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Диета при аутоиммунном тиреоидите Skip to content
Многие доктора замечают, что в последние годы среди их подопечных выросла доля пациентов с аутоиммунной патологией. Такой скачок обусловлен проблемами с ухудшающейся экологией, постоянными стрессами, вирусными инфекциями и многими иными факторами, ведущими к различным иммунным поломкам. Ярким примером таких недугов служит аутоиммунный тиреоидит, при котором образовавшиеся аутоантитела целенаправленно повреждают функционирующие клетки щитовидной железы. Из-за этого постепенно уменьшается количество вырабатываемых железой тиреоидных гормонов. После выявления аутоиммунного тиреоидита многим пациентам назначают серьезные лекарства (в том числе и гормональные), подчас забывая о лечебном питании и его возможностях. При изменениях гормонального баланса коррекция рациона, безусловно, не являются достойной альтернативой заместительной терапии гормональными средствами. Но диетотерапия может помочь понизить их дозу. Перед началом составления нового рациона следует непременно оценить уровень тиреоидных гормонов (свободные фракции Т3 и Т4, ТТГ), чтобы уточнить состояние конкретного больного:
эутиреоз (гормоны в норме); гипотиреоз (гормональный синтез понижен); гипертиреоз (повышенная гормональная продукция). Последний вариант наблюдается реже других, но возможен на начальных стадиях недуга как своеобразная компенсаторная реакция на происходящие изменения щитовидной железы. Питание при эутиреозе мало отличается от диеты здорового человека. А вот в остальных случаях рацион подвергают определенной коррекции.
Диета и гипертиреоз В рацион таких больных должны входить продукты, богатые калием. Гипертиреоз сопровождается значительным ускорением практически всех видов обмена веществ. Нарастают энергозатраты, быстрее распадаются жиры, белки и гликоген, расходуются минералы (особенно калий ) и витамины. Поэтому питание таких больных должно адекватно восполнять изменившиеся потребности в нужных веществах. Их рацион подвергают следующей коррекции:
увеличивают общий калораж на 20–30 % (по сравнению с нормой для конкретного пациента); повышают белковую квоту до 1,5 г на кг исходной массы больного (за счет постного мяса, нежирной рыбы, яиц, гречки, соевых продуктов, овсянки, молочных продуктов); вводится дробный режим приема пищи (до 5 раз и даже больше), чтобы у пациентов не было ощущения голода; частое питье для предотвращения жажды (несладкие отвары шиповника, компоты или отвары из сухофруктов, некрепкие чаи, морсы, обезжиренные молочные напитки) по несколько глотков с перерывами в 10 минут; включают богатые калием продукты (бананы, картофель, абрикосы, персики, ананасы, редька, капуста , крыжовник и др.); показаны пищевые источники кальция (молоко и его производные, брокколи, костная мука, орехи и др.); ограничивают пищу и напитки, активирующие нервную систему (любой алкоголь, крепкие бульоны, рыбные и мясные подливы, крепкий чай, кофе, пряности, шоколад и др.); нерыбные морепродукты и прочие источники йода допустимы, но в таких количествах, чтобы суточное потребление данного вещества не превышало 0,1 мг. Если у пациента отсутствуют поносы, то особой кулинарной обработки не требуется. Только рыбу и мясо лучше сначала бланшировать или отваривать, а уже потом жарить, тушить или использовать их для заливных блюд. Это помогает устранить из данных продуктов возбуждающие экстрактивные вещества. При жидком стуле пищу следует отваривать или готовить в пароварке и протирать.
Питание и гипотиреоз И все же у большей части больных с аутоиммунным тиреоидитом отмечается понижение выработки тиреоидных гормонов. Их нехватка ведет к угнетению обменных процессов, сопровождающемуся расстройствами практически всех систем и органов. Для таких пациентов могут оказаться ценными следующие диетические рекомендации:
редукция суточного калоража на 20 % по сравнению с индивидуальной физиологической нормы больного; ограничение доли легкоусвояемых сахаров (сладости, сдоба, белый хлеб, рисовая каша, варенье, манка, мед, кондитерские изделия и др.) в рационе; уменьшение потребления жиров (до 80 г/сут.) за счет отказа от маргарина, сливок, жирного творога и сметаны, икры рыб, мясных субпродуктов, жирной рыбы, сала, богатых жиром сортов мяса, кожи птиц; показаны продукты с послабляющим эффектом , которые могут одновременно несколько повышать выработку желудочного сока (кисломолочные напитки, свежие ягоды, овощи, фрукты и соки из них, сухофрукты, растительные масла и др.). Одно из ключевых требований диеты касается потребления йода. Ведь, с одной стороны, его дефицит (менее 80 мкг) сам по себе может спровоцировать серьезный гипотиреоз. Но, с другой стороны, и высокие дозы диетического йода не влияют на выраженность болезни Хашимото (второе название аутоиммунного тиреоидита). Более того, избыток йода тоже может вызвать гипотиреоз в случае аутоиммунного поражения щитовидной железы и даже блокировать лечебное действие гормональных лекарств. По мнению докторов, оптимальное суточное количество пищевого йода должно составлять примерно 150 мкг. При этом важно не забывать и о взаимодействии йода с другими веществами. Так, его транспорту препятствуют роданиды, тиоцианаты и тиооксизолидоны. Они содержатся в турнепсе, горчице, кабачках, репе, разных сортах капусты, брюкве. Следовательно, их нужно ограничивать. Кроме того, если пациенту проводится лечение лекарствами с тиреоидными гормонами (Эутирокс и др.), то лучше не совмещать прием препарата с поеданием соевых продуктов. Они угнетают всасывание активных веществ этих лекарств из кишечника. Возможности диетотерапии в лечении пациентов с аутоиммунным тиреоидитом весьма умеренны. Но ими не следует пренебрегать, т. к. иногда именно неадекватное питание служит причиной недостаточного эффекта применяемых фармакологических средств.
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