DIETOTHERAPY

DIETOTHERAPY, therapeutic nutrition, therapeutic dietary regime. D. is the oldest method of treatment. In the writings of Hippocrates, D. already occupies a significant place. The Code of the Salerno school (13th century) contains a number of instructions on nutrition during illness. Starting from the 17th century A.D., dietotherapy already occupies a definite place in medicine. It is partly based on pure empiricism and data from 'folk' medicine, and partly on the peculiar 'scientific' theories of that era (treatment with cold water, dry eating, emetics, etc.). Sydenham already indicated at that time that some diseases, for example gout, could be treated and prevented only by diet. At the end of the 18th century, dietotherapy takes on peculiar forms: in England and France, treatment by abstinence and fasting spreads, based on the idea that food, by sustaining the patient, also sustains their disease. The German physician Hufeland was one of the first to point out the importance of food quality in the nutrition of the patient. Starting from the 19th century, dietotherapy is already built on the scientific foundations of nutritional physiology and physiological chemistry. Liebig's teaching on the construction of tissues from food proteins and on the role of carbohydrates in respiration and oxidation led to the teaching of so-called 'restorative' treatment: the introduction into the body of substances lacking and the exclusion of those present in excess (fattening the thin with fats, excluding fats in the obese, prescribing meat to the weakened, etc.). Dietotherapy developed particularly only with the publication of the major work by Leyden (1832-1910), who categorically emphasized the importance of therapeutic nutrition in every disease and demanded that dietotherapy be built on strictly scientific data. The most prominent Russian clinicians (Zakhar'in, Ostroumov, Botkin, Filatov) also indicated the importance of dietotherapy in certain diseases. The scientific-clinical development of dietotherapy issues proceeded very slowly, and only representatives of individual disciplines, especially diseases of the digestive tract and metabolism, led by Boas and Noorden (Germany) and Mathieu (France), built all treatment of the corresponding diseases on dietotherapy. Along with the brilliant flourishing of nutritional physiology on new scientific foundations, a new approach to questions of therapeutic nutrition begins to emerge: the starting point for any dietotherapy becomes, first of all, a rationally constructed dietary regime for a healthy person, which is regulated and changed in terms of quantitative and qualitative composition of food according to the disease of one or another organ or system. Only rational nutrition in connection with hygienic lifestyle (hygiene of labor and daily life) ensures the full development of spiritual and physical forces and sufficient resistance of the body; being built according to the needs of the body, such nutrition is also preventive. Irrational nutrition can be the cause of a whole range of diseases. For the growing organism, irrational nutrition is the cause of serious disorders up to the development of atrophy in early childhood. The smaller the child, the more sharply this dependence between rational nutrition, normal development, and morbidity manifests itself. The causal relationship between the nature of nutrition and diseases of the digestive tract and metabolism is clear in itself, but modern scientific data show that in all other diseases the nature of nutrition can influence the course of the disease. It has been proven that in a number of cases postoperative course of wounds depends on the nature of nutrition. Clinical manifestations of neuroses are also strongly related to nutrition (exciting effect of spices, animal proteins, calming effect of sugar, influence on the psyche of insufficient nutrition, etc.). The works of Biedl, Zondek and others have proven the influence of food on the functions of endocrine glands (especially the thyroid gland). The latest works of Palladin showed the influence of the nature of food even on the chemical composition of individual parts of the brain. The influence of food quality on the cardiovascular system has been proven: changes in capillaries (observed with the capillaroscope) after administration of large amounts of meat and changes in blood viscosity (Strasser). The influence of dietotherapy in tuberculosis is by no means exhausted by the importance of 'strengthening' nutrition: with food, salts, vitamins, hormones and a number of substances that enhance catalytic and oxidative processes in the cell itself and affect its regeneration are introduced into the body. The latest works of gynecologists have shown the importance of the nature of nutrition for the growth of sexual organs: food rich in vitamins enhances the growth of these organs, lack of vitamins leads to infertility (Guggisberg). In skin diseases, the ratio of anions and cations of the skin plays an important role, which to a large extent depends on the nature of food. The influence of monotonous and vitamin-poor food on the condition and diseases of the skin (dryness, peeling, furunculosis, blepharitis, erythemas and exanthemas) and mucous membranes is known. Thus, from what has been said, it is clear that nutrition, being the cause of a whole range of diseases, on the other hand can also be a powerful therapeutic factor, and one of the most important problems in medicine should be treatment by nutrition. General principles of nutrition for the sick. A healthy person, when choosing food, uses normal regulators (appetite, thirst, feeling of satiety, 'taste' or aversion to certain foods). However, even in a healthy person, in the absence of labor hygiene and other hygienic living conditions, these regulators do not always ensure correct (according to the needs of the body) nutrition. These regulators are almost always disrupted in the sick person: taste is often perverted, and the needs of the body often cannot be satisfied due to disease of one or another organ, so it is necessary to develop a special dietary regime for each patient. It includes: 1. Regulation of food intake (giving it at certain times of the day, 4-6 times a day, with intervals of 2-4 hours, depending on the abundance of previous food, with prohibition of food intake just before sleep). 2. Portion control to avoid introducing large amounts of food at once. 3. Exclusion of any fatigue (work, walks, games, therapeutic procedures) immediately before and after meals. 4. Care of the oral cavity, slow eating, good chewing of food, calm surrounding environment. 5. Quality of food for the sick: a) selection, if possible, of complete food containing all necessary nutrients (complete proteins, fats, carbohydrates, salts, vitamins); b) in necessary cases, exclusion of a number of food substances necessary for a healthy body but harmful in diseases of various organs (exclusion of animal protein, sodium chloride, vegetable fiber, etc.); c) selection of exclusively high-quality products, taking into account the increased sensitivity of the sick person to even the slightest spoilage of products or to various impurities that change taste and smell (traces of hydrogen sulfide in winter-stored eggs, admixture of lard in oil, etc.); d) seasonings permitted by modern therapeutic cuisine; e) skillful culinary processing of food, combining strict medical indications with high taste properties; f) variety of dishes within the prescribed diet, which acquires special importance in chronic cases, when prescribing special regimes for a long or very long time. Monotonous food can lead to complete loss of appetite, reduced secretion of digestive juices and insufficient utilization of food, insufficient (in quantitative and qualitative sense) nutrition, avitaminosis with clinical symptoms that often obscure the symptoms of the main disease (diarrhea, pains in the intestines, constipation, pains in the joints, etc.). 6. The amount of food should correspond to the needs of the body at a given moment, taking into account the desire to achieve the optimal weight of the patient; if it is impossible to introduce a sufficient amount of calories, it is necessary to reduce the body's needs (rest, bed rest, sufficient ambient temperature). For a more accurate determination of the required amount of calories, it is recommended to take into account the energy expended (walking, sitting, reading, therapeutic procedures, etc.), based on the figures of basal metabolism for a healthy person, determined according to the tables of Harris and Benedict by sex, weight, age and height. However, one should not forget that in some cases the figures of basal metabolism may be elevated compared to Benedict's norms (in people accustomed to eating a lot, as well as in some diseases). When prescribing therapeutic nutrition for a long time in case of excess weight, a reduced amount of calories compared to norms should be introduced, in case of insufficient weight - an increased amount (all other conditions being equal). The terms 'light food', 'light diet', 'dietary table' do not give a correct idea of the nature of therapeutic nutrition for a given patient, since a 'light' or 'light' diet for one patient may be heavy for another. Only in relation to the digestive tract can one speak of light or heavy food, giving less or greater work to the digestive organs in terms of the tension of their secretory or motor functions.

The ease of digestion as well as utilization depends not only on the composition of the food itself but also on the method of its preparation: the same food substance can be prepared as both a light and a heavy dish. Through skillful combination of permitted foods and various methods of their preparation, it is possible to satisfy the needs and tastes of the patient. Dietotherapy can accomplish the difficult task of nutrition only by relying on therapeutic cookery. The quantitative and qualitative composition of food should change depending on the clinical course of the disease and the appearance of various symptoms. The precise determination of the quantity and quality of food for each disease (and not simply the prohibition of certain dishes) with designation of meal times is the main condition for successful dietotherapy. Thus, the most desirable form of dietotherapy is individual therapeutic nutrition for each case of a given disease. However, regarding the application of therapeutic nutrition on a mass scale for preventive and therapeutic purposes, it should be noted the difficulty of implementing individual nutrition on such a scale due to the large amount of material resources required and the danger of excessive overload of the kitchen. Therefore, it is necessary to introduce the principle of group nutrition by types of diseases, which is more feasible in large medical institutions, public canteens, and factory kitchens, and at the same time gives very good results, as numerous observations have shown. Most common dietary regimens. I. The regimen of introducing large amounts of fluid into the body ("water regimen") is used to increase diuresis, increase the excretion of toxins and waste products from the body, and compensate for large fluid losses. Indications: 1) acute and chronic infections and intoxications (of alimentary and other origins); 2) metabolic diseases: uric acid diathesis, oxaluria, phosphaturia, and gout; 3) pyelitis and urolithiasis; 4) profuse diarrhea (cholera), putrefactive diarrhea, and bleeding. Contraindications: cardiac insufficiency, hypertension, impaired excretory ability of the kidneys, motor insufficiency of the stomach, and profuse bleeding (increase in blood pressure or enhancement of peristalsis of the stomach and intestines interfere with thrombus formation). Method of application: 1) drinking, if there are no contraindications from the stomach (hypotonia, pyloric stenosis, nausea, vomiting), in small portions from 20 to 200 cm³ at a time, up to 3 liters per day; in addition to plain water—liquid tea, water with berry and fruit juices, infusions of bitter herbs (chamomile, mint for irritation of the gastrointestinal tract), glucose solutions (in intoxications), mineral waters (in metabolic diseases and urinary tract diseases); 2) enemas (in contraindications to fluid administration per os) of 150-200 cm³ of water, physiological solution, inverted sugar, glucose in 5-10% solution (temperature 35°), 2-3 times a day, or better—droplet enemas of 1-2 liters, temperature 38° (in intoxications and peritonitis); 3) subcutaneously 250-600 cm³ or intravenously (for a more rapid effect and in irritation of the stomach and rectum) 200-500 cm³ several times a day (water, physiological solution, glucose solution in intoxications, soda or glucose solutions in acidosis). II. Regimens with limited fluid intake. Complete or very sharp (200 g per day) restriction of fluid is a severe regimen requiring medical supervision and can be prescribed only for a short time; indication for immediate discontinuation of this regimen is oliguria, high concentration of urine, renal and hepatic colic, and severe asthenia. More common are regimens with limited fluid intake (from 800 to 1,000 cm³). Indications: 1) obesity (only in the first period of treatment to enhance water excretion by tissues); 2) motor insufficiency of the stomach; 3) gastrointestinal bleeding (to reduce peristalsis); 4) bronchorrhea, emphysema, and pulmonary edema; 5) severe hypertension; 6) some heart diseases (weakening of the heart muscle, cardiac asthma, edema); 7) some kidney diseases (in violation of excretory ability in relation to water). Of special regimens—a) Ertel's regimen, with fluid restriction to 800 cm³, with limited intake of fats and carbohydrates (150-200 g protein, 20-50 g fat and 80-150 g carbohydrate), with simultaneous training in walking with gradual ascents (terrain-cure) and steam baths; b) Carrel's regimen with fluid restriction to 800-1,000 cm³ with restriction of the total amount of food (see below). III. Regimens of complete fasting are used as a therapeutic means in the form of short-term periodically prescribed regimens in: 1) acute inflammatory processes in the abdominal cavity (to reduce peristalsis of the gastrointestinal tract); 2) acute catarrhs of the stomach and intestines; 3) chronic colitis with predominance of putrefactive processes; 4) complicated ulcers of the stomach and duodenum (profuse bleeding, persistent, severe pains); 5) pronounced stenosis of the stomach or intestines; 6) acute and chronic intoxications; 7) metabolic diseases (obesity, gout, diabetes: Allen and Guelp regimens); 8) kidney diseases with uremic manifestations; 9) attacks of cardiac asthma and angina pectoris (especially in the obese). Method of application: bed rest with exclusion of any physical and mental work, warm room, constant medical supervision of heart activity (especially in the elderly and children), oral hygiene (to avoid inflammation of the parotid gland), rinsing the mouth with carbonated water (to reduce thirst). If there are no special contraindications (acute peritonitis, profuse bleeding, stenosis of the stomach and intestines), the introduction of a certain amount of fluid is permitted (boiled water, weak tea without sugar, water with lemon); in intoxications—administration of large amounts of fluid per os or per anum. The transition to a more normal diet should be gradual. Allen's regimen: complete fasting for 4-5 days with preliminary reduction of the normal food ration. Guelp's regimen (in gout): periods of fasting alternating with periods of meat eating with abundant drinking of acidic fluids. Contraindications: severe general weakness, deep old age and debility, decline in cardiac activity (very dull tones, bradycardia, sharp drop in blood pressure, cyanosis), oliguria, sharp increase in the excretion of nitrogenous substances from the body. If any of these symptoms appear—immediate discontinuation of fasting, administration under the skin or into a vein of 5-10% solution of glucose or table salt and other measures to raise cardiac activity. IV. Regimens of incomplete fasting, quantitative or qualitative: 1) restriction of the total caloric quantity compared to the required norm; 2) exclusion from the normal diet of certain nutrients—relative, qualitative fasting, even with sufficient caloric intake. It should be especially emphasized that most therapeutic nutrition regimens are regimens of relative (qualitative) fasting. With prolonged application, they often harm the body and interfere with coping with the disease for which the regimen itself was prescribed. Partial fasting often proceeds latently and manifests earlier or later depending on the general condition of the body and constitutional peculiarities of the patient. Individual regimens of relative fasting. I. Vegetarian regimen with exclusion of all animal products (meat, fish, eggs, milk, butter, cheese, etc.) is prescribed only for a very short time, as it is associated with a sharp restriction of complete proteins and fats. Indications: uremia, diabetes ("green days"), obesity, gout ("fruit days"), chronic kidney, heart, and vascular diseases. Varieties of the vegetarian regimen are: a) Treatment with raw food (Rohkost), which has recently received considerable dissemination; its essence lies in the consumption of uncooked plant food. The justifications for this regimen are as follows: preservation of all vitamins and salts of the food, increased chewing and increased salivation, greater nutritional value of raw products, increased intestinal peristalsis, increased general resistance of the body and local immunity. The main disadvantages are (Stepp, Scheunert, Pevzner): negative balance (general and nitrogenous), significantly worse digestibility of plant proteins compared to animal proteins, rapid satiety with insufficient caloric intake, excessive volume of food, very poor assimilation in people not accustomed to plant food, relative (qualitative) fasting of the body, b) So-called hungry days with prescription only of greens or fruits or vegetables. Fruit days (for example according to Norden): 1,200-1,500 g apples = 500-600 calories; 1,500 g melon = 450 calories. Strawberry days: strawberries 1,200 g = 500-600 calories. Vegetable days: for example 600 g potatoes, 400 g apples, 100 g tomatoes, 200 g cucumbers, tea, coffee, broth from greens, total—750 calories. Potato days (Brugsch, Hindhede): 1-2 kg potatoes in various forms. Green days: for example 1,000 g sauerkraut, 100 g tomatoes, salad with lemon = about 235 calories. II.

The plant-milk type or plant-milk-egg type, which has until now been incorrectly called a vegetarian regimen, contains little sodium chloride, purine bases, and extractive substances and many carbohydrates and fiber; it contains no meat or fish, and is therefore by some called non-slaughter nutrition. With skillful combination of products, it ensures the supply of all necessary nutrients to the body. - Indications: uric acid diathesis and gout (with the exception of legumes, which contain large amounts of purine bases), Basedow's disease, diseases of the nervous system, especially of a functional nature, spasmophilia in children and tetany in adults, diseases of the heart and blood vessels (especially hypertension and severe sclerosis), acute and chronic kidney diseases, a number of diseases of the digestive tract, liver diseases and some skin diseases. - Method of application: the transition from mixed food to plant-milk should be gradual (with rapid transition, general weakness and depressed mood often develop); with complete exclusion of meat for a long time, it is necessary to ensure adequate protein supply. Implementation of an egg-milk-plant regimen requires good knowledge of cookery to prepare a large variety of dishes, since monotonous plant food becomes tiresome more quickly than monotonous animal food. When compiling menus, it must be taken into account that some patients do not tolerate certain varieties of greens and vegetables. III. The achloride regimen with complete exclusion or partial restriction of table salt is indicated in nephroses (with impaired ability to normally excrete sodium chloride), in cardiovascular diseases with and without edema, especially when simultaneously restricting fluids, in increased acidity of the stomach, in diseases of the urinary tract with increased concentration of urine, in some skin diseases (acne, prurigo, eczema) and in the treatment of epilepsy with bromine (for better accumulation of bromine in the body). - Technique: restriction of table salt compared to normal daily requirement (8-10-15 g) is carried out in the form of three diets of varying severity (Norden): light (with salt content from 5 to 10 g), medium (from 3 to 5 g) and strict (from 1½ to 3 g), depending on the severity of the disease. Complete exclusion of salt is possible only with a regimen of complete fasting or nutrition with glucose alone, since even all berries, fruits and vegetables contain minimal amounts of table salt. The achloride regimen is introduced gradually and, if possible, for a short time; with prolonged administration, so-called salt days (Norden, Strauss) should be periodically introduced with the administration of up to 5-8 g of salt per day. The following products with minimal salt content are allowed: potatoes, carrots, Jerusalem artichoke, white flour, rice, macaroni, cauliflower, cucumbers, pumpkin and all varieties of fruits. Forbidden: salted and smoked meat, sea fish, canned goods and bread of ordinary baking (containing 8-16 g of salt per 1 kg). Milk, containing 0.16% salt, is allowed in limited amounts. As salt substitutes, the following seasonings are permissible: sodium formate according to Strauss (3-4 g per day), soda (Pevzner), powder from greens, tomatoes, grape vinegar (Widal, Norden), lemon, lemon peel, caraway, vanilla, garlic. Achloride diet schemes according to Norden: 1) 1,400 g apples; contain 6 g nitrogen, 0.08 g NaCl = 745 calories; 2) 1,400 g apples and 2 eggs; contain 18 g nitrogen, 0.28 g NaCl = 890 calories; 3) 1,400 g apples, 100 g rice, 100 g sugar; contain 14 g nitrogen, 0.18 g NaCl = 1,519 calories; 4) 100 g potatoes, 150 g butter, 500 g apples; contain 20 g nitrogen, 0.55-0.65 g NaCl = 2,250 calories. Side effects of the achloride regimen: with prolonged use, lassitude, loss of appetite, and general weakness are common. These symptoms often appear suddenly, therefore medical supervision is necessary when conducting the achloride regimen. IV. A regimen with limited protein intake can only be prescribed for a short time. - Indications: 1) kidney diseases with azotemia; 2) gout [in parallel with restriction of foods rich in purine bases, restriction of dietary proteins promotes abundant excretion of uric acid from the body (Achard)]; 3) liver diseases (due to impaired protein metabolism); 4) intestinal diseases with predominance of putrefactive processes; 5) all kinds of intoxications, especially intestinal (exclusion of proteins as sources of ptomaines). - Method of application. a) With general protein restriction, animal proteins should first be restricted as they are richer in purine bases and more toxic. b) When compiling the diet, one can be guided by the following table of protein content in foods: meat 15-20%; legumes (beans, peas, lentils) 20-25%; cereals 10-14%; bread 8%; rice 5%; milk 3-5%; potatoes 2%; fruits 1%. c) In a very strict protein-free diet containing sufficient calories, about 25 g of protein is still usually introduced: approximately: 200 g bread . . . 300 » potatoes 100 » rice . . . 100 » sugar . . 25 » butter . . 27 g protein, 1,500 calories. Leafy greens can be added to this diet. More severe restriction of nitrogenous substances can only be carried out in the form of prescribing individual days with the intake of only fluids or fluids with carbohydrates or leafy greens, butter and sugar. d) A regimen with protein restriction prescribed for a long time should, according to most authors, still contain at least 40-50 g of protein per day. Symptoms of harmful effects of insufficient protein intake in the body: general weakness, decreased work capacity (especially in terms of mental work), in children- delayed growth and development (due to insufficient supply of various amino acids necessary for plastic processes), negative nitrogen balance. V. The milk regimen in its pure form no longer has the previous widespread use, since 1) to cover the daily caloric requirement with milk alone requires at least 3 liters, 2) the milk regimen is not achloride (1 liter of milk contains 1.6 g NaCl) and therefore cannot be prescribed in all cases of kidney diseases, 3) it is quite rich in proteins (in 1 liter of milk- 30-50 g protein), 4) it causes a number of unpleasant symptoms from the digestive tract (bloating, diarrhea or constipation). Of the milk regimens, the Karel regimen is most commonly used, prescribed by some authors for diseases of the cardiovascular system, neuralgia and neuroses: the first 5-7 days 800 cm³ of boiled or raw milk (200 cm³ per serving), then for the following 2-6 days one egg and crackers are added, then gradually a second egg, bread, chopped meat, greens, rice are added; within 12 days transition to varied food. During the month, the amount of fluids does not exceed 800 cm³ per day. - A complete milk regimen, consisting exclusively of large amounts of milk (1½-2 liters per day), can only be prescribed for a very short time; otherwise it almost always causes severe weakness with a significant decrease in cardiac activity. Prescription of the milk regimen in obese people, even if it causes weight loss in the first period, quickly leads to weakening of cardiac activity, irritation of the intestines and reflex irritation of the nervous system if carried out for a long time; it is better to prescribe for obese people 1-2 times a week 'milk' days (1 liter of milk with bed rest). Various proposed modifications of the milk regimen (with the addition of potatoes, rice, fruits, etc.) are no longer a purely milk regimen, but one of the varieties of milk-plant nutrition. VI. Regimens with limited (compared to normal) fat intake are indicated in obesity, in some cases of diabetes and liver diseases. Such regimens are all the above-mentioned partial fasting regimens, in which fats are limited to 50% of the normal daily requirement or even lower. An example of such a regimen is the above-mentioned Ertel regimen. VII. Regimens with limited carbohydrate intake are mainly used in the treatment of diabetes (see), as well as obesity. VIII. Regimens of intensified nutrition aim to make the body stronger, more capable and resistant to various kinds of infections, and not just to increase its weight. Weight gain is indicated where weight is below optimal. Only in certain diseases (tuberculosis, mental diseases) and in age not exceeding 40 years is some excess weight above optimal permissible. - Indications. Regimens of intensified nutrition are used 1) in people with weight below optimal, 2) in tuberculous patients with insufficient weight, and in age up to 35 years in some cases also with normal weight, 3) in asthenics with weakening of musculature and labile nervous system (especially during puberty), 4) with general enteroptosis (congenital or acquired), 5) in convalescents after all kinds of acute and chronic diseases that occurred with severe general exhaustion, 6) in neurasthenia, hysteria and some other diseases of the nervous system. - Method of application. 1.

Start from a normally constructed ration in terms of both calorie quantity and food quality composition; it is completely impermissible to construct a strengthened nutrition ration from only oil, eggs, flour dishes, etc., without consideration of the other nutrients required for nourishing this particular patient. 2. The supplementary ration in strengthened nutrition should not exceed the normal requirement for this person by more than 30%. 3. Weight gain should proceed gradually, slowly (about 1-2 kg per week), as rapid weight gain is unstable and is quickly lost. 4. Weight gain should proceed in parallel with an increase in muscle strength, for which is recommended a) sufficient introduction of proteins, b) introduction of nutrients that conserve the expenditure of proteins in the body (sufficient amount of carbohydrates, fats, and gelatin), c) systematic exercise of muscles (gymnastics, games, massage). 5. When constructing a food ration, it is necessary to take into account the condition of the digestive tract, especially considering the secretory and motor functions of the stomach and the motor function of the intestines (in case of hypersecretion of the stomach, avoid strong secretagogues, in achylia - reduce the amount of animal proteins, etc.). 6. Avoid dishes that quickly satiate this particular patient (e.g. fatty dishes, soups, cocoa, etc.), nutritious soups are better prescribed as the second course. 7. Variety of food and consideration of the patient's tastes - the most important rule in strengthened nutrition. 8. It is advisable to introduce food frequently in small portions. 9. The introduction of supplementary food ingredients that enhance appetite and apparently affect metabolism is indicated: tea, coffee, seasonings, spices, and in some cases, alcohol. 10. In severe weakness, exhaustion, and lability of the nervous system, bed rest is indicated (this is only permitted at the beginning of treatment and for a short time, no more than 2 weeks). Rules for constructing a strengthened nutrition ration. The supplementary amount of calories is covered by prescribing food products taking into account the peculiarities of this particular disease and material possibilities. The most nutritious dishes and products: 1) butter, pleasant to the taste, as additions to various dishes, in an amount of 100-150 g per day; if necessary, it can be replaced with olive oil, added to various salads, vegetable salads, sauces, or in the form of a mayonnaise; 2) sour cream, cream (100 g = 245 calories); in some cases with individual tolerance - fish oil; 3) sugar with tea, coffee, water with lemon, with flour, fruit, berry dishes, jam, whipped cream with sugar, whipped egg whites with sugar (1 egg white with 50 g sugar = 220 calories), with the addition of 50 g of crushed nuts or almonds (300 calories); 4) eggs and egg dishes (no more than 4-5 eggs per day); 5) sweet flour dishes (puddings, biscuits, milk porridges with fruit and berry sauces, pastries); 6) sweet fruits (dried wine grapes, dried grapes, dates and prunes). Products with a high content of calcium, iron, and phosphorus salts and rich in vitamins are extremely valuable: cheese (100 g = 400 calories), eggs, spinach, lettuce and other vegetables, greens and fruits (orange and lemon juice). When it is necessary to supply an increased amount of animal protein (anemia, tuberculosis) - supplementary prescription of meat in the form of additions: to other dishes: chopped meat with herring and potatoes, pureed meat in soups, meat powder in broth and milk. - A strengthened nutrition ration constructed without consideration of the amount of calories and qualitative composition easily leads to overfeeding patients and to a whole series of harmful consequences: 1) if the amount of calories exceeds the required norm by more than 30%, weight gain is often not achieved until the amount of supplementary food is reduced; 2) excessive supply of food, especially protein, often leads to increased metabolism, which consumes an excessive amount of food (Luxuskonsumption); 3) excessive nutrition can lead to fat accumulation exceeding physiological limits - to obesity, often with simultaneous weakening of muscles, which is especially harmful in diseases of the cardiovascular system (burdening the work of the heart), diseases of the joints and bones (excess ballast for the organs of movement), lesions of the gastrointestinal tract and in some diseases of the liver and metabolism (gout, diabetes).

DYSARTERIA

The supplementary amount of calories is covered by prescribing food products taking into account the peculiarities of this particular disease and material possibilities. The most nutritious dishes and products: 1) butter, pleasant to the taste, as additions to various dishes, in an amount of 100-150 g per day; if necessary, it can be replaced with olive oil, added to various salads, vegetable salads, sauces, or in the form of a mayonnaise; 2) sour cream, cream (100 g = 245 calories); in some cases with individual tolerance - fish oil; 3) sugar with tea, coffee, water with lemon, with flour, fruit, berry dishes, jam, whipped cream with sugar, whipped egg whites with sugar (1 egg white with 50 g sugar = 220 calories), with the addition of 50 g of crushed nuts or almonds (300 calories); 4) eggs and egg dishes (no more than 4-5 eggs per day); 5) sweet flour dishes (puddings, biscuits, milk porridges with fruit and berry sauces, pastries); 6) sweet fruits (dried wine grapes, dried grapes, dates and prunes). Products with a high content of calcium, iron, and phosphorus salts and rich in vitamins are extremely valuable: cheese (100 g = 400 calories), eggs, spinach, lettuce and other vegetables, greens and fruits (orange and lemon juice). When it is necessary to supply an increased amount of animal protein (anemia, tuberculosis) - supplementary prescription of meat in the form of additions: to other dishes: chopped meat with herring and potatoes, pureed meat in soups, meat powder in broth and milk. - A strengthened nutrition ration constructed without consideration of the amount of calories and qualitative composition easily leads to overfeeding patients and to a whole series of harmful consequences: 1) if the amount of calories exceeds the required norm by more than 30%, weight gain is often not achieved until the amount of supplementary food is reduced; 2) excessive supply of food, especially protein, often leads to increased metabolism, which consumes an excessive amount of food (Luxuskonsumption); 3) excessive nutrition can lead to fat accumulation exceeding physiological limits - to obesity, often with simultaneous weakening of muscles, which is especially harmful in diseases of the cardiovascular system (burdening the work of the heart), diseases of the joints and bones (excess ballast for the organs of movement), lesions of the gastrointestinal tract and in some diseases of the liver and metabolism (gout, diabetes).