Healthy eating - recommendations of an endocrinologist

The very phrase “healthy eating” is perceived by many of us as an overwhelming burden of responsibility. It often seems that changing eating habits and sticking to a healthy diet is a non-trivial process.

We suggest considering the basic principles and recommendations. And start, so to speak, small, gradually evolving...

Attention! All recommendations are given without taking into account concomitant pathologies of food intolerance or allergies. In these cases, you must make a correction in consultation with your doctor.

What are vitamins, why are they needed and where do they come from?

Our body is like a chemical plant that produces energy around the clock and spends it on movement, digestion and building itself. But if you try to repeat these reactions in a test tube, it turns out that most of them either refuse to occur at all or proceed very slowly. To ensure that bodies have time to brew all the necessary “potions,” evolution created enzymes. This is the name given to proteins that act as “accelerators” of chemical reactions in cells.

But enzymes would remain ordinary proteins if it were not for vitamins - the thirteen organic substances that make up them. These are “atomic reactors”, thanks to which ordinary proteins are able to act as accelerators of chemical reactions. Therefore, if the body lacks vitamins, enzymes first slow down and then completely break down.

This is clearly seen in the example of scurvy, a disease associated with a deficiency of vitamin C. It is part of the enzyme responsible for the synthesis of the collagen protein, which connects all the cells of our body to each other. If people—for example, 17th-century sailors on a months-long voyage—no longer received vitamin C, their bodies would literally fall apart at the seams.

At first, scurvy victims felt weak and irritable. Then their joints and muscles began to ache, then their gums began to bleed, and their skin became covered with bruises. Soon after, teeth fell out and people eventually died. But if the sailors were given citrus fruits or sauerkraut, which contains a lot of vitamin C, they quickly recovered. Moreover, scurvy cannot be cured in any other way than returning the deficient vitamin to the diet.

This happens not only with vitamin C. Almost all vitamins, except vitamin D and vitamin B3, are essential - that is, the body cannot produce them, but must receive them ready-made with food. And in strictly defined quantities: if there are too many vitamins, you can get poisoned.

All vitamins are divided into two groups. Water-soluble B vitamins and vitamin C are destroyed by heat, and if you eat too much of them, they are excreted in your urine. Fat-soluble vitamins A, D, E and K are not destroyed at high temperatures and can accumulate in the liver and adipose tissue. Excess fat-soluble vitamins harm liver health, even leading to cirrhosis.

In general, vitamins are unique substances, in the case of which both their excess and deficiency can harm health. Some network laboratories and private clinics build their marketing strategy on this: they offer clients a check-up for vitamins. It would seem that what’s wrong with this?

What motivates you to take the test?

The two most common arguments used by specialists selling vitamin check-ups are:

• vitamin tests will detect vitamin deficiencies in time and help prevent diseases associated with their deficiency
• Vitamin tests will help monitor the intake of vitamin supplements - this will help to avoid overdose.

The problem is that these statements are not entirely true.

Vitamin tests do not allow an accurate diagnosis. Common problems such as fatigue, dry skin and hair loss are often associated with vitamin deficiencies. The problem is that these symptoms are nonspecific, that is, they can indicate many different unpleasant conditions and diseases.

Indeed, weakness and fatigue may be associated with vitamin B12 deficiency. Weakness can also be associated with a viral infection, insufficient physical activity, poisoning and ordinary physical fatigue. People with vitamin D deficiency sometimes have problems with their skin and hair. Dry skin can also be caused by windy winter weather, high temperatures in the home or office, a hot bath, inappropriate soap, or skin diseases such as atopic dermatitis or psoriasis.

The situation with hair loss is even more interesting. For example, alopecia areata, in which hair falls out only in certain areas of the scalp, is associated with autoimmune problems. However, it is known that patients with some autoimmune diseases such as multiple sclerosis and rheumatoid arthritis do not have enough vitamin D. The problem is that some patients with alopecia areata are deficient in this vitamin, while others are not.

If a person with alopecia takes a vitamin D test, the result will tell him absolutely nothing. It's exactly the same with other vitamins. To figure out what’s wrong, you will have to conduct a detailed examination, which will eliminate other possible causes of the malaise. And since only a doctor can do this, it is more logical to start with a visit to a specialist, and not with a vitamin check-up.

Vitamin tests can be wrong. According to available data, 0.012–0.6% of all laboratory test results are known to be incorrect. But if we are talking about tests that were ordered for patients with serious illnesses, it is much easier to identify an error than if we are talking about a healthy person who did the test just “just in case.”

For example, if a person has a temperature of 39°C and a cough, but a blood test does not show inflammation, the doctor’s first thought will be that the test was wrong. And if a generally healthy person finds out that he has low vitamin D levels, it will be difficult to suspect a mistake. This problem is compounded by two other factors.

• Vitamin tests interpret the “normal” levels of vitamins in the blood too broadly. In the USA, for example, some professional organizations believe that the minimum level of vitamin D in the blood is 20 ng/ml, and some - from 30 ng/ml. If the test result shows that the patient’s blood contains 25 ng/ml of the vitamin, some organizations recognize this as the norm, while others recognize it as a lower level. But if in the first case the person is left alone, then in the second they will either continue an expensive examination or prescribe unnecessary treatment.
• Different vitamin tests give different results. What the analysis shows depends largely on both the manufacturer of the reagents and the method used to carry out the particular test. For example, in people with insufficient levels of vitamin D in the blood, an immunochemical blood test performed with Abbott reagents shows lower concentrations of the vitamin compared to Roche reagents. This does not mean that some reagents are necessarily worse than others - it only means that the results of the same person obtained in different laboratories using different reagents can be very different, so it can be difficult to navigate.

True, there is another, more accurate and independent of reagent manufacturers test for vitamin D - liquid chromatography. However, there is no guarantee that from the available analysis methods, check-up organizers will choose the most accurate, but at the same time the most expensive and complex method. It will be difficult to check - after all, advertising usually does not indicate the method of analysis.

How to calculate daily nutrient requirements?

There are two approaches to calculating consumed nutrients: average population and individual. Many recommended menus are based on the first approach, that is, they do not take into account individual energy expenditure, the presence of diseases, characteristics of the region of residence, etc. Individual or personal calculation takes into account the characteristics of the patient and is carried out by a medical specialist.

Step 1 . With both approaches, the norms for the consumption of proteins, fats and carbohydrates are first calculated, taking into account the required daily calorie intake according to the formula:

Daily caloric intake (DC) for women (approximate calculation of basal metabolism):

• 18-30 years: (0.06 * weight in kg + 2.037) * 240
• 31-60 years: (0.034* weight in kg + 3.54) * 240
• over 60 years old: (0.04 * weight in kg + 2.76) * 240

For men:

• 18-30 years: (0.06 * weight in kg + 2.9) * 240
• 31-60 years: (0.05 * weight in kg + 3.65) * 240
• over 60 years old: (0.05 * weight in kg + 2.46) * 240

If you lead a sedentary lifestyle, then multiply the resulting value by 1.1, with moderate physical activity - by 1.3, with hard work - by 1.5. However, if you can calculate the energy costs for work during the day using special tables, then simply add the resulting number to the results of the calculation using the formula.

You can also determine your individual basal metabolic rate by undergoing a body composition study (Body composition analysis using the bioimpedance method ) and then you will not need a calculation formula.

If you are faced with the task of losing weight, then your daily caloric intake should be reduced by 20%.

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Step 2 .
After you have calculated your daily caloric intake, we proceed to calculating the daily intake of proteins, fats and carbohydrates. For normal functioning, a person needs to consume 25% of total calories and 50% of carbohydrates per day from proteins and fats. Knowing that 1 g of proteins and carbohydrates during the breakdown process provide 4 kcal of energy, and 1 g of fat - 9 kcal, the formula for calculating the daily nutrient requirement will look like this:

• Proteins, g: (SC x 0.25): 4 (20% animal proteins)
• Fats, g: (SC x 0.25): 9 (30% animal fats)
• Carbohydrates, g: (SC x 0.5): 4 (30% - simple carbohydrates)

Step 3 . The last step in creating your menu will be the distribution of calories throughout the day.

The following approaches are recommended:

Why healthy people don't need check-ups for vitamins

“Tests for vitamins are often abused, prescribing them even to those people who, in principle, do not need them,” says Anna Redina, a pediatrician at the Fantasy children’s clinic. Almost all laboratories offer a wide range of vitamin tests, and actively advertise these services as a comprehensive examination. Only a doctor can decide whether the level of vitamins and microelements in the blood of a particular patient needs to be examined or not.”

For example, if at an appointment it turns out that a child has nutritional problems - food selectivity, a special diet - the doctor may suspect a deficiency of necessary substances and prescribe a specific test. This is necessary so that you can adjust the diet or determine whether the small patient requires additional vitamins or microelements.

Healthy people who eat a balanced diet do not need most vitamin supplements. Although the needs of people of different genders and ages differ, people depend so heavily on vitamins that they would have died out long ago if they did not get enough of these substances from food. This means that most people who eat a healthy diet are unlikely to benefit from vitamin supplements.

“Avitaminosis is not typical for people who eat a balanced and varied diet, are regularly exposed to the sun, or drink dairy products fortified with vitamin D,” emphasizes gastroenterologist and family doctor at GMS Clinic Shavkat Nurmatov.

A healthy and balanced diet includes fresh vegetables, fruits, meat, fish, dairy products and eggs. Moreover, the more diverse the set of products, the more balanced the set of vitamins.

Exceptions begin when it comes to people who, for some reason, cannot get vitamins from food - or their need for some vitamin that was previously sufficient increases sharply. According to Shavkat Nurmatov, special populations that need vitamin supplements include:

• Women who are preparing for pregnancy and pregnant women in the first trimester. It is recommended that you start taking vitamin B9 supplements approximately 1-3 months before you plan to conceive. The reserves of the vitamin that are stored in the body of the expectant mother are enough for her needs, but they may no longer be enough for the child. Those mothers who start taking the vitamin in advance and drink it before the 12th week of pregnancy protect their children from problems with the nervous system.
• Older people, especially those who are at increased risk of falls. It is recommended to take vitamin D supplements. Vitamin D controls calcium metabolism - that is, it is responsible for bone strength, muscle strength, nerve impulse conduction and hormone release. Doctors hope the extra vitamin will help older adults maintain muscle strength and avoid fractures if they fall.
• Children in developing countries; the Russian Federation is not included in the list. Vitamin A supplementation is recommended. The vitamin is thought to reduce mortality, possibly by strengthening the immune system. Global health experts hope this will reduce the risk of common infections.

People at risk who need vitamins D and B9 can take them without testing. If a person belongs to the group that needs vitamin D or B9, when taking vitamin supplements, it is enough to follow the dosages:

• women who are preparing for pregnancy - 400 mcg of vitamin B9 per day
• northerners 18-50 years old - 600–800 IU of vitamin D per day
• northerners over 50 years old - 800–1000 IU of vitamin D per day
• pregnant and lactating northern women - 800–1200 IU of vitamin D per day

“Healthy adults are not recommended to do tests for vitamin levels in the blood,” says gastroenterologist Shavkat Nurmatov. — These tests should only be performed when there is clinical suspicion of vitamin deficiency. For example, in patients with macrocytic anemia it makes sense to measure vitamin B12 (or methylmalonic acid) levels, and in people with osteoporosis it makes sense to measure vitamin D levels.”

Nurmatov reminds: high doses of vitamins, especially fat-soluble ones, are toxic, and some of them can be dangerous even in non-toxic doses.

For example, vitamin A in doses greater than 10,000 IU increases the risk of birth defects in the children of women who took supplements during the first trimester of pregnancy. In adults, vitamin A supplementation may increase the risk of osteoporosis. And high doses of vitamin C increase the risk of kidney stones.

Simple Rules for Meal Planning

In order for food to maintain our health at a good level, we must follow simple rules for planning a healthy diet :

• Naturalness - choose only fresh or freshly frozen products for cooking. No canned food, semi-finished products, fast food, smoked meats!
• Completeness - the presence of all vital macro- and microelements;
• Balance - an adequate ratio of proteins, fats, carbohydrates, vitamins, microelements and fiber.
• Timeliness - eating at a certain time, 5-6 times a day.

When are vitamin tests needed?

Doctors are unanimous in their opinion: only for certain conditions.

Low intake of vitamin. This problem occurs in low-income patients suffering from nutritional deficiencies, patients with alcoholism, the elderly and strict vegans.

People who give up animal protein may experience a deficiency of vitamin B12 - it is not found in plant foods. To avoid anemia and damage to the nervous system, vegans should either eat plant-based foods fortified with this vitamin or take a vitamin supplement.

“B12-deficiency anemia can be suspected by certain changes in the general blood test, as well as some patient complaints,” says Anna Redina. “In this case, the doctor will recommend determining the level of vitamin B12 and some other indicators in the blood.”

Malabsorption is a violation of vitamin absorption in the small intestine. This problem occurs in some older people, with celiac disease - a gluten intolerance, with Crohn's disease, which is characterized by inflammation of the gastrointestinal tract, and with short bowel syndrome.

Typically, patients with inflammatory bowel disease are deficient in B vitamins. Doctors often prescribe vitamins in medications or supplements.

Increased loss of vitamin. This happens to patients who need hemodialysis - an “artificial kidney”, and in people with chronic diarrhea.

Disturbed metabolism. For example, with alcoholism, the body uses vitamin B9 more actively, so alcoholics need it more than healthy people.

Inadequate synthesis of vitamin D. People receive part of vitamin D from food, but part is formed in the skin under the influence of sunlight. But in northern latitudes, winters are long and little light reaches the skin. So both the Russian and British ministries of health are worried that the population may not have enough “sunshine vitamin”.

Not surprisingly, guidelines from both countries recommend taking vitamin D supplements at least in the winter and fall, just in case. However, scientists are still arguing about the benefits of this practice.

People who avoid animal foods and patients with diseases that prevent them from absorbing vitamins should consult a nutritionist or their doctor. For vegans, a nutritionist can help you choose the best way to get vitamin B12—from fortified foods or from supplements. And since vitamins are medicine for people with diseases, the attending physician must select the dosage of vitamins individually for each patient.

Catering issues

1. First of all, distribute your meals so that you don’t feel hungry or overeat. It is ideal to eat food every 2-3 hours in small portions (6 meals a day), but options for 5 and 4 meals a day are possible.
2. During the main meal you should not be distracted by anything (TV, computer, newspaper, etc.). Eat slowly, chewing your food thoroughly.
3. After the main meal, it is better to take a walk or walk up the stairs or along the office corridor for 10-15 minutes to allow the body to use up “fast carbohydrates” and speed up the basal metabolism.
4. The last meal should be no later than 3 hours before bedtime.
5. When you feel hungry, don’t hesitate to snack on some protein or vegetables.
6. Food should be varied. Be creative with products, create new dishes, use natural herbs and spices.
7. To provide the necessary fiber to your diet, as well as slow down the absorption of fats and carbohydrates, include vegetable dishes in every main meal.
8. Maintain your daily water intake. You should drink 1.5-2.0 liters of mineral water per day.
9. You can't go hungry!!!

This article describes the most general rules regarding healthy people. If you have any health problems, you should discuss your individual diet with a medical specialist. At the CELT clinic, such professional assistance can be obtained during a consultation with an endocrinologist. We are always ready to help!

Be healthy!

Important to remember

• Adult healthy city dwellers who eat well do not have vitamin deficiency.
• Adults who are not pregnant and eat a nutritious and varied diet do not need vitamin supplements. Certain groups of people are recommended to take supplements with vitamins D, B9, B12, and children from developing countries, but not from Russia, take a supplement with vitamin A. If you follow the recommendations for intake, these vitamins can be taken without tests.
• Blood tests for vitamins are only needed for certain groups of people. These are patients with serious illnesses that prevent them from absorbing vitamins, and people who adhere to a strict vegan diet. The doctor selects dosages individually.

Why do we need food?

So, first we need to understand why we need food?

Food is the only source of energy for our body, as well as a source of positive emotions. In addition, food is necessary for the “construction” of new cells, maintaining the vital functions of the body as a whole, and the normal functioning of organs and systems. Improper, unbalanced nutrition can lead to the development of many diseases, deterioration of appearance, and decreased mood. Therefore, any recommendations for the treatment of various diseases should begin with nutritional correction.