Chapter 2. Generational degeneration in medicine

The above describes negative trends indicating a decline in physical, mental, sexual and reproductive health in relatively healthy children and young adults.These negative trends have gradually developed over the last three generations, that is, since the 1960s, but an obvious acceleration has occurred in the last 15–20 years.

An additional accelerator of the already negative trend was the 2019 coronavirus pandemic, after which many patients noted an exacerbation of existing chronic diseases, and the number of identified new cases of autoimmune diseases also increased.

It should be noted that the pandemic did not cause the development of all the diseases described, but only acted as a catalyst.

Experts who study autoimmune diseases have noted a significant increase in incidence over the past 15 years.At the same time, the severity of the disease has increased, despite the emergence of new targeted therapy regimens.

The last 50 years in medicine have passed under the banner of intensive international programs to combat cardiovascular diseases, obesity and metabolic syndrome.Despite enormous investments in the development of preventive and therapeutic technologies, the significance and severity of this problem not only does not decrease, but, on the contrary, progresses.

All this allows us to talk about a change in the constitutional status of the organism in which these diseases occur, which means it should be considered in the concept of generational degeneration and analyzed in detail.

Metabolic syndrome

Metabolic syndrome is a collection of symptoms and syndromes that are not individual diseases, but indicate the presence of metabolic disorders that predispose to the development of severe somatic pathology.

Metabolic syndrome includes weight gain, increased blood pressure, hyperglycemia (increased blood sugar levels) and abnormal lipid profiles.All components mutually induce each other.

The most noticeable external manifestation of metabolic syndrome, of course, is a progressive increase in body weight - and, as a result, obesity.The number of obese people worldwide increased by 28.8%, from 857 million in 1980 to 2.1 billion in 2013, with a noticeable jump over the past decade.

The prevalence of obesity concerns not only adults; the problem is quite acute among children.Thus, in developed countries in the last decade, 23.8% (22.9–24.7) of boys and 22.6% (21.7–23.6) of girls were overweight and obese.

The connection between obesity and hormonal disorders, in particular insulin resistance, is obvious.In our grandmothers' generation, obesity was explained by age-related degeneration, that is, age-related changes in metabolic rate and age-dependent changes in hormonal levels.

Nowadays, obesity is the lot of young people who have barely crossed the threshold of their thirties.This can be partly explained by a change in social status: driving a car, eating regularly, a more sedate lifestyle.However, we see the progression of obesity in children.Children and adolescents do not have such risks of cardiovascular complications, but there is a decrease in physical strength, endurance, the presence and progression of signs of connective tissue dysplasia during external examination, an increased risk of gastrointestinal disorders, and various types of allergies.Obviously, these changes are also associated with changes in hormonal levels.

If we analyze the phenotype, that is, the external manifestations of obesity in different generations, they also differ.In older men, when they gain weight, their belly becomes enlarged, which is called “male obesity.”An enlarged abdomen is mainly provoked by hypoandrogenism - a decrease in the concentration of male sex hormones, in this case due to age-related involution.Associated phenomena will be the development of impotence, insulin resistance, hypertension and, in the future, the risk of developing atherosclerosis, coronary heart disease, and an increased risk of stroke.

The “female type” of obesity (genoid type), associated with hyperestrogenemia, is characterized by predominant fat deposition in the buttocks, thighs and legs.Adipose tissue itself is a hormonally active organ, predominantly producing estrogen-like substances, so the appearance of any type of obesity in the future is complicated by the genoid type.

“Matching” the type of obesity to the biological sex does not eliminate the problems, but discrepancy (such as the development of female type obesity in a young man) carries additional risks, especially at a young age.Thus, age-associated obesity in an elderly man is a manifestation of individual degeneration, but mixed genoid obesity in a guy 25–30 years old who has not yet realized his reproductive potential is a population problem.

It should be noted that according to our clinical observations, among patients born in the 60s, obesity appeared after the age of 50 years, mainly among women and significantly less in men.Among middle-aged patients born in the 1980s and 1990s, both men and women are equally obese, with weight gain beginning between 20 and 25 years of age.

Children born in the 21st century suffer from weight gain from an early age, and boys are much more susceptible to this.It should be noted that their type of obesity is predominantly genoid, which intensifies the hormonal imbalance that the child already has.In adolescence, this hormonal imbalance inevitably leads to incorrect development of the sexual sphere and low reproductive potential.

If a decrease in sexual and reproductive functions for a man over 60 years of age is considered an individual problem, at the age of 25–30 years this becomes an obstacle to the implementation of reproductive function.Thus, generational degeneration should be considered within each family, and the increase in this problem in childhood should be considered within the framework of a general population threat.

The topic of sexuality and sexual dysfunctions is extremely sensitive and has limited discussion in society, although sexual health is a clear indicator of both personal and population health.The connection between obesity and sexual function is obvious, but if we take a lenient attitude towards decreased erectile function in men, dysfunction in young men associated with obesity is becoming an increasingly pressing problem.The increase in the number of obese young men directly affects the number of sexual dysfunctions in general as they grow older and reach maturity.

Diabetes mellitus type 2

Type 2 diabetes mellitus is one of the consequences of long-term metabolic syndrome, resulting from chronic stress on the pancreas and the gradual development of insulin and leptin resistance.

Glucose is a universal energy substrate, but in order for a cell to use it, the glucose molecule must enter the cell, and this can only be done in the presence of insulin, a hormone produced in the pancreas.For insulin to work, it needs to interact with a receptor located on the cell membrane.However, with long-term metabolic syndrome and/or inflammation, insulin resistance develops, that is, the insensitivity of these receptors even with an increase in the concentration of insulin in the blood.

With the development of insulin resistance, the level of glucose in the blood gradually begins to increase, since its movement into the cell is difficult, and the cell, in turn, continues to be in a state of hunger.

Chronic increases in blood glucose lead to oxidative stress and the accumulation of advanced glycation end products, which, according to their chemical structure, have a high oxidative capacity.Circulating in the blood, they inevitably lead to damage to the walls of blood vessels, nerve fibers, liver, muscles and other organs, causing complications of diabetes.

According to the World Health Organization, since 1980, the total number of people with diabetes has increased fivefold and, according to 2018 data, is 422 million - 5.4% of the total world population.If the increase in incidence continues, the number of patients with diabetes will double by 2030.

In the Russian Federation, from 2000 to 2016, the number of patients with diabetes mellitus increased from 2.043 to 4.3 million, that is, the “increase” of patients amounted to 2.2 million over 15 years.

Previously, diabetes mellitus, like obesity, was a concomitant phenomenon in elderly patients due to a decrease in metabolic activity in general and a decrease in receptor sensitivity.

However, over the past twenty years, diabetes has tragically become younger.Thus, among schoolchildren in Japan, the incidence of type 2 diabetes mellitus has increased 36 times.The number of children and adolescents suffering from type 2 diabetes mellitus in Russia is also inevitably growing.

The prevalence of diabetes mellitus in 2013–2016 was 7.2–8.6 per 100 thousand adolescents, and the forecast for 2030 is already 10–15 per 100 thousand.

Despite the improvement of therapeutic strategies, over the past decade it has been possible to increase the life expectancy of a patient with diabetes mellitus by only six months, while in just six years there has been an increase in the number of patients by 10% and a decrease in the age of onset of the disease by an average of two years.

One of the main risk factors for developing diabetes is obesity, which is being diagnosed more and more often.Accordingly, type 2 diabetes mellitus is growing and getting younger.Considering the catastrophic picture of the increase in obesity in children and adolescents, it is logical to assume a further rejuvenation of diabetes and its transition from a disease of old age to a disease of middle and young age with the appearance of corresponding disabling complications.

Diabetes mellitus type 1

Type 1 diabetes mellitus occurs due to the destruction of beta cells of the pancreas due to autoimmune inflammation, resulting in a progressive increase in blood glucose levels due to an absolute deficiency of insulin.Unlike type 2 diabetes mellitus, type 1 is a disease characteristic of young people with a more aggressive course.The main goal of treatment is stabilization of glucose levels, which is achieved by insulin replacement therapy.

Previously, type 1 diabetes was extremely rare, but in recent years it has been diagnosed more and more often.Public registries of patients with type 1 diabetes show dramatic trends.

For example, according to the official register, among children in Moscow, the prevalence of type 1 diabetes mellitus in just six years (from 2015 to 2021) increased by 25% (from 129.7 to 162.6 per 100 thousand children).

Among adolescents, the prevalence also increased from 2015 to 2020, by 30.3% (from 273.6 to 356.5 per 100 thousand adolescent population).

In Volgograd in 1984, 45 children were registered, and in 2017 – already 250. If earlier (in 1984) there were seven children with newly diagnosed diabetes per year, then in 2010 there were already 23, and in 2017 – 42 children.

In 1994, the proportion of adolescents diagnosed with diabetes was 50%, 5–9 years old 29%, and 1–4 years old 20%.In 2017, the age trend shifted to a younger age: thus, the group of adolescents was only 33%, 5-9 years old increased to 40%, and the group of children from 1 to 4 years old increased to 25%, which demonstrates a significant rejuvenation of the disease.

It is worth noting that the data presented refer to the pre-Covid period, and the coronavirus infection and multiple vaccinations significantly increased the prevalence of autoimmune diseases in general and type 1 diabetes in particular.

Type 1 diabetes is spreading and getting younger, which is another indisputable evidence of generational degeneration.

The statistics published above (excerpts from regional and federal registers) correlate with the global one and cannot be explained by an improvement in the quality of diagnosis and detection, which is often used to justify eloquent figures.These data clearly indicate a rapidly progressing pathological process, and no tendency to reverse the trend has yet been noticed: on the contrary, we are expecting even more dramatic figures.

Bronchial asthma

Bronchial asthma is a chronic non-infectious immunological disease, which is characterized by bronchial hyperreactivity with hypersecretion and the formation of spasm and subsequent respiratory failure (obstructive syndrome).

Despite the pathogenesis studied in detail and the presence of a system for selecting the necessary therapeutic interventions, to this day there remain cases of the most severe course of bronchial asthma with recurrent asthmatic statuses and leading to disabling conditions and death.

As of 2021, WHO estimates that asthma affects 348 million people worldwide (6.9% prevalence among adults), with an increase in prevalence in recent decades.Thus, in the period from the 1930s to the 1980s, there was an increase in the prevalence of bronchial asthma by 7–10 times in Europe and the USA.

This negative trend continues to this day.In Russia, during the period from 1991 to 1994, the prevalence of bronchial asthma increased by 32.3%; from 1998 to 2002, an increase of 28.8% was noted in this indicator.

Regional registers also record a manifold increase in the prevalence and incidence of bronchial asthma.For example, according to statistics on the incidence of bronchial asthma among adults aged 18 years and older, in the Omsk region from 1993 to 2008, the first established incidence increased from 30 per 100 thousand people to 158 per 100 thousand people.

In the first half of the 20th century, bronchial asthma was not a common disease, and only in the 60s did reports of an increase in the incidence of asthma among children begin to appear.In 1969, the first convincing paper was published showing the rising prevalence of asthma among Birmingham schoolchildren.Over the next few years, evidence emerged of the disease's increasing prevalence in Australia and Japan.

In 1985, a significant increase in the frequency of hospitalization of children with exacerbation of bronchial asthma was recorded in New Zealand, England, Wales, the USA and Australia.Over the course of 15 years, the frequency of hospitalizations increased 10 times in New Zealand, 6 times in England and Wales, 3 times in the USA, 4 times in Canada, and 8 times in Australia (Queensland).In 1990, a sharp jump in the prevalence of bronchial asthma was recorded among Finnish young men of military age.

A threefold increase in the prevalence of asthma was found between 1926 and 1961 (from 0.02 to 0.08%) and a sixfold increase between 1966 and 1989 (from 0.29 to 1.79%) in Finnish adolescents

A twelvefold increase in the prevalence of bronchial asthma among Finnish young men of military age was recorded between 1966 and 2003 (from 0.29 to 3.45%).

The incidence of bronchial asthma in children is a serious social and economic problem.In the Russian Federation, children predominate among the population in terms of the incidence of bronchial asthma.Approximately 8.7% of children suffer from asthma, with boys being affected on average 3 times more often than girls.By age criterion: the majority of sick children are of preschool age, with 30% being children under 4 years of age.

Thus, in 2007, the incidence of bronchial asthma among children was 1000 per 100 thousand children, and by 2016 it was 1500 per 100 thousand children.

The statistics on disability are also telling: disability due to asthma is increasing by approximately 30% per year.One should not lose sight of such a criterion as infant mortality.Unfortunately, about 5% of children die during an attack, and the younger they are, the greater the likelihood of this outcome.

Thus, the analysis of the incidence of bronchial asthma confirms the trends described in the previous sections, which allows it to be considered as part of a systemic population degenerative process.

Rheumatic diseases

Over the past 70 years, rheumatic diseases have transformed from acute directly infectious conditions (acute rheumatic fever) into chronic systemic degenerative diseases of connective tissue.

The first rheumatic diseases were streptococcus-associated lesions of various organs and systems, for which it was logical to assume that the era of antibacterial drugs should close the issue of rheumatic heart disease and reactive streptococcal arthritis.Yes, indeed, advanced rheumatic heart disease and acute rheumatic fever have practically left the clinical arena, but they have been replaced by much more etiopathogenetically complex autoimmune diseases with a much wider range of clinical manifestations.

Autoimmune diseases are a broad group of diseases based on dysfunction of the immune system, which mistakenly begins to perceive its own cells and tissues as foreign, develop autoantibodies against them and, as a result, damage them.Autoimmune diseases are always systemic, since damage in the event of dysfunction of the immune system affects organs and the whole organism.

Autoimmune diseases are usually classified and considered separately from each other, but the etiopathogenetic similarity and clinical picture suggest that autoimmune diseases do not occur in humans in isolation and, as the disease progresses, cover more and more organs and systems.Thus, not a single practicing modern doctor will be surprised by the fact that the same patient has autoimmune thyroiditis (AIT) and inflammatory bowel disease (IBD), type 1 diabetes mellitus and thyroiditis, autoimmune encephalitis in a patient with ulcerative colitis or Crohn’s disease, etc. ... The list of various combinations is not limited, and the autoimmune load is increasing.It should be taken into account that a number of autoimmune lesions can be subclinical for a long time and detected before manifestation (that is, before the onset of manifestations) only in the laboratory.

Unfortunately, at present, the treatment of autoimmune processes is limited to immunosuppressive therapy, that is, suppression of the immune system, or symptomatic therapy, while the severity of symptoms immediately decreases, and formally the general condition of the patient improves, but the current autoimmune process continues to exert its destructive effect on all organs and systems, and the manifestation of clinical manifestations of another organ system becomes only a matter of time.

According to the Ministry of Health of the Russian Federation, the total number of registered patients with a confirmed diagnosis of rheumatoid arthritis in 2010 was more than 276.9 thousand people, however, according to multicenter studies, the official number of registered patients does not fully reflect the picture of the prevalence of rheumatoid arthritis, which, according to various expert estimates, amounts to up to 0.61–1% of the total population.

Thus, in reality, the total number of patients with rheumatoid arthritis in the Russian Federation may exceed one million people.

Every year, the number of patients with rheumatoid arthritis increases by 3–4%, with up to 50% of patients becoming disabled within the first five years of the disease.A relatively favorable prognosis with the development of stable remission and preservation of working capacity is observed in no more than 5–6% of cases.But even against the background of prolonged remission, an exacerbation of the disease can develop with progressive destruction of the joints and disability of patients.About 2/3 of patients with rheumatoid arthritis become disabled by the tenth year of the disease and have severe functional impairment and limitations in everyday life.

The peak incidence of rheumatoid arthritis occurs between 30 and 45 years, which coincides with the most active period of working life.

A congruent picture is observed with other autoimmune diseases.Thus, the prevalence of reactive arthropathy increased from 46.5 thousand in 2001 to 76.8 thousand in 2016.

The number of patients suffering from spondylopathies in 2001 reached 35 thousand patients, and in 2016 - 115 thousand people, that is, it increased three times.It should be noted that in the early 2000s, an average of 3.4 thousand people were identified per year, and by 2016 there were already 21.4 thousand people with newly diagnosed spondylopathies, that is, a sevenfold increase over 15 years.

Rheumatic diseases are rapidly progressive and catastrophically disabling.The course of autoimmune diseases depends on the state of the reserve capabilities of the immune system.The increase in the number of rheumatic diseases should be regarded as a degeneration of the immune response, considering this within the framework of generational degeneration.The prognosis for the further increase of this group of diseases looks frightening.Taking into account that all trends are observed in all age groups, doubts arise that in the next 20–30 years there will be people who can be called at least relatively healthy.

Autoimmune thyroiditis (AIT) and other thyroid diseases

Despite the seventy-year history of study, the problem of timely diagnosis and treatment of autoimmune thyroiditis remains relevant to this day, and this relevance is only increasing from year to year.

In 2014, almost a million (more precisely, 913,829) children under 14 years of age with endocrine system diseases were registered in the Russian Federation, of which more than a quarter (256,533) suffered from thyroid pathology.In adolescents aged 15 to 17 years, the share of thyroid pathology among endocrinological diseases increased to 49%.It is worth noting that not only autoimmune pathology, even classical congenital iodine deficiency with the development of cretinism (severe mental retardation) remains a problem.Thus, at the beginning of the 20s of the 21st century in the Russian Federation, 4054 children are registered at the dispensary for this severe, but at the same time completely preventable pathology with timely diagnosis.Meanwhile, hundreds of patients receive this diagnosis only in their late teens.Hundreds of patients have been receiving unsuccessful treatment from neurologists and psychiatrists for more than a decade, with pathology that can be solved by dosing iodine preparations.

With autoimmune pathology the situation is much more complicated.The current incidence of autoimmune thyroiditis is 30–150 cases per 100 thousand people per year;In general, the prevalence of AIT among the population of different countries ranges from 0.1–1.2% in children to 6–11% in women over 60 years of age

The main problem in managing patients with AIT is that the traditional approach involves starting treatment only when a clinical picture of hypothyroidism, associated with an inflammatory and degenerative process in the endocrine gland, appears.Moreover, the titer, that is, the amount of autoantibodies, is not a mandatory component of the management of such a patient in the traditional approach.Thus, the inflammatory process in the gland continues to develop, and the patient remains in the dark and deprived of medical care until his condition becomes critical and he requires total replacement therapy.

The clinical picture, reflecting the progress of the autoimmune process in AIT, undergoes staged changes with an almost obligatory outcome in hypothyroidism.Hypothyroidism of varying severity is diagnosed in 36.5% of patients with AIT;Almost half of the patients, using hormonal studies and a test with thyrotropin-releasing hormone, showed subclinical hypothyroidism, 18.9% had a state of euthyroidism, and only 4.1% had hyperfunction of the thyroid gland.Thus, among patients with AIT, patients with subclinical and manifest forms of hypothyroidism predominate.

The most important are the systemic manifestations of AIT, which often precede the clinical picture of the thyroid pathology itself: skin manifestations, dryness, dullness and slower hair growth, increased fatigue, intolerance to physical and psychological stress, weight changes, dysfunctional manifestations of the autonomic nervous system, muscle and joint pain and many other manifestations.

The course of any autoimmune process is systemic and leads to the involvement of all organs and systems with the only difference being the target organ, which is damaged faster than others.

Mitochondrial changes and hormonal dysfunction, developing against the background of a chronic inflammatory process, are an integral background for the development of autoimmune pathology.That is why the doctor’s main efforts should be aimed at relieving inflammation and replenishing hormonal and mitochondrial status.We will talk about the tactics of treating systemic diseases in the second half of our book.

Inflammatory bowel diseases

Another system often involved in the inflammatory process is the gastrointestinal tract.Every person has experienced the development of food poisoning and intestinal infections in their life.Clinical manifestations of acute intestinal poisoning are intoxication syndrome, weakness, nausea, vomiting, diarrhea, abdominal pain and fever.In the treatment of acute intestinal disease, anti-inflammatory drugs, antibiotics, and sorbents are used.During the regeneration period, probiotic agents are prescribed, the purpose of which is to restore normal intestinal biocenosis, that is, the balance of bacteria involved in metabolic processes in the body.

It has long been studied how disruption of the intestines affects the development of allergies and skin diseases, which are most often considered within the framework of the so-called food allergy, therefore various tests have been developed that indicate the influence of a number of products on the human immune system.

Manifestations of such food allergies are skin rashes and dermatitis.Another important and relatively new discovery was the discovery of the relationship between the intestines and the brain.It has been discovered that a number of foods lead to overexcitement, restlessness and sometimes aggression.In addition, waste products of bacteria and fungi can lead to changes in behavior, fatigue, unmotivated laughter or irritability.Often there are no obvious intestinal symptoms.

In recent years, there has been an increase in the number of diseases of the intestinal tract; many patients experience diarrhea and constipation, and sometimes their alternation, excessive release of gases, and stomach turmoil.Often these symptoms are assessed by patients and even doctors as a conditional norm or the consequences of overeating or enzymatic deficiency, the so-called functional dyspepsia.However, more in-depth studies can reveal that the patient has a much more severe pathology, inflammatory bowel disease of autoimmune etiology.

In a low-resource organism, the functionality and effectiveness of all detoxification and defense systems first decreases, because their maintenance requires a large amount of energy.Disruption of all histohematic barriers, that is, barriers between tissues and blood, inevitably leads to damage to target organs.Damage to some barrier organs, such as the intestines, does not lead to immediate damage, but leads to chronic systemic intoxication.Normally, the gastrointestinal tract is populated by a huge number of representatives of normal and opportunistic microbiome, completely controlled by the immune system.Even opportunistic flora in a healthy resource organism follows the “rules” of its stay in the intestines and does not exceed the permissible population.Normal microflora performs a number of functions necessary for the body, supporting digestion processes.However, under stress, the blood flow in the intestines changes, causing the digestive organ to enter a state of ischemia, that is, lack of oxygen.The lack of proper blood flow also leads to a decrease in the control of the immune system.

In a sharp acute version, for example, in response to fear or stress, ischemia occurs abruptly and, due to oxygen deficiency and carbon dioxide accumulation, there is a sharp increase in peristalsis and a strong urge to defecate.In common parlance, this phenomenon is called bear disease, and in medicine this situation is considered as one of the mechanisms for the development of the so-called irritable bowel syndrome (IBS).Today, IBS affects, according to various sources, from 10 to 20% of the population, which in total can reach a billion people, and this number is steadily growing from year to year.As the syndrome progresses, its close connection with psycho-emotional stress fades away and pathological processes in the intestines become isolated, and the chronic inflammatory process, induced by the proliferation of opportunistic and pathogenic flora with the development of chronic dysbiosis, which, in turn, begins to have a significant impact on metabolic processes in the body, comes first.

Any inflammatory process is accompanied by an increase in permeability; in the case of the gastrointestinal tract, the barrier function of the intestine is disrupted.We are, of course, not talking about “holes” in the intestines, however, the subtle processes of absorption control are disrupted, and those products of the breakdown and metabolism of the microbiome, which normally never enter the blood, begin to circulate in the general bloodstream.This is how a systemic intoxication syndrome is formed, which provokes an already exhausted and irritated immune system, which triggers a nonspecific systemic inflammatory response.

This condition is nonspecific and is called “increased intestinal permeability syndrome.”Due to the nonspecificity of symptoms and the absence of morphological changes during endoscopic studies, the fact of increased intestinal permeability was denied by classical medicine for many years, since there were no tools for laboratory verification of the pathological process.The pathophysiological essence of the syndrome of increased intestinal permeability is an increase in the intercellular space due to the denaturation of proteins that provide intercellular connections of enterocytes.These connections are largely provided by occludin proteins; their functional activity is regulated by hormones and is disrupted, for example, during inflammation, intoxication and due to the action of signaling molecules.

As a result, the elasticity of proteins increases and intercellular connections become “loose”, and the resulting intercellular gaps are sufficient for the passage of molecules of large molecular weight.They enter the systemic circulation, provoking systemic inflammatory reactions.

The immune system's job is to identify the pathogen and eliminate it, either by engulfing and destroying it or by producing antibodies against it.This specific immune response functions when the immune system has sufficient resources and a limited range of provocateurs, however, with chronic inflammation in the intestine, accuracy cannot be achieved and antibodies begin to form against the intestine’s own cells, which, due to their chronic damaged state, themselves become foreign and “bad” for the immune system.

This is how a chronic autoimmune process develops from a chronic inflammatory process.The more damaged the intestinal walls are, due to two inflammatory processes simultaneously - infectious and autoimmune, the worse the immune system performs its functions, which means that there is constant stimulation of the pathological process, the so-called vicious circle, which we will talk about in more detail later.

Inflammatory autoimmune bowel diseases do not always develop against the background of IBS; in a person with dysfunction of the immune system, inflammatory bowel disease (IBD) can develop independently, but the connection with psycho-emotional and hormonal status remains in this case.

Inflammatory bowel diseases are a group of serious diseases that, if treated insufficiently and over a long period of time, lead to organ loss and disability.More than 5 million people in the world suffer from Crohn's disease and ulcerative colitis, 2 major diseases belonging to the group of inflammatory bowel diseases.

For a long time in Russia there was no registry of patients with IBD, and verification of the diagnosis remains a significant medical problem today.The difficulty is that inflammatory bowel diseases rarely manifest clearly and acutely with bleeding, severe weight loss and a general serious condition of the person.Most often, the disease develops gradually over many years and is disguised as a number of other chronic conditions due to the systemic immune response.Most patients turn to doctors with even more nonspecific complaints, such as abdominal pain, periodic bloating, periodic diarrhea, that is, with complaints that doctors regard as a functional gastrointestinal disease, after which such patients are usually treated as patients with IBS, functional dyspepsia or functional diarrhea.Accordingly, they receive symptomatic treatment and not systemic treatment, as required by inflammatory autoimmune bowel disease.

Many patients have been unable to cope with coxitis (inflammation of the hip joints), arthritis of the knee joints, and spondylopathies for years, as they are a consequence of a primary process in the gastrointestinal tract, the so-called IBD-associated arthritis.

Not only lesions of the musculoskeletal and articular systems can be associated with IBD.Damage to the nervous system in Crohn's disease and ulcerative colitis is a common and sometimes inevitable condition, which is why patients with IBD eventually begin to need the help of a neurologist and psychiatrist.However, contrary to popular belief, the involvement of the nervous system is determined not so much by psycho-emotional stress from the fact of having a serious illness, but by a systemic inflammatory and intoxication syndrome leading to neuroinflammation.

The duration of IBD most often determines its severity, since more and more new areas of the intestine, and then other organs and systems, enter the pathological process.

That is why the problem of detecting the disease in the pre-manifest period, or better at the stage of “lightning” - the first autoantibodies, is the main task of a modern clinician, not only a gastroenterologist, but also a doctor of any specialization.

It is noted that the main peak incidence of IBD occurs at the age of 20–30 years, the second peak at 60–70 years.The incidence in men and women is approximately the same.

In Russia, according to the ESCApe study

From various European publications it follows that the incidence of IBD in Western European countries is twice as high as in Eastern European countries (Crohn's disease: 6.5 cases per 100 thousand population compared to 3.3; ulcerative colitis: 9.8 cases per 100 thousand population compared to 4.6).However, according to regional registries of the Russian Federation, the prevalence of IBD is much higher and amounts to 5–12 cases per 100 thousand population in regions where there are no IBD centers, and over 40 cases in regions where an IBD center operates.Data from an epidemiological study in Russia indicate an annual increase in incidence (5–20 cases per 100 thousand population), and this figure continues to increase.There has been an increase in incidence of approximately 6 times over the past 10 years.

Characteristic features of the epidemiology of IBD in Russia are late diagnosis and the predominance of severe complicated forms with high mortality (3 times higher than in most countries).According to the register of the State Budgetary Institution "MKSC im.A. S. Loginova "DZM (Moscow), the time to establish the diagnosis of ulcerative colitis is 8 months from the onset of the first symptoms, Crohn's disease is 1.5 years.

Particular attention in statistical studies is paid to the annual increase in the number of hospitalized patients, including for emergency reasons.Thus, in 2011, in the Russian Federation as a whole, only 10,326 patients were hospitalized with ulcerative colitis, including 3,381 for emergency indications, and in 2017 – 19,656 and 5,883 patients, respectively.

In children, compared to adults, the course of IBD is characterized by greater severity, especially at an early age, and can occur against the background of immunodeficiency states.

In approximately one third of patients, the first manifestation of IBD occurs before they reach 18 years of age.

According to official statistics, the prevalence of IBD in children in the world is currently 2.2–6.8 per 100 thousand children.In the UK and Ireland, up to 700 new cases are registered annually, in Germany - an average of 5 per 100 thousand primary cases of IBD in children under 18 years of age, that is, 800 children annually.

Some Russian studies on the prevalence of IBD in children confirm the general global trend towards their increase.According to the Children's City Clinical Hospital named after.Z. A. Bashlyaeva, a steady and sharp increase in incidence was noted.So, if in 2017 25 children were diagnosed with Crohn’s disease, and ulcerative colitis was diagnosed in 17 children, then in 2021 – already 87 and 188 children, respectively.The number of epidemiological studies of IBD in children and adolescents is small and poorly describes the real picture of morbidity, which is associated with a pre-manifest subclinical course or the onset of the disease with extraintestinal manifestations.

In childhood, IBD often has a different course from adults and affects the child’s growth and puberty.Early onset, late diagnosis of IBD in children leads to more life-threatening complications.

The percentage of pediatric patients with extraintestinal manifestations and blurred intestinal picture is growing.Today, a child with delayed psycho-speech development and autistic features, whose diagnosis reveals high titers of antibodies to intestinal cells, is becoming a fairly typical and common case in our practice.

The huge problem of diagnosing this contingent is associated with the high cost of laboratory tests, the need in some cases to undergo invasive diagnostic procedures (colonoscopy, esophagogastroduodenoscopy, taking biopsies, etc.), as well as the frightening frequency of outpatient pediatricians ignoring the first signs of a developing severe intestinal disease, especially in the presence of neurological and psychiatric disabilities with a complete lack of perception of the cause-and-effect relationships between developmentautoimmune gastrointestinal disease and neuropsychiatric symptoms.

Despite these difficulties, in our opinion, every patient with clinical manifestations of irritable bowel syndrome should be assessed for the risk of developing inflammatory bowel disease.

Multinutritive

Autism spectrum disorder

Children's health is a focus of research for a variety of reasons.Firstly, this can be considered as an assessment of the functional health of parents (healthy parents - healthy children), and secondly, it is known that the child’s body reacts more vividly and contrastingly to all immune and infectious stresses.Any cold that occurs in a child does not go unnoticed.A similar process in an adult proceeds smoothly and often does not require intervention.Psychopathological disorders in adults (neuroses, asthenic conditions, panic attacks, depression) are often not perceived as a disease and are regarded as the result of fatigue, emotional overload, and the symptoms are smoothed out by inhibitory behavioral patterns that allow one to remain within socially acceptable limits.The phrases “pull yourself together”, “endure it”, “gather your will into a fist” are those behavioral models that will make even serious internal problems invisible to others.

In children, these volitional inhibitory mechanisms, due to age, are absent, therefore behavioral deviations are considered as an indicator of bad manners or spoiled behavior, and in fact, psycho-emotional deviations in a child should be considered as a symptom of internal trouble, the same as high fever, cough or wheezing in the lungs.

The number of children with disorders of the nervous system, manifested in the form of behavioral disorders, is also steadily growing, which correlates with a decrease in reproductive health and an increase in autoimmune diseases in adults of fertile age.

Initially, they tried to explain the increase in the number of behavioral problems by the changed external environment: modern children’s passion for gadgets, overprotection on the part of parents, or incorrect approaches to education.The failure of the applied behavioral and correctional techniques is explained by the lack of impact on the root cause - brain damage in these children.Currently, advanced clinics consider behavioral and developmental disorders among a number of serious immunological and metabolic diseases.

The severity of any disease differs from person to person, but this does not change the essence of the pathological process.When assessing behavioral disorders, behavioral disorders that were uniform in essence, but different in severity, were considered within the framework of various nosological forms.

However, conditions such as attention deficit hyperactivity disorder, autism spectrum disorder (ASD), early childhood autism, atypical autism, so-called sensorimotor alalia, autistic-like disorder and other diagnoses denoting behavioral disorders of varying severity are conditions that are common in their pathogenesis.Differences in disease severity among treatments are not significant.

A child with ASD is understood as a child with impaired interaction, contact and socialization, as well as secondary behavioral disorders that are most difficult for others to perceive: aggression, self-aggression, stereotypies, vocalizations.Severe cases of autism spectrum disorders, accompanied by seizures and epilepsy, are also common.

In total, the number of behavioral disorders, which for simplicity we will describe as the general group of autism spectrum disorders, is steadily growing, and currently the number of such children is already 2%.Just 10 years ago there were only a few of them, no more than 0.2%, that is, over the decade we have noted a tenfold increase in the incidence.Over the next decade, we expect a further increase in the prevalence and incidence of ASD among children and adolescents.The basis for such a pessimistic forecast was the emerging pre-Covid trend, as well as the impact of coronavirus infection and post-Covid syndrome on the reproductive health of potential parents.Young people who suffered a coronavirus infection in 2020–2022, planning a pregnancy even 2–3 years after the illness, will have a higher risk of having a weakened child than their peers in the pre-Covid period.

It should be noted that among patients with autism spectrum disorder, boys are six times more common.

The risk of having weakened offspring is higher in mothers with a weakened hormonal status and the presence of any chronic autoimmune disease, even in its subclinical form.

The growing prevalence of autoimmune diseases among the young fertile population was described above, while subclinical current autoimmune conditions are not included in the statistics.Nevertheless, even without a pronounced clinical picture, the presence of circulating autoantibodies in the mother’s blood creates a sufficiently compromising background of the immune system of the developing fetus, which will subsequently determine both the general immune response of the child and the reactivity of the local immunity of the central nervous system, in particular the reactivity of microglial cells.

Another mechanism of pathogenesis of the development of autism spectrum disorders is a violation of the permeability of protective histohematic barriers, especially during their formation.The nervous system begins to form from the 13th day after fertilization and ends its maturation after twenty years.However, the most significant period of brain formation begins from the seventh week of gestation and ends six months after birth, when the blood-brain barrier finally begins to function.During the formation of the blood-brain barrier, the child remains extremely vulnerable to any inflammatory condition, especially of an autoimmune nature.

Fortunately, the high neuroplasticity of the child's brain and incredible regenerative abilities make autism spectrum disorders more treatable than other similar autoimmune diseases, such as type 1 diabetes or autoimmune thyroiditis, in which organ damage during the disease process is most often irreversible.

The progressive increase in the number of patients with autism spectrum disorders should be considered as part of the phenomenon of generational degeneration, which is a consequence of the reduced biological resource of the parent generation, in the absence of adequate and timely treatment of a child who has no prospects for further reproduction.

Conclusions

The danger of degenerative processes lies in the decrease in the functional capabilities of the biological organism, which, due to the pathological processes occurring in it, becomes critically dependent on drug therapy, as, for example, in the case of type 1 diabetes mellitus;rapid disability and inability to self-care, as, for example, with rheumatoid arthritis;impossibility of socialization, finding a partner and further reproduction, as in severe behavioral disorders.The described examples demonstrate variants of individual degeneration that occur within the framework of the established diagnosis.

More dramatic in their biological essence are pathological conditions that lead to impaired reproductive function in seemingly healthy young people.The inability to reproduce without assistive technology indicates a genetic dead end in this genealogical branch.

Isolated personal degeneration is considered as an individual problem, and in the case of its development in elderly patients, as an expected manifestation of the processes of involution and aging as a whole of a biological organism that has already fulfilled its reproductive function.This determines a certain indifference to such processes in the medical community and society as a whole.

Isolated degeneration of a younger biological organism is considered as an accident or bad luck, but which has more significance for society, since it concerns people of working and fertile age.The same interpretation applies to reproductive disorders or the birth of a weakened child.

Conducted population studies analyzing these “accidents” allow us to notice that they develop into a dramatic pattern in the form of a decrease in the level of health in all age groups.Perhaps most experts do not yet consider all of the listed diseases individually as significant changes in the health of the population as a whole.However, in our opinion, the current picture looks terrifying, since even that part of the population that is not affected by diseases is already at risk.And the question in which generation of one genealogical branch the manifestation of severe pathology will occur is solely a matter of time.

Modern medicine is developing on the principle of dividing pathologies into specialties: rheumatoid arthritis is dealt with by rheumatologists, diabetes - by endocrinologists, autism - by psychiatrists, reproductive disorders - by reproductive specialists, etc. As a result, there has inevitably been a dissociation in the interpretation of etiopathogenesis, approaches to the selection of diagnostic tools and therapeutic strategies, but the worst thing is that many perceive the growing statistics on the prevalence and incidence of the described pathologies as an argument of significance andthe demand for a particular specialization.

Another common argument that we see in the description of graphs with increasing incidence rates is “improving the quality of diagnosis and detection of pathology.”That is, doctors are trying to take credit for the upwardly changing numbers, but all of the listed pathologies have a clear clinical picture, are not difficult to diagnose and force the patient to seek medical help independently when the first symptoms appear.It is unlikely that a person with progressive joint destruction and severe pain will sit at home, hiding from the registry and taking painkillers;or that a child who does not sleep at night with a delay in psycho-speech development will not make the young mother worry, and the state of hypoglycemic or hyperglycemic coma will go unnoticed by the family and doctors.

Treatment of the described diseases is usually symptomatic in nature, at best it smoothes out symptoms and improves the quality of life in the moment.For example, the use of monoclonal antibodies can reduce pain and improve motor function in a patient with a disease of the musculoskeletal system;the use of insulin allows you to stabilize and improve the level of glucose in the blood, but does not normalize the integral indicators of glycemia and glycation of metabolic products;the use of psychotropic drugs temporarily stabilizes the psychoemotional state and behavioral status of the patient.In our opinion, the appearance of any severe pathology is the result of a systemic breakdown of compensatory mechanisms in the body.

A healthy and resourceful body easily reflects the immune stresses it encounters, since the compensatory capabilities of the hormonal system are colossal and allow one to maintain reproductive potential.With a full hormonal status, a woman can become pregnant on any day of the cycle, and pregnancy planning does not imply calculating the days and hours of ovulation and arranging a schedule of sexual contacts according to this regime.In a resourceful organism, a panic attack will not occur against the background of minor stress, or even without provocation at all.A healthy child does not require the participation of a nanny, psychologist, teacher and speech therapist in his intellectual, personal and social development, but only improves his creative, sports or other skills in specialized clubs and sections.

In real life, we see the opposite: a growing need for medical clinics equipped with hospitals, the forced introduction of heavy medical technologies and expensive drugs, an increase in demand for psychologists, psychotherapists, neuropsychologists, speech therapists, and speech pathologists, which indicates the increasing relevance of the above problems and becomes another indicator of the slow degeneration of the human population.

Parallel currents of evolutionary processes, the development of information technologies, engineering technologies, advances in medicine, the claimed increase in life expectancy, an increase in its quality create the illusion of evolutionary progress, however, under this shell and the illusion of imaginary well-being hides a rapidly developing population degenerative process, the evidence of which our generation may not yet have time to feel in full force, but in just two human generations, that is, in fifty years, it is obvious that this problem will become dominant,but at the same time, perhaps, it is already difficult to resolve, and perhaps even unsolvable in principle.

Having summed up all the practical experience and assessed the situation not only according to statistical data, but also in the mode of daily consultations and the work of our entire clinic, we have formed, introduced and tested a concept for the treatment of severe autoimmune diseases, which often makes it possible to completely cure the body.The development of this concept was based on the study of the factors that determine the biological resource of the body and the triggers that deplete it.This concept can also help strengthen a relatively healthy body, and therefore prevent decompensation and the appearance of symptoms of serious diseases.Currently, we consider this concept as the only tool for preventing individual biological degeneration, and therefore as a tool for influencing the course of generational degeneration.