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A Cross Sectional Study on Analysis of Human Milk as Per Prakriti (Psychosomatic Constitution)

Background: Ayurveda scholars have given comprehensive descriptions about characteristics of pure and vitiated human milk, measures of its purification, effect of diet, lifestyle on quality of human milk and its effect on growth and development of infant. Recent researches have also shown that the variation in human milk composition is associated with the maternal diet, environment, and potentially with genetic factors. Studies have reported that individual mothers within species often demonstrate variation in milk composition and/or yield affecting infant growth and development. Prakriti refers to genetic account of an individual, so there may be variation in human milk composition because of metabolic peculiarity and dietary differences. Aim and Objectives: To analyze the composition of pure and vitiated Human milk as per Prakriti. Materials and Method: Total 200 healthy lactating Indian mothers, aged between 20 to 35 years were registered after getting informed written consent from OPD of Department of Kaumarbhritya, I.M.S, BHU, Varanasi, India during year 2015-2017. Analysis of milk for fat, SNF, density, protein, lactose, freezing point, conductivity and pH was done through Eco milk Analyzer. The vitiation of milk was assessed by water test mentioned in Ayurveda text viz. Charak Samhita, Sushruta Samhita, Ashtanghridyam, Kashyap Samhita etc. Assessment of Prakriti (Psychosomatic constitution) of mothers was done by validated Performa. Results: The mean values of different constituents viz. Fat(%), SNF(%),Density( g/cm3), Protein (%) and Freezing Point(°C) were more in vitiated milk as compared to pure human milk. The variation in composition of milk was also found as per Psychosomatic constitution, the mean values Current Research in Nutrition and Food Science www.foodandnutritionjournal.org ISSN: 2347-467X, Vol. 08, No. (1) 2020, Pg. 245-255 CONTACT B.M. Singh hodkb2006@yahoo.in Department of Kaumarbhriya, IMS, BHU, Varanasi, Uttar Pradesh, India. © 2020 The Author(s). Published by Enviro Research Publishers. This is an Open Access article licensed under a Creative Commons license: Attribution 4.0 International (CC-BY). Doi: http://dx.doi.org/10.12944/CRNFSJ.8.1.23 Article History Received: 8 August 2019 Accepted: 16 January 2020


Introduction
Human milk (Stanya) is an excellent source of nutrition for infants, as it contains essential nutrients in the correct balance and numerous immunological, biochemical, cellular component, probiotic, and stem cells. Human milk has been also considered as live tissue. The milk has a unique composition which is species specific, evolved over millions of years to suit the needs of infants. There is individual variations in human milk composition, which are attributed to the stage of lactation, the degree of breast fullness, infant feeding, the health of the breastfeeding dyad, and other factors. 1,2 Research has shown a close association between milk fat and cell contents that changes with the degree of breast fullness. It may be associated with the maternal diet and environment, and potentially with genetic factors. 3 Studies have also reported that the lactation strategies along with milk synthesis and its composition vary among individuals within species. In this way infants receive "personalized" milk from their mother. 4,5 WHO (2019) recommends exclusive breastfeeding for the first six months of life, after which, infants should receive nutritionally adequate and safe complementary food while breastfeeding continues for up to two years of age or beyond. 6 Exclusive breastfeeding for the first six months of life is associated with a decreased prevalence of infections and persistent diseases. 7,8 Ayurveda is an ancient holistic, traditional health care system of India. The most fundamental principle of Ayurveda is "TriDosha" or the three vital humours i.e. Vata, Pitta and Kapha. These are the three biological entities that regulate all the biological activities and are responsible for determination of Prakriti (psychosomatic constitution) of an individual. The phenotypic expression of genotype differs as per the predominance of Dosha resulting in variation in physical, physiological and psychological characteristics in an Individual. 9 Ayurveda has categorized human population into seven categories as per Doshika dominance and their permutations. The seven types of Prakriti are namely Vatika, Paittika, Kahaja, Vata-Paittika, Pitta-Kaphaja, Vata-Kaphaja, and SamaDosha or SamaPrakriti (Ch. S. Vi. 8/). 10 In every person these three Dosha differ in permutations and combinations resulting in metabolic and physiological variations. Since human milk (Stanya) is also a product of metabolism that's why there are differences in values of constituents of human milk as per Doshika psychosomatic constitution also. The importance of pure or normal mother milk for health, unimpeded growth and development, longevity of body organs, disease free state in infants was well recognized by ancient Ayurveda scholars and comprehensive descriptions were made about the characteristics of pure and vitiated mother milk, 10,11,12 measures for purification of vitiated milk, effect of diet and lifestyle on quality of mother milk and its effect on infants.
Recent studies have reported the substantial inter individual variation within populations, which have been associated with maternal characteristics. The human milk synthesis and its composition depends on maternal factors such as diet, parity, and body fat exert greater influence on milk synthesis. 13,14,15 Keeping these views in mind, this study was carried out with the aim to find out the analysis of normal and vitiated human milk and its composition among lactating mothers of different Prakriti.

Method of Collection of Human Milk Samples
After getting informed consent, under all the recommended precautions, the mothers were asked to wash their hands and breast particularly nipple and areola part with soap water properly and were allowed to dry. Physical examination was done for the absence of cracked nipple, breast abscess etc. The milk sample was collected between 10.00 am to 12.00 noon. Mothers were asked to express their one breast completely (average quantity 50 ml) in a sterile container with the help of human milk pump(Philip Avent Manual Breast Pump). 19 After complete emptying of one breast, milk was transferred to another sterile glass container for further instant evaluation. An average time for initiation of test was 1 minute to avoid false report.

Assessment and Analysis of Human Milk
As per Ayurveda, Pure milk has certain characteristics viz. white in color, natural odor, sweet taste and cold in touch, dissolves uniformly in water, and after digestion provides nourishment, unimpeded growth and development, strength, longevity of body organs and disease free state i.e. healthy state of the child. 10,16 To assess the quality of mother milk Jala-pariksha as an objective parameter was adopted since it is simple method and can be performed in OPD or bed side in natural light with tap water. Use of tap water was taken by considering the effect of Desha.
In this study, water test (Jal-pariksha) of mother milk was done for differentiating non-vitiated mother milk with vitiated mother milk before doing analysis by lactometer for other objective parameters.

Human Milk Examinations by Water Test (Jala Priksha)
Jala pariksha 10,12,16 was carried out to test the characteristics of mother milk.

Method of Water Test (Jala Pariksha)
The vitiation / purity of milk was assessed by Jala pariksha and categorized accordingly into Vata, Pitta, Kapha Dosha vitiated or pure milk. One drop of milk sample was poured over water surface in a beaker of 500 ml capacity, filled with tap water. Time was noted when the lowest milk fiber touched first time at the bottom of beaker and the time taken for complete dissolution in stagnant water of beaker was recorded.

Interpretation
• When a drop of human milk is put on the surface of water, it gets mixed uniformly without floating over the surface of water or settles down at the bottom of beaker, was considered pure mother milk. • When a drop of milk is put on the surface of water, floats in a scattered manner and spreads like an umbrella is suggestive of Vata vitiated human milk. • When a drop of milk submerged in water with yellow color (hue) streaks, was considered Pitta vitiated human milk. • When a drop of human milk is put on the surface of water, it settles down rapidly (<10 second) towards the bottom of beaker and then persists for a long period (>180 second) before dissolution indicates the Kapha vitiated human milk. 20

Method for Human Milk Analysis
Analysis of milk was done through Eco milk Analyzer (EON Trading LLC, USA Company) in Department of Animal Husbandry and Dairy, Institute of Agriculture Sciences, BHU. The working principle of analyzer is based on ultra sound technology and does not require any reagent or chemicals for the test.
To analyze the mother milk, the sucker point of the analyzer was washed with the distilled water by allowing the water to be drawn through it. The milk was taken in three different test tubes in equal quantity; one tube was placed in pH electrode, second tube in temperature slot for their finding, while milk of 3 rd tube by keeping in given slot, was allowed to be sucked for the assessment of the various parameters viz.fat (%) ± 0.1%, solid non-fat (SNF %) ± 0.2%, milk density (g/cm3)± 0.0005 g/cm3, protein (%) ± 0.2%, lactose (%) ± 0.2%, freezing point (°C) ±0.015°C, conductivity (mS/cm) ±1 % (18°C)and pH ±0.02.   The mean values of Fat %, SNF %, Density(g/cm 3 ) and Protein % were found higher in vitiated milk of Pitta Prakriti mothers as compared to normal (pure) milk while values of Freezing Point(°C)., Lactose (%),Conductivity (mS/cm) and pH were found higher in pure milk of Pitta Prakriti mothers. However, on applying independent sample t -test, none of these mean values were found to vary significantly in pure as well as in vitiated milk. (Table No.3)

Discussion
In Ayurveda, emphasis has been given on quality of human milk and mentioned that this ideal food may get vitiated with different factors like indigestion, excessive intake of food or excessive salty, sour, pungent, decomposed food as well as physical stress, night awakening, excessive mental work, suppression of natural urges in lactating mothers. 9,12,16 These etiological factors result in clinical manifestation in children dependent on vitiated milk of mothers in addition to change in features of pure milk. 10,11 Recent studies 21, 22, 23 have shown that phase of lactation and preterm delivery are well known factors to affect the composition of human milk. Other factors are diet, age, smoking, residential area, overweight, mother's parity and life style.
Diet is considered as an important factor to keep the normal or pure milk of the mother. A person likes a specific type of food as per their Prakriti and his diet has dominancy of such food. Stanya (human milk) is produced from Rasa-Prasada Bhaga (nutrients fluid) 9, 10 and RaktaDhatu. Under this study, controlled diet was not considered and mothers were left to take the diet in accordance to their desire in view of the fact that each person has fond of specific diet and mode of intake (cold/hot) as per their Prakriti. However, the diet was recorded for last 48 hours with a reason that a conversion of Anna (food) to Rasa-Dhatu usually takes place in Ahoratri (48 hours). During this conversion Updhatu Stanya(human milk) is formed as a by-product of Ras Dhatu when its conversion takes place into Rakta Dhatu (blood).
Milk assessment was done as per the subjective and objective parameters. The objective parameters used in the study showed different constituents of milk which include Fat, SNF, density, protein, lactose, freezing point, conductivity, and pH, which were evaluated through Eko Milk Analyzer. The other parameter, water test comprised the assessment of Shuddha (pure or normal) and Doshika vitiation of mother milk. In this study, mother milk (n=200) when assessed for its purity and vitiation, was found 40 % and 60 % respectively at the time of registration by water test.

Difference in Composition of Mother Milk as Per Prakriti
The present study suggests variation in composition of milk as per Prakriti in healthy mothers, but all these were not found statistically significant. These observed variations are inconsistent as mothers have different dietary choices because of their psychosomatic makeup. As per Ayurveda, since, the human milk (Stanya) is subsidiary (Updhatu) of plasma (Rasa Dhatu) so its quality depends on the quality of absorbed nutrient part of food (Aahar Rasa). Based on the findings observed in our study, it can be inferred that the composition of human milk is not same in the entire mother's, it varies as per psychosomatic constitution. There are other factors which are also responsible for variations in composition of mother milk like diet, 16 mother's parity 17 ; life style 18 should be also considered. Incidence of vitiated milk was found higher (60 % mothers) than non-vitiated milk (40 % mothers). In vitiation of milk major contributory factor is maternal diet among respective Prakriti of mother. Changes as per pure (non-vitiated) and vitiated mother milk are significant for Fat % in Vata and Kapha Prakriti mothers only. Relatively, higher values of Fat % and Protein % in milk of Kapha and Pitta Prakriti as compared to Vata Prakriti mothers validate the property of Sneha and Ati-snigdha properties of Pitta and Kapha Dosha, respectively. Maternal Prakriti wise variation in fat contents of pure milk was also found. Higher fat content in pure milk was seen in Pitta and Kapha Prakriti mothers than Vata Prakriti mothers.

Composition of Pure and Vitiated Human Milk
Basically human milk is a nutrient delivery system, transferring all essential nutrients in appropriate amounts from maternal diet and body stores via milk to a infant. The studies have shown that the composition of mother's milk is influenced by certain factors associated with mother viz. parity, period of lactation, diet and nutritional reserve of mother during pregnancy. Fundamentally Prakriti refers to Phenotype of an individual. It refers to genetic makeup of mother which produces the physiological and metabolic peculiarity. The dietary intake of mother varies as per their Prakriti, leading to variation in human milk composition. The lipid composition reflects maternal dietary intakes both during lactation and in the months and even years prior to lactation. Study has also reported that intake of high calorie diet the sugar and fat content of human milk were unchanged whereas protein content was increased. 24 It is suggested by the studies that the food preferences of a baby may be established and learned via human milk by adopting healthy food during early phase of lactation as the neural circuitry of appetite is established in part by food consumed during early development. 25,26,27,28 Therefore the period of breast feeding, by shaping healthy food preferences is a potentially critical period for combating future obesity and dealing with our changing environments.

Conclusion
There are many reported factors for variation in composition of mother milk including genetic factor. Present study suggests that the composition of mother's milk is not same in all the individuals; it varies as per Prakriti and in vitiated state too. Prakriti refers to genetic account of an individual. Thus by correcting diet and lifestyle according to Prakriti, the quality of mother milk may be improved and better growth of infants may be obtained by using medicines for purification of milk as suggested in Ayurveda.

Implications of the Study
Outcome of this study can be used for the dietary and life style modifications of lactating mothers for optimizing in composition of milk as per Prakriti. As human milk is the exclusive source of nutrition in first six months of life, human milk composition might have effect on growth and development of infants. Thus their effect can be observed on infants and suitable measures may be adopted in case of lagging of growth and development in its initial phase itself.

Limitation of the Study
• Sample size was small and the parity of mother was not considered. • Dietary intake of mother was not under the control of investigator as it was left as per the wish of mother assuming that it was in accordance to her Prakriti.