1. The Efficacy of Lo-Chol in Hypercholesterolemia Researcher :Dr. Mujeeb Hoosen Supervisors : Prof. Rashid Bhikha, Dr. Yumna Abrahams Date : 24 September 2011

2. Abstract  Modern medicine has provided impressive results in the past century however currently there is an increase in the lack of public confidence, largely due to several factors like the dehumanization of modern medical practice and procedures, modern medicine is becoming economically unsustainable, its inability to effectively treat chronic conditions, rise of iatrogenic diseases and the re-emergence of life threatening infections.  Globally the public are seeking safe, effective holistic healthcare solutions. Unani-Tibb can make a significant contribution due to its legacy of wisdom, knowledge and the prescription of safe and effective remedies. For this to be integrated in public health, Unani medicine has to rise to the many challenges that it face. One of them being to scientifically prove that Unani medicine are safe, effective and sustainable.

3. Abstract  Coronary artery disease is one of the leading causes of death in Western countries. The disease occurs most frequently in populations with diets high in cholesterol.  This study looks at the efficacy of Lo-Chol, a cholesterol lowering medicine used for the treatment of hypercholesterolemia at the Tibb Medical Centre.  Dietary and medication compliance were recorded for 20 patients to determine the efficacy of Lo-Chol in patients with hypercholesterolemia.  Results showed that Lo-Chol is effective as a cholesterol lowering medication however further studies are needed to confirm its efficacy

4. Research Problem  Coronary artery disease is one of the leading causes of death in Western countries.  The disease occurs most frequently in populations with diets high in cholesterol.

5. Research Problem cont.  Tibb – “most illness results when incomplete digestion of food has occurred over a short or long period of time” (Chisti,1991).  NB – effective assimilation and elimination  Allopathic – ‘Statins’ aimed to lower cholesterol levels. NB – Common adverse effects: GIT effects such as abdominal pain, constipation, diarrhea, flatulence, nausea, dyspepsia etc. (SAMF, 2008).

6. Definitions: Allopathic vs Tibb  Hypercholesterolemia : the presence of elevated concentrations of cholesterol in the blood which predisposes to atheromatous disease  Tibb – C & D / Melancholic imbalance Pathway 2 (chronic)

8. Aims and Objectives  To establish the effectiveness of Lo-Chol in patients with hypercholesterolemia.  Can Lo-Chol lower blood cholesterol levels in patients with hypercholesterolemia  Is Lo-Chol more effective in patients who are compliant to the prescribed diet and medication.  Does the effect of Lo-Chol vary amongst different temperaments

9. Methodology  Sample size - 20 patients  Population - Patients attending the Saartjie Baartman Tibb Medical Centre  Inclusion- Both genders, age 25 - 85 years old, pre- diagnosed patients and newly diagnosed patients. Patients on allopathic medication requesting to change to Tibb medication. All temperament groups.  Exclusion - 24 years old and younger  Time period : March – September 2011

10. Methodology  Equipment- Cholesterol meter, cholesterol strips, alcohol swabs, needles  Testing total cholesterol levels once weekly for 1 month followed by monthly testing for 5 months. Document dietary and medication compliance.

11. Methodology  Therapeutic goal (dosage): Low risk patients - < 5.5 mmol/L High risk patients - < 4.5 mmol/L mmol/L5.5 - 66 - 77 – 7.5> 7.5 Lo CholDiet / 1bd2bd2tds2qid mmol/L4.5 - 5.55.5 - 66 - 7 Lo Chol2bd2tds2qid

12. Parameters  Temperamental evaluation  Age  Gender  Co-morbid factors  Dietary compliance  Medication compliance

13. Treatment Plan  Diet – cholesterol lowering  Herbs – flaxseed, garlic, carrots, mint, psyllium  Purging – Melanpurge / Laxotabs  Exercise  Cupping – dry and wet  Medication – Lo Chol (emphasis on compliance)

16. Results  Data presentation: Table and graph format according to temperament. Table 1-4 : Pts, temperament, age, gender, co-morbid factors Graph 1-4 : Chol/mmol. (3-8) vs visits (1-10) indicates diet /meds /both

17. PatientTemperamentAgeGenderCo-morbid factors 01P/S68MHypertension (HPT),Diabetes (DM) 02S/P33MObesity 03S/P55MHPT 04P/S64MHPT 05S/P53FHPT 06P/S64MCongestive Heart Failure (CHF) 07P/S42MHPT 08S/P37MHPT Table 1 : Sanguinous / Phlegmatic

18. PatientTemperamentAgeGenderCo-morbid factors 01P/S68MHypertension (HPT),Diabetes (DM) 02S/P33MObesity 03S/P55MHPT 04P/S64MHPT 05S/P53FHPT 06P/S64MCongestive Heart Failure (CHF) 07P/S42MHPT 08S/P37MHPT Table 1 : Sanguinous / Phlegmatic

19. Table 2: Phlegmatic / Melancholic PatientTemperamentAgeGenderCo-morbid factors 09P/M65MDM 10M/P57MHypercholesterolemia 11P/M49FAnxiety /Stress 12P/M65FHPT, DM 13P/M58FHPT 14P/M85MHPT, CVD 15P/M52MHPT

20. PatientTemperamentAgeGenderCo-morbid factors 09P/M65MDM 10M/P57MHypercholesterolemia 11P/M49FAnxiety /Stress 12P/M65FHPT, DM 13P/M58FHPT 14P/M85MHPT, CVD 15P/M52MHPT Table 2: Phlegmatic /Melancholic

21. PatientTemperamentAgeGenderCo-morbid factors 16B/S53MHPT, GORD 17B/S48FHPT * Arrows indicates non–compliance to meds/diet/both Table 3: Bilious / Sanguinous

22. PatientTemperamentAgeGenderCo-morbid factors 16B/S53MHPT,GORD 17B/S48FHPT Table 3: Bilious / Sanguinous

23. PatientTemperamentAgeGenderCo-morbid factors 18M/B70FHPT 19M/B30MHypercholesterolemia 20B/M58MMI Table 4: Melancholic / Bilious

24. PatientTemperamentAgeGenderCo-morbid factors 18M/B70FHPT 19M/B30MHypercholesterolemia 20B/M58MMI Table 4: Melancholic / Bilious

25. Data analysis  60% of patients experienced decreased cholesterol levels on the 1 st visit  60% of patients reported that increased cholesterol levels after treatment were due to non- compliance to the prescribed diet / medication / both

26. Data analysis  35% of patients experienced decreased cholesterol levels despite non-compliance to diet / medication / both  50% of patients experienced lower cholesterol levels on the final visit

27. Discussion  S/P displayed the best (consistent) results – compliance / moistness  B/M dom/subdominent displayed varying (inconsistent) results – non- compliance / dryness

28. Discussion  Statistics – women (esp. menopausal) are high risk pts. – dryness?  Age – increase dryness  Patients displayed higher cholesterol levels towards winter – cold ? / diet ?

29. Conclusion  Lo-Chol is effective in hypercholesterolemia  Lo-Chol does lower cholesterol levels in patients with hypercholesterolemia  Lo-Chol’s effectiveness is dependant on dietary and medication compliance

30. Conclusion  NB – considerations when prescribing Lo-Chol : temperament, age, gender, co-morbid factors, season, dietary / medication compliance.

31. Recommendations  Lipogram – asses HDL:LDL (every 3 months)  Comparative study – Intergrative (Tibb) vs Allopathic

33. References  Beers, M. H et al (2006). The Merck Manual. 18 th Edition New Jersey: Merck research laboratories  Bhikha, R and Abdul Haq, M (2001). Tibb– Traditional roots of medicine in modern routes to health. Gauteng: Mountain of Light South Africa  Bhikha, R. (2006). Four Temperaments six lifestyle factors. Roddepoort: Ibn Sina Institute of Tibb  Chisti G,M (1991). The Traditional Healer’s Handbook. Rochester: Healing Arts Press

34. References cont.  Gibbons, C J, et al (2008). The South African Medicines Formulary 8th edition Cape Town: F.A Print  Ibn Sina, (1999). The Canon of Medicine (Al-Qanun fil-tibb) Great books of the Islamic world.  Longmore M, et al (2007).Oxford Handbook of Clinical Medicine 7th edition New York: Oxford University Press Inc.  Mahan, L.K & Escott-Stump, S (2008). Krause’s Food & Nutrition Therapy. 12 th ed.Canada.Sanders Elsevier.

35. References  Siddiqui, S et al (2010). Efficacy of selected Herbal Medicines for Hyperlipidemia. (Abstract) Souvenir Unicon 2010  Salim, M. (2010). Globalization of Unani Medicine (Tibb) : Opportunities and Challenges. (Abstract) Souvenir Unicon 2010  The British Association Illustrated Medical Dictionary (2006). London: D K  Tibb Practitioner Monograph – June 2011: Ibn Sina Institute of Tibb

36. Thank You