Licensed books on medicine
<< Previous || Next >> |
In conclusion, a few words about dietary supplements.
I am often asked about my attitude to the so-called dietary supplements. Ask to evaluate this or that drug. I'll be honest. There are so many of them that I have never even met many of them.
Some of them are registered as medicinal forms and are successfully used for medical purposes (for example, vitamins - "Milgama", or herbs - "Essentiale"). However, the other (largest) group is represented directly in the form of a variety of biologically active additives (BAA), the attitude to which scientists and practicing doctors have mixed. The simplified registration regime, the absence of the need for clinical trials, the inability to monitor side effects and a number of other points represent only a partial list of "painful" points. It came to the point that some firms, to simplify the receipt of their medicines in the pharmacy chain, register them as supplements.
A few years ago, so-called dietary supplements acquired in our country incredible popularity. I remember a time when many bought them boxes. At the same time it does not matter how much they cost - tens of rubles or hundreds of dollars, people got hope for a miraculous healing, and it is not a pity for her neither the strength, nor the time, nor even more money. And if there is demand, then there will be an offer. And the numbers of dietary supplements were increasing day by day. Already in 2004, only more than 4,500 additives were officially registered, and how many were circulating illegally on the market - no one considered it. And all of them, of course, were made from natural medicinal herbs, which grow in the purest mountainous regions of China.
I think that after producing so many of these additives, there probably is not any grass left in China!
In the meantime, the official Russian authorities have suddenly realized and began to be interested in what is so intensely stuffed in the measure of not trusting citizens. And it turned out that everything is not so calm in the "BAD Kingdom", that some supplements not only do not benefit, but also significantly impair the health of people. This was actively written in the press and told on television. Well, as usual, our trustful people immediately began to exercise vigilance. In place of the jubilation came complete distrust and denial. It came to the point that the very word - BAA acquired a certain naming character. Became a synonym for the word - deception, dummy, poison.
And indeed, a lot of additives were just a set of dried herbs. And some dietary supplements even contained the most real drugs that cause persistent dependence. How many of them were then withdrawn from the sale. Many violations were due to the inconsistency of information carried on the label, with information in registration certificates. Many of them did not have data on the date of production and contraindications to the application. Nothing was said about the fact that dietary supplements are not a medicinal product, but only a food product. More precisely, the product that supplements the diet.
The chief state sanitary doctor of Russia, Gennady Onishchenko, made it clear in his commentary in Rossiyskaya Gazeta that dietary supplements are not a cure, and as a remedy they can not be used anywhere and never. The people were intelligibly explained: supplements are not medicines, but simply a combination of vitamins and minerals, which the body often does not get from ordinary food.
He stressed that it was not about eradicating dietary supplements. Manufactured with observance of all technologies, correctly stored, correctly recommended to the consumer, they undoubtedly bring certain benefit. But these are not medicines, but food products, which should only correct the shortcomings of the diet of the modern man.
In the modern world, most food products undergo rigorous processing, are subjected to conservation, thermal exposure, long-term storage, transportation, which negatively affects their quality and the content of biologically active substances in them. In this regard, today the issue of the need for additional enrichment of food products and, in general, the diet of vitally important micronutrients, biologically active substances, is increasingly raised.
Supplements supply the body with the components that we need and that can not provide adequate nutrition in sufficient quantities. Because they are, and they will surely be more. But they must necessarily meet their purpose, all hygienic standards. How to distinguish what is really useful, and what can cause irreparable harm to the body?
Probably, when buying any new unknown drug, you must, first of all, pay attention to advertising. If the "next miracle" is heavily advertised, especially on television, then this is another fraud, and you can not buy it! But however, seriously speaking, never trust a beautiful name that does not say anything to you. If you take responsibility and without consulting a doctor get a drug, then at least you have to imagine the mechanism of its action. Know the indications and contraindications. As they say in one old joke: "Not all yoghurts are equally useful"!
I would like, as an example, to bring the composition of one heavily advertised drug for weight loss in a dream. Let's try to understand from a scientific point of view the practical effectiveness of its components. I will only remind you that this drug is recommended for overnight use!
1. Cambodian Garcinia is a source of hydroxyl ammonium acid, which slows the conversion of excess carbohydrates into fat deposits and suppresses appetite.
Even if you take these words on faith, the involuntary question arises: "Why suppress the appetite at night?" After all, if someone wakes up at night in search of a refrigerator, what's wrong with that? After all, in fact, at night the human body experiences a kind of hunger strike with a length of up to 12 - 14 hours! As a result, the enzyme lipoprotein lipase is released, which contributes to the fact that all fat eaten for breakfast will be put into subcutaneous fatty tissue.
2. Chitosan effectively binds fats and promotes their removal from the body. It really is! But the amount of this chitosan in one - two capsules of the supplement is so small that it is even difficult to imagine the amount of fat that it can bind! Chitosan has a noticeable effect only when used in much larger volumes and even thus it is able to bind about 30% of the fats entering the intestines.
3. Linoleic acid suppresses the mechanism of formation of subcutaneous fat, stimulates thermogenesis (burning of fats).
As I mentioned at the beginning, fat can burn only in the mitochondria of muscle cells with a certain, strictly dosed, physical load!
4. L-carnitine transports fats into cellular mitochondria, where their processing into energy takes place.
It's true. But for this purpose the dosage of L-Carnitine should be at least 1000 - 1500 units. and besides, an involuntary question arises who will perform a serious and prolonged aerobic load at night? If only "sleepwalkers" !?
5. Senna extract improves digestion, strengthens the motor activity of the large intestine, has a mild laxative effect.
Even a slight laxative effect, but at night !? In my opinion, this point does not even need comments!
6. Extract of lemon balm stimulates digestion, has spasmolytic activity, has a calming effect.
Why stimulate digestion at night, when the body should rest?
7. Chromium picolinate maintains a normal physiological level of glucose in the blood, which in turn helps to suppress cravings for sweet and natural weight loss.
This is true, but only in those people who have impaired tolerance to insulin, a hormone that regulates the level of sugar in the blood. And if this tolerance is all right, why enter into the body excess chrome? In extreme cases, it can be taken in the afternoon as a separate food supplement.
8. Vitamins B, E, zinc participate in the exchange of proteins, fats and carbohydrates.
Everyone already knows that vitamins are necessary for each of us, and especially for people who limit their diet. All of them, of course, are important for the normal functioning of the body. Each vitamin has a certain effect on the metabolism, but the effect of many vitamins is interrelated. The constant intake of one vitamin leads to a deficit in another. Thus, the intake of vitamin B1 accelerates the loss of other B vitamins. It is obvious that this pattern is not limited to group B vitamins.
You certainly remember that vitamins do not act alone, they work as a team! Acting as biocatalysts and regulators of metabolic processes, they act through a system of enzymes and hormones, which, in turn, consist of proteins. The lack of one of the components of this balanced system will lead to the uselessness of all the other elements. Vitamins are substances that interact with proteins, so they must be taken at the same time as protein foods for best digestion and functioning!
Conclusion - no component of this additive, does not have any effect on the process of losing weight! Useless waste of money, but most importantly - another disappointment and the formation of a sense of doom.
Despite significant advances in modern medicine aimed at correcting the revealed metabolic disorders, the question of the priority of using biologically active additives (BAA) for food in the complex therapy of obesity still remains controversial. Correctly supplemented dietary supplements should, in combination, influence the basic pathogenetic mechanisms of the onset and development of obesity, taking into account the evolving concomitant pathology. Use of dietary supplements in preventive and curative nutrition is due, first of all, to the possibility quite easily and quickly, without increasing the overall caloric content of the diet, to eliminate the deficiency of minor nutrients, the need for which only increases during the treatment of obesity.
As for the direct question of the tactics of medical measures, I dare to say that it is impossible to preserve the biological usefulness of a limited diet without additional enrichment with the necessary micronutrients!
Of course, with obesity, as can be, with no other disease, a system of competently and individually selected diet is one of the main methods of treatment.
However, after all any restrictive diet is, first of all, a lack of vitamins, minerals and other substances in food, and the needs of the organism in them remain the same and even increase. Therefore, any course of weight loss should take vitamin complexes, other supplements, and, of course, it is desirable to do this under the supervision of a doctor. After all, some vitamins, especially ascorbic acid and B vitamins, play a special role in the normalization of lipid metabolism. They are directly involved in the oxidation of fats.
But about the effectiveness of dietary supplements can be said, only with a properly planned diet. These funds can only contribute to improving the final result, but there are no drugs or dietary supplements that without adequate nutrition correction would reliably restrain weight gain in persons prone to fullness!
A joint study by the Barton School of Business School and the University of Pennsylvania of the Pennsylvania School of Medicine has shown that nutritional supplements and pills designed to combat excess weight, with independent, uncontrolled use, have quite the opposite effect. Even if these drugs are really effective, the people who take them often do not lose weight.
The reason lies in the fact that those who want to lose weight hope for the products of pharmacists rather than on themselves. In particular, they do not abandon bad habits of eating, do not start playing sports, etc. Moreover, people who start using such drugs, less responsible approach to solving the problem of self-control.
The authors of the study argue that part of this is the responsibility of the manufacturers of wonder-tablets, which put in advertising and on the packaging of their products statements that in order to lose weight, it is enough only to consume their products. In this case, consumers usually choose diet pills not based on some objective scientific criteria, but on the basis of their personal belief in the effectiveness of these drugs. That is, the more active the advertisement, the greater the sale. The law of the market.
The main difficulty lies in the fact that a huge number of modern drugs presented on the shelves of pharmacies, raises doubts about their correct selection, even from experienced doctors.
All dietary supplements are designed for the regulation of various body functions. The mechanisms of this action are very different for them, but the principle in most cases remains the same - the physiological necessary saturation of the body with micronutrients. However, physicians often do not take into account the fact that different people have different needs for these substances and different ability to perceive them. It can depend on the age, on the nutritional value, and even on the season. Therefore, a detailed selection of dietary supplements is necessary according to the criterion of their compliance with the requirements of the patient's body. Individual selection of dosages is the most important moment in improving the efficiency of health status correction.
Modern dietology, like never before, needs to develop a single, valid concept for the use of biological active additives.
It can be said without exaggeration that medicines and non-medicines, in varying amounts and proportions containing amino acids and peptides, vitamins and vitamin-like substances, coenzymes and trace elements, are now actively used in all fields of medicine and for any reason. Such popularity, obviously, can be explained as their effectiveness in the treatment of various pathological conditions, and relative harmlessness. This combination of factors leads to the fact that it is easier for a doctor to designate a particular drug "just in case", than to understand the expediency of such an appointment. As a result, due to the thoughtless application, because of the lack of a methodological base, the effectiveness of treatment suffers, which in turn often raises doubts about its fundamental effectiveness.
Such drugs as coenzyme Q10, carnitine, B vitamins and many other substances are widely used in modern medicine, although rational bases for their application are still poorly developed. These drugs are used chaotically, without sufficient knowledge of their capabilities, the specifics of their interaction, without planning a treatment strategy from the standpoint of expediency.
The attending physician should have a clear idea of what mechanisms are the basis for the effects of each drug, and which patients need it at a particular stage of treatment. Often, doctors try to solve these problems on their own, usually based only on personal experience. But, unfortunately, it is not always enough to make the right decision.
Some public statements by well-known doctors in favor of these or those new weight loss products, clearly demonstrate that the financial benefit for someone means more professional honesty. But, thank God, there are still very few such cases. Most of our doctors retain professional honesty and do not go down to advertising dubious means.
In my practice, I always follow the justified necessity of using this or that drug and always try to explain in detail to my patients the mechanism of its action and the goals pursued at different stages of the procedure. And although the very word BAA can instill mistrust and vigilance, but after all, in fact, to the same dietary supplements can be attributed and vitamins, and trace elements and amino acids, without which the human body can not exist.
It is necessary for the patient to understand the difference between an unknown overseas mixture of herbs in a beautiful expensive package and a specific drug whose action has long been studied and tested. So he realized that there are no "pills for obesity" or "burning" fats, but that at the same time some drugs are just necessary for the body in a difficult period for perestroika.
Separately, I want to say about the need to be very careful about such methods of weight loss, as the use of laxatives or diuretics.
The unreasonable use of such drugs that stimulate the release of fluid from the body to "accelerate the process of weight loss" may, in the final analysis, cause a decrease in the ability to absorb food, vitamins and minerals contained in it, lead to an imbalance in the work of the intestine and general dehydration of the body.
Alas, the additives that Americans and Japanese take are often very different from those on the shelves in Russian pharmacies. According to unofficial data, today the number of not only useless, but also dangerous to health, BAD reaches 50% of the total supplements market. Most of the questionable bioadditives are produced in China and Thailand, and they are intended, unfortunately, just to combat excess weight. At least that's what the manufacturers say on the labels.
Восточная, и в частности китайская, медицина сейчас очень популярна во всем мире. Кроме иглорефлексотерапии, прижиганий и травяных чаев для похудения, входят в моду различные комбинированные препараты и биодобавки с причудливыми названиями. Они продаются в аптеках, активно навязываются по телевидению, широко представлены в сети Интернет. И, как ни странно, желающие провести на себе эксперимент, находятся.
Между тем установлено, что несколько из этих препаратов содержали фенфлюрамин — вещество, не только подавляющее аппетит, но и нарушающее функции печени, а посему запрещенное к применению. Употребление этих средств вызывает серьезные нарушения работы печени, щитовидной железы и других жизненно важных органов.
Взять, к примеру, так популярные у нас «чудо-капсулы» для похудения. Проведенные экспертизы обнаружили в них сильнодействующие наркотические и психотропные вещества, хотя продавцы продолжают заявлять, что в этих препаратах ни диуретиков, ни психотропных веществ нет и в помине. К тому же, многие «сжигатели жира» устраняют вовсе не жир, а способствуют усиленному мочеотделению, то есть активно выводят из организма воду. И сброшенные за месяц 5—6 килограммов возвращаются к Вам, как только Вы перестаете принимать препарат. Только вдобавок к этому еще прибавляются проблемы с почками и обменом веществ. Так что сжигаете Вы, скорее всего, не жир, а прожигаете свое здоровье. Однако, вера во всемогущество восточной народной медицины еще очень сильна, и соблазн вогнать фигуру в «золотое сечение» с помощью чудесных средств велик особенно у женщин.
Конечно, не стоит валить все в одну кучу. На российском рынке есть БАДы, которые действительно полезны, а в некоторых случаях и незаменимы. Только вот неясно, как отделить хорошее от плохого. Если доверять нельзя ни рекомендации врача, ни надписи на упаковке, ни регистрации, то, может, вообще от греха подальше отказаться от всех БАДов?
Именно такая логика меня и пугает. На рынке биологических добавок нет порядка. От этого страдают, прежде всего, добросовестные производители. А они ведь есть! Просто меньше афишируют свою деятельность. Меньше навязчивой и многообещающей рекламы и больше реальной пользы. Если Вы хотите в этом разобраться, то обращайте внимание не на яркое название, а на страну изготовления и международный уровень классификации, присвоенный заводу производителю (стандарт GMP).
Вот общие правила применения биодобавок.
1. Приобретать биодобавки следует только по рекомендации врача и только в аптечной сети. Особенно осторожно следует относиться к применению БАДов людям пожилого возраста, детям, беременным женщинам, кормящим матерям.
2. Нельзя принимать два или более препарата одновременно, особенно если речь идет о многокомпонентных препаратах, содержащих смесь различных ингредиентов. Так как никогда нельзя точно прогнозировать каково будет их взаимодействие.
3. Не стоит рисковать и принимать БАДы в состав которых входят неизвестные или мало изученные экзотические компоненты. Поскольку точно неизвестно их влияние на организм человека в целом и на Ваш организм конкретно.
4. В случае возникновения любых побочных реакций необходимо сразу же прекратить прием БАДа и сообщить об этом своему лечащему врачу.
Для того что бы как-то систематизировать все данные о медицинских препаратах используемых при лечении ожирения, о многих из которых я уже упоминал на страницах этой книги я решил дать им повторно краткую характеристику в отдельной главе.
| << Previous || Next >> |
| = Skip to the content of the tutorial = |
В заключение несколько слов о БАДах.
- A few words in conclusion
Eremeev Yury Fedorovich tel. 434-4280 Viktor Zyabkin Boris Katunsky Mikhail Mikhailovich tel. 277-6324 Krasilnikov Aleksey Alekseevich tel. 152-2372 Administration If we summarize all the results of individual studies conducted in different directions to date, we can conclude that multiple sclerosis is an autoimmune disease of the central nervous system
- A few words in defense of fat
"Nothing salty, nothing fried." С утра — бассейн. На завтрак — овсянка на воде. Потом зеленый чай все время пью. Напротив меня сидит девушка весом под сто килограммов, хотя то, что она мне рассказывает, звучит как особая диетологическая симфония. - Now - dinner. All I cook only for a couple, and before going to bed to sleep, I drink half a cup of fat-free yogurt and more no-no! Girl, softly
- A FEW WORDS IN THE BEGINNING
Economists have calculated: a person who will invent an effective remedy for excess weight, will become a billionaire in less than a minute and a half. This proves, on the one hand, the inefficiency of most diets and drugs created for weight correction, and, on the other hand, the topicality of the problem. And here is one more, very revealing statistical fact: after the invention of a cure for cancer
- A few words in defense of cartography
And yet, any speech is valuable not for the absence of vices, but for the presence of virtues. Only vice of vice is different. The flaws 1 ~ 15 of the previous chapter for the speech are criminal, but what about cartoon? My school teacher of geography very juicyly, she cried loudly and incessantly pronouncing the wrong "rrr". Это не только не мешало ее слушать, но и придавало ее голосу удивительную яркость и узнаваемость.
- A few words about the action of antiallergenic drugs
First, we'll figure out what an allergy is. Allergies (from the Greek, olios - the other and ergon - action), the perverted sensitivity or reactivity of the organism to this or that substance, i.e. allergen. Аллергенами могут быть различные вещества — от самых простейших до сложных белковых и небелковых. Allergens that enter the body from the external environment - exoallergens can be infectious
- A few words for fat people and bbw
In the early days of the Program, do not limit yourself to eating! You wanted a cutlet and flavored with condensed milk and peaches an endless piece of biscuit - give yourself this! It is very likely that your Organism will be stupefied in the full sense of the word with such happiness and will allow yourself to be drunk. Но, как только он поймет, что ограничения и наказания действительно кончились и вы не намерены более его унижать и обижать, ваше
- Этапы формирования действия чтения. Phonemic analysis of words
Вопрос о звуковом анализе и его месте в системе обучения чтению — один из старейших и, пожалуй, наиболее спорных. KD Ushinsky's attention to the sound side of the language was associated with his basic principle of writing and reading. Yes, for a letter, a consistent hearing of the sounds of a word is necessary. But is it really necessary to analyze the sound composition of words for reading? In the modern method of sound
- Но если слов недостаточно, что добавить?
The next morning after the meeting, the head of the company called me, who had arranged an informal poll the day before. Он попросил меня прийти на импровизированную встречу. Entering the room, I saw the six leaders of the company (who participated in yesterday's seminar), who were drawing on flipcharts. I was handed a printout of Mike's speech, on which someone had already noted all four strategies. My
- НЕСКОЛЬКО НЕБЕСПОЛЕЗНЫХ СОВЕТОВ
If you are determined to have a kitten in the house, first of all you have to worry about its safety: get rid of poisonous houseplants (see the section below), install on the grill windows (lattices) or tighten the balcony with a metal net so that the kitten can not fall. The mass of dangers for cats is fraught with a kitchen (gas, oven, etc.), and it is better to make sure that the animal happens there as much as possible
- НЕСКОЛЬКО ПОЛЕЗНЫХ СОВЕТОВ МУЖЧИНАМ
Увеличьте потребление витамина С Установлено, что, если в организме не хватает витамина С (аскорбиновой кислоты), сперма становится вязкой. And according to statistics, 16% of infertility cases occur precisely for this reason. Vitamin C has an antioxidant effect, strengthens the cell membranes and generally positively affects the process of sperm formation. Метод «витаминизации» мужского
- AV reciprocal PT with pre-excitation of the ventricles in patients with several DPs
In the opinion of H. Wellens (1986), half of patients suffering from attacks of antidromic tachycardia have more than one DP. Of the 435 patients with electrocardiographic signs of WPW syndrome, G. Bardy et al. (1984) found multiple D77 in 61 (14%). Только v 20 из 61 больного (32,7%) удалось вызвать АВ реципрокную ПТ. The average age of the patients developed was 27 ± 14 years (from 9 to 67 years). Соотношение
- Intrauterine period. Several types of food.
In the embryonic period, the main type of food is histotrophic (after implantation of the blastocyst the embryo feeds on the elements of the uterine mucosa, and then the yolk sac material). After the formation of the placenta (from II-III months of intrauterine development) - it follows the hemotrophic form of nutrition (due to transplacental transport of nutrients from the mother to the fetus). The basis for these first
- Step 6: meeting at a cost of several million
Мы были настолько сильно заряжены ясностью и простотой графика, что не могли дождаться момента, когда вернемся в Thomson и поделимся своими выводами. По всей видимости, представители Thomson чувствовали примерно то же самое — непосредственно перед началом нашей презентации Дик Харрингтон внезапно спросил, может ли присутствовать на встрече. Мы привезли с собой огромную распечатку графика, чтобы
- A few significant remarks on the metabolism and energy
The main goal with which we eat food is to acquire energy. We need energy absolutely for any of our actions - maintaining metabolism, constant body temperature, breathing, heart contractions, muscular work and so on, all these processes need a constant inflow of energy that is contained in food. True, not all food components have energy, but only three.