Lung abscesses and bronchiectasis are characterized by a combination of a purulent inflammatory process with destruction of lung tissue. Stagnation of purulent contents leads to intoxication of the body. A large amount of protein is lost with purulent sputum. With extensive lesions, pulmonary heart failure may develop. A long purulent process is accompanied mainly by exhaustion of the body and leads to amyloidosis.
Therapeutic nutrition is necessary to increase the immunobiological defenses of the body and replenish protein losses in sputum. It should help detoxify the body, reduce the phenomena of inflammatory exudation, stimulate reparative processes, and spare the activity of the cardiovascular system.
For adequate nutrition of the patient, it is necessary to ensure sufficient energy value of the daily diet (10,676-12,393 kJ, or 2550-2960 kcal) by introducing an increased amount of proteins (130-160 g), a moderate amount of carbohydrates (350-400 g) and a slightly reduced fat (70-80 g).
Consumption of increased amounts of protein helps to increase the body's defenses and immune processes, replenish protein lost with purulent sputum, and stimulates reparative processes. Excessive protein nutrition prevents and delays the development of amyloidosis. Care should be taken to include in the diet a sufficient amount of complete proteins of animal origin (meat, fish, cottage cheese, eggs, etc.).
When the process worsens, it is necessary to reduce the amount of carbohydrates (up to 200-250 g), which, in combination with limiting salt (6-8 g) and introducing an excess amount of calcium salts, reduces inflammatory exudation.
A slight restriction of fats in the diet is explained by their ability to suppress the already reduced appetite in long-term feverish patients.
A hypochloride diet has an anti-inflammatory effect due to the fixation of calcium salts in tissues and reduces fluid retention in the body, which is one of the measures to prevent circulatory failure.
To reduce the amount of sputum and facilitate the activity of the cardiovascular system, you should limit the intake of free fluid (up to 700-800 ml).
To stimulate protective forces, reparative processes and compensate for the deficiency of vitamins in the body, their increased administration with food (especially retinol, ascorbic acid, B vitamins) is indicated. In particular, ascorbic acid promotes detoxification of the body; together with thiamine and riboflavin, it has a positive effect on oxidative processes in the body and protein metabolism. Retinol improves the regeneration of the mucous membrane of the respiratory tract. To enrich the body with vitamins, it is recommended to consume foods rich in them (yeast, rosehip decoction, vegetables, fruits).
Improving appetite is facilitated by the inclusion in the diet of foods that stimulate gastric secretion (meat and fish broths, kvass, vegetable and fruit juices, strong tea, coffee).
In cases where there are no signs of heart failure, it is advisable to take as a basis for building a dietary regimen. With concomitant circulatory failure, the construction of therapeutic nutrition should be based on or 10a.
An approximate one-day menu for patients with chronic suppurative lung diseases. 1st breakfast: butter (10 g), crumbly buckwheat porridge (150 g), protein omelette (110 g), tea with milk (180 g). 2nd breakfast: boiled fish, baked with potatoes (250 g), yeast drink with sugar (200 g). Dinner: borscht with meat broth (250 g), beef stroganoff with mashed potatoes (55/130 g), apple compote (180 g). Afternoon snack: rosehip decoction (200 ml). Dinner: potato casserole with boiled meat (260 g), cottage cheese (100 g) with milk (25 g), tea with lemon (200 ml). For the night: curdled milk (200 g). All day: wheat bread (150 g), rye bread (100 g), sugar (30 g).
Pneumonia is an acute inflammatory disease of the lungs. The main goal of the diet is to reduce the activity of the inflammatory process and reduce intoxication of the body. The patient should receive a high-calorie diet with a high content of vitamins and fluids. At high temperatures, a low-calorie diet is indicated, mainly by reducing the amount of fat and carbohydrates consumed. The amount of table salt should be reduced to 7*^8 g per day (with profuse sweating, salt consumption can be slightly increased). Patients are recommended foods containing large amounts of calcium and protein.
To remove toxins from the body, you need to drink more fortified drinks: sweet and sour fruit and berry juices diluted with water, rosehip decoction, tea with lemon, cranberry and currant fruit drinks, compotes.
It is necessary to include dairy products in your diet. As for whole milk, it is preferable to use it only in dishes.
Food should be consumed frequently (5-6 times a day), in small portions.
It is recommended to use easily digestible foods that do not contribute to gas formation, bloating and constipation. It is better to cook food in finely chopped or pureed form, boil or steam it.
Pneumonia is treated mainly with antibiotics, so during treatment the need for additional vitamins increases. So, the patient’s diet should include more foods rich in vitamins B and C, as well as those with antifungal properties (blueberries, tangerines).
Bronchial asthma
This is a chronic, recurrent disease, manifested in attacks of suffocation due to spasm and swelling of the bronchi, so first of all it is necessary to reduce the number of products that can cause an allergic reaction. Most often these are fish, crabs, raw cabbage, radishes, strawberries, and citrus fruits. Many patients do not tolerate yellow-colored foods well, some do not tolerate eggs and milk.
If there is no intolerance to certain foods, patients can receive adequate nutrition, but with a limit on strong meat, fish and mushroom broths and sauces, table salt, spicy and salty foods, spices, seasonings, sugar, honey and chocolate.
However, the diet should not be too high in calories, otherwise the patient may gain weight, which will only worsen the course of the disease.
Patients with bronchial asthma need to include foods rich in calcium (cheese, cottage cheese and other fermented milk products, salads) in their diet. Vegetables and fruits are best consumed raw.
Those suffering from an allergic form of bronchial asthma should pay special attention to daily bowel movements and avoid constipation.
There are many traditional methods for treating respiratory diseases. So, for a long-term cough, you can try this remedy: mix 300 g of honey, 1/2 cup of water, finely chopped aloe leaf and simmer over low heat for 2 hours. Cool and stir. Store in a cool place. Take 1 tbsp. spoon 3 times a day.
For prolonged bronchitis, prepare a mixture of 15 g of aloe juice, 100 g of pork or goose lard, 100 g of butter and 50 g of cocoa (if desired). 1 tbsp. Dilute a spoonful of the composition in 1 glass of hot milk and take 2 times a day.
Fresh fruits or a decoction of dried grapes enhance the separation of sputum and facilitate expectoration: boil 100 g of raisins in a glass of water for 10 minutes and squeeze. Take 1/2 cup 3-4 times a day.
Cherry pulp and juice are an expectorant and diaphoretic.
Fresh pomegranate fruits are eaten with the peel for coughs and colds.
To remove thick, sticky mucus and soften a dry cough, drink tea from a decoction of buckwheat flowers (40 g of flowers per 1 liter of boiling water).
A warm decoction of viburnum berries with honey, or fresh cabbage juice with sugar gives a good result for cough and fever.
Rosehip infusion is taken for acute and chronic lung diseases, hemoptysis.
Tuberculosis
Basic principles. As a rule, with tuberculosis, metabolism is disrupted and the functioning of the digestive organs is weakened, so patients should have a nutritious diet, aimed at increasing the body's resistance to infections and normalizing metabolism.
If no complications are noted, food is processed as usual and taken 5 times a day.
Recommendations. During the period of exacerbation of the disease, the patient needs 2300-2400 kcal per day. Chronic patients, especially young people, need a more high-calorie diet, exceeding the norm by 15-20%, but no more, since as a result of rapid weight gain, the condition can sharply worsen. Protein foods should occupy the main place in the diet, and the amount of fat should be kept to a minimum. The body especially needs vitamins, so eat more fresh vegetables and fruits, juices and decoctions, rose hips.
For pulmonary tuberculosis, you should eat fresh strawberries, drink cabbage juice mixed with honey - the phytoncides contained in cabbage slow down the formation of tuberculosis bacilli
In folk medicine, for pulmonary tuberculosis, it is recommended to drink an infusion of bird cherry and gooseberry leaves.
For skin tuberculosis, take viburnum fruits.
Tibetan medicine recommends using currant leaves for tuberculosis of the lymphatic glands.
In case of acute pneumonia (pneumonia), nutrition should help increase the body's defenses, its resistance to infection, reduce the inflammatory process and intoxication, spare the cardiovascular and digestive systems, and kidney function. At high temperatures and in bed rest, diet No. 13 of reduced energy value (2000-2100 kcal) is indicated, mainly due to the reduction of fats and carbohydrates, limiting table salt to 7-8 g (with profuse sweating, salt intake can be increased), increasing the content calcium (dairy products), as well as vitamins C, A, group B, including through their preparations.
To ensure the body's immune defense, a sufficient amount of protein is needed - 70-80 g (65% animals), primarily from dairy products, fish and eggs. To reduce intoxication, drinking plenty of fluids (1.5-2 liters or more) is recommended, primarily through drinks containing vitamin C: sweet and sour juices of fruits and berries diluted with water, rosehip decoction, tea with lemon, fruit drinks, compotes. Be sure to include fermented milk drinks in the diet, which normalize the state of intestinal microflora and intestinal activity, provide the body with easily digestible protein and calcium, and vitamins. Whole milk is used only in dishes. Food is given 5-6 times a day, in small portions. The diet provides for mechanical and moderate chemical sparing of the digestive organs. With a diverse food set, easily digestible foods predominate and do not contribute to increased gas formation, bloating and constipation. Food is prepared chopped and pureed, boiled in water or steamed.
During the recovery period or during mild acute pneumonia, a diet based on diet No. 15 is recommended, with an increase in sources of vitamins and calcium, fermented milk drinks (especially during treatment with antibiotics), and the exclusion of fatty and indigestible foods and dishes. In case of severe pneumonia in the first days of the disease with high fever and intoxication, the energy value of the diet should be reduced to 1500-1600 kcal due to a sharp restriction of fats (30-40 g), a moderate reduction in carbohydrates (250 g) and proteins (60 g).
After severe, prolonged pneumonia with exhaustion, enhanced nutrition according to the type of diet No. 11 is indicated. The same principles of nutrition during exacerbation of chronic pneumonia. Outside of exacerbation of chronic pneumonia, in sanatoriums, dispensaries, and diet cafes, diet No. 15 or No. 11 is indicated with the physiological norm of fats and carbohydrates, an increase in the amount of protein (90-100 g, 60% animals) and calcium, primarily due to dairy products, as well as vitamins C, E, A and group B, including their preparations. If you have a poor appetite, you need fruit and vegetable juices, moderately salty snacks (soaked herring, cheese, ham, caviar, etc.), pickled and spicy vegetables, and spices.
With suppurative lung diseases (bronchiectasis, lung abscess, purulent pleurisy), severe intoxication of the body, an inflammatory process, and metabolic disorders occur. The diet should help increase the body's defenses, normalize protein, vitamin and mineral metabolism, improve the regeneration of the bronchial epithelium, reduce intoxication and effusion (exudation) in the bronchi and pleural cavity, stimulate gastric secretion and hematopoiesis.
Nutrition can be built on the basis of diets No. 11 or No. 15, taking into account the following principles:
1) increase in protein content (100-120 g, at least 60% from animals), vitamins C, A and group B, calcium, iron, potassium. It is advisable to include in the diet dietary products rich in these nutrients, in particular enpits, as well as vitamin preparations;
2) limit to 75-90 g of fats (25-30% - vegetable); carbohydrates and energy value of the diet are within physiological norms;
3) limiting table salt (about 8 g per day, and in case of exacerbation of the inflammatory process - 5-6 g), which has an anti-inflammatory effect and reduces fluid retention in the body;
4) restriction of free fluid (0.8-1 l) to slightly reduce the formation of sputum and effusion, sparing the cardiovascular system.
At high temperatures, in conditions of bed rest, nutrition is based on diet No. 13, but with a slightly higher energy value of the diet (up to 2300-2500 kcal) and less, if there is no indication, consumption of free liquid. In the chronic course of the disease, during normal work activities, the diet is the same as for chronic pneumonia, but with some limitation of table salt (8-10 g) and free liquid (1-1.2 l). In case of circulatory failure, nutrition is based on diets No. 10A and No. 10 (see “Nutrition for chronic circulatory failure”).
Bronchial asthma is mainly of infectious-allergic or allergic origin. If there are no indications of intolerance to certain foods, a physiologically nutritious diet is recommended, but with a limit on strong meat, fish and mushroom broths and sauces, table salt, spicy and salty foods, spices and seasonings, sugar and products containing it, honey, chocolate products. The diet should not be excessive in energy, so as not to contribute to the development of obesity, which worsens the course of bronchial asthma. In the absence of contraindications, free fluid intake can be increased to thin sputum and improve airway function.
For food allergies and bronchial asthma, a diet is used with the exclusion of foods that cause exacerbation of the disease (see “Therapeutic nutrition for allergic reactions”). In severe cases of bronchial asthma, corticosteroid hormones are used in treatment, which requires dietary changes in order to prevent the side effects of these drugs (see “Features of therapeutic nutrition during drug therapy”). In patients with an allergic (atopic) form of bronchial asthma, special attention should be paid to the need for daily bowel movements, avoiding constipation (see “Nutrition for bowel diseases”).
Therapeutic nutrition for respiratory diseases and tuberculosis
Introduction
1. Nutrition for the treatment of pneumonia
2. Chronic suppurative lung diseases and diet for them
3. Diet therapy for exudative pleurisy and bronchial asthma
4. Nutritional therapy for tuberculosis
Conclusion
List of references
Introduction
Dietary nutrition plays an important role in the complex therapy of respiratory diseases. It is built individually, taking into account the nature of the main process and its pathogenetic mechanisms, complications and concomitant diseases. It is necessary to remember about the possible involvement of the cardiovascular system in the pathological process with the development of cor pulmonale and circulatory failure of the right ventricular type. In particular, for pulmonary emphysema, therapeutic nutrition is mainly prescribed based on the functional state of the cardiovascular system.
1. Nutrition for the treatment of pneumonia
In acute pneumonia, the basal metabolism increases during the febrile period. There is intoxication of the human body with waste products of microorganisms and tissue decay. The load on the cardiovascular system increases, as a result of which, in severe cases, circulatory failure can develop. The functional activity of the digestive organs decreases (B.D. Borevskaya and others).
Therapeutic nutrition should contribute to the rapid resolution of the inflammatory process, detoxification of the body, increasing its immune properties and general reactivity, sparing the cardiovascular and digestive systems, and preventing possible negative effects of pharmacotherapy. The anti-inflammatory effect is ensured by limiting the amount of carbohydrates (up to 200-250 G), salt (up to 6- 7 g) and increasing the content of calcium salts in the diet.
In order to detoxify the body, it is recommended to introduce a sufficient amount of vitamins (especially ascorbic acid) and liquid and (up to 1400-1700 ml); Naturally, drinking such an amount of fluid is allowed only in the absence of cardiac decompensation.
It is recommended to significantly reduce the total calorie content of the diet at the onset of the disease (in the acute febrile period) (to 1500-1800 kcal) by limiting, in addition to carbohydrates, the amount of protein consumed (50-60 G), fat (30-40 G), which, in combination with fractional meals (meals up to 6-7 times a day) and consumption of predominantly liquid and well-chopped food, helps to spare the activity of the digestive organs.
During the recovery period, it is necessary to significantly increase the calorie content of the daily diet (up to 2500-3000 kcal) mainly due to an increase in the content of proteins (up to 130-150 g), fats (80-190 g) and, to a lesser extent, carbohydrates (up to 300-350 G). Enriching the protein diet helps to replenish its losses during tissue breakdown, stimulate reparative processes, produce antibodies, and prevent leukopenia due to the use of sulfonamide drugs. An increase in the amount of salt is allowed (up to 10-12 G), it is necessary for the production of hydrochloric acid by the stomach, which increases appetite. In this regard, the use of products that stimulate gastric secretion and exocrine activity of the pancreas is indicated (meat and fish broths, bread kvass, sauces, spices and seasonings, coffee, cocoa, fruit and vegetable juices, etc.). As you recover, the number of meals can be reduced to 4-5 times a day.
Diet therapy for exacerbations of chronic pneumonia is the same as for acute pneumonia.
2. Chronic suppurative lung diseases and diet for them
Lung abscesses and bronchiectasis are characterized by a combination of a purulent inflammatory process with destruction of lung tissue. Stagnation of purulent contents leads to intoxication of the body. A large amount of protein is lost with purulent sputum. With extensive lesions, pulmonary heart failure may develop. A long purulent process can be accompanied by depletion of the body and lead to amyloidosis.
Therapeutic nutrition is necessary to increase the immunobiological defenses of the body, replenish protein losses in sputum; it should help detoxify the body, reduce the phenomena of inflammatory exudation, stimulate reparative processes, and spare the activity of the cardiovascular system.
To increase the patient’s overall nutrition, it is necessary to ensure sufficient caloric content of the daily diet (2600-3000 kcal) due to the introduction of an increased amount of proteins (130-160 G), - moderate amount of carbohydrates (350-400 G) and slightly reduced fat (70-80 G).
Consumption of an increased amount of protein helps to increase the body's defenses and immune processes, replenish the protein lost with purulent sputum, and stimulate re-. parative processes. Excessive protein nutrition prevents and delays the development of amyloidosis. Care should be taken to include in the diet a sufficient amount of complete proteins of animal origin (meat, fish, cottage cheese, eggs, etc.). When the process worsens, it is advisable to reduce the amount of carbohydrates (up to 200-250 G), which, in combination with salt restriction (6-8 G) and the introduction of an excess amount of calcium salts is aimed at reducing inflammatory exudation.
The need for a slight restriction of fats in the diet is explained by their ability to suppress the already reduced appetite in long-term feverish patients.
A hypochloride diet has an anti-inflammatory effect due to the fixation of calcium salts in tissues and reduces fluid retention in the body, which is one of the measures to prevent circulatory failure.
To reduce the amount of sputum and facilitate the activity of the cardiovascular system, limiting the amount of free fluid (up to 700-800 ml).
In order to stimulate protective forces, reparative processes and compensate for the deficiency of vitamins in the body, their increased administration with food (especially retinol, ascorbic acid, B vitamins) is indicated. In particular, ascorbic acid promotes detoxification of the body; together with thiamine and riboflavin, it has a positive effect on oxidative processes in the body and protein metabolism. Retinol improves the regeneration of the mucous membrane of the respiratory tract. To enrich the body with vitamins, it is recommended to consume foods rich in them (yeast, rosehip decoction, vegetables, fruits). Improving appetite is facilitated by the inclusion in the diet of foods that stimulate gastric secretion (meat and fish broths, kvass, vegetable and fruit juices, strong tea, coffee, etc.)
In cases where there are no symptoms of heart failure, it is advisable to take diet No. 5 as a basis for constructing a dietary regimen. In the presence of circulatory failure, the construction of therapeutic nutrition should be based on diets No. 10 or 10a.
3. Diet therapy for exudative pleurisy and bronchial asthma
The disease most often has tuberculosis and less often another etiology (pneumococcus, staphylococcus, streptococcus, etc.) - It is characterized by inflammatory damage to the pleura. The pleural cavities are filled with inflammatory exudate, rich in protein.
Therapeutic nutrition is aimed at reducing inflammatory exudation and reducing increased reactivity. This is ensured by limiting carbohydrates (200-250 G), salt (up to 3-5 G) and an increase in the content of calcium salts in the diet (up to 5 G); Some restriction of free fluid intake is indicated (500-700 ml).
Care should be taken to introduce sufficient amounts of vitamins (especially retinol, ascorbic acid, vitamin P, vitamin B).
Excluded: food products that cause thirst (pickles, smoked meats, canned food, extracts, etc.).
When prescribing therapeutic nutrition at the onset of the disease, the main ones should be diets No. 7a, 76, 7. In the future, taking into account the tuberculous etiology of the disease, it is advisable to transfer patients to therapeutic diet No. 11.
Bronchial asthma is of an allergic nature and is characterized by periodic bronchospasms. With a long and persistent course, bronchial asthma leads to the development of emphysema and cor pulmonale, which can be complicated by circulatory failure of the right ventricular type.
Therapeutic nutrition is aimed primarily at reducing hyperergy and vegetative dystonia. For this purpose, restriction of carbohydrates, salt and the introduction of increased amounts of calcium are indicated.
You should not eat pickles, marinades, herring, easily digestible carbohydrates (honey, jam, sugar, semolina, potatoes, etc.). Subject to limitation products that stimulate the nervous system (strong coffee, cocoa, meat and fish broths, spicy snacks, spices, etc.). Excluded foods rich in oxalic acid (sorrel, spinach, lettuce), as it helps remove calcium salts from the body.
If a food allergy is detected, foods to which you are hypersensitive should be excluded from the diet, or specific desensitization can be carried out by consuming small amounts of allergenic foods 1 hour before taking the bulk of them.
In case of complications of pulmonary heart failure, appropriate dietary adjustments are necessary (elimination of salt, enrichment with potassium salts, fluid restriction, etc.).
4. Nutritional therapy for tuberculosis
The disease is caused by Mycobacterium tuberculosis. Various organs and systems may be affected (lungs, intestines, bones and joints, kidneys, serous membranes, larynx and nasopharynx, skin, liver, cardiovascular system, etc.).
Pathogenetic mechanisms determine the important role of therapeutic nutrition in the complex therapy of tuberculosis.
Diet therapy is aimed at increasing the body's defenses, stimulating reparative processes, normalizing metabolic disorders, restoring impaired functions and reducing the body's hyperergy.
Therapeutic nutrition should be based on the location, nature of the process, degree of activity, reactivity of the body, state of the digestive organs, fatness and lifestyle of the patient, concomitant diseases and complications, and functional state of the affected organs.
When calculating the total calorie content, along with taking into account the height, body weight, gender and lifestyle (regime) of the patient, it is necessary to keep in mind the frequent presence of increased energy consumption in tuberculosis associated with infection and febrile state. M. V. Pevzner recommends prescribing for each kilogram body weight;
a) in complete rest mode - 35 kcal;
b) in a mode of relative rest (lying down - 5-6 h during the day) with short walks - 40 kcal;
c) during the training regime (lying down for 3.5 hours during the day, outdoor games and work processes) - 45 kcal;
d) in a work regime with a 2-hour rest during the day and work for 3-6 h - 50 kcal
If the patient's body weight is below normal and progressive weight loss, the prescription of enhanced nutrition is indicated, which involves increasing calorie content by 1/3 compared to the proper one. You should not resort to enhanced nutrition if there are severe disturbances in the functioning of the stomach, intestines, liver and cardiovascular system. The previously practiced more significant increase in caloric intake, the so-called “excess” nutrition, did not justify itself; it leads to overload of the digestive organs, interstitial metabolism, overstrain of regulatory mechanisms, weakening of defenses and increased allergenicity of the body. The beneficial effects of increased nutrition are evidenced not so much by an increase in body weight, but by an improvement in appetite, mood and the appearance of vigor. At the same time, if the patient’s body weight does not increase with increased nutrition, it is necessary to reconsider the qualitative composition of the food.
Due to increased protein breakdown, it is recommended to include an increased amount of protein in the diet (during an outbreak, up to 2.5 G and outside an outbreak of tuberculosis up to 1.5-2 G by 1 kg body weight), which helps to increase the body's resistance to tuberculosis infection; at least half of the required amount of proteins must be of animal origin (meat, fish, eggs, milk, cottage cheese, etc.).
There is evidence of the possible formation of substances with antibiotic effects during the metabolism of amino acids such as arginine, tryptophan, and phenylalanine in the body. Therefore, it is advisable to recommend the inclusion in the diet of foods containing these amino acids (milk, cottage cheese, pike perch, cod, beef, chicken, lamb, pork, oatmeal and buckwheat, millet, rice, soybeans, beans, barley, peas, carrots, potatoes, cabbage, etc.).
Outside of an outbreak of tuberculosis, the body should be provided with a normal amount of carbohydrates (7 G by 1 kg body weight). When the process is activated, it is recommended to reduce their content in the diet (up to 4-5 g per 1 kg body weight), which has an anti-inflammatory effect. Limitation of carbohydrates, especially easily digestible ones (sugar, honey, jam, etc.), is indicated for disorders of nervous regulation, which are manifested by lability of the autonomic nervous system (erased symptoms of hypo- and hyperglycemia), hypersensitization of the body.
The previously practiced consumption of large amounts of fat is not recommended, as it has a negative effect on the body. Excess fat in the diet contributes to an acidotic shift, complicates the functioning of the digestive organs, causes diarrhea, fatty infiltration of the liver, and suppresses the already often reduced gastric secretion and appetite. Rapid satiety leads to insufficient introduction of proteins, vitamins and minerals into the body. Currently, the feasibility of some limitation of the amount of fat in the diet during the period of activation of the tuberculosis process (up to 1 G by 1 kg body weight) and a normal amount of fat (1.5 G per 1 kg of body weight) in the remission phase. Preference should be given to butter and vegetable fats. The latter are the main source of essential fatty acids.
With tuberculosis, there is an increased need for vitamins (retinol, ascorbic acid, vitamin O, thiamine, riboflavin, pyridoxine, nicotinic acid), especially in the presence of lesions of the digestive organs (enterocolitis, gastritis, hepatitis, etc.), which make it difficult to absorb vitamins . A deficiency of certain vitamins (pyridoxine, ascorbic acid, etc.) can be caused by the use of a number of antibacterial agents (PAS sodium, ftivazide, isoniazid, larusai, etc.). An experiment on animals has proven increased susceptibility to tuberculosis in the absence of vitamins in the diet (I. Ya-Goldberg). Providing the body with a sufficient amount of vitamins has a beneficial effect on the course of tuberculosis.
Depletion of the body in calcium, its anti-inflammatory and desensitizing effect determines the need to enrich the diet with calcium salts through foods rich in them (milk, cottage cheese, cheese, cabbage, lettuce, legumes, raisins, etc.). Better absorption of calcium is facilitated by introducing it in optimal ratios with phosphorus (1: 1 or 2: 1) and providing the body with a sufficient amount of vitamin B. Fixation of calcium in tissues is facilitated by limiting the amount of salt. It is recommended to use it during an outbreak of tuberculosis up to 8 g and in the inactive phase up to 12 g per day. The presence of fluid in the cavities (exudative pleurisy, empyema, transudate) is an indication for a more severe restriction of salt intake (2-4 G per day), which promotes fluid absorption. At the same time, after large blood losses, profuse diarrhea, frequent vomiting, it is necessary to administer an increased amount of salt (20-25 G per day).
The body's need for other minerals (iron, magnesium, etc.) should be met.
Since tubintoxication increases tissue hydrophilicity, it is necessary to avoid consuming excess fluid.
To increase the often reduced appetite, it is recommended to diversify the menu, include in it, taking into account possible contraindications, stimulants of gastric secretion (meat broth, fish soup, herring, etc.), take care of the high taste and beautiful presentation of dishes, develop an individual diet with regular meals and consuming the main amount when the temperature drops. It is important to create a favorable external environment during meals (a clean and well-ventilated room, absence of excessive noise, pleasant neighborhood, etc.), if overtired - a short rest before and after lunch, eliminate the possible negative effects of certain medications, provide the body with sufficient amounts of vitamins, carry out active treatment of the tuberculosis process.
In case of tuberculous damage to the intestines, it is necessary to keep in mind possible disturbances in the absorption of essential nutrients (proteins, vitamins, calcium, phosphorus, iron, etc.), which leads to a pronounced deficiency of them in the body and requires inclusion in the diet in significantly increased quantities. Retinol plays an important role in the epithelization of intestinal ulcerations. Profuse diarrhea determines the need to introduce an increased amount of salt (up to 20 g). Due to poor tolerance, it is advisable to reduce the amount of fat in the diet. If fermentation processes predominate, the content of carbohydrates in the diet (bread, cereals, vegetables, etc.) should be limited. To prevent intestinal overload, more frequent split meals (5-6 times a day) are indicated.
Excluded: whole milk, spicy foods, smoked meats, black bread, carbonated drinks, cold dishes, kvass, raw vegetables, fatty meats, canned food, marinades, lard, raw eggs.
Allowed consumption of slimy and pureed soups, weak broths, boiled fish, soufflés, steam cutlets, meatballs, meatballs from lean meats, various cereals, white crackers, sour cottage cheese, mild cheese, jelly, jelly, soaked low-fat herring, protein omelet, pudding, butter, jam and pureed vegetables (carrots, pumpkin, potatoes, zucchini, etc.), raw vegetable and fruit juices, rosehip decoction.
In case of tuberculosis damage to the kidneys, irritating foods (pepper, mustard, horseradish, radish, alcohol, smoked meats, canned food) should be avoided.
In case of exudative pleurisy, it is necessary to make the adjustments outlined in the appropriate section (see “Exudative pleurisy”). In case of tuberculous lesions of the larynx and nasopharynx, it is especially important to provide the body with an increased amount of retinol, as it helps restore damaged mucosal epithelium. It is recommended to eat food slowly in liquid, jelly-like, well pureed and mushy form. Prohibited: irritating foods (spicy, salty, pickled, fermented foods, mustard, pepper, vinegar, horseradish, cold and hot dishes), alcoholic drinks. Recommended consumption of slimy soups, weak frozen broths, strained jelly, liquid milk porridges, milk, weak coffee, weak mashed potatoes, tea with milk. In case of tuberculosis of bones and joints, special care should be taken to provide the body with an increased amount of calcium and phosphorus. For better absorption of calcium salts, sufficient vitamin content in the diet is indicated IN, which can, in particular, be achieved through the consumption of fish oil.
For tuberculous skin lesions (lupus), moderate restriction of carbohydrates and salt (up to 3-5 G) and the introduction of increased amounts of vitamins (retinol, ascorbic acid) .
Liver damage determines the advisability of excluding egg yolks, fatty meats, fish and vegetables, butter dough, smoked foods, spicy foods, strong coffee, and alcoholic beverages.
In case of hemoptysis, it is important to provide the body with an increased amount of vitamins (ascorbic acid, Vicasol), calcium salts, and in case of large blood losses - an increased amount of salt (up to 20-30 G per day). Recommended in chilled jelly, fruit and berry jellies, pureed cottage cheese with milk, cream, soft-boiled egg, liquid semolina milk porridge, cool drink (tomato juice, acidified lemon water, etc.).
When pulmonary tuberculosis is complicated by pulmonary-heart failure, fluid and salt restriction, enriching the diet with potassium salts, and fasting days are indicated (for more details, see the section “Chronic circulatory failure”).
When tuberculosis is complicated by amyloidosis in the albuminuric stage without edema, the daily diet should contain 1 kg the patient’s weight up to 2 g of protein, the amount of fat and carbohydrates in accordance with the nature of the main process. The presence of edema requires severe salt restriction (2-4 G). With azotemia, a decrease in the amount of protein in the diet is indicated (for more details, see the section “Chronic renal failure”).
One of the most common methods of diet therapy is kumis treatment. One liter of kumiss provides the body with 530 yakal and contains protein 22 G, fat 17 G, carbohydrates 32.6 G, ascorbic acid 200-250 ml and about 20 G alcohol It is recommended to prescribe kumiss one glass 5-6 times a day. Kumis treatment is contraindicated for acute and decompensated tuberculous lesions, concomitant chronic suppuration in the lungs and pleura (abscess, bronchiectasis, pyopneumothorax, etc.), peptic ulcer and gastritis with increased gastric secretion, liver diseases, the predominance of fermentation processes in the intestines, metabolic diseases (sugar diabetes, gout, obesity), neuroses with severe lability of the autonomic nervous system, hyperfunction of the thyroid gland, circulatory failure stage II-III, intestinal and kidney tuberculosis.
Conclusion
Therapeutic nutrition for diseases of the respiratory system and tuberculosis is very important. The diet for respiratory diseases, especially bronchial asthma, involves prescribing a hypoallergenic, fortified, varied diet. In a family where there is a patient with bronchial asthma, a “Solidarity” meal should be organized. The “gastronomic” solidarity of all family members around the patient is especially important if this is a baby who wants to try everything and no prohibitions or persuasion convinces him. Products that contain preservatives, emulsifiers, and artificial colors (the most dangerous yellow, tartrazine) should be excluded from the diet. Dishes cooked in dark vegetable oil, ghee, butter, and refractory fats can be considered harmful. A Mediterranean diet high in fruits and vegetables and low in saturated fat may help prevent allergies and asthma in children, according to recent research.
A feature of dietary nutrition for tuberculosis, regardless of its location, is the increased need of the patient’s body for vitamins (primarily vitamin C, B vitamins, vitamin A) and minerals. It is recommended to introduce into the diet such products as fish oil, egg yolk, carrots, tomatoes, red peppers, etc.). Since, in conditions of tuberculosis intoxication, it is difficult to compensate for the lack of vitamins and minerals with the help of a balanced diet, it is necessary to take vitamins and minerals in the form of medications.
For patients with reduced body reactivity, general hypotension, a slight increase in temperature, and with a sluggish course of the disease, the calorie intake is in the range of 2700-3000 kcal. The diet is characterized by a high content of ascorbic acid and B vitamins. Culinary processing is normal, meals are fractional.
If there is a deficiency of body weight (Quetelet index below 19.5), an increase in temperature to 38 degrees Celsius, without signs of increased tissue destruction in foci of tuberculous inflammation, the daily calorie content of the diet is raised to 3500 kcal. Foods rich in calcium are introduced into the diet (milk, dairy products - calcined cottage cheese, eggs).
During the period of exacerbation of the disease (high temperature, severe symptoms of intoxication, significant exhaustion), it is necessary to administer additional amounts of ascorbic acid and calcium. The diet is based mainly on consuming large amounts of fresh juices, vegetables, and fruits. During this period, all food is prepared pureed. Meals are split, every 2-3 hours. If the disease occurs with allergic reactions, carbohydrates are limited in the diet, mainly through sugar, honey, sweets, and sweet fruits. If there is a tendency to form effusions (exudates, transudates), limit table salt in the diet.
List of references
1. Breitburg A.M. Balanced diet. M., Gostorgizdat, 1957.
2. Internal diseases. – M.: Kron-Press, 2007.
3. Gubergrits A.Ya., Zimmerman Ya.S. Therapeutic nutrition for internal diseases. Kyiv, “Healthy”, 1965.
4. Zakrzhevsky E.B. Lectures on dietetics. L., Medgiz, 1958.
5. Medical nutrition. Practical guide. – M.: Torsing, 2002.
6. Loris I.F. Medical nutrition. M., 1957.
7. Marshak M.S. A short guide to therapeutic nutrition. M, Medgiz, 1951.
8. Marshak M.S. Organization of therapeutic nutrition in hospitals. M., Medgiz, 1951.
9. Marshak M.S. Diet food. M., “Medicine”, 1967.
10. Menshikov F.K. Diet therapy. Ed. 2. M., “Medicine”, 1972.
11. Pevzner L.M. Basics of technology for preparing food for the patient. M. - L., Medgiz, 1946.
12. Pevzner M.I. Basics of therapeutic nutrition. Ed. 3. M., Medgiz, 1943.
13. Pokrovsky A.A., Savoshchenko I.S., Samsonova M.A., Marshak M.S. Chernikov M.I., Nogaller A.M. Medical nutrition. M., “Medicine”, 1971.
14. Practical guide to therapeutic nutrition. M., Gostorgizdat, 1961.
15. Rafalovich M.B. Therapeutic nutrition in the clinic of internal diseases. Stavropol, 1970.
The main objectives of nutrition for diseases of the respiratory system are:
- reduction of symptoms of intoxication;
- increased immunological reactivity of the body;
- resolution of the inflammatory process;
- improvement of respiratory tract regeneration processes;
- Sparing the cardiovascular, digestive systems, and kidney function.
Pneumonia, chronic bronchitis.
Gray, rye, bran bread. Unsweetened and savory cookies, crispbreads.
Soups mainly vegetarian, vegetable, cereal, fruit, dairy.
Dishes from meat, poultry, fish.
Vegetable dishes and side dishes.
Dishes and side dishes from cereals, flour, pasta.
Eggs and dishes made from them. Soft-boiled eggs (2-3 per week), protein steam omelet, broth with egg flakes.
Dairy products.
Any ripe fruits and berries; any juices (except grape), jelly, jelly.
Beverages. Weak natural tea, tea with milk, tea with lemon, weak coffee, fruit, berry, vegetable juices, kvass, decoctions of rosehip, wheat bran, black currant, chokeberry, citrus fruits.
Fats.
Prohibited: spicy, salty, pickled foods, fatty snacks, cocoa, alcoholic drinks, baked goods, confectionery products, sweets (sugar, jam, jam, honey) are sharply limited.
Bronchial asthma.
The main version of the standard diet (Table 1, Appendix No. 4, instructions for organizing therapeutic nutrition in medical institutions, order of the Ministry of Health of the Russian Federation No. 330 dated 05.08.2003).
Bread rye, bran.
Soups mostly vegetarian, with weak meat or fish broth 1-2 times a week.
Dishes from meat, poultry, fish. Meat, poultry and fish of low-fat varieties. Boiled, baked.
Vegetable dishes and side dishes. Raw vegetables in their natural form and in the form of salads with vegetable oil.
Various crumbly cereals, puddings, casseroles.
Eggs and dishes made from them. Eggs as an independent dish, or as part of other dishes (2-3 pieces per week).
Dairy products. Milk in its natural form and in dishes, kefir, yogurt, acidophilus, koumiss, mild cheeses, sour cream, cream. Fresh cottage cheese in its natural form and in dishes.
Fruits and berries, sweet dishes and sweets. Sour and sweet and sour varieties of fruits and berries; juices, jelly, jelly.
Beverages. Weak natural tea, tea with milk, tea with lemon, fruit, berry, vegetable juices, decoctions of rosehip, wheat bran, black currant.
Fats. Vegetable oil for cooking and ready-made dishes (salads). Butter (add to dishes).
Prohibited: spicy, salty, pickled foods, fatty snacks, cocoa, alcoholicdrinks, baked goods, confectionery, sweets (sugar, jam, jam, honey) are sharply limited,strong meat and fish broths.
The feeding rhythm is fractional, 5-6 times a day.
Suppurative lung diseases beyond exacerbation.
Diet option with increased amounts of protein (high-protein diet) (Table 1, Appendix No. 4, instructions for organizing therapeutic nutrition in medical institutions, order of the Ministry of Health of the Russian Federation No. 330 dated 05.08.2003).
Bread and bakery products. White, gray, rye, bran bread. Incongruous cookies, bread.
Soups mostly vegetarian, with a weak meat or fish broth.
Dishes from meat, poultry, fish. Meat, liver, poultry and low-fat fish. Boiled, baked.
Vegetable dishes and side dishes. Raw vegetables in their natural form and in the form of salads with vegetable oil, as side dishes.
Dishes and side dishes made from cereals, flour, pasta. Various crumbly porridges, casseroles.
Eggs and dishes made from them. Eggs (2-3 per week), steamed egg white omelettes.
Dairy products. Milk in its natural form and in dishes, kefir, yogurt, acidophilus, mild cheeses, sour cream, cream. Fresh cottage cheese in its natural form and in dishes.
Fruits and berries, sweet dishes and sweets. Any fruits and berries; juices, jelly, jelly, pudding, soufflé.
Beverages. Weak natural tea, tea with milk, tea with lemon, fruit, berry, vegetable juices, kvass, decoctions of rosehip, wheat bran, black currant.
Fats. Vegetable oil for cooking and ready-made dishes (salads). Butter (add to dishes).
Prohibited: spicy, salty, pickled foods, fatty snacks, cocoa, coffee, alcoholic drinks, baked goods, confectionery, sweets (sugar, jam, jam, honey), strong meat and fish broths are sharply limited.
The feeding rhythm is fractional, 5-6 times a day.
