"The challenge of modern medicine is to help you live to see your Alzheimer's." Interview with cardiologist Alexey Utin

Alexey Utin is known as a doctor who knows everything about longevity. He studies the heart, helps prevent heart disease and talks about healthy living on the YouTube channel Dr. Utin. We talked with Alexey about killer habits and popular myths: we found out why it is not necessary to drink 8 glasses of water a day, is it worth getting rid of belly fat and what should the ideal take look like food.

"The main thing is just not to die prematurely"

- Since childhood, have you wanted to devote yourself to medicine?

- Honestly, no. I never dreamed of becoming a doctor, but during my school years I liked chemistry. Once I won an Olympiad, and I was offered to enter two universities without exams: medical or chemical-technological. I chose the first one because it was in my city. Of course, the length of training scared me a little, but the profession of a doctor was always romanticized, so I believed that I could do it.

- How did the SMART CheckUp project come about?

- I run a YouTube channel and in one of rollers told how an adequate heart examination should look like: what is really worth paying attention to so as not to waste time on meaningless research. After that, my current partner approached me and offered to create a clinic that would offer people the right medical examination. So we started working together on SMART CheckUp and are now conducting a full-fledged study of the state of the heart and blood vessels. If necessary, we prescribe therapy, focusing on the latest domestic and foreign research.

In addition, we pay special attention to lifestyle modification. Smoking takes awayTobacco-Related Mortality we are from 10 to 14 years old, but there are ways to give up a bad habit - including medication. We teach patients how to integrate physical activity into their lives, explain the principles of healthy eating and help instill healthy eating habits.

- Can we really affect life expectancy if we follow certain prescriptions, or are there factors that are beyond our control?

- It is important to understand that now the main thing to prolong life is simply not to die prematurely. We have already learned how to significantly reducePreventing Heart Disease in the 21st Century mortality from cardiovascular diseases - almost 90%.

If earlier cardiologists said that each person would live to see his cancer, now oncology has become the most dynamically developing science. This year we were awarded the Nobel Prize for another fundamental discovery in this area. Every day, drugs appear that fight this or that type of cancer cells.

Some doctors joke that soon all older people will have great blood vessels and therefore impressive erections, but they won't remember why they need it. The fact is that while all drugs for treatment Alzheimer's disease failed the tests. Therefore, we can say that the task of modern medicine is to help you live to see your Alzheimer's.

- Can you prevent cardiovascular diseases through a healthy lifestyle?

- Yes, healthy lifestyle is really very important. From this point of view, smoking is absolutely stupid. The craving for alcohol can still be explained: at a terribly unprofitable rate, you exchange a piece of health for a certain state, adventure.

But with cigarettes in general, horror: we giveMortality in relation to smoking: 50 years ’observations on male British doctors 10 years of our own life, we pay for it and get practically nothing in return. The best thing a smoker can do for his health is to quit the habit immediately.

- There is a stereotype about a healthy lifestyle: you need to load yourself in the gym, do not drink, do not smoke, and everything will be fine. What is a healthy lifestyle really?

- A huge number of myths really hover around a healthy lifestyle. We are taught that Jerusalem artichoke syrup and brown sugar are much healthier than regular white or refined sugar. And also that sweet bars with the phrase Slim and Fit will help you keep yourself in shape. The label “organic” immediately creates a magical aura of health around the product.

The thing is that they want to make money on a healthy lifestyle.

It is difficult for people without medical education to navigate such health biomarkers as blood pressure and cholesterol levels, and the condition of arterial walls. It is easier for many to think that the one who runs marathons is okay, squeezes a hundred from the chest and drinks handfuls of dietary supplements. The concept of health in society is being replaced by sports achievements, a beautiful body, and healthy behavior.

Remember first that restrictive unbalanced diets work very poorly. As soon as you are offered to removeDietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis from the diet of some product or a whole food component, for example carbohydrates, you need to think about it and take the following words very critically. All this is wrong from the point of view of medicine.

There is also the concept of detox, which many find attractive. Allegedly, toxins and toxins accumulate in the body, and then cause a bunch of problems.

Slag is a term from ferrous and non-ferrous metallurgy. Not a single fighter with slagging has yet been able to bring them for analysisYou can’t detox your body. It's a myth. So how do you get healthy?.

Our liver and kidneys - the most complex biochemical laboratories - copes well with intoxication with alcohol decomposition products, and the immune system - with bacterial toxins. No mixture of vegetables, water, vitamins and a beautiful inscription on the bottle will help cleanse our body.

It's also important to pay attention to the dietary supplement craze. If they really did something useful with our body, they would automatically become a drug. Supplements help worms, mice, bunnies or an interested group that wants to sell them to the maximum, but we do not know anything about the real effectiveness of the substance for people. There are either no such studies, or the ears of dietary supplements manufacturers stick out from them.

Moreover, manufacturers sew everything into their preparations. In order for dietary supplements for weight loss to work, they addThe hidden drugs in your favorite supplements stimulant drug, for example. The consumer feels energy and good spirits, like on a dance floor, but in the end gets a bunch of side effects and diseases. It's best not to risk it because many of the dietary supplements are unsafe. They definitely don't increaseEffects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes: An Umbrella Review and Evidence Map life expectancy, and in some cases can shorten itGlobal hazards of herbal remedies: lessons from Aristolochia.

- And what about excessive sports?

- He's not very helpful eitherTHE PRICE OF FAME FOR PERFORMERS AND ATHLETES: SHORTER LIVES. Optimal is to runDose of Jogging and Long-Term Mortality: The Copenhagen City Heart Study 3 times a week for 4 kilometers, walk at least 10,000 steps every day. Benefit and safety should be noted interval training. The main thing is not to be in the high-pulse zone for more than a minute.

Moreover, the maximum life expectancy is more often observedAssociation of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories in people with a body mass index on the border of normal and average values. And although obesity is almost always accompanied by an increase in blood pressure, impaired carbohydrate metabolism, an increased risk of cardiovascular accidents and oncological diseases, we have no medical reason to say that you absolutely must be thin. The main thing is to feel normal. If you lead a healthy lifestyle with overweight, you will liveLeisure Time Physical Activity of Moderate to Vigorous Intensity and Mortality: A Large Pooled Cohort Analysis longer than a person with a normal body mass index, who sits on the Internet all day and does not move at all.

It is very strange that some people oppose medicine and a healthy lifestyle. It seems that you are either running marathons or taking blood pressure pills. In fact, modern medicine and proper healthy lifestyle in tandem can significantly increase a person's life expectancy.

Some people are unlucky in the genetic lottery. They eat right, exercise regularly, are not overweight, but still suffer from high blood pressure, which takes awayLife Course Analysis from 5 to 7 years of age. Well now, dying of a hypertensive crisis? You can continue to lead a healthy lifestyle, but take drugs that will reduce pressure and prevent injury to the arteries.

- Are there any differences in the choice of healthy habits for men and women?

- Globally, no, but there are interesting gender imbalances. For women, oddly enough, strength training is much more important, and they try to stretch and spend countless hours on yoga. We do not need increased flexibility because it can lead to joint hypermobility and arthrosis. At the same time, overweight men, on the contrary, swing their biceps and triceps in the gym, although it is better for them to do cardio: there are already enough muscles.

I would advise women to do strength training also because after 40 years, muscle mass begins to decline. The same thing happens in men, but in women it is more pronounced, since they are initially smaller. Following this, bone density decreases. To avoid a hip fracture at 70, you should start doing now strength exercises. The harder you squeeze the dynamometer in old age, the longer you will live. CCBYNC Open access Research Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants Balance training is also important - especially for older people.

"Alcoholism takes at least 20 years of life"

- What habits must be introduced into your life and how much will they increase its duration?

- First, let's eliminate bad habits. To give up smoking increases life expectancy by 10 years, and if in addition to this we pass every dayObjectively Measured Daily Steps and Subsequent Long Term All-Cause Mortality: The Tasped Prospective Cohort Study. at least 10-15 thousand steps, we will get rid of hypodynamia and increase our time on earth by another 4-7 years, depending on the body mass index.

Alcoholism takes awayMortality and life expectancy of people with alcohol use disorder in Denmark, Finland and Sweden at least 24-28 years of age, if a person has a heavy addiction. There is no safe dose anywayNo level of alcohol consumption improves health alcohol. Losing control over the amount you drink is very easy. If you are in the habit of having a hangover, then you should definitely exclude alcohol from your diet. On website The World Health Organization can check if you have an alcohol problem.

They are trying to explain to us that the J-shaped dependenceAlcohol and mortality: a review of prospective studies. the relationship between alcohol and mortality is due to the health benefits of small doses of alcohol. But it is worth noting that the non-drinkers in this study in 70% of cases are people who already had an addiction before, but were "encoded". Health damage has already been done, so they died earlier. Or they initially did not drink alcohol due to the fact that their health was weakened.

A person who can drink a little, knows how to control himself. He comes to the corporate party, raises two glasses of red, thanks everyone and leaves. Such people are all right. Chances are they do morning exercises and adhere to other principles of a healthy lifestyle. They are more purposeful and therefore have more material wealth. Earnings are one of the main factors affecting life expectancy. The richest liveThe Association Between Income and Life Expectancy in the United States, 2001–2014 10-15 years longer than the poorest.

Healthy - eat plenty of vegetables. The main problem is not that we eat a lot of junk food, but that we are not eating enoughHealth effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 useful: vegetables, fruits, whole grains. Lack of fruits and vegetables in the diet is associated with an increase inFruit and vegetable consumption and all-cause mortality: a dose-response analysis general mortality from cardiovascular diseases and oncological pathologies. You should eat at least 300 grams of various vegetables and 200 grams of fruit per day. At the same time, kartochuPotato intake and incidence of hypertension: results from three prospective US cohort studies we do not count for a vegetable.

Moreover, it is worth limiting excess intake of salt, processed meat products and red meat.

- What's wrong with red meat?

- WHO has already announcedQuestions and answers about the carcinogenicity of red meat and meat productsthat you should not eat more than 100 grams of red meat and 50 grams of semi-finished meat products. Consuming them in excess can increase the risk of colorectal cancer. And although the last meta-analysisRed and Processed Meat Consumption and Risk for All-Cause Mortality and Cardiometabolic Outcomes: A Systematic Review and Meta-analysis of Cohort Studies did not support these recommendations, many experts note that there are a lot of questions about this product. Substitute chicken or turkey for red meat. And eat at least 3-4 servings of sea fish a week.

- In one of your lectures you mentioned that you don't need to drink vitamins. Why?

- There is a studyPhysicians' Health Study II Finds No Cardiovascular Benefit in Middle-aged and Older Healthy Men Taking Multivitamins — Outcome for Heart Health Does Not Discount Other Important Benefits of the Multivitamin, in which one group of doctors took multivitamins all their lives, and the other did not use them at all. It turned out that this did not in any way affect the incidence and life expectancy. It should be noted that American doctors compare favorably with Russian doctors in that they earn good money and eat well.

People who eat a variety of foods get all the vitamins they need from food. The only exception is vitamin D. Some Fancy Diet Types Are Vegan and Unbalanced diets - can lead to vitamin deficiencies. If we move away from nutritional issues, then it is worth noting that folic acid will not interfere with pregnant women.

Excessive vitamins and antioxidants can increaseMeta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality the likelihood of developing cancer. It would seem that smokers need to be given vitamins A and E in order to fight free radicals - the products of cigarette smoking. In fact, during the studyMortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta ‑ analysis it turned out that in the group that took vitamins, mortality was increased. This is due to the fact that our immune system fights cancer, including with the help of free radicals. In excess of antioxidants, cancer cells survive, so the body does not need anything extra.

- They say that you need to drink a certain amount of water per day to stay healthy and feel good. Is eight glasses really the norm?

- Of course, water should always be freely available. And children who move a lot should be stopped from time to time and offered to drink. We really need about 2 liters of fluid a day, but it doesn't have to be eight glasses of water. People who choke on them live no longer and no better than those who drink when they want. Moreover, water can be obtained from tea, coffee and dairy products.

- What dietary guidelines are better to adhere to so as not to harm yourself?

- Now I’ll tell you how an ideal plate should look like. First, at least 300 grams of vegetables and at least 200 grams of fruit per day. Prefer whole grains. These include various cereals and pasta made from durum wheat. They should make up a quarter of all food consumed. I have already said that potatoes are not a vegetable, but in principle, no more than four times a week can be consumed in baked. It is also a source of carbohydrates.

Try to exclude processed foods from the diet and fill a quarter of the plate with sources of protein: chicken, turkey, fish, nuts, and legumes. The more varied your diet, the more likely you are to avoid vitamin and mineral deficiencies.

"People try to justify their weaknesses"

- How to distinguish reliable information that will really help you live longer and stay healthy from lies and marketing?

I have a few sure-fire markers that the marketing hype begins. The first is the mention of Nobel laureates. For example, Linus Pauling, when they want to take in multivitamins, or Luis Ingarro, when they want to sell Herbalife, or Yoshinori Osumi, if they want to teach how to prolong life by "correct" fasting.

The second bell is space medicine. Ballet and space are what we could be proud of until recently. Thanks to this, it works halo effect: If a drug is related to space medicine, then it is good and works cool.

When you come to pharmacies, immediately remember that there are whole groups of drugs on which they are trying to make money. These are dietary supplements and cold remedies without proven effectiveness, which are laid out on the first shelf.

There is still no cure for colds. There is a flu, but remember: the best way to prevent is still vaccination.

Next to cold medicines are medicines to protect the liver, which are loved by people who do not want to protect it. Most often, these funds do not have proven effectiveness. Evidence-based medicine has no fewer questions about nootropics that promise to improve brain nutrition.

In order not to be mistaken with purchases at the pharmacy, pay attention to the resource of Dr. Zhukov - firing list of drugs. It contains medicines with unproven efficacy. Check to see if the drug you are thinking of buying is there. If there is, do not take it.

- It seems to me that with the extension of life it is quite easy to get paranoid. Does every package of chips, smoked cigarette and bottle of beer really shorten our time, or can we sometimes give ourselves some indulgences?

- There is a disease called orthorexia - an anxiety disorder, which is expressed in the desire to be healthier than the healthiest person. Such people try not to eat anything harmful, do not crawl out of the gym and devote their whole life only to healthy lifestyle. This not normal. If you stopped going to work, left for India and don't see your friends in the name of health, then you have problems. Most likely, there is the same orthorexia. A healthy person can eat fries in peace and without feeling guilty.

- What do you think about stories about people who smoked, drank, ate what they wanted and lived to be 90 years old?

- Every smoker has a story about a grandfather who smoked Belomorkanal, but it seems to me that this is one person for all. There are many different myths because people try to justify their weaknesses.

You need to understand that we are all different and each has a certain number of years. Some have an initially high level cholesterol or poor physical data, but the principles of a healthy lifestyle are universal at the same time - they help to prolong life, albeit for different periods of time.

- How to understand that you really maintain your health at a consistently good level?

- You need to regularly undergo medical examinations. In general, there are two extreme points of view on this matter. Some people think that there is no need to go to the doctors, and even boast that they have never been to them - however, usually already in intensive care. Others begin to check everything at once: they pass oncomarkers, do an MRI of the whole body.

It is not necessary to do tumor markers, because there are a lot of false positive or false negative results. As a result, instead of living a normal life, a person begins to look for cancer and loses valuable time that he could have spent happily. Whole body MRI is also not recommended. The life of the person who made it is divided into two parts: before entering the apparatus and after.

Understand that benchmark results do not exist. It will definitely turn out that you have either a cyst in the kidneys or hemangiomas (a benign vascular tumor. - Approx. ed.) in the liver. You will walk and think about how to deal with it, but in fact, benign neoplasms do not affect life expectancy in any way. We are all a little different outside and inside, so you need to accept this and move on. Some features are the norm, and if you frantically look for something in yourself, it will definitely be found.

- What indicators are really worth monitoring?

- At the age of 14 you need to find out your cholesterol level, because often it depends not on what we eat, but on heredity. Next, an ECG and ECHOKG should be done to diagnose congenital and life-threatening features.

Strokes and heart attacks can make themselves felt as early as 20 years old, so take care of this in advance. After you come of age, measure your blood pressure and continue to take measurements approximately every year if the readings are normal. High blood pressure is one of the factors that greatly affects life expectancy, because blood vessels wear out faster.

At the age of 30–40, vessels should be checked in detail. Go to an appointment with a physician or cardiologist, do an ultrasound of the vessels of the neck to diagnose subclinical atherosclerosis.

After 50 years of age, hard-core smokers need to undergo a nikodose computed tomography every year, and after 65 years, an ultrasound of the abdominal aorta should be done.

Girls after 25 years old need to be examined by a gynecologist, do a smear to identify risk cancer cervix. After 40-50 years, mammography should be done - screening for breast cancer, as well as a colonoscopy to detect colorectal cancer. Also, have your moles checked regularly by a dermatologist. If the family has had recurring cases of oncological diseases - especially in the same organ - it is worth going to a consultation with a medical geneticist.

The most correct option is to assess your individual risk according to special calculators, which will help to choose the right age for the start of screenings and their frequency. These are examinations that you undergo when nothing hurts you. Only because it is written on your calendar. Complaints are another story.

"I try to do everything, but I can't do it"

- Describe your typical working day.

- In the morning I get up, try to wake up and have breakfast coffeeThe Impact of Green Tea and Coffee Consumption on the Reduced Risk of Stroke Incidence in Japanese Population and a tangerine. After that I go to work, see patients, and on the way home I stop by at the sports club for training. Late in the evening I read something, answer questions on YouTube and write scripts for new videos.

I practically never have days off, because I just change my activity: instead of meeting with patients, I shoot videos. Now I also started working on television: I am broadcasting on the Doctor TV channel.

Do you use time management techniques to organize your day?

- My only principle time management - to rank cases according to their importance and necessity. Patients always come first, followed by YouTube channel management. Then there are interviews for various publications, speeches, writing a book. I try to do everything, but I can't.

- What does your workplace look like?

“This is a computer desk with a pressure measuring device and a printer. I don't like paperwork, so the organizer replaces my phone.

- What services and applications do you use to make your work and life easier?

“I keep a calendar that my assistant has access to. She records all the cases there. I don't use anything special. Basically, these are commonplace applications: Sberbank Online, My Tax, RosFines, Parking, a couple of cardiological calculators.

- What do you do in your free time?

- I try to follow what I preach: I walk as much as possible and go in for sports. Due to injuries, I temporarily stopped doing Brazilian Jiu-Jitsu, so while I play squash. I force myself to eat as many vegetables as possible. Sometimes late at night I can watch a TV show, and on Fridays I meet with friends. From time to time I visit the cinema, but more often the theater. Yesterday I went to see "Tales of Pushkin" by Robert Wilson, but of course I am the one who shows off.

Life hacking from Alexey Utin

Books

From professional literature I advise N. M. Shevchenko "Cardiology" (very well written), and four more volumes by E. Braunwald "Heart Disease". This is our Bible. I read a lot of fiction in my youth. I especially liked the works of the brothers Strugatsky and Victor Pelevin. I still like the books of the latter. Now I have less and less time to read, so I switched to audio format and light literature. Just yesterday I listened to Harry Harrison's "Lifeboat".

Films and series

I'm really looking forward to the second season of Plague, which is about the epidemic in Spain during the great geographical discoveries. It was filmed very naturally. I like TV series "The Mandalorian" - an integral part of the Star Wars universe, and I'm also looking forward to new releases of Rick and Morty. From the last films I can mention "Joker" - a very good movie.

Podcasts and videos

I regularly watch the channel "Martial nerds"- he is smart and funny, and such a combination is quite rare. I like Stand Up Club # 1 with an alternative stand-up, as well as a historical channel Redroom. Of course, I periodically turn on interview with Dudya and SUPER_VHS Is a channel that reviews films. I study popular science channels, for example “Anthropogenesis ru».