REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

A healthy diet for Nephrotic Syndrome patients consists of low salt, low fat, and low cholesterol, with an emphasis on fruits and vegetables.

NOTE: The amount of protein and fluid a patient with Nephrotic Syndrome should have depends on the patient’s current condition, age, and weight. It is very important that a nephrologist and/or a renal dietitian be consulted. This information is meant to be used as a resource and is not meant to replace medical advice. Also, this is NOT geared towards those experiencing dialysis or transplant.

Maintaining a Healthy Diet

• Low sodium (salt) can help with swelling in the hands and legs
• Fiber from whole grains and fresh fruits and vegetables can help lower total and LDL cholesterol
• Low fat (1% or skim) dairy products
• Lean cuts of meat, less red meat, more chicken and fish
• SOMETIMES fluids should be restricted, as determined by a nephrologist
• SOMETIMES protein levels should be increased or decreased, as determined by a nephrologist
• RARELY should potassium or phosphorous be restricted, only if kidneys are failing and as determined by a nephrologist.

Healthy diet basics

With all meal plans, including the kidney-friendly diet, you need to track how much of certain nutrients you take in, such as:

• Calories
• Protein
• Fat
• Carbohydrates

To make sure you are getting the right amounts of these nutrients, you need to eat and drink the right portion sizes. All of the information you need to keep track of your intake is on the “Nutrition Facts” label.

Use the nutrition facts section on food labels to learn more about what is in the foods you eat. The nutrition facts will tell you how much protein, carbohydrates, fat and sodium are in each serving of a food. This can help you pick foods that are high in the nutrients you need and low in the nutrients you should limit.

When you look at the nutrition facts, there are a few key areas that will give you the information you need:

Calories

Your body gets energy from the calories you eat and drink. Calories come from the protein, carbohydrates and fat in your diet. How many calories you need depends on your age, gender, body size and activity level.

You may also need to adjust how many calories you eat based on your weight goals. Some people will need to limit the calories they eat. Others may need to have more calories. Your doctor or dietitian can help you figure out how many calories you should have each day. Work with your dietitian to make a meal plan that helps you get the right amount of calories, and keep in touch for support.

Protein

Protein is one of the building blocks of your body. Your body needs protein to grow, heal and stay healthy. Having too little protein can cause your skin, hair and nails to be weak. But having too much protein can also be a problem. To stay healthy and help you feel your best, you may need to adjust how much protein you eat.

The amount of protein you should have depends on your body size, activity level and health concerns. Some doctors recommend that people with kidney disease limit protein or change their source of protein. This is because a diet very high in protein can make the kidneys work harder and may cause more damage. Ask your doctor or dietitian how much protein you should have and what the best sources of protein are for you.

Use the table below to learn which foods are low or high in protein. Keep in mind that just because a food is low in protein, it is not healthy to eat unlimited amounts.

Lower-protein foods:

• Bread
• Fruits
• Vegetables
• Pasta and rice

Higher-protein foods:

• Red meat
• Poultry
• Fish
• Eggs

Carbohydrates

Carbohydrates (“carbs”) are the easiest kind of energy for your body to use. Healthy sources of carbohydrates include fruits and vegetables. Unhealthy sources of carbohydrates include sugar, honey, hard candies, soft drinks and other sugary drinks.

Some carbohydrates are high in potassium and phosphorus, which you may need to limit depending on your stage of kidney disease. We’ll talk about this in more detail a little later. You may also need to watch your carbohydrates carefully if you have diabetes. Your dietitian can help you learn more about the carbohydrates in your meal plan and how they affect your blood sugar.

Fat

You need some fat in your meal plan to stay healthy. Fat gives you energy and helps you use some of the vitamins in your food. But too much fat can lead to weight gain and heart disease. Try to limit fat in your meal plan, and choose healthier fats when you can.

Healthier fat or “good” fat is called unsaturated fat. Examples of unsaturated fat include:

• Olive oil
• Peanut oil
• Corn oil

Unsaturated fat can help reduce cholesterol. If you need to gain weight, try to eat more unsaturated fat. If you need to lose weight, limit the unsaturated fat in your meal plan. As always, moderation is the key. Too much “good” fat can also cause problems.

Saturated fat, also known as “bad” fat, can raise your cholesterol level and raise your risk for heart disease. Examples of saturated fats include:

• Butter
• Lard
• Shortening
• Meats

Limit these in your meal plan. Choose healthier, unsaturated fat instead. Trimming the fat from meat and removing the skin from chicken or turkey can also help limit saturated fat. You should also avoid trans fat. This kind of fat makes your “bad” (LDL) cholesterol higher and your “good” (HDL) cholesterol lower. When this happens, you are more likely to get heart disease, which can cause kidney damage.

Sodium

Sodium (salt) is a mineral found in almost all foods. Too much sodium can make you thirsty, which can lead to swelling and raise your blood pressure. This can damage your kidneys more and make your heart work harder.

One of the best things that you can do to stay healthy is to limit how much sodium you eat. To limit sodium in your meal plan:

• Do not add salt to your food when cooking or eating. Try cooking with fresh herbs, lemon juice or other salt-free spices.
• Choose fresh or frozen vegetables instead of canned vegetables. If you do use canned vegetables, drain and rinse them to remove extra salt before cooking or eating them.
• Avoid processed meats like ham, bacon, sausage and lunch meats.
• Munch on fresh fruits and vegetables rather than crackers or other salty snacks.
• Avoid canned soups and frozen dinners that are high in sodium. • Avoid pickled foods, like olives and pickles. • Limit high-sodium condiments like soy sauce, BBQ sauce and ketchup.

Important! Be careful with salt substitutes and “reduced sodium” foods. Many salt substitutes are high in potassium. Too much potassium can be dangerous if you have kidney disease. Work with your dietitian to find foods that are low in sodium and potassium.

Portions:

Choosing healthy foods is a great start, but eating too much of anything, even healthy foods, can be a problem. The other part of a healthy diet is portion control, or watching how much you eat.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

To help control your portions:

• Check the nutrition facts label on a food to learn the serving size and how much of each nutrient is in one serving. Many packages have more than one serving. For example, a 20-ounce bottle of soda is really two-and-a-half servings. Many fresh foods, such as fruits and vegetables, do not come with nutrition facts labels. Ask your dietitian for a list of nutrition facts for fresh foods and tips for how to measure the right portions.
• Eat slowly, and stop eating when you are not hungry any more. It takes about 20 minutes for your stomach to tell your brain that you are full. If you eat too quickly, you may eat more than you need.
• Avoid eating while doing something else, such as watching TV or driving. When you are distracted you may not realize how much you have eaten.
• Do not eat directly from the package the food came in. Instead, take out one serving of food and put the bag or box away.

Good portion control is an important part of any meal plan. It is even more important in a kidney-friendly meal plan, because you may need to limit how much of certain things you eat and drink.

How is a kidney-friendly diet different?

When your kidneys are not working as well as they should, waste and fluid build up in your body. Over time, the waste and extra fluid can cause heart, bone and other health problems. A kidney-friendly meal plan limits how much of certain minerals and fluid you eat and drink. This can help keep the waste and fluid from building up and causing problems.

How strict your meal plan should be depends on your stage of kidney disease. In the early stages of kidney disease, you may have little or no limits on what you eat and drink. As your kidney disease gets worse, your doctor may recommend that you limit:

• Potassium
• Phosphorus
• Fluids

Potassium

Potassium is a mineral found in almost all foods. Your body needs some potassium to make your muscles work, but too much potassium can be dangerous. When your kidneys are not working well, your potassium level may be too high or too low. Having too much or too little potassium can cause muscle cramps, problems with the way your heart beats and muscle weakness.

If you have kidney disease, you may need to limit how much potassium you take in. Ask your doctor or dietitian if you need to limit potassium.

Use the list below to learn which foods are low or high in potassium. Your dietitian can also help you learn how to safely eat small amounts of your favorite foods that are high in potassium.

Eat this … (lower-potassium foods)

• Apples, cranberries, grapes, pineapples and strawberries
• Cauliflower, onions, peppers, radishes, summer squash, lettuce
• Pita, tortillas and white breads
• Beef and chicken, white rice

Rather than … (higher-potassium foods)

• Avocados, bananas, melons, oranges, prunes and raisins
• Artichokes, winter squash, plantains, spinach, potatoes and tomatoes
• Bran products and granola
• Beans (baked, black, pinto, etc.), brown or wild rice

Your doctor may also tell you to take a special medicine called a potassium binder to help your body get rid of extra potassium.

Phosphorus

Phosphorus is a mineral found in almost all foods. It works with calcium and vitamin D to keep your bones healthy. Healthy kidneys keep the right amount of phosphorus in your body. When your kidneys are not working well, phosphorus can build up in your blood. Too much phosphorus in your blood can lead to weak bones that break easily.

Many people with kidney disease need to limit phosphorus. Ask your dietitian if you need to limit phosphorus.

Depending on your stage of kidney disease, your doctor may also prescribe a medicine called a phosphate binder. This helps to keep phosphorus from building up in your blood. A phosphate binder can be helpful, but you will still need to watch how much phosphorus you eat. Ask your doctor if a phosphate binder is right for you.

Use the list below to get some ideas about how to make healthy choices if you need to limit phosphorus.

Eat this … (lower-phosphorous foods)

• Italian, French or sourdough bread
• Corn or rice cereals and cream of wheat
• Unsalted popcorn
• Some light-colored sodas and lemonade

Rather than … (higher-phosphorous foods)

• Whole-grain bread
• Bran cereals and oatmeal
• Nuts and sunflower seeds
• Dark-colored colas

Fluids

You need water to live, but when you have kidney disease, you may not need as much. This is because damaged kidneys do not get rid of extra fluid as well as they should. Too much fluid in your body can be dangerous. It can cause high blood pressure, swelling and heart failure. Extra fluid can also build up around your lungs and make it hard to breathe.

Depending on your stage of kidney disease and your treatment, your doctor may tell you to limit fluid. If your doctor tells you this, you will need to cut back on how much you drink. You may also need to cut back on some foods that contain a lot of water. Soups or foods that melt, like ice, ice cream and gelatin, have a lot of water. Many fruits and vegetables are high in water, too.

Ask your doctor or dietitian if you need to limit fluids.

If you do need to limit fluids, measure your fluids and drink from small cups to help you keep track of how much you’ve had to drink. Limit sodium to help cut down on thirst. At times, you may still feel thirsty. To help quench your thirst, you might try to:

• Chew gum
• Rinse your mouth
• Suck on a piece of ice, mints or hard candy (Remember to choose sugar-free candy if you have diabetes.)

Special diet concerns

Vitamins

Following a kidney-friendly meal plan may make it hard for you to get all of the vitamins and minerals you need. To help you get the right amounts of vitamins and minerals, your dietitian may suggest a special supplement made for people with kidney disease.

Your doctor or dietitian might also suggest a special kind of vitamin D, folic acid or iron pill, to help prevent some common side effects of kidney disease, such as bone disease and anemia. Regular multi-vitamins may not be healthy for you if you have kidney disease. They may have too much of some vitamins and not enough of others. Your doctor or dietitian can help you find vitamins that are right for you.

Important! Tell your doctor and dietitian about any vitamins, supplements or over-the-counter medicines you are taking. Some can cause more damage to your kidneys or cause other health problems.

Following a kidney-friendly meal plan with diabetes

If you have diabetes, you need to control your blood sugar to prevent more damage to your kidneys. Your doctor and dietitian can help you create a meal plan that helps you control your blood sugar, while also limiting sodium, phosphorus, potassium and fluids.

A diabetes educator can also help you learn how to control your blood sugar. Ask your doctor to refer you to a diabetes educator in your area. A list of diabetes educators is available from the American Association of Diabetes .Educators at Medicare and many private insurance policies may help pay for appointments with a diabetes educator.

Find kidney-friendly recipes on Kidney Kitchen

In Kidney Kitchen, you can take a deep dive into what each nutrient means for people with kidney disease, and how much of these nutrients common foods contain. Learn what healthy eating means for people in every stage of kidney disease, including those on dialysis or living with a kidney transplant.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

The digestive system breaks food down into nutrients and energy that the body can use. Some types of food, including vegetables and yogurt, can help this process of digestion.

Eating certain types of food or making sudden changes to the diet can result in problems with digestion.

In some people, digestive problems can lead to symptoms including:

• bloating
• gas
• constipation
• diarrhea
• nausea
• vomiting
• heartburn

In this article, we list foods that are good for the digestive system. We also cover which ones to avoid.

Foods that help digestion

Adding ginger to food may reduce digestive problems.

As soon as food enters the body through the mouth, the process of digestion begins.

The body gradually moves it through the digestive system, which breaks the food down into smaller, more useable parts.

Various foods can help at different stages of this process. For example, some aid digestion in the stomach, while others support the intestines.

Fiber is essential to digestive health in general. If a person is not used to eating fiber often, it is best to increase fiber intake slowly, starting with soluble fiber such as from oatmeal, apples, and bananas.

Add around one serving of fiber to the diet every 4–5 days. Increasing fiber intake too quickly can be bad for digestion.

Drinking plenty of water is also important, as it combines with fiber and adds bulk to stool.

Specific foods that are good for digestion include:

Foods containing ginger

Ginger is a plant that can reduce bloating and other digestive problems.

Dried ginger powder is an excellent spice for flavoring meals, and a person can also use slices of ginger root to make tea.

Choose a quality ginger root powder for flavoring meals. For tea, choose fresh ginger root for the best results.

Unsaturated fats

This type of fat helps the body absorb vitamins. It also combines with fiber to help encourage bowel movements.

Plant oils such as olive oil are a good source of unsaturated fats.

Always consume fats in moderation. For an adult following a 2,000-calorie-per-day diet, for example, fat intake should not exceed 77 grams daily.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Vegetables with skin

Vegetables are rich in fiber, which is an important nutrient for digestion. Fiber stimulates the bowels to move stool out of the body.

The skins of vegetables are often rich in fiber, and it is best to consume them whole. Some vegetables with skin rich in fiber include potatoes, beans, and legumes.

Fruits

Many fruits are also rich in fiber. They also contain vitamins and minerals that are good for digestion, such as vitamin C and potassium.

For example, apples, oranges, and bananas are nutritious fruits that could help with digestion.

Whole-grain foods

Whole-grain foods also have a high fiber content that aids digestion. The body breaks down whole grains slowly, which helps control blood sugar levels.

Many whole grain foods are available, including brown rice and quinoa.

Yogurt

Many yogurt products contain probiotics. These are live bacteria and yeasts that may have benefits for the digestive system.

Kefir

Kefir is a fermented milk drink that is filling and contains probiotics. As mentioned above, these may promote better digestion and gut health.

Leafy green vegetables

Leafy green vegetables are packed with nutrients that are helpful for digestion.

According to an article in the journal Nature Chemical Biology, these vegetables also contain sulfoquinovose. This is a sugar that may feed healthful bacteria in the stomach, thereby promoting digestion.

What to avoid

Eating too fast may hamper digestion.

Although most foods are fine to consume in moderation, some are not as helpful for digestion.

Some foods and drinks increase the risk of bloating, heartburn, and diarrhea. Examples of these include:

• artificial sweeteners, such as sugar alcohols
• carbonated beverages or sugar sweetened drinks
• refined carbohydrates, such as white bread
• alcohol
• milk or white chocolate
• foods high in saturated fats, such as cheese and cream
• coffee and other drinks containing caffeine
• spicy foods, such as some types of curry
• greasy foods, such as pizza

Some habits can also hamper digestion. These include eating too fast and lying down immediately after eating.

The body can also take longer to digest large meals, which may be problematic for some people. To enhance digestion, it is best to eat several small meals instead of one large one.

However, everyone’s digestive systems vary. For example, some people may have food intolerances and allergies, while others do not.

A doctor may recommend that people with digestive problems such as these keep a food diary. This can help identify foods and drinks that trigger digestive issues.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Gastrointestinal diseases affect the gastrointestinal (GI) tract from the mouth to the anus. There are two types: functional and structural. Some examples include nausea/vomiting, food poisoning, lactose intolerance and diarrhea.

What are functional gastrointestinal diseases?

Functional diseases are those in which the GI tract looks normal when examined, but doesn’t move properly. They are the most common problems affecting the GI tract (including the colon and rectum). Constipation, irritable bowel syndrome (IBS), nausea, food poisoning, gas, bloating, GERD and diarrhea are common examples.

Many factors may upset your GI tract and its motility (ability to keep moving), including:

• Eating a diet low in fiber.
• Not getting enough exercise.
• Traveling or other changes in routine.
• Eating large amounts of dairy products.
• Stress.
• Resisting the urge to have a bowel movement, possibly because of hemorrhoids.
• Overusing anti-diarrheal medications that, over time, weaken the bowel muscle movements called motility.
• Taking antacid medicines containing calcium or aluminum.
• Taking certain medicines (especially antidepressants, iron pills and strong pain medicines such as narcotics).
• Pregnancy.

What are structural gastrointestinal diseases?

Structural gastrointestinal diseases are those where your bowel looks abnormal upon examination and also doesn’t work properly. Sometimes, the structural abnormality needs to be removed surgically. Common examples of structural GI diseases include strictures, stenosis, hemorrhoids, diverticular disease, colon polyps, colon cancer and inflammatory bowel disease.

Constipation

Constipation, which is a functional problem, makes it hard for you to have a bowel movement (or pass stools), the stools are infrequent (less than three times a week), or incomplete. Constipation is usually caused by inadequate “roughage” or fiber in your diet, or a disruption of your regular routine or diet.

Constipation causes you to strain during a bowel movement. It may cause small, hard stools and sometimes anal problems such as fissures and hemorrhoids. Constipation is rarely the sign that you have a more serious medical condition.

You can treat your constipation by:

• Increasing the amount of fiber and water to your diet.
• Exercising regularly and increasing the intensity of your exercises as tolerated.
• Moving your bowels when you have the urge (resisting the urge causes constipation).

If these treatment methods don’t work, laxatives can be added. Note that you should make sure you are up to date with your colon cancer screening. Always follow the instructions on the laxative medicine, as well as the advice of your healthcare provider.

Irritable bowel syndrome (IBS)

Irritable bowel syndrome (also called spastic colon, irritable colon, IBS, or nervous stomach) is a functional condition where your colon muscle contracts more or less often than “normal.” Certain foods, medicines and emotional stress are some factors that can trigger IBS.

Symptoms of IBS include:

• Abdominal pain and cramps.
• Excess gas.
• Bloating.
• Change in bowel habits such as harder, looser, or more urgent stools than normal.
• Alternating constipation and diarrhea.

Treatment includes:

• Avoiding excessive caffeine.
• Increasing fiber in your diet.
• Monitoring which foods trigger your IBS (and avoiding these foods).
• Minimizing stress or learning different ways to cope with stress.
• Taking medicines as prescribed by your healthcare provider.
• Avoiding dehydration, and hydrating well throughout the day.
• Getting high quality rest/sleep.

Hemorrhoids

Hemorrhoids are dilated veins in the anal canal, structural disease. They’re swollen blood vessels that line your anal opening. They are caused by chronic excess pressure from straining during a bowel movement, persistent diarrhea, or pregnancy. There are two types of hemorrhoids: internal and external.

Internal hemorrhoids

Internal hemorrhoids are blood vessels on the inside of your anal opening. When they fall down into the anus as a result of straining, they become irritated and start to bleed. Ultimately, internal hemorrhoids can fall down enough to prolapse (sink or stick) out of the anus.

Treatment includes:

• Improving bowel habits (such as avoiding constipation, not straining during bowel movements and moving your bowels when you have the urge).
• Your healthcare provider using ligating bands to eliminate the vessels.
• Your healthcare provider removing them surgically. Surgery is needed only for a small number of people with very large, painful and persistent hemorrhoids.

External hemorrhoids

External hemorrhoids are veins that lie just under the skin on the outside of the anus. Sometimes, after straining, the external hemorrhoidal veins burst and a blood clots form under the skin. This very painful condition is called a “pile.”

Treatment includes removing the clot and vein under local anesthesia and/or removing the hemorrhoid itself.

Anal fissures

Anal fissures are also a structural disease. They are splits or cracks in the lining of your anal opening. The most common cause of an anal fissure is the passage of very hard or watery stools. The crack in the anal lining exposes the underlying muscles that control the passage of stool through the anus and out of the body. An anal fissure is one of the most painful problems because the exposed muscles become irritated from exposure to stool or air, and leads to intense burning pain, bleeding, or spasm after bowel movements.

Initial treatment for anal fissures includes pain medicine, dietary fiber to reduce the occurrence of large, bulky stools and sitz baths (sitting in a few inches of warm water). If these treatments don’t relieve your pain, surgery might be needed to repair the sphincter muscle.

Perianal abscesses

Perianal abscesses, also a structural disease, can occur when the tiny anal glands that open on the inside of your anus become blocked, and the bacteria always present in these glands causes an infection. When pus develops, an abscess forms. Treatment includes draining the abscess, usually under local anesthesia in the healthcare provider’s office.

Anal fistula

An anal fistula – again, a structural disease – often follows drainage of an abscess and is an abnormal tube-like passageway from the anal canal to a hole in the skin near the opening of your anus. Body wastes traveling through your anal canal are diverted through this tiny channel and out through the skin, causing itching and irritation. Fistulas also cause drainage, pain and bleeding. They rarely heal by themselves and usually need surgery to drain the abscess and “close off” the fistula.

Other perianal infections

Sometimes the skin glands near your anus become infected and need to be drained, like in this structural disease. Just behind the anus, abscesses can form that contain a small tuft of hair at the back of the pelvis (called a pilonidal cyst).

Sexually transmitted diseases that can affect the anus include anal warts, herpes, AIDS, chlamydia and gonorrhea.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Diverticular disease

The structural disease diverticulosis is the presence of small outpouchings (diverticula) in the muscular wall of your large intestine that form in weakened areas of the bowel. They usually occur in the sigmoid colon, the high-pressure area of the lower large intestine.

Diverticular disease is very common and occurs in 10% of people over age 40 and in 50% of people over age 60 in Western cultures. It is often caused by too little roughage (fiber) in the diet. Diverticulosis can sometimes develop/progress into diverticulitis

Complications of diverticular disease happen in about 10% of people with outpouchings. They include infection or inflammation (diverticulitis), bleeding and obstruction. Treatment of diverticulitis includes treating the constipation and sometimes antibiotics if really severe. Surgery is needed as last resort in those who have significant complications to remove the involved diseased segment of the colon.

Digestive Health Tips

From embarrassing gas to uncomfortable heartburn, everyone has digestive problems from time to time. The good news is there are some simple solutions for many of your troubles. Learn about what causes your discomfort, how to prevent and manage digestive problems, what questions to ask your pharmacist, and when to see a doctor.

The Digestive System

How does the digestive system work?

It may seem like digestion only happens in your stomach, but it’s a long process that involves many organs. Together they form the digestive tract.

Digestion begins in your mouth, where saliva starts to break down food when you chew. When you swallow, your chewed food moves to your esophagus, a tube that connects your throat to your stomach. Muscles in the esophagus push the food down to a valve at the bottom of your esophagus, which opens to let food into the stomach.

Your stomach breaks food down using stomach acids. Then the food moves into the small intestine. There, digestive juices from several organs, like your pancreas and gallbladder, break down the food more, and nutrients are absorbed. What’s left goes through your large intestine. The large intestine absorbs water. The waste then moves out of your body through the rectum and anus.

Digestive problems can happen anywhere along the way.

Gas & Bloating

Bloating and passing gas can be uncomfortable and embarrassing. Here’s what you need to know.

What is gas?

Gas is a normal part of healthy digestion. Air that is in your digestive tract is either released through your mouth as a burp or through your anus as gas. You typically pass gas 13 to 21 times a day.

What causes gas?

Gas is created when you swallow air, such as when you eat and drink. But it’s also a by-product of the breakdown of food. Some foods cause more gas than others. You may also be more sensitive to particular foods and may have more gas when you eat them.

Which foods cause gas?

You’ve probably noticed you feel gassy after eating certain foods. Cut back on the common culprits:

• Apples
• Asparagus
• Beans
• Broccoli
• Brussels sprouts
• Cabbage
• Cauliflower
• Milk and dairy products
• Mushrooms
• Onions
• Peaches
• Pears
• Prunes
• Wheat

---

---

Continued

What causes bloating?

Continued

When gas builds up in your stomach and intestines, you may have bloating — swelling in your belly and a feeling of fullness. It may happen to you more often if you have:

• A stomach infection
• Irritable bowel syndrome (IBS). This digestive condition causes stomach pain, cramping, and diarrhea or constipation.
• Celiac disease (When people with this condition eat gluten, their bodies produce antibodies that attack the intestinal lining.)
• Hormonal changes that happen around women’s periods
• Constipation

While bloating is usually just uncomfortable, it can sometimes cause pain in your belly or sides.

How can I reduce gas and bloating?

Diet and lifestyle changes can make a big difference:

• Cut back on fatty foods.
• Avoid fizzy drinks.
• Eat and drink slowly.
• Quit smoking.
• Don’t chew gum.
• Exercise more.
• Avoid foods that cause gas.
• Avoid sweeteners that cause gas such as fructose and sorbitol. They are often found in candies, chewing gum, energy bars, and low-carb foods.

What OTC medicines treat excess gas?

If you have a lot of gas or are very uncomfortable, an over-the-counter medicine may help.

• Lactase supplements. If dairy is causing your problems, taking these tablets or drops just before you eat will help you digest lactose (the main sugar in dairy foods) and reduce gas.
• Alpha-galactosidase. This digestive aid comes as liquid or tablets. You take it before you eat to help your body break down the complex carbs or sugars that cause gas, such as those found in beans, broccoli, and cabbage. Caution: People with the genetic condition galactosemia should avoid it. It may also interfere with some diabetes drugs like acarbose (Precose) or miglitol (Glyset). If you take medication for diabetes, talk to your doctor or pharmacist before taking this aid.
• Simethicone (Mylicon). Taking these liquids or tablets can relieve the uncomfortable bloating and pain from gas.
• Probiotics. These supplements contain “friendly” bacteria that can help digestion. In addition to tablets and powders you sprinkle on your food, foods like yogurt, kefir, and sauerkraut contain probiotics.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

What is the psychology of eating?

What we eat affects how we feel. Food should make us feel good. It tastes great and nourishes our bodies. If you eat too little or eat too much, however, your health and quality of life could be affected. This can result in negative feelings toward food.

By learning how to make healthier and more mindful choices, you may be able to control compulsive eating, binging and weight gain. By taking charge of your appetite, you may also gain a feeling of calm, high energy levels and alertness from the foods you eat.

Overall, there are many benefits to changing deep-seated, unhealthy eating habits, such as:

• An increase in energy level and alertness.
• A more positive relationship with food.
• Improved health.
• Easier movement.
• Improved body image.

While we often have the best intentions to eat healthier, this is often a challenging task.

What factors influence our eating behaviors?

Experts believe many factors can influence our feelings about food and our eating behaviors. These factors include:

• Cultural.
• Evolutionary.
• Social.
• Family.
• Individual.
• Economic status.
• Psychological.

Many people use food as a coping mechanism to deal with such feelings as stress, boredom or anxiety, or even to prolong feelings of joy. While this may help in the short term, eating to soothe and ease your feelings often leads to regret and guilt, and can even increase the negative feelings. You aren’t actually coping with the problem causing the stress. Further, your self-image may suffer as you gain weight, or you may experience other undesired effects on your health, such as elevated blood sugars, cholesterol levels or blood pressure.

What role does psychology play in weight management?

Psychology is the science of behavior. It is the study of how and why people do what they do. For people trying to manage their weight, psychology addresses:

• Behavior: Treatment involves identifying the person’s eating patterns and finding ways to change eating behaviors.
• Cognition (thinking): Therapy focuses on identifying self-defeating thinking patterns that contribute to weight management problems.

What treatments are used for weight management?

Cognitive behavioral treatment is the approach most often used because it deals with both thinking patterns and behavior. Some areas that are addressed through cognitive behavioral treatment include:

• Determining the person’s “readiness for change”: This involves an awareness of what needs to be done to achieve your goals and then making a commitment to do it.
• Learning how to self-monitor: Self-monitoring helps you become more aware of what triggers you to eat in the moment, and more mindful of your food choices and portions. It also helps you stay focused on achieving long-term progress.
• Breaking linkages: The focus here is on stimulus control, such as not eating in particular settings, and not keeping unhealthy food choices in your home. Cognitive behavioral treatment also teaches distraction — replacing eating with healthier alternatives — as a skill for coping with stress. Positive reinforcement, rehearsal/problem-solving, finding social support and changing eating habits are specific techniques used to break linkages.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

What does cognitive behavioral treatment involve?

Cognitive therapy addresses how you think about food. It helps you recognize self-defeating patterns of thinking that can undermine your success at eating healthier and managing your weight/weight loss. It also helps you learn and practice using positive coping self-statements.

Examples of self-defeating thoughts include:

• “This is too hard. I can’t do it.”
• “If I don’t make it to my target weight, I’ve failed.”
• “Now that I’ve lost weight, I can go back to eating any way I want.”

Examples of positive coping self-statements include:

• “I realize that I am overeating. I need to think about how I can stop this pattern of behavior.”
• “I need to understand what triggered my overeating, so I can create a plan to cope with it if I encounter the trigger again.”
• “Am I really hungry or is this just a craving? I will wait to see if this feeling passes.”

What strategies will help me manage my weight?

To lose weight, it’s helpful to change your thinking. Weight management is about making a lifestyle change. It’s not going to happen if you rely on short-term diet after diet to lose weight.

To be successful, be aware of the role that eating plays in your life, and learn how to use positive thinking and behavioral coping strategies to manage your eating and your weight.

To help get you started, here are a few tips:

Tips for healthy eating

• Don’t skip meals.
• Do plan meals and snacks ahead of time.
• Do keep track of your eating habits. (See “food diary” below.)
• Do limit night eating.
• Do drink plenty of water.
• Do delay/distract yourself when experiencing cravings.
• Do exercise instead of eating when you are bored.
• Do be attentive when you eat. Don’t eat while watching TV, working, driving or standing.
• Do only eat in certain settings (kitchen table).
• Do watch your portion sizes.
• Do allow yourself to eat a range of foods without forbidding yourself a particular food.
• Do give yourself encouragement.
• Do look for a support person to help you stay motivated and accountable.
• Do be gentle with yourself! Try not to beat yourself up when you lapse.
• Do think of eating healthfully as a lifestyle change.
• Do use the scale mindfully. Weigh yourself no more than once a week.
• Do make healthy food choices.

The food diary

A food diary is a tool to record in detail:

• What food you eat.
• When you eat.
• How you feel when you’re eating.
• What you are doing (if anything) while you are eating.

The diary can help you get a better understanding of what you eat and why you eat it. It also can help your doctor, therapist, or dietitian work with you to make the necessary changes for successful weight management.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Undernutrition is common in patients admitted for surgery and is often unrecognised, untreated and worsens in hospital. The complex synergistic relationship between nutritional status and the physiological responses to surgery puts patients at high nutritional risk. There are clear prospective associations between inadequate nutritional status and the risk of poorer outcomes for surgical patients, including infection, complications and length of stay. However, practically and ethically evidence that nutritional interventions can significantly reduce these poor outcomes is difficult to obtain. Nevertheless health professionals have a duty of care to ensure our patients are properly fed, by whatever means, to meet their physiological requirements.

Introduction

Well-nourished patients respond to, and recover from illness and surgery better than undernourished patients. While overnutrition is widely thought to be the primary nutritional problem in Australia, undernutrition and/or malnutrition are prevalent in population sub-groups. Studies consistently show that 30–40% of patients show evidence of poor nutrition on admission to hospital and that both normal and sub-optimal nutritional status deteriorate in hospital.¹The physiological and psychosocial stresses of surgery increase the risk of poor nutritional status, which is clearly linked to poorer outcomes Poor nutrition therefore has clinical, financial and quality of life consequences.

Definitions of malnutrition and undernutrition

Adequate nutritional status is more than the absence of nutrient deficiency disease. It is a broad concept which infers that an individual can achieve a food intake sufficient to meet their requirements for specific nutrients to support optimal health and well-being.

There is no universally accepted definition of malnutrition. The term is widely associated with severe food deprivation and the classic consequences of kwashiorkor, marasmus or micronutrient deficiency. Malnutrition may refer to overnutrition, but more commonly is used interchangeably with undernutrition.

Undernutrition refers to a continuum of inadequate nutritional status. It extends from inadequate intake and increased risk of poorer health outcomes, through to measurable functional or clinical changes that influence outcomes and are potentially reversed by nutritional interventions, and finally to clear physical and biochemical evidence of protein, energy or micronutrient deficiency.

Nutritional screening and assessment – how to recognise undernutrition

There is no ‘gold standard’ for identifying either nutritional risk or nutritional status. Nutrition screening aims to identify factors associated with poor nutrition and hence individuals at nutritional risk. It needs to be valid, simple, easy to interpret and sensitive so that it can be widely and consistently implemented by non-specialists. A range of screening tools have been developed and variably validated.They include self-reported indicators of either risk or direct evidence of poor or reduced intake .

Table 1 – Nutrition screening and assessment – commonly used indicators

Nutritional screening identifies patients ‘at risk’
Subjective/self-reported difficulty with access to food: money, shopping, cooking facilities, preparation, feeding, mobility, activities of daily livingsocial isolation, depression, anxiety < two meals per day excess alcohol use poor/decreased appetite nausea, chronic pain gastrointestinal symptoms > two weeksvomiting, diarrhoea indicators of protein intake (< three serves/day of dairy, meat, fish, eggs) < two serves of fruit and vegetables/day unintentional weight loss fluid intake	Objective comorbidities, disease state, duration/severity of symptoms poor dentition, oral health polypharmacy (> three drugs/day) dysphagia, respiratory disease prescribed dietary restrictions unintentional weight loss 10% in six months or > 5% in one month current weight, body mass index triceps skinfold (TSF), mid-arm circumference (MAC) mid-arm muscle circumference (MAMC cm) = MAC (cm) – TSF (mm) x 0.314 ascites, fluid retention pressure sores, skin ulcers serum albumin < 35 g/L
Nutritional assessment assesses the nutritional status of patients identified as ‘at risk’
physical examinationhistory – medical, social, nutritionalcurrent dietary intakeanthropometric measures – weight, height (stature), TSF, MAC, MAMCestimates body compositionfunctional status – grip strengthlaboratory data – serum albumin, transferrin, delayed hypersensitivity skin testing, lymphocyte count

If screening identifies individuals at risk, they should be referred for detailed assessment of their nutrition. Nutritional assessment is a comprehensive process used to define the patient’s nutritional status rather than risk. It helps to quantify the risk of complications and can be used to plan and monitor nutritional support.

Limitations of screening and assessment include reliance on self-reported data, inaccurate measurement of stature in injured or elderly patients and confounding of serum protein concentrations by infection and trauma. Nevertheless, the risk factors in Table 1 should be routinely considered in assessment and follow-up of pre- and postoperative patients. The general consensus is that unintentional weight loss, regardless of initial weight, is the simplest and most reliable way to identify nutritional risk.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

The impact of surgery on nutritional status

The complex response to the physiological stress of surgery and injury, mediated via hormonal changes and the sympathetic nervous system, is one of hypermetabolism and catabolism.There is marked salt and water retention and increases in basal metabolic rate and hepatic glucose production. Wound healing accounts for 80% of the increased glucose production and also requires protein synthesis.Fat (adipose tissue) and protein stores (lean muscle mass) are mobilised to meet the needs of glucose and protein synthesis which results in negative nitrogen balance and weight loss. Overall, the catabolic response increases energy and protein requirements, the magnitude and duration depending on the extent of the surgery.A critical point is that semi-starvation (that is, intake consistently below potentially increased requirements) is also catabolic and further exacerbates negative nitrogen balance and weight loss. Indeed, recent evidence suggests the catabolic response to surgery may not be obligatory and can be prevented by adequate intake.

Adequate energy and protein intakes are essential to limit net protein and fat losses. However, many patients are unable to eat enough to meet increased needs and/or prevent losses after surgery. Common and often underrated issues such as pain, nausea, medication, dry mouth, gastric discomfort and distension, fasting, unpleasant procedures, anxiety, unfamiliar food and hospital routines all potentially reduce appetite and intake. Inadequately or unfed patients will rapidly deplete their reserves of protein and fat. This has significant clinical consequences, particularly for those with preoperative undernutrition.

The impact of nutritional status on outcomes of surgery

Positive outcomes for surgery depend heavily on adequate immune defence and wound healing. Both rely on enhanced synthesis of new proteins, which is significantly limited by negative nitrogen and energy balance. A key point is that positive nitrogen balance (net protein synthesis) cannot be achieved with negative energy balance. Semi-starvation will result within days rather than weeks, when intake fails to meet requirements, particularly for protein and energy.

These problems are also common after surgery, so it is likely that the undernutrition associated with the surgery is contributing to poor outcomes for surgical patients.

Outcomes associated with semi-starvation and undernutrition in healthy people and surgical patients

Semi-starvation – healthy people and surgical patients	Undernutrition – surgical
weight lossanxiety, irritabilitydepressionapathy, malaise↓ organ function – gut, respiratory, cardiac↓ thermoregulatory functionimpaired immunity↓ resistance to infectionpoor wound healing↓ intellectual function↓ concentration↓ work capacity↓ growth	↑ postoperative infectionimpaired wound healing↓ quality of life↓ gut function↓ respiratory and cardiovascular function↑ complications (pneumonia)↑ length of convalescence↑ length of stay↑ readmission↓ return to own home↑ mortality↑ costs

Estimation of energy and protein requirements

Nutritional interventions can only be effective if energy requirements are both accurately estimated and then achieved. The standard approach is to estimate energy requirements from basal energy expenditure, using regression equations and activity and stress factors. Energy requirements range from 85–150 kJ/kg. Protein requirements are usually set at 7–8% of energy needs, although severely ill or injured patients may require 15–20% of their energy as protein. This is approximately 1.5–2.0 g of protein/kg of body weight.²Further research is required to characterise specific amino acid and micronutrient requirements in surgical patients. 

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Nutrition support is the provision of nutrients and any necessary adjunctive therapeutic agents to improve or maintain the nutritional status. Nutrition support is fundamental in the management of patients with a moderate-to-severe burn injury.

The primary goal of nutrition support following severe burn injury is to meet the distinctive demands placed upon the body by hypermetabolism. The adverse effects of the hypermetabolic response can result in life-threatening protein-calorie malnutrition. While management of nutritional needs in burn patients has many features in common with the nutritional management of other critically ill surgical patients, the severity, magnitude, and duration of the hypermetabolic response and the ensuing energy requirements for the severe burn patient are far greater.

Nutrition support is administered into the stomach or small intestine (enteral) and/or by intravenous infusion (parenteral). Enteral nutrition, which is administered through a nasogastric, gastric, or intestinal tube, is the preferred method of feeding critically ill patients and an important means of counteracting hypermetabolism. Supplemental parenteral nutrition should only be given to patients in whom enteral feeds are contraindicated, those who do not tolerate enteral feeds, or for patients who do not reach their target nutrient intake in a reasonable time on enteral feedings alone

The unique characteristics of nutritional requirements in the moderate and severe burn patient, including patient selection, initiation, and delivery of nutrition support, are reviewed. Other aspects of burn care are reviewed separately.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Nutritional management for burn patients

• • Assessment
  • Goals of nutritional management
  • Objectives of nutritional management
  • Nutritional ManagementDepartment of Nutrition and Food ServicesRoyal Children’s Hospital, May 2000AssessmentAll inpatients with a deep burn injury are assessed by a dietitian, in order to establish whether a need exists for nutritional intervention.Goals of nutritional management
  1. To promote optimal wound healing and rapid recovery from burn injuries
  2. To minimise risk of complications, including infections during the treatment period
  3. To attain and maintain normal nutritional status
  4. To minimise metabolic disturbances during the treatment processObjectives of nutritional management
  1. Provide nutrition via enteral route within 6 – 18 hours post burn injury
  2. Maintain weight within 5 % – 10 % of pre-burn weight
  3. Prevent signs and symptoms of micronutrient deficiency
  4. Minimise hyperglycaemia
  5. Minimise hypertriglyceridaemia    Nutritional ManagementEnteral Feeding Should Be Commenced EarlyAppropriate nutritional management of the severely burned patient is necessary to ensure optimal outcome. Initiation of early enteral feeding, within 6 to 18 hours post-burn injury, is recognised as beneficial, and has been shown to be safe in children as well as adults. Advantages of utilising the enteral route, as opposed to the parenteral route, include improved nitrogen balance, reduced hypermetabolic response, reduced immunological complications and mortality.Aggressive Nutritional Support is Often RequiredAlthough oral nutrition is encouraged, young children with severe burn injuries often require naso-gastric feeding as they tend to have difficulty meeting their nutritional goals with oral intake alone.Energy Requirements are Elevated by the Burn InjuryThe hypermetabolic response associated with severe burn injury results in high calorie requirements to allow optimal healing and outcome. Several predictive equations exist which enable estimations of energy requirements. Changes in management of these patients in the past decade have resulted in some reduction in the metabolic response and care must be taken to avoid over-feeding. Variation in energy needs between individuals, as well as with time, means that indirect calorimetry is recommended where practical to aid in determining energy expenditure.Protein Requirements are Substantially IncreasedAggressive protein delivery, providing approximately 20 % of calories from protein, has been associated with improved mortality and morbidity.An Increased Requirement Exists for Nutrients Associated with Healing and Immune FunctionProvision of those nutrients known to be associated with healing and immune function, particularly vitamins A, C, E, some B vitamins and zinc, is especially important. Recent studies have indicated that benefits may also be achieved by supplementation with various additives, including fish-oil.
• REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Dietary counseling provides individualized nutritional care for encouraging the modification of eating habits. It may also assist in prevention or treatment of nutrition-related illnesses such as cardiovascular disease, cancer, obesity, diabetes, and hyperlipidemia.

Diet plays a vital role in the treatment of patients. Proper diet is the key to good health and vigor. Inadequate and improper diets are not only responsible for under nutrition but also contribute to several chronic degenerative diseases such as cardiovascular diseases, diabetes and cancer.
The Dietary department which consists of Dieticians has got a role in the decision making system for patients care. Dieticians not only cater to the patient’s food requirement, but they are responsible for planning, prescribing and counseling patients about their diet according to their diseased conditions.

Purpose

Today’s major health care problems are increasingly the result of acute and chronic conditions related to poor nutrition and/or overconsumption. A large proportion of coronary disease and cancer can be attributed to unhealthy eating habits and obesity. Chronic diseases continue to increase due to such factors as the rise in obesity in the American population.

Individualized nutritional counseling can provide the patient important insight into food-related illnesses and education regarding how various nutrients (protein, carbohydrate, fat, alcohol) affect illnesses or obesity. Alternatively, dietary counseling can assist in prevention of nutrition-related conditions such as the need for weight management. Dietary counseling can be tailored to meet the treatment needs of patients on diagnosis of specific illnesses, can help reduce complications and/or side effects, and can improve general well-being. Prevention at all levels: primary (preventing disease), secondary (early diagnosis), and tertiary (preventing or slowing deterioration) requires active patient participation and guidance and support from the dietician or physician. Education, motivation, and counseling are needed for effective patient participation. In addition to patient education, dietary counseling often includes meal planning.

Consumption of too little or too much of certain vitamins and minerals may lead to a nutrient deficiency or a nutrient toxicity respectively. A guide to the amount an average person needs to remain healthy has been determined for each vitamin and mineral as well as macronutrients. In the United States, this guide is called the Dietary Reference Intakes (DRI). Dietary counselors may use the DRI as a guide when providing counseling. A dietitian can advise the patient about any vitamin or mineral inadequacy concerns during the dietary counseling session. The DRIs have replaced the Recommended Dietary Allowance (RDA), but encompass both the RDAs and the upper intake limits for each nutrient.

Precautions

When providing dietary counseling, registered dietitians and nutritionists should recognize the benefit of individualizing nutritional care and that a “one-size-fits-all” approach to modifying eating habits cannot be effective.

Description

Effective dietary counseling includes a comprehensive evaluation that considers presence of disease, lipid profile, blood pressure, and weight history and goals. In addition, factors such as lifestyle, time available for food preparation, work schedule, and personal food preferences must be considered. Food choices are driven not only by the physiological necessity for nutrients, but also by the social aspects of food consumption, for example, gathering with friends at a restaurant. This complex relationship concerning food choices often makes dietary counseling a challenge for managing specific nutrition-related disease or conditions. For example, a patient with cardiovascular disease may need to select low-fat foods when attending a social dinner or party.

There are many goals that need to be considered when planning appropriate dietary counseling. When considering the appropriate counseling approach for an individual with a specific illness, particular attention needs to be given to usual food choices, food likes and dislikes, learning style, cultural issues, and socioeconomic status.

Other factors that may be assessed during dietary counseling include:

• medical history, including assessment of any nutrition-related illnesses, and biochemical and anthropometric measures
• dietary assessment (dietary analyses)
• psychosocial evaluation, including food-related attitudes and behaviors
• sociological evaluation, including cultural practices, housing, cooking facilities, financial resources, and support of family and friends
• nutrition knowledge
• readiness to learn or change; as well as learning style analyses
• current exercise and activity level

Preparation

A dietary assessment is often conducted to determine the macronutrient content (energy/or calories, protein, carbohydrate, and fat) and the micronutrient (vitamin and mineral) content of the diet to assist in providing dietary counseling. The validation of dietary assessment instruments is important to evaluate the diet in terms of chronic disease risk factors such as a high fat diet or a diet low in antioxidants and/or fruits and vegetables.

Some of the most common dietary assessment tools that assist in providing dietary counseling include food records, dietary recalls, food frequency questionnaires, diet histories, and several other methods, including biochemical indices. A scientific assessment of nutritional status may be made by using a combination of the information collected from clinical evaluations, biochemical tests, and dietary information. The clinical evaluation includes measurements of various anthropometric parameters such as height, weight, and percent body fat (determined by skinfolds or hydrostatic weighing). In addition, a clinical evaluation may also include observations for signs of nutrient deficiencies in the mouth, skin, eyes, and nails. The information collected from a clinical evaluation can be compared with that obtained from the dietary assessment and biochemical tests to provide a comprehensive picture of the patient’s current nutritional status and relative risk factors for diet-related illnesses.

Aftercare

Dietary counseling is only effective if the individual is willing to implement the necessary dietary modifications. If patients do not follow the recommended dietary guidance, they will not receive a benefit from counseling. Typically, modest effects seen in weight loss or reduction in serum lipids are often due to failure to comply fully with the dietary recommendations provided.

Complications

Systematic problems exist in the quantification of food intake using self-reported measures (when patients subjectively report their own food intakes). This is due to the fact that these methods rely on the patient’s ability to recall or record food intake accurately. Therefore, selection of the appropriate method for dietary assessment is important to meet the goals of dietary counseling.

Results

Goals of dietary counseling for preventative nutrition or treatment of nutrition-related illness:

• Providing adequate calories for attaining reasonable weights for adults, ensuring normal growth and development rates for children and adolescents, and meeting increased metabolic needs during pregnancy and lactation or recovery from catabolic illness. Reasonable weight for adults is defined by considering weight history and is a weight that both the individual and health professional determine is attainable and can be maintained long term.
• Achieving optimal lipid levels. The guidelines provided by the National Cholesterol Education Program can be followed for maintaining optimal blood lipid levels (total cholesterol, low-density lipoproteins [LDL], high-density lipoproteins [HDL], and triglycerides). Nutrition intervention plays an important role in reaching recommended lipid levels through maintenance of a low-fat diet.
• Ensuring the diet contains appropriate or reasonable amounts of protein, carbohydrates, fat, vitamins, and minerals.
• Preventing, delaying, or treating nutrition-related risk factors and complications.
• Improving overall health through optimal nutrition.

HEALTHY DIET OVERVIEW

The food choices we make can have an important impact on our health. However, expert opinions continue to change about which and how much of these foods are optimal.

This topic summarizes the relationships between various foods or supplements and specific health conditions and concludes with general recommendations for following a healthy diet. A separate topic review is available about diets for weight loss.

FRUITS AND VEGETABLES

A number of studies have demonstrated important health benefits of eating fruits and vegetables.

●Increased intake of fruits and vegetables is linked to a lower risk of premature death.

●Fruits and vegetables decrease the risk of cardiovascular diseases including coronary heart disease (CHD), stroke, and death from CHD.

●High intake of fruits and vegetables may reduce the risk of developing cancer. Tomato and tomato-based foods may be beneficial at lowering the risk of prostate cancer.

●Recommended intake is at least five servings of fruits and/or vegetables every day.

FIBER

Eating a diet that is high in fiber can decrease the risk of coronary heart disease (CHD), colon cancer, and death. Eating fiber also protects against type 2 diabetes, and eating soluble fiber (such as that found in vegetables, fruits, and especially legumes) may help control blood sugar in people who already have diabetes.

The recommended amount of dietary fiber is 25 grams per day for women and 38 grams per day for men. Many breakfast cereals, fruits, and vegetables are excellent sources of dietary fiber. By reading the product information panel on the side of the package, it is possible to determine the number of grams of fiber per serving . A list of the fiber content of a number of foods can be found in the table .

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

GRAINS AND SUGAR

Whole grain foods (like 100 percent whole wheat bread, steel cut oats, and wild/brown rice) should be chosen over foods made with refined grains (like white bread and white rice). Regularly eating whole grains has been shown to help weight loss and lower the risk of diabetes. Regularly consuming refined grains and added sugars has been associated with weight gain and increased risk of diabetes.

FAT

Eating foods higher in healthy fats and lower in unhealthy fats may reduce the risk of coronary heart disease (CHD).

The type of fat consumed appears to be more important than the amount of total fat. Trans fats should be avoided in favor of polyunsaturated fats, particularly those polyunsaturated fats found in fish (omega 3). Other sources of polyunsaturated fats that may be beneficial include certain oils, nuts, and seeds (like corn oil, flax seeds, and walnuts).

Trans fats appear on food labels as “partially hydrogenated oils” and are solid at room temperature. They are found in many margarines and commercial baked goods as well as in oils kept at high temperatures for a long period, such as frying vats in fast food restaurants.

Although saturated fats (found in animal products such as cheese, butter, and red meat) have typically been viewed as unhealthy, and monounsaturated fats (found in combination with other fats in many oils, such as olive oil) as healthy, newer evidence suggests that saturated and monounsaturated fats do not significantly increase or decrease the risk of CHD, although saturated fats raise cholesterol levels.

If cutting back on certain fats, it is important not to replace them with refined carbohydrates (eg, white bread, white rice, most sweets). Increases in refined carbohydrate intake may lower levels of high-density lipoprotein (HDL) cholesterol (good cholesterol), which actually increases the risk of CHD.

RED MEAT

It is now well-established that regularly eating red meat, particularly processed meats (like salami, pepperoni, and ham), is detrimental to health. It increases the risk of numerous diseases such as cancer, cardiovascular disease, and diabetes.

FOLATE

Folate is a type of B vitamin that is important in the production of red blood cells. Low levels of folate in pregnant women have been linked to a group of birth defects called neural tube defects, which includes spina bifida and anencephaly. Vitamins containing folate and breakfast cereal fortified with folate are recommended as the best ways to ensure adequate folate intake.

ANTIOXIDANTS

The antioxidant vitamins include vitamins A, C, E, and beta-carotene. Many foods, especially fruits and vegetables, contain these vitamins as well as have additional antioxidant properties. Studies have not clearly shown that antioxidant vitamins help prevent disease, specifically cancer, and some studies show they may actually cause harm. There is no evidence to support taking antioxidant vitamin supplements, except for individuals who have specific vitamin deficiencies.

CALCIUM AND VITAMIN D

Adequate calcium and vitamin D intake are important, particularly in women, to reduce the risk of osteoporosis. A health care provider can help to decide if supplements are needed, depending upon a person’s dietary intake of calcium and vitamin D . Although the optimal level has not been clearly established, experts recommend that premenopausal women and men consume at least 1000 mg of calcium per day and postmenopausal women should consume 1200 mg per day. No more than 2000 mg of calcium should be consumed per day.

For vitamin D, 800 international units (20 micrograms) per day is recommended for adults over 70 years old and postmenopausal women. For other adults, the optimal intake is not clearly established, but 600 international units (15 micrograms) per day is generally recommended.

ALCOHOL

Moderate alcohol intake may reduce the risk of heart disease. However, drinking is also associated with many adverse events. Regularly drinking alcohol increases the risk of breast cancer in women; cancers of the mouth, esophagus, throat, larynx, and liver; other illnesses such as cirrhosis and alcoholism; and injuries and other trauma-related problems, particularly in men.

Based on the trade-off between these risks and benefits, the United States Dietary Guidelines recommend alcohol intake in moderation, if at all. This means no more than one drink per day for women and up to two drinks per day for men. Those who do not drink alcohol do not need to start.

Drinking is discouraged for those under 40 years who are at low risk of cardiovascular disease because the risks are likely to outweigh the benefits in this group.

CALORIC INTAKE

Of all aspects of diet, calories are possibly the most important when it comes to good health and preventing disease. Too many calories lead to weight gain and obesity. Excess weight is linked to premature death as well as an increased risk of cardiovascular disease, diabetes, hypertension, numerous cancers, and other important diseases.

The total number of calories a person needs depends upon the following factors:

●Weight

●Age

●Gender

●Height

●Activity level

GENERAL RECOMMENDATIONS FOR A HEALTHY DIET

Eat lots of vegetables, fruits, and whole grains and a limited amount of red meat. Get at least five servings of fruits and vegetables every day. Tips for achieving this goal include:

●Make fruits and vegetables part of every meal. Eat a variety of fruits and vegetables. Frozen or canned can be used when fresh isn’t convenient.

●Eat vegetables as snacks.

●Have a bowl of fruit out all the time for kids to take snacks from.

●Put fruit on your cereal.

●Consume at least half of all grains as whole grains (like 100 percent whole wheat bread, brown rice, whole grain cereal), replacing refined grains (like white bread, white rice, refined or sweetened cereals).

●Choose smaller portions and eat more slowly.

Cut down on unhealthy fats (trans fats and saturated fats) and consume more healthy fats (polyunsaturated and monounsaturated fat). Tips for achieving this goal include:

●Choose chicken, fish, and beans instead of red meat and cheese.

●Cook with oils that contain polyunsaturated and monounsaturated fats, like corn, olive, and peanut oil.

●Choose margarines that do not have partially hydrogenated oils. Soft margarines (especially squeeze margarines) have less trans fatty acids than stick margarines.

●Eat fewer baked goods that are store-made and contain partially hydrogenated fats (like many types of crackers, cookies, and cupcakes).

●When eating at fast food restaurants, choose healthy items for yourself as well as your family, like broiled chicken or salad.

●If choosing prepared or processed foods, choose those labeled “zero trans fat.” They may still have some trans fat but likely less than similar choices not labeled “zero.”

Avoid sugary drinks and excessive alcohol intake. Tips for achieving this goal include:

●Choose non-sweetened and non-alcoholic beverages, like water, at meals and parties.

●Avoid occasions centered around alcohol.

●Avoid making sugary drinks and alcohol an essential part of family gatherings.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

A febrile seizure is a convulsion in a child that’s caused by a fever. The fever is often from an infection. Febrile seizures occur in young, healthy children who have normal development and haven’t had any neurological symptoms before.

It can be frightening when your child has a febrile seizure. Fortunately, febrile seizures are usually harmless, only last a few minutes, and typically don’t indicate a serious health problem.

You can help by keeping your child safe during a febrile seizure and by offering comfort afterward. Call your doctor to have your child evaluated as soon as possible after a febrile seizure.

Symptoms

Usually, a child having a febrile seizure shakes all over and loses consciousness. Sometimes, the child may get very stiff or twitch in just one area of the body.

A child having a febrile seizure may:

• Have a fever higher than 100.4 F (38.0 C)
• Lose consciousness
• Shake or jerk the arms and legs

Febrile seizures are classified as simple or complex:

• Simple febrile seizures. This most common type lasts from a few seconds to 15 minutes. Simple febrile seizures do not recur within a 24-hour period and are not specific to one part of the body.
• Complex febrile seizures. This type lasts longer than 15 minutes, occurs more than once within 24 hours or is confined to one side of your child’s body.

Febrile seizures most often occur within 24 hours of the onset of a fever and can be the first sign that a child is ill.

When to see a doctor

See your child’s doctor as soon as possible after your child’s first febrile seizure, even if it lasts only a few seconds. Call an ambulance to take your child to the emergency room if the seizure lasts longer than five minutes or is accompanied by:

• Vomiting
• A stiff neck
• Breathing problems
• Extreme sleepiness

Get the latest epilepsy help and advice from Mayo Clinic delivered in your inbox.

Subscribe for free and receive the latest on epilepsy treatment, care and management. I would like to learn more about: Latest on newly diagnosed epilepsy care Advice for the management of epilepsy

Causes

Usually, a higher than normal body temperature causes febrile seizures. Even a low-grade fever can trigger a febrile seizure.

Infection

The fevers that trigger febrile seizures are usually caused by a viral infection, and less commonly by a bacterial infection. The flu (influenza) virus and the virus that causes roseola, which often are accompanied by high fevers, appear to be most frequently associated with febrile seizures.

Post-vaccination seizures

The risk of febrile seizures may increase after some childhood vaccinations. These include the diphtheria, tetanus and pertussis vaccine and the measles-mumps-rubella vaccine. A child can develop a low-grade fever after a vaccination. The fever, not the vaccine, causes the seizure.

Risk factors

Factors that increase the risk of having a febrile seizure include:

• Young age. Most febrile seizures occur in children between 6 months and 5 years of age, with the greatest risk between 12 and 18 months of age.
• Family history. Some children inherit a family’s tendency to have seizures with a fever. Additionally, researchers have linked several genes to a susceptibility to febrile seizures.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Complications

Most febrile seizures produce no lasting effects. Simple febrile seizures don’t cause brain damage, intellectual disability or learning disabilities, and they don’t mean your child has a more serious underlying disorder.

Febrile seizures are provoked seizures and don’t indicate epilepsy. Epilepsy is a condition characterized by recurrent unprovoked seizures caused by abnormal electrical signals in the brain.

Recurrent febrile seizures

The most common complication is the possibility of more febrile seizures. The risk of recurrence is higher if:

• Your child’s first seizure resulted from a low-grade fever.
• The febrile seizure was the first sign of illness.
• An immediate family member has a history of febrile seizures.
• Your child was younger than 18 months at the time of the first febrile seizure.

Prevention

Most febrile seizures occur in the first few hours of a fever, during the initial rise in body temperature.

Giving your child medications

Giving your child infants’ or children’s acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) at the beginning of a fever may make your child more comfortable, but it won’t prevent a seizure.

Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye’s syndrome, a rare but potentially life-threatening condition, in such children.

Prescription prevention medications

Rarely, prescription anticonvulsant medications are used to try to prevent febrile seizures. However, these medications can have serious side effects that may outweigh any possible benefit.

Rectal diazepam (Diastat) or nasal midazolam might be prescribed to be used as needed for children who are prone to long febrile seizures. These medications are typically used to treat seizures that last longer than five minutes or if the child has more than one seizure within 24 hours. They are not typically used to prevent febrile seizures.

Modification of diet

METABOLISM IN FEVERS

The metabolic effects of fevers is proportional to the elevation of body temperature and the duration

1. An increase in the metabolic rate amounting to 13 percent for every degree celsius rise in the body temperature (7 percent for each degree farenheit); an increase is also due to restlessness and hence a greatly increased caloric need.

• Decreased glycogen stores and decreased stores of adipose tissue.

• Increased catabolism of proteins especially in typhoid fever and malaria places an additional burden upon the kidneys.

• Accelerated loss of body water due to increased perspiration and excretion of body wastes.

• Increased excretion of sodium and potassium.

DIETARY CONSIDERATIONS

The diet in fever depends on

1. The nature and severity of the pathologic conditions and

• Length of convalescence.

It should meet the body’s need for the following nutrients.

Energy

The caloric requirement may be increased as much as 50 percent if the temperature is high and tissue destruction is great. Restlessness also increases the caloric requirement.

Protein

About 100g of protein or more is prescribed for the adult when fever is prolonged. This will be efficiently utilized when the caloric intake is liberal. High protein beverages may be used as supplements to the regular meals (eg. Milk)

Carbohydrates

Glycogen stores are replenished by a liberal intake of carbohydrates. Glucose – a simple sugar, which is less sweet and readily absorbed into the blood stream is preferred.

Fats

The energy intake may be rapidly increased through the judicious use of fats, (about 35 g of fat). Fried foods may retard digestion.

Minerals

A sufficient intake of sodium chloride is accomplished by the use of soups and liberal sprinkling of salt on food. Fruit juices a relatively good source of potassium should be included.

Vitamins

B complex vitamins are needed at increased levels proportionate to the increase in calories. Fevers increase the requirement for vitamin A and ascorbic acid.

Fluid

The fluid intake must be liberal to compensate for the losses from the skin and to permit adequate volume of urine for excreting the wastes. Daily 2500-5000 ml is necessary in the form of soups, fruit juices and water.

Ease of digestion

Blended, readily digestible foods (well cooked) should be used to facilitate digestion and rapid absorption. The food may be soft or of regular consistency.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Dietary management of surgical patients: effects on incisional wound healing

Haneya M. Elbanna, Kawther G. Tolba and Olfat A. Darwish

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Abstract: A study of 38 patients was undertaken at the main University Hospital in Alexandria. The sample was divided into a control group and an experimental group. Findings show statistically significant differences between the two groups in the level of education, but no difference in blood picture, body mass index or nutritional status. There was a difference in the rate of wound healing in the two groups, and a relationship between the nutritional status and wound healing in the control group. Total hospital stays for the control group were longer than those for the experimental group. The nutritional status of surgical patients, as well as their food intake, should be evaluated at short intervals before and after surgery.

Introduction

Nutritional care plays an important role in the success of surgery. Hospital stay may be avoided, wound healing enhanced and the number of complications reduced by adequate nutritional support. Failure of wounds to heal, however, increases the financial, physical and emotional cost of hospitalization and increases the workload of health professionals.

Clean surgical incisions often heal by primary intention. However, one of the local factors which impede this process is infection. Systematically, healing depends on the delivery of blood with its supply of oxygen, nutrients and leukocytes to the wound site. Some specific conditions that impair healing include neoplasia, anaemia or vital systemic disease. Therefore, preoperative repletion, wound care and postoperative dietary supplements are essential for optimal repair.

Nutritional management is a coordinated effort of the medical, nursing and dietary staff. It entails thorough assessment of the preoperative and postoperative patient’s dietary behaviour and intake, evaluation of nutritional state and providing patients with the appropriate instructions.

Available research data denote a lack of consistent standards of surgical dietary planning. Nutritional surveys are essential prerequisites in this regard, since they serve as scientific bases for subsequent dietary planning and interventions.

Aims and objectives

To assess the general surgical patient’s nutritional status and dietary intake.

To design and implement individualized dietary plans based on the surgical patient’s needs.

To identify the effects of dietary management on incisional wound healing.

Materials and methods

This study was undertaken in the general surgical wards and the private wards at Alexandria main University Hospital. Thirty-eight general surgical patients were included in the sample. They were enrolled in succession into a control group (n = 22) then an experimental group (n = 16).

Criteria for subjects inclusion were: male and female preoperative adults with no associated medical disorders affecting their wound healing, expected to stay postoperatively to be watched for wound healing or at least to return after discharge for suture removal, and willing to participate in the study.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

Tools

Tools used in the study were as follows.

1. Surgical patient nutritional and wound healing assessment sheet. This sheet, developed by the researchers, included the following main points:

1. Patient personal characteristics: age, sex, diagnosis, type of surgery, as well as dates of admission, operative suture removal, healing and discharge.
2. Preoperative laboratory investigations: haemoglobin percentage and white blood cell total count.
3. Anthropometric measures: patient’s weight (kilograms), height (metres), mid-arm circumference (MAC in centimetres) and triceps skin fold (TSF in millimetres) [9],[10].
4. Patient’s nutritional status: an estimation of the patient’s preoperative weight as percentage of standard weight was calculated: (measured weight in kilograms ¸ standard weight ´ 100), to determine whether it was normal, i.e. between 90% and 100%, less than 90%, or more than 110%. Also, body mass index (BMI) was estimated (weight in kilograms ¸ height squared in square metres) to determine whether the subject was non-obese
5. Wound healing checklist: derived from Young and adapted. It involved local and general criteria of inadequate wound healing. One score was allotted for each sign of redness, hotness, oedema, discharge and dehiscence. For the general criteria, one score was given for delay in suture removal and two scores for fever exceeding 38 °C, two days after surgery. Healing scores were thus calculated as a fraction (out of 8), with higher scores indicating poorer wound healing.

2. Preoperative and postoperative dietary intake record. This record was used to assess patients’ dietary intake throughout the three days prior to and following surgery. A 24hour diet recall was used. Dietary analysis was calculated thereafter using food composition tables, and averages were obtained.

3. Preoperative and postoperative meal plans. These dietary plans were designed individually for the experimental group subjects, based on the initial nutritional assessment, as well as the calculation of the surgical hospital patient’s needs. The control group had the same meals as other surgical patients.

4. Preoperatively, nutritional support was geared to the correction of diet. Those patients found to need preoperative repletion received calories and proteins at levels 30% to 50% above maintenance. Minerals, vitamins and fluids required for normal good nutrition and hydration were also provided.

5. Postoperative plans were directed at increasing daily energy requirements to 10% or slightly more, provided that there were no complications. From 0.1g to a maximum of 0.2 g protein per kilogram of usual body weight were supplemented. The goal of this nutritional support was to provide anabolism with sufficient calories [6]. Further dietary vitamin supplements were also considered.

6. These plans involved three meals of alternative foods in ideal quantities deemed important and agreed upon by the attending surgeons and dietitians.

Procedure

Patients in the experimental group were matched with the controls, according to the age, sex and diagnosis variables. Medical and nursing interventions of both groups of subjects, including dressing, were approximately standardized in the study setting.

Patients in the control group were enrolled into the study first. Collecting the two groups at the same time would create bias, since experimental subjects and hospital staff could inadvertently inform the controls about dietary instructions.

Wound healing items were checked by ward surgeons, and dietary analysis was carried out by one of the investigators; in certain instances they were aware of the subjects’ assigned group.

All patients were interviewed, 3 to 7 days prior to surgery, to review their medical records and laboratory studies, consult their treating surgeons and fill in the initial assessment sheets. Additionally, and daily thereafter, they were counselled about their 24-hour dietary intake. Throughout the subsequent 3 to 4 postoperative days, daily interviews were conducted to record the subjects’ dietary intake. Their operative incisions were also checked for signs of wound healing during dressing change and/or suture removal. Compliance with the plans was emphasized during daily visits.

Statistical analysis

Data were analysed and tabulated. Absolute percentage and frequency distribution, means and standard deviations (s) were computed. Data obtained from the two study groups were compared using t, c2 and Fisher’s exact tests. Simple correlation coefficients and regression coefficients were computed and multiple regression and F-tests performed to identify the relations and the collective effect of dietary variables and wound healing.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

• Our Nutrition Service staff will be taking care of your nutritional needs during your time with us. When you are ill, or injured, your body needs specific nutrients and/or a combination of nutrients to help you heal.
• Our job, is to make sure that you are prescribed a nutritionally optimal diet to meet your specific nutrient needs for recovery. To achieve this goal, our Registered Dietitian (RD) will review your medical condition and adjust your diet, if needed, to make sure you receive proper nutrition during your stay.
• We understand that when you are not feeling well, it can be difficult to eat your normal diet. To help you through this period, we can provide alternate meals and nutrition supplements. If you need alternate meals or supplements, just tell our Diet Aide or your nurse.
  Our Diet Aide makes daily rounds to take your meal selection on a hand-held computer and will be able to cater to your food preferences.
• Our menus were designed by a Registered Dietitian and are nutritionally balanced. Our chefs take pride in preparing foods that are appetizing and tasty.
• Many of our recipes come from Gourmet and Bon Appetit magazines. Our menus are reviewed annually and menu items are adjusted, deleted, and added to, as a direct result from our patient’s suggestions. So, please, when you are here, let us know your comments about the quality of our food.

Three of the most common types of prescribed diets:

• Clear Liquid Diet- The clear liquid diet is often prescribed for a short period after surgery to give your GI tract a rest. The diet consists of clear juices, broth, popsicles, gelatin, and tea. Coffee may be allowed with your physicians approval.
  
  
• Full Liquid Diet- The full liquid diet is prescribed after surgery as a transition from clear liquids to a regular diet. This diet includes all the foods on a clear liquid diet plus the addition of dairy products such as: milk, yogurt, pudding, and smooth cream soups.
  
  
• Regular Diet- The regular diet, sometimes called the “house diet” consists of normal foods similar to home. Our “Regular” diet follows the Dietary Guidelines for Americans and is moderate in salt, sugar, and fat.

Three common types of therapeutic diets:

• Cardiac Diet – The Cardiac diet, is sometimes called the Low fat, Low Cholesterol diet. The diet consists of foods which are low in saturated fat, cholesterol and salt. Whole grains and abundant vegetables and fruit, lean meat, poultry, and fish are emphasized.
  Nonfat milk and low fat cheese are used in recipes. The cardiac diet is used for patients who have elevated cholesterol and may also have high blood pressure.
  
  
• Diabetic Diet- The Diabetic diet, is low in sugar and fat. The diet is designed to keep blood glucose (sugar) levels under control. Many sugar free items are offered. The Diet Aide will modify your selections based on the calorie level prescribed for you.
  
  
• Low Sodium Diet- The Low Sodium diet, is prescribed for people who have high blood pressure, pneumonia, kidney disease, or who retain water. A low sodium diet will help your body get rid of excess fluids and assist in improving your medical condition. Herbs are used in place of salt to season most foods. You may notice the real flavor in food as your taste buds become accommodated to less salt.

What is a regular diet?

A regular diet is a healthy meal plan that includes a variety of healthy foods from all the food groups. Follow this meal plan if you do not have any health conditions that require a special diet. A healthy meal plan is low in unhealthy fats, salt, and added sugar. It may decrease your risk of heart disease, osteoporosis (brittle bones), and some types of cancer.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com

What is a healthy meal plan?

My Plate is a model for planning healthy meals. It shows the types and amounts of foods that should go on your plate. Fruits and vegetables make up about half of your plate, and grains and protein make up the other half. A serving of dairy is also included. The amount of calories and serving sizes you need depends on your age, gender, weight, and height. Examples of healthy foods are listed below:

• Eat a variety of vegetables such as dark green, red, and orange vegetables. You can also include canned vegetables low in sodium (salt) and frozen vegetables without added butter or sauces.
• Eat a variety of fresh fruits , canned fruit in 100% juice, frozen fruit, and dried fruit.
• Include whole grains. At least half of the grains you eat should be whole grains. Examples include whole wheat bread, wheat pasta, brown rice, and whole grain cereals such as oatmeal.
• Eat a variety of protein foods such as seafood (fish and shellfish), lean meat, and poultry without skin (turkey and chicken). Examples of lean meats include pork leg, shoulder, or tenderloin, and beef round, sirloin, tenderloin, and extra lean ground beef. Other protein foods include eggs and egg substitutes, beans, peas, soy products, nuts, and seeds.
• Choose low-fat dairy products such as skim or 1% milk or low-fat yogurt, cheese, and cottage cheese.

Tube Feeding: Living With a Feeding Tube

Introduction

Your body needs nutrition to stay strong and help you live a healthy life. If you’re unable to eat, or if you have an illness that makes it hard to swallow food, you may need a feeding tube. The tube is surgically inserted into your stomach and is used to give food, liquids, and medicines.

Depending on why you need a feeding tube, you may have it for several weeks or months or for the rest of your life. Having a feeding tube means learning new skills and adopting new routines. You’ll need to learn how to use and care for the tube, and how to avoid common problems.

• A feeding tube is inserted during a surgery. After the surgery, you’ll have a 6- to 12-inch tube coming out of your belly.
• Foods, liquids, and medicines are given using the tube. The food is a mixture (formula) made up of proteins, carbohydrates, fats, vitamins, and minerals.
• Keeping the tube clean is very important.
• Adjusting to using a feeding tube takes time. The first step is learning all you can about how the tube works and how to avoid problems. Making tube feeding less of a mystery may help you make it a part of your daily life.

REQUEST AN APPOINTMENT OR BOOK A CONSULANT – Sargam.dange.18@gmail.com