miercuri, 31 octombrie 2018

Counting calories

All around the globe we are counting unsuccessfully calories and the obesity is on the rise. In my country all menus in schools and kindergartens have to be approved by a pediatrician or a nutritionist. I was asked at my kids' kindergarten to approve them, so I've searched into  the publication by our government vis à vis of this subject. It was supposed to count the calories for every portion and meal, the quantity of carbohydrates and fats. It's a stupidity sustained, sadly by other doctors. The body doesn't respond to calories, but to nutrients and  how those nutrients stimulates the  hormonal production. I don't say that all the recommendations are bad,  there are some good things ( not to sell sodas, tobacco and alcohol close or in schools, not  to use sugar in tea or too much salt in food, not to serve fried food), but I don't agree with  this calories thing.  The principle of counting calories is by burning a sample and measuring the energy/heat released, it has nothing to do with absorption and interaction with the body. (1)  200 cal of vegetables,fruits or salmon are not the same for the body as 200 cal of doughnut, chocolate or juice. And also, I don't agree that the animal fats are not so bad for a growing body, it's a nonsense to use low fat yogurt/cream in children. All liposoluble vitamins are carried with fat.
The anabolic hormone of the body is insulin which is secreted in pancreas and excreted in blood after ingestion of carbohydrates and proteins. What insulin does? It takes glucose from the blood and brings it into the cells, where can be used for energy, and the excess is stored as glycogen and fat. (3) (4) As a child the fat cells are not just growing, the body forms new ones too.  The  most dangerous period is from two to six years. A growing body doesn't need to fast, so intermittent fasting in children is not an option, so what can we do? There are some rules that can be applied:
  • there is too much snack, including in schools and kindergarten. It goes like this: from nine to four-five a child has two meals and two snacks. Those snacks are healthy ones, fruits and yogurt and cereals, but they still stimulate the pancreas to excrete insulin and insulin forms fat. After that the child gets home and I see them eating all the time after school, parents/grandparents praying  "please, one more bite". it's such a sad picture. At first the child refuses because he is not hungry, but if the parent insists he takes the bite, the body produces insulin and the insulin makes him hungry and then he starts asking for food all the time. The insulin level is coming down circa in an hour after eating something that stimulates it. What can we do about it? I suggest at least 3-4 hours between the meals and take the snack at the end of the meal not between them. Nobody talks about that, because there is a trend that says frequent meals on small portions is healthy. The result is that you are hungry all the time and not that you are not losing weight, you might gain it. And no foods after 8 o'clock in the afternoon, no snack watching TV in the evening. It's so wrong and dangerous.
  • the juices: my favorite subject. I can't get this out of parents mind. The fresh squeezed juice has the same effect as a soda. Give fruits to children which are healthy, have vitamins and minerals, fibers, that prevent the carbohydrates to absorb all at once and promote a good gut health. A kid can't eat as many fruits as you can squeeze in that juice, so it's about quantity too. As the body concern a bottle of  fresh orange juice is the same a bottle of Cola, same response.
  • the macronutrients  create the sensation of fullness, so you don't need to eat anymore. It's not the same with refined sugar, honey ( this is a subject for another time), white flour and juices, even fresh squeezed ones. 
  • spend time outdoors, at least one hour per day. They need to play, to be exposed to natural light, to be thought to have an active life. This is good for development of the eyes and protects from nearsightedness or myopia ( another upcoming subject). (5) (6) (7) (8)
  • you have to form a schedule for your child, after that you can make exceptions. I don't play all the time by the rules with my children, because the mental health, the acceptance by the society is also important. But I never beg my children to eat and there are not three meals/day.
  • the most important is for you to be a role model
dr. Mirabela Cascaval

La numărat de calorii, eficient sau nu?

E un trend peste tot în lume să monitorizăm câte calorii ingerăm, sunt aplicaţii peste aplicaţii, dar obezitatea este în creştere, pentru că ignorăm alte aspecte. Puţini sunt cei care se opresc o secundă şi zic că suntem pe un drum greşit că nu avem rezultate. Organismul uman nu are receptori pentru calorii, el răspunde prin secreţia de hormoni la ceea ce ingerăm. Chiar Ministerul Sănătaţii cere acest lucru pentru meniurile din grădiniţe şi şcoli, cantitatea de glucide şi grăsimi. O pierdere de timp, fără nici o bază ştiinţifică. Nu zic că toate acele recomandări sunt greşite, sunt de acord să nu se vândă sucuri, alcool, tigări in apropierea şcolilor sau în incinta lor, să nu se adauge zahăr în ceai, să nu se se săreze în exces mâncarea, să nu se consume salam şi alte semipreparate, să se evite prăjelile. Un alt aspect neplăcut este cel legat de a se servi smântână, iaurt, lapte semidegresat. Grăsimile animale nu sunt periculoase pentru un organism în creştere, mai ales că apare repede senzaţia de saţietate şi nu pot fi mâncate în cantitaţi mari. În plus, viatminele liposolubile sunt transportatede grăsimi..
Să revin la ceea ce discutam mai sus, organismul răspunde la macronutrienţii ingeraţi prin secreţia de hormoni, care au anumite efecte asupra lui. La ingestia de zaharuri şi proteine se secretă insulina, care facilitează intrarea glucozei în celulă pentru producerea de energie. Excesul de glucoză se depozitează în ficat sub formă de glicogen şi în celule adipoase sub formă de grăsime. Problema cu tesutul grăsos la copil este că se formează noi celule adipoase, nu doar se umplu cele existente cu grăsime. Postul intermitent nu este recomandat copiilor pentru că balanţa horonilor este diferită de cea a adulţilor, dar se pot lua câteva măsuri pentru prevenţia obezităţii şi supraponderalităţii şi combaterea lor
  • sunt prea multe gustări. La grădiniţă, de exemplu, intre 9 si 17 se servesc două mese şi două gustări. Chiar dacă sunt gustări sănătoase, formate din fructe, iaurt, ele tot stimulează secreţia de insulină şi insulina depune grăsime. Iar după ce ajung acasă vad copiii mancând nonstop câte ceva. E o imagine tristă cu părinţi care işi îndeamnă copiii să mai ia încă o gură, de dragul lor, care beau în loc de apă sucuri, limonadă, ceai îndulcit. Ideal ar fi să fie pauze între mese, de câte 3-4 ore, gustările să fie servite imediat după mese, să nu se mai mănânce şi să se bea nimic după ora 8 seara, să nu se consume alimente şi băuturi în timpul vizionării filmelor sau programelor TV. Din păcate, se promovează mesele mici şi dese ca fiind sănătoase, când de fapt, acestea nu permit să scadă nivelul de insulină. 
  • sucurile, un subiect pe care-mi place sa-l abordez. Toţi părinţii sunt convinşi că dacă e natural e şi sănătos. Când le spun că organismul percepe un pahar de suc proaspăt stors din fructe la fel ca pe un suc din comerţ ( Organizaţia Mondială a Sănătăţii zice că sucul natural e mai bogat în zahăr)  (1) au  o reacţie de parcă nu ştiu ce vorbesc. În primul rând nu apare senzaţia de saţietate, se pot bea cantităţi mari in 24 de ore. Cantitatea de fructe folosite este mult mai mare pentru un pahar de suc, decât ar putea să mănance un copil intr-o zi. Fructul conţine şi fibrele, care sunt importante pentru flora intestinală, pentru un scaun normal, febrele care eliberează încet monozaharurile şi nu împiedică absorbţia totală a acestora. În concluzie: limitarea sucurilor naturale la maxim un pahar pe zi, ideal ar fi să nu fie consumate zilnic şi promovarea consumului de fructe şi legume.
  • Am tot vorbit de senzaţia de autosaţietate, care nu este în cazul  dulciurilor, sucurilor, pâine albă. În schimb cartofii nu se pot mânca nonstop, chiar dacă conţin amidon, deci glucoză. valabil şi pentru grăsimi.
  • Copilul trebuie să petreacă cât mai mult timp în aer liber, să aibă o viată activă fizic, cel puţin 1 oră zilnic. Important pentru prevenţia obezităţii, dar şi a miopiei dobândite şi progresiei ei. Acesta este un alt semnal de alarmă pe care vreau să-l trag, că mi se pare că nu se vorbeste suficient în acest sens şi voi scrie un articol pe tema aceasta.
  • E important un program al copilului, dar la fel de important este să facem şi excepţii, să fim flexibili, că sănătatea mentală şi acceptarea copilului de către anturaj sunt la fel de impotante.
  • Si cel mai important este să fim un model pentru copiii noştri. Fiecare în casă respectă aceleaşi reguli
dr. Mirabela Caşcaval



vineri, 19 octombrie 2018

Cancer and intermittent fasting

Cancer: a scary word, nobody wants to deal with radio, chemotherapy  and surgery and be threatened with death every minute. So let's try to do what depend on us to prevent it. OMS has some recommendations: don't smoke, exercise, avoid pollution, eat healthy, drink alcohol in moderation, use screening test.
I want to stop on the subject of eating healthy and why I encourage intermittent fasting. As I said before every day in our body forms around 300 cancerous cells, that are eliminated by our immune system. When for some reason something happens with our immune system one of these cells starts to multiplicate and becomes a tumor. The reason why these cells forms are numerous and little known: heritage, radiation, pollution, oxidative stress, viruses, inflammation etc, etc
Scientists explain how intermittent fasting can protect the body from cancer. The main source of energy for the cancerous cell is the glucose and sometimes glutamate. The healthy cells of our body, including brain cells and cardiac muscle cell can take their energy from ketones. The ketones are the product of fat burning. The body starts to burn fats after 6-12 hours of fasting. If you don't feed the bad cell it will dye. Some studies say that people who do intermittent fasting during cancer treatment have a better response to that.
As I discuss in another article (7) intermittent fasting reduces the oxidative stress,the body is more vigilant and enters a state of repair and cleaning, modifies the expression of genes, phenomenon known as epigenetics.(1) (2) (3) (4) (5) (6)

It takes a little time to adapt  to hungry sensation, but all you need to know that it comes and gos and gets easier with time.

Mirabela Cascaval

marți, 16 octombrie 2018

Aging, what can we do?

As time goes by it is normal to think "What can we do to keep us looking young?" So: "What can we do?"
There is plastic surgery ( and it works!!!):

  • Botox it's accessible, (but truth be told I don't like a bit how it looks on an old skin);
  • there are some promises with hyaluronic acid  
  • face lifting classic or with absorbable stitches.

But if I want to postpone plastic surgery as late as possible, even I'm not at all against it?I 'm a doctor and I don't buy bullshit without a scientific research or at least some logic explanation. But something caught  my attention, there are some promising studies and it's not harmful so I have nothing to lose.
 I' m 35, I have two kids, I don't smoke, I'm physical active and people don't say I look older than 25 and I would like to keep it that way.

I was a skinny kid/ adolescent and I was ashamed to wear dresses, I wanted to gain weight and suddenly this happened between 23 and 29, especially after I was 25 years old. I started my residency I was stressed, preoccupied learning as much as I could to become a good  doctor, on calls I was snacking a lot all the time and drinking juice. I didn't become obese, I wasn't even overweight but I  was not looking good even I was working out. I saw photos with me from earlier years and the comparison wasn't in my favor and  I wanted  be like that  again. My husband always told me the truth how he saw it even it was hard to hear, but I like that, it shows that he cares. In the the fall of 2012 I decided that something has to be done. Diet and nutrition weren't my domain of interest, I knew some things from college, but I never needed to worry about weight. And when I thought to take care of my eating habits I came upon a BBC documentary " Eat, fast and live longer" with Michael Mosley about intermittent fasting.(1)
 People have been fasting for thousands of years, we are built to live like that, when we depended on hunt for food. Later studies suggested that even the children and grandchildren will be healthier if there are short periods of famine, phenomenon explained by epigenetics.(2) (3) (4) (5) (6)
 There are several ways to do that:

  • 16-20 hours  fasting and 4-8 hours of eating every day 16/8 or
  •  500 calories per day,2 days a week, or
  • eating once in 24 hours as many times as a person can do in a week, every week
  •  or long periods of fasting ( that needs doctor supervisions\ because it is the risk of electolyte imbalance) and then repeat the process after couple of months.
     I feel the need to add that fasting means no food or drink except water, a cup of coffee or tea without sugar, sweeteners or honey, not even beverages with zero calories. 

I started  it  with some pauses when I was pregnant with my son,  then with my daughter I was fasting about 12-14 hours per day. I breastfed both my kids more than a year doing that,without any sides effects ( but I don't encourage) .
It's a lifestyle, healthy one and I keep doing for his benefits, not just for the fact that I am skinny and smoking hot.
 The worst enemies for youth are the sun and the food.  Our chromosomes, witch carry the genetic code have at the end of what we call telomeres,like a cap, that protect the chromosome. There are sequences of nucleotides , that repet themselves a couple of thousands times . With every division of the cells these telomeres shorten. It is believed that this is implicated in aging and some cancers like melanoma. UVA radiation is doing just that, on top of oxidative stress. UVB radiation induces inflammation, breaks some covalent bonds and forms some dimers that distort the normal structure of DNA making it susceptible for mutation. Plus weakening of the collagen of the skin , that keeps the skin firm, leads to wrinkles. The best face cream is the sunscreen cream applied every day. (7)
 When we fast our body tends to conserve, so division  it's not an option, only if it is necessary. The organism's mane focus is to repair and destroy what is unnecessary ( autophagy), like:(8)  (9)

  •  bad proteins in the brain and used them for gluconeogenesis,
  •  unhealthy cells affected by oxidative stress and it stops the process of oxidative free radicals that can damage other cells,
  • extra cells from a flappy skin,
  •  cancerous cells 
More articles about intermittent fasting will come, because it is a subject I am fond of and it really works for losing weight at least, it costs you nothing, actually you save money. You need to adjust to the idea of being hungry, but also you need to know that that sensations comes and goes and it gets easier with time.
dr. Mirabela Cascaval