About: Dr.Yugandhara Misal

लठ्ठपणा ...वेळीच आटोक्यात आणा !! डॉ. सौ युगंधरा मिसाळ

आजकालच्या धावपळीच्या आणि दैनंदिन ताण-तणावाच्या जीवनात आपण जसे मधुमेह ,उच्च रक्तदाब अशा विकारांना "लाईफस्टाईल डिसीज" म्हणून सामावून घेतले आहे, त्यातच आताशा लठ्ठपणाचा म्हणजे स्थूलते चा अंतर्भाव करावा लागेल. कारण गेल्या काही वर्षात लठ्ठपणाचे ( स्थूलतेचे) प्रमाण खूपच वाढलेले आढळून येते .आता तर फास्ट फूड, जंक फूड आणि सोबतच टीव्ही ,कॉम्प्युटर मुळे शरीराची खूप कमी प्रमाणात होणारी हालचाल यामुळे लहान मुलेही स्थूलतेला ते ला बळी पडताना दिसत आहेत.

शरीरातील चरबीचे प्रमाण आवश्यकतेपेक्षा जास्त वाढलेले असल्यास लठ्ठपणा म्हणजे स्थौल्य निर्माण होते. वैद्यकीय मानकांनुसार ,उंचीला अनुसरून वजनही प्रमाणात हवे. जेव्हा वजन प्रमाणापेक्षा जास्त वाढते तेव्हा शरीर बेढब तर दिसतेच परंतु वाढलेल्या चरबीमुळे शरीराच्या सर्व अवयवांवर दुष्परिणाम होतात .

वजनामुळे होणारे दुष्परिणाम .. गुडघेदुखी ,अंगदुखी, सांधेदुखी - त्यामुळे रोजची ऊठ-बस

ही त्रासदायक होऊ लागते .शारीरिक आणि मानसिक दौर्बल्य, थकवा येणे ,उत्साह कमी वाटणे इ. खूप भूक ,खूप तहान लागणे ,खूप घाम येणे ,मधुमेह ,उच्च रक्तदाब, पक्षाघात (लकवा) अकाली (लवकर) वार्धक्य (म्हातारपण) येणे ,त्वचारोग अगदी हृदयरोग ,कर्करोग (स्त्रियांमध्ये स्तनांचा ,गर्भाशयाचा तर पुरुषांमध्ये प्रोस्टेट , गुदाचा इ.),वैवाहिक सुखामध्ये कमतरता किंवा औदासिन्य अगदी वंध्यत्व ही.

यावर उपाय सोपा आहे.. वजन नियंत्रणात ठेवणे ! मात्र हे नियंत्रण तज्ज्ञांच्या मार्गदर्शनाखालीच हवे .ऐकीव माहितीवरून ,जाहिराती पाहून ,स्वतःच्या मनानेच वजन आटोक्यात आणणं तितकंसं प्रभावशाली होऊ शकत नाही कारण वाढलेले वजन कमी करताना प्रथमतः ते कशामुळे वाढले आहे हे तपासणे अत्यंत महत्त्वाचे आहे, त्यासाठी शरीरातील चरबीचे प्रमाण (तसेच अनुषंगिक व्याधी ),इतर तपासण्याही करणे गरजेचे असते. बॉडी मास इंडेक्स ,बेसल मेटॅबोलिक रेट , हिप वेस्ट रेशो, आवश्यकतेनुसार अंतस्त्रावी ग्रंथी यांची आणि इतर तपासणी या सर्व तपासण्यांच्या रिपोर्ट नुसार आणि स्थूल रुग्णाचे वय, चरबीचे प्रमाण आणि प्रकार, आहार-विहार व्यवसाय ,दैनंदिन सवयी, मानसिक स्थिती इत्यादी सर्व

गोष्टींचा सर्वंकष अभ्यास करून मगच औषधोपचार योजना बनविली जाते.

जीवन रेखा ओबेसिटी सोल्युशन्स द्वारे अशा रुग्णांचा सर्वांगीण अभ्यास करून एक विशिष्ट औषध प्रणाली विकसित केलेली आहे की ज्यायोगे पहिल्या 48 तासात वजन कमी होण्यास सुरुवात होते आणि पहिल्या सहा दिवसात दोन ते आठ किलो ग्रॅमपर्यंत वजन कमी होते. साधारणतः दहा किलो वजन कमी करण्यास अडीच ते तीन महिने तर 20 किलो साठी सहा ते सात महिन्यांचा कालावधी लागतो. ही चिकित्सा फक्त वाढलेली चरबी कमी करते असे नव्हे तर चरबी निर्माण होणाऱ्या कारणांवर ही कार्य करते.

रुग्णांना आहाराबद्दल सखोल मार्गदर्शन करून उपाशी न ठेवता ,काय खायचे याची माहिती दिली जाते .खूप व्यायामाची ही गरज पडत नाही .क्रीम्स ,मसाज ऑइल मुळे त्वचेवर दिसून येणाऱ्या दुष्परिणामांवर ही नियंत्रण आणता येते. त्वचेखालील चरबी कमी होऊन त्वचा नितळ आणि चमकदार होते, व्यक्तिमत्वही प्रभावी होते !

ही चिकित्सा कोणत्याही वयातील व्यक्तीला तसेच संधिवात, मधुमेह, हृदयरोग ,त्वचा विकार इत्यादी व्याधीग्रस्तांनाही घेता येते.

लठ्ठपणा कमी करून शरीर फक्त सुडौल आणि निरोगीच नव्हे तर नितळ आणि स्वस्तही बनवूया फक्त शरीरातच नव्हे तर रोजच्या जीवनातही एक नवा ताजेपणा एक नवा उत्साह आणू या..

One of the first principles participants learn is that weight loss is not the cure for obesity.Effective lifetime weight management requires absorbing new concepts of nutrition, activity and conflict-resolution, then utilizing a new battery of problem-solving skills to implement and shape new behaviors.

Because most commercial diet centers only focus on the diet, they provide some combination of products special foods, supplements, lectures and so on. Few, if any, actually offer a program that identifies and changes the behaviors that contribute to your being overweight in the first place. Our programs, will help you overcome the avoidance and denial that have made and kept you overweight. While you re losing weight you will receive professional help and be held accountable for your actions. Clinical studies have shown that accountability and behavioral counseling are effective tools in weight loss and they are the cornerstone of Dr.Misal Dental and Ayurved Center program.

Our Programs are designed to treat every individual with varied systemic problems like Diabetes,Heart Problems,Harmonal Problems,DCOD & So on

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About obesity center

(Content is taken from website:www.jeevanrekhaayurved.com)

About 9000 patient from all over India and abroad have undergone this treatment and management for obesity. We are the pioneers to use sesamol as anti ageing and anti obesity drug. Routinely the treatment consists of six days primary treatment which consists of oily medicine containing curcumin an alkaloid from cucuma longa, low molecular weight tannins and sesamol. It also contains essential fatty acid linolic acid. The liquid medicine is given in specific doses and weight reduction starts within 48 hours after administrating the drug. In these six days very strict dietary regimes are advised. After completion of six days therapy normally patients reduce by 2-5 kg of their weight.
There after herbal formulations are administered along with specific diet and fat reduction of 2-4 kg /month is achieved.

Mode of action of the treatment:- This treatment is totally a diet controlled based treatment which is strictly based on Ayurved concepts of diet. The first six days treatment imparts a very strong antioxidant activity which is induced by curcumin and sesamol .
More, the lipid peroxidation in the patient more the weight loss with in first six days.
 
Treatments after six days: This different comprises of different formulations as per the necessity of the patients. The formulations are totally herbal with vacuum distilled extracts. The formulations are totally standardized and are completely devoid of metals. These formulations exerts number of activity like sensitization of insulin receptors, regulation of leptin, regulation of cholecystokinin , stabilization of hunger and satiety center at the hypothalamus levels, regulation of LH in patients of PCOD and regulation of thyroid hormones  . Apart from these activities immuno modulation, antioxidant activity is achieved. These medicines are also known to normalize and regulate Cholesterol and triglyceride levels with imparting unwanted effects.
This anti obesity treatments has helped to reduce maximum 59 kg weight in a time span of six months. On an average first 10 kg weight is reduced with in two and half month. To reduce twenty kg weight it may take 5-6 months and so on.
This management has saved number of joint replacement in the patient of obesity induced arthritis and number cardiac interventions due to obesity. Apart from these results patients are known to develop self confidence and feeling of well being.
The most important aspect of this treatment is that patients are educated along with treatment about the dietary programs, compensation of diet and exercise. This helps to maintain their weight and fitness through out the life.
One thing for obese person is nothing works like diet controls which is to followed for a life time period. Every type of food is allowed but in limits. Limits will be designed by us as per condition of the patients.

Effect of herbal formulation on Obesity.

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Obesity has increased at an alarming rate through out the world and is now a universal public health problem . It is often associated with insulin resistance, dyslipidemia, and hypertension; thus, the concept of the metabolic syndrome has been proposed . Obesity is considered a long-term complex disease. Many factors are involved in determining why some people are heavier than others and how much risk they have for developing other medical problems. In Charak samhita Ashtunindit adhaya of sutra sthan has mentioned about obesity pathology, symptoms, complications and prognosis of obesity. Herbs which can be used and the procedures to be done in obese persons are well mentioned  in Charak samhita.. Asthanga sangraha also elaborated the pathology in obesity and gives more importance to Agni  in obesity.

As per the Ayurvedic literature available excess of fatty diet, diet having Madhura rasa like milk and milk products, sugars , abhishayandi ahar and lack of exercise , day time sleep are the main causes of obesity. Apart from these causes, many more causes have been elaborated by modern science which are to be considered while managing obesity by Ayurvedic means.

The most important causes are insulin resistance, hypothyroidism, PCOD, etc. Excess of lipid peroxidation also plays as an important risk factor in obesity. All these factors collectively   or singly causes obesity . Thus obesity can be said as complex disorder , where causes is to found and must be managed like wise.

In modern medicines drugs like amphetamine, oristat , metformin are used which do not show promising results and also induce unwanted effects. Ayurveda has elaborated lekhaneeya gana in Charak sutra sthan chaper 4. The medicines mentioned in this group are used for weight reduction in different form which show promising results.The most important thing to be noted is that the drugs mention in lekhaniya gana do not have similar mode of action. They exert anti obesity activity by different mode of action. So while selection of the drugs cause of obesity must be diagnosed and then drug must be selected.  Asthanga hrudaya has mentioned the use of Sesame oil for obesity. The unique property of sesame oil mentioned by charka is,  sesame oil makes fat person thin and thin person fat. Much work has been carried by our center on this aspect.   

Thus, in the management of obesity it is important to consider all the causative factors regarding this disorder. Thus a formulation having potent antioxidant activity, strong insulin sensitizers, herbs having thermogenic activity , antilipidimic activity is useful to keep obesity under control. It has been seen by some of the workers that  depression also causes obesity.. In this context the formulation which work on neuropeptide is to be used.

This weight controlled program was started in 1996 . Up till date 9000 patients have under gone this program and found better results which are tabulated below.

Ayurvedic herbs are selected and given for the patients from 5yrs to 65yrs of age with or with complications of obesity.

Diagnosis is done on the basis of BMI , body fat content, Hip and waist ratio, and weight of the patients. Counseling was done for every patient for maintenance of diet controls. 72 weeks follow up after completion of treatment is advised.

Blood biochemistry and hormonal estimation like lipid profile, ESR, Sr.insulin, Thyroid function test and apolipoproteins is conducted  for  suspected patients.

Before starting the treatment a record chart of weight , blood pressure , BMI, Body fat % , Body Fat Mass , Abd Gerth, hip waist ration , FBS and PMBS is given to patient. Body fat % is measured by Bioelectric impedance analysis (BIA): In this method. A harmless amount of electrical current is sent through the body, and then percentage of body fat is calculated. It involves electrodes that are typically placed on a wrist and an ankle, and on the back of the right hand and on the top of the foot. Change in voltage between electrodes is measured. The person's body fat percentage is then calculated from the results of the BIA

The raw material which is used is totally standardized for every batch. Powders and vacuum distilled extracts are subjected to granules and tablets are prepared.

Hydro oxylation procedure is done over sesame oil to increase the sesamol percentage in sesame oil. Treatment is divided in two parts. First six days and after six days treatment.

First Six days treatment.

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For first six days the processed sesame oil is administered to the patients in fixed dosage irrespective of age, sex and cause of obesity . The patient s are asked to come on 3rd and 6th  day for follow up . On the days of follow up weight , Blood pressure and A girth is measured.  Out station patients can check their weight on their scale. It is important to keep a follow up on same scale only.
After six days patients are subjected to various formulations in specified doses  before meals with luke warm water until the patents achieve the target weight loss.
A particular diet is advised to the patients before and after six days.
After six days treatment patients is called every fifteen days and one month. In these follow up Fat % , Fat mass , H.W Ration , Blood pressure and weight was measured and recorded in the record chart of patient. Blood parameters are also recorded for the selected patients.  

The instruments used for total study are
Bio chemistry analyzer Erba bio chem. -5 ( Transasia)
Eliza reader (Lilac make)
Chemiluminosence ( Radio immuno assay) Monobind USA
Fat monitor ( Omran make) HBF -300
Standard weighing scale
Measuring tape.

Instruments  used for drug standardization
TLC
Uv – Vis double beam  Spectrophotometer Jasco make
Flame photo meter Elico make
Refractometer
Chemical analysis  like Acid value, Sap value For oil preparation

Results and up till date summary of the treatment is given in table given below.

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Total number of patients undergone this treatment Males Females Childrens Drop outs 9000 3782 4212 1006 1326 Records of First 6 days t/t with medicated oil 1 Maximum wt. reduced with this treatment 59 kg with in 7 months period. 2 Average weight reduced with in first 6 days 3.5 kg with in first six days. 3 Maximum weight reduced with in first 6 days 6.5 kg in first six days 4 Minimum weight reduced with in first six days 1 kg in first six days. 5 % of patients who did not responded to this t/t 6-7 % 6 Untoward effect found with in 1st 6 days t/t Nausea, head ache , drowsiness  with 40% patients. 7 Maximum abd girth / hip reduced in first 6 days 6 cm abdomen  and 4 cm hips reduction.

Records of After six days treatment with herbal tablets 1 Average Weight reduced with in first 3 months 10.2 kg 2 Maximum weight reduced with in first 3 months 18 .5 kg 3 Minimum weight reduced with in first 3 months 2 kg. 4 Untoward effect found with herbal tablet t/t Mild to moderate hair fall with 20% patients. 5 % of patient who have reduced wt above 10kg 48% 6 % of patients who have reduced wt above 20 kg 30% 7 % of patient who have reduced wt above 30 kg 15% 8 % of patient who have reduced wt above 40 kg 0.2 % 9 Number of patient who have reduced wt above 50 kg 1 10 Maximum wt. of patient when arrived for t/t 146kg 11 Maximum abdominal girth reduced with this t/t 45 cm i.e 1.5 feets 12 Maximum hips reduced with this t/t 50 cm 13 Maximum adipose tissues lost with this t/t 36 kg of adipose tissue

Rate of relapse  % of patients who gave follow up for more than 3 months 42% % of patients who gave follow up for more than 6 months 23% % of patients who gave follow up for one year 12% Rate of relapse of weight after completion of treatment 46%

The treatment is designed by using medicines along with calorie restriction. It has been seen by some workers that therapeutic calorie restriction reduces the aging effect on the body. This was seen at our center by a clinical trail on Argeriya speciosa and analyzing di hydro epi endosteron with some dietary controls.

The first six days diet is a high fat , low carbohydrate and low proteins diet which is called as ketogenic diet. This may induced mild ketosis which burns the fats as fuel for brain. This treatment consists of specially processed   sesame oil which consists very high % of sesamol which is potent anti oxidant , and may increase all the three endogenous anti oxidant like GPX, CAT and SOD at a same given period. It has been seen that the action of this processed sesame oil is very specific that it may not reduce any after 6 days. Thus, we claim that processed sesame oil may be working on only oxidized fats which are present on the body. This will reduce the risk of lipid peroxidation which leads to further metabolic disorder like microangiopathy , aconthosis nigricans, hypertension, diabetes and insulin resistance. This treatment is also useful in obesity induced other disorders like arthritis, coronary diseases, diabetes , hyper cholesterol and high lipid levels  where lipid per oxidation plays a important role.  

After six days herbal tablets are advocated to the patients in a specified dose. . This is a herbal blend having herbs which exert diverse mode of actions. After six days treatment high protein, low carbohydrate and low fat diet is recommended for the patients as per the WHO guidelines. More focus is given on fat, sugar, milk and non veg consumption. Fruits are totally stopped as fructose is known to stimulate hormone ghrelin which is known to stimulate appetite. Substances which are categorized in Abhishyandi group by Ayurved are totally restricted. Vidhur anna like sprouts are also restricted during the treatment.  ( 16)

 The formulation exerts varied mode of action like

 Potent antioxidant, insulin sentisizer, anti inflammatory which reduces pre inflammatory cytokines like interlukines which are raised in obesity. It is also known to reduce ultra sensitive CRP levels.  

 Regulates fat metabolism  and is seen to stimulate satiety center at a hypothalamus level.  

Formulation contains phytochemicals like    berberin apotent alkaloid which is having immuno modulatory and anti inflammatory property.  

Induces thermo genesis and some of the herbs in the formulation are known bio availability enhancer which increases the rate of absorption of other herbs in the formulation.  

Some herbs are  known to inhibit NF kappa B and TNF alpha which are raised in obesity.  
The formulation contains low molecular wt . tannins which  is known to regulate fat metabolism . Tannins are also known to regulate   intestinal hormones like cholecystokinine which plays an important role in obesity. Cholecystokinin (CCK) is a polypeptide hormone, widely distributed in the gastrointestinal tract and nervous system (both peripheral and central); it plays a major role in the digestive process. CCK also occurs in the brain, where it acts as a neurotransmitter and neuromodulator. CCK exists as several different molecular species: CCK-58, CCK-39, CCK-33, CCK-8, and CCK-4. The octapeptide CCK-8, for example, predominates in the brain. Also, there are at least two types of CCK receptors .  
Over the past 10-15 years, there has been much activity in the development of potent and selective CCK agonists and antagonists because these agents may lead to novel therapy for the treatment of disorders such as gastrointestinal disturbances, pancreatitis, gastric and pancreatic carcinomas, obesity, and cognition dysfunction, in which CCK has been implicated. Several such molecules are under active development. There are also satiety agents, fashioned after CCK, which may fight obesity.

Many a times, in weight reduction programs lean body mass decreases which lead to loss of muscle mass. Some herbs in the formulations are known to increase the lean body mass and hence restores the muscular strength of patients who are on weight reduction programs .The herbs stimulate the synthesis of cyclic AMP, which among other outcomes, triggers the release of fat from fat cells and speeds up metabolism by increasing thermogenesis (the rate at which the body burns calories at rest, emitting it as heat to the environment.) It is able to increase the release of stored fats, elevate metabolism and increase lean mass by increasing the synthesis of cyclic AMP, without stimulating the central nervous system.  

It has been seen that the above formulation has a multi dimensional effect on the pathology of obesity. It might be exerting its effect on the fat derived peptides like leptin, ghrelin , metabolic hormones like TSH, and insulin and intestinal hormones like cholecystokinin. The herbal formulation also works as an immuno modulator and antioxidant which are most important effects in the management of obesity.

As obesity is a multi factorial disorder  it is very important to rule out the under laying cause of obesity . Management must be designed in such a manner which will target the main cause and exert regulatory effects on fat and lipid metabolism , hormones concerned with obesity and maintain the lean body mass of the patient . In this study is has been seen that a significant weight loss can be achieved in a bigger group of patients with a pure Ayurvedic management.