The American Cancer Society (ACS) reviewed evidence from human population studies and [...]]]> Recent issue of “CA: a Cancer Journal for Clinicians” published American Cancer Society guidelines on nutrition and physical activity for cancer prevention, updated in 2012 by the ACS Nutrition and Physical Activity Guidelines Advisory Committee.

Many studies have shown garlic has [...]]]> Garlic is widely used around the world for its pungent flavor as a fundamental component in many or most dishes of various regions, including eastern Asia, South Asia, Southeast Asia, the Middle East, northern Africa, southern Europe, and parts of South and Central America.

Many studies have shown garlic has antibacterial, antiviral, and antifungal activity. Garlic is also used to prevent certain types of cancer, including stomach and colon cancers. In fact, countries where garlic is consumed in higher amounts, have been found to have a lower prevalence of cancer.

Furthermore, animal studies have suggested possible cardiovascular benefits of garlic. For example, garlic supplementation reduced accumulation of cholesterol on the vascular walls and the size of aortic plaque of animals.

An article published on the Journal of the Science of Food and Agriculture (2012 Jan 10), after reviewing a number of clinical studies, displays detailed evidence that regular consumption of garlic can reduce blood lipids, especially total cholesterol and triglyceride, implying the potential role of garlic in prevention of cardiovascular diseases (including atherosclerosis, myocardial infarction and stroke).

The study reviewed in-depth 26 randomized, double-blind, placebo-controlled clinical trials of garlic, published on the databases including MEDLINE, ISI Web of Science, EMBASE, Cochrane databases, and China biology medical literature database. The effects of garlic on the levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), Apo-B and TC/HDL-C ratio were examined carefully.

Overall, garlic significantly reduced serum TC and TG levels by 0.28 mmol/L and 0.13 mmol/L, respectively, when compared to the placebo group. However, garlic therapy did not produce any significant influence on LDL-C, Apo-B level, TC/HDL-C ratio, and HDL-C level.

Besides, the longer the consumption, the greater the effects of garlic on serum TC and TG levels. For example, the mean reduction of TC levels was 0.19, 0.26 and 0.41 mmol/L for subgroups of 0-4 weeks, 4–12 weeks, and > 12 weeks of garlic use, respectively, while the reduction of TG levels were 0.02, 0.08 and 0.16 mmol/L, respectively. Also, patients with higher baseline TC level achieved greater reduction in TC level with garlic use.

In addition, garlic powder and aged garlic extract were more effective in reducing serum TC levels, while garlic oil was more effective in lowering serum TG levels.

The lipid-lowering effects of garlic may be attributed to its direct or indirect inhibition on 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMGCR), a key enzyme in cholesterol production in the liver. In addition to HMGCR, several other targets might be also be included, such as

• the suppression of acyl-CoA:cholesterol acyltransferase (ACAT), which participates in cholesteryl ester formation;
• stimulation of cholesteryl ester hydrolase (CEH), which degrades cholesteryl esters;
• inhibition of human gastric lipase, an important enzyme in the digestion and absorption of dietary fats;
• Inhibition of cholesteryl ester transfer protein, the key enzyme in the reverse cholesterol transport system that transports cholesterol from peripheral tissues to the liver;
• Suppression of the assembly and secretion of chylomicrons from the intestine to the blood circulation via inhibition of microsomal triglyceride transfer protein (MTP) gene expression.

In summary, garlic could reduce serum TC and TG levels, and garlic therapy should benefit patients with risk of cardiovascular diseases.

An estimated 25 to [...]]]> Recent issue of Journal of Rehabilitation Research & Development (Volume 48 Number 9, 2011 Pages 1119 — 1128) published that veterans suffering from chronic noncancer pain are willing to accept complementary and alternative medicines (CAM) such as chiropractic care, massage therapy, herbal medicines, and acupuncture for pain relieft.

An estimated 25 to 50 million Americans experience chronic pain, with an annual direct economic effect of $24 billion. Surveys have shown a higher rate of chronic pain among veterans than the general population. Approximately 50%~75% of veterans experience pain some time in their lives.

However, there are various challenges healthcare providers encounter during pain management and treatment, and many patients do not get optimal relief or may go undertreated. Thus, this study investigated the percentage and willingness of receiving alternative treatments among chronic noncancer pain patients

Patients with chronic noncancer pain were recruited between January 2006 and January 2007. From 42,000 patients enrolled at the five primary care clinics, those with complete medical record documentation of a musculoskeletal pain diagnosis (back, arthritic, neck, or joint pain) for at least 12 weeks, Chronic Pain Grade Questionnaire (CPG) intensity and interference item scores of at least 4 on a 0 to 10 scale (indicating moderate or greater severity) were eligible. However, patients diagnosed with bipolar disorder, psychotic disorder, dementia, chronic fatigue syndrome, fibromyalgia, or somatization disorder were excluded. Eventually, 401 participants completed this study.

The results shows that a majority of veterans (82%) reported prior use of at least one CAM modality, and nearly all (99%) were willing to try CAM treatment for pain. Chiropractic care was the least preferred option, whereas massage therapy was the most preferred (75% and 96%, respectively).

Furthermore, previous researches have demonstrated that chronic noncancer pain patients who have higher educational level, greater income, more severe or complex pain presentation, and lower quality of life, are more likely to seek alternative treatments like chiropractic care, massage therapy, herbal medicines, and acupuncture

This study shows that veterans with chronic noncancer pain are at higher rate in receiving and more willing to accept complementary and alternative medicines.

Gastric banding is usually performed by gastric laparoscope, using a adjustable silicone gastric band, commonly referred to as a lap band, which is placed around the top portion of the [...]]]> Gastric banding (GB) and Roux-en-Y gastric bypass (RYGBP) are two main surgeries used in the treatment of morbidly obese patients.

Gastric banding is usually performed by gastric laparoscope, using a adjustable silicone gastric band, commonly referred to as a lap band, which is placed around the top portion of the stomach to restrict food intake so as to treat obesity.

(Attribution: Xopusmagnumx at en.wikipedia)

Roux-en-Y gastric bypass (gastric bypass) is the most commonly employed bariatric procedure in the United States. In this surgery, the small intestine is divided approximately 45 cm (18 in) below the lower stomach outlet and is re-arranged into a Y-configuration, enabling outflow of food from the small upper stomach pouch via a “Roux limb”.

Both gastric banding and gastric bypassing are examples of bariatric surgery designed for obese patients with a body mass index (BMI) of 40 or greater—or between 35–40 in cases of patients with certain comorbidities.

Recently, doctors from Switzerland compared two bariatric surgeries in 442 patients with a body mass index (BMI) less than 50. Four hundred forty-two patients were matched according to sex, age, and BMI, and were undergone either laparoscopic gastric banding or gastric bypass. Operative morbidity, weight loss, residual BMI, quality of life, food tolerance, lipid profile, and long-term morbidity were evaluated during 6-year follow-up period (Arch Surg. Published online January 16, 2012).

The study results show that early morbidity was higher after gastric bypass than after gastric banding (17.2% vs 5.4%), but major morbidity was similar. Most complications were derived from surgery itself, and were not life-threatening and treated successfully with concervative methods.

Gastric bypass acheived quicker and greater weight loss than gastric banding, and weight loss remained significantly better at the sixth year after RYGBP.

However, there were more failures (BMI > 35 or reversal of the procedure/conversion) after gastric banding at 6 years, in comparison with gastric bypass (48.3% vs 12.3%). Furthremore, gastric banding was associated with more long-term complications (41.6% vs 19%) and more reoperations (26.7% vs 12.7%). After gastric banding, there are common long-term complications like esophageal dilatation (10.4%), impairing reflux requiring (or resistant to) daily high-dose proton-pump inhibitor therapy (6.8%), or severe food intolerance (6.3%), together with band erosions (7.7%). Overall, band removal was necessary in 47 patients (21.3%), of whom 29 (13.1%) were converted to another procedure.

At 3 years, there were 39 failures or the need for reversal/conversion after gastric banding compared with zero after gastric bypass.

With gastric bypass, blood lipid levels were greatly improved. Total cholesterol level remained unchanged after gastric banding but significantly decreased after gastric bypass, so did the low-density lipoprotein. Also, high-density lipoprotein increased in both procedures, resulting in a significantly better total to high-density lipoprotein cholesterol ratio for gastric bypass. Two procedures improved triglyceride level in a similar magnitude, and the mean fasting glucose level tended to be lower in gastric bypass.

The study concluded that Roux-en-Y gastric bypass achieves better weight loss, resulting in a better correction of some comorbidities (blood lipid and sugar levels) than gastric banding. Though gastric bypass is associated with higher early complication rate associated, it has lower long-term complication and reoperation rates, compared to gastric banding.

However, weight loss have been reported for topiramate and zonisamide, two antiepileptic drugs (anticonvulsants), published [...]]]> Several anti-seizure (antiepileptic or anticonvulsant) drugs (AEDs) are associated with weight gain such as gabapentin, pregabalin, valproic acid, and vigabatrin and to some extent carbamazepine. Others are weight neutral such as lamotrigine, levetiracetam, and phenytoin.

However, weight loss have been reported for topiramate and zonisamide, two antiepileptic drugs (anticonvulsants), published in the “Handbook of Experimental Pharmacology” (2012;209:433-66).

Topiramate (brand name Topamax) is an anticonvulsant (antiepilepsy) drug. Zonisamide is a sulfonamide anticonvulsant approved for use as an adjunctive therapy in adults with partial-onset seizures for adults; infantile spasm, and generalized tonic clonic seizure.

It has been reported that 13% of patients experience anorexia (loss of appetite) (13.3%) when on topiramate medication. In a one-year clinical trial for migraine prevention (Pain Med. 2012 Jan;13(1):80-6), topiramate was associated with a mean weight loss was of -0.9kg. This effect is also reproduced in high-fat fed rats where oral topiramate (50 mg/kg) group showed weight loss, improved insulin resistance, lessened anxiety behavior without influence on blood pressure (Eur Rev Med Pharmacol Sci. 2011;15(10):1187-95).

Also, Korean researchers conducted a study to examine the long-term effectiveness and tolerability of zonisamide (50mg/day to 300 mg/day) for weight control in psychiatric outpatients, and they found that zonisamide was associated with a mean BMI reduction of 0.8±1.7 kg/m(2). Patients treated with zonisamide showed significant weight loss. Furthermore, the treatment was generally safe and well tolerated with few negative effects on patients’ overall psychiatric symptoms (Prog Neuropsychopharmacol Biol Psychiatry. 2011 Dec 1;35(8):1918-21).

in a sixteen-week randomized, double-blind, placebo-controlled trial conducted at Duke University Medical Center from March 2001 to March 2002 (JAMA. 2003; 289(14):1820-), fifty-five (92%) obese women and 5 (8%) obese men (mean body mass index = 36.3) were randomized and treated with zonisamide (started at 100 mg/d orally, with gradual increase to 400 mg/d and further increase to 600 mg/d) for 12 weeks, on a balanced hypocaloric diet (500 kcal/d deficit). The study shows that the zonisamide group lost more body weight than the placebo group (5.9 kg [6.0% loss] vs 0.9 kg [1.0% loss]) during the 16-week period. Furthermore, after using a longitudinal mixed-model regression to exclude the compounding factors like age, race, sex, and body mass index, zonisamide treatment over the 16-week study duration was associated with significantly greater weight loss than was placebo.

These two drugs have been used in clinics for years, with relatively good safety records. Also, no serious adverse effects have been reported in above studies, implying that these two drugs might be prescribed for weight loss.

The drug combination is naltrexone and bupropion. Naltrexone is an opioid receptor antagonist, marketed under the trade names of Rivia and Depade, and primarily used  [...]]]> Researchers from Wayne State University found that an investigational combination of antidepressant and anti-alcoholism drug helps obese pateint lose and maintain weight (Obes Facts 2011;4:489-494).

The drug combination is naltrexone and bupropion. Naltrexone is an opioid receptor antagonist, marketed under the trade names of Rivia and Depade, and primarily used  in the management of alcohol dependence and opioid dependence. Bupropion, marketed as Wellbutrin, Zyban, Voxra, Budeprion, or Aplenzin, is an atypical antidepressant, commonly prescribed for patients with depression, anxiety, sexual dysfunction and intention for smoking cessation.

In the study, researcher examined results from four phase 3 trials in which naltrexone/bupropion combination was given to patients who are either obese or have a BMI >=27 kg/m(2) with comorbid diabetes, hypertension or hyperlipidemia for a purpose to achieve weight loss or maintain the weight.

Pooled results reveal 1-year naltrexone/bupropion combination treatment resulted into a mean weight loss of 4.7% (range 3.2-5.2%) after placebo substraction; and 26% to 33% more of patients on combination therapy achieved more than 5% weight loss than patients on placebo.

Moreover, naltrexone/bupropion significantly improved the proportion of patients achieving ≥10% weight loss, waist circumference, triglycerides, high-density lipoprotein, fasting insulin, insulin resistance, and obesity-specific quality of life compared to placebo.

Weight loss also benefits patients with diabetes as patients with naltrexone/bupropion therapy have a decreased hemoglobin A1c (HbA1c) by approximately 0.5% more than placebo.

In general, the use of naltrexone/bupropion combination in weight management is safe. Common side effects associated with naltrexone/bupropion include nausea, constipation, vomiting, dizziness, and dry mouth. In addition, greater improvement in systolic blood pressure and pulse were seen with placebo compared to naltrexone/bupropion.

However, the naltrexone/bupropion combination for weight loss management is still in the clinical trial stage and more data regarding its efficacy and safety should be gathered prior to its legal approval.

The study was conducted in the University of Pittsburgh School of Medicine and the lead scientist Dr. Cameron found that a [...]]]> Postmenopausal women have higher chance putting on weight within few years after menopause. New study in animal models might bring about a new treatment option for obese postmenopausal women.

The study was conducted in the University of Pittsburgh School of Medicine and the lead scientist Dr. Cameron found that a new selective estrogen receptor modulator (SERM) GSK232802A treatment reduces body weight and fat amount in monkeies by suppressing food intake and increasing activity, particularly in the most sedentary individuals.

Selective estrogen receptor modulators (SERM) are a class of compounds that act on and modulcate the activity of estrogen receptor. These substances are neither pure agonists nor pure antagonists since  their action is different in various tissues, thereby granting the possibility to selectively inhibit or stimulate estrogen-like action in various tissues. SERMs, in general, stimulate bone miniralization and improve postmenopausal osteoporosis; however, some SERMs including tamoxifen might induce bone loss in premenopausal women. Moreover, all SERMs decrease breast cancer risk, due to their ability to inhibit growth in estrogen receptor-positive breast cancer.

Now, the current study is to explore the effect of SERMs on weight gain in postmenopausal women. To mimic the postmenopausal state, ovaries were removed from experimental rhesus monkeies. Eighteen such female  monkeys were treated with oral SERM (GSK232802A, 5 mg/kg) for 3 months.

After 3-month observation, GSK232802A decreased several steroid hormones such as luteinizing hormone and follicle stimulating hormone; this effect is consistent with the estrogenic action of the compound. GSK232802A treatment produced a small but sustained weight loss (4.6 ± 1.0%) and reduced fat amount. This reduction could be at least in part linked to a suppression of food intake (3.6 ± 3.7%).

Meanwhile, physical activity increased during the third month of GSK232802 treatment, with the most sedentary individuals exhibiting most increased physical activity during the first month of treatment .

Common SERMs include clomifene, femarelle, ormeloxifene, raloxifene, tamoxifen, toremifene, and lasofoxifene.

The findings in the study suggest that SERM treatment may counteract weight gain in postmenopausal women.