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INTRODUCTION
Indian culture represents one of the ancient civilizations which are continuous as well as composite one, enriched with diverse food cultures, ecological variations which jointly influenced its comprehensive view of health and quality of life. Traditional Indian systems strongly recommend unity of diet and medicine aiming to achieve target control of diseases and to achieve overall wellness. In management of conditions like Diabetes Mellitus, dietetics is having an important role. When meticulously modified, traditional Indian dietary practices have demonstrated potential in supporting glycemic regulation and maintaining metabolic equilibrium (Salis et al., 2021).
Diabetes Mellitus (DM) is a heterogeneous group of metabolic disorders characterized by persistent hyperglycemia resulting from insulin resistance, deficiency or both. Among its types, type II DM is the most prevalent and is driven by factors like genetic predisposition and environmental influences (ElSayed et al., 2023).
Globally, DM emerged as a public health issue; it is the ninth leading cause of mortality and accounting for 1.5 million deaths in 2019. The disease burden is raising in low - and middle-income countries. India, in particular, is on a rapid nutritional transition with non - communicable diseases like diabetes contributing over half of the total morbidity burden (Chadwick et al., 2025).
Diabetes is highly influenced by diet; the traditional Indian diet is carbohydrate rich, contributing nearly 60% of total caloric intake, which plays a crucial role in glycaemic control. Recent evidence suggests that low - carbohydrate dietary patterns may improve glycemic outcomes. South Asia population’s shows a higher susceptibility to T2DM compared to other ethnic groups, attributed to genetic factors such as beta - cell dysfunction and adverse fat distribution, combined with rapid lifestyle transitions (Narayan et al., 2021; Deepa et al., 2015). These factors contribute to earlier onset of disease faster progression, and a higher risk of complications, insisting the requirement of culturally proficient and reliable management approaches.
Siddha system of medicine, one of the ancient medical systems in India has defined Diabetes under the broad heading of Megam (WHO, 2022). According to ancient treatise it is considered that Megam is caused due to improper dietary habits and lifestyle. Moreover, in those ancient verses it is detailed that strict dietary practices that are to be followed by an individual living with diabetes. This opens a new horizon in management of Diabetes by following the traditional dietetics which helps in providing a more culturally appropriate dietary pattern in management of diabetes. Integrating traditional dietetics with modern evidence will be helping to develop a new management strategy in tackling conditions like diabetes and this review narrates the dietetics mentioned in Siddha literature and their scientific relevance related to management of diabetes.
METHODOLOGY
This narrative review on Siddha dietetics was undertaken to explore and interpret the dietary principles prescribed for Mekam (WHO, 2022) as described in the ancient Siddha text Pararasa Sekaram (Ponnaiah et al., 2016), and to correlate these traditional concepts with contemporary scientific evidence related to DM. A comprehensive and systematic literature search was carried out using multiple electronic data bases, including PubMed, Web of Science, Science Direct, Google Scholar and Scopus, to identify relevant peer reviewed articles. The search strategy involved combinations of keywords like “diabetes mellitus”, dietary patterns, popular diets, plant - based diet etc.
In parallel, classical Siddha literature was reviewed to extract relevant verses pertaining to dietary inclusions, restrictions, lifestyle modifications associated with Mekam. The data was systematically organized after collection into different domains like food categories, mechanism - mode of action and anti-diabetic property, nutritional correlations etc. This process helped in comparatively analysing the integration of traditional Siddha dietetics with present-day evidence based nutritional science in the metabolic diseases like diabetes.
RESULTS
Pararasa Sekaram an ancient Siddha treatise belonged to 16th century comprises of around 12000 Tamil verses which details different ailments, their etiology, clinical features, treatment methods and dietetics to be followed (Ponnaiah et al., 2016). Mekam - a group of diseases which includes the equivalent for Diabetes is detailed in the 5th volume of Pararasa Sekaram. In this review we examined the dietary regulations detailed in the book for the condition of Mekam and we have tried to correlate its scientific relevance. The present review unfolds the diet strategies like recommended food, restrictions and practices to improve quality of life as well as to restore humoral balance and control disease progression. Through detailed analyses this review pursues to interpret traditional dietetics for Mekam through scientific lens. The dietary strategy for Mekam outlines an organized approach conjoining appropriate food selection with stringent lifestyle practices. It is advised to use fruits and vegetables like cooked gooseberry (Embilica officinalis), Tender raw banana (Musa paradisiaca), tender fig fruit (Ficus racemosa), and certain green varieties like Amaranthus spp. In contrast bitter gourd, pumpkin (Cucurbita maxima), Lablab purpureus, Amaranthus dubius are to be avoided. Brinjal (Solanum melongena) is generally restricted, although small varieties may be taken occasionally in moderation (Tables 1-3).
| Category | Can be Taken (Do’s) |
|---|---|
| Fruits | Gooseberry (Emblica officinalis), Tender fig (Ficus racemosa) |
| Taste | Astringent foods |
| Sweeteners | Honey |
| Vegetables | Tender raw banana (Musa paradisiaca), Small greens (Amaranthus spp.) |
| Cereals | Red rice, long-grained rice (Oryza sativa) |
| Meat | Quail, Goat (Capra hircus), Country chicken (Gallus gallus domesticus) |
| Fish | Neitholi (Stolephorus indicus), Neer sura (Carcharhinus spp.) |
| Oils & Seeds | Sesame (Sesamum indicum), sesame oil, oil-cake |
| Tubers | Palm tuber (Borassus flabellifer), Elephant foot yam (Amorphophallus paeoniifolius) |
| Pulses | Red gram (Cajanus cajan), Black gram (Vigna mungo) |
| Special Note | Occasional intake of sparrow (Passer domesticus) mentioned |
| Category | Should Not be Taken (Don’ts) |
|---|---|
| Taste | Pungent (mustard - Brassica nigra), Bitter substances, Excess sour forms |
| Sweeteners | Alcoholic preparations |
| Vegetables | Brinjal (Solanum melongena - large varieties), Avarai (Lablab purpureus), Arai keerai (Amaranthus dubius), Pumpkin (Cucurbita maxima), Bottle gourd (Lagenaria siceraria), Bitter gourd (Momordica charantia) |
| Meat | Wild animal meat, Pork (Sus scrofa domesticus) |
| Fish | Dried fish (Karuvadu) |
| Pulses | Horse gram |
| Others | Onion (Allium cepa), Fresh tender shoots/leaves |
| Lifestyle | Excessive sexual activity, indulgence in sensual stimuli |
| Siddha Concept | Traditional Indication | Modern Scientific Correlation | References |
|---|---|---|---|
| To be Taken | |||
| Gooseberry (Amla) | Strengthens body, balances deranged humors | Antioxidant, antidiabetic, reduces oxidative stress. In vitro and in vivo studies have confirmed the efficacy of Embilica officinalis in managing diabetes and its complications. | Majeed et al., 2023 |
| Astringent foods | Helps control excessive urination | Tannins improve gut integrity and reduce fluid loss, tannins and tannin-rich crud extracts possess glucose lowering effect according to pharmacological studies | Chung et al., 1998; Ajebli et al., 2019 |
| Honey can be taken | Therapeutic sweetener | Antioxidant, improves glycemic control and inflammation. Consumption of honey has been shown to significantly reduce blood glucose levels or HbA1C, as reported in seven clinical trials. | Erejuwa et al., 2012; Maryam et al., 2020 |
| Tender banana | Easily digestible nourishment | Resistant starch improves insulin sensitivity Modulation of the gut-microbiota-brain axis is proposed as a potential mechanism through which a banana starch-based diet may exert therapeutic effects in diabetes-associated mood disorders. | Zhang et al., 2005; Bai et al., 2022 |
| Lean meats | Provides strength | High-quality protein improves metabolic control | Layman et al., 2005 |
| Fish | Nourishing | Omega-3 fatty acids improve metabolic health. | Calder, 2012 |
| Red rice and Long-grained rice | Anti - diabetic | α-amylase inhibitory, antihyperglycemic, antioxidant and antiglycation activities. | Haldipur et al., 2021 |
| Fig | Anti - diabetic | Antidiabetic activity by reduces blood glucose concentration due to β-sitosterol, antioxidant, anti-inflammatory, hypolipidemic and hepatoprotective. | Yadav et al., 2015 |
| Sesame seeds (Sesamum indicum) | Anti - diabetic | Reduces the total plasma cholesterol level and blood glucose level, improves insulin, secretion activity and cell vitality. Sesamin has hypolipidemic action, calming action and increases immunity. | Saleem et al., 2021 |
| Tender country chicken (Gallus gallus domesticus) | Anti - diabetic | Primary source of protein, reduces microalbuminuria. Higher consumption of chicken, a rich source of histidine-containing dipeptides, is associated with reduced insulin resistance in non-diabetic adult men, as evidenced by a stepwise decrease in serum insulin levels and HOMA-IR from ‘rarely’ to ‘monthly’ to ‘weekly’ intake. | Gross et al., 2002; Yeum et al., 2020 |
| Palm tuber (Borassus flabellifer | Anti - diabetic | Antihyperglycemic, reduces fasting blood glucose level significantly, high in phytochemicals, fiber, sodium, potassium, copper and zinc. | Shaikh et al., 2020 |
| Elephant foot yam (Amorphophallus paeoniifolius) | Anti - diabetic | Reduces fasting blood glucose, rich in complex carbohydrates, fiber, minerals and phytochemicals that helps in regeneration of β-cells of pancreas and facilitate glucose uptake by the tissues. | Rahman et al., 2021 |
| Red gram (Cajanus cajan) | Anti - diabetic, Hypolipidemic | Hypolipidemic effects, prebiotic, reduces serum glucose levels and triglycerides levels. | Shakappa et al., 2018 |
| Black gram (Vigna mungo) | Antioxidant | Antioxidant, α-glucosidase inhibitory and free scavenging properties. | Girish et al., 2012 |
| Finger millet (Eleusine coracana) | Anti-diabetic | High in calcium, soluble fiber, low fat and low glycemic index, effective in controlling blood glucose levels. | Pradhan et al., 2010 |
| Aavaram ver (powdered root of Cassia auriculate) | Anti-diabetic | High antioxidant and antidiabetic activities, α-amylase and α-glucosidase inhibitory action. | Salma et al., 2020 |
| To be Avoided | |||
| Bitter substances | leads aggravation of blood glucose level | Bitter compounds influence glucose metabolism variably. | Habicht et al., 2011 |
| Alcohol | Leads to worsening of Diabetes | Impairs glucose metabolism and kidney function. | Baliunas et al., 2009 |
| Bitter gourd | Avoid in this condition | Momordica charantia has shown potential reproductive toxicity in animal studies, including reduced fertility in females, decreased spermatogenesis in males, and uterine bleeding during pregnancy. Certain plant compounds may exert estrogen-like effects, contributing to these outcomes. Developmental toxicity has also been observed, particularly with seed extracts, which showed lethality and cardiac toxicity in embryo models. In humans, serious adverse effects are rare, but cases of hypoglycemic coma have been reported in young children after consuming leaf preparations on an empty stomach. The seeds contain mildly toxic lectins, and the presence of vicine may trigger favism in individuals with glucose-6-phosphate dehydrogenase deficiency. Therefore, the use of seeds and certain plant parts should be approached with caution, especially in vulnerable populations. | Çiçek (2022) |
| Mature bottle gourd (Lagenaria siceraria) | Toxic effects | As a member of the Cucurbitaceae family, bottle gourd contains toxic tetracyclic triterpenoid compounds called cucurbitacins which are responsible for the bitter taste and toxicity. | |
| Pork | Impairs glucose metabolism | High-oxidative injury pork intake causes glucose metabolism disorders by impairing insulin secretion and increasing hepatic glucose output in mice | Yueting et al., |
| Palm toddy (Borassus flabellifer) | Toxic effects | Regarding amoebic liver abscess, multiple studies from India Ramesh Kumar et al., 2019 & 1 others report strong epidemiological associations between toddy consumption and disease incidence, though one microscopy study Ashish Kumar Jha et al., 2019 found no Entamoeba histolytica in toddy samples examined (n=43). | Ramesh et al., 2019 |
| Regulation of sexual activity | Conserves energy | Excessive activity may worsen fatigue/metabolic stress. | Hackney et al., 2001 |
Cereal - based foods such as red rice and long-grained rice varieties are advised, along with preparations using black rice and finger millet (Eleusine coracana). Pulses including red gram (Cajanus cajan) and black gram (Vigna mungo) are permitted. Lean and dry meat such as goat meat (Capra hircus) and country chicken (Gallus domesticus) are recommended. Certain fish varieties, including Anchovy, Stolephoru indicus and Shark (Carcharhinus spp.), may be taken in moderation. However, dried fish, pork (Scrofa domesticus) and meat from wild animals should be avoided. Sesame products are recommended as a part of daily regimen, whereas alcoholic preparations like palm toddy are contra indicated (Tables 1-3).
Classical verses also describe specific therapeutic dietary preparations. Sprouts of Malai Thaangi and Cassia auriculata are to be consumed along with steam cakes made with rice flour. Additionally, finely cut sprouts mixed with tuber flour of Cyperus rotandus, puffed grain and roasted rice flour may be taken similarly. A medicinal formulation consisting of black rice, Vigna mungo and powdered root of Cassia auriculata, mixed with sesame oil, is advised for regular consumption and is said to alleviate symptoms such as diarrhoea, excessive thirst, dryness of tongue, fatigue, body heat and gastric irritation. Food preparations which are mentioned in literature includes: Pittu (steamed cakes) of Rice flour with tender sprouts of Malai thaangi and Aavarai mixed along with buffalo curd, Flour of black rice along with Eleusine coracana sprouts steamed into cakes and eaten along seasame oil and buffalo curd, Flour of Cyperus rotundus tuber, puffed grains and roasted rice flour, steamed into cakes, Sesame products: Butter, oil cakes and oil, Black gram and powdered root of Cassia auriculata grounded with flour and mixed with sesame oil (Tables 1-3). All these dietary recommendations possess anti-diabetic activity and the items which are contra indicated are having either diabetogenic potential or are found to be toxic (Tables 1-3)
DISCUSSION
The Siddha dietary regimen for Mekam described in Pararasa Sekaram shows both conceptual similarities and notable differences when compared with contemporary dietary strategies used in management of DM. This review gives a relevant insight to strength, potential and applicability of traditional dietetics in modern day clinical practice. While reviewing this, we went through the closest parallels like low - carbohydrate and ketogenic diets recommended for conditions like DM.
Food with low glycemic index is preferable for conditions like diabetes, and evidence suggests that carbohydrate restriction will help to improve glycemic control, lower components of lipid profile like, triglyceride and increase HDL level (Chadwick et al., 2025; Narayan et al., 2021). But the problem is regarding long term adherence of this approach, more moderate approaches which is seen in traditional systems may improve the adherence which may offer better sustainability (Alluwyam et al., 2024).
Siddha dietetics is showing similarities with Mediterranean and plant based dietary patterns, especially the emphasis on intake of fibre - rich and antioxidant rich food. Ingredients like gooseberry, pulses and sesame are found to be good in treating conditions like DM, Cardiovascular diseases and is having anti - inflammatory properties (Salis et al., 2021; Gardner et al., 2022). Clinical trials further prove that both Mediterranean and low carbohydrate diets are effective in reducing HbA1C levels, emphasizing the importance of dietary quality and composition in diabetes management (Gardner et al., 2022; Esposito et al., 2014).
Siddha dietary recommendations show partial alignment in inclusion of animal source food items like mutton, country chicken and quail when compared with high protein diets. High protein diet will help in achieving glycemic control by increased satiety, but the major issue is with the ones with diabetic complications. People with Diabetic Nephropathy may present risks while increasing the intake of high protein diet (Layman et al., 2008).
Siddha adopts a selective strategy rather than complete elimination of entire food groups like Paleolithic and gluten free diets. Likewise, modern nutrition suggests intake of certain food like bitter gourd for its anti-diabetic properties, Siddha recommends restriction of the same under specific conditions, possibly due to its potential systemic effects like uterine bleeding associated with overconsumption which was evident in animal models (Çiçek et al., 2022).
Moreover, Siddha system emphasizes the use of functional and medicinal food preparations including sesame, Cassia auriculata, millets and various other herbal combinations which are having anti- diabetic properties, anti-oxidant and enzyme - inhibitory properties which helps in improving glycemic control (Saleem et al., 2021; Prasad et al., 2017).
So far, no single dietary approach is found to be universally superior as per the recent umbrella review on different dietary patterns like low - carbohydrate, plant based, Mediterranean and low glycemic index (Schwingshackl et al., 2017). Moreover, long term adherence and cultural stability and personalization are the key factors of the success. In this view Siddha dietetics is having a scope in improving the context due to its culturally grounded and adaptable framework of Indian population.
Generally, while present-day dietary strategies tend to emphasis primarily on macronutrient composition and caloric restriction, the Siddha approach involves broader aspects such as dietary quality, lifestyle practices and individual digestive capacity. However, a key limitation remains the lack of standardization through meticulous clinical trials.
CONCLUSION
In summary, Siddha dietetics and practices for Mekam shows congruence as well as difference with available evidence - based nutritional strategies for DM. These unique insights in traditional medical systems when combined with modern nutritional practices, after receiving ample evidence-based knowledge may help to develop more culturally apt and effective approaches in DM management.