Free Healthy Balance Diet Information
Medical teachers usually refrain from teaching dietetics to medical students. As a result, doctors seldom prescribe full dietetic instructions. For example, instructions are commonly given to a patient to 'avoid sour and spiced foods', without specifying the forbidden items. Where facilities are available, dietetic prescriptions are prepared by a dietitian. Unfortunately, this facility is not available everywhere, and hence the need for physicians to be able to prescribe a diet.
Because doctors are not trained to give adequate dietary advice, the public turn to unqualified, unregulated nutritionists. Food faddism is rife. Too much attention is being paid by people to eating 'correct food'; this has killed the pleasure of eating. The US Surgeon General states that 'nutrition fraud has long been recognized as a leading example of health fraud. Only rarely have reputable medical scientists been prepared to devote the enormous amount of time and effort required to expose these dietary frauds.
Before formulating a diet, several factors need to be considered in the patient's routine as well as his requirements. The Recommended Dietary Allowances (RDA) are not standards of minimal requirement; instead, they are amounts that should adequately nourish most healthy people. There is no known advantage of eating more than the advised quantity.
Considerations in diet prescription
The following factors are important considerations in preparing a diet prescription.
Economic status :- The economic status of the patient is an important practical consideration in formulating a diet prescription. During an acute illness or convalescence a few expensive items may be permissible, but for more prolonged or chronic illnesses, foods must be within the means of the patient.
Vegetarian or non-vegetarian :- Whether the patient is a vegetarian or not must be known. If vegetarian, then the 'degree' of vegetarianism should be assessed; for instance, vegans do not eat even eggs or dairy products; 'egg vegetarians' eat eggs and fish but not animal flesh; and 'home vegetarians' are vegetarian at home, for family reasons, but relish meat or chicken at a restaurant or party.
Food intolerance :-The dietetic history should elicit whether a patient can tolerate all foods: especially milk, pulses, spices, egg, meat, fish and prawn. Milk may produce diarrhea in some and constipation in others; those with colonic disorders are likely to get flatulence with pulses. Such foods' should be restricted or excluded as necessary.
Depending on the disease, certain foods may have to be excluded. In peptic ulcer and gastritis, spices and chilies are not permitted. For a patient confined to bed, fried foods and pulses are best avoided as they produce flatulence.
Allergy :- Allergy to food manifests as urticaria, abdominal cramps, or bleeding. The common allergens are shellfish and egg, and these have to be excluded.
Occupation and time of meals :- The occupation of the patient and the time he takes his meals have to be noted. A mill-worker who works on different shifts requires more detailed instructions for a peptic ulcer diet than a clerk whose hours of work are fixed.
Calorie Requirement :- A person confined to bed tends to consume less calories than a person undergoing physical exertion. Bed-rest also decreases appetite. For an average adult confined to bed, about 1400-1600 kcal (5.9-6.7 MJ) may be adequate. Fever increases the calorie needs.
A diet high in calories is indicated for undernourished or convalescent patients. They are advised to take more cereals, butter and oils at the main meals, and snacks of milk, sandwiches or biscuits at mid-morning, mid-evening and before retiring.
A low-calorie diet is indicated for all obese patients. A diet consisting of raw and cooked vegetables, fruits, egg, meat, fish, chicken, and skimmed milk, with a low intake of cereals provides bulk, satiety, adequate proteins, and relatively few calories. Avoiding fat reduces weight.
Protein Requirement :- Total intake of proteins is usually adequate in a standard non-vegetarian diet. For vegetarians, the important sources of proteins are milk, cereals and pulses. In diseases of the colon, whole milk usually produces diarrhea while pulses produce flatulence. The protein requirements of vegetarians with colonic diseases can only be met by providing commercial protein foods, or by supplying skimmed milk powder which is usually more easily digested than fresh milk.
Cirrhosis, nephrotic syndrome, pregnancy and lactation A high-protein diet is prescribed to patients with low serum albumin, as in liver cirrhosis without liver failure and in the nephrotic syndrome. It is also advisable to increase the protein intake during pregnancy and lactation. For a non-vegetarian, this can be done by increasing the quantity-of meat, chicken, fish or egg. For the vegetarian, extra skimmed milk, cottage cheese, and pulses are advised. All pulses, including gram (Bengal gram) and groundnut, are relatively inexpensive and palatable protein-rich foods.
Liver and kidney failure During hepatic coma or uremia, protein has to be with held temporarily, and carbohydrate-rich foods like fruit juice, banana, sugar cane juice, and lemonade with sugar, honey or jaggery are advised.
Fat Requirement :- Fats are a convenient source of calories. Fats are not as indispensable as proteins, though prolonged deficiency of essential fatty acids leads to skin changes. A high-calorie diet should contain fatty foods like cream, butter, ghee and oil, and fats should be freely used in cooking. A low calorie diet contains little fat.
Carbohydrate Requirement :- Carbohydrates provide bulk, and together with fats, form the chief source of calories. If a high calorie diet is to be prescribed, carbohydrates in the form of chapattis (of wheat or other cereals), bread and biscuits provide comparatively inexpensive nourishing foods. For a low-calorie diet they are used sparingly.
Vitamins Requirement :- The best sources of vitamins are liver, yeast, whole grain cereals, and fruits. Vitamin A is derived from egg, milk and butter, while carrots and green vegetables provide the pro-vitamin A, carotene. Vitamin B-complex is derived from unrefined cereals and flesh foods. The best sources of vitamin C are fresh fruits, vegetables, and germinating cereals. Vitamin D can be easily acquired by exposure of skin to the sun for about half an hour.
Minerals Requirement :- Calcium is available from milk. The usual diet is seldom deficient in phosphorus. Iron is available from cereals, liver, kidney and egg. Sodium is easily provided by common salt added to food. A low-sodium diet may have to be prescribed during fluid retention, as in ascites, cardiac failure, or the nephrotic syndrome. The potassium intake can be increased with vegetables and fruits. A low potassium intake is advisable for patients with kidney failure.
Fluid Requirement : -Inadequate fluid intake can lead to constipation. Fluid intake should be liberal enough to ensure the passage of 1500-2000 ml of light-colored urine per day.
Fluids need to be restricted when excretion is impaired, as in acute nephritis and kidney failure. The water requirement per day is then calculated as: 1000 ml a day to replace the insensible loss in respiration and perspiration, plus the volume of urine passed during the previous 24 hours.
Important steps to a healthy diet
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