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Metabolic syndrome: diagnosis, treatment, obesity with MS in women and men

Metabolic syndrome

The problem of metabolic syndrome( MS) today takes the scope of the present epidemic in almost all civilized countries.Therefore, many international medical organizations have been seriously studying it for many years.In 2009, scientists in the field of medicine compiled a list of certain criteria that allow diagnosing a metabolic syndrome in a patient.This list was included in the document entitled "Harmonization of the definition of the metabolic syndrome," under which a number of serious organizations have signed, in particular: the World Health Organization( WHO) and the International Association for the Study of Obesity.

Table of Contents:

The Danger of the Metabolic Syndrome

It should be noted that such an organism disorder as a metabolic syndrome or insulin resistance syndrome is not a separate disease but rather a complex of pathological changes occurring in all human body systems atBackground of obesity .

As a result of metabolic disorders, the patient suffers simultaneously from four such diseases as:

  • hypertension;
  • obesity;
  • type 2 diabetes mellitus;
  • ischemia of the heart.

This "bouquet" of diseases is very dangerous for a person, as it threatens the development of such serious consequences as: vascular atherosclerosis, erectile dysfunction, polycystic ovary, fatty liver, gout, thrombosis, stroke of cerebral vessels and myocardial infarction.

metabolism

With MC cells, the hormone insulin ceases to be perceived, as a result of which it does not fulfill its purpose.Development of insulin resistance and insensitivity to insulin begins, after which the cells poorly absorb glucose and pathological changes of all systems and tissues take place.

According to statistics, MS suffer predominantly from men, in women, the risk of suffering from this disease increases fivefold during and after menopause.

It should be noted that to date, the syndrome of insulin resistance is not treated. However, with a competent medical approach, rational nutrition and a healthy lifestyle, you can stabilize the condition for a long time.In addition, some changes that develop with this syndrome are reversible.

Causes of the onset and development of the metabolic syndrome

First, what role does the hormone insulin play in the human body?Among the multitude of insulin functions, its most important task is to establish a connection with insulin-sensitive receptors located in the membrane of each cell.Through such connections, cells are able to receive glucose from the intercellular space. The loss of receptor sensitivity to insulin contributes to the fact that both glucose and the hormone itself accumulate in the blood, from which the MS begins to develop.

metabolism

The main causes of insulin resistance - insensitivity to insulin:

  1. Predisposition at the genetic level.When mutating the gene responsible for the development of insulin resistance syndrome:
    • cells may have an insufficient number of receptors with which insulin should bind;
    • receptors may not have insulin sensitivity;
    • The immune system can produce antibodies that block the work of insulin-responsive receptors;
    • The pancreas can produce insulin of an abnormal nature.
  2. High-calorie food, which is considered one of the most important factors provoking the development of MS.Animal fats that come with food, or more precisely containing saturated fatty acids in them, are a major cause of obesity.Causing changes in cell membranes, fatty acids reduce their sensitivity to the action of insulin.
  3. Weak physical activity, in which the rate of all metabolic processes in the body decreases.The same applies to the process of fission and assimilation of fats.Fatty acids reduce the sensitivity of the cell membrane receptors to insulin, thereby preventing glucose from being transported into the interior of the cell.
  4. Chronic arterial hypertension, which adversely affects the process of peripheral circulation, which in turn reduces the sensitivity of tissues to insulin.
  5. Low calorie diets.If the daily volume of kilocalories entering the body is less than 300 kcal, then the body has to accumulate reserves by increased fat content.The body starts the process of irreversible metabolic disorders.
  6. Chronic stress.Psychological loads of a prolonged nature adversely affect the process of nervous regulation of organs and tissues, as a result of which hormonal failure occurs.The production of hormones, including insulin, as well as the sensitivity of cells on them, is disrupted.
  7. Admission of hormonal drugs such as corticosteroids, glucagon, thyroid hormones and oral contraceptives.They reduce the ability of cells to absorb glucose and in parallel reduce the sensitivity of receptors to insulin.
  8. Hormonal failures.In the human body, adipose tissue is an endocrine organ that produces hormones that reduce the sensitivity of cells to insulin.In this case, the more excess fatty deposits, the lower the sensitivity of tissues.
  9. Age changes in males.The older the man, the lower the level of production of the male hormone - testosterone, and the higher the risk of obesity, hypertension and insulin resistance.
  10. Breathing stops in sleep( apnea).When breathing stops in a dream, there is oxygen starvation of the brain and an intensive release of growth hormone, which produces the development of cellular insensitivity to insulin.
  11. An incorrect approach to the treatment of diabetes mellitus - the appointment of insulin is more than necessary.With a large concentration of insulin in the blood, the receptors become addicted.The body begins to develop a kind of protective reaction from a large amount of insulin - insulin resistance.

Symptoms of metabolic syndrome

metabolism

MS develops according to the following scheme.Weak physical activity and high-calorie diet provoke changes in the work of cell receptors: they become less susceptible to insulin.In connection with this, the pancreas, trying to provide the cells necessary for their vital functions with glucose, begins to produce more insulin.As a result, an excess of the hormone is formed in the blood - hyperinsulinemia develops, negatively affecting the lipid metabolism and vascular function: a person begins to suffer from obesity and high blood pressure .Since a large amount of undigested glucose remains in the blood, this leads to the development of hyperglycemia.The excess of glucose outside the cell and the deficiency inside lead to the destruction of proteins and the appearance of free radicals damaging the cell membrane, thereby causing their premature aging.

The process of change that destroys the body starts invisibly and painlessly, but it does not make it less dangerous.

Metabolism syndrome

External symptoms MS:

  1. Visceral( abdominal, or upper) obesity, in which the excess fat mass is deposited in the upper half of the trunk and in the abdomen.When visceral obesity accumulates subcutaneous fat.In addition, the fat tissue envelops all internal organs, squeezing them and complicating their work.Fatty tissue, acting as an endocrine organ, secretes hormones that produce inflammatory processes and increase the level of fibrin in the blood, which increases the risk of thrombus formation.As a rule, with upper obesity, the waist circumference in men is over 102 cm, and in women - more than 88 cm.
  2. The constantly appearing red spots in the chest and neck.This is due to increased pressure.So, with obesity, the systolic blood pressure values ​​exceed 130 mm Hg.St., And diastolic - 85 mm Hg.Art.

Sensations of the patient with the development of MS:

  • outbreaks of bad mood, especially in a hungry state.Bad mood, aggression and irritability of the patient due to the receipt of insufficient amounts of glucose in the brain cells;
  • frequent headaches.In MS, the headache is the result of increased pressure or narrowing of the vessels through atherosclerotic plaques;
  • pains in the heart that are caused by a heart failure due to cholesterol deposits in the coronary vessels;
  • intermittent heartbeat.A high concentration of insulin accelerates the heartbeat, while increasing the volume of ejected blood with each contraction of the heart.Subsequently, at the beginning, the walls of the left side of the heart thicken, and in the future, the wear of the muscular wall begins;
  • severe fatigue associated with glucose "starvation" of cells.Despite the high level of sugar in the blood, because of the low sensitivity of cellular receptors to insulin, the cells lack the glucose they need and remain without a source of energy;
  • really want a sweet.Because of the glucose "starvation" of brain cells, eating gives preference to sweet and carbohydrates, contributing to a short-term improvement in mood.At a metabolic syndrome the person is indifferent to vegetables and albuminous nutrition( meat, eggs, sour-milk production), after which use there is a drowsiness;
  • nausea and impaired coordination of movements associated with increased intracranial pressure that occurs as a result of a violation of outflow of blood from the brain;
  • periodically occurring constipation.A high concentration of insulin in the blood and obesity slow the work of the gastrointestinal tract;
  • severe sweating, a feeling of unquenchable thirst and dry mouth.The sympathetic nervous system influences the salivary and sweat glands under the influence of insulin, oppressing them.

Methods for diagnosing the metabolic syndrome

The problem of insulin resistance syndrome should be addressed to endocrinology doctors. But since the human body suffers from a variety of pathological changes with this disease, it may require the help of several more specialists: a cardiologist, a nutritionist or a therapist.

obesity

Endocrinologist for diagnosis makes a survey and examination of the patient. To analyze which causes contributed to the overweight and development of MS, the specialist should gather information on the following points:

  • conditions and lifestyle;
  • at what age the excess weight was started;
  • does any of the relatives suffer from obesity;
  • features diet, nutritional preferences( sweet and fatty foods);
  • blood pressure;
  • suffers from a patient with cardiovascular disease.

Upon examination of the patient:

  1. The type of obesity is defined.Obesity is male( abdominal, visceral, upper) or female( gynoid) type.In the first case, excess fat deposits accumulate in the abdomen and in the upper half of the body, and in the second - on the hips and buttocks.
  2. The waist circumference is measured.In the development of obesity, OT in men is more than 102 cm, and in women over 88 cm. If there is a genetic predisposition, then obesity is diagnosed at OT: in men - 94 cm and more, in women - from 80 cm.
  3. Calculates the ratio of girthWaist and hips( OT / OB).In a healthy person this coefficient, as a rule, does not exceed 1.0 for men and 0.8 for women, respectively.
  4. Determines the body weight and measures the growth.
  5. Calculates the body mass index( BMI), which is the ratio of the weight index and the growth rate.
  6. The body is checked for the presence of stretch marks( striae) on the skin.With a sharp set of weight, the mesh layer of the skin is damaged and small blood capillaries are ruptured, while the epidermis does not lose its integrity.Outwardly, these changes are manifested by red bands 2-5 mm wide, which become lighter in time.

Diagnosis of the metabolic syndrome with the help of laboratory tests

Biochemical blood test makes it possible to determine the presence of MS according to the following indices:

  1. Shir Triglycerides( lipids lacking cholesterol) - over 1.7 mmol / l.
  2. HDLP( high-density lipoproteins) - "good" cholesterol.With obesity, this indicator falls below the norm: less than 1.0 mmol / l - in men, and less than 1.3 mmol / l - in women.
  3. LDL( low-density lipoproteins, cholesterol) - "bad" cholesterol.As a rule, with the disease, this figure exceeds the norm - 3.0 mmol / l.Entering the blood from the adipose tissue of the acid stimulate the liver to produce cholesterol, which is poorly soluble, and deposited on the walls of the vessels, provokes the development of vascular atherosclerosis.
  4. Morning fasting blood glucose is 6.1 mmol / L.Since the mechanism of glucose assimilation does not work well, its level does not decrease even after a night's sleep.
  5. The level of uric acid rises and may be more than 415 μmol / l.Because of the violation of the purine metabolism, cells die, resulting in the formation of uric acid, with the output of which the kidneys do poorly.An increase in this indicator indicates the development of obesity and a high probability of gout.
  6. Microalbuminuria determines the presence of protein molecules in the urine.Violation of the kidneys in the development of diabetes mellitus or hypertension causes the appearance of protein in poorly filtered urine.Check for susceptibility to glucose.
  7. .To do this, a person orally takes 75 grams of glucose, and after two hours, its concentration in the blood is determined.In a healthy state, the human body during this time absorbs glucose, and its level should not exceed the norm - 6.6 mmol / l.

Statistical data on the metabolic syndrome

As the world statistics show, cardiovascular diseases cause 16 million deaths annually.Moreover, most of these diseases arose against the backdrop of the development of MS.

In Russia, more than half of the population is overweight, and almost a quarter of Russians are obese.Although this is not the worst scores, when compared with other countries, however, it is worth noting that the Russian population is very common problem of high cholesterol in the blood, which provokes strokes and heart attacks.

obesity

Almost 75% of Russians die due to the development of non-infectious diseases, most of which were caused by the violation of the exchange processes .This is due to changes in the way of life of the entire earth population as a whole - low physical activity during the day and abuse of fatty and hydrocarbon-containing products. According to the forecasts of physicians, in the next quarter century the number of MS sufferers will grow by about 50%.

Methods for treating metabolic syndrome

Treatment of MS with medication

Group preparations treatment mechanism of action Representatives How to receive
Treatment of Dyslipidemia
Lipid-lowering drugs( statins and fibrates) ReducesIntracellular synthesis of cholesterol, promote the removal of "bad cholesterol" from the bloodstream.Fibrates reduce the level of uric acid, due to the absorption of its salts by the kidneys. Rosuvastatin Take 5-10 mg of the drug once a day.After 4 weeks, the doctor evaluates the level of cholesterol in the blood and may increase the dose.
Fenofibrate Take the drug 2 times a day: 2 capsules at breakfast and 1 capsule during dinner.
Treatment of insulin resistance and glucose control
Drugs for reducing insulin resistance Improves the ingestion of glucose into the cell without stimulating the production of insulin.Slow down the production of fatty acids, accelerate the process of conversion of glucose into glycogen.Improves the binding of insulin to cell receptors, increasing the sensitivity of tissues to it. Metformin The dosage is determined according to the blood glucose level of 1-4 tablets.The daily dose is divided into 2-3 doses.Use after eating.
Drugs that increase insulin sensitivity Drugs slow the absorption of glucose from the intestine, reduce the production of glucose in the liver and increase the sensitivity of cells to insulin.Reduce appetite and help to lose excess weight. Siofor
Glucophage
Initial dosage 500-850 mg 2-3 times a day during meals.After 2 weeks, dose adjustment is necessary taking into account the level of glucose in the blood.
Vitamins Alpha lipoic acid regulates liver function, improves cholesterol metabolism.Improves the absorption of glucose in the skeletal muscles. Alpha-lipon Take 1 tablet 2-3 times a day for 3-4 weeks.
Drugs that normalize metabolism and blood pressure
Angiotensin converting enzyme inhibitors Block the action of an enzyme that causes vasoconstriction.Expand the lumen of blood vessels, reduce blood pressure, facilitate the work of the heart. Captopril The drug is taken on an empty stomach 3 times a day.Daily dose of 25 to 150 mg.
Enalapril 0.01 g 1 time per day regardless of food intake.
Calcium antagonists or calcium channel blockers Reduces blood pressure, reduces the need for cardiac muscle in oxygen and simultaneously improves nutrition.They have a weak diuretic effect. Felodipine
Take 1 tablet a day( 5 mg) once a day.Eat regardless of food.
Treatment of obesity
Inhibitors of fat absorption Reduce the activity of digestive enzymes and thus disrupt the digestion and absorption of fat in the small intestine. Xenical Take one capsule( 120 mg) with each main meal or at least one hour after a meal.
Orlistat Take 120 mg at the time of the main meal three times a day.If the food contains few fats, orlistat can not be taken.
Drugs affecting the central nervous system and suppressing appetite Model food behavior, reduce the need for food, reduce appetite.Help to cope with the feeling of hunger while dieting. Fluoxetine Antidepressant appoint 1-3 tablets throughout the day after a meal.

Medications are prescribed individually for each patient, taking into account the stage and cause of obesity, as well as the biochemical composition of the blood.As a rule, the effect of prescribed medications is aimed at increasing the susceptibility of tissues to insulin, the establishment of metabolic processes and the reduction of blood sugar levels.

Attention! Anorectics( appetite suppressants) can not be used to reduce weight in the treatment of metabolic syndrome.These drugs further reduce the sensitivity of tissues to insulin.Anorectics include such popular drugs: Fluoxetine, Prozac, Meridia, Reduxin .

Adjusting the lifestyle in the treatment of MS

It is very important to completely change your lifestyle and food culture in order to treat MS with a positive result.Regular sessions of exercise therapy in parallel with a low-carbohydrate diet is an effective tool that helps to speed up the metabolism and increase the susceptibility of cells to insulin.

The use of physical activity for the prevention and treatment of MS

Regular physical therapy classes contribute not only to the effective burning of fat reserves, the acceleration of metabolic processes and increase the susceptibility of tissues to insulin, but also the production of more endorphins - a hormone of happiness that improves mood andHelping to control appetite.Physiotherapy is the key to higher productivity, rejuvenation of the body and a slender silhouette.

While practicing sports, it is important to follow a few simple rules that allow you to deal more effectively with obesity:

  1. sport Training should be regular.While playing sports, it is important to remember self-discipline, because your health depends on the correct approach to physical activities.Training should be conducted six days a week for 60 minutes.
  2. Classes should be fun and fun, so you do not have to force yourself to exercise through strength.Therefore, you should choose the type of training that suits you.
  3. When choosing the right sport, it is also important to consider your age and physical abilities.For example, a person whose age has crossed the mark of 50 years, it is desirable to give preference to walking and Nordic walking with ski poles.But a younger man can choose a relaxed jogging.For any age also suitable: swimming in the pool or on the rowing machine, biking, skiing.These sports have a beneficial effect on the work of the cardiovascular system.
  4. It is important not to forget to follow the pulse and not to exhaust yourself with intensive training.Begin with minimal loads and eventually increase them.The optimal heart rate is 110-130 beats / min.It is at this rate that fats are most effectively burnt.Determine the maximum allowable value of the pulse can be according to the following formula: 220 - the number of years.For example, if a person is 50 years old, then for him a dangerous indicator on the pulse meter will be: 220-50 = 170 beats / min.
  5. Contraindications for health reasons should be considered.So, doctors recommend to temporarily give up employment in the presence of protein in the urine, high blood pressure and increased blood glucose - from 9.5 mmol / l.

Uprazhnenija-na-stepe The greatest effectiveness in the fight against obesity brings anaerobic( power) and aerobic( cardio) loads, especially if they alternate between each other.

The 's anaerobic exercises are performed at a fast pace, and considerable effort is required during training.Force loads are well suited to young men and women and are contraindicated in people who have problems with the cardiovascular system.

Heavy lifting in the gym, as well as squatting, push-ups, sprinting, biking on a hill and high-speed swimming perfectly strengthen the bones and joints and visibly outline the muscular relief.In addition, it is the power exercises that can most quickly increase the sensitivity of tissues to insulin.

At first, the duration of anaerobic training should not exceed 15 minutes per day.With each subsequent week, the duration of the exercises can be increased by 5-10 minutes.

Aerobic exercises, or cardio workouts are performed with less load and intensity than force.They can improve the performance of the lungs and heart.In the process of performing cardio workout, effective combustion of subcutaneous fat occurs.To aerobic exercises include dancing, classes on the treadmill, exercise bike or bicycle, as well as aerobics.The duration of cardio, as well as of force, in the beginning should not exceed 15 minutes, and in time can increase by 5-10 minutes weekly.

physical Culture Physiotherapy with a lightweight complex of exercises should be preferred in case of nephropathy( kidney problems) or retinopathy( complication of the eye).These exercises allow you to strengthen joints, activate metabolic processes and improve coordination of movements, while not increasing pressure and not loading sick organs.Classes are performed using dumbbells weighing 300-500 g. Dumbbells can be replaced with plastic bottles filled with water.During the training it is necessary to perform slow and smooth arms lift up, flexion and extension, tilting forward, as well as in the prone position, you need to raise your arms to the sides.In total, three approaches are performed on a daily basis 10 times with interruptions of 10-15 minutes.

Basics of proper nutrition in the treatment of metabolic syndrome - the diet

Low carbohydrate diet is an essential element in the treatment of MS.Without limiting the amount of carbohydrates and fats consumed, the cessation of the obesity process is impossible.Modern nutritionist doctors do not approve of either starvation or low-calorie diets, because the result of such methods, as a rule, is not long-term, can have side effects for health, and the process of losing weight requires considerable willpower from a person. As for a low-carb diet, the huge number of allowed products allows you to make dietary meals sufficiently nutritious and tasty, and combating obesity is an easy and healthy process.

Ideally, low-carbohydrate nutrition culture should become life-long, for which your body will respond with huge gratitude to you - to strengthen the immune system, the intestinal microflora will be normalized, and as a bonus you will get a slender figure, youth and working capacity.

Carbons

To avoid the feeling of hunger, it is necessary to eat small portions 4-5 times a day, while the body should receive at least 1600-1900 kilocalories per day.

With a low carbohydrate diet, the amount of carbohydrates consumed should not be more than 50% of the diet, and simple carbohydrates, including confectionery and flour products, white rice, should be completely replaced by complex ones( rye bread with bran, brown rice, buckwheat).It is recommended to abandon the salt, but sometimes you can include in your menu, washed sauerkraut, low-salted cucumbers and lightly salted herring.To get rid of the "bad" cholesterol, one portion of meat should account for two servings of vegetable dishes with greens.

Authorized products for the treatment of MS:

  1. Ovoshi Protein group: lean meat( rabbit, veal, chicken and other nonfat poultry) - 150-200 g per day, eggs boiled or in the form of an omelette - 1-2 pcs.., Low-fat dairy and sour-milk products, low-fat hard cheeses - up to 30 grams, low-fat sausages and boiled sausages from beef meat - no more than twice a week, baked or boiled fish and seafood - 150 g.
  2. Vegetables and fruits - 400G per day.In this case, vegetables should be eaten in stews, boiled, baked and raw or steamed.With regard to fruits and berries, it is recommended to give preference to unsweetened options, and if possible choose green varieties.
  3. Carbohydrate group: pearl barley, buckwheat, egg, rice( recommended from brown rice) porridge - 150-200 g, rye bread with bran - no more than 200 grams per day.
  4. First courses: it is allowed to cook on the basis of lean meat, fish or mushroom broth, vegetarian soups - 250-300.
  5. Sweets: it is allowed to eat no more than one strip per day of dark chocolate, as well as jellies and mousses, which containSweeteners.
  6. Drinks: You can eat unsweetened fruit and vegetable juices, tea without sugar.

It is recommended to consume liquid within one and a half liters per day.

Prohibited products in the treatment of MS:

  1. Protein group: fatty meat varieties( lamb, pork, duck), smoked and canned foods, fatty sour-milk products.
  2. Carbohydrate group: cakes and pastries, confectionery;Oatmeal, semolina and rice porridge, pasta.
  3. Fats: margarine and other fat used in cooking.
  4. Fruit: do not eat sweet and high-calorie fruits like bananas, grapes, dates.
  5. Beverages: sweet soda, juices and nectars with added sugar.

At most once every 1-2 weeks, you can break the diet and include in the diet anything from prohibited products, but only it is important to remember about the measure.

Prevention of obesity and development of the metabolic syndrome

Health problems can be avoided if you recall it in a timely manner and begin to change your lifestyle for the better.

What actions should be taken not to face the problem of obesity?

First you need to adjust your diet and make adjustments to the diet.If you eat moderate amounts of food at least 4-5 times a day, then the feeling of hunger will never arise, and therefore the body will not need to store nutrients in reserve.From the diet should be excluded fastfood, spices and spices, as well as alcoholic beverages and cigarettes.

In addition, you need to increase your physical activity during the day: walk more outdoors, give up the elevator and start climbing yourself up the stairs, etc. You should also buy an annual subscription for lessons in the pool or gym.Normal physical activity will help normalize all processes in the body and improve overall health.

If you are over 40 years old, the risk of developing obesity and MS is significantly increased, so it is important to make a laboratory blood test every year to the level of "good" and "bad" cholesterol, which will not lose time and if necessary start treatment.

Evtushenko Oleg, endocrinologist


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