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| Date: 11-25-2008 | HC# 060486-365 |
Re: Review of Alternative Modalities in Treating Obesity
Cherniak EP. Potential applications for alternative medicine to treat obesity in an aging population. Altern Med Rev. 2008;13(1): 34-42.
Obesity affects a growing number of people, contributes to
several disease conditions, and reduces quality of life and lifespan. Ill
effects increase with age and over time. Efficacy of conventional therapies is
limited. Many elderly are obese, despite conventional weight loss therapies,
and the aging US population will likely add to their number. No alternative
weight therapy has been studied specifically in the elderly, nor enough in any
population to be definitively recommended. However, exercise and dietary
modification, with the possible addition of supplements, acupuncture, or
hypnosis, may help stem the swelling tide of obesity.
Most weight loss special diet studies have been conducted in
middle-aged women. A review of studies of low carbohydrate diets found 1-10%
body weight loss. In 120 obese individuals, significantly more on a low
carbohydrate diet (76%) adhered to it than those on a low fat diet (59%). The
low carbohydrate group lost a mean 12.9% body weight; the low fat group, a mean
6.7%. In other trials, no significant weight loss difference was found between
low carbohydrate and high carbohydrate diets, and no difference was found after
one year between a low carbohydrate and a conventional diet. In a one-year
study comparing low carbohydrate, higher fat Atkins and Zone diets with low fat
Ornish and LEARN diets in premenopausal women, those on Atkins lost more. The
Ornish low animal protein, high complex carbohydrate diet can modify risk
factors for coronary artery disease and reduce risk of atherosclerosis.
Concerns about long-term use of low carbohydrate diets include potential
vitamin, mineral, and fiber deficiencies.
Supplements for weight loss include conjugated linoleic acid
(CLA) from beef and dairy products, taken as a triglyceride, which produced
small but significant loss after one year in a double-blind, randomized,
placebo-controlled trial. Continued for a year as an open-label trial, no
further loss was seen. When CLA was given as free fatty acids rather than a
triglyceride, no loss was seen. Chitosan, a polysaccharide extract from
invertebrate shells, aided weight loss in animal studies, blocking fat
absorption, but results in humans have been mixed. A meta-analysis recognized
weight loss in chitosan trials, but said studies were not methodologically
sound enough to establish a benefit.
Among botanicals, tea (Camellia
sinensis) leaves, especially green tea (processed soon after collection) in
encapsulated form, has received most attention. Some increased energy
expenditure is attributed to tea's caffeine. However, catechins are thought to
be the main catalyst. Catechins are polyphenols which may inhibit the breakdown
of norepinephrine, generating thermogenesis (internal body heat production) or,
alternatively, slow angiogenesis and growth of fat tissue. Studies using
different levels of catechins with other agents make it difficult to tell which
cause weight loss or to determine effective doses. Green tea extracts are used
to maintain weight loss. One study found this most effective in those with
lower habitual caffeine intake, who regained 13% less weight with green tea
than with placebo. Oolong tea (fermented before processing) did not produce fat
or weight loss in humans unless green tea extract was added. No study has found
that black tea (crushed before fermentation) causes weight loss, but one study
found higher metabolic rates after consumption of black tea, guarana (Paullinia cupana; a source of caffeine),
ginger (Zingiber officinale), dill
weed (Anethum graveolens), vitamin C,
and rutin (a plant polyphenol).
Garcinia (mangosteen; Garcinia
cambogia) fruit's active ingredient is said to be (-)-hydroxycitric acid
(HCA), but in one double-blind trial of standardized HCA with a low-calorie
diet, the active group lost only slightly more than the placebo group.
Synephrine alkaloids from bitter orange (Citrus
x aurantium) may cause weight loss,
but have been combined with other agents in trials, making conclusions
difficult. Two botanicals have only been tested in animals. Platycodin, from
platycodon (Platycodon grandiflorum)
root, produced 13% more weight loss than placebo. Guabiroba, from perfume guava
(Campomanesia lineatifolia), used in
Brazilian traditional medicine, prevented gain in rats fed a high fat diet.
Acupuncture has been more studied for weight loss than any
other alternative modality, but poor study design prevents determination of
efficacy. In one trial, 55 women received electroacupuncture, a restricted
diet, or neither. The electroacupuncture group averaged 4.8% loss; restricted
diet, 2.5%; the control group did not lose weight. In another study, obese and
non-obese participants receiving auricular acupuncture lost weight; non-obese
participants receiving sham acupuncture did not. Hypnosis, used for over 30
years for weight loss, was found in a meta-analysis to produce six pounds of
loss when added to other weight loss regimes and to become more effective over
time.
— Mariann
Garner-Wizard |