Athletes And Invalids

THIS book is concerned with the diet for normal adults and some who are not so normal - fat people, coronary patients, and those special candidates for coronary heart disease who have high blood cholesterol values. But what about athletes and invalids and sick people other than coronary patients?

Invalids And Non-Coronary Patients

Sick people should have the dietary advice of a physician who considers their individual peculiarities, but a diet low in saturated fats, and with total fats within the bounds of moderation, is suitable for most patients. The diet advisable for a particular patient may be soft or liquid or free of purines (compounds found particularly in glandular meats such as sweetbreads) or low in residue; the selection of foods and the methods of preparation can be tailored to the patient and still keep to the pattern of no more than 30 per cent of calories from fats, less than 10 per cent from saturated fats.

In most diets prescribed for patients who are not in hospitals, little attention is paid to total fat and still less to the fatty acids in the diet. Restriction of dietary fat is most often recommended if fat is mentioned at all. A really low fat diet is advised for patients with pancreatitis and gallbladder disease. The same was true until recently in practically all kinds of liver disease. The current trend puts more emphasis on abundant proteins and carbohydrates for liver patients; doctors do not advise high fat diets for such patients. Low fat diets are usually advised for patients with gout.

Hospital diets are, of course, more carefully prescribed, but, again, little attention is paid to the type of fat in the diet. It is interesting to make computations on hospital diets. Usually when a high protein diet is prescribed it also turns out to be a high fat diet, not because the doctor wants a fatty diet, but because forcing proteins with large amounts of meat, milk, and eggs usually provides more fat than protein calories.

In three important conditions the use of high fat diets is, or used to be, commonly advised: emaciation and wasting illnesses, tuberculosis, and peptic (stomach or duodenal) ulcer. In addition, we should say something about diabetes and epilepsy. The only one of these conditions where a high fat diet is clearly necessary is that of the emaciated patient who finds it difficult to eat enough calories.

Emaciation and Inability to Eat For emaciated patients fat is nutritionally desirable simply as a concentrated source of calories. This explains the old custom of feeding these patients much cream, butter, and eggs, that is, soft foods high in calories and agreeable in flavour. In feeding patients who have no appetite or who swallow with difficulty, the diet is dictated by expediency - what the patient will accept and tolerate. Good nursing is an essential part of the dietary prescription. Vegetable oils for such patients have been little tried except recently in emulsions which can be fed by tube or injected intravenously; these evoke enthusiastic reports from doctors treating cancer patients, persons who have been severely burned, and all sorts of surgical patients.

Ulcer Patients

The Sippy diet, proposed in 1915, was long a favourite for ulcer patients. The idea was to counteract the acidity in the stomach by keeping it more or less constantly filled, or coated, with a soft food. So half cream–half milk was given every hour except during sleep, and frequent feedings were given of soft-boiled eggs, cooked cereal with cream, and cream soups. The Sippy diet is less frequently used now because gastric acidity can be effectively controlled in other ways and surgery takes care of many patients formerly doomed to living on cream and milk. A glass of milk between meals is still often advised for ulcer patients; we see no objection to this; we do question the wisdom of drinking cream.

But what about patients managed by the old-fashioned Sippy regimen - are their arteries damaged by the high intake of saturated fat? Several follow-up studies report that these patients are, indeed, unduly prone to die of coronary heart disease, but more critical studies are needed.

Tuberculosis

Tuberculosis traditionally is associated with emaciation, and emphasis in treatment used to be on "feeding up" the patient. The modern view is that treatment of the disease itself is much more important; as the tuberculosis itself improves, appetite picks up and the nutritional state tends to be remedied spontaneously. There is no indication that a high fat diet is desirable to combat the tubercular process. Tuberculosis patients are often fed a diet high in saturated fats simply because that is an easy way to offer calories which will be taken easily. Eggnogs, ice cream, and the like are convenient, but the equivalent of these can be supplied with other ingredients.

As in emaciation in general, the use of vegetable oils in the diet for tuberculosis patients should be considered. Excellent "milk shakes" are easily made by high-speed stirring of the oil with skim milk in an electric mixer, to which dry skim milk or an egg may be added if extra protein is desired. Flavourings and sugar` are added to taste. A smooth and relatively stable emulsion can be made with a homogenizer using these ingredients; the product may be stored in a refrigerator for convenient use.