Diet for diseases of the liver and biliary tract
Gastroenterology / / April 29, 2016
Diseases of the hepatobiliary system known to mankind since ancient times.Archaeological studies provided evidence of their existence in ancient times: the Egyptian mummies were found gallstones.Analysis of historical notes, which have reached us indicates that Alexander the Great, who lived in the IV century BC.e., suffered from cholecystitis, probably calculous.
Currently, liver disease and biliary tract are among the most frequently encountered in the practice of gastroenterology.In this regard, a great challenge to prevent their occurrence and prevention of exacerbations of chronic processes.
Among the treatment and prevention of diet therapy occupies a leading position.Modern principles of clinical nutrition in diseases of the liver and bile ducts were formed based on the latest research that allowed to evaluate the effect of food on the level of the fine structure of the liver, the activity of its enzymes, the formation and secretion of bile.
It will be recalled that the liver is no
liver is very sensitive to the composition of the food.Any violation of the balance of power in the direction as excess nutrients and their deficiency reflected primarily on the functional state of the liver.
Requirements therapeutic diet in diseases of the hepatobiliary system are as follows: food should contribute to the normalization of disturbed metabolism in the body, to create favorable conditions for the functional activity of the liver, biliary strengthen capacity, improve the condition of other organs of the digestive tract, often involved in the pathological process.
One of the main factors of nutritional therapy is rhythmic.Food - the best and most physiological choleretic agent.Recall that the output of bile from the gall bladder occurs only in response to a meal.In the pause of digestion, t. E. Between meals and at night, it persisted in the bladder bile.Therefore, adherence to simple rules - quite often (4-5 times a day) and in strictly defined hours to eat - greatly contributes to the normalization of the evacuation of the bladder bile, prevents the development of bile stasis and infection.Mandatory condition - the exclusion heavy meal late in the evening.Stimulation of digestion and, consequently, the biliary excretion during the night leads to the disruption of normal biological rhythm of the body's vital functions.
It is obvious that for patients with diseases of the liver and biliary tract care about food composition.Given the extremely large role in protein metabolism of the liver, it is necessary first of all to ensure optimal amounts of the protein diet.As in acute and chronic liver diseases, the daily amount of protein should correspond to physiological norm (80-90 g);wherein the animal and vegetable proteins are included in equal proportions.It is necessary to ensure sufficient proportion of protein foods that are rich in factors of the so-called lipotropic action.These include cottage cheese, egg white, cod, oatmeal and so on. The only indication for limiting protein in the diet is prekomatosnoe condition occurs when the liver decompensation functional abilities.In such cases, the total amount of protein should be reduced to 20-40 g up to complete elimination of the period of hepatic coma.
amount and composition of fat also plays an essential role in the diet of this category of patients.Widespread earlier view that patients with liver disease should significantly reduce the consumption of fat, now rejected as unfounded.For the majority of patients with disorders in the hepatobiliary system, there is no need to limit fats.It is forbidden to use a refractory indigestible fat (lamb, pork fat varieties, geese, ducks).The physiological norm for these patients is considered to be 80-90 grams of fat;the most favorable ratio of fat: 2/3 1/3 animals and vegetation.The therapeutic efficacy of such therapeutic diets is provided primarily by vegetable fats.Polyunsaturated fatty acids contained in vegetable oils, have a normalizing effect on a disturbed cholesterol metabolism.Very pronounced choleretic effect of vegetable oils.The latter is especially important in diseases of the liver, accompanied by stagnation of bile, gallbladder dyskinesia gipomotornoy and concomitant intestinal hypomotility.In these cases, the proportion of vegetable oils can be increased to 50% of the total amount of fat (110-120 g).Caution must be exercised in determining the allowable amount of vegetable fats in the diet of patients with calculous cholecystitis.In order to avoid provoking an attack of biliary colic is necessary daily amount of vegetable oil (typically about 30 g) to distribute evenly.We draw attention to the fact that the oil to be administered only with food (non-fasting), in its natural form, ie. E. Without exposing it to heat.From animal fats recommended butter.Introduction of an optimal amount of fat in appropriate proportions protein also improves the exchange of fat-soluble vitamins, flavor and quality of food increases satiety.
Limit fat in the diet is required in all cases steatorrhea hepatic origin, including for cholecystitis, cholelithiasis after cholecystectomy in patients with cirrhosis, in icteric period Botkin's disease.At the same amount of fat is reduced to 50-60 Very limited or excluded fats during threatening or develop coma.
With the introduction into clinical practice of the method of in vivo morphological study of liver tissues proved that only with massive necrosis of liver tissue (active hepatitis, decompensated cirrhosis of the liver) decrease glycogen stores.At the same time it is shown that excessive consumption of refined sugars leads to disruption of the processes of bile formation and biliary excretion contributes to the development of stagnation in the biliary system that provides bile ready to stone formation.In addition, as a result of high carbohydrate food are developing obesity and related disorders of cholesterol metabolism.
In connection with the above, do not exceed the physiological norm of carbohydrates (350-400 g) in the diet of patients with hepatobiliary disorders;the proportion of simple sugars with about '70 carbohydrate portion of the diet must be submitted sufficient amount of foods rich in plant fiber: vegetables, fruits, whole-grain bread.Dietary fiber contained in these products that help to reduce the saturation of bile with cholesterol, and its maximum delayed excretion of cholesterol absorption in the intestine.Thus enriched with dietary fiber foods is an effective prophylactic agent in the biliary tract stone formation.The role of the liver in the metabolism of vitamins.And although almost all diseases of the liver is a mandatory component of the treatment of vitamin, should ensure the optimal administration of vitamins from food sources.Sources of vitamin C can serve as rose hips, black currants, kale, leaf lettuce, tomatoes, dill, parsley, strawberries, strawberry, raspberry, tangerine.Food sources of vitamin A - butter, cream.Carotene (provitamin A) found in carrots, tomatoes, green peas, parsley, lettuce, apricots, cherries.Are important B vitamins, especially B6 and B12.It is advisable to creating and maintaining a background of excess vitamins through the appointment of their preparations.
must be maintained at a certain level of water-salt balance.Do not reduce the amount of liquid (it recommended to 1.5 liters per day fluid free), since the lack of it may increase the concentration of bile, increased amount of nitrogenous wastes in the blood and tissues of harmful metabolic products may accumulate.Limited to only fluid intake in patients with liver cirrhosis.The amount of salt in the diet is reduced to 8-10 g, and when the fluid retention in the body - up to 3-4 g
above principles of diet therapy formed the basis of the most widely used in clinical practice, diet number 5 and its various modifications (diet number 5a, 5sch, 5g).
Indications for diet number 5 are chronic hepatitis, chronic cholecystitis in remission, liver cirrhosis in compensation stage.
list of recommended foods and dishes
Bread - baking wheat yesterday or the dried, seeded rye flour milling of wallpaper, biscuits and other products, from baked dough nesdobnoe.
soups - vegetable, cereals, pasta with vegetable broth or milk, borscht, beetroot, cabbage soup with fresh cabbage, flour and sauté vegetables.
Meat and poultry - lean meats and poultry (beef, veal, chicken) boiled or baked (after pre-boiling) form, as well as steamed (with the removal of juice).Meat and poultry cooked piece or make of them cutlet mass.
Fish - lean fish (cod, walleye, perch, saffron cod, carp, pike) in boiled or baked (after boiling) form.
fats - butter (30-40 g) and vegetable (20-30 g): olive, sunflower or corn (added to the ready-made meals in its natural form without cooking).
dishes and side dishes of vegetables - different kinds of boiled and roasted vegetables (fresh and non-acidic cabbage sauerkraut, potatoes, carrots, pumpkin, zucchini, green peas, young beans, cauliflower);Onion is added only after scalding boiling water.Fruit and vegetable juices are recommended, and in raw form, especially when tilted to constipation (including tomatoes, tomato juice).
Dishes and garnishes from groats and pasta - crisp and semi viscous cereals, especially oat cereal "Hercules" and buckwheat, baked puddings from groats and pasta with cheese Krupenik, lapshevnik.
eggs and dishes from them - no more than 1 egg per day (if tolerated) or 2 protein for the preparation of protein omelet.
Sauces - milk, sour cream on vegetable broth, fruit and berry sauce.Spices are excluded.Flour for the sauce saute with butter.
Snacks - soaked herring, vegetable salads, vinaigrettes, aspic gelatin fish, boiled tongue, cheese.
Fruits and berries - all except very sour grades (lemon and sugar is allowed).Recommended compote, mashed potatoes, jelly, jam, honey.
Milk and milk products - whole milk, natural (if tolerated), and condensed, dry;fresh cheese;cheese "Soviet", "Dutch", "Russian";yogurt, yogurt, acidophilus milk;Sour cream is added to dishes as a condiment.
For patients undergoing cholecystectomy, postoperative and in the presence of "postcholecystectomy syndrome" manifests itself duodenitis, pancreatitis, light diet is number 5 (5sch).It is characterized by even greater reduced fat - 50 g (vegetable oils are excluded), carbohydrates - 250 g (primarily digestible - sugar, sweets, honey, jam), reduced calorie - 2000 kcal.
Sample menu diet number 5sch
1st breakfast.Meatballs, meat steam 100-120 g buckwheat porridge mashed 1/2 servings of tea.
2nd breakfast.Cottage cheese is freshly prepared 100 g apples, 100 g baked
Lunch.Noodle soup vegetarian 1/2 servings, chickens 100-120 g boiled, mashed rice porridge, pureed apple compote without sugar.
Snack.Rusks without sugar, broth hips.
Dinner.Roll meat steam, stuffed with scrambled eggs, 100 grams, mashed carrot 1/2 servings, cheesecake without sugar, 100-120 g of tea.At night.Kissel.
on all day.White bread 200 g sugar '30
In the presence of persistent stagnation of bile in patients with chronic cholecystitis, "postcholecystectomic syndrome" caused angioholitah, chronic persistent hepatitis, biliary dyskinesia on the background of adhesions in holedohoduodenalnoy zone diet number 5 shows the fat(5g) wherein the amount of fat is increased to 120 g (60 g animal and 60 g vegetable).
- transplantation or liver transplant
- doctors called a vegetable, which is "a vacuum cleaner for the liver»
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- Dietin diseases of the liver: an example of the menu
sample menu diet number 5g
1st breakfast.Herring with boiled potatoes in vegetable oil 50/150 g buckwheat porridge with vegetable oil, 150 grams of tea.
2nd breakfast.Fresh apples 100 g, 100 g cottage cheese calcined
Lunch.Soup vegetarian rice in vegetable oil, potato casserole with meat in vegetable oil 260 g, 125 g apple mousse
Snack.A decoction of rose hips, crackers.Dinner.Meatballs 140 g, boiled potatoes with vegetable oil 100g, cheesecake with cottage cheese 130 g tea.At night.Kefir.
on all day.Butter 10 g, 20 g of vegetable oil, 200 grams of white bread, black bread, 100 grams of sugar '30
Timing of application of therapeutic diet options number 5 (5a, 5sch, 5g) should not be long.These options are assigned diet for a period of exacerbation before subsiding pain and dyspeptic syndrome.
In conclusion, it must be emphasized that the use of an adequate diet is able to provide long-term remission, while its violation is a real threat to the process of exacerbation and progress.