Selection of a proper diet in different morbid conditions of the system has for decades been a standing problem with physicians the world over. With the progress of our medical knowledge in various directions, the age old notion that, disease, whatever be its nature and cause, can be tackled solely by medicines, has fortunately been, abandoned. It has come to be recognised that quite a big number of ailments met with in general practice do not require anything else than a dietetic management for a recovery and a still large number, a change of diet supplemented by the aid of a limited number of medicines.
Amongst the former group may be mentioned almost all diseases of a metabolic origin such as rickets, scrofula, diabetes, gout, a few of the anemias, majority of the gastro-intestinal troubles, obesity, blood pressure, etc. and amongst the latter, gastro-intestinal troubles in general, rheumatism, nephritis, toxaemias etc.
Food is said to be easily digestible when it produces no gastro- intestinal discomfort, is passed from the stomach into the intestine at a normal rate of speed and is easily absorbed. Two points should always be stressed whenever determining a diet in any case of gastro-intestinal disturbance, viz.
(1) The power to increase the nutrition of the patient and (2) The necessity of giving food in a digestible form so as to lessen the work of the digestible glands and muscles. The general aim of our treatment should always be to so manage the case before us that digestion of a normal diet should always occur in the alimentary canal without any subjective or objective disturbances. Only under these circumstances can the patient be called cured.
According to their effect on intestinal peristalsis, foods may be divided into three classes, viz (a) those inducing constipation (b) those producing a laxative effect and (c) those exerting no special effect on either direction. In the first class are those foods containing an astringent such as tannin.
Among these may be mentioned tea, cocoa, coffee and certain red wines. Barley, arrowroot, shati, sago, potatoes etc. tend to produce constipation in many individuals. Among laxative foods may be mentioned fruits, specially grapes, dates and apples, and certain vegetables as cucumbers, tomatoes, cabbage etc. Amongst the foods which have no special effect on intestinal movements may be mentioned, meat, fish, eggs, milk, toasted bread etc. It is to be remembered, however, that considerable variations are apt to be met with and a food laxative to one may be constipating to another.
In determining the diet of patients affected with intestinal disturbances, specially diarrhoea, it is best to ascertain first the nature of the stools and thereby gain a first hand knowledge of the physiologic activity of the intestine of the patient. It has been found that the majority of the diarrhoeas met with are due to irritation set up in the large intestine by fermentations of the residual food matter by bacteria which normally inhabit that part of the gut. The foods most liable to be fermented are the carbohydrates and the proteins and the germs which thrive on the former can not do so in the latter and vice versa.
So that a patient who has diarrhoea due to bacterial fermentation of carbohydrates in the large intestine should get well if the carbohydrates are cut down from his diet and substituted by proteins. This prevents the accumulation of any residual carbohydrate in the lower gut, which has not been acted upon by the digestive juices above. Similar would be the treatment for a patient whose diarrhoea originates in bacterial putrefaction of proteins in the large intestine.
His ration of protein should be cut down either or partially according to the demands of the case, to obviate the possibility of any residual protein, unacted by proteolytic digestive ferments, reaching the large bowel. It is possible to judge whether the diarrhoea is caused by decomposition of carbohydrates or proteins, from the nature of the stools. In the former case, there is excessive gaseous collection and the stools are apt to be frothy and sour smelling. In the latter case, the stools are highly offensive and alkaline in reaction.
With this help, it is so possible to vary the diet, which will prevent the responsible flora from getting its suitable material for decomposition, thereby lessening its activity and virulence. In fact, it has often been shown that a simple change from one class of foods to another without any inquiry as to the causation, leads to a suspension of activity of bacteria and a consequent improvement of condition.
Of all the foods at our disposal, milk is undoubtedly the best and can be freely advised both for putrefactive (i.e. protein decomposition) and fermentative (i.e. carbohydrates decomposition) diarrhoeas. Its easy digestibility and absorption is liable to leave very little residue for bacterial action of any kind. Some patients stand milk badly, for whom, milk partially digested outside by any digestive powder (e.g., peptone powder or Sodi citras) or any of the powdered malted milks available in the market, may be prescribed.
But it is better to revert back to native milk as soon as the case permits. Diarrhoeas requiring carbohydrates are best fed by barley, arrowroot or shati, with or without milk or lactose (milk sugar), rice, vegetables, etc. It is, however, only in rare instances that we prescribe a diet consisting entirely of either the carbohydrates or proteins and the intelligence of such a prescription lies in a proper combination of these two essential elements, according to the needs of the case, supplemented with fats wherever necessary.
Besides, not all diarrhoeas are bacterial in origin and other factors such as a sudden change of atmospheric temperature from cold to heat or from heat to cold, extreme nervousness or emotional disturbance, worms, etc. may play their parts in causation. In such cases, a stringent regulation as regards the amounts of proteins and carbohydrates becomes unwarranted.
I shall now attempt to lay out a scheme of feeding patients afflicted with diarrhoeas and dysenteries. It will be noted that I have tried to include as many of such foodstuffs as are sold in our daily bazaars, in preferences to the artificial foods mentioned in common English text-books. Besides being much cheaper and easy of preparation, these foods being grown in Indian soil and climate, afford a much greater chance of easy digestion and assimilation than those grown in foreign soil and dispatched in sealed bottles and tins, a long time after their manufacture.
For acute attacks of diarrhoea, it is best to abstain from all foods for a few hours, preferably twelve or more. Feeding should commence with diluted barley water or milk whey with a dash of lemon juice, repeated in small quantities at intervals. With the diminution of the frequency of the stools, heavier foods may be gradually introduced, the best amongst which are milk diluted with barley or arrowroot, the juices of dal, preferably or boiled, fresh and with fish such as or with this may be added with convenience.
For subacute cases of diarrhoeas, well boiled old rice, jhol (soup) made of —-7,—-6 or —-8 fish, —-5, —-9 and curry made of —–3 together with —10 —-11 are best for the daytime meal. It is best to take barley, arrowroot or shati with a little milk as the evening meal. Breads prepared from these stuff, instead of flour, may be appetising to the patient.
If the appetite is very good, four or five freshly fried —12, with a little juice of —-1 may be taken in the evening, which however, should be thoroughly masticated. The evening meal should preferably be finished before 7 p.m. for lighter refreshments during the period, juices of —-13 or —-14, ripe —15, —16, —17, ————–18, and ——-19 are best.
For chronic diarrhoeas and dysenteries, where diet plays such an important role in their treatment, the following plan should severe the best purpose.
The two principal meals should consist of well boiled old rice with juice of —– or —–1 dal, jhol (soup) made of —6, –7, —20, —-21, or —-8 fish with vegetables such as —5, —-4, —22, —–3 ——23, —–24, etc.
For breakfast and afternoon tiffin, the best article is either ——-19 or any condiment made of this fruit i.e. bael, e.g. ——-18. This is a wonderful fruit, equally valuable in diarrhoeas and dysenteries. This may be supplemented by powdered —25 with a little water and sugar candy to taste. Goats milk, or if unavailable, cows milk may be instituted diluted with barley, arrowroot or water, when the violence of the evacuations are not severe.
When diarrhoea is very obstinate and persists inspite of careful dieting, the following food will be found to be an extremely useful adjuvant. A little technique is required in its preparation, which is worth the trouble. Green bananas (—-)3 are at first skinned and boiled well in water.
