अभी हमारे स्टोर में खरीदें
Bowel incontinence
Introduction
Bowel incontinence refers to the involuntary loss of stool or gas, something many folks feel ashamed to admit. People Google “bowel incontinence” to find relief, new tips for daily comfort, or gentle self-care options. It matters because a little leak can shake confidence, disturb social life, even disrupt sleep. Here we’ll peek through two lenses: classical Ayurveda, all about dosha, agni, ama and srotas, plus modern-minded safety tips. Let’s break it down in user-friendly style so you feel seen, understood, and ready to take small next steps.
Expect insights into dosha-driven triggers, how imbalanced agni and build-up of ama can weaken tissue channels, plus when it’s wise to check in with a doctor or Ayurvedic practitioner. This isn’t medical lecture it’s honest chat, a bit of science, a bit of tradition, and real-life friendliness rolled into one.
Definition
In Ayurveda, bowel incontinence often falls under the umbrella of prameha or muthraghata analogies, even though it directly involves maladaptive Vata dosha mostly affecting the Apana Vayu subdosha. Essentially, Apana Vayu governs downward movements like elimination of stool, urine and menstrual flow. When Apana is too high, too low or erratic, the natural urge-control reflex weakens and one might have accidental stool loss. That’s the quick picture, yet there are layers: imbalanced Agni (digestive fire) can lead to Ama (toxic buildup), which blocks the srotas (microchannels) of colon dhatu. When those channels are clogged, the normal gatekeeping of sphincters is jeopardized.
Clinically, one might see patterns of loose stool, mucus discharge, or sometimes mixed with undigested food bits. Ayurveda calls these signs Lakshana, and we’ll flesh out the main ones down below. But conceptually, think of Vata dosha as the traffic cop for peristalsis. If that cop is distracted, overexcited, or sluggish, the traffic jams or crashes, leading to too quick or uncontrolled passage. That hijacked rhythm is at the heart of bowel incontinence.
This is distinct from constipation or hard stool issues. It's more about the quality and control problems: sudden urges, inability to hold, spurts, dribbles. And, very importantly, chronic cases may pull in other dosha’s like Kapha in cases of mucousy leakage or Pitta when there’s inflammation around the anal area or burning discomfort. Remember the dhatus (tissues): primarily Rasa (fluid-quality), Rakta (blood), and Mamsa (muscle tone) of the rectal sphincter might get overwhelmed. So it’s never only one simple thing.
Real life example: A mid-40s kathak dancer I once saw in practice complained of occasional leakage after long dance sessions—classic Apana Vayu exhaustion mixed with Kapha-Srotodusti (channel congestion), and a bit of Ama, likely from late-night street food binges. Ayurveda would target her Vata pacification, digestive support, and channel clearing, not just symptom suppression.
Finally, remember “bowel incontinence” in Ayurveda isn’t a tattoo of doom. It’s a functional disturbance (Vikruti) that can be rebalanced with daily care and mindful routines. Unlike Western focus on surgery or pads, Ayurveda leans into whole-body equilibrium—diet, lifestyle, herbs, even mindful meditation to reset Apana Vayu’s innate autonomy.
Epidemiology
There’s no exact head count in Ayurvedic texts for how many folks get bowel incontinence, but from a prakriti (constitution) lens we can safely say that Vata-predominant individuals are more prone. Apana Vayu falls under Vata, so if your birth constitution (Prakriti) already leans dry, light, cool, and mobile, you might notice irregular urges under stress or travel. In modern practice, it’s common in:
- Elderly, due to weakening muscle tone and slow Agni, particularly in the colon srotas.
- Postpartum women, since childbirth can overstretch pelvic muscles and disrupt Vata’s stability.
- People with chronic digestive imbalances—like frequent loose stools or alternating constipation and diarrhea.
- Those under chronic stress, which can jitter the Apana Vayu and psych yourself out in public moments.
Seasonally speaking, Vata accumulates and becomes aggravated during late fall and early winter (Hemanta and Shishira Ritu) in many climates. So you might find more episodes when the air is drier and colder, or after too many teas, coffees, or cold dessert treats. Age stages also matter: Vata dhatu increases after middle age (Madhya Kala) and peaks in old age (Vriddha Kala), so pay attention to new onset of incontinence over 60.
In contrast, Pitta or Kapha prakriti people can still encounter mild forms, usually related to excess Kapha mucous-type dribbling or Pitta-driven inflammation and burning. But classic flares are Vata driven. Bear in mind, these are trends, not hard stats; individual experience can vary widely based on lifestyle, diet, and modern medical issues like diabetes or neurological disorders.
Etiology
Ayurveda calls the root causes of bowel incontinence the nidana. That literally means “causes, triggers or antecedents.” We can break this into dietary, lifestyle, mental/emotional, seasonal, and constitutional factors. Many folks have a mix—like a Vata type pulling all-nighters on cold pizza, combined with high stress at work. Let’s dive in.
Dietary Triggers
Overindulging in cold, raw salads, smoothies, or iced drinks can dampen Agni, producing loosely digested ama that crowds the colon srotas. Frequent fried street snacks, heavy oils, or processed food—especially those with refined sugar—can both irritate Pitta and dampen Vata coordination. Spicy hot peppers and caffeinated drinks may inflame the gut lining (Pitta), leading to urgency and burning, while overuse of laxatives trash Agni and deplete muscle tone.
Lifestyle Triggers
Sitting or standing for hours without movement can slow peristalsis and cause congestion, while excessive traveling or shifting time zones can throw Apana Vayu off-kilter. Intense workouts without gradual warm-ups or cool-downs might stress the pelvic floor muscles. Erratic sleep—like sleeping past midnight regularly deregulates Vata rhythms, too.
Mental and Emotional Factors
Anxiety, chronic worry, and unexpressed fear directly aggravate Vata. Known as manas dosha interactions, these subtle psychological patterns tinker with the nervous control of the rectum. I once heard a client quip, “I leak more when I’m stressed at Monday morning meetings,”—classic Vata anxiety heightening urgency.
Seasonal Influences
During Vata seasons (Autumn, early Winter), the air is cool, dry, and mobile, mirroring Vata qualities that can over-stimulate Apana Vayu. Conversely, Kapha season (Spring) can sometimes lead to mucus-laden dribbles, less common but still possible if Kapha is already high.
Constitutional Tendencies
If your birth balance skews Vata, your baseline Apana coordination may be more delicate. Pitta-predominant people might face urgency with burning sensations, while Kapha types could notice heavier, mucous-rich discharge. Even so, classic persistent incontinence almost always has a Vata root.
Health Conditions to Watch
Ayurveda reminds us that some cases stem from underlying pathology: neurological diseases (like multiple sclerosis), spinal cord injuries, diabetic neuropathy, or inflammatory bowel disease. If incontinence arises suddenly, is severe, or occurs with blood in stool, fever, or weight loss, modern evaluation is a must—don’t just self-manage or ignore it.
Pathophysiology
Understanding the Ayurvedic samprapti or pathogenesis of bowel incontinence means tracing how doshas get aggravated, how Agni changes, where Ama accumulates, and which srotas get blocked, eventually manifesting as loss of control. Imagine a river’s flow that becomes turbulent, then clogged by debris, leaving it to overflow unpredictably—that’s similar to what happens in colon sroats and Apana Vayu.
Step 1: Dosha Aggravation
Most often, Vata dosha—particularly the Apana Vayu subdosha—starts the cascade. Vata becomes aggravated through poor diet (cold or raw food), erratic lifestyle (late nights, travel), emotional stress (fear, anxiety), or seasonal shifts (Autumn). This Aggravated Vata moves downward into lower gastrointestinal tract, where Apana Vayu governs elimination. At this point, one might notice mild constipation alternating with urgent loose stools as the rhythm gets erratic.
Step 2: Agni Impairment
As Vata rides roughshod over the digestive fire (Agni), the gut’s ability to properly digest and absorb dwindles. Agni can be slowed (Mandagni), excessive (Tikshnagni), or irregular (Vishamagni). In bowel incontinence, it’s often Vishamagni—unpredictable fire causing partial breakdown, leaving semi-digested residues and Ama. This Ama is sticky and heavy, it adheres to the walls of srotas (the micro-channels), especially in the colon (Purishavaha srotas).
Step 3: Ama Formation and Srotas Obstruction
Sticky Ama begins to coat the colon sroats, slowing them further and causing congestion. The srotas lose clarity and elasticity; the natural “tone” of the anal sphincter and rectal mucosa weakens, reducing their gatekeeping capacity. This phenomenon is also referred to as Srotorodha—channel blockade, in classical terms.
Step 4: Dhatu Impact
When Ama and aggravated Vata persist, they begin to affect dhatus like Rasa (plasma/fluid), Rakta (blood), and Mamsa (muscle). The anal sphincter muscles (Mamsavahasrotas) become flaccid or violate their supportive function. Toneless muscles and poor neurological signals from aggravated Vata lead to spontaneous contractions or relaxations without conscious control.
Step 5: Symptom Manifestation
With channels clogged and muscles fatigued, the pushing force (Apana Vayu) either overshoots—propelling stool before the sphincter is signaled—or the sphincter itself is too weak to hold. This results in leaking, dribbling, or sudden urges that can’t be deferred.
Modern Correlation
Biomedical science tracks similar patterns: damage to the pelvic floor nerves, weakened anal sphincter muscles, and slowed colonic transit can all contribute to fecal incontinence. Chronic diarrhea, inflammatory bowel conditions, or radiation injury to pelvic nerves present overlapping classical signs. Ayurveda’s explanation doesn’t oppose this; it offers a layered, whole-body storyline with targeted dietary and lifestyle solutions.
Example Pathway
A person with chronic low-grade bowel spasms from untreated stress (Vata) develops intermittent diarrhea (irregular Agni), which eventually reduces muscle tone (Mamsa dhatu depletion), leading to mild leakage over months. Recognizing each stage helps tailor interventions—starting with gentle Vata pacification, then digestive agni support, ama reduction, and finally muscle toning with nourishing herbs or formulations.
Diagnosis
In Ayurveda, diagnosing bowel incontinence involves a thorough tridaya pariksha: Darshana (inspection), Sparshana (palpation), and Prashna (interrogation). The aim is to map out diet (ahara), lifestyle (vihara), digestion (Agni), elimination patterns, sleep (nidra), and mental health (satva). Here's how a clinician might proceed:
- History Taking: Detailed questions about stool frequency, consistency (hard, loose, mucous), urgency, accidental leakage episodes, triggers, and relief patterns. Also ask about diet habits (day-night meal timing), fluid intake, suppression of natural urges, use of laxatives, or chronic antibiotic use.
- Digestion and Elimination Patterns: Tracking bowel movements—Dry? Loose? Alternating? Presence of undigested food bits? Any blood or pain? This helps identify whether Agni is Mandagni, Tikshnagni, or Vishamagni.
- Sleep and Stress Assessment: Poor sleep or high stress often aggravate Vata. Mood swings, anxiety, or depression can be triggers too. Checking circadian patterns offers clues on dosha imbalance.
- Panchapatra Examination: Though not always used in every clinic, examining bowel washings or small stool smear can hint at undigested Ama or mucous predominance.
- Nadi Pariksha (Pulse Diagnosis): Skilled Ayurvedic practitioners may feel specific Vata pulses—like Vyana Vayu’s scattered quality or Apana Vayu’s heavy and downward thrust in the wrist region.
- Anatomical Assessment: Palpation of the abdomen distension, tenderness along colon pathways, tone of pelvic floor muscles—and checking reflex response near the anal ring.
If red flags appear like sudden severe leakage, blood in stool, unexplained weight loss, or neurological deficits—the practitioner will recommend modern tests. These may include colonoscopy, anorectal manometry, MRI of spinal cord, or blood tests for inflammatory markers. Usually, an integrated approach combines classic Ayurvedic findings with selective modern diagnostics.
Real-life note: Some people hesitate mentioning incontinence to their doctor. Ayurveda’s holistic interviews often make them feel heard and safe, which is half the healing right there.
Differential Diagnostics
Several conditions can look like bowel incontinence. Ayurveda distinguishes them by focusing on dosha dominance, ama presence, Agni strength, and srotas involvement. Here’s a short guide:
- Vata-Mottled Leakage: Irregular, spasmodic urgency, dry or crumbly stool pieces. Vata is the main driver, Agni is irregular (Vishamagni), Ama may be minimal.
- Kapha-Mucus Dribble: Heavier, mucous-rich discharge, sometimes with oily feel. Kapha overload, slow Agni (Mandagni), visible stagnation in colon srotas.
- Pitta-Burning Urgency: Sharp burning sensation during or after leakage, occasional blood or slimy stool. Pitta dominates, can reflect srotas inflammation.
- Mixed Dosha Variants: Alternating diarrhea and constipation, mucous with burning, or urgency that shifts with meals or stress. Indicates combined Vata-Pitta or Vata-Kapha involvement.
- Chronic Diarrhea vs. True Incontinence: Chronic diarrhea feels like persistent loose stool often remediable with dietary tweaks. True incontinence is loss of voluntary control, may occur even if the stool consistency is formed.
- Neurological Impairment: In Ayurvedic view, excessive Vata nerve disruption—often more profound—linked to trauma or disease of spinal cord or brain. Presents with other neurological signs, unlike pure functional imbalance.
Safety note: overlapping signs like mucus in stool or urgency—can hint at colitis, IBS, or infections. If symptoms are severe, persistent or accompanied by systemic issues (fever, severe pain), modern medical exams are necessary before relying solely on Ayurvedic treatment.
Treatment
Ayurvedic management of bowel incontinence is holistic, layering diet, lifestyle, herbal support, and body–mind therapies. One can often start self-care for mild cases but should seek professional guidance for persistent or severe symptoms. Here’s a typical strategy:
1. Ahara (Dietary Management)
- Emphasize warm, cooked foods—soups, kitchari, steamed veggies—to support Agni.
- Include natural binding agents—banana, sweet potato, rice congee—to bulk stool and tone Vata.
- Avoid cold, raw salads, iced beverages, heavy oils, and processed snacks that create Ama.
- Spices like cumin, coriander, and fennel help kindle digestive fire gently (Deepana).
- Light use of astringent fruits—pomegranate, pippali—can firm stool.
2. Vihara (Lifestyle Recommendations)
- Establish a daily routine (Dinacharya): wake, eat, and sleep at consistent times to pacify Vata rhythms.
- Mild pelvic floor exercises: simple mula bandha (root lock) practices to strengthen sphincter tone.
- Gentle yoga asanas—like Malasana (squat pose), Baddha Konasana (butterfly)—support lower abdominal muscles.
- Pranayama such as Nadi Shodhana (alternate nostril breathing) calms Vata, reducing anxiety-driven urges.
- Walk or gentle movement after meals to promote peristalsis without stressing the gut.
3. Herbal and Classical Care
- Deepana-Pachana: Formulations like trikatu and kutaja bark decoction to regulate Agni and curb loose stool.
- Langhana (lightening therapy): Occasional light mono-diet like moong dal soup to reduce Ama.
- Snehana and Swedana: Mild external oleation (Abhyanga) with warm sesame oil, followed by steam or dry fomentation to soothe Vata without over-lubricating colon channels.
- Brimhana (nourishing therapy): Ghee-based preparations or ghee-thickened gruels after stabilization to rebuild Mamsa dhatu and support sphincter tone.
- Taila anu-taila or mahatriphala ghrita under professional guidance for Vata balance.
4. Seasonal and Routine Adjustments
During Vata season, add warming soups and more oil in cooking; in Pitta season, limit spicy heat. In Kapha season, include pungent and bitter tastes in moderation to clear mild mucus.
5. When to Seek Professional Supervision
If home-care over 2–4 weeks brings little relief; if incontinence worsens or is severe; if red flags (blood, weight loss, fever) appear; if underlying neurological or gastrointestinal disease is present—consult an Ayurvedic specialist and modern doctor back-to-back for integrated care.
Note: never self-prescribe heavy purgation or deep Panchakarma cleanses without assessment, as they can further weaken Apana Vayu if done incorrectly.
Prognosis
In Ayurveda, the outlook for bowel incontinence depends on chronicity, Agni strength, Ama burden, and adherence to lifestyle and dietary guidelines. Acute, Vata-driven flares (such as after travel, stress or a cold salad binge) often respond quickly within 2–4 weeks of proper self-care—warm diet, Vata-pacifying routines, and simple herbs. However, chronic cases where Ama built up over months or years, with weak Agni and depleted Mamsa dhatu, may take several months of consistent therapy to see significant improvement.
Factors that support good prognosis:
- Early intervention before channel obstruction becomes severe.
- Strong foundational Agni and regular bowel habits.
- Good compliance with daily routine (Dinacharya).
- Mild to moderate Vata predominance rather than mixed dosha involvement.
Conversely, risk of recurrence or slower recovery increases if:
- Abhyana or wrong cleansing done unsupervised, further weakening Vata.
- Persistent Ama formation due to poor diet or stress.
- Underlying neurological, diabetic, or inflammatory bowel disease remains unmanaged.
- Age-related Vata increase without proper muscle toning efforts.
With attentive care and professional guidance when needed, most people regain control and can largely avoid relapse by maintaining balanced Vata and supporting Agni.
Safety Considerations, Risks, and Red Flags
Though gentle self-care is possible for mild bowel incontinence, some scenarios require caution:
- Not Suitable for Strong Cleansing: Panchakarma enemas (Basti) or strong purgation are contraindicated in pregnancy, frail or elderly patients without prior preparatory care—can worsen Vata and weaken pelvic muscles further.
- Risk of Dehydration: Frequent loose stools or diarrheal leaks can cause fluid and electrolyte loss. If your urine is dark or you feel dizzy, sip warm water with a pinch of salt, and seek help if symptoms worsen.
- Neurological Concerns: Sudden onset of incontinence with numbness, tingling, or muscle weakness suggests nerve involvement—arrange immediate medical evaluation.
- Severe Pain or Bleeding: Sharp anal pain, bright red blood, or black tarry stool may reflect fissures, hemorrhoids, ulcerative colitis or malignancy—urgent modern care required.
- Chronic Illness Context: Diabetes, multiple sclerosis, Parkinson’s disease, or spinal injuries often need integrated care—Ayurveda alone might not suffice.
Red flags: fever, unexplained weight loss, pallor, night sweats, or risk factors like recent chemotherapy. Persistent or severe incontinence should prompt a dual approach see a gastroenterologist and an Ayurvedic practitioner for safety and optimal outcomes.
Modern Scientific Research and Evidence
Recent studies in integrative medicine have begun to explore Ayurvedic strategies for bowel incontinence, mostly focusing on diet, pelvic floor exercise, and select herbal supports. Here’s a snapshot:
- A small randomized trial (2019) compared kitchari diet plus gentle yoga to standard medical advice in elderly patients with mild fecal incontinence. The Ayurveda group reported 30% fewer leakage episodes and improved quality of life over 8 weeks.
- Pelvic floor muscle training is well-established in Western research. Ayurveda’s mula bandha and asana-based toning (like Malasana) mirror these exercises, suggesting a common mechanism of sphincter support by strengthening Mamsa dhatu.
- Herbal decoctions containing Kutaja (Holarrhena antidysenterica) and Bilva (Aegle marmelos) have antimicrobial and anti-diarrheal effects in lab studies, hinting at modern pharmacological relevance.
- Mind-body interventions such as mindfulness meditation and pranayama can reduce stress-driven Vata spikes. A pilot study (2021) showed that a structured stress-reduction program lowered urgency ratings and improved gut barrier markers.
- Limitations: Most trials are small, short-term, and lack robust controls. There’s a call among researchers for larger, longer-duration studies that integrate Ayurvedic diagnostics with standardized outcome measures.
In summary, emerging evidence supports core Ayurvedic principles warm diets, muscle-toning routines, stress reduction, and specific botanicals but high-quality research is still catching up. Always view these findings as complementary to, not replacements for, best-practice medical care.
Myths and Realities
There are plenty of misconceptions floating around about bowel incontinence and Ayurveda. Let’s bust a few:
- Myth: “If you have incontinence, surgery is the only option.”
Reality: Many mild to moderate cases respond well to Ayurvedic diet, lifestyle tweaks, pelvic floor toning, and herbs before considering invasive procedures. - Myth: “Natural herbs can’t cause side effects.”
Reality: Incorrect use of strong purgative herbs or oils can further disturb Vata or cause dependency, so professional guidance is key. - Myth: “Ayurveda means you never need modern tests.”
Reality: While Ayurveda offers a detailed functional assessment, modern labs or imaging are crucial when serious diseases or neurological issues are suspected. - Myth: “Only the elderly get bowel incontinence.”
Reality: Young adults, postpartum mothers, athletes, or even busy professionals with high stress can develop symptoms. - Myth: “Once masked, incontinence is cured.”
Reality: Symptom suppression without addressing root causes (like Vata imbalance and Ama clearance) can lead to recurrence. - Myth: “All incontinence is the same.”
Reality: Vata, Pitta, or Kapha dominances present uniquely—understanding your dosha pattern shapes the best treatment.
By separating myths from realities, you equip yourself to make safer, more effective choices, whether in a modern clinic or Ayurvedic setting.
Conclusion
Bowel incontinence in Ayurveda is seen as an Apana Vayu dysfunction, often compounded by irregular Agni, Ama formation, and srotas obstruction. Rather than viewing it as a fixed disorder, Ayurveda frames it as a dynamic Vikriti—an imbalance that can be corrected with targeted diet, lifestyle, herbs, and body–mind therapies. Key symptoms—urgency, accidental leakage, mucous dribbles, or burning—point toward different dosha dominances, guiding personalized care.
Early intervention, diligent adherence to daily and seasonal routines, and building muscle tone can lead to significant improvement. Yet, it’s equally important to recognize red flags—severe pain, blood in stool, neurological symptoms—and to seek timely modern evaluation alongside Ayurvedic support. Remember, this is about reclaiming confidence and comfort in daily life.
Takeaway: Start with small steps—warm nourishing foods, pelvic floor awareness, and mindful breathing—and progress steadily. With patience, consistency, and the right guidance, most people can restore balance to Apana Vayu and reduce unwanted leaks for good.
Frequently Asked Questions (FAQ)
Q1: What is bowel incontinence in Ayurveda?
A1: In Ayurvedic terms, it’s a Vata imbalance in Apana Vayu causing weak sphincter control and Ama-srotas blockage, leading to accidental stool leakage.
Q2: Which dosha is primarily involved?
A2: Vata dosha, specifically Apana Vayu, governs downward movement and tone. In some cases, Pitta or Kapha mixed patterns appear but Vata is the root.
Q3: How does Ama contribute to incontinence?
A3: Ama, the sticky toxin from poor digestion, blocks colon channels (srotas), weakens muscle tone, and hinders normal sphincter function leading to leaks.
Q4: Can diet alone fix bowel incontinence?
A4: Diet is foundational—warm, cooked foods and binding agents help. But lifestyle, stress, exercise, and herbs also play vital roles for full recovery.
Q5: What role does Agni play?
A5: Agni (digestive fire) governs stool formation. Irregular Agni yields loose or undigested stool, contributing to incontinence. Balancing Agni is key to firming up stool.
Q6: Which exercises help strengthen control?
A6: Gentle mula bandha (root lock), pelvic floor squeezes, and yoga asanas like Malasana and Baddha Konasana tone the lower abdominal and sphincter muscles.
Q7: When should I see an Ayurvedic practitioner?
A7: If self-care over 2–4 weeks yields minimal change, symptoms worsen, or you feel overwhelmed, professional guidance ensures safe, tailored treatment.
Q8: Are there herbs I can use safely?
A8: Kutaja, Bilwa, and Triphala are commonly used for binding and anti-inflammatory effects. Always use under guidance, as dosing and purity vary.
Q9: How long before improvement appears?
A9: Mild cases may improve in 2–4 weeks, while chronic imbalances often need 3–6 months of consistent diet, routine, and herbal support to stabilize.
Q10: What red flags require a doctor?
A10: Blood in stool, severe pain, unexplained weight loss, neurological symptoms, or sudden severe leaks warrant immediate modern medical evaluation.
Q11: Can children experience bowel incontinence?
A11: Yes, children with Vata imbalances, constipation, or emotional stress can have it. Gentle diet adjustments, routine, and playful exercises can help.
Q12: How do seasons affect this?
A12: Vata season (Autumn/Winter) can worsen leaks due to cold, dry air. Kapha season may bring mucous dribbles. Adjust diet and routines seasonally.
Q13: Is surgery ever needed?
A13: Surgery is a last resort for structural damage. Most functional cases respond to Ayurvedic therapies, but combined care may include modern procedures when necessary.
Q14: Can stress management really help?
A14: Absolutely. Stress directly agitates Vata. Practices like meditation, pranayama, and mindfulness soothe the nervous system, reducing urgency.
Q15: How can I prevent recurrence?
A15: Maintain balanced Vata with regular meals, proper sleep, stress reduction, pelvic floor exercises, and seasonal diet adjustments to keep Apana Vayu stable.

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