Health, disease, normality and the factros of healthy lifestyle Health X Disease Healthe No - disease X Disease No - health Disease - illness – symptom - syndrom • Disease – objectively detectabel • Illness – subjectively felt • Sign – objective „issue“ (swelling) • Symptom – subjective „issue“ (pain) • Syndrome – typical cluster of signs and symptomes • Disease • Asymptomatic (disease without illness/signs without symptoms) • Symptomatic (disease with illnes) Health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (WHO, 1946). Health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (WHO, 1946). Neutral and normative concepts of health/disease • Neutral concept • Objective (disease) • Health – normal function • Disease – impaired function • Normative concept • Subjective (illness) • Health – ability to achieve desired goals • Disease/Illness – limitations causing inability to chieve desired goals What is normal in medecine? • Usual – NO • Functional – YES • Normality may be considered from medical point of view as health • When trying to quantify, we run into the trouble with data variability Intra and interindividual variability repeated measurements of temperature 18.2°C 18.5°C 19.1°C 18.7°C variability of height in population 180 cm 175 cm 165 cm 157 cm diversity in biological populations inter-population or ethnical differences = BIODIVERZITY temporal changes/ fluctuations time Intra and interindividual variability repeated measurements of temperature 18.2°C 18.5°C 19.1°C 18.7°C variability of height in population 180 cm 175 cm 165 cm 157 cm diversity in biological populations inter-population or ethnical differences = BIODIVERZITY temporal changes/ fluctuations time Vácha J.: Health, Disease, Normality; Brno; LFMU; 2004 https://medium.com/mytake/understanding-different-types-of-distributions-you-will-encounter-as-a-data-scientist-27ea4c375eec Data distribution https://www.researchgate.net/figure/llustration-of-the-normal-distribution-mean-standard-deviation_fig1_47300259 Normal data distribution https://bookdown.org/a_shaker/STM1001_Topic_3/4-the-normal-distribution.html Normal data distribution https://bookdown.org/a_shaker/STM1001_Topic_3/4-the-normal-distribution.html Normal data distribution How Much Should We Weigh for a Long and Healthy Life Span? The Need to Reconcile Caloric Restrictionversus Longevity with Body Mass Index versus Mortality Data - Scientific Figure on ResearchGate.Available from: https://www.researchgate.net/figure/U-shaped-curve-showing-the-relationship-between-all-cause-mortality-and-body-mass-index_fig1_264794803[accessed1 Oct, 2022] Vácha J.: Health, Disease, Normality; Brno; LFMU; 2004 Factors influencing the disease development Vácha J.: Health, Disease, Normality; Brno; LFMU; 2004 ➢Alternative model • The all or nothing principle • Influence of major factor / heterogenous set of causes • Focus of curative medecine ➢Continuous (graded) model • Continuous transition between health and disease • Influence of numerous minor factors / homogenous set of causes • Focuse of preventive medecine Healthe and disease models Factors of a healthy lifestyle • The principle of moderation • Risk diversification • We don't have all the information and what seems healthy today may viewed differently in the light of new knowledge in the future • Nutrition • Physical aktivity • Sleep Sleep https://neuropathycommons.org/neuropathy/neuropathy-sleep/sleep-hygiene • Sleep hygiene is the most underrated factor in a healthy lifestyle (perhaps because it has limited marketing potential) • The need for sleep is individual, but in general we can say that we sleep less than we should https://www.hprc-online.org/mental-fitness/sleep-stress/learn-how-sleep-impacts-your-performance Risks associated with chronic sleep deprivation • Cardiovascular systém • Mainly hypertension • Immunity ✓ Increased susceptibility to infections • Metabolism ✓ Higher risk of obesity, metabolic syndrome and DM ➢ Slowing down of metabolism ➢ ↓Leptin ↑Gherilin ➢ ↓ insulin sensitivity and glucose tolerance • Brain ✓ Decreased cognitive performance and concentration ✓ Reduced spontaneity – reduced physical activity ✓ Increased appetite for calorically dense, sweet and fatty food (according to one theory, the brain interprets fatigue as a lack of energy) https://www.hprc-online.org/mental-fitness/sleep-stress/learn-how-sleep-impacts-your-performance Chronic fatigue syndrome • Sleep deprivation is NOT chronic fatigue syndrome • Sleep eliminates sleep deprivation, but sleep cannot improve CFS • CFS is a complex disease of unclear etiology that manifests by ✓ Reduced performance ✓ Load intolerance ✓ Sleep disorders ✓ Cognitive disorders with preserved intellect • Etiology is not clear and is probably multifactorial ✓ Past infection (most commonly reported cause) ✓ Immune systém impairment ✓ Endocrine disorders ✓ Neurological/psychological disorders (especially emotional stress) • Sleep deprivation causes/worsens the course of the abovementioned etiological factors • Thus, sleep deprivation is an indirect risk factor for CFS Physical activity • Reduces the risk of civilization diseases, especially cardiovascular diseases, tumors, DM • Improves the psychological state, in particular it has a beneficial effect on depression, anxiety and a general feeling of well-being • Improves cognitive functions: thinking, learning, judgmentIt • Ensures healthy development in childhood and youth • Globally, 25% of the adult population does not perform the minimum recommended physical activity • Up to 5 million deaths per year could be delayed worldwide by increased physical activity • Insufficiently active individuals have a 20-30% higher risk of death than active individuals • Globally, more than 80% of youth have insufficient physical activity https://www.gov.uk/government/publications/physi cal-activity-guidelines-infographics BenefitsofphysicalactivityaccordingtoWHO https://adamvirgile.com/2021/01/19/world-health-organization-2020-guidelines-n-physical-activity-and-sedentary-behaviour • Recommended ✓ Aerobic activity ✓ Strength training ✓ (Balance exercise 65+) • Beneficial effect ✓ Body weight ✓ Cardiovascular system ✓ Muscles ✓ Bones ✓ Joints ➢ Weight-bearing activities are preferredKomplexní ✓ Complex (involvement of several muscle groups) ✓ Prevention of osteoporosis Physical activity doi:10.1016/j.jsams.2009.09.008 https://neikid.ee/images/617981.pnghttps://amazonleisure.wordpress.com/2016/09/30/featured-content-3/ ✓ HRmax= 220 – age nebo HRmax= 207 - (0,7 x age) ✓ HRR = HRmax- resting HR ✓ 1 MET: the energy requirement of one hour of lying still (cca. 1 kcal/kg) ✓ VO2 max: the maximum amount of oxygen that organism can use ➢ The intensity of physical activity can be determined by heart rate, or according to other parameters Nutrition • Macronutrients • Substances necessary for life received in relatively large quantities through food as a source of energy, a structural element, etc. (alcohol is also a source of energy, but it is not a macronutrient) • Excessive intake - formation of fat reserves ✓ Carbohydrates ✓ Fats ✓ Proteins • Micronutirients • Substances necessary for the proper functioning of the organism, taken in small amounts through food, often in connection with macronutrients (the organism is unable to synthesize micronutrients) • Excessive intake - potential toxicity ✓ Vitamins ✓ Minerals • Hydration Good sources of nutrients Carbohydrates + (10-30%) Fats + (20-100%) Proteins + (10-30%) Carbohydrates Nuts, seeds, olive oil, cheese Eggs, meat, fish Fats - Pasta, rice, cereal, bread, legumes, fruits, vegetables Nonfat Greek yogurt, cottage or cream cheese, turkey or chicken breast, lean ground beef Proteins - Fruits and vegetables Avocado, olive oil, coconut milk Caloric need ➢ Energy per gram • Fats – 38 kJ (9 kcal) • Proteins – 17 kJ (4 kcal) • Carbohydrates – 17 kJ (4 kcal) • Alcohol – 30 kJ (7 kcal) ➢ Optimal proportion • Carbohydrates – 50% • Fats – 30 % • Proteins – 20 %https://readywise.com/blogs/readywise-blog/how-many-daily-calories-will-i-need https://www.quora.com/Whats-carbohydrate-metabolism Carbohydrates • Building blocks – glucose, fructose, galactose • Simple • Mono/oligosacharides • Sweet taste, easy digestibility, fast absorption ✓Sugar, sweets, white flour ✓Ripe fruit (also contains vitamins, minerals, fiber and therefore considered suitable) https://en.wikipedia.org/ Carbohydrates • Complex • Polysacharides • Starch, fiber • Stach • Longer digestion time, slow to zero absorption • Low glycemic index (better insulin response) ✓ Bread, cereals, rice, pasta, legumes, vegetables https://en.wikipedia.org/ https://www.mysportscience.com/post/glycemic-index-useful-or-useless https://www.mysportscience.com/post/glycemic-index-useful-or-useless Natural vs. added sugar • Natural sugar • Fruits, vegetables, dairy products • Naturally bound to another nutrient – vitamins, minerals, macronutrients, water • Added sugar • Added during food processing in addition to natural sugar • A lot of calories, a minimum of other nutrients • Increases cardiovascular risk (via increased triglycerides) Natural vs. added sugar • Natural sugar • Fruits, vegetables, dairy products • Naturally bound to another nutrient – vitamins, minerals, macronutrients, water • Added sugar • Added during food processing in addition to natural sugar • A lot of calories, a minimum of other nutrients • Increases cardiovascular risk (via increased triglycerides) Fructose vs. fructose syrup • Fructose • Naturally present in the fruit in connection with fiber, vitamins, enzymes • Glucose-fructose syrup • Inexpensive sweetener made from starch (corn, wheat) • Starch hydrolysis to glucose, glucose isomerization to fructose, filtration and water removal • Sweeter than white sugar • Calorically dense, no other nutrients • Increases cardiovascular risk (via increased triglycerides)) • Highly addictive (PMID: 1875782, PMID: 20800122) Artificial sweeteners • More types, because it is difficult to mimic a sweet taste - individual everyone has to find what he likes • Stevia, aspartam, sucralose • No calories, sweeter than white sugar • They can disrupt the microbiome • Addictive • Potential disturbtion of metabolism • Polyols – xylitol, sorbitol, erythritol • Caloric content, however less calories than white sugar • Less/as sweet as white sugar • May cause GIT distress (FODMAP) FODMAP • Fermentable carbohydrates may potentialy irritate GIT • Problems ranging from intestinal discomfort to diarrhea • F - Fermentable and refers to the following groups of shortchain carbohydrates or sugars: • O - oligosaccharides • D - disaccharides • M - monosaccharides • P - polyols Recommendations for carbohydrate intake • As much complex carbohydrates as possible from natural sources • Fruits, vegetables, nuts, seeds, whole grains, brown rice • Carbohydrates linked to vitamins, minerals, fiber, proteins... • Fewer complex refined carbohydrates • White rice, white bread, regular pasta • Industrial food processing mainly destroys fiber • As little added sugar as possible • Empty calories - only energy, a minimum of other nutrients Fiber • Recommended intake approx. 30g/day (larger amounts may cause diarrhea) ➢ Soluble • Binds water and forms a gel – increases in volume • Fermentation in the intestineě • Prebiotic – nutrient for the microbiome • Partial absorption – source of energy • Regulation of fat and carbohydrate digestion ✓Oatmeal, apples, peaches, sweet potatoes ➢ Insoluble • Does not ferment • Increases stool volume (shortens passage time) • Dilutes/binds waste materials that are potentially toxic ✓Skin of fruit and vegetables, whole grain bread, nuts Benefits of fiber • Feeling of satiety • Favorably affects cholesterol and blood sugar levels (slowing down absorption) • Favorably affects the microbiome (prebiotic) • beneficial effect on laxation • Soluble fiber softens the stool • Insoluble fiber thickens the stool • Reduces the risk colorectal carcinoma development (binding of potentially harmful substances) Fats • Structural function – membranes • Brain – 60% fat content • Energy storage • Preferred fuel for daily activities and low-intensity physical activity – saving glucose for the brain and erythrocytes • The highest utilization during caloric deficit • Beta oxidation requires glucose as a source of oxaloacetate for the citrate cycle, when deficient, acetyl CoA is metabolized to ketone bodies ("fats burn in a carbohydrate flame") https://www.researchgate.net/figure/3-The-lipid-metabolism-can-be-divided-into-two-basic-pathways-the- exogenous-pathway-and_fig3_304525065/download Fats • Structural function – membranes • Brain – 60% fat content • Energy storage • Preferred fuel for daily activities and low-intensity physical activity – saving glucose for the brain and erythrocytes • The highest utilization during caloric deficit • Beta oxidation requires glucose as a source of oxaloacetate for the citrate cycle, when deficient, acetyl CoA is metabolized to ketone bodies ("fats burn in a carbohydrate flame") https://www.researchgate.net/figure/3-The-lipid-metabolism-can-be-divided-into-two-basic-pathways-the- exogenous-pathway-and_fig3_304525065/download Tuky • Strukturální funkce – membrány • Mozek – 60% tuku • Zásoba energie • Preferované palivo pro každodenní aktivity a fyzickou aktivitu o nízké intenzitě - snaha šetřit glukózu pro mozek a erytrocyty • Největší využití v případě kalorického deficitu • Beta oxidace vyžaduje glukózu jako zdroj oxalacetátu pro citrátový cyklus, při nedostatku se acetyl CoA metabolizuje na ketolátky („tuky hoří v ohni sacharidů“) https://www.researchgate.net/figure/3-The-lipid-metabolism-can-be-divided-into-two-basic-pathways-the- exogenous-pathway-and_fig3_304525065/download ➢ Saturated fatty acids • Solid at room temperature • A significant risk factor for increased LDL (cardiovascular risk) • They should represent maximally 10% of caloric intake ✓Meat, dairy products, coconut and palm oil ➢ Trans fatty acids • They are produced industrially during the solidification of fats (hydrogenation of unsaturated fatty acids) • Solidification of fats - extension of shelf life • They raise LDL and lower HDL (very high cardiovascular risk) • Recommended intake: 0 Unhealthy fats ➢ Monounsaturated (MUFA), polyunsaturated (PUFA) fatty acids • Avocado, nuts, seeds, salmon, tuna, mackerel • Omega-3 a Omega-6 fatty acids • Essential PUFAs • In addition to the positive effect on HDL/LDL, important for immunity and embryonic development (especially omega-3) ➢Omega-6 (linolenic acid) • Recommended intake approx. 15 g/den ✓ Vegetable oils, soybeans • Omega-3 (kyselina alfa-linolenová) – • Recommended intake approx. 1,5 g/den ✓ "fatty fish", linseed, lineseed oil Healthy fats Fats • Fat is preferentially used as fuel at rest or during low-intensity activity (approx. up to 70% HRMAX) • Fat intake does not automatically lead to the formation of fat stores • Everything depends on caloric intake (excess calories from protein / carbohydrates are converted into fat stores too) • However, fat is calorically denser, so with a caloric surplus, fat represents 2 times more energy than carbohydrates or protiens • Low/zero fat foods may not be lower in calories as they may contain more sugar to enhance taste (marketing) Proteins • Dietary proteins are metabolized into amino acids • In small intestine, the amino acids are absorbed to the circulation from where they are available for the needs of cells • Amino acids are not stored, excess amino acids are converted into glucose-glycogen or fatty acids • In the case of adequate caloric intake, amino acids are conserved and fat/carbohydrates are used as the preferred energy source • In the case of chronic caloric deficit • Insufficient production/catabolism of immunoglobulins • Muscle catabolism (especially during inactivity) Amino acids ➢ Essential ✓Valine, leucine, isoleucine, phenylalanine, tryptophan, threonine, methionine, lysine ➢ Semi-essential • Essential in childhoodí ✓Histidine, arginine ➢ Conditionally essential • They can be synthesized from essential amino acids ✓Tyrosine (from phenylalanine), cysteine (from methionine) ➢ Non-essential ✓Glycine, alanine, serine, aspartate, glutamate, asparagine, glutamine, proline ➢ Complete protein sources • They contain all essential amino acids ✓Meat, fish, eggs, dairy products, soy, buckwheat, quinoa ➢ Incomplete protein sources • They lack at least one essential amino acid • It is necessary to combine several sources ✓Beans, nuts, seeds, whole grains, vegetables Protein supplements ➢ Most often based on whey protein or casein ➢ Casein - the main protein in mammalian milk • It represents up 80% of cow's milk proteins • Milk coagulation – precipitated casein + whey • Acid precipitation – using acids produced by lactic acid bacteria (mainly lactic acid) ✓ Yogurts, cottage cheese, some cheeses • Sweet precipitation - with the help of rennets (chymosins – protease enzme splitting casein, products subsequently precipitate even without acidification) ✓ Majority cheeses ➢ Whey – a by-product of milk production • Rich in vitamins, minerals, proteins, lactose ✓Žinčica, protein powders Mikronutrienty Mikronutrienty Mikronutrienty Micronutrients Hydration • Recommended daily intake ✓Men: 3,7 l ✓Women: 2,7 l ✓More during physical activity/ hot day • About 20% of the recommended intake is from food • Alcohol – inhibition of antidiuretic hormone secretion