Combined diet with - An integrated dietary protocol to obtain the best compliance of the overweight and obese patient - Dieta Combinata
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RESERVED FOR NUTRITIONISTS Combined diet ® with An integrated dietary protocol to obtain the best compliance of the overweight and obese patient. Dietosystem Wellbeing as science
INTEGRATED DIETARY SCHEME + Personalised Diet The Combined Diet® with PROTEONORM represents the the qualified answer to the need for a rapid weight loss, in the event of overwight and obesity. The Combined Diet® protocol with PROTEONORM is divided into 5 phases plus two additional: the preparation pha- se (optional) lasting one week, pre-treatment diet and phase 0 or pre-bariatric, in which the feeding occurs exclusively through an amino acidic mixture. All the protocol phases involve the consumption of PROTEONORM, whose quantity is calculated based on the patient’s weight as well as with a drastic reduction of carbohydrates. The optional introduction of high-protein hypoglucidic pro- ducts of the new PROTEOFOOD line is permitted, right from the earliest and most restrictive stages. WEIGHT LOSS TRANSITION MAINTENANCE Preparation Phase 0 Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 OPTIONAL PHASE – Preparation PHASE 2 – Transition diet 1 PHASE 5 – Maintenance diet (7 days) (from 7 to 14 days) (from 7 to 14 days) A slightly hypocaloric detoxifying menu. Low-calorie diet with a slight introduction Normocaloric diet on the model of the Integration of 1 sachet/day of PROTEO- of carbohydrates and personalised nu- Mediterranean diet. Introduction of 1 NORM amino acidic mixture. trition with lean meats and vegetables sachet/day of PROTEONORM amino Integration of 2 DRENORM stick-packs a with a low glycemic index. Integration of acidic mixture. day to proote the body’s purification and 2 sachets/day of PROTEONORM amino Use of healthy and balanced foods in water balance. acidic mixture. order to maintain a healthy weight. Optional introduction of a single food item of the PROTEOFOOD line, to be PHASE 0 – Pre-bariatric diet chose from the products allowed in this (10 days) phase. Pre-bariatric surgery diet for patients with a BMI ≥ 40 The diet requires the intake of at least Feeding using only PROTEONORM ami- PHASE 3 – Transition diet 2 2 liters of mineal water per day. no acidic mixture. About 10-15 sachets/ (from 7 to 14 days) days. Low-calorie diet with a slight introduction of carbohydrates and personalised nu- During the protocol we recommend trition with lean meats and vegetables the following: PHASE 1 – Attack diet with a low glycemic index. Integration of • 2 stick-packs of DRENORM per day (from 14 to 21 days) 2 sachets/day of PROTEONORM amino to promote the purification and the Diet consisting of a drastic reduction of acidic mixture. water balance of the body carbohydrates and the introduction of Optional introduction of a single food • 1 sachet per day of PROTEOFOOD lean meats and vegetables with a low item of the PROTEOFOOD line, to be to promote the basic/acid balance glycemic index. Customised protein sup- chose from the products allowed in this of the organism. plementation using the PROTEONORM phase. amino acd mixture. Approximately 3-4 sachets/day. PROTEOFOOD foods allow the Optional introduction of a single food PHASE 4 – Transition diet 3 reintroduction of “forbidden foods” item of the PROTEOFOOD line, to be (from 7 to 14 days) guaranteeing the sustainability of the chose from the products allowed in this Slightly low-calorie diet with increased ketogenic diet treatment with greater phase. carbohydrates intake and personalised patient compliance, The progressive nutrition with lean meats and low-glyce- reintroduction of carbohydrates, in mic vegetables. Integration of 2 sachets/ the 3 transition phases, facilitates day of PROTEONORM amino acidic the stabilisation of weight loss. mixture. The maintenance phase is the final Optional introduction of a single food step of the food protocol with a item of the PROTEOFOOD line, to be Mediterranean style menu proposed. chose from the products allowed in this phase.
How to proceed The Combined Diet® with PROTEONORM represents the answer to the need for rapid weight loss where the objective conditions of the patient allow it. It is recommended, when undertaking Combined Diet® with PROTEONORM, to monitor at least once a week the serological parameters of the patient and periodically assess the changes in the FFM compartment and the level of hydration of the patient with impedance analysis, in addition to verifying the patient’s ketosis. FOR ALL NUTRITION EXPERTS (Doctors and Nutritional Biologists) The Combined Diet® with PROTEONORM can be PROTEONORM is supplied: processed directly online at www.combineddiet.it • To the nutritionist who prescribes it to his patient after having registered (free of charge). Access to the or alternatively site is exclusively reserved to Doctors and Nutritional • To the patient who will purchase the product directly Biologists, who have been identified through the from Dietosystem, through the Contact Centre, Fax WelfareLink protocol in order to safeguard the patient or Website by providing the purchase code* and guarantee exclusive use to qualified health NOME COGN OME professionals. After registration, the user accesses his IG BASSO Premesse alla Dieta Combinata con PROTEONORM 50 salute. Il menù proposto, unitamente al prodotto Proteonorm, Amararappresenta una Avena nto 25 “soluzione Pasta integr 40 Bulgur Quinoa urgente” al suo calo ponderale. Per tale ragione le consiglio di seguire i menù per la sola durata Riso selvatico 35 Kamut ale cotta 40 Biscotto 40 frolla 55 35 indicata nello schema dietetico senza prolungarne il periodo Farina e attenersi di ceci a quanto prescritto Pasta integr ale 40 Riso rosso 55 35 Pane azzimo Tagliatelle b pesando inizialmente ogni pietanza. Solo con il tempo imparerà Farina a riconoscere di cocco il peso 35 delle porzioni Grano s 40 Manioca en cotte 55 aracen 40 55 senza bisogno della bilancia e scegliere autonomamente il cibo nella quantità 35 e qualità Biscotto più o Spaghetti be • patient data is entered frolla light 40 n cotti 55 Pizza corretta. Se non potesse seguire tale consiglio, potrà optare per le seguenti alternative: Fiocchi d’avena 40 55 Spaghetti co Pane al latte 60 d tti 40 Ravioli tegrate Farina d 60 A. ridistribuire gli alimenti a suo piacimento nel corso della giornata Grano i quinoa 40 Semola 40 di grano d 60 B. scambiare tra loro i vari giorni di dieta evitando di ripeterli Plan In Farina d Riso lu uro i farro 45 ngo 60 Cous cous in Lasagne C. sostituire un piatto del 1° giorno con quello di un giorno successivo appartenente alla tegral 45 60 Dietary Farina d e Orzo perlato • body composition obtained through the impedance i kamut 60 stessa categoria Pane di 45 Farina i ntegra 60 kamut 45 Segale Pane integra le 45 le 60 Alcune semplici regole comportamentali l’aiuteranno a raggiungere il suo obiettivo cBulgur on più facilità: Pane nero 65 45 Mais Riso basmat 65 e Farine i integra 45 Pane di -‐ masticare lentamente consente di digerire e assimilare meglio gli alimenti, raggiungendo Riso b asmati li 45 segale 65 with Muesli Muesli light 65 anticipatamente la sensazione di sazietà. All Bran 50 Brioches method is entered 50 a l cioccol 65 -‐ bere 2 litri di acqua oligominerale al giorno favorisce l'eliminazione Barret delle tossine ta ai cereali 50 Farro ato 65 Riso integral Farina s dall'organismo e 50 emi-‐integral 65 Cereali Pasta integr Farina d e i c 65 -‐ utilizzare i comuni aromi da cucina come prezzemolo, basilico, rosmarino Pane de salvia, rende i quinoa ale le 50 Farina di g astagne 65 50 rano duro Riso co pietanze più appetibili senza ricorrere al sale Biscotti integra 50 mune 70 Cous c li Tacos 70 -‐ i metodi di cottura molto semplici come bollitura, bagnomaria, al forno ous e alla griglia 50 Gnocc hi 70 • the food plan is developed ted by: 50 consentono di preparare le pietanze senza l’aggiunta di olio Tagliatelle Elabora 70 Cereali zuccherati 70 Name Polenta 70 e Last LO SCHEMA DIETETICO INTEGRATO Fette biscot 70 Dott. Nam Biologist tate Biscotti comun 70 nal Corn Flakes i Nutritio Il menù prevede un’integrazione proteica personalizzata tramite il prodotto Proteonorm. Pane bianco 70 70 • the report with the header of your office is printed sio, 100 Pane di Viale Ceni Integratore alimentare ad alto indice proteico contenente magnesio, potassio, inositolo, l-‐ riso 70 o Brioches - Milan 20100 70 carnitina, niacina e cistina in quantità conforme ai fabbisogni consigliati. Miglio 70 Pane azzimo 70 Il prodotto non è addizionato da aromi al fine di rendere possibile l’eventuale assunzione con altre Cialda wafers 70 Crackers bevande tipo caffè, tea e cacao amaro se graditi. Riso so 75 ffiato 80 • the prescription of PROTEONORM which includes Gallette 85 Si raccomanda di non superare la dose giornaliera consigliata e non utilizzare il prodotto come Pane al di riso latte 85 sostitutivo di una dieta equilibrata. Pop corn 85 Maizena 85 Farina d Come utilizzare Proteonorm: Riso a c i grano b ianca 85 ottura r 85 Tapioca apida 85 Versare il contenuto della bustina in una tazza o in un bicchiere capiente ed aggiungere acqua o the purchase code* is printed Pane bianca no glutine 85 altra bevanda non zuccherata (caffè, orzo, cacao amaro, tisane, tea, camomilla) a temperatura Farina d i riso 90 Fecola ambiente nof: elle quantità che ne permetta la completa solubilizzazione. 95 ort scientific supp 100 With the FOR DIETOSYSTEM USERS If you are already a user of the Dietosystem Nutritional Suite®, request the free Combined Diet® with PROTEONORM module and receive an updated software that will allow you to manage the patient, prescribe the DIET and PROTEO- NORM as well as manage and monitor the nutritional state, if equipped with impedanceometry and plicometry. From the software module the prescription will be available for printing, including the purchase code* PRESCRIZIONE INTEGRATORI A SUPPORTO DELLA DIETA COMBINATA ELABORATA DA PER Dott. Nome Cognome Nome Cognome Paziente Biologo Nutrizionista Viale Cenisio, 100 20100 - Milano Data visita 09/01/2017 Per il trattamento dietetico della durata di 21 giorni le ho prescritto N. ___ confezioni di PROTENORM N. ___ confezioni di BISCOTTO MORBIDO AL CIOCCOLATO N. ___ confezioni di PROTENORM MOUSSE N. ___ confezioni di BARRETTA AL CARAMELLO /LAMPONE N. ___ confezioni di DRENORM N. ___ confezioni di BARRETTA AL CIOCCOLATO N. ___ confezioni di DIETOLIP N. ___ confezioni di WAFER AL CIOCCOLATO N. ___ confezioni di PROTEOBASIC N. ___ confezioni di PALLINE DI SOIA AL CIOCCOLATO N. ___ confezioni di ELLEDIELLE N. ___ confezioni di CIOCCOLATO FONDENTE N. ___ confezioni di GLYMELA N. ___ confezioni di CRACKER AI SEMI DI GIRASOLE N. ___ confezioni di BISCOTTI ALLA VANIGLIA N. ___ confezioni di PATATINE AROMA BARBECUE N. ___ confezioni di BISCOTTI ALL’ARANCIA N. ___ confezioni di PANE NERO CON SEMI VARI N. ___ confezioni di PASTA Per una scelta dell’azienda produttrice e per contenere il costo del trattamento potrà acquistare direttamente il prodotto da DS Medica Srl, con una delle seguenti modalità: ONLINE TELEFONO FAX www.dietacombinata.it selezionando sulla colonna Chiamando il Inviando il FORM sotto riportato a sinistra il tasto Call Center consumatori debitamente compilato al numero “ORDINA PROTEONORM” 02 2800 5725 02 8718 1182 Indirizzo fiscale Ragione sociale ____________________________________________ Cognome ______________________________________________________ Indirizzo di spedizione (se diverso) Nome _________________________________________________________ Via ____________________________________________________________ Via ____________________________________________________________ CAP ___________________ Città __________________________________ CAP ___________________ Città __________________________________ Telefono ___________________ Cellulare ___________________________ Note: _______________________________________________________ eMail ___________________________ @_____________________________ _____________________________________________________________ C.F. |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Il costo del prodotto è fissato dall’azienda: Glymela € 22,00 a confezione Wafer al cioccolato € 24,00 a confezione Proteonorm € 57,50 a confezione Biscotti alla vaniglia € 22,50 a confezione Palline soia cioccolato € 24,00 a confezione Proteonorm Mousse € 27,50 a confezione Biscotti all’arancia € 15,00 a confezione Cioccolato fondente € 15,00 a confezione Drenorm € 20,00 a confezione Biscotto morbido cioccolato € 16,00 a confez. Cracker semi girasole € 23,00 a confezione Dietolip € 16,00 a confezione Barretta al caramello € 21,00 a confezione Patatine barbecue € 18,00 a confezione Proteobasic € 22,00 a confezione Barretta al lampone € 21,00 a confezione Pane nero semi vari € 20,00 a confezione Elledielle € 18,00 a confezione Barretta al cioccolato € 24,50 a confezione Pasta € 28,00 a confezione Inviando il FAX si viene ricontattati dal Call Center per confermare l’acquisto e le modalità di spedizione. In ogni contatto indichi il codice di prescrizione sotto riportato. CONTRASSEGNO (costo aggiuntivo di € 5,00 IVA compresa) BONIFICO BANCARIO CONSENSO AL TRATTAMENTO DATI PERSONALI CARTA DI CREDITO Acconsento liberamente ai sensi dell’ART. 13 del D. Lgs 196/2003 Spese di spedizione € 7,00 IVA compresa. al trattamento e alla comunicazione e diffusione dei miei dati personali nei limiti della stessa. FIRMA _______________________________________________________________ (*) Every single prescription generates a purchase code that guarantees that PROTEONORM is distributed exclusively on the basis of a non-repeatable nutritionist’s prescription.
SCIENTIFIC RATIONALE Combined diet ® with Traditional methods for weight reduction include low calorie diets (800 – 1500 kcal/day) balanced in nutrients and accompanied by regular physical exercise. A “low carbohydrate diet” is a diet that includes less than 60 grams of carbohydrates a day and is slightly high in protein, that foresees the intake of protein based on the ratio of 1 to 1.5g per kilo of ideal body weight. G.L. Blackburn (Harvard Medical School) coded the minimum amount of protein needed to protect the organisms lean body mass in 1,2 – 1,5 grams per Kilo of ideal weight1 and applied it in the low-calorie-protein-sparing diets (Protein Sparing Modified Fast) identified by the acronym PSMF. In 1993, the PSMF nutritional dietary protocol was validated by the FDA2, with the coding of the minimum daily amount of protein needed to ensure the equilibrium of the nitrogenous balance to avoid the mobilisation of protein reserves and the consequent reduction of lean mass. The application protocol was then further improved by the Swedish school3. From 2003 to 2010 the Dutch Ministry of Health, as part of the obesity prevention program, indicates the low-calorie, protein-saving diet treatment among the first-level treatments for the treatment of obesity4. Glucose Reduction Protein Increase Lipolysis Decreases insulin Increases glucagon Triglyceride Lean body mass Catabolism protection Free Fatty Acids Glycerol 40% 60% beta Gluconeogenesis oxidation Lactates Gluco-dependant cells INSULIN GLUCOSE Corpi chetonici Krebs Cycle Energy Oxidation Acidosis
Combined Diet® with PROTEONORM is a high protein and low carbohydrate content scheme. It generates two important processes, at metabolic level. Carbohydrates Proteins Modest Ketosis Thanks to this you obtain a reduction in the feeling of hunger, helping you to avoid giving up the treatment and implement changes to your lifestyle, in a healthy way5, 6. Gluconeogenesis With the reduction of carbohydrates, a rapid drop in insulin is obtained, which prevents fat storage and stimulates lipolysis, especially in those areas where fat deposits are located. The organism activates hepatic gluconeogenesis once the energy reserves (glycogen) are used up – this usually occurs after 48 hours. This process is critical in ensuring the amount of glucose for gluco-dependent cells, such as red blood cells, the brain and the retina. INDICATIONS AND CONTRAINDICATIONS Like all medical treatments, even the low-calorie protein-saving diet has indications and contraindications that are already defined in the protocol7-8. Indicated in cases of: Contraindicated in cases of: • Obesity: BMI > 30 • Type 1 (insulin dependent) diabetes mellitus • Overweight: > 25 BMI < 29 • Renal impairments • Overweight associated with risk factors: • Severe hepatic insufficiency – Diabetes mellitus type 2 • Heart failure (and insulin resistance) • Previous strokes – Dyslipidaemia • Pregnancy and breastfeeding – Metabolic Syndrome • Severe psychiatric disorders – Asthma • Evolutionary neoplasms – Sleep Apnoea • Boys/girls in developmental age – Locomotor system Disorders • Senior citizens • Aesthetic reasons • Psychogenic compulsive feeding disorders – Localised Adiposity • Pre-Surgery • Intense Physical Activity References 5. Asia Pac J Clin Nutr. 2006;15 Suppl:49-54. State of the science: VLED (Very 1. Diabetes. 1976 Jun;25(6):494-504. Low Energy Diet) for obesity. Delbridge E, Proietto J. 2. The National Task Force on the Prevention and Treatment of Obesity. Very 6. Finnish Diabetes Association. Development Programme for the Prevention Low-Calorie Diets. JAMA 1993;270:967-74 and Care of Diabetes in Finland DEHKO 2000-2010. 3. Lancet 1997; 350: 423-6 7. Nutr Diabetes. 2014 Feb 10;4:e105. 4. DEHKO– Finnish Diabetes Association 2003 8. Int J Environ Res Public Health. Feb 2014; 11(2): 2092–2107. For a constant updating of scientific works, refer to the news published on www.combineddiet.com
21 sachets of 20 g Food supplement made of soluble whey protein, enriched by Inositol, L-Carnitine, L-Cistine, Niacin, Magnesium, Potassium. PROTEONORM is a food supplement useful in case of increased need or decrea- sed protein intake in the diet. DOSAGE As recommended by the nutritionist. DIRECTIONS Pour the contents of the sachet into a large cup or glass and add water or other unsweetened beverages (coffee, barley, bitter cocoa, herbal tea, tea, chamomile) at room temperature in quantities that allow complete solubilisation. PROTEONORM Whey protein: micro and ultra-filtered with high solubility, is made up of oligo- COMPONENTS peptides that is highly assimilable by the organism and passed directly through the intestinal mucous membranes without undergoing digestive processes. Whey protein does not contain traces of lactose or fat, so it does not favour intolerance or allergic reactions. Whey protein has a very low glycemic index and contains all the essential, non-essential and semi-essential amino acids with a significant con- tent of branch chain amino acids. Inositol: facilitates the detoxification processes of the organism, especially in the liver. It also contributes to the metabolism of fats and helps reduce the concentra- tion of cholesterol in the blood. Useful in case of constipation since it has a stimu- lating effect on the muscular action of the alimentary canal. L - Carnitine: amino acid that the body uses to convert fatty acids into energy. In particular, it facilitates the entry of long chain fatty acids into the mitochondria. Here, they undergo an oxidation process in order to produce energetic molecules that can be used by the body. L - Cystine: essential amino acid for the production of reduced glutathione, a mo- lecule with an antioxidant detoxifying function for the body and in particular for the liver. Its action promotes the proper functioning of the immune system. Niacin: acts in its two forms, the NAD and the NADP. It becomes part, in coenzy- matic form, as an electron acceptor in many reactions concerning the metabolism of carbohydrates, fatty acids and amino acids. NAD intervenes in particular in the reactions of glycolysis, lipolysis and in the Krebs cycle. NADH intervenes in the metabolism of fats and steroids. Magnesium: is involved in more than 300 enzymatic reactions in the body. It con- trols the nervous and muscular activity and participates in the metabolic processes of fats and protein synthesis. Potassium: present in the form of an ion, mainly inside the cells but also in the extracellular fluids, influences the activity of the skeletal muscles and the myocar- dium. In particular, it regulates neuromuscular excitability, acid-base balance, wa- ter retention and osmotic pressure.
INGREDIENTS per 100g per 3 sachets AND NUTRITIONAL Energy 257.60 Kcal 154.56 Kcal VALUES (1078.31 KJoule) (646.98 KJoule) Fats 0.21 g 0.12 g — Saturated Fats 0.04 g 0.03 g Carbohydrates 1.75 g 1.05 g — Sugars 1.75 g 1.05 g Whey Protein 75.10 g 45.06 g Salt 0.14 g 0.09 g Amino acidic Profile (in g) L-Glutamic Acid 12.67 g 7.59 g L-Leucine 8.10 g 4.86 g L-Aspartic Acid 7.70 g 4.62 g L-Lysine 6.90 g 4.14 g L-Isoleucine 6.00 g 3.60 g L-Valine 5.17 g 3.09 g L-Phenylalanine 4.69 g 2.82 g L-Threonine 4.69 g 2.82 g L-Proline 3.85 g 2.31 g L-Alanine 3.50 g 2.10 g L-Serine 3.22 g 1.92 g L-Histidine 3.00 g 1.80 g L-Methionine 3.00 g 1.80 g L-Tyrosine 1.82 g 1.08 g L-Tryptophan 1.70 g 1.02 g L-Cystine 1.54 g 0.93 g L-Arginine 1.47 g 0.87 g L-Glycine 0.98 g 0.60 g with %NRV* (per 3 sachets) Inositol 5.00 g 3.00 g L-Citrulline 1.00 g 0.60 g L-Ornithine 1.00 g 0.60 g L-Carnitine 1.00 g 0.60 g L-Cystine 0.50 g 0.30 g Niacine 0.05 g 0.03 g 187.4 % Potassium Citrate 7.35 g 4.41 g — of which Potassium 2.50 g 1.50 g 75.0 % Magnesium Citrate 2.67 g 1.59 g — of which Magnesium 0.40 g 0.24 g 64.0 % *NRV = nutritional reference values (in accordance with the regulation UE 1169/2011) WARNINGS • Do not exceed the daily dose recommended by the nutritionist. • Do not use during pregnancy and in children, or for prolonged periods of time or if suffering from any pathology, without consulting the doctor. • Contains a source of phenylalanine. • Keep out of reach of children below three years of age. • The product must not be considered a substitute of a balanced diet and a healthy lifestyle. • Keep in a cool and dry place. • Do not use the product after the expiry date shown on the box and on each sachet.
Rev. 02/2018 www.combineddiet.com Contact center +39 02 2800 5700 Fax +39 02 2817 2299 nutrizione@dsmedica.info www.dsmedica.info Dietosystem a DS MEDICA division Office: Milan 20125, Viale Monza 133 Branches: Rome, Viale Regina Margherita 302 Naples, Via Jannelli 646 Certified UNI EN ISO 9001:2008 e UNI EN ISO 13485:2012 by KIWA CERMET
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