Transcription
Friends, today I have one of the most famous endocrinologists, Roman Tirushkin, as my guest. What impresses me is that he treats the person, not the tests. Today we will talk about stress, the thyroid gland, chronic fatigue, excess weight, and how to maintain health and energy, and, yes, how to get it all back without unnecessary chemistry. Roman, I am very glad to see you. Welcome. How did you come to the conclusion that one must treat the person, not the tests? Well, it's a very long story. It probably all started from my first year of university, because in my first year I got my first teacher, my first scientific advisor, who taught us endocrinology. That is, we had an experimental training program where they decided to add this subject. And then I realized that, well, I need to look a little more closely in that direction, because you are what you eat. When we got to patients, to therapy, to the hospital in our third year, you start talking to doctors, you ask: "Why do we use such medications for this particular ailment?" They say: "Well, it's written in the guidelines, that's how the World Health Organization wrote it." Well, okay, but maybe we can think further, why? It's written there. Such a response: "Well, alright." In the fourth year, of course, problems arise with this, because they start asking questions: "Are you the smartest? Where are you sticking your nose?" I say: "No, I'm not the smartest, I'm just interested in why it's like that." So. And somehow from there I had to go my own way. And we came to the conclusion that numbers are interesting, symptoms, complaints are interesting, but what is written in the guidelines is sometimes the tip of the iceberg, and you need to dig deeper and figure it out. Therefore, in addition to regular medical practice, endocrinology was added, then nutritionally, then biochemistry, microbiology. And somehow we came to the cell, because all problems affect it. Roman, well, these are difficult times for us now. First the pandemic, then crises, then the Special Military Operation, rising prices, layoffs in large companies, and people are constantly experiencing stress, and not short-term, but really constant. What happens to our body during chronic stress? Can you explain it simply? In fact, this is the worst scenario, because our body adapts very well to acute stress. Something happened, we reacted sharply, either fought or fled, solved the problem, but it was all closed. From an evolutionary perspective, we are not ready for chronic stress. And when psychologists say: "You need to worry less," well, of course, it's very good, but have you tried it yourself? Calm down, it doesn't work. Yes, yes. Yes. So, unfortunately, as I always say, stress will not decrease. It will either stay the same as it is now, or increase. With responsibility, team, situation in the country, in the world. Well, that's just life. Plus, on top of all this, the increasing speed of our lives is added. Plus, as you correctly said, the pandemic, which has already passed, and many other factors are added to all this. And from this it turns out that the entire paradigm that existed before 2020 from the category, like eating 1 gram of protein per kilogram of body weight, that will be enough. Now you sit and think, and the debit and credit don't add up. And 1 gram. No matter what you do now, it won't be enough for anything. So, how much do you need? Well, now we are talking about at least one and a half grams per kilogram of body weight. And if we are also actively moving, then at least 2 grams per kilogram of body weight. Simply because we are protein-based life forms and resource consumption has significantly increased. And no one talks about this. The quality of products has significantly worsened. And we constantly don't get enough of everything we could be getting. Against the backdrop of chronic stress, a lot of magnesium, a lot of B vitamins are actively burned, which we again don't get enough of from food. And so it turns out that if earlier the question arose: "How to take vitamins, in what courses, and so on," now it turns out that if we want to live long, high-quality lives, and our whole life is not a sprint, we cannot reach some finish line and stop, our whole life is a marathon, and our task is to run it slowly, carefully, so as not to drop out of the distance. And in this case, we understand that the only option is to simply nourish our body on a constant basis. Therefore, when my patients tell me: "Romanovich, how much should I take?" As much as you want to feel good, because unfortunately, you have no other options. So, what happens? Our body, in response to chronic stress, triggers a reaction related to the brain and the limbic system. From there, a command goes to the adrenal glands, cortisol is released. Following cortisol, we have a release of sugar into the blood, because this sugar should be used by muscles. Again, either fight or flight. Insulin is released for sugar, because glucose must enter the muscles. Without insulin, it won't get there. And here a curious story unfolds, because after the release of insulin, our sugar decreases, and then it depends on the person. For some, anxiety appears against the backdrop of a sharp drop in sugar. For some, it can even lead to the development of a panic attack, mood swings, anything. And for some, we get a strong craving. And if it were just a strong craving, we would pull ourselves together and eat normally, with a basin of fiber, carbohydrates, a lot of protein, and so on. But we don't do that. We immediately start stuffing ourselves with sweets, pastries, and so on, because the body needs quick energy. And here is quick pleasure, of course. And here difficulties arise, because you have sugar spikes. For every sugar spike, insulin is released again, and you start constantly snacking, constantly eating everything. And sooner or later, this will become a habit. Uh-huh. That's it. Now we have insulin resistance, weight gain, pre-diabetes, and type 2 diabetes is very close. And nothing good comes of this, what to do with all this, if it's impossible not to worry, not to get nervous. You just need to burn cortisol. The question is, how? There are a great many options. Someone can breathe into a bag, however strange it may sound, but it's a working method, because our carbon dioxide level increases, the brain calms down against the backdrop of carbon dioxide, and everything passes. Well, I've heard that there's also some kind of box breathing, like five in, five hold, five out. Square breathing, yes, it's called that, you can do it for four, if it's easy for us, we can do it for six. There are a great many options. How long to breathe into a bag to lower cortisol levels? It's individual. 15-20 seconds is usually enough. So, that quickly? Yes, yes, yes. Well, if you've already gone into a panic attack, take a bag, and in 2 minutes you'll definitely calm down. It all works. Breathing, again, Wim Hof breathing will also work. Any breathing. There are many techniques, we can choose anything. There is a slightly destructive method, but many like it. It's just putting a rubber band on your hand and switching your brain with pain. Uh-huh. Many do this, so if you're nervous, you pull it, snap yourself. Many like it, but many don't. So it's a matter of taste. But I'm for the next option, which is probably the most unconventional, because it's quite difficult to do in an office. You just need to work your muscles, because cortisol and sugar that you have, you need to use it, you need to burn it. Therefore, if we are girls, we just start squatting until our legs fall off. If we are young men, we can just do push-ups until our arms fall off. If we understand that we have an unusual situation now, well, we can't just start squatting and push-ups, just walk, take a walk. That will also be enough to do everything. Therefore, when they come to me: "What can I do in the evening before bed?" The best option is: don't train before bed. But if we don't have any other time, of course, train. But if the question arises about training or something else, let it just be a 30-40 minute walk. It's very good. And it stabilizes the adrenal glands. You also prevent hypoxia a little, because you breathe, and in general, the body exhales a little before sleep. By the way, I heard that art therapy for 45 minutes also helps reduce cortisol levels. Further, if we dig deeper, there are many yoga, various other things, meditations, and so on, it's for a big fan. The main thing is that we get pleasure from it. That's it. Because if we all burn cortisol just because, because someone said so, it won't lead to anything good. You need to find what suits you best. Well, I understand that you are a proponent of constant magnesium intake. If you are stressed, it is naturally depleted. Which one is better to calm down? There's malate, oxide, citrate, many different forms. There are indeed a great many forms of magnesium. Here, perhaps, I would like to start by saying that magnesium oxide is the most inactive, least effective form, it is very poorly absorbed. The only thing we can do with magnesium oxide is to have a good bowel movement, because it will pass through transit and that's it. And then it depends on what we want, because, for example, I prefer to combine magnesium salts. It works more interestingly. For example, magnesium malate. It's better to take it in the morning, because magnesium has worked, it has stabilized you a bit, and the lactic acid that remains goes into the mitochondria and gives you a little energy, which we need in the morning. Magnesium citrate is better with dinner, if it really knocks us down. It happens. But in my case, it works well with lunch. Why citrate? Because it works well on the gastrointestinal tract. Its side effect is that it improves it. Yes, we used it very often with the team before, but when we encountered a large number of side effects, a significant relaxation of the gastrointestinal tract, so that people could not move far from the toilet, we stopped doing it. This is the best form, especially for girls who have constipation. Well, it happens, because if we don't go to the toilet every day, something needs to be done about it. It's clear that we need to address the root cause. Maybe bile stasis, maybe the thyroid, anything, but magnesium in the morning will at least eliminate this symptom. However, from the point of view of relaxation and beneficial effects on sleep, which is the most important thing for us to go deeper, exhale well, and so on, yes, it is, of course, magnesium glycinate. We take it either with dinner or just before bed, because magnesium has done its job, glycine as an amino acid has stabilized us separately. Everyone is great, everyone is happy. Sometimes the best way to recover is simply to change the scenery. Even a short trip can normalize cortisol levels, sleep, relieve anxiety, and recharge with pleasant emotions. When I understand everything, I need a reboot, I open the One to three application. Everything is convenient and profitable and in one place: hotels, tickets, car rentals, and even excursions. One TRIP has over 3 million hotels and apartments worldwide with payment by cards of any Russian banks. And here it is, my favorite cashback icon. This means that for every hotel booking with this tag, up to 30% of its cost will be returned to you as bonuses directly in the app. You can then use them to pay for your next trip. It turns out that the more you travel, the more you save. Plus, when you buy tickets, they will register you for the flight, remind you of the departure, and offer tickets for Aeroexpress, which is very convenient. And for business trips, there are special favorable conditions. Use the One to service for business and save even more on business trips. Download the app and travel more often with One to trip. After all, rest should be accessible. I will leave the link in the video description. And how much magnesium should you take separately to feel a calming effect? Well, the optimal dosage on average now is about 400 mg for an average person. Then everything depends on what is happening. With my weight, now 106, 107, uh, and with my loads, I very often take a gram, or even 200 grams. That is, with high loads, you can go from the calculation of 10 mg per kilogram of body weight. Of course, not everyone needs this, but sometimes it happens. But it is believed that magnesium is an antagonist of calcium. Will it not turn out that if we regularly consume magnesium, we will end up with osteoporosis? No, it won't happen, because calcium is a vital micronutrient in our body. We have four buffer systems in our body that protect the calcium-magnesium ratio by their work, so that calcium doesn't become too much or too little. Therefore, it will not be leached out. The only thing it can do is interfere with its absorption. But here the question arises: where is calcium in our food? We often exclude dairy. We do something else. I don't exclude it. For example, I eat cottage cheese in the morning and can take magnesium. So, it means we need to separate them. If we get so worried about it, I'm afraid we'll have to take pills on schedule. Therefore, I am for optimizing everything. Yes, I am willing to sacrifice 30% of effectiveness, figuratively speaking, but my patient will not be bothered and will not take something an hour before a meal, half an hour, 15 minutes, before a meal, during, after a meal. Because if you do everything according to the rules, then you will only be taking 12 doses of pills a day. What kind of non-anxiety are we talking about here? Therefore, no, from this point of view, we have optimized everything as much as possible. Everything directly before a meal. If something is not absorbed as effectively, so be it. Let us reach the goal not in 2 months, but in three, but we will do it in such a way as to relieve the extra burden and extra hassle for the person. Well, if a person has started sleeping poorly due to stress, what do you recommend? First of all, magnesium, secondly, a little more walks. Uh-huh. B vitamins, because they are water-soluble vitamins that do not accumulate in the body and are constantly burned. It's better in active forms, because again, the mutation of the folate cycle has not been canceled. Due to this, ordinary intramuscular B vitamins, like Melgamma, Combipen, and similar preparations, are not as effective as we would like. And, of course, we need to look towards protein, because we are again protein-based life forms, if we lack building material for recovery, it will also suffer. Of course, first of all, skin, hair, nails, muscles. And we can very accurately go into classic skinny fat, when we are thin, we haven't gained weight, but we do a bioimpedance analysis, there are no muscles at all, a lot of fat, again insulin resistance, pre-diabetes, and all the rest. Well, I have such a story. For example, I fall asleep with my child at 11:00 PM, but at 2, 3:00, or 4:00 AM I wake up and can't fall asleep. How to stop these early awakenings? Is it cortisol? It is, undoubtedly, cortisol. That is, the circadian rhythms have shifted, because the adrenal glands are a bit tired, in quotes, against the backdrop of your current life, so to speak. But here we need to understand what is happening, because it is clear that cortisol, okay, it is clear that there should be a sugar spike, yes, but then we need to understand what happens next, we need to understand why you wake up specifically, because some patients wake up from a drop in sugar, some patients wake up from a spike in sugar, and the therapy will be fundamentally different. Therefore, initially, to figure it out, you can either conduct an investigative experiment, or install a Libre, a sensor that is placed in the interstitial fluid, and for two weeks you attach your phone. It tracks your average sugar level and what is happening in general. If your sugar drops, then what to do? If your sugar drops, then directly before bed, we add a portion of protein, that is, protein, so that there is more. We add fiber there, so that this protein is absorbed more slowly, and some carbohydrate. You can use a banana, all this in a blender. And we try, we test it before. If our sugar increases, then the question of insulin resistance arises. And most likely, before bed, we will need to work with some kind of berberine or its analogues to improve the sensitivity of receptors to insulin. And then we will still even everything out. And these cortisol spikes, they should be there one way or another, but not at two, not at three, not at four, but around 6:00 or 7:00 AM. How interesting everything is. Well, by the way, returning to the fact that one should not look at a person's analysis, I specifically took an analysis, looked at cortisol, it's normal, but I understand that I am stressed, I wake up, there is a problem, but the tests are normal. But you took it in blood. Unfortunately, blood cortisol is not informative. Firstly, it is destroyed very quickly there. It fluctuates very quickly up and down, or something else. If we really want to assess the work of our adrenal glands, then the only option is to take a cortisol curve in saliva. That is, there are now in four points, there are in six points. We see a beautiful curve. That is, it is taken several times during the day, right? But, firstly, it will not be possible to take it perfectly, because to take it perfectly, you need to not drink any stimulants for 3 days, not get nervous, not have sex, and a large number of other factors. And when I offer patients: "Romanovich, are you kidding me?" No questions asked. But on the other hand, you need to think at all, do you need to take it? I'll explain why. Because I believe that this analysis is purely an analysis for the sake of analysis. Because all of us, given our lives, as we have discussed, have minor issues with our adrenal glands. It's just that some need to look at them more seriously, if we start waking up at night, falling out, and so on. And some can be looked at less seriously, but we still come to the foundation. That is, until we restore the natural functioning of the body, do not provide enough protein, do not provide B vitamins, do not provide magnesium, do not figure out vitamin D, do not figure out iron, the work of the liver, and everything else, it doesn't matter what we do with our adrenal glands, take adrenal peptides or sometimes my colleagues like to immediately give adrenal hormones or something else, it will be useless, because the body is not ready for recovery. It lacks the basic resources for this. And can this chronic stress provoke thyroid diseases? As they say, all our diseases are from nerves, this is indeed a very correct statement, you just need to understand why. Let's go in order. On the one hand, yes, everything related to stress, everything related to the adrenal glands, will be projected onto the thyroid. I'll explain why. Because in our body, the thyroid and adrenal glands very often use the same resources for their work. First of all, the amino acid tyrosine. From the amino acid tyrosine, the thyroid produces hormones. Also, from tyrosine, dopamine is produced in our body, our main neurotransmitter of purposefulness, movement, and so on. Also, from tyrosine, adrenaline and noradrenaline are produced. It turns out one amino acid, but there are as many as four functional variants. This is a lot. It turns out that we very often come to a tyrosine deficiency, because why? Because we don't get enough protein. And then there's the question of genetics. For some, the thyroid will fail first, for some, the adrenal glands will fail, for some, something else. But here we need to look further at how cortisol works. Constantly high cortisol, its constant spikes. What does it do? It reduces the effectiveness of our immune system. As a result, over time, the more we worry, the less actively our immune system works. And we have two systems in our body that protect us from everything. This is the detoxification system, which is responsible for neutralizing and removing all toxins from the body, i.e., our liver, and, of course, the immune system. When these two systems work well, we are protected from oncology and from most all problems that can suddenly befall us and create a lot of problems, difficulties, and so on. And I am for these two systems working as effectively as possible, when you are constantly nervous. What kind of immune system efficiency are we talking about? And if we unravel further, recalling COVID, all this history, according to all studies now, after COVID, the immune system does not work the same way. Yes, it cannot be said that it works worse or better. It just works differently. We all have Epstein-Barr virus, cytomegalovirus, herpes, and so on. They are in our lymph nodes. We catch them in childhood. They don't bother everyone, but after COVID, they start to become active in many people, overloading the work of our immune system, and the immune system stops working normally. Chronic stress is added to this, the immune system no longer works. And many tell me: "But I don't get sick at all." Of course, immune overload can occur in two cases. In one case, you start getting sick often, and in the other case, you stop getting sick altogether. Even so, because the immune system is no longer able to react to anything. And here I don't even know what would be worse. Wow. Well, in general, if you are stressed, you understand that there is an attack on the thyroid gland, including, how can you nourish it, maybe somehow help it? What is needed? First of all, the base, as we have already said, B vitamins, magnesium, vitamin D, omega, to slightly reduce inflammation, and so on. Then you need to look. It is clear that if we have taken tests and see high prolactin, I would give tyrosine separately, because the higher the prolactin, the lower the dopamine. They are antagonists. Also, if we are talking about the female body, I would definitely look at iron metabolism, because it is a matter of time when any girl will face a lack of iron, because the cycle has not been canceled. Sufficient iron intake has not been organized. Plus pregnancies, which happen, breastfeeding, and so on. These are all additional costs, because without iron, we will have hypoxia. That is, each cell will function less effectively than we need. Therefore, I would start with this base. And then everyone is on their own. That is, if there is Hashimoto's and we see an increase in antibodies and our immune system has started to go crazy, has started to destroy, we additionally look towards N-acetylcysteine, selenium, black cumin. If, God forbid, we have gone into some kind of thyrotoxicosis, do not experiment, go to the doctor immediately. This is an emergency situation, you need to stabilize the thyroid function. You don't need to invent anything there. If we see that there is just subclinical hypothyroidism, that is, the numbers are relatively normal, but all the symptoms are similar to hypothyroidism, these problems are not in the thyroid, the problems are precisely in hypoxia. Uh-huh. And here you just need to find the root cause of where it all started, and slowly unravel this ball. Well, by the way, you stated in one interview that when girls come to you for an appointment, in 70% of cases, you cancel hormones. Yes. Simply because most of my colleagues like to play it safe. And it is written in the guidelines that when you come with subclinical hypothyroidism, your TSH may be above the reference range, but at the same time T3 and T4 are normal. They say: "Let's play it safe, here are your hormones." I always ask one single question. Please tell me, after you added the hormone, has anything fundamentally changed? In most cases, the answer is no. Uh-huh. They take hormones because they work here and now and quickly. If they are truly needed by your body, you will feel them like this. If you take them for a week, two, all your symptoms are the same: swelling, weakness, inability to wake up in the morning, hair loss, worsening skin, nails, peeling, excess weight, anything. You don't see any changes. Congratulations. Your problem is not in the thyroid, and you don't need hormones. Uh-huh. Okay. And if people have already been put on hormones, how can they get off them? Figure out why the thyroid doesn't want to work? Because I have only one position on this. If our thyroid gland exists, it is not surgically removed due to oncology, not destroyed by radioiodine therapy due to thyrotoxicosis or something else, that is, it is not destroyed by autoimmune thyroiditis by our antibodies, that is, the organ exists. And it is determined by ultrasound, and everything is fine, and the size is not bad. The question arises, why is this organ not working? Uh-huh. If we find the points of application, why, what is going wrong, there are not many options, actually. That is, first of all, it is a lack of building material. Again, protein, right? What does the thyroid primarily produce hormones from? From the amino acid tyrosine, that is, protein, and iodine. Uh-huh. We are all deficient in iodine. Is it necessary for everyone? The question is open. It's better to check antibodies first. Yes, of course, we have iodized salt, but with the help of iodized salt, we can support something, replenish deficiencies, but we cannot. You would have to eat too much salt. Other problems arise, disruption of the sodium-potassium pump, many other things, overdose. Don't get into that. Understood? Therefore, everything should be in moderation. Then T4 is formed. Then T4 is the most inactive thyroid hormone. It then needs to be converted and
to convert into T3. The conversion mostly does not happen in the thyroid. 80% of the conversion happens in the liver and kidneys. And here the question arises: what happens in our main factory, the liver? Does the liver have enough resources for work? What about phospholipids, what about B vitamins? What about protein? Perhaps we have bile stasis, which overloads the liver's work. Here everything will accumulate like a vicious circle, like a snowball, and nothing will turn out normally. Hair is an adornment, and it needs good care. Due to my work, I often have to style my hair, so in everyday life I try to take maximum care of my hair. That's why I chose the Lifen C2 hairdryer. It is incredibly powerful, dries hair twice as fast as ordinary hairdryers. Airflow speed up to 21.5 m/s. This is a real lifesaver when time is short. At the same time, the hairdryer is lightweight, 390g, quiet, only 59 dB. It's comfortable to dry your hair even at night without waking up the whole house. and smart. It checks the temperature 80 times per second so that the hair does not overheat and remains healthy and shiny. It has several modes: cold, warm, hot, alternating temperature mode for maximum protection, and even a super-gentle children's mode for the most sensitive. The set includes three attachments: a smooth one for everyday use, a concentrator for styling, and a diffuser for gorgeous curls and volume. The hairdryer is amazing, compact, reliable, ideal for home and travel. The minimalist design and stylish colors are pleasing to the eye: yellow, black, purple, pink, and white. So if you are looking for a dream hairdryer that not only dries but actually cares for your hair, the Lifen C2 is what you need. I will leave a link to the hairdryer in the video description. That is, if a person, for example, starts eating a normal amount of protein, calculates it, consumes the norm, they then need to check the liver, how to normalize its work. understand what is happening, because the liver, again, is a large factory. We will not list all the functions that happen there now, otherwise we will stay here forever, approximately. But globally, the liver has two directions of work. This is protein-synthetic, when it synthesizes something for our body. It could be bile, it could be transferrin, iron-binding protein, ceruloplasmin, copper-binding protein, and so on. Or it is involved in detoxification, neutralization, removal of toxins from our body. But globally, all these processes should work 50/50. This is in the ideal case. But for one reason or another: stress, viral load, ecology, anything. We often encounter the fact that the detoxification function takes not 50%, but 80% or 90%. And in such a case, the protein-synthetic function slows down, and the liver no longer has enough resources to produce everything it needs. And it turns out that until you figure out why this is happening, accelerate the removal of all these toxins, improve bile flow, because everything happens through bile, because some people just need to improve bile flow, add a glass of hot water, that will be enough, and some need a glass of hot water plus herbs to improve it. For some, this is not enough and they need antispasmodics, because under stress everything spasms, and nothing drains properly. And for some, in addition to this, the bile needs to be more fluid, so that it drains even better. And some will have a complete overload, an overloaded liver, elevated cholesterol, we understand that we need to give phospholipids, which are also the active substance of bile itself. It turns out that everything here is individual. Someone needs one drug, someone needs none, and someone needs five to cope with the liver's work. I understand that if the liver is spasming, visceral massage can help, right? And what herbs can help the liver? First of all, it is artichoke for improving bile flow. You can also look towards milk thistle, for example. But from the perspective of milk thistle, one needs to be careful, because milk thistle is often given, but many do not consider Gilbert's syndrome. It is now being diagnosed little by little. It is actually present in a hidden form in many people. It is a genetic mutation when the body as a whole produces more bile than necessary. And we can often see high bilirubin in a jaundiced person against the background of stress, against the background of everything. It does not affect life in any way. nothing happens. Well, the only thing is, he won't be able to drink heavily, the body just won't allow it. And most likely, he won't be able to become an Olympic champion, because the body won't withstand the loads that are supposed to be there. In all other cases, there is nothing critical. In their case, it is better not to use milk thistle, because milk thistle will additionally block the gene responsible for this. Or it can slightly worsen the situation. Therefore, if we used to use milk thistle to improve bile flow, now we have moved away from it and use artichoke. So it turns out to be more interesting. Do dry thyroids work better for hypothyroidism than synthetic Euthyrox? This is from the category of peptides. So I am not against peptides, but one needs to be careful with them, because, for example, in dry thyroids, we have both T4 and T3. This is so-called combination therapy. We used to have, and earlier in Russia, there was a large number of combination drugs that contained both T4 and T3. Then they were banned because people started using them not quite correctly. Plus, there were several fatal outcomes, because T3 is very easy to overdose. But now, based on what we hear at conferences, we are still coming to the conclusion that they are indeed necessary. Perhaps, I think, one drug with a combination will return soon, but it is important not to prescribe it to yourself. Unfortunately, our patients often do this, because it is indeed very easy to overdose. And since T3 is very active, you can immediately get a side effect on the heart, arrhythmia, and similar things. That is why any manifestation of hyperthyroidism, when your thyroid is overactive, you see TSH at zero, and T3 and T4 in the cosmos, urgently run to the doctor, you need to stabilize everything urgently. Then the question arises: what to do? Because some of my colleagues have started looking at genetics, looking at how deiodinases work. These are enzymes that are responsible for conversion, that is, for the conversion of T4 to T3. They start explaining that you have a mutation in deiodinases, so you need combination therapy. Well, on the one hand, it seems logical, but on the other hand, if a genetic mutation is really to blame and the problem with deiodinases is to blame, why did we encounter this problem at 40+ years old? If this were really the main problem, why our thyroid doesn't work, we would have encountered it in early childhood, right? Because in childhood, without a properly functioning thyroid, the brain will not develop, and there will be a large number of other problems. Therefore, if we encounter at 30, 40, 20, whatever the age, that we do genetics, we see problems with deiodinases, it exists, of course, but the problem is not there. The problem is initially in the conversion. And before prescribing T4 + T3, I suggest figuring it out, because for our conversion to work well, we recall again the properly functioning liver, kidneys. We also need to have a sufficient amount of cofactors in the body, which are substances that help this entire process. magnesium, iron, selenium, zinc, copper, and many other things. It turns out that if at least one component of this entire mosaic is missing, nothing will work. Therefore, I am very careful with combination therapy. Many patients come: "I am on combination therapy." I say: "How?" "No way." "Let's try, let's keep Euthyrox, I'll just work on your conversion, let's see what happens." And for many, it really works. Yes, there are units, of course, exactly units, one in thousands, figuratively speaking, when Euthyrox simply doesn't work, improving conversion doesn't work, nothing works, they need combination therapy. Such patients exist. But, as practice shows, we arrive at all this through trial and error, or other options. If a person, for example, is helped by Euthyrox, the tests seem to be normal, but at the same time the body temperature is 35.8, 36.2. What does this indicate? This indicates that we have treated the tests, but not the person. Not the person. And here, most likely, we will again run into hypoxia. So the question is again, what is the dosage of Euthyrox, what does normal tests mean? Because many consider TSH 3 to be normal, although the optimal TSH number is from one and a half to two, and anything higher already indicates subclinical hypothyroidism. We need to understand what the T4 number is at this Euthyrox dosage, how well it all converts, what our ultrasound shows, what our antibodies to thyroglobulin, to thyroid peroxidase show. And from there, we additionally look at the general biochemistry, ferritin levels, and complete blood count, because simple inflammation can disrupt thyroid function, and nothing will work for you. It doesn't matter how much you drink or what's happening. Well, if someone wants to get off hormones, for example, some minimal dose of Euthyrox, they drink it. Where should they start? Connect protein and check tests or what? We connect protein basically, even without tests, without anything. We observe for at least 2 weeks, see what has changed in well-being, and then do a full check-up. Unfortunately, we can't just deal with the thyroid. We need to fully see what's happening, and then unravel the tangle. Because absolutely all patients who say: "We don't know what's happening, we've been everywhere, our tests are normal," if you have symptoms. You cannot have normal tests. It means they just didn't look where they should have. You need to find where to look. I'll tell you a personal story. My mother had anemia. She was prescribed Vinifer injections, iron, and after 15 infusions, her thyroid gland was damaged. So it turns out that iron salts in excess also provoke thyroid disease. Here we need to move on. Iron salt does not directly affect the thyroid. But we need to understand how it all works. Why I am very careful with iron infusions? Because now it's a hype, perhaps it's the right word. Indeed, most of my colleagues see low ferritin, they infuse, they pour. Okay, but let's think further. Iron is indeed toxic, a heavy metal in excess for our body. Therefore, firstly, one needs to be very careful with it. Secondly, if we have a slight inflammation in the body, if there is a deficiency of transferrin, the iron-binding protein, then iron will likely not be utilized. All you will do is increase the ferritin number, then it will fall just as quickly. This is in the best case, and in the worst case, you will increase inflammation, because ferritin is also a marker of chronic inflammation. Therefore, one needs to be careful with infusions. I am very glad that they have moved away from injections at least now. what was in the USSR, now they are banning intramuscular injections, because sometimes patients came who had bruises for half a year, yes, they dissolve, yes, and there, except for additional cosmetic procedures, no other way, because everything had to be broken down. That's why here I am for the fact that we must, first of all, understand what is happening with the iron level itself, what is happening with protein metabolism, what is happening with inflammation, with liver function, with B vitamins, and slowly, with cat's paws, move carefully. And let me better restore iron for half a year, but we will do it smoothly, carefully, without sharp jumps and without burdening the body. Because where is the rush here? There is nowhere to rush. Everything needs to be done slowly. And as practice shows, when you do everything slowly, there are no problems. What happened to your mother? With a very high probability, 15 iron infusions. Well, that's a bit much. Let's be objective. It turns out to be toxic exposure. Most likely, there was too much ferritin. The load increased, the liver overloaded. We remember that the conversion of T4 to T3 occurs in the liver, and the liver no longer had time for conversion. And from there, the thyroid went down. Therefore, if we put the question bluntly now, can I solve the problem with your mother and remove her Euthyrox, make the thyroid work, based on your words, with a very high probability, yes, but I need a full anamnesis, all tests, etc., a full consultation, and then we will figure it out. Well, you yourself noted that girls often face anemia. Then how do we replenish and with what medications to replenish this iron deficiency so as not to have such problems? Here, most gynecologists will probably not agree with me, but I no longer explain anything to anyone, we just agree and that's it. My position is that it is only a matter of time when any girl will face iron deficiency, because debit and credit do not match. Yes, I will not argue that iron is present in buckwheat, in apples, in pomegranate juice. It is, of course, but we, unfortunately, are predators, or fortunately, and there iron is not in the right form. We cannot simply absorb it. It is very poorly absorbed by us. The only iron that we can truly absorb is red meat. Meat. And here the question immediately arises, how much red meat do we eat. Girls eat very little of it. That's the point. Now let's talk about expenditure. Iron expenditure during the cycle. For some, it is very heavy, for some, not so much, but it is still there. Iron expenditure during sweating, during training. There is iron expenditure for myoglobin. If we are trying to build muscle, myoglobin, muscle protein also contains iron. Iron expenditure for detoxification. That is, the first phase of detoxification, when cytochrome P450 works in the liver, iron is also needed there for everything to function. I can provide another 20-30 examples where iron is needed. And here it turns out that we do not provide enough iron, and it is consumed colossally. It is only a matter of time when we will face this. And given that many do not plan pregnancy, do not prepare properly, they enter pregnancy already with iron deficiency, and then everything around worsens, then most children who are born are already born with iron deficiency. And then, as they grow up, it only worsens. When girls reach puberty, menarche, the first cycle, it becomes even worse for everyone. And how to replenish it in oneself and in a child? What to work with from childhood, to do tests? Because my daughter, for example, started taking iron at 4 days of her life, yes? Because no matter how much I fed my mother, no matter how much we infused my mother, given the severe hypoxia during pregnancy, given the large expenditures during pregnancy, Solka was still born with iron deficiency. Yes, she still takes it not every day, periodically, but she takes it. And it's immediately visible on her, as soon as the white membrane of her eyes becomes very clearly blue, a sign of iron deficiency hypoxia, it can be given. By the way, it's probably also important to note that one should look not only at hemoglobin, because, for example, my hemoglobin was normal. When I did serum, I looked at iron, ferritin in my blood serum, there was a deficiency, yes, because hemoglobin and complete blood count are constants that the body will maintain until the last. Even serum iron can be normal, or elevated, or low. It is not indicative, it is in the moment. Therefore, we must assess the complete blood count, overlay ferritin on it, the strategic iron reserve, definitely look at transferrin, the iron-binding protein, because sometimes it happens that ferritin is normal, but there is no transferrin, and then nothing will work. Definitely, I would say, look at zinc and copper. I'll explain why. Because copper is a very important factor for iron work. If there is copper deficiency, iron will not be utilized. And we encountered this very seriously during COVID, because during COVID people heard that zinc helps stimulate immunity, and everyone started taking zinc. And zinc is an antagonist of copper, right? And we encountered copper-dependent anemia. That is, there is iron, everything is there, there is copper deficiency, there is a lot of zinc, it displaced everything, and nothing works. And here it was necessary to connect active copper to fix everything. And what does copper contain? What can I feed myself with? We cannot replenish it with food, only with vitamins. No. Well, there are just good dosages needed, so it's completely different. So how to feed our body only with vitamins, if we raise the question of which ones to choose, because there are a great many options. Of the pharmacy options, I only like one drug, because everything else causes a lot of side effects, does not work as effectively. Therefore, I am more for dietary supplements, and I prefer drugs with cofactors. That is, substances that help absorb iron. It is clear that, for example, bisglycinate, the active form, is okay, but iron is a very capricious micronutrient. And besides not washing it down with coffee, of course, you shouldn't, because coffee in general will interfere with the absorption of your favorite micronutrient. For iron to be well absorbed, there must be enough vitamin C, vitamin B9, vitamin B12, B6, manganese, zinc, copper, a large number of other factors. And instead of collecting each of these pills separately, it is easier to take one pill, and you will have everything at once. And ideally, these are not complex vitamins, but rather iron preparations with additional cofactors that help iron work. Understood. Well, as you also noted, many people start eating their stress, get obesity in general. And what hormone is responsible for our night trips to the refrigerator for something tasty? Well, cortisol, and following cortisol, insulin, so that sugar is utilized, and as a result, sugar drops, we go to the refrigerator. How can people lose weight? Your endocrinologist's advice. Where to start? First of all, a very large number of people write from the RMS category: "No money for tests, no money for consultation, no strength for anything. Help." So: "Okay, forget about vitamins, forget about everything. Just increase your protein and fiber intake." And as practice shows, honestly, for 90% of people, half of the problems are already solved. Cravings for sweets disappear, right? Yes. Skin, hair, nail quality improves. Even body structure changes, because muscles finally start receiving enough protein. Can you get the required amount of protein from food at all, or do you still need to, if we weigh less than 70 kg, I don't see any problem with that, because protein is not a replacement for our diet, it is an addition. Since I weigh 105-107, now it will go, I physically cannot eat enough from food. Well, I can, but I would have to do nothing but eat, and I don't have time. Therefore, it turns out that my morning meal after waking up is a portion of protein to get enough protein. But is it necessary for everyone? No. If I had time, I would gladly eat another 300g of meat on top, but unfortunately, there is no time for that. Okay, good. So, we replenish protein deficiency, what else can be done? For the most part, many problems will already be solved. If we have reached the required amount of protein and have been eating it for 2 weeks and realize that nothing is improving, there is no more strength, but the body is not reacting in any way. This is a reason to do tests and figure out what's happening there. Anything can happen there again. It starts with digestive disorders, that what you eat, the body doesn't digest this protein normally, we get heaviness, bloating, heartburn, constipation, diarrhea, anything, any problems, these are sure signs that our digestive triangle, namely the stomach, pancreas, and bile ducts, are not working normally. We need to figure out why, where, how. Girls, iron deficiency. Absolutely everyone. Lack of B vitamins, magnesium, because stress is not canceled. Lack of vitamin D, because there is not enough sun. We don't have that much sun. Vitamin D is still about a hormone. One needs to be careful with it, of course. But again, the question arises: what to do? Because a large number of patients who live not in Russia, who are in the sun all year round, you won't believe it, absolutely all of them have vitamin D deficiency. Therefore, when I am asked the question: "Should I not take vitamin D in the summer? Or when I go on vacation, should I take it, otherwise nothing will work?" Well, for example, I took vitamin D, my FSH started to rise. As soon as I stopped, it stopped growing. So there was a direct connection. The question is, how much did you take and how did you take it? And what? For a very long time after pregnancy, vitamins, the pregnancy period, everything contained vitamin D, D, D, D, of course, D is a prohormone, it affects a large number of receptors, it affects sex hormones, but here we need to consider many other factors. What you are talking about is a very rare, let's say, story, when it directly affects the command from the brain to the ovaries. This certainly happens, but it is a rarity. Therefore, here I am more for the fact that we must definitely consider the amount of magnesium, because vitamin D works with calcium. Here are all the problems that everyone talks about, calcification of blood vessels, formation of kidney stones, and so on, they arise when you take a lot of D and don't eat magnesium. And that's how it is, because it starts to work with calcium, and calcium starts to deposit here, deposit there, and when you eat enough magnesium, magnesium neutralizes all this. As a result, there are no problems, only benefits. My friend eats, counts calories, goes to the gym, trains for 2 hours in the gym twice a week. At the same time, she doesn't lose weight. What's wrong with her body? If we cannot defy the laws of physics, then we are doing something wrong. Firstly, below fifteen hundred is not a physiological norm. Absolutely all girls who come to me say: "I eat 700 calories, I can't lose weight." And you won't lose weight. These are the most difficult patients, because we have to explain for a long time that for you to lose weight now, we need you to start eating three times more. We need to wake up your body, because it thinks you are in a concentration camp, a black streak, you are not feeding it enough, there is trouble, and it will not let you lose a single gram. You will smell a bun and gain weight just in case, it will do everything for this. And here the laws of physics are slightly violated. It's not just that you need to eat less and keep track of calories, you need to give the body the necessary resources. First of all, protein. Let's see what else is missing. Perhaps, against this background, the thyroid has started to slow down, again, and hypoxia, many other things. We need to work on all this specifically, start gradually increasing consumption of everything, first of all calories, and sooner or later the body will wake up, launch all metabolic processes, and then at fifteen hundred we will start walking normally. That's how it is. Ah, okay. And what products do our hormones generally love? What should be included in your diet? Our body loves balance first of all. So I am against demonizing something, praising something on a pedestal, and so on. I am for an adequate ratio of everything, because everything is poison, everything is medicine. Well, let's not talk about counting, because you have to really love doing it. Therefore, it is easier to use the same Harvard plate, which is easier to divide and so on. That half of us is fiber. And fiber is again not about cucumbers and tomatoes, unfortunately, because there is more water in them, but about leafy vegetables first of all, it is a quarter protein and a quarter garnish. That's it. Then you need to look. So, it is clear that if we can add good fats, for example, because the body launches all sex hormones from cholesterol, of course, we look towards avocados, towards fatty red fish, and so on. The question is again about possibilities. Not everyone can look in that direction, and so on. Then at least we look towards butter. Although how much butter costs now is also a separate issue. So, if everything is like that, we at least look towards eggs. Do not demonize eggs, do not demonize the yolk. It's cool, yes? With good egg consumption, say, five a day, our cholesterol may rise. But that's normal, because besides cholesterol, it also contains a large number of phospholipids, which are responsible for redistributing good and bad cholesterol. So our cholesterol will rise, and good cholesterol will rise, and the liver will be happy, and sex hormones will work better. Therefore, ideally, the more eggs we eat, the better it will be. We have no restrictions there. What can be eaten every day? You can eat it every day and as much as you want. Dietitians say you can only have it two to three times a week. I had a period in my life, it was about five to seven years, when I ate 10 eggs every day. No problems. Well, I was just gaining protein, because it's, well, it's cool, it's interesting, why not.
Many patients love eggs. We prepare them in various ways, come up with new things, so it's only for the best. But there are goitrogenic products that are harmful to our thyroid gland. And at the same time, they help with weight loss. Many people, when losing weight, focus on broccoli, on white cabbage. All these products are goitrogenic, yes, because they disrupt the thyroid's metabolism and so on. But the question is again, how much do you need to eat for all this to happen. Right. Therefore, again, you shouldn't do a mono-diet. That is, the worst thing we can do is to go on a buckwheat-only diet, a broccoli-only diet, anything at all. Don't. If there's a little bit of everything in our life, it will be maximally diverse. Our diet is the best option. So, do you like broccoli? Eat broccoli every other day, don't worry about it. Do you like buckwheat, eat it. Don't like it, don't eat it, for your health. There are a great many cereals, choose what's comfortable for you. Just listen to your body. For example, I know for sure that I have gluten intolerance and lactose intolerance. It's a mixed intolerance. So, with lactose, I can't eat milk in any form. But at the same time, cottage cheese and cheese go down perfectly. Okay. From a lactose perspective, I love pasta. I can't live without pasta, but I know I'll feel bad. Therefore, I prepare once every 2 weeks, stock up on enzymes, go, take enzymes, and eat delicious pasta to get pleasure. And I know that if I don't take enzymes, I'll feel bad, but I'll get a lot of pleasure from it. Therefore, I always weigh what's good and what's not. Therefore, if we understand that something harms us for one reason or another, causes inflammation, any problems with the gastrointestinal tract, then perhaps this product should be minimized. It is clear that we are generally talking about minimizing sugar, flour, and similar things as much as possible. I am not against the fact that if you like some dessert or something else, let it be. It will be once a week or once in a while, but not every day. By the way, I think you shouldn't exclude carbohydrates at all, because then the thyroid also suffers. This is a question for all our athletes, like bodybuilders, who are close to going on stage, who very often cut out all carbohydrates, they have to add thyroid hormones, because the thyroid says: "I'm not working, there are no carbohydrates, I'm out." So I believe that we have a base. The base is protein, and the base is fats. That's it, we can only play with carbohydrates in terms of calorie content. That is, protein is 2 g per kg of weight every day. Let's take the example of 55 kg. How much protein do I need to eat? 110 g of protein. So, 110 g, on average, 100 g of meat, any meat, fish, and seafood, has only about 20 g of protein, right? So you need to eat 550 g of chicken. Clearly, 500, half a kilogram of chicken. Clearly, this sounds like a lot and you won't eat that much, so we don't suggest it. Therefore, all this needs to be broken down correctly, at least into three meals, plus a snack, so that it's not difficult. So for breakfast, we can have, for example, three eggs plus some bread with cheese, or something else. And in total, we will get over 20 grams of protein. Uh-huh. Okay. 90 left. For lunch, we eat 150 g of some meat or fish. Again, this is 30 g of protein. In total, we have eaten 50, 60 g left. So, for dinner, we again eat either fish, or seafood, or again poultry, another 150 g. That's another 30. And we have 20 g left. We haven't eaten enough. Therefore, to get another 20 g, you need to add some snack somewhere, possibly with a protein cookie, a protein bar, or just drink a portion of protein, as you feel comfortable. In that case, you will easily reach your goal. In my case, for example, I weigh twice as much, and I need to consume 220, or even 250 g of protein. This means you need a kilogram of chicken and six eggs. Exactly. And in my case, we understand perfectly that without a portion of protein, or even two portions of protein that I drink at once, it is simply impossible to get enough protein. And here it turns out that either I should train less, worry less, work less, or drink protein. The choice is obvious. Why do bodybuilders who relied on protein food, on these protein bars, later have heart problems? We all know, there were examples. Problems are a violation of cause and effect. Their heart problems are not from protein bars and the amount of protein, but, unfortunately, from sports pharmacology, which is used in terrible dosages. There is no talk of health there. It's exclusively high-performance sports. Everything is at stake there. Therefore, now a large number of such athletes die, around 30 plus, or even younger. Simply because they do the wrong things. There is no talk of health there. Understood. Well, another common problem. You even wrote about it in the comments: you just woke up, and you're already tired. And so people start drinking coffee by the liter. By lunchtime, they seem to have woken up, by evening they are even flying, but in the morning they still can't get up. What's wrong with these people? Or are they just night owls? It's a shift in the cortisol curve again, instead of a morning spike, it possibly happens at night. We might not wake up or wake up, depending on how it goes. Despite all this, there's also a surge of energy in the evening, because we should have a second cortisol spike around 4 o'clock, but when it shifts to the evening, there are difficulties, because it's time for you to sleep. It's like being charged with energy. Yes, on the one hand, you can say that we are night owls, but I believe that night owls are broken larks, because from an evolutionary point of view, we were all larks. Because if you were a night owl when mammoths and everyone else were running around, you would be eaten. It's very simple. That's why all night owls are broken larks. It's normal. Well, someone is comfortable with it, someone doesn't feel any problems, no questions asked. The main thing is to find the optimal rhythm of life for yourself. Therefore, if we used to get enough sleep in 7 hours, now we sleep for 7 hours, we have to resurrect, nothing helps. We want to sleep after eating, and so on. With a very high probability, again, we have pronounced hypoxia. Against the background of hypoxia, there is also insulin resistance. Our body doesn't work correctly with carbohydrates. The main problem is protein deficiency. We need to understand where the hypoxia comes from. That is, either the liver, or iron, or B vitamins, or all of this is lacking, or everything is working incorrectly against the background of inflammation. So there are not so many reasons, actually. You just need to break them down and understand where to start solving everything. Many people resort to stimulants. Someone drinks coffee, someone drinks some stimulating drugs, various herbs. And perhaps for a short period of time it will even help, but you will take even more credit from your body, and then you will have to pay back even more. That's how it is. But how do you understand if you're just tired, for example, or if you already have chronic fatigue and some hormonal imbalance? Well, let's rephrase the question. Do you remember how you felt last week? Vaguely. Precisely because our life is too fast, too much is happening. I don't remember how I felt yesterday. Given my schedule and tasks. Everything is done, so it seems normal, but globally I don't remember. Therefore, the only thing I ask everyone is to open notes, notebooks, or something else and start evaluating yourself at least once a week. Once a week, set aside 5 minutes, on Sunday morning, figuratively speaking. Choose the scales that are important to you right now. Physical health, emotional, sexual, libido in young people, erection, something else, weight. And track it once a week on a ten-point scale, as a percentage, as you prefer. And within at least 8 weeks, two months of doing this, you will already have a clear trend of what is happening. If over 8 weeks the trend is downwards, congratulations, something is already going wrong, urgently get tested, find a doctor, solve it. If everything remains the same and you are generally satisfied with everything, congratulations, don't interfere with anything. If you are satisfied with everything, then it should be so. If there is some growth somewhere, I would sit down and think. Check the calendar, remember what happened then, why we grew. Maybe someone fell in love, someone started exercising, someone gave up sweets. It all happens so quickly that we did something and didn't even check it off. Yes. That's important to track. That's why it's important to listen to yourself, because all this happens so smoothly that it's not like you woke up perfectly yesterday, and today you can't wake up. No, it happens so smoothly that everyone blames it on their age, on not having a vacation for a year. Weekends are busy, no time to recover. Everything is fine, all excuses, the body is just breaking down very slowly and very smoothly. And it is precisely with such tracking that we can clearly understand that it's time, we need to do something. And when should one be alarmed? That is, during the week, if you, for example, have a decline in energy, or within two weeks you realize that your physical and emotional state is suffering? My position is that you should be alarmed when you start thinking about it, that something is wrong. That is, if something is already going wrong, then something is going wrong. And it doesn't seem to you, you don't need to cross yourself, you need to get tested and figure it out. Understood. And what habits generally negatively affect our hormonal system? What should people change in their behavior? First of all, it's sleep. That is, it's clear that we can't sleep according to the textbook, from 10 PM to 6 AM. Well, some can, and I'm very happy for them, but very few people. Therefore, the most important thing is to at least go to bed and wake up at the same time. Yes, research is currently being conducted from the perspective of weekends, where on the one hand they say that you can catch up on sleep on weekends and it will be good. Others say you can't. I still adhere to the old opinion that on weekends we can shift by an hour, but no more. I clearly understand that if I sleep 2 hours more, my circadian rhythm is immediately disrupted, it becomes difficult for me to wake up, I don't want anything, and so on. Second, protein deficiency, fiber deficiency, and water deficiency. Uh-huh. Aspects that are worth looking at, because many people don't drink enough at all. And those who drink coffee like water, that's a separate story, because coffee will also dehydrate you. For every cup of coffee, it's better to add a couple more glasses of water. Additionally, it's daily activity. We are not talking about workouts now. Workouts are already advanced. You need to get there, you need to enjoy the workouts. Well, I don't like team sports. Running after a ball or a puck is not my thing, but quietly lifting weights with headphones, not bothering anyone. I like it, I get pleasure from it. You just need to find what works. If we have two workouts a week, that's great, but it's not enough. And most importantly, here comes our daily activity. That is, we just need to walk. Unfortunately, we walk little now. Because we walk little, our calf muscles don't work well. Because the calf muscles don't work well, lymph stagnates. Detoxification is impaired, intoxication of the body occurs, immunity decreases, the liver is overloaded. And it's all because we don't walk. And we don't walk, yes, we don't. If we also don't drink enough water on top of this, I believe that this will be enough to change everything. It's clear that if we also add mental health to all this, because sometimes you need to work with your head, and in addition to our vitamins, pills, everything else, you also need specialists who can competently delve into it, adjust everything, because, well, it's normal, we can't solve all problems ourselves. If we also add the necessary vitamins to all this, not just because I want them, but after taking tests and clearly selecting what is needed, then the result, I believe, will be inevitable. What is more harmful to our body: daily coffee or toxic relationships? A person is in them, constantly experiencing them. Toxic relationships, of course, because coffee is beneficial according to all studies. It's a matter of quantity. That is, 3 to 4 cups a day is beneficial, but anything more will be harmful. Uh-huh. But toxic relationships, they are harmful in any form, in any quantity. But coffee, I read that coffee alkaloids wash out magnesium, B vitamins, lithium. All this causes anxiety. But despite all this, a very large number of studies show that coffee has a very beneficial effect on liver function, on our microflora, on bile flow, and a large number of other aspects of the body. Therefore, coffee in adequate quantities is beneficial. Everything washes out of us. Even water washes things out of us, that's normal. Therefore, we just need to replenish the things that are consumed faster. If we are now coming to the point of what we need on a permanent basis, because, well, it's just not enough, I would say that we are talking about vitamin D, magnesium, B vitamins, and omega-3. This is the base that everyone should have, even without tests, just constantly, because everyone lacks this. But as for everything else, for some it's iron, for some it's lithium, for some it's something else. This is all exclusively based on tests after consultation. If a person realizes that they are not in a good state, they are experiencing chronic fatigue, how can they get out of it? What is the action plan, where should they start? Let's understand, do they currently have the desire and resources to get tested and see a doctor, or do they want to try on their own? Probably try on their own. Probably no extra money. In that case, if there's no money, we exclude buying vitamins and everything else and do it simpler. This person adds walks. Uh-huh. Ideally, wake up in the morning, go for a walk, yes, they might not get enough sleep for half an hour, but go for a walk. In their case, it will be more effective than lying around unnecessarily. They will understand this in the long term, their body will realize it. Plus, add a walk before bed for 30 minutes, or better yet, an hour if possible, and increase protein intake. That's it, in two weeks, a lot should change in their body, because with sufficient protein intake, their cravings for sweets, for flour, will disappear, sugar spikes will stop or be less frequent, which means fewer snacks, less desire for coffee, and many other things. And it turns out that we haven't done anything globally. We've just adjusted two gears. In fact, the body will react colossally. Great. Well, if we talk about women, we are often scared that after 50 years, menopause will come, and you will start to fall apart. What to do to not fall apart after 50-60 and somehow feel good without hormone replacement therapy? No way. How so? Without hormone replacement therapy, it's impossible. That's the point, that unfortunately, unfortunately, our body, from an evolutionary point of view, is designed such that the male body starts to break down after thirty, because testosterone production decreases every year, decreases, decreases, yes? Some will feel it at 30, some at 20, everything is bad, and some will feel it at 70, whose receptors are very sensitive. From the perspective of the female body, everything happens a little later, but when we reach menopause, we can support ourselves with various herbs and so on as much as we want. But, as practice shows, it's not for long. As long as the receptors respond somehow, then it all ends. And then we lose protection for the heart. Why do women generally live longer up to 50 years? Why fewer heart attacks? Because women have a cardioprotective effect from estrogen. Uh-huh. That is, a high level of estrogen helps protect the heart. Men don't have this. Therefore, if we look at the statistics of heart attacks, men under 50 have significantly more heart attacks than women. After menopause, this property disappears, and the number of heart attacks evens out between men and women. Second, osteoporosis. We cannot forget about it. Estrogen affects the density of our bones. If there is no estrogen, bones will gradually, gradually be destroyed. It's only a matter of time when they become brittle. There are no other options besides estrogens here. And only third, after all this, is the quality of skin, hair, nails, libido, sufficient lubrication, and everything else. Therefore, here you need to think not from the perspective of beauty, but from the perspective of the body's functioning. And unfortunately, from an evolutionary point of view, after menopause, we are written off. If we say scary words, if we don't want to be written off, we must simply surrender, prepare our body for hormone replacement therapy, check everything, and choose it correctly. And in that case, there will be no problems, no side effects, nothing for us. And we can calmly feel like we are 35 at 60 and 70, and even give them a run for their money. Well, they say that hormone replacement therapy, I don't know if it's a myth or a truth, provokes oncology, thrombosis, well, many problems. Blood thickens. Undoubtedly, there is a slight thickening of the blood, but for this, we need to supplement with certain vitamins that will neutralize this problem. That's the first thing. Second, we need to prepare your body. Where do various thoughts arise that on the background of hormone replacement therapy? Sudden weight gain, sudden oncology, and so on, because it was given to an unprepared body, where there was already a violation of sex hormone metabolism, the liver was sluggish, a large deficiency of various substances, already existing early oncology, most likely, was simply undetected, and so on. When, against the background of all these factors, you give HRT, of course, everything will flare up. But if everything is done correctly, normally, everything is diagnosed, everything is replenished, and on top of that, you add a little hormone replacement therapy, we will give 60-70 year olds a run for their money. So all Hollywood stars who look good, they all, regardless of gender. Are there any phytopreparations that can replace hormone replacement therapy? There are phytopreparations, and as practice shows, they only work at the very beginning. As soon as the first signs appear, they can slightly level things out and postpone it a bit, but then they stop working. Okay. And what about men's menopause, what should they do? Men's midlife crisis, when he lies down at 30, drinks beer, doesn't know where he's going, whether he's going in the right direction, whether he needs a family, whether he doesn't need a family, whether he has the right job. And all of this. Uh-huh. This is classic when the testosterone level decreases, these decrease, then stress piles on, most likely, and in general, his dopamine system is disrupted, and testosterone doesn't work, and he doesn't know what to do. What to do? First of all, restore the body's functioning. That is, most likely, everything has been depleted due to chronic stress. Not all men at 30 need testosterone, of course. That is, I would consider it after 50. But one cannot deny the fact that a very large number of young people are now entrepreneurs who, at 35, already have everything except time and energy. Most come with the request: "I listened to you, I went to your colleagues, I want it." I say: "Well, want it." I say: "Let's replenish everything for you first, let's fix everything, and you'll tell me in 3 months." And 90% of people come back in 3 months and say: "Everything is okay, we are all excellent, I don't need anything anymore." Because we have replenished the natural functioning of the body, given the body what it has long lacked, and it was able to return to the level where it should be. Therefore, before simply, as my colleagues do, giving testosterone left and right, which unfortunately happens often, you need to first figure out why he is asking for testosterone. Well, we've given viewers so much information today. Let's do a quick blitz at the end, short questions, short answers. If a girl has acne, what hormones should she check and what tests to take? First of all, you need to check the liver, not hormones. With a very high probability, various rashes on the body are a violation of detoxification. That is, the liver copes with elimination through the bile ducts, through the intestines or urine, and starts to excrete through the sweat glands. And that's where all these problems arise. What hormone is responsible for the appearance of dark hair above the lip in girls? Well, first of all, testosterone. But I would blame, again, not testosterone, I would blame insulin resistance first, because it's a complex chain. First, insulin resistance occurs, then PCOS, polycystic ovary syndrome, may occur, and against their background, testosterone will increase, and somewhere between all these processes, hair will appear. What hormone is responsible for baldness in men? Either genetics. That is, you need to look at your father, at your grandfather. That is, I'm still holding on, because judging by what my mother told me, my father was already bald at 25, so I'm fine, yes, there is certainly a genetic predisposition that my dihydrotestosterone, the most active form of testosterone, affects hair follicles, they fall out. There is a solution, well, there is a solution in tablet form, but when young people come to me with a similar story, they say: "My trichologist prescribed it." I say: "Well, well, I lost my libido and erection." I say: "Well, of course, because this drug blocks the conversion of testosterone to its active form." And you just need to accept it, you either have hair or libido and erection. It's very simple. Of course, most choose libido and erection, so the only treatment option is transplantation. Understood. If there is constant anxiety and sleep problems, what tests should be taken? Complete blood count with differential and ferritin, transferrin. That will be enough, because with a very high probability, the problems are either with protein, iron, B vitamins, or all of them at once. If a person has started having problems with memory and concentration, what deficiencies and hormones could be to blame? First of all, it's again hypoxia, the same thing we just learned, complete blood count, ferritin-transferrin, because our brain is very sensitive to oxygen deficiency. When there is not enough oxygen, concentration, memory, attention decrease first, mood swings occur, up to the development of panic attacks, depressive states, and so on. Therefore, first of all, you need to look there, and hormones should be considered last. Understood. And why are pregnant women still prescribed the glucose tolerance test, which is terribly harmful to the health of the mother and fetus? There, it seems, 75 g of sugar is 15 15 teaspoons of sugar. A lot, right? Yes, because that's what the clinical guidelines say. The World Health Organization has not yet revised this protocol, but I strongly urge girls not to undergo it, not to take it, because unfortunately, there have been quite a few patients who developed diabetes mellitus against the background of this wonderful test. Terrible. What is the main deficiency that most often goes unnoticed? I would put protein in first place. What hormone is easiest to support with the right actions? Thyroid hormone. What needs to be done for this? A schedule and sufficient protein intake, and a little iodine. Well, friends, let's please our hormones today, get enough sleep, go for a walk, eat something healthy, tasty, and good. Thank you very much, Roman, for your advice. It was very interesting. Good luck and health. Thank you. M.