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