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NUTRITIONAL EDUCATION AS AN INDISPENSABLE CONDITION FOR THE PREVENTION OF
ALLERGIES AND DIABETES
Kaspruk N.
Associate Professor
Department of Clinical Immunology, Allergology and Endocrinology,
Batranovska S.
Assistant
Department of Pharmacology Bukovinian State Medical University, Chernivtsi, Ukraine
Д1СТОЛОГ1ЧНА ОСВ1ТА ЯК НЕОБХ1ДНА УМОВА ПРОФ1ЛАКТИКИ АЛЕРГ1Й ТА
Д1АБЕТУ
Каспрук Н.М.
доцент
кафедра клШчног iмунологи, алергологи та ендокринологИ'
Батрановська С.О.
асистент кафедра фармакологи' Буковинський державний медичний утверситет
м. Чернiвцi, Украша
Abstract
The search for ways of early prevention of allergic and endocrinological diseases puts on the agenda the issue of the need to popularize the basic rules of nutrition among the population, which is relevant for more than a third of the world's inhabitants. Especially important is the psychological and pedagogical work in educational institutions, doctors with patients, thematic information in the media. The work is devoted to the problems and basic principles of nutrition education, the need for wide coverage and public involvement in the discussion of a burning medical and social problem, as well as educational work among students.
Анотащя
Пошук шляхiв ранньо1 профшактики алерпчних та ендокринолопчних захворювань ставить на порядок денний питання необхвдносп популяризацп серед населения основних правил харчування, що е акту-альним б№ш нiж для третини мешканщв планети. Особливо важливою стае психолого-педагопчна робота в навчальних закладах, лiкарiв з пащентами, тематична шформащя в ЗМ1. Робота присвячена проблемам та основним принципам дiетологiчноï освгги, необхщносп широкого висвплення та залучення громадсь-косп до обговорення пекучоï медико-сощально1 проблеми, а також проведення освггаьо1 роботи серед студентства.
Keywords: Nutrition education, prevention, allergy, diabetes. Ключовi слова: Дieтолоriчна освгга, профшактика, алерпя, дiабет.
According to epidemiologists of the world, the number of allergic diseases (AD) is constantly growing and today every third inhabitant of the planet has had at least one episode of a reaction classified as an allergy. This rapid growth of the problem is due to many factors. Technogenic environmental pollution plays an important role in this. There is a constant trend towards a more severe course of AD, the formation of variants resistant to traditional therapy. This leads to a significant deterioration in the quality of human life, in connection with which a constant search is made for ways of early prevention [5, 9]. Diabetes mellitus is among the leading global medical and social problems of the present. According to WHO, about 300 million people have diabetes, and by 2030, according to the forecast of the International Diabetes Federation (IDF), their number may increase by 1.5 times.
Itching of the skin in diabetes is easily confused with allergies, because it can occur with elevated glucose levels, have a similar pattern of manifestations and go away on its own when blood sugar normalizes. Hypersensitivity reactions in DM develop somewhat more frequently than in the general population, a strong reason for this is the constant use of insulin. These reactions can be confused with food allergies. If positive dynamics is observed with the normalization of blood sugar levels and constant monitoring, then food allergy (FA) is less likely [6].
In diabetes, proper nutrition plays no less significant role than hypoglycemic drugs or insulin. The list of what you can eat with diabetes is based on recommendations for healthy eating. Nutritional education of patients, teaching the basic principles of organizing their own nutritional model, is a paramount condition in the prevention and treatment of all AD and DM. For example, metabolic disorders are one of the risk factors for the formation of hypersensitivity reactions to drugs.
Interesting data are shown on the association of autoimmune DM and milk allergy. A study conducted in Australia and Italy showed an association between cow's milk consumption and type 1 diabetes in children. The reason is sensitization to bovine serum albumin. The protein structures of pancreatic cells responsible for insulin production are very similar to bovine serum albumin, which can provoke hyperimmune cross-reactions on pancreatic cells (as a result, insulin production is reduced). Children who consume cow's milk during the first three years of life are 52% more likely to develop type 1 diabetes [11].
Insulin resistance can develop for many reasons, including FA and other food intolerances. Such reactions can usually take many forms. Highly processed foods, such as fast food, can cause chronic inflammation that interferes with insulin production. In this case, specific allergy testing, if we are talking about IgE-de-pendent allergies, will help with the determination of food sensitization and clarify the etiological significance of allergy in a patient with DM [11].
Therefore, proper nutritional trainings should be carried out by allergists and endocrinologists, family
practitioners on an ongoing basis. Such teachings can also be offered in groups if it is possible to organize a meeting of patients or parents of child patients with the involvement of specialist doctors of other specialties (gastroenterologists, pulmonologists, dermatologists, pediatricians). Among pupils of educational institutions and students, such conversations are extremely important, they are most effective if they are held by pop-ularizers by age, due to the involvement of medical volunteers.
An effective form of such educational work is the speeches of experienced doctors in the media, online publications, and social networks. We consider it necessary to carry out information work not only by stating individual facts, but also to explain the reasons, and in a simplified version, to provide information on the mechanisms of development of pathological conditions. This further motivates patients to maintain a healthy lifestyle. Given the frequency of dietary problems, it is easier to consider them in terms of food intolerances, but the amount of information is of course given in view of the audience.
More often, in particular, in children, it is the food that becomes the first provocateur of an allergic reaction. In this case, we are talking about a hypersensitiv-ity reaction or FA, which is usually manifested by damage to the skin and digestive tract [5, 7]. FA is based on immunopathological mechanisms involving specific proteins (IgE-mediated reactions) or non-IgE reactions [9]. A combination of these mechanisms is often observed. A separate problem is pseudo-allergic reactions caused by the action of histamine liberators, deficiency of digestive canal enzymes, and psychogenic factors.
When it comes to the hypoallergenic diet, a common misunderstanding is about the "all red" ban. In everyday life, there is an opinion that bright berries and fruits are the main source of allergens. But it's not about color. Antigens contained in food products are usually proteins in the form of glycoproteins that are highly soluble in water, more often thermostable, resistant to acids and proteolytic enzymes, so the cooking factor, for example, does not eliminate the allergenicity of the product. Almost any food, drug, herbal collection can cause an allergic reaction. If we analyze the genetically determined variant of the implementation of allergies, the leading role in the occurrence of FA most often belongs to 8 food groups, which, in order of importance, can be placed as follows: eggs (chicken and quail), peanuts, milk, soybeans, nuts, seafood, other crustaceans, wheat. Widespread allergens include cocoa, citrus fruits, some berries, honey, meat, and vegetables [2, 3, 4].
Be sure to take into account the possibility of cross-reactions between different types of allergens, which is explained by the similarity of allergenic determinants. Thus, high allergenicity is inherent not only in cow's milk (CM), but also in the milk of other mammals. For example, goat milk can cause both cross-allergy in persons sensitive to CM proteins, and be an independent allergen, provoking severe reactions. It has
been shown that up to 90% of allergic children with CM sensitization have cross-allergies to goat and sheep milk, which is associated with a high level of homology between the caseins of these species.
The allergenic activity of the chicken egg (CE) is due to both protein and yolk. The most antigenically active components are ovomucoid (Gal d 1) and ovalbumin (Gal d 2) of the protein. They can retain the properties of the allergen in the intestine for a long time. The allergenicity of the yolk of CE is manifested to a lesser extent. A high probability of causing allergies is inherent in the egg protein of other birds. When forming a diet, it should be taken into account that CEs are part of muffins, cakes, sweets, ice cream, etc. Gluten and eggs increase sugar levels for a long time, and dairy products have a similar but less pronounced effect [11]. Another example of cross-sensitization is kefir (kefir yeast) and molds, mold cheeses, yeast dough, kvass, penicillin antibiotics.
Despite the constant improvement of methods for laboratory diagnosis of allergies, these are only additional methods and often a laboratory test cannot determine a specific pathogenetic factor. Therefore, determining the cause and preventing exacerbations requires painstaking work of the patient-doctor pair.
A hypoallergenic diet is prescribed regardless of the mechanism of reactions and clinical manifestations. Anything can become an irritant, and these irritants are capable of accumulation.
It is undesirable for children with allergies during an exacerbation to eat vegetables raw, it is better to bake, boil or stew them. Seasonal cucumbers, zucchini, Brussels sprouts, pumpkin, parsley, dill are very useful for dietary nutrition. From "overseas" vegetables and fruits will have to be abandoned. From fruits it is better to use pears and apples (without peel), dried fruits (apple-pear drying, raisins).
To enrich the body with fats, you can introduce olive oil into the diet. It is important to enrich the diet with calcium, which exhibits anti-inflammatory and anti-allergic properties (found in fermented milk products).
Candy and confectionery, ice cream, condensed milk, vinegar, mayonnaise, smoked meat and fish, margarine, palm oil, chips, alcohol, all colored carbonated drinks, packaged juices are under an absolute ban. As for drinks, you can leave unsweetened tea, coffee, natural fruit and berry juices from sweet and sour berries without sugar (fresh or sugar-free compotes), tomato juice, mineral water, infusion or decoction of rose hips in the diet.
Many questions arise regarding the possibility of drinking low-alcohol drinks. It is necessary to distinguish between drinks containing a lot of sugar (liqueurs, sweet wines), and almost no sugar - dry wines, cognac products, but wines, cognacs are also histamine liberators, therefore, the risk of pseudo-allergies is high.
Now experts refuse to use diabetic products. We are talking about sweets and dry biscuits, in which glucose is replaced by fructose and sorbitol. There is no evidence that fructose is more beneficial for diabetics
than sucrose, and the effects on metabolism and consequences are more detrimental. You should also limit the use of sweeteners as much as possible.
Summing up, we offer the following dietary rules:
• The special diet should start from the moment of verification of DM or AD. The maximum restriction pattern after the onset of an exacerbation for an acute allergic reaction should last 2-3 weeks. It is during this period that all critical moments can be identified and an individual diet can be adjusted, which must be constantly monitored by the attending physician.
• Preference is given to boiled or steamed products.
• Nutrition should be complete and balanced in terms of the amount of proteins, fats and carbohydrates.
• After an exacerbation of an allergy in the conditions of the most limited set of simple products, a new product is administered no more than 1 time in 3 days. If a negative reaction to it is not found, leave it on the menu.
• Follow eat fractional diet (5-6 meals per day) on an ongoing basis.
• Use only fresh products, which is a general rule of nutrition, without emulsifiers, dyes, preservatives, "flavor simulants", on an ongoing basis.
• Rejection of unknown foods that are not typical of the food culture of the patient's region, as well as vegetables "out of season", containing a particularly large amount of chemicals used to accelerate ripening and increase shelf life.
• Do not use complex sauces, spices, food additives when cooking, because any combination gives many options for intermediate substances with unpredictable effects.
• Do not use semi-finished products, if possible, eat homemade food, as simple as possible, preferably one-component, prepared from those products that definitely do not cause allergies in the patient and are not limited to contraindications for diabetes.
• If the cause of the allergy is not found, then it is necessary to exclude all probable, that is, statistically more likely to cause AD, causally significant allergens, such as berries, nuts, cocoa products, honey, eggs, seafood, citrus fruits, nightshade crops. All dishes in which an already detected allergen product is present should be excluded. For example, if hypersensitivity to an egg is determined, then refuse creams, mayonnaise, casseroles, etc.
• Compliance with the water regime, that is, use the maximum daily amount of water, taking into account concomitant pathology, on an ongoing basis.
Following these principles, you can minimize the load on the immune system and the impact of allergens of different groups, and therefore reduce the risk of exacerbation of allergies in any of its manifestations, the development of pathology of the digestive tract, and optimize metabolism.
Keeping a food diary will help to control the effectiveness of the implementation of such nutritional rules, in which it is recommended to carefully record the consumption of all foods or dishes, the amount of water drunk, an increase in an allergic reaction (if this
happened), episodes of an increase in blood sugar levels. Thus, by analyzing this information, with the help of an endocrinologist and an allergist, it is often possible to accurately determine the "guilty" product or their combination, and adjust the daily balance of nutrients.
Since epidemiological studies show a significant increase in allergic diseases and diabetes mellitus throughout the world, and Ukraine also is no exception. This is largely due to the fact that we live in a period of man-made pollution of the environment, the total "chemicalization" of everyday life, primarily the food industry. The organization of diet therapy and nutrition education, which are becoming super relevant for more than a third of the world's inhabitants, is a complex process that requires adequate diagnosis, taking into account the variety of dietary approaches and individual patient education. Especially important is the psychological and pedagogical work of doctors with patients, carried out not only in the conditions of individual work, but also in the media. The need to restore and establish control over the quality of products in the food industry and the use of pesticides in agriculture is becoming ever more acute. All this requires wide coverage and involvement of the public in solving these problems.
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ВЗАИМОДЕЙСТВИЕ ПОКОЛЕНИЙ В КОНТЕКСТЕ СМЫСЛОВ РАЗВИВАЮЩЕГОСЯ
ОБРАЗОВАНИЯ
Грохольская О.Г.
Российская академия образования, член Отделения философии образования и теоретической педагогики, член-корреспондент РАО, доктор педагогических наук, профессор
INTERACTION OF GENERATIONS IN THE CONTEXT OF THE MEANINGS OF DEVELOPING
EDUCATION
Grokholskaya O.
Russian Academy of Education, Member of the Department of Philosophy of Education and Theoretical Pedagogy, Corresponding Member of RAO, Doctor of Pedagogical Sciences, Professor
