07 “Obesity” is an epidemic! — Comments on hepatogenic secondary obesity (Part III) (one of the common symptoms of “deficiency of blood and weakness of qi”

Preface

At the present time, the importance of human diseases caused by “hepatophilic virus” is recognized more and more by people.  Different places of the world have different types of hepatophilic virus and according to statistics; there are over 320 million people in the world having type B hepatitis.  In fact, how many people are infected by the other 6 types of hepatitis virus ?  How many people are yet to be confirmed as victims of infection by hepatophilic virus ?  It is actually difficult to estimate.  The WHO “International obesity working team” pointed out recently, that obesity in human population has spread all over world, in which 750 million are over weight, 300 million suffer from obesity and diseases related to obesity are disseminating.  Since, “abnormal obesity” is generally acknowledged as an epidemic, is it then corrects to say that there is no relationship between hepatophilic virus infection and “abnormal obesity”?

It is beyond doubt that the sequelae of virus hepatitis are “fatty liver”, “hepatic edema” or “hepatogenic secondary obesity”.  We must find out the fundamental cause which leads to the development of obesity and take measures to prevent and treat them accordingly.  We must not let people indulge in the concept of over nutrition and insufficient physical exercise and let them intermingle “secondary obesity” and “simple obesity”.  People should be told to avoid incorrect fat reducing methods and taking fat reducing drugs that hurt the liver.  Otherwise, liver disease patients with obesity might have their illness aggravated from “fat reducing”.

It is commonly accepted that patients with “abnormal obesity” are prone to develop diseases that might affect health. On the other hand, hepatogenic secondary obesity resulted from “hepatophilic virus infection would be neglected.  “Liver disease” itself can produce “abnormal obesity” and the patient becomes susceptible to extra hepatic complications which are commonly seen in obese individuals, such as cardiovascular disease, diabetes, rectal carcinoma and apoplexy.  Therefore, “abnormal obesity” is only one of the sequelae of hepatophilic virus infection and to prevent and treat obesity from the fundamental, one should base on making it known to the public the prevention of “hepatophilic virus” infection and the use of effective systemic TCM therapy.  Fat reducing without physician’s direction often would induce adverse results.  So, we suggest, that individuals suffering from liver disease or not yet ruled out liver disease, and intending to reduce fat, should consider cautiously the following conditions:

(2)       Liver function found to be abnormal by blood examination or positive reaction of virus hepatitis antigen and antibody (antibody positive after hepatic vaccine injection excluded);

(3)       Close relatives or those in close contact with history of virus hepatitis, cirrhosis of liver or carcinoma of liver; close relatives or those in close contact, having positive hepatitis virus surface antigen reaction in blood examination (i.e. virus carrier);

(4)       Those suffering frequently from diseases and symptoms of chronic hepatitis TCM classification (seen in web page) or those with abnormal margin of hepatic dullness or hepatomegaly diagnosed by ultrasound or CT scan;

(5)       Those having history of excessive acute or chronic loss of blood, due to serious diseases, delivery or operation (including menorrhagia, gastric bleeding, hemorrhoidal bleeding and traumatic blood loss) and gradually becoming fat afterwards especially those having blood transfusion;

(6)       Those having been treated for a comparatively long time with steroid drugs because of disease (such as rheumatism, asthma, gout) and gradually developed obesity after a short time of significant increase of body weight;

(7)       Alcohol or narcotics addiction (especially use of injection syringe in common with others) or prolonged use of drugs harmful to the liver (such as prolonged use of bisatin in chronic constipation);

(8)       Homosexuals or those suffering from AIDS.

Anyone who has one of the above conditions should not undergo fat reducing with drugs.  Food control or increase of physical exercise can be done only when liver disease is ruled out so as to avoid the adverse result of malnutrition and more enthusiasm on fat reducing would make more fat deposition and finally, the health condition would be affected.

Methods of fat reducing in patients with “hepatogenic obesity”

“Control food intake and adequate physical exercise” is the only scientific method of fat reducing.  But the premise is that liver disease must be treated, the progressive inflammatory process of chronic hepatitis must be terminated and the liver function improved.  Therefore, the method of first choice to reduce fat in hepatogenic secondary obesity is early effective systemic TCM therapy to achieve clinical cure of chronic hepatitis.

Other important methods are:

Reduce food intake is the chief method of control of calorie intake in reducing fat.  It has been demonstrated that if obese individuals are accustomed to a low calorie diet for a long period, their body weight would finally be decreased, despite of not doing physical exercise.  But eat less does not mean no eating, especially patients suffering from secondary obesity caused by hepatophilic virus disease, who need particularly more fine quality protein, enough vitamins and adequate amount of minerals.  It is only when the patient has a “balanced nutrition”, adequate vitamin and mineral supplements and a project under the direction of physician and maintained with perseverance that the success of fat reducing can be warranted.  The reduce fat “at random” and “blindly” is lack of scientific planning and is also devoid of will power and resolution, and the result undoubtedly would be ineffective.  Some scholars, therefore, pointed out: “Fat reducing by control of food intake has a failure rate between 50% and 95% and this is absolutely not surprising”.

We all know the chief cause of obesity is long term excessive calorie intake.  The best fat reducing method in simple obesity is to follow the acknowledged programme, that is, decrease calorie and increase physical exercise.  To maintain a steady decrease in calorie intake does not depend on the amount of fat, carbohydrate and protein absorption, but is determined by the amount of caloric taken.  So, to ensure health, one shouldhave a diet of adequate proportion, that is, at least 60% glucose, 15% protein and the remaining fat.  Certainly, the diet should contain less meat and oil and should include chiefly vegetables, beans, fish and some meat and plant oil and one should have no scruples about sugar.  If one believes in fat reducing drugs, folk prescriptions or in forcing oneself to control food or even fasting for the purpose of rapid fat reducing, the result will be dangerous to one’s health or even life.  It should be pointed out that prolonged abnormal liver function in hepatogenic obesity patients causes deficiency of protein, imbalance of amino acid contents and insufficient colloidal permeability, therefore, adequate protein amount in the diet is extremely necessary.  Clinical observation shows that intake of adequate amount of fat and carbohydrates may be more effective in achieving fitness.

There is rumour saying that one can use methods like limitation of starch and meat or alternating the intake of simple meat protein with starch food; but actually these are not correct methods which should not be applied, because these administrations would result in hepatogenic hypoglycemia, hypotension or hypertension and cardiac disease.  Some specialists pointed out that many diseases related to obesity are in fact related to interrupted limitation of food intake.  Many patients with such limitations have cardiac and diabetic problems more than obese patients without diet limitation (especially the secondary obesity patients caused by liver disease).  Specialists from many countries have pointed out: “from the beginning, fat reducing by limitation of food intake is destined to end in failure”.  “Limitation of food in the early stage may be effective, but in the long run, only a few individuals can reach the goal; of fat reducing, and on the whole, body weight finally regains.”  Therefore, in the course of fat reducing by limitation of food, one should not do it with reluctance, and everything should be done under the direction of physician and at the insurance of body health.  In addition, during traveling or under emotional embarrassment, one may eat without control and the body weight may increase gradually; but the increased weight is hard to recover, so one should be very cautious about it.

Although, nowadays health food is accepted everywhere with appraisal but with the improvement of economic status of the people, vitamin B group deficiency due to refined food, has become a common phenomenon in the society, especially vitamin B₁ deficiency can give rise to beriberi, polyneuritis, increase susceptibility to generalized weakness and puffiness, induce fatigue, marked saging of lower eyelid and edema of lower limbs.  It can also cause muscular spasm of fingers, toes and gastrocnemius, soreness and weakness o loin, knees and ankles, inability to walk instantly after standing, repeated paroxysmal sciatica, costal neuralgia and these are the result of vitamin metabolic disorder caused by liver function insufficiency.  So, long time supplement of vitamin B1, B6, E and Calcium is necessary.  Those having abnormal blood coagulation or decreased platelet count should have prolonged administration of

vitamin K4 to normalize the coagulation mechanism; as to patients with recurring aphthae and lip mucosal disease, vitamin B2 supplement is advantageous.  Administration of these vitamins and calcium is more important to older patients and long period administration may revive the strength of the lower limbs and prevent walking disability

(2)       More locomotion

More locomotion causes more consumption of calorie.  There are two kinds of locomotion: one is aerobic metabolic locomotive activity, which has significant effect on fat reducing, and another is anaerobic metabolic static locomotion like weight lifting, but its fat reducing effect is not good.  Because decrease of body weight or reducing fat requires time, one must be clear about one’s own dietary habit and learn to adapt new dietary habit and take more time to do exercises to consume calories.  The programme should be blended into one’s daily life so that health and normal body weight can be maintained.  Hepatic obesity patients should proceed to physical training for fat reducing after clinical cure.  The patient should increase aerobic physical exercises with perseverance from a lesser amount to more and from lighter items to heavier, but it should be emphasized that one should not begin unless one has the indispensable resolution and patience.  Increase of locomotion for a short period with eagerness but of not persevered, would often lead to rapid increase of body weight due to increase of appetite following cessation of physical exercise.

(3) Maintenance of body weight is the crux

Specialists remind people that some young ladies are overcritical to seek for “bone sensation beauty” and practice fat reducing blindly.  This is in fact harmful.  It was demonstrated that people with low BMI have a greater mortality rate and also cancer mortality rate than people with normal BMI.  Therefore, one must not go too far in fat reducing.  Now, some young ladies struggle hard to control food intake for the sake of developing a “model” figure, but as time passes by, they would become sufferers of anorexia, menstrual disorders and amenorrhea.  Adolescent female needs adipose tissue by the amount of 17 % of total body weight in order to ensure the appearance of menarche and monthly occurrence of menstruation.  It must not be forgotten that lean and weakness can give rise to many diseases and may even jeopardize life.  Similarly, a lean figure in the elderly may not be a good thing.  Some German nutritionists pointed out that old people at the age of 60-70 years, begin to have muscular atrophy, males developing at the rate of 4% a year and females 6% a year.  So they consider that body weight slightly over normal may be more advantageous to health and they acknowledge that “the best scheme is to maintain the body weight”.  Some other people acknowledge that “the value of keeping body weight in the normal range is no less than anti-cancer”.  The above penetrating opinions are indeed good references for reducing fat.

(4)       Reducing fat should begin in childhood

People infected by hepatophilic virus leading to virus hepatitis are not a small number and most of them are infected early in the infantile period; it is due to the strict standard of diagnosis of liver disease that a certain number of the patients cannot be diagnosed early and treated with effective systemic TCM therapy.  Such neglect is especially common inn children, adolescents and young women.

Recently, some articles, according to investigation, pointed out that newborn infants who increased body weight rapidly would have obesity when grown up.  Some said that obesity patients had increased two times since the sixth decade and the age of the patients became younger.  The investigation reviewed 9179 individuals between the year 1957 and 1964 and found that those born comparatively later had their obesity developing speed quicker by 30% as compared with those born earlier.  In some countries, more than 30% of the children are obese and 22 million children under 5 years of age have been classified as over weight or too fat.  For example, in Africa, the number of obese children is four times of those undernourished.  From these data, it not difficult to find that obesity is endangering children’s health and it is undoubtedly a fact that makes people worry.

Some people have pointed out that abnormal obesity causes chronic injury to children’s cardiovascular and respiratory function, delays their aerobic growth capacity, motivates in advance the reserve cardiopulmonary function, lowers the health quality, hinders the development of psychotic behavior and suppresses the development of potential energy.  In adult age, it is an important risk factor in gradual formation of cardiovascular disease, diabetes, hypertension and cancer in certain sites of the body.  The danger of death at a comparatively early age in obese individuals is 1.2 times of the non-obese.  These risk factors can hardly be explained by “heredity”, “over nutrition”, “disease of the rich” and “insufficient physical exercise”.  It may be more reasonable to ascribe to virus infection, symptoms of extra hepatic complications and abnormal liver function, and it is these conditions that large amounts of “obesity” patients can be seen all over the world.

Therefore prevention and treatment of “abnormal obesity” should be undertaken in childhood, especially for the acute icteric or non-icteric hepatitis pediatric patients, we must tale advantage of effective systemic TCM therapy to avoid the complication of fatty liver.  One should aim at early diagnosis and treatment, education of children to develop proper dietary habits and control of children’s body weight within normal range.  If the sick child had once been too light or too heavy or showed symptoms of different forms of chronic hepatitis, such as recurring long term nasal hypersensitivity, common cold, bronchitis, asthma, nasal discharge, wetness-heat abdominal pain, paroxysmal diarrhea, menstrual disorders, dysmenorrheal and dermal diseases like acne, eczema and rubella, the possibility of hepatophilic virus infection should be considered.  After adolescence, menstrual blood loss in the growing girl should be prevented so that the occurrence of hepatogenic secondary obesity can be avoided.

Infantile and childhood hepatoghilic virus disease patients are sufferers of early stage infection; they deserve more attention in prevention and treatment and the effect would be twice while the effort used is half.  At present, there are numerous viruses which can cause “liver disease” and the use of blood examination to rule out liver disease or preventive injection of type A, type B hepatitis can not absolutely prevent the occurrence of liver disease; one should be aware of this fact.

Now, it is confirmed that not a few fat reducing drugs have anorexia and diarrhea effect and a part of them can also injure the liver and affect the endocrine system of the body.  Some of the drugs can cause palpitation, insomnia, anxiety and if severe, may cause renal failure.  The patient may have psychotic addiction, and the body weight might decrease rapidly in a short time, but as soon as the drugs are stopped, the body weight would increase by double.  Therefore, using drugs to reduce fat is not a clever way.

Case 1

Huang (code number 541) male, age 60 years.  First visit: May, 1997.

Thirty years ago, the patient had arthritis which was cured by physicians in a hospital in his country.  In the recent ten more years, his right knee joint had repeated pain; he felt tired and had feverish sensation in the chest palms and soles.  He had much perspiration and gradually showed generalized edema associated with difficult motivation and loss of libido.  He was treated by TCM and WM physicians for 10 more years with no apparent effectiveness.  For this reason, he came to Hong Kong and visited our clinic after spending much effort to seek for our location.  In May, 1997, physical examination revealed a man of strong build, dark skin color, generalized edema and (++) pitting edema of lower limbs, abdomen distended and full, marked percussion tenderness over hepatic region, intra-abdominal shifting dullness questionable, hepatomegaly at costal margin, no splenomegaly.  The symptoms and signs were compatible with the features of chronic hepatitis deficiency of both liver and kidney form.  Prescriptions about chronic hepatitis were given to him and he was advised of doing liver function tests at his attending hospital.

In August 1997, he visited our clinic for the second time saying that his illness had been relieved after taking 15 parcels of TCM drugs; his knee pain disappeared and his perspiration and dysphonic sensation also decreases and the gastrointestinal system was normal.  His body weight had a reduction of 12 pounds.  His return visit was delayed because of herpes zoster of the neck and chest which required hospitalization for 18 days.  During hospitalization, he had blood examination which revealed type B hepatitis surface antigen and anti-HBC, abnormality of liver function: ALT 82 (normal 5-30), AST 52 (normal 5-30), GGT 60 (normal 5-40), slightly high globulin and abnormal proportion of proteins.

Physical examination: good mental status, lessening of facial; edema, more smooth locomotion, abdomen soft but distended, liver normal, (++) pitting edema of lower extremities.  He was told to take chronic hepatitis TCM basic formula drugs for one month and have a return visit after this course of treatment.

The third return visit was in December 1997, at which time he was feeling well, his appetite and sleeping was normal.  He did not feel tired and his libido recovered.  The joints did not show any swelling and pain, the stools were regular, hard, one to two times a day.  He took the drugs of the preparation Liuwei Dihuang Wan (六味地黃) and the basic formula of hepatitis for two months but now he had stopped the medicine.  Physical examination revealed a normal liver, but the lower extremities still showed (++) pitting edema.  His was told to time to prevent recurrence.

In September 1998, he made a return visit and said that his liver function was entirely normal according to the examination in the local hospital.  His daily life was normal, his sexual ability had recovered but some working itching of the skin was still present.  Physical examination: revealed a normal liver, but the lower extremities still showed (++) pitting edema.  He was told to have supplement of the kidney and take TCM drugs from time to time to prevent recurrence.

In September 1998, he made a return visit and said that his liver function was entirely normal according to the examination in the local hospital.  His daily life was normal, his sexual ability had recovered but some wondering itching of the skin was still present.  Physical examination: puffiness reduced, lower extremities pitting edema (+), generalized sweat stains with scattered hidrotic dermatitis and scratch marks, abdomen soft and distended, liver normal.  His was told to take at times TCM drug that could soothe liver, relieve stagnation, clear wetness-heat and supplement kidney water for maintenance of curative effect

On 3 July, 2003, he visited our clinic because of hoarseness of voice following common cold.  Examination showed a normal liver and (+) edema of lower extremities.  His body weight was reduced by 10 kg, after treatment of liver disease and for the time being, he maintained a balanced diet and a steady body weight.

Published 26th September 2002

Translated by Professor Zheng in July 2005