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PHNG CHNG BNH TIM PH N
Tc gi: M. SARA ROSENTHAL NGUYN MINH TIN CHIU HI (bin dch) BS. V MINH C - BS. NGUYN BNH MINH (hiu nh) Pht hnh theo tha thun gia Cng ty Vn ha Hng Trang v tc gi. Nghim cm mi s sao chp, trch dch hoc in li m khng c s cho php bng vn bn ca chng ti.
KHXB s 134-2007/CXB/68-21/TG
In n v pht hnh ti Nh sch Quang Bnh 416 Nguyn Th Minh Khai, P5, Q3, TP HCM Vit Nam
Published by arrangement between Huong Trang Cultural Company Ltd. and the author. All rights reserved. No part of this book may be reproduced by any means without prior written permission from the publisher.
Tc gi: M. SARA ROSENTHAL

NGUYN MINH TIN - CHIU HI (bin
dch)
BS. V MINH C - BS. NGUYN BNH MINH
(hiu nh)
PHNG CHNG BNH TIM PH N
NH XUT BN TNG HP THNH PH H CH MINH
LI GII THIU
Khi Sara Rosenthal nh ti vit li gii thiu cho cun sch ny, ti cm thy va vinh d va phn khi. Vinh d, l v khng phi ngy no ngi ta cng ngh nhng trit gia chuyn v cc nguyn tc o c trong y hc nh ti ni v bnh tim ca ph n trong th gii thc ny; v phn khi, l v cun sch ca Sara s gip cho hng nghn ph n c sng lu hn v khe mnh hn. V mt l thuyt, l ra khng cn phi c mt cun sch nh th ny. Th gii ca chng ta c th c t chc to ra iu kin sc khe tt mt cch t nhin m khng cn phi c nhng s quan tm c bit, bng cch khuyn khch s vn ng c th, n ung tt v khng ht thuc l. Thuc men v chm sc y t l ra c th c hng n nhng nhu cu ca tt c mi ngi ch khng ch ch trng ring vo nam gii. Vic nghin cu l ra cn
Phng chng bnh tim ph n

phi xem xt n bt k khc bit no gia ph n v nam gii, v cc phng php cha bnh l ra cn c th nghim vi c ph n ln nam gii. Nhng v mt th gii nh th vn ch l trong m c, nn vi cun sch ny Sara Rosenthal s mang n cho bn nhng thng tin cn thit phng chng bnh tim bng cch t b cc thi quen xu (chng hn nh n nhiu cht bo, ht thuc l...) v tp thnh nhng thi quen tt - nhng thi quen c to ra bng cc phng php khoa hc c chng minh qua thc nghim. Trong sch ny c rt nhiu nhng thng tin nh nht nhng l th v mi m i vi chnh ti, cho d ti vn rt t ho v vic lun nhn c y nhng thng tin trong lnh vc chm sc sc khe. Chng hn nh, ch qua y ti mi c bit ti sao cc loi cht bo nhn to li c hi, rng vic tp yoga lm tng lng dng kh cho c th, rng ibuprofen c th 6
Li gii thiu
lm tng huyt p, v rng lng cholesterol cao vn cha c chng minh l c hi cho ph n. Nhng iu thc s c bit ca cun sch ny l s ch trng n nhng kha cnh m rng hn v mt x hi v chnh tr ca mt np sng lnh mnh. Sch ny s gip bn hiu c v sao mi trng chung quanh c th lm cho bn kh c c nhng chn la tt p, v a ra nhng xut v cch thay i cuc sng sao cho nhng ngi khc c th d dng c c nhng chn la khn ngoan. Tht c th, Sara Rosenthal ni ra thng thn mt cch th v v vic nhng thnh kin gii tnh lm thay i nhng quyt nh ca chng ta nh th no khi chm n nhng vn tnh cm. By gi, xin mi cc bn hy cng c thng thc v hc hi! Laura Purdy Tin s Trit hc Gio s o c hc y khoa
DN NHP
Du hiu bo trc cn au tim ph n Bnh tim hin l nguyn nhn hng u gy t vong ph n sau thi k mn kinh. Ph n cht v bnh tim nhiu hn c v cc chng ung th phi hay ung th v. Mi nm, mt na con s t vong v bnh tim Bc M l ph n. Nhng bnh tim khng ch l nhng cn au tim, m cn gm c nhng cn t qy cng nh ton b cc vn gy ra do s tun hon khng tt ca mu. Trong chuyn mn gi y l bnh mch mu ngoi bin, nhng ni d hiu hn l s suy gim kh nng tun hon ca mu. Bnh ny xy ra khi dng chy ca mu n cc vng ngoi bin nh tay, chn, cc ngn chn... b tc nghn, gy ra triu chng co rt, au hoc t cng. Trong thc t, au v t cng cnh tay hoc chn c th l du hiu ca bnh tim, hay thm ch l bo trc mt cn au tim sp n. Mt cuc nghin cu nm 1992 cho thy c 20% ph n trn 60 tui b bnh mch mu ngoi bin, v khi trong t l dn s c nhiu ph n n tui mn kinh hn, con s ny s gia tng ng k.
Dn nhp
Mt trong nhng nguyn nhn dn n t l t vong cao v nhng cn au tim ph n l s thiu hiu bit ca y hc. i tng ca hu ht cc cuc nghin cu v bnh tim khng bao gm ph n, v iu dn n mt nim tin sai lm l nam gii cht v bnh tim nhiu hn ph n! S tht l, trong khi n ng di 50 tui c t l t vong v nhng cn au tim cao hn ph n, th ph n trn 50 tui li cht v bnh tim nhiu hn nam gii, do h qu trc tip ca vic mt ni tit t estrogen. Hn na, nhng ph n no phi phu thut ct b bung trng trc thi k mn kinh t nhin s gia tng nguy c b au tim ln gp 8 ln. V ph n ngy nay ri khi gia nh lm vic bn ngoi nhiu hn trc y, nn mt s chuyn gia xem s cng thng l nhn t ch yu gp phn lm gia tng t l mc bnh tim ph n. Ph n cn c nhng triu chng bnh tim khc bit vi nam gii, v do nhng du hiu in hnh nguy him bit nam gii, chng hn nh chng au tht ngc, thng khng thy ph n. Trong thc t, au tht ngc ph n hu nh chng lin quan g n bnh tim. Ch v cc triu chng bnh tim khc bit vi nam gii

m nhiu ph n c cho ra khi bnh vin ri phi cht nh - ngi ta bo rng nhng cn au tim ca h l do cng thng! Tt c nhng iu cn phi thay i! Cha bao gi c nhiu ph n ng trc nguy c mc bnh tim nh ngy nay. T l dn s th gii cho thy l vo nm 2000 c hng triu ph n bc vo tui 50 - tui c nguy c mc bnh tim cao, y hc buc phi nhn bit nhng du hiu cnh bo c th ca ph n khi xut hin bnh tim v nhng cn au tim. Cun sch ny bn n tt c nhng nguy c gy bnh tim c th thay i c, v nhng du hiu cnh bo cn au tim ph n. Nhng nguyn nhn chnh gy bnh tim ph n l ht thuc l, cao huyt p, bo ph v li sng t hot ng. Cuc nghin cu mang tn Nurses Health Study vi i tng l 120.000 ph n tui trung nin cho thy ph n bo ph b bnh tim nhiu hn n 2 hoc 3 ln. iu ny c bit cng ng vi nhng ph n c nhiu m bng hay phn trn c th. Nhng cuc nghin cu cho thy rng liu php thay th hormone (HRT)1 c th gip lm
1 Hormone Replacement Therapy
10
Dn nhp
gim nguy c bnh tim. Chnh ni tit t estrogen bo v cho ph n chng li bnh tim trc thi k mn kinh; vo tui mn kinh, t l mc bnh tim ph n tng vt do mt estrogen. Thay i cch sng cng c th lm gim ng k nguy c mc bnh tim. Nhng ph n vn ng c th nhiu c nguy c mc bnh tim thp hn t 60% n 75% so vi nhng ph n t vn ng. Bi vy, vic thay i cch sng, nh b ht thuc l, n t cht bo hn v rn luyn thn th nhiu hn... c th ngn nga bnh tim v bnh mch mu ngoi bin. Cc thuc h huyt p v gim cholesterol l nhng chn la khc cho mt s ph n c bit. V c bn, mc ch ca sch ny l gip bn ngn nga bnh tim t trc khi mc bnh. Nhng trc khi i vo nhng phng thc phng nga bnh tim, iu trc tin l chng ta phi bit qua cc du hiu cnh bo phng. Bn s thy l cc triu chng ca bnh tim, hoc thm ch ca mt cn au tim thc s, c th rt m nht ph n, c v nh chng lin quan g n nhng bt n v tim. Cc du hiu bnh tim ph n bao gm mt s triu chng ng ngc nhin nh sau:

Hi th ngn, gp, c th km theo mt mi au hm (thng b nhm l au khp v vim khp) au pha sau c (thng b nhm l vim khp v au khp) au pha di cnh tay phi hoc tay tri au lng (thng b nhm l vim khp v au khp) m hi (thng b nhm l bt n do thi k mn kinh) Ngt xu Tim p nhanh, hi hp Sng ph (sau thi k mn kinh, liu bn c tin y l du hiu tc nghn ng mch vnh khng?) nng, hi hay au trong ng rut (y thng l du hiu bo trc mt cn au tim thc s ph n) Nng ngc, v tr gia 2 v. Mt s ph n m t cm gic ngp th, hoc nng rt; cng c ngi m t l au nhi, hoc cm gic nh ngc 12
Dn nhp
b p cht, hoc cm thy tim p rt mnh nh mun ra khi lng ngc. Vi bnh nhn tiu ng, lng ng trong mu s dao ng rt t ngt. Nn ma M sng hoc l ln, khng tnh to Vi mt hoc nhiu trong s cc triu chng trn, nu bn nghi ng l mnh b bnh tim, nhng xt nghim chn on sau y c th gip xc nh iu : Khm trc tip (bc s thm khm vi ng nghe) o in tm gng sc Thc hin kim tra co bp c tim Siu m tim Nhng xt nghim hnh nh, c th s dng cc cht phng x chp hnh tri tim. By gi, chng ta s bt u xem xt n nhng phng thc c th gip bn c c mt tri tim khe mnh hn v mt cuc sng tt p hn.
B HT THUC L 1. V sao cn phi b thuc l?

Mi nm, na triu ngi Bc M cht v nhng bnh c lin quan ti thuc l. Con s ny chim 20% trong tng s cc trng hp t vong. Chng ta vn bit l ht thuc l gy ra ung th phi, nhng bn c bit l nhng ngi ht thuc l cng c nguy c mc bnh tim tng gp hai ln? Khi xt n cc yu t ri ro khc, chng hn nh vic mt estrogen, th bn c nguy c b bnh tim cc k ln nu bn l ph n ht thuc sau thi k mn kinh. Mt iu thuc c nh hng ngay n c th bn ch trong vi giy, lm gia tng nhp tim, huyt p v nhu cu oxygen. Nhu cu oxygen gia tng cng cao (do cc mch mu b co tht li, v do carbon monoxide - c to ra t thuc l) th nguy c mc bnh tim cng ln hn. Nhng tc hi lu di t c bit n hn ca vic ht thuc l l lm gim mc HDL1(c
1 High-density lipoprotein, mt cht c cng nng lm cho cholesterol tch ri khi thnh ng mch v vn chuyn v gan c quan ny x l. V th, y c xem l mt loi c li.
14
B ht thuc l
gi l cholesterol c li) trong mu, v lm hy hoi lp mng trong ca cc thnh mch mu, to iu kin cho s hnh thnh cc mng cng trong thnh mch. Ngoi vic lm tng nguy c ung th phi v bnh tim, ht thuc l cn c th dn n cn t qy, bnh ngoi vi mch mu v rt nhiu chng ung th khc. Hy th cn nhc mt s ch li t c khi b ht thuc l: Gim nguy c mc bnh tim. Gim nguy c mc cc bnh ung th (bao gm ung th phi, ung th thc qun, ung th ming, ung th c hng, ung th ty, ung th thn, ung th bng quang v ung th c t cung). H thp c nhp tim v huyt p. Gim nguy c mc cc bnh ca phi (nh vim cung phi, kh thng...) Hi phc cc mch mu, gip lu thng tt hn. Khu gic v v gic c ci thin hn trc. Gi c rng tt hn. C t cc np nhn hn. 15

2. Thuc l v nhng h qu i km: bo ph
Vic ht thuc l v chng bo ph thng i i vi nhau. Ph n thng bt u ht thuc vo tui mi ln nh l mt cch gim cn. Mt cuc nghin cu nm 1997 ca trng i hc Memphis bang Tennessee cho thy phng php gim cn ny khng c hiu qu. Nhng thiu nin ht thuc l vn c kh nng dn dn b bo ph nh nhng ngi khng ht thuc. Tht ma mai l nhng ngi cng mp li cng ht thuc nhiu hn. Nhiu ph n dng cht nicotine nh mt phng thuc gim cn. Hoc l h ht thuc mong bt u to ra s gim cn, hoc t hn na l ht tr li sau mt thi gian di b thuc, cng nhm mc ch gim cn. Vic ht thuc p ng cho nhu cu phi c ci g trong ming. Nhng triu chng khi b thuc cng c th thi thc ngi ta n nhiu hn. Nu bn cn gim cn m vn ht thuc, v ch thm mt tc nhn lm tng nguy c mc bnh tim, chng hn nh cao huyt p 16
B ht thuc l
hoc ng mu cao, bn s khng th t c tt c! Vic ht thuc lm cn tr cc mch mu nh, lm tng rt nhiu nguy c mc bnh tim. Tht khng may l khng c gii php d dng cho tnh th lng nan gia vic gim cn v b thuc l. Hu ht cc nhn vin chm sc sc khe u s c nh nguy c hin thi ca bn trong vic mc phi bnh tim hay chng t qy v gip bn t u tin vo vic thay i li sng. Xem xt vic tham gia mt chng trnh b thuc l ng tin cy cng l mt gii php. Nhng phn ln ph n ch b ht thuc khi i mt vi thc t ca mt cn bnh nan y no . Ni cch khc, ng c b thuc l mnh m nht thng l s s hi.
3. Ht thuc l c th gy hi cho gia nh bn

Hu ht ph n khng thch nghe iu ny, nhng thng th y chnh l iu h cn bit c th quyt nh dt khot b thuc l. Phm cht t nhin ca ngi ph n vn sinh ra l lm cng vic chm sc nui dng, v mt khi bit c mnh ang lm tn thng n ngi 17

khc th iu ny thng l ng c thc y mnh m lm chng ta thay i. Hy i mt vi vn - khi thuc m bn thi vo mi trng sau khi ht1 c th gy ra nhng cn bnh nghim trng v c cc chng ung th cho nhng ngi bn yu thng nht: cc thnh vin trong gia nh. iu m hu ht nhng ngi ht thuc khng bit l, nhng ngi khng ht thuc cng d mc phi nhng cn bnh c lin quan ti thuc l. Khi thuc thi vo mi trng c bit l nguyn nhn hng u gy ra ung th phi nhng ngi khng ht thuc, v nhng vn bt n v h hp tr em cng nh ngi ln. Bn c bit l mi nm c n hng trm ngi Bc M cht v ung th phi do khi thuc l thi vo mi trng gy ra? Bo co nm 1986 ca ngnh phu thut a khoa Hoa K kt lun rng vic tip xc vi khi thuc trong mi trng c th gy ra nhng bnh lin quan ti thuc l, k c ung th phi. Ti liu quan trng ny cho thy l khng c ai trnh c cc nguy c do thuc l gy ra c. Chnh ti liu ny lm thay i ngha trng
1 Ngi ht phi khi thuc ny gi l ht thuc b ng hay gn y hn c gi l khi thuc mi trng (ETS).
18
B ht thuc l
tm ca vic khng ht thuc l, t vn ca mi c nhn chuyn sang thnh mt mi nguy hi v sc khe trong mi trng. Mt bo co gn y ca C quan bo v mi trng Hoa K1 xc nhn li nhng kt lun ca ngnh phu thut a khoa bng vic xp loi khi thuc mi trng l cht gy ung th loi A - loi tc nhn gy ung th nguy him nht. Bo co ny cho thy rng khi thuc l thi vo mi trng gy ra ung th phi nhng ngi khng ht thuc cng nh lm tn hi sc khe tr s sinh v tr em. Thai nghn v tr s sinh Nhng bo thai v tr em c cha m l ngi ht thuc l rt d chu nh hng ca khi thuc trong mi trng. Nhng bnh v ng h hp thng gp tr em c cha m ht thuc nhiu hn l nhng tr c cha m khng ht thuc, v vic ht thuc trong thi k mang thai c th dn n rch mng i sm, sinh non, t vong khi sinh n, nhng bt thng v nhau thai v xut huyt trong thi k mang thai.
1 The U.S. Environmental Protection Agency (EPA)
19

Nhng ngi m ht thuc khi ang cho con b s thy ngun sa b nh hng bi cht nicotine. Do , h phi ngng cho con b, v nh vy l tc b i ca a b nhng li ch ca vic c b sa m v phi i mt vi nhng nguy him ca vic b sa bnh. Vin Nhi khoa Hoa K cho rng bt k lng nicotine no cng c hi trong thi gian cho con b. Qu nhiu nicotine c th lm cho tr b sc, nn i, tiu chy, tim p nhanh v bn chn kh chu. Khi thuc thi ra thm ch cn gy hi cho tr hn c lng nicotine cao trong sa m. C rt nhiu nghin cu i n kt lun rng: ng l nhng a tr phi ht khi thuc t cha hoc m s khng c khe mnh nh nhng a tr c cha m khng ht thuc. Khi thuc trong mi trng c th gy vim phi, vim cung phi, hoc thm ch gy hi chng t t tr em.1 4. S h tr ca cc chng trnh b thuc l Khng phi ai cng c th b thuc l mt cch dt khot ngay tc th, mc d l mt
1 Hi chng t t tr em: Sudden infant death syndrome (SIDS)
20
B ht thuc l
phng thc m nhiu ngi thnh cng. Mt s ngi b thuc theo cch ny ni rng, gi mt gi thuc l trong tm tay (mc d khng ht) lm gim bt s cng thng. Cc triu chng khi thiu vng cht nicotine bt u sau vi gi, v ln n cao im trong khong t 24 n 48 gi sau khi b thuc. Ngi b thuc c th cm thy cng thng, bt rt kh chu, cu gt, bn chn kh chu, mt ng v gin d. V nhng trng thi kh chu ny, nhiu ngi nghin thuc chuyn sang chn phng thc b thuc chm, thng l c th bao gm mt s trong cc bin php nu sau y:
S t vn
Vic i tm mt s t vn, nhng li khuyn hay ch dn t mt t chc hay c nhn, c th gip nng cao thm t l nhn thuc t 20% n 25%. Phng thc b thuc ny nhm n vic lm thay i nhn thc v vic ht thuc, nhn mnh, lm r nhng ch li ca vic b thuc, v ch dn nhng k nng cn thit gip ngi b thuc trnh c s li cun vo vic ht thuc tr li. 21

Ko nicotine
Ko nicotine hin nay c by bn t do trn th trng. Ngi b thuc s dng ko nh mt phng thc gim bt cn nghin v xa b cc triu chng. Ko nicotine gip bn t b nicotine bng cch gim dn dn liu dng cho n khi ngng hn, thng l mt tin trnh ko di khong 12 tun l.
Ming dn nicotine
Ming dn c cha nicotine thm qua da, vi cc thng hiu hin nay ti Hoa K nh Habitrol, Nicoderm, Nicotrol... c by bn t do. S dng phng thc ny gip tng gp i t l b thuc thnh cng. Mi bui sng, mt ming dn mi c dn ln mt vng da kh sch, khng c lng, v nguyn nh vy sut ngy. Mt s loi c ch to cung cp nicotine trong sut 24 gi. Tuy nhin, s cung cp lin tc nicotine vo mu i khi gy ra nhng gic m nhiu xo ng. Bn cng c th thy hi nga ngy rm ran hoc bng rt ni ch ming dn trong ln u tin. Tin trnh ny mang li hiu qu tt nht khi c s dng t nht l t 22
B ht thuc l
7 n 12 tun l, vi cng nicotine c gim dn. Nhiu ngi b thuc cho rng phng thc ny c hiu qu l v n gip h i ph vi yu t tm l ca cn nghin trc khi buc phi i u vi nhng triu chng vt l c th ca n.
ng ht nicotine
y l mt ng nha trong c cha nicotine dng c th c ht vo. T l b thuc thnh cng ca phng thc ny l khong 28%, tng ng vi s dng ko nicotine. Hoa K, loi ng ht nicotine ny ch c bn theo toa bc s, cn Canada th n cha c s dng. Ging nh ko nicotine, n c dng theo thi quen ht thuc, ngha l thay th vo mi khi c cn thm thuc. Thi gian s dng thch hp l khong 12 tun l.
ng phun mi nicotine
Tng t nh loi ko nhai v ming dn, ng phun mi nicotine lm gim cc triu chng ca cn nghin khi b thuc, cho php ngi nghin c th b thuc dn dn. Mt ln phun cung cp khong 1 mg nicotine. Trong 3 cuc iu tr th 23

nghim gm 730 ngi, t 31% n 35% khng ht thuc trong 6 thng, so vi t l ch 12% n 15% c kh nng b thuc m khng cn bt c phng thc h tr no. ng phun mi c mt s li th hn so vi ko nicotine v ming dn nicotine. Nicotine hp th rt nhanh qua nim mc ca mi, to cm gic gn ging vi thuc l hn. Tc dng nhanh v liu dng c th thay i c nn thch hp hn vi nhng ngi nghin nng. Tuy nhin, do lng nicotine c a vo mu qu nhanh, ng phun mi nicotine c kh nng gy nghin cao hn l ko nicotine v ming dn nicotine. Loi ng phun mi nicotine ny hin cha c dng Canada.
Cc liu php thay th
Mt s cc phng php nh thi min, ta thin, chm cu... t ra hiu qu trong vic gip cho mt s ngi b thuc l. Vi thi min v ta thin, vic tr liu c th tin hnh vi mt ngi hay vi mt nhm ngi cng tham gia chng trnh. 24
B ht thuc l
5. S dng thuc h tr b thuc l Bupropion l mt loi thuc hin c th s dng gip b thuc l. Thng hiu trn th trng hin nay c Zyban. y l mt kh nng chn la cho nhng ai khng thnh cng trong cc phng thc s dng nicotine thay th. Trc y, bupropion vn c dng nh mt loi thuc chng trm cm. Do tnh c, cc nh nghin cu khm ph ra tc dng ca thuc trong vic gip b thuc l. Nhng th nghim u tin da trn c s l nhng ngi b thuc l thng c mt tm trng chn nn, thiu sinh ng. Do , cc nh nghin cu bt u dng bupropion i ph vi trng thi ny, khng phi l chng li cn nghin. Bupropion t ra hiu qu trong vic lm gim cc triu chng xy ra sau khi b thuc l, v c th c dng kt hp vi cc phng thc cung cp nicotine thay th. Cc nh nghin cu cho rng bupropion tc ng trc tip ln no b ph v sc gy nghin ca nicotine bng cch gy nh hng vo cng mt loi ha cht truyn tn hiu thn kinh ca no, chng hn nh l dopamine, ging nh tc ng ca nicotine. 25

Kh nng to khoi cm ca cc thuc gy nghin, chng hn nh nicotine v cocaine c to ra bi s tit dopamine. Vic ht thuc vo lm cho dopamine trn ngp trong no b. Tp ch y khoa New England cng b nhng kt qu ca mt cuc nghin cu trn hn 600 ngi nghin thuc l s dng bupropion b thuc. Vo cui cuc nghin cu, 44% ca nhm s dng liu cao nht (300mg) khng ht thuc na, so vi 19% ca nhm i chng dng gi dc, ngha l khng dng thuc g c. Sau mt nm, 23% ca nhm c dng thuc vi liu 300 mg tip tc khng ht thuc, so vi 12% ca nhm i chng dng thuc gi. S dng kt hp Zyban vi liu php thay th nicotine c v nh lm tng thm t l b thuc thnh cng. Mt cuc nghin cu ko di trong bn tun cho kt qu t l b thuc thnh cng nh sau: - Nhm i chng dng gi dc - Nhm s dng thuc Zyban 23% 49% - Nhm s dng ming dn nicotine 36% - Nhm s dng kt hp ming dn nicotine v thuc Zyban 58% 26
B ht thuc l
6. Hy ginh ly chin thng ng cc cng ty thuc l chin thng! Hy bit ni gin v ginh li cuc sng ca bn. Khi nhng ngi ht thuc l nghe c nhng s tht sau y, nhiu ngi ni gin v b thuc l ngay. V th, vic tit l nhng iu ny khng phi nhm trng pht bn, m l thc y bn! T lu ngi ta bit n nhng vic lm phi o c trong ngnh sn xut v kinh doanh thuc l, chng hn nh: Che giu nhng bng chng v mi quan h xu gia thuc l vi sc khe. - S dng nicotine tng thm tnh cht gy nghin ca thuc l. Vic sn xut thuc l trong trng hp ny tr thnh s phn phi cht nicotine. - Truyn b nhng thng tin sai lch che du hu qu v sc khe do thuc l gy ra. - S dng vic qung co nhm n nhng i tng d b li cun. Cc chin dch qung co ny bt chp cc chun mc o c, nhm d d tr em, thiu n mi ln v nhng ngi c thu nhp thp. 27

- Xut khu cc sn phm thuc l sang cc quc gia th gii th ba, thng km theo vic qung co nhm vo i tng v thnh nin v cc nhm ngi khng thu nhp mua cht nghin nicotine. 7. V sao ph n cn b thuc l iu quan trng m ngi ph n cn phi nhn ra l: cc cng ty thuc l s dng mi quan tm n vc dng ca bn lm cng c khin cho bn sm ri vo con ng nghin nicotine, v iu ny lm hy hoi sc khe ca bn, v c con gi bn na, v c nguy c rt ln l c b s sm ht thuc ngay khi no m bn l l khng mt n. Kt qu ca rt nhiu nghin cu cho thy l hu ht cc thiu n bt u ht thuc nhm gi cho vc dng c thon p. C n 90% trng hp ri lon v n ung c chn on ph n. Mt cuc thm d ca bo New York Times cho thy l c 36% cc em gi tui t 13 n 17 mun thay i ngoi hnh ca mnh bng vic ht thuc l. Mt cuc kho st c tin hnh bi Trung tm Kim sot Dch 28
B ht thuc l
bnh Hoa K1 vo nm 1995 vi i tng l cc em gi t lp 9 n lp 12 nhn thy rng 60% trong s cc em c tm cch gim cn v 5% n 10% cc em gi tui t 14 tr ln phi chu ng cc ri lon n ung. Nhng qung co thuc l trn cc tp ch ph n tip tc gi cho cc thanh thiu n tng rng hnh nh ph n ht thuc l l xinh p, l quyn r. K t nm 1999, mt nhn thuc l cho in dng ch ng gu phi p cng vi hnh mt c gi xinh p mnh mai trong dng v t nhin. Vi t cch ngi c, bn c th ty chay cc tp ch ph n nhn qung co thuc l ngn chn khuynh hng ny. Vit th cho ngi ch bt v ngi bin tp ca tp ch gii thch v sao bn ty chay tp ch ca h. iu s tc ng rt ln trong vic chm dt vic lm sai tri ca h. Cc cng ty thuc l cng ti tr hot ng thi trang v cc hot ng khc c lin quan ti ph n. Ty chay cc hot ng ny v gi th cho cc t chc lin quan gii thch l do dn
1 The Americas Centers for Disease Control
29

n hnh ng ca bn. y l vic lm quan trng phn khng. Vi t cch l ngi tiu th, bn c quyn thc hin iu .
iu quan trng nht l: vic b ht thuc l v nhn ra tt c cc p lc x hi y ph n n ch nghin thuc chnh l mt phng cch chng li s tn ti ca thuc l nh l mt kiu kinh doanh xm phm n ph n m l ra khng c cho tip tc. Hy ni cho con gi, chu gi... ca bn bit v hnh thc kinh doanh khng ng n ca cc cng ty thuc l. Hy n lc chm dt mi vic v ngn nga con chu bn ri vo nghin thuc.
8. Cng nn b ht x g Ht x g l mt ca nhng ngi ra v tr thc, ca gii c tin hay ca nhng ngi mun t ra bnh thn. y l mt khuynh hng nguy him li cun c hng triu ngi ph n giu c. Trong mt iu x g gm c rut thuc l, cht kt dnh v v bc, tt c u c ch to t thuc l lm kh v ln men. V th, cng ging thuc l, t mt iu x g s thi ra hn 4000 cht ha hc, trong c 43 cht c bit l gy ra ung th. 30
B ht thuc l
Mc d c km hn nhng ngi ht thuc l, nhng ngi ht x g vn c t l t vong v cc bnh lin quan n thuc l cao hn ngi khng ht thuc. Tuy nhin, khi cht nicotine c hp th qua ng ming th nhng ngi ht x g, hay ht thuc bng ng iu, cng nh nhng ai dng thuc l nhai u c nguy c cao v cc bnh ung th thanh qun, ming v thc qun. Nhng ngi ht x g hay ht thuc bng ng iu cng c t l t vong v bnh phi tc nghn mn tnh v ung th phi cao hn nhng ngi khng ht thuc. Ht x g l mt th tiu khin c ph n b tin mua nh l mt iu g hp dn v gi cm. V ph n thc s tin vo iu khi thc t l h b hp dn nhiu hn bi th nam tnh ca iu x g v ci th gii n ng m c v nh n gi ln cho h. Mt iu x g khng n gin ch l iu x g! 9. i li cc chi ph trong vic b thuc l Bi v cc cng ty thuc l thu c qu nhiu tin tiu ph, vic lu tm vo nhng phng thc tt p chi ra th th no? 31

Ngi Bc M chi ra hng t -la mi nm iu tr nhng bnh c lin quan ti thuc l, chng hn nh bnh tim v ung th phi. y l mt gnh nng kinh t cho x hi, nht l khi cn nhc vic c th phng nga c. Bn c th i li chi ph b thuc l v c n b cho nhng thit hi. Nhiu bang ca Hoa K hin ang tin hnh nhng v kin cc cng ty thuc l. Nm 1998, theo sau bi vit mang ta Ngi bit qu nhiu ca bo Vanity Fair th nhng v kin cc cng ty thuc l ln c tin hnh trc tin bi bang Mississippi, ri sau l 40 bang khc. V vic cui cng c dn xp vi mt tha thun 246 t -la! 10. Li ch ca vic b thuc l B ht thuc l l iu quan trng nht m bn c th thc hin lm gim nguy c mc bnh tim. V th, b thuc l sm chng no th bn s cng thy c kt qu sm chng y. Ni cch khc, iu quan trng l ng mong i nhng iu k diu s xy ra ngay tc khc. Nhng cuc nghin cu cho thy rng vi ngi ht thuc lu nm - t tui thiu nin 32
B ht thuc l
cho n 55 tui hoc hn na - th bt k li ch no v sc khe thc s c c do vic b ht thuc l s khng xut hin cho n t nht l 15 nm sau . Mt cuc nghin cu ca Hip hi Ung th Hoa K lu rng t l t vong v ung th ca nhng ngi b thuc l ch gim xung bng vi nhng ngi khng ht thuc vo khong 15 n 20 nm sau khi b thuc. Nu bn ch mi ht thuc trong mt thi gian ngn, hoc b thuc vo tui 30 hay 40 th nhng li ch v sc khe s c nhn ra sm hn nhiu. V th, b ht thuc cng sm cng tt! Vic b ht thuc ca bn cn l mt phng cch quan trng gip ngn chn cc th h tng lai khi ri vo con ng nghin thuc. loi b cc trng hp ung th phi lin quan n thuc l (chim 70% tng s cc trng hp ung th phi) v cc bnh khc c lin quan n thuc l khc, chng ta phi tp trung vo vic ngn nga sm ngay t khi ngi ta cha ht thuc. Vic b ht ca bn gp phn thc y cc chin dch chng ht thuc, v cng gp mt phn nh vo vic bo v th gii ny. Khi bn khng nh khi thuc vo khng kh l gp phn lm gim ng k s nhim mi trng. 33
CH N UNG
11. Tm hiu v cht bo V mt chuyn mn, cht bo c gi l acid bo, l thnh phn dinh dng rt quan trng cho cc t bo ca chng ta. Chng ta khng th sng c nu khng c cc acid bo. Nu bn quan st k mt phn t acid bo, bn s nhn ra c ba loi acid bo khc nhau trong : loi c dng rn, tc l dng bo ha (saturated), dng cha bo ha kt cu n (monounsaturated) l dng t rn hn vi cc ngoi l l du -liu v du phng, v dng cha bo ha kt cu a (polyunsaturated) l dng lng. Hai dng sau thng c ch chung mt cch n gin l acid bo cha bo ha (unsaturated), phn bit vi dng acid bo bo ha (saturated). Ba dng acid bo ny kt hp vi glycerol to thnh mt cht ha hc gi l triglyceride. Mi phn t cht bo l kt ni trong mt chui c to thnh bi glycerol, cc nguyn t carbon v cc nguyn t hydrogen. Trong chui ny, cng 34
Ch n ung
nhiu nguyn t hydrogen th acid bo cng bo ha. Gan c chc nng ph v cu trc phn t ca acid bo bng cch tit ra mt, tch ly trong ti mt. Gan cng to thnh cholesterol. Khi c nhiu cc acid bo bo ha c th lm cho gan sn sinh qu nhiu cholesterol, trong khi triglyceride trong mu s gia tng, lm ko di s bt n. Bi vy, acid bo l mt cht c li vi mc va phi. Nhng vn l hu ht chng ta u dng n qu nhiu. Tha cht bo trong ch n ung, cho n nay l mt trong cc vn tai hi nht phng Ty. Mi gram cht bo cung cp s ca-lo-ri gp 2 ln so vi protein hay carbohydrate. Gim lng cht bo trong khu phn n ca bn v thay th vo bng cc sn phm ng cc, rau ci, tri cy l cch tt nht h thp nguy c ung th kt trng v cc bnh tim mch. Cht bo c cung cp t cc loi thc phm nh tht, cc sn phm ch bin t sa, v cc loi du thc vt. Cc ngun khc na gm c da (60% cht bo), u phng (78% cht bo), b (82% cht bo). C ba dng cht bo khc nhau trong cc ngun cung cp cht bo ny: 35

cht bo bo ha (saturated fat), cht bo cha bo ha dng n (monounsaturated fat) v cht bo cha bo ha dng a (polyunsaturated fat). Thm vo cn c mt dng cht bo th t cng xut hin trong khu phn n ca chng ta, l dng cc acid bo ch bin (transfatty acid). Dng cht bo ny c ch bin trong cc nh my v c th gp trong cc sn phm nh margarine chng hn. hiu r hn v vn ny, chng ta c th chia cc cht bo ra thnh hai nhm: nhm cht bo c hi v nhm cht bo c li.
Nhng cht bo c hi
Nhng cht bo sau y c xem l c hi, bi v chng c th lm gia tng nguy c v cc vn tim mch, cng nh nhiu loi ung th, bao gm c ung th kt trng v ung th v. Nhng loi cht bo ny dng va phi th c li, nhng vt qu nhu cu l c hi. (V nu khng dng n chng th s l v hi!) - Cht bo bo ha (saturated fat). Loi cht bo ny ng cng li nhit trung bnh trong phng. N thc y vic 36
Ch n ung
to thnh cholesterol trong c th. Trong thc t, dng cht bo ny c hnh dng nh th no trc khi n th cng c hnh dng nh th y khi chng vo trong cc ng mch ca bn. Cc loi thc n c cha nhiu lng cht bo bo ha bao gm tht ch bin, tht m, cc loi m, b, s-cla v cc loi du vng nhit i (du da cha hn 90% cht bo bo ha). Dng cht bo ny ch nn n mt lng rt nh. (V nu khng n th tt hn.) - Cht bo ch bin (transfatty acid). Dng cht bo ny c ch bin cc nh my v khi a vo c th th cng tc dng tng t nh dng cht bo bo ha.
Nhng cht bo c li
Nhng cht bo sau y c li cho sc khe ca bn v thc s bo v c th chng li mt s vn , chng hn nh cc bnh tim mch. Bn c khuyn khch dng nhiu nhng loi cht bo ny. Trong thc t, cc nh dinh dng hc ngh nn thay th cc cht bo c hi bng nhng cht bo loi ny: 37

- Cht bo cha bo ha (unsaturated fat). Dng cht bo ny c th ng li mt phn hoc vn th lng di nhit trung bnh trong phng. Cht bo cha bo ha dng lng (polyunsaturated fat) gip h thp mc cholesterol trong c th. Ngun cung cp dng cht bo ny bao gm cc loi du thc vt, cc loi qu, ht. Ni chung, cht bo cha bo ha c ly trong thc vt, tr mt ngoi l l cc loi du thc vt vng nhit i, chng hn nh du da. - Du c (omega-3 oil). y l dng cht bo t nhin c trong cc loi c sng nc su, hon ton l cht bo cha bo ha dng lng. Dng cht bo ny rt cn cho c th, lm h thp mc cholesterol v rt cn cho cc m ca no, ng thi gip chng li bnh tim. Du c c cung cp t cc loi c ph bin nh c thu, c ng, c hi, c mi... 12. Trnh dng cc loi cht bo ch bin Rt nhiu loi cht bo ch bin c a vo ba n ca chng ta v cc nh sn xut thc 38
Ch n ung
phm ang c gng to ra v bo m khng mang li cho ngi dng nhiu calori nh cc cht bo bo ha. Tht khng may l cc cht bo nhn to ny rt ng s. Bi v cht bo c to ra trong cc nh my l loi cht bo ch bin, khng t nhin, gy hi khng ch bng vic lm tng cao mc cholesterol c hi1 trong mu, m cn lm gim mc cholesterol c li (HDL) ang sn c ca c th. Mt cch chnh xc, cc cht bo ch bin c to ra nh th no? Chng c to ra khi lm cho mt cht du lng nh du bp tr thnh rn hn hoc dng sn st c th pht ln thc phm, chng hn nh dng du magarine. Cht bo ch bin c th ni l mt loi cht c hi c to ra t nhng dng tt! Vo thi im u tin, c ai ngh rng nu nh c th bin nhng cht bo c li - cht bo cha bo ha - thnh dng rn th c th nhn i gi tr so vi b hay m heo, v bn s c th n vo cng mt cht - cht bo c li - m khng
1 c hi, hay low-density lipoprotein (LDL), l dng gy bt li cho sc khe, ngc li vi HDL (high-density lipoprotein) l dng c li cho sc khe.
39

mt i li th l c th bi trt ln cc loi thc phm khc. tng nghe c v rt tuyt vi. Nhng tht khng may, lm cho cht bo cha bo ha - vn dng lng - tr thnh dng rn hn, bn phi thm hydrogen vo cc phn t ca n. Qu trnh ny gi l hydro ha, lm bin i cht bo dng lng sang dng sn st. Loi du c c hydro ha, nguyn liu lun c a chung trong vic ch bin ko s-c-la, l mt v d in hnh cho cht bo ch bin. Qu trnh hydro ha cng lm cho cht bo tn ti c lu hn, chng hn nh bnh thng th cc cht bo cha bo ha dng lng c th b oxygen ha khi tip xc vi khng kh v tr mi ngay. Cc loi du n thng phm c dng trong cc nh hng n ni chung u l loi c hydro ha.
Tc hi ca cht bo ch bin
Cc cht bo ch bin c bn ra nh cht bo cha bo ha, vi dng qung co nh Ch bin t du thc vt cha bo ha. Vn l, trong c th bn th n c xem nh cht bo bo ha! V th, cht bo ch bin thc cht chnh l mt kiu cht bo bo ha gi dng. Trong 40
Ch n ung
thc t, cc qung co c th ni rng sn phm khng cha cht bo bo ha hay c li cho sc khe, l so vi m ng vt hay cc sn phm du nhit i c cht bo bo ha. V vy, hy cn thn. Hy c k cc nhn hiu. iu m bn cn ch tm ra l hydrogenated, tc l sn phm c ch bin bng quy trnh hydro ha. Bt k ngi ta qung co nhng g, nu thy c t hydrogenated th hy xem l mt sn phm cht bo bo ha. C th ca bn cng hon ton ng nh vy!
Du magarine v b
Du margarine c lm cho thc n ca bn tt hn khng? iu cn ty. T khi nhng hiu bit ng v acid bo ch bin c a ra vo cui nhng nm 1980, cc nh sn xut du margarine bt u a ra mt s loi margarine t c hi hn. Mt s khng dng n loi du hydro ha, v mt s khc ch cha mt lng t hn nhiu so vi trc y. Cc loi margarine c di 60 - 80% du (khong 9 n 11g cht bo) s cha t 1 n 3 gram cht bo ch bin cho mi khu phn n, so vi b l 41

53% cht bo bo ha. C th ni y ch l mt s la chn gia ci xu vi ci xu hn m thi! Mt loi du thc vt lng cng c th gi c hm lng cht bo khng bo ha cao khi c hydro ha mt phn. Trong trng hp ny, c th s chuyn ha n nh mt phn cht bo bo ha v mt phn cht bo khng bo ha.
Cht bo gi to
Chng ta c nhng cht lm ngt nhn to th ti sao khng c nhng cht lm bo nhn to? Cu hi ny dn n vic to ra mt cht c ch nhiu nhng cng chu nhiu s ng vc: cht thay th cht bo, c to ra thay cht bo tht v nh lm gim lng calori t cht bo tht m khng nh mt v bo. iu ny c thc hin bng cch to ra mt cht bo gi m c th khng th hp th vo c. Mt trong nhng cht thay th cht bo u tin l Simplesse - mt cht thay th cht bo hon ton t nhin c lm t sa v protein lng trng trng do cng ty NutraSweet pht trin. Simplesse cung cp t 1 n 2 calori trong mi gram, thay v nh thng thng l 9 calori 42
Ch n ung
trong mi gram cht bo. Nhng cht thay th cht bo khc ch ly t protein v carbohydrate ri lm thay i chng theo mt cch no gi to nhng cu trc ca cht bo (mn mng, nhn bng...). Tt c nhng cht thay th cht bo ny gip to ra nhng sn phm c bo thp. Cht thay th cht bo khng c calori hin ang c khuyn khch l olestra, do Procter & Gamble pht trin. Hin loi ny ang c bn th nghim Hoa K trong nhiu loi thc n vt thm ngon nh khoai ty chin v cc loi bnh gin. Tuy nhin, olestra l mt cht c kh nng gy nguy him m hu ht cc chuyn gia u thy l c hi nhiu hn c li. Canada vn cha chp nhn loi sn phm ny. Olestra c to ra t s kt hp ca cc loi du thc vt v ng. N c v ging nh cht bo tht, nhng c cu trc phn t v mt sinh ha qu ln n mc gan khng th ph v c. V vy olestra ch i thng qua rut gi ri c bi tit ra. Tuy nhin, olestra li khng ch l mt phn t trng khng. Theo nhn xt ca C quan Qun l Thc Dc phm Hoa K 43

(FDA), olestra c th gy tiu chy, chng chut rt, v lm c th mt i nhng cht dinh dng thit yu, bao gm cc vitamin A, D, E v K cn thit cho s ng mu. Tht vy, tt c nhng cuc nghin cu do Procter & Gamble tin hnh cng cho thy nhng nguy c ny. Nu FDA chp thun cho php s dng olestra nh mt cht thay th du n, bn s thy n trong bt k sn phm c bo cao no c th tng tng ra c. Tuy nhin c mt mi nguy him khc na vi olestra m cc nh dinh dng t ra trong mt bi ph phn olestra c ng trn mt n phm nm 1996 ca i hc California, ng vo nm m olestra c chp thun a ra bn th nghim. Thay v khuyn khch mi ngi chn cc loi thc n dinh dng nh tri cy, ng cc, rau ci thay cho cc thc n nhiu cht bo, th cc sn phm loi ny li khuyn khch ch n nhiu cht bo gi to. Nh vy, ch n s rt t cht x v nhng cht dinh dng thit yu khc. u im khng c cht bo tht ra c ngha l ngi s dng cui cng s c nguy c thiu ht vitamin. Nhng sn phm nh olestra hn phi lm cho bn lo lng! 44
Ch n ung
13. Ct gim lng carbohydrate Cht bo khng phi l yu t duy nht lm cho bn bo mp. Ngoi ra cn phi k n cc cht thuc nhm carbohydrate na. Mt ch n giu carbohydrate cng c th lm cho bn bo mp ra. l v carbohydrate - ngha l cc mn n c tinh bt, chng hn nh cm go, bnh m, hay khoai ty... c th c tch ly dng cht bo khi n vo qu nhiu. Carbohydrate c th l dng c cu trc n gin hoc phc tp. Dng c cu trc n gin c tm thy trong bt c loi thc phm no c cha ng t nhin, nh mt ong, tri cy, nc p tri cy, rau ci, sa... Dng c cu trc phc tp c to thnh bi nhng phn t ln hn, chng hn nh thc phm t ng cc, tinh bt v nhng thc n giu cht x. Thng thng, tt c carbohydrate khi n vo u c chuyn ha thnh ng glucose. Glucose l mt t chuyn mn ch dng ng c cu trc n gin nht. Tt c nng lng ca c th c ly t ng glucose trong mu. Khi hm lng ng glucose trong mu cn kit i, bn cm thy mi mt r ri v c cm gic i. 45

Nhng iu g s xy ra khi bn n vo nhiu carbohydrate hn l nhu cu ca c th? C th s tch ly s lng carbohydrate tha ra dng cht bo. Chng ta cng bit rng, tc c th hp th ng glucose t carbohydrate nhanh hay chm l do nh hng t s kt hp thnh phn ca ba n. Chng hn, nu thc n ch thun ty l carbohydrate, khng c protein hay cht bo, tc chuyn ha thnh ng glucose v hp th vo mu s rt nhanh - n mc m bn c th cm thy hi chng mt khi ng trong mu thay i qu nhanh. Cc chuyn gia dinh dng khuyn chng ta nn kt hp khong t 50% n 55% carbohydrate, vi 15% n 20% protein, v di 30% cht bo ba n c th mang li sc khe tt. 14. Tm hiu v ng ng c tm thy mt cch t nhin trong nhiu loi thc n. Nh ni trn, dng n gin nht ca ng c gi l glucose. Bn c th mua glucose tinh khit bt k hiu thuc no di dng thuc vin dextrose. Dextrose ch 46
Ch n ung
l mt loi glucose n c. Chng hn, khi bn thy ngi ta truyn nc ng cho ngi bnh qua tnh mch th dextrose l loi ng c trong nc y. Khi bn thy dextrose trn nhn ca mt thanh ko c ngha l trong cng thc ca thanh ko , nh sn xut c dng glucose n c. - Glucose l thnh phn c bn ca tt c cc loi ng hnh thnh t nhin, bao gm: - Sucrose: ng kt tinh hay ng trng, c tm thy t nhin trong ma ng v c ci ng. - Fructose: ng t nhin trong tri cy v rau ci. - Lactose: ng t nhin trong tt c cc sn phm sa. - Maltose: ng t nhin trong cc loi ht ng cc Khi bn n bt k loi ng t nhin no, bn s thc s tiu ha mt phn glucose v 2 hoc 3 phn cc loi ng t nhin khc. V 47

d, sucrose c cu trc sinh ha gm mt phn glucose v mt phn fructose. V v sucrose c to thnh t glucose nn s phn ha tr li thnh glucose - mt khi c a vo h tiu ha ca bn. Qu trnh cng xy ra tng t nh vy i vi tt c cc loi ng t nhin khc, ngoi tr ng lactose. Trong thc t, lactose b phn ha thnh glucose v mt loi ng n khc bit l galactose. (Trc y ti vn thng ngh n tn gi ny nh l mt ci g nm trong di ngn h, mi cho n khi ti tr thnh mt tc gi vit v sc khe!) Ch cn nh n ng lactose c trong sa v mi quan h vi di ngn h l bn s nh ngay thi!1 Cc loi ng n gin c th tr nn hi phc tp khi bn ni n cu trc phn t ca chng. Chng hn, cc loi ng n gin c th phn loi thnh monosacharides (ng n) hay dissauharides (ng kp). Nhng tr khi bn ang vit mt bi thi mn ha hc v cc
1 on ny tc gi chi ch mt cch hm hnh. Galactose c so snh vi galaxy (di ngn h) ch r tnh cht khc bit ca n trong nhm cc loi ng, v lactose c trong sa (milk) c so snh vi Milky Way (di ngn h) to s lin tng d nh.
48
Ch n ung
loi ng, khng th bn khng cn thit phi bit v nhng phn bit rc ri ny. Bn ch cn bit rng tt c nhng loi ng hnh thnh trong t nhin cui cng u s phn ha thnh glucose sau khi bn n vo. Glucose c dng mu a n cc t bo v c s dng nh l ngun nng lng ca c th. Vy phi mt bao lu mt trong nhng loi ng trn phn ha thnh glucose? iu ph thuc rt nhiu vo lng cht x trong thc n, lng protein bn n vo, v lng cht bo i km vi ng trong ba n. Nh cp n mc s 13, nu bn c nng lng, th mt khi ng bin thnh glucose, n s c th c tch ly dng cht bo. V l l do v sao ng c th lm bn tr nn bo mp.
ng c b sung khi ch bin thc phm
iu m bn phi cn thn lu l lng ng c thm vo trong qu trnh ch bin thc phm ca cc nh sn xut. Cc loi thc phm c cha nc p tri cy m c hay ng nghch chuyn, xi-r bp thng thng, mt ong hay mt ma ... tt c u c thm ng 49

vo. Tuy nhin, nhiu ngi khng nhn ra rng nc p tri cy khng thm ng vn l mt ngun cung cp ng, thm ch khng cn thm ng vo trong qu trnh ch bin. Lng d tha cc loi ng lactose (ng t nhin trong cc sn phm sa), dextrose (glucose n c) v maltose (ng t nhin trong cc loi ht ng cc) cng c a vo rt nhiu trong cc loi thc phm ca bn. Ni cch khc, cc sn phm c sn lng ng t nhin, v ri rt nhiu ng c thm vo na lm tng thm rn, v ngt... Cch tt nht bit c c bao nhiu lng ng trong mt sn phm l nhn vo thnh phn dinh dng trn nhn hiu tm ch carbohydrates.
Cc cht lm ngt
Di y l nhng g bn cn bit v nhng cht lm ngt nu nh bn ang c gim bo. Mc d cc cht lm ngt nhn to khng cha ng (i vi ngi b bnh i ng, iu ny c ngha l khng lm nh hng n lng ng trong mu) nhng chng c th cha mt lng nh calori. iu ty thuc vo loi cht 50
Ch n ung
lm ngt c xp vo loi c dinh dng hay khng c dinh dng. Loi cht lm ngt c dinh dng c cha calori hoc ng t nhin. ng kt tinh dng trng hoc en, mt ma, mt ong v xi-r, tt c u c xem l cht lm ngt c dinh dng. Cc loi cn c ng cng l cht lm ngt c dinh dng, bi v chng c lm t tri cy hoc l dng thng phm to ra t dextrose. Sorbitol, mannitol, xylitol v maltitol u l nhng loi cn c ng. Cc loi cn c ng ch cha khong 4 calori trong mi gram, ging nh ng thng thng, v s tc ng n mc ng trong mu ca bn ging nh ng thng thng. nh hng ca chng ph thuc vo s lng a vo c th v mc hp th ca ng tiu ha. Cht lm ngt khng dinh dng l nhng cht thay th ng hay cht lm ngt nhn to. Chng khng cung cp calori v khng nh hng n mc ng trong mu. Tiu biu cho cc cht lm ngt khng dinh dng l saccharin, cyclamate, aspartame, sucralose v acesulfame potassium. 51

Aspartame c pht minh vo nhng nm 1980 v c bn di tn thng phm l NutraSweet. Thc ra, aspartame c xem nh cht lm ngt c dinh dng, bi v n c chit xut t ngun gc t nhin (c 2 amino acid, aspartic acid v phenylalanine). iu c ngha l aspartame c tiu ha v chuyn ha ging nh bt k loi thc n protein no khc. Mi gram aspartame cung cp 4 calori. Nhng v aspartame c ngt gp 200 ln so vi ng, nn bn khng cn phi dng nhiu m vn c c ngt mong mun. t nht l 90 quc gia, aspartame c dng trong hn 150 loi sn phm, bao gm cc loi thc n im tm, thc ung, trng ming, ko, xi-r, du trn x lch v nhiu loi thc n vt khc na. iu d gy nhm ln l, aspartame hin cng c bn di nhn hiu l Equal, v gn y nht l PROSWEET. im l th ca aspartame l khng nn dng cho cc loi bnh nng hay bt k mn n no cn ch bin vi nhit cao. Hai amino acid trong aspartame s tch ri ra khi b lm nng, v mn n s mt v ngt. Vic lm nng khng gy hi g, nhng mn n ca bn s khng c c v ngt nh mong mun. 52
Ch n ung
Hin ti, aspartame c xem l an ton cho tt c mi ngi, k c ngi bnh i ng, ph n c thai v tr em. i tng duy nht phi thn trng vi aspartame l nhng ngi b mt chng bnh di truyn him gp gi l phenylketonuria (PKU), bi v aspartame c cha phenylalanine, cht m ngi b bnh PKU khng th dung np c. Mt cht lm ngt thng thng khc na l sucralose, c bn di tn thng phm l Splenda. Splenda l mt cht bt tinh th trng, thc ra l c ch to t ng. N c v ngt gp 600 ln ng kt tinh, nhng khng b phn ha trong h thng tiu ha - v th n hon ton khng cung cp calori. Splenda c th c dng trong cc loi thc n nng hoc lnh, v cng dng trong cc thc ung nng v lnh, thc n ng lnh, cc mn nng v nhng loi thc phm ng gi khc. Hoa K, bn c th mua cyclamate - mt cht lm ngt khng dinh dng c bn di nhn hiu l Sucaryl hay Sugar Twin. Cyclamate cng l cht lm ngt c dng trong nhiu sn 53

phm chng tng cn. N c v ngt gp 30 ln ng kt tinh v khng li d v sau khi n. Cyclamate dng tt cho cc thc n nng hoc lnh. Tuy nhin, Canada bn ch c th tm thy cyclamate vi tn Sugar Twin hay dng mt cht thay th ng dng trong cc dc phm.
Cc loi cn c ng
Khng nn nhm ln vi cc loi thc ung c cn, cc loi cn c ng l nhng cht lm ngt c dinh dng ging nh ng thng thng. Chng c tm thy t nhin trong cc loi tri cy, hoc c ch to t carbohydrate. Sorbitol, mannitol, xylitol, maltitol, xi-r maltitol, lactitol, isomalt v hydrogenated starch hydrolysate u l nhng cht cn c ng. Trong c th, nhng loi ng ny c hp th phn di ca ng tiu ha v s gy nn cc triu chng bnh nu bn dng qu nhiu. Bi v cc loi cn c ng c hp th chm hn, nn c thi k c qung co l rt tt cho nhng ngi b bnh i ng. Nhng v chng l carbohydrate nn chng vn lm tng mc ng trong mu 54
Ch n ung
ging nh ng thng thng. V cc cht lm ngt nhn to hin nay trn ngp trn th trng, nn li th thc s duy nht ca cc loi cn c ng l chng khng gy su rng. Vi khun trong ming khng thch cc loi cn c ng nh l ng tht. Theo FDA, ngay c thc n c cha cc loi cn c ng c th ghi trn nhn l khng c ng. Cc sn phm cn c ng cng c ghi trn nhn l khng gy su rng, v iu thng b nhm ln l c t calori. 15. Hiu ng cc nhn thc phm T nm 1993, cc nhn thc phm phi tun th nhng hng dn nghim khc do C quan Qun l Thc Dc phm (FDA),1 v Cc Thanh tra v An ton thc phm (FSIS)2 ca B Nng nghip Hoa K (USDA)3 ra. Tt c cc nhn hiu phi lit k thnh phn dinh dng bn cnh hoc pha sau ca sn phm. Phn t l trong gi tr dinh dng hng ngy s cho bit
1 The Food and Drug Administration 2 The Food Safety and Inspection Service 3 The U.S. Department of Agriculture
55

v hm lng cao hay thp ca nhiu thnh phn dinh dng khc nhau, chng hn nh cht bo, cht bo bo ha v cholesterol. Ch s 5 hoc nh hn 5 ngha l thp. Nu sn phm ghi ch s cht bo, cht bo bo ha v cholesterol t hn 5, l iu tt. Nhng nu l ch s cht x t hn 5 s l khng tt. Khi lng c tnh cho mt khu phn n cng d gy nhm ln. Cc thc phm tng t c cng khi lng khu phn theo FDA quy nh. iu c ngha l 5 loi ht ng cc c cn nng nh nhau s c cng khi lng khu phn n nh nhau! Lng calori v calori c cung cp ring t cht bo cng c lit k cho mi khu phn thc phm. Tng lng carbohydrate, cht x, ng, cc carbohydrate khc (c ngha l cc loi tinh bt), tng lng cht bo, cht bo bo ha, cholesterol, sodium, potassium, vitamin, v cc khong cht c ghi trong phn t l trong gi tr dinh dng hng ngy, da trn ch n 2000 calori mi ngy do Chnh ph Hoa K ngh. Canada, lng dinh dng xut (RNI)1 c p dng vi cc vitamin v khong
1 Recommended Nutrient Intake
56
Ch n ung
cht, trong khi cc thnh phn dinh dng trn nhn hiu c lit k theo trng lng, theo th t t nhiu n t. khng phi l ni s nhm ln kt thc - hoc thm ch l bt u. Bn phi c qua ht hng khi nhng thng tin khc nhau trn nhn hiu v hiu c ngha ca chng. V d, trn nhn hiu ghi khng c mt cht no , nh khng c ng, khng c cht bo bo ha, khng c cholesterol, khng c sodium, khng c calori... iu c ngha l sn phm khng c cht c ni n hoc c rt t, khng ng k. Vn hon ton khc khi mt nhn hiu ghi 95% khng c cht bo. Trong trng hp ny, sn phm c cha mt lng cht bo tng i nh nhng vn l c. Thng tin ny da trn 100 gram sn phm. V d, nu mt loi thc n vt cha 2,5 gram cht bo trong 50 gram, th c th ni l 95% khng c cht bo. Mt nhn hiu khc khng nh rng lng cht bo bo ha thp hay lng calori thp, iu khng c ngha l khng c cht bo hay khng c calori. N ch c ngha l bn c th 57

n mt lng ln loi thc n m khng vt qu gi tr dinh dng hng ngy c ngh cho loi thc n . mt x c nhiu khoai ty chin, iu c ngha l bn c th n 12 ming khoai ty chin thay v 6 ming. Bi vy, nu bn n ht c mt bao khoai ty chin c bo thp, bn vn a vo c th nhiu cht bo. Hy nh xem k khi lng dnh cho mi khu phn n. Khng c cholesterol hay cholesterol thp c ngha l sn phm khng c hoc c t cht bo ngun gc ng vt. iu ny khng c ngha l t cht bo. Du thc vt tinh ch khng phi l cht bo ly t ng vt, nhng vn hon ton l cht bo!
t hn v nhiu hn
V cn c nhng thng tin theo cch so snh nh l t hn, gim bt, nhiu hn, t calori hn... Nhng t ny xut hin trn cc thc phm v mt dinh dng c thay i t mt sn phm trc , hoc sn phm ca mt nhn hiu cnh tranh khc. Chng hn, mt nhn hiu loi thng c th c nhiu cht bo hn so vi nhn hiu cng loi nhng ghi thm t cht bo 58
Ch n ung
hn. iu khng c ngha l sn phm th hai ny khng c cht bo, hoc thm ch cha hn l t cht bo. N ch c ngha l t l cht bo t hn sn phm loi thng trc ! Tng t, mt nhn hiu sn phm c hm lng calcium rt thp, v nhn hiu sn phm cng loi ra sau ghi thm nay c hm lng calcium cao hn. Thc t th hm lng calcium c th vn l thp, nhng ch l cao hn sn phm trc i cht. Ni cch khc, bn vn phi n rt nhiu loi sn phm ny mi c nhu cu calcium hng ngy! c xem l t calori, mt sn phm phi cha t hn mt phn ba lng calori, hoc mt na cht bo so vi sn phm thng thng. Hoc l, mt thc n c lng calori thp hoc cht bo thp c ngha l n c khong 50% thp hn so vi loi thng thng. Tng t, t sodium c ngha l gim t nht 50% sodium so vi sn phm thng thng, chng hn nh mt loi sp ng hp. (Nhng nu bn mua thuc nhum tc m thy ghi nu nht th l t m t mu sc ch khng cp n thnh phn trong sn phm!) 59

Bn nh mua mt t xi-r ho khi b cm lnh? V loi thuc vin vitamin th sao? Trc ht, hy kim tra ng trong . Dc s ca bn c th ngh mt loi thuc khng c ng!
Khng c ng
Khi mt nhn hiu ghi khng c ng c ngha l loi sn phm cha t hn 0,5 gram ng trong mt khu phn n; cn nu ghi gim lng ng th sn phm c hm lng ng thp hn t nht l 25% so vi sn phm cng loi thng thng. Nu trong nhn hiu tha nhn khng phi l loi sn phm gim lng ng hoc t calori, hoc khng dnh cho mc ch chng tng cn, th hn l lng ng trong cho bn phi cn nhc li. Nhng dng ch khng c ng trn cc nhn hiu ch c ngha l khng c ng sucrose. iu khng c ngha l sn phm khng c carbohydrate, cng nh ni khng c dextrose, khng c lactose, khng c glucose hay khng c fructose. Hy kim tra cc nhn hiu, tm tt c nhng ch tn cng bng ose bit c lng ng cha trong , khng ch 60
Ch n ung
l ng sucrose. Hy cn thn vi nhng dng ch nh khng thm ng. iu ny ch c ngha l nh sn xut khng cho ng thm vo sn phm, nhng ng t nhin th c y! Mt ln na, ch con s cho bit lng carbohydrate phn thng tin v dinh dng l cch chnh xc nht bit v lng ng trong sn phm. 16. Tm hiu v cht x Cht x, ni n gin l mt thnh phn trong thc vt m c th khng tiu ha c. C hai dng cht x, mt dng tan trong nc. Dng th hai khng tan trong nc m ngc li, n ht nc.
Cht x ha tan vi cht x khng ha tan
Hai dng cht x ny gy tc dng khc nhau, nhng chng u c li nh nhau. Bng mt cch no , dng cht x tan trong nc c th lm h thp mc cholesterol c hi1 trong c th. Cc chuyn gia vn cha bit chc c c ch hot ng ca cht x ny nh th no c th to ra c iu k diu , nhng mt trong cc gi
1 Low-density lipid, thng c vit tt l LDL.
61

thuyt ph bin l n ha trn vo vi lng mt do gan tit ra v hnh thnh mt cht lm cn tr s to thnh cc khi cholesterol, do m lm h thp c mc LDL trong c th. Cng tng t nh mt con nhn lm mc kt nhng cn trng nh hn trong ci li ca n ging ra. Cc ngun cht x ha tan bao gm yn mch, cm yn mch, cc loi u (ti v kh), mt s loi ht, c rt, cam, chui v cc loi tri cy khc. u nnh cng l ngun cht x ha tan tt. Cc cuc nghin cu cho thy rng n u nnh mang li li ch nhiu nht cho nhng ngi c chelesterol cao. u nnh cng l mt ngun cung cp phytoestrogen (estrogen c ngun gc thc vt), c tin l lm gim nguy c mc phi nhng bnh ung th c lin quan ti ni tit t estrogen (chng hn nh ung th v), cng nh lm gim bt vic mt estrogen vo thi k mn kinh. Bnh m en, lm t la m cn nguyn lp v cm, cng l ngun cung cp cht x khng ha tan tt. Bnh m lm bng bt xay ht cy lanh c bit rt tt, v ht cy lanh cng l ngun 62
Ch n ung
cung cp c cht x ha tan na. Vn l phi hiu c th no l ht ng cc thc s cn nguyn cm. Chng hn, ngi ta thng mc nhin tha nhn rng bnh m en c nhiu dinh dng hn. iu ny khng hn ng. Trong thc t, nhiu loi bnh m en chng qua ch l bnh m trng c b sung dinh dng ri nhum mu bng mt ma. B sung dinh dng c ngha l nhng dinh dng b mt i trong qu trnh ch bin c b li. Loi bnh m c bit c b sung hm lng cht x cao hin c bn nhng hi kh tm. 17. Nhng nguyn nhn tm l lm tng cn C t nht l 80% trong s ph n vi nguy c mc cc bnh tim mch c trng lng c th vt hn 20% so vi mc thch hp, xt theo chiu cao v tui ca h - v mt chuyn mn y c xem l bnh bo ph. Khi ph n tm n bc s hay cc nh dinh dng hc, h c cung cp cch tnh ton cho cc ba n, bng lit k nhng mn khng nn n... Nhng vn su sc hn nhiu ch khng ch l vic n qu nhiu. im 63

then cht lm gim cn i vi nhiu ph n l phi kho st nguyn nhn ban u lm cho h tr nn bo ph. Nhiu ph n bo ph ni rng t h vn tun th vic n king t trc cho n khi c trng lng c th nh hin ti! Bnh bo ph l nhn t to nguy c ln nht dn n cc bnh tim mch v ung th thng gp tui trn 50, chng hn nh ung th rut kt hay ung th v, cng nh bnh i tho ng loi II. C bn l ngi b bo ph cng lu th c nguy c cng cao. ng kinh ngc l cc chuyn gia nhn thy rng khi bn ch gim cn i khong hn 2 kilogram, c th bn c th thc s bt u hot ng hiu qu hn. Tuy nhin, nhng li khuyn v vic n ung hp l v rn luyn th lc li khng c tc ng cht no vi hu ht ph n ang chng chi vi chuyn tng cn. Mt phn trong vn bnh bo ph phng Ty l phi hiu c ch n ung hin i bt ngun t u. Ni cho cng, bn khng to ra ch n ung hin i, m bn c sinh ra vi ch n . Trong thc t, t ng ch n 64
Ch n ung
ung (diet) c ngun gc trong ting Hy Lp l diatta, c ngha l cch sng. Nhiu quc gia chu u gim ng k cc trng hp bnh c lin quan n bo ph trong thi gian cc cuc th chin th I v th II, khi m tht, sa v trng tr nn khan him i vi phn ln dn s. Khu phn n trong thi chin buc ngi ta phi sng vi bnh m en, yn mch v la mch, cng vi nhng th t lm ra c. Nu khng phi l do cuc khng hong kinh t th gii nm 1929, c th l Bc M chng ta phi thc s i mt vi s gia tng cc bt n v sc khe lin quan n bo ph sm hn nhiu. Li sng t vn ng hu nh c t nhng nm 1920, v nhng tin nghi i sng, ch yu l xe hi v my thu thanh, dn n vic i xe nhiu hn, i b t hn v hnh thc gii tr t vn ng hn. Cuc khng hong kinh t th gii lm gin on giai on c cho l thi thnh vng cho tt c mi ngi. Nhng n cng ngn chn c bnh bo ph cng vi tt c nhng bnh c lin quan n bo ph, bi 65

v ngi dn nhiu quc gia cng nghip ch c n sng cn. S chm dt th chin th II nh du mt thay i ng k na trong ch n ung. Ngi ta mun n mng - h t chc tic tng, ung ru vang, ht thuc l, i n nh hng. Cha bao gi ch n ung ca chng ta li tng thm nhiu n nh lc ny nhng mn c cht bo cao, carbohydrate tinh ch, ng, thc ung c cn v cc ha cht ph gia. Khi ph n bt u qun l cc gia nh ln, thc n ng hp c sn xut tht nhiu v c tiu th bi hng triu ngi. Nhu cu cho ch n ung nhn ri cng thay i ng k nn nng nghip. Ngy nay, 80% thu hoch ng cc ca chng ta dnh cho vic nui gia sc. Phn cn li ca t canh tc c dng cho cc nng sn c gi tr mua bn cao hn nh l c chua, ng, c ph v chui. Cui cng, nhng nng sn c gi tr mua bn cao gip to ra ch n ung hin i ca phng Ty: rt nhiu tht, trng, cc sn phm sa, ng v bt tinh ch. 66
Ch n ung
T 1940, cc ha cht ph gia v cht bo qun thc phm gia tng n 995%! Vo nm 1959 Hip hi cc nh sn xut hng liu Hoa K (FEMA)1 thnh lp mt nhm chuyn gia c nhim v xc nh mc an ton ca cc hng liu thc phm, i ph vi s lng qu nhiu nhng cht ha hc m cc cng ty mun cho thm vo thc phm. Mt trong nhng cht ph gia thc phm ph bin nht l bt ngt (MSG),2 mui sodium ca acid glutamic, mt loi anino acid c trong t nhin, trong cc thc n c cha cht m nh tht, c, sa v nhiu loi rau. Bt ngt l mt cht lm tng hng v m cc nh nghin cu tin rng gp phn to nn v gic th 5 cho cc loi thc n thm ngon nh tht, cc mn hm, c chua v pho mt. Ban u, cht ny c chit xut t to bin v cc ngun thc vt khc, gy tc dng vi thc n cng ging nh cc gia v hay cht trch ly khc. Ngy nay, bt ngt c lm t tinh bt, ng bp hay mt ng (t
1 The Flavor and Extract Manufacturers Association of the United States. 2 monosodium glutamate
67

ng ma hay c ci ng). Bt ngt c sn xut bng qu trnh ln men tng t nh qu trnh sn xut bia, gim v sa chua. Mc d bt ngt c C quan qun l Thc Dc phm Hoa K (FDA) xc nh l an ton trong s dng, nhng nhng vn v tnh an ton trong vic tiu ha bt ngt c nu ln bi v c nhng ghi nhn v tnh nhy cm ca thc phm i vi cht ny. Khng k n vic ny, vn chnh ca bt ngt l n lm tng ngon ming. c dng rng ri trong thc n, bt ngt lm cho mi v thc n ngon hn, v thc n cng ngon hn th chng ta li cng n nhiu. Cc loi m thy phn cng c dng lm cht tng hng v. Nhng cht ny c to ra bng cch dng cc enzym phn ha v mt ha hc cc cht m c trong u nnh, gluten la m, gluten bp, cc ging men n c hay cc ngun thc phm khc. Qu trnh thy phn lm phn ha cc protein thnh cc anino acid tng ng. Ngy nay, c hng trm cht ph gia loi ny c dng trong thc phm. H qu ca ch n ung nhn ri phng Ty l thc n ng hp tr nn r hn so vi 68
Ch n ung
thc n t nhin. th gii phng Ty pht trin, ni no ngi ta sng vi ng lng thp nht th ni c bo ph ln nht. C thi bo ph tng l du hiu ca s giu c v thnh vng. Ngy nay s giu c c nh ngha l c vc dng va phi v khe mnh. Ma mai thay, cc thc n c bo thp, cc chng trnh n king v cc cu lc b th hnh li thu ht nhng ngi t b nh hng ca bnh bo ph nht. Trong thc t, nhng ri lon n ung c khuynh hng gy kh khn cho cc ph n c thu nhp cao. Nhng thng k mi nht v bnh bo ph Hoa K gn y c cng b. Ti liu ny c th c dng gii thch cc kiu bo ph khp th gii phng Ty. Mt bo co quc gia v th trng da trn mt cuc kho st 33 thnh ph cho thy l cc thnh ph c t l tht nghip cao v thu nhp u ngi thp thng c t l bo ph cao hn. Nhng vng c lng ma hng nm cao v s ca hng thc phm cao cng c t l bo ph cao hn. Cng c nhiu ngy ma v tuyt ri, ngi ta cng n vt nhiu hn trc mn hnh ti-vi! 69

Ti sao chng ta thch cht bo
Cht bo c v ngon, v khi cho vo ming to cm gic ngon ming. Thc n c mi v v kt cu c bit nh cht bo d c chp nhn hn nhng thc n khc. y l l do v sao cc nh sn xut thc phm ng gi m t cc sn phm ca h l lng mn, c kem, t, mm v giu dinh dng. Tt c thc phm no c c nhng phm cht ny, t kem cho n s-c-la, ph-mt, u mang li cho chng ta cm gic c o ca s no n v tha mn, lm chng ta thy ngon. n ung l qu trnh mang li s thch th. Khi chng ta thng thc mn n ngon, b no chng ta to ra cht endorphin,1 nhng hormone to cm gic ngon ming, tht bun ci l chng cng c to ra khi chng ta rn luyn th lc. c n cht bo to cm gic khoi khu. i vi nhiu ngi trong chng ta, nu khng c hng v v kt cu ca cht bo th vic n ung tht chng hng th g. V khi chng ta tri qua
1 Endorphin, mt trong cc hp cht ha hc tng t nh encepha lin, c t nhin trong no v c tnh cht gim au tng t nh thuc phin.
70
Ch n ung
nhng cm xc au bun hay khao kht tnh cm th kt cu v hng v ca cht bo thm ch cn quan trng hn. n ung th ca hoc khng tun th ch n king khng phi l do mt kh nng kim sot m l ly li cm gic ngon ming b mt. Thc n, nh hng triu nhng ngi n qu nhiu s ni cho bn bit, l bn ca chng ta. N lun sn sng khng bao gi lm chng ta tht vng.
nh hng ca nhng sn phm c bo thp
T cui nhng nm 1970, ngi M b vy quanh bi qu nhiu sn phm c bo thp. Vo nm 1990, Chnh ph Hoa K pht ng chin dch Ton dn khe mnh nm 2000, mt chin dch thc gic cc nh sn xut phi tng gp i cc sn phm c bo thp vo thi im nm 2000. T nm 1990, mi nm c hn 1000 sn phm mi khng c hoc c t cht bo c a ra bn cc siu th. Nhng hng dn hin nay cho chng ta bit l trong tng nhu cu calori hng ngy, nn c t hn 30% ly t cht bo, v trong s th lng 71

cht bo bo ha khng nn vt qu mt phn ba. Theo c tnh ca Hoa K, mt ngi trung bnh c cung cp khong 34% n 37% lng calori t cht bo v xp x 12% t cht bo bo ha. Cc s liu cho thy l vi cht bo tuyt i, lng a vo c th tng t 81 gram mi ngy vo nm 1980 ln n 83 gram mi ngy vo nhng nm 1990. Tng lng calori hp th cng tng t 1.989 calori mi ngy vo nm 1980 ln n 2.153 calori mi ngy. Thc ra, l do duy nht m cc s liu cho thy c s gim st v t l calori ly t cht bo l s gia tng rt nhiu tng lng calori a vo mi ngy. Kt qu l ngy nay chng ta cn nng hn nm 1980, mc d so vi nm th hin gi c thm gn 10.000 loi thc phm c bo thp! Tuy nhin hu ht cc sn phm c bo thp ny li thc s khuyn khch chng ta n nhiu hn. V d, mt ti khoai ty chin loi thng c 9 gram cht bo trong mt khu phn (mi khu phn thng l khong 5 lt hoc mt nm tay), th bn c nhiu kh nng gii hn mt khu phn . Tuy nhin, nu bn c thy trn nhn hiu ghi c bo thp hn 50%, c 72
Ch n ung
nhiu kh nng bn s n trn c ti khoai ty chin (v ngh l tt v chn n thc phm t bo), v iu c th d dng lm tng gp ba ln lng cht bo a vo c th! Thc n t hoc khng c cht bo nh la c th chng ta bng cc thnh phn nhi theo ging nh cc chc nng ca cht bo trong thc n. iu ny thng c c bng cch s dng cc loi cht bo b bin i khng th chuyn ha trong c th, hoc nu c th ch mt phn nh thi. Mt s loi thc phm lm gim cht bo bng cch loi b cht bo (sa ly vng, tht nc...), nhng hu ht cc thc n t bo u s dng cc cht bo gi di nhiu dng khc nhau nhm bo qun hng v v kt cu ca thc phm. Chng hn nh, nc thng c kt hp vi carbohydrate v protein nhi theo mt kt cu hay hng v, nh trong trng hp ca nhiu loi thc n nng hay cc hn hp lm bnh ngt. Mc d vy, ni chung th cc loi thc phm t bo kiu ny u c thnh phn chnh l carbohydrate, protein hay cht bo. Cc thnh phn c gc carbohydrate l nhng cht tinh bt v nhng cht gm thng c 73

dng lm cht to b dy hnh thnh kt cu ca cht bo. Bn s thy nhng cht ny rt nhiu trong cc loi sn phm t cht bo nh du trn x lch, nc st, nc tht, cc mn trng ming ng lnh v cc mn thc phm nng. So vi cht bo t nhin c khong 9 calori trong mt gram th nhng thnh phn c gc carbohydrate c t 0 n 4 calori trong mi gram. Cc thnh phn t bo c gc protein c to ra bng cch lm cc protein to ra chng phn ng khc i. Chng hn nh, bng cch ly protein trong nc sa hoc lng trng trng ri lm nng hay nh chng ln vi tc cao, bn s to ra c kt cu kem. Cc protein ca u nnh v bp thng c dng trong nhng trng hp ny. Bn s thy nhng thnh phn ny trong cc sn phm t bo nh pho-mt, b, mayonnaise, du trn x lch, cc loi trng ming lm t sa ng lnh kem chua v cc loi thc phm nng. Chng c t 1 n 4 calori trong mi gram. Cc thc n t bo dng cc thnh phn c gc cht bo c tc ng thay i cht bo theo mt 74
Ch n ung
cch no c th chng ta khng hp th hay chuyn ha chng hon ton. Nhng thnh phn ny c thy trong s-c-la, lp bc sc-la bn ngoi cc thc phm khc, margarine, cht pht ln bnh m, kem chua v pho-mt. Bn cng c th s dng nhng cht ny nh l cht thay th t bo khi chin thc n, chng hn nh khi chin trng vi margarine. Olestra, mt cht thay th cht bo mi, va c Cc qun l Thc Dc phm Hoa K (FDA) chp thun, l mt in hnh cho loi cht thay th cht bo khng c c th chng ta hp th, v do khng cung cp calori. Caprenin v Salatrim l nhng v d v cc cht bo ch c hp th mt phn, chng cha nhiu loi acid bo c chui di. y l nhng thnh phn t bo c gc cht bo c dng t rt lu v c cha khong 5 calori trong mi gram. R rng l cc thc n t bo c lm ra cho bn c nhiu kh nng t do la chn hn trong ch n ung, cho php bn gim bt cht bo m khng phi thay i v gic vn c. Cc cuc nghin cu cho thy l v gic ng vai tr quan trng hn cht dinh dng trong b no ca 75

bn. Tuy vy, nhiu chuyn gia tin rng v lu di cc sn phm t bo s to ra mt s tr ngi cho vic gim cn. Cc nh nghin cu i hc Toronto cho rng cc sn phm ny v c bn cho php chng ta lm tng lng calori mc d chng ta ang gim lng cht bo ton din a vo c th. V d, trong mt cuc nghin cu, ph n dng thc n im tm c t cht bo s n nhiu hn trong ngy so vi nhng ph n n sng bng thc n c lng cht bo cao. Mt tt ca cc sn phm t bo hoc khng c cht bo l chng thc s c t cht bo v c to ra nhm thay th cho nhng thc n khng tt, khi bn bit l khng nn n nhng vn khng th khng n. Nguyn tc c rch l mi th phi iu cng p dng vi cc sn phm c lng cht bo thp. Cn bng cc sn phm ny vi mt lng dng va phi l iu then cht. Hy n thc n c bo t vi lng ging nh thc n c bo cao. Ni cch khc, ng n lng thc n nhiu gp i ch v chng c bo thp. Thay vo hy dng mt lng 76
Ch n ung
tng ng nh khi bn dng cc loi thc n trc y. 18. Hy ngng n king theo thi quen Vic n king theo thi quen dn n bnh bo ph. Theo c tnh c t nht 50% ph n Bc M lc no cng n king, trong khi c mt phn ba nhng ngi n king Bc M bt u n king t nht mi thng mt ln. Vic n king tui thiu nin v thanh nin c th dn n bnh bo ph v sau. iu ny xy ra v hu ht mi ngi u c khuynh hng nhit tnh trong nht thi thay v thc hin vic n ung mt cch hp l. Ni cch khc, h l nhng ngi n king thnh thi quen. Phng thc n king gi l nhit tnh trong nht thi l nhng g chng ta thc hin khi mun gim cn n mt mc c th no , trong mt trng hp no . Thng thng l nhn i mt vi ngy ri n ung li bnh thng. Hoc ch n mt s loi thc n no (nh rau cn ty v bi) trong mt thi gian, ri n ung li bnh thng sau khi gim cn. Hu ht nhng ngi n king nh th ny khng kt hp vi 77

vic rn luyn thn th. iu c ngha l cng vi lng m gim i chng ta cng lm suy yu cc c bp. V ri, khi n ung li bnh thng, chng ta ch khi phc li lng m mt m thi. Qua nhiu nm nh th, lng m ngy cng nhiu hn. iu quan trng l khi c nhiu m hn l c bp th c th khng th tiu th calori mt cch hiu qu c. Chnh nh c c bp chng ta mi tiu th calori. Lm suy gim khi lng c bp, bn cng lm suy gim kh nng tiu th m trong c th. Nu vic nhn i l phng thc chng ta c lm gim cn, th c th do s cng lm vic c hiu qu hn trong vic to ra m. Cn i thc y mt s thng minh trong qu trnh chuyn ha. C th nhanh chng thch ng ngay vi iu kin thiu thn hin ti v i vo ch tiu th nng lng vi hiu qu cc k tit kim, bt chp l bn ang sng rt y Bc M hin i. V vy khi quay tr li vic thu nhn lng calori bnh thng, hay thm ch thp hn bnh thng sau khi nhn i, chng ta s tng cn nhiu hn. C th s c khuynh 78
Ch n ung
hng tch ly ngay lng dinh dng a vo phng cn i sp ti! Mt s nh nghin cu tin rng nhn i lm chm tc chuyn ha n mc rt thp hn so vi bnh thng, do vic tng cn tr nn nhanh hn sau mi giai on nhn i. Chu k nhn i tng cn ny c gi l hi chng quay vng, l ch ca hng nghn bi bo trn cc tp ch ph n trong sut 20 nm qua. Ph v ci vng lun qun ny cng n gin thi: Kt hp vic rn luyn thn th vi n ung hp l. Nhng iu tht khng d nu trong sut nhng nm trng thnh bn sng mt cuc sng t hot ng. C 95% nhng ngi n king tng cn li sau khi gim cn v cn tng thm hn na ch trong vng 2 nm. Nh tho lun trc, tht bi trong vic ny thng do cc nhn t tm l v hnh vi. Chng ta cn phi hiu ti sao chng ta cn n trc khi chng ta c th n t hn. Cch tt nht ph v ci vng n king lun qun nh trn l phi sm gio dc cho con ci v thi quen n ung v mt trng lng c th va phi. Cc chuyn 79

gia ni rng, tr khi bn c mt th trng qu ng ngay t u, hoc c mt iu kin bnh l no , khng th ng nn n king. Mt kha cnh khc na trong vn th trng c lin quan n vai tr ca thc n v cht bo trong cuc sng ph n. Tr nn mp hay n qu nhiu khin chng ta mp c nhiu ngi cho l mt s phn khng cng cng chng li vai tr m nhiu ph n c yu cu m trch trong x hi. Do , iu quan trng l phi khm ph ra, v phng din c nhn, vic tr nn mp bo c ngha g vi bn, v nhng vn chung quanh vic m thch n ung. L ph n, chng ta l nhng ngi thng mua sm v chun b thc n cho c gia nh. ng thi, chng ta lin tc phi i ph vi cc tiu chun khng th t c v sc p, s cn i v mnh mai qua nhng hnh nh trn cc phng tin truyn thng. Nhng vai tr mu thun ny nh hng chng ta nh th no? i vi nhiu ph n, tc dng l cm gic bt lc. Ty vo mi ph n, bng cch lm cho vc dng tr nn to ln hn hoc mnh mai hn qua vic 80
Ch n ung
n hay khng n, chng ta bc l nhng mong mun v thc nhm t c s kim sot nhiu hn vi cuc sng ca mnh. Xin lu , ham thch n ung thng l vn ca ph n, iu ni ln rng l mt ph n c nhiu vn hn l nhng g cc bc s v cc nh dinh dng ni chung u cng nhn. Cc nh liu php tm l chuyn v nhng ri lon do ham thch n nhn mnh rng cch duy nht nhm gip ph n gim cn l phi gip cho h hiu c vic tng cn p ng nhng nhu cu thc hay v thc no. Cc nh tr liu lm vic vi nhng ph n v cc vn gim cn nhn xt rng, mt mt s bo mp c lp ngi ph n, mt khc khin c y tr thnh mt i tng tht bi. Ph n, d nhin bit iu ny v thnh thong dng iu ny nh mt li th tm l. Ni cch khc, i vi ph n, to bo c th bo v c ta thnh cng trong 2 lnh vc c th: nhng n lc v mt tnh dc v v mt ti chnh (c lin quan ti ngh nghip). Nhiu ph n c t thnh cng trong s nghip nhn thy mt c th m yu ngay tc 81

khc can thip vo mc tiu . Khi m, h s s l i tng tru chc bng cc ngn ng tnh dc ca cc ng nghip nam (hoc l nh th trong qu kh). Thm ch h cn s nhng ham mun tnh dc ca chnh mnh, hoc s b rung b nh l mt i tng tnh dc. Nhng khi to bo, h thy thot khi vic b coi l gi dc hoc l vt trang tr v thu lm nhng thnh qu thnh cng v mt ti chnh d ch c cho l c kt qu hay c kh nng. Tr nn bo mp, ph n cng c th gi ly gia nh bi do trnh lng nhng vi cc g n ng khc. Mt khc, nhiu ph n khng bao gi thnh cng trong cuc sng (v tnh dc hay v ti chnh) dng vic mp bo ca mnh nh l mt cch sng c lp. iu ny cho php h t ni vi bn thn rng Nu ti m, ti thnh cng ri. To bo tr thnh nguyn do cho nhng n lc thnh cng c nhn b tht bi, iu lm cho nhiu ph n i din vi nhng ni s hay nhng con qu d bn trong ni tm ca h, ngn khng cho h t c iu h thc s mun. i vi nhiu ph n, c bit l nhng ngi tng cn sau khi sinh con, to bo chng dnh 82
Ch n ung
dng g ti hot ng tnh dc hay thnh cng c nhn. N c lin quan ti mi quan h lm m ca h, cm gic ca chnh h v vic nui dng v tr thnh mt b m. Rt cuc, bu v ca ngi m bt u nui dng chng ta, thng qua cc b m chng ta hiu v thc n, hnh vi n ung v vn vn. Cc b m cng l ngun yu thng, d chu v ng h v mt tnh cm. Ngay khi khng nhn c iu ny t chnh cc b m ca ring mnh, chng ta vn lin h tnh mu t bng nhng cm xc ny. Cc nh tr liu quan st thy kch thc c th v n ung dy da vi cc mi quan h gia m vi con gi v c nhng ngha khc nhau i vi mt ph n qu cn. Ni cch khc, iu m s bo ph ca bn ni vi m bn c th c bt k ngha g t Ti l mt c gi b con v c th t mnh chm sc ly n Ti l mt m hn n v chng th t mnh chm sc. Thc s, mt s ngi con gi dng vic bo mp ca mnh khc t vai tr ca ngi m hay ni gin v ngi m khng nui dng ng cch. Trong mt s trng hp, to bo l mong mun v thc nhm mang ngi m vo trong c th bn v b y ang d dnh 83

v nui nng. l cch kh hay khi a m i cng ti bt k ni u bn i. Nhiu ph n cm thy tc gin vi s to bo ca mnh khi h phi ng vai tr l chun mc ca ci p v nhng kim ch tnh dc. Bo mp khng phi bo v m l n lc thn trng nhm xc phm th gii ny. Ti y, to bo ni vi th gii rng Nu tht s mun quen bit tao th my phi dnh thi gian xm nhp vo cc lp m ca tao. Nu khng, tao khng mun bit n my! Nhiu ph n s ngi ta thy mnh. H tin rng Mnh cng khim tn th mi ngi cng tn trng mnh. Do tnh trng bo mp ngn cn khng cho ph n ph by cm xc v gii tnh.
Cc nguyn nhn sinh hc ca bnh bo ph
Ch n d tha cht bo hoc nhiu ca-lori v t vn ng l mt nguyn nhn sinh hc dn n chng bo ph. S trao i cht ca mt ph n chm li khong 25% sau khi mn kinh, c ngha l nu b ta khng gim lng ca-lo-ri 84
Ch n ung
a vo c th 25%, hoc gia tng hot ng th lc ln 25% cn bng, iu tt nhin l b ta s tng cn. Ngoi ra cn c cc vn lin quan n hormon c th gy ra bo ph, chng hn nh tuyn gip hot ng km - gi l gim nng tuyn gip - iu rt thng gp ph n trn 50 tui. Bi v vic thay i ch n ung v np sinh hot hng ngy l rt kh khn, ngi ta quan tm n vic i tm mt nguyn nhn di truyn gy ra chng bo ph. Nu chng ta tha hng chng bo ph, nh th c ngha l chng bo ph nm ngoi kh nng kim sot ca chng ta, gi thuyt ny hn l to c s thoi mi cho rt nhiu ngi. Hin nay, chng ta ang gia chng d n Human Genome, mt d n nhm n vic v ra bn gen ton din ca c th con ngi. Nhiu n lc ang c thc hin nhm tm kim mt gen bo ph. Nhng khng c my nh khoa hc tin rng bo ph l hon ton do mt gen di truyn gy ra. Ni cch khc, c qu nhiu cc yu t mi trng v x hi c th tc ng lm thay i s bo ph. i tm mt 85

gen di truyn gy ra bo ph, c khc g i tm mt gen gy ra s gin d hay gen gy ra ti c? Mt gi thuyt quan trng khc v nguyn nhn gy bo ph c lin quan n s khng vi insulin. Ngi ta tin rng khi c th sn sinh qu nhiu insulin, chng ta s c khuynh hng n vo nhiu hn c duy tr mt s cn bng. y l l do gii thch v sao vic tng cn rt thng l du hiu u tin ca bnh i tho ng loi 2. Nhng ri chng ta li phi t ra cu hi, iu g lm pht sinh s khng vi insulin? n y, nhiu nh nghin cu li tin rng s bo ph chnh l nguyn nhn. Nh vy l chng ta ri vo ci vng lun qun con g v ci trng.1 Nhiu gi thuyt khc xoay quanh chc nng ca cc t bo cht bo. Phi chng c mt s ngi m v mt di truyn s c nhiu t bo cht bo hn nhng ngi khc? Tuy vy, y vn cha c c cu tr li.
1 Mt so snh thng dng ch nhng tnh hung khng c im kt thc, bi v cc d kin va l nguyn nhn, va l kt qu ca nhau. Ging nh con g sinh ra ci trng, nhng ci trng n ra con g. Ci no c trc? Khng c trng s khng c g, nhng khng c g lm sao c trng?
86
Ch n ung
Th liu c mi quan h no gia b no v chng bo ph hay khng? Mt s ngi cho rng chng bo ph l hon ton do ni b no v c mi quan h vi vng di i1 - mt vng ca b no c chc nng kim sot cc tn hiu gi n cho cc phn khc ca c th. V mt nguyn nhn no , vng ny c s nhm ln trong vic gi i tn hiu bo rng bng no. Ngi ta tin rng vng di i c th l ni kim sot cc tn hiu gi i khi c th no . Vi mt s cc nh nghin cu khc, vn c th gy ra do mt s trc trc ca c th lm cho khng nhn ra c cc tn hiu v trng thi i hoc no. Tuy nhin, nhng nghin cu trong lnh vc ny cn cha i n kt lun no c. Mt cuc nghin cu c tng thut trn tp ch y khoa Nature Medicine, s pht hnh trong nm 1997, cho thy rng nhng ngi c nng hormon leptin trong c th thp c th c khuynh hng tng cn. Trong cuc nghin cu ny, nhng ngi tng cn trung bnh 20 kilogram trong ba nm khi u vi mt nng leptin thp hn so nhng ngi khng
1 Hypothalamus
87

tng cn trong cng giai on ny. Do , cuc nghin cu ny c th to c s cho vic iu tr chng bo ph bng leptin. Cc chuyn gia c tnh rng khong 10% nhng ngi b bo ph c th l do s khng vi leptin. Leptin c to thnh bi cc t bo cht bo, v r rng l gi nhng tn hiu n b no v lng cht bo m c th ang c. Ging nh cc loi hormon khc, ngi ta ngh rng leptin c chc nng kch thch hot ng theo kiu tng t nh mt my iu ha nhit . Khi th nghim vi loi chut, mt lng leptin va phi c th kch thch chut tr nn nng ng hn v n t hn, trong khi qu t leptin lm cho chut n nhiu hn v t nng ng hn. iu ng quan tm l, ging th dn Pima Hoa K, vn c khuynh hng bo ph, khi phn tch mu cho thy h c lng leptin rt t, ch bng mt phn ba mc trung bnh ca mi ngi. Hin nay, nhng cuc nghin cu s dng leptin tim vo ngi iu tr chng bo ph ang c tin hnh, nhng cho n nay vn cha t ra l c hiu qu. 88
Ch n ung
Thuc iu tr bnh bo ph
iu tr bnh bo ph bng thuc c mt lch s cc k u m. Ph n lin tc b h thng y t i x phn bit. Trong sut thi k nhng nm 1950, 1960 hay ngay c 1970, ph n c k n cho thuc thyroxine, mt hormone tuyn gip lm tng tc qu trnh chuyn ha. Tr phi ngi no c tuyn gip hot ng chm hay khng c tuyn gip (c th b loi b bng phu thut), nu khng th y l mt phng thuc cc k nguy him c th gy ra cn suy tim. Hy yu cu kim tra chc nng tuyn gip trc khi chp nhn phng thuc ny. Amphetamine hay thuc kch thch thng c rao bn rng ri cho ph n cng nh c cc bc s s dng, nhng chng cng rt nguy him v khin sc khe bn gp phi ri ro. Gn y Chnh ph Hoa K chp thun mt loi thuc vin chng bo ph. Loi thuc ny gy tc ng bng cch ngn cn s hp th khong mt phn ba s lng cht bo c n vo. Loi thuc mi ny l orlistat, tn thng hiu hin nay l Xenical. Mt trong nhng tc 89

dng ph ca n l gy tiu chy mt cch kh chu mi khi ngi dng thuc n cc thc n bo. trnh phn ng ph, ch n gin l trnh khng n cht bo. (Nhng nu khng n cht bo th c l khng cn dng thuc ny. Li l chuyn con g v ci trng!) Tuy nhin, thuc ny cn lm gim hp th ca c sinh t D v nhiu cht dinh dng quan trng khc na. Orlistat l loi thuc u tin chng bo ph thng qua ng tiu ha, thay v l tc ng ln no. c ung vo cng vi mi ba n, cht ny kt hp vi mt s enzym ca ty ngn cn s tiu ha khong 30% lng cht bo n vo. Tuy nhin, v lu di n s gy nh hng n ty nh th no vn cha th bit c. Khi c kt hp vi mt ch n king hp l, nhng ngi dng thuc orlistat gim cn nhiu hn so vi nhng ngi khng dng thuc. Thuc khng cn cho nhng ngi ch mun gim i chng mt vi kilogram, n c nhm n vic s dng cho nhng ngi b bnh bo ph. Ngoi ra, orlistat cng c bit l lm gim c cholesterol, huyt p v ng trong mu. 90
Ch n ung
Mt trong nhng liu php chng bo ph gy nhiu tranh ci nht l vic s dng fenfluramine v phentermine. C hai loi thuc ny u c cho php s dng ring r t cch y hn 20 nm, nhng k t nm 1992, cc bc s s dng chng kt hp vi nhau ko di iu tr chng bo ph. iu ny c xem nh mt cch iu tr khng theo cng nng chnh thc ca thuc. Trong nm 1996, cc bc s Hoa K a ra mi thng tng cng 18 triu toa thuc loi ny! Rt nhiu toa thuc trong s ny c vit ra cho nhng ngi khng mc bnh bo ph. Thng 7 nm 1997, C quan Qun l Thc Dc phm Hoa K1 cng vi cc nh nghin cu Mayo Clinic v t chc Mayo Foundation a ra mt thng co chung cnh bo cc bc s rng s kt hp fenfluramine v phentermine c th gy ra bnh tim. Ngy 15 thng 9 nm 1997, fenfluramine b cm trn th trng. Nhiu thng tin khng tt khc c a ra v vic fenfluramine v phentermine gy tc hi nghim trng n nng serotonin. iu ny cng khng nh thm rng, xt v mt an ton ca nhng
1 The U. S. Food and Drug Administration
91

loi thuc chng bo ph hin nay, vic iu chnh ch n ung v np sinh hot hng ngy vn c xem l con ng tt nht dn n s khe mnh. Mt loi thuc thay th fenfluramine v phentermine l sibutramine (tn thng phm l Meridia) c FDA chp thun vo 11/1997. Sibutramine u tin c pht trin vo cui nhng nm 1980 nh l mt loi thuc chng trm cm, nhng ging nh fenfluramine v phentermine, n tc ng ln no khin bn lun c cm gic no. Sibutramine khc vi fenfluramine v phentermine ch l n khng tc ng n tim.
Nhng ri lon n ung
Vi 2% ph n trong dn s M, nhn i v ung thuc x c coi l cch thng thng khng ch cn nng ca mnh. Ch mt s nh ph n thc s bo ph do cc nhn t di truyn. Hu ht cc ph n cho l h qu nng trong khi thc s li l trng lng l tng ph hp vi cao v kch thc c th ca h. x hi phng Ty, ni s bo ph qu trm trng n ni 60% 92
Ch n ung
cc em gi nh pht trin nhng hnh nh c th mo m t nm lp mt cho n lp su, lun tin l mnh qu mp. C 70% phi yu bt u n king trong khong t 14 n 20 tui. Mt cuc nghin cu Hoa K v cc c gi trung hc thy rng 53% khng hi lng vi c th ca mnh trc tui 13 v 18; 78% tht vng. Mt thc t rc ri nht c tit l trong mt cun phim ti liu ca Canada gy ra nhiu li ch trch vo nm 1991 mang tn S tht bn trong cn i cho thy nu c la chn, hu ht ph n u th cht hn l mp ! Nhng ri lon n ung qu lan rng n ni cc m hnh n ung bt thng c chp nhn trong i a phn dn s ngy mt tng ln. C nhng bc cha m thc t b i nhng a con gi nh ca mnh nhm lm cho chng m i. Hai ri lon n ung thng thng nht lin quan ti nhn i l anorexia nervosa (chng bing n tm thn) v theo sau l ung thuc x gi l bulimia nervosa (chng ri lon cm xc khin ngi ta n nhiu ri buc phi i ra). Ph n b bulimia (chng n v ) s x sau mt thi gian nn ma v lm dng thuc nhun 93

trng, li tiu v hormone tuyn gip. V d kinh hong nht xy ra nhng ph n b bnh i tho ng loi I thnh thong c tnh gi insulin nhm khng ch cn nng ca h. C l hnh vi khng ch cn nng c chp nhn nht l tp th dc qu sc. Ngy nay, tp th dc tch cc c dng nh mt phng php ty x v tr thnh mt trong nhng nguyn l hnh vi phi n c x hi chp nhn vo nhng nm 1990. Mt b xng c bp tay l iu l tng hin nay. Ph n c bnh n b ri lon n ung c nguy c b bnh long xng ln hn. Ph n hi nng cn c xng khe hn nhng ph n m. Bnh long xng ang tng ln ph n b chng bing n tui 20. Ri lon n ung l nhng cn bnh km nn nh hng ban u n ph n mc d nhiu nam gii my nm gn y cng d mc phi. Chng n nhiu ri nn ra v chng bing n thng t qu cao cc mt khc trong cuc sng ca h v xem cn nng qu sc nh l mt thng bo vi th gii rng h b tay. Quan im 94
Ch n ung
ny tr nn b bp mo hn khi thi gian vn c tri i mi cho n khi vic n ung cng khai ( chng bulimia) hay khng n hon ton ( chng bing n anorexia) bng vi kh nng mt kim sot. chng bing n, mong mun cm gic ln cm xc ca ngi c nhn bit c qua thc n. Nhng mong mun khng c p ng ny qu ln n ni ngi b chng bing n s rng mt khi n, c ta s khng bao gi ngng v s ngon ming ca c s khng c bin gii t nhin, ni s thc n dn n mc phi bnh bing n. Hu ht chng ta u nhn thy d lin quan ti ngi b bulimia hn l ngi b anorexia, nhng ngi b bulimia th hin kh nng mt kim sot ca h thng qua vic n qu mc ging nh ai la ht con ci ca h. Ri nhng ngi b bulimia ty x c li c kh nng kim sot ca mnh. Nhng ngi b bulimia c cm gic thoi mi c vic n qu nhiu ln x ra. Thnh thong nhng ngi b bulimia c gi l nhng ngi bing n tht bi bi v h s nhn 95

i nu c th. Tuy nhin, nhng ngi b chng bing n li l nhng thin ti v kh nng kim sot. H khng bao gi ngng. C mt ln ti hi mt ngi mc chng bing n ang hi phc mt cu hi ng ngn Vy th c khng thy i bng sao?. C ta tr li rng nhng dn vt ca cn i khin c cm thy khe khon. Cng i c cng cm thy mnh mnh, sc mnh y thc s ln. Khi nghe ri lon n ung, chng ta thng ngh n ngi b chng anorexia hay bulimia. Tuy nhin c nhiu ngi n rt nhiu m li khng x. iu ny c gi l ri lon n qu nhiu (qu tham n). Trong trng hp ny, n qu nhiu vn thng bo vi th gii rng Ti b tay. C ai thanh tr hnh vi n nhiu ca h l ang che giu kh nng thiu kim sot ca mnh. C ai n nhiu v khng bao gi ty x l ang qung co cho kh nng thiu kim sot ca mnh. Ngi x cu xin s gip mt cch b ng, ngi n qu nhiu khng x li rt hng hi cu xin gip . Cn bnh th ging nhau nhng li c kt qu khc nhau. Nhng s c thm mt chuyn na khi trong trng hp 96
Ch n ung
qu tham n, iu c coi l gy tranh ci v thng b nhng ngi tham n phn bc. Ni nim mong mun c mp thng ng sau s cng bch. Nhiu ngi n qu nhiu u khng khng rng mp l do n thc n, khng phi l mc ch. Nhiu nh tr liu gii quyt bt ng v tham n tin rng nu mt ph n tha nhn c am m cm xc thc s ln th c y s gn i n vic ngn chn vic cng bch phi n. Ngoi ra, nhiu ph n tham n khng nhn thy l h ang tham n. Nhng iu sau y cho thy mt ngi tham n in hnh. - n khi khng i. - Cm thy khng kim ch c vi thc n chung quanh hoc c khng c hoc n nhi nht. - Dnh nhiu thi gian ngh v thc n v cn nng. - Lun cn phi th ch n ha hn kt qu khc na. - C cm gic t min cng v xu h. - Ght b c th ca chnh mnh. 97

- B m nh ci c th hoc s n hoc trc gi n. - n b mt hoc n vi bn b. - Xut hin cng khai l mt ngi n king chuyn nghip c kim ch. - Mua bnh ngt c v nh lm qu tng, yu cu gi li che giu s tht l mua cho chnh mnh n. - C mt ci bp tm tt ch c cc thc n ng chun. - Cm gic hoc khng kim ch c vi thc n (tham n) hoc b n lm t ti (n king). - C cm gic tm thi th gin khi khng n. - Hng v nim vui v d tnh thi gian c th n mt mnh. - Cm gic khng vui v hnh vi n ung Hu ht mi ngi n khi h i. Nhng nu bn tham n, nhng manh mi cn i khng lin quan g ti thi gian bn n. Bn c th n v bt k nhng l do sau y: 98
Ch n ung
- n giao tip: bao gm ba n gia nh gp bn b nh hng. Vn l bn xem thc n nh l mt s tiu khin x hi. Hu ht chng ta u lm iu ny nhng thng lm vy ngay khi khng i. - Tha mn cn thm ca ci ming - cn phi c ci g cho vo ming thm ch khng i. - n ngn cn i tng lai: Hy nn n by gi bi v sau ny, ti c th khng c c hi. - n gii khuy mt ngy bun hay mt chuyn bun, hay n t thng cho mnh mt ngy tt p hay mt vic tt p. - n bi v l nim vui duy nht c th tin vo. - n dp yn nhng cng thng. - n bi v bn chn nn. - Hy n by gi bi v bn sp phi n king vo ngy mai v vy n c thc hin ngoi ni s tht s m bn s c c sau . - n bi do thc n l bn b. 99

Nghin thc n cng ging nh nghin nhng th khc c th c tr liu thnh cng bng chng trnh 12 bc. i vi nhng ai khng quen thuc vi loi chng trnh ny, ti s cung cp ni dung vn bn 12 bc ny. Chng trnh 12 bc c bt u vo nhng nm 1930 bi mt ngi nghin ru vt qua cn nghin ca mnh bng cu ni hu hiu Cha i, hy gip con. Anh ta nhn thy nhng ngi nghin ru khc cng cng v tr v thng qua mt h thng ng h khng phn xt, c t chc, h vt qua s nghin ngp ca mnh bng cch nhn ra rng Cha ngi c quyn nng cao, s hu v tr ny, hay s thng minh - ch gip ai t gip mnh. Ni cch khc, bn phi mun s gip . y l tin ca Nhng ngi nghin ru v danh (AA)1 - chng trnh hi phc thnh cng nht t trc n nay cho nhng ngi nghin ru. Nhng ngi nghin cc th khc thng qua cng chng trnh, dng AA v 12 bc v truyn thng ca 12 bc - tc phm nn tng
1 Alcoholics Anonymous
100
Ch n ung
ca AA. Nhng ngi tham n v danh (OA) thay th cm t ngi tham n cho ngi nghin ru v thc n cho ru. Mc ch ca ton b chng trnh 12 bc ny c lt t ht thng qua kinh cu an. Dng u tin ca kinh cu an ni rng Cha ban cho ti s bnh thn chp nhn nhng iu ti khng th thay i, lng can m thay i nhng iu ti c th v s thng thi nhn bit s khc nhau. Ni cch khc, bn khng th ly li thc n n ngy hm qua hay nm ngoi nhng bn c th kim sot c thc n bn n hm nay thay v cm thy c ti v ngy hm qua. Mi mt chng trnh 12 bc u c 12 truyn thng m thc cht l quy tc hnh kim. tham gia vo OA, bn ch cn tin hnh bc th nht. Trnh n, v 2 bc k tip l iu m hu ht mi ngi c th lm trong vng 6 n 12 thng trc khi vo. Trong chng trnh OA, nhn n c ngha l 3 ba n hng ngy, cn nng v s o chng c lin quan g gia thc ung khng ng hay khng c calori vi ko nhai khng ng. Vit loi thc n bn cn n v n vo. Chng trnh cng khuyn bn nn c 101

s ng ca bc s trc khi bt u. Nu n c tip tc thng qua qu trnh mt ngy mt t v nh vo nhng ngi ti tr - nhng ngi gi bn kim tra v ngi bn c th gi n khi cn thm dy ln. Nhng ngi ti tr ang lm phc hi nhng ngi tham n c mt v c th ni chuyn vi cc cn thm ca bn. Thnh vin hi OA ch yu l ph n. Nu bn l nam gii v mun tham gia vo OA bn c th cm thy d chu hn nhiu trong mt nhm ton n ng. Nhiu ngi tham n phi n n nhiu do h b nam gii hi v cn gin ca h thng nhm n mt ngi n ng trong phng, y c th khng phi l ni thoi mi nu bn l ngi n nhiu phi nam. V l do ny, OA c chia thnh nhm ton nam gii v nhm ton n gii.
12 bc ca ngi tham n v danh.
- Bc 1: Ti tha nhn mnh bt lc vi thc n v cuc sng ca ti tr nn khng th kim sot c. - Bc 2: Ti tin rng c mt quyn nng ln hn bn thn ti c th cho ti s bnh thn. 102
Ch n ung
- Bc 3: Ti quyt nh trao ch v cuc i ti cho ng Ti cao chm sc v ti hiu c iu . - Bc 4: Ti tm kim v khng s bng kim im o c ca chnh bn thn ti. - Bc 5: Ti tha nhn vi ng Ti cao, vi bn thn mnh v vi nhng ngi khc nhng sai phm ch th ca mnh. - Bc 6: Ti hon ton sn sng mun ng Ti cao gip ti loi b tt c nhng khuyt im ny. - Bc 7: Ti ci xin ng Ti cao loi b nhng thiu st ca ti. - Bc 8: Ti lm mt danh sch gm tt c nhng ngi ti hi v sn sng sa i ton b. - Bc 9: Ti sa i trc tip vi nhng ngi nh vy bt k ni u c th ngoi tr khi lm vy s gy thng tch cho h v nhng ngi khc. - Bc 10: Ti tip tc lm bn kim im c nhn v khi ti sai, ti nhanh chng tha nhn. 103

- Bc 11: Ti tm thy qua li cu nguyn v s suy ngm ci thin vic lin lc c thc ca ti vi ng Ti cao v ti hiu cu nguyn cho kin thc ch ca ng Ti cao dnh cho ti v kh nng thc hin c iu . - Bc 12: C nhn thc tm linh lm thnh qu cho nhng bc ny, ti c mang thng ip ny n vi nhng ngi hu n v thc hnh nhng nguyn tc ny trong mi cng vic ca ti. 19. Nhng mo vt gip gim cn nhanh - Bt c khi no bn lm ng lnh thc n bng m ng vt (nh sp, kho hay cc mn cari) hy vt ly lp m pha trn trc khi hm li n. Vt b nc tht xt ra khi xo nu cng gip loi b m, lp m lng xung y, du m ng li pha trn. - Thay th b bng nhng th khc: sa chua (rt tt vi khoai ty), pho-mt gn kem c bo thp; hoc vo ba n ti hy nhng bnh m trong du -liu c mt t ti, phong cch ca . i vi bnh sng-uch, 104
Ch n ung
bt k gia v no khng c b, margarine hay mayonnaise u tt - m tt, sa chua ... - Sa bt khng bo hin li ang c a chung, n c canxi cao nhng thp v lng cht bo. Dng n th sa hoc kem trong cc cng thc ch bin thc n. - Tm kim cc loi tri cy trng ming. Nhng th nh nc hoa qu p lnh vi lp sa chua t bo trn. Hy nh l phi chn ng loi tri cy ph hp cho ngi b bnh i ng. - Nm gia v cc loi thc n t bo. Bng cch ny bn s khng b i hng v cht bo thm vo. - Protein t bo c cc loi rau (c trong cc loi ng cc v cc sn phm lm t u), cc loi protein c bo cao c cc loi ng vt. Nu bn ang chun b ba n: - Nng la hoc luc tht thay v chin quay (Nu bn lm ro tht v nu bng nc th chin quay nng l cng tt). 105

- Ct b cc lp m c th thy c ming tht trc v sau khi nu. - Thm bt, nhng mnh vn bnh m hay p nhng th khc ln ming tht nc tng thm lng calori. - C gng thay tht g ty t bo bng cc loi tht . - Hc cch c ni dung cht bo sa cng l cch ct gim tt: - Cc loi sa c 48% lng calori cht bo. - 2% sa c 37% lng calori cht bo. - 1% sa c 26% lng calori cht bo. - Sa ht vng sa l hon ton khng c cht bo. - Pho-mt c 50% calori cht bo tr khi l pho-mt lm t sa ht vng. - B c 95% calori cht bo. - Sa chua c 15% calori cht bo. 20. Hy chn mt vi loi cy c tt cho tim Bn c bit rng nhng cy c tt cho d con cng tt cho tim khng? Cc loi thc vt lm 106
Ch n ung
mnh d con v tim c mu xanh l cy hoc nh cy to gai, hoa hng, du, qu mm xi. Ung nhiu nc, cc loi dc tho pha ch giu cht khong v nc p nho ti hay n nho cng s gip bn gi li dch v gim tim nh trng ngc.
B tim
-Du mm la mch, 1 hoc nhiu mung (15ml/1 ngy) -Du vitamin E, 1 hoc nhiu mung mi ngy. -Ht cy lanh (linum usitatissinum) c coi l loi du tt cho tim nht - nhng ch khi n tht ti v cha nu chn. Nn dng mt n 3 mung (5 - 15ml) du ht cy lanh trc tin vo bui sng. Bn cng c th nghin cc loi ht v rc vo bt bp ng cc hay x lch hoc nhng ht cy lanh vo trong nc v ung cng lc trc tin vo bui sng. -Cc loi du c kh nng bo v tim khc l cc loi du c p ti t cc loi ht cy l chua en. 107

-Cc acid bo c ch khc c th tm thy chui l hay amaranth. -Cn thuc du cy to gai, 25 - 40 git cn du mi ngy 4 ln. C kt qu trong vng 6 - 8 tun. -To bin. -Cc loi thc n giu carotene - Hy tin cc loi rau qu v tri cy c mu sng. Mu cng sng th chng cng c nhiu carotene. -Ti, knoblauch (Allium satium): n sng rt tt cho tim nhng bn cng c th mua loi kh mi. -Du thm chanh. Ngm 1 nm l ti vo ly ru trng trong 1 gi hoc hn v ung khi n ti. Hoc lm gim du thm chanh n vi x lch. -Cn thuc gc cy b cng anh. Dng 10 - 15 git sau cc ba n. -Gng (Panax ginseng). Nhai r hoc dng 5 - 40 git cn thuc. -Cy mu b (Leonurus candiaca): Dng ngm phn u ca hoa vo trong ru, dng 5 - 15 git nhiu ln trong 1 ngy. 108
Ch n ung
Lm an thn tim
-Tinh cht hoa hng. -Cy to gai (Crataegus species): Dng 25 - 40 git 4 ln 1 ngy. N hot ng chm nn dng phi 1 thng mi c kt qu. -Ngm ru thuc cy mu b: Dng 10 - 20 git vi ba n v trc khi i ng hoc 25 - 50 git lm du ngay tc khc. -R cy n lang lm tr ung hoc ru thuc ung. -Tr r gng, nng hoc lnh. -n 1 ming r cy cam tho h nhng cn nh trng ngc.
Cc loi cy c lm long mu
-Cc cht lm long mu, chng hn nh aspirin, c th lm gim chng t qy hoc cn suy tim. Mt mung gim hng ngy c lm t l, n hoa ca bt k cc loi cy c no sau y cng gip bn sc khe tt nh aspirin v cng gip hp th cht canxi v ci thin h tiu ha. ng dng cc loi cy c lm long mu nu bn ang chy mu nhiu hoc cn phi phu thut. 109

-C linh lng -G bu l -C 3 l ngt -C tranh -Cy dng -C 3 l mu -Cy liu -Cy mu b -Qu to gai en (Viburnum prunisfolium) lm ru thuc, dng 1 liu 25 git khi cn.
110
RN LUYN TH LC
21. ngha thc s ca vic rn luyn th lc T in Oxford nh ngha s rn luyn l vn dng cc bp tht, chn tay... c bit l c li cho sc khe; rn luyn v mt th lc, tinh thn hay tr tu. Th gii phng Ty t lu ch nhn mnh ngha rn luyn th lc, hon ton b qua nhng ngha rn luyn tinh thn v tr tu. Ch n gn y, nhng cuc nghin cu phng Ty mi ch trng n nhng kha cnh li ch v mt tinh thn ca s rn luyn. Chng hn, ngi ta thy rng vic tp th dc to ra endorphin, loi hormone lm cho chng ta cm thy vui khe. Nhng ngi phng Ty cha khuyn khch vic ta thin hay cc hnh thc trm tnh khc ca vic rn luyn tinh thn v tr tu, vn c chng t l lm ci thin tinh thn v sc khe ca chng ta, c th l lm gim i s cng thng - mt yu t quan trng dn n bnh tim. phng ng, t nhiu ngn nm qua s rn luyn tp trung nhm n vic t c 111

tnh trng khe mnh v tinh thn v tr tu thng qua th xc, chng hn nh s dng hi th v t th rn luyn. Chng ta cng khng th b qua nhng truyn thng vn ha c bit l gip hon thin tm hn v mang li hnh phc, chng hn nh nhng iu ma truyn thng, nhng hnh thc cu nguyn sinh ng kt hp cc hot ng th lc, s xng hi c tin l gip c th thi ra nhng cht c nh vic tot m hi nhiu... y l nhng hnh thc lnh mnh m chng ta nn tm hiu. 22. Tm hiu Aerobic l g? Nu tra t Aerobic trong t in, cc bn s tm thy l nh ngha ha hc: Sng trong trng thi oxygen t do. iu ny hin nhin ng. Cuc sng ca tt c chng ta u cn n -xy, v xt cho cng mi hot ng rn luyn ca chng ta u l nhm thc y hi th nhanh hn c th a vo c th c nhiu -xy hn. Ti sao chng ta lm nh th? Bi v trong mu cha -xy. Khi mu chy cng nhanh, lng -xy a n cho cc c quan ca c th cng nhiu hn. Nhng khi mt nhn vin chm sc 112
Rn luyn th lc
y t khuyn bn tp th dc, ngi y khng ch nhm n vic lm tng lng -xy i vo c th, m l s rn luyn c tim. Tim p cng nhanh, lng mu a i cng nhiu. Nhng nu bn ang c vn v tim mch, hoc ang s dng mt loi thuc no c nh hng n tim, cn phi hi kin bc s trnh lm cho tim bn phi qu ti.
Ti sao chng ta cn nhiu oxygen hn?
Khi c nhiu -xy hn trong c th, chng ta t cht bo, hi th c tt hn, p lc trong mu cng tt hn, v tri tim hot ng tt hn. -xy cng lm h thp mc triglyceride v cholesterol, tng thm mc cholesterol c li (high-density lipoprotein - HDL) v lm gim mc cholesterol c hi (low-density lipoprotein - LDL). iu ny c ngha l cc ng mch s c thng sut v bn gim i ng k cc nguy c b bnh tim hay chng t qy. Cng nhiu -xy a vo c th, b no cng hot ng tt hn, v do chng ta cm thy khe khon hn. Cc cuc nghin cu cho thy rng chng trm cm c gim i khi chng 113

ta gia tng lng -xy a vo c th. Nhng phng php c t ngn xa nh yoga chng hn, c bit lm hon thin tinh thn v tr tu ca chng ta bng vo vic kt hp luyn th su v th gin, lm tng cng lng -xy v mu chy n cc c quan trong c th. Rn luyn th lc cho thy lm gim ng k nhiu trng hp bnh khc, k c ung th. C nghin cu cho rng cc t bo ung th c khuynh hng pht trin mnh trong mi trng thiu -xy. V th, lng -xy trong mu cng nhiu th nguy c mc bnh ung th cng gim i. Thm vo , nhiu bnh ung th c quan h n cc c t ha tan trong acid bo. Do , c th cng gim bt lng m tha th cng t tch t nhng loi c t ny. V cng gim thp nguy c b ung th.
t chy cht bo
Loi hnh luyn tp duy nht s t chy cht bo l tp aerobic, bi v oxygen t chy m. Nu bn n t lnh ly ra mt t m ng vt (da g, m tht hay b) nm vo bn ra, ri dng mt que dim t ln, n s chy. Ci khin 114
Rn luyn th lc
ngn la bin thnh mu vng l oxygen, nhin liu cho ngn la l m. Qu trnh tng t cng xy ra trong c th bn nh vy. Oxygen s t chy lng m ca bn, bt k l bn lm tng lu lng oxygen trong c th bng cch no (d l nhy quanh v tng s nhp tim hay luyn tp phng php th su).
nh ngha v Aerobic ca phng Ty
phng Ty, mt cch tp luyn c xem l thuc b mn aerobic nu n lm cho nhp tim p nhanh hn bnh thng. Khi tim p nhanh, bn s phi th nhiu hn v bi tit m hi, v nhp tim s t n phm vi mc tiu hay di l tng (nhng cch ni m rt nhiu ngi khng hiu c). Bn c th tnh ton tm ra di l tng cho nhp tim ca mnh. Chng hn, ly 220 tr i s tui ca bn ri nhn con s vi 60%, bn s tm ra mc thch hp khi u ca mnh iu c ngha l bn nn luyn tp mc sao cho nhp tim s mc ny v ko di t 20 n 30 pht. Nu nhn vi 75% bn s tm c mc ti a - c ngha l bn nn luyn tp 115

mc sao cho nhp tim s khng vt qu mc ny v ko di t 20 n 30 pht. Nhng y ch l mt v d. Nu bn ang dng thuc tr bnh tim (c nhng loi thuc lm tim p chm, c bit nh l cc thuc chn beta) bn cn nh phi tho lun vi bc s ca mnh v mc tiu luyn tp.
Tm mch ca bn
C nhng v tr mch nhy khp ni trn c th bn. Nhng v tr d tm nht l c, gn chn ngn ci, ngay bn di di tai v ni c tay. kim tra s nhp tim, hy nhn vo ng h v bt u m nhp tim trong 15 giy (khi kim giy s 12, m cho n khi n chm v tr 15) ri nhn s vi bn s c s ln mch nhy trong mt pht. 23. S dng thang im Borg1 y l cch o lng cng tp luyn m khng cn tm mch, v rt n gin nn hin nay l phng php c ngh nh gi mc qu ti trong luyn tp. Thang im Borg c
1 Borgs rate of perceived exertion (RPE)
116
Rn luyn th lc
gn cho cc mc t 6 n 20 im. Chng hn, nhng cch luyn tp rt nh nhng c th xp 7 im, trong khi , s rn luyn rt cng thng c th l 19 im. Cc nh chuyn mn cng ngh nn kim tra bng cch ni chuyn. Nu trong khi luyn tp, bn ch c th ni chuyn qua hi th hn hn th c th l vic luyn tp qu cng. Bn nn luyn tp mc sao cho c th thc hin mt cuc ni chuyn bnh thng trong khi luyn tp. iu quan trng phi nh v cch chia thang im Borg ty thuc vo tng ngi - vi ngi ny l 7 im nhng vi mt ngi khc c th 10. 24. Nhng phng thc khc lm tng lng oxygen y s l iu rt ng mng cho nhng ngi gp kh khn trong vic i li do b khp, vim khp hay cc bin chng sc khe khc t cn t qy ti bnh thn. Bn c th tng lng oxygen trong mu m khng phi tp luyn c tim bng cch hc cch th su qua c honh. C nhiu chng trnh tng t nh mn yoga, v c nhng bng hnh dy cho bn k thut 117

ny. Phng thc ny khng i hi bn phi vn ng nhiu. Li ch ca n l gip bn tng lng oxygen trong mu. iu ny tt hn l bn chng lm g c ci thin sc khe, v theo rt nhiu nh thc hnh sc khe th phng php ny c li nhiu cho sc khe. 25. Hy bt u sng nng ng thay v dng aerobic Thut ng hot ng aerobic c ngha l hot ng khin tim bn p mnh v nhanh hn khin bn th nhanh hn lm tng lng oxygen. Cc hot ng nh trt tuyt trn ng trng, i b, leo ni, i xe p... u l tp luyn aerobic. Nhng bn c bit khng, cc nh tp luyn th dc ght nhng thut ng hot ng aerobic v chng trnh aerobic, bi v chng khng phi l iu ngi ta lm trong cuc sng thng ngy. Nhng ngi pht ng sc khe ang thay th nhng thut ng ny bng cm t sng nng ng - bi v cm t ny ch n tt c s nng ng, vn ng nhiu trong cuc sng. 118
Rn luyn th lc
C nhiu cch bn c th to ra mt cch sng nng ng. y l mt s li ngh: -Nu bn i xe hi n u , hy chn mt ni u xe xa im n nht, to iu kin i b t pht trong ngy. -Nu bn i bng cc phng tin cng cng nh xe but, tu in... hy xung sm hn mt vi trm, c th i b on cn li n ni bn cn. -Nn chn i cu thang bnh thng thay v l thang my hoc thang cun. -Khi i mua sm, u xe pha bn ny v i b sang pha bn kia ca khu mua sm. -i do chi quanh khu ph sau ba n. -Dt ch i do chi. -Vo dp cui tun, nn i chi s th hoc cc khu ch tri, khu bn c... (c th l bn chng mua g c) 26. Bt u cc hot ng tp t Bn khng phi tp luyn ch lm cho c tim hot ng v tng lng oxygen m cn khin 119

cho ton b c th mnh hn v hot ng hiu qu hn. im li ca vic ny l c th phng nga nhiu vn bt n cho sc khe, k c bnh tim. Nh mt chuyn gia th hnh ni vi ti: Nu mun c mt cn nh vng chc, bn cn phi c ci sn nh vng chc. Khi tng sc nng ln b xng th xng cng tng khi lng ln. Tng t nh vy, khi gim sc nng ln xng th xng cng gim khi lng i. Xng cng c th chng cng kh v hay trt khp. l l do ti sao cc bi tp luyn to khi lng xng l quan trng - v bn phi tn dng thm lng calori. Nh vo cc hot ng ny lm tng sc mnh c bp, chng ta cn lm tng tnh linh hot ( chng t ng) v sc chu ng. V d, bn s thy rng ln u p xe p t nh ra thnh ph cng chn bn c cm gic au. Nhng khi p nh vy 10 ln, cng chn bn s khng cn au na. Hnh thnh sc chu ng c ngha l vy. D nhin l bn cng s khng b ht hi, l mt loi hnh khc na ca sc chu ng. Tp t tay hay cc bi tp luyn khng c (dng cc dng cao su hay p cc b phn c 120
Rn luyn th lc
th vi nhau) lm gip tng khi tht nc trong c th - m c th khng phi l m. y l l do nhiu ngi thy cn nng ca mnh khng gim khi bt u tp luyn. Nng chn v cnh tay bng c t lm tng tnh thng bng, sc mnh ca xng v gip duy tr tnh do dai. Hy bt u vi trng lng khong 0,5 kilogram, v tng dn ln n khong 2,5 kilogram. Cc hnh thc rn luyn sc khng khc na lin quan n vic di chuyn cc vt nng, hoc chnh trng lng c th ca bn to ra sc khng, s dng cc thit b trung tm th dc hay thm ch c th dng cc vt dng thng thng trong nh nh nhng thng nc, thng cha . Mang loi t Velcro ln c tay v mt c chn ri i li nh bnh thng cng l mt cch tt lm tng sc khng. Khi c bp pht trin ln hn, xng cng chc hn, v lng m trong c th s gim. Bn nn tp c t mi tun 4 ln, mi ln chng 30 pht.
121

Hot ng gip hnh thnh khi xng
Th chn mt hot ng trong danh sch ny lm mn th thao gii tr cho bn. Nu thch bn s lm thng xuyn hn: -i b -Chy b -Chy ti ch -i xe p -Leo ni -Tp dng sinh -Trt tuyt bng ng -Lm vn -C t -Giy i tuyt -Leo cu thang -Chi tennis -Chi bowling -Cho thuyn -Khiu v -Luyn tp di nc 122
Rn luyn th lc
-Chi cu lng -Chi bng r -Chi bng chuyn -Chi bng 27. Trnh tp luyn qu sc Nhiu ph n thy kh khn khi phi lao ngay vo mt thi biu tp luyn mi, c bit nu h c nhng vn v tim mn tnh no nh bnh i ng hay ang ung thuc nh hng n tim. V d, tp luyn cng thng trong nhng trng hp ny c th gp nguy him. Nu bn ch bt u a vic tp luyn vo cuc sng ca mnh sau nhiu nm khng h c hot ng g th tt nht l nn tham kho vi mt nh tp th dc, cng ging nh cch tham kho vi mt nh dinh dng hc. Bn c th tm gp cc nh tp th dc thng qua bc s gia nh hoc cc vin tp th dc ni ting. Nh tp th dc s vch ra cho bn mt ch tp luyn ph hp vi th lc hin ti ca bn v s tng dn cng tp luyn qua thi gian khi bn c thm th lc n nh. Lm vic vi mt nh tp th dc cng s 123

cho php bn tho lun tnh trng sc khe hay bt k loi thuc no bn ang s dng. V vy, cc hot ng ca bn c th h tr thay v lm trm trng thm tnh trng sc khe ca bn. 28. S khi u chm Cc bo co ca Hoa K cho thy c 3 ngi M th c 1 ngi qu cn - mt du hiu cho thy s gia tng li sng t hot ng. Mt s ngi qu tht vng vi cc cu lc b tp luyn, n ni h tr nn ngy cng t hot ng hn. iu ny tng t nh khi tht bi trong vic tun th ch n king: bn tr nn qu nn lng v khng trung thc cho n ni bn li cng n ung ba bi hn! Th no l t vn ng? n gin nht c ngha l khng di chuyn, i li. Nu bn lm cng vic vn phng hay dnh phn ln thi gian trc my vi tnh, hoc trong xe hi, hay xem tivi, bn c xem l ngi t vn ng. Nu bn tp th dc chng 20 pht v mi tun khng c mt ln, bn c xem l ngi t vn ng. Bn cn phi a thm mt s kiu hot ng, di chuyn no vo trong thi biu sinh hot 124
Rn luyn th lc
hng ngy tr thnh ngi c vn ng c th. Nhng kiu hot ng, di chuyn rt l a dng, nh th dc aerobic, i ro bc quanh khu ph, hay dn ch i do... Nu bn sng tnh ti v b bo ph, th bn rt d c nguy c b bnh i tho ng loi 2 tui 40 nu bn b di truyn. Nu khng bo ph, ph n nguy c tt nhin thp hn nhng ri bn d mc phi nhiu vn khc. Nu bn tng t vn ng trong sut phn i qua, iu tt nht l nn khi s vi mt s nhng hot ng n gin, thm ch rt nhn nh, chng hn nh chm sc cy trng, cho chim n trong cng vin, hay thm ch ch l vi ba ln vn vai un mnh... Bt c thay i no ca bn nhm c th vn ng nhiu hn u l quan trng. Cc chuyn gia cng ngh bn nn tm mt ngi bn, hoc mt ngi hng xm chng hn, cng luyn tp th lc vi mnh. Khi vic luyn tp c lin quan n mt ngi khc, bn t c khuynh hng hy b bui tp hoc vin c khng i tp.
125

Chun b cho mt np sng vn ng
Chn mt hot ng no ph hp vi bn, c th l i b, ch ci, nhy dy, khiu v ... bt c hot ng no bn thy thch. Bn cng khng nht thit ch chn mt hot ng. C th thay i nhiu hot ng trnh s n iu, nhm chn. Phi m bo bt k hot ng no bn chn u phi c tp luyn lin tc. i b trong 2 pht ri ngng 3 pht l khng lin tc. iu cng rt quan trng l phi chn mt hot ng khng lm trm trng thm tnh trng sc khe c t trc, chng hn nh cc vn v mt. H thp u xung theo cch no (chng hn nh ci xung a tay chm vo cc ngn chn) hoc cng phn c th pha trn ca bn c th lm tng huyt p hay lm trm trng thm cc vn bt n ca mt. Nu cc vn v bn chn l mi quan tm th c th chn nhng hot ng khng lin quan ti i b, chng hn nh bi xung, s tt hn. Yu cu ca vn l nh th. Chn mc thng xuyn: Hy quyt nh bn s luyn tp thng xuyn n mc no. 126
Rn luyn th lc
(Mi tun 2, 3 hoc 4 ln? Hay mi ngy mt ln? C ng 2 ngy tri qua m khng lm g c. Ngoi ra, phi t mc tiu thi gian cho vic tp luyn. Nu bn l ngi gi hay au yu, tp mt vi pht l s khi u tt ri. Nu bn l ngi trc gi t hot ng nhng rt khe mnh, hy t mc tiu l 20 n 30 pht mi ln tp. Chn cng tp luyn ph hp vi bn: iu ny rt d lm nu bn dng mt my tp luyn no c ng h o. Nu i b, bn phi ngh n vic nh i b nhanh bao nhiu, hoc bao nhiu ngn i bn s i. Ni cch khc, bn mun nhp tim bn s p nhanh n mc no? Kt hp hot ng ca bn vi ch n ung: c bit nu bn b i tho ng, mt khi quyt nh s luyn tp theo cch no v trong bao lu, hy n gp chuyn gia dinh dng ca bn kt hp chng trnh luyn tp vi ch n ung hin thi ca bn cho ph hp. Bn c th cn mt ba n dm nh trc v sau khi tp luyn nu bn nh luyn tp lu hn 30 pht. Nu bn l ngi qu cn, bn khng cn phi tiu th thm nng lng trc khi luyn tp tr khi lng ng trong mu bn thp. 127

Ni cho bc s bit bn ang lm g: Nu bn ang c mt vn sc khe no , chng hn nh bnh i tho ng, bc s ca bn c th cn phi theo di lng ng trong mu bn cht ch hn (hoc ng ta mun bn lm iu ) hay iu chnh thuc men cho bn. ng lm bt c iu g m khng hi kin bc s trc. 29. Hy chn mt mn th thao bt u, hy chn mt mn th thao danh sch bn di. Bn c th thay i cc hot ng ny khi tr nn cn i. Cc hot ng mnh . Trt tuyt . Chy . Chy b . Leo cu thang . Nhy nho ln . Nhy dy . i b c th cn i . i b ua . Cc lp tp aerobic . Trt pa-tanh 128 Cc hot ng t mnh . Chi gn . Chi b-ling . Chi cu lng . Chi cricket . Bi li . i thuyn . i tn b .Dui ngi
Rn luyn th lc
. Trt bng . p xe . Tp t . Chi tennis . Bi li 30. Hy th mt s cch khc nhau trong khi chy b -Sau khi khi ng chy b c 15 pht, hy chy nhanh ti a trong 2 pht ri chm dn trong 1 pht. Gi s nhp tim nhanh bng cch i b ln dc hoc lao v pha trc hoc ngi xm. -Thay i cch i phi hp v cn bng. C gng nng u gi cao ln nh th i tp diu binh. Thay i bng cch l chn, u cc ngn tay chm phi mt t khi bn i b. Hy i ngang ging cua. Lm mnh cc c t s dng ca bn chn v mt c chn, trc tin hy i b bng mt ngoi ca bn chn ri n mt trong ca bn chn hoc i tht li. -Dng 1 dy tp chn bc hay bc mt lc 2 bc thang.
129

Cc bui luyn tp di nc
-Hy bt u i b trong h nc tng i cn (su c ngang eo hoc ngc). Hi th v nhp tim s cho bn bit bn ang hot ng cng n mc no. V bn s di chuyn kh chm, hy ch n c th bn. - lm khe cho ton b cng chn, hy i 50 bc v pha trc, 50 bc ngang ging cua, 50 bc li ri 50 bc ngang. - lm khe 2 cnh tay, hy ngm mnh di nc ngang c, vn ng 2 cnh tay vo ra nh th ang v tay. Nc s em li sc khng t nhin. -Cc bui tp luyn di nc su l kh nht bi mi c ng ca bn u gp phi s khng c li. Hy mc mt ci o phao v chy m khng chm vo di y t c s ti u hay khng h b tc ng. -C th bn cng mun th eo vng mt c chn hay nhng qu t Styrofoam ton thn di nc.
130
Th su
Th gin su v th yoga nh thay i hi th l mi lm bnh an h thng thn kinh v vy lm th gin cc ng mch nh v lm gim huyt p lu di.
CC NHN T RI RO KHC
31. Bn c b bnh i tho ng loi 2 khng? Nu trong ch n, bn n cht bo nhiu hn carbohydrate v cht x thp, s lm tng nguy c b bnh i tho ng loi 2 nu bn b di truyn. Nu nng hn t nht 20% cn nng v tui ca bn (theo nh ngha xc nh ngi b bnh bo ph) l t hot ng v qu tui 45, bn s c cho l c nguy c mc bnh i tho ng loi 2 cao. 73% ph n b bnh i tho ng loi 2 thng c gi l cn suy tim sp xy ra. Nguy c b dn n bnh i tho ng loi 2 v cc bin chng tim mch s tng hn nhiu nu bn: -B cao cholesterol hay cao huyt p -Ht thuc l 131

-C gc th dn (iu ny ng vi cc dn tc th dn trn khp th gii t c n Bc M. Canada, nhng th dn bn x c nguy c b bnh cao nht; M, nhng ngi da Pima c nguy c cao nht.) -C gc ngi chu Phi hay ngi Ty Ban Nha -C tin s gia nh b bnh i tho ng loi 2 -C tin s b bnh i tho ng thai k
Dung np glucose km (IGT)
Trc thng 9/1998 nhiu ngi b bnh i tho ng loi 2 c gi l dung np glucose km (IGT),1 cng gi l bnh i ng ranh gii. Mt cch chnh xc, khng c ci gi l bnh i ng ranh gii. V theo nhng hng dn mi, cng khng cn c trng hp no gi l dung np glucose km. Nhng y l iu c ngha trc 9/1998: IGT tng l vn m nhiu bc s ni n nh l mt phm vi khng th xc nh gia ng mu bnh thng v
1 Impaired glucose tolerance (IGT)
132
Cc nhn t ri ro khc
bnh i tho ng pht trin hon ton. Lng ng mu bnh thng khi i (mc trc khi n) l t 3 n 5 millimole (mmol), mt n v o lng m s lng phn t trong 1 lt. Trong qu kh, ba ln o lng ng glucose trong mu khi i c kt qu nm gia 5 v 7,8 mmol c ngha l bn mc phi IGT. glucose mu khi i ln qu 7,8 mmol hoc ng glucose ngu nhin (bt k lc no trong ngy) ln hn 11,1 mmol c ngha l bn b bnh i tho ng. Tt c thay i. Ngy nay, bt k ai c lng ng mu khi i cao hn 7 mmol (c xc nh thng qua th mu) c cho l b bnh i tho ng v chnh thc c chn on b bnh i tho ng loi 2.
Cc du hiu v triu chng
Nu c bt k triu chng no c lit k di y, u c coi l b bnh i tho ng loi 2, iu ny c th c tin hnh qua mt cuc th mu mu. -Tng cn. Khi c th khng s dng lng insulin mt cch thch hp, bn c th c qu 133

nhiu insulin, lm tng cm gic thm n. y l triu chng loi 2 in hnh. -Nhn thy m hay bt k thay i no th lc (thng to cm gic l mt knh bn ang dng khng ). -Bun ng hoc cc k mt mi vo nhng thi im khc thng. -Nhng vim nhim thng xuyn chm lnh (ph n cn phi cnh gic khi lin tc b vim nhim m o, c ngha l nga vng m o v tit ra mi hi). -T cng bn tay v bn chn. -Bnh rng li: ng mu cao lm nh hng cc mch mu trong ming gy vim nhim rng li, hm lng ng i vo nc ming gy su rng. Cc chuyn gia v bnh i tho ng cng ch ra cc du hiu c th b bnh i tho ng loi 2 nh sau: -C kinh nguyt khng u nh thay i chu k kinh hay lng kinh (y cng c th l du hiu ca thi k mn kinh). 134
Cc nhn t ri ro khc
-Bnh trm cm, c th l triu chng ca ng mu hoc cao hoc thp. -au u (do gim glucoza trong mu). -Mt ng hoc hay nm thy c mng (do gim glucoza trong mu). -C nhng m trn ng chn (cn gi l necrobiosis diabeticorum). -Mng chn b h hoi. -au c hoc au sau khi tp th dc (ng mu cao khin acid lactic hnh thnh, iu c th gy au khng cho bn tip tc tp luyn). Bn cng c th b i tho ng nu bc s chn on c cc triu chng sau: -Cholesterol cao -Huyt p cao -Thiu mu -B c thy tinh th B si tuyn nc bt
Kim sot ng mu ca bn
Kim sot ng mu ca bn bao gm vic kim tra lng ng mu (trao i vi nhn vin 135

chm sc sc khe ca bn l bn phi t kim tra thng xuyn n mc no), ln k hoch ba n (vi mt nh dinh dng hc) v tp th dc. Bng cch kim sot ng mu, bn s thot khi cc triu chng b bnh i tho ng cng nh gim nguy c cc bin chng nh bnh tim. V bnh tim l bin chng chnh ca bnh i tho ng loi 2 v ph n sau thi k mn kinh c kh nng b bnh tim nhiu hn do mt nhiu ni tit t estrogen, ngh hin thi cho ph n b bnh i tho ng loi 2 l phi cn nhc k liu php tr liu thay th hormone sau khi mn kinh. Hin nay, Hi Sng kin Sc khe Ph n1 ang nghin cu 25.000 ph n sau thi k mn kinh, rt nhiu ngi trong s ny b bnh i tho ng. Nhng kt qu ca cuc nghin cu ny (d nh trc nm 2003) hy vng s a ra nhng d kin c th lin quan ti li ch ca liu php thay th hormone i vi ph n sau thi k mn kinh b bnh i tho ng loi 2.
Nhng k hoch cho ba n
Nhng k hoch cho ba n c ngh bi cc chuyn gia dinh dng hnh ngh chnh thc
1 Womens Health Initiative (WHI)
136
Cc nhn t ri ro khc
c thay i thch hp vi tng mc tiu c nhn v ch thuc men ca bn. Nam gii v n gii thng i hi s lng thc n khc nhau. Mc ch l nhm duy tr n nh vic cung cp glucose bng cch b tr cc ba n, cc ba n dm v mc hot ng tng ng. Nu bn st cn, iu ny s cho php c th bn s dng insulin c hiu qu hn, nhng khng phi tt c nhng ngi b bnh i tho ng loi 2 u cn gim cn. Nu bn ang dng insulin th cc ba n phi theo thi gian ph hp vi thi im m insulin ca bn ln cao nht. Nh dinh dng c th gip k mt ba n c nhn nhm lm r nhu cu c th ca bn (kim sot cn nng, lm vic theo ca, i du lch v vn vn). Ln k hoch ba n tt s m bo bn c cht dinh dng p ng nhu cu nng lng v thc n c phn phi u trong sut ngy. V d, nu vic ln k hoch cho ba n ca bn cho php 3 ba n chnh cng vi 2 n 3 ba n dm, th cc ba n phi nn cch nhau 4 n 6 ting c th khng b qu ti. Nu bn b bnh bo ph, cc ba n dm c kh nng khng c khuyn khch bi v chng c th khin bn phi 137

tit qu nhiu insulin v gia tng s ngon ming. Ln k hoch ba n cng gip bn n n nh thay v n qu nhiu trong ngy ny ri nhn i ngy hm sau. Ln k hoch cho ba n tt s m bo cho bn c vitamin v cc khong cht m khng cn b sung g thm nh cht st, canxi, acid folic, cc vitamin A, B1, B2, B3, C, D v E. Sau y l nhng quy lut vng cho cc ba n c ln k hoch cho ngi b bnh i tho ng: n 3 ba 1 ngy vo nhng thi gian tng i thng xuyn (cch nhau khong 4 - 6 ting) Yu cu nh dinh dng gip bn hoch nh cc ba n dm. C gng n nhiu loi thc n khc nhau mi ngy t tt c cc nhm thc n. Hc cch o lng cc kch c khu phn n, s lng chn v ly v vn vn. Hi nh dinh dng hay nhng nh gio dc v bnh i tho ng v cch iu chnh ch n ca bn khi bn ang i du lch (iu ny ph thuc bn c ung thuc khng, ni bn s i n, cc loi thc n no c sn v vn vn). 138
Cc nhn t ri ro khc
Vch ra k hoch ngy bnh vi nh dinh dng ca bn. iu ny ph thuc vo k hoch ba n thng xuyn ca bn c g. Hy hi v bt k phn b sung no cho ba n nh cc qun im tm, cc phng tp th thao hay cc thc ung thay th ba n. Nhng ci ny s c tnh ton nh th no trong k hoch ba n ca bn? Thng xuyn chn cc loi thc n t bo hn. 32. Cao huyt p c ngha l g? Khong 12% ngi ln Bc M b cao huyt p. Vy huyt p l g? Mu chy t tim vo cc ng mch (cc mch mu), to p lc ln cc thnh mch. Cch gii thch n gin nht l hnh dung mt ci my cung ng nc x phng. Khi mun c nc x phng, bn cn phi bm n ra bng cch n ci cn bm nh xung. Tri tim l ci my bm x phng, mu l nc x phng, v ng mch l ci ng nh thng qua nc x phng chy ra. Huyt p c so snh vi p sut c to ra trn thnh ng bm. 139

Khi ng bm rng v sch, bn khng cn phi bm mnh ly x phng, x phng i ra rt d dng. Nhng khi ng bm tr nn hp dn do c, do bm nhiu, do cn x phng lm nghn, bn phi bm xung mnh hn nhiu ly x phng, trong khi lc x phng p vo ng bm li tng ln. R rng y l cch gii thch n gin ca mt vn rt phc tp, nhng v c bn ng mch hp gy ra huyt p cao buc tim bn phi lm vic nhiu hn bm mu. Nu iu ny tip tc qu lu, c tim ca bn s ln ra v tr nn yu hn, iu c th dn n mt cn au tim. p sut cao c th lm yu cc thnh mch mu gy ra cn t qy. Thut ng hypertension (huyt p cao) dng ch lc p ln thnh ng mch ca bn. (Hyper c ngha l qu nhiu nh trong t qu nhiu cng thng). Huyt p c o lng bng 2 s o: X trn Y. X l p sut tm thu, l p sut xy ra trong qu trnh co bp ca tim. Y l p sut tm trng, l p sut xy ra khi tim dng ngh gia nhng ln co bp. Theo cch ni bng hnh nh x phng nc, p sut tm thu l khi bn n cn bm xung, cn p sut tm 140
Cc nhn t ri ro khc
trng l khi bn th tay ra khi cn bm v cho n bt tr li v tr ngh ban u. Huyt p bnh thng l 120 trn 80 (120/80) Ch s 140/90 hoc cao hn ni chung c coi l ranh gii ng bin mc d i vi mt s ngi y vn l con s bnh thng. i vi mi ngi ni chung, ch s 140/90 l lc phi nghe thuyt ging, bc s ca bn s bt u khuyn bo bn v ch n ung v cc thi quen trong cch sng. Vi ch s 160/100, nhiu ngi c k n thuc chng tng huyt p nhm lm gim huyt p. Nhng nguyn nhn thng gp nht ca cao huyt p l bnh bo ph, khng vn ng v cng thng. Huyt p cng do tch ly ca vic ung ru v ht thuc l to thnh v n qu nhiu mui hoc sodium (Ngi c gc chu Phi c bit nhy cm vi mui). Nu cao huyt p xy ra nhng ngi trong gia nh, bn c coi l c nguy cao hn i vi bnh ny. Cao huyt p cng do nhng ri lon v thn gy ra (iu c th lc u do b bnh i tho ng) hay do c thai nghn. Vic 141

dng thuc cng l nguyn nhn thng gp. Nhng loi thuc c cha estrogen (chng hn nh vin ung trnh thai), cc loi thuc khng vim khng phi steroit, chng hn nh thuc ibuprofen, thuc thng mi, thuc tr cm lnh, chng ngon ming, mt s thuc chng bnh trm cm v cc thuc khc u c th lm tng huyt p. Cn phi kim tra vi bc s ca bn.
Vai tr ca s cng thng
Ngi ta tin rng bnh cao huyt p v bnh tim do s cng thng gy ra. Trc khi nhn vo nhng g bn c th lm khng ch s cng thng ca bn, trc tin cn phi hiu tht chnh xc cng thng l g. Ni chung, s cng thng c nh ngha l mt tri nghim cm xc tiu cc c quan h kt hp vi nhng thay i sinh hc cho php bn thch nghi vi n. p ng vi tnh trng cng thng, cc tuyn thng thn tit ra cc hormone tng ng lm tng tc c th - nhp tim tng ln, ng trong mu tng ln glucose c th a ngay n cc c bp ca bn trong trng hp bn cn phi chy. Hin tng ny c bit nh l phn ng sn sng i ph. 142
Cc nhn t ri ro khc
Vn i vi chng ta trong th k 21 ny l, hu ht cc trng thi cng thng ca chng ta u thng l khng cn thit, bi v phn ln nhng cng thng y ch l nhng cng thng v mt cm xc. i khi chng ta cng c th gp nhng trng hp him hoi khi phi c gng trn chy trc mt tn cp ngn hng hoc mt k git ngi, nhng hu ht cc trng hp cng thng ca chng ta li l v mun trn chy khi cng vic hng ngy, hoc thm ch gia nh, con ci... Ni cch khc, nhng hormone tit ra trong tm trng cng thng loi ny l khng thc s cn thit, nhng chng lm c th chng ta tr nn cng thng v gim thp kh nng khng vi bnh tt, vn c th tc ng vo khp mi ni trong c th. Chng ta c th s phi chu ng mt s cc trng hp lin quan n tm trng cng thng nh sau: -au u -Cc vn v tiu ha -Cc vn v bng quang -Cc vn v tim -au lng -Tng huyt p -Tng cholesterol 143

Nhng cng thng tch cc
Nhng cng thng tch cc dn n nhng iu tt p, cho d chng ta c th cm thy cng thng trong mt giai on ngn. S cng thng thch thc chng ta c gng vt qua nhng gii hn nng lc ca chnh mnh, v iu ny gip t c nhng mc tiu ra, sng to ra cc gii php cho nhng vn kh khn... Nhng cng thng tch cc bao gm nhng k hoch, d n nhiu thch thc, nhng quyt nh thay i ln trong i sng nh thay i ch , thay i cng vic, hoc i mt vi s s hi, bnh tt... V c bn, khi mt s kin cng thng lm thc y s pht trin ca cm xc, tr tu hay tinh thn, l mt cng thng tch cc. V th, ng ra khng phi s kin, m chnh phn ng ca chng ta i vi s kin mi l yu t quyt nh xem liu c phi l mt s cng thng tch cc hay khng. Ci cht ca mt ngi thn chng hn, i khi cng c th dn n mt s pht trin nhn cch, v n gip chng ta nhn ra iu g v chnh mnh m trc y ta cha tng thy c. Bi vy, ngay c mt s kin au 144
Cc nhn t ri ro khc
bun nh th cng c th to mt s cng thng tch cc, cho d chng ta c au n v bun kh trong mt thi gian.
Nhng cng thng tiu cc
Nhng s tr tr, bun chn ko di dn n tm trng cng thng tiu cc. Khi mt s cng thng khng thc y pht trin bt c iu g, l mt cng thng tiu cc. Khi nhng s kin tiu cc khng c v g l s to ra c iu g kh hn trong tng lai di lu, m ch ko di thm tnh trng ca hin ti, n to ra s cng thng dn n nhng vn bt n v sc khe ko di v gy suy nhc. iu ny cng khng c ngha l nhng cng thng tch cc khng gy ra vn v sc khe, nhng khi khng c c mt kt qu tch cc no, s cng thng s gy ra nhiu nh hng tiu cc hn i vi sc khe ca chng ta. Nhng cng vic khng pht trin, nhng mi quan h tr tr ko di, s tn tt gy ra do tai nn hoc bnh tt, hoc tnh trng tht nghip ko di... u c th l nhng nguyn nhn gy cng thng tiu cc. Nhng tnh hung ny trong thc t 145

thng dn n tnh trng suy nhc, t ti mc cm v rt nhiu cn bnh v th lc.
i ph vi tm trng cng thng
Mt tnh hung c xem l cng thng thng ph thuc rt nhiu vo kh nng i ph ca chng ta trc tnh hung y. Ni chung, chng ta thng cm thy cng thng trong cc tnh hung: -Nhng s kin tiu cc -Nhng s kin khng th kim sot c, hoc khng th d on trc -Nhng s kin m h, ln ln, khng sao hiu r c Trc mt tnh hung, bn s cng thng n mc no l ph thuc rt nhiu vo tnh cch c nhn ca bn. Chng hn, ngi vn c quan im bi quan s chu nhiu cng thng hn mt ngi c quan im lc quan. Mt s ngi thch tm hiu ngha ca nhng tnh hung khng kim sot c, v iu ny cho h mt cm gic nh l kim sot c tnh th. Mt s ngi khc li thch nhng thch thc trong cc tnh hung kh khn. 146
Cc nhn t ri ro khc
Nhng phng thc i ph ca chng ta rt a dng. Mt s ngi thch ln trnh v n gin ha ti a vn . iu ny ch c li ngay trc mt, nhng v lu di th s cng thng ca chng ta vn cn . Nhng ngi i mt vi s cng thng c th s kh khn hn vo lc u, nhng s thy nh nhng lu di v sau khi vn c gii quyt. Nhng ngi vui v thch a, hoc nhng ngi c th da vo s nng tinh thn, s nng ca x hi i ph vi cng thng s t gp phi nhng vn v sc khe hn. Nu bn ri vo nhng trng hp sau y, iu c ngha l bn khng c kh nng i ph tt vi cc trng hp cng thng: -C suy ngh, tng tng v tt c mi tnh hung xu c th xy ra, thay v l ch quan tm n bn thn v tnh hung cng thng trc mt. -Ngng tt c nhng g ang lm tp trung ton b tinh thn v sc lc nhm gii quyt mt vn ngay tc khc. (C th bn lm nh th l v nu khng, bn s pht khng ln v s lo lng cng thng.) 147

-Suy ngh, nh li nhiu ln v mt cn khng hong tri qua, ngay c sau khi n c gii quyt xong. -Tng tng nh nhn thy tnh hung cng thng ngay trc mt mnh, cng nh hnh dung v kt qu ti t nht m n c th mang n. -C cm gic nh mt kh nng kim sot tt c mi vic, hon ton bt lc. -C cm gic nn nao trong bng, cm thy ming kh i, tim p mnh, hoc cc c c v vai cng cng. -Kh ng v thng thc gic vo na m. -Cng iu ha mi vic, ngay c nhng vn n gin cng tr thnh quan trng. -Cm thy kh khn khi mun ni ra iu g - thng l ni lp bp hoc thm ch khng th ni ra thnh ting, v hai bn tay hay cc ngn tay run ry. -Nhng tng cng thng ni tip nhau trong u vi mt tc rt nhanh m khng sao dng li c. 148
Cc nhn t ri ro khc
S gim nh cng thng ph thuc nhiu vo nguyn nhn gy ra cng thng. Cch duy nht kim sot c nhng cng thng vt ngoi tm kim sot ca bn l thay i phn ng ca bn i vi n. Vi nhiu ph n th iu ny i hi thi gian v c th cn n s t vn, gip ca mt chuyn gia c nng lc. Nu bn t to ra nhng cng thng cho chnh mnh bng vo vic a ra nhng chun mc qu cao hoc i hi s hon thin, bn cn gim bt s i hi ni t thn v bit tha th cho chnh mnh v khng t c s hon thin. Mt ln na, s gip ca mt chuyn gia l hu ch. Trong thi gian ch i, mt vi ngh sau y c th gip gim nh nhng cng thng hng ngy: -Phn tch chnh xc nguyn nhn gy cng thng v tm xem c gii php no gii quyt hay khng. Trong thc t, vic dnh thi gian suy ngh xem thc cht ca vn l g s c th gip bn rt nhiu. -Hng v kha cnh khi hi ca nhng tnh hung kh khn v c rt ra nhng bi hc thay v l t hnh h chnh mnh. 149

-Khi vn tr nn nghim trng, kh khn, hy bit da vo nhng ngi sn sng nng bn: nhng ngi bn thn, nhng ngi trong gia nh... -ng nhn ly tt c mi chuyn v mnh. Khi ngi khc c nhng cch ng x khng nh bn mong i, hy xem xt n cc yu t khc. Chng hn nh, ngi y c th ang gp nhng rc ri no khng lin quan n bn, nhng iu lm nh hng n cung cch c x ca anh ta. -Ngh n nhng iu tt p, lc quan trong tng lai, nhng k hoch, d tnh tch cc m bn s thc hin. -Bit t chi ng lc. Khi mt cng vic hoc s nh cy no vt ngoi kh nng ca bn, hy t chi mt cch lch s. -Dnh thi gian cho chnh mnh. t nht mi tun mt ln, bn cn c mt khong thi gian no mt mnh yn tnh. Bn c th dng thi gian ny i bch b hoc thng thc mt th vui no . 150
Cc nhn t ri ro khc
-Lp thi gian biu. Mt s ngi thy rng vic lp thi gian biu thc s rt c ch. Mt s khc cho rng ch l by thm vic. Nhng nu bn cha bao gi lp thi gian biu, hy th xem. N c th gip bn bit tp trung vo nhng vic cn thit v t chc cng vic mt cch tt hn. -Th tm mt s phng thc xoa du, c th l phng php xoa bp, cc bi tp luyn ca ngi Trung Hoa, chng hn nh kh cng hay Thi cc quyn. -n ung iu v hp l.
Tm mt ngi t vn hay tr liu stress tt
Khi tm kim mt ngi t vn nhm gip bn gim stress, bt k nhng nh chuyn mn no sau y cng u c th gip c bn: -Bc s tm thn, l bc s y khoa chuyn iu tr bnh tm thn v c th k toa thuc. -Nh tm l hc hay Tr l nh tm l hc. y l ngi c cp giy php thc hnh tr liu hoc c bng thc s hoc c bng 151

tin s. Cc nh tm l hc lm sng c bng thc s thng lm vic trong bnh vin hoc cc phng mch. H cng thng c mt cc phng tp t nhn. Cc nh tm l hc thng thc hin cc cuc kim tra, nh gi v k hoch iu tr. -Nh t vn: ngi ny thng phi hon tt cc kha hc chng nhn v t vn v v vy c giy php thc hnh tm l tr liu, c th c bng i hc (nhng iu ny khng bt buc). -Nh t vn hn nhn v gia nh: Tn gi ny l khc bit vi thut ng nh t vn vn bao qut hn. Ngi ny hon tt xong kha hun luyn gay go thng qua mt kha hc cp giy chng nhn v liu php gia nh v cc ng c trong cc mi quan h v c c giy php thc hnh tm l liu php. -Tho lun v chi ph vi nh tr liu ca bn trc l rt quan trng bit cc dch v no phi chi tr cho k hoch sc khe ca bn. Ni chung, cc dch v sc khe tm thn cc bnh 152
Cc nhn t ri ro khc
vin u do bo him chi tr v cc dch v c cc bc s tm thn hc cung cp. Nhng cc nh lm cng tc x hi hay cc nh t vn trong cc phng khm t nhn th phi tr l ph cho dch v.
Hy c mt cuc kim nh
c ri. Bn tm thy ai m bn cho rng c chuyn mn lm nh tr liu cho bn. iu khng c ngha l bn tm thy nh tr liu ph hp cho bn. Hy hi chnh mnh nhng cu hi sau khi ln u ngi xung ni chuyn vi nh liu php. Nu bn tr li khng cho nhiu cu hi di y, hy nn xt li xem liu bn c thc s tm c mt chuyn gia thch hp chng? Nhng cu hi ny s gip bn bit c cm gic tin cy vo nh tr liu ny. 1. Khi bn cnh ngi ny bn c cm thy thoi mi khng? 2. Ngi ny bn c th tin c khng? 3. Bn c cm thy bnh tm vi ngi ny khng? 153

4. Ngi ny c khin cho bn cm thy an ton khng? 5. Ngi ny c tn trng bn khng (hay i x tn trng vi bn)? 6. Ngi ny c linh hot khng? 7. Ngi ny c th da dm vo khng? 8. Ngi ny c em li s thng cm cho bn khng? 9. Ngi ny c ngi gim st tham vn mi khi gp nhng trng hp gay go hoc thch thc khng? 33. Lm h huyt p m khng dng thuc C mt s bc hiu qu bn c th p dng t mnh lm h huyt p. -Thay i ch n ung v bt u tp th dc. -Hn ch cc thc ung c cn -Hn ch lng mui n khong 1,5 mung canh mi ngy. Ct gim tt c cc loi thc n c sodium cao nh sp ng hp, da ngm gim, nc st u nnh... Chng 154
Cc nhn t ri ro khc
hn, mt vi loi sp ng hp cha n 1.000 mg sodium. Nh vy l qu nhiu! -n nhiu thc n c canxi hay cc sn phm lm t sa v cc loi thc n c potassium (kali), chng hn nh chui. Mt s cuc nghin cu vn cha c chng minh cho bit nhng ngi b cao huyt p thiu cht canxi v potassium. -Hy gim mc cng thng. Cc cuc nghin cu cho thy khi bn gim bt phn ng vi s cng thng th huyt p s gim.
Cc loi cy c lm h huyt p
Cc loi tho dc sau c th lm h huyt p -Cy to gai en ngm ru: 10 - 20 git 3 ln 1 ngy. -Cy mu b ngm ru: 10 - 20 git 3 ln 1 ngy. -R cy b cng anh ngm ru: dng 10 15 git vi ba n. -Potassium: 80% - 85% nhng ngi n 6 phn thc n giu potassium hng ngy s 155

gim nhu cu cn thuc gim huyt p n 1/2 hoc nhiu hn. -Ti sng. Ch 1/2 hoc 1 tp ti sng mi ngy c th gim huyt p ng k, hoc trn ti vo trong cc loi mn n khc nhau nh trng, cm hay khoai ty. -Gng. -To bin. 34. Thuc lm gim huyt p Nu khng th h huyt p bng nhng thay i cch sng, c th bn s l i tng ca mt s loi thuc h huyt p sau y: Thuc li tiu: Cc loi thuc li tiu l thuc h huyt p thng c dng nhiu nht. Cn c gi l thuc nc, thuc li tiu hot ng bng cch y lng nc v mui d tha ra khi c th bn. Nhng thuc li tiu thc s c th lm tng nguy c b suy tim bng cch lc mui potassium m tim cn, qu tim c th phn ng vi nhng du hiu thn kinh b nghn bng cch cng ngy cng c gng hot ng mnh hn nhng vn tht bi. Tc dng ph thng thng 156
Cc nhn t ri ro khc
khc na ca tr liu li tiu l c potassium thp. Mc potassium c chiu hng gim khi cc thuc li tiu thay th cho ch n t bo m bn trc gi hot ng qu tch cc duy tr. Nu bn m bo khng phi thay th liu php ny bng mt liu php khc, thuc li tiu s khng nh hng n potassium ca bn. Nhng tc dng ph khc na bao gm ng mu v cholesterol tng cao. Thuc chn beta (Beta-blockers): Cc thuc chn beta lm thay i cch thc cc hormone nh adrenaline khng ch cao huyt p. Chng lm chm s nhp tim bng cch lm gim sc co bp ca tim. Cc thuc chn beta thng c ngi tr tui v nhng ngi b bnh ng mch vnh s dng thng xuyn nht. Cc tc dng ph c th gm mt mi v tng ng mu, tng mc cholesterol. Cc tc nhn hot ng phn trung ng: Cc loi thuc ny hot ng thng qua cc phn trung tm no nhm lm chm s nhp tim v lm th gin cc mch mu. Cc tc dng ph c th gm nght mi, ming kh v bun ng. 157

Cc thuc lm gin mch: lm th gin cc mch mu do lm gim huyt p Cc cht c ch ACE (c ch men chuyn): lm gim huyt p bng cch ngn chn s hnh thnh ca mt hormone l angiotensin II. Hormone ny lm cho cc mch mu b hp li. Cht c ch men chuyn cng c dng iu tr bnh suy tim. Cc tc dng ph c th gm ho v mt li sng phng. Cc tc nhn lm nghn a: cc tc nhn lm nghn a lm nghn tc dng ca noradrenaline cho php cc mch mu th gin. Huyt p gim cng vi cholesterol. Bn c th thy tng HDL hay cholesterol tt. Tc dng ph c th l s thay i huyt p khi ang nm ng ln. Cc cht lm nghn ng canxi: lm gii hn lng canxi i vo cc t bo, cho php cc c trong mch mu c th gin. Cc tc dng ph c th gm sng mt c chn, to bn, mt v n khng tiu. 35. Hy cnh gic v mc cholesterol cao Cholesterol l cht bo dng sp hi trng do gan to ra vi s lng rt ln. l l do 158
Cc nhn t ri ro khc
gan v tht ca cc c quan khc c cholesterol cao. Cholesterol rt cn to ra hormone cng nh cc mng t bo. Nu bn b cao cholesterol, lng cholesterol tha trong mu c th lm hp ng mch v iu ny c th dn n mt cn au tim. Cht bo bo ha - c ni n mt cch chi tit phn Ch n ung - thng l th phm trong trng hp cholesterol cao bi v n lm cho c th bn t sn sinh ra cholesterol. Tuy nhin mc cholesterol cao nht l do mt s khim khuyt di truyn gan. Cu chuyn v ph n v cholesterol cao vn ang c lm r dn. Nghin cu mi y cho thy rng mc cholesterol cao l nhn t nguy c gy bnh tim nam gii cao hn ph n. Nu bn b suy tim th tun theo mt ch n c cht bo bo ha thp s gip bn gim mc cholesterol c hi (LDL) v tng cholesterol c li (HDL). Tng t, nu bn ht thuc, c huyt p cao, b bo ph, b bnh i tho dng loi 2 hay c tin s gia nh b bnh tim, ch n ung t cht bo lm gim mc cholesterol cng s gip ci thin sc khe. 159

Mc d vy, i vi nhng ph n khe mnh trn tui 65 c mc cholesterol cao hn bnh thng, nhng nu khng ht thuc v khng c cc nhn t nguy c gy bnh tim khc ngoi tui gi, th khng c li ch r rng no trong vic lm gim thp mc cholesterol, thm ch khng cn phi lo lng v iu . Chng hn, chng ta thy vic rt him c ph n thi k tin mn kinh vi mc cholesterol cao pht trin bnh tim a cc nh nghin cu i n kt lun rng so vi mc cholesterol cao th ph n cn c cc nhn t khc ng k hn nhiu. V th, trong khi cholesterol cao c lin h r nt vi bnh tim nam gii th n li t quan h r rng vi bnh tim ph n, trong thc t thm ch cn khng phi l chuyn ng ni. Hu ht cc bc s s ngh mt ch n t cht bo cho nhng ph n c nhng nhn t ri ro khc gy bnh tim, bi v ngh hon ton v hi v c th ci thin c cc vn sc khe khc. C ngha l, c nhng hng dn thc hnh lm sng m cc bc s phi tun theo khi iu chnh vi mc cholesterol ca mt ph n. 160
Cc nhn t ri ro khc
36. Cc hng dn iu chnh mc cholesterol Hng dn hin thi a s bc s Bc M tun theo khi iu chnh mc cholesterol ph n l khuyn khch nhng ph n trn tui 20 bt u ch n ung c tc dng lm gim cholesterol1 nu mc cholesterol ca h l 200mg/ dl hoc cao hn. Nu bn c mc cholesterol HDL rt thp (di 35mg/dl) th bc s ca bn s o mc cholesterol LDL. Mc LDL di 130mg/dl l rt tt. Mc LDL t 130 n 159mg/dl l ng bin cao. Mc 160mg/dl hoc hn na l cao. Ch n c cht bo bo ha thp s c th c xut. Nu bn b bnh tim, bn nn t mc tiu l c LDL khong 100mg/dl hoc t hn, thp hn cc hng dn cho ph n khng c bnh tim. Trong trng hp ny, bc s ca bn c th xut nn ung thuc lm gim cholesterol2 ngoi vic n ung thc n c cht bo bo ha thp. Mc cholesterol c kim tra thng qua mt xt nghim mu n gin. Bn cng nn hi dc s v kh nng xt nghim cholesterol ngay ti nh.
1 Xem t mc s 11 n mc s 20. 2 Xem mc s 39.
161

Nu cholesterol trong mu nm mc 200 n 239mg/dl trong trng hp bn khng ht thuc, khng b bo ph, c huyt p bnh thng, ang thi k tin mn kinh v khng c tin s gia nh b bnh tim, nh vy l tt. Mc cholesterol tng s cao thng i hi phi tip tc phn tch HDL v LDL. 37. Lm gim cholesterol m khng dng thuc Bng cch thay i ch n1 v tp th dc,2 bn c kh nng lm h cholesterol m khng cn phi ung bt k loi thuc no. Vitamin E cng t ra c kh nng lm gim cholesterol, ngn chn s hnh thnh ca cc mng cng trong ng mch. Trong mt cuc nghin cu vi 87.000 ngi ung vitamin E, cc trng hp ln cn au tim c ghi nhn gim 46%. Trn nn tng ca cuc nghin cu , cc bc s gi y thng ngh mt liu dng 100 IU3 mt ngy. i vi vitamin C, chng ta vn khng bit cn bao nhiu vitamin C c th gim nguy c
1 Xem mc s 11 n mc s 20. 2 Xem mc s 21 n mc s 30. 3 IU: International unit, n v quc t
162
Cc nhn t ri ro khc
ln cn au tim. Dng mt lng ln vitamin C c quan h vi vic gim t l bnh ng mch vnh trong mt cuc nghin cu 8 nm ti Brigham v Boston. 38. Hy ung mt t ru vang Ru c chng minh l lm tng mc cholesterol c li (HDL). S tht ny c khm ph vo cui nhng nm 1980 khi cc nh nghin cu iu tra l do ti sao nhng ngi Php n thc n giu dinh dng nh vy li c t l b bnh tim rt thp. l nh ru, c th l ru vang , cho thy lm gim c nguy c b bnh tim mch. V th ru vang c th c li, min l bn ung mc va phi.1
1 Cho d thc ung c cn t ra c mt s hiu qu chng li bnh tim mch, iu quan trng khng km l phi xem xt cc kha cnh tiu cc ca chng trc khi bn quyt nh dng mi ngy mt ly nh l cch bo v sc khe. Lng cn a vo mu c kh nng lm tng cao mc ng mu v mc . N cng lm cho huyt p tng cao v dng nh c mi quan h vi ung th v ph n. Ung qu nhiu ru bia c kh nng lm tng nguy c mc bnh c tim v chng lon nhp tim, gy ra x gan, vim thn, vim d dy, mt s chng t qy v cc bnh ung th nh ung th ming, ung th c hng, ung th thanh qun, ung th thc qun v ung th gan.
163

Nhiu ph n cng quan tm n lng calori h thu np vo c th khi ung ru. V vy, sau y l cch gii quyt: mt ly ru nguyn khng pha ung km theo ba n s tng thm khong 100 calori, pha thm mt phn s-a vi mt phn ru s gim mt na lng calori. Khi bn dng ru vang nu chung vi thc n, ru bay hi ht ch li mi hng thi. Nu bn ung bia, v c bn l mi chai bia c cha mt t bp, la mch v vi mung ng mch nha. Bp v la mch ln men hu ht thnh cht cn v mt t maltoza. V lng calori th mi chai bia cung cp khong 150 calori cng thm 3 mung ng mch nha. Bia nh c t calori hn, nhng t nht cng l 100 calori mi chai. Ru cng nng th cng nhiu dinh dng. Cc loi ru mnh nh ru scotch, rye, gin v rum c lm t cc loi ht ng cc; volka, sn phm ca ngi Nga c lm t khoai ty. Trong trng hp ny, cc loi ng cc ln men thnh cht cn. Cc loi ru mnh trung bnh c khong 40% cht cn, nhng khng c ng. 164
Cc nhn t ri ro khc
D vy, mi ly nh c khong 100 calori, min l bn ng thm vo cc loi nc tri cy, nc p c chua hay nhng thc ung nh c ng. 39. Cc loi thuc lm gim cholesterol i vi nhiu ngi, vic gim cn v thay i lng cht bo n vo c th khng gim mc cholesterol xung nh mong mun. Bn c th l i tng ca mt trong rt nhiu loi thuc lm gim cholesterol va a ra th trng trong nhng nm gn y. Nhng loi thuc ny khi c kt hp vi ch n t bo, t cholesterol, tc ng n ng rut ngn cn s hp th thc n, hoc tc ng n gan, ngn cn qu trnh hnh thnh cholesterol. Tuy nhin, y l nhng loi thuc mnh, phi c xem l la chn cui cng sau khi th qua ch n t cht bo v t cholesterol. Bn c th c cho kt hp nhng thuc gim cholesterol cng vi ch n t cholesterol. iu quan trng l phi hi v nhng tc dng ph ca thuc, bi v nhng thuc ny c th gy ra nhng vn v rut d dy, d ng, ri lon mu v trm cm. Mt cuc nghin cu cc bnh nhn nam gii 165

ung thuc gim cholesterol cho thy c t l t st cao khc thng v nhng chn ng tm thn t xut rt cao. Vn cha c cc nghin cu ph n khi ung nhng thuc ny bit chc chng tng tc nh th no vi tnh trng sc khe ca ph n. D sao i na, sau y l nhng g c c vo thi im vit sch ny. Xin lu l y khng lit k cc tn thng phm, bit dc: -Niacin: Khi dng ng cch, niacin l loi thuc cha tr cholesterol tt nht hin c. Vo nm 1986, D n Thuc nhi mu c tim (mt cuc nghin cu ca Vin Y t Quc gia) nhn thy rng s dng ko di thuc niacin lm gim ng k t l t vong cc nn nhn b suy tim. T n tr thnh mt trong nhng loi thuc gim cholesterol ph bin nht trn th trng. Niacin, mt loi vitamin B c th ha tan trong nc, c th lm gim 30% mc LDL v 55% mc triglyceride. N cng lm HDL tng ln khong 35%. Cn c gi l acid nicotinic, niacin phi c ung vi lng ln (1 n 3mg / 1 ngy) c hiu qu tt. 166
Cc nhn t ri ro khc
V liu dng cao hn n 76 ln mc cho php hng ngy c ngh, nn cc tc dng ph tt nhin l khng th trnh khi. Nhiu bnh nhn s thy nga, mt v b hoang mang. Hy ung mt vin aspirin 30 pht trc khi ung thuc ny hay ung sau khi n no c th gip gim mt s triu chng . Niacin c th lm cho c bnh lot d dy ln bnh i tho ng trm trng hn. -Statin: Cc loi thuc statin nh Mevacor v Zocor ngn cn kh nng sn sinh cholesterol ca gan, gi cho mc LDL mc thp nht v lm tng mc HDL. Khi c kt hp vi ch n thch hp, cc thuc statin c th gim gn 40% nguy c t vong v bnh tim. Tuy nhin mt s lovastatin (Zocor) c cho bit l lm tn thng gan, au c v yu ngi. -Cholestyramine: gip c th loi b cholesterol qua ng rut. N c coi l loi thuc lm gim cholesterol an ton nht v l loi thuc c t lu nht. Mt cuc 167

nghin cu ca Vin Y t Quc gia vo u nhng nm 1980 cho bit cholestyramine lm gim t l t vong v nhng cn au tim nh vo vic lm gim mc cholesterol. Trong thc t, gim c 1% mc cholesterol ca ngi bnh s gim tng ng 2% t l t vong. Con s ny kh n tng khi bn xem xt n mc gim cholesterol trong mu thc t trung bnh l 25%. Mc d cholestyramine lm gim LDL hay cholesterol c hi, nhng i khi n cng lm tng mc triglyceride. N cng gy ra nhiu tc dng ph, triu chng kh chu nht l gy y hi. Cholestyramine ngn cn hiu qu cc thuc nh dng a hong, thuc li tiu, warfarin, cc vitamin c th ha tan trong cht bo v nhng thuc chn beta. N cng c th dn n bnh si mt. Cholestyramine nn ung vo bui sng v lc i ng. -Gemfibrozil: lm h mc cholesterol v triglyceride trong mu. Mt cuc nghin cu loi thuc ny ca Phn Lan vi 4.000 nam bnh nhn c mc cholesterol cao 168
Cc nhn t ri ro khc
ghi nhn kt qu gim 34% t l mc bnh ng mch vnh. Gemfibrozil nn ung vin 600 mg 2 ln 1 ngy. -Arginine: Cc cuc nghin cu s b cho thy loi amino acid ny c th lm gim mc cholesterol v ci thin s lu thng mu trong ng mch vnh bng cch tc ng nh mt cht chng oxy ha v duy tr tnh n hi trong cc m mch mu. Arginine hin c bn khng cn toa bc s. -Coenzyme Q10: Cc bc s Nht v chu u rt thch loi thuc chng oxy ha cc mnh ny, nhng cn c thm nhiu cuc nghin cu chng minh tc dng cha c lm r ca n ln cc mng cng ng thnh ng mch. 40. Quan h tnh dc an ton Mc d iu ny nghe c v in r nhng thc s ng: nhng ngi b bnh tim c t l nhim chlamydia cao hn nhiu. Chlamydia l bnh ly nhim qua ng tnh dc c bit lan trn nhng n gii trong tui t 18 n 35. Mi 169

quan h gia bnh chlamydia v bnh tim c pht hin vo nm 1996 qua mt cuc nghin cu gy ngc nhin c cng b trn t bo Journal of the American College of Cardiology. Cc kt qu ch r rng nhng ngi c cc ng mch b bnh nhim bnh chlamydia vi t l cao hn rt nhiu so vi nhng ngi c ng mch bnh thng. Cuc nghin cu ny cho thy 79% nhng ngi c ng mch b bnh cho kt qu xt nghim nhim chlamydia dng tnh, so vi 4% trong s bnh nhn khng ch bnh c kho st, iu khng nh cc cuc nghin cu nh hn c thc hin trc y khp chu u. Nhng khm ph ni bt nh vy by gi c coi l vic thc tp tt cho ton b ph n c bo v khi bnh chlamydia khng ch v sc khe tnh dc ca h m cn cho sc khe qu tim ca h. Chung quy li vic ngn chn bnh tim ph n c lin quan ti vic s dng bao cao su. Chlamydia c khm ph vo cui nhng nm 1970 v khng phi l mt vi khun c trng, cng khng phi l mt loi virus. N rt nh c kch c ging nh virus v c mt s c tnh ging vi khun nhng khng th t sinh ra 170
Cc nhn t ri ro khc
nng lng nh cch ca vi khun hay virus. Thay vo , n hot ng nh mt loi k sinh i vo cc t bo v s dng nng lng ca t bo. N do mt loi vi khun gi l Chlamydia trachomatis, nhng bi v n ri vo min t khng n ng u m ca hnh vi l lng ny nn Chlamydia khng phi d pht hin ra. C khong 10% nhng ngi b nhim Chlamydia nhng khi kim tra cho kt qu m tnh. Hin gi, chlamydia l mt trong nhng bnh ly lan qua ng tnh dc thng thng nht Bc M v trong nhm tui hot ng tnh dc t 18 n 30 c 50% b bnh chlamydia. Tuy nhin chlamydia c bit gy kh chu bi v n thng khng xut hin cc triu chng. Trong mt nm na c khong 4 triu ri ph n Bc M s b nhim bnh chlamydia v 60% trong s h s khng c bt k mt triu chng no c. Ngoi vic lin h ti bnh tim, bnh ny cn c th lm tn hi theo nhng cch khc. Mt s chuyn gia d on chlamydia gy ra 50% nhim trng khung chu v 25% trong thai ng nghim do so ng dn trng. N cng gy 171

nhim trng niu o, vim nhim c t cung v vim nhim khung chu, iu c th dn n hu qu v sinh hoc cc bin chng trong lc mang thai hoc trong khi sinh. Cc triu chng b bnh chlamydia giai on u thng khng xut hin vi 4 trong 5 ph n. Triu chng thng thng nht thng pht trin khong 14 ngy sau khi nhim trng nu vng m o tit dch tng ln hay bt thng. i lc mi vng m o rt nng. Tiu au but, chy mu vng m o bt thng, chy mu sau khi quan h tnh dc v au vng bng di cng c th l nhng du hiu bnh v c t cung c th b vim nhim (c th bit c khi khm bc s). Nu c t cung chy mu mt cch d dng sau khi xt nghim Pap, y cng l mt manh mi ch yu. Nu chlamydia lan n d con v ng dn trng, n s tin trin thnh vim nhim khung chu. iu tt nht c th lm nu bn hot ng tnh dc l phi thng xuyn yu cu bc s gia nh ca bn xt nghim tm chalmydia. Xt nghim cho kt qu chnh xc ti 90%. Vic xt 172
Cc nhn t ri ro khc
nghim rt n gin: Bc s ca bn s ly mt mu cy vi khun ca cht nhy c t cung. C th thc hin kt hp vi xt nghim Pap. Nn xt nghim thng xuyn nh th no? Mi khi bn c mt bn quan h tnh dc mi. iu ng mng v chlamydia l n cc k d tr. Tetracyline s cha lnh bnh. Ngi ta cn tin rng cc thuc phng trnh thai c hormone tng nguy c b bnh v cht nhy c t cung thay i v v vy d mc phi chlamydia hn.
im qua v quan h tnh dc an ton
Bn ngh rng mnh qu gi khng cn phi c nhng iu ny chng? Hy suy ngh li. Khi ph n ln tui, nim mc m o mng i lm cho d mc phi nhng bnh ly lan qua ng tnh dc nhiu hn nh bnh chlamydia v t hn l bnh HIV. V th, di y im qua mt s cch thc hin quan h tnh dc khn ngoan. Quan h tnh dc an ton m ch ti ton b mt lot cc cuc thc hin quan h tnh dc hp l v c thc v sc khe, c bao gm nhng khng ch gii hn vic s dng bao cao su. Quan h tnh dc an ton gm nhng iu sau: 173

1. King nhn. ng bao gi ng vi ngi bn khng quen bit. Trnh quan h cho ti khi mi quan h nghim tc. 2. Hy hi nhng cu hi kh. Phi quen bit vi ngi bn quan h. Hy hi v tin s tnh dc, giao hp qua hu mn v s dng thuc tnh mch v hi xem cc bng chng v xt nghim HIV m tnh (v tnh nguyn xt nghim). 3. ng bao gi quan h tnh dc m khng dng bao cao su nha v cht dit tinh trng tr phi bn v ngi bn quan h l v chng v c 2 u xt nghim HIV m tnh. ng b la bi nhng li nh Tt c cc mi quan h ca ti u l 1 v 1 chng hay ti khng ngc u, hy chc v iu . V c bn, tr phi bn vi ngi trong hn 40 nm bit chc rng anh y khng bao gi lng nhng, v xt nghim HIV m tnh, ng quan h m khng c bao cao su v thuc dit tinh trng. Ngi ta tin rng thuc dit tinh trng gip dit virus HIV. 174
Cc nhn t ri ro khc
4. ng bao gi thc hin quan h tnh dc qua ming m khng c ro cn tr phi bn v ngi bn quan h l 1 v 1 chng v kim nghim HIV m tnh: HIV c truyn qua tinh dch, dch tit m o hay mu kinh nguyt. Bn khng mun nut n ch? V rng ming thng xuyn chy mu c bit nu c lc y p nng trong ming. 5. Hy lun lun mang theo bao cao su v thuc dit tinh trng. 6. Trnh tip xc tnh dc trong thi k c kinh nguyt. Tip xc tinh dch vi mu l mt k git ngi thc s. Ngay c khi ang dng bao cao su bn cng khng mun tng nguy c rc ri ln gp i ch? 7. Trnh mi hot ng tnh dc trong khi nhim trng m o: Dch tit vng m o c th b nhim trng nhiu hn cho n ng trong thi gian ny, HIV d dng truyn sang ph n nhiu hn thng qua kiu dch tit vng m o ny. 8. ng bao gi c quan h trc khi bn sn sng. 175

9. ng bao gi tham gia vo tnh dc hu mn m khng dng bao cao su v nhiu du nhn: Cc nh chm sc sc khe cng cng chuyn nghip cnh bo rng i vi nhng cp thch quan h tnh dc, khoi cm t c l khng ng g nu so vi cc nguy c ln c lin quan ti quan h tnh dc hu mn. Trc tin, qu trnh thm nhp gy rch cc m trc trng v chy mu. y l l do ti sao HIV li c th d dng b ly lan n nh vy trong qu trnh tnh dc hu mn khng c bo v. N mang li cuc tip xc trc tip ca tinh dch vi mu. Ti t hn, cc ch rch trong trc trng b nng hn do vic bi tit phn. iu ny c ngha l c th lm tn thng vnh vin bng, m trc trng, au nhc v chy mu khi bn phi a phn ra. Trong lc quan h tnh dc hu mn khng c bo v, ngi n ng c th dnh phn vo dng vt ca anh ta v ri chuyn cht phn vo trong m o. iu ny tht khng tt cht no, v c th a rt nhiu vi khun kinh tm vo trong m o. Nu bn c quan h tnh dc hu mn, sau y l nhng quy tc: 176
Cc nhn t ri ro khc
-Dng 2 bao cao su v nhiu du nhn ph hp. Du nhn s lm m vng ming v gip ngn nga m trc trng b rch. Hai bao cao su l cn thit trong trng hp c mt bao cao su b rch. -ng bao gi s dng vaseline hay du ng lm cht du nhn tnh dc. N c th n mn bao cao su v lm rch hoc ha tan vo bn trong trc trng (hoc m o). Hy s dng cht du nhn tnh dc thch hp, chng hn nh loi KY Jelly. -Sau khi quan h hu mn, hy m bo ngi bn ca bn ra v lm kh dng vt v 2 bn tay v mang mt bao cao su cn mi mt cch cn thn trc khi tip tc hot ng thm na. Bn phi nh l khng c phn c a vo trong m o ca bn v khng c mu t nhng ch rch ca trc trng i vo bn trong m o ca bn. -Sau khi quan h hu mn, li phi dng du nhn bi ln trc trng ca bn gip bn du i bt k s kh chu no. 177

-Nu bn c quan h tnh dc hu mn thng xuyn, hy nh phi c s r sot bnh ly lan qua ng tnh dc y . 2 ln 1 nm v phi yu cu kim tra trc trng. Nu quan h hu mn ch xy ra 1 ln th hy i khm sau ln . Phi bo co bt k nhng cn au, chy mu hay nhng kh khn khi i tiu sau v vic ln . -Nu c quan h tnh dc hu mn, phi nh thng bo cho bc s ca bn: Quan h tnh dc hu mn c th nh hng n nhng kt qu ca cuc khm ca bn. Bc s bit bn c dnh lu n l rt quan trng c th phn tch chnh xc kt qu kim tra ca bn v cho bn nhiu li khuyn v vic thc hin tnh dc an ton hn. 10. ng bao gi dng chung kim tim. Mc d bit c rng tim ma ty qua ng tnh mch lun lun khng lnh mnh v san s nhng cy kim d bn mang theo tt c cc loi mm bnh v nhim trng bao gm vim gan B, thm ch l AIDS nhng nhng ngi 178
Cc nhn t ri ro khc
s dng ma ty vn l i. Nu bn l ngi ang dng ma ty tim qua tnh mch, sau y l nhng quy tc: -Lun dng kim sch, ng bao gi dng chung kim v ng bao gi s dng kim ca ngi khc. C nhng chng trnh trao i kim tim c thnh lp trn ton lc a. Hy hi bc s v ni bn i n m bo bn s c c nhng chic kim sch. -Nu bn ang chch ma ty tnh mch v nhng l do sc khe chnh ng, hy m bo phi kim tra sc khe thng xuyn vi bc s gia nh ca bn v chc chn rng mnh ang dng nhng sn phm mu an ton. ng dng bt k sn phm mu no tr phi bn bit chc n khng nhim HIV. -Nh mt quy lut, hy khm th nghim bnh AIDS 1 ln 1 nm (hoc yu cu bc s ca bn xut khong thi gian ti khm hp l) m bo bn khng b mc bnh. HIV c th vn m trong nhiu nm trc khi n hot ng. Ch bi v bn 1 ln khm AIDS thy m tnh khng c ngha 179

l bn khng mc phi HIV. L mt ngi s dng ma ty tim qua tnh mch, bn nm trong danh sch c nguy c cao dn n bnh AIDS. V vy hy c kim tra cho n khi tuyt i chc chn. -Hy trnh quan h tnh dc vi ngi s dng ma ty tim tnh mch. -Nu c quan h th hy s dng 2 bao cao su v nhiu thuc dit tinh trng. Nu bn l ngi s dng ma ty, hy lun lun cho ngi bn ca bn bit bn c s dng ma ty v nu bn khng th trnh c quan h tnh dc th hy c dng 2 bao cao su v thuc dit tinh trng.
Quan h tnh dc an ton nht l g?
Di y l danh sch cc hot ng tnh dc, hot ng an ton nht c xp trc tin v cc hot ng cng v sau cng c nguy c ri ro cao hn. -Khng quan h tnh dc -Phng tng -Thi nhm l kha 180
Cc nhn t ri ro khc
-Thi thch ph trng -Th dm -Xoa bp -m nhau -My xoa bp hay cc tr chi tnh dc khc (khng dng chung) -Hn kh -C xt c th khi khng c dch -Th dm cng nhau -Th dm cng nhau vi nhng chi tnh dc sch -Hn t -Quan h tnh dc c phng nga -Tnh dc bng ming (ph n vi ph n, nam gii vi ph n) c bao cao su -Tnh dc bng ming khng c tinh dch -Quan h tnh dc m o c bao cao su (hoc bao cao su nam hoc bao cao su n) -Tnh dc hu mn c bao cao su -Tnh dc bng tay c phng nga 181

-Tay hoc ngn tay tip xc tnh dc c nhng vt ct hoc ch au -Tnh dc bng ming m khng c phng nga trong lc hnh kinh -Tnh dc bng tay khng c phng nga nh chic gng tay -Tip xc hu mn/bng ming khng c phng nga -Tnh dc bng ming c thuc dit tinh trng v khng c phng nga -Tnh dc hu mn c thuc dit tinh trng v khng c phng nga -Tnh dc hu mn khng c thuc dit tinh trng v khng c phng nga -Bt k loi kim tim no c dng chung
182
LIU PHP THAY TH HORMONE

41. Quan h gia thi k mn kinh v bnh tim Trong ting Anh, menopause (thi k mn kinh) l t c gc Hy Lp, gm 2 t menos (thng) v pause (dng li) - s dng li ca cc chu k kinh nguyt. Trong i ngi ph n, y l lc 2 bung trng hot ng chm dn li, khng cn trng na v sn sng ngh ngi. Thi k mn kinh t nhin v thi k c kinh nguyt ln u tin (menarche) c nhiu im ging nhau. C 2 u l nhng qu trnh din ra dn dn, gip ph n cm thy d chu. Mt ph n khng t nhin thc gic thy mnh mn kinh, cng ging nh mt c gi tr khng bt ng thc dy v thy mnh vo tui dy th. Tuy nhin, khi thi k mn kinh xy ra bng phu thut - h qu theo sau phu thut ct bung trng, bung trng h hi theo sau l mt cuc phu thut ct b d con hoc mt s phng thc tr liu ung th - c th l mt qu trnh cc k kh chu. Trong 3 ph n Bc M c 1 ph n s khng c d con nguyn vn khi 183

ti tui 60. Nhng ngi ph n ny s thc dy vo mt bui sng thy mnh trong thi k mn kinh v do s chu ng nhiu triu chng nghim trng v r nt hn nhiu so vi nhng ngi mn kinh t nhin. Do mn kinh bng phu thut nn cc liu php thay th hormone (HRT) v liu php thay th estrogen (ERT) tr thnh nhng vn c tranh ci nng bng v sc khe ca ph n. c bit, mt estrogen dn n nhng thay i ng k v mt ha hc trong c th, gy ra qu trnh lo ha mnh hn, bao gm c vic lm cho ph n d mc bnh tim hn. Mt estrogen lm tng nguy c b bnh tim ca tt c cc ph n, y l nguyn nhn t vong ch yu ca ph n sau thi k mn kinh. Nu bn c nhng nhn t ri ro khc, nh bnh i tho ng loi 2 th nguy c b bnh tim cao hn 2 n 3 ln so vi ph n bnh thng. Trung bnh ph n Hoa K sng c n 78 tui, c ngha l c ta s sng 1/3 cuc i ca mnh sau thi k mn kinh. D nhin, nhiu ph n cng s quan tm n nguy c b ung th v. 184
Liu php thay th Hormone

Mt estrogen c th kch thch hay gy ra s tng trng ca t bo ung th v ph thuc estrogen (c ngha l nhng t bo ung th v sng nh vo hay pht trin nh hormone estrogen). Cc cuc nghin cu hin nay cho thy loi ung th ny d cha tr hn cc loi ung th v khc. V, nh ti s bn n trong mc cui ca sch ny, bi v ngy cng c nhiu ph n cht do nhng cn au tim hn l do ung th v - nht l khi h c nhng nhn t ri ro khc - vic to th cn bng trong vic ngn nga bnh tim (hay thm ch nhng trng hp gy xng do long xng) phi c xem l c li. 42. Nn bit khi no bn mn kinh V mt x hi, thi k mn kinh ch n mt qu trnh ch khng phi l thi im chnh xc ca chu k kinh nguyt trong cuc i bn. Nhng v mt y hc, thi k mn kinh thc s ch n mt thi im chnh xc: ngy thng kinh nguyt cui cng ca bn. Tuy nhin, nhng s kin i trc v theo sau thi k mn kinh ny to ra thay i ln lao cho ph n c v mt th cht ln mt x hi. V mt th cht, qu trnh ny c chia thnh 4 giai on: 185

1. Giai on tin mn kinh: Mc d mt s bc s c th ni n mt ph n 32 tui trong nhng nm sinh con l thi k tin mn kinh, y khng thc s l tn gi ph hp. Danh t ny ng nht l ch cho nhng ph n ang ng thi im mn kinh. Kinh nguyt ca h bt u khng u nhng h vn cha c bt k triu chng mn kinh tiu biu no nh nng mt hay kh vng m o... Thi k tin mn kinh ca mt ph n thng vo tui gia cho n cui tui 40. Nu bc s bo vi bn l bn ang thi k tin mn kinh, hy hi bc s ca bn ang s dng thut ng ny theo cch no. 2. Giai on gn mn kinh: Thut ng ny ch cho nhng ph n giai on kh khn nht ca hin tng mn kinh - chu k kinh nguyt ca h cc k tht thng v m o kh, nng. Tn gi ny c th p dng trong khong 4 nm gm 2 nm u tin trc thi gian hnh kinh cui cng chnh thc n 2 nm sau l giai on kinh nguyt cui cng. Ph n gn mn kinh s tui t gia n cui tui 40 cho n khong 51 tui. 186

3. Giai on mn kinh: Thut ng ny ni n giai on hnh kinh cui cng ca bn. Bn s khng th xc nh r ln hnh kinh cui cng ca bn mi cho n khi hon ton khng c kinh nguyt trong mt nm. Ri bn m ngc tr li ln hnh kinh cui cng ca bn v ngy thng l ngy thng mn kinh ca bn. Quan trng l: Sau hn mt nm khng hnh kinh, bt k hin tng chy mu m o no u c coi l bt thng. 4. Giai on sau thi k mn kinh: Thut ng ny ch n giai on cui cng th 3 ca hu ht ph n, m t nhng ph n mt kinh t nht l 4 nm cho n nhng ph n t chc ln sinh nht th 100 ca h! Mt khi bn qua thi k mn kinh, bn s c xp vo thi k sau thi k mn kinh, ko di cho n cui i. i khi nhng cm t sau mn kinh v gn mn kinh c dng ln ln, nhng v mt chuyn mn th cch dng t ny l khng chnh xc.
Chn on tin mn kinh hay gn mn kinh
Khi bn bt u nhn thy nhng du hiu mn kinh, hoc l t bn s ngh l mnh n 187

giai on mn kinh, hoc l bc s ca bn s lin h cc triu chng kh chu do bn trnh by xc nh. C 2 xt nghim rt n gin s xc nh chnh xc vn , cho thy bn ang giai on no ca thi k mn kinh. Mc hormone kch thch follicle1 tng nhanh khi thi k mn kinh bt u. Nhng mc ny c kim tra d dng bng mt xt nghim mu. (Bnh thng, FSH kch thch vic bt u chu k kinh nguyt v pht tn hiu cho cc bung trng thi trng ra, trong nhng phn u ca chu k kinh gi l 1 follicle. Mc FSH tng ln khi 2 bung trng bt u hot ng chm li.) Ngoi ra, b thnh m o ca bn s mng i v cc t bo nim mc m o s khng cha nhiu estrogen. Bc s s xt nghim b thnh m o ging nh xt nghim Pap - rt n gin v khng gy au - ri phn tch mu xt nghim kim tra teo m o - ngha l mc mng v kh i ca m o. Ngoi ra, nh ti s tho lun di y, bn cn phi nm c s ln hnh kinh ca bn v th hin chng ln biu khi chng tr nn khng u. Biu hnh kinh ca bn s l nhng chi
1 Follicle stimulating hormone (FSH)
188

tit b sung chn on vic bn ang giai on tin hay gn mn kinh.
Cc du hiu mn kinh t nhin
Trc y, mt danh sch di cc triu chng cung lon c quy cho s thay i ca cuc sng. Nhng v mt y hc, thc s c 3 triu chng ngn hn in hnh ca thi k mn kinh: kinh nguyt tht thng, cm gic nng bng lm mt, v kh vng m o. C 3 triu chng ny u do gim estrogen gy ra. i vi cc triu chng cm xc ca thi k mn kinh nh gin d, tm trng tht thng, bun b... tht ra l do tng FSH gy ra khi chu k thay i v vic cung cp trng ca bung trng b hao mn. FSH tit ra vi s lng rt ln v t ti nh im c i ngi cao hn trc y 15 ln. y l cch m c th c nhy khi ng nng lng bung trng. y l l do ti sao nc tiu ca ph n mn kinh c dng sn xut gonadotropin mn kinh ca con ngi (HMG)1 l loi thuc c kh nng c con cha FSH tinh khit.
1 Human menopausal gonadotropin
189

Mc estrogen gim st c th khin bn d b cng thng, bnh trm cm v lo lng hn bi v mt estrogen nh hng n gic ng REM. Khi chng ta ngh ngi t, chng ta t c kh nng gii quyt nhng cn cng thng m bnh thng khng th lm nh hng n chng ta. Hy ch 2 du hiu hay 2 thay i then cht sau y: Kinh nguyt tht thng: Mi ngi ph n u bt u c nhng chu k kinh nguyt khng u n trc ln hnh kinh cui cng. Cc chu k kinh c th di hn hoc ngn hn vi s tng dn thi gian v kinh. Cng c nhng thay i v lng kinh, kinh nguyt t nhin tr nn nht v t hoc m v nhiu. Nhng cn nng: C 85% ph n thi k tin v gn mn kinh u c ci gi l nhng cn nng. Chng c th bt u khi nhng ln hnh kinh vn u n hoc khi bt u khng u. Nhng cn nng thng chm dt khong mt n 2 nm sau ln hnh kinh cui cng ca bn. i vi tng ph n c nhng cn nng khng ging nhau. Mt s ph n c cm gic mt v phn trn c th nng ln. Mt s 190

ph n cm thy lo lng, cng thng, chong vng hay bun nn ngay trc khi cn nng xy ra. Mt s khc cm thy t cc ngn tay hay tim p thnh thch ngay trc . Mt s ph n c nhng cn nng sut c ngy, mt s khc xy ra v m v thc dy t m m hi n mc phi thay tm tri ging hoc qun o ng. Khng ai thc s hiu c iu g gy ra nhng cn nng, nhng cc nh nghin cu tin rng n c lin quan ti cc tn hiu kt hp ca vng di i trong no b - vng no iu khin thn nhit v cc hormone gii tnh. Bnh thng khi c th qu m, vng di i gi mt tn hiu ha hc n tim lm mt du c th bng cch bm nhiu mu hn cc mch mu di da gin n, khin bn tot m hi. Tuy nhin trong thi k mn kinh, ngi ta tin rng vng di i b nhm ln v gi tn hiu lm mt vo nhng thi im sai. Cn nng khng ging nh b nng qu. Mc d nhit ca da thng tng khong 20C n 40C, nhng nhit bn trong c th li gim xung, to nn cm gic kh chu k l ny. Vy ti sao vng di i ca no li b nhm ln? l do mc estrogen b gim. Chng ta bit c iu ny v khi estrogen tng hp c 191

a ti thay th cho estrogen t nhin trong c th th nhng cn nng bin mt. Mt s nh nghin cu tin rng gim leuteinizing hormone (LH) cng l mt nhn t quan trng, v nhiu loi hormone khc na nh hng nhit c th cng ang c xem xt. Mc d nhng cn nng l v hi xt v nhng nguy c sc khe, nhng chng li gy lo lng v cng thng. Mt s ph n tri qua nhng cn nng nghim trng hn nhng ngi khc: -Nhng ph n mn kinh do phu thut -Nhng ph n gy m: khi c t m trn c th d tr ngun estrogen, cc triu chng mt estrogen s trm trng hn. -Nhng ph n khng d dng m hi, kh nng tot m hi gip dung ha nhit cc k cao ca c th. Nhng ph n c vn trong vic m hi c kh nng gp nhiu cn nng nng hn. 43. S khc nhau gia HRT vi NHRT Nhiu bn c th nghe thng tin i chng ni nhiu n liu php thay th hormone t nhin 192

(NHRT)1 - s dng n progesterone t nhin, vi liu php thay th hormone thng thng (HRT).2 S khc nhau ny ging nh dng sa m v sa bnh ca mt a tr s sinh. NHRT l phng php s dng s kt hp estrogen ca con ngi vi progesterone t nhin cng ca con ngi. Trong khi , HRT l estrogen c nh my lm ra (phn nhiu c ly t estrogen ca loi nga) v mt loi progesterone cng c nh my lm ra, gi l progestin. Hin nay, nhiu bo co v nghin cu cho thy cc triu chng mn kinh c kim sot tt hn bng NHRT do c nhng tc dng ph t hn. Cc cuc nghin cu cng cho thy nhng li ch ca HRT - bo v khi bnh tim v bnh long xng - gy n tng nhiu hn v cng b vic s dng NHRT.
C g trong NHRT?
Khi s dng phng php NHRT, bn s nhn c khong 60% - 80% estriol, 10% - 20% estrone v 10% - 20% estradiol cng nh progesterone t nhin ca c th con ngi v DHEA (dehydroepiandrosterone), mt loi androgen t nhin
1 Natural Hormone Replacement Therapy 2 Hormone Replacement Therapy
193

chuyn ha thnh testosterone t nhin trong c th (iu m tt c ph n cn duy tr ham mun tnh dc). Cn vi HRT, bn s c 75% 80% estrone, 6% - 15% equilin (mt loi estrogen ly t loi nga) v khong 5% - 19% estradiol cng nh loi progesterone c lm t nh my v i khi l nhng steroid anabolic nu bn mun thc y tnh dc. iu quan trng l ph n hot ng vi cc hormone con ngi tt hn vi nhng hormone ly t ng vt, ging nh tr s sinh dng sa m tt hn sa b. Nh bn c th thy c nhng hm lng v estrogen t nhin khc nhau, tuy nhin, bn phi mt mt thi gian mi tm ra c liu lng thch hp cho mi loi estrogen t nhin v progesterone t nhin. Bn phi lm vic vi bc s ca bn v th nghim cho n khi c c kt qu thch hp. C mt nhn xt l NHRT rt hon ho trong ln u tin bn dng, nhng nhiu ph n phi loay hoay vi vic tng gp 3 ln lng estrogen trc khi tm c mt kt hp cn i. Mt toa thuc khi u in hnh i vi NHRT l 10% estrone, 10% estradiol, 80% estriol trn ln vi khong 194

25 mg - 30 mg progesterone t nhin v 10 - 30 mg DHEA, nn (nhng khng lun vy) chuyn thnh lng testosterone cn thit. (Nu n khng chuyn i, bn cn phi thm mt steroid cho vic trn ln cc hormone t nhin nu ham mun tnh dc ca bn xung rt thp nh cp trc y.)
Phi tm NHRT u?
Tt c cc sch bo v liu php thay th hormone t nhin u lm cho bn ngh sai l NHRT c sn mi ni. Khng phi vy. Bn khng th c i vo mt ca hng bn thc n tt cho sc khe v mua estrogen hay progesterone t nhin c. Chng cn phi c bc s k toa. Mt dc s phi c o to chun b mt toa thuc NHRT t nhng thnh phn c k. Ngi ny c gi l dc s pha ch. Khng phi tt c cc nh thuc u l nhng nh thuc pha ch, v vy hy hi bc s ca bn hay dc s ca bn v ni ly toa thuc c k ra. 44. Li ch ca liu php thay th hormone Cho d bn chn hormone t nhin hay tng hp, cc phng php ny u l liu php phng 195

nga bnh v cha lnh cc triu chng mn kinh. Cc hormone ny nhm thay th estrogen b mt sau khi mn kinh v v vy ngn cn hay xoay ngc li cc hu qu lu di ca vic mt estrogen nh bnh tim, bnh long xng, nhng thay i v da, m o mng v kh, v nhng bnh tt khc. (N)HRT cng nhm iu tr cc triu chng mn kinh ngn hn nh nhng cn nng v kh m o. V vy, bn phi chn la s dng (N)HRT hoc theo liu php ngn hn hoc theo liu php di hn. Tuy nhin cng c mt s ri ro c lin quan n HRT v ERT m bn s cn phi cn nhc vi nhng li ch c c.
Nhng li ch cho tim
Ngoi vic bo v xng v gn gi cc c quan sinh sn, estrogen cn gip duy tr mc lipoprotein c t trng cao thch hp (HDL), gip cc ng mch thanh tr ba rng ngn khng cho chng ng cc v gy ra nhng cn au tim v nhng cn t qy. Bng cch nng cao mc HDL cn gi l cholesterol c li, mc cholesterol c hi s c gim thp. Estrogen cng gip 196

bo v chng ta khi bnh vim khp mn tnh tng dn. Tt nhin chnh bung trng l ni to ra estrogen, nhng estrogen cn c t nhng ngun khc nh trong androsterdione (mt loi hormone) v testosterone c cc m chuyn thnh mt dng ca estrogen gi l estrone, l dng estrogen yu hn loi bung trng sn sinh ra. Ph n b bo ph c lng estrone rt ln. Mc d c th ngn chn cc triu chng mn kinh trm trng nhng estrone khng c coi l dng estrogen c kh nng bo v chng li bnh long xng hay bnh tim. Ngy nay, tt c nhng ph n tri qua thi k mn kinh mt cch t nhin v l nhng ngi quyt nh s dng (N)HRT s c cung cp estrogen v progesterone. Tt nhin, progesterone lm cho nim mc t cung rng u n, ngn chn nguy c b ung th mng trong d con lin quan vi liu php thay th estrogen - ch c estrogen v khng c progesterone, l phng php trc y c dng cho ph n. Estrogen kt hp progesterone cn nhi theo c ch ca chu k kinh nguyt bnh thng v gip ngn nga cc tc dng ph thng c khi dng ring 197

estrogen. (Nu bn ct b t cung, bn khng cn progesterone v d con ca bn mt nn bn khng c nguy c b ung th d con.)
Nhng g mong i trong thi gian ngn
Ni chung, (N)HRT s bt u lm du cc triu chng mn kinh mt estrogen trong vng nhng ngy bt u tr liu. Nhng cn nng ca bn s bin mt, m o s tr li m t v s tit cht nhn trong khi quan h tnh dc, v mi trng c acid ca m o s c phc hi bo v khi b nm v cc nhim trng m o khc gy kh chu cho bn. Tuy nhin, nu thay i nh v khng dng tr liu na, cc triu chng ca bn s quay tr li vi dng nng hn nhiu. Nhng li ch cho tim c thy cng vi estrogen ch xut hin nu estrogen c ung bng ming, khng phi bng nhng ming dn hay kem bi m o. estrogen pht huy tc dng vi HDL, n cn phi c chuyn ha trong gan. Tuy nhin, estrogen s khng lm thay i c hu qu ca mt ch n ung ngho nn v cch sng khng hp l. Nu bn ht thuc, 198

ung ru qu nhiu s phi gp rt nhiu cng thng hay n nhiu lng thc n khng ng (bn bit l nhng thc n no ri), th ng mong ch nh vo estrogen lm ro cn cho bn trnh c bnh tim. 45. Cch dng HRT hay ERT thng thng Bi v c nhiu ph n quyt nh chn liu php thay th hormone (HRT) c lm t nh my, nn vic hiu bit cch dng n rt quan trng. Sn phm estrogen thng thng nht c gi l Premarin. Premarin s dng qu trnh tng hp cc estrogen khc nhau c ly t nc tiu ca nhng con nga ang mang thai nhm to ra estrogen ging theo t nhin mt cch chnh xc hn. Premarin l vit tt t pregnant mares urine (nc tiu ca nga ang mang thai). Premarin l tn thng phm ca loi estrogen thay th ny v xut hin di dng thuc vin, ming dn v kem bi m o. Cc dng tng hp thng gp khc ca estrogen bao gm estradiol c vi m ha, ethinyl estrogen, estrrified estrogen v quinestrol estrogen. 199

i vi vic tr liu ngn hn, bn c th ch cn kem dng bi m o nhm gip cha kh m o hay nhng vn ca bng quang. i vi vic tr liu di hn, bn s cn thuc dng vin nu bn mun bo v chnh bn khi bnh tim. Cc thuc Premarine c rt nhiu nhn hiu khc nhau, cht lng nh nhau. Estrogen cng c th c mang trn ngi. N c t trong mt ming dn bng nha do nh nh mt ng xu, dn ln vng bng, i hay mng v thay i mi tun 2 ln. Khi estrogen dng ming dn hay dng kem, n i trc tip vo ng mu, khng qua gan v v vy khng lm nh hng HDL hoc bo v chng li bnh tim. Mt s ph n cng b d ng vi ming dn trn da v ni mn . Nu bn ri vo trng hp ny th hy th dng estrogen cc dng khc.
Progesterone
Progestin tng hp (mt nhm cc thuc progesterone, bao gm c progesterone t nhin) l norethindrone hay norethindrone acetate. Progestin t nhin l medroxyprogesterone. 200

Progestin c dng dng thuc vin, ring bit vi estrogen. Khi dng estrogen v progestin cng nhau tc l bn ang s dng liu php thay th hormone. Liu php ny c th c iu hnh bng 2 cch: theo chu k hoc lin tc. Dng theo chu k rt ging vi thuc ung trnh thai, bi v cc hormone hot ng rt gn ging theo chu k t nhin. Ngy u tin bn dng thuc c coi l ngy th nht ca chu k gi. Bn dng estrogen t ngy 1 n ngy 25, ri thm progesterone t ngy 14 n ngy 25. Ri bn ngng ung thuc v ra mu trong 2 hoc 3 ngy - cng ging nh khi bn s dng kt hp cc vin ung trnh thai. Vic chy mu m o ny c gi l chy mu thu hi. N c mu nht hn, t hn lng kinh nguyt bnh thng v ch ko di 2 hoc 3 ngy - ging nh mt giai on kt hp ung thuc trnh thai. Thc t, nu chy mu nhiu v ko di, iu ny cnh bo mt iu g khng hay v bn phi nn i khm. Ngoi ra, bn c th b chy mu nhiu - xut hin trong 3 tun u tin sau khi bn bt u dng HRT. Loi hnh chy mu ny cng tng 201

t vi nhng g xy ra v khi kt hp ung thuc trnh thai. N thng bin mt sau mt vi thng nhng bn nn bo co chuyn . Bn cn phi iu chnh lng estrogen thp hn hoc dng lng progestin cao hn. Mt khi giai on ngn ca vic chy mu thu hi kt thc, bn li bt u li mt chu k khc. Nhiu ph n khng th chu ng c HRT theo chu k bi v h mun dt b kinh nguyt v khng phi dng n nhng ming m v bng v sinh na. Tuy nhin, ngi ta tin rng HRT theo chu k bo v tim tt hn. Khi HRT c dng lin tc, bn ch cn dng mt vin estrogen v mt vin progestin mi ngy. Khi bn thc hin theo cch ny, progesterone s lm gim tc dng ca estrogen, nim mc t cung s khng c hnh thnh v vy khng c xy ra chy mu thu hi.
Liu dng ph hp
Mi ph n c liu dng estrogen v progestin khc nhau. Ban u bn s lun lun phi dng liu thp nht c th c cho 1 trong 2 loi , liu dng c th tng dn ln nu cn thit. 202

Nu liu dng estrogen qu cao, bn s gp phi nhng tc dng ph ging nh thy estrogen khi ung thuc trnh thai: au u, sng ph v vn vn. Trc khi quyt nh cn bao nhiu estrogen, iu quan trng trc tin l phi nh gi xem c th bn hin vn cn sn sinh ra bao nhiu estrogen. iu ny thc s ph thuc vo cn nng ca bn, cc triu chng mn kinh v hng trm chuyn khc.
Estrogen
Vin estrogen thng c cc dng 0,3 mg, 0,625 mg, 0,9 mg hoc 1,25 mg. Liu dng cng ty thuc vo l do bn dng estrogen. i vi nhng ph n c nguy c b long xng cao, liu dng ban u thng thng nht l 0,625 mg. Nhng i vi nhng ph n ch mun gim cc triu chng mn kinh ngn hn nh nhng cn nng, th thng thng hn l bt u dng khong 0,3 mg. Nu qun dng thuc vin estrogen 1 ngy, ng lo lng. Bn khng cn phi ung gp i ging nh thuc trnh thai. Tuy nhin quan trng l mt khi bt u dng estrogen, bn phi 203

tip tc dng hng ngy khng ngh (v d nh ngh ung nhiu hn 2 ngy). Cc cuc nghin cu cho thy khi ngng dng estrogen, bn c th phi chu ng nhng cn nng v mt ng trm trng hn rt nhiu so vi trc khi dng thuc. Thay v ung estrogen nu bn dng kem estrogen bi m o, th bn c th dng kem trong khong 3 tun lin tc v 1 tun ngh. Nhng ph n quyt nh chn kem bi m o quyt nh estrogen nhm gim kh m o v mng m o trong mt thi gian ngn cng nh mt kh nng kim sot vic tiu tin, cc vn sau mn kinh khc na c tho lun di y. Tuy nhin, kem m o khng gim nhng cn nng hay bo v khi bnh long xng hay bnh tim. S dng kem bi m o theo cch khng thng xuyn, ging nh dng du nhn, s khng c ch g c. Mt ln na, mi ph n u khc nhau, cng nh mi nhn hiu thuc u khc nhau v c cn lng liu dng khc nhau. Hy nh l phi bn bc vi bc s hay dc s ca bn v vic s dng bao nhiu estrogen cho mi ln. 204

Cc ming dn trn da cha 4 mg hoc 8 mg estrogen. Ming dn 4 mg cung cp 0,5 mg estrogen mi ngy, ming dn 8 mg cho lng gp i. Mt s bc s khuyn bn dng ming dn trong 3 tun ri ngh 1 tun trc khi bt u dng li. Hin nhin, bn cn phi tho lun iu ny vi bc s ca bn v quyt nh xem th no l ph hp cho bn. Li na, nhng ph n dng ming dn s khng c c li ch no cho tim nhng li c bo v khi b long xng v cc triu chng mn kinh. Thc ra, ming dn cung cp lng estrogen lin tc hn nhiu so vi thuc vin ung, bi v xt v liu dng khng c dao ng. i vi thuc vin, khng th no gi tuyt i chnh xc thi im ung thuc, v c nhng s st tt nhin.
Androgen
Cc phng php ERT hay HRT i khi dng n androgen, loi hormone nam tnh. Cc bc s k toa c androgen lm tng ham mun tnh dc nu bn gp phi nhng rc ri v vic ny. iu ny c th ph hp nhng quan trng l bn phi hiu bit v loi thuc ang dng. Nu liu 205

dng androgen qu cao, bn c th pht trin cc c tnh ca nam gii nh mc nhiu lng trn c th, ging ni trm hn v 2 bu v teo li. Nhng triu chng ny khng mt i ngay khi bn ngng dng androgen. Mt s nghin cu cng cho thy androgen c thm vo c th c nhng tc dng tiu cc ln cholesterol mu lm tng nguy c bnh tim ln tht s. iu ny c th l gii ti sao n ng ung estrogen li khng c c nhng ch li cho HDL. 46. Tc dng ph ca HRT thng thng Nu bn ang dng progestin theo chu k cng vi estrogen bi v bn vn cn d con, th vic chy mu khng phi l mt tc dng ph. Ton b vn thm progestin cho estrogen ca bn l nhm gy ra chy mu thu hi v cho php nim mc d con rng hng ngy. Nu bn ang dng progestin lin tc cng vi estrogen, th vic chy mu l bt thng v cn phi xem xt. Tc dng ph thng thng ca estrogen l gi nc, bi v estrogen lm gim lng mui v lng nc ca thn bi tit ra khi chng c 206

gi li trong c th, cng chn, bu v v bn chn sng ph ln. Bi v gi nc nn c th bn nng hn nhiu. Nn i l mt tc dng ph khc na, cng c thy cng vi cc loi thuc trnh thai. Nn i xy ra trong 2 hoc 3 thng u tin dng thuc v t bin mt. Mt s ph n thy rng ung thuc vin vo ban m s lm gim nn i. Gim liu lng cng l mt s la chn tt. Mt s tc dng ph khc c ghi nhn bao gm au u, mu da thay i trn khun mt, gi l melasma (ging nh trong thi k thai nghn), tit cht nhy c t cung nhiu, 2 bu v tit dch lng, thay i ng cong ca gic mc, bnh vng da, mt tc trn da u v nga ngy. Nhng tc dng ph ny khc nhau v ty thuc vo nhn hiu thuc bn ang dng, liu lng, bnh s ca bn v vn vn. Nhiu ph n hon ton khng gp phi nhng tc dng ph. Cui cng, mt tc dng ph khng quan trng m estrogen sinh ra l thiu vitamin B6 nh c thy vi vic s dng thuc ung trnh thai. Cc triu chng thiu ht ny rt m h v 207

gm c mt mi, bnh trm cm, mt tp trung, mt hng khi tnh dc v mt ng. Nhng vn ny d dng cha khi bng cch b sung vitamin B6. 47. Khi no khng nn dng HRT thng thng HRT hay ERT thng thng khng phi dnh cho mi ngi. Mt s ph n dng tt hn mt s khc. Sau y l bng hng dn c th gip bn quyt nh: Bn c nm trong nhm ngi c nguy c cao b nhng cn suy tim hoc t qy khng? Nu vy, ERT hoc HRT s h thp nguy c ca bn. Bn c ang nm trong danh sch c nguy c cao b bnh ung th nim mc trong d con khng? Nu vy dng progestin gy ra chy mu thu hi s lm gim nguy c ca bn. Bn c nm trong nhm ngi s b bnh long xng khng? ERT hoc HRT s gim ri ro cho bn. Bn c tin s b bnh ung th v khng? Bn khng nn dng ERT hoc HRT nu c tin s b 208

ung th v. Bn tng bao gi b t qy khng? ERT hoc HRT u khng c dng. Bn c b ri lon s ng mu khng? Khng c dng ERT hay HRT. Bn c b chy mu m o cha c chn on? Khng nn dng bt k mt liu php no. Bn c b ri lon chc nng gan khng? Bn c th s dng ming p estrogen hoc kem bi m o lm gim cc triu chng mn kinh nhng khng nn ung bt k loi thuc vin no. Bn nn suy ngh k v HRT hay ERT nu gp phi bt k nhng ri lon sau y: Bnh hng huyt cu hnh li lim. Bnh cao huyt p. Chng au na u. U x t cung. C tin s b nhng bnh v v lnh tnh nh cc ti nang hoc fibroadenonas. Bnh mng trong d con. 209

ng kinh. Bnh ti mt. C tin s gia nh b ung th v. C tin s ht thuc l hoc ang ht thuc l. Sau y im qua s lc tt c cc li ch ca HRT: Gim mt xng trong v sau khi mn kinh. Gim cc triu chng mn kinh. Gim nguy c bnh tim xung 40% - 50% (cc li ch t r rng khi progesterone c cng vi estrogen, mt s cuc nghin cu cho bit iu ny thm ch cn c th loi b kh nng bo v chng li bnh tim). Gim lm mng cc m m o v nhng kh chu c lin quan. V sau y l im qua s lc cc ri ro ca HRT: Khng chc chn hiu qu vi tt c mi ph n. C th lm tng cao mc cholesterol. 210

C tc dng ph nh b bnh trm cm v lo lng. C th tng nguy c ri ro ln nhng ph n c nguy c cao b bnh ung th v hoc c tin s b nhng ri lon ng mu nng. 48. Cn nhc vic s dng Phytoestrogen Nu bn khng thy thoi mi vi tng dng liu php thay th hormone th c th xem xt n nhng li ch tr liu ca phytoestrogen l cc estrogen thc vt. Rt nhiu ph n ang iu tr cc triu chng mn kinh bng nhng vin thuc nhng tho dc c sy kh thnh bt nh cam tho, ngu bng, khoai lang di, cy mu b v dong quai (Angelica sinensis). Cc tho dc ny c cha nhiu cht ha hc bao gm nhng cht estrogen. Mc d phytoestrogen c dng chu hng th k nay iu tr nhng cn nng th chng ch mi c bit n phng Ty. Cuc iu tr th nghim c kim sot u tin bt u vo nm 1996 ti Trung tm Y khoa Columbia-Presbyterian New York. 211

Nhiu ngun thc n nh u ph v cc loi thc phm lm t u nnh khc c cha hm lng phytoestrogen cao. Cc nh khoa hc tin rng iu ny c th l gii cho t l thp cc triu chng mn kinh ng kinh ngc Nht, l nc c ch n c nhiu u ph. Mc phytoestrogen trong mu ph n Nht cao hn cc ph n phng Ty t 10 n 40 ln, v nhng cn nng xut hin ph n Nht thng ch bng khong mt phn ba so vi ph n phng Ty. Thm ch hu ht nhng ngi n chay cng khng tiu th u nnh gn bng mc trung bnh ca ngi ph n Nht. Th v hn l cc hormone thc vt khng ch gip ngn nga cc triu chng mn kinh m cn c th bo v bn khi b ung th v. T l b ung th v Nht Bn gim ng k hn so vi Hoa K. Tuy nhin c th c nhng nhn t khc tham gia vo nh cc tp qun nui con v ch n t bo. Sau khi mn kinh, cc ch n c cht bo cao c th lm tng nguy c suy tim v t qy cho bn - cho d bn c ung bao nhiu estrogen i na. ng thi, cc thi quen xu nh ung qu nhiu c ph, ru v ht thuc l 212

c th lm tng nguy c bnh long xng. Hin nay, a s cc bc s s khuyn bn c n cng nhiu u nnh cng tt. iu c th rt c li, v tt nhin l hon ton v hi! Phytoestrogen c th ung hoc dng dng kem bi ln c th. Tuy nhin, dng kem gn nh l t nhin v cc hormone thc vt ca chng c thay i trong phng th nghim. Bi v cc hormone gc thc vt c cha nhng cht ha hc tng t nhng khng ging vi estrogen t nhin ca bn, nn vic s dng chng vn cn t ra nhiu nghi vn. 49. Tm Phytoestrogen u? Sau y l mt s phytoestrogen bn c th mua cc ca hng bn thc n tt cho sc khe. Mt ln na, nhng loi ny s gip bn rt nhiu trong vic cha tr nhng kh chu ca thi k mn kinh v c th bo v bn khi b bnh tim: Cy tha (Agave americana): mi liu dng l n 1 mung c ph hoc 1 n 5 ml nc p ca cc ngn l. 213

C linh lng (Medicago sativa) Amerikanerischer schneeball hoc schneeball Cohosh en (Cimicifuga racemosa) Cy l chua en Cy to en (Viburmem pnenifolium) hay cy Viorne obier (V. opulis) Bockshornklee Casses (Ribes nigrum) Cy trinh n (Vitexagnus castus) V cy hoc hoa t cu Cy b cng anh (Taraxacum officinale) Devils club (Chanalirium luteum) Dong Quai/Dang Gui (Angelica sinensis) Fenugreek (Trigonella foenungraecum) Rt tt cho nhng cn nng Cy x thm (Salvia officinalis) Rt tt cho vic cha chng m hi m. Gemeines kneuzkraut Nhn sm (Panax ginseng) Cy cc bc (Senluo vulgaris) 214

Cy hoa bia (Humulus lupulus) Hopfen Cy cam tho (Glycyrrbiza glabra) Lu : Cy ny vi liu dng cao c th c, gy cao huyt p v nc. R cy sng i (Senecio aureus) Lowenzahn Cy mu b (Leonurus cardiaca) Rt tt cho vic cha chng m hi m. Cy tm ma (Urtica dioica hoc U. Urens) Cy mu n (Paeomia officinalis) thng c kt hp vi Dong Quai/Dang Gui. Cy lu (Punica granatum). Trong 85 gram ht tri cy ny cha 1,7g estrone, ch cn n lun ht thay v nh chng ra khi n tri lu, hoc xay nhuyn trong my xay, hoc nghin nh ri tm vo du t lm thnh kem estrogen. Cy 3 l mu (Trifolium pratense) Nhng cy h hoa hng (qu mm xi, du ty, cy to gai, hoa hng ch, hoa hng di) Cy th phc linh (Smilax officinalis hoc S. 215

Regelii). Loi c trng Jamaica l tt nht, tip n l loi M-hi-c v Honduras. Cy c ln hnh ca (Serenoa repers) Schlangenwurzel Schvarze hay Schnarze Johannisbeere Cy khoai lang di (Dioscorea villosa v tt c 500 loi cng h): Kem progesterone c ly t cy khoai lang di c cho bit c th lm hi phc bnh long xng. C thi (Achillea millefolium) 50. Tn dng nhng thng tin trong sch ny Bo v bn thn khng b bnh tim gm nhiu quyt nh v c mt s quyt nh rt kh a ra. i vi nhng ngi bt u khng d khi phi cn nhc cc ri ro b bnh tim vi cc nguy c ca liu php thay th hormone, c bit nu bn quan tm n bnh ung th v. Nhng nu bn mn kinh ri th cuc tho lun v bnh tim v liu php thay th hormone cn thit phi bao gm c vn nguy c bnh ung th ca bn. Bi v ung th v cc nc phng Ty ang 216

cc k cao sau khi mn kinh v mt s nghin cu cho thy HRT gp phn vo s gia tng ny (Lu : nu bn ang dng HRT v c chn on b ung th v, cc bc s ch cn ngng s dng liu php thay th hormone l s hon ton loi b c vn v a t l sng cn ca bn tr li mc bnh thng. Nhiu bi bo y hc cng ngh vic ph n ang iu tr ung th v vn c th s dng HRT. Hai liu php khng nht thit phi loi tr nhau.) Xin lu , ph n cht v bnh tim nhiu hn l ung th v, v HRT chnh xc c th h c mc cholesterol, lm gim nguy c b bnh tim v gim nguy c t vong v bnh tim. Ngoi ra, nu bn c nguy c b long xng cao (tt c chng ta u c nguy c, nhng nhng ph n tp th dc hoc c xng nng s chm pht trin bnh hn) th HRT s ngn chn s tin trin ca long xng. Trong thc t, nu c bt u ngay trong mt vi nm u sau khi mn kinh, HRT thm ch c th lm tng khi lng xng ln. Hy nh rng: Nhng ch gy nt xng hng v xng sng c th gy suy 217

yu trm trng (thng e da ti mng sng) v thc s lm nh hng xu n cuc sng. Bn cng s phi bn bc vi ngi cung cp dch v chm sc sc khe nhng thun li ca HRT thng thng v liu php thay th hormone v lm cn bng tt c nhng nhn t cng vi nhng vn sc khe mn tnh khc m bn c th c. Ri sau tt nhin tt c nhng thay i trong cch sng c a ra sm hn xem xt nh b ht thuc l, n king v tp th dc. Khi xem xt t m nhng trang sch nh ny bn s thy n gi gm rt nhiu thng tin c ly t nhiu ngun t liu. Trong tay bn gi c mt ro chn y quyn nng chng li bnh tim: nhng thng tin ng. V l nhng thng tin m nhiu bc s khng bit bi v nhng iu c dy trng y trc y mi cho n rt gn y ch yu l nhng iu v bnh tim nam gii. Hy hc hi nhng thng tin ny v chuyn cho cc thnh vin gia nh ln tui (m, b ngoi, ni hay cc d v nhng b c ca bn) cng nh cho nhng ngi h hng tr tui (con gi, chu gi ca bn, c bit nu h ht thuc l). Bng 218

cch b ht thuc l (Xem mc s 1 n s 10), iu chnh ch n (Xem mc s 11 n s 20), tp th dc (Xem mc s 21 n s 30), h huyt p v cholesterol (Xem mc s 31 n s 39), t bo v mnh khi b bnh ly lan qua ng tnh dc, bnh chlamydia (Xem mc s 40) v chn la c hiu bit hoc tr liu hormone t nhin hoc HRT thng thng, bn c th gim ng k nguy c b bnh tim cho bn. Ti hy vng rng bn s tn dng nhng thng tin tt p ny.
219
MC LC
LI GII THIU ............................................................. 5 DN NHP ................................................................... 8 Du hiu bo trc cn au tim ph n ........................ 8 B HT THUC L ..................................................... 14 1. V sao cn phi b thuc l? ..................................... 14 2. Thuc l v nhng h qu i km: bo ph ................ 16 3. Ht thuc l c th gy hi cho gia nh bn ............ 17 Thai nghn v tr s sinh.............................................. 19 4. S h tr ca cc chng trnh b thuc l ............... 20 S t vn ...................................................................... 21 Ko nicotine ................................................................. 22 Ming dn nicotine ...................................................... 22 ng ht nicotine ........................................................... 23 ng phun mi nicotine ................................................. 23 Cc liu php thay th ................................................. 24 5. S dng thuc h tr b thuc l ......................... 24 6. Hy ginh ly chin thng........................................ 27 7. V sao ph n cn b thuc l ................................... 28 8. Cng nn b ht x g .............................................. 30 9. i li cc chi ph trong vic b thuc l .................. 31 10. Li ch ca vic b thuc l .................................... 32 CH N UNG ..................................................... 34 11. Tm hiu v cht bo .............................................. 34
220
Mc lc
Nhng cht bo c hi ................................................. 36 Nhng cht bo c li .................................................. 37 12. Trnh dng cc loi cht bo ch bin.................... 38 Tc hi ca cht bo ch bin ...................................... 40 Du magarine v b ..................................................... 41 Cht bo gi to ........................................................... 42 13. Ct gim lng carbohydrate .................................. 45 14. Tm hiu v ng.................................................. 46 ng c b sung khi ch bin thc phm ................ 49 Cc cht lm ngt ........................................................ 50 Cc loi cn c ng .................................................. 54 15. Hiu ng cc nhn thc phm .............................. 55 t hn v nhiu hn ...................................................... 58 Khng c ng ........................................................... 60 16. Tm hiu v cht x ................................................ 61 Cht x ha tan vi cht x khng ha tan .................... 61 17. Nhng nguyn nhn tm l lm tng cn ................ 63 Ti sao chng ta thch cht bo .................................... 70 nh hng ca nhng sn phm c bo thp ........... 71 18. Hy ngng n king theo thi quen ......................... 77 Cc nguyn nhn sinh hc ca bnh bo ph ................ 84 Thuc iu tr bnh bo ph ......................................... 89 Nhng ri lon n ung ................................................ 92 12 bc ca ngi tham n v danh. ....................... 102 19. Nhng mo vt gip gim cn nhanh.................... 104
221

20. Hy chn mt vi loi cy c tt cho tim .............. 106 B tim ........................................................................ 107 Lm an thn tim ......................................................... 109 Cc loi cy c lm long mu ................................... 109 RN LUYN TH LC ............................................... 111 21. ngha thc s ca vic rn luyn th lc ............ 111 22. Tm hiu Aerobic l g?......................................... 112 Ti sao chng ta cn nhiu oxygen hn? ..................... 113 t chy cht bo ...................................................... 114 nh ngha v Aerobic ca phng Ty ...................... 115 Tm mch ca bn ..................................................... 116 23. S dng thang im Borg ...................................... 116 24. Nhng phng thc khc lm tng lng oxygen ... 117 25. Hy bt u sng nng ng thay v dng aerobic . 118 26. Bt u cc hot ng tp t ................................. 119 Hot ng gip hnh thnh khi xng ....................... 122 27. Trnh tp luyn qu sc........................................ 123 28. S khi u chm ................................................. 124 Chun b cho mt np sng vn ng ......................... 126 29. Hy chn mt mn th thao ................................. 128 30. Hy th mt s cch khc nhau trong khi chy b . 129 Cc bui luyn tp di nc ...................................... 130 Th su ...................................................................... 131 CC NHN T RI RO KHC ................................... 131 31. Bn c b bnh i tho ng loi 2 khng? ........ 131
222
Mc lc
Dung np glucose km (IGT) ..................................... 132 Cc du hiu v triu chng ....................................... 133 Kim sot ng mu ca bn .................................... 135 Nhng k hoch cho ba n ....................................... 136 32. Cao huyt p c ngha l g? ................................. 139 Vai tr ca s cng thng ............................................ 142 Nhng cng thng tch cc ......................................... 144 Nhng cng thng tiu cc ......................................... 145 i ph vi tm trng cng thng ............................... 146 Tm mt ngi t vn hay tr liu stress tt................... 151 Hy c mt cuc kim nh ........................................ 153 33. Lm h huyt p m khng dng thuc ................. 154 Cc loi cy c lm h huyt p ................................. 155 34. Thuc lm gim huyt p ..................................... 156 35. Hy cnh gic v mc cholesterol cao .................. 158 36. Cc hng dn iu chnh mc cholesterol .......... 161 37. Lm gim cholesterol m khng dng thuc .......... 162 38. Hy ung mt t ru vang .................................... 163 39. Cc loi thuc lm gim cholesterol ...................... 165 40. Quan h tnh dc an ton ..................................... 169 im qua v quan h tnh dc an ton ....................... 173 Quan h tnh dc an ton nht l g? .......................... 180 LIU PHP THAY TH HORMONE ........................... 183 41. Quan h gia thi k mn kinh v bnh tim .......... 183 42. Nn bit khi no bn mn kinh ............................ 185
223

Chn on tin mn kinh hay gn mn kinh ............ 187 Cc du hiu mn kinh t nhin ................................. 189 43. S khc nhau gia HRT vi NHRT ........................ 192 C g trong NHRT? ..................................................... 193 Phi tm NHRT u? ................................................ 195 44. Li ch ca liu php thay th hormone ................ 196 Nhng li ch cho tim................................................. 196 Nhng g mong i trong thi gian ngn ..................... 198 45. Cch dng HRT hay ERT thng thng ................. 199 Progesterone .............................................................. 201 Liu dng ph hp...................................................... 203 Estrogen..................................................................... 203 Androgen ................................................................... 206 46. Tc dng ph ca HRT thng thng .................... 206 47. Khi no khng nn dng HRT thng thng .......... 208 48. Cn nhc vic s dng Phytoestrogen ................... 211 49. Tm Phytoestrogen u? ..................................... 213 50. Tn dng nhng thng tin trong sch ny .............. 216
224

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PHNG CHNG BNH TIM PH N

Tc gi: M. SARA ROSENTHAL

BS. V MINH C - BS. NGUYN BNH MINH

PHNG CHNG BNH TIM PH N

NH XUT BN TNG HP THNH PH H CH MINH

Phng chng bnh tim ph n

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B HT THUC L 1. V sao cn phi b thuc l?

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3. Ht thuc l c th gy hi cho gia nh bn

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