Restoring Lifelong Metabolic Health with Evidence-Based Solutions
Medical & Scientific Information
Information about Heart Health (recommended book)
Journal of Endocrinology and Metabolic Syndrome – Rapid effects of novel phytoandrogen adjuvant therapy (PAT) on metabolic health: a gender, age and BMI matched case-control study.

This is the world’s first peer-reviewed and published case-control clinical study (N = 15) on the pharmacological therapy of the metabolic syndrome using non-steroidal AR-cognate SARM phytoandrogens (Enerbolis™), in combination with ES-TriGUARD™ augmented lifestyle modification. Within 4 weeks of treatment, average blood pressure (BP) were lowered by 5 mmHg (systolic) and 4 mmHg (diastolic) respectively, from 116/79 mmHg to 111/74 mmHg.

The Waist-Hip Ratio (WHR) associated risks for type 2 diabetes, hypertension and cholesterol disorders in the control (ES-TriGUARD™ augmented lifestyle modification) and PAT (Enerbolis™ combined with ES-TriGUARD™ augmented lifestyle modification) groups were lowered by 19% and 48% respectively.

Creeping fat phenomenon in both treatment groups were effectively stopped within 4 weeks. In fact, the body fat in both control and PAT groups showed declines of 0.2% and 0.8% respectively.

Figure 1.1. The human androgen receptor (hAR), when transcriptionally active, drives the repair and energy metabolism of all major systems in the human body (both male and female), such as heart, blood vessels, kidney, liver, brain, nerve cells, bone marrow, bone, joint, skin and connective tissues.

The major difference between phytoandrogens and androgens, is the molecular capacity to 'switch on' and 'switch off' hAR transciptional activities. Androgens are NOT able to 'switch off' the hAR, which leads to overdose risk and side effects. In contrast, SARM phytoandrogens (in Enerbolis™) directly interact with the hAR, and are able to 'switch on' and 'switch off' the hAR selectively. These unique pharmacological attributes of the non-steroidal phytoandrogenic Enerbolis™ oral formulation enables tissue repair and healing, without the adverse effects associated with conventional steroidal androgens (which generally require injections).

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Journal of Endocrinology & Metabolic Syndrome_Dec 2011
Journal of Diabetes & Metabolism - Reversal of metabolic dysfunction through polyvalent pharmacotherapy-augmented lifestyle intervention

The World Health Organisation (WHO) 2011 bulletin report has stated the number of patients achieving treatment goals for blood glucose, blood pressure and cholesterol levels to be extremely low - from 1% in Mexico, 7% in Thailand to 12% in United States. Patients not reaching treatment goals suffer complications (leg amputation, kidney failure, heart disease, blindness, stroke etc) and early death, over the long term. This is the key reason behind urgent emphasis by WHO and international medical community to find new clinical solutions to overcome the practical challenges faced by both doctors and patients, in preventing progression of the metabolic syndrome over time, WITHOUT the need to increase drug load or carry out drastic lifestyle changes.

Co-author of publication:

Professor Dato (Dr) Anuar Zaini, MD. Eminent Endocrinologist and Head of JC School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University.

Vivo Health LLP and Monash University Faculty of Medicine have jointly published a groundbreaking clinical report in Jul 2011, on advancing best standard-of-care for type 2 diabetes and the metabolic syndrome. Key highlights are:

  • Peer-reviewed and published in United States medical journal - Journal of Diabetes & Metabolism.

  • New treatment approach* enables patients with the metabolic syndrome to normalise blood glucose, blood pressure and cholesterol levels - WITHOUT increasing the dosage and number of prescribed drugs, WITHOUT major weight loss and WITHOUT vigorous exercise.

  • First-ever clinical report on the use of non-steroidal AR-cognate SARM phytoandrogens and SuHLAs (Enerbolis™) to improve MEASURED anabolic health.

*comprising 5 actions (modified diet, appropriate behavioriet, ES-TriGUARD™ polyvalent medicine, right sleep routine and minimised exercise)

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Journal of Diabetes & Metabolism July_2011
European Journal of Nutraceuticals & Functional Foods - Case report of euglycaemic reversion in type 2 diabetes with 15 years history

In a medical breakthrough, the world's first clinical report on the normalisation of blood sugar control and reduced medications, adiposity and obesity in type 2 diabetes patient with the metabolic syndrome, using an integrative metabolic healthcare model (combination of best practice medical care by physician AND diet-behavioriet-energy shifts [DBES] methodology) was published in Dec 2009.

Importantly, the reversal of hyperglycaemia enabled the physician to withdraw one oral anti-diabetic drug (OAD), a sulphonylurea, from the treatment regimen, leaving just the biguanide, metformin.*

The combined treatment regimen of outpatient medical care with DBES methodology took place with minimised daily exercise (to reduce joint and back injury risks), and maximised lifestyle options for patient, through an integrated programme of dietary, behaviorietary and medicinal therapies.**

*See clinical report for more details on the medications, functional foods and supplements prescribed.

**Refer to books War on Weight, 2007 and Aetiology of Individual Obesities, 2008, for definition and explanation of the behavioriet versus diet and medicine.

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Euro Journal Paper Nov/Dec 2009
BioMed Central CAM and USA Patent - Discovery of phytoandrogens and supra-hormonal lipid augmenters
The androgen receptor (AR) plays a pivotal role in human (both male and female) physiology such as skeletal muscle development, bone density, fertility and sex drive [1,2]. The α and β estrogen receptors (ERs), likewise, have fundamental impact on the sex hormone-mediated physiological milieu. Availability and binding of cognate ligands to the ligand binding domain (LBD) of the sex steroid receptors are required for the proportionate expression of specific genes responsible for such sex hormone-mediated processes [3,4].

Vegetative foods such as the legumes, particularly soybean (Glycine max), contain phytoestrogens that modulate the transcriptional activities of the estrogen receptor isoforms, α and β. The former has been linked to the chemoprevention of specific cancers in the breast and prostate gland [5].

Here, we report that the tree bark (cortex) of the Gutta-Percha tree Eucommia ulmoides OLIVER possesses novel bimodal phytoandrogenic and synergistic augmentation of hormone-dependent receptor activity.

E. ulmoides is also known variously as the Gutta Percha Tree, the Rubber Bark Tree or Du-Zhong [6,7]. The toothed elliptic leaves and tree bark of E. ulmoides are used medicinally in herbal pharmacopoeias such as Kampo (traditional Japanese medicine) and Zhong-Yao (traditional Chinese medicine) for indications such as the relief of back pain, to increase stamina, to make bones and muscles ‘strong’ and to hasten recovery from fatigue. It is noted that these are male hormone-related pharmacological effects.

Through the combined use of varied technologies - recombinant DNA constructs, reporter gene assays, animal studies and separation chemistry, extracts of E. ulmoides were shown for the first time, to specifically activate the tranactivational capacity of the sex steroid receptors in both in-vitro and in-vivo settings. A series of bioassay-guided fractionation showed that the phytoandrogenic and hormone potentiating effects of E. ulmoides were mediated by distinct groups of phytocompounds; triterpenoids and short-chain lipids respectively.

In addition to well-known phytoestrogens, the existence of phytoandrogens is reported here. Furthermore, a form of tripartite synergism between sex steroid receptors, sex hormones and plant-derived lipids is described for the first time. Extracts containing these phytocompounds could have clinical applications for weight-healthcare, hypogonadal- and hyperlipidaemic-related disorders.
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Ong BMC CAM Ong Patent
The Lancet Paper– the Prospective Study Collaboration report
The Prospective Studies Collaboration between the UK Medical Research Council, British Heart Foundation, Cancer Research UK, EU BIOMED programme, US National Institute on Aging and Clinical Trial Service Unit (Oxford, UK), recently published a landmark paper in The Lancet, Mar 2009. The specific causes of death and prevalence of diseases in 900 000 adults across 57 prospective studies were investigated and analyzed.

The results reaffirmed international healthcare professionals long-held concerns - excess body weight shortens life span - the number of overweight and obese people dying from stroke, heart disease, liver disease, diabetes (these constellation of factors also include hypertension and dyslipidaemia, collectively termed as the Metabolic Syndrome) and types of neoplastic conditions such as breast cancer and prostate cancer are much higher compared to people with normal weight (based on the body mass index- BMI). Strikingly, within the normal weight and underweight individuals, other causes of mortality such as cancers of the mouth, throat and airway are heightened, even after excluding smokers.

These findings lend credence to an ideal weight management model of caring for underweight, normal weight, overweight, obese and morbidly obese people, that extends beyond the standard BMI, encompassing other measures of body weight, such as body shape (for instance, the clinical marker waist-to-hip ratio - WHR), body composition (such as measurements of body fat percentage and bone mineral density) and body function (blood and urine tests of fasting blood glucose, homocysteine, cholesterol, blood pressure, inflammation, oxidative stress levels, immune and tumour markers etc).

In other words, normal BMI is simply normal body weight and cannot be equated to ideal weight i.e. optimal health.
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The Lancet – the Prospective Study Collaboration Report
The Lancet – Directed pharmacological therapy of genetic (DNA) disease

In 1999, the use of molecular techniques to model actual mutations that occur in human diseases with genetic basis was carried out. The specific type of drug that could interact with and rescue the defective functional protein (caused by the DNA mutation) was determined using a combination of genetic and proteomic assays. 

Directed pharmacological therapy was then initiated in the patient with the DNA mutation, using the drug selected through molecular modelling. This approach was subsequently applied in cancer drug research, targeting defective P53 protein (P53 mutations occur in over 50% of all cancers).

Co-author of publication:

Emeritus Professor (Dr) Wong Hock Boon, MD. Father of Paediatrics in Singapore.

This paper is also cited by:

Oxford Handbook of Clinical Specialties, 7th Edition, 2006. Oxford University Press, under Web-based references.
Chapter 02: Paediatrics 400 – 479.

Principles of Molecular Medicine, 2nd Edition, 2006. Humana Press, pg 426.
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The Lancet – Directed Pharmacological Therapy of Genetic (DNA) Disease
Molecular Human Reproduction - Human androgen receptor structure & function

All androgens act through the androgen receptor (AR) which is encoded by a single copy gene located on the X chromosome. The AR, when activated by the appropriate ligand, translocates to the cell nucleus (of tissues and organs) and binds to specific response elements in the promoters of androgen-responsive genes, thereby initiating transcription and downstream gene expression. The latter leads to anabolic-associated therapeutic benefits, such as tissue repair (heart, brain, kidney and other organs, skin, nail, bone, joint etc), enhanced mental fitness (sense of wellbeing, alleviation of mood swings, stamina etc) and efficient metabolic processing (such as ATP energy release) in BOTH women and men.

Like other members of the steroid/nuclear receptor superfamily of transcription factors, the AR has four main functional domains, comprising the N-terminal transactivation domain, a DNA-binding domain, a hinge region and C-terminal ligand-binding (LBD) domain. Transactivational activity of the AR is induced by the binding of an androgen to its LDB. The tertiary architecture of the AR LBD, in common with other steroid receptors, is a sandwich of 12 alpha-helices.

Figure 1.2. The AR LBD, which steroidal androgens (stimulant effects only) and non-steriodal TRUE phytoandrogens (selective androgen receptor modulating [SARM] effects) directly interact with.

In recent years, plant compounds capable of binding to the LBD of the AR, ERs, PPARs and other members of the steroid/nuclear receptor superfamily have been discovered. For example, phytoandrogens and phytoestrogens. However, the major differences between androgens (steroids) and TRUE (LBD-interacting) phytoandrogens (triterpenoids and iridoids) are:

1) Androgens are steroidal stimulants (which carry side effects) whereas phytoandrogens are non-steroidal modulators (unique SARM moderators which 'swtich on' and 'switch off' the AR selectively, thereby preventing overdose and the side effects typically associated with steroids/hormones).

2) Androgens cannot be taken orally whereas phytoandrogens have been scientifically and clinically proven, in both animal and human studies, to be effective when taken orally.

3) Phytoandrogens can also act as anti-oxidants unlike androgens.


Ong YC, Kolatkar PR, Yong EL. Androgen receptor mutations causing human androgen insensitivity syndromes show a key role of residue M807 in Helix 8-Helix 10 interactions and in receptor ligand-binding domain stability. Molecular Human Reproduction 2002 Feb; 8(2): 101-8. Impact Factor 3 (international top-ranked journal in Obstetrics & Gynaecology).
Ong VY, Tan BK. Novel phytoandrogens and suprahormonal lipidic augmenters from Eucommia ulmoides. BMC Complementary and Alternative Medicine. 2007 Jan; 7(3).
Ong YC, Yong EL. A method for modulating steroidogenic activity. United States Patent No: US 6,905,714 B2. Jun 14, 2005. United States Patent and Trademark Office (USPTO).
Yong EL, Lim LS, Wang Q, Mifsud A, Lim J, Ong YC, Sim KS. Androgen receptor polymorphisms and mutations in male infertility. Journal of Endocrinological Investigation. 2000 Oct;23(9):573-7.
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Molecular Human Reproduction – Human Androgen Receptor Structure & Function
War on Weight - Botanical therapeutics for cancer and the metabolic syndrome

War on Weight is retailing at, Kinokuniya and Times bookstores. This book is also available for loan from the National Library and the Health Promotion Board Library.

Emeritus Professor (Dr) Marcin Krotkiewski, MD, PhD
Father of the Waist-Hip Ratio (WHR) and anthropometric definition of Pear and Apple Body Shapes. Click on hyperlink

"It is with profound seriousness and a sense of urgency that I recommend this book to discerning readers
and health professionals"

Obesity, cancer and the metabolic syndrome have complex casual factors (aetiology). Clearly, current pharmaceutical and consequent clinical treatment modalities cannot adequately address the management or amelioration of these disorders by using a single ‘magic bullet’ or even ‘bullets’.

Botanical therapeutics in the form of botanical drugs, dietary supplements and functional foods proffer the pleiotropic (multiple actions) pharmacological effects that complex diseases need, in order to be optimally treated or more tantalizingly, cured.

The classical approach to drug discovery uses combinatorial chemistry combined with a target screen to discover new compounds with desired pharmacological attributes. This involves the synthesis of various chemical derivatives based on a main molecule, usually with known activity. For example, the synthesis of new androgens (male hormones) would be based on a steroidal aglycone. However, there are two key drawbacks to the combinatorial chemistry approach – 1. Lack of true novel structure, 2. Toxicity profile. With regard to the former, there is a finite number of derivatives that can be synthesized from a basic structure and more importantly, failure of compounds to exert their therapeutic effect could affect all derivatives of the same chemical, such as antibiotic resistance to ampicillin and similar derivatives with beta-lactam structure. Secondarily, the toxicity profile of the new derivatives is usually not known and requires extensive toxicology studies.

On the other hand, plants synthesize a vast array of primary and secondary metabolites for their growth and defense against pathogens. These phytocompounds can range from very simple structures such as the straight chain hydrocarbon structure of fatty acids found in vegetable cooking oils, to more complex structures such as conjugated polycyclic lignan derivatives such as podophyllotoxin, an anti-cancer agent. From these myriad of phytocompounds and botanical metabolites synthesized by plants, fungi and alga, the botanical drugs of the future will emerge. In fact, numerous pure compound drugs in use today were originally discovered and isolated by scientists from plants and other natural sources.

Existing drugs first discovered in plants

Paclitaxel[1] is a chemotherapy drug used in the treatment of ovarian and breast cancer. Camptothecin[2] is used by oncologists for the clinical treatment of colorectal cancer. Proteoglycans[3] PSK and PSP are in Phase II/III trials in Japan and China for broad spectrum anti-cancer treatment of gastrointestinal, gynaecological and pulmonary tumors. Galanthamine[4] and huperzine A[5], both inhibitors of acetylcholinesterase, are now used in the therapy of Alzheimer’s disease. Artemisinin[6] is the drug-of-choice to treat malaria…the list goes on and on. The common link between all these drugs in clinical use or under clinical development is simple – they derive from botanicals, which refer to plants, fungi and even marine zooxanthellae (symbiotic algae living in corals).

Pharmaceutical companies such as Novartis, Bristol-Myer Squibbs and AstraZeneca have active drug discovery and development programmes involving natural products. In fact, paclitaxel is marketed for cancer treatment by Bristol-Myer Squibbs as Taxol.

To quote Dr Emma Knight, PhD, Cancer Research UK –

Contrary to popular belief, a number of anti-cancer drugs are derived from natural sources. The periwinkle, yew tree and African bush willow are just some of the plants that have important place in the treatment of cancer today"

  1. Paclitaxel was isolated from the Pacific Yew tree (Taxus species).
  2. Camptothecin was isolated from the Chinese herb Camptotheca acuminata.
  3. Proteoglycans was isolated from mushrooms.
  4. Galanthamine was isolated from snowdrop (Galanthus species).
  5. Huperzine A was isolated from Chinese clubmoss (Huperzia serrata).
  6. Artemisinin was isolated from Chinese herb sweet wormwood Artemisia annua L.

Discovering and developing new therapeutics

Therapeutic products encompass small molecule drugs, complex medicines, dietary supplements and functional foods. Previously, in the context of modern classification and legislation, botanical medicinal products were largely confined to structure-function and general health claims, with specific exceptions in countries such as Germany, where standardised herbal extracts such as Panax ginseng and Ginkgo biloba are classified as over-the-counter (OTC) drugs. In China and Taiwan, complex formulations used in TCM are recognised and regulated as pharmaceuticals (medicines).

In 2004, the United States Federal Drug Administration (USFDA) introduced a new pharmaceutical category that allowed New Drug Application (NDA) i.e. legally recognised drug status and patent protection, for complex therapeutic formulations derived from botanical sources. This differs from single entity or pure compound drugs that were till then, the only legally recognised and patentable pharmaceuticals used in mainstream Western-based medicine worldwide.

This new type of pharmaceuticals is categorised as Botanical Drug (USFDA-CDER, 2004). A botanical drug product is intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in humans.

  • A botanical drug product consists of vegetable materials, which may include plant materials, algae, macroscopic fungi, or combinations thereof.
  • A botanical drug product may be available as (but not limited to) a solution (e.g., tea), powder, tablet, capsule, elixir, topical, or injection.

Botanical drug products often have unique features, for example, complex mixtures, lack of a distinct active ingredient, and substantial prior human use. Fermentation products and highly purified or chemically modified botanical substances are not considered botanical drug products.

Exemplar of botanical drug lead – VAC

Case Study 1

VAC is an assortment of vegetables consumed as food in Asia. This assortment refer to collectively as VAC, was consumed by an elderly male suffering from a rapidly growing solid tumor in his liver, complicated by a history of hepatic cirrhosis. He was clinically monitored by his physician, at 3-6 months intervals using:

  • CT scans
  • Liver function tests (AST and ALT)
  • Tumor marker (AFP) blood assessment

The period of VAC food supplementation lasted 6 months (month 3 to month 9) until his liver and health condition stabilized sufficiently for him to opt for standard cancer treatment. In figure 2.1, the graph shows 75% inhibition of tumor growth over a 9-month period as measured by CT scans. Concurrent plasma assessment using the biochemical tumor marker AFP (alpha-fetoprotein) showed striking correlation in terms of decreased tumor marker levels, indicating an anti-neoplasia effect (figure 2.2).

Figure 2.1. Line chart showing tumor size over time with VAC Figure 2.2. AFP (tumor marker) level over time with VAC

Conversely, both ALT (alanine aminotransferase) and AST (aspartate aminotransferase) tests showed significant improvement; particularly AST levels, which attained near normal range (figure 2.3). ALT and AST are enzymes located in liver cells. These leak out when liver cells are damaged and are detectable in the blood plasma. The higher the enzymes’ levels in the blood, the greater is the extent of liver damage and consequently, the poorer is the state of liver function..

Figure 2.3. ALT and AST (liver function tests) levels over time with VAC

Figure 2.4. Actual CT scans of cirrhotic liver -  at baseline (during regular health screening of alcoholic patient) 3 months prior to tumor detection (left photo), subsequent detection of rapidly growing tumor (centre photo, grey arrow), tumor growth arrest 9 months later (right photo, yellow arrow) during VAC oral therapy. This enabled successful surgical resection and cancer remission in the patient.

Case Study 2

In a separate case study, a young adult male patient with a solid growth in the external ear lobe shows tumor regression and total resorption after VAC treatment (Figure 3).

Figure 3. Left photo shows neoplasia (indicated by red arrow). Right photo shows complete resorption of the cancerous growth after 36 months.

Based on these clinical case studies and historical use, VAC would be a good candidate for downstream molecular characterisation and botanical drug development via Phase II/III Clinical Trials targeted at USFDA NDA filing.

VAC shows highly desirable pharmacological attributes, which exemplify the advantages of botanical drugs in general:

  • Efficacy - anti-neoplasia bioactivity that antagonises liver tumor growth (measured using CT scans plus AFP tumor marker), and complete tumor resorption in the 2nd case study.
  • Safety - in this case, adaptogenic (tonic) effect that actually improves patient's health (assessed using AST and ALT liver function tests).



United States Federal Drug Administration Center for Drug Evaluation and Research (USFDA-CDER): Guidance for industry – botanical drug products. Rockville; 2004.

Aetiology of Individual Obesities - Causal clusters involving genes, viruses, gut microbes, personal habits and societal poverty factors

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Causal Clusters in Obesities - Physiological Cluster

  • Genetic factors such as OB, GHRL, FTO genes.
  • Endocrine factors such as clinical/subclinical hypothyroidism, Cushing's Syndrome and sexual dimorphism in the musculoskeletal system.
  • Metabolic factors such as retention level in adult brown adipose tissues, and variations in adaptive thermogenesis.

These physiological factors can be hereditary (inherited traits), congenital (at birth, due random assortment of genes in gametogenesis and sexual reproduction), iatrogenic (resulting from treatment) or chronological (time dependent, due to yearly ageing, monthly menstrual cycle or daily circadian rhythm). In terms of relevance to obesities, either energy flux and/or distribution are negatively impacted upon by these factors.

Secondarily, water retention (oedema) affecting the hydration level within the body can co-occur with obesity and adiposity, complicating diagnosis and treatment. Disorders that can affect hydration levels in the body include Conn’s Syndrome (primary hyperaldosteronism), Cushing’s Syndrome, premenstrual syndrome, estrogen replacement therapy, renal disease etc.

Genetic factors can translate into endocrine or metabolic effects and vice versa (epigenetic/transcriptional levels), e.g. Prader-Willi Syndrome1. Hence, they are grouped under the same physiological cluster of obesity causes.

1 Deleterious and inheritable mutations of genes at Chromosome 15q11-13 loci. Clinical presentation of hyperphagia, hypogonadism (with concomitant hypogenitalism), obesity and sleep apnoea. Gender-specific endocrinological disorders include amenorrhoea, late menarche or irregular menstrual periods in female patients.

Causal Clusters in Obesities - Environmental Cluster


Pathogenic factors.  The involvement of infectious agents.


Nutritional and dietetic factors. Food and fluid-related abnormalities.

Obesity in humans can also be caused by infectious agents. Cutting-edge research shows that viral or microbial infections of the adipose tissue and colon respectively, can skew the energy balance (flux and distribution) of the body.

The viral agent that can cause obesity and adiposity in humans is the adenovirus-36 (Atkinson RL et al, 2005). The adenovirus-36 belongs to the family Adenoviridae, which are structurally, double-stranded, non-enveloped DNA icosahedral virion particles (Davison AJ et al, 2003). There are many serotypes within the adenovirus family that are known to cause diseases in humans, such as the common cold, bronchitis, diarrhoea and urinary tract infection.

Another interesting (almost science fictional) pathogen-mediated obesity is the Methanobrevibacter smithii (M. smithii) and Bacteroides thetaiotaomicron (B. theta) co-infection of the human gut.

Within the subcluster of nutritional and dietetic factors, there is a wide and diverse distribution. Some of these nutritional factors can also crosslink to the physiological cluster. While malnutrition or under-nutrition can be a cause of individual obesities, it is vital to remember that over-nutrition and “dys-nutrition” of specific vitamins and other essential nutrients can also be toxic and occasionally fatal. Hence, only foods and water in the daily main meals (the diet) should contain essential nutrients. Non-dietary foods and drinks (the behavioriet), that exceed dietary requirements, should not contain vitamins, minerals and the like, since overdosing (acute or chronic) may occur.

The most well-known (and overly abused/blamed) obesity-causing factor is the deficiency in energy cofactors of metabolism, such as vitamin B complex, chromium or zinc, which impacts on energy burning (ATP production and/or non-ATP thermogenesis) and energy building (muscle anabolism) capability of the body.

Causal Clusters in Obesities - Behavioural Cluster


Preferences factors. The likes and dislikes of the individual.


Habitual factors. Repetitive actions by the individual, which could be - a conscious and deliberate effort, a subconscious set pathway or a semi-compelled act with central nervous system involvement.

It is not always possible to draw clear lines between preferences and habitual factors within the behavioural cluster. Where clear patterns of cognition and emotion are present, straightforward counselling and psychotherapy, such as using Prochaska Diclemente techniques to bring about behavioural change will suffice.

In other cases, the prescribing of behavioural/behaviorietary aids may be required to effect lasting modulation of the obesity causal factor(s). Quite often, counseling alone will have limited success over the lifetime of the patient. Abstinence is never the preferred solution. Convenient, affordable, safe and close-matching substitutions should always be the first choice. Only if the alternatives are not feasible, unsafe or unrealistic, should abstinence be advocated.

Causal Clusters in Obesities - Psychosocio-economic Cluster


Occupational and financial factors.

A few general examples are cited here:

  • Entertainment of clients, due to job requirement, that compels hyperphagia and/or hypercalorification;
  • Lack of time and mental exhaustion to exercise/prepare balanced dietary meals;
  • Buying cheaper, nutritionally poor, energy-rich food and drinks, as alternatives to balanced meals that are relatively more costly leading to obesity/adiposity and under-nutrition. Published social sciences research shows a distinct link between economically disadvantaged communities and obesity (Jain A et al, 2001; Chamberlin LA et al, 2002; Evers S et al, 2007). Paradoxically, the affluent also suffers from obesity/adioposity, but more likely than not, to suffer from over-nutrition instead (Hakeem R, 2001; Sakamoto M, 2006).

Family and social factors.

  • Ethnic and cultural influences are strong predicators

Behaviorietary food and drinks consumption due to gatherings and parties, which exceeds daily energy requirements. Dinners that are actually sumptuous feast – nine days out of 10.

  • Psychosocial stress and/or entertainment-related triggers.

In adults, this can involve work-related stress triggering off habitual factor in the behavioural cluster. For example, hyperphagic and hypercalorifying actions as means of relaxation or solace (Wallis DJ and Hetherington MM, 2004; O’Connor DB et al, 2008). For children, this may include bullying at school, boredom (lack of social or recreational activities) or the pressures of school work or meeting parental expectations (Kaltiala-Heino R et al, 2000).

Sleep deprivation can also cause disruptions to the orexigenic hormonal homeostasis milieu. For instance, nocturnal social activities in adults, late night studying in school children or the involvement of the Hyperphagic Short Stature Syndrome2 (affecting children in foster homes or living with family abuse).

  • Traditional, universal family values.

A belief by some parents, that to care and lavish attention upon their child is to make available plenty of healthy food and drinks, and to partake in it too!  Secondly, during mealtimes, the need to finish all the food that is on the individual’s plate and ‘left-overs’ on the table, to prevent ‘food wastage’.

2  There are aetiologic and phenotypic differences between the Hyperphagic Short Stature and Prader-Willi Syndrome, even though endocrine factors are involved in both syndromes affecting obesity in children. A salient comparative paper by Gilmour J et al, 2001, has been published in this regard.

Information about Diabetes (recommended book)
Conquering Diabetes

"A cutting-edge guide to prediabetes and diabetes by a world-renowned pioneer in treatment and management"

The numbers are epidemic-more than 60 million Americans have prediabetes or diabetes-and the complications (heart disease, blindness, kidney failure) can be devastating. But they are not inevitable, says Dr Anne Peters (Associate Professor, Keck School of Medicine, USC), medical specialist in diabetes, who in Conquering Diabetes explains how prediabetes can be reversed, and diabetes can be conquered.

As a university academic, researcher and clinician, Dr Peters is at the forefront of the latest developments in the prevention and treatment of the disease. Conquering Diabetes offers Dr Peters’ complete program to reverse prediabetes and to treat both types of diabetes mellitus (type 1 and type 2), including what foods to eat/avoid, which medications help/hurt, and how to get the best treatment from your doctor.

PLUME, Penguin Group, 2006
Copyright © Anne Peters, 2005
Information about Stress Management and Complete Health (recommended book)

Full Catastrophe Living

Emeritus Professor (Dr) Jon Kabat-Zinn, MD, PhD.

Father of MBSR in modern evidence-based medicine.

BANTAM, Revised Edition, 2013

Copyright © Jon Kabat-Zinn, 1990

Stress. It can sap our energy, reduce our quality-of-life (QoL), undermine our health if we let it, and even shorten our lives. It makes us more vulnerable to illnesses, such as hypertension, depression, cancer, stroke and heart disease in the long run

This book Full Catastrophe Living is based on the renowned Buddhist mindfulness-based stress reduction (MBSR) program, scientifically researched and clinically proven by Harvard Medical School. This classic, groundbreaking work - which gave rise to a whole new field in modern medicine (contemplative neuroscience) - shows you how to use medically proven mind-body approaches derived from meditation to counteract stress, normalise blood pressure, reduce cancer risk and stimulate complete wellbeing.

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