• How does one make it easier for patients who are terminally ill or suffering from side-effects of modern medicine. Ayurveda suggests a diet which makes it easier for patient. Article shares insights.

Although infectious diseases pose substantial challenges to the public health system, burden of non-communicable diseases is also escalating. Exacerbating this problem are the issues of multiple chronic conditions, lack of awareness and insufficient health-care access or drastically changing lifestyle and dietary habits in developing countries.

Among these, cancer, autoimmune diseases, allergic diseases, cardiac failure, neurodegenerative diseases, chronic renal failure, and metabolic dysfunction are major cause of concern due to lifelong treatment, resulting in side effects of the medicines and later ending in complicated advanced conditions. These conditions are life-threatening as well as decrease the quality of life of patients and their family members and usually such cases do not respond to medicines indicated for it and thus patients with terminal condition are becoming major concern.
End-of-life care refers to the health care of patients with terminal condition and intends to improve the quality of life of such cases.

It relates to identification and assessment of the disease that has advanced, has become progressive and incurable, and aims to provide treatment of pain and other physical and psychological concerns.

As per the WHO, palliative care provides relief from pain and other distressing symptoms, affirms life and regards dying as a normal process, integrates the psychological and spiritual aspect of patient care, and enhances quality of life of patients and their family and is an integrated approach toward a specialized and customized holistic care for people suffering from life-limiting illnesses or life-threatening conditions. It aims at improving the quality of life of the patients and also to lessen the suffering of their family.

Although it does not replace active treatment, it works toward alleviating the suffering incurred due to the underlying disease condition, or those due to the side effects of the ongoing treatment, or the anxiety or depression caused by the fear of the diagnosis and/or the unsure future.

To improve the quality of life of such patients, maintenance of nutrition is the first goal.

The principles and care advised in Ayurveda in the form diet plan can play a critical role in improving health status and nutrition level of the terminally ill patients.

Certain studies indicate that Ayurvedic formulations effectively control the side effects of chemotherapy, as Ayurveda treatment focuses on improving the immunity by strengthening the digestion and metabolism of the patient.

Further, appropriate dietary approach and lifestyle modifications as per the principles of Ayurveda as indicated for advanced and incurable conditions or as a part of Pathya (disease specific diet) for such diseases can help improve the patients' quality of life, minimize adverse effects, improve body physiology and complement, and enhance the effectiveness of the ongoing treatment.

During diseased condition when the body is no longer under normal physiological state, nutritional requirements dramatically change.

This is the reason why nutritional demand and care of terminally ill patients differs greatly from the healthy person. The body of person who has a life-limiting illness is in the state of diminished digestion and metabolism. Such patients do not require routine quantity of nutrients; therefore, their appetite or desire for food diminishes.

Due to prolonged medications, complications such as flatulence, nausea, vomiting, diarrhoea, or constipation may occur. Even the introduction of intravenous fluid may sometime cause complications such as edema or fluid overload. Anorexia, food discomfort, taste and smell changes, early satiety, and severe dysphagia are major challenges seen in palliative nutritional care. These factors deteriorate nutritional level and induce emotional and psychological stress to patients and their family members.

As per Ayurveda, in a chronic ill condition, due to provocation of Vayu (one of the biohumor) which occurs due to wasting, Agni (factors responsible for digestion and metabolism), specifically Jathragni (digestive system) undergoes in hypofunctioning state and thus demand for food is reduced and digestion is hampered.

Thus, a special care of such patients with food which is easy to digest, yet nutritive and satisfying the taste is must. 

Pathya Ahara (disease-specific diet) mentioned in Ayurveda is nutritive as well as disease modifying. Pathya Kalpana (food preparation specifically for disease) has been described in almost all Ayurveda texts for providing special nutrition to specific diseased condition.

Various food articles which are advised to promote health of healthy individuals can also be judiciously used in terminally ill patients depending on the state of Agni and the disease.

Some of the dietetic preparations mentioned in Ayurvedic which can be used as food supplements for terminally ill patients can be Yavagu and Manda where the main ingredient is rice, Yusha (the main ingredient is pulse). Mamsarasa (meat soup), Raga–Shadava (the main ingredients are sugar, rock salt, and juice of pomegranate), Takra Kalpana (butter milk), and Mantha Kalpana (which contains fruits, sugar, meat soup, cow milk, and cow ghee).

Such food preparation provides nutrition as well as it contain various medicinal plants, fruits, vegetables, oil, ghee, etc., which may be useful to improve the quality of life of patients and serve as a medicinal diet. Moreover, as these preparations are liquid, palatable, and easy to digest, it can be ingested and digested easily and restore hydration. Further, as these food preparations can be modified such a form that, it is suitable for tube feeding in patients of dysphagia and unconscious patients.
In terminally ill patients, suitable dietary intervention may provide considerable impact in improving quality of life of patients and hence a special diet plan intended to provide nutrition and management of disease shall be a goal of treatment of end-of-life care. 

Ahara Kalpana and Pathya Kalpana mentioned in Ayurveda may have significant role in nutritional aspect of palliative care by providing nutrition, food satisfaction, and health benefits and play a major role in quality of life improvement in terminally ill patients.

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Source of Support: None, Conflict of interest: None

About Author: Executive Editor–AYU, Department of Kayachikitsa, IPGT and RA, Jamnagar-361 008, Gujarat, India.

Article available online/offline on: AYU, Vol. 40, Issue 1, January to March 2019, Page no.1-2, for more details please visit: www.ayujournal.org

Address for correspondence: Mandip Goyal, Executive Editor–AYU, Department of Kayachikitsa, IPGT and RA, Jamnagar-361008, Gujarat, India.
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