DINH DNG V IU TR

Tc gi: Nguyn c
Pht hnh theo tha thun gia Cng ty Vn ha Hng Trang v tc gi. Nghim cm mi s sao chp, trch dch hoc in li m khng c s cho php bng vn bn ca chng ti. GPXB s 2-545/XB-QLXB KHXB s 161/XBYH

In n v pht hnh ti Nh sch Quang Minh 416 Nguyn Th Minh Khai, P5, Q3, TP HCM Vit Nam

Published by arrangement between Huong Trang Cultural Company Ltd. and the author. All rights reserved. No part of this book may be reproduced by any means without prior written permission from the publisher.

BS. NGUYN C

Dinh dng v iu tr
NH XUT BN Y HC

Vi Li Gii Thiu
Nhng nm gn y, y hc pht trin cng lc theo hai chiu hng c v nh tri ngc nhau. Mt mt, chng ta lin tc chng kin nhng thnh tu vt bc trong lnh vc nghin cu v cc mt sinh l, bnh l, phng nga v tr liu, gip kim sot bnh tt mt cch hiu qu hn v hn ch n mc ti thiu cc trng hp t vong. Mt khc, nhng nghin cu khoa hc cng ngy cng nhn r hn tnh u vit ca nn y hc c truyn dn tc thun theo t nhin, vn c t ngn xa, v do m i a s qun chng ang c chiu hng quay v ngun ci, a chung mt nn y hc gin d v nh nhng, gn vi t nhin hn. Cc phng thc tr bnh c truyn, s dng cy c v cc phng php thun theo t nhin ang c qu chung hn so vi cc phng thc iu tr hin i. iu l th l chng ta c th thy c mt s dung ha v vn dng hp l c hai khuynh hng ni trn trong khoa Dinh dng hin i, v in hnh c th l b sch DINH DNG V AN ToN THC PHM ca Bc s Nguyn c m qu c gi ang c trong tay. B sch ny gm ba quyn, c ni dung lin quan nhau, nhng cng c th s dng ring r nh nhng ngun kin thc chuyn bit. l: 1. Dinh dng v thc phm: Trnh by cn k nhng yu t dinh dng cn bn cn thit cho con ngi. Qua tp sch ny, c gi s hiu r c v sao chng ta cn n mt t l cn i cc loi thc phm tht c, rau qu v khong cht, vitamin, cng nh cn n bao nhiu l va .

2. Dinh dng v sc khe: Khi n mt bt cm, mt ming tht g luc, mt bt canh ci hoc con c r kho... chng ta thng mun bit chng c tiu ha, hp th ra sao, cng nh tc dng nh th no n sc khe. Thc phm c th gy tc hi n sc khe nu khng c s dng, nu nng hay bo qun ng cch, m bo nhng nguyn tc an ton thc phm. l nhng ni dung chnh ca quyn sch ny. 3. Dinh dng v tr liu: Ngoi vic s dng thuc men v cc phng thc tr liu, dinh dng cng gi mt vai tr rt quan trng i vi ngi bnh. Mt bnh nhn tiu ng nu bit cch n ung s c th hn ch hu qu xu khi lng ng trong mu ln qu cao; ngi huyt p cao m khng tit gim mui n th s d dng b tai bin no hoc cn suy tim... Quyn sch ny a ra nhng hng dn v n ung c th h tr vic tr bnh, c cc nghin cu khoa hc v thc t chng minh l mang li hiu qu tt. Ngi ta thng ni: n sng ch khng phi sng n. Tht ra, y ch l mt li khuyn c tnh cch lun l ch khng h c bo ta phi coi thng vic n ung, v thc t l: Sng th phi n. sinh tn, c th cn n nng lng cng nh ng c cn xng du. Thc phm cung cp nhng yu t m c th hp th c to thnh nng lng, gi chung l dinh dng. Do , dinh dng chnh l cha kha ca sc khe. Ngi ta c th khe mnh hay au yu do ngun dinh dng thch hp hay khng thch hp, phong ph hay ngho nn. Dinh dng l yu t quyt nh chi phi phn ln, nu khng ni l ton b, vn sc khe ca con ngi. V th, dinh dng l mu cht ca hu ht cc vn bnh l, v qu tht khng c g l khi hu ht cc nh iu tr u quan tm c bit n vn dinh dng.

Vi li gii thiu
i vi phn ln chng ta th khoa Dinh dng cn c nhiu l do ng quan tm hn na. Khoa Dinh dng gip ta tc ng n sc khe mt cch c th, tc thi, vi nhng gii php v ngh thit thc, trong tm tay ca mi ngi. Nhng tc hi do sai lm v dinh dng hay li ch ca vic s dng dinh dng ng cch c th d dng thy c. V d sao i na, sng th phi n, nay li c th vn dng vic n ung tr bnh hay phng bnh, qu tht l mt cng i ba vic, nht c lng tin. Do , chng ta ai cng mun bit v vic thc phm m ta s dng s tc ng nh th no n sc khe, c th gip ta phng tr bnh hay s to iu kin gy ra thm bnh tt. V khi p dng nhng hiu bit vo cuc sng hng ngy, chng ta s c th tr v gn vi thin nhin hn, s thy vic phng tr bnh tr nn d dng, gin tin hn v ch cn s dng nhng th c sn trong t nhin nh cc loi thc phm, rau c qu, dc liu cy c...m vn c th bo v tt sc khe cho c th. Nh ni, b sch ca Bc s Nguyn c l s dung ha v vn dng c hai khuynh hng: kin thc khoa hc hin i v s pht trin lnh mnh thun theo t nhin. i vi nhng ai mun hiu r v cc thnh phn dinh dng c trong thc phm, mun theo di s phn ca cc mn n khi i vo c th, hoc ni chung l t m mun tm bit r hn v thc phm, b sch ny s cung cp tht phong ph nhng kin thc v cc c tnh ha hc, sinh l... ca tng mn n v qu trnh bin i ca chng trong c th. i vi nhng ai mun p dng ngay nhng hiu bit v dinh dng vo cuc sng gn gi thin nhin hn, sch cung cp nhng kin thc c bn v thit thc v cc thc phm thng dng mi ngy v nhng tnh cht c li hoc c hi ca chng. Nhng kin

Dinh dng v iu tr
thc ny c trnh by mt cch cn k nhng khng qu rm r, d hiu nhng cng khng v th m tr thnh s lc, th thin. Do , vi nhng ai quan tm n vn dinh dng th b sch ny tht xng ng l kim ch nam trong thc t, l ngi hng dn trung thnh v thc tin mi ngy, c th gip ch tc th v thit thc. Sch m t mt cch khoa hc cc mn n, c bit chi tit hn l nhng mn n thng c s dng mi ngy, gi nhng chn la thch hp m chng ta lun phi a ra trong cuc sng. Mt phn quan trng - gn nh trng tm ca b sch c dnh bn n mi tng quan gia dinh dng v cc bnh tt thng gp nh: tiu ng, tim mch, huyt p cao, vim gan, to bn... Tc gi lun c nhng li khuyn hu ch nhm t cn bn vng chc cho mt cuc sng khe mnh, t bnh tt. Ni chung, b sch nhm n tr li phn ln nhng cu hi lin quan n vn n ung, nhng c bit cung cp cho bn c mt cch chi tit hn nhng g cn bit trong vic n ung hng ngy, khi ang khe mnh cng nh khi c bnh. Vi mc tiu ra nh vy, b sch ca Bc S Nguyn c c th ni l mt thnh qu rt ng khen v c hai mt khoa hc cng nh thc dng, bi v n p ng c c tnh chnh xc ca mt tc phm khoa hc cng nh tnh d hiu ca mt ti liu hng dn dnh cho qung i qun chng. Khi gii thiu b sch ny n vi qu c gi, chng ti hy vng l n s mang li nhng kin thc b ch v thit thc ngay trong cuc sng hng ngy, gip cho qu v c th t mnh bo v sc khe v nim vui trong cuc sng. Bc S TRN MINH TNG

DINH DNG VI BNH TIU NG

i l bnh tiu ng, nn c lc nhiu ngi ngh rng bnh ny l do n nhiu ng ngt m ra. S thc, ng v tinh bt c th lm lng glucose trong mu tng cao t ngt khi khng c insulin, nhng ng khng gy ra bnh tiu ng.

Insulin l cht ni tit c nhim v chuyn ha glucose trong mu thnh nng lng, do lm iu ha lng glucose trong mu. V vy, tiu ng l bnh ca mt trong nhiu c quan ni tit trong c th, v dinh dng c mt vai tr rt quan trng trong vic iu tr.
Trong bnh tiu ng, s chuyn ha ng glucose trong mu b ri lon. Glucose l ngun nng lng quan trng cho c th v ch yu do carbohydrat cung cp. Cht m (protein) v cht bo (lipid) cng c th to ra glucose, nhng khng nhiu nh carbohydrat.

Carbohydrat l nhm hp cht hu c c trong t nhin bao gm cc dng ng, tinh bt, dextrin, cellulose, v glycogen. Trong thc phm th hai dng carbohydrat ch yu l ng v tinh bt. Khi a vo c th, carbohydrat c phn h thnh ng glucose, gi chc nng duy tr

Dinh dng v iu tr
cc m protein, gip chuyn h cht bo v cung cp nng lng cho h thn kinh trung ng. Khi glucose trong mu khng c s dng ht th nng glucose trong mu s tng cao. Trong tnh trng bnh thng, thn c kh nng gi ng ny li thay v bi tit ra ngoi. Ngi bnh tiu ng c lng glucose qu cao nn thn buc phi thi bt ra ngoi theo nc tiu. T c tn l bnh tiu ng. Bnh thng gia tng vi tui cao, nht l t sau 55 tui. Ngi chu t b tiu ng ph thuc vo insulin hn l ngi da trng; n gii c t l mc bnh cao hn nam gii. iu ha ng trong mu l trch nhim ca cht ni tit insulin do ty tng tit ra. Insulin chuyn ng t huyt tng vo cc t bo chuyn ha ra nng lng. ng thi insulin cng gip gan chuyn h mt phn glucose thnh cht bo d tr trong cc t bo m. Khi v mt l do no m insulin khng lm c cng vic chuyn ha ny th nng ng glucose trong mu s tng cao. Cholesterol trong mu cng tng cao v thiu insulin. Mc bnh thng ca glucose trong mu khi i thay i trong khong t 50mg/dl ti 115mg/dl mu. Khi nhn n lu nh qua m th mc ny thp nht, sau ba n th nng ng tng hi cao hn. Mu c ly vo bui sng khi cha n ung g th nng ng. Nu sau hai ln th nghim lin tip m nng glucose trn 140mg/dl th xc nh l bnh tiu ng. Nu nng ng trong khong 115mg/dl ti 140mg/dl th ch nghi ng

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Bnh tiu ng
nhng cha c xc nh c bnh, cn theo di v c thm nhiu th nghim khc mi c th xc nh bnh.

Phn loi
Bnh tiu ng lin quan trc tip n insulin, v ty theo cch gy bnh ca cht ni tit ny m bnh c phn ra lm hai loi chnh nh sau:

- Loi I: Do thiu insulin. Thng xut hin khi cn tr, do ty tng khng tit ra hoc tit ra rt t insulin. V vy, iu tr bnh ny ch yu ph thuc vo vic cung cp b sung lng insulin cn thit cho c th. Loi ny chim khong 10% trong tng s bnh nhn tiu ng, nhng rt kh kim st v ngi bnh thng ri vo tnh trng nhim acid (ketoacidosis) rt nng. Bnh nhn tr nn gy m v bnh tin trin rt nhanh.
- Loi II: Do c th khng s dng c insulin, mc d ty tng vn tit ra lng insulin nh bnh thng. V vy, iu tr bnh ny khng lin quan n vic cung cp insulin. Bnh thng xy ra ngi ln tui, bnh nhn thng mp v bnh din tin chm.

Nguyn nhn
Nguyn nhn gy bnh tiu ng cha c xc nh. C nhiu trng hp do di truyn hoc bnh xut hin trong khi c thai, sau gii phu, sau nhng cng thng v th xc, tinh thn hoc do mp bo, nhim c.

Bnh tiu ng loi I c th do cc virus hay c t gy ra nhng ngi m gen di truyn c mang mm bnh.

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Dinh dng v iu tr
Bnh tiu ng loi II c th do nhiu nguyn nhn, nhng tnh trng qu cn v d tha cht bo ca c th thng c coi l nhng nguy c gy bnh hng u.

Triu chng
Cc triu chng chnh ca bnh tiu ng l rt kht nc. Ngi bnh tiu tin lin tc vi nhiu nc tiu, n nhiu m vn st cn. g. i khi ngi bnh tiu ng loi II khng c triu chng

Khi khng c kim st, iu ha, nng ng trong mu tng cao bt thng a ti cc bin chng trm trng cho nhiu c quan khc nh mt th gic, suy thn, bnh tim mch vi huyt p cao, cao cholesterol, va x ng mch, ri lon cm gic thn kinh, lit hoc cng dng v d b bnh nhim trng. Nhiu ngi b nhim c chi di trm trng n ni phi ct b bn chn. Nu khng c iu tr, ngi bnh ri vo tnh trng suy dinh dng, mc d trong mu vn y trn cht b khng dng n phi thi theo nc tiu ra ngoi m t bo cn n li khng tip nhn c. Bnh tiu ng l nguyn nhn t vong ng hng th t do bnh tt gy ra ti Hoa K. T l t vong c th gim nhiu nu bnh c pht hin v iu tr sm.

Dinh dng vi bnh tiu ng

Trng tm ca vic iu tr bnh tiu ng l gi cho nng ng glucose trong mu mc bnh thng.

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Bnh tiu ng
Dinh dng ng vai tr rt quan trng bn cnh dc phm v cc phng thc tr liu khc. Trong mt s trng hp, ch vi mt ch dinh dng thch hp cng c th iu ha c nng ng trong mu. T nhiu ngn nm qua, con ngi nhn ra iu ny v lun quan tm n vic xc nh mt ch dinh dng thch hp cho ngi mc bnh tiu ng. Cc v lng y c xa cho rng ngi bnh tiu ng cn phi n nhiu carbohydrat b li lng ng thi ra trong nc tiu. n th k 17, nhiu ngi p dng ch t tinh bt, nhiu cht bo v cht m ng vt. Sau li chuyn sang t tinh bt, t nng lng. Cho n nm 1921 khi cc bc s Canada l Frederick Grant Banting (1891-1941), v Charles Herbert Best (18991978) khm ph ra insulin trong ty tng v vai tr ca n trong bnh tiu ng th phng thc iu tr bnh ny bt u thay i hn. Ch dinh dng mi cho ngi bnh tiu ng c iu chnh nhiu ln trong nhng thp nin qua vi mc ch l iu ha lng glucose trong mu. Ch ny thay i ty tng ngi bnh v bnh nhn cn lu rng khng c mt thc phm duy nht no p ng c nhu cu ca tt c mi ngi. Vi tiu ng loi II, insulin vn c ty tng tit ra nhng ngi bnh khng s dng c, ch n ung tp trung vo vic kim st th trng, hn ch tng cn. C ti 90% ngi bnh tiu ng loi II trong tnh trng bo ph.

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Dinh dng v iu tr
Trong tiu ng loi I, bnh nhn cn v ph thuc vo insulin th ch dinh dng c tnh ton sao cho ngi bnh vn c th dng ba n chung trong gia nh nhng c s thay i linh ng v nng lng cho thch hp vi liu lng dc phm, nht l insulin. xc nh mt ch dinh dng thch hp cho mi ngi bnh cn c s c vn ca chuyn gia dinh dng hoc bc s iu tr. Ngi bnh cng cn c hng dn bit r tnh trng bnh ca mnh, thng tho cch t o mc ng trong mu v sau c th t gia gim s nng lng cn tiu th ty theo tnh trng bnh, v hiu bit r cng dng cc dc phm ang dng. S cn i t l nng lng cung cp t ba cht dinh dng c bn: carbohydrat, cht bo v cht m l iu rt quan trng. T l ny thng c cc chuyn gia xc nh l khong t 50% n 60% t carbohydrat (tinh bt v ng), di 30% t cht bo v 15% n 20% t cht m. V carbohydrat th cn gii hn ng tinh ch mc 5% v nn n chung vi cc thc phm khc trnh glucose trong mu tng cao qu nhanh. Nh vy, phn nng lng cn li l ly t tinh bt. Cht bo th nn dng nhiu loi cht bo bo ha ca thc vt hn l cht bo bo ha ca ng vt, v hn ch ti a cc dng cht bo cha bo ha.1
1

Cc acid bo c ba loi khc nhau: loi c dng rn, tc l dng acid bo bo ha (saturated), dng t rn hn l acid bo cha bo ha dng n (monounsaturated) vi cc ngoi l l du -liu v du phng, v dng lng l acid bo cha bo ha dng a (polyunsaturated). Hai dng sau thng c ch chung mt cch n gin l acid bo cha bo ha (unsaturated), phn bit vi dng acid bo bo ha (saturated).

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Bnh tiu ng
Cht x (fiber) cng c tc dng trong vic kim st lng ng trong mu, gim bt nhu cu insulin v gim thiu cc bin chng ca tiu ng. Cht x c nhiu trong ng cc. Ngoi ra, cn ch thm n mt s cc vitamin nh vitamin B, C, E v cc khong cht calci, km, phosphor, kali. Nhiu chuyn gia cho rng qu nhiu m bo lm thay i s chuyn ha ca glucose v lm tng sc khng ca c th vi insulin. Ngi bo ph cng t vn ng c th, v s vn ng t bt nng lng v khin c th s dng c insulin cng hiu hn. Mt ch dinh dng t 1.000 ti 1.200 calori2 mi ngy cho n gii, 1.500 calori ti 1.800 calori mi ngy cho nam gii c nhiu chuyn gia y t ng . S nng lng ny cn c phn chia theo t l: 55% carbohydrat, 30% cht bo v 15% cht m. Theo thng k, nu p dng ch ny th kt qu tt ln ti 95%. Ngoi ra s nng lng trn cng cn c chia ra lm nhiu ba nh trong ngy ty theo kt qu o mc ng trong mu hai gi sau mi ba n. C ngi n ti su, by ln trong ngy, mi ln vi s lng thc phm nh. Trong ch dinh dng cho ngi bnh tiu ng, vic tiu th cht ngt l vn c nhiu tranh ci. Trong nhiu nm qua, ngi bnh c khuyn co l khng nn n ng v cc thc phm ngt. T s khuyn co ny, cc loi ng thay th c a ra v gii thiu l an ton cho ngi bnh, gm c cc loi nh Saccharin, Cyclamate, Aspartame, Acesulfame...

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Dinh dng v iu tr
Gn y vic n ng c nghin cu li, v a s cc chuyn gia u khuyn l ch nn dng khong di 5% tng lng carbohydrat l ng, v dng chung vi thc phm khc. ng thi lng ng ny cng cn gia gim cho ph hp vi liu lng cc dc phm ang dng. Cng trong chiu hng ny, vo thng 12 nm 2001, t chc The American Diabetes Association a ra mt hng dn mi, theo ngi mc bnh tiu ng i khi c th n cht ngt, min l h gi mc ng trong mu bnh thng. Hng dn cng khuyn ngi bnh nn n nhiu thc phm c gi tr dinh dng cao nh rau, tri cy v nng vn ng c th.

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BNH TIM MCH

my tun hon gm tri tim v mt h thng nhng mch mu chy khp trong c th. y l b phn tip t cc cht dinh dng thit yu cho mi hot ng ca con ngi. Mt gin on, mt trc trc d nh ca h thng ny s to ra nhiu kh khn cho tim v mch mu m kt qu l a ti cc bnh tim mch cng nh nhiu nh hng khng tt khc cho c th. Ti nhiu quc gia, bnh tim mch l nguyn nhn t vong hng u. Bnh ng mch vnh, cn suy tim (heart attack), tai bin ng mch no (stroke) v huyt p cao, bnh thp tim (Rheumatic heart disease) l nhng bnh thng gp v u a ti hu qu nghim trng. C rt nhiu nguy c a ti bnh tim mch. C nhng nguy c khng thay i c nh tui tc, gii tnh, chng tc, di truyn... Nhng cng c nhng nguy c c th thay i c nh np sng c nhn, bo ph, nghin thuc l... v nht l ch dinh dng n ung. Cc bnh tim mch khng phi xy ra ngay trong u hm sm mai, m t t pht trin. Bnh tim mch thng xy ra khi cholesterol trong mu tng cao; khi thn nhn c tin s bnh tim; khi c du hiu au tht tim; khi c nguy c bnh tiu ng v khi b bo ph. Bnh c lin h nhiu hn ti dinh dng l bnh ng mch vnh, va x ng mch (atherosclerosis) v huyt p cao.

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DINH DNG VI BNH NG MCH VNH

Bnh ng mch vnh (Coronary artery disease - CAD)
Sau mi nhp tim p th mu c a i nui khp c th qua ng mch ch. Ring mu nui tim th c chuyn trc tip vo ng mch vnh. Cc ng mch ny gm hai nhnh bao quanh tri tim nh mt ci vng min. Nu mt trong nhng phn nhnh b nght th t bo tim vng thiu dinh dng, thiu dng kh (oxy), gi l s thiu mu cc b c tim (myocardial ischemia) v ngi bnh s c nhng cn au tht tim (angina pectoris). Nu ng mch b nghn vnh vin th cn suy tim s xy ra v nhi mu c tim (myocardial infarction) v t bo tim b tiu hy.

ng mch vnh l nhng mch mu chy quanh tri tim nui c quan ny.

Nguyn nhn
V sao c s tc nghn ng mch vnh? Trong a s cc trng hp, c nhng mng cht bo dn dn ng li thnh ng mch, khin cho lng mch mu thu

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Bnh ng mch vnh

hp dn, khin mu lu thng b tc li v tc hn theo nm thng. l hin tng va x ng mch (atherosclerosis).

Va x ng mch khng xy ra bt thnh lnh m t t din tin trong hng chc nm. i khi, s tc nghn bt u ngay t khi cn tr, nhng cha trm trng a ti bnh tim tui trung nin. Va x ng mch l nguyn nhn chnh ca cn suy tim, tai bin ng mch no, hoi th (gangrene) u ngn chn, ngn tay. Cc mch mu d b va x nht l ng mch ch ni bng (abdominal aorta), ng mch vnh v ng mch no.
Nguyn nhn gy va x ng mch cha c xc nh r, nhng theo kt qu ca nhiu nghin cu th cht bo trong mu v cc yu t sau y l nhng nguy c c kh nng gy bnh: a. Tui tc Hn 50% trng hp bnh ng mch vnh xy ra ngi trn 65 tui, cho nn nguy c bnh tim tng theo tui tc. b. Gii tnh Theo thng k th nam gii trn 45 tui thng b bnh tim mch nhiu hn n gii, nhng sau tui mn kinh ca n gii th t l mc bnh gn nh nhau. Nam gii thng c lng cholesterol LDL (dng cholesterol c hi) cao hn v HDL thp hn, mt phn do tc dng ca hormon nam

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Dinh dng v iu tr
testosterone. Cn n gii th mt phn c s bo v ca hormon n estrogen lm gim cholesterol LDL. Khi mn kinh, ngi ph n khng cn hormon n estrogen th cholesterol LDL nhch ln cao.
c. Di truyn

Va x ng mch i khi thy nhiu ngi trong cng mt gia nh, nht l khi cha m hoc anh ch em b bnh.
d. Chng tc Ngi chu t b va x ng mch v cn suy tim hn ngi u M, ngi M gc chu Phi li hay b bnh tim v huyt p cao nhiu hn. . Thuc l

Nicotin trong thuc l lm tng huyt p v nhp tim, lm mu d ng cc, lm gim HDL, tng LDL, tt c u c th a ti bnh tim mch. Nicotin l mt trong nhiu yu t khi s lm h hng t bo ng mch, a n va x mch mu ny. Ht th khi thuc l do ngi khc thi ra cng c hi. B ht thuc l s lm gim nguy c mc bnh tim mch mt cch ng k.
e. Bo ph Thng k cho thy ngi bo ph hay b huyt p cao, bnh tim, cao cholesterol v do thng b suy tim.

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Bnh ng mch vnh

g. Huyt p cao Huyt p cng cao th nguy c suy tim v va x ng mch cng tng, nht l khi km theo nghin thuc l v bo ph. p sut tng cao lm yu thnh mch mu, a ti h hng, ng ba cht bo v cc cht khc trn thnh mch. h. Bnh tiu ng Ngi b bnh tiu ng thng c nhiu nguy c b cc bnh tim mch nh cn suy tim, huyt p cao, do cht bo HDL thp v triglycerid cao. i. t vn ng c th Ngi t vn ng c th c nguy c mc bnh ng mch vnh cao gp i ngi nng vn ng. S vn ng lm gim qu trnh va x, tng mu lu thng ti tim, tng HDL, gim bo ph, gim huyt p cao. k. Cao cholesterol Vai tr ca cholesterol trong bnh tim mch c nghin cu su rng trong nhng thp nin qua vi nhiu dn chng khoa hc v vn ny. Mc cholesterol trong mu ln ti 240 mg/dl l nguy c ln a ti va x ng mch, ri cn suy tim v tai bin ng mch no. Nguy c cng cao khi cholesterol cng nhiu trong mu. Thnh phn ca cc dng cht bo trong tng lng cholesterol cng rt quan trng. l cc dng cholesterol

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Dinh dng v iu tr
LDL (low density lipoprotein), HDL (hight density lipoprotein) v triglycerid.

Protein l cht vn chuyn lipid v hn hp c tn l lipoprotein. T trng (density) l t l protein/lipid. Khi nhiu protein (high density) th l HDL, t protein (low density) th l LDL.
Trong tng lng cholesterol th t 60-70% l LDL, 2030% l HDL, 10-15% l VLDL (very low density lipoprotein). Cholesterol mc di 200mg/dl l l tng, t 200mg/dl n 239 mg/dl cn tm chp nhn c, nu ln trn 240 mg/ dl th l rt cao v c nguy c xu. LDL thng c coi nh khng tt v n l thnh phn gy nhiu rc ri cho h tim mch. Dng cholesterol ny vn chuyn cht bo (lipid) trong thc phm vo cc t bo. Khi t bo ht ch cha th cht bo ng thnh ng mch, lu dn a ti va x, tc nghn. Mc l tng ca LDL trong mu l di 130mg/dl. T 130mg/dl n 159mg/dl l bt u c vn , v ln cao hn 160mg/dl l nguy him. HDL vn chuyn cht bo vo d tr trong gan cho lng cht bo trong mu ch va dng, khng c d ng vo thnh ng mch. Lng HDL trong mu m bng hoc cao hn 35mg/dl l tt, nu HDL c th cao hn 60mg/dl th tht l tng v an ton. Bnh thng, c th to ra va s cholesterol m ta cn. Cholesterol trong mu c ti 85% l do c th t to ra; cn li 15% l do thc phm cung cp.

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Bnh ng mch vnh

V th, cholesterol trong mu c th tng cao nu ta tiu th nhiu cholesterol v cc cht bo bo ha. Hu qu l s ng mng trong lng ng mch. Khi nght ng mch vnh, ta b cn suy tim (heart attack). Khi mt mng cht bo ng mch no chy ln no th gy ra tai bin ng mch no (stroke).

Dinh dng vi bnh ng mch vnh

V nhng nguy c , vic hn ch cht bo cholesterol l iu cn thit v lin quan trc tip n ch dinh dng. 1. Chn thc phm c t cht bo Nguy c mc bnh tim gim mnh khi bt tiu th cht bo cc loi, gii hn di mc 30% tng s nng lng cung cp cho c th mi ngy. Nn nh l ch gim cht bo ti mc va phi vi tnh trng sc khe ca mnh, bi v thiu cht bo cng c hi cho sc khe. 2. Gim cht bo bo ha Cht bo bo ha lm tng cholesterol, nht l LDL v triglycerid. Ch nn gii hn cht bo ny khong 1/3 tng s cht bo n vo. Cht bo bo ha c nhiu trong m ng vt, kem, b, pho mt... Cht bo bo ha cng c bit c nhiu trong du c, du da. Du ny thng c dng rt nhiu trong vic lm bnh, ko.

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Dinh dng v iu tr
3. Tng cht bo cha bo ha thay th cho cht bo bo ha, nn dng nhiu cht bo cha bo ha. Du liu, du ht ci du (canola) c nhiu cht bo cha bo ha dng n. Du ng (bp), du ht cy rum (safflower) c nhiu cht bo cha bo ha dng a. S dng cc loi du ny c th lm gim cholesterol v tng t l HDL trong mu. 4. Gim cholesterol

Cholesterol khng c trong thc vt, m c nhiu trong cc thc phm t ng vt. Cholesterol trong thc n c th lm tng lng cholesterol trong mu. Lng trng, gan ng vt c t cht bo bo ha nhng li c nhiu cholesterol. Nu khng c bnh tim, c th n khong ba lng trng mt tun. Lng trng trng, rau tri khng c cholesterol. C th n nhiu lng trng trng v y l ngun cht m kh cao. ng vt c v nh tm, cua, s, hn khng c nhiu cholesterol, nn c th n vi mc va phi.
5. n nhiu c Nn n nhiu cc loi c nh c hi (salmon), c lam (bluefish), c thu, c ng, c trch, c sardine... v cc loi c ny c nhiu du Omega-3. Dng cht bo ny c xem l c kh nng h mc triglycerid, ngn chn qu trnh ng cc mu gy ngng nhp tim bt thng, tng cng tnh min dch, gip mt v no pht trin tt hn. Acid bo Omega-3 cng c trong ht v du qu c ch (walnut), du ht lanh (flaxseed)...

24

Bnh ng mch vnh

Ch dng vin ung du c (cha Omega-3) theo s ch dn ca bc s iu tr trnh tng tc vi cc dc phm khc ang dng. 6. Tng lng cht x ha tan v tinh bt Gia tng cc loi thc phm cha nhiu cht x ha tan v tinh bt thay th cho cc thc phm c nhiu cht bo bo ha. Cht x v tinh bt cng lm gim cholesterol v cht bo bo ha trong mu, li cung cp t nng lng, nhiu vitamin, khong cht. Ng cc, rau tri, cc loi ht... u thuc nhm thc phm ny. Ngoi ra, gim bt cholesterol, ta nn duy tr mt chng trnh vn ng c th u n, gi c th cn nng thch hp vi tui tc, ng thi gii hn cc loi ru bia. Vi lng tiu th cao, ru kch thch gan sn xut nhiu triglycerid. C kin cho l khi ung va phi, ru c th lm tng HDL, nhng nhiu ngi, d ung va phi cng c th a n nguy c tai bin ng mch no. Ngi bo ph thng c cholesterol trong mu cao hn ngi khng mp. Ung nhiu c ph (vi ly mt ngy) cng c th lm tng cholesterol trong mu. Vn ng c th lm tng HDL, gim LDL ng thi cng gip gim bo ph, h huyt p, lm tim mch mnh hn v lm tinh thn th gin. Tt c u c tc dng tt cho h thng tim mch.

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Dinh dng v iu tr
Trong my thp nin qua c nhiu tin b trong vic bo ch cc dc phm c th h cholesterol ti 40%. Tuy nhin, theo s ng cc chuyn gia y t, dc phm nn dnh cho trng hp cholesterol ln rt cao, sau khi khng thnh cng vi cc phng tin khc nh dinh dng, vn ng c th, thay i np sng. Thuc cn c s dng di s hng dn ca bc s theo di liu lng, tc dng ph, v nn dng dc phm c bo m an ton. Khng nn dng dc phm thay th cho tit ch n ung cng nh cc phng tin khc. Kim st cholesterol l vic lm lu di, cn kin nhn vi cc phng php c nhiu chuyn gia cng nhn. Nn d dt vi nhng gii thiu, qung co cha khi hon ton m khng cn thuc hoc mt ch n ung nhiu cht ny, b cht kia. Dinh dng trong bnh tt cng nh trong sc khe cn s a dng, phi hp cn i nhiu loi thc phm khc nhau.

26

DINH DNG VI BNH HUYT P CAO

- C , ti b huyt p cao hn mi nm, ung thuc g cng khng khi. Mi y ngi ta mch ti ung nc l i. Mi ngy ch ung mt l thi. Th m khi dt y! - Cn b nh ti y , chng cn thuc men g, ch tp th dc m huyt p xung trng thy.

i vi nhau v huyt p cao l chuyn u mi trong nhng dp gp g ca nhiu ngi, v y l bnh rt thng xy ra. C ngi sng vi bnh c nm by nm m khng bit hoc khng thy c triu chng g, cho ti khi b bin chng bt ng nh thn suy, cn au tim hoc tai bin no, th qu tr. Vy th xin cng qu c gi tm hiu i cht v chng bnh nguy him kh ph bin ny.

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Dinh dng v iu tr

Huyt p l g?
Huyt p l p lc hay sc p ca mu vo thnh ng mch. p lc ny c to ra khi tri tim bp, y mu vo huyt qun. Ty theo lng mu v sc cn ca thnh mch m p sut cao hoc thp. Huyt p c m t bng hai ch s:
- Huyt p tm thu (systolic), l ch s ng trc, ch p sut khi tim bp vo a mu sang ng mch ch. - Huyt p tm trng (diastolic), l ch s ng sau, ch p sut khi tim th gin gia hai nhp p v mu t ng mch ch chy vo cc mao qun i nui c th. Ly v d, khi kt qu o huyt p l 120/80, iu cho bit huyt p tm thu l 120 v huyt p tm trng l 80. n v o p sut y l milimt thy ngn (mmHg), v kt qu trn c ghi y l: 120/80 mmHg. Trung bnh, ngi t 18 ti 50 tui c huyt p di 140/90. Bui sng khi mi ng dy, huyt p thng thp; huyt p cao hn t sng ti chiu. Huyt p cng tm thi nhch ln khi ta c cm xc mnh hoc vn ng nhiu. T o huyt p nh k l vic ng khuyn khch ghi nhn s thay i p sut trong ngy, gip thy thuc d iu chnh thuc men. C th o hai ln mt ngy trong hai tun, ri mi ngy mt ln trc khi ung thuc. Khi huyt p tng i bnh thng th ch cn o vi ln trong tun. Khi o huyt p cn phi th gin, thoi mi th kt qu mi chnh xc.

28

Bnh huyt p cao

V my o th c hai loi: Loi my bm bng tay, c kim ng h ch s huyt p trong khi ta nghe nhp tim bng ng nghe v loi my digital vi s huyt p hin trn mn nh nh. Loi th nht d mang theo khi di chuyn, c gi tin va phi, nhng c vi nhc im l d hng, km chnh xc, khng thun tin cho ngi nng tai v phi nghe nhp tim bng ng nghe. My digital hin nay ph thng hn, d c kt qu v con s hin trn mn nh, i khi c th in kt qu ra giy. My d s dng, tin li cho ngi b km thnh gic v khng phi nghe nhp tim. Tuy vy, my loi ny t tin hn nhiu v chnh xc cng thay i khi c th c ng hay khi nhp tim khng u. My vn hnh bng pin in. Trong c th, huyt p c gi mc trung bnh nh c h thn kinh giao cm v thn. Khi huyt p xung thp, h thn kinh giao cm tit ra cht norepinephrine lm mch mu co cng, tng lc cn v nng huyt p cao. Thn tit ra cht renin iu ha thng bng khi lng dung dch cht lng ngoi t bo.

Th no l huyt p cao?
Tht ra, khng th c mt ch s tuyt i c nh xc nh tnh trng gi l huyt p cao, bi v c rt nhiu yu t phc tp lm cho huyt p ca mi ngi khng hon ton ging nhau. Cng mt s o c th xem l bnh thng

29

Dinh dng v iu tr
ngi ny nhng li l ng lo ngi mt ngi khc. iu ty thuc vo tui, cn nng, chiu cao, thi im o... Tuy vy, cch y nhiu nm, y hc vn c gng a ra mt tiu ch chung mang tnh thc dng xc nh tnh trng huyt p cao, l gii hn ch s o bnh thng khng qu 140/90mmHg ngi trng thnh. Nu vt qu gii hn ny l xem nh b huyt p cao, v cn thit phi c iu tr. Hin nay, tiu ch nh trn c cho l khng chnh xc, v tnh trng huyt p cao c xc nh theo mt tiu ch mi cht ch hn. xc nh bnh huyt p cao, s o huyt p phi l cao hn 150/95mmHg, v kt qu ny phi c ghi nhn 3 ln lin tip trong 3 ngy, vo 3 thi im khc nhau trong ngy. Theo tiu ch mi ny th c mt s ngi trc y b xem l huyt p cao nay bng nhin c khi bnh! V iu ny l cc k nguy him. gii quyt tha ng s bt hp l ny, mi y cc nh chuyn mn ngh mt tiu ch xc nh tnh trng gi l tin tng huyt p. l khi huyt p tm thu t 120-139mmHg v huyt p tm trng t 8090mmHg. Gi l tin tng huyt p, v nhng ngi c huyt p nh th ny tuy cha xp vo loi huyt p cao nhng c nhiu nguy c s b huyt p cao trong tng lai gn, nu khng bit gi gn, phng.

Nguyn nhn v iu tr
Huyt p cao l ri ro ln a ti tai bin ng mch no, ng thi cng l yu t quan trng gy ra cn suy tim v bi thn.

30

Bnh huyt p cao

Ch c khong 5% trng hp huyt p cao l do s suy yu, h hng ca mt c quan nh thn, cn 95% cc trng hp khc u khng r nguyn nhn, nhng mt s yu t c xem nh c nguy c gy bnh c xc nh. l: 1. Di truyn: Huyt p cao thng xy ra cho nhng ngi trong cng mt gia nh. 2. Chng tc: Theo thng k, ngi chu Phi, chu v chu M La Tinh thng b huyt p cao hn cc sc dn khc. 3. Tui tc v gii tnh: Ni chung, tui cng cao th nguy c tng huyt p cng tng theo. Nhng n ng thng b huyt p cao sm, cn ph n th phi qua tui 4550 mi c nguy c tng ng nh nam gii. 4. Bo ph: Ngi bo ph d b huyt p cao v mc cc bnh ng mch vnh hn so vi ngi bnh thng. 5. Mui n: Mui n lm tng huyt p mt s ngi mn cm vi vic tiu th nhiu mui. Ngoi ra, cn c mt s nguy c khc cng c th gy huyt p cao, nhng cha c chng minh c th. l ung nhiu ru bia, ht thuc l, tnh trng cng thng tm l, cam tho (licorice)... Cc cht ny nn c s dng mt cch va phi hoc hn ch trnh ri ro. Huyt p cao cao l bnh ko di sut i nn cn dng thuc lin tc duy tr huyt p mc bnh thng. Bnh huyt p cao ch c th cha dt mt s trng hp c nguyn nhn gy bnh r rng v c th khc phc c. Chng hn

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Dinh dng v iu tr
nh huyt p cao v co hp mch mu thn hoc do u bu nang thng thn.

Dinh dng vi bnh huyt p cao

Cn c vo nhng nguy c gy bnh va lit k trn y, c th thy l bnh huyt p cao c quan h vi ch dinh dng, c bit l s tiu th mui n v bnh bo ph. y l hai yu t c th thay i c theo hng tch cc hn cho ngi bnh. 1. Mui n Cch y vi thp nin, khi cha c cc loi thuc hiu qu kim st huyt p cao th hn ch n mui l bin php chnh. Trong mt thi gian di, thy thuc ch bit khuyn bnh nhn hn ch mui (n cm lt) v vn ng c th i ph vi bnh huyt p cao, v khng bit lm g khc hn. Ngy nay, tuy vic gim mui khng cn l bin php chnh, nhng vn c vai tr quan trng trong vic phng nga v iu tr huyt p cao mt s ngi. c nhiu kin khc nhau v vic gii hn lng mui n mi ngy. Mt s nh nghin cu cho l mui khng gy nh hng g i vi ngi c huyt p bnh thng. Vi ngi tng huyt p th gii hn mui ch h thp mt t l rt nh. Do cc nh nghin cu ca nhm ny khng tin tng nhiu vo cng hiu ca vic gim mui trong iu tr huyt p cao.

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Bnh huyt p cao

Trong khi , mt s cc nh nghin cu khc qu quyt l c mt s lin h gia huyt p cao v dng nhiu mui, c bit l ngi trung nin v cao tui. Theo h, gii hn tiu th mui l iu cn cha v phng nga huyt p cao. Nhiu ngi rt nhy cm vi mt lng mui ln, khin c th gi nhiu nc cn bng dung mi cht lng. Khi nc c gi li nhiu hn th dung lng ca dng mu cng tng theo, mch mu cng ra lm huyt p tng ln. Tri tim v thn cng phi lm vic nng nhc hn lu hnh mu ph tri. Vi nhng ngi ny th gii hn mui l iu nn lm trc khi huyt p ln cao. ng l nhiu mui ch nng huyt p cao mt s ngi (10-20%), nhng y cng l con s ng k. Hn na, qu na qu v lo nin u mc bnh huyt p cao m khng bit. C th l do dng nhiu mui trong lc thiu thi lm suy yu s bo v ca gen di truyn vi bnh ny. Nhn xt v cch n ung ca mt s sc dn trn th gii cho thy rng, nhm dn no dng nhiu mui th t l huyt p cao gia tng v ngc li, nhng ni tiu th t mui th t t l bnh ny gim xung. Theo cc chuyn gia dinh dng, ta ch nn dng di 2g mui mi ngy, tng ng vi mt tha nh. Ch rng l bao gm tng lng mui c trong thc n, thc ung trong ngy. Bi v mui cng sn c trong nhiu loi thc n, thc ung ch khng phi ch do chng ta thm vo khi nu nng.

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Dinh dng v iu tr
a s thc phm lm sn nh hp, thc phm ng lnh u c nhiu mui. Cc nh sn xut c gng ct gim mui trong thc phm ch bin, nhng vn cn kh cao. L do l khi thm mui th mn n s hp dn hn so vi mt mn n nht nho. V th, cc v cao nin thng dng nhiu mui gp hai ngi tr tui, m thc ra ch l tha mn khu v ch khng cn thit cho c th. gim mui cng khng kh khn lm, ch cn c s quyt tm. Khi nu, nn cho mui hi nht, ri thm vo i cht khi n nu cm thy cn; x bt mui trong rau ng hp; lu s lng mui trong nc ung, v nhiu ni c lng rt cao; c k nhn hiu trn thc phm bit r s lng mui trong mn n (c ghi l natri hoc natri). 2. Cht bo Cht bo trong mu nhiu qu s lm cho cc thnh phn khc ca mu kt dnh vi nhau, tim phi tng sc co bp y s mu dnh cc ny vo ng mch v do p sut ng mch tng ln. Mt s nghin cu cho thy khi gim cht bo th huyt p cng gim theo. C kin cho rng gim cht bo lm h huyt p tt hn l gim mui. Mt vi loi c cha nhiu cht bo omega-3 li c tc dng lm h huyt p. 3. Bo ph Rt nhiu kt qu nghin cu chng minh s lin h nhn qu gia bo ph v huyt p cao. Ngi mp c nguy

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Bnh huyt p cao

c b huyt p cao hn ngi bnh thng gp hai ti su ln. Theo mt vi thng k th khong 60% ngi huyt p cao u mp. L do l vi ngi mp th tri tim phi lm vic nhiu hn cung cp mu cho khi lng t bo ln hn ca c th. Mt l do na l ngi mp d b bnh tiu ng loi II, m tiu ng l mt trong nhiu nguy c a ti huyt p cao. Do , gim cn thng l bc u trong vic iu tr huyt p cao ngi mp. Gim tng s nng lng tiu th, gim mui, tng vn ng c th l nhng phng thc hu hiu gim cn. Gim cn cng lm gim cholesterol, gim tiu ng v cui cng l gim cc nguy c bnh tim mch. 4. Ru Thng k cho thy l t 5% ti 7% ngi huyt p cao u tiu th nhiu ru bia cc loi. Ch cn 100ml ru l nng p sut thnh mch ln 3mmHg. Do , nga huyt p cao, tt nht l khng nn ung ru bia. V nu c ung ru th nn gii hn mi ngy khng qu 2 ln, mi ln 50ml. Nu l ru vang th khng qu 150ml, v bia khng qu 350ml. 5. Mt s mui khong Mt s cc loi mui khong nh kali (K), magnesium, calci cng c vai tr tuy khim nhng nhng tch cc i vi huyt p.

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Dinh dng v iu tr
Theo mt s nghin cu, kali gip gim huyt p bng cch lm th gin mch mu, lng mch mu rng hn, gim sc cn thnh mch; lm tng s bi tit nc v mui natri ra khi c th; lm gim renin tit ra t thn. Kali c nhiu trong tri b, chui, cam, khoai ty, ht u...

Magnesium lm h huyt p bng cch lm gin n mch mu, gim lc cn thnh mch. Magnesium c nhiu trong cc loi rau c l mu xanh, cc loi ht, tht, c, trng... Calci lm gim huyt p cao gy ra do n nhiu mui natri. Calci c nhiu trong rau l xanh, sa, phomt, sa chua, c hp sardin, salmon...
6. Rau, tri cy Thc phm thc vt cng gip lm gim huyt p cao, l nh c nhiu cht x (fiber) v cc cht chng oxy ha nh

vitamin C. Cc nh dinh dng ngh nn dng nhiu loi rau, tri cy, cc loi ht khc nhau. Ti, rau cn ty, mp ng, c dn gian dng cha huyt p cao v tnh cch li tiu ca chng.
Ngoi ra, kim st huyt p, ngi bnh cng cn c mt chng trnh vn ng c th u n, va sc mnh. Ngi t vn ng d b huyt p cao hn ngi vn ng nhiu ti 30%. S vn ng c th u n c th lm h c huyt p tm trng v tm thu t 6-7mmHg.

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Bnh huyt p cao

Ch dinh dng cho ngi bnh huyt p cao do y ban c nhim Chng huyt p cao ca Hoa K a ra vo thng 4 nm 2004 l mt ch n t trng tm vo rau, tri cy; cc loi sa v pho mt b bt cht bo; thc phm t cht bo bo ha v cholesterol; nhiu cht x, khong kali, magnesium; v cht m va phi.

Kt lun
Nhiu thy thuc, nhiu nh nghin cu y hc coi bnh huyt p cao nh nhng tn st nhn thm lng. V nhiu ngi mc bnh c vi nm m khng bit cho ti mt lc no tnh c pht hin khi i khm bnh. Mc bnh huyt p cao m khng iu tr th tui th ch cn khong vi chc nm k t khi triu chng xut hin. Khi c bin chng m khng can thip bng thuc men th sng c ti a khng qu nm, by nm. Cn nu iu tr nghim tc th tui th s ko di hn. V th, s la chn l trong tm tay ca mi ngi. V nhng hiu bit v dinh dng gp phn ng k trong vic gim nh nguy c mc bnh cng nh lm chm qu trnh tin trin khi mc bnh.

37

DINH DNG VI BNH ALZHEIMER

nh Alzheimer l tnh trng ri lon no b gy ra s sa st dn dn v khng th hi phc cho tr nh v kh nng s dng ngn ng, kh nng nhn thc v khng gian, thi gian, v cui cng dn n tnh trng mt kh nng t chm sc trong cc nhu cu hng ngy. Nm 1906, bc s ngi c Alois Alzheimer ln u tin xc nh v m t cn bnh ny. Ngy nay, bnh Alzheimer c tha nhn l nguyn nhn ph bin nht gy ra s sa st nng lc tinh thn v tr tu nhng ngi t 65 tui tr ln. Bnh him khi xut hin tui t 30 - 60. Ti Hoa K, s bnh nhn trong tui ny ch chim khng n 10% trong tng s 4 triu ngi mc bnh Alzheimer. Ni mt cch d hiu, bnh Alzheimer lm cho bnh nhn dn dn tr nn l ln, nhng nghim trng hn nhiu so vi trng thi l ln thng thng do km minh mn tui gi. L l trng thi suy km, hu nh khng cn tr nh, tr khn, cn ln l khng phn bit c s vic, nhn lm s vic ny ra s vic khc. L ln l ni chung tnh trng suy km tr nh, hay ln, hay qun. Nhng l ln trong bnh Alzheimer l mt s suy km nghim trng n mc lm cho ngi bnh ngoi cc ri lon v nhn thc v suy xt cn c s thay i v hnh vi, nhn cch v nht l khng cn kh nng t chm sc trong cc nhu cu hng ngy.

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Bnh Alzheimer
Bnh c th xy ra tui trung nin, nhng nhiu hn t 60 tui tr ln, v t l mc bnh c bit tng cao theo tui tc. Ti Hoa K, thng k cho bit c khong 10% s ngi trn 65 tui mc bnh ny, v nu tnh trong s nhng ngi trn 85 tui th t l mc bnh ny ln n 50%. Bnh Alzheimer l nguyn nhn gy t vong ng hng th t ngi gi. Kt qu gii phu no ngi bnh Alzheimer cho thy c nhiu thay i nh s thoi ha v xon ln t bo thn kinh ni kt. Cc thay i c tm thy nhiu nht phn v no v thy no l ni kim st tr nh v s nhn thc. Cho ti nay, c nhiu thuyt c gng gii thch nguyn nhn gy ra bnh, nhng cha c thuyt no c mi ngi cng nhn. Mt s nh nghin cu cho rng nhm c mt vai tr no , v trong t bo no mt s bnh nhn c lng nhm cao gp 30 ln so vi ngi bnh thng. Nghin cu khc cho l thay i chuyn ha km trong c th cng l mt nguyn nhn. Km rt cn cho cc chc nng ca no. Nghin cu loi vt cho thy thc phm thiu cc vitamin B6 (pyridoxine), folacin, magnesium lm thay i cu trc ca no. Li c nhng nghin cu khc cho rng mt s virus c th l nguyn nhn gy bnh ny. i n kt lun chnh xc v nguyn nhn gy bnh Alzheimer, khoa hc cn cn c nhiu nghin cu hn na. V cho ti nay, vic xc nh bnh thng ch c thc hin sau khi khm nghim no b t thi ngi bnh.

39

Dinh dng v iu tr
Tuy nhin, tm hiu y s v quan st mt s triu chng du hiu cng gip nh bnh s khi, trong giai on u ca bnh. Ngi mc bnh Alzheimer thng c nhng biu hin sau: - Hay qun, thm ch qun c tn cc con vt nui trong nh hoc cc vt rt thng dng. - Mt nh hng trong khng gian. - C nhng nghi ng hoang tng. - Tnh tnh bng bnh, ph phch v thay i trong dng iu i ng. Bnh thng ko di c nm, mi nm, qua nhiu din tin khc nhau ty tng ngi bnh. Cui cng, v suy nhc ton b, ngi bnh i n tnh trng nm lit ging lit chiu, khng kim st c i tiu tin, suy dinh dng, v thng ra i vnh vin v nhim trng hoc sng phi. Mi bin php can thip u ch tp trung vo vic h tr, chm sc ngi bnh, v thc ra cha c dc phm hay phng thc no iu tr bnh ny. c nhiu th nghim mt s dc phm, nhng a s ch ci thin c i cht v ri lon tri thc m thi. Mt vi nghin cu cho rng niacin c th c cng dng tng mu lu thng ln no. Gn y, mt s nghin cu cho thy acetylcholine, mt cht c chc nng dn truyn tn hiu thn kinh (neurotransmitter) c v nh gim rt nhiu ngi bnh Alzheimer. Acetylcholine c nhiu nh hng ti s hc hi v tr nh, nn nhiu nh khoa hc cho l thc phm c acetylcholine s gip ch cho ngi bnh mt phn no.

40

Bnh Alzheimer
Cc dc phm sau y thng c dng gip ngi bnh ci thin phn no tr nh: Donezepil, Tacrine, Namenda, Galantamine, Rivastigmine. Tm thi, chng ta ch c th nui hy vng l trong tng la, khi bit r nguyn nhn bnh cng nh gii m c ton b cc gen ca c th, may ra s c c mt phng thc iu tr hu hiu bnh Alzheimer. Mc d vy, trc mt th s gip tn tnh ca thn nhn cng vi ch dinh dng y vn c th tr hon phn no tin trin ca bnh, ngha l s thoi ha ca cc t bo no, v nht l c th gip ngi bnh cm thy phn no d chu, thoi mi hn trong khi phi chu ng cn bnh.

Dinh dng vi bnh Alzheimer

Trong sut thi gian ko di ca bnh, ch dinh dng ng vai tr rt quan trng trong vic chm sc ngi bnh Alzheimer. Mt khc, c nhng kh khn ca ngi bnh m ta cn hiu bit vic nui dng c d dng cng nh gip bnh nhn hu hiu hn. 1. Nhng kh khn ca ngi bnh Bnh nhn mt dn tr nh, gim kh nng i thoi, tm thn ri lon, mt nh hng, ri lon suy ngh, i khi cng t ra bun phin cho nn khu v v s tiu th thc phm khng u n, kh nng t chm sc gim dn, a n c th st cn trm trng. a s bnh nhn thng hay qun, l l hoc t chi n ung. H khng din t c cm gic i v khng i hi thc n. i khi h li n nhng th tp nham, khng phi l

41

Dinh dng v iu tr
thc phm m h nht u . Vi hnh vi ca mt tr th, h cng giu hoc nm thc phm i. Nhiu khi ngi bnh khng nhn ra thc n l g, a vo ming m khng nhai nut. Ngi bnh cng nghch vi thc phm nh chi; khng bit tha a dng lm g, hoc khng nh c cch a thc n vo ming. Bnh nhn hay giy gia, chuyn ng c th nn vic t n hoc nui n cng tr ngi. Trung tm thn kinh iu hnh cm gic i v kht b suy hao nn ngi bnh khng thy i kht. Km v sinh rng ming nn ngi bnh nhai nut kh khn, nht l khi ming kh khng c nc bt. Mi hi ca nc tiu, phn trong ngi lm ngi bnh mt hng th n ung. Vic dinh dng hu nh l thuc vo ngi chm sc. Nhu cu dinh dng vn l s cn bng ca nhng nhm thc phm c bn hp vi s thch v tnh trng sc khe ngi bnh. Nn ti nhng mn n m ngi bnh thch hoc khng thch, hoc phi king c v ang mc vi bnh mn tnh no khc. 2. Mt s vn m ngi chm sc cn lu a. Lu xem bnh nhn c cn mc phi nhng bnh no khc, hoc do nh hng dc phm no khin h khng n ngon ming. i khi ch v bun ru m ngi bnh bing n. b. a ngi bnh i khm nha s kim tra tnh trng rng ming, nu c th cn x l thch hp gip ngi

42

Bnh Alzheimer
bnh nhai nut d dng hn. Khm mt xc nh xem ngi bnh c cn kh nng phn bit v s dng thc phm hay khng. c. Cn c thi mm mng, tnh cm, khuyn khch ngi bnh n: chiu chung, v v ngi bnh kh tnh; b tr ngi bnh hay p ph n ring; trnh s n o lm h thm bi ri. d. Nn cho dng nhiu cc mn n cm tay c nh ming khoai chin, tht g chin, bnh m kp, pho mt, cm nm, tri cy, rau, trng luc... ngi bnh khng phi dng n tha, a. Chn cc mn n m ngi bnh thng a thch. . Trnh cc loi thc phm qu dnh vo nhau lm ngi bnh kh nhai; nu thc n mm vi nc xt thng d n hn. e. Thn trng vi cc mn n qu nng, c th lm phng ming ngi bnh. Thc n c nhit m, nng va phi thng d n hn. g. Cho ngi bnh ung nc lc, nc tri cy trnh kh nc trong c th. h. Dng ly, bt ln thc n khi vng vi ra ngoi. Trnh dng mung na bng nha cng gin v d gy, c th ln vo thc n. i. By thc n ring r tng mn ngi bnh khi bi ri khi la chn. Cho n tng mn, v nhiu ngi bnh khng phn bit c khi chuyn t mn ny sang mn khc qu nhanh.

43

Dinh dng v iu tr
k. Dnh nhiu thi gian ngi bnh n cng nh gip ngi bnh n. Nhc nh ngi bnh nhai, nut khi thy h l ng. l. Mt s bnh nhn thng i lang thang nn tiu hao nhiu nng lng m li khng ngi yn n, do rt d b suy dinh dng. Cn c sn mt s thc phm d n, lm sn tin u cho n . m. Vi bnh nhn khng t n ung c, ngi chm sc cn kin nhn gip h n, khch l h nhai, nut; to khng kh vui nh bnh nhn khi phn tm, bi ri. n. Lu nhiu nu bnh nhn hay b nghn v thc phm, nc ung, nht l ngi ang ung cc loi thuc thn kinh, an thn. Nhng ngi ny rt d b kh khn v h hp, a n thc n i lm ng vo kh qun, gy ra sng phi. S chm sc thng ko di nhiu nm. Nn ngi chm sc cn c s gip , h tr ca thn nhn, bn b. Khi cn, cng khng nn ngn ngi nh n c quan y t x hi v cc ni ny thu hiu vn nn c sn cc phng tin tr gip.

44

DINH DNG VI NGI THIU MU

u l mt dch lng lu thng khp c th qua h thng ng mch v tnh mch v l phng tin chuyn ch cc cht dinh dng ti m v cc c quan. Mu c cc t bo mu l lng trong dung dch lng gi l huyt tng. Mi ngi trung bnh c t 5 n 6 lt mu, chim khong 7 n 8% trng lng c th. Mu c hai chc nng chnh l mang n cht dinh dng v oxy cung cp cho tt c cc c quan, t bo ca c th v mang i nhng cht thi t cc c quan, t bo y a ra khi c th. Trong huyt tng cha cc cht b dng nui c th v cc yu t chng mu ng cc. a s t bo mu c sn xut t ty sng (bone marrow) v c nhiu nhm vi nhim v khc nhau: - Hng cu vi nhim v chnh l chuyn ch dng kh (oxy) v thn kh (dioxide carbon).

Bch cu vi nhiu loi v nhim v chung l bo v c th bng c ch min dch v dch th, chng hn nh: bch cu trung tnh (neutrophil) chng xm nhp ca vi khun; lymph bo (lymophocyte) to ra tnh min dch cho c th; bch cu n thun v i thc bo (monocyte, macrophage) tiu dit vi khun.

45

Dinh dng v iu tr
Tiu cu (platelet) to nt bt ch h mch mu v kch thch s ng mu chng li tnh trng chy mu khi c th b thng tch, bng huyt...

Thiu hoc tha dinh dng u gy ra nhiu ri lon cho c t bo mu ln huyt tng. Huyt tng c qu nhiu cht bo s a ti cc bnh tim mch. Hng cu l thnh phn ca mu chu nh hng trc tip t ch dinh dng. Thiu dinh dng dn n bnh thiu mu (anemia) l trng hp rt thng xy ra.

Thiu mu
Thiu mu l tnh trng gim kch thc hng cu v lng huyt cu t (hemoglobin). Nguyn nhn thiu mu c th l do chy mu, xut huyt ni tng, bng huyt... hoc do mt cn i khi c th to ra t hng cu hn s lng b mt i, do mt s bnh mn tnh, do tiu hy hng cu trong mt s bnh bm sinh, do c tnh ca mt s dc phm, ha cht, do thiu cc cht dinh dng cn thit cho s sn xut hng cu nh st, vitamin B12, E, folacin... hoc do tp hp ca tt c cc nguyn nhn ny. Nh vy, thiu mu t n khng phi l mt chng bnh, m l biu hin ca nhiu bnh khc nhau. Hu qu ca thiu mu l gii hn s trao i dng kh v thn kh gia mu v cc t bo c th, cng nh cung cp khng lng dinh dng cn thit cho s hot ng ca cc t bo, c quan... C nhiu loi thiu mu, nhng da vo nguyn nhn c th phn thnh hai nhm chnh:

46

Thiu mu
- Thiu mu do dinh dng: nh do thiu vitamin B12, folacin, v nht l khong cht st. - Thiu mu khng do dinh dng: nh do chy mu nhiu, bng huyt, hoc do cc bnh tiu hao mu (ung th bch cu, mt s bnh nhim k sinh trng...) Theo tiu chun ca T chc Y t Th gii (World Health Organization - WHO) th tnh trng thiu mu c xc nh khi lng hemoglobin xung thp: Di 11g/100ml mu ly tnh mch i vi tr em t 6 thng n 6 tui. Di 12mg/100ml mu i vi tr em t 6 tui n 14 tui. Di 12mg/100ml i vi n gii trn 14 tui. Di 13mg/100ml i vi nam gii trn 14 tui. Di 11mg/100ml i vi ph n ang mang thai.

Tr em v ph n trong thi k sinh thng hay mc bnh thiu mu do dinh dng. 1. Thiu mu do thiu st Thiu st l hu qu chnh ca km dinh dng, v st l mt khong cht c rt nhiu trong thc phm. Mc d c th ch cn mt lng st rt nh, nhng thiu st l chuyn thng xy ra trong vn n ung. St gip hemoglobin chuyn ch dng kh i nui t bo vo gip loi b thn kh khi c th. St cng l thnh phn ca nhiu enzym trong h thng min dch chng nhim khun. St cn gip chuyn ha beta caroten thnh vitamin A, to ra cht collagen lin kt cc t bo vi nhau.

47

Dinh dng v iu tr
C th hp th st nhiu hn khi lng d tr ca c th xung thp v t hn khi lng d tr y . Trong thc phm c hai dng st: st heme c nhiu trong tht (tht heo, b, cu...), tht g, c... v st nonheme c nhiu trong thc vt v lng trng. St heme c hp th d dng hn nn c th hp th nhanh v nhiu dng st ny hn so vi st nonheme. Nhng khi n chung thc phm gc thc vt vi tht c hoc dng thm vitamin C th s hp th st nonheme cng tr nn d hn. Th d n sng vi trng trng m c thm t tht nc s gip hp th st d hn; tht g gip hp th st c trong go; tht heo gip hp th st c trong u... Gan b c nhiu st hn tht b, tht g, tht heo, c. Trong thiu mu do thiu st, hng cu thng nh v lng hemoglobin cng thp. y l bnh thiu dinh dng thng thng nht trn th gii v cng l bnh thiu mu thng thy ph n c thai v tr em.

Nhu cu st

Nhu cu st cao tr sinh thiu thng: mi ngy 1mg st, so vi tr sinh bnh thng ch cn mt phn ba s lng ny. Tr 2 tui cn 1mg /ngy, v tng ln 2mg/ngy tui ang ln ri tr li mc trung bnh l 1,2mg/ngy. Ph n trong tui sinh th cn khong 2mg/ngy b li lng st tht tht vo mi k kinh. Khi c thai, nhu cu st tng gp i vo khong thng th 6, gp ba vo thng th 9 cung ng mu cho thai nhi v cho t cung ln rng.

48

Thiu mu Nguyn nhn

Nguyn nhn a ti thiu mu do thiu st gm c: 1. Khng dng st v phn n thiu. Chng hn n nhiu thc phm thc vt, khng c loi st heme. 2. Khng hp th c st v cc bnh tiu ha nh tiu chy, khng c acid trong d dy, bnh rut, ct b d dy, do tc dng ca dc phm. Cc thuc cha lot d dy nh Tagamet, Zantac, thuc tetracyclin u lm gim dch v d dy. 3. Khng s dng c st nh trng hp bnh d dy kinh nin. 4. Khng p ng nhu cu st tng cao hn mc bnh thng tng khi lng mu, nh tui ang tng trng, c thai, cho con b. 5. Do tht tht nhiu mu nh chy mu v thng tch, do lot d dy, bnh tr, ung th rut, k sinh trng rut, khi c kinh nguyt...

Triu chng
Bnh nhn thng c mt s triu chng nh l nh, km tp trung, mt mi, bing n, lm vic mau ht hi. Mt triu chng c bit cha gii thch c l bnh nhn thch n nhng mn bt thng nh t st, nc cc, mnh vn sn tng... v c th a ti tn thng nim mc d dyrut. giai on trm trng, da bnh nhn ti nht; nim mc mi mt trng nht thay v ti; mng tay mng v phng; li vim trn bng nh bi sp; d dy khng cn dch v. Tr em thiu mu c th chm hc hi, km tng trng.

49

Dinh dng v iu tr nh bnh

Thng thng, xt nghim kch thc, hnh dng v mu ca hng cu cho ta mt khi nim c bn v loi thiu mu. chnh xc hn, c th o lng ferritin trong huyt tng bit kho d tr st c thiu hay khng; o lng transferin c chuyn cho hng cu; o lng erythrocyte protoporphyrin t do, mt cht m khi hp vi st s tr thnh hemoglobin. Nu cht ny c nhiu trong mu l du hiu ca thiu st. V th, khng phi c thy st trong mu thp l ung st, m phi cn c vo mc ferririn v transferin.

iu tr
iu tr cn c vo vic xc nh nguyn nhn gy bnh ri tr nguyn nhn. Ngoi ra, cng cn b sung cho kho d tr st bng cch cho ngi bnh dng st di dng ferrous sulfat t 200-300mg/ln, mi ngy ba ln. C 2 dng thuc vin v thuc nc. St c hp th d dng khi bng i, nhng li gy ra kch thch nim mc. trnh kh chu d dy v to bn, c th ung khi no bng. Khi khng ung c nh l ri lon tiu ha th c th tim dung dch thuc b c st. V thc phm th tht b, c, g, gan, trng, u, sa, u c nhiu st. St trong cc thc phm ng vt (dng st heme) c hp th nhiu hn st trong thc vt (dng st nonheme).

50

Thiu mu
Vitamin C, ng lactose trong sa, acid hydrochloric gip tng hp th st nonheme. Ru cng gip hp th st tt hn, nn cc thuc b mu u c mt cht alcohol.
Ngoi ra, nu thc phm trong ni bng st cng tng khong ny trong thc n.

Calci, phosphat, lng trng, tr, cht x, u nnh sng lm gim hp th st nonheme. Cc thuc chng acid d dy, thuc cimetidin, tetracyclin, zantac u lm gim hp th st.
Trng hp tiu th qu nhiu st th c th b bnh Hemochromatosis, l tnh trng st tch t gan, l lch, ty sng, t bo tim di dng ferritin v hemosiderin. Trng hp ny thng xy ra khi thc phm c qu nhiu st, hoc mt s quc gia dng ni bng st nu thc n. Dng thm cht st theo hng dn ca bc s th t khi xy ra trng hp ny. Bnh nhn Hemochromatosis c cc triu chng nh mi mt, au bng, nhc mi xng khp, ph n kinh nguyt khng u, nam gii lon cng dng. Khi trm trng, gan sng to, da thm en, tim suy v c th t vong. Bnh thng c cha bng cch lc mu loi bt lng st tha. 2. Thiu mu do thiu vitamin B12

B12 ng hng th tm trong nhm vitamin B, c khm ph vo nm 1948 trong gan sc vt. Vitamin ny rt cn cho s phn bo. Thc phm ng vt u c vitamin B12, cn trong cc loi thc vt khng c loi vitamin ny.

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Dinh dng v iu tr
Thiu vitamin ny thng l do: a. Khng n y thc phm c B12 nh tht, pho mt, trng, sa b, sa chua... Bnh thng gp ngi n chay thun ty, ch n rau tri. Tr em b sa ca ngi m n chay hoc p dng ch dinh dng sai, thng l do king khem, v i khi bnh cng xut hin ngi nghin ru. V gan d tr nhiu vitamin B12, nn bnh ch xy ra sau khong vi nm lin tc khng n thc phm c vitamin ny. b. Khng hp th c vitamin B12 l nguyn nhn chnh gy bnh. S hp th ny xy ra on cui ca hi trng (ileum) vi s hin din ca mt nhn t ni ti (intrinsic factor) do d dy tit ra. B12 bm vo nhn t ny c hp th vo rut. Bnh xy ra trc khi kho d tr cn hn vitamin ny. Nhng l do a ti km hp th l: bnh d dy tit ra khng nhn t ni ti; ct b mt phn d dy; bnh hi trng (ileum) nh trong bnh Crohn; k sinh trng trong rut s dng ht vitamin B12. Hp th cng gim dn khi cao tui, v dch v d dy t dn i. V th, sau 60 tui nn kim tra mc B12 hng nm pht hin nhng trng hp thiu vitamin ny v b sung bng cch tim B12. c. Khng s dng c B12 trong cc bnh thn, gan, suy dinh dng, ung th. Din tin ca bnh rt m thm. Ngi bnh n mt ngon, i tin khi bn khi lng, au ngm bng di, li rt, st cn, ri lon chc nng dy thn kinh ngoi vi. Khi bnh c chn on th bnh nhn cn c tim B12. Ban u tim mi tun mt mi, cho ti khi hng cu tr

52

Thiu mu
li bnh thng th gim cn mi thng mt mi trong nhiu nm trnh tn thng thn kinh. 3. Thiu mu v thiu folacin Folacin hay acid folic c trong cc loi thc phm thin nhin nh rau, tri, gan ng vt... v i khi c b sung trong cc sn phm ng cc ch bin. Folacin rt d b nhit phn hy khi nu thc phm qu chn. V th, nu mi ngy u n thc phm nu va phi th khng th thiu vitamin ny. Thiu folacin c th do thc phm khng c folacin hoc do b phn hy khi nu vi nhit cao qu lu, hoc do rut km kh nng hp th. Cc dc phm chng kinh phong v thuc nga thai cng lm gim s hp th folacin. Nhng ngi c thi quen n thc n nu chn k d b thiu folacin. Ngi nghin ru cng thng thiu folacin. Bnh do thiu folacin xy ra rt nhanh, ch ngay trong vng vi thng khi c th khng c cung cp loi vitamin ny. Mi ngy c th cn khong 150mcg (microgram) folacin. Khi c thai hoc cho con b th ngi m cn gp hai hoc ba ln s lng ny. Triu chng thiu mu do thiu folacin v do thiu vitamin B12 u tng t nh nhau, ngoi tr tn tht v thn kinh ch c trong trng hp thiu vitamin B12.

Ngoi ra, thiu vitamin B6 (pyridoxine) lm gim s tng hp hemoglobin; thiu vitamin E lm mng hng cu mng manh d b tiu huyt; thiu vitamin C a ti bnh Scurvy vi chy mu nu rng, di da. V th, cn ch n lng cung cp cc vitamin ny trong thc phm hng ngy.

53

DINH DNG VI BNH THN

t s ngi sinh ra ch c mt tri thn, trong khi nhng ngi bnh thng c 2 tri thn, c hnh ht u vi kch thc ngi trng thnh l khong t 10cm n 13cm chiu di v t 5cm n 7,5cm chiu rng (ngha l khong gn nh con chut my tnh) v c b tr nm cn i hai bn xng sng, pha sau bng. Tri thn mu hng nht, na na nu, nng khong 115g. Thc ra, mi ngi ch cn mt tri thn l hon tt nhng nhim v cn bn. Nhng to ha c l d phng l mt lc no thn c th h hng, nn t vo mi ngi n hai tri thn. V nh th, nu hng i mt tri, chng ta vn c th sng bnh thng; cn nu hng c hai, vn cn c c hi nhn c mt tri thn t ngi thn no tip tc sng, bi v mi ngi u c 2 tri thn nn chuyn san s ny l hon ton c th lm c. Cu to chnh ca thn l hng triu vi cu thn nh b. Mi ngy c ti gn 200 lt cht lng vi cc thnh phn ha cht c lc qua v khong 1,5 lt nc tiu c bi tit ra ngoi. Tuy nh b nhng thn gi nhiu chc nng rt quan trng i vi c th. Cc nhim v cn bn ca thn l iu ha ton th khi cht lng trong c th, cn bng nng acid-kim; thi cc

54

Bnh thn
cht cn b nh ure, acid uric, creatinin, ammonia; gi li cht dinh dng nh ng glucose, m, hng cu, bch cu, tiu cu. Ch cn cc chc nng ny ngng li khong hai tun l c th dn n t vong. Thn tit ra antidiuretic hormon e (ADH) kim st lng nc trong mu. Thn cng gp phn iu ha lng khong natri v kali. Thn gip gi huyt p bnh thng; gp phn vo vic cu to hng cu. Thn cng lin quan ti vic s dng khong calci v phosphor trong tin trnh to xng. Thn cn tit ra hormon erythropoietin c lin quan ti s cu to hng cu ty sng. Dng nh nhng chc nng thc tin nh trn vn cha ngi ta tn vinh tri thn, nn nhiu ngi cn gn ghp thm cho thn mi quan h vi vic km kh nng hot ng tnh dc, ri than phin l do bi thn v tm ung cc loi thuc b thn khc phc tnh trng ny. S tht th thn khng c lin quan g n kh nng hot ng tnh dc c.

Suy thn (Renal failure)

Vi cc sinh hot bnh thng v vi s chm sc, bo v ng cch th thn c th tn ti v phc v chng ta cho n cui i. Nhng, cng nh cc b phn khc trong c th, thn c th b suy yu h hao v nhiu l do. Chc nng bi tit ca thn gim mt cch t nhin theo tin trnh lo ha ca c th. Ti tui 70 th s lng vi cu thn - cc n v lc ca thn - gim, lng mu qua thn cng bt i v thn c mt vi kh khn trong vic p ng vi nhng thay i cc thnh phn trong mu.

55

Dinh dng v iu tr
Bnh thng, thn c th tip tc nhim v bi tit d ch cn li khong vi chc phn trm s lng vi cu thn. Cc n v lc cn li ny s ln ln v lm vic gp i, gp ba b p cho cc vi cu thn suy hng. 1. Bnh l Thn c th b vim do cc tc nhn ha hc, dc phm, vt l hay tc nhn gy nhim. Bnh ngoi thn nh tiu ng, huyt p cao, hoc mt cn tr lu thng mu ti thn cng lm thn suy. Hu qu ca suy thn l s ng cc cht thi trong mu, nht l ure, cht thi ca m. Suy thn din tin chm. Giai on u hu nh khng c du hiu. Ri mt s bnh nhn cm thy hi mi mt, hay i tiu ban m v thn khng cn kh nng c ng nc tiu; bn chn hi sng, huyt p hi ln cao, hng cu hi gim. Khi bnh trm trng th cc bin chng cng leo thang: huyt p tng vt, nhp tim ri lon, thiu hng cu, xng yu d gy, xut huyt d dy, bng huyt v mu long, mt cht dinh dng. Khong natri v kali b gi li trong c th. Nhiu natri qu a n huyt p cao, sng ph chn. Kali cao lm nhp tim ri lon. Bnh nhn i ma, gim cn, tr nn suy yu dn nu khng c cha chy. Khi n giai on cui ca suy thn th ch cn c cch thay thn (ghp mt tri thn khc) hoc lc mu (Hemodialysis) loi b kali, ure v cc cht c hi khc trong mu. 2. Dinh dng vi ngi suy thn Dinh dng trong suy thn c vai tr rt quan trng v tp trung vo cc mc ch sau y:

56

Bnh thn
a. Trnh cho thn khi lm vic qu sc; b. Trnh suy dinh dng v gi cn nng bnh thng cho c th; c. Trnh mt cn i lng natri v kali trong mu. d. Trnh mu nhim cht thi ure. Cn b ca cht m trong chuyn ha l ure m thn c chc nng loi b. n cng nhiu cht m th lng cht thi ure cng cao v thn cng phi lm vic kh nhc hn loi b. Mc tiu th cht m nn tng hay gim ty theo tnh trng suy thn. Vi suy thn kinh nin th cn hn ch cht m trong khu phn. Cht m cho ngi bnh phi c phm cht tt, vi cc loi acid amin. Tht ng vt hi iu kin ny hn cht m t thc vt. Nhng ngi bnh vn cn mt s nng lng, nn khi gim m, ta c th tng carbohydrat hoc cht bo dng cha bo ha. V suy thn c khuynh hng gi natri v kali trong mu, nn trong thc phm cn gii hn hai mui khong ny trnh ph nc v cc bin chng khc. S hp th calci ty thuc vo mc phosphor trong mu. Trong suy thn, phosphor b gi li, a n gim calci. M khng th tng calci li khng tng phosphor trong thc phm, nn ngi suy thn cn ung thm khong 500mg calci mi ngy, trnh cc bin chng suy yu xng. Lng nc ung cng cn phi cn bng vi nc mt i qua tiu tin, m hi, bc hi qua hi th...

57

Dinh dng v iu tr
Ngoi ra ngi bnh cng cn dng thm cc vitamin C, B, folacin m khng cn ung thm cc vitamin ha tan trong m nh vitamin A, E, K. Mt ch dinh dng cho ngi suy thn rt phc tp, nn ngi bnh cn phi tham kho li khuyn ca chuyn vin dinh dng, v nht l tun th cc ch dn ca bc s iu tr. Mi c nhn cn c mt khu phn ring bit, thch hp vi bnh tnh ca mnh.

Si thn
1. Phn loi Theo thng k, trung bnh c khong 10% nam gii v 3% n gii b si thn t nht mt ln trong i. C bn loi si thn, phn loi theo cht cu to si. Mc d triu chng cc loi si thn ging nhau nhng nguyn nhn cng nh phng thc iu tr li khc nhau. Thng thng nht l si do khong calci oxalat hoc phosphat, vi t l 90% v thng thy nam gii vo tui trung nin. Ba loi khc l si do acid uric, magnesium ammonium sulfat v cystin. Loi sau cng ch c mt s ngi b ri lon bm sinh v chuyn ha cht dinh dng cn bn. Khi nng cc cht ny trong nc tiu ln cao th chng kt tinh thnh si trong thn hoc ng dn nc tiu. Nguyn nhn ca s kt tinh cng nh lm sao ngn nga s kt tinh u cha c lm sng t mc d c nhiu nghin cu khoa hc. Nhng iu chc chn l si thng ti kt tinh nhiu ln trong cuc i ngi bnh.

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Bnh thn
Mt s yu t c th a ti si thn nh thc phm c t calci - nhiu phosphor, nhiu kali, nhiu m ng vt, thiu vitamin A, nhim trng hoc tr ngi lu thng ng tiu tin, khng ung nc y , nm bt ng qu lu, lng calci qu ln v cui cng l do di truyn. Si m thm kt tinh. Si nh c th theo nc tiu ra ngoi. Khi si di chuyn l lc ngi bnh thy au but ngang tht lng, chy xung bn v i v tiu ra mu. Si to c lm tan bng k thut lithotripsy hoc ly ra bng phu thut. D si thuc loi no hoc kch c no, bnh nhn u c khuyn co l nn tiu th mt lng nc ln mi ngy (1,5 ti 2 lt/ngy) c 2 lt nc tiu, nhm trnh s kt tinh a ti si thn. 2. Dinh dng vi bnh si thn Ngi b si thn thng rt quan tm ti vn n ung. H rt s nhng cn au but khi si di chuyn nn t gic king khem trong n ung theo ng ch dn vi mong mun si khng ti pht. Trc y ngi bnh thng c khuyn bt n thc phm cha nhiu calci gim nguy c si thn. Nhng thc ra, s lin h khng hon ton nh vy. Lng calci cao trong nc tiu khng hon ton do nhiu calci trong mu. Mt vi bnh nh cng tuyn cn gip (Hyperparathyroidism), ri lon tha vitamin D, u bu xng, bnh sarcoidosis u lm tng calci trong mu v u l nguyn nhn a ti si trong thn. iu tr nhng bnh ny s lm gim calci trong mu v nc tiu.

- Si calci oxalat

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Dinh dng v iu tr
Nhiu khi lng calci trong nc tiu tng l do s hp th calci km t thc phm trong mt vi bnh ng rut nh bnh Crohn, suy ty tng... hoc khi dng qu nhiu vitamin C (vitamin ny c chuyn ha ra oxalate) hoc do thn r calci ra ngoi. Nu l do hp th t rut th s hn ch thc phm c calci oxalat gip ch cho vic iu tr. Thc phm c nhiu oxalat l rau spinach, qu du, s-c-la, cc loi qu hch, tr... Nhiu chuyn gia khuyn gim bt s tiu th calci. Nhng cn tham kho kin ca bc s, v hn ch qu lm thiu calci, c th s rt calci xng v lm xng suy yu, d gy. C kin khc cho l s gii hn calci c th lm tng nguy c b sn oxalat, v calci cao s gip gia tng s hp th oxalat trong rut v gim sn oxalat trong nc tiu.

- Sn acid uric
Acid uric sinh ra t s chuyn ha cht purin trong m ng vt v mt s thc phm khc. Acid uric trong nc tiu cng tng cao ngi b bnh thng phong (gout) khi ung nhiu thuc Aspirin, Probenecid. Do , khi hn ch thc phm c nhiu purin s lm gim mnh nguy c b si ny.
Thc phm c nhiu purin l: gan, c, tim, thn ng vt, c herring, sardin, bia, ru vang, tht, u, sp l, nm, rau spinach, tm c...

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Bnh thn - Si struvite

L cc tinh th cha ammonium, magnesium v phosphat. Loi si ny thng gp n gii. Bnh thng do nhim vi khun ng tiu tin vi cc loi Proteus hoc Klebsiella, lm cho cht ure phn ha thnh cc tinh th ammonium, ri kt tinh li v to thnh si thn. Si thn loi ny thng c iu tr nhim trng bng thuc khng sinh loi tr nguyn nhn, hoc phu thut ly si ra. Dinh dng khng c vai tr g trong si thn loi ny. 3. Kt lun Trong tt c cc trng hp si thn, s lng nc tiu th hng ngy gi mt vai tr rt quan trng. Nc ung vo lm nc tiu long v ngn nga cc tinh th gy si kt t vi nhau. Cho nn, mi ngy, ngi b bnh si thn cn ung t nht l 2 lt nc. Xin lu l mt s thc phm lm thay i mc kim hoc acid ca nc tiu (ch s pH) v c nh hng ti s kt tinh cc cht to si thn. Rau, tri cy, sa... lm nc tiu tng kim. Thc phm c nhiu m nh tht, c, trng, pho mt, ng (bp)... lm nc tiu tng acid.

61

DINH DNG VI BNH LONG XNG

u nh tnh cht tiu biu ca da l s uyn chuyn, do dai b ngoi, th xng l tng trng cho s kin c bn trong ca c th con ngi. C th mt ngi trng thnh c 206 chic xng, chim 14% tng trng lng c th. Nhim v chnh ca b xng l to ra mt b khung vng chc trn phn b tt c cc c quan ca c th, ng thi cng bo v cc c quan ni tng. Xng cng phi hp vi bp tht gip c th chuyn ng v di chuyn mt cch uyn chuyn v vng chc.

Cu to ca xng
Thnh phn ha hc ca xng l hn hp cht hu c v v c theo t l 1:2. Xng c cu to vi ba cht cn bn: 45% khong cht, trong calci chim a s, 30% cc m mm collagen vi t bo, mch mu v 25% nc. Khong cht chnh l calci phosphat (5/6), s cn li l calci carbonat, fluorid, chlorid, magnesium, mt t natri chlorid v sulfat. Collagen l cht hu c c th tch ring khi ngm xng vo dung dch. C ti 98% tng lng calci trong c th c d tr xng v 1% lu hnh trong mu. Khi calci trong mu gim

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Bnh long xng

xung di mc nhu cu th xng s nh ra mt t calci nng cao mc calci trong mu.

Calci to cho xng s rn chc cn cc m mm gip xng bn b. Trn b mt 1cm2 xng c th chu ng sc p ca 6000kg, nhng khi ly ht khong cht, xng ch cn l mt si dy mm nhn.

Nhu cu dinh dng ca xng

Sut i ngi, khi khe mnh, au yu cng nh lc v gi, xng lun lun trong tnh trng kin to v ph hy. Nhng vi tui gi th s hao mn xng nhiu hn s bi p v xng yu hn v khong cht t c hp th. S hao mn ny thc ra m thm bt u t tui bn mi. N gii hao mn nhiu hn nam gii, c khi gp i, c bit khi ngi ph n bc vo thi k mn kinh. Nhu cu calci ca c th bt u t khi cn nm trong bng m, nht l vo ba thng cui. Cho ti tui ln mi, s lng calci trong xng c nh hng rt ln cho khi xng sau ny. T 10 ti 18 tui l thi gian m c th cn nhiu calci nht to ra mt b xng vng chc. Mi ngy, c th cn c cung cp khong 1.000mg calci t thc phm tiu th. Calci c nhiu nht trong sa, pho mt, kem, sa chua, c hp sardine, salmon, tm, cam, sung, u nnh, u pinto, cc ht vng, hng dng, sp l xanh, rau dip... Calci cng c th c cung cp di dng vin ung. S hp th ca calci c h tr, iu ha bi cc hormon ca tuyn cn gip (parathormon ), estrogen v vitamin D.

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Dinh dng v iu tr
Khi lng calci trong mu gim, parathormon rt calci t xng ra cn bng. Khi nhu cu calci ri th tuyn gip li tit ra hormon calcitonin chn tc dng ca parathormon .

Estrogen l loi hormon n, nhng cng c mt lng rt nh nam gii. Estrogen lm gim s rt ly calci t xng. V th, khi mn kinh n gii thng b bnh long xng. Vitamin D gip s to xng v duy tr xng cng chc.
Trong khi , mt s cht nh c ph, thuc l, ru li lm gim s hp th calci. Thuc khng sinh tetracyclin, erythromycin, isoniazid, lm gim hp th calci; cc thuc chng acid d dy nh Mylanta, Maalox, thuc li tiu furosemid, thiazid lm tng bi tit calci qua nc tiu.

Calci trong thc phm t khi gy ra xo trn cho c th, nhng khi ung thm th calci c th gy ra mt vi vn chng hn nh y hi, to bn hoc nc tiu nhiu calci a ti si thn.
V d dy ch c th hp th tng lng nh calci, ta nn ung khong cht ny lm nhiu ln, mi ln mt t. S xo trn ca calci c th dn n mt bnh ph bin l long xng.

Bnh long xng (Osteoporosis)

Thoi ha xng l mt din bin bnh thng, khi s ngay t tui trung nin v ni tip cho ti khi v gi. Trong din bin ny, thnh phn cu to xng khng thay i, nhng khi lng v c ca xng thay i.

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Bnh long xng

Bnh long xng xy ra khi xng thoi ha nhiu n mc khng chu ng c cc sc p bnh thng, tr nn d gy, chm lnh, nht l xng hm, ct sng v xng hng. S cng chc ca xng ty thuc vo dinh dng, s vn ng c th v lng hormon estrogen. Cho nn phng bnh, ta cn lu duy tr tt ba yu t ny. Long xng thng xy ra n gii, khong 10 - 15 nm sau khi mn kinh. Bnh thng thy xng c tay, xng ct sng, xng hng. Long xng v tui cao, khong 70 tui tr ln, th xy ra c nam ln n v cc loi xng. Cc nguy c a ti long xng gm c: 1. Tui tc. Nguy c b long xng tng theo vi tui cao, d l nam hay n gii. 2. Gii tnh. N gii b long xng nhiu hn nam gii gp bn ln. Nhng n tui gi th c nam ln n u b hao xng v xng d dng b tn thng. 3. Mu da. Ngi da trng v da vng thng hay b long xng hn ngi da en, v nhng ngi ny c khi xng ng c hn. 4. Thiu estrogen. Trong cc trng hp mn kinh n gii, ct b bung trng hoc gim chc nng tuyn sinh dc nam n. Ph n khng c kinh k trong mt thi gian lu v bt c l do no cng a n hao xng. Th d cc n vn ng vin do vn ng nhiu nn kinh nguyt thng gin on, cc trng hp ny c xng u gim i.

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5. Cho con b. Khi nui con bng sa m qu su thng th s hao xng nht thi c th xy ra, v lng calci trong sa rt ln (khong 320mg/lt). V th, ngi m cn dng s calci v vitamin D phng bnh xng. 6. Dc phm. Mt s dc phm nh Dilantin, Phenobarbital, Corticosteroid, Lithium, Phenothiazine, Tetracycline, Cyclosporin, hormon tuyn gip... lm tiu hao calci t xng hoc ngn cn s hp th calci rut. 7. t vn ng c th. C th t vn ng dn n hao xng, gim khi xng. Ngi bnh nm lit ging lu ngy th xng rt yu v d gy. 8. Tm trng cng thng nh chn thng, i kht, s hi. 9. Dng nhiu ru v thuc l. 10. Thiu vitamin D. Quan st nhng ngi s dng cng lng calci nh nhau, ngi sng vng c t nh nng thng b long xng nhiu hn ngi sng vng c nhiu nh nng. l v nng chiu trn da to ra vitamin D, v vitamin D gp phn tch cc trong vic bo v xng. Ngoi ra, thc phm c nhiu cht x lm gim hp th calci; n nhiu m ng vt lm tng bi tit calci trong nc tiu, trong khi m thc vt khng c tc dng ny. Ung nhiu c ph cng lm hao xng ngi cao tui, nht l khi khng ung thm loi sa c b sung calci. trnh long xng, ngoi vic tiu th y lng calci nh ni trn, ta cn trnh cc nguy c a n h hao xng.

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Bnh long xng

Long xng (osteoporosis) khc vi mm xng (osteomalacia) l bnh do thiu vitamin D v dinh dng khng y hoc thiu nh nng mt tri.

Vitamin D rt cn thit cho s hp th calci c trong thc phm. Khng c vitamin D, xng tr nn mm, i dng, au nhc, bp tht yu, co cng. iu tr bng vitamin D, khong 25mcg (tng ng vi 1.000 IU) mi ngy c th khc phc tnh trng ny. Ngoi ra, phng bnh nn thng xuyn tm nng, ung sa c nhiu calci v vitamin D. Tr em thiu vitamin D s b bnh ci xng (ricket).

67

DINH DNG VI BNH VIM KHP XNG

Cc c thng thy au nhng khp gn u ngn tay, xng sng, u gi, hng v c tay, do s thoi ha ca xng v sn. Nam n u c th mc bnh nh nhau. i khi, c nhng v cao tui b vim khp m khng bit, cho ti khi tnh c chp X quang mi bit l c bnh t my thp nin qua. Ta cn phn bit bnh vim khp xng (osteo-arthritis) vi bnh thp khp (rheumatoid arthritis). Thp khp xut hin bt c tui no, thng gy tn thng cho nhiu khp, nht l t cui ngn tay, ngn chn, c tay, u gi. i khi bnh lan ti cc c quan ni tng nh tim, thn, phi, dy thn kinh v gy ra nhng triu chng tng qut nh st, mt mi, bing n, thiu hng cu, gim cn...

Nng ma l chuyn ca tri, au xng, nhc khp, chuyn ngi tui cao. ngi cao tui, vim khp xng l bnh rt thng xy ra, nht l khi thi tit i thay.

Cu to ca khp

Bnh vim khp xng thng xy ra cc khp c ng nh u gi, khp hng, khp ct sng... Mi khp c nhiu thnh phn nh bp tht, dy chng, sn, xng, gn. Tt c hot ng nhp nhng vi nhau

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Vim khp xng

gip c th thc hin mt chc nng rt quan trng, l s di chuyn ca con ngi.

Dy chng c nhim v ni kt xng vi xng, gi cho khp c vng. Gn ni xng vi tht v chuyn sc co ca bp tht vo xng. Sn l lp t bo trong nh thch, rt bn v dai, khng c mch mu, dy thn kinh. Sn c cng dng che ch u xng, trnh s c xt khi khp c ng. Quan trng nh vy m sn li l nhng t bo rt mng manh, kh nui cy, d thoi ha, v s ti to sau khi chn thng cng rt kh khn.
Sn cha 75% nc. Khi khp c ng, nc ra vo, thm qua mng hot dch ly cht b dng nui sn. Cho nn sn s b suy yu khi khp bt ng, khng c dng ti. Sn khng c dy thn kinh nn n khng gy au trong bnh vim khp. Khp nm trong mt ci ti m t bo mt trong ti tit ra mt hot dch lng nhn nh du lm khp trn, trn ln nhau khi co dui, c ng. Hot dch cng l ngun cung cp cht b dng cho sn v sn khng c mch mu.

S thoi ha ca khp

Vi tui i chng cht, chc nng cng nh cu to ca khp u c nhiu thay i, tr nn km linh ng. T bo khp thoi ha, gn v dy chng phn on, ng vi, kh cn, tr nn km bn b, km co gin, gim sc chu ng vi lc cng ln v d b tn thng. Sn tr nn c

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mu, ha x, kh nc, rn nt vi nhiu tinh th calci lm khp au. Khp co dui kh khn v mng hot dch mng v kh dn. Khi b vim, khp xng c nhiu thay i nh s ha x v g gh ca sn, kh nng cht m km i, u xng mc gai, xng gim khi lng. Mc d ta khng bit r c ch gy vim, nhng s hao mn hay thoi ha do s dng khp lu nm c coi nh l nguyn nhn chnh. V th nhng khp chu sc nng ca c th nh xng tht lng, hng, u gi thng hay b bnh. S thoi ha ny din ra t t trong khong thi gian kh lu v tr nn r rng khi v gi. Tuy thng xy ra ngi cao tui nhng khng phi ngi cao tui no cng mc phi bnh vim ny. Thanh thiu nin khng thy c bnh, tui trung nin c nhng rt him, v t tui 50 tr ln th t l mc bnh tng theo tui: 27% tui 60-70, 45% tui 80. Cc nguy c lm d mc bnh gm c bo ph (gim cn l phng thc tr liu tt), chn thng khp, tt bm sinh, bnh v chuyn ha, di truyn, xo trn lng hormon . Cc vn ng vin lin tc b chn thng khp, d ch l nh thi, hoc mt ngi lao ng sut ngy khun vc nng nhc, u l nhng i tng d b vim khp khi tui cao. hiu r hn v vim khp, cn gii thch i cht v hin tng vim (inflammation). Vim l mt p ng bo v ca c th vi tn thng gy ra do tc nhn sinh nhim, ha cht hoc tc nhn vt l. Cc mch mu gn ni tn thng gin n, a nhiu mu ti vng ny. Bch cu vo m tit ra cht prostaglandin,

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Vim khp xng

leucotrien v tiu dit cc tc nhn gy tn thng. Trong din tin ny, vng m b tn thng sng to, nng, v au. Nu vim khng c cha lnh th s tr thnh vim kinh nin.

Triu chng
Cc triu chng thng gp khi vim khp l khp au, sng, c ng kh khn, co cng. Khp co cng mi sng khi thc dy hoc sau mt thi gian bt ng v ko di khong na gi. Nhng khi ta ngm tay trong nc m hay tp co ti co lui mt lc th khp bt cng i. Nhng thay i khc khp nh vim mng dch, vim dy chng, tiu hao ca sn, co bp bp tht u c th gy au. Ngi cao tui mc bnh vim khp c th b nhng cn au bt thnh lnh hoc khi thi tit i thay, kh hu lnh, m, c bit l khp u gi. Khp au m , va phi thi, nhng gia tng khi phi c ng, v gim bt khi yn. Ban m ng m b nhng cn au khp hnh h th bnh cng gia tng m li d gy ra tm trng u bun. Sau mt thi gian, cc triu chng trn pht trin dn a ti mt chc nng ca khp, khin ngi bnh khng thc hin c nhng sinh hot thng thng nh ci cc o, ct dy giy, cm lc chi u, cm bt vit... ng ln ngi xung, bc ra khi xe, ln xung cu thang... u tr nn kh khn, gii hn. Thng k cho thy c ti 12% ngi bnh khng thc hin c nhng sinh hot hng ngy v qu na s ngi ny phi nm lit ging hay sut ngy ngi trn xe ln.

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Dinh dng v iu tr
Quan st cho thy n ng thng b gii hn s dng cc chi trn, cn ph n hay b cc chi di, nhng khi ti tui trn 80 th t chi u b nh hng nh nhau. Vic nh bnh cn c vo cc triu chng, khm tng qut c th v chp X quang. Vim khp kh cha lnh hn, nhng sau mt nm, chng au nhc thng gim bt. S thoi ha lm mn ht sn, hai u xng tip tc c xt vo nhau v tr nn nhn bng nh ng.

iu tr
Cho ti nay, cha c dc phm hay phng thc no c th gip phc hi t bo sn v cha dt vim khp xng, m ch cha theo triu chng: au u cha , au lc no ung thuc lc y. Tuy nhin, vi nhng phng tin hin c, ngi bnh c th duy tr, ci thin mt s chc nng ca khp b bnh, lm bt au v lm cho i sng linh d chu hn. Ngi bnh cn c hng dn, tm hiu v bnh, bit r cn nguyn, nguy c gy bnh trnh, bit phi lm g bt au v thch nghi vi nhng kh khn, khim dng do bnh gy ra. 1. Vt l tr liu y l phng thc c dng rt nhiu hin nay v t ra c nhiu cng hiu. N gip bnh nhn phc hi mt s chc nng ca bp tht v khp nh kh nng co dui, s di ng, mm mi; hng dn cch chn la v s dng gy chng, nng ta ngi...

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Vim khp xng

2. Vn ng S vn ng c th lm tng s mm mi ca c tht, co vo dui ra d dng, khp c ng nh nhng, tng mu lu thng ti nui dng khp, lm bt au, lm tm c ng rng hn. Cn lu l ch vn ng va sc; khng vn ng khi khp ang sng, nng, au. Trc khi vn ng, c th p nng lm th gin c tht, lm mu lu thng tt, hoc chm lnh trn khp lm bt au, sng v vim . i khi c th kt hp lun phin 2 phng thc chm lnh v chm nng, mi cch chng 30 pht. 3. Gim bo ph Bo ph c xem nh mt trong cc nguy c chnh gy vim khp xng, nn gim cn l mt cch tt lm cho c th nh nhng hn, gim bt sc nng dn trn khp, nht l khi ta di chuyn. 4. Dc phm Dc phm c dng vi mc ch chnh l lm gim au, chng vim sng. Thuc acetaminophen (Tylenol) c coi nh l thuc cn bn, c dng vi liu cao ti 4g mt ngy. Thuc ny dng nhiu c th nh hng ti gan, nht l khi ngi bnh ung ru, hoc a n suy thn. Thuc c cht phin ch nn dng ngn hn khi cn au d di khng chu ni hoc lm mt ng.

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Dinh dng v iu tr
C nhiu loi thuc bi lm du cn au nh kem bi capsaicin, mi ngy thoa u trn khp au ba hoc bn ln. Thuc chng vim khng c stroid nh ibuprofen, naproxen, Celebrex, Daypro... c nhiu cng hiu. Cc thuc gim au u c nhiu tc dng ph khng tt, nn trc khi dng cn tham kho kin bc s iu tr. Ngoi ra, s dng nhng my pht sng t trng hoc chch thuc Corticosteroid, Hyaluroran... vo khp cng gip gim cn au nhc mt phn no. Trng hp nng c th gii phu thay khp.

Dinh dng vi bnh vim khp xng

Trong nhng nm gn y, nhiu chuyn gia ngh p dng dinh dng trong vic cha bnh vim khp xng. Tuy nhin, cha c nghin cu no xc nh l mt ch n ung hoc mt mn thc phm no c th tr c bnh vim khp. C ngi cho rng n vi trm gram c mi ngy th c th gim cng khp mi sng khi thc dy. Bc s Joel M. Kremer ca i hc Y Khoa New York cho hay, ung vin du c trong hai tun l lin tc c th gip bnh nhn vim khp gim sng au. Du c c cha acid bo Omega-3. Mt s th nghim cho thy c chua, sp l xanh cng lm gim bt au vim khp. Hin c mt vi loi thuc ang lu hnh c cho l c kh nng lm thuyn gim cc triu chng ca vim khp. l:

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Vim khp xng

- Glucosamin. Glucosamin sulfat l cht c ly t v s, v cua, v c bn di dng thuc vin. Theo cc nh sn xut, mi ngy nn ung 1500mg, chia ra lm ba ln. Thuc gy kh chu i cht cho d dy. Theo kt qu nghin cu th phi ung lin tc mt thng mi thy cng hiu. Nghin cu cng cho bit l glucosamin c tnh cht chng vim v kch thch sn xut sn. - Chondritin. y l cht c ly t sn c mp hoc b, c bn di dng vin thng hoc vin con nhng. Cng nh glucosamine, thuc ny c cho l c kh nng chng vim v to sn. Mt s nghin cu th nghim cho thy thuc chondritin c tc dng tt hn so vi nhm i chng dng gi dc. Thuc cng t gy ra tc dng ph. Liu dng mi ngy khong 120mg, chia lm ba ln v phi ung lin tc khong mt thng mi thy cng hiu. - SAMe. y l tn gi tt ca S-Adenosylmethionine, l mt hp cht thin nhin c trong mi t bo sng v c sn xut bng cch nui t bo cc loi men, nm. SAMe c bn theo toa bc s chu u t nm 1975 cha vim khp v trm cm. Thuc ny kh t v phi dng t 400mg ti 1200mg mi ngy. Tc dng ph l gy kh chu tiu ha, chng hn nh tiu chy. - Ngoi ra, theo kinh nghim ca nhiu ngi th gng, khong boron, dimethyl sulfoxid (DMSO) cng c cng dng chng vim khp xng.

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Kt lun
Vim khp xng kinh nin a ti nhiu tr ngi, kh khn cho ngi bnh. Ngoi thuc men v cc phng thc tr liu, bnh nhn cng nn kho lo t chc hp l cc sinh hot hng ngy trnh khp au nhiu hn. Chng hn nh: - Khi lm vic, khi n, nn ngi nhiu hn l ng. - Gh ngi c ch da lng gim cng thng cho bp tht lng. - Gh c da tay gip ng ln ngi xung d dng. - M hp thc n vi dng c thay v dng sc mnh ca bn tay. - ng cm vt g nng qu lu. - Nn thng xuyn co dui cc khp xng, vn vai ct sng khi cng nhc. - Khi cn nng mt vt nng, nn s dng c hai tay thay v mt tay v chu sc nng vo hai chn ch khng vo xng sng lng. Lm c nh vy l ta mt phn no trnh c s mt kh nng di ng. M khng t di ng l mt trong nhng nguyn nhn a ti l thuc vo ngi khc ca tui gi cng nh ca bnh vim khp xng trm trng.

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DINH DNG VI BNH UNG TH

c d cc kt qu nghin cu khoa hc phn no lm sng t vic nh bnh v tr bnh, nhng cho n nay ung th vn l mt trong nhng bnh nan y ca nhn loi. Mi t bo bnh thng u c kh nng phn bo: mt thnh hai, ri hai thnh bn, bn thnh tm... theo mt nhp iu ring bit, nh sn, khi no th tng sinh, khi no th ngng ngh. Nhng cc t bo ung th th khng tun theo nhng quy lut hp l sn c. Chng tng sinh, tng trng mt cch ri lon, khng c nh mc, khng c nhp iu no, v nht l khng th kim st. Ban u, cc t bo ung th t hp vi nhau thnh mt nhm nh, ri tip tc bnh trng ln p, chn p cc m bo khc, chim ot ht cht dinh dng khin cc t bo lnh mnh phi suy nhc, cht dn. Ri n mt giai on no , chng a nn nhn n t vong. Nhng t bo ung th c th pht xut t bt c b phn, c quan no trong c th. nam gii, ung th tuyn nhip h dn u ri n phi, i trng, bng quan. N gii th ung th v ng u ri n i trng, phi, t cung, non so. C nhiu yu t c th gy ung th nh cc tc nhn vt l, ha cht, mi trng, vi sinh vt, s cng thng, cm xc v ngay c dinh dng, np sng na.

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Thc vy, trong lnh vc dinh dng, qua nghin cu v quan st dch t hc, ngi ta tm ra c mt lin h gia thc phm v ung th. Nu c mt s thc phm c th lm tng nguy c ung th th mt s khc li c kh nng lm gim. iu cn nh l nguy c gy ung th ty thuc vo s lng tc nhn: Tc nhn gy ung th cng nhiu th bnh cng mau pht trin. Thi gian t khi tip xc vi tc nhn cho ti khi c du hiu bnh cng kh lu, c khi c 5 n 10 nm, v khng phi mi ngi tip xc vi cng mt tc nhn u mc bnh. Mt khc, cn bit l nhng kt qu quan st dch t khng xc nh lin h nhn qu, khng cung cp kt lun khoa hc m ch cung cp nhng u mi khoa hc nghin cu. Cho ti nay cha c bng chng hin nhin rng mt thc phm no gy ra ung th hoc c kh nng ngn nga ung th. Nhng bit c mt s cc mi lin h ng nghi ng trnh, hoc c li tun theo cng l iu nn lm.

I. Thc phm tng nguy c ung th

1. Cht bo Nhiu quan st dch t v nghin cu khoa hc nhn thy c mt lin h no gia s lng cht bo trong thc phm vi cc trng hp ung th v, tuyn nhip h, i trng. Cc bnh ung th ny xut hin vi t l cao Hoa K, ni m cht m c tiu th rt nhiu, v vi t l rt thp Nht Bn, ni m ngi ta t n cht bo.

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Bnh ung th
S lin quan gia ung th i trng vi thc phm nhiu cht bo c gii thch nh sau: Tiu ha cht bo cn n nhiu ha cht trong c acid mt. Cht bo cng nhiu th nhu cu acid mt cng cao. Acid mt c vi sinh vt clostridia rut phn tch ra lm nhiu cht nh methylcholanthrene c xem nh c kh nng gy ung th. V ung th v th n nhiu cht bo lm tng estrogen, prolactin l nhng cht c coi nh nguy c gy ung th v. i vi n gii, t l ung th v thng cao cc i tng: 1. C kinh ln u sm. 2. Khng c thai hoc c thai ln u sau 30 tui. 3. Chm n thi k mn kinh. 4. Nhng ngi qu nng cn. nhng ngi ny, lng hormon trong mu cao hn. Nhng mt nghin cu khc ti i hc Harvard th li kt lun l khng c lin h no gia ung th v ph n vi s tiu th cht bo, v nguy c c l cao hn khi tiu th nhiu nng lng ch khng phi nhiu cht bo. Nm 1993, Edward Giovannucci cng b kt qu nghin cu cho l tiu th nhiu m ng vt lm tng nguy c pht trin ung th tuyn nhip h. Mt nghin cu Nht vo nm 1997 cng cho kt qu tng t. Mt quan st na l ngi n nhiu rau tri t b ung th tuyn nhip h hn nhm ngi tiu th nhiu cht bo, ng thi lng testosterone trong mu cng thp. T bo ung th tuyn nhip h tng trng nhanh hn nu c nhiu testosterone.

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Ring v cholesterol th c nghin cu li cho rng nu qu thp c th lm tng nguy c ung th ln i cht. Nh vy, nu mc cholesterol khong di 180mg/dl th khng nn tm cch h thp na, v cng cha hn hon ton c li. 2. Cht m Mt s nghin cu cho rng tiu th nhiu m c mt nh hng no vi ung th v, d con, thn, tuyn nhip h, i trng, ty tng. Quan st cho thy ung th gim khi n m di mc cn thit, v tng khi n gp i hoc gp ba. Cc nghin cu ny thng gp kh khn v trong m i khi c ln nhiu m v t cht x. Theo Edward Giovannucci, ung th tuyn nhip h pht trin nhanh hn khi n nhiu tht. Nhng nghin cu ca t chc Iowa Women Health Study li t nghi vn v mi lin h gia ung th i trng vi tht, cht bo v hot ng th thao. Mt nghin cu khc li thy rng khi gii hn vi loi acid amin th c th khng ch t bo ung th. Ngi ta cng ni n mt s kin l tht nng than qu chy to ra mt ha cht c nguy c gy ung th. Nhng vn nu trn c nhng mi lin h an xen rt phc tp gia nhiu yu t, v cho n nay vn cn nhiu iu kh hiu cn tip tc nghin cu lm sng t hn. 3. Carbohydrat Cho ti nay, cha c nhn xt no v s lin h gia carbohydrat vi ung th nh trng hp cht m v cht

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Bnh ung th
bo, ngoi tr mt m ch gin tip v vic tng nng lng v n nhiu carbohydrat. 4. Tiu th nng lng C nghin cu v lin h gia s gia gim s nng lng tiu th v ung th loi chut. Nhng con chut nui vi ch n t nng lng t b u bu hoc u bu chm pht trin hn l chut n thoi mi, khng hn ch. Chut c nui vi ch nhiu cht bo, t nng lng cng t ung th hn l chut n t do bt k cht bo nhiu hay t. Lin h ny c nghin cu vi ung th v, ung th nim d con. Bo ph dng nh c lin h ti ung th t cung v thn n gii. 5. Ru Nhiu quan st dch t hc cho thy ung ru kinh nin l nguy c gy ung th ming, thanh qun, thc qun, cung hng, l nhng ni tip xc trc tip vi ru. Nguy c ny cao hn nu km theo ht thuc l. X cng gan v ru cng l mt trong nhiu nguyn nhn gy ung th gan. Kt qu nghin cu ca G. A. Kune v L. Vitetta vo nm 1992 cho rng thc ung nhiu cn, nht l bia, c th tng nguy c ung th i-trc trng. Theo M. P Longnecker th ung th v cng c nhiu nguy c hn ngi nghin ru. Thiu dinh dng v nghin ru cng l nguy c gy ra vi loi ung th. 6. Cht ph gia thc phm Hin nay c n vi ba ngn loi cht ph gia c s dng vi thc phm bo qun, gip thc phm ti lu, trng hp

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dn hn v tng mi v. Cc cht ph gia ny c th c ly t tho mc hoc tng hp trong phng th nghim. Theo lut php th cc nh sn xut thc phm phi bo m l ch s dng cc cht ph gia an ton v c chnh quyn kim tra, chp thun. Tuy nhin, cng c nhng cht m sau khi dng mt thi gian mi pht hin c nguy c ca chng. ng ha hc cyclamat v saccharin c cho l lm tng nguy c ung th bng quang loi chut. Cyclamate b cm Hoa K t thp nin 1970. Trong khi , T chc Y t Th gii cng nh C quan Thc phm Th gii li tuyn b l ng ny an ton v vn c dng trn 40 quc gia. Saccharin cng b C quan Qun l Thc - Dc phm Hoa K ngh cm vo nm 1972, nhng v p lc v nhu cu ca dn chng nn ng vn cn c bn. Thc ra, loi chut th nguy c gy ung th bng quang cng ch xy ra khi cho chng tiu th mt s lng rt ln cc loi ng ni trn. Cc cht ph gia nitrit v nitrat c ni n trong nguy c gy ung th, v c s chuyn ha sinh ra nitrosamin l cht c kh nng gy ung th nhiu loi vt. Nitrit v nitrat c dng bo qun tht v ung. Nhng hai cht ny cng c t nhin trong mt s thc phm v trong nc bt ca chng ta. Ni chung th cc cht ph gia thc phm hin ang c php s dng u c coi nh an ton cho ngi tiu th. Cht no b nghi ng gy ung th, nh cc cht to mu Red # 32, Orange # 2 u b cm. C thi k, d lun nhc ti nguy c gy ung th ca hai cht bo qun

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Bnh ung th
thc phm butylated hydroxytoluene (BHT) v butylated hydroxyanisole (BHA), nhng C quan Qun l Thc - Dc phm Hoa K v Vin Ung th Quc gia Hoa K tuyn b l hai cht rt an ton. 7. Aflatoxins Ti nhiu quc gia, thc phm c ct gi ni kh hu m t c th to ra cht aflatoxin m nhiu ngi cho l c nguy c gy ung th gan. 8. Thuc tr su Gio s Richard Levins ca i hc Harvard gii thch: Thuc tr su l cht c i vi su b, m c th su b v ngi c nhiu im ging nhau, nn thuc tr su cng nh hng xu ti con ngi. Nhiu nghin cu cho thy mt s thuc tr su l nguy c gy ung th khi con ngi tip xc lu vi nng cao, chng hn nh ht qua phi, ngm qua da, hoc b ln trong thc phm. Thuc tr su rt cn bo v ma mng, nng phm, nhng khi nng dn lm dng thuc th ngi tiu th phi chu nhiu ri ro. mt s nc, chnh ph kim st rt nghim ngt vic nng dn s dng cc ha cht ny. Nhng quan trng hn l ngi dn phi c thc t kim st v cao cnh gic, cng nh cn c hng dn phng nga nhng ri ro c th c do thuc tr su mang n. 9. Nu nng thc phm Qun chng c gii y t cnh bo l thc phm nng bng than hoc chin du m c th to ra nhng cht gy ung

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th d dy v thc qun. l cc cht polycyclic aromatic hydrocarbon (PAH) v heterocyclic aromatic amine. 10. C ph c mt thi c ph b gn cho l c th gy ung th d dy, ming, gan, v, i trng. Nhng cc nghin cu mi g mi oan ny cho c ph. Vin Ung th Hoa K xc nh c ph dng va phi khng c nguy c gy ung th. Ngc li, nghin cu ca Lee Wattenberg ti i hc Minnesota cho l c ph c th ngn chn ung th loi chut v nghin cu ti Na Uy cng cho bit c ph c th nga ung th i trng. 11. Thuc l Mc d thuc l khng phi l thc phm nhng li l cht c s dng rt nhiu v ph bin. V th, tc hi ca n gy ra cho sc khe c mt tm quan trng rng khp i vi s ng ngi. Cc nh ha hc phn tch v nhn dng t nht l mt t cht gy ung th nm trong nha thuc l. c nhiu dn chng khoa hc v vic thuc l l nguyn nhn ca nhiu loi ung th c nam v n gii, nht l ung th phi. C ti 85% trng hp t vong trong bnh ung th phi l do ht thuc l. Ht thuc l cng l nguy c gy ung th ming, bng quang, thn, ty tng. Ngi ht khi thuc do ngi khc thi ra cng chu nhiu tc hi n sc khe. V th, hin nay phong tro vn ng b ht thuc l c pht ng rng ri trn khp th gii gim thiu nguy c ung th phi.

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Bnh ung th

II. Dinh dng lm gim nguy c ung th

1. Vitamin A Cng dng ngn nga ung th ca vitamin A c nhiu nh khoa hc tha nhn. Bnh thng, vitamin ny ng vai tr quan trng trong s tng trng v bit ha ngc (differentiation) ca t bo. S bit ha ngc cng mau th nguy c ung th ca t bo cng gim. Quan st cho thy tiu th nhiu vitamin A s lm gim tc dng ca mt s tc nhn gy ung th sc vt. Tri li khi thiu vitamin A s c nhng thay i tin ung th b my tiu ha, bi tit v h hp.

Vitamin A c nhiu trong sa, b, pho mt, gan ng vt, rau, tri. Trong rau vi l xanh m c cht beta carotene s c c th chuyn ha thnh vitamin A. Vitamin A v beta carotene c tc dng nh nhng cht chng oxy ha (antioxidant).
Tuy nhin, vi liu dng qu cao v ko di, vitamin A c th gy hi cho c th, nht l cho gan. Bi v khi vt qu nhu cu cn dng, vitamin ny s c c th gi li v tch t ngy cng nhiu hn. Trong khi tiu th nhiu beta carotene trong rau, tri cy li t ri ro. 2. Vitamin C Nhiu nghin cu cho thy t l mc bnh ung th d dy gim khi tiu th nhiu rau tri ti, nht l cc loi chanh, cam... c nhiu vitamin C.

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Mt ch dinh dng thiu rau tri ti v t vitamin C lm gia tng nguy c b ung th ming, cung hng, c t cung. Nhng kt qu tt ny ch c c khi s dng vitamin C c t nhin trong rau tri ch khng phi vitamin C c bo ch dng vin ung. 3. Vitamin E

Vitamin ny ngn chn s to thnh cht gy ung th nitrosamin.

4. Calci Nghin cu loi vt cho thy calci c th lm gim nguy c ung th i trng. Cc nh khoa hc gii thch l calci tc dng vi cht bo v acid mt rut, to ra mt hp cht khin rut bt tip xc vi cht c hi, nh m rut c bo v. Tuy vy, nghin cu nh hng ca calci i vi bnh ung th ngi th cha a ti kt lun chc chn no. 5. Selen

Selen l mt nguyn t kim him, hin din rt t trn tri t. Nhu cu c th vi kim ny rt nh. Selen c trong ng cc v tht ng vt.
Gn y, kim ny c m t l c nhiu ng gp cho sc khe con ngi. Ring trong lnh vc ung th th selen c th gii c cc cht gy ung th, tng sc khng ca c th vi t bo bt bnh thng. Gio s Gerhard N. Schrauzer, thuc trng i hc San Diego cho rng selen l mt kh nng ha hn ln trong vic

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Bnh ung th
phng chng ung th. Hin nay c nhiu nghin cu trn khp th gii v tc dng ny ca selen. 6. Cht x (fiber) Mi lin h tt gia ung th v cht x bt ngun t nhng nhn xt v chu Phi, ni ngi ta n t cht bo, nhiu cht x v kt qu l rt t b ung th i trng. Sau , c rt nhiu nghin cu chng minh l cht x c kh nng phng nga ung th i trng bng cch ngn chn s xut hin ca mn polyp. Cng dng phng chng ung th ca cht x c gii thch nh sau: Cht x lm gim c tnh ca tc nhn gy ung th bng cch ha long hoc v hiu ha chng, lm cht b di chuyn trong rut mau hn, lm gim acid ca phn b, v thay i mi trng vi sinh trong rut. 7. Hp cht indole Vi hp cht indole trong cc loi rau nh bp ci, sp l xanh, ci Brussel... kch thch rut tit ra cc enzym c th lm t lit cc tc nhn gy ung th. 8. Bioflavonoid Thc phm c cht bioflavonoid c th gip chng ung th nh mt cht chng oxy ha v cc nh khoa hc ang nghin cu tc dng ny. Cn c gi l vitamin P, cht ny c trong rau, tri cy, cc loi ht v hoa di dng cht mu thin nhin. Cng dng chnh ca vitamin P l trong vic iu tr cc bnh ca mao qun, xut huyt...

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III. Nhng quan nim sai lm

V cho n nay ung th vn l mt bnh kh tr, nn nhiu bnh nhn sau khi tht vng vi cc phng thc tr liu ca khoa hc, bn quay sang cc phng thc tr liu khc. c nhiu qung co, gii thiu mt s thc phm c ch, mt vi loi thuc thin nhin, vi phng php gia truyn c th tr khi ung th. Nhiu ngi qung b phng php ty c c th cha ung th. H gii thch nguyn nhn cc bnh, k c ung th, l s tch t cc cht c trong c th. Ty b ht cht c l ht bnh. Nn h p dng phng php ra rut bng nhiu cht nh c ph, nc p mm la mch... ri cho bnh nhn n mt ch dinh dng vi thc phm thin nhin, hu c, khng tht, khng ng, khng gia v. Phng php ny a ti mt s ri ro nh mt thng bng cc cht in gii trong c th, vim rut do tc dng ca cc cht a vo ty c, nhim trng rut, i khi thng rut. Mt s ngi khc dng cht Laetrile tr ung th. Laetrile cn c gi l vitamin B17 hoc amygdalin, c ly ra t ht tri hnh ng (bitter almond), rt c v c cha cht cyanogenic glycoside. Cht c ny c ngi Ai Cp xa kia dng hnh quyt ti phm.

Laetrile c sn xut v bn cng khai ti hn 20 quc gia nh c, , B, Mexico, Philippin. C quan Qun l Thc - Dc phm Hoa K khng cng nhn cht ny v cm lu hnh, nn nhiu bnh nhn ung th phi sang Mexico mua.
V c qu nhiu ngi tin dng, nn vo cui thp nin 1970, mt s bang ca Hoa K cng thng qua lut cho php

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Bnh ung th
nhng bnh nhn ung th trm trng c quyn s dng cht ny nu h mun. V sang u thp nin 1980, Vin Ung th Quc gia Hoa K chnh thc tin hnh mt cuc nghin cu quy m xc nh kh nng chng ung th ca laetrile. Kt qu cho thy cht ny thc s khng c bt c tc dng tch cc no trong vic cha tr ung th. Mt s ngi khc tin vo phng php cha ung th bng ch n ung ch gm c ng cc, tri cy, khng c tht ng vt hoc sa. Dinh dng nh vy s thiu nhiu vitamin, khong cht. Li c ngi cho rng dng liu lng vitamin tht cao nh vitamin A hoc C c th cha c ung th, v gii thch rng nhng vitamin ny l nhng cht chng oxy ha c kh nng lm tiu c cc u bu. iu cn lu l c th ngi bnh ung th b suy nhc v cn bnh, th iu m h cn phi l mt ch dinh dng y hn l mt s hn ch.

IV. Hu qu ca ung th v mt dinh dng

Ung th gy nhiu nh hng xu cho s n ung dinh dng ca bnh nhn, a ti gim cn v gim tui th. Khi u c th gy tc nghn ng tiu ha nh ming, cung hng, rut. Khi ung th ln ln, chc nng ca c quan b bnh s suy yu, ngng tr. Ung th cn tit ra cc cht nh hng ti s tiu ha cng nh cc chc nng khc. Bnh nhn khng cn cm gic vi thc phm, l l vic n ung, mau no chn. T bo

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ung th chim ot ht cht dinh dng khin t bo lnh b suy kit. Kt qu l chng suy nhc tng qut v gim cn (cachexia). Ngi bnh yu t, suy sp ton din c th, cng thm mt thng bng nc v cht in gii v thng b i ma v tiu chy.

V. nh hng ca phng thc iu tr ung th vi dinh dng.

Ngoi nh hng ca ung th, cc phng php tr liu cng nh hng ln ti s dinh dng. Cc phng php tr liu c th l ha tr, phng x tr liu, gii phu, min dch tr hoc s phi hp ca nhiu phng php. Ha tr liu c nhc im l gy cho ngi bnh cc vn nh i ma, vim ming, to bn, suy gan, tht tht kali, m, calci. Mc ca cc vn ny ty thuc vo loi thuc, thi gian dng v liu lng. nh hng ca phng x tr liu ty thuc vo vng c th nhn cht phng x. Chng hn phng x vng u s a ti vim kh ming, thay i v gic v khu gic; phng x vng bng a ti vim d dy, i ma, tiu chy, bing n, km tiu ha. Phng x cng lm gim sc khng ca c th nh l ha tr. Gii phu c th ct bt phn c th b bnh, a ti gim chc nng ton din cng nh suy dinh dng. i khi gii phu li thng kt hp vi ha tr hoc x tr, khin cc tc dng xu gia tng.

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VI. Dinh dng vi bnh ung th

Ngoi tr liu, ngi bnh ung th cn mt chm sc v dinh dng chu o, y ngn nga gim cn, suy dinh dng, km khng. gip bnh nhn n ung tt, ngi chm sc cn c s kin nhn v nhng hiu bit nht nh v dinh dng. Mt vi gi sau y c th gip ch phn no: a. Khuyn khch bnh nhn n ung bng cch thay i thc n, cch nu v cch trnh by. b. Chn thc phm m h a thch, nhng phi a dng, cn bng c cht dinh dng. c. Bnh nhn b gim cm gic vi thc phm, c th cho thm gia v tng sc hp dn. d. Dng vi loi thuc gim au do bc s cho c th gip h n ung d dng v nhiu hn. . Gip ngi bnh nhai nut d hn bng cch nu thc phm mm, lng. e. Nc bt nhn to c th c dng khi ming bnh nhn qu kh, kh nhai, kh nut. f. Gim cht bo trnh mau no bng. g. Chia thc n thnh nhiu ba nh. Bui sng l lc ngi bnh c th n c nhiu hn. Cng v chiu th cm gic thm n cng gim v dch v tiu ha t i, tiu ha kh khn hn. h. To ra bu khng kh thoi mi, vui v khi nui n bnh nhn.

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Khi ngi bnh khng th n ung bnh thng c th phi cho n bng ng a vo thc qun v cn s gip ca nhn vin c hun luyn v kinh nghim v dinh dng.

Kt lun
Cht dinh dng v bnh ung th chc chn l phi c nhng mi lin h tch cc cng nh tiu cc. Tuy nhin, hiu r v vn dng tt cc mi lin h ny theo hng c li, khoa hc cn phi c nhiu nghin cu lm sng t vn hn na. Tuy nhin, vi nhng hiu bit hin nay ca chng ta v dinh dng v bnh ung th th chn la tt nht l nn gim bt cht bo, n nhiu rau, tri, cung cp cc vitamin v khong cht, v trnh nhng mn n c chng minh l c kh nng gy ung th.

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DINH DNG VI CHM SC DA

a l b phn c b mt ln nht ca c th, vi din tch 18 - 20m2. Da cha ng nhiu mch mu, dy thn kinh, tuyn m hi. Da gi nhiu nhim v nh: - Bo v c th chng li s xm nhp ca vi sinh vt, ha cht, chn thng do va chm. - iu ha thn nhit. - Nhn cc cm gic nng, lnh, au... do tc ng t bn ngoi. - L ngun sn xut vitamin D khi tip cn vi nh nng mt tri. Da l phn trng thy ca c th nn sc khe con ngi v mt s bnh ni tng c phn nh trn da. Cng nh cc b phn khc, da tip nhn cht dinh dng t mu. Vi mt ch dinh dng y th da s pht trin lnh mnh. Thiu cht dinh dng l nguy c a ti mt s vn cho da.

1. Thiu cht m
m l thnh phn c bn ca t bo cng nh cc cu trc khc ca c th. Thiu m s a ti suy dinh dng.

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Dinh dng v iu tr
Thiu m trm trng a ti bnh Kwashiorkor. Bnh ny thng thy tr em di bn tui ti mt s cc b lc chu Phi. Bnh pht trin khi a tr thi b sa m v n ung theo ch truyn thng ca gia nh, vn khng y cht dinh dng. Ch ny c nhng cht m tr em khng th tiu ha, hp th c, nn chng b thiu cht m. Triu chng bnh gm c: sng ph c th, n mt ngon, tiu chy, mt cm xc, a tr khng tng trng c. Ring v da th c s thay i mu trn da, da rt kh, biu b trc vy mng vi nhiu vt nhn. Tc rt tha, mt mu sc. Ch cn thay i ch dinh dng, n nhiu tht, c, rau tri, bnh s thuyn gim rt nhanh.

2. Thiu cht bo

Thiu cht bo l trng hp rt him khi xy ra, v thng thng th ch n hng ngy ca chng ta cung cp qu d tha cht bo n mc cn phi gim bt. Tuy nhin, i khi cng c nhng trng hp thiu. Chng hn nh khi n ch c rt t cht bo hoc ngi phi nui dng qua truyn mch mu lu ngy th s thiu mt s acid bo cn thit nh acid linoleic. Da bnh nhn s kh v lp biu b s trc ra nhng vy da mng nh.

3. Thiu Vitamin A

Thng thng, ch thiu vitamin A khi c bnh v b my tiu ha, khi gii phu ln b phn ny hoc khi c th khng hp th c thc phm.

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Chm sc da
Cc triu chng ca thiu vitamin A gm c: tr em chm tng trng; gim th gic khi ti tri, kh mt, xng v rng chm pht trin, tiu chy, sinh kh khn, si thn. Ring vi da th c: da nga, kh, trc vy, xu x, nom ging nh ni gai c (gooseflesh) v cc tuyn nhn km hot ng.

Vitamin A c nhiu trong gan ng vt, c rt, rau c mu xanh m, khoai lang, b ng...
Nhu cu hng ngy cho ngi ln l khong 700mcg -900mcg. Tha vitamin A c th a ti mt khu v n ung, mt m, rng tc, da kh, tnh tnh nng ny.

4. Thiu vitamin B2 (riboflavin)

Vitamin B2 c cc cng dng nh sau:
- Tc ng qua li vi cc vitamin B khc v gi vai tr thit yu trong s to thnh hng huyt cu, s tng trng ca c th. - Gi vai tr quan trng trong vic ngn nga chng c thy tinh th ca mt. - Gip cho da, mng chn tay, tc pht trin lnh mnh. - Gip cho chc nng ca h thn kinh c hon ho. - Tng cng sc khe bng cch gip cc t bo s dng oxygen. - Gip to ra nng lng t cc cht dinh dng. - L thnh phn cht mu ca vng mc. - Sn xut ra cc hormon nang thng thn.

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Dinh dng v iu tr
Thiu vitamin, c th s mi mt, vt thng lu lnh, ming l; mi sng, , nt; da trn mi nt; li sng , au, nt rnh; mt v mch mu ni ln nhiu, m mt; thiu hng cu. Ph n c thai thiu vitamin B2 c th gy ra chm pht trin xng ca thai nhi. Trn da c ri lon cc tuyn nhn, da kh, trc vy mng, c bit l np da gp, chung quanh mi v bu di n ng. Cc cht nhn ng cc trn l chn lng khin da nom rt xu, g gh. Vitamin B2 c nhiu trong gan, thn, tim ng vt; c va phi trong pho mt, trng, tht nc, nm, sa, c sardine. Nhu cu mi ngy cho ngi ln l 1,3-1,5mg; tr em l 1,1mg. Cha c bo co no v hu qu ca tha vitamin B2.

5. Thiu vitamin B3 (niacin)

Vitamin B3 (niacin) c nhiu trong thc phm. ng vt, niacin c di dng nicotamid; thc vt th dng acid nicotinic. Niacin c cng dng nh sau: - L thnh phn ca hai loi enzym cn thit cho s h hp ca cc t bo. - Gip chuyn ha cht m, cht bo, carbohydrat to ra nng lng;

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Chm sc da
- Gip duy tr cc chc nng ca da, dy thn kinh v h tiu ha. - iu ha lng ng v cholesterol trong mu. - Cn thit c th to thnh nhng hormon cn bn nh cortisone, estrogen, progesterone, thyroxin... - Cn thit cho s tng trng c th; - Gip gim thiu nguy c nhi mu c tim (myocardial infarction).

Niacin c nhiu trong gan, thn, tht b, tht g, tht vt, tht heo, sa. Ng cc, cm go, cc loi ht cng c mt t niacin.
Thiu vitamin B3 a ti bnh Pellagra. Bnh ny thng thy cc cng ng m thc phm chnh l ng. Ng c rt t niacin v trytophan l cht chuyn ha thnh acid nicotinic trong c th. Mt s ngi nghin ru hoc c ri lon trong tiu ha thc phm cng b bnh ny. Triu chng chnh ca bnh l: - Tiu chy, i khi phn c ln mu; - Tnh tnh nng ny, d b kch thch, trm cm, lo lng, hong lon, mt nh hng; - Vim da, nhiu khi l du hiu sm nht ca bnh. da sng, trc vy, nht l phn l ra di nh sng mt tri hoc chn thng; nim mc ming v li sng . Bnh c cha bng dc phm c acid nicotinic hoc cho bnh nhn n nhiu tht ng vt.

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Dinh dng v iu tr
Tha vitamin B3 c th lm mch mu ngoi vi gin n, mu a n da nhiu v lm da nng, nga; ng trong mu ln cao; suy tim. Nhu cu vitamin B3 hng ngy cho ngi ln l t 1517mg, tr em l 5mg. Mt s vn khc Khi thiu st v km, da cng trc vy mng, kh nt da khe ming, tc rng, mng chn tay gin d gy. Nhiu ngi cho rng s-c-la, pho mt v cc mn n nhiu cht bo gy ra mn trng c trn da hoc lm cho mn trm trng hn, nhng cc nghin cu khoa hc cha chng minh c iu ny. Nhiu bnh nhn bnh chm (eczema) cho rng sau khi n trng hoc ung sa th bnh nng hn, nhng khoa hc cha xc nh iu ny. Mt vn khc v da cng c nhiu ngi lu tm trong phm vi cht dinh dng, l tnh trng da nhn kh khi tui gi. Thay i trn da l mt hin tng bnh thng ca s lo ha. Sau tui 25, cht collagen chng cho lp da bt u thoi ha; t bo m gim dn; da tr nn kh hn v t gi nc, ri vi nin k chng cht, tc ng ca trng lc, da s xung, nhn nheo.

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Chm sc da
Ngoi ra di nh hng ca nh nng, cc ngun tia t ngoi thin nhin, da cng mau h hao. S h hao ny c coi nh quy lut, khng th tr v tnh trng thu thanh thiu nin, nhi ng c. Trn th trng c bn nhiu m phm cha cc cht dinh dng nh vitamin E, kem tri da, vi cht m acid amin, cht chit t nhau thai... m cc nh sn xut ni l c th xa b s lo ha ca da. Theo cc nh nghin cu th cc sn phm ny thc ra ch lm da m mm tm thi m thi, ch khng lm da bt nhn nheo. Ring thuc bi c cha vitamin A Tretinoin dng nh c th to ra cht collagen di da, tng thm s lu thng mu. Nh da bt nhn nheo v bt kh mt phn no.

99

DINH DNG VI BNH CA RNG

thi c La M, Hy Lp, cc thy thuc nhn thy c s lin h gia thc n v cc bnh ca rng. Vo th k 3 trc Cng nguyn, Aristotle qu quyt rng vic n qu v l mt trong nhng nguyn nhn lm h rng. Ngy nay, nhiu nghin cu chng minh rng s n ung v thc n c vai tr ln i vi qu trnh mc rng, s vng chc ca rng cng nh cc bnh rng-ming. Thnh phn dinh dng ca mt mn n, cch tiu th mn n cng c th ngn nga hoc gy ra bnh cho rng. Ngc li, tnh trng tt xu ca rng - ming cng c nh hng ln ti dinh dng ca c th.

Qu trnh mc rng v nhu cu dinh dng

Con ngi c hai thi k to rng. Ngay t khi bo thai mi c hai, ba thng, rng bt u hnh thnh. Sau khi sinh, t 6 thng ti 30 thng tui, rng nh ra v tng trng. y l lp rng sa gm c mi chic hm trn v hm di. Ri ti khong 6 tui th rng vnh vin ln lt mc , c thy t 28 ti 32 chic, ty theo 4 rng khn c mc ra hay khng. Cc cht dinh dng m ngi m tiu th cn y cho s cu to v tng trng ca thai nhi.

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Bnh ca rng
m, cht cn bn ca mi loi t bo, trong c rng, l cht phi c y trong thi k ngi m mang thai. Bnh thng, b m n khong 50g m mt ngy. Giai on mang thai cn n thm 10g m dnh cho thai nhi. Thiu m, c nguy c rng sa khng nh c m sau ny cn d b h rng. Ngi m cng cn tng lng calci trong thc phm n vo ln khong 1200mg/ngy gip thai nhi to mm rng. Thiu calci trong thi k to rng v xng hm s a ti rng khng hon chnh, qu lin vi nhau hoc km phm cht. ng thi cng cn gia tng vitamin D calci d c rut hp th. Thiu vitamin D, men rng xu, c vt rn d b hng rng. M nhiu qu th li a ti ri ro cho cm a tr. Vitamin C kch thch sn xut to keo collagen m cht ny rt cn thit cho vic to cht ng rng (dentin). Vitamin A to cht keratin cho men rng (enamel). Thiu vitamin A lm men nt, xng hm km pht trin khin rng mc khng ngay hng. Fluor lm cng rng trong thi k to rng v nga h rng sau ny.

Iod gip rng mau nh.

Ni chung, v dinh dng, ngi m phi tiu th thm khong 300 calori mi ngy, vi cc thc phm a dng, y cc cht dinh dng. Ngi m cng nn trnh khng dng mt vi th trong khi c thai trnh nh hng ti thai nhi. Th d nh khng ung thuc Tetracyclin rng con khng mang mu vng xn vnh vin.

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Dinh dng v iu tr
V sau khi a tr cho i cho n sut qu trnh ln ln v pht trin, s vng chc v ton vn ca rng ty thuc rt nhiu vo ch dinh dng. Rng c th b su rng, rng; nha chu c th b vim lm h hao ti rng...

Su rng
Nm 1986, khi khai qut mt ngi m c Ai Cp, ngi ta thy mt hm rng c chic rng c nht mt mu kim loi vo thn rng. Cc nh kho c suy lun rng, v c nhn ny nht mu kim loi vo rng ngn su khi vo nm trong m ph rng. Nh vy th bnh su rng khng phi l mi l, m vn c t ngn xa. Ngy nay, khoa hc lm sng t nhiu vn lin quan n bnh su rng, ch r nhng nguyn nhn gy su rng cng nh c nhiu phng thc phng nga hu hiu. 1. Din tin ca qu trnh su rng Su rng l mt loi bnh nhim khun. Quan st cc ng vt khng c vi khun trong ming u cho thy chng khng b su rng. Trong bnh ny, cc sn phm chuyn ha acid hu c sinh ra do tc dng ca vi khun trn thc phm dnh kt trong rng ming, lm mt dn khong cht calci men rng. T rng b ph hy dn dn. Su rng c th xy ra bt c rng no trong ming cng nh bt c phn no ca rng. Rng mi mc d b h hn rng c lu, v th khi mi mc rng sa hoc rng thng phi chm sc k hn.

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Bnh ca rng
Vi sinh vt trong ming lm h rng nhiu nht l loi Streptococcus Mutans, ri n loi Lactobacillus casein v Streptococcus sanguis. Qu trnh su rng din ra nh sau: Sau khi n mt mn thc phm no , th mt phn nh thc phm dnh li trn rng hoc gia cc k rng, to ra mt mng ba (plaque). Ba ny l mi trng dinh dng tt cho vi khun sinh sn. Ba l hn hp ca 70% vi khun v 30% cht ng, acid. Lu ngy calci ng vo ba, cng hn, bm cht vo rng v nu rng. Ti vi khun lm thc phm ln men, sinh ra acid lactic. Acid n mn cht bo v men rng, vi khun xm nhp c vo cu to rng hy hoi. Cao im ca tc hi l na gi u sau khi n vi mc acid ln cao nht. Din tin ny xy ra rt m thm, i khi ko di c vi nm v khng gy au n g cho nn nhn, cho ti khi rng hng. 2. Dinh dng vi su rng Thc phm cc loi khi kt li trong rng u b vi khun chuyn ha. Thi gian cng lu th cng c hi.

Carbohydrat d ln men, nh cc loi ng saccharose, fructose, maltose, lactose; mt ong, ng vng, mt ma; tri cy ti, kh hoc ng hp; nc ngt... u l nhng mn a thch ca vi khun. Ch mt cht ng trong bnh, ko cng lm cho cc mn ny dnh lu trong ming, to iu kin thun li cho tc dng ca vi khun.
Quan st cho thy ngi hay n ngt b su rng nhiu gp 12 ln ngi t dng. ng ha hc saccharin, aspartame,

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Dinh dng v iu tr
cyclamate khng gy su rng; ng trong ru xylitol, sorbitol khng ln men li c coi nh bo v rng.
Cht m trong tht, trng, c; cht bo, vi loi pho mt c tc dng bo v rng khi su. Cht bo to ra mt lp du mng che rng nn c tc dng lm gim tc dng ca ng, lm gim dnh ca thc phm vo rng ming. Thc phm c nhiu x nh da gang, rau rip gip lm sch rng v loi b mng ba vi. Thc phm khng gy su rng l loi khi n khng lm tng nng acid ca nc bt. n ung nhiu ln (n vt) trong ngy cng lm thay i acid/kim ca nc bt v nh hng ti s su rng. Th d n nm ci ko mt lc ri sc ming th t c hi hn l lai rai n s ko trong ngy. n qu vt cng l mt nguy c gy su rng v acid trong ming ln cao nhiu ln trong ngy. Cn nh l mi ln c mt lng nh carbohydrat d ln men c a vo ming th acid trong nc bt li tng cao v n mn men rng. Thc phm n xen k cng c nh hng ti kh nng gy su rng. Thc phm gy su rng m n xen k vi thc phm khng gy su rng th s tt hn. Chui thng hay dnh rng, d a n su rng, nhng khi n km theo ung sa th tc dng xu gim i. Trng ming vi ming bnh ga-t dnh rng m sau li nhai ming pho mt Thy S th ming sch mau hn. Sa c nhiu calci, phosphor nn c tc dng trung ha vi thc phm d gy su rng nh ng. Dng lng hay c ca thc phm cng l mt yu t quan trng.

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Bnh ca rng
Thc phm lng ri ming mau hn mn n c nn acid cng thp hn. Mt vin ko cng ngm trong ming tan dn to ra mi trng thun li cho vi sinh vt. Ko cao su khng ng nhai lu lm tng nc bt v ra sch rng. Ng (bp) rang c nhiu cht x, t carbohydrat ln men nn cng tt cho rng. Nc bt c vai tr quan trng trong s tiu ha cng nh bo v rng. C ba tuyn nc bt l tuyn mang tai, tuyn di li v tuyn di hm. Nc bt c tnh kim v nhim v chnh l gi m cho ming, gip tiu ha thc phm, gim thay i acid trong ming v tiu ha tinh bt. Nc bt c nhiu calci v phosphor nn trung ha acid do vi khun to ra. S nhai lm tng nc bt. Ngi hoc nhn thy mn n thm ngon cng lm chy nc bt. S tit nc bt gim khi ng nn ming thng kh, v cng gim trong mt vi chng bnh hoc do tc dng ca mt s dc phm nh thuc tr kinh phong, trm cm, d ng, huyt p cao, thuc c cht phin, hoc cc tia phng x tr liu. 3. Phng nga su rng Su rng c th xy ra mi la tui, nht l khi cn th u. S chm sc nhng rng sa lin quan c bit ti s tng trng ca hm rng khn sau ny. Rng sa gip tr nhai thc phm, gi cho hm v tr tt cho rng vnh vin. Rng tm thi m rng sm th khong trng s b cc rng khc lp vo v chon ch ca rng khn. Rng sa c th b su khi tr mi hai tui, nn cha m cn lu chm sc rng cho con.

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V dinh dng th nn cn thn vi thc phm c nhiu ng ngt. Mc d ng ngt c chng minh l nguy c s mt gy su rng, nhng khuynh hng chung ca chng ta vn l thch cc mn n ngt. Khuynh hng ny c bit nguy him tr em ang tui pht trin, khi cha c c thc t bo v trong vic chn la mn n tt cho sc khe. Nhiu b m dng ko ngt khen thng con. Nhiu ngi cho con b bnh nc pha vi ng, thay cho sa. C b m li nhng nm v cao su vo mt ong ri cho con ngm. Tt c u l nguyn nhn d dng lm hng nhng chic rng non. Khi ng, khng nn cho ngm bnh sa, v c th tr khng nut ht, sa ng trong ming v l mi trng tt cho vi khun. C th cho b ngm nm v gi hoc ngm bnh nc l. Ngoi vic sa m c nhiu b dng, con mt nm v m cn gip hm rng ngay ngn hn. Tr em cn ch n ung y , a dng vi y calci, phosphor p ng nhu cu tng trng ca rng. Fluor, mt ha cht ngn nga su rng rt cng hiu, cng cn c hin din trong thc phm hoc nc ung. Cha m cn hng dn con tr trong vic gi gn v sinh rng, cch dng bn chi, dy c rng (flossing). Bn chi rng nn thay mi khi khng cn m bo lm sch rng, v cn c thng xuyn ra k loi b thc phm cng nh vi khun dnh vo. V sinh rng ming ni chung gm c:

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Bnh ca rng
- nh rng mi ngy hai ln, nht l sau ba n. - Sc ming sau khi n hoc ung. - Nhai ko cao su khng ng trong 15 pht sau ba n nc bt ra nhiu. - C khe rng mi ngy hai ln. - Dng kem nh rng c fluor. - Sc ming bng dung dch chlorexidin. - Bt n thc phm ngt hoc c nhiu carbohydrat d ln men. Cc nh khoa hc hin ang tm kim mt loi vaccin ngn nga su rng. Hy vng trong tng lai gn, vaccin ny s c bo ch. Bc s nha khoa Jeffry Hillman ca i hc Florida ang nghin cu thay i bin d ca vi khun Streptococcus mutans, khin chng khng cn kh nng gy su rng na. Nha chu l cc m nng v gn rng, gm c nu (gum), mng nha chu (periodontal membrane), xng rng (alveolair bone) v xi mng (cementum). Bnh ca nha chu l nguyn nhn quan trng ca s rng rng sau tui 35-40. tui ny, c ti 75% ngi mc bnh nha chu. Nguy c hng u ca bnh nha chu l khng gi gn v sinh rng ming. Nha chu l bnh nhim vi khun. C hai loi chnh l vim nu (gingivitis) v vim hy hoi cc m nng rng

Bnh nha chu (Peridontal disease)

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Dinh dng v iu tr
(periodontitis). Vim nu rng c th iu tr c v cn c iu tr ngay trnh nhiu trm trng hn cho m nng v s rng rng. Khi u ca bnh nha chu l mng ba (plaque) bm trn ranh gii rng v nu m thnh phn cu to c vi khun vi cht hu c. Vi khun tit ra cht c lm nu sng, vim, chy mu. Nu khng cha s c nhng ti nh cha y vi khun xut hin chung quanh rng. Nha chu, v i khi c xng hm, s b nhim c. Cc mng ba bm cht cn c nha s gip ly i, v dng bn chi nh rng khng lm sch chng. Trong bnh nha chu, ngoi v sinh rng ming, s dinh dng cng c vai tr ng k. Mt ch dinh dng y s lm nu khe mnh ngn chn s xm nhp ca vi khun v cc cht c hi. Thiu vitamin C, folacin lm yu nu. Thiu vitamin C trm trng khi ch n ung khng c rau ti v tri cy s gy ra bnh scurvy trong nu rng sng v chy mu. Thiu cht m, vitamin A v B cng u a ti bnh nha chu. Ngoi ra, ngi b bnh tiu ng, bnh tuyn cn gip (parathyroid gland), bnh thiu hng cu, kh ming, hoc ang iu tr bng phng x cng c nguy c mc bnh nha chu.

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DINH DNG VI BNH D DY - RUT

dy v rut l hai b phn quan trng trong h tiu ha. Cc c quan tiu ha l tiu ha thc phm nhm cung cp cho c th cc cht b dng v nng lng. Nu chng may m h tiu ha b tn thng th ton b c th b nh hng. Con ngi s b suy dinh dng vi nhiu hu qu trm trng khc. Bnh ca h tiu ha c th l ming, thc qun, d dy, rut non, i trng. V tnh cch quan trng v ph bin ca bnh d dy-rut, di y chng ta s tm hiu v mi quan h qua li gia ch dinh dng vi bnh ca hai c quan ny.

Bnh lot d dy
Lot d dy l bnh rt ph bin, ngi ta c tnh l c 10 ngi th c 1 ngi b bnh (10%). Bnh xut hin mi thnh phn trong x hi, v nhiu nht vo tui 50 - 70. Bnh thng xy ra vi nhiu ngi trong cng mt gia nh, nn c v nh c tnh cht di truyn. Nguyn nhn Trc kia, hu ht mi ngi, trong cng nh ngoi y gii, u cho rng lot d dy l do n nhiu chua, ung nhiu aspirin, n ung qu vi vng, suy ngh qu hoc do cng thng. C gi thuyt cn cho l ht qu nhiu thuc l cng l mt nguy c.

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Nhng cho n nm 1983, ti Australia, bc s Barry J. Marshall chuyn v bnh d dy v rut tm ra thm mt nguyn nhn ca bnh, l vi khun Helicobacter pylori. Khm ph ny thay i hn phng thc iu tr v cng nh cch nh bnh lot d dy. Sau nhiu nghin cu, cc bc s u cho l c n 90% cc trng hp lot d dy do vi khun gy ra, v khi tr vi thuc khng sinh th dt bnh. Tuy nhin, nguyn nhn u tin a n nhim vi khun cng nh c ch ly lan ca bnh vn cha c hiu r. Trong d dy lun lun c dch v v nc acid rt mnh do d dy tit ra tiu ha thc n. Bnh thng, nc acid khng gy ra vn g cho d dy, bi v d dy c mt lp nim mc che ch v v lun lun c mt s cn bng gia acid v dch v. Khi v mt l do no m s cn bng ny b xo trn th nim mc d dy b n mn v to ra nhng vt lot. C gii thch cho l vi khun Helicobacter pylori v thuc gim au nhc lm ri lon sc khng ca nim dch, m ng cho acid lm mn nim mc d dy. Ngoi phn trn ca d dy, bnh c th xy ra on u ca rut t (duodenum) hay phn di ca d dy. Triu chng Ngi b lot d dy thng thy au ngm ngm bng trn hay di ngc. Cm gic au ny nh ang b gm nhm, nng rt rt kh chu. Nhng khi ung mt cht sa, n mt t thc n hay ung vin thuc chng acid l gim lin. Nhng vi mt s ngi, thc n li lm tng cn au.

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Bnh d dy - rut
Bnh nhn c th i ra phn c mu en, cm thy y trng bng sau khi n, i khi i ma. Khi lot rut t th cn au thng xy ra ban m, nu n vo th bt au nhng ch vi gi sau au tr li. Bnh c th a n mt vi bin chng nh xut huyt, thng d dy, nght d dy. M khi xut huyt nhiu th bnh nhn b thiu mu hng cu. Chp X quang v ni soi d dy (endoscopy) l hai phng php thng dng xc nh bnh. iu tr Trc nm 1983, lot d dy c cha bng cc thuc c chc nng lm gim acid trong d dy hay lm tng sc chu ng ca nim mc d dy, ch yu l chng li s tn cng ca acid. C nhiu loi thuc ngn chn tit acid nh Cimetidine, Ranitidine, Famotidine v thng c ung vi liu iu tr lin tc trong 6 thng. Sau tip tc ung vi liu thp hn ngn nga ti pht. Bnh cng c th c gii phu ct dy thn kinh kch thch s tit acid trong d dy. T khi pht hin c vai tr ca vi khun Helicobacter pylori trong vic gy bnh, vic nh bnh v iu tr chuyn hng sang ch nhiu ti th phm ny. Sau khi thc hin cc xt nghim cn thit xc nh c s hin din ca vi khun Helicobacter pylori trong d dy, ngi bnh s c iu tr thuc khng sinh vi liu cao lin tc trong khong t 10 n 12 ngy. Thuc thng c dng l hn hp ca tetracycline, metronidazole v bismuth.

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Dinh dng v iu tr
Nhng trng hp lot d dy do vi khun Helicobacter pylori gy ra (chim n 90%) thng c tr dt bng thuc khng sinh v him khi ti pht. Cn nu xt nghim vi khun Helicobacter pylori cho kt qu m tnh th vn phi p dng cc phng php iu tr truyn thng lin quan n acid trong d dy. Trong nhng trng hp ny, bnh nhn thng t c kh nng dt hn bnh, cng nh nguy c ti pht rt cao. Di y ni qua v cc thuc thng dng trong iu tr bnh lot d dy.

a. Cimetidine, Ranitidine, Famotidine

Nhm thuc ny chn khng cho acid tit ra t cc t bo trong d dy. Thuc khng c dng trong au d dy nh nh no hi, chua, kh chu d dy v khng c cng hiu. Khi ung cc thuc ny, cn lu mt s im sau y: - Thng bo ngay vi bc s nu d ng vi thuc hay ang c cc bnh v thn, gan. - Khng ung ru hay ht thuc l. - Ung thuc khi n v trc khi i ng. Nu qun mt ln ung th khi no nh ra cn ung ngay; nhng nu gn n gi ung ln k tip th b qua ch ng ung b hai liu thuc cng mt lc. - Gi thuc ni nhit va phi, khng m thp, trnh nh sng. - Tham kho kin bc s trc khi mun ung cc loi thuc gim au nhc nh aspirin, ibuprofen hay cc thuc chng vim khng steroid khc.

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Bnh d dy - rut
- Thuc c th gy ra o gic, lm mt nh hng, au cung hng, st, tim p khng u, mt mi, yu sc. Trong nhng trng hp ny cn thng bo cho bc s ngay. - Ngi cao tui chuyn ha thuc chm nn thng c cho ung liu thp hn, nht l khi c bnh v gan v thn. Cc thuc ny c dng lm trung ha acid c sn trong d dy v thng l mt hn hp ca cc cht aluminum hydrochlorid, magnesium hydrochlorid. Khi ung cc thuc ny, cn lu mt s im sau y: - Aluminium c th gy ra to bn, magnesium gy tiu chy, nhng hn hp hai cht th qun bnh khng c nh hng g ti i tin. - Khng ung thuc ny khi hoc ang c bnh thn, cc bnh chuyn ha xng. - Cn thng bo bc s trc khi dng thuc nu c cc trng hp sau y: d ng vi thuc, au bng nng, vim rut, ri lon i tin lu ngy, nght rut. - Ung thuc ba gi sau khi n v khi i ng, ung tht nhiu nc. - Khng ung loi thuc no khc trong vng 1 hay 2 gi sau khi ung cc thuc ny. - Bo qun tt trnh thuc hng v nng qu hay m qu. - Nu qun mt ln ung th khi no nh ra cn ung ngay; nhng nu gn n gi ung ln k tip th b qua ch ng ung b hai liu thuc cng mt lc.

b. Thuc Mylicon, Mylanta, Riopan, Maalox

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Dinh dng v iu tr
Dinh dng vi bnh lot d dy - t trng Ngi b lot d dy - t trng thng hay thiu dinh dng. L do l h n khng thy ngon, thng hay bun nn, i ma. Khi n thc n hi cng l au bng nn h gim n ung. Theo nhiu bc s, trong khi iu tr bnh ny th mt ch n ung gii hn loi thc phm no l khng cn thit, gip ch rt t cho s lnh bnh. Hn th na, kin thc v dinh dng thay i cng lm ngi ta ngh khc i v mt s loi thc phm. Chng hn nh trc y c kin cho rng sa lm gim cn au th ngy nay c ngi li ni sa kch thch d dy tit ra nhiu acid hn; trc y nhiu ngi thng khuyn khng nn ung nc cam th ngy nay li ni l ung c; cc thc phm c v cay trc y thng trnh, ngy nay cng cho l dng c, ngoi tr t qu cay. Thuc l c cho l tc nhn lm bnh kh cha hoc d ti pht. V th bnh nhn lot d dy-t trng tt nht l nn ni li t gi vi thuc l. V thi im n ca ngi bnh cng c nhiu kin thay i. Trc y bnh nhn c khuyn n lm nhiu ba nh gim au. Ngy nay, cc nghin cu mi cho rng cch n nh vy s kch thch d dy tit ra nhiu acid hn. Cho nn bnh nhn c khuyn l nn n u n vo cc ba chnh trong ngy vi lng thc phm va phi. V cc loi thc phm nn dng v nn trnh th sau y l mt s kin chung:

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Bnh d dy - rut a. Thc phm nn dng

- C ti nng, hp - Tht mm - Nc tri cy pha long - Tri cy chn, gt b v - Rau nu chn - Cm np

b. Thc phm nn trnh

- Cc loi ru bia, nc c ga, c ph, tr, s-c-la - Ko, thc phm chin, rn - Thc phm nhiu cht bo - Tht nng, hun khi, p mui, xc xch - Tri cy kh, tri cy cn v - Cc loi ht - Rau tri ngm dm - Cc loi rau sinh nhiu hi trong rut nh sp l xanh, sp l trng, ci Brussels, da leo, hnh ty.

Hi chng km hp th

y l tnh trng mt hoc nhiu cht dinh dng b km hp th rut non. Hi chng ny l hu qu ca mt s bnh khc nhau ch khng phi ch do mt bnh.

Nguyn nhn gy ra hi chng km hp th (malabsorption syndrome) c th l cc bnh tim mch; bnh c quan ni tit; km tiu ha v hp th thc phm; tc nghn h bch huyt trong vic vn chuyn cc cht in gii, nc, cht m; gim tit mt... V khng c hp th nn cht dinh dng b thi ra khi c th.

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Dinh dng v iu tr
Bnh nhn c mt s triu chng nh i tiu chy; phn c cht bo v khng c hp th i khi mi rt hi; st cn; cc bp tht teo dn; bng cng phng nhiu hi; hu qu ca thiu vitamin nh hng cu thp, to nh bt thng... Km hp th cht bo l trng hp thng xy ra. Khi cht bo b thi ra ngoi th cc vitamin ha tan trong cht bo nh A, D, E v K cng mt theo. Ni chung bnh nhn c nguy c thiu dinh dng v h n t i. Dinh dng vi hi chng km hp th Dinh dng c vai tr quan trng trong vic iu tr. Trc ht l phi pht hin v iu tr nguyn nhn gy ra hi chng km hp th.

Vitamin v khong cht cn c b sung.

Ch dinh dng cn c thay i ty theo nguyn nhn gy ra bnh. Ni chung, ch n ca ngi bnh cn c tng thm nhiu cht m v nng lng. Trong mt vi trng hp c th cn phi gii hn carbohydrat, acid amin. Nu b tiu chy nhiu th cn gii hn cht x.

Bnh vim lot i trng

Vim lot i trng (ulcerative colitis) l bnh c th gp mi la tui, nhng thng gp nht l t 15 ti 35 tui v thng thy nhng ngi trong cng mt gia nh. Rut b vim vi nhng vt lot v cc t m nh ri rc trn nim mc ca ton b i trng.

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Bnh d dy - rut
Nguyn nhn gy ra bnh cha c bit r nn khng th iu tr dt bnh. Cc yu t nh tm trng cng thng, thuc l, d ng, thc phm cay chua, nhim trng, thi tit nng lnh, thiu dinh dng... c coi nh gy ra cc cn bc pht ca bnh. Bnh nhn c cc triu chng nh au bng, to bn hoc tiu chy, phn c mu, suy nhc, gim cn. Nu khng cha sm, bnh nhn ri vo suy dinh dng, xut huyt v ung th rut cng c th xy ra. Dc phm iu tr gm cc cht chng vim nh sulfasalazin, mesalamin, olsalazin, corticosteroid. Khong 25% bnh nhn khng p ng vi tr liu bng thuc c th c gii phu. V dinh dng, bnh nhn khng n ngon ming, li hay au bng nn h n rt t. Thc phm n vo li khng c tiu ha, hp th nn hu ht cc cht dinh dng, vitamin b thi ra nggoi. V ch n ung, cn dng cc mn n d tiu ha v d hp th, nhiu vitamin, nhiu cht m, t cht b, mm, khng kch thch rut. Trn th trng c bn cc sn phm ch bin vi cht m, carbohydrat d tiu ha, c nhiu vitamin, khong cht v mt t cht bo c bit. Trong mt s trng hp c bit nghim trng, bnh nhn c nui n bng ng a vo thc qun hoc bm dinh dng vo tnh mch.

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Hi chng rut d kch thch

Theo nhiu kt qu quan st, hi chng rut d kch thch (irritable bowel syndrome) rt thng gp v chim n 70% trong s nhng ngi mc cc bnh ng tiu ha. Bnh thng gp tui thiu nin v n gii nhiu hn nam gii. Bnh nhn thng hay au bng vi cc thay i v i tin. au c th bt c ni no trn bng, xy ra sau khi n v gim au sau khi i tin. y hi cng thng xy ra, v nu hi tht ra c th bnh nhn thy d chu. Bnh nhn thng hay b to bn nhiu hn l tiu chy. Phn ra thnh nhng vin nh v kh. Nguyn nhn gy bnh cha c xc nh. C th l do nhu ng cc c thnh rut b ri lon hoc do thay i chc nng cc hormon . Bnh thng bc pht di tc dng ca mt vi loi thc phm cng nh khi ngi bnh c nhng cng thng, lo u, bun phin... Khi thy c cc triu chng bnh, nn i khm bc s c chn on v iu tr ng n. Nhiu ngi bnh lm dng thuc nhun trng v thng xuyn b to bn. y l im cn xt li v hu qu s lm dng s lm bnh trm trng hn cng nh tht tht cht in gii trong c th v tiu chy kinh nin. Nhiu ngi cng p dng ch n ung khc thng, loi b mn ny, mn n ch v nghi ng chng gy ra bnh. Kt qu l thiu dinh dng.

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Bnh d dy - rut
Nu bit chc chn l thc phm no gy kh chu th hy loi b, v phi lu tm mt thc phm c cht dinh dng tng t thay th. Tng cht x trong thc phm s gip s tiu ha v bi tit cht cn b. Rau, tri cy ti rt tt, nhng la chn n va trnh y hi. Ci bp, u c th sinh nhiu hi trong rut. Thay i mn n d tiu cng gip gim thiu cc triu chng. i khi c th dng thm thc phm ph c cht x bn sn trn th trng, nhng nn tham kho kin bc s v s lng cng nh loi no nn dng. Bnh nhiu khi dai dng nhiu nm, nhng may mn l khng a ti hu qu trm trng.

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DINH DNG VI BNH VIM GAN

an l tuyn ln nht trong c th, c trng lng trung bnh t 1,2kg n 1,6kg v nm gc trn bn phi khoang bng. Gan c n hn 500 chc nng khc nhau, trong c nhiu chc nng quan trng trong qu trnh tiu ha v hp th dinh dng nh l: a. Gan tng hp mt, cha trong ti mt trc khi a vo t trng. Mt gip nh ha cht bo ti t trng lipase ca ty tng bin i d dng hn thnh cc acid bo v glycerol, l nhng cht s c hp th vo mu. b. Gan l ni quan trng chuyn ha cc cht dinh dng nh cht m, cht bo, carbohydrat. c. Gan iu ha lng ng glucose trong mu, chuyn ha lng glucose tha thnh glycogen v d tr cho nhu cu trong tng lai. d. Gan loi b cc acid amin tha bng cch phn hy chng thnh ammonia, urea v thi ra ngoi. . Gan to hng cu thai nhi v sn sinh protein, cc vitamin B12, D v K. e. Gan v hiu ha cc cht c, tiu hy cc t bo hng cu gi v cc cht bt li cho c th nh estrogen nam gii. f. Gan tng hp cc cht ng mu thit yu prothrombin, fibrinogen, heparin v cc cht khng ng.

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Bnh vim gan

Nh vy, c th thy r l gan c rt nhiu mi lin h vi dinh dng. Mt ri lon, tn hng no trong cu trc hoc chc nng ca gan u a ti cc hu qu khng tt cho vic n ung, nui dng c th. Gan l mt trong s rt t c quan c kh nng ti to cc t bo thay th nhng t bo h hao. Nhng nu s h hao qu ln th cc chc nng ca gan cng b suy yu. Vi y hc hin i, gan c th c ghp t ngi cho sang ngi nhn. Phu thut ghp gan hin nay c t l thnh cng kh cao.

Vim gan do virus

Vim gan l mt trong nhng bnh thng thy gan v dinh dng c vai tr rt quan trng trong vic iu tr bnh ny.

Vim gan thng do mt s loi virus gy ra, nhng cng c th do cc cht c nh ru, thuc, vi khun, nm c... Vim gan gy ra do virus l nhm bnh c khp mi ni trn th gii. Chng thng c nhiu im tng t v triu chng nhng li do cc virus khc nhau gy ra, do m vic chm sc v iu tr cng khc nhau. I. Vim gan A Tc nhn gy bnh vim gan A l virus hepatitis A (HAV).

Truyn bnh
a. Virus ny c phn ca bnh nhn. Bnh lan truyn do tip xc trc tip qua ng ming, thng nht l

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do a vo ming cc thc n c ln phn ngi bnh. Trng hp ny rt thng xy ra a phng km v sinh cng cng hoc c nhn khng gi v sinh ring. b. Bnh cng ly lan qua thc phm nhim trng, nht l n bin cn sng. c. Mu v dch thi ca ngi bnh. d. Sinh hot tnh dc vi ngi c bnh. Giao tip thng thng vi ngi bnh nh bt tay, cho hi... khng b ly bnh trc tip, tr trng hp khng m bo cc iu kin v sinh nh sau khi tip xc dng tay cha ra sch cm nm thc n. c nhiu trng hp vim gan A Hoa K do hnh ti nhim virus ti ni trng trt dng phn c ln virus ny.

Triu chng
Thi k bnh t 2 n 6 tun l. i khi bnh khng c triu chng. Nhng khi c th xut hin rt nhanh vi nng st, mt mi, km n, i ma, au bng, nc tiu m, da vng. Cc du hiu ny ko di t 2 thng ti 6 thng. Tr em t c triu chng v l ngun mang virus cng nh ngun gc ly lan bnh rt ln. Bnh khng li hu qu lu di, khng a ti vim gan mn tnh. Khng c thuc c tr cha vim gan A. V th, iu tr ch yu l gii quyt cc triu chng, h tr sc khe, trnh nhng cht c hi cho gan.

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Bnh vim gan Phng nga 1. V sinh c nhn l quan trng. Lun lun ra tay sch

s sau khi i tiu hoc thay t cho con, trc khi n v nu n. 2. Chng nga. Thuc chng nga vim gan A rt cng hiu. Mc d vy, v l do kinh t nn khng phi tt c mi ngi u c th c chng nga. Sau y l mt s i tng u tin cn c chng nga:

a. Mi ngi t 2 tui tr ln m i du lch hoc lm vic ti vng ang c t l mc bnh vim gan A cao u cn c chng nga. Cc vng l: Trung v Nam M, Mexico, chu (tr Nht Bn), chu Phi v cc quc gia Nam v ng u. b. Mi ngi ang sng trong vng c dch vim gan A. c. Nhng ngi ng tnh luyn i. d. Nhng ngi nghin ma ty thng s dng chung ng tim. . Ngi lm ngh phi tip xc thng xuyn vi virus gy bnh vim gan A. Thuc chng nga c tim 2 mi, cch nhau 6 thng. C th chng nga vim gan A cng vi cc loi thuc chng nga khc. Cn chng nga t nht mt thng trc khi n cc vng thng xuyn c bnh, v sm hn thuc cha tc dng. Thuc nga c cng hiu 5 nm, i khi ti 20 nm.

Nhng ai khng nn chng nga? a. Ngi c d ng mnh vi thuc chng nga.

b. Ngi ang au m.

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Dinh dng v iu tr
c. Sau khi tip xc vi ngi b vim gan A. V thuc chng nga c hiu lc chm sau mt thng, nn trong trng hp ny phi dng loi huyt thanh min dch c khng th (immune globuli) c tc dng phng bnh tc thi. Thuc chng nga vim gan A, cng nh mi loi dc phm khc, u c th gy ra d ng. Nhng ri ro do thuc chng nga vim gan A gy ra khng nguy him. Thng th khong 4, 5 ngy sau khi tim c th hi au ni kim tim, hoc nhc u nh trong vi ngy. S an ton ca thuc nga vi ph n c thai cha c xc nh, nhng cc ri ro, nu c u nh. Huyt thanh min dch c khng th (immune globuli) thng c dng cung cp tnh min dch tm thi cho nhng ngi tip xc vi bnh nhn vim gan A, hoc nhng ngi i n nhng vng c bnh ny m cha c chng nga trc .

II. Vim gan B

Bnh vim gan B (Hepatitis B) trc y c gi l vim gan huyt thanh. Khi , ngi ta tng l bnh ch ly truyn do tip nhn mu c virus, do dng chung kim tim nhim virus, hoc khi xm da, x l tai... Ngy nay, khoa hc chng minh l virus gy bnh vim gan B cn c trong nc bt, nc mt, tinh dch ngi bnh v c th ly truyn qua hot ng tnh dc. Vim gan B l nguyn nhn ng hng th hai gy ung th, c bit l ung th gan, sau thuc l.

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Bnh vim gan

Virus gy bnh c rt nhiu trong mu, nn vim gan B d lan truyn hn bnh AIDS. Mi nm, ti Hoa K c trn 200.000 ngi mc bnh ny v c ti trn 4000 trng hp t vong. Ngi Vit Nam c t l nhim virus vim gan B kh cao, t 15% ti 20%.

Truyn bnh
Virus gy bnh vim gan B lan truyn theo nhiu cch: - Qua kim nhim virus khi ngi nghin ma ty dng chung hay khi xm mnh trn da vi dng c c nhim virus. - Do hot ng tnh dc, hoc tip xc, ng chm vo mt, ming, vt t trn da ngi mang virus. - Ly t m sang con. - Khi dng chung a bt, bn chi nh rng, dao co ru, dng c ct mng tay... vi ngi mang virus. Virus vim gan B c th sng n c thng trn nhng dng c ny. Thi gian t khi nhim bnh ti khi c triu chng ko di ti t 40 ngy ti 6 thng, trung bnh l 2 thng. y l thi k bnh ly lan mnh nht.

Nguy c mc bnh

Nhng nguy c c th a ti mc bnh vim gan B l: a. Lm cng vic tip xc vi mu hoc dch lng ca c th ngi b vim gan B. b. Ngi nghin dng chung kim tim v ng chch. c. Giao hp vi ngi b bnh. d. X l tai hay xm da vi dng c c nhim virus.

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. Sng chung vi ngi b vim gan B. f. Ngi lc mu v thn suy hay tip nhn mu. Mc d an ton ca vic truyn mu c ci thin rt nhiu so vi trc y, nhng vn c mt t l nh nhim virus vim gan B qua ng ny. g. Nhn vin y t, nhn vin chm sc sc khe cng ng, bc s, nha s... thng tip xc vi ngi bnh vim gan B u c th b ly bnh. h. Tr s sinh m m b vim gan B th trong qu trnh sinh n, do tip cn vi mu ca ngi m nn c th b ly bnh.

Triu chng
C n hn 50% s ngi mc bnh vim gan B khng c triu chng, nht l tr em. Ngi bnh c cc du hiu ging nh b cm cm: mt mi, n mt ngon, suy yu c th, i ma, nng st, nhc u, au nhc ton thn, da nga ni mn , nc tiu vng, phn trng, vng da v trng mt. Thng thng bnh ko di t 4 n 8 tun l ri t thuyn gim khng cn tr liu nu khng c bin chng hay hu qu xu nh chuyn sang vim gan mn tnh (10%), suy gan, x gan (cirrhosis). X gan i khi a n ung th gan. Ngi b vim gan mn tnh thng khng c biu hin triu chng bnh, nhng bnh vn c th lan truyn sang ngi khc v h c mang virus gy bnh. Trong thi k cp tnh, Interferon c dng iu tr vi hiu qu ngn chn s tng sinh ca virus. Vic dng thuc ny cn c bc s ch nh v theo di.

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Bnh vim gan Phng nga

Vim gan B c th phng nga bng cch p dng v sinh c nhn, cn thn phng khi tip xc vi ngi c bnh v bng chng nga. Vic chng nga c th c p dng cho mi la tui, ngay c tr em mi sinh, v nht l nhng i tng c nhiu nguy c nhim bnh nh nhn vin y t, ngi c quan h tnh dc ba bi, ngi ng tnh luyn i. Thuc chng nga c tim 3 mi, chia ra trong khong thi gian 6 thng. V sao nn chch nga cho tr em? Bi v, tuy a s bnh nhn b nhim bnh vim gan B vo tui trung nin m nhiu khi khng r nguyn nhn, ng thi cng c nhiu ngi mang virus vim gan B, tuy khng c du hiu ca bnh m vn truyn bnh cho ngi khc. V th, m bo an ton cn phi chng nga c cho tr em mi sinh. Mi tim u vo khong mi sinh cho n 2 thng tui, mi th nh khong 1 hay 2 thng sau mi th nht, v mi th ba sau khong 6 thng cho ti 18 thng. Thuc chng nga c sn xut bng mt cht m ly t virus gy vim gan B, m bo an ton v cng hiu. Ch hn hu lm mi c phn ng mnh, cn bnh thng l hi sng au ch tim.

III. Vim gan C

Bnh vim gan C ly truyn qua ng mu. Nm 1989, virus gy bnh vim gan C ln u tin c khm ph, l virus Heppatitis C (HCV).

Virus HCV l nguyn nhn chnh ca vim gan cp tnh v cc bnh gan mn tnh nh ung th gan, x gan. Hng nm

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c ti gn 200 triu ngi nhim bnh trn ton th gii, vi t 3 ti 4 triu trng hp mi pht hin. Truyn bnh Bnh ly truyn do tip xc trc tip vi mu ngi bnh. C ti 80% vim gan C do truyn mu c virus hoc s dng li kim tim, ng chch khng c dit trng k. Nhng trng hp ly truyn t m sang con v ly truyn do giao hp u rt him. Xm chm, x khuyn tai... u c th ly truyn bnh nu dng c b nhim virus. Vim gan C khng ly lan do ho, ht hi, qua thc phm, dng chung vt dng hoc tip xc thng thng nh bt tay, m hn... Cha c trng hp ly bnh no khi nui con bng sa m. Ti cc quc gia ang pht trin th c n 90% ly lan do s dng chung ng tim, do c truyn mu c bnh, ngi b bnh mu, bnh thn ang lc mu, giao hp vi nhiu ngi. Vim gan C xut hin nhiu mt s quc gia chu Phi, vng ng Nam , pha ng a Trung Hi, rt t Bc M v Ty u. Triu chng Thi k bnh t 3 ti 16 tun l. Bnh thng khng c triu chng, hoc ch c mt mi, bing n, nhc xng, st nh, vng da.

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Bnh vim gan

Tin lng Khong 80% bnh nhn s chuyn sang tnh trng mn tnh. T l x gan ln ti 10-20%; ung th gan t 1-5% trong thi gian t 20 n 30 nm. iu tr Vim gan C mn tnh c th iu tr vi cc dc phm chng virus nh Interferon km theo thuc Ribavirin, nhng ph tn rt cao. Interferon c 10% ti 20% cng hiu, khi phi hp vi Ribavirin th cng hiu tng ln t 30% n 50%. Vic dng cc thuc ny phi do bc s ch dn, cn c vo tnh trng bnh, kt qu th nghim, tui tc bnh nhn. Phng nga Cho ti nay cha c thuc chng nga vim gan C. Cc phng thc sau y c p dng ngn ly lan bnh: a. Kim st, th nghim mu v cc ch phm mu. b. Dit trng cc dng c y khoa trc khi dng. c. Khng dng chung bn chi nh rng, dao co ru. d. Bng che cc vt thng trn da. . C np sng lnh mnh. Dng bao cao su khi giao hp

IV. Dinh dng vi bnh vim gan

Trong cc bnh vim gan va k, ngoi dc phm, s iu tr ph thuc rt nhiu vo ch dinh dng tt v s ngh ngi ca c th.

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Bnh nhn thng c cm gic i bng nhng li b mt khu v, bing n. Do dn n thiu dinh dng, trong khi gan li rt cn cht b phc hi v ti to cc t bo b tn thng. i khi ngi bnh b nn i sau khi n. V th, thc phm nn phn chia thnh nhiu ba nh. Mi ngy cn khong 60g cht m vi tht ng vt v rau tri. Khng cn gii hn cht bo, tr khi ngi bnh khng tiu ha c cht ny. Cht bo t sa, trng d tiu hn l t mn n chin xo vi m hoc ln trong tht. Cn carbohydrat th dng lng va phi. Nu bnh nhn i ma qu nhiu sau khi n th phi s dng phng php nui n bng ng hoc qua mch mu.

Bnh x gan
X gan (cirrhosis) l bnh do gan phn ng li vi cc chn thng hoc t vong ca t bo bng cch to ra nhng m si kt li vi nhau. gia cc m si ny l mt nhm cc t bo mi c sinh sn. Gan tr thnh mu hung en v c nhng cc x cng nh ri rc y. Cc m si ngy cng nhiu hn v chim ch ca t bo gan bnh thng. Cc chc nng ca gan b suy yu v ch cn mt s t t bo gan hot ng c. Nguyn nhn gy ra x gan gm c nghin ru, nhim virus, nght ng mt ko di, bnh t min gan, hu qu ca suy tim mn tnh, suy dinh dng v rt nhiu trng hp khng r nguyn nhn.

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Bnh vim gan

i khi x gan khng c triu chng. Triu chng thng thy l n mt ngon, bun nn, i, mt mi, vng da, au bng, st cn, chy mu rut, da vng, ph nc chn v bng. n ng c du hiu ri lon cng dng; n gii b ri lon kinh nguyt. X gan l bnh him ngho v t bo b thoi ha khng tr li bnh thng c na. Bt hnh hn na l khng th iu tr dt x gan. Cc phng thc iu tr ch l hng v cc nguyn nhn gy bnh. Nu do ru th cn phi ngng ru ngay. V dinh dng, ngi bnh cn c ch n ung cn bng. Mi ngy cn khong 40g cht m, y carbohydrat v cht bo c s nng lng cn thit. Trc y c kin gii hn cht bo. Nhng ngy nay th cht bo c dng va phi tr khi bnh nhn khng tiu ha, hp th c v cht bo theo phn ra ngoi. Cc vitamin cng cn c tng cng, c bit l cc vitamin nh folacin, thiamine (B1), pyridoxine (B6), riboflavin (B2). Ngoi ra ngi bnh cn ngh ngi thoi mi, trnh cc cng thng tm thn cng nh lao ng qu sc. Khi gan suy yu qu trm trng m cc phng thc tr liu u khng c hiu qu, th thay th gan hin nay l mt li tht. Phu thut ghp gan rt tin b v ngi nhn gan c th sinh hot tr li bnh thng.

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DINH DNG VI BNH TO BN

o bn l mt tnh trng gy kh chu kh ph bin, nhng thng gp nht l tui gi, bi v c t nht l 25% cc v lo nam v 34% cc v lo b phi chu nh hng ca tnh trng kh chu ny. To bn c th l du hiu ca mt s bnh, l tc dng ph ca mt vi dc phm, hoc hu qu ca mt np sng t vn ng, hoc dinh dng khng cn i. N lm nhiu ngi b m nh, mt vui trong cuc sng. V ngi ta khng ngi b tin ra cha chy hy vng c c s hanh thng i tin. To bn c ng t ca nn y hc phng Ty l Hipprocrates quan tm n khi ni rng Mun c mt sc khe tt, cn phi i tin u n.

nh ngha

C th mi ngi c mt thi quen ring trong vic o thi cht b ca s tiu ha thc phm. C ngi i tin u n mi ngy mt ln, c ngi n hai hoc ba ngy mt ln. Khi tnh trng tiu ha bnh thng, c th lun tun theo thi quen u n , c n ng thi im l s c mt cm gic kch thch nhc nh ta thc hin nhim v. Khi thi quen khng c duy tr nh thng l th iu c ngha l h tiu ha ang c vn . Mi ngi c th hiu v to bn theo mt cch khc nhau.

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Bnh to bn
C ngi than phin vi bc s l b to bn v t sng n chiu m vn cha i tin. C ngi li ngh rng mnh b to bn v sut my ngy tip mi khi i tin u phi gng sc, ri phn c thi ra cng nh t st kh, li nh nh phn d, i khi c ln cht mu ti. Ni chung, ngi ta thng cho l b to bn khi s ln i tin trong mt qung thi gian nht nh b gim i so vi thi quen. Tht ra, i tin 3 ln mt ngy hay 3 ngy mt ln cng u c th xem l bnh thng, nu l thi quen u n c t lu, nht l khi i tin khng thy kh khn hay gy ra cm gic kh chu. Thng thng, ngi cao tui cho l b to bn khi phn kh ra, cng v kh, m khng quan tm n s ln i tin. Ngi cao tui i khi cn c khuynh hng c lng t i s ln i tin ca mnh. Mc d c nhiu hnh thc to bn, nhng ni chung l s ko di thi gian nm li ca phn trong i trng v s tr hon tng xut cht b ra khi trc trng. Mt s hnh thc to bn khc nhau c phn bit nh sau y: a. Hnh thc trm trng nht l khi lng i trng thu hp hoc b nght, phn kh cng v nc b ht tr li rut. Nn nhn phi ngi lu mi gii ta c, sau vn thy m c, kh chu hu mn, i khi ngm ngm au bng. Trng hp ny thng thy trong bnh ung th rut, vim rut, v cn i khm bnh ngay. Nht l khi thy trong phn c mu.

Cc loi to bn

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b. K n l to bn co cng rut: thay v th gin sau mi nhp bp th i trng li co cng, m cht cht b, phn tr nn kh, kt thnh tng cc nh. Nguyn nhn c th do khng tp thnh thi quen i tin u n, khng n sng kch thch i tin, lm dng thuc. c. Loi th ba l to bn do mt trng lc rut: thng thy ngi cao tui, c bit ngi b bnh tm tr. Trong trng hp ny, rut khng khng co bp di chuyn cht b, khin cho phn nm y trong trc trng m vn khng kch thch hu mn to ra cm gic mun i tin.

Thay i chc nng ca rut khi tui gi

Sau khi c tiu ha, hp th ht cht b dng d dy v rut non, phn b ca thc n s c chuyn xung i trng. Ni y, nc trong cht b c rut ht gi li, phn c thnh hnh v c o thi ra khi c th. Trung bnh, thi gian cn thit mt mn n vo ming cho ti lc c o thi l 8 gi. Rut co bp u n, nht l sau ba n, v vi tr gip chuyn ng nhp nhng ln xung ca c honh bng, cng y phn xung trc trng. Phn kch thch khin c vng hu mn m rng v phn tht ra ngoi. Nghin cu cho thy l cc chc nng ca rut trong vic i tin khng thay i my ngi cao tui: thi gian lu thng ca phn trong i trng khng chm, s y phn ra khi trc trng khng b tr hon.

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Bnh to bn
Nhng ngi cao nin b to bn th cc ng tc ny u chm li, nht l khi h au yu hay c mt vi bnh mn tnh, li t hot ng hay ang ung mt loi thuc no . Nhng yu t ny lm cht b kh, gim p lc trong lng rut, tr hon s lu thng cht b v nc c rut ht li nhiu. C mt vi thay i cu to rut nh thoi ha ca c c chc nng a cht b vo trc trng, gim cht nhn tit ra t rut, nhng khng c nh hng my ti thi quen i tin ca ngi gi.

Nguyn nhn
ngi cao tui, to bn thng gy ra do s phi hp ca nhiu yu t nh sau: 1. Ch n ung Mt khu phn khng cn bng, nhiu m, t cht x, t nc l nguy c thng thng ca to bn. Ngoi ra, to bn d xy ra nu ngi cao tui khng nhai k thc n, v rng li yu km, kh khn khi nut. 2. Tc dng ph ca dc phm Nhiu loi dc phm lm gim s th gin hay co bp ca cc c trong rut, lm tr ngi s di chuyn ca cht b, chng hn nh: - Thuc tr bnh tm thn (Thorazine, Holdol, Elavil...), - Thuc c cht st, khong calci... - Thuc chng vim - Thuc li tiu

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Thm vo , qu v cao nin thng ung nhiu loi thuc cng mt lc nn vic o thi cht b tiu ha li cng kh khn hn. 3. Cc bnh mn tnh Bnh lm suy nhc thn kinh, tr hon chc nng co bp, n y ca i trng, nh cc bnh Parkinson, tiu ng, tai bin mch mu no... nht l khi b chn thng thn kinh ct sng. Ngoi ra, ung bu rut, gim nng tuyn gip, gim kali, tng calci trong mu cng l nhng nguy c a ti to bn. 4. Bnh tm thn Trm cm, sa st tr tu lm gim tng xut phn hu mn. Ngi bnh i khi mt cm gic, khng bit ti nhng thi thc i tin nh bnh thng. 5. t vn ng Khi c th t vn ng, rut, c honh u gim co bp, phn chm di chuyn, a ti tnh trng to bn. S vn ng c th lm tng chuyn ng ca rut.

nh bnh
S nh bnh v tm nguyn nhn trc ht l cn c vo cc chi tit do ngi bnh cung cp. Khi ngi cao tui than phin c s thay i t ngt v thi quen i tin, v kch c v mc m c ca phn th h cn c lu , khm nghim. y c th l du hiu ca ung th i - trc trng hay cc bnh nghim trng khc.

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Bnh to bn
Nu bnh nhn khng t m t, thy thuc cn hi k v mu sc, kch c, khi lng ca phn, cng nh nhng cm gic khi i tin. Cc chi tit sau y rt quan trng: a. Ngi bnh phi gng sc rn trong khi i tin b. C cm gic nh phn cn st li trong trc trng c. Thi gian i tin ko di, nhiu khi phi dng tay vo hu mn y phn ra d. au bng hay au hu mn khi i tin, phn dnh trong qun lt. Thy thuc cn khm tng qut t ming ti hu mn, chp X quang rut hoc ni soi ng rut, trc trng, th phn nh bnh. Cn trng hp to bn kinh nin c t trn 2 nm th nn tp trung vic lm gim thiu xo trn ny.

Bin chng
To bn lu ngy ngi cao tui c th a n mt s bin chng nh: a. S nm cht phn i trng v trc trng. y l bin chng thng xy ra, i khi nguy him ti tnh mng. Bnh nhn b st cao, bng cng au, tim p nhanh vi nhp ri lon, ngi mt mi, c th a ti bt tnh. Phn b nm cht c th p ln bng quang lm b tiu tin v lu ngy a ti suy thn. b. Rut kt to v xon rut, nht l ngi b tn thng ct sng c. Cn thiu mu cc b v ngt v phi rn lu, nh hng xu ti s tun hon no b v ng mch vnh.

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d. Sa trc trng v ngi to bn phi rn y phn ra v c th a n phn dnh. . Chuyn sang cc bnh tr ni, tr ngoi. e. To bn kinh nin c th l nguy c a n ung th i trng v trc trng.

iu tr
Ngy nay c rt nhiu thuc chng to bn c bn t do trn th trng, nn vic cha theo triu chng, au u cha y c coi l thun tin hn c. Mi ln i tin kh khn ch cn mua my vin thuc nhun trng l gii quyt c ngay, tht d dng! Nhng thc t cho thy nh vy l khng gii quyt c tn gc vn , nn khng phi l gii php tt. Vic iu tr chng to bn cn phi bao qut hn, vi vic hng dn ngi bnh v s bi tit cht b ca qu trnh tiu ha, s i tin bnh thng, tp thi quen i tin u n, cng nh thay i ch dinh dng, tng vn ng c th. Mi ngi bnh cn p dng mt cch iu tr thch hp, ty theo nguy c gy bnh, m mc tiu l gip ngi bnh i tin u n v d dng, t nht l ba ln mt tun v trnh nhng bin chng. C hai phng thc iu tr h tr cho nhau l khng dng dc phm v s dng dc phm. 1. Khng dng dc phm Trc ht, cn iu chnh mt nhn thc sai lm rt thng gp l phi i tin mi ngy mi tt. Tht ra, nh ni, ch

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Bnh to bn
cn i tin c d dng v u n, cho d l 2 hay 3 ngy mt ln cng vn tt. a. iu quan trng l phi c gng to ra mt thi quen i tin u n. Mi ngy d khng c cm gic mun i tin, nhng vn nn ch ng i tin vo mt gi nht nh, tt nht l khong na gi sau khi n sng, khi thc n kch thch rut v d dy. Ban u thng hi kh khn, nhng lp li u n sau mt thi gian s to thnh thi quen. Mt khc, nh v sinh nn sch s, thong rng to s thoi mi cho nhu cu. b. Khi c cm gic mun i tin th nn i ngay, v nu tr hon, phn nm lu trong rut s b ht ht nc thnh kh cng, kh y ra. c. Ngi chm hm kiu a ng l tt nht, hoc nu ngi trn bn cu th t hai chn ln ci gh thp tng p lc trong bng, ngi ng v pha trc, bn tay vo bng di. d. Ngng lm dng thuc nhun trng. Nu ang dng cc thuc tr bnh khc, nn ngh bc s iu tr kim tra li tc dng ph ca cc thuc y, xem c thuc no gy to bn hay khng. Nu c, cn thay th bng thuc khc hoc gim liu dng, ty theo s cn nhc quyt nh ca bc s. . Nu khng b cc bnh cn hn ch tiu th nc nh bnh tim, bnh thn, nn ung t nht 1,5 lt nc mi ngy trnh kh nc, c bit l vo ma h nng bc hay khi ang ung thuc li tiu, hoc khi ch n c nhiu cht x. Khng nn ung nhiu c ph v nc ny lm i tiu nhiu.

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e. Tng thm lng cht x trong thc n hng ngy. Quan st chu Phi vo thp nin 70 cho thy ngi dn y n nhiu cht x v t b to bn, i tin nhiu hn so vi nhng ngi n t cht x chu M v chu u. L do l cht x khng b tiu ha v c thi nguyn dng t d dy xung rut non ri vo i trng. i trng, mt s cht x c cc vi sinh vt lm ln men, ht nhiu nc trong rut, lm phn tr nn mm v to hn khin rut d dng y ra ngoi. Do gim nguy c to bn. f. Vn ng c th u n v va phi vi iu kin th lc l rt tt ngi cao tui. Ngi b bt ng cn c a ra khi ging, t ngi trn gh nhiu ln trong ngy, gip h c ng chn tay, tr mnh qua li cng gip ch nhiu cho vic i tin, li cn trnh hy hoi da lng v nm lu qu.

Ni thm v cht x
Mc d cht x ng vai tr tch cc trong vic chng to bn, nhng cht x cng c mt vi u, nhc im m ta cn lu khi s dng. Nhng u im ca cht x l: - Cht x lm gim nguy c ung th i trng v cht ny thi b mt vi cht gy ung th do vi sinh vt to ra. - Cht x lm gim nguy c bnh vim ti rut. - Cht x lm gim nguy c mc bnh tr. - Nu ta b tiu chy th cht x li gip ht bt nc, phn s kh hn. - Cht x gip h cholesterol trong mu, gim tiu ng.

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V nhng nhc im ca cht x l:
- To ra nhiu hi trong rut, d sinh cm gic y bng, kh chu. - Vi loi cht x nh trong cm yn mch hoc trong la m c th chim ly khong calci, st, km v mang theo ra khi c th.

c nhiu cht x, khi chn mn n nn lu :

- n c phn cht x c trong thc phm. - n cc thc phm khc nhau nh cc loi ht, rau, tri cy. - Hn ch cc loi thc phm c t cht x. - V tri cy thng c nhiu cht x, v th vi mt s loi tri cy c th ra sch v n c v thay v gt b. Mi ngy nn dng t 20 ti 35g l , v nhiu qu c th gy tiu chy v y hi trong d dy. 2. S dng dc phm S dng dc phm chng to bn ch yu l cc loi thuc nhun trng. Trn th trng, ta thy c n hng trm loi khc nhau vi cng mc ch l lm gim bt kh khn khi i tin, nhng ng thi cc loi thuc ny cng c khng t nhng tc dng ph m ta cn bit. Cc thuc tr to bn hin c trn th trng c th phn loi nh sau: a. Thuc lm phn thu thnh khi. Khi gp nc, cc cht ny n, to ra khi mm trn lng trong i trng v kch thch nhu ng rut. Thuc c tc dng trong

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thi gian t 12 n 24 gi. Thuc thng dng l bt Citrucel, Konsyl, Fiberall, Metamucil; vin Fibercon, Fiberall; thuc ht Serutan, Perdiem Fiber... b. Thuc lm phn mm. Cc thuc ny lm b ngoi ca phn m trn, c tc dng sau 2, 3 ngy. Thuc thng dng l Docusate natri (Kasof); Docusate Natri (Colace, Corectol, Modane Soft). c. Thuc ty (x) nh du Mineral, c tc dng sau khi ung khong 6 gi. d. Thuc ty mui nh magnesium citrate, magnesium hydroxide. . Thuc tht hu mn bng nc l, nc pha mui, du, Fleet Phosphosoda. e. Thuc vin nht hu mn c Glycerine hoc Bisacodyl. Cc thuc ny gip i cu d dng nhng cng c nhiu nhc im khi ta lm dng chng. Chng hn nh: - Khi dng qu thng xuyn, qu liu, thuc nhun trng s a ra khi c th nhng cht b dng, vitamin trc khi cc cht ny c rut hp th. - Thuc lm tng s bi tit nc, natri, kali trong c th. - Dng lu s thnh quen, khin c rut yu, khng hot ng hu hiu. Khi ngng thuc, to bn tr nn trm trng hn.

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Bnh to bn
- Dng nhiu qu ta th b tiu chy v cng c th nh hng ti tc dng ca cc dc phm tr bnh khc. S la chn cc thuc chng to bn cn c s hng dn ca bc s iu tr, da vo nguyn nhn gy to bn, cc bnh ang c, cc thuc ang ung, ph tn cng nh ty theo s thch ca ngi bnh. Li khuyn chung ca cc chuyn vin y t l: mt i khi dng th thuc nhun trng s an ton nhng n khng phi l s thay th lu di cho mt ch n ung lnh mnh, mt np sng chng mc, c vn ng c th.

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DINH DNG VI S VN NG C TH
t s vn ng vin th thao cho rng ch cn c hun luyn tt l t thnh tch cao. Tuy nhin, nhiu nghin cu cho thy rng mt ch n ung vi cht dinh dng cn i v y s c nhiu nh hng tt ti thnh tch t c ca cc vn ng vin trong thi u cng nh khi tp luyn hng ngy. Cht dinh dng l thc phm m ta tiu th c th tng trng v duy tr sc khe. C khong trn 50 cht dinh dng chnh, cn thit. Cc cht ny c trong nhiu loi thc phm khc nhau v chia ra lm ba nhm c bn: cht m (protein), cht bo (lipid), cht bt ng (carbohydrat). Mi loi thc phm u c mt hn hp ca hai hay nhiu cc nhm chnh k trn. Cc vn ng vin th thao c nhu cu tiu th nhiu nng lng, nn cn nhiu carbohydrat, cht m, cht bo hn ngi thng.

y l nhm hp cht gm c cc nguyn t carbon, hydrogen, oxygen v l ngun nng lng quan trng ca c th. Carbohydrat tiu th c tn tr gan, c tht di hnh thc glycogen. Carbohydrat ch cung cp nng lng, khng c vitamin, m hay khong cht.

Carbohydrat

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Vn ng c th
Carbohydrat c chia ra lm hai loi:
- Carbohydrat n: nh ng, ko, cht ngt trong nc ung c ga... - Carbohydrat phc tp: c trong ng cc, go, khoai, tri cy, rau, nc tri cy... T lu, cc nh chuyn mn nhn thy rng khi tiu th mt lng ln carbohydrat, c th s chu ng c s tp luyn lu di v n kch thch c bp, tng lng glycogen tn tr, do tng nng lng cn thit cho s vn ng. Vi mt vn ng ngn hn nhng cn nhiu sc lc th carbohydrat l ngun nng lng chnh; sau 20 pht th mt s lng cht bo c s dng tng cng thm ngun nng lng. Khi tip tc ko di thi gian vn ng th nng lng s do cht bo v carbohydrat cung cp ng u. Trong trng hp vn ng cn t sc lc v ko di u n nh i b th ngun nng lng chnh li do cht bo cung cp. V th nhiu ngi i b bt vng hng v vng bng. t hiu qu tt nht, cc vn ng vin nn tiu th nhiu carbohydrat theo lch trnh nh sau: - Mt tun l trc khi hi thao, nn n t carbohydrat, nhiu m, ng thi tp dt ht sc. - Ba ngy trc khi biu din, gim tp dt, n nhiu carbohydrat trong khoai, go, u, bp, chui, to, bt, tri cy, rau...

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Cht m
Cht m c nhiu trong sa, tht sc vt, trng... Vn ng vin khng cn tng lng m khi tp luyn nng, v khu phn bnh thng cn i theo t l khuyn co cung cp nhu cu ri. Trong thc t, v c th ch s dng m cho nhu cu nng lng khi carbohydrat v cht bo khng p ng , nn khi gia tng mc hot ng th ngun cung cp nng lng chnh khng phi l cht m. Tiu th nhiu cht m qu s c hi v c th phi thi thm cht b nitrogen qua ng tiu tin, lm cho tht tht nhiu nc v calci.

Cht bo
Vi mc tp luyn trung bnh, cht bo cung cp 50% tng s nng lng cn thit. Nhiu cht bo qu s gy tr ngi cho s hp th cht m v carbohydrat, ngoi ra cn c th gy vi bnh mn tnh nh bnh tim, tiu ng, vi loi ung th. Mt khu phn c 30% cht bo l .

Nc
C th cha 65% dung dch cht lng. Do dng khi lng nc l iu cn thit cho cc vn ng vin. Khi ung nc, vn ng vin tp luyn tt hn l thiu nc. Nc cn lm gim bt nhit sinh ra trong khi tp dt, lm mu lu thng tt, mang dng kh v cht dinh dng n cho cc c bp ang lm vic. Ngoi ra nc cng cn cho cc chc nng ca no b nh phi hp, tp trung t tng, suy ngh trong lc tp luyn.

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Vn ng c th
Vi ngi t hot ng, c th cn t nc hn so vi ngi hot ng nhiu. V th, cc vn ng vin cn rt nhiu nc khi tp luyn hay thi u. Mt ngi hot ng trung bnh mi ngy phi ung t 6 n 8 ly nc (1,5 - 2lt) v ngi vn ng nhiu th cn nhiu hn. Mt nc lm c th mt, lm xo trn s iu ha thn nhit, chc nng ca tim v cc phn ng sinh ha bp tht. i khi s tp luyn lm gim cm gic kht nn cc vn ng vin cn ung nc u n, nu ch n khi cm thy kht mi ung th thng khng cung cp nc cho c th. Cc vn ng vin th thao nn ung khong na lt nc trc bui tp luyn khong 15 pht, ri sau ung u n. Nu bui tp luyn ko di, th c khong 5 pht li ung mt cht nc, i khi ch cn nhm nhp mt ngm cng . Cn ung nc mt ch khng lnh qu. Sau khi tp luyn xong, cng cn ung mt lng ln nc gip c bp v no b hi phc li. Trn th trng c nhiu loi nc ung gi l nc gii kht th thao, trong khong cht chnh l natri, chlor, kali, cng thm cht ng, c qung co l thay th nc v khong cht mt i trong khi vn ng. Nhng tr trng hp phi vn ng vi cng cao ngoi tri nng bc, cn bnh thng th khong cht khng mt i qu s lng d tr trong c th. C nhiu nghin cu cho rng khi ung cc dung dch ny trong cc cuc tp luyn cng thng v ko di s gip vn ng vin chu ng lu hn v tng kh nng vn ng. Thc t l loi nc gii kht ny c v ngon nn cc vn ng vin cng thy thch hn l nc l.

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Vitamin v khong cht

Kinh nghim cho thy l cc vn ng vin khng cn nhiu vitamin hn ngi bnh thng, v vitamin khng c dng to ra nng lng. C ngi cho rng ung nhiu vitamin C c th lm tng tnh min dch, nhng thc ra th s gia tng ny ch c khi tnh min dch b gim hn mc bnh thng, cn nu khng th vitamin C chng c tc dng g. Trong s cc khong cht, vn ng vin tr tiu th cn thm calci lm chc xng v st to hng cu.

Vitamin v khong cht dng ph thm khng cn thit khi cc cht c t nhin trong thc phm vi ch dinh dng cn bng. i khi vic tn nhiu tin mua vitamin c th l ph phm.
Khi tp luyn ko di, c bp thng sinh ra acid lactic. Khi lng acid ny ln qu cao, c bp s au nhc, i khi n mc lm cho vn ng vin khng th tip tc tp luyn c na. Mun trnh tr ngi ny, nhiu ngi khuyn nn ung mt t baking soda lm trung ha acid lactic.

Vi trng hp c bit
i vi cc vn ng vin n chay th mt ch n ung c nhiu carbohydrat, t cht bo cng lm tng hiu qu tp luyn, d rng khng dng cht m ng vt. Cc loi ht hay u nnh cng c th cung cp cht m. Tuy nhin,

148

Vn ng c th
vn ng vin cn dng thm vitamin B12 v khong calci, v khi khng n tht v ung sa s rt d thiu nhng cht ny. Cc vn ng vin n cn kim tra phng thiu cht st khi khng n tht ng vt. Cc vn ng vin mc bnh tiu ng loi 1 (cn iu tr bng insulin) c li im l nh tp luyn m c th gi mc ng trong mu bnh thng, mc cholesterol v huyt p thp. Nhng i khi cng c nguy c mc ng trong mu xung qu thp, nn cn n thm mt t cht carbohydrat khi no thi gian tp luyn ko di. Ngi b tiu ng loi ny nn c b tr tp luyn khong na gi sau khi n, hoc l vo thi im m nng insulin trong mu ln cao nht. Tp luyn vo bui sng l tt hn c, trnh bui chiu. Mt s vn ng vin cn dng thm vi cht khc tng cng kh nng tp luyn v thi u, nh hormon nam (anabolic steroid), creatinin. Trong th chin th hai, hormon nam c c Quc X cho on qun ch lc SS dng lm tng kh nng chin u. Trong cc cuc tranh ti ti Th vn hi vo thp nin 50, cc vn ng vin Nga cng dng hormon nam tng cng sc lc. K t nm 1974, cht ny b Th vn hi cm dng v tc dng khng tt, nn cc vn ng vin u c kim tra trc khi thi u xem c vi phm lut hay khng. C vi iu cn ch khi dng cht hormon nam l sc mnh t c khng ko di, mau kit sc. Thuc c th

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Dinh dng v iu tr
gy ra mt s bnh nh sng tuyn nhip h, bnh tim, gan. Cht creatinin lm tng khi lng bp tht khi dng vi liu lng nh, trong thi gian ngn.

Kt lun
Tm li, mt ch n ung y v cn i dinh dng nh carbohydrat, cht bo, cht m, vitamin v khong cht s gip vn ng vin tp luyn v thi u hiu qu hn, bn b hn. Nn lu rng nc rt cn cho mi hnh thc vn ng. Cn cn thn khi dng anabolic steroid v creatinin.

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SUY DINH DNG NGI CAO TUI

n ung y cht dinh dng l yu t quan trng c mt sc khe tt cho mi ngi, mi la tui, nht l ngi cao nin. Suy dinh dng hoc dinh dng sai lm l tnh trng gy ra do mt cn bng gia thc phm tiu th v nhu cu nng lng ca c th. S kin ny c th l do n qu t, qu nhiu hoc khng ng u cc thc phm c bn nh cht m, cht bo v cht bt ng. Bnh do suy dinh dng c ngha l sc khe b thng tn v thc phm khng cung cp y cht dinh dng hoc do ri lon cc chc nng sinh hc ca c th trong vic hp th v cung cp cht dinh dng cho cc t bo. Thut ng dinh dng thiu hay dinh dng thp c dng ch tnh trng n vo khng cht dinh dng, cn dinh dng qu mc hay dinh dng tha l khi tiu th cht dinh dng nhiu hn mc nhu cu. Mt ngi lnh mnh m lin tc n khng cht dinh dng th gi l thiu dinh dng tin pht. Ngi c th do chn la thc n khng ng vi nhu cu c th, hoc do khng n y . Chng hn nh khi n nhiu thc n sy

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Dinh dng v iu tr
kh th cho d lng thc n vn no bng nhng s c nhiu nguy c thiu mt s cht dinh dng. Khi thiu dinh dng do nhng ri lon ca c th th gi l thiu dinh dng th pht. Trong trng hp ny, mc d lng thc n vn y nhng c th khng tip nhn, tiu ha, hp th, chuyn ch, s dng c mt cch hiu qu nh bnh thng. Th d nh cc bnh ung th, bnh ca h tiu ha... thng a n thiu dinh dng th pht. Cn tnh trng suy dinh dng th c xc nh khi b st cn ngoi mun t 5% n 10% sc nng c th trong vng 6 thng ti 1 nm. Theo thng k, c ti mt phn ba nhng ngi trn 65 tui b suy dinh dng, nht l v cht m. Suy dinh dng c nh hng quan trng ti sc khe, l mt trong nhiu nguy c a ti bnh tt v t vong.

Din tin bnh thng tui gi

Khi ti tui cao, c bp gim, da kh, xng xp, nhng bng, mng th t bo m pht trin rt mnh. Cc chc nng sinh hc v tiu ha suy yu: chuyn ng co bp v s hp th thc phm ca rut v d dy gim; bt cm gic v n ung nh nm, ngi, nhn thc phm; rng lung lay; t kht nc, t thy i. Nhiu dc phm m ngi gi dng cho cc bnh mn tnh cng nh hng ti khu v.

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Suy dinh dng ngi cao tui

Nguy c suy dinh dng

C nhiu nguy c a n suy dinh dng ngi cao tui: a. Sng n c. n ngon cn c ngi cng n mi thy c hng th. Ngi cao tui sng mt mnh thng n qua loa cho xong ba, nn n t, nht l khi khng c ngi bn i nu cho mnh n, cng nh chia s ngt bi. b. Ri lon tm thn, nh trm cm, c bit l vi qu c sng trong vin dng lo, hoc v tic thng s ra i ca ngi bn trm nm. c. Khng thc c s quan trng ca dinh dng, n g cng c, ct sao cho no bng th thi. d. n khng cht dinh dng hoc khng ng cch, khng bit ct gi, nu nng thc n. . Thiu thn vt cht, khng cung cp thc phm. Nhiu ngi au m ko di phi dnh tin mua thuc hoc tr tin nh, in, nc... hn l mua thc phm. H c th n thc phm r tin, qu hn, ht cht dinh dng, ct sao cho khi i. e. Ph thuc vo ngi khc. Ngi b au xng khp mn tnh, di chuyn kh khn, khng i mua v khng nu nng c. Cc c b suy yu tm thn c th qun khng n hoc thy n ung l khng cn thit. Nhiu ngi cn s gip bn thc n. f. Mt s ngi gi b gia nh b ri, khng c nui dng y .

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Dinh dng v iu tr
g. Cc bnh mn tnh nh ung th, bnh phi, bnh tim u a ti suy dinh dng. Gim dch v d dy khin hp th cc cht dinh dng nh st, ng lactose b tr ngi. Chc nng ca gan gim, khin cho s chuyn ha thc phm chm. Tht tht cht dinh dng qua i ma, nc tiu, phn. h. Bing n v tc dng ca dc phm ang dng. Mt vi dc phm c nguy c a ti n mt ngon (Digoxin, Prozac, Quinidine, qu nhiu vitamin A); gy i ma nh vi loi thuc khng sinh, Aspirin, Theophyline; lm km hp th thc n nh cc loi thuc tr to bn, thuc tr suyn loi Theophylline, thuc kch thch amphetamine. Dng nhiu vitamin D c th a ti tn thng cho thn; nhiu khong st gy hi cho gan. k. Bnh rng ming. Rng b lung lay, rng gi khng kht hm a ti kh khn khi nhai thc n; ming kh nc bt khin nhai thc phm nh nhai bng gn; nut thc n xung thc qun kh khn. i. Mt cm gic nm, ngi thc phm. Nhiu v cao nin mt hng th trong m thc v h khng cm thy hng v v khng nhn thy s hp dn ca thc phm do gic quan, th gic yu. Thc phm tr nn khng mi, khng v, i khi h n thc n i thiu m khng bit. Nhiu khi, c khu v, h tng gia v nh n nhiu mui, nhiu ng, nhiu cay. Mt cm gic mt phn l do cc n nm ca li b c st vi rng m km nhy cm hn.

154

Suy dinh dng ngi cao tui

l. Ung nhiu ru. S ngi cao tui thch ung ru ln ti 10%. Cc c ung t mt nhng nhiu ln trong ngy, gi l nhm nhi cho m bng, tiu cm. Ru khng cung cp cht dinh dng cho c th, nhng nhiu v li dng ru thay cm, n t thc phm, nht l dng ru qun i, gii su... m. Trng hp suy dinh dng v mt cm gic ngon ming cn c ni thm. Nhiu ngi cho rng mt cm gic ngon ming l chuyn ng nhin ngi gi, nhng thc ra iu ny c th l do mt s bnh mn tnh nh: - Bnh phi: S mt k ngoi mun thng thy 75% ngi c bnh phi mc d h n ung y . l do nng lng mt i v tng ch s chuyn ha, a n suy yu c honh, dn n th kh. - Bnh tim. Theo nhiu chuyn gia, sau thi gian vi nm gim cn v bnh phi th bnh tim s xut hin. Bnh nhn gim cn, n mt ngon, mt mi, c bp tiu hao. Ngoi ra thuc tr bnh tim cng lm gim s n ngon. - Bnh ung th. Hu ht ngi mc bnh ung th u gy i, c th v c s gia tng chuyn ha, thay i ni tit hoc do tc dng ca thuc cha ung th. - Sa st tr tu. Nhm ngi ny thng mt kh nng t n ung, khng cn cm gic vi thc phm. i khi h khng chu m ming nhn thc n a vo, khng chu nhai hoc nut chng thc n, nh ph ngi bn thc n cho h, giu thc phm...

155

Dinh dng v iu tr

Nhng du hiu ca suy dinh dng

Suy dinh dng i khi c pht hin khi cc c thy qun o t nhin rng, lng. Cn khi i khm bc s th nh bnh cn c vo bnh s, khm ton thn, cn o sc nng, th nghim mu (hng cu, hormon tuyn gip, chc nng gan), th phn tm k sinh trng, mu; chp X quang tim, phi, h tiu ha. Ngi b suy dinh dng n, l l vi mi ngi, mi s vic xy ra chung quanh hoc i khi li gt gng, kh tnh. Da kh, xanh lt, d bm, vt thng lu lnh. Tc kh dn, rng nhiu; mng tay kh, nt; n khng ngon ming; gim cm gic vi mi v thc phm; ming kh, li v mi l; nhai nut kh khn; hay bun nn; i tin to bn hoc lng bt thng; nhp tim nhanh; hi th kh khn. C th mi ngy mt gy i, sc khe suy gim, cc bnh ang c trm trng ln, di chuyn kh khn, d ng, d tai nn.

Hu qu ca suy dinh dng

- Thng tn th xc v tm thn. - D dng mc cc chng bnh truyn nhim. - Tng ri lon vi cc bnh chuyn ha. - Gim kh nng hot ng. - Tng nguy c t vong.

iu tr v phng nga suy dinh dng

Vn u tin l pht hin v iu tr cc nguyn nhn a ti suy dinh dng nh k trn.

156

Suy dinh dng ngi cao tui

Ngi bnh cn c thy thuc theo di, chuyn vin dinh dng gip ch dn cc mn n b dng, nhn vin x hi gip gii quyt cc vn v hon cnh, gii thiu ti cc c quan tng tr ngi gi, cc on th... S bing n l nguy c thng thng nht a ti suy dinh dng. Sau y l vi phng thc trnh tnh trng ny: a. Khuyn khch ngi cao tui tm bn cng n cho vui. Ngi cao tui c th n n ti cc trung tm cao nin, n chung vi ngi thn trong gia nh, ti cc c s tn gio c sinh hot x hi. b. Nhiu ngi b qua ba n ch v cm thy mt khi nu nng. Nn ngh cho khe ri nu, ch ng b qua ba n. i khi nu mt ln cho hai ba n. Hoc nu qu kh khn th c th mua thc phm nu sn ri hm nng bng l vi-ba. c. Khuyn khch n nhiu vo ba m ngi cao tui thch. Nu ba tra l thi gian n th c th tng phn n ba ny. C th n lm nhiu ba nh thay v ch ba ba chnh nh thng l. d. Trnh mau no bng nh khng nn ung nc, ung thuc ngay trc khi n. . Trnh thc phm gy ra nhiu hi nh ci bp, u, nc ngt c ga, c ph... e. Nng vn ng c th ty theo iu kin sc khe kch thch khu v.

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Dinh dng v iu tr
f. Gi gn v sinh rng ming. Ngi hay b kh ming th n nhiu canh, nc xt. Kh khn nhai vi rng gi th c th dng thc phm bm nh, ninh tht nh la lu hn cho tht mm. g. Nhiu ngi thng nn i khi n th nn trnh n mt lc qu nhiu m chia ra lm nhiu ba nh, trnh thc n nhiu cht bo. h. Khuyn khch dng thm thc phm ph cng nh vitamin, khong cht. i. Thm gia v vo thc phm tng sc hp dn khu v ngi cao tui.

Kt lun
Suy dinh dng, nht l ngoi mun, l vn h trng i vi ngi cao tui. N lm tng nguy c bnh hon v t vong lp ngi ny. Hu ht nhng nguyn nhn a ti suy dinh dng u c th iu tr v phng nga c. Tuy nhin, phn ln cc v cao tui thng t mnh khng gii quyt c vn m cn phi c s quan tm gip , chm sc ca con chu. Tm hiu v tnh trng suy dinh dng ngi cao tui do li l trch nhim ca nhng ngi tr tui. Nu mi ngi trong chng ta u thc ng vn ny, nhng nm thng cui i ca cc v lo ng, lo b chc chn s tt p hn nhiu, cng nh c thm phn m p, chan ha tnh cm.

158

RU V NGI CAO TUI

rong nhng thp nin va qua, y gii bt u quan tm hn ti mt vn b coi nh t nhiu nm. l s nghin ru nhm ngi cao tui vi nhiu bnh l sinh ra do mn thuc x hi ny. H thc c l c vn nghin ru lp ngi t 60 tui tr ln. Cho ti nay, y gii qu ch tm vo nn nghin ngp lp tr, cng nh ngi cao tui thng che y, bo cha cho s ung ru ca mnh. Hip hi Y khoa Hoa K coi nghin ru ngi cao tui nh mt bnh dch c gi kn.

nh ngha
Theo cc nh chuyn mn y hc th ru l mt dc phm c th b lm dng v nghin ru l mt bnh cng nh nhiu bnh khc xy ra cho con ngi. Cc c quan y t c thm quyn nh ngha nghin ru nh mt bnh mn tnh, nguyn pht m s mc nghin, s pht trin, biu l u chu nh hng ca cc yu t v di truyn, tm l x hi v mi trng chung quanh. Cc nh chuyn mn xc nh tnh trng nghin bia ru l khi ung mi ngy nhiu hn:

159

Dinh dng v iu tr
- 680ml bia c 5% cn nguyn cht, - hoc 290ml ru vang c 12% cn, - hoc 90ml ru mnh c 40% cn. Ung va phi c th l ch tng ng hoc gp ri lng ru bia ni trn trong mt tun. Ngi nghin ru th tnh trng khng dng li mt mc nht nh. Vi nhiu bin chng, bnh thng s tr nn ngy cng nng hn v dn dn a ti t vong. c im ca bnh l c nhng ri lon kh nng kim st s ung, lun lun m nh vi ru, tip tc ung d bit hu qu xu, l tr b mo m, sai lc, v nht l lc no cng ph nhn s nghin ngp ca mnh. S ph nhn ny l mt iu bt li v ru c sc tn ph ng k ln c th suy yu ca ngi gi.

Dc tnh ca ru
Ru l dc cht an thn lm du thn kinh trung ng no b. Vi pht sau khi ung l ru vo mu ngay v lm t di dy thn kinh, lm chm tn hiu t no ra ngoi vi c th. Dng nhiu, ru s nh hng ti cc chc nng nh suy ngh, phn xt, tr nh, ngn t, phi hp cc ng tc. Nhiu hn na s a ti trn p thn kinh, lm ng vi, t lit ton thn i khi hn m, t vong v h hp b gin on. Khi nng ru trong mu ln ti 0,1% th b xem l say sa vi phm lut ri. Sau khi ung, 80% ru c rut hp th, chuyn ngay sang mu; 20% cn li c hp th d dy.

160

Ru v ngi cao tui

ngi cao tui, nc trong t bo gim v bp tht nh i, m gia tng; khi ung vo, ru s c phn phi trong mu nhiu hn t bo do nng ru trong mu ngi gi cao hn ngi tr ti 30%. n no, n nhiu cht bo lm chm s hp th ny. Hu ht ru ung vo c gan chuyn ha thnh dioxid carbon v nc; ch c 5% c thi ra ngoi theo ng tiu tin, qua m hi hay qua hi th.

T l v nguy c nghin ru
Bnh nghin ru rt thng thy ngi cao tui nhng t c pht hin, cng b. Trung bnh c t 10% ti 14% ngi cao tui ung ru nhiu; nam gii ung sm hn v nhiu hn n gii gp 5 ln. Khong hai phn ba s ngi nghin ru bt u ung ru t khi cn tr v di truyn, sinh ra trong mt gia nh c cha m nghin ru, kinh t gia nh c thu nhp thp, gia nh xo trn hoc bn thn h hng v chy theo bn b xu... Ngc li, khong mt phn ba nhng ngi nghin ru tr khi n tui gi li thng c thu nhp cao, kin thc rng, c thn, sng xa cch vi x hi, nhng h li c s h tr, gip ca gia nh, x hi, sn sng th nhn c vn , d dng tip nhn iu tr, do mau bnh phc hn. Mt s nguy c c th a n nghin ru khong cui ca cuc i l:

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Dinh dng v iu tr
- Nhng kh khn cng thng trong cuc sng gia nh. - Bnh hon, phi sng ph thuc vo ngi khc. - Bun ru, c n, l loi khi mt ngi bn i thn thng, khi bn b tm giao ln lt ra i. - C qu nhiu thi gian nhn tn, bun t, bt n v ti chnh. - Sau khi hu tr khng c s chun b chng trnh hot ng hay sinh hot b ch no, li xem nh c thi gian rnh ri c t do vui nhu vi nhng bn b ng cnh.

Du hiu pht hin ngi nghin ru

C mt s du hiu khin ta nghi ng mt ngi ung ru qu : - Sao lng sn sc c nhn, nh ca khng ngn np, sch s nh trc; - Qun b hn ngy khm bnh, b sinh hot thng nht, khng lin h vi thn nhn, bn b; - Gim kh nng nhn thc, bi ri mt nh hng vi nhng cng vic rt thng thng nh ngy gi, s vt chung quanh; - Hay b t ng, gp tai nn thng tch; - Km n, thiu dinh dng, mt ng, d mc cc bnh d dy, phi, gan, thiu mu; d nhim c. - Trn c th thy c nhng vt da bm, vt so v thng tch ca t ng hoc p ph trong khi say; da mt, da

162

Ru v ngi cao tui

bn tay ng; tay run, ngn tay ngn chn au nhc, cm xc s m gim. - Tnh tnh thay i, hay cu gt, nht l khi c ai cp ti vn ung ru ca mnh; - Km tp trung, mau qun nhng lun lun ngh ti ru.

Tc dng ca ru trn sc khe

Ru c tc hi trn ton b c th ngi gi nht l khi h c sn mt vi bnh mn tnh, ang dng nhiu dc phm v gim sc chu ng vi cn trong ru. Mt s tc hi ca ru c th k ra nh sau: - Xut huyt d dy, rut l nguyn nhn thng phi a n phng cp cu. - Vim x cng gan, vi qu mt na s nn nhn phi t vong trong vng mt nm; - Ru cng l mt dng carbohydrat, tch t trong gan nn lm bnh tiu ng nng thm; - Ru a n km dinh dng, thiu vitamin, c bit l vitamin nhm B, v ngi nghin ung ru nhiu hn n. - Mt thng bng c th, hay t ng gy thng tch, gy xng hng, d b bnh long xng. - Tnh min dch suy gim nn d nhim bnh. - Gy ra mt s bnh ung th nh ung th ming, cung hng, thanh qun, gan, d dy, rut.

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Dinh dng v iu tr
Nhng h trng hn c l nh hng ca ru ln h tim mch, thn kinh, tm thn: - Huyt p v bnh tim tng a n nhiu nguy c tai bin mch mu no; - Chc nng no b suy km, ri lon nh hng, khng phn bit s vic, sa st tr tu, m sng, hay bun ng; - T yu ngoi bin, mt thng bng a n t ng; - Thay i tm thn, b trm cm, i khi c ngh quyn sinh. C ti 13% ngi trn 65 tui b trm cm thng ung ru, v khi ung ru nhiu th bnh trm cm cng nng thm. So vi nhng ngi cng tui khng ung ru, ngi cao tui nghin ru thng c t l mc bnh v t vong cao hn, v ru thng l nguyn nhn a h vo cc bnh vin tm thn, nh dng lo, bnh vin a khoa. Ngoi ra, vn tng tc gia ru vi cc dc phm cha bnh khc m ngi cao tui ang dng cng cn c lu . C ti 75% qu v cao nin thng ung nhiu loi dc phm cng mt lc v mt s dc phm ny khi gp ru s gia tng tc dng ph hay c tnh, c bit l cc thuc v thn kinh v thuc c chuyn ha ti gan. Dc phm c tng tc mnh vi ru l: Aspirin, Tylenol, thuc tr bnh m trong mu, tiu ng, thuc chng vim khng c steroid, thuc an thn nhm benzodiazepine (Valium, Librium...), mt vi loi khng sinh, thuc nitroglycerine cha cn au tht tim.

164

Ru v ngi cao tui

nh bnh
Vic nh bnh thng gp nhiu kh khn v ngi nghin ru, nht l tui cao, thng khng bao gi nhn l mnh nghin ru. Thn nhn th ngi khng mun cp n, bc s th i khi xem nh v ngi cao tui vn c nhiu vn nghim trng khc v sc khe. Mt khc, vi ngi cao tui d c t nhn, s lng ru ung c h ni ra thng cng khng chnh xc v khng nh r hay tnh nhm sai. Hn na, nhiu triu chng ca ngi gi nghin ru nh au nhc xng tht, mt ng, bun ru, km tp trung, gim suy t... c th b coi l du hiu ca cc bnh khc thng thy ngi khng ung ru. So vi nhng ngi nghin ru tr, ngi nghin cao tui t gy ra tai nn xe c, t lm xo trn trt t cng cng, t hnh vi phm lut nn h t c pht gic v gii thiu i iu tr. V vy, pht hin nghin ru ngi cao tui cn c s lu tm tht t nh. Hng nm, nhng ngi trn 65 tui u nn c nh nhng hi thm v thi quen ung ru nh: s lng ru v s ln ung, loi ru thng ung, cm ngh, thi v ung ru, nh hng ca ru vi np sng ca h. Ngi gi sng qua thi k m s ung ru c coi nh mt vi phm lut l tn gio, o c, nn rt nhy cm, ng lng khi b coi l nghin ru. Bn cu hi trc nghim sau y thng c dng:

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Dinh dng v iu tr
- C bao gi c cm thy l cn phi ct gim s lng ru ang ung khng? - Khi b ngi khc ch chch thi quen ung ru, c c thy kh chu khng? - C bao gi c cm thy khng vui hoc c cm gic ti li v s ung ru ca c? - C bao gi, vo bui sng, c thy cn phi lm mt ly ly tinh thn hoc lm mt i nhng hu qu kh chu sau khi ung qu nhiu ru? Nu cc c tr li c cho hai cu hi trn th cc c c vn vi ru ri; nu ch tr li c cho mt cu hi th cn iu tra thm. Vin i hc Michigan cng a ra mt bn trc nghim vi 22 cu hi tp trung vo thi quen ung ru, loi ru, nh hng ca ru trn c th, cm ngh v s ung ru... Bn trc nghim ny cng rt hu ch trong vic pht hin ngi nghin ru.

iu tr - Cai ru
Cng nh bnh nghin ru cc tui khc, vic iu tr hu hiu ngi bnh phi c thc cao v vn nn ca mnh, v nh hng xu ca ru trn c th, trong np sng hng ngy cng nh nguy c c th tr thnh bnh hon, tn ph vo cui cuc i, nu khng ni l cn b rt ngn tui th.

166

Ru v ngi cao tui

Ngoi ra, s tn tm ca bc s iu tr trong vic phi hp cc chng trnh, phng thc tr liu, s ht lng thng cm, h tr ca thn nhn u l nhng yu t cn thit cho vic phc hi ngi bnh. Cn ph v s ph nhn tt bnh ca ngi gi, gii thch cc hu qu xu ca ru, nu ra nhng kh khn v c nhn, v gia nh, x hi do ru gy ra m h ang gnh chu. Bnh nhn s qua thi k nh ru rt kh chu trong my ngy u cai ru. H tr nn mt t ch, run ry t chi, mt ng, i ma, c nhng o tng, o gic, bn chn lo s, i khi ln cn kinh phong. Cc trng hp ny cn c theo di iu tr khn cp ti cc trung tm y khoa chuyn bit. Khi n nh qua cn nghin, bnh nhn s tham d cc nhm tho lun, c vn, h tr, sinh hot chia s tm t, hc cch thc i ph vi s thi thc i hi ung ru. Ti Hoa K c rt nhiu t chc cc a phng tham d tch cc vo nhng chng trnh gip ngi nghin ru phc hi np sng bnh thng. Mt s trong c tm hot ng m rng khp th gii nh Alcoholics Anonymous (A.A.), Al-

Anon Family Groups (Al-Anon, Alateen):

- T chc Alcoholics Anonymous (A.A.) c thnh lp t nm 1935, quy t nhng ngi nghin ru v ang cai nghin, v mun hon ton quay li vi np sng bnh thng. H ngi li vi nhau lng nghe v

167

Dinh dng v iu tr
chia s nhng kinh nghim v i sng, thy rng h khng c n. Hi vin khng phi ng l ph, ch cn c nguyn mun cai ru l . - c thnh lp nm 1950, Al-Anon Family Groups l hi ca nhng ngi khng nghin ru nhng c thn nhn nghin ru. H chia s nhng kinh nghim, kh khn do ngi khc gy ra v h tr ln nhau, to iu kin gip thn nhn ca h cai nghin. T chc ny hot ng chia thnh hai nhm l Alateen dnh cho nhng ngi di 21 tui v Al-Anon dnh cho nhng ngi t 21 tui tr ln.

Thuc Disulfam
y l loi thuc vin khng phi gip cai nghin ru, m ngn nga ung ru. Tc dng ca thuc l lm ri lon s chuyn ha ca ru trong gan. Nu c ru trong c th, thuc s gy ra mt phn ng mnh, kh chu nh i ma, nhc u, au bng, mt nng bng... khin ngi dng thuc s khng dm ung ru na. Trong khi ung thuc ny m dng nc hoa, kem bi da, thuc sc ming c cht cn cng b phn ng nh trn.

Kt lun
Nhng ng my ru nghin ru thng t bin h bng cu: Nam v tu nh k v phong. (Lm trai khng ung ru nh l c khng c gi.)

168

Ru v ngi cao tui

Nhng gi mnh th c cng rch nt, m nhng ngi cao tui ung ru nhiu th c th cng chng tiu hao. Nu ch dng iu mi ngy nhm nhi mt ly nh, chc cng khng sao, i khi li tt cho tim. Nhng nghin ru th li khc. ngi cao tui, nghin ru l mt vn c tht nhng thng hay b che giu, a ti nhiu hu qu xu cho sc khe trong khong cui ca cuc i. Bnh c th phc hi c nu ngi ung chu chp nhn vn , t bit rng mnh khng kim ch c s thm mun ung ru, sn sng tham gia vo cc chng trnh tr liu v sn sng n nhn s h tr t mi pha.

169

DINH DNG VI S LO HA
heo S. Day Olshansky, Trung tm Lo khoa ca i hc Chicago th mi s vt u tan r dn theo thi gian, cho nn lo ha l din bin khng th o ngc c. y l s tch ly ca qu trnh thoi ha din ra ngay trong cu trc cn bn ca cc phn t to thnh c th. Thoi ha l sn phm ca s tng trng, xy ra ngi gi cng nh ngi tr. Nhng ngi tr c th d dng ti to cng nh gii hn s thoi ha mc ti thiu, cn ngi gi th s thoi ha i n gn gii hn cui cng ca n, nn vn tr nn nghim trng hn nhiu. Tui gi thng a ti s suy yu ca c th. M con ngi th khng nhng khng mun gi m cng khng mun yu. Nn t xa xa c rt nhiu c gng tm ti, nghin cu khoa hc nhm chinh phc hoc tr hon s lo ha. M mun chinh phc, tr hon mt tr ngi, bnh tt no th iu tt yu l phi bit r cn bnh ra sao, din tin nh th no, nguyn nhn nm u. V s lo ha th cng c nhiu l thuyt a ra gii thch l do, nhng dng nh cha thuyt no c a s cc nh nghin cu ng . Cho nn, s chinh phc tui gi cng ch l nhng d dm, c mong c kt qu.

170

S lo ha
C ngi i tm p s trong cc phng thuc thin nhin hoc tng hp ha cht. C ngi s dng cht dinh dng nh phng thc ci lo hon ng. Nhiu ngi m mng ho huyn i tm thuc trng sinh bt t trn ni non him tr hoc ngoi hi o xa xi. Cng c nhiu tay lang bm ba t ra thuc chng gi lm tin thin h. Nhng ngi c tin, b lng gt ri tht vng khng phi l t. Theo Leonard Hayflick, mt nh nghin cu v Lo khoa c uy tn th cha c mt phng thc no c chng minh l c th lm ngng hoc o ngc c tin trnh lo ha.

Deepak Chopra, ngi vit nhiu nhiu quyn sch v s o ngc tin trnh lo ha cng xc nhn: Cc phng thc chng gi hp l nht cng ch lm ta khe mnh hn, gim thiu nguy c cht yu ch khng lm ta tr li.
Nhng cng c nhiu nh nghin cu lc quan hn. Khi gii thiu mt ha cht ko di tui th, Richard J. Marsh, mt bc s y khoa c gn 30 kinh nghim nghin cu v Lo khoa, hn hoan bo tin: Khoa hc chng minh c rng gi y chng ta c th lm cho con ngi tr li t 10 ti 20 tui trong vng 6 thng. ng ta ang ni n mt loi hormon tng trng c gi l HGH (Human Growth Hormon e). Hormon ny c bc s Daniel Rudman khm ph ra cng dng hi xun v cng b trn tp ch y hc uy tn New England Journal of Medecine vo ngy 5 thng 7 nm 1990.

171

Dinh dng v iu tr
Bc s Ronald Klatz, ngi ng u Academy of AntiAging Medicine cng tuyn b rt lc quan rng mt x hi khng tui tc thc s bt u vi HGH. Mt s nh khoa hc gia tin rng trong mt tng lai khng xa, tui th trung bnh ca con ngi s tng ti 100 tui hoc nhiu hn na. Nhng trong thc t i sng hin nay, a s trong chng ta c th chng li tin trnh lo ha n mc no v bng cch no? Di y xin trnh by mt s vn xem nh p n cho cu hi .

H nhit c th

Quan st cho thy con thn ln vng New England lnh lo sng lu hn ng loi Florida vi kh hu n ha, v mt vi loi c sng trong h nc lnh c tui th cao hn sng trong vng nc m. T cc nhn xt ny, nhiu nh khoa hc gia th nghim ko di tui th ca sc vt bng cch h nhit c th xung t 3 n 5 . Kt qu ban u kh ha hn, v h ang tip tc nghin cu ng vt c xng sng. Nhiu ng vt hoang d i vo gic ng sut ma ng (hibernation) v khi thc dy chng rt khe mnh.

Ngn chn phn ng gc t do

Mi t bo u cn n oxygen chuyn ha cht dinh dng thnh nng lng. l phn ng oxy ha. Phn ng ny to ra cc phn t c s l in t gi l gc t do. Gc t do c cng dng cho c th, ng thi cng gy ra tn thng cho mng t bo, cht m v nhn DNA. Cc gc ny

172

S lo ha
c nh ha hc Denham Harman coi nh l nguyn nhn ca s lo ha v mt s bnh thoi ha nh ung th, va x ng mch, c thy tinh th. Nhiu nh nghin cu gia khc cng tn thnh kin ny. hy hoi gc t do nhm mc ch ko di tui th, c nhiu nh khoa hc ngh dng cc cht chng oxy ha nh vitamin E, vitamin C, beta caroten hoc mt s enzym nh superoxide dismutase (SOD), catalase, glutathione, peroxidase.

S dng dc phm
Cc thuc sulfhydryl (SH), Thiazolidine, Merceptoethylamine (MEA), Calci Pantothenate, Procain, Pyridoxine, Deprenyl, Melantonin, Chromium Picolinate, Coenzym Q10 qua th nghim loi chut cho thy c kh nng ko di tui th ca chut.

Thiazolidine c dng Ty Ban Nha v Rumani tr liu chng lo suy. Procain l hot cht chnh ca cc thuc Gerovital, H3 hoc GH3, KH3, c bn chu u, nht l ti c t nm 1957. Elderpryl l thuc tr bnh Parkinson v gim tr nh ngi gi. Kt qu nghin cu Nht v Canada cho thy thuc ny c kh nng ko di i sng.
Hin nay c nhiu ngi dng Coenzym Q10 v thuc tng tnh min dch, gip c th chng tr c nhiu cng thng do vi khun, virus ti phc hi bnh tim mch v ko di tui th.

173

Dinh dng v iu tr
Nhng nhiu thy thuc chn chnh vn cn nghi ng kh nng ko di tui th ca cc thuc ny v ngn ngi cha mun s dng k n cho ngi gi mun sng lu. H ch kt qu nghin cu ca khoa hc chnh xc hn l tin n.

S dng hormon
Vi tui gi, mt s hormon trong c th gim xung, con ngi cng yu i. Chng hn nh testosteron, hormon tng trng HCG, hormon tuyn thng thn DHEA. Da vo iu , nhiu ngi tin rng vic b sung cc hormon ni trn c th gip con ngi tr li, sng lu hn. Nhng vic b sung cc hormon cng gy ra tc dng khng tt cho c th, nn khi dng cng cn d dt, cn tham kho kin bc s iu tr. Ngoi ra mi ln tim HCG cng tn kh nhiu tin v khng phi ch tim mt ln.

Gim nng lng tiu th

Nghin cu tit gim nng lng loi kh do Vin Lo khoa Hoa K thc hin cho thy: nhm kh gim tiu th 30% tng s nng lng u nh hn, nh con hn nhm kh n ung bnh thng, nhng chng dng nh t b cc bnh v tim cng nh ung th. Nghin cu ang c tip tc kim chng xem s tit gim nng lng c lm con ngi khe mnh hn v sng lu hn hay khng.

174

S lo ha
Nhng theo mt s ngi th d s tit gim c mang li kt qu tt con ngi th cha chc c nhiu ngi chu ng c s gim dinh dng ti 30%, v tt yu phi lm thay i thi quen n ung bnh thng ca h. Nh vy th phng php ny chc cng khng c nhiu s ng h lm, v bn tnh con ngi l hay n v n th tht nhiu mi b cng.

Thay i cu trc gen di truyn

Quan st cho thy thnh vin trong mt s gia nh c n hu sng rt lu. Thc vy, theo kt qu cc nghin cu ca New England Centenatian Study Boston th nu mt ngi trong cp song sinh sng ti tui 100 th ngi kia c nhiu trin vng sng gn ti tui . Hin nay ang c nhiu nghin cu theo hng ny, xc nh xem DNA c nh hng g ti vic ko di tui th hay khng.

Gii phu thm m

Cc phng thc thm m hin thi c kh nng lm tr li th dng con ngi. Vi tia laser, cc khun mt nhn nheo v tui i c xa b, vi gii phu thm m, chnh hnh, v b ngoi ca con ngi sun s hn v nom tr trung hn. Thi th cng tm chp nhn c. Trong khi cha c nhng phng thuc ci lo hon ng, nhng ai mun c v ngoi tr li nh tui mi tm, i mi cng c th tm n vi khoa thm m.

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Dinh dng v iu tr

i sng tinh thn

Benjamin Franklin ni: Keep up your spirits, that will keep up your body. (Hy gi vng tinh thn, iu s gip duy tr c th khe mnh.)
Trong Cung on Ngm Khc c cu rng: Git nhau chng ci dao cu, Git nhau bng ci u su, c cha. Khoa hc cho thy, khi ta tc gin th lng adrenalin trong mu ln cao, huyt p tng. Lin tc nh vy th tri tim s mau suy yu, sc khe st gim, tui th do ngn li. Cho nn gi vng tinh thn l iu cn lm. Mt thi sng tch cc, lc quan cng vi khng bnh tt c tc dng tt trn cc chc nng tm thn v th xc. V lc quan, trng th; bi quan, mnh yu l vy. Mt v hong hi lo s Chi Po v b quyt sng lu, Chi Po p: Con ng i n bch nin trng th l phi hp np sng tinh thn v th xc.

c tin
Nim tin tn gio cng c nh hng ti s sng lu. Kt qu cc nghin cu ca Jeffrey S. Levin v Harold Y. Vanderpool cho thy c nhng nh hng tt ca c tin v s tham gia cc nghi l tn gio i vi nhiu bnh tt nh bnh tim, huyt p cao, tai bin mch mu no, ung th... v tnh trng sc khe ton din. Nghin cu ca cc tc gi D. A. Mathews, D. B. Larson v C. P. Barry cho hay yu t tinh thn v tn gio lm tng

176

S lo ha
s lnh mnh ca tm hn v th cht, v t tham gia cc nghi thc tn gio c th coi nh l ri ro a ti bnh hon, t vong.

Vn ng c th
Nhiu nh nghin cu cng nh cc chuyn gia lo khoa u ng vi nhau v ch li ca s vn ng c th trong vic lm chm tin trnh lo ha. Theo nhng ngi ny, s vn ng c th hiu qu hn cc loi thuc chng lo ha hin c. Mt ngi khe mnh, n ung y , vn ng c th u n c th tr hn tui thc c mi, mi lm tui. Vn ng u n s gip lm tr hon s suy yu ca tin trnh lo ha, bi v: - Sc mnh ca xng v khi c tht tng ln. - Sinh lc di do. - Tng kh nng chu ng cng thng th xc, tinh thn. - Tng h hp dng kh v lng mu lu thng. - Gim huyt p cao, tiu ng. - Tinh thn sng khoi Ch cn vn ng va sc nhng u n. Nn hi bc s xem kh nng mnh nn tp nh th no. Mn vn ng no cng tt c. C th con ngi l mt cu to vn ng tuyt ho, v mun duy tr tt kh nng vn ng chnh l phi thng xuyn vn ng, ng c th nm im mt ch qu lu.

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Dinh dng v iu tr
Vi vn ng c th, ta c th ly li mt phn sinh lc mt cng nh loi b kh nng th xc tiu hao do s t vn ng ch khng phi do s lo ha. Nhiu s kin thng b gn cho s lo ha, nhng thc ra li l do thiu vn ng. Th d mt cnh tay gy b bt mt thi gian, bn tay teo nh, yu, nom nh gi i, nhng thc ra khng phi do lo ha m l do khng vn ng. S khng vn ng lm c tht v da mm x, xng yu, h thng min dch suy yu... tt c u gp phn y nhanh tin trnh lo ha.

Dinh dng vi s lo ha
Dinh dng ng hoc sai c nh hng rt ln ti ton b c th con ngi, t tinh thn ti th cht, t chc nng cc c quan ni ti cng nh ngoi vi. Hy so snh mt ngi thiu dinh dng vi mt ngi n ung y . Mt bn th hng ho, y sinh lc, yu i. Bn kia th m yu, gy cm, chm chp. Thiu dinh dng kinh nin th lm sao c nng lng sng lu, chng khc chi ngn n cn du, tt li dn dn. Cho nn bit n m sng lu l c mt ngh thut. Cc c ta vn ni Bnh tng khu nhp. Bnh gy ra do nhng thc phm m ta a vo ming, nhng thc phm qu nhiu hoc qu t t s lng ti phm cht. Vy th n nh th no va khe mnh, va sng lu? Khi n, khng phi ch no bng cho hm nay, tun ny m cn nh l n cho mai sau, cho sc khe ca nhng nm sp ti.

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S lo ha
T khi nm trong lng m, s dinh dng y c tc dng tt cho khi sinh ra v ln ln. Thi quen n ung tt t tui nh, mn n m ta tiu th by gi c nhiu nh hng ti s ta s sng bao lu v nhng nm sng s mnh yu ra sao. Nhiu ngi thc mc rng c mt ch n ung mu mc, chung cho mi ngi hay khng: mt ch mang li sc khe ton din, sc chu ng vi bnh hon v tr hon tui gi. Cu tr li s l khng c. Nhng c mt s nguyn tc, mt s hng dn m ta c th p dng t c iu c mun. 1. Va phi n va phi, ng vi nhu cu, ng nhiu qu, t qu. Cc c ta vn khuyn l nn n ba phn i, by phn no l tt hn c, khi nng bng, ln cn. Nhu cu thc phm cng thay i ty tng ngi, ty cu trc c th to nh, khi lm vic, khi ngh ngi. Con ngi thng c khuynh hng n qu nhiu, n bt c lc no, coi d dy nh mt thng cha. Th l bo ph, tiu ng, suy tim mch, gim tui th tri cho. Ln cn va phi vo tui 60 c th chp nhn c v l din tin bnh thng, nhng mp mp qu khng bao gi l du hiu tt ca sc khe. 2. Cn bng Thc phm cn c s cn i gia cc cht dinh dng cn bn. Khng nht thit l phi cn i mi ba n, m

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Dinh dng v iu tr
c th trong ngy, trong tun. Cc chuyn gia dinh dng vn khuyn nn theo t l 30% bo, 15-20% m, 45-50% carbohydrat. 3. a dng ng s thch chi phi hon ton vic chn la mn n, m cn phi lu n vic n nhiu mn khc nhau. Mi mt thc phm c cht dinh dng vi cng dng ring m nhng mn khc khng c v khng thay th c. B qun mt cht dinh dng no qu lu s a ti thiu dinh dng. Sau y l mt s hng dn v vic s dng cc cht dinh dng:

a. Cht m

m gm c nhiu acid amin, trong c mt s c th khng t tng hp c v phi do thc phm cung cp. m ng vt c hu ht cc acid amin, m thc vt c th thiu mt vi loi, nhng khi n nhiu rau tri khc nhau ta s c b sung y . Khi s dng m ng vt, chng ta cng cn lu : - Tht b, ln, cu thng km theo nhiu cht bo. - Tht g, g ty t bo hn nu b da; n c tt hn na, tm hi nhiu cholesterol; - Sa, trng, pho mt loi t bo th tt hn; - Sa chua gim cholesterol. - Hn ch cc mn chin rn. Hp, nng b l tt hn.

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S lo ha b. Cht bo
C th rt cn cht bo, nhng nhiu qu th li c nguy c gy bnh. V th, cn hn ch mc va phi khi n cht bo, nht l cc cht bo bo ha. Cht bo to ra nhiu phn ng oxy ha t bo, sn xut nhiu gc t do. Cc gc t do ny a ti nhiu h hao cho t bo v c coi nh l mt trong nhng nguyn nhn gy ra bnh tim mch, tiu ng, mt vi bnh ung th cng nh s lo ha.

l ngun cung cp nng lng chnh cho no b. Trong c th, cht dinh dng ny c chuyn ha thnh ng glucose. Theo tp qun lu i ca nhiu dn tc ng th carbohydrat trong cm go l ngun lng thc chnh.

c. Carbohydrat Carbohydrat gm hai nhm chnh l tinh bt v ng, c nhiu trong bnh m, cm, rau v tri cy. Carbohydrat

d. Cht x

C nhiu trong rau, tri cy. Khi thiu cht x, ta thng hay b to bn, bnh ti mt, tng nguy c ung th i trng.

Cht x gip gim cholesterol trong mu, lm i tin d dng hn. Nhng dng qu nhiu c th gy y bng, gim hp th cc khong cht nh st, km, calci.

. ng

Do s hp dn ca v ngt nn c rt nhiu ngi n ng qu s lng m c th cn.

ng trng khng cung cp cc acid amin v vitamin cho qu trnh dinh dng m ch cho nng lng. Khi c cung

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Dinh dng v iu tr
cp qu nhiu, nng lng tha s chuyn thnh ra m bo, dn n bo ph. Tiu th nhiu ng cng d gy su rng, lm tng nguy c mc bnh tiu ng khi tui ln cao, lm tng cholesterol v bnh tim mch.

e. Mui n
Mui n (NaCl) l thnh phn quen thuc v khng th thiu trong hu ht cc ba n. Nhng n nhiu mui qu c th b huyt p cao. Thng th chng ta n nhiu hn nhu cu cn thit ca c th ch tha mn khu v, v nh vy l buc thn phi hot ng nhiu hn bi tit lng mui tha. Khi iu ny thng xuyn xy ra, thn s suy yu, h hao.

g. Vitamin v khong cht Vitamin v khong cht rt cn thit cho c th, nhng

iu khng c ngha l vic ung b sung cc cht ny bao gi cng tt cho sc khe. Trong thc t, mt ngi khe mnh vi ch dinh dng cn i, a dng th khng cn ung thm vitamin v khong cht. Ngi n chay thun ty rau tri c th cn dng thm vitamin B12, ph n c thai cn thm folacin, st. Mt s vitamin nh cc vitamin C, E, beta caroten hin nay rt ph bin. Nhiu ngi dng v tc dng chng oxy ha ca chng, nhng nn trnh dng liu qu cao.

h. Nc
Nc rt cn cho hu ht cc chc nng ca c th. Nc iu ha thn nhit, chuyn ch cht dinh dng v dng

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S lo ha
kh ti t bo, thu thp cc cht ph thi bi tit ra ngoi. Nc cng l cht m cho cc khp xng v bo v cc b phn. Nhu cu nc ca c th c tha mn khi ta ung khong 6 - 8 ly nc (1,5 - 2 lt). Khi ung t hn mc ny, c th vn hot ng nhng nhiu bin php tit kim nc s c c th p dng dn n gim kh nng hot ng v pht trin bnh thng. C nhiu loi nc ung cung cp nc hng ngy cho c th. Sa l ngun cung cp nhiu nc m li km theo nhiu calci, m, vitamin... Nn dng sa loi b bt cht bo. Cc loi nc ngt c nhiu ng v cht ga nn cn gii hn. Nc p tri cy, nc khong thin nhin... u l cc thc ung tt. Ngoi cc loi nc k trn, nn dng thm nc lc cho mc nhu cu. 4. Thc phm c tc dng chng lo ha Sau y l tm tt mt s thc phm m kinh nghim cho l c th lm chm tin trnh lo ha. Mt s thc phm ny ch yu c cha nhng cht chng oxy ha (antioxidant). y l cht c kh nng ngn chn cc gc t do (free radical), ngun gc ca tin trnh oxy ha cc t bo v l mt trong nhiu nguy c a n lo suy. 1. Thc phm c nhiu beta caroten (tin t vitamin A) u t gc thc vt nh: da hng, t , khoai lang, u , t cay, c rt, xoi, b ng, ci xanh lc... Da hu, tri b, qut, bp su, du, cam o, c chua... cha mt lng beta caroten t hn nhng cng l ngun cung cp khng km quan trng.

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Dinh dng v iu tr
2. Thc phm c vitamin B5 (pantothenic acid) c kh nng va chng gc t do va lm gim cholesterol, chng nhim, bo v gan. Vitamin B5 c nhiu trong men, go lc, ht b ng, ht m... 3. Vitamin C c nhiu trong tri cam, chanh, du, ci l xanh, c chua, sp l xanh, khoai ty, khoai lang... 4. Vitamin E c trong mm la mch, u nnh, bp su, sp l xanh, ci l xanh... 5. Thc phm cha nhiu calci gm c sa t bo, u phng, sa chua khng bo, qu c ch (walnut), ph mt, ht hng dng, u nnh, cc loi u kh, c ng hp (n c xng), ci l xanh, c hi (salmon), sp l xanh... 6. Khong cht iod c trong to b (kelp), hnh, cc loi hi sn, a s ci l xanh... 7. Khong cht st c nhiu trong s hn, qu hch, o sy kh, cc loi u, tht nc, mng ty (asparagus), mt ma, trng, bt yn mch (oatmeal)... 8. Mm la mch (wheat germ), cm, c tuna, hnh, c chua, sp l xanh cha khong cht selen. 9. Thc phm giu cht m gm c: c, tm cua, sa t bo, sa chua khng bo, tht g, tht cu, tht b lc b bt m, ht hng dng, ht b ng, u phng rang, b u phng... 10. Tri cy chng lo suy gm c: qu kiwi, nho en Hy Lp, hng qua, u , cc loi qu thuc ging cam qut, du, i, o lng (peach), qu xun o (nectarine), da hu... Nhng loi qu ny c cha lng vitamin C rt

184

S lo ha
ln. Ngoi ra cn phi k n nhng loi qu c cha bioflavonoid, mt cht chng oxy ha mnh, nh: qu m (apricot), nho, du en, qu anh o (cherry), qut, bi, cam...

Kt lun
tr hon s lo ha, con ngi th qua nhiu cch khc nhau. C nhng phng thc phi tn nhiu tin, c nhng loi thuc c th mang ti kt qu, cng c nhng nghin cu vi nhiu ha hn. Nhng phng thc m mi ngi u c th p dng c, c kt qu chc chn m li t tn km chnh l p dng mt ch dinh dng ng n, hp l, cn i, a dng v kt hp vi s vn ng, rn luyn th lc.

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DINH DNG VI PH N C THAI

hi mt ngi ph n mang thai, nhng ngi thn u cu chc cho c m trn, con vung, ng l s sinh n s c thun li, d dng v c m ln con u bnh an, khe mnh. Nhng t c nh vy, khng ch da vo nhng li cu chc, m cn phi cn n rt nhiu yu t khch quan, trong ch dinh dng dnh cho ngi ph n c thai ng mt vai tr rt quan trng. Trc khi mang thai, trong thi k mang thai cng nh khi cho con b m ngi m c mt ch dinh dng y th c m ln con u trnh c mt s bnh tt, ri ro. a con s trn trnh, cn lng, c th vn ton, tr c pht trin tt. Cng c trng hp m thiu dinh dng m con vn khe, nhng thc ra l ngi m phi tr gi t, v khi thai nhi pht trin rt ly nhiu cht dinh dng t c th ngi m. Hn na, s khe mnh ca a b trong trng hp ny chc chn cha phi l ti u, v b cn c kh nng pht trin tt hn na nu nh ngi m c c mt ch dinh dng y . V ch khi mi c th thc s c xem l m trn, con vung, tt p cho c m ln con. T thu xa xa, cc danh y nh Hippocrates (460-377 trc Cng nguyn), Galen (129-199) nhn thy rng mt

186

Dinh dng vi ph n c thai

ch dinh dng tt dnh cho ngi m s c th gip trnh c nguy c sy thai, sinh con nh cn. Ngy nay mi ngi u ng rng n ung y rt cn cho ngi m, khng nhng trong thi k mang thai m c sau khi sinh, khi nui con bng sa m. Trong 3 thng u tin ca thai k, ngi m cn nhiu m thai nhi hnh thnh cc b phn, c bit l no b. Trong 3 thng k tip, cn nhiu calci hn xng tng trng v to ra cc t bo mu. Ba thng cui cng l giai on m nhu cu cht dinh dng tng cao hn na, v y l lc thai ln gp i. Do , ngi m khng nhng khng nn ct gim n ung vo giai on ny m cn phi gia tng hn mc trc . Khi hai v chng c nh sinh con th ngi v phi ngh ngay n chuyn n ung cht dinh dng. V ngay t vi tun l u ca thai k, a s cc b phn ca thai nhi thnh hnh v cn nhiu dinh dng to lp. Nu km dinh dng, thai nhi s nh hn, c nhiu ri ro bnh tt, khuyt tt thnh, th gic, ch s thng minh (IQ) thp, chm pht trin tr no, thm ch c nguy c sy thai. C nhn ni ngi m n cho hai ngi, nhng thc ra cng chng cn phi n n gp i s lng, v y l cho mt ngi trng thnh v mt thai nhi b bng. Khi sinh m con cn nng c khong 3,5 k l tt ri.

Thay i c th khi c thai

C rt nhiu thay i v cu trc v chc nng trong c th ngi ph n mang thai. Sau y l mt s thay i quan trng:

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Dinh dng v iu tr
1. H tun hon - Lng mu lu thng tng ln 1/3. - Nhp tim tng nhanh, t 70 ln 85 nhp mt pht. - Khi lng mu trong c th t 4 lt tng ln 5,2 lt; - Khi huyt tng tng 40%. - Hng cu tng 18%. Cc gia tng ny u l p ng nhu cu dinh dng cho ngi m v thai nhi. 2. Tuyn ni tit C nhiu thay i quan trng a. Nang thng thn tng sn xut hormon aldosterone gi nc v mui trong c th nhiu hn cho nhu cu ca thai nghn. b. Estrogen v progesteron t non so gia tng bo v thai nhi, trnh sy thai trong hai thng u. c. Lng ng cao hn trong mu ngi m nui thai nhi, insulin t ty tng gia tng kim st n nh mc ng. d. Tuyn gip hi ln ln tng hp th khong iod. . Progesteron, estrogen, human chorionic gonadotropin t nhau c sn xut duy tr thai trong 8 tun l u. e. Sau khi sinh con, tuyn yn tng sn xut prolactin kch thch vic tit sa cho con b. 3. H tiu ha Thc phm lu li d dy v rut lu hn c tiu ha k v s hp th cht dinh dng cao hn cho nhu cu thai

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Dinh dng vi ph n c thai

nghn. Do thai nhi p vo trc trng, nhu ng rut chm nn ngi m hay b to bn. 4. C quan sinh dc Nh hoa ln ln, tuyn sa tit sa sn sng nui con. D con tng trng nng khong mt kilogram.

Nhu cu dinh dng

Mt ch dinh dng a dng, cn i v hi nhiu hn bnh thng l iu cn thit c sc khe lnh mnh cho c ngi m ln thai nhi. Bnh thng, ngi ph n cn khong 2.200 calori mi ngy, nhng khi c thai cn tng thm khong 300 calori, theo t l cung cp khong 40% - 50% t carbohydrat, 20% - 30% t cht m v 30% t cht bo. Phn dinh dng tng thm ny l p ng cho nhu cu tng trng ca thai nhi cng nh cc thay i c th ngi m. a. Cht m m l vt liu c bn to ra cc m bo ca thai nhi cng nh l ngun d tr m ngi m cn khi sinh con. Bnh thng, nhu cu m mi ngy l 47g. Khi c thai, cn tng thm khong 30g mi ngy, nht l trong ba thng cui ca thai k, v y l lc m thai nhi tng trng mnh. Ngoi ra m cng cn nhiu m v t cung, tuyn v v cc t bo khc u ln hn h tr thai nhi v cho con b sau ny. Nn cn i khong mt na nhu cu m t ng vt nh tht nc, trng, pho mt, tht g, c, sa... v nu ch dng

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Dinh dng v iu tr
ton m thc vt s c nguy c thiu mt vi loi acid amin cn thit. Mt cch c th, nu ngi m ung hai ly sa, n mt ming tht nc, ming c bng lng bn tay, km theo cc loi ht, rau l c th cho nhu cu trong ngy. b. Carbohydrat V cht m c dng cho s tng trng t bo, nn carbohydrat s l ngun nng lng chnh cho m v con. Carbohydrat nn c s dng a dng t go cn cm, bnh m, bt ng cc b sung cc loi vitamin, rau, tri cy, khoai... c. Cht bo Cht bo rt cn thit cho s pht trin ca no b thai nhi cng nh l ngun nng lng quan trng. d. Nc Nc cn gia tng khi lng mu; trnh kh da, to bn cng nh to ra nc i che ch phi thai. . Vitamin A

Vitamin A gip da lnh mnh, th gic tt v xng mau ln.

Nhu cu vitamin A khi mang thai khng cn gia tng, ch cn gi nh mc bnh thng l khong 750mcg mi ngy. Lng vitamin A ny c th d dng c c trong ph mt, sa, b, cc loi rau tri...

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Dinh dng vi ph n c thai

Trnh ung thm vitamin A qu nhiu v c nguy c ng c. Ngi m c th b nhc u, au c, bun nn... Thai nhi c th b khuyt tt tai, t chi, ri lon chc nng thn v h thn kinh. Cn lu l thuc tr mn trng c da Accutane c hot cht chnh l vitamin A, nn khng c dng khi mang thai. Trong giai on cho con b, ngi m cn tiu th thm khong 200mcg vitamin A mi ngy. e. Cc vitamin nhm B Mi ngy, ngi m cn khong 1.5mg vitamin B1 (thiamine), 1.6mg vitamin B2 (riboflavin), 17mg vitamin B3 (niacin). Cc vitamin ny u c nhiu trong cc loi thc phm nh tht, sa, pho mt, rau v cc loi ht... Khi thiu nhiu vitamin B1 th a con c th b bnh beriberi, thiu vitamin B2 th ngi m hay i ma, con sinh thiu thng. g. Vitamin E Nhu cu bnh thng l 8mg mi ngy. Khi mang thai, ngi m cn tng thm khong 2mg. S lng ny sn c trong cc loi thc phm nh du thc vt (du olive, du bp), cc loi ht... h. Vitamin B12 v folacin

Thiu c hai vitamin ny th khi lng mu ca m s gim vi hu qu km dinh dng, dng kh v a ti sy

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Dinh dng v iu tr
thai hoc sinh con nh k. Nu ch thiu folacin (acid folic) th thai nhi d b tt nt t sng (spina bifida), khuyt tt ng thn kinh (neural tube defect). Nhu cu folacin ca ngi m tng gp i bnh thng hoc hn na, vo khong 400mcg mi ngy. S lng ny c cung cp y trong rau l xanh, tri cy, gan... Nu nhiu folacin qu th s hp th km s gim. Nhu cu vitamin B12 bnh thng l 2mcg - 4mcg, khi c thai cn thm khong 0,2mcg mi ngy. Vitamin B12 c nhiu trong thc phm ng vt, nn vi nhng ngi n chay cn ung b sung. i. Vitamin C Nhu cu vitamin C bnh thng l 60mg mi ngy. Khi mang thai, ngi m cn tng thm khong 10mg. Ch cn ung mt ly nc cam l c th p ng nhu cu ny.

Vitamin C gip thai nhi pht trin tt xng v rng li, tng cng hp th khong calci v st.
k. St St l khong cht cn thit cho vic to hng cu. Nhu cu st ln cao nht vo 3 thng cui ca thai k, khi thai nhi cn st d tr cho khong 6 thng sau khi sinh, v trong sa m c rt t st. Thai nhi t khi b thiu st v c th ly ngi m, nhng cng v th m ngi m d b thiu st nu khng n y , v s dn n thiu mu. Nhu cu st bnh thng l 15mg, khi c thai ngi m cn tng thm 15mg mi ngy. Nu ung thm vin st th nn

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Dinh dng vi ph n c thai

ung vi nc chanh, v c acid ascorbic gip rut hp th st tt hn. St c nhiu trong tht , rau spinach, u ph, tri cy kh, cc loi ht... l. Km Nhu cu km mi ngy bnh thng l 15mg. Khi mang thai ngi m cn tng thm khong 3mg. Km rt cn cho s tng trng ca t bo. Thiu khong ny, a con sinh ra s nh k, thn kinh km pht trin. m. Calci v phosphor Nhu cu calci v phosphor c bit quan trng nht vo ba thng cui ca thai k, v thai nhi cn nhiu cc khong cht ny tng trng, to xng v rng. Trung bnh ch trong mt gi thai nhi cn n 13mg calci. Nhu cu bnh thng mi ngy l 1000mg calci v 800mg phosphor. Ngi m khi mang thai cn tng thm mi loi khong 400mg. Sa l ngun cung cp calci tt nht. Ngoi ra calci cn c trong sp l xanh, c ng hp (n c xng)... n. Iod Nhu cu iod bnh thng mi ngy l 150mcg. Ngi m khi mang thai cn tng thm khong 25mcg. Trong trng hp ch dinh dng khng cung cp nhu cu iod, thai nhi s rt ly iod t c th ngi m. Do , thiu iod s nh hng trc ht n ngi m, nu trm

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Dinh dng v iu tr
trng th ngi m c th b bu c (ln tuyn gip), hormon tuyn gip gim v n lt thai nhi b nh hng. a con sinh ra c th s b n n, thiu nng tuyn gip bm sinh, chm pht trin tr tu, da v nt mt th, xng thiu khong cht v c th ln thp. Nhng a tr ny s cn phi ung hormon tuyn gip sut i. Dng mui iod v hi sn u c th gip trnh c s thiu ht khong cht ny.

Cc bnh thng gp
1. Bnh tiu ng Khi mang thai, mt s hormon lin h ti thai nghn nh estrogen, human chorionic gonadotropin, lactogen ca nhau (placenta) c tit ra. Cc hormon ny lm gim tc dng ca insulin khin ty phi lm vic nhiu hn sn xut thm. Nu insulin sn xut khng th du hiu ca bnh tiu ng s xut hin. mt s ngi, hin tng ny mt i sau khi sinh, nhng hn 50% trng hp c nhiu nguy c mc bnh tiu ng trong tng lai. Mi ph n c thai u nn c kim tra k cc du hiu ca bnh ny, v nu khng pht hin hoc khng iu tr s c nhiu nguy c t vong cho c m ln con. Ngi m c th b nhim c, rt ngn thai k (sinh non), huyt p cao cng vi cc bin chng thng thng ca tiu ng nh bnh vng mc, thn, dy thn kinh. Thai nhi c th b khuyt tt thn kinh, bnh tim hoc km pht trin ct sng.

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Dinh dng vi ph n c thai

Tiu ng do thai nghn thng xy ra vo gia thi k c thai. Ngi m cn c th lng ng trong mu lc mi c thai v khong tun l th 26 ca thai k. Nu xc nh c bnh th ngi m phi n ung theo hng dn ca bc s v chuyn vin dinh dng cng nh iu tr ng mc, thng l vi insulin. 2. Huyt p cao Huyt p cao c th l ko di hay tm thi. Huyt p cao ko di gy t vong cho thai nhi hoc suy nhc chc nng ca nhau thai. Huyt p cao tm thi c th l du hiu ca nhim c huyt thai nghn (toxemia of pregnancy), c th gy tai bin mch mu no, ri lon ng mu ngi m; nhau thai gim chc nng, tch sm v thai nhi sinh non. Nguyn nhn ca toxemia trong giai on thai nghn vn cha c tm ra. Mt s kin cho l v m st cn khi thai nghn, km dinh dng, huyt p cao, khng c chm sc tin thai sn, khng tiu th y calci. Nhng trng hp ny thng thy nhng b m t tui hoc trn 35. iu tr huyt p cao khi c thai rt kh khn v phi ht sc thn trng, v dc phm c th gy nhiu ri ro cho thai nhi, nhng nu khng iu tr th li c nhiu bin chng. Do , vic p dng mt np sng hp l phng trnh cc nguy c a ti huyt p cao l iu rt cn thit. 3. nc trong c th Sng ph t chi, nht l bn chn v c chn, l chuyn thng gp ngi c thai. l do c th gi li nc vo

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Dinh dng v iu tr
thng cui ca thai k v khi lng mu ca ngi m gia tng. Hin tng ny l bnh thng v s mt dn i sau khi sanh khong mt tun. Nhng nu ng cht lng cc phn khc ca c th km theo huyt p ln cao, nc tiu c nhiu ure th li l iu cn quan tm. y c th l du hiu ca chng tin sn kinh (preeclampsia), i khi tip tc a ti sn kinh (eclampsia), mt tnh trng him gp nhng cc k nghim trng, c th e da tnh mnh ca c m ln con. Khi thy c cc du hiu ny, ngi bnh cn thng bo ngay cho bc s iu tr. 4. Thiu mu S lng hng cu v hemoglobin trong mu ca ngi c thai thng di mc trung bnh. Nguyn nhn thng thng l do thiu cht st trong thc phm hoc thiu cc yu t khc nh m, vitamin B6, B12, C, folacin, khong cht ng, hoc do mt mu m khng c thay th. Dinh dng vi y khong cht st trong thc phm (nht l tht, gan) l iu cn thit. i khi bc s cng cho ung thm t 30 - 60mg st mi ngy. 5. St cn hoc tng cn Khi ngi m st cn n hn 15% trng lng c th th d b bnh tim, phi, thiu hng cu, nhau thai s nh v nh, t phn t tip nhn dinh dng v thi cht b, do c tc dng xu cho thai nhi. Nhng tng cn qu mc cng khng tt, c th a ti huyt p cao, tiu ng, thai nhi qu ln. Thai nhi n thi

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Dinh dng vi ph n c thai

im ra i m nng trn 4,5kg cng c ri ro bnh tt, i khi thai qu ln ngi m phi sinh bng cch m d con. Tng cn qu mc thng l do tiu th nhiu cht bo, carbohydrat, nhiu nng lng m li t m, khong cht v vitamin. Khi ngi m c thai, tng cn va phi l chuyn bnh thng. Mc tng trung bnh cho n cui thai k khong t 9kg - 12,5kg l va phi, a b sinh ra c trng lng khong 3,5kg l tt. S tng cn cng cn din ra u n trong sut thai k. Ba thng u, mi thng tng khong t 0,7kg ti 1,4kg l va. Sau th trung bnh mi tun tng khong 0,3 kg cho n ngy sinh. Tng cn qu nhanh cng khng tt cho c m ln con. Ngi m s au lng, nhc bp tht, mau mt, nhiu khi sng ph chn tay v nc. 6. chua (heartburn) S ln ln ca thai nhi gy ra sc p vo d dy. Thc phm v dch d dy b dn ngc ln thc qun v gy ra triu chng chua. Hin tng ny thng xy ra vo thng cui ca thai k, nhiu nht l sau khi n hoc nm ngh. hn ch s kh chu ny, ta c th chia thc phm ra nhiu ba nh trong ngy, trnh n hai gi trc khi i ng, trnh dng thc phm cay, chua kch thch d dy. Cng c th k u ging ln cao hn khong 6 phn. Vi t th nm nh vy c th gip gim bt chua.

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Ch c dng thuc chng acid khi c hng dn ca thy thuc. 7. To bn Vo nhng thng cui ca thai k, nhiu b m than phin b to bn. Phn thng rn v vi ngy mi i tin mt ln. Nguyn nhn c th l do thai ln, to sc p vo h tiu ha hoc do gim sc cng ca bp tht vng bng nn s tiu ha thc phm chm li, phn nm i trng lu hn. gim bt to bn, khi mang thai nn ung nhiu nc, n nhiu rau tri c cht x, ng cc, go lc... v nng vn ng c th theo ch dn ca thy thuc. Ch dng thuc nhun trng khi c hng dn ca thy thuc trnh tc dng ph. Mt triu chng khc l ngi m mang thai n cui thai k thng hay tiu tin nhiu ln hn, v thai p vo bng quang, lm cng ln v gia tng nhu cu tiu tin. 8. Nn i Triu chng ny thng xy ra vo thng u ca thai k, khi hormon human chorionic gonadotropin ln cao gip non so th tinh lm t d con. n thng th t, hormon ny gim th nn i cng gim theo. Nn i c th xy ra bt c lc no trong ngy, nhng thng nht l vo sng sm, khi va thc dy. C ngi b nhiu, c ngi ch b nh trong t ngy.

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Dinh dng vi ph n c thai

Khng c thuc v cng khng nn dng thuc gii quyt hin tng t nhin ny. Tuy nhin, c th p dng mt s phng thc sau y gim bt: - Bui sng thc dy nn n mt ming bnh kh mn. - Chia thc phm trong ngy thnh nhiu ba n nh. - Trnh thc phm c nhiu cht bo. - Trnh nhng cht kch thch d dy nh cay, chua. - Trnh thc phm c mi d gy bun nn, nh c tanh. - Trnh ru, c ph, thuc l. - Khi thy mun nn i th th su mt hi tht di a nhiu khng kh trong lnh vo phi ri th gin tm hn. 9. Thm mn n khc thng C ngi khi c thai thm n chua, n kem, n thc phm mn... Kinh nghim dn gian cho rng khi ph n thm n nh vy l du hiu c thai. tha mn, c th n mt t cc mn n cng khng sao. Nhng c mt s ngi khi c thai li thm n nhng cht khng phi l thc n nh t st, tro, sn, , qun o... S thm n rt k l ny l c tht, nhng cha gii thch c v sao. C ngi cho rng y l du hiu ca thiu khong st, v khi dng khong ny th khng cn cm gic thm n k l nh vy na.

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Mt s ri ro khi mang thai

Mt s thi quen khng tt c th a ti ri ro cho thai nhi v ngi m: 1. Ru Cc chuyn gia u ng rng, khng c mt lng ru no c th gi l an ton cho ngi m ang mang thai. Ngi m nghin ru s a ti nhiu ri ro bt thng cho thai nhi, m hi chng khuyt tt l r rng nht. Tr sinh ra nh cn, ngn chiu cao, u m, mi rng... Khi ln ln, nhng a b ny s chm pht trin tr tu v mi chc nng c th. L do l v ru t mu ngi m s qua nhau thai i vo thai nhi, ha trong mu v t bo. V thai nhi cha c loi enzym cn thit phn hy ru nn ru gy ra hu qu xu cho no b, nht l vo thi k u ca thai k, khi h thn kinh ang c kin to. V th, tt nht l khi c thai khng nn ung bt k loi ru bia no, d l vi mt lng rt nh. 2. Thuc l

Carbon monoxyd (CO) trong khi thuc l bm vo hemoglobin trong mu, gy tr ngi cho s chuyn ch oxy. Do , thai nhi s b gim oxy, sinh ra nh cn, chm hc hi. Thuc l cng lm cho ngi m thiu oxy, tim phi lm vic nhiu hn, d b sy thai. Khi ht thuc nhiu, ngi m cng n ung t hn nn suy dinh dng.

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Dinh dng vi ph n c thai

3. Dc phm Mt s ln hot cht trong cc dc phm khi c ngi m s dng u i qua nhau thai n vi thai nhi v c th gy ra nh hng khng tt. Do , khi c thai m cn ung thuc phi tham kho kin bc s trc. Cc loi thuc gy nghin nh cocaine u gy ra bin chng cho c m ln con. Cocaine lm huyt qun co hp, gim lng mu ti t cung v dn ti huyt p cao, sinh non, chm tng trng, tn thng thn kinh thai nhi. Thai nhi cng c th b nghin ngay sau khi sinh vi cc du hiu nh thuc nh bing n, mt ng, d b kch thch... 4. n chay khi c thai Nu l n chay thun ty, ch n rau tri, khng c sa, trng, tht th ngi m s rt d thiu cc vitamin B12, B2 v cc khong cht nh calci, st, km. V th, trong rt nhiu trng hp cn ung b sung cc vitamin v khong cht ny. Ngoi ra, cn ch n nhiu loi ht, nhiu loi rau c s acid amin cn thit. Nhng d vy, vn c nhiu nguy c thiu mt s acid amin cn thit. V th, cc nh dinh dng u khuyn nhng ngi n chay khi c thai nn tm thi chp nhn vic ung thm sa, n thm trng trong thi gian mang thai v nui con bng sa m.

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5. n king khem bt mp Nu ngi m ang mang thai p dng mt ch n ung king khem gim cn, s c nhiu nguy c thiu dinh dng cho c m ln con. Ngay c nhng ph n khng c thai m gim n ung cng khng tt, c th a ti ri lon kinh nguyt, khng c trng rng, v sinh. 6. C ph Mt s nghin cu cho rng ngi m mang thai ung c ph mc di 200mg mi ngy th khng c nh hng xu cho thai nhi. Nu s dng trn 500mg mi ngy th thai nhi c th b nh hng nh nh cn, vng u nh. Tuy nhin, cc chuyn gia y t u khuyn nhng b m khi mang thai nn trnh dng c ph.

Kt lun
Dinh dng ng vai tr rt quan trng trong thai nghn. Vi thai nhi, c cu ni M n sao th con l vy. Ch dinh dng dnh cho ngi m c c y th a con mi b bm, khu khnh, tr tu tinh anh, mau ln, cn ngi m th duy tr c sc khe, sc chm sc tt cho con v vui vi gia nh.

202

NUI CON BNG SA M

Nng niu b mm m ngy, Cng cha ngha m coi ty bin non. Ca dao

Hnh nh ngi thm nm vch v cho con b trn mt chic vng gai, vo mt bui tra h ti min qu Bc Vit. a b khong su thng, trn trnh nh c khoai, hng ho nh mt tri b qun. N lim dim mt, ming ngm mt v sa, tay mn m nm v bn kia. N nut tng git sa ti mt t bu v ngi m. Thm c su a con. a no thm cng cho con b sa mnh cho ti hn mt tui mi cai. Thm cn nhai cm vi tht nc mm cho cc con. Gi l n trn. B ni Vinh vn thng ni chng c g tt bng sa m. Ni ti vic nui con bng sa m vo thi i vi tnh tin b ny th c v nh chm tin chng? Ngoi ch, thiu g cc loi sa dnh cho tr s sinh, va tin li, v sinh li c y cht dinh dng. Th h c g phi ngi vch o cho con

trn na th k m ci hnh nh p vn cn in su trong tr nh ca Vinh.

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Dinh dng v iu tr
b, h bc? Va mc c li xu ngi i. C chu tn thi ca ti ni vy. Ch hiu c ta ni a hay ni tht. Nhng c l chng phi mt mnh chu ni vy, m nhiu b m by gi cng ngh nh th. Ngy nay, ch vi tun sau khi sinh l cc b m u phi tr li vi cng vic lm n, khng c nhiu th gi ngi cho con b. Nn ci tp tc cao p m con vo lng, cho con b cng dn dn i vo d vng. Nht l vi nhng ngi dn thnh th. V nht l ti cc quc gia vn minh, k ngh. Ti Hoa K, cch y hn na th k, c khong 65% tr s sinh c m bu sa m. n cui th k va qua th con s tr em may mn tt xung cn 25%. Cng c mt s b m c l do chnh ng nh t sa, khng cho con b, hoc au bnh, km sc khe... Nhng cng c nhiu ngi l v khng c hng dn v li ch ca dng sa m. T thu to ra loi ngi, Thng tin cy giao cho ph n ci trng trch mang thai, sinh con ri cho con b. Do h mi c Thng ban cho cp nh hoa bu bnh y p sa. Sa m l thc phm hon ton thch hp cho s tng trng ca b mi sinh. Sa b c nhiu calci v cht m khc cn cho con b mau ln, bit i. Cn tr s sinh li cn tng trng no b v dy thn kinh nhiu hn, v sa m cung cp nhng cht dinh dng ng vi nhu cu ny.

204

Nui con bng sa m

u im ca sa m
Cc nh dinh dng nu ra nhiu u im khi m cho con b sa mnh. 1. V phng din tm l, khng c mt s kin p v cao qu no bng vic ngi m trc tip truyn s sng ca mnh qua tng git sa dnh cho con. Con nm trong lng m hin, nt tng git cht dinh dng tinh khit. Trong tim thc ca n, mt s bit n manh nha. S quyn luyn, tnh thng yu t m tng dn theo nm thng. a b trng thnh trong nim tin: Cng cha nh ni Thi Sn, Ngha m nh nc trong ngun chy ra. Vic cho con b cng to c hi cho ngi m tip cn thng xuyn vi con nhiu ln trong ngy. S m p v v cung cp nhng kch thch a con pht trin tnh cm. M con c nhiu cm thng, thng yu, nn ngay t tm b a con c khuynh hng qun quanh chn m. Khi cho con b m lng m th thn, t tin th con s ha nhp vi m. Con s tin tng m v qua m, vo th gii bn ngoi. Tri li khi ngi m vi vng, nn nao, ch mun con b cho xong ba th a con cng cm nhn ngay c s bt an . a con s khc v nhiu khi t chi sa. 2. Nhng git sa u (colustrum) c nhiu cht m, khong, vitamin A hn sa thng, ng thi li c

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Dinh dng v iu tr
nhiu khng th gip con chng tr vi mt s bnh thng mc phi trong thi gian my thng u. 3. Sa m l ngun thc phm t nhin, hon ton tinh khit v lc no cng c gi nhit thch hp, sn sng khi con cn n. Ngi m khng cn phi quan tm n bnh sa, ni ct sa, pha sa, un nu nc si... 4. Sa m c thnh phn ha hc c bit thch hp vi c th tr s sinh m khoa hc cho n nay vn khng th to ra c. Sa m c cht dinh dng, t cht m, cht bo, vitamin, khong cht... Sa m li d tiu ha v d hp th. Cht bo trong sa m thuc nhm cha bo ha nn rt tt cho tr. 6. Sa m thng t ng cc hn sa b nn t khi gy ra to bn, tiu chy hoc d ng. 7. c bit sa m c nhiu khng th chng li mt s bnh tt. Tr s sinh b sa m c hng s min dch t nhin i vi cc bnh nh bi lit, bnh do cc vi khun E. Coli, Salmonella, Shigella gy ra cho h tiu ha. 8. Cho con b sa m rt an ton, khng b nhim ha cht, khng sinh, li khng phi mt tin mua cc loi sa c bit dnh cho tr s sinh. Hn na, ngay c loi sa t tin nht cng vn khng tt bng sa m. 9. Khi b sa m, em b thng t nh nm v khi no bng. Nh vy trnh c trng hp b qu nhiu

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Nui con bng sa m

khi ngi m pha bnh sa qu tay, p con phi b cho ht. 10. Khi cho con b, ngi m cng hng nhiu ch li, Ngi m bt mp v m bo tch t trong khi mang thai c s dng chuyn sang sa. y cng l cch nga thai t nhin v khi cho con b sa th s rng trng ca ngi m cng nh thi gian tr li vng kinh s chm li khong 10 tun, cng c khi n 1 nm. Ngi m cng gim thp c nguy c long xng, ung th v vo tui mn kinh.

Khi no bt u cho con b sa m?

Nn cho tr b sa m cng sm cng tt, thng c th l sau khi sinh t 24 n 48 gi. Khi tr ngm v nt sa t nm v s kch thch lm sa tit ra nhiu hn. Trong giai on u tin, tr c th i b sau 2-3 gi, ri sau khong cch dn dn tng ln 3-4 gi. Sau mt thng, c th khng cn cho tr b ban m. Thng thng, sau khi b no th tr nh v ra v ng. Khi b, tr thng nut theo vi sa nhiu hi vo d dy. Ngi m nn gip tr hi ra sau mi ln b xong bng cch b vc tr ln vai, hoc gi t th ngi thng, hoc cho tr nm sp trong lng v gi u cao hn khng kh trong d dy c th tht ra. Trong khi lm vic ny, xoa hay v nh vo lng lm cho tr yn tm. i khi tr b mt bn v no. Nhng khi sa ra u n, nn thay i tr lun b u c 2 v.

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Dinh dng v iu tr
Mi tun u nn theo di mc tng cn ca tr. Mt vi vn cn lu 1. Sa m thng c rt t vitamin A v cc khong cht st, ng. Thng th khng gy tc hi g, v c th tr d tr mt s ln cc cht ny dng trong khong 6 thng u tin. Nhng nu ch dinh dng trong thi gian mang thai km, tr sinh ra nh k, ngi m cn lu b sung y cc cht dinh dng ny trong thi gian cho con b. 2. i khi ngi m c th khng sa cho con b. Tuy nhin, trng hp ny t khi xy ra, tr phi ngi m mc mt bnh no gy ra thiu sa, tt tuyn sa... Nu thiu sa ko di, cn cho tr b dm thm sa bnh.

Ch dinh dng cho ngi m

Trong khi nui dng con bng sa ca mnh th ngi m cng cn lu tm ti ch dinh dng y cho bn thn. Ngi m phi tng thm khu phn n, cn i a dng cc loi thc phm nh tht, c, trng, sa, rau tri v cc loi vitamin, khong cht. Nc ung khong 2 lt mi ngy b p li s cht lng chuyn sang sa. Ngay sau khi sinh, nu ngi m khng phi ung thuc, b cho i bnh thng khe mnh, th c th cho con b mi bn v vi pht. Nhng git sa non (colustrum) rt l qu gi v c nhiu cht b dng cng nh khng th.

208

Nui con bng sa m

Sang ngy th hai, cho con b mi v khong 5 pht, cch nhau 4 gi. Khi sa tit ra nhiu th c th tng ln 20 pht. B cng nt nm v cng lm tng hormon prolactin v sa cng tit ra nhiu hn. Khi nhiu sa n mc tr khng b ht, c th vt ra, ct vo t lnh bo qun, cho tr b vo lc khc. Nhng trng hp khng cho con b sa m Tuy cho tr b sa m l rt tt, nhng trong mt s trng hp nh sau y ngi m c th phi trnh khng c cho con b: 1. Khi nh hoa b sng, nhim trng, tc nhn gy bnh c th truyn sang con; 2. Ngi m mc cc bnh trm trng nh lao phi, tiu ng, bnh tim, bnh thn, thiu hng cu hoc thiu dinh dng. 3. Ngi m c bnh tm thn ang phi ung thuc iu tr. 4. Khi tr sinh ra c khuyt tt ch mi hoc bit l khng hp vi sa m th cng khng nn cho b. 5. Khi ngi m c thai trong thi gian cn ang cho con b. 6. Khi ngi m phi s dng mt s thuc gy nh hng khng tt cho con. Ni chung, khi ngi m dng thuc th hu ht cc loi thuc u c th chuyn sang sa. Tuy nhin, nh hng n a tr th cn ty theo loi thuc, s lng c trong sa v kh nng hp th ca

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Dinh dng v iu tr
em b. V th, khi s dng bt c loi thuc no cng cn phi tham kho kin ca bc s iu tr bit l c nn tip tc cho con b hay khng. Khi dng cc thuc sau y th khng cho con b: - Thuc atropin, thuc warfarin chng ng mu. - Thuc cha bnh tuyn gip. - Thuc cha ung th. - Thuc c cht phin. - Khng sinh tetracyclin, metronidazole v nhiu thuc khc.

Cafeine, nicotine vi lng nh c th khng sao, nhng nu nhiu th s c tc dng khng tt n em b.

Kt lun
Sa m l ngun dinh dng qu gi m to ha ban tng cho con ngi. Mi con ngi ch c c mt thi gian rt ngn ngi tn hng dng sa m. Tht khng may khi v bt c l do no m mt a tr sinh ra khng c nui bng nhng git sa ngt ca m hin. Ngoi s bt li v mt dinh dng, tr ln ln thiu s vut ve tru mn v gn gi vi ngi m cng s c mt tm l khi u cuc sng khng tt lm. V th, nhng bc lm cha m nn hiu r v cn nhc tt c nhng u im ca vic nui con bng sa m, ng v thiu hiu bit m cho a con thn yu ca mnh phi chu mt s thit thi khng g c th b p c.

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DINH DNG CHO TR TRONG NM U TIN

m u tin trong cuc i ca tr chnh l thi gian c rt nhiu s pht trin thay i lin tc, nhanh chng v hnh dng, cu trc cng nh tr tu. p ng vi s pht trin nhanh chng ny, vic p dng mt ch dinh dng y l iu rt quan trng. T s sinh cho ti khi c mt thng tui, b s tng cn khong 0,5kg - 1,5kg v pht trin chiu cao khong 3cm. Cho n khi trn mt tui th cn nng tng ln khong gp ba ln lc mi sinh, v pht trin chiu cao 5 - 6cm. Vo lc ny, b c khong 6, 7 ci rng. V kh nng vn ng c th th khong ba thng b bt u bit ly, by thng b bit b, v ti mi thng b bt u tp i. Tuy nhin, nhng mc thi gian ny cng c th sm mun hn ty theo tng trng hp. V dinh dng, c mt s vn m cc b m tr thng khng nm vng, do khng bit phi nui con nh th no cho thch hp. Di y trnh by nhng kin thc thng

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thng nht m ngi m cn bit c th nui dng con tht tt.

1. Nn cho tr b loi sa no?

Trong 6 thng u tin, ch cho con b sa m l tt nht. Tr phi v mt l do no m ngi m khng sa tha mn nhu cu ca con hoc khng th cho con b th mi chn mt loi sa c bit dnh cho tr s sinh b sung hoc thay th. Hin nay, dng sa ph bin nht c dng l sa hp dng bt (formula), c nhiu loi khc nhau, c ch bin theo yu cu cung cp y cht dinh dng thch hp cho tng tui, t s sinh cho n cc d tui ln hn. Sa b ng hp hoc sa ti cha pha long c nhiu cht m, mui khong, t carbohydrat. Loi sa ny thch hp vi s pht trin c th rt nhanh ca loi vt, v kh tiu ha i vi c th ca tr em. Nghin cu cho thy rng mt con b ch cn khong 50 ngy tng cn gp i so vi lc mi sinh ra, trong khi tr con ln chm hn nhiu, ch c th tng cn gp i sau khi sinh khong 150 ngy. Nu phi dng sa b nh s chn la bt buc th cn pha long ty theo tui ca tr. Nhiu a tr b d ng hoc khng dung np sa b th c th thay th bng loi sa ch t u nnh.

2. Nhu cu dinh dng ca tr nh th no?

- Nng lng : - Cht m: 650 - 850Kcal 13 - 14 gram

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Dinh dng cho tr trong nm u tin

- Calci: - Phosphor: - Mui n: - Chlor: - Magnesium: - Kali: - Iod: - St: - Km: - Vitamin A: - Vitamin D: - Vitamin E: - Vitamin K: 400 - 600mg 300 - 400mg 120 - 200mg 180 - 300mg 40 - 40mg 500 - 700mg 40 - 50mcg 6 - 10mg 5mg 375 mcg 7,5 - 10mcg 3 - 4mg 5 - 10mcg

Lng cht dinh dng nh trn cn phi c cn i t nhiu ngun thc phm a dng, trnh cho tr n n iu, thng xuyn mt vi loi thc n m cha m cho l rt b dng.

3. Bao lu cho tr b hoc n mt ln?

T s sinh n 3 thng tui, c th cho tr b 5, 6 ln mi ngy, cch nhau khong 3 gi. Khi tr ln dn ln th s ln gim i. Chng hn, 5 thng tui th 4, 5 ln mt ngy; ti 9 thng th rt xung cn 3 ln. Nu tr c b hon ton l

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Dinh dng v iu tr
sa m th s ln cn tng ln, v sa m rt d tiu ha, tr s mau i.

4. Thc phm cho con: mua sn hay lm ly?

Nng niu b mm m ngy, Cng cha ngha m coi ty bin khi. B mm l hnh thc nui con ca cc c ta khi xa. Sa t bu v m, thc n th m nhai ri mm cho con, cho ti khi con n thc n c c. Thc l c mt cng trnh m ch tnh thng ngi m mi lm c cho con mnh. Nhng ngi m ngy nay chng ta khng lm ging nh cc c xa kia, mt phn v s thay i quan nim trong cch nui con, mt phn v sn c nhng loi sa v thc phm rt tin dng v y dinh dng. Thc phm c ch bin sn c rt nhiu loi, thch hp cho tr tng tui khc nhau, ngi m ch vic chn mua loi no thch hp vi tui v tnh trng sc khe ca con mnh. V vic nui tr bng nhng loi thc phm ny rt d dng v tin li. Cc thc phm ny c nhng c im chung nh sau: a. Da theo thnh phn trong sa m nn c y cht dinh dng. b. Tun th cc tiu chun v sinh v an ton thc phm, c kim nghim k trc khi lu hnh nn rt an ton khi s dng.

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Dinh dng cho tr trong nm u tin

c. Gi c phi chng nh c ch bin vi s lng ln bng cng ngh hin i. d. Ct gi d dng trong t lnh khi s dng khng ht. Cc loi thc phm ny c th c b sung cht st v trnh by di hnh thc bt, dung dch c cn pha ch hoc sn sng cho tr n. Dung dch c hay dng bt cn c pha vi nc trc khi dng. Cn theo ng ch dn ca nh sn xut, ng pha nhiu hoc t nc qu. Khng nn thm ng hoc mui. Thc phm c th hm nng hoc cho n ngui ty theo thch ca tr. Thc phm dng lng c th cho b bng bnh. Bnh cn c ra sch s v kh trng bng cch luc trong nc si trc khi dng. Nu t ch bin thc n cho con th cn mua mt my nghin thc n. Nu thc n chn theo yu cu, thm mt cht nc, ri cho vo my nghin nh. Phi thn trng trong qu trnh ch bin, m bo tuyt i cc iu kin v sinh trnh nhim c thc phm.

5. Khi no bt u cho tr n thc phm c?

iu ny ty thuc vo nhu cu dinh dng, kh nng tiu ha v sc khe ca tng a tr.

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Dinh dng v iu tr
B nt sa khi i v y nm v ra khi no l phn x t nhin m a tr no cng c. T s sinh cho n 3, 4 thng tui, ming b cha sn sng nhn thc phm a vo, ch bit ngm nm v. V th, cho n thc phm c bng tha s b y ra v cng khin b kh chu. Sau 4 thng tui, mi ming sc mnh khp kn ming v vic n bng tha c th thc hin c. ng thi tui ny, tr c th ngi vng, h ming n thc n. Nh vy, v mt kh nng th tr c th bt u n thc phm c t khong sau 4 thng tui. Tuy nhin, cc nghin cu cho thy l h tiu ha ca tr vn cha thc s sc tip nhn thc n c, bao gm c kh nng tiu ha v hp th dinh dng trong thc n. V th, li khuyn chung ca tt c cc chuyn gia dinh dng v y t l ch nn bt u cho tr n dm vi thc n c k t sau 6 thng tui. T s sinh cho n 6 thng tui, iu kin dinh dng l tng nht vn l sa m, hoc nu khng c vy th c th b sung thm bng cc loi sa c bit dnh cho tr s sinh. Sau 6 thng tui, vn tip tc cho tr b sa m, nhng c th bt u cho tr n dm thm mt t thc n trong ngy. Thc n dm cho tr nn bt u vi cc loi bt ng cc. C th l bt go lc, cc loi u nh u xanh, u ... v hu ht u c b sung cc vitamin v khong cht, rt d tiu ha. Khng cho tr n bng cch pha long bt ri cho vo bnh. Tt nht l tp cho tr lm quen dn vi vic n bng tha v vi thc phm c m c tng dn.

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6. Khi no cho n rau tri?

Tri cy mang v ngt vi nhiu vitamin, khong cht rt tt cho tr. Ngay khi bt u cho tr n dm, c th cho tr lm quen dn vi mt lng nh tri cy cc loi. Cho tr n bng cch nghin hoc xay nh thnh dng bt nho ri t bng tha. Nn bt u vi mt vi tha nh ri tng dn sau nhiu ln cho n. C th nghin rau v cho tr n chung vi bt. Nn dng cc loi rau c l mu xanh sm hoc vng c nhiu vitamin v dinh dng. Khi cho tr n mt loi tri cy hoc rau ln u tin, nn cho tr n lin tip trong vi ngy tr quen vi hng v ca loi thc n mi, v theo di xem tr c b d ng hay khng. D ng vi mt vi loi thc n l iu rt thng gp v n nay vn cha r nguyn nhn. Tuy nhin, ngi m cn lu pht hin v ghi nh nu c, trnh gy kh chu cho tr khi gp phi cc loi thc n ny.

7. Bao gi cho b n tht, c, trng?

Khi bt u cho tr n dm vo sau 6 thng tui, c th cho thm mt lng nh tht g, tht b nc, gan, c vo thc n dm ca tr. Tt c u dng nghin nh pha ln trong bt nho. Bt u vi lng rt nh ri tng dn tr lm quen. Cng nh vi rau, nn cho n mt loi tht, c... no lin

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Dinh dng v iu tr
tip trong vi ngy tr phn bit v lm quen vi hng v mi. Nn lm chn tht, gan, c... bng nhng phng php nh luc, hp, nu nh... nhng trnh khng chin, rn vi nhiu du m. Lng trng cng c th bt u cho tr n vo sau 6 thng tui, bt u ch vi mt tha nh ri tng dn cho ti mt lng trng mi ngy. Lng trng trng c th gy d ng cho tr, ch nn cho n khi ln hn nhiu v phi d dt theo di ln n u tin.

8. C nn cho b t n mt mnh?
Khi ln t cm tha xc thc n a vo ming, tr thng rt thch lm vic ny. Nhiu b m ngi khng cho tr t n, v tr thng lm thc n vng vi cng nh thc n dnh vo tay chn, mt mi... Tuy nhin, cho tr t n mt mnh l iu cn thit gip tr pht trin nhanh cc k nng vn ng. C ng ca tr s ngy cng kho lo hn khi c iu kin vn ng theo mun, cn nu ngn khng cho tr t lm mt s vic, tr s chm pht trin hn. Mc d vy, ch nn cho tr t n mt mnh di s gim st theo di cht ch ca ngi m. Trc ht, phi tm ra cho tr tht sch s trc khi n, v tht ra tr khng ch n bng tha m cn rt thch dng tay bc thc n cho vo ming. Thc n ri xung lm bn cn ly i ngay tr

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Dinh dng cho tr trong nm u tin

khng nht li n. i khi tr c th lin tc cho thc n vo ming, qu nhiu n mc sc sa... Tt c u cn c s can thip gip kp thi ca ngi m. V th, khi thy tr c khuynh hng mun t n mt mnh th ngi m nn to iu kin tr tp dn, nhng nht thit khng c tr ngi n mt mnh ri b i lm mt cng vic khc.

9. Cch cho tr n
Nn kin nhn, dnh nhiu thi gian thoi mi khi cho con n. ng hi thc chng, v mi b c cung cch n ring. i khi cng nn b nghch vi thc n, nh b pht trin c kh nng t n mt mnh.

10. Lm g khi b bing n?

Bing n khng phi bao gi cng do au m. Khu v con ngi thay i mt cch t nhin ty theo tm trng, thi gian... C nhng a b mi chi, khng ngh ti n ung. Nhng i khi con bing n cng do li cha m. Nhiu ngi p buc phi n khi chng cha mun n; cho chng n nhng mn m chng khng thch; pha thuc vo mn n lm chng s... S lng thc phm m b tiu th l cn thit nhng cng cn theo di tng trng c th. Nhiu b c v nh n t nhng vn tng cn u, khng bnh tt, vn khe mnh, vui chi. Nh th th thc ra lng thc phm m tr n c

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Dinh dng v iu tr
khng phi l t. Ch v cha m lun mun cho tr n nhiu hn nn mi thy rng lng thc n nh th l t. Tuy nhin, c nhng trng hp m tr thc s bing n, khng chu n lng dinh dng cn thit, khin cho cc bc cha m rt lo ngi nhng khng bit lm sao tr chu n nhiu hn. Sau y l mt s gi c th gip tr n ngon hn, v nh c th n nhiu hn: a. Ba n cn c khng kh thoi mi, thn thin, khng p tr ngi g b trn gh. b. Khch l tr bng nhng tr vui, va chi va n, bng thc phm nhiu mu sc, hng v khc nhau. c. tr c thoi mi, t khm ph mn n vi cc gic quan ca mnh, s m mn n, ngi mn n, nm th mn n... Tt nhin l phi m bo cc iu kin v sinh trc khi cho tr n. d. Cho tr n nhiu mn n khc nhau t khi b c 7 - 8 thng tui, tr quen vi nhiu loi thc n; . C khi tr thch mn ny m khng thch mn kia, khng nn p tr n nhng mn khng thch. C th vo thi gian khc tr li thay i khu v v s thch mn . e. Khng nn cho thuc b, thuc tr bnh vo thc n, v mi v thay i v lm tr thy e ngi khi n. e. Khng c p tr n ht phn n, khi tr khng thch s nn e. Ly thc n va , khng qu nhiu c th lm tr ngn khi nhn thy. Khi tr n c, nu cn th ly thm.

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f. Khng cho n cc mn vt gn hoc ngay trc ba n chnh, tr thy i mi c th n ht lng thc phm chun b cho ba chnh. g. Khng dng thc n nh mt hnh thc thng pht. Tuy nhin, bing n cng c th l du hiu ca mt s bnh nh nhim c, tiu chy, bnh h hp, giun sn... Nn tham kho kin bc s khi thy b c triu chng bing n ko di.

11. Nhng mn n nn trnh

Trnh cc loi thc phm c th gy d ng nh lng trng trng, s-c-la, c, c chua... Khi tr bt u nhai c v c th n thc n dng rn, trnh cc loi thc n cng kh nhai nh c rt, cc loi ht, tri cy c v dai nh nho, thc phm nho dnh nh b u phng... v c nguy c lm nghn cung hng. V h tiu ha ca tr cn non yu, nn trnh cc thc n c qu nhiu cht bo. Sa cu nguyn cht thng c rt t acid folic. M thiu acid ny c th a ti thiu mu. Sa cu ch bin thng c b sung acid folic. Khng nn dng sa b cha tit trng, v c th nhim cc tc nhn gy bnh.

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DINH DNG CHO TR T 1 - 5 TUI

a trn mt tui, tr chp chng bit i, hc ni, v bt u bit lc lo tm ti trong x ny, gc kia... Nh bp vi nhiu ngn t l ni tr rt thch sc so, thm him. Bao nhiu l ni niu, xoong cho, hp thc phm, chn bt cho b ly ra, by la lit trn sn nh. Ri ln qun ht phng ng, n phng khch, cm vt ny, nm vt kia... B tro cu thang, lc 3 tui. Vo tui ny, tr tng trng vi tc chm hn giai on trc, nhu cu nng lng cng thay i. Tr s khng n nhiu ln nh trong nm u tin, m c th n theo ch chung vi c gia nh: ba ba mt ngy, km theo mt vi ln n vt gia cc n ba chnh. n vt trong thi gian cch khong gia cc ba n chnh l cn thit cho tr, nhng ng cho n qu nhiu ko tr b c ba n chnh hoc n t i. Tr cn c n nhiu loi thc phm c tt c cc cht dinh dng cn thit. Nhng ba n khng nn qu cng

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Dinh dng cho tr t 1 n 5 tui

nhc, ba no cng ging nh nhau. B c th n nhiu rau trong vi ngy ri chuyn sang tht c vi ngy lin.

Thc phm c bn
Sau y l mt s thc phm c bn cho tr trong tui ny: a. Tht, trng y l ngun cht m rt quan trng tr tng trng. Mi ngy cn t ba ba tr ln. Trc hai tui cng khng nn gii hn cht bo v cc cht ny rt cn cho tr ln ln. Sau th n cht bo va phi. Nn gii hn trng 3, 4 ln mt tun l . b. Sa Mi ngy cn 4 ln, thay i vi sa, pho mt, sa chua. y l ngun calci rt phong ph xng v rng chc khe. Vi tr mt tui, mi ln ung khong 120ml, trn tui ny l khong 180ml. Tr trn hai tui nn cho ung sa c 2% cht bo. c. Rau, tri cy Nhiu tr khng thch n rau, tri cy. Nhng y l ngun cung cp cht x, cc vitamin C, A. Ngoi thc n chnh, mi ngy u nn cho n thm cc loi rau, tri cy.

223

Dinh dng v iu tr
d. Carbohydrat C trong cc thc phm nh cm, bnh m, ht ng cc... Mi ngy cho n khong 4 ln. Vi tr mt tui th mt ba n c th l na lt bnh, 15g bt ng cc, 60g m hoc cm. Vi tr 5 tui, mi ba n c th l mt lt ri bnh m, 28g bt ng cc, 140g cm hoc m. Mt cu hi m cc bc lm cha m thng thc mc l nh hng ca cht ngt trn hnh vi ca con. Nhiu ngi vn tin rng ng lm tr qu nng ng (hyperactive). Nhng kt qu cc nghin cu khoa hc u khng chng minh c tc dng ny. Thc ra ng li tng s sn xut serotonin, mt cht c tc dng xoa du. Nhng ni vy khng c ngha l c th cho tr con n ng t do, v ng ch cho nng lng, khng c cht dinh dng. Tr con n nhiu ng thng c nguy c bo ph v su rng.

Bo ph tr em
Mt vn cn lu tm l s tr em bo ph ngy mt gia tng. L do l tr em tiu th qu nhiu nng lng hn mc nhu cu hot ng ca c th. Mt trong cc nguyn nhn a n bo ph c th l do gen di truyn, nhng hu ht cc trng hp th nguyn nhn chnh vn l do n qu nhiu so vi nhu cu v khng vn ng c th.

224

Dinh dng cho tr t 1 n 5 tui

Ngy nay tr em c nhiu hnh thc gii tr tnh ti, khng hot ng c th, t vic ngi xem tivi hng gi lin cho ti cc tr chi in t, m tt c hot ng chnh trong my gi lin tc ch l ng y my u ngn tay. Ngoi ra, trong khi xem tivi hoc ngi chi trc my, chng li hay n vt nhiu hn. No kem, no bnh ko, hoc cc thc n vt c nhiu cht bo... Sau y l mt s gi trnh vn ny: - Khng nn p buc tr n nhiu qu. Khi tr n th tr thng quay u i hoc mm cht mi khi ta a tha thc n vo ming. - Khng nn bt tr lun phi n ht thc n, ch v s b i th ung ph. - Khng nn cho nhiu gia v vo thc n ca tr nh ng, cht bo. - Khng nn v thng con m cho tr hon ton t do trong vic n ung, khng chn lc, ty thch. - Khng dng thc n nh mt hnh thc thng pht, chng hn nh khng cho n pht hoc ha cho mn ny mn kia thng. - Cho tr n thc phm trong c nm nhm chnh, vi cht dinh dng, hn ch cht bo ng vt. - Gim m bo trong tht, n nhiu rau, tri cy ti. - Khuyn khch tr chy nhy, n a, hn ch xem tivi, chi tr chi trn my vi tnh.

225

DINH DNG CHO TR T 6 - 12 TUI

i tui ny, s tng trng c th tng i n nh. Mi nm tr cao ln khong 6cm, nng thm khong 4 - 5kg. No b pht trin gn nh no ngi trng thnh. Tr rt thch hot ng, chy nhy. Ti cui giai on ny th s tng trng li rt mnh sa son bc vo tui dy th, ri tui thanh nin. Trong vic n ung giai on ny, tr thng chu nh hng t bn b, mi trng tip xc... Cha m nn lu tm hng dn cho tr nhng s chn la tt sm tp thnh thi quen theo ch dinh dng lnh mnh. Nht l cn phi lm gng tt cho con ci noi theo trong vic n ung: va phi, iu v c chn lc.

Mt s vn cn lu :
a. Thc phm nn hn ch cht bo, mui, cht ngt; nhiu carbohydrat, cht x;

226

Dinh dng cho tr t 6 n 12 tui

b. tui ny, ba n sng rt quan trng. im tm khng cn cn k: sa, bt ng cc, tri cy, hoc mt qu trng, nhng gip tr rt nhiu trong my gi hc trc ba n tra. c. Ba n tra nn c xem l ba n chnh, cn ch tnh ton tr n y cht dinh dng. d. Khng nn qu hn ch nhng mn n vt ngoi ba n chnh nh tri cy, sa chua, bnh... Bi v d sao th h tiu ha ca tr vn cn ang pht trin cha hon chnh, khng th hp th dinh dng vi ch 3 ba n chnh trong ngy. . Tnh tnh, hnh ng ca tui ny c nhiu bt thng. Nn tm hiu h tr, gii quyt ch khng dng thc phm lm bin php k lut, thng hay pht. e. Thc phm phi cung cp y c nng lng v cht dinh dng, v tr ang trong tui tng trng, cn vt liu ln cng nh cho cc hot ng c th; nhng khng qu nhiu trnh bo ph. f. Khuyn khch tr nng vn ng c th, tham gia cc mn chi th thao va sc, v nht l tp thnh thi quen tp th dc u n mi bui sng. g. tui ny, s bo ph cng thng xy ra, v l mi quan tm ca nhiu bc cha m. n va nhu cu nng lng, gim cht bo, cht ngt. Vn ng c th u n cng l bin php tt trnh bo ph.

227

DINH DNG CHO TR T 13 - 19 TUI

th con ngi c hai thi k tng trng nhanh v mnh nht, l nm tui u tin v giai on t 13 ti 19 tui. tui dy th, con trai ln nhanh v nng hn con gi. Con trai c nhiu khi c, trong khi con gi li nhiu m hn, c bit l hng v nh hoa. C th con gi c 25% m, trong khi nam ch c 20%. Nhu cu dinh dng mi ngy nh sau: - S nng lng: nam 2500Kcal, n 2200 Kcal. - m: - Vitamin C: 45g 50mg - Vitamin A: - Vitamin E: - Vitamin B12: - St: - Iod: 800-1000mcg 8-10mg 2mcg 12-15mg 150mcg. - Vitamin D: 10mcg

- Folacin: 150-180mcg - Calci: - Phosphor: 1200mg - Km: 12-15mg

1200mg

228

Dinh dng cho tr t 13 n 19 tui

Mt s vn cn lu :
- Nhu cu dinh dng n thp hn nam, ngoi tr n cn khong st nhiu hn v st tht tht mi khi c kinh nguyt. - V bp tht v xng tng trng mnh nn cn nhiu hn cc cht m, calci, st, km. - tui ny, thanh nin thng rt bn rn vi nhiu sinh hot: hc tp, th thao, vui chi... nn d b qua cc ba n hoc n vi vng cho xong, v c th thiu dinh dng. - Thanh nin thnh ph thch chn thc phm theo mnh, li thng hay i n ngoi gia nh nn cha m cn lu hng dn cho con vic chn cc mn n ung y cht dinh dng. - Thanh nin thng hay ti vc dng, sc nng c th ca mnh, n th s bo, nam li s gy, nn cn cn thn khi thy con ci p dng nhng ch n ung khng bnh thng. - Thanh nin thng thch n thc phm cc tim n, nn c th c nhiu cht bo bo ha, nhiu mui, qu nhiu nng lng nhng li thp v calci, vitamin C, cht x. - Mt s thanh nin thch n chay, khng tht c trng s thiu vitamin B12, calci, st, km.

229

RU V SC KHE
gy xun, nh no cng chun b mt vi chai ru: ru ngm thuc b, ru np bch nht, ru ty... cho n xong nht l ru th cng phi c t cht, gi l cho vui. Tt nhin l ngy thng, nhiu ngi cng ung ru, nhng chn ru ngy xun li c ngha khc, d ngi bit ung hay khng bit ung cng phi ung vi nhau cht nh, nh mt th tp tc, l nghi lu i m ai ai cng tun theo. M l tp tc lu i th hn l cng c ci kha cnh hay hay ca n. Trong khi nhng cuc nhu li b ri dn ti quy lng ph xm lun b tt c mi ngi ln n, ph phn, th i cht men cay trong ngy vui li c tc dng lm cho tinh thn hng phn hn, khin cho cuc vui li cng vui hn. V qu tht ru cng khng phi hon ton ng ght hay ng s nh nhiu ngi vn tng. Ci ng ght hay ng s l chnh v c qu nhiu ngi lm dng ru. M l qu mc th chng c mn n thc ung no li khng c hi.

230

Ru v sc khe
T rt xa xa, y hc bit dng ru nh mt mn thuc tr bnh, nht l y hc phng ng dng ru nh mt cht dn thuc h tr cho rt nhiu loi thuc khc. Nh vy, c th thy l ru nh mt con dao hai li, va c kh nng gip ch trong mt chng mc no cho sc khe, li va c th l nguyn nhn tn ph sc khe n mc khng hi phc. Chn dng ly kh nng no ca ru, tt nhin l chuyn ca mi ngi. Nhng iu cng do ni nhng hiu bit nht nh v tnh cht cng nh cc u nhc im ca loi nc cay ny. V ngy nay c khng t nhng cuc nghin cu quy m c tin hnh nhm lm r tnh cht c li v c hi ca ru. Ru, vi tn ha hc l ethyl alcohol, c con ngi s dng t nhiu ngn nm trc, v c l s vn cn c tip tc s dng trong tng lai. Theo mt trong nhiu truyn thuyt th ru c khm ph ra rt tnh c. Ngy xa c mt v hong t n thch n tri nho. M nho thu khng trng bn ma c nn ng ta phi ct trong kho dnh. Mt thng nho lu bin cht, thnh mt dung dch nom k l. S c, ng ta b i. Mt trong nhiu v phu nhn lu nay b phng khng bc i, chn sng nn ly nc ung vi nh vnh bit tnh qun. Ung xong mt bt, chng nhng khng cht m cn yu i, yu ngi hn. Nng bn trnh cho v hong t hay. Nng c nng niu tr li. V t ru c sn xut, s dng mi ni, trong nghi thc tn gio, cha bnh, gii su nhn th, kt bn tm giao...

231

Dinh dng v iu tr
Chng bit cu chuyn c tht hay khng, nhng s hin din ca ru trong cuc sng con ngi t rt lu xa v c mt nh hng quan trng n np sng ca hu ht cc dn tc trn th gii th qu l iu c tht.

V sao ngi ta ung ru?

C ngi ngi nhm nhi, nhm nhp thng thc hng v thm ngon ca ru. Ngi snh ru phi tri k v, tri k hng, tri k o, tri k linh ca ru. C ngi ung qun s i, gii quyt tm trng hoc suy ngm v s phn ca mnh. H ngi ung mt mnh nh i thoi vi chnh mnh. Hoc ch tc khch th, bn chc mng, bn p li. Nng chn ru chc nhau cng c cung cch: ngi t tui khng nng chn mnh cao hn chn ngi nhiu tui. Nhng khi chn ch chn anh, ng tu, ng hng th t do, thoi mi. T thng c, khi tnh c ung cht nc ca mt ming bnh b qun trong ly nc l hoc chm nho ln men, con ngi bng thy sng khoi, ln tinh thn, hng hi. Ri n khi quen vi men cay, thy thch ci v nng, lc y th vui cng ung, m bun cng ung. Ung cho ti khi mt c l tr, chng cn bit mnh l ai, ty ly cn khn. Nh vy tt nhin l khng th trnh khi v s nhng ri ro, nguy him v tn hi sc khe. V th, c mun ung ru th phi ung va phi, chng mc mi c th trnh c s nguy hi, v nu c thy

232

Ru v sc khe
thuc ch nh th phi tun th liu lng mi c tc dng tt cho sc khe. Nhng th no l va phi, chng mc? Theo mt s cc nh chuyn mn th lng ru bia va phi l c th chn dng mt trong cc loi ru vang, bia hoc ru mnh vi gii hn khng bao gi vt qu: 350ml bia, 150ml ru vang, hoc 50ml ru mnh. Nam gii c th s dng 2 ln mt ngy. N gii khng nn vt qu mt na cc gii hn nu trn. Danh y L Thi Trn ca Trung Hoa t xa c nhn nh: Ung t ru s lm kh huyt lu thng; ung nhiu s lm hi tinh thn, lm tn thng tinh dch, d dy v kch thch ha t. V th, im ct li khi s dng ru bia chnh l s chng mc v gii hn.

Tc dng tch cc ca ru
Phng ng v phng Ty dng nh gp nhau trong quan im s dng ru mc va phi. Theo cc sch ng y, ru va phi lm thng huyt mch, tn thp kh, gip khai v h thc (kch thch tiu ha n ung ngon ming), n trng v, ng phong hn (lm m rut, d dy, chng phong t v hn t). Ru cn c coi nh ng u trong trm loi thuc (Tu vi bch dc chi trng). Cc kin ny u do kinh nghim thc t tuy cha c khoa hc kim chng, nhng c gi tr lu truyn qua nhiu i.

233

Dinh dng v iu tr
Ngoi ru nguyn cht, ngi ta cn ung ru ngm thuc vi nhiu cng dng tr bnh nh Nhn sm tu, Thp ton i b tu, Ng gia b tu, Lc nhung tu, Phong thp dc tu, Cp gii tu (ru tc k)... Cc nghin cu thc nghim ng Ty cng nu ra nhiu tc dng tch cc ca ru i vi sc khe, nu c dng va phi, hn ch. Chng hn: 1. Kch thch khu v Ru khai v l ru dng ngay trc ba n kch thch s ngon ming. Vi cc c th thng l mt chung ru thuc, ngi trung nin c th dng ru mnh. Nhng ch mt ly tht nh thi. ru c tc dng kch thch khu v, ch cn mt cht nhm nhp t ming l khi ng nhng n v gic trn li, tng hot ng ca tuyn nc bt cng nh d dy tit thm dch v chun b cho s tiu ha thc n sp a vo. Ngoi ra, ru cng lm tng cm gic i, nn trong cc ba tic c ru ta thng n nhiu hn. Trong y hc, cc v thy thuc thng khuyn ngi cao tui, ngi mi bnh phc sau cn bnh nng, nhng ngi khng b bnh d dy, c th ung mt cht ru nh vy trc ba n n ngon hn. 2. Gim cholesterol kin v nh hng ca ru cc loi ln cht bo cholesterol vn cha c hon ton thng nht. Nhng kt qu nhiu nghin cu cho thy bia c th lm tng mc

234

Ru v sc khe
cholesterol tt (HDL) v gim mc cholesterol xu (LDL) trong mu.
Bc s Peter Cremer ca i hc Gottingen (c) c cng kt lun, nhng thm rng ru ch tt vi ngi c mc cho cholesterol trung bnh, cn vi ngi c mc cao trn 230mg/dl th khng c li. 3. Gim nguy c tai bin ng mch no Thng 1 nm 1999, cc nh nghin cu thuc New York Presbyterian Hospital - Columbia University cng b kt qu v vic quan st 677 ngi ung lng ru trung bnh mi ngy: h u c t nguy c tai bin no gy ra do mu ng cc gy tc nghn trong thnh ng mch no. Bng cch no m c nh hng tt ny th cha c cu gii p, nhng iu chc chn l nhng ngi ung nhiu ru li d b tai bin no hn. Hn na, nu ai ang ung nhiu, by gi gim xung th cng c cng li ch. 4. Ru v bnh tim mch Cc d kin do American Cancer Society quan st trn mt triu ngi M 25 tiu bang ti Hoa K cho thy ung 15ml ru mnh mi ngy th nguy c b cn suy tim t hn ngi khng ung ti 25%. Nghin cu v vic ung ru bia ca dn chng Tip Khc, bc s Martin Bobak ca University College, London kt lun l: Cch hu hiu trnh bnh tim l ung bia,

235

Dinh dng v iu tr
nhng gii hn mi ngy ch t na lt cho ti mt lt v rng s bo v ny l do tc dng ca cht cn ch khng phi do ha cht no khc c trong cc loi ru, bia. Bc s Arthur Klasky, chuyn gia v tim Oakland, California, l mt trong nhng ngi u tin lu n tc dng tch cc ca ru vi tim. Cch y gn 30 nm, khi so snh h s bnh l ca trn 100.000 bnh nhn, ng ta thy nhng ngi khng ung ru u b nhi mu c tim nhiu hn nhng ngi ung va phi. i hc Harvard khi theo di 85.000 n iu dng tui t 34 n 59 trong thi gian 12 nm, cng i n kt lun tng t. V nguyn nhn gy nhi mu c tim, gn y c mt khm ph mi gip hiu r hn i cht v bnh ny. T trc, nguyn nhn ca nhi mu c tim c gii thch nh sau: nhng mng ba (plaque) gm cc cht m, t bo ng vo thnh ng mch, lm s lu thng ca mu chm li. Mt lc no , t nhin c mt cc mu ng xut hin, lm tc nghn s lu thng ca mu ti ch c mng ba. Mu khng n tim c, t bo tim suy nhc v thiu dinh dng, khng hot ng, tai nn tim xy ra v gy t vong. Hin nay, s kin ny c gii thch hi khc i mt cht. Ngi ta nhn thy rng nhng mng ba ln ch gy ra khong 15% tai nn tim, s cn li l do nhng ba nh, nht l nhng ba mm, v n d tan v thnh nhng mnh vn. Nhng mnh ny gy mt phn ng ha hc dy chuyn, to

236

Ru v sc khe
ra mt cc mu ng. Mt lc no , cc mu lm nghn mt trong ba ng mch chnh trn mt tri tim v gy ra tai nn. Bc s Steven Nissen ca Cleveland Clinic cho bit l s v ra ca nhng ba nh, mm ny l nguyn nhn t vong ca mt na s ngi mc bnh tim M. Tm hiu xem ti sao n v ra s l ti quan trng cho nhng chuyn vin v bnh tim trong tng lai. Cng ti i hc Harvard, tin s Eric Rimm quan st 44.000 nam nhn vin y t trong vng 2 nm v thy l nhng ai ung khong 30ml ru mnh mi ngy th gim ti 30% nguy c mc bnh tim so vi ngi ch ung 8ml. C nhiu kin cho l ru vang c ha cht bo v c th gim nguy c bnh tim. Nhng nhiu kin khc li gii thch rng, ngi ung ru vang thng l nhng ngi kh gi, t ht thuc v n ung chng mc, y dinh dng hn, nn t bnh. Trc nhng kt qu nghin cu nh trn, Hi Tim mch Hoa K (American Heart Association) cng phi tha nhn vic ung mt cht ru c th c tc dng tt cho tri tim. Dn Php ni ting ung nhiu ru vang v qu tht t mc bnh tim, nhng h cng khng sng lu, m thng cht v bnh gan v nhng tai nn do ru gy ra! 5. Ru v tm tr Kt qu nghin cu ca Institution Nationale de Sant ti Php cho thy n gii cao tui m ung mt lng va

237

Dinh dng v iu tr
phi ru mi ngy th cc chc nng ca no b kh hn: h t c nguy c b sa st tr tu. Theo kt qu nghin cu Netherland, n ng ung ru mt cch chng mc, iu u t b gim kh nng nhn thc. Trong k i hi Quc t nm 2000 v bnh Alzheimer ti Washington D.C., bc s Lindsay A. Farrer c trnh by l nhng ai ung mt, hai ly ru vang hoc bia mi ngy c th gim nguy c mc bnh Alzheimer ti 30%. Theo ng ta th ru lm tng lng mu lu hnh ln no v ru cng c nhng cht chng oxy ha gip t bo no hot ng tt hn. Mi y, tp san y hc uy tn Lancet ng kt qu mt nghin cu ti H Lan v ru vi hin tng sa st tr tu. Theo bo ny th khong 15 - 30ml ru mi ngy c th ngn nga bnh Alzheimer. L do c a ra gii thch l mt cht ru lm mu long hn, lm gim cholesterol, mu lu thng khng tr ngi. Nhng cn c mt cch gii thch khc l lng ru va phi kch thch no tit thm ha cht acetylcholine, mt cht gip cho vic hc hiu v ghi nh tt hn. 6. Loi ru lm gim nguy c ung th Nghin cu ti i hc South Carolina - Columbia cho thy l n tht nng qu chn c th a n nguy c ung th v. Theo nghin cu Nht th cht gy ung th thuc nhm heterocyclic amines (HAs), nhng khi dng chung vi ru ct bng men ch t cy hoa bia th nguy c ny gim i.

238

Ru v sc khe
Theo cc nghin cu ca Okayam University ti Nht th chnh nhng hot cht trong chm hoa ca cy hoa bia (hop) dng lm men ru to ra kt qu tt ny. Trng phng dinh dng John Miller ca Penn State University cng ng rng cy hoa bia c th l nguyn do bo v ngi n tht nu qu chn khi b ung th v. 7. Ru vi bnh tiu ng Kt qu nghin cu vo nm 2004 ca i hc Albert Einstein Bronx, New York cho bit rng nu ung di 45ml ru mi ngy c th gim nguy c mc bnh tiu ng t 35% - 56%, nhng nu ung nhiu hn th nguy c mc bnh li tng ti 43%. 8. Ru gip an thn Mt cht ru c th lm gim bt s bn chn, lo lng thi qu, hoc to mt cm gic thn thin d kt giao. Cho nn trong nhng ba n giao t, mt ly ru l vt xc tc tt a cho vic tho lun cng kia vic n. Nhng phi lun nh rng: Ru nht ung lm cng say, Ngi khn ni lm du hay cng nhm. Va phi, chng mc v c gii hn vn l nguyn tc tt nht cn gi vng khi chm tay n ly ru, d l trong bt c hon cnh no.

239

Dinh dng v iu tr

Tc dng tiu cc ca ru
1. Ru l cht gy nghin Ngay c khi s dng ru nh mt loi thuc tr bnh, ru vn c th gy nghin nu ung nhiu v lin tc. V ghin ru l mt bnh c th a ti s hy hoi c th, phn xc cng nh phn hn. Ghin cng ko theo nhng bng hoi trong gia nh v l gnh nng cho x hi. 2. Ru c nhiu nguy c gy ung th Theo American Cancer Society, ngi ung trn 45ml ru mnh mi ngy th c nhiu nguy c b ung th ming, cung hng, ring vi ph n cn c thm kh nng tng nguy c ung th v. Nghin cu ti University of Oklahoma cho thy l ung nhiu hn 525ml bia mi ngy th c nhiu nguy c b ung th trc trng. 3. Ru a n suy dinh dng Ung nhiu ru a n suy dinh dng. Nh trnh by trn, ru ch cung cp cho c th mt s nng lng, cn cht dinh dng li rt t. Ung mt t bia c th gip n ngon ming hn, nhng ung n vi lon th no c bng, trong d dy khng cn ch cho thc phm. Ngoi ra, nu ung nhiu, i tiu nhiu, li thm i ma, tiu chy th mt ht vitamin, khong cht. Th l thiu dinh dng vi nhiu hu qu nguy hi khn lng.

240

Ru v sc khe
4. Ru lm ri lon cng dng c nhiu bng chng l ung nhiu ru a n gim c mun tnh dc cng nh kh nng cng cng ca c quan sinh dc nam gii. 5. Ru gy mt mi sau cn say Khi ung say qu chn, sng hm sau thc dy s thy trong ngi mi mt, u nhc nh ba b, d dy qun au. Phi my gi sau cc kh chu ny mi thuyn gim. L do l c th, hay ng hn l gan khng sc chuyn ha v loi b mt lng ru qu ln trong thi gian ngn. Bnh thng, ung mt lon bia cn khong vi gi ha gii. Ung nhiu hn, bin cht ca ru s tch t trong ngi di dng m; cc mch mu trn no n to, git lin hi khin nhc u; acid lactic trong mu tng lm con ngi mi mt; i tiu nhiu lm mt khong magnesium, calci nhng li gi acid uric cao nn ngi b thng phong (gout) au nhc khp xng. Nhiu ngi cho rng c ph c th ha gii ru tc dng ca ru, nhng iu ny hon ton khng ng. Khi l ung say, tt nht ch c cch l ung nhiu nc nng ru trong mu gim i, v nm ngh. 6. Ru lm tng t bo m vng bng iu ny to ra mt ci bng ph rt kh coi. Mt nghin cu ti i hc Utal cho thy l khi ung lin tc mt vi loi ru, nht l bia, lm tng t bo m vng bng.

241

Dinh dng v iu tr
Bng ph nam gii km theo nhiu bt n v sc khe hn l cao vng mng m n gii. M trong bng ph s tp trung cc b phn quanh bng, vo mch mu v nng cao cholesterol trong mu. Cn m ng vng s ba khi ph n ln cn th t c nh hng xu cho sc khe.

Gerard Klose, mt nh nghin cu c cho bit l n ng c vng bng 94cm bt u c vn , nu vng bng ln trn 102cm th ngi c nhiu nguy c mc bnh tiu ng, bnh tim, bnh ung th.
7. Ru gy khuyt tt cho thai nhi Hi chng m nghin ru, con khuyt tt l mt hu qu ng ch trch khi ngi m ang mang thai m ung nhiu ru. Khi mang thai d ung t ru cng khng tt, cn nu ung nhiu v ko di, lin tc th s rt ngn thai k (sinh non), a tr c u nh, mt d dng, tim h, tr tu n n... Nhng a con bt hnh do m nghin ru l mt gnh nng v mi mt cho c gia nh v x hi. 8. Ru gy mt t ch Ung nhiu c th a n mt t ch, d nng gin, gy g v hay gy ra tai nn nh ng xe, t ng. Hng trm s vic khng mong mun u c th bt u t ch khng lm ch c bn thn.

Ung vo lc no
a s u ng l nn ung vo ba n c cm c tht. Thc n to lp lt trong lng d dy, ru cng ha ln trong

242

Ru v sc khe
thc n nn gim tc ru ngm vo mu. Thc n cung cp cht dinh dng, lm ta mau no bng, s ung t v thc phm lm chm s hp th ru t rut. Thc phm cn c nhiu m, khong, vitamin, t ng v bo. Nn trnh n thc phm qu mn, v n mn s kht v lm c khuynh hng ung nhiu ru hn. Ru tc dng rt nhanh. Ch ngi thi, hi ru vo mu. Sau khi ung, 20% ru s t d dy chuyn sang mu v vi pht sau phn tn khp c th.

C nn pha long ru khng

Vi ru mnh, nn pha vi nc hoc ung vi nc nng ru gim i. Khng nn pha vi nc c soda nhiu hi v hi lm tng p sut trong d dy khin ru truyn sang mu nhanh hn.

Mt s vn cn lu
Ung ru d nhiu hay t cng nn nh mt s vn sau y: 1. Ru v thuc acetaminophen (Tylenol) khng i i vi nhau c, nht l khi c hai u c dng mc cao v c hai u do gan chuyn ha v a ti suy yu cc chc nng ca gan. 2. Cc thuc chng au nhc khng c steroid nh Aspirin,

Ibuprofen, Naproxen u kch thch nim mc d dy, a n vim d dy, ging nh tc dng ca ru. Khi

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Dinh dng v iu tr
dng cc thuc ny m ung nhiu ru th nn coi chng v bnh tr nn trm trng hn. 3. Thuc tr trm cm v ru u c tc dng lm du thn kinh, m nu du qu th li c nhiu hu qu khng tt v s c tai nn khi li xe, gim chc nng nhiu c quan, a n kh th, bun ng, huyt p thp, hn m. Bnh nhn ang ung loi thuc tm thn Monoamine Oxidase (MAO) u khng c ung ru v tng tc mnh ca hai th. 4. Ti cc trung tm cai nghin ru, ngi bnh thng c cho ung thuc vin loi Disulfam. y khng phi l thuc tr nghin, m l loi thuc dng rn e, nhc nh ngi nghin ng ung ru. V khi ung Disulfam th d ch ung mt t ru l mt my s nng bng, i ma, chng mt, huyt p gim, tm thn bn lon rt kh chu. Mi ln ngh ti phn ng ny l ngi nghin s gh s, khng dm ung ru na. 5. ang ung thuc cm mu, ang c bnh tiu ng th khng nn ung ru, v ru lm chuyn ha thuc cm mu, lm mu long hn cng nh lm gim ng trong mu khin c cn thiu ng trm trng. 6. Ngi ung ru m ht ti mt bao thuc l mi ngy th c nhiu nguy c ung th phi hn ngi khng ung ru.

244

Ru v sc khe
7. Bia c nhiu purin, tin thn ca acid uric, nn ngi b thng phong (gout) khng nn ung trnh cn au nhc ngn chn. 8. Ngi b huyt p cao ung nhiu ru cng d b cn huyt p t ngt ln cao. 9. C ngi cho l ru lm tng kh nng hot ng tnh dc. iu ny ch ng khi ung mt cht ru trong lc tm thn th gin, dc tnh ln cao, v n c kh nng kch thch. Cn khi ung nhiu, ru khng nhng khng lm tng m cn c tc dng lm mt c kh nng thc hin hot ng tnh dc.

Kt lun
i, xt cho cng l, th mi s u phc y, ha y ty theo s khn kho la chn, quyt nh ca con ngi. Bia ru c c t nhiu ngn nm trc. Ngi ung cng nhiu m ngi khng ung cng chng t. Hu qu tt cng c, m xu m cng chng xu. Nhng nu bit cn nhc, ly s chng mc, iu v c gii hn lm kim ch nam th chc l s phc nhiu hn ha v cuc i cng s nhiu vui t bun. Bng nh ngc li, s dng ru mt cch ba bi, khng kim ch th chc chn khng bao lu s dn n cnh ha v n ch, m cuc i v th cng s vui t bun nhiu.

245

RU V PH N C THAI
u l mt trong cc dc phm c xa nht m nhn loi tng bit ti. V ru cng l mt trong nhng cht c hi m con ngi t nguyn tiu th. Ti mt vi quc gia u M, ru l nguyn nhn hng u gy ra chm pht trin tr tu cho a con khi ngi m mang thai nghin ru. Hu qu ny ng trn c hi chng Down, trng hp a con chm tr do m ln tui sinh con ln u. T th k th 18, cc nh nghin cu v cc thy thuc Anh, Php quan st thy hu qu khng tt ca ru i vi thai nhi khi ngi m mang thai ung ru. Nhng thc ra nh hng tai hi ny c ghi nhn trong Kinh Thnh: Ngi n c thai u c nghim tc khuyn co l khng ung ru nho hoc ung mnh v khng c n thc phm khng tinh khit trnh tn thng cho thai nhi. Trit gia Aristote th ni nhng ngi m say sa, in khng, thng sinh ra con l , chm chp.

246

Ru v ph n c thai
nh hng ca ru trn thai nhi c cc gii chc y t Php nghin cu v cng b vo nm 1968. Nm 1973, trn tp ch Y hc Lancet, Kenneth Lyons Jones v David W. Smith t tn cho nh hng ny l Fetal Alcohol Syndrome (FAS). H nghin cu hnh dng bt bnh thng ca 5 a tr do cc b m nghin ru kinh nin sinh ra. Ri n ngy 31 thng 5 nm 1977, trong chng trnh pht hnh bui chiu, i NBC trnh chiu hnh nh em b Melissa b nh hng ca ru do ngi m ung khi mang thai em. u em nh, thn hnh mnh khnh, m mt hp. Dung mo bt bnh thng ca em gy mt xc ng ln trong cng chng. Ngay ngy hm sau, hai c quan uy tn v bnh nghin ru M cng b rng: n b c thai m ung trn 30ml ru nguyn cht mi ngy th u c nguy c sinh con d dng, chm tr. H cng cng b kt qu cc nghin cu dch t rng ru l cht gy ra qui thai, tm tr bt thng khi cn l bo thai hoc khi trng thnh. Cc h thng truyn thng ln cng vi vng ph bin rng ri tin tc quan trng ny. T , cng chng bt u lu tm nhiu hn n vn m nghin ru, con khuyt tt. Gii y khoa m rng phm vi nghin cu, iu tr. Y t cng cng a ra cc chng trnh phng nga, gio dc, hng dn ph n c thai ng ung ru.

247

Dinh dng v iu tr
n nm 1989, trn mi chai ru u buc ghi li cnh bo v FAS nh sau: Ph n khng nn ung ru khi mang thai v c nguy c gy khuyt tt cho thai nhi. Vic ghi r li cnh bo ny trn nhn hiu ru l s thnh cng ca nhiu cuc vn ng k t nm 1977, v cc hng sn xut ru lun phn i bo v quyn li ca h. Cng nm 1989, ti Hoa K, trn giy khai sinh c dnh thm mt trng ghi r nu ngi m nghin ru trong thi gian mang thai a tr. Cng ging nh vi trng hp thuc l, nhiu ngi ng ra kin cc nh sn xut ru v tc dng tai hi ca ru trn thai nhi. Mc d c nhiu n lc, cho n nay ngi ta vn ghi nhn mt t l t 1 n 3 phn ngn tr em trn ton th gii chu nh hng ca tnh trng ng bun ny.

nh hng ru trn thai nhi

Khi ung ru th m ung bao nhiu con cng ung by nhiu, v ru theo mu lu chuyn sang con vi cng nng . Nu trong mu m c nng ru l 0,3% th thai nhi cng l 0,3%. Nhng nh c th to ln hn, l gan ln hn, nn ngi m phn hy lng ru ny nhanh chng hn so vi thai nhi. V th, nu ngi m say ru ch trong vi gi th thai nhi vn cn tip tc li b n vi ngy! Ung say kht trong thi gian ngn li cng nguy hi hn c ung lai rai ko di nhiu nm.

248

Ru v ph n c thai
1. Tc hi ca ru Sau khi ung, cht ru (ethanol) c chuyn thnh acetaldehyd, gy c hi ln t bo thai nhi. Cc chuyn gia a ra mt s gii thch nh hng ny nh sau: a. Ru tng tc vi cht prostaglandin, mt cht c lin h rt nhiu ti s tng trng v cc chc nng ca thai nhi. b. Ru lm gim s lu thng mu t m qua con, do cht dinh dng, dng kh gim v t bo thai nhi b suy yu, km tng trng. c. Ru cng c th nh hng ti s hp th khong cht km v magnesium hoc lm thay i cc enzym, lng hormon nh costicosteroid v hormon tng trng. Mi ngi, mi chng tc c nhng enzym khc nhau phn hy ru, nn nh hng ca ru thay i ty ngi, ty ging ni. d. Ru lm thay i cu trc ca mng t bo, a n thay i hnh dng, kch thc, lm chm s tng trng v chm phn bo. Mi t bo u b nh hng, nht l t bo thn kinh vo giai on u ca thi k c thai. . Ru cng gim kh nng tng hp cc cht dn truyn tn hiu thn kinh cho nn cc hot ng tr no u b nh hng rt nng. 2. Tc hi lu di Tc hi ca ru ln thai nhi khng ch trong mt thi gian ngn, m cn ko di hu nh mi mi v sau. Ty theo

249

Dinh dng v iu tr
tui ca a tr khi ln ln, cc tc hi ny c nhng biu hin khc nhau. Khi tui cn th, tr hay bn chn, d b kch thch, n ng kh khn, chm ln, chm pht trin, c ng khng nhp nhng. Trc tui i hc, tr c biu hin hiu ng qu mc, km tp trung, chm hiu, din t ngn ng kh khn. Vo tui i hc th tr khng th tp trung s ch , qu hiu ng, khng bit lm ton, hc hi chm, km tip thu, hnh ng khng t ch. Khi ln ln, tr km tr nh, km suy lun, nhn xt, khng bit cch s dng tin bc, khng bit hu qu vic lm, hnh ng theo dc tnh khng hp l, c vn trong hnh vi, c x. Hi chng ny l mt tn tt vnh vin, v khng th cha tr dt cng nh c th tr khng th t vt qua khi ln ln nh mt s bnh tt khc. L do l v t bo thn kinh h hng khng hi phc. Nhiu t bo thn kinh khng pht trin, khng tng trng, b trng, thiu dy thn kinh ni kt nn cc chc nng b ri lon.

y l mt vn quan trng gy nh hng ti sc khe nn nhn cng nh c nhiu hu qu xu cho c gia nh v x hi.
3. Giai on mang thai Nghin cu trn c th loi vt mang thai cho thy tc hi ca ru trong giai on u tin ca thai k (tng ng vi 3 thng u tin ca thai k con ngi) a ti khuyt

250

Ru v ph n c thai
tt cc c quan c th; giai on th hai v th ba dn n hnh vi bt thng. Nhiu quan st cho thy ngng ung vo giai on ba ca thai k cng gim bt mt phn nh hng xu. Mt vi ln ung say kht ri ngng cng vn nguy hi d sau ngng ung hon ton. 4. Ung bao nhiu ru l c hi? Cu hi u tin c nu ra l: c mt liu lng ru no c th xem l an ton cho ngi m nghin ru khng? Mt s kin cho l c nhiu th h ph n mang thai ung ru, m tc hi u c xy ra tt c mi trng hp? Mt khc, ngay c cc nh nghin cu hin nay cng cho rng c th mi ngi mi khc nn rt kh xc nh mt liu lng c th xem l gy hi cho thai nhi. V nh th th cng khng th xc nh c mt liu lng an ton. S lng ung nhiu t c d lun trong ngoi y gii quan tm v tr thnh mt ti v sc khe cng cng. Ph n c hng dn, gii thch l khng nn ung ru khi c thai. Cc phng tin truyn thng i chng cng nhc nh cc b m c thai nn trnh ru khi gy ri ro cho con mnh. Trong giai on u tin khi vn va c nu ra, cha c nhiu kt qu nghin cu c th nn mt s thy thuc cho l nu ung di 30ml mt ngy th khng sao. Trong mt quyn sch v sn ph khoa xut bn nm 1977, Benson cng cho l i khi ung ru, chng hn nh ru tri cy trc ba n ti, th khng c nh hng g cho thai nhi. Nhng sau , v nh hng ca ru ngy

251

Dinh dng v iu tr
cng c lm r, nn sch ny khi ti bn nm 1983 sa li l khi c thai nn trnh ung ru l tt nht. Nm 1977, hai t chc quan trng v bnh nghin ru ti Hoa K l National Institute on Alcohol Abuse and Alcoholism (NIAAA) v National Council on Alcoholism and Drug Dependence (NCADD) ra mt thng co chung tuyn b rng ph n c thai nu mi ngy ung t 90ml ru mnh tr ln s c nhiu nguy c sinh con khuyt tt. Cn thn hn na, h cn xc nhn thm ngay c t 30ml cho ti 90ml ru mnh cng c th gy ra tn thng cho thai nhi. Tp san ca Hi Y s Hoa K vo thng 10 nm 1984 c ng mt bi i l d ch ung lng ru va phi cng

gy ra chm tng trng cho thai nhi.

Cng ngy cng c nhiu chng minh chc chn l tc hi ca ru ln thai nhi ty thuc vo s lng: ung nhiu, hi nhiu. V th, nhiu ngi d dng i n kt lun l ung t, hi t; hay ni khc i l khi ngi m ang mang thai th khng c mt liu lng ru no c th xem l an ton cho thai nhi c. c bit, ch cn c mt i ln ung say mm cng qu gy hi nghim trng cho thai nhi. V khng thng nht kin vi nhau v mt liu lng an ton, nn gii chc thm quyn li thng nht a ra mt li khuyn rt an ton l khng nn ung ru khi c thai. Vn FAS t ra ng vo giai on c t l ph n, nht l thiu n, dng ru tng cao. Trong khi k ngh sn xut ru li pht trin rt mnh v ng gp nhiu cho ngn

252

Ru v ph n c thai
sch ca nhiu quc gia. Ru li rt ph bin, c bn hp php, c qung co rng ri, c nhiu ngi ung. Ru cng gy nhiu tc hi cho chnh bn thn nhng ngi m nghin ru trong thi gian mang thai. H d b bng huyt, nhau thai tch sm dn n sy thai.

Du hiu ca khuyt tt
Ngay khi mi sinh, a b c du hiu nh ca mt ngi nghin nh ru: rt d b kch thch, mnh run ry, c tht co git nh ln kinh phong. Hai thay i chnh sau y c m t: 1. Thay i hnh dng Phn u l ni c nhng thay i r nt, c bit nht. u nh, tc mc sau gy, trn d, mt dp, g m thp, tai thp, mi mt sp, mt nh, mi ngn, sng mi dp, mi trn mng i khi ch, rng nh, cm lm, khong cch gia mi v ming rng. Lng ngc nh ra hoc xp vo, ct sng nghing vo; khp xng v t chi bt bnh thng: ngn tay t ngn, co qup; du ngn tay m, c tht nho, khp xng lng lo; c ng xng hng gii hn. Ng quan cng b nh hng: v th gic th c lc mt, rung git nhn cu (nystagmus), cn th c hai mt. Dy thn kinh mt b gim sn. Mt phn ba nn nhn b ic, trong khi th nhiu em li nhy thnh gic bt thng. Hu ht thng b bnh vim tai gia.

253

Dinh dng v iu tr
Tim thn c d tt. Vch nh tht thng rch. Thn gim sn, chia i; bng quang c ti (bladder diverticula), ngc hnh nm trong bng. Cc em u chm ln, bing n, nh cn, ng ngh bt thng. a s c th tng trng c nhng rt chm. 2. Chm pht trin tr tu Hu ht cc em c ch s thng minh IQ (intelligence quotient) thp, khong 68 (so vi ch s trung bnh l 100). Kh nng c hiu v kh nng ton hc pht trin khng ng u v c hai u chm chp. V phng din gio dc, mc d vn c th dy d c, nhng c n 90% cc em km kh nng tip thu v din t ngn ng, 95% khng hc bit c cch s dng tin. Cc em c ting ni l l, m thanh nm li trong cung hng, u u, cng nhc, pht m khng r d ngha v ni dung bnh thng. Thi gian phn ng chm, km tp trung; khng phn bit c mu sc, kh nh tn ngi v s vt; km phn xt, khng bit hu qu hnh ng ca mnh; khng thc c tng lai; khng phn bit khen ch, n ngha; km phi hp cc hnh ng. Ngay t khi cn b, cc em ngang ngc, hay i hi v gy bc mnh cho ngi khc. Ln ln chng thch sng c c, bt cn i, khng chi vi ai, khng nghe li ai, li bing, th ng, bun v c, n cp vt, xm phm tnh dc, lm dng ru.

254

Ru v ph n c thai
Mt hi ngh vo nm 1980 ca cc chuyn gia v hi chng ny ngh l nh bnh, phi c mt trong cc du hiu ca ba nhm biu hin sau y: a. Chm tng trng trc v sau khi sinh vi thiu cn, thiu chiu cao, u nh so vi tui. b. Ri lon v h thn kinh trung ng vi cc du hiu bt bnh thng cc chc nng thn kinh, chm pht trin v hnh vi hoc c h hao tr tu. c. C t nht hai du hiu bt thng v u - mt nh u nh, mt ti h, mp trn rng, mi trn mng, mi ngn, g m dp.

iu tr v chm sc
Trng tm ca vic chm sc l gii quyt nhng vn nn x hi ca ngi m say sa, nhng hu qu m a con tt nguyn gnh chu. ng c a ngi m ti nghin ru cn c tm hiu, gip , chng hn nh: c vn gia nh, mt vic lm, c am m, p lc ca b bn... hoc do khng bit r v tc hi ca ru. Nhng ph nhn, giu gim cn c pht hin, k khai. Gio dc, gii thch v tc hi ca ru i vi ngi m v thai nhi: nguy c khuyt tt, chm tr, nhng vn c nhn v x hi m a b khi ln ln phi gnh chu ch v s say sa ca ngi m. Ngoi ra cn phi ni ti nhng tn km cho gia nh v cho c ngn sch quc gia.

255

Dinh dng v iu tr
Thc t cho thy l nhng ph n c thai cn tr, hn nhn tan v, km vn ha, nghin thuc l l nhng i tng thng ung nhiu ru. H cn c lu tm khuyn gii nhiu hn. Trng hp xt thy cn phi bo v thai nhi th c th t ngi m di s gim st ca lut php. Nghin ru khi c thai c nhiu ngi xem nh mt hnh thc bo hnh vi thai nhi, cp mt i quyn sng cuc i bnh thng ca chng. Trong hng dn, gio dc, nn nhn mnh nhng nh hng xu ca ru v li ch ca c m ln con khi m ngng ung. Khng bao gi qu tr b ru, v ngng lc no l thai nhi bt nguy hi lc , v d mun n u cng vn cn hn l c tip tc ung. Thuyt phc hn l da nt trnh thi i khng, bng bnh. Vi a con th vic chm sc, iu tr phc tp, tn km v lu di hn v a b sinh ra vi nhiu vn tn thng v th xc v tm thn hu nh khng hi phc. Vo tui i hc, cc em u c nhiu kh khn trong hc ng. Ln ln, cc em hay c nhng hnh vi khng hp l, phm php, khng gi c lin h gia nh, nht l i vi ngi m sinh ra mnh. a s cc em c chm sc bi cha m nui hoc trong vin m ci. Nhiu em sau ny cng ri vo vng nghin ngp, b tha. V x hi phi cu mang gnh nng gip cc em sut i.

256

Ru v ph n c thai

Kt lun
Tuy t l mc phi hi chng m nghin ru con khuyt tt khng cao lm (khong 0,1 - 0,3% trn ton th gii), nhng nhng a con sinh ra u mang nhiu tn ph ca c th v sng trong nhng hon cnh ng thng. Tt c ch v s thiu thc km theo mt cht yu lng ca ngi m. Hiu c nhng iu , khi c thai th ngi m d ang nghin ru cng nn dn lng b hn cho qua khi thi gian chn thng mi ngy cu mang, m trn con vung, cho gia nh m m vi ting ni trong vui ca tr th lnh mnh.

257

CHOLESTEROL V SC KHE

xa xa, con ngi bit rn m ln ly m nc xo nu. Tp m cn c ch bin thnh mn n nh chin gin, xo vi cc loi rau hoc nu canh c chua. Ngi ta n m heo th ca, v t. Mn tht m da hnh, tht kho ng vi nhiu m trng khng th thiu trong dp c khch hay l lc. Ri n thi gn y, khi k ngh ch bin thc n pht trin mnh th tht hp, pa t, b sa, jambon nhiu cht bo lan trn khp ni trn th gii v tr thnh nhng mn n thi thng, sang trng. Cht bo ng hnh trong cc ba n ca con ngi khng bit t bao gi. Vy m khng my ai c th ng c rng, vi nhng khm ph mi ca khoa hc ngy nay th m ln c ch r l mt trong nhng cht bo c nguy c a n bnh va x ng mch vi cc bin chng gy nhiu t vong, tn ph.

258

Cholesterol v sc khe

Vi hng y s
Nm 1755, mt nh sinh hc Thy S m t s thoi ha, ng cc ca cht bo vo thnh ng mch. n nm 1908, cc nh khoa hc Nga nhn thy rng, khi c nui bng sa v lng trng, th s mc bnh va x ny. Nm 1913, cc nh khoa hc chnh thc xc nh cht bo cholesterol trong m bo l th phm gy bnh. Nm 1916, khi quan st cc th dn mt vi hi o thuc Indonesia, mt y s ngi H Lan nhn thy rng cholesterol trong mu h thp hn nhm quan li cai tr ngi phng Ty, v s ngi b bnh tim cng t hn. Nhng khi th dn ny b mn n qu hng chy theo dng cc thc n phng Ty th cholesterol tng cao v t l bnh tim cng tng theo. Ri n th chin th hai, khi m tht, b, sa u khan him, t l bnh tim gim r rt v nhng ngi b ln cn au tim (heart attack) bao gi cng c lng cholesterol trong mu cao hn. Mt so snh na l th dn Eskimo Alaska t mc bnh tim mc d h tiu th rt nhiu m, nhng l m t cc loi c. Nm 1949, mt ti liu y hc ni v nguyn nhn gy ra bnh va x ng mch c pht hnh. Trong sch, tc gi nhn mnh ti vai tr ca m bo v cholesterol trong bnh ny.

259

Dinh dng v iu tr
V t con ngi rt lu tm, i khi qu m nh, ti vai tr ca cht bo trong bnh tim mch. Nhiu ngi cn khng nm vng, i khi bi ri v s tng quan gia cht bo trong thc phm vi cc bnh tim v c qu nhiu thng tin nghin cu phc tp.

Cht bo
Cht bo hoc lipid l nhng phn t khng ha tan trong nc. Lipid c cha nhiu acid bo (fatty acid), rt cn thit cho s tng trng ca con ngi. Ngoi ra lipid cn c nhiu vai tr quan trng khc trong c th nh: 1. L thnh phn cu to mng t bo. 2. L ngun cung cp nng lng. 3. L lp n cch ly v bo v ph tng. 4. L phng tin chuyn ch cc vitamin ha tan trong cht bo. C nhiu loi lipid m cholesterol v acid bo c nhc ti nhiu hn c. a. Acid bo Gm c cc nhm khc nhau nh acid bo bo ha (saturated fatty acid) acid bo cha bo ha dng n (monounsaturated fatty acid) v acid bo cha bo ha dng a (polyunsaturated fatty acid). Tt c u c cu to bi cc phn t carbon, hydrogen v oxygen. Khi cc phn t c carbon mang mt s lng ti a nguyn t hydrogen th cht bo c gi l bo ha (saturated fat).

260

Cholesterol v sc khe
Dng cht bo ny c nhiu trong thc phm ngun gc ng vt nh tht b, tht heo, b, sa, m heo... v trong du da v th rn vi nhit bnh thng. Nu thiu nguyn t hydrogen th cht bo c gi l cha bo ha (unsaturated fat). Nu ch thiu mt nguyn t hydrogen th c gi l cha bo ha dng n (monounsaturated), nu thiu nhiu nguyn t hydrogen th c gi l cha bo ha dng a (polyunsaturated). Dng cht bo cha bo ha thng trng thi lng, c nhiu thc n thc vt nh du liu, du u phng, du ng (bp), ht hng dng... hoc trong vi loi hi sn. Omega-3 v omega-6 thuc nhm cht bo cha bo ha dng a. Gn y, s phn chia cht bo tr nn phc tp hn khi loi acid bo ch bin (transfatty acid) c to ra. y l dng cht bo c cc nh my ch bin to ra bng cch b sung nguyn t hydrogen cn thiu vo cht bo cha bo ha lm cho n tr thnh bo ha. Quy trnh ch bin ny c gi l hydro ha (hydrogenation), v n lm cho cht bo c dng rn nhit bnh thng. Mt th d cho dng cht bo ny l du thc vt margarin c ng thnh tng cc bn cc siu th. b. Cholesterol L mt cht ging nh sp, mu trng. Mc d chu nhiu ting xu trong vic lm hi sc khe, nhng thc ra n c

261

Dinh dng v iu tr
chc nng gp phn trong vic to mng t bo, m thn kinh no b, v l thnh phn cu to ca mt, hormon steroid, vitamin D. Hu ht lng cholesterol cn thit trong c th u c gan cung cp nn ta khng cn phi n thm. ngi khe mnh, gan s gim vic to ra cholesterol khi thc phm c nhiu cht bo loi ny c tiu th. Ch c thc phm t ng vt mi c cholesterol, th d nh trong tht b, sa, b, pho mt... Trong mu, cholesterol c cht m (protein) chuyn ch v c gi l lipoprotein. Ty theo t l protein nhiu hay t, ta c lipoprotein t trng thp (LDL - low density lipoprotein), hay lipoprotein t trng cao (HDL - high density lipoprotein), cng c mt phn rt nh lipoprotein t trng rt thp (VLDL - very low density lipoprotein) c gan to ra. HDL thng c coi nh phn t hin ha tt bng v n a cholesterol vo tch tr trong gan ri c o thi ra khi c th, do lm bt m lu thng trong mu, lm gim nguy c ng m thnh ng mch, gim nguy c bnh va x ng mch. Ngc li LDL l thnh phn tiu cc, xu tnh. N chuyn cholesterol vo cc t bo ca c th. Khi cholesterol trong mu ln cao, t bo khng ch nhn th cholesterol s ln vn trong mu v gia tng s ng ba thnh ng mch.

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Cholesterol v sc khe
Ch s cholesterol cc loi trong mu c o bng n v milligram (mg) trong mt decilit (dl) mu (mg/dl). Vin Sc khe Quc gia Hoa K a cc ch s sau y dng lm tiu chun:
L tng Tng s cholesterol dl HDL cholesterol LDL cholesterol dl Di 200mg/dl Trn 45mg/dl Tm c Khng tt 200-240mg/dl Trn 240mg/ 35-45mg/dl Di 35mg/dl

Di 130mg/dl 130-160mg/dl Trn 160mg/

Ngi bnh thng khe mnh cng nn kim tra lng cholesterol trong mu khong 2, 3 nm mt ln. Nn kim tra thng xuyn hn khi c triu chng cholesterol tng cao. Vic th mu c th thc hin bt c lc no trong ngy. c. Triglycerid v VLDL Ngoi ra mc hin din ca cc cht triglycerid v VLDL trong mu cng cn c theo di. Mc d vai tr ca chng trong nguy c gy bnh tim cha c xc nh, nhng nhiu nghin cu cho l khi dng cht bo ny ln cao th u khng tt cho tim. Triglycerid c gan sn xut, l dng tn tr ca cht bo trong c th v c loi VLDL chuyn ch trong mu. VLDL lm tng triglycerid v gim HDL trong mu. Lng triglycerid di 200mg/dl c coi nh bnh thng. Cht ny thng tng cao trong cc bnh tiu ng, bnh thn. Khi ly mu kim tra mc triglycerid, cn nhn n t nht l 14 gi.

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Dinh dng v iu tr
d. Acid bo omega-3 Loi acid bo ny cng ng vai tr rt tch cc trong vic nga nguy c bnh tim. N c nhiu trong m ca cc loi c hi, c ng, c thu, c sardin... Th dn Eskimo n nhiu c nn s ngi b bnh tim rt thp v c rt t cholesterol trong mu.

Vai tr ca cht bo trong c th

Cht bo l mt trong ba ngun cung cp nng lng ch yu cho cc chc nng ca c th: cht m, cht carbohydrat v cht bo. Cht bo cung cp nng lng nhiu gp i so vi 2 loi kia: 1g cht bo cung cp cho c th 9kcal, trong khi 1g carbohydrat hay cht m ch cho 4kcal. Cht bo cng nh cholesterol khng phi l c cht i vi c th, m l cht thit yu cho mi t bo ng vt. Cho nn thc khng cng bng khi xp loi cht bo l thc phm xu. Tc hi ca cht bo thc ra l do s tiu th qu mc ca con ngi, v mt ch dinh dng khng cn i hp l th d l thnh phn dinh dng no cng c th a ti hu qu bnh tt cho con ngi. Mi tng quan gia cht bo, cholesterol vi bnh tim l mt vn phc tp, c quan st thy nhng xc p Ai Cp t nhiu ngn nm trc, nhng dn tc thuc cc vng c ch n ung khc nhau, nhng kt qu nghin cu, iu tra khoa hc trong nhiu thp nin va qua.

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Cholesterol v sc khe
Tt c u c cng kt lun cho l mt ch dinh dng nhiu m bo qu s a ti nguy c bnh tim m va x ng mch l bc khi u. ng thi khi lm gim cholesterol mt ngi c mc bnh thng v khng c du hiu bnh tim mch u lm h thp nguy c t qu (heart attack) ti 40 - 50%. V th, mc cholesterol cng thp cng tt. hot ng hu hiu, cc mch mu cng nh cc c bp cn c khe mnh, linh hot v gi c tnh n hi. Lng mch mu cn trn nhn mu lu thng d dng. Trong bnh va x ng mch, thnh ng mch c nhng mng ba ging nh cho, gm c cholesterol v t bo mu ng vo, khin cho tr nn g gh, thu hp li, gy tr ngi cho s vn chuyn ca mu. Lng mu n tim gim, tim c nui dng km, gim hot ng, ri mt lc no a n cn t qu. Nhng mng ba c th bt ri thnh mch mu, ngao du khp c th theo h tun hon, gy ra nghn mch. Ln n no, n to ra tai bin mch mu no; khi ti tim, n gy ra nhi mu c tim. Mi nm, c c hng trm ngn ngi cht v nhng bin c tim mch thuc loi ny. C mt im cn lu l c th c kh nng t sn xut lng cholesterol cn thit. Khi cp n con s cholesterol th l ni ti lng cholesterol lu hnh trong mu, trong c ti 85% do c th to ra v 15% do thc phm a vo.

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Dinh dng v iu tr
Cholesterol trong mu c th tng cao khi ta tiu th thc phm cha nhiu loi cht bo ny hoc nhiu cht bo bo ha.
Ngoi ra cholesterol trong mu cng tng cao theo tui tc, khi tng cn qu nhiu, nht l bo mp vng bng, khi mc cc bnh tiu ng, huyt p cao; khi c np sng khng lnh mnh nh lm dng ru, thuc l, c i sng qu tnh ti hoc c nhiu mi lo u, bt mn. V mt s trng hp c mc cholesterol cao cn l do yu t di truyn.

Lm th no gim cholesterol?
im cn lu u tin l n t cholesterol khng c nh hng my ti lng cholesterol trong mu. Nhng gim bt cc thc phm c cht bo bo ha th kt qu tt hn nhiu. Th hai l trong thc phm, tt c cholesterol u ging nhau, khng c loi xu, loi tt. Nhng trong mu th

cholesterol tr nn tt hay xu l ty theo loi lipoprotein chuyn ch n.

Th ba l cc loi cht bo cha bo ha t thc vt khng gy ra s ng cc mng ba trong lng ng mch. Sau y l mt s hng dn lm gim cholesterol trong mu: 1. Chn thc phm c t cht bo. Nu gim cht bo xung cn 30% tng s nng lng do thc phm cung cp th nguy c bnh tim mch s gim theo rt nhiu.

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Cholesterol v sc khe
Dn chng vng a Trung Hi u t mc bnh tim v h dng nhiu du liu, cc loi ht, v rt t khi n tht b, tht heo. 2. Chn thc phm c t cht bo bo ha v dng cht bo ny lm tng cholesterol, LDL v triglycerid trong mu. Nn n nhiu rau, tri cy, ht ng cc. Cht bo bo ha c nhiu trong kem, b, sa nguyn cht, pho mt, da g, m trn tht nc, m heo... 3. Hn ch thc phm c nhiu cholesterol nh lng trng, gan. Lng trng trng v thc phm t thc vt khng c cholesterol. Mt lng trng c ti 250mg

cholesterol. Theo Hip hi Tim mch Hoa K th ngi ang khe mnh c th n khng qu 4 qu trng mi tun.
4. Trnh cc loi du da, du c (palm) v c nhiu

cht bo bo ha. Du ny thng c trong ko s-cla, bnh bch quy...

5. Dng cht bo cha bo ha trong du ng (bp), du liu, du u phng, du m (vng), tri b... v mt vi loi c. Cht bo cha bo ha c tc dng lm h

cholesterol.
6. Hn ch cht bo ch bin (transfatty acid) nh margarin dng rn v c tc dng lm gia tng cholesterol trong mu. Margarin mm t hi hn. Loi b thay th

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Benecol hay margarin ch t u nnh c th gip h cholesterol trong mu.
7. Tiu th nhiu acid bo omega-3, c nhiu trong c hi, c ng, c thu, c sardin... Lu l nu mun dng du c dng vin ung, nn tham kho kin bc s v du c c th tng tc vi mt vi dc phm. 8. Tng lng cht x v tinh bt c trong ng cc, rau tri, m ng, m si... Cc cht ny c rt t cht bo bo ha,

cholesterol v cung cp t nng lng.

9. Gi cn nng mc trung bnh, trnh tng cn qu nhiu. 10. Nng vn ng c th lm tng lng HDL, gim LDL, gim cn, h huyt p. Vi s vn ng, tp luyn c th u n v gim tiu th cht bo c th lm h

cholesterol trong mu xung ti 15%.

Ngoi ra, nn tiu th nhiu cc sn phm ch bin t u nnh, c t cholesterol li nhiu m thc vt, d tiu; tng cc cht chng oxy ha nh vitamin E, C, beta carotene v tc dng tt trong s chuyn ha

cholesterol.
Trc y mt s ngi thng nhn thc sai lm v cc mn n thy sn nh tm, cua, trai, s... cho rng chng c nhiu cholesterol. Thng tin gn y cho bit l cc thc phm ny u an ton v phng din cht bo,

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Cholesterol v sc khe
nht l khi chng c ch bin bng nhng cch nh hp, luc, nng, b l ch khng chin trong du m. 11. i khi, p dng tt c nhng bin php tch cc nhng cholesterol trong mu vn cao v nh hng ca gen di truyn th phi s dng n cc dc phm. Tiu chun dng dc phm thng l khi LDL cao qu mc, khong 190mg/dl hoc trn 160mg/dl cng thm vi nguy c gy bnh tim khc nh ht thuc l, huyt p cao, bo ph. Th trng hin nay c rt nhiu loi thuc cng hiu lm h mc cholesterol trong mu, ngn nga s ng cc mng ba vo thnh ng mch v ngn mng ba khng tch ri khi thnh mch mu chy ti cc b phn quan yu nh no, tim. Vic dng cc dc phm ny cn c bc s cn nhc k ty theo tng trng hp, v khi ung th phi ung trong nhiu nm, c khi sut cuc i. Thuc li rt t tin v vi loi thuc c nhng tc dng ph nguy him hng hn nh lm hi ti gan. 12. Ngoi cc loi tn dc, cn mt s dc tho cng c cho l c th lm gim cholesterol trong mu nh betasitosterol ch bin t u nnh v go, citrus pectin t h chanh, cam bi; t ti.

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Dinh dng v iu tr

Kt lun
C qu nhiu ti liu ni v cht bo - cholesterol, i khi lm ta bi ri. Gn y, nghin cu li tm thm ra lipoprotein(a) cng xu khng khc g LDL. Sau hn 50 nm, khoa hc lm sng t mt phn no vai tr ca cholesterol tng cao trong mu i vi bnh va x ng mch, mt nguyn nhn a ti t vong v bnh him ngho v nhi mu c tim, tai bin mch mu no. Nhng nguyn l sinh bnh ca va x ny cn nhiu b n cn tip tc c khm ph. Khi , vic iu tr v phng nga bnh ny hy vng s d dng v cng hiu hn. Hn na, ta khng th gt b cht bo khi khu phn dinh dng v c th cn nng lng t cht bo, cn vitamin tan trong cht bo, cn cht bo cu to mng t bo, m thn kinh, tim... Cho nn gin d hn c l khi mun trnh bnh tim mch do cc cht bo ny gy ra, ta ch cn hn ch tiu th thc phm t ng vt nh tht, sa v cc ch phm ca sa, tng thm lng thc phm t thc vt. Song song theo l hnh thnh mt np sng lnh mnh, thng xuyn vn ng v rn luyn c th. c nh vy th c th lun c c nhng iu kin ti u chng li bnh tt. V cng nh m c th bo v c tri tim cng nh mt sc khe ton din.

270

DINH DNG V BNH BO PH

Bo ph c th xy ra tui ang ln, trong t bo m va tng trng va phn sinh, hoc tr hn t tui trng thnh bng s phnh ln t bo m. y l mt bnh ko di, ngi bnh phi lun lu tm n vic n ung, vn ng c th v tun theo mt np sng lnh mnh mi c th thay i c tnh trng.

o ph l tnh trng tch t cht bo vt qu nhu cu duy tr cc chc nng ca c th.

nh ngha
Vic tch t m trong c th l iu t nhin bt c ai, v y l cch c th d tr nng lng cho nhng lc thiu ht. Tuy nhin, nu vt qu mt gii hn hp l th s tch t m s bt u tr thnh bt li, c nhiu nguy c gy ra cc bt n v sc khe. V lng m tch t s lm cho c th tng trng, nn ty theo mc tng cn m ngi ta nh gi lng m trong c th l va phi, hi qu mc hoc ng bo ng. T chc Y t Th gii c a ra cch tnh ch s trng lng c th (body mass index - BMI) xc nh mc bo mp ca c th.

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Dinh dng v iu tr
tnh ch s ny, ta ly trng lng c th tnh bng kilogam chia cho bnh phng chiu cao tnh bng mt. Th d: mt ngi nng 69kg, cao 1,8m, ch s BMI s l 69: (1,8 x 1,8). Kt qu c lm trn s l 21,30. Ch s BMI t 18,5 ti 24,9 l bnh thng; t 25 ti 29,9 l qu cn (overweight); t 30 tr ln l bo ph (obesity), v trn 40 l rt bo ph. Ch s BMI da vo chiu cao v trng lng c th, nhng khng tnh ti t l gia cc thnh phn nh xng, c bp, cht bo. Trong thc t, t l gia cc thnh phn ny khc nhau nhng ngi c cng ch s BMI. Do , cch tnh BMI xc nh tnh trng bo ph ch ng vi mt s ngi - c th l a s - trong khi vi mt s ngi khc th ch s ny khng th hin ng tnh trng sc khe ca h. Ly v d, mt ngi c c bp pht trin rt tt c th c mt trng lng c th kh cao nhng trong c bp chim t l cao hn m bo. Ch s BMI ca ngi ny c th xp vo loi c vn , trong khi thc t l ngi y rt khe mnh. Ngc li, vi mt ngi t hot ng c th, c bp km pht trin, c th c mt ch s BMI thuc loi kh tt, nhng trong thc t l lng m bo tch t trong c th ln n mc ng lo ngi. Mt s nh khoa hc ngh mc cn nng c xem l l tng nh sau: N gii: Chun mc c bn l: cao 152cm, cn nng 45kg. Vi ngi c chiu cao tng thm 1cm th cn nng tng thm 0,9kg.

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Dinh dng v bnh bo ph

Nh vy, mt ph n cao 160cm th cn nng l tng l: 45kg + [(160 - 152) x 0,9] = 52,2kg. Nam gii: Chun mc c bn l: cao 152cm, cn nng 47,25kg. Vi ngi c chiu cao tng thm 1cm th cn nng tng thm 1,06kg. Nh vy, ngi n ng cao 170cm th cn nng l tng l: 47,25kg + [(170 - 152) x 1,06] = 66,33kg. Mt ngi c xem l bo ph (obesity) khi cn nng vt qu mc cn nng l tng t 20% tr ln. Trn mc trung bnh v thp hn mc ny, ngi c th c xem l qu cn (overweight). Trong trng hp cc v d nu trn, nu ngi n ng cao 170cm nng t 79,6kg tr ln, ngi ph n cao 160cm nng t 62,64kg tr ln th u c xem l bo ph. Mt s ngi khc ngh cch o t l vng bng/vng hng xc nh nguy c bo ph. Cch lm nh sau: dng thc dy o vng bng ch ngang rn (th d 71,12cm) v vng hng ch ln nht (th d 96,52cm). T l c lm trn s l 0,74. Nam gii c t l trn 0,95, n gii trn 0,8 l bt u c nguy c bo ph.

i iu cn bit v bo ph
a. Bo ph thng thy n gii nhiu hn nam gii. M n gii li rt hay quan tm ti chuyn bo gy. kin chung vn cho l ph n s p, hp dn v hnh phc hn nu c mt thn hnh mnh mai, thon th.

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Dinh dng v iu tr
Ph n trung bnh c 20% m bo v 10% l cht bo cn thit (essential fat) trong khi nam gii ch c t 12 ti 15% m bo vi t 4-7% cht bo cn thit. C th nam gii khi bo ph c hnh dng mt qu to vi 20% m t phn bng. N gii khi bo ph li mang hnh dng mt qu l vi 8% t bo m t vng mng v cp i. S phn phi ny cng c mt s nh hng ti sc khe. Vi n gii, khi mang thai, nui con, th m l ngun cung cp nng lng cho nhu cu dinh dng thai nhi v con th. Cn nam gii, cht bo ni bng li c chuyn thnh cc dng m bo nh triglycerid, cholesterol... i vo mu kh mau l v nng cao nguy c bnh tim mch, tiu ng, huyt p cao. b. Trong c th, m c loi rt cn v loi cn va phi. Rt cn l m bao bc che ch tri tim, phi, cu to ty xng, mng bc dy thn kinh, chuyn ch cholesterol trong mu. M cn va phi thng nm di da, gia cc th tht v cc c quan ni tng. Bo ph c th l do t bo m va phnh to va sinh sn nhanh tui tr hoc ch tng trng qu c cc t bo m c sn vo tui ln hn. c. Khi vn ng c th, tit gim n ung hoc khi au m th t bo m nh i nhng s lng khng gim. Cc t bo m nh i ny lun lun ch c hi bnh trng tr li khi thc phm n vo vt qu nhu cu nng lng c th. trnh bo ph, khng phi ch gim m, m cn phi lu s nng lng n t cc nhm thc phm khc,

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Dinh dng v bnh bo ph

cn i vi nhu cu tiu th nng lng ca c th, v tt c nng lng tha u s chuyn sang dng m. d. Bnh thng con ngi khng bo qu hoc gy qu, v trong c th c mt c ch iu ha cn nng. C ch ny hot ng qua trung gian ca h thn kinh vi cc cht nh norepinephrine, dopamine, to ra cm gic i v n ngon ming sau khi thc phm c hp th v kho d tr vi, ng thi cng to ra cm gic tha mn, no sau khi n mc nhu cu ca c th. Nhng trng hp bo ph thng l khi u t s ph v quy lut ny, n ung ba bi khng tun theo nhng cm gic t nhin ca c th. iu ny c th l do np sng khng lnh mnh, hoc do c nhng ri lon xut pht t bnh tt, cc vn tm l...

Nhng nguy c a n bo ph
c nhiu gi thuyt gii thch ti sao ngi ny bo m ngi kia li khng mc d n ung gn nh nhau, cng nh ti sao rt kh khn trong vic gim cn nhng ri li mp ra qu d dng. 1. Di truyn Theo thng k, t 25% ti 40% ngi c BMI cao l do di truyn v 30% ti 60% l do mi trng. Mt chuyn gia gim cn, George Bray cho rng: di truyn l yu t to iu kin v mi trng l yu t thc y trong qu trnh bo ph.

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Dinh dng v iu tr
Di truyn c nh hng ti: a. Cm gic thm n v no , qua trung gian hormon v h thn kinh. Khi cm gic ny khng bnh thng th vic n ung cng khng bnh thng, vt qu nhu cu thc s cn thit ca c th. b. Kch thc v s phn phi ca t bo m trong c th. nh hng ca di truyn tng khi trong gia nh c cha, m bo ph. Khi ch c hoc cha hoc m bo ph th con c 50% nguy c bo ph. Nhng nu c cha m u bo ph th nguy c ny tng ln ti 80%. 2. Cu trc ha hc Cch y t nm, cc nh nghin cu ni n mt cht m do t bo m tit ra c th lm tiu m. l cht leptin hoc obgene, c tm ra nm 1994. Vo lc , tun bo Time gi lepsin l mt thn dc c th lm tiu m trong vi tun l. loi chut, khi tim cht ny th m bo c tiu i rt mau. Nhng ngi th cho ti nay cha thy chng minh c tc dng ny. Mt cht khc l propiomelanocortin (POMC) cng pht tn hiu ngn chut khng n cht bo qu nhiu, nhng cc nghin cu khng tm ra tc dng tng t vi con ngi. Cc nh khoa hc cng phn bit hai loi t bo m: t bo m trng v t bo m nu.

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Dinh dng v bnh bo ph

T bo m nu chuyn cht bo ra nhit nng thay v cht bo d tr, cn t bo m trng th lm ngc li, chuyn cht bo thnh m trong c th. Cc nghin cu ang hng n vic s dng t bo m nu loi b m ngi bo ph. 3. Dc phm Mt s dc phm c th lm tng cn ngoi mun, l: thuc tr bnh tm thn lithium, thuc tr kinh phong Depakene, Tegretol, cc hormon corticosteroid, estrogen, progesteron, testoteron; thuc insulin tr tiu ng... 4. t vn ng c th Bo ph l hu qu ca s mt cn i gia cung v cu v nng lng: n ung nhiu m vn ng c th t nn tiu th khng ht nng lng a vo. Ngi cao tui gim vn ng, ngi qu say m cc hnh thc gii tr tnh ti nh xem phim, c truyn... ngi lm cng vic vn phng... u c khuynh hng tng cn. 5. Thi quen sai lm Mt s thi quen sai lm cng dn n bo ph. Chng hn, khi cn nh chng ta thng c cha m khuyn l khng nn phung ph b thc n tha, v cn c rt nhiu a tr khc khng c g n. Nhng suy ngh mang ngha chia s ny l ng, nhng i khi chng ta vn dng sai lm khi ln ln. Thay v tit gim phn n ca mnh mc va phi c iu kin chia s vi nhng ngi kh khn, chng ta li c

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n cho ht nhng g dn ra trn bn n, ch khng b ph thc n, v do dn n bo ph. 6. n ung giao t Chng ta thng c thi quen kt hp vic n ung vi giao t, chng hn nh mi ba cm tra bn chuyn lm n l chuyn rt bnh thng. Tuy nhin, khi n ung trong nhng trng hp ny chng ta thng khng gi c theo nhu cu t nhin, m rt thng l qu c. Km theo vic thc n di do cc mn gy mp, cn l bia ru kch thch n nhiu hn v cung cp nng lng tha... V th, d khng loi b hn c nhng ba n loi ny, chng ta cng cn phi tnh to nhn bit gii hn chng mc c th chp nhn c. 7. Kh hu Kh hu vng c tr cng c i cht nh hng. Chng hn, quan st cho thy nhng ngi sng vng lnh thng t vn ng v n nhiu thc phm c cht bo hn nhng ngi sng vng c kh hu nng. Do , h thng d tng cn.

Hu qu ca bo ph
Ngi bo ph thng mau mt, ht hi th, thiu sc sng, au nhc xng tht. H cng thng mc phi cc bnh tiu ha, bnh tim, bnh tiu ng, x gan, sng phi, vim ti mt, gin tnh mch, huyt p cao, lu lnh vt thng, thng phong (gout), him mun, gim kh nng khng vi bnh tt, v d gp nhng s c bt thng v sc khe.

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Dinh dng v bnh bo ph

Bo ph cng tng nguy c cc bnh ung th: v, t cung, tuyn nhip h, i trng, thc qun. Ring nguy c ung th v tng rt cao ph n tng cn vo tui i mi v vo thi k mn kinh.

iu tr bo ph
Cc chuyn gia u ng rng bo ph l mt bnh lin quan n nhiu yu t khc nhau nn cn c iu tr ton din v lu di. Trong thc t, khng c bt c loi thn dc hay phng thc thn k no c th lm gim cn tc khc nh rt nhiu qung co thng c nghe thy. Mt khc, c nhng gii hn khng th vt qua. Chng hn, nhiu ngi mun gim cn tr li nh thu cn hc sinh, sinh vin. y l mt o tng khng bao gi c th thc hin c. D l p dng bt c phng php gim cn no, ch cn mi tun gim c 1kg hoc 2 n v BMI l kh quan lm ri, v cng mang li rt nhiu li ch cho sc khe. Vic gim cn nht thit phi cn n thi gian. Trc khi quyt nh gim cn cn phi tham kho kin bc s v quan trng hn l phi pht hin cc tc nhn gy bo ph. Mi ngi c mt c th khc nhau, cch mp khc nhau, nn mun gim cn cng phi c mt chng trnh, k hoch ring. V th, vic trc tin khng phi l mun gim bao nhiu trng lng c th, m l phi lp ra mt chng trnh hnh

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Dinh dng v iu tr
ng ton din bao gm: ch n ung lnh mnh, vn ng c th u n v lu di, thay i cc thi quen xu v lu tm ti cc nguy c do bo ph gy ra. Cc bin php c th gim cn c trnh by sau y: 1. Gii hn nng lng tiu th a. gim cn, vic u tin l phi gim s nng lng t thc phm a vo c th, nhng vn m bo y cht dinh dng. Mt trong nhiu mc ch l buc c th phi ly nng lng t s m bo tch t vng mng, vng bng cho nhu cu hot ng hng ngy. Trung bnh mi ngy ch nn tiu th t 1200 2000Kcal, ty theo mc sinh hot. b. Nn n nhiu loi ht ng cc, tri cy, rau... l nhng th khng c hoc c rt t cht bo v nng lng. Nhiu ngi khuyn nn n va phi carbohydrat, kh m, thm mt t cht x bng mau no v thc n chm ra khi d dy. c. V cht bo th hn ch khng dng qu 30% tng s nng lng mt ngy, t 20 n 25% l tt nht. Chng hn nh v sa. Thay v dng mt ly 240ml sa nguyn cht vi 47% nng lng t cht bo, ta c th dng mt ly sa khng bo (di 0,5% cht bo) hoc sa gim bo (2% cht bo) ch c di 35% nng lng t cht bo. Tng t, nu s dng tht cng phi ch chn loi rt t hoc khng c m bo. Bnh m n vi b khng tt bng vi mc tri cy, v b cung cp n 120Kcal trong mt mung, trong khi mt tri cy ch c 50Kcal m li khng c cht bo.

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Dinh dng v bnh bo ph

d. Chia u phn n ca mt ngy cho ba ba n, mi ba c t nht 25% tng s nng lng mi ngy. Lm nh vy s gip ta cm thy ngon ming trc mi ba n, ch khng phi l mt ba cm chiu thnh son v ba tra khng n. Nhiu ngi cn cho rng nn chia lng thc n ra thnh 5 hoc 6 ln trong ngy. . Mn trng ming cng ch cn gii hn trong mc hp l ch khng cn thit phi b hn, chng hn nh mt ly tri cy, mt ming bnh ngt nh... e. Cn phi tun th nghim nht ch dinh dng c bc s hng dn ra. n nhiu loi thc phm a dng, cn bng theo nhu cu nng lng v n vi mc va phi. g. Ghi r thnh mt bng k nhng thc n nn trnh nh ru, du salad, mn n trng ming nhiu ng, bo... v lun lun ghi nh trnh. h. Khi i n tim, ng c thc n qu lu trc khi gi mn n v d b quyn r bi nhiu mn. Cn bit trc chnh xc mnh nn n mn no ch khng chu nh hng ca ngi khc khi chn thc n. ng ngi t thng vn vi ngi phc v v cc yu cu ca mnh, chng hn nh b da, cho t b... Trnh cc mn n chin, mn nhi v c nhiu cht bo, chn cc mn t bo nh khoai b l, rau, cc mn luc, hp... i. Khng nn xem tivi khi ang n v c th s theo thi quen n qu nhiu.

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Dinh dng v iu tr
2. Dinh dng gim bo C nhiu ch dinh dng c gii thiu gip gim mp nh chng trnh n nhiu cht m, t carbohydrtat; hoc nhiu carbohydrate t m, nhiu cht x... Ngi gii thiu phng php no cng nu ra nhng u im v thuyt phc ngi bo ph p dng phng php ca mnh. V th, vn ny cn c cn nhc k. V nguyn tc, d nhm n bt c mc ch no th c th vn cn phi c mt ch dinh dng cn bng c cht m, cht bo, carbohydrat, vitamin v khong cht, ch khng th ch gii hn mt vi loi cht dinh dng. Vn y l s cn i hp l t l cc thnh phn cht dinh dng trong mt ch n c th t n mc ch ra. Hn na mc ch gim cn phi l hc cch sng vi thc phm ch khng phi loi b th ny th kia. Kinh nghim nhiu ngi cho thy khi gim cn theo cch hn ch n ung th mp tr li rt nhanh. H m nh vi ch n ung ang tun theo, m tng calori c trong cc mn n tnh ton v thng t ngh rng: Sau khi ht bo ph, ta s c tha h n mn ta thch. V kt qu ca s th ca tt yu l dn n bo ph tr li trong thi gian rt ngn. 3. Vn ng c th

Steven Blair, mt chuyn gia v Dch t hc, a ra nhn xt rng ngi mp thng cht sm hn ngi gy. Nhng nu ngi mp vn ng c th nhiu th c th ha gii c nguy c ny, cng c th sng lu.

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Dinh dng v bnh bo ph

Trong phng php gim cn, vn ng c th a n nhng ch li v sinh hc cng nh tm l hc. Vn ng c th lm tng mc tiu th nng lng, gip duy tr t bo t m, tng c ca xng, nht l cc xng chu sc nng ca c th, gim cht bo trong mu v gim t bo m. V phng din tm l, vn ng lm tng nim vui sng, gim cc triu chng trm ut, tng thm s t tin, gim t ti mc cm, to ra mt tm trng nhiu hy vng, nhit tnh. S vn ng thng c th tp theo mt chng trnh cc cu lc b hay lp dy, ti phng tp th dc... Nhng s tham gia ny nhiu khi b b ngang v thi gian eo hp, bn rn vi cng vic lm n hoc ngi phi i xa, thi tit cn tr. Theo nhiu chuyn vin, mi ngy ch cn mt ln tp 30 pht hoc 3 ln tp mi ln 10 pht l . i khi, tng cc cng vic hng ngy cng tt. Chng hn, tp thi quen i b vi nhng khong cch khng xa lm thay v s dng xe; ln xung lu bng cu thang thay v thang my; ng khi ni chuyn in thoi lu bc ti bc lui hn l ngi yn trn gh... Khng cn thit phi vn ng n mc m hi, m ch ti khi no thy nhp th hi nhanh, tim p nhanh hn mt cht l . iu cn thit l vn ng thng xuyn mi ngy. ng thi, nn t ra mt mc tiu thc t, kh thi. Bt u chm ri ri tng dn cng . Nn ghi chp v kt qu vn ng theo di. Cng theo kinh nghim nhiu ngi, i b l mn tp luyn d dng v thch hp vi nhiu ngi hn c, v c th

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Dinh dng v iu tr
thc hnh bt c lc no, u cng c, khng tn km v c th tng gim ty theo tnh trng sc khe. 4. Dc phm Thuc gim cn thc ra l lm gim s ngon ming khi n, qua hn ch lng thc n c n vo. Hin nay, trn th trng c nhng thuc sau y: amphetamines, Phentermine (Ionamine, Fastin, ObyTrim, Adiped-P); Sibutramine (Meridia), Orlistat (Xenical), Phenylpro panolamine (Dextramin); Phendime-trazine (Bontril, Plegine, Prelux-2); Mezindol (Sanorex, Mazanon). Thuc c th dng ring r hoc phi hp vi nhau nh Xenical v Sibutramine; Fluoxetine v Phentermine hoc vi cc hn hp dc tho. Ngoi ra cn cc loi kem thoa nh Dream cream, Smooth Contours cng c qung co l lm gim m bo sau my tun bi thoa. Tuy nhin, khi s dng dc phm gim cn, cn nh mt s iu sau y: a. Thuc ch c th gip mt s ngi mp xung cn, vi iu kin l phi phi hp vi gim tiu th nng lng v tng s dng nng lng qua s vn ng c th. b. Thuc ch dng cho nhng ngi bo ph (vt qu 20% cn nng l tng) ch khng nn dng cho nhng ngi mp mun gim bt vi ba kilogram, hoc mun gim cn thn hnh p hn. Ngi mp va phi li c thm vi vn v sc khe nh bnh tim, tiu ng

284

Dinh dng v bnh bo ph

ch nn dng thuc trong mt thi gian ngn v phi c s theo di ca thy thuc. c. Thuc dng t 5 tun n 5 thng c th l an ton. Trong thi gian ny, thuc c th lm h huyt p, cholesterol v triglycerid trong mu. d. Khi ngng thuc, c th ln cn tr li. . Cc i tng nh: ph n ang c thai hoc cho con b, ngi c ri lon v n ung, ngi ang dng thuc cha bnh thn kinh tm tr, ngi ang mc cc bnh tiu ng, bnh tim, huyt p cao, tng nhn p, ngi nghin thuc hoc sp phi phu thut... nu mun dng thuc phi c s ch nh v theo di ca bc s. e. Hu ht cc thuc c nhiu tc dng ph nh gy ra nhc u, i ma, to bn, kh ming, nng ny, chng mt, au bng, tiu chy, huyt p cao, tng nhp tim. g. Khi dng lu (trn 6 thng) thuc c th gy nghin hoc c hin tng quen thuc (khng cn tc dng). h. Mt iu ti quan trng l cn c s khm nghim cng nh hng dn k cng ca bc s trc khi dng cc thuc ny. i. Khng dng thuc li tiu, v thuc ch ly bt nc i ch khng ly m. k. Ch cc loi thuc gim n nh Slim 10, Quick Slim, Diet B, Minica, tr Mirapront u b cm lu hnh v c tc dng ph nguy him.

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Dinh dng v iu tr
5. Gii phu Gii phu c mc ch lm gim dung lng d dy, thu hp cm nhai, ht bt m bo. Cc phng php ny hin nay rt ph thng v kh cng hiu gim cn nhng cn c cc bc s chuyn khoa thc hin. Nhiu ngi cho rng ht thuc l lm gim cn, v nhng ngi ngng thuc u ln cn. iu ny thc ra l do ngi b thuc l thng c khuynh hng mun nhai, mun n lin tc thay th cho s thm thuc, v do m ln cn.

Phng nga bo ph
Vic gim cn bao gi cng kh khn v tn km hn so vi p dng cc bin php phng nga, duy tr trng lng c th mc va phi trc khi xy ra bo ph, nht l tui thanh thiu nin. Cn khm sc khe tng qut hng nm, nht l vi ngi c BMI trn 30, khi pht hin c du hiu tng cn bt thng th phi c ngay cc bin php thch ng nh iu chnh ch n, tng thm mc vn ng c th...

Kt lun
Bo ph l mt bnh ang c chiu hng gia tng nhiu quc gia trn th gii. Bnh a ti nhiu hu qu nghim trng cho sc khe con ngi. V th, vn lm th no gim cn v ang l mc tiu ca nhiu nh nghin cu, nhm p ng nhu cu ca cng chng.

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Dinh dng v bnh bo ph

Vi mt s ngi, vic lm gim cn c th l cng vic rt kh khn, nhng khng n ni gy ra bun bc, tuyt vng. Thng th phi tri qua nhiu thng, nhiu nm c th mi tr nn bo ph, nn mun gim cn cng cn phi c thi gian, thm ch c khi cn lu hn c thi gian mp. Khng nn cho rng ch cn mt vi tun iu tr l c th gim cn c. Nhng vi phng php khoa hc, vi lng kin nhn v nhng hiu bit ng n v dinh dng, v cch n ung, th mc tiu gim cn chc chn s c th t n. Ngoi ra cng chng cn b tin mua sm nhng dng c, my mc lm gim cn - thng l rt t tin, m ch cn c gng duy tr ch, quyt tm theo ui vic gim cn, km theo mt ci cn chnh xc v mt tm gng soi t bit mnh l .

287

CHT X V SC KHE
ai tr ca cht x (fiber) i vi sc khe con ngi ch mi c khm ph t my chc nm gn y. Tuy nhin, con ngi bit n v dng thc n c nhiu cht x t rt lu. Vo khong th k th 5 trc Cng nguyn, thy t ca nn y hc phng Ty l Hippocrates ni ti cng dng ca cht x. T nhiu ngn nm nay, cc v tng s Pht gio duy tr ch n chay vi thc phm hon ton t thc vt v cc ngi lun c sc khe rt tt. Ngoi ra, thc phm chnh yu ca tru, b, nga l c v la m thnh phn cn bn u c cht x.

nh ngha
Cht x l mt hn hp tinh bt-ng (carbohydrat) nm trong mng t bo ca thc vt. C nhiu loi cht x nh: cellulose, gum, mucilage, pectin, lignin. Cc cht ny u khng c tiu ha v hu nh khng c gi tr dinh dng. Tuy nhin khi n vo th cht x c nhng tc dng tt nh:

288

Cht x v sc khe
- Khi vo ming, cht x cn c nhai lu nn n kch thch tit nhiu nc bt. - Ti d dy v rut non, cht x tr hon s tiu ha thc phm v s hp th cht b dng nn to ra cm gic no. - Trong rut gi, cht x l mi trng tt cho cc vi sinh vt d ln men, ht nhiu nc khin phn mm, to v c o thi ra ngoi mau hn.

Nghin cu, quan st v cht x

Trc kia ngi ta vn tng cht x l mt thnh phn khng c gi tr dinh dng ln trong thc phm, cho nn n khng c gii y khoa, dinh dng ch nhiu. Nhng qua kt qu ca nhiu cuc nghin cu gn y, cht x c tha nhn c mt vai tr quan trng trong vic iu tr v phng nga mt s bnh mn tnh nh tim mch, ung th, tiu ng, to bn. Cu chuyn bt u vo thp nin 1960 vi nhng nhn xt ca bc s Denis P. Burkit, mt chuyn gia ni ting v ung th ca Anh quc nhng sng v lm vic nhiu nm ti Uganda, chu Phi. Bc s Burkitt hnh ngh y v truyn gio ti cc quc gia chu Phi trn ba mi nm. ng ta nhn thy rng dn chng y rt t b ung th rut gi v trc trng, v km theo ng cng nhn thy trong thc n ca h c nhiu cht x.

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Bc s Alexander P. Walker Nam Phi th nghim tm xem c s lin h no gia cht x v tiu ha. ng ta cho mt s ngi tnh nguyn nut nhng vin nha nh ri dng X quang theo di xem bao lu th nhng vin nha ny c a ra ngoi. Vi dn chng chu Phi, ch cn 30 gi, cn ngi da trng phi mt n ba ngy. ng kt lun l khi n nhiu cht x, s o thi cht cn b trong rut nhanh chng hn. c nhiu cuc th nghim v so snh ch dinh dng ca ngi dn vng nng thn ti cc nc ang pht trin vi ch dinh dng ca ngi dn thnh th ti cc nc k ngh m mang. Kt qu cho thy l s d dn chng nng thn t b cc chng bnh tim mch, ung th rut gi, tiu ng, to bn hn so vi dn chng thnh th l v h n nhiu thc phm c cht x. Thc phm nhiu cht x li c t cht bo. Trong khi , dn thnh th n nhiu tht v m hn, m cc thc phm loi ny li khng c cht x. Ngoi ra, n nhiu cht x lm ta mau no v gim nhiu s thm n cc mn khc. Mn n giu cht x cn cha nhiu cht chng oxy ha (antioxidant) v vitamin C.

Ngun gc cht x
C hai loi cht x thin nhin m a s thc phm gc thc vt u c: Loi cht x ha tan trong nc, c nhiu trong cc loi ht u nh u nnh, u ng, u ty; mt s tri cy, rau,

290

Cht x v sc khe
ht yn mch (oats), la mch (barley)... Cc cht x ny c th lm h cholesterol v gip c th iu ha lng ng trong mu. Loi cht x khng ha tan trong nc, c trong cm la m (wheat bran), ht ng cc cn nguyn cm, rau... Cht x ny ht nc, tng khi lng cht b khin s o thi phn tr nn nhanh hn. V mi loi cht x c cng dng khc nhau, nn ta cn n thc phm c c hai loi. Ngoi ra, cn c cht x c to ra trong phng th nghim, c s dng b sung vo cc loi thc phm ch bin. Trung bnh, c th cn khong 10 n 20g cht x mi ngy. Mt qu to n c v c 2,8g cht x, trong 2,5g cht x khng ha tan v 0,3g cht x ha tan. Mt qu chui c 2g cht x, mt qu cam c 2,2g cht x. Trong mt chn nh c rt (khong 16 mung canh) c 2,5g cht x. Khi n cc mn n c cht x th ta cn ung nhiu nc gip cht x di chuyn qua rut d dng. Cht x c nhiu trong: - L xanh ca cc loi rau. Cung l c nhiu x hn r v c. - Thc vt ti khng ch bin c nhiu hn thc phm ch bin, tr khi thc vt c hong kh hoc cho thm

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Dinh dng v iu tr
bt ng cc, cm. V th tri cy kh c nhiu cht x hn tri cy ti. - V cc loi ht v v tri cy. - Cc loi ht ny mm (gi u). - n tri cy nguyn tri th c nhiu cht x hn l ung nc vt. Ngoi ra, ta c th mua cc cht x ch bin nh: - Thch (agar) lm t rong bin (seaweed), rau cu (gelium amensi). - Bt cy linh lng (alfalfa hoc lucerne) c nhiu cht dinh dng, mui khong v vitamin. - Cm ng cc, rt r, c cng dng nhun trng nhng kh n. Cm thng c pha thm vo ng cc kh hoc cc mn n b l. - Ht cy lanh (flax) c trong ng cc kh v c cng dng nhun trng. - Bt ht cy psyllium, n to trong nc v c tc dng nhun trng tt khi ung nhiu nc, cng c th gip chng tiu chy khi ung t nc.

Cng dng ca cht x

Mc d y hc nhn loi bit n mt s u nhc im ca thc phm c cht x t rt lu, nhng ch gn y ngi ta mi ngy cng khm ph thm nhiu li ch c th ca cht

292

Cht x v sc khe
x. C nhiu kin cho rng trong tng lai gn y, cht x c th s c coi nh cht dinh dng thit yu. Sau y l mt s tc dng tch cc ca cht x: 1. Cht x vi bnh to bn Cc cht x khng ha tan trong nc khi c n vi nhiu nc c th l mn thuc an ton v hu hiu nht phng chng bnh to bn. N lm mm v tng lng phn h tiu ha d dng thi ra khi c th. Ngoi ra, khi vo n rut gi, cht x c vi sinh vt tranh nhau n, to ra nhiu cht c hi (gas). Cc hi ny kch thch rut gi lm pht sinh cm gic mun i tin. Mt nhn xt c th l tru, b n c, rm rt nhiu cht x, nn phn rt to v mm. 2. Cht x vi bnh vim i trng Trn vch i trng thng ni ln nhng np nh t m theo bc s Lauren V. Ackerman ca trng i hc New York th hu nh ngi trng thnh no cng c. Mi khi thc n b ngng ng trong nhng np nh th gy ra tnh trng vim i trng (diverticulosis). Bnh ny tr nn rt ph bin cc quc gia phng Ty trong my chc nm qua, v rt him gp vng nng thn chu Phi. Cc cht x khng ha tan trong nc c th ngn nga s hnh thnh cc np gp trn vch i trng bng cch gim

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Dinh dng v iu tr
thiu s to bn v gim s cng phng ca i trng trong qu trnh o thi phn. Cc nh nghin cu c th gy ra bnh ny nhng con chut trong phng th nghim bng cch cho n thc phm khng c cht x lin tc trong mt thi gian di. Ti Western Genera Hospital, Ireland, ngi ta c th ngn nga s ti pht bnh nhn sau phu thut bnh vim np gp rut bng cch cho n nhiu cht x. Mt nhn xt na l dn qu chu Phi cng t b chng vim rut tha nh h n nhiu cht x. L do l khi khng n cht x d sinh ra to bn, lm ming rut tha b nght, p lc tng, vi trng xm nhp lm rut tha sng vim. 3. Cht x vi ung th i trng Ung th i trng hin nay ng hng th nh trong cc loi ung th ti Hoa K v l nguyn nhn gy t vong cho 10.000 ngi mi nm. Dinh dng c nhc nh n nh mt cch phng nga bnh ny. Vin Ung th Quc gia Hoa K v nhiu t chc y t khc khuyn khch vic phng nga bnh ny bng cch gim tiu th cht bo v tng thc phm c cht x. Cc khuyn co ny c kt qu ca nhiu cuc nghin cu khoa hc h tr. Tin trnh ung th phi tri qua mt s giai on nh sau:

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Cht x v sc khe
- Bc u l s ny sinh mt nhn ung th trong t bo lnh tnh, do thay i cu to gen. Giai on ny din ra rt nhanh v khng th o ngc, thng do cc tc nhn nh virus, ha cht hay tia phng x gy ra. - Giai on k tip l tng trng v pht trin khng trt t, bin t bo thnh khi ung th. Trong giai on ny, c nhiu yu t c th lm trm trng hoc gim thiu bnh tnh nh cht dinh dng, li sng, hormon. Cht x c coi nh c th ngn s pht trin t bo ung th, chnh l trong giai on th hai ny. Nh trnh by trn, lin h gia ung th v cht x bt ngun t nhng nhn xt v bnh ny chu Phi, ni m ngi dn qu t n m, tht v n nhiu cht x. Quan st tng t 18 qun huyn ti Thy in trong 10 nm (1968 - 1978) a ra kt lun rng cht x rt tt

ngn nga ung th i trng. Bnh ung th ny cng gim rt nhiu trong Th chin th hai ti cc nc Anh, Thy S, Ireland v thc phm thiu ht, cm c gi li nhiu hn trong la go. Ti an Mch, khi dn chng gim n cht x th ung th i trng gia tng.
C hng chc cuc kho st chng minh cht x c kh nng phng nga bnh ung th i trng. Mt cuc nghin cu bnh vin New York nm 1989 cho thy l cht x ngn chn s xut hin ca cc mn tht tha (polyp) i trng

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Dinh dng v iu tr
v hu mn. Nhng mn ny c khuynh hng pht trin thnh bu ung th. Nm 1992, t cng bo ca Vin Ung th Quc gia Hoa K cng thng bo kt qu mt cuc kho st rng ln cho thy cht x gip ngn chn s pht sinh v pht trin ca cc mn tin ung th (precancerous polyp). gii thch, nhng kin sinh hc sau y c nu ra: Cht x lm gim c tnh ca tc nhn gy ung th bng cch ha long hay v hiu ha tc nhn ny; lm gim thi gian cht b di chuyn trong rut; lm gim acid ca phn b v thay i mi trng vi khun trong rut. Vic lm gim thiu thi gian m i trng phi tip xc vi cc thnh phn cn b c c kh nng gy ung th trong thc n l im rt quan trng. c tc dng phng bnh, nn dng t 25-30g cht x mi ngy. 4. Cht x vi bnh tim mch Bc s James Anderson ca i hc Y khoa Kentucky, Hoa K dnh nhiu chc nm nghin cu cng dng cht x vi bnh tim mch v tiu ng. Theo ng, cht x, nht l cht x t la mch, lm gim cholesterol bng cch lm cho gan gim ch to m bo LDL v tng HDL. Ti Anh, nghin cu ca bc s Hugh Trowell cho thy l bnh tim mch quc gia ny tng u cho ti nm 1939 ri gim trong thi k Th chin th hai (1939 - 1945), v phi

296

Cht x v sc khe
hn ch thc phm nn lc ngi dn n nhiu la m c nhiu cht x. Sau th chin, bnh tim mch li gia tng. Mt nghin cu khc cho nhng ngi tnh nguyn n nhiu b th cholesterol tng rt cao, nhng khi thm cht x vo khu phn th cholesterol gim xung ti 20%. Cholesterol tng cao trong mu c coi nh nguyn nhn gy mt s bnh tim mch v l ti ca nhiu nghin cu khoa hc cng nh l mi quan tm ca rt nhiu ngi. 5. Cht x vi bnh tiu ng Tiu ng l mt bnh c nng ng glucose trong mu tng cao. Bnh ny do thiu insulin hoc do gim tc dng ca insulin trong c th. Bnh rt ph bin v gy ra nhiu hu qu xu cho sc khe, gim kh nng lm vic v s vui sng ca ngi bnh. Bnh cng gy nh hng ti nn kinh t quc gia v con s bnh nhn ngy cng gia tng, rt tn km cho s chm sc lu di. Ngoi dc phm, ch dinh dng thch hp v s thay i np sng c th gip duy tr bnh thng nng ng glucose trong mu. p dng ch dinh dng thch hp l bin php rt cng hiu li r tin, an ton. Theo kt qu cc nghin cu ca bc s James W. Anderson, thc phm c cht x c nhiu kh nng bnh thng ha lng ng trong mu, gim ng sau ba n, tng tc dng ca insulin. Theo ng, cc cht x ha tan c

297

Dinh dng v iu tr
tc dng tt v to ra c mt lp keo (gel) mng ngn khng cho ng hp th vo rut v nh c th lm gim lng ng trong mu ti 30%. Ngi mc bnh tiu ng cng hay b chng va x ng mch v triglycerid tng cao. Bc s Anderson cho bit l cht x c th lm gim triglycerid v c LDL, cng nh lm tng lng HDL trong mu. 6. Cht x vi bnh bo ph Ngi b bo ph thng v n nhiu, nht l cc cht bo, v t vn ng nn khng tiu th ht nng lng a vo c th. Phn nng lng tha tch t qu nhiu trong c th di dng m bo s gy ra bo ph. V th, tit ch n ung v tng vn ng c th l iu cn thit gim cn. Phn nhiu thc phm giu cht x u ngho cht bo, cho nn l mn n l tng cho nhng ngi mun gim cn. Thc phm giu cht x cn thi gian nhai lu hn, cht x li khng c tiu ha v hp th d dy, thng lm ngi n mau no v no lu, do gim nhu cu n nhiu, mt iu kin tt yu khi bo ph. Cht x thin nhin trong thc phm c tc dng tt hn nhng vin cht x ung b sung. 7. Cht x vi bnh ung th v Mt nghin cu mi y ca American Health Foundation ti thnh ph New York cho thy l cm la m (rt giu cht x khng ha tan) c kh nng gim thiu lng estrogen trong mu. T ngi ta suy on rng cht x trong cm

298

Cht x v sc khe
la m c th gim thiu nguy c mc bnh ung th v. Cc nghin cu v vn ny vn ang c tip tc.

Vi nh hng khng tt ca cht x

Dng nhiu cht x qu c th nh hng ti s hp th cht dinh dng trong rut. Mt s cht dinh dng cha kp hp th th b cun theo cht x thi ra ngoi. Qu nhiu cht x c th gy ra s ln rng v xon ca khc i trng sigma, au thc qun, thng rut, nht l khi khng ung nc. Bnh nhn b vim rut hoc sau khi phu thut ng tiu ha cn n t cht x cho ti khi lnh bnh. t ngt chuyn t ch n t cht x sang nhiu cht x c th gy ra kh tiu ha, au v y bng, tiu chy.

Cch dng cht x

Sau y l vi iu cn nh khi dng cht x: - Tn dng cht x trong thc phm thin nhin tt hn l cht x ch bin, v cht x ch bin thng ch cha mt loi cht x. - Nu c th c, n rau sng hoc nu va chn ti, rau cn gin khi nhai, v nu chn qu cht x bin thnh loi bt ng. - Vi mt s loi tri cy c th n c v thay v gt b, v lp v ngoi tri cy c nhiu cht x khng ha tan. Tuy nhin, cn ra tht sch trc khi n loi ht thuc tr su c th dnh trn tri cy.

299

Dinh dng v iu tr
- Trong khong cch gia cc ba n chnh trong ngy, nn dng tri cy kh lm thc n vt khi i bng. - Tng cht x trong khu phn mt cch t t b my tiu ha thch nghi dn vi s thay i ny v cng trnh y bng, no hi. - Ung nhiu nc, khong 1,5 - 2 lt mi ngy v cht x ht kh nhiu nc trong rut.

Kt lun
Mc d cht x c coi nh mn qu ca thin nhin ban tng cho con ngi bo v sc khe, nh li bc s Burkitt ni cch y hn 30 nm, nhng rt nhiu ngi khng tn dng mn qu ny ch v thiu s hiu bit v dinh dng. Theo cc nh chuyn mn, mi ngy c th cn t 10 ti 20g cht x, nhng nhiu ngi li ch n rt t, khng s lng ny. Trong khi , theo thng k, nhng ngi cao tui c v nh bng vo kinh nghim sng bit c tc dng tch cc ca cht x cho sc khe nn rt thng dng. Hu ht cc v cao tui u thch n nhiu rau ti, tri cy... u l nhng thc phm c nhiu cht x. Nh m sc khe cc c c tt hn.

300

N MT NGON V ST CN
n mt ngon, bt k do nguyn nhn no, l mt vn quan trng i vi sc khe. Thc phm cung cp nng lng cho mi hot ng ca c th, v l ngun cht liu tu b, ti to cc loi t bo. Khi khng n cht dinh dng th cc hu qu sau y xy ra: - St cn, c th mt mi, bp tht teo. - Tm thn bun ru, d b bin chng ca nhiu bnh. - Gim kh nng min dch, khng bn sc, km chu ng khi cn phu thut. - C nguy c t vong nu mi nm st i 5% trng lng c th.

Nguyn nhn
C nhiu nguyn nhn gy ra tnh trng n mt ngon. Trong c th k n mt s nguyn nhn nh sau: 1. Do bnh tt C nhiu bnh a n thay i khu v, lm n ung kh khn m hu qu l ngi bnh n mt ngon, dn dn dn n suy dinh dng.

301

Dinh dng v iu tr
a. Bnh ung th: nht l ung th phi v d dy. b. Bnh nhim trng, nh trong cc trng hp bnh lao, bnh HIV-AIDS. c. Bnh ni tit, nh bnh tuyn gip c tnh, bnh tiu ng. d. Suy sp tinh thn, nh cc trng hp trm cm, bun phin v sng c c hay thng nh ngi thn mt cng gy bing n, km ng ri gy yu. 2. Do nghin ru Rt thng xy ra ngi cao tui. Khi ung ru say, h khng mun n ung. Sau cn say, h i ma, tiu chy, cng khng mun n. Ru cng gy h hng chc nng v cu trc ca gan, nh hng ti s tiu ha, hp th v d tr nng lng, cc loi vitamin v khong cht cn thit. 3. Do tc dng ph ca dc phm - Thuc tr sinh gy tiu chy v lm thay i v gic, khu gic, lm ngi bnh cm thy nh thc phm c mi v khc i, do n mt ngon. - Thuc tr ung th gy n mt ngon ng thi cng gy to bn, i ma, tiu chy. - Cc thuc tr bnh tim, thuc an thn, thuc ng u lm gim cm gic ngon ming khi n. - Vi loi thuc gy kh ming (cogentin, artane), khin vic nhai nut thc n kh khn, do n mt ngon.

302

n mt ngon v st cn
- Ngi cao tui cn km n v dng nhiu th thuc trong ngy, y bng, khng mun n. 4. Do cc bnh rng ming Cc bnh rng ming lm ngi bnh nhai nut kh khn, n rt chm lm thc n ngui i khng ngon, i khi lm ngi bnh b d ba n. Ngoi ra, c khong 25% n mt ngon khng r nguyn nhn. Cn lu l c nhng trng hp st cn khng phi do n mt ngon. Nh trong cc bnh tim, phi, ngi bnh vn n c bnh thng nhng st cn v mt nhiu nng lng v tng chuyn ha c bn. i khi ngi bnh c n t i do thuc tr bnh tim phi nh steroid, theophyllin to nhiu hi trong d dy. Trong nhng trng hp ny, s km dinh dng li lm cho bnh tim phi nng hn v lm gim chc nng ca c honh, gim s trao i dng kh. Mt s ngi cao tui vn n c bnh thng nhng st cn do khng c ngi chm sc nn khng thc n (ngho, yu khng i mua thc n c), hoc qu yu khng nu nng c, hoc yu sc, au nhc khng s dng tay hu hiu trong vic a thc n vo ming, khng c ngi bn thc n...

303

Dinh dng v iu tr

iu tr
Bc s nh bnh bng cch hi bnh nhn v nhng thay i trong vic n ung, xc nh mc st cn trn 10% cn nng bnh thng, xng lng ngc v xng mt nh ra v tht teo i. iu tr chng n mt ngon thng phi xem xt n c hai mt nguyn nhn v hu qu ca bnh. Nhng nguyn nhn gy ra bing n s c thy thuc nghin cu, iu tr. Nhng hu qu do s bing n gy ra cn phi c tch cc ngn nga. i vi bnh nhn, c nhng iu sau y cn lu : - Khi n c bn b thng vui hn v n c nhiu hn. - Ba n no thy ngon ming nht trong ngy th c th tng thm nhiu mn n hn. - Trnh ung nhiu nc hoc ung thuc ngay trc ba n v s lm no bng. - Trnh nhng mn n c th lm no hi nh nc ung c gas, c ph, rau ci bp, sp l xanh... - Trnh to bn v tiu chy. - Nng hot ng c th. - Gi gn v sinh rng ming.

304

SUY NHC C TH

Bnh nhn thng than phin l trong ngi bi hoi, khng c sinh lc, khng thit n s g i. Sng ra khng mun ri khi ging. C ngi i lm v l nm vt xung chic gh bnh, ch ti gi n. Ni chung l h khng khe mnh, thiu sc sng. Bi v tnh trng khe mnh, theo T chc Y t th gii (WHO), l tnh trng thoi mi hon ton v th xc ln tinh thn v trong tng quan giao tip x hi, ch khng ch l khng c nhng bnh hon v tn tt c th. ngi cao tui, suy nhc l tnh trng ph bin hng th nh, sau au nhc, v i khi n l du hiu ca mt bnh no ang trong giai on ngm ngm cha bc l. Trung bnh c n 70% qu c c vn suy nhc. N gii b nhiu hn nam gii. Tuy nhin, v mt s nhng l do no hoc ch v thiu hiu bit, c nhng ngi d suy nhc vn khng ni

uy nhc (fatigue) l trng thi kit sc, r ri c th cht ln tinh thn.

305

Dinh dng v iu tr
ra, ch m thm chu ng v ch bit thay i np sng thch nghi vi tnh trng ny.

Du hiu
Mi ngi c mt s nhng du hiu suy nhc khc nhau. C ngi khng tp trung t tng, khng suy ngh c, chm chp, khng th quyt nh c vic g. C ngi lm vic chng mt. C ngi thay i tm l, khng gi c quan h mt thit vi bn b, ngi thn. C ngi thay i s thch, khng cn hng th vi nhng th vui trc y. C ngi khng cn sinh lc, khng mun vn ng, ch mun nm, c th r ri, chn tay bi hoi. Tuy nhin, d c mt s khc bit nhng tt c cc trng hp suy nhc vn thng c mt s im chung nh sau: - Suy nhc c th gy ra do nguyn nhn tm l ri nh hng ti th xc v chc nng c th hoc ngc li. - Suy nhc c th l du hiu bo trc mt cn bnh no sp xy ra. - Suy nhc cng c th l mt c ch bo v c th, ngn nga s kit sc, bi v n lm cho ngi ta phi dng li trc khi c th suy sp hon ton v kit sc. Trong a s cc trng hp, ngh ngi l phng thc i ph chung kh cng hiu.

306

Suy nhc c th

Nguyn nhn
Bc s Kurt Kroenke, mt chuyn gia v suy nhc c th cho rng a s nhng triu chng ny khng phi gy ra do tui gi hay bnh tt, m thng l du hiu ca s qu nhiu hay qu t mt ci g lm ta mt sc. Cng thng thn kinh v phi i ph vi qu nhiu rc ri hng ngy trong cng vic s, vic nh vi v con, hay giao tip vi bn b. Lm vic qu nhiu, lin tc, hai ba ca ni nhau, khng chia thi kha biu r rng. n qu nhiu, vn ng qu t, ln cn vi nhiu mng m, lm tr tr con ngi, kh nng lm vic gim r rt. n qu t, khng nng lng cho hot ng c th. S vn ng qu nhiu hay qu t cng gy ra mt mi. Trong khi vn ng, c th s tit ra acid lactic, v loi acid ny phn hy khi ta ngh ngi. Nu vn ng lin tc, acid lactic tng cao, tch t nhiu trong c tht lm ta au nhc v lun cm thy mt mi. Cn khng vn ng, th nh chuyn vin th dc Ralph LaForge ni mt c th ngh ngi th c khuynh hng ngh ngi hoi, do yu mt. Nhng trng thi bun phin, tht vng cng lm con ngi u oi, chn chng, gim sinh kh, ch mun nm ng.

307

Dinh dng v iu tr
Qu v cao nin mi ln tin a mt ngi bn gi v bn kia th gii l lng mnh li se st: bao gi n lt mnh y! Mt vi bnh tt cng gy suy nhc nh nhim trng kinh nin, bnh tiu ng, bnh tim phi, bnh ca h thn kinh. Mt s dc phm nh thuc an thn, thuc d ng, thuc tr bnh thn kinh, thuc tr ung th... cng lm con ngi bn thn, mt mi. Ni chung th suy nhc c th do nguyn nhn th xc hay tinh thn. Thng suy nhc do nguyn nhn th xc th s mt mi tng ln trong ngy, ngh ngi mt lc s thy bt, i khi ch cn au nhc c bp. Cn suy nhc do tinh thn cng thng th s mt mi trm trng vo bui sng khi mi thc dy, v kh hn vi ngy tri qua v c bp khng b ri lon.

iu tr

Cn phn bit mt s trng hp: 1. Suy nhc do nguyn nhn bnh tt th cn iu tr nhng bnh ny. 2. Suy nhc do tc dng ph ca dc phm th c trnh v gim thiu nhng tc dng ph . 3. Suy nhc do nhng nguyn nhn tinh thn, cn tm mt cng vic lm thch hp tp trung tinh thn v to

308

Suy nhc c th
s hng th, cng c th da vo c tin c thm sc mnh tinh thn. Cch y t nm, bc s E. J. Kepler dng ng Mayo, Rochester ngh phng thc iu tr trng hp ny vi mt m hnh ch thp m 4 nhnh mang cc biu tng vic lm, tnh thng, ngh ngi v c tin. Theo chuyn gia ny, nu ta gi thng bng c 4 yu t trn th c th vt qua c s suy nhc do cc nguyn nhn tinh thn.

309

MT S VN SC KHE THNG GP
1. No hi

- Ti b no hi, thng hay tht theo hu mn. Xin cho bit ti sao v cch phng nga?
Qu nhiu hi trong rut v d dy s gy kh chu cho c th, chng hn nh tc bng, no hi. Hi s tht ra khi ta ra hoc tht qua hu mn (trung tin). Nguyn do ca y hi c th l: a. Khng hp th ht mt s cht tinh bt v ng. Cc vi khun trong ng tiu ha s lm cc cht ny ln men v sinh ra hi. b. n nhiu cc thc phm d sinh hi nh to, u, ci bp... nc gii kht c nhiu hi carbonat. c. Khi n nut theo nhiu khng kh, nht l n qu nhanh. trnh nhiu hi: a. Khi n nn nhai chm ri, ngm ming, nut thc n t t.

310

Mt s vn sc khe thng gp
b. Trnh hoc gii hn thc phm sinh nhiu hi, nht l loi u, ci bp, hnh, gi u, chui, mn. Sa v pho mt cng gy no hi nu c th thiu men lactase tiu ha ng lactose trong sa. c. Hn ch dng ng thay th nh sorbitol, manitol c nhiu trong mt s loi bnh ko gi l sugar free. d. Khng lm dng dc phm chng acid trong d dy. . C th dng cc cht chng ga nh Beano, Simethicone

(Phazyme; Mylanta gas), Lactaid.

2. n g b y

- Nhiu ngi tin tng l ta n mn n t b phn no ca ng vt th s b dng cho c quan trong c th ca ta. Ni nm na l n g b ny, quan nim ny ng hay sai?
y l nhng tin tng trong dn gian c t xa xa, thng thy khp ni trn th gii. Ta bit l cc b phn ca c th c th suy yu v l do bnh hon, tui gi... Cho nn c tin tng l n mt b phn ca ng vt no s thay th hoc b dng cho b phn ca ta b h hao. Chng hn, c tin tng rng n c ng vt s thng minh hn; n ngc hnh (tinh hon) d s mnh m hn trong i sng tnh dc; n tim h bo s dng cm hn; n tit canh b mu... V th nhiu ngi mi i tm cc mn n him n g b ny.

311

Dinh dng v iu tr
Xt v phng din dinh dng, cc mn n ny cng c cc cht m, bo, tinh bt hoc vitamin, khong cht nh cc mn n khc m thi. 3. Nhn i s loi b ht cht c trong c th? Khng c chng minh khoa hc no h tr hoc xc nhn quan nim ny. C th c to ra vi y cc chc nng ca cc b phn tiu ha, hp th cc cht dinh dng; o thi cn b ca s tiu ha. Cht cn b tiu ha m nh urea c thn bi tit ra ngoi; cc cht b khc c i trng a ra khi c th. Nhn n mt ngy i vi mt s ngi c l khng sao, nhng nhn lu ngy chc chn s b suy dinh dng, sc khe s b nh hng. Thiu nc s a ti tnh trng kh nc, huyt p xung thp, t bo h hao, khi lng mu gim, tim p bt thng. Ngi mc bnh tim, bnh tiu ng m li nhn n ty cht c trong c th, th bnh trng s trm trng hn. 4. Xin cho bit vai tr ca vitamin D trong c th. c b xng v hm rng chc khe, c th cn c y khong calci. Nhng nh th cng cha . C th cn cn vitamin D mang calci ti xng. Ngun cung cp vitamin D nhiu nht l t thc phm. B, trng, cc loi c nh c trch, c thu, c hi... c cha

312

Mt s vn sc khe thng gp
vitamin D di dng t nhin. Ngoi ra c nhiu loi thc phm c b sung vitamin D nh sa, margarin, bt ng cc dinh dng...
Ngun cung cp vitamin D khc l t lp da ca chng ta. Di tc dng ca nh nng mt tri, nht l tia t ngoi, mt cht c sn di da s chuyn bin thnh vitamin D. Mi ngy ta ch cn phi nng khong 15 pht l c mt lng vitamin D ng k. Trong c th, gan v thn chuyn ha vitamin D sang cc cht m xng c th s dng c. Mc d c sn trong thc phm v nh nng mt tri, i khi ta cng thiu vitamin D. Chng hn nh cc trng hp: - Vi tui gi, kh nng to vitamin D da gim i. Nu t phi nng v khng ung hai ly sa mi ngy th nn ngh ti vic ung thm vitamin D. Nhng khng ung qu 10mcg (400 IU) mi ngy, tr khi do bc s ch nh. - Bnh tim, thn cng gim kh nng chuyn ha vitamin D sang cc cht m xng s dng c. - Mt vi loi thuc nh phenytoin (Dilantin) cha kinh phong cng a ti thiu vitamin D. 5. Mt ly c ph c bao nhiu cafein? Ty theo ly ln hay nh. Sau y l lng cafein trong mt ly 180ml: - C ph bnh thng: 115mg

313

Dinh dng v iu tr
- C ph bt tan ngay: 55 - 60mg - C ph ly bt cafein: 2mg Ngoi ra, trong 180ml nc tr cng c 35 - 40mg cafein. Mt ming bnh s-c-la nng 28g c 25mg cafein. 6. Lm sao trnh ng c thc phm nh? nh, nhim c thc phm thng do cc vi khun gy ra. Vi khun c khp mi ni trong nh, nht l trong bp. ng tht nc di ch ra chn bt l cha vi khun, ri n ming xp ra bt a... Trong tht c rau qu m ta mua v cng c vi khun. Nu nng khng k, bo qun khng cn thn, n ung khng m bo v sinh c nhn l nhng nguyn nhn a ti ng c thc phm. trnh ri ro ny, ta c th p dng mt s bin php phng nga nh sau y: - Gi gn bp nc, cc nu nng sch s. - Ra tay vi x phng, nc nng trc v sau khi lm mn n, trc v sau khi n. - Khng thc n nu v cha nu ln ln. - Ra dao tht sau mi ln dng ct, thi mt mn n. - Lau chi bp sch s. - ng thc n nu chn ngoi phng qu 2 gi. Thc n cn d vo trong t lnh ngay.

314

Mt s vn sc khe thng gp
- Thc phm mi mua v cn ni mt lnh trnh h thi, nhim trng. 7. Thuc tr su trn rau qu c nguy hi khng? Lm sao trnh? ngn chn su b ph hoi ma mng, nng dn thng phi dng thuc tr su. Nu dng ng cch, theo s hng dn ca nh sn xut th t ri ro. Tuy nhin, nhiu ngi lm dng, dng qu nhiu v thiu hiu bit hoc v tham li nhun. Do thc phm c th c nhiu cht khng tt cho c th khi tiu th. trnh cc ri ro ny: a. Lau ra rau qu ti trc khi n. b. Khng dng x phng ra rau tri, ch cn x di vi nc lnh. c. Bc b lp v bc ngoi ca vi loi rau nh rau dip, ci bp... l ni c nhiu ha cht. 8. Khi i cm tri lm sao bo qun thc phm? i cm tri, nhiu khi ta mang thc n nu sn, dnh nhiu th gi vui chi. Thc n m khng c gi cn thn l d h hng, c nguy c gy ng c. Sau y l vi iu c th p dng trnh cc ri ro ny: a. Dng mt thng p lnh cha thc phm. Xp thc phm di, t ti nc ln trn.

315

Dinh dng v iu tr
b. Thc phm phi ly ra t t lnh hoc ngn ng lnh. c. Gi thc phm ring r; gi kn nht l tht c cha nu trnh nc chy ra v ln vo cc mn n khc. d. ng thng p lnh trong thng xe, ch mt ni cm tri. . y kn thc phm, bt a cho ti khi n trnh rui b. e. Ra tay trc khi phn chia thc n v trc khi n. g. Nm b thc phm ra ngoi khng kh qu hai gi. 9. Ung thm cht chng oxy ha

- Ti nm nay 65 tui. Nhiu ngi ni nn ung thm cc cht chng oxy ha trnh bnh tt v sng lu. iu ny c ng khng?
Phong tro ung thm cht chng oxy ha ang rt ph bin vi cc c. Gp nhau l cc c u hi nhau v loi ny hay loi kia. t nht mi c cng ung mt hoc hai loi. l do truyn tai nhau hoc thu lm kin thc qua truyn thng, bo ch. Vy cht chng oxy ha (antioxidant) l nhng cht g? Thc ra, cng ch l nhng cht dinh dng thng c sn trong thc phm m ta dng hng ngy. Cc cht chng oxy ha thng c nhc ti nhiu nht l vitamin C, vitamin E, beta caroten. Beta caroten cn gi l tin t vitamin A, v n s c c th chuyn ha thnh vitamin A.

316

Mt s vn sc khe thng gp
Cht chng oxy ha c th ngn chn phn ng ca mt vi thc phm vi oxygen. Tc dng ny rt quan trng, v nhiu thc phm i mu hoc h thi v s oxy ha. Trong c th th mt s cc nh nghin cu ni rng cht chng oxy ha c th ngn chn tc hi ca cc phn t gi l gc t do (free radical). Trong hot ng bnh thng, t bo to ra cc gc t do. y l cc phn t thiu mt in t (electron). c s in t chn, gc t do tn cng chim ot in t t cc phn t khc v gy ra mt lot nhng tn thng cho t bo m kt qu l cc bnh thoi ha, ung th. Cc nh nghin cu cho rng trong bnh tim mch, khi b oxy ha th LDL- cholestrol gy ra tn thng cho lp lt ca mch mu. Cht chng oxy ha s ngn chn s oxy ha ca LDL bng cch v hiu ha gc t do. Cht chng oxy ha cng lm gim nguy c ca nhiu bnh ung th. Cht chng oxy ha lm bt c ca thy tinh th v trnh c cm mt. Do nhiu ngi ung thm cht chng oxy ha. Nhng mt s chuyn gia y t li d dt hn. H khng khuyn khch vic ung thm mt lng qu cao cht chng oxy ha, v: a. Cha c chng minh khoa hc cng nh lm sng v tc dng ca cht chng oxy ha gim thiu bnh mn tnh. b. Khng bit r hu qu v lu di ca cc cht oxy ha khi c dng vi liu lng cao.

317

Dinh dng v iu tr
c. Cha xc nh c liu lng cht chng oxy ha cn thit phng nga bnh. V th, theo cc nh dinh dng th nn ch ch n ung y , cn bng cc cht dinh dng l tt hn. Khng nn b tin mua nhng cht chng oxy ha do con ngi tng hp ung thm, va tn tin m va cha bit chc vic li hi nh th no. 10. Nhu cu calci

- Nm nay ti 62 tui. Bc s ni cn ung thm calci, ko xng b long. Xin cho bit thc phm no c nhiu calci. Nu khng ung c sa th phi lm g? Calci l xi mng ct st ca b xng. Trong c th, 99% calci nm xng v rng, 1% cn li trong t bo mm v dung dch cht lng khc.
Nhu cu calci m c th cn n u sn c trong nhiu loi thc phm. Ta c th thiu calci khi khng n ung y nhng thc phm c calci, hoc khi c th khng hp th c calci. Khi trong khu phn hng ngy c nhiu cht x, nhiu cht bo, mt s cn bng gia calci v phosphor, thiu vitamin D u a ti gim hp th calci. Cng thng tinh thn, khng vn ng c th hoc tui gi cng gim hp th calci. Cho nn v l m bc s khuyn ngi cao tui nn dng thm calci trnh b bnh long xng. Thc ra nguyn

318

Mt s vn sc khe thng gp
nhn ca bnh ny cha bit r, nhng thiu hp th calci trong sut i ngi l mt nguy c chnh.

Calci c nhiu trong mt s thc phm. Cc thc phm sau y c khong 300mg calci:
- Sa: 1/3 ly sa bt, hoc 1 ly sa c 2% cht bo. - Pho mt: 40 g pho mt loi cheddar. - 420g kem; 240ml sa chua; - C: 140g c hi; 7 con c sardine cn xng. - Rau: mt ly ri rau spinach. - Mt ming ri u ph. Nh vy, sa l ngun cung cp calci nhiu hn c. Ch vi hai ly sa t bo l ta c nhu cu calci cho mt ngy. Nu khng ung c sa th c th dng rau cng c nhiu calci. V nu cn, th phi lm theo li bc s: ung thm calci. Liu lng nn dng nga long xng l 1000-1200mg mi ngy. Nn chia liu lng ny ung lm hai ln trong ngy trnh kh chu d dy. 11. Vitamin vi n ngon ming

- Mi ln i khm bnh, ng lo nh ti c xin bc s chch cho mt mi B12, ni l chch v thy khe khon hn, nhiu sinh lc hn v n ngon ming hn. Vy th theo bc s, iu c ng khng?
Thc ra th khng phi ch mnh c thc mc v vn ny, m l thc mc ca nhiu ngi. Nht l sau khi nghe qung co gii thiu thuc ny tng cng sinh lc, vitamin kia lm ta n ngon ming hn. Ring v vitamin B12 ni ring

319

Dinh dng v iu tr
v cc loi vitamin khc ni chung, lin quan ti thc mc ca c, th kin ca cc nh dinh dng nh sau: Cho ti by gi, ta bit l c 14 vitamin khc nhau. Vitamin l nhng cht hu c cn thit vi mt lng rt nh song rt cn cho sc khe, s tng trng, s sinh sn v s bo tr ca c th. Hu ht cc cht vitamin ny c c th hp th t thc phm v khng t tng hp c, hoc l ch sn xut c rt t.

Vitamin t n khng c nng lng nh cc cht dinh dng trong tht, c, cm... Do vitamin khng trc tip cung cp nng lng cho c th. Nhng mt cch gin tip, cc vitamin nhm B can d vo mt s phn ng ha hc gip c th ly nng lng t thc phm.
Mi vitamin c mt chc nng ring, nn vitamin ny khng th thay th cho vitamin kia. Ni chung, vitamin cn cho mt s phn ng sinh ha hc trong c th m khi thiu, s a n nhng ri lon khc nhau, ty theo thiu vitamin no. Chng hn nh thiu vitamin D th rng v xng s yu; thiu vitamin A th th gic ban m ca ta s km; thiu vitamin B12 ta s b thiu mu. Thnh ra, mt mi vitamin B12 cho mt ngi bnh thng ang khe mnh cng khng lm cho n ngon hn hoc nhiu sinh lc hn. Chch mt mi B12 s a vo c th dm chc miligram vitamin ny th cng ging nh khi ta n mt a b thui, c cng lng vitamin. Nu ng c ang thiu B12 th c li, cn nu ng c nh n ung y c trong c th th B12 s theo nc tiu ra ngoi.

320

Mt s vn sc khe thng gp
Nhng nh hng tm l ca mi vitamin B12 ny cng tng t nh khi thy thuc cho bnh nhn dng gi dc (placebo), ngha l chng c cht tc dng vt l no. Nhng n lm tinh thn ng c phn chn, hng khi th cng tt. C iu l ta cng nn d dt cn thn, v dng thm nhiu vitamin tng hp cng a ti nhiu ri ro. Chng hn, ung nhiu vitamin A s lm kh mt, gim th lc, rng tc, da trc vy, ni mn nga. 12. Hi ming

- Mt c gi hi ti rng: Bn trai ca c khng hi lng lm v khi h ngi gn nhau th dng nh c mi khng thm t ming c thong ra. Bn c ni ti v c n ung khng gi gn, li n qu vt lun ming nn b nh vy. C xin cho bit ti sao, v iu ny lm c bun lm.
Chng ti thng cm vi tm trng rt bun bc ca c khi mc phi chng hi ming gy nhiu kh chu ny. Theo nh c m t th chng hi ming ca c c t lu v iu tr m khng ht. Thc ra, khng ch mnh c mc phi chng bnh kh chu ny, m cn c rt nhiu ngi khc cng ng cnh ng. C nhiu nguyn nhn khc nhau gy ra hi ming, khng phi ch hon ton do dinh dng, n ung. Sau y l mt s nguyn nhn: a. Nguyn nhn trong ming - Khi thc n st li trong ming hay mc cc k rng, b vi khun phn ha s to ra mi hi.

321

Dinh dng v iu tr
- Nhim trng nu rng. - Ba vi ng vo chn rng l mi trng tt cho vi khun tc ng vo v a n hi ming. - Khi ming kh, nh ng ban m hoc di tc dng ca mt s dc phm hoc thuc l khin ming ng ba, vi khun tc dng vo v gy mi hi. Mi hi gy ra do cc cht bay hi nhm sulfur nh l hydrogen sulphid... b. n mt s thc phm c du lm cho hi th c mi hi, chng hn nh ti, hnh... Cc thc phm ny sau khi c tiu ha, cht bay hi ca chng c hp th vo mu, ln phi v theo khng kh ht th m bay ra ming. Mi ru sau khi ung vo cng tht ra nh vy trong hi th. c. Mt s bnh v b my h hp nh nhim trng mn phi, vim xoang mn, ung th phi, vim cung hng cng lm cho hi th c mi hi. d. Khi c ri lon v s co bp ca d dy, thc phm chm tiu ha, lu trong d dy, b ln men cng to ra mi hi, nht l khi ta . . Mt s bnh gy suy yu cho c th nh yu gan, thn, tiu ng cng gy mi hi ming. Vic iu tr phi ty thuc vo nguyn nhn gy hi ming nh k trn. Sau y gi mt s phng thc c th: a. Nu nguyn nhn hi ming l t trong ming, cn lu nhiu n vn v sinh rng ming. nh rng sau khi n, nht l sau nhng ln n vt. Ch lm sch ht thc n st trong ming, nht l k rng. C th

322

Mt s vn sc khe thng gp
s dng ch rng (dental floss) c cc k rng cho sch thc n kt . Nn i khm nha s xem c b su rng hay nhim c nu th phi iu tr. Gi ming m bng cch lu lu ung mt cht nc. Nu li ng ba th co cho ht. b. Trc khi c nhng cuc gp g, tip xc, khng nn n cc thc phm c th gy mi hi ming nh hnh, ti... c. i khm bc s pht hin cc bnh mn tnh gy hi ming, v nu c th iu tr cc bnh ny. Cn ch l cc m phm lm thm ming ch c tc dng che y, lm bt hi ming trong thi gian rt ngn sau khi dng ch khng tr dt c hi ming. 13. Cholesterol trong mu

- Sau khi kim tra, mc cholesterol trong mu ti c xc nh l 240mg/dl. Bc s iu tr cha cho ti ung thuc, ch khuyn p dng ch n gim cht bo v tp th thao. Ti ly lm lo ngi v nghe nhiu ngi ni mc cholesterol trong mu trung bnh ch l 200mg/dl. Ti nn lm g by gi? Cholesterol hin ang l vn quan tm ca nhiu ngi, v cc phng tin truyn thng, bo ch, ti liu y hc thng cnh bo rng cholesterol trong mu cao th s gy ra tai bin no, suy tim, tiu ng...
Nhng ch o mc cholesterol tng qut trong mu thi cha . Cn phi o bit t l cc thnh phn trong nh: HDL, LDL v triglycerid. V phi o t nht 2 ln so

323

Dinh dng v iu tr
snh kt qu, nu ging nhau th mi c th i n kt lun nh gi l cholesterol cao hoc bnh thng. c xem nh bnh thng nu lng cholesterol di 200mg/dl. Nu mc ny th khong 5 nm nn kim tra li mt ln. c xem l hi cao nu lng cholesterol t 200 ti 239mg/ dl. Trong trng hp ny, bc s thng khuyn nn gim tiu th cht bo. Nhng nu km theo nguy c khc nh mc bnh lin quan n ng mch vnh (Coronary Artery Disease CAD) th bc s s th nghim thm, khuyn nn gim n cht bo v cng c th cho dng thuc h cholesterol. Nu cholesterol ln trn 240mg/dl th phi ung thuc h cholesterol. Lng LDL th bnh thng l di 130mg/dl, bt u c nguy c nu t 130 ti 150mg/dl, v rt nguy him nu trn 160mg/dl. Lng HDL trn 35mg/dl l tt. Nu di s ny th d mc tng s cholesterol bnh thng vn cn phi gim m bo, vn ng c th nhiu hn. Nu vn thp sau mt thi gian gim m v vn ng c th th c th cn phi iu tr bng thuc. Trong nhng trng hp cha n mc quyt nh iu tr bng thuc, cc bin php nh gim n cht bo v tp th dc, vn ng c th c thc hin nh mt gii php th nghim, v th cn tip tc theo di kim tra mc cholesterol lin tc trong mt thi gian nht nh. Nu c du hiu mc cholesterol gim xung l tt. Nu khng thay i hoc c chiu hng tng cao th c th phi iu tr bng thuc.

324

Mt s vn sc khe thng gp
S d dt trong s dng thuc h cholesterol l cn thit, v hu ht cc loi thuc u c nhng tc dng ph khng tt. Ch nn s dng khi khng cn chn la no khc m thi. Ngoi ra, khi p dng ch n gim cht bo, cng cn lu n lng cholesterol c trong thc phm. Sau y l hm lng cholesterol trong 100g ca mt s loi thc phm thng dng:
- Pho mt cheddar: - Trng luc: - B mn: - Margarin: - S: - Bacon: - G: - c: - Li - Kem sa: 106 mg - Swiss: 548 mg - Trng omelet: 220 mg; - B nht: khng c - Cua: 230 mg 81 mg 60 mg 210 mg 60 mg - Tm: - Tht b: - Vt: - G ty: - Sa chua: 6 mg 93 mg 338 mg 260 mg 101 mg 150 mg 70 mg 70 mg 375 mg 82 mg

2100 mg - Thn:

14. Lm sao cho con tr n rau? y l mt kh khn chung ca nhiu bc cha m: tr con khng chu n rau! M rau li l thc phm b dng, cn cho s tng trng ca chu b. C chu nht nh khng n mt cht rau no, mc d cha m tm mi cch d dnh. C chu khng n loi rau c mu xanh hoc mu .

325

Dinh dng v iu tr
Sau y l mt s gi gip cc chu n rau: a. Ngay t khi cho tr n dm ln u (sau 6 thng tui) nn cho tr lm quen ngay vi cc loi rau. b. Cho tr chi nghch vi mt ming rau sng hoc nu chn va phi, cn gin. c. Cho tr nm qua mi ln mt loi rau. d. t cho rau mt tn c bit vui nhn no gi s t m v thch th ca tr. 15. Cc loi qu hch c b dng khng? Qu hch l ch chung nhng qu kh c v cng bao bc. Trong ht kh ny c nhiu cht dinh dng, nhiu cht m (t 10-25%); cht bo cha bo ha, nhiu st, calci, kali, phosphor, vitamin B1 (thiamin), vitamin B2 (riboflavin), vitamin E v cht x (fiber). C nhiu loi ht m ta thng n nh: a. Ht iu (o ln ht), c bn di dng tch b v (v c c), rang chn v c mui. b. Ht hnh nhn (almond) nh, dp, hnh bu dc, nm trong v rt d p v. Ht c mu trng vi hng v rt thm. C hai lot ht: ht ng ly nc chit, ht ngt n sng hoc nu nng. Hnh nhn c bn di nhiu hnh thc: nguyn dng trong v cng, hoc b v, ct nh hoc nguyn ht, cho thm ng, mui. c. Ht d (chestnut) c v cng mu nu, c rt t cht bo, t nng lng nhng nhiu tinh bt. Ht c bn nguyn dng ti hoc luc, rang hoc ng hp. Mc

326

Mt s vn sc khe thng gp
d c th n sng nhng ngi ta thng n loi nu chn. d. Ci da, c th n t nhin, sau khi phi kh hoc xay nh ly nc. Ci c nhiu cht bo bo ha v cung cp nhiu nng lng. Ta thng hay kho tht ln vi ci da ct nh bng ngn tay. . Ht lc (u phng) c bn nguyn dng, luc, hoc rang c cho thm mui, thm hng v hng lu. e. Ht b o (pecan) tht mm vi hai nhn nm trong v cng mu nu, n sng hoc rang vi mui. g. Ht c ch (walnut) vi v d p v, c th n sng hoc nu chn. Ni chung, cc loi ht ny n rt ngon v c nhiu cht dinh dng li t cht bo bo ha, nn cc nh dinh dng u khuyn nn n. Ngoi ra cn nhng ht mm nh ht hng dng, ht vng (m), ht da, ht b... cng rt b dng. iu cn lu l nhng ht rang chn bn thng c cho thm nhiu mui hoc ng. 16. Mt s ng nhn v cht m

a. C ngi ni phi n nhiu tht mi khe.

Thc ra, c th dng cht m rt thng minh, theo ng nhu cu: ch cn mt ming tht bng lng bn tay l cht m cho nhu cu ca mt ngy. Nhiu hn mc nhu cu khng lm c th khe hn m ngc li, v thn phi lm vic nhiu hn thi cht b.

327

Dinh dng v iu tr
b. n nhiu tht s c nhiu bp tht n nang.
Tht trong thc phm khng trc tip i vo cc c bp ca ta, v cng c tiu ha ging nh cc thc phm khc. C th c th to ra t bo tht vi cht dinh dng khc nh tinh bt ch khng ch t tht b, tht heo m thi. Nhng ngi n chay khng h n tht nhng h vn c th c c bp n nang, khe mnh.

c. n nhiu cht m gip ta gim cn.

Cht m khng c kh nng t cht bo nh nhiu ngi tng. Ngoi ra, khi n nhiu tht qu th s mt cn i cc cht dinh dng, ng thi cng khin thn phi lm vic nhiu hn thi cht b. Cc chuyn gia dinh dng vn khuyn nn n cn i mi th v t nng lng gim cn. Nn cn thn vi cht m bn di hnh thc bt hoc lng v dng nhiu khng tt cho sc khe, nht l cho tim. Khi dng cn tham kho kin thy thuc.

d. Tho mc khng c cht m

y l mt hiu lm ln. Rau qu, nht l cc loi ht, u nh u nnh, u xanh... c rt nhiu m (protein). Tuy nhin, trong cc cht m thc vt ny thng khng c cc acid amin cn thit nh tht ng vt. Nhng khi n nhiu loi rau tri th s b sung cho nhau gip c cc acid amin.

. Ngi gi khng cn n tht

Gi hay tr cng u cn cc cht dinh dng nh nhau, cho d ngi gi khng cn tng trng. Tuy nhin, nhu cu ng l c gim i mi ngy mt cht.

328

Mt s vn sc khe thng gp
e. Protein trong cc m phm rt tt cho da v tc
Thc ra, cc m phm c protein ny khng thm qua da v tc, nn ch c tc dng lm mt da m, mm khi ta bi ln thi. Mun da mm mi, tc ng mt phi n y , cn i cc cht dinh dng, v vic ny tt nht l phi bt u t nh. 17. Thng chn i mi, thng mi mng nm Hai cu ca dao ny ni ti nhng ngy c ri, mt mn n rt c bit ca vi tnh min Bc Vit Nam. Ri l nhng sinh vt rt nh, nom ging con giun nhng hai bn mnh li c nhiu lng v nhiu cht nht. Lng l b phn dn ng cho ri c v ri ci tm n nhau. Ri c nhiu cc huyn Thanh Min (Hi Dng), ng Triu (Qung Ninh) v mt s a phng Kin An v Hi Phng. Thng thng ri xut hin vo cc m 20 thng 9 v 5 thng 10 m lch. Trng ri t nm trc, nm trong t, ti khi nc thy triu ln cao vo cc ngy ny th n ra con v nh ln khi mt t. Dn a phng thng t n ban m, dng mt loi li lm bng vi mn m vt. Ri c cho vo thng ri a v th H Ni, Hi Phng, Hi Dng m bn. C nhiu cch n ri: hp, rn, xo, lm ch ri, mm ri... - Ch ri gm tht nc bm nh, trng nh nhuyn, th l ti xanh, vi ming v qut thi nh li ti, p vi nc mm, ht tiu trn vi ri. vo cho rn nh

329

Dinh dng v iu tr
la, ch ri c mt hng v rt c bit, thm lng ra ti hng xm. - Ri hp vi mc nh (nm mo), c hnh ti, th l, nc mm v qut. y l mn n thanh lch, ngon li c rt t cht bo. Ri l mn n qu him, ch c mi nm mt ln v trong vi ngy, nn qu nhau mi tht nhau mt ba n ri. C ngi bit x c na th k, v H Ni c bn gi khi xa dnh cho mt a ch ri th cm ng bit my! Dn gian c cu v nhau v ri nh sau: Con g b t t ti, Mnh i di t, bng i trn tri. Mt nm my bn i chi, i th l t, long tri mi yn? 18. Ma thu su cm, su hng Hng l qu ca mt loi cy trng thn g to, l mc cch hnh trng hay tri xoan. Qu chn c mu hoc vng lc rt ngon ngt. Hu nh tnh no min Bc cng u c hng, c bit l hng Vit Tr, Ph Th hoc hng Lng Sn. Tri hng chn vo ma thu, khi tr em sa son n trng rm Tt Trung Thu. Hng chn cy ngt lm, n vo ngt mt ti d dy. Hng gi nhng cn xanh ngm vo nc vi trong chu snh dm ba ngy, n gin ngt v cng. Hng hng hng trn cnh c th hi, vi trong chum thc vi ngy l chn mng cng, hng nh hn ngc.

330

Mt s vn sc khe thng gp
C hai loi hng c a chung l hng dn v hng mm. Cm l mn n rt hp dn, c bit l min Bc. Cm lm bng la np non, cn gi l np bao t. Khng phi np no cng cho cm ngon, m phi l np sm Bc, np sm ta, np Phng, np chm, np hoa vng. Cm lng Vng gn H Ni c ni ting khp ba min Trung, Nam, Bc. Cm ny rt do, thm, ngon v c ch bin theo cch thc gia truyn, khng c tit l ra khi lng. Cm c th n t nhin vi chui, vi hng, hoc c th nu ch, lm bnh cm. Cm gi l sen xanh nh nh gi cho cm mm lu, l hnh tng gi ngun cm hng ca nhiu vn nhn thi s. Ma thu thng l ma ci. Su cm su hng l tp tc khi ci hi. Cho nn mi c cu ca dao rng: Hi thm em cha c chng, Nn anh mua cm, mua hng sang thm. Sang thm em c chng, cm anh mc, hng long tai... 19. Nhau thai c b dng khng? Nhau thai l mt b phn trong d con cho phi bo bm vo thnh t cung. Nhau c nhim v tit ra cc cht b dng nui phi bo, loi b cc cht ph thi, thc hin vic trao i dng kh cho thai nhi. Cng vic ny c thc hin qua s tip xc mt thit gia cc mch mu ca ngi m v thai nhi trong nhau thai. Nhau thai cng hot ng nh mt tuyn ni tit, tit ra cc hormon nh gonadotrophin nhau, progesteron, estrogen.

331

Dinh dng v iu tr
ng y gi nhau thai l T h sa, thai bn, thai y, nhn bo, c xem l mt v thuc b rt tt i vi cc bnh lao lc, gy cm, di tinh, kinh nguyt khng u, au nhc xng, km n, km ng, hen suyn. Ti liu Bn tho Cng mc ca L Thi Trn, Trung Hoa t th k 16 c bi thuc H sa i to hon rt ni ting v phng din b dng cho ngi suy yu. Bi thuc gm cc v: t h sa, quy bn, hong b, trng, ngu tt, a hong, thin mn, mch mn ng, nhn sm v ng quy. Mun n nhau thai phi chn nhau t ngi khe mnh, nu c thai ln u th cng tt. Nn chn nhau cn ti, khng qu mt gi sau khi sinh v cn nguyn trong bc, nhn nhi c mu hng y huyt. Nhau c mt g gh, mn nh l b nhim trng, khng nn dng. Sau khi ly, nhau c ra bng nc mui cho sch cht nhn v mu. Cn thn ng nhau b tn thng, chy nc, chng hng. Nhau ct nh ngm ru trng, sau 15 ngy bt u ung dn, mi ngy khong 25ml. Nhau ngm vi mt ong nguyn cht cng rt tt. Thi nh, ngm chng mt thng th mt ong lm nhau ha tan. V cu to, nhau thai cng c cc cht m, cht bo v cc cht dinh dng khc. 20. Xin cho bit yn b dng nh th no? Yn l nc di ca loi chim yn nh ra lm t. Chim yn thng sng cc hi o vng ng Nam nh Trung Hoa, Vit Nam, Philippin, Indonesia... Chim yn

332

Mt s vn sc khe thng gp
sng trn cc mm chnh vnh dng ng rt cao, di l vnh nc y ngm su. Yn lm t bng nc di ca chng. Ban ngy, chim i kim c n, ti v nh nc di thnh tng bi trn nh, cun vi nhau thnh t. Ma lm t thng l vo thng 4 v thng 6. Yn c loi gi l mao yn, c lng chim nh v huyt yn, c ln cht mu ca chim. Huyt yn rt him nn nhiu ngi a chung, do gi rt t. Theo ng y, yn c v ngt, tnh bnh, i vo hai kinh ph v v. Yn c dng bi b sc khe, cha hen suyn, suy nhc phi, th huyt, ho lao, st cn, trng dng, li tiu tin. Trc y yn c dng nh thc phm trong cc ba n cung nh, vng gi, nh giu c, nhng ngy nay, chim c nui nhiu nn yn tr thnh mn n kh ph bin. Yn c mt s cht m nh protein, tryptophan, arginin, cystein v vi khong cht nh calci, phosphor.

333

1. Sch ting Vit

-

Ti liu tham kho

Dinh dng ng dng, T Giy H thnh hng v v, Nguyn H Ming l min Nam, V Bng Ming ngon H Ni, V Bng Nhng ng vn m thc, Thi H su tm Nhng cy thuc v v thuc Vit Nam, Tt Li Phong tc Vit Nam, Toan nh Qu H Ni, Nguyn Th By Quc vn gio khoa th, Trn Trng Kim - Nguyn Vn

Ngc - ng nh Phc - Thn Th n chi ngi H Ni, Bng Sn Thng nh mi hai, V Bng Tc ng phong giao, Nguyn Vn Ngc Vn ha m thc & mn n Vit Nam, Xun Huy Vn ha m thc Vit Nam, Nhiu tc gi - Nh xut bn Thanh Nin Vn ha ru, Thi Lng

2. Cc bi vit v mn n Vit Nam:

- Bn v ngh thut nu bp v n ung ca ngi Vit, Trn Vn Kh. - Cch m thc ca ngi Vit, Phan K Bnh.

334

Sch tham kho

Cm, Nguyn Tun. Gi la, Nguyn Tun Nem rn, nem chua, Mai Khi Phong tc n ung ca ngi Vit, o Duy Anh
7 Anti-Aging Secrets by Dr. Ronald Klutz and Dr. Robert

3. Sch ting Anh

Goldman

A Parentss Guide to Good Nutrition GROWING UP HEALTHY by Myron Winick, MD. Age Proof Your Body by Elizabeth Summer, MA, RD. All About Ginseng by Stephen Fuller, PhD. All About Soy Isoflavones by Victoria Dolby, MPH.

- All you should Know about Health Foods by Wuth Adams and Frank Murray. Amazing Amino Acids by William Lee, Rph, Phd. Carbohydrat Gram Counter by DJ Arneson. Count Out Cholesterol by Art Ulene, MD. Diet for A New America by John Robbins. Diet for A Small Planet by Frances Mooore Lappe. Dr. Molens Anti-Aging Diet by Dr. Art Mollen, Dr. Wrights Book of Nutritional Threrapy by Jonathan V.

Wright, MD. - Dr. Wrigths Guide to Healing with Nutrition by Jonathon V. Wright, MD. - Eat Better, Live Better: A Commonsense Guide to Nutriton and Good Health by Readers Digest. - Eaters Choice by Dr. Ron Goor & Nancy Goor.

335

Dinh dng v iu tr
- Eating Right: Recipes for Health by Time Life Books, Alexandria, Virginia. - Fat is a Femisist Issue by Susie Orbacj. - Finally Im A Doctor by Neil Shuman, MD. - Food and You by The Editors of PREVENTION Magazine Health Books. - Food for Life: How the New Four Food Groups can save your Life by Neal Barnard, MD. - Food for Today by Helen Kowtaluk and Alice O. Kopan - Food for Us All by United States Government Printing Office - Food Fundamentals by Margaret McWilliams. - Food the Yearbook of Argiculture 1959 by US Department of Agriculture. - Food Theory and Application by Pauline and Helene Palmer - GREEN MEDICINE The Search for Plants that Heal by Margaret B. Kreig. - Guide to Good Food by Velda L. Largen, CHE - Health & Healing -The Natural Way: Diet & Weight Control by Readerss Digest - Helping Yourself to HEALTH FROM THE SEA by Howard H. Hirschhorn. - How to Parent by Dr. Fitzjhugh Dodson - International Conference on Rural Household Food Security Organized by: Association of Vietnamese Gardeners (VACVINA), Nationnal Institute of Nutruition (NIN)

336

Sch tham kho

- Japanese Herbal Medicine by Robert Rister - Ladys Brodys Good Food Book by Jane E. Brody.
Lets Get Well by Adelle Davis Listen to Your Body by the editors of PREVENTION

- Lick the Sugar Habit by Nancy Appleton, PhD. Magazine - Lose Weight Naturally by Mark Bricklin - Management of Pain Before It Manages You by Margaret Caudill MD, PhD.
Modern Meals by Roberta L. Duyff, MS, RD, CHE, Doris

Hasler, MS, CHE and Susanne Sickler Ohl, MS. Naturess Big Beautiful Bountiful Feel -Good Book by Keats Publishing, Inc. Nutrition Almanac by Nutrition Search, Inc. Nutrition: Principles and Application in Health Promotion by Suitor and Crowley. Osteoporosis: Is In Your Future? An informational Guide From Marion Laboratories. Prescription for Nutritional Health by Readers Digest. Prescriptive in Nutrition by Waxdain Insel Report Card in Nurtriton by B. L. Frye. Seven Weeks to a Setteled Stomach by Ronald L. Hoffman, MD. Stress and Old Age by Wilbur H. Watson Stress by Ogden Tanner and the editors of Time Books. The 8 Week Cholesterol Cure by Robert Kowalski.

337

Dinh dng v iu tr
- The American Association Complete Food and Nutriton Guide by Robert Loerson Douryff, MS, RD, CFCS.
- The Complete Ginseng Handbook by Jacques Mora Marco, OMD

- The Concise Encylcopedia of Foods and Nutrition by Ensimenger, Ensiminger Konlade and Robson.
The Element Illustrated Encyclopedia of Mind Body-spirit & Earth by Joanna Crosse.

- The Endometiosis Answer Book by Niels H. Lauersen, MD. PhD and Constance de Swaan. - The Food Pharmacy by Jean Carper. - The Garlic Book: Natures Powerful Healer by Stephen fulder, PhD. - The Goldbecks Guide to Food by Niki and David Goldbeck - The Holistic Health Lifebook by Berkely Holistic Health Center - The Holistic Way to Health & Happiness by Elizabeth Kuber-Ross. - The Honeset Herbal: A Sensible Guide to the Use of Herbs and Related Remidies by Vario E. Tyler, PhD. - The Juice Ladys Guide to Juicing for Health by Chereic Calboun, MS. - The Last 5 lbs -A Liberating Guide to Living Thin by Jamie Pope, MS, RD. - The Low Salt Diet and Recipe Book by Beverly Barbour. - The Meditation Diet: The Relaxation System of Easy Weight Loss by Richard Tyson, MD with Jay R. Walker

338

Sch tham kho

The Nature Doctor by H.C.A Vogel

- The New Complete Book of FOOD by Carol Ann Rinsler - The New DIET DOES IT by Gayelord Hauser
The New Fit or Fat by Covert Bailey.

- The Non -Toxic Home by Derbra Lynn Dadd - The Nutribase Nutrition Facts Desk Reference by Art Ulene, MD. - The Philosophers Diet by Ricahrd Watson. - The Total Woman by Marabel Morgan - The Trained Mind: Total Concentration by Time Life Books, Alexandria. Virginia - Total Nutrition: The Only Guide Youll Ever Need by Victor Herbert, MD, JD and Genell J. Subak-Sharpe, MS., Editor Tracy Stopler Kasdan, MS, RD - Understaning Human Behavior in Health and Illness by Richard Simons, MD. - Wellness: Optimal Health and Longevity by Time-life Books, Alexandria. Virginia. - What to Expect When Your Expecting by Arlene Eisenberg, Heidie Murkoff and Sandee Hatenow, RN. - What You Need to Know about Cancer by National Institutes of Health. - When Bad Things Happen to Good People by Harold S. Kushner

339

MC LC
DINH DNG VI BNH TIU NG ................. 9 Phn loi ....................................................................... 11 Nguyn nhn................................................................. 11 Triu chng ................................................................... 12 Dinh dng vi bnh tiu ng .................................... 12 BNH TIM MCH....................................................... 17 DINH DNG VI BNH NG MCH VNH .... 18 Bnh ng mch vnh .................................................. 18 Nguyn nhn................................................................. 18 a. Tui tc ................................................................... 19 b. Gii tnh ................................................................. 19 c. Di truyn ................................................................ 20 d. Chng tc ............................................................... 20 . Thuc l.................................................................. 20 e. Bo ph ................................................................... 20 g. Huyt p cao ........................................................... 21 h. Bnh tiu ng ...................................................... 21 i. t vn ng c th .................................................... 21 k. Cao cholesterol........................................................ 21 Dinh dng vi bnh ng mch vnh ........................... 23 1. Chn thc phm c t cht bo ................................ 23 2. Gim cht bo bo ha ........................................... 23 3. Tng cht bo cha bo ha .................................... 24 4. Gim cholesterol ..................................................... 24 5. n nhiu c ........................................................... 24 6. Tng lng cht x ha tan v tinh bt .................... 25 DINH DNG VI BNH HUYT P CAO ........... 27 Huyt p l g? .............................................................. 28 340

Mc lc
Th no l huyt p cao?................................................ 29 Nguyn nhn v iu tr ................................................ 30 Dinh dng vi bnh huyt p cao ................................. 32 1. Mui n .................................................................. 32 2. Cht bo ................................................................. 34 3. Bo ph ................................................................... 34 4. Ru ....................................................................... 35 5. Mt s mui khong ................................................ 35 6. Rau, tri cy............................................................ 36 Kt lun......................................................................... 37 DINH DNG VI BNH ALZHEIMER ................. 38 Dinh dng vi bnh Alzheimer .................................... 41 1. Nhng kh khn ca ngi bnh ............................. 41 2. Mt s vn m ngi chm sc cn lu ............ 42 DINH DNG VI NGI THIU MU...................... 45 Thiu mu ..................................................................... 46 1. Thiu mu do thiu st ............................................ 47 2. Thiu mu do thiu vitamin B12 .............................. 51 3. Thiu mu v thiu folacin ....................................... 53 DINH DNG VI BNH THN ............................. 54 Suy thn (Renal failure) .................................................. 55 1. Bnh l ................................................................... 56 2. Dinh dng vi ngi suy thn ................................ 56 Si thn ......................................................................... 58 1. Phn loi ................................................................ 58 2. Dinh dng vi bnh si thn.................................. 59 3. Kt lun .................................................................. 61 DINH DNG VI BNH LONG XNG............ 62 Cu to ca xng ......................................................... 62 Nhu cu dinh dng ca xng ...................................... 63 Bnh long xng (Osteoporosis) .................................... 64 DINH DNG VI BNH VIM KHP XNG ... 68 Cu to ca khp ........................................................... 68

341

Dinh dng v iu tr
S thoi ha ca khp .....................................................69 Triu chng ....................................................................71 iu tr...........................................................................72 1. Vt l tr liu ............................................................72 2. Vn ng .................................................................73 3. Gim bo ph...........................................................73 4. Dc phm ..............................................................73 Dinh dng vi bnh vim khp xng ...........................74 Kt lun..........................................................................76 DINH DNG VI BNH UNG TH ....................... 77 I. Thc phm tng nguy c ung th .............................. 78 1. Cht bo ..................................................................78 2. Cht m .................................................................80 3. Carbohydrat .............................................................80 4. Tiu th nng lng .................................................81 5. Ru ........................................................................81 6. Cht ph gia thc phm ...........................................81 7. Aflatoxins.................................................................83 8. Thuc tr su ...........................................................83 9. Nu nng thc phm ..............................................83 10. C ph ...................................................................84 11. Thuc l.................................................................84 II. Dinh dng lm gim nguy c ung th .................... 85 1. Vitamin A ................................................................85 2. Vitamin C ................................................................85 3. Vitamin E ................................................................86 4. Calci........................................................................86 5. Selen .......................................................................86 6. Cht x (fiber) ..........................................................87 7. Hp cht indole .......................................................87 8. Bioflavonoid.............................................................87 III. Nhng quan nim sai lm ...................................... 88 IV. Hu qu ca ung th v mt dinh dng ................ 89 V. nh hng ca iu tr ung th vi dinh dng....... 90

342

Mc lc
VI. Dinh dng vi bnh ung th .................................. 91 Kt lun..........................................................................92 DINH DNGVI CHM SC DA............................ 93 1. Thiu cht m ..........................................................93 2. Thiu cht bo ............................................................94 3. Thiu Vitamin A .........................................................94 4. Thiu vitamin B2 (riboflavin) .......................................95 5. Thiu vitamin B3 (niacin)............................................96 Mt s vn khc.........................................................98 DINH DNG VI BNH CA RNG ................... 100 Qu trnh mc rng v nhu cu dinh dng ...................100 Su rng .......................................................................102 1. Din tin ca qu trnh su rng .............................102 2. Dinh dng vi su rng.........................................103 3. Phng nga su rng ..............................................105 Bnh nha chu (Peridontal disease) .................................107 DINH DNG VI BNH D DY - RUT .......... 109 Bnh lot d dy ..........................................................109 Nguyn nhn .............................................................109 Triu chng................................................................110 iu tr ......................................................................111 Dinh dng vi bnh lot d dy - t trng ....................114 Hi chng km hp th ................................................115 Dinh dng vi hi chng km hp th .........................116 Bnh vim lot i trng ...............................................116 Hi chng rut d kch thch .........................................118 DINH DNG VI BNH VIM GAN .................... 120 Vim gan do virus .........................................................121 I. Vim gan A .............................................................121 II. Vim gan B ............................................................124 III. Vim gan C ...........................................................127 Truyn bnh .................................................................128 Triu chng ..................................................................128

343

Dinh dng v iu tr
Tin lng..................................................................129 iu tr ......................................................................129 Phng nga ................................................................129 IV. Dinh dng vi bnh vim gan ................................129 Bnh x gan .................................................................130 DINH DNG VI BNH TO BN ...................... 132 nh ngha ...................................................................132 Cc loi to bn ...........................................................133 Thay i chc nng ca rut khi tui gi........................134 Nguyn nhn................................................................135 1. Ch n ung ......................................................135 2. Tc dng ph ca dc phm .................................135 3. Cc bnh mn tnh ................................................136 4. Bnh tm thn .......................................................136 5. t vn ng.............................................................136 nh bnh....................................................................136 Bin chng ...................................................................137 iu tr.........................................................................138 1. Khng dng dc phm..........................................138 2. S dng dc phm ................................................141 DINH DNG VI S VN NG C TH ......... 144 Carbohydrat ..................................................................144 Cht m ......................................................................146 Cht bo ........................................................................146 Nc ..............................................................................146 Vitamin v khong cht ............................................... 148 Vi trng hp c bit ................................................ 148 Kt lun ........................................................................150 SUY DINH DNG NGI CAO TUI .............. 151 Din tin bnh thng tui gi ....................................152 Nguy c suy dinh dng................................................153 Nhng du hiu ca suy dinh dng ..............................156 Hu qu ca suy dinh dng .........................................156

344

Mc lc
iu tr v phng nga suy dinh dng..........................156 Kt lun........................................................................158 RU V NGI CAO TUI ...................................159 nh ngha ...................................................................159 Dc tnh ca ru .......................................................160 T l v nguy c nghin ru ........................................161 Du hiu pht hin ngi nghin ru ...........................162 Tc dng ca ru trn sc khe ...................................163 nh bnh....................................................................165 iu tr - Cai ru .........................................................166 Thuc Disulfam ............................................................168 Kt lun........................................................................168 DINH DNG VI S LO HA ............................170 H nhit c th ........................................................172 Ngn chn phn ng gc t do......................................172 S dng dc phm .....................................................173 S dng Gim nng lng tiu th .................................174 Thay i cu trc gen di truyn .....................................175 Gii phu thm m .......................................................175 i sng tinh thn ........................................................176 c tin .........................................................................176 Vn ng c th ...........................................................177 Dinh dng vi s lo ha.............................................178 1. Va phi ................................................................179 2. Cn bng ...............................................................179 3. a dng.................................................................180 4. Thc phm c tc dng chng lo ha ....................183 Kt lun........................................................................185 DINH DNG VI PH N C THAI ................... 186 Thay i c th khi c thai ............................................187 1. H tun hon .........................................................188 2. Tuyn ni tit .........................................................188

345

Dinh dng v iu tr
3. H tiu ha ............................................................188 4. C quan sinh dc ...................................................189 Nhu cu dinh dng .....................................................189 a. Cht m ...............................................................189 b. Carbohydrat ...........................................................190 c. Cht bo ................................................................190 d. Nc .....................................................................190 . Vitamin A ..............................................................190 e. Cc vitamin nhm B ..............................................191 g. Vitamin E...............................................................191 h. Vitamin B12 v folacin ...........................................191 i. Vitamin C ...............................................................192 k. St .........................................................................192 l. Km........................................................................193 m. Calci v phosphor .................................................193 n. Iod .........................................................................193 Cc bnh thng gp ....................................................194 1. Bnh tiu ng .....................................................194 2. Huyt p cao .........................................................195 3. nc trong c th ................................................195 4. Thiu mu..............................................................196 5. St cn hoc tng cn ............................................196 6. chua (heartburn) .................................................197 7. To bn .................................................................198 8. Nn i ..................................................................198 9. Thm mn n khc thng .....................................199 Mt s ri ro khi mang thai ...........................................200 1. Ru ......................................................................200 2. Thuc l.................................................................200 3. Dc phm ............................................................201 4. n chay khi c thai ................................................201 5. n king khem bt mp ....................................202 6. C ph ...................................................................202 Kt lun........................................................................202

346

Mc lc NUI CON BNG SA M ......................................203 u im ca sa m .....................................................205 Khi no bt u cho con b sa m? ..............................207 Mt vi vn cn lu ...............................................208 Ch dinh dng cho ngi m ..................................208 Nhng trng hp khng cho con b sa m .................209 Khi dng cc thuc sau y th khng cho con b: .........210 Kt lun........................................................................210 DINH DNG CHO TR TRONG NM U TIN ... 211 1. Nn cho tr b loi sa no? .....................................212 2. Nhu cu dinh dng ca tr nh th no? ..................213 3. Bao lu cho tr b hoc n mt ln? ..........................213 4. Thc phm cho con: mua sn hay lm ly?................214 5. Khi no bt u cho tr n thc phm c? ...............215 6. Khi no cho n rau tri? ............................................217 7. Bao gi cho b n tht, c, trng? ..............................217 8. C nn cho b t n mt mnh? .................................218 9. Cch cho tr n ........................................................219 10. Lm g khi b bing n? ..........................................219 11. Nhng mn n nn trnh ........................................221 DINH DNG CHO TR T 1 - 5 TUI................. 222 Thc phm c bn ........................................................223 a. Tht, trng ..............................................................223 b. Sa ........................................................................223 c. Rau, tri cy ...........................................................223 d. Carbohydrat ..........................................................224 Bo ph tr em ...........................................................224 DINH DNG CHO TR T 6 - 12 TUI............... 226 Mt s vn cn lu : ...............................................226 DINH DNG CHO TR T 13 - 19 TUI............. 228 Mt s vn cn lu : ...............................................229 RU V SC KHE ...............................................230 V sao ngi ta ung ru? .............................................232 347

Dinh dng v iu tr
Tc dng tch cc ca ru ...........................................233 1. Kch thch khu v ..................................................234 2. Gim cholesterol ....................................................234 3. Gim nguy c tai bin ng mch no....................235 4. Ru v bnh tim mch..........................................235 5. Ru v tm tr .......................................................237 6. Loi ru lm gim nguy c ung th .......................238 7. Ru vi bnh tiu ng .......................................239 8. Ru gip an thn ..................................................239 Tc dng tiu cc ca ru ............................................240 1. Ru l cht gy nghin .........................................240 2. Ru c nhiu nguy c gy ung th .........................240 3. Ru a n suy dinh dng .................................240 4. Ru lm ri lon cng dng ...............................240 5. Ru gy mt mi sau cn say ................................241 6. Ru lm tng t bo m vng bng ....................241 7. Ru gy khuyt tt cho thai nhi .............................242 8. Ru gy mt t ch ...............................................242 Ung vo lc no ..........................................................242 C nn pha long ru khng ........................................243 Mt s vn cn lu ................................................243 Kt lun........................................................................245

RU V PH N C THAI ...................................246 nh hng ru trn thai nhi.........................................248 1. Tc hi ca ru.....................................................249 2. Tc hi lu di .......................................................249 3. Giai on mang thai ..............................................250 4. Ung bao nhiu ru l c hi? ...............................251 Du hiu ca khuyt tt ................................................253 1. Thay i hnh dng ................................................253 2. Chm pht trin tr tu ...........................................254 iu tr v chm sc .....................................................255 Kt lun........................................................................257 348

Mc lc CHOLESTEROL V SC KHE ..............................258 Vi hng y s................................................................259 Cht bo ......................................................................260 a. Acid bo ...............................................................260 b. Cholesterol ............................................................261 c. Triglycerid v VLDL ...............................................263 d. Acid bo omega-3 .................................................264 Vai tr ca cht bo trong c th ...................................264 Lm th no gim cholesterol?..................................266 Kt lun........................................................................270 DINH DNG V BNH BO PH ......................... 271 nh ngha ...................................................................271 i iu cn bit v bo ph .........................................273 Nhng nguy c a n bo ph....................................275 1. Di truyn ...............................................................275 2. Cu trc ha hc ....................................................276 3. Dc phm ...........................................................277 4. t vn ng c th ..................................................277 5. Thi quen sai lm...................................................277 6. n ung giao t .................................................278 7. Kh hu ..................................................................278 Hu qu ca bo ph.....................................................278 iu tr bo ph ............................................................279 1. Gii hn nng lng tiu th ..................................280 2. Dinh dng gim bo ........................................282 3. Vn ng c th .....................................................282 4. Dc phm ............................................................284 5. Gii phu...............................................................286 Phng nga bo ph ......................................................286 Kt lun........................................................................286 CHT X V SC KHE .........................................288 nh ngha ...................................................................288 Nghin cu, quan st v cht x....................................289 349

Dinh dng v iu tr
Ngun gc cht x ........................................................290 Cng dng ca cht x..................................................292 1. Cht x vi bnh to bn........................................293 2. Cht x vi bnh vim i trng .............................293 3. Cht x vi ung th i trng ..................................294 4. Cht x vi bnh tim mch ....................................296 5. Cht x vi bnh tiu ng ...................................297 6. Cht x vi bnh bo ph .......................................298 7. Cht x vi bnh ung th v ...................................298 Vi nh hng khng tt ca cht x .............................299 Cch dng cht x ........................................................299 Kt lun........................................................................300 N MT NGON V ST CN ..................................301 Nguyn nhn................................................................301 1. Do bnh tt............................................................301 2. Do nghin ru ......................................................302 3. Do tc dng ph ca dc phm ............................302 4. Do cc bnh rng ming .......................................303 iu tr.........................................................................304 SUY NHC C TH ...............................................305 Du hiu........................................................................306 Nguyn nhn ................................................................307 iu tr ..........................................................................308 MT S VN SC KHE THNG GP ........ 310 1. No hi ......................................................................310 2. n g b y ...............................................................311 3. Nhn i s loi b ht cht c trong c th? ...........312 4. Xin cho bit vai tr ca vitamin D trong c th. .........312 5. Mt ly c ph c bao nhiu cafein? ...........................313 6. Lm sao trnh ng c thc phm nh? ..................314 7. Thuc tr su nguy hi khng? ..................................315 8. Khi i cm tri lm sao bo qun thc phm? ...........315 9. Ung thm cht chng oxy ha .................................316

350

Mc lc
10. Nhu cu calci .........................................................318 11. Vitamin vi n ngon ming .....................................319 12. Hi ming ..............................................................321 13. Cholesterol trong mu .............................................323 14. Lm sao cho con tr n rau? ....................................325 15. Cc loi qu hch c b dng khng? ....................326 16. Mt s ng nhn v cht m .................................327 17. Thng chn i mi, thng mi mng nm ........329 18. Ma thu su cm, su hng .....................................330 19. Nhau thai c b dng khng? ................................331 20. Xin cho bit yn b dng nh th no? .................332

TI LIU THAM KHO ............................................334 1. Sch ting Vit ........................................................334 2. Cc bi vit v mn n Vit Nam: .............................334 3. Sch ting Anh ........................................................335

351