contrariia). Practitioners have at their disposal a nearly incalculable range of dietary variations, given permutations of different specific foods and food combinations, coupled with variations in cooking technique, seasonality, and geographical source. The complexities of food classification and assignment of specific characteristics within the Ayurvedic, allopathic system of India is illustrated by the following examples:

Animals born in water or who

live in such places and eat heavy

food are heavy…. Animals born

of the desert or who move in such

places are light…. Different cuts

of meat from the same animal

have different characteristics:

kidney, liver, skin or testicles are

heavier than muscle meat, shoulder

portions heavier than thigh

cuts, thigh portions lighter than

chest meats, chest meats lighter

than cuts removed from the head.

.. [When considering animals of

the same species] active animals

are lighter than sedentary animals.

. . . Meat from males is

heavier than that from females

[of the same species]. . . . Eating

small portions of heavy foods

produces a diet that is light. . . .

Intake of large quantities of light

foods makes the diet heavy. The Three Healing Foods. Three common foods are perceived especially therapeutic when humoral balance is to be restored: oil, ghee (clarified butter) and honey. The allopathic context of these foods is easily recognized. Oil, characterized as hot, heavy and smoothing, counters air humor which is cold, light and rough. Thus, dietary intake of oil reduces an excess of air humor. Ghee, characterized as cold, dull and sweet, balances fire humor, which is hot, sharp, and sour. Ghee, therefore, pacifies and reduces excessive fire humor. Honey, considered astringent, rough and sharp, complements water humor, which is sweet, smoothing and dull. The use of honey, thus, is recommended when “balance” of water humor is being restored. The Eight Paths of Dietary Management. When designing a therapeutic diet, ancient Ayurvedic practitioners drew upon years of extensive training. They followed a professional code that, in essence, represented an eight-fold path to correct dietary management. The Ayurvedic practitioner mastered an understanding and integration of: * Nature (Prakrti), or knowledge of the characteristics and properties of food and the essence of products present in food; * Processing (Karana), or knowledge of how to make and refine natural products, how properties are imparted to other foods by contact with water and fire, cleansing, churning and other forms of food processing, with considerations given for location and place, time (seasonality); * Combination (Samyoga), or knowledge of how foods are blended and the benefits or problems that resulted; * Quality (Rasi), or knowledge of how much to eat, whether food quantity through time (sarvagraha) or proper quantity of food to be consumed at specific meals (parigraha); * Growth (Desa), or knowledge of how the body grows, how components of food are distributed within the body and the creation and role of organ feeders that nourish each vital body component (dhatu); * Time (Kala), or knowledge of seasonality and suitability of different foods and food combinations at different times of the year; * Dietary rules (Upayogasamstha), or knowledge of specific foods and their roles after digestion; and consideration of the * Consumer (Upayodta), or knowledge of the patient’s habits, personality and social practices. The Nine Nutrition-Dietary Rules. The eight-fold path of dietary management that evolved through the centuries in India led to the formulation of nine basic nutrition-dietary rules. These nine nutrition-dietary rules from ancient India, over 3500 years old, are more than mere antique curiosities. They are, in essence, ancient dietary guidelines. From a perspective of 3500 years they may be compared and contrasted with the recent 20th century U.S. dietary guidelines proposed in 1990 (Table 4). The nine rules proposed in the Caraka-Samhita document hold that foods consumed should be: 1. Wholesome and timely, that is,

they should be religiously pure

and eaten in season; 2. Warm, smoothing (unctuous),

and tasty; because such food

characteristics stimulate digestive

fire, lead to easy and rapid

digestion and reduce excessive

water humor; 3. Consumed in proper quantity, so

not to disturb air, fire and water

humors; because if done so

digestion will occur with minimal

discomfort, and long life will

be promoted; 4. Eaten only after the previous

meal has been digested; because

this will not overactivate or stimulate

body humors or interfere

with vital body components or

their respective organ feeders,

and the appetite will not be

aroused too quickly; 5. Nonantagonistic; because such a

diet will keep the three humors

balanced; 6. Eaten in a suitable place using

familiar accessories; because this

sooths the consumer, does not

lead to mental disturbances

sometimes seen when people eat

in unfamiliar, distracting surroundings; 7. Eaten at a suitable pace, one not

too fast nor too slow. because

speed denies personal satisfaction

of food and eating too

slowly causes food to become

unduly cold, leading to digestive

irregularities; 8. Consumed in silence, without

laughing, with full concentration

given to eating; because talking,

laughing or focusing the mind

elsewhere causes consumers

similar problems as eating too

fast or too slow; and 9. Consumed only after full consideration

to the self; because to

know oneself is the basis for understanding

dietary requirements.

These ancient dietary guidelines found within the Caraka-Samhita document strike a reasonable chord when viewed from the perspective of 3500 years. Would nutrition educators today argue against eating a wide range of foods in proper quantity, that is, not over eating or consuming too little? Twentieth century dietitians trained in science agree that people should dine in suitable places, eat in familiar settings, surrounded by family and friends, and that eating should be at a suitable pace, not too, fast or too slow. Do not contemporary nutrition educators advise obese clients to eat slowly, with measured pace and full concentration to the activity at hand? Paleo-nutritionists and historical-nutritionists find it especially interesting that such views were not proposed initially by the American Dietetic Association, American Institute of Nutrition, Nutri-System(C), or Weight Watchers(C), but by Ayurvedic, allopathic practitioners more than 3500 years ago ! Scientific nutritionists and dietitians today support the view initially proposed in the Caraka-Samhita text that successful dietary management is best accomplished when the consumer takes responsibility for their actions. For thousands of years allopathic practitioners in India have taught that food intake affects health, that dietary balance is important, that moderation in eating leads to improved well-being, that consumers should understand the dietary and health implications of their way of life, that daily activities, environmental setting and work activities all have positive or negative impacts upon human health. In essence: the ancient Indians held that if individual nutritional-dietary needs were not met, health would be compromised. CONCLUDING COMMENTS Allopathy, a medical-nutritional-dietary healing system originated in ancient India more than 3500 years ago. Examination of the early Caraka-Samhita text (ca. 1500 B.C.) and the later Dharma-Sutra texts (6th century B.C.) reveals that Indian dietary patterns originally were meatbased, not vegetarian. Beef, avoided by most Indians of Hindu faith today, was widely consumed by Indians in the past. Dietary use of beef declined only after the rise and spread of Buddhism in India after the 5th century B.C. Even today in India, meats other than beef continue to be widely consumed by those able to afford them; vegetarianism so commonly reported by recent noncritical observers as prevalent throughout the Indian subcontinent is more related to wealth and limited economic choice than to specific religious dictate.

The medical-nutrition CarakaSamhita document and the religious-dietary Dharma-Sutra texts challenge nutrition educators to examine the evolution of 20th century dietary concepts. Examination shows that a wide range of prescientific, nonscientific principles dictated food intake and medical treatment long before the first nutritionist, Lavoisier. Science permits the understanding and determination of biochemical and physiological mechanisms that relate to assimilation, metabolism, utilization and excretion. But common sense achieved through millennia of observation, measurement and introspection also has produced a corpus of nutrition and dietary knowledge. The widespread availability of ancient texts, whether in the original language or in translation, attracts scientific scholars to the study of ancient dietetics and evaluation of these works facilitates modern understanding of prescientific dietary management of disease. This process of scientific evaluation of nonscientific materials permits ancient prescriptions to be measured and tested, and conclusions drawn as to efficacy of different recommendations. Examination and testing allow effective components to be retained, while the ineffective may be winnowed. The relative merit of allopathy then may be examined and evaluated, set against modern scientific knowledge and appropriate nutrition education materials designed, tested and implemented.

The Ayurvedic allopathic system explored in this article evolved into traditional Indian medicine used today. Many of the practices identified also are used today by Americans with ethnic origins to the Indian subcontinent. It is not difficult to manage scientific nutrition and dietetics using an Ayurvedic context. Dietitians and nutrition educators can readily design appropriate materials using Ayurvedic concepts of elements, humors, organ feeders and tastes. The food group concept is well established within Ayurvedic medicine. An American Basic-4 or Basic-5 can easily be set within an Indian modified Basic-12. Further, information on food attributes (i.e., hot-cold, heavy-light, unctuous-rough, dull-sharp, soft-hard, smooth-coarse, etc.) is not difficult to obtain from clients. Indeed, dietary management and client compliance will improve sharply once consideration is given to temperature and other characteristic attributes of individual foods and food combinations. Once a decision is made to explore allopathic principles with a client, to determine whether or not they are followed, and if followed how they are represented in individual dietary intakes, the time required to obtain such information is more than offset by an increased compliance rate. It is the thesis of this article that merely recommending standard diet number “x” to a client suffering from “y” nutritional condition, without considering the role of allopathy, is poor nutritional counseling. If we want to improve dietary compliance and assist our clients, then we need to understand not only nutrition science, but how nutrition science and allopathy fit into a social-cultural-medical system. POSTSCRIPT Indian Ayurvedic medicine spread westward into the Mediterranean region after trade was established with Persia and Greece. This geographical link between India and the Mediterranean may well have stimulated the development of allopathy that later characterized ancient Greek, Roman and Byzantine medicine and subsequently the healing-dietary practices of Jews, Christians and Moslems of the Mediterranean.

Islam, founded by the Prophet Mohammed in the 6th century of the common era, spread out of the Arabian peninsula. The Moslems learned of allopathy from the Byzantines and took this form of medical-dietary healing across north Africa. Islam eventually reached the lberian peninsula of southwestern Europe where allopathy was impressed upon an earlier Roman system of healing. Seven centuries later, Portuguese explorers circumnavigated the world, sailed eastward around Africa and established colonies in Asia. One Asiatic Portuguese colony, Goa, was situated on the west central coast of India. There in Portuguese Goa, Mediterranean allopathic medicine-originally based upon practices that evolved in India-ultimately returned to the Indian heartland. While Goa, today, is no longer a Portuguese colony, this interesting blend of medicine-nutrition continues to exist side by side with traditional Indian Ayurvedic medicine.

And what of the ancient Indian influences on contemporary dietetics in the United States in the 20th century? Besides contributions to American culture by immigrants from the Indian subcontinent who follow diets and food combinations that blend Ayurvedic and Western nutritional practices, there is a linguistic debt that all Americans today owe to ancient allopathy. Who has not heard or used within the last week the following phrasesEnglish words to be sure-but nonetheless based upon ancient allopathic principles formulated initially in India:

When you’re hot, you’re hot;

When you’re not, you’re not!

Chill out!

Feed a cold; starve a fever!

Hot stuff!

All wet!

In Part one of this series we have seen that the ancient Ayurvedic, allopathic nutrition-dietary system is not all wet, just as scientific nutrition is not all dry. Today, amid hotly contested nutrition debates over nutrient requirements and the RDAs, there are calls from many to cool and dampen the rhetoric, Perhaps we scientists can warm to the premise that much may be learned from the past and through the process of historical enquiry we scientists may become better nutrition educators. REFERENCES CITED Apastamba. The sacred laws of the Aryas. As taught

in the schools of Apastamba, Guatama, Vasishtha,

and Baudhayana. Part 1. Apastamba and Gautama.

Vol. 2 of The sacred books of the East. Muller FM,

ed. Buhler G, translator. Oxford: Clarendon

Press, 1896. Baudhayana. The sacred laws of the Aryas. As taught

in the schools of Apastamba, Gautama, Vasishtha,

and Baudhayama. Part 2. Vasishtha and Baudhay – ana. Vol. 14 of The sacred books of the East. Muller

FM, ed. Buhler C, translator. Oxford: Clarendon

Press, 1882. Bhagvat Sinh Jee HH. A short history of Aryan

medical science. 2nd ed. Gondal, India: Shree (4) Specific citations to document the text are available from the editor-send a stamped self-addressed envelope.

Ghagvat Sinh Jee Press, 1927. Brothwell DR. Diseases in antiquity. A survey

of the

diseases, injuries, and surgery of early populations.

Springfield, IL: Charles C Thomas, 1967. Caraka. Caraka-Samhita. Agnivesa’s treatise refined

and annotated by Caraka and redacted by Drdhabala.

Vol. 1. Sutrasthana to Indriyasthana.

Sharma P, ed. Delhi: Chaukambha Orientalia,

1981. Chakravarti AK. Regional preferences for food.

Some aspects of food habit patterns in India. Call

Geographer, 1974;18:395-410. Darby WJ, Ghalioungui P, Grivetti LE. Food. The

gift of Osiris. 2 Vols. New York: Academic Press,

1979. Dash VB, Kashyap VL. Basic principles of Ayurveda.

Based upon Ayurveda Saukhyam of Todarananda.

New Delhi: Concept Publishing Company, 1980. Dietary Guidelines Advisory Committee. Report of

the Dietary Guidelines Advisory Committee on the

Dietary Guidelines for Americans, 1990. [Report]

To the Secretary of Agriculture and the Secretary

of Health and Human Services. Washington, DC:

U.S. Government Printing Office, 1990. Emmart, EW. The Badianus manuscript. (Codex Bar – berini, Latin 241) Vatican Library. An Aztec herbal

of 1552. Baltimore: The johns Hopkins University

Press, 1940. Gautama. The sacred laws of the Aryas. As taught in

the schools of Apastamba, Gautama, Vasishtha, and

Baudhayana. Part 1. Apastamba and Gautama. Vol.

2 of The sacred books of the East. Muller FM, ed.

Buhler G, translator. Oxford: Clarendon Press,

1986, Grivetti LE. Cultural nutrition. Anthropological and

geographical themes. Annu Rev Nutr 1981;1:47 – 68. Hastings J. Hindu law. In: Hastings J, ed. Encyclopaedia

of religion and ethics. New York: Charles

Scribner’s Sons, 1951;7:850-3. Iyer TGR. The hand book of Indian medicine. The

gems of Siddha System. Delhi: Sri Satguru Publi – cations, 1981. Kingsley DR. Hitiduism. A cultural perspective. Englewood

Cliffs, NJ: Prentice-Hall, 1982. Leopold AC, Ardrey, R. Toxic substances in plants

and the food habits of early man. Science

1972;176:512-4. Lusk G. Nutrition. Clio Medica Series. Krumbhaar

EB, ed. New York: Paul B. Hoeber, 1933. Manu. The Laws of Manu translated with extracts

from seven commentaries. Vol. 25 of The sacred

books of the East. Maller FM., ed. Buhler G,

translator. Oxford: Clarendon Press, 1886. Numbers RL. Medicine in the New World, New Spain,

New France and New England. Knoxville: University

of Tennessee Press, 1987. Reddy DVS. Medicine in India in the middle of the

XVI century. Bull Hist Med 1940;8:49-67. Simoons FJ. Eat not this flesh. Food avoidances in the

Old World. Madison, WI: University of Wisconsin

Press, 1961. Vasishtha. The sacred laws of the Aryas. As taught in

the schools of Apastamba, Guatama, Vasishtha, and

Baudhayana. Part 2. Vasishtha and Baudhayana.

Vol. 14 of The sacred books of the East. Muller

FM., ed. Buhler G, translator. Oxford: Clarendon

Press, 1882. Wells C. Prehistoric and historical changes in nutritional

diseases and associated conditions. Prog

Food Nutr Sci 1975;1:729-79. Wise TA. Commentary on the Hindu system of medicine.

An exposition of ancient Indian medicine as

embodied in Sanskrit literature. Amsterdam: APA

Oriental Press, 1860 [reprinted 1981).

COPYRIGHT 1991 Lippincott/Williams & Wilkins

COPYRIGHT 2004 Gale Group