1) Three ayurvedic publications on herbal medicines for obesity were systematically reviewed. Ephedra and caffeine were found to reduce body weight and fat over 12 weeks without serious side effects. 2) Several herbal supplements including Cissus quadrangularis, ephedra and caffeine, and extracts of ginger and other plants were found to reduce body weight, fat levels, and waist circumference in human studies on obesity. 3) Terminalia arjuna bark powder was found to have antioxidant effects comparable to vitamin E and significantly reduced cholesterol levels in patients with coronary heart disease.

1. CENTRAL COUNCIL FOR RESEARCH IN
AYURVEDIC SCIENCES
Ministry of AYUSH, Government of India
Assignment-4
A presentation
over discussion of evidence based clinical
research data of 3 ayush publications
Presented to:
D.Gnanabhaskar
16TMM2364
Presented to:
Dr S M Tripathi
sir

2. A systematic review of the efficacy and safety of herbal
medicines used in the treatment of obesity
Shirin Hasani-Ranjbar, Neda Nayebi, Bagher Larijani, Mohammad Abdollahi
World J Gastroenterol 2009 July 7; 15(25): 3073-3085
wjg@wjgnet.com World Journal of Gastroenterology ISSN 1007-9327doi:10.3748/wjg.15.3073
Efficient decreases in body weight and fat were observed with the administration of 210 mg caffeine and
72 mg ephedra per day for 12 wk with an improvement in lipid metabolism and blood pressure without
serious adverse effects. In this study, the weight loss at 12-wk was -3.5 ± 0.6 kg with the test compound
which was significantly (P < 0.02) higher than that of the placebo. The percentage fat loss shown by
DXA was -7.9% ± 2.9% and -1.9% ± 1.1%, respectively (P < 0.05). In another study[20], ephedra at a
dose of 40 mg/d and caffeine at a dose of 100 mg/d for a longer time (9 mo) was found to be more
efficient than the previous study in lowering body fat and weight, improving lipid metabolism and blood
pressure and had no serious adverse effects. The treatment group lost significantly more body weight (-
7.18 kg) and body fat (-5.33 kg) than the control group (-2.25 and -0.99 kg, respectively). The difference
in data from these two studies possibly resulted from the different dosages and duration of interventions
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3. HUMAN STUDIES
Change in human body weight
All studies showed loss of body weight except one which seemed to have problems with the study design,
and one other study which showed a significant decrease only in body fat.
Studies with Cissus quadrangularis (CQ) or combined with Irvingia gabonensis (IG), a
combination of Sambucus nigra and Asparagus officinalis,calcium hydroxycitrate in Garcinia atroviridis,
supplements containing ephedra and caffeine and Slimax as an extract of several plants including Zingiber
officinale and Bofutsushosanshowed significant decreases in body weight.
Body fat
A significant decrease in body fat was shown with CQ, supplements containing ephedra and caffeine[9,13], a natural compound containing
capsicum and some lipotropic nutrients[10], Bofutsushosan[14], and calcium hydroxycitrate in Garcinia atroviridis[18]. These
phytopharmaceuticals showed a significant decrease in triceps skin fold thickness indicating significant loss of fat.
Waist and hip circumference
Efficient decreases in both waist and hip circumferences in trials with a supplement containing ephedra and caffeine[9] and
Slimax (extract of several plants including Zingiber officinale[8] were shown whereas Caralluma fimbriata[19] and CQ with or
without IG[15] significantlydecreased waist size.
Food intake:
Decreases in appetite or amount of food or energy intake with a supplement containing ephedra and caffeine[20] and
Caralluma fimbriata[19] were shown (notsignificant) but hydroxycitric acid (HCA-SX) with or without Gymnema sylvestre[23]
decreased the amount offood intake efficiently. A natural compound containingcapsicum and other lipotropic nutrients[10] did
not significantly change energy intake.
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4. Conclusion:
Compliance with conventional weight-managementprograms, which often include increasing
energyexpenditure via physical activity, is low.
In this paper a variety of herbal supplements had beneficial effects on
obesity especially compounds containing ephedra, CQ, ginseng, bittermelon (Momordica
charantia), and zingiber. Most of the introduced herbals have also been shown to have antioxidant
effects, and with regard to the role of oxidative stress in the pathophysiology of some diseases and
conditions, their further positive effects may be very promising.Attention to these natural
compounds and further work on the isolation and characterization of their constituents is highly
recommended.
ephedra, CQ, ginseng, bitter melon, and zingiber were found to be
effective in the management of obesity. Attention to these natural compounds would open a new
approach for novel therapeutic and more effective agents.
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5. Antioxidant and hypocholesterolaemic effects of Terminalia arjuna treebark
powder: a randomised placebocontrolled trial.
Gupta R , Singhal S, Goyle A, Sharma VN.
J Assoc Physicians India. 2001 Feb;49:2315. Department of Medicine, Monilek Hospital and Research Centre,
Jaipur.
One hundred and five successive patients with coronary heart disease (CHD) presenting to our centre
were recruited and using a Latinsquare design divided into 3 groups of 35 each. The groups were matched
for age, lifestyle and dietary variables, clinical diagnosis and drug treatment status. None of the patients
was on lipidlowering drugs. Supplemental vitamins were stopped for one month before study began and
American Heart Association Step II dietary advice was given to all. At baseline, total cholesterol,
triglycerides, HDL and LDL cholesterol and lipid peroxide estimated as thiobarbituric acid reactive
substances (TBARS) were determined. Group I received placebo capsules; Group II vitamin E capsules
400 units/day; and Group III received finely pulverized T. arjuna tree barkpowder.(500 mg) in capsules
daily. Lipids and lipid peroxide levels were determined at 30 days followup.
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6. Result:
Response rate in various groups varied from 86% to 91%. No significant
changes in total,HDL, LDL cholesterol and triglycerides levels were seen in Groups I and II (paired
ttestp > 0.05). InGroup III there was a significant decrease in total cholesterol (9.7+/12.7%),and LDL
cholesterol(15.8+/25.6%)(paired t test p < 0.01). Lipid peroxide levels decreased significantly in both
thetreatment groups (p < 0.01). This decrease was more in vitamin E group (36.4+/17.7%) As compared
to the T. arjuna group (29.3+/18.9%).
Conclusion:
Terminalia arjuna tree bark powder has significant antioxidant action
that iscomparable to vitamin E. In addition, it also has a significant hypocholesterolaemic effect.
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7. Garlic Powder and Plasma Lipids and LipoproteinsA Multicenter, Randomized, Placebo-Controlled Trial
Jonathan L. Isaacsohn, MD; Marvin Moser, MD; Evan A. Stein, MD, PhD; Karen Dudley, RN, BSN; Janice A. Davey, MSN; Ellen
Liskov, RD; Henry R. Black, MDArch Intern Med. 1998;158:1189-1194
From The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio (Dr Isaacsohn and Stein and Ms Dudley), and the Yale University
Cardiovascular Disease Prevention Center, New Haven, Conn (Drs Moser and Black, and Mss Davey and Liskov). Drs Isaacsohn and Stein and
Ms Dudley are now with the Metabolic and Atherosclerosis Research Center, Cincinnati. Dr Black is now with the Rush-Presbyterian-St Luke’s
Medical Center, Chicago, Ill.
This was a randomized, double-blind, placebocontrolled, 12-week, parallel treatment
study carried out in 2 outpatient lipid clinics. Entry into the study after 8 weeks of diet stabilization required a mean low-density lipoprotein
cholesterol level on 2 visits of 4.1 mmol/L (160 mg/dL) or lower and a triglyceride level of 4.0 mmol/L (350 mg/dL) or lower. The active
treatment arm received tablets containing 300 mg of garlic powder (Kwai) 3 times per day, given with meals (total, 900 mg/d). This is equivalent
to approximately 2.7 g or approximately 1 clove of fresh garlic per day. The placebo arm received an identical-looking tablet, also given 3 times
per day with meals. The main outcome measures included levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-
density lipoprotein cholesterol after 12 weeks of treatment
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8. Twenty-eight patients (43% male; mean ± SD age, 58 ± 14 years) received garlic powder treatment
and 22 (68% male; mean ± SD age, 57 ± 13 years) received placebo treatment. There were no
significant lipid or lipoprotein changes in either the placebo- or garlictreated groups and no
significant difference between changes in the placebo-treated group compared with changes in the
garlic-treated patients.
Conclusion: Garlic powder (900 mg/d) treatment for 12 weeks was ineffective in lowering cholesterol levels in
patients with hypercholesterolemia. Arch Intern Med. 1998;158:1189-1194
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