Recomandari nutritionale

Diabet zaharat tip 2/obezitate/suprapondere

Obiective pacient (dupa caz):

o scaderea in greutate
o scaderea colesterolului total si a LDL colesterolului; scaderea trigliceridelor
o controlul DZ, scaderea HbA1c (hemoglobina glicozilata), scaderea necesarului de insulina, remisia DZ
o scaderea TA
o scaderea riscului cardiovascular
o scaderea acidului uric (in caz de hiperuricemie / guta)
o sevrarea FUMATULUI
o activitate fizica zilnica

Foarte important: scaderea in greutate – obtinuta prin reducerea aportului alimentar

 scadere in greutate de 15 kg, poate duce la remisia diabetului zaharat de tip 2, la pacientii cu o
durata a bolii mai mica de 6 ani. (conform celui mai nou ghid de tratament pt diabetul de tip 2 - consensul ADA-
EASD, oct 2018)1
 scaderea in greutate obtinuta prin restrictie calorica poate duce la scadere a hemoglobinei glicozilate
cu pana la 2% la pacientii cu diabet zaharat.2

Extrem de important: activitate fizica zilnica

- activitatea fizica intensa creste supravietuirea in special la varstnici si la pacientii cu HTA3 (cu cat este
mai intensa sau prelungita cu atat rezultatele sunt mai bune – se va adapta conditiei medicale a fiecarui pacient)
- activitatea fizica redusa/ sedentarismul – mai nocive decat fumatul, boala cardiovaculara sau DZ4
- activitatea fizica intensa5 (de 2-3 ori/saptamana – alergare in aer liber, alergare pe banda, inot,
ciclism, sala de forta – cu cresterea pulsului la 70-90% din capacitatea maxima) duce la cresterea rezistentei
fizice, scaderea partiala/totala a necesarului de medicamente antihipertensive, cresterea capacitatii pulmonare si a fractiei de
ejectie (capacitatea inimii de a pompa sange), creste longevitatea

 zilnic (exercitii de tip aerobic)6: o plimbare scurta (15- 30 min)7 cu ritm moderat-intens/alergare
usoara, dupa fiecare masa, in special dupa masa de seara
sau 30-60min8 cu ritm intens la 15min dupa masa principala a ziei si dupa cea de seara
 30 min (2-3 zile/sapt) de exercitii fizice de rezistenta, de tipul ridicarii de greutati / sala de forta
(adaptate conditiei medicale a fiecarui pacient)
 vom avea in vedere si urmatoarele activitati:
o coborat-urcat scari in locul utilizarii liftului
o mers pe jos cateva statii in loc de autobuz/tramvai
o mers alert, alergare usoara
o bicicleta, inot

De consumat zilnic: (regim alimentar pt o perioada de 6-7 luni)

1. OVAZ / fulgi de ovaz > 200-300gr --- fiert in lapte degresat/lapte de soia/lapte de migdale. Se pot
9

adauga si alte cereale precum: orz, secara, mei, hrisca, amarant, quinoua, sorg... dar ovazul (sau
eventual orzul) sa fie in proportia cea mai mare (peste 75%).
Pentru gust se pot adauga fructe de padure, seminte, nuci, scortisoara, cacao.
Efecte ovaz/orz
  Scade valarea colesterolului sanguin10 - Ovazul11 fiert (sau taratele de ovaz si in proportie mai mica, cele de
orz) contine o substanta numita beta-glucan, care se leaga de colesterolul si sarurile biliare prezente in intestin si
duce la scadere colesterolului sangvin (LDL colesterol).
 scade glicemia postprandiala12 13 (glicemia data de masa)
 Scadere in greutate14

2. O portie din leguminoase: fasole pastai, fasole boabe (alba, rosie, neagra), linte, soia, branza tofu,
naut, humus, mazare, bob
3. Legume/verdeturi – 2 portii zilnic din urmatoarele:
a. salata verde/rosie/iceberg/china, alte tipuri, spanac, andive, ceapa verde/rosie/alba, praz,
usturoi verde, frunze de telina, urzici, stevie, patrunjel …
b. crucifere: varza alba/rosie, brocoli, conopida, varza de Bruxelles, napul, hreanul, ridiche (alba,
rosie, neagra), varza kale, gulia, salata rucola
c. rosii, castraveti, ardei, vinete, dovlecei, morcovi, radacinoase, cartofi
4. Semintele de in– doar rasnite: 2 linguri (30gr) – contin acizi grasi Omega 3, fibre, lignani in cantitate foarte mare
(substante puternic anticancerigene)
Efecte ale inului - Scade colesterolul sangvin15 16 17 18 19
- scade TA20 - 30gr/zi seminte de in, timp de 6 luni, pot scade TAS cu 15mmHg si TAD cu 7mmHg
5. Nuci si seminte: 30-50 gr/zi, neprajite, nesarate.
 Nuci, seminte de floarea soarelui, dovleac, caju, migdale, fistic, alune de padure, seminte de
canepa - continut crescut de acizi grasi Omega 3, proteine (30% - toti aminacizii esentiali) si fibre, seminte de chia
(continut crescut de acizi grasi Omega 3 si fibre).
 Semintele pot fi consumate macinate cu rasnita de cafea, de catre persoanele care au probleme cu dantura.

6. Fructe de padure: zmeura, mure, merisor, afine, coacaze, catina, macese, dude, goji… dar nu confiate.
Afinele 30-50gr/zi (consumate timp de 3-6 luni, zilnic)
 Scad valoarea colesterolului LDL21 cu o medie de aprox 50mg/dl si cresc HDL colesterolul cu 17mg/dl.
 scad riscul de boala cardiovasculara 22 cu 12-32%.
 imbunatatesc activitatea cognitiva (memoria de durata lunga 23, performanta cognitiva pe termen scurt24)
7. 3-4 fructe proaspete zilnic
 Ciuperci

De evitat:
• Margarina vegetala -> Atentie!! torturile, prajiturile, prod de patiserie contin foarte multa margarina
• Prajelile – NU carne, peste, oua, cartofi, ciuperci, chiftele, ceapa prajite
• Cascavalul…poate ajunge sa aiba 60% din calorii sub forma de grasime, branza grasa, untul
• Bauturile carbogazoase (Coca Cola, Fanta, Pepsi, etc…), sucurile de fructe, mustul
• Ouale, (contin foarte mult colesterol.... aproximativ 200mg/un ou = cantitatea maxim admisa pt toate alimentele
consumate intr-o zi intreaga de catre un pacient supraponderal/obez care trebuie sa slabeasca)
• Alimente cu continut crescut de grasimi trans -> biscuiti, croissant, margarina, crackers, chipsuri,
popcorn (pregatit la microunde), gogosi, alimente prajite (cartofi prajiti, chipsuri, nuggets), produse
pastrate sub forma congelata (pizza, prajituri)

Alte recomandari
 Lactatele se vor consuma doar degresate.
 Uleiul, consumat in cantitati mici, va fi de preferinta de masline, presat la rece. La felurile de mancare
preparate termic, uleiul se va adauga dupa racirea acestora.

Atentie!!! Pentru o perioada de 3-6 luni se vor limita produsele de origine animala la aproximativ
400gr/sapt25.
Insa trecerea la aceasta dieta se va face treptat in decurs de cateva saptamani. Initial se va reduce numarul de
mese dintr-o zi la care se consuma alimente de origine animala, de la 3 mese la 2 mese si apoi la o singura
masa. Apoi vom alterna zilele, in care la o singura masa se vor consuma alimente de origine animala (lactate,
peste, carne – max 100gr/zi), cu zilele in care se vor manca doar alimente de origine vegetala (dieta de post).

Apa – 2 litri/zi
 nu se va consuma apa in timpul meselor si cel putin 2 ore dupa masa
 dimineata pe stomacul gol se vor bea 1-2 pahare de apa usor incalzita

EFECTELE acestui regim alimentar26 - mentinut timp de 7 luni de 13 pacienti cu diabet zaharat tip 2, cu
suprapondere sau obezitate (IMC medie = 34,3kg/m2....valori individuale pt IMC intre 25.0 si 45.6kg/m2)
 TA sistolica a scazut cu 27mmHg (de la 148/87mmHg la 121/74)
 Hemoglobina glicozilata HbA1c a scazut cu 2,4% (de la o valoare medie de 8,2% la 5,8%)
 Trigliceridele au scazut cu 68mg/dl (de la 171mg/dl la 103mg/dl)
 Colesterolul HDL (colesterolul bun) a crescut de la 48,3 la 52,6mg/dl
 Numarul mediu de medicamente necesare zilnic (pt controlul diabetului si tensiunii arteriale) a scazut de la 4.3 la 1.4
 IMC mediu (indice de masa corporala) a scazut de la 34.3 la 26.8kg/m2. O scadere ponderala medie de aproximativ 20 kg
in 7 luni

Recomandari HIPERCOLESTEROLEMIE27
1. Scadere in greutate (in cazul persoanelor supraponderale si obeze).
2. Cresterea nivelului de activitate fizica.
3. Diminuarea semnificativa a aportului de grasimi saturate, grasimi trans si colesterol. Astfel vor fi
evitate: ouale, cascavalul, branza grasa, untul, margarina vegetala, uleiul de cocos si de palmier,
prajelile, prajiturile. Vor fi consumate lactate doar degresate.
4. De consumat zilnic:
 ovaz - 200-300gr, fiert in lapte degresat/lapte de soia/lapte de migdale
 seminte de in rasnit - 2 linguri (30gr)
 afine (crude/congelate 30-50gr/zi, ceai de afine) - consumate timp de 3-6 luni
 alimente bogate in acizi grasi omega 3 si fibre, precum - leguminoase (fasole, naut, soia, linte),
nuci si citrice.
5. In cazul pacientilor cu diabet zaharat, normalizarea glicemiilor duce la scaderea nivelului lipidelor
serice (in special a trigliceridelor, dar si a colesterolului).

Recomandari HTA
1. Activitatea fizica intensa28 (de 2-3 ori/saptamana – alergare in aer liber, alergare pe banda, inot, ciclism, sala
de forta – cu cresterea pulsului la 70-90% din capacitatea maxima) duce la cresterea rezistentei fizice, scaderea
partiala/totala a necesarului de medicamente antihipertensive, cresterea capacitatii pulmonare si a fractiei de ejectie
(capacitatea inimii de a pompa sange), creste longevitatea
2. Scadere in greutate (pt supraponderali/obezi), prin scaderea aportului alimentar. Tesutul adipos in
exces contribuie la cresterea TA.
3. Scaderea aportului de sare (max 5 grame/zi)
4. Cresterea consumului de fructe si legume29 (8-10 portii/zi).
5. Semintele de in consumate zilnic30 (doar rasnite: 2 linguri = 30gr), timp de 6 luni, pot scadea TA sistolica cu
15mmHg si TA diastolica cu 7mmHg
6. Lactatele se vor consuma doar cele cu continut scazut in grasimi.
7. Evitarea consumului de alcool, cafea, bauturi energizante. (cafeina poate creste semnificativ TA pe termen
scurt chiar si la normotensivi)
8. Durata scurta a somnului31/insomnia/sindromul de apnee in somn... duc la cresterea TA (prin
eliberarea hormonilor de stres).

Recomandari HIPERURICEMIE32
 • activitate fizica constanta dar moderata
• legume, verdeturi
• lactate degresate
• vitamina C
NU se recomanda – (Se vor evita)
• bauturile alcoolice (in special berea si bauturile spirtoase)
• carnea rosie, fructe de mare
• bauturile indulcite
• diureticele, aspirina in doze mici
1
Melanie J. Davies & David A. D’Alessio & Judith Fradkin & Walter N. Kernan & Chantal Mathieu & Geltrude Mingrone &
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2
Diabetes Care, Volume 42, Supplement 1, January 2019, pag 48
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Kyle Mandsager, MD1; Serge Harb, MD1; Paul Cremer, MD1; et al, ” Association of Cardiorespiratory Fitness With
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Kyle Mandsager, MD1; Serge Harb, MD1; Paul Cremer, MD1; et al, ” Association of Cardiorespiratory Fitness With
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doi:10.1001/jamanetworkopen.2018.3605
5
generation 100 study - https://foreverfitscience.com/research/generation-100-the-3-year-follow-up/
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cholesterol is a risk factor in the development of coronary heart disease”
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