New principles of therapeutical nutrition

· Individual nutrition based on somatometric (height, weight, etc) and metabolism data of the patient.

· Supporting digestion in cases of digestive enzymes formation dysfunction. E.g., deficiency of peptidase enzyme in intestine that split protein gluten of rye, barley, oats (gluten disease) or increased sensitivity to gluten (celiac disease) the diet must not contain any of the mentioned cereals.

· Taking into consideration the interaction of food substances inside the gastric-intestine tract and organism: it is essential to balance the nutrient elements, e.g. absorption of calcium is decreases when there is excessive amount of fats, phosphor, magnesium, oxalic acid.

· Stimulating recovery processes in organs and tissues using appropriate elements, especially aminoacids, vitamins, microelements, essential fatty acids.

· Compensating the loss of elements during the disease. E.g., in anemia treatment particularly after blood loss the diet should contain increased amount of elements needed for hematosis (iron, copper, etc.), vitamins and animal proteins.

· Direct change of nutrition programme in order to train biochemical and physiological processes in the organism (e.g., frequent intake of food with decreased energy value used in cases of obesity).

· Use of sparing methods in nutrition (irritation or functional insufficiency of an organ or system) – limitation of chemical, mechanical or thermal irritants.

· Use of gradual enrichment of the diet introducing less sparing products and meals.

Use of unload (discharge) methods and “contrastive days” – on the background of the basic therapeutical diet introduction of load (charging) (e.g. inclusion into the diet of the excluded elements) and unload days. Load days not only provoke the stimulation of functioning, but also test its stability. The purpose of the unload diet is to temporarily ease the functioning of organs and systems, help the organism to discharge products of metabolism. On the basis of food elements the unload diets are divided into protein (milk, curds, meat-vegetable), carbohydrate (fruit, sugar-vegetable), fatty (cream, sour cream), combined (include different types of products). For prescription of a particular diet there are strict recommendations. E.g., in case of chronic cardiac deficiency we can prescribe protein, carbohydrate, combined unload diets or we can interchange them.

Diets

Milk diet

Carell diet (was introduced by Philip Yakovlevitch Carell) – is a method of treatment of patients (who have cardio-vascular and kidneys diseases) with skim milk (0,8-3 l per day) and keeping bed rest. The classical variant of the diet includes 200 ml of skim milk 4 times a day, then the nutrition is enriched with eggs, rusks and gradually the patient starts eating everyday food.

Apart from cardiac insufficiency the diet is used for essential hypertension, obesity, liver and bile-excreting tracts diseases, pyelitis, pyelocystitis. The diet includes milk, kefir, clotted milk in 2-2,5 hour-intervals with 200-250 ml 6 times a day (all in all 1,2-15, l).

Curds [cottage cheese] diet

Prescribed in cases of expressed cardiac insufficiency; chronic nephritis with edemata, but not azotemia; obesity. It includes 500 gr of curds and 150 gr of sugar, 1-2 glasses of hips decoction. The food is given in equal portions 5 times a day with 2-2,5 hour-intervals.

Apple diet

It is used in cases of obesity, essential hypertension, chronic nephritis, chronic pancreatitis. The patient is given 250-300 gr of ripe raw apples 5 times a day (all in all 1,25-1,5 kg). In cases of chronic enterocolitis the patient is given grated raw apples without peel and seeds, 250-300 gr 5 times a day. Caloric value is 500-600 kcal.

Compote diet ( stewed fruit)

It is prescribed for the same diseases as apple diet. The patient is given 1 glass of compote 6 times a day. The compote is made of 200 gr of desiccated fruit, 60-70 gr of sugar and 1,5 l of water. Caloric value – 750 kcal.

Milk-potato diet

It is prescribed for chronic nephritis with edemata and azotemia, cardiac insufficiency, diseases accompanied by acidosis. The diet lasts 2-6 days, it includes 1 kg of potatoes and 0,5 l of milk. No salt allowed. Caloric value 1200-1300 kcal.

Meat-vegetable diet

It is prescribed for obesity, includes 350 gr of boiled beef, 0,6 kg of vegetables.

Raisin diet

It is prescribed for the same diseases as milk-potato diet. It lasts one day, includes 0,5 kg of raisin without seeds. Raisin is given 5-6 times a day in equal portions.

Tea diet

It is used in cases of gastritis with secretory insufficiency, enterocolitis. It lasts 1-2 days. During the day the patient drinks 7 glasses of sweet tea, each glass contains 10-15 gr of sugar.

Watermelon diet

It is prescribed for nephritis, gout, nephrolithiasiswith uraturia. The patient is given 300gr of watermelon 5 times a day.

№0a№0b№0c

These diets contain easily digestible proteins, fats and carbohydrates, increased amount of liquid and vitamins. Sodium chloride is strictly limited. The food is taken frequently, but in small portions. After zero diets we use №1 or №1 surgical. The latter differs from №1 with the inclusion of weak meat and fish broths and vegetables decoctions as well as limitation of whole milk.

№0a

Usually it lasts 2-3 days. The food consists of liquid or jelly-like meals. It has 5 gr of protein, 15-20 gr of fat, 150 gr of carbohydrate, caloric value 3,1-3,3 Mjoule (750-800kcal); salt 1 gr, liquid 1,8-2,2 l. temperature of the meals is not higher than 45⁰C. The diet also includes 200 gr of vitamin C; other vitamins can be added according to doctor’s prescription. Food is taken 7-8 times a day, one intake contains no more than 200-300 gr of food. Products that are allowed: weak fatfree meat broth, rice decoction with creams or butter, compote, berriesliquid kissel, hips decoction with sugar, fruit jelly, tea with lemon and sugar, fresh fruit and berries juices diluted with sweet water two- or threefold (50 ml per one intake). If the condition of the patient improves on the third day soft-boiled egg, 10 gr of butter, 50 ml of creams are added to the diet.

Jelly soft-boiled.

№0b (№1a surgical)

It is prescribed on the 2^nd-4^th day after №0a diet, it also includes liquid grated rice, buckwheat, oats porridge made on water or meat broth. The diet contains 40-50 gr of protein, 40-50 gr of fat, 250 carbohydrates, caloric value 6,5-6,9 Mjoule (1550-1650 kcal); 4 gr salt, 2 l of liquid. The food is given 6 times a day, 350-400 gr per one intake.

№0c (№1в surgical)

The diet serves as an enrichment of the previous diets and gradual transfer to normal food. Cream-soups, steamed meals of boiled grated meat, fish or chicken, fresh curds grated with creams or milk, baked apples, grated fruit and vegetables purée, up to 100 gr of rusks. Tea with milk; milk porridges. The diet contains 80-90 gr of protein, 65-70 gr of fat, 320-350 gr of carbohydrates, caloric value 9,2-9,6 Mjoule (2200-2300 kcal); salt – 6-7 gr. Food is given 6 times a day. Temperature of hot meals is not higher than 50⁰C, cold ones – no less than 20⁰C.

Therapeutical diets

Diet №1a

Prescribed: acute exacerbation of stomach or duodenum ulcer during the first 6-8 days of treatment; acute exacerbation of chronic gastritis during the first days of treatment; acute gastritis on the 2-4 day of treatment.

Purpose: maximal mechanical, chemical and thermal sparing of gastric-intestine tract, decrease of inflammation, improve healing of ulcers.

General characteristics: the diet of decreased energy value of carbohydrates and insignificantly – proteins and fats. Salt is limited. Meals that provoke gastric secretion or irritate its mucous coat are limited. Food is grated, boiled or steamed, is given in liquid or porridge-like form. No hot or cold meals.

Chemical substance and caloric value: 80 gr protein (60-70% animal proteins), 80-90 gr fat (20% vegetable fats), 200 gr carbohydrates; caloric value 8-8,4 Mjoule (1900-2000 kcal); salt 8 gr; liquids 1,5 l.

Nutrition regime: 6 times a day, small portions; milk before sleep.

Forbidden products: bread and any bakery foods, vegetables, snacks, cultured milk foods, cheese, sour cream, curds, confectionery, sauces and spice, coffee, cocoa, soda water.

Diet №1b

Prescribed: stomach and duodenum ulcer; chronic gastritis after recovery from acute exacerbation after diet №1a; acute gastritis after diet №1a.

Purpose: significant mechanical, chemical and thermal sparing of gastric-intestine tract, decrease the inflammation, improve healing of ulcers.

General characteristics: small decrease of carbohydrates, proteins and fats are in norm. Strictly limited products that provoke stomach secretion or irritate its mucous coat. Meals are boiled or steamed, grated, given in semi-liquid or puree form. Salt is limited. Very hot or cold meals are forbidden.

Chemical substance and energy value: protein 90 gr (60-70% animal proteins), fat 90-95 gr (25% vegetable fats), carbohydrates 300-350 gr; caloric value 10,5-10,9 Mjoule (2500-2600 kcal); salt 8-10 gr; liquids 1,5 l. Nutrition regime: 6 times a day, milk before sleep.

Forbidden products: snacks, coffee, cocoa, soda water, raw fruit, confectionery, cultured milk foods, cheese.

Diet №1

Prescribed: stomach and duodenum ulcer during the recovery after acute exacerbation and in cases of non-acute exacerbation; non-acute exacerbation of chronic gastritis with stable or increased secretion; acute gastritis during recovery period. If ulcer is accompanied by other diseases of the digestive system then variants of Diet №1 are prescribed. Diet №1 without mechanical sparing (“nongrated”) is used at the last stages of ulcer exacerbation. According to its chemical substance choice of products this diet is equal to “grated” Diet №1, but all the products that provoke gastric secretion are excluded.

Purpose: moderate chemical, mechanical and thermal sparing of gastric-intestine tract and at the same time keeping normal nutrition, decreasing inflammation, increasing ulcer healing, normalizing secretory and motor functions of stomach.

General characteristics: according to caloric value, number of proteins, fats and carbohydrates this is physiologically complete diet. Agents that provoke increased gastric secretion, irritants, hard to digest products are excluded. The food is cooked mostly grated, boiled or steamed. Some meal are baked without crust. Fish and some tender meat is allowed to eat nongrated. Salt is moderately limited. Very hot or cold meals are excluded.

Chemical substance and caloric value: proteins 90-100 gr (60% animal), fats 100 gr (30% vegetable), carbohydrates 400-420 gr; caloric value 11,7-12,6 Mjoule (2800-3000 kcal)’ salt 10-12 gr, liquid 1,5 l.

Nutrition regime: 5-6 times a day; milk, creams before sleep. Excluded foods and meals: rye and any fresh bread, pastry, meat and fish broth, mushrooms and strong vegetable decoctions, cabbage soup, borsch, okroshka; fatty or hard meats, tinned food, smoked food; hot, spicy, salt cheese; hard-boiled or fried eggs; cereals; beans; vegetables; sour, not ripe enough, rich with cellulose fruit and berries, nongrated dried fruit, chocolate, ice-cream; sauces; soda water, kvas, black coffee.

Diet №2

Prescribed: chronic gastritis with secretory insufficiency in case of nonacute exacerbation and during the recovery period after exacerbation; acute gastritis, enteritis, colitis during the recovery period as a step towards normal every-day nutrition; chronic enteritis and colitis after and without exacerbation and diseases of liver, biliary tracts, pancreas or gastritis with stable or increased secretion.

Purpose: provide normal nutrition, moderately stimulate secretory function of digestive organs, normalize gastric motor function.

General characteristics: physiologically complete diet with moderate mechanical sparing and moderate stimulation of digestive organs secretion. Meals of various degree of chopping and heat processing are allowed: boiled, stewed, baked, fried without crust; grated – food that is rich in cellulose. Excluded: long and hard digestible meals, products that irritate gastric-intestine tract, very cold or hot meals.

Chemical substance and caloric value: proteins 90-100 gr (60% animal), fats 90-100 gr (25% vegetable), carbohydrates 400-420 gr; caloric value 11,7-12,6 Mjoule (2800-3000 kcal); salt up to 15 gr, liquids 1,5 l.

Nutrition regime: 4-5 times a day excluding large portions of food.

Excluded products and meals: fresh bread and pastry, soups – milk, bean, pea, millet, okroshka; fatty meat, duck, goose, smoked meat, tinned products (except dietary); fatty, smoked fish, tinned fish; hard-boiled eggs; beans; limited are: millet, pearl barley, fine-ground barley, samp, fresh nongrated vegetables, garlic, mushrooms; hot, spicy snacks, sauces; fruit and berries with hard seeds (rasberry, redcurrant) or hard peel (gooseberry), dates, fig, chocolate, ice-cream; grape juice, kvas; pork tallow, beef, mutton fat and cooking oil.

Diet №3

Prescribed: chronic stomach diseases with constipation during or without nonacute exacerbation, hemorrhoid, analfissue without inflammation.

Purpose: normalize intestine malfunctioning and metabolic processes.

General characteristics: physiologically complete diet including food and products that stimulate intestine motor function and bowel emptying (vegetables, fresh and dried fruit, bread, cereals, cultured milk products, etc). Exclude products and meals that force fermentation and decaying in the intestine and influence other digestive organs. Meals are mostly nonchopped, boiled or steamed, baked. Vegetables and fruit in raw or boiled form. The diet includes cold first and sweet meals, drinks.

Chemical substance and caloric value: proteins 90-100 gr (55% animal), fats 90-100 gr (30% vegetable), carbohydrates 400-420 gr; caloric value 11,7-12,6 Mjoule (2800-3000 kcal); salt 15 gr, liquids 1,5 l.

Nutrition regime: 4-6 times a day. In the morning it is preferable to drink cold water with honey or fruit and vegetable juices, before sleep – kefir, compote made of fresh or dried fruit, fresh fruit, prune.

Excluded products and meals: bread made of extra quality flour, pastry; fatty meat, duck, goose, smoked meat, tinned meat; smoked fish; hard-boiled, fried eggs; hot, spicy sauces; kissel; chocolate, cocoa, coffee, strong tea; animal fats and cooking oil.

Diet №4

Prescribed: acute enterocolitis with diarrhea after hunger days, exacerbation of chronic enteritis, dysentery, after intestine surgery.

Purpose: providing nutrition during digestive malfunction; decreasing inflammation, fermentation and decaying processes in the intestine; normalize intestine and other digestive organs functions.

General characteristics: proteins normal, fats and carbohydrates decreased. Mechanical, chemical and thermal sparing of gastric-intestine tract (GIT). Exclude products and meals that force fermentation and decaying in the intestine. Meals are liquid, semi-liquid, grated, boiled or steamed. Very hot and cold meals are excluded.

Chemical substance and caloric value:proteins 90 gr (60-65% animal), fats 70 gr, carbohydrates 250 gr (40-50 gr of sugar); caloric value 8,4 Mjoule (2000 kcal); salt 8-10 gr, liquids 1,5-2 l.

Nutrition regime: 5-6 times a day in small portions.

Excluded products and meals: bakery and pastry; soups with cereals, vegetables, macaroni; milk, strong and fatty broth; fatty meat, sausages; fatty fish, caviar, tinned products; whole milk and dairy products; raw, hard-boiled, fried eggs; beans; fresh and dried fruit and berries; compote, honey, jam and sweets; coffee and cocoa, soda water and cold drinks.

Diet №4b

Prescribed: acute intestine diseases during improvement stage; chronic intestine diseases after acute exacerbation or during nonacute exacerbation and also in cases when the disease affects other digestive organs.

Purpose: to provide normal nutrition in case of moderate dysfunction of digestion, to decrease inflammation and normalize intestine and other digestive organs functioning.

General characteristics: according to its energy value and chemical substance it is a complete diet with a slight increase of proteins. The diet moderately decreases the number of mechanical and chemical irritants that affect gastric-intestine tract. Excluded products and meals: everything that can increase decaying and fermentation processes in the intestine; sharply stimulate gastric and pancreas secretion, bile excretion; irritate liver.Meals are grated, steamed or boiled. Hot and cold meals are excluded.

Chemical substance and caloric value: 100-110 gr proteins (60-65% animal proteins), 100 gr fats (mostly butter), 400-420 gr carbohydrates (50-70 gr sugar); energy value 12,2-12,6 Mjoule (2900-3000kcal); salt 8-10 gr, liquid 1,5 l.

Nutrition regime: 5-6 times a day.

Excluded products and meals: rye bread, wheat bread made from coarse flour, fresh bread, fancy/short pastry and puff/flaky pastry; leguminous, milk soup, cabbage soup, borsch,okroshka; fatty meats, duck, goose, smoked meats, sausages, tinned food; fatty fish, smoked, salt fish, tinned fish; milk and milk products with increased acidity, spicy, salt cheese; hard-boiled eggs, fried eggs; cabbage, beet, garden radish, radish, onions, garlic, cucumbers, rutabaga, turnip, dock, spinach, mushrooms; grapes, apricots, plums, dried fruit, ice-cream, chocolate, cakes; hot, spicy, fatty sauces, mustard, horseradish, pepper; grapes, plum, apricot juices, kvas, fruit water.

Diet №4c

Prescribed: acute intestine diseases during recovery period (as a preliminary stage before normal rational nutrition); chronic intestine diseases during recovery after exacerbation, as well as without exacerbation in cases when the disease affects other digestive organs.

Purpose: to provide full nutrition in cases of partial intestine insufficiency, recovery of intestine functions and other digestive organs functions.

General characteristics: physiologically complete diet with a slight increase of proteins and moderate decrease of table salt; decrease of mechanical and chemical irritants of intestine; exclude products and meals that increase fermentation and decaying processes in intestine, secretory and motor functions, intestine, pancreas and bile secretion. Meals are not grated, cooked by steaming, boiling or baking. Food temperature is normal.

Chemical substance and caloric value: 100-120 gr proteins (60% animal), 100 gr fats (15-20% vegetable), 400-420 gr carbohydrates; energy value 12,2-12,6 Mjoule (2900-3000 kcal); 10 gr sodium chloride, 1,5 l liquids.

Nutrition regime: 5 times a day.

Excluded products and meals: rye bread, fresh bread, fancy/short and puff/flaky pastry; strong, fatty broths, milk soup, cabbage soup, borsch, okroshka, leguminous, mushroom soup; fatty meats, duck, goose, most sausages, smoked meats, tinned food; fatty fish, smoked, salt; hot, smoked cheese, milk products with increased acidity; hard-boiled, fried eggs; leguminous porridges; garden radish, radish, onions, garlic, cucumbers, rutabaga, turnip, dock, spinach, mushrooms; apricots, plums, fig, dates, berries with hard peel, ice-cream, chocolate, cakes; hot and fatty sauces, mustard, horse radish, pepper;grapes, plum, apricot juices.

Diet №5

Prescribed: acute hepatitis and cholecystitis during recovery; acute hepatitis in non-exacerbation phase; cirrhosis without liver insufficiency; chronic cholecystitis and cholelithiasis in non-exacerbation phase.In all cases – without expressed stomach and intestine diseases.

Purpose: chemical sparing of liver saving complete nutrition, improving liver and bile excreting tracts functioning and bile secretion.

General characteristics: physiologically normal amount of proteins and carbohydrates with a slight decrease of fats (mostly high-heat fats). Excluded products: rich in nitrous extractive substances, purines, cholesterol, oxalic acid, essential oils and products of fats oxidation.Amount of lipotropic substances, cellulose, pectine, liquids is increased. Meals are boiled, baked, sometimes stewed. Only stringy meats and rich in cellulose vegetables are grated. Very cold meals are excluded.

Chemical substance and caloric value: 90-100 gr proteins (60% animal), 80-90 gr fats (30% vegetable), 400-450 gr carbohydrates (70-80 gr sugar); energy value 11,7-12,2 Mjoule (2800-2900 kcal); 10 gr sodium chloride, 1,5-2 l liquids. Xylite and sorbite can be added (25-40 gr).

Nutrition regime:5 times a day; kefir before sleep at night.

Excluded products and meals: fresh bread, fancy and flaky pastry, fried pasties; meat, fish, mushroom broths, okroshka, green cabbage soup; fatty meats, duck, goose, liver, kidneys, brains, smoked meats, most sausages, tinned food; fatty fish, smoked salt fish; hard-boiled, fried eggs; leguminous; spinach, dock, garden radish, radish, spring onions, garlic, mushrooms, pickles; hot and fatty snacks, caviar; chocolate, ice-cream; mustard, pepper, horse radish; black coffee, cocoa, cold drinks; pork, beef, mutton tallow, cooking oil.

Diet №5a

Prescribed: acute hepatitis and cholecystitis; exacerbation of chronic hepatitis, cholecystitis and cholelithiasis; cirrhosis with moderately expressed liver insufficiency; chronic hepatitis or cholecystitis in combination with ulcer, expressed gastritis, enterocolitis with diarrhea.

Purpose: chemical, mechanical and thermal sparing of all digestive organs, providing maximal rest for liver; improving liver and bile excreting tracts functioning.

General characteristics: the diet limits fats (mostly high-heat), proteins and carbohydrates are normal. Excluded products: rich in extractive substances, purines, oxalic acid, cholesterol, tough cellulose, fried meals. Amount of lipotropic substances, vitamins, liquids is increased. Meals are boiled, grated, some are baked, but without crust. Food is warm, cold meals are excluded.

Chemical substance and caloric value: 90-100 gr proteins (60% animal), 70-75 gr fats (20-25% vegetable), 350-400 gr carbohydrates (80-90 gr sugar); energy value 10,5-10,9 Mjoule (2500-2600 kcal); 8 gr sodium chloride, 2-2,5 l liquids.

Nutrition regime: 5-6 times a day, in small portions.

Excluded products and meals: fresh and rye bread, fancy and flaky pastry; meat, fish, mushroom broths, leguminous broths, duck, goose; fried, stewed and non-minced meat; liver, brains, kidneys, smoked meats, tinned food; fatty, salt, fried, stewed fish, caviar; cream, fatty and increased acidity curds, salt, hot cheese; leguminous; macaroni, millet; mushrooms, pickles, cabbage, turnip, garden radish, radish, dock, garlic, onions; sour and rich in cellulose fruit, chocolate, ice-cream; spices; cocoa, black coffee, cold drinks and soda water.

Diet №5p

Prescribed: chronic pancreatitis during recovery after exacerbation and without exacerbation.

Purpose: to normalize pancreas functioning, provide mechanical and chemical sparing of stomach and intestine, decrease gall bladder excitability, prevent fatty liver infiltration and changes in pancreas.

General characteristics: diet with increased proteins, decreased fats and carbohydrates, sugar in particular. Strictly limited extractive substances, purines, high-heat fats, cholesterol, essential oils, tough cellulose; fried meals are excluded. Vitamins and lipotropic substances are increased. Meals are mostly grated and chopped, boiled or steamed, baked. Hot and very cold meals are excluded.

Chemical substance and caloric value: 110-120 gr proteins (60-65% animal), 80 gr fats (15-20% vegetable), 350-400 gr carbohydrates (30-40 gr sugar; 20-30 gr xylite instead of sugar in sweet meals); energy value 10,9-11,3 Mjoule (2600-2700 kcal); 10 gr sodium chloride, liquids 1,5 l.

Nutrition regime: 5-6 times a day; before going to sleep at night – kefir.

Excluded products and meals: rye and fresh bread, fancy and flaky pastry; meat, fish, mushrooms and vegetables broths, milk soup, borsch, cabbage soup, okroshka, beet soup; fatty meat, duck, goose, fried and stewed meat, smoked meat, sausages, tinned food, liver, brains, kidneys; fatty fish, fried and stewed, smoked, salt fish, caviar; dairy products of increased fatness with addition of sugar; hard-boiled, fried eggs; leguminous, friable porridge; white cabbage, aubergine, radish, turnip, garden radish, onion, garlic, dock, spinach, sweet pepper, mushrooms; raw nongrated fruit and berries, grapes, dates, fig, bananas, confectionery, chocolate, jam, ice-cream; spices; coffee, cocoa, soda water and cold drinks, grapes juice.

Diet №6

Prescribed: gout, urolithiasis with the formation of stones from salts of uric and oxalic acids.

Purpose: purine metabolism normalization, decrease of uric acid and its salts formation, shifting the urinary reaction to alkalinuria (alkalizing the urinary reaction).

General characteristics: exclude products that contain much purines, oxalic acid; moderate limitation of sodium chloride, increase the number of alkalizing products (dairy products, vegetables and fruit) and liquids [in case there are no contra-indications from cardio-vascular system]. Slight decrease of proteins and fats (mostly high-heat), and in case of obesity – carbohydrates as well. Cooking is usual, but meat, fish and fowl must be boiled. Food temperature is normal.

Chemical substance and caloric value: 70-80 gr proteins (50% animal), 80-90 gr fats (30% vegetable), 400 gr carbohydrates (80 gr sugar); energy value 11,3-11,7 Mjoule (2700-2800 kcal); 10 gr sodium chloride, 1,5-2 l and moreof liquids.

Nutrition regime: 4 times a day, during intervals and on empty stomach – drinks.

Excluded products and meals: meat, fish and mushroom broths, dock and spinach soups; liver, kidneys, tongue, brains, meat of young animals and fowl, sausages, smoked meat, salt fish, tinned meat and fish, caviar; salt cheese; leguminous; mushrooms; fresh seedpods, spinach, dock, rhubarb, cauliflower; pickles; chocolate, fig, raspberry, cranberry; sauces made of meat, fish and mushroom broths, pepper, mustard, horseradish; cocoa, strong tea and coffee; cow and sheep tallow, cooking oil. Consumption of lard is limited.

Diet №7

Prescribed: acute during the recovery period (starting from the 3^rd-4^th week of treatment); chronic nephritis without exacerbation and without renal insufficiency.

Purpose: moderate sparing of kidneys functioning, reduction of arterial hypertension and edemata, improving the discharge of nitrogenous and other products of metabolism.

General characteristics: proteins are slightly limited, the number of fats and carbohydrates is physiologically normal. Meals are cooked without sodium chloride. Salt is given to the patient in the amount prescribed by the doctor (3-6 gr and more). The amount of liquids is reduced to 1 l. Extractive substances of meat, fish, mushrooms, sources of oxalic acid and essence oils are excluded. Meat and fish (100-150 gr a day) is boiled. Food temperature is normal.

Chemical substance and caloric value: 80 gr proteins (50-60 gr animal), 90-100 gr fats (25% vegetable), 400-500 gr carbohydrates (80-90 gr sugar); energy value 11,3-12,2 Mjoule (2700-2900 kcal); 0,9-1,1 l liquids.

Nutrition regime: 4-5 times a day.

Excluded products and meals: bread, pastry with addition of sodium chloride; meat, fish and mushroom broths; fatty meat, fried and stewed meals, sausages, smoked meat, tinned products; fatty fish, salt, smoked fish, caviar; cheese; leguminous; garlic, radish, garden radish, dock, spinach, pickles; chocolate; meat, fish and mushroom sauces, pepper, mustard, horseradish; strong coffee, cocoa, mineral water rich in sodium.

Diet №7a

Prescribed: acute nephritis in severe stage after fasting days and in moderately severe stage from the first days of the disease; chronic nephritis with vividly expressed chronic renal insufficiency.

Purpose: maximal sparing of kidneys functioning, improving the discharge of metabolism products, reduction of arterial hypertension and edemata.

General characteristics: mainly vegetable diet with sharp limitation of proteins, exclusion of sodium chloride. Fats and carbohydrates are moderately reduced. Products that are rich in extractive substances, essence oils, oxalic acid are excluded. Cooking: boiling, baking, slightly fried. Meals are cooked without slat, bread is also salt-free. The amount of liquid must be equal to or by 300-400 ml exceedthe amount of urine excreted during the previous day.

Chemical substance and caloric value: 20 gr proteins (50-60% animal, and in case of chronic renal insufficiency – 70-75%), 80 gr fats (15% vegetable), 350 gr carbohydrates (80 gr sugar); energy value 8,8-9,2 Mjoule (2100-2200 kcal).

Nutrition regime: 5-6 times a day; the diet lasts 5-6 days.

Excluded products and meals: bread, pastry with salt; meat, fish, mushroom broths, milk soup, cereal (except sago) and leguminous soups; all meat and fish products (sausage, tinned food, ect.); cheese; cereals (except rice) and macaroni, leguminous; pickles, spinach, dock, cauliflower, mushrooms, radish, garlic; chocolate, milk kissel, ice-cream; meat, fish, mushroom sauces; mustard, horseradish, pepper; cocoa, coffee, mineral water rich in sodium.

Diet №7b

Prescribed: acute nephritis after diet №7a or in case of mild form of the disease; chronic nephritis with moderately expressed chronic renal insufficiency.

Purpose: maximal sparing of kidneys functioning, improving excretion of metabolism products, decreasing arterial hypertension and edemata.

General characteristics: the diet significantly reduces proteins and strictly limits sodium chloride. Fats, carbohydrates and energy value are within physiological norm. Cooking methods, list of excluded meals and products – see diet №7a. Meals are cooked without salt. In comparison with the diet №7a the proteins are two times increased, mostly because of inclusion of 125 gr fish or fowl, 1 egg, up to 125 gr of milk or sour cream. Meat and fish can be replaced with curds taking into account the required amount of proteins. The amount of protein-free salt-free bread made on corn starchis increased to 150 gr, as well as sago (or rice), potatoes and vegetables (300 gr and 650 gr accordingly), sugar and butter, in order to provide necessary amount of fats and carbohydrates.

Chemical substance and caloric value: 40-50 gr proteins (50-60% animal, in case of chronic renal insufficiency – 70-75%), 85-90 gr fats (2025% vegetable), 450 gr carbohydrates (100 gr sugar); energy value 10,9-11,7 Mjoule (2600-2800 kcal). The amount of liquids is under control by the amount of urine and other clinical signs (see diet №7a), 1-1,2 l in general.

Nutrition regime: 5-6 times a day.

Diet №7c

Prescribed:nephrotic syndrome in chronic renal pathology and other diseases.

Purpose: compensating the loss of proteins after urination, normalizing proteins and fats metabolism, cholesterol, decrease edemata.

General characteristics: the diet of physiologically normal energy value with increased proteins, moderate decrease of fats (animal), normal carbohydrates. Strict limitation of sodium chloride, liquids, extractive substances, cholesterol, oxalic acid, limitation of sugar, increased number of lipotropic substances. Meat and fish are boiled. Meals are cooked without salt. The temperature of meals is usual.

Chemical substance and caloric value: 120-125 gr proteins (60-65% animal), 80 gr fats (30% vegetable), 400 gr (50 gr sugar); energy value 11,7 Mjoule (2800 kcal); liquids 0,8 l.

Nutrition regime: 5-6 times a day; before going to sleep at night – kefir.

Excluded products and meals: usual bread, fancy and flaky pastry; meat, fish, mushroom broths; fatty meat, liver, kidneys, brains, sausages, smoked meat, tinned meat and vegetables; fatty fish, salt and smoked fish, caviar; salt, hot cheese; radish, garlic, dock, spinach, pickles; chocolate, cream; meat, fish, mushroom sauces, mustard, horseradish, pepper; cocoa, mineral water rich in sodium.

Diet №7d

Prescribed: terminal (final) stage of renal insufficiency (when the patient is subjected to hemodialysis – cleansing patient’s blood using artificial kidney).

Purpose: providing balanced nutrition considering the metabolism special features in cases of severe insufficiency and side effects of hemodialysis.

General characteristics: moderate decrease of proteins (mostly vegetable) and potassium, strict limitation of sodium chloride and significant reduction of liquids. The diet of normal energy value due to fats and carbohydrates. Meals are cooked without salt, bread is salt-free. In case of absence of arterial hypertension and edemata the patient gets 2-3 gr of sodium chloride. Products rich in potassium are limited. The necessary amount of amino-acids is provided with meat, fish, eggs and in limited amounts with dairy products. Meat and fish are boiled. The taste of meals is improved with sauces, spices, citric acid. The temperature of the meals is usual.

Chemical substance and caloric value: 60 gr proteins (75% animal), 100-110 gr fats (30% vegetable), 400-450 gr carbohydrates (100 gr sugar and honey); energy value 11,7-12,1 Mjoule (2800-2900 kcal); potassium up to 2,5 gr, 0,7-0,8 liquids.

Nutrition regime: 6 times a day.

Excluded products and meals: usual bread (except for wheat and salt-free) and pastry; meat, fish, mushroom broths; sausages, salt fish, smoked and tinned products, caviar; cheese; leguminous; pickles, mushrooms, rhubarb, spinach, dock; chocolate, dried fruit, confectionery; meat, fish, mushroom sauces; cocoa; high-heat fats.

Diet №8

Prescribed: obesity as the major disease or as an accompanying other diseases that require no special diets.

Purpose: influencing metabolism to remove excessive lipopexia.

General characteristics: decrease of energy value by decreasing carbohydrates, especially easily digestible, and to a lesser extent – fats (mostly animal) with the normal or insignificantly increased proteins. Liquids, sodium chloride and appetizers are limited. Dietary fibers are increased. Meals are boiled, stewed or baked. Fried, grated or chopped meals are undesirable. Sugar substitutes are used for sweet meals and drinks (xylite and sorbite are included in the energy value estimation). Temperature of the meals is usual.

Chemical substance and caloric value: 90-110 gr proteins (60% animal), 80-85 gr fats (30% vegetable), 150 gr carbohydrates; energy value 7,1-7,5 Mjoule (1700-1800 kcal); sodium chloride 5-6 gr, 1-1,2 l liquids.

Nutrition regime: 5-6 times a day with enough portions to feel satiation; at night before going to sleep – non-fatty kefir.

Excluded products and meals: wheat pastry of extra quality flour, fancy and flaky pastry; milk soup, potato, cereal, leguminous, macaroni soups; fatty meat, duck, goose, ham, sausages, tinned meat; fatty, salt, smoked fish, tinned fish, caviar; fatty curds, cream, sweet yogurt, ryazhenka, baked milk, fatty and salty cheese; fried eggs; cereals (except for buckwheat, pearl barley and fine ground barley); macaroni; leguminous; fatty and hot snacks; grapes, raisin, bananas, figs, dates, very sweet fruit, sugar, confectionery, jam, honey, ice-cream, kissel; fatty and hot sauces, mayonnaise, spices; grape and other sweet juices, cocoa; meat fat and cooking oil.

Diet №9

Prescribed: diabetes mellitus of light and moderate severity; patient with normal or slightly increased body masswho do not take insulin or take it in small doses (20-30 units); this diet is also prescribed when the patient is trying for the necessary dose of insulin or other sugar-reducing drugs. There are variants of the diet №9 which take into account the character of insulin therapy, accompanying diseases and other factors.

Purpose: improving carbohydrate metabolism and preventing lipometabolism disorders, determining tolerance towards carbohydrates (estimating the amount of digestible carbohydrates from food).

General characteristics: the diet with moderately decreased energy value due to decrease of easily digestible carbohydrates and animal fats. Proteins are physiologically normal. Sugar and sweets are excluded. Sodium chloride, cholesterol and extractive substances are moderately decreased. The amount of lipotropic substances, vitamins, dietary fibers is increased. The following products are recommended – curds, nonfatty fish, sea products, vegetables, fruit, whole grain cereals, bread made of meal. Boiled and baked meals are preferable, to lesser extent – fried and stewed. In sweet meals xylite and sorbit are used instead of sugar and they are counted as part of the energy value. The food temperature is normal.

Chemical substance and caloric value: 90-100 gr proteins (55% animal), 75-80 gr fats (30% vegetable), 300-350 gr carbohydrates (mostly polysaccharides); energy value 9,6-10,5 Mjoule (2300-2500 kcal); sodium chloride 12 gr, 1,5 l liquids.

Nutrition regime: 5-6 times a day with equal portions of carbohydrates.

Excluded products and meals: flaky and fancy pastry; strong, fatty broths, milk soups with semolina, rice, noodles; fatty meat, duck, goose, smoked products, most sausages, tinned meat; fatty, salt fish, tinned fish, caviar; salty cheese, creams, sweet curds; rice, semolina and macaroni; pickles; grapes, raisin, bananas, figs, dates, sugar, jam, candies, ice-cream; fatty, hot and salty sauces; grapes and other sweet juices, lemonade with sugar; meat fats and cooking oils.

Diet №10

Prescribed:cardio-vascular system diseases without signs of cardiac insufficiency.

Purpose: improve blood circulation, functioning of CVS, liver and kidneys, normalizing metabolism, sparing of CVS and digestive organs.

General characteristics: slight decrease of energy value by decreasing fats and partially carbohydrates. Significant limitation of sodium chloride, decrease of liquids consumption. The amount of substances that excite/stimulate cardio-vascular and nervous systems, irritate liver and kidneys, substances that make work of gastric-intestine tract difficult, substances causing flatulence/windiness are limited. The amount of potassium, magnesium, lipotropic substances, products creating alkalizing effect (dairy products, vegetables, fruit) is increased. Meat and fish is boiled. Hard to digest meals are excluded. Meals are cooked without salt. Food temperature is normal.

Chemical substance and caloric value: 90 gr proteins (55-60% animal), 70 gr fats (25-30% vegetable), 350-400 gr carbohydrates; energy value 10,5-10,9 Mjoule (2500-2600 kcal); sodium chloride 6-7 gr, liquids 1,2 l.

Nutrition regime: 5 times a day with relatively equal portions.

Excluded products and meals: fresh bread, flaky and fancy pastry, pancakes; leguminous soups, meat, fish, mushroom broth; fatty meat, duck, goose, liver, kidneys, brains, smoked and tinned meat, sausages; fatty, salt, smoked fish, caviar tinned fish; salty and fatty cheese; hard boiled, fried eggs; leguminous; pickles; spinach, dock, radish, garden radish, garlic, onions, mushrooms; hot, fatty and salt snacks; fruit with hard cellulose, chocolate, cakes; sauces made of meat, fish, mushroom broths, mustard, pepper, horseradish; coffee, cocoa; meat fats and cooking oils.

Diet №10a

Prescribed: cardio-vascular system diseases with expresses cardiac insufficiency.

Purpose: improving blood circulation, functioning of CVS, liver, kidneys, normalizing metabolism, providing of CVS, kidneys, digestive organs.

General characteristics: decrease of energy value by decreasing proteins, carbohydrates and especially fats. Strictly limited are liquids and sodium chloride. Meals are cooked without salt, bread is also salt-free.The amount of substances that excite/stimulate cardio-vascular and central nervous systems, irritate liver and kidneys, substances causing flatulence/windiness (extractive substances of meat and fish, cellulose, fatty products, cholesterol, tea and coffee, etc.) are strictly limited.The necessary amount of potassium, lipotropic substances, alkalizing products (dairy products, fruit, vegetables). Meals are boiled and grated, made sour or sweet, flavoured. Fried meals are forbidden. Hot and cold meals are excluded.

Chemical substance and caloric value: 60 gr proteins (70% animal), 50 gr fats (20-25% vegetable), 300 gr carbohydrates (70-80 gr sugar and other sweets); energy value 7,9 Mjoule (1900 kcal); sodium chloride is excluded, liquids 0,6-0,7 l.

Nutrition regime: 6 times a day in small portions; the diet is prescribed for a short time, no longer than 4 weeks.

Excluded products and meals: fresh and other types of bread, pastry; fatty, stringy meat, pork, mutton, duck, goose, sausages, smoked meat, tinned meat; fatty, salt, smoked, tinned fish, caviar; cheese; hard-boiled, fried eggs; millet, fine-ground barley, pearl barley, leguminous, macaroni; fruit with hard cellulose, hard peel, grapes; chocolate; sauces on meat, fish, mushroom broths, fatty sauces, horseradish, pepper, mustard; coffee, cocoa, grapes juice, soda water, kvas; fats (except for fresh butter and in cases of tolerance – refined oil, 5-10 gr in meals).

Diet №10s

Prescribed: atherosclerosis with damage to heart vessels, brain or other organs; myocardial infarction in the scarring stage, hypertonic disease.

Purpose: slow down the development of atherosclerosis, reduce metabolism dysfunction, improve blood circulation, reduce overweight, provide nutrition without overloading CVS and CNS, liver, kidneys.

General characteristics: reduced amount of animal fat and easily digestible carbohydrates. Proteins are normal. The degree of fats and carbohydrates decrease depends on the body weight (two variants). Table salt, liquids, extractive substances, cholesterol are limited. The number of C and B group vitamins, linoleic acid, lipotropic substances, dietary fibers, potassium, magnesium, microelements (vegetable oils, vegetable and fruit, sea products, curds) is increased. Meals are cooked without salt, they salted while eating. Meat and fish is boiled, vegetables and fruit with hard cellulose are chopped and boiled soft. Food temperature is normal.

Chemical substance and caloric value:

I variant: 90-100 gr proteins (50% animal), 80 gr fats (40% vegetable), 350-400 gr carbohydrates (50 gr sugar); energy value 10,9-11,3 Mjoule (2600-2700).

II variant: 90 gr proteins, 70 gr fats, 300 gr carbohydrates; energy value 9,2 Mjoule (2200 kcal); sodium chloride 8-10 gr, liquids 1,2 l.

Nutrition regime: 5 times a day in small portions; kefir at night before going to sleep.

Excluded products and meals: flaky and fancy pastry; meat, fish, mushroom broths, leguminous broths; fatty meat, duck, goose, liver, kidneys, brain, sausages, smoked meat, tinned meat; fatty fish, salt, smoked fish, caviar; salty and fatty cheese, heavy cream, sour cream and curds; garden radish, radish, dock, spinach, mushrooms; fatty, salt and hot sea products; limited or excluded (in case of obesity); grapes, raisin, sugar, honey (instead of sugar), jam, chocolate, ice-cream; meat, fish, mushroom sauces, pepper, mustard; strong tea and coffee, cocoa; meat fats and cooking oil.

Diet №10i

Prescribed: myocardial infarction.

Purpose: improving heart muscle recovery, improving blood circulation and metabolism, decrease the stress on CVS, normalizing intestine motor function.

General characteristics: the diet of a significant decrease of energy value by ddecreasing proteins, carbohydrates and especially fats, decreasing the amounts of food, sodium chloride and liquids. Among the excluded are hard to digest products, products that cause fementation in the intestine and flatulence, products rich in cholesterol, animal fats and sugar, and also extractive substances of meat and fish. The diet includes products rich in lipotropic substances, C and P vitamins, potassium, as well as products that mildly stimulate intestine motor function (to treat constipation).

The diet №10i consists of 3 consequtive rations.

I ration is prescribed during the acute period (1^st week)

II ration is prescribed in subacute period (2^nd-3^rd week)

II ration – scarring period (4^th week).

In I ration the meals are grated, in II – mostly chopped, in III – chopped and in one piece. Meals are cooked without salt, boiled. Cold meals (less than 15⁰C) and drinks are excluded.

Chemical substance and caloric value:

I ration: 50 gr proteins, 30-40 gr fats, 150-200 gr carbohydrates; energy value 4,6-5,4 Mjoule (1100-1300 kcal); liquids 0,7-0,8 l; ration mass 1,6-1,7 kg.

II ration: 60-70 gr proteins, 50-60 gr fats, 230-250 gr carbohydrates; energy value 7,1-7,5 Mjoule (1600-1800 kcal); sodium chloride 3 gr, liquids 0,9-1 l, ration mass 2 kg.

III ration: 85-90 gr proteins, 70 gr fats, 300-350 gr carbohydrates; energy value 9,2-10 Mjoule (2200-2400 kcal), sodium chloride 5-6 gr, 1-1,1 l; ration mass 2,2-2,3 kg.

Nutrition regime: I-II rations – 6 times a day, III ration – 5 times a day in small portions.

Excluded products and meals: fresh bread, pastry, fatty meat and fowl, fish, liver and other meat subproducts, sausages, tinned meat, caviar, whole milk and cream, egg yolk, millet, pearl barley, fine-ground barley, leguminous, white cabbage, cucumber, garden radish, onions, garlic, spices, animal fats and cooking oil, chocolate and other confectionery, coffee and cocoa, grapes juice.

Diet №11

Prescribed: pulmonary, bones, lymph nodes, joints tuberculosis in non-sharp exacerbation or decline in case of low body weight; exhaustion after infectious diseases, surgeries, injuries, in all cases when there is no damage of digestive organs. There are variants of this diet that depend upon the localization and character of the tubercular process, state of digestive system, complications.

Purpose: improving the state of organism, its protective functions, increasing recovery processes in a damaged organism.

General characteristics: the diet of increased energy value with dominating number of proteins, vitamins, minerals (calcium, iron, etc.), fats and carbohydrates are moderately increased. Cooking and food temperature is usual.

Chemical substance and caloric value: 110-130 gr gr proteins (60% animal), 100-120 gr fats (20-25% vegetable), 400-450 gr carbohydrates; energy value 12,6-14,2 Mjoule (3000-3400 kcal); sodiu chloride 15 gr, liquids 1,5 l.

Nutrition regime: 5 times a day; kefir before going to sleep.

Excluded products and meals: very fatty meat and fowl; sheep, cow fats and cooking oil; hot and fatty sauces, cakes with much cream.

Diet №12

Prescribed: CNS diseases accompanied by increased nervous excitement; intermediate period between diet №10 and normal nutrition.

Purpose: decrease the excitement of CNS, sparing transfer to normal diet.

General characteristics: sufficient caloric value with normal amount of proteins, fats and carbohydrates; calcium is increased. Products that excite nervous system are maximally reduced. Cooking can vary, without limitation.

Chemical substance and caloric value: 100-110 gr proteins, 90-100 gr fats, 450-550 gr carbohydrates; sodium chloride 12-15 gr, calcium 1-1,2 gr.

Nutrition regime: 5-6 times a day.

Excluded products and meals: strong meat and fish broths; hot meals, snacks and spices (mustard, pepper, etc.); strong tea, coffee, chocolate, alcoholic drinks.

Diet №13

Prescribed: acute infectious diseases in feverish period, tonsilitis.

Purpose: helping the organism and increasing resistance to infections, decreasing intoxication, sparing of digestive organs during feverish conditions and bed rest.

General characteristics: the diet of decreased energy value by decreasing fats, carbohydrates and to lesser extent proteins; vitamins and liquids are increased. Mostly includes products that are easily digestible, do not cause flatulence and constipation. Sources of hard cellulose, fatty, salty, hard to digest meals are excluded. Food is chopped or grated, boiled or steamed. Meals are hot (no more than 55-60⁰C) or cold (no less than 12⁰C).

Chemical substance and caloric value: 75-80 gr proteins (60-70% animal, especially milk), 60-70 gr fats (15% vegetable), 300-350 gr carbohydrates (30% easily digestible); energy value 9,2-9,6 Mjoule (2200-2300 kcal); sodium chloride 8-10 gr (the amount is increased in case of heavy sweating, vomiting), liquids 2 and more litres.

Nutrition regime: 5-6 times a day in small portions.

Excluded products and meals: rye and any fresh bread, pastry; fatty broths, cabbage soup, borsch, millet or leguminous soups; fatty, salt, smoked fish; whole milk and cream, fatty sour cream, hot, fatty cheese; hrad-boiled, fried eggs; millet, pearl barley, fine-ground barley, corn groats, leguminous, macaroni; white cabbage, garden radish, radish, onions, garlic, cucumbers, rutabaga/swede, mushrooms; fatty and hot snacks, smoked meat, vegetable salads; fruits rich in cellulose, with hard peel, chocolate, cakes; hot, fatty sauces; cocoa.

Diet №14

Prescribed: urolithiasis with alkaline uric reaction, pyelocystitis, phosphaturia.

Purpose: restore acid uric reaction and thus prevent sedimentation.

General characteristics: according to its energy value, number of proteins, fats and carbohydrates it is physiologically normal diet; the diet limits the amount of products that produce alkalizing effect and products rich in calcium (dairy products, most of vegetables and fruit); diet mostly includes products that change uric reaction to acid (bread and pastry, millet, meat, fish). Cooking and food temperature is usual. If there are no contra-indications – profuse drinking.

Chemical substance and caloric value: 90 gr proteins, 100 gr fats, 380-400 gr carbohydrates, energy value 11,7 Mjoule (2800 kcal); sodium chloride 10-12 gr, liquids 1,5-2,5 l.

Nutrition regime: 4 times a day, during intervals and on empty stomach – drinking.

Excluded products and meals: milk, vegetable and fruit soups; smoked products; salt, smoked fish; milk, cultured milk drinks, curds, cheese; vegetables (except for peas and pumpkin), potatoes; vegetable salads, beetroot salad, tinned vegetables; fruit and berries (except sour types of apples, cranberry, cowberry); fruit, berries and vegetables juices.

Diet №15 ("obschyistol", literally "common table", in Russian "stol" means both table and diet)

Prescribed: no indications for any special diet, intermediate diet before normal nutrition after recovery or special diets. "Common diet" is prescribed for patients who have no GIT diseases.

Purpose: providing physiologically sufficient nutrition in hospital conditions.

General characteristics: energy value and number of proteins, fats, carbohydrates are almost equal to norms for a healthy person without physical stress. Vitamins are increased. All types of cooking are allowed. Temperature of food is normal. Most hard to digest and hot/spicy products are excluded from the diet.

Chemical substance and caloric value: 90-95 gr proteins (55% animal), 100-105 gr fats (30% vegetable), 400 gr carbohydrates; energy value 11,7-12,1 Mjoule (2800-2900 kcal); sodium chloride 15 gr, liquids 1,5-2 l.

Nutrition regime: 4 times a day.

Excluded products and meals: fatty meat, duck, goose, high-heat animal fats, pepper, mustard.