When diabetes is disturbed primarily carbohydrate metabolism: sugar deteriorates combustion in tissues, increasing its concentration in the blood, and it is excreted in the urine. Formed in this toxic metabolic products (acetone, etc.) Can cause poisoning organism.
At the heart of diabetes is a decrease in the production of the hormone insulin hormone by the pancreas or its relative deficiency in the body.
A lack of insulin in the body leads to a violation of glycogen deposition in the liver, a decrease in the penetration of glucose into the tissues, and therefore their starvation occurs. Disturbed protein synthesis. The deposition of fat in the liver leads to a decrease in its functions. Due to the long course of the disease, the functions of the kidneys, digestive organs change, vascular atherosclerosis develops.
The therapeutic nutrition of patients with diabetes is aimed at improving the absorption of carbohydrates by the body. It is determined by the severity of the disease, the nature of the complications and cannot be standard. An individual diet is compiled for each patient. No other disease requires such an accurate record of the foods eaten as with diabetes. Therefore, the first time, until the necessary skill is acquired, it is necessary to assess the carbohydrate content in food using weights, measuring dishes and tables reflecting the composition of food products.
General requirements for the diet of a patient with diabetes can be formulated as follows:
1) the balance of the major food ingredients;
2) the correspondence of the energy value of food to the needs of the body in the absence of concomitant obesity and a partial restriction of the energy value of food (by 15%) in the presence of obesity;
3) the exclusion from the diet of products containing glucose or sucrose (sugar, confectionery, preserves);
4) a certain restriction in the diet of animal fats, an increase in the amount of vegetable oils and lipotropic substances;
5) adherence to a strict diet throughout the day, especially during treatment with insulin.
For the proper organization of the diet of a patient with diabetes mellitus for a long period, it is fundamentally important to determine the tolerance of carbohydrates by the body by dosed limiting them taking into account the sugar content in blood and urine. For this purpose, a standard trial diet is used. The total value of such a diet is 9462 kJ. It contains 116 g of protein, 136 g of fat and 130 g of carbohydrates. If within 5-7 days of staying on this diet, the level of sugar in the urine and blood decreases or stabilizes, then after 10-14 days you should proceed to expand the diet, adding 3 g of brown bread or other products every 5-25 days, except containing sugar in an equivalent amount (for example, 15 g of cereal or 50 g of potato). Each increase in carbohydrates must be controlled by the sugar content in the blood and urine. Thus, you can create a diet that is used as an independent method of treating mild diabetes.
In the presence of contraindications to this diet or the failure of its use, a physiologically complete diet is prescribed in combination with tabletted sugar-lowering drugs or insulin.
If sulfonamide sugar-lowering drugs are prescribed, carbohydrate-rich foods should be evenly distributed throughout the day. The first intake of products is recommended 1-2 hours after taking the medicine, and then every 4-5 hours. After subcutaneous administration of simple insulin, carbohydrate foods are taken after 30-40 minutes, and then after 2,5-3 hours. First 2 1
consume - and later - prescribed carbohydrates. At once insulin is taken, food is taken at least 4 times a day, with twice - at least 5 times a day, and with three times - at least 6 times a day. In the case of administration of protamine-zinc-insulin in combination with simple insulin, carbohydrate-rich foods should be taken 30–40 minutes later, then 3,5 hours after injection, then every 4–5 hours, and also in the morning (shortly after awakening) and before bedtime. When using a suspension of amorphous zinc-insulin, the first intake of carbohydrates should be 2-3 hours after injections, and then after 4-5 hours. If a crystalline zinc-insulin suspension is used, then when it is administered in the morning, the maximum amount of carbohydrates should be taken for dinner. The use of a suspension of zinc-insulin necessitates the use of carbohydrates in the morning (soon after waking up), then 2-3 hours after the injection, then every 4-5 hours and always at night.
Within the permissible amount of proteins, fats and carbohydrates, foods can be selected from which, depending on the taste of the patient, prepare various dishes.
A patient with diabetes should know that all products are divided into three groups: 1. Almost devoid of carbohydrates: eggs, fats, cabbage, tomatoes, cucumbers, lettuce, spinach, meat and fish products (except for the liver). 2. Low in carbohydrates: dairy, various vegetables, many berries, fruits (beets, carrots, siliculose, sour apples). 3. Carbohydrate-rich: cereal products, potatoes, sweet fruits, dried fruits.
Sugar, honey, jam, sweets, chocolate and other sugar-containing products are excluded from the diet of patients with diabetes. Flour dishes and products containing starch in the diet are sharply limited, and the carbohydrates they contain are counted in quantity. Excessive intake of proteins and fats is impractical, since carbohydrates are formed from proteins in the body of patients with diabetes mellitus, and from fats toxic metabolic products - acetone, acetoacetic acid, etc. In addition, a large amount of fat in food adversely affects the course of atherosclerosis, diseases of the heart, kidneys, and liver, which are often associated with diabetes.
Currently, on sale you can find culinary products made specifically for patients with diabetes, which are low in carbohydrates. These include special types of bread (protein-wheat, protein-bran), crackers, chocolate and sweets with saccharin, marshmallows with sorbitol, etc.
If there is a threat of diabetic coma, you should limit your intake of fats to 30 g and proteins to 50 g per day. The use of alkaline mineral waters (Borjomi, Polyana-Kvasova, Luzhanskaya) is shown. After removing the patient from a diabetic coma, he can be given carbohydrate food (jelly, fruit juices, compotes, cereals, potatoes, bread), provided that insulin is administered. As the acetone accumulated in the blood is eliminated, it is necessary to gradually increase the amount of proteins with lipotropic properties in the menu that are found in cottage cheese, cheeses, and oatmeal. Before the disappearance of acetone from the urine, the amount of fat in the diet should not exceed 40-50 g. The painful condition associated with an overdose of insulin and a sharp decrease in blood sugar levels is stopped by ingestion of a sugar solution (1-2 tablespoons per half glass of water). To prevent this condition, patients taking insulin should always have a few pieces of sugar with them.
The food is recommended to take mostly boiled or baked. Avoid fried foods.
In the diet management of patients with mild diabetes mellitus, especially in obesity, the use of the well-known contrast nutrition occupies an important place. This is achieved by using loading or unloading days. So, fasting apple days contribute to a decrease in body weight in obese, reduction in the excretion of sugar in the urine and a decrease in its level in the blood.
Dining with thyroid diseases
Thyrotoxicosis (bazedova disease, diffuse toxic goiter) - a disease associated with excessive thyroid hormone production of the thyroxine hormone. At the same time, the metabolism increases sharply, there is a significant breakdown of proteins, the amount of glycogen in the liver and muscles decreases. Thyrotoxicosis is most often manifested by symptoms such as an enlarged thyroid gland, weight loss, irritability, excessive sweating, palpitations, etc.
In connection with increased metabolism, patients with thyrotoxicosis increase the energy value of food to 15-072 kJ.
A therapeutic diet should ensure the intake of at least 1 g of protein per 1 kg of body weight, since tissue deficiency is consumed when they are deficient.
The amount of fat in the food of patients with thyrotoxicosis should be 100-120 g per day (of which 25% are vegetable oils). It should be noted that retinol, which is predominantly contained in butter, inhibits thyroid hormone thyroxine production. Therefore, the diet of patients should contain milk fats (at least 50 g), as well as other foods containing this vitamin, or carotene, from which it is formed in the human body (liver, carrots, tomatoes, bell peppers)
Carbohydrates, which are the main source of energy, are included in the diet of patients with thyrotoxicosis in a slightly increased amount (500-550 g per day). Of these, up to 150 g are simple carbohydrates contained in sweet fruits, honey, sugar. The food of a patient with thyrotoxicosis should contain a sufficient amount of products rich in nicotinic and ascorbic acids, thiamine, pyridoxine, minerals, especially calcium, the increased need for which can be satisfied with the use of milk and dairy products.
Excluded from the diet foods that excite the nervous system and the heart: strong tea, coffee, cocoa, chocolate, meat and fish broths, sharp and spicy food, alcohol, smoked.
Culinary processing of food can be different. Eating should be no more 4 times a day, as if each step is increased metabolism.
Hypothyroidism (a severe illness called myxedema) develops due to inadequate thyroid function. A limited amount of the thyroid hormone produced by the thyroid gland leads to a decrease in metabolism, a tendency to be overweight, fluid retention in the body, drowsiness, and reduced ability to work.
Diet therapy of patients with hypothyroidism is aimed at increasing metabolic processes and preventing the development of obesity. The energy value of the diet decreases mainly due to a decrease in the amount of carbohydrates (up to 200-250 g per day). Foods rich in simple carbohydrates (sugar, confectionery) are especially limited or even completely eliminated. Preference is given to foods rich in dietary fiber, which, with a small energy capacity, have a sufficient volume, due to which saturation when consumed, of low-calorie food is achieved. With constipation, black bread, beetroot, prunes, one-day sour-milk products are indicated.
To increase metabolism in the diet of a patient with hypothyroidism include 120-140 g of protein.
It is recommended to limit cholesterol-rich foods. To normalize cholesterol metabolism, products containing lipotropic substances are introduced: cottage cheese, low-fat beef, vegetable oils (up to 25% of the total amount of fat), and seafood.
The diet of patients with hypothyroidism should be rich in all vitamins, with the exception of ergocalciferol. Increased intake of ascorbic acid is recommended. In the presence of edema, it is necessary to significantly reduce fluid intake.
Food should be prepared mainly boiled with a limited amount of table salt and spices. Eating is recommended 5-6 times a day.
Dietary principles of treatment of obesity
Regardless of the causes of obesity, adherence to certain dietary principles is crucial in its treatment. In order for a fat person to lose weight, it is necessary, first of all, to limit the energy value of food, which should be significantly less than the energy expenditure of the body. This can be achieved by increasing physical activity, or limiting food intake, or - due to both.
Limit the energy value of the diet should, first of all, by reducing the amount of carbohydrates (up to 110-150 g per day). Sugar, sweets, pastries and other sweets are excluded from food completely. Instead of sugar, sorbitol or xylitol (up to 30 g per day) can be used to sweeten tea. The amount of bread (from simple flour, rye, bran) in the daily diet of an obese patient should not exceed 100-150 g. Potatoes, flour products and cereals can be consumed, but in a limited amount - mainly in the first dishes.
The use of products containing mainly proteins (meat, fish, eggs, cottage cheese) should not be especially reduced. Fats, including sour cream, should be consumed 70–80 g per day (of which 20–25 g should be vegetable oils, preferably unrefined sunflower). Fats in the diet of obese people are necessary, since fatty foods contribute to a longer preservation of a feeling of satiety, reduces the thirst that often bothers these patients. In addition, edible fats inhibit insulin secretion, stimulate the production of enzymes that break down fats in the body, which leads to a more intensive expenditure of them. Thus, fatty foods have a beneficial effect on fat metabolism in the body of obese patients, which contributes to weight loss.
It is desirable to limit the energy value of the diet of an obese person to 7536–7955 kJ.
The patient should take a limited amount of food 6 once a day during certain hours. This decrease is achievedshenie hunger and increased energy consumption for absorption of ingested food. The evening meal should be no later than 3 hours before bedtime, and then recommended to walk in the fresh air.
The diet should include low-calorie, but in sufficient quantities foods: cabbage, beets, cucumbers, carrots, apples, plums, berries. Vegetables and fruits stimulate the digestion and absorption of proteins and carbohydrates. In combination with fats, vegetables increase the formation and secretion of bile, which is very important for obese patients, as they often have stagnation of bile. Betaine, which is in sufficient quantities in beets, prevents the development of fatty liver. The sitosterols of fruits and vegetables inhibit the conversion of carbohydrates to fats. In addition, vegetables and fruits are an important source of vitamins, mineral salts and organic acids necessary for metabolism. Of vegetables, obese patients should be somewhat limited in the diet of potatoes, melons, from fruits - pears, grapes, apricots, tangerines, oranges.
It is useful to avoid foods that stimulate appetite. For this purpose, it is better to use boiled food. Reduce the consumption of salt and water (they cook food without salt, adding salt to ready-made meals). Sugar drinks, beer and alcohol are strictly prohibited. Thirst is recommended to quench in small portions of alkaline mineral water or rose hip infusion. At the same time, the performance of normal physical exertion at work and at home is considered as an important therapeutic factor. It is necessary to reduce the body mass gradually, by no more than 4-5 kg per month.
Fasting days and crisp food
To reduce body weight at home 1-2 times a week, you can spend fasting days during which to take food of much lower energy value. At the same time, uniform foods are usually introduced into the diet. Unloading days by chemical composition are divided into carbohydrate (apple, watermelon, cucumber, etc.); fatty (sour cream or creamy); protein (meat, cottage cheese, kefir, fish); combined (complex).
When choosing a fasting day, one should take into account the tastes and habits of the patient, however, it is best to start treating obesity with a meat, cottage cheese or sour cream day, as they are easier to tolerate by the body and are not inferior to others in effect. If the patient tolerates the hunger felt on the fasting day, it is recommended to carry out dual fasting days to enhance the therapeutic effect.
The basis of carbohydrate fasting days on the principle of limitation in the diet of protein and fat with the introduction of products that contain complex carbohydrates, fiber, vitamines, mineral salts. To this end, unsweetened apples, fresh cucumbers, watermelons, tomatoes, plums, cherries, currants, as well as other vegetables and fruits, are most often used. During the day at regular intervals, the patient in 5 doses consumes 1500 g of any of these products in raw form. Receiving extra fluid during fasting days is usually not recommended, since the products used contain enough water.
Fat unloading days stimulate the activity of enzymes that break down fats, inhibit the transition of carbohydrates into fats and create peace for the overexcited pancreatic insulin apparatus of an obese patient. On this day, 500 g of 20% sour cream or cream is consumed in 5 equal portions at regular intervals. Twice a day is allowed to drink 1 cup of coffee with milk without sugar or rose hip infusion.
Protein fasting days are easily tolerated by obese patients. They improve metabolism and increase the activity of enzymes that destroy fat. For protein fasting days, cottage cheese can be used, which is consumed 150 g 4 times a day with 15 g sour cream. Two more times you can drink 1 glass of coffee with milk (50 g) without sugar or with sorbitol. Kefir day is carried out using 1500 ml of kefir, which is distributed in 6 doses of 250 ml.
Meat fasting days are quite effective. For the whole day, 450 g of boiled lean meat is recommended (usually obtained from 600 g of raw meat), which is divided into 5 servings. With this unloading, it is allowed to consume 3 cups of coffee with milk without sugar (can be with sorbitol or xylitol) and 2 cups of rosehip infusion.
On combined fasting days, it is recommended to use different combinations of products. So, on a rice-apple unloading day, the patient receives 3 servings of rice porridge (25 g of rice and 150 ml of milk per serving) and 800-1000 g of raw or baked apples. When combining cottage cheese with yogurt, take 3 servings of cottage cheese of 150 g each (you can cook cottage cheese) and 3 servings of yogurt for 200-250 g. Combine desirable chemical products (meat and fish, vegetables and fruits, vegetables and berries, etc.) .).
If 2 unloading days in a row are used, then the first is better to spend meat, and then sour cream or vegetable. As a result of these 2 days of unloading, body weight may decrease by 2–2,5 kg. In the days of unloading, it is advisable to engage in normal physical or mental work, which distracts from thoughts about food. Food should be taken separately from other family members. The effectiveness of the fasting day is preferably controlled by weighing. Night sleep during unloading is extended to 9 hours.
Fasting days are used to treat not only obesity, but also other diseases: jade, gout, chronic renal failure, etc.
In diet therapy, contrast nutrition is successfully used, in which the diet of each subsequent day differs significantly from the diet of the previous one. The contrast of food products activates metabolic processes, allows you to diversify the food and its constituent components.
To treat obesity, you can use a diet according to which a different menu is offered for each of the 6 days of the week: vegetable, meat, egg, milk, fish, fruit. On the seventh day, the patient is allowed to eat at his discretion. This diet is made with a slight restriction of the energy value of food, with frequent meals in small portions.
Fasting for therapeutic purposes has been used since ancient times to date in schizophrenia, bronchial asthma, obesity and other diseases. Dosed therapeutic fasting for 14 days is carried out with a complete refusal of food, but with the intake of water. Conducted methodologically correct, such starvation does not lead to degenerative changes in the body, as is the case with forced starvation. In the process of therapeutic fasting, the body is freed from excess fat and so-called toxins (metabolic products). During fasting, in addition to fats, the body uses cellular proteins for energy purposes. The transition of the body to food at the expense of internal funds can have negative consequences. Protein consumption is especially enhanced after 15 days of fasting, when other energy sources are exhausted. In this case, there is also a lack of vitamins, which, in turn, leads to even more significant metabolic disturbances.
Such negative consequences of fasting make many scientists wary of the use of fasting for medicinal purposes. The duration of a course of therapeutic fasting is prescribed individually by a doctor, depending on the state of human health. During this period, smoking is prohibited, no drugs are prescribed. Every day the patient needs to conduct cleansing enemas. Waters recommend consuming at least
1,5 liters per day. There are unloading and recovery periods. In the first period - within 3 days from the onset of starvation (the stage of food arousal) - a painful feeling of hunger is felt, irritability appears, restless sleep, previous diseases often worsen, on the 3-5th day the hunger feeling usually dulls, and sometimes completely disappears. The tongue is covered with a thick white coating, acetone appears in the urine, which is often determined in the exhaled sick air (acidosis develops). Acidosis increases within 7-10 days. Then well beingessentially improves - the so-called acidotic crisis sets in, when cheerfulness appears, the mood improves. The tongue is gradually cleansed of plaque, daily loss of body weight becomes minimal (100-200 g per day). However, the patient’s condition gradually worsens again: general weakness, headache, sometimes pain in the heart area appear, a feeling of severe hunger is restored. This usually ends the unloading period.
The recovery period is approximately the same in duration as the unloading period. The assigned diet is gradually expanding, and its energy value is increasing. On the first day after the cessation of starvation, the patient is given half-diluted juices with water - 100-120 g per reception, up to 1 liter per day. From the second day add mashed ripe apples, oranges and other fruits, from the third - grated carrots (400-600 g per day). The use of 500-600 g of kefir per day is allowed. Starting from the fifth day, the patient receives 100 g of bread per reception. After the sixth day, the menu includes vinaigrette made from potatoes, beets, raw grated carrots and finely chopped cabbage with vegetable oil (15-20 g). From the eleventh day it is allowed to use semi-liquid cereals in milk with butter (5-7 g). Food is prepared without table salt. Meat, fish, eggs are introduced into the diet after the end of the recovery period.
Therapeutic fasting should be carried out exclusively in a hospital environment and only in cases where other medication and dietary measures do not have the desired effect. Particularly cautious should be applied to complete therapeutic starvation in patients with obesity, since they develop more severe acidosis (a violation of the acid-base state) than with other diseases, and serious complications are often noted: convulsions, a sharp decrease in blood pressure (collapse) with impaired cardiac activity and impaired consciousness.
How to eliminate a diet constipation
Constipation is a delayed, obstructed, or insufficient bowel movement. Depending on the reasons that cause constipation, it happens: 1) alimentary, that is, associated with the consumption of easily digestible, processed food (from lat. APshep-1agshz - food); 2) neurogenic, which is based on mental overstrain, mental depression or reflex effects from the digestive apparatus; 3) hypodynamic, caused by lack of physical activity; 4) inflammatory, arising from inflammatory bowel diseases; 5) proctogenic, caused by diseases of the rectum (hemorrhoids, fissures, inflammatory processes, etc.); 6) toxic or medicationthe result of chronic poisoning by some industrial toxic substances, nicotine, as well as as a result of treatment with certain medications. Constipation often occurs after prolonged use of laxatives or enemas.
Regardless of the cause of constipation, nutrition can enhance it or act laxatively. The laxative effect of food products is known, which attract liquid to the intestines (salted herring, honey, sweet fruits, syrups), irritating receptors (nerve endings) of the intestines (brown bread, wheat bran, beets, radishes, carrots, cabbage, greens, melons, prunes, wine berries). Products that affect the receptors of the stomach (cold water, water with honey, beer, kvass, ice cream), the pancreas (cream, butter, sour cream, vegetable oils, mayonnaise, sardines in oil, fatty foods) promote bowel movements. The consumption of foods that change the chemical composition of the contents of the intestines (kefir, yogurt, beetroot, ice cream, juice, kvass, sour lemonade) also facilitates bowel movement.
Hot dishes, jelly, rice and semolina porridge, flour dishes (pies, pancakes, noodles), soft-boiled eggs, strong tea, coffee, cocoa, chocolate, blueberries and decoction from it, fresh bread, especially from fine flour, cottage cheese.
With alimentary constipation without signs of inflammation of the intestines, a diet rich in dietary fiber is recommended. For this purpose, use black stale bread, cabbage soup, borsch, beetroot, okroshka, fish soup, beef, veal, boiled and stewed lamb, fresh fish of all kinds. Vegetables (beets, carrots, cabbage, pumpkin, cucumbers, tomatoes, turnips, radishes, leafy greens), cheeses, kefir, yogurt, jelly, pickles, marinades, smoked products, dried fruit compotes, fresh berries, fruits are included in large quantities in the diet. , honey, prunes. It is useful to drink on an empty stomach in the morning 1 glass of cold water or cold milk with I tablespoon of honey, and at night - 1 glass of yogurt. You can also use cold carbonated mineral waters, sorbitol or xylitol, as well as dishes from legumes, millet, buckwheat, pearl barley and barley, white cabbage. It is recommended to increase the amount of fluid consumed to 2,5 liters per day.
With alimentary constipation, the use of foods that are low in fiber should be limited: pasta, bakery products of premium and first grade flour, rice and semolina porridge, potatoes, cauliflower, berries. It is necessary to accustom yourself to empty the intestines at the same time. This is especially important in the treatment of constipation arising from the suppression of the urge to defecate (relieve intestines). To restore stool, it is recommended to drink 1 glass of cold water or fruit juice in the morning on an empty stomach. Half an hour after that, you need to try to cause bowel movements.
In case of neurogenic constipation, the regime of work and rest should be adjusted, including more kefir, yogurt, various fruit and vegetable juices, a sufficient amount of vegetable fats in the diet. At the same time, Jermuk, Essentuki, Batalinskaya mineral waters are useful in cold or heated form.
In case of reflex constipation associated with diseases of the stomach, therapeutic nutrition, indicated for the underlying disease, should be carried out taking into account the stimulation of the intestines. So, with peptic ulcer of the stomach and duodenum with concomitant constipation during an exacerbation, a sparing diet No. 1a is prescribed, however, the number of products from the number of permitted, enhancing intestinal motility (vegetable and butter, cream, mashed potatoes from boiled vegetables and fruits) increases.
The presence of constipation in patients with diseases of the liver and biliary tract requires the inclusion in diet No. 5 of foods rich in magnesium salts and fiber (buckwheat, millet, bran bread, vegetables and fruits), as well as honey, fruit and vegetable juices.