London: The first global review of complementary medicines (herbal and dietary supplements) for weight loss in 16 years — combining 121 randomised placebo-controlled trials including nearly 10,000 adults — suggests that their use cannot be justified on the basis of current evidence. The findings of two studies, being presented at The European Congress on Obesity (ECO) held online this year, suggest that although some herbal and dietary supplements show statistically greater weight loss than placebo, it is not enough to benefit health, and the authors call for more research into their long-term safety. “Over-the-counter herbal and dietary supplements promoted for weight loss are increasingly popular, but unlike pharmaceutical drugs, clinical evidence for their safety and effectiveness is not required before they hit the market”, says lead author Erica Bessell from the University of Sydney in Australia.“Our rigorous assessment of the best available evidence finds that there is insufficient evidence to recommend these supplements for weight loss. Even though most supplements appear safe for short term consumption, they are not going to provide weight loss that is clinically meaningful.”

The authors report on herbal supplements, containing a whole plant or combinations of plants as the active ingredient, and dietary supplements containing naturally occurring isolated compounds from plants and animal products, such as fibres, fats, proteins, and antioxidants. They can be purchased as pills, powders and liquids. Between 1996 and 2006, 1,000 dietary supplements for weight loss included on the Australian Register of Therapeutic Goods weren’t evaluated for efficacy. Supplements can be sold and marketed to the public with sponsors (who import, export or manufacture goods) required to have, but not necessarily provide, evidence backing their claims. Just 20 per cent of new listings are audited annually to make sure they meet the requirement. In some countries, the only requirement is that supplements contain acceptable levels of non-medicinal products. Estimates suggest that 15 per cent of Americans trying to lose weight have tried a weight loss supplement, a USD 41 billion global industry in 2020. Despite their increasing popularity, it has been 16 years since the last review of the scientific literature on all available herbal and dietary supplements. To provide more evidence, Australian researchers did a systematic review of all randomised trials comparing the effect of herbal supplements to placebo on weight loss, up to August 2018. Data were analysed for 54 studies involving 4,331 healthy overweight or obese adults aged 16 years or older. Weight loss of at least 2.5kg (5.5lbs) was considered clinically meaningful. They also evaluated study design, reporting, and clinical value. Herbal supplements included in the analysis were: green tea; Garcinia cambogia and mangosteen (tropical fruits); white kidney bean; ephedra (a stimulant that increases metabolism); African mango; yerba mate (herbal tea made from the leaves and twigs of the Ilex paraguariensis plant); veld grape (commonly used in Indian traditional medicine); liquorice root; and East Indian Globe Thistle.

The analysis found that only one single agent, white kidney bean, resulted in a statistically, but not clinically, greater weight loss than placebo (-1.61kg; 3.5Ibs). In addition, some combination preparations containing African Mango, veld grape, East Indian Globe Thistle and mangosteen showed promising results but were investigated in three or fewer trials, often with poor research methodology or reporting, and the findings should be interpreted with caution, researchers say. A new systematic review up to December 2019, also identified 67 randomised trials comparing the effect of dietary supplements containing naturally occurring isolated compounds to placebo for weight loss in 5,194 healthy overweight or obese adults. Dietary supplements included in the analysis were: chitosan; glucomannan; fructans and conjugated linoleic acid.

A new research being presented online this year, suggests that a measure of body shape should be used alongside body mass index (BMI) to help determine the risk of obesity-related cancers. The research was presented at the European Congress on Obesity. BMI is a simple way of measuring body fat from the weight and height of a person. But its reliability is often criticised, because it does not distinguish fat from muscle, or consider where body fat is stored or an individual’s sex or age. Similarly, waist circumference takes into account belly fat, which is linked to several health risks including cardiovascular disease, type-2 diabetes and cancer, but fails to account for height. A new metric to measure obesity, called ‘A body shape index’ (ABSI), takes into account an individual’s age, sex, weight, height and waist circumference–and it may provide a more accurate estimate of cancer risk than BMI. To explore this further, researchers from the University of Glasgow and the University of Newcastle, combined data from 442,614 participants (average age 56 years) from the UK Biobank prospective cohort who were followed for an average of 8 years, during which 36,961 individuals were diagnosed with cancer.

Participants were broken down into three groups (tertiles) according to their body shape to examine the associations with the risk of 24 different types of cancer, and to examine ABSI and BMI as predictors of cancer risk. Results were adjusted for age, sex, ethnicity, deprivation, education, income, smoking, alcohol consumption, dietary intake, physical activity, and sedentary time. The analysis found that body shape and BMI predicted different obesity-related cancer risks in adults. Specifically, ABSI was linked with an increased risk for three cancers. Participants in the highest ABSI tertile were 38 per cent more likely to develop liver cancer, 40 per cent more likely to develop lung cancer, and had a 17 per cent increased risk of bowel cancer, compared to those in the lowest ABSI tertile, regardless of BMI.

However, researchers found that high ABSI and high BMI combined were linked with an increased risk for seven different types of cancer–uterine, oesophageal, liver, stomach, kidney, bowel, breast cancer. For example, participants in the highest ABSI tertile who were also overweight or obese were at twice the risk of developing uterine cancer than those with the lowest ABSI and normal BMI.

“Our findings underscore the importance of measuring more than just BMI when predicting cancer risk, and suggest that people’s body shape may increase their risk of certain cancers”, says lead author Dr Carlos Celis-Morales from the University of Glasgow, UK. “Whatever method you use, being overweight or obese is the single biggest preventable cause of cancer after smoking. More urgent actions are needed to help people maintain a healthy bodyweight and shape throughout their lives, starting at an early age.” Having excess body fat can lead to biological changes that alter levels of sex hormones, such as oestrogen and testosterone, cause levels of insulin to rise, and lead to inflammation, all of which have been linked with increased risk of 13 different types of cancer. This is an observational study, so cannot establish cause, and it is not a representative sample of the UK adult population, so the results cannot be generalised to the general population.

London: Mild Covid-19 infection is very unlikely to cause lasting damage to the structure or function of the heart, according to a study. The study was led by UCL (University College London) researchers and funded by the British Heart Foundation (BHF) and Barts Charity. The researchers say the results, published in JACC Cardiovascular Imaging, should reassure the public, as they relate to the vast majority of people who had Covid-19 infections with mild or no symptoms.This study of 149 healthcare workers recruited from Barts Health and Royal Free London NHS Trusts is the largest and most detailed study to date into mild Covid-19 infection and its longer-term impact on the heart.It follows concerns that because severe hospitalised Covid-19 infections are associated with blood clots, inflammation of the heart and heart damage, mild infections may cause similar complications. However, up until now, there has been little information specifically looking at this group of people and the effects on the heart further down the line after infection.

Researchers identified participants with mild Covid-19 from the COVIDsortium, a study in three London hospitals where healthcare workers had undergone weekly samples of blood, saliva and nasal swabs for 16 weeks. Six months after a mild infection, they looked at the heart structure and function by analysing heart MRI scans of 74 healthcare workers with prior mild Covid-19 and compared them to the scans of 75 healthy age, sex and ethnicity matched controls who had not previously been infected. They found no difference in the size or amount of muscle of the left ventricle – the main chamber of the heart responsible for pumping blood around the body – or its ability to pump blood out of the heart. The amount of inflammation and scarring in the heart, and the elasticity of the aorta – which is important for blood to easily flow out of the heart – remained the same between the two groups. When the researchers analysed blood samples, they found no differences in the two markers of heart muscle damage – troponin and NT-proBNP – six months after mild Covid-19 infection.

Now, the team of researchers and cardiologists suggest that there is little benefit from screening the hearts of people who’ve had a mild infection, and research should focus on those who’ve suffered severe Covid-19, high-risk groups or those with ongoing symptoms. Dr Thomas Treibel (UCL Institute of Cardiovascular Science and Barts Health NHS Trust), said: “Disentangling the impact Covid-19 has on the heart has been a challenge. But we’re now at the stage of the pandemic where we can really start to get a grip on the longer-term implications Covid-19 has on the health of our heart and blood vessels. “We’ve been able to capitalise on our incredible frontline staff who’ve been exposed to the virus this past year and we’re pleased to show that the majority of people who’ve had Covid-19 seem to not be at increased risk of developing future heart complications. We now need to focus our attention on the long term impact the virus has on those who’ve been hit hardest by the disease.” Dr Sonya Babu-Narayan, Associate Medical Director at the British Heart Foundation and consultant cardiologist, said: “These findings one year on from the start of the pandemic are welcome reassurance to the hundreds of thousands of people who have experienced Covid-19 with mild or no symptoms. “Throughout the pandemic, BHF researchers have made progress investigating the short and long-term effects of Covid-19 on the heart and circulatory system. There’s still a lot more work to be done, but for now, it seems the good news is that mild Covid-19 illness does not appear to be linked to lasting heart damage.”There were small abnormalities identified by MRI but these were not found more often in people who had mild Covid-19 than those that have never had it. The changes could have been caused by something other than coronavirus and they may not make any noticeable difference to the health of that person.

A chronic musculoskeletal or auto-immune condition, arthritis is a group of diseases that affects the joints, the spine and other parts of the musculoskeletal system. Arthritis is among the leading causes of disability worldwide that impact the quality of life as well as productivity of millions of people. While arthritis is associated primarily with ageing and auto-immune conditions, in recent years, lifestyle factors such as increased rate of obesity, lack of physical activity and unhealthy diets have contributed to its rise.

Arthritis is commonly divided into two forms: osteoarthritis, which is primarily age-related or injury-related wear and tear of the joints and rheumatoid arthritis, which is a systemic auto-immune form of the disease prevalent in different age groups. According to WHO estimates, as many as 9.6% of men and 18.0% of women aged over 60 years have symptomatic osteoarthritis. Similarly, the incidence of rheumatoid arthritis varies between 0.3% to 1% .

NEED FOR THE INTEGRATED TREATMENT APPROACH

Whichever the type, arthritis is a chronic disorder that majorly affects the mobility of patients and needs medical intervention to slow its progression and minimize damage to joint cartilage and bones. Arthritis is a debilitating condition that interferes with millions of people’s daily lives, preventing them from fulfilling their true potential.

Lifestyle changes, weight loss, the routine form of exercises, and consumption of a healthy diet and anti-inflammatory diet are critical interventions to reduce disease progression and improve quality of life.

Conventional treatment of arthritis involves a combination or drugs such as analgesics, NSAIDs (non-steroidal anti-inflammatory drugs), steroids, and immunosuppressants. In patients with a rapid progression of the disease or debilitating pain, these drugs help reduce the inflammation and reduce the disease’s progression. However, chemical-based drugs come with potentially serious side effects.

Alternative drugless therapies and naturopathic interventions can help patients improve their quality of life while reducing harmful drugs’ dosage in the long run. When naturopathic interventions are made early on in the disease cycle, they prove to be the most beneficial and may even help some patients avoid harmful drugs altogether.

Therefore, it is important to develop a treatment approach for arthritis that can enable patients to benefit from naturopathy and modern medicine. Naturopathic interventions also help patients lose weight, an important element in controlling joint degeneration.

ACUPUNCTURE FOR ARTHRITIS

Acupuncture is a traditional Chinese medicine practice that believes that life energy known as ‘qi’ (Chee) flows through the body along different meridians. The human body has 20 such meridians. When the flow of energy through these channels is blocked or imbalances human body experiences pain. There are more than 2000 acupuncture points that connect to meridians. Stimulating those points with needles corrects the flow of energy in the body and alleviates pain.

Modern medicine may not recognize the concepts of acupuncture, but acupuncture has been used as an alternative treatment method for the disease for a long time. Many patients who have failed to benefit from conventional medicine turn to acupuncture treatment and find relief.

Acupuncture, through the insertion of very fine needles on the pressure points, stimulates the brain to release natural pain killers called endorphins and stress hormone cortisol. The stimulation helps reduce pain and control inflammation. Research has shown that acupuncture helps in relieving stiffness and pain in arthritis patients along with promoting joint mobility and preventing cartilage breakdown.

A study published in the journal Evidence-Based Complementary Alternative Medicine in 2018 examined a series of cross-sectional studies to review the benefits of acupuncture for arthritis patients. The study found that acupuncture itself or when combined with other treatment modalities, offers benefits to patients with rheumatoid arthritis and can improve joint function and quality of life without any adverse effects. The study concluded that acupuncture seemed to have anti-inflammatory, antioxidative well immunomodulatory effects on patients, thereby ushering in the benefits .

PHYSIOTHERAPY FOR ARTHRITIS TREATMENT

Physiotherapy and physical exercise are crucial in keeping joint mobility and muscle strength intact. A physiotherapist will first examine the joints and the symptoms of the patient and then recommend a tailored exercise approach for each patient’s requirements depending upon the condition and severity of the disease.

Physiotherapy helps build muscle strength to support the joints, enabling the use of affected joints along with improving overall mobility. As arthritis progressively impacts joint health, regular physiotherapy helps patients maintain fitness and preserve the ability to perform their quality of daily activities.

In certain cases, physiotherapists may also use few electrotherapy modalities to relieve the pain like hydrotherapy, manual therapy, thermotherapy & cryotherapyin arthritis patients. Thus it helps to increases mobility and relieves the pain while also helping patients with ortho supports such as braces or splints for affected joints to maintain and avoid further worsening of the alignment of the joints.

CONCLUSION

Physiotherapy and acupuncture are slowly gaining acceptance as supplementary treatment methods for arthritis. With an ageing population leading to a higher burden of arthritis, there is bound to the greater need for complementary treatment approaches that help minimize adverse drug effects. When used in tandem with modern medicine, naturopathic interventions such as acupuncture can significantly improve patients’ quality of life and clinical outcomes.

The author is Assistant Chief Medical Officer, Jindal Naturecure Institute.

Vegetarians appear to have a healthier biomarker profile than meat-eaters, and this applies to adults of any age and weight, and is also unaffected by smoking and alcohol consumption, according to a new study in over 166,000 UK adults, being presented at week’s European Congress on Obesity (ECO), held online this year.

Biomarkers can have bad and good health effects, promoting or preventing cancer, cardiovascular and age-related diseases, and other chronic conditions, and have been widely used to assess the effect of diets on health. However, evidence of the metabolic benefits associated with being vegetarian is unclear. To understand whether dietary choice can make a difference to the levels of disease markers in blood and urine, researchers from the University of Glasgow did a cross-sectional study analysing data from 177,723 healthy participants (aged 37-73 years) in the UK Biobank study, who reported no major changes in diet over the last five years.

Participants were categorised as either vegetarian (do not eat red meat, poultry or fish; 4,111 participants) or meat-eaters (166,516 participants) according to their self-reported diet. The researchers examined the association with 19 blood and urine biomarkers related to diabetes, cardiovascular diseases, cancer, liver, bone and joint health, and kidney function.

Even after accounting for potentially influential factors including age, sex, education, ethnicity, obesity, smoking, and alcohol intake, the analysis found that compared to meat-eaters, vegetarians had significantly lower levels of 13 biomarkers, including:

Total cholesterol; low-density lipoprotein (LDL) cholesterol–the so-called ‘bad cholesterol; apolipoprotein A (linked to cardiovascular disease), apolipoprotein B (linked to cardiovascular disease); gamma-glutamyl transferase (GGT) and alanine aminotransferase (AST)–liver function markers indicating inflammation or damage to cells; insulin-like growth factor (IGF-1; a hormone that encourages the growth and proliferation of cancer cells); urate; total protein; and creatinine (a marker of worsening kidney function).

However, vegetarians also had lower levels of beneficial biomarkers including high-density lipoprotein ‘good’ (HDL) cholesterol, and vitamin D and calcium (linked to bone and joint health). In addition, they had a significantly higher level of fats (triglycerides) in the blood and cystatin-C (suggesting a poorer kidney condition).

No link was found for blood sugar levels (HbA1c), systolic blood pressure, aspartate aminotransferase (AST; a marker of damage to liver cells) or C-reactive protein (CRP; inflammatory marker).

“Our findings offer real food for thought”, says Dr Carlos Celis-Morales from the University of Glasgow, UK, who led the research.

“As well as not eating red and processed meat which have been linked to heart diseases and some cancers, people who follow a vegetarian diet tend to consume more vegetables, fruits, and nuts which contain more nutrients, fibre, and other potentially beneficial compounds. These nutritional differences may help explain why vegetarians appear to have lower levels of disease biomarkers that can lead to cell damage and chronic disease.”

Although their study was large, the authors point out that it was observational, so no conclusions can be drawn about direct cause and effect. They also note several limitations: they only tested biomarker samples once for each participant, and biomarkers might fluctuate depending on factors unrelated to diets, such as existing diseases and unmeasured lifestyle factors. They also note that were reliant on participants to report their dietary intake using food frequency questionnaires, which is not always reliable.

With 4,03,738 new Covid-19 cases in the last 24 hours, India continued to report more than four lakh daily coronavirus infections for the fourth day on the trot. With this, the cumulative national tally of the infection went up to 2,22,96,414, the Union Health Ministry informed on Sunday morning. The country saw 3,86,444 fresh recoveries on Saturday, pushing the total number of discharges to 1,83,17,404. At present, India has 37,36,648 active coronavirus cases.

In an interview with AFP, World Health Organization’s chief scientist Soumya Swaminathan warned that “the epidemiological features that we see in India today do indicate that it’s an extremely rapidly spreading variant”. She said that the B.1.617 variant of Covid-19, which was first detected in last October, was clearly a contributing factor to the catastrophe unfolding in her homeland.

“There have been many accelerators that are fed into this,” Swaminathan said, stressing that “a more rapidly spreading virus is one of them”.

The WHO recently listed B.1.617 — which counts several sub-lineages with slightly different mutations and characteristics — as a “variant of interest”. But so far it has stopped short of adding it to its short list of “variant of concern” — a label indicating it is more dangerous than the original version of the virus by being more transmissible, deadly or able to get past vaccine protections.

Several national health authorities, including in the United States and Britain, have meanwhile said they consider B.1.617 a variant of concern, and Swaminathan said she expected the WHO to soon follow suit.

“B 1.617 is likely to be a variant of concern because it has some mutations which increase transmission, and which also potentially could make (it) resistant to antibodies that are generated by vaccination or by natural infection,” Swaminathan was quoted as saying by AFP.

She, however, insisted that the variant alone could not be blamed for the dramatic surge in cases and deaths seen in India, lamenting that the country appeared to have let down its guard down, with “huge social mixing and large gatherings”. But even as many in India felt the crisis was over, dropping mask-wearing and other protection measures, the virus was quietly spreading.

“In a large country like India, you could have transmission at low levels, which is what happened for many months,” she said. “It was endemic (and) probably gradually increasing,” she said, decrying that “those early signs were missed until it reached the point at which it was taking off vertically.”

“At that point it’s very hard to suppress, because it’s then involving tens of thousands of people and it’s multiplying at a rate at which it’s very difficult to stop.”

While India is now trying to scale up vaccination to rein in the outbreak, Swaminathan warned that the jabs alone would not be enough to gain control of the situation. She pointed out that India, the world’s largest vaccine-making nation, had only fully vaccinated around two percent of the 1.3 billion-plus population. “It’s going to take many months if not years to get to the point of 70 to 80 percent coverage,” she told AFP.

With that prospect, Swaminathan stressed that “for the foreseeable future, we need to depend on our tried and tested public health and social measures” to bring down transmission.

The surge in India is frightening not only due to the horrifying number of people who are sick and dying there, but also because the exploding infection numbers dramatically increase the chances of new and more dangerous variants emerging. “The more the virus is replicating and spreading and transmitting, the more chances are that… mutations will develop and adapt,” she told AFP.

With agency inputs