Compilation of Diets: Myrrh Ariane Y. Gaitano

COMPILATION
OF DIETS
Myrrh Ariane Y.
Gaitano
MSU-IIT STUDENT
TABLE OF CONTENTS
NURSE
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Eating Disorders (5-11)
 Bulimia Nervosa
 Anorexia Nervosa
Burns (12-17)
Cardiac Disorders (18-26)
 Coronary Artery Diseases
 Hypertension
 Congestive Heart Failure
Endocrine Disorders (26-55)
 Diabetes Mellitus
 Thyroid disorders
 Parathyroid disorders
 Pancreatitis (Acute and Chronic)
 Diabetes Insipidus
 Addison’s Disease
 Cushing’s Disease
 Pheochromocytoma
GI disorders (55-82)
 Gastroesophageal Reflux Disease
 Dumping Syndrome
 Irritable Bowel Syndromes
 Inflammatory Bowel Diseases
 Peptic Ulcer Diseases
 Cholecystitis
 Gastritis
 Gastroenteritis
 Peritonitis
 Paralytic Ileus
 Diverticulitis
Respiratory Disorders (82-93)
 Acute Airway Attacks
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 Chronic Obstructive Pulmonary Disease
 Tuberculosis
Immune Disorders (93-107)
 HIV and AIDS
 Rheumatoid Arthritis
 Systemic Lupus Erythematosus
 Anaphylaxis
Liver Disorders (107-112)
 Hepatitis (All types)
 Liver Cirrhosis
Musculoskeletal Disorders (112-125)
 Fractures
 Osteoarthritis
 Osteoporosis
 Osteomyelitis
 Gouty Arthritis
Neurological Disorders (125-138)
 Guillain-Barre Syndrome
 Myasthenia Gravis
 Parkinson’s Disease
 Spinal Cord Injury
 Multiple Sclerosis
 Bell’s Palsy
 Meningitis
 Stroke
Hematologic Disorders (138-144)

 Iron Deficiency Anemia
 Leukemia
 Sickle Cell Anemia
 Polycythemia Vera
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 Pernicious Anemia
Genitourinary System (144-150)
 Benign Prostatic Hypertrophy
 Kidney Stones
 Urinary Tract Infection
 Acute Glomerulonephritis
 Renal Failure (Acute and Chronic)
REFERENNCES (150-154)
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EATING DISORDERS
Anorexia Nervosa
Overview
People who have anorexia have an intense fear of gaining

weight. They severely limit the amount of food they eat and
can become dangerously thin.
Anorexia affects both the body and the mind. It may start
as dieting, but it gets out of control. You think about
food, dieting, and weight all the time. You have a
distorted body image. Other people say you are too thin,
but when you look in the mirror, you see your body
as overweight.
Associated Nutritional Problems
In anorexia nervosa’s cycle of self-starvation, the body is

denied the essential nutrients it needs to function
normally. Thus, the body is forced to slow down all of its
processes to conserve energy, resulting in serious medical
consequences:
• Abnormally slow heart rate and low blood pressure,

which mean that the heart muscle is changing. The
risk for heart failure rises as the heart rate and
blood pressure levels sink lower and lower.
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• Reduction of bone density (osteoporosis), which
results in dry, brittle bones.
• Muscle loss and weakness.
• Severe dehydration, which can result in kidney

failure.
• Fainting, fatigue, and overall weakness.
• Dry hair and skin; hair loss is common.
• Growth of a downy layer of hair called lanugo all

over the body, including the face, in an effort to
keep the body warm.
Dietary measures
The first priority in anorexia treatment is addressing and

stabilizing any serious health issues. Hospitalization may be
necessary if you are dangerously malnourished or so
distressed that you no longer want to live. You may also
need to be hospitalized until you reach a less critical
weight.
Often people with anorexia will be reluctant to admit to

their problem due to embarrassment or trepidation about
what the treatment might involve. It can also feel like they
are relinquishing the control they fought so hard to obtain.
If you suspect that a close friend or family member has

anorexia, it is advisable to try to get help as soon as
possible. A GP will conduct an assessment and possibly
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refer the sufferer to a specialist care team (a care team can
include a specialist counsellor, a psychologist, a
psychiatrist, a dietician and a nurse). Once any
psychological or physical factors have been assessed, a
course of treatment can be established.
Nutritional Monitoring
For an anorexic sufferer, gaining weight is an incredibly

delicate process. The long periods of starvation could have
caused any number of biochemical abnormalities such as
deficiencies in proteins, micronutrients and fatty acids.
This usually means that specialist dietary plans must be

made in order to correct the imbalances and not cause
additional problems. Experts believe that weight should not
be gained until these deficiencies have been corrected.
Aggressive attempts to boost weight gain during the early
stages of treatment could be extremely hazardous.
Any course of treatment for anorexia is usually considered

within a wider psychological context. This means that
emphasis will be placed on speaking with the patient and
understanding their needs. A person suffering from
anorexia may find the treatment challenging and upsetting.
This is because their connection with food is more personal
and complex than most outsiders can understand, and may
be connected to underlying psychological issues.
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Bulimia Nervosa
Overview
Bulimia nervosa, commonly called bulimia, is a serious,

potentially life-threatening eating disorder. People with
bulimia may secretly binge — eating large amounts of food
— and then purge, trying to get rid of the extra calories in
an unhealthy way. For example, someone with bulimia may
force vomiting or engage in excessive exercise. Sometimes
people purge after eating only a small snack or a normal-
size meal.
Bulimia can be categorized in two ways:
• Purging bulimia. You regularly self-induce vomiting

or misuse laxatives, diuretics or enemas after
bingeing.
• Nonpurging bulimia. You use other methods to rid

yourself of calories and prevent weight gain, such as
fasting, strict dieting or excessive exercise.
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However, these behaviors often overlap, and the attempt to
rid yourself of extra calories is usually referred to as
purging, no matter what the method.
Associated nutritional problems
 Dental
 Damaged skin
 Swollen glands
 Bowel issues
 Chemical imbalances
 Heart problems
Dietary measures
Since negative body image and poor self-esteem are often
the underlying factors at the root of bulimia, it is important
that therapy is integrated in the recovery process.
Treatment for bulimia nervosa usually includes:
•Discontinuing the binge-purge cycle: The initial

phase of treatment for bulimia nervosa involves
breaking this harmful cycle and restoring normal
eating behaviors.
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• Improving negative thoughts: The next phase of
bulimia treatment concentrates on recognizing and
changing irrational beliefs about weight, body shape,
and dieting.
• Resolving emotional issues: The final phase of
bulimia treatment focuses on healing from emotional
issues that may have caused the eating disorder.
Treatment may address interpersonal relationships
and can include cognitive behavior therapy, dialectic
behavior therapy, and other related therapies.
Don’t delay and risk serious medical complications. Seek
out an eating disorder treatment facility in your area.
Nutritional monitoring
Nutrition therapy is an integral part of the eating disorder
(ED) treatment and recovery process. The primary role of
nutrition therapy is to assist patients in normalizing their
eating patterns. Normalized eating encompasses
Eating adequately to meet the body’s daily nutritional

needs
A balanced and sustainable relationship with food, free

from negative or distorted thoughts about oneself
Listening to and trusting your body’s internal cues to

determine hunger and fullness
While underlying thoughts and emotions remain at the core

of a person’s illness and recovery, their relationship with
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food, eating and nutrition can play a major role in inhibiting
or promoting the recovery process. This is why The Center
for Eating Disorders incorporates nutrition counseling with
specially trained experts at every level of our program. Our
staff of Registered Dietitians (RD,) as part of an
interdisciplinary team of professionals, support and assist
individuals in meeting nutritional goals and progressing in
recovery. The nutrition staff facilitates educational and
supportive groups as well as individual sessions tailored to
each person’s unique struggle with food and eating.
Throughout the program, many opportunities are provided
for patients to incorporate and practice their new balanced
approach to eating.
BURNS
Overview
Burns are a type of injury caused by heat. The heat can be
thermal, electrical, chemical, or electromagnetic energy.
Most burn accidents occur at home. About 75 percent of all
burn injuries in children are preventable.
Smoking and open flame are the leading causes of burn

injury for older adults, while scalding is the leading cause of
burn injury for children. Both infants and the elderly are at
the greatest risk for burn injury.
A burn injury usually results from an energy transfer to the

body. There are many types of burns caused by thermal,
radiation, chemical, or electrical contact:
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• Refeeding Syndrome -This potentially lethal

syndrome of severe electrolyte and fluid shifts
associated with metabolic abnormalities in
malnourished patients undergoing feeding orally
enterally, or parenterally has been well defined in
the malnourished free-living and sick populations
alike. The prerequisite for risk of refeeding is recent
dramatic or chronic nutrition depletion. The burn
patient is at risk if pre-burn nutrition has been
compromised.
• Non-obstructive Bowel Necrosis
Although rare, several case reports have defined

this syndrome of diffuse or defined areas of full-
thickness necrosis of small bowel due to aggressive
enteral feeding, without obstruction. For high-risk
patients, it is recommended that initial cautious
feeding is effected, with a fibre-free enteral feed.
Bowel function and GIT symptoms need to be
monitored closely. (2) Burn patients at risk include
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those experiencing severe trauma shock, ventilator
dependence, anaesthetic and analgesic medications,
general vasoconstriction (including
pharmacological), hypovolaemia, bowel dysmotility.
(2)
Dietary Measures
 Minor burns can be treated with natural products.

However, severe burns always require immediate
medical attention. It is especially important for
people who have been seriously burned to get
enough nutrients in their daily diet. Burn patients in
hospitals are often given high calorie, high protein
diets to speed recovery.
 DO NOT try to treat a second or third degree burn
by yourself. Always seek medical advice. Ask your
doctor which supplements are best for you. Always
tell your doctor about the herbs and supplements
you are using or considering using, as some
supplements may interfere with conventional
treatments.
 Following these tips may improve your healing and
general health.
 Eat antioxidant foods, including fruits (such as
blueberries, cherries, and tomatoes), and vegetables
(such as squash and bell peppers). One study found
that high doses of vitamin C after a burn reduced
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fluid requirements by 40%, reduced burn tissue
water content 50%, and reduced ventilator days.
 Avoid refined foods, such as white breads, pastas,
and sugar.
 Eat fewer red meats and more lean meats, cold-
water fish, tofu (soy) or beans for protein.
 Use healthy cooking oils, such as olive oil or coconut
oil.
 Reduce or eliminate trans-fatty acids, found in
commercially baked goods, such as cookies,
crackers, cakes, French fries, onion rings, donuts,
processed foods, and margarine.
 Avoid caffeine and other stimulants, alcohol, and
tobacco.
 Drink 6 to 8 glasses of filtered water daily.
 The following supplements may also help. Be sure
to ask your doctor before taking them if your burns
are moderate or severe:
 A daily multivitamin, containing the antioxidant
vitamins A, C, E, the B-complex vitamins and trace
minerals such as magnesium, calcium, zinc, and
selenium.
 Omega-3 fatty acids, such as fish oil, 1 to 2 capsules
or 1 tbsp of oil, 1 to 2 times daily, to help reduce
inflammation, and for healing and immunity. Cold-
water fish, such as salmon or halibut, are good
sources, but you may need a supplement to get a
higher dose. Omega-3 fatty acids can interact with
blood-thinning medications such as warfarin
(Coumadin) and aspirin, and may decrease clotting
time.
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 Vitamin C (1,000 mg, 2 to 6 times per day) helps
skin heal by enhancing new tissue growth and
strength. Lower dose if diarrhea develops. You
should use vitamin C only under a physician's
guidance if you have cancer, certain blood iron
disorders, kidney stones, diabetes, and a metabolic
deficiency called "glucose 6 phosphate
dehydrogenase deficiency" (G6PDD).
 Vitamin E (400 to 800 IU a day) promotes healing.
May be used topically once the burn has healed and
new skin has formed. Higher doses may help in
healing burns. Talk to your doctor before taking
vitamin E if you are scheduled to have surgery.
Vitamin E can interact with certain medications,
including, but not limited to
antiplatelet/anticoagulant drugs. Speak with your
doctor.
 Coenzyme Q10 (CoQ10), 100 to 200 mg at bedtime,
for antioxidant and immune activity. CoQ10 may
have a blood-clotting effect and can interact with
blood-thinning medications
(anticoagulant/antiplatelet drugs).
 L-glutamine, 500 to 1,000 mg, 3 times daily, for
support of gastrointestinal health and immunity.
Glutamine in high doses can affect mood
particularly in patients with mania. There is some
concern that people who are sensitive to MSG
(monosodium glutamate) may also be sensitive to
Glutamine. People with hepatic encephalopathy,
severe liver disease with confusion, or a history of
seizures, should not take Glutamine. Glutamine can
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interact with certain medications, so speak with
your physician.
 Probiotic supplement (containing Lactobacillus
acidophilus), 5 to 10 billion CFUs (colony forming
units) a day. Taking antibiotics can upset the
balance of bacteria in your intestines. Probiotics or
"friendly" bacteria can help restore the balance,
improving gastrointestinal and immune health.
Some clinicians have raised concerns about giving
probiotics to severely immunocompromised
patients. More research is needed. Refrigerate your
probiotic supplements for best results.
 Coconut oil. After a burn heals, applying coconut oil
topically may be helpful for reconditioning and
moisturizing the skin.
The pediatric burn patient presents a particular challenge

nutritionally. Nutritional reserves are limited, and excesses
are often poorly tolerated. Ongoing monitoring is essential
for discovering at an early stage the dynamic shifts in
energy, protein, and other nutrients that may be occurring.
Adequate enteral intake may be difficult to achieve as a
result of repeated holding of feedings on surgery days and
gastrointestinal tolerance problems such as poor gastric
emptying and abdominal distention. This case report
illustrates techniques, such as the nutritional assessment
record and parenteral nutrition evaluation form, which
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may assist the clinician in optimizing the nutritional
management of the patient.
CARDIAC DISORDERS
Coronary Artery Disease

Overview
Coronary artery disease is the most common type of heart

disease. It's also the number one killer of both men and
women in the United States.
When you have it, your heart muscle doesn't get

enough blood. This can lead to serious problems,
including heart attack.
It can be a shock to find out that you have coronary artery

disease. Many people only find out when they have a heart
attack. Whether or not you have had a heart attack, there
are many things you can do to slow coronary artery disease
and reduce your risk of future problems.
Associated Nutrtional Problems
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• Uncontrolled diabetes and impaired glucose
tolerance
In healthy people, insulin keeps the blood sugar level

relatively constant. However, for those vulnerable to type 2
diabetes, the body gradually loses its sensitivity to insulin.
This leads to chronically elevated blood sugar levels, also
known as impaired glucose tolerance.
Uncontrolled diabetes can damage the artery walls and

contribute to coronary heart disease. People who are obese
are more likely to develop type 2 diabetes than people of
normal weight.
Dietary measures
• Avoid fried fast food and processed foods containing

vegetable shortening.
• Choose a variety of oils (extra virgin olive oil, canola,
peanut) and foods containing natural fats (nuts, seeds,
avocado, olives, soy, fish).
• Switch to low-fat or non-fat dairy products.
• Increase the amount and variety of plant foods consumed –
eat more unrefined vegetables, fruits and wholegrain
cereals. Reduce intake of refined sources of carbohydrates
with higher glycaemic indices.
• Include legumes (like baked beans, soybeans, lentils and
tofu) in your diet.
• Have a handful of a variety of raw, unsalted nuts on most
days of the week, especially walnuts and almonds.
• Eat oily fish at least once per week.
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• If you drink alcohol, have no more than two drinks per day.
• Trim all visible fat from meat.
• Remove poultry skin and eat only the meat.
• Avoid added salt at the table and cooking and salty foods.
Check the sodium content of foods and choose the lowest
sodium products.
Hypertension
Overview
Blood pressure is the force of blood pushing against blood

vessel walls. The heart pumps blood into the arteries
(blood vessels) which carry the blood throughout the
body. High blood pressure, also called hypertension, means
the pressure in your arteries is above the normal range. In
most cases, no one knows what causes high blood pressure.
What you eat can affect your blood pressure.
In most people, the kidneys have trouble keeping up with

the excess sodium in the bloodstream. As sodium
accumulates, the body holds onto water to dilute the
sodium. This increases both the amount of fluid
surrounding cells and the volume of blood in the
bloodstream. Increased blood volume means more work for
the heart and more pressure on blood vessels. Over time,
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the extra work and pressure can stiffen blood vessels,
leading to high blood pressure, heart attack, stroke,. It can
also lead to heart failure. There is also some evidence that
too much salt can damage the heart, aorta, and kidneys
without increasing blood pressure, and that it may be bad
for bones, too.
Cancer- Research shows that higher intake of salt, sodium,

or salty foods is linked to an increase in stomach cancer.
The World Cancer Research Fund and American Institute
for Cancer Research concluded that salt, as well as salted
and salty foods, are a “probable cause of stomach cancer.”
Osteoporosis- The amount of calcium that your body loses

via urination increases with the amount of salt you eat. If
calcium is in short supply in the blood, it can be leached out
of the bones. So, a diet high in sodium could have an
additional unwanted effect—the bone-thinning disease
known as osteoporosis.
Dietary measures
DASH stands for Dietary Approaches to Stop Hypertension.

The diet is simple:
• Eat more fruits, vegetables, and low-fat dairy foods

• Cut back on foods that are high in saturated fat, cholesterol,
and trans fats
• Eat more whole-grain foods, fish, poultry, and nuts
• Limit sodium, sweets, sugary drinks, and red meats
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A healthful eating pattern, regular physical activity, and

often pharmacotherapy are key components of diabetes
management. For many individuals with diabetes, the most
challenging part of the treatment plan is determining what
to eat. It is the position of the American Diabetes
Association (ADA) that there is not a “one-size-fits-all”
eating pattern for individuals with diabetes. The ADA also
recognizes the integral role of nutrition therapy in overall
diabetes management and has historically recommended
that each person with diabetes be actively engaged in self-
management, education, and treatment planning with his
or her health care provider, which includes the
collaborative development of an individualized eating plan.
Therefore, it is important that all members of the health
care team be knowledgeable about diabetes nutrition
therapy and supports its implementation.
Congestive Heart Failure

Overview
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Heart failure does not mean the heart has stopped working.
Rather, it means that the heart's pumping power is less
effective than normal. With heart failure, blood moves
through the heart and body at a slower rate, and pressure
in the heart increases. As a result, the heart cannot pump
enough blood carrying oxygen and nutrients to meet the
body's needs. The chambers of the heart may respond
by stretching to carry more blood to pump through the
body or by becoming more stiff and thickened. This helps to
keep the blood moving for a while, but in time, the heart
muscle walls may weaken and are unable to pump as
strongly. As a result, the kidneys respond by causing the
body to retain fluid (water) and sodium. If fluid builds up in
the arms, legs, ankles, feet, lungs, or other organs, the body
becomes congested, and congestive heart failure is the term
used to describe the condition.
• Coronary artery disease. Coronary artery disease (CAD), a
disease of the arteries that supply blood and oxygen to the
heart, causes decreased blood flow to the heart muscle. If
the arteries become blocked or severely narrowed, the
heart becomes starved for oxygen and nutrients.
• Heart attack. A heart attack may occur when a coronary
artery becomes suddenly blocked, stopping the flow of
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blood to the heart muscle and damaging it. All or part of the
heart muscle becomes cut off from its supply of oxygen.
A heart attack can damage the heart muscle, resulting in a
scarred area that does not function properly.
• Cardiomyopathy. Damage to the heart muscle. Causes
include artery or blood flow problems, infections, and
alcohol and drug abuse.
• Conditions that overwork the heart. Conditions
including high blood pressure, heart valve
disease, thyroid disease, disease, diabetes, or heart defects
present at birth can all cause heart failure. In addition,
heart failure can occur when several diseases or conditions
are present at once.
Dietary measures
• Check food labels, and limit salt and sodium to 1,500 to
2,000 milligrams per day.
• Replace salt and other high-sodium seasonings with
alternatives that have no salt or are low in sodium
• When eating out, think about hidden sources of salt and
sodium, such as salad dressings and soups. Ask for options
low in salt and sodium.
• Choose meats and other foods that are low in saturated fat
to help lower your cholesterol levels.
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• Avoid alcohol. If your heart failure is caused by alcohol, it's
especially important that you don't drink any alcoholic
beverages.
Reading labels for sodium content is recommended. There
are certain foods that are high in sodium that should be
avoided. These include vegetable or tomato soups, salted
crackers, bacon, canned meats or fish, cold cuts, dehydrated
soups and pickled vegetables. Canned foods and
dehydrated prepared foods are also high in sodium.
Instead of pre-packaged foods, try having fresh fruits and
vegetables. Since you are preparing them, you know that
there is no added salt. Check the labels of enriched breads
and cereals for sodium content prior to purchasing. Lean
protein sources, such as chicken or tofu cooked without
sodium, are healthy choices for protein. For dairy products,
try to stick with low fat or non-fat milks, cheeses or
yogurts.
Endocrine Disorders
Diabetes Mellitus
Overview
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Diabetes is a disorder of metabolism -- the way our bodies
use digested food for growth and energy. Most of the food
we eat is broken down into glucose, the form of sugar in
the blood. Glucose is the main source of fuel for the body.
After digestion, glucose passes into the bloodstream, where

it is used by cells for growth and energy. For glucose to get
into cells, insulin must be present. Insulin is a hormone
produced by the pancreas, a large gland behind
the stomach.
When we eat, the pancreas automatically produces the

right amount of insulin to move glucose from blood into our
cells. In people with diabetes, however, the pancreas either
produces little or no insulin, or the cells do not respond
appropriately to the insulin that is produced. Glucose builds
up in the blood, overflows into the urine, and passes out of
the body. Thus, the body loses its main source of fuel even
though the blood contains large amounts of sugar.
Dietary measures
If you have high cholesterol along with diabetes, your
doctor will probably recommend the TLC (Therapeutic
Lifestyle Changes) plan.
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The goal is to lower your cholesterol level, drop extra
weight, and get more active. That helps prevent heart
disease, which is more common when you have diabetes.
On the TLC diet, you will:
• Limit fat to 25%-35% of your total daily calories.

• Get no more than 7% of your daily calories from saturated
fat, 10% or less from polyunsaturated fats, and up to 20%
from monounsaturated fats (like plant oils or nuts).
• Keep carbs to 50%-60% of your daily calories.
• Aim for 20-30 grams of fiber each day.
• Allow 15% to 20% of your daily calories for protein.
• Cap cholesterol at less than 200 milligrams per day.
You'll also need to get more exercise and keep up with your
medical treatment.
Although assessment is the initial step of the four-step

model, beginning the relationship or establishing rapport
with a client is an important preliminary step. Usually, this
begins during the assessment phase and continues
throughout the educational process, to develop a genuine
and trusting relationship between diabetes educator and
client.
Nutrition assessment is the most crucial step in diabetes
MNT. The assessment forms the basis for developing the
intervention plan and identifying potential changes to a
client’s lifestyle and health habits that will improve health.
The main purpose of an assessment is to gather
information needed to assist in the development of
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individual nutrition goals and subsequently establish an
appropriate nutrition intervention.
Thyroid disorders
Overview
The thyroid gland, located in the anterior neck just below

the cricoid cartilage, consists of 2 lobes connected by an
isthmus. Follicular cells in the gland produce the 2 main
thyroid hormones, tetraiodothyronine (thyroxine, T4) and
triiodothyronine (T3). These hormones act on cells in
virtually every body tissue by combining with nuclear
receptors and altering expression of a wide range of gene
products. Thyroid hormone is required for normal brain
and somatic tissue development in the fetus and neonate,
and, in people of all ages, regulates protein, carbohydrate,
and fat metabolism.
T3 is the most active form in binding to the nuclear
receptor; T4 has only minimal hormonal activity. However,
T4 is much longer lasting and can be converted to T3 (in
most tissues) and thus serves as a reservoir for T3. A 3rd
form of thyroid hormone, reverse T3 (rT3), has no metabolic
activity; levels of rT3increase in certain diseases.
Additionally, parafollicular cells (C cells) secrete the
hormone calcitonin , which is released in response to
hypercalcemia and lowers serum Ca levels

Hypothyroidism is one of the most commonly diagnosed
conditions in the United States today but very few doctors
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actually pay attention to the nutritional relationships
between your thyroid and vitamins and minerals. I want to
talk today about what you can do to ensure that the reason
your thyroid isn’t working properly isn’t just something to
do with nutritional deficiency.
The first thing that we want to understand is that there is a

hormone your doctor typically measures TSH (Thyroid
Stimulating Hormone) that comes from your brain and it
travels to your thyroid gland and tells your thyroid gland to
produce T4. That T4 is what we call inactive thyroid
hormone. The T4 travels through the blood stream and
when it gets to the peripheral tissues it is converted into
T3, what we would call the active form of thyroid hormone.
T3 then has to get inside of your cells. DNA is in the center
of the cell inside the nucleus. On the surface of the cell
nucleus we have this little tiny key hole called the nuclear
receptor and, in the case of thyroid hormone, that little
nuclear receptor is where thyroid hormone binds. We get
the binding of T3 onto that nuclear receptor and that my
friends is what increases your metabolism.
What are the symptoms of low thyroid? With low thyroid

most people will experience energy loss, weight gain, hair
loss, dry skin, elevated cholesterol, constipation. These are
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all common symptoms of low levels of T3 or low levels of
thyroid hormone overall.
Now I hope you have a general understanding of the way

these hormones work. Now let’s insert the nutritional
parameters so that you have a better understanding
nutritionally of what needs to happen.
The very first thing is that this TSH doesn’t just magically
appear. In order to properly make TSH you have to
maintain adequate protein in your diet.Magnesium,
vitamin B-12, and zinc are also required to make this
particular hormone. These three micronutrients
(magnesium, B-12, zinc) and this major macronutrient
(protein) are all responsible for helping us to properly
produce TSH.
There are certain nutrients required to make T4. One of

them is iodine. That 4 in T4 refers to 4 molecules of iodine,
so to make T4 you have to have 4 molecules of iodine. If you
ever see iodized salt, salt in the United States is iodized as a
result of widespread goiter epidemic. Goiter is when the
thyroid enlarges because of in this case iodine deficiency.
This is why table salt is iodized however I don’t recommend
trying to get your iodine from that particular source
because there are other negative consequences to over-
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consumption of standard table salt. You can get iodine from
eating fresh vegetables, seafood, kelp, and seaweed.
Iodine is not the only nutrient required to make T4. There’s

a mechanism inside your thyroid gland that helps to draw
iodine into the thyroid gland. That mechanism is a little
kind of doorway called a symporter and it requires Vitamin
B2 and Vitamin C. That symporter won’t work to bring
iodine into the thyroid gland unless you have these two
nutrients in place to run that symporter pump.
So far we have talked about 7 different nutrients associated

with getting from TSH down to T4. Now we have to get
from T4 to T3. This process right here also requires
nutrition. There is an enzyme that does this conversion for
us and that enzyme is driven by the nutrient or
mineral selenium. Without selenium we won’t convert T4
to T3. What we’ll actually do without selenium is make
another compound called Reverse T3 (RT3). Reverse T3 is
also inactive. The problem is if your doctor doesn’t run a
Reverse T3 lab test. Many doctors don’t run Reverse T3.
Most doctors from my experience look at TSH only and they
skip all these other components. If your doctor isn’t looking
at Reverse T3, and maybe they did measure T3, you can’t
differentiate Reverse T3 and T3 from each other without
30 | P a g e
actually teasing them out. The way you do that is have your
doctor measure Reverse T3 as well as T3.
Dietary measures
The thyroid gland needs specific vitamins and minerals to
properly do its job. Since we are all unique in how our
hormones are functioning, the best way to get a handle on
what our body specifically needs is to have a full thyroid
panel done to help pinpoint where individual levels may be
off balance. Research shows us that there are a few key
nutrients that are highly valuable for everyone.
Iodine (I): This is the most important trace element found

in thyroid functioning. Without iodine, our thyroid does not
have the basic building blocks it needs to make the
necessary hormones to support all of the tissues in the
body. Thyroxine (T4) and Triiodothyronine (T3) are the
most essential, active, iodine-containing hormones we
have. In 2012, a CDC report showed that women of
childbearing years in the United States, ages 20-39, had the
lowest iodine levels of any other age group. This is
something we can easily improve by eating more iodine-
rich foods.
Selenium (Se): This element is indispensable to our
thyroid in several ways. Selenium-containing enzymes
31 | P a g e
protect the thyroid gland when we are under stress,
working like a “detox,” to help flush oxidative and chemical
stress, and even social stress – which can cause reactions in
our body. Selenium-based proteins help regulate hormone
synthesis, converting T4 into the more accessible T3. These
proteins and enzymes help regulate metabolism and also
help maintain the right amount of thyroid hormones in the
tissues and blood, as well as organs such as the liver,
kidneys, and even the brain.Selenium also helps regulate
and recycle our iodine stores. These are all very important
functions!
Zinc (Zn), iron (Fe), and copper (CU): These three trace
metals are vital to thyroid function. Low levels of zinc can
cause T4, T3, and the thyroid stimulating hormone(TSH) to
also become low. Research shows that both
hyperthyroidism (overactive thyroids)
and hypothyroidism (under active thyroids), can
sometimes create a zinc deficiency leading to lowered
thyroid hormones.
Decreased levels of iron can result in decreased thyroid
function as well. When combined with an iodine deficiency,
iron must be replaced to repair the thyroid
imbalance. Copper is needed to help produce TSH, and
maintain T4 production. T4 helps cholesterol regulation,
and some research even indicates copper deficiency may
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contribute to higher cholesterol and heart issues for people
with hypothyroidism.
The best treatment for any disorder is to address the

causes. The medical treatment is to prescribe a synthetic
form of T4 and experiment with the dose until the blood
TSH level is normal. One point of view is that the body is
defective and the patient will have to compensate by taking
T4 for the rest of their life. Another point of view is that T4
and possibly T3 or a natural thyroid product should be
supplemented to get the TSH level down into the lower
normal range. The intent is to give the thyroid gland a rest
period. The doctor then gradually decreases the dosage of
the thyroid medication to allow the thyroid gland to resume
natural operation. Anecdotal evidence from doctors who
apply this philosophy indicates that it works about half of
the time.
Another point of view is that thyroid disorders of most if
not all types are often caused by iodine deficiency. This
view is supported by a minority of medical doctors and
alternative practitioners who
apply orthoiodosupplementation as a primary therapy.
They advocate using high doses of iodine to displace the
fluorides and bromides in the body and
restore iodine reserves. In clinical practice, this whole
process is monitored by laboratory tests.
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Parathyroid Disorders
Overview
Parathyroid glands are small glands of the endocrine
system that are located behind the thyroid. There are four
parathyroid glands which are normally about the size and
shape of a grain of rice. They are shown in this picture as
the mustard yellow glands behind the pink thyroid gland.
This is their normal color.
The sole purpose of the parathyroid glands is to regulate
the calcium level in our bodies within a very narrow range
so that the nervous and muscular systems can function
properly. Although they are neighbors and both part of the
endocrine system, the thyroid and parathyroid glands are
otherwise unrelated. The single major disease of
parathyroid glands is overactivity of one or more of the
parathyroids; that's hyperparathyroidism.

Calcium is a mineral that the body needs for good health
and healthy bones. It is also critical for the body’s normal
functioning. Calcium is naturally found in some foods, or
can be taken as a nutritional supplement. When the body
has too much or too little calcium, calcium-related
problems can occur. This can be due to improper calcium
intake or the inability for the body to regulate calcium
levels properly, such as with parathyroid disorders.
34 | P a g e
The parathyroid glands regulate calcium levels in the body.
Parathyroid disorders may cause a loss of energy, kidney
stones, depression and many other symptoms.
Calcium-related medical problems include hypocalcemia,

vitamin D deficiency, kidney stones and osteoporosis.
These disorders can have devastating effects on your health
and well-being. Diagnosis and treatment are key to
managing these conditions, and will help to control
symptoms and decrease the risk of other related complex
problems.
Dietary Measurements
Eating, diet, and nutrition have not been shown to play a

role in causing or preventing primary
hyperparathyroidism.
Vitamin D. Experts suggest correcting vitamin D deficiency
in people with primary hyperparathyroidism to achieve a
serum level of 25-hydroxy-vitamin D greater than 20
nanograms per deciliter (50 nanomoles per liter). Research
is ongoing to determine optimal doses and regimens of
vitamin D supplementation for people with primary
hyperparathyroidism.
For the healthy public, the Institute of Medicine (IOM)
guidelines for vitamin D intake are
• people ages 1 to 70 years may require 600
International Units (IUs)
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• people age 71 and older may require as much as
800 IUs
The IOM also recommends that no more than 4,000 IUs of
vitamin D be taken per day.
Calcium. People with primary hyperparathyroidism
without symptoms who are being monitored do not need to
restrict calcium in their diet. People with low calcium
levels due to loss of all parathyroid tissue from surgery will
need to take calcium supplements for the rest of their life.
Some people who have mild primary hyperparathyroidism

may not need immediate or even any surgery and can be
safely monitored. People may wish to talk with their health
care provider about long-term monitoring if they
• are symptom-free
• have only slightly elevated blood calcium levels
• have normal kidneys and bone density
Long-term monitoring should include periodic clinical
evaluations, annual serum calcium measurements, annual
serum creatinine measurements to check kidney function,
and bone density measurements every 1 to 2 years.
Vitamin D deficiency should be corrected if present.
Patients who are monitored need not restrict calcium in
their diets.
If the patient and health care provider choose long-term
monitoring, the patient should
36 | P a g e
• drink plenty of water
• exercise regularly
• avoid certain diuretics, such as thiazides
Either immobilization—the inability to move due to illness
or injury—or gastrointestinal illness with vomiting or
diarrhea that leads to dehydration can cause blood calcium
levels to rise further in someone with primary
hyperparathyroidism. People with primary
hyperparathyroidism should seek medical attention if they
find themselves immobilized or dehydrated due to
vomiting or diarrhea.
Pancreatitis
Overview
The pancreas is a large gland located behind the stomach
and beside the duodenum or upper part of the small
intestine. The pancreas works to:
 Facilitate the digestion of carbohydrates, proteins

and fat by the secretion of very powerful digestive
enzymes into the small intestine.
 Release two hormones, insulin and glucagon, into

the bloodstream. These hormones are involved in
blood glucose metabolism.
 Pancreatitis is a rare disease in which the pancreas
becomes inflamed. Pancreatic damage occurs when
the digestive enzymes are activated and begin
37 | P a g e
attacking the pancreas. In very severe cases,
pancreatitis can result in bleeding into the gland
itself; serious tissue damage, infection and fluid
collections may occur. Severe pancreatitis can
result in damage to other vital organs such as the
heart, lung and kidneys.
There are two forms of pancreatitis:
 Acute pancreatitis occurs suddenly and may result

in life-threatening complications; however the
majority of patients (80 percent) recover
completely.
 Chronic pancreatitis is usually the result of

longstanding damage to the pancreas from alcohol
ingestion. Chronic pancreatitis is primarily marked
by severe pain and loss of pancreatic function.
Acute pancreatitis is a sudden attack causing inflammation
of the pancreas and is usually associated with severe upper
abdominal pain. The pain may be severe and last several
days. Other symptoms of acute pancreatitis include nausea,
vomiting, diarrhea, bloating, and fever. In the United States,
the most common cause of acute pancreatitis is gallstones.
Other causes include chronic alcohol consumption,
hereditary conditions, trauma, medications, infections,
electrolyte abnormalities, high lipid levels, hormonal
abnormalities, or other unknown causes. The treatment is
38 | P a g e
usually supportive with medications showing no benefit.
Most patients with acute pancreatitis recover completely.
Chronic pancreatitis is the progressive disorder associated
with the destruction of the pancreas. The disease is more
common in men and usually develops in persons between
30 and 40 years of age. Initially, chronic pancreatitis may
be confused with acute pancreatitis because the symptoms
are similar. The most common symptoms are upper
abdominal pain and diarrhea. As the disease becomes more
chronic, patients can develop malnutrition and weight loss.
If the pancreas becomes destroyed in the latter stages of
the disease, patients may develop diabetes mellitus.
The most common cause of chronic pancreatitis in the

United States is chronic alcohol consumption. Additional
causes include cystic fibrosis and other hereditary
disorders ofthe pancreas. For a significant percentage of
patients there is no known cause. More research is needed
to determine other causes of the disease.
The treatment for chronic pancreatitis depends on the

symptoms. Most therapies center on pain management and
nutritional support. Oral pancreatic enzyme supplements
are used to aid in the digestion of food. Patients who
39 | P a g e
develop diabetes require insulin to control blood sugar. The
avoidance of alcohol is central to therapy.
Dietary Measures
People with pancreatic cancer who have a Whipple’s
procedure may have many questions and concerns about
their diet following the operation. The suggestions on the
below may be helpful when you start to eat after surgery.
• Have small meals every 2–3 hours rather than three large
meals.
• Ensure that meals and snacks are nourishing and include
protein, e.g. meat, chicken, fish, dairy products, eggs,
legumes, tofu and nuts. This will help recovery and improve
your nutrition.
• Sip only small amounts of liquids during meals to avoid
filling up too quickly.
• Limit foods that produce wind (gas), e.g. legumes (dried
beans, peas or lentils); vegetables such as broccoli, Brussels
sprouts, cabbage, cauliflower or asparagus; and carbonated
(gassy) drinks.
• Talk to a dietitian or your doctor about vitamin and enzyme
supplements you may need if you can’t digest and absorb
food properly. You may need a multivitamin supplement to
provide calcium, folic acid, iron, vitamin B12 and the fat-
soluble vitamins A, D, E and K.
• Take the right amount of digestive enzyme supplements, if
prescribed.
40 | P a g e
• Limit or avoid eating fatty, greasy or fried foods if these
cause discomfort, even when taking adequate pancreatic
enzymes.
• Nutritional supplements drinks, such as Sustagen®
Hospital Formula, Ensure® and Resource®, are high in
energy and protein and have important vitamins and
minerals. These may be prescribed after surgery.
The pancreas is a major player in nutrient digestion. In
chronic pancreatitis both exocrine and endocrine
insufficiency may develop leading to malnutrition over
time. Maldigestion is often a late complication of chronic
pancreatic and depends on the severity of the underlying
disease. The severity of malnutrition is correlated with two
major factors: (1) malabsorption and depletion of nutrients
(e.g., alcoholism and pain) causes impaired nutritional
status; and (2) increased metabolic activity due to the
severity of the disease. Nutritional deficiencies negatively
affect outcome if they are not treated. Nutritional
assessment and the clinical severity of the disease are
important for planning any nutritional intervention. Good
nutritional practice includes screening to identify patients
at risk, followed by a thoroughly nutritional assessment
and nutrition plan for risk patients. Treatment should be
41 | P a g e
multidisciplinary and the mainstay of treatment is
abstinence from alcohol, pain treatment, dietary
modifications and pancreatic enzyme supplementation. To
achieve energy-end protein requirements, oral
supplementation might be beneficial. Enteral nutrition may
be used when patients do not have sufficient calorie intake
as in pylero-duodenal-stenosis, inflammation or prior to
surgery and can be necessary if weight loss continues.
Parenteral nutrition is very seldom used in patients with
chronic pancreatitis and should only be used in case of GI-
tract obstruction or as a supplement to enteral nutrition.
Diabetes Insipidus
Overview
Diabetes insipidus (die-uh-BEE-teze in-SIP-uh-dus) is an
uncommon disorder that causes an imbalance of water in
the body. This imbalance leads to intense thirst even after
drinking fluids (polydipsia), and excretion of large amounts
of urine (polyuria).
While the names diabetes insipidus and diabetes mellitus

sound similar, they're not related. Diabetes mellitus —
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which can occur as type 1 or type 2 — is the more common
form of diabetes.
There's no cure for diabetes insipidus, but treatments are

available to relieve your thirst and normalize your urine
output.

If your body's thirst control is normal and you drink
enough fluids, there are no significant effects on body fluid
or salt balance.
Not drinking enough fluids can lead

to dehydration and electrolyte imbalance.
If DI is treated with vasopressin and your body's thirst
control is not normal, drinking more fluids than your body
needs can cause dangerous electrolyte imbalance.
Dietary Measures
No specific dietary considerations exist in chronic DI, but
the patient should understand the importance of an
adequate and balanced intake of salt and water. A low-
protein, low-sodium diet can help to decrease urine output.
43 | P a g e
Monitor for fluid retention and hyponatremia during initial
therapy. Follow the volume of water intake and the
frequency and volume of urination, and inquire about
thirst. Monitor serum sodium, 24-hour urinary volumes,
and specific gravity. Request posthospitalization follow-up
visits with the patient every 6-12 months. Patients with
normal thirst mechanisms can usually self-regulate.
Addison’s Disease
Overview
Addison's disease is a disorder that occurs when your body
produces insufficient amounts of certain hormones
produced by your adrenal glands. In Addison's disease,
your adrenal glands produce too little cortisol and often
insufficient levels of aldosterone as well.
Also called adrenal insufficiency, Addison's disease occurs

in all age groups and affects both sexes. Addison's disease
can be life-threatening.
Treatment for Addison's disease involves taking hormones

to replace the insufficient amounts being made by your
44 | P a g e
adrenal glands, in order to mimic the beneficial effects
produced by your naturally made hormones.

Most cases of Addison’s disease result from a problem with
the adrenal glands themselves (primary adrenal
insufficiency). Autoimmune disease accounts for 70% of
Addison’s disease. This occurs when the body's immune
system mistakenly attacks the adrenal glands. This
autoimmune assault destroys the outer layer of the glands.
Long-lasting infections -- such as tuberculosis, HIV, and

some fungal infections -- can harm the adrenal
glands. Cancer cells that spread from other parts of the
body to the adrenal glands also can cause Addison's
disease.
Dietary Measures
Corticosteroids generally impact bone health by decreasing
bone formation, and regular use of this medication may
increase your risk of osteoporosis. Thirty to 50 percent of
people taking corticosteroids for other conditions suffer
from osteoporotic fractures, according to an April 2009
review article published in "Therapeutic Advances in
Musculoskeletal Diseases." To prevent osteoporosis due to
45 | P a g e
your long-term need for corticosteroids, your doctor may
recommend calcium and vitamin D supplements. Including
calcium- and vitamin D-rich foods may also help maintain
bone health. Mineralocorticoids help the body maintain
normal levels of sodium. People with untreated Addison’s
disease have low levels of sodium, which can cause serious
problems such as low blood pressure, seizures and even
coma. Treatment with mineralocorticoids will maintain
normal levels of sodium most of the time. However, if a lot
of sodium is being lost from the body, as may occur with
excessive sweating, sodium levels may fall. Talk to your
doctor about whether you should increase your sodium
intake in hot weather, especially if you are exercising
outside.
When people with Addison’s disease are aldosterone deficient, they
can benefit from a high sodium diet. Their physicians will be able to
give them specific suggestions and guidelines on the amount of
sodium required.
Treatment with steroids is associated with an increased risk of
osteoporosis which is a condition which may cause bones to
fracture or become less dense. By consuming enough calcium in

46 | P a g e
their diet along with vitamin D, they may help protect against this
condition and maintain good bone health.
Cushing’s Disease
Overview
Cushing syndrome occurs when your body is exposed to
high levels of the hormone cortisol for a long time. Cushing
syndrome, sometimes called hypercortisolism, may be
caused by the use of oral corticosteroid medication. The
condition can also occur when your body makes too much
cortisol on its own.
Too much cortisol can produce some of the hallmark signs

of Cushing syndrome — a fatty hump between your
shoulders, a rounded face, and pink or purple stretch marks
on your skin. Cushing syndrome can also result in high
blood pressure, bone loss and, on occasion, type 2 diabetes.
Treatments for Cushing syndrome can return your body's

cortisol production to normal and noticeably improve your
symptoms. The earlier treatment begins, the better your
chances for recovery.
47 | P a g e
Pituitary Adenomas
Pituitary adenomas cause 70 percent of Cushing's

syndrome cases,1 excluding those caused by glucocorticoid
use. These benign, or noncancerous, tumors of the
pituitary gland secrete extra ACTH. Most people with the
disorder have a single adenoma. This form of the
syndrome, known as Cushing's disease, affects women five
times more often than men.
Ectopic ACTH Syndrome

Some benign or, more often, cancerous tumors that arise
outside the pituitary can produce ACTH. This condition is
known as ectopic ACTH syndrome. Lung tumors cause
more than half of these cases, and men are affected three
times more often than women. The most common forms of
ACTH-producing tumors are small cell lung cancer, which
accounts for about 13 percent of all lung cancer cases, 2 and
carcinoid tumors-small, slow-growing tumors that arise
from hormone-producing cells in various parts of the body.
Other less common types of tumors that can produce ACTH
are thymomas, pancreatic islet cell tumors, and medullary
carcinomas of the thyroid.
Adrenal Tumors
In rare cases, an abnormality of the adrenal glands, most
often an adrenal tumor, causes Cushing's syndrome.
Adrenal tumors are four to five times more common in
women than men, and the average age of onset is about 40.
48 | P a g e
Most of these cases involve noncancerous tumors of
adrenal tissue called adrenal adenomas, which release
excess cortisol into the blood.
Adrenocortical carcinomas-adrenal cancers-are the least
common cause of Cushing's syndrome. With adrenocortical
carcinomas, cancer cells secrete excess levels of several
adrenocortical hormones, including cortisol and adrenal
androgens, a type of male hormone. Adrenocortical
carcinomas usually cause very high hormone levels and
rapid development of symptoms.
Dietary Measures
Beware of too much sodium
Excess sodium can affect your blood pressure, cause
swelling, and make you gain weight. So, try to follow these
tips:
• Don’t add extra salt to your food
• Avoid food that is prepared with added salt1
Be sure to get enough daily calcium and vitamin D

People with Cushing’s disease often
develop osteoporosis (fragile bones). Calcium and vitamin
D can be important in strengthening bones.
Here are guidelines for daily calcium and vitamin D intake
based on age. These recommendations are the same for the
general population.
Try to keep cholesterol in check

 Cushing’s disease can cause cholesterol levels to go
up. So you should try to limit your intake of fatty
49 | P a g e
foods and eat dairy products (such as milk and
cheese) that are low in fat.1
High blood sugar may require special dietary changes

 Cushing’s disease can also cause high blood sugar
levels (called hyperglycemia). If this happens,
special medicine and a special diet may be needed.1
Getting proper nutrition through a well-balanced diet is
very important for people living with Cushing’s. Because
this condition can affect how your body processes some
foods, it’s a good idea to consult with your doctor or a
registered dietician, who can advise you on your diet.
Pheochromocytoma
Overview
Pheochromocytoma is a rare endocrine tumor

originating in the adrenal glands, specifically, the medulla
of adrenal glands. The adrenal glands are two small glands
that sit on top of the kidneys and produce hormones called
catecholamines. Catecholamines include metanephrine,
norepinephrine (noradrenaline), epinephrine (adrenaline),
and dopamine. These hormones help regulate your
responses to stress, heart rate, and blood pressure. Once
50 | P a g e
your body encounters any stress, your adrenal glands
secrete these hormones into your bloodstream which in
turn affects the functions of other organs and tissues in
your body. In patients with pheochromocytoma there is a
release of excessive amounts of these hormones, which can
potentially increase your heart rate and blood pressure.
Having pheochromocytoma may become life threatening
when the tumor goes unrecognized or untreated.
Decreased appetite
Lack of appetite, or decreased hunger, is one of the most
troublesome nutrition problems you can experience.
Although it is a common problem, its cause is unknown.
There are some medicines that might stimulate your
appetite. Ask your doctor if such medicines would help you.
Diarrhea
Diarrhea is an increase in either the number of stools, the
amount of liquid in the stools, or both. Medicines, a reaction
to certain foods, stress, and ordinary colds or flu can cause
diarrhea.
Prolonged diarrhea can cause dehydration, weakness,

fatigue, and weight loss. When you have diarrhea,
important nutrients such as calories, protein, vitamins,
water, sodium, and potassium are lost. This loss can be
serious if you are already ill or trying to recover from an
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illness. Your doctor must know the cause of diarrhea to
treat it correctly.
Try the following solutions for two days. If after that time
you are still having diarrhea, call your doctor. Liquids and
nutrients are lost quickly, and treatment must begin before
prolonged diarrhea causes harm.
Constipation
Constipation occurs when bowel movements become
difficult or infrequent, usually more than 48 hours apart.
Constipation can be caused by medicines and by not
drinking or eating enough liquids or food, and inactivity.
GASTROINTESTINAL
DISORDER
Gastroesophageal Reflux
Overview
Gastroesophageal reflux disease occurs when the amount of
gastric juice that refluxes into the esophagus exceeds the
normal limit, causing symptoms with or without associated
esophageal mucosal injury

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• Belching
• Difficulty or pain when swallowing
• Waterbrash (sudden excess of saliva)
• Dysphagia (the sensation of food sticking in the

esophagus)
• Chronic sore throat
• Laryngitis
• Inflammation of the gums
• Erosion of the enamel of the teeth
• Chronic irritation in the throat
• Hoarseness in the morning
• sour taste
• Bad breath
Dietary measures used as treatment
 Losing weight (if overweight)or maintain a healthy

weight

Avoiding alcohol, chocolate, citrus juice, and
tomato-based products

Avoiding peppermint, coffee, and possibly the onion
family
53 | P a g e

Eating small, frequent meals rather than large
meals

Waiting 3 hours after a meal to lie down

Refraining from ingesting food (except liquids)
within 3 hours of bedtime

Elevating the head of the bed 8 inches

Avoiding bending or stooping positions

Eat slow. Eat smaller, frequent meals

Avoid fried junk food

Choose foods with care

Quit smoking

Don’t eat within two to three hours before bedtime

Wear loose-fitting clothes

Manage stress
Common Trigger Foods for People with Reflux:
High-Fat Foods- Fried and fatty foods can cause the LES to
relax, allowing more stomach acid to back up into the
esophagus. They also delay stomach emptying. Eating such
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foods puts you at greater risk for reflux symptoms.
Reducing your total daily fat intake can help.
The following foods have high fat content. Avoid them or

eat them only sparingly.
-french fries and onion rings

-full-fat dairy products like butter, whole milk, regular
cheese, and sour cream
-fatty or fried cuts of beef, pork, or lamb-bacon fat, ham fat,
and lard-high
-fat desserts or snacks like ice cream and potato chips
-cream sauces, gravies, and creamy salad dressings
Tomatoes and Citrus Fruit- Fruits and vegetables are

important to a healthy diet. However, certain fruits can
cause or worsen GERD symptoms. Specifically, highly acidic
fruits are more likely to make your symptoms worse. If you
suffer from frequent acid reflux, you may want to reduce or
eliminate your intake of:
-oranges
-grapefruit
-lemons
-limes
-pineapple
-tomatoes
-tomato sauce (or foods where tomato sauce or paste is a
main ingredient, such as pizza or chili)
-salsa
Chocolate- Chocolate contains an ingredient called

methylxanthine. It has been shown to relax the smooth
muscle in the LES. This can increase reflux.
55 | P a g e
Garlic, Onions, and Spicy Foods- Spicy and tangy foods
trigger heartburn symptoms in many people. This includes
foods such as onions and garlic.
Pharmacotherapy
The following medications are used in the management of
gastroesophageal reflux disease:
-H2 receptor antagonists (eg, ranitidine, cimetidine,

famotidine, nizatidine)
-Proton pump inhibitors (eg, omeprazole, lansoprazole,
rabeprazole, esomeprazole, pantoprazole)
-Prokinetic agents (eg, aluminum hydroxide)
-Antacids (eg, aluminum hydroxide, magnesium hydroxide)
DUMPING SYNDROME
Overview
Dumping syndrome is a condition that can develop after
surgery to remove all or part of your stomach or after
surgery to bypass your stomach to help you lose weight.
Also called rapid gastric emptying, dumping syndrome
occurs when food, especially sugar, moves from your
stomach into your small bowel too quickly.
Most people with dumping syndrome develop signs and
symptoms, such as abdominal cramps and diarrhea, 10 to
30 minutes after eating. Other people have symptoms one
to three hours after eating, and still others have both early
and late symptoms.
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 hypoglycemia
 sweating
 weakness
 rapid or irregular heartbeat
 flushing
 dizziness
Dietary Measures
 eating five or six small meals a day instead of three
larger meals
 delaying liquid intake until at least 30 minutes after
a meal
 increasing intake of protein, fiber, and complex
carbohydrates—found in starchy foods such as
oatmeal and rice
 avoiding simple sugars such as table sugar, which
can be found in candy, syrup, sodas, and juice
beverages
 increasing the thickness of food by adding pectin or
guar gum—plant extracts used as thickening agents
Foods to avoid.
 Avoid eating sugar and other sweets such as:
 Candy
 Sweet drinks
 Cakes
 Cookies
 Pastries
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 Sweetened breads
Also avoid dairy products and alcohol. And avoid
eating solids and drinking liquids during the same
meal. In fact, don't drink 30 minutes before and 30
minutes after meals.
Foods to eat. To help with symptoms, also try these tips:

 Use fiber supplements, such as psyllium (Metamucil
or Konsyl), methylcellulose (Citrucel), or guar gum
(Benefiber).
 Use sugar replacements, such as Splenda, Equal, or
Sweet'N Low, instead of sugar.
 Go for complex carbohydrates, such as vegetables
and whole-wheat bread, instead of simple
carbohydrates, such as sweet rolls and ice cream.
 To prevent dehydration, drink more than 4 cups of
water or other sugar-free, decaffeinated,
noncarbonated beverages throughout the day.
IRRITABLE BOWEL SYNDROME

Overview
Irritable bowel syndrome (IBS) is a common disorder that
affects the large intestine (colon). Irritable bowel syndrome
commonly causes cramping, abdominal pain, bloating, gas,
diarrhea and constipation. IBS is a chronic condition that
you will need to manage long term.

 Abdominal pain or cramping
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 Bloated feeling
 Gas
 Diarrhea or constipation — sometimes alternating
bouts of constipation and diarrhea
 Mucus in the stool
 Rectal bleeding
 Abdominal pain that progresses or occurs at night
 Weight loss
Dietary Measures used as Treatment

 Acupuncture
 Herbs
 Hypnosis
 Probiotics
 Regular exercise, yoga, massage or meditation.
 Experiment with fiber.
 Avoid problem foods
 Eat at regular times
 Take care with dairy products
 Drink plenty of liquids.
 Exercise regularly
 Use anti-diarrheal medications and laxatives with

caution
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Medication specifically for IBS:
Alosetron (Lotronex)
Lubiprostone (Amitiza)
INFLAMMATORY BOWEL DISEASES

Overview
Inflammatory bowel disease (IBD) is an idiopathic disease
caused by a dysregulated immune response to host
intestinal microflora. The two major types of inflammatory
bowel disease are ulcerative colitis (UC), which is limited to
the colon, and Crohn disease (CD), which can affect any
segment of the gastrointestinal tract from the mouth to the
anus, involves "skip lesions," and is transmural. There is a
genetic predisposition for IBD, and patients with this
condition are more prone to the development of
malignancy.

 Diarrhea
 Constipation
 Bowel movement abnormalities
 Abdominal cramping and pain
 Nausea and vomiting

Testing:
 Complete blood count
 Nutritional evaluation: Vitamin B12 evaluation, iron
studies, red blood cell folate, nutritional markers
 Erythrocyte sedimentation rate and C-reactive
protein levels
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 Fecal calprotectin level
 Serologic studies: Perinuclear antineutrophil
cytoplasmic antibodies, anti- Saccharomyces
cerevisiae antibodies
 Stool studies: Stool culture, ova and parasite
studies, bacterial pathogens culture, and evaluation
for Clostridium difficile infection
Imaging studies:
 Upright chest and abdominal radiography
 Barium double-contrast enema radiographic
studies
 Abdominal ultrasonography
 Abdominal/pelvic computed tomography
scanning/magnetic resonance imaging
 Computed tomography enterography
 Colonoscopy, with biopsies of tissue/lesions
 Flexible sigmoidoscopy
 Upper gastrointestinal endoscopy
 Capsule enteroscopy/double balloon enteroscopy
 Corticosteroids such as prednisone and
methylprednisolone
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 Aminosalicylates such as sulfasalazine and
olsalazine
 Immunosuppressives such as 6-mercaptopurine
and azathioprine
 Metronidazole, an antibiotic with immune system
effects.
PEPTIC ULCER DISEASES

Overview
A peptic ulcer is a sore in the inner lining of the stomach or
upper small intestine.
Ulcers form when the intestine or stomach's protective
layer is broken down. When this happens, digestive juices-
which contain hydrochloric acid and an enzyme called
pepsin-can damage the intestine or stomach tissue.
Peptic ulcers that form in the stomach are called gastric
ulcers. Those that form in the upper small intestine are
called duodenal (say "doo-uh-DEE-nul" or "doo-AW-duh-
nul") ulcers.
The two most common causes of peptic ulcers are:
Infection with Helicobacter pyloriHelicobacter pylori (H.
pylori) bacteria.
Use of nonsteroidal anti-inflammatory drugs (NSAIDs),
such as aspirin, ibuprofen, and naproxen.

 A burning, aching, or gnawing pain between the
belly button (navel) and the breastbone
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 Some people also have back pain
 Pain that usually goes away for a while after you
take an antacid or acid reducer.
 Loss of appetite and weight loss.
 Bloating or nausea after eating.
 Vomiting.
 Vomiting blood or material that looks like coffee
grounds.
 Passing black stools that look like tar, or stools that
contain dark red blood.

 Not taking nonsteroidal anti-inflammatory drugs
(NSAIDs), if possible. These include aspirin,
ibuprofen (such as Advil), and naproxen (such as
Aleve).
 Quitting smoking.
 Not drinking too much alcohol (no more than 2
drinks a day for men and 1 drink a day for women).
Medicines to reduce stomach acid:
 Proton pump inhibitors (PPIs) (such as Prilosec).

 H2 blockers (such as Zantac). Some H2 blockers are
available without a prescription.
 Antacids (such as Tums).
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Medicines to kill H. pylori bacteria:
Doctors prescribe combination drug therapy to cure
infection with H. pylori bacteria. This usually includes at
least two antibiotics, a proton pump inhibitor, and
sometimes a bismuth compound.
Medicines to protect the stomach:

 Proton pump inhibitors (PPIs) (such as Prilosec).
 H2 blockers (such as Zantac).
 Prostaglandin analogs (such as Cytotec).
CHOLECYSTITIS
Overview
Cholecystitis is inflammation of the gallbladder that occurs
most commonly because of an obstruction of the cystic duct
by gallstones arising from the gallbladder (cholelithiasis).
Uncomplicated cholecystitis has an excellent prognosis; the
development of complications such as perforation or
gangrene renders the prognosis less favorable.

Fever, tachycardia, and tenderness in the RUQ or epigastric
region, often with guarding or rebound
Palpable gallbladder or fullness of the RUQ (30-40% of
patients)
Jaundice (~15% of patients)
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You should avoid excessive consumption of white flour,
sugar and highly processed foods. You may also be
intolerant of spicy foods. While you need some fiber in your
diet, too much of it may actually exacerbate symptoms of
cholecystitis if they cause you to have gas. You may be able
to tolerate only small amounts of foods such as beans,
cabbage, cauliflower, broccoli and whole grain products, all
of which are high in fiber
In acute cholecystitis, the initial treatment includes bowel
rest, IV hydration, correction of electrolyte abnormalities,
analgesia, and IV antibiotics. Options include the following:
 Sanford guide – Piperacillin-tazobactam, ampicillin-
sulbactam, or meropenem; in severe life-
threatening cases, imipenem-cilastatin
 Alternative regimens – Third-generation
cephalosporin plus metronidazole
 Emesis can be treated with antiemetics and
nasogastric suction
 Because of the rapid progression of acute
acalculous cholecystitis to gangrene and
perforation, early recognition and intervention are
required.
 Supportive medical care should include restoration
of hemodynamic stability and antibiotic coverage
for gram-negative enteric flora and anaerobes if
biliary tract infection is suspected.
 Daily stimulation of gallbladder contraction with IV
cholecystokinin (CCK) may help prevent formation
of gallbladder sludge in patients receiving TPN
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In cases of uncomplicated cholecystitis, outpatient
treatment may be appropriate. The following medications
may be useful in this setting:
 Levofloxacin and metronidazole for prophylactic
antibiotic coverage against the most common
organisms
 Antiemetics (eg, promethazine or
prochlorperazine) to control nausea and prevent
fluid and electrolyte disorders
 Analgesics (eg, oxycodone/acetaminophen)
Surgical and interventional procedures used to treat

cholecystitis include the following:
 Laparoscopic cholecystectomy (standard of care for
surgical treatment of cholecystitis)
 Percutaneous drainage
 ERCP
 Endoscopic ultrasound-guided transmural
cholecystostomy
 Endoscopic gallbladder drainage
GASTRITIS
Overview
Gastritis describes a group of conditions with one thing in
common: inflammation of the lining of the stomach. The
inflammation of gastritis is most often the result of
infection with the same bacterium that causes most
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stomach ulcers. Injury, regular use of certain pain relievers
and drinking too much alcohol also can contribute to
gastritis.
Gastritis may occur suddenly (acute gastritis), or it can

occur slowly over time (chronic gastritis). In some cases,
gastritis can lead to ulcers and an increased risk of stomach
cancer. For most people, however, gastritis isn't serious and
improves quickly with treatment.

 Eat smaller, more-frequent meals.
 Avoid irritating foods. Avoid foods that irritate your
stomach, especially those that are spicy, acidic, fried
or fatty.
 Avoid alcohol.
 Consider switching pain relievers.
 Manage stress.
 Antibiotic medications to kill H. pylori. For H. pylori
in digestive tract
 Medications that block acid production and
promote healing. Proton pump inhibitors reduce
acid by blocking the action of the parts of cells that
produce acid. Long-term use of proton pump
inhibitors, particularly at high doses, may increase
your risk of hip, wrist and spine fractures.
 Medications to reduce acid production. Acid
blockers — also called histamine (H-2) blockers —
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reduce the amount of acid released into your
digestive tract, which relieves gastritis pain and
promotes healing.
 Antacids that neutralize stomach acid. Your doctor
may include an antacid in your drug regimen.
Antacids neutralize existing stomach acid and can
provide rapid pain relief. Side effects can include
constipation or diarrhea, depending on the main
ingredients.
GASTROENTERITIS
Overview
Gastroenteritis is inflammation of the lining of the stomach
and small and large intestines. Most cases are infectious,
although gastroenteritis may occur after ingestion of drugs
and chemical toxins (eg, metals, plant substances).
Acquisition may be foodborne, waterborne, or via person-
to-person spread. In the US, an estimated 1 in 6 people
contracts foodborne illness each year. Symptoms include
anorexia, nausea, vomiting, diarrhea, and abdominal
discomfort. Diagnosis is clinical or by stool culture,
although PCR and immunoassays are increasingly used.
Treatment is symptomatic, although some parasitic and
some bacterial infections require specific anti-infective
therapy.
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Lack of fluid (dehydration) and salt (electrolyte) imbalance
in your body.
 Reactive complications.
 Spread of infection to other parts of your body such
as your bones, joints, or the meninges that surround
your brain and spinal cord.
 Persistent diarrhoea syndromes may rarely
develop.
 Irritable bowel syndrome
 Lactose intolerance can sometimes occur for a
while after gastroenteritis.
 Haemolytic uraemic syndrome is another potential
complication.
 Reduced effectiveness of some medicines.

 Rehydrate orally or intravenously as needed.
 Treat symptoms (eg, fever, pain) as indicated.
 Identify complications.
 -Prevent the spread of infections.
 Identify public health concerns and treat certain
cases with specific or empiric antibiotic therapy.
 Antiemetics- may be useful in the treatment of
nausea and vomiting in adults
 Empiric therapy- for infectious diarrhea is
sometimes indicated. Food-borne toxigenic
diarrhea usually requires only supportive
treatment, not antibiotics
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 Rehydration
 Antibiotics
PERITONITIS
Overview
Peritonitis is defined as an inflammation of the serosal
membrane that lines the abdominal cavity and the organs
contained therein. The peritoneum, which is an otherwise
sterile environment, reacts to various pathologic stimuli
with a fairly uniform inflammatory response. Depending on
the underlying pathology, the resultant peritonitis may be
infectious or sterile (ie, chemical or mechanical). Intra-
abdominal sepsis is an inflammation of the peritoneum
caused by pathogenic microorganisms and their products.
[1] The inflammatory process may be localized (abscess) or
diffuse in nature.

 A ruptured appendix, diverticulum, or stomach
ulcer
 Digestive diseases such as Crohn's disease and
diverticulitis
 Pancreatitis
 Pelvic inflammatory disease
 Perforations of the stomach, intestine, gallbladder,
or appendix
 Surgery
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 Trauma to the abdomen, such as an injury from a
knife or gunshot wound

 Hospitalisation – often in an intensive care unit
 Antibiotics – tailored to the specific bacteria to kill
the infection
 Intravenous fluids – to rehydrate the body and
replace lost electrolytes
 Surgery – to repair the ruptured organ and wash
out the abdominal cavity of blood and pus
 Treatment for the underlying cause – such as a
perforated ulcer.
 Thoroughly wash your hands, including the areas
between your fingers and under your fingernails,
before touching the catheter.
 Wear a mouth/nose mask during exchanges.
 Observe the proper sterile exchange technique.
 Apply an antibiotic cream to the catheter exit site
every day.
Antibiotics-You'll likely be given a course of antibiotic
medication to fight the infection and prevent it from
spreading. The type and duration of your antibiotic therapy
depend on the severity of your condition and the kind of
peritonitis you have.
Surgery-Surgical treatment is often necessary to remove

infected tissue, treat the underlying cause of the infection,
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and prevent the infection from spreading, especially if
peritonitis is due to a ruptured appendix, stomach or colon.
Other treatments- Depending on your signs and symptoms,

your treatment while in the hospital may include pain
medications, intravenous (IV) fluids, supplemental oxygen
and, in some cases, a blood transfusion.
PARALYTIC ILEUS
Overview
Obstruction of the intestine due to paralysis of the
intestinal muscles. The paralysis does not need to be
complete to cause ileus, but the intestinal muscles must be
so inactive that it prevents the passage of food and leads to
a functional blockage of the intestine. Ileus commonly
follows some types of surgery, especially abdominal
surgery. It also can result from certain drugs, spinal
injuries, inflammation anywhere within the abdomen that
touches the intestines, and diseases of the intestinal
muscles themselves. Irrespective of the cause, ileus causes
constipation, abdominal distention, and nausea and
vomiting. On listening to the abdomen with a stethoscope,
few or no bowel sounds are heard (because the bowel is
inactive). Also called paralytic ileus. Also simply called
ileus.

 Electrolyte (blood chemical and mineral)
imbalances
 Dehydration
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 Hole (perforation) in the intestine
 Infection
 Jaundice (yellowing of the skin and eyes)
 If the obstruction blocks the blood supply to the
intestine, it may cause infection and tissue death
(gangrene). Risks for tissue death are related to the
cause of the blockage and how long it has been
present. Hernias, volvulus, and intussusception
carry a higher gangrene risk.
 In a newborn, paralytic ileus that destroys the
bowel wall (necrotizing enterocolitis) is a life-
threatening condition. It may lead to blood and lung
infections.

In patients with uncomplicated obstruction, management is
conservative, including fluid resuscitation, electrolyte
replacement, intestinal decompression and bowel rest.
Endoscopy can be used for bowel decompression, dilation
of strictures or placement of self-expandable metal stents
to restore the luminal flow either as a final treatment or to
allow for a delay until elective surgical therapy. When
gastrointestinal obstruction results in ischaemia,
perforation or peritonitis, then emergency surgery is
required.[9]
Resuscitation is very important. Correction of fluid and

electrolytes considerably reduces the operative risk before
surgery for obstruction. In pseudo-obstruction, correction
of such abnormalities will facilitate the return of normal
bowel function. Note urine output as a sign of adequate
73 | P a g e
replacement. In paralytic ileus a nasogastric tube will
reduce vomiting.
Hospitalization to stabilize your condition
When you arrive at the hospital, the doctors will first work
to stabilize you so that you can undergo treatment. This
process may include:
-Placing an intravenous (IV) line into a vein in your
arm so that fluids can be given
-Putting a nasogastric tube through your nose and
into your stomach to suck out air and fluid and relieve
abdominal swelling
-Placing a thin, flexible tube (catheter) into your
bladder to drain urine and collect it for testing
Treating intussusception
A barium or air enema is used both as a diagnostic
procedure and a treatment for children with
intussusception. If an enema works, further treatment is
usually not necessary.
Treatment for partial obstruction

If you have an obstruction in which some food and
fluid can still get through (partial obstruction), you may not
need further treatment after you've been stabilized. Your
doctor may recommend a special low-fiber diet that is
easier for your partially blocked intestine to process. If the
obstruction does not clear on its own, you may need
surgery to relieve the obstruction.
Treatment for complete obstruction

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If nothing is able to pass through your intestine,
you'll usually need surgery to relieve the blockage. The
procedure you have will depend on what's causing the
obstruction and which part of your intestine is affected.
Surgery typically involves removing the obstruction, as well
as any section of your intestine that has died or is damaged.
Alternatively, your doctor may recommend treating the
obstruction with a self-expanding metal stent. The wire
mesh tube is inserted into your colon via an endoscope
passed through your mouth or colon. It forces open the
colon so that the obstruction can clear.
Stents are generally used to treat people with colon cancer
or to provide temporary relief in people for whom
emergency surgery is too risky. You may still need surgery,
once your condition is stable.
Treatment for pseudo-obstruction

If your doctor determines that your signs and
symptoms are caused by pseudo-obstruction (paralytic
ileus), he or she may monitor your condition for a day or
two in the hospital, and treat the cause if it's known.
Paralytic ileus can get better on its own. In the meantime,
you'll likely be given food through a nasal tube or an IV to
prevent malnutrition.
If paralytic ileus doesn't improve on its own, your doctor
may prescribe medication that causes muscle contractions,
which can help move food and fluids through your
intestines. If paralytic ileus is caused by an illness or
medication, the doctor will treat the underlying illness or
stop the medication. Rarely, surgery may be needed to
remove part of the intestine.
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In cases where the colon is enlarged, a treatment called
decompression may provide relief. Decompression can be
done with colonoscopy, a procedure in which a thin tube is
inserted into your anus and guided into the colon.
Decompression can also be done through surgery.
DIVERTICULITIS
Overview
Diverticula are bulging sacs that can appear in the lining of
your large intestine. The condition is often referred to as
diverticulosis. Diverticulitis occurs when these sacs get
acutely infected or inflamed. Although diverticula are most
common in the large intestine (colon), they can develop
anywhere in your digestive tract. Pain in the lower left side
of your abdomen may indicate diverticulitis, especially
when it’s accompanied by rectal bleeding. The condition is
treatable, but it can recur.

 An abscess, which occurs when pus collects in the
pouch.
 A blockage in your colon or small intestine caused
by scarring.
 An abnormal passageway (fistula) between sections
of bowel or the bowel and bladder.
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 Peritonitis, which can occur if the infected or
inflamed pouch ruptures, spilling intestinal
contents into your abdominal cavity. Peritonitis is a
medical emergency and requires immediate care.

 bedrest
 a liquid diet to allow your diverticula to heal
 prescription antibiotics
 pain medication, such as acetaminophen or codeine
products
 Add more fiber to your diet slowly by eating more
fresh fruits and vegetables, such as:
 pears
 apples
 oranges
 bananas
 mangos
 carrots
 broccoli
 beets
 collard greens
 spinach
 raspberries
 sweet potatoes with the skin on
 black beans
 kidney beans
 whole grains or cereals with 5 or more
grams of fiber per serving
 Going to the bathroom when you feel the urge is
also important for avoiding constipation. Waiting
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too long before going to the bathroom can cause
your stool to harden, which can increase the
pressure in your bowels.
Diverticulosis is treated with lifelong dietary modification.
Antibiotics are used for every stage of diverticulitis.
Empiric therapy requires broad-spectrum antibiotics
effective against known enteric pathogens. For complicated
cases of diverticulitis in hospitalized patients, carbapenems
are the most effective empiric therapy because of
increasing bacterial resistance to other regimens.
RESPIRATORY DISORDERS
ACUTE AIRWAY ATTACKS

Overview
This occurs when fluid builds up in the air sacs in your
lungs. When that happens, your lungs can’t release oxygen
into your blood. In turn, your organs can’t get enough
oxygen-rich blood to function. You can also develop acute
respiratory failure if your lungs can’t remove carbon
dioxide from your blood.
Respiratory failure happens when the capillaries in your air

sacs can’t properly exchange carbon dioxide for oxygen.
The condition can be acute or chronic. Acute respiratory
failure causes you to experience immediate symptoms from
78 | P a g e
not having enough oxygen in your body. In most cases, this
failure may lead to death if it’s not treated quickly.
Dietary Measures
Your doctor may prescribe pain medications or other
medicines to help you breathe better.
For severe cases, a tracheostomy, an operation that creates
an artificial airway in the windpipe, may be necessary.
You may receive oxygen via an oxygen tank or ventilator to
help you breathe better. Portable air tanks are available to
go home with you if your condition requires one.
 Anticholinergics
 Corticosteroids
 Other pharmacological agents, such as Xanthienes
(Theophylline) and Anti-leukotrienes
(Montelukasts)
 Other nonpharmacological therapies:
o Smoking cessation
o Vaccination against influenza
o The use of bronchial thermoplasty
o Pulmonary rehabilitation and an increase in
physical activity interventions
CHRONIC OBSTRUCTIVE PULMONARY

DISEASE
Overview
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COPD, or chronic obstructive pulmonary (PULL-mun-ary)
disease, is a progressive disease that makes it hard to
breathe. "Progressive" means the disease gets worse over
time.
COPD can cause coughing that produces large amounts of

mucus (a slimy substance), wheezing, shortness of breath,
chest tightness, and other symptoms.
Cigarette smoking is the leading cause of COPD. Most

people who have COPD smoke or used to smoke. Long-term
exposure to other lung irritants—such as air pollution,
chemical fumes, or dust—also may contribute to COPD.
Two main conditions—emphysema and chronic bronchitis

In emphysema, the walls between many of the air sacs are
damaged. As a result, the air sacs lose their shape and
become floppy. This damage also can destroy the walls of
the air sacs, leading to fewer and larger air sacs instead of
many tiny ones. If this happens, the amount of gas exchange
in the lungs is reduced.
In chronic bronchitis, the lining of the airways is constantly

irritated and inflamed. This causes the lining to thicken.
Lots of thick mucus forms in the airways, making it hard to
breathe.
Most people who have COPD have both emphysema and

chronic bronchitis. Thus, the general term "COPD" is more
accurate.

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 Heart problems: COPD can cause an irregular
heartbeat (called arrhythmia) and heart failure.
 High blood pressure: COPD can cause high pressure
in the vessels that bring blood to your lungs. This is
called pulmonary hypertension.
 Respiratory infections: You are more likely to have
frequent colds, the flu, or even pneumonia. These
infections can make your symptoms worse or cause
more lung damage. You should have a flu shot every
year and talk to your doctor about whether you
need a pneumonia shot. You are less likely to get flu
or pneumonia if you have these shots.
Dietary Measures
 Stop smoking
 Medicines: Your doctor may prescribe one or more
medicines to make you feel better and help you
breathe. These medicines may include:
 Antibiotics: These medicines help treat
bacterial respiratory infections, which can
make your symptoms worse.
 Bronchodilators: These medicines help
relax the muscles around your airways and
may make it easier for you to breathe.
 Steroids: These medicines may help make it
easier for you to breathe, but usually are
only used in people who have more severe
COPD.
 Vaccines: Vaccines can help prevent certain
respiratory infections, such as influenza and
pneumonia. These infections can make your
symptoms worse or cause more lung
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damage. Talk to your doctor about when
and how often you should receive vaccines.
 Oxygen therapy: Some people who have more
advanced COPD need to use oxygen. You breathe
the oxygen through tubes that you put in your nose
or through a mask that goes over your mouth and
nose.
 Pulmonary rehabilitation
 -Surgery
The best way to keep COPD from starting or from getting
worse is to not smoke.
There are clear benefits to quitting, even after years of
smoking. When you stop smoking, you slow down the
damage to your lungs. For most people who quit, loss of
lung function is slowed to the same rate as a nonsmoker's.
Stopping smoking is especially important if you have low
levels of the protein alpha-1 antitrypsin. People who have
an alpha-1 antitrypsin deficiency may lower their risk for
severe COPD if they get regular shots of alpha-1 antitrypsin.
Family members of someone with alpha-1 antitrypsin
deficiency should be tested for the condition.
Avoid bad air

Other airway irritants (such as air pollution, chemical
fumes, and dust) also can make COPD worse, but they are
far less important than smoking in causing the disease
Get vaccines
Flu vaccines
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If you have COPD, you need to get a flu vaccine every year.
When people with COPD get the flu, it often turns into
something more serious, like pneumonia. A flu vaccine can
help prevent this from happening.
Pneumococcal vaccine
People with COPD often get pneumonia. Getting a shot can
help keep you from getting very ill with pneumonia. People
younger than 65 usually need only one shot. But doctors
sometimes recommend a second shot for some people who
got their first shot before they turned 65. Talk with your
doctor about whether you need a second shot. Two
different types of pneumococcal vaccines are recommended
for people ages 65 and older.
Pertussis vaccine
Pertussis (also called whooping cough) can increase the
risk of having a COPD flare-up.8 So making sure you are
current on your pertussis vaccinations may help control
COPD.
TUBERCULOSIS
Overview
Tuberculosis, or TB, is an infectious bacterial disease
caused by Mycobacterium tuberculosis, which most
commonly affects the lungs. It is transmitted from person to
person via droplets from the throat and lungs of people
with the active respiratory disease.
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In healthy people, infection with Mycobacterium
tuberculosis often causes no symptoms, since the person's
immune system acts to “wall off” the bacteria. The
symptoms of active TB of the lung are coughing, sometimes
with sputum or blood, chest pains, weakness, weight loss,
fever and night sweats. Tuberculosis is treatable with a six-
month course of antibiotics.
Dietary Measures
Physical measures (if possible or practical) include the
following:
 Isolate patients with possible TB in a private room
with negative pressure
 Have medical staff wear high-efficiency disposable
masks sufficient to filter the bacillus
 Continue isolation until sputum smears are
negative for 3 consecutive determinations (usually
after approximately 2-4 weeks of treatment)
Initial empiric pharmacologic therapy consists of the

following 4-drug regimens:
 Isoniazid
 Rifampin
 Pyrazinamide
 Either ethambutol or streptomycin
Special considerations for drug therapy in pregnant women

include the following:
 Streptomycin should not be used
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 Preventive treatment is recommended during
pregnancy
 Pregnant women are at increased risk for isoniazid-
induced hepatotoxicity
 Breastfeeding can be continued during preventive
therapy
Special considerations for drug therapy in children include

the following:
 Most children with TB can be treated with isoniazid
and rifampin for 6 months, along with
pyrazinamide for the first 2 months if the culture
from the source case is fully susceptible.
 For postnatal TB, the treatment duration may be
increased to 9 or 12 months
 Ethambutol is often avoided in young children
Special considerations for drug therapy in HIV-infected

patients include the following:
 Dose adjustments may be necessary
 Rifampin must be avoided in patients receiving
protease inhibitors; rifabutin may be substituted
 Considerations in patients receiving antiretroviral
therapy include the following:
 Patients with HIV and TB may develop a
paradoxical response when starting antiretroviral
therapy
 Starting antiretroviral therapy early (eg, < 4 weeks
after the start of TB treatment) may reduce
progression to AIDS and death [4]
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 In patients with higher CD4+ T-cell counts, it may
be reasonable to defer antiretroviral therapy until
the continuation phase of TB treatment [5]
 Multidrug-resistant TB
When MDR-TB is suspected, start treatment empirically

before culture results become available, then modify the
regimen as necessary. Never add a single new drug to a
failing regimen. Administer at least 3 (preferably 4-5) of the
following medications, according to drug susceptibilities:
 An aminoglycoside: Streptomycin, amikacin,
capreomycin, kanamycin
 A fluoroquinolone: Levofloxacin (best suited over
the long term), ciprofloxacin, ofloxacin
 A thioamide: Ethionamide, prothionamide
 Pyrazinamide
 Ethambutol
 Cycloserine
 Terizidone
 Para-aminosalicylic acid
 Rifabutin as a substitute for rifampin
 A diarylquinoline: Bedaquiline
Surgical resection is recommended for patients with MDR-
TB whose prognosis with medical treatment is poor.
Procedures include the following:
 Segmentectomy (rarely used)
 Lobectomy
 Pneumonectomy
 Pleurectomy for thick pleural peel (rarely
indicated)
 Latent TB
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Recommended regimens for isoniazid and rifampin for
latent TB have been published by the US Centers for
Disease Control and Prevention (CDC) : An alternative
regimen for latent TB is isoniazid plus rifapentine as
directly observed therapy (DOT) once-weekly for 12 weeks;
it is not recommended for children under 2 years, pregnant
women or women planning to become pregnant, or
patients with TB infection presumed to result from
exposure to a person with TB that is resistant to 1 of the 2
drugs.
Screening methods for TB include the following:
 Mantoux tuberculin skin test with purified protein
derivative (PPD) for active or latent infection
(primary method)
 In vitro blood test based on interferon gamma
release assay (IGRA) with antigens specific for
Mycobacterium tuberculosis for latent infection
Obtain the following laboratory tests for patients with

suspected TB:
 Acid-fast bacilli (AFB) smear and culture using
sputum obtained from the patient: Absence of a
positive smear result does not exclude active TB
infection; AFB culture is the most specific test for
TB
 HIV serology in all patients with TB and unknown
HIV status: Individuals infected with HIV are at
increased risk for TB
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Other diagnostic testing may warrant consideration,
including the following:
 Specific enzyme-linked immunospot (ELISpot)
 Nucleic acid amplification tests
 Blood culture
IMMUNE DISORDERS
HIV and AIDS
Overview
HIV stands for human immunodeficiency virus. If left
untreated, HIV can lead to the disease AIDS (acquired
immunodeficiency syndrome).
Unlike some other viruses, the human body can’t get rid of
HIV completely. So once you have HIV, you have it for life.
HIV attacks the body’s immune system, specifically the CD4
cells (T cells), which help the immune system fight off
infections. If left untreated, HIV reduces the number of CD4
cells (T cells) in the body, making the person more likely to
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get infections or infection-related cancers. Over time, HIV
can destroy so many of these cells that the body can’t fight
off infections and disease. These opportunistic infections or
cancers take advantage of a very weak immune system and
signal that the person has AIDS, the last state of HIV
infection.
No effective cure for HIV currently exists, but with proper
treatment and medical care, HIV can be controlled. The
medicine used to treat HIV is called antiretroviral therapy
or ART. If taken the right way, every day, this medicine can
dramatically prolong the lives of many people with HIV,
keep them healthy, and greatly lower their chance of
transmitting the virus to others. Today, a person who is
diagnosed with HIV, treated before the disease is far
advanced, and stays on treatment can live a nearly as long
as someone who does not have HIV.

Infections common to HIV/AIDS:
 Tuberculosis
 Cytomegalovirus
 Candidiasis.
 Cryptococcal meningitis
 Cryptosporidiosis
Cancers common to HIV/AIDS:

 Kaposi's sarcoma
 Lymphomas
Other complications:
 Wasting syndrome
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 Neurological complications
 Kidney disease

Although it's important to receive medical treatment for
HIV/AIDS, it's also essential to take an active role in your
own care. The following suggestions may help you stay
healthy longer:
 Eat healthy foods. Emphasize fresh fruits and
vegetables, whole grains, and lean protein. Healthy
foods help keep you strong, give you more energy
and support your immune system.
 Avoid certain foods. Foodborne illnesses can be
especially severe in people who are infected with
HIV. Avoid unpasteurized dairy products, raw eggs
and raw seafood such as oysters, sushi or sashimi.
Cook meat until it's well-done.
 Get immunizations. These may prevent infections
such as pneumonia and the flu. Make sure the
vaccines don't contain live viruses, which can be
dangerous for people with weakened immune
systems.
 Take care with companion animals. Some animals
may carry parasites that can cause infections in
people who are HIV-positive. Cat feces can cause
toxoplasmosis, reptiles can carry salmonella, and
birds can carry the fungus cryptococcus or
histoplasmosis. Wash hands thoroughly after
handling pets or emptying the litter box.
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If you receive a diagnosis of HIV/AIDS, several types of
tests can help your doctor determine what stage of the
disease you have. These tests include:
 CD4 count. CD4 cells are a type of white blood cell

that's specifically targeted and destroyed by HIV.
Even if you have no symptoms, HIV infection
progresses to AIDS when your CD4 count dips
below 200.
 Viral load. This test measures the amount of virus in
your blood. Studies have shown that people with
higher viral loads generally fare more poorly than
do those with a lower viral load.
 Drug resistance. This blood test determines
whether the strain of HIV you have will be resistant
to certain anti-HIV medications.
There's no cure for HIV/AIDS, but a variety of drugs can be

used in combination to control the virus. Each class of anti-
HIV drugs blocks the virus in different ways. It's best to
combine at least three drugs from two classes to avoid
creating strains of HIV that are immune to single drugs.
The classes of anti-HIV drugs include:
 Non-nucleoside reverse transcriptase inhibitors
(NNRTIs). NNRTIs disable a protein needed by HIV
to make copies of itself. Examples include efavirenz
(Sustiva), etravirine (Intelence) and nevirapine
(Viramune).
 Nucleoside or nucleotide reverse transcriptase
inhibitors (NRTIs). NRTIs are faulty versions of
building blocks that HIV needs to make copies of
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itself. Examples include Abacavir (Ziagen), and the
combination drugs emtricitabine-tenofovir
(Truvada), and lamivudine-zidovudine (Combivir).
 Protease inhibitors (PIs). PIs disable protease,
another protein that HIV needs to make copies of
itself. Examples include atazanavir (Reyataz),
darunavir (Prezista), fosamprenavir (Lexiva) and
indinavir (Crixivan).
 Entry or fusion inhibitors. These drugs block HIV's
entry into CD4 cells. Examples include enfuvirtide
(Fuzeon) and maraviroc (Selzentry).
 Integrase inhibitors. These drugs work by disabling
integrase, a protein that HIV uses to insert its
genetic material into CD4 cells. Examples include
raltegravir (Isentress), elvitegravir (Vitekta) and
dolutegravir (Tivicay).
Rheumatoid Arthritis
Overview
Rheumatoid arthritis is a chronic inflammatory disorder
that can affect more than just your joints. In some people,
the condition also can damage a wide variety of body
systems, including the skin, eyes, lungs, heart and blood
vessels.
An autoimmune disorder, rheumatoid arthritis occurs
when your immune system mistakenly attacks your own
body's tissues.
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Unlike the wear-and-tear damage of osteoarthritis,
rheumatoid arthritis affects the lining of your joints,
causing a painful swelling that can eventually result in bone
erosion and joint deformity.
The inflammation associated with rheumatoid arthritis is
what can damage other parts of the body as well. While
new types of medications have improved treatment options
dramatically, severe rheumatoid arthritis can still cause
physical disabilities.

 Osteoporosis
 Rheumatoid nodules
 Dry eyes and mouth
 Infections
 Abnormal body composition
 Carpal tunnel syndrome
 Heart problems
 Lung disease
 Lymphoma

 Exercise regularly.
 Avoid exercising tender, injured or severely
inflamed joints.
 Apply heat or cold.
 Alternative medicines:
 Fish oil
 Plant oil
 Tai chi
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The types of medications recommended by your doctor will
depend on the severity of your symptoms and how long
you've had rheumatoid arthritis.
 NSAIDs. Nonsteroidal anti-inflammatory drugs

(NSAIDs) can relieve pain and reduce inflammation.
Over-the-counter NSAIDs include ibuprofen (Advil,
Motrin IB) and naproxen sodium (Aleve). Stronger
NSAIDs are available by prescription. Side effects
may include ringing in your ears, stomach irritation,
heart problems, and liver and kidney damage.
 Steroids. Corticosteroid medications, such as
prednisone, reduce inflammation and pain and slow
joint damage. Side effects may include thinning of
bones, weight gain and diabetes. Doctors often
prescribe a corticosteroid to relieve acute
symptoms, with the goal of gradually tapering off
the medication.
 Disease-modifying antirheumatic drugs (DMARDs).
These drugs can slow the progression of
rheumatoid arthritis and save the joints and other
tissues from permanent damage. Common DMARDs
include methotrexate (Trexall, Otrexup, Rasuvo),
leflunomide (Arava), hydroxychloroquine
(Plaquenil) and sulfasalazine (Azulfidine).
Side effects vary but may include liver damage,

bone marrow suppression and severe lung
infections.
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Systemic Lupus Erythematosus
Overview
Systemic lupus erythematosus (also known as lupus or
SLE) is a chronic inflammatory disease that can affect
various parts of the body. Lupus is an autoimmune
condition, meaning that your body's immune system
attacks your own tissues, thinking that they are foreign.
This can lead to pain, swelling, and damage to organs such
as the kidneys. The cause of lupus is not clear.
People with lupus often have disease flares, in which

symptoms worsen, followed by a period of remission, in
which symptoms improve. Lupus is mild in some people
and is life-threatening in others. However, treatments are
available to reduce symptoms, reverse inflammation, and
minimize organ damage.

 Anemia
 Antiphospholipid Syndrome
 Vasculitis
 Thrombocytopenia
 Leukopenia and Neutropenia
 Blood Cancers
 Atherosclerosis, or plaque buildup in the arteries
 Unhealthy cholesterol and lipid (fatty molecules)
levels
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 High blood pressure, often associated with kidney
damage and corticosteroid treatments
 Heart failure
 Pericarditis, inflammation of the tissue surrounding
the heart
 Endocarditis, inflammation in the lining of the heart
 Myocarditis, inflammation of the heart muscle itself
 Coronary vasculitis, inflammation of the blood
vessels of the heart
 Inflammation of the membrane lining the lung
(pleurisy) is the most common problem, which can
cause shortness of breath and coughing.
 In some cases, fluid accumulates, a condition called
pleural effusion.
 Inflammation of the lung tissue itself is called lupus
pneumonitis. It can be caused by infections or by
the SLE inflammatory process. Symptoms are the
same in both cases: fever, chest pain, labored
breathing, and coughing. Rarely, lupus pneumonitis
becomes chronic and causes scarring in the lungs,
which reduces their ability to deliver oxygen to the
blood.
 A very serious and rare condition called pulmonary
hypertension occurs when high pressure develops
as a result of damage to the blood vessels of the
lungs.
 Inflammation of the kidneys (lupus nephritis)
 Complete kidney failure
 Irritability
 Emotional disorders (anxiety, depression)
 Mild impairment of concentration and memory
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 Migraine and tension headaches
 Problems with the reflex systems, sensation, vision,
hearing, and motor control
 Infections
 GI complications
 Joint, muscle and bone complications
 Eye complications
 Pregnancy complications

Diet and nutrition — Most people with lupus do not require
a special diet but should instead eat a well-balanced diet. A
well-balanced diet is one that is low in fat; high in fruits,
vegetables, and whole grains; and contains a moderate
amount of meat, poultry, and fish.
However, you may need to make changes to your diet,

depending upon how lupus has affected your body. In
general:
 People with active lupus and fever may require

more calories.
 Glucocorticoids (prednisone) increase appetite,
potentially causing you to gain a lot of weight. Try
to control your appetite and to stay active. Weigh
yourself daily while taking prednisone, and talk to
your healthcare provider if you gain more than five
pounds.
 If your cholesterol or triglyceride levels become
elevated, you may be advised to eat a special diet.
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 If you have swelling (edema) in your feet or lower
legs, decrease the amount of salt and sodium in
your diet.
 Extra vitamins are rarely needed if you eat a
balanced diet. If you are not able to eat a balanced
diet or are dieting to lose weight, you should take a
multivitamin.
 If you take glucocorticoids every day or are a
postmenopausal woman, you should take 1000 to
1500 mg of calcium and 400 to 800 units of vitamin
D per day to minimize bone loss. ●Drinking a
moderate amount of alcohol (one drink or less for
women and two drinks or less per day for men) is
usually safe for people with lupus. However, alcohol
can interact with medications used to treat lupus.
Talk to your healthcare provider if you have
questions.
 Herbal and other dietary supplements are not
recommended and may even cause harm.
 Exercise — Being inactive while ill can cause you to
lose muscle and energy quickly. A separate article
discusses how to incorporate exercise into your life.
 Immunizations — Vaccines to prevent pneumonia
and the flu are recommended for people with lupus.
 Medication precautions — A number of medications
are known to worsen lupus. You should not take
these medications if there is an acceptable
alternative. Sulfa-containing antibiotics are
examples of medicines that should be avoided.
 Pregnancy and birth control — Women with lupus
are at increased risk of miscarriage; however, the
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majority of women with lupus who get pregnant are
able to carry to term.
-Avoid the sun. Strong sunlight can aggravate symptoms of
SLE. Long-sleeved clothing and wide-brimmed hats are best
in sunny weather. On hot sunny days you should wear a
sunblock on exposed skin, with a protection factor of 25 or
above that protects against UVA and UVB.
-Try to avoid infections. If you have SLE you are more
prone to infection, particularly if you take steroids or
immunosuppressant medication. Avoid contact with people
who have infections.
-Pregnancy. Although fertility is not usually affected in
people with SLE, some women with SLE have a higher
chance of miscarriage. Women who have badly inflamed
kidneys, due to SLE, may have high blood pressure in
pregnancy. However, most women with mild or well-
controlled SLE at the start of pregnancy are likely to go
through pregnancy with few problems.
-Some contraceptive pills may not be advised depending on
disease severity. A doctor or nurse will advise on the best
method of contraception.
-Other autoimmune diseases such as Sjö gren's syndrome
and thyroid problems are more common than average if
you have SLE. These are sometimes tested for in people
with SLE.
Anaphylaxis
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Overview
Anaphylaxis is an acute, potentially fatal, multiorgan
system reaction caused by the release of chemical
mediators from mast cells and basophils. The classic form
involves prior sensitization to an allergen with later
reexposure, producing symptoms via an immunologic
mechanism.

An anaphylactic reaction can be life-threatening when a
severe attack occurs; it can stop breathing or stop your
heartbeat. In this case, you'll need cardiopulmonary
resuscitation (CPR) and other emergency treatment right
away.

Supportive care for patients with suspected anaphylaxis
includes the following:
 Airway management (eg, ventilator support with
bag/valve/mask, endotracheal intubation)
 High-flow oxygen
 Cardiac monitoring and/or pulse oximetry
 Intravenous access (large bore)
 Fluid resuscitation with isotonic crystalloid solution
 Supine position (or position of comfort if dyspneic
or vomiting) with legs elevated
The primary drug treatments for acute anaphylactic
reactions are epinephrine and H1 antihistamines.
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Medications used in patients with anaphylaxis include the
following:
 Adrenergic agonists (eg, epinephrine)
 Antihistamines (eg, diphenhydramine,
hydroxyzine)
 H2 receptor antagonists (eg, cimetidine, ranitidine,
famotidine)
 Bronchodilators (eg, albuterol)
 Corticosteroids (eg, methylprednisolone,
prednisone)
 Positive inotropic agents (eg, glucagon)
 Vasopressors (eg, dopamine)
LIVER DISORDERS
HEPATITIS (ALL TYPES)

Overview
Hepatitis means inflammation of the liver. Many illnesses
and conditions can cause inflammation of the liver, for
example, drugs, alcohol, chemicals, and autoimmune
diseases. Many viruses, for example, the virus causing
mononucleosis and the cytomegalovirus can inflame the
liver. Most viruses, however, do not attack primarily the
liver; the liver is just one of several organs that the viruses
affect. When most doctors speak of viral hepatitis, they are
using the definition that means hepatitis caused by a few
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specific viruses that primarily attack the liver and are
responsible for about half of all human hepatitis. There are
several hepatitis viruses; they have been named types A, B,
C, D, E, F (not confirmed), and G. As our knowledge of
hepatitis viruses grows, it is likely that this alphabetical list
will become longer. The most common hepatitis viruses are
types A, B, and C. Reference to the hepatitis viruses often
occurs in an abbreviated form (for example, HAV, HBV, HCV
represent hepatitis viruses A, B, and C, respectively.) The
focus of this article is on these viruses that cause the
majority of human viral hepatitis.
Hepatitis viruses replicate (multiply) primarily in the liver
cells. This can cause the liver to be unable to perform its
functions.
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For patients with milder alcoholic hepatitis, a general diet
containing 100 g/d of protein is appropriate. Provide
supplemental multivitamins and minerals, including folate
and thiamine. Salt restriction may be required in patients
with ascites.
Acute Hepatitis
- initial treatment consists of relieving the symptoms of
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nausea, vomiting, and abdominal pain (supportive care).
Careful attention should be given to medications or
compounds, which can have adverse effects in patients with
abnormal liver function. Only those medications that are
considered necessary should be administered since the
impaired liver is not able to eliminate drugs normally, and
drugs may accumulate in the blood and reach toxic levels.
Moreover, sedatives and "tranquilizers" are avoided
because they may accentuate the effects of liver failure on
the brain and cause lethargy and coma. The patient must
abstain from drinking alcohol, since alcohol is toxic to the
liver. It occasionally is necessary to provide intravenous
fluids to prevent dehydration caused by vomiting. Patients
with severe nausea and/or vomiting may need to be
hospitalized for treatment and intravenous fluids.
Acute HBV is not treated with antiviral drugs. Acute HCV -
though rarely diagnosed - can be treated with several of the
drugs used for treating chronic HCV. Treatment of HCV is
recommended primarily for the 80% of patients who do not
eradicate the virus early. Treatment results in clearing of
the virus in the majority of patients.
Chronic Hepatitis
Treatment of chronic infection with hepatitis B and
hepatitis C usually involves medication or combinations of
medications to eradicate the virus. Alcohol aggravates liver
damage in chronic hepatitis, and can cause more rapid
progression to cirrhosis. Therefore, patients with chronic
hepatitis should stop drinking alcohol. Smoking cigarettes
also can aggravate liver disease and should be stopped.
LIVER CIRRHOSIS
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Overview
Cirrhosis is defined histologically as a diffuse hepatic
process characterized by fibrosis and the conversion of
normal liver architecture into structurally abnormal
nodules. The progression of liver injury to cirrhosis may
occur over weeks to years. Indeed, patients with hepatitis C
may have chronic hepatitis for as long as 40 years before
progressing to cirrhosis.

 Variceal bleeding
 Confused thinking and other mental changes

Regular exercise, including walking and even swimming
should be encouraged in patients with cirrhosis, to prevent
these patients from slipping into a vicious cycle of inactivity
and muscle wasting. Debilitated patients frequently benefit
from a formal exercise program supervised by a physical
therapist.
 Help limit the damage to your liver and control the
symptoms by:
Do not drink any alcohol. If you don't stop
completely, liver damage may quickly get worse.
 Talk to your doctor before you take any medicines.
This includes prescription and over-the-counter
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drugs, vitamins, supplements, and herbs. Medicines
that can hurt your liver include acetaminophen
(such as Tylenol) and other pain medicines such as
aspirin, ibuprofen (such as Advil or Motrin), and
naproxen (Aleve).
 Make sure that your immunizations are up-to-date.
You are at higher risk for infections.
 Follow a low-sodium diet. This can help prevent
fluid build-up, a common problem in cirrhosis that
can become life-threatening.
Once treatment for these complications becomes

ineffective, a liver transplant is considered. Almost
all of the complications can be cured by liver
transplantation; however, in many circumstances,
careful management can reduce the harmful effects
of cirrhosis and delay or even prevent the need for a
liver transplant.
Musculoskeletal Disorders
Fractures
Overview
A fracture is a break in a bone. Most involve a single,

significant force applied to normal bone. May also
seriously damage other tissues, including the skin,
nerves, blood vessels, muscles, and organs
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In a closed fracture, the overlying skin is intact. In an
open fracture, the overlying skin is disrupted and the
broken bone is in communication with the
environment.
Types:
Pathologic fractures occur when mild or minimal
force fractures an area of bone weakened by a
disorder (eg, osteoporosis, cancer, infection, bone
cyst). When the disorder is osteoporosis, they are
often called insufficiency or fragility fractures.
Stress fractures (see page Stress Fractures) result

from repetitive application of moderate force, as may
occur in long-distance runners or in soldiers marching
while carrying a heavy load. Normally, bone damaged
by microtrauma from moderate force self-repairs
during periods of rest, but repeated application of
force to the same location predisposes to further
injury and causes the microtrauma to propagate.
 Greenstick fracture: In a greenstick fracture,

the bone sustains a small, slender crack. This
type of fracture is more common in children,
due to the comparative flexibility of their
bones.
 Comminuted fracture: In a comminuted

fracture, the bone is shattered into small pieces.
This type of complicated fracture tends to heal
at a slower rate.
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 Simple fracture: In a simple fracture, or
'closed' fracture, the broken bone has not
pierced the skin.
 Compound fracture: In a compound fracture,
or 'open' fracture, the broken bone juts through
the skin, or a wound leads to the fracture site.
The risk of infection is higher with this type of
fracture.
 Avulsion fracture: Muscles are anchored to

bone by tendons, which are a type of
connective tissue. In an avulsion fracture,
powerful muscle contractions can wrench the
tendon free and pull out pieces of bone. This
type of fracture is more common in the knee
and shoulder joints. Avulsion fractures are
reported to be more common in children than
adults. In adults, the ligaments and tendons
tend to be injured, whereas in children the
bone may fail before the ligament or tendon is
injured. Children have a particularly weak point
in their skeleton called the growth plate. This is
the area of bone that is actively growing. In
children, tendons or ligaments near a growth
plate can pull hard enough to cause the growth
plate to fracture.
 Compression fracture: A compression
fracture occurs when two bones are forced
against each other. The bones of the spine,
called vertebrae, are prone to this type of
fracture. Elderly people, particularly those with
osteoporosis, are at increased risk.
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 Hip fracture: A broken hip is a common injury,
especially in elderly individuals. In the United
States, hip fractures are the most common
broken bone that requires hospitalization;
about 300,000 Americans are hospitalized for a
hip fracture every year. Women are two to
three times as likely as men are to experience a
hip fracture, because women lose bone density
at a greater rate than men do. A hip fracture is a
serious injury, particularly if the individual is
older, and complications can be life-
threatening. Fortunately, surgery to repair a
hip fracture is usually very effective, although
recovery often requires time and patience.
Most people make a good recovery from a hip
fracture. Generally, the better the individual's
health and mobility before a hip fracture, the
better their chances for a complete recovery.
 Malnourished
 Undernourished
 Fat embolism syndrome
 Exacerbation of underlying diseases such

as diabetes or coronary artery disease
(CAD)
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 Bone deformities
Dietary Measures
 Calcium-Rich Foods & vitamin D-rich foods:

best for maintaining bone integrity and
preventing future bone fractures
 Calcium: for repair and regeneration of bone
cells
 Lysine-rich foods: a building block for cellular
repair
 Vitamin C-rich foods: essential for efficient
calcium use and bone repair
 High Protein Diet: improved bone health and
reducing the risk for hip fractures
 Vitamin K-rich foods: improves your body's
ability to absorb and use calcium from food
sources
 Malnutrition risk assessment
 Osteoporosis risk assessment
 Monitor metabolic status
Osteoathritis
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Overview
Osteoarthritis, also called degenerative joint

disease and osteoarthrisis, is the most common form
of arthritis. It is characterized by the breakdown of
cartilage in joints (i.e., intersections of two bones) and
is often caused by "wear and tear."
Cartilage cushions the ends of the bones and allows for

easier movement within the joints. As osteoarthritis
progresses, bone spurs (osteophytes) develop within
the affected joint and the joint space narrows,
increasing pain and decreasing mobility.
Osteoarthritis causes joint pain and stiffness and may

result in loss of joint function. The disease, which can
cause significant disability, is the reason for
most knee and hip replacement surgeries.
Symptoms of osteoarthritis (e.g., joint pain and

stiffness, loss of joint function) usually develop
between the ages of 40 and 60. The condition
primarily affects the weight-bearing joints (e.g., knees,
hips, feet, back). It also may affect the neck and the
joints in the fingers and hands.
There are 2 types of osteoarthritis—primary and

secondary:
 Primary osteoarthritis is associated with aging.
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 Secondary osteoarthritis is associated with an
additional cause, such as injury, heredity or
obesity.
 Estrogen Deficiency
 Hematochromatosis
 Vitamin D deficiency
Dietary measures
 Vitamin D, vitamin C, beta-carotene,

and niacin: helps reduce progression of
osteoarthritis
 Vitamin E, boron, niacinamide,

and omega-3 fatty acids: help reduce the
pain and swelling that comes with
osteoarthritis
 Foods that may help: whole foods, fish,

ginger
Substances to avoid:
 Vitamin and retinoids
 Iron
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Though no specific diet will necessarily make
your arthritis better, eating right and
controlling your weight can help by minimizing
stress on the weight-bearing joints such as the
knees and the joints of the feet. It can also
minimize your risk of developing other health
problem
Osteoporosis
Overview
Osteoporosis, or porous bone, is a disease

characterized by low bone mass and structural
deterioration of bone tissue, leading to bone fragility
and an increased risk of fractures of the hip, spine, and
wrist. Men as well as women are affected by
osteoporosis, a disease that can be prevented and
treated. Osteoporosis is the most common type of
bone disease. There are no symptoms in the early
stages of osteoporosis. Many times, people will have a
fracture before learning they have the disease
 Celiac Disease
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 Anorexia Nervosa
 Asthma
 Diabetes
 Inflammatory bowel disease
 Lactose Intolerance
 Lupus
Dietary measures
Eating a balanced diet that contains a variety of foods is

important when looking at bone health. This ensures you
get enough vitamins, minerals and energy you need to
maintain health and reduces your risk of developing
chronic conditions.
 Vitamin D-rich foods
 Calcium rich foods
Foods to limit:
 Salt
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 Carbonated drinks
 Caffeine
Osteomyelitis
Overview
Osteomyelitis is an infection in a bone. Infections can
reach a bone by traveling through the bloodstream or
spreading from nearby tissue. Infections can also
begin in the bone itself if an injury exposes the bone to
germs.
In children, osteomyelitis most commonly affects the

long bones of the legs and upper arms. Adults are
more likely to develop osteomyelitis in the bones that
make up the spine (vertebrae). People who have
diabetes may develop osteomyelitis in their feet if they
have foot ulcers.
 Patients with acute osteomyelitis of

peripheral bones usually experience weight
loss, fatigue, fever, and localized warmth,
swelling, erythema, and tenderness.
 Diabetic foot ulcers
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 Growth arrest
Dietary measures
 Foods that contain significant amounts of
vitamins A, C and E, selenium and zinc may be
helpful in treating this health problem
 Probiotics -- acidophilus and bifidobacteria --
may also be beneficial in treating osteomyelitis
 Spinach may be a beneficial food in treating
your osteomyelitis
 increasing your consumption of fresh fruits and
vegetables, whole grains and fish are important
general dietary strategies in treating this
condition
 Avoid alcohol
Gouty Arthritis
Overview
Gout is a form of inflammatory arthritis that develops

in some people who have high levels of uric acid in the
blood. The acid can form needle-like crystals in a joint
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and cause sudden, severe episodes of pain, tenderness,
redness, warmth and swelling.
There are several stages of gout:
 Asymptomatic hyperuricemia is the period

prior to the first gout attack. There are no
symptoms, but blood uric acid levels are high
and crystals are forming in the joint.
 Acute gout, or a gout attack, happens when
something (such as a night of drinking) causes
uric acid levels to spike or jostles the crystals
that have formed in a joint, triggering the
attack. The resulting inflammation and pain
usually strike at night and intensify over the
next eight to 12 hours. The symptoms ease
after a few days and likely go away in a week to
10 days. Some people never experience a
second attack, but an estimated 60% of people
who have a gout attack will have a second one
within a year. Overall, 84% may have another
attack within three years.
 Interval gout is the time between attacks.
Although there’s no pain, the gout isn’t gone.
Low-level inflammation may be damaging
joints. This is the time to begin managing gout –
via lifestyle changes and medication – to
prevent future attacks or chronic gout.
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 Chronic gout develops in people with gout
whose uric acid levels remain high over a
number of years. Attacks become more
frequent and the pain may not go away as it
used to. Joint damage may occur, which can
lead to a loss of mobility. With proper
management and treatment, this stage is
preventable.

 Kidney stones
 Hyperuricemia
Dietary measures
 Drink plenty of fluids (no alcohol or sweet
sodas)
 Coffee
 Vitamin C
 Cherries
 Limiting alcoholic beverages and drinks

sweetened with fruit sugar (fructose). Instead,
drink plenty of nonalcoholic beverages, especially
water.
 Limit intake of foods high in purines, such as
red meat, organ meats and seafood.
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 Exercising regularly and losing weight. Keeping
your body at a healthy weight reduces your risk of
gout.
Neurologic Disorders
Guillain-Barre Syndrome
Overview
Guillain-Barre (gee-YAH-buh-RAY) syndrome is a rare

disorder in which your body's immune system attacks
your nerves. Weakness and tingling in your extremities
are usually the first symptoms
These sensations can quickly spread, eventually
paralyzing your whole body. In its most severe form
Guillain-Barre syndrome is a medical emergency. Most
people with the condition must be hospitalized to
receive treatment.
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Guillain-Barré syndrome can affect anybody. It can
strike at any age and both sexes are equally prone to
the disorder. No one yet knows why Guillain-Barré —
which is not contagious — strikes some people and
not others. Nor does anyone know exactly what sets
the disease in motion.

 Sluggish bowel function
 Urine retention
 Significant weight loss
 antecedent viral illness with gastrointestinal
sequelae
 cranial nerve deficits impairing oral intake and
gastrointestinal motility
 depressed serum transferrin
 Hypermetabolic
 Hypercatabolic
Dietary measures
Nutritional changes, such as eating more fresh fruits
and vegetables and less red meats, may be effective in
reducing symptoms associated with neurological
disorders such as Guillain-Barre syndrome (GBS)
 High-protein feedings
 Zinc rich foods
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 It is best to avoid caffeine and other stimulants,
alcohol, and smoking.
 It may be best to eliminate potential food
allergens, including dairy (e.g. milk, cheese, and
sour cream), eggs, nuts, shellfish, wheat
(gluten), corn, preservatives, and food additives
(such as dyes and fillers). Food allergies can be
a contributing factor in neurological
imbalances.
 It may be best to avoid refined foods such as
white breads, pastas, and sugar. Doughnuts,
pastries, bread, candy, soft drinks, and foods
with high sugar content may all contribute to
worsening symptoms of neurological disorder
 Maintaining physical fitness is important to
those suffering from movement disorders.
Myasthenia Gravis
Overview
Myasthenia gravis (MG) is a chronic autoimmune

disorder that results in progressive skeletal muscle
weakness. Skeletal muscles are primarily muscle fibers
that contain bands or striations (striated muscles) that
are connected to bone. MG causes rapid fatigue
(fatigability) and loss of strength upon exertion that
improves after rest. The most common primary
disorder of neuromuscular transmission. The usual
cause is an acquired immunological abnormality, but
some cases result from genetic abnormalities at the
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neuromuscular junction.

 weakness of the tongue, jaw, mouth and
throat muscles may make it difficult for
some to chew or swallow food
 malnutrition and unexpected weight loss
 Bone loss
 Diarrhea
 Stomach upset
Dietary measures
 Soft Diet
 Puree Diet
 Liquid Diet
 Tube Feeding
 it is best to eat small meals and snacks 5-6
times a day
 Milk is a good base for snacks and meals
throughout the day
 When portions are small – it is necessary to
make the food as nutritious as possible
 Avoid certain foods such as commercially
prepared soups, smoked of prepared meats
such as bacon, sausage, lunchmeat, ham
and other pork products
 Don’t add salt to foods when cooking or at
the table. Removing the saltshaker from the
table is good idea
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Parkinson’s disease
Overview
Parkinson's disease (PD) is a chronic and progressive

movement disorder, meaning that symptoms continue
and worsen over time. Nearly one million people in the
US are living with Parkinson's disease. The cause is
unknown, and although there is presently no cure,
there are treatment options such as medication and
surgery to manage its symptoms.
Parkinson’s involves the malfunction and death of vital

nerve cells in the brain, called neurons. Parkinson's
primarily affects neurons in an area of the brain called
the substantia nigra. Some of these dying neurons
produce dopamine, a chemical that sends messages to
the part of the brain that controls movement and
coordination. As PD progresses, the amount of
dopamine produced in the brain decreases, leaving a
person unable to control movement normally.

 Dysphagia
 Constipation
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Dietary measures
While there is no special diet for people
with Parkinson's disease, eating a well-balanced,
nutritious diet is extremely beneficial. With the proper
diet, our bodies work more efficiently, we have more
energy
To control nausea:
 Avoid fried, greasy, or sweet foods
 Drink clear or ice-cold drinks. Drinks
containing sugar may calm the stomach
better than other liquids.
 Eat light, bland foods (such as saltine
crackers or plain bread)
Spinal Cord Injury
Overview
Spinal cord injury is damage to the spinal cord as a
result of a direct trauma to the spinal cord itself or as a
result of indirect damage to the bones, soft tissues, and
vessels surrounding the spinal cord. The spinal cord is
the major bundle of nerves carrying nerve impulses to
and from the brain to the rest of the body. Rings of
bone called vertebrae surround the spinal cord. These
bones constitute the spinal column (back bones).
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Spinal cord damage results in a loss of function, such
as mobility or feeling. In most people who have spinal
cord injury, the spinal cord is intact. Spinal cord injury
is not the same as back injury, which might result from
causes such as pinched nerves or ruptured disks. Even
when a person sustains a break in a vertebra or
vertebrae, there might not be any spinal cord injury if
the spinal cord itself is not affected.
The effects of a spinal cord injury can vary based on

the injury’s location. Injuries that are sustained near
the top of the spine result in more extensive disability
(numbness and paralysis, breathing difficulty) than
injuries low in the spine. Some common outcomes are
muscle spasms, the loss of sensation in parts of the
body, numbness, and paralysis. Death can result if
there is a paralysis of the breathing muscles.

 Malnutrition
 Hyper catabolic
 Altered glucose and lipid metabolism
 Pressure Ulcer
 Osteoporosis
 Neurogenic Bowel and bladder
Dietary measures
 Low Fat diet
 Calcium
 Vitamin D
 Dietary Fiber
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 Physical activity is important
 Dont skip meal
 Monitor your BMI
Multiple Sclerosis
Overview
Multiple sclerosis, or MS, is a long-lasting disease that
can affect your brain, spinal cord, and the optic nerves
in your eyes. It can cause problems with vision,
balance, muscle control, and other basic body
functions.
The effects are often different for everyone who has

the disease. Some people have mild symptoms and
don’t need treatment. Others will have trouble getting
around and doing daily tasks.
MS happens when your immune system attacks a fatty

material called myelin, which wraps around your
nerve fibers to protect them. Without this outer shell,
your nerves become damaged. Scar tissue may form.
The damage means your brain can’t send signals

through your body correctly. Your nerves also don’t
work as they should to help you move and feel.
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 Fractures
 Osteoporosis
 Intestinal gas and bowel problems
 UTI
 Uric Acid and Gout
Dietary measures
 Diet low in fats, high in fiber
 Vitamin D
 Biotin
 Gluten-Free Diet
 Skip saturated fats
 Skip full-fat dairy products
 Avoid diet drinks
 Fruits instead of sugar replacers
Bell’s palsy
Overview
Bell's palsy causes sudden weakness in your facial
muscles. This makes half of your face appear to droop.
Your smile is one-sided, and your eye on that side
resists closing.
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Bell's palsy, also known as facial palsy, can occur at
any age. The exact cause is unknown, but it's believed
to be the result of swelling and inflammation of the
nerve that controls the muscles on one side of your
face. It may be a reaction that occurs after a viral
infection.
For most people, Bell's palsy is temporary. Symptoms

usually start to improve within a few weeks, with
complete recovery in about six months. A small
number of people continue to have some Bell's palsy
symptoms for life. Rarely, Bell's palsy can recur.
 Deficiency in Vitamin B which leads to stress

that can result to herpes simplex virus
Dietary measures used as treatments

 High intake of carbohydrates
 Fruits
 Vitamin B-rich foods
 Avoid caffeinated products
 Avoid artificial sweeteners
 Eat nuts or seeds for snacks
Meningitis
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Overview
Meningitis is an inflammation (swelling) of the

protective membranes covering the brain and spinal
cord known as the meninges. This inflammation is
usually caused by an infection of the fluid surrounding
the brain and spinal cord.
Meningitis is usually caused by bacteria or viruses, but

can be a result of injury, cancer, or certain drugs.
It is important to know the specific cause of meningitis

because the treatment differs depending on the cause.

 Kidney problems
 Arthritis

 fruits and vegetables that are rich in
vitamins A, B, C, D and E
 essential fatty acids
 Ices from citrus fruits like lemons,
pineapples and oranges are also helpful.
Other foods like chicken, lean meats,
salmon and peanuts
 Deli meats, processed foods, smoked fish
and sushi are other foods that must be
completely avoided in a meningitis
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recovery diet.
 include dairy products, meats, sugary
foods, white flour foods, salt, caffeinated
beverages and even alcoholic drinks should
be avoided
Stroke
Overview
Stroke, also called “brain attack” or cerebrovascular
accident, occurs when blood flow to the brain is
disrupted. Disruption in blood flow is caused when
either a blood clot or piece of plaque blocks one of the
vital blood vessels in the brain (ischemic stroke), or
when a blood vessel in the brain bursts, spilling blood
into surrounding tissues (hemorrhagic stroke).
A loss of brain function occurs with brain cell death.
This may include impaired ability with movement,
speech, thinking and memory, bowel and bladder,
eating, emotional control, and other vital body
functions. Recovery from stroke and the specific ability
affected depends on the size and location of the stroke.
A small stroke may result in problems such as
weakness in an arm or leg. Larger strokes may cause
paralysis (inability to move part of the body), loss of
speech, or even death.

 Malnutrition
 Lack gag reflex
 Choke
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 Chronic respiratory infection
 Poor appetite
 Weight loss
Dietary measures
 Fruits and vegetables
 Lean protein
 Grains
 High Fiber diet
 Limit salt
 Don’t skip meals
Hematologic Disorders
Iron Deficiency Anemia
Overview
Iron deficiency anemia develops when body stores of
iron drop too low to support normal red blood cell
(RBC) production. Inadequate dietary iron, impaired
iron absorption, bleeding, or loss of body iron in the
urine may be the cause. Iron equilibrium in the body
normally is regulated carefully to ensure that sufficient
iron is absorbed in order to compensate for body
losses of iron
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 Growth problems
 Heart problems
 Increase risk of infections
 Restless leg syndrome
Dietary measures
 Iron-rich foods
 food and drink containing vitamin C are
important as vitamin C helps your body absorb
iron
 recheck complete blood counts every three
months for one year
 Substances that impair iron absorption include:
coffee, tea, high fiber, calcium and eggs
Leukemia
Overview
Leukemia is a cancer of cells in the bone marrow (the
cells which develop into blood cells). With leukemia,
the cancerous cells in the bone marrow spill out into
the bloodstream. There are several types of leukemia.
Most types arise from cells which normally develop
into white blood cells. (The word leukemia comes from
a Greek word which means 'white blood'.) If you
develop leukemia it is important to know exactly what
type it is. This is because the outlook (prognosis) and
treatments vary for the different types.

 Weight loss
132 | P a g e
 Fatigue
 Nausea
 Anemia
 Low blood count
 Constipation

 neutropenic diet
 High antioxidants food
 Fruits and vegetables
 Adequate water intake
 Diet recommendations may include avoiding
raw/undercooked foods (e.g., meats, seafood,
eggs, vegetables or unpeeled fruits) or
unpasteurized dairy products.
 Maintaining a healthy body weight
 Daily activity, such as walking
 Relaxing (managing stress)
 Getting enough sleep
Sickle Cell Anemia
Overview
Sickle cell disease changes normal, round red blood
cells into cells that can be shaped like crescent moons.
The name "sickle cell" comes from the crescent shape
of the cells. (A sickle is a tool with a crescent-shaped
blade.)
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Having sickle cell disease means a lifelong battle
against the health problems it can cause, such as pain,
infections, anemia, and stroke. But many people are
able to have a very good quality of life by learning to
manage the disease.

 Infections
 Anemia
 Stroke
Dietary measures
 High calorie, nutrient-dense diet
 folic acid and vitamin B12 and B6 supplements
 Protein Diet
 Fat Diet
 Do not smoke and avoid smoking areas
 Avoid crowded areas
Polycythemia Vera
Overview
Polycythemia vera (pol-e-sigh-THEE-me-uh VEER-uh)
is a slow-growing type of blood cancer in which your
bone marrow makes too many red blood cells.
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Polycythemia vera may also result in production of too
many of the other types of blood cells — white blood
cells and platelets. These excess cells thicken your
blood and cause complications, such as such as a risk
of blood clots or bleeding.
Polycythemia vera isn't common. It usually develops

slowly, and you may have it for years without noticing
signs or symptoms. Often, polycythemia vera is found
during a blood test done for some other reason.
Without treatment, polycythemia vera can be life-

threatening. However, with proper medical care, many
people experience few problems related to this
disease. Over time, there's a risk of progressing to
more-serious blood cancers, such as myelofibrosis or
acute leukemia

 Stroke
 Heart attack
 Enlarged spleen
 Peptic Ulcers
 Gout
Dietary measures
 Balanced Diet: right amount of calories,
protein, vitamins and minerals your body needs
(nutrient-rich foods from each of the food
groups, including fruits, vegetables, whole
grains, lean proteins and low-fat dairy food)
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 Low-Sodium Diet
 Iron-rich foods
 Avoid tobacco
 Avoid asparagus
 Exercise regularly
Pernicious Anemia
Overview
Pernicious anemia is a decrease in red blood cells that
occurs when the intestines cannot properly absorb
vitamin B12.
Pernicious anemia is a type of vitamin B12 anemia.
The body needs vitamin B12 to make red blood cells.
You get this vitamin from eating foods such as meat,
poultry, shellfish, eggs, and dairy products.
A special protein, called intrinsic factor (IF), helps

your intestines absorb vitamin B12. This protein is
released by cells in the stomach. When the stomach
does not make enough intrinsic factor, the intestine
cannot properly absorb vitamin B12.
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 Constipation
 PICA
 Fatigue
 Lack of energy
 Bleeding gums
 Swollen, red tongue
 Gastric Polyps
Dietary measures
 High in Vitamin B12 foods
 Folic Acid-rich foods
 Avoid drinking tea
 Avoid smoking
 Try not to overcook foods containing folic acid
Genitourinary System
Benign Prostatic Hypertrophy
Overview
Benign prostatic hyperplasia (BPH), also known as
benign prostatic hypertrophy, is a histologic diagnosis
characterized by proliferation of the cellular elements
of the prostate. Chronic bladder outlet obstruction
(BOO) secondary to BPH may lead to urinary
retention, renal insufficiency, recurrent urinary tract
infections, gross hematuria, and bladder calculi.
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 UTI
 Kidney stones
 Urinary retention
 Bladder Stones
 Bladder Damage
Dietary measures
 Vitamin E-rich foods
 Vitamin B6-rich foods
 Fruits and vegetables diet
 Vegan Diet
 Low Fat Diet
 Avoid caffeine
 Limiting or avoiding animal products and
vegetable oils
Kidney Stones
Overview
Kidney stones are made of salts and minerals in the
urine that stick together to form small "pebbles." They
can be as small as grains of sand or as large as golf
balls. They may stay in your kidneys or travel out of
your body through the urinary tract. The urinary tract
is the system that makes urine and carries it out of
your body. It is made up of the kidneys, the tubes that
connect the kidneys to the bladder (the ureters),
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the bladder, and the tube that leads from the bladder
out of the body (the urethra).
Kidney stones form when a change occurs in the
normal balance of water, salts, minerals, and other
things found in urine. The most common cause of
kidney stones is not drinking enough water. Try to
drink enough water, enough so that your urine is light
yellow or clear like water (about 8 to 10 glasses a day).
Some people are more likely to get kidney stones
because of a medical condition, such as gout.
Kidney stones may also be an inherited disease. If

other people in your family have had kidney stones,
you may have them too.
Kidney stones often cause no pain while they are in

the kidneys. But they can cause sudden, severe pain as
they travel from the kidneys to the bladder.

 Stomach Upset
 Nausea and Vomiting that might result to
dehydration
 UTI
Dietary measures
 Plenty of fluids especially water
 Low sodium diet
 Low protein diet
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 Calcium-rich foods
 Monitor your weight
 Avoid low carbohydrate foods
 Avoid meat
Urinary Tract Infection
Overview
A urinary tract infection (UTI) is an infection in any
part of your urinary system — your kidneys, ureters,
bladder and urethra. Most infections involve the lower
urinary tract — the bladder and the urethra.
Women are at greater risk of developing a UTI than

men are. Infection limited to your bladder can be
painful and annoying. However, serious consequences
can occur if a UTI spreads to your kidneys

 Sepsis
 Kidney Problems
 Diarrhea
 Dehydration
Dietary measures
 Water intake
 Cranberry Juice
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 Antioxidant-rich foods
 Drink plenty of fluids
 Eat fruits and vegetables
 Monitor your urine output
Acute Glomerulonephritis
Overview
Acute glomerulonephritis is a syndrome characterized
by the abrupt onset of hematuria often accompanied
by proteinuria, hypertension, edema, and renal
dysfunction. Acute glomerulonephritis can be
subdivided into primary glomerular disease, post
infectious glomerulonephritis, and glomerulonephritis
associated with systemic disease. With few exceptions,
the underlying mechanism of acute
glomerulonephritis is an immunologic one.

 Lack of appetite
Dietary measures
 Low Salt Diet
 Diuretics
 Calcium supplements
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 Sodium and fluid restriction
 Protein restriction for patients
with azotemia should be advised if there is
no evidence of malnutrition
Renal Failure (Acute and Chronic)
Overview
Acute renal failure (ARF) is the rapid breakdown of
renal (kidney) function that occurs when high levels of
uremic toxins (waste products of the body's
metabolism) accumulate in the blood. ARF occurs
when the kidneys are unable to excrete (discharge) the
daily load of toxins in the urine.
Chronic renal failure (CRF) or kidney failure is the

progressive loss of kidney function. The kidneys
attempt to compensate for renal damage by hyper
filtration (excessive straining of the blood) within the
remaining functional nephrons (filtering units that
consist of a glomerulus and corresponding tubule).
Over time, hyper filtration causes further loss of
function.

 Decreased urine output
 Food distaste
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 Anemia
Dietary measures
ARF:
 Low Protein Diet
 Carbohydrate and Fat Diet
 Fluid Intake
CRF:
 Sodium intake
 Protein Diet
ARF:
 Restrict sodium
 Less protein intake
CRF:
 Fluid consumption should be controlled
 Restrict potassium consumption
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Compilation of Diets: Myrrh Ariane Y. Gaitano

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COMPILATION

Hematologic Disorders (138-144)

People who have anorexia have an intense fear of gaining

Associated Nutritional Problems

In anorexia nervosa’s cycle of self-starvation, the body is

• Abnormally slow heart rate and low blood pressure,

• Muscle loss and weakness.

• Severe dehydration, which can result in kidney

• Fainting, fatigue, and overall weakness.

• Dry hair and skin; hair loss is common.

• Growth of a downy layer of hair called lanugo all

The first priority in anorexia treatment is addressing and

Often people with anorexia will be reluctant to admit to

If you suspect that a close friend or family member has

For an anorexic sufferer, gaining weight is an incredibly

This usually means that specialist dietary plans must be

Any course of treatment for anorexia is usually considered

Bulimia nervosa, commonly called bulimia, is a serious,

Bulimia can be categorized in two ways:

• Purging bulimia. You regularly self-induce vomiting

• Nonpurging bulimia. You use other methods to rid

Associated nutritional problems

•Discontinuing the binge-purge cycle: The initial

Eating adequately to meet the body’s daily nutritional

A balanced and sustainable relationship with food, free

Listening to and trusting your body’s internal cues to

While underlying thoughts and emotions remain at the core

Smoking and open flame are the leading causes of burn

A burn injury usually results from an energy transfer to the

• Refeeding Syndrome -This potentially lethal

• Non-obstructive Bowel Necrosis

Although rare, several case reports have defined

 Minor burns can be treated with natural products.

The pediatric burn patient presents a particular challenge

Coronary Artery Disease

Coronary artery disease is the most common type of heart

When you have it, your heart muscle doesn't get

It can be a shock to find out that you have coronary artery

Associated Nutrtional Problems

In healthy people, insulin keeps the blood sugar level

Uncontrolled diabetes can damage the artery walls and

• Avoid fried fast food and processed foods containing

Blood pressure is the force of blood pushing against blood

Associated Nutritional Problems

In most people, the kidneys have trouble keeping up with

Cancer- Research shows that higher intake of salt, sodium,

Osteoporosis- The amount of calcium that your body loses

DASH stands for Dietary Approaches to Stop Hypertension.

• Eat more fruits, vegetables, and low-fat dairy foods

A healthful eating pattern, regular physical activity, and

Congestive Heart Failure

After digestion, glucose passes into the bloodstream, where

When we eat, the pancreas automatically produces the

On the TLC diet, you will:

• Limit fat to 25%-35% of your total daily calories.

Although assessment is the initial step of the four-step

The thyroid gland, located in the anterior neck just below

Associated Nutritional Problems

The first thing that we want to understand is that there is a

What are the symptoms of low thyroid? With low thyroid

Now I hope you have a general understanding of the way

There are certain nutrients required to make T4. One of

Iodine is not the only nutrient required to make T4. There’s