Indications for the purpose of the diet. 2-4 months or more after resection of the stomach with a mild form of dumping syndrome and a moderate form, in the presence of complications of cholecystitis and hepatitis.
Special purpose. Prevent and reduce the manifestation of dumping reactions, contribute to the normalization of the functional state of the liver and biliary tract.
General characteristics of the diet
The diet is physiologically complete, with a high protein content, normal fat and complex carbohydrate content with a sharp restriction of simple carbohydrates, a normal salt content (15 g), mechanically non-sparing, with a moderate restriction of chemical irritants of the gastrointestinal tract, with the exception of strong biliary stimulants and pancreatic secretion, with the exception and restriction of foods and dishes that cause the development of dumping syndrome.
Culinary processing. All dishes are cooked boiled or steamed, give uncooked . Allowed individual dishes in baked form without a rough crust. The third dish at lunch is unsweetened or cooked on xylitol (10-15 g per serving). Sugar is given to the patient. The chemical composition and calorie content. Protein 140 g, fat 110 g, carbohydrates 390 g. Caloric content about 3100 kcal. Salt 12-15 g. The diet is fractional (5-6 times a day). Food temperature. The food is given warm; hot and cold meals should be avoided. A list of recommended foods and dishes. Bread and bakery products. Wheaten gray bread of yesterday’s baking, undesirable and unsweetened varieties of bakery products and cookies. Seeded rye bread. Soups On vegetable broths and cereals, vegetarian. Borsch, cabbage soup, beetroots from fresh cabbage. Low-fat meat soup 1 time per week. Meat and fish dishes. Various products of low-fat beef, veal, chicken, rabbit, low-fat fish (cod, pike perch, common carp, saffron cod, pike, carp, etc.) are boiled, baked, stewed, you can not chop. Dishes from eggs. Soft-boiled eggs (no more than 1 pc. Per day), protein omelet. Dishes and side dishes from cereals, pasta. Crumbly and viscous cereals, pudipgi , cereal casseroles – unsweetened; boiled pasta in the form of casseroles. Buckwheat, hercules and rice cereals are recommended. Semolina is limited. Dishes and side dishes from vegetables. Raw, boiled, baked, stewed vegetables. Non-acidic sauerkraut is allowed. Boiled cauliflower with butter, zucchini and stewed pumpkin, salads, vinaigrettes, green peas. Tomatoes with vegetable oil. Early raw finely chopped greens can be added to various dishes. Fruits. berries, sweet dishes, sweets. In raw form, not very sweet fruits and berries. Unsweetened compotes, jelly, mousses. Limit the grape juice that! causes bloating. Sugar, mod, sweets, jams are sharply limited. Milk, dairy products and dishes from them. Milk with tea and other drinks or as part of various dishes, with tolerance – whole milk, yogurt, kefir, acidophilus milk. Sour cream as seasoning and in salads. The curd is not acidic, fresh. Fats. Butter, ghee, olive, sunflower. Snacks Mild cheese, low-fat herring, doctor’s sausage, diet sausages, home-made meat paste, ham without lard. Salads, vinaigrettes, jellied fish on gelatin, jelly on gelatin. Sauces and spices. Sauces on vegetable broth, sour cream sauces. Onions and chives in very moderate amounts. Drinks and juices. Weak tea and coffee with and without milk. Juices unsweetened fruit and berry, vegetable. Rosehip broth. The same foods and dishes are prohibited as with the rubbed version of the diet, except for white cabbage. An approximate one-day menu of the unprotected diet option is given in table. The methodology of medical nutrition. In the first days after gastrectomy, the patient is prescribed a special diet. After 1-2 weeks, in the absence of complications, you can prescribe the wiped diet option. First, bread in the form of crackers is recommended, and then you can eat stale white bread. In the first days of using the mashed version of the diet at a time, give no more than 1-2 dishes, limit the side dishes. Then, they gradually switch to a full diet of a pureed diet. After 2-4 mine (in some patients after 4-5 months ) it is recommended to switch to an unapproved diet. The transition must be made gradually, in the first days, non-mashed vegetables are given in limited quantities, including them in the first dish. Brown bread, sauerkraut, salads are recommended to be included later, also gradually. If the patient has anastomositis , a peptic ulcer of any localization, then the wiped version of the diet is prescribed. For patients who ate gastric resection, in which the symptoms of nancreatitis predominate in the clinical picture , a variant of a pureed diet with a certain decrease in fat content is proposed. With a severe degree of doming-indroma, a diet is prescribed without mechanical sparing with the restriction of complex carbohydrates to the lower limit of the norm (300 g per day) and the complete exclusion of simple angles . All dishes are cooked boiled or steamed. This version of the diet provides for the complete exclusion of sugar, a decrease in the amount taken at one meal (due to side dishes), and more frequent meals. You must eat lying down and staying in bed for 20-30 minutes after each meal. The chemical composition of the diet: protein 130 g, fat 100 g, carbohydrates 320 g. Calorie content 2600 kcal.
If in the clinical picture of the disease inflammatory phenomena come to the fore (enterocolitis, neuriviscritis ), then the tin diet of the rubbed version is used, but with a sharper restriction of carbohydrates, mainly easily digestible, they exclude sugar, reduce the number of side dishes, and limit salt.
In case of complication of the dumping syndrome with enterocolitis or intestinal dyskinesia , a diet is used depending on the nature of the course of the disease. When administered exacerbation rubbed embodiment diet with the exception of cabbage, beet, ropy , radish, radish, spinach, onion, garlic, mushrooms, barley and millet CSGNs , melons, apricots and plums.
With colitis with a tendency to constipation and flatulence, an unprotected diet option is given . In raw form, ripe tomatoes and leafy salad are allowed. Black bread, turnips, radishes, radishes, sorrel, spinach, onions, garlic, mushrooms are excluded. Fruits are allowed without peel. Milk is consumed with good tolerance, better diluted. It is recommended to introduce an increased amount of food stimulants of peristalsis (cream, vegetable oil in dishes, vegetable juices, vegetables and fruits, bran bread, dairy products).
After G-12 months after surgery, in the absence of complications from the liver, pancreas and intestines, it is recommended to switch to a diet with the usual culinary processing. But even when receiving diet No. 15, the patient must comply with the principles of fractional nutrition and restriction of dishes that provoke dumping syndrome.
The transition to a more diverse diet is carried out in these patients by reducing the degree of mechanical sparing , while chemical sparing is preserved for a longer time due to persistent secretory disorders of the digestive tract.
In patients who have undergone a resection of the stomach, without signs of dumping syndrome, the clinical picture for prophylactic purposes also recommends fractional nutrition (4-5 times a day), restriction of foods and dishes that most often cause dumping syndrome (sweets, sweet milk porridges, very hot and cold dishes). Food should be taken slowly, chewing it carefully.