Effect of Dieting and Weight Reduction on Cardiovascular Risk Factors and the Level of Stem Cells in the Circulation

Part of the out Research Institute’s mission is to provide research that will aid physicians in evaluating orthomolecular treatments used at the Riordan Clinic.   The Riordan Clinic is making a push toward “Lifestyle Care”, and part of this is a weight management program based on combining human chorionic gonadotropin (HCG) treatment with a low calorie diet.  While we have seen weight loss using this regiment, the clinic was interested in learning how the HCG diet affected typical measures of cardiovascular risk.

Living in an environment characterized by calorie-rich foods and low physical activity, over two thirds of Americans are overweight. This is a major public health problem, as obesity predisposes to a variety of age-related inflammatory diseases, including insulin resistance, type 2 diabetes, atherosclerosis and its complications, fatty liver diseases, osteoarthritis, rheumatoid arthritis, and cancer. Clinical studies have identified a relationship between increased body weight and cardiovascular disease including coronary atherosclerosis, congestive heart failure, arrhythmias, and stroke.

In addition to established cardiovascular risk factors, systemic inflammation, increased oxidative stress, and altered hemodynamics associated with excess weight may directly contribute to endothelial injury and dysfunction. Progenitor cells, which are released from the bone marrow are sensitive to oxidative stress. Circulating endothelial pro-genitor cell (EPC) numbers have been found to be lower in obese subjects compared to overweight or normal weight adults, and the colony-forming capacity of these cells is blunted. Alterations in endothelial cells and EPC function associated with obesity precede atherosclerosis and thrombosis. Moreover, EPCs expanded from the obese subjects possessed reduced adhesive, migratory, and angiogenic capacity  and fail to respond to vascular endothelial growth factor.                   Dyslipidemia of obesity is characterized by elevated fasting triglycerides and decreased high-density lipoprotein-cholesterol concentrations. Endothelial damage and dysfunction is considered to be a major underlying mechanism for the elevated cardiovascular risk associated with increased adiposity.

The goal of our study was to examine how cardiovascular risk factors and circulating CD34-positive cell numbers correlate when overweight subjects attempt to lose weight through calorie restriction. The particular weight loss regimen we examined consisted of severe calorie restriction along with vitamin supplements and administration of human chorionic gonadotropin (hCG), a hormone that encourages metabolic utilization of visceral fat reserves.

The very low calorie diet can be summarized as follows: breakfast consisted of coffee/tea with no sugar or one fruit serving, while lunch and dinner each consisted of 3.5 oz lean protein, a vegetable serving, bread serving, and a fruit serving. The program schedule was as follows: patients took supplements, B12, and hCG for two days prior to beginning a 36-day very low calorie diet. This was followed by a 35 day maintenance period during which calorie intake was gradually raised while restricting sugar and starch intake (at this point, hCG treatment stopped).

During this dieting program, the following parameters were assessed weekly for all participants: fat free mass, body fat, BMI, extracellular/intracellular water, total body water and basal metabolic rate. For part of participants blood chemistry parameters and circulating CD34-positive cells were determined before and after dieting.

The data indicated that the treatments not only reduced body fat mass and total mass but also improved the lipid profile. The changes in body composition correlated with the level of lipoproteins responsible for the increased cardiovascular risk factors. These changes in body composition and lipid profile parameters coincided with the improve-ment of circulatory progenitor cell numbers.

A clinical trial with roughly fifty volunteers undergoing the HCG treatments in conjunction with a low calorie diet allowed us to establish the following:

• Subjects lost an average of eight percent body weight. This includes a twelve percent average decrease in percent fat mass and a six percent decrease in percent lean mass. Some decreases in water weight (roughly five percent) were also seen.
• Weight loss occurred both during the forty day treatment phase and during a forty day maintenance phase.
• Blood chemistry parameters used as indicators of cardiovascular risk, such as total cholesterol and LDL levels, changed for the better during the diet.
• For participants who represented weight loss and fat mass loss, the maximum reduction in lipids that have effect on overall cardiovascular health was 29% for cholesterol, 38% for LDL, 26% for cholesterol to HDL ratio and 35% for LDL to HDL ratio.
• Patients undergoing the HCG treatment/diet saw increases in their circulating progenitor cell counts. This suggests improvements in stem cell formation, which in turn would provide extra repair for tissue damage associated with aging.
• The basal metabolic rate of subjects tended to decrease as they lost weight, but not as drastically as observed in other types of diet regiments.

As part of our interest in obesity and health, we examine how weight correlated with various laboratory parameters.  Among our findings:

• Serum cytokine levels were higher in volunteers with higher body fat masses. This is particularly true of leptin, an adipose based hormone thought to regulate appetite.  The elevation of leptin levels in obese subjects suggests a development of leptin resistance.
• Obese subjects (BMI > 25) showed significantly higher serum levels of insulin (a potential marker of Type II diabetes and “syndrome X”) and C-reactive protein (a maker of inflammation).

Our analysis of obesity and the HCG treatment has been published in a peer-reviewed journal.

• Effect of weight reduction on cardiovascular risk factors and CD34-positive cells in circulation. Mikirova NA, Casciari JJ, Hunninghake RE, Beezley MM;  J. Med. Sci.  2011, 8:445-452.