Means used to improve vitamin and mineral metabolism in patients with ulcerative colitis and Crohn's disease at the stage of rehabilitation. Diet therapy for protein deficiency in patients with inflammatory bowel diseases

How I recovered from UC.

Hi all. I'll tell you how I recovered from UC. Say "it's a sin to laugh at sick people." I don't laugh. I understand that it sounds like science fiction, but nevertheless everything turns out to be simple.

I’ll make a reservation right away that I’m not going to prove anything to anyone, I won’t convince and argue. I'll just tell my story. Let everyone decide for himself.

I got sick ten years ago. The doctor prescribed sulfasalazine, at first it helped. Two years later, he was hospitalized for the first time with an acute exacerbation.

Over the years, I tried to be treated with herbs, traditional healers, at the bioenergotherapist - everything is useless. I tried to starve, even dry - it helps, but not for long.

In the end, neither salofalk nor pentas helped, only hormones had an effect.

In 2010, I went to the hospital with a severe exacerbation, I thought I would die, I lay under droppers for 11 days, it did not help. I was preparing for death, and they took me to MONIKI for an operation. But suddenly I began to recover sharply, and the operation was canceled, and three weeks later I was already discharged from the hospital in remission. After that, every six months, he was consistently hospitalized with an exacerbation.

It's not for you to tell me about all the horrors of this disease, about the constant state of weakness and lethargy, about panic before the hopelessness of your situation.

In short, I was seriously puzzled by the cause of this disease. Why does the body attack itself? What does he lack? Why is this happening, what is the reason, because there is no smoke without fire.

At the end of last 2012, I accidentally decided to look on the Internet for what the acid-base balance of the body is. This information shocked me with its simplicity! Now I am convinced that medicine is a business. And any business is not interested in losing customers.

So, in a nutshell, what have I read about acid-base balance. Well, first of all, it turns out that 70% of human health depends on nutrition! And only 30% of everything else. There are two environments in the human body - acidic and alkaline. Each food product, assimilated, forms either an acidic or alkaline environment to a strong or weak degree.

The thing is that enzymes live and work in an acidic environment, and hormones, which are the rulers of all processes in the body, live and work in an alkaline environment.

If the balance is disturbed in the acidic direction, then the hormones cannot perform their functions, and the destruction of the body begins - the disease.

Why and deduce from an exacerbation by hormones.

The balance of the body consists of 75 - 80% of the alkaline environment, and only 20 - 25% of the acidic. This is the norm. You can figure out for yourself whether you get such a norm. alkaline foods It's just fruits and vegetables. Acidic - meat, sugar, white bread). Cereals are mostly slightly acidic or neutral. But pearl barley is slightly alkaline. Milk is alkalizing. But pasteurized milk is sour.

So, in summary: I gave up sugar, I gave up white bread and muffins, refused meat, and specifically got hooked on salads, fruits, barley porridge. Definitely lemon - strongly alkalizes, despite the fact that it is sour.

As a result, for half a year now I have not taken any medications, the well-being of a healthy person, stool 1-3 times a day. What is weakness lethargy I forgot. Never in the last 10 years have I felt so good. In short, long live life!

Good luck to all.

Last edited by Andrus at 22:21

My mom has had it for three or four years now. Maybe it was before, but she didn't know. It seems that there is an attending physician, she was on some foreign program for several years - they gave THEIR medicines for free. Now the program is over, he buys medicines in a pharmacy - again an exacerbation.

Mom is 58 years old, and she is going through this very hard, constantly on the verge of depression - often a depressed mood, talks about some kind of deadlines, etc.

When I was about to give birth, she told me that they say "I will see my granddaughter and you can die": 008: - although she still looks very good and no one will ever give her 58 years.

Maybe someone knows a proven doctor for this disease. there is little chance that there are people who know, but LV is big and has helped me out more than once.

How to cure ulcerative colitis with folk remedies

Non-specific ulcerative colitis causes inflammation of the colon, with the formation of multiple ulcers, bleeding, loose stools mixed with mucus. blood and pus. The disease causes a violation of absorption processes in the intestine, the patient loses a large number of protein and blood. disorganized in the body mineral metabolism, infection and intoxication develops.

Traditional medicine recipes

Cure diarrhea. accompanied by the release of blood, a decoction of the roots and rhizomes of the burnet will help. To prepare it, you need to take two tablespoons of crushed roots, pour an incomplete glass of hot, pre-boiled water and put it on for half an hour. water bath. Infuse for 10 minutes, after the cake squeeze, and dilute the resulting broth boiled water to the original volume. Take in a heated form, one tablespoon 5-6 times a day after meals. After two days, prepare a new decoction. According to the same recipe, an infusion of oak bark is prepared - it also helps to recover from ulcerative colitis.

During the period of relapse, it is useful to prepare and drink infusions from rose hips, bird cherry and blueberries. Four tablespoons of the fruits of one particular berry pour ½ liter of hot water, put in a water bath for a quarter of an hour. Cool, strain and take half a glass 2-3 times a day for half an hour before meals. This is with regard to astringent infusions - blueberries and bird cherry, and drink rosehip infusion after eating as vitamin remedy. A good source of B vitamins is a decoction of oats, which can also improve the function of the nervous system and restore intestinal motility. To prepare it, you need to pour one tablespoon of unpeeled grains into 1000 ml of warm water, leave it in a warm place for 4 hours, and then put the pan on the fire and boil for 1 hour. Strain, drink half a glass 3-4 times a day for half an hour before meals.

What other folk remedies can help

It is necessary to take perforated St. marsh cinquefoil. raspberry leaves and branches and a string in the ratio 5:3:2:2:2:1:1:1:1:1:1. Mix everything, pour one tablespoon of the mixture with ½ liter of boiling water, leave for half an hour and take ¼ cup every hour for two days. Then the dose is increased to ½ cup, which should be taken 3 times a day 20 minutes before meals and once before going to bed.

Cigarettes cure ulcerative colitis

23-year-old Stefan Pendry shocked doctors by saying that in just a week he got rid of ulcerative colitis by simply starting to smoke, writes The Daily Mail. Prior to that, he had to use the toilet 15 times a day. Now this problem does not exist, since the man smokes four cigarettes daily.

Doctors talked about the need for an operation. But the patient decided to go the other way. He was spurred on by research by Dr. Sean Kelly of the York Hospital on the effects of nicotine on colitis. According to Kelly himself, cigarettes helped two of the three patients he personally knew.

This assertion reinforces the following fact: colitis is often found in people who have recently quit smoking. Some experts believe that the positive effect is associated with nicotine. Therefore, the nicotine patch can be a better alternative to cigarettes.

Nonspecific ulcerative colitis

Nonspecific ulcerative colitis - chronic illness, which is based on the inflammatory process in the colon with pronounced destructive changes in the mucous membrane.

Risk factors for non-specific ulcerative colitis

Risk factors: genetic characteristics, hereditary predisposition, sensitization to various types of allergens, mental trauma.

Manifestations of nonspecific ulcerative colitis

Clinical features of nonspecific ulcerative colitis. The disease begins gradually with the appearance of blood impurities in the stool. Sometimes there is a lightning-fast onset with the rapid development of intoxication and diarrhea of ​​a muco-bloody nature. With a mild course of the disease, there is a small amount of blood in the feces in the form of separate clots or smears. The frequency of bowel movements during the day does not exceed 4. Often, after eating and before the act of defecation, there is a cramping pain in the abdomen, caused by a spasm of the inflamed colon.

In moderate colitis, the frequency of bowel movements is more than 5-6 times. As a result of significant blood loss, anemia develops with a decrease in hemoglobin levels. There is a decrease in appetite, weight loss.

In severe colitis, all patients have loose stools, the frequency of stools is 8-10 or more times a day. The amount of blood in feces significant. The act of defecation is accompanied by intense cramping pain in the abdomen. Appetite is sharply reduced, in most patients there is an increase in body temperature from subfebrile to high numbers. There is a sharp loss of body weight, a significant decrease in hemoglobin in the blood, an increase in ESR.

In severe colitis, complications are possible: bleeding, perforation of the intestine with the development of peritonitis.

Diagnosis of nonspecific ulcerative colitis

Diagnostics based clinical features, characteristic complaints patients, research peripheral blood, studies of feces for dysbacteriosis. Of the instrumental methods of examination, sigmoidoscopy, colonoscopy are used, which allow to determine the swelling of the intestinal wall, diffuse bleeding of the mucous membrane, superficial erosions and ulcers; morphological study of biopsy specimens from the edges of ulcerative defects allows you to determine the inflammatory process, more accurately establish the diagnosis. With the help of irrigoscopic examination, it is possible to establish the prevalence of the inflammatory process in the sections of the large intestine.

Treatment of nonspecific ulcerative colitis

Treatment. In the period of exacerbation of the disease, the patient must be provided with bed rest and mental rest. A diet with a decrease in carbohydrates, but an increase in protein is prescribed. The food is mashed, served warm, the frequency of meals is at least 5-6 times a day.

In connection with possible secondary mental disorders against the background of the disease, psychotherapy sessions are prescribed for patients.

The basis of the drugs used in this pathological process is the group of salazosulfapirin preparations. Correction of dysbiotic disorders is carried out, probiotics are prescribed, if necessary, enzymes, vitamins. In severe cases, hormone therapy is indicated. With the development of anemia, iron preparations are prescribed. Inefficiency conservative therapy and the development of complications are indications for surgical treatment.

Sources: kronportal.ru, 2006-2009.littleone.ru, www.kakprosto.ru, versii.com, medicalhandbook.ru

Chronic disease ulcerative colitis is associated with inflammatory processes localized in the rectum and colon. Mainly inflammation and dystrophic changes occur in the large intestine (in its mucous membrane). Colitis usually takes a long time, the acute form of the disease is caused by pathogens: salmonella, streptococci, staphylococci, often occurs as a response of the body to the penetration of toxins or allergens. As for ulcerative colitis, the causes of its occurrence have not been reliably established. And this is despite the fact that the disease is by no means rare and is observed in a fairly large number of people. Often, the treatment of ulcerative colitis with folk remedies becomes a way out of this situation.

Pathogenic microorganisms can destroy normal work intestines, in particular, the large intestine, and stagnation of the contents may occur. Other factors that impair the full functioning of the colon and provoke inflammation can be: infections in organs that are associated with the intestine ( gallbladder, pancreas, etc.); constant use indigestible food, alcoholic beverages, acute. In addition, frequent constipation can contribute to the accumulation of fecal matter that is not fully excreted, as it should be. Moreover, laxatives can only worsen the situation, as they irritate the intestinal mucosa. The disease can be triggered by the use of antibiotics, an allergic reaction to food, neuro-emotional disorders, stress, therefore, in such cases, treatment of ulcerative colitis, including folk remedies, will be required.

It has been noted that women are more likely to suffer from ulcerative colitis than men, and exacerbations occur due to nervous or physical overstrain. If the colon becomes inflamed completely, they speak of a total lesion, if partially, a segmental lesion occurs. The main symptoms of ulcerative colitis are diarrhea, abdominal pain, blood in the stool, and in rare cases, pus is observed in them. General health worsens, appetite disappears, a person loses weight, he is apathetic, body temperature can rise to 37-37.5 degrees. Sometimes the disease is very difficult, there is a perforation of the intestinal wall, bleeding ulcers. All this suggests that the treatment of ulcerative colitis should be mandatory, in addition, due to the long-term course of the disease, the body should also be supported by folk remedies.

1. Long known healing property potato juice with ulcerative colitis. In order to cook it, you need to take a few potatoes, peel them, grind, squeeze the juice in the amount of ½ cup. Drink half an hour before meals, every day. Normalizes the natural intestinal microflora, acidity, helps with gastritis, ulcers, including colitis.

2. Strawberry leaves. Collect wild strawberry leaves, dry, measure out 1 tbsp. Pour into a container and pour boiling water (2 cups), put to cool for a while, then strain. The decoction is quite useful for colitis if you drink it daily instead of tea, but if the amount of the remedy is limited, the course should include daily drinking of the decoction ½ cup 2 times a day for 2 weeks.

3. Healing herbal collection that helps with ulcerative colitis. Yarrow, sage, chamomile are taken in 1 tbsp. and are mixed. Pour the collection with boiling water (3 cups), let it brew until cool, then strain. Take for a month 8 times a day, 1 tbsp. After the specified period, reduce the amount of funds taken up to 4 times a day. This medicine not only helps with ulcerative colitis, it is also an excellent means of preventing the disease. It is good to use it for constantly tormenting diarrhea, indigestion.

4. For the treatment of nonspecific ulcerative colitis, one good remedy is used, which has established itself as the most effective. It's about about alder cones, sometimes even the doctors themselves recommend this remedy if the disease is long and medical preparations don't help much. An important condition is that alder cones must be collected at the end of winter - the beginning of spring (February, March). Measure this remedy 1 tbsp, pour cold water(1 cup), put on fire, bring to a boil and keep for another 15 minutes. At the end of cooking, strain the product, then add boiling water to 250 ml. Drink throughout the day, whenever you want (instead of water, tea), you can add sugar, jam, honey, lemon for taste. If spasms are felt in the intestines, add a little valerian infusion (15 drops) to the remedy and drink in the mornings and evenings on an empty stomach. If you are treated with such a remedy for 3-4 months, you can get rid of the disease, and in cases of exacerbation, you need to eat exclusively cereals, jelly.

5. To treat this unpleasant disease- ulcerative colitis, a method such as enemas with useful herbal infusions instead of water. The effectiveness of the enema in the treatment similar diseases due to the fact that thanks to it you can act almost directly on the intestinal mucosa, thereby achieving the desired therapeutic effect. And if you use special healing decoctions, the benefits of enemas increase many times over. One of the most effective remedies is St. John's wort with chamomile. Measure out 1 tbsp. St. John's wort, or chamomile, put in an enamel pan, pour boiling water. Cover the pan with a lid, wrap with a towel or blanket, let it brew for 1 hour. The product should cool to room temperature, and then, after straining, it can be used for an enema. The procedure is repeated daily for a month, after improving the condition, do it every other day and for prevention once every six months.

A patient diagnosed with ulcerative colitis should adhere to a therapeutic and prophylactic diet. The "key" to it can be useful products that form the basis daily nutrition, which give the body the necessary nutrients, but do not aggravate the clinical picture of the disease, having a gentle effect on the digestive tract.

"Diet harms many people with ulcerative colitis, especially during flare-ups," says Mark Schwartz, MD. medical sciences from the Department of Gastroenterology, Hepatology, and Nutrition at the University of Pittsburgh Medical Center.

Although not scientific justification that nutrition directly causes or cures ulcerative colitis, it certainly is effective tool which helps to cope with pathological symptoms. Moreover, a healthy diet should be balanced and satisfy the needs for calories, proteins and micronutrients.

Salmon, sardines, mackerel and other fish farmed and caught in natural conditions rich in omega-3 polyunsaturated fatty acids. They are useful not only for heart health, but also for improving the condition of the colon.

According to scientists at the University of Maryland Medical Center, essential fatty acids reduce inflammation. This means that "eating salmon may help balance the inflammation that occurs during an ulcerative colitis flare," according to Lisa Kimperman, a clinical nutritionist at CaseHospital Medical Center in Cleveland.

In addition to fish, excellent food sources of omega-3s include:

• linseed oil;
• walnuts
• olive oil, etc.

Enjoy pumpkin!

All varieties of pumpkin are healthy choices. “Pumpkin is high in fiber and also contains the antioxidants beta-carotene and vitamin C,” says Kimperman. Dietary fiber helps maintain a healthy gut microflora, while antioxidants help repair damage caused by inflammation.

Generally, pumpkin is well tolerated by the digestive system of a person diagnosed with ulcerative colitis.

This versatile product can be baked, cooked with it side dishes, soups, etc. You can even cook spaghetti from it by rubbing it on a special grater that is used to make Korean salads.

Avoid raw pumpkin during exacerbations. Dietary fiber may worsen the clinical picture of the disease at this point.

Yogurt and other fermented products (kefir, miso, kombucha drink, sauerkraut etc.) are probiotic. “Probiotics are beneficial bacteria found in fermented foods and in the gut,” explains Kimperman, noting that these bacteria are very valuable as they are essential for digestion and health. immune system.

"Foods containing live, active bacterial cultures help maintain the bacterial balance in the human digestive tract," she states.

• Choose yogurt that contains live, active cultures.
• The best choice is unsweetened, natural yogurt.
• Those with a sweet tooth can add some fruit or honey to natural yogurt.

Don't forget the eggs!

In order for a patient with ulcerative colitis not to have an imbalance of essential nutrients and various nutrients in the body, he should include this product in the diet more often.

"Eggs are excellent source protein and are usually well tolerated, even during ulcerative colitis flare-ups,” says Kimperman. They are also rich in B vitamins, which help convert food into energy, and selenium, which is an antioxidant.

It is best to cook them in a steam or oven-baked omelet, or boil them for snacks at work, on the road, etc.

Choose eggs that are fortified with omega-3 fatty acids for even more valuable nutrients.

Snack on an avocado!

This fruit contains monounsaturated fats that are good for the heart. When a patient with ulcerative colitis has a weight loss due to an exacerbation, a nutritious and quite high-calorie fruit gives optimal nutrition body.

The pulp of the fruit can be used to make salads, scrambled eggs, sauces, toppings for sandwiches.

With an exacerbation of the disease, it is necessary to exclude nuts from the menu, since a high fiber content can complicate the pathological symptoms of the disease.

As well as olive oil, nuts and oils from them are important sources caloric monounsaturated fats.

• Grab a bag of nuts when you leave the house. They serve as a healthy snack.
• Or make a nut butter sandwich.
• And don't forget to sprinkle your morning oatmeal with chopped nuts.

Benefits of applesauce

Although apples are rich in phytonutrients, their high fiber content makes them difficult to digest, according to experts from the Crohn & Colitis of America Foundation. But, according to scientists from the Medical Center of the University of Minnesota, applesauce is useful product for patients suffering from this disease, even during exacerbations.

Apple puree can be used as a dessert or prepared on the basis of various sauces. Roast apples with a variety of spices to enjoy new flavor notes.

Don't forget to remove the seeds!

quick oatmeal

Instant hercules is the best choice. This version of healthy grains is generally easily absorbed by patients with ulcerative colitis, according to data published by researchers at the University of Minnesota Medical Center. Instant oatmeal contains less fiber than regular oatmeal because it goes through additional processing, which is important when the disease flares up.

• Choose the simplest, low-calorie varieties with no added sugar.
• You can sweeten the finished dish with fruit puree or deceive the taste buds by powdering porridge with cinnamon.

lean meat

Experts from their foundation Crohn & Colitis of America note that patients diagnosed with ulcerative colitis should consume more healthy protein.

A large amount of saturated fat can cause problems in the digestive tract. Therefore, you should eat lean meats:

• pork loin;
• beef fillet;
• chicken (without skin);
• veal;
• turkey.

Intestinal colitis is a formidable condition that requires timely diagnosis and proper treatment. To a large extent, the treatment of colitis consists in choosing the right and balanced diet, without which getting rid of such an unpleasant and dangerous pathology impossible

What can you eat with colitis?

With colitis in the acute phase, the use of astringent "fixing" drinks is allowed: black tea. It is recommended to drink jelly, berry decoctions. Blueberries and black currants have a particularly pronounced astringent effect. In addition to decoctions, you can eat fresh berries. The consumption of natural fruit juices should be limited. Concentrated juices should not be drunk, since most have high acidity and can lead to even more irritation of the already inflamed intestines.

Vegetables fresh and boiled. The consumption of vegetables is allowed in the form of puree. Boiled vegetables must be in crushed form (also in the form of mashed potatoes). The consumption of vegetables that cause increased production of intestinal gases is excluded. Has a calming effect cauliflower. It should definitely be included in the diet.

Fruits . It is allowed to use apples, peaches, pears (in particular), but also in the form of mashed potatoes.

Soups, cereals. Soups and cereals for the purposes of dietary nutrition must be prepared in water or low-fat broth. The high fat content of the dish increases the load on digestive system(liver, small intestine, etc.). The consistency of soups and cereals should be homogeneous, pureed (as for baby food).

Dairy products. It is better to refuse fermented milk products during the acute phase of colitis, however, low-fat cottage cheese, low-fat milk, and low-fat varieties of cheese are allowed in small quantities.

Meat fish. Minced meat and fish should be cooked, and then steamed cutlets with the addition of pearl barley or whole grains of rice.

Offal. Homemade liver pate is allowed.

Bakery products. Fresh bread is excluded. You should consume only yesterday's bread from durum wheat, crackers (soaked in tea).

Confectionery. Sweets in a small amount, sugar up to two teaspoons a day.

What can not be eaten with colitis?

It is forbidden to use following products:

Bread is fresh, muffins. Fresh bread and rich bakery products contribute to increased production intestinal gases, and also accelerate intestinal motility. In conditions of damage to the wall of the colon, this will aggravate the already serious condition of the patient.

Broths from meat, fish (strong). Animal fats in large quantities are difficult to process and significantly burden the liver and the entire gastrointestinal tract.

Pasta, as well as legumes and peas. They increase the production of intestinal gases, "loading" the intestines.

Fried meat, fish, fatty meat products(fat, bacon, ham).

Pickles, smoked dishes, marinated dishes. They irritate the mucous membrane of the small and large intestines, provoke.

canned food, pickles.

fatty dairy products: sour cream, whole milk, etc.

Strong coffee and cocoa in full fat milk.

Food fast food(fast food).

Spicy products, seasonings.

Eggs (consumption of 1 hard-boiled egg per day is allowed).

Cereal dishes.

Menu for a week with colitis

Monday

Meal number 1: cauliflower salad with pureed, buckwheat with a small amount of natural butter, berry broth.

Meal #2: pureed fruit.

Meal number 3: vegetable broth, pureed boiled beef s, fruit decoction.

Meal #4: Pureed fruit.

Meal number 5: a piece of boiled fish (chopped).

Tuesday

Meal number 1: boiled prefabricated vegetables (carrots, tomatoes, etc.), cottage cheese casserole, berry broth.

Meal #2: Baked fruit with powdered sugar (or).

Meal number 3: barley soup, cabbage rolls stuffed with boiled rice.

Meal #4: Fresh Carrot Salad with.

Meal #5: a piece boiled fish(shredded), decoction of.

Wednesday

Meal number 1: cucumber salad with chopped beef, scrambled eggs from one egg, dried fruit broth.

Meal #2: Mixed vegetable salad.

Meal number 3: cabbage soup (shchi), boiled beef with tomatoes, rosehip broth.

Meal number 4: soaked dried fruits (except for prunes, since they have a pronounced laxative effect).

Meal number 5: steamed chicken cutlets, stewed vegetables, strong tea.

Guidelines for patients "Dietary nutrition in inflammatory bowel diseases (ulcerative colitis, Crohn's disease)" were prepared at the Department of Gastroenterology and Dietetics St. Petersburg GBOU VPO "North-Western State medical University them. I.I. Mechnikov "(former SPbMAPO).

Professor A.Yu. Baranovsky, Professor L.I. Nazarenko, nutritionist A.G. Kharitonov

Saint Petersburg

Introduction

In recent decades, in Russia, as well as throughout the world, there has been an increase in the incidence of inflammatory bowel diseases (IBD), which include Crohn's disease and ulcerative colitis.

Ulcerative colitis - a chronic disease of an inflammatory nature, characterized by ulcerative changes in the mucous membrane of the colon. Women and men get ulcerative colitis equally often. People of different ages get sick, but there are two peaks of incidence: 15-30 and 50-70 years. During the course of the disease, an exacerbation is distinguished (manifested by frequent stools mixed with mucus and blood, abdominal pain, fever, etc.) and remission (lack of activity of the inflammatory process). Ulcerative colitis is characterized by a progressive course and often - the development of complications.

Unlike ulcerative colitis, Crohn's disease the entire digestive tube can be involved in the process of inflammation, from the oral cavity to anal canal, but the ileum is most commonly affected. It is possible to develop complications both from the intestine (abscesses, fissures, fistulas, narrowing, etc.), and extraintestinal complications (cholelithiasis and urolithiasis disease, protein-energy deficiency, etc.).

For the treatment of IBD, anti-inflammatory (derivatives of 5-aminosalicylic acid), hormonal (prednisolone, methylprednisolone) drugs are used, antibacterial agents, immunosuppressants and immunomodulators, drugs biological therapy, surgical methods treatment. An integral part of the treatment of IBD is diet therapy.

Question proper nutrition in Crohn's disease and ulcerative colitis is still difficult for both the dietitian and the patient. Patients often note that such manifestations of the disease as pain or diarrhea occur immediately after eating. Therefore, most of them want clear recommendations about what they can eat and drink. However, unlike diseases that are strictly dependent on diet, such as diabetes mellitus or gout, there are no hard and fast dietary recommendations for Crohn's disease and ulcerative colitis.

However, together with medications, surgery, and lifestyle modifications, diet therapy forms the basis of successful disease management.

It should be remembered that the dietary measures taken for Crohn's disease are different from those for ulcerative colitis. The diet during an exacerbation is different from the diet during remission of the disease. Moreover, each patient reacts differently to food.

Does not exist universal diet which would suit all patients with IBD. Each patient needs individual approach, as well as every patient should be attentive to himself and his eating habits. On the other hand, it would be incorrect to say that patients with IBD do not require a diet and that there are no recommendations for them.

Many patients with IBD are malnourished, manifesting as weight loss, malabsorption of nutrients, and (less commonly) malnutrition. For example, 65%-75% of all IBD patients, especially those with Crohn's disease, are underweight. In addition, 60%-80% of all patients suffer from anemia. Inadequate nutrition should be corrected by a well-chosen diet with sufficient intake of vitamins, minerals, proteins and other nutrients. Underweight or malnutrition in patients with IBD should not go unnoticed, as they weaken their immune defenses.

One of the causes of deficiency is inadequate nutrition. Many patients are afraid to eat. They operate on the principle: "It is better to eat nothing than to eat something wrong." Other patients suffer from various types of food intolerance that restrict their diet to certain food groups.

Diet therapy for various activities inflammatory bowel disease

If disease activity is high ( frequent stool with a significant admixture of blood, abdominal pain, fever, joint pain, etc.) it is necessary to limit or completely exclude ordinary food and replace it with artificial nutrition. Artificial nutrition is divided into enteral (in which nutrient mixtures enter the body through the mouth or tube) and parenteral (in this case, nutrient mixtures are administered intravenously).

Currently allocate the following types mixtures for enteral: standard, semi-elemental mixtures, modular, directional mixtures.

Standard mixtures - contain all the necessary macro- and micronutrients in accordance with the daily needs of the body. They are used in most clinical situations where there are indications for enteral nutrition, with the exception of severe disorders of digestion and absorption of nutrients, as well as organ pathology (hepatic, renal, etc.). Such mixtures include Nutricomp Standard Liquid, Nutrizon Standard, Clinutren Optimum, Fresubin Original and a number of others.

Semi-elemental mixtures also include fully balanced nutrients, in which proteins are presented in the form of split molecules (peptides and amino acids). They are prescribed for severe disorders of the digestive and absorption functions, including in the early postoperative period (Peptamen, Nutrien Elemental).

Modular mixtures contain only one of the nutrients (protein, fat) or individual amino acids (glutamine), metabolism regulators (L-carnitine). They are used to supplement the diet of artificial or conventional medical nutrition.

Targeted mixtures are designed to correct metabolic disorders typical for this pathology (hepatic - Nutricomp Hepa Liquid, renal - Nutricomp Renal, immune disorders (Impact Enteral, Nutricomp Immune Liquid, Nutrien Immun, diabetes- Nutricomp Diabetes Liquid, Diazon).

Ways of introducing enteral mixtures into the body: through a probe (conducted medical staff) or by mouth (by the patient). For better absorption of mixtures and prevention adverse events it is better to introduce the volume of the mixture recommended by the doctor in small parts throughout the day. In this case, for probe feeding, you can use drip introduction mixtures through a probe. If the patient is able to eat on his own, the "sipping" mode (drinking through a cocktail tube or in small sips) is recommended.

Parenteral nutrition can be complete or partial. Total parenteral nutrition is carried out with completely balanced mixtures, including whites, fats and carbohydrates, as well as vitamins and trace elements necessary to maintain the body's vital functions. Partial parenteral nutrition is provided by the administration of one or two essential nutrients (eg proteins and carbohydrates).

In the case of intravenous administration of nutrient mixtures, the gastrointestinal tract is switched off from the digestion process. This type of food has both its advantages (no irritating effect on the intestines, i.e. sparing it) and disadvantages (prolonged shutdown of the gastrointestinal tract). The value of the latter can be reduced if the duration of intravenous administration does not exceed 7-10 days, and even before the end of parenteral nutrition, enteral mixtures are taken.

As the activity of inflammation subsides, together with enteral mixtures, it is possible to prescribe dishes of natural food. The addition of dry composite protein mixes (DISO Nutrinor, DISO Nutrifib and others) to meals helps to increase the nutritional value of a natural diet (see below)

General characteristics of the diet in the phase of severe exacerbation of the disease. The content of fats and carbohydrates is limited; protein content is normal or slightly elevated. Reduced Diet table salt, with a sharp limitation of mechanical and chemical irritants of the mucous membrane of the gastrointestinal tract. Excluded are foods and dishes that enhance the processes of fermentation and putrefaction in the intestines; especially milk, coarse fiber, spices and all dishes that stimulate bile secretion, secretion of the stomach and pancreas. The diet is fractional - 5 - 6 times a day.

The chemical composition and energy value of the diet. Proteins - 70-85 g (of which 40-45 g are animals), fats - 70-80 g (of which 10 g are vegetable), carbohydrates - 250-300 g (of which simple 50 g). Energy value- 1900-2200 kcal. Table salt - 6 g. Free liquid - 1.5-2 liters.

Culinary processing. All dishes are mashed, prepared boiled or steamed. The temperature of hot dishes - 55-60 0 С, cold - not lower than 15 0 С.

- bread and bakery products- crackers from white wheat bread, not toasted, thinly sliced;

- soups - on a vegetarian, fat-free meat or fish broth with the addition of slimy decoctions (rice, buckwheat, oatmeal, wheat flour), meat or fish dumplings steamed or boiled in water, meatballs, egg flakes, boiled and mashed meat, which is added along with slimy decoctions;

- meat and fish dishes- low-fat and non-fat varieties (beef, veal, poultry) in the form of steam cutlets, dumplings, meatballs, boiled meat soufflé - minced meat is passed 3-4 times through a meat grinder with a fine grate. Fish is allowed only fresh (not frozen) and low-fat varieties (perch, bream, carp, cod, saffron cod, etc.). The technology for preparing fish dishes is the same as for meat dishes;

- eggs and egg products-eggs (no more than 1 egg per day) are added to meals;

- milk and dairy products– fresh cottage cheese (preferably precipitated with calcium salts - calcined) in a pureed form. Whole milk - according to tolerance;

- vegetables and herbs- are excluded;

- fruits, berries, sweets– are excluded;

- - porridge mashed from rice, oatmeal, buckwheat, semolina and other cereals are cooked in water or low-fat meat broth. Legumes are excluded;

- fats- fresh butter is added to dishes;

- snacks- are excluded;

- sauces and spices– are excluded;

- drinks and juices- weak tea, juices in the form of jelly, jelly from fruits and berries, decoction of dried black currant, blueberries, bird cherry.

Forbidden: fresh bread, vegetables, greens, legumes, fruits, berries in in kind, mushrooms, whole milk, sauces, spices, snacks, natural eggs, sweets, confectionery, honey, jam, carbonated drinks, cold dishes.

Table 1 . Approximate one day menu diets with severe exacerbation of inflammatory diseases, accompanied by diarrhea

This version of the diet is physiologically defective and monotonous. That is why in the phase of a pronounced exacerbation of the disease, it is better to prescribe it only as an addition to standard enteral mixtures in the form of separate dishes for 5-7 days

In the phase of subsiding exacerbation they switch to a physiologically complete diet with a normal content of proteins and fats, a decrease in the content of carbohydrates with a moderate restriction of salt, mechanical and chemical irritants of the intestinal mucosa. Excluded are foods and dishes that enhance the processes of fermentation and putrefaction in the intestines, active stimulants of gastric secretion. Fractional diet - 5-6 times a day.

Culinary processing. Dishes are mashed, cooked boiled or steamed. Soups pureed or with finely chopped vegetables and well-boiled cereals. Individual dishes can be baked, but without a rough crust. The temperature of hot dishes - 55-60 0 C, cold - not lower than 15 0 C.

Proteins 70-85 g (of which 45-50 g are animals), fats - 80-100 g (of which 10-15 g are vegetable), carbohydrates - 350-450 g (of which 50-60 g are simple). Energy value - 2400-2900 kcal. Table salt - 6 g.

- bread and bakery products- yesterday's wheat bread, dry biscuit, dry biscuits of the "Ma-ria" type (total bakery products no more than 200 g per day);

- soups- cooked in water, low-fat meat or fish broth with well-boiled cereals, vermicelli, finely chopped vegetables (except for white cabbage);

- meat and fish dishes- from meat and fish of low-fat varieties (non-old and lean beef, veal, chicken, turkey, rabbit, pike perch, pike, cod cod) cutlets, meatballs, dumplings, soufflés, rolls in boiled or steam form are prepared in chopped form;

- eggs and egg products- eggs (1 piece per day) soft-boiled or in the form of additives to dishes; egg white omelets, meringues, snowballs;

- milk and dairy products- milk only in dishes in limited quantities, fermented milk drinks - kefir, acidophilus, acidophilus milk, fermented baked milk, yogurt, etc. Freshly prepared cottage cheese (preferably calcined), natural, in the form of curd mass, curd steam puddings;

- vegetables and herbs- zucchini, pumpkin, carrots, green peas and a limited amount of potatoes are cooked boiled and mashed, steamed vegetable soufflé from mashed vegetables is used. Ripe tomatoes in their natural form - no more than 100-150 g per day;

- fruits, berries, sweets- sweet varieties of berries and fruits (except for melons, watermelons, apricots and plums) in the form of pureed compotes, jelly, jelly, mousses and various juices; baked apples, pears, jams and jams from sweet varieties of berries and fruits; with good tolerance in limited quantities (up to 150 g), you can eat raw strawberries, sweet ripe apples and pears;

- cereals and pasta-rice, buckwheat, oatmeal, oatmeal, semolina and other groats in pureed form as side dishes, cereals, casseroles (without a crust); vermicelli, noodles, small pasta - in soups, in the form of side dishes and casseroles. It is advisable to add dry composite protein mixtures to cereals (for example, "DISO" Nutrinor) in the amount of 2 tablespoons in order to increase the protein content in dishes;

- fats- unsalted butter is added to ready-made dishes and to the table, but not more than 10 g per reception;

- snacks- mild cheese, Russian, Yaroslavl, etc.; doctor's sausage, pate, veal, soaked herring, aspic meat, aspic tongue;

- sauces and spices- sauces on meat, vegetable and fish weak broths with dill, parsley leaves, milk bechamel sauce with a small amount of sour cream, fruit sauces; cinnamon can be used;

- drinks and juices- tea with milk, a decoction of thorns, weak black coffee with milk; fruit and berry sweet juices, vegetable juices(not canned) half with water.

Prohibited: black bread, muffins and pastry products; white cabbage, cucumbers, peas, beans, lentils, meat, fish, canned vegetables; fatty varieties of meat and fish; fried foods; strong coffee, whole vegetable juices; carbonated and cold drinks; ice cream, whole milk, cream, natural sour cream; chocolate and chocolate candies.

Table 2. Approximate one-day diet menu for patients with inflammatory bowel diseases in the phase of subsiding exacerbation

1st breakfast: boiled fish, mashed potatoes, mashed rice porridge with the addition of the DISO Nutrinor mixture, tea

2nd breakfast: calcined cottage cheese (100 g)

Lunch: mild mashed cheese (30 g), pearl barley soup in meat broth with mashed carrots, meatloaf with pureed buckwheat porridge, apple jelly

Snack: rosehip broth (1/2 cup), protein omelette

Dinner: boiled tongue with carrot puree, calcined cottage cheese

At night: kefir (1 glass)

For the whole day: white bread - 300 g, sugar - 50 g, butter - 10 g, fruits, berries - 300 g

In inflammatory bowel disease in recovery period they prescribe the same diet, expanding the diet by eating the same dishes, but not in a pureed form, which allows you to restore the disturbed functions of the digestive system.

General characteristics. The diet is physiologically complete, with a normal content of proteins, fats, carbohydrates and salt restriction, with some limitation of mechanical and chemical irritants of the mucous membrane of the gastrointestinal tract, with the exception of foods and dishes that enhance the processes of fermentation and putrefaction in the intestines, as well as strong stimulants of bile secretion, secretion of the stomach and pancreas, substances that irritate the liver. Fractional diet - 5-6 times a day.

Culinary processing. Food is cooked in boiled form, steamed, and also baked in the oven, served to the table mostly not crushed. The temperature of hot dishes is 55-60 0 С, cold ones - not lower than 15 0 С.

Chemical composition and energy value. Proteins - 75-85 g (including animals 40-50 g), fats - 80-110 g (including vegetable 15-20 g), carbohydrates - 350-450 g (including simple 40-60 g). Energy value - 2400-2900 kcal. Quantity free liquid- 1.5 l. Table salt - 6 g.

- bread and bakery products- yesterday's wheat bread, dry biscuit, dry biscuits like "Maria" 1-2 times a week, no more than 2-4 buns, well-baked, but without adding butter to the dough. Pie with boiled meat and eggs, apples or cheesecake with cottage cheese.

- soups- on water, low-fat meat or fish broth with various cereals (except for millet), noodles, vegetables (potatoes, carrots, zucchini, pumpkin, cauliflower). With good tolerance, white cabbage, green peas, young beans, beets are allowed;

- meat and fish dishes- low-fat and non-fat meat (beef, rabbit, turkey, chicken), tongue, low-fat ham, diet sausages, low-fat fish (perch, pike, bream, saffron cod, cod, carp). Meat and fish in pureed and chopped form, boiled, stewed, steamed, baked 2 times a week, in pieces;

- eggs and egg products- Whole eggs (no more than 1 per day) in dishes, protein steam omelettes, meringues, snowballs. With good tolerance - whole soft-boiled eggs, steam omelettes from whole eggs;

- milk and dairy products-milk in dishes, with good tolerance, it can also be used in pure form; fermented milk drinks - kefir, sour milk, acidophilus, acidophilus milk, ryazhenka, etc. (with good tolerance); fresh, natural cottage cheese, in the form of curd paste, steam and baked puddings;

- vegetables and herbs- potatoes (in limited quantities), carrots, beets, pumpkins, zucchini, cauliflower boiled, baked, steamed, unmashed and mashed; lettuce leaves and parsley, fresh tomatoes in the form of a salad; finely chopped young greens as an additive to dishes. Turnips, cucumbers, radishes, radishes, sorrel, spinach, onions, garlic, mushrooms are excluded;

- fruits, berries, sweets- fresh ripe fruits and berries (except melons, apricots, watermelons and plums), raw, natural, baked; dry fruits and berries; ripe varieties of apples and pears (no more than 200 g per day); with good tolerance - tangerines and oranges; marmalade, marshmallow, marshmallow, sugar;

- cereals and pasta- various crumbly cereals (except millet and pearl barley) on water, in meat broth, with the addition of milk or a third of 10% cream, steamed and baked puddings, cutlets (without breading), pilaf, zrazy, dumplings, pancakes; boiled vermicelli, finely chopped pasta, milk noodles in the form of side dishes, casseroles, puddings. During cooking, dry protein composite mixtures (“DISO” Nutrinor” are added to cereals);

- fats- butter (do not fry) is added to ready-made dishes, given in its natural form to the table, no more than 10 g per 1 meal;

- snacks- jellied fish, tongue, veal, mild cheese, black caviar, doctor's sausage, soaked herring, low-fat ham;

- sauces and spices- sauces on vegetable broth, meat broth using bay leaf, dill, parsley leaves, cinnamon; milk bechamel sauce with the addition of a small amount of sour cream; fruit sauces;

- drinks and juices- rosehip broth, natural tea with milk or cream, coffee with milk or cream and weak black coffee, fruit juices (except grape), berry; vegetable juices (except cabbage), diluted 1/3 with water.

Forbidden: black bread; millet, barley; white cabbage, beans, peas, lentils, mushrooms, fatty meats and fish, fried foods; cucumbers, turnips, radishes, radishes, sorrel, spinach, onions, garlic; fresh melons, apricots, watermelons, plums; grape juice; undiluted vegetable juices; cabbage juice; meat, fish, canned vegetables; chocolate, cocoa, honey.

With good tolerance, it is allowed to add white cabbage, green peas, young beans, beets to soups, whole milk, young finely chopped greens, tangerines and oranges, marmalade, marshmallows, marshmallows are introduced into the diet.

Table 3 sample menu dietary option for patients with inflammatory bowel disease in remission

1st breakfast: rice milk porridge with the addition of a mixture of "DISO Nutrinor", protein steam omelet (from 2 eggs), tea with milk

2nd breakfast: calcined cottage cheese (150 g)

Lunch: soup in meat broth with cauliflower, boiled meat with boiled rice, fresh apples

Snack: boiled meat, rosehip broth (200 g)

Dinner: baked cottage cheese pudding, steamed meat roll with stewed carrots and green peas, tea with milk, fresh fruits (or berries)

At night: kefir (1 glass)

For the whole day: white bread - 300 g, sugar - 40 g, butter - 10 g

In the case of maintaining a stable remission in a patient, significant restrictions on certain products are not required. Culinary processing includes, in addition to boiling, also baking, and even frying. During this period, it is recommended to eat the most natural and fresh products possible. Despite the ongoing remission, it is desirable to exclude seeds, nuts, mushrooms, vinegar and a number of other foods that injure and irritate the intestines from the diet.

Diet therapy for protein deficiency in patients with inflammatory bowel diseases

With relapses of the disease, as well as with a constant inflammatory process in the small intestine, the intake of proteins into the body is impaired or reduced. In Crohn's disease, a large amount of protein is lost through inflamed areas of the mucous membrane. small intestine. Protein deficiency results in weakness, weight loss, poor resistance to infection, and slow healing of mucosal defects.

In the presence of protein deficiency, patients with Crohn's disease and ulcerative colitis should consume 1-1.2 g/kg/day of protein. With severe depletion, the amount of protein can be increased. Vegetarians who exclude animal proteins from their diet are especially prone to developing protein deficiency, so the selection of an individual diet for this category of patients is especially important. Products containing increased amount proteins, these are meat, liver, fish, poultry, dairy products, eggs, as well as some cereals and soy products.

It is far from always possible to adequately meet the body's needs for proteins only at the expense of ordinary food. For the best solution to this problem, it is recommended dry composite protein mixes, due to the introduction of which into standard, specialized and individual diets, up to 20% of the proteins in the daily diet of the patient's diet are replaced. Dry composite protein mixes(such as, for example, "DISO" "Nutrinor", "DISO" "Nutrifib") belong to the category of enhanced dietary nutrition, are safe and comply with established sanitary and hygienic standards.

Dry composite protein mix "DISO Nutrinor" is produced with different composition protein component:

100% milk whey protein concentrate

100% vegetable protein isolate

50% milk whey protein concentrate

50% vegetable protein isolate

Dry composite protein mixture "DISO Nutrinor" has good taste data, when used, it does not violate the usual organoleptic and taste qualities of ready-made dishes, its use significantly reduces the time for preparing specialized dishes (wiping process is excluded). 20.0 g (1 tablespoon) of the mixture "DISO" Nutrinor "contains 8.0 g of proteins of high biological activity, so a double intake of a mixture of protein composite dry "DISO" Nutrinor "provides 20-25% daily requirement squirrel.

Here are several options for preparing ready-made meals using dry protein composite mixtures:

When preparing slimy soups, mix flour (rice, oatmeal, buckwheat, cereal) with the dry mixture "DISO Nutrinor", gradually, in a small stream, pour into boiling water with constant stirring. Cook until cooked;

When preparing cereals, sort the cereals, rinse in cold and hot water, put them on a sieve, then pour them into boiling water, cook until half cooked, then add the DISO Nutrinor dry mixture, mix and cook until tender.

Diet therapy for vitamin deficiency in patients with inflammatory bowel disease

Vitamin deficiency is more often observed in Crohn's disease, since with this disease, as a rule, the small intestine is affected, where the absorption of nutrients occurs. For example, vitamin B 12 is absorbed in the final section of the small intestine (in the ileum). With inflammation of this part of the intestine or when it is removed (resection), vitamin B 12 deficiency occurs, which is manifested by anemia and neurological symptoms. In the case of ulcerative colitis, vitamin B 12 deficiency occurs more often due to a reduced intake of foods rich in this vitamin. In the presence of an inflammatory process in the small intestine, the absorption of both water-soluble (groups B and C) and fat soluble vitamins(A, D, E, K), that is, multivitamin deficiency develops.

Table 4 shows the products - sources of various vitamins.

Table 4. The content of vitamins in 100 g of the edible part of the products

vitamins	The amount of vitamin in 100 g of product	food products
Vitamin C	Very large (100 mg or more) Large (40-99 mg) Moderate (15-39 mg)	Fresh rosehip, sweet red pepper, black currant, sea buckthorn, sweet green pepper, parsley, Brussels sprouts, dill, wild garlic. Cauliflower, white and red cabbage, oranges, garden strawberries, horseradish, spinach, garlic (feather), lemons, kiwi, grapefruit, spinach, white currant. Tangerines, liver, swede, green onion, green pea, tomatoes, radishes, potatoes, leeks, green onions, lettuce, zucchini, melon, gooseberries, chokeberry, cloudberries, dogwood, raspberries, quince, cranberries, cherries, cherries, apples, cranberries, red currants, pineapple, sauerkraut
Vitamin B 1	Very large (1 mg or more) Large (0.4-0.9 mg) Moderate (0.15-0.39 mg)	Pork tenderloin, pig meat. Shelled peas, bacon pork, yeast, cereals (oatmeal, buckwheat, millet), beans. Offal, wholemeal bread, pork sausages, boiled sausages, green peas, veal bread, barley groats, rabbit meat, catfish, pink salmon, chum salmon, grenadier, horse mackerel, tuna, caviar (sturgeon, stellate sturgeon, pollock), pasta, bread.
Vitamin B 2	Very large (more than 0.4 mg) Large (0.2-0.4 mg) Moderate (0.1-0.19 mg)	Liver, kidneys, heart, yeast, almonds, cheeses, eggs, mushrooms, granular beluga caviar. Tongue, fat cottage cheese, bread, beef, goose, turkey, soy, rosehip, green beans, mushrooms, buckwheat, halva, sheep's milk, spinach, chum salmon, fatty herring, mackerel, tuna, Cow's milk, goat's milk, cream, kefir, butter, sour cream, green peas, Brussels sprouts, cauliflower, sweet green pepper, parsley, celery, dill, green onion, granular caviar (sturgeon, stellate sturgeon, pollock) flounder, pink salmon, grenadier, perch, halibut, sardine, pike, cod, hake, pork, chicken, rabbit meat, boiled sausages, oatmeal.
Vitamin PP	Very large (3 mg or more) Moderate	Peanuts, yeast, offal (liver, kidney, tongue, etc.), tuna, herring, mackerel, sardine, sunflower seeds, fresh mushrooms, poultry, beef, lamb, almonds, buckwheat, wholemeal bread. Legumes, pork, boiled sausages, cod, sea bass, halibut, chum salmon, peas, beans, green peas, barley, barley, rice groats, wheat bread from 2nd grade flour, hazelnuts. Horse mackerel, hake, pike perch, pike, wheat bread from premium flour, rice, millet, oatmeal, corn, semolina, pasta, carrots, walnuts, potatoes, sweet red pepper, garlic.
Folic acid	Very big (30 mcg or more) Large (20-29 mcg) Moderate (10-19 mcg)	Yeast, beef and pork liver, soybeans, parsley, beans, spinach, lettuce, leeks, low-fat cottage cheese, porcini mushrooms, millet, horseradish, wild garlic, beans, hard cheeses, buckwheat and barley, Brussels sprouts. Cottage cheese, many cheeses, cereals (oatmeal, semolina, pearl barley), bread, pasta, green peas, dill, early cauliflower and white cabbage Egg yolk, cereals (rice, corn), herring, horse mackerel, hake, pike perch, eggplant, zucchini, onion, peas, pumpkin, rhubarb, late white cabbage, beets, strawberries, figs.
Vitamin A	Very large (3 mg or more) Large (0.4-2.9 mg) Moderate	Chicken liver, beef liver, canned cod liver, pork liver. Beluga granular caviar, egg yolk, butter. Cheese, sour cream, 20% fat cream, fat cottage cheese, kidneys, halibut, sprats (canned food), sturgeon caviar, stellate sturgeon caviar.
β-carotene	Very big (2 mg or more) Large (1-1.8 mg) Moderate	Carrots, parsley, celery, spinach, wild garlic, wild rose, red bell pepper, leek, chives, garlic (feather). Lettuce, apricots, pumpkin, ground tomatoes, sea buckthorn, sweet green pepper, dill, chokeberry, beef liver. Green peas, Brussels sprouts, greenhouse tomatoes, green beans, melon, peaches, raspberries, gooseberries, red currants, butter, yellow carrots, cheeses (cheddar, camembert).

If the diet fails to correct the deficiency of vitamins, they must be administered in the form multivitamin complexes or by injection (intravenously or intramuscularly).

Diet therapy for deficiency of macro- and microelements in patients with inflammatory bowel diseases

Calcium deficiency is often seen in patients with inflammatory bowel disease. Calcium has anti-inflammatory, antidiarrheal, antiallergic effects, accelerates the recovery of the intestinal mucosa. Deficiency may be caused by malabsorption, increased losses, and/or insufficient dietary intake of calcium. Foods containing calcium - dairy products (the source of more than half of the amount of calcium consumed), cheeses, eggs, soy isolates, buckwheat and oatmeal, fish and fish roe.

It is not uncommon for patients with IBD to be deficient in micronutrients such as zinc. In the human body, zinc performs whole line functions in relation to immune defense and fight against inflammation, it has an antidiarrheal effect, accelerates the recovery of the intestinal mucosa. Zinc deficiency is more common in Crohn's disease than in ulcerative colitis, with excess zinc excretion in the faeces. Untreated diarrhea is often the result of zinc deficiency as it is lost in the faeces. In case of zinc deficiency, vitamin-mineral complexes containing zinc should be taken (for example, Gerimaks, Tri-vi-plus, Zinkit, etc.). In this case, the frequency of stool decreases rapidly. However, not all zinc preparations are well absorbed in the intestine. It is difficult to achieve a high zinc content in the diet, because. only a few foods have a high content of this trace element. These include: yeast, eggs, cereals (buckwheat, oatmeal), corn products, legumes, mushrooms, hard cheeses, meat, viscera (which, however, should be avoided in the acute phase of the disease due to their possible high content of toxins) and oysters. Plant-based foods usually contain small amounts of zinc and in many cases may even impair intestinal absorption of zinc.

The cause of iron deficiency and the development of iron deficiency anemia in Crohn's disease is mainly a decrease in the absorption of this trace element in the small intestine due to the inflammatory process. In ulcerative colitis, this deficiency occurs mainly due to increased loss iron with blood during defecation. Healthy people absorb approximately 5-10% of the iron contained in food, and in conditions of its deficiency - 10-20%. The absorption of iron from the intestine depends on the type of food, it is best absorbed from the meat of mammals - 22%, from the liver - 12-16%, from fish - 9-11%, from eggs and beans - 2-3%, from fruits - 3-4%, from rice and spinach - 1%. Iron absorption is impaired by oxalic acid (spinach, sorrel, legumes), tannins(blueberries, quince), phosphates and phytins (cereals, legumes), strong tea and excess dietary fiber. Egg and soy proteins also reduce the absorption of iron from the gut. Organic acids (malic, citric, ascorbic) improve iron absorption. The optimal combination in one dose of products containing heme iron with high bioavailability (meat of animals, birds, liver, kidneys), and products rich in organic acids (broth of wild rose, blackcurrant, clarified juices, lemons, etc.)

Since iron absorption cannot exceed certain values, dietary correction of this trace element deficiency may not be enough. In these cases, it is necessary to use preparations containing iron for oral administration or intramuscular and intravenous administration.

How do you know which foods you tolerate well and which don't?

Great help in answering this question is provided by food diary, which reflects daily all the foods and dishes that were consumed during the day, as well as changes in well-being. Be sure to indicate the frequency and nature of the stool, the intensity of abdominal pain, the presence of nausea. Foods that may be poorly tolerated by patients with bowel disease: vegetables, herbs, legumes, fruits, berries in their natural form, mushrooms, nuts, citrus fruits, whole milk, sauces, spices, snacks, sweets, confectionery, honey, jam, carbonated drinks, cold dishes.

One food that is often poorly tolerated by patients with IBD is whole milk. It occurs due to an enzyme deficiency. lactase which is produced in the small intestine and breaks down milk sugar- lactose. Lactase deficiency is often observed during exacerbation of both Crohn's disease and ulcerative colitis. As a result, a large amount of undigested milk sugar accumulates in the intestinal lumen, which causes diarrhea, bloating, nausea, heaviness and pain in the upper abdomen. If milk intolerance is observed during an exacerbation of the disease, this does not mean at all that the symptoms of intolerance will persist during the period of remission.

Dairy products that are generally well tolerated in lactose intolerance include yogurt and cheese. It is desirable to keep dairy products in the diet for those patients who tolerate them well.

With IBD, the so-called latent food intolerance is often found, which is based on the processes of inadequate response of the patient's immune system to certain foods. Without vivid symptoms, the components of a number of food products cause a violation of the digestive and absorption functions of the intestine, destabilization of its microflora, leading to intoxication of the body, and even an additional factor of intestinal damage in patients with ulcerative colitis and Crohn's disease. Identification of the fact of latent (immune-dependent) food intolerance is carried out using special immunological tests, in which antibodies (associated with G 4 immunoglobulins) to food products are determined. To do this, all patients with inflammatory bowel disease should pass the so-called York-Test, developed at the British Scientific Laboratory of Clinical Nutrition in York (in some Russian laboratories and clinics it is called the “latent food intolerance test”). This blood test identifies the degree of intolerance (mild, moderate or severe) to specific nutrients from over 100 tested foods.

Some patients with inflammatory bowel disease have celiac disease- a disease of the small intestine, characterized by intolerance to gluten (a protein found in wheat, rye, barley). As a result, to some extent, the absorption of nutrients in the intestine is disrupted, which manifests itself in the form of a deficiency of proteins, vitamins, and microelements. Celiac disease can often be combined with Crohn's disease and even mimic its exacerbation.

The main treatment for celiac disease is a lifelong diet, the main principle of which should be the exclusion of all foods containing gluten, this is - barley, millet, wheat, rye, oats and products containing them (white and black bread, pasta, dumplings, pancakes, cakes, pastries, cookies, gingerbread, ice cream, puddings, etc.).

Cereals intolerable to patients with celiac disease are found in some alcoholic beverages (beer, whiskey), instant soups, and instant coffee drinks. Flour can be added to the composition of yoghurts, glazed curds, sausages, sausages and sausages, cheeses, canned food, ketchups, mayonnaises, sauces.

Dietary restrictions should be strictly followed by the patient, since taking even 100 mg of gluten-containing products (a few crumbs of bread) can worsen the course of the disease. Food colorings and preservatives are prohibited.

Products made from gluten-free cereals and vegetables (rice, corn, legumes) are allowed. When cooking various dishes(for example, pastries, sauces) rice flour, corn flour are used as substitutes for wheat flour. Buckwheat shown in limited quantities.

Table 5 Foods allowed and prohibited for celiac disease

	Allowed	Forbidden
	Decoctions, vegetable and meat soups without a thickener	Noodle soup, canned soups, bouillon cubes, dry soup mixes
Dairy	Milk and dairy products, cheese	Some commercial dairy drinks (milk sauces, ice cream, yoghurts, some cheeses (including processed ones), yoghurts, glazed curds
	All types of fats	Margarines with gluten-containing stabilizers
Meat products, eggs	All types of meat, eggs	Products cooked in breading, products in sauces, some types of sausages, ready-made cutlets, canned meat
Fish, seafood	All kinds of fish and seafood, canned fish in oil and own juice	Breaded products, products in sauces, imitation seafood, some canned fish
Cereals and pasta	Rice, corn	Wheat, rye, barley, oats (cereals - wheat, semolina, oatmeal, pearl barley, Hercules, oatmeal, pearl barley, barley, Artek, Poltavskaya, 7 cereals, 4 cereals, etc.), bran, Muesli and other breakfast cereals, children's cereals, pasta, corn flakes when using barley molasses
Flour and starch	From rice, buckwheat, corn, potatoes, tapioca, cassava, sweet potatoes, beans, peas, soybeans, various nuts	wheat, rye, oat flour and starch
	All types of legumes	canned legumes
Vegetables and fruits	All kinds of vegetables and fruits in various options cooking	Commercially prepared salads, vegetables in sauces, breaded, many canned vegetables and fruits, incl. tomato pastes, ketchups
Bakery products	Specialty breads (corn flour, soy flour, etc.)	Bakery products from wheat, rye, barley, ready-made confectionery
	Coffee, tea, juices, cocoa	Dry mixes for preparation of drinks, coffee substitutes
Sauces, spices	Yeast, vinegar, monosodium glutamate, chili	Mustard, chewing gum; some types of vinegars and salad dressings, ketchups, mayonnaises; multi-component dry seasonings and spices (“Vegeta”, etc.)
Sweet dishes	Marmalade, marshmallows, some varieties of ice cream and sweets. Jams, preserves, caramel, etc. homemade	caramel, soy and chocolate candies with filling, oriental sweets, industrial jam
	Juices, coffee beans	Kvass, instant coffee and cocoa drinks, some alcoholic drinks (vodka, beer, whiskey)
Nutritional supplements		Annatto dye E160b, caramel colors E150a-E150d, oat gum E411, maltol E636, ethyl maltol 637, isomaltol E953, malititol and maltitol syrup E965, mono- and diglycerides of fatty acids E471)
Non-food products containing gluten		Glue on postage stamps and envelopes, some types of cosmetics, incl. lipstick, some types of toothpaste
Medications	Most medicines	Certain medicines (mostly film-coated tablets)

Features of diet therapy in patients with inflammatory bowel diseases in the treatment of hormones

Some patients taking hormonal drugs (prednisolone, etc.) may experience unwanted effects, such as, for example, increased appetite and weight gain. In this case, it is very important to observe the diet and not eat uncontrollably. If the patient has an increased appetite, it is recommended to increase the proportion of fruits and vegetables in the diet (limiting confectionery, pastries, and other foods rich in simple carbohydrates). After a reduction in the dose of hormones or their withdrawal, body weight usually decreases to the original.

With prolonged use of hormones, especially medium and high daily doses of drugs, especially in middle-aged and elderly people, especially women, calcium deficiency may develop, which leads to muscle cramps or the development of osteoporosis. For this reason, in the diet of a patient with IBD receiving hormonal drugs, milk (if it is well tolerated) and dairy products (cottage cheese, cheese) should be present as sources of calcium.

Often increases with hormones arterial pressure Therefore, it is advisable to limit salt (up to 3 g per day), alcoholic beverages and foods containing caffeine. It is also necessary to limit free fluid to 1-1.5 liters per day.

In connection with the increased catabolism (breakdown) of proteins against the background of hormonal therapy, special attention should be paid to the protein part of the diet. The amount of protein should be 1.0-1.5 g/kg of body weight per day.

Diet therapy for patients with inflammatory bowel disease after bowel surgery

The condition that develops after the removal of the small intestine or part of it in patients with Crohn's disease is accepted call it a syndromemouth (or shortened) intestine. The presence and degree of malnutrition that occurs after the removal of a part of the small intestine depends primarily on the area of ​​the resected area, the volume of resection and the length of the preserved part of the small intestine. It is known that the removal of more than 50% of the small intestine leads to severe malnutrition, and with the removal of 75% or more, the patient is shown total parenteral nutrition.

Removal of the entire duodenum is a rarity. In this case, the body receives an insufficient amount of iron, calcium, magnesium, folic acid, fat-soluble vitamins (A, D, E, K), since these nutrients are absorbed mainly in the duodenum and the initial sections of the small intestine.

Removal of the ileum impairs absorption bile acids and vitamin B 12. Bile acids are necessary for the breakdown of fats, and, accordingly, are involved in their absorption. If the lining of the ileum is inflamed or removed, the bile salts pass into the large intestine and are excreted in the stool. This means that fat is absorbed worse, and steatorrhea (fatty loose stools) appears. In addition, bile salts stimulate colonic peristalsis, which aggravates diarrhea. The loss of bile acids in the feces, which are necessary for the absorption of fats and fat-soluble vitamins, leads to their deficiency in the body.

During operations on the small intestine without removing part of the organ, the restoration of bowel function occurs quite quickly. Parenteral nutrition (often involving only the administration of energy substrates such as glucose solution) is given for 1-2 days after surgery. Already from 2-3 days it is possible to feed using standard enteral mixtures in combination with surgical diets. Gradually (within 7-10 days), the number of natural food dishes expands, the volume of enteral mixtures administered decreases. IN further patient it is necessary to follow the principles of the diet described above, depending on the activity of inflammation in the intestine.

When a large section of the small intestine (up to 50%) has been removed from a patient, it is necessary to establish full parenteral nutrition already on the first day after the operation. In this case, the introduction of nutrients through the vein should fully meet the needs of the body. On the 4th-5th day after the operation, it is possible to start enteral nutrition through a tube with preservation parenteral administration nutrients. The introduction of enteral mixtures is important to start with small volumes (250-300, in some cases 100-150 ml on the first day, then 300-500 ml, followed by an increase of 300-500 ml every day). Under favorable circumstances, after another 5-7 days, the patient receives nutrition with enteral mixtures in the amount of 1500-2000 ml per day in combination with surgical diet No. 0a (2-3 days), then No. 1a (2-3 days). With good tolerance of natural food, the volume of enteral mixtures gradually decreases (by about 100 ml per day), the patient is transferred to the surgical diet No. 1. It is important to note that the above timeframes for switching from one diet to another are approximate, individual for each patient and should be determined by a dietitian, nutritionist or, in their absence, by the attending physician.

Characteristics of diet No. 0a. Average appointment time: 2-3 days. Diet - 8 times a day (no more than 200-300 g per reception). Culinary processing of dishes - liquid or jelly-like. Meal temperature< 45° С. Содержание соли – 1 г/сутки. Разрешаются: слабый обезжиренный мясной бульон, рисовый отвар со сливками или сливочным маслом, процеженный компот, кисель ягодный жидкий, отвар шиповника с сахаром, желе фруктовое, чай с лимоном и сахаром, свежеприготовленные фруктово-ягодные соки, разведенные в 2–3 раза сладкой водой (до 50 мл на прием).

When the condition improves on the 3rd day, add: soft-boiled egg, butter - 10 g.

Up to 200 mg of vitamin C are added to meals, other vitamins are prescribed. Forbidden: any dense and puree-like dishes, whole milk, sour cream, grape and vegetable juices, carbonated drinks.

Table 6 Approximate one-day diet menu No. 0a

1st breakfast: 100 g of warm tea with 10 g of sugar, 100 g of liquid fruit or apple compote

2nd breakfast: 180 g of liquid from apple compote

3rd breakfast: 200 g weak meat broth with 10 g butter

Dinner:. 150 g fruit jelly, 150 g rosehip broth

Afternoon snack: 150–200 g of tea with lemon and 10–15 g of sugar

Dinner: 180 g rice water with 10 g butter or cream, 100-150 g fruit jelly

2nd dinner: 180 g rosehip broth

At night: 180 g of compote liquid

For the whole day: white bread - 300 g, white crackers - 50 g.

With good tolerance of diet No. 0a and the absence of diarrhea, after 2–3 days, the patient is transferred to surgical diet No. 1a.

Characteristics of diet No. 1a. Average appointment time: 2-4 days or more (in case of loose stools). Diet - 6 times a day (no more than 350-400 g per reception). Culinary processing of dishes - liquid, wiped. Meal temperature<45°С. Содержание соли – 4-5 г/сутки. Разрешаются: жидкие протертые каши из рисовой и гречневой крупы, геркулеса, сваренные на мясном бульоне или на воде с 1/4–1/2 молока;

Mucous cereal soups on vegetable broth;

Weak fat-free meat broths with semolina;

Steam protein omelette, soft-boiled eggs;

Steam soufflé or puree of lean meat or fish (free of fat, fascia, tendons, skin);

Up to 100 g of cream, jelly, mousses from non-acidic berries;

Strained compote, liquid berry jelly, rosehip broth with sugar, tea with lemon and sugar, freshly prepared fruit and berry juices, diluted 2-3 times with sweet water.

Forbidden: any dense and puree-like dishes, whole milk, sour cream, grape and vegetable juices, carbonated drinks.

Table 7. Approximate one-day diet menu No. 1

1st breakfast: liquid pureed buckwheat porridge on water - 200 g with milk and 5 g butter, steam protein omelette from 2 eggs, tea with lemon

2nd breakfast: cream - 100 g, rosehip broth - 100 g.

Lunch: meat broth with semolina - 200 g, steamed soufflé from boiled meat - 50 g, compote broth - 100 g.

Snack soft-boiled egg, fruit jelly - 150 g, rosehip broth - 10

Dinner: steamed fish soufflé - 50 g, liquid mashed oatmeal porridge in meat broth - 200 g with 5 g butter, tea with lemon

At night: fruit jelly - 150 g, rosehip broth - 100 g.

For the whole day: 50 g sugar and 20 g butter

In cases where the regenerative processes of the digestive system proceed favorably, the patient is transferred to the surgical diet No. 1 (wiped version) - on average on the 14th-15th day after the operation. Such a transition should be carried out gradually by expanding the number of products introduced into the diet. With good tolerance of "new" products in the postoperative diet, their list may increase.

Characteristics of diet No. 1 surgical

Purpose of appointment: moderate chemical, mechanical and thermal sparing of the gastrointestinal tract with proper nutrition, reduction of postoperative inflammation, stimulation of regenerative processes, normalization of the secretory and motor-evacuation functions of the stomach and intestines. Diet - fractional, 5-6 times a day. Culinary processing: pureed, boiled in water, meat, fish or vegetable weak broth, as well as steamed Separate dishes are baked without a crust. Fish and coarse meats are allowed in pieces. Temperature of dishes: very cold and hot dishes are excluded.

- bread and bakery products: wheat bread from flour of the highest and 1st grade of yesterday's baking or dried; dry biscuit, dry biscuits;

- soups on water, weak meat, fish, vegetable broths from allowed mashed vegetables, from mashed or well-boiled cereals (hercules, semolina, rice, etc.), vermicelli with the addition of mashed vegetables; soup-puree from vegetables, from pre-boiled chickens or meat, from mashed sweet berries with semolina. Flour for soups is only dried. Seasoned with butter, protein-egg mixture, cream;

- meat and poultry dishes: lean, without tendons, fascia, skin in birds. Steam and boiled beef dishes, young low-fat lamb and cut pork, chickens, turkeys. Boiled dishes, including meat with a piece of lean veal, chicken, rabbit. Steam cutlets, meatballs, quenelles, soufflé, mashed potatoes, zrazy; beef stroganoff from boiled meat. Boiled meat baked in the oven. Boiled tongue and liver;

- fish dishes: low-fat species in the first six months of rehabilitation (pollock, goby, asp, flounder, crucian carp, macrorus, burbot, navaga, perch, haddock, pollock, pikeperch, cod, hake, pike, etc.) and moderately fatty fish with good tolerance (pink salmon, catfish, carp, chum salmon, sprat, bream, perch, bonito, herring, lean herring, with ig, catfish, horse mackerel, tuna, ide, etc.) without skin, in a piece or in the form of a cutlet mass; boiled in water or steamed;

- milk and dairy products: skimmed milk (not higher than 1.5% fat), cream (not higher than 10% fat), diluted with water in a ratio of 1:2–1:3, no more than 1-2 times a week (with good tolerance). Non-acidic kefir, curdled milk, acidophilus fermented milk products with bioadditives (fermented milk bifilakt, antacid bifilak, Narine, Bifidok, Vita laminolact, fermented milk bifidumbacterin with lysozyme, etc.), yogurt, fermented baked milk. Fresh non-sour cottage cheese (mashed) and sour cream. Baked cheesecakes, soufflés, lazy dumplings, puddings. Mild grated cheese, occasionally in slices;

- cereals and pasta: cereals boiled in water, with the addition of milk, semi-viscous and mashed (semolina, rice, buckwheat, oatmeal). It is advisable to add dry composite protein mixtures (for example, "DISO" Nutrinor) to cereals in the amount of 2 tablespoons in order to increase the protein content in dishes. Steam soufflés, puddings, cutlets from ground cereals. Vermicelli, boiled pasta;

- eggs and egg products: egg 2 pieces a day soft-boiled, steam omelette;

- vegetables and herbs: potatoes, carrots, beets, cauliflower, steamed or in water and pureed (mashed potatoes, soufflés, steam puddings). Unmashed pumpkin and zucchini;

- fruits, berries, sweets: mashed, boiled and baked sweet berries and fruits. Puree, kissels, mousses, jelly, sambuki, compotes (mashed). Meringues, snowballs, buttercream. Sugar, honey, non-sour jam, marshmallows, marshmallow;

- sauces and spices: milk sauce (bechamel) without flour sautéing (if milk is tolerated), with the addition of butter, sour cream, fruit, milk-fruit;

- drinks and juices: tea, tea with milk, cream, weak cocoa and coffee with milk. Sweet juices from fruits and berries. Rosehip decoction;

- fats: butter unsalted butter, cow ghee of the highest grade. Refined vegetable oils added to dishes.

Table 8. Approximate one-day diet menu No. 1 surgical (wiped)

1st breakfast: soft-boiled egg, rice porridge on the water with the addition of 1/3 milk and 2 tablespoons of the DISO Nutrinor mixture, mashed. Tea with lemon

2nd breakfast: baked apple with sugar (no peel), soy jelly (200 g)

Lunch: oatmeal soup in meat broth, mashed, steamed meatballs with carrot puree, fruit mousse

Snack: protein omelette, rosehip broth, croutons

Dinner: boiled fish, baked with sour cream sauce, mashed potatoes, tea with cream

At night: fermented milk product with bioadditives 200 g (Bifidok, etc.)

If this diet is well tolerated, a gradual transition to an appropriate extended diet is required - surgical diet No. 1 (non-mashed version).

Table 9 Approximate one-day menu of diet No. 1 surgical (unrubbed)

1st breakfast: soft-boiled egg, crumbly buckwheat porridge with the addition of the DISO Nutrinor mixture, grated cheese, cream tea

2nd breakfast: fresh non-acidic cottage cheese with sour cream, wheat croutons, rosehip broth, jam (20 g).

Dinner:. soaked herring, potato-vermicelli soup in meat broth, boiled meat, baked under bechamel, boiled vegetables (cauliflower, carrots, potatoes), boiled dried fruit compote

Snack: liver pate (50 g), wheat bran decoction, dry biscuits

Dinner: boiled tongue (75 g), boiled fish baked with milk and vegetable sauce, carrot and apple roll, cheesecake, tea with lemon

At night: fermented milk product with bioadditives 180 g (Narine, etc.)

For the whole day: 250 g of premium wheat bread, 60 g of sugar, 40 g of butter

The gradual transition from one diet option to another implies a daily reduction in the number of dishes with maximum thermal and mechanical processing of food products. The good tolerance of the "new" dish is evidence of the normalization of the functions of the digestive system (in relation to the newly introduced products in the diet) and, accordingly, the possibility of continuing to expand the diet.

With poor tolerance of milk in the diet of patients, it is necessary to limit whole milk as much as possible and for a long time. This applies to a lesser extent to dairy products (cottage cheese, sour cream, sour-milk products).

If diarrhea occurs due to poor absorption of fats, the consumption of fatty foods, muffins and oils should be limited. Underweight people who consume too few calories while on a low-fat diet can supplement their caloric intake with enteral formulas containing medium-chain fats that are readily absorbed in the small intestine.

In the event that a large area of ​​the small intestine is removed (residual or residual intestine less than 1 meter), a long stage of first complete (5-7-10 days) and then partial parenteral nutrition is required, sometimes extended for several months. At the same time, it is important to ensure a sufficiently early start of enteral nutrition (from 5-7 days after the operation through a probe, and later in the “sipping” mode, but no later than 30 days). It is important to note that in the first 2-3 weeks after the start of enteral nutrition, it is advisable to use semi-elemental mixtures (see above), since they are rapidly absorbed in a small area of ​​the intestine. After that, it is necessary to switch to standard mixtures, which are prescribed for up to a year (in combination with surgical diets). During such a long recovery period, there is a gradual restructuring of the remaining section of the intestine. With a favorable course of the recovery period, the young age of the patient, it can be expected that over time, the residual (remaining intestine) will take over the functions of absorption in the volume that it was before the operation.

Natural food in the first weeks and even months does not play a significant role in restoring energy and vital nutrients for the body. However, it allows the gut to adapt.

After switching to a complete natural diet, patients with a short intestine are recommended a diet with a high content of proteins, carbohydrates and a moderate amount of fat. , multivitamins in liquid forms, vitamin B 12 (intramuscularly 1 mg every 2-4 weeks), folic acid (intramuscularly at 15 mg per week), vitamin K (intramuscularly at 10 mg per week), iron preparations (intramuscularly or intravenously, and then inside).

After 2 years after the operation, when the maximum adaptation of the gastrointestinal tract, and primarily the intestines, is achieved, various variants of the course of the disease can be observed, which require appropriate individual approaches to the nutrition of patients:

a) natural normal or close to normal nutrition;

b) natural nutrition using individually selected products;

c) natural nutrition with partial parenteral support;

d) total parenteral nutrition.

The condition after colectomy (removal of part or all of the colon) is often characterized by loose stools, therefore, in this case, a diet with a moderate restriction of mechanical and chemical irritants of the gastrointestinal tract is used (corresponds to a diet with a moderate exacerbation of inflammatory bowel diseases). In addition, foods containing an increased amount of calcium (cheese, calcined cottage cheese, etc.) are included in the diet. The diet after colectomy is individual and can only be selected by a gastroenterologist or nutritionist.

At all stages of postoperative dietary rehabilitation, the most important condition for the most rapid and adequate process of transition of patients from non-physiological, but temporarily necessary, so-called surgical postoperative diets, to a physiological diet is the timely use of protein composite dry mixtures in dietary rations (a component of the preparation of ready-made meals), due to the introduction of which into the composition of dietary dishes, up to 20% of the proteins of the daily diet are replaced. This has already been discussed in detail above. Protein composite dry mixes in meals are well tolerated by patients with IBD in the postoperative period and are recommended for long-term use for many months to improve digestion and metabolism.

Diet therapy of patients with inflammatory bowel disease with intestinal stenosis

If stenosis (narrowing of the intestinal lumen) occurs as a result of inflammatory bowel disease, especially Crohn's disease, then you should beware of excess fibrous food. These foods include: apples, tomato peels, pepper peels, lettuce, cabbage, asparagus, spinach, beets, citrus fruits, whole grains, nuts, seeds, mushrooms, grains, dried fruits, fruit peels and seeds, mushrooms, cucumbers. For each patient with intestinal stenosis, an individually acceptable amount of food containing a lot of dietary fiber can be determined by an experienced gastroenterologist or nutritionist. This takes into account the degree of stenosis, the anatomical zone of intestinal stenosis and a number of other conditions. If, despite the stenosis, the patient excessively consumes fibrous food, intestinal obstruction may occur. These complications can be prevented by avoiding fibrous foods (such as vegetables) or by peeling them (fruits and vegetables).

Our experience shows that subcompensated, and even more so decompensated intestinal stenosis, should be considered as life-threatening conditions for the patient, which are an absolute indication for reconstructive surgical treatment. Compensated stenosis requires especially careful dynamic monitoring by specialists of the center for the diagnosis and treatment of patients with IBD and, of course, constant correction of diet therapy.

Diet therapy for urinary and gallstones in patients with inflammatory bowel disease

Patients with IBD, especially Crohn's disease, are 20-70 times more likely to suffer from kidney stones (oxalic acid stones) than healthy people. In healthy people, oxalic acid becomes insoluble and non-absorbable when combined with calcium in the intestine. This compound is excreted from the body. Oxalic acid is found in a variety of foods and is a breakdown product of vitamin C. If fat absorption is impaired as a result of Crohn's disease or ulcerative colitis (which occurs when the ileum is inflamed or removed), the undigested fat reaches the lower segments of the intestine. Fat binds to calcium, and the amount of calcium in the intestine decreases. This means that a smaller amount of oxalic acid can be bound. Oxalic acid is absorbed into the blood and can lead to the formation of kidney stones. In the presence of poor utilization of fat, a diet rich in calcium (milk, fermented milk products) and containing low levels of oxalic acid salts (oxalates) should be followed.

Table 10 Foods High in Oxalates

There is evidence of the role of magnesium and vitamin B 6 in the prevention of the formation of oxalate stones, so the diet of patients should include foods rich in them, primarily wholemeal bread, cereals.

Diet therapy for intestinal dysbacteriosis in patients with inflammatory bowel diseases

Both in Crohn's disease and in ulcerative colitis, the vast majority of patients have intestinal dysbacteriosis. Normal intestinal microflora inhibits the growth of pathogenic microorganisms, normalizes intestinal motility, participates in the process of digestion and metabolism, synthesizes many vitamins (B1, B2, B6, B12, C, nicotinic acid, folic acid), has an immunomodulatory effect. With intestinal dysbiosis, these functions of the microflora are violated, so it is very important to restore the normal composition of the microflora. For this purpose, probiotics are used - preparations containing microorganisms that are part of the normal intestinal flora (for example, lactobacilli or bifidobacteria). Probiotics are particularly useful as adjuvant therapy for Crohn's disease and ulcerative colitis. Lactic acid-producing probiotics are beneficial even in inflammatory bowel disease patients with milk sugar (lactose) intolerance caused by a deficiency of lactase, an enzyme that breaks down lactose.

Phytotherapy for inflammatory bowel disease

Medicinal plants have proven their effectiveness in the treatment and prevention of diseases of the digestive system. The use of medicinal herbs is possible as an adjuvant therapy for patients with ulcerative colitis and Crohn's disease. The correct use of herbal medicine is possible only with an established clinical diagnosis of the disease, which reflects, in addition to the nature of the pathological process in the intestine, its stage, course variant, activity phase, degree of functional impairment, as well as complications and concomitant diseases. As for the dosage, it is purely individual. The selection of the dose is the task of the doctor, it may vary at the beginning of treatment and in the dynamics of the course of the disease.

Means used for the treatment and prevention of anemia in patients with ulcerative colitis and Crohn's disease at the stage of rehabilitation:

Collection number 1. Ingredients: St. John's wort grass 3 parts, nettle flowers 2 parts, blackberry leaves 2 parts. Cooking method: chop everything, mix well, pour 3 cups of boiling water, insist in a thermos for 3 hours, strain. Application: drink 1 glass 3 times a day while hot.

Collection number 2. Ingredients: stinging nettle leaves and birch leaves equally. Method of preparation: two tablespoons of the mixture, brew 1.5 cups of boiling water, leave for 1 hour, strain, add half a cup of beetroot juice. Application: drink a day in 3-4 doses 20 minutes before meals. The course of treatment is 8 weeks.

Collection number 3. Ingredients: stinging nettle leaves, flowering tops of buckwheat, leaves of fireweed angustifolia equally. Cooking method: brew three tablespoons of the mixture with two cups of boiling water, leave for 3 hours, strain. Application: drink a day in 3-4 doses 20 minutes before meals. The course of treatment is 6-8 weeks.

Collection number 4. Ingredients: nettle leaves, common yarrow inflorescences, dandelion root equally. Cooking method: brew 1.5 cups of boiling water for one tablespoon of the mixture, leave for 3 hours, strain. Application: drink infusion per day in 3-4 doses 20 minutes before meals. The course of treatment is 6-8 weeks.

Collection number 5. Ingredients: white lamb grass, tricolor violet grass, wild strawberry leaves (equal in total). Method of preparation: brew two tablespoons of the mixture with a glass of boiling water, boil for 10 minutes, leave for 3 hours, strain. Application: drink a day in 2-3 divided doses 10 minutes before meals. The course of treatment is 4-6 weeks.

Decoction of herb fireweed angustifolia. Method of preparation: pour 15 g of grass with a glass of water, boil for 15 minutes, leave for 1 hour. Application: drink 1 tablespoon 3-4 times a day before meals.

Decoction of inflorescences of meadow clover (red clover). Method of preparation: pour one teaspoon of inflorescences with 1 glass of hot water, boil for 5 minutes, strain. Application: drink 1 tablespoon 4-5 times a day.

Infusion of wild strawberry leaves. Cooking method: one tablespoon of dry chopped leaves (you can mix herbs and roots) and pour 1 cup boiling water, leave for 1/2 hour, strain. Application: drink 1 glass 1-2 times a day for 1-2 months.

Means used for intestinal dysbacteriosis, flatulence in patients with ulcerative colitis and Crohn's disease at the stage of rehabilitation:

Collection number 1. Ingredients: St. John's wort grass, cudweed marsh herb, yarrow grass equally. Method of preparation: three tablespoons of the mixture insist 2 hours in 1 liter of boiling water, strain. Application: drink 1/2 cup 4-5 times a day.

Collection number 2. Ingredients: peppermint leaves, fennel fruits, cumin fruits, anise fruits equally. Method of preparation: brew two teaspoons of the mixture with a glass of boiling water, insist in a tightly closed container for an hour, strain. Application: drink in several doses during the day 1 glass of infusion in small sips.

Collection number 3. Ingredients: peppermint leaves 20 g, chamomile flowers 30 g, calamus rhizome 15 g, common fennel fruit 15 g. Method of preparation: infusion. Application: drink as a warm infusion 1/2-3/4 cup 3 times a day after meals.

Collection number 4. Ingredients: erect cinquefoil rhizome - 25 g, blueberry leaves - 20 g, blueberry fruits - 20 g, chamomile inflorescences - 55 g. Method of preparation: leave one tablespoon of the mixture for 6 hours in a glass of cold water, boil for 5-7 minutes, strain. Application: drink the entire infusion in small sips throughout the day. The course of treatment is at least 2 weeks.

Decoction of bird cherry fruits. Cooking method: brew one tablespoon of fruits with 1 cup of boiling water, cook for 5 minutes on low heat, leave for 2 hours, strain. Application: drink 1/4 cup 2-3 times a day on an empty stomach. Especially indicated for patients with ulcerative colitis with concomitant pathology of the digestive system (chronic gastritis, pancreatitis, etc.).

Infusion of leaves and rhizomes of wild strawberry. Method of preparation: pour two tablespoons of dried and crushed leaves and rhizomes of wild strawberries with 2 cups of boiling water. Insist in a thermos for 1.5-2 hours, strain, cool. Application: drink 2-3 tablespoons 3-4 times a day before meals. The course of treatment is 10-12 days.

Means used to improve vitamin and mineral metabolism in patients with ulcerative colitis and Crohn's disease at the stage of rehabilitation:

Collection number 1. Composition: the whole lingonberry plant and the whole wild strawberry plant equally. Method of preparation: pour one tablespoon of the mixture with 1 glass of water, bring to a boil, strain, add honey to taste. Application: drink hot in a glass 3-4 times a day.

Collection number 2. Ingredients: rowan fruits 7 parts, nettle leaves 3 parts. Cooking method: brew one tablespoon of the mixture with 2 cups of boiling water, boil for 10 minutes, leave for 4 hours in a tightly closed container in a cool dark place, strain. Application: drink 1/2 cup 3 times a day.

Collection number 3. Ingredients: rose hips, raspberry leaves, currant leaves, lingonberry leaves equally. Cooking method: brew two tablespoons of the mixture with a glass of boiling water, boil for 10 minutes, insist in a tightly closed container until cool, strain, add sugar or honey to taste. Application: drink 1/2 cup 2 times a day.

Collection number 4. Ingredients: rose hips 3 parts, cranberries 2 parts, nettle leaves 3 parts. Method of preparation: mix the crushed raw materials well. Brew two tablespoons of the mixture with a glass of boiling water, leave for 3-4 hours, strain. Application: drink a glass 2-3 times a day.

Collection number 5. Ingredients: rose hips, black currant fruits, nettle leaves, carrot root equally. Cooking method: brew one tablespoon of the collection with 2 cups of boiling water, boil for 10 minutes, insist in a well-closed container for 4 hours in a cool dark place, strain. Application: drink 1/2 cup 3 times a day.

Collection number 6. Ingredients: string (grass), black elderberry (flowers), walnut (leaves), burdock (leaves, root), hops (“cones”), birch (leaves), strawberries (leaves), cocklebur (grass), yasnitka (grass), licorice (root), bedstraw (grass) - 10 g in total, verbena (grass) 5 g. Method of preparation: brew one tablespoon of the mixture with a glass boiling water, insist like tea. Application: and drink in between meals. For the day you need to use 1 cup of the dried mixture.

Application

The technology of preparation of some dishes used in the diet for inflammatory bowel diseases

1. Steam meat dumplings

Product name			Chemical composition
					Carbohydrates, g	Calorie content, kcal
Beef, boneless
Wheat flour
Butter
Weight of the finished dish (without oil)

Cooking technology:

Rinse the meat, remove tendons and fat, pass 2-3 times through a meat grinder, salt. Prepare a white sauce from milk and flour, cool and add to the meat mass with continuous beating, add eggs, mix thoroughly. Put the finished mass with a spoon in the form of quenelles into a saucepan moistened with water, pour warm water, bring to a boil and cook until tender (until the quenelles float) or steam. Drizzle with oil before serving. (“Card file of diet food dishes (therapeutic and preventive) nutrition of an optimized composition”, V.A. Tutelyan, 2008)

2. Natural steam omelet

Product name			Chemical composition
					Carbohydrates, g	Calorie content, kcal
chicken eggs
Butter
Finished meal weight:

Cooking technology:

Milk and salt are added to the eggs. The mixture is thoroughly stirred, poured onto a greased baking sheet and placed in an oven for 8-10 minutes. Salt is put at the rate of 0.5 g per 1 egg. The omelette mixture is poured onto a baking sheet 2.5-3 cm high, put in a steamer for 10-15 minutes. (“Therapeutic nutrition”, Preobrazhenskaya E.N., 2002).

3. Oatmeal soup with vegetables

Product name			Chemical composition
					Carbohydrates, g	Calorie content, kcal
Potatoes 01.03 – 31.08
Vegetable oil
Groats "Hercules"
Carrots 01.01 – 31.07
Finished meal weight:

Cooking technology:

Groats are poured into boiling water and boiled at a low boil until fully cooked. The resulting broth is filtered, and the grits are rubbed. A decoction with grated groats is placed on the edge of the stove. Potatoes and carrots are peeled, washed, chopped and stewed in a small amount of water in a bowl under the lid until cooked, then rubbed. The mashed vegetables are mixed with cereal broth. The soup is brought to a boil and salt is added. The oil is put into the pan before the soup is released. (“Therapeutic nutrition”, Preobrazhenskaya E.N., 2002).

4. Steamed boiled chicken soufflé

Product name			Chemical composition
					Carbohydrates, g	Calorie content, kcal
Chicken fillet from thigh
Chicken egg
Wheat flour
Butter
Butter (for lubrication)
Finished meal weight:

Cooking technology:

Pass the pulp of boiled chickens through a meat grinder twice, then gradually introduce milk sauce into the minced meat, beat the mass, add the yolks, at the last moment - whipped proteins, knead slightly from the bottom up. Put the mass on a greased baking sheet, cook for a couple. (“Therapeutic nutrition”, Preobrazhenskaya E.N., 2002).

5.Meat steam soufflé

Product name			Chemical composition
					Carbohydrates, g	Calorie content, kcal
1. Beef, boneless
3. Wheat flour I grade
6. Butter
Finished meal weight:

Cooking technology:

Rinse the meat, clean it from bones and tendons, cook, cool, turn through the fine grate of the meat grinder 2-3 times. From milk and dried flour, prepare a white sauce and add to the meat puree in small portions, kneading thoroughly. Add egg yolks and stir. Beat egg whites until stiff and gradually fold into meat puree. Put the finished mass on a greased baking sheet and cook in a steam cabinet. (“Therapeutic nutrition”, Preobrazhenskaya E.N., 2002).

6. Boiled fish soufflé

Product name			Chemical composition
					Carbohydrates, g	Calorie content, kcal
1. Hake with a head
1. Hake without a head
1. Pink salmon gutted with head
1. Gutted headless cod
3. Chicken egg
4. Wheat flour
5. Butter
Finished meal weight:

Cooking technology:

Pass the boiled fish fillet through a meat grinder, combine with thick milk sauce, butter, egg yolks. The mass is salted, kneaded and the whites whipped into foam are carefully introduced. Put the finished mass on a greased stewpan and steam. (“Therapeutic nutrition”, Preobrazhenskaya E.N., 2002).

7. Souffle curd steam with sour cream with/without sugar

Product name			Chemical composition
					Carbohydrates, g	Calorie content, kcal
Wheat flour
Chicken egg
Butter for lubrication
Sour cream 15%
Weight of the finished dish (with sugar):
Weight of the finished dish (without sugar):

Cooking technology:

Rub cottage cheese, add egg yolk, sugar (for a dish with sugar), milk, add flour in a trickle, salt, mix well. Beat the egg whites into a thick foam, add them to the curd mass, stirring from top to bottom. Put the prepared mass on a baking sheet, greased with oil, cook for a couple. Drizzle with sour cream when serving. (“Card file of diet food dishes (therapeutic and preventive) nutrition of an optimized composition”, V.A. Tutelyan, 2008)

8. Porridge from cereals "Hercules" dairy liquid

Product name			Chemical composition
					Carbohydrates, g	Calorie content, kcal
Oat flakes "Hercules"
Mix protein composite dry
Vegetable oil
Weight of the finished dish (for 9 and 18 grams of the mixture):

Cooking technology:

"Hercules" combine with a mixture of protein composite dry. Pour the prepared mixture into boiling water, add salt, sugar, bring to a boil. Drizzle with oil when serving. (“Card file of dishes for dietary (therapeutic and preventive) nutrition of an optimized composition”, Tutelyan V.A., 2008).

9. Liquid buckwheat porridge

Product name			Chemical composition
					Carbohydrates, g	Calorie content, kcal
Buckwheat
Milk 3.2%
Mix protein composite dry
Weight of the finished dish (for 24 g of the mixture):

Cooking technology:

Sort buckwheat, rinse, pour into boiling milk with water, add salt, cook over low heat under a lid until tender. 5-7 minutes before the end of cooking, pour in the dry protein composite mixture. Wipe the hot liquid porridge (for the pureed version), add sugar and bring to a boil again. (“Card file of dishes for dietary (therapeutic and preventive) nutrition of an optimized composition”, Tutelyan V.A., 2008).