The general principles of cholecystitis diet therapy (diet No. 5) are: a diet with frequent consumption of a small amount of food (5 — 6 times, with a mandatory intake for 2 h before sleep of a cup of kefir). It excludes irritating ingredients in the diet - spices, pickles, pork, beef and mutton fats, smoked meats, fried foods.
Food should be eaten freshly prepared and always in a warm form.
You should consider the effect of food on the motor function of the biliary tract. So, for example, when increased peristalsis with increased tone of unstriated muscle tissue (biliary tract) products that stimulate contractions of the gallbladder (vegetable oils, meat broths) should be restricted in the diet. With a reduced tone of the loose muscle tissue of the biliary tract, patients usually tolerate weak meat broths and vegetable oils. The question of the mechanical processing of food is solved individually: if there are signs of damage to the stomach and duodenum, it is necessary to eat, for example, boiled meat and fish, twice passed through a meat grinder.
The individual intolerance to the sick of certain foods should also be taken into account. Salt in the daily ration is limited to 4 g. The patient's need for liquid (fruit juice, rosehip broth, tea, soups) is up to 2 liters per day. It is very important to include in the diet food containing a large amount of lipotropic (reducing fatty liver infiltration) substances: cottage cheese, oatmeal and buckwheat porridge, cod. The carbohydrate content in the diet is advisable to bring to 400 — 500 g per day. It is also necessary to ensure that patients with cholecystitis receive enough vitamins.
During exacerbation of chronic cholecystitis during the first week, the patient receives no more than 50 — 75 g of proteins, 250 g of carbohydrates and no more than 60 g of fats (vegetable and butter, cream) per day. From the second week, the diet includes 100 g of proteins, 300 g of carbohydrates, 90 g of milk fats and vegetable oil per day.
With a decrease in inflammation, the diet expands even more. If during exacerbation of the disease the total energy value of food does not exceed 10 467 kJ, then as the inflammatory process in the gall bladder fades, it can be increased. A patient with chronic cholecystitis without aggravation is recommended to have at least 200 g per day of boiled lean meat (beef) or the same amount of boiled chicken, boiled lean fish, cottage cheese with sour cream, to 95 g of butter and vegetable oil. Vegetable oil is better absorbed with a boiled potato and beetroot salad, and butter - with porridge (manna, mashed rice and buckwheat). Recommended boiled vegetables. In some cases, when congestion of the gallbladder can be recommended weak broths. Sick jelly from natural fruit juice, water with lemon, black currant and sugar, compotes, liquid fruit jelly, tea with milk, dogrose broth, mineral water, grape, apricot, orange, as well as some vegetable (cabbage, tomato) juices .
It is undesirable to use a bow food, sorrel, spinach, containing large amounts of oxalate. Flour for filling soups need to fry without oil in order to avoid the formation of harmful products of oxidation of fats.
Meals patients after gallbladder removal
The basis of diet after removal of the gallbladder is the principle of stimulation of biliary excretion, the normalization of impaired metabolism. It is organized with the restriction of products that promote the formation of stones in the bile ducts. Food is a stimulator of bile formation, so it should be consumed in small portions, often in the form of heat. Cold foods and drinks cause spasm of the bile ducts. In this regard, the pain may increase and there may be difficulties in the biliary excretion. The diet is used with a sufficient content of proteins, carbohydrates and a somewhat limited amount of fat, with a full vitamin and salt composition. The first time after surgical treatment should be eaten boiled food. Fried and all kinds of coarse, irritating and difficult to digest food are excluded. Proteins are recommended in the composition of cottage cheese, milk and dairy products, low-fat varieties of meat and fish, egg dishes. Fats are used in moderation in the form of butter and vegetable oils, cream. Food should be no less than 5 — 6 once a day. As you recover, the diet expands and comes close to normal. Spicy dishes for many months after recovery should be avoided. The use of any alcoholic beverages, even with full recovery is unacceptable.
To improve bile secretion, products with a choleretic effect are used: vegetable oils, vegetables, fruits, eggs (1 egg per day), sorbitol or xylitol (instead of sugar).
Dietolechenie chronic hepatitis and liver cirrhosis
Considering the long-term course of chronic liver diseases, patients need to eat nutritionally complete food with a content of at least 1,5 g per 1 kg of body weight of proteins, i.e., from 80 to 120 g. Milk proteins and dairy products, meat, fish, eggs are valuable. . Prepare milk soups, cereals, use dairy products. Curd and curd dishes are very valuable (have a lipotropic effect). Cottage cheese should be consumed at least 100 g daily. Meat and fish are recommended low-fat - in boiled or steam dishes.
Patients are allowed to use 1 — 2 pcs. Eggs 2 — 3 once a week (soft-boiled or scrambled eggs), with poor tolerance of yolks - only in the form of a protein omelet.
Until recently, in chronic liver diseases, a sharp restriction of fat in the diet was recommended. These recommendations were based on the idea that dietary fats are bad tolerated by patients and increase liver damage. However, scientific observations have shown that with a sufficient amount of fats in the diet of these patients, their recovery is accelerated or the indicators of the functional state of the liver improve significantly. Therefore, at present, in chronic hepatitis without exacerbation and liver cirrhosis, it is recommended to use physiologically necessary amount of fat in the compensation stage (90 — 100 g per day). In this case, half of them should be vegetable oils, which contribute to the intake of fat-soluble vitamins, the restoration of the basic functions of the liver. From animal fats it is better to use butter. Mutton, beef and goose fats are limited in nutrition.
Only in the presence of severe dyspeptic disorders (nausea, vomiting, feelings of heaviness and distention in the stomach, as well as diarrhea with the release of large amounts of fat in the feces), the fat content in food should be reduced to 50 — 70 g per day.
Carbohydrates are recommended approximately 400 — 450 g per day, including easily digestible 100 g (in the form of sugar, in the composition of fruits, honey, jam). Bread is allowed to eat yesterday’s black and white pastry, cookies are made from lean dough. It is often necessary to include vegetables in food, prepare salads with sunflower oil or side dishes; fresh fruit or stewed fruit from them, jellies, mousses, jellies, puddings, other dishes. Exclude from the diet legumes, spinach, sorrel, rich products, strong coffee and cocoa.
Four to five meals a day with small portions are recommended. In the stage of remission of the disease, patients can periodically switch to a free diet, while respecting the regime and avoiding overeating. At the same time, spicy dishes, spices, individually - vegetables rich in essential oils (raw onions, garlic, radishes, radish), cold dishes and drinks are still excluded from food. Strongly prohibited alcohol.
If cirrhosis of the liver is complicated by edema, it is necessary to sharply limit the use of table salt (to 2 — 5 g per day) and water (to 0,8 l per day); more often foods that are rich in potassium (baked potatoes, figs, dried apricots, raisins, prunes, and
Medical nutrition in enteritis and colitis
One of the causes of chronic inflammation of the intestines (enteritis and colitis) is a violation of the diet - eating a dry ration, irregular meals, overeating, abuse of spicy snacks, drunkenness.
An important part in the complex of effective methods of treatment of acute and chronic diseases of the intestines of any origin is medical nutrition.
By affecting the function of the intestines, food products are divided into promoting their emptying, delaying emptying and indifferent.
The first group includes sugary (sugar, honey, syrups, sweet dishes); products containing organic acids (for example, yogurt, fruit juices, black bread, sour fruit varieties; foods rich in salt, containing carbonic acid (mineral water); fats; foods rich in fiber, cold foods.
Foodstuffs containing tannin (blueberries, strong tea, cocoa), mashed food, mucous soups, warm liquids delay emptying of the intestines.
By indifferent products include meat, fish, well-baked wheat bread, flour products.
Doctors recommend injecting 100 — 120 g of proteins into the diet of patients with chronic colitis, and proteins into the diet of patients with chronic enteritis 140 — 150 g, since the latter have a certain deficiency of proteins in the body.
Patients with chronic diseases of the intestines do not experience an increased need for fats even during the period of exacerbation of the disease. They are sufficiently normal physiological norms (100 — 120 g), distributed evenly throughout the day.
Foods containing carbohydrates can enhance the fermentation processes in the intestines, so their quantity in the daily ration is limited to 300 — 350 g, and during the period of exacerbation of chronic enteritis and colitis - to 250.
The tolerance of carbohydrates by the body is mainly determined by the content of plant fibers in them and the nature of cooking. By consuming foods with less fiber and applying special cooking methods to them (steaming, wiping), it is possible to significantly increase the tolerability of carbohydrates by patients and bring their content in the diet to the physiological norm.
In diseases of the intestines, it is recommended to consume large amounts of vitamins (with food and in the form of finished products), as well as readily absorbable calcium, the source of which is cottage cheese and cheeses.
In order to prevent anemia in such patients, it is necessary to enrich their diet with iron. A lot of iron in meat, eggs, wheat flour of the second grade, oatmeal, quince, pears, apples, dogwood. Fruits should be consumed in the form in which they are well tolerated by patients: be it kissels, juices, baked fruits, etc., and during remission - in raw form.
When enteritis and colitis are not recommended mushroom broths and mushrooms, spicy and salty dishes, canned snacks and smoked meats, spicy seasonings, spices, pastry, refractory fats, black bread, vegetables with high fiber and essential oils (cabbage, turnip, radish , rutabaga, beets, legumes, with the exception of a limited amount of green peas and young beans, radishes, onions, garlic), fruits and berries, rich in organic acids (cranberries, lingonberries, gooseberries, red and black currants, red cherries, lemons, sour apples). Foods rich in cholesterol, nitrous extractive substances, cooking salt.
Nutrition of patients with chronic pancreatitis
Diet therapy in chronic pancreatitis is not only a therapeutic method, but also an important condition for the prevention of exacerbations, and hence the progression of the disease.
In the first 2 — 3 days of exacerbation of chronic pancreatitis, food intake is excluded. Food of the body is provided by intravenous administration of glucose, isotinic sodium chloride solution. Thirst quench 1% solution of baking soda. From the fourth day, gradually increase the energy value of food so that by the end of the first week it reaches 8374 — 9211 kJ. Food should contain easily soluble simple carbohydrates, ascorbic acid, vitamins of group B, a lot of liquid. It should not be salt. Eating is necessary in small portions, 7 — 8 once a day. The patient can eat fruit juices, sugar, honey, jam; decoction of black currant, decoction of dogrose, cranberry juice - just up to 2—liters per day of liquid.
On the fifth day, food with a low content of vegetable and milk proteins is allowed. From the sixth to the seventh day of treatment in the diet increases the amount of proteins and carbohydrates, fat is introduced. Food rubbed.
From the patient's diet excludes foods that have a pronounced stimulatory effect on gastric secretion and function of the pancreas: broths of meat, fish, vegetables, mushrooms, alcoholic and soft drinks, black bread, coffee, strong tea, raw vegetables and their juices, meats, preserves, spices. Prohibited pancreatic secretion stimulants such as chocolate, cocoa, pastry, sour cream, sausage, sour fruit juices, acids (citric, acetic, etc.).
In order to reduce the reflex excitability of the gallbladder, pancreas and limit the motor function of the digestive system during an exacerbation of the disease, foods rich in cellulose, connective tissue (cartilage and tendons), cold foods and drinks should be excluded from the diet.
At the remission stage, the energy value of the patient's food is brought to 12 560 kJ. Currently, it is proved that a sufficient amount of protein in the diet of a patient with chronic pancreatitis improves the course of the disease. Therefore, in the diet of such a patient include about 140 g of proteins, of which 60 — 70% is of animal origin. The amount of carbohydrates is limited to 350 — 400 g per day, and sometimes to 150 — 200 g due to excludetain simple carbohydrates. The fat content is reduced to 80 grams per day.
During the period of exacerbation of chronic pancreatitis and during remission, mechanically and chemically sparing, steamed, ground, and rubbed food is recommended. Eat often and in small portions. A diet is observed for a long time.
The use of medicinal mineral water
Mineral waters have a diverse effect on the human body. Features of the therapeutic action of mineral waters are determined by the degree of their mineralization, ionic and gas composition, the content of organic substances and trace elements, temperature and active reaction of the environment.
Low-mineralized (Smirnovskaya, Slavyanovskaya, Borzhomi, Berezovskaya), medium and high degree of mineralization (Morshinsky brine, Yessentuki, Mirgorodskaya, Luzhanskaya, Naftusya and others) waters are used for treatment.
The main effect of mineral water depends on its ionic composition. Thus, hydrocarbonate waters have an alkalizing effect on the contents of the stomach, and also increase the alkaline reserves of the body. Hydrocarbonate mineral waters include Avadhara, Borjomi, Dilijan, Luzhanskaya No. 1, Polyana Kvasova, Sairme, Svalyava, Sirab, Utser and others. They are indicated in chronic gastritis, mainly with increased secretory and acid-forming function of the stomach, peptic ulcer, and a duodenal ulcer Hydrocarbonate water helps remove mucus from the stomach, urinary tract and respiratory organs, and has anti-inflammatory effects in diseases of the liver and biliary tract. The presence of calcium ions in bicarbonate waters enhances their anti-inflammatory effect, and the magnesium content provides an antispasmodic effect (removing the reduction of loose muscle tissue) of many drugs.
Chlorine ion dominates in chloride waters and is combined with sodium or calcium cations. Treatment with chloride waters increases metabolic processes, has a choleretic effect, improves the secretory function of the stomach and pancreas. These include the mineral waters of Värska No. 2, Dolinskaya, Druskininkai, Minsk, Mirgorodskaya, Nizhne-Serginskaya, Talitskaya, Tyumenskaya, Khadyzhenskaya, etc. * They are not recommended for increased secretory and acid-forming functions of the stomach, diseases of the kidneys and urinary tract, pregnancy, allergic diseases, tendency to edema.
Sulfate waters contain mainly sulfate ions, which, in combination with sodium or magnesium ions, form Salts that are poorly absorbed in the intestines and have a laxative effect. Treatment with these waters contributes to the activation of oxidative processes in the body, improves bile secretion and prevents stone formation in the biliary tract. Sulphate waters are used in diseases of the liver, biliary tract, diabetes, obesity, chronic constipation. They are not recommended for spastic colitis and pregnancy. Sulfate mineral waters include Batalinsk and Lysogorsk.
Mineral waters of complex composition contain many mineral salts, the action of which is often summarized, thereby expanding the indications for their use. Thus, the combination of chlorine and bicarbonate ions in mineral water (Arzni, Java, Yessentuki No. 4 and No. 17, Rychalsu, Semigorskaya) increases the effect of one or another ion depending on the method of administration. These waters are used in gastritis with both increased and with reduced secretion. They are impractical to use in diseases of the liver, urinary tract, pregnancy, allergic conditions.
The combination of sulphate ion and chlorine ion in mineral water (Alma-Atinskaya, Vyarska No. 1, Lipetsk, Narzan, Nizhne-Ivka No. 4, Novoizhevskaya, Uglichskaya, etc.) has a beneficial effect in diseases of the stomach, mainly with reduced secretory capacity in combination with diseases of the liver, biliary tract and constipation. These waters are not recommended for diarrhea, spastic colitis.
Mineral waters containing boron in pure form or in the form of metaboric acid (Bjni, Karmadon, Polyana-Kvasova, Polyana-Kupel, Svalyava, Semigorskaya, etc.) reduce the intensity of oxidative processes, therefore they are not recommended for obesity.
Some waters, along with mineral substances, have substances of organic nature (Naftusya, Berezovskaya). They are indicated in the treatment of kidney, renal and gallstone diseases, chronic hepatitis and cirrhosis of the liver, as well as atherosclerosis.
Treatment with mineral waters is carried out according to the purpose and under the supervision of a physician, since it is necessary to take into account the nature of the disease, the secretory function of the stomach, the time of water intake relative to the time of eating, the frequency of water intake, its dosage, temperature and duration of drinking treatment.
The course of treatment with mineral water at home should last no more than 4 weeks and is prescribed by the attending physician. Strongly contraindicated use of medicinal water without consulting a doctor.
It should be noted that mineral water bottles should be stored only in a horizontal position at 5 — 12 ° С. Well-preserved mineral water is clean, contains a lot of gas, does not have an unpleasant smell.
Poor quality mineral water contains flakes, turbid, has an unpleasant taste and smell, abundant sediment of salts falls on the bottom of the bottle.
Allergy refers to the increased sensitivity of the body to various substances, manifested by its painful conditions. The basis of allergies are the so-called immunological mechanisms. Immune reactions in the human body can proceed in different ways. Some of them are acute and very violent, others are characterized by a long course. Some of the body’s allergic reactions result in reversible functional changes, while others are accompanied by irreversible changes in tissues and organs, sometimes leading even to death. A variety of allergic reactions of the body occur simultaneously or follow one after the other. This explains the significant diversity of allergic diseases.
In response to ingestion of a foreign protein into the human body, antibodies (counter-bodies) are produced in it, which subsequently bind exclusively to the protein that caused their formation. The most common foods that can allergize the human body are milk, fish, eggs, cereals, vegetables, fruits, berries, etc. The most pronounced allergenic properties are egg protein ovomucoid. When cooking, these properties of ovomuco-ida decrease, and therefore some people tolerate boiled eggs better. In fish, the ichthulin protein has the most pronounced allergenic property, which during boiling turns into a decoction. Therefore, allergic reactions are observed with the consumption of fish soups and even with the inhalation of vapors formed during the cooking of fish. Severe allergies can occur to honey, nuts, cocoa, chocolate, coffee, brandy, champagne and beer.
Typical manifestations of food allergies are: in the oral cavity - swelling, desquamation of the mucous membrane, hemorrhage, numbness of the lips; in the esophagus - difficulty passing food; in the biliary tract - colic; in the small intestine - pain, increased motor ability, bleeding; in the colon - pain, constipation, diarrhea, spasm, bleeding; in the anus - itching, cramping, inflammation.
Allergic reactions caused by food factors can occur not only in the digestive organs, but also in other organs and systems. Examples of food allergies that do not affect the digestive system are bronchial asthma caused by flour (flour asthma); urticaria, angioedema caused by strawberries or eggs; eye and ear lesions caused by meat or fish allergens, etc. Allergiescal reactions to food can mimic almost all known human disease.
The penetration of allergens through the wall of the alimentary canal is possible with functional insufficiency of digestion. In childhood, it is determined by the discrepancy between the functional ability of the digestive organs and the requirements imposed on them, especially when artificially feeding the child. In mature and senile age, digestive insufficiency develops as a result of a decrease in the secretory function of the digestive glands. The emergence of food allergies contribute to the inflammatory state of the intestinal mucosa, chronic foci of infection, the presence of parasites in the digestive system, the way of cooking, etc.
Food allergies are relatively easy to establish using a diary kept by a patient on the recommendation of a doctor in order to identify food substances (allergens) that provoked the disease. An allergen may be one or more different products.
When keeping such a diary, a patient is prescribed a diet that excludes products with pronounced allergenic properties. If against the background of such a diet, the exacerbation of the disease repeatedly coincides with the use of certain products, they are excluded from food for a period of at least 2 weeks. After the disappearance of the symptoms of the disease, one of these products is added to the food as prescribed by the doctor and, if there is no exacerbation, if the latter is taken daily, 4 is administered into the diet of the other, previously excluded product. An exacerbation of the disease with repeated use of a certain product indicates that the food allergen is found correctly.
Experience has shown that eggs, milk and wheat are most often food allergens.
Nutritional care for allergic diseases
Limiting or completely eliminating allergens from the diet leads to the extinction of allergic diseases. The so-called elimination basis (excluding diets) is based on this principle. However, recovery does not always occur.
The best method of treating patients with food allergies is a strict diet, which excludes not only identified food allergens, but also spicy foods, spices, other foods and beverages that irritate the mucous membrane of the alimentary canal and increase the absorbability of allergenic substances into the blood. If food allergies exclude mustard, pepper, vinegar, onion, garlic, horseradish, radish, tomato paste and sauce, cloves, nutmeg, mayonnaise, as well as various canned foods, pickles, herring, salted fish, cheese, smoked foods. Strongly forbiddenconsumption of alcoholic beverages (including beer) is avoided even in small doses. All fried dishes must be replaced boiled, stewed or baked. Eggs, chicken meat, fish, pork, brains, offal (liver, kidneys), nuts, legumes, peas, beans, tomatoes, citrus fruits (lemons, oranges, tangerines), peaches, melons, and some berries (strawberries, strawberries , raspberry, black currant), as well as coffee, cocoa and chocolate. Fats are allowed butter and vegetable fats. Of course, many products can be excluded from the diet without damage to human health: strawberries, lemons and other citrus fruits, nuts, fish, caviar, crabs, honey, chocolate, etc. It is much more difficult to do without basic foods: flour products, milk, eggs , birds.