Case Study: Bringing a Patient's Existing Ayurvedic Care into a Functional Medicine Plan
Level 3, Clinical application
In brief
This illustrative case follows a 58 year old woman with type 2 diabetes, hypertension and knee osteoarthritis who uses Ayurvedic care alongside conventional treatment. It shows the integrated history, the evaluation of each Ayurvedic element for evidence, safety and fit, the letters exchanged with her physician and her Ayurvedic practitioner, and a single plan that kept what helped, reviewed what posed risk and built nutrition around the common ground between the 2 traditions.
Many patients use traditional systems of medicine alongside conventional care, often without telling their doctors. This case shows how Integrated Functional Medicine brings that care into view, evaluates it honestly and coordinates it safely. It is an illustrative composite, and the reasoning applies equally to other traditions.
Presentation
A 58 year old retired teacher, born in India and living in the United Kingdom, is referred for nutrition support for type 2 diabetes, which is not well controlled despite metformin and a sulphonylurea. She also has hypertension treated with an ACE inhibitor, and knee osteoarthritis. Her HbA1c is 66 mmol/mol. She reports occasional episodes of shakiness and sweating before lunch, which she has not mentioned to her doctor.
The integrated history
Asked specifically about other care, she describes seeing an Ayurvedic practitioner, a registered practitioner in India whom she consults by video and during annual visits. Her Ayurvedic care includes:
| Item | Details | Her reason |
|---|---|---|
| A herbal powder for blood sugar | A classical formulation containing several herbs, including some traditionally used for glucose; taken twice daily for 2 years; obtained from a licensed manufacturer in India | “To help my sugar” |
| Bitter gourd juice | Fresh juice each morning, prepared at home | For blood sugar |
| A herbo mineral tablet | Prescribed a year ago for joint pain; label lists a processed mineral ingredient | For her knees |
| Warm sesame oil massage of the knees | Several times a week | For stiffness |
| Dietary advice | Avoid “cold” foods such as yoghurt and many fruits; eat the main meal at midday; early dinner | To balance her constitution |
| Daily yoga and pranayama | Gentle practice for 30 minutes | For wellbeing |
She has not told her doctor about any of this, expecting disapproval.
Evaluating each element
| Item | Evidence | Safety and fit | Decision |
|---|---|---|---|
| Herbal powder for glucose | Some constituent herbs have limited glucose lowering evidence | May add to sulphonylurea effect; possible contributor to pre lunch shakiness | Review with physician and Ayurvedic practitioner; do not stop abruptly without a plan |
| Bitter gourd juice | Small trials with mixed results for glucose | May add to glucose lowering effect | Include in the review |
| Herbo mineral tablet | Limited clinical evidence | Some herbo mineral preparations have been found to contain heavy metals; long term use | Ask physician to consider blood lead and review; discuss with Ayurvedic practitioner |
| Oil massage | Traditional practice; low risk | Safe; valued | Support |
| Main meal at midday, early dinner | Consistent with evidence on meal timing and glucose tolerance | Helpful | Build on it |
| Avoiding yoghurt and fruit | No evidence of harm from these foods in her situation | Reduces calcium, protein and variety | Discuss respectfully; find acceptable options |
| Yoga and pranayama | Evidence for wellbeing and some benefit for knee osteoarthritis and blood pressure | Safe with adaptations for her knees | Support |
Coordination
Letter to her physician
Situation: I am providing nutrition support to Mrs K for type 2 diabetes. Background: in addition to metformin, gliclazide and ramipril, she takes an Ayurvedic herbal powder for glucose twice daily, fresh bitter gourd juice daily, and for a year a herbo mineral tablet for knee pain, all from a registered Ayurvedic practitioner. Assessment: she reports several episodes of shakiness and sweating before lunch, which may reflect hypoglycaemia, possibly contributed to by the glucose lowering herbs alongside gliclazide. The herbo mineral tablet may contain processed minerals. Recommendation: could you review her glucose lowering treatment, consider a blood lead level and review the tablet? She is happy for you to contact her Ayurvedic practitioner, whose details are attached.
Message to her Ayurvedic practitioner
With her consent, a respectful message explains her current prescribed medicines, the possible hypoglycaemic episodes and the concern about long term use of the herbo mineral tablet, and asks whether an alternative for her knees might be considered while her physician reviews her results.
Outcomes of coordination
- Her physician confirms low glucose readings before lunch and reduces her gliclazide dose.
- Her blood lead level is mildly raised. Her Ayurvedic practitioner agrees to stop the herbo mineral tablet and suggests an alternative approach for her knees based on massage, diet and yoga. Follow up lead levels fall.
- The herbal powder and bitter gourd juice continue, now with her physician’s knowledge and monitoring.
The nutrition plan
The plan builds on the common ground between the 2 traditions. Her main meal remains at midday, with a lighter early dinner. Refined carbohydrates are reduced: smaller portions of white rice, replaced partly with millets she already uses, and more dal and vegetables. Protein is increased at breakfast. On foods, a respectful conversation about her understanding of “cold” foods leads her to accept warm spiced milk and yoghurt at room temperature with lunch, and fruits she considers acceptable, such as papaya and guava. A physiotherapist adapts her yoga practice to protect her knees and adds strengthening exercises.
6 months later
Her HbA1c has fallen to 54 mmol/mol, there have been no further hypoglycaemic episodes, her blood lead is normal, her knee pain is improved and she feels that all her practitioners understand what she is doing. She says that for the first time she does not have to keep secrets from her doctor.
Reasoning notes
- Asking specifically revealed care that a general question had missed.
- Evaluating each element separately avoided both wholesale acceptance and wholesale rejection.
- Safety came first: hypoglycaemia risk and heavy metal exposure were addressed promptly.
- Common ground in meal timing and whole foods allowed a plan consistent with both traditions.
- Respect for her beliefs and her Ayurvedic practitioner made her more willing to change.
- Coordination with both practitioners was the key intervention.
Integration in practice
This case captures the purpose of Integrated Functional Medicine: to understand every form of care a patient uses, to evaluate each by evidence and safety, to keep what helps, to address what poses risk and to bring everyone into one coherent plan with the patient at its centre.
Questions about this case
How was her Ayurvedic care evaluated?
What safety issues were found?
What made the plan work?
References
- Saper RB, Phillips RS, Sehgal A, et al. Lead, mercury, and arsenic in US and Indian manufactured Ayurvedic medicines sold via the Internet. JAMA. 2008;300(8).
- Kennedy J, Wang CC, Wu CH. Patient disclosure about herb and supplement use among adults in the US. Evidence Based Complementary and Alternative Medicine. 2008;5(4).
- Peter EL, Kasali FM, Deyno S, et al. Momordica charantia L. lowers elevated glycaemia in type 2 diabetes mellitus patients: systematic review and meta analysis. Journal of Ethnopharmacology. 2019;231.
- World Health Organization. WHO global report on traditional and complementary medicine 2019. Geneva: WHO; 2019.
Continue your learning
Integrating traditional care safely
Bringing traditional care into a coordinated plan is the defining skill of Integrated Functional Medicine, practised throughout IIFM’s 6 month Functional Medicine and Clinical Nutrition program.
This article is for the education of healthcare professionals. It is not a substitute for individual medical advice, diagnosis or treatment, and does not change any practitioner’s scope of practice. Regulation and guidelines differ between countries.