Lesson 5: Diet Therapy
Food is essential to life. To sustain life, the nutrients in food must perform three functions within the body: build tissue, regulate metabolic processes, and provide a source of energy. A proper diet is essential to good health. A well-nourished person is more likely to be well developed, mentally and physically alert, and better able to resist infectious diseases than one who is not well nourished. Proper diet creates a healthier person and extends the years of normal bodily functions. Diet therapy is the application of nutritional science to promote human health and treat disease.
We all eat certain foods for reasons other than good nutrition and health. Our eating patterns develop as part of our cultural and social traditions and are influenced by our life style and life situation. It is important for the nurse to understand factors, which influence food choice and eating patterns.
a. Social Aspects. Most people prefer to eat with someone, and the patient is probably used to eating meals with his family. In the hospital he is served his food on a tray and left alone. Poor nutrition may be the result.
b. Emotional Aspects. The patient may feel guilty for not eating all the food served, or may overeat just because the food is there. The patient may overeat because he or she feels sad, lonely, or depressed or may refuse to eat for the same reasons. Certain foods may be considered "for babies." Some foods may be used as rewards."
c. Food Fads and Fallacies. These are scientifically unsubstantiated, misleading notions or beliefs about certain foods that may persist for a time in a given community or society. Many people follow fad diets or the practice of eating only certain foods. Food fads fall into four basic groups: Food cures, harmful foods, food combinations that restore health or reduce weight, and natural foods that meet body needs and prevent disease.
d. Financial Considerations. The patient's financial status has a great bearing on eating patterns. Most people in the United States can afford a diet, which includes a variety of foods and a sufficient number of calories. However, many Americans consume an excessive amount of fat and sodium. Excess fat consumption has been shown to be related to the development of heart disease. Excess sodium consumption may be a problem for some patients with hypertension. Many Americans with lower incomes consume a great percentage of their calories in the form of fat, since fat is the least expensive nutrient (when compared to carbohydrate and protein) and provides for greater satiety (feeling of "fullness" after eating) than both carbohydrate and protein."
e. Physical Condition. The patient may not feel well enough or strong enough to eat. Encourage the patient to eat without forcing him to do so. Encourage him to feed himself, so that he will not feel helpless.
f. Cultural Heritage. Food preferences are closely tied to culture and religion. Understanding these preferences will enable you to assist the patient in reaching and maintaining good nutritional health.
Cultural and religious practices are often intertwined. Many people refrain from eating certain foods, or eat specific foods in certain combinations, because of their religious beliefs. There are some major religious customs related to diet that, as a nurse, you must be aware of.
a. Hindu. Most Hindus are lacto-ovo vegetarians. They do not use stimulants such as alcohol or coffee.
b. Moslem (Islam). Meat and poultry must be slaughtered according to strict rules. Moslems do not eat pork or pork products. They do not drink alcoholic beverages. They do drink tea. Moslems fast for one month each year, avoiding food from dawn until after dark.
c. Jewish (Orthodox). Orthodox Jews do not eat pork, shellfish, or scavenger fish. They do eat beef, veal, lamb, mutton, goat, venison, chicken, turkey, goose, and pheasant. Meat must be slaughtered by a ritual method. Meat and milk may not be served at the same meal. Meat and dairy foods must be prepared in separate containers and with separate utensils. Certain days of fasting are observed, but a rabbi may excuse an elderly or ill patient.
d. Mormon. Mormons do not drink alcohol, coffee, tea, or caffeine containing carbonated beverages. They do not use extremely hot or cold foods (no ice in beverages).
e. Roman Catholic. Catholics may voluntarily abstain from eating meat on Fridays and during Lent. They do not eat or drink (except water) before taking Holy Communion. They fast on Good Friday and Ash Wednesday, but a priest may excuse the elderly or an ill patient.
f. Seventh Day Adventists. Seventh Day Adventists do not drink alcohol, coffee, or tea. They are usually lacto-ovo vegetarians.
a. Because of the dangers of too much animal protein resulting in health problems or for ecological reasons, many people have chosen to be vegetarians. They do not eat any type of meat. Some vegetarian diets are stricter than others.
b. The greatest concern in the vegetarian diet is attaining adequate amounts of complete protein. This is easy in the lacto-ovo vegetarian diet, but difficult for the vegan. The most efficient protein available is that found in dairy products, eggs, and fish. Among the sources of protein that can be used most efficiently by the body, meat actually ranks third. The second best supply of efficient protein is legumes, soybeans, nuts, and brown rice.
c. Complete proteins are needed to sustain life and to promote growth. Incomplete protein sources can be combined to become a complete protein.
d. Vegans should eat at least two of the following at the same meal in order to provide all essential amino acids:
e. Whole-wheat grains and cereals are preferred in vegetarian diets. Other foods must be added to the protein sources to supply vitamins and minerals. Vegetarian diets are often deficient in calcium, iron, zinc, vitamin D, iodine, and riboflavin. Vitamin B12 is probably missing entirely. Supplements of these substances often need to be taken.
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