Neuro Acupuncture Weight Loss

As a well-trained and fairly conservative Chinese medicine practitioner, I assumed that acupuncture for weight loss was a marketing fad and complete fantasy. In fact, at least two of my professors during my medical training said just that. Little did I know, that even while I was at school, licensed acupuncturists and herbalists were already helping people lose weight clinically. In fact, some people lose weight under Chinese medical treatment as a result of getting healthier while treating other problems.

But, back to my skepticism. While researching an upcoming book, I found some positive research results that began to change my mind. Here's the story of my journey from skeptic to detective:

One of the more difficult tasks of planning and writing a book, especially on such a large and foreign subject as Chinese medicine, is trying to figure out how to make it interesting to the average reader. With some reluctance, I began to look for ways to make this powerful and valuable medicine's wisdom more, shall we say, "Reader's Digest-like."

The fact is, those "5 steps to get all the money, sex, and love you want in just 5 minutes without lifting a finger!" article titles really do grab people's attention - they sell magazines, and they get authors on radio and TV. As I was considering what people were really interested in, of course the topic of weight loss came up, and, with it, my skepticism. But then I found the research, and heard the experience of patients and practitioners.

Reviewing the Facts:
Scientific Evidence For and Against
Chinese Medicine Weight Loss

So, let me examine this issue with you in detail. How real is this possibility that Chinese medicine can help you with weight loss? To do that, we'll have to look at several therapies, including acupuncture, diet modification, and exercise. And the first thing we're going to do is look at the research. We'll talk about the quality of the research, and the conclusions of each study. If the results are bad, we'll try to figure out why. If they're good, we'll make sure the study quality was good too.

It's likely that given the thousands of possible acupuncture point selections, and herbal formulas, that there may not be any research on certain parts of the Chinese medicine weight loss plan. Remember that there are levels of evidence- the best is certainly the level 1 double-blind placebo controlled study (considered the "gold standard" or best kind), and the worst is level 8, conjecture or common sense - but in between, when there are no gold standard studies, a level 5 series of patient cases (without a control group) does count for something. It may not be rock solid evidence, but neither is it easily dismissed. They demonstrate the need for more research.

Adrenal Function and Metabolic Rate

A 1993 study conducted at the Nanjing College of TCM (China) and published in the Journal of Traditional Chinese Medicine looked at the relationship between simple obesity, adrenal function, and acupuncture. They also watched the patients' lipids, blood-glucose, noradrenaline, dopamine, and cortisol levels.

Simple obesity means obesity that is not caused by some other medical condition, like an endocrine disease (e.g., hypothyroidism). They found that simple obesity patients had two under active bodily systems:

• The sympathetic-adrenal (sympathetic nervous) system (SNS) and
• The hypothalamus-pituitary-adrenal (HPA) system/axis
  

The first system, the sympathetic-adrenal, or SNS system [click for a picture], is the normal "fight or flight" response. The adrenal gland releases DHEA, among other hormones, and DHEA had been shown to inhibit the development of obesity. The opposite of the SNS is the parasympathetic nervous system, which is involved in relaxation, sleep, and meditation. So, maybe you're too relaxed! In any case, the SNS helps determine the way energy is spent, and this means your metabolic rate and fat oxidation ("burning") rate.

Both systems are involved with the regulation of leptin, the fat cell hormone that leads to weight loss. The sympathetic system can decrease leptin secretion, but the HPA system [click for a picture] can increase it. Low levels of leptin may contribute to further obesity, and are associated with type 2 diabetes.

In the Nanjing study, acupuncture led to weight loss and enhanced the function of both the SNS system and the HPA axis. They speculated that there might have been a relationship between these systems and weight loss.

More on Obesity and the Hypothalamus-Pituitary-Adrenal (HPA) Axis

In 1990, the Department of Acupuncture & Moxibustion at the Nanjing College of TCM studied acupuncture and moxibustion (heating acupuncture points) for weight loss in 39 patients. They found that acupuncture and moxibustion were markedly effective for 38.5% of them, effective for 51.3%, and ineffective for 10.3%.

In this study, researchers monitored the body mass index (BMI), lipid levels, plasma ACTH, and salivary cortisol. They saw that obese patients had an under active HPA axis. Acupuncture and moxibustion regulated lipid levels, reduced weight, and enhanced the function of the HPA system. The scientists concluded that the "key factor of anti-obesity by acupuncture and moxibustion was to increase the function of hypothalamus-pituitary-adrenal system."

An Outcome Study Using Traditional Criteria

In a 2003 Chinese study, 40 men and women (7 male) fit a specific set of symptoms , which in Chinese medicine define a pattern called Yang Ming Replete Heat. The patients also all had greater than 20 BMI's, and more than 30% body fat. A specific acupuncture protocol , which often included electroacupuncture, was followed.

After 1 to 4 courses of treatment (which usually means 10-40 treatments, and in China they often treat every day or every other day), the results were as follows:

• Two cases (5%) were clinically controlled, and had fat reduction of up to 30%.
• Thirteen cases (32.5%) seeing a 9-10% reduction in percentage of fat.
• Twelve cases (30%) got a 5-8% reduction in percentage of fat.
• Ten cases (25%) experienced a 2-5% reduction in percentage of fat.
  
• Three cases (7.5%) got no result. Therefore, the total effectiveness rate was calculated as 92.5%.

The important characteristics of this study, which may be essential to acupuncture weight loss success, were:

• Pattern differentiation: Usage of points based on the Chinese medical pattern (Yang Ming replete heat), rather than just one point prescription for all weight loss situations
  
• Strong needle technique: Typically, Chinese acupuncturists use strong needle technique, which produces strong sensations for the patient. Not all acupuncturists practice this way. In fact, Japanese acupuncturists barely puncture the skin. Plus, some patients are quite needle sensitive, and Americans are pain phobic, so not all patients will allow this kind of treatment.
  
• Electro-acupuncture: This may be enough even if the previous technique is not used. The electricity increases the stimulation of the points.

As translator Bob Flaws goes on to discuss, most patients cannot see an acupuncturist this often, but herbs can be added to the treatment strategy to take up the slack. This is also where food selection according to Chinese medical pattern diagnosis, and the right exercise program come in.

Ear Acupuncture for Weight Loss

The previous study used what are called "body points," acupuncture points located everywhere but the scalp or ears. In 1998, two Australians, one a private practice acupuncturist, and the other an MD, studied the use of only ear acupuncture points for weight loss. There are hundreds of points on the ears, and there are several charts that map these points to just about every other part and function of the body [click for a picture, another picture].

The study begins with the notion that, "acupuncture stimulates the auricular branch of the vagal nerve and raises serotonin levels, both of which have been shown to increase tone in the smooth muscle of the stomach, thus suppressing appetite. "

This study tested two ear acupuncture points (Shenmen, which has a calming effect, and Stomach, which is indicated for indigestion, gastritis, peptic ulcer, stomach distention, belching, and insomnia.). The points were not needled, but instead were stimulated electrically. They conducted this study on 60 overweight people, randomly divided between the therapy group, and the control group, who received electrical stimulation on their thumb. The electrical stimulation happened twice daily for 4 weeks. The results were:

• 95% of the therapy group had less appetite, while the control group's appetite was unchanged.
  
• None in the control group lost more than 4.4 lbs, while 78.5% of the active therapy group did.
  
• The average weight loss over those 4 weeks for the therapy group was about 6.6 lbs.
  
• Those who continued for 3 months lost as much as 22 lbs.

I want to make a few comments on these results. First, if you think that's not very much weight loss, you're right. I agree. My overall sense of the research and reports is that acupuncture patients lose more weight than this, and faster. So why would the results be positive but diminished in this study?

First, we have to look at their point selection. They chose their points backwards- they went from what was known at the time about acupuncture mechanisms, and applied those to what they thought were the weight loss mechanisms. They did not choose all the points used traditionally and in modern China for weight and hunger. They only chose points that raise serotonin levels, stimulate the vagus nerve, and produce endorphins and dopamine. Other research - even science released before this acupuncture study - makes it clear these are not the only factors in weight loss.

Knowing what we know from other acupuncture weight loss studies, to increase the effectiveness, we could also choose these ear points:

• Spleen, to improve digestion.
  
• Hormone, may affect the HPA axis.
  
• Subcortex, may regulate metabolism.
• Pituitary, should affect the HPA axis.
  
• Endocrine, the adrenals and pituitary are involved in the endocrine system.
  
• Adrenal, to stimulate adrenalin and adrenocortical hormones- might fix the under activity of the SNS in obesity.
  
• Hunger, relieves hunger, diabetes, and compulsive eating.

Because the study's point selection was based on a limited view of how acupuncture works in the body, and because obvious points like Hunger were not chosen, we can see that the study designers did not include everything we would want for weight loss success.

Plus, we cannot know without further studies the difference in effect only electrical stimulation and needling. For all we know, there could be slightly different bodily effects from the same point, depending on the mode of stimulation.

Acupuncture's Affect on the Satiety Center in the Hypothalamus

Next up, we have another Chinese study - this one was conducted in 2000 at the Second Clinical College of Nanjing University of Traditional Chinese Medicine and Pharmacy on rats with experimental obesity. They monitored the effect of acupuncture on the part of the brain that makes us feel satisfied with the amount of food we've eaten (the VMH, or VentroMedial nucleus of the Hypothalamus [click for picture]). They found more activity in the VMH from acupuncture than in two other non-acupuncture groups of rats. Their results also showed that acupuncture's effects on the VMH lasted longer than the other non-control group.

Unfortunately, again we only have the abstract of this Chinese study, and it leaves us with some serious questions: What was the point selection? What was the other non-control group's therapy? It has been observed by westerners that most Chinese writers and researchers do not adhere to the same standards that we do in the west. This would be a prime example.

Regardless, we can take their observations and conclusions, and look into how important the effect of acupuncture on the VMH might be. A good year 2000 review of the hypothalamus, eating, and energy explains that though there may be anatomical areas that regulate feeding and satiety, researchers are instead emphasizing the neurotransmitters that affect these behaviors.

• Neuropeptide Y (NPY) stimulates appetite in the paraventricular nucleus (PVN), and repeated administration causes obesity.
  
• Leptin and insulin inhibit the neurones that express NPY.
  
• Antagonists of the Y5 receptor are anti-obesity.
  
• Activation of Melanocortin-4 receptors (MC4-R) by agonists such as alpha-melanocyte-stimulating hormone inhibits feeding and causes weight loss.
  
• Conversely, MC4-R antagonists such as 'agouti' protein and agouti gene-related peptide (AGRP) stimulate feeding and cause obesity.

Great information, but do we have any research about the effects of acupuncture on these agents?

Neuropeptide Y:

Neuropeptide Y: Neuropeptide Y (NPY) is the most abundant neuropeptide in the brain. It is a member of a family of proteins that include pancreatic polypeptide, peptide YY and seminalplasmin. In addition to its function in feeding behavior, several other physiologic roles have been assigned to NPY, including involvement in circadian rhythms, sexual function, anxiety responses and vascular resistance.

NPY is known to be an extremely potent stimulator of feeding behavior. Feeding behavior in rodents is blocked by injection of antibodies or antisense RNAs against NPY. More importantly, leptin appears to act, at least in part, by inhibiting NPY synthesis and release in the hypothalamus. Additionally, mutations that interfere with signaling via the hypothalamic melanocortin-4 receptor lead to obesity that is at least partially explained by perturbations of NPY expression.

Although NPY is clearly involved in control of food intake, the complexity and apparent redundancy of that system is illustrated by recent experiments in which the NPY gene was disrupted in mice. Leptin's effect on body weight is mediated in part by its effect on NYP expression, but that other systems have overlapping control over food intake and energy expenditure.

Acupuncture's Effects on Neuropeptide Y:
(More NPY in hypothalamus = More hunger = More Obesity)

• Acupuncture treatment at acupoint Shenmen (HT7) resulted in a significant increase in both body weight and locomotion. These findings suggest that acupuncture has an effect on the depression-like disorder caused by MS, possibly by modulating NPY expression in the hippocampus. Relevant? This is NPY in the hippocampus, not the hypothalamus, and the weight gain might have been in rats underweight due to depression. May not bear on obesity.
• Stimulation of the acupuncture point, ST36, resulted in increased cell proliferation in the dentate gyrus (DG) and neuropeptide Y levels in the diabetic group. The dentate gyrus can reduce in size due to stress, and is involved in the forming of new memories. Relevant? Probably not.
• A 2001 Korean study at Semyung University studied the effect of acupuncture on food-deprived rats. As might be expected, the starving rats had increased production of NPY (to stimulate feeding) [In this bullet, NPY levels are always in reference to both the arcuate nucleus (ARN) and the paraventricular nucleus (PVN) of the hypothalamus.]. So, it is even more important that the auricular acupuncture they did decreased the NPY levels. Even when they were starving, acupuncture could reduce the impulse to eat by lowering NPY levels in the hypothalamus. Interestingly, they also needled the same points on fed rats, and found that it increased NPY levels. Unfortunately, this also is only an abstract, and did not specify which ear points were used. Relevant? Very.

Acupuncture and Beta Endorphin

Beta endorphin stimulates feeding. Thus, acupuncture that affects beta endorphin in these areas might affect feeding behavior - acupuncture that decreases beta endorphin in these areas might reduce feeding. However, I couldn't find an acupuncture study that proved it could control beta endorphin.

Acupuncture and POMC

This is not what you'd call an immediately positive study - the idea was that electroacupuncture (EA) of different frequencies stimulates different opioids in the brain. The good news here is that you can fine-tune which opioid you want released, depending on the EA frequency.
EA can increase POMC.

Acupuncture's Effect on Leptin

• No studies found.

Acupuncture's Effect on Insulin:
(Insulin Inhibits NPY -> Lower Appetite -> Weight Loss)

• In 2001, 21 cases of acute cerebral infarct due to non-insulin dependent diabetes mellitus were treated with acupuncture vs. a control group. The acupuncture group had lower levels of insulin and glucagons, and improved hypercoagulability. No more details provided.
• Animal experiments have shown that acupuncture can activate glucose-6-phosphatase (an important enzyme in carbohydrate metabolism) and affect the hypothalamus. Acupuncture can act on the pancreas to enhance insulin synthesis, increase the number of receptors on target cells, and accelerate the utilization of glucose, resulting in lowering of blood sugar.
• A 1999 Taiwan study at China Medical College measured the effects of electroacupuncture on the acupoint Ren-12 in terms of blood glucose (sugar). They found that it lowered the blood glucose level, and in looking for the agent of glucose lowering, they found support for insulin, and eliminated glucagons. Thus, their best guess was that Ren-12 had induced secretion of beta-endorphins, and thus somehow led insulin to reduce the blood glucose levels.
• A 1989 Chinese study look at the effects of moxibustion of the acupoint St-36 (vs. a control group; 20 in each group) in terms of blood levels of TSH, T3, T4, FSH, LH, testosterone and insulin. The results were a significant increase in insulin, and a prominent decrease in T4, but no marked difference was found in FSH, LH, testosterone, TSH or T3.
• In 1990, 41 simple obesity patients with hypertension received acupuncture and moxibustion at the Nanjing college of TCM. 87.8% lost weight. Based on blood and physical measurements, acupuncture and moxibustion regulated overeating, blood pressure, lipid level and energy metabolism.
• In 1991, 46 cases of obesity were measured and given acupuncture. Interestingly, they were sub-diagnosed in terms of an uncommon Chinese medicine pattern; 39 were considered to have health Liver yang (group 1) and 7 were considered Liver yang deficient (group 2). The study found that SNS function was markedly higher in the normal Liver yang group. Indeed, when Liver yang is hyperactive and excess, symptoms like anger, red face, yelling, and hypertension are rather SNS-like (“fight or flight”), aren’t they? Fat metabolism was abnormal in both groups. The marked effects were achieved on the cases which received one course of treatment (1 month) by acupuncture, the total effective rate being 84.8%. The effects were anti-obesity, and regulation of fat metabolism. There was also an effect on blood pressure, but not enough details were given to interpret. While generally in standardized CM, Liver yang is usually only talked about as being excess (not deficient, as it is here), there is some diversity in Chinese medicine diagnosis. The famous physician Qin Bowei discussed Liver yang deficiency. "Illnesses of qi counterflow and hyperactivity of yang are generally referred to as liver qi and liver yang patterns. When these are seen with lassitude, anxiety, timidity, headache, numbness, and lack of warmth in the extremities, they are called liver qi and liver yang vacuity (deficient) patterns."
• In 1992, 102 cases of obesity were studied in terms of reduction of heart disease risk. Acupuncture made positive change in 88.24% of cases. The changes that reduced heart risk were improvement of the “hip-loin ratio,” decrease in arteriosclerosis, and improvement of the nerve functions that regulate the heart and blood vessels. “All this suggests that acupuncture is a treatment of choice for obesity and an important method of preventing and treating complicating cardiovascular diseases.”
• In 1998, 202 case of childhood obesity were divided into two groups. One used photo-acupuncture, and the other a method of ear-pressing. Both resulted in significantly lowered obesity indexes and marked improvement of the levels of blood lipids, glucose, cortisol and triiodothyronine. Photo-acupuncture is yet another method of stimulating acupuncture points, in this case with a certain frequency of light. A typical device is a light emitting diode of 15,000 millicandle callibrated illumination, with a 660 Nanometer wavelength, and a pulse rate of 266 cycles per second.

References:

1. Liu Z, Sun F, Li J, Wang Y, Hu K. Effect of acupuncture on weight loss evaluated by adrenal function. Journal of Traditional Chinese Medicine, 1993 Sep, 13(3):169-73.
2. Al-Harithy RN. Dehydroepiandrosterone sulfate levels in women. Relationships with body mass index, insulin and glucose levels. Saudi Med J. 2003 Aug;24(8):837-41.
3. Sandoval DA, Davis SN. Leptin. Metabolic control and regulation. Diabetes Complications. 2003 Mar-Apr;17(2):108-13.
4. Liu ZC. Effect of acupuncture and moxibustion on axis suffering from simple obesity. Zhong Xi Yi Jie He Za Zhi. 1990 Nov;10(11):656-9, 643-4.
5. Zhang Lu. Acupuncture on Spleen, Stomach, and Ren Mai Channel Points for the Treatment of Stomach & Intestinal Replete Heat Pattern Simple Obesity abstracted & translated by Bob Flaws, Dipl. Ac. & C.H, Lic. Ac., FNAAOM, FRCHM. Bei Jing Zhong Yi Za Zhi (Beijing Journal of Chinese Medicine), issue #1, 2003 of the Bei Jing Zhong Yi Za Zhi (Beijing Journal of Chinese Medicine)
6. Richards D, Marley J. Stimulation of auricular acupuncture points in weight loss. Aust Fam Physician. 1998 Jul;27 Suppl 2:S73-7. (http://www.shpinternational.com.au/trialres.html)
7. Jayasuriya A, Fernando F. Principles and practice of scientific acupuncture. Sri Lanka: Lake House 1978; 458-459.
8. Soulairac A, Soulairac M L. Handbook for experimental pharmacology. 1960; XIX: 358, 752-753. & Blundell J. Serotonin blamed for over eating. Aust Dr Wkly 1993; 23 July: 43.
9. Zhao, M., Liu, Z., and Su, J. The time-effect relationship of central action in acupuncture treatment for weight reduction. J Tradit Chin Med Vol.20 Issue 1 pp. 26-29. 2000.
10. Williams G, Harrold JA, Cutler DJ. The hypothalamus and the regulation of energy homeostasis: lifting the lid on a black box. Proc Nutr Soc. 2000 Aug;59(3):385-96.
11. Erickson JC, Clegg KE, Palmiter RD: Sensitivity to leptin and susceptibility to seizures of mice lacking neuropeptide Y. Nature 381:415, 1996.
12. Lim S, Ryu YH, Kim ST, Hong MS, Park HJ. Acupuncture increases neuropeptide Y expression in hippocampus of maternally-separated rats. Neurosci Lett. 2003 May 29;343(1):49-52.
13. Kim EH, Jang MH, Shin MC, Lim BV, Kim HB, Kim YJ, Chung JH, Kim CJ. Acupuncture increases cell proliferation and neuropeptide Y expression in dentate gyrus of streptozotocin-induced diabetic rats. Neurosci Lett. 2002 Jul 12;327(1):33-6.
14. Kim EH, Kim Y, Jang MH, Lim BV, Kim YJ, Chung JH, Kim CJ. Auricular acupuncture decreases neuropeptide Y expression in the hypothalamus of food-deprived Sprague-Dawley rats. Neurosci Lett. 2001 Jul 13;307(2):113-6.
15. Guo HF, Wang XM, Tian JH, Huo YP, Han JS.. 2 Hz and 100 Hz electroacupuncture accelerate the expression of genes encoding three opioid peptides in the rat brain. Sheng Li Xue Bao. 1997 Apr;49(2):121-7.
16. Zhu CB, Li XY, Zhu YH, Xu SF. Preproopiomelanocortin and preprodynorphin mRNA expressions in rat brain after electroacupuncture + droperidol. Zhongguo Yao Li Xue Bao. 1997 Jan;18(1):53-5.
17. Hu H. A review of treatment of diabetes by acupuncture during the past forty years. J Tradit Chin Med 1995;15:145-154.
18. Chang SL, Lin JG, Chi TC, Liu IM, Cheng JT. An insulin-dependent hypoglycaemia induced by electroacupuncture at the Zhongwan (CV12) acupoint in diabetic rats. Diabetologia. 1999 Feb;42(2):250-5.
19. Liu ZC. Regulatory effects of acupuncture and moxibustion on simple obese complicated with hypertension. Zhong Xi Yi Jie He Za Zhi. 1990 Sep;10(9):522-5, 515.
20. Liu ZC, Sun FM, Shen DZ. Effect of acupuncture and moxibustion on antiobesity in the variation of plasma cyclic nucleotide and the function of vegetative nervous system. Zhong Xi Yi Jie He Za Zhi. 1991 Feb;11(2):83-6, 67-8
21. Liu Z, Sun F, Li J, Shi X, Hu L, Wang Y, Qian Z. Prophylactic and therapeutic effects of acupuncture on simple obesity complicated by cardiovascular diseases. J Tradit Chin Med. 1992 Mar;12(1):21-9.