N. 04 - January 2012 by Accademia del Fitness - Wellness - Antiaging

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January 2012 | year II

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Lâ&#x20AC;&#x2122;Accademia del Fitness Wellness & Anti-aging Magazine

n.04

Corso di formazione in Anti-aging

L’ Accademia del Fitness, in convenzione con l’Università La Sapienza di Roma - Facoltà di Farmacia e Medicina - organizza il Corso in Anti-aging “BENESSERE E STILI DI VITA” Direttore : Prof. Francesco Tomei Responsabile parte pratica: Prof. Massimo Spattini presso: Accademia del Fitness (Parma) Prof. Adolfo Panfili presso Area Sporting Club (Roma) Iscrizioni: entro e non oltre il 12 gennaio 2012 Importo corso: € 2.000,00 (possibilità di finanziamenti - Per informazioni contattare la segreteria dell’Accademia del Fitness : tel. 0521 941319 - info@accademiadelfitness.com) Indirizzo web per scaricare il Bando : http://www.uniroma1.it/didattica/corsiformazione/25816-benessere-e-stili-di-vita

L’Accademia del Fitness in occasione del Cibus organizza il Convegno

FIERE DI PARMA Informazioni: AKESIOS GROUP S.r.l. - Tel. 0521 647705 - info@akesios.it

number 04 Number 04//2011 2011 ACCADEMIA DEL FITNESS Galleria Crocetta 10/A 43126 PARMA Ph. +39 0521.941319 Fax +39 0521.294971 info@accademiadelfitness.com www.accademiadelfitness.com

Editorial

Editor in Chief: Massimo Spattini Editorial staff: Claudia Bonini Silvia Iorio Cristiana Pedrazzini Cinzia Ruggeri Scientific committee: Ph. Marianno Franzini Ph. Fulvio Marzatico Dr+. Filippo Ongaro Ph. Adolfo Panfili Ph. Mario Passeri Writers: Davide Antoniella Alberto Battezzati Simona Bertoli Pierangelo Bosio Marco Tullio Cau Claudia Conti Ciro di Cristino Alberto Fidanza Marianno Franzini Alessandro Gelli Eugenio Luigi Iorio Giampaolo Lavagetto Claudio Lombardo Serena Missori Giovanni Montagna Filippo Ongaro Adolfo Panfili Maurizio Salamone Gianfranco Scarsella Massimo Spattini Enrico Veronese Cover: photo Alex Ardenti Photographers: Alex Ardenti Massimo Spattini Publisher: Profitness S.a.s. Galleria Crocetta 10/A 43126 Parma Ph. +39 0521.941319 Printed and delivered by: Mattioli 1885 S.r.l. Str. della Lodesana, 649 sx Loc. Vaio 43036 Fidenza (PR) Ph. +39 0524.530383 www.mattioli1885.com

Even if this period is characterised by the economic crisis, the market connected to health services in general and wellbeing is in ferment. The awareness that treating one’s body is not actually an expense has by now been progressively spread: it is considered an investment aiming at producing more return and at reducing subsequent therapeutic, particularly expensive, costs. As a consequence, our magazine is growing: the first issue counted 32 pages, the second one 40, the third 48 and this one 60. This linear progression mirrors the extreme coherence of our route, which will become concrete at the latest conference “Anti-ageing: Wellbeing and Lifestyles” to be held in Rome on 3rd December 2011 at the Rome Cavalieri Waldorf Astoria Hotels & Resorts. Sponsored by the Faculty of Pharmacy and Medicine at the University La Sapienza in Rome, the conference has been promoted and organised in collaboration with Professor Adolfo Panfili, and will be characterised by a multi-disciplinary technical-didactic day. All the aspects connected to health attainment and life quality will be treated and the conference will also briefly describe fundamental elements such as behavioural training, food and postural hygiene, physical education and stress management, which are by now necessary for modern people’s training. Themes regarding therapeutic approach in subjects with cardiovascular risk (metabolic syndrome – postinfarct subjects) and in subjects with problems in their spine (backache – discopathy – herniated disc) will be dealt with. The conference will be attended by authoritative professional figures and scholars who have been researching for years a lifestyle model which may optimize people’s well-

being as well as provide the basic knowledge for future closer examinations aiming at the various categories of work and professionalism. In fact, the training course in Anti-ageing “Benessere e Stili di Vita” (Wellbeing and Lifestyles), sponsored by the Faculty of Pharmacy and Medicine at the University La Sapienza in Rome, will start in February. The course aims at providing a training route in order to give suitable and concrete answers to what has lately become a priority need: create self-knowledge, therefore a higher state of wellbeing and higher serenity in social relations. As a consequence, this will create great opportunities to obtain further university qualifications for all the professional figures in the sector. The course, directed by Prof. Francesco Tomei, will last nine months. Classes will begin in February and will finish in September. For further information on the modalities and requisites for admission http://www.uniroma1.it/didattica/ corsiformazione/25816-benessere-e-stili-di-vita. On 10th May in Parma, on the occasion of Cibus Fair, during the event Planet Nutrition, the Accademia del Fitness – in collaboration with Akesios – will organize its annual conference on the theme “Nutrition and anti-ageing integration”. Another confirmation that our association is achieving success and legitimation at the highest levels. Finally, do not forget my workshops on 10th December 2011 and on 29th April 2012 “Spot Reduction or localized loss of weight”: there will be news! Massimo Spattini Accademia del Fitness President

Registration n. 12/2004 Court of Parma

Lâ&#x20AC;&#x2122;Accademia del Fitness index

Editorial

PHYSICAL CULTURE AS THE BEST ANTI-AGEING STRATEGY

POSTUROLOGY

Epigenetic: how lifestyle modifies the gene-expression

Physical exercise For a better life quality in subjects with cardiovascular risk

calculation on metabolism

Outpatient treatment for a herniated disc

Bone metabolism and physical activity

From hypoxia to endothelial dysfunction Cellular bionutrition as an innovative anti-ageing approach

Eating disorders

NATURAL TECHNIQUES FOR STRESS MANAGEMENT (anxiety, depression, panic) and for the development of willpower and determination

number 04 / 2011

OXYGEN OZONE: HEALTHY AND FIT

Facial Skin Rejuvenation Combined Medical-Surgical approach

Food and the Metabolic Syndrome

TODAYâ&#x20AC;&#x2122;S HEALTHY MEDITERRANEAN DIET And vitamin supplementation

Magnesium aN essential mineral

ANTIOXIDANT, ORGANIC AND KM-0 FOOD An intelligent way to preserve our health, get old in a clever way and protect the environment

THE BIOCHEMICAL APPROACH As a practical support to monitor ageing, in order to favour wellbeing and health

I do not exercise yet I am under stress

Modelling in anti-ageing

BIOELECTRIC IMPEDANCE IN THE CALCULATION OF BODY COMPOSITION

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PHYSICAL CULTURE

AS THE BEST ANTI-AGEING STRATEGY Anti-ageing medicine is mainly based on 5 cornerstones: nutrition, physical exercise, food integration, stress management, hormonal balance. We can properly say that these components have always been the essence of physical culture. Obviously, by physical culture we mean the one of the so-called “fathers of physical culture” going from the pioneer Eugene Sandow to Steve Reeves to body builders in the ‘70s. With the explosion of “body building” in the ‘80s, the health concepts of physical culture become less important and muscle development - literally “body building” – is favoured, even going to extremes at all costs. I started practising physical culture in 1975 because I was fascinated by a photo of Frank Zane, an athlete endowed with a perfectly proportioned body. With an height of 5.75 feet and a weight of about 190 pound, he won the title of Mr Olympia for three times in 1977-78-79. Just think that Jay Cutler won some of the recent titles of Mr Olympia with the same height but with a weight of 275 pound. Frank Zane graduated in Science in Pennsylvania in 1964 and taught Mathematics and Chemistry for 13 years. Then, he graduated in Psychology in California in 1977 and, finally, in 1990 he got a master’s diploma in experimental Psychology. His nickname being ‘the chemist’ due to his degree, Frank Zane says: “in the past years I have taken a great amount of supplements and tons of amino acids. I still do, but it was unusual at the time. This is why I was nicknamed ‘the chemist’”. According to me Frank Zane has always been the ‘guru’ of physical culture. I had already met him back at the time of his wins, and I met him again some time later. Yet, this year I wanted to go and visit him during my updating holidays in California. I wanted to meet him in his residence in San Diego, to know his opinion about Anti-ageing medicine. We had a long conversation, some hours long, and we faced all the topics connected to health and wellbeing. First of all, Frank

Anti-ageing medicine is mainly based on 5

cornerstones: nutrition, physical exercise, food supplements, stress

management, hormonal balance

( Frank Zane at 64 )

number 04 / 2011 Zane does not approve of the term Anti-ageing. He prefers to call it Age Management because you cannot avoid the ageing process but you can control it and make it slow down. According to Frank Zane, Age Management is based on four factors: exercise, mental aptitude, diet, recovery. Each one of these factors is 100% important. At the age of 69 Frank Zane trains every other day following a specific routine: one day he trains the push muscles (pectoral muscles, shoulders, triceps), one day the pulley muscles (dorsal, trapezius, biceps) and one day the legs. He makes around twelve sets for the big muscles and six for the small ones. He pays a lot of attention to the proper way of execution and to the feeling of ‘pumping’ rather than using heavy weights. As for his diet, he consumes about two grams of proteins and one gram of carbohydrates per kg of his body weight, with a level of about 2000 calories. On the fourth day, he consumes two grams of carbohydrates and then goes back to the cycle. Moreover, he constantly practises stretching, aerobic activities, music therapy and meditation – thanks to which he manages to sleep less hours and to spend more time studying and reading. At the end of this interview I asked Frank Zane how much time should be devoted to keeping fit. He replied: “every second of your life”. Going back to our parallelism between physical culture and antiageing, we must admit that the main aspects of morphological and metabolic ageing are the loss of muscle mass, bone tissue, cartilaginous density and water. All of this is followed by a loss of elasticity in the blood vessels, a reduction in the hormones and by an increase in body fat. The loss of muscle mass, due to the ageing process, causes sarcopenia, which leads to a loss of muscle power and can therefore be disabling, favouring fall. Actually, the number of muscle fibres is the same, as is the number of blood vessels. What gets worse is the capacity of vasodilatation in blood vessels due to insulin stimulation. That is, the ageing process involves creating a sort of insulin resistance at muscle level. This works against the access of nutrients at the level of muscle cells. This process is reversible through physical exercise. In fact, physical exercise increases the blood flux at muscle level, increasing the use of nutrients. More specifically, weight training – through a direct and hormonal effect – stimulates the increase of muscle mass. Bone density decreases with age. This phenomenon is partly due to a wrong diet, for example an excess in acidifying food, and partly to a decrease in sexual hormones (osteoporosis is particularly frequent in menopausal women) but it can be fought through physical exercise, above all gravitational such as running and weight lifting. Instead, swimming and bicycle are less effective. Ageing is associated to the loss of water and to a decrease of polysaccharides in tissues. This leads to

a decrease of elasticity, articular pain and arthrosis. Yet, we must bear in mind that the use of articulations keeps their functions active and the quickest way to their deterioration is lack of exercise. With age, the blood vessels tend to lose their elasticity, their internal diameter decreases while atherosclerotic plates increase. This cause hypertension, reduces cardiovascular and muscle abilities, favours erectile dysfunction and is the first step towards cardiovascular diseases. Once again, a proper diet helps keeping good circulation. According to a study, physical exercise can have the same effect as Viagra. The use of supplements such as arginine may contribute to improve the blood flux and to prevent cardiovascular diseases. With age the majority of the hormones decrease – this has been considered by many a cause of ageing. Hormonal therapy through bioidentical hormones may bring back hormonal values to the ones of a young 20-30-year-old person. However, a proper diet, supplements, stress management, physical exercise (above all with weights) may positively influence the hormonal values and any hormonal therapy will be much more effective if supported by a correct diet, supplements, stress management and physical exercise. In the end, there are three factors which determine our life quality and length: genetics, the environment and one’s lifestyle. We cannot do anything to change genetics, many of us can do little about the environment where we live. Yet, we can all do a lot about our lifestyle. Physical culture represents the perfect lifestyle to promote health and wellbeing and to slow down the ageing process. Dr. Ph. Massimo Spattini Specialist in Sports Medicine Specialist in Food Science Board Certificate in Anti-Aging & Regenerative Medicine (ABAARM-USA)

( Eugene Sandow )

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POSTUROLOGY In the previous article I explained how – through evolution – man has reached the upright posture. I also explained his relative adaptation to the conquest of this privileged posture, which sometimes presents anomalies that must be recognised and corrected, in order to optimize the aims of health and performance.

In the different levels of the human body, the muscles – therefore also the articulations – will modify from static to

Straightening – A certain number of articulations must be fixed in order to ensure the upright posture (ankle, knee, hip, backbone). Each one of our muscles, besides having great dynamic ability, takes part in the fixation of the articulations it subtends. In the different levels of the human body, the muscles – therefore also the articulations – will modify from static to dynamic, from below to above and from inside to outside. Hence: stability of the carrying structure and mobility of the head and upper limbs: a) the foot: the gravity line, which falls anterior to the malleolus, ensures the verticality of the leg, through the passive tension of the rear muscles, mainly of the “soleus”; b) the knee: keeping the stability of two long bones (the set tibia-fibula and femur), which are articulated at the extremities, is a mechanical ability which will only be possible through their precise reciprocal position and their rigorous block. The resultant from the action of the rear muscle of the thigh, divided into two big groups – external and internal – ensures the stability of the knee; c) the hip: the stability of the ilium is a real victory for the biped posture. This essential stability is guaranteed starting from the ground, from the gluteus maximus, the obturator internus, the quadratus femori, the iliopsoas and the tripod of the “goose’s foot” muscles (semitendinosus, rectus internum or gracilis, sartorius); d) the sacrum-iliac articulation: the stability of the sacrum, at the level of the sacrum-iliac articulation, is ensured by the gluteus maximus, the pyramidalis and the ischium-coccygeal, re-

dynamic, from below to above and from inside

to outside.

number 04 / 2011

( Core stability )

inforced by the great and small sacrum-ischial ligaments and by the fibrous-tendinous excess of the articulation. No muscles from below are linked to the sacrum; e) the backbone: the poly-articulated spinal muscles, starting from the sacrum and ilium, take part in the functionality of the backbone. They extend to the occiput. They are placed so that it is possible to describe a lumbar trunk (“common mass”) which sends ramifications ascending along the dorsal plane, and a cephalic trunk which sends its ramifications descending along it. The highest insertion of spinal muscles is, therefore, in the lordotic regions (lumbar and cervical). The lumbar mass has, more specifically, a static aim, while the cervical mass also ensures the mobility of the head and preserves the horizontality of the look (with the sternocleidomastoid). The intervertebral connections, at the level of the back articular apophyses, are ensured above all by the spinal transverse. With its pillars the diaphragm contributes to the solidity of the system and it emphasises lumbar lordosis like the iliopsoas. In the cervical region, the scalene muscles, inspiratory muscles placed sideways to the transverse apophyses of the cervical vertebrae as far as the first two ribs, increase cervical stability. Anatomo-Physiology – Muscles are normally under a certain tension (“base tone”). The static ones have shorter muscle fibres and have more connective tissue than the dynamic muscles. The anterior muscles make the movement, the posterior resist to the movement. In stretching, besides the passive forces represented by the connective tissue, also the active forces represented by myofibrills must be added. In the symmetrical upright posture, the articulations of the pelvic arch are stressed by the weight of the trunk, which exerts on the upper side of the first sacral vertebra and tends to lower the promontory. The sacrum is therefore stressed in the sense of nutation. This is limited by the sacrum-iliac ligaments or nutation restraints, and above all by the sacrum-ischial ligaments, which prevent the movement of the sacrum from the ischial tuberosity. Simultaneously the reaction from the ground transmitted by the femur is applied at the level of the coxofemoral articulations, thus forming – with the body weight applied on the sacrum – a retroversion of the iliac bone, which emphasises the nutation at the level of the sacrum-iliac articulations. These stresses are controlled by the ligaments and corrected by muscles.

Practice for rational stretching: a rational method for stretching must consider that the rear muscles of the rachis is numerous and strong. In particular, we notice the presence of two considerable muscle structures at lumbar and cervical level, in correspondence of the two physiological lordoses. These muscles, constantly stressed due to their tonic activity, normally tend to shorten. This shortening must be related to the more marked posterior concavity of the rachis. Moreover, the lumbar rachis - which so frequently presents hyperlordosis due to the action of the spinal muscles, the psoas and the diaphragm – does not present direct muscles for delordosis apart from the peritoneal. In fact, even if the rectus abdominis is an important antagonist of the muscles for lordosis, it does not act directly on the lumbar spine. Its concentric action simply brings the ribs closer to the pubis. The dorsal muscles are then part of a functional unit represented by the static muscles, which form a polyarticular kinetic chain extended from the tip of the feet to the occiput. On the basis of these considerations, a rational practice for those who are starting a physical activity at the gym should be based on renouncing the reinforcement of the static rear muscles through concentric contractions, fighting against their tendency to retraction. A logical method of muscle stretching

( Postural control in sport )

must mainly aim at the detension of such muscles, not analytically and segmentarily, but acting on these muscles globally and as personalised as possible. The stretching postures must be statically kept for a considerably long period, since time favours the possibilities of the myo-fascial retracted system. The inspiratory block of the diaphragm must be avoided. Quick and intense elastic bends (intermittent or ballistic stretching) must be avoided, too, not only for their scarce effectiveness on the aim, but above all because of their potential danger. It is obvious that muscle stretching needs a state of tonic relaxation, since a subject in a state of tonic hyperactivity cannot stretch his/her muscles. It is necessary to believe in the possibility of affecting the weakest part of the posture, doing as we please on circumstantial elements. This can be achieved through a stimulation of sensorial afferents, intervening in the regulation of the neurological control on posture. Postural therapies built on few hours of ex-

L’Accademia del Fitness ercises per week are useless. Also the psyche must be involved to the point of conditioning the deepest layers, which are basically the ones which give everybody’s posture a proprioceptive and more qualifying character. The posture defines both the physical behaviour of one’s upright position and the psychological one towards the external world at the same time. Looking for stability without care and giving up a permanent adaptation that ensures availability represent a makeshift attitude, a lack in self-confidence and in being open towards the external world. The posture is therefore an adaptation corresponding to a challenge between ourselves and the external world. It may be expressed as a Dialogue, or a Compromise, or finally a Conflict, if it is not possible to find any agreement. The natural attitude is neither aware nor intentional. It is a way of personal reaction to a constant stimulus: weight. Postural training will be a training for “sensations”. There are many methods for therapeutic approach and medical gymnastics for postural correction. The aims of the therapy can be summarised into: - training patients to perceive “their own body”, in ( Mézières Posture ) order to experiment new more physiological postures by means of an ongoing research for the right segmentary and global place of the body in space; - developing and enhancing the means of patients to keep the new acquired postures in time. The general working programme must surely include exercises of mobilization, tone, muscle trophism etc. Yet, in order not to consider the body as a simple gathering of bones, muscles, nerves etc, it will have to include a phase of active recovery based on postural gymnastics. Re-education consists for everyone (according to one’s morphology) in finding a personal solution which, through stimuli, allows to build a natural and plastic attitude suitable for every situation. This process will take place in phases which, on a neural-motor level, will be based on the refinement of the pro-

prioceptive perceptions and progress lies in the automatic adjustment of postural tone. The proprioceptive postural adjustment, if generated by sensory afferents, can be realized in three types of motor activities for the reaction of readjustments. The most simple reactions are the ones that exist in a state of rest: 1) reactions of static support; 2) static-kinetic reactions, corresponding to the tone variations during movement; 3) straightening reactions. Postural training will basically aim at giving a better image of oneself. It is necessary to readjust the information and the action: acquiring a balanced and economic posture of habitual statics, in the most complex dynamic situations. A kinesiologist will help rediscovering one’s body and automatically readjusting one’s posture, to be found as quickly as possible, through exteroceptive and proprioceptive stimulations. The postural adjustment involves the trunk muscles and the muscles of the lower limbs, for which the stabilization functions are clearly dominant. The antigravity muscles are mainly composed of tonic fibres responding to the stimulus of a prolonged contraction and, in normal working conditions, they are tireless. Therefore, it is wrong to correct posture through the contraction of mainly phasic (dynamic) muscles, at high energy expense, with limited resistance capacity. In training with weighs, I believe it is important to know all that I have exposed, in order to avoid overload damages. The use of eccentric contraction of the erector spinal deep muscles helps us keeping the most suitable posture economically and, as a consequence, gives a higher possibility to perceive globally and analytically “one’s body”, optimising one’s health and performance at the gym and in life. Prof. Ciro di Cristino Trainer and Physical-Athletic Instructor

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Epigenetic:

How lifestyle modifies the gene-expression Over one and a half billion people in the world are estimated to be overweight or obese. The majority of them is at high risk for the development of cardiovascular pathologies, diabetes, arthritis and some forms of cancer. Even if it is undoubtedly true that sedentary life – and subsequently minor calorie expenditure – has played an important role in the explosion of this overweight epidemic, it is not so certain that in average people take much more calories than in the recent past. What seems to be clear, instead, is that food containing these calories is considerably different from the past as for its level of nutrients, its amount of sweeteners, salt and of many chemical substances. It has been more and more clear on a scientific level that the chronic diseases afflicting a wide range of the population share many common biochemical foundations, all of which are rooted in a wrong diet. Some authors have calculated that about 72% of the calorie intake in a western diet comes from food that the primitives would have never been able to eat, since it did not exist back then. This “modernization” and “industrialization” of our food becomes particularly worrying when we abandon the purely energetic and calorific idea of food to adopt a vision where all the food is fist of all a vehicle of information. Getting into our body and cells, it contributes to

regulate the most complex cellular processes such as the expression of our genes. For many years it has been clear that the non-codifying part of the DNA is the one responsible for the wide capacity of regulation in the expression of our genes. In other words, the genetic code gives a relatively slight contribution to our health and predisposition to the development of diseases if compared to the importance of the constant interaction between the non-codifying parts of the genetic code and the stimuli coming from the outside world. Basically, this interaction regulates which genes are expressed and which are repressed in a series of processes which go under the name of epigenetics, that is, of what is “above” genetics and regulates it. According to many researchers, the 30-60 tons of food we eat in a lifetime are the single most powerful regulation element of this complex epigenetic machine. For this reason it is necessary to adopt a vision of food which goes beyond its calorific value, in order to try and understand its nutritional properties on the whole. Only by doing this it will be possible to prescribe nutritional approaches able not only to prevent and treat excess weight but also to intervene radically on many pathological processes depending on the alteration of epigenetics. To do so, calorie reduction is not enough. The type of food patients consume must be completely re-examined, and targeted nutraceuticals must be associated to that diet in order to achieve specific therapeutic results. The use of nutraceuticals in many pathological conditions - among which the metabolic syndrome - is treated in a wide and exhaustive range of scientific literature which is today available. Therefore, doctors cannot show prejudices on this kind of intervention anymore. In fact, nutraceutical intervention is today associated to and enhances possible pharmacological treatments in what is called a multimodal approach to prevention and pathology. Dr. Filippo Ongaro Medical Director of Institute of Regenerative and Anti-aging Medicine (Ismerian), Vice President of AMIA Board Certified Anti-Aging & Regenerative Medicine (ABAARM) Diplomated Functional Medicine (AFMCP) Certified Practioner International School of Gynecological Endocrinology (ISGE)

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Physical exercise

For a better life quality in subjects with cardiovascular risk Many studies have provided evident results on the capacity of physical activity in improving physical performances and in reducing cardiovascular morbidity and mortality. Moreover, physical activity has proved to be particularly important also in the significant reduction of the risk of developing other chronic diseases such as obesity, osteoporosis, diabetes, neoplasia and depression. For this reason, higher importance is finally being given to physical activity as a physiological preventive and therapeutic device, economical and effective in many clinical conditions. Physical activity is considered a real “cardio-active” MEDICINE. Today the promotion of physical activity towards the general population represents one of the primary goals on part of our health institutions. Wrong lifestyles typical in our time and the progressive ageing of the populations have led to a staggering increase in chronic-degenerative pathologies, first of all cardio-vascular diseases, which are dealt with difficulty by the health systems. On this point, the most prestigious international scientific societies have introduced physical activity in all the programmes of cardiovascular prevention, both primary and secondary. Studies carried out on 25000 healthy subjects have evaluated the effect of regular physical activity – able to improve physical performance - on total and cardiovascular mortality. These studies (BLAIR – ERIKKSEN), with a max follow-up of 22 years of age, have reported a reduction of about 50% on total mortality, apart from the basal physical capacity of the subjects. The HARVARD ALUMNI HEALTH STUDY, involving 12000 middle aged subjects, has demonstrated that in order to obtain a mortality reduction of 20% it is necessary to practise an activity leading to an

Wrong lifestyles have led to a staggering increase in chronicdegenerative pathologies, first of all cardio-vascular diseases.

amount of energy consumption of about 4.200 KJoule per week (corresponding to about 30’ of physical exercise per day, for at least 4-5 days a week). As for secondary prevention, International literature basically lacks large trials on cardiovascular benefits connected to physical activity. The most recent meta-analysis has studied the data by Cochrane Library, based on over 5000 studies. After excluding the non-eligible trials, 48 studies have been analysed (a total of 8490 patients) divided into those where intervention was only based on physical activity and those presenting all-inclusive intervention (exercise plus the other risk factors). The results have shown a 20% reduction on total mortality and a 26% reduction on cardiovascular mortality in patients who underwent training compared to the control group, with no significant difference between the programmes based on physical exercise only and the all-inclusive ones. These results confirm the previous ones and indicate a significant reduction in global and cardiac mortality in the patients suffering from ischemic cardiopathy who take part in these programmes. The ETICA study (EXERCISE TRAINING INTERVENTION AFTER CORONARY ANGIOPLASTY) has demonstrated, also in patients who underwent coronary angioplasty, that 6 months of aerobic exercise for 3 hours a week can significantly reduce cardiovascular events. Moreover, in patients with stable angina, physical training has proved to be more effective than angioplasty in reducing the number of cardiovascular events during follow-up. Finally, in patients who had suffered from myocardial infarct and/ or left ventricular dysfunction, the training has beneficial effects on the remodelling process. Also, there are many proofs on how physical exercise in patients suf-

number 04 / 2011 fering from hearth failure decompensation can improve life quality and tolerance to exertion, reducing the number of cardiovascular events. Moreover, physical activity is surely the most effective way to improve the symptoms and slow down the progression of the disease in patients suffering from obliterating arteriopathy of the lower limbs. Despite these positive effects, physical activity also implies some risks, in particular as for the cardiocirculatory apparatus, above all if advised without careful analysis on the subjects. Physical exercise may represent the key factor in acute cardiovascular events such as myocardial infarct, angina pectoris and sudden death. Regular physical activity, above all if characterised by high cardiovascular exertion, may potentially be responsible for an unfavourable evolution of the clinical picture for some cardiopathies (such as hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia and some valvulopathies and arrhythmic pathologies (atrial fibrillation and sinus node dysfunction). It is therefore fundamental to say that every individual who is on the point of starting regular physical activity, above all if suffering from a heart disease or with cardiovascular risk factors, should undergo preventive careful medical examination, including the collection and critical interpretation of some clinical data (anamnesis, objectivity, arterial pressure, ECG at rest, ergometric tests) and functional data (body composition, cardiovascular and muscle fitness, articular flexibility and motor coordination). The main aim of preventive screening is to verify the presence of predisposition to clinically silent cardiopathies in subjects who are apparently healthy, and to stratify risk associated to physical activity in case of cardiopathy, activating possible therapeutic interventions. The prescription of exercises must therefore provide medical evaluation as well as a technical-sports evaluation by the trainer. Doctors make a diagnosis and give the indications to apply correct motor protocols. An ideal prescription is determined by the objective evaluation of the subject’s response to exercise, including measurements of the heart rate (HR), blood pressure (BP), rate of perceived exertion (RPE), subjective response to exercise, electrocardiogram (ECG), VO2 directly measured or calculated through an incremental stress test, of the parameters calculated through submaximal tests. The protocols must not be rigidly applied, by simply applying mathematic calcula-

tions to the measurements of the tests and the analyses. Besides these data , observations by the trainer must be added, too. They include the analysis of the following factors: type of issues, problematic combinations, postural analysis, articular biomechanics, complete anamnesis, previous sports experiences, age of the subject, type, psychological factors. Then the trainer distributes the protocols, explains them in accessible language, measures the changes and communicates them to the doctor, establishes the goals (on medical indications), manages the activity of COUNSELLING towards the subject. A customization of the protocol involves considering: modalities, intensity, duration, frequency and progression of the activity. The trainer will have to observe: • Physiological and perceptive responses to the exercise • Adaptations to the physical training according to its intensity and frequency • Progress control of evaluating HR and RPE responses. • The level of satisfaction so that suggestions satisfy individual interests, capacity and limits in order not to demotivate the subject • The protocols must be inspired to GRADUALNESS and PROGRESSIVENESS according to the indications of the World Health Organization Physical exercise will have to include the following characteristics: • Modularity: the workload can shift to another level in a prearranged way • Measurableness: the workload can be easily measured • Proper technical component: gestures must not involve particular difficulties of execution, which may determine extra energy consumption difficult to quantify, particularly unsuitable for subjects with pathologies • Proper biomechanical impact: the exercises must not determine excessive functional overload for the locomotor apparatus. From what has been said, ideal physical-sports activities are aerobic with constant cardiovascular exertion and moderate intensity, such as race walk, jogging, cycling. In order to reach an improvement in cardiovascular adaptability to exertion, physical exercise must have an intensity of 60-75% on the maximum aerobic capacity. This corresponds to a cardiac frequency between 70-80% of the one reached at the peak of

L’Accademia del Fitness exercise during the initial cardiorespiratory functional evaluation. It has also been demonstrated that beneficial cardiovascular effects can be achieved through less intense workloads, too. With workloads reaching an intensity over 85% of the maximum aerobic capacity, instead, the risk of cardiovascular complications correlated to exercise appears higher than the benefits it produces. High-intensity physical exercises must therefore be prescribed only to carefully selected subjects. Updates in the field of cardiological rehabilitation have also introduced, together with traditional activities, isotonic work with overload. In the recent past, power muscle exercise was considered a risk factor due to the higher increase in the double product and myocardial oxygen consumption caused by counterresistance work. However, in the last years rehabilitation experiences have demonstrated the effectiveness and safety of this kind of training (if applied following proper indications). The fundamental requirements to respect are characterised by low muscle loads with control of cardiac frequency, control of the respiratory act (avoid the Valsalva manoeuvre). The method of muscle power training does not aim at developing hypertrophy and fast force, but rather resistance force with low-intensity exercises, many repetitions, linear time of performance and enough recovery time to determine a moderate increase in peripheral resistance and a decrease in sudden changes in the heart beat and pressure . The individual articular biomechanics must be carefully studied in order to apply the proper operational techniques and avoid any kind of injury. The fundamental exercises at the gym will have to be oriented to the various muscle chains. For healthy subjects in overall good condition, the activities may also include proprioreceptivity exercises, activities on sand and in water, use of vibration boards combined with PHYSICAL ACTIVITY BENEFITS PRODUCED BY REGULAR PHYSICAL ACTIVITY Improvement in the cardiovascular and respiratory functions • Increase in oxygen consumption due to central and peripheral adaptation • Lesser period of ventilation to reach submaximal activity • Reduced consumption of myocardial oxygen to reach submaximal exertion • Lower levels of cardiac frequency and arterial pressure, in correspondence to submaximal exertion • Increase in capillary density in the skeletal-muscle apparatus • Increase in the exercise threshold due to the presence of lactate in the circulation • Increase in the exercise threshold due to the appearance of pathological signs or symptoms (angina, ST segment depression, claudication) • Reduction of coronary risk factors • Reduced values of systolic/diasystolic pressure at rest • Increase in the levels of the HDL lipoproteins in the serum and reduced levels of triglycerides • Fewer fats in the body, particularly in the intra-abdominal region • Reduced insulin demand, better tolerance to glucose

isotonic exercises. For activities addressed to subjects suffering from heart diseases, sports centres have to meet structural and instrumental requirements including machines with simplifying systems and gradual increment, frequency meters, possible telemetric systems, emergency equipment with trained staff on BLSD cardiopulmonary resuscitation. Studies have demonstrated that power training reduces body fat and increases the HDL levels, reduces high blood pressure, favours the improvement of glycaemic control, that is, a better use of the body glucose. A recent study carried out on 3233 men, between 20 and 80 years of age, has found out an inverse relation between the development of the metabolic syndrome and muscle power. Muscle power protects men, both with normal weight and obese, in a large age range. Compared to the weakest men, the strongest ones showed a 34% lower risk of developing the metabolic syndrome . We can therefore sum up what has been said about the benefits of regular and proper physical activity in preventing or improving life quality in every subject, above all in those with cardiocirculatory risk: Bibliography The prescription of physical exercise in the cardiological field “documento Task Force Multisocietaria” American College of Sports Medicine Position Stand Fletcher, Balady, Blair, ….. benefit and recommendations for physical activity programs for all Americans D’Andrea “The sports-therapeutic prescription for the quality of life in ischemic cardiopathy patients Prof. Davide Antoniella ISEF Degree Athletic Trainer • Less mortality and morbidity • Primary prevention (operations requested to prevent cardiac dysfunctions) • Intense physical exercise is associated to a reduced incidence of mortality for coronary causes and to the reduced appearance of cardiovascular and coronary diseases, colon cancer and type 2 diabetes • Secondary prevention (operations to predispose after cardiovascular dysfunction in order to prevent from a second one) • Death due to cardiovascular reasons, or to other causes mentioned above, is reduced in patients with myocardial infarct who undergo a programme of cardiac rehabilitation through physical exercise, especially if parallel to a reduction of the risk factors. The same patients do not, however, show a reduction in the number of non-fatal reinfarcts. Other benefits • Less anxiety and depression • Higher capacity of doing one’s job and recreational activities • Increased sense of wellbeing We can add: • Decrease in the body fat • Hypertrophy of the skeletal muscle • Increase in the maximum stress of bones, ligaments, tendons.

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calculation on metabolism by measuring

When calculating metabolism we can estimate a person’s general energy need both in activity and at rest. By evaluating metabolism at rest we calculate the daily amount of energy which is necessary to keep an individual in minimal (or basal) conditions. Unfortunately, in our extremely sedentary world, this value can represent a very good approximation of a person’s energy need. Instead, by measuring oxidative metabolism it is possible to calculate the energy consumption which can be associated to metabolic activities consuming oxygen. Finally, reworking the data we obtain the respiratory quotient, an essential parameter to trace the macronutrient which is mainly metabolised. These data allow a specific intervention aiming at providing operators, doctors and even athletic trainers with analytical results. This leads to nutritional improvement for the patients. In order to obtain these evaluations, complex and expensive tools have been used so far. On the contrary, more modern methodologies use physiological measurements which are essentially spirometric (indirect metabolimetry). The same result that in the past could only be achieved through the use of the metabolic helmet – a complex and delicate measure requiring equipment only owned by few specialised centres – thanks to miniaturization and the use of computers can now be obtained through simple and very light systems, even directly at the gym, provided you have disposable sterile bags and a connection – even by phone – to a calculation system. Therefore, this is an innovative approach since it is not invasive and it is easy to use, also without the use of complex

oxidative metabolism it is possible to

calculate the energy

hospital structures. The system is composed of an “insufflator” machine, a sac for the determination of basal metabolism, a syringe with an extension, a test tube, a vial and an insufflator spout. With these very simple objects it is possible to calculate oxidative metabolism by determining the production of carbon dioxide.

consumption which

Systems to improve athletic performance There are many ways to improve athletic performance, going from the measurement of one’s energy needs (see above) to the need of providing an integration of essential metabolites. This last aspect has until now been achieved through oral medication and/or through injections, with problems depending both on the way of medication and on the need of diluents. The employment of new technologies allows the use of the transdermal way (transdermal restoration). Besides presenting similar effectiveness to the ones used so far, it also removes a series of problems, among which medication. Moreover, the use of these technologies also allows to influence physiological parameters such as perspiration and/or thermogenesis and thermo-dispersion. In short, those who use these systems – which may look like mere sportswear to a non-expert (thanks to nanotechnology) – will find an improvement in their athletic performance.

can be associated to

metabolic activities consuming oxygen.

Ph. Gianfranco Scarsella

Lecturer in General Physiology at the Faculty of Physical and Mathematical Sciences La Sapienza - Rom

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Outpatient treatment for a herniated disc Diagnostics In the past, the limits of CT and MRI in the evaluation of a possible compression on the roots or on the dural sac where due to the fact that they were both performed without load. Therefore, for an evaluation which is closer to reality it may sometimes necessary to use MRI with Axial Loader. Thanks to this technique it is possible to apply an axial load during the MRI exam of the lumbo-sacral spine. The axial loader device, used for compression, is made of a rigid support on which the patient – blocked at shoulder level - is positioned. The patient’s feet touch the board which

The many improvements made in the history of Medicine have been stimulated by the need to give new therapeutic perspectives to an urgent social demand.

compresses the patient. The patient’s position is, therefore, supine with extended lower limbs (with no support for the legs). The load applied by the board is set by the operator and is controlled by a computer keeping a constant compression during the exam. The applied load must be equivalent to 65% of the patient’s weight, as indicated by the constructor of the axial loader machine. The exams consists of the acquisition of routine images for the MRI study of the lumbo-sacral rachis and – after the application of the axial load – of the acquisition of T2 weighted sagittal and axial images

number 04 / 2011 (Fast-spin-echo). It is better to repeat the T2 weighted images rather than the T1, for their better contrastive resolution in the evaluation of the intersomatic disc. After the application of the axial load and before the acquisition of the images, it is necessary to carry out a new centring sequence since the load application implies a modification of the patient’s position. Minimally-invasive Percutaneous Surgery Minimally-invasive Percutaneous Surgery for the treatment of herniated disc with no scalpel has significantly increased in recent years, improving the patients’ quality of life considerably and giving them the possibility to recover their functionality and wellbeing in a short time, thus reducing discomfort and increasing therapeutic flexibility. Even though it is a real surgical operation, it is carried out through the use of special instruments, thanks to a guided xray machine or CAT and with possible television monitoring (video-assisted). With this method, they are introduced in the body through needles and, if necessary, through micro incisions which do not even need suture. This is the reason why it is defined as a minimally-invasive-endoscopic kind of surgery.

hernia and disc protrusion. Restrained herniated disc, if disabling and refractory 1-2 months after conservative treatment, is usually treated with a microsurgical discectomy operation with 90% of immediate positive results. The introduction of minimally-invasive surgery – that is, with no use of scalpel - has represented a significant improvement for these forms of Hernia. Thanks to it, in many cases it is possible to avoid the classical surgical operation with a scalpel. Dr. Ph. Adolfo Panfili Specialised in Orthopaedics and Traumatology of the Locomotor Apparatus Centre of Minimally-invasive Surgery, Spine, Shoulder, Knee, Hand and Foot Member of the EFSA (European Food Safety Authority)

This said, it is necessary to understand that the fundamental principles of traditional surgery must be respected in this new way of operating, too. Make sure that the doctor who performs the technique has specialised in orthopaedics with clear competence in the spinal cord. Do not trust specialists of other nonpertaining branches who turn “minimally-invasive surgeons for the treatment of herniated disc”. On the other hand, the many improvements made in the history of Medicine have been stimulated by the need to give new therapeutic perspectives to an urgent social demand. In this case, offering the patient a successful and satisfactory surgical operation for the treatment of a crippling herniated disc by respecting the external integrity of the patient’s body and providing a quick return to one’s routine can be considered an achievement. The pain due to herniated disc also has a huge impact on social profitability, to such an extent that it can influence the GDP up to 1.5%....... So, these operations are quick and effective if carried out by experts. They have been studied in order to reduce access trauma as much as possible, without breaking the rules of anatomy and surgical technique. On this point it is important to specify that even if minimallyinvasive surgery involves a decrease in surgical risk, it does not cancel it, nor does it represent a surgical performance requiring less expertise. On the contrary, it may lead to severe, irreparable damage if performed by the wrong doctors. THE OPERATION FOR HERNIATED DISC (cervical, dorsal or lumbar) is usually carried out under local anaesthesia or short-time sedation, with no general anaesthesia, also if performed as an outpatient treatment. Particularly promising, it is suitable for

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Bone metabolism and physical activity The response of bone tissue to both static and dynamic load, which occurs in situations of compression and impact on the skeletal structure, depends on quantitative factors such as the bone mass, the volume and mineral density, and on qualitative factors such as macro and microarchitecture and on the bone turnover. The Peak of bone mass reached during growth, which represents the most decisive factor for interpersonal variation of the bone mass, depends on the genetic component, on the amount of calcium in one’s diet and on physical activity. In adulthood, the modified balance in the process of remodelling, the modifications of mineralization as well as extra-skeletal factors involved in falling all represent further elements in determining skeletal resistance. Bone resistance, therefore, depends on its density (BMD) and quality. In particular, a loss in the trabecular architecture of the vertebrae, as happens in osteoporotic women, reduces bone resistance, leading to higher possibilities of fractures. In particular, horizontal trabeculae are the most important as far as bone resistance is concerned. In the process of bone turnover, two different processes can be distinguished: modelling and remodelling. Both of them work in the growing skeleton keeping proper serum levels of ions and repairing the bone regions which are structurally compromised. Active modelling mainly takes place in the first two-three decades of life. It involves a phase of bone resorption and neoformation, never at the same time in the same region. Remodelling, instead, involves a phase of activation, resorption and neoformation. These process all take place in the same region and allow the replacement of damaged bone with the neoformed one. The resorption cavities are weak points on the surface of the trabeculae, increasing the possibility of fracture. The effects of load on bone remodelling can be represented by a U bend, where remodelling increases in non-use (insufficient load) or in excessive use (overload causing damage). In literature, many contributes can be found on the relation between

physical exercise and bone mass. They show, for example, an increase in the loss of bone matrix due to prolonged immobilization and absence of load; a close relation between physical exercise in adolescence and Bone Mineral Density (BMD), obtained at the peak of bone mass; correlations between competitivesports activities in many disciplines and an increase in “site-specific” bone density; a positive relation between physical exercise and BMD both in pre-menopausal women and in post-menopausal ones. Some studies pointed out a correlation between physical activity and a reduced risk of fracture, demonstrating an inverse proportionality between basal motor activity and risk of fracture. At the same time, some works show osteopenia (reduced bone density) due to reduced load. It can be caused for example by diseases of the locomotor apparatus, by prolonged lactation (0.9%/week of bone loss) or by district immobilization. In particular, at the end of the XIX century Wolff highlighted a change in the bone distribution and mass related to the different forces to which the bone was exposed. In the ‘80s it was found out that the load on bones determines a stimulation of osteoblastic activity by means of piezoelectric effect, which affects the ionic component of the bone mineral matrix (mechanostatic model). It has recently been shown that load has a deep influence on bone remodelling. The load disuse or absence cause an acceleration in bone turnover with a prevalence of resorption over deposition and, as a consequence, a loss of bone mass. The factors which regulate the relation between physical exercise and bone mass are muscle contraction – since the muscle is a producer of forces and movement -, gravitational load and general variations (hormones, circulation, respiration, psyche, etc.) provoked by exercise itself. Dr. Giampaolo Lavagetto Specialised in Internal Medicine Associated partner of the Italian Federation of Sports Doctors Head of Spa & Medicine Style Life

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From hypoxia to endothelial dysfunction Cellular bionutrition as an innovative anti-ageing approach Maintaining proper levels of tissue oxygenation is essential for all the vital processes. In fact, when the partial pressure of oxygen (pO2) decreases below 60mm of Hg – a condition known as hypoxia – the cellular functions may undergo changes to such an extent that they may favour the appearance or accelerate the progression of several diseases, often insidious and chronic. Hypoxia, in fact, is followed by acidosis. Through the release of transition metals (iron and copper) from the respective carrier proteins (transferrin and ceruloplasmin), acidosis induces the transformation of the circulating hydroperoxides - produced by cellular oxidative insult and not properly removed by glutathioneperoxidase (GPx) - into free radicals or reactive oxygen species, ROS. The ROS exert a direct damaging action also directed to extracellular matrix, finally leading to the so-called endothelial dysfunction, common pathogenetic moment in all the diseases, not only in cardiovascular ones. Unfortunately, beyond a certain critical time interval, the possible yet by now belated restoration of blood flux in the hypoxic region leads to the generation of other ROS – due to the conversion of xanthine dehydrogenase into xanthine oxidase –, which oxidative insult (damage caused by ischemia-reperfusion) and, if not effectively fought by antioxidant defence – mainly performed by superoxide dismutase (SOD), GPx and catalase – they lead to a condition of oxidative stress (OS), an emerging risk factor for health associated to precocious ageing and at least to one hundred pathologies, from atherosclerosis to cancer. On the basis of these considerations it is obvious that the metabolic problem causing cellular suffering in any disease and, in particular, in precocious ageing, depends on the changed

number 04 / 2011

On the basis of these considerations it

bioavailability of oxygen, an element placed at the extreme end of the chain of metabolic events which leads to the transformation of nutrients into energy, but it is also the starting point for the production of oxidant chemical species with damage potential. Unfortunately, both traditional approaches – aiming at increasing, in case of hypoxia, the level of tissue oxygenation - such as for example hyperbaric therapy and conventional high-dosage antioxidant treatments - aiming at fighting, in case of hyperoxia, the exuberant production of ROS – may paradoxically increase the risk of OS. In this scenario, Cellfood® (CF),also known as Deutrosulfazyme® - natural colloidal formulation containing, in the aqueous dispersant phase, deuterium sulphate together with 17 amino acids, 34 enzymes and 78 trace minerals – offers to modulate on-demand oxygen bioavailability, increasing its levels in case of hypoxia and fighting undesired effects of the ROS in case of hyperoxia, so that it collaborates effectively to the normalization of oxidative metabolism, which is at the basis of all the cellular functions. Therefore, CF seems to be the promising prototype of a new class of neutraceuticals, the “physiological modulators”, that is, agents which can potentially prevent or slow down - through a fine regulation of metabolism - the appearance of diseases or which can favourably influence the evolution of a series of diseases, often degenerative and chronic, such as those associated to the SO. On this point, it has recently been pointed out that in acellular systems CF is able to protect both glutathione (GSH) – the coenzyme of GPx – and the DNA from the oxidation induced by hypochlorous acid, while in cellular systems it prevents from the oxidation of erythrocytes (reducing cellular and intracellular depletion of GSH) and of lymphocytes. Moreover, on endothelial cells taken from human umbilical vein, CF has stimulated

is obvious that the metabolic problem causing cellular

suffering in any disease and, in particular,

in precocious ageing,

depends on the changed bioavailability of oxygen.

the velocity of oxygen consumption and the synthesis of ATP, keeping the intracellular concentrations of lactic dehydrogenase, and it has also inhibited the production of ROS induced by hypoxia, through the regulation of the expression of the manganese-dependant SOD, whose antioxidant function is well known. In conclusion, taking Cellfood® – within a balanced diet and followed by proper physical exercise – by “physiologically” modulating the bioavailability of oxygen and acting on endothelial cells, can be useful both in preventing precocious ageing and diseases correlated to the SO in healthy subjects (especially if they regularly practice sports) and in the nutritional integration associated to conventional medical treatments of acute and chronic morbid conditions connected to a lack of balance in the oxidative process.

Essential bibliography 1. Iorio EL. Hypoxia, free radicals and antioxidants. The “Deutrosulfazyme®” paradox. Hypoxia Medical J. 2006. 1-2: 32. 2. Iorio EL. Deutrosulfazyme® (Cellfood®). Clinical-pharmacological overview [original title “Overview clinico-farmacologica”]. Proceedings International Conference Safety Evaluation of Complementary and Alternative Medicine. 2003. Empoli (Italy). 2003, October 24th–25th. 3. Iorio EL, Bianchi L, Storti A. DeutrosulfazymeTM: a powerful antioxidant [original title: “Deutrosulfazyme®: un potente antiossidante”]. Aesthetic Medicine. 2006. 30 (1): 115 – 116. 4. Benedetti S, Catalani S, Palma F, Canestrari F. The antioxidant protection of CellfoodTM against oxidative damage in vitro. Food and Chemical Toxicology. 2011. 49: 2292–2298. 5. Ferrero E, Fulgenzi A, Belloni D, Foglieni C, Ferrero ME. CellfoodTM improves respiratory metabolism of endothelial cells and inhibits hypoxia-induced ros generation. J Physiol Pharmacol. 2011. 62 (3): IN PRESS. Eugenio Luigi Iorio, MD, PhD International Observatory on Oxidative Stress (Salerno)

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Eating disorders Part II In the previous issue we only saw the definitions of that set of pathologies belonging to the group of Eating Disorders. Let’s try to explore this complex universe, starting from their diffusion. In the last few years Eating Disorders have increased to such an extent that they have alarmed the society, above all in the western world and also in Italy. These pathologies, which seemed to affect only the upper-middle classes in the past, are by now visible in all the strata of the population. On a social-cultural level, the second half of last century brought about a deep change in social expectation as far as women were concerned. Having to face values in clear contrast with the traditional definitions of their role, women have experienced many difficulties in building their personal identity.

The same social pressure also applies to little girls, since Barbie – the most famous doll in the world – would have a waist measurement of 1.38 feet compared to real women.

number 04 / 2011 Competitiveness, independence, leanness: new opportunities, but also new pressure… Since beauty and attractive appearance have always been required in women, these standards – if absorbed and used to establish one’s level of physical and social suitability – can influence the representation of one’s body, therefore they can affect one’s eating behaviour. An interesting study was carried out by Garner, Garfinkel et al on the evolution of body sizes and weight in Playboy cover-girls and in the winners of Miss America competition, who were considered as female parameters. This diachronic analysis found out that from the ‘50s to the ‘80s both categories lost weight and “curves”, becoming thinner and thinner… and the same social pressure also applies to little girls, since Barbie – the most famous doll in the world – would have a waist measurement of 1.38 feet compared to real women… Moreover, if at the beginning Eating Disorders were almost exclusively present in “developed” countries (Europe, North America, Japan), after a while they spread to immigrants in the most wealthy countries. This process must be related to the “process of westernization”, that is, of integration and acceptance of food habits in the new countries. Eating Disorders are now present in areas of the world where they used to be unknown. A study dating back to ’72 did not detect traces of Eating Disorders in Central and South America, while some (only relatively) more recent reviews (’87,’88 and ’89) found several examples in Chile, Brazil and Argentina, also in this case due to the adoption of western cultural values. In a recent workshop which took place in Miami in January 2011, some experts reported that in Mexico over one million people suffer from Eating Disorders, while in Colombia there are about eight hundred thousand cases, and “only” five hundred thousand were detected in Venezuela and Argentina. In Colombia the town of Medellín, the capital of Latin-American haute couture, can “boast” the record of the highest percentage of Eating Disorders among teenage girls: 17.7%! Moreover, the huge cultural globalization as well as the growing influence of mass media have caused the spread of Eating Disorders in Africa, India and many countries in Southern Asia such as China, Hong Kong, Singapore and South Korea. Doctor Becker from Harvard carried out two paradigmatic studies (1999/2011) related to the Fiji, a small archipelago in the Pacific Ocean, where being plump has always been preferable, since eating over one’s satiety indicates richness. Her working group has studied the changes towards food and ideal body weight of teenage girls since 1995, when Television and other media appeared. Well, after only three years of programmes such as “Beverly Hills 90210”, “Melrose Place” and the like, it was possible to notice a total change in aesthetic models, followed by pathological eating behaviour, which can be compared to the one of American teenage girls, also characterised by the appearance of anorexia and bulimia. The influence of Mass Media (may they be the press, television/ cinema or the Internet) has by now become undeniable and its close examination – even superficial – would require a whole

book. However, I think it is important to refer to how even the male sex has become the target of strong social influences: you only have to leaf through any magazine… In a studied dating back to 1999 (“Boys to Men: Media Messages About Masculinity”), Children Now – an organization which studies the effect of Mass Media on young people – concluded that the representation of the male figure made by the media reinforces social practices which link maleness to power, control and dominance. Also a recent survey by the University of Wisconsin (2002) shows us that the focus of the Media on the image of a more and more muscular male is causing in men the same degree of anxiety and insecurity which has been experienced by women for decades: ““Men are finding they are being objectified in the same way they have objectified women”! Yet everybody can see this… on a more “subliminal” level we can quote one among the innumerable studies of my friend Harrison Pope, Psychiatrist at Harvard, about the devious influence of action toys, such as Big Jim or GI Joe, on male imagination

L’Accademia del Fitness since childhood. Well, after a thorough research, Pope has seen through an allometric measurement that, from the ‘60s to the present, the muscles of these toys have been enhanced out of proportion, much more than the average man, with an arm that – starting from 1.07 feet (1964) has shifted to 1.25 feet (’74), 1.50 feet (’98) and in some cases even to about 1.97 feet! In a book by Pope there is a sentence by Mark Hamill - the Luke Skywalker who was the protagonist of the first “Star Wars” – which stroke me very much: during the presentation of a new edition of the toy which had been representing him since 1978, Hamill cried out: “My God, I’ve been put on steroids!” Actually, the toy looked more like a body builder than like the slender American actor… It is however important to point out once again how the socialcultural influence, as important as it may be, is just one of the factors of this kind of disorders. In concluding this short hint to the social-cultural influence of the mass media, it is also necessary to mention pro ana/ pro mia websites (literally pro-anorexia and bulimia…). Internet is a powerful means and we have recently been able to see how sometimes it is the only vehicle of communication for many oppressed populations with the rest of the world… The pro ana and pro mia websites, instead, offer a really heterogeneous heap of blogs and forums created by girls, mainly teenagers, who tell their daily life dealing with Nervous Anorexia or Bulimia. Some scholars talk about young women who find mutual support to face the disease in the web, but surfing the majority of these blogs and forums you can only find exaltation of the two main Eating Disorders, and even some advice on how to excessively lose weight, on self-induced vomiting… Their unconfessed motivation seems therefore to be the creation of social bonds to give life to a virtual Community where to identify oneself, through a collective reinforcement of the strong attraction towards Eating Disorders…

They reach the point of minimising what is globally recognised as severe pathologies, spreading to subjects who are still developing their body and identity the message that Eating Disorders are actually a desirable “trend”, almost a religion of thinness… And here is its set of rules, taken from a random site: 1. If you are not thin you are not attractive 2. Being thin is more important than being healthy 3. Buy some clothes, have your hair cut, take laxatives, starve to death, do everything you can to look thinner 4. You cannot eat without feeling guilty 5. You cannot eat fat food without punishing yourself afterwards 6. You have to count the calories and reduce their consumption consequently 7. What your scales says is the most important thing 8. Losing weight is good, gaining weight is bad 9. You will never be too thin 10. Being thin and avoid eating are symbols of real will power and self-control I think it is more than clear how the spread by the media is a double-edged weapon, which can become extremely dangerous… Everything I have just written only regards some of the cocauses of Eating Disorders: they still have to find fertile ground and on this point several psychological explanations have been isolated. Many of them are about the concept of control and, not by chance, anorexia and bulimia generally arise during adolescence, when body changes are very powerful, above all for girls… but we will talk about this in next article! Dr Marco Tullio Cau Degree in Clinical Psichology and Science Communication

number 04 / 2011

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NATURAL TECHNIQUES FOR STRESS MANAGEMENT (ANXIETY, DEPRESSION, PANIC) AND FOR THE DEVELOPMENT OF WILLPOWER AND DETERMINATION

Let’s make a distinction

As we all know by now, Stress can worsen many pre-existing pathologies and it is often their concomitant cause. Generally, pathologies have a high cost for the National Health Service, while an Anti AGEING System for global prevention gives the possibility to reduce its cost, defining targeted and concrete Anti-Stress strategies. Short-term acute stress is part of everyone’s life and can even be considered an evolutive experience. On the contrary, excessive chronic stress can be considered a predisposing factor to many pathologies, also due to a lower response of the immune system. Let’s make a distinction between the various types of stress which were identified back in 1975 by the pioneer Selye, who divided stress into Eustress and Distress. By Eustress we mean stress perceived as pleasant, enjoyable even if objectively bad (like getting home late after a night at the disco). Instead, Distress is a kind of stress that is perceived as unpleasant, negative (doing a job we do not like or going to the disco and getting home late in order to stay with other people even if we do not like the place – we face it in order not to be alone). In short, we know that a state of chronic stress leads to an increase in the levels of basal cortisolemia, an increase in oxidative stress and in the circulating levels of free radicals. It is also responsible for excessive – rationally unjustified - hyperactivity of the hypothalamus-pituitary gland network, and of the subsequent alteration of the perfect psychoneuroimmunoendocrinological connection. The reaction is exaggerated and rationally unjustified, based on the wrong perception of the specific subject. The body reacts in constant hypothalamic “attack-flight” hyperactivity, secreting excessive amounts of ACTH, therefore of cortisol released by the cortical part of the suprarenal gland, while the medullary part of the suprarenal gland produces continuous

between the various

types of stress divided into Eustress and Distress.

By Eustress we mean stress perceived as

pleasant, enjoyable

even if objectively bad, instead, Distress is a kind of stress that is

perceived as unpleasant, negative.

number 04 / 2011 adrenaline discharge as if the subject were chased by a fierce animal or by an enemy. Objectively, in the real world there are not situations of physical aggression for which nature has conceived this kind of reaction, and anyway, once the danger has ceased, the reaction should be deactivated. Catecolamins (noradrenaline or norepinephrine, dopamine and adrenaline or epinephrine) are destroyed by the COMT enzymes (catecol OR methyltransferase). While the parasympathetic system should intervene to rebalance the sympathetic (they are the main components of the Autonomic Nervous System). Instead, in chronic stress balance is difficult, and this favours the perpetuation of the state of alarm, therefore of sympathetic hyperactivity. In depressed, discouraged, apathetic subjects, instead, the parasympathetic system is activated (parasympathicotony). The Anxiety-Depression Syndrome, which is quite common in many subjects, presents a manifest emotive alternation with mood fluctuations going from hyperactivity-hyperexcitement – even with clear euphoria (symptom of sympacotony) – to moments or even long periods of psychological depression, discouragement, weakness, apathy and desire not to get up from bed in the morning (parasympathicotony). In subjects suffering from this mood alternation - which is particularly heightened in seasonal changes (due to the alteration of the serotoninergic systems and to a reduced production of melatonin) – a pharmacological therapy may be supported by a specific global system of natural and anti stress remedies, which may be enough to solve less severe cases. Obviously, when dealing with forms of paranoia, bipolarity, anxiety crises and manifest panic attacks, in the acute phase, a pharmacological therapy seems to be the most immediate and effective remedy for the treatment of the symptoms yet not for its management. The global natural system consists in the training, in particular, of a new category of doctors on specific sequences of anti stress and relaxation techniques, techniques to throw oneself again in case of depressed patients, and on specific customised advice on food and supplements, vitamins, amino acids and phytoextracts. So, doctors will deal with the emotive alternation of the patients by promptly prescribing the global natural remedies suitable for the symptoms of that moment-period. Therefore, in real-time, and in support, doctors will have to teach the patients specific techniques to perform also by themselves in order to favour the rebalancing of the ANS actively. Doctors will also have to explain how food influences the emotive state, and which food must be avoided or preferred in specific circumstances, even using short brochures. For example, in the period when the subject is suffering from anxiety, nervousness, tachycardia, restlessness, insomnia with subsequent psychosomatic manifestations such as irritable bowel, higher tendency to muscle contractions and to muscle pain, bruxism and the like, the subject will have to avoid the food that worsens such symptoms. The main kind of food which worsens sympathycotonia is rich

in tyramine (natural sympathomimetic indirectly belonging to the pharmacological class of amphetamines, which are clearly more powerful on equal doses). Fermented cheese, red wine and also bananas – which also contain a small amount of melatonin – are all examples of food rich in tyramine. However, since bananas are not easy to digest, they give the feeling of being on a full stomach and in an anxious person or in a person suffering from panic attacks this may lead to an alarming irritation and to the perception of respiratory difficulty (due to the feeling of being on a full stomach, not due to real respiratory difficulty). This simple example is useful to understand how a proper diet must be part of the global system and of how doctors must optimise every detail. In the last 20 years the levels of stress and anxiety have basically increased in all the subjects. The current historical context allows quite an easy detection of the symptoms both in the subjects predisposed to anxiety and to the Anxiety-Depression Syndrome, and in depressed subjects who live practical situations of everyday life with impotence (like dismissals, difficulty in finding a job and subsequent repercussions on one’s private life). The techniques to apply must therefore be extremely effective and targeted on the very patient. According to the global system, doctors must learn strategies

L’Accademia del Fitness and methodologies with specific adaptations based on the main categories of patients. Methodologies such as classical yoga are for many patients ridicule, Oriental-style, lacking any scientific validity. So, these methods will not create motivation nor will they help the establishment of a trustworthy relationship between doctor and patient. The method to propose must therefore be scientific and experimented and tested practically, so that it can be used as a complementary medicine. In particular, the global method we refer to has been tested through practical experience since the ‘80s. Then, university research and teachings on these methods were carried out at the beginning of the ‘90s by Prof. Venturini, professor of Clinical Psycho-Physiology (Cavallo, Ferri, Gelli “Dal respiro alla voce” brochure on research and experiments at the department of Clinical Psycho-Physiology used by the students in that course, year 1993-94). Since then, practical experience has gone on, particularly in the sectors of self-control breathing, physical techniques for the reduction of muscle tension of psychogenic origin and of the subsequent pains to neck and back, methods of “nervousness discharge”, relaxation and therapies for insomnia. Some Oriental disciplines which can be modified and adjusted to the typical Western problems have been presented at the International “EURO-CHINESE” Congress, a COMPARISON of 2 CULTURES. [Accademia S.A. Sanitaria-Ospedale S.Spirito, Rome). The typical disciplines for relaxation, known as the old autogenous training, are usually difficult to apply in subjects who are prone to suffer from tachycardia, psychic sense of suffocation, excessive restlessness, etc… since these subjects cannot usually lie down for the whole duration of the training.

In many cases (hypochondriac, hyperanxious subjects), instead of relaxing they become restless and sometimes they even manifest a panic attack caused by their difficulty in letting themselves relax. Other subjects experience headaches few minutes after the beginning of the treatment. For these subjects, who have been more and more during the years) sequences called SYSTEMATIC AND PROGRESSIVE INDUCTION TO RELAXATION (SPIR) have been created. The SPIR consists of a series of systematic and progressive movements associated to the famous technique of development of the opposites contraction-relaxation, associated to contemporaneous and synergic breathing. Step by step the patients will not be “scared” anymore by letting themselves go, and will also learn techniques to “recall their private place” so that thanks to their memory they will be able to go quickly back to a state of quietness and serenity as the one achieved with the therapist. Patients can perform it without the imposition of keeping their eyes closed (a big mistake on part of many operators who are only used to “easy” cases), explaining step by step the aim of every technique in a simple way, easy to understand but scientific (for example the beneficial feeling of heaviness gradually taking place during relaxation is caused by the reduction of muscle tension and by vasodilatation, so it leads to an improvement in the circulation). Unlike autogenous training and definitely unlike other sessions based on classical yoga, the subject is trained and reassured by the doctor who knows (and must) answer the frenetic and anxious questions asked by the subject. Dr. Alessandro Gelli o.m. European Health Manager Forum

number 04 / 2011

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OXYGEN OZONE:

HEALTHY AND FIT

OXYGEN OZONE THERAPY The oxygen ozone therapy uses a mixture of O2/O3 for therapeutic purposes. The use of ozone in medicine dates back to 1915 in Germany, when it was found out that it had a bactericidal effect on infected wounds at war. Since the beginning of the century it has been experimented in many ways, on different pathologies. In Italy oxygen ozone therapy officially started in 1983 with the establishment of the Scientific Society for Oxygen Ozone Therapy, and it is now performed in many countries all over the world. Research on Oxygen ozone therapy is currently active in universities on an international scale. TOXICITY In order to define accurately the toxicity of a gas it is necessary to define its concentration, the time of exposition and the way it is given. According to a clinical study carried out by Jacobs in 1981, ozone therapy is considered the methodology with fewer risks of side effects. CONTRAINDICATIONS Among the contraindications of ozone therapy are hyperthyroidism (only for GAET), pregnancy and epilepsy (always). SIDE EFFECTS The characteristic of Ozone Therapy is the absence of side effects, except for cough, in case of ozone inhalation – if inhaled – and hypotension due to malpractice (pain, performance in the upright posture, intravenous). The fundamental rules to operate in full security are: 1. Correct medication 2. Use of suitable and authorized equipment 3. It must not be inhaled

The ways of medication through Ozone Therapy are as follows: • Great Auto Emo Infusion • Small Auto Emo Infusion • Subcutaneous • Intramuscular • Intra-articular • Insufflation (anal, vaginal, uterine, urethral, articular) • Topical • Hydropinic • OZOil • OZOcream • OZOdent Years of experience have demonstrated that Oxygen Ozone Therapy has many positive effects. This, in fact, contributes to the patient’s metabolic readjustment, it improves the use of body oxygen and corrects circulatory ischemia. Moreover, it also determines the readjustment of body water, it provides toxin and free-radical detoxification, it increases resistance to exertion and has an analgesic action, both immunostimulating and lipolytic. Finally, it is a great treatment for bacterial and/or viral infections, even antibiotic-resistant.

number 04 / 2011 Ozone has many biological effects, among which antibacterial and antiviral activity, the increase in the production of 2,3-bisphosphoglycerate responsible for O2 transfer to tissues. Moreover, ozone enables the activity of phagocytosis, of cytokines and enzymes which stop peroxides and free radicals in the red blood cells. Other biological effects of ozone are disinfection and direct trophic action, the fo rmation of ROS (reactive oxygen species), among which hydrogen peroxide, which determine antimicrobial activity (Respiratory Burst) and antiviral activity. There is also an increase in deformability of the red blood cells and a decrease in blood viscosity. Finally, ozone considerably improves the transfer of O2. OZONE THERAPY CLINICAL INDICATIONS Fungicide – Bacteriostatic – Anti-inflammatory Virustatic – Reactivating the circle - Immunoregulator

Years of experience have demonstrated that Oxygen Ozone Therapy has many positive effects. Ozone has many biological effects, among which antibacterial and antiviral activity.

OZONE MEDICAL APPLICATIONS: Diabetes and its complications – Circulatory activator It increases resistance to exertion – Immunoregulator – It favours the use of body oxygen DERMATOLOGY Herpes Zoster and Simplex – Acne – Eczema – Lipodystrophy (Cellulite) INTERNAL MEDICINE Hepatopathy – Crohn’s Disease – Adjuvant in treating ischemic metabolic osteoarticular attendant pathologies OPHTHALMOLOGY Degenerative Maculopathy – Blood Detoxicant NEUROLOGY Vascular headaches – Depression – Neurovascular diseases – Chronic fatigue syndrome DENTISTRY Treatment of caries and post- implant surgery disinfection – Osteonecrosis ONCOLOGY Adjuvant in radio/chemotherapy for the increase of O2 interstitial p. in neoplastic tissue ORTHOPAEDICS Herniated disc – Articular rheumatism – Lumbar sciatica – Gonarthrosis VASCULAR Venous insufficiency – Diabetic ulcer – Post-phlebitic ulcer – Buruli ulcer – Arteriopathy

INTESTINAL DYSBIOSIS Colitis –Irritable Colon – Metabolic disorders – Food intolerance – Gastric ulcer – Helicobacter Pylori – Constipation PHYSIATRICS Neuromotor rehabilitation – Fibromyalgia CARDIOLOGY Cardiac ischemia SURGERY Infectious diseases – Pre and Post surgery PNEUMOLOGY Pulmonary hypertension – Respiratory failure RARE DISEASES Adjuvant in: ALS (Amyotrophic lateral sclerosis) – Parkinson – Fibromyalgia – Multiple sclerosis – Scleroderma – Precocious senile dementia

AGEING Ageing is the consequence of a reduced elimination of cell catabolites, with their accumulation in the tissues and an increase in oxidative stress. The dismantling of blood and lymph circulation represents, at the same time, the main cause and effect of the reduced elimination of catabolites. By stimulating the mitochondrial antioxidant system, ozone reactivates the blood and lymph circulation, helps the elimination of cell catabolites having, as a consequence, a considerable anti-ageing effect. Dr. Arthur C. Guyton, M.D., President of the American Physiological Society (ASP), in his book “Human Physiology” says that “Every pain, suffering or chronic disease is also caused by insufficient cell oxygenation” There are many documents on ozone and the positive effects of the therapy. As for Medicine, there are 2108 published works on www. pubmed.com and on the website www.ossigenoozono.it. On contraindications of ozone therapy (respiratory inhalation) there are 1750 works. On Legionnaires’ disease, instead, 367 works have been published, on industrial use 1480 while on water treatments 1357 works can be found. All these numbers prove that oxygen ozone therapy is one of the most studied and used molecules in science. Ph. Marianno Franzini Lecturer at the University of Pavia www.ossigenoozono.it – Ph. 035.300903

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Facial Skin Rejuvenation combined Medical-Surgical approach Facial skin rejuvenation can performed through a combined Medical-Surgical approach. That is, through the use of medical treatments (peelings, laser, dermal fillers, botulinum toxin) and of surgical ones (blepharoplasty, cervical-facial lift, lipofilling) associated or performed at a distance in time in order to treat the phenomena concerning skin ageing (wrinkles, laxity, hypotrophy, keratosis, etc.). (pics. 1-2) Let’s study them more in detail. The medical treatments are as follows: Peelings: thanks to the use of special acids (alpha hydroxy acids, trichloroacetic acid, phenol etc.), these medical treatments induce a chemical exfoliation of the superficial layers of the skin, causing facial rejuvenation. Laser: the ray of specific lasers (UltraPulse CO2, CO2 Erbium and others) can cause, through the mechanism of photoablation, a selective destruction of the superficial layers of the skin, with consequent cutaneous rejuvenation. Dermal Fillers: they are the most famous and used materials in medicine and aesthetic surgery. They can be divided into reabsorpable (hyaluronic acid, etc.) and non-reabsorpable fillers (acrylates, biopolymers). They are used for the correction of wrinkles, furrows, cutaneous depressions, as well as for lip, cheekbone and chin filling. Botulinum Toxin: used since 1980 by Ophthalmologists to treat strabismus and blepharospasm, it has then been used by Neurologists to correct facial hemispasm, and by Gastroenterologists to treat anal rhagades etc. It has been used in Aesthetic Medicine since 1992 for the treatment of wrinkles in the upper third of the face (frontal, glabellar, periocular). The Botulinum Toxin determines a chemical denervation of the treated muscle,

Botulinum Toxin

since 1992 for the

The surgical treatments are as follows: Blepharoplasty: it is an operation used to remove the skin and fat in excess from the upper and lower eyelid. Skin laxity, also called Blepharochalasis – whether it is associated to adipose hernias or not (bags) – is generally a typical phenomenon of the facial skin ageing process. It generally appears in people over the age of 50 but it may also be congenital, thus appearing at a young age. The operation consists in making a small incision on the upper eyelid orbital sulcus or under the lower ciliary margin, removing the skin and fat in excess, thus giving the eye a younger and graceful expression. Blepharoplasty is normally performed as outpatient treatment, under local anaesthesia. The operation lasts about 1 hour. The stitches can be taken out after 5-7 days and the patient is socially presentable after about 10 days. Cervical-facial lift: this surgical operation is used to correct skin laxity in the cervical-facial region through the removal of the skin in excess and the repositioning of the platysma muscle. The operation can be performed in a ward, preferably under general anaesthesia. It lasts about 4 hours. It can be associated to upper and lower blepharoplasty.

treatment of wrinkles in the upper t

hird of the face

causing the relaxation of the overhanging cutaneous region. The phenomenon is reversible: the muscle regains its contractile capacity within 4/6 months.

Lâ&#x20AC;&#x2122;Accademia del Fitness Hospitalization lasts 1 day. The stitches can be removed after 5 days for the preauricular region and after 10-12 days for the retroauricular region. The patients is socially presentable after about 15 days and the final results will be visible after a couple of months. The Minilifts or partial lifts (temporal, cheekbone, cervical, facial) are generally performed on young patients with less skin laxity or, in case of revision (touch-up) some time after previous complete lifts. They are normally performed as outpatient treatment, under assisted local anaesthesia and they last about 2 hours. Lipofilling: it is the grafting of autologous adipose tissue generally taken from the periumbilical region and reimplanted in

the facial region in order to re-form those volumes involved in the ageing process, above all the zygomatic-genian region. Moreover, thanks to the high concentration of totipotent stem cells it contains, fat transplant causes the regeneration of the tissues where the graft was performed, with extraordinary effects on skin rejuvenation which would not be possible with conventional methods (fillers, laser, peeling etc.). Dr. Pierangelo Bosio Degree in Medicine and Surgery, University of Milan, Member of the Italian Society of Aesthetic Surgery, Promoter and Founder of the Italian Society for the Treatment of Obesity

1) Cervical-facial lift, upper-lower blepharoplasty, chemical peeling, filling of lips and genieni-nose furrows, botulinum toxin in the frontal and periorbital regions.

2) Cervical-facial lift, upper-lower blepharoplasty, filling of lips and genieni-nose furrows, botulinum toxin in the frontal and periorbital regions.

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Food and the Metabolic Syndrome The Metabolic Syndrome (MetS, metabolic syndrome) has been widely defined in recent years. Both the World Health Organization (WHO), the Adult Treatment Panel III (ATPIII) of the National Cholesterol Education Program (NCEP) and the National Heart, Lung and Blood Institute, and recently the International Diabetes Federation (IDF) have tried to define its features as accurately as possible. The definition given by the IDF is focused on CENTRAL OBESITY, based on the waistline, whose limits of normality have been set on different scales according to the ethnic group (≥94 cm in men and 80 cm in women, for the European ethnic group). At least two among the following conditions must be added to it: • Hypertriglyceridemia (>150 mg/dl or

1.70 mmol/L) or specific treatment; • Low HDL-cholesterol (<40 mg/dl or 1.03 mmol/L in men; <50 mg/dl or 1.29 mmol/L in women) or specific pharmacological treatment; • Arterial hypertension (>130/85 mmHg) or specific pharmacological treatment; • IFG (>100 mg/dl or 5.6 mmol/L) or known type 2 diabetes mellitus. Despite the non-univocal definition, the Metabolic Syndrome exists in all its complications. It is therefore necessary to implement a series of concretely effective strategies to fight against it as much as possible. In the fight against the Metabolic Syndrome, one of the aspects which has been lately welcomed by the scientific commu-

At the heart of the

MetS is central obesity, which has been more

and more frequently the consequence of a wrong lifestyle, characterised by sedentariness and excessive calorie intake.

number 04 / 2011 nity is the study on the influence of food and dietary habits, and on how such habits affect the very syndrome. At the heart of the MetS is central obesity, which has been more and more frequently the consequence of a wrong lifestyle, characterised by sedentariness and excessive calorie intake. In parallel with it, a change in the lipid metabolism occurs, leading to atherogenicity. Recent studies have shown that the low-glycemic Mediterranean diet reduces the atherogenic lipoproteins and lipoprotein (a) as well as the LDL in women suffering from the Metabolic Syndrome. This emphasizes the key role of carbohydrate intake and of the type (slow-release, fast etc.) in dealing with pathologies responsible of and correlated to the Syndrome itself. Other studies confirm the role of lipidic intake in the oxidative stress present in the MetS and in endothelial dysfunction. Therefore, it is by now certain that high-glycemic carbohydrates, as well as trans fats, must be considered enemies when facing the Metabolic Syndrome. The first ones are enemies because they generate an insulinemic peak: in case of insulin resistance the habit of consuming simple carbohydrates worsens-perpetuates abdominal and visceral obesity. Because of the increase in atherogenic risk, fats favour endothelial damage. Instead, the consumption of low-glycemic food is associated to higher levels of HDL and lower levels of triglycerides and CRP (C-reactive protein). So, knowing the food which contrast the MetS (low and medium glycemic carbohydrates, fibres, fats), it is possible to combine them in a synergetic way, modifying the glycemic reaction. For example, through an increase in the fibre content, in order to slow down the absorption of glucose in food, thus limiting the breadth of insulinemic response. The consumption of a proper amount of fibres is also associated to a 20% reduction â&#x20AC;&#x201C; approximately - (according to studies carried out in the USA) in the plasmatic levels of CRP. According to a recent meta-analysis, high-fibre consumption is associated to a significant reduction (minus 18 per cent) of cardiovascular risk, like in the Mediterranean diet. This approach can be then applied on a large scale to the population, with no consequences for the health service. Other fundamental elements in the anti-MetS diet are fats and dressing oils. Rather than paying attention to the total amount of fats in a diet, today it is important to be careful of the lipid composition, especially related to the presence of single specific fatty acids. Actually, the available data clearly show that a diet rich in saturated or unsaturated trans fats (easily recognizable since they are both solid at room temperature) increases total and LDL cholesterolemia, thus increasing cardiovascular - especially coronary - risk. The opposite effect is caused by the unsaturated fatty acids present both in the typical oils of our culture â&#x20AC;&#x201C; such as extravirgin olive oil â&#x20AC;&#x201C; and in the seed oils such as corn, soy, grape-

L’Accademia del Fitness seed and sunflower. It is also relevant to notice the correlation between consumption of food fats and HDL cholesterolemia or triglyceridemia, lipid parameters which are often modified in patients suffering from the metabolic syndrome. While saturated fats (found in milk, by-products and in many animal meats) tend to increase, even if slightly, HDL cholesterolemia (the so-called “good” cholesterol), the trans unsaturated (contained above all in solid margarine and in many pre-packed products) tend to reduce this parameter. As everybody knows, the HDL reduction is associated to an increase in cardiovascular risk. Olive oil basically contains monounsaturated fatty acids (also hazelnuts and almonds are rich in it), whose effect on lipidemia is basically neutral. Instead, seed oils - rich in polyunsaturated fatty acids such as linolenic acid - have a more prominent effect in reducing cholesterolemia, especially LDL cholesterolemia, but a less favourable effect on HDL cholesterolemia. Generally, all these nutrients – if consumed in excessive amounts – tend to favour the development of weight gain and obesity, conditions where triglyceridemia is high. On the contrary, the scope of the effects of polyunsaturated fatty acids of the omega-3 series – present both in fish oil (in the form of alpha-linolenic acid, which the human body can partially turn into compounds of the same family with a longer chain) and in some vegetables. Omega-3, whose effect reduces platelet aggregation, have proved to be effective hypo-triglyceriders, with anti-inflammatory effect and important anti-arrhythmia action. From all these aspects it can be assumed that one of the preferential approaches in the fight against the Metabolic Syndrome is a fooddietary approach aiming at modifying the hormonal and pro-

atherogenic response typical of the Syndrome, together with a lifestyle as balanced as possible, avoiding excess, abuses and food which increase pathogenicity. Certainly, a proper dietary approach cannot be reached by selftaught people. It is obvious that those who have become obese because of their bad food habits and because of their excessive sedentariness would not have become so, even if they lived in a place characterised by the culture of the “Mediterranean diet”. Food education must be carried out by qualified experts. A proper lifestyle is something that some people choose by instinct. Others, instead, need to learn through specific training. In order to fight sedentariness, which contributes to the worsening of the METABOLIC SYNDROME (once called MEDITERRANEAN SYNDROME), a specific methodology of physical exercises is needed, bearing in mind the laziness of users whose range often goes from medium to severe obesity. This also implies subsequent technical and psychological problems that doctors and/or operators of the sector inevitably have to face. In particular, I can refer to my technical-practical experience as a doctor-trainer (at the gym of S. Andrea hospital in Rome), with patients suffering from the Metabolic Syndrome who took part in the Ides study. I taught them many exercises combining a special methodology of psychic “interface” suitable for effective motivation addressed to special users: those suffering from the Metabolic Syndrome. Dr. Serena Missori Degree in Endocrinology and Metabolic Diseases

Foto Mauro Mamone

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TODAY’S HEALTHY MEDITERRANEAN DIET AND VITAMIN supplementation Since the ‘90s, the researchers of the Institute of General Physiology at the University “La Sapienza” in Rome – Prof. Luigi Consalvo, Prof. Lucia Martinoli, Prof. Alessandro Gelli, Prof. Eugenia De Luca - have been analysing, under my supervision, the studies on the “MEDITERRANEAN DIET”. They have noticed that the scholars who had worked on this topic had not taken into consideration the importance of the quantitative aspects in the diet. Therefore, the consumption of excessive amounts of the food of which the Mediterranean Diet is composed – especially pasta – does not prevent from what has lately been the most widespread pathology in contemporary society: overweight and obesity. The researchers of the University “La Sapienza” in Rome have then observed that, as for the practical use of the food characterising the “Mediterranean diet” – especially in restaurants and pizza restaurants – the procedure of cooking is not taken into consideration at all. Frying oily fish “typical of many village fairs in Cilento” completely destroy the nutritional value both of the fish and of extra virgin olive oil: at a temperature of 200°C, it totally loses all the vitamins and antioxidants that characterise it. Not to mention barbecue inside wood-burning ovens or on metal plates: at a temperature of 300-400°C, it burns all the nutritional principles of the food, which is thus “enriched” with many carcinogenic substances produced by the combustion. As for fruit and vegetables, we must bear in mind that many of these, after harvesting, are stored for a long time “even months” in fridges. Therefore, their nutritional value is almost completely lost, especially vitamins. Fruit and vegetables must be picked and consumed immediately.

Here follows “my” Healthy Mediterranean Diet. Today it is necessary to change the people’s dietary habits completely. The energy consumption of an individual is today reduced by almost 50%. Therefore, also the calories to consume with food must be reduced by 50%. We have to cut out the 3000 calories of the past to 1500, which are more than enough. This can be achieved by consuming, both at lunch and dinner, a single course: pasta or rice plus a side dish for lunch, meat or fish for dinner, always together with a side dish. This dietary model guarantees health, wellbeing and the prevention of many diseases such as cardiovascular diseases, diseases of the digestive tract, kidney diseases and diabetes, which is not curable, leading to many invalidating complications. Moreover, considering that 1500 daily calories cannot grant the proper vitamin requirements, I believe it is fundamental to combine the diet with complete and balanced vitamin complexes which contain all the vitamins we should always take, daily.

We have to cut out

the 3000 calories of

the past to 1500 this can be achieved by

consuming, both at

lunch and dinner, a single course.

Ph. Alberto Fidanza Professor of Nutritional Physiology At the University “La Sapienza” in Rome

L. ARSENIO

>>> Sessualità, Explora

cibo e cervello Nel corso del processo evolutivo l’alimentazione ha certamente condizionato lo sviluppo del corpo umano ed in particolare del cervello, che a sua volta ha progressivamente modificato il comportamento alimentare, determinando una serrata concatenazione di rapporti causaeffetto che insieme hanno influenzato il comportamento sessuale e altri funzioni fondamentali come il sonno.

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Magnesium

aN essential mineral Magnesium is a essential mineral for man, since it plays a key role in many biological processes. It is involved in several enzymatic activities related to the production of energy, the nervous equilibrium, muscle contractility, blood coagulation and protein metabolism. Magnesium is necessary for the energy metabolism of our body, for the transmission of nervous impulses and for proper muscle functioning. Moreover, this mineral contributes to the solidity of the skeleton (50% of the magnesium in our body is located in our bones) and it is necessary, for example, to build our muscles (almost 25% of the magnesium in our body). Which are the sources of magnesium? Magnesium is present in almost all the food, even if in different amounts depending on the source. Foods rich in magnesium are, for example, wholemeal grain, nuts, green leafy vegetables, seeds and legumes. Great sources of magnesium are leafy vegetables such as watercress, spinach, parsley. Several types of mineral water also contain magnesium and they are recommended in case, for example, or magnesium deficiency due to excessive perspiration. How much magnesium do we need? The recommended daily amount of magnesium for adults has been set as 350mg for teenagers and adults. Sportsmen and sportswomen, pregnant women or nursing mothers need a higher amount of this mineral. Do we have enough magnesium? Actually, it is often likely not to reach the recommended amount. Magnesium deficiency is partly due to the environment and to our diet. A balanced diet of 1000 kcal provides between 100 and 120 mg of magnesium. This means 200-240 mg a day for 2000 kcal. This amount is clearly not enough. So, we can face magnesium deficiency. This was also demonstrated by a French study evaluating magnesium intake during one year in a population of 5448 volun-

teers. According to the SU.VI.MAX analysis, it seems that 77% of women and 72% of men have an amount of food magnesium which is lower than the daily recommended quantity. Moreover, in 23% of women and 18% of men the value was two-thirds lower than the requirements. What are the consequences of magnesium deficiency? Among the symptoms of magnesium deficiency are: stress, muscle cramps, palpebral clonia, anxiety, water retention, recurrent tiredness, lack of energy, sleep disorders, irritability, headache, sensitivity to noise, cardiac arrhythmia, palpitations, intestinal swelling, fragile nails… Who is more exposed to magnesium deficiency ? Stressed people often present a deficiency in this mineral, since stress accelerates the loss of magnesium through urine. Also sportsmen and sportswomen risk magnesium deficiency due to abundant perspiration and to the production of stress hormones. Pregnant women need a higher amount of magnesium for the development of the fetus, and the same applies to nursing mothers, since magnesium is also present in mother’s milk. The third age presents higher risks of deficiency due to the prescription of diuretic pills, responsible of an increase of magnesium excretion through urine. How can magnesium be supplemented? Magnesium is a mineral that can be taken orally. However, there are many differences on bioavailability and gastrointestinal tolerance. Magnesium glycerophosphate is a liposoluble magnesium salt which is well absorbed by our body and almost never causes digestive disorders. Therefore, it represents the first choice compared to other (inorganic) forms present on the market. Dr. Maurizio Salamone Degree in Natural Sciences and Biological Sciences

presenta

Massimo Spattini www.massimospattini.it

It is real … now we know it! I grandi del body building l’hanno sempre saputo : Arnold Schwarzenegger lo afferma nella sua enciclopedia del body building. Massimo Spattini lo sostiene da 20 anni. Chi lo nega si avvale di studi obsoleti e probabilmente non si è mai allenato. Ma ora lo sappiamo:

SPOT REDUCTION … it works!

La Spot Reduction o "dimagrimento localizzato" è un argomento controverso, ma recenti acquisizioni scientifiche ne hanno dimostrato l'esistenza. Nel seminario verranno analizzate le basi fisiologiche, i metodi di misurazione, le tecniche di allenamento, gli approcci dietologici, gli integratori, in riferimento ai vari biotipi costituzionali morfologici (ginoide, misto, androide) secondo i concetti della Dieta COM (CronOrMorfodieta) e della DADAM (Dieta e Allenamento Differenziati per Aree Muscolari) per ottenere un dimagrimento localizzato anche nelle zone più resistenti. QUOTA : € 120,00 (comprensiva della quota associativa)

ACCADEMIA DEL FITNESS

Galleria Crocetta 10/A - 43126 PARMA Tel. +39 0521.941319 Fax +39 0521.294971 info@accademiadelfitness.com

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L’Accademia del Fitness

ANTIOXIDANT, ORGANIC AND KM-0 FOOD an intelligent way to preserve our health, get old in a clever way and protect the environment Km-0 food or short-chain food is the local food that retailers find in the areas next to their shop. The idea aims at providing consumers with fresh goods coming from neighbouring farms, so that they do not need long-distance transport, thus avoiding unnecessary CO2 emissions. In this way, the food keeps its freshness – therefore also its nutritional properties and antioxidants – for a longer time, with considerable saving on the cost of transport and intermediation. Moreover, there is a higher control on part of consumers on genetically modified crops. The short-chain food involves the use of historical varieties and breed, the ones which go beyond the schemes of a standard supermarket product, thus being tastier and more palatable. Also, local crops can count on a long productive season, a thinner skin, bright colours under natural light and better taste due to a lower content of lignin. Instead, mechanical harvesting consists in the selection of hybrids for simultaneous harvesting and this requires specific characteristics based above all on

practical needs connected to the working line rather than quality or taste (for example, thick skin). Some consumers think that Km-0 food are organic, too. This is possible, but not consequent. The varieties or breeds used for the short-chain do not always undergo organic processes for their development, while it is possible to buy organic food coming from very distant areas from the shop (even from abroad). Very strict regulations have been created to protect these products. Organic agriculture applies productive techniques which exclude the use of SYNTHETIC CHEMICAL PRODUCTS (among which pesticides, parasiticides and fertilizers) and genetically-modified organisms (the accidental presence of GMO does not exceed 0.9%). Organic agriculture increases the biological diversity of the system. By increasing the organic activity of the soil – through crop rotation and higher cultivation – its structure improves (together with the percentage of organic substance in it), thus

Short chain organic foods are the best

protection for the consumer.

number 04 / 2011 keeping fields fertile for a longer time. No chemical fertilizers are used in these cultivations: the fertility of the fields is obtained through natural techniques such as the use of organic fertilizers (manure), vegetable fertilizers or mixed fertilizers (green manure or compost). The animals are reared with techniques which respect their wellbeing and they are fed with vegetable products obtained according to the principles of organic farming. There is no use of growth-boosting techniques and some industrial farming methods are prohibited, while diseases are treated with homeopathic and phytotherapeutic remedies, limiting allopathic medicines to the cases provided for by the regulations. Only fields far from polluting sources (industries, highways, etc.) on which no chemical products have been used for a certain number of years are entitled to be used for organic agriculture. Instead of herbicides, crop rotation is used. This makes the habitat unsuitable for the reproduction of weeds. Parasites are fought biologically, by trying to reintroduce either adjacent crops which limit their presence (such as garlic, scallion and onion) or natural enemies. Neither colouring agents nor preservatives are used. So, besides producing more natural food with no toxic residues, organic agriculture also contributes to a drastic reduction on the energy consumption necessary for the production of synthetic chemical products. For transparency towards consumers, the ministry for agricultural policies has disciplined the regulations for labelling. Therefore, people who buy organic food must look for the following words and procedures which must be written on the packaging of the products: -- from organic farming – EEC regulations -- name and acronym of the controlling body -- vegetables must be kept in closed packaging (so the ones which are sold loose are not organic) -- meat can be sold both in packaged portions and by the cut, but in this case the butcher will have to cut the piece before the consumer. The mandatory indications – possibly followed by the words “from organic farming” – will have to be indicated on a visible notice. Yet, organic poultry cannot be cut before the consumer: it must be sold in packaged portions or in whole carcass. Organic rabbit does not exist yet, since it is not regulated. The same applies to fish. The control of organic productions in Italy is carried out by special authorised bodies recognised by the EEC and by the ministry for agricultural policies. They are private bodies. They carry out periodical controls in farms, analyse the production and they also guarantee the application of community regulations. Organic food can also come from abroad. There is a control at the customs, yet as accurate as it may be, it cannot verify whether the country of origin has carried out the necessary checks.

Short-chain organic food contain more antioxidants and more nutrients: for example, in a study published in June 2007, the scientists at the University of Davis, California, measured the concentration of flavonoids in organic and non-organic tomatoes harvested between 1994 and 2004. It was a ten-year long study used to compare tens of different cultivation systems in a controlled environment. The results showed that, on average, organic tomatoes had 97% more kaempferol, 79% more quercetin and 31% more naringin. It was also demonstrated that the soil cultivated with biological methods improves in time, giving better and better crops. Antioxidants have very important functions in the body, therefore it is fundamental to consume food rich in them. In fact: They neutralize free radicals and protect the body from their negative action. They also have anticarcinogenic power, they stimulate the immune system, fluidify blood, reduce blood pressure, work as antibacterial and antiviral. In normal conditions there is a balance between the endogenous production of free radicals and their neutralization. In order to keep healthy, everyone should take 5000 units of antioxidants per day. 1 cup of strawberries = 1170 units 3 black plums = 1454 units 1 orange = 983 units 1 cup of blueberries = 3480 units 1 cup of cooked spinach = 2042 units 1 glass of black grapes juice = 5216 units 1 cup of blackberries = 1466 units 1 cup of cooked beet = 1782 units 1 cup of cooked green cabbage = 2048 units A unit of measurement named ORAC (oxygen radical absorbance capacity) has been defined. The main antioxidant food is composed of fruit and vegetables because they contain vitamin A, vitamin E, simple phenols, resveratrol, tannins, flavonoids, catechins. In order to introduce the right amount of antioxidants in our body it is essential to: - eat raw food as much as possible, since cooking reduces or destroys the antioxidant power of food - if possible, eat fruit and vegetables of different colours, containing polyphenols of different complexity - drink one glass of red wine a day - if possible, use fresh seasonal food (and avoid cooking it) - avoid saturated fats - use specific integrators in case of need (like curcuma, lipoic acid, acetylcysteine, polyvitaminic complex, etc.) - obviously, do physical exercise and keep a healthy lifestyle. Enrico Veronese Master in Agricolture Food Technology

L’Accademia del Fitness

THE BIOCHEMICAL APPROACH

AS A PRACTICAL SUPPORT TO MONITOR AGEING, IN ORDER TO FAVOUR WELLBEING AND HEALTH What is the modern population interested in and worried about? The answer certainly regards the possibility to live a healthy and long old age, finding a remedy to stay younger, more good-looking and healthier for a longer time. So, what should the specialists suggest to fight ageing? A healthy diet, varied and balanced, suitable treatments according to personal needs and physical activity aimed at improving psycho-physical conditions. The importance of proper physical activity to decrease the risk of chronic and cardiovascular diseases is by now well-known. The conditions which can be modified in one’s life style to prevent from precocious ageing are first of all excess weight and obesity, which are also one of the causes of the increase in cardiovascular risk, chronic pathologies and subsequent complications. Oxidative stress must not be underestimated either, especially if psycho-physical, caused by disorderly, frenetic or sedentary life. And, last but not least, excessive consumption of alcohol, drugs and smoke. This description shows that modern society risks precocious ageing. Because of these evaluations, NatrixLab has developed innovative, non invasive, safe and certified tests easy to use in order to monitor and help specialists in the prevention against ageing and disorders closely correlated to it, favouring wellbeing and individual health. The Food Intolerance Test (F.I.T.), for instance, was created to

evaluate food intolerance, often cause of disorders of the digestive tract, contributing to an increase in inflammation. The AntiAging Profile (A.A.P.) is useful to determine the concentration of free radicals and of the antioxidant barrier. It allows to obtain a picture of oxidative stress in the body and of the state of wellbeing of the subject. The Lipidomic Profile (L.P.) on plasma and eritrocitary membrane is an important diagnostic instrument for an accurate evaluation of the lipidic profile due to nutrition and of the incorporation capacity of fatty acids at cellular level. The Cardio Wellness Test (C.W.T.) is essential for the evaluation of the health of the heart and vessels. Finally, the Cellular Ageing Factors (C.A.F.) is an innovative test which includes in a single analysis the evaluation of the main physiological processes leading to ageing: oxidation, methylation, glycation and inflammation. These modified conditions can be found in overweight subjects, people with excessive calorie intake, sedentary people, pre-menopausal women, to make some examples. The result of these tests represents a necessary instrument for the elaboration of a correct anamnesis, a personalised treatment and care according to the clients’ needs.

Fight ageing?

A healthy diet,

suitable treatments

and physical activity.

Dr. Claudia Conti Degree in Medical and Pharmaceutical Biotechnology Masters in Human Nutrition and Dietetics

L’INVECCHIAMENTO NON PUO’ ESSERE BLOCCATO, MA SI PUO’ FARE MOLTO PER RALLENTARLO! Il test CELLULAR AGING FACTORS (C.A.F.) di NatrixLab nasce con l’obiettivo di rispondere ad alcune preoccupazioni sentite dalla popolazione riguardo all’aspettativa di invecchiare al meglio e rimanere più giovani, più belli e più sani più a lungo. Il C.A.F. è un test innovativo, il più completo e unico nella categoria dei profili AntiAging, poiché riunisce in un'unica analisi la valutazione dei principali processi che portano all’invecchiamento: l’ossidazione, l’infiammazione, la glicazione e la metilazione. Questo test può essere utilizzato come valutazione complessiva dello stato di benessere dell’individuo: l’alterazione di un parametro può rappresentare un importante fattore di rischio di invecchiamento cutaneo e tissutale. Ma quali sono le condizioni da modificare nello stile di vita per prevenire questo temuto invecchiamento precoce? Il sovrappeso e l’obesità, per tutte le complicazioni che ne derivano; lo stress psico-fisico, una vita sregolata, frenetica oppure troppo sedentaria e non da ultimo, un eccessivo consumo di alcol, droghe e fumo. Anche i fattori ambientali esterni sono purtroppo protagonisti dell’invecchiamento, non dimentichiamo lo smog e i raggi UV. Quindi attenzione, da questa descrizione si evince che siamo tutti a rischio invecchiamento precoce! Oggi lo specialista può disporre di uno strumento di facile comprensione, affidabile e certificato, comodamente nel suo studio. E’ sufficiente un rapido prelievo di sangue capillare da polpastrello per eseguire l’analisi C.A.F. e ricevere un referto di facile interpretazione. Grazie a questo importante passo avanti nella biologia dell’invecchiamento, lo specialista sarà in grado di personalizzare al massimo l’alimentazione, i trattamenti e l’attività fisica del paziente, a seconda delle necessità e dei bisogni individuali.

Altri test diagnostici effettuati da NatrixLab FOOD INTOLERANCE TEST (F.I.T.): analisi quantitativa delle intolleranze alimentari in E.L.I.S.A. ANTIAGING PROFILE (A.A.P.): valutazione dello stress ossidativo: marker di ossidazione LIPIDOMIC PROFILE (L.P.): profilo lipidomico e di membrana eritrocitaria ZONA TEST (AA/EPA): rapporto acido arachidonico/acido eicosapentaenoico, indicazione dell’equilibrio tra acidi grassi Omega 6 e Omega 3 CARDIO WELLNESS TEST (C.W.T.): valutazione del rischio di incorrere in patologie cardiovascolari. PER ULTERIORI INFORMAZIONI:

NATRIX S.r.l.

Via Cavallotti, 16 42122 Reggio Emilia – loc. Mancasale Tel. +39 0522 232606 Fax. +39 0522 506136 e-mail. info@natrixlab.it

www.natrixlab.it

L’Accademia del Fitness

I do not exercise yet

I am under stress

The loss of skeletal muscle is one of the most evident consequences of chronic diseases. The physiological consequences can be devastating when prolonged inactivity is combined with insult, like orthopaedic trauma or burns (Ann Surg. 1993;218:679– 84; Crit Care Med.1992;20:216–26.). The loss of fat free mass in these populations is facilitated and amplified by an increase in the circulatory concentrations of counterregulatory hormones such as adrenaline, noradrenaline, glucagon and cortisol. The increase in the concentration of such hormones is generally proportional to the seriousness of the damage (Crit Care Med.1992;20:216–26; J Clin Endocrinol Metab. 1999;84:3515–21; Am J Physiol.1988;255:E366–73). Even if all the counterregulatory hormones

Injured athletes tend to reduce calorie intake as a consequence of the reduced activity and of anorexiant substances produced during the injury. This may be counterproductive for recovery.

have a role in the initial phase of metabolic deregulation (J Clin Invest 1984;74:223848), it seems that a chronic increase in plasmatic cortisol is the primary hormonal stimulus for muscle-protein catabolism (J Clin Endocrinol Metab 90: 1453–1459, 2005). Prolonged inactivity and hypercortisolemia represent a persistent catabolic stimulus which provokes the loss of strength and fat free mass though a chronic reduction of muscle protein synthesis (The Journal of Clinical Endocrinology & Metabolism Vol. 91, No. 12 4836-4841). Skeletal muscle atrophy induced by glucocorticoids is associated to the super regulation of the expression of the myostatin gene (Am J Physiol Endocrinol Metab 285: E363-E371, 2003).

number 04 / 2011 The expression of myostatin increases with food restriction in a muscle-specific way, and it contributes to muscle atrophy in a prolonged state of food deprivation (in mice) (J Appl Physiol 109: 692-701, 2010. First published July 1st, 2010). Higher protein consumption may support higher protein turnover, but the necessary amount is not as high as we may think. Consume a proper intake of carbohydrates and fats (be careful to essential fats) for protein conservation. Do not consume proteins in excess: they are ineffective and risk producing scoriae which have to be eliminated. Focus on quality and timing of protein intake according to the training and to the presence of other substances. However, a study demonstrates that the consumption of 7.5 g EAA (essential amino acids) stimulate FSR (post absorptive muscle protein fractional synthesis rate). The expression of IGF-I increases in those who take EAA after three months. EAA improve fat free mass and protein synthesis in the elderly. The anabolic response of EAA supplementation keeps in time and it improves fat free mass compensating the debilitating effects of sarcopenia (J Clin Endocrinol Metab .2009; 94: 16301637).

The reasons why… will be explained next time. 1. Eat every 2-4 hours. 2. Every meal/snack should contain complete proteins among which lean meat, fish, lean dairy products, eggs or protein integrators (if the whole food is not available) 3. Every meal/snack should contain 1-2 portions of vegetables and/or fruit, paying particular attention to vegetables. 4. Carbohydrates should come from wholegrain cereals, non-refined sources such as oats, sweet potatoes, beans, wholegrain rice, quinoa, etc. Athletes should eat less starch, above all if injured or immobilized.

Besides decreasing muscle degradation, it has been shown that the EAA are also effective in the reduction of the readings of some inflammatory indexes in the elderly after hospitalization for post-trauma rehabilitation (femur and/or pelvis and/or vertebrae) (Vol. 44 - Suppl. 1 to No. 3 EUROPA MEDICOPHYSICA). Calorie intake is another important factor. The first goal is to avoid the increase of body fat in injured athletes, also because fat itself produces inflammatory substances which do not help muscle rehabilitation. Injured athletes tend to reduce calorie intake as a consequence of the reduced activity and of anorexiant substances produced during the injury. This may be counterproductive for recovery. The ideal solution would be to train the muscles which are not involved in immobilization (in order to obtain higher calorie consumption). In immobilization, calorie intake is also reduced due to the reduction in protein turnover. Yet, it is obvious that during the process of recovery energy consumption increases – particularly in the initial phase; if it is a severe trauma it may reach ~ 20% more. Evaluating the various factors involved, energy consumption may not be much lower than in non-injured conditions. It must also be considered that if the subject walks on crutches this may increase energy consumption of 2-3 times compared to normal walking (Waters et al., 1987). Since excessive calorie reduction implies further protein synthesis and may accelerate catabolism, may it be better sometimes to risk slight weight gain to avoid catabolism?? (option to be considered). (Eplasty. 2009; 9: e9 Published online 2009 February). This article is only a part of the topic regarding sports injury and nutrition. It will be interesting to find out next time how to deal with nutrition, above all as for recovery and post-trauma muscle hypertrophy. Anyway, since I do not like leaving you empty-handed, here follows a set of rules on how injured athletes should deal with nutrition. Dr. Giovanni Montagna M. 3939967076 / giannidiet@tiscali.it

5. An amount of “good” fats should be eaten daily – avocado, olive oil, nuts, linseed and linseed oil. Moreover, 3-6g of fish oil should be added to the diet. 6. The following anti-inflammatory food should be added: curry/curcuma powder, garlic, pineapple, cocoa, tea, blueberries and wine. 7. The following vitamins and supplementary minerals should be included for 2-4 weeks after injury – vitamin A, C, copper and zinc. 8. A combination of arginine, HMB, glutamine should be included to contribute in keeping fat free mass and in accelerating collagen synthesis and deposit. 53

L’Accademia del Fitness

Modelling in anti-ageing A fundamental aspect in Neurolinguistic programming (NLP) is modelling. It can be defined as a process aiming not only at discovering, codifying and extrapolating behavioural strategies, techniques, values, convictions, mental maps of who excels at any activity, but it aims above all at favouring their reproduction in order to guarantee improvement in any individual. Studying the Hunza population (in Northern Pakistan), particularly long-lived and healthy, it was discovered that besides following a correct diet – consuming natural food and water with a high PH – these people do not know the words “disease” or “old age”, since their society is not mainly devoted to appearance. This population was not classified precisely according to their age, but the two only existing classes were those of children and adults, and the oldest person was the point of reference for the group, the active part of the system (people’s power increases when they are given greater importance or authority) since provided with wider experience. In 1978 Rob Hopkins, a young artist, visited the Hunza valley and described it in these words: “I came across a society that managed to live according to its means and which had developed an incredible and sophisticated – yet simple – way to do it. Its citizens were so resilient, happy and attached to one another by a strong community feeling”. The studies carried out on the existing relation between language and health (Rodin 1986) indicate a close connection between physical health, sense of control and symptom classification of. So the Hunza bypassed the nocebo effect caused by pre-eminently disqualifying information, which had little to do with the survival of the species. Their brain, having no experience of old age or disease, processed a kind of reality which was different from today’s reality. This aspect further confirmed the fact that the information of thought generates the information according to which the individuals live. We can perceive any event only after it has reflected on the mirror of memory. According to quantum physics, there are infinite positions and realities, but we only choose the one we have acquired, that is, the one that seems “real” to us. This

number 04 / 2011 one is dictated by our mental programmes which we have creating since our very early age. Yet how is it possible that many individuals of this population could manage to live over the age of one hundred, even if excluded from the global economy and from any kind of health system? Easy: “By not thinking of things as things” (Werner Karl Heisenberg), that is, by not being influenced by disqualifying beliefs such as the possibility to face the ageing process or to fall ill. In the western world age is defined by specific time units. The annual recurrence of birthdays marks the regular increase in age and the gradual ageing process. There is a sharp difference between the societies where recording archives provide precise data and societies which do not know writing. For them age is just an approximate value. However, the social importance of age is not merely the result of recording systems and techniques which fill in chronological registers. The classification of human beings differs from the classifications of other beings living in societies since the former influences the behaviour of those who are classified. Human beings identify themselves and the others according to the age distinctions characterising their society, and they express such classifications in their language, actions, mutual expectations and life expectancy. The cultural establishment of an age-based classification implies a moral connotation which, besides classifying the individuals, also influences them. It is as if at a certain age we expected to get old. We expect people to change their behaviour and take on other roles in the same way as we expect them to move on to another stadium.

Going back to the model of vibrational waves, these are influenced by our thoughts, including the belief that reaching a certain age necessarily implies getting old. According to Roy Martina (well-known doctor, psychologist, kinesiologist and educator), the most long-lived people in the world do not take vitamins, do not meditate, do not go to the gym but they have the power to let go of their negative thoughts. The truth probably lies in the middle: in medio stat virtus, suggested the ancient Romans. It is indeed important to be thoroughly careful about all those factors which allow each individual to evolve and improve oneself as time goes by, without declining. To sum up, the psychological structure to follow and model in order to increase the chance to live longer is mainly composed of these elements: • A happy life; • Strengthening socio-cultural perception (absence of age-based classification); • The elderly as an active part of the system; • Positive approach towards troubles (focusing on solutions rather than on the problem); • Community of intents (sharing); • Lack of weakening beliefs (for example that at a certain age one is supposed to get old).

Hunza population,

particularly long-lived and healthy, it was

discovered that these people do not know the word “old age”,

since their society is

not mainly devoted to

Dr. Claudio Lombardo www.claudiolombardo-pnlsport.com Sport Coach – Diet Coach Science Degree in Organizational Managemt

appearance.

L’Accademia del Fitness

BIOELECTRIC IMPEDANCE IN THE CALCULATION OF BODY COMPOSITION Those who are interested in their state of and total body water (TBW) or free fat Bioelectric impedance nutrition often know that the ponderal state mass (FFM). In the last 20 years many reis an advantageous is classified on the basis of the proportion gression equations have been developed between weight and height. Through the from the comparison with other methods technique for the calculation 2 Body Max Index (Kg/m ) it is possible to of reference for body composition (dencalculate if a person has, for example, a sitometry or dilutometry techniques with of body composition, normal weight or is obese. However, this isotopes) and the validation studies have approach is not accurate enough. pointed out good accuracy for TBW (Total since it is easy to use, People provided with abundant muscle Body Water) and FFM (Free Fat Mass) with mass may be classified as overweight, reproducibility between 1.8 and 2.5%. it is not invasive while half of the people with fat in excess It is necessary to carefully follow standand provides quick result as having normal weight. In order to ardization regulations, especially as for calculate fitness or cardiometabolic risk it the positioning of electrodes and of the measurement, the is therefore necessary to make use of spesubject during measurement. Measurecific instrumental techniques for the calcuequipment can be moved, ment must be calculated far from meals lation of body composition. and never after intensive playing or sports Bioelectric impedance is an advantageous activity. The accuracy of the estimations therefore it can be also technique for the calculation of body comof fat free mass and of intra and extracelused “in the field” and for position. Since it is easy to use, it is widely lular fluid compartments is only high when applied thanks to the recent creation of the individual is not suffering from alteraepidemiological research. new octopolar instruments which can be tion in his hydration state. The use of imapplied in orthostatism with contact elecpedantiometry is of great relevance and trodes. It is not invasive and provides quick it is very useful for nutritional evaluation measurement (<2 minutes); the equipment can be moved, there- in general and for sports medicine in particular, both to study fore it can be also used “in the field” and for epidemiological FFM in periods of training and to monitor the state of hydraresearch. tion, especially in endurance sports and in long-lasting sports. The physical principle is very simple: body water constitutes Predictive accuracy is supported by the considerable amount of about 73% of fat free mass and it is at the same time the main research carried out and by comparison with other techniques electric conductor in the body. The measurement of bioelectric (ex. Densitometry). impedance (in physical terms the sum of body resistance and reactance) allows to calculate it applying the formula V =r x S2/R References where V represents the volume of the conductor, that is, total -Why bioelectrical impedance analysis should be used for estibody water, r is specific resistivity, S is the height (of the subject) mating adiposity. Houtkooper LB, Lohman TG, Going SB, Howell and finally R is resistance. Multifrequence instruments allow to WH. Am J Clin Nutr. 1996 Sep;64(3 Suppl):436S-448S. measure in low frequency extracellular water, or in high fre- Heymsfield SB, Wang ZM, Visser M, Gallagher D, Pierson RN quency total water. By calculating their difference it is possible Jr.Techniques used in the measurement of body composition: to get intracellular water, a parameter which is closely linked to an overview with emphasis on bioelectrical impedance analysis. the mass which is metabolically active. Am J Clin Nutr 1996; 64: 478S-84S. In the elaboration of the datum, the machine must actually con- Lukaski HC. Biological indexes considered in the derivation sider the complexity of the human body, where the tissues have of the bioelectrical impedance analysis. Am J Clin Nutr 1996; different resistivity and are variously oriented. The trunk and the 64:397S-404S. four limbs constitute a system which can be measured as five interconnected cylinders. Despite these assumptions on the huDr. Simona Bertoli and Ph. Alberto Battezzati man body, both in adults and in children there is a significant ICANS Centre – Department of Food and Microbiological statistic association (with coefficients of correlation which are Sciences and Technologies University of Milan often around 1) between the S2/R ratio (impedantiometric index)