Yoga/ Clinical Applications

Doctor Yogi: The Clinical Applications of Yoga

The Art of Yoga in Chiropractic Practice: Happy, Healthy and Holy

By Hari S. S. Khalsa, DC

The techniques of yoga (and chiropractic) have powerful effects on health and wellness; however, they are only techniques. A teacher (physician) is necessary to direct the practice (adjustment) to achieve the goals of removing the blocks (subluxation) from the chakras (nerve plexus), so the kundalini (pure innate) can flow naturally through the shusmana (major central nerve of the spine).

A teacher or chiropractic physician who has walked the path of awareness (and removed many subluxations) can direct his or her students and patients through the stages of development. The art of detection and safe removal of subluxation results in an experience of the true self, free from interference between the individual human and the infinite nature. The yoga practitioner and the adjusted patient both experience a similar consciousness whereby the infinite self (innate self) and the individual self are one and the same. All is free and natural, functional and healthy. In the kundalini yoga lineage, this holistic and reverent state of equilibrium is expressed as happy, healthy and holy. (See www.3HO.org for more information.)

The Science of Yoga in Chiropractic Practice

Science has quantified and qualified the effects of chiropractic and yoga in countless ways. Scientific studies show how the chiropractic adjustment affects every system of the body, including the immune system, the endocrine system and especially the nervous system. Yoga has been shown to have a positive effect on more than a few conditions, ranging from diabetes and asthma to schizophrenia, headaches, and digestive disorders. A flood of information can be found regarding the health benefits of a regular yoga practice. Those wishing to examine these studies might start with a Pub Med search on kundalini(www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?CMD=&DB =PubMed).

The Mental-Emotional Connection

The mind-body connection is no longer a mystery, thanks to the work of Candace B. Pert, Deepak Chopra, Andrew Weil, and other modern pioneers in this field. Meditation is being shown to produce lasting, beneficial changes in immune function and brain electrical activity, according to a University of Wisconsin-Madison study by Richard Davidson, PhD. Davidson found 5 percent to 25 percent higher levels of flu shot antibodies in meditators as opposed to nonmeditators. Researchers found roughly 50 percent more electrical activity in the left frontal regions of the brains of meditators. The level of antibodies increased in direct relation to the level of increased brain-wave activity.

Mental-emotional aspects clearly affect physical function, as is illustrated in over 500 transcendental meditation (TM) studies performed by the Transcendental Meditation Association, among others. A 1989 study shows a sustained 10-point reduction in blood pressure after meditation instruction (Journal of Personality and Social Psychology1989;57(6):950-964).

Stress is a major contributing factor (if not the root cause) of the vast majority of modern health issues. The overstimu-lation of the sympathetic nervous system and subsequent glandular secretions, age us, degenerate us and kill us. Hans Selyes' classic text, The Stress of Life, illustrates the mechanism of what he calls the "relaxation response." Herbert Benson later quantified the physiology of meditation by measuring reduced cortisol levels during the "relaxation response" (Benson, Herbert. Timeless Healing: The Power and Biology of Belief; New York, Scribner, 1996). This deep relaxation, which yoga practice can facilitate, is essential to the healing and regenerating process.

Applied Yoga Techniques

Although practicing kundalini yoga may provide tremendous health benefits and improvements, it is important to note the following:

Yoga techniques are not used for curing specific conditions, illnesses or diseases.

"Kundalini Yoga as a system was never illness based. It wasn't started as a system to cure anything. As a system, it is not inherently a therapeutic model, even though it has enormous therapeutic benefits. Rather, it was based in excellence and exaltation. It is the science of how to excel and fulfill oneself in the experience of being human. We do not teach Kundalini Yoga to heal a disease. We teach yoga to the person who has the disease. Kundalini Yoga is a sacred science. Through it, the sacredness of the student is awakened. It is designed to give us the experience of connection; to respond to the command of the soul and the Infinite."

- From the Kundalini Research Institute's
International Teacher Training Manual, Level I.

Yoga has many limbs, some of which are briefly described below. The clinical application is specific to the individual patient. An experienced, qualified, certified and compassionate teacher will supervise every therapeutic regimen. Kundalini yoga uses all limbs and facets of yoga, so the certified kundalini yoga teacher is knowledgeable and experienced in each therapy.

Breath (Pranayama) - Breath is essential to life. Breath contains vital force, which is known by yogis as prana - pure energy. The first manifestation of stress is in the breath. Breath analysis provides many insights into the posture, mental aspects and stress factors of a patient. By bringing awareness to the breath, we can access the "override" system of the mind. In the practice of pranayama, specific breath patterns help override or direct both the subconscious patterns of breathing and the unconscious patterns of living. This is partly because breathing patterns profoundly affect the glandular system. A yogi breathes every breath to its full capacity, with a total and complete inhale and what is often called an authentic or "honest" exhale (meaning no air is held in reserve). With proper breathing, every organ is massaged, every system revitalized, and the mind is fed.

Physical (Hatha) - The physical body is the first frontier of exploration as a human being. The purpose of the body is to act as a vehicle for happiness and provide a temporary home for the soul.

In the West, the physical postures of yoga have been strongly emphasized. The physical aspects of yoga provide a foundation for the journey. Specific yoga exercises allow strength and flexibility to be achieved physically. Through movement with synchronized breath, the patterns of the psyche that manifest in the body are released and health restored. The physical matrix of the yogi is comprised of various channels and nadis, organs and glands, which are activated to produce states of awareness. Balance in the body directly impacts capacity, stability and overall experience.

Meditation (Raja) - The mind is a very complex, sophisticated broadcaster and receiver of the electromagnetic waves that guide awareness and perception. As you think, so you are! The mind guides emotions and can sometimes distorts perceptions with preconceptions. Specific meditations are utilized to address blocks in the mind. Meditation has been shown to encourage the development and evolution of the prefrontal cortex and also has a positive effect on cardiac function.

Sound (Naad and Laya) - Sound affects us in many ways. It is the way humans manifest reality. You can hear in the voice how a person perceives reality. Sound is vibration. We are frequency generators and receivers, transmitting and receiving constantly. Yoga involves both the listening and the creation of specific sounds.

Diet and Lifestyle - Changing the chemistry of the brain affects the nervous system, which affects all other systems. The goal of yoga diet therapies is alkalization of the blood, which reduces the reactivity of excitatory neurons and synapses, lowering pain thresholds and inflammatory processes while facilitating meditative states. Specific dietary regimens are utilized to address specific organs and conditions.

Hydrotherapy (Ishnan) - Bathing techniques are utilized to sustain proper blood flow and to flush the capillary system. Hot water, cold water, special oils, iced sheets and massage are used in Ishnan treatments.

Massage Therapy - Massage is a very traditional therapy, originally applied in conjunction with yoga practice. There are many specific massage techniques that draw on a systematic relaxing of muscle, fascia and tissues. (See Healing Hands by Dr. Wahe Guru Khalsa for more information.)

Analysis

Several areas of analysis will help pinpoint existing or potential restriction. The following is a guideline for some of the examination parameters:

Navel Point: Observe the position, rate and rhythm

Breath: Observe depth and rhythm

Posture: Observe standing and walking; tone, tension and flexibility

8 Chakras: Observe tranquility, vitality, sensitivity and stability

Digestion: Observe assimilation and elimination

Treatment in Addition to Regular Chiropractic Adjustments

Kriyas - Specific movements, breathing techniques and eye focus are implemented in a specific sequence to achieve a desired effect. Kriyas are designed to strengthen and fortify the glands, organs, nervous system and tissues, not to treat specific conditions or diseases.

Meditations - Meditations involving breath, eye focus and sound are utilized to expand aspects of the mind.

Diet - Diet directly affects the chemistry of the body, the vitality and adaptability of the nervous system and brain functions. Dietary recommendations can be utilized to provide a supporting neurochemical environment.

Treatment Plan

Frequency of care

Ongoing lifestyle enhancements

Systematic progress reviews

Re-evaluation of patient

YOGA/Clinical Applications

Doctor Yogi: The Clinical Applications of Yoga (Part 1 of 2)

By Hari S. S. Khalsa, DC

Hari S.S. Khalsa, the founder of kundalini chiropractic, began practicing and teaching yoga in 1981. In 1990, he attended Life Chiropractic College - West, graduating with a citation in clinical excellence in 1993. 
Since then, he has been practicing chiropractic and applied kundalini yoga therapies.

D.D. Palmer suggests the connection between chiropractic and yoga in his Laws of Life:

"Want to let the innate contact you? The sincere yogi would make an excellent chiropractor for getting sick well if he had knowledge and ability to correct the intermediary adjustment to restore power of internal innate, to perfect greater understanding." - Palmer's Laws of Life,
Vol. XXXIV, pp. 22-23.

Chiropractic Patients and Yoga Students

Of those who practice yoga, 95 percent are likely to utilize complementary and alternative therapies, according to the results of a recent national survey. (Presented at the International Scientific Conference on Complementary, Alternative and Integrative Medicine Research, Boston, Mass., April 12-14, 2002). Chiropractic and the practice of yoga are both growing, because of an increase in patients' participation in their own health care and their demand to be healthy in a natural way.

Recent studies indicate that in America more than 15 percent of the population has consulted a chiropractor. (Trends in alternative medicine use in the United States, 1990-1997, Eisenberg DM, et al., JAMA 1998;280:1569.) JAMA reported in 1997, and Roper revealed in 2000, that over 20 percent of Americans has either practiced or expressed interest in yoga. As the average age of the population increases, so will the demand for holistic health care services. The pressures of the times are upon us to deliver people to their own infinity. The chiropractic physicians of today are the teachers and leaders of tomorrow. We are not technicians; our impact must educate, inspire and uplift.

The Basic Philosophy of Chiropractic

The philosophy of chiropractic is described in a Web page from Life Chiropractic College - West (www.lifewest.edu/docs/about.html.):

Chiropractic is a natural, preventative, and non-invasive form of health care, which is based on the principle that the body has the inherent ability to heal without the use of drugs or surgery. This fundamental approach to wellness mirrors a new and changing attitude toward health care in the United States and around the world.

Since an individual's health is either directly or indirectly controlled by the nervous system, interference within this system impairs normal function and lowers resistance to disease.

Through chiropractic adjustments, nervous system interference due to abnormalities in the musculoskeletal relationships of the vertebrae (called subluxations) can be corrected. This allows the nervous system to function properly, enabling the body to self-regulate and self-heal through its own natural recuperative powers.

The Basic Philosophy of Yoga

Yoga is a practical system of human development. Its goal is an experience of infinite innate consciousness within the physical form, allowing one to reach his or her full potential, live a happy life, and excel in one's excellence.

Human is really "hue-man": "light person." Yoga is a development of the "being," not a system of doing. The Sanskrit word yoga is translated as, "yoke, union, a joining together." Yoga is an ancient system of synchronized actions designed to unite you with you.

Each individual is complete, autonomous and whole. The whole range of experiences contained in the universe is present and available to the yogi. Yoga is an inside journey; an adventure in consciousness. We each have a yogi inside us; a happy, natural, subluxation-free human being; a person of radiant light and infinite happiness. We are born to be most excellent radiant souls, beaming a radiant light.

The body has an ability to heal itself and can be self-regulating. Yoga teaches that the body is the vehicle for the primary self (soul, atma, spirit, infinite, and innate: true self). That which is not the mind and not the body is the soul or spirit. The life force or vital force is an expression of this primary self.

The first expression of the soul is through the psyche, which designs and constructs our spiritual architecture and the way we contextualize our life. The psyche directs the mental waves, which manifest themselves in physical patterns through the nervous system.

Bioelectrical energy flows through channels in the body referred to by yogis as nadis, which include the nervous system and meridians.

Yoga puts you in command of your domain. The skill of directive action is practiced to develop the self-command center. The classic analogy is of the chariot: the horse and the driver. The chariot is the body; a vehicle for experience. The horse is the pull; the mind; and it brings the body along. The rider is you; the essence; the soul. The self directs the mind, and the body follows the mind.

The traditions of yoga are thousands of years old. There is a clear connection between the lineage, philosophy and application of yoga and that of chiropractic.

The basic philosophy of innate intelligence directly parallels the yoga concept of infinite consciousness. Yogi Swami Vivekananda traveled throughout the Midwest extensively, drawing the attention of fellow scientists such as Nicholas Tesla and others. It is possible that Drs. D.D. Palmer and A.T. Still both encountered Swami Vivekananda in the American Midwest in the early 1900s.

Kundalini Is the Currency of Yoga

The goal of all forms of yoga is the circulation of kundalini - the coiled energy stored in the spine that circulates through nerve plexuses called chakras or naadies. Kundalini is pure innate intelligence; the total potential energy of the human. It is the vital force: the infinite organizational force that spins every electron and supports every aspect of life. With practice, we can direct it to heal, communicate and create. Kundalini is the energy that prevails throughout the universe.

What Is Yoga?

Yoga means union: a yoking; a connection between you (personal) and YOU (infinite innate). The techniques of yoga free restrictions in the natural flow of your true nature. Yoga eases resistances in all aspects of life. Each yoga action is a microcosm of life.

In chiropractic vernacular, when we are free of subluxation, we are able to express the greatest human potential, mentally, physically and spiritually. The liberated human existence is possible. Free from restriction, we can live with happiness, harmony and gratefulness. The philosophy of yoga directly parallels the values and principles of chiropractic. Yoga is a natural system of techniques utilizing the breath, mental focus, and physical movements and postures to create an experience designed to increase awareness and remove any restrictions or contractions in the fluidity of the nervous system and the psyche. Restrictions and conflicts in consciousness manifest in the spine as subluxations.

What Is Kundalini Yoga?

Kundalini yoga is an adventure in consciousness; a systematic approach utilizing all the limbs of yoga in a synchronized manner to create a symphony of infinite innate experience. In 1969, Yogi Bhajan, PhD, came to America and for the first time, openly delivered the teachings of kundalini yoga to the Western world. Since then, he has taught the science of kundalini yoga and humanology to thousands. Included in his instruction are several ancient yoga massage techniques specifically appropriate for chiropractors. (Dr. Wahe Guru Singh Khalsa details several of these techniques in the book Healing Hands.)

Kundalini yoga is unique because it utilizes all of the limbs and facets of yoga, creating a complete, transformative experience.

Brain Chemistry and Healing

D.D. Palmer emphasized the three pillars of health: structural, mental/emotional and chemical. These ancient techniques of yoga and food therapies are at the center of what has become known as mind-body medicine. This mind-body connection is discussed in Dr. Candace Pert's book, The Molecules of Emotion (Simon and Schuster, 1999). She illustrates how meditation affects brain chemistry, and how brain chemistry affects every organ system. Dr. Pert has identified receptor sites for brain chemicals like serotonin in the digestive and immune systems.

The tradition of yoga addresses brain chemistry by preparing the individual's internal chemistry to receive clear or undistorted knowledge. Often, a preparatory diet and other specific lifestyle enhancements are recommended before the practice of yoga even begins. This is designed to allow a person to perceive the teachings and experiences with clarity, rather than distortion.

According to recent research at the National Institute of Health, yoga and related relaxation techniques appear to have a positive effect on the body's ability to heal and stay healthy. Recent studies show that patients with insomnia, depression and stress-related conditions are positively affected with the use of yoga therapies. (Yoga treatment in psychological insomnia, Koch U, et al. J Sleep Res;7(Suppl 2):137, 1998.)

Yoga in Chiropractic Practice

The basic chiropractic concept, "The force that made the body can heal the body," is similar to the ancient yoga principle that the creator and the creation are one. We are spiritual beings, here to have a human experience, not humans searching for a spiritual experience. Our spirit, in chiropractic terms, is referred to as innate intelligence.

Both yoga and chiropractic look to the mind, full of preconceptions and beliefs, as the essential cause of human suffering. By nature the soul is happy, content and in harmony. It is our mind that creates expectations, conditions and contractions, which are expressed as fear in our lives and manifest as physical contractions. The subluxation complex is this manifestation of the contraction of a human psyche. Chiropractors remove interference between the central nervous system and the peripheral nervous system by removing subluxation or blocks in the spine. The goal of a yoga practice is to annihilate the restrictions of consciousness that manifest as mental patterns and restrictions in the physical structure.

Yoga practitioners approach their yoga practice with the same deep reverence chiropractors utilize in adjusting patients. The practice of yoga utilizes two distinct aspects: Bakti and Shakti. Bakti is pure devotion. It is the attitude with which one approaches a personal practice. This is applied in the chiropractic practice as a sense of sacred duty toward the patient. Shakti is pure power. It is the voltage and amperage within the individual. It is the autonomous self and the infinite spirit combined to create a person of light: hue-man. This is applied in the chiropractic practice as the knowledge and magnetism the chiropractor brings to the patient's awareness through his own excellence and integrity.

Yoga and chiropractic are sciences of applied consciousness, both utilizing awareness to see the universe without separation. It is the destiny of chiropractors to remove subluxation; it is the destiny of yogis to liberate themselves from the reactions and tendencies that restrict consciousness; and it is the destiny of a teacher to guide others to their freedom and happiness. Kundalini yoga therapies and the chiropractic adjustment create a complementary, complete, holistic health care system and can be integrated to serve the needs of all your patients.

Hari Simran Singh Khalsa, DC
Phoenix, Arizona 

STRESS

Stress, the Mind and the Body

Reductionism vs. Holistic Approach

By J. P. Pawliw-Fry and Todd Stephens, chiropractic interns at Cleveland Kansas City

Rather than addressing the whole system contributing to health and well-being, medical and chiropractic science often limit themselves to a uni-analysis of factors -- to the germ or the fixated segment -- viewed as the cause of dis-ease or ill health. 
These one-point analyses are essential elements but, they are just one component of what is required to fully understanding illness and health.

The approach to health care has been, and continues to be, largely based on this reductionistic disease model, which not only is limited in its utility, but also extremely costly. Even so, it has remained the standard paradigm of our approach to health and disease. David Sobel, MD, MPH, of the Kaiser Permanente Foundation, points out:

"Medical treatments, especially the drug and surgical treatments of sick individuals, have had relatively little to do with the better health that people enjoy[ed]. We are wedded to medical ideas that are incorrect."

Emerging Disease Trends

In the post-industrial societies, new demands and realities influence health and well-being. Infectious disease is no longer the threat it once was, resulting in major limitations of the germ theory. We are now faced with so-called problems of well-being and prosperity: chronic conditions such as cardiovascular disease, cancer, and pain syndromes.

In an address presented at a recent international symposium on the effectiveness of disease prevention and health promotion held by the Centre for Health Promotion (University of Toronto), Dr. Bo J. A. Hagland of the Karolinska Institute in Sweden, described another emerging disease trend in the area of "psycho-emotional social health." This trend is thought to escalate into the 21st century, largely caused by the stress of life in post-industrialized societies. According to Dr. Hagland, no longer are infectious diseases the major cause of ill-health, nor the so-called unhealthy lifestyle behaviours (smoking, alcohol use, sedentary lifestyles, etc.) be seen as so critical. Stress is now becoming the major challenge to optimal health of individuals and societies. The physical and social environments in which we work and live will be the major contributors to our health. Given this new emergence of psychosocial emotional disease, a modified approach is essential for ensuring a relevant response by the health care system. A New Strategy: Behavioural Medicine Mind/Body Medicine

Behavioural medicine or mind/body medicine (a subspecialty of behavioural medicine) is a newly developed area that responds to the psychosocial component of disease. In this field, mental and emotional factors, the ways in which we think and behave, are recognized for the significant role they play in our health. Such factors have a fundamental impact on our ability to withstand and recover from illness and injury. Mind/body medicine recognizes the strong interconnection of mind and body, believing it is only through a deeper understanding of this relationship that we can truly understand health and disease. The power that made the body can heal the body; in this way, it shares a strong similarity with chiropractic philosophy.

Through mind/body medicine, allopathic medicine is gradually developing a response to shifting disease trends. New clinics focusing on the "whole person" and the stresses they face in their lives are emerging as a consequence. Although the notion of stress interventions is certainly not new, there are growing successes in the range of illnesses found to be amenable to this type of treatment. There is very good research to suggest that interventions based on current stress reduction techniques are highly efficacious for such diverse conditions as: 

• pain syndromes (headache, low back pain, neck pain)
• gastrointestinal problems;
• premenstrual syndrome and menopausal hot flashes;
• infertility;
• cardiovascular disease;
• insomnia; and
• immune system disorders.

Chiropractic and Mind/Body Medicine

So where does the chiropractic profession stand on this issue? As with the majority of other illnesses, joint and muscle disorders do not exist in a vacuum. Are we reductionistic like the traditional medical practitioners? Do we need to consider other components of the subluxation complex, not just the fixated segment? What is our philosophy of health? These are important questions when respected institutions such as Harvard's Mind Body Medical Institute states that 70-90 percent of all disease and illness is caused by stress.

The doctor of the future, whether in chiropractic or medicine, will have to consider all relevant components of the presenting patient, from the necessary one-point analyses to larger behavioural determinants. This combined form of treatment is not only clinically effective and cost-effective, but the emerging disease trend of the 21st century requires this approach. Already HMOs in the U.S. are covering these interventions. Furthermore, the National Institutes of Health in the U.S. recently published a consensus statement describing stress interventions as a treatment of choice for chronic pain syndromes.

Max Plank once said that a scientific truth does not triumph by convincing its opponents, rather its opponents die off and a new generation grows up aware of the new truth. The era of mind/body medicine is upon us. It possesses part of the best current explanation of what constitutes optimal health. Will chiropractic be part of the new paradigm or part of the old generation?

References

Ornstein, R, Sobel, D. The Healing Brain. New York. Simon & Schuster. 1987

Proceeding of: Symposium on the Effectiveness of Health Promotion: Canadian and International Perspectives. The Center for Health Promotion, University of Toronto. 1996. In Press.

Kabat-Zinn J et al. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry 1992; 149: 936-943.

Benson, H. The Mind/Body Effect. New York Simon & Shuster.

J.P. Pawlin-Fry BA, BPHE, DC
Elizabeth Pawlin-Fry BSc., M.HSc

STRESS

Stress in the Modern Age: Impact on Homeostasis and What You Can Do (Pt. 2)

By Jerry Jacobson, PhD, DMD, IOM

Editor's note: As the author states in part 1 of this article, "The list of negative consequences from chronic, unresolved stress is seemingly endless. Clearly, communications net-works (e.g., electrochemical and electromagnetic, of homeostatic function), must be renormalized through various methodological approaches initially external to the organism's natural adaptive mechanisms." That statement sets the stage for the following discussion.

Neurotransmitters and the Stress Response

GABAergic neurons are decreased in generalized anxiety disorders. GABA is gamma-amino butyric acid, a principle inhibitory neurotransmitter used to treat epilepsy. In generalized anxiety disorder (GAD), there is increased noradrenaline transmission from the locus ceruleus and caudal raphe nuclei, increasing heart rate, dilated pupils, tremor and sweating.

Serotonergic pathways also show the effects of generalized stress, etc. Thus, it is necessary to utilize methods that affect neurotransmitters (e.g., neurotransmitter intensification or inhibition), synaptic transmission (e.g., nerve growth factors that affect neuronal protection mechanisms and plasticity of synapses), the charge densities and distributions of neuroendocrine tissues, neuroendocrine communications networks; the electromagnetic profiles of tissue to maintain molecular coherence, cooperativity and communications; and regulation of the tonicity of the autonomic nervous system, among other considerations.

Various methods have been utilized effectively to accomplish this, ranging from spiritual healing to meditation, massage, physical therapy, dietary regulation, nutritional supplements, biofeedback, craniosacral therapy, herbal medicine, homeopathy, imagery, acupuncture, naturopathy, osteopathic medicine, psychoneuroimmunology, psychotherapy, Tibetan / Chinese medicine, yoga, reiki, and reflexology. Research suggests another method to reduce stress, tension, strain and anxiety – the synergistic use of chiropractic care and magnetic resonance therapy.

Using Natural Mechanisms to Modulate the Stress Response

As has been discussed, regulation of communications between the brain and end organs is critical to the control of CNS and autonomic nervous system functionality. When the body's natural mechanisms for adapting to stressors become inadequate over time, it becomes necessary to change the tonicity of the nervous system – e.g., enhance the parasympathetic function while removing the anatomical mesoscopic blockages of the spinal cord, to permit flow of information to the end organs such as viscera, muscles and joints.

Even a slight displacement and strain of the vertebrae causes electromechanical interference with the spinal cord and nerves, impairing electrochemical conduction mechanisms required for coherent communication between the brain and end organs.

Chiropractic care frees the body of impingements that derogate necessary information transfer and homeostatic mechanisms. Stress adversely affects the ANS, which innervates smooth and cardiac muscles, as well as glands, while the visceral nervous system is a major component of the ANS. Thus, chiropractic care is required to permit the body to rebound from stress and all its negative sequelae.

What's more, parasympathetic stimulation maintains (or renormalizes) body functions analogous to quiet, day-to-day living conditions, promoting relaxation and diminution of stress (whatever the stimulus).

Magnetic resonance therapy utilized to enhance parasympathetic function may permit heart rate reduction, promote digestion and absorption of food, promote regular heart rhythm, normal sleep patterns, (for the body to rest and recover), promote normal kidney function, and enhance feelings of relaxation. This can reduce pain, tension, anxiety and strain. Pulsed, electromagnetic field therapy, utilizing naturally occurring, physiologic magnetic fields, helps the body to restore its own state of natural adaptability.

Thus, picoTesla (pT) magnetic fields (measured as natural to the brain) can be used to modulate (from an atomic and molecular level) ANS and brain function, providing a safe, efficient, non-invasive modality to be utilized synergistically with chiropractic care to address conditions of stress, strain, pain, stiffness and inflammation.

What the Science Says: Magnetic Fields for Stress

Recent basic science, animal and clinical research has demonstrated that extremely low-frequency (within the EEG spectrum) magnetic fields (MFs) of low amplitude (natural biological intensities) can modulate the brain magnetic profile and the tone of the ANS. Numerous studies on rats and dogs have revealed that picoTesla magnetic fields exert a profound parasympathetic effect on nervous tissues of the heart (ganglionated plexi on the heart surface) to decrease heart rate and restoration of normal rhythmicity. This research was conducted at the University of Oklahoma Arrhythmia Research Institute, under the direction of Professor Benjamin Scherlag.¹¹

Studies at the Weill Medical College of Cornell University revealed the capacity of low-frequency, low-intensity magnetic fields to induce, in vivo, regeneration of peripheral nerves after poisoning with neurotoxin. Structures seen to renormalize (under electron microscope) were Golgi bodies, producers of nerve growth factor; myelin sheath, mitochondria, axonal membrane, neurofilaments and microtubules. The studies were replicated in mice at Fairleigh Dickinson University under the direction of Professor Anjali Saxena.¹²

Additionally, utilizing pT MFs, a double-blind, placebo-controlled, randomized clinical study on idiopathic Parkinson's disease revealed a statistically significant benefit in the cardinal features of this CNS disorder, including postural stability, rigidity, tremor and bradykinesia. Additional benefits were noted in sleep, pain and affect.¹³

It is particularly important to note that vagal effects secondary to magnetic resonance stimulation of the parasympathetic nervous system are durable.¹¹ When an individual is more relaxed over time, the capacity for adaptation to stress is improved, thus maintaining homeostatic mechanisms critical for health. In fact, durability of magnetic resonance therapy was noted in all the basic science and clinical studies discussed above.^11-14

For example, in a double-blind clinical study on osteoarthritic knees, the statistically significant benefits in pain reduction and stiffness were almost identical one month after the last of eight treatments administered over a two-week period.¹⁴

Since 2007, more than 16,000 patients have been treated with PT MFs, revealing a safe and effective method of enhancing feelings of relaxation non-invasively and painlessly, to provide the synergistic modality for chiropractic care in reducing life's stresses and strains.

References (for parts 1 and 2)

1. Selye H. The Stress of Life. NY: McGraw-Hill, Inc., 1956.
2. Humphrey JH. Anthology of Stress Revisited. Nova Science Publishers, 2005.
3. Cannon WB. Physiological Regulation of Normal States: Some Tentative Postulates Concerning Biological Homeostatics. In: Jubilee volume to Charles Richet. Paris: Editions Medicales, 1926:91-93; reprinted in Homeostasis: Origins of the Concept, Benchmark Papers in Human Physiology, 1973.
4. Selye H. Confusion and controversy in the stress field. J. Human Stress, 1975;1(2):37-44.
5. Van De Graaff KM, Ward RR. Human Anatomy and Physiology. NY: McGraw-Hill, Inc., 1987.
6. The Merck Manual, 18th Edition. NJ: Merck and Co., Inc., 2006; pp. 118, 601-603, 1677-1678.
7. Murray M, Pizzorno J. Encyclopedia of Natural Healing. NY: Three Rivers Press, 1998.
8. de Kloet R, et al. Stress and the brain; from adaptation to disease. Nature Rev Neurosci, 2005;6(6):463-475.
9. Schore A. Affect Regulation and the Repair of the Self. NY: W.W. Norton, 2003.
10. Shaley AY, et al. International Handbook of Human Response to Trauma. NY: Klower Academic/ Plenun Press, 2000.
11. Scherlag B, et al. Magnetism and cardiac arrythmias, Cardiology in Rev, 2004;12(2):85-96.
12. Saxena A, et al. A hypothetical mathematical construct explaining the mechanism of biological amplification in an experimental model utilizing pico-Tesla (pT) electromagnetic fields. Med Hypoth, 2003;60(6):821-839.
13. Klepitskaya O; Kumar R. Efficacy and safety of low level electromagnetic field treatment in Parkinson's disease. Movement Disord, 2008;23(11):1628-1637.
14. Jacobson JI, et al. Pico-Tesla range magnetic fields tested in four site, double blind clinical study for treatment of osteoarthritic knees. Estratto da Gazzetta Medica Italiano-Archivo Per Le Scienze Mediche, 2001;160:1-18.

Obesity, Part I: Just the (Fat) Facts

By G. Douglas Andersen, DC, DACBSP, CCN

In the western world, and especially the United States, obesity is a problem that continues to grow. Today's fat facts are by no means complete. These are just some of the more recent findings I dug up one night in my study: 

• Obesity and its effects cost Americans $100 billion per year.¹


• Americans spend $33 billion per year to lose weight.¹


• Americans eat more fast food than ever before.²


• Americans ate eight million more orders of french fries, almost six million more hamburgers, and five million more servings of fried chicken nuggets this year compared to last.²


• Eight-six percent of Americans consumed at least one no-fat or low-fat product within the last two weeks.²


• Our nation's largest fast-food chain dropped its low-fat hamburger due to poor sales.³                          
• 
  
• In 1995 this same company spent $800 million to promote their products.In contrast, the National Cancer Institute spent $1 million to promote fruits and vegetables. These statistics are even worse when one considers that the 800:1 ratio only includes one fast food company.⁴

• Cardiovascular disease caused by obesity costs $29.4 billion per year.⁵


• Fifty-seven percent, or $8.8 billion per year of the money spent on noninsulin-dependent diabetes mellitus is due to obesity.⁵


• Musculoskeletal conditions and arthritis related to obesity costs $3.75 billion per year.⁵


• Thirty percent of gallbladder disease, costing $3.2 billion per year, is caused by obesity.⁵


• A few years ago scientists told us obese people with abdominal fat (apple shaped) were at a higher risk for fat-related diseases than obese people with lower body fat (pear shaped). A new Canadian study demonstrated that pear shaped people are also at a higher risk for fat-related disease than their nonobese counterparts.⁶


• A study from Harvard made headlines when they concluded that breast cancer was not related to fat intake.⁷


• Other research has shown that consumption of excess calories regardless of the source does increase the risk of breast, prostate, and colon cancer.⁸


• Up to 70% of hypertension is caused by obesity.⁹


• The USDA food consumption survey revealed the percent of fat in American's diet continues to go down: 33% in 1994, 34% in 1990, and 40% in the 1970s.¹⁰


• Calories consumed in this average American diet continue to rise, averaging 1949 in 1994 versus 1839 in 1990 (this is why Americans continue to gain weight).¹⁰


• Although the percent of fat is lower, the total amount of fat consumed per day is greater because the total calories are higher.¹⁰


• Americans consumed 73 grams of fat per day in 1994 versus 72 grams of fat in 1990.¹⁰


• A Harvard Medical School and Brigham and Women's Hospital study showed women who weigh 15% less than average live longer. The death rate increases as women gain weight, even in those not defined as obese.¹¹


• Women who gained 22-40 pounds after age 18 had a 70% increase in deaths from cardiovascular disease and a 20% increase in deaths from cancer.¹¹


• The metabolism of the average woman is 11% slower than that of the average man. This calculation included adjustments for height, weight, age, basal metabolic rate, and calories burned during exercise.¹²


• When women of normal weight were given yogurt and told it was low fat, they ate considerably more than when they were given yogurt which was described by researchers as being high in fat. What they were not told was that it was the same yogurt manufactured by the same company.¹³

Fighting obesity is a huge industry. With so much information on fats in the news on a regular basis, it is not surprising many Americans get confused. This confusion came to a head last year when studies and surveys continued to show that Americans are heavier than ever before, even though they are reducing the percentage of calories consumed from fat. Popular diet books and the media immediately targeted carbohydrates as the bad guys and labeled them "fattening." What was ignored is the fact that in 1994 the average American consumed 40,000 calories (over the course of a year) more than they did in 1990. The correct message should be that excess calories from any source will result in increased body weight.

G. Douglas Andersen, DC
Brea, California

References 

1. A survey by Decision Resources, a market research company in Waltham, Massachusetts. Drug Topics, September 2, 1996.
2. A survey from NPD Group, a market research company in Rosemont, Illinois. New York Times, November 20, 1996.
3. Newsday, February 6, 1996.
4. New York Times, September 5, 1996.
5. PharmoEconomics 5, 1 (1994).
6. JAMA, December 27, 1995, 274.
7. The people rejoiced. New England Journal of Medicine, February 8, 1996.
8. Food Chemical News, April 22, 1996.
9. American Journal of Clinical Nutrition, 1996, 63, 41.
10. USA Today, January 17, 1996.
11. New England Journal of Medicine, 1995, 33: 667-685.
12. European Journal of Clinical Nutrition, February 1996, 50, 2:72-92.
13. Muscular Development, July 1995, 168.

Obesity/Green tea Green tea and thermogenesis: interactions between catechin-polyphenols, caffeine and sympathetic activity A G Dulloo1, J Seydoux2, L Girardier2, P Chantre3 and J Vandermander3 Introduction Current strategies to stimulate thermogenesis in assisting the management of obesity focus upon agents that would mimic the thermogenic action of catecholamines released by the sympatho-adrenal system¾an important physiological regulator of thermogenesis.1 While the pharmaceutical approach concentrates on the development of drugs that would target 3-adrenoreceptors, believed to be the pivotal adrenoreceptors via which sympathetically released noradrenaline (NA) activates thermogenesis,2 there is also considerable interest in the nutritional/nutraceutical areas for screening foods and/or dietary ingredients with potential thermogenic properties by virtue of their mode of action by interference with the sympathoadrenal system.3Indeed, interest in coffee/caffeine as a potential promoter of thermogenesis followed the realization that, in relatively small amounts, caffeine is effective in potentiating thermogenesis induced by drugs than enhance NA release from sympathetic nerve endings, e.g. ephedrine.4 These findings have led to clinical trials which showed that a combination of caffeine and ephedrine was a safe anti-obesity drug cocktail which was more effective than either ephedrine alone, caffeine alone or placebo in inducing losses in body weight and body fat in obese patients.5,6 To elucidate the mechanisms of interaction between caffeine and sympathetic control of thermogenesis, we have previously utilized an in vitro system of rat brown adipose tissue (BAT), a tissue which has a rich sympathetic innervation and whose respiration rate is a sensitive index of thermogenesis. Using this system, we demonstrated that the effect of low doses of caffeine on thermogenesis in this tissue is entirely dependent on intact sympathetic innervation,7 and that caffeine potentiates the effect of sympathetically released NA on thermogenesis primarily by inhibiting phosphodiesterase enzyme activities, and to a much lesser extent by antagonizing adenosine receptors.8 Since the physiological actions of sympathetically released NA are in part modulated by negative feedback mechanisms operating in the synaptic clefts (e.g. through adenosine, prostaglandins), as well as intracellularly through enhanced breakdown of NA-induced cAMP phosophodiesterase enzymes activities, the net effect of caffeine¾by inhibiting adenosine and phosophodiesterases¾is therefore to prolong the intracellular levels of cAMP, a critical intracellular mediator for the thermogenic effects of NA. The level of NA at the synaptic junction and its interaction with adrenoceptors is also likely to be negatively modulated through its enzymatic degradation by COMT, i.e. catechol-O-methyl-transferase,9 thereby providing an additional target for pharmacological interference aimed at prolonging the effect of NA and hence increasing cAMP and thermogenesis. Interestingly, there is evidence that the enzyme COMT can be inhibited by certain plant polyphenols,10 and notably by those in the class of catechins which are found in high quantities in tea prior to its fermentation, i.e. tea.11Consequently, green tea seems to contain pharmacologically active compounds (catechin-polyphenols and caffeine), which by virtue of their ability to relieve inhibition along the NA-cAMP axis at different control points, might confer it with quantitatively important thermogenic properties. With the use of our in vitro system for measuring the respiration rate of BAT, we report here investigations aimed at testing the hypothesis that a green tea extract, by virtue of its high content both in these catechin-polyphenols and caffeine, possesses thermogenic properties that are greater than can be accounted for by its caffeine content per se, and that is thermogenic potential resides at least in part in an interaction between catechin-polyphenols and caffeine with the sympathetically released NA.

Materials and methods Animals and diets All studies were conducted on 7-8-week-old male Sprague-Dawley rats (Tierzucht, Zurich, Switzerland), which were housed in a temperature controlled room (23°C) with a 12:12 h light-dark cycle. Before each experiment the animals were adapted for 5-7 days to room and cage conditions, and had free access to water and a standard laboratory chow diet (Provimi-Lacta, Cossonay, Switzerland) with the following macronutrient content (w/w): 20% protein, 5% fat and 60% carbohydrates. The study was approved by the institution's ethical committee for animal experimentation, and was conducted according to its guidelines and regulations. Chemical denervation Chemical sympathectomy was performed using 6-hydroxydopamine (6-OHDA; Sigma, St Louis, MO) dissolved in distilled water containing 0.001 M HCL and equilibrated with nitrogen. Rats (n=5) were injected subcutaneously with 6-OHDA (50 mg/kg body wt) twice in a day (8:00 a.m. and 5:00 p.m.) and were killed 15 h after the second injection. Tissue preparations Animals were killed by decapitation between 7&30 and 8:00 a.m. and two fragments 10-12 mm long, ~1 mm thick, 10-14 mg wet weight, of interscapular brown adipose tissue (IBAT) were rapidly dissected out from the middle part of the fat pad. The tissues were perifused with Krebs-Ringer bicarbonate buffer of the following composition (in mmol/l): 116.8 NaCl, 25 NaHCO3, 5.9 KCl, 1.2 MgSO4, 1.2 NaH2PO4, 1.25 CaCl2, and 5 glucose. The medium was gassed continuously with a mixture of 95% O2 and 5% CO2 and was maintained at a set temperature of 30±0.2°C. Measurement of tissue respiration rate The respiratory rates of IBAT fragments were measured by a method involving repeated O2 uptake determinations, as described by Barde et al.12 The O2 partial pressure (PO2) of a bubble-free liquid phase enclosed in a thick-walled Lucite chamber was measured by a Clark O2electrode connected to a polarographic circuit, whose output voltage is directly proportional to PO2. All values for O2 uptake rate (MO2) were taken during steady-state respiration and after 40-90 min when drug administration resulted in changes in MO2. Green tea extract and drug administration The green tea extract, under the code name of AR25, is obtained by alcohol extraction from dry tea leaves of unfermented Camellia sinensis, standardized at 8.35% caffeine and 24.7% catechins (~70% as (-)-epigallocatechin gallate), and commercialized in capsular form under the name of EXOLISE (Arkopharma Laboratories, Nice, France). The green tea extract was added in the perifusion buffer medium, and the resulting suspension was automatically filtered before entering the respiratory chambers. Analysis of the filtrate from several samples of the green tea extract for caffeine and (-)-epigallocatechin gallate (EGCG, the most abundant of tea catechins) was performed by liquid chromatography with electrochemical detection, and yielded values, as percentage dry weight of extract, in the range of 5-10% for caffeine and 16-19% for (-)-epigallocatechin gallate. L-Ephedrine hydrochloride, caffeine and (-)-epigallocatechin gallate (Sigma, St Louis, MO, USA) were added to the medium by means of motor-driven syringes connected to needles set at the inlet of each chamber. It is to be noted that, at high concentrations, the green tea extract and (-)-epicallocatechin gallate interfere with oxygen in the buffer medium since they had an effect on the rate of O2 consumption in the absence of the biological tissue. Consequently, the utilization of both the green tea extract and (-)-epigallocatechin gallate were limited to concentrations below which they had no impact on the pO2 of the buffer medium. Statistics Data are presented as mean±s.e. (n=5-7). Statistical analysis was performed as follows: (a) by analysis of variance with repeated measures on absolute MO2values (i.e. a tgwo-factor Anova with sequential treatments as one factor and individual rats as the other factor) for the effect of sequential administration of increasing concentrations of a given compound (caffeine, green tea, or EGCG), and also for the effect of sequential administration of two or more compounds; these analyses were then followed by post-hoc pair-wise comparisons by the Newman-Keul's test, with the level for establishing significant differences taken atP<0.05; (b) by unpaired t-test on absolute MO2 values for comparisons between compounds at a given concentration of caffeine or EGCg, the level of significance denoted as *P<0.05, **P<0.001 and ***P<0.001; and (c) by unpaired t-test on changes in MO2 relative to basal MO2 for comparisons between tissues from intact vs sympathectomized animals or between unstimulated vs stimulated states (with ephedrine).

Results and discussion Using this in vitro IBAT system, we have previously shown in dose-response studies7,8 that the administration of either caffeine at 2-5 mM or ephedrine at 1-10 M resulted in marked stimulation of IBAT respiration rate (>5-fold basal MO2 values). However, at low subthreshold concentrations of caffeine (100-250 M) and ephedrine (0.05-0.1 M), i.e. at concentrations at which neither drug alone stimulated IBAT MO2, their administration in combination resulted in a synergistic effect on IBAT MO2, with increases of 2-3-fold above basal values. The findings that this synergistic effect was prevented by pretreatment of the animals with 6-OHDA (a procedure that destroys the sympathetic nerve endings and depletes the NA stores) suggested that the interaction between caffeine and ephedrine requires intact sympathetic neural innervation.7,8 Thus, at subthreshold concentrations, ephedrine enhance the release of NA (hence mimicking in vitro an increase in sympathetic activity), but at levels that do not overcome the effects of the negative modulators both in the synaptic cleft and at the tissue level. At such concentrations, therefore, ephedrine alone had no net effect on basal tissue respiration. Consequently, the permissive effects of caffeine in allowing a subthreshold dose of ephedrine to activate thermogenesis is explained by ephedrine's enhancement of sympathetic neuronal release of NA, together with the ability of caffeine to inhibit phosphodiesterase activity, thereby resulting in an elevated cellular level of cAMP, leading to increased thermogenesis. Comparison between green tea extract and caffeine on thermogenesis In the first study reported here, we repeated this approach to compare caffeine and green tea containing isomolar concentrations of caffeine on IBAT MO2} under two conditions, namely: (i) in the unstimulated state, and (ii) in the stimulated state, using a subthreshold concentration of ephedrine (0.1 M) as a pharmacological tool to release NA from sympathetic nerve terminals, and hence to mimic a small increase in sympathetic activity. The results, shown in Figure 1 (panel A), indicate that caffeine in its own right does not increase basal IBAT MO2 (in line with previous findings7 that caffeine has to be at a millimolar concentration to stimulate IBAT respiration rate). By contrast, the administration of green tea containing isomolar concentrations of caffeine resulted in significant increases in IBAT MO2 above basal levels in a dose-dependent fashion (P<0.001; Figure 1, top of panel A), namely by 28% at 50 M, 77% at 100 M, and by more than 5-fold at 250 M, with post-hoc pairwise comparison across concentrations indicating statistically significant increase with the green tea at 100 and 250 M of caffeine equivalents. Comparison between green tea and caffeine indicates statistically higher MO2 values with the green tea than with caffeine at 100 M (P<0.01) and at 250 M (P<0.001). The effects of green tea and caffeine on tissue MO2 were then compared when added in combination with ephedrine (Figure 1, bottom of panel A). In line with our previously reported findings,7 the addition of low doses of caffeine (50-250 M) enabled an otherwise ineffective (subthreshold) dose of ephedrine (0.1 M) to enhance IBAT MO2 in a dose-dependent fashion (P<0.001). However, this synergistic effect between ephedrine and caffeine was much more pronounced when the caffeine was substituted by green tea containing equivalent amounts of caffeine: whereas the combination of ephedrine+caffeine increased basal MO2 significantly by about 38%, 2-fold and 2.5-fold at caffeine concentrations of 50, 100 and 250 M, respectively (P<0.001), the combination of ephedrine+green tea increased basal MO2 by 4.5-fold, 4.8-fold, and 6.8-fold with green tea containing 50, 100 and 200 M of caffeine, respectively (P<0.001). The synergistic interaction between ephedrine+green tea is evident with green tea containing 50, 100 and 250 M of caffeine, since the combination of ephedrine+green tea resulted in increases in MO2 above basal values (136, 150, 255 nmol O2/mg tissue/h at the respective concentrations), which were all significantly greater (P<0.01) than the additive effects of green tea alone (10, 28, 150 nmol O2/mg tissue/h at the respective concentrations) and ephedrine alone (no significant increase in this experiment). Comparison between ephedrine+green tea and ephedrine + caffeine at 50, 100 and 200 M of caffeine indicates that the higher MO2 values with ephedrine+green tea were statistically significant (P<0.001) at all three concentrations. To examine the extent to which the greater effect of green tea than caffeine (in the unstimulated state or in the stimulated state induced by ephedrine) is mediated via interference with NA released from the sympathetic nerves innervating this tissue, the experiments above were repeated in IBAT tissues from animals chemically sympathectomized by pretreatment with 6-OHDA, an agent that destroys sympathetic nerve endings and markedly reduces the endogeneous NA levels by 90% or more in IBAT.13 The results, shown in Figure 1 (panel B), indicate that the effect of green tea on MO2 or its synergistic interactions with ephedrine in increasing basal MO2 were considerably blunted, these being particularly evident for green tea containing 250 M caffeine and for ephedrine+ green tea containing 50, 100 or 250 M of caffeince, in which cases the values of MO2 in BAT from sympathectomized animals were all markedly lower than in BAT from intact controls (P<0.001. It is to be noted that, at the end of each measurement with chemically sympathectomized IBAT, exogeneous administraiton of NA (0.1 M) to the same IBAT tissue resulted in a 6-8-fold increase in MO2 (results not shown). The lack or blunted effect of ephedrine+caffeine, ephedrine+green tea or green tea alone on BAT thermogenesis in sympathectomized animals cannot therefore be attributed to postsynaptic tissue damage following 6-OHDA treatment, but is due to the depletion of NA stores following chemical sympathectomy. Indeed, previously reported studies7,14 of NA dose-response curve with IBAT of rats treated with similar doses of 6-OHDA and a similar injection protocol as utilized here indicated that the sensitivity and maximal thermogenic response to NA with IBAT from sympathectomized animals are not reduced but actually increased¾this most probably arising from the development of denervation supersensitivity and from the fact that NA-reuptake mechanisms (and hence inactivation of NA) are also disrupted following chemical sympathectomy. These data thereby suggest that the effect of green tea in activating IBAT thermogenesis (in absence of ephedrine) requires an intact sympathetic neural innervation, and consequently its effects on thermogenesis are likely to be highly dependent upon the release of endogeneous NA, rather than by direct effects on the tissue per se. This dependency of the stimulatory effect of the green tea extract upon sympathetic innervation even in the absence of ephedrine implies that, in the isolated BAT, there is a basal tonic release and reuptake of NA in the synaptic cleft¾a contention which is supported by the fact that, in our in vitro BAT system, the basal respiratory rate of IBAT has previously been found to be reduced (by 20%) in response to the non-selective -adrenoreceptor blocker, propranolol (unpublished data) and to be increased (by 25%) in response to the NA-reuptake blocker, desipramine.15 Taken together, these findings are consistent with the hypothesis that the ability of the green tea extract to stimulate thermogenesis cannot be explained solely by its content in caffeine per se. To what extent the effect of the green tea extract on BAT thermogenesis may also be attributed to an interaction between its high content both in catechin-polyphenols and caffeine with sympathetically released NA is the subject of investigations reported below. Interactions between epigallocatechin gallate, caffeine and ephedrine on thermogenesis The catechin-polyphenols in green tea exist in several isoforms, namely (-)-epigallocatechin gallate (EGCG), (-)-epigallocatechin (EGC), (-)-epicatechin (EC) and (-)-epicatechin gallate (ECG), with EGCG constituting >50% of the total amount of tea catechins, and which is believed to be pharmacologically the most active tea catechin.11,16 To obtain direct evidence that catechin-polyphenols contribute to the efficacy of the green tea extract in potentiating thermogenesis, we have therefore tested the effect of the EGCG on the in vitro respiration rate of IBAT. The results, shown in Figure 2 (panel A), indicate that EGCG alone has no effect on IBAT MO2 at does of 50 and 100 M, but at 200 M it induced a small, though statistically significant, increase in MO2relative to basal values (+40%, P<0.05). In combination with 100 M of caffeine (which, as shown in the study above, has no effect on IBAT MO2 in its own right), EGCG also had no effect at 50 and 100 M, but at 200 M of EGCG the combination of EGCG + caffeine enhanced IBAT MO2 to a greater extent than EGCG alone (+2.4-fold versus 40% relative to basal values, respectively, P<0.01). In another study (Figure 2, panel B), the combination of EGCG (50-200 M) and caffeine (100 M) on IBAT MO2 was studied under stimulated conditions (i.e. increased NA release) induced by the administration of ephedrine either at 0.1 or 0.25 M. The data of this study are divided into two subsets, according to whether administration of ephedrine per se did not increase or increased IBAT MO2. In the data subset when administration of ephedrine had no effect on basal MO2 (broken lines), the addition of caffeine to ephedrine resulted in an 84% increase in MO2 above the basal level (P=0.06), and subsequent addition of EGCG increased IBAT MO2 further, such that with EGCG at 200 M, the combination of E+C+EGCG resulted in a significant 2.8-fold increase in MO2 relative to basal values or in a 70% increase in MO2 relative to that for E+C (P<0.001). In the data subset when administration of ephedrine alone resulted in a significant stimulation of IBAT MO2 by 50-100% (solid line), the addition of caffeine to ephedrine resulted in a 4-fold increase in IBAT MO2 above basal values. Subsequent addition of EGCG resulted in further synergistic increases in IBAT MO2(shaded zone), such that with EGCG at 100 and 200 M, the combination of E+C+EGCG increased basal MO2 values by 5.7-fold and 7.4-fold, respectively, or by 40% and 90% respectively relative to that for E+C (P<0.001). Thus although the effects of EGCG per se or EGCG+caffeine on IBAT thermogenesis are either absent or relatively small (+50%) in the unstimulated state (i.e. in the absence of ephedrine), it is shown that in the stimulated state (i.e. during increased NA release) induced by ephedrine, the combination of EGCG+caffeine led to marked synergistic effects in stimulating IBAT MO2 by several fold. Similarly, in another study presented in Figure 3, it is shown that EGCG alone at 100 M, a concentration at which it is ineffective in increasing IBAT thermogenesis, is nonetheless capable of potentiating thermogenesis in the presence of low concentrations of ephedrine (i.e. either at 0.1 or 0.25 M), and that this potentiating effect between EGCG and ephedrine is more marked in the subset of data when administration of ephedrine alone resulted in a significant stimulation of IBAT MO2 by about 2-fold (solid line), as compared to the other subset (broken line) when ephedrine per se had no significant effect on basal MO2. Taken together, these studies therefore suggest that the efficacy of the green tea extract to potentiate BAT thermogenesis, to a large extent, resides in an interaction between its high content in caffeine and EGCG (and probably also other catechin-polyphenols) with sympathetically released NA. Indeed, a consequence of the inhibitory action of catechins on COMT would be a reduction in enzymatic degradation of NA and hence a prolongation of action of sympathetically released NA on adrenoceptors. In turn, the increased NA-induced cAMP activation in the cell would be prolonged by caffeine's ability to inhibit phosphodiesterase-induced degradation of intracellular cAMP. Thus, on the basis of the inhibitory actions of the two main ingredients of green tea extract¾catechins and caffeine¾on two different enzyme systems that diminished the half-life and action of NA, the green tea extract is more effective than caffeine per se in potentiating sympathetic activation of thermogenesis.

Concluding remarks The thermogenic properties of green tea are of particular interest since it has been widely consumed in China and in Japan for many centuries, and hence is regarded as safe. In fact, the potential therapeutic value of green tea is well recognized, and currently, because it possesses outstanding anti-oxidant properties, its ability to confer a protective role against free-radical mediated diseases (including coronary heart disease and cancer) is an active area of medical research.16,17,18 According to current concepts, such anti-oxidizing effects, as well as its reportedly capillary-strengthening, anti-bacterial and antidepressane effects,19 are primarily attributed to its remarkable content of caffeine and catechin-polyphenols (notably EGCG). Our studies, showing that the green tea extract¾rich in catechin-polyphenols and caffeine¾is a more effective potentiator of sympathetically mediated thermogenesis than caffeineper se, raise the possibility that the therapeutic potential of the green tea extract, or indeed a combination of EGCG and caffeine, may be extended to the management of obesity. However, a main limitation in the extrapolation of in vitro to in vivo responses resides in our lack of knowledge in the fate of polyphenols or caffeine from ingestion to an effective concentration at the critical sites (e.g. within the sympathetic neural cleft) that may lead to thermogenic stimulation. Although, the presence of substantial amounts of EGCG and other catechin isoforms has recently been demonstrated in the plasma of human volunteers after ingestion of a green tea powder, the peak plasma concentrations of catechins (non-conjugated) or indeed those of caffeine are low (<0.5 and <25 M, respectively), and in the case of catechins, this correponded only up to 3% of the ingested dose.20 However, the distribution of the latter is not known and its interaction with sympathetic activity may have been reached despite low circulating levels. Indeed, the recent findings in humans21 that administration of capsules containing the green tea extract (but not an equivalent amount of caffeine per se) resulted in a significant increase in 24 h energy expenditure, thermogenesis, fat oxidation, and 24 h urinary noradrenaline relative to placebo, is consistent with the present findings in IBAT in vitro that the effect of green tea on thermogenesis and fat oxidation may be attributed to an interaction between its high content in catechin-polyphenols and caffeine on sympathetic activity.