Diet with various degrees of obesity
The topic of my presentation is the diet with different degrees of obesity, i.e. how can we “thin” patients who, in addition to other pathologies, are overweight.
With the exception of cases of genetically determined obesity (since childhood) or obesity associated with endocrine pathology, namely:
- hypofunction of the thyroid gland,
- hypothalic obesity, other cases of obesity are a consequence of energy imbalance, i.e. inconsistencies between the amount of energy supplied from food and its costs in the body. Excess energy is deposited in the adipose tissue in the form of triglycerides, i.e. fat Whatever the opponents of the “high-calorie” theory of nutrition say, excess weight is always an excess calorie intake compared to its consumption.
Therefore, there are only two ways:
- reduce calorie intake with food
- while maintaining the same level of calories, significantly increase energy consumption, i.e. increase physical activity.
Unfortunately, the second path to many of our patients is not applicable, since all of them have significant comorbidities, advanced age, pathology of the musculoskeletal system. I propose a simple, effective diet with normal and even reduced loads, with the use of the usual available food.
A bit of theory. The pancreas plays a leading role in the pathogenesis of obesity: the level of endocrine secretion by its beta cells of the islets of Langerhans, the main carbohydrate metabolism hormone insulin, and the alpha cells of its antagonist glucagon. Insulin is an anabolic hormone that enhances the synthesis of carbohydrates, proteins, nucleic acids and fat in insulin-dependent organs, which are, above all, the liver, skeletal muscles and subcutaneous fat. Insulin lowers blood glucose and increases glycogen synthesis in the liver and muscles (its participation in carbohydrate metabolism), stimulates protein synthesis and inhibits its breakdown (effect on protein metabolism), stimulates lipid synthesis, suppresses lipolysis in adipose tissue (participation in fat metabolism). Conclusion: an increased level of insulin in the blood prevents the breakdown of fat in the subcutaneous fatty tissue. The most powerful stimulator of insulin secretion is sugar, glucose. The higher the blood level, the higher the insulin level.
In addition, amino acids alanine and leucine cause hyperinsulinemia (i.e., the use of excess protein also maintains a high level of insulin), as well as a number of other biologically active peptides: growth hormone, ACTH, glucagon, gastrin, glucocorticoids, etc. Inhibit insulin secretion hypoglycemia, nicotine acid and some other amines.
Glucagon is an insulin antagonist, i.e. it increases blood sugar (glucose), as it stimulates the breakdown of glycogen in the liver and muscles, increasing the breakdown of fat in the fatty acids. But glucagon has a number of positive properties:
- it increases glycogenolysis in the liver and muscles, which contributes to an increase in cardiac output;
- expands small arterioles, thereby reducing the total prophylactic vascular resistance (OPS);
- reduces platelet aggregation - all this greatly improves the blood supply to all vital organs and tissues both in the center and on the periphery;
- glucagon reduces the secretion of pancreatic enzymes (in acute pancreatitis - the appointment of hunger for several days!).
The basal level of glucagon increases significantly during fasting, especially on the 3-5th day. The insulin level decreases. I emphasize that during long breaks in food intake (from 6 to 12-14 hours) and during a natural night break, the energy needs of organs and tissues are supported by the energy of fatty acids formed during lipolysis. Thus, fasting from 12–14 hours to 3–5 days in exceptional cases is useful for normalizing insulin-glycagon imbalances in overweight patients.
Obese patients have different pathologies, but all of them are united by three features of carbohydrate metabolism:
1st feature. Hyperinsulinemia is a high level of basal insulin in the blood, i.e. that insulin, which is always available regardless of meals. With an increase in the level of obesity, basal hyperinsulinemia increases, and at 3-4 degrees of obesity significantly exceeds the norm. Moreover, this is combined with a normal or even higher than normal blood glucose level, i.e. the body of obese people is constantly in a state of prediabetes type 2, which at any time can “manifest”. Practically these people can not lose weight, because elevated insulin inhibits lipolysis.
2nd feature. It follows from the first - an inadequate response of the beta cells of the pancreas in response to their stimulation, i.e. carbohydrate intake with food. This inadequacy is expressed in an excessive increase followed by an excessive decrease in comparison with the norm of the insulin pool. It is clinically expressed in a constant feeling of hunger. These patients eat all the time, because sudden drops of “fast” insulin stimulate the feeling of hunger immediately after eating, despite the fact that the blood is full of glucose.
3rd feature. The ineffectiveness of the action of endogenous insulin in patients with obesity, since there is a so-called high insulin resistance, when the content of this hormone in the blood is above the norm, and the glucose level not only does not decrease, but even in some cases exceeds the norm. Cells do not seem to react to insulin. The body is clogged with energetic material in the form of glycogen, fat, and the patient constantly experiences a sucking feeling of hunger (glucose “floats” in the blood, not getting enough to react inadequately to insulin cells).
These features of nutritional-constitutional obesity determine the dietary profile and tactics of these patients.
Our first task is to create in these patients a clear mood to reduce weight by limiting the amount of food eaten and its caloric content. Whatever opponents of a low-calorie diet and creators of the Montignac-type theories write about, reducing calorie intake is the only way. All the newfangled American diets, similar to those described in the works of Montignac, Shelton, Brega, are all explicit or disguised low-calorie diets and disguised advertising of meat and some other products. “Eat more to lose weight!” - excuse me, lies! And the patient should be adjusted to the fact that there should be less in volume, and some products will have to be completely eliminated. This is, above all, the restriction of carbohydrates, especially refined sugars, up to their complete exclusion, with a significant restriction of other carbohydrate foods. This is necessary to reduce insulin and restore lipolysis.
Especially dangerous in terms of insulin emissions are refined carbohydrates: sugar and its derivatives, products from white wheat flour, potatoes, and to a lesser extent boiled beets and carrots, white rice, from fruits - bananas, melons, grapes. In addition, with an excess of carbohydrates, according to the Maiar reaction, glycolysis of proteins occurs. It is proved that hypercholesterinemia is associated with an excess of carbohydrates, and not with an excess of fat in food.
It is a sharp restriction of carbohydrates in the diet that triggers the 1st phase of weight loss - rapid weight loss due to the use of liver glycogen and especially muscles and water excretion. The “fat” muscles are crammed with glycogen and its use will entail a rapid weight loss, which will be greater, the greater the degree of obesity.
With carbohydrates, everything is clear, but what about the proteins? Is it possible to limit them or, on the contrary, increase their consumption and compensate them for the decrease in carbohydrates, as some nutritionists recommend? I believe that for obese people for the entire period of weight loss, proteins should be significantly limited, especially animals and, especially, meat. The question arises: what about the plastic needs of the body (food proteins, including the synthesis of their own proteins, enzymes, blood cells, hormones, etc.)? How to deal with ten essential amino acids, which we supposedly must get from meat? According to various sources, from 300 to 400 g of protein are consumed per day in the human body, about 2/3 is used for new synthesis, but 1/3 is irreversibly oxidized in energy chains and must be supplemented by intake from the outside. That is, it is believed that food should be supplied from 70 to 100 g daily, moreover, 40% should be of animal origin.
Rubner's coefficient - wear coefficient, i.e. The loss of protein in a person weighing 70 kg is 23 g / day, but the physiological minimum of animal protein is 30–45 g / day. It turns out that for the assimilation of 20 g of protein (animal), it is necessary to eat almost 40 g of it due to high energy consumption for its digestion.
Nobody argues, animal protein is necessary for man, but what protein and in what quantity?
I believe that the norms of vegetable protein of 90–100 g proclaimed by official nutritionists and 30–50 g of an animal are significantly overestimated, since they do not take into account two points:
- during the formation of normal microflora in the intestine and when moving mainly to plant foods in our large intestine, the synthesis of most of the vitamins and all the essential AKs is getting better. Thus, in obesity, one of the most important measures is the fight against dysbiosis, in which the use of fiber plays an enormous role, especially in the form of bran (up to 10 spoons per day);
- the existence of the mechanism of apoptosis. Now dozens of articles are being written on this topic, this process is being actively studied, in particular, by oncologists (it is assumed that apoptosis breakdowns play a leading role in oncological diseases), and the norms for the consumption of animal proteins in this regard are still not corrected. I will comment briefly on how apoptosis is related to protein standards.
Apoptosis - “self-falling”, self-death — the term was first described and introduced by Aristotle. This is the process of "altruistic" suicide, i.e. self-death of obsolete, aged cells with any genetic damage. It has nothing to do with inflammation, when abnormal cells are destroyed by different fractions of Z-cells. A huge number of cells in our body daily "sacrifice" their lives for the sake of maintaining the life and health of the body as a whole.
In the small intestine alone, such cells die and are expelled into the lumen of millions, and it is in the small intestine that the main process of protein digestion takes place. Where do the millions of these cells, which are protein formations, consist, including, of the irreplaceable AK, besides genetically “native” and “pure” to us?
Of course, some of them are excreted in the feces, the other burns in energy chains, but a significant proportion of these apoptotic cells are included in the protein cycle in the body (like a repeated Ca cycle, bile acids, etc.).
At one of the meetings of the gastroenterology section of prof. Ugolev sounded such information: we, as it were, “eat up” 100 g of our own full-fledged protein again due to apoptosis. Thus, the dispute between meat-eaters and vegetarians is decided more in favor of the latter, although I am opposed to fanatical full vegetarianism, the “depreciation” of proteins still goes on and at least 20-25 g of animal protein must be ingested from food. But which one?
I offer my patients a compromise. This is not a complete vegetarianism or lactic vegetarianism, since I advise temporarily (for the period of active weight loss) to exclude milk and dairy products, so as not to additionally load the liver and kidneys, which will already work in high load due to active lipolysis and excretion of all accumulated in adipose tissue. With the same purpose, I propose to remove from the diet meat and chickens, replacing them with eggs and fish, as well as seafood, which is much easier to digest, contain high-grade protein, but do not contain such amount of obviously harmful to humans substances that are in meat.
I motivate the provisional refusal of meat with the following provisions. I call them "eight arguments against meat."
- The meat, especially the beef we eat, is extremely polluted:
a) hormones. Heifers are fed with androgens so that they grow better, and bulls feed with estrogens. We eat mostly bulls (they grow faster and do not give milk), hence the terrifying hyperestrogenism in men of all ages (starting with children) - a decrease in potency, genomicostasis in women - this is manifested in extrogen-dependent tumors of the RIPS, especially the mammary glands (mastopathy is practically everyone has!);
b) antibiotics and other antiseptics used against infection of cows in veterinary medicine. By the way, all of them, together with the infection itself, are safely found in milk (in cottage cheese, cheese - but less).
- The meat, which we can actually get, has already been affected by decay with the release of the corresponding poisonous metabolites, and even freezing this process only slows down, but does not interrupt.
- Meat contains eggs of various helminths; it is especially dangerous in terms of infection with cystodes (chains, echinoca, alveococa). Of course, fish also suffer from helminthiasis, but we do not make kebabs out of fish - our favorite dish in the summer, which is a “heated” helminth.
- In addition to helminth infections, meat is dangerous alongside other infections of both bacterial and viral nature. Our relative species proximity to it (compared to fish) determines the common pathogens, especially viral.
- The identical protein structure of mammals (especially our affinity with the pig is close) gives a strong allergization, a shaft of various allergies in recent years. Autoimmune diseases - autoimmune thyroids, hepatitis, food allergies - the scourge of modern humanity! Despite this, pediatricians and other specialists around the world continue to persistently recommend meat as a diet food. Of course, protein is necessary, but not with such "appendages." I will draw an analogy. The use of atomic energy is much more economical than the use of hydroelectric power plants, but it pollutes the environment with almost indestructible and detrimental effects on the entire gene pool of waste. Of course, meat is protein, it is nourishing and, most importantly, tasty, but it “litters” our entire body.
- We overeat proteins! I have already spoken about this, I will give only a clinical picture of the 1st stage of liver failure:
- hepatic encephalopathy, which is expressed in inappropriate behavior (both inhibition and unmotivated aggressiveness while maintaining control over their actions);
- sleep disturbance (daytime sleepiness, sleeplessness at night);
- spider veins;
- icteric sclera;
- palpar erythema, especially in alcoholic liver damage.
Comments are superfluous. 80% of obese patients have jaundice sclera, red palms, spider veins on the body. Hepatologists in the presence of such a picture, in the first place, do not simply limit, but completely exclude from the diet, proteins, not only animal, but also vegetable, which immediately reduces the load on the liver and reduces the body’s poisoning by proteins not metabolized by the liver. That is why I advise my patients, especially in the 1st and 2nd phases of active weight loss, there are as few proteins as possible (they all have liver pathology of varying severity).
- Excess AK in the body is spent on energy needs (especially when limiting carbohydrates), so truncated diets, where carbohydrates are replaced by large amounts of protein, are meaningless and even harmful because of all of the above.
- Bioenergy argument (forgive me materialists, it is not for them). Now they talk a lot about energy information programs. It is believed that they are the cause of chronic human diseases. This has not yet been proved, but the 21st century, the age of information, I think, will clarify this issue. It can be assumed that in an animal slaughtered for slaughter, at the time of death, certain "mortal" programs are formed, which are probably recorded in blood proteins or other connecting elements. It is believed that the soul of the animal is in the blood, drinking blood is a great sin. But where have you seen meat without blood? Thus, we constantly “feed” ourselves with mortal energy-information programs, reducing our lives from those prescribed to us for much more than 100 years to 50–80 at best.
All my patients, whom I helped to get rid of "meat addiction", noted a significant improvement in health and the loss of several kilograms of weight without any effort. This is explained by the fact that the exclusion from the diet of meat immediately reduces the level of appetite, especially against the background of manual manipulations on the stomach according to A. T. Ogulov's scheme. About sausage products, I, in general, do not consider it necessary to mention in this section. It is rather a carbohydrate-starch food, richly flavored with preservatives and various food extractants that increase appetite. There is almost no protein in them, and they cause tremendous hyperinsulinemia.
What is the meat to replace? And in general, what then is, if almost everything is impossible? What is possible? And “it is possible” much more than “it is impossible”.
1. You can any fish, better - steam. And even fat, such as mackerel, caviar, cod liver, in a small amount even lightly salted herring.
2. You can any seafood (according to material possibilities) - from squid to lobster.
3. Eggs - you can! And the yolk is more useful than protein. It has as much anti-cholesterol as the notorious cholesterol. Can 1-2 eggs per day.
4. Porridges made from natural steamed cereals - oatmeal, buckwheat, barley, millet, and even rice, but from brown untidy rice. It is impossible, of course, semolina. In porridges add as much bran as possible (from 3 to 10 tablespoons of bran per day, especially for constipation).
5. Oils - mostly vegetable unrefined, but can also be creamy (10–15 g per day). But no margarine! In Denmark, for example, the sale of hydrogenated fats and other foods containing transformed fatty acids is prohibited. But they are all in wholesalers, including our Rama. On their packages, as on cigarettes, it would be necessary to write “the Ministry of Health warns ... etc.”. In addition, exactly five molecules of fat form one molecule of margarine, while one molecule of butter gives one molecule of fatty acid in our body. Our fats and even cholesterol are not from fat, but from carbohydrates, this has already been proven by biochemists.
6. You can dried wholemeal bread, better - whole grain, dry cereal bread. But all this in very limited quantities, no more than 30–50 g / day.
7. You can fruit, almost everything; better - sour, citrus, apples, berries, especially cranberries, lingonberries, they have a lot of fiber, and she is our main assistant in the fight against obesity.
8. Raw vegetables - any, in boiled - any, except potatoes, beets, carrots. Canned corn and peas are not recommended - they add a lot of sugar. Green beans, all kinds of cabbage, pumpkin, radish, radishes, any greens, cucumbers, eggplants, peppers, etc. are especially useful.
9. You can nuts and dried fruit as a substitute for candy with tea. Figs and dried apricots are especially good.
10. You can low-fat cheeses such as Adygei, Suluguni. Low-fat and, of course, non-sweet cottage cheese.
11. Olives, olives, sea kale, many seasonings, are allowed in small quantities: horseradish, mustard, ginger, saffron, nutmeg, etc.
12. Drinks. Of course, all carbonated sweet waters like “Pepsi”, “Fanta” and others like them are prohibited - they give a huge release of insulin and negate all our efforts. Compotes and juices, too - sugar in them a lot, but no good. Ideally, it is recommended that natural freshly squeezed juices - vegetable and fruit in an S-1 glass per day (diluted with water) and unsweetened fruit juices made from fresh or frozen berries (pour boiling water over the evening, stand overnight, strain in the morning and drink during the day - blueberries, cranberries, currant without sugar), herbal teas.
13. If the patient cannot do without coffee, one cup per day is allowed, but only from grains without milk and sugar.
It is very important to limit the quantitative side of nutrition. All these permitted products should be consumed in very small portions, not more than 200–250 g, i.e. a portion on a plate the size of a nursery, not a “flying” one, and with a slide (as it was before). Our enzymes (this is proven by prof. Ugoliev) are enough for complete simultaneous digestion of only 200–250 g of food, the rest in the form of large underdeveloped and under-oxidized residues will “roam” in the intestine and increase gas formation, and the absorbed “large” underdigested molecular fragments in the form called "slags" slag the body. Meals should be 4-6 meals a day (but 200 g each), and fruits are also considered food.
Another important point in the fight against obesity: you need to take daily 12–14-hour breaks in the diet daily and weekly 24-hour, and better 36-hour “herbal days”. I am against the water and the more dry starvation. Maybe it is useful to someone, but not to our patients with gallbladder pathologies. And as a gastroenterologist, I know what happens to him during these days. But to spend one day on collecting gall-diuretic herbs, drinking in addition 2.5-3 liters of pure warm water is very useful for the hepatobiliary system, and for the whole organism. Weight loss for a day from 0.5 to 2-3 kg! The “herbal” day of unloading seems to put insulin in place, increases blood glucose levels, well reduces appetite and cleanses the intestines and kidneys.
Approximate composition of tea for fasting day:
- Immortelle 1 part
- Corn silk 1 part
- Horsetail 1 part
- Cowberry 1 part
- Knotweed 1 part
- Bean valves 3 pieces
- Violet 1 part
- Krushin 1 part
- Valerian 1 part
- Licorice 1 part
Daily 12–14 hour breaks for “larks” are taken from 18–19 to 9–10 in the morning of the next day. Biorhythmic accounting is required. If a person cannot fall asleep without having supper, let him do it, but then he will have to eat breakfast after 12 am the next day.
Features of weight loss are such that the 1st stage of rapid weight loss (under our leadership) goes into the 2nd stage - active lipolysis. This stage is slow and does not need to be forced. Sometimes it takes from six months to 2–3 years to achieve an ideal body weight, depending on the condition of our patient’s body. At the 2nd stage, the patient must be under our control, it is desirable to meet at least once a month, conduct a deep visceral massage according to the scheme of A. T. Ogulova, correct herbal medicine and nutritional supplements. I am initially a homeopath, therefore all my patients receive the appropriate homeopathic therapy (these drugs increase the function of the thyroid gland, normalize the work of the adrenal glands, CTA), bypass homeopathic preparations. All this in the complex perfectly lowers the appetite and activates lipolysis and the process of general healing of the body. It is also desirable to carry out the tyubazhs according to the Ogulov scheme at least once a month on the 2-3rd day of the full moon.
But here comes the 3rd stage - the patient has not yet reached his ideal "youthful" type, and ceases to lose weight, even with such a "harsh" diet. What happened? There was a restructuring of the body for a more economical mode of operation. Without going into the wilds of biochemistry, we can say that he learned to extract energy from lactic acid, which is formed during the anaerobic oxidation of glycogen in muscles. That is, if at the 1 st and 2 nd stages physical activity is increased to certain limits (swimming, light aerobics, walking, moderate sports activities can be recommended), then at the 3 rd stage, on the contrary, the more the patient moves, the less will lose weight. At this stage, it is possible to increase the proportion of animal proteins in the diet and replace dynamic loads with static ones (classics, yoga exercises) - all this gives positive results. So that the patient does not “break away”, it is necessary to explain to him that further weight loss will follow only with the improvement of the functions of organs and tissues, cleansing them, bringing them to a qualitatively new level of vital activity, therefore, work must be carried out constantly! In addition, we should not forget about the entropy, which seeks to "nullify" all our efforts, therefore, work to improve the function of organs and tissues must be carried out constantly. This includes GEMF, homeopathy, herbal medicine, hirudotherapy, various types of massage, acupuncture on the background of proper nutrition. All this inevitably yields its fruits, and the further improvement of the body and weight loss will be the more successful, the better the results of this health work.