An experienced endocrinologist has revealed the truth about hormones, weight loss and useless tests.
'26.09.2019'
Source: Adme
Marina Berkovskaya is an endocrinologist and nutritionist. She graduated from Sechenov Medical University, receiving a diploma with honors. Then she defended her doctoral dissertation. Now Marina teaches at her native university and leads patients in Moscow, and also shares useful health information and medical experience on her page in instagrama.
The expert answered 9 questions. For example, how to lose weight and overcome cravings for sweets, what to do with constant fatigue and how to deal with PMS, writes Adme.ru.
1. What is a “disturbed hormonal background" and is it necessary to take tests for all hormones from time to time?
There is no diagnosis of “disturbed hormonal background” in medicine, and it is not necessary to check all the hormones in the blood, urine, saliva and other biological fluids. In endocrinology, as in medicine in general, it is customary to treat a patient, not his analysis.
Endocrinological diseases, as a rule, have a vivid clinical picture, and diagnoses are often made, as they say, “from the threshold”. Of course, there are exceptions, for example hypothyroidism with its own “masks”, so experts check the level of thyroid-stimulating hormone in almost everyone. But this is only TSH, and not 10 – 15 hormones, which are tested without indications. For any hormonal analysis, there are clinical indications, and the correct sequence of actions is the following: analysis of complaints, anamnesis and clinical presentation - the appointment of an appropriate examination - treatment.
Therefore, if you have no problems with the cycle, hair growth, infertility, please do not take tests for sex hormones. If you are slim and have a normal blood glucose level, do not check your insulin. Do not take unnecessary tests - take care of funds and nerve cells (yours and the endocrinologist).
2. How to deal with PMS?
The official recommendations are to turn off the ovaries (combined oral contraceptives, estrogen patch in the second phase) in difficult cases and use antidepressants and anxiolytics. If everything is very bad, please do not treat yourself. Find a good gynecologist.
In most cases, we can help ourselves. First, deal with nutrition. Remove simple carbohydrates, limit salt, with anxiety - exclude coffee. Lean on protein, proper fats, eat regularly.
Secondly, change your lifestyle. Here a lot is possible: to leave the house in a fitness center for yoga, in the pool, go to a beauty salon, for shopping, acupuncture, massage, chocolate wrap. The main thing in this business is that you are satisfied and do not vent your PMS on your husband and children.
Third, take supplements.
3. There are problems with sleep, and lose weight does not work. What could be the reason?
Perhaps melatonin, the hormone of sleep, harmony and youth, is to blame. In addition, it is also a powerful antioxidant and “relaxation hormone”. Difficult falling asleep, frequent waking up, morning breakdowns, nightmares, late falling asleep and waking up, poor tolerance of changing time zones are all the most obvious signs of a lack of melatonin.
Just do not rush after him to the pharmacy, it's still not ascorbic. First, try to normalize your own melatonin: go to 23: 00, don’t shine in your eyes with gadgets at night, don’t get too full.
If you still can’t do without the drug, start with small doses, gradually increasing them to individually tolerated. If after taking melatonin you fell fast asleep, but woke up in the middle of the night from a heartbeat, anxiety, sweating and cannot fall asleep, you overdosed melatonin.
Contraindications for taking are pregnancy, lactation and autoimmune diseases. Long-term use of melatonin is possible only under medical supervision.
On the subject: "Are these all hormones"? How hormonal background actually influences the behavior and health of a woman
4. How to lose weight?
It is much more important not to lose weight, but to maintain body weight. Here the main difficulties lie, because diets are not helpers in this matter. You will have to change your attitude to food, gradually reducing its calorie content. You need to eat thoughtfully, slowly, without a TV and the Internet before your eyes.
How to eat? What food style to choose? In fact, this is not so important. It has long been proven that any diet will work if it creates a calorie deficit. This is the law of conservation of energy; you cannot fool it.
Eat 2 once a day or 5? By and large - no difference. Someone, eating 2 once a day, eats less and does not constantly think about food, and fractional nutrition for him creates a picture of constant zhor, someone, on the contrary, does not feel satiety from 2 — 3-one-time nutrition, and he is more comfortable doing 1 – 2 small snack. Find what is right for you.
Should you follow a low-carb, low-fat, or vegetarian diet? So far, it has been reliably known that the health of the cardiovascular system and life expectancy are best affected by the Mediterranean and DASH diets, as well as pescatarianism, which allows the consumption of fish and seafood.
5. What tests to pass with constant fatigue?
Serious diseases can be hidden behind banal fatigue, therefore the diagnosis of asthenia (chronic fatigue syndrome) is made by the method of their elimination. This business is complex and confusing and sometimes requires the coordinated work of a team of specialists. Here is the minimum that I assign when complaining of persistent weakness:
- Clinical blood test (with white blood cell count and ESR).
- General urine analysis.
- Blood chemistry.
- Pregnancy test or β-hCG in the blood.
- TTG, free T4.
- Screening for infections: HIV, syphilis, hepatitis B and C. A number of experts propose to exclude Lyme disease.
ECG. - X-ray of the lungs (or fluorography, low-dose CT - at the discretion of the doctor).
- For women, an examination by a gynecologist, ultrasound of the pelvic organs and mammary glands is also recommended, for men, a blood test for PSA.
6. Is milk true for acne?
It is believed that dairy products, especially low-fat ones, stimulate insulin secretion or contain growth factors, which leads to an increase in the action of androgens on the skin, an increase in the production of sebum, that is, the development and progression of acne. At the moment, there are several studies according to which conclusions are made about a slight increase in the severity of acne amid increased consumption of dairy products. But this data is not enough for official recommendations.
What should we do? My opinion is still unchanged: no problem - we consume dairy products (not fat-free), we want to lose weight - we consume dairy products in the morning, preferably with vegetables. Tortured acne - we exclude sweet, carbonated, chemical, and if this does not work, then milk. And do not forget to visit a gastroenterologist, because the intestines are most likely to blame.
7. Are there any useless tests that do not need to be taken?
There are 7 analyzes that I never prescribe, but which I have to interpret more often lately, that is, to reassure patients alarmed by their “abnormality”. So this is:
- Cortisol in the blood on a clean background. As a rule, higher values get to me, but it does not mean anything.
- Insulin, C-peptide and leptin in individuals with normal glucose without obesity. Here I have to “rake” both high and low values.
- 17-OH-progesterone in women without infertility and with a couple of successful births in the anamnesis.
- Levels of androgens and prolactin during pregnancy.
- Thyroglobulin. The only situation when it needs to be controlled is the observation of the patient after radical treatment of thyroid cancer.
- Aldosterone in the absence of high blood pressure.
- Progesterone in the blood.
8. How to overcome cravings for sweets?
To overcome the pathological craving for sweets, you need to understand the causes of this hated addiction. Stress, depression, reduced emotional background, dissatisfaction with ourselves - and now we are reaching for sweets, as we lack endorphins. How to be Look for them in a different, less sweet place. Here's where to start:
Add regular exercise. Believe me, this is another drug, and no less endorphins will stand out.
Balance your diet. You may be short of complex carbohydrates and proteins.
Go to bed before 23: 00 and get up near 7: 00. And even on holidays. Otherwise, you will get an imbalance of cortisol, growth hormone, melanin with all the consequences in the form of excess weight, daytime lethargy, and so on.
Avoid strict diets, because they are a direct road to chronic stress and breakdowns. If you ate half a kilo of sweets a day before yesterday, you don’t need to switch to one broccoli - proceed gradually.
On the subject: Diet from the endocrinologist: how to lose weight on 7 kg per month
9. Which is better: iodine supplements or iodized salt?
To combat iodine deficiency (for example, in Russia, 75% of the population experiences iodine deficiency), they use iodized salt. This is not bullshit, not a marketing move, but the easiest, cheapest and most effective way to protect people from iodine deficiency.
Many people believe that sea salt is a better source of iodine than table iodized. No. Only residual amounts of iodine are present in sea salt, mainly in the form of iodide, but most of it evaporates when evaporated. In contrast, iodized salt contains more stable potassium iodate. However, sea salt can also be iodized; see labels carefully.
Supplements with "organic iodine" do not have significant advantages over conventional iodized salt or potassium iodide preparations. Just pay attention to the form and dose of iodine in the product of your choice.
