Nutrizione enterale chetogena per il dimagrimento, l’intervista

La nutrizione enterale chetogena come metodo di dimagrimento gode, da un po’ di tempo a questa parte, di crescente popolarità. Non a caso riceviamo sempre più spesso sollecitazioni in proposito dai nostri lettori, i quali ci chiedono, tra l’altro, se la NEC è efficace, se è sicura, come si svolge e se vi sono controindicazioni. Per rispondere a queste, ed altre, domande sulla nutrizione enterale proteica, abbiamo intervistato per voi il dottor Gaetano Avola, responsabile U.O.C. Chirurgia presso l’Ospedale Buccheri La Ferla di Palermo.

Dottor Avola, ci spieghi cos’è la nutrizione enterale chetogena

La nutrizione enterale chetogena, o nutrizione enterale lipolitica domiciliare, è un sistema di alimentazione basato sulla somministrazione di proteine. E’ noto che con le diete ipocaloriche l’organismo, per soddisfare le proprie necessità energetiche, deve ricorrere ai depositi di grassi (localizzati su fianchi addome ecc.) e proteine (che si trovano nei muscoli); l’efficacia di questo metodo è data dal fatto che la soppressione dei carboidrati e la somministrazione delle proteine consente all’organismo di non aggredire i depositi di queste ultime, e quindi i muscoli, mentre la perdita di peso è esclusivamente a carico della massa grassa.

Quali sono gli effetti collaterali delle nutrizione enterale proteica?

Come risultato della combustione dei grassi si ha la formazione di corpi chetonici che vanno nel sangue e finiscono per nutrire adeguatamente il cervello poichè si tratta di molecole semplici il cui utilizzo a livello cerebrale è ottimale, come se fossero glucosio. Per questo motivo il cervello non soffre della carenza di carboidrati tanto che il tono dell’umore durante il trattamento si mantiene elevato, talvolta addirittura euforico. D’altra parte, la presenza di corpi chetonici riduce il senso di fame per cui il paziente sopporta bene il trattamento.

La produzione eccessiva di corpi chetonici è un rischio reale per chi si sottopone al trattamento?

La produzione eccessiva di corpi chetonici rappresenta un’eventualità piuttosto remota, anche perchè l’organismo compensa con i propri meccanismi tampone che vengono potenziati dalla somministrazione, associata alle proteine, di vitamine, sali minerali, fermenti lattici e fibre. Inoltre, l’assunzione di almeno due litri di acqua al giorno, che consigliamo sempre, insieme all’acqua introdotta nell’organismo con le proteine, aiuta l’organismo a diluire la chetosi in modo da non avere complicanze.

A chi è controindicata la nutrizione enterale proteica?

E’ necessario che i pazienti si presentino alla prima visita muniti di accertamenti ematici che ci facciano escludere un’eventuale insufficienza renale e/o diabete insulino-dipendente, condizioni che controindicano il trattamento.

A chi invece è consigliata?

La nutrizione enterale nasce come supporto a pazienti che non sono in grado di alimentarsi a sufficienza; da questa origine si è passati ad altre applicazioni quali la cura dell’obesità, che è l’indicazione principale; tuttavia la nutrizione enterale proteica comporta benefici anche in caso di diabete di tipo II per il quale rappresenta un vero e proprio trattamento dal momento che la riduzione del peso può portare alla sospensione della terapia farmacologica. Altra condizione che giova della nutrizione enterale proteica è l’ipertensione, grazie alla riduzione dell’apporto salino. Inoltre, questo tipo di trattamento di solito è riservato a coloro che hanno provato altre diete senza ottenere risultati significativi per i quali la nutrizione enterale proteica è più sopportabile perchè, come accennato, a differenza delle diete tradizionali non induce fame e fiacchezza e permette di ottenere risultati in tempi brevi.

Di che tipo di risultati parliamo in termini di perdita di peso?

I risultati variano dal 7 al 10% della perdita di peso corporeo a seconda della durata del ciclo, che varia da otto a quattordici giorni.

Esistono fattori costituzionali  in grado di influenzare l’efficacia del trattamento?

Si è notato alcuni individui appartenenti a particolari gruppi sanguigni ottengono risultati minori.

Da cosa dipende la durata del ciclo?

Fondamentalmente dal tipo di paziente: pazienti in condizioni di obesità patologica è bene che facciano trattamenti più prolungati, alternati a periodi di alimentazione controllata, chi vuole semplicemente tornare in forma può fare anche un solo trattamento di una settimana.

Come si svolge il trattamento? E’ necessario il ricovero? Il paziente viene sottoposto ad anestesia?

La prima fase si svolge in ambulatorio entro strutture sanitarie idonee. L’introduzione del sondino avviene entro pochi istanti, talvolta viene utilizzato un anestetico locale che non è indispensabile. Il trattamento in genere prosegue a casa, il paziente rimane in contatto con noi telefonicamente. E’ possibile effettuare il ricovero presso strutture convenzionate autorizzate solo in caso di obesità patologica.

Cosa deve fare il paziente una volta a casa?

Una volta a casa il paziente deve assumere i farmaci che gli sono stati prescritti e tenere sotto controllo la chetosi utilizzando gli appositi test in vendita in farmacia. Se è diabetico bisogna che controlli la glicemia, mentre se è iperteso la pressione; quindi i dati vanno comunicati telefonicamente al medico fino al controllo successivo.

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  1. Io ho seguito lo stesso percorso con la NEP e sono rinato. Dieta del sondino e contemporaneamente programma di “rieducazione alimentare” (cioè, ho imparato a mangiare correttamente tra un ciclo e l’altro) seguito da un endocrinologo competente in materia. Per chi volesse trovare maggiori informazioni, si può rivolgere a DIMAGRIRE CON LA NEP (dott. D’Auria). Il link è: http://www.dimagrireconlanep.it

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