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Health Strategy.

Complementary strategies for breast cancer.

Weight Loss Program.

The multifactorial nature of obesity requires a multifaceted approach to its treatment. The comprehensive weight loss program outlined below includes chronic stress relief, dietary changes, gut health, systematic muscle loading, and circadian compliance.

Ten points of the program to reduce body fat mass:

Restriction of calorie intake.

Suppression of hunger.

Slowing down the absorption of carbohydrates from the intestines.

Blocking the absorption of fat from the intestines.

Decreased levels of insulin and blood glucose.

Suppression of the growth of fat cells.

Increased energy consumption.

Normalization of intestinal microflora.

Restoration of hormonal balance.

Decreased overall inflammatory levels.

Calorie restriction is the drastic reduction of calories in the diet to a level that is lower than required for growth, but sufficient to maintain overall health *. This decision slows down the body's growth processes and targets it to the protective mechanisms of recovery.

Numerous experiments on mammals, including monkeys, have shown that calorie restriction dramatically improves their health indicators, reduces age-related degenerative changes and increases life expectancy * *. In rodents, caloric restriction can reduce the incidence of various types of cancer by 75.5% *. A significant reduction in the incidence of cancer on a calorie-restricted diet, compared to a control diet, was also observed in the group of anthropoids (rhesus monkeys) *. Data from randomized clinical trials show that non-obese people experience similar metabolic and molecular changes *.

The American Heart Association, the American College of Cardiology, and the Obesity Society jointly evaluated several types of diets and concluded that overall dietary energy deficiency has a greater effect on weight loss. than consumption pattern *. None of the popular diets proposed so far has been able to show sustainable weight loss if it did not involve a reduction in total calorie intake *.

Indeed, to date, there is no conclusive evidence that any particular macronutrient balance is superior to another for weight loss. The ability of any diet to reduce weight was manifested only with a simultaneous deficit of energy from food *. Special clinical studies of three different diets – high in carbohydrates and fiber, high in fat and high in protein, show that they all differ little from each other in the degree of reduction in body weight, waist circumference and triglyceride levels * * *.

Caloric restriction reduces not only the incidence but also the growth and metastasis of breast cancer *. In mice, dietary restriction in combination with radiation therapy significantly reduced tumor growth compared to radiation therapy alone *. In humans, reducing caloric intake already by 22-30% of normal levels reduces markers of inflammation (C-reactive protein and TNF-α), reduces risk factors for cardiovascular disease (LDL, triglycerides and blood pressure), reduces the risk of diabetes (glucose levels and fasting insulin levels), improves hormonal profile (T3, T4, TSH, androstenedione) * * * *.

In addition to weight loss, intermittent fasting has beneficial effects on circadian rhythm, gut microflora, and sleep *. Conversely, manipulation studies have found disruption of the normal circadian rhythm with uncontrolled consumption of obesy-producing foods *.

A more detailed study of the phenomenon of low-calorie nutrition has given reason to believe that it is based not only on a decrease in the total number of calories consumed, but also on a change in the ratio of fat:carbohydrates and protein:carbohydrates in favor of carbohydrates *. Indeed, a two-year low-calorie (1'750-2'100 kcal/day) diet of vegetables, fruits, nuts, grains and legumes, with a small amount of dairy, eggs and meat (~ 12% of calories from protein, ~ 11% from fat and ~ 77% from complex carbohydrates) reduced body weight by up to 19% in men and up to 13% in women *, and improved all health indicators measured during the experiment compared to baseline.

An extremely low calorie diet (550 kcal/day for 6 weeks), in addition to weight loss, increased insulin sensitivity by 35% in obese people; reduced the level of C-reactive protein by half, and the level of triglycerides in the liver – by 60% * *. However, a longer period of such a diet began to give negative results, and therefore cannot be recommended.

Calorie restriction is the most effective, albeit psychologically uncomfortable, part of a weight loss program.

Fats and alcohol contribute the most calories to food, so reducing their intake will be more effective than reducing carbohydrate or protein intake. Some fatty acids tend to be stored in adipose tissue rather than being burned for energy. Medium chain saturated fatty acids such as lauric, alpha-linolenic, oleic and linoleic have faster oxidation rates than some long chain saturated fatty acids such as palmitic or stearic * *. It can be assumed that animal fats and palm oil are more likely to be deposited in the body than coconut or olive oil. In addition, the former usually accumulates intraperitoneally, while the latter accumulates subcutaneously *.

Reducing the proportion of fat in calories from 38% to 23% within 3 months resulted in a 25% reduction in average energy intake, an average weight loss of 2.8 kg, and a 7.7% reduction in serum cholesterol *. In a similar study, dietary fat intake of 23% calories in the treatment group versus 31% in the control group after 5 years was associated with a mean weight difference of 2.5 kg between the groups. If in the control group the weight increased by an average of 0.7 kg, then in the experimental group it decreased by 1.9 kg *.

In both cases, the ratio of types of fatty acids in the food taken remained, apparently, at the same level. But their balance can have no less expressive results. Even at the same level of calorie and total fat intake, replacing saturated fatty acids with monounsaturated fatty acids in the diet can reduce body weight and fat mass (up to 2.6 kg) in as little as 4 weeks *.

Another intervention study showed that ω-6 fatty acids (most liquid cooking oils) are more likely to cause high blood insulin levels and fat accumulation than ω-3 fatty acids (fish oil, flaxseed oil), and even more than saturated fatty acids *. Obviously, it is precisely the reduction in the consumption of saturated and polyunsaturated ω-6 fatty acids that should be given special attention *.

Another trick to improve the balance of income:expenditure, can be to increase protein intake by reducing the same amount of carbohydrates. The calculation here is based on the fact that the metabolism of proteins requires more energy expenditure than the metabolism of carbohydrates *. However, in practical terms, vegetable protein (for example, legumes) should be used here, because. an increase in animal protein intake means an automatic increase in saturated fat intake.

Interestingly, in experiments on mice fed ad libitum, an increase in dietary carbohydrate and protein reduced the amount of food consumed by rodents, while an increase in dietary fat did not reduce their appetite *.

But, as already mentioned, the best strategy is to reduce total calories, not just fat and carbohydrates. It is believed that reducing energy intake by about 500 kcal/day leads to weight loss of about 0.5 kg per week and about 2 kg per month *.

Calorie restriction must be chronic, otherwise there may be a «rebound» of the lost, and even excess of the initial weight. It has been reported that in only 3% of cases, weight loss was maintained for 5 years after a calorie-restrictive diet *. At the same time, long-term extremely low-calorie diets (< 1'200 kcal/day) even in healthy people can cause some negative effects, such as increased uric acid levels, increased risk of gallstones, loss of lean body mass, electrolyte disturbances. balance and disorder of the liver *.

In addition, reducing the amount of food intake can lead to a decrease in the intake of many essential substances and, accordingly, will require the intake of appropriate supplements. All 4 of the most popular diets in the US in 2010, limiting calories to 1'100-1'700 kcal/day, were found to be only 43.5% adequate in the recommended daily intakes (RDI) for 27 essential nutrients *. These were the South Beach Diet, the Best Life Diet, the Atkin's For Life Diet, and the low-fat DASH diet recommended by the US National Institutes of Health (NIH) and the American Heart Association. Thus, the desire to lose weight without eliminating this potential deficit can cause others instead of some problems.

A deficiency in certain vitamins and minerals limits the body's ability to burn nutrients for energy. Riboflavin, niacin, biotin and vitamin B12 prepare stored fats for burning in the metabolic mechanisms of the body. Pantothenic acid, vitamin B1 and magnesium are nutrients involved in this process, but they are lost during the processing of grain into flour.

Magnesium deficiency can slow aerobic energy production. Lack of energy makes it difficult to completely break down nutrients into water and carbon dioxide, which causes the formation and accumulation of fat.

Vitamin B6 is needed to release energy from certain carbohydrates; without enough B6, it becomes harder to burn carbohydrates. Without iodine and selenium, the thyroid gland cannot adequately regulate metabolism, and iodine deficiency is a worldwide problem. Iron plays an important role in the production of aerobic energy in the cell in several different ways, but iron deficiency is also widespread.

How to ensure a low calorie diet, and at the same time maintain its usefulness? Part of this difficulty can be circumvented by increasing the consumption of raw plant foods. Thermally unprocessed carbohydrates are less digestible, while the absorption of micronutrients remains at the same level. There are other ways to reduce the absorption of ingested food.

Calorie restriction mimetics (CRMs) are a group of substances that, by altering cell metabolism, mimic the metabolic, hormonal, or physiological effects of calorie restriction without actually restricting it, and improve overall health. First of all, it is metformin *. Resveratrol *, hesperidin *, ginkgo biloba *, aspirin *, curcumin and green tea polyphenols * do a much worse job. Consumption of antioxidant-rich unsweetened beverages such as guarana *, green tea * *, hibiscus *, ginger * and coffee (up to 4 cups per day) * * makes a modest contribution to the overall weight loss effort.

Finally, regular fasting is the most powerful calorie reduction strategy. There are several options for fasting: overnight fasting for 14-16 hours daily; fasting for 2 days in a row during the week; fasting every other day; intermittent fasting for 4-20 days. Each additional 5 days of zero calories results in 1.8 kg of weight loss *.

Reducing energy intake and increasing its expenditure is the main point in the fight against obesity. However, chronic calorie restriction induces complex compensatory metabolic mechanisms to increase energy intake and restore weight, which poses serious problems for dieting and weight loss attempts *. To overcome them, various dietary strategies have been proposed that affect satiety and metabolism.

Suppressing hunger makes it psychologically easier to reduce calorie intake. The satiety hormone leptin, which regulates food cravings, is produced by fat cells: an increase in fat storage should theoretically reduce the need for food. However, leptin sensitivity can be lost in the same way that it occurs with insulin. Because of this, there is a feeling of hunger, even when the body does not need food. The main cause of leptin resistance is believed to be the binding of leptin to C-reactive protein (CRP), the level of which increases with systemic inflammation *.

However, the real cause of leptin disturbance in hunger regulation may be the low amount of dietary fiber. For almost the entire history of mankind, the amount of fiber consumed was equivalent to the amount of food consumed. Fiber is broken down and fermented by intestinal microflora to produce short chain fatty acids. Those, in turn, increase the production of hormones that cause satiety. Insufficient amount of fiber in food leads to a chronic feeling of hunger.

Neuronal signaling peptides such as serotonin, histamine, dopamine are also associated with the regulation of satiety. Normalizing brain serotonin levels and reducing stress help suppress hunger signals. Artificial restriction of calorie intake, including various restrictive diets, although temporarily reduces weight, but also reduces the level of circulating tryptophan by 14-23%, and with it the synthesis of serotonin. Thus, hunger increases, which complicates the task *.

Lorcaserin (Belviq®) is a pharmaceutical preparation (20 mg/day) that can reduce total body weight by up to 5% * * within a year due to the effect on leptin levels through the activation of serotonin receptors *, however, it has some negative side effects.

Cissus (Cissus quadrangularis) significantly increases serotonin levels and improves lipid profile *. A standardized plant extract (2×514 mg) reduced fat mass by 6% over 8 weeks even without the use of a low-calorie diet and exercise *. In obese individuals, plant stem extract (300 mg/day) reduced body weight by up to 4 kg for 10 weeks, and in combination with African mango (Irvingia Gabonensis) seed extract, up to 5.3 kg *. Unfortunately, cissus raises the level of estrogen, which in experiments led to an increase in the uterus in experimental animals *.

Anti-inflammatory drugs such as curcumin * *, omega-3 fatty acids * * and others can lower CRP levels and increase leptin sensitivity.

L-Tryptophan (3 g) * * or Pine Nut Oil (2-6 g) *, taken one hour before a meal, reduces food intake by 22% and 9%, respectively, by reducing subjective hunger.

Yeast hydrolyzate is a fermented Saccharomyces cerevisae brewer's yeast that, during processing, yields peptides (short chain amino acids) that reduce appetite. Yeast hydrolyzate supplementation (1 g/day for 10 weeks) reduces abdominal fat accumulation by 2.6 kg without loss of non-fat body mass *. In addition, yeast hydrolyzate, after two weeks of taking it, improves depression and anxiety scores *, which also reduces food cravings. «Fast» proteins such as whey, which are quickly absorbed and signal satiety, also help to reduce the amount of food you eat * *.
Such tricks are similar to the «Chinese trick» – to start the meal with sweets to induce rapid satiety, and thus reduce appetite. However, the «Chinese» idea is bad. Any sweet food product enhances the amount (and calorie content) of the food eaten.

Meals high in protein, fiber, and water make you feel full faster, while foods high in fat do the opposite *. Of the 100 foods studied, foods with low energy density, low fat, and high protein content had the highest capacity to induce satiety *. Eating a meal high in protein leads to a decrease in later energy intake *. At the same time, protein consumption increases energy expenditure for its absorption (up to 23% of the energy obtained from protein goes to its metabolism, compared with 6% for carbohydrates and 1% for fats) *. Both can help in the fight against excess weight.

Slowing down the absorption of carbohydrates from the gut helps to reduce post-meal glucose spikes.

• Refusal of more simple carbohydrates (sugar, wheat) in favor of more complex ones (legumes, flax) stretches the process of assimilation of carbohydrates. Fiber, supplied with food, slows down the intestinal absorption of fats and carbohydrates; thus, pre-mealing a high-fiber meal makes it difficult to absorb high-calorie foods.

Guar gum, containing more than 85% dietary fiber, prolongs the passage of food through the stomach, thereby stimulating the satiety hormone cholecystokinin and providing a feeling of fullness after eating. Regular intake of guar fiber (2-5 g/serving) helps reduce calorie intake by approximately 20% *. Any other insoluble fiber (up to 35 g/day) *, without adding calories, but creating the volume of food, can also create a feeling of satiety.

Cereal bran is the most valuable source of fiber. They contain over 40% dietary fiber and are food for friendly intestinal bacteria. Supplementation of 30-40 g/day of oat bran for 3 months reduces total cholesterol and low-density lipoprotein levels by up to 7% * *.

Psyllium bran is an alternative to cereal bran for gluten sensitive people. It creates a feeling of satiety and lowers cholesterol levels. In a clinical trial, psyllium (10 g/day for 12 weeks) statistically significantly reduced lipid, glucose, and triglyceride levels, as well as body weight in patients *. Psyllium is water-binding and therefore requires sufficient fluid intake *.

L-arabinose, an indigestible plant substance, while in the digestive tract, delays the decomposition of sucrose under the action of the sucrase enzyme, thereby smoothing blood sugar surges and the synthesis of triglycerides *. The combination of L-arabinose and white bean extract not only moderates postprandial glucose and insulin peaks, but also slightly reduces systolic blood pressure *.

Chlorogenic acid, taken before a meal, reduces intestinal absorption of later consumed glucose *, suppressing insulin release after a meal, and prevents the accumulation of triglycerides in the liver *. Alcoholic extract of green coffee beans Robusta (3×350 mg), half consisting of chlorogenic acid, helps to lose an average of up to 2.5 kg of body weight within six months, of which half is fat *. Interestingly, the decaffeinated extract (Coffee Slender®) can reduce body fat mass by 3.6% in 12 weeks, while the caffeinated extract (Nescafe® instant) has no noticeable effect *.

White beans contain an inhibitor of α-amylase, an enzyme that breaks down starch into simple sugars, further slowing carbohydrate absorption *. An amylase inhibitor extracted from white kidney bean provides a slight but statistically significant reduction in body weight *.

Acarbose (Precose®) is an anti-diabetic agent that delays the release of glucose from complex carbohydrates by inhibiting the enzyme α-glucosidase *, but the weight loss effect of acarbose was not noticeable * compared to other agents such as metformin *.

Blocking the absorption of fat from the intestine reduces the fat calorie content of the food taken. It can be achieved by inhibiting the activity of lipase, the pancreatic enzyme responsible for breaking down dietary triglycerides into fatty acids so they can pass through the intestinal wall *.

Orlistat (Alli®, Xenical®), a synthetic agent, helps to reduce body weight by 2.5 kg in a year *. Although orlistat is clinically approved for the treatment of obesity, it does exhibit some negative gastrointestinal side effects *.

Alpha-cyclodextrin is a natural fiber that effectively binds saturated and trans fats *. A daily dietary intake of 3×2 g of alpha-cyclodextrin can bind up to 500 fat calories *.

Chitosan due to the inhibition of lipase at a dosage of 3 g/day for 8 weeks led to a loss of 1.3 kg of fat mass (22%) *.

• A wide range of natural ingredients such as saponins, flavonoids, polyphenols, including those from fenugreek *, green tea * and green coffee * have lipase inhibitory effects.

The type of fat absorbed has a major impact on obesity. Compared to unsaturated and conjugated fatty acids, saturated fatty acids take longer to metabolize and are more likely to be converted into body fat.

Decreased levels of insulin and blood glucose interfere with the creation of fat stores and reduce overall inflammatory levels. Insulin increases the risk and development of breast cancer through several different mechanisms *, and reducing it will certainly work positively.

Vitamin D deficiency is a risk factor for obesity and type II diabetes, especially in women of late reproductive age. Low blood levels of 25(OH)D are correlated with high body fat, high glucose levels, and decreased insulin sensitivity *.

Inositol, alpha-lipoic acid, and a low-calorie, low-glycemic diet work together to improve high-density lipoprotein levels, increase insulin sensitivity, and reduce body mass index and waist:hip ratio *.

Metformin activates AMP-activated protein kinase (AMPK), an enzyme that controls numerous metabolic pathways associated with the extraction of energy from food, its further storage and distribution throughout the body *. Metformin impairs the absorption of simple sugars from food and inhibits the production of glucose in the liver. In addition, it enhances the growth of the slimming gut bacteria Akkermansia muciniphila *.

Metformin (500-1'000 mg/day) has a variety of antitumor effects *, and within a year is able to reduce weight by an average of 2-3 kg without further gain.
In a clinical trial in patients with breast cancer (T1-T3, N0-N3, M0) at the end of standard treatment, the metformin group (850 mg/day) after 6 months of taking it compared with the placebo group showed a slight decrease in weight body (-3.0%) and some improvement in blood parameters (glucose: -3.8%, insulin: -11.1%, C-reactive protein: -6.7%) *.

Nigella, aka Black cumin (Nigella sativa). Nigella seed oil, taken orally, improves lipid and insulin levels, and reduces cellular insulin tolerance. Dosage: 3-5 g/day (1 tsp) for 3-6 months * *.
In a clinical study, consumption of kalinji seeds (3 g/day for 3 months) resulted in a 6% reduction in weight, 26% in triglycerides, and 6% in total weight *.

Jiaogulan (Gynostemma pentaphyllum). Saponins, extracted from gynostemma with 50% ethyl solution, help fight obesity by activating the AMPK pathway. Gynostemma extract called actiponin at a dose of 450 mg/day for 12 weeks reduced abdominal fat deposits in obese people by 6% without any other manipulations *.

Hesperidin, a flavonoid from citrus peel, is able to increase insulin sensitivity and lower lipid levels * * through AMPK – the main cellular energy level sensor *. Hesperidin 500 mg/day supplementation for 3-6 weeks improved glycemic control in diabetic patients, increased total antioxidant levels *, and significantly reduced C-reactive protein, total cholesterol, and markers of vascular inflammation compared to controls * *.

Fish mint (Houttuynia cordata) reduces glucose levels and enhances the action of metformin. Dosage: 3 g/day of dry raw material, or 300 mg/day of plant extract (3×100 mg).

Magnesium (500 mg/day) reduced fasting insulin levels in one study *.

Increasing the amount of low-processed food and decreasing the amount of highly processed food reduces the intake of sugar, because two-thirds of the processed foods available in grocery stores contain added sugar.

Fasting also lowers blood glucose levels. Reducing blood glucose levels is a smarter solution than reducing insulin resistance of cells, since when glucose is limited, the energy supply of cells is reduced. At the same time, the method of fasting is important: intermittent short-term fasting reduces glucose levels by up to 75%, while long-term caloric restriction of food causes a decrease of only 15% * *.

Suppression of the growth of fat cells.

Metformin interferes with the differentiation of mesenchymal stem cells in the bone marrow, which shifts the balance between bone development (osteogenesis) and fat cell development (adipogenesis) in favor of the latter *. It is not yet clear to what extent Metformin will be able to strengthen the bone, but it is known that it helps to reduce the mass of fat cells *.

Polyunsaturated fatty acids, act as signal molecules for the differentiation of fat cells (adipocytes) *. Thus, they are able to significantly inhibit lipogenesis by suppressing adipocyte differentiation *.

African mango (Irvingia gabonensis) as a seed extract, by increasing the hormone adiponectin, as well as by reducing the levels of leptin and C-reactive protein, significantly reduces body weight in overweight subjects *. Daily intake of 3 g of seeds or 150 mg of extract for a month reduced body weight by almost 4 kg compared to the control group *.

Ginger (Zingiber officinalis) increases the metabolic rate by burning excess fat and inhibits the absorption of fat from the intestines. Ginger powder added to rat feed (200 mg per 1 kg of food) significantly reduced their triglycerides and cholesterol levels *, however, in a clinical study (2 g of powder per day for 12 weeks), ginger showed noticeable, but inconspicuous results *.

Roselle (Hibiscus sabdariffa), in the form of a hibiscus drink or flower extract (500 mg/day) reduces triglycerides to some extent * *. Consumption of an aqueous extract of the plant's flowers (450 mg/day) for 12 weeks is very insignificant, but statistically significant, reduces body weight, body fat and waist:hip ratio *.

Garcinia cambogia (Garcinia cambogia) is an inhibitor of the mitochondrial enzyme ATP-citrate lyase involved in the synthesis of fatty acids (lipogenesis) *. Garcinia extract (2.4 g/day of extract for 60 days) has been shown to significantly reduce triglyceride levels * in clinical trials, but garcinia has not been found to contribute significantly to weight loss either alone * or in combination with a low-calorie diet *.

Increased energy consumption. Physical activity increases energy expenditure, and thus can balance energy intake and expenditure, and help reduce body weight and fat mass. To convert fat reserves into energy, an excess of energy expenditure over its income is required. That is, regular intense physical activity is required, combined with restriction of incoming calories. Although moderate to low-intensity exercise can only slightly reduce body weight *, it helps to distract and improve mood, and at least this will reduce appetite *. Physical activity also helps reduce blood glucose levels, and with it insulin resistance, which is also associated with obesity *.

Humans have experienced high levels of physical activity for thousands of years. Even without taking into account the efforts to obtain and process food and arrange their lives, a person traveled long distances on foot. For example, women of modern hunter-gatherers of the Hadza tribe walk at least 6 kilometers a day, and men twice as much *.

In addition, energy expenditure can be increased at rest, which will curb the accumulation of fat. True, in this case, the loss of fat mass will be even less noticeable compared to the loss as a result of physical activity.

Capsaicin is the main ingredient in chili peppers, giving them their spicy flavor. Due to its warm sensation and increased energy expenditure when consumed, chili is considered a potential candidate for the treatment of obesity *, however its dosage and efficacy are not clear.

Polyunsaturated fatty acids may inhibit weight gain regardless of their hypotensive and anti-inflammatory role. There are reasons to believe that they can contribute to the production of heat from stored energy *. Supplementation to a low-calorie (1'600 kcal/day) diet of oily fish or fish oil for 4 weeks resulted in greater weight loss (approximately 1 kg) in overweight patients than the same diet without fish oil supplementation *.

7-Keto®DHEA is an analogue of the natural hormone DHEA discussed below, can also increase resting energy expenditure.

Normalization of intestinal microflora. There is a complex but very strong bi-directional relationship between the gut and the brain, and the composition of the gut microflora has a strong influence on mood, appetite, food preferences, and overall health, including body weight *.

Indigestible complex carbohydrates are broken down by the microflora of the colon with the formation of short-chain fatty acids (acetate, propionate, butyrate). Many studies show that increasing dietary fiber intake reduces the risk of various chronic diseases, including obesity *. Higher fiber intake may reduce macronutrient absorption, suppress appetite and thereby reduce body weight in humans *. Some of these positive effects may be due to short-chain fatty acids (SCFAs), which not only provide the body with energy, but are also involved in a complex signaling network that affects digestion *.

In animal studies, SCFAs dietary supplementation resulted in an increase in the Bacteroidetes bacterial division and a decrease in Firmicutes, which significantly suppressed the weight gain caused by a high-fat diet *. Despite this success, it is more natural and beneficial to produce SCFAs directly in the intestines, for which you should increase your intake of dietary fiber.

In addition to prebiotics, probiotics * may also be helpful in reducing body fat. The weight loss effect of probiotics is highly strain-specific *, so multi-strain probiotics may be more effective than a single strain.

Probiotic complexes (such as Prescript-Assist), taken occasionally or as needed, enrich the bacterial diversity of the gut.
Cleansing enemas, including the well-known «coffee enemas», are not recommended unless absolutely necessary due to the fact that they wash out the bacterial mass quantitatively and, like antibiotics, sharply and permanently worsen it qualitatively, impoverishing the bacterial spectrum of the intestinal microflora.

Prebiotics, including psyllium, vegetables, legumes, flax, oats, bran, supply the beneficial part of the microflora with the necessary nutrition, ensuring its strain diversity and prosperity. Adding 14 g/day of fiber to the diet is associated with a 10% reduction in energy intake and a 1.9 kg weight loss over three months *. The FDA recommended intake for a diet of 2'000 kcal/day is at least 25 g/day of soluble fiber and about 50 g/day of insoluble fiber.

Restoration of hormonal balance corresponding to a young age. Unhealthy weight gain and obesity can be contributed by age and/or lifestyle imbalances in estrogen, testosterone, progesterone and cortisol. The main hormone imbalances are estrogen dominance, adrenal imbalance, insulin resistance, thyroid deficiency, and vitamin D deficiency.

Thyroid hormones. Thyroid dysfunction can affect body weight and composition, body temperature, and energy expenditure, regardless of the degree of physical activity. The thyroid gland is the central regulator of metabolism. An underactive thyroid reduces the metabolic rate, converts stored energy into heat, and promotes weight gain *.

Thyroid dysfunction is about five times more common in women than in men, and the risk increases with age. Thyroid health measures are discussed in «Hormonal Modulation» section .

Sex hormones. Similarly, levels of sex hormones (such as testosterone, progesterone, pregnenolone and dehydroepiandrosterone) drop significantly with age and due to thyroid insufficiency *, which can lead to a decrease in lean body mass, an increase or redistribution of fat mass * *. Moreover, the natural balance between them is disturbed, contributing to the accumulation of fat.

Dehydroepiandrosterone supplementation (50 mg/day for 2 years) slightly (0.5 kg) reduced abdominal fat mass and increased glucose tolerance in older women, as well as reduced levels of inflammatory cytokines *. While oral dehydroepiandrosterone sulfate (DHEA-S) 50 mg/day for 12 months did not reduce fat mass in postmenopausal women *, 100 mg/day for 3 months resulted in a statistically significant reduction in total weight * and improved profile of fat acids in plasma *.

DHEA is a precursor to testosterone and estradiol, so there is concern that its supplementation will cause an increase in the concentration of these hormones. Especially considering that adipose tissue activates an enzyme called aromatase that produces this transformation. Therefore, it looks more attractive to use 7-Keto® DHEA (3-acetyl-7-oxo-dehydroepiandrosterone), which does not seem to activate the androgen receptor and does not turn into other hormones *. In another study, 400 mg/day 7-Keto® for 8 weeks reduced body weight by 2 kg, raised testosterone by 16%, and reduced estradiol by 30% compared to control *.

Estrogens, the main female hormones, are produced by the ovaries during premenopause and throughout the body during postmenopause. Both high and low estrogen levels can lead to weight gain. Compared to normal weight women, obese women generally have higher levels of estrogen *. Popular methods for reducing excess estrogen include: high intake of fiber * * *, cruciferous vegetables * *, flax seeds * *; moderate physical activity * *.

However, it is worth remembering that the correction of sex hormones is a delicate procedure, and requires the guidance of a specialist. It begins and is accompanied by a comprehensive analysis of hormone levels every six months. At the same time, we can independently and without consulting a doctor manipulate the level of many other hormones associated with weight regulation through dietary modification.

Insulin is produced by the pancreas and is the main fat storage hormone in the body. An increase in the amount of insulin in the blood causes the cells to increase their consumption of glucose. To reduce the concentration of insulin is recommended: refusal of sweet * * * *; enough omega-3 fats * and magnesium * * *; green tea * *; physical activity * * *.

Leptin is produced by fat cells and limits appetite and food intake. However, chronically elevated insulin levels * * * and inflammation in the hypothalamus * * disrupt leptin signaling. The best ways to restore leptin sensitivity are to avoid pro-inflammatory foods like sugar and fat and increase your intake of anti-inflammatory foods like plant fiber, berries, fish * and alpha lipoic acid *; as well as regular physical activity * * * *; quality sleep * *.

Ghrelin is produced by the stomach and causes hunger. In overweight people, ghrelin is deregulated. To restore it, it is recommended to minimize the consumption of sugar-containing products * * and increase protein intake * * * *, especially for breakfast.

Cortisol is produced by the adrenal glands and released in response to stress. Chronic stress contributes to overeating and weight gain *. Normalization of cortisol levels can help: a balanced diet (high carbohydrate with moderate calories) *; meditation *; yoga *, other relaxing practices, incl. soft music * *; as well as a fairly long sleep *. Elimination of iodine deficiency helps to regulate the level of the stress hormone cortisol *. Omega-3 fatty acids, vitamins C (up to 1 g/day) and B5, and ashwagandha extract (600 mg/day) * * can be taken as supplements to reduce excess cortisol secretion in the afternoon.

Neuropeptide Y is produced by the cells of the brain and nervous system, and stimulates appetite, especially cravings for carbohydrates. Its level is highest during fasting * * * and stress, which stimulates the transfer and accumulation of abdominal fat * * *. Recommendations for lowering this hormone include adequate protein intake *; abstaining from food for no more than 24 hours * * *, increasing fiber intake, as well as probiotics *.

Peptide YY is produced in the small intestine and large intestine and also controls appetite * *. Strategies to increase this hormone include a protein-based diet *; fiber * * *; vegetables; as well as the rejection of simple carbohydrates in favor of long-digestible carbohydrates.

Glucagon-like peptide-1 (GLP-1) is a hormone also produced in the gut. It is released in response to the intake of nutrients in the intestines, and creates a feeling of satiety. Eating fast-digesting proteins such as fish *, whey protein * or yogurt *, as well as leafy greens *, probiotics * and anti-inflammatory foods * helps to create sufficient levels of this hormone on a low-calorie diet. The production of GLP-1 by endocrine cells is stimulated by short chain fatty acids (acetate, propionate, butyrate), which are formed as a result of the metabolism and fermentation of dietary fiber by the intestinal microflora *.

Cholecystokinin is produced by intestinal cells in response to the intake of fats, proteins and fiber, and also causes a feeling of satiety * *. To increase cholecystokinin, it is recommended to take enough protein *, healthy fats * and fiber, such as flax or beans *.

Melatonin, a sleep hormone (3 mg per night), helps to reduce body fat by 6.9% in postmenopausal women and increase muscle mass by 2.6% * within a year, which may be a consequence of its action against aromatase * produced by adipose tissue and beneficial effects on leptin and adiponectin levels *. Insufficient sleep is known to cause not only an increase in total calorie intake, but also changes food choices in favor of foods high in carbohydrates *.
Melatonin supplements in such doses, especially in old age, can be taken without consulting a doctor.

The lack of certain vitamins and minerals can complicate the task of reducing excess body weight.

Vitamin A regulates the level of leptin, a hormone that suppresses appetite.

Vitamin B3 increases the amount of adiponectin, the weight control hormone, thus promoting weight loss.

Vitamin D, which is deficient in 95% of the Ukrainian population, as well as magnesium, are strongly associated with the quality of carbohydrate metabolism: instead of efficiently burning carbohydrates for energy production, the body accumulates them, converting them into fat reserves.

Decreased overall inflammatory levels. Obesity is closely and mutually associated with inflammation in adipose tissue, so any action aimed at reducing the inflammatory index will contribute to weight loss. Anti-inflammatory interventions have been reviewed under «Anti-inflammatory therapy» .