Tiredness in IgA Nephropathy: An Ayurvedic Perspective

Fatigue and exhaustion are one of the most prevalent symptoms in IgA nephropathy, an auto-immune kidney disease. Ayurveda has some ideas to help with that.

That feeling of not having enough energy to get through the day…

Maybe you are still young and find that you like doing fun things, but really need the weekend or your free time to recover. Or maybe your battery needs recharging by mid-day, despite the fact that you would love to keep going. You feel older than you are, like your body is letting you down.

Tiredness or fatigue is a big challenge. It is something common in IgA nephropathy patients. In addition, the varying course of the disease and the uncertainty it brings does not help. Unfortunately, fatigue is not always seen as a symptom of the disease, nor is there necessarily a whole lot that can really be done about it. It is often recommended to take it easy and live a healthy life, but what is healthy living? Is there a way to empower yourself to feel better? From my experience, there can be.

Ayurveda has a holistic view, everything is connected.

Ayurveda, the millennia-old science of life and medicine from India (in India, there is also a whole surgery branch within Ayurveda). Some say it has been around for 5000 years, others 10000, it has been around for a while. And, it is also still there, so it has stood the test of time.

‘Ayur’ means life and ‘veda’ means knowledge or wisdom. The aim of Ayurveda is to maintain the health of the person and improve it when possible, for a long healthy life. Ayurveda also recognises that there are diseases that cannot be cured. Where possible, it does a lot to preserve the health that is still there for as long as possible. Which, in the case of IgA nephropathy, is very interesting.

Ayurveda has a very big focus on food and lifestyle, since these are the things we do every day that makes our bodies function. It is based on the physical principle of cause and effect with the logic behind it. If there is no logic, it is not Ayurveda.

In addition, Ayurveda looks at each person’s unique constitution and lifestyle, and thus approaches every situation accordingly.

Nourishment, sleep and energy management are Ayurveda's 3 pillars of health.

Ayurveda works with different principles that, with the mainstream way of looking at health, you might not really be used to. Ayurveda’s 3 pillars of health play an important role in this. I’ll explain some of the principles first, so that the connection between any symptoms you may be experiencing becomes clearer.

Ether, air, fire, water and earth are the 5 elements that Ayurveda uses to describe everything. Everything in the universe consists of a combination of these elements. Combining the different elements creates different properties or qualities. These are called ´gunas´ in Ayurveda. With the properties you can think of something being hot or cold, hard or soft, sharp or blunt/mild, obvious or minute, mobile or stable, clear or subtle, dry or oily, clear or cloudy, smooth or rough, light or heavy, etc.

It is not only all tangible things like nature around us and our bodies, but also our minds or emotions which can show different qualities. For instance, you may have a hot, soft, oily, heavier stew or a cold, dry salad with hard and raw vegetables as a meal. Your thoughts can be clear, obvious and stable which might make you feel light and mentally sharp. But thoughts can also be cloudy/confusing and moving, which might make you feel heavier. In this way, you can assign different qualities to everything.

And why would you want to do that?

To bring balance to the body, these properties are immensely useful. When we assume that – like increases like – and – opposites reduce – it becomes easier to bring balance to the body. For example: when you are hot and put on a jacket and drink a cup of hot water, you will feel warmer. In other words, like increases like. When you are hot and take off your jumper and sit in the shade with a cool breeze, you will be less hot. In other words, opposites reduce. That may all sound quite simple and it is. Though at the same time, it is true that your body is complex and there are many things happening simultaneously that may or may not be in balance with YOUR normal state.
And what is your normal state then?

The doshas can be compared to modern genetics and epigenetics.

Ayurveda assumes that everyone is born with a certain constitution, your blueprint. You can compare this to your DNA. In Ayurveda, these are the ‘doshas’. There are 3: ‘vata’, ‘pitta’ and ‘kapha’. Vata is formed from the space and air element and its associated energy and qualities. Pitta from fire and water and kapha from earth and water and its associated energy and qualities.

As mentioned earlier, everyone is made up of a combination of all the elements, and so each dosha is also expressed in you. Everyone has their unique ratio vata, pitta and kapha at birth, with usually 2 out of the 3 doshas being dominant.

During daily life, you come into contact with different things, the weather, food, your lifestyle, other people, your stage of life, the rhythm of the day or month, you name it. And these affect the doshas, increasing them or reducing them, depending on their qualities. Imbalance can occur because you have too much or too little of your doshas. For example, a Dutchman who has a lot of pitta, which is fire and water, but moves to the tropics, will eventually start having issues from the heat and humidity. If this person then also starts eating spicy and fatty food, even more of the same fire and water qualities are added. This can then manifest itself through diarrhoea, becoming easily irritable or angry, heartburn, headache, swelling etc.

When the disease cannot be cured, there is still plenty that can be done to maintain the health that is still there.

You can compare this to epigenetics, the expression of genes and formation of proteins influenced by your environment and lifestyle. Environmental factors, diet, stress, how you were cared for in childhood, all these factors contribute to balance or imbalance in your body and can eventually cause disease.

Sometimes the disease develops to such an extent that there is no way back to health with absence of disease, as with IgA nephropathy. This is the case in modern medicine and also in Ayurveda. You can however work towards as much health as possible within the imbalance that exists.

Strong digestion (agni) is essential, especially when you are an IgA patient

Now for the 3 pillars of health. These are nourishment, sleep and energy management.

The first pillar is nourishment. Somehow very logical, because that is what our bodies are made of and function with. Now Ayurveda doesn’t look so much at the specific nutritional values as you might be used to. Again, you look at the different gunas, the qualities or properties, of what you take in, whether it brings balance or not.

And perhaps most important: the digestive capacity which is called the ´agni´. The agni is the digestive fire, which you can imagine as a campfire in your stomach. To keep a fire going you need good wood. Not too much (meaning not having a large, heavy meal), not too little (meaning not having a small light snack/meal), not too wet (meaning taking in cold, raw food), but enough so that the fire stays fed. Moreover, it is not only food that needs to be digested, experiences and emotions also need to be processed by the agni.

So when there is a lot of stress, or a lot of emotion, your agni has a lot to do. It is then important to take in easily digestible food to keep your body functioning properly. Unfortunately, this is usually not is what you tend to do, making it easier to get sick or experience discomfort/pain at times like these.

When what we take in in life cannot be digested properly, indigestion happens. Ayurveda calls this ‘ama’. Too much ama creates inflammation and causes illness in the long run. Here, you can think of the body as a porous tubular system. When these tubes are clean, with strong agni and little ama, nutrients can be transported to the right places, waste products are drained and everything within your body can communicate effortlessly. When there is accumulation of undigested food, experiences and emotions, the tubes slowly clog up. If this is the case for a short while, it is not a problem, but the more ama accumulates, the less your body will be able to absorb nutrients and dispose of waste, resulting in illness.

IgA nephropathy is an interesting example of this. The IgA is not produced properly in the body, it clumps together and accumulates in the kidneys. Here it creates inflammation and the longer that lasts the greater the damage. So, in this case, it’s easily comparable to ama. This is why protein loss in urine is such an important indicator for long-term prognosis. The more protein in the urine, the more active the inflammation is, meaning more ama that is not being cleared.

This idea also brings me to the point that strong digestion (agni) is essential when you have IgA nephropathy and suffer from fatigue and other ´vague´ symptoms. It’s not so much specifically about WHAT you eat, but whether if what you eat can be digested and whether that contributes to balance or imbalance in your body. The more ama accumulates in other places in your body, the less likely your body will be able to get around to cleaning up around the kidneys. And the more imbalance in your body the weaker your digestion will be. Your body is limited in what it can do in recovery and clearance in a day and needs well-digested food to do that at all. So there is a link between accumulated waste and your digestive capacity. This also shows why fatigue can be such a problem, your body just can’t handle all these tasks in a day.

Signs of poor digestion:

Fatigue
No feeling of hunger
Feeling bloated after meals
Too much gas, burping etc.
Heartburn, belching or nausea
Headache, feeling of heaviness, pain
Bad sleep
Rashes, itching

In Ayurveda, these are all symptoms, imbalances which will develop into illness if balance is not regained. The earlier you recognise the imbalance the easier it is to restore.

How to strengthen your agni:

Eat a satiating cooked meal whenever you are hungry (avoid snacking and uncooked food)
Get as much routine into your day as possible, especially in the morning to start the day clean
Make lunch the biggest/heaviest meal (that’s when your agni is strongest)
Daily exercise (walking is best)
Shower before meals, never after and avoid ice baths.
Avoid cold, raw and heavy food (ice cream, salads, pizza/cheeseburgers)
Use herbs and spices while cooking, these stimulate the agni and make the food more digestible.

Now, what are signs of good digestion:

Daily easy bowel movements (no constipation, no diarrhoea and no discomfort)
A feeling of hunger before each meal (and a belly grumbling is not it, that’s too much air (vata) in your system)
A sense of energy and purpose during the day
Getting up and feeling rested

One small change can set off a whole chain reaction.

The second pillar of health is sleep. It is important to have a good, undisturbed, restorative night’s sleep. During sleep, your body continues to digest (both food, experiences and emotions), remove waste products (ama), build and repair your body and refill your energy tank. This one is pretty obvious, but certainly not obvious for everyone. From an Ayurvedic perspective, the hours between about 22 and 2 are the most important for sleep. During this period, pitta energy (fire) dominates, providing processing of the day and all the important maintenance takes place then.

The beauty is, that better digestion as well as the right nutrition improves your sleep and better sleep improves your digestion. All these pillars are intertwined, so 1 small change can start a whole chain reaction.

Diet and lifestyle are essential in improving your digestion and immunity, to reduce fatigue.

The third pillar is energy management. And in Ayurveda, ´ojas´ plays an important role in this. You can think of this as your immunity/resilience and vitality. If you have a lot of resilience, you are more at ease within yourself and better able to handle stress, hard to digest foods etc. before it can no longer be buffered and makes you sick. With IgA you already have a challenge happening, making resilience play an important role.

Ojas is built up through good nutrition, sleep, actually all the things we know that are really good for us. So here you see the first 2 pillars coming back again. Poor sleep or digestion also reduce your immunity. That makes it important to be aware of the resilience or ojas you have, because it takes time to recover it when lost.

These 3 pillars come together as diet and lifestyle and influence greatly how you feel. Your fatigue can reduce through diet and lifestyle that are appropriate for you and your kidneys will likely last a bit longer as well.

My Story

I myself have been working with food and lifestyle since my diagnosis in 2019. When I heard I might have IgA I didn’t take it very seriously, I felt fine, so I couldn’t be a kidney patient, could I? After the diagnosis was confirmed, my former nephrologist told me to enjoy Christmas and be admitted to the hospital on January 2^nd to start prednisone treatment to bring down my protein loss of 1.5 grams. This came as a big shock making me look for other options. Through Facebook, I read that there were people working with food and lifestyle. I came into contact with my current nephrologist, with whom I had a good and enlightening conversation and who felt there was still time to work with nutrition.

Those became 4 intense months of a strict diet, a blood pressure medication and supplements, resulting in a proteinuria of 0.6g. The diet itself was no longer good for my overall health after those 4 months, I lost weight and felt weaker. In the period that followed, the diet became less strict, which felt better, lowered the protein loss further and we kept adjusting.

The desire to postpone dialysis is a huge motivator

I started my Ayurveda training in 2021. The knowledge from this explained to me why the diet worked for that period and then didn’t. Also, I now better understand and feel what does and does not contribute to my wellbeing. I now know better how to, intelligently and logically deal with the elements affecting my health. It remains a search and fine-tuning as to when and which foods and lifestyle adjustments work and when not. Also, because this changes with the seasons, age and stage of life.

My protein loss has been reduced from over 1.5 grams to currently around 0.4 grams. And my kidney function is currently around 35%. I still take some supplements and blood pressure medication, despite my blood pressure being low. It certainly hasn’t always been easy, since food has such a social aspect (I live in a community) and habits are not so easy to change. But for me, the idea of postponing dialysis is a huge motivator to keep going. The goal of getting protein loss down was achieved and maintained so far. I am immensely grateful for the journey I have traveled so far, everything it has taught and brought me and how healthy I feel now.

If you feel like sharing your story or struggles, I would love you to do that. You are not alone, whatever you have on your plate.

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