"You don't need to put anyone on a diet": an interview with endocrinologist Yuri Poteshkin

Lifehacker talked to Yuri and learned how to prevent endocrine diseases, why we gain weight, whether its excess is always harmful to health and what should not be done in any case if you want to lose weight. We also found out whether it is worth cleaning the body of toxins and how to properly deal with diabetes.

About endocrinology, disease prevention and excess weight

What is endocrinology and why is it needed?

Endocrinology used to be the science of endocrine glands, the products they produce, and how all this regulates body function. I think that now it is expanding its boundaries: it is now, rather, the science of humoral Humoral regulation is one of the mechanisms of regulation of vital processes in the body, carried out through the body's liquid media (blood, lymph, tissue fluid, saliva) with the help of hormones secreted by cells, organs, tissues. regulation. And speaking in a clinical sense, endocrinology is a discipline that studies diseases of the endocrine glands.

In what cases do you need to go directly to the endocrinologist, bypassing the therapist?

Always, in any situation, first of all, you need to go not to an endocrinologist, but to a therapist. The latter has a broad outlook and has a large amount of knowledge from various fields of medicine.

Of course, if you have a chronic endocrine disease or you know in advance that you have endocrine problems, then you can immediately go to the appropriate specialist.

But if you are not sure, go to a therapist. He will rule out the most common problems and send you to the right doctor. While the endocrinologist will exclude diseases only from his own area, the problem may remain. In addition, there are many more therapists. Therefore, it is more logical to contact them first.

What do people mainly turn to an endocrinologist with?

Most often, people contact who have passed the tests on their own and now do not understand what to do with their results. Why they handed them over, we can not always understand. But sometimes, thanks to this, it turns out to identify some kind of disease.

When a person undergoes a routine health check in a clinic, different doctors are involved. And also a therapist who summarizes all the information, systematizes it, communicates with colleagues, and then explains everything to the patient. But when people themselves decide to do some kind of analysis, they then have many questions. And they just go to the endocrinologist - to ask what it all means.

Also, there are those who have some symptoms - they do not know what is wrong with them and what tests need to be taken. And they decide that it is better to go to the doctor right away. These are perfectly reasonable people. And it seems to me that there are fewer of them.

Is it necessary to independently donate blood for thyroid hormones or something like that, if nothing bothers you?

There are completely routine tests that need to be done at different times - depending on gender and age. Your therapist can tell you about them.

Sometimes you can also donate blood to determine the level of thyroid-stimulating hormone (TSH). This is needed to scan for hyperthyroidism. So you will not miss the occurrence of this disease, because its symptoms are nonspecific and disguised as anemia, menstrual irregularities and much more. When should a TSH test be done? I will say, probably, the bad thing - when you have almost any symptoms. Basically, therapists do this.

And it is also very important, even without the presence of symptoms and complaints, for all people at the age of 45 to pass the lipid spectrum and glycated hemoglobin for screening for diabetes mellitus and lipid metabolism disorders. For people under 45, such tests should be done if they are overweight, have high cholesterol, high blood pressure, or have relatives with diabetes.

It is also worth checking a woman if she is overweight and she gave birth to a child weighing more than 3 600 g. You should not worry about the baby, but the mother could have a carbohydrate metabolism disturbed during pregnancy.

How to prevent endocrine diseases?

Most endocrine diseases occur by accident - simply because we're out of luck. We cannot prevent them. But there are those that you can work with - obesity and diabetes. They can and should be prevented. And everyone knows how, but nobody does it.

The first level of prevention is, of course, certain nutritional rules. But definitely not a diet. You don't need to put anyone on any diets. You need to know the basic principles of nutrition and the rules for choosing products. This is what the endocrinologist is doing.

And if there are questions “And I ate this and this, and then this. What would it all mean?”, Then you already need to contact a nutritionist.

In fact, people are quite willing to make changes in nutrition. But physical activity - the second level of prevention - can be more difficult to integrate into your daily routine.

What is the mechanism of weight gain?

It's simple enough. This is a standard mismatch between energy consumption and expended energy. The complex begins further. We have regulatory mechanisms for appetite and hunger. Fat tells the whole body: reduce appetite, eat enough. But why does a person continue to do this?

When we talk about a little excess weight, then a behavioral factor can play a role. For example, a person did not even think about and did not aim at maintaining a normal weight. Well, he eats and eats, delicious and tasty. These can all be corrected with cognitive behavioral therapy, dietary intervention, and physical activity.

And in people with a higher body mass index (over 35), psychological problems are already unambiguously connected. As a rule, they already have an emphasis on getting pleasure from food. And this can arise due to various reasons: depression, anxiety, personality traits, unfulfilled needs and much more.

It is also often said that a person recovered "because of hormones." How true is this?

Yes, because of them, a person can get better. But even because of hormones, he will not be able to gain a body mass index of more than 35. For example, with hypothyroidism, weight gain can be up to 5% of the weight. That is, the person weighed 70 kg, and became 73. Agree, not such a big difference.

Among all cases of obesity, the pathology of the endocrine system as the cause of weight gain is only 2%.

What tactics for treating obesity works?

When a person takes care of himself, he begins to think: “So, I began to eat more sweet or fatty foods. Why? He must ask this question, analyze the diet, draw conclusions, make decisions and change the diet.

When we, endocrinologists, explain the basic principles, we rely on a conscious person who will understand that something has changed. Therefore, it will act in this way: “Yeah, I began to eat more of the wrong products. Now I will switch to others and find out what is the matter. Maybe I need to see a psychologist, change jobs, or do something else."

And the tactics here are very simple. With a body mass index of up to 27, we only have nutrition and physical activity in our arsenal. As soon as the BMI rises to 27 or more, drug therapy can be connected. For example, if there are complications in the form of hypercholesterolemia, high blood pressure and other problems.

And with a BMI of 35 or more, it is already necessary to prescribe drugs and / or surgical treatment. Everything here is already very serious, because obesity is inevitably fraught with joint pathology. It can also lead to problems with the cardiovascular system and diabetes.

And what are the bad advice? What in no case should you do if you want to lose weight?

The most harmful advice is drastically limiting your calorie intake. And even more harmful is energy limitation. All this leads to the fact that a person finds himself in a situation where he does not have the strength to perform current tasks.

And he will definitely not engage in physical activity. And if it does start, it will lead to catabolism, as a result of which muscle tissue will begin to break down. This should never be done.

Severe calorie restriction is bad for long-term results. Yes, someone can lose weight quickly using this method. But this rapid weight loss ends with a rebound: the weight just comes back.

And another rather harmful method used by many experts is calorie counting.

The fact is that people start to bother and worry a lot when they count how many calories they spent there and got here. As a result, this leads to neurosis.

And those we are talking about now most likely have psychological characteristics. You need to be careful with them. They shouldn't be alarmed. And the weight correction scheme should have been comfortable for them. After all, it is always unpleasant for us when a stranger interferes in our life.

And imagine that you are constantly being told: "Now you will eat this." You answer that you do not like it, but they tell you: "No, you only have to eat this." What do you think? Just send it to yourself to hell. Someone may have obedience tendencies and will follow the pattern for a while. But even they will have a limit of patience.

Therefore, it is better not to count calories, but to keep a diary or photograph the food that you have eaten and show it to your doctor. And he will gently and smoothly adjust the diet. It is comfortable. Trust me, every change we make to nutrition is a victory. We must leave a person with a permanently altered adequate understanding of how to eat.

Is excess weight always harmful? Or is there some kind of range when you can not worry about your health?

The first thing to know is that any excess weight harms your joints. You will feel it not tomorrow or the day after tomorrow, but at the age of 60. Everyone around you will suddenly start Nordic walking, and you won't be able to walk normally because your knees hurt.

If we talk about metabolic changes, then it is enough to measure blood pressure for several days. If it doesn't rise above 135 to 85, you don't have to worry too much. And if it rises above 135, then this, too, may not be a problem yet. But in this case, it is worth putting a daily blood pressure monitor so that we know for sure whether it is high or low, whether there are drops during the day and at night. This is all very important.

The next point is a glycohemoglobin test, which helps to estimate the average blood glucose level over the past three months. If the result is not within the normal range, this is a marker of the onset of diabetes. Control it. This is the most common problem in overweight people.

And the last is the lipid spectrum. These are total cholesterol, low and high density lipoproteins, triglycerides. Get tested for their level in the blood. If the values are within the normal range, you don't have to worry.

If any of the above does not correspond to the norm - this is a reason to think about losing weight. By the way, smoking is strictly prohibited.

That is, if, with excess weight, all of the above indicators are normal, then you can not worry too much?

Yes, apart from future joint problems. And if there are relatives with diabetes, I would try to keep track of my weight. Its excess speeds up the passage of time.

If everything is done correctly, the development of diabetes mellitus will begin at the age of 60–70 and will be much milder.

But if you don't take care of yourself, at the age of 40 you will have complications and take a bunch of medications. That is, simply by maintaining a healthy weight, you can gain 30 years of quality life.

About diets, detox and hormonal disruptions

How do you feel about the newfangled diets, for example, the paleo diet or the keto diet? Are there any really useful ones?

Well, how can I relate to them if I said that eating habits should be changed smoothly and carefully. They need to be adapted to the person's lifestyle so that they stay with him forever. And all diets are temporary. We cannot assign any of them permanently.

Of course, these diets have fans. But the body of each person is individual, and not everyone can withstand for a long time what others adhere to.

And if you just look at the statistics, then the results of people who are on the same keto diet are not very good: they may develop or worsen chronic diseases or other health problems. Generally, this diet was created to treat epilepsy. In all other cases, properly selected nutrition works well. And that is all.

And in fact, all diets are very similar. There are not many ingredients in our diet, and we have few options. One of the principles of nutritional correction - limiting sugar intake - is present in general in all schemes.

Further, the diet is divided into two types: with restriction of carbohydrates and restriction of fats and proteins. And most diets are anti-carbohydrate. For example, the same paleo and keto diet.

Indeed, for carbohydrates to be in the diet and to work well, you need to work very closely and comprehensively with a person. And this is a difficult task for people who want to write a book about nutrition and then simply replicate thoughts from it. If they say: "Eat a little", a bunch of interesting questions will immediately arise, a la "a little is how much?" Therefore, it is easier for them to say: “Don't eat at all. Our ancestors didn't eat, and we don't need to. " But our ancestors did not live long.

Now it is still fashionable to cleanse the body of certain "toxins". Why shouldn't you do this?

Because toxins don't exist. When we say this word, perhaps an image of barrels with a green liquid, some kind of boiling poison, pops up in someone's head. And here's the question: how do you think such things got into our bodies? Nobody uses them on purpose.

We live on a planet where there are different trace elements and substances. Over hundreds of thousands of years of evolution, we have developed a special metabolism. We have a liver, special enzymes to inactivate various substances. That is, we are adapted to a certain amount of substances that enter our body, and we have everything we need to eliminate them.

Also, everything that is inside us is part of the overall system. All biochemical reactions in our body are strongly interconnected. And you cannot "clean up" something without changing the balance of different forces. And it is quite difficult to unbalance this system.

For gross methods of blood purification, there must be compelling indications - for example, poisoning with a specific poison. Or, with hereditary hypercholesterolemia, doctors use plasmapheresis to lower lipids. Because a person in this state is so bad that nothing else works.

Someone might think that since it even helps them, why shouldn't I do the same. But it doesn't work that way. Good reasons are needed. And if they are not there, then such cleaning will not only not help, but rather harm.

There are no unplanned toxins inside of us. And if some substances conditionally poison us, then, most likely, someone poured poison.

Toxins can be difficult to obtain from conventional foods, especially in the right doses. And most importantly - in those doses that could be removed by methods of "cleaning" the body.

But there are absolutely stupid methods. For example, many try to cleanse the body through the intestines using enemas. But we have a microbiota there that feels normal. It ensures our well-being by balancing hundreds of bacteria species. If you think that something is wrong with her, consult a nutritionist and gastroenterologist. They will find out its composition and say if it can be somehow improved.

And if you do something yourself, you will fatally disrupt the delicate balance of bacteria. And as a result, pathogenic microorganisms, which are normally present in small quantities, multiply and start inflammatory processes.

If you look at our cities, you can see that the ideal picture of the world for a person is the surrounding world rolled into asphalt, neat square bushes and fences. If your body is just as "clean", then it will simply die. Just like nature dies when man comes.

To interfere with this system, you need a supercomputer loaded with data on how biochemical processes in a particular person take place. But he is not. We are even a proteome A proteome is a collection of body proteins produced by a cell, tissue or organism at a certain period of time. have not decrypted and we cannot do it yet. It's all complicated. Therefore, you should not listen to people who once read a book on biochemistry and say that now they will correct everything for you.

What to do if a person is diagnosed with a pre-diabetes condition? And what misconceptions and fears do you most often face in this area?

Most often I come across the psychology of the ostrich. I see people who have not been treated for years. They come and say, "I was diagnosed with prediabetes seven years ago." Unfortunately, at my appointment, such a person may already be diagnosed with diabetes.

If we detect prediabetes at the earliest stage, then we give minimal therapy - literally one drug. And she has been supporting patients without additional medications for quite a long time - 5-10 years. And if people do not get treatment, ignore proper nutrition, do not play sports and do not monitor their weight, then after 5 years they will be overtaken by diabetes mellitus.

His treatment is no longer one drug. I think it should be clear to you that it is better to take 1-2 drugs after 10 years than after 5 years already several. And most importantly: if the sugar is high, the state of health is slowly but surely deteriorating.

What should be done if a person has already been diagnosed with diabetes mellitus?

If type 2 diabetes is diagnosed, the first step is to be screened for late complications. This disease does not develop immediately. And during the time that a person was going to diabetes, he could have problems with the eyes, kidneys or nerves.

You also need to get medicines and recommendations on nutrition and lifestyle from your doctor. And all this must be done at once and at the same time.

Is there such a phenomenon as a violation or failure of the hormonal background, which explains the occurrence of some kind of disease?

There is no such thing as hormonal levels. A person has many different endocrine glands. They are regulated slightly differently. As a rule, if one of them has a failure, we can already talk about the occurrence of some kind of pathology.

If the failure occurred at once for everyone, then this is a serious problem that is difficult to miss. And usually everything together breaks down when the pituitary gland fails. A person has an insufficiency of almost all endocrine glands.

Imagine that with the frequency with which hormonal disruption is mentioned, the work of the whole organism would really be disrupted in people.

Why are people wary of hormonal drugs? How much do their fears relate to reality?

It seems to me that hormonal drugs are badly treated only because of glucocorticoids, in particular - prednisolone. Because of this group of drugs, people think that all hormonal drugs lead to weight gain. And they are very surprised when I tell them that there are those that lead to his loss.

And even glucocorticoids by themselves will not add weight. For example, when I prescribe hormonal drugs to treat kidney failure, I explain that if you take them, your appetite will return and you will start eating more. Then they say to me: "Yeah, okay, that is, if I do not increase the portion size, then the weight will remain the same." I answer: "Quite right." Patients do this, and everything remains as it was.

What myths in endocrinology do you dislike most of all?

I absolutely do not like it when they say that it is possible to cure some serious disease without medication. It seems to me that this is not just an accidental delusion, but a statement purposefully invented by charlatans. And they promote it in their own interests.

For example, there is Graves' disease, an autoimmune disease in which the body attacks its own thyroid receptors. As a result, a person's muscles atrophy, heart problems appear. He may be bedridden. Although at the onset of the disease it usually feels very good. But over time, he begins to understand that something is wrong.

This person comes to the doctors. And we say that there are two options. The first is drug treatment. We appoint him for 1–1, 5 years and observe. If a relapse occurs, you will have to resort to the second option - surgery or radioiodine therapy.

Naturally, there are people in the medical environment who say that this should not be done. They prescribe diets and other complete nonsense.

As a result, after 5-7 years of such "treatment", this person comes to us in a very serious condition: he missed all the chances of staying healthy.

There are also people who say that insulin should not be used for type 1 diabetes. It's a heartbreaking story. Insulin was invented at the beginning of the last century and saved a huge number of lives. Prior to that, type 1 diabetes was a deadly disease.

And now, against the background of the fact that everything is fine and people do not die so easily from it, opinions of various mediocrity begin to appear, who say that insulin should not be used. Those to whom it is assigned and who does not use it will go to intensive care and are likely to die.

But insulin is the safest way to compensate for carbohydrate metabolism, which can be used in any difficult situation. For example, if a person is unconscious, has respiratory problems or is seriously ill with coronavirus.

So what I hate most of all is that which can harm a person. Here, rather, we are not even talking about myths, but about harmful social movements.

What advice can you give the readers of Lifehacker as an endocrinologist?

As an endocrinologist, I cannot give advice, because I evaluate the person as a whole. The general recommendation is to get a good personal doctor and see him at least once a year. He will monitor your health, guide and help you.

The doctor will allow you to do what you want in life - all thanks to the fact that you will have health for it. And you will not buy it in any way if you have lost it. You can earn it yourself, by your own labor. And the doctor will help you avoid mistakes.