LE POTENZIALITA’ DELLA TERAPIA NUTRIZIONALE PERSONALIZZATA NEL DIABETE MELLITO DI TIPO 2
Il diabete mellito è una problematica molto diffusa nella società occidentale ed in rapida espansione. Non si tratta di una patologia ma di una sindrome dismetabolica, caratterizzata da diversi sintomi, segni clinici e complicanze.
Attualmente il diabete mellito viene classificato in tre gruppi sulla base dell’eziologia: il diabete mellito di tipo 1 (T1DM), di tipo 2 (T2DM) e altre tipologie (per esempio in diabete mellito gestazionale). L’aspetto che accumuna le tre forme di diabete è un riscontro di iperglicemia, causata da un deficit assoluto di insulina, un ormone fortemente legato alla regolazione del metabolismo, dalla sua ridotta efficacia biologica, o da entrambe le cause. Tuttavia le cause della patologia sono molto diverse nelle tre forme; il T1DM rappresenta i casi più rari e si tratta di una particolare forma auto-immune che interessa principalmente pazienti pediatrici e adolescenti; le altre tipologie di diabete hanno cause diverse e spesso sono secondarie ad altre problematiche; infine, la forma più diffusa, il T2DM, oltre ad una componente genetica, presenta diversi fattori di rischio riconducibili allo stile di vita dei pazienti.
Per questo motivo, accanto alla diagnosi medica e al trattamento farmacologico del T2DM, che non sono oggetto di questo articolo, la terapia nutrizionale riveste un ruolo chiave sia nella prevenzione che nel trattamento del disturbo.
La diagnosi di T2DM è spesso silente all’esordio, tanto che il paziente si rende conto di essere effettivamente diabetico al momento della comparsa di una o più delle complicanze. La gravità dal punto di vista clinico del disturbo diabetico, infatti, si trova principalmente nelle complicanze patologiche a lungo termine, rappresentate da conseguenze di microangiopatia (retinopatia, nefropatia e neuropatia) e di macroangiopatia (aterosclerosi, ischemia, trombosi, ictus cerebrale, TIA e patologie ischemiche periferiche), pericolose per la vita del paziente. I fattori di rischio del T2DM sono principalmente, oltre alla familiarità, l’età, l’obesità, lo stile di vita (alimentazione e sedentarietà) e la compresenza di patologie associate, come ad esempio la dislipidemia e la sindrome metabolica. Se su alcuni di questi fattori di rischio non c’è modo di intervenire, dal punto di vista dell’alimentazione con un approccio nutrizionale mirato si può fare in primo luogo un importante intervento di prevenzione, qualora il soggetto interessato sia consapevole di possedere
uno o più degli altri fattori di rischio, e secondariamente affiancarsi in modo costruttivo all’eventuale terapia medica. In particolare si parla di prevenzione primaria quando si cerca di modulare i fattori di rischio di determinati eventi e di prevenzione secondaria quando si interviene su una problematica già conclamata. In questo contesto, una componente comportamentale importante nel trattamento del diabete è rivestita da una corretta alimentazione. Storicamente, prima dell’ottenimento dell’insulina ricombinante e del suo uso nel trattamento farmacologico, i regimi
dietetici proposti per il trattamento del diabete mellito si caratterizzavano per essere molto restrittivi, specialmente in relazione all’uptake giornaliero di carboidrati. Successivamente, quando l’insulina è diventata di uso comune, questi protocolli sono stati via via abbandonati a favore di studi che hanno portato alla luce approcci dietetici nuovi, che non propongono un trattamento nutrizionale univoco, ma vanno ad intervenire sui diversi fattori di rischio tipici della patologia diabetica, allo scopo di ottenere un effetto complessivo positivo.
I principali obbiettivi di una terapia nutrizionale sono rappresentati dal raggiungimento e mantenimento di valori glicemici, pressori e lipidici in un range di normalità, fornire un apporto calorico adeguato all’ottenimento e successivo mantenimento di un peso corporeo adeguato, gestire i fattori di rischio cercando di prevenire le complicanze finora illustrate e migliorare globalmente lo stato di salute del paziente, il tutto nel rispetto non solo delle necessità nutrizionali del singolo individuo, ma anche dei gusti e delle preferenze del soggetto, al fine di ottenere la migliore
aderenza possibile al protocollo dietetico e limitando il suo sacrificio. Il protocollo dietetico adottato deve essere un progetto con obbiettivi a breve e a lungo termine, a seconda delle caratteristiche del paziente e del suo stato di salute. In particolare gli elementi di cui bisogna tener conto sono l’apporto calorico e nutrizionale con particolare attenzione all’apporto di carboidrati giornaliero e all’interno del singolo pasto, il calo ponderale, la distribuzione dei pasti e
l’adattamento alla terapia farmacologica in collaborazione con il medico. L’apporto calorico viene calcolato sulla base di diversi fattori paziente-dipendenti, quali il suo peso attuale e quello desiderabile, la distribuzione del tessuto adiposo in relazione a quello muscolare, valutabile con varie metodiche, il grado di attività fisica che il paziente svolge, che generalmente è consigliabile incrementare o introdurre, laddove non sia presente, in quanto utile sia al fine del calo ponderale, sia al miglioramento generale dello stato di salute. Il calo ponderale, infatti, proporzionato alla
situazione di partenza del soggetto, è uno dei principali goals del protocollo dietetico in quanto il tessuto adiposo ed in particolare il grasso viscerale, che si riscontra tipicamente in quantità superiore alla norma nel caso del paziente obeso, non costituisce semplicemente una riserva di grassi, ma è un grosso rischio dal punto di vista metabolico, poiché si comporta a tutti gli effetti come un organo endocrino andando a produrre molecole capaci di indurre insulino-resistenza. Lo stress metabolico ed infiammatorio dati da un eccessivo accumulo di tessuto adiposo, sono un
fattore molto rilevante per il paziente diabetico, che spesso inizia una terapia nutrizionale in uno stato importante di obesità che, se in passato era una caratteristica legata all’età, oggi compare tipicamente in pazienti sempre più giovani, il che rende necessario uno screening precoce ed accurato. Anche il contenuto nutrizionale, l’apporto di carboidrati e la distribuzione dei pasti nell’arco della giornata sono aspetti che vanno soppesati in relazione non solo alla situazione
patologica a cui ci si trova di fronte, ma anche alle abitudini ed allo stile di vita del paziente.
Complessivamente, un approccio altamente personalizzato pensato ad hoc su ogni singolo paziente risulta essere la strategia più efficace sia per andare ad intervenire in modo assolutamente mirato su problematiche singole o concomitanti, sia per assecondare gusti personali, esigenze culturali, sociali e religiose, facendo vivere serenamente al paziente l’adozione del protocollo nutrizionale in modo che possa avere un valore educativo ad una sana alimentazione. Una nutrizione corretta, infatti, al di là dello scopo puramente terapeutico, dovrebbe nel lungo periodo integrarsi alle abitudini del soggetto, andando insieme ad altri fattori a costruire un nuovo stile di vita che non assecondi una situazione patologica aggravando fattori di rischio già presenti, ma promuovendo la salute ed il
benessere.
Dott.ssa Benedetta Zanetti
BIBLIOGRAFIA
Guthrie RA, Guthrie DW. Pathophysiology of diabetes mellitus. Crit Care Nurs Q. 2004 AprJun;27(2):113-25. doi: 10.1097/00002727-200404000-00003. PMID: 15137354.
Hamdy O, Barakatun-Nisak MY. Nutrition in Diabetes. Endocrinol Metab Clin North Am. 2016
Dec;45(4):799-817. doi: 10.1016/j.ecl.2016.06.010. PMID: 27823606.
The final observe on Dianabol administration is when to take it throughout a cycle.
The commonest level of use is as a kick-start to a new off-season mass gaining cycle.
This will give the individual quick and notable positive aspects early on while the slower injectable steroids are building in their system.
This type of use will also end in the most dramatic gains in weight.
These dietary supplements play an important function in lessening the adverse
results that come up from the use of anabolic steroids, including liver toxicity, elevated blood strain, and ldl cholesterol imbalances.
Whether an individual aims to construct muscle, improve
endurance, or help recovery, Steroid Warehouse USA provides an intensive number of supplements tailored to diverse health goals.
Their product vary consists of choices for these targeted
on muscle building and weight reduction, catering to varied health fanatics.
Research indicates that specific dietary supplements can significantly assist muscle hypertrophy by offering
essential amino acids and different vitamins crucial for muscle synthesis.
They could also be unaware that long-term use of supplements can have adverse effects.
Dietary Supplements could doubtlessly worsen some health circumstances or work together with
drugs. If you’ve received the time, nothing will beat a great
workout routine and diet!
In order to avoid damage, use ought to be restricted to six weeks of whole use.
There also needs to be no less than 6 weeks of no C17-aa use earlier than beginning a new course.
However, most is not going to begin a new course till their subsequent cycle.In order to offer
safety, past duration of use recommendations there are several factors of consideration. When using a
C17-aa steroid like Dianabol, it is extremely important that you just
keep away from extra alcohol consumption, as excess will promote tremendous liver stress.
D-Bal comes packed with natural components like amino acids to enhance your body’s natural muscle protein synthesis,
making your muscles grow faster. It also contains vitamin D3, ashwagandha, and tribulus terrestris, along with magnesium and
soma root extract. This mixture ensures pure testosterone assist,
elevated vitality production, and better overall efficiency.
FDA is notifying shoppers of sure products promoted for body
constructing which have been found to comprise
hidden ingredients and should pose a major well being danger.
Identified for providing the finest quality, XT Labs is the go-to selection for athletes, bodybuilders, and fitness trainers in search of
maximum gains, energy, and fast recovery. Whether you’re utilizing whey protein, creatine, or
a full CrazyBulk authorized steroid stack, the benefits are undeniable when paired
with disciplined training and diet. WIN-MAX is broadly considered to be among the many most effective non-steroidal performance enhancers for both strength and endurance.
Your workouts shall be simpler as a result of the necessary nutrients that it incorporates,
which can ultimately result in elevated muscular power.
Many individuals are joining gyms because they wish to
look fit and strong. In some countries, steroids are illegal for athletic or bodybuilding use.
They are nevertheless acquired only with correct prescription and for medical functions.
Dietary Supplements are widely obtainable in health retailers
and can be utilized with out authorized or medical restrictions.
Nonetheless, other than creatine, no natural product is accredited
for bodybuilding in humans. The Meals and Drug Administration (FDA) doesn’t contemplate most such products safe,
given their lack of regulation and tendency to contain unlisted,
unlawful components.
Due to the speedy and pronounced will increase in power, which can translate
into extra energy and speed, this is normally a solid athletic enhancer.
The particular person must also expertise a degree of
enhanced recovery and endurance. When it involves
the load acquire, it’s important to keep in thoughts that this will largely revolve round total caloric consumption. Whereas the steroid can promote enormous quantities of
mass, you need to feed the body enough calories to succeed in this finish.
We wouldn’t call this one of the best athletic enhancing
steroid due to different choices, but if strength is
the one true concern it might be a good possibility.
It is an EAA for critically unwell sufferers when the body’s want for glutamine exceeds its capability to provide
enough amounts. The two short-term studies in men described
above found no unwanted effects from the DHEA; blood lipid ranges and liver perform remained normal.
Other studies have discovered that in girls, use of DHEA for months considerably raises serum testosterone but not estrogen ranges, which may cause zits and development of facial hair [129].
Caffeine is a methylated xanthine naturally present in variable quantities in espresso;
tea; cacao pods (the source of chocolate); and other herbal/botanical sources,
similar to guarana, kola (or cola) nut, and yerba mate.
Caffeine stimulates the central nervous system, muscle tissue, and other organs corresponding to the guts by binding to adenosine receptors on cells,
thereby blocking the activity of adenosine, a neuromodulator with sedative-like properties [83,84].
In this way, caffeine enhances arousal, increases vigor, and reduces fatigue [13,eighty five,86].
During the early phases of endurance exercise, caffeine may mobilize free fatty acids as a source of vitality and
spare muscle glycogen [38].
Oral tablets are one of the most common methods of HT administration, particularly for estrogen and
progesterone. Individuals typically take them every
day, and they provide a simple dosing schedule. Some doctors may prescribe it off-label to extend
energy levels and libido.
Water retention and other estrogenic side effects are
not a problem with this steroid, making it useful as a half of a
cutting cycle. If you’re going to run a Tbol cycle, take a
glance at my full Oral Turinabol cycle information.
Winstrol will suppress your testosterone so much, so you’ll want exogenous
testosterone in your cycle. There aren’t any estrogenic effects, and androgenic effects are normally delicate.
It’s an especially efficient cutting compound that may ship that extremely fascinating
onerous, dry appearance and is particularly useful
when you’re already lean and need more extreme results.
However, they are extraordinarily helpful in people who are very tired (fatigued) with their respiratory, or people who discover themselves very breathless.
Nebulisers are used mainly in hospital for extreme assaults of COPD when large doses
of inhaled medicines are wanted. Different breath-activated inhalers are additionally known as dry powder inhalers.
These inhalers don’t comprise the pressurised inactive fuel to propel the medicine.
Accuhalers, clickhalers, easyhalers, novolizers, turbohalers, diskhalers
and twisthalers are all breath-activated dry powder inhalers.
You have to breathe in fairly onerous to get the powder into your lungs.
A survey by the Nationwide Institute on Drug Abuse found that
round 1 million individuals within the Usa
have used anabolic steroids at some point of their lives, with 22% of those users
beginning before the age of 20. This is regarding, contemplating that
the American Academy of Pediatrics strongly discourages the
use of performance-enhancing substances in youth, because of the potential for
serious well being dangers. Individuals who misuse anabolic steroids report extra anger than nonusers,
as well as more fights, verbal aggression, and violence towards
their significant others, generally known as “roid rage” 131, 132.
One study suggests that the temper and behavioral results seen during anabolic steroid misuse might outcome from secondary hormonal changes 128.
It can take as much as 4 months to restore the body’s pure testosterone ranges if taking
excessive anabolic steroids doses for an extended period of time 28.
Don’t think of gear as a magic resolution, having you pack on muscle and
get ripped whilst you down donuts watching Netflix all night.
One factor you’re going to get with that way of life is a
few good water retention! So before starting, think about how and what you will eat, how usually, how a lot, and the way your training
will work. Ideally, you’re already consuming and training well
anyway, so you’ll have to tweak it to get your desired results.
If your food regimen or coaching just isn’t on level, you’re merely throwing cash down the
drain. Hey, I’m Joe, and I consider myself only a common mid-40s
guy who happens to have an excellent interest in steroids and what they will (and can’t) do for us.
I’ve been concerned in studying every little thing there’s
to learn about steroids for most of my adult life, and my
objective is to assist others like you find out about your first steroid
cycle.
When this drug is used as a prescription drug for sure circumstances
such as asthma, nevertheless, unsupervised and off-label abuse of this drug can lead to severe side effects and dangers.
These unwanted facet effects have been confirmed to manifest in animals
who have been given the drug, however, they’re
but to be documented in people. Medical Doctors warn that using this drug can have long-term effects on the center as the drug is bound to do damage to the cardiac muscle and
cells. Steroids that are manufactured to cross
drug exams are known as ‘designer’ steroids, a few of which embody desoxymethyltestosterone and
norbolethone. Because of those steroids, drug
checks are continuously adapting to try and detect these synthetic medication. These treatments are available in a variety
of formulations, together with tablets, liquids, intravenous preparations, lotions, injections, inhaled merchandise, suppositories,
and eye drops.
Women may experience excessive growth of body hair (hirsutism) however lose scalp hair 100.
With continued administration of anabolic steroids, some of these effects become irreversible.
It is often believed that anabolic steroids will produce
irreversible enlargement of the clitoris in females, although there aren’t
any studies on this one hundred and one.
Approximately 2% of females and 6% of males worldwide use or abuse anabolic steroids, with
related estimates for the Usa. Most data on the long-term
effects of anabolic steroids in people come from case reviews quite
than formal epidemiological studies. Severe and life-threatening antagonistic results could also be underreported, especially
since they might happen many years later. One animal research found that exposing male mice for one
fifth of their lifespan to anabolic steroid doses comparable to those taken by human athletes brought on a high frequency of early deaths 82.
Steroids are a synthetic form of testosterone, a intercourse hormone naturally produced by men and
women alike. Taking steroids increases testosterone levels, causing
results like elevated muscle mass and strength. Steroids are often used in patterns
called “biking.” This includes taking a number
of doses of steroids over a specific period of time, stopping for a
period, and beginning again.
In Distinction To most illicit drug use, misuse of anabolic steroids most commonly
begins in younger adulthood somewhat than adolescence. But
anabolic Steroid Cream Withdrawal (Totalfratmove.Com) use in teens is of concern, particularly
for the explanation that hormonal systems they interact with play a crucial
function in mind development during these years 143, a hundred and forty four, a hundred forty five, 146,
147. In adolescent rats, publicity to anabolic steroids increased neuronal backbone densities in the hippocampus and amygdala—brain areas involved in learning and
emotions (e.g., aggression), respectively.
This swelling of the breast tissue is amongst the most visible and
embarrassing potential unwanted effects of steroid use
and undoubtedly one that goes to nice lengths to attempt to prevent.
Anadrol and Dianabol are two of the steroids
recognized to return with a higher risk of gyno improvement.
Gyno is brief for gynecomastia – male breast growth, which is a standard
facet effect of some steroid use. If too much estrogen conversion occurs, gyno comes about, and it’s not reversible
in addition to with surgery like liposuction. Maintaining
frequent sense hygiene and safety practices ensures you won’t be risking your well being with any infection when injecting steroids.
When you’re new to steroids, you’re prone to have plenty of questions.
Below are a number of the most typical questions I see being asked by
folks contemplating utilizing steroids for the first time.