ACUPUNCTURE FOR OBESITY

INTRODUCTION:

• Obesity is a worldwide epidemic associated with rapidly growing morbidity and mortality which imposes an enormous burden on individual and public health.
• The expansion of fat mass, adipocyte size increase, and to a lesser extent cell proliferation (hyperplasia) are important features of obesity. 
• It is generally believed that obesity is the second leading form of metabolic disorders after cardiovascular disease.
• As a part of Traditional Chinese Medicine (TCM), acupuncture has shown the positive efficacy in the management of obesity.
• According to the basic theory of TCM, the pathogenesis of obesity is mainly considered to be blood vessel obstruction by Qi deficiency and phlegm dampness stagnation, which might be caused by various internal and external factors such as stasis of liver qi, deficiency of spleen, or over intake of greasy flavour.
• The vital viscera associated with obesity in Chinese medicine refer to spleen, liver, kidney, and the Sanjiao (triple energizer). 
• Based on the foundation of TCM theory, the therapeutic principle of obesity is invigorating spleen to remove dampness and relieving Qi stagnancy in liver to remove blood stasis. 
• Not only ancient literature but also modern scientific evidence has shown the positive efficacy of acupuncture interventions in the management of obesity.
  

ACUNPUNCTURE POINTS:

• Zhongwan (CV12) & Guan yuan (CV4)
  

• Tianshu (ST25)  & (CV 4)

• Zusanli (ST36) & Sanyinjiao (SP6)
  

• Fenlong (ST40) 

• Yinlingquan (SP9) 

EAR POINTS:

• Sanjiao (Hungry) & Shen Men (Stomach) 

MECHANISM:

1.    Acupuncture regulates endocrine system:

• Nesfatin-1, which is a new hypothalamus peptide derived from nucleobindin 2(NUCB2), is distributed in the appetite-associated hypothalamic nuclei, such as paraventricular nuclei, arcuate nuclei, supraoptic nuclei, and lateral hypothalamic areas.
  

• Nesfatin-1 inhibits body weight growth and appetite.
  

• It acts as an "Anorexigenic hormone".
  

• Acupuncture significantly inhibited body weight, fat mass, body mass index (BMI), and waist circumferences and increased the Nesfatin-1 level of plasma in obese patients after being performed for 30 min.

• A randomised controlled study that applied acupuncture treatment to obese women

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•  showed a decrease in leptin levels and a significant increase in ghrelin after 6 weeks of treatment.

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•  The subjects were blinded and randomly divided into groups A and B.

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•  Group A received acupuncture treatment, and group B received sham acupuncture using placebo needles, twice each week for 6 weeks.  

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• Acupuncture enhanced the fasting blood Cholecystokinin (CCK) level, a hormone that is involved in feeding behavior through central and peripheral channels. 

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• CCK is said to be a neurotransmitter activating satiety signal by affecting the central nervous system after a meal, and there is a close relationship between CCK and ghrelin which starts the meal while CCK ends it

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•  Acupuncture also activated other endocrine-related cytokines such as insulin and epinephrine.

2.    Acupuncture promotes digestion:

• Obese subjects treated with acupuncture showed decreased salivary amylase (S-Am), serum pepsinogen (SPG), and serum amylase (B-Am) after being performed for 20-30 min

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• All the subjects received acupuncture treatment once every other day for 1 month.

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• It indicated that acupuncture therapy may be a useful method for inhibiting the function of hyperactive gastrointestinal digestion and absorption.

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• After acupuncture treatment, the active component such as 5-Hydroxytryptamine (5-HT) and Histamine (HB) in the gastrointestinal microcirculation decreased in obese patients, while prostaglandin E₂(PGE₂) increased on the effected side

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• The local regulation mechanism may be attributed to the suppressed gastric acid secretion and colon contraction activity. 

• A Clinical Trial by observing the changes of the surface electrogastrogram in obese patients

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• showed that body acupuncture with auricular pressure for 1 month

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• obviously delayed the increase of electrical amplitude in the stomach after the meal, indicating that acupuncture can delay the gastric emptying.

3.   Acupuncture on metabolism:

•  A recent analysis showed that acupuncture modulated the secretion of multiple serum lipids in obese patients. 
  

• Acupuncture downregulated the level of serum triglyceride, total cholesterol, and low-density lipoprotein cholesterol and 
  

• Upregulated the level of serum high-density lipoprotein cholesterol, which could contribute to the removal of excess blood lipid.

• In physiological conditions, adiponectin is exclusively secreted by adipocytes and activates adenosine monophosphate-activated protein kinase (AMPK)

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• In turn, activation of AMPK helps in regulating the energy metabolism

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• However, in obese conditions, increased adiposity leads to low plasma levels of adiponectin production, resulting in a decreased AMPK activity.

"Repeated acupuncture at Zhongwan (CV12) and Guanyuan (CV4) acupoints caused an increase in adiponectin and a decrease in leptin".

4.    ACUPUNCTURE ON INFLAMMATORY RESPONSES:

• Obesity has been shown to be closely related to a different type of inflammation which is referred to as chronic low-grade inflammation 

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• It is characterized by a modest increase of proinflammatory factors in the circulatory system and the absence of clinical signs of inflammation

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• Acupuncture reduced mRNA levels of several cytokines in adipose tissue, including interleukin-6(IL-6), monocyte chemotactic protein-1(MCP-1) and tumor necrosis factor-α (TNF-α)

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• IL-6 and TNF-α, which are pro-inflammatory cytokines, have been confirmed to be elevated in obese subjects

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• The decrease of TNF-α indicated that acupuncture was effective in reducing insulin resistance and in reducing the overall inflammatory state 

5.   ACUPUNCTURE SUPPRESSES APPETITE:

The hypothalamic arcuate nucleus (ARC), which is the major appetite regulatory site

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receives input from central and peripheral (pancreas, adipocytes. and brain) sources 

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The ARC consists of at least two populations of neurons with opposing functions on food intake: 

• primarily lateral anorexigenic (pro-opiomelanocortin-POMC and cocaine and amphetamine-regulated transcript-CART) and 
  

• primarily medial orexigenic (neuropeptide Y-NPY and agouti-related protein-AgRP) neurons

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acupuncture up-regulated CART peptide expression in the ARC

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As a hypothalamic satiety factor, CART neurons in the ARC contain a number of pro-opiomelanocortin (POMC) mRNA which plays a key role in the regulation of inhibiting appetite

6.   ACUPUNCTURE ON PROMOTING BROWNING PROCESS:

• The adipose tissue is mainly composed of two types:

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• White adipose tissue(WAT) stores energy and releases cytokines and hormones that regulate insulin resistance and metabolism.

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• Brown adipose tissue (BAT)consumes energy mainly through mitochondrial uncoupling in nonshivering thermogenesis mediated by Uncoupling protein-1 (UCP-1), as an adaption process to cold exposure

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• Acupuncture on Neiting (ST44) and Zusanli (ST36) acupoints remodeled WAT to BAT via inducing the expression of UCP-1 in obese rats, thus decreasing adipocyte size and promoting lipolysis in WAT. 

7.   AURICULAR ACUPUNCTURE:

Acupuncture stimulates the auricular branch of the vagal nerve and raises serotonin levels. 

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These activities have been shown to increase tone in the smooth muscle of the stomach, thus suppressing appetite

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Serotonin enhances intestinal motility

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It also controls stress and depression via endorphin and dopamine production.