Successful treatment of most diseases requires not only drug therapy, but also rational therapeutic nutrition. Therapeutic diets have been developed for various diseases. Patients who adhere to the principles of therapeutic and preventive nutrition, as a rule, recover faster and have fewer relapses of chronic diseases.

In many cases, exacerbation of the disease is associated precisely with a violation of the diet. Examples include chronic pancreatitis, hypo- or hyperglycemic comas in diabetes mellitus, type 2 hypertensive crises in patients with arterial hypertension.

For rational and therapeutic nutrition, it is important not only what foods you eat, but also the method of cooking them, the frequency of meals, etc.

The main goal of a prescribed therapeutic diet for a disease is to influence the cause that caused it. It may even be the only treatment option for the disease. This happens with metabolic disorders, kidney diseases, and diseases of the gastrointestinal tract. However, most often dietary and therapeutic nutrition is combined with other methods of treatment.

In any medical or preventive institution, as well as in schools and kindergartens, you can find examples of therapeutic and preventive nutrition.

The Institute of Nutrition of the Russian Academy of Medical Sciences has developed special therapeutic diets. There are 15 of them in total. Some diets for diseases may include subgroups, because at the beginning of many diseases, the requirements for the diet, its calorie content and the mechanism for preparing dishes may be more stringent than when the clinic fades or during a period of remission.

Diets for diseases No. 1, 2, 5, 9, 10, 15 can be followed by the patient for a long time, because correctly balanced in all respects: calorie content, ratio of nutrients, etc. This cannot be said about diets No. 4, 5a, 8. They are used in short courses for relevant pathologies.

The main condition and principle of rational and therapeutic nutrition is adherence to the principles of sparing the body from the mechanical, thermal or chemical effects of food.

Mechanical sparing involves eating foods that have been crushed, pureed, etc. Such food enhances the motility of the gastrointestinal tract and helps normalize its functioning.

Chemical sparing implies the exclusion of sour, spicy, salty, fried foods from the therapeutic diet, because. they are able to enhance the secretory activity of the gastrointestinal tract, and some have a stimulating effect on the entire body.

Thermal sparing involves eating foods whose temperature is in the range of 15-65°C.

To maintain a proper diet during illness, the frequency of meals is also important. Experts recommend five and six meals a day. The intervals between meals should be about 4 hours. The last meal is no later than 2-3 hours before going to bed.

Characteristics of individual therapeutic diets for diseases

And a person’s ability to work.

By changing the nature of nutrition, you can 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 for a healthy person, which changes qualitatively and quantitatively according to the disease of an organ or an entire organ system.

Dietary measures either completely eliminate certain nutrients from the diet, or prepare them technologically in such a way that the impaired functions are compensated. For example, in diabetes mellitus, when the disturbance in the absorption of carbohydrates changes, simple sugars are temporarily or completely eliminated from food, and the inclusion of foods rich in starch is limited. In some cases, simple sugars are replaced with sweeteners. For gastritis with hypersecretion of gastric juice, food substances that are strong irritants of gastrointestinal secretion are excluded from the diet.

Sparing

These techniques constitute the principles of dietary (therapeutic) nutrition, the so-called “sparing”. There are three types of sparing: mechanical, chemical, thermal.

Mechanical sparing is achieved mainly by grinding food, as well as by an appropriate method of heat treatment - grinding cooked food (steamed or in water).

Chemical sparing is achieved by eliminating or limiting those nutrients that can further disrupt the functions of the diseased organ, as well as by changing the method of culinary processing.

Thermal sparing- exclusion of strong thermal irritants from food, i.e. very cold or very hot food. The temperature of the first and second hot courses should not be higher than 60°, snacks and drinks should not be lower than 15°. This must be taken into account, since hot dishes have a juice-like effect and weaken gastric motility, while cold foods reduce gastric secretion and increase motility. Thermal sparing is used mainly for gastrointestinal diseases.

When prescribing a particular diet, it is necessary to take into account the overall impact of foods and dishes on the gastrointestinal tract. For example:

• foods that quickly leave the stomach (dairy products, soft-boiled eggs, fruits and berries);
• slowly digestible foods (fresh bread, refractory fats, fried meats, legumes);
• having a pronounced juice effect - nitrogenous extractive substances (mushrooms (broths made from them), cheese, spices, cabbage, cucumbers, smoked meats);
• those with a weak juice effect (milk and dairy products, boiled vegetables and fruits, boiled meat, green peas, butter, fresh cottage cheese, soft-boiled eggs);
• having a laxative effect (prunes, vegetable oil, xylitol, sorbitol, cold vegetable dishes, cold vegetable juices, sweet drinks, vegetables and fruits, one-day kefir, cold mineral water, wholemeal bread);
• reverse action (hot dishes, jelly, rice and semolina porridge, flour dishes, cocoa, coffee, chocolate);
• have a choleretic effect (vegetable oil, especially olive oil, vegetables rich in plant fiber, tomatoes, grated radish with vegetable oil, beets, sorbitol, xylitol);
• cause flatulence (legumes, fresh bread, especially rye, white cabbage, whole milk);
• stimulate the central nervous system (meat and fish broths, cocoa, strong tea, herbs, spices).

For some diseases (obesity, atherosclerosis, hypertension, etc.), fasting diets are used, the purpose of which is to ensure the most complete sparing of the affected organs and systems, to help normalize metabolism and remove excessive amounts of adversely active substances from the body. This is achieved by sharply reducing the energy value of the diet and the content of nutrients that burden the functioning of diseased organs.

The diet is very important in dietary nutrition. The number of meals a day is increased to five. Accordingly, the intervals between meals are reduced (up to 3-4 hours). Due to a decrease in appetite in patients, it is necessary to strictly observe the timing of meals, with the exception of diet No. 1 (for gastritis with increased secretion of gastric juice) and diet No. 8 (obesity). Some diets recommend a more even distribution of calories across meals. The assortment of dishes, culinary processing of food, which improves the taste of dietary dishes and ensures all types of pacing, preserves the biological value of the diet and optimal digestibility of nutrients, is important.

Characteristics of basic diets

Dietary nutrition is used both in hospitals (hospitals) and in sanatoriums. In our country, a group number system for prescribing therapeutic nutrition is used. The main diets are designated by corresponding numbers from No. 1 to No. 15. The most common diets are No. 1, 2, 5, 7, 8, 9, 10, 15.

Diet No. 1

Indications: inflammatory diseases of the stomach (gastritis) with impaired secretory and motor functions, gastric and duodenal ulcers. The causes of these diseases are systematic violation of the diet, consumption of very hot and spicy food for a long period, very hot or cold food, poor chewing, dry food, nervous system disorder, smoking, alcohol abuse.

Purpose of destination. Normalize the secretory and motor functions of the stomach, stimulate the process of restoration of the mucous membrane and promote the healing of ulcers.

general characteristics. A complete diet. All types of sparing are used.

Mechanical sparing. All dishes are prepared boiled (in water or steamed), chopping, pureed dishes, meat is consumed without tendons, cartilage, fish and poultry - without skin.

Chemical sparing. The diet excludes extractive substances (strong meat, fish, mushroom broths, all sour dishes and salty, fermented foods, all types of spices, except dill and parsley). It is not recommended to use strong tea, coffee, or fried foods.

The diet is 5 meals a day, with short breaks and small portions.

Diet No. 2

Indications: inflammatory processes of the gastric mucosa, gastritis with reduced secretion of gastric juice, chronic inflammatory diseases of the small (enteritis) and large intestines (colitis).

Purpose of destination. Stimulate the secretory function of the stomach, normalize the motor function of the stomach and intestines, reduce putrefactive and fermentative processes in the gastrointestinal tract.

The causes of stomach diseases are similar to those described in diet No. 1. A common cause of intestinal diseases are intestinal infections (food poisoning, dysentery, etc.), consumption of rough food (unripe vegetables and fruits), disordered eating, nervous system disorders, etc. d.

General characteristics. A complete diet. Moderate mechanical, chemical and thermal sparing is used.

Chemical sparing involves eliminating excess fat, which inhibits gastric secretion.

Dishes that are difficult to digest, irritating the mucous membrane of the gastrointestinal tract, increasing fermentation (whole milk, white cabbage, rye bread, sweet fruit juices, sweets, etc.), rotting (fried meat dishes in large quantities) are excluded.

To stimulate gastric secretion, extractive substances from meat, fish and mushroom broths are used, but they must be secondary, since it is necessary to reduce the fat content in the broths. The same goal is pursued by maintaining a diet, especially strictly observing the time of eating to develop a conditioned food reflex. The conditions of eating, table setting, and organoleptic characteristics of the food are also important. The correct composition of the menu is also important, especially for lunch - including a snack and a hot dish.

Meal regimen: 5 meals a day, 4 meals a day allowed. Diet No. 5

Indications: acute and chronic diseases of the liver (hepatitis), gall bladder (cholecystitis), cholelithiasis.

Purpose of destination. Help normalize the activity of the liver and gallbladder and prevent the formation of stones.

The most common causes of these diseases are infections of the biliary tract and violation of the principles of rational nutrition: overeating, especially foods rich in animal fats, cholesterol (meals and gastronomic products made from fried meat, offal, goose, duck, eggs); restriction in the diet of protein, vegetable oils, vegetables with a choleretic effect, grain products rich in dietary fiber; abuse of salt, pickled vegetables, vegetables containing oxalic acid (sorrel, spinach, rhubarb, etc.), fried foods; non-compliance with the diet (food intake is a stimulus for bile secretion: the less often a person eats, the longer and more bile stagnates in the gallbladder).

General characteristics. A complete diet, but with a limitation of refractory fats, and the inclusion of an increased amount of lipotropic substances in the diet. Also excluded are products rich in extractives, purines, cholesterol, oxalic acid, essential oils, and fat oxidation products. To normalize liver function, in addition to lipotropic substances, it is necessary to include fiber, pectin substances and a lot of liquid.

Diet - 5 times a day, in small portions at the same time.

Diet No. 7

Indications: acute and chronic inflammation of the kidneys (nephritis).

Purpose of destination. Sparing the affected organ and removing excess fluid and nitrogenous waste from the body.

general characteristics. The diet is complete, with some protein restrictions. The fluid content in the diet is reduced, all dishes are prepared without salt, 3-4 g of salt are given to the patient, dishes rich in extractive substances, foods rich in oxalic acid and essential oils are excluded. Your diet should include foods rich in potassium.

Diet - 5 times, 4 times allowed.

Diet No. 8

Indications: obesity as a primary disease or concomitant with other diseases.

The main causes of obesity are physical inactivity, excess nutrition, rare but plentiful meals, abuse of fatty gastronomic products and flour confectionery products, sweets, and spices.

Purpose of destination. Normalize body weight, promote metabolism restoration.

General characteristics. The diet is incomplete. Calorie restriction due to carbohydrates (digestible) and partly fats (animal). Excluding appetite-stimulating foods and dishes, confectionery and sweets from the diet, limiting salty foods and liquids.

Including increased amounts of seafood and fiber-rich foods in the diet.

Diet: 5-6 meals a day.

Diet No. 9

Indications: contribute to the normalization of carbohydrate metabolism, prevention of lipid metabolism disorders.

General characteristics. A diet with a moderately reduced energy value due to the exclusion of easily digestible carbohydrates and fats of animal origin. Complex carbohydrates (starch) and foods that burden the liver, containing cholesterol, and extractive substances are limited.

In the diet, the content of lipotropic substances, vitamins (especially vitamin C and the B group of vitamins), and dietary fiber is increased. Food is prepared boiled and baked.

For sweet dishes, sweeteners are used - xylitol and sorbitol.

Diet: 5-4 meals a day.

Diet No. 10

Indications: for diseases of the cardiovascular system (hypertension, coronary heart disease, myocardial infarction, atherosclerosis).

Purpose of destination. Help restore impaired blood circulation, normalize liver and kidney function, and slow the progression of atherosclerosis.

General characteristics. The diet excludes substances that stimulate the central nervous system and the cardiovascular system, strong tea, coffee, cocoa, chocolate, meat, fish, mushroom broths, spicy dishes, smoked meats, and foods rich in cholesterol. Limit vegetables that cause flatulence (radish, cabbage, garlic, onions, legumes), and carbonated drinks. Products of predominantly alkaline orientation (containing K, Mg, Ca salts) are recommended.

The share of vegetable fats increases (up to 40%). The diet is enriched with dietary fiber, vitamins C, P, E, carotenes, and iodine.

Limiting salt and water.

Diet: 4-5 meals a day.

Diet No. 15

Indications: various diseases that do not require the use of special diets, as well as a transitional diet during the recovery period from special medical nutrition to a balanced diet.

Purpose of destination. Provide physiological needs for nutrients and energy.

General characteristics. The diet is physiologically complete, rich in biologically valuable substances: essential amino acids, unsaturated fatty acids, vitamins. Table salt - 10-15 g, free liquid 1.5-2 l. Avoid hard-to-digest foods and dishes, spicy foods and spices, and smoked foods.

Diet- 4 times.

Order No. 330 of the Ministry of Health of the Russian Federation

Information letter from the Ministry of Health of Russia dated 04/07/2004, which provides clarifications, additions and clarifications to the specified document. It says that a new nomenclature of diets (a system of standard diets) is being introduced into health care facilities, which differ from each other in the content of basic nutrients and energy value, food preparation technology and the average daily set of food products.

Previously used diets of the number system (1-15) are combined or included in the system of standard diets, which are prescribed for various diseases depending on the stage and severity or complications of the organs or body systems.

Table 1. System of standard diets

The introduction of a new nomenclature of diets (a system of standard diets) into the work of medical institutions provides for the possibility of using in these institutions an individual approach to dietary therapy for a specific patient with a specific disease (Tables 1, 2).

Table 2. Chemical composition and energy value of standard diets

Diet therapy is a therapeutic factor that is an integral part of complex therapy for any disease. Diet therapy is often much more effective than other therapeutic methods.

Nutritional therapy is a preventative measure that prevents exacerbation of chronic pathologies and is an important component of the rehabilitation program.

Basic principles of diet therapy

The basis of diet therapy is the following principles:

· rational nutrition with various additions and changes;

· providing the body with a sufficient amount of energy: calorie content is determined taking into account age, gender, severity of the condition, the patient’s regimen, the nature of the disease (obesity requires limiting foods with high calorie content, tuberculosis requires increasing their consumption, etc.);

· balanced, nutritious nutrition, taking into account the patient’s body’s need for certain nutrients (to avoid the appearance of nutritional deficiencies, the diet should not be long and one-sided;

· determining the choice of diet in accordance with the state of the digestive system, the activity of which may be impaired due to diseases;

· choosing a diet in accordance with the metabolic state suffering from various pathologies;

· use of a specific list of products in each diet;

· introduction of foods with healing properties into the diet;

· dietary adjustments in the case of physiotherapeutic procedures and physical therapy;

· control over individual tolerance to foods recommended for consumption in the diet;

· use of high quality, environmentally friendly products;

· the basic principles of diet therapy involve the use of culinary processing methods that allow maximum preservation of the nutritional properties of products;

· mechanical, chemical and temperature sparing of affected organs;

· use of sanitary and epidemiologically impeccable products in the diet;

· maintaining a proper diet;

· differentiated approach in choosing a diet depending on the disease.

List of diets according to indications

Specialists at the clinical nutrition clinic have developed indications for the use of diets, each of which is assigned an individual number:

No. 1 - for peptic ulcers of the stomach and duodenum, with increased acidity of gastric juice;

No. 2 - for chronic gastritis with low acidity, enterocolitis;

No. 3 - for disorders of intestinal motor function (constipation);

No. 4 - for intestinal disorders (diarrhea);

No. 5 - for chronic diseases of the liver and gall bladder;

No. 6 - for gout, uric acid diathesis;

No. 7 - for renal pathologies;

No. 8 - for obesity;

No. 9 - for diabetes;

No. 10 - for cardiovascular diseases;

No. 11 - for lung diseases;

No. 12 - for diseases of the nervous system;

No. 13 - for acute infectious diseases;

No. 14 - for oxalaturia, phosphaturia;

No. 15 - for various diseases during the period of recovery and return to the usual diet after using therapeutic diets.

Diets can be strict (there is no right to choose dishes) or extended (you can choose dishes).

Each diet differs from the other in individual characteristics: purpose, chemical composition, specific calorie content, list of permitted and prohibited foods, cooking methods, diet and physical properties of food (weight, consistency and temperature).

All indicated principles of dietetics are the basis, general recommendations for diet. If it is necessary to prescribe a therapeutic diet, the doctor determines the most important requirement in each individual case. Some diseases require the selection of a method of culinary processing of products, others - a certain composition of products.

The most important principles of dietetics concern the variety of foods that can be consumed during a diet, diet and avoiding overeating.

To avoid harm to the body, like any method of treatment, the diet must be prescribed strictly by a doctor. We must also not forget that diet therapy cannot be an independent health remedy.

The patient’s nutrition is of great importance not only for restoring losses in the body that occur during illness and for maintaining strength, but also as an effective remedy. Modern science has established that for any disease, the diet has a certain effect, and in some cases has a decisive influence on the course and outcome of the disease. Consequently, the patient’s nutrition must be based on certain therapeutic principles, which is why it is called therapeutic. And from this follows its definition.

Therapeutic nutrition is the use of specially formulated food rations and routine nutrition for sick people for therapeutic or prophylactic purposes. Therapeutic nutrition most effectively promotes recovery if it is used in combination with such therapeutic factors as medicinal plants, mineral waters, physical therapy and massage. You can use nutritional therapy at home only as prescribed by a doctor. Nutritional therapy carried out without the advice of a doctor and his instructions may, instead of the expected benefit, cause harm to the patient.

Therapeutic nutrition is prescribed in the form of food rations, which consist of certain products that are subjected to appropriate culinary processing. A therapeutic food diet is called a “healing table” or “diet”. The word “diet”, which in Ancient Greece meant “way of life, diet”, after multiple transformations from the original dio, dies (day) is today interpreted as “diet and diet prescribed to the patient.” Nowadays, the science of nutrition includes dietetics, which studies the nutrition of healthy and sick people, develops the basics of rational nutrition and methods of its organization, and diet therapy (nutrition therapy), i.e. The treatment method involves using a specific diet.

Thus, today diet is considered not only one of the effective means of complex treatment of many ailments, but also a means of promoting their prevention.

The Institute of Nutrition has developed and tested extremely effective special diets for several years. Now they are widely known even outside our country.

Some diets, such as those for diabetes and obesity, must not only contain certain foods, but the daily diet as a whole for these diseases must have a strictly established chemical composition. When a doctor prescribes such diets, the patient must follow a certain menu, and each dish in these cases must be prepared exactly according to the prescribed standards.

In order to benefit from therapeutic nutrition (diet), i.e. the diet and composition of food in the treatment of diseases, it is necessary to keep in mind several simple and easy-to-understand provisions:

First. Therapeutic nutrition should promote a targeted effect on metabolism; it should both treat and prevent the exacerbation of many diseases. Thus, for obesity, a low-calorie diet is prescribed, which limits the consumption of easily absorbed carbohydrates (sugar, sweets), which helps to reduce body weight. In the diet of patients with diabetes, the use of easily absorbed carbohydrates, the excess of which contributes to an increase in blood sugar levels, is reduced.

Second. It is necessary to follow a diet: eat regularly, at the same hours. In this case, a conditioned reflex is developed: at a set time, gastric juice is most actively secreted and the most favorable conditions for the digestion of food arise. The human body, especially during intense physical or mental work, is not at all indifferent whether it receives food after 3-4 hours or after 10 hours. It costs us too much to eat this kind of food when systematically, over the course of months or even years, breakfast is tea or coffee with a sandwich, lunch is again sandwiches or pies, and dinner is a hearty lunch. Such irregular nutrition leads to an increase in the incidence of gastritis, cholecystitis, and contributes to the increase in excess body weight.

It is a common belief that if an obese person wants to lose weight, he should eat less and less often, say, twice a day. This is not true. Rare meals cause a feeling of extreme hunger, and such a regime, in the end, only leads to overeating. A person eats more in two meals than with four or five meals a day, because with a strong feeling of hunger it is difficult to control his appetite. If you are overweight, frequent, split meals are necessary. In any case, you need to eat at least three to four times a day. It is recommended to have dinner no later than an hour and a half before bedtime: eating a large meal before bedtime contributes to obesity and makes sleep restless. But don’t go to extremes and go to bed hungry. For some diseases, for example, disease of the resected stomach, six divided meals a day are recommended.

Third. It is necessary to diversify your diet. If the food is varied and includes products of both animal (meat, fish, eggs, milk, cottage cheese) and plant origin (vegetables, fruits, cereals, bread), then you can be sure that the body will receive everything it needs for life.

We can identify the main food groups that should be represented in everyday nutrition.

1. milk and dairy products (milk, kefir, yogurt, cottage cheese, etc.);
2. vegetables, fruits, berries (fresh and sauerkraut, potatoes, carrots, beets, tomatoes, cucumbers, lettuce, pumpkin, apples, currants, strawberries, etc.);
3. meat, poultry, fish, eggs (sources of animal protein);
4. bakery products, pasta, cereals;
5. fats (butter and vegetable oil);
6. sweets (sugar, honey, confectionery).

The diet should be varied.

Fourth. It is necessary to individualize therapeutic nutrition: treat not the disease, but the patient.

The doctor must take into account the form and stage of the disease, metabolic characteristics, body weight, concomitant diseases, as well as the habits and tastes of the patient, if they are reasonable and do not harm health.

When talking about the individualization of therapeutic nutrition, it is necessary to take into account intolerance and food allergies to certain foods. There is no need to include in the diet even dishes that are very healthy in chemical composition if the patient does not tolerate them well due to various circumstances.

Fifth. It is necessary to take into account the calorie content and chemical composition of main products and dishes in order to create a therapeutic diet.

The caloric content and chemical composition of the diet are of paramount importance for many ailments, but especially for obesity and diabetes mellitus, which often occurs in combination with many diseases. Properly selected products can play the role of a remedy. With mild forms of diabetes, you can often do without medications at all, you just need to choose the appropriate diet. As with obesity, with diabetes, the consumption of easily digestible carbohydrates (sugar, sweets, flour products), which contribute to an increase in blood sugar levels and the formation of excess fat tissue, is limited first of all; they are replaced with xylitol, sorbitol, etc. If you are overweight, it is recommended to include low-calorie foods such as cucumbers, zucchini, pumpkin, and low-fat cottage cheese in your diet.

The necessary components of food are not only proteins, fats, carbohydrates, minerals, vitamins, but also ballast substances - dietary fiber. They play an important role in normalizing the activity of the gastrointestinal tract, affecting its peristalsis, the rate of absorption of nutrients in the small intestine, the habitat of bacteria in the intestine, and are one of the important sources of nutrition for them.

Sixth. You need to know the most appropriate culinary processing of products.

They say that cooking is the key to health. The doctor must know himself and be able to explain to the patient that, for example, during an exacerbation of peptic ulcer of the stomach and duodenum, accompanied by an increase in the secretion of gastric juice, rich meat broths are excluded from the diet: they contain too many extractive substances that serve as chemical irritants to the gastric mucosa. Patients are prescribed a diet that is as gentle as possible on the stomach: foods are advised to either be boiled or steamed, soft-boiled eggs or in the form of a steam omelet, semolina porridge, rice porridge or prepared from Hercules oatmeal are recommended.

Seventh. Be sure to take into account concomitant diseases when creating a diet. Most patients, especially those over 40 years old, quite often have more than one disease, but several. Therefore, for example, in case of chronic cholecystitis combined with obesity, the consumption of fried foods and rich broths is limited, a significant amount of pure fat is excluded - lard, fatty meat, a large piece of butter, etc., and at the same time the calorie content is reduced diet, the consumption of sugar, sweets, confectionery products is minimized, fasting days are periodically prescribed - vegetable, cottage cheese, etc. - subject to good tolerance.

Medical nutrition in some cases can be the main and only therapeutic factor, in others it can be a general background that enhances the effect of other factors, favoring drug treatment. Thus, for some forms of large intestinal dyskinesia, accompanied by constipation, to achieve a therapeutic effect, it is enough to include in the diet salads, vinaigrettes from various vegetables - beets, carrots, cabbage, cucumbers, seasoned with vegetable oil, bread with bran.

Therapeutic nutrition most effectively promotes recovery if it is used in combination with such therapeutic factors as medicinal plants, mineral waters, physical therapy and massage.

Basic principles of therapeutic nutrition

Medical nutrition is an essential element of complex therapy. It is usually prescribed in combination with other types of therapy (pharmacological drugs, physiotherapeutic procedures, etc.). In some cases, with diseases of the digestive system or metabolic diseases, therapeutic nutrition plays the role of one of the main therapeutic factors, in others it creates a favorable background for more effective implementation of other therapeutic measures.

In accordance with the physiological principles of constructing food rations, therapeutic nutrition is structured in the form of daily food rations, called diets. For practical use, any diet must be characterized by the following elements: energy value and chemical composition (a certain amount of proteins, fats, carbohydrates, vitamins, minerals), physical properties of food (volume, weight, consistency, temperature), a fairly complete list of permitted and recommended foods products, peculiarities of culinary processing of food, diet (number of meals, meal times, distribution of daily ration between individual meals).

Diet therapy requires a differentiated and individual approach. Only taking into account the general and local pathogenetic mechanisms of the disease, the nature of metabolic disorders, changes in the digestive organs, the phase of the pathological process, as well as possible complications and concomitant diseases, the degree of fatness, age and gender of the patient, can it be possible to correctly build a diet that can have a therapeutic effect, both on the affected organ and on the entire body as a whole.

Therapeutic nutrition should be based on the physiological needs of the patient’s body. Therefore, any diet must satisfy the following requirements:

1. vary, but its energy value in accordance with the energy expenditure of the body;
2. provide the body’s need for nutrients, taking into account their balance;
3. cause optimal filling of the stomach, necessary to achieve a slight feeling of satiety;
4. satisfy the patient’s tastes within the limits allowed by the diet, taking into account food tolerance and menu variety. Monotonous food quickly becomes boring, contributes to the suppression of an already often reduced appetite, and insufficient stimulation of the digestive organs impairs the absorption of food;
5. ensure proper culinary processing of food while maintaining the high taste of food and the valuable properties of the original food products;
6. observe the principle of regular nutrition. Therapeutic nutrition should be quite dynamic. The need for dynamism is dictated by the fact that any therapeutic diet in one way or another is restrictive, and, therefore, one-sided and incomplete. Therefore, long-term adherence to particularly strict diets can lead, on the one hand, to partial starvation of the body in relation to certain nutrients, and on the other, to the detraining of impaired functional mechanisms during the recovery period. The necessary dynamism is achieved by applying the principles of sparing and training widely used in diet therapy. The principle of sparing involves the exclusion of nutritional factors that contribute to the maintenance of the pathological process or its progression (mechanical, chemical, thermal irritants, etc.). The principle of training is to expand the initially strict diet by removing the restrictions associated with it in order to switch to a full-fledged diet.

Loading diets (“plus - zigzags”) are used in accordance with the principle of training. They are also called “holidays”. They provide for the inclusion in the diet of nutrients, the content of which is either sharply limited or completely excluded from the main diet. Periodic administration (initially 1 rai in 710 days) of loading diets contributes to the jerky stimulation of weakened functions. These diets provide the introduction of deficient nutrients into the body, cause an increase in appetite as a result of introducing variety into the patient’s diet, and facilitate the tolerance of often long-term and very strict dietary regimes. Stress diets, moreover, are a functional test. Good tolerance of a loading diet has an important psychoprophylactic value: it strengthens the patient’s confidence in the positive changes that have occurred and indicates the possibility of transferring to a more expanded diet. A gradual increase in the frequency of loading days and the degree of loading, with good tolerance, leads to the fact that the main diet can become a loading one, and the previously main one becomes an unloading one. Thus, a zigzag transition is made from a strict to a more varied and nutritious diet.

Fasting diets (“minus zigzags”) are based on limiting energy value or are associated with a targeted restructuring of the chemical composition of the diet, ensuring the sparing of damaged functional mechanisms, as well as the correction of metabolic disorders. Special fasting days can be periodically (once every 710 days) prescribed for a number of diseases (from the beginning of treatment against the background of relatively strict diets). Carrying out fasting days is advisable even after the restoration of impaired functions, since during this period they are characterized by some lability and require periodic unloading and sparing.

Recommended for diseases of the cardiovascular system (hypertension, circulatory failure, atherosclerosis and coronary heart disease with obesity); for obesity; diabetes mellitus with obesity; acute diseases of the stomach and intestines in the first days of treatment; kidney diseases (acute nephritis, kidney failure), diseases of the liver and biliary tract (exacerbation of chronic cholecystitis, cholelithiasis, liver failure, etc.); gout; urolithiasis.

Based on the predominance of food products in diets, fasting diets are divided into vegetarian - only plant foods (fruits, potatoes, vegetables, rice), dairy (milk, cottage cheese, etc.), sugar, meat and fish, liquid (vegetable and fruit juices). Fasting diets are deficient in chemical composition and energy value and can cause hunger. Therefore, at home, fasting diets are prescribed for 12 days and no more than 12 times a week, taking into account the nature of the disease, the tolerability of certain diets and the conditions of treatment at home in case of acute or exacerbation of a chronic disease, in case of a chronic disease with preserved ability to work and return to work. In the latter case, fasting diets should be timed to coincide with weekends. If these diets are used for two days in a row, then it is advisable to vary them: for example, for obesity, the first day is an apple diet, the second is a meat (fish) diet.

Nutrition– entry into the body of substances necessary to cover energy consumption, build and renew body tissues and regulate body functions.

Diet– the diet of a healthy and sick person consists of the qualitative composition of food, the amount of food (total and individual components), the time and frequency of meals.

Diet therapy is the use of nutrition for medicinal purposes. It is an integral part of the healing process.

Medical nutrition– this is the nutrition of a sick person, providing his physiological needs for nutrients and having a therapeutic effect on the course of the disease.

Basic principles of rational nutrition– completeness, variety, moderation.

Dietary regime depends on the nature of the disease, its stage, the patient’s condition and his individual characteristics.

Most diets, especially those prescribed for a long time, contain physiological norms of all nutrients.

If there is an increased need for some of them due to a disease, the content of individual components may be increased. In some cases, it is recommended, on the contrary, to limit or eliminate foods that have an adverse effect on the course of the disease.

Sometimes For a short period of time, a physiologically inadequate diet or starvation may be prescribed.

Finally, the treatment of some patients requires changes regime food and character culinary processing of products.

REMEMBER! To organize dietary nutrition, you first need to determine:

qualitative composition of food (increase or reduce proteins, fats, carbohydrates, etc. in the diet) and its quantity;

the nature of the culinary processing of products (degree of grinding, heat treatment: boiling by steam or in water, baking, etc.);

diet (meal times).

Basic principles of therapeutic nutrition.

One of the basic principles of therapeutic nutrition, as well as nutrition in general, is:

Balance food ration (the amount of food products that meet a person’s daily need for nutrients and energy), i.e. compliance with certain ratios proteins, fats, carbohydrates, vitamins, minerals and water in necessary for the human body proportions.

When determining the composition of the diet, it is also necessary to take into account it energy value and compliance with the body’s energy costs - energy consumption to maintain the body’s basal metabolism and various human physical efforts.

Medical nutrition also requires adherence to certain power mode. The most optimal diet for a healthy person is considered to be 4 meals a day, and for some groups of patients 5, 6 and even 8 meals a day.

The daily ration should be distributed as follows (as a percentage of the total energy value of the day):

Breakfast – 30 – 35%;

Lunch – 35 – 40%;

Dinner - no more than 25 - 30%.

Characteristics of diets.

№ diets	Indications for use	Destination purpose	General characteristics	Calorie content and composition	Diet
Diet No. 1a			Eliminates substances that stimulate the secretion of gastric juice. Food is given mainly in liquid and semi-liquid form. Calorie intake is limited mainly through carbohydrates. Table salt is limited	Proteins 80 g, of which at least 50 g are of animal origin, fats 80 - 90 g, carbohydrates 200 g, calories 2000	Frequent meals (every 2 - 3 hours) in small portions, at night - milk or cream
Diet No. 1b	Exacerbation of peptic ulcer during the first 8–10 days of treatment and with bleeding; exacerbation of gastritis with increased secretion; esophagus burn	Maximum sparing of the stomach with the exception of chemical, mechanical and thermal irritants	Eliminates substances that stimulate the secretion of gastric juice. Food is given mainly in liquid and semi-liquid form. To the products add crackers from white bread, dry biscuit, pureed cottage cheese from the dairy kitchen, and increase the amount of steamed meat and fish dishes. Calorie intake is limited mainly through carbohydrates. Table salt is limited	Protein 100 g, fat 100 g, carbohydrates 300, calories 2600	Frequent meals (every 2–3 hours), milk or cream at night
Diet No. 1	Peptic ulcer disease in the stage of subsiding exacerbation, with scarring of the ulcer, as well as during remission for 2 - 3 months. Gastritis with increased secretion during an exacerbation.	Spare the stomach and duodenum, excluding chemical irritants and limiting mechanical irritants; promote the process of scarring of the ulcer	Eliminates substances that stimulate gastric secretion. Food is given mainly pureed, boiled or steamed. A diet with a normal amount of calories and a normal ratio of proteins, fats and carbohydrates, with an increased content of vitamins A and C	Protein 100 g, fat 100 g, carbohydrates 400, calories 3000	Frequent meals 6 times a day, before bedtime milk or cream, or fresh kefir
Diet No. 2	Chronic gastritis with secretory insufficiency; chronic enterocolitis without exacerbation; violation of the masticatory apparatus; the recovery period after surgery and after an acute infection, as well as in other cases when moderate sparing of the gastrointestinal tract is indicated	Promote the normalization of the secretory and motor functions of the stomach and intestines; moderate mechanical sparing of the gastrointestinal tract	A physiologically complete diet that preserves extractives and other substances that stimulate the secretion of gastric juice, but do not irritate the gastric mucosa. Meat with coarse connective tissue and products containing plant fiber are given mainly in crushed form	Protein 80 – 100 g, fat 80 – 100 g, carbohydrates 400, calories 3000. Vitamin C 100 mg, other vitamins in increased quantities	Meal frequency 4 – 5 times a day
Diet No. 3		Strengthening peristalsis, regulating bowel movements	Increasing the diet of foods rich in plant fiber and foods that enhance intestinal function. Drink plenty of mineral waters	Protein 100 g, fat 100 g, carbohydrates 450 g, calories 3500; increased amount of table salt 25 g	4 – 5 times, at night 1 glass of kefir, prunes, beets
Diet No. 4	Gastroenterocolitis, acute enterocolitis and exacerbations of chronic ones; dysentery in the acute period. After intestinal surgery	Significant mechanical and chemical sparing of the intestines; exclusion of foods that increase intestinal motility and fermentation processes in the intestines	A diet with calorie restriction due to carbohydrates and fats, proteins within the lower limit of the physiological norm. Avoid milk and products containing plant fiber. The diet is prescribed for a period of no more than 5 – 7 days	Protein 80 g, fat 70 g, carbohydrates 50 g, calories 2000, vitamin C 100 mg. The amount of vitamins of group B and others missing in food products is replenished with vitamin preparations	Meals 5 – 6 times in limited quantities. Free liquid 1.5 l in the form of hot tea, black coffee, broth, rosehip decoction
Diet No. 4a	Chronic enterocolitis during a period of moderate exacerbation when intestinal disease is combined with damage to the stomach; dysentery during the period of subsidence of acute phenomena	Provide adequate nutrition during the period of moderate exacerbation of chronic enterocolitis, help reduce the inflammatory state and normalize impaired functions of the gastrointestinal tract	In a physiologically complete diet, the content of carbohydrates and table salt is moderately limited. Avoid products that mechanically and chemically irritate the intestinal mucosa and enhance the processes of fermentation and decay in it. Products containing coarse plant fiber (mashed vegetables, prunes, apples, bread made from flour) are introduced into the diet in moderation.	Proteins 100 – 120 g, fats 100 g, carbohydrates 300 – 350 g, calories 1600 – 2900	Food is given 5 – 6 times a day
Diet No. 5a	Acute cholecystitis or exacerbation of chronic. Acute pancreatitis or exacerbation of chronic pancreatitis when the process subsides. Chronic cholecystitis in the presence of peptic ulcer. 5–6 days after bile duct surgery	Promote restoration of impaired liver function, accumulation of glycogen in the liver; stimulate bile secretion; limit mechanical irritation of the stomach and intestines	Fat-restricted diet; proteins and carbohydrates – within normal limits; the content of lipotropic factors is increased. Extractive substances and fat breakdown products obtained during frying are excluded. All dishes are prepared from pureed products, boiled or steamed.
Diet No. 5	Chronic diseases of the liver and biliary tract - cholecystitis, hepatitis, cirrhosis of the liver without exacerbation of the process and in the absence of diseases of the stomach and intestines. Botkin's disease in the recovery stage	Promote the restoration of impaired liver function: a) promote the accumulation of glycogen in the liver; b) normalize liver fat metabolism by limiting fats in food (mainly refractory) and introducing substances that have a lipotropic effect; c) reduce liver intoxication by regulating intestinal function; d) stimulate bile secretion; e) eliminate nutrients that irritate the liver and cause exacerbations of the disease	A diet with a physiological norm of proteins, a slight increase in carbohydrates, a moderate restriction of fats and the exclusion of nitrogenous extractives, purines and fat breakdown products obtained during frying (acroleins). A diet with an increased amount of lipotropic factors and vitamins. Table salt up to 10 – 12 g	Proteins 80 - 100 g, fats 60 - 70 g, carbohydrates 450 - 500, calories 2800 - 3000. For patients with fat metabolism disorders, carbohydrates are limited.	Frequent meals (every 2 – 2.5 hours) and plenty of warm drinks up to 2 liters
Diet No. 6	Gout and uric acid diathesis. Erythremia and other cases when exclusion of meat and fish products is indicated	Help normalize purine metabolism and reduce endogenous formation of uric acid	Avoid foods rich in purine compounds. Introduce foods containing alkaline radicals (vegetables, fruits, berries and milk), moderately limit table salt	Proteins 80 - 100 g, fats 80 g, carbohydrates 400 g, calories 2700. For overweight patients, carbohydrates are limited	Meals 5 times a day. Drink plenty of fluids up to 2 - 2.5 liters in the form of tea, fruit and berry juices, alkaline waters
Diet No. 7a	Acute glomerulonephritis. The diet is prescribed after rice-apple, potato or sugar days. Chronic nephritis in the stage of renal failure		A diet with a sharp restriction of protein, fat and carbohydrates within the physiological norm. Salt-free, hyposodium diet (food is prepared without salt, salt-free bread is specially baked). The sodium content of food is 400 mg, which corresponds to 1000 mg (1 g) of table salt. For patients with insufficient renal function in the presence of azotemia, 1–3 g of table salt is added as prescribed by the attending physician. These patients are allowed to give as much fluid as urine excreted in the previous day. Culinary processing of products - without mechanical sparing. Vegetables, fruits, and berries are introduced in sufficient quantities, some in raw form.	Proteins 25 – 30 g, fats 80 – 100 g, carbohydrates 400 – 450 g, calories 2500 – 2600. Vitamin C and B vitamins are administered in increased quantities	Eating 5 times a day
Diet No. 7b	Acute nephritis. Prescribed after diet No. 7a. Exacerbation of chronic nephritis with edema, high blood pressure, but with preserved renal function	Create conditions that are as gentle as possible on the kidneys. Limiting table salt affects hypertension and edema	The content of fats and carbohydrates is within the physiological norm, but the amount of proteins is increased to 45 - 50 g by adding one serving of boiled meat or boiled fish and 200 g of milk or kefir. Otherwise, in terms of the set of products and the nature of culinary processing, the diet is the same as diet No. 7a. The content of table salt in products is increased to 1.5 g	Protein 45 – 50 g, fat 100 g, carbohydrates 450 – 500 g, calories 3000	Meal frequency 5 – 6 times a day
Diet No. 7	Acute nephritis during the recovery period. Chronic nephritis with mild changes in urine sediment. Hypertension and other cases when a salt-free diet is necessary. Nephropathy in pregnancy	Moderate sparing of renal function. Effect on high blood pressure and edema	Salt-free in terms of the range of products and the nature of culinary processing is the same as diet No. 7a and No. 7b, but the amount of proteins is increased to 80 g by adding boiled meat or fish, as well as cottage cheese	Protein 80 g, fat 100 g, carbohydrates 400 - 500 g, calories 2800 - 3200. Table salt content in products is about 3 g. Vitamins C, P and group B are given in increased quantities. For patients with renal amyloidosis with preserved renal function and for patients with nephrosis are prescribed diet No. 7 with a high protein content of up to 140 g, lipotropic factors, polyunsaturated fatty acids and vitamins.	Meal frequency 4 – 5 times a day.
Diet No. 8	Obesity in the absence of diseases of the digestive organs, liver and cardiovascular system requiring special diets	Influence metabolism to prevent and eliminate excess fat deposition	The restriction is mainly due to carbohydrates and partly due to fats, the protein content is higher than the physiological norm. Vegetables and fruits are introduced in sufficient quantities. Limit table salt, exclude flavorings and nitrogenous extractive substances that stimulate appetite. Moderately limit the introduction of free fluid (1000 ml)	Proteins 100 - 120 g, fats 60 - 70 g, carbohydrates 180 - 200 g, calories 1800 - 1850. Vitamin C - in increased quantities, other vitamins - within the physiological norm	Frequent meals of low-calorie food with sufficient volume, eliminating the feeling of hunger
Diet No. 9	Diabetes mellitus in the absence of acidosis and concomitant diseases of internal organs	Create conditions that maintain a positive carbohydrate balance and prevent lipid metabolism disorders		Protein 100 – 120 g, fat 70 g, carbohydrates 300 g, calories 2400	Meals 6 times a day, carbohydrates are distributed throughout the day. During the insulin injection and half an hour after the injection, the patient should receive food containing carbohydrates. Patients with diabetes mellitus with concomitant diseases of internal organs are prescribed a combination diet indicating No. 9 and another diet corresponding to the concomitant disease. For example, for liver diseases, diet No. 9/5 is prescribed, in which fats are limited to 60 g, extractive substances and spices are excluded. Diet No. 9/5 can also be prescribed to patients with atherosclerosis and hypertension
Diet No. 10	Disease of the cardiovascular system: a) rheumatic heart defects in the stage of compensation or with circulatory failure of the first degree; b) hypertension stages I and II; c) diseases of the nervous system; d) chronic nephritis and pyelonephritis only with changes in urine sediment, acute and chronic pyelitis	Create the most favorable conditions for blood circulation; exclude substances that excite the nervous system; improve the excretion of nitrogenous substances and eliminate foods that irritate the urinary tract	A diet with limited table salt (5 – 6 g), exclusion of nitrogenous extractives and spices. Products that regulate the action of the intestines are introduced - vegetables, fruits and berries containing coarse plant fiber, as well as wheat bread with bran and rye bread. Cooking with moderate mechanical gentleness	Proteins 80 g (of which animal proteins 50 g), fats 65 - 70 g, carbohydrates 350 - 400 g, calories 2500 - 2800	Eating 5-6 times a day in moderate quantities, dinner 3 hours before bedtime. For patients with cardiovascular diseases, the administration of free fluid is limited to 1000 - 1200 ml
Diet No. 10a	Heart disease in the stage of circulatory failure of II and II – III degrees. Hypertension with circulatory failure or cerebrovascular accident. Myocardial infarction in acute and subacute periods	A sharp limitation of table salt (1.35 - 1.8 g in food) and enrichment of the diet with potassium can affect impaired heart function and edema. Reduce the load on the digestive organs		Proteins 70 – 80 g (of which 50 g proteins of animal origin); fat 60 g, carbohydrates 80 g, calories 2000 - 2100. Table salt in food products no more than 1.5 - 1.8 g; potassium 3.3 – 3.8 g	Frequent meals at least 6 times a day, in small quantities
Diet No. 10b	Atherosclerosis of the arteries with predominant damage to the vessels of the heart, brain or other organs. Myocardial infarction in the scarring stage. Hypertonic disease	Prevent further development of atherosclerosis. If you are obese, promote weight loss	Calorie restriction due mainly to easily digestible carbohydrates (sugar, white flour products) and animal fats. Avoid foods rich in cholesterol and vitamin D. The following are included in the diet: a) foods that have a lipotropic effect; b) vegetable oil with a high content of polyunsaturated fatty acids; c) vegetables, fruits and berries as natural sources of vitamin C, and they also contain plant fiber; seafood rich in iodine. Culinary processing eliminates nitrogenous extractives and coarse plant fiber	Proteins 80 – 100 g, fats 60 – 70 g, including vegetable 35%, carbohydrates 250 – 300 g, calories 2000 – 2200. Limit table salt and free liquid to 1000 – 1200 ml	Meals 5-6 times a day in moderate quantities, dinner 3 hours before bedtime
Diet No. 11	Pulmonary tuberculosis in the stage of remission, exacerbation or in the form of a chronic form in the absence of diseases of the internal organs, under sanitary conditions (walks, etc.)	Help increase the body's resistance to tuberculosis infection. Increase the patient’s overall nutrition and help restore vitamin balance	A high-calorie diet with a high content of proteins and vitamins, a moderate increase in fats and carbohydrates. The diet includes dairy products rich in calcium in sufficient quantities. Table salt and liquid are within normal limits. Culinary processing is usual with preservation of nitrogenous extractive substances; spices are allowed	Proteins 120 – 140 g, fats 100 – 120 g, carbohydrates 500 – 550 g, calories 3800 – 4000. Vitamins in increased quantities	Eating 4 – 5 times a day
Diet No. 12	Nervous system diseases	Do not overstimulate the nervous system	A mixed table with a limit on spicy foods and seasonings, as well as foods that stimulate the nervous system (strong tea, coffee, chocolate, alcoholic drinks)
Diet No. 13	Infectious diseases in the acute febrile period. Sore throats. Condition after surgery (after appendectomy on days 2–3, after gastrectomy on days 8–9 according to indications).	Help maintain the general strength of the patient’s body in an acute febrile state or in the postoperative period; spare the gastrointestinal tract		Proteins 70 – 80 g, incl. animal origin 50 g, fat 70 g, carbohydrates 300 g, calories 2200. Vitamin C and other vitamins in increased quantities	Meals at least 6 times a day, in limited quantities
Diet No. 14	Phosphaturia with alkaline urine reaction and precipitation of phosphorus-calcium salts	Help restore the acidity of urine and thus prevent sedimentation	Products are introduced into the diet that help change the urine reaction in an acidic direction. Avoid foods that have an alkalizing effect and are rich in calcium (milk, cottage cheese, cheese). The total amount of free liquid is 1.5 - 2 liters. Cooking is normal.	Protein 80 – 100 g, fat 100 g, carbohydrates 400 g, calories 2800	Eating 4 – 5 times a day
Diet No. 15	Various diseases in the absence of indications for prescribing a special therapeutic diet and subject to the normal state of the digestive organs	In a medical institution, provide nutrition to the patient according to physiological standards	The content of proteins, fats, carbohydrates and calories corresponds to the nutritional standards of a healthy person not engaged in physical labor, and vitamins are in increased quantities. Food consists of a variety of products. Avoid fatty foods that are difficult to tolerate; fatty meat, fatty lamb and pork, beef, lamb and lard, butter dough, spices - in moderation. Conventional rational cooking with preservation of vitamins	Proteins 80 – 100 g, incl. animal origin 50 g, fat 80 – 100 g, incl. vegetable 20 – 25 g, carbohydrates 400 – 500 g, sugar 50 – 100 g, calories 3000	Eating 4 – 5 times a day. They recommend meat, poultry, fish in any culinary preparation, sausage, frankfurters, canned food in limited quantities; various dairy products: daily milk or kefir at 21:00; fats – butter and daily vegetable oil in its natural form in salads, vinaigrettes and other dishes; vegetables and potatoes in the form of various dishes and side dishes; some raw vegetables and greens for dishes; fruits and berries, some – raw; wheat and rye bread
Diet No. 0	the first days after surgery on the stomach and intestines, as well as in a semi-conscious state (cerebrovascular accident, traumatic brain injury, febrile illnesses)		The food consists of liquid and jelly-like dishes. Free milk and dense foods, even in the form of purees, are excluded. Allowed are tea with sugar, fruit and berry jelly, jelly, rosehip decoction with sugar, juices of fresh berries and fruits diluted with sweet water, weak broth, rice water.		Food is given in small, frequent doses throughout the day and at night. The diet is prescribed, as a rule, for no more than 3 days
Diet No. 1 surgical	On the 4th – 5th day after surgery on the stomach and intestines, on the 2nd day after appendectomy		Steamed dishes made from pureed boiled meat or chicken are allowed; soft-boiled eggs and steam omelet; low-fat, weak meat or chicken broth, slimy rolled oats soup in broth; liquid porridge 10% from semolina or rice and buckwheat flour baby food, during cooking you can add a small amount of milk or cream; fruit and berry jelly, jelly; juices of fresh fruits and berries diluted with sweet water, rosehip decoction, tea with lemon; white bread crackers; butter, kefir