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Sulfad
Morbid Obesity
Dr. Islam Sobhy
Mr. Mohammed
Age: 36 Years OldProfession: Accountant
Controlled DiabetesFatty LiverHigh Liver EnzymesBMI = 35
Feel Dizziness and tiredness
Morbid Obesity
• Four studies evaluating > 600 morbidly obese patients undergoing gastric bypass
– All patients underwent intraoperative liver biopsies– Prevalence of NAFLD ranged from 30-90%– NASH was documented in 33-42%. – > 2/3 of morbidly obese patients undergoing
gastric bypass surgery have NAFLD/NASH
Abrams GA, et al. Hepatology 2004;40:475-483; Frantzides CT, et al. J Gastrointest Surg 2004;8:849-855; Dallal RM, et al. Obes Surg 2004;14:47-53; Beymer C, et al. Arch Surg 2003;138:1240-1244.
Dyslipidemia
• Canadian study used U/S to screen 95 adults with dyslipidemia
– Detected fatty liver in 50%– Steatosis was particularly common in individuals
with moderate to severe hypertriglyceridemia or mixed dyslipidemia
– Hypertriglyceridemia and mixed dyslipidemia increased the risk for hepatic steatosis by ~5-fold
Assy N, et al. Dig Dis Sci 2000;45:1929-1934.
FATTY LIVER
Also known as Hepatic Steatosis or fatty liver refers to a reversible condition in which there are acummulation of trygliceride fat into intracitoplasmic vacuoles.
Prevalence of fatty liver
• Estimated prevalence is 2.8 - 25 % of population Hepatology 2003
• 20 to 30 % adults in western countries have NAFLD Imaging & autopsy study• Steatosis seen in 80 % obese patients
Hepatology 2003• NASH seen in 9 - 30 % obese Hepatology 2003
Pathophysiology
Salgado W, et al. Acta Cir. Bras. 2006; 21.
Two-hit Hypothesis
Fatty Liver1st Hit
Damaged Liver
2nd HitOxidative Stress
ToxinsInflammatoryMolecules
Susceptibility
Donnelly et al. J. Clin. Invest. 113: 1343, 2005Day and James. Gastroenterol. 114: 842, 1998
DietFFA
BurnedVLDL-TG
Liver Damage
2nd Hit
Liver DamageSat FA
2nd Hit
Apoptosis
Hepatocyte Mass
Fatty Liver
Controlling Obesity & Fatty Liver
Diet Medication
Emotional Well-being
Exercise
Treatment
Inflammation
Oxidative Stress
Cellular Insulin
Resistant
Cholesterol& TG
Treatment•Increase Bile Flow 1
•Lipid Lowering Effect 2,3,4,5,6
• Free Radical Scavenger8
• Stem Cell Stabilizer 9,10,11
• Anti-inflammatory7
• Insulin Sensitizer7
CAF6- CAF8 Glyc-6
Mariana 90Tumeric
What is Sulfad
Sulfad is combination of four potent compounds acting in synergy and delivering rapid control for hepatitis and Fatty liver patients.
CAF6-CAF8 “Bioactive compound of Cynara”
Glyc-6 “Bioactive of Liquorice”Tumeric “Bioactive compound of curcuma” Mariana 90 “Bioactive compound of Milkthistle”
Main active Ingredients
Manufacturer and Package
Sulfad produces byABC PHARMACEUTICAL S.P.AMarketed by Land Pharma s.r.l- Italy
Dose
1 Tablet BID or TID
Best given half an hour before meals
References
1. Antichoke Increase Bile Output, Herbal Gram. 1996; 37:16 American Botanical Council
2. Beneficial effects of Artichoke leaf extract supplementation on increasing HDL –cholesterol in subjects with primary mild hypercholesterolemia: a double-blind, randomized, Placebo-controlled Trial, Feb 2013
3. HerbClip™ April 30, 2010. Potential Cholesterol-Lowering Effect of Artichoke Leaf Extract
4. HerbClip™ September 30, 2008. Efficacy of Artichoke Leaf Extract in Reducing Plasma Cholesterol concentrations
5. HerbalGram. 1998; 44:21 American Botanical Council. Benefits of Artichoke Leaf Extract in Hypercholesterolemia, Dyspepsia, and Liver Function.
6. HerbClip™ April 15, 2011. Natural Cholesterol-lowering Agents as Alternatives to Prescription statins
References…
7. HerbClip™ June 15, 2009. Picroliv, Ellagic Acid, and Curcumin: Effectiveness in Treating Liver Diseases
8. International Journal of Molecular Sciences 2011. Hepatoprotective and Antioxidant Effects of Licorice Extract against CCI4-Induced Oxidative Damage
9. HerbClip™ September 24, 2002. Liver Detoxification and Herbs10. National Institute for Health Research.
http://www.ahrq.gov/clinic/epcsums/milktsum.htm. Milk thistle: effects on liver disease and cirrhosis and clinical adverse effects
11. HerbClip™ May 31, 2005. Silymarin in the Treatment of Liver Disease- A Conservative Meta-analysis
Thank You
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