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The diet has to be well-balanced; for the body needs a lot of energy as a woman progresses during her pregnancy.


An ideal diet is a balance of various types of foods and one supplies the body with crucial inputs required during pregnancy. Producing a baby requires a lot of energy especially in the earlier months of pregnancy, since the division of cells is most intense. Moreover, energy that you build is needed not just during your pregnancy but also after delivery and during the lactation period. The body of a pregnant woman needs about 300 kilocalories per day. (A kilocalorie is a unit of energy, which is the measure of either 1 food calorie, or 1,000 energy calories).  Carbohydrates like wheat, unpolished rice, potatoes, beans, sugar fruits as well as fats like butter, oil, cream, and nuts are rich sources of energy. Though the fetal organs already do have fat reserves, nevertheless, supplying the body with additional essential fatty acids (EFA) during pregnancy holds one in good stead, both during and after pregnancy.


Minerals like calcium, phosphorus, iron, zinc, sodium and iodine are crucial during pregnancy. Chances are that the deficiency of these minerals may lead to complications and can have adverse effects on the unborn child resulting in physical or mental deformity of the child. So why take that risk?
(An ideal Indian Food Platter)

Proteins are important for the formation of cells, bones, and tissues of the fetus; with at least 15 grams per day of additional proteins that has to be increased in your normal diet. Milk and milk products, poultry, egg, cheese, yoghurt, soy, nuts are rich in proteins; as also pulses and whole grains.

Calcium induces the formation of good teeth, strong bones and the coagulation of blood.  Milk, nuts and green vegetables are rich in calcium. The baby has the tendency to extract calcium needs from the mother, especially in the last trimester as the baby’s bones get denser. Therefore adequate calcium needs to be taken care of, by the mother, both to protect herself and the child low calcium or lack of calcium in the body of the mother is evident through muscle cramps especially in the lower legs and to allow the baby to draw its calcium supplies from the mother. Natural food sources of calcium are dairy products, soy products, nuts, seaweed, wheat germ and wheat bran.


Water is a very important nutrient as it keeps the body hydrated, prevents constipation, haemorrhoids, and edema and flushes out any toxins.

Fluids: including water, juices, herbal drinks etc. maintain the body’s metabolism.


Fibres - A common problem during pregnancy is constipation. Therefore the diet should contain plenty of fibre in the form of whole fruits and vegetables, whole grain cereals, vegetable soups and whole pulses. Fibres act as a cleansing agent, scrubbing and cleaning out the toxins that will have accumulated in the body.

Vitamins especially during pregnancy are an essential food for the body. They play a special role in the physiological state of the mother and fetus.


Vitamin A is good for the formation of the eyes, improves vision and maintains the integrity of the cells; and is found in Milk, green vegetables, and orange-red fruits like peaches, and papayas.

Vitamin D is essential for maternal calcium absorption and calcium metabolism of the infant. Foods like butter and fats, that are rich in Vitamin D, are good for bones and blood circulation. It also provides the much needed energy.


Vitamin E helps in preventing miscarriages. Vitamin K helps in preventing neo-natal haemorrhages. Sources of Vitamin E are wheat, leafy vegetables, vegetable oils and cereals. Vitamin B is good for appetite, growth, eyes and skin. Cereals, milk, green vegetables are rich in Vitamin B. Vitamin B can be sourced from yeast, seeds, beans, nuts, dairy foods, wheat germ, whole grains, avocadoes . . . 


Vitamin C is vital for the development of bones, teeth, blood vessels and is found in oranges, lemons, sweet limes, cabbage, and tomatoes. 

Vegetarians can source vitamins from pulses and legumes (peas, lentils, beans, nuts, soy products) eaten in combination with whole grains such as rice, wheat, oats, barley, rye, corn, buckwheat etc. Try to eat high protein foods for lunch when you will be able to process them more efficiently than at night. 

In the last months, calcium is released from the maternal bones to provide calcium supplies for the baby, so increased dairy, soy, greens and seaweed are recommended. Raspberry leaf tea is especially useful in the last months as it softens up the cervix in preparation for birth as well as stimulates lactation. 

Besides these, pregnant mothers have special dietary requirements like Folic acid or foliate as is commonly known, which is supplied via Vitamin B6. Vitamin B6 is very important to prevent anaemia and promote normal fetal growth, preventing serious birth defects.

Folic acid aids cell division in early pregnancy. Folic acid is well sourced from yeast, whole grains, pulses, nuts, dairy products, jaggery etc.


Iron is best sourced from nature’s own balance. Iron supplements, unless recommended by your doctor, is just not necessary. In fact iron is a highly toxic material which can damage the liver if over- consumed.  Iron can be derived from the foods you eat. You can source iron from leafy greens, seaweed, dried fruits, pulses, wheat germ, bran, yeast, nuts, seeds, parsley, molasses, and jaggery. Green vegetables, cereals, dates, apricots, grapes and raisins are vital for blood formation lack of iron can lead to miscarriage, foetal malformation and anaemia.

Foods in natural form are the best bet. Try to avoid supplements, especially Vitamin B as this can cause urine to turn dark yellow, which is a result of high protein; and this can lead to pre-eclampsia! Also, taking supplements may deceive you of whether you are taking enough fluids!!  In between meals, if you do feel hungry, it’s good to have water, or a lime juice or seasonal fresh fruit or vegetable juices. Avoid alcohol, tea or coffee and aerated water during pregnancy. Try and eat small meals every four hours. Enjoy eating in as much as you enjoy the pregnancy!!

Joyce d’Souza is a regular contributor of Yogic Arcles to Six Senses Yoga Society.  She is a trained instructor of Yoga, and a Yoga Therapist having studied Yoga at the Gurukul and at University level.  Joyce lives in India.

© 2008 Six Senses Yoga Society

Child birth is an event. The road between conceiving and delivery is an adventure. After that, it’s pure joy!!

Bringing a new human life into this world is an exhilarating experience and every woman’s dream. From the time she knows she is pregnant, preparations automatically begin to give the best and most comfort to the baby . . . before it even begins to pop its head out and make its appearance into this big, wide, and wonderful world.

Experiencing the joys of motherhood is very spontaneous affair. One would hardly need any kind of confirmation or an outside source to let her know that she is pregnant. The connection between the mother and her unborn child clicks instantly. So deep is this attachment that the mother-to-be begins to prepare herself for the big day . . . the birth of her child; tuning in, adjusting to the constant changes that her body will go through intriguing, fascinating, and enjoying each step along the way.

The practice of Yoga during pregnancy not just enables you to enjoy a relaxed and smooth pregnancy, but will go a long way in ensuring a special kind of bonding between mother and child. While it is important to inculcate a feeling of happiness around you, without allowing minor things upset you, do remain cool, calm, composed and cheerful at all times. Yoga emphasizes on positivity of the mind and believes that it is the mind that can make or break a situation. The ability to gain complete control of the mind is important; the body willingly follows!!

As the baby within you grows, you will experience moments that you will enjoy and cherish . . . listening to the first heart beat of your child, the first kick that may catch you unaware at an odd time when your falling asleep or perhaps even when you are in the midst of a high-level conference at work . . .  The baby responds to sounds or music that you listening to the foetus receives signals, absorbs them, and responds to stimuli. This is most ecstatic!! Therefore it becomes necessary to feed the baby not just the best kinds of food for his physical growth but also with good emotional and spiritual material. How can this be done? Perhaps curl up in bed, read a good book in a relaxed atmosphere; listen to soft, soothing music that you’d enjoy; always carry kind and positive thoughts; avoid sudden and excessive bursts of emotions . . .

In pregnancy, the practice of yoga is the ideal way to keep your mind alert and body fit and prepared for the big day! A good session of yoga practice can work wonders. It helps to keep the mother-to-be stay in a happy and tranquil state of mind at all times, which in turn ensures an easy pregnancy and a natural childbirth. Besides working well for the mother-to-be, the practice of yoga also works wonders for the physical and mental development of the unborn child.

Simple asanas (physical yogic exercises) and pranayams (yogic breathing) helps bring about a world of positive changes in a pregnant mother. Meditation practised alongside can be very soothing. It assists you to be in touch with your inner self, relieves stress, is therapeutic in nature, calm and subtle on your senses, and can have a positive effect both on you and the baby.

A pregnant woman should always be aware of her posture and keep her spine erect. It is very important that the mother-to-be practices asanas that strengthen the spine. Yogic asanas are a perfect way to attain this. As pregnancy progresses, the spine helps the woman and makes it easier for her to carry the increasing weight of the child within her womb; or there is a probability that the protruding abdomen shifts forward the weight of the body causing not just discomfort but also the tendency to topple forward due to the growth and increasing weight of the baby. A strong spine ensures that the weight of the foetus is directly over the pelvis, which reduces pain, fatigue and discomfort for the woman’s back muscles.

Asanas are a very gentle and complete way of exercising during pregnancy, as it helps to keep the body active and supple without exertion or jerky movements.

Yogic breathing in combination with asanas can reduce nausea, morning sickness and mood swings. While certain asanas (Bhadrasana, Sukhasana, Padmasana) when practiced opens up the pelvic region, relieving tension around the cervix and birth canal area making labour easier and quicker; asanas like Utkatasana, Parvatasana gives mobility and flexibility to the joint muscles. During pregnancy, practicing simple basic pranayams or yogic breathing (Purakh, Khumbakh and Rechakh) can have extensive and far-reaching benefits as it not only helps conserve prana or energy for yourself but also provides high quality oxygen for the foetus. Moreover, a mother who breathes well and breathes complete taking in a good supply of oxygen will be stronger, and can offer a better life force for her child. Additionally, it prevents a bad back, pelvic floor weakness, uterus prolapse and mental and emotional tension.

Continuous practice of yoga helps in natural childbirth, a smooth-sailing pregnancy and quick restoration of the body after childbirth. Pregnancy is a very joyful period for a woman; but then it does bring with it a whole lot of discomfort and inconveniences as the body goes through changes physical, mental and emotional tiredness, abdominal discomfort, nausea, back pain, edema or fluid retention, cramps, varicose veins, impatience, depression, diabetes in some . . .

Muscle cramps, puffiness and/or edema (water retention especially in the ankles, feel and legs) is natural in most pregnant women; but, nature has its own way of taking care of these minor discomforts. Yogic practise can work wonders both for the mother and the baby-to-be as certain asanas help in the gentle massage of the abdominal muscles which strengthens and helps stimulate appetite, increases metabolism, and helps in bowel movement. Yoga in the post-natal stage (after delivery) helps in restoring the uterus, the abdomen and the pelvic floor, relieves upper back tension and breast discomfort. It helps the woman to get back into shape and to her normal self soon after delivery.

Part II of this article will demonstrate to you, simple asanas and pranayams mentioned above that can be practiced during pregnancy. 

Joyce d’Souza is a regular contributor of Yogic Arcles to Six Senses Yoga Society.  She is a trained instructor of Yoga, and a Yoga Therapist having studied Yoga at the Gurukul and at University level.  Joyce lives in India.

Fibromyalgia and its close ally the chronic fatigue syndrome has been a recent addition to the list of Psychosomatic disorders troubling human life. It is clearly a life style disorder when we verify the causes. An outcome of erratic life style, unhealthy food, stress, lack of exercise and a possible injury as a precipitating factor, this disorder disturbs normalcy in ones life.

Many patients feel it is triggered by stresses such as an illness, emotional trauma, hormonal imbalance and heavy physical work. This is often followed by generalized pain, fatigue, sleep and mood disturbance .This is often accompanied by severe fatigue and tiredness. The work hours, family life and social life of the individual is usually affected, as the person fall into a vicious cycle.

Pain is generally distributed, but often has trigger points across the body where it is having higher intensity. Though Fibromyalgia is similar to the chronic fatigue syndrome it is characterised by the presence of severe muscular pain. Modern science relates it to low Serotonin level in blood. Basic approach in management is suggested as steps for Pain reduction, sleep improvement and maintaining stable Serotonin and Magnesium levels in blood. 

Fibromyalgia in ayurvedic
Ayurvedic classics have not referred this name or have mentioned any particular symptom complex similar to it .With a thorough reading of the classics do provide an understanding into this problem and its management.

Diagnosing Fibromyalgia- the ayurveda way
Analysing the symptoms it is clear that all its symptoms resembles a Vatha vikara(disease due to vatha increase or imbalance).But it is not mentioned with a specific name nor mentioned other than its symptoms .Here one may be curious to know ‘what does a Vatha imbalance signifies?’

Vatha one among the three functional attributes of our body is considered to be made of Vayu and Akasa (air and space elements).The reasons for its imbalance are as follows as mentioned in Ashtanga Hridayam the classic: 

a. Dietary reasons - intake of bitter, spicy and astringent tastes in excess, eating too little, eating too dry food, eating too much.
b. Life style reasons- holding natural urges like the one for urination ,defecation etc, pressing the natural urges , non sleeping at night ,talking too loud, excessive physical excretion, excessive sex ,too much of thinking and worrying
c. Clinical reasons- doing too severe purifications like purgation or vomiting
d. Emotional reasons- Fear (anxiety) and sorrow (depression)
e. Climatic reasons- summer
f. Diurnal variations- like end of day and night, and end of food digestion. 

Once Vatha is imbalanced then it could cause a multitude of signs and symptoms including Bala upaghatha(weakness) ,Asthisoola (pain related to bones) Malasanga(constipation),Atopa (bloating) Moha (hallucination )Bhaya (fear- anxiety),Soka(sorrow- depression),Samja nasa(unconsciousness),Nidra nasa(insomnia) and so on. Quite many of these symptoms we see in Fibromyalgia as well. The Primary functions of Vatha being movement and control and co ordination of sensory as well as motor functions- the functions of the Central nervous system, there are implications of vatha imbalance on this most important system of our body. The Vatha imbalance thus in a way may be synonymous to the upset of our nervous system which translates as pain.
Soolam (pain) is considered the cardinal sign of any Vatha imbalance in ayurvedic classics.

The breakthrough in diagnosing this dreaded problem was achieved by Padmasree Dr.K.Rajagopalan MBBS DAM FNAA, my mentor. We had many patients who showed a certain success with the management protocol suggested by him in severe health issues including Cancer and Neurological disorders. In such a clinical consultation he shared his thoughts.

According to him Fibromyalgia resembles Vatha vridhi in the Dhathus- Mamsa and medas (vatha increase in muscle and fat tissues).
Mamsa meda gatho grandheen thodadhyan karkasan bhramam
Gurvangam cha athiruk sthabdham mushti danta hathopamam- (Ashtangahridayam)
The signs of vatha increase in mamsa and medas are abscesses, piercing pain, and squeezing pain, and vertigo, heaviness of the body, severe pain with lack of flexibility and pain resembling the one due to punching by the fist.
Here we may look into the theory of the Dhathus (tissues).

Dhathus represent the structural entity of the human body, and are considered the building blocks. The seven dhathus with their functions are:

1.Rasa - (Lymph or plasma ) - Preenana - Nourishment
2.Raktha -(Blood) -Jeevana - Life giving (oxidation)
3.Mamsa-(Muscle) -Lepa - Coating
4.Medas (Fat) -Snehana -Lubrication
5.Asthi (Bone) -Dharana -Giving the frame work
6.Majja (Bone marrow) -poorana - Filling(the bones )
7.Sukra (Sperm/ovum) -Garbholpada - Embryo formation

Fibromyalgia is considered as the Vatha imbalance caused by any of the above mentioned reasons getting localized and affecting the Mamsa (muscle) and medas (fat) tissues. The two important patterns of Vatha imbalance are “Dhathu kshaya” (tissue degeneration) and “Srotho rodha” (bock in the functional channels).Here the second idea, the block in the functional channel of the muscle and fat tissues seems to be more relevant. More over due to poor digestive activity most patients show the signs of “Ama” (toxic indigestion).

Thus the primary concern in management is “amapachanam” (Digesting away the toxic indigestion) and Srothosodhanam (cleansing the channels).
The main symptom of Vatha affliction of the muscle is “sankocha” (spasm) which may cause more pain which puts one in a vicious cycle of spasm pain- insomnia-depression- spasm ,once and for ever unless checked. Hence early detection and pain reduction is also very important.

The dictum of ayurvedic management of these pathological symptoms are explained in Ashtanga hridayam as-
“Vireko mamsa medasthe niruha samanani cha”
Virechana (purgation), Niruha(decoction enemas) and Samana (pacifying medications) are in this order the steps of managing this problem.
Virechanam is the second among the Panchakarmas or five purification procedures.
Even if it is highly indicated in Pitha dominant disorders, Virechanam with appropriate Erandam (herbal extracts in castor oil) is of great significance in Vatha balancing.

Niruha mentioned as the fourth in the Panchakarmas is of at most importance in the treatment of Vatha imbalances having Neurological impacts.
Samana or pacification often comprises of herbs and life advises to pacify remaining imbalances and to nullify the impacts as well as tendencies.
This was an eye opener for me and my colleagues in the management of fibromyalgia.

Experiences
We had so many Patients suffering from fibromyalgia as health tourists who started traveling in search of its management. My first patient was a US singer; a Grammy award winner in 2001.She was treated by Vaidyamadham Cheriya narayanan Namputhiri at vaidyamadham nursing home and was given the follow up from our hospital. She had considerable progress, though not a total cure. She was advised to do yearly follow ups.

The most stunning result was in 2005 with a UK patient, a girl of 22 years, the daughter of a surgical registrar. Her case sheets were sent earlier. So we arranged her consultation and treatment. She was advised a treatment protocol for 30 days. She meticulously followed it irrespective of the palatability of several ayurvedic medicines and the severe purification procedures.

Her management principle was exactly as mentioned above. Virechanam (purgation) was repeatedly administered with the combination Eranda sukumaram. This has been very important as this combination clears up the channels and digests away ‘ama’ the toxic indigestion, together with its purifying effects.

After seeing indications of the removal of toxic indigestion and good digestive activity, she was also prescribed snehana(oleation) and swedana (sudation) procedures like Dhara,Pizhichil and Elakkizhi. Kheerabalathilam was used for sirodhara for seven consecutive days. This process involves a general oil smearing on the body followed by the application of medicated oil as a stream on the fore head on a person lying down in supine position from a height equal to the thickness of his four fingers. The stream must be as thick as his little finger, and it moves and sways on the forehead, followed by a gentle head massage at intervals during the stream. Duration was from 45 to 90 minutes.

Dhanwantharam kuzhampu was used for Pizhichil. Pizhichil or Sekam is simultaneously oleating and fomenting. The procedure involves a gentle smearing of medicated oil on the body followed by streaming of medicated oil using cotton towels .This treatment is carried out in seven positions- sitting, supine, left lateral, supine, right lateral, supine and sitting in this order ,for seven consecutive days. Duration was 45 to 90 minutes.

Samana chikitsa (pacifying therapy) included the use of ‘Dasamoola hareethaki lehya’ (herbal food supplement with molasses )and Dhanwantharam gulika( herbal tablet) as well as ‘Gandharva hasthadi kwatha’( a poly herbal decoction) . Her food was totally vegetarian, and the amapachana (digesting away toxic indigestion) was given importance. Medicines to stimulate her ‘agni’ (digestive fire) were also administered.

Viharas (life style modifications) and charyas (daily and seasonal routines) were also advised .She took a lot of rest, simple yoga, and relaxation methods. She was rehabilitated under the care of a family like situation. She took home medications for a 3 month follow up, and adhered to it.
Results were simply great. Her occupational therapist checked her biceps capability back home on her arrival. The test showed she could raise 8.5 kg instead of the earlier 1.5kg which he recorded the month before her departure to India.This was a true success story for ayurveda in managing fibromyalgia.

Summary of a few cases from different backgrounds
Among our case reports, most patients were western women and in the age group 30-50yrs. But we had a single case from India, a software engineer, woman, aged 24, possibly indicating the life style changes rapidly attributing to newer health issues. Most of our patients lived a stressed life and had neither specific routines nor dietary regimen until the disease. Most of them had the history of an emotional trauma, like the death of some one so close or family separation and so on.

Some had a physical precipitating cause like a home moving, night shifts with heavy physical strain and lack of sleep etc. The hospital stay was for a minimum of 14 days and a maximum of 40 days. The follow up was suggested for a minimum period of 90 days.  Annual visit for review was also suggested.

The results taking into account the level of analgesia (pain reduction), sleep improvement and recovery from fatigue were encouraging. More than 70 percentages of our patients showed considerable relief from pain and reported better sleep at the end of 90 days follow up. Fatigue was no more bothering around half of our patients at the end of the hospital stay .General improvement in the quality of life and a feeling of wellness were also witnessed.

Conclusion
Ayurveda presents a theoretical and practical stand in the management of fibromyalgia. It is evident that the chances are better with young patients than in middle aged or aged. This emphasizes early detection and management.  Even if it seems to be a western problem, the single Indian patient, being a young software engineer from Bangalore, India, it could be understood as a problem with a western life style. It is also clear that the out patient ayurvedic management also provide a certain help. The life style as well as diet plays an important role in managing this problem. This experiences gives us the conviction that ayurveda may complement modern medicine in searching out an answer for the management of Fibromyalgia and newer life style problems.

Sarve santhu sukhinaha
Sarve santhu niramayah
Sarve bhadrani pasyanthu
Ma kaschith dukhabhag bhaveth (a prayer from the Vedas)
(Let all be happy, let all be healthy- without any diseases,
Let all see only positive things in Life, and let no one suffer pain)

Dr Hari is a medical superintendent at KNM NSS ayurveda hospital Vallamkulam NSS Ayurveda hospital Aranmula Kerala,India.
http://www.doctorhari.com

© 2008 Six Senses Yoga Society

A first-time mother, when discovering she is pregnant, may wonder what is pregnancy like? Together with joy and excitement, she may experience some form of anxiety, doubt or fear of the unknown. RELAX. Nature is kind and takes care of itself. You will also find that, as time goes by, everything falls in place.

© 2008 Six Senses Yoga Society