therapeutic diet.pptx

NUTRITION THERAPY FOR OBESITY
AND WEIGHT CONTROL
OBESITY is defined as an abnormal increase of fat in the
subcutaneous connective tissue. This means a lot of fat
cells are gathered in the tissue under the skin. Eating
greater amounts of food than the body can use for energy
causes this deposition.
It is also not a merely condition; rather it is a metabolic
disease that accumulates to the extent that health is
impaired.

 Overweight and obesity are defined as abnormal or excessive fat
accumulation that presents a risk to health. A body mass index (BMI)
over 25 is considered overweight, and over 30 is obese.
 caused by eating too much and moving too little. If you consume high
amounts of energy, particularly fat and sugars, but do not burn off the
energy through exercise and physical activity, much of the surplus
energy will be stored by the body as fat.

Prevention of Obesity ;
 in adults involves regular physical activity, a decrease in saturated fat
intake, a decrease in sugar consumption, and an increase in fruit and
vegetable consumption. In addition, family and healthcare professional
involvement may help to maintain a healthy weight.
 Consume less “bad” fat and more “good” fat
 Consume less processed and sugary foods
 Eat more servings of vegetables and fruits
 Learn how to food budget and meal prep

Planning for Weight Loss;
1.Creating a calorie deficit in a nutrient-dense way
All weight loss plans have one thing in common — they get you to
eat fewer calories than you burn
A good weight loss meal plan should follow some universal criteria:
*Limits processed foods and added sugar
*Includes a variety of fruits and vegetables

BREAKFAST
Half Banana
Soft cooked egg
1 Slice toast bread
1 tsp. butter
Coffee without cream and sugar
LUNCH
SALAD( tomato, tuna fish, diced
celery, french dressing, lettuce,
sliced hard-boiled egg)
1 cup rice
1 cup skim milk
1 slice papaya
DINNER
Roast Beef
Boiled Vegetables
Rice
Tea with Lemon
BEDTIME
1 Apple
Cheese
SAMPLE MEAL ( 1,200 CALORIES)

NUTRITION THERAPY FOR DIABETES MELLITUS
DIABETES MELLITUS refers to a group of diseases that
affect how the body uses blood sugar (glucose). Glucose is
an important source of energy for the cells that make up
the muscles and tissues. It's also the brain's main source
of fuel. The main cause of diabetes varies by type.
a disorder in which the body does not produce enough or
respond normally to insulin, causing blood sugar (glucose)
levels to be abnormally high. Urination and thirst are
increased, and people may lose weight even if they are not
trying to.

Two types of Diabetes;
1) Juvenile Diabetes occurs at any age from birth through
adolescence.It is severe, requires insulin for treatment and it is
difficult to manage.or insulin-dependent diabetes, is a chronic
condition. In this condition, the pancreas makes little or no insulin.
Insulin is a hormone the body uses to allow sugar (glucose) to enter
cells to produce energy
2) Adult type Diabetes occurs primarily among obese people who
become diabetic in middle age. The disease is usually mild, stable
and well-regulated by diet alone or by diet and oral compound.It is
also a disease in which your blood glucose, or blood sugar, levels
are too high. Glucose is your main source of energy. It comes from
the foods you eat. A hormone called insulin helps the glucose get
into your cells to give them energy.

What does a diabetes diet involve?
A diabetes diet is based on eating three meals a day at regular times. This
helps you better use the insulin that your body produces or gets through a
medication.
A registered dietitian can help you put together a diet based on your health
goals, tastes and lifestyle. He or she can also talk with you about how to
improve your eating habits, such as choosing portion sizes that suit the
needs for your size and activity level.

Recommended foods
Make your calories count with these nutritious foods. Choose healthy
carbohydrates, fiber-rich foods, fish and "good" fats.
Healthy carbohydrates
During digestion, sugars (simple carbohydrates) and starches (complex
carbohydrates) break down into blood glucose. Focus on healthy
carbohydrates, such as:
Fruits
Vegetables
Whole grains
beans and peas
Low-fat dairy products, such as milk and cheese
Avoid less healthy carbohydrates, such as foods or drinks with added fats,
sugars and sodium.

Fiber-rich foods
Dietary fiber includes all parts of plant foods that your body can't digest or
absorb. Fiber moderates how your body digests and helps control blood sugar
levels. Foods high in fiber include:
Vegetables,Fruits,Nuts
beans and peas
Whole grains
Heart-healthy fish
Avoid fried fish and fish with high levels of mercury, such as king mackerel
'Good' fats
Foods containing monounsaturated and polyunsaturated fats can help lower
your cholesterol levels. These include:
Avocados
Nuts
Canola, olive and peanut oils
But don't overdo it, as all fats are high in calories.

BREAKFAST
1 cup low-fat plain Greek yogurt
¼ cup blueberries
3 Tbsp. chopped walnuts
LUNCH
1 serving White Bean & Veggie Salad
DINNER
1 serving Garlic Butter-Roasted
Salmon with Potatoes &
Asparagus
BEDTIME
1 medium apple
Sample meal plan for Diabetes

Assessment Diagnosis Planning Interventions Rationale Evaluation
Subjective data:
1. Fatigue and
blurred vission
2. frequent
urination
3. ‘’ Lagi ako
nagugutom at
nauuhaw’
verbalized by the
patient.
4. Sudden weight
Loss
Objective data:
Bp:140/100mmHg.
weight : 100lbs.
PR : 88bpm.
Imbalanced Nutrition
Less
Than Body
Requirements
related to reduction of
carbohydrate
metabolism due
to insulin deficiency,
inadequate
intake due to nausea
and
vomiting.
effective
treatment to
normalize blood
glucose levels
and decrease
complications
using insulin
replacement, a
balanced diet, and
exercise
Explain the
importance of
having consistent
meal content or
timing.
Educate the patient
on maintaining
consistency in food
and the
approximate time
intervals between
meals
Educate the patient
about the health
benefits and
importance of
exercise in the
management of
diabetes.
The recommendation is
three meals of equal size,
evenly spaced meal times
(5-6 hours apart), with one
or two snacks. Pacing
food intake throughout the
day places more
manageable demands on
the pancreas.
A consistent amount of
food and time interval
between meals helps
prevent hypoglycemic
reactions and maintain
overall blood glucose
control
Exercise plays a role in
lowering blood glucose
and reducing
cardiovascular risk factors
for patients with diabetes.
Exercise lowers blood
glucose levels by
increasing the uptake of
glucose and improving the
utilization of insulin.
Goals meet: return
the blood sugar to
the natural or non-
diabetic level
the patient learn
how to manage
their disease and
be as healthy as
possible

NUTRITION THERAPY FOR DISEASES OF THE GASTROINTESTINAL
TRACT
The primary functions of the gastrointestinal (GI) tract include obtaining and
digesting food, absorbing nutrients and water, and eliminating wastes from the
body as feces. In order to distribute nutrients, prevent nutrient deficits and
malnutrition, repair injured intestinal epithelium, restore normal luminal bacterial
populations, encourage normal GI motility, and maintain healthy immunological
responses, a healthy diet and GI tract are essential (eg, both tolerance and
protection from pathogens). Food quantity, form, feeding frequency, and diet
composition all have a significant impact on GI function and can be used to
help reduce symptoms of GI disease..

Nutrient composition
GI tract can be affected by a wide range of nutritional and non-nutritional
disorders, choosing the right diet can help treat most GI conditions more
effectively. For the treatment of GI disorders, a variety of therapeutic diets
are available, including those that are highly digestible, new antigen or
hypoallergenic diets, hydrolyzed (protein) diets, and diets with increased
dietary fiber concentrations. These diets can all be used to treat different
GI issues.
The bland diet is a nutritionally appropriate diet that consists of bland-
tasting, soft-textured, mechanically and chemically non-stimulating foods.
Any diet consumed for an extended period must be nutritionally sufficient.

Peptic ulcer is an ulceration in the protective inside layer of the
lower esophagus, stomach, or duodenum.
Peptic ulcer is a lesion of the mucosal lining of the upper
gastrointestinal tract characterized by an
imbalance between aggressive and protective factors of the
mucosa, having H. pylori as the main
etiologic factor. Dietotherapy is important in the prevention and
treatment of this disease.

Assessment Diagnos
is
Inference Planning Interventions Rationale Evaluation
SUBJECTIVE DATA:
(I've Been
experiencing
Abdominal pain
immediately after
eating) as
verbalized by the
patient OBJECTIVE
DATA: Abdomi
nal guardin g 
Restles sness 
Facial grimaci
ng Pain scale
of 6 out of 10
•V/S taken as
follow: T: 37.5
°C P: 65 R: 14
BP: 110/80
Acula
pain t
Chamical
burn of
gastric
mucosa
Chemical
burn of
gastric
mucosa -
Damage to
the pain
G.1 lining -
Acute pain
After 8 hours of
nursing
interventions, the
patient will
verbalize relief of
pain 
Demonstrated
relaxed body
posture and be
able to sleep/rest
appropriately.
Independent Note
reports of pain,
including location,
duration, intensity
(0 10 scale ) 
Review factors that
aggravate or
alleviate pain. 
Identify and limit
foods that create
discomfort such as
spicy or carbonated
drink Encourage
small frequent
meals Encourage
the patient
always present, but if
present should be
compared with
patient's previous pain
symptoms. This
comparison may
assists assist in
diagnosis of etiology of
bleeding and
development of
complications Helpful
inestablishing
diagnosis and
treatment Food has an
acid neutralizing affect
and dilutes the gastric
Small meals prevent
dimension and the
release of gastrin
Reduces abdominal
tension and promotes
sense of control.
Goal met. Patient has
verbalized relief of pain. -
Demonstrated relaxed
body posture and be able
to sleep/rest
appropriately. .

Ulcerative colitis
is an inflammatory bowel disease of the large intestine limited to
the rectum and the colon which causes profuse and bloody
diarrhea. It is characterized by severe diarrhea, rectal bleeding,
cramping, abdominal pain, anorexia, and weight loss.
Treatment: Rest, nutritional therapy, sulfonamides

Assessment Diagnos
is
Inference Planning Implemention Rationale Evaluation
SUBJECTIVE
DATA: “My
stomach hurts a
lot since I went
in and out of
CR” verbalized
by the patient
OBJECTIVE
DATA: Fatigue -
Weight loss -
Hyperactive
Bowel Sounds
Vital signs: HR:
110 bpm RR: 19
BPM BP:
90/60mmhg
Temperature :
38.1°C Physical
Assessment:
Pallor
Acute pain
related to
prolonged
diarrhea.
Ulcerative colitis is
achronic, or long
lasting, disease that
causes inflammation
—irritation or
swelling—and sores
called ulcers on the
inner lining of the
large intestine.
Ulcerative colitis
shows intestinal and
extraintestinal
findings on physical
examination. These
include abdominal
tenderness, fever,
pallor ,inflammation
of the iris and uvea,
skin rash,
inflammation of the
joints,aphthous
ulcers and clubbing
of the fingers.
Short Term
Goal After 8
hours of
nursing
intervention
the patient
will be able
to relaxed
and rest
appropriately
.
NDEPENDENT
NURSINGACTION:
· Encourage patient
to report pain. ·
Assess reports of
abdominal cramping
or pain, noting
location, duration,
intensity (0–10
scale). Investigate
and report changes
in pain
characteristics ·
Note nonverbal cues
(restlessness,
reluctance to move,
abdominal guarding
withdrawal, and
depression).Invest
igate discrepancies
between verbal and
nonverbal cues. ·
Review factors that
aggravate or
alleviate pain
May try to tolerate pain
rather than request
analgesics. · To measure
the intensity of pain and
to know what
management should be
given. · Body language or
non-verbal cues may be
both physiological and
psychological and may be
used in conjunction with
verbal cues to determine
extent and severity of the
problem. · May pinpoint
precipitating or
aggravating factors (such
as stressful events, food
After 8 hours
intervention the
patient was able to
relieve rest
appropriate.
Symptoms and
decrease in Pain
Scorey. .

Gastroesophageal reflux disease, hiatal hernia, and esophagitis or heart burn
- GERD, hiatal hernia, and esophagitis occur 1 to 4 hours after a meal when
sphincter pressure drops. This is typically induced by pregnancy, oral
contraceptives, smoking, and chocolates, soft drinks, citrus fruits and juices,
and caffeinated drinks.
Treatment: Reducing intra-abdominal pressure and gastric acid production
Diet Therapy
1. Avoid foods high in fat.
2. Avoid large meals.
3 Limit foods that relax the lower esophageal sphincter.
4. Increase the intake of foods that do not affect the lower esophageal
sphincter pressure.
5. Maintain the ideal body weight.

Foods that Relax the Lower Esophageal Sphincter
• Alcohol
• Mint
• Chocolates
• High-fat foods
Foods that Do Not Affect the Lower Esophageal Sphincter Pressure
• Protein foods with low-fat content
• Carbohydrate foods with low-fat content
Foods that Can Irritate Damaged Esophageal Mucosa
• Soft drinks
• Citrus fruits and juices
• Coffee
• Herbs Spices
• Tomato products
• Very hot/cold foods

NUTRITION THERAPY FOR DISEASES OF THE LIVER,
GALLBLADDER, AND PANCREAS
The liver, pancreas and gallbladder have an irreplaceable role in the
digestion and absorption of nutrients
in the diet. Problems with them, whether acute or chronic, have a
significant impact on the above functions
of the digestive tract (digestion and absorption). The most common
dietary component we have to pay
attention to with different diets and illnesses of these organs is fats. That
is why doctors often recommend
a reduced fat diet for various lengths of time. If a patient is experiencing
digestion or absorption problems
due to diseases of these organs, and has to stick to a low-fat diet, they
can often start to lose weight.

FRUTY JUICES
Nutritionally incomplete fat-free hypercaloric nutrition with fruit flavour. It is
especially intended for malnutrition or the risk of it in patients with diseases of
the gallbladder, pancreas or liver. It is suitable as part of a reduced-fat diet or
for those with intolerance of dairy forms of nutritional support. It does not
contain gluten or lactose, so it is suitable for lactose intolerance and coeliac
disease.
Food for special medical purposes.
Nutritional values in packaging (330 ml): energy 495 kcal, protein 14.9 g,
fat 0g, carbohydrates 109 g, of
which sugars 16,8 g
• Recommended daily dosage: 1 – 3 bottles for supplementary nutrition

Diet Therapy
1.Protein. The diet should be enriched with foods that are concentrated sources
of protein.
2.Energy. Whenever the protein allowance is increased, the caloric level of the
diet must be sufficient to meet the body’s energy needs.
3.Minerals and Vitamins. Supplements are required only for patients who have
faulty absorption.
4.Moderate Fat. 80-100 g of fat should be provided daily.
5.Hepatitis E produces symptoms similar to hepatitis A although the process can
be fulminant in some patients. A person can get it by drinking water infected with
the virus or through oral-anal contact.

BREAKFAST
Blueberry Oats Bowl
Non-fat dry milk
LUNCH
Stir Fried Vegetables
½ roast chicken
DINNER
Salmon
Potatoes and Corn Salad
Sample meal plan

Cirrhosis
-Chronic degenerative disease in which the build-up of fibrous
connective tissue replaces the liver cells following fatty
degeneration of long standing.
-Can cause the lover cells to die and form new cells
Treatment
 Rest
 Supportive care
 Nutritional therapy

Diet Therapy
1.In severe cirrhosis of the liver, a serious complication of ascites, diets
restricted to 250 mg sodium may be prescribed in an effort to control the
edema.
2.Patients with cirrhosis of the liver are often depleted of protein.
3.It is no longer believed necessary to restrict the amounts of fats in
patients with cirrhosis of the liver.
4.Alcohol is strictly forbidden
Edema is an imbalance in the capillary fluid shift, mechanisms caused
by increased-venous pressure from failing heart, compounded by
aldosterone mechanism and by ADH mechanism.

BREAKFAST
1 slice of toasted bread
Baked beans
1 orange
LUNCH
Cooked meat with tofu
½ cup rice
Coconut water
DINNER
Smoked salmon
½ cup rice
Water
Sample meal plan

Hepatic coma
-Where there is too much ammonia in blood circulation.
-Brain is especially affected and the patient becomes tremulous,
disoriented, confused, and lapses into coma.
Treatment
 Nutritional therapy
Diet Therapy
 High calories about 1,500-2,000 calories.

BREAKFAST
1 Egg
1/2 cup Milk
1 Pancake
Banana
Orange Juice
1 tsp Trans-Free Fat
Syrup
LUNCH
1 oz Roast Beef
1 oz Swiss Cheese
2 slices Bread
2 tsp Mayonnaise
Apple Juice
DINNER
2 oz Sautéed Chicken
1/2 cup Rice
1 Tortilla
1/2 cup Broccoli
Green Salad with Oil & Vinegar Dressing
2 tsp Trans-Free Fat
Grape Juice
Sample meal plan

Assessment Diagnosis Planning Implementation Evaluation
Subjective data: “I am
feeling weak, confuse, and
fatigue lately. Also having
trouble with writing or with
even moving my hands. I
have trouble sleeping and
bowel complications.” As
verbalized by the patient.
“He has been drinking a lot
of alcohol and taking
sleeping pills for about 6
months ago.” The relative
of the patient verbalized.
Objective data: BP:
110/70Temp: 35.9°CPR:
108 beats per
minuteElevated ammonia
levelsTremors Patient diet
and eating habit/s:Patient
always eat protein such as
red meat and poultry
almost every meal of the
day.Dependent on alcohol
for 6 monthsTakes
sleeping pills to aid in
sleeping.
Patient experiences
confusion, weakness, and
fatigue with trouble
sleeping and in bowel
movement.Active drinking
lifestyle with high-protein
diet
After 2 days of nursing
intervention, the patient
will:Demonstrate improved
motor functionShow
normal mental state or
consciousnessInitiate
change in lifestyle and
eating habits
Give medications
(lactulose) as indicated by
the physicianMonitor
changes in LOC with neuro
examsCheck respiratory
statusMonitor handwriting
as it can be worse with
increased ammonia
levelsDaily protein intake
should be 1.2 to 1.5 g/kg
ideal body weightSmall
meals evenly distributed
throughout the
dayEncourage a diet rich in
vegetableAvoid high intake
of high-protein
meals.Encourage patient
to consume a fiber-rich diet
to promote fecal ammonia
excretion and prevent
diarrhea in patients who
already take
lactuloseConsult a
nutritionist and the
nutritional support team to
prepare a diet to the
required patient’s diet
Goals meet:Patient
demonstrate modifications
on lifestyle and eating
habits to return and
maintain normal
status.Restore proper brain
function of the patient

GALLBLADDER
Cholecystitis
- Inflammation of the gallbladder which might result from either the
formation of gallstones blocking the cystic duct or infection of the
gallbladder.
- Common among people consuming high fat and calories.
- Choledolithias develops when stones fall into the common bile duct.
Two Types of Stones
1. Cholesterol stones
2. Pigment gallstones

• Treatment
• Nutritional therapy
• Reduced discomfort
• Diet Therapy
• 1. Low-fat diet
• 2. Plain and simple foods arerecommended
• 3. Spices and high-residue foods must be
avoided

Foods restricted
o Whole milk, cream, ice cream
o Whole milk, cheese, fatty meats, fish, and poultry
o Chocolates, fried foods, gravies, cooking fats, lard
o Most baked foods
Foods limited
o Lean meat
o Egg yolk
o Butter, margarine, salad dressings
Food Preparation
a.Meat should be lean. All visible fats must be trimmed off.
b.Vegetables cannot be dressed with butter, margarine, or sauces.
c.Vegetables and fruit salads may be included, but only lemon juice,
vinegar, or low-calorie, fat-free dressings should be used.

BREAKFAST
2 slices of toasted bread
Low-fat cheese
Fresh fruits
Orange juice
LUNCH
Grilled lean pork
½ cup rice
Fresh pineapple juice
DINNER
Broiled chicken
Baked vegetables
Fresh apple juice
Sample meal plan

PANCREAS
Pancreatitis
- Inflammation of the pancreas due to a decreased production
of the digestive enzymes.
- May also result from biliary tract disease and surgery, alcohol
abuse, and gallbladder disease.
Two Types of Pancreatitis
1. Acute
2. Chronic

Treatment
o Depends on the severity of pancreatitis itself
Diet Therapy
1. NPO for 48 hours for acute attacks
2. Low-fat, low-elemental formulas when enteral feeding is
appropriate.
3. For chronic cases, a low to moderate fat, high CHO, and
moderate protein diet for chronic cases
4. Fluids and electrolytes given intravenously
5. Six feedings daily to facilitate adequate nutritional intake.

Assessment Diagnosis Planning Implementation Evaluation
Subjective data:“I am
experiencing
abdominal pain, fever,
and vomiting for the
past 5 days.” The
patient verbally said.
Objective data:BP:
80/50Temp:
37.5°CPR: 105 beats
per minuteRR: 21
breaths per
minuteCyanosisMild
dehydrationAbdominal
tenderness Patient
diet and eating
habit/s:Alcohol
dependencyFrequent
intake of fried food,
processed food, junk
foods, and full-fat
dairy.
Patient experiences
pain and discomfort
Patient has
imbalanced
nutritionIneffective
breathing pattern
related to severe
painLack of appetite
due to impaired
digestion from
inflammation in the
pancreas.
After 5 days of nursing
intervention, the
patient will be able
to:be relieved from
pain and
discomfortchange and
maintain a new
lifestyle and eating
habitsbring back its
normal
breathingrecover his
appetite
Promote adequate
nutrition.Assess
nutritional status;
monitor glucose
levels; monitor IV
therapy, provide a
high-carbohydrate,
low-protein, low-fat
diet when tolerate; and
instruct the client to
avoid spicy
foods.Maintain optimal
respiratory
status.Place the client
in semi-Fowler’s
position to decrease
pressure on the
diaphragm.Teach the
client coughing and
deep-breathing
techniques
Goals meet:Patient
will restore the health
of its pancreasPatient
demonstrates the
change in lifestyle and
nutritional diets.

BREAKFAST
2 slices of toasted bread
Low-fat cheese
Low-fat frozen yogurt
LUNCH
½ cup rice
DINNER
Cooked lean beef
Mixed fruits
Water
Sample meal plan
LUNCH
Grilled chicken breasts
Baked vegetables
Apple juice

Cystic fibrosis
- Hereditary disease in which the levels of sodium and chloride
in tears and saliva, electrolytes in sweat, and viscous
secretions in the small intestine. pancreas, bile ducts, and
bronchi become high.
- Lungs and the digestive system are mainly affected resulting
to progressive disability.
Life expectancy: 30-40 years

Treatment
Improvement of nutritional status
Diet Therapy
1. Calories enough to supply demands for growth.
2. High-protein diet
3. Liberal fat intake for calories.
4. Vitamins and minerals
5. Liberal fluid intake

BREAKFAST
Scrambled egg
½ cup rice
1 glass of whole milk
Banana
LUNCH
½ cup rice
DINNER
Fried chicken in avocado oil
Fruit smoothie
Sample meal plan
LUNCH
Steak
Baked potatoes
Milkshake

NUTRITION THERAPY FOR CARDIOVASCULAR DISEASES
Atherosclerosis
- Hardening of the arteries
- Thickening of the inside walls of the blood vessels
- Caused by accumulation of fatty materials
- Most common cause of heart attacks

Most susceptible to atherosclerosis:
1. Male: ages 45 and 64 years
2. Overweight persons
3. Diabetics
4. Persons with high blood pressure
5. Persons consuming a diet high in saturated fat
6. Persons with high cholesterol levels
7. Persons whose family has a history of heart and blood vessel diseases
8. Sedentary individuals
9. Persons who have much tension, frustration, and stress
10. Heavy smoker

Treatment
o Drugs
o Diet
Diet Therapy
1. Low-fat diet, low saturated fat and cholesterol
2. Increase in monounsaturated fatty acids to lower plasma total cholesterol and
LDL cholesterol levels
3. Increase in polyunsaturate fats, the omege-6 and omega-3 fatty acids at least
2 servings per week to decrease plasma cholesterol levels
4. A total of 300 ng cholesterol intake per day
5. Increase in complex carbohydrate intake and restriction of simple sugars
6. Dietary fiber: 25-30 g/day
7. Restriction of calories to 1,200-1,600 for women and 2,000-2,500 for men.

BREAKFAST
Oatmeal with berries
Low-fat milk
Orange juice
LUNCH
½ cup rice
DINNER
Baked tuna
Avocado salad
Grapes
Water
Sample meal plan
LUNCH
Lean ground pork with tofu
Baked beans
Mixed fresh fruits

Congestive heart failure (CHF)
- Cardiac failure
- Circulatory congestion resulting in the heart's inability to
maintain adequate blood supply to meet the oxygen demands
- Characteristics: dyspnea and abnormal fluid retention

Diet Therapy
1. Sodium-restricted diet for prevention, control, and elimination of edema.
a. Mild restriction: 2-3 g Na
b. Moderate restriction: 1,000 mg Na
c. Strict restriction: 500 mg Na
d. Severe restriction: 250 mg Na
2. Calorie control is applied to reduce the work of the heart.
3. Texture control is applied in acute stages
4. Caffeine should be limited

BREAKFAST
2 hard boiled eggs
1 cup brown rice
Low-fat milk
LUNCH
½ cup rice
DINNER
Baked salmon
Legumes
Pineapple juice
Sample meal plan
LUNCH
Grilled chicken breast
½ cup rice
Orange juice

Hypertension
- High blood pressure
- Common among males rather than females with ages 55
years and below
Treatment
o Lifestyle modifications
o Nutritional therapy
Diet Therapy
1.Mild restriction of sodium
2.Weight reduction may facilitate the lowering of blood pressure.
3.Low-fat diet with emphasis on unsaturated oils is
recommended.

BREAKFAST
Oatmeal
DINNER
Bibimbap
Sample meal plan
LUNCH
Canned tuna (in oil or water)
Salad

Myocardial infarction (MI)
- Heart attack
- Results from atherosclerosis of the coronary arteries
Treatment
o Reduced workload of the heart
Diet Therapy
1. Liquid diet on the initial stages and as the condition improves,
progresses to foods of regular consistency.
2. Small, frequent meals
3. Restriction on caffeine-containing beverages
4. Sodium, cholesterol, fat, and calorie restriction
5. Consumption of omega-3 fatty acid-rich foods to reduce blood clots

BREAKFAST
Greek yogurt with
strawberries and chia
seeds
DINNER
Tuna salad with greens and
olive oil, as well as a fruit salad
Sample meal plan
LUNCH
Grilled chicken with vegetables,
sweet potato fries, and fresh fruit

Nutrition therapy for diseases of the kidney
Kidney is one of the most important
organs in our body that helps purify our
blood and flush out the toxins. A kidney
failure leads to serious problems. In the
initial stages, medication and diet may be
a solution. However, as the condition
worsens, it becomes important to seek
serious medical advice and may involve
taking dialysis or kidney replacement.

Lifestyle changes to prevent/control kidney failure
The following lifestyle measures are usually recommended for people with kidney
disease:
● stop smoking if you smoke
● eat a healthy balanced diet
● restrict your salt intake to less than 6g a day – that's around 1 teaspoon
● do regular exercise – aim to do at least 150 minutes a week
● manage your alcohol intake so you drink no more than the recommended limit
of
14 units of alcohol a week
● lose weight if you're overweight or obese
● avoid over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen, except when advised to by a medical professional – these medicines
can harm your kidneys if you have kidney disease

Acute glomerulonephritis
Acute glomerulonephritis may be caused by infections such as strep throat. It may
also be caused by other illnesses, including lupus, Goodpasture's syndrome, Wegener's
disease, and polyarteritis nodosa. Early diagnosis and prompt treatment are important
to prevent kidney failure.
Treatment
Treatment depends on what caused the glomerulonephritis and the damage done to
thekidney filters. A mild case may not need any treatment. At other times, your
healthcareprovider may recommend:
● Changes to your diet so that you eat less protein, salt and potassium.
● Corticosteroids such as prednisone.
● Dialysis, which helps clean the blood, remove extra fluid and control blood

● Diuretics (water pills) to reduce swelling.
● Immunosuppressants, if a problem with the immune system causes
glomerulonephritis.
● Medicine to lower your blood pressure, such as angiotensin-
converting enzyme
(ACE) inhibitors or angiotensin II receptor blockers.
● Plasmapheresis, a special process that filters protein from the blood.

Can I prevent glomerulonephritis?
There is no proven way to prevent glomerulonephritis, though some practices and
proper diet may help such as:
● Eat healthy, unprocessed food.
● Manage high blood pressure with a low salt diet, exercise and medication.
● See a healthcare provider whenever you think you have an infection like strep
throat.
● A person might need to drink less fluids than usual and eat a diet that's low in
protein, salt, and potassium.

Nephrotic syndrome
Nephrotic syndrome is a collection of symptoms that indicate kidney damage.
Nephrotic syndrome results from a problem with the kidneys’ filters, called
glomeruli.Glomeruli are tiny blood vessels in the kidneys that remove wastes and excess
fluids from the blood and send them to the bladder as urine.
Treatment
Treating nephrotic syndrome includes addressing the underlying cause as well as
takingsteps to reduce high blood pressure, edema, high cholesterol, and the risks of
infection.Treatment usually includes medications and changes in diet.
Eating, Diet, and Nutrition
Eating, diet, and nutrition have not been shown to play a role in causing or
preventingnephrotic syndrome in adults. For people who have developed nephrotic
syndrome,limiting intake of dietary sodium, often from salt, and fluid may be
recommended to helpreduce edema. A diet low in saturated fat and cholesterol may
also be recommended tohelp control hyperlipidemia.

Breakfast 2 slices of bread with peanut butter1
fresh apple1 glass of almond milk
Lunch ½ cup cooked rice1 oz cooked fishGlass
of water
Snacks Unsalted popcorn, potato chips or
nutsBanana smoothie
Dinner 1 cup of riceLow-sodium canned tuna or
salmonDried beans and peas1 pint of
water

Assessment Diagnosis Planning Implementation Rationale Evaluation
Subjective data:
“Namamaga ang
binti at mukha ko,
kakaunti din ang
lumalabas tuwing
iihi ako” as
verbalized by the
patient Objective
data: Edema on
legs and face 30 ml
urine output for the
last 8 hours Height:
5 feet 3 inch
Weight: 150lb Vital
signs TEMP: 36.9
°C BP: 140/90
mmHg PR: 87 bpm
RR: 19 bpm
Excess Fluid
Volume
Related
Factors
Compromise
regulatory
mechanisms
Immunologica l
injury
Evidenced by
Oliguria
Changes in
urine-specific
gravity Venous
distention; BP
and CVP
changes
Peripheral or
periorbital
edema
Changes in
mental status,
confusion
Abnormal
breath sounds
Decreased
hematocrit and
hemoglobin
After nursing
intervention the
patient will
demonstrate
compliance with
dietary and fluid
restriction The
patient will be
able to identify
the suitable
meal plan for
her/him
Measure intake and output
accurately and document.
Monitor the client's vital
signs Weigh the client daily
at the same time of the day,
on the same scale, with the
same equipment and
amount of clothing. Plan
oral fluid replacement with
the client, within multiple
restrictions. Encourage
protein-rich foods and
rescue sodium intake
Educate the client about
smoking cessation
A decreased urine output of less than 400 mL/24
hours may be the first indicator of impending renal
failure, especially in a high-risk client. Accurate
I&O is necessary for determining fluid replacement
needs and reducing the risk of fluid overload.
Tachycardia and hypertension can result from
kidney failure and alterations in the
reninangiotensin system, which helps regulate
long-term blood pressure and blood volume. Daily
body weight is one of the best monitors of fluid
status. A weight gain of more than 0.5 kg/day
suggests fluid Retention Allow the client to choose
from a variety of beverages, including hot, cold,
and frozen options. This may assist to avoid times
of dehydration, eliminates the routine of limited
options, and lessens feelings of deprivation and
thirst.. Restricting salt intake and protein intake
may reduce the amount of protein lost in the urine,
but most clients who are losing large amounts of
protein actually need more protein. For
progressive disease, dietary restrictions of 2g
sodium, 2gpotassium, and 40 to 60g protein a day
help reduce the build-up of wastes and prevent
fluid overload states.. Cessation of smoking is also
paramount in decreasing the aggravation of renal
disease.
After the
Implementation
n of nursing
interventions, the
client is
expected to:
1.Display
appropriate
urinary output
with normal
specific gravity.
2.Demonstrate
stable weight
and vital signs
within the normal
range. 3.Be free
of edema..

Acute renal failure (ARF)
Acute renal failure (ARF) - sudden decline of kidney function
Treatment
Treatment for acute kidney failure typically requires a hospital stay. Most people
with acute kidney failure are already hospitalized. Methods of treatment include
dialysis, which is often administered for a few days or weeks before the kidneys
again function on their own, or medication. In severe cases, a kidney transplant
may be necessary. How longyou'll stay in the hospital depends on the reason for
your acute kidney failure and how
quickly your kidneys recover.
In some cases, some may be able to recover at home

Lifestyle and home remedies
During your recovery from acute kidney failure, your doctor may recommend a special
diet to help support your kidneys and limit the work they must do. Your doctor may
referyou to a dietitian who can analyze your current diet and suggest ways to make
your dieteasier on your kidneys.
Depending on your situation, your dietitian may recommend that you:
● Choose lower potassium foods. Your dietitian may recommend that you choose
lower potassium foods. High-potassium foods such as bananas,oranges, potatoes,
spinach and tomatoes should be avoided. Examples oflow-potassium foods that you
can consume include apples, cauliflower,peppers, grapes and strawberries.

● Avoid products with added salt. Lower the amount of sodium you eat each
day by avoiding products with added salt, including many convenience foods,
such as frozen dinners, canned soups and fast foods. Other foods with added
salt include salty snack foods, canned vegetables, and processed meats and
cheeses.
● Limit phosphorus. Phosphorus is a mineral found in foods, such as whole-
grain bread, oatmeal, bran cereals, dark-colored colas, nuts and peanut
butter. Too much phosphorus in your blood can weaken your bones and cause
skin itchiness. Your dietitian can give you specific recommendations on
phosphorus and how to limit it in your particular situation.
As your kidneys recover, you may no longer need to eat a special diet given by
your dietitian, although healthy eating remains important.

Chronic renal failure (CRF)
* Chronic renal failure (CRF) - decline of kidney function
Treatment
There's no cure for chronic kidney disease (CKD), but treatment can help
relieve the symptoms and stop it getting worse.
Your treatment will depend on the stage of your CKD.
The main treatments are:
● lifestyle changes – to help you stay as healthy as possible
● medicine – to control associated problems, such as high blood pressure
andhigh cholesterol
● dialysis – treatment to replicate some of the kidney's functions, which
maybe necessary in advanced (stage 5) CKD
● kidney transplant – this may also be necessary in advanced (stage 5) CKD

Diet
• You may need to make changes to your diet when you have chronic kidney
disease(CKD). These changes may include limiting fluids, eating a low-
protein diet, limiting salt,potassium, phosphorus, and other electrolytes,
and getting enough calories if you arelosing weight.
• You may need to alter your diet more if your kidney disease gets worse, or
if you need dialysis.
Why do we need to follow this diet?
• The purpose of this diet is to keep the levels of electrolytes, minerals, and
fluid in your body balanced when you have CKD or are on dialysis
• People on dialysis need this special diet to limit the buildup of waste
products in thebody. Limiting fluids between dialysis treatments is very
important because most people on dialysis urinate very little. Without
urination, fluid will build up in the body and cause too much fluid in the
heart and lungs.

Breakfast 1 cup of rice2 ounces of meat½
cup of low-fat milk
Lunch ½ cup of rice2 ounces of fish1/2
cup serving green cabbageGlass
of water
Snacks 1 cornFat-free yogurt
Dinner 1 cup of rice2 ounces of
chickenCarrot soupGlass of water

Renal calculi (urolithiasis)
Renal calculi (urolithiasis) also known as kidney stone- are hard
deposits made of minerals and salts that form inside your kidneys.
Treatment
The treatment for kidney stones is similar in children and adults. You
may be asked todrink a lot of water. Doctors try to let the stone pass
without surgery. You may also getmedication to help make your urine
less acidic. But if it is too large, or if it blocks the flow of urine, or if
there is a sign of infection, it is removed with surgery

Breakfast Vegetable sandwichQuarter slice of ripe
papayaGlass of milk
Lunch ½ cup of rice1 serving of salmon½ cup of
broccoli Glass of water
Snacks Half slice of appleGlass of lemon juice
Dinner 1 cup of rice2 ounces of fish½ cup of
green peasGlass of water

What is the most important factor to prevent kidney stone formation?
One of the best things you can do to avoid kidney stones is to drink plenty of
water every day. This will help make sure that you urinate frequently to avoid any
build up of calcium or uric acid.Don't underestimate your sweat! Saunas, hot yoga
and heavy exercise may sound goodfor your health, but they also may lead to
kidney stones. Why? Loss of water throughsweating whether due to these
activities or just the heat of summer may lead to lessurine production. The more
you sweat, the less you will urinate, which allowsstone-causing minerals to settle
and deposit in the kidneys and urinary tract.Hydrate with water. Be sure to keep
well hydrated, especially when doing exercise oractivities that cause a lot of
sweating. You should drink 2-3 quarts of liquid or 8-12 cupsper day to produce a
good amount of urine. Speak with a healthcare professional aboutthe right
amount of water that's best for you. Try to avoid sodas (especially those with
high amounts of fructose), sweetened iced tea and grapefruit juice.

Kidney stones are solid crystals formed from the salts in
urine. They are sometimes called renal calculi. Kidney
stones can block the flow of urine and cause infection,
kidney damage or even kidney failure.
NUTRITIONAL THERAPHY: Follow a healthy diet plan
that has mostly vegetables and fruits, whole grains, and
low-fat dairy products. Limit sugar-sweetened foods and
drinks, especially those that have high fructose corn syrup.
Limit alcohol because it can increase uric acid levels in the
blood and avoid short term diets for the same reason.

Assessment Diagnosis Planning Implementation Rationale Evaluation
Subjective data:
“Madalas po
akong mahilo at
manghina,
namamaga din
po ang binti ko”
as verbalized by
the patient
Objective data:
Edema 50 ml
urine output for
the last 8 hours
Height: 5 feet 3
inch Weight:
150lb Vital signs
TEMP: 36.9 °C
BP: 140/90
mmHg PR: 87
bpm RR: 19
bpm
Ineffective renal
tissue Per fusion
related
glomerular
malfunction to
secondary to
acute renal
failure as
evidenced by
increase in lab
results (BUN,
creatinine, uric
acid, eGFR
levels), oliguria,
peripheral
edema,
hypertension,
muscle twitching
and cramping,
fatigue, and
weakness
Nursing goal of
treating
patients with
acute renal
failure is to
correct or
eliminate any
reversible
causes of
kidney failure.
Provide
support by
taking accurate
measurements
of intake and
output,
including all
body fluids,
monitor vital
signs and
maintain
proper
electrolyte
balance.
Assess and
monitor vital signs
Perform the
necessary renal
function blood
tests as ordered.
Monitor
electrolytes,
particularly
potassium level
Administer
medication as
prescribed.
Encourage the
patient to have a
low potassium,
low phosphorus,
and low salt diet.
Start a food chart.
To establish baseline data. To monitor the
patient's blood pressure level as
hypertension can worsen kidney damage.
To monitor renal function. The kidney may
not be able to filter potassium in the blood
in a patient with ARF. This may result in
hyperkalemia or high serum potassium
levels. ARF is reversible. It can be treated
by underlying causes, signs and
symptoms. The kidneys may not be able
to filter potassium in the blood in a patient
with ARF. A low potassium diet can give
the kidneys rest and prevent further
deterioration of renal perfusion and
function. On the other hand, too much
phosphorus can weaken the bones, so a
low phosphorus intake is advised. Too
much salt may lead to fluid retention. Food
charting can help monitor dietary protein
and caloric intake. To enable the patient
to have specialized advice on renal diet
while incorporating his/her food
preferences. To reduce peripheral edema
and to manage obesity, hypertension,
fatigue, and weakness.
The client/patient
will actively
participate inthe
treatment plan
and will be able to
demonstrate
behaviors that will
help prevent
complications. .

NUTRITION THERAPY FOR CANCERS
CANCER is a disease in which some of the body’s cells grow
uncontrollably and spread to other parts of the body. Cancer
can start almost anywhere in the human body, which is made up
of trillions of cells. Normally, human cells grow and multiply
(through a process called cell division) to form new cells as the
body needs them. When cells grow old or become damaged,
they die, and new cells take their place.

Carcinogenesis
The process by which normal, healthy cells transform into cancer cells is
termed carcinogenesis or oncogenesis. The development of a malignant tumor
in otherwise healthy tissue is the result of a complex series of events beginning
with a single cell that has acquired malignant properties through cellular DNA
damage..
CARCINOGENS
are defined as agents capable of initiating the development of malignant
tumors by inducing cellular genetic changes. The transformation of a normal
cell to a malignant cell is thought to be due to successive and cumulative
exposures to carcinogens and other factors over the course of decades.

TYPE OF CANCER
1. CARCINOMA- is cancer that forms in epithelial tissue. Epithelial tissue lines most
of your organs, the internal passageways in your body (like your esophagus),
and your skin. Most cancers affecting your skin, breasts, kidney, liver, lungs,
pancreas, prostate gland, head and neck are carcinomas.
2. SARCOMA- is the general term for a broad group of cancers that begin in the
bones and in the soft (also called connective) tissues (soft tissue sarcoma). Soft
tissue sarcoma forms in the tissues that connect, support and surround other
body structures.
3. LYMPHOMA- types of cancer that begin in the lymphatic system (the various
lymph glands around the body) when abnormal white blood cells grow.
Lymphomas are the sixth most common form of cancer overall (excluding non-
melanoma skin cancer).

Nutritional Management
1.Oral Nutrition
a. High-calorie, high-protein beverages may be offered.
b. In case of lactase deficiency, Lactaid® may be given.
2.Tube Feedings
a. Complete products-meal replacements that require digestion and absorption
b. Chemically-defined products – minimal or no digestion; for pancreatic cancer
patients
C. Modular products – used in combination with other tube feeding products to
enhance calorie or protein intake
d. Specialty products – vary in terms of specific amino acid, carbohydrate, and fat
content; for patients with hepatic or renal failure
3. Total Parenteral Nutrition
a. Used when the digestive tract is not functioning
b. Nutrients administered intravascularly

BREAKFAST LUNCH SNACK DINNER DESSERT
ORANGE PISTACHIO
QUINOA
GREEN
SALAD WITH
ASSORTED
VEGGIES,
AND
COOKED
SALMON
SEASONAL
SMOOTHIE
STIR-FRIED
BABY BOK
CHOY WITH
MUSHROOM
S
APPLE CONFIT WITH
TOPPED WALNUTS
MEAL FOR 24 HOURS

NUTRITION THERAPY FOR ACQUIRED IMMUNE
DEFICIENCY SYNDROME (AIDS)
THE DEFINITION OF AIDS
Acquired immune deficiency syndrome (AIDS) is the name used to
describe a number of potentially life-threatening infections
and illnesses that happen when your immune system has
been severely damaged by the HIV virus. While AIDS cannot
be transmitted from 1 person to another, the HIV virus can.

AN INFECTED PERSON CAN TRANSMIT THE VIRUS THROUGH
FROM:
a. Sexual intercourse
b. Blood transfusion
c. Sharing contaminated needles
d. Mother to child during pregnancy, child birth, or breastfeeding[
It cannot spread by mere kissing, coughing, sneezing and touching.

Nutritional Management
1. Dietary Management
a. Energy – 35 to 45 kcal/kg BW
b. Protein – 2 to 2.5 g/kg BW
c. Fats – increase omega-3 sources and decrease saturated fats
in the diet
d. Vitamins and minerals – an increase to be recommended in
case of altered metabolism
2. Alternative Management
a. Common in patients with chronic or terminal illness
b. May range from vitamin and mineral supplementations

DOES AIDS PATIENTS HAVE MEAL PLAN?
There’s no specific eating plan for people with HIV, but an overall healthy diet
can help your health a lot.
Follow this simple tips:
1. Eat a lot of fruits and vegetables. since they are rich in nutrients called
antioxidants that help to maintain a healthy immune system. Five to nine
servings of produce should be consumed every day. Filling half of your plate
with fruits and vegetables at each meal is a simple approach
to achieve this objective. To receive the most vitamins and minerals, eat a
variety of fruits and vegetables.
2. Choose lean proteins. It helps your body create muscle and a strong
immune system. Lean beef, chicken, fish, eggs, beans, and nuts are all good
choices.
If you are underweight or have advanced HIV, you might need to eat more
protein. The ideal dosage for you can be determined with the advice of your
doctor.

3. Choose whole grains. Like gas in a car, carbs give your body energy.That makes
whole-grain carbs, like brown rice and whole wheat bread, high-end fuel.
They're packed with energy-boosting B vitamins and fiber. And when you eat plenty
of fiber, that can lower your chances of getting fat deposits called lipodystrophy, a
potential side effect of HIV.
4. Limit your sugar and salt. Whether because of the virus or the treatment drugs
you’re taking, HIV raises your chances of getting heart disease. Too much sugar and
salt can harm your ticker. So
aim to get less than 10% of your calories each day from foods and drinks with added
sugar. You should also have no more than 2,300 milligrams of sodium per day.
5. Have healthy fatsin moderation. Fat provides energy, but it’s also high in calories.
If you’re not trying to gain weight, limit how much of it you eat. Heart-healthy
choices include nuts, vegetable oils, and avocado.

Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially
life-threatening condition caused by the human immunodeficiency virus
(HIV). By damaging your immune system, HIV interferes with your
body's ability to fight infection and disease
NUTRITION THERAPY: For all AIDS patients who experience
unexplained weight loss, calorie counts should be obtained, and
appetite stimulants and oral supplements are also appropriate.

ROLE OF NUTRITION ON SOFT AND HARD DENTAL TISSUES
Maintenance of Healthy Periodontal Tissues
After birth, nutritional quality affects tissue synthesis as nutrients work to maintain and
repair periodontal tissues when essential.
Healthy oral tissue is the best protection against microbe invasion. Some nutrients
influence the process of maintaining and repairing periodontal structures more than
others. Some have a singular benefit while others offer multiple advantages. Their joint
effort affects soft and hard periodontal tissues, host susceptibility, immune response,
and wound healing.
In a human being's lifetime, optimal oral health depends on adequate quantities of
vitamins A, B-complex, C, D, and E; proteins; calcium, phosphorus, and magnesium;
iron; zine; copper and some lipids, such as omega-3 fatty acids

•Lipids perform a key role in one's general health status (energy, obesity, diabetes, and
hypertension) and have slight implications for the control of one's oral health status.
Lipids include triglycerides, phospholipids, sterols, and lipoproteins. Fat provides a
protective layer on teeth and prevents biofilm adherence. Some fatty acids have
antibacterial properties. Low levels of omega-3 fatty acids correlate with a risk for
periodontitis. Clinicians should observe caution in recommending fat intake, as excess
is implicated in several chronic diseases.
• Protein is responsible for repair and maintenance of body tissues. Amino acids repair
tissues and form antibodies to help resist infection. Protein deficiencies can influence
the synthesis of new tissue, as key amino acids are important for maintenance and
healing. Unacceptable amounts of protein in the diet increases vulnerability to
infection, slows wound healing, and causes deterioration of periodontal connective
tissues. Excess protein can decrease calcium retention and influence bone health.
People with plant-based diets need to pay special consideration to acquiring sufficient
amounts of protein in their diets. Vitamin C is present in large amounts in neutrophils,
so when protein intake is insufficient, this can also reduce the availability of vitamin C.

• Vitamin A in adequate amounts helps sustain immune function and the integrity of sulcular epithelium,
assists with bone remodeling, and keeps the salivary glands working efficiently. An early sign of this
vitamin deficiency is a decrease in the rate of epithelial cell differentiation. Deficiencies throughout life
may cause salivary glandatrophy, hyperkeratinization of some oral structures, compromised periodontal
tissue healing, or carotene coloration. Excess vitamin A can result in increased catabolism of collagen and
bone.
• Vitamin D in constant amounts is important throughout life since calcified tissues remodel. Vitamin D is
vital to general health because it controls the presence of calcium, magnesium, and phosphorus in blood
plasma. The danger of vitamin D deficiency increases with age, lack of exposure to sunlight, and poor
eating habits. Osteomalacia, osteopenia, osteoporosis, lamina dura and cementum loss, and an even
bigger risk of developing some cancers can be the result of such deficiency. Excessive vitamin D can cause
irreversible kidney and cardiovascular tissue damage. Vitamin D and calcium levels have been linked to
periodontal problems due to their role in bone homeostasis, including attachment and bone and tooth
loss. However, it is possible for depleted bone structures to reconstruct with vitamin D supplementation.
• Vitamin E is a group of 10 lipid-soluble compounds that include tocopherols and tocotrienols. Vitamin E
functions as an antioxidant and protects red blood cells. Insufficient vitamin E is rare but can manifest as
hemolytic anemia. Excess amounts of vitamin E in the body can create a vitamin K deficiency, obstruction
with anticoagulant drugs, and bleeding problems.

•Vitamin K functions as a cofactor (enzyme partner) for the synthesis of prothrombin. Prothrombin is essential
for blood clotting and is produced by some intestinal bacteria. Deficiencies are caused by conditions that
decrease fat absorption or by antimicrobial medications that alter intestinal flora. Symptoms include delayed
bleeding and clotting time. High doses of vitamin K interfere with anticoagulants, which could result in
hemorrhage.
• Vitamin B-complex is a group of coenzymes. These coenzymes work together to sustain healthy oral tissues
by forming new cells and preserving the immune system. The risk of a vitamin B-complex deficiency increases
with age, ingestion of certain medications (phenytoin and methotrexate), eating disorders, addictions, and in
vegans, such deficiency can result in increased oral tissue sensitivity, burning mouth syndrome, loss of taste,
angular cheilosis, pernicious anemia, gingivitis, and frequent oral lesions..
•Vitamin C assists with collagen and connective tissue formation. It aids with blood vessel integrity,
phagocytosis, and wound healing. It is also a strong antioxidant that facilitates calcium and iron absorption and
protects vitamins A and E. Low levels of vitamin C produce an increased intracellular permeability of blood
vessels and the sulcular epithelium, allowing microbial penetration into deeper structures. The first symptom of
vitamin C deficiency is often exhibited as gingivitis. Enlarged, magenta, hemorrhagic gingiva along with a
widened periodontal ligament is the result. Low levels of vitamin C increase the risk of developing periodontal
disease. Insufficient vitamin C intake combined with smoking can result in grave consequence on periodontal
tissues. Smokers have greater metabolic turnover rate for vitamin C. Excessive vitamin C in the diet can obstruct
anticoagulants.

• Calcium, magnesium, and phosphorus in the diet can affect absorption and
create aggressive bone resorption It also increases the risk of tooth mobility,
premature tooth loss, and hemorrhage. Reduced dietary intake of calcium results in
more severe periodontal disease and low dietary intake is a risk factor for
periodontal disease. Hypercalcemia, excess magnesium, and excess phosphorus are
almost unknown.
• Iron can lead to angular cheilosis, pallor, burning mouth syndrome, glossitis, and
atrophy or denudation of the filiform papillae, and candidiasis as a result of lowered
immune function. Excessive iron is rare, as most individuals regulate the absorption
of iron well.

• Zinc is an essential mineral needed for wound healing and new tissue
healing. Zinc works along with iron and copper for wound healing.
Malnourished individuals run the risk of having low zinc levels. Zinc levels
are naturally suppressed during infection. Zinc deficiencies quickly
weaken immunity and reduce antibody activity. Even a modest
insufficiency of zinc can lead to increased opportunistic infections.
Immune status is closely linked to zinc status--an important mineral to
control periodontal disease. Zinc toxicity is uncommon.
• Copper is an important mineral, involved in both collagen and elastin
formation and regeneration. A copper deficiency causes considerable
decrease in the tensile strength of collagen. This produces bone lesions,
malformed joints, bone fragility, and vascular lesions.

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