The Challenge of an Obese Patient

By Anthony Cichoke, MA, DC, DACBN
Do your patients have that post-holiday weight gain? Has their skin stretched to the limit? Does their hyperlordosis have a hyperlordosis? Do your adjustments hold? Is there a sharp, stabbing pain down the leg? Has innate forgotten?

Chiropractors know the problem. Your patients have put on weight and may even be obese. That anterior paunch has pulled the abdomen down and forward, bringing the low back with it. There is an impingement of the nerve root as it passes through the intervertebral foramen. The ligaments which reinforce the intervertebral articulations, plus the overlying musculature, are torqued and/or stretched beyond normal. All ranges of motion are guarded and painful. It might even hurt to cough or sneeze. Further, the knees and ankles could also ache.

Your patients' back pain is compounded by overweight and obesity. The body's ability to help itself is hindered. You know your patients should get plenty of exercise and eat a reduced-calorie, low-fat diet. They've probably tried that with varying degrees of success. They've probably also tried diet foods, pills, programs, diet this and that, but none of these man-made solutions has yet to resolve their largely man-made problem. But nature may be able to do what man has not -- cure obesity.

Researchers are almost daily unearthing discoveries and applying health-giving ingredients from nature's pharmacy to some of our most serious killers. For instance, Taxol (from the Yew tree) is used to fight cancer, while heart disease is sometimes treated with digitalis (from foxglove). Research by the pharmaceutical giant, Hoffmann-LaRoche (and others) has found that (-) hydroxycitric acid (HCA), an effective, natural compound can suppress appetite, thereby reducing food intake, plus inhibit fat and cholesterol synthesis. Studies also suggest that HCA may increase energy levels and be of benefit to athletes.

But, what is HCA? HCA is an extract from Garcinia cambogia, a tree which grows high in the mountains and deep in the fertile, lush green jungles of South Asia. (-) Hydroxycitric acid is isolated from the dried rind (pericarp) of the orange-sized, pumpkin-shaped fruit. The fruit has been used for centuries in native food preparation as a spice and to make meals more "filling."

An organic acid, HCA is similar to the citric acid found in oranges. But, unlike citric acid (distributed widely throughout the plant kingdom), HCA is limited to only a few plant species, particularly Garcinia cambogia. In addition, HCA is as safe as, or safer than, citric acid.

But what does the minus sign (-) mean? Do you remember organic chemistry class, when you studied isomers? The minus sign (-) indicates a particular molecular configuration and signifies the naturally occurring, biologically-active form of HCA which exhibits its potent weight loss properties. For these reasons, HCA may be the perfect diet ingredient for your patients.

The Dangers of Obesity and Dieting

In today's modern culture, obesity is an increasing problem. We live sedentary lives and consume high-fat fast foods with empty calories, saturated fats, and refined carbohydrates. Red meats, eggs, organ meats, and dairy products provide excessive amounts of cholesterol and triglycerides and overtax our systems. A life of high stress and little, if any, exercise can accelerate fat build up, leading to obesity.

From 1960 through 1980, the number of U.S. adults who are overweight increased 25 percent (according to a recent study by the National Center of Health Statistics in the Centers for Disease Control and Prevention).1 But it grew by 33 percent from 1980 to 1991. Obesity was defined as being 20 percent or more above a person's desirable weight.

The U.S. Public Health Service estimates that obesity can be implicated (directly or indirectly) in more than 300,000 deaths per year.2 And chances of suffering from diabetes, stroke, cardiovascular disease, osteoporosis, or hyperlipidemia increase with each added pound.

Though weight loss might be indicated, dieting, per se, can be dangerous to health. We've all seen patients preoccupied with being thin, which may lead to serious eating disorders such as bulimia or anorexia nervosa. Dieting can lead to depression, and in extreme cases, low-calorie diets can even result in death. Yo-yo dieting may make losing weight more difficult each time, plus it could be harmful.

What if we could safely and naturally curb appetite, decrease food intake, and inhibit fat and cholesterol? An ingredient which could do all these things -- such as HCA -- could be the answer to permanent, healthy weight loss.

How Does HCA Function?

The foods we eat are converted to calories which provide the energy our bodies need to function. The liver and muscles store any excess calories as glycogen.3 As additional energy is needed, enzymes "split" glycogen molecules into smaller molecules of energy-charged glucose, which are then sent through the blood stream.

But unfortunately when we consume excess calories, our liver is unable to hold all the glycogen produced. Instead, it is converted to acetyl co-enzyme A, and then to fatty acids which are stored throughout the body as fat or converted to cholesterol with help of the enzyme, ATP-citrate lyase.4

Through competitive inhibition, HCA inhibits ATP-citrate lyase by binding to the enzyme and decreasing the production of fatty acids from carbohydrates. This in turn decreases the production of stored fat and cholesterol. More liver glycogen is synthesized and stored. This increases the satiety signal to the brain. As a result, appetite is suppressed and food cravings diminish.

Is (-) Hydroxycitric Acid Safe?

Appetite suppressants usually fit into one of two categories, that is those that act peripherally (outside the brain) such as HCA, or those that act directly on the brain and central nervous system, such as methamphetamine, amphetamine, fenfluamine, phenmetrazine, diethylpropion, phenylpropanolamine (PPA), and ma-huang (an ephedrine-containing herbal extract used in many diet formulas). Unfortunately CNS-acting products frequently cause depression, insomnia, rapid heart rate (tachycardia), hypertension, and nervousness. In addition, the body tends to develop a tolerance to them.

In contrast, appetite suppressants which work on the periphery (such as HCA) do not initially act on the central nervous system or brain. Consequently HCA won't result in tolerance or cause the side effects associated with CNS stimulants. In reference to HCA, it reduces appetite and decreases lipid production by increasing the liver's production of glycogen. As a result, glucoreceptor sites in the liver are stimulated and signal the hypothalamus' "satiety center" (via the vagus nerve), thereby effectively curbing appetite.

In addition to suppressing appetite and decreasing food intake, many scientific studies indicate that HCA can inhibit lipogenesis (the progress of cholesterol and fat production by the body). According to a New York University study, HCA significantly blocked fat production in rat liver within 150 minutes following oral administration. Studies by Hoffmann-LaRoche found measurable inhibition of cholesterol and fatty acid syntheses of approximately 40-70 percent eight to 12 hours following a meal.5

Finally, Dr. Anthony Conte conducted a double blind study in 1991. His findings noted that over a two-month period, those subjects taking an HCA/chromium combination lost an average of 11 pounds, while those taking a placebo lost only four pounds, on average.6 Patients taking HCA reported decreased appetite, fewer cravings for sweets, and increased energy.


One of chiropractic's greatest challenges is an obese or overweight patient with back pain. Recent holidays (with high calories, high fats, and high cholesterol) make it worse. Don't suggest a "quick fix" weight loss drug or a crash "yo-yo" diet.

(-) Hydroxycitric acid (HCA) seems to be a safe, effective, natural, and proven weight loss product which can curb appetite, thereby decreasing food intake, and inhibiting fat and cholesterol synthesis.

Nature's weight loss tool for the chiropractic profession can result in a better treatment, and a happier, satisfied patient. What more can we ask of a weight loss product?

Anthony Cichoke, MA, DC, DACBN
Portland, Oregon

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