On 21st July, the Academic Council of MU-Varna appointed Dr. Ruzha Zlatanova Pancheva - Dimitrova, PhD, to take the academic position of "Associate Professor" in the professional field and academic specialty Hygiene (Nutrition and Dietetics).
Assoc. Prof. Pancheva, you are a researcher with versatile interests and research developments. You have done research on cell biology and adipobiology, connective tissue diseases in infancy, Nutrigenomics and infant feeding, probiotics.
Yes, I understand a lot of things, which means I do not understand anything (Assoc. Prof. Pancheva is laughing and making fun of herself). A variety of things have excited me and provoked my interest over the years. Probably, because, I have met a variety of teachers and colleagues throughout my studies and my work, who have involved, intrigued and encouraged me to be excited about various aspects of medical science. However, I have dealt mostly with the topic of probiotics recently. Another one is infant feeding and breastfeeding.
Would you tell us a little more about probiotics? When did people start talking about probiotics for the first time?
The beneficial effects of fermented milk products were described in the Old Testament. Moreover, their health effects were observed throughout the Middle Ages. However, Bulgarian yogurt is considered to be one of the most popular products, containing probiotics, which attracted the attention of the Nobel Prize laureate Prof. Ilya Mechnikov at the beginning of the 20th century. He noticed that despite the difficult economic conditions at that time in our country, Bulgarians had remarkably long lifespan. As a result of his research and observations, he concluded that the secret of the longevity of Bulgarians probably lies in the consumption of yogurt and other fermented milk products. Thus, he appears to be the founder of scientific observations about the positive effects of some bacteria on health. In 1905, in Geneva, the Bulgarian Dr. Stamen Grigorov isolated the cause of the process of turning sour – a lactic - acid bacteria, subsequently named in his honour Lactobacillus Bulgaricus. Our country has specific climatic conditions which favour the development of these specific bacteria. There has been a very serious Bulgarian school in the research on the effects of probiotics since the middle of the 20th century.
And my relationship with probiotics, if I can say so, began in the period of 2003-2008, when I was a PhD student at the Department of Pediatrics of MU – Varna, Clinic of Endocrinology, Diabetes, Gastroenterology, Metabolic Diseases, Nutrition. At that time, my senior colleague – Assoc. Prof. Miglena Georgieva, had already started applying probiotics successfully in some diseases in Pediatric Gastroenterology. I wrote a research project at MU-Varna, ranked third out of a total of 24 ones, entitled "Application of Probiotics in Diseases of the Gastrointestinal Tract and Metabolic Diseases". Subsequently, within a research project under Young Scientists Fund of the Ministry of Education and Science, I explored some probiotics in terms of their preventive and local immunomodulatory effect on antibiotic-induced dyspepsia and dyspepsia of hospital origin. In 2008 I defended a PhD thesis on "Probiotics in Prevention of Dyspepsia in Hospitalized Children Aged 0-7 Years".
There are more bacteria in human digestive system than cells in the whole human body. Therefore, the influence of pathogenic and beneficial bacteria - probiotics on human physiology is of great importance and continues to be a subject of plenty of observations and new scientific data.
Actually, how does this 'invisible' ecosystem influence human health? Do we all need to take probiotics or is it enough to consume qualitative Bulgarian yogurt?
The consumption of yogurt with probiotic yeast is just enough for healthy people. It is believed that beneficial bacteria compete with pathogenic decay bacterial flora in the colon. Consequently, the intestinal pH is decreased, which has certain beneficial effects on the organism. An increasing number of studies have also proved the immunomodulating effect of probiotics, which are both local - on the intestinal tract and remote - on the respiratory tracts, for example. We should bear in mind, however, that not all probiotic bacteria have one and the same effect. Their action is different from strain to strain within a single species. Therefore, probiotics cannot be recommended as a general concept in all conditions. It takes a lot of research to specify which probiotic for what disease is appropriate.
How come you began dealing with infant feeding?
I am a pediatrician and worked for 14 years at the Pediatric unit at St. Marina University hospital, mainly in the field of Pediatric Gastroenterology, Hepatology and Nutrition. I have noticed that a lot of conditions can be prevented and controlled by an appropriate diet. Furthermore, for the whole world, feeding is a hot topic, resulting in an increasing number of scientific publications and achievements. I believe that child nutrition is a prerequisite for the health both of children and adults.
We are a complex system, which, in its constant interaction with the environment, strives to maintain the perfect balance. Plenty and various factors affect this system, but food is perhaps the one that exerts the most direct impact on the processes in our bodies.
Yes, that's right. The digestive tract, affected by food, is the first door to any further effects on the child's, respectively, the human body. So, here we can talk about Nutrigenomics, which examines the effects of nutrition on health and diseases at a molecular level and according to the genetic peculiarities. It is important for us to be aware of the fact that the micro-and macronutrients can be important signals that influence the metabolic pathways in the cells, but also that these effects can be modified both by genetic factors and those of the environment.
Is there a relation between nutrition and allergies - quite a topical issue nowadays?
In infancy and early childhood, allergies are mainly related to food. As we age, their focus is moved to the respiratory system. It is interesting, however, that in southern countries the cases of infectious diseases are much more frequent, in contrast to North Europe and America, where there is a boom in allergy cases.
In your opinion, what is the reason for this?
I personally have grounds to believe in the so-called "Hygiene Hypothesis", which argues that the lack of early exposure of the body of infants to infectious agents (and possibly probiotics), and parasites increases the risk of allergies by inhibiting the natural maturation of the immune system. So, it is believed that the lack of such exposure leads to defects in the immune tolerance.
You are the founder of the school of breastfeeding in Varna at the National Association for Breastfeeding Support and the creator of the website of Varna lactation consultants: www.kurmene.org. Besides, you are a lecturer for "Nine Months" magazine, for the "School for Parents", where you give practical advice on breastfeeding. You invariably participate at events on the occasion of the annual initiative Breastfeeding Week in Varna. Why do you get committed to such initiatives?
Over the past 40 years, worldwide, there has been a trend to reduce breastfeeding. It started with the boom of infant formulas in the late 19th century. The lowest percentage of breastfed children worldwide was reached in the 1960s. While in 1911, 58% of the children in the USA were breastfed, in 1966, they were 18%. A favorable trend for turning back to breastfeeding has been observed first in the Scandinavian countries since the late 80s, and then worldwide in the 90s. For example, all over the world, total breastfeeding of infants at 4 months of age increased from 48 to 52% in 1990.
For Bulgaria breastfeeding is still a problem. Our practices haven't reached the international ones yet, despite the fact that all we need to achieve this is just one- way knowledge (generally, a 40 - hour course will do), not any expensive equipment. 10% of mothers do not breastfeed at all. Putting on the breast, within 1 hour after birth, happens in 2% of the cases, within 6 hours - 23%, after 24 hours - 36%. Furthermore, the duration of breastfeeding is short. In 52% of the cases the cause of stopping breastfeeding is shortage of breast milk. Indeed, it appears that only 2-3% of mothers do not have the physiological ability to produce breast milk. Juices are introduced at the age of 2 months on a mass scale.
Fortunately, in our city we observe quite a positive trend of improvement of these outdated practices, and I think that this is due to the more advanced way of thinking, one – way collaboration and intelligence at various levels - medics, mothers. After all, worldwide, it is believes that breastfeeding is an intelligence "criterion" of the family.
Breastfeeding the baby is a common question, which raises a number of discussions of medical, social and psychological point of view. According to you, how long should a baby be breastfed?
By definition, the World Health Organization recommends that breastfeeding continues for at least one year, possibly two, in general, as long as the mother and child wish. Nowadays the psychological aspects of continued breastfeeding have been examined, but my observations confirm that the majority of mothers, who have been well prepared about the process of successful breastfeeding, feed their children naturally for 1-2 years.
I take this opportunity to announce the forthcoming Breastfeeding Week, which will be held with a series of events for the ninth consecutive year, from 1 to 7 August. We are going to deliver lectures, hold consultations, discuss the topic of breastfeeding, in cooperation with the National Association for Breastfeeding Support and La Leche League. We will try, again this year, to improve last year's record for mothers breastfeeding their babies / children, at the same time, for 1 minute, on the lawn of the crooked tree, in the Sea Garden.
In some of your papers and scientific developments you deal with the issue of malnutrition in children with cystic fibrosis and nutrition of children with autism. You have been working in close cooperation with the Centre for Children with Special Needs in Varna - Karin Dom. Please, tell us a little bit more about it.
Malnutrition is still a major problem in children with cystic fibrosis. It has been proved that it is directly related to the duration and quality of life. Therefore, the approaches to its prevention and its overcoming are particularly important for the care of children with this disease. Malnutrition has a relevant impact on the disease progression and it is connected with deterioration in the quality and duration of life. It affects the function of the respiratory muscles, reduces the ability of active movement and results in immunologic disorders. Poor nutrition in patients is connected with severe lung injury, suggesting that malnutrition may be part of a causal relationship, leading to increased mortality.
As regards children with autism, over the recent years it has become evident that some of them have had improvement in their main complaints on the basis of a diet without gluten, casein, soy. It should be clarified exactly which ones and to what extent have been improved due to this diet. In the sector of Pediatric Gastroenterology, Hepatology and Nutrition at St. Marina University Hospital a large group of children with these conditions has been monitored and conclusions have been drawn in order to specify more precisely the recommendations on following a certain diet plan. We intend to organize a postgraduate training course in the autumn, in cooperation with Karin Dom Foundation, where we are going to discuss this topic, as well.
I'd like to take advantage of this interview and to thank my teachers, supervisors, colleagues and friends who have been my allies and inspirers. In addition, I'd like to share with you that the progress in my knowledge as a medical doctor and a lecturer,is due to a great extend to my family - parents, husband, children.
Assoc. Prof. Pancheva, thank you for your time! Good luck in all you future endeavors and scientific quests! Next week we hope to find out from you how the World Breastfeeding Week in Varna is going on.
An interview of D. Velcheva