|
| Topic | Conventional Medicine | Persian Medicine |
|
| Definition of a CIP | Severe conditions that require continuous monitoring and artificial support of more than one vital organ [1] | Patients in need of constant medical attention due to being in the crisis period of a disease. The body's struggle against disease has reached a peak [17] |
|
| Possible side effects in CIPs | Critical illness is usually associated with catabolic stress, systemic inflammatory response, and complications including increased incidence of infections, multi-organ dysfunction, prolonged hospital stay, and increased mortality [1, 4]. Neurological complications, such as delirium, acute ischemic stroke, intra-cerebral hemorrhage, hypoxic-ischemic brain injury, flaccid paralysis, and rhabdomyolysis, are also expected in these patients [28] | Crisis is a sudden and drastic change in the course of a disease. Depending on various factors, it ultimately leads to complete recovery, chronic illness, or death. A range of symptoms, including headache, physical and mental restlessness, delirium, and loss of consciousness, can be expected in such condition [11, 12] |
|
| Importance of proper nutrition in CIPs | Malnutrition in CIPs is directly related to infectious complications and prolonged length of hospital stay. Providing proper nutrition for these patients is part of standard treatment [2, 3] | Lack of proper nutrition in CIPs can lead to Patient deterioration, disease exacerbation, disease prolongation, increased morbidity and mortality [17] |
|
| Food restriction | Treatment outcomes are improved by relative calorie restriction in the early days, while consuming enough protein [1, 3, 29, 30] | Relative food restriction and sometimes transitory fasting is necessary in CIPs. Consuming excessive or thick and slow-digesting food can be fatal. In weak patients, receiving enough meat and food is especially important [17] |
|
| The rationale behind food restriction | Due to metabolic changes caused by secretion of hormones and cytokines, increased catabolism and hypermetabolism, food restriction seems reasonable and has positive effects on prevention and control of inflammation [1] | Regular diet, in addition to strengthening the patient, may intensify the disease [21]. On the other hand, excessive food consumption, reduces the body's ability to fight disease due to the involvement of body forces in digestion and absorption processes [17, 19] |
|
| Factors determining the amount of required energy (which is related to the amount and type of required food) | There are many determinants of energy expenditure, including the severity of trauma, sepsis, fever, age, physical activity, medications, and the duration and developmental stage of critical illness. These factors overlap in very complex ways, adding or subtracting effects of each other [1, 31] | According to PM principles, the most important variables determining the type of diet suitable for each patient include disease duration, disease stage, disease quality, patient’s energy, digestive power, appetite, the status of body reserves, prior eating habits, and body mass [17, 19] |
|
| Duration of food restriction | Normally, relative food restriction is considered in the acute phase for 2-4 days. This is longer in overweight cases and shorter in case of malnutrition. When discontinuing intestinal feeding, based on patient tolerance and malnutrition, complete intravenous feeding may be delayed for up to 7 days [1] | In Al-Hawi, Rhazes allows the most severe state of food restriction between 4 to 7 days depending on physical condition of the patient [32] |
|
| Complications of prolonged food restriction | Prolonged food restriction can increase in the risk of infections, organ complications, need for mechanical ventilation, length of ICU stay and the duration of antibiotic use [1] | Prolonged food restriction can cause fatigue. weakness, disease prolongation, and dysfunction of various organs [16, 17] |
|
| Type of food in acute conditions | Numerous studies have shown that the most important factor in the final outcome is the amount of protein intake so that when the amount of protein is the same, calorie reduction does not cause significant change in the final disease outcome [1, 3, 29, 30] | The most important raw food that is considered in food restriction is meat. The amount of meat should be increased in food, if the patient is weak. However, if tolerated by the patient, meat is limited in the early days of the disease and food is prepared using vegetables, grains, and legumes [16, 17] |
| Increase in food quantity | There is no approved standard for food restriction, but high calorie and protein intake in the first 7 days will worsen prognosis in CIPs. Overeating in the early days will increase the incidence of complications such as hypercapnia, hyperglycemia, uremia, and hypertriglyceridemia [1] | An increase in food in times of crisis exacerbates the disease unless the patient is weak and malnourished. Although it is necessary to reduce the consistency of food, even in weak patients [16, 17] |
|
| Changing the consistency of food | In conditions such as acute infections, gastrointestinal disorders, inability to chew, and after surgery, it is recommended to use clear liquids, and liquid, soft and semisolid diets [33, 34] | If the patient isn’t weak or malnourished, the patient's food should be more diluted and softer than regular diet. It’s similar to clear liquid, liquid, soft, and semisolid diets as described in Table 1 [16, 17] |
|
| Preferred route of feeding | If tolerated, intestinal nutrition is the preferred route to nutritionally support CIPs [2, 4, 5] | In the past, intestinal feeding was restricted to intestinal nutrition, which was mainly oral and, in some cases, rectal. Accordingly, the focus was on changing the consistency of food. For example, in patients who were unable to eat, clear liquids, called Vajoor, were gently poured into the patient's mouth from the corner of the mouth with special containers [20] |
|
| Carbohydrate intake | Due to increased sympathetic activity in the acute phase, insulin resistance and hyperglycemia, it has been recommended to reduce the consumption of carbohydrates [1] | In the absence of fatigue and weakness, vegetables and fruits as carbohydrate sources are a significant part of the recommended foods for patients in the early days of crisis, which are consumed in the form juice, pureed and soup [17] |
|
| Protein intake | Food reduction is effective when sufficient amount of protein provided for the patient [1]. Perhaps the importance of proteins is due to the presence of essential amino acids such as leucine, arginine, and glutamine, which play a special role in strengthening the immune system [2, 35, 36] | In case of fatigue, weakness and malnutrition, the most important food component is meat, which should be added to the patient's food in sufficient quantity [16, 17] |
|
| Fat intake | The consumption of lipids increases in the acute phase. Because fats produce more energy, they reduce the patient's need for large amounts of food, and of course, they do not increase blood sugar too much and produce less carbon dioxide. Omega-3 fats, unlike omega-6, also help stop the inflammation process. Unlike glucose, fats are well consumed in the acute phase [1] | Fats are used in the patient's food for the following reasons: modifying the food and making it pleasant, softening dry and hard foods, modifying the spiciness of the food, facilitating urination and defecation, facilitating the patient's sleep [37]. In respiratory diseases , special attention has been paid to increase the share of fats in food [17] |
|
