La nutrizione in gravidanza e i perturbatori endocrini: 13 consigli per iniziare a riprenderci il futuro

Nel 1996 in USA uscì un libro di grande successo, dal titolo che in italiano suona più o meno “Il nostro futuro rubato: stiamo minacciando la nostra fertilità, intelligenza e sopravvivenza?” di Theo Colborn, Dianne Dumanoski e John Peterson Myers. Il libro racconta lo sviluppo della teoria degli interferenti endocrini da parte dello stesso Colborn. Anche se è un testo divulgativo destinato al grande pubblico, il libro contiene una notevole quantità di prove scientifiche. Una prefazione dell'allora vicepresidente americano Al Gore aumentò la visibilità del libro, che ha persino influenzato la politica del governo attraverso udienze al Congresso e ha contribuito a promuovere lo sviluppo di un’iniziativa di ricerca e regolamentazione all’interno dell’Agenzia per la protezione ambientale degli Stati Uniti (EPA).

Da allora sono stati pubblicati migliaia di articoli scientifici sulle alterazioni da interferenti endocrini, oggi ne sappiamo molto di più e le conoscenze scientifiche ci sono: che sia giunto il momento di riprenderci questo futuro?

Se sei in gravidanza ci sono cose che ti avranno ripetuto fino alla noia: l’apporto proteico, l’aumento di peso controllato, l’acido folico, gli omega 3, l’apporto di calcio, la vitamina D, le tossinfezioni...Tutte cose giuste e importantissime, sgombriamo il campo da possibili equivoci. Qualunque professionista che vi segue per la nutrizione in gravidanza DEVE pianificare con voi i fabbisogni nutrizionali, l'apporto proteico e di acidi grassi polinsaturi, l'eventuale integrazione di vitamine e minerali, l'ottimizzazione del controllo glicemico, la prevenzione delle tossinfezioni. Per fortuna questo in genere succede, e la maggior parte delle future mamme si rende perfettamente conto che è importante seguire queste indicazioni.

Quello che spesso non sa (e non per colpa sua ma perché non è stata informata) è che ci sono anche altri fattori da tenere in considerazione, e che possono fare tutta la differenza del mondo per la salute del futuro individuo. Ce ne sono diversi, come ad esempio il microbiota, che oggi sappiamo essere il centro della nostra salute – ricordiamo che il microbiota si eredita sempre dalla madre, e che il momento chiave per il trasferimento verticale è proprio il parto, insieme all'allattamento. Dedicherò presto un altro post a questo argomento, ma oggi partiamo da un altro aspetto fondamentale, che è stato definito “la minaccia invisibile”: i perturbatori endocrini, detti anche POP (Persistent Organic Pollutants, inquinanti organici persistenti).

Un tema che dovrebbe essere totalmente centrale per chi si occupa di gravidanza, come sottolinea nientemeno che l'American College of Obstetricians and Gynecologists:

“Le esposizioni tossiche legate alla salute riproduttiva e dello sviluppo sono state associate principalmente a infertilità e aborto spontaneo, esiti ostetrici come parto pretermine e basso peso alla nascita, ritardo dello sviluppo neurologico come autismo e disturbo da deficit di attenzione e iperattività e cancro negli adulti e nei bambini. (…) Gli incontri clinici offrono l’opportunità di esaminare e consigliare i pazienti durante la gravidanza e il periodo prenatale sulle opportunità per ridurre le esposizioni tossiche per la salute ambientale.” si legge in un documento ufficiale dell'ordine dei ginecologi americani. In estrema sintesi, stiamo parlando di sostanze esogene che alterano la funzionalità del sistema endocrino, causando effetti avversi sulla salute di un organismo.

I POP possono avere diverse origini: cibo, acqua, contaminanti domestici... E possono legarsi ai recettori per gli ormoni, andando a interferire con tutti quei processi biologici che sono guidati dagli ormoni. E vi assicuro che sono tanti, e importanti.

Non vi tedio con gli elenchi delle molecole e i meccanismi d'azione, e non mi dilungo a presentarvi queste sostanze perché ho già pubblicato un post introduttivo sul tema che vi consiglio di leggere, a questo link: https://www.sebastianlugli.it/approfondimenti/pop-matters-interferenti-endocrini

Veniamo al dunque: come potete facilmente intuire, il feto per le sue caratteristiche fisiologiche è particolarmente sensibile ed esposto ai rischi da contaminazione alimentare e non.

La radice di molti problemi di salute infantile come l’autismo o le difficoltà di apprendimento, così come le malattie che si manifestano in età adulta, come il diabete, alterazioni della tiroide, l'obesità, il cancro e persino l’Alzheimer, possono avere le loro radici nelle esposizioni chimiche prenatali.

L’esposizione a determinate influenze ambientali durante lo sviluppo fetale e neonatale può avere conseguenze significative sulla salute a lungo termine di un individuo.

Per cominciare l’equilibrio ormonale è fondamentale per la crescita e lo sviluppo del feto e del bambino: pensiamo al ruolo di estrogeni e testosterone per il corretto sviluppo sessuale e la pubertà, o della tiroide per lo sviluppo cerebrale. Lo stesso inquinante endocrino può indurre effetti molto diversi nei maschi e nelle femmine, perciò la valutazione degli inquinanti endocrini deve tenere conto della vulnerabilità legata all’età ed al sesso. I danni prodotti da queste sostanze sono confermati da ricerche mediche che indicano che le persone più esposte hanno un maggiore rischio di patologie riproduttive (infertilità, abortività, endometriosi, ecc.), di disturbi comportamentali nell’infanzia, e secondo gli ultimi studi anche di diabete e di alcuni tipi di cancro (testicolo, mammella, etc.).

Ma c’è dell’altro: il feto in via di sviluppo, se esposto ad un ambiente uterino ostile (ad esempio per cattiva alimentazione, infezioni, sostanze chimiche, metaboliti o perturbazioni ormonali), risponde sviluppando adattamenti a lungo termine, tanto impercettibili quanto irreversibili, nella struttura e nella funzione di alcuni tessuti e organi vitali (timo, muscolo scheletrico, polmoni, pancreas, rene) a seguito di modificazioni dell’espressione genica, differenziazione e proliferazione cellulare. Una volta nato e a contatto con l’ambiente esterno, il bambino può quindi essere predisposto a un rischio maggiore di alcune malattie non trasmissibili (NCD).

Tra l'altro questi cambiamenti epigenetici sono anche trasmissibili in via ereditaria, quindi l’esposizione della madre a un inquinante produce effetti addirittura per 3 generazioni!

Nutrizione e stile di vita in gravidanza sono fondamentali per abbassare il rischio di malattie

DOMANDA: ma chi ha detto che queste sostanze vengano assorbite?

Be', diversi studi lo hanno dimostrato. Per esempio studi sui cordoni ombelicali compiuti in tutto il mondo occidentale hanno mostrato ovunque livelli di PCB (uno di questi perturbatori endocrini) molto alti, tali da avere effetti molto negativi.

Ma anche più vicino a noi, uno studio fatto in Italia ha evidenziato la presenza del diesil-etilftalato (idem) nel sangue materno e nel cordone ombelicale.

Già dosi molto piccole di perturbatori endocrini possono avere un impatto enorme sulla salute. Il che non dovrebbe stupire: gli ormoni nel corpo funzionano già a concentrazioni infinitesimali, nell'ordine delle parti per trilione (mille volte meno di una parte per miliardo, un milione di volte meno di una parte per milione), tanto che i dosaggi ormonali nel sangue sono tecnicamente complessi perché non è facile misurare con precisione quantità così piccole.

E queste sostanza non sono altro che dei “falsi ormoni” che ingannano i nostri recettori e, in parole povere, mandano in confusione il nostro sistema endocrino.

Peraltro esiste un fenomeno noto come “effetto cocktail” per cui, esponendosi a diverse di queste sostanze contemporaneamente, gli impatti negativi non si sommano in modo lineare ma si amplificano (1+1=3).

Entriamo un attimo nel concreto, cito solo qualche esempio tra i tanti: già dagli anni '60 del secolo scorso era noto che alcuni pesticidi possedessero un'attività estrogenica, e tra gli anni '80 e '90 alcuni studi hanno dimostrato che un noto pesticida era in grado di provocare obesità nei ratti, e alterazioni nello sviluppo sessuale nei pesci e negli uccelli. In seguito, dati raccolti sia in laboratorio che su specie selvatiche hanno mostrato lo stesso effetto su vari tipi di vertebrati.

Oggi la letteratura scientifica ha dimostrato che i bambini esposti a perturbatori endocrini durante la vita fetale hanno un’aumentata prevalenza di criptorchidismo e ipospadia (problematiche dello sviluppo genitale maschile).

Diversi inquinanti endocrini sono stati associati ad una alterazione dell’esordio puberale sia in senso ritardato che anticipato, che a sua volta si associa a tante malattie.

Nel 2000 sono state studiate a Porto Rico le ragazze con telarca precoce e nel 68% del campione sono stati identificati livelli elevati, in maniera statisticamente significativa rispetto ai controlli, di ftalati, di probabile origine alimentare. Gli ftalati non sono una singola sostanza ma una intera classe di sostanze chimiche.

Si trovano in molti tipi di plastica, negli alimenti (a causa degli imballaggi alimentari e delle apparecchiature di produzione in plastica), nei detergenti domestici, nei prodotti per la cura personale, nel trucco, nei prodotti per il bucato, nei prodotti farmaceutici, persino nelle attrezzature ospedaliere come tubi e sacche per il sangue, impermeabili, ecc. indumenti, fili e cavi e altro ancora.

Vi rendete dunque conto di quanto l'ambiente domestico e il cibo siano potenziali di esposizione pericolosa per l'equilibrio ormonale dei nostri figli. E non solo, dato che l'esposizione agli ftalati è stata anche associata a:

- Diabete di tipo II e insulino-resistenza

- Sovrappeso/obesità

- Cancro al seno (nota: più di 900 perturbatori endocrini sono stati identificati come cause di cancro al seno)

- Allergie e asma

- Problemi riproduttivi di varia natura (dall'endometriosi all'ovaio policistico, all'infertilità e alla femminizzazione dei maschi)

E vogliamo parlare degli PFAS?

Noti perturbatori endocrini e modulatori epigenetici, sono contenuti ad esempio nelle padelle antiaderenti (Teflon®) e negli indumenti impermeabilizzati (come Gore-Tex®) nonchè nei prodotti per la pulizia dei pavimenti e detersivi in genere; nei contenitori di alimenti (ad esempio nei fast food), negli shampoo, nei dentifrici e molto altro. Particolarmente critico è l’uso delle PFAS e altri interferenti endocrini nei contenitori per alimenti, dai quali possono essere facilmente rilasciati ai cibi in essi contenuti. E' facilmente dimostrabile che gli PFAS sono presenti in tutta la catena alimentare.

Tra le patologie che in letteratura risultano associate all'esposizione a PFAS, figurano:

• Cancro del rene

• Cancro del testicolo

• Malattie della tiroide

• Ipercolesterolemia

• Colite ulcerosa

• Ipertensione gravidica/preeclampsia

Questi erano solo un paio di esempi, ce ne sarebbero tantissimi altri ma lo scopo qui non è tanto fare una rassegna della letteratura scientifica, quanto piuttosto darvi qualche piccolo strumento concreto per iniziare a migliorare la vita dei vostri figli. Ci sono tantissime altre sostanze di questo tipo, alcune addirittura contenute naturalmente in alcuni vegetali.

Anche se non possiamo mai evitare l'esposizione totale ai POP, possiamo lavorare per ridurre al minimo l'esposizione nel maggior numero di posti possibile...Si sa che il meglio è nemico del bene, e a volte bisogna accontentarsi di migliorare le cose senza pretendere per forza la perfezione.

DOMANDA: ok, dove si trovano queste sostanze e come evitarle?

Sono state identificate più di 1.400 sostanze con effetto di perturbazione endocrina, e ogni giorno siamo esposti a diverse decine di esse: non sarebbe possibile spiegare tutto questo in un singolo post, e forse non basterebbe nemmeno un libro. Per questo serve il supporto personalizzato di un professionista che conosca bene il tema e abbia fatto ricerca per voi su quali materiali utilizzare, come sostituire quelli tossici, come evitare che il feto sia esposto a influenze pericolose per il suo futuro, senza per questo dover dedicare ore a infruttuose ricerche.

Qualcuno che non abbia protocolli precostituiti, ma che parta dalla vostra realtà concreta, analizzando con voi tutte le possibili fonti di esposizione nella vostra casa e nella vostra routine quotidiana.

SEMPLICI CAMBIAMENTI NEL PROPRIO STILE DI VITA POSSONO RISULTARE IN UNA DIMINUZIONE MISURABILE DELL'ESPOSIZIONE A MOLTI PERTURBATORI ENDOCRINI. 

Uno studio del 2022 pubblicato su Environment International ha dimostrato che un percorso di supporto personalizzato da parte di professionisti che analizzavano le personali fonti di esposizione delle pazienti e fornivano consigli personalizzati per limitarle, determinava una diminuzione significativa dei livelli di perturbatori endocrini di queste persone.

Per questo ci tengo moltissimo ad accompagnare le donne in gravidanza che seguo non solo dal punto di vista della nutrizione stricto sensu, ma in tutto quello che è la loro vita quotidiana che disegna le esposizioni ambientali del nuovo individuo. Dopo tutto, dieta in senso etimologico significa “stile di vita”.

Già dalla prima visita mi prendo tutto il tempo necessario per fare molte domande sulla vita in casa e fuori, le abitudini alimentari, i materiali utilizzati in cucina, i prodotti che si scelgono per l'igiene personale e domestica e molto altro. Tutto ciò necessita di un grado di approfondimento e personalizzazione che si verifica solo nel rapporto 1:1 del percorso nutrizionale.

Nel frattempo vorrei lasciarvi però con qualche consiglio veloce che vi permetta di migliorare da subito il vostro esposoma (parolaccia tecnica che significa semplicemente l'insieme di tutto ciò a cui si è esposti), migliorando dunque immediatamente il destino genetico delle creature che portate in grembo.

E' davvero solo la punta dell'iceberg, ci sono migliaia di altri aspetti che andrebbero approfonditi, ma si sa che ogni grande impresa comincia con un piccolo passo e sta solo a voi decidere se accontentarvi di questo o investire energie per scrivergli un futuro di salute veramente migliore.

1.  Evita il più possibile gli alimenti processati industrialmente. Cerca di mangiare più spesso a casa piatti preparati da te o da persone della tua famiglia, di cui conosci gli ingredienti e gli strumenti usati per prepararli

2. Non mettere in contenitori in plastica (tipo Tupperware) alimenti e bevande che siano grassi (tutto ciò che contiene oli o burro, carni grasse, pesce grasso, salumi, cioccolato, frutta secca...), né alimenti caldi, né acidi. Quando possibile, scegliere sempre contenitori di vetro per conservare i tuoi avanzi.

3. Mangiare pesce 3 volte a settimana è importante per l'aumentato fabbisogno di DHA, ma attenzione ai pesci contaminati da molti perturbatori endocrini. In generale i più contaminati sono i pesci di taglia più grande, come tonno e pesce spada, per via della biomagnificazione. Ma attenzione anche ai pesci di fondale come la triglia. Al contrario, i migliori sono i pesci pescati di piccole dimensioni come alici e sardine.

4. Limitare l’utilizzo di utensili da cottura antiaderenti, specie se il rivestimento è usurato. Un solo graffio in una padella antiaderente può rilasciare in 30 secondi fino a 9000 particelle di PFAS, e un rivestimento rovinato 2 milioni di nanoparticelle. Usa pentolame integro, e dove possibile scegli materiali come acciaio, ghisa, ferro, titanio, acciaio al carbonio.

   
   

   

   Grazie Associazione Medici per l'Ambiente

   
   

5.  Evitare la pellicola per alimenti a contatto con gli alimenti, specie se sono grassi (tutto ciò che contiene oli o burro, carni grasse, pesce grasso, salumi, cioccolato, frutta secca...) o caldi. Leggere con attenzione l'etichetta della pellicola che acquistate.

6.  Durante la cottura dei cibi garantire un’adeguata ventilazione dei locali

7.  Evitare la combustione di incensi e candele profumate, e attenzione a deodoranti e profumatori per ambienti

8.  Fare molta attenzione agli involucri lacerati e/o usurati degli oggetti con imbottitura in schiuma (sedili dell’auto, materassi, divani ecc.). Specie se sono stati prodotti prima del 2012, la schiuma potrebbe essere molto tossica: considera di cambiarli.

9.  Nella scelta di materiale per la casa limitare l’uso di PVC morbido contenente DEHP

10.  Per cucinare evita gli utensili di plastica. Scegli piuttosto legno o metallo.

11.  Scegli teglie da forno di vetro Pirex, da evitare anche qui l'antiaderente

12.  Confrontati con un professionista che abbia approfondito la tematica degli inquinanti ambientali per scegliere in modo mirato la frequenza di consumo delle diverse fonti proteiche

13.  Se hai una tenda della doccia di plastica vinilica, rimpiazzala di frequente e considera di sostituirla con altri materiali, perché a contatto con l'acqua calda rilascia molti perturbatori endocrini.

Dott. Sebastian Lugli

Per consulenze e percorsi personalizzati (anche online):

dietista.lugli@gmail.com 349 5089964

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