And so far in Russia dozens of works on diets and nutrition based on the ideas of Pevzner are published – they are issued as relevant and useful. “Today, these diets are also sold in the form of ready-made sets for every day with home delivery,” says a gastroenterologist, author of the Gastropub telegram channel Alexei Gollenko in a conversation with Medusa. “People take money for this.” 2A, what is the essence of these diets? Manuel Pevzner developed his system of therapeutic nutrition in the first half of the 20th century. Together with his colleagues, he proposed 15 main diets intended for patients with obesity, diseases of the gastrointestinal tract, cardiovascular disorders, and so on. These diets were built on the limitation or exclusion of certain products, accounting for calories, proteins, fats and carbohydrates (KBJU) and the method of processing food. They were used in Soviet and post -Soviet hospitals and sanatoriums. For example, for diseases of the liver Pevznere table No. 5: “Normal amount of protein, a sufficient amount of carbohydrates (raw vegetables and fruits), a slightly reduced amount of fats.” In addition, you need to eat as few products rich in essential oils (as an example, garlic, onions and zest of citrus fruits are given), white bread (but only yesterday) is allowed, “sometimes” you can eat a “piece of herring, soaked for at least 12 hours (not smoked)”, fried meat (without panning) is allowed no more than times 10 days, acidic berries and fruits are prohibited. You need to eat often in small portions. If a person has bed rest, it is possible to arrange “watermelon days” (they are also unloading) and there are from 1.5 kilograms to 2.5 kilograms of watermelons per day (but only five doses). If you look at the third edition of the book (1958), in which Pevzner with colleagues described diets, then there are resolved: drinks – weak tea, milk, water with sugar and lemon, bars, juices of raw raw damp, juices vegetables and fruits; bread – white yesterday, brown bread (25-50% of all bread), bread from ground wheat bran; dairy products – cottage cheese, sour cream in limited quantities, yogurt, non -resistant cheeses, milk, butter – occasional omelets, dryers – sometimes a piece at least 12 hours (not smoked); soups – dairy, vegetarian and fruit; meat and fish – low -fat varieties in boiled form, fried meat without panning once every 10 days (or fish on a spit), baked in a fraat of boiled meat; flour dishes – in all kinds, except for the same dough, which is permitted in a limited amount; greens and vegetables – everything, everything, everything, everything, everything, everything, everything, everything, everything, all, all, greens and vegetables. In addition to legumes (yellow peas and large large, beans, beans of all varieties, lentils), beet tops, spinach, sorrel; berries and fruits – except for very sour ones (for example, Antonon apples, cranberries) in all species; sweet – compotes, jelly, jelly, biscuits, cakes of beaten proteins with sugar, cookies; sauces and cookies; The seasonings are non -hair, non -resistant, low -fat. “In some cases, it is advisable to prescribe special diets for a short time. Such diets include: 1) Diet of Carrele, 2) sugar days, 3) Apple days, 4) composite days, 5) watermelon days, 6) grape treatment. ”3rd is there some kind of scientific basis? Pevzner diets on the beginning of the 20th century about the work of the body in normal and changes in the disease. Between the first and second conditions, doctors tried to establish a causal relationship at the level of physiology and directly reduce the load on the affected organs. For example, if the patient has diabetes (and it is associated with an increase in blood sugar), it means that it is important to exclude products that contain sugar. Such assumptions became the basis for recommendations, and recommendations – the basis for the experience of a particular doctor, clinic or institution. In the twentieth century, referring to the “experience of our hospital” was still quite appropriate. 4th Preferen, is it bad? Why is something wrong with Pevzner’s diets? Pevzner’s tables were created in those years when there were no reliable criteria for assessing the influence of products on health. The gastroenterologist Alexei Golvenko says: in 1927, the first book of Pevzner was published, and he began his research earlier. In those days, the world did not conduct methodologically verified clinical trials that we conduct and use now. Now we understand: you cannot say anything without statistics. It must be, and another. But most of all, as a doctor, I am embarrassed by a grouping of diseases. For example, a universal table for diseases of the biliary tract and liver is something like a special gypsum bandage for fractures in the upper half of the body. The doctor explains: liver diseases are a wide class of conditions. With autoimmune liver diseases, a specific diet is not needed, with an alcoholic disease of the liver, a diet is primarily a rejection of alcohol. That is, therapeutic tables ignore this spectrum and limit in the set of products of all patients. This can be useless and sometimes even harmful: for example, leading to a deficiency of nutrients. It is also that the Pevzner diets do not take into account the initial state of the patient: his age, the level of physical activity, accompanying diseases, personal preferences and cultural food characteristics. 5 No why they are still popular? Officially, treatment for the singer in Russia was preserved until 2003. Then, instead of the main 15 diets, the Ministry of Health introduced six in a separate order: standard, sparing, high -white, low -white, low -calorie and high -calorie diets. In the practice of the hospital and sanatoriums, they did not change the old system. Many brought the names of tables in line with the requirements of the order, but their content has changed little. Someone did not do this either. Loop tables can be found even in current clinical recommendations. At the level of recommendations of individual doctors – even more so. Gastroenterologist Alexei Golvenko says: I will say in defense of doctors that the patient often has a request for a simple and understandable brochure. The doctor’s reception is short, you need clarity. It is convenient to take a printout with tables and all patients to give it. Therefore, the ideas of the singer live, and this can harm. Why do the doctors sometimes communicate rudely? And how do doctors and patients find a common language? Medical communication specialist Anna Sonkina-Dhodman-that will help the doctor and patient establish dialogue doctors sometimes rudely? And how do doctors and patients find a common language? Medical communication specialist Anna Sonkina-Dhodman-that it will help the doctor and the patient to establish dialogue. What to focus on? Not every patient needs a diet. Gastroenterologist Alexei Golvenko explains that a good modern doctor makes a decision, prescribe or not prescribe a diet, just as to prescribe or not prescribe the drug. The specialist evaluates whether it is safe whether this medicine or diet will not worsen life more than the disease itself: a person can come to the doctor due to one-time heartburn. This could happen because he began to smoke more often or gained five kilograms. You can write out a proton pump inhibitor for five months. You can prescribe a single medicine. And you can recommend table No. 4, call the patient, provoke a disorder of food behavior. The benefits are doubtful, and the harm is huge. We are fighting for the quality of life. We rarely save life, to be honest. More often we fight for quality. Today, there are no strict recommendations for nutrition even with diseases such as inflammatory intestinal diseases, ulcerative diseases of the stomach and duodenum. In the book “Intestinal with comfort, stomach without problems”, gastroenterologist Alexei Paramonov writes: a diet with ulcers and gastritis is not needed, neither according to the singer, nor any other. It is reasonable to observe the principles of healthy diet – to avoid heavily fried and smoked foods, long breaks between meals, overeating. In addition, everyone knows the products individually intolerable for themselves, from which the stomach hurts or nausea arises; They should be avoided during the exacerbation. Gastroenterologist Alexei Golvenko agrees with this example and believes that “with most gastroenterological diseases, a special treatment diet loses to drugs or even psychotherapy.” Когда нужно идти к диетологу и как выбрать хорошего Инструкция «Медузы»Когда нужно идти к диетологу и как выбрать хорошего Инструкция «Медузы»Алиса Горбунова (Tagstotranslate) News
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