Digestive problems as a symptom of modern times in their Joint Overheating

Wim van Daele is in Sri Lanka, and has been using Ayurvedic learning to understand how a complex interplay of hot foods, stress, fertilizers, inactivity, changed temporalities, and acceleration of life is leading to gastritis and other digestive problems - in short, an Overheating of the human body.

In a newspaper of 22 May, the president was referred to as saying that Sri Lanka is moving towards a time where Non-Communicable Diseases (NCDs) are accounting for 70% of the deaths in Sri Lanka. These NCDs include: cardiovascular illnesses, diabetes, obesity, cancer, and so forth. During my interviews with local healers, both Ayurvedic and Sinhala vedakam (a local health system influenced by Ayurveda), all agreed that, with the introduction of new foods and the increased processing of traditional foods, the overall picture of illness is changing (even though there are numerous local class, ethnic, and environmental variations to be taken into account). In short, the transformation of ingredients and related food practices lead to a modification of health problems, and this is also agreed upon by biomedical doctors. The transformation is not only symbolic or at the level of signification, but it is also very real and material, hence I use the term symptom instead of symbol.

Even though doctors from the three different medical systems seem to agree on the general picture, their explanation of the genesis or aetiology of these illnesses diverges quite drastically. Whereas biomedical doctors focus on isolating specific causative relations at the minuscule level of nutritional components, such as transfats, sucrose, cholesterol, vitamins, and so forth, the explanation of local doctors is very different and less familiar to Westerners. That is why I will focus on their explanation here, and this will also show that digestive and stomach problems are not just symbolic of changing times, but also following physically from it.

Wim van Daele. Photo: UiO

Several of these NCDs emerge when some less serious problems, such as indigestion, disturbed digestion, or gastritis, are not taken care of. In the Ayurveda and Sinhala vedakam, they have element- and humour-based explanations for these illnesses. To understand how these explanations work I will introduce the general approach of Ayurveda that has influenced and underpinned much of the Sinhala vedakam as well. Ayurveda holds that all entities in the world, including human beings, are co-composed of the five proto-elements or panchabhutas: earth, water, wind, fire and ether. All beings and entities are composed of different relative amounts of these elements accounting for their differentiations. Health is achieved when these elements are ‘quiet’ and in their right balance according to the being (with its minor individual variations as well within classes of beings). If one element “gets angry”, one gets an ailment with particular symptoms that relate to the element and that express themselves both physically and mentally. For instance, since the fire element is hot, an excess of it will give pimples, burning sensations, outbursts of anger and volatility of mind. These five elements constitute the basic building blocks of the three humours that run throughout plants (vrksa-Ayurveda), animals (Hasti-Ayurveda) and human beings (Ayurveda). The phlegm humour is predominant in the water-element, the bile humour in the fire element, and the wind humour is composed of the wind element. So, when the fire-element is ‘angry’, it will generally lead to the excitement of the bile humour or pitta. The humours are also related to general dynamics and principles. The wind humour or vata involves the principle of motion, the pitta or bile humour is connected with heat and light, and the kapha/semme or phlegm humour involves steadiness and inactivity. If the wind humour is ‘angry’ or ‘excited’, it gives rise to fear, grief and depression and impairs strength and well-being. In the environment where the humours are also present, it can uproot trees, cause earth quakes, form rain clouds, and so forth. Indeed, the wind humour is an animating force. The bile humour is hot and helps sustaining the gastric fire that is crucial in the digestion of food, but when this humour is excited it can lead to indigestion, fever, fear and anger as mentioned earlier in relation to the fire element dominant in the bile humour. When excited in the environment it causes droughts. The phlegm humour predominant in water can lead in its excited state to fatness, dullness, ignorance and depression. In the indigenous medicinal system, the bile and phlegm humours are the most active, but controlled by the overarching wind humour. Cold foods affect phlegm and hot foods (hot and cold referring not to an actual temperature, but to their respective sensorial and humoral effect in the body) increase the bile humour, both of which get modified under influence of the wind humour. These three humours also have to be calm and in a right balance in order to achieve good health. They can be upset owing to internal and external factors. For instance, food is considered an internal cause of upsetting and appeasing the humours. So, unbalanced food with for instance too much food predominant in the fire element creates an angry bile humour with its physical and mental consequences. Indeed, mental health problems arise when these angry humours reach the heart where consciousness is located. As such, Ayurveda offers not so much a psycho-somatic but rather somato-psychic account of mental illness. An external aetiology of illness entails that these three humours get affected by the presence of yakkhas or by the anger of deities. Then these non-human beings have to be dealt with before being able to restore the balance of the three humours. Of course, the whole approach is much more complex, but I try to convey the basic mode of explaining health and illness.

Interestingly, a lot of problems related to the stomach and digestion involve pitta problems and this is related to the present times with its multiple, complex, and contradictory forces that are hard to digest.

A McDonald's restaurant opens in Battaramulla . Photo: Daily News

An elaborate example will make my point clear. Since the 1960s and 1970s, new rice varieties have been introduced to create a faster and higher yield. To increase the output, these plants were developed and bred to respond well to external fertilisers. Hence, they are input-dependent, but these inputs are deemed acid and burning (særay) to the earth, which loses therefore its regenerative capacity, and so ever more is required, thereby overheating, burning and depleting the earth. This heat of the acid gets absorbed in the rice, and by extension in the other vegetables and drinking water as well. Through the ingestion of these poisonous foods, the heat in the body increases, exciting the pitta, and creating an imbalance with the two other humours. This heat and excitement of the pitta is exacerbated by the increased consumption of hot ‘foreign’ foods, like wheat flour, many bakery snacks, hot (alcoholic) drinks, tomatoes, cabbage, and other vegetables introduced by the Europeans. Wheat flour has by nationalist politicians often been called the evil of society and they argue for a total ban on it, since they feel wheat plays a core role in the rise of NCDs. One reason that these local healers give for this increased consumption of these hot foods is that life is accelerating. Since school starts earlier than about 40 years ago (starting at 7.30 am) and since increasingly both parents take on jobs to pay for their increased desire for luxury, there is often too little time to prepare a full breakfast of rice and curry, unless one gets up at 4 am (as was pointed out by the president of the diabetes association as well). Yet, this early rise occurs less due to electricity and TV that delay bedtime. So, the healers argue, the mothers get lazy, and together with the proliferation of numerous establishments selling bakery products and ‘short eats’ (a Singhalese English term for fast food), these mothers just go to one of these places and stuff these children with junk food, such as various types of spring rolls and roti. This is not nourishing food and it is moreover very oily, creating pitta and vata problems. Children then don’t get real food until they get home at 2 or 3 pm, but then again, if mothers are out at work, these kids have to take out rice or bakery snacks for lunch, and then if the mother is too tired from work to cook decent rice and curry in the evening, she again takes food from the kade or food stall. That is where urban life is heading to in the view of these healers and their view strikingly resonates with the likewise negative views of biomedical doctors on this issue (generally blaming the women). Having lived with several families where mothers did go at length to provide good nourishing food (=rice), I did not observe this evolution, not even in Colombo (so it may be a general discourse that starts leading its own life in a process of myth-making and fetishization), but looking at the success of these bakery shops, I can recognize some truth in this general evaluation.

Rice and curry. Photo: Mike Powell

The acceleration of life also leads to a modification in the rhythms of eating, since one has to eat breakfast very early and lunch very late. This leaves the stomach empty and this can lead to a burning of the stomach. In the local health systems, the digestion and combustion of food is done by the gastric fire that digests the food (gastric fire somewhat overlapping with metabolism). This fire has to be fed decently, otherwise it can increase and burn the stomach, or it can decrease and lead to indigestion and constipation. Delaying the intake of food can thus lead to the gastric fire burning the wall of the stomach. Hence, a steady and regular rhythm of eating is deemed very important, but this health prescription is very rarely adhered to in everyday life (which is related to the whims of life, people, social relations, and temporal dispositions of Sri Lankans). The exigencies of the changing times complicate a regular intake in food and tend to lead to an overheating of the digestive system, which is compounded by the intake of too many hot foods. On top of that, food gets increasingly stored in fridges with the arrival of electricity, by way of which foods are kept cool in the actual sense of the word, but some cold foods have a heating effect on the body. That is why ice cream is generally called a hot food in the Ayurvedic sense.

Interestingly, the excessive intake of these hot foods leads to a contradictory effect, namely that the gastric fire gets overheated and over time its function gets taken over partially by the hotness of the ingested food by way of which the gastric fire gradually weakens.

This apparent contradiction becomes intelligible in the distinction that local doctors make between different types of gastritis. The local word for gastritis is ammela pitta, pointing to excessive fire in the stomach. However, there are three types: vata ammela pitta, pitta ammela pitta, and semme ammela pitta. The vata or wind ammela pitta or gastritis gives a bloated feeling and makes one burp the whole time, since the wind is excited in this case. Sometimes, vomit may come along with the burps. The pitta ammela pitta is marked by an ongoing burning sensation in the gullet, whereas the semme ammela pitta makes one feel very heavy inside the stomach and uncomfortable to move. (It is clear that Ayurveda and this local health system are very attentive in their approach to the body and its sensations.) In the vata and semme variation of gastritis the digestive power is decreased by a weakening of the gastric fire owing to an overload of hot foods, whereas in the pitta form the fire is compounded by it. If not treated well, the heat burns the wall and creates wounds, and later holes.

Still the picture of explaining digestive problems, such as gastritis, is not complete. Another factor is stress. When the mind is not able to disconnect from the senses and from the thoughts in the mind (called mind objects), it continues thinking and worrying. This requires fuel from digestion and when not fed, during a sleepless night for instance, the gastric fire can cause too much heat as well. So, stress easily creates an overheating in the body alongside all other factors, and local doctors say they perceive much more stress these days. One has to juggle more different things, such as work, farming, and domestic management, and children have a huge pressure to be the best in education. Just going to school is no longer enough in the rat race. Everywhere, you can see announcements for additional classes to improve one’s knowledge and one’s results to have a better chance to enter a better institution. Children follow extra tuition classes in one or another form up to seven days a week. Education is in this way very competitive and a great cause for stress, not only for the children, but also for the parents who do everything to make their child enter into a, preferably foreign, university. Indeed, education is highly valued here in the wider quest for knowledge and truth, something stressed in Buddhism. All this stress can cause an excess in fire, and if it lasts long it can cause an exhaustion of the fire (depending on particular combinations of other factors as well), leading to indigestion that increases the wind in the stomach, leading particularly to vate ammela pitta.

The increase of these heat-related problems is also joined by its counterpart; an increase of a particular problem of an excess in the sweet tastes that lead to diabetes, which could be classified as an illness of a cold nature. The sweet flavour is seen as being predominantly composed of the water element which is deemed cooling (a reason for debate whether ice cream is hot or cool). So, eating a lot of sweet foods increases the phlegm humour and water element in the body causing more lung problems, coughing, phlegm, depression, excessive desire for sex (since the sweet taste produces more semen), but also an excess in water that has to be secreted in the night. The regular urination during night is regarded as a symptom of diabetes and that is why diabetes is called literally “too much water” madumeehe or diyavediaava. So, the sweetness is causing diabetes which is seen as a cooling disease related to an excess in water.

Here we can thus clearly see how illnesses are explained in terms of the three body humours and the five elements (as well as the six flavours that have their particular agency, but to keep it simple I refrained from entering this discussion). Moreover, as I pointed at earlier, the increased pitta seems to explain also most of the mental health problems these doctors perceive today. Pitta unmade is a common problem that is characterized by an overheated mind that cannot concentrate and in which thoughts move here and there. The persons afflicted by a pitta unmade can be quite unpredictable in their reactions, getting angry easily. Indeed, this hot mental illness is also perceived by several doctors to be the cause for increased violence and jealousy. Jealousy in turn accounts for various sorcery attacks that then seek to disturb another person’s agency as well as one or several of the person’s three humours. In those cases, healing by eating counteracting foods will not work as a sole remedy. An additional healing rite is then required, one of which I hope to film coming Sunday.

This explanation of digestive problems should have highlighted a salient aspect in the difference between the biomedical systems on the one hand, and the Ayurveda and Sinhala vedakam, on the other hand. The scale upon which they focus differs greatly. Biomedicine isolates certain minuscule agents that causally shape illnesses, even though the focus on lifestyle increases with respect to the NCDs. Ayurveda and Sinhala vedakam clearly focus on the scale of the human person in its interrelatedness with environment, lifestyle, food, non-human entities, humours, primordial elements and so forth. It is a complex system in which deploys less deterministic forms of causality, since the beneficial or detrimental actions of an entity only become actualized as such in relation to a context of multiple interactions. For instance, in combining two ingredients their specific properties of hot or cool, tastes, and effects on the humours may drastically change and this context-driven actualization occurs also when food is entering a person with its specific composition and being located in a specific (cool, windy, or hot) environment. As such, in the local health system, the approach is very individualistic, taking into account its context, way of life, environment, social relations, humoral composition, and so each healing therapy has to be adjusted to each person and each context in which this person is living.

To conclude, I hope to have illustrated how a complex interplay of various factors (hot foods, stress, fertilizers, inactivity, changed temporalities, and acceleration of life) is leading to an overheating of the body in a quite literal and not just metaphoric sense, creating common digestive and metabolic problems of a pitta nature, which is predominant in the fire element. Or, how gastritis and other digestive problems become a symptom of a changing way of life in their joint Overheating…

By Wim van Daele
Published June 24, 2015 11:12 AM - Last modified Oct. 8, 2015 9:40 AM