source: "Dietotherapy, Volume 3, By William Edward Fitch, 1918
The usual dietetic rule in such conditions is, wherever possible, to increase judiciously the amount, and especially the assimilation, of the food. There is a need for from 10 per cent to 50 per cent more food than the usual standard, and it is also possible to increase its digestion and absorption by the administration of pancreatin, for the need for this hyperalimentation does not necessarily imply that the digestive or assimilative capacity is increased. In addition to the effect of pancreatin upon digestion, it has been suggested that the adrenal irritability and sympatheticotonus, invariably a part of the syndrome of thyroid excess, may be favorably affected by increasing pancreatic activity, since the pancreas hormone antagonizes that of the adrenals and possibly also the thyroid. At least pancreatin (15 to 30 grains a day) has been given with clinical advantage in conditions of this character. On the contrary, digestive disturbances not infrequently complicate thyroid excess, especially late in its course; hence particular care must be exercised not to overtax the alimentary organs.
The dietetic management of thyroid excess attempts to introduce foods of easy digestibility and high caloric value. The salads, vegetables and bulky but not especially nutritious foods are advantageously replaced in part by other combinations in which cream, eggs and butter are among the more important ingredients. Usually the writer has found that farinaceous puddings, especially rice, in which cream and eggs are generously used, are preferable to less nutritious and not more tasty desserts.
Generally speaking, meats are not the most desirable foods for those suffering from thyroid irritability, for the purins undeniably present in flesh foods not only stimulate the thyroid (for this organ happens to he an important part of the detoxicating system of the body), but obviously are no advantage to an organism already "on edge" from an excess of a purin-like toxin of marked activity. In fact, it is the writer's opinion that meat should be prescribed or at least allowed only occasionally, and then only in small amounts.
On the other hand, it is a routine custom in this condition to advise some supplementary feeding, and buttermilk and ice cream serve this purpose very well. In addition to three good meals at the usual hours, I usually prescribe a pint of buttermilk (natural or cultured with the B. bulgaricus) two hours before lunch, and from four to six ounces of ice cream in the afternoon at about four o'clock.
In this condition, the cell activities are much below par, digestive activity is sluggish, muscular tonicity is decreased and constipation is the rule. The most usual single accompaniment of hypothyroidism, be it well-marked cretinism or myxedema or the less definite "minor thyroid insufficiency"—which, by the way, is said to be "as common as the exanthemata," though too often it is not discovered—is infiltration. This means that the cells throughout the body are overburdened with their own wastes and are distended, just as we expect to find the skin puffy, inactive and infiltrated in myxedema. This reduces the sensitiveness of the organism and naturally the digestive system is not immune, for in fact the secretory cells are infiltrated and cannot perform their proper service, the musculature of the intestine is infiltrated and flabby, intestinal stasis is the rule, and while the weight of the individual may be above normal, it is an unhealthy weight and is a great discomfort to the patient.
In this connection it may be of interest to emphasize the important relationship which thyroid insufficiency bears to constipation. Dr. Leopold Levi of Paris, whose work and writings, with Baron Henri de Rothschild, on the thyroid gland are well known, refers to the intimacy of constipation and hypothyroidism in the following terms: "La constipation thyroidienne est frequente et peut-etre la plus frequente des constipations" ("Constipation of thyroid origin is frequent, and, perhaps, the most frequent form of constipation"). This being the case, and clinical experience confirms the fact that thyroid insufficiency is very often discovered in those having chronic constipation, not only should patients suffering from thyroid insufficiency be treated from a dietetic standpoint, but physicians well versed in the management of these cases might profitably establish to their satisfaction that there is a thyroid element in a given case and supplement the dietetic and other treatment by the judicious administration of thyroid extract. Such cases may benefit greatly from one-fourth to one-half a grain of thyroid extract (U.S.P.) three times a day during every other week, in addition, of course, to other indicated treatment.
As a general rule, the best advice regarding diet in hypothyroidism includes the suggestion that food combinations be as simple as possible and that the high caloric foods be replaced in a measure by cellulose-containing foods and bran, for not only is this bulk useful in combating the stasis and muscular insufficiency in the bowels, but it facilitates the reduction of the ration.
After a few days of limited diet or even starvation, provided the patient is able to stand it, the caloric value of the food prescribed should approximate that necessary for a normal individual of the same height; in other words, since hypothyroid cases commonly are obese and heavier than proper, their actual weight is no index of their need of nourishment. Further, since many individuals with varying grades of this disorder, especially the more decided cases, exhibit mental and physical peculiarities, one often finds in them a tendency to overeating which should be curbed promptly, for this habit, uncontrolled, undoubtedly complicates the constipation, adds to the toxemia and favors the obesity.
A morning meal of apples alone has been suggested by me many times with
clear-cut benefit. The patient is instructed to eat three or four moderate sized apples, raw, stewed or baked, and to take nothing else till lunch. Raw apples are preferable since there is no need for added sugar, nor is there the imaginary need for cream, etc. Occasionally, hunger is great by the middle of the forenoon, especially in persons whose hands and minds are not fully occupied, and here it may be well to allow a glass of buttermilk.
For lunch a bulky meal of low caloric value with plenty of greenstuffs seems to be the best, and the supper is as scanty as the temperament and willingness of the individual will permit. The total caloric content of the day's food may be from 30 to 60 per cent lower than the average, and this may be continued for some weeks, the amount and caloric value of the food being very gradually increased as the weight and other symptoms respond to the regimen.
DIETETIC MANAGEMENT IN HYPERTHYROIDISM.
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| image source- wiki commons |
The dietetic management of thyroid excess attempts to introduce foods of easy digestibility and high caloric value. The salads, vegetables and bulky but not especially nutritious foods are advantageously replaced in part by other combinations in which cream, eggs and butter are among the more important ingredients. Usually the writer has found that farinaceous puddings, especially rice, in which cream and eggs are generously used, are preferable to less nutritious and not more tasty desserts.
Generally speaking, meats are not the most desirable foods for those suffering from thyroid irritability, for the purins undeniably present in flesh foods not only stimulate the thyroid (for this organ happens to he an important part of the detoxicating system of the body), but obviously are no advantage to an organism already "on edge" from an excess of a purin-like toxin of marked activity. In fact, it is the writer's opinion that meat should be prescribed or at least allowed only occasionally, and then only in small amounts.
On the other hand, it is a routine custom in this condition to advise some supplementary feeding, and buttermilk and ice cream serve this purpose very well. In addition to three good meals at the usual hours, I usually prescribe a pint of buttermilk (natural or cultured with the B. bulgaricus) two hours before lunch, and from four to six ounces of ice cream in the afternoon at about four o'clock.
HYPOTHYROIDISM
In this condition, the cell activities are much below par, digestive activity is sluggish, muscular tonicity is decreased and constipation is the rule. The most usual single accompaniment of hypothyroidism, be it well-marked cretinism or myxedema or the less definite "minor thyroid insufficiency"—which, by the way, is said to be "as common as the exanthemata," though too often it is not discovered—is infiltration. This means that the cells throughout the body are overburdened with their own wastes and are distended, just as we expect to find the skin puffy, inactive and infiltrated in myxedema. This reduces the sensitiveness of the organism and naturally the digestive system is not immune, for in fact the secretory cells are infiltrated and cannot perform their proper service, the musculature of the intestine is infiltrated and flabby, intestinal stasis is the rule, and while the weight of the individual may be above normal, it is an unhealthy weight and is a great discomfort to the patient.
RELATION OF THYROID INSUFFICIENCY TO CONSTIPATION
In this connection it may be of interest to emphasize the important relationship which thyroid insufficiency bears to constipation. Dr. Leopold Levi of Paris, whose work and writings, with Baron Henri de Rothschild, on the thyroid gland are well known, refers to the intimacy of constipation and hypothyroidism in the following terms: "La constipation thyroidienne est frequente et peut-etre la plus frequente des constipations" ("Constipation of thyroid origin is frequent, and, perhaps, the most frequent form of constipation"). This being the case, and clinical experience confirms the fact that thyroid insufficiency is very often discovered in those having chronic constipation, not only should patients suffering from thyroid insufficiency be treated from a dietetic standpoint, but physicians well versed in the management of these cases might profitably establish to their satisfaction that there is a thyroid element in a given case and supplement the dietetic and other treatment by the judicious administration of thyroid extract. Such cases may benefit greatly from one-fourth to one-half a grain of thyroid extract (U.S.P.) three times a day during every other week, in addition, of course, to other indicated treatment.
DIET IN HYPOTHYROIDISM
As a general rule, the best advice regarding diet in hypothyroidism includes the suggestion that food combinations be as simple as possible and that the high caloric foods be replaced in a measure by cellulose-containing foods and bran, for not only is this bulk useful in combating the stasis and muscular insufficiency in the bowels, but it facilitates the reduction of the ration.
After a few days of limited diet or even starvation, provided the patient is able to stand it, the caloric value of the food prescribed should approximate that necessary for a normal individual of the same height; in other words, since hypothyroid cases commonly are obese and heavier than proper, their actual weight is no index of their need of nourishment. Further, since many individuals with varying grades of this disorder, especially the more decided cases, exhibit mental and physical peculiarities, one often finds in them a tendency to overeating which should be curbed promptly, for this habit, uncontrolled, undoubtedly complicates the constipation, adds to the toxemia and favors the obesity.
A morning meal of apples alone has been suggested by me many times with
 |
| image source- wiki commons |
For lunch a bulky meal of low caloric value with plenty of greenstuffs seems to be the best, and the supper is as scanty as the temperament and willingness of the individual will permit. The total caloric content of the day's food may be from 30 to 60 per cent lower than the average, and this may be continued for some weeks, the amount and caloric value of the food being very gradually increased as the weight and other symptoms respond to the regimen.
