|Year : 2015 | Volume
| Issue : 1 | Page : 14-21
Fermented milk products: Probiotics of Ayurveda
Subrahmanya Kumar Kukkupuni, Aparna Shashikumar, Padma Venkatasubramanian
Centre for Pharmacognosy, Pharmaceutics and Pharmacology, Foundation for Revitalisation of Local Health Traditions, Bengaluru, Karnataka, India
|Date of Web Publication||5-Dec-2014|
Centre for Pharmacognosy, Pharmaceutics and Pharmacology, Foundation for Revitalisation of Local Health Traditions, No. 74/2, Jarakabande Kaval, Post Attur, Via Yelahanka, Bengaluru 560 106, Karnataka
Source of Support: Fund support from DST-DPRP, Government of India., Conflict of Interest: None
Despite the diversity, an Indian meal would invariably contain a dish made of milk products. Milk and milk products are considered as wholesome food (pathya) or rejuvenator (rasayana), which can be correlated to modern probiotics and prebiotics that increases the life force (ojas). Ayurveda explains a physiological component/process called " agni", - responsible for digestion and metabolism. Fermented milk products are known to normalize " agni". Ayurvedic treatises dedicate chapters to describe types of milk, preparation of various fermented milk products, and their medicinal uses, which are not known to modern world. Use of fermented milk has been indicated as treatment/diet in many gastrointestinal diseases. The word "probiotics" per se and the microorganisms involved have not been mentioned in the ancient texts, but Indian medicine was certainly aware about the specific uses of dairy products for health benefits and was well-documented. This calls for a closer scientific scrutiny.
Keywords: Ayurveda, fermented-milk, pathya, probiotics, rasayana
|How to cite this article:|
Kukkupuni SK, Shashikumar A, Venkatasubramanian P. Fermented milk products: Probiotics of Ayurveda. J Med Nutr Nutraceut 2015;4:14-21
|How to cite this URL:|
Kukkupuni SK, Shashikumar A, Venkatasubramanian P. Fermented milk products: Probiotics of Ayurveda. J Med Nutr Nutraceut [serial online] 2015 [cited 2019 Jan 24];4:14-21. Available from: http://www.jmnn.org/text.asp?2015/4/1/14/146149
| Introduction|| |
Ayurveda (the science of life) is a well-known traditional Indian System of Medicine, which has been in practice for more than 2000 years. Ayurvedic treatments are holistic, personalized and include not just drugs but also diet, exercise and life style prescriptions.
It recognizes "health" as not the mere absence of disease but a state of complete homeostasis between the three humors (doshas), seven tissues (dhatu), three types of waste products (mala), digestion and metabolism, pleasant senses, mind, and soul.  This time-tested life science emphasizes the importance of the right kind of food for the formation and sustenance of body.  Caraka, says that the body is the product of food and humans attain pleasure and sorrow (health and disease) because of wholesomeness and unwholesomeness of the diet. 
Pathya is a term used to describe suitable or special diet recommended during disease conditions.  The importance given to pathya is evident from the following verse in Caraka Samhita, "without proper diet, medicines are of no use and with proper diet medicines are not required."  It is worth observing that the codified Ayurveda texts written 2000 years back had dedicated chapters to describe diets.  Wholesome (pathya) and unwholesome (apathya) food and drinks for a disease are generally found described at the end of the chapter dealing with that particular ailment.  Examples of pathya include milk, milk products (buttermilk, curd, whey, cottage cheese, butter, ghee), old red rice, horse gram, turmeric, bitter gourd, barley, cardamom, clove, ginger, pepper, pomegranate, lemon, Indian gooseberry, honey, meats of animals and birds such as deer and pigeon etc.  These food items are also often incorporated in medicinal formulations or prescribed to be taken along with medicine.  Pathya supports a medicine to bring back the homeostasis of humours (doshas), which are vitiated during disease conditions.  Epistemology of Ayurveda explains a physiological component/process called "agni", is responsible for digestion of food components and metabolism of tissues. Specific fermented milk products have been indicated to normalize "agni" (metabolism). 
Milk and preparations from fermented milk such as curd, buttermilk and ghee (clarified butter) form a part and parcel of daily diet in India. Medieval literature on dietetics, Kshemakutuhalam emphasizes the importance of including components of milk products in diet. Hundreds of culinary preparations using milk and milk products have been described in this work.  Sanskrit poets have gone to the extent to say that several Hindu Gods would not have suffered from several diseases if buttermilk had been made available in heaven.  Detailed properties and uses of milk and milk products have been described under separate chapters in classical Ayurvedic literature. At the same time contraindications or cautions of use of these products have also been stated.  Panchagavya, the five products of cow namely milk, curd, ghee, urine and dung have been an inseparable part of Hindu rituals. Cow's milk, curd and ghee have been considered important among five elixirs on earth (Panchamrita-cow's milk, curds, ghee, sugar and honey). 
The origin of the science of modern probiotics lies in 1908 when Metchinikoff observed that the Bulgarian peasants lived longer because of the consumption of yoghurt. Bacteria like Lactobacillus, Bifidobacterium and a few other single-celled organisms like yeasts (e.g. Saccharomyces boulardii) have been evaluated as probiotics.  Probiotics have been accepted as a nutraceutical or dietary supplement and has been defined by Food and Agricultural Organization/WHO as "live microorganisms which when administered in adequate amounts confer a health benefit on the host". 
The objective of this paper is to provide comprehensive referenced information from classical Ayurvedic literature on the properties and uses of milk and milk products for medical benefits, especially of rejuvenative (rasayana) kind and drawing attention to its use in diarrhea and to correlate with modern perspective of probiotics. No single book chapter/Ayurvedic classical literature chapter or review paper give a complete picture of Ayurvedic concepts on milk and milk products with Prebiotic or Probiotic perspective. Since the philosophy and principles of Ayurvedic pharmacology are epistemologically distinct from those of the western biomedicine, approximate English translation has been provided to the Ayurvedic terminologies.
| Methodology|| |
Citations on milk and milk products in Ayurvedic literature
Properties and actions of milk and milk products have been described in detail in Ayurvedic literature. These include basic preparations like curd (dadhi); and the secondary products such as whey (mastu), cheese (ghola), butter (navaneeta), buttermilk (takra) and ghee (ghrta), which are obtained by further processing.
Brihattrayis (classical, comprehensive Ayurvedic encyclopedia of c. 1500 BCE to 6 th CE), Nighantus (lexicons of c. 10-16 th CE) and Chikitsagranthas (texts of 16 th CE on pathophysiology, treatment principles and treatment) were referred for the purpose of compilation of information. Entire chapters were studied to pull out relevant information. Ayurvedic texts [Table 1] were scanned for verses containing Sanskrit words for milk (synonyms: ksheera, payas, dugdha, stanya), curd (dadhi), buttermilk (takra), butter (navaneeta), ghee (ghrita/ajya) and products of processed milk (piyusha, ksirasaka, kilata, takrapinda, morata, sara, manda) to compile pertinent information for further literary analysis [Figure 1]. Caraka Samhita, dedicates a chapter to food and drinks called "Annapanavidimadhyayam", in which the details of milk and milk products are described.  Susruta Samhita and Vagbhata also systematically describe the properties and action of types of milk, curd, buttermilk, butter, and clarified butter/ghee. ,
|Table 1: List of Ayurvedic classical texts referred and the nature of information available |
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Properties and actions of milk and milk products
The properties and pharmacological action of milk of eight different animals have been mentioned in the classical Ayurveda texts. Depending on the animal source, the qualities of milk (such as taste, potency and post digestive action) vary [Table 2]. Milk is sweet in taste and cold after digestion, unctuous, beneficial for vital physiology of individuals (ojasyam), increases tissues, balances humors Vata and Pitta, aphrodisiac, increases humor Kapha, heavy to digest and assimilate in its properties. Milk, irrespective of its source, has been generally indicated in several disease conditions as compatible diet. It is useful for those suffering from chronic intermittent fever, mental disorders, emaciation, fainting, giddiness, anemia, burning sensation in body, thirst, cardiac problems, spasmodic pain, flatulence, abdominal mass, diseases of bladder, hemmoriods, hemorrhage, diarrhea, diseases of female genital tract, tiredness, exhaustion, miscarriages. Ayurveda explains specific methods of use of milk in each of the above mentioned disease conditions.
Milk is a rejuvenative (rasayana) and extremely beneficial to children, elderly people, the emaciated, hungry and weak. ,
However Vagbhata cautions that, uncooked milk produces excess secretions and blocks the body channels (Abhishyandi), not easily digestible and therefore can cause diseases related to indigestion. Too much of boiling is also said to make it very heavy to digest. Milk generally should not be given to those who are suffering from Kapha driven disorders. It is advised not to consume milk with sour fruits. 
Caraka mentioned cow's milk as the best among vitalizes and rejuvenators (rasayana). Human milk is considered to be good to treat a variety of eye diseases. Goat's milk is said to be the best as galactagogs, for alleviating debility, hemostatic and pacifiers of internal hemorrhage. Sheep's milk as Pitta and Kapha aggravators. Buffalo's milk is ideal to induce sleep [Table 2]. 
Curd (dadhi) is the product obtained through fermentation of milk by adding a few drops of curd or buttermilk. Ayurveda explains specific methods of preparation of fermented products from milk. [Figure 2] explains in detail on the methods of preparation of different fermented products from milk. Properties and uses of curd prepared from different animals have been mentioned in the lexicons. Curd has sour and astringent taste, hot in potency and is unctuous. It is aphrodisiac, vitalizer, relishing, appetizer, and strength promoting. Curd prepared from cow's milk is considered to be the best. 
|Figure 2: Preparation of milk-curd-buttermilk-butter-ghee: Ayurvedic suggestion|
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Ayurveda has also classified curds based on the physical features and taste into five types, namely bland sweet (manda), sweet (swadu), sweet-sour (swadwamla), sour (amla) and excessively sour (atyamla), each imparting a different action [Table 3].  In general, sweeter the curd, heavier it is and will increase Kapha dosha accordingly. As it becomes sour, Pitta dosha is increased and excessive sourness vitiates blood. Consumption of sour yogurt for long time may lead to skin diseases.
The upper thick layer of the curd is called sara and the watery portion is called mastu. Sara is sweet tasting, heavy to digest and an aphrodisiac. The watery portion, mastu is light to digest, increases appetite, cleanses body channels, and pacifies thirst.
Curd is recommended to be used with caution during autumn, late summer, beginning of rainy season and spring. As per Ayurveda curd should not be consumed during night since it increases Kapha that can affect metabolism (agni). If curds are used when it is not supposed to be used it can produce adverse effects such as fever, hemorrhage, erysipelas, skin disorders, anemia, giddiness, and jaundice. 
Takra is obtained from curd (dadhi) after churning well with water [Figure 1] and [Figure 2]. Buttermilk is sweet, sour with astringency as subsidiary taste, hot in potency, easily digestible and may cause some dryness in body. It stimulates digestive fire, alleviates minor poisons if consumed, decreases edema, and helps to control diarrhea, anemia, hemorrhoids, and splenomegaly. It is helpful in anorexia, intermittent fevers, vomiting, excessive salivation, dysuria, and excessive body fat. 
Buttermilk is recommended in cold seasons, during conditions of deficient digestive fire and in diseases caused by Kapha and Vata doshas.
Three types of buttermilk and their properties are mentioned in Ayurveda based on fat content, namely fat-free, half fat and full fat. These are to be consumed according to the power of digestion in individuals. 
The medieval period lexicon, Bhavaprakasha Nighantu details the different methods of buttermilk preparation based on the quantities of water used, while churning the curd along with the uses [Table 4]. 
Even though buttermilk is a well-advised diet in many diseases, Ayurveda gives a word of caution in its use in certain conditions. It is contraindicated in debilitating diseases like tuberculosis, emaciation, giddiness, fainting, burning sensation and intrinsic hemorrhage. Excessive consumption of thick buttermilk during summer is also contraindicated as it increases pitta dosha.  It can act as a non-aphrodisiac on excessive consumption. 
Ayurvedic literature also describes some uncommon secondary products of curd and buttermilk. Kilata or kurchika is the solid portion obtained after boiling curds or buttermilk. Dadhikurchika is the thick, milky liquid obtained by stirring new curd. Takrapinda is the solid portion of buttermilk after draining the whey. Morata or morana is the thin watery portion separated out. Ksirasaka is curds or buttermilk that is blended with certain herbs like ginger (Zingiber officinale Roscoe.), curry leaves (Murraya koenigii L.) without heating. 
Butter is derived from churning curd after addition of sufficient quantity of water [Figure 2]. Butter is cold, sweet and slightly astringent and sour to taste. It relieves vata and pitta vitiation. It has the potential to relieve tuberculosis, hemorrhoids and facial paralysis. 
Butter prepared directly by churning the cream of milk (i.e. without curdling) is more unctuous and heavy to digest and can cause constipation. However it is useful in curing bleeding disorders and eye disorders.
Ayurveda advises to consume only fresh butter. Old butter (rancid) is considered to be alkaline, pungent and sour. It may cause vomiting, piles, skin diseases, kapha disorders and obesity. ,
Clarified butter/ghee (ghrta)
Though, ghee cannot be considered as probiotic, it has been discussed here since, the special appreciation Ayurveda has about this cow product. Ghee is well appreciated for its medicinal values. It is one of the bases for many medicinal preparations called ghritapakas. Ghee, among all fats has sweet taste, and retains its sweetness even after digestion. Being a rejuvenator (rasayana), it promotes memory, intelligence, digestion, life force (ojas) and reproductive tissues when used moderately. However, excessive consumption may increase kapha dosha and body fat. It alleviates vata, pitta doshas and removes poison.
Ghee obtained from cow's milk is considered to be the best for general use. That from buffalo is considered to be a better aphrodisiac and is useful in eye diseases. Goat's ghee is specially indicated in treating the diseases of respiratory tract such as cough, dyspnea and tuberculosis. Camel's ghee is useful in relieving swellings. Sheep's ghee is contraindicated for people with mild to moderate digestive capacity, since it is very heavy to digest. 
Ayurveda indicates consumption of fresh ghee for dietary usage, in anemia and jaundice. Apart from that, for medicinal purposes, old ghee is advised. Ghee stored and preserved for 10 years is known as "purana ghrita" and that which is preserved for 100 years is called as "mahapurana ghrita". Older the ghee more the therapeutic potency. It alleviates intoxication, epilepsy, insanity and poison. A supernatant clear liquid formed in ghee container is called as ghritamanda, which is comparatively lighter and easier to digest.
Consumption of ghee is contraindicated in conditions of chronic debilitating diseases like tuberculosis, in kapha dosha dominating diseases, depressed digestion, diabetes, abdominal diseases and acute fever. ,
Panchagavya or the combination of cow's milk, curd, ghee, urine and dung in equal proportion and diluted with water has a unique role in every Hindu ritual. Ayurveda, even though not a supporter of any Hindu or Vedic rituals, emphasizes the medicinal uses of unique combination of panchagavyas in both body and mind related diseases like epilepsy. The ghee preparation with equal quantities of panchagavyas is commonly used in diseases of mind and brain.
Tenth Century Lexicon, Dhanwantari Nighantu describes the combination of panchagavyas as the purifier of physical impurities from all over the body. It is said to relieve diseases related to Kapha irrespective of their tissue specificity. 
"Pancagayvya" and "brihat panchagavya gritha" cooked with some herbs and ghee are commonly indicated medications to treat epilepsy and insanity by the Ayurvedic fraternity.  Texts like Ayurveda Chikitsa Marga emphasize daily consumption of "panchagavya ghrita" to enhance intellect in children. 
Role of milk and milk products in diarrheal disorders
It is interesting to note that Ayurveda has spelt out the merits of milk and fermented milk products like buttermilk both as food and medicine, while treating diarrhea. Diarrheal disorders are called as atisara in Ayurveda. Atisara is said to be caused mainly due to consumption of unwholesome food and indigestion. Ayurveda classifies diarrhea into six types based on the dominance of vata, pitta, kapha and all three humors, due to fear and grief. Grahani is a disease entity, where a person suffers frequent spells of exacerbations and remissions of diarrhea and features of indigestion. Rectal prolapse is said to be a complication of frequent or chronic diarrhea. 
Both milk and buttermilk have significant role to play in Ayurvedic treatment of diarrheal disorders, either in the form of medicine or food [Table 5]. They have specific roles in inhibiting or reversing the pathophysiology of diarrheal diseases as summarized in [Figure 3]. Ayurveda believes that any diarrheal incident is associated with compromised digestive power of the body. Buttermilk (takra) plays a unique role as diet regimen (pathya) in this condition because of the sour and astringent taste. It is worth mentioning here that Ayurveda recommends the use of only that buttermilk, which is prepared by complete removal of fat in diarrheal disorders. This is obtained by churning curd with four parts of water.  Addition of a pinch of salt and garnishing with spices like asafetida (Ferula asafetida L.), ginger (Z. officinale Roscoe.), curry leaves (M. koenigii L.), coriander leaves (Coriandrum sativum L.) etc., is a common traditional practice in South India.
|Figure 3: Properties of milk and buttermilk and their role in treating diarrheal diseases (atisara)|
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|Table 5: Indications of buttermilk, curd and milk in different diseases |
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Except in a few diarrheal con1ditions, curd is generally not indicated because of its heavy and unctuous nature due to persistent fat content.
Milk is useful in some specific conditions of chronic diarrhea, associated with passage of blood and mucus. Milk, by nature is sweet, cool and nourishing. By virtue of this, milk plays a considerable role in reducing Pitta. Therefore it can be used in Pitta dominant diarrhea (atisara) with symptoms of burning sensation and passage of blood. Milk also is indicated in convalescent stages of diarrhea as nourishing agent and helps the person to regain normalcy of health [Figure 3].
Milk and milk products are advised in diarrheal diseases to be consumed in two forms, either as medicine or as "wholesome food".  Panchagavya ghrita and takrarishta (Ayurvedic medicine - fermented buttermilk) are examples where milk and other cow products are part of complex Ayurvedic formulations. Advice to consume milk and other milk products as supportive dietary therapy is commonly observed in the treatment of diarrheal diseases. 
| Discussion|| |
Ayurveda has a unique approach and understanding of properties, actions and medical uses of milk and milk products. A closer look at the described pharmacology and pharmacodynamics of milk and milk products reveals Ayurvedic concept of functional foods. Ayurveda has used fermented milk products such as curd and buttermilk to treat diseases such as diarrhea, which suggests that there was an appreciation of the role of probiotics even if not exactly in the same way as it is understood today. ,
From the range of milk products described in Ayurveda, one can consider the fermented milk products like curd and buttermilk as probiotics. Ghee is a sub product of curd, but its role as a probiotic is not clear. Ayurveda considers dilute buttermilk, after removal of butter to be the best among fermented milk products. Scientific studies on its role in treating diarrheal conditions may unearth not just new probiotic products, but contribute to a new understanding of the physiological role of probiotics. While describing the milk and milk products Ayurveda takes care to caution the users about contraindications and use as per season and disease condition. Season specific indication and contraindication of food articles is the specialty of Ayurveda.
"Probiotics" as per modern definition refers to the specific live cultures of microorganisms while the Ayurvedic understanding of the products is more holistic. The medicinal benefits suggested may not be just due to the microflora but also to the prebiotic minerals and other components in the product. Several recent pharmacological studies showed the effect of Ayurvedic probiotics like curd on gut health. A preclinical study demonstrated the effect of traditionally prepared curd on the nutritional status and hind gut health of dogs. A decrease in fecal pH, ammonia and health negative coliform was observed. Meanwhile increase in health positive microbial count (lactobacilli and bifidobacteria), lactates and short chain fatty acids suggests improvement in gut health. Apart from that, total erythrocyte count was also found to increase.  Immune modulation and anti-inflammatory and pro-healing effects of whey on rats have been observed. 
Bacterial species that have traditionally been regarded as safe are used in probiotics; the main strains used include lactic acid bacteria and bifidobacteria that inhabit the intestinal tracts of humans and animals. However, reports of frequent isolation of bacteria used in probiotics from infection sources in recent years have raised much debate over the safety of probiotics. 
Safety of probiotics has recently been raised as a matter of concern. Various reports have documented health-damaging effects of probiotic translocation in immuno-compromised patients. Moreover the antibiotic resistance of some strains has increased the complexity of their eradication. , Bacterial species such as Bifidobacterium and Lactic acid bacteria have been isolated from traditionally used foods, and have been reported to be safe.  In this backdrop, scientific study of holistic Ayurvedic preparations of milk and fermented milk products, their application, benefits and contraindications may throw light on a better and safe way of use of probiotics.
| Conclusion|| |
Milk and fermented milk products have been emphasized in Ayurveda as the rejuvenators (rasayana and pathya), could be correlated to modern probiotics and prebiotics, or aspects thereof. Appropriate understanding of the Ayurvedic concept and knowledge of pathya and rasayana can help in proper use of probiotics as well as an understanding of the properties and action of milk and milk products.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]