Health diet

While preparing a diet plan for cirrhosis patients, some important points should be kept in mind for making recovery from disease fast and also for reversing architectural distortions of cirrhosis, which may take very long time and may not be able to reverse completely if not taken care of in a proper manner. Without observing the important points the diet plan of cirrhosis may not be complete.

The following points are important and should be kept in mind and followed strictly while preparing a diet plan for cirrhosis:

1. Diet of cirrhosis patient should be soft and easily digestible, as the liver is damaged in cirrhosis the metabolism of the food that a patient take may not be proper and easily digestible foods are helpful.
2. If the patient is very sick, he/she may require liquid diet, till the patient is fit enough to take solid food. The liquid diet may be taken 6 to 8 times a day or every few hours to maintain adequate nutrition. After patient recover from acute illness, he/she can be given soft and well cooked diet for easy digestion.
3. The patient should be encouraged to eat adequate amount of food which he/she can digest easily. The food served to the patient should attractive, appetizing, well cooked, and acceptable to the local customs and traditions and to the liking of the patient, so that patient is encouraged to eat. Likes and dislikes of the patient are important for encouragement, so patient takes adequate amount of food to maintain nutrition.
4. The salt intake should be restricted, both for cooking as well as for table use.
5. Large meals should be avoided and instead of large meals small and frequent meals should be taken. This will make digestion easy and faster.
6. Foods to be included in liberal amounts are sugar, honey, glucose, cereals, pulses, milk and milk products, eggs, fruits, and vegetables. Foods to avoid are fried and fatty foods, fats, oils, nuts and oilseeds, strongly flavored vegetables etc.
7. Complete avoidance of alcohol is must for speedy recovery and for proper reversal of architectural distortions of cirrhosis, at least for one year and if possible alcohol should be stopped for life. The avoidance of alcohol for life can reduce future problems to a great extent.

The diet plan for cirrhosis should be done as per recommended dietary modification for cirrhosis. The diet of cirrhosis patient should be according to the different modifications like increased energy requirements, provision of quality proteins, addition of easily digestible fats (although total fat consumption should be reduced), simple forms of carbohydrates like glucose, sugar, fruits and fruit juices and starches like cereals (avoidance of irritating carbohydrates) etc. The diet plan for cirrhosis should be made such a way that it promotes speedy healing of liver (reversal of architectural distortions) by providing all the essential nutrients (proteins, fats, carbohydrates, vitamins and minerals) in adequate amounts. The diet should be planed in such a way that it is also palatable and acceptable to the local customs, traditions and to the liking of the cirrhosis patient. There is no universal diet plan for any medical problem; it should be based on local food habits and one which is acceptable to the patient.

The following diet plan can be followed for cirrhosis:

Early morning: The early morning should start with tea and biscuits with less fat and more carbohydrates.

Breakfast: The breakfast should consist of porridge, easily digestible fruits like papaya.

Mid morning: The midmorning snack can be with sweet potato, potato mix etc.

Lunch: The patient of cirrhosis can have lunch with whole grain like well cooked rice, vegetables and well cooked fish.

Mid afternoon: Custard can be taken in the mid afternoon.

Evening tea: It can be with noodles and fruit juice along with tea or coffee.

Dinner: It should start with soup (vegetable soup or chicken soup). Dinner should be with blend soft rice mixed with vegetables, noodles etc.

Bed time: It should be with a sweet dish.

N.B: The most important point should be remembered in preparing a diet plan for patient with cirrhosis is that the meals should be small and frequent instead of large infrequent meals.

Dietary modification in cirrhosis is very important for speedy reversal of architectural distortions of cirrhosis. Along with dietary modification, the removal of the causative or aggressive factors of cirrhosis is also important for architectural distortions of cirrhosis.

The following dietary modifications are essential for speedy reversal of architectural distortions of cirrhosis:

Energy requirement:

The energy requirements are increased to correct nutrition deficiencies and to promote reversal of architectural distortions liver, but due to the bedridden condition of the patient the energy requirement of cirrhosis patient is actually less than normal person.

Proteins:

The protein intake should be normal to overcome malnutrition, regenerate liver cells and to replenish plasma proteins. However, if there is hepatic coma, the protein intake should be less than normal depending on the individual tolerance.

Carbohydrates:

A high carbohydrate diet is essential and recommended for increased energy demand and to protect the liver from further damage. Carbohydrates should be in the simple forms like glucose, sugar, fruits and fruit juices and starches like cereals and root vegetables etc. Irritating fibers should not be taken and refined cereals and low fiber vegetables and fruits should be consumed.

Fats:

Many cirrhotic patients suffer from mal-absorption of fat and fat should be restricted to help such patients (although inclusion of adequate amount of fat to improve the palatability of the diet and to promote recovery is recommended). The amount of fat to be included in the diet varies depending on individual. Emulsified fats, which are easily digested like fat from milk, butter, cream, eggs should be given.

Vitamins:

The absorption of fat-soluble vitamins like vitamin A, D, E & K may be affected due to the decreased intake and impaired absorption of fat. Therefore, diet should include fat-soluble vitamins like vitamin A, D, E & K rich foods and vitamin B complex supplements may be required to replenish liver store and repair tissue damage.

Minerals:

Adequate amounts of calcium, magnesium and other minerals should be provided in the diet for cirrhosis patient. The intake of sodium needs to be restricted because of water retention in the body.

Cirrhosis is a condition that consists of the development of fibrosis to the point that there is architectural distortion with the formation of regenerative nodules in the liver. This results in a decrease in liver mass (due to decrease of liver cells), and thus function, and an alteration of blood flow.

The common causes of cirrhosis are alcohol abuse that cause alcoholic liver disease, chronic hepatitis C etc. Cirrhosis has a variety of clinical manifestations and complications, some of which can be life-threatening. In the past it was thought that the architectural distortions of cirrhosis are never reversible, but fortunately it has become apparent that when the underlying insult that has caused the cirrhosis has been removed (like successful treatment of chronic hepatitis C and stopping of alcohol consumption completely), there can be reversal of architectural distortions (mainly fibrosis).

The main objectives of a diet for cirrhosis are as follows:

1. To promote regeneration of liver cells by supplying adequate amount of nutrition through planning an appropriate diet for cirrhosis. Liver cells have tremendous capacity to regenerate, unlike many other organs, but for proper regeneration of liver cells, a suitable diet is basic need. Supply of adequate good quality protein is essential for regeneration of any cell, including liver cells (without protein the DNA and other important biomolecules can not be synthesized and without these biomolecules regeneration is not possible).
2. Due to architectural distortions of liver cells, generally there is nutritional deficiency in cirrhosis, which can hamper the proper regeneration of liver cells. By supplying adequate nutrition with planned diet the regeneration can be sped up. Nutritional deficiencies are also common among alcoholics (chronic alcohol use or abuse is the commonest cause of cirrhosis).
3. In a patient of cirrhosis fluid and electrolyte imbalance may be a problem, especially during the initial stage of management of cirrhosis. This electrolyte imbalance should be corrected through intake of fluids and by adequate diet.

For speedy recovery and to avoid potentially serious complications of typhoid fever, it is very important to have a good and balanced diet plan. If not treated promptly and adequately (with suitable antibiotics and diet) typhoid fever may cause serious complications like perforation of typhoid ulcer of intestine and chronic carrier state (which is very difficult to cure). To avoid serious complication diet plays an important role in typhoid by hastening recovery.

The following diet plan for typhoid can hasten recovery and help to avoid serious complications:

Early morning: The early morning should be started with milk or tea with bread (breads are easy to digest and have good amount of protein).

Breakfast: The breakfast should consist of boiled eggs (boiled eggs are the easiest to digest among high protein foods), porridge etc. Both of these are easily good for health.

Mid morning: This should be with tea with sandwich.

Lunch: Mixed vegetables, whole grain cereal, fish, egg and white meat etc. should be taken during lunch.

Evening tea: It should be with tea, bread with jam or bread with butter.

Dinner: It should be with soup, whole grain cereals and vegetables.

At bedtime custard with fruits should be taken.

Some points should be remembered while planning a diet for typhoid fever patients. The following are the points to remember:

1. Meals should be small and given at frequent interval, instead of a few large meals a day. Larger meals can be given like for any normal person, as the general health condition improves.

2. Intake of oral fluids and salts should be sufficient to cover up the loss.

3. The diet of typhoid fever patient should be bland, soft (for easier digestion and absorption), high in protein and calorie and low in fiber content.

If you are suffering from typhoid fever, it is important to know that certain foods should be avoided or restricted and certain foods should be consumed in liberal quantities. For speedy recovery some foods should be taken in liberal amounts and certain foods should ideally be avoided.

The following food should be restricted or avoided in typhoid:

1. Avoid all types of foods that are cause irritation to the digestive tract. The foods that can cause irritation to digestive tract are spices, pickles, chillies etc. Strongly flavored vegetables also should be ideally avoided or restricted. Some examples of strongly flavored vegetables are garlic, onion, radish, turnip, capsicum etc. These types of foods (irritants and strongly flavored vegetables) should be avoided because there may be injury (ulcer) to the intestine as a complication of typhoid. The ulcer may perforate in severe cases.

2. Raw vegetables and certain types of fruits should also be avoided or restricted due to possibility of damage to intestine during typhoid.

3. Highly fatty and fried foods (French fries and others

4. High fiber foods like whole grain cereals and their products, excessive amount of vegetables, whole pulses (pulses with husk) should be avoided or restricted.

Foods to be consumed in liberal amounts during typhoid:

1. Foods with high protein and which are easily digestible should be consumed in liberal amounts. Eggs, cheese, fish and white meat are the foods with high protein and easily digestible.

2.  Fluid consumption should be high during typhoid fever to replace lost fluid and electrolyte through sweating (and sometime diarrhea). Fruit juice, soup, milk and milk based liquids should be taken in liberal amounts. Fluid intake should be 3 to 4 liters a day.

3.  Low fiber foods such as refined cereals and their products, well cooked vegetables in soft pure form and boiled potatoes etc. should be taken.

4.  The diet during typhoid fever should have adequate amounts of calories (through carbohydrates and fats), proteins, vitamins and minerals.

In typhoid fever there is need of certain dietary modifications due to increase need of energy during typhoid fever. The following dietary modifications are required during typhoid fever:

Energy requirements:

In typhoid fever, like any other fever the BMR (basal metabolic rate) increases. Due increased BMR the energy requirement increases. The energy need is also more if there is restlessness. But due to loss of appetite the patient of typhoid fever, may be able to take only 1000 kcal to 1200 kcal per day. This energy (food) consumption should be gradually increased to meet increased energy need in typhoid fever.

Protein requirements:

During typhoid fever protein requirement also goes up. Increased protein intake will also make the recovery much faster. Foods with high protein and easy digestible foods like eggs should be taken to make up the increased requirements of energy.

Carbohydrates requirements:

Increased requirement of energy during typhoid fever is generally met by increased intake of carbohydrates. The carbohydrates should be easily digestible as well as easily absorbable. Well cooked, easily digestible carbohydrates like starches, glucose, honey, sugarcane etc. should be taken in liberal amounts during typhoid.

Fats requirements:

The fat requirement in typhoid fever is mainly for increased requirements of energy (as fats are the providers of highest calories). The fats should be easily digestible and easily absorbable (like butter, cream and milk fat). If diarrhea, is a presenting symptom of typhoid, than fat intake should be restricted.

Mineral requirements:

There is excessive loss of electrolytes like sodium, potassium and chloride due to increased sweating and also due to diarrhea in some patients with typhoid. Salty soups, broths, fruit juices and milk help compensate the loss of electrolytes.

Vitamins requirements:

Infection and fever can increase the requirement of vitamins (vitamin A, B complex and C). Due to increased requirements the vitamin supplementation may be required or supplied adequately in the diet.

Dietary fibers:

Due to the chance of injury in the digestive tract in typhoid the diet should contain less fiber. All types of harsh and irritant foods also should be avoided.

Fluids:

In typhoid there may be increase loss of fluid and electrolytes. In order to compensate for the losses through the sweat and also to ensure adequate volume of urine for excreting waste, a liberal intake of fluids is very essential. Fluid intake should be 3 to 4 liters per day during fever. Fluids may be taken as water, tea, milk, juices and soups.

Typhoid is a common waterborne disease, especially in the developing countries due to lack of safe drinking water supply and poor personal hygiene among people (due to high prevalence of illiteracy). Another important cause of transmission of typhoid is the ability of Salmonella (the causative organism of typhoid is Salmonella typhi and Salmonella paratyphi) organism to survive even in freezing temperature for long time. Due to this ability the organisms can survive in ice cream and can be transmitted through ice cream.

In the developed countries typhoid is almost eradicated by provision of safe drinking water and by improvement of environmental sanitation. Poor habits of defecation (e.g. open air defecation in many developing countries) are a major cause of high prevalence of typhoid in developing world.

The main objectives of typhoid diet are as follows:

1. To maintain adequate nutrition during typhoid fever is very important. Loss of appetite may be a problem during typhoid fever and during this time marinating of adequate nutrition may pose a problem.
2. During typhoid fever there may be water and electrolyte disturbance in the body due to loss of body fluids and inadequate intake of oral fluids. Diarrhea is sometimes a symptom of typhoid and need fluid replacement. Maintaining of water and electrolyte is very important during water and electrolyte fever.
3. Along with maintaining of adequate nutrition (mainly calorie) the provision of adequate quantity of protein through diet is also very important. Without adequate protein the recovery from typhoid fever may be slower. Proteins are also essential for healing of wounds.
4. By taking a planned and balanced diet the recovery from typhoid fever is much faster. With proper diet the symptoms of typhoid fever also disappear faster.

By planning a proper diet for a patient of typhoid fever, the recovery from fever and typhoid can be very fast and without much complications of typhoid fever.

For patients who are suffering from tuberculosis it is very important to have good, nutritious and balanced diet for speedy recovery. A balanced diet plan is also essential to prevent some complications of tuberculosis as well as to prevent the side effects of anti tubercular antibiotics, especially Isoniazid (anti tubercular antibiotic). Because tuberculosis can take a heavy toll on the health of the patient diet plan for maintaining the health of tuberculosis patient is of utmost importance.

The following diet plan can help a tuberculosis patient greatly in speedy and uneventful recovery:

Early morning diet: It should consist of milk and biscuits.

Breakfast: Breakfast should be with porridge, bread with butter or jam or whole grain (as per the local food habit).

Mid-morning diet: It should liberal servings of fresh fruits (locally grown fruits are best) and sprouted gram.

Lunch: Lunch should be with whole cereal preparation, liberal amounts of vegetables and seeds and nuts. Lunch also should contain fish and meat as per the linking and local custom.

Evening tea: It should consist of tea/coffee with bread or sandwich or any such local preparation.

Dinner: It should be with whole cereal (rice, maize, wheat etc. as per local tradition); one or two servings of vegetables and fish/meat (preferably white meat).

The following points should be remembered while preparing diet plan for patient of tuberculosis:

1. The diet should be simple, easily digestible, well prepared and to the liking of the patient to encourage for consuming.
2. Meals should be small, but at frequent interval and larger meals can be given if condition of the patient is improved.
3. Force feeding should not be done as it may harm.
4. Fluid intake should be sufficient.
5. Diet should be bland (fiber content of diet should not be high) and diet (easy to digest and absorbed).

Tuberculosis is still a general public health problem in many developing countries such as India. As tuberculosis is common in developing countries, where poverty and malnutrition are also rampant, tuberculosis takes a huge toll on health of the nation as a whole and affects individual health in particular. Tuberculosis patients are generally malnourished and malnutrition is one of the cause of reduced body immune status (malnutrition can not supply adequate proteins and proteins are vital in maintaining immune status of an individual). Due to the possibility of malnutrition in tuberculosis patients it is important to provide proper nutrition to them with adequate protein in the diet.

The following dietary modifications are recommended in tuberculosis:

Energy: The requirement is increased in tuberculosis. This increased energy requirement is to minimize weight loss and for speedy recovery from tuberculosis.

Proteins: Tuberculosis generally has fever of long duration and in fever of long duration there is considerable loss of tissues and to compensate tissue loss the protein intake should be higher in tuberculosis. Serum albumin is also reduced in tuberculosis.

Carbohydrates: The carbohydrate content of diet of tuberculosis patient should be enough to meet increased energy demands, which generally comes from carbohydrates.

Fats: The fat content should be moderate in tuberculosis, because too much fat can frequently cause stomach upset and diarrhea.

Vitamins: The diet of tuberculosis patient should have adequate amount of vitamins. Because some anti tubercular antibiotics use vitamins for their metabolism, especially vitamin B6, so vitamin content should be adequate in diet, especially vitamin B6.

Minerals: The mineral content of tuberculosis diet should be high, especially calcium content. Liberal amount of calcium is required for proper and faster healing and recovery of tuberculosis. For enough calcium, milk and milk products should be taken in liberal quantities. There may also be anemia in tuberculosis patients due to malnutrition and iron should be supplied adequately in diet or supplemented artificially.