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ALIMENTATIA SI TULBURARILE DE TRANZIT IN SM

ALIMENTATIA SI TULBURARILE DE TRANZIT IN SM. SEMINARUL NATIONAL DE SM 2009. SM – boala autoimuna, cauze si mecanisme de producere incomplet elucidate Consecinta: ipoteze si recomandari dietetice variate, uneori contradictorii Manifestari clinice polimorfe

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ALIMENTATIA SI TULBURARILE DE TRANZIT IN SM

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  1. ALIMENTATIA SI TULBURARILE DE TRANZIT IN SM SEMINARUL NATIONAL DE SM 2009

  2. SM – boala autoimuna, cauze si mecanisme de producere incomplet elucidate • Consecinta: ipoteze si recomandari dietetice variate, uneori contradictorii • Manifestari clinice polimorfe • Afectarea directa si indirecta a aparatului digestiv

  3. Scopul recomandarilor dietetice in SM • Posibil rol al alimentatiei in ameliorarea evolutiei bolii • Adaptarea alimentatiei la disfunctiile gastro-intestinale specifice • 5% constipatie • 51% incontinenta fecala • 68% diferite forme de disfunctii intestinale

  4. PREMISE • Prevalenta diferita a SM in functie de obiceiurile alimentare • Rolul acizilor grasi esentiali in • Imunitate • Structura mielinei si a membranei neuronale • Diete sarace in grasimi saturate si bogate in acizi grasi esentiali au dus la scaderea dizabilitatii si a frecventei si severitatii puseelor in SM

  5. Grasimi • Saturate • Trans • Nesaturate • Mononesaturate: masline, alune, avocado, migdale • Polinesaturate : floarea soarelui, soia, poromb, nuci, ulei de peste • acizi grasi esentiali • Omega 3: peste, fructe de mare, soia, nuci • Omega 6: ulei fl soarelui, susan si porumb, leguminoase, legume cu frunze, cereale, viscere

  6. Diete • SWANK • CRAWFORD • EVERS • MC DOUGALL • GREER, etc

  7. Consens – USA National MS SocietyRecomandari 2008 • Minimum 3 mese principale si 2 gustari pe zi • Optimizarea masticatiei si deglutitiei • Mese mici si dese • Alimente moi, taiate, pasate • Bolusuri alimentare mici • Aport de fluide sub forme de gelatine, sucuri

  8. Scaderea cantitatii de grasimi saturate (carne rosie grasa, pielea de la pui sau curcan, unt, produse lactate grase) • Optim: grasimi 30% din calorii, 93% nesaturate • Consum regulat de peste (somon, hering, macrou, ton, sardine) • Folosirea uleiurilor vegetale si de peste

  9. Consum crescut de fasole, mazare, linte, soia, nuci, orez ne-decorticat • Minimum 5 portii de fructe sau legume pe zi • 3 – 4 portii de cereale integrale pe zi • Aport optim de fibre (cresc senzatia de satietate, leaga grasimi in intestin, regleaza tranzitul intestinal) • Evitarea excesului (crampe, diaree)

  10. Aport suficient de calciu si vit D (prevenirea osteoporozei) • surse recomandate: • Suplimente : carbonat de calciu, citrat de calciu • produse lactate degresate, peste, legume (broccoli, spanac, migdale) • surse nerecomandate: produse obtinute din cochilii, dolomite, os (posibil metale toxice)

  11. Antioxidanti: • vit A, C, E, • Seleniu, • CoQ10 • Atentie! Pot stimula sistemul imun (vitC, E) • Se recomanda sursele alimentare (fructe si legume proaspete) nu suplimente

  12. Aport suficient de fluide • Tendinta de consum scazut de fluide -> ITU, tulb deglutitie, scaderea apetitului, hTA • De evitat: cafea si bauturi cofeinizate, alcool, sucuri cu aspartam -> iritatie vezicala • Recomandat: coacaze (fruct, suc, tb) pt preventia ITU

  13. Constipatia in SM • Mecanism predominant indirect (nelegat de leziuni medulare): • Tranzit lent (anticolinergice) • Spasticitate scaderea relaxarii planseului pelvin • Scaderea sensibilitatii rectale • Spasm al sfincterului striat extern

  14. Incontinenta fecala in SM • Mecanisme • Scaderea senzatiei de plenitudine rectala • Scaderea controlului voluntar al sfincterului anal si al planseului pelvin • Scaderea compliantei rectale • Frecvent asociate constipatia-incontinenta

  15. Tratamentul tulburarilor de tranzit in SM • Dietetic • Clisme evacuatorii • Terapia vibratorie • Medicamentos • Laxative (lactuloza, ceaiuri laxative) • Imipramina, propantelina (pt urgenta la defecatie)

  16. SM – o boala cu mecanisme de producere si manifestari clinice complexe, • necesita o abordare terapeutica complexa si completa

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