Diet and Diseases

– Dr Prasanna Kumar K. BHMS, MD( Hom)

Indiscriminate eating is a pandemic problem.  If you know ‘WHAT-WHEN-HOW MUCH’ about eating patterns you can certainly prevent  many diseases.  Old saying goes “one who knows to eat properly will be free from diseases and one who knows to speak properly will be free from fights and quarrels” is very apt for ever.  Indians are not so much concerned about eating patterns and no standard statistical analysis is available to measure the eating related diseases.

Diet of a person implies a routine of food intake grown out of habit and tradition or on the specific advice and instructions rendered to him or her. A doctor is expected to know not only the diet in various diseases also various aspects of food like adulteration, fortification, food allergy, food poisonings, food preservation and economics of food.  Dietary planning whether in health or in disease must take into consideration certain elementary facts and essential principles.  In other words a balanced diet with relative proportion of carbohydrate, protein and fat/oil, vitamins and minerals.

A balanced diet should provide all the essential nutrients in required amounts and proper proportions. The quantities of foods required vary with age, sex, climatic condition, physical activity.

Some general guidelines for eating pattern:

1. Prefer traditional, home made foods.
2. Avoid processed snack food at meal times.
3. Limit intake of processed foods to decrease load of food additives on the body.
4. Always look for information on the food label regarding shelf life and the additives used.
5. Match food intake with physical activity.
6. Eat food in many divided portions in a day.
7. Avoid food faddism and discard erroneous food beliefs.
8. Do not wash vegetables after cutting.
9. Do not heat the left over oil repeatedly
10. Encourage consumption of sprouted/fermented foods.
11. Prefer pressure/steam cooking to deep frying/roasting.
12. Salt should be used in moderation.
13. Cooking oils and animal foods should be used in moderation and vanaspathi/ghee/butter should be sued only sparingly.

Advantage of being a vegetarian:

The human body system and physiology of our gastrointestinal system is basically meant for a vegetarian diet. The total oral architecture of a man is totally different from the carnivorous animal. It is for the herbivorous diet. All over the world the trend is towards a vegetarian diet.  Vegetarians are abundantly supplied with fiber rich diet which will protect them from many metabolic diseases.

Fat:

Fats provide essential fatty acids and promote absorption of fat soluble vitamins. They are essential for meeting some of the nutritional needs like the essential fatty acids (linoleic n-6 and Alpha linolenic n-3) and serve as rich sources of energy.  However fats should be consumed in moderation. Dietary fats are derived from both plant and animal sources and are classified as “visible” and ‘invisible” types.  Invisible fats are present in various food stuffs like rice ( 2-3 %). Animal foods provide high amounts of invisible fat. The visible fats are vegetable oils, vanaspathi, butter, and ghee).  The total fat( invisible+visible) in the diet should provide between 15-30 % total calories.  Some rich sources of alpha linolenic acid  are wheat, bajra, blackgram, soyabean, green leafy vegetables, mustard seeds, mustard oil, soyabean oil and fish.

Special Diets for various diseases:

I. PEPTIC ULCERS:

1. The patient of peptic ulcer should avoid excessively sour, salty or spicy foods also excessively hot drink or food.
2. Smoking and alcoholic beverages should be avoided.
3. Meat should consist of small servings.
4. Sufficient calories are to be given and vitamin C may be helpful in healing the ulcer.
5. Fat like butter, ghee, cheese and cream are helpful whereas fats of fried food articles are difficult to digest and may increase the symptoms.
6. Milk protein will not irritate gastric mucosa.

II. INFECTIVE HEPATITIS:

1. Large quantities of oral carbohydrate are given because they constitute the major source of calories and they minimize the endogenous protein breakdown.
2. Fat may be limited up to 30 gms daily.
3. Excessive intake of protein is not advisable.

III. HYPERTENSION:

1. Restrict the intake of added salt from an early age.
2. develop a taste for foods/diets low in salt.
3. Restrict intake of preserved and processed foods like papads, ketchup, chips, cheese.
4. Strictly avoid pickles, pastries, salted biscuits, eggs, tinned foods.
5. Extra salt and baking powder should be avoided.
6. Adequate protein, moderate fat and carbohydrate.

IV. IHD:

Low cholesterol, low triglyceride with high HDL diet

1. Diet is low fat, high fibre and low in refined carbohydrates and sugars.
2. Avoid all refined carbohydrates like sugar, juice, jams, honey, chocolate, biscuits, noodles, macaroni etc.
3. Avoid all fried foods, aerated drinks and alcohol.
4. Avoid whole milk and use skimmed milk for tea, coffee and curd.
5. Avoid the use of processed cheese, pure ghee, butter, ice cream and other cream based desserts.
6. Avoid all dry fruits and nuts.
7. Mix rice with whole grams or dals in a ratio of 1:1 to incorporate fibre.
8. Use white meat i.e. fish and chicken; avoid the use of pork, mutton and other glandular meats.
9. Use plenty of green leafy vegetables and sprouts.
10. Use whole grain cereals, whole grams and pulses.

V. OBESITY:

1. There is no single dietary regimen for weight reduction; it has to be individualized.  Loss of half a kilogram per week is considered safe.
2. Low fat intake in any form, rich in proteins and low in carbohydrate.
3. Plant food that provide complex carbohydrates and fibre may be preferred as they reduce blood glucose, cholesterol and triglycerides.
4. Consumption of plenty of fruits and vegetables would not only result in satiety but could also help in maintain adequate micronutrient intake.
5. Avoid refined sugars and alcohol.
6. Slow and steady reduction in body weight is advised.
7. Severe fasting may lead to health hazards.

VI. DIABETES MELLITUS:

1. Diet for diabetes should be weight reducing diet as mentioned in obesity.
2. Low cholesterol, low triglyceride and high HDL diet ( as mentioned in IHD diet)
3. Quantity of carbohydrate food is also determined by GLYCEMIC INDEX which is a measure of the blood glucose response to a particular food.  Foods with higher amylase content are recommended like grams, wheat etc.   Foods with higher fibre content are better.
4. Calorie requirements are 25 calories per kilogram of the ideal body weight.
5. Proteins – 10-20 % of daily calories should come from proteins.
6. Fat: Predominantly monounsaturated fat like sunflower oil, safflower oil.
7. sweet drinks, carbonated drinks, dried and canned fruits, cakes, pastries, cream should be strictly avoided.

VII. Gout:

1. Excessive purine intake and overindulgence in alcohol should be avoided.
2. Purine rich foods in vegetarian diet are beet root, tomato, beans, peas, cauliflower, pulses, lentils, spinach, apple, mushrooms etc.
3. Purine rich non vegetarian foods are Liver, kidney, fish, meat proteins.

VIII. Nephrotic syndrome:

1. Diet should contain minimum salt.  Preferably no salt or the barest minimum salt can be used in cooking.
2. Diet should be sufficient in calories.
3. About 1.5-2 gm of protein per kg of ideal body weight or not less than 100 gm of protein intake per day has to be ensured for an adult.  Protein provided should be low in salt content or salt free.  The egg to be taken minus the yolk.
4. Since blood cholesterol is found high egg yolk, red meat, should be avoided.  Fish, milk casein, chicken etc are allowed as well as proteins of vegetable source.

IX. CHRONIC RENAL FAILURE (Chronic Uremia):

1. Due care is taken to ensure sufficient fluid intake based on the intake output chart.
2. Salt restriction to the limit of the minimum use in cooking and exclusion of any free salt intake are generally required.
3. salted biscuits, butter, meat, papad, pickles are not permitted.
4. Potassium is restricted.

X. CHOLECYSTITIS:

1. Pastries, cheese, fried potato chips, fatty meat, fried eggs should be avoided.
2. Nuts, pop corn, dry fruits, pickles, condiments, spices also should be avoided.

Conclusion:

Effective management of any case depends not only on medicinal treatment but also includes various non medicinal measures like diet restrictions, life style modifications, insisting on maintaining Ideal body weight etc.  It is the responsibility of every physician to involve the patient in primordial prevention. High risk candidates should be identified.  For e.g.  People who are potential diabetics can be identified in an early stage and a strict dieteric and life style modifications can be advised.  Hence knowledge of various diets in different diseases is essential.

Recommended reading:

1. Sharma rekha, DIET MANAGEMENT, B.I Churchill livingstone publication, second edition, New Delhi.
2. Virk R S and M P Kapilashrami, LECTURE NOTES IN NUTRITION, Jaypee brothers medical publishers, New Delhi.
3. Manual- Dietary guidelines for Indians, National Institute of Nutrition, Hyderabad.
4. Majumdar K, ESSENTIALS OF HUMAN NUTRITION,  Jaypee brothers medical publishers (P) ltd., New Delhi.
5. Kusum Gupta, L C Gupta, Abhishek Gupta,  FOOD AND NUTRITION, Facts and figures, Jaypee brothers medical publishers, New delhi.