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Diet Therapy of Diseases

Diet Therapy of Diseases

NUTRITION IN HEPATITIS

OVERVIEW
Everything you eat and drink has to go through your liver in order to change food substances into stored energy and chemicals which are necessary for life. Your liver makes nutrients available so your body can use them to build cells, give you energy, and maintain normal body functions.

The liver is responsible for:
– removing toxins from drugs and alcohol from the body
– metabolizing fat
– excretion of bilirubin (a product of broken-down red blood cells), cholesterol, hormones, and drugs
– breakdown of carbohydrates, fats, and proteins
– activation of enzymes, which are specialized proteins essential to body functions
– storage of glycogen (a form of sugar), minerals, and vitamins (A, D, E, and K)
– synthesis of blood proteins, such as albumin
– synthesis of clotting factors

HOW DIET AFFECTS THE LIVER
An unhealthy choice in diet can sometimes give the liver to much work to do thereby leading to a liver failure. If your diet provides too many calories, you will gain weight. Being overweight is linked to the buildup of fat in the liver, called “fatty liver.” Toxins, such as alcohol, damage the liver over time.
One very common liver disease (failure) is hepatitis.
Hepatitis refers to a common inflammation of the kidneys caused mostly by viral infections and other factors as toxins, auto immune diseases and alcohol.
There are different types of hepatitis and are all differentiated by Alphabets A-G.
According to the Centers for Disease Control and Prevention (CDC)Trusted Source, approximately 4.4 million Americans are currently living with chronic hepatitis B and C. Many more people don’t even know that they have hepatitis.
There are 5 types of viral infections with 5 distinct types of viruses:

Hepatitis A
Hepatitis A is caused by an infection with the hepatitis A virus (HAV). This type of hepatitis is most commonly transmitted by consuming food or water contaminated by feces from a person infected with hepatitis A.

Hepatitis B
Hepatitis B is transmitted through contact with infectious body fluids, such as blood, vaginal secretions, or semen, containing the hepatitis B virus (HBV). Injection drug use, having sex with an infected partner, or sharing razors with an infected person increase your risk of getting hepatitis B.
It’s estimated by the CDC that 1.2 million people in the United States and 350 million people worldwide live with this chronic disease.

Hepatitis C
Hepatitis C comes from the hepatitis C virus (HCV). Hepatitis C is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact. HCV is among the most common bloodborne viral infections in the United States. Approximately 2.7-3.9 million people currently living with a chronic form of this infection.

Hepatitis D
Also called delta hepatitis, hepatitis D is a serious liver disease caused by the hepatitis D virus (HDV). HDV is contracted through direct contact with infected blood. Hepatitis D is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection. The hepatitis D virus can’t multiply without the presence of hepatitis B. It’s very uncommon in the United States.

Hepatitis E
Hepatitis E is a waterborne disease caused by the hepatitis E virus (HEV). Hepatitis E is mainly found in areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water supply. This disease is uncommon in the United States. However, cases of hepatitis E have been reported in the Middle East, Asia, Central America, and Africa, according to the CDC .

COMMON SYMPTOMS OF HEPATITIS
• fatigue
• flu-like symptoms
• dark urine
• pale stool
• abdominal pain
• loss of appetite
• unexplained weight loss
• yellow skin and eyes, which may be signs of jaundice

DIAGNOSIS OF HEPATITIS
Hepatitis can be diagnosed by liver function test, blood test, ultra sound, liver biopsy. The doctor always checks for risk before deciding what method to adopt in diagnosis.

TREATMENT OPTIONS FOR HEPATITIS
All types of hepatitis require either anti-viral vaccination, hydration if there is diarrhea (especially in type A), and nutrition.
Currently, there is no vaccination for Hepatitis C. Those that develop cirrhosis during the course of this would require a liver transplant.
Acute cases like Hepatitis E usually don’t require vaccination or treatment as they go on their own if the individual heeds to lifestyle modification by a professional.

RISK FACTORS
These include contact with an infected person (either living in close contact or sexual contact), poor hygiene, traveling to areas with inadequate sanitation, contaminated food (especially shellfish), and illicit drug use. Also, Patients with underlying liver disease (e.g., autoimmune hepatitis, hemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency) are at increased risk of developing symptomatic hepatitis.
Alcohol use, smoking, HIV infection, and fatty liver are risk factors for progression of hepatitis.

NUTRITION AND HEPATITIS
Dietary management in hepatitis involves more of a lifestyle modification and hygienic approach.
Hygiene and sanitation: you should be careful of what you eat as a travller as you can pick up the virus from under cooked and contaminated foods. Make sure you heat food appropriately.

Avoiding contaminated shellfish and game meats.

Avoiding high-iron foods and iron supplements. Hepatitis C progression occurs in patients as a result of accelerated hepatic iron uptake and the oxidative stress caused by iron-catalyzed free radical production. Along with phlebotomy, a low-iron diet helps lower the risk for hepatocellular carcinoma (HCC) in these patients.

Nutritional supplementation may be required. Treatment with interferon (IFN) has shown to be very effective especially in Hep C patients. Research has it that it could help in weight reduction as it reduces appetite.

A low-fat, low-cholesterol diet may be helpful. Chronic hepatitis C (CHC) infection increases the risk for hepatic steatosis. A higher intake of dietary cholesterol contributes to this problem and is associated with the progression of hepatitis C-related liver disease. A dietary regimen that is reduced in fat (23% of calories) and cholesterol (185 mg/d) is adviced to help in the management of this Hepatitis.

Adequate vitamin D status. Vitamin D deficiency is common in patients with chronic liver disease, and these patients may have a reduced ability to convert vitamin D to its active form. An inverse relationship seems to exist between vitamin D concentrations and viral load in patients with CHC. Deficiency significantly lowers the chance for a sustained virological response to pegylated interferon and ribavirin, and vitamin D supplementation improves the probability of response to treatment.

Avoidance of extremes in B12 status. Adequate B12 status helps with clearance of hepatitis C from the circulation of infected patients. However, overly high serum B12 levels may also foster viral replication and are associated with concentrations of hepatitis C RNA levels.

Coffee consumption and chronic hepatitis C. Coffee consumption may be helpful, reducing oxidative DNA damage, increasing death of virus-infected cells, stabilizing chromosomes, and reducing fibrosis.

HOW HEPATITIS C AFFECTS DIET
If you have hepatitis, you usually don’t need a special diet. Just trying to eat healthy, maintain a healthy weight, and avoid alcohol is all that is needed. Its mostly lifestyle modification. Though, in severe cases, there might be nutrient restrictions especially fat restriction.
There are special cases, however, when hepatitis C can affect the diet:
• Patients with cirrhosis
As liver disease progresses, patients may lose their appetite and become so tired they have a hard time eating. They may become very thin and poorly nourished and be less able to fight off disease. They may need to limit salt in their diet to prevent their body from putting fluid into their legs and abdomen.
• Other medical conditions and diet
People who have other medical conditions may need other specific changes in their diet. Conditions that warrant specific dietary restrictions include high blood pressure, heart disease, diabetes mellitus, high cholesterol, celiac sprue or chronic kidney disease.

EATING TIPS
People with hepatitis C don’t need to follow a special “hepatitis C diet.” The advice that an average, healthy person gets will work just as well for people with hepatitis C, unless those people also have cirrhosis or another condition, such as diabetes, HIV, or kidney disease.
General dietary advice:
• Eat regular, balanced meals
• Maintain healthy calorie intake
• Eat whole-grain cereals, breads, and grains
• Eat lots of fruits and vegetables
• Get adequate protein
• Go easy on fatty, salty, and sugary foods
• Drink enough fluids
• Reach and maintain a healthy weight
Cautions:
• Avoid alcohol
• Be careful with dietary supplements
Herbal products
Just because something is “natural” doesn’t mean it is harmless. Certain herbs, including Kava-Kava and pennyroyal, can cause liver damage.
Endeavour to always talk to your doctor before taking megavitamin therapy, herbal products, or any other dietary supplement. Remember, your first concern should be safety.
SOURCE: https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342052/all/Viral_Hepatitis
https://www.hepatitis.va.gov/hcv/patient/diet/single-page.asp#:~:text=If%20you%20have%20hepatitis%2C%20you,is%20all%20that%20is%20needed.&text=As%20liver%20disease%20progresses%2C%20patients,have%20a%20hard%20time%20eating.

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Diet Therapy of Diseases

Non Alcoholic Fatty Liver Disease: What you need to know

Your liver  is your largest internal organ which is responsible for digestion, detoxification, and storage of energy. 

A very little infection could lead to its damage if not treated properly. 

The term ‘liver disease’ is a compendium of many different conditions including hepatitis, liver cancer, fatty liver disease and genetic conditions like hemochromatosis. Let’s delve a little bit into a disease that could be curbed nutritionally, especially one that affects about 25% of the world’s population (Non alcoholic fatty liver disease (NAFLD)

What is NAFLD & NASH?

Non-alcoholic fatty liver disease (NAFLD) is a condition in which fat is inappropriately stored in the cells of the liver. As the name implies, this particular type of fatty liver disease occurs in people who drink little/no alcohol – while there is also fatty liver that can result from excessive alcohol consumption. Often times, it’s not stereotypical, you may drink moderately, as well as have nutrition and lifestyle habits which can still  contribute to fatty liver disease. Regardless of the cause, lifestyle changes are typically the first intervention.

If left undiagnosed or untreated, having NAFLD could also increase a person’s risk of developing a more advanced form of liver disease, called non-alcoholic steatohepatitis (NASH). 30% of those with NAFLD progress to developing NASH. So, what’s the difference? In NAFLD, there are fatty deposits throughout the liver, but little to no inflammation or liver cell damage. 

NASH on the other hand, is a form of NAFLD and is characterized by fatty deposits in the liver PLUS inflammation and liver cell damage, fibrosis (hardening of the liver) and can even lead to permanent scarring in the liver, called cirrhosis. In other words, it is more permanent and irreversible than normal NAFLD – but can still be managed with lifestyle, diet, and/or medications.

Why would someone who doesn’t consume excess alcohol still have fat deposits around their liver? There are a few risk factors that are associated with developing NAFLD and NASH including:

  • Having characteristics of metabolic syndrome – this includes factors such as high blood pressure, high cholesterol, diabetes mellitus or insulin resistance, and large waist circumference
  • Rapid weight loss may be due to a previous illness or stringent eating patterns 
  • Obesity
  • Excessive intake of energy, in particular fat and sugar, and overall lack of balance in the diet
  • Genetic risk factors

SYMPTOMS OF NAFLD?

One of the most challenging aspects of NAFLD and NASH is that they could be asymptomatic, particularly in the early stages in which many people get little to no symptoms at all. If individuals do present with symptoms, they generally experience one or more of the following things:

  • Pain/discomfort in the upper right abdomen (where the liver is located)
  • Fatigue
  • Unexplained weight loss
  • General feeling of unwell

“In the more extreme cases, where liver cirrhosis and scar tissue develop, people may experience fluid buildup called edema or ascites, and yellowing of the skin and eyes called jaundice”. However, this is unlikely to occur in the beginning stages of NAFLD and NASH.

“Because this condition is difficult to detect with physical symptoms, it is key to manage your health by seeing your doctor regularly and having routine blood work – usually annually or every couple of years unless you are at higher risk. This is especially important for anyone with a personal history or family history of liver issues, diabetes mellitus (particularly type 2), or any of the other risk factors listed above”.

How is NAFLD diagnosed?

Doctors use routine medical check-ups in detecting liver disease, which can involve physical examination, blood work, and imaging tests. In many cases, the first signs of NAFLD pop up in blood tests. Doctors will commonly include a check for liver enzyme levels including alanine aminotransferase (ALT) and aspartate aminotransferase (AST). If these are elevated, your doctor may want to investigate fatty liver disease.

Other tests for diagnosing NAFLD & NASH include imaging tests such as abdominal ultrasounds, fibro scans, and CT scans to view the liver and detect fatty tissue. 

A combination of blood tests and imaging is typically enough to determine if someone has NAFLD, but your healthcare team may decide to do additional testing to identify the severity of your condition such as a liver biopsy or additional blood testing.

ARE THERE TREATMENT OPTIONS?

You have realized that drinking alcohol In moderation doesn’t stop you from developing NAFLD, so it’s wise to watch your lifestyle patterns to avoid developing this disease. Poorly managed fatty liver disease can ultimately lead to cirrhosis and increased risk of liver cancer. 

Treatment of NAFLD involves a combination of lifestyle and medication management, although some people might not require pharmacotherapy to improve their liver function.

IS THERE NEED TO LOSE WEIGHT IF I HAVE NAFLD?

A vast majority of the recommendations that exist regarding nutrition for NAFLD are focused on reducing overall weight as a means for improving liver biomarkers. However, a systematic review from 2003 revealed that a vast majority of the studies that analyzed the connection between weight reduction and NAFLD had flawed methods, making it difficult to truly connect the dots between weight loss and NAFLD, predominantly because weight loss if often not permanent, and weight cycling appears to be a possible risk factor for worsening NAFLD and progression to NASH or cirrhosis.

As earlier stated, weight loss especially if rapidly chased, could lead to development and worsening of NAFLD . Pursuing weight loss does not always mean someone is healthy! If weight loss must be involved, it should be realistic and sustainable and not some type of “crash diet” lose 30kg in 3 weeks” type of diet. 

DIETARY MANAGEMENT 

There is no standard “NAFLD diet”, but there are some key dietary concepts that are linked to better outcomes in those with non-alcoholic fatty liver which includes :

  • Reducing saturated fat intake – saturated fat is primarily found in animal products, particularly beef, pork, creamy sauces, cheese, and other high fat dairy. It is also in coconut and palm oil.
  • Reducing intake of simple carbohydrates, especially fructose – high consumption of simple sugars such as those found in pop, juice, baked goods, candy and highly processed grains can contribute to excess fat being deposited in the liver. Avoiding these foods is recommended. Enjoy these foods occasionally and continue to eat natural sugars from fruits, vegetables, and dairy.
  • Increasing consumption of unsaturated fats such as omega-3s – Omega-3 fatty acids have been shown to help with reducing inflammation and fat synthesis in the liver. Foods high in omega-3 fatty acids include fish (particularly salmon, trout, tuna, mackerel & sardines), nut, seeds, plant oils and fortified foods like omega-3 eggs.
  • Increasing fibre consumption – getting enough fibre in the diet can actually help to reduce the amount of fat we uptake into our bloodstream and carry to the liver. Fibre, particularly soluble fibre, binds to fat in the digestive track and helps us to do away with it naturally.  Yes sure- we poop it right out! Fibre also plays a key role in regulating blood sugars and gut health, both factors implicated in the development of NAFLD.
  • Reducing or eliminating alcohol intake – like mentioned earlier, we often see those with moderate alcohol intake diagnosed with NAFLD. Alcohol is very hard on the liver, so reducing intake or entirely cutting it out  is helpful.
  • Exercise – staying active always is a key component of reducing fat deposits in the liver. If you think the gym is a scary place, then you can try dancing.

THINK MEDITERRANEAN! 

To be on a safer path, following a Mediterranean-style eating plan with an emphasis on lots of plant-based foods (veggies, fruit, and whole grains) ,leaner cuts of meat like chicken, turkey, and fish. Alongside this, consuming 1-2 meatless meals that include pulses like beans, chickpeas, and lentils is a great way of displacing intake of foods higher in saturated fat, plus an excellent source of fibre which might range from fleshy fruits with pulps or leafy vegetables.

Working with a dietitian is also highly recommended if you have NAFLD, as each case is very unique and should be individualized.

Medications

“There are numerous drugs that have been studied for NAFLD – almost too many to count! Generally speaking, medications used for the treatment of NAFLD mainly target the underlying cause (or suspected cause) of NAFLD”. In particular, medications that aid in cholesterol reduction and blood sugar management are a mainstay of care for NAFLD. 

SUMMARY

If you have been recently  diagnosed with NAFLD, working with a dietitian to incorporate a balanced diet that will help to reduce fatty deposits in your liver is highly recommended!

Many health professionals would  encourage weight loss to treat NAFLD. While this might sound appropriate, please remember that weight loss without a focus on sustainable behaviours and long-term health can actually worsen NAFLD, particularly rapid weight loss. 

 

Sources: https://ignitenutrition.ca/blog/non-alcoholic-fatty-liver-disease-what-you-should-know/?utm_source=dlvr.it&utm_medium=twitter

 

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Diet Therapy of DiseasesUncategorized

GASTROPARESIS

GASTROPARESIS

As a saying goes thus : “ to eat is human, to digest is divine; a number of people find it difficult to utilize their digestive tracts after enjoying a sumptuous meal. Really, it’s saddening to be afraid to eat that very delicious meal because you know you would probably be bloated or even constipated. So, what to do? 

Let’s take a look at this exciting digestive disorder called gastroparesis, shall we?

Gastroparesis (abbreviated as GP) represents a clinical syndrome characterized by sluggish emptying of solid food (and more rarely, liquid nutrients) from the stomach, which causes persistent digestive symptoms especially nausea and primarily affects young to middle-aged women, but is also known to affect younger children and males.

It’s thought to be the result of a problem with the nerves (vagus) and muscles that control how the stomach empties.

Sadly, If these nerves are damaged, the muscles of your stomach might become dysfunctional and the motility of food can slow down.

“While delayed emptying of the stomach is the clinical feature of gastroparesis, the relationship between the degree of delay in emptying and the intensity of digestive symptoms does not always match”. For instance, some diabetics may exhibit pronounced gastric stasis yet suffer very little from the classical gastroparetic symptoms of: nausea, vomiting, reflux, abdominal pain, bloating, fullness, and loss of appetite. “Rather, erratic blood-glucose control and life-threatening hypoglycemic episodes may be the only indication of diabetic gastroparesis. In another subset of patients (diabetic and non-diabetic) who suffer from disabling nausea that is to the degree that their ability to eat, sleep or carry out activities of daily living is disrupted gastric emptying may be normal, near normal, or intermittently delayed”. In such cases, a gastric neuro-electrical dysfunction, or gastric dysrhythmia (commonly found associated with gastroparesis syndrome), may be at fault.

 

DIABETES AND GASTROPARESIS 

Over time, diabetes can affect many parts of your body (especially nerves). One of those is the vagus nerve, which controls how quickly your stomach empties. “When it’s damaged, your digestion slows down and food stays in your body longer than it should”.

Although it’s more common in people with type 1 diabetes, people with type 2 can also get it.

 

From a study carried out by Phillips LK et al., 2015 : 

Glucose and gastric emptying: bidirectional relationship. The rate of gastric emptying is a critical determinant of postprandial glycemia. Glucose entry into the small intestine induces a feedback loop via CCK, peptide YY (PYY) and glucagon-like peptide 1 (GLP-1), which are secreted from the intestine in response to nutrient exposure. GLP-1 and gastric inhibitory polypeptide (GIP) induce the release of insulin, and GLP-1 inhibits glucagon secretion, which attenuates postprandial glycemic excursions. Amylin, which is co-secreted with insulin, also slows gastric emptying. At the same time, the blood glucose concentration modulates gastric emptying, such that acute elevations of blood glucose levels slow gastric emptying (effects are evident even within the physiological range) and emptying is accelerated during hypoglycemia.

 

DIAGNOSIS 

Diagnosis of gastroparesis begins with a doctor asking about symptoms and past medical and health experiences (history), and then performing a physical exam. Any medications that are being taken need to be disclosed.

Tests will likely be performed as part of the examination. These help to identify or rule out other conditions that might be causing symptoms. Tests also check for anything that may be blocking or obstructing stomach emptying. Examples of these tests include:

  • a blood test,
  • an upper endoscopy, which uses a flexible scope to look into the stomach,
  • an upper GI series that looks at the stomach on an x-ray, or
  • an ultrasound, which uses sound waves that create images to look for disease in the pancreas or gallbladder that may be causing symptoms.

 

SYMPTOMS 

The digestive symptom profile of nausea, vomiting, abdominal pain, reflux, bloating, early satiety, and anorexia can vary in patients both in combination and severity.

Others may include weight loss/weight gain, constipation and/or diarrhea, wide glycemic fluctuations in diabetics, belching and bloating-again, developing soon after meal ingestion and lasting for hours-along with visible abdominal distention. The distention and bloating may push up against the diaphragm making breathing uncomfortable.

“A poorly emptying stomach additionally predisposes patients to regurgitation of solid food, as well as gastroesophageal reflux disease (GERD)”. The reflux may range from mild through to severe. GERD complications can create esophageal spasm (also called non-cardiac chest pain) and can add to the burden of chronic pain. In severe cases, reflux aspiration pneumonitis compounds the clinical picture.

 

CAUSES

Reports from one tertiary referral center found that out of their 146 patients with gastroparesis: 36% were idiopathic (unknown causes), 29% were diabetic, 13% were post-surgical, 7.5% had Parkinson’s disease and 4.8% had collagen diseases. Any disease of metabolic, neurological (psychiatric, brainstem, autonomic including sympathetic and parasympathetic or enteric), or connective tissue (autoimmune) origin has the potential to disrupt gastric neural circuitry.

Apparently, diabetes is the most common known cause of gastroparesis. It can damage nerves — including the vagus nerve, which regulates your digestive system — and certain cells in your stomach.

Other causes of gastroparesis include:

Related Disorders

A stomach motor disturbance known as “dumping syndrome” whereby food or liquids empty too quickly from the stomach can present with similar symptoms as are found in gastroparesis. Other disorders that may clinically present as gastroparesis (gastritis, gastric ulcers, pyloric stenosis, celiac disease, and GI obstructions) need to be ruled out.

 

TREATMENT 

You may find these tips helpful:

  • instead of 3 meals a day, try smaller, more frequent meals – this means there’s less food in your stomach and it will be easier to pass through your system
  • try soft and liquid foods, or even semi solid foods which are easier to digest. In severe cases, broths might be advisable. 
  • Masticate well before swallowing ( i tried to check how long it’ll take to carefully grind a spoon of rice and i got 21seconds; you should try eating slowly. winks).
  • drink non-fizzy liquids with each meal

It may also help to avoid certain foods that are hard to digest, such as apples with their skin on or high-fibre foods like oranges and broccoli, plus foods that are high in fat, which can also slow down digestion.

 

MEDICATIONS 

Use of drugs like domperidone, erythromycin, anti-emetics. Also note that these drugs might have side effects so it’s important to discuss with your doctor before using them. 

Domperidone should only be taken at the lowest effective dose for the shortest possible time because of the small risk of potentially serious heart-related side effects.

Other options like electric stimulation, botulinum toxin injections, a feeding tube, surgery

 

FOOTNOTE FOR DIABETICS

The nerves to the stomach can be damaged by high levels of blood glucose, so it’s important to keep your blood glucose levels under control if you have diabetes.

Your doctor alongside a dietitian can advise you about any changes you may need to make to your diet or medicine. For example, if you’re taking insulin, you may need to divide your dose before and after meals and inject insulin into areas where absorption is typically slower, such as into your thigh.

 

SOURCES: https://www.nhs.uk/conditions/gastroparesis/

https://rarediseases.org/rare-diseases/gastroparesis/

https://aboutgastroparesis.org/signs-symptoms.html/diagnosis-tests.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028327/

https://www.webmd.com/diabetes/type-1-diabetes-guide/diabetes-and-gastroparesis#1

 

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Diet Therapy of Diseases

ACHALASIA: CAUSES, SYMPTOMS AND TREATMENTS

Achalasia is a rare disorder of the food pipe (oesophagus), which can make it difficult to swallow food and drink.

Normally, the muscles of the oesophagus contract to squeeze food along towards the stomach. A ring of muscle at the end of the food pipe then relaxes to let food into the stomach.

The upper esophageal sphincter is a muscular valve that is located at the upper portion of the esophagus, which is typically about 8 inches long.

Unlike the lower esophageal sphincter (LES), which opens and closes without our conscious effort, the upper esophageal sphincter is under our conscious control. We can control when it opens. For example, we can open the upper esophageal sphincter by swallowing foods or liquids.​

In achalasia however, there is a failure of organized esophageal peristalsis causing impaired relaxation of the lower esophageal sphincter, and resulting in food stasis and often marked dilatation of the esophagus

Obstruction of the distal esophagus from other non-functional etiologies, notably malignancy, may have a similar presentation and have been termed “secondary achalasia” or “pseudoachalasia“.

SYMPTOMS 

Patients may present with: 

  • dysphagia for both solids and liquids: this is in contradistinction to dysphagia for solids only in cases of esophageal carcinoma 
  • chest pain/discomfort
  • eventual regurgitation
  • drooling of vomit or saliva
  • gradual but significant weight loss

CAUSES

Almost thought to be familial, but is also thought to happen when the nerves in the oesophagus become damaged and stop working properly, which is why the muscles and ring of muscle don’t work. It could also be as a result of the body’s immune system attacking healthy cells (autoimmune condition).

PATHOLOGY

“Peristalsis in the distal smooth muscle segment of the esophagus may be lost due to an abnormality of the” Auerbach plexus” (responsible for smooth muscle relaxation), resulting in weak, uncoordinated contractions that are non-propulsive”. The abnormality may also occur in the vagus nerve or its dorsal motor nucleus.

The lower esophageal sphincter eventually fails to relax, either partially or completely, with elevated pressures demonstrated manometrically . Early in the course of achalasia, the lower esophageal sphincter tone may be normal or changes may be subtle.

 

TREATMENT OPTIONS 

MEDICATION: Medicines like nitrates or nifedipine can help relax the muscles in your oesophagus and make swallowing less painful and difficult.

Botox injection and balloon dilation could also be useful.

 

DIETARY MANAGEMENT 

The management of the patient with achalasia and nutritional problems is very similar to that of patients with dysphagia due to neurologic disease or esophagogastric cancer. Oral feeding has relevant psychosocial significance to patients and their families, and should be continued whenever possible. In some patients, oral intake is often not adequate even in the absence of significant swallowing difficulties. In mild to moderate achalasia, nutrition is generally mildly affected and, if the family encourages the patient to follow dietary modifications, loss of weight and malnutrition rarely occurs.

Dysphagia diets should be highly individualized, including modification of food texture or fluid viscosity. Food may be chopped, minced, or puréed, and fluids may be thickened.

If a patient is unable to eat or drink or to consume sufficient quantities of food, or the risk of pulmonary aspiration is high, tube feeding should be provided. If there is a possibility for surgical myotomy, enteral nutrition via a nasal feeding tube will be adequate as a provisional measure, considering that a malnourished patient is always at major risk for postoperative complications.

 

SOURCES : https://www.nhs.uk/conditions/achalasia/

https://radiopaedia.org/articles/achalasia

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108680/

 

 

 

 

 

 

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Diet Therapy of Diseases

Gastroenteritis: All You Need to Know

Gastroenteritis is an inflammation/irritation of the gastrointestinal tract (the pathway responsible for digestion that includes the mouth, oesophagus, stomach, and intestines). Gastroenteritis is majorly caused by a viral or bacterial infection and not an influenza.
Who is at risk for gastroenteritis?
Anyone can get the disease. People who are at a higher risk include:
• Children in day-care
• Students living in dormitories
• Military personnel
• Travellers
People with immune systems that are weakened by disease or medications or not fully developed (i.e., infants) are usually affected most severely
What causes gastroenteritis?
As stated earlier, gastroenteritis can be caused by viral, bacterial, or parasitic infections. Viral gastroenteritis is contagious and is responsible for the majority of outbreaks in developed countries.
Common routes of infection include:
• Food (especially seafood)
• Contaminated water
• Contact with an infected person
• Unwashed hands
• Dirty utensils
In less developed countries, gastroenteritis is more often spread through contaminated food or water.
Actually, the most common cause of gastroenteritis is a virus. Many types of viruses can be responsible for the flu but the main types are rotavirus and norovirus.
Also, often times, bacteria such as E.coli and salmonella can also trigger the stomach flu.
Another bacteria, shigela, is often passed from one child to another in day-care centres; especially through contaminated food and water.
Another way to contact gastroenteritis is through parasite (very rare and uncommon) as giardia. You can pick them up from contaminated swimming pools.
Other unusual ways to get gastroenteritis are:
1. Heavy metals (arsenic, cadmium, lead, or mercury) in drinking water.
2. Eating a lot of acidic foods like citrus foods and tomatoes.
3. Medications such as antibiotics, antacids, laxatives, and chemotherapy drugs.
What are the symptoms of gastroenteritis?
The main symptom of gastroenteritis is diarrhea. When the colon (large intestine) becomes infected during gastroenteritis, it loses its ability to retain fluids, which causes the person’s faeces to become loose or watery. Other symptoms include:
• Abdominal pain or cramping
• Nausea
• Vomiting
• Fever
• Poor feeding (in infants)
• Unintentional weight loss (may be a sign of dehydration)
• Excessive sweating
• Clammy skin
• Muscle pain or joint stiffness
• Incontinence (loss of stool control)
Because of the symptoms of vomiting and diarrhea, people who have gastroenteritis can become dehydrated quickly. It is very important to watch for signs of dehydration, which include:
• Extreme thirst
• Urine that is darker in color, or less in amount
• Dry skin
• Dry mouth
• Sunken cheeks or eyes
• In infants, dry diapers (for more than 4-6 hours)

  1. Management of Gastroenteritis
    There are three ways to manage the stomach flu which are:
    • Palliative method
    • Medications
    • Dietary approach.
    palliative method:  involves fluid replacement, oral rehydration therapy, intravenous therapy.
    medications like antibiotics and antidiarrheal drugs are administered during gastroenteritis. Examples are loperamide hydrochloride, acetaminophen, zinc supplements
    Dietary approaches involves some restrictions like staying off tea and caffeine, staying of hot and spicy foods (bland diet), dairy foods, sugar, soda, gluten, artificial sweeteners. Some research suggests that the BRAT diet (banana, rice, applesauce and toast), could help in treating the stomach flu. Taking of probiotics (plain unsweetened yoghurt).
    Conclusion
    It is important to practise good hygiene in order to stay away from stomach flu; food safety is also of the essence. Make it a habit to always wash fruits and vegetables thoroughly before eating them, make sure you boil meats and other animal products very well before consumption, wash your hands during preparation of meals and after using the toilet.

Sources: https://my.clevelandclinic.org/health/diseases/12418-gastroenteritis
https://Medicinenet.com/stomachflu

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Diet Therapy of DiseasesGeneral Research

LOW CARB DIET AND DIARRHEA

Lowering your carb intake might give you an edge on weight loss — at least in the beginning. But first, you have to get over the hurdles that such a big diet change can throw in your path. Low-carb diet side effects, including diarrhea, can be bothersome as your body adapts to the diet.

DIET CHANGES AND DIGESTION

Once you make a change to your eating habits BOOM! you risk disrupting your digestive system’s homeostasis — or balance. Taking away foods and nutrients your body is used to relying on or adding new ones can throw your gastrointestinal, or GI, system into a dilemma  — and it may let you know in more ways than one 😁.

Suddenly cutting your carb intake is bound to have at least some effect on your digestion. It may improve your digestion if you used to eat a lot of refined grains and sugary junk foods or if you’re one of those people who are sensitive or intolerant to certain types of carbs.

If that’s not you, then rest assured you are not alone. Most people who cut carbs experience some low-carb diet side effects — and those who cut carbs drastically experience more.

A common result of eating fewer carbs is constipation. Carbs are a rich source of dietary fiber, which adds bulk to stool and softens it so it’s easier to pass. Eating less fiber will have the opposite effect. Diarrhea is also a common side effect of low-carb diets. This is likely due to the foods you have added to your diet to replace the carbs you have cut.

KETO DIARRHOEA FROM FAT INTAKE.

The ketogenic diet is an extreme low-carb diet that cuts carbs to a maximum of 50 grams daily, but often much less than that. In addition, fat intake is increased to as much as 90 percent of calories. That is a whole lot of fat for your digestive system to have to deal with suddenly.

Even in normal amounts, fat is harder for the body to digest than protein, starches or sugars. Of the three macronutrients, fat takes the longest to digest, which can put more stress on your GI system and cause diarrhea, gas, bloating and other uncomfortable symptoms. People with digestive disorders are often encouraged to lower their fat intake because of this.

A high-fat diet can probably disrupt the microbiome — the population of beneficial bacteria in your gut that regulates digestive health. This is especially true of increased ingestion of saturated fats from meat and dairy products. Also, a  link between high fat intake and digestive disorders such as Crohn’s disease and ulcerative colitis exists.

Last, some people have more trouble than others digesting fat. When your body can’t digest and absorb fats normally, they are broken down in the colon into fatty acids. This causes the colon to secrete fluids, which can trigger diarrhea.

PROBLEMS WITH PROTEIN AND DAIRY

An increase in protein can also cause digestive disruptions for some people. The keto diet keeps protein intake at a moderate levels, about 35%.

However, if you are choosing to follow a low-carb, high protein and low- to moderate-fat diet, rather than a high-fat keto diet, a large increase in protein can be problematic, causing either constipation on diarrhea. Like fat, protein is also harder for the body to digest; it has to work harder to break down the macronutrient into its constituent amino acids.

A high-protein or high-fat diet may also include increased amounts of dairy. For people who have trouble digesting the milk sugar lactose, this can cause a host of problems, including diarrhea. Using a protein supplement can be a good way to boost your protein intake; however, you may be sensitive to some types of protein more than others. Whey protein is a common culprit because it contains lactose.

EFFECTS OF SUGAR SUBSTITUTES

Having a sweet tooth on a low-carb diet can be excruciating. This causes many people to turn to sugar substitutes, such as erythritol, xylitol, sucralose and stevia. These sweeteners have no calories and no effect on blood sugar, and many people go overboard because of this.

Some may find sugar substitutes cause no problems — whether or not they are actually good for them is another story. For other people, these sweeteners can have a laxative effect, especially when consumed in large amounts. This can leave you running for the bathroom right after indulging in your favorite treat, which isn’t so sweet.😂🤣

IS IT JUST TEMPORARY?

The good news is that diarrhea and other low-carb diet side effects are often fleeting. They may last for a week or so while your body adjusts to the change. After that, you may find that your digestive system normalizes. But whenever you are making a diet change, it helps to do so gradually, so your body can take more time to adjust. This may prevent low-carb diet diarrhea altogether.

In other cases, for example, for those who are lactose intolerant, the diarrhea may persist. If you find that your new diet continues to cause digestive problems, it just may not be a good fit for you. Diarrhea that lasts longer than a few days is not only uncomfortable, but can also lead to dehydration and nutrient malabsorption. In this case, it’s best to go back to your regular diet immediately and check in with your doctor

You should consult a registered dietitian whenever you consider going through with this type of diets if you must. Cutting out a particular food group from your diet isnt too healthy, so you probably shouldn’t.

SOURCES:

Fields H, et al. Are low-carbohydrate diets safe and effective? Journal of the American Osteopathic Association. 2016;116:788.

Sackner-Bernstein J, et al. Dietary intervention for overweight and obese adults: Comparison of low-carbohydrate and low-fat diets. PLOS One. 2015;10:1.

Raynor HA, et al. Position of the Academy of Nutrition and Dietetics: Interventions for the treatment of overweight and obesity in adults. Journal of the Academy of Nutrition and Dietetics. 2016;116:129.

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Diet Therapy of Diseases

IRRITABLE BOWEL SYNDROME

Irritable bowel syndrome is a disorder of the large intestine that causes abdominal pain, excess wind, diarrhoea, mucus in stool, constipation and irregular bowel habits to the individual. Well, the cause is really not know, but once you see these symptoms, then you might just have IBS. It could aslo be called ‘spastic colitis, mucuous colitis or nervous colon. IBS is chronic and long term, so you might just have to live with it and manage it for a long period of time😢😟.
FACTS ABOUT IBS
🍅 it wont lead to cancer.
🍆 Though it causes discomfort, it doesnt really lead to severe or serious complications.
🌽 reduced alcohol intake can help in managing IBS
🍍excluding foods that can cause gas e.g onions, cucumber e.t.c can help reduce symptoms
🍞 dietary and emotional factors play major roles in IBS😁.
🍒 No cure yet, but it can be managed effieciently.
Most times, signs and symptoms vary among individuals and they tend to resemble signs in other disease conditions. Examples are :
1. Polyuria (frequent urination)
2. Halitosis or bad breathe
3. Joint pains
4. Pain with sex for females or sexual dysfunction
5. Irregular menses.
CAUSES? 🤔🤔🤔
Eerrmm, it is not really know what could lead to this gastrointestinal discomfort, but some factors that could be implicared are:
🌽Diet.
🍆Environmental factors, such as stress.
🌷Genetic factors.
🍋Hormones.
🍅Digestive organs being excessively sensitive to pain.
🍌A malfunction in the muscles used to move food through the body.
🍞An inability of the central nervous system (CNS) to control the digestive system properly.
🍓Hormonal changes can make symptoms worse especially for women during their menstrual cycle.
🌰Infections, such as gastroenteritis, can trigger post-infectious IBS also, just to mention but a few.

MEDICATION:
The following medications are basically used for IBS symptoms:
🍉Antispasmodic medications reduce abdominal cramping and pain by relaxing the muscles in the gut.
🍋Antimotility medications for diarrhea include loperamide, which slows down the contractions of the intestinal muscles.
🥕Tricyclic antidepressant (TCAs) often help to reduce abdominal pain and cramping.
🍒Alosetron (Lotronex) for severe diarrhea-predominant IBS in women also works well.

DIET AND TREATMENT:
Following a low FODMAP diet would be a good dietary approach to managing IBS. FODMAP is an acronym that connotes : Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And polyols.
They include short chain oligo-saccharide polymers of fructose (fructans) and galactooligosaccharides (stachyose, raffinose), disaccharides (lactose), monosaccharides (fructose), and sugar alcohols (polyols), such as sorbitol, mannitol, xylitol and maltitol. Examples of foods to avoid and foods to add to your diet are:

DIAGNOSIS:
Majorly, symptoms are used to diagnose the type of IBS present in an individual.
1.IBS-C : IBS with just constipation.
2.IBS- D: IBS with diarrhoea
3. IBS-A : IBS with alternating stool pattern.

RISK FACTORS:
The major factors to be considered are
1. Gender: it affects majorly women
2. Younger adults; people below ages 40, mostly from 20-30.
3. Environment
4. Family history: if a relative had IBS, you might be likely to have it too.
Be really mindful of your diet and stress levels to reduce episodes😁😊.

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Diet Therapy of DiseasesGeneral Research

NUTRITION AND CANCER

DIETARY GUIDELINES

NUTRITION AND CANCER
Cancer is simply termed ‘growth of unhealthy tissues (malignant) which results from abnormal or uncontrolled cell division.
Cancer occurs in all parts of the human body and has the ability to spread across (metastasize) to another region in the body.
Carcinogens are possible factors that when exposed to, can cause or promote cancer. There are both environmental and dietary factors that could be carcinogenic in nature.
Exposure to certain factors like radiation, sunlight, toxic substances from creams , and smoking could lead to cancer.
DIETARY FACTORS THAT COULD LEAD TO OBESITY
1. Abuse of alcohol could lead to mouth, throat and liver cancer.🍺🍻
2. High intakes of smoke or salt preserved foods, refined flour or starch, and processed meat🍗 could lead to stomach cancer.
3. High intake of saturated fats, red meat, and supplemental iron with reduced intake of fibre could lead to colorectal cancer. 🍖
4. Folate deficiency and low intake of dark green leafy vegetables could lead to cervical cancer.
Fruits and vegetables don’t have the ability to cure cancer but adequate consumption of them could help prevent the development of cancer. For example, the cruciferous vegetables – cabbage, cauliflower, broccoli contain phytochemical that could be beneficial in defending against colon cancer.
Maintaining a healthy body weight could also help to reduce risks of cancer in both genders👬. Obese postmenopausal women are at the risk of developing breast cancer because fat tissues produces oestrogen and extended exposure of this oestrogen in obese postmenopausal women is linked to an increased risk of developing breast cancer.
DIETARY RECOMMENDATIONS FOR REDUCING CANCER RISKS
1. Maintain a healthy body weight by eating small portions of foods, balancing energy intake with physical activities and choosing healthy fats
2. Eat at least 5 servings of fruits and vegetables daily.
3. Choose lean meats, fish and poultry as alternatives to pork and processed meats as hot dogs and sausages.
4. If you must take alcohol, limit it to 2 drinks per day.
5. Choose whole grains like oats, whole wheat bread instead of pastries and breakfast cereals.

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Diet Therapy of Diseases

CAUSES OF GALLSTONES

The craze to lose weight now is really becoming a social menace and a means to distort money from people. Everyone seems to be a weight loss expert because they tried one funny way and it worked out well for them which might be risky to your health.
Lets take a little journey on gallstones shall we?

Gallstones are not stones per se 😁, but are pieces of solid materials that form in the gall bladder, a small organ located under the liver. This stones tend to block the bile duct supplying bile. Bile is produced by animals to help digest fats. You know that blackish green stuff? When it bursts in chicken, it spoils the taste? Thats bile. When there is lot of cholesterol in Bile, lots of calcium, it could lead to production of these gallstones which would need immediate treatment or surgery. Major problems that could lead to gallstones?
🍏Obesity: your body tends to produce more cholesterol when you are heavily endowed😁.
🍑Rapid weight loss: all of you doing ‘lose 20kg in 2weeks, while doing this, your livers are at high risk of producing extra cholesterol during that period.
🍹Too much intake of birth control pills which tend to boost production of cholesterol.
🌶 too much fasting: uncle/aunty intermittent fasting. During this period, your gall bladder doesnt squeeze effectively as they should. You are at risk too. Please be mindful of the junks you pick off the internet😁.

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Diet Therapy of DiseasesLifeStyle

MISCONCEPTIONS ABOUT WEIGHT LOSS

Beauty they say is in the eye of the beholder. The main crux will be what will be the yard stick to define something as beautiful and as the entire opposite. A big question I must say and it becomes me to answer. Kindly hit the brakes and allow me a soft landing by enjoying this piece. It is always an uphill task writing about sizes of humans because no one takes it likely when you touch their self esteem at wrong spots which may deflate their ego. We are all beautiful in our ways. The world is blessed with the short, tall, skinny, or plus size. No matter what dice life throws at you or what ever faculty you find yourself, remember you are your beautiful. As long as it does not in any way affect your health status then rock your style with a bounce under your feet. The BMI is (Dietitian define)… Talk about the balance of how your size must align with your height. If you fall into the class of unhealthy BMI ( >27kgm sq.), then it is advised you shed some weight. If you must do so, do it beautiful… Misconceptions about weight loss

1. DETOX TEA HELPS TO LOSE WEIGHT The whole idea of DETOX is actually very funny. The body has a well developed system that has its own built-in mechanism to detoxify and remove waste and toxins. The body’s main organs of detoxification are the kidney, skin, lungs and gut. Our body constantly filters out, breaks down and excretes toxins and wasted products like alcohol, medications, products of digestion, dead cells, chemicals from pollution and bacteria.

2. YOU CAN LOSE 5KG IN ONE WEEK: You didn’t gain that fat in one day, so it’s not healthy if you go so drastic in losing it. Ideally, you should lose 0.5kg -1kg per week. You can achieve this by a deficit of 3,500 kilocalories per week from your diet.

 

3. INTERMITTENT FASTING: When you fast, you tend to reduce rapidly due to the heavy restriction on intake of energy (calories). But this weight loss is largely water and glycogen (body’s carbohydrate stores), rather than fat. You tend to feel dizzy and fatigue during this fast, thereby leaving no energy for physical exercise.

4. KETOGENIC DIET: By doing this, you by pass the normal metabolic pathway thereby neglecting the body’s normal sources of energy (carbohydrates) and breaking down fats which leads to build up ketones (ketosis). Prolonged build up of this ketones leads to ketoacidosis which causes serious havoc for your internal organs. Ketogenesis is use on epileptic patients because they have more synaptic responses in their brains than normal humans. These responses are triggered by glucose, which is removed totally from the diet. The patient is closely monitored by a medical team.

5. Green tea would help you lose weight: 🤣😅. The major ingredients in most slimming tea is ‘senna’;a very strong laxative. Senna contains glycosides that stimulates digestive system. So how would you be stooling frequently and not lose weight? Healthy choice?🙄🙄.

There are lots more, but these aforementioned are more common in our society today.

*Your weight loss journey is not a death sentence, it rather should be enjoyed and should become a lifestyle.

*Weight loss regimes should not be rigid or full of restrictions.

*Take a new habit slowly, set goals for yourself.

* Get yourself a food diary and record your consumption and level of satiety per portion.

* Exercise is very important in weight loss regimens.

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