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Cu re

Vita

N째09 March

Autorizzazione n째 1962/75/2011

Prev en t

tion lita bi

a p r y Re e h T ha n io

2014

m a g a z i n e

02 Editorial 03 4 Questions to Tiziano Bugli 05 Health in Sammarinese Philately

06 Tell us about it.. 08 Cuore-Vita goes to School 12 Life according to... Vito 13 Notes on Nutritional Therapy in Patients with

Diabetes 14 Curiosities from the World of Science 15 Health and the Commonplace of Medicine


the

ed it or ial Welcome Back! Editorial by Dr. Giovanni Michele Zangoli

N

ew year, new life. A ready-made statement that should, in any case for some, be a healthy motivation albeit gradual, to change their way of life for the better. Change you can, in certain

cases, you have to when, over time, bad habits are likely to jeopardize your health. Can’t we do it on our own? Better to get help than always put it off until tomorrow. In the U.S.A for example, there are (free) services to help people to stop smoking or to give advice on the use of drugs (use, not abuse). Not only that. Using smartphones, suggestions arrive on healthy diets, how to measure blood pressure, on helpful physical exercise and any other advice that can motivate people to care for the health of your heart. If this is done overseas why can’t we do it? Cuore-Vita has always been striving to spread a culture of health in the form of bite-size advice, easy to understand and easy to put into practice. We have the same technology, the same tools for easy communication as countries most aware of the subject. Is it perhaps a touch of willpower that we’re missing? Admitting it would already be a start to change course. Spring is upon us, the season of awakening is ideal for finding stimulation and healthful energy.

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Four Questions to Tiziano Bugli

By Dr. Giovanni Michele Zangoli

Director U.O.C. Primary Care and Territorial Health. ISS

What is the extent of heart disease in our territory? Does San Marino fall into the global average? I would say yes. However, the data we have refers to about six thousand people in therapy with one or more drugs, that’s about 15% of the population; I would say that therapy is too small with respect to the actual needs of the hypertensive who, in reality, would constitute much more of the population. From our study we found that over a thousand people come into the criteria of the metabolic syndrome; that means hypertension, hyperglycemia, waist circumference over a certain level... For these people the first therapy would be to diet but they probably don’t and that’s why they take medication, so the problem is there. Over and above pharmacological therapies, what support could a psychologist give in post heart attack cases? It is obviously very important, however, it’s often the same cardiologist who monitors the patient in this delicate phase who also offers antidepressants. There are very effective, well tolerated, anti anxiety drugs compatible with the cardio vascular condition, that are not habit forming or addictive and the psychological factor cannot be other than affected. There aren’t many cases, but it happens.

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Is the much-vaunted prevention entirely delegated to the common sense of individuals? Does the Public health have a margin to engage the population in the notion that prevention is better than cure? We are working on a renovation of the project, a review of the role of medicine in the territory. I cite only one fact: in 2013, primary care physicians made 70 thousand outpatient visits, this means the doctor uses virtually all her time to provide answers to the population’s most varied questions. So it’s clear that as a doctor I have an important possibility in medical opportunities: seeing if the patient is hypertensive, I can set up a discussion related to the prevention of cardiovascular disease, such as in the diabetic patient for example. Diabetes is a cardiovascular disease; diabetics are managed in an integrated fashion within the antidiabetes service. Doing checks according to precise protocol also clearly led by the pharmacological level, diet, physical activity; with a variety of controls, from the cardiologist to the optician, in order to deal with any eventual complications. But here we are already in secondary prevention. And who’s left to think of the primary one? At the level of population I think the primary one should fall to the schools, because it is important for people to acquire a concept of healthy living. It is obvious that the doctor can do her part, we did it for example to help patients quit smoking. Unfortunately, we find that the most needy patient is sometimes the most recalcitrant, because not only is he not going to listen to our suggestions but nor those of the cardiologist or pulmonologist. He prefers to take drugs; that is the easiest way not to change his lifestyle. A trivial example: drink two glasses of wine with a meal, that is almost a litre a day, it’s like eating two pasta meals a day. Simply one glass of wine a day would give a nice cut in calories.

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Health in Sammarinese Philately By Dr. Daniele Cesaretti

That the philately of San Marino is a vehicle of recurrent health messages and hope, is also evident in a series of stamps issued on February 11, 1998, celebrating the sixth World Day of the Sick.

The issue coincided with the Fifth World Day of Loreto at whose shrine were found the sick in meditation and prayer, finding added comfort and stimulus in the solidarity of willing assistants to combat the challenge of pain and the battle for life. Here, the sick and elderly Sammarinese find comfort while being transported on their pilgrimages, thanks to the work of the Union of San Marino Transport of the Sick-Lourdes Loreto (USTAL), an association of numerous volunteer assistants. USTAL works for over 65 years, thanks to the efforts of over 300 volunteers, including many teenagers and children, most of them Sammarinese and the remaining from Montefeltro often in collaboration with their counterpart institution, the Italian UNITALSI. The series World Day of the Sick (Sassone catalogue n ° 1611/1612) consists of two values ​​to L.650 and L.1.500 with allegorical subjects that represent the hope of healing. The cartoons on the two stamps denote, on a blue background, a stylized composition depicting the globe, a rainbow and respectively the value of L.650 a sunflower and on the value of L.1,500, a dove, both facing the sun: universal symbol of hope . The sketches are by Magdalene Medes and Michela Mangani. Offset Printing at the Irish BDT polygraph on sheets of 20 copies each. Print run: L.650 n°400,000 - L.1.500 n°200,000

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Tell us about it... Edited by Sports Physician Dr. Marco M. Benedettini and by Nutritionist Dr. Marina Corsi

The days are getting longer, the temperatures gradually increasing and this increases the hours of training, how much and what is it best to drink in order to avoid dehydration? Luke, 23 years old amateur runner

and milk, replenish electrolytes normally lost through sweat. In the case of intense training it is necessary to integrate with drinks containing minerals which preferably must have the following characteristics: rapid gastric emptying, excellent intestinal absorption, adequate intake of minerals and carbohydrates, excellent palatability and good thirst quenching capacity. It is advisable to drink even if you do not feel the need, preferring water that has the ideal chemical and physical characteristics that reintegrate electrolytes lost by sweat. Avoid drinking carbonated beverages or that are too cold. In addition, avoid alcoholic beverages and coffee that increase sweating and the feeling of warmth, helping to worsen dehydration.

The Sports Physician’s advice In exercising individuals hydration plays the same fundamental importance as nutrition. If your muscles are in need of food in order to better carry out their function, they likewise need an adequate supply of water. In fact, we must remember that the human body, in particular at age 28, is composed of 65% water and that about 30% of this water is involved in the formation of blood plasma in which minerals are carried. For those who like you do endurance sports, with prolonged exposure to the sun, it is important to drink at least two litres of water a day. The human body has an optimum temperature of 37 ° C and in ambient conditions of high temperature, poor ventilation or excessive moisture, through sweating, a mechanism of compensation kicks in that ensures the body temperature is kept constant. Since through sweating you also lose large amounts of minerals such as sodium, magnesium and potassium, at the end of training it will be useful to take salt supplements as well. Actually, those who have a regular diet rich in fruits, vegetables

I am an occasional sportsman, when I exercise what and how much should I drink? Giovanni The nutritionist’s advice As previously recommended hydration is important. Because our body is formed for the most part of water, in order to perform its many organic functions it requires a reasonable intake of fluids that should be increased in the case of heat, profuse sweating or physical activity every day. It is important to not only satisfy the thirst already present that rings alarm bells in a

SEND YOUR QUESTIONS TO: info@cuore-vita.sm

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state of dehydration, but it would be good to drink in small sips on a continuous basis throughout the day without needing to feel the urge to drink as a sign of insufficient hydration. For those who practice sport it is advisable to drink before, during and after physical activity. In the case of an amateur sportsman who does not practice activities that are too intense and for prolonged periods, it may be enough to drink non-carbonated mineral water (with fixed residue reported greater than 500 mg / l), maybe adding mineral salts such as magnesium and potassium if sweating should be noticeable. The water should be pleasant at room temperature, neither too hot nor too cold, and possibly not carbonated because the presence of bubbles may block the feeling of thirst in advance due to the carbon dioxide it contains and is therefore likely to not hydrate enough. Obviously the amount of liquid required depends on how much sweat has been eliminated during the exercise. Given the choice, however, it is always preferable to overhydrate rather than risk dehydration. The athlete’s preparation for proper hydration starts at least 24 hours before the performance and as a very general indication, for example, the consumption of a glass of tomato or orange juice that allows such exercise to take place to replenish lost electrolytes (such as potassium, calcium, magnesium) in a litre of sweat. Athletes should not exaggerate with drinks containing an excess of

carbohydrates (sugars) for both the excess energy that they are likely to provide as well as for the laxative effect that they can induce. Furthermore this type of beverage is indicated appropriate only in the case of performance that exceeds 90-60 minutes, for physical activity of lesser duration in fact there is no evidence these should indicate usual consumption. Thus, despite the vast supplement market increasing in products designed for the large population of sportspeople, the most appropriate and the surest indication that can be given to anyone who wants to take care of their hydration and nutrition needs, remains to consult an experienced Sports Physician and a Nutritionist. Never take for granted the fact that any different integration is necessary other than a healthy and constant hydration with the right type of water.

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Cuore-Vita goes to school By Dr. Giovanni Iwanejko President of the Sammarinese Association Cuore-Vita

The Association Heart – Life’s programme also has the objective to embolden, with deep conviction and enthusiasm, the culture of health education, which today is linked to the quality of life and especially the consequences of assumed behaviours. And it is convinced that this is the way to impact on unhealthy lifestyles and in particular, involving age groups most susceptible to assuming positive behaviours and lifestyles. Therefore, the ultimate recipients of the preventive measures are identified in children and teenagers; the school environment is a privileged place for the establishment of a dialogue on health and correct lifestyles, in as far as it is a meeting point for all interventions aimed at the education of individuals. So I think it is very useful for the close involvement of Schools to our projects on health education. Our Association does not substitute public institutions, rather it makes

its contribution with tools that recognize and prevent the behaviours, attitudes and risks that can damage health. In 2012 we began a project shared with the Elementary and Nursery Schools within our Republic, which has as its objectives to: • Raise awareness on healthy lifestyles in order to prevent chronic diseases and cardiovascular diseases. • Disseminate correct information on Healthful Lifestyles. • Provide school personnel with Healthy Lifestyles tools to pass on to the recipients. • Reinforce appropriate behaviours that have not yet rooted. • Open channels of communication and collaboration with the world of school. The tools that our Association has offered and also offers this year to the Schools are paper placemat tray covers for School

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Lunches, printed with edible ink, that show images and phrases on issues relating to healthy lifestyles. This year’s novelty is that the mats were developed by the students of the schools, with the help of their teachers and respective Documentation Centres. The Nursery and Primary School have been offered a predetermined number of mats

with different design content for their school lunches, that are patronized by the Secretary of State for Culture and Education and sponsored by the Fondazione Cassa di Risparmio-SUMS.

Con il Patrocinio della Segreteria di Stato Istruzione e Cultura

ĂŠ importante e dormire bene la el b a n u e far colazione

Examples of some of the 20 placemats

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Life according to Vito

“Arterial Hypertension is fought at the table�

Cartoons by: Gigi Belisardi

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Some indications of nutritional therapy in patients with diabetes By the Dietology Service ISS - Republic of San Marino

Part One

caloric intake is necessary to maintain and or achieve the desirable body weight: being mostly normal weight, for insulindependent diabetic patients, there are no significant limitations in calories. The composition provides that the main nutritional intake must contain carbohydrates (CHO) that will deliver 50-60% of total caloric intake. Meal times must conform to the use of insulin; snacks can be eaten only if necessary to avoid hypoglycemia determined by physical activity or, if necessary, by the insulin schedule used.

Diabetes in popular culture has always been thought of as life on a strict diet necessarily sugar-free and away from the pleasure of nutrition that meets the needs of the palate. Instead it is possible to combine taste to a healthy and varied diet. Nutrition plays an important role and the repressive or almost punitive concept of diet has to make way for a dynamic and proactive concept of proper nutrition: eating well is essential because a properly nourished body has the chance to live longer, to resist better to diseases and to have a longer lasting life. Eating is essential: it is true that today there’s no food shortage, but nevertheless a correct way of eating is essential to achieve and maintain a good state of health, to carry out the activities of daily living; therefore do not eat to survive, as we did until a few years ago, but eat sensibly to live well.

Diabetes type 2 is the most common form in countries where we are witnessing a growing presence of obesity due to incongruous nutrition in childhood or adolescence; Diabetes type 2 is starting to show up even in the youngest age groups! Gestational diabetes is a form that appe-

ars during pregnancy almost without any symptoms, but that is discovered during routine tests that are performed during pregnancy. Almost always it disappears after the birth, but women who have had this form of diabetes have a high probability of becoming diabetic subsequently. Healthy lifestyles are important for all these forms of diabetes.

Proper nutritional therapy has as its fundamental objectives to: • Keep your blood glucose as close as possible to normal. • Maintain normal values ​​of blood lipids. • Provide adequate calories to achieve or maintain reasonable weight. The nutritional therapy of diabetes mellitus provides a nutritional composition and

quantity that is similar to that recommended for the general population to maintain a good state of health, but certain rules must be complied with to fit the type of treatment. For patients on insulin therapy,

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Curiosities from the Scientific World By Dr. Niksa Simetovic

More than 180 new diabetes drugs are at an advanced stage of research. Pharmaceutical Research announced that more than 180 new drugs for diabetes are in clinical trials or under review of the FDA. Of these, 30 are concentrated on type 1, 100 are for diabetes type 2, while 52 are taking indications for disorders related to complications.

likely to gain weight than those with low adherence to the diet.

Technology can contribute to obesity in low-income countries. Families in low-income countries that have had at least one television, a computer and a camera, have spent more time sitting and had a period of less physical activity and a larger waist size than those that had none of the objects mentioned above, reports a study in the Canadian, Medical Association Journal. The researchers also found that the rates of obesity and diabetes in the poorest countries were higher among those who had all three devices, compared to those who did not. However, the link between the possession of such objects, and increased rates of diabetes and obesity has not been observed in residents of high-income countries.

The age and disease duration influence morbidity in type 2 diabetes. A report in JAMA Internal Medicine has found that age and duration of disease have played a key role in hypoglycaemia and other complications of type 2 diabetes. Researchers examined 72.310 patients and found that hypoglycaemic events ranged between 3/1000 people per year in younger patients and in 19.6/1000 people a year in older patients with longer disease duration, indicating that the second group can not benefit from intensive glycaemic control. Abdominal obesity is linked to metabolic risk factors Researchers at the University of Texas found that a larger waist coincides with a higher prevalence of all metabolic risk factors. Less than 50% of the participants had 3 or more markers. The findings, published in the metabolic syndrome and related disorders, show the importance of “individual variability� in metabolic risk. (Endocrine Today)

Another study highlights the benefits of the Mediterranean diet. Data of about 800 fire fighters in the United States have shown that those who adhered strictly to a Mediterranean diet had a 35% lower risk of developing metabolic syndrome and were 43% less

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Health and the Commonplace of Medicine By Dr. Daniele Cesaretti

sportivi/carne?

Eggs are bad for the liver

Even today this is a fairly widespread belief. But it has no foundation. The opposite is true. Eggs are a low cost, plus an excellent food. They are good not only for the liver but also for the whole organism. The reason is simple. They are rich in two substances (choline and methionine) that have a protective action on the liver and are low in fat. They are therefore rich in noble proteins and have low-calorie content. However, they are not recommended for people already suffering from gallstones because they stimulate the excretion of bile and therefore can move the gallstones unleashing a biliary colic. But to be clear: they’re not responsible for the formation of these same gallstones. If anything, they prevent formation as stimulating the gallbladder to empty, avoids stasis and sedimentation of bile salts that give rise to unwelcome gallstones.

reduce the consumption of sugars that are the main source of (the liver’s) domestic production of cholesterol. In fact, the endogenous cholesterol amounts to 80% of the value measured in blood and only the remaining 20%​​ is attributable to the assimilation of cholesterol already present in food. It is therefore the daily bombardment of dietary sugars that we voluntarily consume that is the main cause of high cholesterol. Among other things, the cholesterol content in the egg is not made up of only the so-called bad cholesterol. In part even the good cholesterol is also present, with a protective effect on the arteries.

Eggs increase cholesterol rate. They should therefore be avoided.

Here’s another one of those beliefs. The rate of cholesterol of eggs is relatively high (250 mg), but it has no effect on serum cholesterol. To prevent or combat high levels of cholesterol in the blood, the most important rule is not to exclude foods high in cholesterol, but reduce the daily intake of calories. Even more important is to drastically

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Grafica: AVALON | Stampa: Seven Seas

Cuore-Vita continues to invite your much-appreciated financial support, if it is possible for you to give it, to enable us to deliver excellence in health education programs and facilities like defibrillators and other life saving equipment for the people of the Republic of San Marino. Every donation you make is put to immediate good use by our Association. Grazie di Cuore! (info@cuore-vita.sm)

Sponsors:

it

presso Centro Commerciale Atlante

Dogana - San Marino 0549.905767

Director: Giovanni Iwanejko / Chief Editor: Gianni Michele Zangoli Editorial Committee: Niksa Simentovic – Emidio Troiani – Daniele Cesaretti Publisher: Gloriano Amici of Avalon |Via Tonso di Gualtiero, 12 47896 Faetano- RSM Translated by dr. Sacha G Mullins a Moving Universe translator – www.movinguniverse.org

Associazione Cuore Vita - Via Napoleone Bonaparte, 25 47890 Repubblica di San Marino Tel e fax: 0549 991011 - info@cuore-vita.sm

www.cuore-vita.sm


Cuore-Vita Magazine N.9 - March 2014