DR. ALEXANDRE AMATO (ESPECIALISTA EM LIPEDEMA) - PODPEOPLE #132

[Music] C [Music] [Music] our guest today is a functional and integrative vascular surgeon specialized in lipedema as a professor, writer, researcher and speaker, he contributes to the dissemination of knowledge and the advancement of science in his area today we will address topics relevant to vascular health including the relationship between cardiovascular health and mental health as well as lipedema and other issues related to care and quality of life with you Dr Alexandre Amato [Music] [Music] Hello everyone, welcome to more an episode of pod people a place where we meet to see and hear people People who

do People who happen people who inspire our guest Today is a vascular surgeon his name is Dr Alexandre Amato everything is good my dear everything is good thanks for the invitation Wow, it's It's a pleasure to have you here, we're grateful, I'm honored, good evening, Good evening, Ana, good evening, Alexandre, welcome, good evening, thank you, my dear, you know I've been scouring people's networks to see why our channel is a channel. that in addition to being certified by health, but it is a channel that people, our audience, began to demand that we bring more topics

related to health, which makes me very happy because in the sea of ​​things that have so many superficial things, I'm not making any judgment There are a lot of people wanting to learn and what caught my attention was a vascular surgeon specializing in lipedema. I said, well, let's bring this up and clarify for people what this is . your trajectory what led you to choose vascular surgery vascular surgery well I did medicine I studied medicine there are some interesting stories there along The way first in choosing Medicine hey I come from a family of doctors

So my parents are my doctors, my grandfather on one side is a doctor, grandfather on the other side, there wasn't much of a doctor on the other side, you know, and there wasn't much of an option because my mother said Oh, you're not going to be a doctor, Mom, I want to be a firefighter, no, you're going to study medicine and then you're going to work inside the fire engine , but as a doctor attending, no, but I want to do IT, no, you're going to do medicine and then medical IT, so there wasn't much

of an option, but my mother told me and also said that we had to do medicine, I have two brothers, right? also doctors, three of them were male children, three sons and they said that we had to do medicine to take care of ourselves and the people around us, right? That was a very strong thing, this medicine of Purpose, right? You have to improve yourself and improve those who so around ex exact beautiful, right? She felt that way because at that time there was that thing, will you believe what one is saying, what the other

is saying, at the very least, you have to create a judgment to take care of your own health, right? My choice For medicine was kind of natural But thank you, I liked it, it was never, it was not voluntary, but from the moment it started you said this thing is cool, that's right, that's the path and I came in wanting to do genetics, so I'm talking about 20 5 years 26 years ago, it's a long time to do genetics, you know, crazy, but it was already innovative, so few people at that time came in wanting

to do exact genetics, so I didn't really like the initial presentation of genetics and right away I switched to vascular surgery, man. father, vascular surgeon, my grandfather, vascular surgeon, Ah, your father is a vascular surgeon, ok. And then I said, oh, that's what I want and that's the end of it . because there is a lot of propaedeutics Clinic there are a lot of surgeries for those who want to do aesthetics there are aesthetics for those who want trauma there are traumas for those who want big giant surgeries there are for those who want to

work with technology there is work for those who want to do ultrasound exams and tomography, that's how it is, there's a little bit of everything in medicine, so I, because there are vessels in every Place, right? We treat them from the tips of the toes to the head, just not inside the head, and there are some who still take risks, but it's more for the neurosurgeon. exact formula of brain but there is also no impediment to a vascular surgeon with some current endovascular techniques we can get there, right? I didn't need to go there to

be happy, but the fact that it works on the entire body showed me the scope of medicine and how it works. That could be interesting, right, so that was the reason for my choice because it's just for us to define it for lay people, right ? It's the figure that was sort of added to the vascular surgeon, right? The vascular surgeon also does angiology, which is the clinical part of vascular surgery, so we treat all the vessels, arteries, veins and lymphatics, we can't do lactics, which are extremely important, right, but no. only with surgery So

we have to have this clinical vision too, so in reality a vascular surgeon is also a clinician, he has to Be a clinician to know whether or not it indicates how to get there, the path is not through the medical clinic and surgery general, but you have to have this experience, you have to have this Clinical experience , otherwise it won't work, which is the basic content of the angiologist, that's not it, so the vascular surgeon has the knowledge of the angiologist and he also has the technique of performing surgeries within this context. vascular Exactly

exactly, it's obvious that there are some who end up staying full time in surgery, others who like to stay in the clinical part, now I've always liked doing a little bit of everything, I can't, I can't stay in one thing for a long time, I like it. From now on, Alexandre, it's a curiosity of mine, I worked for a long time in a hospital with patients at the entrance to the ICU, providing guidance to the family, the patient and I had some episodes, right, in carrying there along with the general ICU, of patients with motorcycle

accidents that There's amputation, it's a type of surgery that you have to be present because of the high vascularization, right? It's like, if you're in the hospital and you hear that voice in the background, right? Doctor, vascular surgeon is present At the hospital, ready, it's a catastrophe Cat, something is there really happening, really, this happens, you know, ah, a serious accident patient came in and right after we actually hear it like this, Doctor so-and-so surgeon, show up at the surgical block, show up at the surgical block, that's it, that's just the way it is and

say in depth that the thing is going to go far away and it's an emergency room, it has to have a vascular surgeon because some larger emergency rooms have to have one and most of the trauma surgeries have a trauma surgeon who manages almost everything and then there are much more injuries. specifics that the vascular surgeon has to enter into, there's that concept of Damage control, right? Let's control the damage of what's happening now and then the specialist can recover, try to recover what we couldn't see exactly And then the And then the surgery vascular

acts secondarily, right primarily, it is the trauma surgeon and then the specialist can be the vascular specialist, but it can be uro, it can be any other necessary specialty, which are the most common clinical settings in your specialty, and From the outpatient clinic, surgery is the most It's common venous disease, right, varicose veins , varicose veins, and that's also linked to why I ended up getting into the story of lipedema, but venous insufficiency is one of the most common diseases on the face of the earth, right, it's really very common, the diagnosis is very easy,

right, the jealous neighbor, look at the leg and As you say, there are varicose veins there, so you don't need to go to the doctor to get a diagnosis. Aqua is also educated, uhm, right . And so the diagnosis is easy and there is a wide spectrum of symptoms, right, from those that are just aesthetic to those that already have even a venous ulcer, then, or else the symptoms of heaviness, that sensation of exact heaviness, but then the correlation with lipedema comes in because the symptoms are very similar to venous insufficiency and exact lipedema, which

is the heaviness in the leg, pain fatigue, swelling, eh, all of this is often confused with lipedema and as venous disease is much more common, obviously the patient will end up in the hands of the vascular surgeon because they already have that in mind, right? The neighbor said that he already has varicose veins. know that It's the vascular surgeon who has to treat it who will come in, right? And what would be the difference between varicose veins and vein disease, lipedema? dilated visible to the naked eye and tortuous, ok , in the lower limbs, it

has degrees, right, there are degrees, lipedema is the symmetrical deposition, when I say symmetrical on the left side with the right side and not the bodies, the upper body with the lower body, right, so it's a correlation, it's the left side. It's the same as on the right side, but the waist down is disproportionate to the waist up in the proportion of fat. So it's women who have a higher proportion of fat in the lower limbs, upper limbs as well and it's a pain that brings inflammatory symptoms such as weight, tiredness pain on palpation hematomas

very frequent ecchymosis, often poorly explained, I don't remember hitting it and those purple spots start to appear and one thing that is very common is the sensation of fluid retention, you know, the sensation of swelling because the swelling itself is not necessarily there. There, but there's this Whole feeling, eh, and they're people who have often spent their lives fighting to lose this fat and can't, eh, they lose weight in the trunk but can't lose it in the lower limbs . of a supposed obesity but it is not obesity it is another entity which is lipedema

And then the treatment is different fat accumulation is disproportionately bilateral this is what predominates from the waist down and or upper limbs too but not upper limbs it is so bilateral it has to be bilateral this differentiation is because it differs from lymphedema lymphedema can be bilateral but much more often it is unilateral it is asymmetrical if you have lymphedema one leg will be different from the other different from the other so no no if it doesn't fit There, it's not even the exact varicose veins, the varicose veins can be both bilateral and unilateral, primary

varicose veins are varicose veins of genetic origin, they are normally bilateral, bilateral, when they occur due to a post-thrombotic syndrome, for example, a patient who had a trauma had a thrombosis afterwards I started to get varicose veins and then It's just one side, so lipedema predominates in women and they're overweight or obese. So this question seems simple but it's one of the biggest problems in this whole issue because I'm going to go back a little and talk about BMI, body mass index is the relationship between weight and height, this is a generic way for us

to talk about whether someone is obese or overweight or obese, but then we are using two metrics, just weight and height, if we take the Arnold schas deny his BMI at the time of his Golden Age was 30 and there you go he was obese at that time he was super muscular, I understand he wasn't obese but he had a very high BMI so he had a very large proportion of muscle which increased his weight right versus height height Uhum And then it could fall into the obesity criteria but it wasn't so now explained that

I'm going to talk about lipedema, lipedema, this fat on the legs is a fat that reduces cardiovascular risk, it's a protective fat, it's a fat that uh, it reduces the problems of inflammatory diseases, that would be what was talked about for a long time about pear-type fat, yes, you remember , there was a lot of talk about this, there was apple-type fat, which is the central one, which is the visceral fat, ISO accumulation And then the peripheral fat, which It's pear-type fat that predominates in the hips, lower limbs, more or less exactly that. Uh, and

this peripheral fat provides protection against cardiovascular risk, while central fat has an increase in cardiovascular risk . the following is a disease that brings a lot of cardiovascular risk a lot of diseases of inflammatory origin so it increases the risk of cancer it increases the risk of heart attack it increases the risk of atherosclerosis of stroke if it increases all of this and peripheral fat protects from all of this I cannot Saying that it's the same thing, I can't say the increase in fat, loss brings obesity, it brings weight gain, but it doesn't, obesity increases

The exact risks of obesity increase BMI but do not increase cardiovascular risks. So they are two different entities, with Arnold Schweger, which was muscle, it is very obvious. There is a lot of muscle, it increases weight, it is not obesity, and now when I am talking about two fats bad fat And good fat are different things, different things, although they look similar, they are different things, so there is an increase in visceral fat, that is obesity, there is an increase in peripheral fat in the limbs, that is lipedema, so and this differentiation is fundamental for

us to understand what the lipedema brings on Muler's health interesting So you're saying that even though it's for women and it's aesthetically uncomfortable, it's not pathological in the sense that it brings risks to her that are much worse, hypertension, cancer , dyslipidemia and heart risk, you know, something that I love. It's being the dumbest person in the room because we always have to learn, right, and I like being in a place that will bring me something that I'll learn, so you quickly captured something that I try to explain countless times to surgeons. For a lot

of people who don't understand, lipedema is a protective layer. It provides protection against inflammatory events and cardiovascular risk at the expense of aesthetics and beauty. We interviewed here a wonderful doctor, Dr Denis Birman, who said that migraines were an evolutionary process because the person signaled, right? What was happening, the inflammatory process ? lipedema I'm here making an association, if I'm wrong, please correct me But it gave me the feeling that, evolutionarily, lipedema is a very protective factor, imagine women with lipedema, I don't know, at the time of the caves, at the time of the caves

there was much more advantages of surviving M imagine in the cave era it was the following we have to and drought lack of water food is at war with another tribe the stress high stress that what we need to do whoever is going to survive will survive whoever can store energy and I'm talking more about the difference between man and woman at that moment it was glaring because the woman's role was, I'm speaking biologically, right, perfect, it was to take care of the pro and the man's role in a situation like this was to go

hunting, bring food to hunt, bring water, food or fight with The tribe So it's like that back in the cave era, something has to warn you that you need to store energy and that you need to run after everything, what it warned you about was inflammation, so something inflamed something triggered this system And for those women who They had lipedema , which is a huge energy storage system, turning on this system, it retained energy in the form of fat and did not release it in any way . of lipedema, she was able to breastfeed, survive

a long period of drought and come out alive and spread her genetics. Meanwhile, the same inflammation in the man did something different, making him run after food, drink and win a war, right? of this pandemic, so the need for the two was different, so then we evolved, we arrived at all this technology that we have and we created a world where inflammation permeates everything, right? Just go out there and you're breathing pollution, there's pollution. there is noise pollution of everything like there is stress you try to cross The guy gives a honk the body doesn't

understand a honk the difference from a warning from a distant tribe that is going to attack you, right, all of this is stress at the same time they changed the exact factors at the same time as we have plenty of food, we no longer need to store all this energy so women with lipedema can complain about lipedema and I understand why there is an issue and this is another thing that we can delve into which is this aesthetic part because and if it's body dysmorphia if it's not it's because there's a lot of inflammation involved

in it but in fact it's a good evolutionary mechanism back there anything that has a high prevalence in the population It was useful At some point in our history clear exact exact 12 we did the work on the prevalence of lipedema in the Brazilian female population and found 12.3 per. uhum It's a lot of people isn't there It's a lot of people if it wasn't related to our survival this wouldn't exist exactly there are V for example and false-form anemia ahem it has nothing to do with our area but It alters the vascularization tremendously alters

it but see here it is an evolutionary advantage in some areas of the world Where there is a lot of malaria because it prevents red blood cells from being infected by the skin, so it is a disease and brings harm but in some certain areas of the world this was an advantage at some point that It was an exact advantage, so lipedema is a huge battery, an evolutionary advantage, it was probably the women who passed the most, that skinny friend who, a woman with lipedema, dies of envy. She would be the first to be decimated,

right, back then, I understood perfectly, now it's changing too. the concept of beauty , right ? It's successful, right? It's so much so that women who are very dry or women who suffer from anorexia stop menstruating, yes, literally, right, so that's one, it's a criterion, especially because there's not enough fat hormone, PR prod, one more aspect oo fatty tissue is an organ, for example, it is an endocrine organ, it produces a lot of the hormone adiponectin, leptin and so on, there is A lot, right? So when you simply remove this fat you are amputating the

body of an endocrine organ and if you don't understand the metabolic part of this you It's creating a disease that no one knows how to treat because you're taking away something that was there because it has an exact function, uhm, exactly, so that's why, unfortunately, people take advantage of the name lipedema, which, on the one hand, is great that it appeared in the media because everyone was alert but on the other hand there are also a lot of people taking advantage of this exact secondary to sell the Miraculous solution to sell the thousand-thousand device to

sell the surgery that they say is aaa resolution the solution looking for the disease, right you remove an organ endocrine, you amputate the woman from her endocrine organ, which is fat, it's good fat, it's good fat, right, and that way she'll look pretty with a pretty leg What is the metabolic, immunometabolic repercussion on the body, there's a lot of things to show, I see This is true at the consultation because no one goes back to the surgeon who removed the fat to say oh I have these other health problems because no one correlates something with

another Plastic surgeon makes this type of correlation No, he only has positive feedback, that is the woman turns and says like this oh really my leg looks nice cool great then he says like this Oh so I made my leg look beautiful So I'm going to keep replicating this over and over again without f because it's working but in fact you're removing an organ that will influence the metabolically metabolically it whole organism exactly what happens this is already work showing you do the liposuction removes fat begins to deposit visceral fat I understood that it is

the balance the body will find a balance and the balance of fat deposition is where in the na deposition of visceral fat, but visceral is what I said, it is the one that brings all the cardiovascular risk, what you are talking about is that the body will always create a balance between viceral fat and peripheral fat, so to speak, that would be it. If I removed a lot of peripherals, he understands that I need it to be perfect and that is a catastrophe because a catastrophe is not perfect, the High Balance mechanism that the body

has, even though it is wrong, the woman with lipedema Has low visceral fat when the lipedema is removed. visceral fat bursts, look, we're putting it there and a few little things, right, oh, original, Dr Alexandre, you're right, I'm saying that my derico, this one, so it's really cool for us to talk about this because this is how it is. the evolutionary stage the evolutionary classification of lipedema first of all, every classification in medicine has to have some reason for existing if it doesn't have it it is useless and Normally when we present some type of

classification it is to discuss and define the best treatment but this is being used in an erroneous way because you show it to women Look, there are stages one to four She's in stage one she's going the first thing she'll think is I'm going to surgery because I don't want to get to stage four I just understand that neither It doesn't mean that everyone who is in stage one will evolve to stage four, it just means that those who are in stage four were once in stage 3, 2 and 1. But those who really evolve

to reach stage four are rare, there has to be a confluence of very large factors, including the persistence of chronic inflammation throughout life, Most women, the 12.3 that I said is in stage one, stage one is the beginning, it's calm, it's the easiest, but Alexandre, we have it like now I'm going to speak as a layman who is our audience, right? It's like we're in stage one and the doctor is already able to have a perception that if he can't treat it now, it's going to progress and be arrested because you said so. Not everyone

who's in stage one will reaching stage four does not progress But it is possible that already in stage one we have some individual that will reach stage four, I am the patient who arrives with stage one and I think that this one has the condition to reach the Stadium that that is, is there any way that we can see this? I believe that the best way to say it would be someone who arrived at the doctor uhum and is a person who is actively looking for a solution, this person will no longer reach perfect stage

four because they she's already searching because she's already searching, I already know that she may not find the solution to her problem right now, but it means that she's searching and that she's not going to give up, those who reached stage four, here are all Those who They didn't have any information, none at all It's sad, it makes me cry, I have a stage four patient that I couldn't help her Because it was already too late but I managed to help the three daughters, I understood that they were in perfect stage two, so Eh, because

there is a genetic component very very big which is that thing that doesn't go the car starts to fail we take it for maintenance and And if we don't go we just delay until the car's engine stops completely This is a case like A person who reaches stage four, if he had looked for it previously, already has all the support to avoid reaching level four, right, exactly, exactly, that's how it is. One of the factors of the whole confluence that I mentioned is misinformation, certainly, and misinformation, not just from the patient. This has to be

made very clear that it's not the patient's fault, it's the doctors' fault, but it's the training's fault , because no one ever talked about lipedema at the university. at the bottom of a book, no, I was that one, I didn't miss class, okay, I made a notebook with the teacher, I sneezed, I Put it, okay, because as I'm dyslexic and I'm ADHD, I had to stay there otherwise I'd stray, I couldn't, my hand had to be occupied with my mind and I remember, for example vascular, I had great teachers and I said people but I

never heard of them when I was looking for you I said damn I missed class then someone, a colleague of mine who is an angiologist said, no, no, Bia, we really didn't . I said, thank God there was no one to talk, it's a disease that was described in 1940 and they forgot about it because in 1940 the War came and then everyone was worried about vascular reconstructions, let's correct the large vascular lesions caused by the War, right? And then everything The world forgot about an issue that seemed aesthetically accurate, perfumery, the war demand, right?

So that was kind of forgotten, and there's another problem, too, which is that propaedeutics was being lost during technological developments, right? Everyone started asking for exams. to prove that I think psychiatry is the only area that is still somewhat distant from this demand. But you know that no, I always examined my patients and there was one thing about them. Patient no no what I'm talking about is exactly that and there's still a lot of exam and propaedeutic work, no, exams are important for us today . With the patient, it's the examination that allows you to

give a diagnosis, so by taking an anamnesis, you don't need a laboratory test. Now, when something like this comes up, people start to move away from this diagnosis from the art of propaedeutics, right? Ah, no, I want one. blood test showing that you have lipedema it doesn't exist uhum but that's how it is there is an examination of the work of the last century with tomography with resonance showing the diagnosis of lipedema But everyone Forget about that oh there is so it can be an additional resource within it is completely relevant because the diagnosis is

clinical, but I think some things are so important, Alexandre, because sometimes there are patients who are not convinced. Then you do it, but without finishing the diagnosis, when you do it, there is an exam that may not define, but may have the indication that you Possession, you see, look, this is happening here, then it seems to wake up A little, it sinks in a little more because it doesn't just depend on believing in the doctor It depends on what he is perceiving and seeing I see two phases in my office in relation to lipedema uhum

In the beginning, speaking 10 years ago, women went to the office with varicose veins Uh, I diagnosed lipedema and said, oh my God, she's here to treat varicose veins. If I say anything, I'll keep quiet, I'll say something. what what was I doing I planted the seed of the idea end ah Read a little bit about this subject then when she came back she ah I want to talk more about this I said great wonderful gave accessible material right right today it has already changed today women already come with this awareness that this is the

case, you just want confirmation and it can also come with it, right? Double Hand , literally, right, so this awareness led to this. Obviously, women come to me because of lipedema, so they already come with this awareness to other doctors, maybe They don't have this awareness and it is necessary to plant the seed in their colleague too so that he can forward it Say that it's our job to try and publicize this to the scientific medical community as well so that she can forward it, right, give one I remember that in the beginning I went

to conferences, people were like Ah, Amato there who is treating obesity invented the disease, right? Oh my love, so welcome to the club because when I started treating Panic, I'm already graduated, I'm 30 and I'm 37, I don't know, I've already lost count, I'm from the 1988 class of werge So I've been deformed for a long time, I joined in 83 84 I remember, I remember that I started treating Panic very early on, so that panic disorder thing today was isolated attacks and I started treating it at the time, even with paroxetine, and people said

Bia Now you invented this panic thing because that everything is one this iia She invented this, right? And then years later, some colleagues who accused me of inventing it came to my office in a panic attack to ask me to take care of it. I said, look, I didn't send this, hey, that's fate, it wasn't me. but it's it's it's it's very interesting recently I was at a conference I met a teacher of mine Italian Italian is great because he can't speak softly, you know, you always have to be very strident, right? Amato is Italian

so I can I can speak without fear but then I explain that I was treating lipedema, I know Amato, you're treating obesity That's my boss, I understand Uhum And the difficulty people have with things that weren't seen in college, right? And medicine is much bigger than college, thank God, right? it evolves regardless of what college thinks or not, so we learn a lot more later it's yours to stop and review nowadays I don't do anything I learned in college nothing was worth it the basics were worth it that's what gives the PR bases we can

evolve, right anatomy, but we have to understand whoever enters medical school will study a lot and will look back he said It's good that I don't do it like that anymore , I don't do it like that anymore because you're catching up, right? I was a university professor for 10 years, right? do this and do it, I don't know what will work and I kept saying that the university doesn't exist for that, to give you something to chew on, it exists to teach you how to think and create a critical judgment and even more basic,

learning how to learn exactly me I think the big thing is the eternal learner, college has to make you an eternal learner and like that, the big leap in my life was when I really learned to learn exactly and and I always liked learning, but learning to learn in the way that works for you is It's the way you can carry it forward for the rest of your life, continue enjoying learning today, lipedema is my focus today, it's what I like to do, but I don't know for how long, maybe at some point you fascinate

you to the point where you want to change and then I'll want to learn again and I think that's what's cool, right ? Attributes to your creativity eternal curiosity eternal curiosity curiosity is more or less that, right? And I have a book that I read, eh, davin corse It would be something like davin's cina uhum uhum right It's restless for knowledge In quiet Something cool appears in front Ah I'm going after this dopamine, that's exactly a wonderful quiet and then and then I think that answering the initial question, right, why I because I lipedema because

I was always looking for something new Some new dopamine within my area and I I saw one a a rough diamond something that someone needed to start polishing and when polishing each polishing is more dopamine is more Let's learn something different let's add something to the general knowledge it's so good to have this thing of being the trailblazer, right? right, let's say that we're inventing things, let's say that we decided to create some concept to make money, imagine everything that we don't make money when you decide to be a trailblazer, everyone is winning, making money

on top of that and making mistakes, I say oh my god from heaven I think I did something wrong I opened Pandora's Box here it's out of control you 're going to get hit there's no way around it but the dopamine that exploring gives you is so fantastic I usually say that there's a thrill in learning how to learn which for me is that for me I have a physical orgasm and I have a mental orgasm the mental orgasm is my own and is supplied by learning That's it, sometimes I come to my wife with

an article Wow, that's cool, she looks like that, like, that's interesting, right, that look on her face? interesting dear But what is the treatment of lipedema let's go ok so it wasn't very clear so for me do you have any questions do you want to say anything else I'm going to do the opposite I'm going to say I'm going to start with the surgery and then I'll give it the other way around So why isn't surgery the solution, right? Because if I remove the fat, I keep all this metabolic issue in check. But I can

speak from the point of view of a scientific study article and everything else Uh, I think Curiously, I did the meta-analysis and I had to find out all the lipedema surgeries in the world Wow, you did this work, I published 421 published lipedema surgeries in the world, 421 of these works, all of them. The vast majority were actions due to gigantic self-questioning, that is, people operated and disappeared Afterwards, the work simply ignored this data and only saw the ones that didn't disappear, of those that Didn't disappear, they went home. I answered a questionnaire and this

one is the evaluation of the results of the surgery, we have a long way to go before we can say that surgery is standard or something thing of relevance in this scenario parameter, right, there is no 421, it's a lot, it's very small, not a sample Very little, although there are people who say they've already operated 2000 4000 I want to see it published because no one, it's not published, right, so there's a long way to go So this is the science side, the pathophysiology side, is everything I talked about about the immunometabolic expert Right,

so okay, so if surgery is not the solution What is the treatment, right? But surgery is the solution. At some point, after you have the whole immune-metabolic and immune-endocrine-metabolic-controlled issue, you say immuno, because in addition to substances of inflammatory hormones are more important, even though it modulates immunity, it's also true, okay, after we have this under control, thinking about surgery for an aesthetic issue that is more aesthetic than anything else, you can just think that then the disease is already under control, I don't even know if it is. disease, I understand from That whole issue,

if we went back 20,000 years ago, it wouldn't be seen as a disease, it would be an advantage, right, an advantage then, or maybe even as a symptom, because a big problem in today's medicine, something called early closure, have you ever heard of early closure? no early closure is the following when you give a diagnosis you stamp on the person's forehead a ready diagnosis everyone around you stops investigating anything else anything else early closure I said it's lipedema so okay then let's treat it to remove the fat that resolved early closure I said it's a

plaque in the carotid artery No, I won't look at the risk factors anymore training Take some medicine or have surgery and that's it early closure is one of the biggest fallacies but one of the biggest mistakes in medicine today it is early closure so when I call lipedema a disease I induce the error of early closure because the disease itself is contained in that name lipedema if I say it is a symptom I have not closed it I have to I have to r oou THAT'S the same thing as a headache or a brain tumor

headache I Still have to investigate I don't know what it is I can treat the headache but I'll always have the flea behind me What's wrong? how do you make a hypothesis but not make an exact conclusion when you give the final diagnosis, you even talk about a headache, there's a tension headache, that's it, that's it, I'm not going to investigate other causes . as a whole, right as a whole, I agree with you as a whole , so hey, I got lost, no, you were talking about the issue of surgery, that's what we were

talking about because it's not the first one, so we said it, but is there any case where surgery is indicated? and you said if everything is balanced, right? This issue of fat, the immunological issue, the last lines were comparing headaches with brain surgery, for example, if I think of lipedema as a diagnosis, then you might think like that, so take the fat solves it, it's not a symptom, it really is, you have a headache Ah, so cut off your head because there won't be any more pain, it will end, jokes aside, I heard this from

a seaweed in relation to a Member, it hurts. amputation that if it resolves it really resolves it resolves that pain but there will be a ghost, that's probably what I was going to say EA about the ghosts Exactly, it's impressive, right? But what about that thing about simplicity, right? simplicity is the pinnacle of sophistication, but in medicine you have a limit you can't simplify too much because if you simplify too much you could make another mistake, right, it's very complex, right, it's very complex, very complex and everything is interconnected, you move one thing, one little

thing here, it will interfere on the other side there, right, there's no, there's no How can we not think that everything is interconnected, right? So, okay, talk about the surgery, let's talk about the treatment, the treatment, I try to summarize it in one sentence, right? And you have to find out what inflames you that causes this inflammatory storm, right? which is leading to this inflammation because lipedema is the body's response to inflammation. So if it's a response to inflammation, I'm not going to remove this fat because the inflammation will continue to be there and will

continue to appear and overflow into other organs other symptoms until it turns into visceral fat as Visceral fat is an inflammatory response it is a response and it causes the inflammatory response, right? But it's not just that, it can appear in other ways too, right ? It can get inflamed, right? What I see on a daily basis is that everyone There are several inflammatory triggers, but there is one that is an elephant in the room, one that is much bigger than all the others here. People, right, I can remove them all . overflowing And then

it could be a lot of things, it could be a lack of nutrition It could be some medication, it could be another disease, it could be and stress could be a lot of things, right? So this varies from patient to patient, it varies a lot, right? Ah, I'm already doing everything in the Clinical treatment conservative treatment which is how I refer to non-surgical treatment and they don't get better F like that so you're not doing everything, you certainly didn't remove the elephant, you didn't remove the elephant from the room, the elephant from the room, exactly,

and and a lot of people you think you took it off and didn't take it off because You did it more or less something happened. At some point it slipped on something exactly. And that's where the food issue comes in. That's why I wrote two books, from anti-inflammatory food to the anti-inflammatory diet, cog, a strategic ketogenic diet. what is this one and the anti-inflammatory diet anti-inflammatory diet are the foods that can cause inflammation but see even poorly done exercise can cause inflammation and then the exercise thing for exercise method for lipedema that's why that's how

it is I have to give guidance practical for the personal trainer and for the patient, it was also written for both, right, so, it's very good, right, Physical Education teacher, the patient himself can give a step-by-step guide to develop himself, exactly. Tell us a little about these three here. I'm going to tell us and the reason why there's even a story why, right? It's about the anti-inflammatory diet, I can even tell you a personal story, it's easier to understand, uhm, well, many years ago I was traveling and on a farm And then I started with

abdominal pain then I examined myself sudden positive decompression apic appendicitis I called my brother who is a surgeon he also examines there appendicitis oh my God he was on tiptoe sun the holiday is over let's go straight to the hospital it's over, but it's with a doctor, yeah I'm stubborn, I said, I'm just going tomorrow, I'm not going today, My God, I'm traveling. I went back to São Paulo, I went to the hospital, then I found him in the emergency room, I found my teacher Then he, oh, come here, come here, he examined me, boy,

you still have a lot to learn, don't you? Pendicitis is colitis, I said no, Professor, look, there's a penditis in this region, he operated on me, no, it's not colitis, I'll prove it to you Hmm, and then he did a bunch of tests and saw that it wasn't a pendicitis, so he gave it to me. an anti-inflammatory, take this anti-inflammatory and go home, I'm scared to death because an anti-inflammatory in appendicitis could do the opposite, you get a suppuration and it was chipped, the cemia, I took it, I got better Uh, a week later, a

laboratory representative came by and talking about a a certain food intolerance test, so I asked him, let's do this test, I want to find out what happened to me, I took the test and you were fine with that anti-inflammatory, the point Passed, I was much more worried, but any time, any time, this thing is going to explode. right here , I took the exam and it turned out that I had an intolerance to some foods, including barley and corn and some others that weekend I had spent the entire weekend eating popcorn and drinking beer, the

perfect combination, right? I said damn, I removed that, that and the other foods, I improved a lot, so it was my first , uh, reality check with this issue of inflammation first, right? for my patients in a way and I kept repeating it but the story is long and difficult to explain so I ended up writing the book to show one of the ways to identify these foods that trigger each one's trigger, it was corn and barley at that time Today, not so much, but that's where the issue of Liak Gut comes in. Teaching intestinal

permeability is much more about more things than just that, but I needed to bring it in a simpler way for patients to do it, right, so the book came out from there. I needed to give them a solution, which is the anti-inflammatory diet, to identify what could be causing inflammation for them, right? It's simple, right? remember if you don't have it It's true It's definitely just that you can have an intolerance up to 72 hours after what you ate Uhum So you can identify various food and inflammatory factors by keeping a diary understanding what's behind

it, right but here you it also talks about foods that somehow have the diary all right here but that somehow have an anti-inflammatory power in themselves. So this is a big problem and a fallacy too and these are the anti-inflammatory diets in which there is a list of foods that cause inflammation and a list of foods that reduce inflammation And then, eat more of this, eat less of what you're on an anti-inflammatory diet, well, I had a patient who had an intolerance and absurd inflammation with Brazil nuts, which is a great anti-inflammatory food I said,

damn, There's something else there, so it's more of an individualization, eh, each body works in a different way, specifically this patient, she only got better when I removed the chestnut from stopping, for the love of God, people, I'm not talking to you, are you? This exact patient is talking about And there is something very individual, but there are some foods that are more likely to cause inflammation in the general population, an example like this everyone knows is wheat and gluten. Exactly, it is an auto-inflammatory, there are people who tolerate it There are people who tolerate

it, but most of them have some immunological response to it, so and more symptoms, too, of abdominal tension, gas, everything you're talking about makes perfect sense at the beginning of the year, now I went into hospital for a routine exam and at exam, I didn't do the exam, I ended up being hospitalized for other reasons and one of the things I went to investigate was an inflammatory process in the intestine. And then I did a whole reconstruction and a process opposite to what I was eating and it completely changed Bia I was already very worried

Wow, you've been having a swollen abdomen You're very swollen, that 's not normal, that's not fat, there's something And then we actually went through a process of removing some foods and that's really how my process zeroed out, so it is. very often as a surgeon I was that guy for a long time that the problem is there let's get it out and the problem is solved mentality bye when I had this reality check with me when I ended up on the other side I would have had surgery that day uhum I I would have had

my appendix removed and I'm sure it would have been that white appendix that I would have had to flick to make it turn red and be able to justify the surgery myself. I said damn there's a lot more to this and I have to worry about interesting food when things hit us we change our perspective of vision, more than that, when it hits our own family and then I go all the way around and arrive at that prophecy of my mother which was you have to do medicine to take care of the from your close

ones, right Uhum from you When my children were born, right, and it's good for my daughter, I had some problems, right, and so I went to several specialists, no one could help, And then I was always a guy who studied things outside of my specialty on the day. We were traveling somewhere I fell into an article and I had a light I said I need to do two things I convinced my wife She's a doctor too but I convinced her to take my daughter off gluten Uhum And it's for a month and if it didn't

work take it off do a ketogenic diet which is another one here that I can also explain and see what would happen I convinced my mother because if grandmother doesn't help, it's not for sure because she goes to grandmother's house and is spoiled. That's when we remove gluten one week M Ah, one week, it's me, the plan, the plan was a month. In one week, she resolved all the symptoms, my God, all the symptoms, he became a completely normal child, I said, my God, I ran into something here and it's huge because if none of

the specialists told me that there could be this correlation possibility, right, I stumbled upon something that no one knows for the love of God, right, or that's another problem, which is the hierarchy of knowledge in which people think that what they know is greater than the other, right, well, I said fine. Until that moment I didn't know what was happening but I had discovered the trigger possibility so I did Everyone's Genome at home Obviously for us to remove gluten from a child we have to remove it from everyone in the house so fam I I

have a son, a daughter, my wife, right, everyone is gluten-free, what happened this week, my daughter decided it, my son was in that period of night terrors, he decided it, my wife stopped having mood swings and fighting with me, sorry, wonderful, no, but you've already gone through it. It passed, uh, and I started sleeping better, but then you can argue You're sleeping better because your whole life has improved, yes, ok No, I can't say that gluten had a direct influence on me, but it had a great impact, an impact of peace in your home which

may have exactly improved your sleep so I did everyone's Genome and I discovered that my daughter has a Zinha mutation there and so does my wife and that they are inflammatory triggers my son doesn't have it I don't have it but this Zinha mutation it was enough to trigger the inflammation, it was at that point, no, no, when it happened to me, when it happened to me, I just looked at the Other side of the wall and said, there really is, there's a much larger field than exactly what we 're seeing when it happened. with

my daughter I said no now I'm going to jump over this wall and I'm really going to study everything about this subject and I'm going to dive in, cool, right? Then I fulfilled my mother's prophecy and then I sometimes say that I fulfilled my role on earth, right? I can die today because I'm happy because I helped my daughter have a life I saw better, better, right? So then came the story of the ketogenic ketogenic diet that first you did the anti-inflammatory, the ketogenic, then the ketogenic was next, right, at that time everything I had

already improved a lot but I myself was a little chubby, you know, I had done a ketogenic diet before and it had improved and the ketogenic one has a very strong anti-inflammatory character but you say the ketogenic one is radical because there is that one, there is the issue of radical schedules. In Radical Ketogenic we produce ketone bodies in such quantity that they have a very strong anti-inflammatory effect, unlike an anti-inflammatory diet in which you don't offer inflammatory foods. The Ketogenic diet obviously won't offer these foods that cause inflammation. changing the metabolism so that the

metabolism leans more towards de-inflammation, I understand it's like if you gain an extra ally you don't inflame And in addition you have an exact anti-inflammatory factor and there are people who do very well with ketogenic, no It's everyone, but there are people who like this, BR, as not everyone is corn and barley, right, that's what causes the exact problem, and so, as this is also a strategic, an anti-inflammatory strategy, I ended up writing it to try to help my patients who want to follow this path. benefit from the diet uhum it's specifically me that's how

the ketogenic diet is like that. Honestly I think everyone on the face of the earth should try the ketogenic diet for a month uhum because the people who do well on the ketogenic diet do so well so well afterwards they maintain that they deserve to know of this and then make a decision, I understand choosing to choose if you have never done a ketogenic diet in your life you don't know what a ketogenic diet is for you, you may be fine today but wouldn't you be better off on a ketogenic diet, right ? self-knowledge Surely

you make the choices ultimately you give freedom of choice to anyone when you give knowledge the exact possibilities we are born without the instruction manual Uhum And the instruction manual that we try to create is not the same for everyone and in addition to not having an instruction manual, we don't have a strategy manual, they are different things, right? I can't become a Formula 1 driver by reading the car manual, that's strategy, it's much more than just the manual. So we have to create throughout our lives and and If you allow it, it's proof that

it's possible to experiment. If you allow it, I think it's perfect, right? Because sometimes people think that you have to allow me as a doctor. Give you a diet, no, no, no, no, you have to allow yourself self-knowledge ex me I arrived too late for self-knowledge, right, I, I, in the first part of my life, right, I was in that flow of I'm doing what everyone else does, what I think is right, and that's the end of it, and I don't care about the answer. of my body, when I started paying attention to this, I

saw that Self-knowledge is very noble and trying to instill this in people to really understand their own bodies . here your freedom regardless of whether I'm alive or not I always say that the great doctor is the one who inspires when he is no longer here everything is going to be fine It's because you learned the path to Freedom I agree I show you this is the path here I I help you walk from here, but I can't walk this path for you exactly, but most people want the doctor to pick them up and take

them to the other side, which would be either the medicine that will solve the problem or the surgery that will solve the problem procedure only for someone to carry you and place you on the other side you have gained nothing in self-knowledge, learn nothing exactly and sometimes you have created a situation in which you will have to relearn the little you have learned you will have to relearn everything because you changed your body's metabolism exactly so uh and that's where ketogenic exercise also takes place, you completely take PR away from people knowing that carbohydrates are

totally Zero carbohydrates based on protein and fat based on protein and fat exactly it's not for everyone It's much more restrictive than an anti-inflammatory diet, but it brings extraordinary and enormous benefits to people who do well with it, right? So there are countless studies with even oncological benefits, right? [Music] that's what it's all about, right? because the Cancer cell feeds on glucose, it's a yes, it's a sucker, it's a very cool vampire, huh? So really, ketogenic for those who have it, it's a malignant tumor, it makes perfect sense. I remember I had a patient who

took her husband with her while she was there. During the consultation with me, she was undergoing chemotherapy and then afterwards she said, Doctor, now I'm going to take So-and-so for an ice cream, I said don't do that, he just had chemotherapy and you're going to give him nutrition for the cancer cells, Doctor, he deserves this. I said no, he doesn't deserve it, he deserves it, the opposite, begging you, don't do that, no, the little animal stayed there during chemotherapy, don't give him sweets, then until I convinced him, I had to get a book, eh, anti-cancer

diet, okay, okay, okay, there She said, Doctor, I was doing everything wrong. I said no, but God forgive you, I didn't know, there are people today, we're talking a lot more about this, but we make cupcakes to celebrate the end of chemotherapy, then put the brigadeiro on top, that's it, conv, one of the reasons for writing the book was the convincing because I explained all this and then the patient would go out and start listening to information by ear from people who don't know anything about the subject and then saying Ah, you won't be able

to train if you're on keto, that's it, if you come, I'm clearly aware that I'm just another doctor in front of the patient, so if my information is the same as that of another doctor or the same as any information she finds on Instagram or or, in fact, if there's something opposite to what I'm saying, she's ready. it won't do one or the other and it becomes inert, right? So one of the reasons for writing the book was to try to hold the person in C so that they can reason, let's take it easy, we'll

get there, eh, be patient, block out the noise, right, I don't want to. Well, the noise gets in the way of the main points we're talking about here, You talked about the issue of genetic tests, right, for food there are also genetic tests that come with the best diet, right? For example, I don't do well with ketogenic mine really is like that, I've already done ketogenic, I do very well in the sprint and then I'm losing energy, but I'm getting a little silly like that, you know, I'm a bit sea but you have this knowledge

but then mine was but every now and then I like to do it, it's to give me that metabolic shock like that, I said oh, I need it, reset it. the carbohydrates are there, I like it a lot, I'm genetically Mediterranean and I really do very well with salad, the Mediterranean diet, I like to say that it's that diet that you, for people who don't want to make mistakes, no, but no, no, for you, it's a I get it right but the Med diet is that you don't make mistakes you may not hit the target

exactly But you're in the right direction there I need this fat thing for the intestine to work if I eliminate the fat then it won't go I need a literal oil right then, but then it comes to exercise, which was also a subject that I would consult with and sometimes I would spend An hour talking about exercise, I said, my God, I lost control here and no, and I can't take it exactly because exercise is bad. carried out, it can certainly cause inflammation and then it can also be an inflammatory trigger, so I've had several

patients, but one that stood out to me was one who exercised every day, including on Sunday, some days, twice on the day, and then she I couldn't gain muscle or lose fat, so I didn't have another trigger, there wasn't another elephant in the room, I turned to her and said, reduce the intensity, that's all, she, oh, I'm not going to do that because it's already difficult, if I do that, it's going to get worse. I need to rest my muscle mass and it came back. After I had gained 5 kg of lean mass, I asked

what you did. Decrease the intensity, right? So that's the extreme. That's the extreme, right? what we can do to help with Exercise, no, and it also comes with an injury, right? These are Areas that we need to target in order to have a better response and then I realized that I needed to write this down otherwise it would just stay in my head and there would also be that thing that says the patient at the time of the consultation listens but then no and then You go to the gym and then someone says something different,

then the clash comes and you don't do what the other person said or what I said and then the person becomes inert And then there's also something that I think is cool to comment on, eh I 'm obese, right, I may be thin today but I'm obese so I, your metabolism works, I have to always be thinking about it, so I've been in the position where I looked at people running marathons, it's crazy How can you do that What a boring thing, right? I was a healthy chubby guy because I went to the gym at

least twice a week so I considered myself a healthy chubby guy. My dopamine in the gym was zero, I think it even drained my dopamine. And then I realized that my problem wasn't with my exercise. The problem was that I didn't know where my dopamine was, where exactly I was going to find it and I realized that it's The problem with most people with lipedema is that many of them, right ? Most doctors at least have a good intention, right? So they say you have to do physical exercise, but when the doctor says that and

that's all, the only thing that goes through the person's mind is what the gym is like, then I remember. healthy chubby guy going to the gym with zero dopamine oh that was more stressful than anything else, exactly, right? Then when I discovered my sport, right in this case it was table tennis, I realized that I needed the competition, I needed it, table tennis has the speed, it has eh, it has everything, everything I need, not too much, I spend more on table tennis than it is then Eh, when I realized that, eh, I could also

be the one who I thought was crazy doing a marathon, I could be the same crazy person in table tennis, exactly and then I said damn So that means that everyone can meet, everyone can meet, but the big mistake is that the doctor said that it's exercise, it's the gym, but children don't, right, children have sports schools when children go there Do a little bit of football, do a little bit of volleyball, do a little bit of everything And then choose what you like, the poor adult is limited in one option or another, it's true,

right ? In the same way that there are triggers, eh, food, there are also triggers from poorly done exercises or because doing so, displeasure also inflames, yes, people don't understand that, oh, any exercise is good, no, what you don't like is terrible, because because it will stress you out, it will stress you out. and there is also another factor when when I left the gym I said accomplish my mission I deserve to eat something and I was going to eat the worst rubbish I could find today if I'm playing table tennis and I have 15

more minutes I said let's go play for another 15 minutes I'm not going to eat anything because I deserve to do what I like Exactly, look every time someone uses this expression a lot I deserve it I deserve it review this What I deserve is I deserve to buy Because I worked I deserve to eat I don't know what because I don't know what I deserve to drink because I don't know what there has to be reviewed because it's a I deserve it autom exact That's what you have to have quality of life exactly quality

of life exactly And then when I I I started to realize that most lipedema patients have a TDH profile uhum hey I studied I wrote an article and published it the first article on the association of TDH and edema was mine uhum and I have an easy time identifying TDH because I have it too so people it's not possible Ah, I don't believe in talking about something, both of them here are TDH and dyslexic But there's one thing, I swear to God, I didn't know, you are and the rate is reaching 80% the people we

call and people are thinking that we call knowing We We don't know, I just found out about this now, so for the love of God, we don't know, it must be this satellite dish, yes, so I made this correlation, please, I want this article to put it in the human community, I'll send it, yes, and then That's when it hit me, damn, the same difficulty I had, which was a lack of dopamine, is the difficulty my patients are having And if I apply to them the strategy that I used for myself and which worked The

Search For I'll tell you a story that this Dopamine thing is very interesting, look for it, I exercise today almost every day, almost because, because there isn't a table tennis championship every weekend, because if there was, I would be there every day, there was a day that I year last time I jumped because I had to do something I skipped my exercise ex And then I went to do what I had to do Look at the madness I couldn't take it in the middle of the morning I took the car I went to the gas

station I bought some snacks I came back I put the snack in front of me and said it's the dopamine from this crap that I'm looking for, it's not that, I don't need it, I'm not hungry but I couldn't control it, I know, I'm aware of what was happening, I couldn't not eat the snacks, snacks and then it became clear to me that early exercise, dopamine was my dopamine that kept me under control And you're saying something so interesting because there are two types of dopamine, right? Instagram cupcake snacks and there is one where the

graph goes in a constant, which is this, right, which is doing what We like, exercising what we like and studying what we like, this is this dopamine that we want then you control the rest so it was like this. It was clear to me that if I skip the exercise I have to have some other strategy to control it, otherwise I won't get it perfect, but it also made it clear that it was exactly what my patients were looking for. when trying that sugary food that sweet thing that I don't know what They have the

TDH profile and they are looking for their dopamine exactly if I start to solve it and the worst of all TDH is impulsive TDH is not stupid TDH is impulsive very impulsive And then there are a lot of people taking advantage of this impulity of women with lipedema because if you put a next best attempt at treatment I'm going to skip it because the next one is there so the next one is device to treat cellulite Ah, I'm going to need to try it soon, but you're exploring You burn what has to be done for

you and not for the device, what food, what physical activity that gives you pleasure, ex, I just think that's how people are on the other side, right? They are exploring this, they do it even Unconsciously, but these patients who have TDH who find the next Miraculous solution, they will jump on that one, they will jump to the next one, they will jump to the next one and they will be spending money and not having the result. surgery as a Miracle cure, go there and do it because you have this impulsivity And then you have this

Like I said, they are not stupid at all, they just have impulsivity after they say it, but it wasn't that and then comes the regret and then comes the guilt and here comes the drama, it's very sad to see this cycle, see what's happening, saying what you're saying, even through this profile, that patients with lipedema tend to have a TDH profile of impulsiveness and that with these impulsive things and regret and guilt, they they are more predisposed, certainly, to depression, depression, anxiety and TDH, right, they are the most common because anxiety disorder within TDH is

almost one, it's already common, it goes hand in hand, right, it's rare, but like that, depression is oooo step Next, right, is when you've already reached exhaustion, I'm I was going to use that word, it's more exhaustion than because TDH doesn't depress like a depressed person, like, it depresses due to exhaustion exon I want to do everything at the same time I want to do this but I want In lipedema, it's very common that mother of the family is there with eight tentacles Trying to take care of everyone's life around her except hers, exactly, right?

And then she tries to balance it all, I have that image of balancing the dishes, it's impossible You have to take care of yourself to be able to resolve the rest, you won't pass on someone else's experience, right? And then comes exhaustion, which some people will see as depression, I would say it's depression due to exhaustion, which is different from the depression caused by the disorder. Depressive, right? It's different, we know the difference exactly, TDH depresses in an exhaustive way, mental exposition, exactly after he does a lot of things, he enters this situation that then

our T goes into a depression, but it's not a depression, it's wear and tear, right, exactly due to wear Bru Let's go to our pipinho reporter Oh that was it and it caught my attention A lot of attention this last year very sad story very sad, right, like that influence, Right? It was having surgery for lipedema, if I'm not mistaken, in the knee area, yes right and they don't like the way her knee looks, it's interesting, it looks like she lost work. She was a beautiful girl, right, a beautiful girl, right ? the surgeon swears

and good But regardless of that, she is a beautiful girl and it was told to her that she had lipedema And then the realization dawns that the surgery has to be done, I understand, it has to be done, look, look at the question of you offering this and the person with impulsiveness goes when the other side is not concerned with health but with aesthetics or with not seeing the big picture, right or with the dollar sign Zinho running around there you asked me I will give it to you Surely it was you who You asked,

it was you who asked It doesn't matter, there is enough information for you to know if it is a choice or if it is simply a manipulation, we have to, as a doctor, we have to deliver what the patient needs and not exactly what he asks for. and this is sometimes painful for the patient and even for the Doctor It would be great if we only gave good news or or sold miraculous products, but often we have to tell truths and people are not so prepared to hear these truths speak these truths, whoever is prepared

will reach self-knowledge and be fine, right, her story so I didn't examine her, I can't say if she had it or not, but what I can say is She could have it. So because there are a lot of people who spoke in the time Ah, she doesn't have it at all, she can't have it, she can have it in an Initial stage and very well in stage one and no never underestimate the symptoms of a patient with lipedema because what is not visible is the inflammation and the inflammation hurts, it hurts too much, ex exact,

and often this inflammation is misunderstood as body dysmorphia, so we improve the inflammation and it . Lipedema has pain, it's a main characteristic, we reduce inflammation, the patient becomes at peace with her body, she starts to like her body, it doesn't hurt anymore, right, it doesn't hurt anymore, she no longer has this aesthetic complaint, so it was really a complaint. aesthetics or was the Information in fact a symptom of lipedema symptom so looking at her I believe she must be at her peak at the peak of this inflammatory issue uhm desperate looking for a solution

to her problem, right I saw it on a podcast here and those who have pain have it It's true ISO talking about Betinho, right, those who are hungry are in a hurry, but those who are in pain are in a hurry, are in a hurry, so she wanted to, she couldn't wait, right, she went looking for the quick and miraculous solution and there was an eventuality, right? I don't know the details, I can talk about any procedure. any anesthesia any procedure anyway, so it's one it's one it's a sadness he made a point of bringing

it to to give a warning, right to people, it's what I would say is what happened happened because of the urgent exaction of the problem that wasn't a problem a solution M that on the contrary, lipedema in the primitiveness of humanity in the primitive times she would be able to carry a child in a bad time and both of them would come out alive, certainly, certainly And then there's the other one there too, right from the society that imposes an aesthetic issue and that's tough, no matter what they say today, I think the Standards are

still unattainable, especially on social networks, unattainable and malicious, even causing harm to health, more stress, more inflammation, right? Let's go There, bru Well, let's go, we've arrived at our moment pipinho that he reporter pipinho we have a community that is the community of sustainable human beings and when our guest is close to coming we introduce him to our guests and the possible networks they have and They ask within their content questions that they would like to ask and that I think helps everyone so they are questions asked by them and sometimes you will say wow

but I like to talk about this because exactly they research this a lot and went there OK, they went there Wonderful, we can start, I read, no, I read, ask Dr Alexandre What is the relationship between vascular health and brain function, damn, the brain needs a lot, a lot of blood to function properly, if the vascular function isn't working, the brain doesn't work. There's a way, the brain is more than the muscle, it depends, right, more than the muscle, more than the muscle, for some people, no, I loved it, okay, but in theory, in theory,

it's more than the muscle, but like that, we have the carotid arteries, right? and there are the vertebral arteries, they are the main arteries that nourish the brain in the carotid arteries, the biggest vascular problem that we encounter is atherosclerosis, the carotid plaque that can lead to evc stroke, but often when this happens it is already too late because it is already like this decades of endothelial damage that is occurring and decreasing cerebral vascularization mainly due to the inflammatory issue, mainly inflammatory, yes, that means everything comes back, right? It's all interconnected . something that ignites

or ex is what we have to talk about cigarettes cigarettes is kicking a dead dog nowadays, right, everyone knows something cool, I think the thing to comment on is how well Brazil has become with the issue of cigarettes compared to other countries, even more on the front, in quotation marks, in Brazil, there was a real reduction, Brazilians smoke little today compared to other countries, this is very cool because it reduces vascular diseases, it's true, right ? of the next Chapter, right, exactly, which seems to me to be scarier than tobacco itself. I think we're going

to miss tobacco or not at all, but that's not the case, but I understand, you understand what I meant, right, but I understand next time, Bru asks how the health of our blood vessels can influence cognition Ok I think it's the same way, right? cognition, the brain is all there in the no, if blood doesn't arrive, blood with good nutrients doesn't arrive, that's what I can say more, eh maybe go a little deeper into the inflammation, right? The telal wall is the first layer of cells inside the vessel and it is extremely sensitive and before

I believed it was just a cell wall with no function but it is metabolically very active it produces something called oxide nitric acid which is responsible for vasodilation and when we have vasodilation we can have vasoconstruction, also when we have vasodilation there is a greater supply of blood so if we lose this endothelial function which is what inflammation causes or the species reactive oxygen levels, oxidative stress ends up decreasing This endothelial function, we will reduce cognition, right? So we have to keep the vascular wall functioning to maintain cognition. I certainly was, I was remembering here,

about 5 years ago, a soft plaque was located. and in my carotid artery, I don't know if it was right or left And then I just know that after that I started doing everything very de-inflammatory on my own, through study, and not just changing my diet, physical activity, some anti-inflammatory supplements, turmeric, example and the tantina I did it My Way And then when I went for the exam last year it was very funny I went in there Sat let's see, okay, I just want her to be stable and in a little while the doctor will

come because it was there recommendation sign the man will come It's ok with you, I told you everything in the cop, sorry, you don't know what it is, I said, I don't know what caused a problem, we're going to have to redo it, no, are you sure, was there this sign? I said, look, it was done there during the exam. I even opened the place, it's super good, he said no but there's nothing I already redid it I redid it I said ok And then he said a sign doesn't go away Then I said it

stabilized that's it then he can't see it he just doesn't mind staying a little longer not going in go back come back I said people so if it disappeared if it didn't disappear if he thought it might have been someone else's mistake I don't think I don't think I think it was there it must have stabilized because ultrasound doesn't have this capacity but sometimes there is a small scarinspiration and in which I had to give him the news that I never like to give, which is that I had to amputate my leg uhum, right, but

I still told him you're in such a bad way that I don't even know if you can handle it because the problem is so big I understood then he turned to me and said, Doctor, I'm going to do everything you ask of me, everything, everything, to avoid avoiding, I don't think I had ever said that but I turned around and said, now it's too late, now I can't do it anymore, right? Then I received it the news a month later that he had canceled the appointment because the family that had canceled it had passed away

I understood so you saw the problem your trigger for change was early you did what you had to do and Wonderful some people need Wow, reaching the limit, reaching the limit To really wanting to change That's it, it's like playing Russian roulette with life, right, it's sad, very sad, but medicine has a limit, we have a limit of what we can do, there's a limit, and so I think you talked about the quality of life, right? It's essential that we think about this. I don't want to be that person who's going to give others trouble

up front. I'm also a strong supporter of women from Mothers, right? this role of Wonder Woman who is responsible for the children Works outside the home, does everything and this love that women have, especially like this, lipedema can happen to anyone, but right? A lot of it is this self-care that we have to have because before I want to take care of someone I have to take care of myself, right, so I can be there to take care of my son, I need to be well, otherwise I'm going to leave that exact child and we

often see in the history, right, we want Health, this one is going to last longer, I'm going to prioritize my son I'm going to prioritize my husband, I'm going to prioritize work and when she looks for help, sometimes it's already too late, that's how many times we See that Car like that, no, that's no big deal, I'll wait another year and lots of stories I take them in the office like this, right, patients, truths are hard to listen to But you only change based on the truth. How many patients, I'm sure you must have had

several, who stay for exams or postpone going to the doctor and still say I'm not going because I don't want to find out what it was like. On the contrary, well, if you find out, you can do something Of course, you certainly have obsessive thoughts and want to avoid it Dr Alexandre How can we identify early signs of vascular problems such as stroke early signs of clinically it is no longer early the definition is carotid disease it It's asymptomatic It doesn't bring any symptoms and you have to do it prophylactically because if you wait for

your mouth to crook, it's a headache or the first symptom is AIT or a stroke, the first thing that will happen is catastrophe. So you have to get a checkup prevention there is no way to escape this prevention, exactly, especially those who already have the risk factors, right? The more risk factors, the sooner you have to do It, dyslipidemia, dysemia, sex, male, you have to start investigating first, right, male, the probability is, gender, sex, I don't know anymore today day, in this case, not men, right, regardless, in this case, women with lipedema are more protected,

right? Surprisingly, it seems that vascular and cardiological problems are 100% protected during this period, a very interesting thing, most patients with lipedema have their HDL burst. up which is good cholesterol exactly it's there 60 70 it's marathon runner level they go to the doctor and then the doctor takes the tests and says wow I'm jealous of your tests and then she comes out in quotes with the diagnosis of healthy chubby girl exactly no A healthy chubby girl is nothing, she has lipedema, which is a great cardiovascular protection, which is why she has this HDL, even

though she is sedentary, if you don't do something very well coordinated, you just need to know how to drive. Exactly because otherwise you take that away, you can take away all this. metabolic balance, which is what happens afterwards, the cholesterol profile becomes rubbish after the surgery. So you can have surgery if you have already resolved the inflammatory problem you already have, but Are aware that you will be a different person metabolically, that ease in controlling cholesterol it will no longer exist you will start to have the difficulty that I have as I don't have lipedema

so you will have the same difficulty to control perfect cholesterol next Bru What is the relationship between cardiovascular health and mental health in what way anxiety depression it can impact vascular and cognitive health, we talked about this, right, about it a lot, I think it's too much, I think it's so much so that I don't usually say that what's good for vascularization is good for everything and what's bad for Vascularization will be bad for the brain mainly because the brain needs a lot of blood with good nutrients, because also if you decide to eat only

junk you will flood your brain with junk Hi, interesting, this one came out last month, an article from last month, and they did a study. with carotids with plaque And then they took the plaque off of the people, put it under the Ultra special microscope and found microplastic plastic, they made two groups of the people they found plastic and The people they didn't find plastic, the ones who found plastic had a much worse evolution all of them complications occurred in this group, where is this microplastic coming from in the carotid artery ? It's not an

article either, but every now and then I get nosy, I didn't tell you in your first question because vascular surgery, right ? there is the organism It really is the universe each organism is the universe next Bru What are the main benefits of lycopene for vascular health in which foods lycopene is present OK lycopene lycopene is in tomatoes It's in watermelon, it's in guava, right? It's the red pigment, red pigment, that's what I'm talking about, lycopene has a lot of properties . a flavonoid they are different groups but they are all phytotherapeutic also lycopene has

an effect it doesn't mean that all red foods have the same one, for example strawberries it has nothing to do with eating tomatoes Tom is not the same thing now lycopene hey, it has an effect on stabilizing the mast cell wall, so it reduces degranulation and the release of stamina and stamina is the trigger for inflammation, yes, so it's the inflammatory chain, the inflammatory chain, right, the mast cell is our first cell of defense, right? it warns the rest of the body that we are being invaded by something and it warns us by doing this

by releasing stamina, it is a normal process that has to happen but there are some people who have this kind of rampant And then lycopene has the ability to stabilize a little bit of this membrane, a little bit of this Cascade starts to trigger inflammation and then it also has the anti-inflammatory effects of the natural flavonoids, it's a super beneficial substance, eh Unlike reviewing astrol, They are also equivalent there, right? Unlike all the others It's lycopene, we need to process the food for it to become bioavailable Uhm So, you can access more lycopene in tomato

sauce than in pure tomato fra. Uhm, I understand what I've already reviewed astral, no, and all the others are, it's the opposite, ok. perfect next Bru question D Alexandre could you explain how fructose or sugar found in fruits and other foods can negatively impact vascular health Wow, but they're getting really deep, I said, they're a bit obsessive about health and not everyone is self-aware, not the majority It's not the case, it's the majority, it's not, so let's go with fructose, it's a sugar, it's like other sugars. But there's a difference from other sugars, which is

the way it's metabolized, so much so that, uh, that's not current, I'm talking about the past. Fructose was indicated for the treatment of diabetes because it does not increase insulin, so it was an indication and today we know that it doesn't make any sense because it will increase metabolic syndrome, visceral fat and everything else, there were even fructose-based sweeteners. It was crazy and there was that Fruit diet. Do you remember that there were diets where people ate only fruit for 15 days, there was gluten bread, right? These are such absurd things, right? So the way

in which fructose is metabolized is different, but it continues to be a sugar sugar, right in fruits, it comes with a lot of flavonoids, so there is no work showing that the consumption of fruits will lead to a worse metabolic condition and everything else, no, I'm talking about everything within moderate consumption, right, the person eats a box of persimmons goes mod goes sza right now the fructose that comes in cyop in syrup right Eh, it's a poison, that thing and it's what is also used in soft drinks in juices to sweeten it, it's very related

to the syndrome metabolic and vascular disease, so moderate fructose from fruit is healthy. Any other external fructose is not recommended, as are boxed juices, that's right, next syrup. Bru, what concerns should we take when consuming foods rich in fructose? lifelong moderation in everything, even too much water, it can be bad to dilute it, right, when the person arrives, I had a patient, I want to one day be able to drink 10 liters of water a day Fi You're crazy, you 're going to dilute all its components next Bru asks how obesity and related diseases can

affect cognitive function there are specific measures we can take to mitigate this impact we talk about, right, everything that improves vascularization will improve You know what I find interesting, it's obvious, right, because of your specialty, because of yours, too, right, the community She's worried about her cognitive function, I think it's an important focus, I think it's a fear, and it's a fear, and it's easy to understand, being afraid of losing your cognitive functions, to begin with, very The fear of losing a leg is greater than the fear of ceasing to be, because when you lose

your memory, your cognitive processes, you cease to be you. There's one thing I'm afraid of, and that's losing it. You can say that we made an appointment to come here and two weeks ago I had Covid and I had that post - covid syndrome. It's a lot, I said, My God, it's not me, I'm going to call her, I'm going to cancel, I said, but I can't cancel because then she won't call me again, no, that wouldn't happen, everything went well, but it's not with Neva, isn't it? No, no, it's already balanced, it's going very

close Bru What is the action of the superoxide enzyme, damn, it's full of biochemicals, there are foods or supplements that are especially rich in this enzyme, superoxide dismutase, okay, superoxide dismutase, it's one of the anti-inflammatory pathways that we have, right? There is a positive enzyme, it is a good enzyme, people see inflammation as a bad thing, inflammation is not a bad thing, there is no life without inflammation, we need to have a balance, life on the face of the earth, it depends on whether we think about a scale, it tilts towards inflammation and that is

normal, what it cannot do is tip too much or too much to go down PR, we breathe, we have oxygen, which is inflammatory, inflat life, life, it is a balance between so much of inflammation that we can have exact, so if we reach this balance with a little bit of a risk for inflammation, what can I say About superoxide dismutase, that's what it is, that's what pushes the scales to the other side, we you have to have enough to maintain and my grandfather liked to say that it's enough enough it's not enough it's enough it's

enough it's enough it's enough to keep it balanced Uhum So eh eeee we have this mechanism in the body there are some people who have a genetic change and this enzyme is not that efficient and then we need to give it a little help and this support can be in the flavonoids it can be in the diet so we find ways to stimulate this, improve this There are exact superoxide systems in foods or supplements, but I can't go out and say the name of yours. You're talking based on this enzyme that has a very interesting

anti-inflammatory effect. We have four major pathways, right? glutathione and superoxide dismutate are the two main ones, uhum, perfect, next, glutao is very good, there are specific risk factors that increase the probability of a person developing varicose veins . Wrong choice of Grandparents is as if we could choose grandparents, right, but it's the main genetics, but there are several other things, right, obesity, for those who have genetics, there are triggering factors and worsening factors, so a pregnancy um o a trauma that may have caused a thrombosis can lead to post-thrombotic syndrome and varicose veins a trauma

leading to a venous artery fissure There are several things now to bring up the subject of lipedema a little bit because this is not written clearly in the literature and I have already I'm talking more about my head, because you experience the two go together, varicose veins and obesity and lipedema, lipedema, so this Association is where in a Gene which is mthfr which is methylene tetrahydrofolate reductase this Gene has already been implicated in the Genesis of varicose veins now it happens in everyone, not just those who have inflammation in that location and the inflammation destroys

the vessel wall, saying it's genetic, but the unbalanced inflammatory process causes this, eh, let's say this is how genetics manifests itself, but that's exactly it, exactly, I have one. one of the worst genes for obesity Uhum I'm obese I'm thin today I'm Continually fighting against my genetics so oh I have this Gene I have to go out crying and say there's no more chance no you have to do exactly the opposite you have to trying is almost like, like, I'm going to deceive you, it's almost like playing a little game where you pick up the

enemy and you kind of try to take paths that he doesn't know so he doesn't like that let's stimulate the good genes that I have, right, I obviously have some good genes and although I have this and another, so let me elaborate here, this is epigenetics, right? Let's modulate what we can with the environmental factors with the phenotype, right, ours genotype nosas n perfect this next Bru Ah now we arrived Alexandre at the moment pipinho is a moment the pipinho is this happy happy celebrity is our symbol Here, Ana's son, he likes to listen to

great content so he participated here in this content and now as you a pingpong athlete It's true, it's going to be easy, table tennis, it's going to be easy, he's going to play through his mother, some questions and you give back what I saw in the cab, whatever comes into your head, if you want to pass, pass pipinho, don't take anything Personal, it won't get you cheat if we have to call him again we will call him with or without covid Ok let's go T now we will have to call him again because Without covid

without covid it must be better it is even much better a quality of life health quality of life is the future quality of life is everything without quality of life we ​​no no it's not worth living perfect two motivation family no he plays PIS this boy plays P deois really everything that I did in life was for my own eh it may seem so a little bit, that speech from your mother, a little egocentric, a little bit, but that way, I can only teach others what I have for myself and my family, such as the

best values, I can only propose surgery for myself if I did that. for my daughter perfect so I can't say anything different perfect perfect love now you're going to confuse love is love is it's a chronic thing love is something that lasts love is it's more than passion right love is something you can take forever I think it's difficult to say I think it's a very vague concept , Right? We can have it for everything, I also have it for my profession, it's love, I have it to show love, I have it for learning, love

I have it for talking about, it's communicating, love I have for positively changing people's lives, right? That's all love, I think it's more. than only love has millions of facets is that we have to learn four challenges Oh my life is me I live for the next challenge I think that when it is no longer challenging it has lost its fun, there is no let's move on to the next one you don't hit the heart, right? It's complicated five Complete the sentence to be healthy is to have health is to have perfect self-knowledge I know

food Fundamental seven gratitude to my family More specifically it's my perfect grandfather what was his name Irani nová Morais Irani Irani The eight is If you could enter a capsule of time when would you choose to visit the past or future just once, right? You can't go back and forth, it's not that thing that asks the magician with the lamp for three more requests, it's just one, right, not just one, I think it would go to the future, my curiosity It's immense, don't go back to the past Look at the impulse, right, the perfect restlessness,

A book that you recommend, it can't be yours, it can be yours, it can even be a method of exercise, which is very good, which is from Dr. Per mter, which is a diet of the mind, a diet of mind has changed my life, it has changed my way of seeing a lot of things, that's cool, I really recommend it, I recommend the mind diet, but the restless mind, yours is excellent. Who knows, maybe we won't update it by posting this, his discovery, I think I'll go with that, eh, and now for complete Complete the

sentence to be happy is to be happy is to pursue some objective you have to have a goal you have to have an objective and you can change goals and objectives but you have to pursue and eh being happy is the path is not the objective But you have that having the objective PR I understand what you are talking about you are talking about a purpose you have to have an exact purpose the word is that but happiness is not there happiness is on the way to get there this desire to go and get it

exactly because the time To arrive, you have to have a next purpose, otherwise it's over, exactly, darling, I really wanted to thank you, it was a pleasure, it passed quickly, right, my God, I really wanted to thank you, I wanted to give it to you here, restless minds, Autographed, depressed minds, BR me, please and happiness, right? all autographed I want thank you here I want to thank you so much the exercise method for lipedema strategic anti-inflammatory diet the personal diet your personal diet and strategic ketogenic diet transform fat into energy I now want you to

use this camera here you can turn to it now to leave all your messages on your networks what you want to say to those who follow you for those who don't follow you yet feel free So let's go um me my main network currently is YouTube I'm there on YouTube as Amato Instituto de Medicina advanced, my personal one on Instagram is @d Alexandre Amato, I use these two networks mainly and social media, that's it, I wanted to leave a message for everyone who is actively seeking a better quality of life and is suffering from the

diagnosis of lipedema The first impulse is to despair but know that you are the same person you were yesterday before you knew, you don't need to make a decision that has no return before self-knowledge before you understand Your body, right, seek knowledge, seek information, be smart, understand that There are a lot of people trying to sell something, trying to sell a product, a ready-made solution and the solution is within you, I often see people saying Oh, but the high cost of treatment, not the high cost, the high cost, it's your time, it's your time. dedication

is your desire to want to improve, that's perfect, dear, I wanted to thank you so much, let's put the cycle together properly. Thank you very much. It was a huge learning experience, thank you very much, oh dear, we are finishing another episode of kite powder and today it was with this guy Here's a great Dr Alexandre Amato, if you want to understand everything that is vascularization, the importance and especially lipedema, don't forget to follow him on YouTube, his address will appear below for you, on Instagram and here on pod pipo a We believe that only

knowledge and self-knowledge can make us truly free because freedom is knowing the best choices we can make for each of us, thank you very much and see you next time.