Prof. Dr. Darina Naydenova Hristova, M.D., is a physician specializing in Nutrition and Dietetics, and the head of the Department of Hygiene and Epidemiology at the Medical University in Varna. She also serves as the chairperson of the national association "Practical Dietetics and Integrative Medicine" (NAPDIM). Her primary professional and scientific interests lie in the areas of healthy, preventive, and dietetic nutrition for various conditions, disturbances in eating behavior, as well as personalized nutrition based on genetic testing. In this interview, we discuss the pros and cons of diets, contemporary trends in healthy eating, and how bread can be a part of it.

Simid: Prof. Naydenova, you have been involved in the ever-relevant topic of nutrition and dietetics for over 20 years. Many people strive to eat healthily, lose weight, or even gain a few kilograms. In the quest for safe and lasting results, various methods and approaches are tried. There are many arguments for and against diets. What is your opinion on this matter?

Prof. Naydenova: For me, the term "diet" has a negative connotation. Most people associate diets with serious restrictions and strict limitations, but only for a short period. After the diet, they often return to the same eating patterns, leading to dissatisfaction with their weight or body. In reality, to be in good shape and healthy, we don't need to follow extreme diets that exclude entire food groups or severely limit calorie intake. Instead, we should adopt a good eating routine and include a variety of foods.

The optimal eating routine for most adults (excluding children) involves at least three meals a day – breakfast, lunch, and dinner.

It is crucial for good health and optimal weight that our long-term menu provides all essential nutrient groups: proteins, carbohydrates, beneficial fats, and also bioactive substances such as vitamins and minerals. Replacing diets with sensible eating eliminates the need for extreme restrictions. However, this often requires a change in eating habits and dispelling popular myths. It's important for people to understand that changing eating habits is not a month or two endeavor (as with following a diet) but a lifelong commitment.

Simid: There are constantly new trends in eating – food combining, Keto, the Zone, Atkins, raw foodism, intermittent fasting, etc. What are the latest trends in weight loss diets based on the newest scientific discoveries? Is the Mediterranean diet still the most suitable for health and a good balance?

Prof. Naydenova: The fact that a new "revolutionary" diet is launched every 5-6 years, promising success for everyone, shows how unrealistic it is to expect a universal eating model suitable for everyone. In reality, we, as individuals, are very different in terms of our nutritional needs. These differences reflect thousands of years of evolution in different environments with characteristic regional foods. For most Bulgarians, the Mediterranean eating model is the safest path to good health, but some of us may have slightly different needs. Some may benefit more from a low-fat diet (the Mediterranean diet being the "fattiest" among all healthy eating options), while others may benefit from a menu with fewer carbohydrates than the standard. The latest trends in diets are associated with a personalized approach: dietary recommendations are individualized, taking into account the patient's current health status, the presence of accompanying conditions, metabolic peculiarities, food intolerances, nutritional deficiencies, taste preferences, and familial predisposition (i.e., genetic characteristics).

Simid: Our parents are used to eating three times a day, and every meal from "grandma's kitchen" always included a slice of bread. But modern young people no longer follow this rhythm, rarely eat at home, grab something quick, often from a package, skip meals, and for some, bread is entirely absent from their diet. Are the old habits of Bulgarian families a part of history, and should we make an effort to continue the tradition? How and to what extent should we include bread?

Prof. Naydenova: Bread has traditionally been a part of our daily lives, not just on the table but also in our language - "take a big bite, don't use big words," in our traditions - welcoming with bread and salt, making ritual bread for celebrations - salted bread for Christmas Eve, bread for welcoming a newborn, a bread-wish for a small child, breaking bread at weddings, bidding farewell to our loved ones with wheat... Traditions are what preserves us as a nation, and I see a revival among some young people in this regard. The fast-paced daily life implies fast eating, and bread often appears in our menu in the form of hamburgers, sandwiches, salads, etc. Unfortunately, more often than not, it's made from white flour, with an abundance of salt, palm oil, enhancers, and preservatives. Lately, there's a return to the traditional preparation of bread with sourdough.

Bread made from quality ingredients is a food with high biological value and has a place in modern nutrition.

The strength of bread lies in the whole grain, which contains important vitamins, minerals, and valuable fiber. Including various grains (rye, spelt, oats, etc.), pseudocereals (quinoa, buckwheat), seeds (flaxseed, sesame, pumpkin), and nuts (walnuts) in the dough enhances the taste of bread and increases its nutritional value. Besides the type, the quantity of consumed bread is essential. As part of a varied diet, whole-grain bread is an excellent alternative to so-called "slow" carbohydrates with a low glycemic index. This means that its consumption supports the stabilization of blood sugar and insulin levels, provides energy to the working brain and muscles, and contributes to a feeling of satiety and pleasure from food. Dense, whole-grain bread is a much better choice to satisfy carbohydrate and fiber needs compared to crackers, sweets, honey, dried fruits, potatoes, etc. For bread, the well-known saying applies: "There is no harmful food - there are harmful quantities."

Simid: Why has bread as a staple food survived for thousands of years? What makes it valuable for human health, and is it dangerous to completely exclude it from our menu, as many people try to do? Others give up white bread because it contains gluten, without being sure they are intolerant to it, and it's so delicious. Is this approach correct?

Prof. Naydenova: White flours mainly contain starch (65-75%) and proteins (gliadin and glutenin, 7-12%). The absorption of carbohydrates from bread is very high, around 95%, and for proteins - up to 80%. However, vitamins, minerals, and fiber are mainly found in the bran and germ of the grain and are absent in white flours. The protein in cereal crops (wheat, spelt, rye, barley) lacks several essential amino acids, limiting the absorption of the others. If, however, we consume bread with legume stew (mature beans, lentils, peas) during a meal, it naturally complements the amino acid composition and completeness of the protein. It's not a coincidence that our grandmothers used to put a slice of bread next to a plate of beans - even in vegan eating, a good portion of protein is provided!

Due to its high baking qualities and taste, white flour and bread are often the most desired but far from the healthiest. White bread has a high glycemic index - it rapidly raises blood sugar and insulin levels. Preferring it over whole-grain varieties may contribute to some metabolic problems and diseases. However, it's not necessary to completely exclude white bread from our menu; rather, we should use it moderately, especially during festive meals (New Year's Eve bread, lucky phyllo pastry, Easter sweet bread, etc.). White bread lacks cellulose, making it suitable for the dietary therapy of various gastrointestinal diseases.

The topic of gluten in bread is often discussed today. This specific protein in cereal crops is the "culprit" for the rising of bread and the formation of bubbles during baking. Gluten is present in all types of bread, not just white. It is hazardous for people with proven gluten allergy (celiac disease). This disease affects about 2% of the population and requires the consumption of a special, gluten-free bread. Sometimes, after severe gastrointestinal infections, gluten intolerance may occur. The topic of FOR and AGAINST gluten in people with autoimmune diseases (psoriasis, Hashimoto's thyroiditis, etc.) is particularly exploited.

My expert advice is, before resorting to excluding bread from the menu, seek advice from a doctor or specialist. Very often, in these diseases, laboratory tests for gluten intolerance are negative, and the unjustified exclusion of bread and other gluten-containing foods does not lead to an improvement in health status. On the contrary, bread in the menu is often replaced with far more refined alternatives, with a high glycemic index, many technological additives, and flavor enhancers. Of course, in cases of proven gluten sensitivity, all products containing wheat, spelt, rye, and barley should be permanently removed from daily eating.

Simid: In their desire to look good, some people deprive themselves of food without increasing their physical activity in their daily lives. Is it possible to lose weight this way, or is it necessary to engage in active sports alongside adopting a special diet?

Prof. Naydenova: The weight loss process is complex and depends not only on the energy balance.

If we deprive our bodies of sufficient calories for too long (by reducing food intake), protective mechanisms related to long-term survival are activated, and weight loss is slowed down, sometimes even completely stopped (the phase of the so-called "plateau"). On the other hand, overloading the body with too much physical activity can cause excessive stress and, again, hinder weight loss.

A moderate and comprehensive approach is crucial in the weight reduction process. It's essential to reduce calorie intake without risking nutritional deficits. It's crucial to approach it thoughtfully and ensure an optimal intake of proteins, enough healthy fats, and slow carbohydrates, such as those found in whole-grain bread. Moderately increasing physical activity will lead to an accelerated metabolism and increased energy expenditure. Regular physical activity, combined with sensible eating, provides an additional guarantee that weight loss will primarily come from excess fat rather than muscle.

Simid: We have created the Simid website with the ambition to be useful to professionals like yourself, nutrition consultants, and also to people who follow their diet and the products they consume. Therefore, we have provided detailed information on macronutrients and micronutrients for each of our breads, both per 100g and per slice. This information can be obtained in the store while looking at the product on the shelf by scanning the QR code on its packaging. It would be interesting to hear your opinion, and if you have heard feedback from your colleagues or patients – is this information helpful?

Prof. Naydenova: This detailed information is very useful not only for us professionals but also for anyone striving for good health and optimal fitness. Personally, for us, doctors with a specialization in nutrition and dietetics, it is a great relief to "dress up" our recommendations to a specific patient in more easily understandable units of measurement, for example, instead of talking about abstract 80g of dense bread or 40g of slow carbs, we can specify: 2 slices of "Zhivena Spelt" bread. The added value for me is the information on the website about fiber and salt content – important for a large part of modern socially significant diseases.

In reality, on the Bulgarian market, "Zhivena" bread has the lowest salt content without compromising its taste!

This is a significant achievement, considering that we, Bulgarians, consume a significant portion of our salt intake through bakery products, including bread. Bread with lower salt content is the best daily choice for children, pregnant women, people with cardiovascular, gastrointestinal, renal diseases, osteoporosis, obesity, etc.

Simid: The association you founded and chair is organizing a large symposium in March 2024, "Nutritional Days at the Sea," at the Astor Garden Hotel in the resort of St. St. Konstantin and Elena, on the topic "Metabolic Disorders – Challenges in Practice, Part I: Insulin Resistance." Simid will also participate with its stand, presenting its product range. Tell us more about the symposium, and what inspired you to take on the challenging task of organizing and hosting such a significant forum, especially since this is its second edition?

Prof. Hristova: The idea for the symposium originated during numerous friendly discussions among doctors on various professional topics. Many patients are unaware that they can turn to a doctor with a specialization in "Nutrition and Dietetics" for professional, scientifically based advice on how to improve their health through an appropriate dietary model. As practicing doctors – dietitians, we see daily the difficulties and wanderings both of colleagues and patients through the intricacies of pseudoscientific nutritional information. Often, specialists in narrow fields do not have the time and specific qualifications for individual dietetic counseling. In our discussions, we reached the necessity of popularizing the possibilities of modern diet therapy. When prescribed by a specialist doctor, diet therapy is a safe, effective, and absolutely essential component in the treatment of numerous chronic, socially significant diseases and conditions. In line with this thinking, we formulated the concept for the annual "Nutritional Days," dedicated each time to different health problems, diseases, and conditions requiring specific diet therapy and an integrative approach. For the first edition of the forum, we chose the topic of obesity – a global, chronic, progressive disease faced by almost every doctor daily. The second edition is dedicated to one of the most common metabolic disorders – insulin resistance and type 2 diabetes. The main goal of the symposium is to raise awareness in the field of preventive and dietary nutrition, first on a level of medical specialists and from there – to our entire society.