Dietotherapy

the dietetic treatment of various diseases, the scientific basis for which is the study of dietetics.

The effect of dietotherapy is determined by the quantity and composition of the food consumed (proteins, fats, carbohydrates, vitamins, minerals, trace elements), the caloric content and physical properties of the food (volume, temperature, consistency), the eating regimen (time, number, and distribution of meals), and the therapeutic value of the particular foods (for example, cottage cheese, milk, honey).

Dietotherapy takes the form of special diets that take into account the pathogenic nature of the disease, the particular features of the course of the primary and concomitant diseases, and the tastes and ethnic customs of the patient. The dietotherapy chosen is closely coordinated with the general plan of treatment. Sometimes it is used as the principal method of treatment. At other times, it is the essential therapeutic background against which all other treatment (including the specific therapy) must be used. When indicated, “contrast days” (milk, cottage cheese, apple, watermelon, potato, and other diets) are prescribed in addition to the basic diet. “Special days” (potassium, magnesium, and other diets) are also sometimes prescribed.

In diseases of the digestive system, when impaired, unbalanced, or irregular nutrition is a causative factor, dietotherapy is the principal method of treatment. For ulcers or chronic gastritis, a diet with restricted intake of chemical and mechanical irritants and with enriched foods that have favorable effects on gastric secretion, motility, and evacuation helps to restore proper gastric and duodenal function.

Diet is also the principal method of treating chronic intestinal diseases. The diet for these purposes is characterized by physiologically normal amounts of proteins, fats, and carbohydrates; some restriction (to 8 g) of salt intake; moderate restriction of the intake of mechanical and chemical irritants of the receptors of the gastrointestinal mucosa; and exclusion of any foods that intensify fermentation and putrefaction in the intestine. The diet also requires the exclusion of substances that irritate the liver and of powerful stimulants of bile production and gastric and pancreatic secretion.

For chronic liver diseases, the diet is enriched with vegetable oil and with proteins containing lipotropic substances (for example, cottage cheese, soy, oatmeal). For some forms of hepatitis (chronic hepatitis with cholestasis and chronic cholecystitis), the fat content of the diet is increased (to 140 g) by adding more vegetable oil (50 percent of the total fat content of the diet); for other forms (acute hepatitis, cholelithiasis, cholecystectomy for cholecystitis, cirrhosis of the liver), restricted fat intake (to 70 g) is indicated.

The diet for atherosclerosis calls for the restricted intake of animal fat and cholesterol-containing substances; simple carbohydrates (glucose, fructose); salt; vitamin D; extractives with large amounts of lipotropic factors (cottage cheese, oatmeal, soy); vitamins C, B₁, B₆, P, and PP; cellulose (fruits, vegetables); sitosterols and phospholipids (vegetable oils); and seafood. Such a diet normalizes lipid metabolism, the condition of the vascular walls, the coagulation and anticoagulation systems, and the circulatory and other functions.

The diet used in the treatment of hypertension and chronic cardiovascular insufficiency comprises foods containing no more than 2–3 g of common salt, enriched in potassium and magnesium salts and vitamins, and containing physiologically normal amounts of proteins, fats, and carbohydrates. In addition, a magnesium diet is prescribed briefly from time to time for the benefit of the depressor action of its magnesium salts.

Fasting or a short-term sodium-free diet is sometimes prescribed for patients with acute diffuse glomerulonephritis. This is followed by a low-sodium diet containing about 30 g of protein. Low-protein diets, containing 20 or 40 g of protein, are prescribed for chronic nephritis (especially in the phase of renal insufficiency and azotemia). New protein-free products (protein-free cornstarch, sago starch, and amylopectin) can be used in cooking for these diets. The salt present in these diets amounts to that which is contained only in the products themselves.

Various desensitizing diets are suggested for inflammations involving allergic reactions. The diet prescribed with rheumatism contains no more than 250–300 g of carbohydrates, no more than 4–5 g of salt, and physiologically normal amounts of protein and fat. In the case of food allergies, the substances that produce the allergic reaction are excluded from the diet.

Most diabetics must restrict their intake of the readily soluble carbohydrates (sugar, glucose). The quantity of carbohydrates permissible is determined individually, according to the severity of the course of the disease. Sugar can be replaced by xylitol and sorbitol, which have no effect on the glycogenic function of the liver. The diet should contain 70–80 g of fat (including 30 g vegetable oil), 100–120 g of proteins (chiefly those possessing lipotropic properties), and vitamins A, B, and C.

High-calorie foods (dairly products, readily assimilated carbohydrates), large quantities of liquids, and vitamins (especially C, P, PP, and A) are prescribed to maintain the water-salt balance and the energy equilibrium in cases of acute infectious diseases (influenza, pneumonia, scarlet fever). If the fever is high and protracted, the daily amount of protein in the diet is reduced to 60–70 g. For chronic infections, hypovitaminoses, and chronic intoxications, the protein content of the diet is increased (1.5–2 g per kg of body weight).