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Unloading and diet therapy
Last reviewed: 23.04.2024
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Unloading and dietary therapy (RET) or dosed therapeutic starvation is a complete abstinence from eating without restricting the intake of water during the discharge period, followed by a gradual transition to exogenous food (food intake) with the help of special diets.
Indications
- bronchial asthma of all degrees of severity, predominantly atonic, resistant to conventional therapy;
- cortically dependent forms with a duration of glucocorticoids not more than 2 years;
- bronchial asthma in combination with obesity, polyvalent and drug allergies, ulcerative, urolithic, hypertensive disease, chronic colitis, irritable bowel syndrome, psoriasis, eczema, neurodermatitis.
[General information of the unloading and dietary therapy
The mechanism of the therapeutic effect of RDT:
- hyposensitization;
- increased non-specific resistance and anti-infectious immunity;
- suppression of allergic inflammation in the bronchi;
- stimulation of glucocorticoid function of the adrenal glands;
- desintoxication;
- improvement of bronchial patency;
- suppression of the immunopathological component of the pathogenesis of bronchial asthma;
- autolysis of pathologically altered cells;
- the formation of biogenic stimulators, which increase regenerative processes.
The methodology of the RDT provides for 3 periods: preparatory, unloading, and recovery.
In the preparatory period, indications for RDT are established, a clinical and laboratory study of the patient and active treatment of the inflammatory process in the bronchopulmonary system, psychotherapeutic preparations for RET.
The unloading period has the main task - the transition from exogenous to endogenous nutrition. This period lasts 10-14 days. In this period, the body turns to the primary use of fats, with the development of acidosis, hypoglycemia is possible. Therefore, in the first days of fasting, there is sluggishness, fatigue, headaches. On the 7-14th day the state of acidosis is smoothed. During the entire period of fasting, medication is stopped, in some cases, expectorates, diuretics, sedatives are allowed. Smoking and alcohol are strictly prohibited.
On the eve of the first day of fasting, the patient does not have supper and receives a salt laxative (50 ml of 25% magnesium sulfate), daily cleansing enemas are made. During defecation for self-emptying the bowels self-massage is performed.
After the action of the enema, a general bath should be taken (water temperature 37-38 ° C, duration 10 minutes) or a circular shower. Every day, there is a general massage, self-massage, including a face.
After the massage and shower (bath), rest is required for 1 hour, then with a good state of health, a walk (3-4 hours per day) is allowed.
Drinking the liquid is not limited, the amount of it should be at least 1 liter per day. Usually it is boiled water of room temperature or mineral water.
In the presence of acidosis alkaline mineral waters (Borjomi) are recommended, as well as 3-4% sodium bicarbonate solution in enema (0.5-1 L) or less frequently intravenously - 200-300 ml.
It is necessary to check the urine daily for acetone, with pronounced acetonuria take in 1 to 2 pieces of sugar.
If the blood pressure dropped to 85 and 50 mm Hg. V., fasting should be stopped.
Asthma attacks disappear or become less severe by the 7th day of fasting.
The recovery period in terms of duration is equal to half of the unloading period. From the first day of the recovery period, walks, massages, baths, enemas are canceled. The first 4-5 days patients should rest (lie, sit in a comfortable chair).
The food expands gradually to the days. Meat and table salt are prohibited for the entire period of restorative treatment.
In some cases with moderate bronchial asthma in the early days of RDT, it is necessary to use medications that are gradually canceled in the first 3-4 days. In severe bronchial asthma, RDT is combined with medical treatment, physiotherapy, these measures are gradually canceled as the condition improves.
SG Osinin (1981) suggested combining RT with acupuncture, it should be connected with 1-2 days of the recovery period and carried out for 8-12 days. The goal of acupuncture is to reduce the phenomena of discomfort in the abdominal cavity that occur in the first days of eating, normalize sleep, eliminate psychoemotional lability, enhance the effect of RDT. The combination of RDT and acupuncture can significantly reduce the dose, and sometimes completely eliminate, glucocorticoids in patients who received them before. In general, RDT gives good results in 62% of cases.
Contraindications
- active pulmonary tuberculosis;
- diabetes;
- circulatory insufficiency IIB - III st;
- exhaustion;
- malignant tumors;
- early childhood (under 14 years) and old age (more than 70 years);
- pregnancy and lactation;
- decompensation of liver and kidney function;
- helminthiases;
- mental illness;
- an active inflammatory process of any localization.
Complications
Possible complications during RDT:
- exacerbation of chronic foci of infection;
- severe course of ketoacidosis; In this case, alkaline mineral waters or sodium hydrogen carbonate are used inside (2-3 g every 2-3 hours), less often - intravenous infusions of 200-400 ml of 4% sodium bicarbonate solution. With non-self-limiting ketoacidosis, RDT is discontinued;
- orthostatic syncope;
- violation of heart rhythm and conductivity; at the same time, potassium and RTD preparations are prescribed;
- renal or biliary colic, RDT ceases at the same time;
- acute erosive and ulcerative changes in the gastroduodenal zone - therapeutic starvation in such situations ceases;
- convulsive syndrome;
- syndrome "food overload" during the first 3-5 days of the recovery period;
- "saline edema" in case of a diet violation in the recovery period;
- exacerbation of sciatica.
RDT should be carried out under the supervision of a physician who has undergone special training.
In recent years, it has been proposed to use a combination of enterosorption and therapeutic starvation. The main mechanism of action of enterosorption is the detoxification of intestinal contents, the release of the organism from poisonous or potentially dangerous substances of exo- and endogenous nature through binding and neutralization of them in the gastrointestinal tract.
Enterosorption is connected in the discharge period, the patients take inward 30-60 ml of enterosorbent SKNP-2 (nitrogen-containing activated carbon of spherical granulation, oral, large porous) for 3-4 doses with an interval of 4-6 h, squeezed with water and not chewing granules. From 8-10 days of the discharge period, when the probability of acidosis is significantly reduced, the dose of enterosorbent is reduced by 2 times and continues until the end of the discharge period.
In the presence of erosive gastritis, peptic ulcer of the stomach and duodenum, ulcerative colitis apply not granular sorbents, but other drugs of sorption action (Vasulene, polyphepan, enterodez, white sorb). The combination of RDT and enterosorption is highly effective in bronchial asthma and allows to completely prevent acidosis during medical starvation.