20 January 2009

The surest way to treat obesity

Nutritional correction of obesityOlga ANISIMOVA, PhD, Associate Professor of the Department of Preventive and Restorative Medicine of RSMU

Russian Pharmacies Magazine No. 7-2008

According to WHO, currently more than 30% of the inhabitants of our planet suffer from obesity, and the scale of pathology is constantly increasing. Alas, despite the sufficient level of informing the population about the inextricable relationship between overweight and serious health problems, in the minds of most people, obesity remains more of a cosmetic problem than a disease requiring serious attention.

It is also surprising that until now this pathology, accompanied by serious metabolic disorders and predisposing to the development of atherosclerosis, diabetes mellitus, liver and biliary tract diseases, the formation of malignant neoplasms, does not meet with proper understanding even among most doctors. In this regard, the role of nutritional prevention of the occurrence and progression of obesity is difficult to overestimate.

About the causes of obesityThe formation of excess weight is invariably based on disorders of carbohydrate-fat metabolism.

The reasons for these violations can be very different, but most often their totality is significant.

Currently, there are several forms of the disease, the most common of which are metabolic-alimentary and endocrine obesity. In the first case, overweight develops due to eating disorders, in the second - against the background of existing endocrine pathology. It should be noted that this division is very conditional, because both forms of pathology are closely intertwined. Thus, alimentary-metabolic obesity very rarely occurs in the absence of any endocrine disorders (hypofunction of the thyroid gland, imbalance of sex hormones, hyperproduction of insulin, etc.), and endocrine obesity, in turn, is impossible without overeating and inactivity.

It is important to remember that many people who are prone to obesity have a slow basic metabolism, as a result of which a significant part of the daily diet is deposited in fat depots. But this is not a pathological mechanism, but, on the contrary, an evolutionary mechanism of survival. After all, adipose tissue is the main source of energy for the body, maintaining energy balance for a long time in conditions of food shortage. Its level is a strict constant that the body strives to maintain, preventing sudden fluctuations. When correcting obesity, we come into conflict with this mechanism. That is why the process of recycling excess fat can be difficult and slow, even if strict dietary restrictions are observed. Moreover, according to research, with a rigidly reduced diet, the body primarily sacrifices its structural proteins and carbohydrates, while maintaining fat reserves.

Of course, the development of obesity is impossible without overeating. One of the reasons for the tendency to over–nutrition is not unreasonably considered a deficiency in the diet of important biological regulators and micronutrients, i.e. increased appetite is a kind of compensatory reaction of the body to the lack of a number of essential and vital nutrients. In order to receive these micronutrients, a person is forced to absorb large amounts of refined food, extracting the substances necessary for the body at the cost of excess calories, fats, cholesterol and carbohydrates.

Due to chronic overeating, constantly high levels of insulin and stucco are maintained in the blood, which at a certain stage of the disease are perceived by the hypothalamic centers of regulation of fat metabolism as the norm and do not cause activation of fat utilization. But the body reacts to a decrease in their concentration that occurs during a diet as a deviation from the homeostatic constant, including mechanisms for preserving fat resources.

The situation is aggravated by a decrease in motor activity, leading to insulin resistance and impaired absorption of blood glucose, i.e. energy starvation occurs, accompanied by the activation of hunger centers, despite the huge reserves of energy substrates.

Prevention of obesityPrimary prevention of obesity is reduced to measures aimed at preventing the disease with pre-existing prerequisites for its occurrence.

It includes an adequate increase in physical activity, stimulating the processes of metabolic transformation of food glucose, as well as enriching the diet with those nutrients that contribute to the removal of excess glucose and fatty acids from the body, as well as optimal utilization of that part of these substances that has been absorbed from the gastrointestinal tract. For these purposes, it is important to have sufficient amounts of dietary fiber, vitamins (especially group B), phospholipids, omega-3 PUFA, trace elements (iodine, zinc, chromium, vanadium, etc.), choline, carnitine and other lipotropic factors in the daily diet.

Principles of restoring carbohydrate-fat metabolismAn imbalance in the structure of nutrition when the body is predisposed to obesity inevitably leads to the emergence of this pathology.

Therefore, corrective and restorative measures should be based on the principles of dietary correction. The success of these measures depends on how much in the process of their implementation it will be possible to restore the disturbed carbohydrate-fat metabolism. By the way, failures in the treatment of obesity are most often associated with the incompleteness and incompleteness of the treatment and recovery process.

Of course, strict restriction of caloric intake is a mandatory element of all therapeutic schemes. However, at the same time, the losses of many nutrients must be taken into account and replenished – first of all, those that are important for the regulation of fat metabolism. In addition, if the starting factor for the restructuring of fat metabolism is a reduced diet, then the most effective result in the form of a complete restoration of carbohydrate-fat metabolism in most cases is possible only with an integrated approach that takes into account the specifics of various pathophysiological phases of lipolysis.

The first phase of lipolysisThe first phase of lipolysis, characterized by an excess of insulin, leptin, and excess adipose tissue, proceeds quickly and is accompanied by a relatively rapid weight loss, which, however, occurs due to the breakdown of proteins and carbohydrates with an almost unchanged volume of adipose tissue.

The prevention of protein catabolism and the strengthening of the breakdown of fat deposits contributes to the replenishment of the diet with ready-made forms of amino acids, which show their maximum effectiveness in building a muscle frame with increased physical activity. In the first phase of lipolysis, it is important to remember about detoxification measures (sufficient drinking and intake of food sorbents), ensuring the elimination of catabolism products.

We must not forget that against the background of strict dietary restrictions, the intake of many important minerals, vitamins, amino acids into the body decreases, which can lead to a decrease in immunity, disruption of the heart and vascular tone, general asthenization of the body and other disorders. Optimization of the food ration with these nutrients allows avoiding them.

The second phase of lipolysisThis phase, which is a turning point in the process of correcting obesity, lasts for several months and is characterized by a restructuring of the mechanisms of regulation of adipose tissue and energy metabolism.

This stage is the most difficult, because hunger centers are activated and lipolysis is sharply restricted due to the slowing down of the basal metabolism. These processes are a manifestation of the body's protective reaction aimed at preserving adipose tissue.

In the therapeutic aspect, during the second phase of lipolysis, it is important to use dietary supplements based on compounds that stimulate basal metabolism, anorexigenic drugs, and agents that prevent the formation of fat. For example, the introduction of amino acids tryptophan 5-hydroxytryptophan into the diet, which have a regulating effect on serotonin synapses of the brain, causes a decrease in appetite, especially cravings for sweets. The effect of dietary fiber, glucomannan, guar gum, which are also used in the second phase of lipolysis, is associated with an increase in these products in volume, irritation of stomach mechanoreceptors and slowing its emptying. In addition, this group of substances has the ability to absorb carbohydrates and fats and remove them from the body. It is also appropriate to use dietary supplements containing garcinia cambogia fruits, fennel seeds, bitter melon, since these compounds suppress appetite and normalize gastrointestinal motility.

And of course, during the second phase of lipolysis, one should not forget about intense physical exertion, which increases the utilization of adipose tissue. As a result, the level of stucco, insulin and other peripheral mediators increases, which reduces the feeling of hunger.

The third phase of lipolysisThis phase is the stage of restoring carbohydrate and fat metabolism: the sensitivity of the hypothalamic centers of regulation to stucco, insulin and other metabolic mediators is normalized, their concentrations in the blood are returned to normal, and an equilibrium is established between the processes of lipolysis and lipogenesis.

Here, such measures as the selection of a rational balanced diet with mandatory enrichment with micronutrients, lipotropic factors and dietary fibers, as well as the preservation of physical activity, are of key importance. It must be remembered that food should be not only low-calorie, but also 4-6 times, because with rare but abundant food consumption, energy-saving mechanisms are activated.

This also needs to be rememberedObesity as a multifaceted metabolic syndrome is characterized, among other things, by a pronounced violation of water-salt metabolism, one of the manifestations of which is excessive accumulation of fluid and sodium in the tissues of the body.

Excess extracellular fluid in obese patients can average from 2 liters to 20 liters (!). Leveling weight loss, water retention creates a false impression of the lack of effectiveness of the means used, which can negatively affect the psychological mood of the patient. However, despite this, in the process of performing therapeutic schemes, it is impossible to limit the use of water, since in conditions of intensive catabolism of tissue structures, such tactics will lead to intoxication and increased metabolic disorders (stone formation in the gallbladder, etc.). Dietary supplements based on herbal diuretics contribute to the removal of fluid from the body.

In addition, therapeutic tactics for obesity should necessarily include metabolic correction of complications accompanying this condition, including atherosclerosis of blood vessels, calculous cholecystitis (with preserved gallbladder function), diabetes mellitus, etc., since these disorders are a manifestation of the general metabolic syndrome.

Portal "Eternal youth" www.vechnayamolodost.ru20.01.2009

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