Archive for September, 2010

Calcium supplements boost heart-attack risk: Meta-analysis


Calcium supplements boost heart-attack risk: Meta-analysis

Source: http://www.theheart.org/article/1108009.do

The use of calcium supplements without co-administered Vitamin D is associated with an increased risk of myocardial infarction (MI) [1]. The finding, from a meta-analysis encompassing 15 randomized trials and up to 11 921 participants, warrants a reassessment of the role of calcium supplements in the management of osteoporosis, researchers report online July 29, 2010 in BMJ.

Most guidelines for the prevention or treatment of osteoporosis recommend the use of calcium supplements, despite the fact that they reduce the risk of fracture only marginally, write Dr Mark J Bolland (University of Auckland, New Zealand) and colleagues.

Studies have yielded conflicting results about their use, with some observational studies suggesting that high calcium intake is protective against vascular disease, and others showing that calcium supplements speed vascular calcification and increase mortality in patients with kidney failure and increase cardiovascular events and MI in women.

Senior author Dr Ian R Reid (University of Auckland) told heartwire that women should discuss the finding from his study with their doctors, but that in most cases, “discontinuation of calcium would seem appropriate.”

The researchers had previously found an adverse effect from calcium supplements in a clinical trial, which they published in BMJ in 2008 [2], Reid explained. They repeated electronic database searches in March of this year to consolidate those findings.

Their current meta-analysis looked at randomized trials of calcium supplements that supplied at least 500 mg/day of elemental calcium vs placebo. Each of the trials lasted for at least a year and had at least 100 participants with a mean age of 40 years or older. Cardiovascular outcomes were obtained from self-reports, hospital admissions, and death certificates.

In a combined analysis of the five studies that had contributed patient-level data, the investigators found that calcium supplements were associated with about a 30% increase in the incidence of MI (hazard ratio 1.31; 95% CI 1.02–1.67; p=0.035) and smaller, non-significant increases in the risk of stroke and mortality.

The findings were consistent across trials, and the risk of MI with calcium supplements tended to be greater in those with higher dietary calcium intake. The MI risk was independent of age, sex, and type of supplement.

A similar analysis of 11 trials that contributed trial-level data showed a 1.27 relative risk of MI (95% CI 1.01–1.59; p=0.038) associated with calcium supplements.

“Clinicians should tell their patients that, for most older people, the risks of calcium supplements outweigh the benefits. Changing to calcium-rich foods may be appropriate,” Reid said.

Calcium Supplements Causing Heartburn, Not MI?

In an editorial accompanying the article [3], Dr John Cleland (Castle Hill Hospital, Kingston upon Hull, UK) and colleagues wonder why calcium supplements should increase cardiovascular risk, as found in this meta-analysis. “Accumulation of calcium in the arterial wall leading to reduced compliance would be expected to take years, but the increased risk of myocardial infarction reported by Bolland and colleagues occurred early after calcium supplementation (median follow-up of 3.6 years).”

Cleland et al suggest that the increased risk of MI may not be a true effect, because the increased risk of MI was not accompanied by an increase in mortality. “Calcium supplements could simply be causing gastrointestinal symptoms that could be misdiagnosed as cardiac chest pain,” they write, adding that even if the supplements are safe, the neutral effect on mortality “casts doubt on whether they are effective prophylaxis for fractures.”

Until more becomes known about the best way to prevent osteoporotic fractures, the editorialists conclude that “patients with osteoporosis should generally not be treated with calcium supplements, either alone or with vitamin D, unless they are also receiving an effective treatment for osteoporosis for a recognized indication.” They add that research on whether such supplements are needed in addition to effective osteoporosis treatment is “urgently required.”

Dr John Schindler (University of Pittsburgh Medical Center, PA), who isn’t a coauthor of the study from Bolland et al, told heartwire that the increased MI risk in the study, although quite modest, is concerning because of the large numbers of people who take calcium supplements. He also questioned whether vascular calcifications could be the cause, because of the trials’ relatively short follow-up times.

Gender Differences May Be Important

For Schindler, research into gender differences may yield answers to the increased risk of MI seen in this meta-analysis.

“In this analysis, 88% of the participants were women, and we know that cardiovascular disease in women is radically different from cardiovascular disease in men. The same holds true for cerebrovascular disease. There is something we need to get at, and at this point, no one has really been able to do so.”

Schindler also said that the real risk of MI appeared to be in people who took calcium supplements on top of high levels of dietary calcium. “I think the safest thing to tell your patients right now is if you can get your dietary calcium from good dietary sources, such as yogurt, sardines, and skim milk, that potentially might be all you need to ward off the risk of osteoporosis. Then we don’t have to deal with this increased cardiovascular risk.”

He added that it is important to consider the potential safety concerns along with the benefits of bone health. “The benefits of calcium supplementation in older women with a low risk of fracture may not outweigh the potential cardiovascular risk.”

Finally, Schindler noted the absence in the meta-analysis of the Women’s Health Initiative, a large study that looked at the role of calcium supplementation with vitamin D in reducing osteoporotic fracture. “There are a lot of data that show that vitamin D is protective from a cardiovascular standpoint. They excluded studies with vitamin D probably because they are trying to isolate one variable. They didn’t want to cloud the picture.”

This study was funded by the Health Research Council of New Zealand and the University of Auckland School of Medicine Foundation. Bolland, Cleland, and Schindler have reported no relevant financial interests. Reid reported financial relationships with Fonterra.

References

  1. Bolland MJ, Avenell A, Baron JA, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010; DOI:10.1136/bmj.c3691. Available at: http://www.bmj.com. Abstract
  2. Bolland MJ, Barber PA, Doughty RN, et al. Vascular events in healthy older women receiving calcium supplementation: Randomised controlled trial. BMJ 2008; 336:262-266. Abstract
  3. Cleland JG, Witte K, Steel S. Calcium supplements in people with osteoporosis. BMJ 2010; 341; DOI:10.1136/bmj.c3856. Available at: http://www.bmj.com. Abstract

Additional Resources

The National Institutes of Health has an online fact sheet about calcium supplementation for health professionals.

Clinical Context

Calcium supplements are used to treat osteoporosis among older patients but are only modestly effective in increasing bone density, with a number needed to treat of 39 to 48 patients for 5 years each to prevent 1 fracture. Calcium supplementation has also been associated with adverse effects, including higher mortality rates in patients with renal failure and an increased risk for cardiovascular disease.

This is a meta-analysis of trials examining calcium supplementation to determine the effect on cardiovascular disease outcomes and death.

Study Highlights

  • The investigators searched the databases of MEDLINE, EMBASE, and the Cochrane register for randomized controlled trials of calcium supplements.
  • Included were double-blind randomized controlled trials with calcium supplementation of 500 mg/day or more, participant mean age of at least 40 years, 100 or more participants, and duration of at least 1 year.
  • Excluded were trials that provided both vitamin D and calcium supplementation because vitamin D supplementation has been associated with decreased mortality rates, and trials using dietary modification as calcium addition or in which participants had an indication other than osteoporosis.
  • The researchers considered diagnoses of MI, stroke, and death by using words describing the events or referring to International Classification of Diseases, Ninth Revision, codes.
  • The prespecified primary endpoints were time to first MI; first stroke; and first composite event of MI, stroke, or sudden death.
  • The secondary endpoint was time to death (all-cause mortality).
  • Analysis was performed at the patient level and at the trial level, and random-effects models were used to pool summary data at the trial level.
  • There were 15 eligible trials, of which 5 contributed patient level data with 8151 participants.
  • The median duration of follow-up was 3.6 years in the 5 patient level trials.
  • The HR for MI was 1.31 (95% CI, 1.02 – 1.67; P = .035) in these trials (143 vs 111 MIs for calcium vs no calcium supplementation).
  • The HR for stroke was 1.20 (95% CI, 0.96 – 1.50; P = .11), but the increase was not significant.
  • There was no significant increase in the risk for the composite of MI, stroke, or sudden death for the calcium supplementation group.
  • The number needed to treat for calcium supplementation for 5 years was 69 for MI; 100 for stroke; 61 for the composite of MI, stroke, or sudden death; and 77 for death.
  • Higher calcium intake (> a median of 805 mg/day) was associated with a higher HR (1.85; 95% CI, 1.28 – 2.67) for MI, and intake below the median was not associated with an increased risk for MI.
  • The HRs were 1.18 for an intake of less than 500 mg/day, 0.68 for an intake of 500 to 699 mg/day, 2.28 for an intake of 700 to 899 mg/day, 1.81 for an intake of 900 to 1099 mg/day, and 1.41 for an intake of more than 1100 mg/day.
  • Recurrent cardiovascular disease occurred among 10% to 17% of participants and was more frequent among those who were supplemented with calcium, although this was not statistically significant.
  • Trial level analysis of all 11 trials showed an increased risk for MI with a pooled relative risk for 1.27 (95% CI, 1.01 – 1.59; P = .038) for calcium supplementation but not for stroke, the composite endpoint, or all-cause mortality.
  • The increased risk for MI with calcium was independent of age, sex, and type of supplement.
  • The authors concluded that calcium supplementation without vitamin D added, especially with an intake of more than 805 mg/day, was associated with an increased risk for MI with a trend toward an increased risk for stroke and sudden death but not all-cause death.
  • They recommended a reconsideration of using calcium supplementation to treat osteoporosis in older adults because the risk for MI may be translated into a large disease burden in the population.

http://cme.medscape.com/viewarticle/727002?src=cmenews&uac=131172FT

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Clinical tips part – 1


Cholera and Antim tart: It has the nausea, vomiting, loose stools, prostration, cold sweat, and stupor or drowsiness found in almost all bad cases of this disease, and I have seldom been obliged to give more than two or three doses, one after each vomiting before the case was relieved. — Dr. E. B. Nash

Obstinate Constipation and Aloe: I was called to treat a child five years of age suffering from birth with a most obstinate form of constipation. He had to be forced and held to the stool crying and screaming all the while being totally unable to pass any faeces even after an enema. I then gave a few doses of Aloe 200th and cured the whole trouble quickly and permanently.– Dr. E. B. Nash

Goitre and Iodum: I have cured many cases of Goitre with Iodine CM, every night for four nights, after the moon fulled and was waning. — Dr.E.B.Nash

Liver Cancer and Cadmium: I frequently find cancer of the liver yielding to Calcarea ars. In every way but with a tendency to relapse, when a single dose of Cadmium in high potency will render the cure permanent.– Dr. A. H. Grimmer

Scar and Graphitis: if you know a woman who is suffering from an old scar that has formed a lump, when she is about to go into confinement, give a dose of Graphitis as a general remedy, unless some other special remedy is called for. — Dr.  J. T. Kent

Fracture of Fingers and Symphytum: Fracture of hand and finger bones knit more quickly with Symphytum 30 two or three times a day for a week. — Dr. Pierre Schmidt

Cirrhosis of Liver and Muriatic acid: is useful in last stages of dropsy from Cirrhosis of Liver.– Dr. E. A. Farrington

Pain in biliary passage and Calcarea carb: when given in repeated dose of 30 th dilution relieves the pain attending the biliary passage. — Dr.Hughes

Animal/Insect bites and Cantharis: Cantharis 200 given internally quickly cures the inflamed and horrible swelling that may follow great bites. — Dr. M. L. Tyler

Uterine Contraction and Pulsatilla: It will very often cause in five minutes a very strong contraction of the uterus, sometimes almost in a painless way.  — Dr. J. T. Kent

Toothache and Plantago: Toothache with the 2X dilution of Plantago, I cure seven-tenths of all cases of this kind in about 15 minutes. — Dr. Ruetlinger

Appendicitis Rhus tox is the homeopathic knife in appendicitis.– Dr.Biegler

Cramps and Viburnum Q: cramps in the abdomen and legs of pregnant women are controlled very quickly by this remedy. — Dr.Hale

Blisters on Hand and Aristolochia: Blisters on the hands from heavy manual labour disappear overnight after the application of 10% Aristolochia ointment. — Dr. Julius Mezger

Claustrophobia and Argentum nit: Argentums nitricum cures Claustro-phobia. — Dr. M.L.Tyler

Weak Ankles and Natrum carb: Weakness of the ankles from childhood finds a good remedy in Natrum carb.– Dr. E.B.Nash

Stiff Back and Causticum: Painful stiffness of the back and sacrum, especially on rising from a chair.– Dr. E.B.Nash

Kreosote and Cancer Cervix: One has seen Kreosote 200 annihilative of the terrible odours that sometimes accompany cancer of the cervix, where if it did nothing more, it made life more supportable for patient and for entourage. — Dr. M.L.Tyler

Stiff neck and Belladona: Belladona is the best remedy for stiff neck of the rheumatic origin or from cold. — Dr.E.A.Farrington

Temperature and Sulphur: Sulphur dreads the cold in hot weather and the heat in cold weather: —Dr. Constantine Hering

Kent on Potency: Never leave a remedy until you have tested it in a higher potency if it has benefited the patient.
Dr.J.T. Kent

Coccus cacti & Paroxysmal cough: Coccus cacti suits almost any paroxysmal cough when the attacks are violent, but not very close together, and are attended by much redness of the face and a general sense of feeling too hot. If irritation of the kidneys, with scanty, thick heavy urine, passed pretty often also attends, it is doubly indicated and the results will be brilliant. — Dr. Boger C.M

Arnica in Pleuro-pneumonia: If pleura-pneumonia has followed upon an external injury, such as a blow, or a fractured rib, or some other traumatic cause, we should choose Arnica in preference to Bryonia. — Dr. Hale R

Sinapis nigra in Colic: Everyone has patients with a Dioscorea colic, but when there is very offensive breath, the remedy called for is ‘Sinapis nigra’.  — Dr. Robert Redfield

Acalypha Indica on GI tract: Aclypha indica is indicated for haemorrhagic broncho-pulmonary disease especially with burning GI symptoms. — Dr. Furman T. Kepler

Leucorrhoea in Children: If there are no specific reasons for other remedies, I start treatment in young girls with mild catarrhal discharge (leucorrhoea) by giving Pulsatilla especially is the discharge is thick like cream, and then Sulphur or Sepia according to symptoms. If these remedies are not sufficient to effect a cure, then Cal. carb is mostly indicated. — Dr. Wassily

Lycopodium in infantile eczema: Lycopodium is a master remedy in infantile eczema. — Dr. Leon Renard

Ignatia for Stage fright: To be given prophylactically a few doses on the day of performance, and one dose just before it. — Dr. Bennett

Ruta for straining flexor tendons: Ruta is the medicine for complaints from straining flexor tendons. — Dr. C.C. Boericke

When Carefully chosen remedy not responded: When not withstanding the carefully chosen remedy and the patient’s faultless diet, the sick condition lies on the contrary is not at all changed, the cause usually lies in want of receptivity which we must seek to remove either by repeated small doses or by medicines recommended for deficient reaction. — Dr. Boger C.M

Belladona in insomnia: I often use frequent doses of belladonna 1X to relieve the insomnia due to pain caused by rheumatism. — Dr. Cuthbert

Naja in Heart cases: Always prescribe Naja in heart cases when symptoms are scarce, unless guided away from it by some specific symptoms. — Dr. Moore

Pulsatilla in Tuberculosis: Pulsatilla is probably the strictly homeopathic remedy that I use most often in early tuberculosis. — Dr. Walter sands Mills

Bellis perennis in Soreness of joints: Bellis perennis is indicated when there is a bruised, strained feeling with general soreness of joints and muscles, resulting from exposure, and after vigorous physical exercise, and in Dr Hinsdale’s experience, surpasses Arnica in these conditions. — Dr. Skinner

If old obscured symptoms returned: If old obscured symptoms, complained of perhaps months or years before the first prescription was made, reappear and trouble the patient, they should be carefully noted, and their course observed, but these symptoms should not be hastily prescribed for until a picture of the proper remedy is presented, for such conditions frequently appear and then disappear of themselves, never to return. — Dr. Hardy

3 Pointers to Aethusa cynapium: -Acute vomiting, diarhoea or chronic GI complaints.  -Milk intolerance -Associated brain symptoms, anxiety, uneasiness, discontent, restlessness. — Dr. Furman T. Keple

A HOLISTIC APPROACH TOWARDS OBESITY


Dr. Archana Narang (M.O.T), Dr. Saurav Arora (SRF),

Dr. Latika Nagpal (SRF)

Thyroid Clinic, Dr. B. R. Sur Homoeopathic Medical College & Hospital,

Nanak Pura, Moti Bagh, New Delhi – 110021

shmc.thyroidclinic@gmail.com

Life style and endocrine disorders would be the next challenge to medical fraternity in coming few years.

Anonymous

ABSTRACT

In this ever-changing era of competition and stress we are losing harmony with nature and our surrounding environment. Life style and endocrine disorders are on the verge and to a certain extent we may be responsible for them. Many risk factors are now identified, most common being related to life style. It is very hard to deal with them especially when they assume a state of ‘poor response to offered or prevalent therapies’. Many a times, we being practitioners of the true healing art encounter ‘obstacles to cure’ for these life style disorders. Thus it becomes need of the hour to learn the scopes, limitations and how to deal with them judiciously. In this article, obesity’, one of the rapidly emerging life style disorders is discussed keeping in mind the basic philosophy of Homoeopathy.

INTRODUCTION

According to textbook of medicine by Harrison ‘Obesity is a state of excess adipose tissue mass’. It can also be defined as a progressive disease with excess fat accumulation which has multiple consequences. It is associated with the accumulation of adipose tissue in the body (as body fat) that is excessive for an individual’s height, weight, gender and race to an extent that it produces adverse health outcomes. It is one of the most neglected yet visible risk factor contributing to the several other disorders worldwide. Obesity is the tip of ice berg which includes various diseases like cardio vascular disease, Type II Diabetes, osteoarthritis or even some types of cancers. On many occasions it becomes a cosmetic issue, but at the same time can cause various other risks and decreased quality of life.

EPIDEMIOLOGICAL CONSIDERATION

Obesity is emerging as one of the major health problems, particularly in the urban areas of the country. About 30 – 65 % of adult urban Indians is either overweight, obese or has abdominal obesity. In 1997, the World Health Organization (WHO) formally recognized obesity as a global epidemic. According to a recent survey it is estimated that at least 1.1 billion adults and 10% of children are overweight and/or obese. Comparison of two major studies conducted by National family health survey (NFHS-2) in 1998–1999 and NFHS-3 in 2005–2006 shows that prevalence of obesity among Indian women has elevated from 10.6% to 12.6% (increased by 24.52%).

ASSESSMENT OF OBESITY

Body fat percentage is total body fat expressed as a percentage of total body weight. It is generally agreed that men with more than 25% body fat and women with more than 33% body fat are obese. A certain amount of fat is necessary for body to function properly as it is the key factor for storing energy, heat insulation, shock absorption, and other functions. It is stored in the form of adipose tissue in our body. Although not a direct measure of adiposity, the most widely used method to gauge obesity is the body mass index (BMI), which is equal to weight/height2 (in kg/m2). The reference range used to categorize individuals is:

BMI CLASSIFICATION
< 18.5 Underweight

18.5–24.9

Normal weight

25.0–29.9

Overweight

30.0–34.9

Class I obesity

35.0–39.9

Class II obesity

> 40.0

Class III obesity

(Morbid Obesity)

Along with BMI certain other measures may also be taken into consideration to assess an individual in terms of nutrition. These are:

  • Waist circumference
  • Hip circumference
  • Waist to hip ratio: a ratio of >0.9 in women and >1. 0 in men is considered abnormal
  • Markers of nutrition e.g. mid arm circumference, skin fold thickness, etc.

OBESITY PATTERNS

Two major patterns of obesity are observed in population, although these patterns are not gender specific, both the sexes can have any pattern, but it is seen that cross patterns are more dangerous. In females, the pattern seen is pear-shaped obesity, i.e. they tend to collect fat in their thighs and buttocks. In males, fat usually collect around the belly, giving them “apple” shaped pattern of obesity.

CAUSES OF OBESITY

For each individual, body weight is the result of a combination of genetic, metabolic, behavioural, environmental, cultural and socioeconomic influences. Behavioral and environmental factors are large contributors to overweight and obesity and provide the greatest opportunity for actions and interventions designed for prevention and treatment.

  • Fundamental or the miasmatic causes:
    • Heredity: determines how susceptible an individual is to become overweight or obese.
    • Genetically a person is influenced by how the body uses calories for energy and how the body stores fat.
    • Familial obesity is an established risk factor, which exposes an individual to develop obesity.
  • Exciting and  maintaining factors:
    • Eating habits: contribute to the development of overweight and obese states specially in individuals consuming food rich in animal fats, vegetable oils and sugar/syrups and less of vegetables, fruits and other high fibre starchy foods.
    • Lack of exercise and workout.
    • Increasing industrialization, better transportation facilities, more mechanization at home and workplace.

Medical causes associated with obesity

o  Cushing’s syndrome

o  Hypothyroidism

o  Insulinoma

COMPLICATIONS

Obesity is just the tip of the “ice berg” of major symptom syndromes. It has direct association with many syndromes like Diabetes, Hypertension, Insulin resistance, etc. (Mixed miasmatic states which are harder to treat). Obesity affects more or less every system of the body. Some of the complications associated with obesity are:



Cardiovascular System: Ischemic heart disease, angina and myocardial infarction, congestive cardiac failure, hypertension, dyslipidemia, deep vein thrombosis and pulmonary embolism.

Endocrinology and Reproductive System: Diabetes mellitus, polycystic ovarian syndrome, menstrual disorders, infertility, complications during pregnancy, birth defects and intrauterine fetal death.

Neurological disturbances: Stroke, meralgia paresthetica, migraines, carpal tunnel syndrome, dementia, idiopathic intracranial hypertension,

Psychiatric Problems: Depression and social stigmatization, disrupted self image, lack of confidence.

Dermatological problems: Stretch marks, acanthosis nigricans, lymphedema, cellulitis, hirsutism, intertrigo.

Gastrointestinal Problems: Gastroesophageal reflux disease, fatty liver disease, cholelithiasis, hernias.

Oncology: Breast, ovarian, Esophageal, colorectal, Liver, pancreatic, Gallbladder, stomach, Endometrial, cervical, Prostate, kidney, Non-hodgkin’s lymphoma, multiple myeloma.

Respiratory Problems: Obstructive sleep apnea, Obesity hypoventilation syndrome, Asthma, Increased complications during general anesthesia

Rheumatology & Orthopaedic problems: Gout, Poor mobility, Osteoarthritis and low back pain.

Urological & Nephrological Problems: Erectile dysfunction, Urinary incontinence, chronic renal failure, Hypogonadis.


MANAGEMENT

Hahnemann in aphorism 261 has rightly stressed on the importance of proper diet and exercise. “The most appropriate regimen during the employment of medicine in chronic diseases consists in the removal of such obstacles to recovery, and in supplying where necessary the reverse: innocent moral and intellectual recreation, active exercise in the open air in almost all kinds of weather (daily walks, slight manual labor), suitable, nutritious, unmedicinal food and drink, etc.”

Management is one of the most important key factors in dealing with obesity in long-term.

It is a chronic dis-ease that requires long-term intervention and judicial employment of medication, if necessary. The intervention in obesity can be from any of the following listed strategies, single or in combination:

þ Dietary

þ Life style related physical exercise, behavior modification etc.

þ Medicinal

þ Surgical

All of the above intervention require close monitoring and follow ups.

Physical exercise: Weight reduction is not only the mathematical calculation and reduction in calories; rather it is an array of complex mechanism to be understood keeping in mind other factors also. Minimum public health recommendation for physical activity is 30 minutes of moderate intensity physical activity on preferably all days of the week. This duration also depends upon lifestyle, average daily workout, age, gender and other circumstances like nutrition, weight etc. A simple mathematical calculation of daily caloric intake helps in planning the average daily physical activity. Exercise helps in maintaining circulation, reduces the risk for cardio vascular diseases, diabetes and other complications of obesity.

Commonly followed patterns of exercise in our society are:

  • Brisk walking (for about 30 minutes) at an intensity that makes speaking difficult during walking. It is the preferred initial mode of exercise.
  • Work related exercise: taking 10-15 minutes break to walk around during working hours.
  • Muscle strengthening exercises such as lifting weights or push ups.

Amount of calories burnt during some of common exercises:

TYPE OF EXERCISE kcal/hr
TABLE TENNIS 245
TENNIS 392
DANCING 372
GARDENING 300
CYCLING (15 km/hr) 360
WALKING (04 km/hr) 160
RUNNING (08 km/hr) 353
JOGGING 145
SWIMMING 180

Behavioral therapy: Cognitive behavioral therapy is used to help change and reinforce new dietary and physical activity behaviors. Strategies include self-monitoring techniques (e.g. weighing, and measuring food and activity); stress management; stimulus control (e.g., using smaller plates, not eating in front of the television or in the car); social support; problem solving; and cognitive restructuring to help patients develop more positive and realistic thoughts about themselves.

Dietary modification: A few suggested behavior modifiers include change in eating habits, e.g. less of caloric and fat intake. National Institute of Health guidelines suggest that people who desire to lose weight should reduce their caloric intake by 500 to 1000 kcal per day, which may produce a weight loss of 0.45 to 0.90 kg per week. Women may choose a diet of 1000 to 1200 kcal per day and men may choose a diet of 1200 to 1500 kcal per day. Along with this basic knowledge about nutritional facts like following diet and calorie charts is recommended.

Surgical treatment: surgery is indicated for the treatment of morbid obesity which includes co-morbid conditions which are life-threatening. It is only advised for those with very high BMI of 40 or more. Bariatric surgery changes the anatomy of the digestive system. It leads to early satiety, reduction in appetite and also hormonal changes that lead to weight reduction. This surgery lowers the risk of medical problems associated with obesity.

HOMOEOPATHIC APPROACH TOWARDS OBESITY

Homoeopathy has long been remained a therapeutic tool which goes by symptom similarity. The homoeopathic approach towards obesity should be scientific and feasible. In our materia medica many remedies are given which act wonderfully in cases of obesity and overweight, but it needs an understanding of the sphere of action of these remedies. Literature is loaded with many discoveries and experiences, which must be explored and understood.

The basic approach should be the judicial approach. Many a times, remedies alone are not able to benefit a patient fully, here comes the concept of obstacles to cure and exciting and maintaining factors. Thus it becomes necessary to motivate the patient to follow others management factors like diet control, controlled exercise, changes in life style pattern, etc.

Homoepathy has a vast scope to offer individuals suffering from obesity or related disorders. Like other systems, Homoeopathy has its own scopes and limitations. A basic knowledge of disease process and sound knowledge of homoeopathic philosophy can make one fully enabled to deal with these cases.

In aphorism 5 of Organon of Medicine, Hahnemann has described the constitutional approach towards state of the patient. By constitutional approach one means “An individual”, his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual functions etc. An individual is the basic unit which is affected by interior (mental generals) and exterior (environment), thus the approach to rectify it should be holistic. For internal phenomenon and obstacles we may give the best similimum remedy, this will make one individual strengthen from inside so that the vital force can preserve the state to health whereas the exterior phenomenon are dealt with various management tools (e.g. exercise, weight reduction, diet etc) discussed in the previous section.

The brief importance of various factors associated with obesity and their homoeopathic approach are:-

FACTOR CAUSING/ASSOCIATED WITH OBESITY HOMOEOPATHIC APPROACH
1. Type of obesity: familial or hereditary Fundamental maintaining factor is underlying miasm. Thus antimiasmatic approach can be adopted.
2. Constitutional predisposition of the subject Selection of the constitutional remedy with intercurrent antimiasmatic remedy is suggested.
3. Mode of living.

  • Sedentary lifestyle, lack of exercise.
  • Faulty diet
These factors are obstacles to cure, so selection of appropriate constitutional remedy with dietary and exercise management should be done.
4. Stress related factors. De-stressing techniques and counselling along with appropriate constitutional remedy help removing obstacles to cure.
5. Obesity associated with specific diseases. Diagnosis of underlying cause and its treatment with appropriate indicated remedy can be adopted.

Case analysis and justification is same for an individual who is obese and require intervention as for any other diseased condition. The commonly used drugs are:

  • Drugs in potencies e.g. calc. carb, graph, caps, ferr met, etc
  • Drugs in trituration e.g. phytolacca berry, fucus, thyroidinum, etc.,
  • Drugs in crude form: e.g. phytolacca, fucus, etc.

Some references from repertory:

Obesity in young people: Antim crud, Calc, Calc act, Lach.

Obesity abdomen: Pip-n

Obesity abdomen but thin legs: Am-c, Am-m, Ant-c, Graph, Lith-c, Plb (as in Cushing’s)

Obesity in old people: Am-c, Aur, Bar-c, Fl-ac, Kali-c, Op, Sec.

Obesity during menopause: Calc-ar, Graph, Sep.

Obesity in children due to improper nutrition: Calc, Carc, Graph.

Obesity in children: Ant-c, Bad, Bar-c, Bell, Brom, Calc, Caps, Cina, Coloc, Ferr, Graph, Guaj, Ipecac, Kali-bi, Kali-c, Puls, Sars, Senegam Sulph.

Indigestion accompanied by obesity: All-s.

Obesity with goiter: Fucus

The common indications of some remedies are presented below:-

Antim crud: Tendency to grow fat, obese people with thickly coated tongue and digestive disturbances of varying degrees. The constitutions are very irritable and fretful.

Calcarea carb: suitable for women and children of leucophlegmatic temperament with tendency to obesity. Constitutions deficient in assimilative powers are benefited by this remedy. Rapid deposit of fat in cellular tissues, especially around abdomen but tissues is imperfectly nourished.

Capsicum: suited to persons who are fat, indolent, opposed to physical exertion, get homesick easily. Persons having feeble digestion and lax fiber. Chilly subjects with lack of vital heat.

Ferr met: Flabby, anemic and plethoric persons with false plethora and relaxed muscles. Easily irritable constitutions having voracious appetite.

Fucus vesiculosis: obesity associated with non-toxic goitre with flatulent tendency and obstinate constipation. This remedy is used in material doses and triturated preparations.

Graphites: Suitable for women, inclined to obesity with habitual constipation and delayed menstruation. It follows well calc carb in young women with large amount of unhealthy adipose tissue.

Kali brom: it is adapted to persons who are inclined to obesity; it also acts better in children than in adults.

Kali carb: For diseases of old people, dropsy and paralysis; with dark hair, lax fibre, inclined to obesity.

Lac def: obesity associated with fatty degeneration of tissues, dropsy and liver complaints. It is also helpful in dealing with complications of obesity.

Phytolacca berry: Clinically found to be efficacious in obesity.

So the primary goal of management of obesity should be improvement of obesity-related co-morbid conditions and reduce the risk of developing future co-morbidities. It involves balance of three essential elements of lifestyle: dietary habits, physical activity, and behavior modification along with Homoeopathic intervention. Hahnemann has rightly mentioned in Aphorism 4: “He is likewise a preserver of health if he knows the things that derange health and cause disease, and how to remove them from persons in health.

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” – Hippocrates c. 460-377 BC.

Belladona reproved to be antiviral to JE virus on research grouds


Since ages we have been proving and using Belladona in various viral diseases with success and cures, but questioned many a times about the authenticity of such cures and claims by others. We all know it works and we use it very frequently.

Now, there is a good news for the Homeopathic fraternity, especially the researchers and scientist lobby. Central Council for Research in Homoeopathy has recently concluded a study in collaboration with Department of Microbiology, Virology Unit, School of Tropical Medicine, Kolkata-700073, India. The study concluded that ultradiluted (potentized) Belladona is capable of checking virus load on chick Chorioallantoic Membrane. The study has been published in American Journal of Infectious Diseases.

This study showed the antiviral properties on scientific grounds (we as clinicians are more well-verse already).

You can use the following link to see and download the study.

Click here to download the full article!

The Sunset tint.


It was a fine evening when I was sitting at my part-time clinic, and planning for time ahead. I was sitting idle at that time, it has just rained, probably because of that there was no rush today. Buried deep in my thoughts I suddenly realized the sepia tint outside, from sudden darkness of clouds couple of minutes back the sky and houses were glowing like old copper polished with metal polish. It was an amazing scene to cherish, and see. Suddenly I realized it to be language of nature, language of omens and signs (those who have read Alchemist might appreciate it more). The God is the wisest and The Ultimate creator, there is a reason behind everything created and happening each moment. The sepia tint in the sky is an indication to tell us about the glow in the sky when it is happy to pacify the thirst of earth after rain.

The similar kind of glow can be observed before rains or in between rainy seasons when there are shiny clouds, shining like silver in the sky. It seems that they are the soldiers who welcome rain with all the glory and shine, then comes the rainy clouds, not so shining but colored deep and hazy. They are loaded with the happiness (and sometime anger) & vastness. They have in them the secrets, the unknown secrets. And after they have arrived and poured what they were loaded with then we come to know, it’s a gift or punishment of nature. It is not difficult to read their minds, just look at them, and follow the first thought that comes to your mind. It’s all about following your dreams and working hard to wove those dreams to realities. Not all dreams are made true but those made true becomes the realities and those who left becomes the memories.

Logical Homeopathy


Samuel Hahnemann Memorial at Scott Circle in W...

Image via Wikipedia

It is not a matter of wonder that Homoeopathy is existing but is a matter of science and nature’s law which is saving Homoeopathy for centuries to disappear in darkness. For hundred of years it remained in era of darkness, ignored by the brilliant minds. It was in late 1700’s when Hahnemann observed the pattern of nature’s law of cure. To his surprise he went on to uncover its validity and find the real truth. It took him decades to refine and research into the real meaning of Homoeopathy. Today also Hanhnemann is the authority and our master. This all happened because of laborious work and hard efforts which he put in his life time towards Homoeopathy.
Homoeopathy is nothing magical, its logical. Logical only when we are willing to understand the in depths. It’s a human tendency to search for the truth and criticize the unknown. The same thing happens with Homoeopathy also, those who know it cherish it, others feel unhappy. Homoeopathy as we all know is a therapeutic science of symptom similarity discovered some 200 years back. This means that it was present before that also whose examples are written in Organon of Medicine.
Let us go back to the initial publication of Hanhnemann, “Medicine of Experience”, now why I emphasized on experience is because it is related to experience of a judgmental and rational mind. There were no complex investigative modalities at that time in Hanhnemann’s era, it was all based on what you could see, prove and presented in easy words. This is the reason why many of Hahnemann’s theories and writings are still mysterious and loaded with vast experiences and observations of him written in pure language.
It’s a saying that ten people will ten opinions on one thing, this is very obvious with respect to the complexity of human mind. The same goes for the theories and principles of Homoeopathy. We know what is true, but still we express that in different forms and words.

The whole of Hahnemann’s teaching are close to ground realities. He accepted the limitations with the aim that we will learn to cross those after a substantial research. But somewhere this is lacking (what i perceived over these few years being a homeopath), not only we lack in funds and opportunities, but because many of us are not open to new ideas and work. It’s not the question for us, “Does Homoeopathy works?”, but it’s a pressure on us to explain how it works. I know that it is impossible (as now) to explain how it works on cellular and metaphysical level, but we cannot deny the well-known philosophy of ours “EVIDENCE BASED MEDICINE”. If some effects are being produced then there must be a stimulus (strong enough then psychological and placebos effects). This we can only observe by contrast (James Krauss in Introduction to Organon of Medicine, 6th edition)… to be continued…

Its all about scientificity


Well, I am again here to discuss the most firey topic of today’s scenario…. scientificity and homeopathy…. one of the recent article at Homeopathy Shake-Up Goes Global – Christopher Wanjek – Live Science (richarddawkins.net) said that ignorance of Homeopath killed a two months old baby. Well again Homeopathy has not failed, it was sheer ignorance, which can be done by anyone, be it Homeopath or Allopath or whatever….

Science and homeopathy has long been remained together, but their exact existence is still a query for most of the macro and microscopic researchers and scientists. For a simple reason that it cannot be judged by naked or microscopic eyes, its existence cannot be challenged. There are subtle sciences beyond materials, whose existence can only be proved not “checked”, likewise is the case of Homeopathy. One can prove it wonderfully at clinical level, by proving that it acts. Now the biggest question is raised… how to standardized the proving and research. This is the most difficult part to achieve, because only on this part depends the outcomes and their utility and application. Doing a research with no or vague motives and without a road map of guidelines will end in bogus and useless work which invites nothing but insult and criticism form every nook and corner of world. The question also doesn’t end here, there is one more aspect associated with it, how many of us are actually interested in these kind of scientific and literary activities? because this is the basic what is expected, if one is not interested and doing some w0rk in compulsion, then we can think of the quality of work.

We can be more simple yet strong! rather than actually proving some unknown theories with proper tools and techniques we can go by simpler means to achieve our goals. I am not denying or speaking against the ultra or nano molecular research in homeopathy, but I am in favor of simple and scientific work. Rather than concentrating fully on molecular theories at this point of time, we can spend some time and finances for the “Clinical Science” or in simpler words “Evidence based Homeopathy” , when magnetism was discovered nobody knew how it attracts iron, but one thing was sure, that “IT ATTRACTS”. It was proved that there is something immaterial and hidden (and which cannot be proved at this point of time) which “exists”. Likewise should be our effort, we can divided our energy and hard work for the scientific, literary and clinical provings.

Its not impossible, but yes difficult to follow the path. The only reason I think is the absence or improper or you can say inadequate guidelines which we are following. I will take an example here, suppose a teacher ask students to write an essay on myself, every kid will write in different words, and difference in count of words. This is individuality, but let us put some guidelines in this, Teacher says to write an essay on myself limiting to 1000 words (for example), to be written in half an hour, on single side of paper. In this case the uniformity will be formatting and count of words which help teachers to check and give proper time of analysis to each and every essay written.

Thus, uniformity in “diversity” is the key of future research. Once protocols and guidelines are set and followed, we can draw some basic conclusions out of them. This will also preserve the integrity of Homoepathy. For example, if I am working on Diabetes mellitus and i have to get the HbA1c done every three months, then it after applying different or single mode of treatment I can judge whether the research is right or not, if one treatment plan doesn’t work or work partially I can switch over to other methods and materials. This is just an example.

We have to go a long way, and to cover this long way we must make pillars, for others to follow the right path.

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