Table 1 Package of Integrated Naturopathy and Yoga provided at 'Manthena Sathyanarayana Raju Arogyalayam' hospital for management of Diabetes mellitus in Andhra Pradesh, India, May-August, 2014

Diet

A special package of diet is designed for DM patients admitted in MSRA containing low glycaemic-index, fibre-rich, plant-based diet containing whole grains, legumes, vegetables and fruits which are high in protein and no added salt, oil and sugar. Nearly two-thirds of the diet is constituted by the foods in their natural form (not cooked) which includes high-quality, protein-rich sprouted pulses and fruits and vegetable salads. Indian breads prepared out of whole-wheat flour are provided instead of steamed rice as a source of carbohydrate. Special care is taken to prepare tasty, low-calorie recipes and flavoured with locally available herbs without the use of additional salt, spices and oil. Contrary to other reported dietary interventions in the published literature, there was no restriction in the quantity of the food consumed by the patients, who are encouraged to eat as much as they want. A principle of ‘early dinner’ (before 7:00 pm) is followed. This is in tune with the behaviour of all diurnal animals in nature and is intended to provide adequate rest to the body, especially the organs involved in the digestion of food. The meals (breakfast, lunch and dinner) are provided at pre-specified times of the day to ensure that the body gets into a natural rhythm of metabolism. Patients are also taught the methods of preparing the recipes in ‘daily cooking classes’ (1 hour) to enable them to prepare their meals once they return home.

Exercise

Regular exercise (two times a day) in the form of Yogic exercises and Pranayama (breathing exercises) are taught to the patients who practice under the supervision of qualified yoga teachers. Emphasis is given on ‘Asanas’ (yogic postures) which have an effect on weight reduction (especially reducing the abdominal fat stores) and stimulation of pancreas to produce insulin. In addition, patients are encouraged to do aerobic exercises like walking, swimming or boat-pedalling in the river.

Rest and Relaxation

Several measures are taken to ensure that patients are adequately rested and live a stress-free life in the institute. In addition to the relaxing and quiet environment of the MSRA, daily lectures are provided about stress and methods of addressing them. Interested patients are also offered an opportunity to learn meditation and practice under supervision of experts. Naturopathy advocates “Therapeutic Fasting” using honey, lemon and water which allows the body to rest completely and heal itself. Patients who are able to completely stop anti-DM medications and whose blood sugar is under control are offered an opportunity to fast for 1–3 days. Patients are carefully monitored during this process for their blood sugar and electrolytes. In addition, several treatments such as various types of mud/steam bath and body massages are administered to relieve pain and relieve stress.

Patient education

Naturopathy emphasizes on self-responsibility of one’s own health. A minimum of 15 days of stay in the institution is needed to understand the rationale of the intervention and for motivating the patients to practice on their own. The emphasis is on patient empowerment to promote a sense of self-responsibility after going back to their day-to-day lives and in the long run. There are daily lectures and discussion in the evening (60 minutes) to provide the patients an understanding of the principles of naturopathy. There are also daily morning lectures (60 minutes) on personality development, stress management and meditation. Videos and books about these principles are also made available to patients. In addition, patients are counselled one-to-one by the doctors every day.