Interview with dr. Dmitry Iskenderov: Insights on gastroenterology and nutrition

— Yes, yes, please.

— It’s very simple, we have lost wisdom. And this applies to any area of ​​life, not just medicine. If a person has no foundation, no awareness or critical perception, but has a habit of shifting all responsibility for everything that happens in an illness to pharmaceuticals, then absolutely any person, and not only a doctor, can influence such a person.

We do not have such a task, at least not a Russian doctor. We are clinicians, and I was taught that my life and medical task is still healing, well, or the desire for this healing at any level. More precisely, at the level that both medicine and the patient can afford. And this is still a movement towards health, to put it simply.

If in a conversation one of the heads of a well-known pharmaceutical company, for advertising purposes and not without pride, tells me that his patients have been taking proton pump inhibitors for 10-15 years, I want to ask what the strategy of such long-term therapy is and how justified it is. Whether we are talking about sales for the purpose of treatment or sales for the purpose of selling and making a profit.

— Here I will anticipate an unasked question. Since I have always been involved in nutraceuticals, and they, as a rule, were present on our market as part of one or another MLM company, that is, they used MLM models as a means of promotion, it is necessary to distinguish: are you primarily doing business, or are you treating with these drugs. If treatment is a priority, then the marketing system is usually more primitive and is in second place. Or the opposite example, when one of the most serious and successful companies of the 90s used nutraceuticals as a tool for building and developing a business. In fairness, it should be noted that high-quality drugs were distributed, for the most part, by people without medical education. 

— And your assumption is completely justified. To answer the question, I will once again return to what was said earlier. Personal and collective passivity, unwillingness and inability to think about the need for change leads to the fact that patients for 10-15 years, or even their whole lives, rely on pharmaceutical support, considering drug treatment to be the main and sufficient. That is, figuratively speaking, they consciously put themselves in a kind of wheelchair, limiting themselves to its parameters and do not try to look for other paths to health.

And this is the result of choice, conscious or subconscious, but nevertheless. A person today is most often a person with a broken self-identity position. Accordingly, he does not have enough basic elements which he could rely on. I mean the base, which consists of family and ethnic traditions, upbringing, education, what forms a system of thinking and allows one to think, doubt and search. Otherwise, castles in the air appear in life, and they do not last long… Without support, neither spiritual, nor educational, nor cultural, nor any other, we again become a favourable field for all kinds of manipulation, imposition of artificial values, formation of alien tendencies or trends. And without such support, a person becomes plasticine, from which you can mould anything.

— We used to rely on traditions, national ideas, and universal human values. Religion and the church in the broad sense used to be the guide and legislator since ancient times. A person remained in their parental home until they came of age — it was a kind of sacred land, in terms of traditions, where all the customs were carved in granite. This also deals with the subject of our conversation. People relied on nutritional traditions for centuries. Now I would talk about the gradual weakening of the influence of nutritional traditions in the life of society, when even parents do not know how to properly feed themselves and their children. And we see children who return from school with bags of chips. Why is this a problem? Because, as a rule, we eat the way we were fed. Eating behaviour is formed in childhood and is projected onto the next generations. In other words, what can a person who grew up on chips and pizza teach his children? And this is no longer about health, and on a national scale.

Previously, families ate traditionally: food was an inevitable basic element, an accent in life. It was not separated from culture, from values, and so on. Without such a food culture, a person eats the way he wants, and he wants the food that contains flavour enhancers. And if such food is put to the consumer by advertising, the manufacturer, the environment, and if such food is contrary to health, and it usually so, sooner or later the body’s resources run out. Where they run out, disease sets in.

That is why a fairly large group of modern diseases is called accumulation diseases, those are diseases acquired over the course of life. They are not treated, or rather, they cannot be cured, but they are successfully being treated. And, again, since we are controlled by collective commercial consciousness, the main aspect in treatment becomes the aspect that was sold. That is, pharmaceuticals.

— That’s the thing, you can’t sell a diet, it’s free. Eat. Live. Cook. There are a lot of paradoxes in the world now, I would even say, distortions, and medicine is no exception. Here we supposedly base our activities on evidence-based medicine, and we don’t really think about what evidence-based medicine is built on. Who conducts these studies? They are usually conducted by pharmaceutical companies. Hence we see a lack of studies that would be worth paying for, which, however, are “not interesting” to sponsors, primarily due to the lack of a commercial component.

When a doctor tells me: “Something has not been proven from the point of view of evidence-based medicine,” I understand that it has not been proven, because no one has tried to prove it. Because no one is interested in proving anything.

It is not interesting to prove vegetarianism or, on the contrary, meat-eating, although periodically, “British scientists” discover something there – today they discover that coffee is harmful, tomorrow they will say that 5 cups of coffee is an iron standard for a person. Exactly the same, excuse me, confusion is happening about sugar, lard and whatever.

This is not a matter of faith and not a proof of harmfulness or, on the contrary, benefit. This is business. You can’t trust anyone for the sake of a joke. Conventionally speaking, despite the development of medicine, you can safely believe in bandages, brilliant green and iodine.

You can’t even trust aspirin anymore, because it is no longer as relevant as it was previously considered. We have advanced far ahead, but in reality, we are again at a primitive level in terms of the fact that you can’t trust anyone. A person is pumped up from all sides, and if his criticality level is low, he, naturally, swallows it all.

Therapy for gastroenterological patients is also far from unambiguous. For example, there is data showing that chronic users of proton pump inhibitors have a more than 40% higher risk of dementia compared to those who did not take any similar drugs, and their risk of hip fracture also increases.

And the doctor, consulting the patient, prescribing treatment and, being an agent of influence, by virtue of his qualifications and breadth of clinical thinking, gives certain recommendations regarding health. But you will pay for this too.

— With resources and time. You actually pay with your own time for your life time and for the quality of this life. But you still pay. Just like me. The question is, what do we pay with?

One way or another, nutrition issues can be discussed at different levels. On the one hand, nutrition is porridge in the morning, and on the other hand, nutrition conceptually is a personal, social and other set of principles. And as long as a person has a desire to change something, without doing anything, he is an obedient blind consumer.

In other words, if you have something “opaque” in your life, or don’t fully understand what you’re putting in your mouth, no matter if it’s porridge or fly agaric, you will pay for it in the short term, or in the long term.

And if I can reduce some probabilistic risks for the patient in my clinical practice, then I already consider one of my tasks accomplished. If, thanks to my recommendations on proper nutrition, you eat a cheeseburger at night only twice in 10 days, instead of 10, I will consider that my life has not been lived in vain.

— But this is a different question. If your system has resources, then it will forgive you periodic harmfulness. If there are no resources, you have a high probability of acute diseases or exacerbation of chronic ones. If you often and in uncontrolled quantities eat vegetables from the nightshade family at night, namely: potatoes, eggplants, tomatoes, bell peppers, then sooner or later you will suffer.

And here we combine the issues of nutrition and physical activity.

If my life includes regular physical activity with an emphasis on cardio exercises involving diaphragmatic practices, if my abdominal cavity has adequate lymphatic drainage, good blood flow and massage of the internal organs by the anterior abdominal wall, the periodic gastronomic delicacies will be forgiven.

— Yes, as soon as the parity is broken, you will go into exacerbation. Proper or optimal nutrition, regular physical activity and correct, positive thinking are the three pillars on which your health is based. Because the third aspect that disrupts health through blocking the diaphragm is negative emotions due to stress.

— The mechanism of this phenomenon is very simple.

During stressful situations, adrenaline and cortisol hormones are released. They promote the release of glucose into the blood, slow down the processing of sugar by muscles, and reduce the body’s sensitivity to insulin. Nervous shocks force the pancreas to produce more insulin.

A person under stress gets tired faster, becomes irritable, aggressive, and sleeps poorly. Constant high levels of cortisol provoke the development of complications. These can be: obesity, hypertension, osteoporosis, diabetes, etc.

All this is physiology, there is no magic here. And an attempt to present this as something cosmic and mysterious is ordinary ignorance.

— Well, Ozempic is an attempt to have your cake and eat it too. And rapidly. And even yesterday. You will pay for this too.

Any aggressive, extreme factor is always realised at the expense of your own resources and it doesn’t matter what it will be: 5 cups of coffee when you have an emergency project, climbing Everest or other things where all your resources are mobilised. You will pay for it.

You jump with a parachute, you have an adrenaline rush, you will also pay for this with a period of asthenia, general weakness and early fatigue. That is, after a period of emergency, you will always have a period of rollback, because the body has reached zero, it has given up its resources. And since we live by the law of conservation of energy – what we put in, that’s what we get out. We always have as a result what we put in to achieve it.

This is what the most optimal system of treating a person who is able to listen to the doctor is built on. Perhaps, later we will achieve something more, but at the most primitive level and at the same time sufficient level to obtain the result, it looks like this. However, the previously described approach to treatment often seems to the patient to be too expensive, too complicated a task, and compliance, i.e. patient commitment to treatment, in the majority of cases, suffers already at its very beginning.

— At the beginning of the conversation, we touched on this issue. Due to problems with self-identity and the presence of anxiety. What can you cling to when you do not find support? What lies on the surface? The refrigerator and its contents are like the easiest compensator for anxiety. And so a person eats away stress. In other words, a person tries to achieve calmness with the help of food, because when the brain is full, it reduces its electrical activity, and the body, as it were, goes into hibernation. And so on in a circle.

In a general biological sense, evolution can go in different directions, not necessarily in the direction of increasing or improving the quality of population parameters. A population can evolve in any direction, including in the direction of degeneration and degradation.

And in the long run, the most successful population will be the one that is healthy or healthier in all respects, including in terms of spirituality and collective consciousness. And nutrition is one of the key elements here.

— A person is always a product of his actions, and in this sense the law of cause and effect or the law of conservation of energy works flawlessly: a person is what he has worked for in this life. He studied, got an education, got a good job, got a good income, drank himself to death and lost it all. Or, on the contrary, he began to raise his level not only in the direction of materialism, but also adding spiritual content to the material, and now he is different, his personality is multifaceted, he is thriving. He does have something to say to someone, he begins to benefit not only himself, but also others.

And this is a much higher manifestation of being: if you can give something to people – give it. Otherwise, why are you still living, except to give something to people?

— The first step in treating any disease is the regimen and diet, i.e. a lighter regimen of digestive functioning. And by ignoring or treating the explanation of these provisions to the patient in a formal manner, the doctor, in my opinion, neglects factors that are essential in their influence on the recovery process.

On the other hand, doctors do not even hope that the patient will hear them, but we still need to fulfil our social role in order to provide the patient with medical care at least at a basic level. Otherwise, what doctor is capable of showing interest in the patient’s problem if the patient does not invest in himself, having a low level of motivation and compliance?

— The only thing you have is hope. The same as I do. I go to the hairdresser, I call an electrician. What do I have? Hope that the specialist will be qualified and will do the job conscientiously.

— Yes, an electrician or a hairdresser does not have the same influence or social responsibility as doctors, teachers and, perhaps, judges. Because representatives of these professions are capable of radically changing a person. An incorrect sentence, an incorrect diagnosis or distorted knowledge can undoubtedly have a significant impact on life in the long term.

— The brilliant restaurateur and, as it seems to me, a good person, chef Jamie Oliver, tried to carry out a culinary revolution in British schools by restructuring the food system, replacing harmful dishes and products in the school menu with healthy and varied ones. He showed what kind of lunches parents give their children to take to school – chips, M&Ms and other snacks. Jamie Oliver tried to rebuild all this. How did it end? As far as I remember, his innovations gradually faded away, the school administration returned to the old menus, and the kids were in no hurry to get used to the new tastes, preferring the usual but not always healthy food.

I would suggest taking responsibility and, relying on the historical experience of mankind and culinary gastronomic wisdom, on the one hand, and the achievements of modern dietetic science, on the other, rebuilding a working system on a state/society scale.

— Good question. I like to look for culinary folk wisdom in traditional food systems. For example, in Prague, together with the boar’s knee, they will definitely serve stewed cabbage, mustard and horseradish, because sauerkraut is an absorbent, it is microflora, it is fibre which compensates for the “heaviness” of the main component.

Caucasian cuisine will offer you a glass of matsoni or kefir as an aperitif before eating fatty foods. There you will not be served potatoes with shashlik, only vegetables and greens. In the East, no one will wash down shashlik with beer or marinate shashlik in mayonnaise. Here are simple illustrations of wise folk cuisine.
If you go to Asia, you will see that there will be special spices in the dishes of that cuisine as a counterargument against excess fat. There, barberry and garlic are added to pilaf, but not for nothing, but with a specific purpose.

All this knowledge about the rules of cooking and spices was invented by the people, they were crystallised and cleaned over the centuries. And if in our lives we know something other than bay leaves and allspice, this is already not bad. However, spices must be used wisely, but this is a subject for a separate conversation.

— This folk wisdom has already grown into a life motto for some of my patients. The saying is actually profound, and it is based on the fact that you understand the word “useful” correctly. You know what is useful, and you know what is harmful. And this fact will already, to some extent, help you to occupy your gastronomic niche and raise you above the primitiveness of fast food.

— Yes. And all these experiments with dragging everything that fits into your mouth are an alarming, ignorant attempt to ignore health. Pseudo biohackers work in accordance with this principle exactly. We all want eternal life, we want health, because we ignore the fact of the finiteness of existence.

This is where all these products of commerce and products of manipulation arise. Therefore, believe me, requests for a magic pill will always be satisfied.

Any diet, if you approach it as a system of restrictions, is wretched and flawed. The patient has a negative attitude to any restrictions, especially to attempts to change his eating habits, psychologically perceiving it as punishment. Any restriction in the food basket, if it is not temporary for the treatment period, but permanent, does not lead to good results.

In turn, a built system of harmonious nutrition, diverse in terms of species presence based on your own convictions and those acquired with the help of a doctor, is doomed to success.

In general, harmonious nutrition, harmonious life, harmonious thoughts are a super task for me, as a doctor.
Try to expand your horizons through the support of specialists, through the help of pharmaceuticals, through helping yourself! After all, the gastronomic world is endless in its diversity!

— If I eat it while sitting on the couch, it is poison. There is no refined sugar in nature. There are dates, sugar cane, stevia, and honey in nature.

The logic in nutrition is very simple: “I have to work to get food.” Man, by virtue of his evolution, is called, must and is obliged, figuratively speaking, to periodically starve, run and freeze. If a person received energy, but did not spend it, this energy becomes excessive, and loses its positive properties. We are adults, we no longer grow, our bodies do not change, and we do not need much to maintain ourselves.

Our nutrition, as a rule, is excessive, especially in terms of carbohydrates and cooking fats.
There is a separate miserable topic about cooking fats, because the body does not know such mechanisms. The mechanisms that help the body process and digest cooking fats have not been born evolutionarily, so it puts them away. The body does not know trans fats, fats that you cook with, modified fats, we do not have enzymatic systems that understand how to digest them.

— You can do well without coffee at all. Coffee is a stimulant in any case. Caffeine and other stimulants are needed to charge you up. Coffee, of course, has psychotropic properties. However, not everything in our life is measured in categories of soulless expediency. Therefore, save coffee as a morning ritual that gives positive emotions, a good mood and creates your own personal traditions.

— An excellent idea, especially since food itself does not play a key role in eating behaviour. Sometimes I want to tell my patients: “Come on, stop! Try to slow down your run through life!”

Why did yoga and other similar practices become popular? To slow down the rapid pace of life, to make the outlook on life more conscious and to take the role of a director in your life, but not a puppet. After all, people are in such a fuss and chaos that they do not have the opportunity to reach a slower mode of functioning. Or a person slows himself down, with what? Unfortunately, more often with alcohol or drugs than with meditation and yoga.

On the other hand, by acquiring and maintaining the right pace, wisely distributing resources, we achieve optimal functioning of our body.

Ask yourself how you see your life. This will be the first key to it. Take care of yourself and stay healthy!