GINGIVITIS AND ITS DIETARY INTERVENTION

GINGIVITIS
Gingivitis means inflammation of the gums (gingiva). It commonly occurs because of films of the bacteria that accumulate on the teeth, called plaque. This type is called plaque induced gingivitis.


Gingivitis is a non-destructive type of periodontal disease. However, if left untreated, gingivitis can progress to periodontitis, which is more serious and can eventually lead to loss of teeth.

TYPES OF GINGIVITIS
1. Dental plaque induced gingival disease: This can be caused by plaque, systemic factors, medications or malnutrition.

2. Non─ plaque induced gingival lesions: Can be caused by a specific bacterium, virus or fungus. It night also be caused by genetic factors, systemic conditions including allergic wounds, or reactions to foreign bodies (such as dentures).

CAUSES OF GINGIVITIS
• Accumulation of plaque and tartar between and around the teeth. The plaque triggers an immune response, which eventually lead to the destruction of gingival (gum) tissues and further complications, including loss of teeth.


• Dental plaque.

• Changes in hormones: Which may occur during puberty, menopause, the menstrual cycle and pregnancy. The gingiva might become more sensitive, raising the risk of inflammation.

• Drugs: E.g; dilatin (anti­convulsant).

• Smoking.

• Age: the risk of gingivitis increases with age.

• Family history: people whose parents had gingivitis have a higher risk of developing it too.

SIGNS AND SYMPTOMS OF GINGIVITIS
a. Gums are bright red or purple.
b. Gums are tender and sometimes painful to the touch.
c. Gums bleed easily when brushing teeth or flossing.
d. Halitosis (bad breath).
e. Inflammation (swollen gums).
f. Receding gums
g. Soft gums

Note: In mild cases of gingivitis, there may be no discomfort or noticeable symptoms.

TREATMENT/DIET INDICATION
If the patient is diagnosed early on, and treatment is prompt and proper, gingivitis can be successfully reversed.

Probiotics may help to decrease gingivitis and plaque, bacteria in fermented foods might suppress the growth of pathogens in the oral cavity.

Consuming fermented dairy products is associated with less periodental diseases.

1. Protein: for tooth structure, mucosal/corrective tissue development and immune function.

2. Calcium: tooth structure; may enhance enamel remineralization.

3. Phosphorous: tooth structure.
4. Zinc
5. Folate
6. Iron
7. Vitamin A
8. Vitamin C
9. Vitamin D
10. Omega 3 fatty acids (modulates the inflammatory response).

DIET PLAN
1. Whole foods diets with lots of lean protein and fresh vegetables
2. Avoid most processed foods, especially those high in simple sugars.
3. Oily fish/Fish oil and fluoride sources (e.g in tooth paste)

KEY POINTERS DURING THE SELECTION OF A PRE-OPERATIVE DIET

PRE-OPERATIVE DIET
Patients who have lost much weight prior to surgery benefit considerably by ingesting a high protein, high calorie diet for even a week or two prior to surgery.

The diet maybe of liquid, soft or regular consistency depending upon the nature of the pathologic condition.

Parenteral nutrition or semisynthetic fibre-free diets are sometimes used. In addition, the maintenance of metabolic equilibrium as in diabetes or other diseases must not be overlooked.

Foods which provide a maximum amount of nutrients in a minimum volume are essential.
Small feedings at frequent intervals are likely to be better accepted than large meals which cannot be fully consumed.

For additional protein, milk beverages may be fortified with non-fat dry milk or commercial protein supplements.

Fruit juices fortified with glucose or high carbohydrate food, increase carbohydrate intake and facilitate storage of glycogen.

Butter incorporated into foods and light cream mixed with equal amounts of milk are also useful for increasing the calorie intake. On should remember that the excessive use of sugars and fats may cause nausea.

Foods and fluids are generally allowed until midnight just preceding the day of operation, although a light breakfast maybe given when the operation is scheduled for afternoon and local anaesthesia is to be used.

It is essential that the stomach be empty prior to administering the anaesthesia so as to reduce the incidence of vomiting and subsequent danger of aspiration of vomitus.

When an operation is to be performed on the gastrointestinal tract, a diet very low in residue maybe given 2 to 3 days prior to operation.

In acute abdominal conditions such as appendicitis and cholecystitis, no food is allowed by mouth until nausea , vomiting pain and distension have passed in order to prevent the danger of peritonitis.

DIET IN SURGERY
Good nutrition prior to and following surgery ensures fewer post-operative complications, better wound healing, short convalescence and lower mortality. chronic diseases increase the nutritional requirements.

Malnutrition can lead to weight loss, poor wound healing, decreased intestinal motility, anaemia, oedema or dehydration and the presence of ulcers. The circulating blood volume and the concentration of the serum proteins, haemoglobin and electrolytes may be reduced.

Following surgery or injury the need for nutrients is greatly increased as a result of loss of blood, plasma, or pus from the wound surface, haemorrhagefrom the gastrointestinal or pulmonary tract, vomiting and fever. During immobilization, loss of some nutrients such as protein is accelerated.

A fairly simple operation often involves moderate deficiency in food intake for a few days following the operation /surgery. Some nutrients may be supplied by parenteral fluids, but the full needs of the body usually are not met by that means alone.

Adequate oral intake is often delayed for a considerable period following cardiac or gastrointestinal surgery. Metabolic losses are great and alternative methods of nutritional support needed.

The objectives in the dietary management of surgical conditions are:

1. To improve the pre-operative nutrition whenever the operation is not of an emergency nature.
2. To maintain correct nutrition after operation or injury as far as possible and
3. To avoid harm from injudicious choice of foods.

REQUIRED NUTRIENTS

(1) PROTEIN: A satisfactory state of protein nutrition ensures

a. Rapid wound healing
b. Increases resistance to infection
c. Exerts a protective action upon the liver against the toxic effects of anaesthesia and
d. Reduces the possibility of oedema at the site of the wound .

The presence of oedema is a hindrance to wound healing and in operations on the gastrointestinal tract, may reduce motility thus leading to distension.

When protein is depleted in post-operative condition complications are increased. Protein catabolism is increased for several days immediately following surgery or injury , patients are characteristically in negative nitrogen balance even though the protein intake may be appreciable. The degree of negative balance can be reduced at higher intakes of protein and calories.

The level of protein to be used in pre-operative and post-operative diets depends on the previous state of nutrition, the nature of the operation and the extent of the post-operative losses. Intake of 1.0 to 1.5g per kilogram or about 100g of protein are necessary as a rule.
   
(2) ENERGY: Without sufficient caloric intake tissue proteins cannot be synthesized. Excess metabolism of body fat may lead to acidosis, whereas depletion of the liver glucose may increase the likelihood of damage to the liver with 2500 to 3000 kcal patients make progress.
Obesity delays healing. Whenever possible, it should be corrected. Rapid weight loss results in loss of lean body mass and should be avoided.

(3) MINERALS: Phosphorus and potassium are lost in proportion to the breakdown of body tissue. In addition derangements of sodium and chloride metabolism may occur subsequent to vomiting, diarrhoea, perspiration, drainage, anorexia and dieresis or renal failure.

Iron-deficiency anaemia occurs in association with mal-absorption or excessive blood loss. Diet alone is ineffective in correction of anaemia, but a liberal intake of protein and ascorbic acid, together with administration of iron salt is of value in convalescence. Transfusions are usually required to overcome severe reduction in haemoglobin level.

(4) FLUIDS: The fluid balance maybe upset prior to and following surgery owing to failure to ingest normal quantities of fluids and to increased losses from vomiting ,exudates , haemorrhage , diuresis and fever. A patient should not be operated in a state of dehydration since the subsequent dangers of acidosis are great. When dehydration exists prior to operation, parenteral fluids are administered, if the patient is unable to ingest sufficient liquid by mouth.

(5) VITAMINS: Ascorbic acid (vitamin C) is especially important for wound healing and should be provided in increased amounts prior to and following the surgery. Vitamin k is of concern to the surgeon since the failure to synthesize vitamin k in the small intestine, the inability to absorb it or the defect in conversion to prothrombin is likely to result in bleeding. Haemorrhage is especially likely to occur in patients who have diseases of the liver.

IN-HOUSE REMEDY TO DIARRHOEA

DIARRHOEA
This is the second most common cause of death in childhood.  In diarrhoea, the stools are liquid or semi solid and large volumes of these are passed frequently. There is also vomiting, cramps and abdominal pain. The food passes through the GIT so rapidly that its digestion and absorption is reduced. The faecal matter moves through the colon so fast that water and electrolytes are not re­absorbed.
Frequent and/or prolonged attacks result in loss of fluids, electrolytes, minerals, vitamins, proteins, fats, CHO & as a result, there is loss of body weight. This leads to dehydration.


If diarrhoea occurs more than 14days, it is called persistent diarrhoea.




AETIOLOGY/CAUSES
Acute diarrhoea may be due to
1. Indigestion
2. Poor food hygiene or improperly handled foods (cause infectious diseases)
3. Food intolerance and allergy
4. Infections
5. Virus (rotavirus)
6. 6 .General dietary excesses with fermentation of sugars
7. Excess fibre stimulation of intestinal
8. Excess fibre stimulation of intestinal function

SIGNS AND SYMPTOMS
1. Frequent loose, water stools
2. Abdominal cramps
3. Abdominal pain
4. Fever
5. Bleeding
6. Light-headedness or dizziness from dehydration.

DIET THERAPY
The first step is to identify the cause and remove it. If diarrhoea is so severe and dehydration has set in, fluids and electrolytes may be given intravenously to let the GIT rest. This is followed by feeding fluids with gradual move to ORT and later to a very low residue diet and then a nutritionally adequate diet .probiotics or its sources can also be given.

HOME FORMULA FOR ORS
Water ─ 1L
Sugar  ─ 6 level teaspoons/cubes
Salt ─ ½ level teaspoon.
Or
Oral rehydration therapy/salt formula by WHO in packaged form

MAL-ABSORPTION SYNDROME

MAL-ABSORPTION SYNDROME
Mal-absorption syndrome occurs when the bowel is prevented from absorbing important nutrients and fluids, including proteins, fats and vitamins.

AETIOLOGY
The main role of the intestine is to absorb nutrients from food into the blood stream.
Mal-absorption syndrome therefore, refers to a number of disorders in which the small intestine cannot absorb enough of certain nutrients and fluids. E.g; macro and micro nutrients.

Factors that may cause mal-absorption syndrome include;

1. Damage to the intestine from infection, inflammation, trauma, or surgery.

2. Prolonged use of antibiotics

3. Other conditions, such as celiac disease, Crohn’s disease, chronic pancreatitis or cystic fibrosis.

4. Lactase deficiency, or lactose intolerance

5. Certain defects that are congenital (present at birth), such as biliary atresia (i.e, when the bile ducts don’t develop normally and prevent the flow of bile from the liver).

6. Diseases of the gallbladder, liver or pancreas

7. Parasitic diseases

8. Radiation therapy, which may injure the lining of the intestine.

9. Certain drugs that may injure the lining of the intestine, such as tetracycline, colchicine, or cholestyramine.

10.  Digestive problems (due to inability of stomach to produce enzymes for digestion).

SIGNS AND SYMPTOMS
1. Light coloured, floating stools
2. Dry hair or hair loss
3. Oedema (fluid retention)
4. Bloating or explosive diarrhoea
5. Anaemia, malnutrition.
6. Weight loss, muscle wasting

DIETARY GUIDELINES
The rationale for diet in mal-absorption syndrome is to help decrease rate of intestinal emptying and to improve nutritional status. Adequate nutrition can be achieved by:

1. Eating small, frequent meals.
2. Limiting intake of high fat foods (e.g, fried foods, and high fat meats)
3. Limiting high fibre foods.
4. Limiting dairy products
5. Limiting intake of concentrated sweets and confectionaries; soda, sugar and sweet desserts.
6. Drinking enough liquids in-between meals.

Successful management is to identify the under lining defect and implement specific therapy to correct it.

HAEMORRHOID - THE DIETARY INTERVENTION

HAEMORRHOID (PILE – JEDI JEDI)

The term haemorrhoid refers to a condition in which the veins around the anus or lower rectum have swollen and inflamed. It may result from straining to remove stool, pregnancy, old age or ageing, chronic constipation or diarrhoea and anal intercourse, i.e: homosexual.
Haemorrhoid is either inside the anus (internal) or under the skin around the anus (external).

SYMPTOMS
Many anorectal problems including fistulate, abcesses or irritation and itching have similar symptoms with haemorrhoid. Haemorrhoid usually are not dangerous or life threatening. In most cases, haemorrhoid symptoms may go away within few days. The most common symptoms of the internal haemorrhoid is bright red blood covering the stool, or in tissue paper or toilet bowl. However, an internal haemorrhoid may protrude through the anus outside the body, becoming irritated and painful. It is known as protruding haemorrhoid.

Symptoms of external haemorrhoids may include painful swelling or a hard lump around the anus that result when a blood clot forms. This condition is known as thrombosed external haemorrhoid. Excess straining, rubbing or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Straining muscles may also cause itching.

TREATMENT
Medical treatment of haemorrhoid is usually aimed at relieving symptoms. Some of the things they tell them to do:

1. Tub bath/sit bath several times a day in plain warm water for about 10 minutes and application of haemorrhoid cream or subpository to the affected area for the affected time.

NUTRITION THERAPY
 Increase fibre in the diet
 Increase fluid intake
 The person should exercise regularly and not strain when in the toilet, and serious cases may require haemorrhoidectomy (surgery of the haemorrhoid)
 Also, pass stool easily and decrease pressure on the anus and empty bowel as soon as possible after the urge.

CONSTIPATION AND ITS DIETARY INTERVENTION

CONSTIPATION

AETIOLOGY:

Each person develops a usual bowel pattern, so that a bowel movement every day or every second or third day may be perfectly normal for a given individual.  Constipation refers to a decrease in a person’s normal frequency of defecation, especially if the stool is hard, or difficult to expel. Aside from disease conditions like obstruction in the colon,certain drugs like sedatives.

The common causes of constipation are:
• Poor/ faulty dietary habits( lack of water and fibre in the diet),
• lack of excercise and immobility
• voluntary retention(poor bowel habits)
• prolong use of laxatives
• others like change of environment and nervous tension.
• Treatment involves dietary and life style chances, not laxatives.

SIGNS AND SYMPTOMS
• Passing fewer than 3 stools a week
• Having a lumpy or hard stool
• Straining to have bowel movements
• Feeling as though there is a blockage in the rectum that prevents bowel movement
• Feeling as though you cannot completely empty stool from the rectum.

DIET INDICATION
High fibre and fluid is required so as to initiate easy passage of stool.

Note: Persons who have little or no exercise, especially the elderly, suffer from atonic constipation. They limit their food selection to soft, low fibre foods, they limit fluid intake to prevent urination, especially at night. They become dependent on laxatives, and yet find no relief, as the causative factors not eliminated.



The following dietary changes helps get rid of constipation.

1. Increased fluid intake to 2litres (that is: 8 glasses of water, in addition to other beverages and liquid foods, e.g, soups, milk etc).

2. Include 200─250g of vegetables and fruits in the diet.

3. Eat raw vegetables (e.g, cabbage, carrot, cucumber, tomatoes).

4. Include 2 or more servings of fruits(e.g, banana,oranges, guava, pawpaw, apple, e.t.c).

5. Include cooked preparations of germinated pulses in diet.

6. Good bowel habit

7. exercise

NOTE: changes in the diet must be introduced gradually to avoid feeling of bloating or cramping due to the changes.

Breakfast: whole wheat bread (2─3 slices) + buttermilk or pap (1cup).

Lunch: rice, beans + fruit salad

Supper: wheat + vegetable soup
Enough water and fruits are also necessary.

Fruits may serve in-between meals

DIETARY INTERVENTION TO PEPTIC ULCER

PEPTIC ULCER
This includes both gastric (stomach) and duodenal ulcers.

PATHOPHYSIOLOGY AND AETIOLOGY:
In ulcer patients, the mucosa is not sufficiently resistant to the acids secreted by the stomach. If just the superficial cells are involved, the lesions is called an erosion. If the muscular layer of the stomach or duodenum is involved, the person has an ulcer.

Gastric ulcers are more common the right side of the stomach, while duodenal ulcers account for 60% of all ulcers, and are associated with increased acidity of the stomach.
• The majority of all peptic ulcers are related to Helico­bacter Pylori infection.
• The second most common cause is related to the excessive of NSAIDs (Non­steroidal Anti­inflammatory Drugs) such as aspirin, ibuprofen and naproxen.

H. Pylori and NSAIDs break down the stomach or intestine’s protective mucus layer, leading to peptic ulcer. Long term use of other medications, such as potassium chloride (KCl) and corticosteroids is also associated with ulcer formation.

Smoking, alcohol, coffee and stress are all predisposing factors.

Genetic factors, physical factors such as imbalance between the gastric acid and pepsin secretions and inability of the mucosa to resist these secretions.

SIGNS AND SYMPTOMS
1. A gnawing burning epigastric pain, when the stomach is empty, characterizes duodenal ulcer. This occurs 1─3 hrs after eating or at night.
2. With gastric ulcer, the pain is made worse by ingesting food, or is unrelated to food intake.
3. Bleeding, experienced by one fourth of ulcer patients, which occur more often with duodenal than with gastric ulcers.
4. Coffee  ground emesis, which means vomiting of blood immediately after bleeding begins. The vomitus is brown black and granular
5. nausea, anorexia and sometimes, weight loss


MANAGEMENT
• Drug Therapy: this includes use of antacids to neutralise excess gastric acid secretion
• Rest
• Nutritional therapy
• In severe cases surgery

RATIONALE FOR DIET INDICATION
The objective of peptic ulcer diet therapy is to prevent hyper secretion of HCL acid in order to reduce the sore and pain in the gastric and duodenal mucosa. Also, nutrition therapy aims to promote healing, based on a complex sequence of events, going from the initial trauma to the repair of the damaged tissue.

In nutritional therapy the traditional approach is provision of bland diet and small frequent meals, and modification of food consistency.
The liberal approach is to consider the traditional approach and relate it to the available scientific backing treating each patient individually.

DIET PLAN
Calories distribution should be adjusted according to the patient’s needs, so as to normalize the nutritional status, having a protein intake of 1.2g/kg/BW/day in the acute stage (5th ─8th week) and up to 1.5g/ BW/day in the recovery stage.

CHO should be adjusted to the patients needs, without disaccharides concentration, so as to avoid fermentation. Also, lipids, without concentration of saturated fats.

Micronutrients, such as zinc, is needed to maintain the immune system function, as a response to oxidative stress and to heal wounds.

Also, selenium may be used to reduce infection complications and improve healing, together with vitamin A.

A fibre rich diet (20─30 g/day) intake advisable,(more of soluble fibre) because fibres act as buffers, reducing concentrations of bile acids in the stomach and the intestinal transit time, resulting in less abdominal bloating, thus decreasing discomfort and pain the G.I.T.

MEAL PLAN
Morning: Skimmed milk + boiled egg
Afternoon: soft semo + okro + fish
Night; Cooked rice + Vegetable salad + natural juices (not coffee nor citrus nor acidic fruit juices)
Snack: Apple/ banana/ walnuts,/carrots.
Food Groups Allowed Use With Caution Prohibited
Dairy Milk, low fat cheese, yoghourt Fatty or cream cheese ─
Oil Seeds Flax seeds, walnuts ─ ─
Oils Vegetable oils, olive oils

─ Fried foods
Fruits Apple, paw─paw, banana Orange, pineapple,lemon
Vegetables Leafy dark green vegetables, carrot, spinach, leek, radish, zucchini, green beans Broccoli, cauliflower, cabbage, cucumber, onion, red pepper Spicy peppers (black pepper, chilli)
Meats Lean meat (beef, pork, fish, chicken) Fatty meats, organ meats and sausages ─
Beverages Natural juices Citrus/acidic fruit juices Coffee, black tea, cola drinks

GASTRITIS

GASTRITIS

Gastritis is an inflammation, irritation, or erosion of the lining of the stomach. It can occur suddenly (acute) or gradually (chronic).

AETIOLOGY:
Caused by irritation, due to excessive alcohol use, chronic vomiting, stress, or the use of certain medications, such as aspirin or other anti-inflammatory drugs. It may also be caused by the following:

1. Helicobacter pylori: A bacteria that lives in the mucous lining of the stomach; without treatment, the infection can lead to ulcers, and in some people, stomach cancer.
2. Bile reflux: A backflow of bile into the stomach from the bile tract (that connects to the liver and gall bladder).
3. Infections: Caused by bacteria and viruses.

If gastritis is left untreated, it can lead to a severe loss of blood and may increase the risk of developing stomach cancer.

SYMPTOMS OF GASTRITIS
This varies among individuals and in many people, there are no symptoms. However, the most common symptoms (if any) include:
• Nausea or recurrent stomach upset
• Abdominal bloating
• Abdominal pain
• Vomiting
• Indigestion
• Burning or gnawing feeling in the stomach between meals or at night
• Hiccups
• Loss of appetite
• Vomiting blood or coffee ground─like material
• Black, tarry stool.

DIET INDICATION
RATIONALE:
Diet is modified in gastritis, so as to incorporate foods that does not cause irritation to the stomach, or that do not increase stomach acids, or that cause symptoms such as stomach pain, heart burn, or indigestion.
Small and frequent feeding is also important. The patient is advised not to eat right before bedtime.

FOODS TO BE AVOIDED
BEVERAGES: 
1. Hot cocoa and  carbonated drinks
2. Whole milk and chocolate milk
3. Orange, grape fruit juices, alcohols.
SPICES AND SEASONINGS:
1. Black and red pepper, chilis
2. Garlic powder, chili powder.
OTHER FOODS:
1. Highly seasoned, high fat meat, eg: sausages
2. Onions and garlic
3. Tomato products.

FOODS TO BE INCLUDED
1. Fruits
2. Vegetables
3. Whole grains and fat free dairy foods
4. Healthy fats (olive oil and canola oil)
5. Lean meats (poultry, fish, beans, eggs and nut)
6. Whole grains include cereals.

DIET PLAN
Not all foods affect everyone the same way. It is important therefore, to learn which foods cause the symptoms. Below is a sample menu:
Breakfast: 1 cup skimmed milk + boiled egg
Mid─morning snack: 100 ─ 150g garden egg + boiled egg
Lunch: 250g cooked brown rice + fish (unspiced)
Snack: Any fruits (except citrus)
Dinner: Wheat + Soup & Soft vegetables.

NOTE: A healthy meal plan is low in unhealthy fats, salt and added sugar.

DUMPING SYNDROME

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DUMPING SYNDROME
Dumping syndrome occurs as an effect of altered gastric reservoir function, abnormal post­operative gastric motor function, and/or pyloric emptying mechanism. It can affect patients after gastric surgery (gastrectomy, vagotomy or pyloroplasty).

Dumping symptoms can be separated into early and late forms, depending on the occurrence of symptoms, in relation to the time elapsed after a meal.

PATHOPHYSIOLOGY:
Postprandially, the function of the body of the stomach is to store food and allow for initial chemical digestion by acid and proteases before transferring the food to the gastric antrum. Solids are then reduced to desired size, before they are able to pass through the pylorus.

An intact pylorus prevents the passage of larger food particles into the duodenum. Therefore, in this way, emptying is controlled and regulated.

AETIOLOGY:
Both early and late forms of dumping syndrome occurs because of rapid delivery of large amounts of osmotically active solids and liquids to the duodenum. This is a direct result of alterations in the  storage function of the stomach and/or pyloric emptying mechanism.
However, the severity of dumping syndrome is determined by the rate of gastric emptying. Gastric surgery alters the rate and mechanism of gastric emptying; hence it is a major cause of dumping syndrome.

Any surgery in which the pylorus is removed, by­passed, or destroyed increase the rate of gastric emptying. Also, gastric mucosal function is altered by surgery and acid, and enzymatic secretions are decreased. This would affect the hormonal secretions that sustain the gastric phase of digestion, thereby making the food pass to the duodenum without initial digestion in the stomach.
Also, dumping syndrome is due to inappropriate composition of diet, with sugars being used as a carbohydrate source.

SIGNS AND SYMPTOMS:
1. Diarrhoea
2. Vomiting
3. Weight loss
4. Nausea.
5. Weaknes
6. Sweating
7. Faintness soon after eating.



Due to absence of stomach enzymes or the pyloric sphincter, food enters into the intestines directly and cause dumping.

DIET INDICATION
RATIONALE:
Rationale for diet modification in dumping syndrome is to slow down emptying of food from the stomach, to slow intestinal motility and to supply the body with enough fluid, vitamins and minerals that would help maximize patient’s nutritional status, with regular sugar meals.

HIGH PROTEIN, MODERATE FAT, LOW CARBOHYDRATE DIET (DIET PLAN)

DIET PATTERN
FOOD ALLOWED AND DISALLOWED

EACH DAY
100 ─ 120g complex CHO daily Egg ─ 1 (soft or hard boiled)
Avoid simple sugars, Syrups, sweet deserts, etc Low fat milk : 300mls if tolerated
Include liberal protein and moderate fat Fish, poultry, meats of all kinds (boiled, not fried)
Include 6 small meals regularly, every day Bread substitutes: rice, boiled or mashed potato
Take liquids 30 ─ 60 minutes after meals Cereal (1 serving)
Include vegetables and mineral supplements,
Avoid very hot or cold food Vegetables, all fruits and nuts if tolerated (iron, calcium, folate, B12)

Therefore, this sample includes the following:
 Calories ─ 1550
 Fat ─ 62g
 Protein ─ 87g
 CHO (Complex) ─ 119g
 Sodium ─ 2327mg
 Potassium ─ 2372mg

SAMPLE
 Breakfast ─ 1 egg, 1 teaspoon margarine, 2 bread slices, ½ grapefruit
 Midmorning snack ─ 6 crackers (biscuits), 1─2 banana fingers
 Lunch ─ ½ cup fresh fruit salad, brown rice
 Snack ─ ½ turkey sandwich, with very little mayonnaise
 Dinner ─ ½ chicken breast, wheat or semo and okro soup
 Bed time snack ─ 1 small apple (60 minutes after meal)

GASTRO-ESOPHAGEAL REFLUX DISEASE (GERD)

GASTRO-ESOPHAGEAL REFLUX DISEASE (GERD) 
  It is the regurgitation of thee gastric content into the esophagus through the lower esophageal sphincter. This is due to increased abdominal pressure or relaxation of the lower esophageal sphincter.

SIGNS AND SYMPTOMS:
Its major symptoms includes
 Heartburn
 Delayed gastric emptying
 Delayed esophageal clearance rate
 Irritation of the esophageal mucosa


DIET INDICATION:
There are four main goals of nutritional therapy for GERD which includes:

 Maintain lower esophageal sphincter pressure by limiting dietary fat intake

o The patient should also loose weight because obesity increases abdominal pressure.

o Foods like chocolate, coffee should be avoided because they decrease lower esophageal sphincter (LES) pressure.

o Avoid alcohol because it increases gastric acid secretion

o Avoid very tight clothes around the abdomen.

 To decrease reflux frequency in volume by eating small meals more frequently

o By drinking fluids between meals rather than with meals

o Take adequate fibre to avoid constipation

 To decrease esophageal irritation and limit the intake of carbonated beverages, spicy
foods, and any food that the patient discovers causes heartburn should be avoided, also smoking should be avoided.

 To improve esophageal clearing ability by counseling the patient to sit upright after eating or eat 2-3 hours before bed time. If you can elevate the head of the bed.

DIET PLAN PREPARATION:
 Avoid fried foods
 Avoid carbonated drinks
 Avoid spicy foods

ESSENTIAL BENEFITS OF WHEY PROTEIN

ESSENTIAL BENEFITS OF WHEY PROTEIN 

Milk is made of two proteins namely whey and casein. Whey protein can be separated from casein in milk or formed as a by-product of cheese making. Whey protein is considered a complete protein and it contains all nine (9) essential amino acids and is low in lactose content. Whey is found in the watery portion of milk.

EFFECTS OF WHEY PROTEIN 
 Whey can be consumed alongside vitamin D and exercise to boost fat free muscle mass, strength, functional outcomes and wellbeing in the elderly to combat age-related muscle mass decline.

 Several designed studies (well) have shown that whey protein supplementation specifically, with dosages varying from 20g – 40g, is effective in maximizing the stimulation of muscle protein synthesis in all individuals respective of age (29, 67, 73).

 Research shows that infants who consume whey protein by mouth during the first 3-12 months of life have a lower risk of developing red, itchy skin (eczema) by the age of 3.

 Taking whey protein by mouth in people with HIV/AIDs can help to decrease weight loss.

 It also reduces psoriasis i.e. red, scaly skin, when consumed by mouth.

 Infants who consume whey protein by mouth for the first 3 – 12 months of life are less likely to be prone to allergies and allergic reactions.

Generally, whey protein can be consumed by the following groups:
 Athletes
 Cyclers
 Body builders,
 Elderly,
 Infants
 Adolescents

SOURCES OF WHEY PROTEIN
Food sources of whey protein includes the following:
 Chicken
 Beef 
 Soy
 Quinoa
 Pea
 Tiger nut milk etc

ESSENTIAL PROVEN BENEFITS OF COCONUT

ESSENTIAL PROVEN BENEFITS OF COCONUT 
Coconut is a fruit and a member of the family aracaaceae and the specie of the Genus cocos. The term coconut can refer to the whole coconut palm or the seeds, or the fruit, which botanically is a drupe, not a nut.

IMPORTANCE OF COCONUT 
• Helps treat malnutrition because it is easy to digest and absorb.

• Protects against heart disease by increasing good cholesterol and lowering the ratio of bad and good cholesterol

• Helps to reduce the rate of being diabetic through the mechanism of slowing the release of sugar to the blood stream.

• Kills diseases-causing bacteria, fungi, yeast and viruses because of the anti-microbial effects of its fatty acids.

• Prevents strokes and brain disorders such as Alzheimer’s and Parkinson.

• Boosts metabolism and increases energy because it is more likely to be burned as fuel than stored as body fat.

• Prevents tooth decay – coconut oil fights bacteria and could be a healthy, non-chemical additive in toothpaste and mouth wash.

DENTAL CARIES

It is simply tooth decay and occurs majorly in children.

DENTAL CARIES is the scientific term for tooth decay. It is a chronic disease that affects the mineralized tissues of the teeth which include enamel, dentine and cementum. It is caused by the action of microorganisms on fermentable carbohydrate in the diet. The main lesion (scar) that is detected clinically is known as a white spot.


Untreated dental caries can affect growth and quality of life in preschool children, early childhood and sometimes permanent if nothing is done about it.

SIGNS AND SYMPTOMS:
Depending on the extent and the location there may be no symptoms on the early stage, but as the decay becomes larger it may cause the following symptoms
 Tooth ache: this pain occurs without any apparent cause
 Tooth sensitivity: mild or sharp pain when eating or drinking something sweet, hot or cold
 Visible holes or pit in the teeth.
 Brown, black or white staining on the surface of the tooth.
 Anytime the person bites i.e. pain when there is a bite down.

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DIET INDICATION:
The aim of the diet is to reduce this caries by dietary means (meals). The frequency of sugar eaten is the primary factor involved in the caries process. Excessive consumption of sugary foods and lipids should be minimized to reduce the bacteria from feeding and producing acids that can breakdown the teeth. Hence, proper brushing and oral hygiene is necessary.