Non Alcoholic Fatty Liver Disease (NAFLD) · The fatty liver index is associated with increased...
Transcript of Non Alcoholic Fatty Liver Disease (NAFLD) · The fatty liver index is associated with increased...
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Die nicht alkoholbedingte Fettleber
Non Alcoholic Fatty Liver Disease
(NAFLD)
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Aufgaben der Leber
3
Kontrollzentrum Speicher
Hormonherstellung
Filter und
Entgiftung
Ab- und
Umbau
Immunsystem-
Unterstützer
© Sagittaria – Fotolia.com
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Die Leber
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Die Leber in der TCM
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Die Leber
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Definition der NAFLD
●Fettleber, die nicht durch Alkohol oder andere Ursachen
(z.B. Medikamente) bedingt ist
Frauen: < 20g Alkohol/Tag
Männer: < 30g Alkohol/Tag
●Unbehandelt führt die Fettleber zu u.a.
Bluthochdruck, Fettstoffwechselstörungen
Diabetes…
8
0,2l Wein:
18g Alkohol
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NAFLges. Leber NASH Le-Zirrhose Le-Krebs
Transplantation
Tod
Progression der Fettleber
30%
= 25% „Chance“ auf Zirrhose!
10-25%
Le-Versagen
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Jeder 3. ist betroffen!
12
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Die NAFLD ist die häufigste
chronische Lebererkrankung
der Industrienationen!
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30 bis
40 %
Erwachsene
70 %
Übergewichtigebis zu
90 %
Typ II - Diabetiker
(Denzer C. Deutsches Gesundheitsblatt 2013;56:517-527)
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30 %
stark übergewichtige Kinder
Erschreckend:
(Denzer C. Deutsches Gesundheitsblatt 2013;56:517-527)
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Rank und schlank schützt?
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Jeder 7. Schlanke hat eine NAFLD
18
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TOFI
Thin Outside Fat Inside
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Er hat den
höheren BMI!
... aber sein
Bauch ist
gefährlicher!
20
© C
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• Energieverbrauch
• Kohlenhydrataufnahme
• Ballaststoffreiche Kohlenhydrate
• Bewegung/Aktivität
Früher Heute
Warum?
• weniger Schlaf / wenig Sonnenlicht - Vitamin D / Stress / Rauchen …
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Nicht-alkoholische Fettlebererkrankung
(NAFLD)
Wieso ist sie so gefährlich?
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NAFLges. Leber NASH Le-Zirrhose Le-Krebs
Transplantation
Tod
Progression der Fettleber
30%
= 25% „Chance“ auf Zirrhose!
10-25%
Le-Versagen
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0
1,25
2,5
3,75
5
AbdominaleAdipositas
Bluthochdruck ErhöhteBlutfettwerte
Diabetes
Inter-Heart-Study N=29.972 (Lancet 2005)
Abdominale Adipositas + Herzinfarktrisiko
(Yki-Järvinen H. Lancet Diabetes Endocrinol. 2014;2(11):901-10)
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Mit NAFLD verbundene Störungen
●Typ 2-Diabetes
●Adipositas
●Metabolisches Syndrom
●Hyperurikämie
●Polyzystisches Ovarialsyndrom (PCOS)
●Hypothyreose
●25(OH)-Vitamin D-Mangel
●Störung des Mikrobioms (Firmicutes/Bacteroidetes)
●Hypogonadismus
●Schlaf-Apnoe-Syndrom
26
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NAFLD durch Medikamente
●Acetylsalicylsäure (Aspirin…)
●Kortikoide
●Östrogene
●Tamoxifen (Östrogenrezeptorantagonist)
●Chemotherapie (CASH; 5-FU, Taxane, Platin-haltige Chemos)
●Amiodaron (Antiarrhythmikum)
●Methotrexat (Zytostatikum)
●Nifedipin, Diltiazem (Calciumantagonisten)
●Tetrazykline (Antibiotika)
●Valproinsäure (Antiepileptikum)
27
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Symptome der NAFLD
●Meistens keine Beschwerden
●Müdigkeit, Abgeschlagenheit
●Erschöpfung
●Unspezifische Symptome
●Schmerzen bzw. Spannungsgefühl im rechten Oberbauch
●Tastbare Lebervergrößerung in ca. 50% der Fälle
28
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Diagnosemöglichkeiten
29
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Diagnosemöglichkeiten der NAFLD
Ultraschall - sehr ungenau (erst bei deutlich über 10% Fettzellen erkennbar und keine genaue Abschätzung über das Ausmaß der Verfettung möglich)
MRS (Magnetresonanzspektroskopie) - sehr genaue Bestimmung aber für Routine zu teuer
Biopsie - invasives Verfahren mit Risiken aber sehr genau
BMI - zu ungenau und keine alleinige Aussagekraft
Blutwerte zu ungenau: in 80% der Fälle sind Leberwerte unauffällig
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Fatty Liver Index (FLI)
Online-Rechner: www.leberfasten.com
www.fegato.it
Berechnung des FLI mittels
● Gamma-GT (U/l)
● Triglyzeride (mg/dl)
● Bauchumfang in cm
● BMI (Größe, Gewicht)
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Diagnosemöglichkeiten der NAFLD
FLI Einschätzung
< 20 Fettleber ist praktisch ausgeschlossen
< 30 Fettleber unwahrscheinlich
30 - 60 Fettleber möglich - weitere Abklärung angeraten
> 60 Fettleber liegt mit hoher Wahrscheinlichkeit vor
> 76Herzinfarkts- und Schlaganfallrisiko ist um das 2-3fache
erhöht - unabhängig sonstiger Risikofaktoren
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Diagnosemöglichkeiten der NAFLD
3.316 Patienten bei Koronarangiographie
7,7 Jahre Follow-Up
Berechnung des FLI auf Überlebensdauer
Conclusion: In subjects referred to coronary angiography,
high FLI levels are independently associated with increased all-cause,
cardiovascular, and non-cardiovascular mortality
as well as fatal cancer.
Lerchbaum, E., Pilz, S., Grammer, T. B., Boehm, B. O., Stojakovic, T., Obermayer-Pietsch, B., & Marz, W. (2013).
The fatty liver index is associated with increased mortality in subjects referred to coronary angiography.
Nutrition, Metabolism and Cardiovascular Diseases, 23(12), 1231-1238. DOI: 10.1016/j.numecd.2013.02.004
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34
Der Fettleber-Index (FLI)
5 Monate
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Wie verfettet die Leber?
Ist Nahrungsfett die Ursache?
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NAFLD
•
59% der Fettsäuren in der Leber stammen von
Körperfettzellen (Lipolyse von Adipozyten)
26% der Fettsäuren von Kohlenhydraten (Lipogenese)
15% der Fettsäuren von Nahrungsfett
(Donnelly KL, et al. J Clin Invest 2005;115:1343–1351)
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Hauptfuttermittel für Gänsestopfleber!
37
© sommai; Dionisvera - Fotolia
konventionell bio
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Hauptfuttermittel für „Menschenstopfleber“
38
© Ben; areif; sommai - Fotolia.com
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Sichere Wege zur NAFLD
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Zuviele Kohlenhydrate bei zuwenig
Bewegung!
Insulin hilft tatkräftig mit!
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Die Wirkung des Insulins
41
© Sagittaria; pixelcaos; lom123; Sebastian Kaulitzki - Fotolia.com
Blutzucker Insulin
Fettgewebe
Fettabbau
MuskelLeber
Glukose-
aufnahme
Glukose-
abgabe
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Die Wirkung des Insulins wird gestört
43
MuskelFettgewebeLeber
© Sagittaria; pixelcaos; lom123; Sebastian Kaulitzki - Fotolia.com
Blutzucker Insulin
FettabbauGlukose-
abgabe
Glukose-
aufnahme
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Das Insulinsignal wird nicht mehr gehört
44
MuskelFettgewebeLeber
© Sagittaria; pixelcaos; lom123; Sebastian Kaulitzki - Fotolia.com
Blutzucker Insulin
Glukose-
aufnahme
FettabbauGlukose-
abgabe
Insulinresistenz
freie Fettsäuren BlutzuckerLeber „opfert“ sich…
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Insulinresistenz
Fettleibigkeit
Dysbiose
Rauchen
Schlafmangel
ballaststoffarme
Überernährung
Inaktivität Schwangerschaft
Lichtmangel
Stress
Alter
Genetik
Hyperinsulinämie
Fettleber und andere
Zivilisationserkrankungen
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Viszerales Fett betrifft alle Organe
positive Energiebilanz
Störung des Fettgewebes
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Erhöhtes Risiko für DM II
Risiko für Herz-Kreislauf-Erkrankungen
„Flutung“ des Bauchraumes/Organe mit Fett
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Die Leber ist das
schnellstregenerierendste Organ:
Bei 70% Entfernung sind nach 2 Monaten
90% wieder da
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Die Leber entfettet überproportional schnell:
Schon nach 1 Woche extrem niederkalorischer
Kost (800 kCal)
reduziert sich das Leberfett um 30%!
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In der gleichen Zeit verliert Pankreas
„nur“ 10% Fett -
nach 8 Wochen NAFLD-Ernährung hat sich
zumeist die Insulinproduktion wieder
normalisiert! (bei DM II)
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Gewichtsreduktion ist NICHT gleich
Leberfettreduktion!
Leberfettreduktion geht definitiv schneller!
Gewichtsreduktion von „nur“ 3-4kg =
Leberfettreduktion von 30%
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Ziel
• NICHT so viel Gewicht wie möglich verlieren
• SONDERN Organe so weit wie möglich entfetten
• OHNE dabei Muskelmasse zu verlieren
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Ernährungsmassnahmen
• 4 Grundbausteine:
* Kalorienreduziert
* Kohlenhydratreduziert
* Hoher Proteingehalt
(möglichst Whey)
* Moderater Fettgehalt
• zusätzliche Nährstoffe:
* O-3 Fettsäuren (EPA+DHA)
* ß-Glukan
* Inulin
* Carnitin
* Vitamin E
* Cholin
* Taurin
* Resveratrol
* Quercetin
* Koffein
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Ernährungsprinzip bei NAFLD/DM II
55
Umstellung der Energiebereitstellung
von kohlenhydratbetont - auf fett-/proteinbetont
von Kohlenhydratverbrennung - auf Fettverbrennung
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Wie löst man das NAFLD-Problem?Die Ernährung ist der Trick!
Und auf Muskelaufbau nicht vergessen!
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©Daniela Pfeifer, 2019
Variante #1
• 1-2 Wochen ärztlich kontrollierte/begleitete
Fastenkur
• danach weiter mit VeryLowCarb-Ernährung bzw.
ketogener Ernährung bis Zielgewicht erreicht ist
• bei erreichtem Zielgewicht weiter mit dauerhaft
LowCarb-Ernährung
2-3 handvoll Obst/Tag
keine Fruchtsäfte
reduzierter Alkoholkonsum
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©Daniela Pfeifer, 2019
Vor- und Nachteile
• Effekt schon nach 2 Wochen merkbar (30% weniger
Leberfett)
• Verlust von Muskelmasse
• nicht leicht alltagstauglich zu Beginn
• engmaschige ärztliche Kontrolle notwendig
• es fehlen die Leber-entfettenden Wirk- und Ballaststoffe
• nicht nachhaltig (fasten)
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• VeryLowCarb-Ernährung (striktes LCHF) bzw.
ketogene Ernährung konsequent über 6 Monate
• Zusätzlich im ersten Monat strikte kalorienreduzierte
Kost (max. 1.000 - 1.200 kCal pro Tag)
• bei erreichtem Zielgewicht dauerhaft
LCHF-Ernährung
höchstens 2-3 handvoll Obst/Tag
keine Fruchtsäfte
reduzierter Alkoholkonsum
Variante #2
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©Daniela Pfeifer, 2019
Vor- und Nachteile
• Effekt nach 1-2 Monaten merkbar (Reduktion von Leberfett)
• Muss wirklich konsequent umgesetzt werden
• Monatliche ärztliche Kontrolle empfohlen
• Genaues Einhalten von Ernährungsempfehlungen damit keine Muskelmasse verloren geht
• es fehlen eventuell die Leber-entfettenden Wirk- und Ballaststoffe
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©Daniela Pfeifer, 2019
Nach 6 Monaten LowCarb/Ketogene Ernährung:
* ca. 13 kg Gewichtsreduktion
* signifikante Verbesserung der Leberhistologie
* signifikante Verbesserung der Entzündungswerte
* und Fibrose
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Beide Varianten können durch
Intermittierendes Fasten
verstärkt/unterstützt werden!
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Beide Varianten können durch
Supplementierung von
leberaktiven Wirk- und Ballaststoffen
verstärkt/unterstützt werden!
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©Daniela Pfeifer, 2019
• 2 Wochen striktes Leberfasten nach Dr. Worm® mit
Hepafast® (3x täglich leberoptimierter Protein- und
Ballaststoff-Shake)
• anschließend 2x täglich Hepafast® und 1 Mahlzeit
LowCarb-Ernährung bis Zielgewicht erreicht ist
• weiter mit LowCarb- oder ketogener Ernährung mit
Hepafast®-Tagen bei Bedarf
Variante #3
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©Daniela Pfeifer, 2019
Vor- und Nachteile
• Sehr rascher und nachhaltiger Erfolg merkbar (innerhalb 1 Woche 30% weniger Leberfett - nach 3 Jahren noch feststellbar)
• Muss konsequent umgesetzt werden
• Einfache Umsetzung - man braucht sich weder um Kalorien noch um Inhaltsstoffe kümmern; leberentfettende Wirk- und Ballaststoffe ausreichend vorhanden
• Monatliche ärztliche Kontrolle bzw. Kontrolle durch Betreuer empfohlen
• Ev. „langweilig“ für 2 Wochen (nur Shake und Gemüse)
• Nur über Ärzte und ausgebildete Berater erhältlich
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Fallgeschichte
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Rascher Gewichtsverlust - besser als sein Ruf!
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Leberaktive Wirk- und Ballaststoffe
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Leberaktive Wirk- und Ballaststoffe
• 4 Grundbausteine:
* Kalorienreduziert
* Kohlenhydratreduziert
* Hoher Proteingehalt
(möglichst Whey)
* Moderater Fettgehalt
• zusätzliche Nährstoffe:
* Inulin
* O-3 Fettsäuren (EPA+DHA)
* Carnitin
* Cholin
* Taurin
* ß-Glukan
* Vitamin D + E
* Resveratrol
* Quercetin
* Koffein
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©Daniela Pfeifer, 2019
Nach 4 Wochen Whey-Supplement (60g/Tag):
* - 21% Leberfett
* - 15% Triglyceride
* - 7% Gesamtcholesterin
* + 4% fettfreie Körpermasse
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Einfluss von Inulin vs. Cellulose auf Leberfett
(18 Wochen mit 30g Inulin bzw. 30g Cellulose; n = 44 Prediabetiker)
Wochen 0 - 9 Wochen 0 - 18
(Guess ND, et al. Nutrition & Metabolism 2015;12:36)
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(Lu W, et al. Gastroenterol Res Pract 2016: Article ID 1459790)
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* signifikante Senkung von AST, AL T und GGT
* signifikante Senkung von LDL- und Gesamt-Cholesterin
* signifikante Senkung der Serum-Glukose und HOMA-Index
* signifikante Senkung des CRP
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Leberaktive Wirk- und Ballaststoffe
• Cholin
„Halbvitamin“ (verhindert Fetteinlagerungen in der
Leber und hilft beim Abbau vom Leberfett) =
essentieller Nährstoff
• Taurin
hat antientzündliche Wirkung und positiven Effekt
auf Zuckerstoffwechsel. Typ-2-Diabetiker haben
verminderte Taurin- und L-Carnitinspiegel
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©Daniela Pfeifer, 2019
„Hafer (ß-Glukan) und Leber für die Leber“
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Zusammenfassung
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©Daniela Pfeifer, 2019
So bekommt die Leber ihr Fett weg…
maximal 1.000 kcal pro Tag für 2-4 Wochen
Kohlenhydrate stark reduzieren
ausreichend hochwertiges Eiweiß
„gute“ Fette - „Ölwechsel“ vornehmen
leberaktive Wirk- und Ballaststoffe aufnehmen
Bitterstoffe nicht vergessen!
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Austauschen - nicht verzichten!
9,5g Ballaststoffe 16,6g Ballaststoffe
2g Ballaststoffe 12g Ballaststoffe
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©Daniela Pfeifer, 2019
Wenn Kohlenhydrate, dann:
● Ballaststoffreich
● Mit hohem Wassergehalt
● Gemüse und Obst
● Nüsse, Kerne, Samen (moderat)
● Bunt!
88
© Kurhan - Fotolia
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KEINE Fruchtzucker-Bomben!
89
© udra11 - Fotolia
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Die Schlank-Kombination für die Leber
91
Satt essen, viel Gemüse (+ frische Kräuter, Sprossen, Keimlinge)
+ Portion hochwertiges Protein
+ zum Verfeinern hochwertige Fette
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So bleibt die Leber dauerhaft „schlank“
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So bleibt die Leber dauerhaft „schlank“
94
Hochwertige Lebensmittel ohne Zusatzstoffe
Viel Gemüse (bunt, sonnengereift, biologisch, frisch)
Viele frische Kräuter, Sprossen, Keimlinge
Tierische Produkte aus artgerechter Haltung
Zuckerarmes Obst
Ausreichend Eiweiß
Wenige Kohlenhydrate
Hochwertige Öle/Fette + mehr Omega-3-Fettsäuren (EPA/DHA)
Leberaktive Wirk- und Ballaststoffe sowie Bitterstoffe nicht vergessen!
Leichtverdauliche Zubereitung der Speisen mit leicht scharfen Gewürzen
Auf Darmgesundheit achten!
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©Daniela Pfeifer, 2019
So bleibt die Leber dauerhaft „schlank“
Mit genügend Schlaf
Genügend direkter Sonnenbestrahlung
Genügend anstrengende Muskelaktivität
Vermeidung von Stress oder
Effektive Stressbewältigung
Kein Zigarettenrauchen
95
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Vielen Dank für die Aufmerksamkeit!
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ERNÄHRUNGSBERATUNG
Ketogene Ernährung (Gewichtsregulation, Leistungssteigerung, Unterstützung bei Krankheiten…)
Ernährung bei Hashimoto/Autoimmunerkrankungen
Ernährung bei nicht alkoholbedingter Fettleber (NAFLD/NASH)
Umfangreiche Informationsfilme, Unterlagen, Zusatzinformationen
inkl. persönlicher Ernährungsberatung
Abwicklung: online + telefonischer Beratung auf Termin
DANIELA PFEIFERDIÄTOLOGIN
ERNÄHRUNGGENUSSWISSEN
KOMPETENZ
www.daniela-pfeifer.at
++43-676-3201572
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