HEART CARE – PREVENTION & MANAGEMENT – 2
Non-communicable diseases such as CVDs dominate over communicable in the total disease burden of our country, having increased from 30% to 55% as stated by the India Council of Medical Research (ICMR)1. Looking at the increasing morbidity & mortality of CVDs, prevention of risk factors, strengthening the immune system & maintenance of cardiac health are the need of the hour.
The WHO lists lifestyle modification as one of the first & foremost points in prevention of risk factors & in reducing disease morbidity2. American Heart Association states that “The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life”3. Lifestyle refers to the diet & regimen of an individual. Therefore nutrition, sanitary practices & environment play a major role in shaping the structural & functional health of the heart.
Ayurveda has emphasized prevention before cure3. Practices of Dinacharya (daily routine), Rutucharya (seasonal regimen) & Sadvrutta (personal & social regulations) are the 3 pillars for healthy living. These work in harmony with the circadian rhythm, while also helping in adapting to seasonal changes. These also help in restoration & maintenance of the well-being in physical, psychological & spiritual planes. Protecting Hrudaya, a marma (vital point), is of great importance. These protocols are flexible & are always put into practice based on the individual’s needs. Therefore, general principles & their impact on strengthening the Hrudaya will be dealt with.
Dinacharya : Dina = day, Charya = regimen / routine
After waking up in the Brahmi muhurtha, one should clear the natural urges & clean himself. He shall then brush his teeth (Danta dhavana) & clean his tongue (Jihwa nirlekhana). After which the use of collyrium (Anjana), nasal instillation of drops (Nasya), mouth gargling (Gandusha), inhalation of specific fumes (Dhumapana) & Tambula sevana shall be done in the same order. Oil should be applied on the body (Abhyanga) & then exercises (Vyayama) shall be done. After rubbing various powders on the body (Udwartana), bathing (Snana) is advised. After these, the rules for maintaining personal hygiene & social regulations to be followed throughout the day are described in detail.
- Waking up in Brahmi Muhurtha :
How & when you start the day is an important regulator of health. The proverb “Early to bed, Early to rise; Makes a man healthy, wealthy & wise” is the Western version of what was already told centuries ago as “Brahme Muhurthe Uthishtet Swastho raksharthamayushaha” by Acharya Vagbhata.
Brahmi Muhurtha is calculated to be around 4:30 to 5:30 AM. Though it varies according to seasons based on the time of sunrise, it usually falls between the aforesaid time. This also indirectly emphasizes on going to bed early.
Effects on the body : To live a long & healthy life (Swasthya), the most easiest & medicine-free solution is to just wake-up before dawn! Ashtanga Hrudaya & other treatises in Ayurveda state that waking at this time of dawn helps in enhancing both quality & quantity of lifespan. Swasthya includes physical wellbeing in various planes of Dosha, Dhatu & Mala, the Agni ; while also incorporating Manas (psychological plane) & Atma (spiritual plane).
Effects on the mind : It has special impact on cardiac health as Hrudaya is the seat of Manas & Brahmi Muhurta is said to be the best time for introspection & emotional welfare. This is very important in de-stressing & reducing anxiety which reduces the major risk of CVDs. A healthy mind ensures a healthier heart. Several studies have proven that early risers are more motivated, punctual, and are always brimming with new ideas & positive energy.
Waking up late causes accumulation of Kapha dosha, which leads to sluggishness in both physical & mental faculties. It also increases Tamas, further hampers the sharpness of mind. Kapha is associated with qualities of Manda (slow), Slakshna (sticky), Guru (heavy) etc, which contribute to slowing down of physiological processes while also affecting the density & consistency of bodily fluids. With time, this slows down nerve conduction, reduces cellular sensitivity, encourages plaque formation etc. The natural Vata dosha can also aggravate due to Kaphavarana (Kapha enveloping Vata), which leads to a bunch of diseases including Hrudroga.
Effect on digestion & defecation : Agni (digestive fire) varies according to Dina (day) & Rutu (season). Waking early ensures proper bowel movement, which ensures healthy Apana vata. In case of inefficient digestion, bowel urges do not occur timely & such persons may sleep past Brahmi Muhurtha, giving the body time to ensure complete digestion. The Proper kindling of Agni & correct functioning of Samana vata coupled with Apana vata are necessary to ward off Ajirna (Indigestion). Chronic indigestion is listed among the causes of Hrudroga.
Contra indications : Though there seems to be only benefits, there are few conditions exempted. The elderly, the kids, the pregnant women, those with indigestion & other diseases may practice sleeping early & there by get added number of hours sleep (Dinner by 7.30 PM & sleep by 9.30 PM). Those who missed night sleep due to unavoidable reasons, can sleep half the time during the day, on empty stomach / digestion of previous food. This applies ONLY to those who couldn’t sleep at night rarely. This is not an ideal/substitute method.
Substantiating this Ayurveda guideline to waking early & its impact on Hrudaya, researches in allied sciences have proven that chronic disruptions of the circadian clock, for example with night-shift work, contribute to increased cardiovascular risk 5. Similarly, sleeping early & rising at crack of dawn has given results where heart is healthier6.
Circadian rhythm (biological clock in the body) & Cardiovascular system : Western perspective7
The body has a main regulating clock located in the brain (Hypothalamus) which coordinates with peripheral clocks located in all tissues. There is a distinct “Clock gene”, which when removed in laboratory mice showed effects on platelets aggregation. The biological clock is affected by light & dark (day & night).
Factors related to the Heart which follow different 24-hr activity patterns based are :
- Blood pressure : reduces by 10-20% during sleep at night. Any change in normal sleep-wake cycle will change the normal increase & decrease of B.P.
- Circulating catecholamines (epinephrine & nor-epinephrine)
- Blood coagulation markers, vascular endothelial function : platelet aggregation & anti-atherosclerotic properties of endothelium; Blood clotting can be life-saving when it’s necessary & can also lead to ischemic stroke, myocardial infarction, and sudden cardiac arrest. The balance between normal clotting and bleeding tendency is according to circadian rhythm.
- Autonomic Nervous System : affects the heart directly by controlling heart rate, peripheral resistance, contraction & relaxation etc. ANS follows the biological clock resulting in varied pattern set through the 24-hr duration. Any changes in the internal clock will thus directly affect rhythmicity & contractibility of heart.
Ideal routine :
- Eat 2-3 hours before hitting the bed by 10.00 PM. Avoid heavy dinner & curds.
- Limit mobile & TV screen time to at least an hour before sleep. Do not carry cell phones to bed / keep them at a safe distance.
- If not used to waking early, start with waking up half hour before present habit. Gradually get used to Brahmi muhurtha.
- Use melodious music or music mimicking nature sounds as alarm tones. Avoid blaring & loud songs that jolt you awake.
- Set up a bedtime & morning routine to look forward to. Try and spend this time for introspection & meditation practice.
Waking up in Brahmi Muhurtha for those who are indicated, significantly reduces the chances of Hrudroga by warding off risk factors which lead to Atherosclerosis, ischemia etc. A healthier heart ensures proper circulation, which in turn boosts immunity. A simple act of waking up at the right time ensures protection of the heart, a happy mind, boosts immunity & prolongs lifespan!
For other interesting inputs on Brahmi Muhurtha, please read https://ayurvedamysore.org/early-to-bed-and-early-to-rise/
- India : Health of the Nation’s States: The India State-Level Disease Burden Initiative (2017)
- WHO : “Prevention of cardiovascular disease: Guidelines for assessment and management of total cardiovascular risk”.
- 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease.
- “Swasthasya swasthya rakshanam…”Charaka Samhita
- Role of the circadian system in cardiovascular disease: https://www.ncbi.nlm.nih.gov/pubmed/29856365
- People who sleep and wake up early have healthier hearts: study https://www.huffingtonpost.ca/2016/04/22/sleeping-heart-health_n_9759030.html
Author : Dr. Spoorthy S Naik, B.A.M.S
Fellowship Student, Prakruthi Ayurveda Prathishtana ®,
Kuvempunagara, Mysore – 570023