Dr. Tatyana Mateva is a graduate of the Medical University of Pleven, having completed her degree in 1997. She holds two specialties: one in general medicine and another in Nutrition and Dietetics from the Medical University of Varna. Currently, she works as a general practitioner in Ruse and also practices as a dietitian. Additionally, she is a doctoral student at the Medical University of Varna. For the past four years, she has been a member of the team at the National Academy of "Practical Dietetics and Integrative Medicine." Dr. Mateva proudly shares her involvement in organizing the "Bulgarian Dietetic Days" Symposium in Varna for the third consecutive year, with strong support from the Medical University of Varna. We spoke with her about keto nutrition in general and whether it can have a positive effect on conditions such as osteoporosis and hyperuricemia.

Osteoporosis is a condition where the bones become brittle and fragile due to the loss of bone mass and decreased density. It develops with age and is influenced by factors like hormonal changes, calcium and vitamin D deficiencies, a sedentary lifestyle, and genetic predisposition.

Hyperuricemia is a condition where the levels of uric acid in the blood are elevated, potentially leading to the formation of crystals in the joints and the development of gout. Causes include dietary habits, impaired kidney function, genetic predisposition, and certain diseases.

Simid: As a nutrition expert, do you think the keto diet could improve the condition of patients with osteoporosis and hyperuricemia?

Dr. Mateva: Over the past two decades, the keto diet (KD) has become widely used as a therapeutic approach. The weight loss associated with this diet can reduce the risk of conditions such as type 2 diabetes, hypertension, high cholesterol, sleep apnea, fatty liver disease, osteoarthritis, and polycystic ovary syndrome.

Although there is limited research on the connection between KD and muscle metabolism, it is known that chronic metabolic acidosis increases calcium excretion in urine without improving its absorption in the intestines. This leads to calcium loss from the bones and increased bone resorption. Any variation of KD that causes metabolic acidosis could negatively affect bone mineral composition.

Studies have also examined the effects of low-carbohydrate diets on bone turnover. These studies show no significant changes in bone resorption, bone formation, or overall bone turnover in people who followed such a diet for one to three months. There was no increase in bone turnover markers compared to control groups, although patients on low-carb diets lost more weight.

Regarding hyperuricemia and gout, high-fat diets are not recommended as they can trigger acute gout attacks with excessive intake.

Simid: Our Keto Bread is rich in magnesium (22.03 g per slice) and Omega-6 fatty acids (3.87 g per slice) due to the flaxseed flour used in its production. How could it be included in the diet of individuals with osteoporosis?

Dr. Mateva: In short, Keto Bread can be included in moderation.

Magnesium has been shown to regulate calcium's active transport, leading to increased interest in its role in bone metabolism. The recommended daily intake of magnesium varies for children and adults. Generally, 350 mg is the optimal amount for an adult, although this can vary depending on physical activity, weight, and diet. Magnesium can be obtained through food, supplements, or a combination of both.

Omega-6 fatty acids have both positive and negative effects. Therefore, their consumption from natural sources should be moderate. Excessive intake can negatively impact tissues. In optimal amounts, omega-6 fatty acids positively affect high blood pressure and alleviate symptoms of blocked blood vessels. Many studies show a reduced risk of heart disease in people with higher omega-6 levels in their bodies. Moderate consumption can improve both types of cholesterol levels and overall cardiovascular health.

Omega-6 fatty acids also enhance immune response, promote the health of skin, hair, and bones, and improve bone density. Insufficient intake of polyunsaturated fatty acids is associated with bone loss and decreased bone density. After menopause, bone density decreases rapidly, so additional omega-6 intake is crucial for maintaining good physical condition and preventing fractures and injuries.

Many women experience positive effects from omega-6 on alleviating hot flashes associated with menopause. Similar benefits have been observed in premenstrual syndrome (PMS), especially for symptoms like depression, irritability, bloating, and breast tenderness. This is likely due to the phytoestrogens found in plant sources of omega-6 fatty acids, such as flaxseed, which is particularly rich in phytoestrogens.

Simid: Flaxseeds contain phytoestrogens. Since Keto Bread is made from flaxseed flour, could it help women in menopause who often experience unpleasant vasomotor symptoms like severe hot flashes, anxiety, and palpitations?

Dr. Mateva: As part of a balanced diet, Keto Bread would be a suitable source of both phytoestrogens and magnesium and fats for women in peri- and post-menopause. With this bread's composition, we could expect it to have an effect on vasomotor symptoms.

Simid: How important is the presence of sufficient fiber in the daily diet of every individual?

Dr. Mateva: Fibers are polysaccharides made up of long chains of monosaccharide molecules. Unlike other polysaccharides, like starch and glycogen, fibers cannot be processed by digestive enzymes. However, this does not make them useless. On the contrary, they positively impact digestion, blood sugar and cholesterol levels, immune function, and gut bacteria.

Fiber is found only in plant-based products, with the richest sources being cereals, legumes, fruits, vegetables, nuts, and seeds. They are divided into two categories: soluble and insoluble. For example, fruits and oats primarily contain soluble fibers, while grains, legumes, and vegetables are rich in insoluble fibers. Insoluble fibers are especially beneficial for digestion.

Fiber is essential for good digestion. It increases the volume of intestinal contents, speeds up its passage through the intestines, and helps prevent constipation. Additionally, fiber acts as a prebiotic and nourishes gut flora.

Foods high in fiber reduce the risk of colon cancer. According to the World Health Organization, this is the third most common cancer worldwide. Fiber also reduces carbohydrate absorption and regulates blood sugar levels after meals, which is especially important for individuals with diabetes or insulin resistance.

Fiber also helps with weight loss by increasing satiety and slowing gastric emptying. This leads to less frequent feelings of hunger. The European Food Safety Authority recommends a daily intake of at least 25g of fiber.

Simid: Our Keto Bread contains a high amount of oat fiber and vitamin C — 1.72 g of fiber and 0.28 g of vitamin C per slice. How many slices per day would contribute to the digestive comfort of an average person, and how would the vitamin C benefit the body?

Dr. Mateva: Keto Bread is a beneficial choice for those following a keto or low-carb diet. Not only does it aid weight loss, but it also offers additional benefits. For individuals who regularly have breakfast, 3-4 slices a day can diversify the menu while providing important nutrients. The bread is an excellent source of protein and can be combined with various foods, such as dairy products, eggs, and fresh vegetables like baby spinach, bell peppers, or tomatoes, or with hummus and ajvar, complemented by boiled broccoli.

The presence of vitamin C in the bread is particularly important, as low-carb diets typically limit fruits (which are natural sources of vitamin C). Adding Keto Bread can help prevent vitamin C deficiency. Vitamin C plays a crucial role in supporting the immune system and recovery.

Personally, as a nutrition expert, I would recommend following a low-carb diet rich in fiber, especially for people in risk categories like those with obesity, insulin resistance, or diabetes.