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Новини и Събития

The Implementation of Long-Term Preventive Programmes Ensures Health for the Nation - Interview with Dr. G. N. Chaldakov (PART 2)

Interviewer: Darina Velcheva

                                                                                    Translator: Milena Popova

What is the essence of a healthy diet?

A healthy diet and physical activity prevent diseases, on the other hand, the consumption of over-salted, over-fatty, high-calorie food and the lack of exercise are powerful risk factors for the development of cardiovascular diseases (more correctly, cardiometabolic diseases - atherosclerosis, hypertension, obesity, type 2 diabetes mellitus and metabolic syndrome). Healthy eating is a lower calorie diet, which, however, does not apply to sportspeople because they require much more energy, which should be compensated. You shouldn't eat too much animal fats, carbohydrates and salty food, you should "overdo it" with fruits and vegetables. And a glass or two of red wine a day. The cooperation between the owners in food industry sector and the governments are a part of the strategy to combat these diseases. The statistics in the United States indicate that, as a result of this, 513 885 strokes and 480 358 heart attacks were prevented in 2006. This medicinal product has a huge economic impact: 32 billion dollars are being saved annually - according to the data of scientists from Stanford University in Palo Alto (Annals of Internal Medicine 2010; 152: 481-487).

For further information related to calorie restriction and the related to it genes Sir (silent information regulator) and proteins SIRT (sirtuins) you can ask David Sinclair at Harvard Medical School in Boston and Mark Mattson at the Laboratory of Neurosciences, Biomedical Research Centre in Baltimore, or search for it in PubMed. Here I'd like to mention that some of my BHF among the doctors are vegetarians - the most famous of them, of course, is Prof. Kosta Kostov, a pulmonologist and editor-in-chief of InSpiro – a journal for respiratory medicine and inspiration, the only one in the world, combining science - poetry - jazz.

 Important: All of us, especially children and young people, should get de- mcdonaldized! From 1st February to 2nd March 2003 the American filmmaker and journalist Morgan Spurlock carried out and documented the following experiment - every day he had breakfast, lunch and dinner at the restaurants of McDonald's. Consequently, three products were obtained: (i) Morgan put on 11 kg and his liver and other laboratory tests indicated a significant damage to his health, (ii) his documentary Super Size Me was nominated for the Academy Award for the Best Documentary Feature, (iii) the book Do not Eat this Book. Fast Food and the Supersizing America became the most consumed book in the USA. The Bulgarian Svilen Dimitrov made the animations for the film Super Size Me – and he is welcome to make Super Salt Me, addressing the worrying situation of too much salt in Bulgarian diet.  Because all of us - doctors, politicians, businessmen and citizens – must put an end to the Bulgarian "song of the goat" (tragedy, I will say more about it later). EU and NATO do not care about this - the health of the Bulgarians is not a Euro-Atlantic value for them.

And what about you, are you a vegetarian?

I am not, but my son has been a vegetarian for 15-20 years.

You've also mentioned that each doctor should be a teacher in health as well.

Yes, exactly. And I often repeat this to my students. Ages ago, the wise Chinese people paid the doctors for the number of healthy people in the area, not for the number of patients they had examined. Thus they couldn't rob the Chinese Health Insurance Fund. The new requirement that was introduced in our country, which is really a rather positive thing, is that it is already compulsory for everyone of us to undergo a prophylactic blood test for cholesterol, glucose, pro-inflammatory and other biomarkers once a year. Predictive, preventive and personalized medicine are extremely important concepts of modern biomedicine. Thus, for example, men at the age of 40-45 must have their prostate and prostate-specific antigen examined, while on the other hand, women must periodically undergo preventive examinations for cervix and breast cancer. I've publicly written that Prof. Aleksandar Chirkov has harmed the Bulgarian Healthcare as much as he has contributed to it, because he put the stress on surgery, which is the final therapeutic stage of the cardiovascular diseases. It's a pity Dr. Chirkov, with all his talent and the political Todor Zhivkov's support which he used to enjoy, rarely or never at all discussed effectively preventive medicine of cardiovascular diseases.

At the same time countries (Finland, Japan, the USA), which have organized and implemented long-term preventive health programmes, have already achieved significant success. The results of the investment in preventive medicine become visible in 10-15-20 years' time. As I have said before: "To act and think preventively and within a long term, and not within the term of office and in a highway-like way, is the privilege of wise politicians – people-loving ones (demophiles)." The fact that politicians in our country do everything from one term of office up to the next one turns out to be a significant issue. Yes, a highway could be completed much more quickly and the results could be evident. But the pending demographic catastrophe, which I call demostrophe, requires long-term preventive programmes that run on a daily basis - from early childhood to adulthood. Prof. Violeta Yotova and Assoc. Prof. Rouzha Pancheva are more profoundly acquainted with the pediatric aspects of cardiometabolic diseases. It is high time politicians listened more carefully to the top scientists, doctors and teachers. Perhaps to the good poets, as well.

There are scientific laws - if the parents of a person have died of a heart attack or stroke before the age of 45-50, their children are at risk and they might suffer from an early heart attack or stroke. Therefore, starting from neonatal, even intrauterine age, they should live in a preventive environment - and that prevention should be long-term! This is exactly what the science called exposomics deals with today (exposome is the total number of adverse health internal and external factors that a person is exposed to - from the English word "expose", including intrauterine and neonatal life, when the developmental programming takes place - and has impact on the human health in adulthood). Every aspect of the human being is a result of the action of the genome, exposome and memes of an individual, i.e. of biology, the external environment and culture. "The world is in the research laboratories, not in the banks." These are the wise words of the Israeli President Shimon Peres. In the research laboratories, but not in the one of the Commander (the nickname of one of the Bulgarian former Prime Ministers), or, as I call him now, the Laboratory Technician. The problem is that there are no Bulgarian politicians that would listen to the Israeli President - and understand him. So how could they hear my friends and me!

"To be a flower, is profound responsibility" - wrote Emily Dickinson. I'd like to paraphrase it: "To be a politician, is profound responsibility." To teach people to be health-aware is beneficial, people-loving action. This is an effective state policy for healthy Bulgarians in a healthy Bulgaria.

Precisely the politicians (and our gullibility to choose them) are to blame for the fact that "the song of the goat" still goes on (Gr. tragos - goat, aeidein - sing) - tragedy (tragoidia) in our Bulgarian style - the most alarming national phenomenon that must be urgently and for a long term curbed in order to avoid the demostrophe. According to data of the National Statistical Institute in 2012 these and other diseases have caused the death of 109 281 Bulgarians - a whole big Bulgarian city!  71 644 of them have died of stroke and heart attack, 18 299 – of cancer. On the other hand, significantly fewer children were born during the same year - 69 121. Thus, the induced (not natural) decline in the population of Bulgaria is 40 160 per year from a total of 7 284 600 Bulgarian citizens on 31 December 2012. Dividing 109 281 by 365, we get 299 – that's horrible, that's the number of people dying every day in Bulgaria!

And is it possible to prevent cancer?

Yes, it is. However, the scientific answer to this question can be provided by the colleagues who deal with these diseases - for example, Prof. Temelko Temelkov, Prof. Aleksandar Hinev, Prof. Bogomila Manevska, Assoc. Prof. Petar Genev, Prof. Nadezhda Deleva, Prof. Iskren Kotsev, Assoc. Prof. Valeria Kaleva, Assoc. Prof. Dimitar Kalev...

Recently there has been a lot of talk about personalized medicine, i.e. therapy based on human genes. What do you think about this?

-Yes, here we talk about something much more profound. Today, this is also designated as precision medicine, which is an emerging approach for disease therapy and prevention that takes into account variability in genes, environment and lifestyle for each person. Thus, the Centre for Translational Medicine and Cell Therapy, opened quite recently, at St. Marina University Hospital in Varna is an initiative with high scientific and practical application potential and prospects. I hope that the Centre will become the locus biomedicus for conveying basic science, lectures, auditoria to the bedside of patients, the popular in Western countries bench-to-bedside (BtB) translational education and science. Perhaps I myself will have access to the Centre and thus a dream of mine will come true: translational cell biology. Now it is presented in some of our research projects and related publications, also in my textbook of Cell Biology, where I lead (Lat. ducere, English education) students from MSF to DPT – the curious ones know what these abbreviations stand for. At the Centre it will be possible the genetic profile of a person to be examined and consequently to be assessed their susceptibility to a particular disease and whether a particular drug will be effective or not. For example, it is well-known that some of the drugs used for treating breast cancer have a therapeutic effect on some women, while they do not have such an effect on others. Another "translational" example is stem cell transplant - this is cell therapy - it could be a drug of choice in some diseases:

And another important thing: it is not fatal to be predisposed to a particular disease. The fatal thing is, if this predisposition is not detected in good time and the necessary prevention and treatment does not start. This is the genetic part of predictive and personalized medicine and respectively - therapy. One of its branches is called Pharmacogenetics, which is well-known to Assoc. Prof. Maria Zhelyazkova - the daughter of my teacher. About epigenetics of diseases you can ask Dr. Trifon Chervenkov from the University Laboratory of Cellular Immunology.

In his book "The Biology of Belief" the American specialist in cell biology Bruce Lipton claims that it is not the nucleus but the cell membrane that is the "brain" of the cell, because the signals from the environment pass precisely through it and depending on them, the cell reacts in a certain way, including at the level of gene expression. What do you think about this?

In my Cell Biology it is written: "The membrane surrounding the cell is the first supramolecular structure arising in the course of cell evolution. It is the centre of the interactions between signal and receptor molecules, called receptor-mediated signal transduction, it is the core of cellular life."

"The membrane is the "brain" of the cell" - perhaps this could be a nice metaphor, if it were written, for example, by Günter Blobel - the creator of the signal hypothesis, one of the apotheoses in modern cell biology. I am learning from George Palade, Albert Claude, Christian de Duve, Rita Levi-Montalcini, Günter Blobel, Luigi Aloe, John Heuser...

The "colleague" Bruce Lipton reminds me of the poem Declaration by the great Bulgarian poet Konstantin Pavlov. Here's a part of it:

The flame of each petty truth

does not attract me.

Satellites of the oil lamps

are the flies.

I am an even vainer insect -

the sun is my little candle.


Is it possible to stop cell aging?

- 45-50 years ago the American scientist Leonard Heyflik discovered that human cells (in vitro, in culture) have a limited number of division, about 50 times – this is called the Hayflick limit. After that the cells begin to grow old (senescence). It was found that this is due to the shortening of the end parts (telomeres) of chromosomes – look at this beautiful micrograph, taken from Wikipedia: the telomeres are the white balls at both ends of each of the chromosomes, coloured in blue.
Later on - in 2009 – Elizabeth, Carroll and Jack were awarded with the Nobel Prize for the telomerase, an enzyme that restores telomeres and the cell continues to be divided. There were talks about "a fountain of life". However, if cell division continues uncontrollably, this may result in carcinogenesis - birth of cancer cells. Similar to most biological processes, in cell division and cell aging, at least for the time being, it is difficult to control the delicate balance of health and disease. Cell biology is self-regulating, relatively stable but delicate, sometimes romantic matter. Is there any greater challenge for curiosity! - for students, teachers and scientists. Please pay attention to the fact: Carroll Greydar, one of the Nobel Prize winners for telomerase, was born in 1961 in San Diego, California - if I had been there, she would have been my student. She became a Professor at the Faculty of Medicine of John Hopkins University in Baltimore in 1997, i.e. at the age of 36 - a phenomenon that rarely happens in biomedicine in Bulgaria - Anton Tonchev and Drozdstoy Stoyanov are the only examples I know, elected for professors under 40 years of age.

One more thing: what I said about calorie restriction-Sir-sirtuins, increasingly investigated by David Sinclair, Mark Mattson and other researchers, applies to biology of aging – it is called aging science. Accordingly, there is a Journal of Aging Science and National Institute on Aging Research in the USA, which is exactly where Mark Mattson works. Unfortunately, for the time being "The Fountain of Youth" is only in the picture of the German painter Lucas Cranach, painted in 1546, and in my article "Hormesis, Resveratrol and a Fountain of Youth", published in InSpiro in 2008.
Please allow me to finish this biochronological topic with a verse by the great Romanian poet Lucian Blaga:
The child laughs: The game is my wisdom and my love.

The young man says: Love is my wisdom and my game.
The old man whispers: Wisdom is my love and my game.
To be continued…