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A
HIGH-PROTEIN REGIMEN AND AURICULOMEDICINE
FOR THE TREATMENT OF OBESITY: A SECOND CLINICAL
OBSERVATION
By
Richard C. Niemtzow, Colonel, USAF, MC,
FS, James R. Little, Lieutenant Colonel,
USAF, MC, SFS, Mary Ann Matanga, Captain,
USAF, NC, Beth Ferrer, Senior Airman, USAF,
Jeffrey Corn, M.A., and William
Kitto, Ph.D.
ABSTRACT
BACKGROUND
In a previous article by Niemtzow, "A
High-Protein Regimen and Auriculomedicine for Treatment of Obesity:
A Clinical Observation" (Medical Acupuncture), Fall/Winter 1997/98,
Vol. 9/No. 2), a sustained average weight loss of 2.7 pounds (lbs)
per week, and a statistical reduction in triglycerides (TG) was
reported. Although the total cholesterol (TC) lowered clinically,
it was not statistically significant. From this previous group
of patients, only 6 data points were available l"or he determination
of TG, TC, heavy density lipids (HDL), and light density lipids
(LDL). Because of the paucity of lipid data, a larger group consisting
of 42 patients was evaluated under the same criteria, with the
exception that the high-protein regimen underwent minor modifications
to meet the minimum guidelines of the American Dietetic Association
and the United States Recommended Dietary Allowances. 
METHODS
Forty-two patients were treated For simple
clinical obesity who were either self-referred or referred by
their primary physician. The majority of these patients admitted
to failing popular diets and never reached their weight goal,
or were short-termed successful but eventually regained weight.
Patients were evaluated to eliminate organic causes. Each patient
underwent a history and physical examination. The previous high-protein
diet was prescribed with minor modifications. Auriculomedicine
was performed for each patient.
RESULTS
The regimen was well tolerated and a
statistically significant decrease in weight and TG was observed
during the 12-week period starting at week 0. The TC decreased
significantly only during the first 6 weeks starting at week 0.
HDL levels decreased in the first 3 weeks and started to rise
in weeks 9 lo 12. LDL appeared to decrease in the first 3 weeks
and then, rose in weeks 6 to 12. TC, LDL, HDL value changes were
not statistically significant long-term, but this could be due
to a diminishing sample population. There were no untoward reactions
despite a minor change in the high-protein regimen. Acceptability
for the diet remained high. Patients reported that auriculomedicine
helped to prevent cravings for carbohydrate-rich foods. After
discharge from the program, 38.9% of the patients reported a relapse.
CONCLUSION
A high-protein animal regimen in combination
with auriculomedicine was employed successfully to produce a sustained
weight loss in patients previously failing popular diets. Ail
patients reached their weight goals losing an average of 1.6 lbs
per week. TG levels significantly decreased in a similar fashion,
whereas TC and HDL dropped significant in the first 6 weeks and
3 weeks, respectively. LDL levels did not vary significantly.
The possible homeostatic effect auriculomedicine and a high protein
regimen on serum lipids warrant further investigation.
KEYWORDS
Obesity, High-Protein Regimen, Weight,
Total Cholesterol. Triglycerides, Heavy Density Lipids, Light
Density Lipids, Auriculomedicine
(Opinions and view points expressed
herein by the authors and publisher are their own and not to be
considered an official expression of the Department of the Air
Force.)
BACKGROUND
Adult obesity remains a clinical challenge
(1,2,3). More than 94 million American adults are overweight.
In a recent article in Air Force Times, it was reported that nearly
half of Armed Forces personnel were overweight (4). Until recently,
benign obesity was considered to be the direct result of a sedentary
lifestyle plus chronic ingestion of excess calories. Although
these factors are undoubtedly the principal cause in some situations,
there is now evidence for strong genetic influences on the development
of obesity. As much as 50 to 75% of obesity cases may be explained
by genetic influences (5).
Millions of dollars are spent on medical
visits, diets, and exercise to correct this condition. Even more
important are the consequences of long-term obesity linked to
many comorbidities.
Acupuncture as an adjunctive solution
may be appealing to certain groups of patients, as it appears
to be a natural drug-free therapeutic modality. In any case, physician,
patient, and medical insurance companies seek reliable, safe,
cost-effective solutions, and a low relapse rate to deal with
this clinical disorder.
Many patients inquire whether acupuncture
might be useful in the treatment of obesity. Given the large prevalence
of obesity in our society, it appears to be a worthwhile adjunct
to consider.
In a previous paper, 21 patients were
observed on a combination of a high-protein regimen and auriculomedicine
(6). Weight and TG levels decreased significantly. Clinically,
it also appeared that the TC decreased, while HDL and LDL values
did not undergo significant changes. Neither of these events,
however, could be appreciated because of the small sample size.
Patients reported that auriculomedicine was helpful in maintaining
compliance and prevented bingeing.
|
Table
A - Summary Results of Weight Program Data
|
| |
|
Paired Differences
|
|
| Measures |
Week 3-Week
0
|
Week 6-Week
0
|
Week 9-Week
0
|
Week 12-Week
0
|
| Weight
(lbs) |
*-6.9[42,<0.001]a
|
*-13.3[30,<0.001]a
|
*-16.8[19,<0.001]a
|
*-19.2[13,<0.001]a
|
|
Cholesterol
(mg/l)
|
*-18.5[34,<0.001]a
|
*-14.7[20,0.02]a
|
-9.5[15,0.181]a
|
7.2[10,0.432]a
|
|
HDL
(mg/l)
|
*-3.8[33,0.013]a
|
-3.6[22,0.205]a
|
0.5[13,0.846]a
|
3.7[9,0.211]a
|
|
LDL
(mg/l)
|
-7.1[32,0.092]a
|
2.9[20,0.586]a
|
9.7[10,0.357]a
|
12.3[7,0.27]a
|
|
Triglyceride
(mg/l)
|
*-32.7[33,0.010]b
|
*44.5[19,0.014]a
|
*89.3[11,0.004]a
|
*-89.0{7,0.021]a
|
*
= statistically significant difference (p-value<0.05)
[ ] = number of patients, p-value
a = paired-samples t-test
b = Wilcoxon signed ranks test (used when either sample of the
pair is not normally distributed, i.e. one sample Kolmogorov-Smirnov
test yields a p-value <0.05) |
GOAL
This paper describes a practical and
safe approach to clinical obesity when the etiology is dietary
mismanagement of calories. In this observation, we observed and
followed 42 patients. The larger sample size than previously reported
on afforded an opportunity to examine more closely the weight,
TG, TC, HDL, and LDL values. The treatment protocol incorporated
the same, almost exclusive, animal-protein regimen with minor
modifications as described below, and the use of auriculomedicine
(6).
Each patient decided how much weight
to lose on an individual basis. Aerobic exercise was emphasized
but not required.
METHOD
Subjects
We enrolled 43 patients with clinical
obesity. Each patient underwent a history and physical examination.
All patents had lipid panels, fasting blood sugars (FBS), creatinines
(Ct), and blood urea nitrogen (BUN) studies. We excluded electrocardiography,
thyroid, and urine studies, unless the history and/or clinical
examination justified further evaluations. Patients having elevated
TC, TG, LDL, and low HDL were not excluded, but further work-up
was performed to determine suitability for our program. Patients
with elevated FBS levels were excluded.
High-Protein Regimen
1. Meat
Red (cooked)
meat: unlimited
Chicken: unlimited
Low-fat fish:
unlimited
2. Vegetables
Green vegetables
only. Small portions (slightly less than half-a-cup)
with at least
2 meals. Examples: greens, spinach, peas,
asparagus, green
beans, broccoli, lettuce, and cucumbers.
3. Fruit, Juice, or Bread
2 (8-oz.) glasses
of fruit juice, or 2 pieces of fruit, or 6 slices
of low-calorie
bread per day (40 calories per slice).
They may be mixed,
e.g. 3 pieces of bread and 1 fruit,
or 3 breads and
1 juice, or 1 juice and 1 fruit.
Meat must be
eaten with all meals, i.e. apple and meat.
4. Salad Dressing
1 tablespoon
of salad dressing a day of any variety is acceptable.
5. Beverages
6 (8-oz.) glasses
of water a day must be consumed, with
an optional twist
of lemon, lime, or orange.
Unlimited diet
caffeine-and sodium-free drinks are permissible.
Caffeine-free
coffee and tea are permitted.
6. Excluded
No sugar products:
cakes, cookies, candy, or soda.
No starch products.
No potatoes,
rice, noodles, or cereals.
No sauces, gravies,
mustard, or ketchup.
No tomatoes,
onions, or any vegetables that are not green.
No dairy products:
eggs, cheese, or butter.
No alcoholic
beverages. No yellow vegetables.
No ice cream.
We adhered to and recognized the
need to meet the minimum nutritional requirements of the American
Dietetic Association Food Guide Pyramid as found on the Internet
at http://www.eatright.org
and the United States Recommended Dietary Allowances (7). As a
consequence, we modified our regimen by increasing the amount
of low-calorie bread (40 calories per slice) from 4 to 6 slices
a day. In addition, we added calcium 500 mg, and a multivitamin
tablet daily (7).
AURICULOMEDICINE
Auriculomedicine served the purpose of
suppressing bingeing. The therapy was started one week after initiation
of the high-protein regimen. The auriculomedicine procedure is
very simple, consisting of 3 or 4 points: Appetite Control Point,
Shen Men, and Point Zero. Tranquilizer Point may be added or substituted
for Point Zero (8). The treatment should have a duration of 15
minutes. We have found in some instances, a mild suppression of
appetite with therapy over 15 to 20 minutes; this should be avoided.
One wants the patient to indulge in eating meat to prompt a weight
loss. Seirin blue-topped needles were employed: No. 3 (0.20) x
30mm J type with tube.
STATISTICAL
ANALYSIS
Both the pre-treatment and post-treatment
samples of the five groups (weight, TG, TC, LDL, and HDL) were
first tested for normality using a one-sample Kolmogorov-Smimov
test. Based upon the results of this test, differences between
pre-treatment and post-treatment means of the five groups were
then compared using either one of two tests. If both the pre-
and post-treatment samples of a given group were normal, then
a two-tailed paired-differences t-test was used for that group.
If either the pre- or post-treatment sample of a given group was
not normal, then a two-tailed Wilcoxen signed ranks test was used
for that group (Table A).
Table B depicts follow-up data on patients
that were contacted by telephone. We were interested in determining
a relapse rate based on weight gain over time, and other parameters
such as no change in weight or weight loss.
STATISTICAL
RESULTS
Weight decreased in a statistically significant
manner an average of 19.2 lbs over a 12-week period starting at
week 0, going from an average value of 206.2 lbs at week 0 to
an average value of 186.9 lbs at week 12 (Figure
1). 
TG levels decreased in a statistically
significant manner an average of 89.0 mg/L over a 12-week period
starting at week 0, going from an average value of 175.1 mg/L
at week 0 to an average value of 86.1 mg/L at week 12 (Figure
2).
TC levels decreased in a statistically
significant manner an average of 14.7 mg/L over a 6-week period
starting at week 0, going from an average value of 206.1 mg/L
at week 0 to an average value of 191.4 mg/L at week 6. Changes
thereafter were not statistically significant (Figure
3).
LDL levels did not change in any direction
in a statistically significant manner during the 12-week period
(Fig 4). HDL levels decreased in a statistically
significant manner an average of 3.8 mg/L over a 3-week period
starting at week 0, going from an average value of 46.4 mg/L at
week 0 to an average value of 42.6 mg/L at week 3. Changes thereafter
were not statistically significant (Figure 5).
The number of patients participating
in the study steadily decreased over the 12-week period. If the
number of patients had remained steady, then it is possible that
the increasing changes observed in some of the measures toward
the end of the study, which were not statistically significant,
would have been significant. It is also possible that these increasing
changes would have disappeared.
Table B and Figure
6 show that 50% of the patients did not gain weight, while
38.9% did; 11.1% desired to lose more weight, for whatever reasons.
The data goes out to over 91 days and thus, no final conclusions
should be made. 
RESULTS
Forty-two patients successfully completed
a clinical program incorporating a high-protein regimen and auriculomedicine.
Each patient reached his or her desired weight goal. The average
weight loss was 1.6 lbs per week. There were no clinical complications.
Compliance was excellent throughout the course. It was the unanimous
opinion of the patient group that the auriculomedicine greatly
decreased an urge to binge. There was a significant decrease in
weight, TG, TC (up to week 6), and HDL levels (up to week 3).
No clinically significant changes occurred in LDL, FBS, CT, or
BUN levels. There were no adverse effects reported by patients
from the high-protein regimen or auriculomedicine. 
The number of patients participating
in the study steadily decreased over a 12-week period as individual
goals were met. We telephoned our patients and found a long-term
relapse rate of 38.9%; 50% were still maintaining their weight,
and 11.1% decided to lose more weight by employing the high-protein
regimen alone (Figure 6). Table B only represents 18 patients.
Our military patient population is geographically unstable.
Several patients stated that the protein
diet was expensive and increased their weekly grocery bill by
$45. Others stated that the diet did not add to their food expenditures.
DISCUSSION
This paper is not a research endeavor
nor was it designed as such. Instead, we are reporting on a very
efficient clinical treatment for simple obesity that combined
a high-protein diet and auriculomedicine. 
There are many popular "crash" diets:
The One-Week Cabbage/Chicken Soup Diet Plan, the Cambridge Diet,
the Doctor Kretnzman No-Diet DietTM Program and others, which
can be easily found in various references, including the Intemet.
Although it is not the purpose of this paper to compare and contrast
other programs, we state our observation and make no claims other
than the data presented. The true test of obesity is the relapse
rate.
The high-versus-low-protein diet controversy
is more an issue of fear and confusion than fact. From the above
data, it appears that the high-protein meat regimen does not produce
an acute elevation of lipids; the fact is that there is a significant
drop in TG levels. None of the patients complained of fatigue.
There was no negative impact on kidney function.
It is believed that a high-protein and
low-carbohydrate regimen apparently causes the body to burn its
stored body fat to meet energy needs throughout the day. Large
amounts of meat must be digested and this, in turn, requires energy.
The amount of energy to digest large amounts of protein in the
presence of low and simple carbohydrates may lend itself to the
rapid metabolism of adipose tissue. It is also well-known that
a high-protein diet suppresses insulin peaks and false hunger
pains. 
One patient, who was not part of this
group, requested only auriculomedicine. He was not able to eat
a high-protein regimen because of possible kidney disease, and
was being treated medically for hyperlipidemia. It is challenging
to understand why he also lost weight, and his triglycerides and
cholesterol values normalized for the first time since the onset
of his condition.
|
Figures
1-5 * Data
|
| Measure |
Week 3-Week
0
|
Week 6-Week
0
|
Week 9-Week
0
|
Week 12-Week
0
|
| Weight |
-6.9
|
-13.3
|
-16.8
|
-19.2
|
| Cholesterol |
-18.5
|
-14.7
|
-9.5
|
7.2
|
| HDL |
-3.8
|
-3.6
|
0.5
|
3.7
|
| LDL |
-7.1
|
2.9
|
9.7
|
12.3
|
| Triglyceride |
-32.7
|
-44.5
|
-89.3
|
-89.0
|
Auriculomedicine and the choice of the Appetite Control Point,
Shen Men, Point Zero, and the Tranquility Point attenuate cravings
more so for carbohydrates. The role of auriculomedicine as reported
by patients allows them to comfortably pass up the need to return
to their previous dietary carbohydrate errors. It was noticed
that sessions over 20 minutes seemed to mildly suppress the appetite
for a few days.
Omura reported that acupuncture can induce
decreases in TG, TC, and phospholipids. It may also provide a
regulatory mechanism towards homeostasis, which depends on pre-treatment
levels. The significant changes for TG and TC that we noted may
be due to this homeostatic effect (9, 10). 
CONCLUSION
In conclusion, this paper demonstrates
a practical high-protein diet that is very successful for the
treatment of obesity caused by poor carbohydrate management. When
coupled with auriculomedicine, patients report a very subjective
but definite increase in the quality of the program and prevention
of bingeing. The homeostatic effect of auriculomedicine on serum
lipids needs to be further investigated. An effort to obtain an
increased patient population size and data points would be of
significant interest in determining the long-term effects of our
program on weight, TG, TC, LDL, and HDL levels.
|
Figure 6
* Weight Change After Program Discharge Data
|
| Change |
1 to 30
|
31 to 60
|
61 to 90
|
91+
|
Total
|
Percent
|
| Gain |
0
|
2
|
1
|
4
|
7
|
38.9%
|
| Lost |
0
|
1
|
0
|
1
|
2
|
11.1%
|
| Maintained |
1
|
3
|
3
|
2
|
9
|
50.0%
|
| Total |
1
|
6
|
4
|
7
|
18
|
100.0%
|
|
Table B
* Relapse Data
|
|
Weight
Change
|
Days After
Program Disccharged
|
| |
1 to 30
|
31 to 60
|
61 to 90
|
91+
|
Total
|
Percent
|
| Gain |
0
|
2
|
1
|
4
|
7
|
38.9%
|
| Lost |
0
|
1
|
0
|
1
|
2
|
11.1%
|
| Maintained |
1
|
3
|
3
|
2
|
9
|
50.0%
|
| Total |
1
|
6
|
4
|
7
|
18
|
100.0%
|
REFERENCES
1. Shapiro L."Is fat that bad," Newsweek. April 21, 1997; 58-64.
2. Shute N. "The joy of fat," U.S. News. January 12, 1998; 55-58.
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overweight among US adults from 1987 to 1993: a multi-state telephone
survey. Am J Public Health. 1996; Vol.86/No. 12, 1729.
4. Jowers K. Air Force Times. Times Publishing Company. November
23, 1998; 6.
5. Tierney JR, Lawerence M, McPhee S J, Papadakis MA. Current
medical diagnosis & treatment. Appleton and Lange, Connecticut,
1999; 1185.
6. Niemtzow RC. A high-protein regimen and auriculomedicine for
treatment of obesity: a clinical observation. Medical Acupuncture,
Fall/Winter 1997/98; Vol.9/No.2, 15-21.
7. National Research Council, Recommended dietary allowances.
National Academy Press 10th Edition, Washington, DC 1989; 41,45,125,262,284.
8. Oleson T. Auriculotherapy manual: Chinese and Western systems
of ear acupuncture. Health Care Alternatives 2nd Edition, Los
Angeles, 1996; 135, 56-57, 58.
9. Omura Y. Pathophysiology of acupuncture treatment: effects
of acupuncture on cardiovascular and nervous systems I. Acupuncture
Electrotherapeutics Research 1,1976; 51-141.
10. Helms JM. Acupuncture energetics: a clinical approach for
physicians. Berkeley: Medical Acupuncture Publishers, 1995; 1.
AUTHORS'
INFORMATION
Dr. Richard Niemtzow
is a Colonel in the United States Air Force Medical Corps, and
is stationed at Edwards Air Force Base, California. He is serving
as the 95th Medical Operations Squadron Commander. Dr. Niemtzow
heads a daily acupuncture clinic.
Richard C. Niemtzow, M.D., Ph.D, M.P.H.
Col, USAF, MC, FS
Commander, 95th Medical Operations Squadron
30 Hospital Road
Edwards AFB, California 93524-1730
805-277-2183
Or 21282 Hwy. 14, Sierra Trails RV Park,
Mojave, CA 93501
Phone: 760-373-1051 ? Fax: 760-373-2430
Email: N5EV@aol.com
Dr.
James Little is a Lieutenant Colonel in the United States Air
Force Medical Corps, and is stationed at Edwards Air Force Base,
California. He is serving as the 95th Aerospace Medicine Squadron
Commander. Dr. Little is residency-trained in family practice,
aerospace medicine, and occupational med- icine with a Master's
Degree in Public Health, Harvard School of Public Health.
James R. Little, M.D., M.P.H.
Lt Col, USAF, MC, SFS
Commander, 95th Aerospace Medicine Squadron
55 No. Wolfe Avenue Edwards AFB,California
93524-6200
805-277-6818
MaryAnn
E. Matanga is a Captain and a Registered Nurse in the United States
Air Force, and is stationed at Edwards Air Force Base, California.
She is the Officer in Charge of the Acupuncture Clinic, and an
assistant to Col (Dr) Richard C. Niemtzow in daily patient treatments.
MaryAnn E. Matanga, RN, BSN
Capt, USAF, NC, Officer in Charge /Acupuncture
Clinic
95th Medical Operations Squadron
30 Hospital Road
Edwards AFB, California 93524-1730
805-277-3732
Senior
Airman Maribeth O. Ferrer is an Emergency Medical Technician in
the United States Air Force. She is stationed at Edwards Air Force
Base, California, and is currently working with Dr Niemtzow as
an assistant technician in the Acupuncture Clinic.
SrA Maribeth O. Ferrer
95th Medical Operations Squadron
30 Hospital Road
Edwards AFB, California 93524-1730
805-277-3732
Mr.
Jeffrey Corn is Chief of the Software Engineering Section of the
Computer Sciences Branch at Edwards Air Force Base, California.
He has a Master's Degree in Mathematics, and has over 8 years
of experience in data analysis.
Jeffrey D. Corn, MA
Chief, Software Engineering Section
306 E. Popson Ave.
Edwards AFB, California 93524-6680
Dr.
William Kitto is the Chief of the Computer Science Branch at the
Air Force Flight Test Center at Edwards Air Force Base, California.
He has worked in the field of data analysis for over 25 years.
He received a Ph.D. in Mathematics from the University of Washington
in 1972.
William G. Kitto, Ph.D.
Chief, Computer Sciences Branch
306 E. Popson Ave.
Edwards AFB, California 93524-6680
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