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Author: Sylvia Marinova, PhD student in the Genomic Stability Laboratory at BAS

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Back pain, and in particular lower back pain, are attributed to the most common complaints of modern man. Largely due to the nature of work and daily life, leading to "sedentaryness", irregular posture and insufficient movement.

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This in turn causes the appearance of functional changes of the musculoskeletal system, and hence complaints described as pain, discomfort, stiffness or heaviness.

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In this article, we will focus on the lower back area, its anatomy and the most common causes of pain, as well as treatment options.

What-you-might-not-know-about-the-lower-back

What you might not know about the lower back

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Here is a brief anatomical reference to the spine device and in particular its cruciate area. Do not miss this part, even if it seems boring, because it will help you better understand the origin of back pain.

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Together, <a href="https://www.bioseek.eu/en/eng/research/pubmed/Treatment_of_chronic_low_back_pain_new_approaches_on_the_horizon_28546769" target="_blank" rel="noopener"></a> the vertebrae form the spine [ref.1], forming a protective duct in which the spinal cord is located. Thespine absorbs much of the weight of the human body and provides us with a standing, which is also supported by the musculature around.

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They form the lower back, starting from the last thoracic vertebrae and reaching the last part of the spine- sacrum. They increase their size progressively, allowing them to absorb most of the weight of the body.

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Between the vertebrae are the so-called " intervertebrae discs. They act as shock absorbers in the spine and take away the vibration and tension that is created when moving, protecting the vertebrae in this way.

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Each disc is made up of a rigid outer fibrous ringthat surrounds a soft gelatin-like core consisting of85% water, type 2 collagen and small connective tissue cells.

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The vertebrae are connected by joints and ligaments that allow the movement of the spine in different planes. There are also small and large muscles that support the entire structure. Their even development is extremely important for proper posture, as well as for reducing tension onthe spine itself. If the muscles do not function sufficiently, then the risks of trauma and pain increase.

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It remains to mention the nerve fibers that come out of the spine through small openings in the lumbar vertebrae. Where they are fed out ofthem, we call them nerve roots . Lumbarnerves are 5 pairs and inert the lower part of the human body, responsible for the sensory and movements of its parts. If the nerve roots are affected for one reason or another, it is possible that the pain will spread along their entire length and even lose sensitivity.

What-causes-lower-back-pain

What causes lower back pain

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The identification of <a href="https://www.bioseek.eu/en/eng/research/pubmed/Assessment_of_spinal_pain_26096091" target="_blank" rel="noopener"></a> the origin of back pain and precise diagnosis are of utmost importance for the appointment of the correct therapy. In general, pain is considered nonspecific [ref.2] in the majority of cases as the root cause remains unclear.

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Some common causes of back pain can be:

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<ul>
<li style="font-weight: 400;">Disc hernia - in this condition, the nucleus of the intervertebrae disc shifts, tearing the fibrous ring. Due to the structural changes that occur in the intervertebrae discs described above. The pain in this case comes both from mechanical irritation of the nerve roots and from inflammation that is caused. In some patients, acute pain passes within a week or two, but in others it remains for a long time. Other risk factors for a herniated disc are heavy physicallabor, overweight, weight lifting.</li>
<li style="font-weight: 400;">Muscle spasms and stretching - muscle spasms can be caused by trauma due to physical activity, injury or concomitant disease (e.g. fibromyalgia).</li>
<li style="font-weight: 400;">Spinal distortions - congenital distortions or those due to improper posture are very often the cause of backache.</li>
<li style="font-weight: 400;">Some diseases - for example, osteoarthritis, spinal stenosis, etc. Some of them can be particularly serious. Therefore, it is important to consult a doctor if we suffer from back pain for a long time and do not know what they are due to.</li>
</ul>

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Pain is defined as acute ,when its duration is not more than 6 weeks, and chronic , whenit does not pass at least 3 months.

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You will learn more from <a href="https://www.spine-health.com/video/video-understanding-different-types-back-pain" target="_blank" rel="noopener">this video</a>.

Role-of-the-muscles

Role of the muscles

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There are large and complex muscle groups, the role of which is to keep the spine in an upright position, take away from the tension on it and allow it different movements such as twisting and bending in different directions.

Role-of-the-muscles_2_1

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Some of them are involved in our daily movements such as pelvic muscles, but others remain unevenlyloaded . This leads to their weakening over time, and the consequencescan be muscle spasms, greater predisposition to trauma, as well as changes in the spine itself.

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Physiotherapy, as well as some specific exercises, can be aimed at strengthening the three main muscle groups supporting the spine:

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<ul>
<li style="font-weight: 400;">Spoilers (extensors) - these are the dorsal and pelvic muscles</li>
<li style="font-weight: 400;">Folding (flexors) - abdominal (abdominal) muscles and ilopsoasa</li>
<li style="font-weight: 400;">Rotators - hang on the side of the spine and are connected to the rotation and maintenance of the stand</li>
</ul>

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This is usually also part of the first steps in the treatment of back pain.

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See more in <a href="https://www.spine-health.com/video/lower-back-strain-video" target="_blank" rel="noopener">this video</a>.

What-is-the-treatment-of-lower-back-pain

What is the treatment of lower back pain

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Treatment depends on the root cause of the onset ofpain. In general, it can be divided into two groups - conservative and invasive treatment.

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The conservative treatment consists in taking medications that aim to reduce inflammation, relieve pain and relax muscles. Some of this type of treatment is also physiotherapy and special exercises that strengthen the muscles around the waist.

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In the absence of improvement and conversion of pain into chronic, then it is possible to switch to more invasiveprocedures.

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There are different <a href="https://www.ninds.nih.gov/DISORDERS/PATIENT-CAREGIVER-EDUCATION/FACT-SHEETS/LOW-BACK-PAIN-FACT-SHEET" target="_blank" rel="noopener">types of operational</a> procedures [ref.3]that are chosen according to the specific need.

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In conclusion, we will say that prevention is extremely important. We can protect ourselves from the onset of back and waist pain and their recurrence by improving our general physical condition and making sure to create proper moving habits, consciously monitor our posture and develop our musculature informedly.

<a href="https://www.bioseek.eu/en/eng/research/pubmed/Treatment_of_chronic_low_back_pain_new_approaches_on_the_horizon_28546769" target="_blank" rel="noopener">Treatment of chronic low back pain - new approaches on the horizon</a>, Journal of Pain Research, 2017

<a href="https://www.bioseek.eu/en/eng/research/pubmed/Assessment_of_spinal_pain_26096091" target="_blank" rel="noopener">Assessment of Spinal Pain</a>, Best Practice and Research in Clinical Rheumatology, 2014

Low Back Pain Fact Sheet, NIH

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It is known that children who live in modern societies and in urban environments suffer more often from autoimmune diseases, asthma, allergies, atopic dermatitis, than children who live closer to nature. There are many reasons for this...

Children need to play outside for a healthy immune system

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Lower back pain, the role of muscles and treatment

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 Lower back pain, the role of muscles and treatment

Силвия Маринова

Atopic dermatitis causes the appearance of red and itchy spots on the skin. The disease is the most common form of eczema and is more commonly known as atopic eczema.

Its onset is usually in early childhood, but it can occur at any age. Although its etiology is not fully understood, there seems to be a complex relationship between impaired barrier function of the skin, dysfunction of the immune system, infectious factors and those of the environment. The disease is also associated with food allergies, asthma and allergic rhinitis.

In this article you will read what science thinks about the root causes of atopic dermatitis, what are its triggers and what is the connection with other diseases. You will also learn how to take proper care of the good condition of the skin and prevent exacerbations of its condition in you or your child.

Children-are-prone-to-atopic-dermatitis

Children are prone to atopic dermatitis

Children-are-prone-to-atopic-dermatitis_0_0

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Atopic dermatitis is observed in 10% to 30% of children and in 1% to 3% of adults in developed <a href="https://www.ncbi.nlm.nih.gov/books/NBK448071/" target="_blank" rel="noopener">countries</a> [ref.1] and in recent decades there has been a significant increase in the spread of the disease. It is more common in areas with a high latitude. Perhaps this is due to the fact that the humidity is low and access to sunlight is more limited than in areas closer to the equator.

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Atopic eczema usually occurs in early childhood . Up to 60% of cases begin in children even before their first birthday. Often the diseaseis "growing" by the age of 12, but in other cases it remains chronic and has its exacerbations in the later stages of life.

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An initial occurrence of atopic dermatitis is also possible in adulthood after puberty. Another unusual form of the disease is the so-called senenium dermatitis - dermatitis, which occurs for the first time in adult individuals over 60 years of age.

What-is-atopic-dermatitis

What is atopic dermatitis

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What-is-atopic-dermatitis_1_1

Symptoms of atopic dermatitis are individual and vary from person to person. As a rule, it is characterized by the appearance of skin redness, which usually cause severe itching. Since the disease is chronic, alternation of periods of exacerbation of the condition with those of remission (complete recovery) throughout life or part of it is observed.

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Other symptoms include:

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<ul>
<li>Dry skin - due to a lack of good hydration due to the impaired functions of the skin,</li>
<li>Itching - can be very strong especially at night,</li>
<li>Disturbed sleep - due to itching,</li>
<li>Cracked and coarse skin,</li>
<li>Sometimes inflamed skin maybe secreted or peeled</li>
</ul>

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It is important to note that the impaired protective function of the skin makes it more prone to secondary infections with fungi, viruses or bacteria.

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There <a href="https://www.bioseek.eu/en/eng/research/pubmed/Atopic_dermatitis_30275844" target="_blank" rel="noopener"></a> is a difference [ref.2] between the place of occurrence of atopic zones in children andadults.

What-causes-atopic-dermatitis

What causes atopic dermatitis

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The etiology of atopic <a href="https://www.bioseek.eu/en/eng/research/pubmed/Atopic_dermatitis_30275844" target="_blank" rel="noopener"></a> dermatitis is not yet fully understood.

What-causes-atopic-dermatitis_2_2

<ul>
<li style="font-weight: 400;">
Role of genetics - it is known that the protein filagrin (more <a href="../p/kakva_ie_razlikata_miezhdu_bieltk_i_protiein_b1b6b96e_e340_46d2_9768_ac9fa8cd6adc" target="_blank" rel="noopener"></a> on what proteins are found<a href="https://ghr.nlm.nih.gov/gene/FLG" target="_blank" rel="noopener"></a> here [ref.4]) is involved in the formationof the outermost layer of the skin, called the stratumcorneum. 
</li>
</ul>

What-causes-atopic-dermatitis_2_3

Homozygous mutations in the filamine gene (this means that both copies of the gene are damaged) are associated with the early onset of atopic dermatitis and the development of more serious symptoms. Heterozygous mutations result in disorders in 50% of the protein produced. About <a href="https://www.bioseek.eu/en/eng/research/pubmed/Filaggrin_mutations_associated_with_skin_and_allergic_diseases_21991953" target="_blank" rel="noopener">10% of Europeans</a> [ref.6]heterozygous carriers of this defect.

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The aforementioned mutation in filagarine cannot give a complete genetic justification for the occurrence of atopic dermatitis. It is known that differences in genes involved in immune system pathways are also a predisposing factor. Recent studies also indicate epigenetic changes (these are changes affecting which gene and when it will manifest itself) that play a role in the development of the disease. These changes are also due to interaction with environmental factors.

What-causes-atopic-dermatitis_2_5

<ul>
<li style="font-weight: 400;">
Disregulation of the immune system - impaired regulation of certain components of the immune system is observed, as a consequence of which is the increased secretion of specific interleukins such as IL4, IL13, IL31, IL33. This leads to a violation of the barrier function of the stratum corneum of the skin, allergic inflammatory processes and suppression of the secretion of antimicrobial peptides.
</li>
<li style="font-weight: 400;">
Neuroimmunological mechanisms - TSLP, as well as the aforementioned interleukins, lead to activation of signaling pathways that cause characteristic itching in patients. There is also a group of sensory neurons in the skin that produce histamine, which is again associated with inflammation and itching.
</li>
<li style="font-weight: 400;">
Dysfunction of the epidermis - it is the result of impaired regulation of the gene expression of proteins, Interestingly, <a href="https://www.bioseek.eu/en/eng/research/pubmed/The_skin_as_a_target_for_prevention_of_the_atopic_march_29413338" target="_blank" rel="noopener"></a> the malfunctioning of the epidermis not only leads to the development of atopic dermatitis, but also increases the risk [ref.7] of developing other allergies (such as food allergies) and leads to hyperactivity of the respiratory tract. 
</li>
<li style="font-weight: 400;">
Different lipid composition of the epidermis - different lipids have an important role in maintaining the barrier function of the stratum corneum. In patients with atopic eczema, their composition is different.
</li>
<li style="font-weight: 400;">
Disorders in the microbiome - last but not least, we will mention changes in the microbiome of patients with atopic dermatitis. <a href="../p/zashcho_chrievniiat_mikrobiom_ie_tolkova_vazhien_za_nas_i_nashieto_biebie_f1c8c877_5195_4564_831e_1e2eef76df59" target="_blank" rel="noopener">As</a> we know [ref.8] the microbiome is the coexistence of multiple microorganisms in different <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991899/" target="_blank" rel="noopener"></a> organs of our body. in our body as much as cells. 
</li>
</ul>

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The skin of patients with atopic dermatitis is characterized by pronounced dysbiosis especially during acute conditions. Some bacteria develop over-the-counter at the expense of others, disrupting the overall fine balance anddiversity.

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In other words - it is very important to maintain the good condition of the skin and intestines with the right care and lifestyle, but on this we will pay more detailed attention below.

What-are-the-risk-factors-for-atopic-dermatitis

What are the risk factors for atopic dermatitis

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What-are-the-risk-factors-for-atopic-dermatitis_3_1

Atopic skin can be affected by some additional factors, since it isespecially sensitive:

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<ul>
<li>Stress - research <a href="https://www.bioseek.eu/en/eng/research/pubmed/Psychoneuroimmunology_of_psychological_stress_and_atopic_dermatitis_pathophysiologic_and_therapeutic_updates_22101513" target="_blank" rel="noopener"></a> suggests a link [ref.10] between atopic eczema and stress.</li>
<li>Asthma or allergies (food or hay fever);</li>
<li>Materials of clothing - examples are wool and nylon. Exacerbation can cause including some dyes in clothes;</li>
<li>Cleaning products and cosmetics;</li>
<li>Too hot or warm weather - large and sharp temperature amplitudes too;</li>
<li>Cigarette smoke</li>
</ul>

How-to-diagnose-atopic-dermatitis

How to diagnose atopic dermatitis

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How-to-diagnose-atopic-dermatitis_4_1

Laboratory tests are not needed to diagnose atopic dermatitis . The treating dermatologist will examine you or your child and, based on a clinical picture and family history, will be able to assess whether thisdiagnosis is involved. At least three of the four main clinical findings in atopic dermatitis are needed:

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<ul>
<li style="font-weight: 400;">pruritus (itching),</li>
<li style="font-weight: 400;">chronic or intermittent dermatitis,</li>
<li style="font-weight: 400;">family encumbrivity,</li>
<li style="font-weight: 400;">typical lesion location (described above)</li>
</ul>

How-to-treat-atopic-dermatitis

How to treat atopic dermatitis

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The treatment of atopic skin is aimed at relieving symptoms. Depending on the severity of thedisease, there are various medications that your treating dermatologist can refer to. Here are a few tips foryour own skin care:

How-to-treat-atopic-dermatitis_5_2

<ul>
<li style="font-weight: 400;">Avoiding the sing-in,</li>
<li style="font-weight: 400;">Avoidance of triggers such as allergens and stress,</li>
<li style="font-weight: 400;">Regular use of emollients - they keep theskin hydrated , which is extremely important both in the calmphases and in the stages of exacerbation of the condition,</li>
<li style="font-weight: 400;">It is recommended that the showers be lukewarm and not toohot.</li>
<li style="font-weight: 400;">Some detergents and fragrances may irritate the skin,</li>
<li style="font-weight: 400;">It should be approached with great care to cosmetics - it is good to avoid the use of soaps and creams with an alcohol content</li>
<li style="font-weight: 400;">Baths can be made that relieve itching</li>
</ul>

Myths-about-atopic-dermatitis

Myths about atopic dermatitis

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For the finale, we'll debunk afew myths that are going on on social media aboutatopic skin:

Myths-about-atopic-dermatitis_6_2

<ul>
<li style="font-weight: 400;">Atopic dermatitis is infected - perhaps this idea has spread due to the redness and itching it causes, but as we explained above, the causes of its appearance are internal;</li>
<li style="font-weight: 400;">Children "grow it" - in some cases it is true, in others it is not;</li>
<li style="font-weight: 400;">Corticosteroids are the best treatment - corticosteroids are used to suppress the reaction of the immune system and relieve redness and itching. It is good to use them in more severe cases and for a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5901393/" target="_blank" rel="noopener">limited</a> period [ref.11] from time to time, as it is mandatory to be with a doctor's prescription;</li>
<li style="font-weight: 400;">Pets predispose to the appearance of atopic dermatitis - there are numerous studies in this direction and the topic is controversial. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052969/" target="_blank" rel="noopener"></a> In general, there is no conclusive data [ref.12] for a negative effect, and there is even research showing that cohabitation at an early age lowers the risk of developing the disease.</li>
</ul>

Atopic dermatitis. NCBI, 2020

<a href="https://www.bioseek.eu/en/eng/research/pubmed/Atopic_dermatitis_30275844" target="_blank" rel="noopener">Atopic dermatitis</a>. Allergy, Asthma and Clinical Immunology, 2018

<a href="https://www.bioseek.eu/en/eng/research/pubmed/Pathophysiology_of_atopic_dermatitis_Clinical_implications_30819278" target="_blank" rel="noopener">Pathophysiology of atopic dermatitis: Clinical implications</a>. Allergy and Asthma Proceedings, 2019

<a href="../p/kakva_ie_razlikata_miezhdu_bieltk_i_protiein_b1b6b96e_e340_46d2_9768_ac9fa8cd6adc" target="_blank" rel="noopener">What is the difference between protein and protein</a>

FLG gene

<a href="https://www.bioseek.eu/en/eng/research/pubmed/Filaggrin_mutations_associated_with_skin_and_allergic_diseases_21991953" target="_blank" rel="noopener">Filaggrin mutations associated with skin and allergic diseases.</a> New England Journal of Medicine, 2011

<a href="https://www.bioseek.eu/en/eng/research/pubmed/The_skin_as_a_target_for_prevention_of_the_atopic_march_29413338" target="_blank" rel="noopener">The skin as a target for prevention of the atopic march</a>. Annals of Allergy, Asthma and Immunology, 2018

<a href="../p/zashcho_chrievniiat_mikrobiom_ie_tolkova_vazhien_za_nas_i_nashieto_biebie_f1c8c877_5195_4564_831e_1e2eef76df59" target="_blank" rel="noopener">The intestinal microbiome is extremely important to us and our baby</a>

Revised Estimates for the Number of Human and Bacteria Cells in the Body, NCBI, 2016

<a href="https://www.bioseek.eu/en/eng/research/pubmed/Psychoneuroimmunology_of_psychological_stress_and_atopic_dermatitis_pathophysiologic_and_therapeutic_updates_22101513" target="_blank" rel="noopener">Psychoneuroimmunology of psychological stress and atopic dermatitis: pathophysiologic and therapeutic updates.</a> Acta Dermato-Venereologica, 2012

Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement, Br. J.Dermatol, 2018

Does Exposure to Cats or Dogs in Early Life Alter a Child's Risk of Atopic Dermatitis? J. Pediatr, 2011

Atopic Dermatitis in Children and Adults

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 Atopic Dermatitis in Children and Adults

Author: Yana Nencheva, Biochemist, PhD candidate in Biophysicist

Every 10 seconds, <a href="http://www.mh.government.bg/bg/informaciya-za-grazhdani/svetovni-zdravni-dni/svetoven-den-za-borba-s-diabeta-14-noemvri/" target="_blank" rel="noopener"></a>one person on the planet dies of diabetes and two are diagnosed with the disease. The World Health Organization (WHO) expects that in about ten years, more than 500 million people will be affected by diabetes.<a href="https://usbale.org/wp-content/uploads/2018/03/Doklad_Diabetes_Reg_2016_.pdf" target="_blank" rel="noopener"></a>

What-is-diabetes?

What is diabetes?

What-is-diabetes?_0_0

The hormone insulin is responsible for the metabolism of glucose (blood sugar). When for some reason the body can not provoke a normal reaction to the "orders" that insulin gives, or it is not produced in sufficient quantity, the path of glucose is disturbed.

What-is-diabetes?_0_1

In general, diabetes is an impaired metabolism that leads to high levels of glucose in the blood. By its very nature, diabetes mellitus is a chronic disease. The most common types of the disease are: type 1 diabetes, type 2 diabetes and gestational diabetes (in pregnancy). Type 2 diabetes is the most prevalent, accounting for 90% of the cases.

What-is-diabetes?_0_2

Detailed information on causes, symptoms and treatment can be found on the following links:

What-is-diabetes?_0_3

<ul>
<li style="font-weight: 400;"><a href="/p/vsichko_za_diabiet_tip_1_na_iedno_miasto_751da342_2d55_43af_ae7f_1e1c89cd3800" target="_blank" rel="noreferrer">All about type 1 diabetes in one place</a> </li>
<li style="font-weight: 400;"><a href="/p/vsichko_za_diabiet_tip_2_na_iedno_miasto_9b1be4d6_84a7_42c6_8e37_de3bd6480ba1" target="_blank" rel="noreferrer">All about type 2 diabetes in one place</a> </li>
<li style="font-weight: 400;"><a href="/p/diabiet_po_vriemie_na_briemiennost_simptomi_riskovie_i_svieti_245acb17_9bf9_4af8_a562_bd8e4664e6e5" target="_blank" rel="noreferrer">Diabetes during pregnancy: symptoms, risks and advice</a> </li>
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What-are-the-five-herbs-that-might-help-in-diabetes

What are the five herbs that might help in diabetes

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We will consider 5 of the most famous herbs, which are considered useful in people suffering from diabetes and those who are at risk of the disease. Do they really help, or is it just a myth that science debunks?

Diseases conditions and symptoms