Diet of the Sondino - Side effects of the NEC

What is the Sondino Diet

Ketogenic Enteral Nutrition (NEC), also known as the Sondino diet, is a weight-loss strategy based on fasting with few proteins and therefore not without side effects.

The NEC has been proposed and disseminated by Professor Gianfranco Cappello of the Umberto I polyclinic in Rome and, as you can guess, consists of the nasal-enteral administration (using a portable electric infusion pump) of a liquid solution based on:

• amino acids (30-40g / day),
• mineral salts and water.

To buffer the side effects of NEC, the specialists who take advantage of this technique recommend:

• continue to hydrate yourself by drinking water,
• integrate with multivitamin products,
• take proton pump inhibitors (to protect the gastric mucosa)
• take laxatives (to keep the bowel active despite the absence of feces in it).

This diet of the Sondino is continued for one or two weeks (based on the patient's tolerability) at each cycle, alternating therapies with periods of food nutrition of about 10-20 days; during the NEC treatment a maximum weight loss of 1% of the total body weight per day is allowed (for a subject of 100kg it is allowed to go down by 1kg per day).

Side effects

The side effects of Ketogenic Enteral Nutrition are different and should not be underestimated.

Ketone bodies and acidosis

Being a ketogenic strategy, the diet of the tube finds its strength in reducing appetite and hunger, as a consequence of the high production of ketone bodies following the high catabolism of fatty acids and neoglucogenesis.

In fasting and at moderate concentrations, ketone bodies represent a makeshift energy substrate for most body tissues and their disposal is facilitated by alveolar excretion (as for carbon dioxide - CO2) through ventilation. However, one of the side effects of NEC is the risk of excessive accumulation of ketone bodies in the blood that can induce the subject to the typical symptoms of metabolic keto-acidosis such as:

Dehydration, abdominal pain, polyuria, nausea, vomiting, fever, profuse sweating, hypotension, tachycardia, brain dysfunction, loss of muscle mass, acetonemic breath, polydipsia (continuous thirst) and altered cardiac function due to changes in blood potassium. In order to prevent these side effects of NEC, the specialists who use them investigate the composition of blood and urine at the end of each cycle.

The doctors who prescribe the diet of Sondino affirm that the quantity of amino acids administered prevents the muscle catabolism of the patients; this cannot be true.

In the absence of food carbohydrates, the body consumes the fatty acids of storage for almost all the metabolic processes, with the exception of the nervous ones that need glucose; to ensure the proper functioning of the brain, the body maintains constant blood sugar through the neoglucogenesis of the amino acids and glycerol. Glycerol is obtained from the hydrolysis of adipose triglycerides, while most of the blood amino acids are of muscular and cutaneous derivation. The catabolism of protein tissues is one of the side effects of NEC, as the exogenous administration of only 30-40g / day is not sufficient to comply with the need for plastic and neoglucogenetic replacement of patients.

Food education

A nod to the post-treatment repercussions that the tube diet can have on patients; probably, among the side effects of NEC it is also possible to find recidivism. The risk of restoring the initial weight is very high because:

1. A patient selection protocol is totally lacking, and being an extreme practice, it can be deduced that it attracts a large portion of SUBJECTS AFFECTED BY FOOD DISORDERS.
2. It has no educational function, ANZI! Launches an extremely negative message: "to lose weight you MUST FAST".
3. It is an invasive monodisciplinary approach in which there is NO MOTOR THERAPY, which is also impossible due to the bulk of the treatment and nutritional insufficiency. A patient enterally fed with a tube who decides to practice physical activity would risk collapse due to hypoglycemia, dehydration and metabolic acidosis.
4. In all probability, the prolonged caloric deficit and the absence of motor practice significantly affect thyroid endocrine production by reducing the basal metabolism.

The side effects of NEC are many and extremely serious; the diet of the tube is an invasive, monodisciplinary, passive, educational, drug-dependent and deleterious treatment for the organism and which normally should not be applied in the field of nutrition.