complementary and alternative therapies for obesity

Complementary and Alternative

Medicine for

Obesity Dr. P.Naina Mohamed PhD

Pharmacologist

Introduction The therapies which could be combined with

conventional medicine is termed “Complementary Medicine”.

“Alternative Medicine” includes therapies that are used in place of conventional medicine.

“Complementary and Alternative Medicine” (CAM) refers to a wide range of clinical therapies outside the conventional medicine.

“Conventional Medicine” is a type of medicine practiced by medical doctors and by allied health professionals, such as physical therapists, psychologists, and registered nurses. It is also called Western or Allopathic medicine.

“Integrative Medicine” represents a combination of conventional medicine, CAM, and evidence-based medicine.

CAM Use An US study reported that the Complementary and

Alternative Medicine (CAM) use is high and continues to increase.

The most important reason cited by patients for the supplemental CAM use is the perception that CAM is harmless.

CAM use is highest in patients include Female Nonsmokers Physically active Having normal body mass index (BMI) Eating low-fat diets with a high fruit and vegetable content Individuals aged 35 to 54 years with a high level of education.

Types of CAM Practices

Mind and Body Practices Traditional Medical

Systems "Modern" Medical Systems

Mind and BodyPractices

  Acupuncture and Acupressure Yoga Hypnosis Massage Meditation Reflexology Alexander technique Tai chi Spinal manipulation Therapeutic touch Guided imagery Rolfing/structural integration

Traditional Medical Systems

  •Ayurvedic medicine •Siddha medicine •Unani medicine •Native American medicine •Tibetan medicine •Traditional Chinese medicine •Curanderismo

"Modern" Medical Systems

  •Homeopathy •Naturopathy •Osteopathy •Chiropractic •Anthroposophic medicine

Obesity The imbalance between caloric intake and expenditure

might result in to Overweight or Obesity. Obesity has become one of the most important avoidable

risk factors for morbidity and mortality. Obesity can increase the risk of Type 2 diabetes,

Cardiovascular diseases, Chronic kidney disease, Sleep apnea, Arthritis, Lung disease, and several forms of Cancer.

Obese or Overweight individuals might be benefited from Increased physical activity Caloric restriction Behavioral therapy

CAM used to treat Obesity

Dietary Supplements Ephedra (Ma Huang) Green Tea Bitter Orange Hoodia (Kalahari cactus) Acai (Amazonian palm berry) Chitosan Chromium Picolinate Garcinia cambogia Glucomannan Guar gum Pyruvate Yohimbe (Yohimbine)

Acupuncture/Acupressure Yoga Naturopathy

Ephedra (Ma Huang)

Taking ephedra can result in anxiety, difficulty urinating, dry mouth, headache, heart damage, high blood pressure, irregular heart rhythms, irritation of the stomach, kidney stones, nausea, psychosis, restlessness, sleep problems, and tremors.

Using ephedra may worsen many health conditions such as cardiovascular disease, kidney disease, and diabetes.

Dietary supplements containing ephedra are banned by FDA in 2004.

https://ods.od.nih.gov/factsheets/WeightLoss-HealthProfessional/

Green Tea

Other mechanisms of Green tea include inhibition of Acetyl-CoA carboxylase and Fatty acid synthase and obstruction of absorption of fat via the gut.

The data is very limited to determine whether green tea can aid in weight loss.

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8415209&fileId=S0007114511003849

Bitter Orange

There is not enough scientific evidence to support the use of bitter orange for health purposes.

People having a heart condition (Hypertension, etc) or taking medications (such as MAO inhibitors), caffeine, or other herbs/supplements that speed up the heart rate should avoid bitter orange containing products.

https://ods.od.nih.gov/factsheets/WeightLoss-HealthProfessional/

Hoodia (Kalahari cactus)

There is no published clinical studies to support the use of Hoodia.

http://www.academicjournals.org/article/article1380698552_Pereira%20et%20al.pdf

Acai (Amazonian palm berry)

There is no definitive scientific evidence to support the efficacy of Acai berry products which have been marketed as folk or traditional remedies for weight-loss and anti-aging purposes.

Researchers found no body weight changes in rats given acai-fortified juice compared to controls.

https://nccih.nih.gov/health/providers/digest/weightloss-science

Chitosan

Chitosan is derived from crustaceans. According to a meta-analysis, the effectiveness of

chitosan for body weight reduction is not established beyond reasonable doubt.

Adverse events of chitosan may include constipation and flatulence.

https://ods.od.nih.gov/factsheets/WeightLoss-HealthProfessional/

Chromium Picolinate

Chromium is a cofactor to insulin and it can increase the lean body mass, decrease percentage body fat and increase the basal metabolic rate.

Chromium supplementation also boosts glucose metabolism, body composition, and insulin sensitivity, to a modest extent.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386228/

Garcinia cambogia

Hydroxycitric acid is obtained from extracts of Garcinia cambogia.

A number of human trials have produced unconvincing evidence.

Further independent studies are needed. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386228/

Glucomannan

Glucomannan is a component of konjac root (Amorphophallus konjac).

Its chemical structure is similar to that of galactomannan from guar gum and comprises a polysaccharide chain of glucose and mannose.

https://ods.od.nih.gov/factsheets/WeightLoss-HealthProfessional/

Guar gum

Guar gum is a dietary fibre derived from Cyamopsis tetragonolobus.

https://ods.od.nih.gov/factsheets/WeightLoss-HealthProfessional/

Pyruvate

Pyruvate is generated in the body via glycolysis.

Pyruvate supplementation may enhance exercise performance and improve measures of body composition.

https://ods.od.nih.gov/factsheets/WeightLoss-HealthProfessional/

Yohimbe (Yohimbine)

Yohimbine, an alpha-2 receptor antagonist is the main active constituent of the ground bark of Pausinystalia yohimbe (yohimbe).

At present, it is unclear whether yohimbine is effective for reducing body weight.

https://ods.od.nih.gov/factsheets/WeightLoss-HealthProfessional/

Hydroxy methylbutyrate

Hydroxy methylbutyrate is a metabolite of leucine and is available as a dietary supplement.

It is primarily used by bodybuilders as a supportive measure to induce body composition changes.

http://www.nature.com/ijo/journal/v29/n9/full/0803008a.html

Plantago psyllium

Psyllium is a water-soluble fibre derived from the ripe seeds of Plantago psyllium.

According to one double-blind RCT, there were no significant changes in body weight in either the treatment group or the placebo group.

http://www.nature.com/ijo/journal/v29/n9/full/0803008a.html

Cynanchum Auriculatum

According to Chinese traditional medicine, the roots of C. auriculatum enhance immunity and espouse longevity.

Pregnane glycosides and baishouwubenzophenone have been found to exist in C. auriculatum.

The efficacy and safety of pregnane glycosides need to be further investigated.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386228/

Acupuncture Insertion of needles into certain points (Acupoints)

on the skin, is known as Acupuncture. Acupuncture was found to reduce more body

weight than conventional medication in a systematic review and meta-analysis including 29 randomized controlled trials.

Due to poor methodological quality of the trials reviewed, the reviewers suggested to conduct more organized and long-term studies to determine the efficacy of acupuncture in treating obesity.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386228/

Possible Mechanisms of Acupuncture

Naturopathy Naturopathy identifies and treats root cause rather than

symptoms. Causes of obesity include lack of awareness, emotional triggers, hormone imbalance, stress, neurotransmitter imbalance, and toxicity. Naturopathy focuses on attaining overall health (e.g., regaining insulin sensitivity and reversing insulin resistance; optimal digestion; psychological well-being; decreasing stress) not on “weight loss”.

Serotonin and the catecholamines (Dopamine and Norepinephrine) are important in the regulation of appetite and satiety. Naturopathy uses amino acid precursors (5HTP for serotonin, L-tyrosine and Mucuna pruriens for dopamine and norepinephrine synthesis) as supplements, rather than using medications such as SSRIs and phentermine.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791327/

Yoga

Yoga may be most beneficial in the treatment of overweight and obesity before an individual begins a diet and exercise program.

http://ajl.sagepub.com/content/early/2013/06/24/1559827613492097.full

Mindfulness Mindfulness programs are used to treat a variety

of health related issues. Forms of mindfulness include…

Mindfulness-Based Stress Reduction (MBSR) Mindfulness-Based Cognitive Therapy (MBCT) Dialectical Behavior Therapy (DBT)

Mindfulness programs have recently gained popularity for obesity related eating behaviors such as binge eating, emotional eating, and external eating.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046117/

Non Invasive Body Contouring

Non invasive Body Contouring methods include… High Intensity Focused Ultrasound (HIFU) Low Level Laser Therapy (LLLT) Cryolipolysis Radiofrequency

Only 2 to 4 cm in limb or waist circumference could be reduced by Non invasive body contouring techniques.

High Intensity Focused Ultrasound

(HIFU)

Subcutaneous fat could be removed by using High Intensity Focused Ultrasound (HIFU) technique.

Available evidence suggests patients with a BMI lower than 30 kg/m2 show the optimal results to HIFU.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386228/

Low Level Laser Therapy

Low Level Laser Therapy (LLLT) has yielded successful results in fat reduction of localized areas, such as the hips, waist, thighs, and upper arms.

Further research into LLLT is required to understand the safety and effectiveness.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386228/

Cryolipolysis

Cryolipolysis targets fat selectively through controlled cooling.

According to a study, cryolipolysis managed to remove fat from abdomen, back and flank areas most effectively.

The conclusion of a 2009 review of four clinical studies suggested that there was sufficient evidence to support the efficacy and safety of cryolipolysis.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386228/

Radiofrequency

At present, Radiofrequency based devices are used most commonly as a non-invasive technique.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386228/

Facts about Weight loss Supplements

Most of the dietary supplements marketed for weight loss or appetite suppression haven’t been proven safe or effective.

There is no definitive scientific evidence to support the use of acai berry, bitter orange, and green tea supplements for weight loss.

Ephedra can increase the risk of heart problems and stroke and in 2004, the FDA banned the U.S. sale of dietary supplements containing ephedra.

Further research is needed to improve the understanding of the role of CAM in the treatment of obesity.

TIPS on choosing CAM for Weight loss

Be cautious of the products marketed with exaggerated or unrealistic phrases like “Quick and Effective” or “Totally safe.”

Be skeptical about information from personal “Testimonials” about the product’s benefits.

The U.S. Food and Drug Administration (FDA) has found weight loss products sold as dietary supplements that contain hidden ingredients which can cause serious harm to consumers.

Consider a mind and body approach such as mindfulness meditation or yoga. There is some emerging evidence suggesting that some mind and body approaches are generally safe and may be useful as complements to other weight-loss interventions.   

Overweight and obese individuals should make lifestyle changes like healthy eating plan and regular physical activity for safe weight loss.

References Textbook of Complementary and

Alternative Medicine Chun-Su Yuan, Eric J. Bieber

Evidence Based Guide to Complementary and Alternative Medicine Bradly P. Jacobs, Katherine Gundling

Obesity Prevention and TreatmentJames M. Rippe, Theodore J. Angelopoulos

References https://nccih.nih.gov/health/integrative-health?

nav=govd http://www.ncbi.nlm.nih.gov/pmc/articles/

PMC4386228/ http://www.nature.com/ijo/journal/v29/n9/full/

0803008a.html http://onlinelibrary.wiley.com/doi/10.1038/

oby.2008.239/full http://www.ncbi.nlm.nih.gov/pmc/articles/

PMC2791327/ https://nccih.nih.gov/health/providers/digest/

weightloss-science