Therapeutic Diets: Principles Of Construction And Examples Of Tables

The concept of therapeutic diets

Properly organized rational nutrition ensures the normal course of the processes of growth and development of the body, maintaining the health and working capacity of a person. By changing the nature of nutrition, it is possible to regulate the metabolism in the body and thereby actively influence the course of the disease. When prescribing dietary nutrition, the starting point is a rationally constructed diet of a healthy person, which changes qualitatively and quantitatively according to the disease of an organ or an entire organ system.

The basis for choosing the type of dietary nutrition is the determination of the causes and mechanisms of the development of the disease, the state of digestion and metabolism in a given person. Diets have a therapeutic effect by changing the qualitative composition of the diet (a set of products, the ratios between nutrients within the range of fluctuations in physiological norms, the inclusion of products with a therapeutic effect) and the nature of the culinary processing of products (the degree of grinding, heat treatment - frying, baking, boiling in water or steam cooking). Depending on the nature of the disease, the diet also changes.

Choosing a diet is a serious and responsible undertaking that only a doctor can competently perform. Self-medication and passion for so-called trendy diets pose a danger to health, especially for a sick person.

The principle of building each diet is determined, on the one hand, by the physiological need of the body for nutrients and energy, and on the other hand, by functional digestive disorders.

Principles of building a diet

• Ensuring the physiological needs of a person in nutrients and energy.

  A person's need for nutrients, vitamins and minerals can change taking into account certain disorders in the body in various diseases. This may lead to a change in the recommended balance of nutrients in the diet for healthy people.

  Almost always, in diseases of the gastrointestinal tract, there is a deficiency of vitamin C and B vitamins, in addition, the absorption of vitamins and minerals also leaves much to be desired. Nutritional deficiencies are eliminated by using foods rich in certain vitamins and minerals in the diet.

• Accounting for the physiological and biochemical conditions that determine the absorption of food in a sick person.

  When choosing a diet, it is very important to take into account all stages of food absorption: in the gastrointestinal tract during digestion and absorption, during the transport of absorbed nutrients to tissues and cells, in cells during their nutrition and metabolism, as well as during the excretion of metabolic products from the body . Some diseases are directly associated with various deficiencies presented in the table.

  Table. Deficiency of vitamins and minerals in certain diseases

  Disease

  Nutrient deficiency

  Chronic atrophic gastritis

  Vitamins B1, B6, B12, iron, PP

  After gastrectomy

  Vitamin B12, folic acid, iron

  Chronic enterocolitis

  Vitamin B12, folic acid, iron, calcium

  Frequent vomiting, diarrhea

  Vitamin PP, potassium, sodium

  Chronic hepatitis, liver cirrhosis

  Vitamins B2, B6, PP, A, D, E, K, choline

  Diseases of the biliary tract

  Vitamins A, K, calcium, magnesium

  Chronic pancreatitis

  Vitamins A, K, calcium

  Worm infestation (wide tapeworm)

  Vitamin B12

  Acute and chronic blood loss

  Iron

  constipation

  Magnesium

  In therapeutic nutrition, there must be a correspondence between the nature of the food taken, its chemical composition and the ability of the patient's body to absorb it. So, with a deficiency in the intestine of the enzyme lactase, which breaks down the milk sugar lactose, dairy products containing lactose are excluded from the diet.

  In diseases of the digestive system, the formation of many digestive enzymes may be impaired. A more complete assimilation of food is achieved in these cases with the help of the selection of food products and methods of their culinary processing. Sources of easily digestible proteins, fats and carbohydrates are introduced into the diet, dishes from crushed and mashed foods are used.

  It is also necessary to take into account the interactions and combinations of nutrients in the gastrointestinal tract. For example, absorption of calcium from the intestine worsens with an excess of fat, phosphorus, magnesium, oxalic and phytic acids in the diet. Therefore, in diseases that require an increased intake of calcium, a balance in the diet of this element with other nutrients that affect its absorption is of particular importance.

  An increased content of carbohydrates in the diet increases the need for vitamin B1 (thiamine), which is necessary for carbohydrate metabolism. Also, after heavy blood loss, the content of hematopoietic minerals (iron, copper, etc.) and complete proteins of animal origin should be increased in the diet.

• Accounting for the local and general effects of food on the body.

  With local action, food affects the senses (vision, smell, taste) and directly on the gastrointestinal tract. The attractive appearance of dietary dishes, the improvement of their taste and aroma with the help of permissible seasonings and spices (vanillin, cinnamon, herbs, citric acid, etc.) improve appetite, acquiring particular importance in strict diets with a limited set of foods, salt, and a predominance of boiled dishes.

  The mechanical action of food is determined by its volume, consistency, degree of grinding, the nature of heat treatment (cooking, stewing, frying, etc.). Of great importance is the qualitative composition of food, especially the amount of substances in it, the digestion of which occurs both in the small and large intestines (fiber, cell membranes and connective tissue). Liquid and mushy meals have less mechanical action and are more quickly evacuated from the stomach than meals with a firmer consistency and compact.

  Fried dishes, meat cooked in a piece have the greatest mechanical effect, to a lesser extent - dishes baked in the oven, and the least - boiled in water and steamed. In mechanical sparing diets, foods rich in cell membranes are excluded or limited and given boiled and pureed.

   

  The chemical action of food is due to substances that are part of the products or are formed during their preparation. Chemical food irritants are represented by essential oils, organic acids, mineral salts. All this has a powerful effect on the secretion of gastric juice and bile.

  Some foods and dishes have both a strong mechanical and chemical effect (fried meat, smoked and salted foods) or a weak one (steam or boiled dishes from minced meat or chopped vegetables).

  The temperature effect of food occurs when it comes into contact with the mucous membranes of the mouth, esophagus and stomach. The most indifferent are dishes with a temperature close to that in the stomach cavity (37–38 °C). Foods with a temperature close to human body temperature have a minimal effect. Dishes of contrasting temperature (below 15 °С and above 57–62 °С) have an irritating effect.

• Using the principles of sparing, training, unloading and contrast days in nutrition.

  Sparing is used in case of irritation or functional insufficiency of an organ or system. Depending on the severity of the disease, it means a different degree of restriction in the diet of chemical, mechanical or thermal stimuli. These types of sparing may not coincide. So, in chronic gastritis with secretory insufficiency, a mechanically and thermally sparing diet with the inclusion of some chemical stimulants of gastric secretion can be used.

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  In therapeutic nutrition, one should also take into account the duration of the diet, especially the sparing one. It is necessary to avoid the hasty expansion of strict diets and their excessive tightening, which can have a negative effect. For example, a prolonged bland diet for diarrhea can lead to constipation.

  Diets with severe food restriction can lead to multiple deficiencies. Therefore, sparing is combined with the gradual expansion of strict diets through new sparing dishes and products. For example, with an exacerbation of peptic ulcer, a chemically and mechanically sparing diet is prescribed. With the clinical effect of dietary treatment, the patient is transferred to a “non-mashed” diet (without mechanical sparing). If there is some deterioration, the patient is temporarily prescribed the same diet.

  Against the background of basic diets, contrasting days that differ from them are sometimes used, for example, with the inclusion of previously excluded nutrients (fiber, etc.) in the diet.

  In addition to such loading days, oppositely directed unloading days are used. Load days contribute to jerky stimulation of the function and are a test for functional endurance. The purpose of fasting days is to short-term relieve the functions of organs and systems, to promote the excretion of products of impaired metabolism from the body, for example, due to unloading fruit diets for liver diseases.

• Accounting for the chemical composition and processing of food and individual nutritional characteristics.

  Most diets take into account nutrient content and cooking methods. The importance of the physiological usefulness of long-term diets should be emphasized, the therapeutic effect of which should be based on the correct selection of products and their processing.

   

  Diets with significant changes in comparison with the physiological norms of nutrients should be used for a short time in acute diseases or exacerbation of chronic ones. In some diseases, the absorption is disturbed or a number of nutrients are lost. Processing leads to a decrease in the nutritional value of products. In these cases, it is necessary to take vitamin and mineral complexes.

  The choice of the necessary diet and the duration of its use is determined by the doctor, taking into account the patient's condition and the tolerability of the prescribed diet. When prescribing a diet, one must take into account climatic conditions, local and national dietary traditions, personal harmless habits, intolerance to certain types of food, the state of the chewing apparatus, the characteristics of work and life, and material opportunities for the purchase of certain products.

Therapeutic nutrition systems and treatment tables

When prescribing therapeutic nutrition, two systems can be used: elemental and dietary.

The elemental system provides for the development of an individual diet for each patient with a specific enumeration of the indicators of each of the elements of the daily diet. The dietary system is characterized by the appointment on an individual basis of one or another diet from a number of pre-designed and tested. All medical institutions use a dietary system, while the elemental system is developed specifically for each person by a dietitian or nutritionist.

This system of therapeutic nutrition, previously referred to as "group", provides for the existence of 15 basic therapeutic diets (tables) and a group of contrast, or so-called unloading, diets. In addition, some of the main diets (1, 4, 5, 7, 9, 10) have several options, indicated by capital letters of the Russian alphabet, which are added to the number of the main diet (for example, 1a, 16, 5a, etc.).

Each diet and its variants are characterized by:

• indications for use;
• target (therapeutic) purpose;
• calorie content and chemical composition
• features of culinary processing of food;
• diet;
• a list of allowed and recommended dishes.

Next, we will consider the main dietary tables and the conditions for their appointment.

Indications - gastritis with high acidity, duodenal ulcer and stomach ulcer for six months to a year after the exacerbation. The diet is prescribed by a gastroenterologist.

The purpose of the diet is to normalize acidity, eliminate and reduce inflammation, heal ulcers, erosions, and stabilize the secretory function of the stomach.

Recommended: pureed soups, boiled pureed vegetables, pureed cereals, boiled low-fat fish and meat, steamed fish and meat cutlets, boiled skinless chicken, milk, vegetable and butter, cream, non-acidic sour cream and yogurt, soft-boiled eggs, stale white bread , sweet fruits and berries, fruit and vegetable juices.

Table No. 1a is indicated during an exacerbation of chronic gastritis with high acidity, with an exacerbation of an ulcer.

Recommended: slimy soups, milk, liquid cereals, soft-boiled eggs, low-fat fish or meat soufflé, olive and butter, berry jelly, cream, fruit juices, tea, rosehip broth. Salt should be limited, and liquids should not be drunk more than one and a half liters a day.

Table No. 1b is indicated for patients with subsidence of chronic gastritis and peptic ulcer.

Recommended: in addition to the products listed above, you can eat steamed fish and meat dishes, mashed milk soups with vegetables, mashed milk porridge, wheat crackers.

Indications - chronic colitis and chronic gastritis with low acidity.

The purpose of this diet is to stimulate the normal secretion of digestive enzymes. In addition, in the course of therapeutic nutrition, the motility of the digestive tract improves. Motility of the gastrointestinal tract ensures the movement of food through the digestive tract, its mixing with gastric juice.

Recommended: vegetable and cereal soups with fish, mushroom and meat broths, boiled chicken, lean meat, cutlets, lean boiled fish, lean ham, low-fat salted herring, butter, milk and dairy products, mild cheese, cereals, soft-boiled eggs, stale white bread, fruits, vegetables, vegetable and fruit juices, coffee, tea, cocoa, marmalade sugar.

Almost all types of heat treatment are allowed. the diet should be about 80% boiled or steamed. Also, food can be baked, stewed or fried. The main thing is that there is no dense crust. When frying, it is not allowed to use breading in breadcrumbs or batter with flour.

Indications - atonic constipation.

Problems with regular bowel movements are quite common, which are more often caused by malnutrition, a sedentary lifestyle, and poor-quality food. All these factors affect the majority of working people, as well as students.

The purpose of the diet is to restore the motility of the gastrointestinal tract, improve metabolism, stimulate the restoration of the mucous membrane of the stomach and intestines.

You can eat foods containing a large amount of vegetable fiber, figs, prunes, compotes, fruit and vegetable juices, mashed carrots, beets, dried fruits, kefir, cream, milk, yogurt, black bread, pearl barley and buckwheat porridge, honey, fried meat and fish, sugar, vegetable and butter. At the same time, it is recommended to drink plenty of water, including mineral sparkling water.

You can not use cocoa, strong tea, kissels, mucous soups. If constipation is static, fiber-rich foods should be limited.

Indications - exacerbation of intestinal diseases.

Diet number 4 is prescribed for intestinal diseases, accompanied by frequent and loose stools, acute pain and flatulence. In addition, it is used for colitis and exacerbations of chronic diseases of the gastrointestinal tract (ulcer, gastritis, dysphagia). Under such conditions, the patient develops dyspepsia, which is characterized by stool disorder, abdominal pain, nausea, and spasms. Also, the diet is aimed at restoring microflora, relaxing muscles, improving intestinal motility.

The purpose of the therapeutic diet is to provide maximum relief of the digestion process, and then the restoration of the gastrointestinal tract.

You can use cocoa, strong coffee and tea, stale white bread crackers, soft-boiled eggs, cottage cheese, semolina and rice porridge on the water, boiled meat and fish, three-day kefir, kissels, a decoction of blueberries and black currants. Salt should be limited.

The basic rules of the diet: you need to eat in small portions and often, 4-6 times a day, it is strictly forbidden to starve and overeat. Fried and baked with a crust are completely excluded from heat treatment. Food can be boiled, steamed, baked in foil, stewed. These rules apply to all diet options: No. 4, 4a, 4b, 4c.

Table No. 4a is indicated for colitis. You need to eat the same as in the fourth diet, but you need to limit carbohydrate-rich foods and increase protein content.

Table No. 4b is indicated for patients with chronic colitis during the attenuation of the disease. Recommended: stale white bread, broth with meatballs, soups from cereals in meat or fish broth, pureed cereals, steamed and boiled vegetables, mild cheese, kefir, non-acidic sour cream, dry biscuit, non-bread cookies, kissels and compotes from unsweetened fruits and berries, coffee with milk, tea, butter.

Table No. 4c is indicated for chronic and acute bowel diseases during the recovery period. This diet is prescribed in order to provide good nutrition in case of disruption of the intestines to restore the function of other digestive organs.

The diet is physiologically complete with limited salt intake and a slight increase in the amount of protein foods. It excludes products that enhance the processes of putrefaction and fermentation in the intestines, activates its secretion, as well as the secretion of the pancreas and stomach.

Indications - diseases of the biliary tract, gallbladder and liver without the stage of exacerbation.

Its main goal is aimed at improving and restoring the functioning of the liver and biliary tract. In this regard, indications for the appointment of diet No. 5 are: chronic cholecystitis, cirrhosis of the liver (without decompensation), chronic hepatitis, liver steatosis. In addition, it is prescribed for 14-17 days after removal of the gallbladder. Also, table No. 5 can be used for mild toxicosis during pregnancy.

You should eat dairy and fruit soups without meat, soups from cereals in vegetable broth, boiled fish, poultry and low-fat meats, cottage cheese, kefir, milk, flour dishes and cereals, white and black stale bread, sweet berries and fruits, herbs and vegetables , honey, jam, sugar, fruit and vegetable juices, weak tea with milk. Limit your intake of fats and salt.

You need to eat five times a day.

You can not use alcohol, brains, liver, legumes, bacon, spinach, mushrooms, onions, sorrel, fatty meat and fish, pastry, smoked, spicy and fatty foods, vinegar, spices, canned food, cocoa, ice cream, creams, chocolate, drinks with gas.

Table No. 5a is recommended for chronic pancreatitis.

Nutrition is the same as in diet number 5, but you should eat more protein-containing foods, limit foods containing fats and carbohydrates. All food should be steamed, chopped and pureed.

Indications - nephrolithiasis and gout.

The diet is used for a specific disorder of purine metabolism and an excess of uric acid in the blood. Table No. 6, prescribed for this disease, reduces the content of uric acid in the blood and almost completely excludes the entry of purine bases into the patient's body through food.

The basis of the diet is vegetable and dairy dishes. Products that contain oxalic acid are excluded from the menu and the amount of salt is limited. There should be little protein and fat, if diseases are accompanied by weight gain, carbohydrates also decrease.

It is recommended to consume black and white bread, milk and dairy products, honey, sugar, dairy and vegetable soups, cereals, sweet fruits, fruit juices, jam, cucumbers, lettuce, carrots, bay leaves, vinegar, lemon, low-fat fish and meat, eggs.

In this case, you need to drink at least two to three liters of fluid.

You can not eat meat soups, kidneys, liver, brains, smoked and fried meat, fish soup, fried fish, herring, lard, sardines, sprats, mushrooms, pates, spinach, sorrel, legumes, cocoa, coffee, alcohol and strong tea.

Indications - chronic kidney disease in the absence of renal failure.

At the beginning of therapy, the patient is shown several days of fasting, during which it is allowed to drink only water (300 ml / day). After that, table 7a is applied, then 7b, 7c or other diets according to Pevzner.

In addition, fats and proteins are limited in order to prevent the accumulation of nitrogenous “slags” that are formed as a result of the digestion of protein, fatty foods.

You should eat vegetarian soups, low-fat poultry, meat, fish, gray and white bread with bran, pasta, cereals, flour dishes, milk and dairy products, cottage cheese, vegetables, herbs, fruits, berries, jam, honey, sugar. You should limit the consumption of sour cream and cream.

Meals should be five times a day.

You can not drink carbonated drinks, eat creams and cakes, legumes, mushroom, fish and meat broths, canned food, smoked meats, pickles. In addition, oxalic acid is prohibited. It also causes complications and can cause exacerbations. It is found mainly in green foods, chocolate, spinach, rhubarb, raspberries, gooseberries, etc.

Table No. 7a is indicated for acute and chronic nephritis in the acute stage. You need to eat boiled vegetables, fruits, flour and cereal products, white bread without salt, tea with milk, butter, sugar.

If uremia develops, you need to reduce the daily intake of proteins to twenty grams per day, especially vegetable.

Table No. 7b is indicated during recovery from acute inflammation of the kidneys. This diet is transitional from #7a to #7.

You can eat white salt-free bread, boiled lean fish and meat, reduce salt intake.

Indications - obesity.

Diet, or, as it is also called "table", No. 8 is used to treat obesity in all three stages. It can be prescribed by a doctor or used on its own. A specially selected diet of diet No. 8 contributes to the normalization of metabolism, the splitting of the subcutaneous fat layer.

The essence of diet number 8 is to gradually reduce the daily caloric intake of the diet. In this treatment program, a sharp decrease in the calorie content of food and, moreover, starvation is unacceptable. A sharp transition to a rigid diet in the fight against obesity does not work. To what level you need to cut calories depends on the degree of obesity and physical activity of a person. If the lifestyle is sedentary, the daily norm should be in the range of 1200-1300 kcal. With average loads, you need to gain about 1800 kcal. For those who are busy with hard work or combine diet with sports per day, you need to consume 2000-2100 kcal.

One hundred grams of protein, eighty grams of fat, one hundred and fifty grams of carbohydrates should be consumed per day.

Of the products, rye, protein-bran and protein-wheat bread, vegetable soups with cereals, borscht, cabbage soup, beetroot, okroshka, low-fat fish, poultry, stewed, baked or boiled meat, jelly, beef sausages, seafood, milk , cheese, cottage cheese, dairy products. Fruits and vegetables can be eaten in any form, but fruits are limited.

You should exclude from the diet products made from pastry and premium flour, pasta, legumes, cereals and potato soups, fatty fish, poultry and meat, smoked meats, sausages, canned food, sweet berries and fruits, legumes, fatty cheese, cottage cheese, cream, pasta products, oatmeal and semolina, spicy and fatty snacks, mayonnaise, sauces, spices and spices.

Food is fractional, about 5 times a day with a gradual decrease in portions. The drinking regime consists of 1.5-1.7 liters of water per day.

Indications - mild to moderate diabetes mellitus.

With the help of selected nutrition, the patient's carbohydrate metabolism is normalized during treatment and a normal glucose level is maintained. The energy value of the diet should be reduced by animal fats and easily digestible carbohydrates, sweets should be excluded. In the daily diet of proteins should be about one hundred grams, fat - eighty grams, carbohydrates - three hundred grams.

You can eat protein-bran, wheat, rye bread, vegetable soups, low-fat fish and meat broths, fish, poultry and low-fat meat, milk, cheese, low-fat cottage cheese, dairy products, cereals, vegetables, potatoes, sweet and sour berries and fruit.

You can not use fatty and strong broths, rich flour products, salted fish, sausages, semolina, rice, pasta, pickled and salted vegetables, raisins, grapes, jam, sugar, sweets, lemonade, sweet juices.

For cooking, gentle heat treatment should be used. It is forbidden to eat fried, but all other types of cooking are available: steamed, grilled, in the oven, on the water. To give flavor to dishes, it is forbidden to add a lot of salt to them, spices bright in taste (curry, hot pepper, turmeric), sugar, honey. To brighten up diet food, you can season the food with garden herbs, basil, Provence herbs.

Indications - diseases of the cardiovascular system.

The purpose of the appointment is to help restore impaired blood circulation, normalize the function of the liver, kidneys, slow down the progression of atherosclerosis.

You should slightly reduce the energy value due to carbohydrates and fats, limit the intake of salt and foods that stimulate the cardiovascular system.

Ninety grams of protein should be consumed per day, of which a little more than half are animals, seventy grams of fat, four hundred grams of carbohydrates. You should eat stale bread, biscuits, stale biscuits, vegetarian soups, milk, cottage cheese, dairy products, poultry, fish and low-fat meats, cereals and pasta, baked and boiled vegetables, ripe fruits, jam, honey.

It is necessary to exclude from the diet pastry products, fresh bread, mushroom, fish and meat broths, legume soups, sausages, smoked meats, kidneys, fatty and salty cheeses, salted fish, legumes, pickled, pickled and salted vegetables, fruits containing coarse fiber, cocoa, strong coffee, tea, chocolate.

Indications - tuberculosis of bones, lungs, joints, lymph nodes during a period of mild exacerbation or recovery, in the postoperative period, after injuries, with exhaustion after infectious diseases.

The diet is characterized by high energy value with a high content of proteins, minerals and vitamins.

One hundred and twenty grams of protein, one hundred grams of fat, four hundred grams of carbohydrates should be consumed daily.

You can eat almost all dishes, except for very fatty poultry and meat, culinary, beef and mutton fats, cakes and cakes with a lot of cream.

Indications - people with functional diseases of the nervous system.

The essence of the diet is to alleviate the emotional and physical state by excluding stimulating foods from consumption: salty, sour and spicy dishes, spices.

You can eat many foods with the exception of strong soups, hot spices, smoked meats, fried and fatty foods, strong coffee, tea, and alcohol. You need to limit salt and meat a little.

It is advisable to use tongue, liver, legumes, dairy products more often.

Indications - acute infectious diseases.

The energy value of this diet is reduced mainly due to carbohydrates and fats, while it is rich in vitamins.

Eighty grams of protein, sixty grams of fat, three hundred grams of carbohydrates should be consumed per day.

The diet includes dried wheat bread, low-fat fish, poultry and meat, low-fat meat and fish broths, cereal mucous decoctions, vegetable soups, cottage cheese, sour-milk drinks, beets, carrots, potatoes, tomatoes, cauliflower, mashed buckwheat, semolina and rice porridge, ripe berries and fruits, marmalade, jam, jam, honey, sugar, rosehip broth.

Fresh bread, rich flour products, fatty fish, poultry, meat, fatty broths, smoked meats, sausages, canned food, salted fish, cheeses, fatty sour cream, cream, whole milk, pasta, barley and pearl barley, millet, onions should be excluded from the diet. , garlic, radish, radish, white cabbage, legumes, cucumbers, cocoa, cakes, chocolate, high-fiber fruits.

Indications - urolithiasis.

It is a complete diet with limited calcium-rich and alkalizing foods.

A day you can consume ninety grams of protein, one hundred grams of fat, four hundred grams of carbohydrates.

You can eat bread and flour products, broths and soups, fish and meat, cereals, pumpkin, green peas, sour berries and apples, mushrooms, honey, sugar, confectionery. Fruit, vegetable and milk soups, salted fish, smoked meats, dairy products, vegetables, except those allowed, potatoes, vegetable and berry juices, cooking and meat fats should be excluded.

Indications - diseases in which there is no need for therapeutic diets.

This diet is physiologically complete, while spicy and indigestible foods are excluded.

A day should consume ninety grams of protein, one hundred grams of fat and four hundred grams of carbohydrates. You can eat almost all foods, except for fatty poultry and meat, mustard, pepper and refractory animal fats.