Инсулиновата резистентност е в основата на метаболитния синдром, който увеличава многократно риска от развитието на сърдечно-съдови заболявания и диабет тип II. За да забавим или предотвратим тази коварна диагноза се налага да отслабнем. Обаче не винаги това е възможно...Защо понякога е толкова трудно да отслабнем въпреки, че сме на диета? Аргументирано и обширно обяснение на това явление ни дава отново д-р Мария Николова.

Много са възможните отговори, но най-вероятните са: липса на адекватна оценка на хранителния статус и прием на кандидат диетиращия, неадекватна или напълно липсваща оценка на подлежащи заболявания и като резултат неадекватно изградена и или прилагана хранителна терапия. Като се започне от режима на хранене - не може всички да изпълняват петкратен режим на хранене, при някои режимът е трикратен, при други четирикратен. Възможен е дисбаланс в приема на макронутриенти - свръх прием на мазнини или въглехидрати, но трябва да се оцени настоящия и обичайния хранителен прием. Може да е наличен, недиагностициран и съответно нелекуван метаболитен проблем, хормонален дисбаланс (хипо/хипертиреоидизъм, променени нива  на половите хормони или инсулинова резистентност). В тези и ред други случаи поради неоценен здравен статус, няма резултати в посока редукция на тегло, въпреки силно редуцирания хранителен прием. Връщам се на неправилно оценените нужди на пациента.
  Освен продуктовия набор и това какъв тип да бъде диетата (нисковъглехидратна, нискомазнинна, средиземноморска диета), режимът на хранене, важно е да се оцени и какво да бъде нивото на физическата активност. Понастоящем са достъпни нутрогеномични тестове, които дават информация за това какво трябва да е нивото на физическа активност у всеки един човек в зависимост от индивидуалните му генетични полиморфизми. Представете си, че човек прави примерно 2 пъти седмично тренировка по 30 минути, само че неговият геном изисква той да тренира всеки ден по 1 час. Човекът си мисли, че прави някакви усилия: спазва режим, спазва диета, обаче не му стига физическата активност. И тогава ние можем да го мотивираме в правилната посока и да определим не само каква да бъде диетата, дали с високо, умерено или ниско съдържание на мазнини или без въглехидрати, но и съответно съобразно това дали има склонност да трупа мазнини около талията, какво да бъде нивото на неговата физическата активност, има ли ген за пристрастеност например към сладки храни, какви са гените му относно циркардните ритми - на сън и бодърстване и пр. Освен адекватна анамнеза на хранителните навици, оценка на хранителния прием, при нужда водене на хранителен дневник, трябва да се направят антропометрични измервания, последвани от ред кръвни, хормонални, биохимични, имунологични и евентуално нутрогеномични изследвания. Необходимо е да се запознаем с цялата медицинска документация и да оценим предишните опити на пациента да редуцира теглото си. Важно е да подчертая, един макар и частен, но често срещан в практиката случай, а именно опити за редукция и контрол на теглото посредством различни степени на гладуване години наред, което създава предпоставки за проява и изостряне на инсулинова резистентност в организма. Едва след като имаме цялата тази информация, можем да пристъпим към назначаване на определен диетотерапевтичен режим. Подкрепям и настоявам за цялостна, холистична оценка на здравния статус на всеки пациент, било с помощта на съвременните нутрогеномични изследвания, чрез които много лесно можем да установим дали човек има определени предразположености към социално-значими заболявания (диабет, ССЗ) или поне с цялостна оценка на метаболитни, хормонални, функционални тестове. Налични са ред тестове за оценка на хранителни непоносимости, които се влияят от типа имунна система, състоянието на организма, нивата на стрес, на почивка, на типа храна, и са инструмент чрез който да се изготви индивидуален хранителен план. Генетичните фактори са налични и детерминирани, но ако може гените да бъдат сравнени с написани ноти, то от всеки един от нас зависи как тези ноти ще бъдат изсвирени. Какво имам предвид, дори и да си носител на определени генетични полиморфизми предразполагащи те към свръх тегло, ако водиш адекватен начин на живот, не си прехранван в детска възраст, спортуваш, няма високи нива на стрес, правилен е режимът на труд и почивка, то тези предразполагащи гени може и да бъдат контролирани и да не се стигне до затлъстяване. Принудителната липса на сън е фактор за отключване на инсулинова резистентност. Неадекватен режим на труд и почивка много често се наблюдава и при младежите и децата, тяхното среднощно стоене пред телефон или компютър. Те не се наспиват и недостигът на сън нарушава съотношението между два много важни хормона – лeптин и грелин, които контролират съответно ситостта и апетита, и желанието за сладки храни. И така този сериозен медицински проблем стартира още в детска възраст и се запазва след това в юношеството, при младите възрастни и здравните последици се задълбочават.
 
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