Dr. Vessela Mihneva: Balanced Diet Is Especially Important In Metabolic Syndrome

- What is the frequency of the metabolic syndrome in our country?

Millions of people around the world suffer from metabolic syndrome. In Bulgaria we can say that about 30% of the population is obese and a large number of people also suffer from metabolic syndrome. Obese people do not have to have a metabolic syndrome. As we have said, weaker patients also suffer from it. But the frequency is high, not only in adults but also among adolescents. Children also often suffer from some of the components of the metabolic syndrome, which as adults turn them into patients with a number of diseases that develop over time. For example, type 2 diabetes, arterial hypertension, which is increasingly difficult to treat and change motor and eating habits, which are otherwise essential in the treatment of metabolic syndrome. 

- Tell us more about the main risk factors for the occurrence of metabolic syndrome?

Hypertension is one of the main risk factors. In these cases, patients usually do not seek medical help for a long time. They can live with high blood pressure for years and not feel it. In the beginning it manifests itself with pain in the occipital region, headaches and crises - a rise in blood pressure to 160-180 per 100. But at certain times people are already seeking medical help, when the diagnosis of essential hypertension is already made and treatment is started. 

As for triglycerides and high cholesterol, things are a little different. We have a certain amount of familiarity there. Many patients even eat healthily, exercise, and yet their cholesterol and triglycerides are high. We should not forget the increased alcohol consumption, which can also cause hypertriglyceridemia. We need a correction of eating habits , but if you get in these circumstances, should initiate a therapeutic response. It is usually done with statin drugs, which many people say they will not take after reading about their side effects. But they affect cholesterol. 

In these cases, it is recommended to consume more unsaturated fatty acids, omega 3, fish, seafood and limit the consumption of meat, especially game, which may also be richer in cholesterol. Eggs are wrongly considered harmful. They contain some level of cholesterol, but still have more useful substances and should not be completely excluded from the menu. In addition, cholesterol should not be condemned as harmful, as it is at the heart of the production of many of the hormone chains, and at the heart of this metabolic chain is cholesterol. Decreased levels are also harmful to the body, so there must be maintenance of normal limits, and these drugs that we give are not always indicated only for high cholesterol, but are also given to stabilize atherosclerotic plaques., which is especially important when preventing heart attacks and strokes, for example. 

The third component of the metabolic syndrome is a disorder of carbohydrate metabolism . When there is increased fasting glucose, increased glucose tolerance, usually there are no symptoms. People run prophylactic tests, find some fasting blood sugar - 6.1 to 6.5, but they tell themselves that there is nothing special in this and that it will return to normal. And so they do not pay attention to the condition, and in fact behind an elevated fasting blood glucose lies insulin resistance, which can also be leading in people who have a family history, obesity and overweight. In practice, the problem leads to the onset of type 1 diabetes,as its prevention is at an early stage, even while we are talking about a slight violation of carbohydrate metabolism, because turning into type 2 diabetes, it comes with its many complications that we all know and which for a long time have no symptoms. 
 
- Apart from monitoring blood pressure and healthy eating, what else do patients need to watch out for to avoid complications?

Unfortunately, some of them do not follow therapeutic approaches at all, they think that blood should be treated accidentally, only when necessary, only in a crisis, and this is not the case at all. Treatment should be carried out daily, continuously, for years. Patients usually improve their hypertension after weight loss . This happens in the summer months - due to the vasodilating effect of hot weather. They must follow a therapy that keeps blood pressure within normal limits - about 120 to 70 on the background of treatment, as cardiovascular risk increases with untreated hypertension. 

- You said that very often patients neglect the symptoms. Can people calculate for themselves whether they are overweight and when they should consult a specialist? 

Our idea with the campaigns we conduct in the Clinic of Endocrinology of the Military Medical Academy is to emphasize these conditions, to draw attention to the fact that overweight is by no means an aesthetic problem that we think of in early summer, when our clothes are tight, but just keep that in mind and keep a normal body mass index. People can also, with a simple sewing meter, track the waist circumference, separately calculate the body mass index - the kilograms on the height per square meter. When measuring the waist, people should keep in mind that it should not exceed the reference limits, having respective for men and women. There is also a table with which we determine overweight and obesity. Usually when we get a result below 25, the weight is normal, between 25 and 29 we talk about being overweight, and between 31 and 34 - for the first degree of obesity. From 34.9 to 39 is the second degree and now over 40 it is the fourth degree of obesity. And in my practice there are patients with 50-60 body mass index.

- What are the risks of this high index?

The health risks to these patients are enormous. Initially there is a risk of arterial hypertension, increased cardiovascular, type 2 diabetes, liver cyatosis, kidney disease . Also, the musculoskeletal system is not designed to carry such a huge load and over time there are bone and joint problems , disc herniations, low back pain. These people become immobilized and usually do not follow a very good motor regime, because they can not work and more than a dozen steps a day, stagnate. They have an unhealthy dietand in practice there is a vicious cycle in which obesity and overweight become a disease that is much more difficult to correct over time. One of the reasons for this is the slowdown in metabolism over the years. Of course, bariatric surgery and other invasive weight loss methods are not uncommon in these patients, but we initially recommend diets and physical activity that help reduce weight loss and obesity. When we achieve a result, we move on to recommendations for other types of interventions that can reduce weight. 

- How should these patients be fed? 

These drastic diets, which most people read on the Internet - high-fat, high-protein, starvation diets - are not very acceptable. In most cases, people can not cope with their appetite and blame various factors for their eating disorders. They have no time to exercise or eat healthily. They start the day with coffee and a cigarette, and throughout the day they hardly eat. In the evening (after 7 pm) people consume large amounts of food, as well as alcohol. And between 20 and 23 hours the body has a significantly slower metabolism than the early morning hours. Therefore, our recommendation is to always have breakfast, lunch and dinner no later than 6 pm, without abusing food, especially many high-calorie foods such as chips, waffles, cakes and more. Simple dietary restrictions could have great results without people having to go on drastic diets that disrupt their quality of life, their daily lives. It can also happenimpaired caloric intake and electrolyte imbalance, as many of these diets are not suitable for concomitant diseases that patients have. We recommend a balanced diet , moderate exercise, which, even if there is no long stay in the gym, at least associated with 30-40 minutes of walking daily . 

- Should people with metabolic syndrome also visit a nutrition consultant during therapy?

Specialist supervision is highly recommended. It is good for people to forget about resorting to herbal medicine, internet advice or what, for example, the neighbor observes as a regime, because things are very individual for different people . They should not rely on their family predisposition, because to a large extent everything is the result of environmental factors. And while many of us have a family history of overweight and obesity, if our lifestyle is healthy and we start at an early age, these people will have no problem later. They need to know that this is not a regime to be followed for a few months, but rather for the rest of their conscious life.