STUDY - Technical - New Dacian's Medicine
Diet
Therapy (4)
Translation Draft
With this post I will be able to complete the presentation of the main elements about diet therapy. Let's continue the previous posts with liver disease!
The liver plays a central role in carbohydrate, lipid and protide metabolism. Liver failure leads to both decreased protein synthesis and increased protein catabolism, which, together with anorexia and reduced food intake, can lead to severe protein and energy malnutrition and limited liver regeneration and functional recovery capacity. In general, the more severe the malnutrition, the worse the prognosis. In patients with massive hepatic necrosis or portal hypertension, a diet rich in protein nitrogen may promote or accentuate hepatic encephalopathy, but severe restriction of protein intake should not be imposed if not necessary.
Patients with stabilized disease or minimal liver failure receive a protein intake of at least 1g/kg daily, with an energy intake suitable for efficient use of proteins (at least 30 kcal/kg/day). Patients with chronic stabilized liver disease should ensure adequate dietary intake, avoiding nutritional loss. In the case of progressive liver failure, protein intake may be altered due to encephalopathy.
Vegetable proteins are better tolerated than animal proteins, probably because plants contain less nonprotein nitrogen. Studies on the effects of specialized dietary preparations enriched with branched amino acids on amino acid and ammonia levels, as well as on liver encephalopathy have shown inconsistent results. When establishing the protein ration, the best attitude is to test the patient's tolerance by monitoring the neurological status when using 1g protein/ kg/ day (ideal intake). A protein intake of at least 0.5-0.75 g/kg/day or about 40g/day is recommended (a more severe restriction may lead to the catabolization of own proteins).
For some patients with liver disease, fat restriction (less than 30g/day) may be required by malabsorption and steatorea. Improved energy intake, restriction of long chain fatty acids may be associated with the use of medium chain triglyceride preparations, which are absorbed in the absence of bile salts. Water-emulsified forms of fat-soluble vitamins or other micronutrients may be used. Sodium restriction (less than 2g/day) is usually necessary due to edema and ascites, but very low levels (less than 1g/day) are not well tolerated and limit food choices, so increase the risk of malnutrition. Regular bread, dairy products, semi-prepared foods (except low sodium) should be removed to reach less than 1g/day sodium.
Let's move on to chronic neurological conditions now! Patients with Parkinson's disease have an increased risk of nutritional disorders due to the effects of the disease on the gastrointestinal tract. The varied degrees of dysphagia, with or without aspiration of gastric juice, and constipation lead to the nutritional depletion of these patients. Dietary advice is advisable to ensure an adequate regimen in the early stages of the disease. The decrease in the clinical effectiveness of levo-dopa, which usually occurs during Parkinson's disease and leads to motor variability and increased disability, can be improved by changing the schedule for protein intake. The interaction between protein intake and clinical response appears to be due to inhibition of levo-dopa reuptake in the central nervous system due to plasma amino acids.
Because of this, the restriction of protein in the diet during the day (less than 7g protein before dinner) reduces unforeseen variations in motor response during active, productive periods of the day. During the evening meal, increased amounts of protein-rich foods can provide daily needs. In motivated individuals who adhere to this regimen, symptoms usually improve and have no deterioration in nutrition status, but this regimen increases the risk of malnutrition when the diet is only apparently balanced.
Patients with Alzheimer's disease have more risk factors and more indicators of poor nutritional status than the rest of the elderly population. Decreased olfactory function produces bad eating habits and increases the risk of ingestion of altered foods, and dysphagia and refusal of nutrition are common. Agitation and wandering increase energy needs. The use of semi-solid or regular supplements is a way to increase the nutritional intake of these patients. During the course of the disease, monitoring of food intake is necessary to prevent weight loss and worsening of physiological and cognitive function due to malnutrition, but also to prevent dehydration, aspiration of gastric juice and increased risk of infectious diseases.
I've reached lung disease. Malnutrition is common in patients with chronic obstructive pulmonary disease (COPD). The area and mass of the diaphragm are reduced in relation to weight loss in malnourished patients with COPD compared to normoweight patients with COPD. Reducing carbon dioxide production and oxygen consumption in malnourished patients may predispose to lung infections. Patients with COPD and weight loss have a lower (and shorter) survival rate than those with stable weight. Limited evidence suggests that improving nutrition improves the strength and strength of the respiratory muscles, albeit in the short term. Patients with COPD have more than 10% higher basal energy needs due to increased respiratory exertion due to increased lung resistance and decreased respiratory muscle efficiency.
However, excessive energy intake can be inharm. Increasing carbon dioxide production by overeating with an energy excess (1.5 to 2.25 times higher than energy rest expenses), mainly from carbohydrates, can lead to overuse of breathing. Low carbohydrate -- (25-35% of kcal), lipid-rich (50-55% kcal) and energy (2 kcal/ml) enteral formulas were useful (improved lung function compared to lipid-rich and high-carbohydrate formulas - for example, 74% of the energy supplied by carbohydrates and only 9% of lipids). A diet containing 1.2 times more calories than the estimated energy needs at rest is a starting point in proper calorie administration with a protein level of 1.2-1.5 k/kg daily. However, individualized dietary therapy should avoid overoring patients.
There is also something to be presented about transitional diets (other types of diets). Changes in the consistency and texture of the diet may be important, especially for hospitalized patients. A simple liquid diet brings, orally, liquids, energy and nutrients, leaves minimal residues in the gastrointestinal tract, is used in the preparation of diagnostic procedures, as in the initial postoperative diet or after parenteral nutrition, as well as during acute gastrointestinal infections. These diets are not nutritionally appropriate in the absence of supplements and should not be used for more than three days. An additional liquid diet is liquid or semi-liquid at room temperature and is prescribed to patients with chewing disorders or as an intermediate diet to solid nutrition in patients who have undergone surgery or parenteral nutrition.
It may also be nutritionally inadequate in the absence of enteral nutritional supplements. A pasty diet, which includes pasty, crushed and liquid foods, is useful for patients who are diagnosed or have disorders that affect chewing. The light diet consists of foods that can be chewed more easily than those of the usual diet and includes soft and light solid meat, while avoiding raw fruits and vegetables, as well as wholemeal bread and cereals. Pasty and mild diets are nutritionally appropriate, ensuring an optimal amount and variety of food. Diets that eliminate a specific dietary compound, such as oxalations (in the treatment of hyperoxaluria), galactose (in the treatment of galactosemia) and gluten (in the treatment of celiac disease) have also been described.
Let us not forget the interactions of medicines with nutrients (in fact, I will dedicate a large number of posts to the interaction of medicines in the human body). A change in diet may be required due to the drug-nutrient interaction. Certain medicines or culinary habits can lead to impaired effectiveness of medicines and vice versa, medicines can change food needs. Absorption of medicines is usually slowed by food administration (therefore there are prescriptions before or after meals). Similarly, the metabolism of medicines can be affected by changes in protein intake and micronutrients, drugs can either reduce appetite and dietary intake potency, through central and/ or peripheral action (and many others - I will not go into details).
And complete this series of posts with alternative dietary therapies! New or alternative dietary therapies are promoted by popular nutritional literature, which is developed by a lot of practitioners, who develop and recommend various dietary therapies based on various reasonings and experimental data. In addition, both practitioners and patients may have beliefs and attitudes that can be classified as fadism, cultism or food quackery-ism. Food fadism is an exaggerated belief in the specific effects of nutrition on health and disease. Food worship involves certain religious or philosophical beliefs about food, often with the emergence of a charismatic authoritarian figure.
Food Quackerism carries the presumption of fraud, but refers to people who are sincere in their beliefs jump misguided in promoting questionable dietary therapies. Popular diets often focus on limiting or regulating specific foods, using either speculative information or half-truths to explain reasoning. Unusual foods, food combinations or other eating rituals may be described. The examples are multiple but do not eliminate the presence of correct therapies.
Unverified dietary therapies exist for the treatment of chronic fatigue syndrome, premenstrual syndrome, arthritis, multiple sclerosis and numerous other medical problems. vegetarian diets are sometimes considered alternative diets, although nutritional needs can be relatively easily reached by adults who consume dairy but avoid meat (including poultry or fish). Diets that avoid any animal product may be nutritionally appropriate, although nutritional and vitamin B12 supplements may be necessary. Although a randomized clinical trial is the latest test of effectiveness, popular diet and disease theories are often derived from epidemiological studies, such as group/cohort, ecological and controlled studies.
These studies are useful for developing hypotheses, but associations between diets and disease can be altered by uncontrolled factors or by other potential determinants of health and disease. as in other medical therapies, the use of dietary therapies should be based on solid, rational data, not on "non-centralised"/unverified and certified experiences. Feelings of medical abandonment or necessity and desire to control the treatment of the disease can motivate patients to adopt popular diets. Such diets can be sought especially by the chronically ill. Caution to alternative dietary therapies, careful exploration, together with the patient, of nutritional habits in a non-critical manner, along with the patient's calming, are strategies that can limit the health risk of these diets.
A few general questions are essential for evaluating popular or alternative diets. Is the diet nutritionally appropriate and appropriate to the patient? comparing the components of the diet with nutritional guidelines may clarify this. Is the scientific basis of the diet rational? A minimum understanding of nutritional needs is required to assess the safety of the diet. Can there be risks or accidents with physical and psychological consequences? Even if the diet seems to involve health risks, some patients will choose such a regimen and their decision must be respected. It may help the suggestion to try such therapy within a limited time followed, to return for reassessment. Continuous monitoring of adverse effects, follow-up and support reduce the possibility of abandonment of conventional treatment.
In this respect it is important to promote adherence to dietary therapy. No dietary therapy can be effective if not followed or if it is followed incorrectly. Many factors such as complexity or dietary costs, social or environmental circumstances, the type and quality of the patient-clinician relationship, as well as the techniques of patient counseling and education will influence the adhesion. Compliance with traditional therapies of any type, including diet and medication, is low. Traditional approaches such as ensuring a meal plan and a food list are to be avoided because they are usually to no avail.
Similarly, the emergence of a conflict-like relationship between the doctor and the patient leads to failure. Large-scale clinical studies have shown that adhesion can be improved, even in complex diets, when dietary therapy includes specific behavioral and educational strategies. These strategies are based on new behavioural theories and a self-treatment approach, especially when dietary changes need to be maintained throughout life or diet changes need to be extended. The self-treatment approach involves a partnership relationship between the patient and the nutritional counsellor (for a long-term compliance, the patient must learn to solve a number of problems and believe in their own strengths).
A basic strategy for increasing adherence is to focus on positive behavior and proper food choices rather than dietary restrictions. One method is to start with a light diet (so it should be perceived by the patient) and identify the changes that the patient is willing and able to make. Built on goals that can be achieved, the patient can practice and develop abilities that allow him to continue his diet under specialized follow-up. Frequent contact with the doctor or nutritionist, who encourages the patient and strengthens progress, increases compliance and promotes motivational support.
For almost all patients, family involvement and assistance and social support are mandatory for the success of dietary therapy. Individual education and communication are necessary, as socio-cultural influences are involved in choices and eating habits. The success of dietary therapy is accentuated by working with a nutrition assistant. To obtain the accreditation of the dietitian requires a complete and approved training program, involving didactic components and supervised practice. The dietitian provides nutritional care in the hospital or outpatient, while the doctor has in assigning programs involving groups, community programs and in the field of public health. A dietitian can be a guide and support, translating nutritional and metabolic needs into specific food choices and developing strategies that allow the patient to change their dietary habits.
With this post I will be able to complete the presentation of the main elements about diet therapy. Let's continue the previous posts with liver disease!
The liver plays a central role in carbohydrate, lipid and protide metabolism. Liver failure leads to both decreased protein synthesis and increased protein catabolism, which, together with anorexia and reduced food intake, can lead to severe protein and energy malnutrition and limited liver regeneration and functional recovery capacity. In general, the more severe the malnutrition, the worse the prognosis. In patients with massive hepatic necrosis or portal hypertension, a diet rich in protein nitrogen may promote or accentuate hepatic encephalopathy, but severe restriction of protein intake should not be imposed if not necessary.
Patients with stabilized disease or minimal liver failure receive a protein intake of at least 1g/kg daily, with an energy intake suitable for efficient use of proteins (at least 30 kcal/kg/day). Patients with chronic stabilized liver disease should ensure adequate dietary intake, avoiding nutritional loss. In the case of progressive liver failure, protein intake may be altered due to encephalopathy.
Vegetable proteins are better tolerated than animal proteins, probably because plants contain less nonprotein nitrogen. Studies on the effects of specialized dietary preparations enriched with branched amino acids on amino acid and ammonia levels, as well as on liver encephalopathy have shown inconsistent results. When establishing the protein ration, the best attitude is to test the patient's tolerance by monitoring the neurological status when using 1g protein/ kg/ day (ideal intake). A protein intake of at least 0.5-0.75 g/kg/day or about 40g/day is recommended (a more severe restriction may lead to the catabolization of own proteins).
For some patients with liver disease, fat restriction (less than 30g/day) may be required by malabsorption and steatorea. Improved energy intake, restriction of long chain fatty acids may be associated with the use of medium chain triglyceride preparations, which are absorbed in the absence of bile salts. Water-emulsified forms of fat-soluble vitamins or other micronutrients may be used. Sodium restriction (less than 2g/day) is usually necessary due to edema and ascites, but very low levels (less than 1g/day) are not well tolerated and limit food choices, so increase the risk of malnutrition. Regular bread, dairy products, semi-prepared foods (except low sodium) should be removed to reach less than 1g/day sodium.
Let's move on to chronic neurological conditions now! Patients with Parkinson's disease have an increased risk of nutritional disorders due to the effects of the disease on the gastrointestinal tract. The varied degrees of dysphagia, with or without aspiration of gastric juice, and constipation lead to the nutritional depletion of these patients. Dietary advice is advisable to ensure an adequate regimen in the early stages of the disease. The decrease in the clinical effectiveness of levo-dopa, which usually occurs during Parkinson's disease and leads to motor variability and increased disability, can be improved by changing the schedule for protein intake. The interaction between protein intake and clinical response appears to be due to inhibition of levo-dopa reuptake in the central nervous system due to plasma amino acids.
Because of this, the restriction of protein in the diet during the day (less than 7g protein before dinner) reduces unforeseen variations in motor response during active, productive periods of the day. During the evening meal, increased amounts of protein-rich foods can provide daily needs. In motivated individuals who adhere to this regimen, symptoms usually improve and have no deterioration in nutrition status, but this regimen increases the risk of malnutrition when the diet is only apparently balanced.
Patients with Alzheimer's disease have more risk factors and more indicators of poor nutritional status than the rest of the elderly population. Decreased olfactory function produces bad eating habits and increases the risk of ingestion of altered foods, and dysphagia and refusal of nutrition are common. Agitation and wandering increase energy needs. The use of semi-solid or regular supplements is a way to increase the nutritional intake of these patients. During the course of the disease, monitoring of food intake is necessary to prevent weight loss and worsening of physiological and cognitive function due to malnutrition, but also to prevent dehydration, aspiration of gastric juice and increased risk of infectious diseases.
I've reached lung disease. Malnutrition is common in patients with chronic obstructive pulmonary disease (COPD). The area and mass of the diaphragm are reduced in relation to weight loss in malnourished patients with COPD compared to normoweight patients with COPD. Reducing carbon dioxide production and oxygen consumption in malnourished patients may predispose to lung infections. Patients with COPD and weight loss have a lower (and shorter) survival rate than those with stable weight. Limited evidence suggests that improving nutrition improves the strength and strength of the respiratory muscles, albeit in the short term. Patients with COPD have more than 10% higher basal energy needs due to increased respiratory exertion due to increased lung resistance and decreased respiratory muscle efficiency.
However, excessive energy intake can be inharm. Increasing carbon dioxide production by overeating with an energy excess (1.5 to 2.25 times higher than energy rest expenses), mainly from carbohydrates, can lead to overuse of breathing. Low carbohydrate -- (25-35% of kcal), lipid-rich (50-55% kcal) and energy (2 kcal/ml) enteral formulas were useful (improved lung function compared to lipid-rich and high-carbohydrate formulas - for example, 74% of the energy supplied by carbohydrates and only 9% of lipids). A diet containing 1.2 times more calories than the estimated energy needs at rest is a starting point in proper calorie administration with a protein level of 1.2-1.5 k/kg daily. However, individualized dietary therapy should avoid overoring patients.
There is also something to be presented about transitional diets (other types of diets). Changes in the consistency and texture of the diet may be important, especially for hospitalized patients. A simple liquid diet brings, orally, liquids, energy and nutrients, leaves minimal residues in the gastrointestinal tract, is used in the preparation of diagnostic procedures, as in the initial postoperative diet or after parenteral nutrition, as well as during acute gastrointestinal infections. These diets are not nutritionally appropriate in the absence of supplements and should not be used for more than three days. An additional liquid diet is liquid or semi-liquid at room temperature and is prescribed to patients with chewing disorders or as an intermediate diet to solid nutrition in patients who have undergone surgery or parenteral nutrition.
It may also be nutritionally inadequate in the absence of enteral nutritional supplements. A pasty diet, which includes pasty, crushed and liquid foods, is useful for patients who are diagnosed or have disorders that affect chewing. The light diet consists of foods that can be chewed more easily than those of the usual diet and includes soft and light solid meat, while avoiding raw fruits and vegetables, as well as wholemeal bread and cereals. Pasty and mild diets are nutritionally appropriate, ensuring an optimal amount and variety of food. Diets that eliminate a specific dietary compound, such as oxalations (in the treatment of hyperoxaluria), galactose (in the treatment of galactosemia) and gluten (in the treatment of celiac disease) have also been described.
Let us not forget the interactions of medicines with nutrients (in fact, I will dedicate a large number of posts to the interaction of medicines in the human body). A change in diet may be required due to the drug-nutrient interaction. Certain medicines or culinary habits can lead to impaired effectiveness of medicines and vice versa, medicines can change food needs. Absorption of medicines is usually slowed by food administration (therefore there are prescriptions before or after meals). Similarly, the metabolism of medicines can be affected by changes in protein intake and micronutrients, drugs can either reduce appetite and dietary intake potency, through central and/ or peripheral action (and many others - I will not go into details).
And complete this series of posts with alternative dietary therapies! New or alternative dietary therapies are promoted by popular nutritional literature, which is developed by a lot of practitioners, who develop and recommend various dietary therapies based on various reasonings and experimental data. In addition, both practitioners and patients may have beliefs and attitudes that can be classified as fadism, cultism or food quackery-ism. Food fadism is an exaggerated belief in the specific effects of nutrition on health and disease. Food worship involves certain religious or philosophical beliefs about food, often with the emergence of a charismatic authoritarian figure.
Food Quackerism carries the presumption of fraud, but refers to people who are sincere in their beliefs jump misguided in promoting questionable dietary therapies. Popular diets often focus on limiting or regulating specific foods, using either speculative information or half-truths to explain reasoning. Unusual foods, food combinations or other eating rituals may be described. The examples are multiple but do not eliminate the presence of correct therapies.
Unverified dietary therapies exist for the treatment of chronic fatigue syndrome, premenstrual syndrome, arthritis, multiple sclerosis and numerous other medical problems. vegetarian diets are sometimes considered alternative diets, although nutritional needs can be relatively easily reached by adults who consume dairy but avoid meat (including poultry or fish). Diets that avoid any animal product may be nutritionally appropriate, although nutritional and vitamin B12 supplements may be necessary. Although a randomized clinical trial is the latest test of effectiveness, popular diet and disease theories are often derived from epidemiological studies, such as group/cohort, ecological and controlled studies.
These studies are useful for developing hypotheses, but associations between diets and disease can be altered by uncontrolled factors or by other potential determinants of health and disease. as in other medical therapies, the use of dietary therapies should be based on solid, rational data, not on "non-centralised"/unverified and certified experiences. Feelings of medical abandonment or necessity and desire to control the treatment of the disease can motivate patients to adopt popular diets. Such diets can be sought especially by the chronically ill. Caution to alternative dietary therapies, careful exploration, together with the patient, of nutritional habits in a non-critical manner, along with the patient's calming, are strategies that can limit the health risk of these diets.
A few general questions are essential for evaluating popular or alternative diets. Is the diet nutritionally appropriate and appropriate to the patient? comparing the components of the diet with nutritional guidelines may clarify this. Is the scientific basis of the diet rational? A minimum understanding of nutritional needs is required to assess the safety of the diet. Can there be risks or accidents with physical and psychological consequences? Even if the diet seems to involve health risks, some patients will choose such a regimen and their decision must be respected. It may help the suggestion to try such therapy within a limited time followed, to return for reassessment. Continuous monitoring of adverse effects, follow-up and support reduce the possibility of abandonment of conventional treatment.
In this respect it is important to promote adherence to dietary therapy. No dietary therapy can be effective if not followed or if it is followed incorrectly. Many factors such as complexity or dietary costs, social or environmental circumstances, the type and quality of the patient-clinician relationship, as well as the techniques of patient counseling and education will influence the adhesion. Compliance with traditional therapies of any type, including diet and medication, is low. Traditional approaches such as ensuring a meal plan and a food list are to be avoided because they are usually to no avail.
Similarly, the emergence of a conflict-like relationship between the doctor and the patient leads to failure. Large-scale clinical studies have shown that adhesion can be improved, even in complex diets, when dietary therapy includes specific behavioral and educational strategies. These strategies are based on new behavioural theories and a self-treatment approach, especially when dietary changes need to be maintained throughout life or diet changes need to be extended. The self-treatment approach involves a partnership relationship between the patient and the nutritional counsellor (for a long-term compliance, the patient must learn to solve a number of problems and believe in their own strengths).
A basic strategy for increasing adherence is to focus on positive behavior and proper food choices rather than dietary restrictions. One method is to start with a light diet (so it should be perceived by the patient) and identify the changes that the patient is willing and able to make. Built on goals that can be achieved, the patient can practice and develop abilities that allow him to continue his diet under specialized follow-up. Frequent contact with the doctor or nutritionist, who encourages the patient and strengthens progress, increases compliance and promotes motivational support.
For almost all patients, family involvement and assistance and social support are mandatory for the success of dietary therapy. Individual education and communication are necessary, as socio-cultural influences are involved in choices and eating habits. The success of dietary therapy is accentuated by working with a nutrition assistant. To obtain the accreditation of the dietitian requires a complete and approved training program, involving didactic components and supervised practice. The dietitian provides nutritional care in the hospital or outpatient, while the doctor has in assigning programs involving groups, community programs and in the field of public health. A dietitian can be a guide and support, translating nutritional and metabolic needs into specific food choices and developing strategies that allow the patient to change their dietary habits.
Love, Understanding and
Gratitude!!!
Dorin, Merticaru