Dr. Ekaterina Tolstikova: Today, it's possible to have a range of illnesses at 35, rather than just at 60.

On the impact of stress on health, folk remedies, "rejuvenation" of diseases, self-treatment, use of dietary supplements and vitamins, and the rejection of gluten, lactose, and carbohydrates, high cholesterol, as well as the benefits and harms of coffee and overeating during holidays, endocrinologist and dietitian Ekaterina Tolstikova shared in an exclusive interview with RBK-Ukraine.

Ekaterina Tolstikova is a general practitioner, dietitian-endocrinologist, food therapist, specialist in anti-age nutrition and functional medicine, assistant at the Department of Bioorganic and Biological Chemistry of the A. A. Bogomolets National Medical University, and a postgraduate student.

Throughout her career, Ekaterina has authored two books: on protecting the body from stress, "Stress Through Life - My Mood," and on rational nutrition, "Your Temple - Health."

She is also the personal dietitian for professional athletes, including the absolute world boxing champion Oleksandr Usyk, Bellator champion Yaroslav Amosov, tennis player Katarina Zavatska, and FC "Koloss" (Kovalivka).

Read about the causes of chronic fatigue, nutrition for professional athletes, body "drying," intermittent fasting, deficiencies in the body, and reducing the impact of stress on health in Dr. Tolstikova's interview for RBK-Ukraine.

This is a shortened version of our conversation. Watch the full interview on the YouTube channel of RBK-Ukraine.

– You often mention that stress affects all systems in the human body. How does this happen?

– It's not the stress itself, but rather our reaction to triggers that alters behavior. Of course, different people have different backgrounds, such as upbringing, childhood, adolescence, social environment, and a certain level of experience. Depending on this, the body will react. There is a psychological aspect and a biochemical one.

If we talk about a person who is strong, has a nutrition regimen, a schedule, and discipline, then for them stress is merely a challenge, one of those tasks that gets resolved quickly because they are not in a state of high anxiety and psycho-emotional imbalance. Therefore, nutrition serves as a support to protect against negative reactions to stress.

For individuals without any system, any strong external event can further "throw" them off in terms of the biochemical reactions that alter their eating behavior. Eating disorders may arise, and their gastrointestinal tract may function differently.

Stress can actually be beneficial. We must understand that we can manage it and influence our reactions. For those without a foundation, stress leads to a constant increase in cortisol levels, resulting in chronic stress.

Interestingly, many skin-related diseases are reactivated specifically due to stress. That's why I always say: we need to work on stress protection to reduce reactions and bring diseases into remission.

– If we talk about people who react strongly to stress, what should they do about their diet and routine?

– First of all, they need to structure their diet so that it resembles a schedule. For example, breakfast at 9:00, lunch at 1:00, a snack or third meal at 4:00, and dinner at 8:00. This will help stabilize them.

Secondly, if there is a certain demonization of foods, I would recommend consulting a psychologist or psychotherapist. If stress significantly throws them off balance, therapy in the form of antidepressants or supplementation to maintain the biochemical levels of substances produced during stress may also be necessary.

– What tests should a person take if they feel fatigued and have low energy levels?

– Fatigue is already a consequence, not a cause. If we talk about deficiencies, we are looking at vitamin D, iron (ferritin), but I advise checking not just ferritin but the entire iron panel.

There might be water-soluble vitamins, primarily B vitamins, due to the fact that people are currently not consuming enough carbohydrates. Especially whole grains, which are chewed and contain fiber, are rich in B vitamins. These are necessary daily since they are excreted from the body.

In addition to deficiencies, there may be hormonal imbalances. For example, elevated TSH levels indicate hypothyroidism, while low free T3 and T4 may suggest insufficient foundational nutrients for the thyroid to function properly.

The thyroid regulates the entire metabolism. If it doesn’t function well, there will be fatigue, swelling, hair loss, and many other symptoms.

The second most common hormonal issue is elevated prolactin and cortisol in saliva, as blood tests are not informative.

There is a wide spectrum here, and relying on a single marker may not pinpoint the cause but rather the consequence. Therefore, I always recommend visiting therapists who look at the overall picture.

I'd like to emphasize that waiting until it hurts will be much more costly than addressing it now.

– Which dietary supplements and vitamins can be taken independently, without a doctor's supervision?

– Magnesium in glycine form, at 200-400 mg, can be taken without issues. Increasing the dosage may lead to side effects, so it's better not to take risks.

I should mention vitamin D: if you start taking magnesium consistently, vitamin D levels may decrease. Therefore, its level should be monitored during magnesium intake, especially if it was low to begin with.

I wouldn't recommend taking vitamin D continuously on its own. It depends on the individual. If someone has absorption issues with vitamin D, they can take doses to maintain their levels.

If I were to say that everyone should take this vitamin, that would be an incorrect strategy because some may have normal levels, while others could develop hypervitaminosis D, which would also have negative effects.

As for other medications, it's better to do so under a doctor's supervision, on an individual basis. I would advise looking at your nutrition; if it’s not balanced, for example, lacking carbohydrates while having proteins and gastrointestinal issues, it may be necessary to take enzymes consistently, but again, this should be assessed individually.

[IMAGE_5]

Ekaterina Tolstikova: If there are deficiencies, it’s worth reevaluating your diet (photo: Vitaliy Nosach/RBK-Ukraine)

– What symptoms can also indicate deficiencies in the body?

– Each micronutrient can have its own symptoms. Chronic fatigue, difficulty waking up, poor mood, and depressive states may indicate vitamin D or zinc deficiency.

Hair loss, dull hair, and significantly thinning hair compared to two or three months ago can also be signs. When it comes to skin health, it’s essential to check B vitamins, vitamin D, zinc, and selenium.

Pale skin, fatigue, restless leg syndrome, menstrual cycle disturbances, and libido issues suggest iron deficiency. Each micronutrient has its own "symptom bouquet."

If your condition starts to differ from how you felt last week without any apparent reason, it’s likely time to see a doctor, get tested, and understand the cause.

– In many interviews, you state that when we want to lose weight, we don’t need to eat fewer carbohydrates. But today you also mentioned that women are consuming fewer. So where is the golden mean, how should one approach this correctly?

– I always compare the body to a car. There are cars that run on gasoline and others that run on diesel. If we put diesel in a gasoline car, will it run, and what will happen to it? I think that fuel is unsuitable for it. Why? Because it has specific basic settings for which it was designed. The same goes for humans. There are basic settings, biochemistry, anatomy, and physiology.

Glucose enters the cells. Why do we need it? ATP (adenosine triphosphate - ed.) is one molecule of energy. Can other nutrients provide this? Yes, proteins can be converted through various metabolic pathways. Can fats? Yes, they can. But carbohydrates are the simplest and most basic way to obtain energy since the other nutrients, fats, and proteins have different roles.

It’s like an office. A lawyer goes for a walk, but we urgently need a document signed. So, a person walks in and asks the accountant to sign for the lawyer. And the accountant does it, for example. But normally, that shouldn't happen. The same occurs in the body.

People, not understanding the purpose of carbohydrates, start thinking, "I gain weight from carbs." There’s nothing inherently wrong with them. Just stabilize your diet to avoid overeating, whether with carbs or other nutrients. Often, when people reduce carbohydrates, they switch to fats.

Carbohydrates aren’t to blame for weight gain or other issues. It's more likely improper eating habits,