Hypertension is a common disease manifested by increased blood pressure. In this disease, the heart, central nervous system and kidneys are affected. A sudden significant increase in blood pressure, usually abruptly disrupting the patient's condition, is called a hypertensive crisis. Hypertension is characterized by a long course with alternating periods of deterioration and improvement. Unfavorable living conditions, overwork, various experiences aggravate the course of the disease, and, on the contrary, a calm atmosphere at work and at home, normal sleep, good nutrition in combination with drug treatment can, as a rule, significantly improve the condition and often normalize blood pressure. Therapeutic nutrition plays an important role in the treatment of hypertension.
When the initial forms of the disease, when the increase in pressure is not persistent, it is possible to confine the strict observance of the regime of a balanced diet recommended for healthy individuals.
In severe form of hypertension, accompanied by a persistent increase in blood pressure, therapeutic nutrition is necessary.
The diet of hypertensive patients should be complete in terms of food composition, energy value, mineral salts and vitamins and differ from the rational nutrition of a healthy person by limiting fluids, salt and high cholesterol foods. Food is prepared without salt, using no more than 3 — 5 g per day for salting ready-made food. Avoid foods containing salt in large quantities. Sausages, ham, herring, pickles, cheeses, pickles are excluded from the diet. To make food tasty, spices and greens are added to it.
Restriction of water in the diet is achieved by reducing liquid foods and drinks, taking into account the fact that the necessary vegetables and fruits contain water in large quantities. The moderate limitation of fluid (up to 1 liters per day) is easily tolerated by patients, as food with limited salt content reduces thirst.
The protein content in the diet should be sufficient. Animal fats (mutton, beef, pork) should be limited due to their high cholesterol content, giving preference to vegetable oils.
The carbohydrate content in the diet is not limited, since they reduce the processes of excitation in the cerebral cortex. Nevertheless, it is necessary to reduce the consumption of easily digestible carbohydrates (sugar, honey, confectionery) with a corresponding increase in the consumption of foods rich in plant fiber (bread, fruits, berries, vegetables), B vitamins, ascorbic acid and vitamin P. It is useful to limit the introduction to the body products with ergocalciferol, as its increased content in food contributes to the development of atherosclerosis.
Foods containing salts of potassium, magnesium, iodine (baked potatoes, prunes, raisins, dried apricots) are recommended. Potassium, being an antagonist of sodium, enhances its excretion from the body, and also favors the contractile function of the heart muscle. Magnesium contained in cereals and legumes, raisins, and dogrose, enhances the inhibitory processes in the cerebral cortex, reduces spasm of loose muscle tissue, blood vessels, and thereby reduces blood pressure. The feasibility of enriching the diet with iodine is associated with its anti-sclerotic effect. Iodine is found in sea fish, sea kale, shrimps, crabs, Ocean pasta and other sea foods. Foods that excite the central nervous system and heart activity (meat and fish broths, strong tea, coffee, cocoa, chocolate, alcohol), irritating kidneys (spicy snacks, seasonings, smoked meats) are subject to exclusion from the diet. Meals should be frequent 4 — 5 once a day with the last meal no later than 3 hours before bedtime.
On the main background diet appropriate, especially when cloudsand circulatory failure, periodically (1 — 2 times 7 — 10 days) to hold fasting days (see Fasting Days).
Dietetic therapy at rheumatism
Diet therapy for rheumatism aims to reduce inflammation and metabolic disorders, increase the effectiveness of drug treatment and reduce the side effects of certain medications.
In the active phase of rheumatism, when inflammatory lesions of the joints, heart, other organs are pronounced and the patient must comply with bed rest, the energy value of the food must be significantly reduced - to 7536 — 8374 kJ. At the same time, carbohydrates (up to 200 g), especially simple, are somewhat limited, fats (up to 70 — 80 g) and proteins (up to 70 — 80 g). Food is cooked without salt (3 — 4 g is given to the patient’s hands), meat and fish are boiled or lightly roasted after cooking, and vegetables are well boiled. The total amount of liquid in the daily diet, taking into account the first dish does not exceed 1 l. Food is taken in small portions of 5 — b once a day. The diet is enriched with ascorbic acid, vitamin P by introducing fruits and juices, as well as broth hips, lemons, black currants.
Usually, in the treatment of rheumatism with modern medical means, the activity of the process and the main symptoms of the disease are significantly reduced by 6 — 12 day Therefore, after 12 — 14 days, patients with rheumatism gradually expand the diet, mainly due to an increase in protein content, first up to 120 g, and then up to 130 — 140 g per day (up to 50% of this amount is animal proteins). This diet is used for a long time, until the most minimal signs of rheumatism activity disappear. If the process becomes inactive, the amount of protein in the diet can be reduced to 110 g per day. During anti-relapse treatment, it should be increased again — to 130 g per day. Meat and poultry, fish, eggs, milk and dairy products, bakery products and legumes can be the main sources of proteins.
Carbohydrates in the diet of patients with rheumatism are limited to 250 — 300 g for a long period in order to prevent exacerbation of the disease under their influence. Sugar is allowed to use 30 g per day, it can be replaced with an appropriate amount of honey, jam, jam, jam.
Carbohydrates should arrive in an organism mainly in the form of starch (from cereals, potatoes, fruit, vegetables and bakery products).
The amount of fat in the diet during the period of mild rheumatic activity is brought to 100 g per day. Allowed to include sour cream, cream, butter and vegetable oils (30 g per day). Limited mutton, pork, beef and goose fats.
The total energy value of the ration of the patient with rheumatism at the stage of recovery is 10 886 — 11 723 kJ. The process of recovery from acute rheumatism can take several months, and sometimes patients start to work, continuing treatment. In such cases, the energy value of the food must correspond to the body's energy consumption. Food should be taken in small portions of 5 — 6 once a day. Prepare food without salt, for its salting give out on 3 — 5 g of salt per day. Liquid limit to 1,5 liters per day, taking into account the first courses. The weight of the daily ration should not exceed 2,5 kg. To improve the taste of food is allowed to use onions, garlic, parsley, dill, celery.
Inclusion in the diet of foods rich in calcium (milk, dairy products, cheeses, nuts, cauliflower), it is advisable both in order to obtain an anti-inflammatory effect, and to compensate for its losses during treatment with some antirheumatic drugs. You must also enter with food (fruits and vegetables, fresh juices without sugar, oatmeal, buckwheat and millet porridge, almonds, walnuts), a sufficient amount of magnesium.
In case of sluggish rheumatism, especially in combination with obesity, it is advisable to 1 — 2 once a week to prescribe a contrast diet, alternating meat, fish, or cottage-cheese unloading diets with fruit and vegetable.
Dietolechenie circulatory failure
Chronic circulatory failure develops as a result of a weakening of the contractile function of the heart muscle due to various diseases. In this case, the metabolism in the body worsens, the functions of many internal organs are violated, in particular the kidneys, the liver, the pancreas, the intestines. Metabolic disorders, capillary compression of fluid accumulating in the tissues during edema, in turn, violate the contractile function of the heart muscle and aggravate circulatory failure.
The tasks of diet therapy in this case are primarily reduced to the elimination of metabolic disorders and the removal of excess fluid from the body, improving the contractile function of the heart muscle, enhancing the action of drugs.
The overall energy value of the diet is somewhat limited depending on the severity of circulatory insufficiency, but not less than 4187 kJ, otherwise tissue proteins will be spent on energy needs, which adversely affects the function of many organs, in particular, the myocardium.
Food prescribed digestible, full, in the form of heat. It is recommended to use milk, cottage cheese, kefir, boiled meat, fish, steam cutlets, butter and vegetable oils. Fat meat, lard, fat dough (cakes, cakes), creams are limited in nutrition. Carbohydrates, as the main energy source, are limited for a short time (during 5 days). Preferred carbohydrates contained in fruits and fruit dishes should be preferred. Exclude products of plant origin, causing bloating (legumes, cabbage, grape juice, black bread). The diet should contain vitamins - thiamine, ascorbic acid, riboflavin, pyridoxine, vitamin P, which are abundant in vegetables, fruits, and berries.
It is necessary to sharply limit table salt in the diet of patients with chronic circulatory failure. It is believed that 1 g of salt contributes to the delay in the body 50 ml of water. In this regard, exclude herring, pickles, pickles and other foods rich in sodium chloride. All dishes are prepared without salt. The patient receives very little salt, only due to its natural content in food products (1 —1,5 g). However, a long salt-free diet can lead to impaired renal function, the formation of edema, which are not amenable to treatment with diuretic and other means. Therefore, once a week 1 should be given to the patient's hands with 2 — 4 g of salt, and after the disappearance of edema, every day, up to 5 g, to add some salt to the salt.
In parallel with the restriction of table salt, it is necessary to reduce fluid intake, but not more than up to 1 liters per day. A more significant reduction in water intake in the body leads to thirst, weakness, constipation, makes it difficult for the kidneys to work. The volume of the first dish should not exceed 250 ml. It is especially advisable to limit fluid intake in the evening.
To improve the taste of food and facilitate the tolerability of a salt-free diet, it is recommended to boil meat and fish in concentrated vegetable broths, give the dishes a sour or sweet taste, add bay leaf, parsley, vanillin, anise, dill, cumin. You can use dietary salt Sanasol, consisting of salts of potassium, calcium, magnesium, ammonium chloride and glutamic acid. Sanasol is added mainly to main dishes just before their use (1,5 — 2,5 g per day). To provide the body with potassium salts, foods rich in potassium are introduced into the diet: dried apricots, prunes, baked potatoes, dried apricots, raisins, dates; for enriching the diet with magnesium include nuts, almonds, cereals, vegetables, fruits; calcium - milk, cottage cheese, cheese, prunes, apricot, cauliflower; phosphorus - milk, carrots, cauliflower, apricots, peaches. Some foods rich in potassium, contain a lot of oxalic acid (sorrel, rhubarb, lettuce, radishes, red currants), contraindicated in shortsufficiency of blood circulation, so they can not be used in the nutrition of patients.
Food and dishes that excite the activity of the heart (meat and fish broths, mushroom soup, strong tea, coffee, cocoa, chocolate) and spicy seasonings (pepper, mustard) that irritate the kidneys are excluded from the diet. Fried foods that irritate the liver and are difficult to digest are contraindicated. It is strictly forbidden to consume alcoholic beverages, overload the stomach with food, especially at night.
Patients with chronic circulatory failure are shown once a week fasting days. Sometimes for a short time (5 — 7 days), a diet consisting of 7 milk intake during the day is prescribed: from 8 am in the morning to 100 ml every 2 h. In 22 h the patient takes 100 of fruit juice or hip decoction. Currently, three more modifications of this diet are used, in which 150 g of salt-free bread, 1 — 2 soft-boiled eggs, 50 g of sugar, 200 g of mashed potatoes, 10 g of butter, 100 g of baked apples and Xnumx meat soufflé.
Nutritional care of patients with pneumonia
In acute pneumonia (inflammation of the lungs) with intoxication of the body with products of microorganisms and tissue disintegration, basal metabolism increases and the load on the cardiovascular system increases, and the functional activity of the digestive organs decreases.
Medical nutrition should contribute to the speedy resolution of the inflammatory process, the elimination or reduction of intoxication of the body, the increase of its protective forces, the affection of the organs of the cardiovascular and digestive systems, and the prevention of side effects of drug treatment.
Anti-inflammatory effect is provided by limiting the amount of carbohydrates (200 — 250 g), especially those contained in wheat and semolina porridge, chocolate, pasta, rice and legumes. The consumption of edible salt is reduced to 6 — 7 g per day, and the amount of calcium salts is increased due to the inclusion of fermented milk products.
In order to detoxify the body, it is necessary to consume a sufficient amount of ascorbic acid. If a patient has no heartbeat, edema of the legs, shortness of breath associated with heart disease, he needs to increase fluid intake to 1400 — 1700 ml per day due to unsweetened rosehip broth, tea with lemon, fruit compote, berries and alkaline mineral water (Borjomi , Polyana-Kvasova, Narzan). Liquid need to be consumed warm, a glass every 30 —40 minutes. Drinking alkaline mineral water prevents negeffect of antibiotics and sulfa drugs used in the treatment of pneumonia.
At elevated body temperature, the total energy value of the diet should be reduced to 6280 — 7536 kJ, not only due to the restriction of carbohydrates, but also proteins (50 — 60 g) and fats (30 — 40 g). Meals should be frequent (6 — 7 once a day), in small portions. Liquid and chopped food is well absorbed and improves the activity of the digestive organs. Low-fat meat broths, mashed potatoes, steamed vegetables, meat patties, and kissels are recommended.
During the recovery period, the daily ration energy value rises to 10 467 — 12 560 kJ due to an increase in protein content (130 — 150 g) and fats (80 — 90 g) and, to a lesser extent, carbohydrates (300 — 350 g per day). An increase in the amount of proteins in the diet contributes to replenishing their losses due to the breakdown of tissues, stimulation of regenerative processes, production of protective antibodies; prevents a decrease in the number of leukocytes, which can occur as a result of taking antibacterial drugs. In the same period, it is permitted to increase the use of edible salt to 10 — 12 g per day, since it is necessary for the production of hydrochloric acid in the gastric juice. To increase appetite, products that stimulate gastric secretion and pancreatic activity produce enzymes that improve digestion are recommended. Such products include meat and fish broths, bread kvass, sauces, spices, cocoa, fruit and vegetable juices.
As you recover, the number of meals can be reduced to 4 — 5 once a day.
Clinical nutrition in chronic suppurative lung disease
With abscesses (boils, abscesses) of the lungs and bronchiectasis (bronchiectasis - expansion of the bronchial areas), the purulent inflammatory process is combined with violation of the integrity (destruction) of the lung tissue. The purulent contents, which are located in the abscess cavity or bronchiectasis, lead to intoxication of the body. In patients, about X150 — 200 ml of sputum is secreted per day, along with which large amounts of proteins are lost. With extensive lung lesions, pulmonary heart disease develops. A long purulent process leads to depletion of the body and deposition of dense protein-like masses (amyloid) in organs and tissues.
Therefore, therapeutic nutrition should be aimed at increasing the immunobiological defenses of the body, replenishing protein losses, reducing toxicity, - inflammatory process in the lung tissue, stimulating the healing process.
To improve the overall nutrition of the patient's body, it is necessary to ensure sufficient energy of the daily ration (up to 10 886 — 12 560 kJ) due to the introduction of a large amount of proteins (130 — 160 g), moderate amounts of carbohydrates (350 — 400 g) and fat (70— 90 d).
Increased protein nutrition activates immune processes, prevents and retards the development of such complications of suppuration, like amyloidosis. Food should include mainly animal proteins (meat, fish, cottage cheese, eggs, etc.).
The total amount of carbohydrates is reduced to 200 — 250 g per day, limiting sugar and confectionery. The reduction of carbohydrates and salt (up to 6 — 8 g), along with the predominant consumption of products containing calcium salts (cottage cheese, milk, cheese, egg yolk, cabbage, leafy lettuce), provides a good anti-inflammatory effect.
Drinking a large amount of fat is not recommended because they impede the work of the digestive system, causing diarrhea, oppress and without that the lowered gastric secretion and appetite. Preference should be given butter and vegetable fats.
A diet with restriction of salt, in addition to providing anti-inflammatory action by stabilizing the level of calcium salts in the tissues, reduces fluid retention in the body, which is one of the measures to prevent the development of circulatory failure.
To facilitate the activity of the heart, the amount of fluid consumed is limited to 700 — 800 ml per day.
In order to stimulate the body's defenses, regenerative processes and fill up the vitamin deficiency, they are administered with food and in the form of drugs (especially group B vitamins, ascorbic acid, retinol). Ascorbic acid helps to reduce intoxication, and in combination with thiamine and riboflavin improves protein metabolism and oxidative processes. Retinol is involved in the restoration of the mucous membrane of the respiratory tract. These vitamins are contained in sufficient quantities in brewer's yeast, rosehip broth, cabbage, vegetables and fruits, herring.
To normalize the appetite, it is recommended to diversify the menu, include gastric secretion stimulants (meat broth, fish soup, herring, etc.), to take care of high taste and beautiful design of dishes. It is important to create a favorable external environment while eating. Eating should be often (5 — 6 once a day) in small portions.
If patients with bronchiectasis continue to work during outpatient treatment, the energy value of their diet must be increased to 12 560 — 13 398 kJ. It is recommended to consume 140 g of proteins (of which 94 g animals), 100 g of fat (of which 85 g of animals), 430 — 450 g of carbohydrates (of which 65 g of simple carbohydrates). The total amount of liquid is limited to 1 liters per day, taking into account first courses, the consumption of table salt should not exceed 6 g per day. Food should be taken at least 5 once a day. The diet of such a person should be enriched with calcium, phosphorus, magnesium, potassium, iron, ascorbic, nicotinic and folic acids, retinol or carotene, riboflavin, thiamine, pyridoxine, cyanocobalamin through products containing these minerals and vitamins.