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Updated questionnaire for patients with metabolic syndrome (MS): diabetes mellitus (DM) and hypertension (SAH)

Parisi, GA; Neto, SGB; Barros, CL


Dr . Gabriel Adriano Parisi 11948137465
Pesquisador UFG Sodré GB Neto 62991683230 cancerlinfocito@gmail.com
Nutricionista Cristhiane Barros Lima 11997726269 cristianebarroslima@hotmail.com

 

Summary:  Several findings related to diabetes and hypertension are described in the literature as metabolic syndrome (MS)  ^[1]  that should be exposed to health professionals in emergencies due to the high mortality rate  ^{[2]  [3 ]. [4]}  . Several questionnaires  ^{[5]  [6]  [7]  [8]  [9]}They are made by citing some concerns in relation to diabetes and hypertension, in this new questionnaire that we propose, we insert questions related to new discoveries of evidence of what should be avoided, done, ingested and practiced, patients with DM and SAH; In this review study of some findings, we add some relevant questions that reflect some scientific updates that we consider urgent and strategic for the best approach, efficiency and follow-up. We hope that more studies will be carried out to enrich the ways of treating and accompanying these patients who represent the most prevalent diseases in the world.

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Keywords:  HyperDia, hypertension, renal, HSA, diabetes, insulin, probiotics, NTCD, comorbidities, family health, diabetes mellitus, systemic arterial hypertension, genetic entropy, quality control, mass spectrometry, nutritionist, physiotherapy, captopril, kidney complications , social networks of health, colostrum, nutraceuticals, municipality of Barueri, international federation of diabetes, SUS, federal government, HiperDia program, MS, genetic entropy, microbiome, microbiota, intestinal flora, alkaline water, blood acidity, internal heat, cellular metabolism Acid, aconite, Krebs cycle.

 

Introduction

For decades, a high relationship has been observed between diabetes, hypertension, kidney disease, sleep, exercise, stroke, ischemia, heart disease and microbiome. In people with diabetes, poor quality sleep (which may also be due to lack of exercise) we see that they may develop increased insulin resistance, which increases aspects of hypertension, strokes  ^[10]  [11]  and renal disease. Exercise, use of alkaline water, use of sleeping supplements such as melatonin  ^[12]  and probiotics that play an important role in the gut-microbiota-brain axis  ^[  13]With the use of more modern medicines, we observe that they should be more available or at least informed and indicated on the public network, and pay more attention to the dietary part of the program, as evidenced by clinical research published in the most recent scientific publications, as well as recommending strategies, guidelines and how to use and distinguish the cheapest sources that meet these new approaches and as many people as possible  ^[14]  [15]

In order to improve efficiency in the care of patients with MS, the Hiperdia SUS (Single Health System) program was created, which despite treating diabetic and hypertensive patients throughout Brazil, but we observe problems and solutions related to Low adherence to the program that serves HSA and DM in Brazil (HyperDia) are mainly related to physical activities, as well as the lack of information on important elements for the treatment of the disease, which consequently generates results that could be improved if there would be greater synchronization with scientific updates.

We have gathered some recent research that points to the need to update and introduce new methods, including concerns with several elements related to previous research, such as 1) herbal supplements and medications to meet the challenges on how to improve sleep quality; 2) herbal medications that help encourage more exercise; 3) verification and information or availability of more modern medicines  ^[16]and more suitable; 4) new and / or millenary methods of complementary medicine, especially for 5) renal complications, which in most cases prove to be the link between the two diseases; 6) use of probiotics 7) use of alkaline water; 8) anti-inflammatory foods such as turmeric, oregano and 9) economic methods of how to make alkaline water at home, to decrease the acidity in the pH of the blood by increasing its stability, such as the buffer electrolyte, to withstand sugars and other acids not metabolized, 10) strategies for a good renal function that avoids the increase in pressure in this way, and 11) the use of colostrum as a multifaceted agent in the intestinal and immunological aspects.

QUESTIONÁRIO PARA PACIENTES COIM SÍNDROME METABÓLICA QUE REÚNE DIABETES E HIPERTENSÃO

1) Quais medicamentos, suplementos e fitoterápicos, para poder cumprir desafios de como melhorar a qualidade do sono você tem usado

2) Quais fitoterápicos, suplementos, ou psicotrópicos, tem usado para ajudar a promover ânimo para mais exercícios; sexo e trabalho?

3) Quais os medicamentos mais modernos[16] e mais adequados; você conhece , qual tabela de medicamentos e suas ações você ou seu profissional lhe explicou que servem como opção melhor ou pior para seu caso?

4) Quais métodos novos e/ou milenares da medicina complementar, fisioterápicos , estilo de vida, terapias, você tem usado para ajudar no controle da SM (sindrome metabólica) quando inclui diabetes e hipertensão.

5) Como tem resolvido suas complicações renais, que demonstram ser na maioria dos casos, o elo entre as duas enfermidades? Usa quais medicamentos, quais fitoterápicos conhece?

6) Faz uso de probióticos ? Quais ? Como é seu coco na escala de bristol? Sabe distinguir quando o coco está saudável tanto em humanos quanto em animais (para caso faça uso de probióticos animais)? Tem sujado seu papel higiêncico quando limpa ou tem ele saído limpo?

7) Faz uso da água alcalina; O que tem colocado no filtro de sua casa ou na bombona de 20 litros para alcalinizar sua água? Quanto dura sua digestão, mastiga bem, usa casca de limão quando come coisas muito gordurosas , e você tem tomado água alcalina no intervalo de quanto tempo das mesmas? Conhece métodos baratos de como fabricar água alcalina em casa, para diminuir a acidez no PH sanguínio aumentando sua estabilidade, como eletrólito tampão, para suportar açúcares e outros ácidos não metabolizados?

8) Quais alimentos anti-inflamatórios como alho , curcuma, orégano, cebolinha, brócolis e crus tem usado? Com que frequência?

9) Faz uso de colostro como agente multifacetário nos aspectos intestinais e imunológicosprincipalmente se você estiver vivendo longe da cidade onde nasceu? Sabe onde adquirir ? Já usou suplementos bovinos de fatores de transferência ?

10) Uso de leites de camelo antidiabéticos.

 

QUESTIONNAIRE FOR PATIENTS WITH METABOLIC SYNDROME MEETING OF DIABETES AND HYPERTENSION

1)  What medications,  supplements and medicinal herbs meet the challenges on how to improve the quality of sleep  you have been using?

a) Melatonin a) Diazepan b) Passion fruit b) Lexotan  c) Valerian d) Canadibiol e) Hemp oil

2)  What  medicinal herbs,  supplements or psychotropic have you used to help  encourage more exercise? sex and work?

a) Ginseng b) Tribulus terrestrial c) Marapuana d) St. John's wort  e) Dog knot  f) Peruvian garbage g) Licorice

3)  What are the  most modern  and appropriate medications  [16] ; Do you know which medication program and its actions have explained to you or your health professional that they are the best or the worst option for you?

a)  b)

4)  What  new and / or ancient methods of complementary medicine,  physiotherapy, lifestyle, therapies have you been using to help control MS (metabolic syndrome) when it includes diabetes and hypertension?

a) Moringa Olifera b) Cow's foot c) Picão Preto d) Jambolão e)

5)  How were your kidney complications resolved  , which in most cases prove to be the link between the two diseases? What medications do you use, what medicinal herbs do you know?

a) Juice or parsley tea b) Chicken hen c) Whipped egg shell washed with a very fine cloth at breakfast d) Dry avocado leaf tea e) Peanut  tea f) Monkey ladder tea g) Water with lemon for breakfast (  h) Magnesium chloride

6)  Do  you use probiotics? Which? How is your coconut on the Bristol scale? Can you tell when coconut is healthy in both humans and animals (if you use animal probiotics)? Does the toilet paper get dirty when it is cleaned or is it clean?

a) Kefir b) Bacterial pool  c) Simbioflora  d) Floratil  e) Cow manure with healthy manure controlled by the veterinarian  f) Yakult g) Activia h)

7)  Make  use of alkaline water; What have you put in your home filter or in a 20 liter can to alkalize your water? How long does your digestion last, chew well, use lemon peel when you eat very fatty things and have been drinking alkaline water for how long? Do you know economic methods on how to make alkaline water at home to decrease the acidity in the pH of the blood and increase its stability, such as the buffer electrolyte, to resist sugars and other non-metabolized acids?

a) Use 100 g of bicarbonate for 20 liters b) Use 100 g of magnesium chloride for 20 liters c)

8)  What  anti-inflammatory foods such as  garlic,  turmeric, oregano,  chives, broccoli and  raw foods  have you used? How often?

a) Do you use garlic that is not only anti-inflammatory but also anti-diabetic? b)

9)  Do you  use colostrum as a multifaceted agent in intestinal and immunological aspects,  especially if you live far from your hometown? Do you know where to buy? Have you ever used meat transfer factor supplements?

a) Do you know cheese makers?  b) Do you have access to milk producers, cooperatives or milk trucks? C)

1  0  )  Use of antidiabetic milk of camels.

 

 

These highlights added to the Self-Care Activities Questionnaire (SDSCA) are aimed at improving the results in the quality of life of patients, which in itself would significantly increase adherence to the Hyperdia program, which has had a low adherence rate ( except for receipts and high but insufficient medication expenses). To this end, we gathered the application of these updates in a new questionnaire and proposed that it be made to the patients, which contains the conclusions and notes that we propose in this literature review study.

Hyperdia

About 40% of early retirements in Brazil had DM and SAH  ^[17]  . In 2011, 16.8 million Brazilians with hypertension and 7.7 million registered in the Unified Health System (SUS) were estimated. As for diabetes, of 5 million, only 2.6 million  ^[18]  . Globally, "global health spending for people with diabetes was estimated at $ 850 billion in 2017"  ^[19]  . High blood pressure and diabetes mellitus have alarming numbers  , such  as SH "The number of adults with high blood pressure increased from 594 million in 1975 to 1.33 billion in 2015  ".

These diseases require changes in diet, use of probiotics, extreme kidney care  ^[20]  , correct medication intake, good sleep quality, exercise, stress reduction, indicating the urgent need for a change in the style of life  ^[21]  without which, studies point to the increase in fatal comorbidities.

Due to the association between diabetes and hypertension  ^{[22]  [23]  [24]  [25]  [  26]  [27]}  in response to this great demand, the Brazilian Ministry of Health has created the HiperDia program that serves more than 15 Millions of Brazilians  ^{[28]  [29]  [30]}  control, donate medications, encourage and recommend important measures to reduce symptoms and improve the quality of life of patients.

The Jardim Tupã unit in Barueri-SP was inaugurated in 2018 with good structure and functionality in the care of some specialties such as gynecology, psychiatry, pediatrics, infectious diseases, physiotherapy, nursing care, laboratory collection room, pharmacy for supplies. , immediate attention and attention in some emergencies, and strong support for the care of patients of the hyperdia program, although we notice in the treatment of patients with these chronic diseases, there is a lack of submission to the hyperdia program probably among other causes, due to to the lack of expressive and convincing results, and other causes, such as the lack of greater support for exercise, good sleep, good digestion, nutritional advice, supplements, probiotics, complementary herbal medications,

 

Diabetes Mellitus (DM)

"Brazil is the fourth country with the highest number of diabetics in the world, according to the International Diabetes Federation (IDF). 12.5 million (7%) of Brazilians affected, according to the Ministry of Health. According to the WHO (World Organization The number of people with diabetes in the world increased from 108 million in 1980 to 422 million in 2014, and it was estimated that in 2017 we would have 451 million people (18 to 99 years old) with diabetes worldwide. 5 million deaths worldwide were attributed to diabetes in the age group of 20 to 99. Global health spending for people with diabetes was estimated at $ 850 billion in 2017 "  ^[31]  .

Regarding the number of diabetes  mellitus  (DM), there are several predictions and calculations in which some bet that "the number could reach 592 million by 2035"  ^[32]  . The fact is that "50% of diabetics are unaware of the disease"  ^[33]  and had a mortality of more than 5.1 million people in 2013. "  ^[34]  Diabetes mellitus (DM) is a cause associated with death of many older people In a study of 291 deaths, "the proportion of deaths from diabetes as the underlying cause was 51.5%, being higher in women than in men. ^[35]  [36]  Diabetes has increased from eighth to seventh cause of death in Brazil and holds seventh position in the world. ^[37]  [38] In Brazil there was an "increase in mortality rates from diabetes mellitus "  ^[39]

Hypertension (SAH)

In Brazil, few studies on stroke have been published, at least until 2005, which stood out as "at odds with Brazil's general contribution to science, including the biomedical field"  ^[40]  , but most likely due to related government programs. With pressure control, there was a significant drop in deaths related to cardiovascular diseases. ^[41]  With respect to statistics of systemic arterial hypertension (SAH), high demographic concentrations have a high mortality rate in these elderly hypertensive patients. ^[42] While systemic arterial hypertension, including comorbidities and other diseases such as stroke, renal failure, hemorrhagic stroke, occupy from the first to the third position of lethal comorbidities in Brazil and around the world, where only in 2002, for all the causes of deaths, the stroke was "the leading cause of death in Brazil, with 87,344 deaths"  ^[43]  the Brazilian government has interfered with this by offering free medicines in primary care, cheaper "popular pharmacies" and even delivering them by mail As this is the case in the municipality of Barueri / SP.

Hypertension is the main cause of hemorrhagic stroke and ischemic stroke that causes significant damage to mental and motor capacity, in addition to affecting socioeconomic, family and macroeconomic strategies. "Hypertension is considered one of the main risk factors for the occurrence of cardiovascular complications, such as stroke (CVA)"  ^[44]  . In 52% and 45% come congenital aneurysms, and others such as trauma, disease, brain, vascular and cardiovascular. It is known that damage between 15 and 20 million neurons occurs in the first hours of the acute hypertensive brain.

"As for epidemiology, in Brazil there are 36 million patients with hypertension, where patients over 65 are more likely to develop the disease. This systemic disorder is responsible for a large number of diseases, such as" heart disease, stroke, kidney failure "  ^[45]  , and large-scale deaths worldwide and nationally  ^[46]. "The data analysis allows us to observe that the majority were women (56.9%), single (61.2%)", of mixed race (57.7%), aged between 18 and 34 (7.6%), with a predominance of Complete secondary school (34.8%) "..." There was a higher prevalence of hypertension in women (12.0%), widowers (25.0%) with 45 years or more (51.4%), lower education (39.0%) and black people (11.3 %). The prevalence of hypertension in the study population was 9.6% "  ^[47] " The study showed a profile of people aged 18 to 30, women with normal BMI, risk factors such as stress prevail (49%) , physical inactivity (44%), sex (43%), alcohol consumption (40%), dyslipidemia (12%), obesity (10%), high blood pressure (8%), heart disease (6%), diabetes (3%) and smoking (2%) ". 

Chronic noncommunicable diseases (NCDs) that can be transmitted by genetic inheritance and entropy

It is part of the global program to combat chronic noncommunicable diseases (NCDs) to address four major groups of diseases; circulatory diseases, cancers, chronic respiratory diseases and diabetes together with the "modifiable common risk factors (smoking, alcoholism, physical inactivity, unhealthy eating and obesity) and defines guidelines and actions in three axes: a) surveillance, information, evaluation and monitoring; b) health promotion; c) comprehensive care "  ^[49]  Some research indicates that" together with the increase in life expectancy, there was an increase in the prevalence of chronic noncommunicable diseases (NCDs) ". ^[fifty] and the general BMI increases among Brazilians ranging from 22.7 kg / m 2 to 26.6 kg / m 2 between 1974 and 2013  ^[51]  which is closely related to DM and SAH.

In addition, we had a percentage increase in many NCDs and "on average, everyone in the world experienced an 11% reduction in their general health in 2010 due to illness and injury"  ^[52],  indicating not only environmental factors but also aspects Genetic . A natural genetic tendency called "genetic entropy" has accumulated diseases of the most varied origin, even bringing humanity closer to accumulation and increasing the frequency of harmful alleles  ^[53]  increased diseases  ^[54]  [55]  especially neurological  ^{[56]  [ 57]  [58]}  25% of diabetes  ^[59]  [60]  cardiomyopathies  ^[61]  [62]increasingly dependent on genomic medicine  ^[63]  to avoid bitter statistical tendency towards extinction rather than faster evolution. ^[64]  [65]The research indicates that these diseases considered NCDs are not transmissible, but they can be transmitted to the offspring, as a mutation already present or acquired, generated by the lifestyle and epigenetic aspects, viruses, radiation and pollution, a free radical generated by a Poor diet and a Mutations that generate pesticides in heavy metals, before or during the reproduction phase, can lead to genetic defects in the offspring. This research reveals extreme and worrying aspects to increase the prevalence related to diabetes and hypertension, where the repair of cellular DNA becomes even more necessary to decrease the frequency and accumulation in the offspring.

Complementary medicine

Complementary medicine, the use of medicinal plants  ^[66]  and innovative strategies (although often "innovative" research only confirms millenary practices by passing them through the filter of Western science only today) has been a great ally for quality of life  ^{[67]  [68]  [69]}  "Psychotropic nutrients / herbs are a new class of supplements such as St. John's wort, Kava, Ginkgo Biloba, Ginseng and L-tyrosine" that give life to weakened patients. "It is believed to serve as antidepressants, relaxants and mental stimulants"  ^[70]  and help people exercise more, work harder and have more sex (detesting the earthly tribulus  ^[71]plays an aphrodisiac and rejuvenating role for men and women  ^[72]  that stimulates testosterone, which is quite relevant for men after the age of 40 that has decreased the manufacture of this hormone  ^[73]  ), similar effects we see in related studies with the catuaba that "improves glucose homeostasis and pancreatic endocrine morphology and inhibits the development of diabetic nephropathy"  ^[74]  , marapuana  ^[75]  , dog knot (Heteropterys aphrodisiaca)  ^[76]  and encourages patients to Exercise more, in addition to a multitude of plant molecules described in this review of antidiabetic and hypoglycemic plants:

"This review focuses primarily on antidiabetic plants, chemically characterized plant molecules and plant-based foods in the treatment of DM. There is little scientific evidence available on the mechanism of action of plant-derived food molecules on MD targets. Critical objectives of DM include α-amylase, α-glucosidase, DPP-IV, aldose reductase, PPAR-γ, AMP kinase and GLUT4 ". ^[77]

"Among the 71 species bred in RENISUS, five have hypoglycemic potential: Bauhinia forficata (cow), Bidens pilosa (black prick that helps the kidneys and liver), Solanum paniculatum (  jurubeba  ), Mormodica charantia (San Melon) -caetan )  ^[78]  and Syzygium cumini "  ^[79]

In Pelotas-RS we also find a study of plants that reveals that "57% of popular knowledge is compatible with scientific knowledge"  ^[80]   :

Recalling that often the popular empiricism and the millenary cultural wisdom of the peoples anticipates scientific knowledge, especially clinical knowledge, which has the filter of economic viability of clinical research projects with almost difficult to copy formulas that will guarantee return guarantees High investment required to meet your requirements. Even so, useless and selfless initiatives carried out under strictly personal care motivations are done as in several studies cited here.

The fact that the proportion of doctors per capita in Brazil is 1.8 per 1000 population. but there is a poor distribution that concentrates them in large cities (3.7) while there are places with only 0.04  ^[81]  [82]In addition to the dispute over health plans by specialists, which forces the population to seek family medicine and integrative practices, sometimes this is their only way out. In addition, the need to hire foreign doctors who worked mainly through the program "More doctors", nutritionists, physiotherapists, dentists integrating actions and methods that help good care, to help in primary care, strategies of attention to municipalities by coordination. Primary health care and family health, and other initiatives, represented concrete support to reduce comorbidities and promote improvements in the quality of life, helping a productive life of these patients.

"Recently it has been reported that camel milk may have these properties. The review of the literature suggests the following possibilities: i) insulin in camel milk has special properties that facilitate absorption in the circulation than insulin from other sources or causes resistance to proteolysis ii) camel insulin is encapsulated in nanoparticles (lipid vesicles) that allow it to pass through the stomach and enter the circulation iii) some other elements of camel milk make it antidiabetic. their expected digestion pattern does not suggest differentiation to overcome mucosal barriers before they degrade and reach the bloodstream "  ^[83]  .

Stress, emotional factors and sleep quality.

We observed that these adult and elderly patients with HyperDia had increased stress, inadequate nutrition and chronic physical activity, and reduced physical activity, which affected the quality of sleep that, perceived as a therapeutic process  ^[84]  translated into cellular repair  ^{[ 85]}  , improved Immune  ^{[86]  [87]  [88]  [89]  [90]}  helping to combat obesity  ^[91]  , depression  ^[92]  and even some heart disease  ^[93], is a fundamental element for the quality of life of patients with hyperdia. To achieve REM paradoxical sleep of level 6 of deep sleep, several strategies can contribute, from psychological, religious, physiotherapy, baths, saunas, hearing protectors and hearing aids to supplements such as "L-teanine, cap grass   (  Scutellaria lateriflora  L .), Rhodiola (  Rhodiola rosea  L.) and chamomile (  Matricaria Recutita  ) ... melatonin "  ^[94]  " considers the possibility of using melatonin and its analogues for "prophylaxis" or treatment of diabetes mellitus "  ^[95]

In diabetics with sleep problems, less hormonal replacement occurs  ^{[20] and}  tends to occur less frequently in homeostasis. ^[96]Therefore, being asleep is not just a simple rest, but a therapeutic action, which has essential functions for our body. The recommended recommendations for a modeling effect require supplementation because its use does not require commitment, continuity and habit of at least 6 to 8 h / day without granting hormonal conditions, or even when there are comorbidities such as sleep disorders, apnea, insomnia, or other disorders, the corresponding benefit can only be achieved with greater patient care. "The poor quality of sleep alters the metabolism and alters the synthesis of some hormones, favoring various chronic diseases such as obesity, depression, as well as diabetes and diabetes. Hypertension." ^[97]  [98]

"The prevalence of hypertension was 87.1% in patients with" bad sleepers "versus 35.1% in" good sleepers "(p <0.0001). Our results allow us to conclude that, such as breathing with sleep disorders, quality disorders Sleep, evaluated The Pittsburgh Sleep Quality Index (PSQI) is associated with significant comorbidities such as hypertension and diabetes mellitus.We assume that the evaluation of sleep quality through the Pittsburgh Sleep Quality Index (PSQI) could be considered in the detection of cardiovascular risk ". ^[99]

According to endocrinologist Alessandra Rasovenski, the disease is less important for the control of type II diabetes. It is during sleep that the body stabilizes the glycemic and hormonal states of all organ systems. Those who do not have a quality sleep suffer from uncontrolled glucose levels and an increase in cortisol, which can develop instability in insulin production, making it difficult to control glycemic oral medications and an increase in the injectable insulin load. According to an investigation by the Warwick School of Medicine in the USA. UU., Shows that lack of sleep or escape to nightlife increases the risk of cardiovascular diseases, strokes, heart attacks and cardiovascular diseases. The authors of the research continued for 25 years in the United States, Sweden and the United Kingdom. According to the researchers, poor sleep quality produces an imbalance in the production of hormones and chemicals in the body, which increases the chances of developing cardiovascular diseases and strokes. The research proposes that at least 7 hours per night protect your future health from the development of chronic diseases, such as diabetes and high blood pressure. It was not observed in comparison, sedentary patients and active patients as was done in Bauru / SP. Complete data of the Jardim Tupã Unit in the city of Barueri / SP, which also includes patients from the Jardim Silveira, Santa Monica and Votupoca neighborhood. The research proposes that at least 7 hours per night protect your future health from the development of chronic diseases, such as diabetes and high blood pressure. It was not observed in comparison, sedentary patients and active patients as was done in Bauru / SP. Complete data of the Jardim Tupã Unit in the city of Barueri / SP, which also includes patients from the Jardim Silveira, Santa Monica and Votupoca neighborhood. The research proposes that at least 7 hours per night protect your future health from the development of chronic diseases, such as diabetes and high blood pressure. It was not observed in comparison, sedentary patients and active patients as was done in Bauru / SP. Complete data of the Jardim Tupã Unit in the city of Barueri / SP, which also includes patients from the Jardim Silveira, Santa Monica and Votupoca neighborhood.

Exercise and its relationship with mitochondria and the benefits of sleep.

There is a high relationship between exercise, mitochondrial enlargement and the beneficial effects in diabetic patients and hypertension  ^{[100]  [101]}  . In addition, the high relationship between exercise and sleep quality  ^[102]  makes adherence to the Hyperdia program increasingly urgent. There is also savings in reducing treatment costs due to physical activity, "Investigating the Pelotas / RS population, he observed that sedentary people used more drugs, 39% more than active patients." ^[103]We should be effective in this proposal, because the organic repair is carried out on a good night's sleep by increasing the cardiac pumping, improving the supply of oxygen in the blood, increasing renal filtration and decreasing insulin resistance. The usual practice of physical activities has been proposed  ^{[104]  [105]}which was completed by the research coordinator through individual interviews. "The patients were subdivided into quartiles (four groups) and according to the total individual score provided by the instrument, they resulted in the following physical activity groups: the analyzed sample of 40.5% were men and 59.95% men. In the total sample , 11.6% of diabetics reported being smokers and 36.4% were using insulin and smokers were not included in the physical activity group. These differences remain when patients with hypertension and diabetics are evaluated under the same criteria, "after two years of intervention, these authors found that the cost per person with medications decreased significantly. "  ^[106]

But we wonder what causes low adherence to exercises, but the lack of stimulants such as terrestrial tribulus  ^[107]  , Peruvian maca, Marrapoana, ginseng, as well as the accumulation of comorbidities, especially old age, which They affect our patients and do not leave them. Adhere to exercises that are critical for your improvement and economy in the use of medications.

Drugs, kidney complications and the use of captopril

Several studies have shown a close causal relationship between hypertension and renal causes associated with diabetes  ^{[108]  [109]  [110]  [111]  [  112]}  "Diabetes mellitus is the most common cause of chronic kidney disease in the world "  ^[113]  " Diabetes nephropathy (DN) is one of the most common complications of diabetes mellitus (DM), which occurs in one third of diabetic patients "  ^[114]  Of the secondary forms, approximately 40-45% they are renal causes, 20% are renovascular, the remaining 15% have etiologies in other endocrine diseases or due to the use of certain groups of medications  ^[115]  .

Among them we can identify and quantify this event in this investigation, where blood pressure was measured after 40 minutes of arriving at the clinic, and of the 35 patients who used captopril 25 mg, we observed that we had 20 patients with moderate to high hypertension. and in 15 patients with no desired effect of the medication (little effect, allergic condition, cough, irritability, etc.); As a result, there was a change in the alternative medical prescription to another antihypertensive group, which achieved a good action of the renal vessels. Therefore, it is recommended through this investigation for a better therapy to always replace captopril with another medication, when there are complications in which the kidneys can be an important causal factor, except in cases in which the patient has a good medication availability

These are related to the bad habits of the population and aging, which are the main causes, as well as the consumption of sweets, ice cream, chocolates, cakes, cookies and other processed foods in excess. This investigation of the Ministry of Health corroborates this investigation in at least two points, among them, the practice of physical activities and adequate nutrition are essential to contain the disease.

Among the various forms of secondary arterial hypertension, in descending order, are the renal, renovascular, endocrine causes (pheochromocytoma, hyperaldosteronism, thyroid disease, acromegaly) and also those induced by medications (contraceptives, MAO inhibitors, etc.). Numerically essential hypertension accounts for 90% of cases of hypertension  ^[116]and secondary forms represent 10% of cases. With respect to secondary hypertension, we observe that this is not the main diagnosis and, therefore, essential arterial hypertension is the main cause of the disease, representing 90% of the total, which has multiple unclear etiological mechanisms; Although only 10% of hypertension in a hypertensive population shows definite etiologies and reasonably clear psychopathologies, once identified, can be completely remedied.

 

BMI increase, correct feeding, alkaline water

Acidic blood due to the accumulation of sugar and its consequences can be reduced by promoting the alkaline environment, among which we can mention the use of alkaline water in the distant interval between approximately 30 minutes and 2 hours of meals (remembering that the speed of a Digestion is related to chewing, post-meal movement, nutrient absorption, late acidification), its benefits for the kidneys  ^{[117]  [118]}  and its direct effects  ^[119]  in hyperdial patients, as we read in the Summary of the clinical study. Kuninobo Yokuda and others:

"The effects of magnesium (Mg) supplementation on nine mild type 2 diabetic patients with stable glycemic control were investigated. Water from a salt lake with a high natural Mg (7.1%) content (MAG21) was used for supplementation after dilution with distilled water to 100 mg / 100 ml 300 ml / day was administered for 30 days The fasting serum immunoreactive insulin level decreased significantly, as did HOMA □ R (both  p<0.05). There was also a marked decrease in the average triglyceride level after supplementation. Patients with hypertension had a significant reduction in systolic (p <0.01), diastolic (p = 0.0038) and mean (p <0.01) blood pressure. The Salt Lake water supplement, MAG21, has had a clinical benefit as a Mg supplement in patients with mild type 2 diabetes mellitus. "  ^[120]

Probiotics

There has been "an increase in the average BMI in recent decades in Brazil"  ^[121]  despite an intense campaign for the ingenious project of deploying equipment in the squares and promoting exercise with outdoor gyms throughout the country. We understand that primarily herbal medications and other items discussed here may increase the frequency in them. Therefore, more efficient measures or projects should be implemented to combat obesity, since these diseases are related to various diseases, not only hypertension and DM, including cancer, among which we can mention strategies in the use of probiotics  ^{[122 ]  [123]  [124]}The efficacy confirmed in a meta-analysis of 986 publications and 18 clinical trials with a total of 1337 patients, which showed that "probiotic and symbiotic supplementation among patients with diabetes significantly decreased CRP and TNF-α and increased NO levels, but no affected the levels of IL-6 "(where its increase above the midline is fatal). ^{[125]  [126]}  decrease in DM  ^[127]  and obesity  ^{[128]  [129]  [130]}  . Probiotics also generate greater satiety by causing the patient to use more nutrients and this decreases mass consumption by reshaping energy metabolism  ^[131]  .

A simple way to know if the diet is correct is the Bristol scale, which looks for the cohesive pattern that has no dysbiosis and / or "dirty" toilet paper  ^{[132]  [133]}  . Probiotics can help correct in babies  ^[134]  . The use of bovine colostrum or female donkey  ^[135]  also contributes to many applications in which we highlight the intestinal benefits  ^[136]  by providing better absorption of the macromolecules and the drug's insulin  ^[137]. ]  not to mention countless immunological effects  ^{[138]  [139]}  .

Diet

In patients with HyperDia, the diet acts to increase comorbidity, in patients with hypertension we notice salty, salty foods, fatty barbecues; Recommendations for fruits such as pear and apple are the most tolerated, a small banana is also recommended for breakfast. A low-calorie diet for overweight patients, a normocaloric diet for ideal weight patients and a high-calorie diet for overweight patients, obviously concomitant under daily glycemic control.

The opportunities that nutraceuticals generate to improve the quality of life of patients with DM and SAH and related comorbidities, so given these few useful examples, we can confirm that the urgent recommendation to perform more nutritionists  ^[140]  , work together in HyperDia joining more specific and diagnostic medical actions, since the number of doctors in Brazil is insufficient and, however, few doctors with experience in nutrition and the workforce of a nutritionist represent a lower expense.

Problems and possible solutions for program membership

We observed the lack of adherence to the program in many initiatives demanded for these patients that pointed to the need to change our approach and our observation was confirmed by research that indicated that "the main reports on the lack of self-care reported by patients with hypertension are: medication use sometimes. " improper diet, improper diet, lack of physical activity, difficulties in changing habits and lack of knowledge about the consequences of hypertension "  ^[141]  .

Many possibilities of lack of motivational and / or structural factors to reformulate our behavior can be enumerated. Some defects, such as the lack of "use of a non-individualized approach, that is, fail an approach that values ​​individual conditions and needs"  ^{[142]  [143]}which would require even more doctors and health professionals, or a system that would allow for more personalized contact. It is expected through this set of proposals, favoring the processes of attention to the NASF team and the Family Health Program, achieving success in the recommended care. Always remembering that these patients cannot be exposed to a high level of anguish and hostile environments, raising the rates of cortisol and other hormones that can unbalance the triggers of comorbidities.

The research indicates that the use of online diabetic communities in social networks has a positive action to have better access to information and greater adherence to the proposed programs  ^[144],  but mainly there is a lack of adherence with respect to the exercise  ^{[145]  [146]  [147]}  . The misfortune of these diseases (from the HyperDia program) that causes them stress and the hopelessness of quality can be reflected in poor adherence and neurological demotivating and depressive aspects may be associated  ^[148]. We also question the possible lack of quality of the medicines offered by the laboratories acquired by the government, since we see a low occurrence of qualitative and quantitative tests of active ingredients and toxic byproducts of synthesis, evaluated by the mass spectrometry technique, which It doesn't seem to happen. in developed countries  ^{[149]  [150]}  which urges us to promote the urgent requirement of certified quality and purity reports in Brazil from pharmaceutical representatives, together with the report of the main suppliers of China and India given that Brazilian "industries" distribute more drugs than they manufacture here  ^[151]  .

 

conclusion

Given the scientific update here, we realize that a new questionnaire can at the same time investigate the situation of patients, it can also inform dozens of strategies both to patients with MS and to professionals who attend them daily, which contain some of the main solutions that the research has highlighted, and we believe that this will generate greater value for programs such as Hyperdia in Brazil, as well as greater adherence, because the most expressive results always attract more competition, and word of mouth advertising proves to be More efficient than expensive advertising campaigns. We hope that better questionnaires will be conducted by adding more discoveries to help this growing demand in our world population.

References