In the overall structure of joint disease arthritis occupy a leading place, often pass into a chronic form with an actively progressive course and are one of the leading causes of disability patients. Many diseases with the joint component are often not separate diseases, but are part of the structure of various rheumatic and metabolic diseases. Accordingly, the therapeutic diet is differentiated depending on the etiology of the disease, its shape (acute attack, chronic form, interictal period), the condition of the patient and the medications taken.
Diet for rheumatoid arthritis joints
Treatment of rheumatoid arthritis includes a set of measures, one of which is dietotherapy. Its goal is to reduce the inflammatory process and tissue allergy, strengthen connective tissue structures, correction metabolism. The diet is built taking into account the current phase of the disease (active / inactive), the degree of joint damage and the presence of complications (circulatory insufficiency, amyloidosis).
To the basic principles of therapeutic nutrition of patients rheumatoid arthritis relate:
- ensuring an adequate physiological energy requirement of the body and a balanced diet for macro- and micronutrients;
- restriction of fat, without reducing the specific gravity of vegetable fat;
- restriction of allergen products;
- restriction of the carbohydrate part of the diet due to digestible carbohydrates;
- reduction of table salt to 3-5 g / day;
- compliance with the principle of maximum shaking (in the acute phase) of the gastrointestinal mucosa;
- compliance with fractional power (not less than 5-6 times / day).
The basis of therapeutic nutrition is taken Diet №10Р on Pevzner. Caloric content of the daily ration varies at the level of 2400 kcal (at normal weight) and decreased by 20-25% with increased body weight. The amount of protein at the level of 90-100 g, fat – 70 g and 250 g carbohydrates. The total amount of free liquid is reduced to 0,8-1,0 l, sodium chloride – 3-5
In the original phase rheumatoid apt at a heightened polish, accompanied by edemas caused by disturbance of the coal and water-salt metabolism, the calorie content of the pectin decreases to 1700-1800 with a salt restriction up to 2-3 grains per day. The protein content at the level of 70 g, fat 70-75 g and consumption of liquid to one liters per day.
The caliphiness of the paion is reduced mainly due to the availability of easily assimilated carbonaceous substances (ovoschi, fukuty, nekotopye species kpup). Sugar in the diet should not exceed 20 g. Reducing caloric content helps to reduce pain and inflammation, autoimmune reactions and excess veca, which will reduce the burden on the foot. The restriction of salt reduces edema and effusion into the joint bag. At the same time, the food is prepared without salt, and the dishes are dosed out within the daily rate directly at the table. Also, products containing a lot of salt are excluded: marinades, canned food, pickles, sea fish are replaced by river.
The restriction of proteins is due to their ability to activate autoimmune inflammation, while the specific weight of animal proteins is not less than 60%. After reducing inflammation to activate the recovery processes, protein intake increases to 90 g per day.
During an exacerbation, dietary nutrition should provide for the relief of gastrointestinal tract problems – food is cooked in a veal or cooked on a steak, crushed, with the exception of meat, fish, mushroom broths, spices, smoked products, spices. This is especially true in cases of appointment salicylates, glucocorticoids, indomethacin (methanol), which suppressing inflammation and reducing the pain, cause damage to the gastric mucosa, disrupt the functions of the gastrointestinal tract.
However, in cases of prolonged use, the protein should not be restricted in the pa- cion, as the need for them under the influence of such drugs is significantly increased. The menu for rheumatoid arthritis joints should include foods rich in ascorbic acid, niacin, bioflavonoids, contained in large quantities in rose hips, black currant, sweet pepper, tangerines, oranges, gooseberries, apples, rice and wheat bran, green tea.
Rheumatoid arthritis in the phase of remission provides a physiologically nutritious diet with the use of 90-100 g protein, 75-80 fats with a restriction of up to 300 g of easily assimilated carbohydrates (sugar, honey, confectionery, jam, jam). The salt content in the diets is still limited, but already to the level of 5-6 g / day. The diet excludes the use of strong coffee and tea, carbonated drinks and alcohol, which can provoke a relapse of the disease. Nutrition is fractional with 5-6 meals per day.
In popular articles on therapeutic nutrition, other diets are often used (Mediterranean, diet Donga, gluten-free diet, Diet Sister Hills and others), which are based on similar principles restricting products containing preservatives, dyes, chemical flavors, red meat, citrus and dairy products, however, they have not been widely used in our conditions.
Treatment of gouty arthritis
At the heart gouty arthritis lie violations of the exchange of purine bases, manifested by joint damage, more often of the toes caused by deposits of salt crystals uric acid in the synovial membrane of the joints.
The diet for gouty arthritis is based on the principles:
- decrease in the intake of purine bases and oxalic acid in food with food;
- reduction in the dietary intake of proteins and fats (mostly refractory), and if available obesity – and carbohydrates;
- moderate restriction in the diet of table salt;
- increase in the intake of foods with alkalizing action (vegetables and fruits, dairy products);
- increased consumption of free fluid (if there are no contraindications).
The main diet for gout и arthritis is aimed at normalizing the metabolism of purine bases, reducing the concentration of uric acid and its salts formed during processing of purines, and shifting the urine reaction to the alkaline side. The energy value varies within 2750-2800 Kcal. The diet is physiologically complete with moderate restriction in the diet of proteins up to 70-80 g and fats up to 80-90 g (mostly refractory).
The content of carbohydrates at a normal weight of the patient is about 400. Free liquid at the level of 2 l. The diet provides for a restriction / ban on products containing many purines and oxalic acid with restriction of table salt (up to 10 g / day). At the same time, foods that have a pronounced alkalizing effect (vegetables / fruits, milk) are introduced into the diet. To products with a high content of purines are all types of meat and especially various kinds of offal (tongue, liver, brains), dry yeast, sardines, legumes, red fish, seafood.
Where available obesity patient is assigned diet. Diet is not physiologically full and can be administered for a short time. Its energy value is 1900-2000 Kcal. The protein content in the diet is reduced to 70 g, fats – up to 80 g, carbohydrates up to 250 g, mainly due to simple carbohydrates (honey, fresh wheat bread, sugar, various sweets, flour and confectionery products) and to a lesser degree – complex carbohydrates (some types of cereals). Meat / fish reception – no more than 1-2 times a week. Vegetables and fruits are recommended to eat raw, baked or boiled. Food is divided into small portions up to 5-6 once a day, a plentiful intake of slightly alkaline mineral waters.
Great importance in the therapeutic diet for gouty arthritis is protein / carbohydrate unloading days, which should be conducted at a frequency of 1-2 times a week. It is recommended that:
- fruit and vegetable day, up to 1,5 kg of vegetables or fruits and 500 ml of unsweetened rosehip broth;
- Milk day: (1 l milk and 200 g curd);
- kefir day (up to 1,5-2 l kefir per day);
- cottage cheese day: (500 g skim curd, 500 ml milk).
Especially important is the diet for gouty arthritis during an exacerbation. It provides for the complete exclusion from the diet of all meat and fish products. During this period, the diet should be based on vegetarian products, as well as liquid cereals, vegetable / milk soups, sour-milk products, vegetable / fruit decoctions and juices, herbal teas.
During the exacerbation of the disease, frequent unloading days are needed (optimally every other day) and increased consumption of alkaline, non-carbonated mineral waters. Some articles recommend raw food and describe the treatment of arthritic arthritis with starvation, which is highly undesirable, since hunger treatment leads to a sharp increase in the level uric acid. Only unloading days.
Diet for psoriatic arthritis
In an integrated approach to treatment psoriatic arthritis therapeutic nutrition significantly reduces the severity of clinical manifestations of arthritis, reduces the frequency and intensity of seasonal exacerbations. Dietary food is directed to:
- normalization of metabolic and metabolic processes in the body;
- creation in the body of an optimal acid-base balance with the predominance of an alkaline reaction over an acid reaction;
- decrease in intensity, frequency and severity of exacerbations psoriatic arthritis;
- increasing the immune status of the patient’s body psoriasis;
- normalization of the function of the digestive tract.
It is advisable to select a diet individually according to the severity of the clinical manifestations of psoriatic arthritis, the rate of progression, the immune status of the patient, and the specificity of the metabolism.
With benign flow and absence of deformations of the joints outside the period of exacerbation, the diet is taken as a basis with the exclusion of fatty meat varieties, canned foods, spices, smoked foods and pickles from the diet, snacks and muffins. Enrichment of the diet with vegetable products containing fiber (carrots, cabbage, turnips, apples, rutabaga), which contribute to improvement of gastrointestinal motility, is enriched toxins and prevention constipation, saturation of the organism with macro- and micronutrients. It is important to observe a strict diet for a long period. Introduced into the diet of various vegetable oils, alkaline mineral water. The food should be a fraction, small portions.
At the stage of exacerbation, with the appearance of changes on the part of the joints (increase in size, deformity, soreness) or the development of polyarthritis, therapeutic nutrition provides for a restriction in the diet of carbohydrates to 200-250 g due to the reduction of digestible carbohydrates and protein restriction to 70-80. meat / fish broth, limited to fish and meat, which are used only in boiled form without salt.
The ration is enriched with foods rich in vitamins (vegetables, fruits, berries) and their juices, as well as broth of rose hips, sea buckthorn, mountain ash. The volume of free liquid is reduced to 1-1,5 l. With sluggish flow psoriatic polyarthritis it is recommended to hold vegetable and fruit-free days.
With intensive use of glucocorticoids, salicylates requires an additional correction of dietary nutrition. The diet is supplemented with products containing high-grade protein and lipotropic substances – fish, lean meat, cottage cheese, seafood, berries, vegetables, fruits. Restrict refractory animal fats, reduce salt intake, reduce the carbohydrate content, due to sugar, and products containing oxalic acid – by-products (brain, kidney, liver, tongue), strong meat / fish broth, salted cheese, chilli, spinach, sorrel, tomatoes, chocolate, celery, gelatin, rhubarb). Increase the content of products rich in potassium – fresh fruits / vegetables, dried apricots, prunes, raisins.
The diet includes mainly vegetarian soups or prepared on light meat / fish broths first courses with a little addition of cereals. For second courses, it is recommended to use dietary meat of turkey, chicken and rabbit, as well as low-fat red meat varieties boiled or baked in the oven. Fish, both marine and river, mostly lean.
Fats in the diet are introduced in the form of linseed or olive oil and unsalted butter. Dishes from chicken eggs are used in the form of a protein omelet. The use of cereals, both in the form of an independent dish, and as a side dish is not limited. White and black bread, biscuits are allowed. In the diet should include low-fat cottage cheese and dishes from it, sour-milk products, low-fat milk, unsalted varieties of cheese.
It is recommended to increase the volume and range of vegetables and fruits, both in the form of vinaigrette and salads dressed with vegetable oil, and in boiled or stewed. From sweets to the diet can include marshmallows, marmalade, pastille, not chocolate candies, jam. As soft drinks are recommended non-strong green tea, vegetable / fruit juices, fruit drinks and compotes, broths of wheat bran, dog rose, chicory, kvass, and also – not aerated, slightly mineralized alkaline mineral water.