Ask an expert - general - weight problems

9 questions

Q:  This is quite different from the usual enquiries about weight loss!

A: However, the first thing we would want to know in any case like this is what conventional medical investigations had been done, especially checks on many of the hormones of the body, to see if there are any major issues about uptake of nutrients or excessive burning off through, for example, an elevated thyroid function. We would also need to ask, as delicately as possible, whether there were any issue with food in the background, periods of anorexia in teenage years, from which the system has not yet fully recovered and re-balanced. And, of course, we would always ask about the rest of the family - it used to be said that oaks beget oaks, and willows beget willows. If someone comes from a family who are all slightly under-weight according to the charts which people use as a defining standard, then the chances are that this is a normal state for them.

 We would also want to ask a great many questions about food intake and appetite. Many people eat their meals at the wrong time of day, and often have foods which do not suit them, and this could well reduce their chances of gaining weight. This is much more likely to result in the opposite phenomenon, though, and we have to be honest and say that we have not come across people who have lost weight through eating the wrong types of food at the wrong time of day.

 The best that we can say, really, is that if the system is in balance, then unless there are physical reasons which prevent someone reaching a target weight they should be able to achieve some weight gain by the simple expedient of eating more. When looking at someone's digestion from a traditional Chinese medicine perspective we would be looking at their digestion, distribution and absorption processes to see if there were any signs that these were not working as they should. Such is the nature of Chinese medicine that this in itself would not be enough. It is critically important to see these functions within the context of the whole system, and that is why twenty people with the same symptom may be treated in twenty entirely different ways - we treat people, not conditions.

 The best advice we can give, however, is to visit a local practitioner to seek face to face advice about what is going on. If they can see something straight away which might indicate that there was an issue in your system that might be addressed and help your problem that would be a good basis to give treatment a try. Even if there weren't treatment of the person as a whole to re-balance everything can have a remarkable effect. What we advise people to avoid, though, is getting drawn into prolonged treatment at great expense without any real results.

 In your case, it would be important to establish what a reasonable target weight was, and also to research what kind of pace this change would need using conventional methods, i.e. not just gaining weight but doing so in a way which was sustainable and good for the body. This 'expert' could gain five pounds this weekend  by eating cream cakes but not in a way which was good for the body, or its shape. This would/could determine how much treatment might be necessary and over what period. If the desired change could take six months it might be unrealistic and unnecessary to have weekly treatment. It'a a bit like watering a plant; the plant has to have time to absorb and can't simply be watered daily to make things happen faster.

 We hope that this helps, and are sorry we can't be more specific, but this really is one of those cases where we would actually need to see what is going on to give more specific advice.

Q: I have hypothyroidism and am taking a 100 dose of thyroxine daily.
Since being diagnosed 10 years ago my weight went from 10stone to 12 stone over the first 3 years and has been steady at 12stone ever since. I do not eat sweets etc and have a pretty good diet. I know I am overweight and need help do you think acupuncture could be the answer. I have faith in it as I had a course to relieve severe hip pain some years ago and it worked wonders. I am a 65 year old female.

A:  We are always a mite cautious in answering questions about the management and effects of thyroid problems. Our clinical experience is that it can often take patients a considerable time to achieve a good balance of thyroxine, and one of the consequences of using acupuncture is that it can boost residual functions across the whole system. When people have limited function in the thyroid, and also in the pancreas and other endocrine glands, we are always concerned that we might just prompt the whole system to work better and cause fresh problems.

The first thing we would want to check is whether your thyroxine dose is precisely matched to your needs. Fluid retention and subsequent weight gain would be a sign of hypothyroidism, and it may just be that the dose you are taking is not quite meeting your current needs. On the assumption, though, that we can rule this out, the advice we give to people about acupuncture and weight loss is consistently the same - unless there is clear evidence that there are functional disturbances from a Chinese medicine point of view which might be causing some of the weight gain, we would never recommend acupuncture as a general treatment for weight loss. While our underlying belief is that a system in balance will perform better in all respects, and might in theory bring weight under control, the evidence from research and from our clinical practice is not that favourable.

One of the problems, of course, is that when we treat people for weight loss, it is rarely the only thing they are doing, and as people who go to Weightwatchers and similar organisations know from their initial briefing, after a short period of rapid loss every pound takes time, with targets set very low at a pound every two weeks or so. It is very difficult with this kind of time frame in mind to be able to determine whether acupuncture works or not, and whether it is having a direct effect or simply helping to maintain someone's determination to carry on.

That said, there are a number of syndromes recognised in Chinese medicine where we can and do give advice, and sometimes treatment, which can have an effect. Chinese dietary advice is always to eat more at the beginning of the day than later, and to avoid certain types of food. There was a saying used in this country 'breakfast like a king, lunch like a lord and dine like a pauper' which expresses well the best pattern of eating to fit in with the body's natural rhythms. Our digestive functions are far better in the earlier part of the day, and meals taken in the evening are never digested as well.

The main Organs of digestion, the Stomach and Spleen (we capitalise them to denote the Chinese medicine understanding), also work better when the food is fit for purpose. The Spleen is said to like warm dry food, and if it is over-loaded with cold and damp food, it under-performs and can lead to a condition the Chinese call Dampness which can mean an accumulation of fluids, especially in the middle third of the body and lower limbs) and a general feeling of sluggishness. When you think that the usual reaction to weight problems is to eat lots of salad, raw fruit and raw vegetables, it is not hard to see how things can easily get worse rather than better. This doesn't mean not eating all of these foods; they are still a healthy diet. It means rather to balance the coldness with something either physically hot or spicy hot. You rarely see cold food in a Chinese restaurant; even fresh vegetables are stir-fried to retain the crispness but lose the coldness.

What we sometimes advise prospective patients to do is to begin with a number of small dietary changes, and perhaps have a number of acupuncture treatments to see what happens. If the system is waterlogged this can sometimes mean that there is an immediate response to treatment and better dietary patterns. We have to be realistic insofar as people can't always change their eating patterns in one go, and we also need to be able to distinguish between what we do and what the dietary change is doing. However, if there seems to be some progress, then we usually discuss regular but spaced out treatment to keep the system working towards a better overall balance.

As always, it is best to visit a BAcC member local to you for a brief chat about what may be possible. Whatever we say here it will never be as accurate as what someone can tell you even from a brief look at diagnostic signs.

A:  As you can imagine, this is a topic which pops up relatively frequently, and a typical answer we have given in the past is:

Weight loss was the subject of some critical scrutiny a decade ago, and the conclusion drawn at the time was that acupuncture did not have any significant effect on
weight loss. However, trying to test whether acupuncture can help someone to reduce their weight is likely to be a difficult matter; there are dozens of reasons in Chinese medicine why someone's weight may be increasing. Trying to group together a sufficiently large number of patients whose western problem
and eastern diagnosis are the same is extremely difficult.

In one or two cases there is a very direct correlation between someone's weight and their underlying imbalances from a Chinese medicine perspective. Correcting these may have an immediate impact on, say, the amount of fluid someone is carrying, and that could create a 3-5kg loss very quickly.

However, all of the best dietary programmes say that after the initial and often quite dramatic week or two most good weight loss programmes at best will see someone
lose only a pound or two every month, and in fact, there is discouragement from trying to do more in order for the body's system to keep pace with the change.
Acupuncture may well have been used successfully alongside some fairly strict dietary rules, and from a patient's perspective it would be very difficult to say whether the acupuncture treatment added value to what someone was doing already.

The bottom line is that there are are no 'magic' points which reduce someone's weight without effort, and the effect of acupuncture may be no more than to give
someone the support and commitment to keep trying with diet and exercise programmes. However, if someone remains motivated as a consequence of acupuncture
treatment that itself would be a very positive outcome.

There is nothing that we would add to this advice other than to beware of anyone making promises they cannot keep about what acupuncture treatment can deliver. Some of the less reputable high street shops still appear to be making claims of a fairly speculative nature without any evidence which supports what they claim.

This is probably the best advice that we can give. Our clinical experience is that their are often subtle emotional and spiritual issues underpinning the loss of control which people have of their weight, and some of these are amenable to acupuncture treatment. We have answered many questions on anxiety and depression, and we find quite often that a response to depression is to comfort eat. Helping with the depression may well reduce the desire to use food in this way.

One has to be realistic, however. Some of the psychological issues are not best suited by long term acupuncture treatment and really do need to be addressed directly by
someone skilled in this area. There are also many occasions when the 'habit energy' to eat is so well entrenched that a direct intervention like hypnotherapy or cognitive behavioural therapy is appropriate because it goes straight to the point. We also have to tell some patients, sensitively we hope, that oaks breed oaks and willows breed willows. If a family are all size 18, then the chances are that trying to be a size 8 is not going to be likely.

The best advice we can give is that visiting a BAcC member local to you will be able to provide you with advice based on a brief face to face assessment. This is very
likely to offer you the best range of options for you. All of our members are concerned to ensure that a patient gets the help they need, which is not always what they have to offer. We often refer to other colleagues if we feel something would work better. Each patient is unique, and finding what works for each individual case is the best guarantee of success.

Q:  I have had hypothyroidism for approx 6 years now, and despite endless efforts, yoga, Zumba, walking, Pilates, diets of every kind, supplements, etc etc, I have not been able to shift the extra weight I gained when my thyroid condition first presented. 
I am now approx 1.5 stones overweight and very miserable and self conscious as a result. And the constant failure despite every effort is even more disheartening. 
Now I am contemplating acupuncture for weight loss but need to check if I can have acupuncture if I have hypothyroidism? 
I also have a brain tumour, (an ependymoma in the 4th ventricle, for which I was treated 11 years ago with surgery where some of it was able to be removed, followed by 6 weeks radiotherapy) 
So, please could you advise if I am able to have acupuncture?

A:There are no contra-indications to the use of acupuncture when someone has hypothyroidism. Indeed, we are sometimes asked if acupuncture can be used to treat hypothyroidism, and a sample answer that we gave says:

A: There isn't a great deal of research to underpin a straight recommendation for the use of acupuncture in the treatment of hypothyroidism. What there is suggests that acupuncture may be of benefit, but this is a condition for which some form of maintenance medication is often essential and this makes testing it in trial conditions somewhat more difficult.

For the same reason our members are always told to be cautious in treating conditions where someone is on essential medication. Recommending that someone stops their medication is out of the question - only a doctor should be making this decision in the case of essential meds - and there is always an issue about adjustment. If the treatment as the effect of improving someone's thyroid function it may then mean that the dose of medication which they take may no longer be suitable. Since it often takes a long time to achieve a stable balance with the medication in the first place, it is important to avoid as much as possible the kind of yo-yo adjustments which people often experience when they are first prescribed their medication.

That said, the important point to make is that the Chinese would have recognised the symptoms of hypothyroidism two thousand years ago but have no idea about the relationship they had to a thyroid malfunction. The symptoms would have been analysed within the diagnostic systems of Chinese medicine, and a treatment plan devised to help correct them. The Chinese understanding of human physiology was entirely different, and rested on a concept of energy, called 'qi', and its various functions and inter-relationships. The kinds of symptoms which someone experiences with hypothyroidism would be linked to a failure of organic function as understood by the Chinese, and even where there was no explicit correspondence, the underlying premise that where there is balance symptoms disappear would nonetheless apply.

If you are thinking of having treatment it would be good to see if you can discuss your specific presentation first with one of our members, and see if they feel that this is something which they feel would be of benefit to you.

We would offer the same advice today and re-iterate the fact that it can quite often take a long time to stabilise thyroid medications. If acupuncture does have the effect of improving the residual function of the thyroid it may take a while to balance the doses of medication again.

We are always cautious when people ask us about using acupuncture for weight loss. There are a number of well-defined and easily recognised syndromes in Chinese medicine where additional weight gain, often in the form of retained fluids or precipitated by an under-performance of parts of the system, may be amenable to treatment. However, even here there is no guarantee that someone will lose weight, and evidence overall for acupuncture and weight loss is poor. It is also, even when part of a successful regime, not entirely clear what causes what. Very few people do only one thing to try to lose weight, and it might be any factor or all in combination which achieve a result.

What we can say is that there may be some aspects of managing one's diet according to Chinese medicine principles might be of benefit, and most practitioners will be only too happy to share this simple wisdom whether you proceed with treatment or not. The best and only advice we could give, though, is to see a BAcC member local to you for a brief assessment of your own unique situation and whether they think acupuncture treatment may be of benefit.

Q:  Is acupuncture an effective treatment of Bile Salt Malabsorption? I've put on about 3 stone since I've had this, and there is no cure. I'm desperate to lose weight and get some treatment for this condition, which although isn't life threatening is debilitating. Any advice you can give would be much appreciated.
A:  Bile Acid Malabsorption syndrome is one of those conditions which appears to have only recently warranted a name of its own, so there hasn't been a great deal of chance for anyone to research the use of acupuncture under problems with this name. We are fairly sure that you have done a great deal of research on the internet over the time that you have suffered from these problems, so you are probably conversant with the different ways in which the condition can manifest and some of the causes. Unhelpfully, of course, one of the most frequent labels is 'idiopathic', which is a Western medical way of saying 'it just happens and we don't know why'.
From a Chinese medicine perspective, though, the disease labels are often very unhelpful. What interests a practitioner of Chinese medicine is the symptoms with which a patient presents, together with the history and sequence of how they developed and the patterns which they form. The Chinese understanding of the body is very different from the Western one, with the concept of 'qi', or energy, being a central one. The quantity, flow and balance of qi determines good health, and the Organs of the body (we always use capital letters because what they do is very different from the way they are understood in the West) have a variety of functions which with a good flow of qi they maintain. When symptoms arise, they point to a weakness of flow in parts of the system. With the help of the patient's description of their symptoms and case history, together with diagnostic signs which are unique to Chinese medicine like looking at the tongue and taking the pulse at the wrist, the practitioner aims to establish where disharmony lies and addresses it.
In your case the weight gain, which is commonly reported in this condition, might have one of a number of recognised causes from an Eastern perspective, and if the diagnostic signs and answers to questions about other bodily systems point in consistent directions, there may be something for which a practitioner could offer hope. In Chinese medicine,for example, weight gain can often be tracked back to the poor function in the Spleen (note the capital letter - we are not talking about the western organ, the spleen!), which can cause an accumulation of fluids, especially in the central part of the body. If this is malfunctioning to a significant degree, then other aspects of the Spleen's functions will start to manifest problems. Someone may find they are visiting the toilet more frequently and urgently with looser stools, or they may find themselves bruising more easily, or their short term memory and concentration may be not as good as it was. These are all signs that the Spleen may be off key. The Chinese medicine practitioner would ask many questions to get a sense of what may be going on, and if the tongue and pulse supported this diagnosis, there are clear protocols to follow.
The beauty and complexity of Chinese medicine,however, lies in its ability when practised well to go to the heart of the problem, not simply treating where symptoms arise. The complex inter-relationships within the system can mean an Organ under-performs not because it is actually suffering but because it is not being supported by another Organ, and the reason that one can never reduce good Chinese medicine to formula treatments for named conditions is that a single named condition might have any one of a dozen different causes - it is the skill of the practitioner which enables them to go the point which will have the greatest effect in putting things back in order.
This may not seem as though it is directly addressing your problem, but what we are saying is that this is one of a number of conditions where the symptom and disease label alone are not enough for us to be able to offer a view at a distance, especially since the variety of possible causes means that there has not even been any targeted research on the basis of the evidence of which we could offer a view. What you need is a brief face to face assessment by a practitioner, hopefully without charge, to establish whether what they see encourages them to offer treatment with some hope of success.
That is not to say that there has to be a distinct and visible cause from a Chinese medicine perspective; the oldest systems still in use were broadly asymptomatic, treating people rather than diseases in the straightforward belief that a system in balance did not generate symptoms. However, even within this system, a practitioner can usually give an honest appraisal of the possible value of treatment before committing your time and money.
You can find a list of all the BAcC members in your area by using the practitioner search function on the BAcC's home page.    

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