1)IRON DEFICIENCY ANEMIA

Iron deficiency anemia is a common type of anemia — a condition in which blood

lacks adequate healthy red blood cells. Red blood cells carry oxygen to the body's
tissues. As the name implies, iron deficiency anemia is due to insufficient iron.

Depending on the severity of the anemia, daily dosage of elemental iron should
be 50 to 200 mg for adults and 6 mg/kg for children. Ascorbic acid greatly
increases iron absorption. It takes 4 to 30 days to note improvement with iron
therapy, especially the hemoglobin level. Iron therapy should be continued for
several months, even after the hemoglobin level is restored, so that the body iron
reserves are replete.

Dietary strategies involve: 1. providing foods that have a higher iron density 2.
increasing the iron absorption from food

Iron Density

Beef, legumes, dried fruit, and fortified cereals are foods that rank the highest in
iron content. In general, foods that obtain most of their calories from sugar, fat,
and unenriched flour have a low iron density. Foods made from whole grain and
enriched flour, as well as unrefined foods (fruit, vegetables, and meats), have a
higher iron density. Dairy products have a low iron density.

Iron Absorption

Dietary iron is provided in the diet in two forms: heme and nonheme. Heme iron
constitutes 40% of the iron present in meat, fish, and poultry. Nonheme iron
constitutes the balance of the iron in meat, fish, poultry and all the iron present in
plant food, eggs, milk, and cheese. Heme iron is better absorbed than nonheme
iron. The absorption of nonheme iron is influenced by several dietary enhancing
factors, particularly ascorbic acid and meat, fish, and poultry. Ascorbic acid binds
iron to form a readily absorbed complex. Good sources of ascorbic acid include,
but are not limited to, citrus fruit and juices, tomatoes and tomato juice, greens,
broccoli, strawberries, and sweet potatoes
Approaches Guidelines to increase iron intake and absorption are as follows:

Increase ascorbic acid at every meal

Include meat, fish, and poultry at each meal, if possible.

Avoid drinking tea or coffee with meals.

Avoid foods with high quantities of EDTA (ethylenediaminetetraacetic acid) by

checking food labels.

Increase food selections that have a high iron density

2)NEPHROTIC SYNDROME
Nephrotic syndrome is a kidney disorder that causes your body to excrete too
much protein in your urine.

Signs and symptoms of nephrotic syndrome include:

 Severe swelling (edema), particularly around your eyes and in your ankles
and feet
 Foamy urine, which may be caused by excess protein in your urine
 Weight gain due to excess fluid retention
 Fatigue
 Loss of appetite
A 24-hour urinary protein excretion of 3.0 g or greater is indicative of nephrotic
syndrome . Nephrotic syndrome is associated with other metabolic disturbances
including hyperlipidemia caused by increased lipid synthesis and decreased lipid
catabolism. Edema is caused by sodium retention or imbalance, fluid retention,
hypoalbuminemia, and underlying diseases such as renal, or liver disease.

Dietary Approaches

Protein: Provide 0.8 to 1.0 g/kg of ideal body weight.

High–biological value protein should contribute at least 50% of protein intake.
Animal sources of protein are meat, poultry, fish, eggs, milk, cheese and yogurt,
and they provide high biological value proteins.

Sodium: The level of sodium prescribed is based on the severity of edema and
hypertension. Sodium is usually restricted to 1 to 2 g/day, depending on the
severity of the patient’s signs and symptoms . Fluid restriction is often necessary
and should be based on the patient’s symptoms.

Fat: Target less than 30% of energy from fats,less than 7% from saturated and
trans fats

Vitamins and minerals: Abnormalities in iron, copper, zinc, and calcium levels are
directly related to the urinary loss of proteins that are involved in their
metabolism. For example, the increased loss of transferrin causes decreased
plasma iron levels. Iron supplementation is important for patients who have
nephrotic syndrome. Copper is also bound to protein, and serum copper levels
are often compromised. However, clinical manifestations do not occur as a result
of the low copper levels; therefore, supplementation is not necessary.
Supplemental zinc may be needed, as zinc is bound to albumin. In addition,
decreased levels of calcium and serum 1,25- dihydroxycholecalciferol may occur
as a result of being bound to albumin . Supplemental calcium, vitamin D, and iron
may be needed to normalize serum levels.

3) PEPTIC ULCER
Peptic ulcer disease includes esophageal, gastric and duodenual ulcers. Research
identifies the Helicobacter (H.) pylori bacteria as the primary cause in 95% of
gastric and duodenal ulcers (1-3). The remaining 5% is caused by non-steroidal
anti-inflammatory medication usage (eg, aspirin and ibuprofen) and excessive
production of stomach acid. The treatment for individuals infected with the H.
pylori bacteria includes healing the ulcer with acid suppressing medication and
curing the infection by using antibiotics.
Treatment

Recommended nutrients can be different in the acute phase and in the recovery
phase, and there is a greater need of protein and some micronutrients, such as
vitamin A, zinc, selenium, and vitamin C in the recovery phase. In addition, some
studies have shown that vitamin C has a beneficial effect in eradication of H.
pylori.

Fibers and probiotics also play a important role in the treatment of peptic ulcer,
because they reduce the side effects of antibiotics and help reduce treatment
time.

Coffee can increase acid production and exacerbate symptoms in individuals with
ulcer disease.Alcoholic beverages can erode the protective mucosal lining along
the gastrointestinal tract and lead to further inflammation and bleeding.To
minimize symptoms, individuals with ulcer disease should avoid or limit both
coffee and alcohol.

Spicy foods do not cause ulcers, but they may make symptoms worse in some
people. If spicy foods bother you, avoid or eat less of them. You can continue to
eat spicy foods if they don't cause you discomfort.

4) WILSON’S DISEASE
Wilson’s disease is an inherited disorder of copper metabolism that is
characterized by the abnormal transport and storage of copper, resulting in
neurologic damage, and damage to the kidney, brain, and cornea. Onset may
occur from 5 to 40 years of age. Liver disease is always present.

Wilson’s disease is treated with a copper chelating agent, such as penicillamine to

keep the patient in a negative copper balance. The chelating agent bonds with
copper to form stable complexes that are excreted in the urine. A patient initially
treated with a chelating agent may receive maintenance therapy with zinc
acetate. This is particularly important for the patient who has experienced
adverse reactions to chelating agents. Zinc acetate acts by blocking the absorption
of copper in the intestinal tract, which results in both the depletion of
accumulated copper and prevention of its reaccumulation. Chelating agents
should be taken orally before meals. A vitamin B6 supplement is needed with this
medication. Usually 25 mg/day of vitamin B6 is adequate. Zinc may also be
necessary. If the treatment with penicillamine alone does not achieve a negative
copper balance, a low-copper diet (1 to 2 mg/day) may be an appropriate adjunct.

A normal diet provides 2 to 5 mg/day of copper. To achieve 1 to 2 mg/day of

copper, limit intake of the following foods:

Organ meats, such as liver, kidney, and brain

Shellfish, such as oysters, crab

Dried legumes, except peas

Whole wheat and bran breads and cereals

Baked potato with skin,Sweet potato

Dried fruits, such as raisins, dates, and prunes

Mushrooms  Chocolate Nuts and seeds Mineral water