LONGEVITY, REGENERATION, AND OPTIMAL HEALTH

A Traditional Tibetan Medical Response to Advancements in Basic Longevity ResearchTenzing Dakpaa and Brooke Dodson-Lavelleba b

Gaia Holistic Health Center, New York, New York, USA

Columbia Integrative Medicine Program, Department of Surgery, Columbia University Medical Center, New York, New York, USA

This paper is intended to serve as a traditional Tibetan medical response to advancements in basic longevity research, with particular attention to current models of caloric restriction. This is a complicated task, as Tibetan medicine traditionally approaches dietary modication from a radically different perspective, and relies upon a complex model of health and balance in the treatment and prevention of disease. This paper offers a brief overview of the traditional Tibetan medicine (TTM) model and suggests potential areas for collaborative research on dietary modication. Key words: Tibetan Medicine; dietary modication; humors; humoral theory; balance; caloric restriction

Advancements in caloric restriction (CR) research suggest the existence of nontraditional strategies for increasing longevity and combating diseases associated with aging, including cardiovascular disease, diabetes, and cancer. From the perspective of traditional Tibetan medicine (TTM), unconditional restriction of caloric intake would not be employed as a strategy to increase longevity. Rather, TTM seeks to foster a state of optimal health in the individual through the resolution of underlying states of disorder and elimination of their fundamental causes. This orientation is based on a basic conception of the individual as a conglomeration of processes, both gross and subtle, internal and environmentally-oriented, which interact in a dialectic fashion. TTM primarily aims to treat disease by restoring balance between the three humors wind (rlung), bile (mkhris pa), and phlegm (bad kan) typologies that refer to pervasive psychological, physiological, and subtle energetic processes. The humoral theory has

Address for correspondence: Brooke Dodson-Lavelle, M.A., Columbia University Medical Center, Integrative Medicine Program, 177 Fort Washington Avenue, MHB 7-435, New York, NY, 10032. bd165@columbia.edu

been described elsewhere in more detail than is possible here1 (see also Loizzo et al. in this volume). In practice, TTM physicians aim to restore a state of overall balance, which is understood to include increased longevity and enhanced well-being, primarily via dietary modications, administration of herbal medicines, and self-regulatory cognitive-behavioral practices including meditation and yoga. TTM is a sophisticated system of integrated care, and as such, it employs the least invasive treatment strategies (including the aforementioned as well as massage, medicinal compresses, and the application of ointments) as its rst line of defense for a host of disorders. For cases in which such treatment is inadequate, more extreme accessory therapies including moxabustion and emetics may be applied. The therapeutic focus on diet and nutrition can also easily be understood as a longevity-enhancing strategy, as the development of a majority of age-related diseases, such as cardiovascular disease, diabetes, and cancer, can be linked either directly or indirectly to poor diet and/or health behaviors. Humoral imbalances may result from various conditions including maladaptive

Longevity, Regeneration, and Optimal Health: Ann. N.Y. Acad. Sci. 1172: 7073 (2009). doi: 10.1111/j.1749-6632.2009.04404.x C 2009 New York Academy of Sciences.

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behavioral patterns (such as poor diet and unhealthy lifestyle choices) as well as climatic and seasonal change. The humors are each associated with a particular time of day, season, and stage of life, and so disorders of each humor are said to naturally predominate during the corresponding period. Physicians must also consider other factors in assessing imbalances, including the organ or region of the body where the disease localizes, and the pathway by which the disease spreads.2 In addition, disturbances to the overall state of balance often involve more than one humor. Because a delicate interaction between the three humors and their constituent elements contributes to the individuals state of overall humoral balance, and therefore overall health, TTM physicians must consider a range of complex, interactive systems and processes when diagnosing disease and prescribing treatment. Thus, rather than reducing caloric intake (albeit while maintaining a nutritionally balanced diet), TTM practitioners would instead recommend individually-tailored dietary regimens in order to correct any existing humoral imbalances. In the context of TTM, a proper, balanced diet is the essence of preventive medicine. For example, a generic caloric restriction diet is contraindicated for one with a wind disorder, as fasting promotes excessive wind and thereby exacerbates the disease. Wind disorders (such as Alzheimers disease) are primarily associated with old age, and in general, it is recommended that those aficted by wind disorders, as well as the elderly, consume three full balanced meals per day. The various properties of different foods must also be considered when prescribing a diet to address a specic humoral imbalance. Though the therapeutic properties of food may be less acute and therefore often less observable than those of herbs or medications, they do have specic biochemical effects. In the TTM tradition, foods are classied according to their thermal properties and tastes (i.e., heating, cooling, sweet, pungent, salty, bitter, sour, detoxifying, and building or sustaining). These classications are more complicated

than stated here, as individual foods may have multiple classications, and these properties are not necessarily static. Rather, they have a dynamic relationship with the humors, and their properties can also be affected by preparation.3 People aficted by wind disorders generally require heavy nutritious foods, such as root vegetables and stews. Despite the existence of general guidelines for diets which target certain humoral imbalances, there is no universallyappropriate diet in the TTM paradigm, as the balance of all systems must be considered in the processes of diagnosis and treatment. Eating a diet that lacks balance and full nutritional content can also increase wind disorders and in effect cause weight gain. TTM physicians agree that obesity, inactivity, and age are the primary factors contributing to diabetes. We also recognize that dietary habits particularly the excessive intake of salty, sugary, cooling, and heavy foods contribute to the development and progression of this disease. Although there is a lack of published research in this area, anecdotal evidence suggests TTM is remarkably effective against diabetes. One recent study demonstrated that Tibetan medicine, combined with dietary and behavioral modication, was more effective in reducing fasting blood glucose than dietary and behavioral therapy alone.4 If Tibetan medical therapies can be proven to signicantly reduce fasting blood glucose levels, this could potentially (though indirectly) have signicant implications for reducing heart disease and cancer, and ultimately enhancing longevity. Calorierestricted diets based on principles of humoral balance may indeed prove to be a fruitful area of research. TTM has an extensive herbal pharmacopeia. This system also derives thousands of medicines from various gems and minerals.5 In addition to humoral-targeted dietary modications to improve health, TTM also prescribes medicinal butters to promote longevity and relieve disorders. Medicinal butters are made with claried butter, which is one of the four main healing oils of the medical tradition

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(in addition to seed oil, fats, and animal bone marrow oil, which contains the vital nutrient omega-3 fatty acids). Claried butter (butter from which the milk solids have been removed) is said to promote mental clarity and sharpness, and also aids digestion and nutrient assimilation. It also contains butyric acid, a fatty acid with antiviral and anti-cancer properties, which may also prove useful in the prevention and treatment of Alzheimers disease.3 Traditional Tibetan medical texts also state that claried butter sustains bone marrow. Bone marrow produces B cells which in turn produce antibodies and enhance the immune response. Significantly, in TTM medicinal butters are said to promote innate regenerative processes. Medicinal butters for wind disorders also contain the following substances: Terminalia chebula (balances energy, sustains life, facilitates digestion, and improves appetite); Terminalia belerica (pacies bile and phlegm combined disorders, lymph disorders, fever, and diarrhea); Embelica ofcinalis (promotes digestion and appetite; pacies bile heat, liver disorder, bile and phlegm combined disorder, and hair loss); and molasses (pacies wind disorder and constipation; promotes sleep, body weight, and sexual drive). Supplemental ingredients include: Myristica Fragrans (promotes body heat, digestion, appetite, sleeping, and kidney function); Halitum violaceum (pacies abdominal distension and cramps, constipation, and intestinal fever; promotes digestive power and appetite); Piper longum (alleviates indigestion, asthma, and abdominal distension; promotes kidney function, warmth, and sexual drive); Elettaria Caradmomum (alleviates kidney disorder and cold disorder; promotes digestive warmth and appetite); and Zingiber ofcinale (alleviates indigestion, stops vomiting and diarrhea caused by indigestion, clears blood vessels, and facilitates blood circulation). Medicinal butters are generally taken orally, and their potency is thought to increase with time. In TTM, the root cause of humoral imbalance, and by extension all disease, is understood to be destructive habitual or addic-

tive emotional patterns, rooted in the fundamental misknowledge (or self-habit) described in the Four Noble Truths the basic framework for Buddhist philosophy and contemplative science. As TTM recognizes a direct link between physiological and psychological processes, physicians and practitioners emphasize the importance of self-regulatory mind-training practices aimed at overcoming the addictive emotions which continue to reinforce maladaptive cognitive-behavioral patterns and compromise overall health. Physicians regularly encourage patients to receive meditation instruction from a qualied teacher. The link between the psychological and physiological realms is bi-directional, and thus it is accepted that supplemental medical treatments (including cognitive and somatic therapies) are more effective when the patient engages in a proper, humoral-balanced diet. Maintenance of levels of dehydroepiandrosterone (DHEA) and reduced body temperature are two of the most notable biological markers of caloric restriction. Herbert Benson demonstrated that meditators can signicantly lower resting body temperature and metabolism.6 The signicance of reduced metabolism for increased longevity is a matter of some dispute, however some theories maintain that reduced metabolism results in increased longevity.7,8 Meditation and similar cognitive-behavioral practices may also trigger increases in DHEA as well as melatonin.913 Interestingly, meditative practice increases parasympathetic tone; recent advancements in the eld of psychoneuroimmunology have demonstrated that increased parasympathetic activity suppresses excessive inammatory responses to injury.14 As excessive inammation is currently being implicated in the pathogenesis of a host of chronic and agerelated conditions, such as cardiovascular disease and diabetes,15 it is conceivable that meditative practice confers direct benet for these conditions via this physiological pathway, and offers a possible explanation of TTMs anecdotal success in treating chronic conditions such as diabetes.

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Overall, advancements in caloric restriction suggest avenues for collaborative research on dietary modication. Clinically, it is difcult to imagine caloric restriction regimens as developed in current animal models, which involve a reduction of up to 30% in total daily calories, being feasible as long-term lifestyle modication strategies. Mimetics of CR pose a different challenge for TTM doctors: because they attempt to fool cells into activating maintenance and repair activities, such therapies do not necessarily address underlying habits (such as poor diet), system imbalances, and root causes of disease (mental, emotional, energetic) which ultimately reduce longevity. Instead, they simply manage symptoms. Certainly TTM doctors recognize the difculty in changing seemingly instinctual or programmed behavior patterns and altering dietary habits, and we must remain open to alternative therapies which may aid those unable to make such changes swiftly, as they would suffer without acute medical intervention. Ultimately however, TTM doctors aim to address the root cause of disease, even if the desired results are not immediately realized.Conicts of Interest

The authors declare no conicts of interest. References1. Clifford, T. 1984. Tibetan Buddhist Medicine and Psychiatry: The Diamond Healing. Motilal Banarsidass Publishers. Delhi, India. 2. Donden, Y. 1986. Health Through Balance: An Introduction to Tibetan Medicine. Snow Lion, Ithaca, NY.

3. Pitchford, P. 1993. Healing with Whole Foods: Asian Traditions and Modern Nutrition. North Atlantic Books. Berkeley, CA. 4. Namdul, T., A. Sood, L. Ramakrishan, et al. 2001. Efcacy of Tibetan medicine as an adjunct in the treatment of type 2 diabetes. Lett. Diab. Care 24: 176 177. 5. Clark, B. 1995. The Quintessence Tantras of Tibetan Medicine. Snow Lion. Ithaca, NY. 6. Benson, H., M.S. Malhotra, R.F. Goldman, et al. 1990. Three case reports of the metabolic and electroencephalographic changes during advanced Buddhist meditation techniques. Behav. Med. 16: 90 95. 7. Weyer, C., et al. 2000. Energy metabolism after two years of energy restriction: the Biosphere 2 experiment. Am. J. Clin. Nutr. 72: 946953. 8. Bordone, L. & L. Guarente. 2005. Calorie restriction, CIRT1 and metabolism: understanding longevity. Nat. Rev. Mol. Cell Biol. 6: 298305. 9. Massion, A.O., et al. 1995. Meditation, melatonin and breast/prostate cancer: hypothesis and preliminary data. Med. Hypotheses 44: 3946. 10. Tooley, G.A., et al. 2000. Acute increases in nighttime melatonin levels following a period of meditation. Biol. Psychol. 53: 6978. 11. Glaser, J.L., et al. 1992. Elevated serum dehydroepiandrosterone levels in practitioners of the Transcendental Meditation and TM-Sidhi programs. J. Behav. Med. 15: 327341. 12. MacLean, C.R.K., et al. 1993. Apparent serum dehydroepiandrosterone response to acute laboratory stress. Soc. Neurosci. Abstr. 19: 169. 13. Ryu, H., et al. 2000. Modulation of neuroendocrinological function by psychosomatic training: acute effect of ChunDoSunBup Qi-training on growth hormone, insulin-like growth factor (IGF)-1, and insulinlike growth factor binding protein (IGFBP)-3 in men. Psychoneuroendocrinology 25: 439451. 14. Tracey, K.J. 2002. The inammatory reex. Nature 420: 853859. 15. Ershler, W. & E. Keller. 2000. Age associated increased interleukin-6 gene expression, late life diseases, and frailty. Annu. Rev. Med. 51: 245270.