Medical foods at inflammatory damages of a gall bladder and bilious ways
Acute and chronic cholecystitis, cholangitis (angiocholitis) concern to them, holetsistokholangit (holetsistoangiokholit), a cholangiohepatitis. They develop as a result of penetration into a gall bladder or the bilious courses of various infectious beginnings (colibacillus, streptococci, staphylococcus and so forth), are followed by disturbance of bile secretion and frequent involvement in pathological process of a liver (cholangiohepatitis). Developing of a disease is promoted by stagnation of bile because of irregular food, pregnancy, insufficient physical activity, dyskinesia of bilious ways and obstacles to bile outflow (stones, strictures, excesses, commissures and so forth). Adverse influence accords welcome of spicy, greasy and fried food.
Medical foods are directed to stimulation of bile secretion, elimination of inflammatory process in bilious ways, prevention of damages and normalization of the broken functions of a liver, a korrigirovaniye of exchange disturbances and the prevention of formation of stones in bilious ways.
The dietotherapy has to be under construction taking into account a disease phase (an aggravation or remission) and conditions of other bodies of system of digestion.
At chronic inflammatory defeats in the period of the expressed exacerbation of a disease for 3 — 4 days purpose of antiinflammatory option of a diet No. 5 (A. M. Nogaller) is reasonable in the beginning. Restriction of energy value of a diet at the expense of proteins and fats and reduction of amount of salt is provided in it. Within 3 — 4 days energy value of a diet with 6531 (1560 kcal) to 12 225 kJ (2920 kcal), the content of proteins from 50 to 100 g, fats — from 40 to 80 g and carbohydrates — from 250 to 450 g increases. Food is eaten 6 times a day in the wiped view with an exception of mechanical and chemical irritants.
At less expressed aggravation the diet No. 5a can be appointed quickly (to 3 — 5 days). Further, in process of improvement of health of the patient, medical foods are carried out within a medical diet No. 5.
Energy value of a daily diet has to correspond to energy costs. It is reasonable to limit it a little in the period of the expressed exacerbation of a disease (in the first 2 — 3 days) at excess food and to increase at exhaustion.
Enough proteins (90 — 100 g), fats (80 — 100 g), carbohydrates (350 — 400 g) and vitamins of group B (Retinolum, phylloquinones, ascorbic acid, Niacinum and Folacinum) is entered. It must be kept in mind that proteins of fish and meat lead to shift of bile reaction in the acid party that promotes loss of cholesterol from colloidal solution of bile and to a lithogenesis. However proteins, taking part in education in a liver of bile acids and increasing holatokholesterinovy coefficient, can interfere with a lithogenesis. In this regard there are no bases to restriction of meat and fish in a diet that practiced earlier. The use of such products rich with protein which contain a lot of calcium (cottage cheese, cheese) is more reasonable. Calcium promotes shift of bile reaction in the alkaline party that interferes with loss of cholesterol from colloidal solution of bile and the lithogenesis warns.
Administration of milk, dairy products (cottage cheese, kefir, curdled milk), lean beef, low-fat grades of fish, cheese, soy flour, millet and buckwheat provides receipt in an organism of enough lipotropic factors (sincaline, methionine and so forth) that warns fatty dystrophy of a liver. It is especially important when involving in pathological process of a liver (cholangiohepatitis).
There are instructions that the effect of antibiotic therapy at diseases of bilious ways increases at enrichment of food proteins.
The need for fats becomes covered generally at the expense of vegetable oil (sunflower, olive, corn and so forth). They have lipotropic effect, stimulate bile secretion and interfere with stagnation of bile. Fats of animal origin (mutton, beef, duck, fat), pork and other fat grades of meat and fish which are badly transferred by patients are subject to an exception and can cause attacks of bilious colic. Besides, animal fats are rich with cholesterol which administration should be limited for the purpose of prevention of a lithogenesis in bilious ways. Therefore the use and other products rich with cholesterol is not recommended (an egg yolk, a brain, a liver, heart and so forth). Fried dishes in oil (fish, meat, flour products, vegetables) are especially harmful which strengthen pain and irritate a liver parenchyma at the expense of the toxic products which are formed when frying (acrolein).
In the period of the expressed exacerbation of a disease reasonablly some restriction of fats (50 — 70 g). Digestible carbohydrates (sugar, honey, jam, fruit jelly) promote formation of a glycogen in a liver. However, according to modern data, digestible carbohydrates promote stagnation of bile. Therefore at inflammatory defeats of bilious ways with the phenomena of hypomotor dyskinesia, and also at the accompanying obesity restriction of digestible carbohydrates is shown. The cellulose (vegetables, fruit, berries etc.) has to join in a diet in enough as it stimulates bile secretion. Retinolum interferes with a lithogenesis in the bilious courses. Therefore it is reasonable to enter it even in a little increased quantity.
Salt is a little limited (8 — 10 g), especially in the period of the expressed aggravation (5 — 7 g) that has antiinflammatory effect.
The increased contents in a magnesium diet is shown. It reduces a spasm of smooth muscles, reduces nervous irritability, has anesthetic and gipokholesterinemichesky effect, stimulates bile secretion and motive function of guts.
It is necessary to accept enough liquid. (1,5 — 2 l). In this respect especially beneficial effect is exerted by mineral waters ("Yessentuki No. 17", "Truskavetskaya", "New and Izhevsk", "Donetsk", etc.) which stimulate bile secretion and promote washing of bilious ways.
At bent to a lock inclusion of the products stimulating emptying of guts (lactic products, prunes, beet, cellulose of fruit and vegetables, honey) is justified. Besides, it promotes removal from an organism of cholesterol which is allocated with an intestinal wall. During the weakening of motive function of a gall bladder and stagnation of bile purpose of a diet with the increased amount of fat generally at the expense of vegetable oil is reasonable.
It can be reached by use of a lipotropic and fatty diet. It contains proteins 100 — 120 g, fats of 120 — 130 g (50% vegetable), carbohydrates of 350 — 400 g; energy value 12058 — 13 607 kJ (2880 — 3250 kcal).
Approximate one-day menu of a lipotropic and fatty diet of a diet No. 5. 1st breakfast: a pudding cottage cheese without sugar (130 g), friable buckwheat cereal with vegetable oil (160 g), tea with milk (180 g). 2nd breakfast: apples fresh (100 g). Lunch: Russian cabbage soup vegetarian on vegetable oil (500 g), meat boiled in milk sauce (55 g), carrots, stewed on vegetable oil (150 g), compote from dried fruits (180 g). Afternoon snack: croutons without sugar (25 g), dogrose broth (200 g). Dinner: fish boiled in milk sauce with vegetable oil (85 g), potatoes boiled with vegetable oil (150 g), cutlets cabbage and carrot, baked with vegetable oil (200 g), tea (200 g). For the night: kefir (180 g). For all day: white bread (300 g), sugar (30 g), butter (10 g).
After elimination of an exacerbation of chronic cholecystitis at insufficient emptying of guts, hypotonic and hypokinetic diskineziya of bilious ways, the phenomena of the general neurosis the magnesian diet (A. M. Nogaller and Yu. S. Vishnevskaya) can be applied. It has sufficient energy value — 12 225 kJ (2920 kcal) contain normal amount of protein (100 g) and carbohydrates (450 g), moderately limited amount of fat (80 g) the increased amount of magnesium (1300 mg) and vitamins (Retinolum — 2 mg, thiamin — 4 mg, Niacinum — 52 mg, ascorbic acid — 175 mg). The diet is rich with a cellulose. Thus, at the expense of the products rich with magnesium, the diet contains more than 4 times more magnesium in comparison with a diet No. 5. The magnesian diet is not shown at the accompanying gastritis and a coloenteritis with the phenomena of fermentation and a diarrhea.
Daily set of products of a magnesian diet
The food is a good stimulator of bile secretion therefore it is necessary to accept it fractionally — not less than 5 — 6 times a day in a warm look. Cold dishes and drinks cause a spasm of the gatekeeper and reflex bilious channels. In this regard pain can amplify and be at a loss bile secretion.
Are prohibited: extractive substances (fish and beef-infusion broths, mushroom broths etc.), cocoa, fancy and puff pastry, fat creams, acid berries and fruit (gooseberry, red currant, cranberry, antonovka), nuts, hot, salty, marinated dishes, smoked products, many spices and seasonings (pepper, mustard, strong vinegar), alcoholic and carbonated drinks. At obesity beneficial effect is exerted by carrying out (once a week) fasting days (cucumber, cottage cheese, etc.).
At acute cholecystitis and a cholangitis medical foods are under construction by analogy with that at an aggravation of chronic inflammatory damages of a gall bladder and bilious ways.