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L’Accademia del Fitness Wellness & Anti-aging Magazine

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La dieta COM (acronimo di CronOrMorfo dieta) è un approccio integrato che tiene conto della Cronobiologia degli Ormoni e della Morfologia dell’essere umano. Non siamo tutti uguali e trovare la giusta alimentazione e tipologia di esercizio fisico per ognuno di noi è la strada per raggiungere la salute. Determinate morfologie, ovvero determinate forme del corpo, sono legate a specifiche espressioni caratteriali. Tutto questo, si sa, è legato alla genetica che indirizza il nostro sviluppo secondo le nostre predisposizioni. Oggi, tuttavia, si ha la certezza c he anche l’epigenetica (cioè l’influenza dell’ambiente esterno) gioca un ruolo fondamentale nel permettere o impedire il manifestarsi di determinate predisposizioni: “Nasciamo come siamo, diventiamo come mangiamo, come ci muoviamo, come pensiamo!”. La dieta COM tiene conto della Morfologia dell’individuo (a mela, a pera o a peperone) che corrisponde a specifiche prevalenze Ormonali, la cui influenza sulla distribuzione del grasso può essere controllata e modificata, in parte, dalla scelta qualitativa, quantitativa e Cronologica degli alimenti, favorendo, di conseguenza un dimagrimento localizzato.

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number 10 / 2013

EDITORIAL

ACCADEMIA DEL FITNESS Galleria Crocetta 10/A 43126 PARMA Tel. 0521.941319 Fax 0521.294971 www.accademiadelfitness.com magazine@accademiadelfitness.com Editor in Chief: Massimo Spattini Editorial staff: Claudia Bonini Silvia Iorio Cristiana Pedrazzini Cinzia Ruggeri Scientific committee: Prof. Fulvio Marzatico Dott. Filippo Ongaro Dott. Damiano Galimberti Prof. Mario Passeri Writers: Andrea Angelozzi Alessandro Gelli Andrea Grieco Eugenio Luigi Iorio Raffaello Michelotti Giovanni Montagna Giovanni Occhionero Filippo Ongaro Maria Letizia Primo Giorgio Severgnini Domenico Siepi Publisher: Profitness S.a.s. Galleria Crocetta 10/A 43126 Parma Tel. 0521.941319 Printed and delivered by: Mattioli 1885 S.r.l. Str. della Lodesana, 649 sx Loc. Vaio 43036 Fidenza (PR) Tel. 0524.530383 www.mattioli1885.com

The Spring season, which hasn’t blessed us with its warm weather yet, has however been full of events connected to the world of Fitness, Wellness & Anti-aging. The magazine’s editorial staff participated to most of these events with the double aim of giving our readers an account of them and of increasing the circulation of the magazine itself. The eleventh edition of “Anti-aging Medicine World Congress”, held in Montecarlo on 4-5-6 of April, confirmed itself as the most important event on an international scale dedicated to Global Anti-aging Management. Many parallel conventions, taking place in separate halls, drew the attention of the participants, who had the opportunity of walking around a vast exposition area, an ideal setting for companies dealing in this field to display their products in a sort of Anti-aging “expo”. Compared with Anti-aging made in USA, mainly addressed to the prevention of degenerating diseases related to aging, the congress in Montecarlo concentrates mostly on the field of beauty and aesthetic medicine, in that the concept of Anti-aging in Europe is mainly linked to facial and skin rejuvenating techniques. However, in spite of this, an entire convention of the duration of a day was dedicated to preventive Anti-aging, therefore it is possible to say that a very interesting Anti-aging convention took place alongside with others concerning Aesthetic Medicine. The great number of operators in this field from Eastern countries, from Russia confirm this to be one of the few sectors in growing expansion. The same can be said of the Rimini Wellness convention, held in Rimini from 9 - 12 of May. A greater number of initiatives from various companies and a growing number of more and more interested and prepared visitors could be noticed this year, in spite of the crisis partly due to economical contingencies and also to the static proposals of the last few years. Various technical and scientific conventions with the aim of fostering interest and development also took place at the “Rimini Wellness”. The recent contraction in the field of gyms, intimately connected to the present overwhelming power of low-cost opportunities, can be contrasted only through the better quality of the facilities,

together with technical competence. Finally, in the latest edition of “Pianeta Nutrizione ed Integrazione” (Nutrition and integration planet), held on 16th of May at the Fiere di Parma, AFFWA (Accademia Funzionale del Fitness Wellness and Antiaging) had a leading role with its convention “Alimentazione ed integrazione funzionale Anti-aging” (Anti-aging functional nutrition and integration), which, once again, received the greatest number of participants of all the other conventions. “Pianeta Nutrizione ed Integrazione” is structurally organized in the same way as the “Anti-aging Medicine World Congress” in Montecarlo, with a series of parallel conventions and a wide exposition area. Originally conceived as a congress event, thanks to the growing number of participants of exhibiting companies, it is now becoming a real exhibition fair which can aspire to become a reference point as far as functional foods and integrators are concerned. The advantage for the exhibiting companies is that, given its congress features, most of the participants are real operators in this field and not simply visitors who are often driven to fairs only out of curiosity. The event promoted by AFFWA was finally concluded with a dinner party at Maxim’s restaurant at the museum Fondazione Magnani Rocca in Mariano, Traversetolo (PR), which gave all the guests the opportunity of a fascinating visit by night to the exhibition on Surrealism which was then being held. The dinner, cooked by the functional food chef Marcello Ghiretti, was accompanied by the musical performance of Bobby Solo and his band coordinated by Valerio Merola. Bobby, who is a keen Anti-aging fan and a fervent supporter of weightlifting training, thanks to his acclaimed talent and surprising humour, was able to fascinate all diners, including the younger ones who perhaps did not know him to be the great artist he actually is. Thanks Bobby, hope to meet you soon! Massimo Spattini Accademia del Fitness President

Registration n. 12/2004 Court of Parma

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L’Accademia del Fitness

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number 10 / 2013

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L’Accademia del Fitness

INDEX EDITORIAL

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by Massimo Spattini

ANTI-AGING MEDICINE

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by Filippo Ongaro

EXTRASKELETAL EFFECTS OF VITAMIN D

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by Giorgio Severgnini

FROM NUTRITIONAL INTEGRATION TO PHYSIOLOGICAL MODULATION: THE ROLE OF GAS MEDIATORS 16 by Eugenio Luigi Iorio, Domenico Siepi

INTEGRATORS FOR THE METABOLIC SYNDROME

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by Giovanni Montagna

CREATINE: NOT ONLY FOR SPORT

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by Andrea Angelozzi

PLANTS AND VEGETAL EXTRACTS WITH “ADAPTOGENIC” ACTION: HEALTHY ANTI-AGING AND ANTI-STRESS EFFECTS

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by Alessandro Gelli

FOOD INTOLERANC: A light on the present and on the future

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by Raffaello Michelotti

MEDICINAL PLANTS FOR SPORT

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by Giovanni Occhionero

LEAKY GUT SYNDROME

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by Maria Letizia Primo

WHEN LOSING WEIGHT IS A PROBLEM, IT IS OFTEN DUE TO HORMONES!

46

By the editorial staff

HEALTH, DISEASE AND ACID-BASE BALANCE OF EXTRACELLULAR MATRIX by Andrea Grieco 6

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L’Accademia del Fitness

ANTI-AGING

MEDICINE

The term anti-aging medicine is often used to define aesthetic interventions sometimes without real scientific foundation. Actually, anti-aging medicine has a specific clinical approach aiming at the modulation of biological aging mechanisms and is at present supported by important scientific evidence. Owing to our increasing life expectancy and to the parallel spreading of many chronic-degenerative diseases, it is time to adopt a new approach of pro-active medicine which intervenes in advance not only to make our lives longer, but to assure the best life quality to an aging population. Anti-aging medicine has this specific aim and goes beyond approaches of super specialization which are useful in acute conditions, but are difficult to apply in the prevention and management of chronic conditions. In fact, by intervening on the network of those molecular and biochemical processes which characterise physiopathology more

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than the disease of the organ, anti-aging medicine on the one hand shortens intervention time compared with traditional approaches and, on the other hand, it widens the range of action to systematic and multi-organ prevention. Moreover, anti-aging medicine represents a fundamental further step ahead in clinical practice, as it goes from standardised medicine to personalised approaches according to the needs of every single patient. Anti-aging medicine is based on the use of advanced scientific technology and on clinical methods for the prevention, the identification in advance and treatment of dysfunctions, disorders and diseases associated with aging. 90% of the diseases of adults are linked to degenerative aging processes. These include cardiovascular diseases, most tumours, diabetes, cerebral vascular diseases, hypertension, osteoporosis, osteoarthritis, self immune diseases and Alzheimer.


number 10 / 2013

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L’Accademia del Fitness By means of preventive interventions and early diagnoses most of these diseases can be avoided so as to guarantee the best health conditions all life long. The clinical approach to the patient must however be changed and must not be limited to the treatment of the disease after it has appeared, but systematic intervention on the patient must be carried out in order to prevent and optimize the subject’s psycho-physical condition. In fact, anti-aging medicine has its origins in advanced medical sectors such as sports and spatial medicine, for which the main aim is the improvement of functionality and performance. Traditional medicine tends to wait for the symptom or for a sign to appear and then makes a rapid diagnosis and a pharmacological or surgical intervention in order to block or control the altered physiological processes. Although this model is absolutely suitable for the treatment of acute diseases, it has various limits when applied to today’s many chronic diseases or simply in the management of personal wellbeing and aging. Wanting to reach a diagnosis and a therapy rapidly often means reducing the patient’s problems to his most evident and recent symptom, thus losing sight of the patient’s personal history, genetic predispositions and the interactions between genetics and life conditions. Every pathological symptom thus becomes an isolated phenomenon and reflects the separation between the various medical specializations which operate independently. This creates the fragmentation of the patient into his various symptoms, which instead often have a common origin. Instead, the clinical methodology in anti-aging medicine consists in evaluating and correcting some fundamental clinical disorders which are the precursors of the signs and symptoms generally used in traditional medicine in order to make the diagnosis of a disease. The fundamental clinical disorders are as follows:

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- hormonal and neurotransmitter disorder - oxidative stress and mitochondrial malfunctioning - detoxification, biotransformation and excretion disorders - immunity disorders - inflammatory disorders - digestion, absorption and intestinal flora disorders - structural disorders - psychological disorders These biochemical and structural disorders are at the root of many pathologies. They emerge owing to harmful environmental conditions such as an unhealthy diet, the bad quality of the water we drink and of the air we breathe, the lack of physical exercise, stress, high toxin concentrations and possible traumas which all interact with our DNA and with our psyche, exploiting possible genetic and psychological predispositions. Moreover, such disorders are a consequence of the degenerative process linked to aging. Thanks to a new clinical methodology as well as to the more and more sophisticated diagnostic exams and multi-modal therapeutic interventions (life style, diet, food integration, phytotherapy and drugs), anti-aging medicine represents a deep transformation in the conception and management of anti-aging. Dr. Filippo Ongaro Health Director Institute of Regenerative and Anti-Aging Medicine s.r.l. (Ismerian) Vice-President (AMIA) Italian Association of Anti-Aging Medical Doctors Board Certified Anti-Aging & Regenerative Medicine (ABAARM) Diplomate Functional Medicine (AFMCP) Certified Practioner International School of Gynecological Endocrinology (ISGE)


number 10 / 2013

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L’Accademia del Fitness

EXTRASKELETAL EFFECTS

OF VITAMIN D

The first description of rickets was made by the physician Soranus of Ephesus (I century A.D.) in the city of Rome. Galen himself, a Greek physician who operated in Rome in the same period, describes how “... the women (and their children) stayed at home without getting exhausted out of work and they were not exposed to direct sunlight...”. It was only in 1645 when Daniel Whistler, a British student of Medicine, made the first detailed description of rickets (or “paedosteocaces”). In 1650 he was then followed by Francis Glisson, who published in Cambridge a treaty in Latin called “De Rachitide”. Rickets clinically appears with a delay in the closing of the fontanelle, thus giving the cranium the typical shape of craniotabes. The chest presents the typical “rachitic rosary” with enlargement of the intercostal spaces, the socalled “Harrison’s groove”. Globose abdomen, valgus or varus knee and bending of long bones are also present. In 1903, Nils Finsen from Denmark was awarded the Nobel prize for Medicine because of his research on the phototherapeutic treatment of lupus vulgaris. At the beginning of the 1900 Mellanby and Huldschinsky (1919) observed that children in urban areas situated in temperate zones developed rickets. They linked rickets to the lack of pure air and sunlight, and assumed that some dietetic factor was lacking. They also observed that the addition of cod-liver oil in the diet or exposure to sunlight prevented or cured the disease. In 1924 A.F.Hess and Weinstock; Steenbock and Black observed that UV irradiation of food for animals or of the animal itself prevented rickets. The ergo- and the cholecalciferol, of vegetable and animal derivation respectively, were finally identified. In 1918, using the experimental method to study health problems, Sir Edward Mellanby – who was working at King’s College in London – irrefutably demonstrated that rickets is a disease also caused by the lack of a liposoluble vitamin in food, later defined as Vitamin D. In 1919-1920 Sir Edward Mellanby reached a similar hypothesis by studying dogs who were bred indoors. In 1925 A. Windaus was invited to New York by the American Physiologist Alfred Hess to collaborate in the study of the antirachitic vitamin. The structure of Vitamin D was then identified in 1930 by A. Windaus himself. Yet, only in the 70s with Kodicek (1974) and De Luca and Schnoes (1976) the mechanisms of metabolic activation of Vitamin D were finally understood. Scientific literature on this topic has been particularly flourishing in the last 10 years. This is due to the many proofs regarding the extraskeletal effects of Vita-

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min D. It is estimated that about one billion people in the world suffers from Vitamin D deficit; among these, the great majority are the elderly. A key note: the plasmatic levels of Vitamin D sufficient for the human body correspond to values over 30ng / ml, while those over 100ng/ml are correlated to excess. Values over 150ng /ml correspond to the case of vitamin Intoxication. The biosynthesis of vitamin D begins in the basal layers of the skin and is caused by the sun beams, in particular by the ultraviolet radiation UVB. Here, the 7dehydrocholesterol is turned into Lumisterol, inactive, and Tachisterol, inactive. The latter is turned into cholecalciferol, inactive, put into the circulatory flow linked to the transport protein DBP. At hepatic level the oxydril OH is linked in position 25, so that the 25 hydroxycholecalciferol, inactive, will be formed. At the level of the kidney tubule another oxydril is finally linked in position 1 of the molecule of Vitamin D, which becomes 1-25-hydroxycholecalciferol, active. Vitamin D is liposoluble and acts like a steroid hormone. It can be considered a vitamin because its lack in food causes clinical conditions of lack. It is important to know that the amount of Vitamin D taken with food is insufficient compared to the requirements. The levels of 25-hydroxyvitamin D define the vitaminic state of a person. Values of 25-OH-D>30ng/ml guarantee normal phosphor-calcium and skeletal homeostasis in adults. The non-hydroxylated form of Vitamin D3 (cholecalciferol) is accumulated in the adipose and muscular tissue and is left on the levels of PTH (Parathormone, produced by the Parathyroid glands) of blood calcium and phosphoremia. As for the seasons and latitude over 35°North - a reference could be Lampedusa – very little or no Vitamin D can be synthesised from November to February. The effect of a reduced synthesis of Vitamin D is of 92.5% with sunscreen SPF 8; 99% with SPF 15. The required amount of Vitamin D varies from 1000 UI/day (healthy adults) to 2.300 UI/day (the elderly). Food in Italy provides on average 300UI/day, so when exposition to sunlight is virtually absent supplements are needed.


number 10 / 2013 Exposition of the arms and legs to sunlight for 5’-10’ at midday in the first summer months provides about 3000 UI of Vitamin D to a person with fair complexion. People whose skin contains higher levels of melanin simply need more time in the sunlight to produce the same amount of Vitamin D as people with low melanin levels. The extraskeletal effects of Vitamin D and the need of a supplement are correlated to: 1. The changes in the body composition during the aging processes. 2. Cardiovascular risk and cerebrovascular diseases. 3. Obesity and the metabolic syndrome. 4. Diabetes. 5. Neurologic diseases such as Parkinson, Multiple Sclerosis, cognitive Decay. 6. Autoimmune diseases such as bronchial asthma, rheumatoid arthritis. 7. Infectious diseases, from tuberculosis to flu. 8. Atopic dermatitis The aging process implies a change in our body composition, with a loss of the Lean Mass (Sarcopenia) and an increase in the Fat Mass. In particular, abdominal fat is associated to the Metabolic Syndrome (according to the IDF classification it is characterised by: waistline > 90 in man > 80 in Caucasian women, AP > 130/80, glycaemia > 100mg /dl LDL>130mg/dl HDL> 40mg /dl in men > 50mg/dl in women, triglycerides > 150mg/dl). Sarcopenia – when particularly emphasized it causes unstable balance, incapacity to go up and down the stairs or carry the shopping. It increases the risk of fall and its seriousness. Osteoporosis worsens due to the reduction of the muscular tension on the skeletal structure and due to the reduction of the buffer effect of the muscle on the bone. In other words, the consequences of sarcopenia - that is, the loss of lean mass - are as follows: 1. decrease in muscular strength, power and resistance 2. decrease in bone mass 3. decrease in balance 4. decrease in the body’s amount of water 5. decrease in the basal metabolism 6. alteration of thermoregulation (intolerance and reduced response to cold) Moreover, other consequences are: • Increase in osteoporosis • Increase in the risk of fall and fracture • Increase in the adipose tissue (fat) • Increase in the cardio-vascular risk Men tend to lose by far more muscular mass than women. Some authors maintain that sarcopenia in men is the equivalent of osteoporosis in women. In women the decrease in the concentration of estrogens due to menopause causes the increase in the loss of muscular mass of about 3 kg and increases the fat mass of about 2.5 kg.

The arm measurement is an index of sarcopenia, and a correlation between this and the increase in mortality has been demonstrated. However, in obese elderly people this parameter is not enough. In order to diagnose sarcopenia, more complex instruments for body mass evaluation are required (double X-ray densitometry, bioimpedentiometry). The histological exam of muscular tissue of people with osteomalacia demonstrates an increase in the interfibrillar spaces, infiltrated with adipose tissue and fibrosis. Biopsic samples taken before and after supplementary treatment with Vitamin D and calcium have demonstrated an increase in the number and in the section area of the type IIA (or fast) muscle fibres. Moreover, it has been ascertained that the supplement of Vitamin D (1000 IU /day of ergocalciferol or Vit D /2years) was associated to an increase in percentage and in diameter of the type II muscle fibres as well as of the muscle strength. It is interesting to notice that the type II muscle fibres are the ones more involved in the prevention of fall. The levels of Vitamin D are correlated to bone mass and to an increase in the risk of femur fracture and of non-vertebral facture. These events are fought with supplements of at least 1000U/ day of Vit. D. Data show an expressive inverse correlation between vitamin D, BMI and % of fat mass. Both HOMA (index of insulin resistance) and TG (Triglycerides) / HDL (high-density lipoprotein) are correlated to the decrease of vitamin D. The levels of 25OHD are inversely correlated to the main risk factors for diabetes. Diabetic patients treated with supplements of vitamin D3 have also shown an increase in the number of T regulatory cells which, together with CCL2, act to slow down the autoimmune destruction of pancreatic cells, which characterises type 1 Diabetes. CCL2=factor which leads to the formation of TH2 cells (with anti-inflammatory and protective action towards type 1 Diabetes Mellitus). On the basis of analysed epidemiological studies, three reasons why the lack of vitamin D is a risk factor for the MS (Multiple Sclerosis) have been identified: • the frequency of MS increases at higher latitudes. • prevalence at higher altitudes is lower to the expectancy in the populations who consume more fat fish. • the risk of MS decreases in the populations who move and live at lower latitudes. Other studies show a close correlation between low levels of 25 (OH) D and risk of developing MS, and they show that the risk of developing MS significantly decreases with the increase in the levels of 25 (OH) D.

The biosynthesis of vitamin D begins in the basal layers of the skin and is caused by the sun beams, in particular by the ultraviolet radiation UVB.

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L’Accademia del Fitness Vitamin D and multiple sclerosis Lancet Neurology, 2010 The risk factors are relatively unknown, but the neuroprotective effect of vitamin D (through antioxidant mechanisms, regulation of neuronal calcium, increase in nerve conduction etc.) and the presence of its receptors and of the enzyme responsible for its activation inside the substantia nigra lead to the assumption that vitamin D is involved in Parkinson’s disease. In 30 years of observation, 50 cases of Parkinson’s Disease have been reported. Patients whose values of 25 (OH) D were at least of 50 mmol/L presented <65% risk of developing Parkinson’s Disease compared to those with levels lower than 25 mmol/L. (Serum Vitamin D and the Risk of Parkinson Disease Archives of Neurology, 2010.) The lack of vitamin D is also correlated to the development of depression. Higher levels of vitamin D are associated to a lower risk of depression. On the contrary, conditions of lack of vitamin D are linked to higher probability of depression, above all in people who had already suffered from this disease in the past. Association between low serum 25-hydroxy-vitamin D and depression in a large sample of healthy adults: the Cooper Center Longitudinal StudyMayo Clinic Proceedings, 2011). Wilkins and pupils have recently demonstrated a reduction in the cognitive function in elderly patients with vitamin D deficit. A sub-expression of VDR (vitamin D receptors) in the hippocampus cells has been demonstrated in patients suffering from Alzheimer’s Disease. In animal samples an increase in the density of the hippocampal neurons with vitamin D supplement has been demonstrated. The relation between hypovitaminosis D and the slowdown of the speed of nerve conduction has been demonstrated, too. As for cardiovascular risk, individuals with myocardial infarction have shown levels of Vitamin D <15ng/ml, while values <30ng/ ml have been considered protective. Giovannucci et al, Arch Intern Med, 2008 In subjects with stroke, values of Vit. D=25 are within the average of age, with respect to protective levels if above the average of age. (Pilz et al, Stroke, 2008) There are correlations between the levels of vitamin D and the levels of aortic calcification, reduced if > than 30ng/ml Naves-Diaz et al, Osteoporos Int, 2012 More elevated levels of vitamin D are associated to fewer infections in the respiratory tract, whatever the season. Ginde et al, Arch Intern Med, 2009 The 1-25-hydroxyvitamin D is also a powerful immune modulator. Its capacity to stimulate the production of catecalcidin (peptide able to destroy various infectious agents, among which M. Tuberculosis). Liu PT, Stenger S, Li H,Wenzel L Tan BH, Krutzik SR, et al.’’Toll-like receptor triggering of vitamin D-mediated Human antimicrobial response.Science2006;311:1770-3 ‘A monthly supplementation of 100,000 U.I. of vitamin D makes respiratory rehabilitation more effective in patients with COPD (Chronic Obstructive Pulmonary Disease)’. Vitamin D Supplementation During Rehabilitation In Pa-

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tients With Chronic Obstructive Pulmonary Disease: An Intervention Study American Journal Of Respiratory And Critical Care Medicine, 2011 The supplementation with 1600 UI per day of vitamin D highly improves the symptoms of atopic dermatitis. Vitamin D supplementation in the treatment of atopic dermatitis: a clinical trial study Amestejani M, Salehi BS, Vasigh M, Sobhkhiz A, Karami M, Alinia H, Kamrava SK, Shamspour N, Ghalehbaghi B, Behzadi AH. Journal of drugs in dermatology, 2012 An adequate intake of Vitamin D is recommended during pregnancy. In pregnancy, 18% of mothers showed severe lack of serum levels of 25(OH)D, that is <11 µg/L (27.5 nmol/L); 31% was lacking [11 µg/L (27.5 nmol/L)< 25(OH)D < 20 µg/L (50 nmol/L)]. The low serum levels of 25(OH)D of mothers are associated to a reduced development of the bone mineral content (BMC) of the child at the age of 9 years old (p=0.0088 total BMC and p=0.03 lumbar BMC). Moreover, children born from mothers who lacked vitamin D have shown a lower deficit at the level of BCM compared to the one of children born from mothers who had a severe lack. Javaid MK, Crozier SR, Harvey NC, Gale CR, Dennison EM, Boucher BJ, Arden NK, Godfrey KM, Cooper CMaternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study The Lancet, 2006 From the oncological perspective it is important to know that the mammary tissue – both normal and pathological – expresses 1.25(OH) D and its analogous ones inhibit in vitro and in vivo cell replication, implying its possible use in the therapy of mammary carcinoma. J. Cell.Physiol 1989;138:611-616 - Lancet 1989;1:188-191 There is a project aiming at evaluating the reduction of new cases of mammary carcinoma with the intake of 2000UI/day of Vit D3 Garland et al, Ann Epidemiol, 2009 Therefore, knowing the extraskeletal effects of Vit. D can be compared to observing an Iceberg on whose surface we see rickets and osteomalacia. Yet, looking deep down we discover a world of pathologies that cannot be treated without an adequate supplement of Vitamin D. Dott Giorgio Severgnini Surgeon specialised in Endocrinology and Metabolism Diseases


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L’Accademia del Fitness

FROM NUTRITIONAL INTEGRATION TO PHYSIOLOGICAL MODULATION: THE ROLE OF GAS MEDIATORS. The correct functioning of all vital processes is modulated by the action of a number of gases, oxygen in primis. This element, under its molecular form (O2), by accepting the couples of reducing equivalents extracted in the course of terminal metabolism by a series of substrates, allows ATP synthesis which is necessary in all our biological functions. Moreover, by accepting single reducing equivalents, it generates specific reactive species (reactive oxygen species, ROS), such as superoxide anion (O2Ÿ), hydroxyl radical (HOŸ) and hydrogen peroxide (H2O2) which, in low amounts, modulate fundamental activities (i.e. cellular signal transduction, defence against bacteria) but, in high amounts, owing to their tendency to reach a stable configuration (electron pairs in all the orbitals), can subtract electrons from key molecules (i.e. nucleic acids), oxidising them and therefore altering their functions. In order to keep the high ROS production under control, and consequently their undesired effects, living organisms have developed a complex defence system made up of the various endogenous antioxidants (i.e. superoxide dismutase, peroxidase, catalase, albumin, bilirubin, uric acid, etc.) and exogenous antioxidants (ascorbic acid, tocopherols, carotenes, polyphenols, etc.). The absence of a physiological oxidant/antioxidant balance determines the so-called oxidative stress (OS), an emerging risk factor for our health which is associated not only to precocious aging but also to a high number of diseases (over 100), among which the most common and invalidating are for instance cardiovascular pathologies, neurodegenerative diseases, metabolic syndrome, obesity, diabetes, cancer etc. Unfortunately, OS does not give place to any clinical manifestation. Therefore, it can be diagnosed, in the presence of grounded suspects, only by means of specific laboratory exams (available today on blood, urine, exhaled breath etc.) (1). On the basis of such tests it is possible to identify subjects at risk,

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submit them to preventive personalised therapeutic strategies and monitor their efficacy over time, avoiding undesired effects of many integrators which are too often unnecessarily taken at present. The spreading of knowledge on oxygen, considered not only as hydrogen acceptor for energy production, but as the origin of reactive species which can modulate biological functions, has opened the way in the last thirty years to studies on other gases considered in the past inert or even toxic, such as ozone (O3), carbon monoxide (CO), carbon dioxide (CO2), nitric oxide (NO), sulphuric acid (H2S) and, very recently, molecular hydrogen (H2). Among these, molecular oxygen is produced exclusively through photosynthesis. The ozone derives from molecular oxygen, owing to the effect of electric discharges. Carbon monoxide is generated by heme thanks to the heme oxygenase enzyme. Carbon dioxide is released, spontaneously or enzymatically, by decarboxylation processes of β-keto acids. Nitric oxide is produced by the amino acid arginine through the catalytic action of nitric oxide synthase. The sulphuric acid is synthesized in the process of cysteine metabolism through cistathionine-β-synthase, cistathionine-γ-lyase and mercaptopyruvate sulfotransferase. The endogenous production mechanisms, if they exist, of molecular hydrogen are less clear. More and more studies show that all these “biogases”, thanks to their particular physical-chemical properties, by spreading more or less rapidly from the production site in the surrounding microenvironment, specifically tie themselves to determined molecular “receptive” targets, acting as real pleiotropic biochemical mediators (autocrine and/or paracrine) which can control vital biological functions such as vascular tone, stress response, apoptosis etc. (fig. 1) (2). For instance, if endogenously produced, nitric oxide - which had been considered an envi-


CONOSCERE CIO’ CHE MANGI

TI RENDE LIBERO FOOD INTOLERANCE TEST Le intolleranze alle proteine alimentari, dette allergie ritardate, sono reazioni conseguenti l’introduzione di alimenti di consumo comune. Queste reazioni sono causate da un’iperproduzione di immunoglobuline di classe G (IgG). Emicrania, disturbi gastro-intestinali e respiratori, stanchezza cronica, dermatiti, irritabilità, sovrappeso, sono solo alcuni dei sintomi ricorrenti nei soggetti affetti da allergia ritardata. Il FOOD INTOLERANCE TEST (F.I.T.) di Natrix permette di verificare la reazione dell’organismo nei confronti di 46, 92 o 184 alimenti. Ciò che ha reso il F.I.T. affidabile è la metodica analitica ELISA,

affidabile e ripetibile e la lunghissima esperienza di Natrix nel campo della diagnostica delle intolleranze.

celiaci, per il monitoraggio della malattia celiaca in soggetti che seguono una dieta priva di glutine.

CELIAC TEST

Natrix Lab: il laboratorio certificato (UNI-ENI-ISO 9001: 2000) di riferimento per le analisi:

Ad oggi per ogni celiaco diagnosticato, ve ne sono sette a cui la celiachia non viene diagnosticata. L’ingestione di glutine, nei pazienti affetti o predisposti a celiachia, provoca un grave danneggiamento della mucosa intestinale. Il CELIAC TEST è una prova allergometrica che consente di effettuare un saggio di I° livello completo per la celiachia. Il CELIAC TEST è consigliato in caso di sospetto di malattia celiaca, in familiari di primo grado (genitori, fratelli) di soggetti

• • • • • • • •

FOOD INTOLERANCE TEST CELIAC TEST ANTIAGING PROFILE CELLULAR AGING FACTORS LIPIDOMIC PROFILE ZONA PLUS TEST CARDIO WELLNESS PROFILE PROFILI ORMONALI

Tutte le analisi sono eseguibili anche tramite un semplicissimo prelievo capillare e salivare.


L’Accademia del Fitness Precursors

HEME

L-arg

L-ser

L-Hcy

Enzymes

HO

NOS

CBS

CSE

C

Gas mediators

O

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S H

Noneminic protein sensors

Eminic protein sensors

Targets

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ing or worsening pre-existing disease conditions. In this fascinating scenario, traditional nutraceutics should not limit itself to simply proposing solutions to “contrast” the effects of these precious mediators, but must contribute, through a healthy diet and, when necessary, careful integration, to the harmony of various biogases, avoiding, for instance, extreme conditions of hypoxia and hyperoxia. Since ROS accomplish absolutely necessary biological roles for the economy of the entire organism, it is absolutely senseless to “contrast the effect of free radicals with antioxidants”, but it would be necessary “to modulate their action physiologically”. In this scenario Deutrosulfazyme® (Cellfood®) appears as the prototype of oxygen’s physiological modulators “on demand” (3), thanks to its documented capacity to stimulate APT synthesis without increasing lactate levels. Above all, it improves the expression of mitochondrial superoxidedismutase (figure 2) (4).

enzymes mitochondria vessel carrier s

Effectors

Eugenio Luigi Iorio, Domenico Siepi International Observatory of Oxidative Stress (Salerno)

Picture 1. Biogases as physiological modulators.

Picture 1. Biogases as physiological modulators.

ronment polluter for a long time - reduces leukocytes adhesion to epithelium and platelet aggregation, meanwhile fostering release of smooth vasal muscles thus preventing inflammation and ischemia. However, conditions of oxidative stress such as for instance a high level of anion superoxide (due to increased synthesis and/or reduced inactivation of superoxide dismutase), can foster the conversion of nitric oxide into peroxynitrite, which has an inflammation, aggregating and vase constricting action. More in general, pollution and unhealthy life styles, together with unfavourable genetic predispositions, can alter the delicate existing balance between the various biogases, thus caus-

Bibliography 1) Iorio EL, Balestrieri ML. Lo stress ossidativo. Trattato Italiano di Medicina di Laboratorio, (Oxidative Stress. Italian Treaty of Laboratory Medicine) by A. Burlina. Piccin, Padua. 2009. IX: 533–549. 2) Kajimura M et Al. Interaction of multiple gas-transducing systems: allmarks and uncertainties of CO, NO, and H2 gas biology. Antiox Redox Sign. 2010. 13 (2):157-192. 3) Iorio EL. Hypoxia, free radicals and antioxidants. The “Deutrosulfazyme®” paradox. Hypoxia Medical J. 2006. 1-2: 32. 4) Ferrero E et Al. CellfoodTM improves respiratory metabolism of endothelial cells and inhibits hypoxiainduced reactive oxygen species generation. J Physiol Pharmacol. 2011. 62(3):287-293

Stimulation of ATP synthase

**

ROS (increase%/NT)

160 120 80

50

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* 0 Reduction in the levels of lactic dehydrogenase

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* **

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0.5

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Picture 2. Effects of Cellfood® on the endothelial cells.

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Picture 2. Effects of Cellfood® on the endothelial cells.


number 10 / 2013

19


L’Accademia del Fitness

INTEGRATORS FOR THE METABOLIC SYNDROME The Italian Longitudinal Study on Aging (ILSA) identifies a 25.9% metabolic syndrome prevalence (J Gerontol A Biol Sci Med Sci 2006;61:505-10). The physiopathological mechanisms of this syndrome have not been clearly identified yet, although a fundamental role is certainly played by insulin resistance (IR), by fatty acid accumulation mainly in the abdomen and by oxidative stress which can give rise to variations in the body mass composition of elderly people and not only. (Domiguez L, Barbagallo M. The cardiometabolic syndrome and sarcopenic obesity in older persons. J Cardiometab Syndr 2007;2:183-9.). Moreover, the adipose tissue can produce many biologically active substances, generally known as adipokines, in response to specific extracellular stimuli or to modifications in metabolic conditions. These substances - as well as some inflammatory cytokines such as interleukin 1 (IL-1), interleukin 6 (IL-6), Tumour necrosis factor α (TNFα), which are probably produced also by inflammatory cells which filter into the adipose tissue - include new highly active substances such as ghrelin, leptin and adiponectin (Am J Physiol HeartCirc Physiol 2007). Therefore, in obese subjects adipokines - together with inflammatory cells which spread into the adipose tissue - produce a number of cytokines which not only enhance inflammation but give rise to a process of chronic inflammation which is strictly linked to the appearance of the main complications of obesity such as insulin resistance, diabetes mellitus and cardiovascular disorders. This situation is associated to a clear decrease in cytokine levels and in anti-inflammatory and regulating chemokines such as adiponectin and IL10 (Signalling role of adipose tissue: adipokines and inflammation in obesity. Biochemical Society Transactions 2005). A chronic state of inflammation due to excessive fat can lead to micro-vascular dilation reduction together with capillarization reduction and also to hypertension and modulation of post receptor peripheral insulin signal (IRS – 1, IRS - 2 and P – 3kinases mediators) together with generalised insulin resistance, but above all concerning muscle tissue.

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States of “chronic” hyperglycemia can lead to: Glucotoxicity with mitochondrial disorder and reduction in ATP, fusion proteins and lipid oxidation. There is a possibility of intracellular lipid deposition and reduction of type 1 muscular fibres (sarcopenia) which, moreover, are the most sensitive to the action of insulin, with further deterioration of insulin resistance. Cytoplasmic dysfunction and free radicals increase. Protein glycation of vasal walls with microangiopathy and endothelial alteration. Increased TRG level in VLDL (dyslipidemia) with production by the liver of small and dense LDL which have high levels of apolipoproteins B and are more atherogenic for the same values of circulating LDL, as they tend to penetrate the arterial walls more easily. This determines their involvement in the pathogenesis of an atheromatous lesion independently from other risk factors. As we have seen, various factors are involved in the metabolic syndrome going from chronic inflammation, excessive production of free radicals, glucose disorders, dyslipidemia and so on. Therefore, integration must take into consideration a number of factors and never concentrate on one single disorder (in short, stabilising glycaemia is not enough). Only a small range of integrators which are useful for the metabolic syndrome and which can be used daily are taken into consideration here. Magnesium, chrome and vanadyl help keep insulin sensitivity under control and have an effect on glucose control. A recent study ((2013) (High Dietary Magnesium Intake Is Associated with Low Insulin Resistance in the Newfoundland Population. PLoS ONE 8(3): e58278) puts into correlation the intake of high levels of magnesium with a low incidence of metabolic syndrome and insulin resistance, above all in obese or overweight subjects. Green tea is also useful (Agric Food Chemistry. 50:7182-7186), and so are high quantities of vitamin B such as biotin (9-16 mg per day) and cinnamon extract, which controls disorders in insulin interaction with cells (1-6 g per day). Lipoic acid, or ALA, reduces high glucose levels independently from insulin and acts as an antioxidant in both lipo- and hy-


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ACCADEMIA DEL FITNESS - Galleria Crocetta 9/A - 43126 PARMA - Tel. 0521.1682083 - Fax 0521.294971

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L’Accademia del Fitness dro-soluble environments. Lipoic acid fosters the recycling of other antioxidants such as vitamin C and E after they have been oxidized. It also increases the levels of endogenous glutathione and has anti inflammatory and anti oxidising effects. The advisable amount to be taken daily is 600 mg which should be taken in different times of the day, as ALA remains only one or two hours in the blood. Many integrators can help reduce the excess of lipids in the blood such as for instance policosanol (20 mg per day), vegetable integrators of sterols (taken during meals they prevent cholesterol absorption) and omega-3 fats contained in fish oil which can reduce 60% of blood triglycerides in excess. Red rice yeast extract contains lovastatin and other substances which can lower cholesterol levels. A study on mice has shown that by following a 1% green tea diet, which corresponds to drinking daily 800ml of green tea, cholesterol absorption was reduced by 37%. Tocotrienols, an isoform of vitamin E, inhibit cholesterol synthesis in the liver in the same way as statin drugs but without their side effects. Gamma and delta tocotrienols are 30 times more effective than the alpha version (however, since vitamin E under the form of alpha-tocopherol interferes with the effects of tocotrienols in lipid reduction, there should be a 12 hour interval between the intake of tocotrienols and tocopherols). Also pantothen, a form of B complex, reduces blood lipids. Niacin is probably the most powerful nutrient for the reduction of blood lipids, but only in amounts of about 1 g per day. Refined carbohydrates should be avoided: for example corn syrup, which contains high amounts of fructose, an ingredient which is present in processed foods and determines an enormous increase in blood triglyceride levels and ends up directly in visceral fat reserves. The same applies to trans fats which lower HDL and increase LDL, thus deteriorating an already negative situation under the point of view of blood lipid levels. Among the amino acids, arginine and taurine have a positive effect on blood pressure and on heart function. The loss of insulin’s specific power to determine the increase of muscle perfusion and the endothelium dependent vasodilation is, for instance, described in the metabolic syndrome. The endothelial cell release of nitric oxide (NO), which is the main mediator of such vascular effects, is apparently compromised in insulin resistance conditions owing to a selective block of the postreceptor metabolic means of phosphatidylinositol 3 kinases. Arginine under the form of alpha ketoglutarate, has a positive effect on nitric oxide synthesis. Therefore, its use has a rationale in the MS. Garlic is also useful as well as Q10 co- enzyme integrators. Stress should be avoided, as it is directly connected to the excessive release of cortisol which favours fat deposit in the abdomen (Psychosomat Med. 64:418-435.).

Food integrators which can modify cortisol release, such as phosphatidylserine, can be very useful. The lack of sleep increases cortisol and favours insulin resistance (Occup Environ Med. 58:747-752), therefore melatonin integration can be useful in sleep disorders because, although it does not directly interfere with metabolic syndrome disorders, melatonin can improve the quality of sleep and thus keep stress levels low. According to a study (Am J Clin Nutr 91: 1044-1059, 2010), integration with resveratrol, green tea extract, -tocopherol, vitamin C, n–3 (omega-3) polyunsaturated fatty acids and tomato extract acts on inflammation, oxidative stress and metabolism of proteins and plasma, urine and adipose tissue metabolites, reducing inflammatory conditions and oxidative processes. Berberine has a hypocholesterolemic effect (Nat Med. 2004 Dec;10(12):1344-51). Its intake for 3 months has produced a 29% CHOLESTEROL DECREASE, a 35% TRYGYCERIDE DECREASE and a 25% LDL DECREASE. The study shows that Berberine stimulates the expression (up-regulates) of the LDL receptor. (Expert Opin Investig Drugs. 2005 May;14(5):683-5). Berberine also has a hypoglycemic effect and stimulates the decrease of glycated haemoglobin (Metabolism. 2008 May;57(5):712-7; Clin Endocrinol Metab. 2008 Jul;93(7):255965). Berberine has the important effect of increasing the expression of insulin receptors, thus increasing insulin sensibility itself. (Metabolism. 2010 Feb;59(2):285-92). As far as the “destruction” of chronic inflammation is concerned, curcumin has proven to be effective in LOWERING VASCULAR INFLAMMATION MARKERS AND OXIDATIVE STRESS LEVELS, THUS CONTRIBUTING TO LOWER GLYCEMIA AND THE RISK OF VASCULAR INFLAMMATION IN DIABETES. (antioxid redox signal 2009 Feb; 11(2):241-9). Curcumin modulates inflammatory response, down-regulating the activity of COX-2, lipoxygenases, iNOS and inhibiting the production of TNF-α inflammatory cytokines, interleukins (IL) -1, -2, -6, -8 e -12, MCP and migration inhibiting protein. Sorbitol accumulation, due to the increase of the activity of aldo reductases, is involved in the development of various secondary complications of diabetes. Curcuma can inhibit aldo reductases with one IC50 of 10 microM not competitively. Besides, curcumin can inhibit the accumulation of SORBITOL IN ERYTHROCITES in conditions of hyperglycemia, thus showing that it can potentially be used in the prevention of diabetes complications. (FEBS. Lett 2009 Nov 19; 583(22):3637-42)

Among the amino acids, arginine and taurine have a positive effect on blood pressure and on heart function.

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Doctor Giovanni Montagna Dietitian - Bio Age Advisor 393 9967076 - giannidiet@tiscali.it


QUANTI ANNI DIMOSTRI? EQUILIBRIO ORMONALE: ELISIR DI LUNGA VITA Gli ormoni fungono da messaggeri e rispondono alle necessità e ai bisogni dell’organismo; essi vengono prodotti e secreti da ghiandole che li rilasciano a seconda degli stimoli che giungono dal sistema nervoso. Esiste una correlazione fra la diminuzione dei livelli ormonali e il processo di invecchiamento. Per questo la valutazione dei livelli ormonali è fondamentale per prevenire e rallentare il processo di invecchiamento dell’organismo e favorire il mantenimento dello stato di benessere.

PROFILI ORMONALI NATRIX PROFILO DIMAGRIMENTO: permette di determinare il nostro metabolismo, è consigliato quando si inizia, in maniera consapevole, un percorso alimentare finalizzato al dimagrimento. PROFILO STRESS: determina i livelli bioattivi di due importanti ormoni dello stress:

il cortisolo e il DHEA. Il livello di cortisolo tende ad aumentare con il passare degli anni o in seguito a stress severo e prolungato. Il livello del DHEA, al contrario, diminuisce progressivamente con l’età e l’aumento dello stress. PROFILO SPORT: permette di valutare l’impatto dell’attività sportiva sull’organismo. Il test è consigliato per perfezionare la performance sportiva ed evitare l’overtraining. PROFILO DONNA FERTILE: permette di conoscere i livelli di progesterone ed estradiolo in tre diversi momenti del ciclo. Rappresenta un utile strumento per comprendere eventuali squilibri ormonali e definire insieme al proprio medico una strategia mirata a riequilibrare l’assetto ormonale. PROFILO DONNA MENOPAUSA: è utile per il controllo dello stato ormonale della donna nel periodo che precede la menopausa e durante la menopausa. Fornisce importanti informazioni sulla necessità di una terapia ormonale antiaging. PROFILO UOMO: permette di verificare l’efficienza ormonale e sessuale maschile in età fertile e andropausa. Il test deter-

mina i livelli di testosterone che indica la funzione dei testicoli, e l’estradiolo i cui alti livelli concorrono nello sviluppo di patologie cardiovascolari e osteoporosi. PROFILO BUONANOTTE: permette di conoscere la concentrazione serale di melatonina, fondamentale neurormone che regola il ciclo sonno-veglia. Il test è consigliato in periodi di elevato stress psico-fisico, durante l’invecchiamento, in menopausa. Utile anche nei bambini che hanno difficoltà a dormire nelle ore notturne. Natrix Lab: il laboratorio certificato (UNIENI-ISO 9001: 2000) di riferimento per le tue analisi personalizzate: • • • • • • • •

FOOD INTOLERANCE TEST CELIAC TEST ANTIAGING PROFILE CELLULAR AGING FACTORS LIPIDOMIC PROFILE ZONA PLUS TEST CARDIO WELLNESS TEST HORMONAL PROFILES

Tutte le analisi sono eseguibili anche tramite un semplicissimo prelievo capillare e salivare.


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CREATINE: NOT ONLY FOR SPORT Monohydrate creatine is undoubtedly the most investigated molecule in the field of sport in order to help professional and amateur athletes to recover from their great physical efforts and to increase their explosive power. Creatine has recently (in the last 15 years) been studied as an additional molecule to one’s daily diet to prevent the appearance and diminish the symptoms of degenerative diseases such as Alzheimer’s, Parkinson’s etc. Neurodegenerative diseases are usually characterised by the degeneration of neurons inside specific brain areas. Neuron loss or dysfunction can be due to a wide range of neurological diseases, depending on the localization of the neuron loss and on the advance of the disease itself. A great number of studies have shown that this type of diseases have a biochemical aetiology which contributes to the pathogenicity and to the clinical appearance of many neurodegenerative pathologies. The combination of processes including cytotoxicity, oxidative stress, energy exhaustion and mitochondrial dysfunction are involved in many disorders such as Huntington’s disease (HD), Parkinson’s disease (PD), amyotrophic lateral sclerosis (ALS) and mitochondrial diseases in general.

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As it is well known, mitochondria are small cellular organs which have the function of producing energy and of regulating the cell’s energy condition by means of the oxidative phosphorylation process which produces huge ATP quantities for the supply of tissues such as the striated muscle, the skeletal muscle and the cerebral tissue. These functions (supply and regulation of cellular energy) are involved in neurodegenerative processes such as excitotoxicity, the production of reactive oxygen species (ROS), the calcium homeostasis dysregulation process and the apoptosis process. One of the most frequent neurodegenerative diseases in the world is Parkinson’s disease (PD). This pathology is due to the chronic and progressive degeneration of the nervous structures which constitute the extrapyramidal system. Such alteration occurs in an area of the central nervous system called substantia nigra, a nucleus situated at the level of the mesencephalon in which dopamine is produced. This is the area where the loss or dysfunctioning of the dopaminergic neurons occurs, leading to the suppression of the neuron activity of the motor cortex. The pathogenesis therefore consists in the loss of cellular


PROGRAMMA: ANTROPOMETRIA: misurazioni- plicometria ed impedenziometria BIOCHIMICA ED ENDOCRINOLOGIA DELL’ALIMENTAZIONE ALIMENTAZIONE NELL’ATTIVITA’ FISICA DIETE DEL FITNESS: Gruppi sanguigni - Mediterranea - Metabolica - Paleodieta - Warrior Diet - Dieta Zona DIETA “COM” E DIMAGRIMENTO LOCALIZZATO INTEGRAZIONE ALIMENTARE INTOLLERANZE ED ALLERGIE ALIMENTARI - I PREBIOTICI ALIMENTAZIONE ANTI-AGING PROGRAMMAZIONE NEUROLINGUISTICA: l’aspetto motivazionale Il corso di Educatore Alimentare serve a dare una credibilità ed una competenza maggiore all’operatore di fitness che si trova a relazionare nell’ambito del suo lavoro con persone che cercano di migliorare il loro stato fisico come estetica, benessere, salute, tramite un percorso che prevede un adeguamento dello stile di vita. Se la pratica dell’esercizio fisico corretta è fondamentale in questo percorso altrettanto lo è un corretto approccio alimentare. Questo traguardo è raggiungibile tramite un’adeguata educazione alimentare che può essere impostata appunto da una figura come l’“Educatore Alimentare”, che non deve essere confuso con il “dietista” o il medico specialista in Scienza dell’Alimentazione, il primo preposto alla costruzione di una dieta calcolata e impostata per specifici obiettivi, il secondo unica autorità preposta a prescrivere diete finalizzate alla cura di patologie. Il compito dell’Educatore Alimentare sarà appunto quello di insegnare a scegliere i cibi più indicati nelle corrette proporzioni e modalità di assunzione senza impostare diete specifiche con grammature e percentuali.

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Per il corso “senza frequenza” Verrà fornito il materiale didattico e tutoraggio telefonico o via e-mail.

Data esame: da definire - E’ previsto un esame finale scritto (test a risposte multiple) e orale.

QUOTE: Corso con frequenza: € 560,00 + € 40,00 (quota associativa) Corso senza frequenza: € 460,00 + € 40,00 (quota associativa) Data pagamento: entro il 15-11-2013 L'importo può essere pagato, con una maggiorazione in due rate : Corso con frequenza: - 1a rata entro il 15-11-2013 : € 310,00 + € 40,00 (quota associativa) - 2a rata entro il 28-02-2014 : € 310,00 Corso con frequenza: - 1a rata entro il 15-11-2013 : € 250,00 + € 40,00 (quota associativa) - 2a rata entro il 28-02-2014 : € 250,00

ACCADEMIA DEL FITNESS Galleria Crocetta 9/A 43126 PARMA Tel. 0521-1682083 Fax 0521.294971


L’Accademia del Fitness groups which are able to facilitate movements through dopamine secretion; such pathological event has its clinical correspondent in the typical triad which defines Parkinson’s disease: • Bradykinesia: definition of the reduction of autonomous and voluntary mobility unaccompanied by a reduction of muscular power; • Rigidity: of asymmetric, plastic type due to which a patient affected by this disease has the sensation of “bending a lead pipe” or of modelling wax if he tries to lift a limb; • Trembling: at rest, at 4-6 cycles per second, begins in the distal limb sections. Many histological analytic studies on patients showing the first symptoms and on post-mortem tissues of substantia nigra of patients with diagnosed PD inform us that there are deficiencies inside the complex I of the electron transport chain.

Mitochondria involved in Parkinson’s disease, potential therapeutic efficacy of creatine in Parkinson’s. This disease is characterised by the damage of the complex I of mitochondrial electron transport chain (1). The suppression/ inhibition of complex I by neurotoxin MPTP diminishes the production of ATP, thus diminishing the ATP quantity which can be used by the PCr generated by mtCK (2). The damage to the electron transport chain increases the production of ROS, affecting the change of mtCK from an octameric to a dimeric shape making it inactive. Moreover, high ROS concentrations reduce CK cytosolic activity. Exogenous Cr intake brings about a general improvement of the cellular and mitochondrial bioenergy functions and increases the supplies of PCr which reduces the loss of neurons associated to Parkinson’s disease. In order to study and consolidate the role of mitochondria in Parkinson’s disease, neurotoxin MPTP (1-metyl-4-phenyl-1,2,3,6tetrahydropyridine) has been utilized as it damages mitochondrial functions and determines PD development in utilized human and animal models. Exposition to MPTP damages the complex I of the electron transport chain and is highly selective of dopaminergic neurons of the substantia nigra (SN) region. Moreover, MPTP easily penetrates through the haemato-encephalic barrier and, when they are inside the glial cells, the

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MAO-B oxidise it into MPP+ (1-metyl-4-phenylpiridine). This compound penetrates the dopaminergic cells, in the substantia nigra area, exploiting the dopamine carrier. This causes the death of the neuron due to mitochondrial respiration inhibition, and also causes oxidative stress, which generates further damage. The effect of creatine combined with protector agent CoQ10 has been studied as an experimental model in rodents in which Parkinson’s disease was induced by means of MPTP intake. A 2% creatine and 1% CoQ10 supplement was added in the diet of some of the rodents for 2 weeks, whereas some other groups were not submitted to any at all or the two substances were submitted separately. After 28 days of this therapy, a significant decrease (56%) of the total striatal dopamine was seen in the group of rodents which had not received Cr and CoQ10; there was instead a significant reduction of dopamine depletion (33%) induced by MPTP in the mice treated with the diet integrated with Cr and CoQ10. The diet supplements consisted either in 2% creatine or 1% CoQ10 intake or a mix of both substances. Intake of both substances significantly reduced the MPTP negative effect on dopamine production, thus proving to be the best treatment.

Neuroprotective effect of creatine integrated with CoQ10 in reducing neurodegenerative effects on nigrostriatal dopaminergic neurons induced by toxin MPTP. (A) Cr and CoQ10 significantly reduce depletion caused by MPTP of striatal dopaminergic neurons. (B) Quantity of cells present and quantity of TH (tyrosine hydroxylase) present in dopaminergic neurons of SNpc. Intake of Cr and CoQ10 drastically reduce loss of neurons caused by MPTP. (C)Photomicrography of SNpc section of rodent, creatine and CoQ10 inhibit loss of neurons producing TH induced by MPTP. Immunohistochemical analysis of Substantia Nigra Pars Compacta (SNpc) dopaminergic neurons demonstrated that, after 28 days of MPTP treatment, there was a heavy loss of tyrosine hydroxylase (TH) enzyme functionality. This enzyme adds a hydroxyl group (-OH) in position 3’ to Tyrosine to produce the compound L-DOPA (Levodopa).


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L’Accademia del Fitness The three different types of diet followed by the rodents under exam had a protective role against TH function loss in SNpc dopaminergic neurons. Chronic MPTP intake causes a further event in SNpc neurons, an oxidative damage, besides increasing accumulation of protein – synuclein (principle component of Lewis bodies). The accumulation of – synuclein is localized in Th immunoreactive neurons of SNpc. The creatine treatment combined with CoQ10 significantly inhibits the formation of Malondialdehyde (MDA) induced by MPTP, besides reducing pathological accumulation of -synuclein and neurotoxin-produced oxidative stress.

gives evidence that both compounds have a neuroprotective effect, though by means of different mechanisms. CoQ10 has greater anti-oxidative effect than creatine which, in turn, seems to act mainly on the energy metabolism. A daily supply of 2-3 g of CoQ10 is recommended for humans because the levels of this compound in the plasma reach the palteau already taking 2.4 g/day, whereas the recommended dose of creatine is of 30 g/day above all in patients affected by Huntington’s and Parkinson’s diseases. In short, these studies have shown the potential neuroprotective value of creatine in combination with CoQ10 in animals affected by Huntington’s and Parkinson’s diseases. Moreover, the therapy based on the combination of both compounds has shown its efficacy in the presymptomatic treatment of the above mentioned neurodegenerative pathologies, as both creatine and CoQ10 are two natural well-tolerated compounds with only few side effects. Doctor Andrea Angelozzi Graduate in Biological Sciences

The combination of Creatine and CoQ10 inhibit lipidic oxidation induced by chronic MPTP intake and the accumulation of – synuclein in SNpc dopaminergic neurons. These studies give evidence of various modalities of action of both compounds. CoQ10 has both an anti-oxidative effect and of help in the electron transport chain functionality, whereas creatine produces an increase of phosphocreatine (PCr) production acting as an “energy blocking system”. Moreover, all this

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number 10 / 2013

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L’Accademia del Fitness

PLANTS AND VEGETAL EXTRACTS WITH “ADAPTOGENIC” ACTION:

HEALTHY ANTI-AGING AND ANTI-STRESS EFFECTS Interest in natural health has become by now an increasingly widespread phenomenon: not only do more people wish to live in better conditions and possibly longer; they would also like to have more vital energy and to be able to resist daily stress better. The above words represent a short summary of the many lessons kept by Prof. Alessandro Gelli both in University courses - concerning “ Anti-Aging and Anti-Stress Methodologies”, at the Department of Physiology and Pharmacology, Sapienza University in Rome - and in the ISS course (Higher Health Institute) in herbal medicine, for doctors and pharmacists. Decades ago, the healthy effects of plants were taught in Academic seminars and congresses. However, interest was by then limited to

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a limited number of keen doctors and pharmacists. The present growing interest in “Anti-Aging” (or better Aging Management), has made it an institutional subject taught at universities. This shows that times change, but an essential principle will never change: synergic technical “Anti-Stress education” is essential for serious technical “Anti-Aging education”. Plants can offer a valid contribution when they are recommended on personal needs. Such recommendations must come from a real expert with a global education in practical, technical sectors for the concrete management of the issue with which we must all come to terms, using all possible means: that is, with Stress.


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L’Accademia del Fitness Possible Definitions of “Adaptogenic”: The word “Adaptogenic” can be referred to a substance which makes our body adapt more efficiently to the many conditions and circumstances which give rise to Stress in our body. The reaction to Stress is a vital one and one of the 9 functions of the Hypothalamus is the well known “attack or flight reaction”, which is strongly involved in the reaction to Stressors. Selye conceived the general idea of Adaptation as referred to psychophysiologic mechanisms which a subject under Stress puts into action in order to react against Stressors, the various Stressing agents, subdivided in turn into Eustress and Distress (both harmful stressors, yet they can be interpreted by the subject as pleasant or, on the contrary, unpleasant). The body has its own personal way to react and adapt itself. In fact, its interpretation of stressing events and its intensity reaction is subjective and should be well calibrated in order to manage Stress efficiently. However, doing so is not easy for many subjects, as “basic” chronic Stress can be amplified by a specific event (acute event). In such situation, which is very common today, the subject’s psycho-neuro-endocrine network reaction can be more or less acute depending on his state of basic tiredness and exhaustion. The adaptation reaction limit also lies in the specific “energy Adaptation” reserves which are not unlimited and vary a great deal according to the subject. Any event or substance which helps the body empower vital mechanisms of Adaptation, fundamental for survival can be potentially considered as Adaptogenic. More recently, Brekhman has defined the concept of Adaptogenic in these terms: “An active principle or drug (part of a plant which is used in medicine) which can increase the body’s defences against Stress factors can be considered Adaptogenic”. Moreover, such substances must be toxin-free. Both natural substances and specific Anti-Stress strategies and methodologies can, if well personalized, improve psycho-physiologic adaptation capacity, fundamental for real Anti-Aging, against daily stress. Natural Adaptogenic substances could be defined as metabolic regulators-adaptors which can help the body adapt against any type of Stressors and Stress (environmental, situational, physical, biological etc). There are not many natural substances which

can be included in this restricted category, since they must be neither directly and clearly stimulating nor soothing, but supply a suitable reaction of S.N.A and of all the psycho-neuro-endocrine network depending on the specific stressing situation. Many of the most common plants - tea, Ginseng, Damian, Guarana etc., which are all stimulating and have their related side effects, do not belong to this category of adaptogenic plants; on the contrary Passionflower, Hawthorn, Valerian etc, have decidedly soothing effects. Dried Extracts: dried extracts are the most common and easiest way to take concentrated amounts of certified A.P. The drug (correct scientific definition which indicates the part of the plant utilized in medicine) is composed of part of the plant, even if - according to Indian Ayurvedic medicine - the whole plant is used. However, specific parts of the plant (leaves, roots or cortex) are clearly present in suitable A.P for specific health and/or therapeutic purposes. A.P. titration is necessary to provide information on the quantity of A.P. present, for instance, in 100g of extract. Titration must be reported on all the “standardized” lot and must be specifically referred only to that lot and production. In fact, the percentage of various A.P. significantly varies according to the period in which the plant is harvested, its geographical site, method of conservation and of extraction. The intake of powder - compared with the plant, or better, the utilized part of plant - has more concentrated percentages of active principles, declared for example at 1-2-3 or 5% etc. This makes it possible to take a sufficient quantity of active principles in a reduced space, thus limiting the possible gastric effects determined by cellulose, resins, inert plant supports which might give rise to intestinal irritation. In this way, the doctor has a more “scientific” possibility, by quantifying the A.P. prescribed to the patient, whereas this would not be possible using a non-titrated extract. Pharmaceutical botany, Pharmacognosy and phytotherapy in general are subjects which study plants, various preparations, contents and pharmacological effects, although recently plants and relative preparations made up of one or more compounds are not simply applied in traditional therapeutic fields but also

Any event or substance which helps the body empower vital mechanisms of Adaptation, fundamental for survival can be potentially considered as Adaptogenic.

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L’Accademia del Fitness in “Anti-Aging”, Anti-Stress (Aging and Stress Management) fields and for general psycho-physical performance improvement. PLANTS WITH ADAPTOGENIC ACTION Pink Rodiola, Maca, Suma, Ginkgo Biloba, Schizandra and Eleutherococcus are among the potentially more useful so-called “Adaptogenic” plants (however, we must always take subjective reactions into account). These plants can be included in this category in that they contribute to the ADAPTOGENIC action on our psycho-neuro-endocrine network; they have different useful bio-chemical and physiological mechanisms to empower a nonspecific and effective reaction to both chronic and acute Stress. Some “Adaptogenic” plants could limit the hyper production of Catecholamines (typical of subjects who tend to be anxious) in situations of Stress. Various plants of this kind also have an anti-oxidising action which contrasts the well-known free radicals. It seems they can have a role in the reduction of lipid peroxidation. According to some authors adaptogenic plants and adaptogens in general can be distinguished into: -Immunostimulants (they contribute to keep our immune system efficient)

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-Nootropics (they improve cerebral functions; Piracetam, Oxiracetam, Aniracentam etc are allopathic nootropic drugs) -Anabolizers (in the sense that they improve protein synthesis in a natural way) -Tonifiers (they help reduce some non sufficient body and/or organ conditions; they basically have a coadjuvation role in metabolic-physiological Stress management) -Geriatric (useful to help contrast various correlated effects of aging, many adaptogen plants and vegetal extracts - personally and well dosed - have an effective and concrete Anti-Aging) or better Stress Management effect). Some studies have utilized a combination of Pink Rodiola and Eleutherococcus Sativus. Note: Eastern Ginseng is so well known that there are also other plants called Siberian or Russian Ginseng ( Eleutherococcus), Brazilian Ginseng (Suma), Ginseng of the Andes (Maca). Doctor Alessandro Gelli Coordinator and Teacher at Higher Training and Training Course in “Anti-Aging and Anti-Stress Methodologies”, Sapienza University in Rome. Faculty of Pharmacy and Medicine, Department of Physiology and Pharmacology.


Naturalmente innovativa La For Farma è una realtà italiana consolidata presente sul mercato dell’integrazione alimentare dal 2004, specializzata in fitoterapia clinica, particolarmente attenta alla qualità di materie prime, processi produttivi e prodotto finito. Attenzione alla qualità significa poter fornire alla Classe Medica e ai Farmacisti prodotti sicuri, ben tollerati ed efficaci. I nostri nutraceutici sono tutti formulati da esperti fitoterapeuti e specialisti clinici. Vengono prodotti presso stabilimenti certificati che ci garantiscono:

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L’Accademia del Fitness

FOOD INTOLERANC:

A LIGHT ON THE PRESENT AND ON THE FUTURE A healthy diet keeps the body “young”, helps prevent excessive accumulation of subcutaneous fat and, if necessary, it avoids contact with gluten, lactose or other food allergens. But not only this. A healthy diet makes it possible to prevent inflammation, which is the cause of many common disorders such as swelling, abdomen cramps, dysentery headache, eczema which are characteristic of what we call food intolerance. Clinical experience and research give us more and more evidence that in sensibilized people any food is potentially able to determine the appearance of symptoms due to the production of cytokines or other inflammatory substances. This leads us to the need to identify 1) sensible subjects 2) the foods which give (or can give) intolerance problems. However, it is not easy to give a clear clinical picture to food intolerance: it is not a matter of allergy or of real forms of intolerance such as for instance intolerance to gluten or lactose. This has contributed to the circulation of many research methodologies which the American Gastroenterological Association has defined as “unreliable” and has ended up putting these forms of intolerance under a not very positive light. This category includes famous tests such as the EAV/Vega, the kinesiological and cytotoxic tests which are unreliable for two main reasons: they are difficult to repeat and excessively depend on the operator’s experience. However, also the field of food intolerance has adopted more and more the immunoenzymatic method E.L.I.S.A. (Enzyme Linked Immuno-Sorbent Assay), which has been standardized in laboratory and has been exploited in the execution of the RAST test in the allergologic field. This procedure guarantees the univocity of results and high levels of repetitivity and therefore distinguishes itself from all the other methods. This method established itself when it appeared clear that the immune system played a key role in the mediation between the intake of food and the appearance of the symptoms, exactly as in the case of allergies. However, unlike allergies, in this case the mediation is not operated by immunoglobulins class E (IgE), but by a different class, G (IgG), the dosage of which allows us to give evidence that a contact with food which can determine inflammatory events has occurred. Research has progressively advanced further and from the general analysis of IgG it has gone on to a particular subclass represented by IgG4. This is a fundamental step in clinical practice, as was underlined in 2008 in a publication by the Department of Laboratory Medicine in the Hospital of Padua (Time to reconsider IgG4, Clin Chem Lab Med 2008; 46(5):687-690). This study

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number 10 / 2013 showed that the dosage of IgG4 has remarkable advantages as it allows to identify both the sensibilized patients and the food which, when repeatedly consumed, can cause inflammation. This precious information allows us not only to intervene after the appearance of symptoms, but also to achieve preventive action. Moreover, in this research carried out in Padua it emerged that IgG4 have a high negative predictive value (0.99) and can therefore tell us which food the patient is not sensible to and therefore is not harmful to him. However, most of the tests with these characteristics are unattainable for the patient because of excessively high costs. In fact, it was initially believed that the analysis of a high number of food could, in spite of its costs, be useful to effect a diagnosis and even today many tests are based on this principle. However, it has been already observed for some years that if on the one hand the number of food which more often give rise to food intolerance is relatively low (14, according to a study in 2009), on the other hand, the really useful information concerns the food which is more frequent in our diet.

Consequently, many specialists today agree that through a pool of extremely selected food it is possible to effect a clinically useful screening, with minor costs for the patient. Remarkable progress has been made since the first studies dating back to the middle of the previous century and this gives evidence of the great interest in this field. This interest is particularly active in Northern Europe: the research which a pool of allergologists began in the laboratories of Schwerin (GERMANY) gave the possibility to make tests which allow the screening of food intolerance (or allergies) directly in the laboratory, saving the time of both the patient and the specialist, without giving up the examâ&#x20AC;&#x2122;s reliability. Such progress, which was unthinkable only ten years ago, has permitted a rapid revaluation of the problem of food intolerance, too often labelled as â&#x20AC;&#x153;purely inventedâ&#x20AC;?, although it concerns millions of people all over the world.

A healthy diet makes it possible to prevent inflammation, which is the cause of many common disorders such as swelling, abdomen cramps, dysentery headache, eczema which are characteristic of what we call food intolerance.

Dr Raffaello Michelotti Biologist

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L’Accademia del Fitness

MEDICINAL PLANTS

FOR SPORT

Medicinal plants have been receiving more and more attention in the medical field in the last few years as vegetal extracts have proven to be precious allies in various health disorders to be used also in combination with drugs, to prevent their use and to contrast their side effects. Scientific magazines have been giving increasingly more space to studies concerning the use of medicinal plants and this has contributed to developing protocols for progressively safer and more effective treatments. Paradoxically, one of the fields in which vegetal extracts have been less employed is the world of sport in which amino-acid integrators, mineral salts and antioxidants have had more success. The rational use of phytotherapy in sports could instead turn out to be an excellent means to solve various problems of amateur or professional athletes. From the achieved experience of the clinical world it is possible to attain phytotherapeutic preparations to help cope with the different phases of trauma, to contrast lumbar, cervical and articular pain and to improve the performance and recovery of the athlete. Example of phytotherapeutic treatment of trauma: First phase of trauma (reactive phase): Contusion, sprain, distortion, muscular strain, ligament and meniscus fracture, fracture

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Symptoms: Pain, swelling, heat, recent haematoma, altered functionality Useful medicinal plants: Boswellia –Reduces localised tension, improves articular functionality; relieves tendonitis, reduces oedema- Myrrha - Reduces pain and oedema, helps microcirculation, reduces blood stasis, helps tissue regeneration - Curcuma – Helps microcirculation, reduces blood stasis, improves articular functionality- Hippocastanum –Reduces pain and oedema, helps microcirculation, reduces blood stasisBromelain - Reduces pain and oedema, helps microcirculation, reduces blood stasisSecond phase of trauma (about seven days from trauma): damaged tendon tissue, ligaments, meniscus, muscles, bone healing. Symptoms: Pain in movement and under effort, manifest haematoma, residual oedema Useful medicinal plants: Boswellia, Myrrha (see above) Centella – Reduces blood stasis - Chinese angelica –Reduces pain and oedema, helps microcirculation - Remannia –Reduces inflammation- Carthamus -Helps microcirculation, reduces blood stasis- Peony – Helps microcirculation -


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L’Accademia del Fitness Third phase of trauma (final recovery phase): Post recovery phase, after any immobilization before resuming normal activity Symptoms: Muscular tension, rigid articulations, slight pain in movement, muscular and chronic rheumatic pain, muscular atrophy and local weakness after immobilization. Useful Medicinal plants: Remannia (see above), Equisetum – Trophic action on bone and connective tissue -Peony, Centella, Chinese Angelica (see above), Mandarin –Helps blood circulation, articular functionality The treatment of traumas is only one of the many fields of application of phytotherapy in sport but, as already underlined, vegetal extracts can be very useful against acute inflammation of superior and inferior arts such as tendonitis, bursitis, synovitis, carpal tunnel syndrome, periarthritis humeroscapularis, epicondylitis, coxalgia, pubalgia, gonalgia, tarsalgia which can be treated with plants such as arnica, boswellia, myrrha, nettle. Also during training sessions, which require great physical effort, phytothera-

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peutic plants can be used and best results can be achieved with phytotherapeutic solutions made with eleutherococcus or rhodiola, Greek hay and schisandra, whereas astragalus, oats, American ginseng, jujube, peony and rhodiola are recommended to recover from intense psycho-physical efforts.

From the achieved experience of the clinical world it is possible to attain phytotherapeutic preparations to help cope with the different phases of trauma and to improve the performance and recovery of the athlete.

The topic use of medicinal plants must also be remembered both to relieve pain, to prepare muscles to physical activity and to achieve rapid muscular efficiency (oil solutions with ginkgo, capsicum, camphor, marjoram, black pepper and grapefruit) and to help recovery after sport activity ( oil solutions with Chinese angelica, boswellia, ginger, lavender, pimento and mint) This article clearly represents only a small introduction to the potential employment of vegetal extracts, but it is certain that the athlete cannot but profit in terms of toleration, effectiveness and safety from the union of Nature and sport! Dr. Giovanni Occhionero


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

LEAKY GUT SYNDROME SECOND PART The discovery of zonulin has led scholars to reconsider a great deal of medical literature, making them find that a number of self-immune diseases share a serious intestinal permeability. In many of these pathologies the increased permeability is determined by abnormally high zonulin levels. It is by now well known that in celiac disease it is gluten itself that stimulates an excessive zonulin secretion, perhaps due to the genetic profile of the patient. Therefore, it would be this excessive permeability, in patients affected by celiac disease, that makes gluten (the environmental factor) filter among the extra-intestinal TJ and interact with the already excessively reactive MALT cells. Prof. Fasano, one of the main experts in leaky gut, together with his team discovered that zonulin is the precursor of the haptoglobin 2 protein which had been considered for a long time an inflammation marker and which is believed to have a key role in self-immune diseases. The future of millions of patients affected by celiac disease might depend on this protein by means of the longwished-for â&#x20AC;&#x153;celiac disease pillâ&#x20AC;?. Celiac disease and hypersensitivity to gluten through leaky gut might represent a determining factor of autistic spectrum disorder (ASD) and of infantile hyperactivity. In particular, in patients affected by autism (36.7%) and among their relatives (21.2%) a high percentage of intestine permeability anomalies was found compared with normal subjects (4.8%). Patients with autism who follow a gluten and casein free diet have significantly lower intestine permeability values compared

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with those who do not follow a restricted diet and the control group. Gastro intestinal symptoms are present in 46.7% of children with autism: constipation (45.5%), diarrhoea (34.1%), and other (alternation of diarrhoea/constipation, abdomen pain, etc: 15.9%). ASD diagnosis is based on lack of social and communicative interactions and on the presence of repetitive behaviour. However, although these are elements of the diagnosis of the disorder, many other medical problems are ignored which frequently refer to patients with autism such as, for instance, problems concerning the immune system, oxidative stress and intestine inflammation. If, on the one hand, there is limited evidence showing a causal relation between these disorders and ASD, it is more and more evident that a high number of children present various biomedical problems which are often neglected, but which could be relieved by a gluten free diet and specific integration products.

Picture 2 Leaky gut correlated mycotoxin The contamination of mycotoxins represents an emerging prob-


number 10 / 2013 lem in the field of hygiene-sanitary safety of raw materials and of the cereal food chain. Deoxynivalenol (also called vomitoxin owing to its effects on the gastrointestinal apparatus) which forms in wheat before being harvested can be frequently found in different types of flour, bread, biscuits, in various cereal containing foods, also destined to very young children, and in industrially-made beer. Its symptoms affect many organs and apparatus; among the symptoms, neurological cytokine ones which are responsible for c.d Sickness like behaviour (chronic inflammation at cerebral level due to IL1β, IL6; TNFα). Clinical findings gave evidence of abnormal intestinal permeability with damage at Claudin 4 of Tight Junction which, in turn, will develop mycotic infestations even with minimum amounts of mycotoxins present in one’s food. At the same time, sensitivity to food antigens and low dose respiration takes place (quantum immunologic). In allergology the connection between food intolerance and leaky gut is by now well known and manifests itself in the hyperactivation of intestinal mast cells which, by releasing histamin and serotonin, increase intestinal permeability which, in turn, deteriorates food intolerance. The release of neuromediators such as P, CRH; NGF (neurogenic inflammation) is responsible for some symptoms such as bloating. Leaky gut is intimately connected to self immune diseases and is in turn maintained by drugs. Single doses of aspirin or indometacin increase intestine wall permeability due to inhibition of anti-inflammatory prostaglandins; such complication can be partly prevented treating patients before with prostaglandin E analogues. Instead, chronic FANS exposition is associated to a condition of chronic irreversible flogosis with misoprostol. In this case some improvement was obtained submitting the patients to antibiotics or metronidazol, thus confirming the importance of bacterial endotoxines in the maintenance the vicious circle. Patients affected by rheumatoid arthritis treated with FANS present high levels of antibodies directed against Clostridium perfrigens and its α-toxin. Moreover, increased intestinal permeability seems to be at the root of some extra-intestinal tumours. As we have seen, the epithelial cells are highly polarised cells and are interconnected by cellular junctures. Mesenchymal phenotype cells, instead, do not establish inter-cellular contacts and have migratory features. Tumour development is correlated to c.d epithelium mesenchymal transition (EMT) which is a key factor of embryonic development; EMT allows an epithelial cell to migrate from the primary tumour site. During EMT the epithelial cells lose intercellular junctures in exactly the same way as in leaky gut. In this case the main marker is not zonulin, but the loss of E-cadherin, an event which is associated to inter-cellular juncture destruction. The increase of N-cadherin, of α-actin of smooth muscle (α-SMA) and of ma-

trix metalloproteases (MMP) are other mesenchymal markers. Therefore, the cells which effect EMT acquire mesenchymal features, which are necessary to migrate from the primary tumour site. TGF-β1 is the EMT inducer par excellance and carries out a fundamental role both in ontogenic processes and in neoplastic transformation. However, in recent studies reactive oxygen species (ROS) have been proven to be capable of inducing EMT as well as generating DNA oxidative damage responsible for genomic instability. EMT is dependent on ROS because in the presence of N-acetylcysteine (NAC, generic “scavenger”) cells do not effect transition. In the presence of NAC the E-cadherin is not lost and the levels of N-cadherin, of α-SMA and of MMP2 do not increase. NAC drastically reduces the activation level of transcriptional factors.

Leaky gut is intimately connected to selfimmune diseases and is in turn maintained by drugs.

Picture 3 Action of guanylate cyclase From the research it emerges that the receptor of the guanylate cyclase C hormone (GC-C) - an already famous suppressor present in the intestinal tract - plays a key role in strengthening the intestinal barrier separating the intestinal environment from the rest of the body. Without the receptor, the barrier gets weaker. The team of Scott Waldman discovered in a pre-clinical study that GC-C silencing in mice compromises intestinal barrier integrity, thus allowing possible cancerous agents - environmental and/or taken with food- to migrate and damage the DNA of external intestinal tissues, too. On the contrary, GC-C stimulation in the intestines of mice strengthened intestinal barrier and prevented contamination of such pathological events. The study paves the way to future pre-clinical and clinical studies aiming at the understanding of the capacity of GC-C in human beings, including the prevention and the treatment of inflammatory intestinal celiac and cancer diseases. In order to prevent intestinal inflammation or certain types of cancer in human beings we will probably have to find the way to intervene on GC-C activating hormones to make the intestinal barrier “thicker”. Also in the ophthalmic field (the conjunctiva is an integrating

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L’Accademia del Fitness part of the MALT system) it has been confirmed that an altered intestinal absorption can condition lacrimal film composition creating the sensation of “extraneous body”, red eyes and ocular tiredness with mute eye objectivity. Eyesight can therefore really represent an exact mirror of the general health situation. It is by now acknowledged that integral intestinal mucosa is responsible for barrier selectivity, playing a fundamental role not only of absorption, but also in defence mechanisms. Selectivity is also assured by the balance between the various bacterial populations which all together constitute the intestinal ecosystem. Dr Maria Letizia Primo Nutritionist –Legal Doctor- Psychiatrist

TEST OF INTESTINAL PERMEABILITY Integrity of intestinal mucosa can be evaluated noninvasively by means of measurement of urinary excretion ratio of two test substances submitted orally. These substances present a different permeability index: a lager molecule, a disaccharide (lactulose or cellobiose) and a smaller one, a monosaccharide (mannitol or L-rhamnose). They are hydrosoluble, non-absorbable molecules which do not suffer metabolisation or degradation by intestinal flora. They are not submitted to mechanisms of active transport or facilitated diffusion and, if absorbed, (in conditions of abnormality) they are completely eliminated through the kidneys (dosage permitting). The monosaccharide of smaller dimensions passes through the mucosa across the cells through enterocyte hydrophilic pores by virtue of its small dimensions, whereas the disaccharide diffuses with greater difficulty, as it can pass through the barrier only at intercellular tight junctions, generally not very permeable to macromolecules. These sugars will behave paradoxically in patients who have damaged intestinal mucosa, that is, larger molecules (disaccharide) will pass more easily than smaller ones (monosaccharide). In the former, the increase of monosaccharide/ disaccharide urinary excretion ratio is above all due to a decrease in monosaccharide absorption, whereas in inflammatory diseases with compromised mucosa (MC and RCU) the increase is due to greater macromolecule permeability. Although the sensibility of this test is sufficiently high (90%), its specificity is very low (54%), since similar results are obtainable in every condition of altered intestinal permeability.

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L’Accademia del Fitness

WHEN LOSING

WEIGHT

IT IS OFTEN DUE TO HORMONES!

You exercise regularly, you have eliminated fats and sweets and try to follow a healthy diet. Yet, the fat around your waist and cellulite are still there. This might be due to some hormones not working properly. The word “hormone” comes from the Greek verb ormao, which means ‘put into movement’. This definition mirrors perfectly well the role of these chemical “messengers” which deliver messages from one cell to the other. Hormones regulate our feeling of satiety, our appetite, the speed at which we burn energy. They work together, so if their synergy is not perfect it might be difficult to lose weight. Stress can increase or decrease the number of hormones we produce and can break the delicate balance between these substances. In many cases, the lack of hormones turns into fat accumulation and body weight increase. These are the hormones involved and what happens when their level is not optimal. LEPTIN: it is produced by fat cells. Its task is to signal when we are replete and to regulate our appetite. When we accumulate fat, leptin levels rise and, as a consequence, our sense of being hungry fails. However, a diet which is too rich may reduce the capacity of our body to react to the stimuli of this hormone. The result is that we eat even when we are replete. This condition is called leptin-resistance. Even a lack of it may determine excessive appetite. Alarm signals: generalised body weight increase, immoderate appetite, sense of hunger which increases when we start eating. CORTISOL: it is produced, starting by cholesterol, by our suprarenal glands. It is fundamental for our survival because it gives us a supply of energy when we need it. Its function is to prepare our body to flight in case of danger: it makes our heart beat faster and increases artery pressure to input more oxygen and sugar in our blood, so that our muscles may use them. Moreover, it reduces the speed at which we burn calories and induces us to eat sugar for a rapid supply of energy. When we are under stress, our body produces more cortisol. But, since the energy we input in the blood is not used for physical effort, our body accumulates it under the form of fat. Alarm signals: tiredness

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number 10 / 2013 and lack of energy, irritability, hunger attacks. Fat accumulation at the base of the nape and in the upper part of our back. TYROID HORMONES: the thyroid is a gland at the base of the neck which controls metabolism, that is, the speed at which we burn calories. This gland, under the stimulus of the hormone Tsh, produces two hormones: T3 and T4. Besides their other functions, these hormones stimulate the production of protein, and they burn fats and sugars. If the gland does not work properly and produces few hormones, our metabolism slows down and we tend to gain weight even without changing our life-style. Alarm signals: fat accumulation in the lower part of body, swollen face and eyes upon awakening in the morning, severe water retention, unmotivated increase in weight and cholesterol. INSULIN: this hormone is produced by the pancreas and has many tasks; the main one is to keep the sugar levels in blood stable. Insulin turns the sugar in our blood into energy for our cells to be used. If our body does not have enough insulin quantities, or if our cells do not respond adequately to its stimulus (insulin-resistance) glycemia levels rise and can give rise to diabetes. This is a typical condition of overweight subjects and is associated to leptin-resistance. Alarm signals: generalised body weight increase, above all around the abdomen and hips. Cellulite. Hunger attacks. ESTROGENS: These hormones regulate the menstrual cycle and provide the typical female shape, together with smooth and soft skin. They are produced by ovary follicles, by the corpus luteum and placenta, and in lower quantities by the liver and suprarenal glands. Estrogen excess can determine water retention and fat accumulation on hips and thighs. Alarm signals: fat accumulation around hips and thighs. Mammary tension, cellulite. Less tonic and compact skin. GROWTH HORMONE: this hormone facilitates weight loss, it is produced by the hypophysis, a small gland in the brain, behind the nose. Lack of it may determine lean mass reduction, osteoporosis, cardiovascular and respiratory disorders and body weight increase, above all around the abdomen and hips. Alarm signals: weight increase, drop in sexual desire, depression and alteration of the cycle, muscle and power reduction, lack of skin elasticity, appearance of deep wrinkles. Through simple capillary blood or saliva tests it is possible to effect a wide range of diagnostic tests to control the dosage of important hormones. The results represent a fundamental evaluation instrument of hormonal and functional balance, and they provide fundamental information in order to give specific advice concerning food, neutraceuticals , physical activity and general wellbeing. There is a variety of hormonal profiles which can be tested, and they can answer specific issues: from the difficulty in losing weight, to problems concerning the menstrual cycle or connected to menopause and to the sexual sphere, sleep disorders, stress evaluation and overtraining syndrome in athletes.

WEGHT LOSS PROFILE: for subjects who wish and are unable to lose weight. STRESS PROFILE: for subjects who lead frenetic, unhealthy or incorrect life-styles and for those who suffer from anxiety. SPORT PROFILE: for subjects who practise sport at amateur or professional level , in particular to improve training or avoid over-training. FERTILE WOMEN PROFILE: advisable in case of premenstrual syndrome, drop in sexual desire, appearance of hair in typically male zones, irritability, depression. MENOPAUSE PROFILE: advisable in cases of menopause heat waves, sudden sweating, sleep disorders, weight increase, pressure increase, voice modifications, drop in sexual desire, appearance of hair in typically male areas, irritability, depression. MEN PROFILE: advisable in cases of weight increase, drop in sexual desire, sudden sweating, pressure increase, depression, tiredness, anxiety and irritability. GOOD NIGHT PROFILE: advisable in case of sleep disorders, insomnia, heavy psycho-physical stress, anxiety, depression, memory problems.

Hormones regulate our feeling of satiety, our appetite, the speed at which we burn energy.

By the editorial staff

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L’Accademia del Fitness

HEALTH, DISEASE

AND ACID-BASE BALANCE OF EXTRACELLULAR MATRIX PART 1 Acid-base balance has been an increasingly debated issue for some time, but the people who speak or write about it do not always do it in clear terms. We must first of all clear this concept: the only acid-base balance which can be heard of in Outpatient Medicine - but this is not the case for Hospital Medicine - is the one concerning the extracellular matrix. The blood’s acid-base balance is in fact an issue for specialists belonging to the field of anaesthetists-resuscitators, clinical doctors, lung specialists, nephrologists who work in hospitals where seriously ill patients, often in danger of death, normally end up. Keeping in mind that the range of pH in blood is between 7.35 and 7.45, at 6.90 the patient risks a heart attack or a coma. A pH value of 6.80 is incompatible with life: expressions we come across in health magazine such as “if the blood becomes acid one falls into anxiety or many other problems could occur” or “a protein diet acidifies the blood” do not make any sense, as they are groundless from the clinical point of view which would consider even a slight acidity in the blood as a serious danger for one’s life.

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What we may speak about, outside the professional field of hospitals, is the acid-base balance of the extracellular matrix. By this definition we refer to all those areas surrounding the cell, spaces made up by water, cells, vessels, neurovegetative nervous terminations with which all the cells of the body are in constant exchange. The concept of extracellular matrix was defined at the end of the 70’s by Pishinger from the University of Vienna, who introduced the concept of a basic System of adjustment, a System which worked like a network, a communicative network with the function of exchanging information between the cells and their surrounding environment. This represents an important progress compared with the concept - still considered valid in the text books of General Pathology - which identifies the extracellular matrix in the anist or amorphous fundamental substance: an histological definition which is static and therefore unfit to describe the dynamicity of the matrix, the real “organ” of connection between all the biological systems of the body. The cells receive micronutrients, vitamins, minerals, oxygen from the extracellular matrix and to


number 10 / 2013 them they release the acid residues of their metabolism. Therefore, both the health of the cells and the exchange of information between the various organs depend on the quality of the extracellular matrix. In particular, its pH must be slightly alkaline, that is, about 7.4. Only at this pH value the enzymes (called transmembrane carriers) which carry micronutrients along the cellular membrane accomplish their function at their best. The acidosis of these extracellular spaces can be the result of an acute or chronic lack of oxygen, of obstructive vascular origin or due to vasospasm, but also and above all, it can be a consequence of an acidifying life style (unhealthy diet, insufficient water supply, lack or excess of physical exercise, excessive stress, drugs, nicotine, alcohol etc). Acidosis generates a stagnation of acid toxins in the extracellular matrix which the immune system tries to eliminate by activating an inflammatory response. In clinical practice based on the suppression of the symptoms, also inflammation, which is the most important defence mechanism of the body, has become a “disease” to be clinically treated. If acidosis lasts, also the immune response remains active and will become increasingly more serious resulting into degenerative, if not even self-immune, forms and the inflammation will address itself against components of the body (cells, articulations, mucosae). Only in this self immune phase must the excessive inflammation be modulated in order to reduce its self-destructive effects. At an extreme degeneration level, a tumour degeneration can occur. Therefore, in conclusion, the process goes from acidosis to inflammation, from inflammation to degeneration, from degeneration to tumour degeneration. We must keep in mind this equivalence between acidosis-inflammation-degeneration as it will help us explain many diseases and it will give us important information on how to cure them. Some news which has recently circulated on the internet has been received with dismay, as a crime against information. The news was more or less this: “The cause for cancer was discovered decades ago but it has been kept secret until now”. The caption added that in 1931, a German physiologist, Otto Heinrich Warburg, was awarded the Nobel Prize for Medicine because of his studies on the metabolism of the tumour cell. He established that the lack of oxygen and an extraordinary increase of anaerobic glycolysis (which is used by glucose cells in conditions of oxygen lack) were the first events that transformed a normal cell into a tumour one. Tissue acidosis, that is, the accumulation of acid substances, generates lack of oxygen, thus an acid environment is an environment lacking oxygen. There is no need to comment on the fact that in all these years after Warburg’s research, his studies have not had any influence

on the approach against the struggle against tumours, above all in terms of prevention. The clinical application of alkalinisation (let us use the term “de-acidification” as its synonym) has been practised and studied since the 60’s above all in German speaking countries to contrast progressive acid accumulations. I have been investigating this subject for about thirty years so we cannot consider it something new. Its very little circulation is due to the difficulty for Medicine - based on the search and the elimination of symptoms - to consider in a more general context the cure of the “biological ground” of the body. Acidosis is associated in magazines and books to overweight, obesity, pain, headaches, diabetes, inflammations, tiredness, hormonal imbalances, anxiety, depression, tumours etc. It might seem an exaggeration to associate so many diseases to a single physiopathological process: it actually is not because the extracellular matrix itself is the organ which, thanks to the intrinsic dynamism linked to its prevailing composition in water, poses itself in the centre of the connections between psyche, Central and Peripheral Nervous Systems, hormonal and immune Systems. In practice, PsychoNeuroEndocrinoImmunology exists thanks to the extracellular matrix. How is it possible to contrast the acidification of the extracellular matrix? By adopting an alkalinizing style of life in which the diet plays a fundamental role . In many articles and books on this subject, as soon as acidosis and diet are mentioned, there is almost a tendency to “accuse” the intake of proteins of animal origin. I do not want to take a position in favour or against animal proteins here. My personal impression is that it is all useless as whoever has to deal with people’s food habits today immediately realises that animal proteins are not the problem (on the contrary, I often find a lack of them), but rather the excess of carbohydrates. The media have contributed to distort the celebrated “Mediterranean diet” into pasta, bread and pizza transforming it into a diet rich in carbohydrates; the different kinds of flour, especially if processed, are acidifying. A number of books, often bestsellers, are being published on the unhealthy effects of animal proteins; I wonder what value books that do not make any reference to the daily amounts of food to be taken might have. Our diets have become more and more acidifying, above all for our increased consumption of cereals, sweets, coffee, alcohol, sugary soft drinks and the so-called junk food instead of alkalinizing food (simplifying, fruit but above all vegetables) and an adequate daily supply of water. In a healthy diet, from the acid base point of view 70-80% of our calories should come from vegetables (in a minor degree from alkalinizing fruit). That we

In particular, its pH must be slightly alkaline, that is, about 7.4. Only at this pH value the enzymes (called transmembrane carriers) which carry micronutrients along the cellular membrane accomplish their function at their best.

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L’Accademia del Fitness

cannot do without fruit and vegetables is a universal truth: the acid base vision can help our motivations to prefer this kind of food because of its positive effects. All these considerations on acidosis are of particular interest for people who practise sports who, on the one hand produce more acids as a result of their accelerated cellular muscular metabolism, on the other hand, especially in the case of power sports, they might not know which food choices to make to avoid acidosis. It might be useful when choosing food, to keep in mind PRAL: positive for acidifying, negative for alkalinizing food. I would like to make this clear: no food is to be absolutely avoided. Also acidifying food can be consumed as an integrating part of a healthy diet. What we must keep in mind is that the ratio between alkalinizing and acidifying food should be about 4 to 1. Food considered acidifying: meat, fish, eggs, seasoned cheeses (fresh cheeses are less acidifying), cereals (pasta made with processed flour is more acidifying than pasta made with integral flour) legumes, especially dried sweeteners and soft drinks coffee, tea, spirits sweets and all sweetened food Food considered alkalinizing: vegetables (especially uncooked) potatoes dry fruit (almonds, Brazilian nuts, figs, dates, raisins) with the exception of nuts and hazel nuts fresh ripe fruit, especially bananas, pears, melons (let us

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consider the spontaneous natural popular wisdom of popular dishes such as ham and melon or pears and Parmesan cheese or bresaola and garden rocket; in these cases we have an opportune combination of acidifying food (ham, Parmesan and bresaola) and alkalinizing food (melon, pears, garden rocket). Fruit produces the so-called “volatile” acids which are eliminated with our breath; at the end of its metabolization, the alkalinizing effect of its mineral salts and vitamins remains. Eating a lot of fruit is not advisable in cases of a completely inactive life and old age, as it is more difficult to eliminate its acids and the resulting load of sugars through the lungs. Many people think that: “If some food is good for me, eating a lot of it will do me better”. Let us keep in mind the Latin saying “Est modus in rebus”... there is a measure in things which is a source of wisdom. Some portions of fruit are healthy, but kilos of fruit are not! In the second part we will analyse more closely what can be useful for people who practise sport in order to contrast acidosis which appears to be a silent, hardly known enemy of any intense physical activity which tends to be acid forming. Dr. Andrea Grieco Neurologist, Nephrologist, Psychotherapist specialised in Natural Medicine author of “Vivere alcalini, vivere felici” www.andreagrieco.it www.naturvis.com www.saluteviva.it Dr Grieco’s book can be purchased at www.naturvis.com


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N. 10 - July 2013