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• FOODS ALLOWED LIBERALLY: Raw & Boiled Vegetables (Except Carrots), Juices Like Fresh Lemon, Coconut Water, Soda Vegetable Juices like Tomato Juices, Clear Soups, Water Melon, Jamun.
• FOODS TO BE AVOIDED: Sugar, Jaggery, Honey, Sugar Cane Juice, Sweets, Cakes, Pastries, Ice Cream, Jams, Fruit, Preserves With Sugar, Fruit Juices, Mango, Cheeku, Grapes, banana. Excess Of Cream, Butter, Oil, Excess of Fried Foods, Puri Parantha, Pakora. Excess of Dried Nuts. Excess Of Rice and Rice Products, Potato, Sweet Potato, Zimikand, Arbi, Whole Milk Its Products, Sugar-Free Equal.

IMPORTANT DIETARY GUIDELINES FOR IDDM PATIENTS:

1. Eat three small meals & three snacks evenly spaced throughout the day instead of 3 large meals.
2. Cereals- Avoid very coarse cereals such as bran & high cereals. Take about 6-11 servings per day to meet the calorie requirement.
3. Vegetables- Avoid raw vegetables like salads & gas-forming vegetables such as broccoli, cabbage, onions, cauliflower.
4. Meat & meat substitutes- Highly seasoned & though meats should be avoided. All tender meats, eggs & meat stocks can be taken.
5. Seasonings- Strongly flavored seasoning & condiments such as green chili, chili sauce, black paper, red chili powder & other highly spiced foods to be avoided.
6. Caffeine-containing beverages (coffee, tea, & cola drinks) & decaffeinated coffee can irritate the lining of the stomach.
7. Avoided foods that are spicy.
8. Avoided alcohol in concentrated forms.
9. Quit smoking- It is best eliminated as it hinders ulcer healing.
10. Rest- Adequate rest, relaxation & sleep are important.

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FOODS ALLOWED LIBERALLY:

Raw & Boiled Vegetables Juices Like Fresh Lemon, Coconut Water, Soda Vegetable Juices like Tomato Juices, Clear Soups, Watermelon, Jamun, Slim Milk & Its Products.

FOODS TO BE AVOIDED:

Sugar, Jaggery, Honey, Sugar Cane Juice, Sweets, Cakes, Pastries, Ice Cream, Jams, Fruit, Preserves With Sugar, Fruit Juices, Mango, Cheeku, Grapes, banana. Excess Of Cream, Butter, Oil, Excess of Fried Foods, Puri Parantha, Pakora. Excess of Dried Nuts. Excess Of Rice and Rice Products. Potato, Sweet Potato, Zimikand, Arbi, Whole Milk Its Products.

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FOODS ALLOWED LIBERALLY:

Raw & Boiled Vegetables. Lime, Coconut Water, Soda, Aam Panna Vegetable Juices like Tomato Juices, Clear Soups, Clear soups, Fresh Fruits.

FOODS TO BE AVOIDED:

Excess Of Cream, Butter, Oil, Excess Of Fried Foods, Puri Parantha, Pakora, Chips, Cutless, Spicy Foods Heavy Dals & Vegetables.

GENERAL DIET INSTRUCTIONS:

Plenty of Fluids-8-10 Glasses Daily, Avoid Having Late Dinner, Small & Frequent Meals.

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FOODS TO BE TAKEN IN MODERATION:

Sugar, Jaggery, Honey, Sugar Cane Juice, Sweets, Cakes, Pastries, Ice Cream, Jams, Fruit Preserves with Sugar, Fruit Juices, Mango, Cheeku, Grapes, Banana, Excess of Rice & Rice Products, Potato, Sweet Potato &, Arbi, Snacks Like Idli with Vegetables, Dhokla, Stuffed Parantha, Brown Bread, Roasted Chana Chaat, Three Bean Salad, Brown Rice Salad, Sauté Paneer, Sprouted Salad, Besan Cheela, Moong Dal Cheela, Moong Dal Pakora, Fruit, Etc can be Taken.

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FOODS ALLOWED LIBERALLY:

Raw & Boiled Vegetables (Except Carrots), Juices Like Fresh Lemon, Coconut Water, Soda Vegetable Juices like Tomato Juices, Clear Soups, Water Melon, Jamun.

FOODS TO BE AVOIDED:

Sugar, Jaggery, Honey, Sugar Cane Juice, Sweets, Cakes, Pastries, Ice Cream, Jams, Fruit, Preserves With Sugar, Fruit Juices, Mango, Cheeku, Grapes, banana. Excess Of Cream, Butter, Oil, Excess of Fried Foods, Puri Parantha, Pakora. Excess of Dried Nuts. Excess Of Rice And Rice Products, Potato, Sweet Potato, Zimikand, Arbi, Whole Milk Its Products.

FOODS TO BE IDLI WITH TAKEN IN MODERATION:

Snacks Like Idli with Vegetables, Dhokla, Paneer Cutlet, Egg Roll, Egg S& Wich, Corn Salad, Popcorn, Stuffed Parantha, Dahi Bhalla, Brown Bread Sandwiches, Roasted Chana Chaat, Three Bean Salad, Brown Rice Salad, Sauté Paneer, Sprouted Salad, Besan Cheela, Moong Dal Cheela, Moong Dal Pakora, Etc Can be Taken.

RENAL DISEASE

Kidneys are composed of one million functional units called nephrons. Each nephron consists of a glomerulus which is a tuft of capillaries, invigilated into an epithelial sac called Bowman’s to about 1/4th of the cardiac output at rest 130ml/min.

FOODS TO BE AVOIDED:

Extra Milk, Milk Product, Excess Dal, Besan, Excess Meat, Chicken, Fish or Egg. Vegetable Soups Salad. Fruit juices Squash. Fresh Lime, Coconut Water. Green Leafy Vegetables, Kamal Kakri, Mushroom. Dried Fruits, Nuts, Mint, Tomato Coconut Chutney. Avoid salt shaker on the table. Chat Masala, Metha Soda. Tinned, And Canned, Preserved Processed Products. Bakery Products Like Biscuits. Avoid Papads.

FOODS ALLOWED:

Fruits 100g/Day (Apple, Guava, Pineapple, Pear, Papaya). Refined Cereals Like Maida, Semolina, Vermicelli, Sago, Refined Oil, White Butter.

TIPS FOR REDUCING POTASSIUM IN YOUR DIET:

1. Dialyzing potatoes other vegetables- you can remove some of the potassium from potatoes other vegetables by peeling them, then soaking in a large amount of water for several hours before use.
2. Drain, rinse well before cooking.
3. Cooking all the vegetables helps in removing some potassium.
4. Avoid taking too much raw salad.
5. Limiting potassium content by protein control (the amount of food that you eat at one time) e.g. a high potassium tomato (1 small) provides 273mg of potassium. If you cut a thin slice to slice to accent your sandwich it provides much less; 1/6th of 1 small tomato provides 45mg of potassium.

RENAL DIET

Glomerulonephritis, also called nephritis means an inflammation of the nephrons. The inflammatory process affects the glomeruli i.e. the tuft of blood capillaries in the head of a nephron. It is most common in its acute form in children between 3-10 years of age, young adults, although a few cases (5percent or more) of initial attacks do occur in adults over the age of 50 years. Although, the glomeruli are particularly affected the functioning of tubules is also disturbed.

Dietary Management

The energy requirement is essentially the same as it is in good health. In the absence of fever and at bed rest, these allowances can be reduced somewhat if there is no previous condition of malnutrition. Restriction of protein is only needed when the blood urea nitrogen (BUN) is elevated and oliguria is present. Usually, the diet provides about 0.5g of protein/kg of ideal body weight. To provide sufficient kilocalories for energy needs, need to be given liberally. Both simple such as sugar as well as complex from such as starches can be included in the diet. There is no need to restrict the fat in the diet. Infant, including emulsified and easily digestible fat in the diet will provide non-protein calories of energy needs, reduces the bulk of the diet as well as make the diet more palatable. If renal function is impaired, oliguria Edema is present, the sodium needs to be restricted to 500-1000mg/day. The renal clearance of potassium is impaired when severe oliguria is a complication. Fruits juices being a good source of potassium, could be a cause of potassium intoxication if included in a large amount in the diet. Therefore, their intake must be restricted if oliguria is present. Fluids need to be restricted according to the ability of the kidney to excrete urine.

• Diet and Feeding Pattern: A low-moderate protein, low-sodium, and fluid-restricted diet is prescribed.
• Foods included: Rice, Sugar,Vegetables, Sago, Honey.
• Foods avoided: Salts, Greens Rich in Sodium Like Amaranth, Bakery Products, Pulses, Fruits Like Mango, Amla, Plums, Sapota, Lemon, Peach, Pineapple, Papaya, Banana, Guava, Watermelon, Meat, Chicken, Egg, Milk, Curd, Jaggery, Pulses.

The primary degenerative effect, in nephrosis, is in the capillary, basement membrane of the glomerulus. As the degeneration continues, the kidney tissue pore size increase to allow the passage of protein into the filtrate.
The disease is characterized by large amount of protein loss in urine by the body. Initially, there is an accumulation of body fluid seen as swelling of the yield s legs. Serum albumin fails while blood cholesterol rises to every high level. The cause of this disease is unknown though most cases may be a form of glomerulonephritis related to streptococcal toxins. Nephrotic syndrome or nephritis is the inflammation of the nephrons. It is characterized by a group of symptoms resulting from kidney damage, impaired nephron's function.

MODIFICATION OF DIET:

Nutritional management: One of the aims of nutritional management is to replace as much of the protein loss in the urine with an intake of good quality protein. The dietary modification may be as follows:

• Dietary Management: Fluids need to be restricted according to the ability of the kidney to excrete urine. When oliguria is present, restriction of fluid intake is imposed. The volume of fluid to be given is calculated from the volume of urine passed in the previous 24hrs plus the estimated insensible water loss usually 500ml daily. During 1st few days of treatment, the fluid given should be less.
• Protein: A balanced diet adequate in both energy and protein (1-2gs per kilogram body weight) should be adequate for most children. Since Indian children usually have a low intake of protein (even less than the RDA), adequate-protein intake- up to 2g/kg/day in children not more than 3g/kg/day in infants is advocated. A very high protein diet may cause tubular damage to the kidneys as the kidneys will have to filter more of the proteins. Foodstuffs rich in protein are cow’s milk, skimmed milk, eggs, fish, chicken, lean meat, paneer, sprouts, pulses legumes. The daily protein allowance is increased by 100-200 g. This should be provided through high-quality protein. Restriction of protein is only needed when the blood urea nitrogen (BUN) is elevated and oliguria is present. Usually, the diet provides about 0.5g protein/kg of ideal body weight.
• Fat: There is no need to restrict the fat. Infact, including emulsified easily digestible fat in the diet, will provide non-protein calories for energy needs.
• Sodium: The restriction of sodium varies with the degree of oliguria and hypertension. If renal function is impaired, the sodium can be increased. If Edema is present sodium is restricted. To prevent massive edema, sodium levels in the diet must be low. Usually, a 500mg sodium diet is satisfactory. Salt should be restricted but the diet should be palatable. To prevent massive edema, sodium levels in the diet must be low, usually, a 500mg sodium diet is satisfactory. Usually added salt is prohibited. Some of the foodstuffs high in sodium are listed as follows:
  • High sodium food: Banking soda, salt, Ajinomoto, Salted wafers, Popcorn, salted biscuits, Papads- all varieties, Salted pickles, chutneys, curry powder- commercial, Commercial salad dressing sauces, Ready to serve soup, Soft drinks containing sodium benzoate, Bakery products, bread, biscuits, Nuts such as salted cashew nuts, pistachio, walnuts, peanuts, Commercial cheese, Preservative containing foods, Canned tinned foods.
• Potassium: When kidneys do not work properly, potassium builds up in the body and causes the heart to beat unevenly and suddenly. All renal patients should remember that too little potassium can also be dangerous.
• Food allowed: Bread, Wheat, Rice, Jowar, Omelette, Pulses, and vegetables. Salad, Milk and Milk Products, Soup, Butter, Honey, Jam, Pastries, etc.
• Foods avoided: Papad, Chutney, Pickles, And Spices.

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Acute renal failure causes a sudden stoppage of renal function as a result of metabolic insult or traumatic injury to be normal kidneys. There is high mortality and the condition needs a medical emergency in which the nutritionist plays a supporting role.

• Causes:
Loss of blood can cause acute renal failure, as the blood flow to the kidney decreases as in an accident, ulcers, etc, Loss of plasma as in burns and crush injuries, Loss of fluid in diarrhea, vomiting, diabetic coma. General anesthesia and surgical operation reduce renal blood flow and may precipitate renal failure; Serious infections produce shock and reduce renal blood. Nephrotoxins like paracetamol and mushrooms, Nephritis and nephritis can also in ARF.
• Symptoms::
Low urine volume, increased serum urea nitrogen and creating, diminished excretion of potassium, lethargy, anorexia, nausea, vomiting, etc.

DIETARY MANAGEMENT

A minimum of 600-1000 kcal is necessary. A high calories intake is desired, mainly from carbohydrate and fats. All foods containing protein are stopped if the patients are under conservative treatment and blood urea nitrogen is rising. However, 40g is allowed when the patient is on Hemodialysis or Peritoneal dialysis as it will reduce endogenous protein breakdown, a minimum of 100g/day is essential to minimize tissue protein breakdown.
Fluid permitted is 500ml+ losses through urine and gastrointestinal tract, with visible perspiration, an additional 500ml may be necessary. Potassium intoxication (hyperkalemia) occurs with a daily rise of 0.7m Eq serum potassium. It has deleterious effects on the heart. A bowel wash may remove 100mEq of potassium. Potassium sources like tomato juice, coffee, tea, coca, and potassium-rich vegetable are avoided.

• Foods to be allowed: Beard, Salt-Free Butter, Grape Juice, Low Protein Pudding.
• Foods to be avoided: Protein Concentrates, Pulses, Excess Consumption of Milk, Egg, and Meat
• Diet and feeding pattern: During the initial period, when vomiting and diarrhea may interfere with feeding via the oral route, intravenous feeding may have to be used to provide nutrients in sufficient quantity. A normal diet with free fluid intake is prescribed and may even need to be supplement with electrolytes. Proteins should continue to be restricted until BUN and serum creatinine levels return to normal.

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It is also known as uremia as the level of urea in blood is extremely high. When the 90percent of functioning renal tissue is destroyed uremia occurs. It may be the result of acute Glomerulonephritis and nephrotic syndrome. CRF is a slowly progressive loss of renal function for a month or year and is defined as an abnormally low glomerular filtration rate which is usually determined indirectly by the creatinine level in the blood serum.

• Causes: Progression of acute nephritis or nephritis or nephritis, chronic infection of the urinary tract. High blood pressure. Infections (chest infection)- sub-acute bacterial endocarditis. Polycystic kidneys, Gout, Exposure to a toxic substance. Abdominal surgical emergency.
• Symptoms: Loss of nephrons and decreased renal blood flow and glomerular filtration, dehydration, loss of appetite, vomiting, convulsions, and coma can also occur.

DIETARY MANAGEMENT

Adequate kilocalories are mandatory and fat must supply sufficient non-protein kilocalories to spare protein for tissue protein synthesis and to supply energy. About 300-400g carbohydrate should be provided to be patient daily. Failing kidneys need to be given rest. Protein intake can be reduced to 0.5g/kg of body weight/day. Patients can maintain nitrogen equilibrium for long periods with as little as 35-40g of protein/day if accompanied by liberal calorie intake. When BUN rises, the protein intake needs to be restricted to 20g/day. Only essential amino acids supplied with milk and egg protein should be used to provide this small protein intake. There is a danger of both water intoxication from overloading as well as dehydration due to too little water intake as the capacity of failing kidneys to water is limited. The strict restriction is necessary only if hypertension and Edema are present. 0.2mMol/kg of body weight/day + diuretics are given until the crisis is over. Potassium is restricted to 1 mMol.kg of body weight/day. Double boiling and draining excess water reduce potassium content.

• ENERGY: 30-40kcal/day in adults, 100-150kcal/day for children.
• PROTEIN: 0.5/day with 60-70percent increased biological value protein decreases nitrogen load. A mixture of amino acids is recommended. If BUN is increased 20g/day to decreases nitrogen load in advance case. Decreases in GRF can slow glomerulosclerosis normally phosphorus decreases so delay the onset of renal secondary hyperthyroidism and may slow the progression of glomerulosclerosis.
• SODIUM: Intake will be varying between 500mg-2g.
• POTASSIUM: 1500mg/day as the kidney cannot excrete potassium, in severe vomiting and diarrhea carefully potassium supplement should be given.

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Renal calculi are also known as Kidney Stone/ urolithiasis/ nephrolithiasis/ nephron calcinosis. They may be found in the bladder, kidney, urethra. Deposition of varied sizes crystals in an organic matrix leads to the formation of these stones. As stones of varied sizes, they normally move towards the ureter. Small smooth stones pass into the ureter, but a large one can block the water opening which impedes normal flow causing intense pain. The pain may be accompanied by nausea, vomiting, and even chills with fever. Kidney stones can form when urine contains too many certain substances. This substance can create small crystals that become stones. Kidney stones are common. A person, who has had kidney stones, often gets them again in the future. Kidney stones often occur in premature infants. A kidney stone is a solid mass made up of tiny crystals. One or more stones can be in the kidney or ureter at the same time. A patient with acidic urine tends to form triple phosphate calcium carbonate or calcium phosphate crystals. The kidney stones are made by the mucopolysaccharides, uric, urate, calcium oxalate, calcium carbonate, calcium phosphate, etc. Generally, uric acid and calcium oxalate stones are found.
A kidney stone, also known a renal calculus is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine. A urine concretion with calcium phosphate and ammonium phosphate predisposes to stone formation. A patient with acidic urine tends to form uric acid or calcium oxalate crystals. A patient with alkaline urine tends to form triple phosphate, calcium carbonate or calcium carbonate, or calcium phosphate crystals.

• Causes: Climate, Occupation, Infection of the urinary tract, Dietary habits, Heredity, Vitamin A and B complex deficiency, Hyperthyroidism.
• Most urinary calculi are made up of calcium phosphate, calcium oxalate, uric acid, or magnesium ammonium phosphate. In India, the most common type of calculi is calcium oxalate.

FOODS TO BE INCLUDED and EXCLUDED IN RENAL CALCULI

FOODS RICH IN CALCIUM, PHOSPHATES, OXALATES, and PURINES

• Types: The most common constituent of kidney stones are oxalate, urates, or phosphate, combined with calcium.
• Calcium: The normal range of urinary calcium in adults taking an ordinary diet is 100-300mg per day in men, 100-250mg per day for women. Patients who pass calcium stones, in general, tend to show increased urinary calcium excretion. The prevalence of calcium stones is higher in those taking a low fiber diet.
• Oxalate: The normal urinary oxalate excretion is about 15 to 40mg/day; less than 10percent of this is from the diet. Patients with oxalate Stone may have normal oxalate excretion. Vitamin B deficient eats have increased urinary oxalate excretion, probably due to excessive endogenous breakdown, result in oxalate nephrocalcinosis.
• Uric acid: The average daily excretion of uric acid is 0.5-1.0g. When the urine is strongly acid uric acid crystals are precipitated; this predisposes to urate stones. Uric acid stones are common inpatient with gout, are also seen in the tropics. Pure uric acid stone are radiolucent.
• Phosphate: The normal daily excretion of inorganic phosphate is 500-1500mg in men 500-900mg in women. Excretion of phosphate is not increased in patients with stones.
• Magnesium: Low urinary magnesium excretion high urinary calcium excretion predisposes individuals with hyperparathyroidism to stone formation. These people may benefit from supplements of magnesium.
• Cystine: Cystine urea is an inherited condition with defective reabsorption by the renal tubule of the amino acid cysteine, lysine, arginine. Some of these patients excrete a large amount of cystine, 480-360mg in the urine. Cystine is hexagonal, is visible only in acid urine.
• Symptoms: The main symptoms are severe pain that starts suddenly may go away suddenly Pain may be felt in the belly area or side of the back, Pain may move to groin or testicle area, Abnormal urine color, Blood in the urine, Chills, Fever, Nausea, Vomiting.
• Etiology
  1. Heredity: Family history may show that some of the blood relations of a patient with a kidney stone had a similar problem.
  2. Climate: Those residing in the hot tropical area are prone to develop urinary calculi. Because, in a warm climate, the urine volume is low concentrated with urates, oxalate calcium salts.
  3. Occupation: People who work directly under the sun, a lot may pass concentrated urine. Because with exposure to the sun, more vitamin D is formed, which increases absorption of calcium from the gut and leads to increased urine calcium excretion.
  4. Infection of the urinary tract: Frequent infection of the urinary tract may result in pus cells around the urinary tract.
  5. Fluid: In the tropics, a lot of fluid is lost through perspiration, so crystals are easily precipitated for oxalate urate urolithiasis. However, foods with a significant source of oxalates should be omitted which include beans, beet green, cola, cocoa, dried figs, plums, potatoes, spinach, tea, tomatoes.

Dietary management:

The fundamental principle in the treatment of kidney stones is to supply adequate fluids like water, coconut water, and barley water, fruit juices, and weak tea to ensure the passage of over 200ml of urine/day. It is advisable to restrict foods that are rich in calcium, oxalates, or uric acid according to the type of stone formed.

• Fluids: The fundamental principle in the treatment of kidney stones is to supply adequate fluids like water, barely water, fruit juice, weak tea to ensure the passage of over 200ml of urine/day. The simplest guide to the patient is to drink enough fluid to see that the urine when voided is light in color.
• Foods restricted: It is advisable to restrict foods that are rich in calcium, oxalate, or uric acid according to the type of stone formed. Thus, a person who has passed calcium oxalates stone should avoid a diet rich in calcium oxalate.

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Cardiovascular diseases are the class of diseases that involve the heart or blood vessels (arteries veins). While the term technically refers to any disease that affects the cardiovascular system (as used in MeSH C14), it is usually used to refer to those related to atherosclerosis (arterial disease).

Role of fat in the development of Atherosclerosis

Cholesterol and triglycerides are the main forms of fat carried in the bloodstream. These fats or lipids come partly from food, partly from the body’s production in the liver, fats are not water-soluble hence cannot travel through the blood easily with the help of lipoprotein; digested fat from the liver and is carried to various parts of the body by the blood vessels. The cholesterol returns to the liver and repeats its job. The liver place cholesterol into packages called lipoproteins, made from lipid-protein, there are mainly four kinds of lipoprotein packages namely chylomicrons VLDL (very low-density lipoprotein), LDL (low-density lipoprotein), HDL (high-density lipoprotein), High-density lipoprotein has more protein content. Chylomicrons carry triglycerides whose fatty acids contain more than 10 to 12 carbon atoms, monoglycerides, glycerol small amounts of cholesterol, and phospholipids. VLDL also transports triglycerides, but mainly endogenous triglycerides are formed in the liver. The VLDL becomes LDL. LDL is the main carrier of cholesterol. Some LDL pieces get stuck to the blood vessel walls narrowing the same.

• HDL Protects against Atherosclerosis: HDL plays a role in the reverse transport of cholesterol from tissue throughout the body back to the liver. HDL particles enriched in free cholesterol can then be modified by the enzyme lecithin cholesterol acyltransferase, which esterifies the free cholesterol with linoleate from lecithin. The cholesterol ester moves from the surface of lipoprotein to the core (because of its hydrophobicity), allowing more free cholesterol to be adsorbed onto the surface resulting in particle enlargement. As HDLS become enriched in cholesterol ester, they become significant vehicles for delivering ester to the liver for conversion to bile acids or excretion as biliary cholesterol. The second potential antiatherogenic activity of HDL relates to its role as an antioxidant or antiaggregant in the vessel wall.
• Saturated fatty Acids: Saturated fatty acids raise the level of LDL total blood cholesterol level. Both these effects increase the risk of CHD. The activity of the LDL receptor- its ability to mediate the entry of LDL- appears to be suppressed by saturated fatty acids. When LDL receptor activity decreases, LDL catabolism decreases, LDL increase. Individual saturated fatty acids differ in their ability to change blood LDL- cholesterol levels. Palmitic, myristic to a lesser degree lauric acids increase the LDL- cholesterol level. In contrast stearic acid, medium to short-chain saturated fatty acids does not.
• Saturated fatty Acids: Saturated fatty acids raise the level of LDL total blood cholesterol level. Both these effects increase the risk of CHD. The activity of the LDL receptor- its ability to mediate the entry of LDL- appears to be suppressed by saturated fatty acids. When LDL receptor activity decreases, LDL catabolism decreases, LDL increase. Individual saturated fatty acids differ in their ability to change blood LDL- cholesterol levels. Palmitic, myristic to a lesser degree lauric acids increase the LDL- cholesterol level. In contrast stearic acid, medium to short-chain saturated fatty acids does not.
• Trans fatty Acids: Trans fatty acids raise LDL cholesterol to the same extent as myristic acid in addition to lowering HDL cholesterol. Thus, Trans fatty acids turning out to be even more atherogenic than myristic acid. Further trans fatty acids have been found to raise lipoprotein (a) levels, thus raising the risk of CHD. Trans fatty acids in the diet come from two main sources.
  1. Bacterial fermentation: - In the gut of ruminants’ fatty acids are produced. Meat dairy products contain trans fatty acids.
  2. Hydrogenated fats: - Hydrogenation of vegetable oils alter the geometric saturation of the polyunsaturated fatty acids from natural ‘cis’ to ‘trans’ forms. The only cis form can serve as essential fatty acids to be incorporated in cell structure. Depending on the degree of hydrogenation, trans-fats in food products contain anywhere from 5percent to a high 40percent.

DIETARY MANAGEMENT

• Objectives:
  1. Maximum rest for the heart.
  2. Maintenance of good nutrition
  3. Acceptability of the program.
• Principle of diet: Low calorie, low fat particularly low saturated fat, low cholesterol, high in PUFA with n-6 to n3 ratio 4-10:1, low normal protein, minerals vitamin are suggested. A high fiber diet is also recommended.
• Total energy: Those patients whose weight is at a desirable level are permitted a maintenance level of calories. The total calorie should be restricted to achieve desirable weight according to height, age, sex. Mild degree of weight loss for the cardiac patient of normal weight is recommended. Usually, a 1000 to 1200 calorie diet is suitable for an obese patient in bed.
• Fat: The first step involves the restriction of fats to not more than 20percent of the total calories consumed. Levels as low as 20percent are tolerated without side effects. Proportion of monounsaturated to polyunsaturated fat should be 5:6.
• Polyunsaturated fatty acids: The important n-3 polyunsaturated fatty acids are χ- linolenic acid, eicosapentaenoic acid, docosahexaenoic acid. The n-6 polyunsaturated fatty acids are linoleic acid, arachidonic acid. n-6, n-3 fatty acid also known as an omega-6, omega-3 fatty acid respectively. Omega-6 fatty acid, linoleic acid lower both total cholesterol and LDL- cholesterol levels. However, very high levels of linoleic acid also lower HDL- cholesterol levels. Omega-3, polyunsaturated fatty acids lower LDL- cholesterol, total serum cholesterol levels but not HDL cholesterol levels.
  PUFA promotes the esterification of cholesterol and puts it into an easily utilizable form. PUFA, especially arachidonic acid are precursors of prostacyclin thromboxane leukotrienes. Thromboxane is vasoconstrictors while prostacyclins are vasoconstrictors while prostacyclin is vasodilators hence help in the prevention of thrombus formation. These substances also decrease the stickiness of platelets prevents their aggregation decreasing the tendency of blood platelet clot. Linoleic acid prevents the accumulation of cholesterol in blood serum walls of blood vessels plays a key role in the transport of cholesterol. PUFA decreases the synthesis of the precursor of VLDL which is associated with an increased incidence of CHD. PUFA decreases the synthesis of the precursor of VLDL. PUFA decreases the production of LDL triglycerides. They also help in the clearance of LDL. Fish are a good source of n-3 fatty acids. Consumption of 100 to 200g of fish two to three times a week helps to prevent heart disease. Vegetable oils with moderate levels of linolenic acid include groundnut rice bran oil. The daily consumption of 10-15g of fish oil extract, representing 3-5g n-3 fatty acid is probably adequate to control moderate hypertriglyceridemia. Fish flesh is rich in B-vitamin., especially niacin and B6, seafoods contain significant amounts of vitamin B12. FAO and WHO recommends n-6 to n-3 fatty acid ratio to be between is it 4.1:10.1. Excessive intake of linolic acid should be avoided.
• Monounsaturated fatty acids: The monounsaturated fatty acids, oleic, erucic acid. Monounsaturated fats are present in vegetable sources such as olive oil, canola, almond oil, groundnut. The larger proportion of MUFA in diet may be conducive to thrombolysis and may be anti-inflammatory.
• Cholesterol: Cholesterol level in the diet should not exceed 300mg. Liver synthesises as much as 2g of cholesterol per day. If cholesterol levels are above 260mg/dl, it is almost impossible to bring about a drop, by diet alone. The advantage of a vegetarian diet is that is low in calories, fat, cholesterol, it has a high p/s ratio. It has adequate fiber which helps in binding cholesterol hence increasing the excretion of cholesterol. Vegetable oils diminish the plasma cholesterol not only due to polyunsaturated fatty acids but also because the plant sterol inhibits cholesterol absorption. Mustard oil, soyabean oil are rich in (n-3) ,alpha linolenic acid, safflower oil ,corn oils are rich in (n-6) linoleic acid.
• Contributing causes: Confirmed risk factors/markers include:
  1. Increasing age
  2. Male gender
  3. Females (post-menopause)
  4. Socio-economic status
  5. Ethnic background
  6. Physical inactivity
  7. Smoking Diabetes
  8. Obesity
  9. High blood pressure
  10. Serum total cholesterol
  11. Serum LDL cholesterol
  12. Serum HDL cholesterol
  13. Serum triglycerides

Role of food in Coronary Heart Disease (CHD) at a glance

Protect from CHD

α-linolenic acid, (n-3)- fish monounsaturated fatty acid-walnut, almonds, Anthocyanicus-Redwire,Vitamin C-Amla, Vitamin E-vegetable oils, B-carotene-carrots, Dietary fiber-whole grains, Allyl sulfur compounds-garlic are preferred foods.

Increase risk of CHD

High calorie diet, High amount of fat, High amount of sugar, High amount of dietary cholesterol, High amount of Trans saturated fatty acid, High amount of coffee can increase your risk of CHD.

Cardio protective diet

• Primary prevention: Nutritional recommended for the general population, including those with CVD risk factor-
  • Eat oily fish at least once per week e.g. sardines, salmon, fresh tuna.
  • Eat five or more portion of fruits, vegetables per day.
  • Reduce amount of all fat eaten, e.g., select lean meat, lower fat dairy product, use less oil/fat in cooking, reduce use of full fat spreads, eat less fried food, high fat foods such as cakes, biscuits, pastries.
  • Choose oils/spreads that are higher in monounsaturated fats and lower in saturated fat e.g., Olive oil, Rapeseed oil.
  • Reduce salt intake by using less at table, in cooking salty foods.
  • Eat more starchy foods e.g., bread, potatoes, pasta, rice etc.
• Secondary prevention: Recommendations based on systematic review of randomized controlled trails show that providing dietary advice to all individuals who have had a myocardial infarction (MI), probably others with CVD, have a higher chance of living than targeting dietary advice to only those with raised serum lipids or who are overweight. The dietary advice that saves lives improves the health of people who have had an Myocardial infarction/heart attack: