3: Acupuncture and Weight Control

 

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News Letter, Vol. 1 (3), March, 2009, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic.
Acup.

www.rmac.yourmd.com
www.drxuacupuncture.co

Rehabilitation
Medicine and Acupuncture Center

1171 East
Putnam Avenue, Building 1, 2^nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Case Discussion 3 : Weight Control

Susan W, a 45 year old female, came to me complaining of knee pain which she had been experiencing for more than seven years, but which has become much worse in the last two months.  I noted that, at about 5’6,” she weighed in excess of 210 lbs. and walked in an awkward position.  She told me she liked to walk for exercise, and even run, but, because she was getting bigger and bigger, her knee pain was getting worse.  She said she ate “very little” but was unable to get her weight down, and even walking caused  pain as well as heart palpitations.  She had high blood pressure and cholesterol.  She claimed to have tried everything including calorie control, exercise and diet pills, but nothing had worked.  Her clothes no longer fit and she was embarrassed to go to the gym and expose herself in exercise clothes.

Obesity is a chronic condition defined as an excess amount of body fat.  The normal amount of body fat is between 25-30% in women and 18-24% in men.  Anything over those percentages is considered obese.  Overweight is different from obesity. Overweight is having extra body weight from muscle, bone fat and/or water. Obesity is having a high amount of extra body fat.  The most useful measure of overweight and obesity is body mass index, which is based on height and weight, used for children, adults and teens.  There are many reasons for overweight and obesity.

1.
Unbalanced energy in and out.  In developed countries, the main cause of obesity is overeating; people ingest too many calories for their height and level of activity, so weight gain happens over time.

2.
Physical inactivity.  Many Americans are not very physically active.  One of the biggest causes is spending too much time in front of computers and the television.  A study finds that more than two hours of regular TV viewing per day has been linked to overweight and obesity.  Other reasons include the dependence on cars instead of walking and light physical demands at work and home.  The people who are inactive are more likely to gain weight because they do not burn up the calories they take in from food and drink.

3.
Environment .  Our environment prevents a healthy lifestyle since there are not enough sidewalks for people to walk on and, as many people spend two hours or more commuting to their jobs with cars or train, they do not have time for physical exercise.

4.
Poor nutritional information or lack of access to healthy foods.

5.
Genes and family history.  Many people are obese because their parents were, due to genes and bad habits relating to food and physical activity.   There is definitely a link between genes and the environment, as children adopt the habits of their parents.

6.
Medical conditions.  Some diseases can cause overweight, such as hypothyroidism, Cushing syndrome and polycystic ovary syndrome.

7.
Medicines.  Certain medicines such as cortcosteroids, prednisone and antidepressants such as Elavil and Neurontin may cause weight gain.

8.
Emotional factors such as depression, anger and stress can make people overeat.

9.
Age. As people age, they tend to lost muscle, especially if they become less active. Muscle loss slows down the rate at which the body  burns calories. After age 50, it is wise to reduce the number of calories consumed daily, otherwise it is easy to gain weight.

10.
Pregnancy. While it is normal to gain weight during pregnancy, many women retain this weight even after the baby is born due to lack of activity and increased calorie intake.

11.
Lack of sleep.  Studies have found that the less sleep people have, the more likely they are to be overweight or obese.

Overweight can also induce  the following medical risks or diseases:

1.
Heart disease, heart attacks and congestive heart failure.  Many people have coronary artery diseases and other heart related illness, they are afraid of physical activities and stressed, therefore, they do not perform physical exercise and very often eat junk food to reduce their stress. Because of increased body weight, the heart has to pump more blood to the body, which increases the heart load, and in turn, can lead to a heart attack and congestive failure.

2.
High blood pressure.  Obesity can induce high blood pressure, forcing the heart to pump more blood to the extremities, which increases the intensity of the arteries and make the blood pressure go higher.

3.
Stroke.  Fatty tissue deposits in the blood vessels, subsequently narrows the blood vessel and makes the blood supply decrease to all the important organs. If the blood supply is blocked to the brain, this will cause a stroke.

4.
Type 2 diabetes.  Overweight and obesity  increase the resistance to the insulin contained in the body tissue, which will increase the pancreatic function,  in the long run, means the pancreas cannot secrete enough insulin. Lack of insulin causes  type 2 diabetes.

5.
Increased cholesterol level.  Because high fat tissue supplies a high amount of triglycerides and low-density lipoprotein, which is bad cholesterol, they will cause heart attacks, hypertension and the like.

6.
Cancer.  Being obese raises the risk of colon, breast, endometrial and gallbladder cancers.

7.
Osteoarthritis.  Being overweight puts tremendous pressure on knee and hip joints and low back, which causes pain just as in Susan W’s case.

8.
Sleep apnea.

9.
Reproductive problems such as infertility in women.

10.
Gallstones.  Cholesterol can form gallstones, which cause  abdominal or back pain.

Overweight and obesity can be diagnoses by body mass index (BMI).  Take your
height and weight. You can calculate  your BMI with the following formula or
check the following tables. The BMI 18.5 – 24.9 is normal, below 18.5 is under
normal weight, 25 -29.9 is overweight, 30-39.9 is obese and anything over 40 is morbidly obese.

 

 

 

BMI Categories:

• Underweight = <18.5
• Normal weight = 18.5-24.9
• Overweight = 25-29.9
• Obesity = BMI of 30 or greater

Please see the following tables
from National Heart Lung and Blood Institute for your reference:

http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm

Table for MBI greater than 35, as provided by National Heart Long and Blood Institute.

Many people seek medical advice for weight loss.  In traditional western medicine, the patient is sometimes prescribed anti-obesity medication to try to help with weight loss.  The two medicines approved by the FDA for weight loss are Meridia, which sends signals to the brain to curb the  appetite.  There are, however, side effects of  raising blood pressure and pulse.  Another medication is  Xenical, which reduces the absorption of fat and calories, also vitamins A, D and K, which could cause mild side effects such as  loose stools.

Surgical Procedures:

The American Society for Bariatric Surgery describes two basic approaches thatweight loss surgery takes to achieve change:

1.
Restrictive procedures that decrease food intake:

Gastric Restrictive Procedure –
Vertical Banded Gastroplasty (VBG)

Vertical Banded Gastroplasty
(VBG) is a purely restrictive procedure. In this procedure the upper stomach near the esophagus is stapled vertically for about 2-1/2 inches (6 cm) to create a smaller stomach pouch. The outlet from the pouch is restricted by a band or ring that slows the emptying of the food and thus creates the feeling of fullness.

2.
Malabsorptive procedures that alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in the stool, which include the following:

(A)    Biliopancreatic Diversion (BPD )

(B)     Extended (Distal) Roux-en-Y Gastric Bypass (RYGBP-E )

(C)     Biliopancreatic Diversion with “Duodenal Switch”

3.
Combined Restrictive & Malabsorptive Procedure – Gastric Bypass Roux-en-Y.

For non surgical treatment, I usually use the following six programs together:

1.
I first ruled out any medical illness which might have caused her obesity.   She was screened for polycystic ovary syndrome and checked for hypothyroidism and/or Cushing’s syndrome.  All tests came back normal.

2.
Acupuncture.  I combined body acupuncture with auricular acupuncture points. For the body, the most important points are ST-34,  Liang Qiu points and SP-4, Gong Sun.  Liang Qiu points belong to the stomach meridian and can inhibit stomach activity and make the food absorption slower and decrease the appetite.  Gong Sun SP-4 is a point of the spleen, which can increase the body’s metabolism and decrease the appetite, too.  Ren 12 (Zhong Wan) and Ren 3 (Guang Yuan) are local points adjacent to the stomach and intestine, they directly affect and facilitate the bowel movement, therefore, inhibit the absorption of the food in the GI system.

Pic 10-1 and 10-2:

Table 10-1

Auricular needles are the most important part for weight loss program. I chose the points of spleen,  stomach, liver, small intestine and Sheng Meng.  These points can inhibit stomach activity, slow the absorption of nutrition from food in the stomach and small intestine, also improve energy of human body and decrease the stress and depression.  The patients should press the ear needles to lessen their craving for food while she or he feels hungry.  The points on the liver, endocrine and Sheng Meng may reduce the stress and anxiety, in  adjunction with the points of spleen, stomach and small intestine, to decrease the craving sensation.  It is possible to  substitute vegetable or plastic seeds in place of the needles, for those who fear needles, and generally speaking, they will have
the same effect.

3.
Diet program.  Diet is the most important and the most difficult part for entire weight loss program. The principal is “You must eat less than the calories you burn”.

The following points are must to follow:

1.
Eat healthy and good breakfast.  You may eat healthy food as much as you like for breakfast. I do not suggest skipping breakfast because we need  breakfast to supply entire day’s energy.

2.
Have a moderate meal as lunch to maintain necessary energy for afternoon.

3.
Eat minimum dinner or no dinner. Most American are doing the opposite, i.e. they do not eat breakfast, eat moderate lunch and huge dinner. Because they think they deserve the banquet after all day’s hard work. However, they do not understand that they can burn the calories we take during the day time due to their work.  Most people watch television after dinner or engage in some other activity which burns few if any calories, and the foods eaten at dinner which have all night to be digested  mostly turn to fat.  Turning around the way we eat can cause significant weight loss, with breakfast now being the largest meal and dinner, small or non-existent.

4.
Chinese herbal program.  I usually also prescribe herbs to  improve the
bowel movement and loosen the bowel, which hasten the food through the system faster than usual, thus not being able to be absorbed as fat.

5.
Nutrition supplements. There are thousands of nutrition supplements in the market.

After careful selection, I chose 3 nutrition supplements for our patients.

1.
Transitions Carbohydrate Absorption Inhibitor (CAI)

CAI  inhibits the enzymes that normally breakdown starch into glucose in the small intestine.   As a result, the absorption of glucose from carbohydrate-rich foods, such as bread, potatoes, rice and pasta is limited. The active ingredient, wheat amylase inhibitor, delivers the advantage of maximum effectiveness in small amounts.

2.
Transitions CLA (Conjugated Linoleic Acid (CLA)

Transitions Conjugated Linoleic Acid (CLA) Caffeine Free is ideal for those who have lost weight or are losing weight and want the extra support to keep it off.  Transitions^TM CLA Caffeine Free contains natural ingredients that can help redistribute fat to fat burning muscles tissue to  assist in promoting lean muscle mass and decreasing the amount of fat stored in your body.

3.
Transitions Fat Conversion Inhibitor (FCI)

Transitions Fat Conversion Inhibitor (FCI) helps reduce the number of calories being converted to fat, assist in maintaining normal blood sugar levels, and can decrease appetite. It contains the natural ingredient, Garcinia cambogia, that inhibits the fat conversion process in your body’s cells and promote more effective burning of  calories.  Garcinia cambogia also increases serotonin levels which controls your appetite putting you in control. Transitions FCI also contains other natural ingredients that effectively promote weight loss: Gymnema sylvestre is a natural herb that can help maintain blood sugar levels and reduce cravings for sweets. Chromium is an essential trace mineral that promotes normal glucose uptake by the cells. This process aids in the maintenance of blood sugar levels and ultimately helps maintain your energy level and decrease your cravings.

6.
Physical activity. I encouraged Susan to do physical exercise 45 minutes to an hour six days a week.  If she did not exercise she still would be
unable to burn the calories she eats.  Susan liked to run, I advised her to give up running and she was in encouraged to have swim and stationary bicycle, as swimming and station bicycling do not have an impact on the knee and hip joints.   It is also very good exercise for the entire body, especially all other joints.  Susan now swims and bicycles around one hour a day six days a week.

After two months of sticking to her program, Susan lost about 14 pounds. Her auricular needles were changed once a week, to prevent infection.  She also continued to take Chinese herbs and nutritional supplement and kept up her diet and physical activity program.  After six months she had lost almost 40 pounds and no longer needed the auricular needles.  Her knee pain was much improved after she lost weight.

Tips for Patients:

1.The key is the dinner. If you eat very little dinner or no dinner, you will lose weight very soon.

2.The acupuncture and nutritional supplement will greatly decrease your appetite.

3.Exercise will help you burn more calories. The following idea will help you do more exercise without spending more time:

A.Always park your car far away from the shopping center or any place you go.

B.Try to walk upstairs and downstairs without taking elevator.

C.Always hold your abdomen while you sitting in  your chair.

D.Always walk to somewhere if you do not have to drive.

Tips for acupuncture practitioners:

1. The most important issue is to encourage your patient to stick to the program for al least 3 to 6 months.
2. Auricular needles might be useful without combining with body acupuncture to suppress the appetite.
3. Diet program alone might be enough for some patients to loose weight.

4. Prevention are always more important than the treatment.

If  you like to lose weight , please call my office to make an appointment.

For more info, please visit:

http://www.win.niddk.nih.gov/publications/myths.htm