Introduction, Definition, Measurement techniques: Yes, but... am i obese?, Classification of obesity.

Risks and complications associated with obesity: (Heart diseases, High Blood Pressure, Diabetes, Respiratory disorders, Locomotor system, Digestive disorders, Pregnancy, Obesity in infancy.

Treating obesity: Dietetic actions, phitotherapy in the obesity and associated pathologies. Dangerous medicines in the treatment of obesity. Strange and dangerous diets.

Strange as it may seem, problems concerned with obesity or overweight, or more to the point, the pathologies linked to the same, including all those which need some form of weight correction, are responsible for the majority of visits that we make to the general practitioner or “family doctor” in our country.

The problem has reached such proportions that we can safely say that in so-called developed or industrialised countries it affects one quarter of the population. Furthermore, it is the most frequent problem of the so-called metabolic disorders.

The problem sharply increases if we take only the over-50 population into account, where the statistics prove to be even more shocking, given the fact that some 50% of this group suffer from obesity or overweight.

In Spain, recent statistics have shown that among the general population over 42% are suffering from overweight, or are obese. If the aforementioned statistics are to be accepted, they suggest that we find ourselves in a situation where 12.4% of the men in our country and 21.3% of the women between the ages of 35 and 65 are obese.

In no way whatsoever does this book claim to be a “bible” with respect to its subject matter, given that, fortunately, we have some of the most important experts who have dedicated their whole lives to research. They are the ones who can really show us the way to follow if we truly wish to “do things properly”. It simply aims at concentrating, in a few pages, several years spent at the head of a medical clinic dedicated to Cosmetic Medicine, Dietetics and Nutrition, thus responding to the demand that has arisen during courses and conferences that we have given on pointing out some specific guidelines which might serve as a reference to those professionals, and the public in general, who might share my way of thinking.

It must be clearly understood that in Medicine two and two practically never add up to four. There are no such things as sicknesses, merely people who are ill, and aggressiveness or aggressive treatments are, to all intents and purposes, of no use, when what we are really trying to do is “to enlighten” our patients.

I patently refuse to prescribe quick diets that only serve to make long-suffering patients have a bad time, without providing them with rationalised behavioural guidelines which will stand to them throughout the rest of their lives. There is no justification for a rapid loss of weight. I would much prefer that my patients learn healthy, lasting concepts than that they manage to lose a lot of weight in one week, then relax and give up the treatment. It is much more reasonable to lose weight by “eating properly” than by “not eating”. Our mission is to help to learn. We do not believe in illogical and extreme treatments that only lead to discouragement.

I might say exactly the same as regards the preparations or phytocompounds that we are going to refer to in the course of this book. None of these can replace a proper and healthy diet, but they can help to make it more agreeable. Their aim is to make the dietetic treatment “a little easier to bear”, certainly not to replace it. As we will see, the magic pill has yet to be invented that will enable the patient to lose weight while at the same time eating whatever he or she wants, without damaging his or her health. Nevertheless, it is true that with the contribution of specific preparations we can make our patients lives a little easier, and solve a lot of the problems that their excess weight might provoke in them. All of the preparations mentioned are only used when they prove to be necessary or essential, because the pathology requires an action consistent with it. I give the commercial names of all of them, given that experience has taught me that it is better to be clear and specific with respect to the guidelines, and not to let each patient look for a product that fulfils the same functions without being familiar with it. Based on my professional experience, I recommend products in which I have complete confidence and which have never let me down. Of course, whenever I can, I recommend homeopathic or phytotherapeutic complexes, given that, in addition to solving the problems that I am confronted with, they provide me with the security of avoiding any undesirable secondary and side effects.

A DEFINITION OF OBESITY

WHAT IS OBESITY?

The question should not be taken lightly. It is not a platitude, given that we are being so constantly bombarded in the mass media that we are really and truly being hounded with a prototype of sculptural beauty which only helps to confuse us with concepts that fortunately have nothing to do with the guidelines for a healthy body that we should all follow.

Certainly, obesity has nothing to do with the opposite of the sculptural bodies, which sometimes verge on the grotesque, that are to be seen on the fashion catwalks these days, nor, fortunately, does it have anything to do with the antithesis of the Apollo-like bodies of the young men that are sprawled all over advertisements.

How quiet they keep the sacrifices, occasionally unhealthy, or the hours and hours of strenuous, back-breaking exercises in the gym that have to be suffered in order to achieve these sculptural figures which have so managed to obsess us!

Obesity can be defined as the “accumulation of excess fat in the body”, or as the “accumulation of excessive fat in the body to the extent that it represents a health risk”, and which, as a rule, tends to manifest itself as an increase of body weight.

All well and good, but what about those athletes who weigh so much, and if we analyse their composition we find that their body fat is at a minimum? The answer is simple. “They are all muscle”, and muscle weighs a lot.

As we can see, although in many cases we can clearly identify an obese person on sight, clearly defining the concept of pure obesity in order to apply it to everyone, without taking other considerations into account, is not so easy. Personally, I prefer to consider obesity under the prism of the negative effects for the health that it brings with it, and to leave the aesthetic approach under the heading of the more subjective parameters that may arise as a consequence of the problem.

MEASUREMENT TECHNIQUES

YES, BUT. . . AM I OBESE?

This question is not as easily answered as one might expect at first sight. Obviously, in many cases, the question can be answered by merely looking at those people whose large volume and enormous weight can be readily perceived. However, it is much more difficult to recognise obesity in those who may not readily display such characteristics, but are overweight to a certain degree. And much less in the large amount of young girls that come to our surgery with a certain minimal overweight, and the only thing they ask is to improve their aesthetic condition.

In both cases, not only with respect to clearly evident obesity, but also with respect to those that simply wish to achieve a certain remodelling of their figure, the following question must be asked: WHAT IS MY IDEAL WEIGHT?.

There are several ways in which to calculate a person’s body mass, from the most sophisticated densitometric and dilution techniques, which are only carried out in specialised anthropometric centres, to more simple ones, such as those used in nutrition and dietetic clinics.

Logically, we will refer to the latter, which are easier to use and which will enable us to monitor the treatment objectively and in a manner that can be easily reproduced. There are basically three techniques that fall into this category:

Broca’s formula: this establishes the ideal weight of a person by stating that an adult man should weigh as many kilos as he is centimetres above one meter. Thus, for example, someone who measures 1m 75cm will have an ideal weight of 75 Kg. Obviously, we all agree that this is at once the simplest, but at the same time the most pointless way of assessing obesity, given the fact that it does not take other extremely important criteria into account, such as the constitution of the individual, his or her muscular quality, etc.

Skinfold measurement: This is, perhaps, one of the most frequently used methods in clinics dedicated to weight loss. A type of compass is used (known as a lipometer) which measures the thickness of fat in specific places. Generally, in the triceps, or between the thumb and the index finger. The result is correlated with standard tables that contain different ages and heights, which provide us with percentiles. Generally, a person giving a result above a percentile of 85 is deemed to be obese.

Quetelet Index or the Body Mass Index (BMI): This is a very easy system, and quite often used to give us an idea of an obese person’s ideal weight. It links weight to height. It is got from dividing the weight in Kg. by the square of the height in metres. A person whose BMI is equal to, or above, 30 Kg/m2 is deemed to be obese.

CLASSIFICATION OF OBESITY

There are many etiological (causal) classifications of obesity, which can prove to be of great importance in clinical treatment or research, but in practical terms their contribution is minimal, given that they simply provide us with information as to how the obesity has come about.

Nevertheless, we can draw up a short list of the classifications that are most frequently employed:

From the causal perspective we find:

- Genetic obesities: A high degree of heritability of the obese condition has been revealed as a genetic defect, in accordance with the laws of heredity. Practically all obesities that we come up against will, to a greater or lesser extent, possess a degree of genetic conditioning.

- Dietetic obesity: This form of obesity is due to the abuse of extremely energetic foodstuffs, which are currently available in abundance, and which moreover, present us with such attractive flavours and appearances that they turn out to be, especially for children, very difficult to resist eating. - Obesities due to imbalances in body weight control systems. These are undoubtedly the most frequent forms of obesity. On the one hand, the defect of the satiety balance comes into play, which gives rise to ingestion shooting up, and on the other hand, the organism struggles to maintain a weight, which it mistakenly considers to be normal, even when this may be very high. This is the big problem that arises when it comes to maintaining a weight that we have lost, which our organism considers to be under that which it analyses as normal, trying to recover the same quickly.

- Obesities due to thermogenic disorders: these are not very frequent. They consist in the difficulty that the organism has in “burning” the excess of the foodstuff that has been ingested, thus giving rise to a caloric build-up that can go as far as causing obesity.

- Obesity of the nervous type: the cause of this type of obesity lies in disorders in the central nervous system such as, depression, hypoactivity, psychological upsets, etc. which interact with that part of the nervous system in charge of regulating body weight, upsetting the satiety or the thermoregulator mechanisms.

- Obesity as a result of endocrine diseases: these are not very common. The most important ones are due to a deficiency in the secretion of thyroid hormones (hypothyroidism). The excess in the production of insulin (hyperinsulinism) and the excess in the secretion of glucocorticoids (hypercorticism). Both of the latter are very common in the majority of obese patients.

- Obesity due to drugs: these basically refer to corticoids, anti-depressants and anti-tubercular medicines, all of which normally give rise to an accumulation of fat. This of course, without referring to what we unfortunately come across with great frequency in our surgeries. The large amount of obesities provoked by inadequate obesity treatments, that is to say, treatments essentially based on thyroid hormones which tend to accelerate the metabolism, thus producing a large and rapid loss of weight, and later resulting in a thyroid blockage with means that the obesity rebound is very serious and extremely difficult to treat.

- Chromosomal obesities: these are linked to chromosomal defects such as Down Syndrome and Turner Syndrome.

According to the distribution of fat in the body, obesity is classified into:

- Android obesity: when the fat prevails in the upper half of the body. This is typically male obesity.

- Gynoid obesity: Typical of the female sex, in which the fat is deposited in the lower half of the body. Mainly in the peritrochanteric area giving rise to the excess fat on the upper thighs which we find so disagreeable.

According to the age at which the individual begins to suffer from obesity, we can classify it as:

- Hypertrophic obesity: this form of obesity is typical in adults. Here there is an increase of the size of the fat deposits in the adipocytes (fat cells).

- Hyperplastic obesity: this form of obesity is also known as childhood obesity. Here the size of the adipocytes is normal, but their number is greatly increased. It is much more difficult to treat than the above.

Finally, we can classify obesity according to the seriousness of the same. To do so we normally base our classification on the Body Mass Index in accordance with universally accepted parameters:

RISKS AND COMPLICATIONS ASSOCIATED WITH OBESITY

Obviously the importance of the majority of the obesity or overweight cases that we come across daily in the clinic, do not go beyond the confines of the merely aesthetic. The problem can be solved with a minimal dietetic adjustment, and the help of some phytotherapeutic medicine or other.

Nevertheless, it is important to stress the fact there are a series of clinical symptoms arising from the condition of the obese patient that justify their treatment. We must not overlook the fact that the mortality rate of an obese person is 2.5 times greater than that of a person of normal weight.

Thus, obesity is quite frequently associated with a wide range of diseases, which we will comment upon briefly. With respect to these diseases, a loss of weight always results in a considerable clinical improvement.

Obesity and heart diseases:

Numerous studies have been carried out revealing the relationship of obesity with heart diseases and the appearance of angina pectoris, or the much-feared heart attack. Above all, as we will see, when it is linked to other factors, such as high blood pressure, the increase of lipids in the blood, or diabetes, which are also much more frequent in the obese patient than in the person who enjoys a normal weight.

Alterations to the lipids in blood, increasing LDL cholesterol and reducing HDL cholesterol (“good cholesterol”) favour the depositing of fatty plaques inside the arteries that serve the heart (the coronary arteries). These deposits narrow the calibre of the vessels, thus notably reducing the amount of blood that flows through them. This is what is known as arteriosclerosis. If we add this to the spasm that is provoked on account of the high blood pressure or the overstrain, not enough blood manages to get to the heart, which gives rise to the causing of myocardial injury, which in turn, might even have a fatal outcome.

Obesity and High Blood Pressure:

High Blood Pressure is a very common disease, which is largely associated with obesity. It is 2.5 times more frequent in obese patients than in those who have a normal weight. Moreover, it has been estimated in numerous clinical studies that the control of obesity can manage to reduce the number of cases of high blood pressure by over 50%. There is evidence available to suggest that the loss of weight in obese people with high blood pressure gives rise to an important improvement in their pressure figures, regardless of the amount of sodium that they might be taking in their diet. It may even have a beneficial influence by virtue of reducing the need for hypertension medicines, thus diminishing the undesirable effects of the same.

Obesity and Diabetes:

Diabetes is by far the disease most commonly associated with obesity. The figures speak for themselves: 25% of obese children suffer from glucose tolerance disorders. In 80 % of diabetics, the disease surfaces after the age of 45 (adult diabetes) and practically all of these suffer from some degree of obesity.

The problem of these patients is not that their pancreas is not working properly, but that the amount of insulin that it secretes is not enough for their body weight. Insulin secretion is relative, not because of pancreatic insufficiency, and this imbalance between the amount of insulin normally secreted can be remedied with a loss of weight and by reducing the patient’s fatty mass.

Dietetic treatment is not only the most important treatment, but quite frequently the only one required to solve the diabetic problem in the obese patient. It is extremely important that we direct our efforts to encouraging these patients to act consistently with their dietetic symptoms. The symptoms of their diabetic disorder (thirst, polyuria, nycturia, itchiness etc.) must be considered as lessor symptoms that accompany their obesity problem, given that the intolerance to carbohydrates presented by these patients can be completely overcome if they lose weight, but, on the other hand, it is going to get inexorably worse if the obese diabetic does not manage to achieve his or her weight loss, thus exposing himself or herself to the evolution of his or her diabetic disease, along with complications that this brings with it (neuropathies, vasculopathies etc.)

Obesity and respiratory disorders:

Respiratory disorders deriving from obesity are due to the reduction of total lung volume, a marked reduction of the espiratory volume, a reduction of ventilation in the lower part of both hemithorax and the accumulation of fat on the thoracic wall, with the consequent reduction of its expansion capacity.

The final result of these alterations is a fall in the intake of oxygen and an increase of carbonic acid, which explain, along with the increase of hematocrit and of haemoglobin, the clinical respiratory disorders that the obese patient suffers from. We can summarise the latter in: sudden daily sleepiness, quite often related with little rest at nighttime, fatigue, or serious dyspnea. Snoring, apneas during sleep, that is to say, periods of up to 30 seconds without breathing, cyanosis, or the turning blue of the skin due to the lack of oxygen in the blood, morning migraines, psychopathological disorders ranging from slight irritability to serious reactive depression.

The aforementioned are disorders associated with obesity and may become extremely serious, not only affecting the daily life of the patient suffering from the illness, but also affect his or her social, family and work environment, and may turn out to be the source of such serious ventilation problems that they might give rise to the patient having to be taken into respiratory intensive care units.

In spite of everything, we must not forget that such consequences of obesity can greatly relieved with amazing speed as soon as the patient follows dietetic treatment for his or her problem. Improvements obtained in the respiratory field are probably the first to manifest themselves as soon as the first weight reductions have been achieved.

Obesity and the locomotor system:

Pains in the bones and/or joints are some of the main reasons for which the obese patient most frequently and spontaneously visits his or her general practitioner. Other times it is normally the rheumatologist, orthopaedist or physiotherapist who recommends that the obese patient consult a dietician in order to try to lose some weight, an essential condition to solving the patient’s bone-joint discomfort.

It is quite logical to think that the muscular – skeletal system of our body is designed to support a specific weight, and when this point is exceeded the continued traumatism, represented by the overweight, conditions the appearance of characteristic joint problems or disorders.

The most common of these is osteoparthritis, which up to 50% of obese patients tend to suffer from, depending on their age and the degree of obesity in question. It basically affects the lower extremities (hips and knees) and the spine. It is one of the pathologies that most conditions the quality of life of the obese patient. With respect to this matter, it is very important to highlight the fact that obese children are most prone to suffer bone-articulation deformities, given that they are at the growth stage.

The problem becomes even worse as the osteoparthritis develops, along with the concomitant operational impotence which this brings with it, which in turn impedes the solution of the obesity problem. The obese patient becomes increasingly more sedentary, which means that we find ourselves entering a vicious circle that is extremely difficult to overcome: obesity – osteoparthritis – sedentarism – obesity.

Another anomaly, frequently associated with obesity is hyperuricemia, which gives rise to attacks of gout and to the gouty arthropathy which can be so often observed in the most serious cases of obesity, generally of the android or upper trunk type.

Obesity and digestive disorders:

Obesity is basically linked to gallbladder problem. On the one hand, the bile contains a higher level of cholesterol, thus explaining the fact that the individual in question is much more prone to suffering gallstone calculus than a person whose weight is normal for them. On the other hand, the accumulation of fat on the abdominal wall greatly conditions the proper development of the digestive functions, thus giving rise to the typical dyspeptic syndrome of the obese patient, which is characterised by slow and heavy digestive processes, regurgitations, meteorism and aerophagia, fullness after meals, etc.

The general increase of fat conditions its depositing in the liver, which is what we call Hepatic Steatosis, a chronic disease characteristic of the obese person. This disorder gives rise to the “malfunctioning” of the liver, which in turn leads to the loss of its detoxicating functions. It is responsible for the appearance of “general intoxication” displayed by some extreme cases of obesity, and a large part of the dyspeptic disorders that we have referred to above.

Another consequence of the accumulation of fat on the abdominal wall, with the subsequent heavy pressure exerted over the diaphragm, is the appearance of the hiatal hernia. Part of the stomach crosses the diaphragmatic sphincter and is situated over the diaphragm, in the thoracic cavity. Part of the food consumed, as a result of the upper sphincter of the stomach proving to be insufficient, rises through the oesophagus irritating its walls, to the point of eroding them. This is clinically characterised by an increase of the oesophageal reflux, with intense heartburn, precordial pain, aerophagia etc.

Obesity and pregnancy:

Taking into account the fact that 75 % of obese women develop the condition from the age of 14 on, and that only a small number of women begin to suffer from obesity after 40, we will understand that child-bearing age, and therefore, pregnancy and the rearing of children represent important risk factors in the genesis of their obesity.

In the majority of cases, the problem lies in the peculiarity of the condition. During the gestation period an excess of weight accumulates and is not shed after the pregnancy, accumulating considerably in multipara who have gone through consecutive pregnancies.

The change of life caused by pregnancy and breast-feeding is normally accompanied by a drop in exercise, as well as the fact that the woman becomes more “tied” to the home as a result of her new and peculiar condition, which unconsciously contributes even more to a caloric increase in the diet. If we do not impress upon our pregnant patients of the risk involved, both motives may turn out to be responsible for an uncontrolled weight increase.

There is a concept that is universally accepted by the medical community which holds that the pregnant woman must not “eat for two”. Indeed, the only energetic supplement that is normally recommended is equivalent to an increase of 250 cc more of the daily intake of milk. This minimal supplement is more than sufficient to cover the added caloric needs provoked by the pregnancy, and any further supplementary food may give rise to an ill advised increase in weight. The interest that gynaecologists have in maintaining the total increase in weight during pregnancy at somewhere between 9 kg. and 12 kg. is specifically motivated by the fact such a weight can be lost by the woman, with a normal confinement, after giving birth.

Obesity before pregnancy and the excessive increase of weight during the same are linked to a series of pathologies that, to a greater or lesser extent, surface in these cases: high blood pressure, preeclampsia, eclampsia. This, without taking into account the risk of death, diabetes, pielonephritis, and of difficult deliveries for extremely obese people.

We must not forget that numerous studies have been carried out confirming the fact that obese mothers beget obese children.

Obesity in infancy:

It is estimated that approximately 10% of boys and 15% of girls are obese. Regardless of the aforementioned, and the fact that the obese child can become an obese adult and the problems that this brings with it, the big problem is that although obese children are apparently taller, the definitive height of obese children not only fails to exceed, but is normally lower, than that of the children with normal weights.

It is very advisable that children suffering from obesity lose weight, given that problems may arise which will inhibit their normal development, not only in the psycho-emotional sphere, with the classic “fat boy” put downs and insults, but also with respect to respiratory and orthopaedic problems, as a result of the fact that obese children are more prone to such disorders.

TREATING OBESITY

WHY SHOULD IT BE TREATED?

In the first case, there is a reason that needs to be carefully “weighed”. In my experience, as well as in that of a large number of fellow doctors who have been consulted, after many years of work in a diet clinic, we can safely say that no one likes being obese. Therefore, the first benefit to be gained will be of a psychological nature. We can focus on the problem in whatever way we wish, but the gaining of self-esteem, security in oneself, social acceptance, etc. is very important when it comes to encouraging someone, and motivating oneself, to achieve the desired loss of weight.

On the other hand, there is little doubt that the most important gain will be the benefits obtained in the obese person’s health. The loss of weight is accompanied by an obvious gain in both the quality and the amount of life. Obese people who lose weight reduce their possibility of suffering from diabetes, high blood pressure, osteoparthritis, hepatic-biliary diseases etc., in addition to improving their physical tolerance to exercise and avoiding complications when it comes to surgical interventions, in those cases where the latter may be required.

The aim of the treatment would be to try to achieve the ideal theoretical weight of the patient. Nevertheless, although this may seem to be so simple in theory, in many cases, can turn out to be an impossible endeavour. I am happy with, and encourage my patients to obtain, a weight, which although it may not coincide with the one deemed to be ideal by the anthropometric ideal, but which is, nonetheless, aesthetically acceptable, and within the what we might call “non-risk” range for their health, and what is even more important, one which can be maintained without the need to be tormenting themselves, dietetically speaking, every day.

First off, however, I like to make things as clear as possible to all the optimistic candidates about to embark on a dietetic treatment for their obesity. In this sense, I try to impress upon them the fact that, whether we like it or not, obesity is a chronic illness, and that it is extremely important that everyone understand this. Obesity is a life-long disease, and therefore, the obese person will have to either fight to lose excess weight, or fight to try to maintain the weight that he or she has managed to lose, throughout the course of their lives.

Unfortunately, there is no magic formula to enable us to “change the metabolism” of a person. This concept is an outright LIE. And it is quite shameful that even in our day and age, some people who claim to be health “professionals”, will use it to attract “clients” to their surgeries.

WHO SHOULD BE TREATED AND WHO MUST OVERSEE THE TREATMENT OF AN OBESE PERSON?

No, I am not joking when I ask this question. Any person who is either obese, or has an overweight problem should be treated. What I have just said may seem to be quite self-evident. The problem, and mothers know it only too well, is that quite often we come across many young girls, who for reasons of fashion, either go to dietetic centres of their own accord in order to lose a few kilo’s, the sad thing being that they are attended to, once again are we confronted with the insatiable lust for money, or they subject themselves, at their own risk, to completely senseless “diets”, which are harmful to their health, and what is more, a lot of time extremely frustrating, when the reality is that they are literally slim, and in no way suffering from any overweight.

What I am trying to do here is to call on that statically least common of senses, which we most inappropriately refer to as common sense. Great care should be taken with strange, incomplete, “weird”, aggressive diets, etc., which unfortunately are readily available in a wide range of easy-to-read publications, or which travel by hearsay and which claim apparently “miraculous” results. In general, such diets are extremely dangerous, and if we add to this the frustration that they eventually give rise to with the non-stop flow of deceptive publicity that the imperatives of slimness provokes in our youth, we should in no way be surprised at the amount of pathologies that we come across as a result of extreme thinness and anorexia.

In any case, there is no need to become alarmist. The loss of 3, 4 or 5 kg. in a healthy person should not lead to any complication, as long as they are genuinely superfluous, and if, aesthetically-speaking, they are going to make the person in question feel better about himself or herself. In this chapter, we will put forward several dietetic guidelines that can be used to meet these aims. We will also proffer some advice that modern Phytotherapy has revealed to us in order to help us to meet said aims and to solve frequent problems that may arise, and which are related to these few extra kilos.

The treatment of obesity as an established clinical fact is an entirely different matter. In this case, numerous factors combine which must be taken into account. Reference to these factors has been made in previous chapters. They consist of psychological, metabolic, endocrinal factors etc. which compel us, at the very least, to carry out a correct differential diagnosis and to propose a combined therapy in which a medical professional with wide experience in dietetic and nutritional matters is undoubtedly required, not to mention one with fitting knowledge of how to solve the problems arising from a continued diet and to solve the problems that the obesity is causing in the first place.

KEYS TO TREATMENT

Let us not beat about the bush. The basis of all obesity treatments is to be found in two compulsory principles:

a) Either we manage to help the obese patient to decrease his or her caloric intake (diet).

b) Or we see to it that his or her energetic consumption increases (exercise).

Or best of all, we manage to achieve both at the same time.

The keys to a serious treatment of obesity are based, therefore, on a multi-disciplinary method which combines the following three measures:

a) The choice of a diet with a lower caloric content than being followed at present, and one that suits the patient and is as pleasant and fun as possible, if any weight losing diet can be called fun, but one which, at least, is to the “taste of the consumer” and which will not give rise to such boredom that he or she will give it up.

b) To try to draw up a physical exercise program that fits in with the physical and psychological characteristics of each patient. I repeat, this does not imply Olympic training, nor should the patient feel “obliged” to do the exercise in question, which might turn out to be dangerous. There is nothing that patients who come for help to lose weight hate more, and I say this from experience, than the doctor practically obliging them to break speed and resistance records, both of a physical and morale nature, or that he or she “force” them into long and exhausting sessions of “back-breaking” gym work-outs, which to add salt to the wound, is nearly always replete with slim statuesque young ladies who go there to show off their figure.
We can begin by suggesting that the patient take, more or less, hour-long walks, in order to increase his or her energy consumption. Gradually, the patient’s cardio-respiratory function will improve, upon which we can propose a little more intense exercise.

c) Periodical monitoring of the treatment. This measure has several purposes. In the first place, it serves as a psychological back-up to the endeavour on which our patient is about to embark. We all know that one about, “we’ve got them on the run!” Well, that is more or less the spirit that must prevail among our patients. To play down the efforts, to highlight the successes, and basically always to have an alternative ready at hand in order to avoid the patient falling into a routine, becoming bored and giving up the treatment. A none too strict, calm approach is to be preferred when it comes to drawing up the diet. It should be one which will enable us to achieve a gradual, smooth and constant loss of weight. The stress of overly strict diets, although they may achieve big weight losses at the outset, usually end in failure for the patient on account of their severity.

A HYPOCALORIC DIET PLAN

BREAKFAST:

Choose from:

A cup of coffee with milk (skimmed or semi-skimmed is better) with saccharine being preferred to sugar.

A natural fruit juice and an infusion (tea, camomile tea, pennyroyal mint etc.)

DURING THE COURSE OF THE MORNING:

One or two “doses” of fruit.

I say “doses” and not “pieces” of fruit because a “dose” of fruit may be an apple, but a “dose” of fruit is also “half an apple”, you catch my meaning, don’t you?

If there are two or more doses of fruit to be taken, we will try to leave an hour between the first and second dose.

The following, listed in order of preference, are the most advisable fruits: Pineapple, kiwi, apple (unpeeled), pear, water melon, melon, peach, strawberries, plum, orange, etc.

DINNER:

FIRST COURSES: choose from:

- Leaf or stalk vegetable: borage, Swiss chard, spinach, celery, leek, thistle, artichoke, cabbage, cauliflower, Brussels sprouts, asparagus, green peas, etc.
In small portions and, it goes without saying, dressed with olive oil.

- Salad with garden produce: Lettuce, curly endive, chicory, asparagus, tomato, cucumber, gherkin, pepper, mushroom, carrot, onion, etc.
Also in small portions and dressed to taste (olive oil).

- Broth or creamed soup, light, degreased and natural (neither package nor stock cubed). No pasta. It can be made of vegetables, meat, poultry, fish or seafood.

SECOND COURSES: A “normal” dish, with a Fish, Seafood, Poultry or Meat basis. Avoid very fatty meats. Grill, oven or steam cooked, but they can also be stewed (with onion,, asparagus, carrot, etc.). Always without any flour and no bread.

WE DO NOT HAVE DESSERTS. We can have a coffee or infusion.

DURING THE COURSE OF THE AFTERNOON/EVENING:

I recommend having a dose of pineapple or kiwi.

SUPPER:

We can have a griddled egg, or an omelette made with asparagus, garlic, onion, courgette, mushroom, etc.

Or fish, poultry or meat, just as at dinner.

We can accompany the egg with vegetables, a salad or a soup.

We do not have desserts.

AN HOUR AFTER SUPPER:

I recommend having a dose of pineapple or kiwi.

It is very important to observe the number of mealtimes, or intake times, per day. Many studies have revealed that more weight is lost eating a little more often, that eating the same quantity per day, but concentrated in two larger intakes.

We always recommend drinking at least a litre and a half to two litres of water per day. This intake should preferably occur outside dinner and supper mealtimes.

HOW CAN WE HELP?:

We resort to phytocompounds and homeopathy given the fact that they provide us with the most valuable aid in facilitating the following of the diet that needs to be observed by our patients, what is more, they help increase the lipolytic effects of same, as well as helping to solve the problems that are either provoked by the obesity itself, or that might arise from a particular diet. Furthermore, these aids have the advantage of providing us with the security that we will not come up against any undesirable side effects, given the harmlessness of the products.

DIETETIC FIBRE:

In the first place, dietetic fibre is an essential complement to the diet. There are numerous statistical studies which show that the obesity index is directly related to a low fibre consumption diet. In our country, the problem of obesity has been seen to increase sharply as the population has given up on the Mediterranean diet (very rich in fibre) and has replaced it with low fibre manufactured foods.

But this is not all. There are many epidemiological studies that reveal the importance of dietetic fibre as a preventative measure against several diseases. The industrial influence on our eating habits in developed countries brought with it the abuse of refined food consumption, and thus, a fall in the fibre content in our diet. Consequently, there has been an increase in a large number of diseases we consider to be proper to industrialised countries, and which on the contrary, are extremely rare in other areas of the globe, poorer areas, shall we say, but areas where there is a much higher rate of fibre consumption in the diet. These pathologies, in addition to obesity, are as follows: Constipation, Appendicitis, Hiatus Hernia, Intestinal diverticulosis, Colon cancer, Haemorrhoids, Varices, Biliary lithiasis, Atheromatosis, Ischemic cardiopathy and Adult diabetes. All of the aforementioned, as we can readily see, are extremely serious.

Dietetic fibres are a group of large molecules, formed by polysaccharides, which have a common origin, namely the vegetable kingdom, and which cannot be digested by the digestive enzymes in our body. Consequently, they are not assimilated and do not represent any caloric addition.

THE EFFECTS OF DIETETIC FIBRE ON OBESITY:

As far as the loss of weight is concerned, fibre acts and helps us in the following ways:

a) The so-called Trapping effect, which consists of the metabolism offloading the fats towards lipolysis, as a result of the decrease of the intestinal absorption of glucose and the consequent insulin response.

b) Fibre is extremely hydrophilic, that is to say, it is very fond of water, by means of which it dilutes many of the foods, thus reducing the caloric absorption capacity.

c) Satiating effect, on increasing the sensation of gastric fullness, it decreases the appetite and shortens the satiety time. Patients become “full” quicker.

d) Fibre decreases the intestinal absorption of lipids, especially that of cholesterol, which means that it also reduces the caloric absorption of the diet.

e) It considerably increases the faecal discharging of matter, with a large amount of food waste being diluted in same, thus indirectly decreasing the caloric absorption of said food.

We have a series of products based on dietetic fibre which, to a great extent, enable us to achieve our aim of losing weight. I normally make use of these products. Given that each one has specific characteristics, I provide a summary of them below:

If we are seeking a large amount of fibre, with great satiating power, a large intestinal uptake and slightly anti-dyspeptic in character, I normally recommend the taking of METABOL. This also contains artichoke, which apart from being choleretic and cholagogic, it is a good anti-oedematous agent. The normal dose is two capsules, more or less, one hour before dinner and before supper, accompanied by lots of water. I always recommend that a small fruit be taken at the same time. In some cases, I increase the dose and recommend a capsule halfway through the morning and another halfway through the afternoon, also to be taken with water and fruit.

If we wish to reinforce the metabolic effect with more lipolytic compounds and fatty mobilisers, I use ADELPLUS, which apart from containing a higher fibre content, contributes a series of acknowledged lipolytic and coenzymatic effects. The recommended dose is the same as the aforementioned product, once again to be taken with plenty of water and some fruit.

We know, as we have already commented above, that obesity rarely surfaces “alone”. There are numerous pathologies that accompany the problem of excess weight, or in cases where they are not already established pathologies, very frequent, typical symptomatologies appear that are responsible for a sharp drop in the quality of life of our patients. The loss of weight will probably improve the situation quite a lot, but there is no doubt that if at the beginning we manage to achieve a clinical improvement in these unpleasant discomforts we are going to gain the confidence of the patient, given that even a small initial loss will produce an evident clinical improvement. On the other hand, our obligation is always to solve what we know, thanks to our knowledge, to be the risk for the patient that we are treating, even though a lot of the time the patient himself or herself is not aware of this. Given that we also have a therapeutic arsenal based on phytocompounds, which are completely harmless when taken in the recommended doses, and which guarantee to avoid us from having to confront side effects, in addition to being extraordinarily effective, I believe that we possess all the guarantees needed for a successful treatment, and that our patients will reap the benefits.

The symptomatology and pathologies that I most often come across in obese patients are listed below, as are the treatments that I normally use to combat them:

HEPATIC – BILIARY SYNDROMES:

Dyspeptic pathology is an extremely frequent problem in obese patients. They generally have prominent abdomens, and are the typically obese patients that also present severe, slow digestive problems, with a strong feeling of fullness after having eaten, abdominal inflammation, a lot of gases and difficulty in letting them off, etc. If we are dealing with women, they tend to suffer from nauseous crises and vomiting, very often of the bilious and bitter type, which are accompanied by general discomfort and strong headaches, along with a continuous feeling of “giddiness” and “empty-headedness”. They may also suffer from constipation, but they practically always have some diarrhoeic discharge of white or yellow-coloured stools, thus improving their symptomatology. We are undoubtedly speaking here of a hepatic – biliary pathology in which various processes may combine at the same time which are responsible for this whole symptomatic retinue. On the one hand, the typical fatty liver of large obese patients, and on the other hand, that which we refer to as biliary dyskinesia, quite often accompanied by biliary lithiasis on account of the great dietetic disorders and transgressions. We have a product which will solve this symptomatology in an extraordinary fashion, completely reducing the digestive problem and which our patients are going to take quite willingly, given that they will immediately note its beneficial effects, it is called BHIOERBA – 1 - HB . It is composed of choleretic and cholagogic elements, hepatic correctors, carminatives, dyskinetic agents etc. all of which will contribute to solving the hepatic and biliary pathology. How many wrongly diagnosed “headaches” and “migraines” have we cured in patients suffering from intense headaches by normalising their hepatic and biliary operation!

The dosage to be taken is normally one large tablespoonful (10 cc) after each of the three main daily meals.

VARICES:

The varicose syndrome is another problem frequently found in the female population, and one which becomes more acute with obesity. In fact, many patients come to our surgery as a result of the symptomatology caused by varices, and which they put down to the excess of weight. Drowsiness, tiredness, pain, itchiness etc. form part of the symptomatic make-up of the varicose process; symptoms which also become more acute with the overweight.

We know that the varicose pathology is evolutionary and chronic in character. A reduction in weight plays an essential part when it comes to proposing a treatment, but it is extremely important to stop the evolution of the process, given that it can give rise to extremely dangerous complications for the health and safety of our patients. Our work is not only symptomatic, but must also be preventative when it comes to treating said complications (phlebitis, thrombophlebitis, varicose ulcer etc.). Phytotherapy provides a series of active principles contained in some plants that solve the varicose problem for us and also provide vascular protection which will avoid the natural evolution of this disease. I recommend VACIRTON. It contains all of the active principles derived from the medicinal plants that are effective in treating return circulatory insufficiency and vitamin assimilation cofactors. It comes in the form of drinkable vials, and by taking one each day we can solve the entire symptomatology, as well as putting a stop to the evolution of the varicose process.

OEDEMAS:

Either accompanying the varicose syndrome, or as a clinical entity proper, or surfacing in the days before menstruation, the edematisation sensation, above all in the legs, is extremely frequent among the female population, and even more so in those who are overweight. In some patients, it manifests itself clinically and objectively in a continuous fashion in the form of cellulitic puffing and accumulations throughout the lower extremities. In other patients, it simply manifests itself as a serious feeling of “liquid retention” accompanied by drowsiness and tiredness in the legs. Above all, it is a big problem in those whose jobs require them to be on their feet for protracted period of times without moving about. All coincide in the discomfort of that strange sensation of “inflammation” in the legs and reveal that there is an alteration to the drainage and lymphatic systems that give rise to a decrease of the return of liquids. Whether or not it is merely an aesthetic pathology (cellulitis), the phytotherapeutic agents that go to make up the product that was referred to in the chapter on cellulitis, namely, BHIOERBA – 3 – LD, act as lymphokinetic agents, anti-oedematous agents and protectors of the microcirculation. They are, as we have already commented, the chosen treatment for the cellulitic problem, but also when the symptom is operational and manifests itself as its own clinical symptom.

I recommend the taking of three tablespoonfuls during the course of the day, either straight, or dissolved in a glass of water, continuously in the most serious cases, or only during the days prior to menstruation, in those in whom the symptomatology becomes evident, as a treatment of the discomfort typical of those days.

ANEMIAS – TIREDNESS (ASTHENIA).

Albeit a big mistake, we are used to mentally associating anaemia with extreme thinness, and this is not entirely true. Quite often we come across female patients who, apart from suffering from a serious level of obesity, present a typical symptomatology of tiredness and general exhaustion, which they put down to their excessive weight. Nevertheless, when we carry out a simple analysis we are surprised to find an important deficit in their iron reserves, accompanied, or not, as the case may be, by a deficit of red globules or haemoglobin. These are the frequent anaemias caused by more or less abundant periods, which have given rise to small but continuous losses of iron, and which along with dietetic disorders, finally end up by manifesting themselves with an important symptomatology. Obviously, we cannot propose a dietetic treatment aimed at losing weight without addressing this problem at the same time, given that we could make it a lot worse, and in the end the patient would either be forced to give up the diet or we would find ourselves needing to take more urgent measures. We need to quickly improve the iron reserve level, as well as the clinical condition, managing to achieve the desired weight loss, but, at the same time, making sure that the patient feels strong and “energetic”. The only way to do this is by supplying the body with iron and with the assimilation cofactors of this iron, which will serve to guarantee a filling-up of the reserves, as quickly and effectively as possible. I systematically use BHIOERBA – 2 - FF , a syrup with a base of Organic iron, Hibiscus, Alhova, Rosehip, Beetroot and Gooseberry, along with all the vitamins and assimilation cofactors of this iron, which condition the great absorption speed and benefits of the iron that is supplied. It has no side effects, and is perfectly accepted by the digestive system. Moreover, the speed with which patients begin to recover their “vital tone” is widely acknowledged. I recommend the taking of one large tablespoonful. (10 cc) per day, preferably in the morning, and accompanied with an orange juice.

What is more, I always recommend that the patients who suffer from copious periods, as soon as their iron deposits have stabilised, whether they are losing weight or not, have BHIOERBA – 2 – FF ready at hand, keeping it in the refrigerator, in order to be able to take it only over the days they are having their periods. By means of this simple measure, we avoid imbalances in their ferric metabolism, which so often gives rise to the menstrual losses, and much of the weakening that these may provoke.

MENOPAUSE:

We define menopause as the permanent cessation of menstruations that is the result of the loss of ovarian follicular activity. Menopause can occur spontaneously, appearing in the majority of women between the ages of 45 to 52, or surgically, when the ovaries are removed for a particular reason.

The term perimenopause or climacterium refers to the period before the appearance of the menopause, and at least one year after the appearance of same.

We find ourselves at a stage of a woman’s life which, although we should always consider it to be “normal” and physiological, is undoubtedly accompanied by a series of special meanings due to the varied and multisystemic symptomatology that it can provoke.

The classic symptomatology of menopause can be superficially classified by systems in accordance with the following scheme:

a) Vasomotorial alterations, which will include the classic hot flushes, profuse perspiration, mainly at night, sometimes accompanied by palpitations and a feeling of anxiety.

b) Psychological alterations, mainly anxiety, nervousness, irritability, and a strong sensation of tiredness, both physical and mental, quite often accompanied by sadness and a tendency to depression. Quite often, there is a serious loss of libido or sexual appetite and sleep disorders, frequent awakening, difficulties in getting to sleep and sometimes insomnia.

c) Genitourinary alterations: atrophy of the urethral mucus, and in general of all the estrogen-dependent genital system, reduction in the secretion of cervical mucus, and possibly, the most uncomfortable of all, the atrophying of the vaginal mucus, which implies pain and even bleeding during coitus. Or simply itching, burning sensation, etc.

d) Skin alterations. The skin experiences a gradual thinning and atrophy, the collagen degenerates and an ageing, dryness and wrinkled aspect appears.

e) Osteoporosis, or what is just the same, the loss of bone mass. The problem is that no normally no symptom is produced, until it is gradually increasing and bone fractures appear. Unfortunately, in these cases the therapies must be extremely aggressive, thus it seems quite clear that the best way of avoiding the situation is preventing it happening. And there is no doubt whatsoever that obese patients, who are going through the menopause, are much more open to the risks of suffering from these bone fractures.

f) Cardiovascular alterations. Basically, the alterations due to the increase of LDL cholesterol (extremely atherogenic) and the fall in HDL cholesterol or “good cholesterol”. This gives rise to an increase in the risk of atheromatosis and, therefore, to the possibility of suffering from cardiovascular faints (angina pectoris or heart attack). No more needs to be said when we are reminded of the fact that, in those under 40 years of age, the frequency of suffering an acute heart attack is 30 times greater in the male than in the female, nevertheless, after 50, this difference has completely disappeared.

If added to this wholly discouraging panorama, we find ourselves having to tackle the added problem of obesity, we will surely understand that either we facilitate or improve the situation, or our prospects of success with our patient will drop considerably.

As standard procedure in these cases, I recommend a phytocompound, which in addition to being the most complete one with respect to antioxidants and free antiradicals, consequently, acting quite amazingly as an anti-ageing agent, provides Eleutherococci, which acts as an adaptogen, an anti-asthenic and an anti-stress agent. It contains Onagra, which provides a polyinsaturate fatty acid that functions very well on skin and mucus, Calcium and Boron, avoiding bone losses and providing calcium, a little iron, minerals and vitamins. The product is called BORONAGRA and the normal dosage is two tablets and breakfast and one at dinner.

Several studies that have been carried out on the Asiatic female population at the menopausal age reveal that the consumption of soya-derived products, especially isoflavones, cause a significant reduction in menopausal symptoms as compared to western women from the same group.
Comparing the western diet with the oriental one revealed that the former contains to the order of 5 Mg. / per day of Isoflavones, as compared to 40-50 Mg. of the Asiatic countries, or the 200 Mg. /per day in Japan.

Onagra oil is a dietetic complement, rich in essential fatty acids, especially linolein. The essential fatty acids are needed by the body, without this having the capacity to synthesise them, thus they have to be taken externally by means of the diet.

Vitamin E, in addition to acting as an antioxidant “per se”, prevents rancidity by means of the peroxidation of the essential fatty acids contained in the Onagra Oil.

Whenever my menopausal patients have a big problem with hot flushes, and vasomotorial alterations, I resort to soya isoflavones and onagra oil, a basic composition of a product called CLIMASIM, which provides them with an excellent quality of life a result of the reduction achieved in these terribly unpleasant symptoms, and which what is more, does not possess any contraindication. Another advantage of these products is that just one capsule a day provides all the recommended soya isoflavones.

SKIN, HAIR AND NAILS

There is nothing strange in the fact that the periodical check-ups carried out on our patients undergoing a dietetic treatment for obesity, reveal symptoms such as dryness of the skin, increasing hair loss, nail fragility, leaving them more prone to breaking, flaking of the skin, etc. These are symptoms that we must not underestimate, given that, although they do not “obviously” endanger the life of the patient, on the one hand it is an aesthetic problem which can be avoided, but on the other hand, and I deem this to be more important, we are being clearly told that we are facing a deficiency, either of vitamins or minerals, which if we allow to evolve, might give rise to more serious consequences. This could be caused by the fact that the diet is not as complete as it should be. Perhaps, and this is the most likely reason, the problem already existed, and on losing weight it manifested itself with greater virulence.

The first thing to discard is an anaemia, given that deficiency symptoms of this type are normally the first to surface. If this is the case, we have already learned how to solve it with the phytocompounds that have been mentioned above. If there is no anaemic component, we will check to see whether the diet is excessive and does not contain the recommended amount of polyunsaturated fatty acids (olive oil, onagra oil). Whatever the case, a vitamin – mineral supplement, specifically for the skin, nails and hair, will quickly solve the problem for us, and the patient will be aesthetically satisfied. As we have already mentioned, BORONAGRA is especially indicated in these cases.

We have a complement to treat cases of this type in which, as a result of the hormonal alterations peculiar to the menopausal condition, the skin becomes altered with clear signs of cutaneous ageing. CLIMASIM - Cream is an anti-ageing cosmetic, highly moisturising and nutritive, which prevents facial and neck skin density loss. It provides stretching and toning for the face, reducing sagging and preventing the appearance ageing and relaxation signs.

Its components, Soya isoflavones, Black cohosh, Rosehip oil, Glycolic acid, Regenerating vitamins A and E, as well as incorporating factor 12 solar protection, grant it regenerative, antioxidant, nutritional, anti-wrinkling and moisturising properties.

The soya isoflavones and the rosehip act by stimulating cellular renovation, increasing the concentration of collagen and elastin protecting the skin from degradation and combating ageing provoked by the fall in hormonal activity as a result of its “estrogen-like” action.

ANXIETY SYNDROME OR LIGHT DEPRESSION:

The fact that obese patients present some degree of emotional instability is something that we can verify in our surgeries every day. On the one hand, the lack of aesthetic acceptance of themselves, added to socio-cultural pressures, and why hide it, the negligible acceptance in many cases by their social setting, gives rise to behavioural vicious circles, which in the majority of cases end up making the overweight problem even worse. Both the obese young girl, with the specific factors associated with this group, as well as the obese woman with her own peculiarities, so often faced with the lack of affection, fall into the trap of easy food, and on many occasions, the compulsive food self-compensation trap, in order to make up for such an unpleasant fact, thus later creating a feeling of self-blame, which brings with it the most serious breakdown in morale, and the further search for another culinary compensation, with which we close the aforementioned circle, worsening the problem of obesity and creating a state of permanent anxiety, or a light depressive process, which is certainly not the most advisable manner of facing up to a decisive dietetic approach.

Whenever I suspect such a condition, I resort to a plant that provides my patients with the necessary mental stability in order enable them to follow the treatment which I propose for them, in both an optimistic and effective fashion. The product I use is called Hypericum Perforatum. It has a long tradition of use in Traditional Medicine, given its numerous medicinal virtues, and we know that in ancient Greece it was administered to treat several processes, among which, we find insomnia, nervousness and depression.

At present, thanks to the numerous clinical studies that have been carried out, the therapeutic qualities of which have been proved, along with their action mechanisms, the medicine referred to above is being increasingly used with greater regularity in the treatment of anxious and depressive processes, as an alternative to conventional anti-depressants as a result of the fact that it is practically void of any side effects, and of the excellent results that it produces.

The most important active components of this plant are the hypericins and pseudo-hypericins, given that in studies on in-vitro receptors and enzymatic tests their affinity with NMDA receptors has been revealed. Nevertheless, during the course of the aforementioned tests, evidence suggests that it is the “Totum” of the plant, mainly the flavonoids and coumarins that it contains, which possess an important receptor affinity with adenosine, GABAA, GABAB, benzodiazepine, inositol – triphosphate, and monoamine oxidase (MAO) A and B.

The capacity to inhibit the synaptic uptake of serotonin, dopamine and norepinephrine has been revealed by other tests, reducing the beta receptors and increasing the 5-HT-2 receptors in the frontal cortical neurons. Consequently, we might conclude that the hyperic action biochemical mechanism can be likened to that of other anti-depressants, such as, for example, tricyclic anti-depressants.

I use a preparation based on a Hyperic extract known as DISTONICUM, standardised to total hypercin content of 0.45%. The normal dose ranges from between two or three capsules a day. It is recommended that the dosage be taken always at the same time of the day. It has, in addition to the excellent results achieved, a series of tremendous advantages with respect to other commonly prescribed anxiolytics or anti-depressants: it does not produce addiction; it exercises no influence on the sympathetic and parasympathetic nervous system; it does not provoke constipation, or dryness in the mouth, nor does it give rise to urine retention. It does not cause any decrease of the libido. It does not interact with alcohol, nor does it interact with any foodstuff. It does not affect the patient’s capacity to drive or to handle machinery etc., thus the patient is perfectly willing to accept its use, given the fact that he or she will quickly become aware of an improvement in their humour, and a drop in their moments of sadness and low spirits, as well as being able to sleep better and feeling more relaxed and “in control”.

OSTEOPARTHRITIS

We have commented in previous chapters the frequent association of obesity with osteoparthritis, mainly with respect to the lower extremities, such as the knee, hip and ankles. In fact, very few obese people, who do not tackle their problem of overweight, manage to avoid suffering from a degenerative osteoparthritic rheumatic disease.

Clearly, the first measure to be taken to combat osteoparthritis in the obese person is the loss of weight. Nevertheless, we find that on many occasions these patients have focused on their osteoparthritic problem without concerning themselves with losing weight. We frequently come across obese patients who have spent a long time taking anti-inflammatories orally, giving rise in some cases to serious digestive upsets, and apart from the fact that their problem has not been solved, they find themselves having to resort to taking corticoids, which worsen the digestive problem and even make them gain weight. On top of this, they normally have snacks between meal times, quite often cakes and products which are rich in fats and hydrates in order to calm the stomach upsets, thus the weight gain become a cause for despair.

What has to be done in these cases? The most important thing is to propose a diet in which the food is distributed into a lot of small intakes, basically fruit, (avoiding the acid fruits: oranges, grapefruit, etc.). This will enable a reduction in gastric hyperacidity or heartburn and at least a cessation of these discomforts, while at the same time we are introducing a very depurative diet. The second thing to be done is to try non-aggressive therapeutic measures in order to give rise to, apart from a loss of weight, an improvement in the quality of life, which the rheumatic problem has been denying the patient. These measures will depend on the moment at which we catch the disease.

If the patient comes to our surgery at a crucial point in the osteoparthritic pathology, and is suffering from great pain, inflammation, oedema, muscular contraction and functional impotence, the most important thing is to relieve these discomforts without giving rise to any undesirable side effects. In cases of this nature I resort to a phytotherapeutic preparation which combines anti-rheumatic therapeutic properties to tackle these symptoms, with excellent anti-inflammatory, contraction relaxing, anti-oedematous, analgesic, depurative and re-mineralising agents. It is called CONDRORAL, and provides a large amount of oligoelements, aminoacids, vitamins and I consider it to be the most complete and comfortable anti-rheumatic to take. In addition, it does not provoke any of the undesirable side effects of classic analgesics and anti-inflammatories. It comes in drinkable vials. A dosage of one or two vials per day will produce noticeable improvements in the condition being treated.

In practically all cases, I complement the action of the phytocompound with a homeopathic product called CONDRODISTROFIN, which is made up of homeopathic dilutions of Formic acid, Rhus Toxicodendrum, Bryonia, Arnica, Spirea Ulmaria, Cartilage Suis and Aconitum. This covers a wide range of anti-rheumatic action and does not provoke any undesirable side effects. I normally administer it once a week mesotherapeutically, and I recommend the taking of an ampoule orally, placing it under the tongue, twice a week before breakfast.

If the pathology affects an accessible joint (knees, elbows, ankles, back, etc.) I still like to round off the treatment with a topical anti-rheumatic medicine. I use CONDROGEL, which is also a phytocompound, but with maximum penetration powers. It is made from a base of Devil’s claw, Aloe Vera, Arnica, Marigold, Cosuelda, Daisy, Cinnamon, Cayeput, Eucalyptus, Clove, Tepezcohuite and Trementina which provide a vasodilation that enables an increase in the penetration of the active principles. It produces an immediate analgesic affect on the affected joint and a lasting anti-inflammatory effect, as well as great relaxation in the contracted musculature. I recommend that the patient apply it twice a day, while at the same time gently massaging around the joint in question. Overnight occlusive treatments work very well. It is applied with a certain amount of CONDROGEL on the affected joint and is covered with a cloth or not too tight bandage overnight.

If, however, we are not faced with a crucial stage of the osteoparthritic pathology, we must not forget that the disease inexorably advances giving rise to the degeneration of the intra-articular hyaline cartilage and an alteration of the bone, which in extreme circumstances could get to the stage of making the joint in question useless. Overweight is one of the most important factors to affect the evolution of osteoparthritis, thus its reduction must be treated as a priority. We must and can act, decreasing as far as possible the advancement of the disease by adding the nutrients that go to make up the basic and structural substance of the damaged cartilage to the diet (collagen, Hyaluronic acid, Proteoglycans, etc.), while on the other hand adding minerals and oligoelements that are essential to avoiding the rarefaction and loss of bone mass. It plays, therefore, a restraining function with respect to the degenerative advance of the disease, reinforcing the damaged structures as far as possible. I recommend CONDROVIT – Ca, which contains Chondroitin sulphate, Glucosamin, Ferrous citrate, Sodium fluoride, Sodium selenite, Manganese gluconate, Copper – gold – silver, DL – Phenylalanine, L – Tyrosine, Vitamins C, D, E, B-1, B-2, B-6 and B-12, Beta-carotene, Cobalt gluconate, Citric acid, Magnesium stearate. That is to say, as we can see, all of the bone and cartilage structural materials, along with all the assimilation cofactors which make their complete integration into the damaged structures possible. I normally recommend the taking of two capsules per day, but always stressing the face, that they will have to be taken for a long time.

HOMEOPATHIC LIPOLYTIC AGENTS:

I systematically use Lipolytic Homeopathy in all obesity treatments. In the first place, because it gives rise to no undesirable side effects or contraindications, secondly, because it presents neither addiction or habit forming characteristics, nor does it have any rebound effects. Moreover, I have a complement that truly meets are the requirements of harmlessness, on the one hand, and effectiveness on the other. The format I use comes in 2 ml. ampoules, which can also be injected, thus enabling me to administer them mesotherapeutically in localised obesities, or when there is a specific interest in forcing the loss of weight more in one part of the body than another in order to achieve a more aesthetic proportion. It is called METABOLITES, and its composition (Graphites, Levothyroxine, Fucus, AMP-c, ATP, and Tiratricol in homeopathised dilutions) enables me to act, on the one hand, on the constitutional tendency to adiposis, and on the other hand, at an intra-adipocyte level it blocks the phosphodiesterase which are enzymes that inhibit lipolysis, thus we favour the transformation of the triglycerides (fats) into their metabolites (Fatty acids and Glycerol), that is to say fatty combustion.

I normally recommend the taking of two or three ampoules per week, always before breakfast and dissolved in a little water. If possible, it should be held for a few seconds in the mouth in order to favour its sublingual absorption.

To further the comfort of my patients, and with the same results as with METABOLITES, I normally use a new product called TURMALIN given its lipolytic and draining effect, which brings together the homeopathic pharmacopoeia tradition with the therapeutic effects of the oligoelements. Its base of action is similar, as we have said, to that of METABOLITES, as are its therapeutic effects. It is, however, quite novel on account of the fact of its draining effect and the ease with which it can be taken, given that it comes in drops, thus avoiding the bother which, for some people, the breaking of the ampoules may represent, etc. It dosage is very simple, namely, 60 drops dissolved in a finger of water, every day immediately after getting up.

DYSLIPIDEMIA:

The increase of triglycerides in the blood is a direct result of obesity. We know that this is one of the most common factors found in obese patients that have suffered an ischemic cardiopathy. There is no doubt whatsoever that the weight reduction diet constitutes the best manner of reducing the amount of triglycerides in the blood. Dietetic fibre is the best therapeutic aid that can be employed in these obese patients. We have commented above on the fatty molecule uptake effect that it implies at the intestinal level.

In Hypercholesterolemia, we must assess the real distribution that exists with respect to the various cholesterol fractions. If we focus exclusively on the practical terrain, the purpose of every cholesterol alteration treatment is basically concerned with reducing the total cholesterol figures, at the expense of reducing the LDL cholesterol figures, which is the atherogenic, responsible for the depositing of fat on the arterial endothelium, and the increase of the HDL cholesterol figures, which is exactly the one that avoids the depositing of such fats.

The diet is our greatest ally; plenty of fruit and fibre in multiple small intakes, maximum reduction of polyunsaturate fats (butters, animal fats, etc.), an increase in the amount of polyinsaturate fats (basically olive oil and blue fish). In order to specifically increase the HDL cholesterol, the best therapy is continuous moderate exercise, walks, cycling, etc. In addition, Phytotherapy offers us excellent help through active principles derived from plants that we know to have a clearly “hypercholesterolising” effect, as well as being protective of the arterial endothelium. Pine, Rosemary, Shii – Ta – Ke, Soya Lecith, Lemon possess these properties. I recommend the taking of a product based on these components called BETACOLESTERON. By taking a teaspoonful dissolved in a little water, 30 minutes after dinner and supper, we greatly contribute to normalising the different cholesterol figures.

PREGNANT OBESE WOMAN:

It is very important to make clear the fact that pregnancy must not be considered to be a period in which it is not possible to keep up an obesity treatment for the mother. The energy requirements of the foetus, which are to the order of approximately 200 Kcal. per day, can be perfectly supplied by the mother’s fat reserves, and even more so if the latter are excessive. Moreover, it has been perfectly demonstrated that a dietetic reduction in the obese mother in no way whatsoever alters the normal development of the future baby. Furthermore, we must keep in mind the fact that we are, in this way, preventing a future obesity both in the mother, as well as in her child.

It goes without saying that we are not proposing a strict or extreme diet for the expectant mother, quite the contrary, we are suggesting a balanced, healthy diet containing all the nutrients required for the normal evolution of her condition, and one which is perfectly supplemented with calcium, iron and high quality biological proteins (meat, liver, milk, cheese, etc.), which does not only prevent her from gaining any weight, but quite prudently, even aids her in loosing some of those unwanted kilos.

There is nothing strange in coming across expectant mothers experiencing periods of pregnancy characterised either by an increase in appetite, or being subject to a series of “whims”, which in the majority of cases simply reveal a rather special state of mind. Satisfying these moments with fruit is not the same as doing so with unhealthy biscuits, chocolate or cakes. The therapist plays a fundamental role here in channelling these desires and offering valid, dietetically correct alternatives for the patient, in order that she can deal with these “special” moments successfully, while at the same time achieving the proposed goals.

Apart from that, I insist that there are no reasons whatsoever for any excessively special treatment, simply a healthy and balanced diet, calcium and iron supplements, plenty of proteins, and above all, taking peaceful strolls every day, and not falling into the temptation, in those moments of psychological weakness, of consuming food that can only be classified as far from healthy.

THE BREASTFEEDING OBESE WOMAN:

Our approach will be somewhat different during this period. The caloric needs of the mother are to a large extent increased during pregnancy, and there no scientific reasons that point to any benefits to be gained by a caloric reduction during the breastfeeding period.

There are concepts, however, that need to be clarified. During the breastfeeding period, the body suffers certain adjustments that require a greater provision of energy, which is linked to the production of the mother’s milk. The old adage that refers to “eating for two” during the pregnancy could not be further from the truth. Notwithstanding, it is perfectly justifiable with respect to the breastfeeding period. The breastfeeder’s diet must be perfectly adjusted, balanced and supplemented in nutrients, basically calcium and high quality biological proteins, in addition to vitamins and other minerals, glucides and lipids in order to meet the metabolic needs of a body, which during this period is literally wholly given over to the supplying of energy to the mammary glands to aid in the production and secretion of milk.

This does not mean that during breastfeeding, they must of necessity gain weight uncontrollably, however, neither does it mean that she has to subordinate her aesthetic aspirations to the health and affective gains that breastfeeding supposes for her children. I think that there is time enough after this “delicate” period to adjust the mother’s diet, and with the help of physical exercise, to recover that “figure” that might have been lost during this period . It is a question of priorities.

As you can see, my criterion during the breastfeeding period is of the most conservative nature. I always wait for it to end, and then I act with all of the dietetic corrections and supplements that may be required, but throughout the breastfeeding period I simply bide my time.

THE OBESE CHILD:

Let me clarify some things from the outset. Before starting out on a severe dietetic treatment on a child aimed at losing weight, we must be completely assured that the diagnosis of obesity and overweight in this young person is correct. The pointers that merely take into account height and weight do not suffice in this case. The definition of obesity in this period must be based on measurements of the skin folds, or on any other more scientific and accurate method (impedance). Such measurements, not to mention the diagnosis, must be made by specialists. Children grow with great speed, and we cannot foresee whether or not the weight / height standards will stabilise when the child simply “takes a stretch”, thus avoiding the possible psychological trauma of having to undergo an unnecessary diet .

It is not a good idea to subject children to unreasonable dietetic restrictions just out of a desire to solve a tendency to fatness. We are fed up with seeing overweight children resisting the stress to which the warnings and fears of their parents subject them to because they do not want their children to be “fat”. The conflicts and feelings of guilt suffered by these children can lead to alterations in the development of their personality, to such an extent that said conflicts will be genuinely responsible for their future obesity.

From the energetic standpoint, the basic nutrients must not be lacking in the child’s diet: cereals, vegetables, etc. It is a good idea to redirect their tastes in the direction of accepting meet and fish, both white and blue, given the fact that they contain highly valuable proteins, such as iodine. We will supplement their diet with large amounts of dairy products: milk, yoghurt, fresh cheese, etc. given that these will provide the calcium needed for their normal growth. We will get them to eat plenty of fruit for its vitamin, fibre and mineral content, and we will use it as a fall-back for something to eat between meals, thus taking the utmost advantage of its absorption capacity, and as a snack. We cannot deprive them of potatoes, pastas and bread, although we must try to moderate their consumption of same. Basically, we should try to make their diet, as far as possible, as varied, rich and tasty as it can be for them.

It is quite another thing to try and educate the child with respect to the quality of food that he or she eats, and to try and explain that the eating of certain foodstuffs is harmful to their health on account of their fat content, instead of focusing the argument on the fact that such foodstuffs lead to fatness. There is no logic behind the amount of cakes, fried foods, sauces and sugared soft-drinks, etc. with which the children are constantly bombarded by means of advertising and publicity, which can, should the child become addicted to such items, become responsible for his or her overweight.

To sum up, education about the different tastes and qualities of various foodstuffs, the search for the acceptance or approval of these by the children, a varied and fun diet, which is complete and sufficient to aid in their normal development and growth, plenty of fruit between hours to satisfy their appetite, and restrictions with respect to “junk” food, as well as their acceptance that these represent a danger to their health, instead of representing such foodstuffs as prohibition and reproach for their overweight, all contribute to the most effective manner of tackling obesity in children.

OBESITY IN THE ELDERLY:

First off, we must distinguish the problems that we can come across. Old age is not the same as decrepitude, there are loads of “elderly youngsters” that might very well be the envy of many a young person, who in spite of their youth, are mentally speaking “solemn elders”. In these more “mature” young people, even the desire to preserve a certain aesthetic look, can turn them into candidates who, either want or need, some dietetic correction in order to loose those “extra few kilos”. Well, good for them I say!

In the second place, we must, of course, assess the situation to establish whether the obesity or overweight is causing the patient’s pathologies, or whether it is these pathologies themselves, which are more plentiful at this stage of life, that suggest the need for a loss of weight . High blood pressure, diabetes, hypercholesterolemia, or neurological and mental problems are much for frequent in the aged than in young people, and will invariably condition the dietetic guidelines that we set out .

In the elderly person, there is an inevitable loss of functionality in the whole body, there is a reduction in fat, protean and mineral reserves, affecting a functionality that is gradually dwindling due to these shortages, which are progressive to boot.

The strange thing is, however, that it is becoming increasingly more difficult to find a middle ground. Either we come across the typical decrepit elderly person with his or her mental faculties extremely affected and with a large amount of added pathologies, or on the contrary, we find ourselves facing a person full of physical and mental strength, who for several psychological reasons is abusing his or her daily food consumption, and has developed a worrying obesity which requires a serious reduction of weight as an aid to tackling the pathologies typical of advancing age, or as a preventative measure so that these do not develop.

If the problem is the latter, we must be very clear about the fact that the elderly person’s diet differs very little from that which is proposed for the general population. We must provide such a patient with a large amount of high quality biological protean material that contains enough plastic material to enable the recomposition of his or her structures and systems. Plenty of vitamins, minerals and oligoelements in the shape of fruit and garden vegetables, given that the patient’s digestive system may be a little deficient and be incapable of extracting them completely. A lot of calcium for his or her bone problem, in the form of milk, fresh cheeses and yoghurts. Abundant fibre, by means of leaf and stem vegetables, which will also aid to cure any constipation problems, which also tends to be quite common in these patients. Fatty polyinsaturate acids, basically to be found in olive oil and blue fish. And of course, we will reduce their caloric provision by decreasing the amount of refined hydrates, advising less cakes, sweets, bread, starch, etc.

We will be extra careful of the salt we use in our meals. The elderly person, on account of the drop of sensorial quality tends to prefer stronger and more salty foods, which can worsen a blood pressure problem, and in some cases even be the cause of it.

We will also try to introduce a routine. This is important, given that the old person needs discipline which provides security and the feeling of protection. Perhaps this is our greatest ally, setting out specific guidelines and routines, which will greatly help in his or her compliance with the dietetic instructions.

Phytotherapy provides us with great help in these cases. Basically, all the advice and products that we have mentioned with respect to each of the pathologies referred to previously will be of great help to us. Nevertheless, I would like to make special mention of a product I regularly recommend for my elderly patients, given that it provides them with a great amount of anti-oxidants, free anti-radicals and specific nutrients for their bone and brain system. It is called BORONAGRA, and we have mentioned its properties above. I advise two capsules a day as a diet supplement.

As a basic and constant therapy to combat senescent deterioration (progressive ageing), I always recommend that my elderly patients take a daily dose of MUSCLEBIG – ORAL. This product, which brings together all of the homeopathic anti-ageing factors, reaffirmant, muscular potentiator, relaxant, anti-asthenic agent etc., is in truth a geriatric remedy of the first order, presenting neither incompatibilities, interactions nor contraindications. I normally recommend the taking of 60 drops before breakfast, dissolved in a finger measure of water

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Well, we have now more or less dealt with the problems that we are generally confronted with, as well as the therapeutic measures that we have available to us in order to tackle said problems effectively, safely, and above all, without unpleasant or disagreeable side effects.

Whether we are genuinely obese and we need to lose weight, or if we are professionals who are dealing with a patient with such needs, and if we have either taken on, or suggested that someone take on a diet, made to measure, to our taste, or to that of the patient, and one which is well distributed, the only thing we have to do is to face up the big problem that all diets concerned with weight loss face : namely, to keep it up.

That is the truth of it, nothing more, nothing less. Willpower is the best weapon available to an obese person. What is more, if we are professionals in the material, we have to face up to and make ourselves aware of the fact that, and I say this from experience, our patience must know no limits when it comes to understanding the anxiety that a person may suffer in his or her battle against obesity. Unlimited psychological support, always proposing alternatives to meals, dishes, cooking styles, accompaniments, dressings, etc. are subjects that we need to master in order to be able to make the life of our patient that little bit more pleasant. Maximising achievements, minimising those small setbacks and relapses, those little white dietetic sins that are the exception that prove the rule. And, above all, getting across the fact that there is even something more important than losing weight, namely, not putting in back on again.

MAINTENANCE DIET:

If we have already managed to achieve the desired weight, or if we wish to take a breather from trying to lose weight, in order to renew our efforts, it is essential that we have a strategy available to us which will enable us not to destroy any achievements that might have been gained.

A strategy that I employ is to divide the week into two parts. A few days are devoted to keeping up the diet, which are complemented by other foodstuffs for the rest of the week. In accordance with the patient’s development, he or she must add diet days if any weight is gained, and can discount days if any weight is lost, which means that there will be no excessive weight gain. It is always a lot easier to lose a recently gained kilo, than to try and lose several that have been allowed to accumulate over time in the form of fat.

For example, a classic maintenance diet at the beginning, or having recently lost the kilos that we needed to, could be as follows:

From Monday to Friday (five consecutive days)

Hypercaloric diet that we are observing
Insisting in respecting the number of intakes
Always eating fruit between mealtimes
Respecting the exact intake of fibre and the rest of the medication prescribed to lose weight.
Drinking a lot of water, etc.

Weekends (two days in a row)

We will add the following to the diet:

Vegetables, Pasta, Rice, Peas, Potatoes, etc. as basic foodstuffs in order to achieve a complete diet overall.

We will not take any supplementary medication in the diet.
We will continue to eat fruit in between mealtimes.

During these two days, it is very important that we allow ourselves, or are allowed, to indulge in some dietetic whim, without any importance being given to the type of foodstuff or drink. The idea, I repeat, is to make it very clear that we are not on a diet during these days. They are holidays or feast days, and we must enjoy them as we wish. On Monday, we will once again return to our diet in order to compensate for any weight that we may have gained over the weekend.

If we find, on monitoring ourselves every fortnight, or more, that we have gained some weight, we will write off one of the “feast” days, and if we have lost weight, we can add a feast day.

It is a very simple way of making ourselves aware of the fact that on certain days we cannot indulge any whims, while on the weekend we can satisfy all of same.

DANGEROUS MEDICINES

Unfortunately, there is no “wonder” pill which enables us to lose weight, and which, in addition, enables us eat whatever we might wish. Nowadays, this is a utopia, although, in the not too distant future we may manage to come up with such a panacea.

This chapter is basically dedicated to preventing the dangers of a large amount of “magic pills” that are currently being prescribed without a second thought, and with great impunity by so-called “professionals” who are regrettably taking in and deceiving a population eager to achieve the ideal physique by means of the least amount of effort, even though they are aware, so often turning a blind eye, that they are literally putting their health at great risk, and that sooner or later, a high price will have to be paid for their daring, or ignorance, as the case may be.

In the first place, the point needs to be made that the majority of anorexigenic products, which we will gloss over below, are genuinely prohibited by Law as treatments for weight loss, and that the majority of same have been removed from the pharmacopoeia. Nonetheless, and quite regrettably, there is a dark network of suppliers who, somehow or other, manage to supply a large part of the medical population, or others, with these “poisons”.

From this small space, I would like to earnestly advise everybody against those pills that do not possess all the phytosanitary requirements, against any strange or rare preparations or against any medicines that do not carry seals from Pharmacies, against all those pills that are available by mail order, or which are prescribed for slimming while at the same time permitting the person taking them to indulge in all foodstuffs that he or she might wish, or against those products which are sold directly by so-called “professionals”. All doctors are obliged to prescribe by means of a duly legalised prescription, and are further obliged not to “sell” medicines. Lastly, as we all know, wherever there’s a will there’s a way, which leads me to be believe that the best friend of reason is knowledge. I wish to appeal to the use of reason in order not to fall into the trap of miraculous cures, which always turn out to be extremely deceptive.

ANOREXIANTS:

Amphetamine, Phentermine, Phenmetrazine, Diethylpropion, Mazindol, etc.

These are Central Nervous System stimulants, which have an appetite blocking effect, although such an effect is merely fleeting. They provoke an addiction similar to that of opiates. Dependence on the medicine is gradual, and gives rise to the need, after a short period of time, for large doses in order to achieve the desired anorexiant effects. They provoke a state of continuous anxiety and are capable of producing a psychotic symptom quite akin to that of paranoid schizophrenia. As equally serious as the aforementioned is the situation that arises when they are cut out, given that such an action can provoke severe depression, even to the extent of the patient in question becoming suicidal.
Phenmetrazine can provoke toxic psychosis and permanent brain damage, in addition to the fact that it is teratogenic.
All produce side effects such as hyperexcitability, excessive perspiration, nervousness, palpitations, dryness of the mouth and insomnia.
They must never be used to treat obesity.

SEROTONIN AGONISTS:

Fenfluramine, Dexfenfluramine

These drugs stimulate thermogenic activity and deaden the appetite. They have been removed from the pharmaceutical market; however, most regrettably, they continue to be used uncontrollably.

They provoke depression, vertigo, lethargy and even a feeling of unreality. They alter the electroencephalograms during sleep, thus increasing agitation and nightmares. Depression is a frequent consequence of cutting out the drug. As far as the digestive system is concerned, it gives rise to dryness in the mouth, a metallic flavour and a feeling of thirst. In some cases, nauseas, vomiting, abdominal pains, and more often diarrhoea have been reported. An overdose of this drug is life endangering, giving rise to agitation, severe abdominal pain, hyperventilation, tachycardia, etc., with the patient occasionally ending up in coma.

At present, well-informed health care professionals and proper professional people do not use these medicines when treating obesity.

THYROID HORMONES:

The use of thyroid hormones to lose weight is medical “blasphemy”; a situation to which we are quite unfortunately only too accustomed to bearing witness. It is very easy to offer patients desirous of losing weight quickly, the panacea of “take a pill and eat whatever you like, and you will see how, in spite of everything you will lose all the weight you like.”

By using these hormones, the patient manages to increase his or her basal metabolism, thus although he or she will slightly reduce the intake of food, on the caloric consumption being artificially increased, a significant loss of weight ensues.

The trouble begins when we stop taking the pills. The thyroids, like practically all of our body’s glands, work by feedback mechanisms. That is to say, if a small amount of the substance for which it is responsible is detected, in this case the thyroid hormone, the secretion increases until normal values have been obtained in the blood. Nevertheless, if the values in the blood are above normal, as is the case in point, given that we are supplying it artificially, the body stops producing it.

What happens? Well, it’s really quite simple. When we stop taking the artificial substances, it turns out that our thyroids fail to react to the low levels of the hormone in the blood, and do not produce it. Thus, the basal metabolism drops sharply, giving rise to a sub-clinical hypothyroidism as a result of thyroid pseudoatrophy. The clinical translation of this circumstance means that the patient, on stopping to take the hormones, gains a lot more weight than he or she has lost, and at amazing speed. This newly obtained weight is much more difficult to lose later on.

The aforementioned are, shall we say, the "normal" effects of the thyroid hormones, given that the most frequent side effects are palpitations, nervousness, hyperperspiration, tiredness and diarrhoeas. This is not to mention the danger that it implies for patients with cardiovascular problems, in which it might give rise to angina pectoris, or high blood pressure. Neither must we overlook the extreme risk of provoking a thyrotoxic cardiomyopathy, which could turn out to be fatal.

All of these risks arise because of taking some "miraculous" pills. Furthermore, it has been conclusively demonstrated that the majority of the weight loss that occurs is not at the expense of the fat that is consumed, rather the muscular mass that has been lost, which in turn gives rise to a large increase in nitrogen loss that will go on for over a month after the patient has stopped taking the pills.

Of course, we must be clear about the fact that the use of thyroid hormones is only justified when we diagnose and perfectly identify a clinical hypothyroidism. Whatever the case, we must consider their use, as a conscious or not, attack on the health of the patient.

DIURETICS:

This is another type of drug that is widely used, and quite pointlessly, in the treatment of obesity, above all forming part of the magical, fraudulent and dangerous formulae group.

Diuretics produce a rapid elimination of water and salts through the urine, thus they obtain a rapid loss of weight, of the water that is eliminated that is, but obviously, the amount of body fat remains completely unaltered.

The unjustified use of these drugs is clinically pointless, given that it can provoke problems of imbalance in the body’s electrolytes, especially of sodium and potassium, to the point of producing severe hypotensions, tachyarrhytmia, intense and painful muscular contractions, and serious asthenia. In addition, it in no way translates into a real loss of the body’s fatty mass, and the weight that is momentarily lost is immediately recovered when we replace the normal water needs.

LAXATIVES:

Except for people suffering from constipation, and under strict medical control, it is quite absurd to administer laxatives indiscriminately with the aim in mind of obtaining a loss of weight. In the first place, because they do not significantly alter the absorption of nutrients, and in the second place because the caloric loss is minimal. However, they do give rise to severe intestinal injuries, which in turn give rise to the blocking of the intestine on faecal transit on account of custom. Thus, the use of laxatives must be scrupulously controlled by health care professionals, given that when confronted with a problem of constipation, the most important thing is to prevent it and to use the arms that we have available to us to solve the problem, not to provoke it on the rebound.

It is really discouraging to see how people trade in other people’s health and hopes, by offering false promises concerning objectives that are never met.

The majority of the magic capsules contain, in varying proportions, quantities of the drugs that we have just mentioned: An amphetamine with anorexiant effects, a benzodiazepine, which counteracts the stimulant effect of the amphetamines, a thyroid hormone, a diuretic and a laxative that are more or less strong. These are genuine metabolic cocktail bombs, which, thanks to obtaining a momentary loss of weight, "hook" patients and produce enormous profits for their suppliers, without taking into account the serious damage that they can do as a result of those gullible people who follow the treatment.

STRANGE DIETS

We have already mentioned a prototype of diet that we can use in order to lose a few kilos without causing any problems for ourselves. This is what we call a “balanced diet”; that is to say, it provides us with the materials needed for the correct functioning of our organism. It contains enough proteins, and sufficient glucides and fats to avoid giving rise to negative nitrogen balances, or what is basically the same, it does not reduce our muscular mass, solely our fatty mass. Moreover, it is rich in vitamins, minerals, oligoelements and fibre, thus there is extremely little chance of provoking any nutrient deficiency.

The big problem, when it comes to providing examples that might serve to surprise us slightly with respect to hypocaloric balanced diets, is that in order for them to meet these requirements, unfortunately, all are quite similar, and their differences reside more in the socio-cultural, geographical and gastronomic determining factors than in other nuances that can serve to make them more or less effective. Let us not forget that the big difficulty with a hypercaloric and balanced diet such as the one we have proposed in the previous chapter, is constancy, and of course, imagination.

UNBALANCED DIETS

A diet of this type, which became famous more so as a result of the place from which it came and its name, rather than for the solutions it provides, is the Beverly Hills Diet, which took advantage of a body cult cultural setting to propose a diet rich in complex hydrates (starches) and very poor in fats, albeit only slightly hypercaloric. The loss of weight was came about more as a result of the exercise that accompanied the diet, than as a consequence of the diet itself.

FASTING:

This was a therapeutic approach used to tackle obesity up to the 70’s. At present, it is advocated in rather pseudo-philosophical circles in which the supposed therapeutic advantages are combined with organic and spiritual purifications, which, without wishing to question same, I do find lacking in any scientific justification which endorses it.

The basic principle is very simple: 0 contribution of calories, although the most sensible ones do allow for certain minimal vitamin, mineral and oligoelement contributions in the form of fruit juices, albeit, without providing any nutrients, such as hydrates, proteins and lipids.

Fasting sees an extremely swift depletion of glycogens, while the maintenance of the glucose levels for cerebral functioning is accomplished by the consumption of its own protein, which means that muscular weakness is one of the important characteristics of the person who is fasting, and let us not forget that the heart is a muscle.

During the evolution of the fasting, the organism must make enormous metabolic adjustments to face up to a situation of total deficiency as regards nutrient elements. Firstly, it uses up all non-essential amino acid reserves, preserving the essential ones for a time. Nevertheless, if the fasting continues without the person receiving any proteins, the body also resorts to the aforementioned essential ones, which implies that the protean loss is comprehensive. The body tries to adapt itself by decreasing its metabolic rate to a minimum, forsaking the performance of functions that are not strictly linked to pure survival, as for example, the maintenance of muscular mass, the reproductive system, its own physical, intellectual and immunological activity which fall to truly minimal levels of activity.

If the fasting continues, it can lead to the continued protean losses reaching a point of no return, even though we may try to administer proteins rapidly by means of the diet. As of this moment, the metabolic imbalances become so serious that the body is incapable of assimilating the proteins that we might administer, and enters a process of progressive weakening, coma and finally, death.

At present, fasting techniques, if they are to be used must be properly overseen by health care professionals, who will perfectly monitor the nitrogen balance and all analytical and vital signs. Above all, paying special attention to cardiac activity, given that serious problems have been revealed just before the metabolic adjustments provoked by the fast begin to take place.

Whatever the case, no serious therapist recommends prolonged fasting as a means for an obese person to lose weight, given that we are all well aware of the fact that the big weight losses that are seen at the beginning of the fast are not due to a loss of fatty mass, but rather a loss of water bound up with glycogen and proteins.

LIQUID DIETS

We are all familiar with these. Their use has become generalised and they are on offer in all pharmacies. What we have here are the typical packets of powders which are used to prepare a type of shake which is purported to have a pleasant flavour, and which supposedly contains all the nutrients required for normal survival, but which provide a minimal caloric input.

At first, diets of this type, the so-called first generation diets, presented numerous problems, given that the quality of the proteins that were provided was not properly controlled, giving rise to serious nitrogenous imbalances that eventually gave rise to a large number of caridomuscular damage, and deaths as a result of heart failure.

In general, they have quite a ketogenetic character, given that they provide a very small amount of glucose, giving rise to a high acidosis content which forces the loss of minerals through the urine, mainly of calcium and potassium, which in turn provokes even further alterations of the cardiac muscle, that is to say, the heart.

This problem has been solved at present by providing these diets with proteins of a high biological power, which are generally got from milk, and a larger content of hydrates, which without being untrue to their philosophy, makes them less aggressive on the body, but which carries with it a loss of their effectiveness, without at the same time losing their main characteristic, namely how boring they are.

The general problem that they cause is their lack of fibre, which invariably brings with it a persistent constipation. This must be cured with large supplementary doses of fibre, thus making them so much more bothersome to follow, given that, in addition to their being so unattractive, they are also subject to the taking of pills or capsules with fibrous components.

Otherwise, at present they do not present further problems, as long as they are supplemented as we have suggested, except for the fact that few people are prepared to put up with such a boring and monotonous diet for such a long time.

HYDRIC DIETS:

These are very popular, while at the same time being very dangerous, if they are kept up over a certain period of time. Every year, a diet of this type becomes all the rage. It is invariably presented as the latest dietetic revolution designed to lose weight quickly, and I stress, only quickly, given that although it is true that weight is lost quickly, but at the expense of water, glycogen and the bodies own proteins.

They are based solely on the intake, and generally without restrictions with respect to quantity, of boiled vegetables, or juices made from certain fruits, or syrups made from a particular plant that has exclusive properties, supposedly depurative, not to say miraculous, for the entire body.

This is achieved by drinking large quantities of water, up to three or four litres per day, with a large intake of vitamins, minerals and oligoelements, but with minimal quantities of glucides and practically no proteins.

The low caloric content of these diets give rise to the rapid loss of weight, but solely at the expense of water, given their extremely diuretic nature, and the fact that they feed off the body’s protein resources. The associated protean deficit carries with it serious risks, given the fact that such diets also fail to provide sufficient quantities of hydrates as a result of using the body’s own proteins to maintain suitable levels of glucose in the blood. We are of the opinion that the protean deficit has its origin in two mechanisms, first the zero contribution of overall proteins provided by such diets, and on the other hand the lack of essential amino acids, which alters the replacing of the bodies own proteins even more.

There is little doubt that these diets are not the best way to lose weight properly. In addition, given the risk involved both in the medium and long term, they must not be justified as a therapeutic method to be employed in the treatment of obesity.

DISSOCIATED DIETS

Such a diet is based on the continued breaking of the body’s metabolic lines, in such a way that, even though we do not restrict our overall intake of nutrients, the majority of their content cannot be used, thus creating a negative energetic balance.

This is achieved by dividing the intake of different nutrients into exclusive intake days: Monday, eggs; Tuesday, vegetables; Wednesday, meat; Thursday, fruit, etc. This dissociation of glucides on the one hand, and proteins on the other, means that a large part of the proteins consumed are used not as plastic material, their main function, but as energetic material to be transformed into glucose and to maintain their levels stable in the blood.

When analysed in overall terms, they do not result in the lack of any particular nutrient, and what is more, with the passing of time become genuinely hypocaloric diets, given that very few people are able to go one whole day, in a repetitive manner, eating only eggs, for example.

These diets mean that the individual spends one day only eating meat, given that they are diets of a ketogenic character, to strongly hypocaloric days without any protein provision, to days on which the person basically lives off fats and proteins, thus lacking in fibre and hydrates, being strongly cholesterolemic days. Among other things, this gives rise to an enormous assault on the intestines, on account of the change from a strong overdose of lipids to a practical lack of same, from an large contribution of fibre to merely minimal protean remains, resulting in the inevitable consequences, namely periods of diarrhoea to periods of intense constipation, and ending up in a intestinal disorder, quite difficult to remedy.

I repeat, they are not a valid dietetic alternative to be employed in the treatment of obesity, and are not currently used, at least seriously and consistently with the health of the patients.

PROTEINIC DIETS

These consists in basing the daily diet solely on the consumption of proteins and fats, and avoiding the intake of any hydrate whatsoever.

On account of the large initial losses of weight, which as we will see, are not at the expense of fat, and due to the great amount of publicity and marketing campaigns that are carried out extolling the “scientific” qualities of their supposed discoverers, they became extremely popular and famous. Nevertheless, we have to point out that, in the long run, the loss of weight obtained in comparison to that achieved by means of balanced diets, which are less strict and safer, is exactly the same. What is more, the former carry with them numerous and serious side effects.

They are ketogenic diets. They use the proteins and the fats of the diet and of the person himself or herself in order to maintain glucose levels in the blood. As a result of the movement of a large number of fats, an excess of ketonic bodies is produced, which are eliminated through the saliva, by means of perspiration and in the urine.

This disproportionate increase of ketonic bodies gives rise to an acidotic condition (an excess of acids), which the body invariably tries to neutralise by resorting to its own ions, mainly sodium at first, and soon after to the ammonium ions that it obtains from the destruction of its own proteins in a last ditch effort at neutralisation, thus the loss of its own protean mass is obvious and dangerous.

The high levels of ketonic bodies in the blood produce extremely undesirable and bothersome side effects: irritability, bad taste in the mouth, bad breath, perspiration and urine, which turn the diet into a genuine discomfort. Furthermore, there is the added serious danger that, if their levels rise sharply, they could give rise to delirium, coma and death by poisoning.

Another serious negative effect is that the proteinic diet is, in the majority of cases, a hyperlipidic diet, and very seldom does the person that follows it over a period of time avoid ending up having extremely high cholesterol levels, as well as a lipidic disorder that endangers his or her health to an even greater extent.

The inevitable result is that the loss of the body’s own protein is the norm, along with all the dangers that have been mentioned that such a loss brings with it. In comparative studies that were been carried out between patients following a healthy balanced diet and patients subject to a ketogenic diet revealed that, even though the final loss of weight may be the same, those who followed the latter had suffered a loss of proteins, water and minerals which was quite worrying with respect to their general health, while those who followed the balanced diet had no such problems.

To put some sort of a name tag on these diets, and with the aim in mind facilitating their identification, we would say that the diets advocated by Atkins, Scarsdale and Montignac are ketogenic, hyperfatty and dangerous diets. Moreover, I would even go as far as saying that they are fraudulent and non-scientific, given that they have managed, on the one hand, to do harm to the health of the patient, and on the other hand they have managed to deceive naïve patients by means of a grand advertising display and parascientific reasoning, wholly false and refutable, in pursuit of easily accomplished and utopian ends, while the only thing they have genuinely succeeded in doing is to harm their health and shamefacedly fill the pockets of the leading players in this distasteful business.

Nowadays, nobody seriously proposes a ketogenic diet as a therapeutic method of treatment for obesity. On the one hand, because the results in terms of weight loss are similar to those achieved by any balanced diet, and on the other hand, because they present numerous and dangerous risks to the health of the patients.

MAGICAL AND RIDICULOUS DIETS:

I choose the word magical in the light of the fact that there is no remotely professional nutritionist or dietician behind those that are advocated, and the fact that such diets are always surrounded by an aura of mysticism and subjugation given the irrational and mysterious forces on which they are based. I refer to such diets as ridiculous for reasons that will become wholly self-explanatory when we study them in detail. None of these diets have any scientific, logical or rational bases; thus the only relevant epithet to describe them that occurs to me is the aforesaid, namely, ridiculous.

One or other of these types of diet appears every year in the mass media, and is generally endorsed by some “minor celebrity” who uses his or her influence in the gossip magazines in order to launch his or her “book on the revolutionary and definitive diet ”, with the aim in mind of obtaining some extra income when it comes to publicising it. Or we find ourselves dealing with a mere charlatan, witch, healer or miracle worker who appears to have discovered the final panacea for a problem that is becoming too much for a sizeable number of people eager to achieve a social acknowledgement and popularity that their overweight is, supposedly, denying them. Such people espouse the postulates of the former with unjustified fervour and devotion. It goes without saying that the easy, the quick, the paranormal and the mysterious is much more attractive than the rational, self-sacrificing, the logical and the coherent.

Do you not think it disgraceful that a society in which practically all of us are trying to be daily more just, rational and logical, that more attention is paid to what parascientific minds are advocating just because of their appearing in the mass media, than to what might be recommended by experts in the material, proud possessors of a cultural background and lifelong scientific recognition? But, of course, the mysterious and enigmatic sell, the rational does not.

We could make a long list of these types of “diet”: the lemon diet, the grapefruit diet, the single meal diet, the eat-before-eight o’ clock in the morning diet, the peach diet, and the list just goes on, and on...

Grapefruit and lemon diets are rather curious. They are advocated on the supposition that as these items of fruit are acidic, they dissolve the fat. Therefore, we should eat loads of lemons and grapefruit and we will notice how the fat dissolves as soon as we have ingested it, to the extent that the process can even be noted with the food still in our mouth. What is more, do the washing-up liquids we use to dissolve the grease on our plates after meals not smell of lemon? No further comment.

The diet to be eaten before eight o’ clock in the morning is based on I know not what theories, according to which the calories that we ingest in the early morning before this hour do not count, and do not make the individual put on weight. However, the food we eat afterwards does imply the putting on of weight. Very well then, why do we not tell this to the baby who requests his or her food in the morning, explaining that if we feed him or her now it is pointless exercise, given that he or she is not going to make use of the feed. Futhermore, according to the same reasoning, we would have neither garbage collectors nor night security personnel, given that they would have all died of starvation. Well that is how it works. It certainly is curious, and admit it, just a little sad, no?

I feel no more need be said. We would only end up filling page after page of this book with the absurdities conceived by the human mind, a truly unending task. The power of the mass media cannot be denied. Neither can we deny the existence of several swindling minds, nor the existence of a subscribed field where all such strange, parascientific and health speculating ideas can see the light of day. Notwithstanding, it is also quite true that that intelligence and reason exist, and these will always come out on top. All of those who have been deceived, in the end, will find themselves resorting to a professional with due experience to solve their problems. Unfortunately, however, in many cases they come to us after the damage has been done by these charlatans, a damage that can prove very difficult for us to remedy.

My one desire, is simply that these pages of good intentions serve, at the very least, to create a reasonable doubt when we find ourselves facing a definitive, novel, or tempting approach, unless we can perceive a rational and scientific argument to back up the treatment in question.