TAKE CONTROL of your own health
MUDr. Monika Koubová has spent over twenty years working in internal medicine in a hospital, as emergency physician in the pre-hospital acute care and in the emergency ward, saving patients. After many years managing life threatening health conditions she has come to learn that it is important not just to treat disease, but especially to prevent it. As such, she was the first board-certified Lifestyle Medicine Physician in the Czech Republic. Did you know that up to 70% of chronic diseases that heavily impact health care budgets can be stopped, reversed or even cured? Although we met up during the week, our interview took place over a home-cooked lunch. We discussed epigenetics findings, superfoods, silent killers and, in particular, how small changes in our habits can bring large results. There were also lighter-hearted moments during our serious discussions. MUDr. Monika Koubová can explain even complex scientific principles in an understandable and humorous manner.
Monika, you tell your patients that you can’t guarantee beauty or slimness. The traditional viewpoint of “lifestyle medicine” is that it deals with lifestyle diseases and their prevention.
The medical approach in lifestyle medicine is not about slimming, as one might assume here in the Czech Republic according to the various advisory studies that have been proliferating. In Australia, America and Great Britain, this term signifies a modern medical science based on long term research, which has led to an approach to chronic diseases of the modern era being stopped or cured. The huge range of what at first sight seem to be unrelated diseases has one common denominator: the modern era and our habits, or rather bad habits, which result in pathophysiological changes within our organism. Diabetes, high blood pressure, cardiovascular disease, heart failure, heart attacks, autoimmune diseases and renal failure, which, for example, affect 10% of the population, without half of those affected being aware of it. 920 000 citizens of the Czech Republic suffer from diabetes, and it is estimated that by 2030 the number of type 2 diabetics will grow to 1 200 000. And those suffering congenital type 1 diabetes comprise just about 3 % of patients with diabetes.
You say that we rely too much on our own family histories. When I was in hospital in January, it seemed almost absurd to me, at 42 years old, that they were asking me about illnesses suffered by my parents and grandparents. I realised that it was I who was responsible for my condition. I would add self-critically that I had not been particularly responsible.
The belief that we inherit diseases from our parents remains prevalent. We do not inherit most of the diseases; we create them. If your grandmother died of a stroke, then that may have been the consequence of poorly treated high blood pressure, or many other related causes. Until the age of 40, our body is able to seemingly forgive a lot, but after that all our sins are summed up. With added interest. Preventive medicine has been a subject of study in the West for over 30 years as a result of the rapid increase in lifestyle diseases in developed countries. The modern era changes our biorhythms, lifestyle regime and thus the functioning of our whole body. Thanks to modern medicine, we are able to extend life expectancy. We have great cardiac and cardio-surgical clinics, specialized stroke units, diabetes and oncology centres, transplant medicine and the development of new medicines is significant. Behind an extended life expectancy, however, there is a rapid fall in vitality, and patients thus spend the last 10 to 20 years of their life dependent and reliant on the care of others. Even cancer research has shown that only 5-10% of tumours are inherited. You can even investigate the specific genes responsible for a tumour. Other types of cancer arise through pathological mutations during cellular division.
So we come to epigenetics as a field of medicine with great potential.
Epigenetics demonstrates that we can affect the behaviour of up to 70% of our genes regardless of our particular genome. We ourselves can influence whether most of our genes work for us or against us. I wouldn’t recommend going blind into genome screening without subsequent consultation with an expert who can recommend suitable adjustments to your lifestyle and diet. I compare epigenetics to a lock – it’s up to us whether we give a free pass to diseases and let them develop, or whether we stand up to the challenge of even poor genetic makeup and adjust our overall lifestyle. I don’t want to talk purely about alimentation. It can happen that we need to add some elements through vitamins, minerals, or even medicine in general. This incredibly complex field has had to set out its own path for itself outside the so-called mainstream of medicine, in which many studies are sponsored by pharmaceutical companies. Epigenetics studies on patients with prostate cancer have shown that a treatment programme incorporating just a minimum of the drugs necessary, but also stressing changes in diet, sleep and exercise, can suppress the activity of adverse genes while, in contrast, supporting the activity of beneficial genes. The outcome is a reduction in tumour growth. The same principles for influencing how our genes behave undoubtedly also apply in the effect on some other tumours.
Can this type of approach be used to improve overall fitness?
I tell patients who have had a heart attack that if they follow all the recommendations and take the necessary drugs, then no more arteries need become clogged up. One can also speak of diabetes without insulin. Patients with type 2 diabetes needn’t develop their disease into daily insulin administration. But if insulin is already vital, they can work towards achieving a half-dose. Insulin, which is vital for some, unfortunately causes obesity and is also carcinogenic. Although the lifestyle regime measures I propose are more intensive, they bring results. Clinical studies have shown that through the right micronutrients one can reduce telomere shortening, leading to the slowing of the ageing process. All the procedures I use are the result of science-based clinical studies verified on specific patients. Although we have known some of the results for 30 years, the increase in lifestyle diseases demonstrates that we still haven’t learnt. A wider adoption of this medical approach will require not just much greater doctor training, but also a change in their rewarding. The current system is set up such that we are treating patients, not healthy people. I don’t want to always be treating my patients; I would rather restore them to health.
Diet is one of the key components of a healthy lifestyle. But dietary recommendations change so frequently that it is easy for the lay person to become confused.
There was a massive growth in the food industry during the 1970s, and food began to be produced industrially. Remember the film The Wing or the Thigh in which Louis de Funès fought against Tricatel? Industrially produced food, however, contain not enough of important micronutrients such as enzymes, vitamins and minerals which provide important nutrition to our bodies. Food can contain up to 100 thousand various micronutrients. There are also a lot of trends that promote erroneous and unhealthy dietary recommendations. I’ve got a patient who followed a ketogenic diet for 13 years, meaning she ate lots of fats and proteins, and no carbohydrates. At 52 years of age, she is experiencing severe osteoporosis, and has suffered necrosis of the hip joint. Paradoxically, osteoporosis is most prevalent in countries that consume a lot of meat and dairy products. The motto of milk for healthy bones is obsolete. Dairy products are tasty, but they provide excessive fat and salt. We absorb twice as much calcium from dark green vegetables such as broccoli, kale and Savoy cabbage, while also getting twice as much of calcium and a lot of protein from them. Another widespread myth is the advice to consume a lot of protein. We do need protein, but a specific quantity should be recommended on the basis of age and physical activity. Growing children, people over 65 and active athletes need larger amounts of protein than the rest of the population. In contrast to fats and sugars, the body is unable to store protein except of in our muscles. However to achieve that, our muscles must exercise. As such, it is better to consume protein in smaller amounts over the course of the day rather than all at once. And almost all of us suffer from a lack of fibre in our diet. Fibre is not just important for gut function, but it is also a food for the so-called microbiome. Up to two kilograms of our body weight comprises bacteria, bacterial films and the bacterial community in our gut. This collection is sometimes called our second brain, and only in recent years have researchers focused on its functions and importance. Again, if we take lactobacilli without the necessary fibre, then the lactobacilli won’t stay in our gut anyway, something the television commercials don’t stress. Instead of lactobacilli tablets, you can also eat sauerkraut or kimchi.
You’ve invited me to a home-made lunch. Your favourite motto is: Have all the colours of the rainbow on your plate and you don’t need to count the calories.
I’ve cooked home-made pheasant from South Bohemia. My 81-year-old father, a walking advertisement for lifestyle medicine, hunted and gutted it. He is still active, runs a medical practice once a week, teaches at university and is also an active hunter. The portion of meat is a lot smaller than that served in restaurants; about 0.8 grams of proteins per kilo weight per day is enough. And protein isn’t just in meat. We’ve got a beetroot, celery, rocket and chard salad as a side. I’ve gone for groats instead of rice, which contains protein, and surprisingly also fat, as well as slow-release carbohydrates. I follow the recommendations I give my patients. I hate diets and I’m not going to be counting calories. I give my clients a graph in which I draw a thick line. If you eat the recommended foods, you’re not going to feel hungry, you’re going to have enough nutrients, and it won’t be so hard to maintain the regime. Other foods won’t spoil the diet, but I only recommend a very small amount. And don’t ignore the folk wisdom that hunger is hidden thirst. I recommend drinking at least a quarter litre of water a quarter of an hour before a meal. During the day and overnight, we perspire about 3⁄4 litre of water, so it is important to drink properly in the morning. You can also begin every meal with a salad like Italian, Swiss and other of the healthiest nations do.
What happens in the initial examination and subsequent treatment?
I begin with a comprehensive initial examination, and on the basis of the problem or risks I determine what laboratory tests need to be done. I focus on examinations, which provide information of early signs of diseases. One of the tests is patented by Harvard Medical School for example. As it is comprehensive, this initial examination doesn’t take 10 minutes, but rather an hour. It is important to eliminate medical conditions which are not related to wide range of lifestyle diseases (e.g. thyroid disease). On the basis of the results, I propose suitable measures, whether they be medicines, or dietary or other changes. The number one killer now is no longer cigarettes, but rather a lack of exercise. Another silent killer is a lack of sleep. The first results following a change in overall regime come in 14 days, which is motivating for the patient. This is followed by further gradual changes. You can’t make too many dramatic changes at once, as they won’t be sustainable in the long run. Patients who come to me take control over their own health. I provide this programme to both individuals and companies. It has been shown in the USA, Canada and Australia that companies which invest in health improvement programmes (not to be confused with preventive examinations) don’t just have healthier employees, but also more motivated, more loyal and more satisfied employees. Corporate programmes, and also team workshops, take place on the basis of group consultations. The programme can reveal individuals’premature diseases, while also fostering a positive relationship to health and fitness in the company in general. Employees learn which habits they need to change for better long lasting health, their diet and spend quality time together and learn about new findings in the nutrition and food supplements field. And, of course, I work on the basis of evidence-based procedures, with the programme beginning and ending with laboratory tests.
By Linda Štucbartová