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Освен да помагат в редуцирането на теглото, диетите могат и да навредят на здравето ни. Чували сме, че строгите и дълготрайни режими могат да доведат до нарушаване на месечния цикъл, да ни докарат косопад и дори да отключат депресия. Наистина ли е толкова страшно?
Както казва моята учителка по йога „в живота всичко трябва да бъде баланс и равновесие“, а аз ще добавя - включително баланс и равновесие по отношение на диетирането. Разбира се, че е възможно да си навредим при крайни форми на гладолечение, на интермитентно хранене, на монотонно хранене. В такива случаи човек може да стигне до състояние на недохраненост, на микродефицити по отношение на определени витамини и минерали, на много силна редукция на телесно тегло. Тук вече отиваме в друга посока и говорим за хранителните разстройства, за анорексия, булимични състояния, за хиперфагия, която също е в групата на хранителните разстройства. Естествено, че е възможно това да се получи, но наличието на такива симптоми означава, че човек има някакви микродефицити в организма или прекалено бързо и рязко е настъпила редукцията на телесното тегло. По отношение на депресиите, изчерпването на определени медиатори в нервната система или неадекватното усещане и възприятие на външния вид и съответно хранителния прием, категорично могат да доведат до такива състояния на изчерпване и проява на депресивни симптоми. Но депресия от недохранване? В случая по-скоро пак отиваме към хранителните разстройства, защото те много често вървят ръка за ръка с депресивни прояви. Косопадът може да е свързан и с някакво автоимунно състояние.
Чували сме например, че ако спрем да ядем хляб, започва да ни капе косата.
Ако се ограничат силно въглехидратите и храните, които съдържат витамини от група В, пантотенова киселина, биотин и ако дълго време се храним по този начин, би могло да се стигне до такива прояви. Но витамините от група В не се съдържат само в хляба, съдържат се и в ориза, царевицата, овеса, просото, елдата, киноата. Така, че храненето трябва да е много строго, може би тип „Дюкан“, което е високобелтъчно и то да се спазва дългосрочно или например да се практикува гладолечение, или веганство, като други прояви на алтернативни диетични режими. Всички монотонни форми на диети, прилагани за дълго време, в крайна сметка водят до прояви на определени микродефицити, като може да липсват макронутриети, може да липсва пълноценен протеин, може да липсват витамини от група В, може да липсва омега 3 полинаситени мастни киселини. Но вероятно се касае за дисбаланси, които настъпват в организма. Сега много модерен е витамин В12. Дори в новите физиологични норми на хранене за възрастното население над 19-годишна възраст, витамин В12 е увеличен от 2,4µg, на 4 µg. Не е чак толкова лесно човек да се вкара в микродефицит. Например за витамин В12, ние имаме запаси в нашия черния дроб, поне за около 3 години. Витамин В12 се съдържа в продукти с животински произход – в месо и яйца. Човек доста дълго трябва да бъде на веганско хранене, тоест да изключи абсолютно всички животински продукти от диетата, за да се стигне до проява на дефицит на В12 и да има по-сериозно заболяване, свързано със стомашно-чревния тракт, алкохолизъм или атрофичен гастрит. Дефицит може да се получи и при дългосрочен прием на медикаменти, например от групата на метформина и т.н. Досега съм изследвала много пациенти и много малка част от тях са били с дефицит на В12. Вижте, ние всичко можем да проверим, но това са скъпи изследвания. Човек, който добре разпитва, добре лекува. Имаме едно правило в медицината: ако направим една адекватна оценка на хранителния прием и адекватна оценка на терапията, която получава пациента, ако сме запознати и с допълнително придружаващи заболявания, вероятно ние бихме оценили риска този човек да развие подобен микродефицит. Така, че не е нужно да изследваме всичко. За хората със свръх тегло и затлъстяване категорично знаем, че те имат определен набор от микродефицити. Много често срещани са дефицит на витамин D, на витамин А, витамин К2, микродефицит на желязо, магнезий, на калций. Това са по-разпространените микродефицити и ние трябва да ги проследим. Защо? Защото определено хората, които имат свръхтегло и затлъстяване много често се люшкат между 2-те крайности – от свръх ограничителни режими (само растително хранене или само монотонно хранене) до периоди на свръхприем на храна, която е с висока енергийна стойност и ниска биологична плътност. След периоди на дълго ограничаване или хранене с един-два-три-пет хранителни продукта и стриктни диети, тези хора не издържат и се нахвърлят върху шоколади, бонбони, пакетирани храни, мазни храни, които обичайно съдържат много добавена захар, трансмастни киселини, наситени мастни киселини и в същото време нямат кой знае каква биологична плътност по отношение на витамини и минерали. И така дългосрочно, люшкайки се между недохранване и преяждане, те се вкарват в още по-сериозен проблем на микродефицитни състояния.
В такъв случай кога трябва да спрем? Ако сме на някакъв краен режим, за какви симптоми трябва да внимаваме, за да не стане по-лошо?
Вие изобщо не трябва да почвате. Така, че аз няма как да насърча човек да спазва подобен режим на хранене. Ако някой има проблем, свързан с телесното тегло, моля да се обърне към специалист, било то гастроентеролог, ендокринолог, гинеколог, диетолог или дори към личния си лекар, който вероятно ще даде първите насоки. Не се опитвайте да се самолекувате. Знам, че свръхтеглото и затлъстяването са масов проблем, понастоящем в световен мащаб и има много информация за най-различни диети, но моля Ви, не се самолекувайте. Вие сама бихте ли си извадила жлъчката? Ами защо тогава човек се самолекува по отношение на свръхтеглото си? Аз не съм видяла досега някой да си извади сам сливиците, а същевременно постоянно се срещам с хора, които се опитват да се самолекуват по отношение на свръхтеглото си. Това може да бъде един изключително сериозен проблем. Зад простото натрупване на килограми, могат да стоят медицински показатели. Аз не отричам, че има форми на елементарно затлъстяване: повишаване на теглото, вследствие на преяждане. Въпрос на време е неконтролируемото хранене да се превърне в метаболитен проблем. Преди няколко години имаше едни понятия „дебел здрав човек“. Има такива пациенти, на които всички изследвания са им добри, но те са със затлъстяване. На последния конгрес на който присъствах, този термин отпадна. В общи линии схващането е, че е въпрос на време да се проявят метаболитните нарушения, свързани с наднорменото тегло и затлъстяването. Имаше и едно друго понятие „слаб метаболит“ - слаби хора, но с метаболитни проблеми. Това, че си с нормален индекс на телесна маса, в никакъв случай не те защитава.
Тогава какво е мнението Ви за лечебното гладуване? Помага или вреди на здравето?
Още преди много години са правени проучвания на хора с високостепенни затлъстявания, които са на нискокалорийно, нисковъглехидратно хранене и такива, които са оставени на лечебен глад, включително пълно гладуване и резултатите като редукция на тегло са били напълно идентични. Науката вече толкова доказателства даде за това, че човек не трябва да гладува, че не знам дали трябва да го повтарям за пореден път. Поставянето на организма в състояние на глад забавя базалния метаболизъм, тоест човекът се научава да не яде и организмът гледа да покрива само основните си нужди. На следващо място когато човек не се храни достатъчно адекватно или се храни много нискокалорично какво става? Заминават първо гликогенът и водата от мускулите. Ако искате може да си направим експеримент. В първите 10-15 дни нещото, което човек редуцира е вода и гликоген, пада мускулната маса, а мазнините си седят. Механизмът, в който започват да се губят мазнини е много по-сложен. Когато се отслабва по метода на гладолечението и започнат да се губят мазнини, тогава спадат нивата на лептина, а се покачва грелинът. Грелинът е хормона, който ти казва, че си гладен, а лептинът е хормона, който ти казва, че си сит. И когато се получи този дисбаланс, хората озверяват, гладни са и се нахвърлят върху храна. Колко време човек може да гладува? Седмица, 10 дни, 15 дни... Времето, което е необходимо човек да си загуби мускулната маса, организмът да се дехидратира и да паднат нивата на гликогена от мускулите. След гладолечението някои се захранват, други се нахвърлят директно върху висококалорийна, мазнинна храна. Човекът е загубил мускулна маса и в следващия момент когато започне да се храни, той какво качва: само мазнини! Добре дошла, инсулинова резистентност! Това е резултатът когато се прилагат форми на гладолечение: загубва се мускулна маса, разбира се не веднага, а се трупа мастна маса. Това многократно съм го наблюдавала, не целенасочено, а с мои пациенти, с които по една или друга причина сме се видели, седмица, 10 дена, след първата ни среща, за да видим някакви допълнителни изследвания. Те са стартирали режима, свалили са няколко килограма и винаги, когато се направи импедансметрия, процентът на мазнини в организма се е повишил. Мастната маса все още не е почнала да се редуцира и те са загубили мускулна маса или безмастна маса, като това най-често е вода и гликоген, защото молекулите гликоген са обградени с много водни молекули. Когато гликогенът си замине от мускулите, в общи линии те се отбъбвати човек може да свали килограми. Но ако си 120 кг, ти имаш повече гликогени и повече вода, ако си 70 кг съответно много по-малко. Така, че редукцията, която се постига е различна, но много често се вижда как всъщност тази редукция няма никакъв ефект по отношение на мазнините. Затова е много важен контролът на телесния състав. Нас ни интересува водното съдържание като телесен състав, а не като прием на вода, интересува ни какъв тип маса губи човек и как се балансира след това телесния състав. Висцералната мастна маса, тази около талията, вътрекоремната мазнина, която се държи като ендокринен орган и генерира свободни мастни киселини, тя най-трудно се променя и стои в основата на инсулиновата резистентност и последиците ѝ. Аз няма как да насърчавам хората да гладуват. Дори и малка закуска забързва метаболизма. Аз постоянно съм обсадена от хора, които спазват интермитентен глад: 24-часов, 36-часов. Много моля, не е необходимо!
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