TEXTBOOK IMMUNOLOGY - Mercury Podillya 2013

IMMUNOTOXIC IMPACT OF ENVIRONMENTAL FACTORS ON THE HUMAN BODY

Modern Concept of Dietary Management in Patients with Bronchial Asthma and Chronic Fatigue Syndrome

Bronchial Asthma (BA) is among the most prevalent human pathologies, characterized by an ongoing upward trend in morbidity and mortality rates worldwide. It is estimated that in Ukraine, BA affects approximately 5% of the adult population and 7% of children, totaling around 7 million patients. Currently, BA is recognized as a chronic inflammatory airway disease, which significantly alters our therapeutic approach to affected individuals.

It is known that 60% of BA patients concurrently suffer from chronic fatigue that persists after rest and eventually leads to a decline in both mental and physical performance. This condition is accompanied by a pronounced immune system imbalance; consequently, in recent years, the nomenclature of the syndrome has been updated to chronic fatigue and immune dysfunction syndrome (CFIDS).

CFIDS predominantly emerges in ecologically unfavorable regions characterized by high levels of environmental chemical pollution, elevated radiation, inadequate Nutrition, and chronic stress. These factors negatively impact The Immune System, weakening it and thereby facilitating the activation of latent Viruses, persistent viral infections, and allergic inflammatory processes against the backdrop of BA.

The Development of the body's stress response is primarily governed by the nervous, hypothalamic-pituitary-adrenal, and immune systems, as well as nutritional status, given that the quality and adequacy of dietary intake have a profound influence on the course of BA with CFIDS and overall immune competence.

Despite revised approaches to the pharmacotherapy of BA, medical nutrition therapy for this condition remains poorly developed and has traditionally relied on the strict elimination of numerous food items. The restricted list often includes biologically and chemically valuable foods such as eggs (the benchmark for dietary protein), pork (which, alongside high-quality protein, contains Essential Fatty acids, including omega-3), fish (a source of complete protein and omega-3 fatty acids), and tomatoes (a rich source of antioxidants). Prolonged and frequently lifelong unjustified elimination of valuable foods, lacking proper dietary substitution, can exacerbate immune impairments—including the ability of airway mucosa to produce IMMUNOGLOBULINS and other protective factors against viral and bacterial agents—while also promoting asthenia, weight gain, and other adverse metabolic shifts.

Nutrition exerts a decisive influence on the course of numerous pathologies. Unlike medications, food contains a vast array of diverse bioactive substances that exhibit pleiotropic effects and remain safe for the Organism. To date, a substantial body of experimental research and clinical observations indicates that proper nutrition can effectively prevent and treat most diseases, slow their progression, and modulate their clinical course.

A healthy airway epithelium exhibits marked antibacterial and antiviral properties. Conversely, altered epithelium that produces excessive mucus demonstrates reduced phagocytosis and diminished synthesis of secretory immunoglobulin A, thereby lowering airway Resistance to Infectious agents. Moreover, mucus serves as an optimal growth medium for microorganisms. It has been established that epithelial Cells of the respiratory tract secrete a smooth Muscle-relaxing factor, thereby contributing to the maintenance of airway patency. Epithelial damage leads to a decrease in the synthesis of this relaxing factor. Experimental studies have demonstrated that bronchial epithelium not only regulates smooth muscle Cell function in sensitized animals but also influences the magnitude of the contractile response to antigenic stimuli. This is further supported by studies showing that epithelial denudation increases tracheal and bronchial sensitivity to allergens by 8-fold. Neutral endopeptidase is another crucial factor influencing airway patency; a decline in The activity of this enzyme during Influenza or other infections can precipitate neurogenic airway inflammation. A second potent factor is prostaglandin E2, which is synthesized by the epithelium and directly suppresses Nerve Impulse transmission to smooth Muscles, inducing relaxation.

Disruption of capillary-interstitial equilibrium can lead to Connective Tissue edema, lymphatic drainage blockage, significant alterations in epithelial regeneration, and the establishment of chronic pathology. In this context, it is vital that the body possesses factors capable of mitigating bronchial epithelial Damage caused by oxidative and free-radical stress, as well as excessive proteolytic activity and leukocyte metabolic products. These protective mechanisms help preserve epithelial permeability at a level that prevents microvascular hyperpermeability and fluid accumulation, which would otherwise impair the proliferation of the basal cell layer required for The formation of a new barrier.

Patients suffering from chronic bronchial inflammation and bronchial asthma are frequently prescribed Antibiotics and glucocorticosteroids, which contribute to the development of secondary immunodeficiency, thereby paving the way for secondary infections. Immunosuppression commonly activates opportunistic microflora, locking the patient into a pathological loop that worsens with age-related immunological shifts and mucosal senescence.

Human health is largely determined by the body's adequacy of energy supply, Macronutrients, and a broad spectrum of micronutrients, the number of which currently totals around 700.

An adequate Immune Response is paramount in the host-pathogen interaction and can be characterized as follows: a weak response is detrimental, while an excessive response is equally harmful as it may trigger autoimmune inflammation. Inappropriate Interference in the host-pathogen dynamic can sometimes cause more harm than inaction; therefore, therapy should aim not at mere stimulation, but at modulating the immune system toward a balanced state.

Immunomodulation is a set of measures aimed at restoring and balancing all Components of the immune system. It involves the elimination of adverse impacts on Immunity, specifically avoiding: alcoholic beverages, smoking, unjustified medication use, dietary and household toxins, excessive exhaustive physical exertion, intense ultraviolet radiation, intestinal dysbiosis and constipation, psycho-emotional distress, Sleep deprivation, starvation, unbalanced high- or low-energy diets, and helminth infections.

The functional state of the immune system largely depends on adequate nutrient supply. Dietary deficiency is the primary cause of secondary immunodeficiency. Research has established that prolonged deficiency of even a single dietary factor can impair the body's immune defense. Investigations into the causes of high measles mortality among children in certain African regions—a viral infection rarely fatal in developed countries—revealed that supplementing the diet with vitamin A (deficient in the local population due to low consumption of animal-derived foods) dramatically reduced child mortality from measles.

The development of an immune response against viruses relies on cell proliferation and differentiation processes. These mechanisms demand substantial Energy Expenditure and high protein availability. It has been shown that the initial activation of the immune system in the presence of an infection is accompanied by a 7-to-15-fold increase in the transmembrane influx of Amino Acids, nucleosides, and other Blood-borne substances. This accelerated amino acid uptake kinetics is driven by heightened intracellular Protein Synthesis. Antigen-dependent lymphocyte activation is characterized by elevated metabolic activity, requiring continuous energy and substrate support at levels significantly higher than in the uninfected state.

Following antigen-dependent lymphocyte activation, a state of dynamic equilibrium is established, which demands sustained energy and substrate provision over an extended period. Immune cells draw necessary nutrients from the blood, the levels of which are maintained through exogenous intake. Given that bronchial asthma is a chronic condition, lifelong adequate nutrient intake via A balanced diet is essential to maintain proper immune function.

A critical requirement for an optimal immune system is the presence of adequate amounts of amino acids in the diet, particularly essential ones.

In recent years, The impact of individual amino acids on the immune system has been intensively studied. Research has identified Arginine as an amino acid with pronounced immunotropic effects. Exogenous arginine administration leads to increased thymic mass, elevated T-lymphocyte counts, improved immune response, and enhanced IL-2 kinetics. Clinically, it exhibits positive effects, manifested by a reduction in bacterial complications in burn patients, post-cholecystectomy cases, Sepsis, and stress. Arginine also plays a crucial role in nitric oxide (NO) synthesis. NO molecules are known to be key regulators of vascular endothelium, inducing vasodilation, and are equally essential for macrophage function.

Viral infections are known to increase the demand for energy substrates. Glutamine is the primary amino acid utilized by immune cells as an energy source. It is the most abundant free amino acid in the body, serving as a plastic and energy substrate, as well as a neurotransmitter precursor for gamma-aminobutyric acid (GABA), which is involved in signaling within certain Brain regions. Glutamine promotes Growth Hormone release and Supports lean muscle mass accretion.

The beneficial effects of glutamine on The Human Body are consistently supported by medical practice. It is the most widely utilized amino acid for parenteral nutrition in intensive care units. Glutamine exerts an immunomodulatory effect by enhancing the bactericidal function of neutrophils and increasing macrophage phagocytosis and cytotoxicity, as it serves as an indispensable nutrient for rapidly dividing cells.

Glutamine is abundant in meat products, particularly in bone broth. In broth, glutamine does not require preliminary Digestion; it is rapidly absorbed within minutes, producing a swift therapeutic effect. This effect is experienced by anyone consuming fresh, properly prepared chicken broth. The action of broth is manifested by a comforting sensation in the abdomen, a pleasant overall calming effect, and reduced fatigue. It is no coincidence that this dish is classically recommended for postoperative and convalescent patients.

Another amino acid whose therapeutic role in viral infections has been proven is Lysine. Lysine is a key limiting amino acid that determines the nutritional quality of food Proteins. This essential amino acid is a vital component of all proteins in the body. Numerous experimental and clinical studies have established the anti-herpetic activity of lysine, and it is utilized pharmacologically in the management of herpes infections. Furthermore, lysine enhances neutrophil activity. Currently, researchers are exploring the potential application of lysine not only against Herpesviruses but also against Chronic Fatigue Syndrome viruses, hepatitis, and HIV.

Among nutrients with proven immunoprotective properties, Vitamin C holds a special place. Vitamin C protects immunocompetent cells from damage by acting as an antioxidant. It is worth noting that vitamin C exhibits antioxidant properties only in synergy with bioflavonoids; synthetic ascorbic acid in high doses can act as a pro-oxidant. Vitamin C has been proven to normalize the phagocytic activity and antimicrobial properties of neutrophils and macrophages, activate antibody synthesis (particularly immunoglobulins A and M), stimulate the Synthesis of the C3 Complement component and interferon, promote phagocytosis, enhance polymorphonuclear leukocyte migration and chemotaxis, restore leukocyte function suppressed during viral infections, and suppress inflammatory and allergic reactions via histamine inactivation. The crucial role of vitamin C in the immune system is underscored by the fact that the concentration of ascorbic acid in neutrophils is 150-fold higher than in Blood Plasma.

The important role of vitamin A and carotenoids in supporting the immune system has been well established. They help normalize Cell Differentiation by altering Gene Expression within the Major Histocompatibility Complex, enhance DNA Synthesis, and suppress proliferation, thereby inhibiting tumor growth and metastasis. Vitamin A and carotenoids increase mucosal resistance to infections, participate in the synthesis of immunoglobulins (including secretory immunoglobulin A), protect dividing immunocompetent cells, and provide immunoprotection for various specific and non-specific defense factors (such as interferons and Lysozyme). Additionally, they activate Lysosomes in phagocytes, which is essential for digesting engulfed microorganisms.

Vitamin E also exhibits immunotropic properties through the antioxidant protection of immunocompetent cells. Furthermore, it activates protein synthesis, including immunoglobulins, and raises endogenous interferon levels.

Selenium and zinc have also demonstrated pronounced immunomodulatory properties. Selenium is a component of more than 100 proteins, and selenium-containing proteins are even found in viruses. For instance, the selenium preparation Ebselen is used in the Treatment of viral diseases, including AIDS, due to its ability to penetrate the coding region of The Cell. Selenium deficiency in the body not only impairs antioxidant defense but also increases susceptibility to viral infections, including newly mutated strains. As for zinc, its role in the immune system is critically important. Research shows that zinc deficiency causes thymic involution, a reduction in the number and function of thymocytes, lowered serum thymulin levels (since zinc is required for its activation), decreased delayed-type hypersensitivity, fewer peripheral T-lymphocytes, reduced T-lymphocyte proliferation in response to PHA, and diminished cytotoxic activity of T-lymphocytes, helper T-cell function, NK cell activity, macrophage function (phagocytosis and intracellular killing), and neutrophil function (phagocytosis and chemotaxis), alongside reduced antibody production.

Restoring normal zinc levels in the body leads to several positive effects: an increase in thymulin levels, the recovery of impaired immunological Functions, an increase in CD4+ lymphocytes in AIDS patients, a reduction in opportunistic infections in AIDS patients, enhanced production of IFN-alpha, IFN-gamma, IL-1, IL-6, and TNF-alpha, and increased expression of the IL-2 receptor.

There is a close interconnection between zinc and vitamin A METABOLISM. Because vitamin A hypovitaminosis is frequently accompanied by zinc deficiency, it is advisable to consume them in combination. The same applies to vitamin C, which is also best taken alongside zinc. High amounts of zinc are found in meat, Liver, fish, and eggs, and zinc deficiency is particularly common among vegetarians.

One of the hallmark features of chronic Inflammatory Diseases of the Upper Respiratory Tract is the impairment of Adrenal gland function. This problem is further compounded by the fact that glucocorticoids are among the most frequently prescribed medications for these patients, which exacerbates adrenal insufficiency and leads to various complications. The adrenal cortex synthesizes a range of Steroid Hormones derived from Cholesterol. For the normal functioning of the adrenal cortex, it is essential to ensure an adequate supply of high-quality protein, cholesterol, lecithin, Vitamins A, E, C, and B-complex vitamins, especially pantothenic acid. Among the Adrenal Cortex Hormones, glucocorticosteroids are the most important in inflammatory conditions. They actively influence all metabolic processes in the body. By enhancing glucose synthesis in the liver, stimulating Gluconeogenesis, reducing glucose utilization by muscles, and acting as Insulin antagonists, glucocorticosteroids can disrupt Carbohydrate Metabolism to the point of inducing Diabetes Mellitus.

In addition, glucocorticosteroids possess potent anti-inflammatory properties, which include increasing capillary resistance, amplifying the vasomotor action of noradrenaline, and inhibiting the release of histamine and serotonin. Glucocorticosteroids also suppress leukocyte migration and chemotaxis, and inhibit Other Aspects of the tissue response to inflammatory stimuli. Furthermore, they suppress Antibody production in plasma cells and exert anti-allergic effects. The anti-inflammatory action of glucocorticosteroids stems from their ability to inhibit phospholipase A2 synthesis, thereby restricting the availability of arachidonic acid for The production of inflammatory Prostaglandins and Leukotrienes. It is worth noting that both pro-inflammatory and anti-inflammatory factors are derived from various classes of fatty acids. External influences, endogenous factors, and Hormones Involved in inflammatory reactions do not act directly, but rather exclusively through cellular components.

Glucocorticosteroids affect a wide array of Organs and systems in the body. In excess, they reduce muscle protein synthesis, induce Protein Catabolism, and impair glucose utilization. Their impact on immune organs involves causing involution of The Lymphatic system, resulting in decreased lymphocyte and eosinophil counts in the blood alongside an increase in neutrophils. Glucocorticosteroids also promote bone demineralization, leading to Osteoporosis and urinary calcium loss, while inhibiting intestinal calcium absorption and acting as vitamin D3 antagonists. Excessive intake of glucocorticosteroids can alter mental status and cause gastrointestinal disturbances, such as increased gastric secretion and the formation of erosive and ulcerative lesions.

While the long-term THERAPEUTIC USE OF glucocorticosteroids is justified by their effectiveness in managing allergic reactions, prolonged administration leads to more pronounced Changes in the adrenal cortex, decreased endogenous hormone synthesis, and a higher risk of side effects.

The nutritional goals for patients with bronchial asthma and chronic fatigue syndrome are to provide an adequate supply of energy, building blocks, and regulatory factors, create favorable nutritional conditions for the regeneration of bronchial mucosal cells, reduce inflammation, normalize immune function, improve adrenal health, and mitigate the Adverse effects of pharmacotherapy.

When designing the diet, any allergies or intolerances to specific foods must be considered and those items eliminated from the menu. Patients are advised to keep a food diary recording not only the food items consumed but also their culinary preparation and food combinations. Dietary restrictions should be well-founded rather than hypothetical. True food allergies are actually quite rare; According to the British Allergy Foundation, true food allergies affect about 1.5% of the population. They typically develop in early childhood, most commonly in response to milk. With age, the prevalence of true food allergies drops to 6% in older children, 4% in adolescents, and 1-2% in adults. Unjustifiably eliminating most "suspicious" foods impoverishes the patient's diet and worsens nutritional deficiencies. We recommend consuming natural, whole foods and avoiding products of unknown origin and composition that are rich in preservatives, colorants, and other additives.

To meet the patient's Energy Requirements, we prescribe a diet with an caloric value that matches physiological needs. For overweight individuals, we recommend reducing caloric intake by 450–500 kcal by cutting back on readily digestible CARBOHYDRATES and starch-rich foods. Easily digestible carbohydrates promote fluid retention and worsen edema. Overweight patients with bronchial asthma should be strongly encouraged to gradually lose weight. Obesity is typically associated with impaired cardiac function and left ventricular weakness, which can overwork the right ventricle, raise blood pressure in the Pulmonary Circulation, and inevitably lead to plasma transudation into the alveoli. Conversely, in cases of underweight, the caloric value of the diet is moderately increased across all components—proteins, fats, and carbohydrates.

Protein is a fundamental dietary component that serves as the building block for virtually every cell in the body. The protein quota for these patients should be at least 1.2–1.5 g per kg of ideal body weight, with 50–60% coming from animal sources. Ensuring an adequate protein intake is particularly crucial for children and adolescents with bronchial asthma. Outdated dogmas regarding the restriction of animal protein in asthma should be abandoned. If bronchial asthma is accompanied by an infection, protein intake must be increased. Any infection is a stressor for the body; during stress, proteins in mucosal and immune Tissues break down rapidly, diminishing the protective function of the epithelium and impairing the immune system. This increased protein requirement should be met using foods with high biological activity—primarily animal products such as eggs, meat, liver, fish, cottage cheese, and fermented dairy products. These foods are rich in Essential Amino Acids, fatty acids, and vitamins. Only those specific animal protein sources that are genuinely not tolerated by the patient should be excluded, while concurrently increasing the quota of other well-tolerated protein foods. In cases of food intolerance, attention should be paid to the gastrointestinal tract and appropriate corrections made.

When selecting carbohydrates, preference should be given to locally traditional vegetables (such as cabbage, bell peppers, carrots, pumpkin, and tomatoes), fruits, and berries. Early greenhouse-grown vegetables and berries cultivated with growth promoters should be avoided. The amount of grain products depends on the patient's weight. For those with normal or, in particular, reduced body weight, dishes made from oatmeal, buckwheat, millet, and rice are recommended. Flour products should be consumed in moderate amounts, or kept to a minimum in case of elevated body weight. Sugar intake should not exceed 20 g per day. Patients are encouraged to drink tea (especially green tea), rosehip infusion, and natural coffee with milk or cream.

Fats play a vital role in the nutrition of patients with bronchial asthma and chronic fatigue syndrome, acting not merely as a nutrient source but as therapeutic agents. It is worth noting that the bronchopulmonary system is exceptionally well-adapted to fat. After intestinal absorption, chylomicrons (fat droplets) are too large to enter the portal circulation and instead travel via the thoracic lymphatic duct directly into the lesser circulation's Vascular System. Consequently, the bronchopulmonary system is practically bathed in blood rich in chylomicrons. People have long intuitively recognized the healing properties of natural fats in pulmonary diseases and traditionally used goat milk, kumis, tea with butter, badger fat, and other remedies for treatment.

Today, this phenomenon has received scientific validation. Fatty acids are precursors to crucial regulatory factors—prostaglandins—which dictate how cells react to environmental changes. A cell's state, The properties of its membrane, and its response to incoming signals depend heavily on the specific types of fatty acids present. The primary Lipids of cell membranes are Phospholipids, glycosphingolipids, and cholesterol. Membrane Proteins vary in number from 6–8 to 100, with The Plasma Membrane containing the highest concentration: Enzymes, transport proteins, structural proteins, histocompatibility markers, receptors for various molecules, and integral proteins. Each type of membrane features its own distinct set of proteins. When cholesterol levels rise, membrane fluidity decreases and permeability drops; conversely, when cholesterol falls, fluidity increases and the membrane becomes more permeable to molecules. The fatty acid composition of cell membranes is influenced by the Dietary intake of cholesterol, phospholipids, and omega-6 and omega-3 fatty acids. A diet dominated by vegetable oils and margarine, combined with a reduction in dietary cholesterol, lecithin, and Choline, can alter cell Membrane Structure, lower its resilience and resistance to damaging factors, and accelerate Lipid Peroxidation (LPO). LPO generates a large quantity of aldehydes, ketones, and alcohols within membranes, most of which are toxic. LPO products also include isoprostanes, isothromboxanes, and isoleukotrienes—physiologically active metabolites of arachidonic acid produced via cyclooxygenase and lipoxygenase pathways. Particularly dangerous are long-lived LPO products such as hydroperoxides, aldehydes, epoxides, and isoprostanes, which can migrate into the cell interior and interact with DNA nitrogenous bases, as well as DNA Replication and Repair enzymes. This can cause DNA strand breaks and ultimately lead to cell death.

Given The Importance of fats for the bronchial epithelium, dietary fat should not be restricted. For patients with normal or reduced body weight, the fat quota should be increased to 1.5–1.8 g per kg of ideal body weight, while for overweight individuals it should be moderately reduced. However, in all cases, the intake of lecithin should be increased and The ratio of omega-6 to omega-3 fatty acids adjusted to 1:4. Omega-6 fatty acids serve as precursors for inflammatory prostaglandins. It is important to recognize that modern foods are rich in hidden omega-6 fatty acids found in various light oils, margarine, industrial cooking fats, and even 72.5% fat butter, which often contains significant vegetable oil admixtures. Patients should be informed of this when prescribed a diet. Sour cream, heavy cream, and the natural fats found in meat and fish are preferable fat sources. Furthermore, consumption of foods rich in omega-3 fatty acids—such as fish oil, flaxseed oil, black currant seed oil (an excellent source of Eicosanoids), mackerel, salmon, and others—must be increased, as omega-3 fatty acids give rise to anti-inflammatory and relaxing prostaglandins.

The modern human diet is overloaded with polyunsaturated fatty acids, predominantly of the omega-6 Class. In recent years, the consumption of many traditional foods in Ukraine has declined—including sources of lecithin (eggs, dairy), cholesterol (eggs, meat), and omega-3 fatty acids (fish)—while vegetable oil consumption has surged by 35%. Considering these dietary trends, patients with bronchial asthma and chronic fatigue syndrome should adjust their nutrition by limiting vegetable oils to 1–2 tablespoons per day, eliminating margarine and light spreads, supplementing with lecithin and fish oil, and avoiding overly low-fat products by instead choosing standard-fat dairy items and cream.

The diet for patients with bronchial asthma and chronic fatigue syndrome should be enriched with VITAMINS AND MINERALS, particularly vitamins A, E, and C (preferably in esterified form), Vitamin B12, niacin, Vitamin B6, zinc, selenium, and molybdenum. Numerous studies have established that vitamin B12 helps ease asthmatic breathing, although the exact mechanism remains fully understood. A similar effect has been observed with vitamin B6. Patients suffering from hypersensitivity to sulfites (found in wine and eggs) have been found to exhibit a molybdenum deficiency. In such cases, molybdenum supplementation is recommended at 250 mcg twice a week, gradually increasing to 500 mcg, and eventually to 750 mcg twice a week. As clinical improvement occurs, the dose should be tapered back down to 250 mcg once a week. Magnesium is another mineral that helps regulate bronchial function and can be taken separately at 500 mg daily or in combination with calcium, noting that calcium also helps reduce inflammatory and allergic reactions.

The patient's diet must contain adequate amounts of cholesterol and lecithin. The ideal food item for these patients is the egg yolk, preferably from free-range, home-raised chickens. Such yolks are rich in cholesterol, lecithin, vitamin A, and other components essential for restoring adrenal cortex function and synthesizing glucocorticosteroids. Additionally, egg yolks are an excellent source of vitamin D3, which is necessary for preventing osteoporosis. The number of egg yolks is unlimited for patients with autoimmune hepatitis. Proper culinary preparation is important; raw egg yolks are ideal and can be used in egg-milk shakes, nog, and other dishes.

Patients with bronchial asthma and chronic fatigue syndrome undergoing glucocorticosteroid therapy often experience Water-electrolyte imbalances, fluid retention, and increased urinary potassium excretion. To restore potassium balance, we recommend vegetable juices (especially potato juice) and jacket potatoes. Concentrated vegetable broths rich in potassium can also be prepared for cooking: finely chopped potatoes, cabbage, parsley ROOT, celery, carrots, peppers, and other vegetables are covered with cold water, simmered for 20–30 minutes, infused, and strained. The resulting broth is then used in soups and sauces.

To regenerate the adrenal cortex, patients should be additionally prescribed lecithin, S-adenosylmethionine, vitamins A, E, carotenoids, vitamin C (preferably the L-form with bioflavonoids), B-complex vitamins, pantothenic acid at 50 mg per day, and omega-3 fatty acids. If esterified forms of vitamin C are unavailable, ascorbic acid should be taken in small doses throughout the day. In this case, it is best to add ascorbic acid to beverages like juices or compotes and sip these enriched drinks continuously. Since vitamin C without bioflavonoids can sometimes exhibit pro-oxidant properties, it is advisable to include herbal hepatoprotectors rich in bioflavonoids to counteract any potential negative effects of ascorbic acid.

To prevent osteoporosis, small doses of vitamin D3 are recommended, particularly during the winter months. In summer, when patients have ample opportunity to spend time outdoors, vitamin D3 supplementation can be omitted. Because hypervitaminosis of vitamins A and D3 carries risks, dosages must be modest, not exceeding 3,000 IU (or 1.5 mg of pure retinol) daily for 3 weeks; in cases of true Vitamin A deficiency, doses can be increased to 5,000 IU daily. Using carotenoids—such as beta-carotene and lycopene—is a safer alternative. Excellent sources of carotenoids include orange pumpkin and red carrots (12 mg and 9 mg per 100 g, respectively), which should be cooked with butter, sour cream, or heavy cream.

The dosage of vitamin D3 can range from 150 IU to 1,000 IU depending on the severity of osteoporosis. High doses of vitamin D3 should be prescribed only in winter for 2–3 months, with 400–450 IU being the optimal daily dose during this period; the dose should be tapered in late autumn and early spring, and discontinued entirely in summer. Higher doses of vitamin D3 are required for patients receiving high-dose glucocorticosteroid therapy. Foods rich in vitamin D include the livers of tuna, cod, halibut, and chum salmon, as well as herring, salmon, sardines, milk, and butter. One of the ideal dietary sources of vitamin D3 is egg yolks from backyard chickens, which are also much more accessible than seafood.

For the Prevention and treatment of osteoporosis, calcium supplements are recommended (preferably balanced with other key components, particularly magnesium, vitamin C, and The amino acid lysine). Magnesium is a vital structural component of Bone tissue, with about 50% of the body's magnesium localized in bones, Cartilage, and tooth enamel. An adequate intake of vitamin C is also essential, as it is required for Collagen synthesis and the metabolism of bone-critical amino acids like Proline, which is formed from the amino acid lysine exclusively in the presence of vitamin C.

To reduce circulating immune complexes and autoimmune aggression, enteral detoxification using food products is recommended. For this purpose, we recommend consuming foods rich in Pectins (such as vegetable purees made from pumpkin and carrots, pumpkin, carrots and apples, baked pumpkin, baked beets, and juices with pulp), birch sap, carrot-apple juice, cucumber juice, and other vegetable or fruit-vegetable juices. For patients with bronchial asthma, normalizing the functional state of the intestine and intestinal microbiocenosis is of utmost importance. It is a well-known fact that All living organisms require nutrition; the COMPOSITION OF THE intestinal contents determines which microflora will predominate. Fructooligosaccharides, which are abundant in certain vegetables such as pumpkin, carrots, beets, Jerusalem artichoke, and onions, serve as essential nutrients for bifidobacteria and lactobacilli. In addition to exerting a positive effect on the intestinal microflora, dietary fibers—especially pectins—are readily fermented by the gut microbiota to produce short-chain fatty acids, namely acetate, butyrate, and propionate. Furthermore, pectins increase the population of propionic acid Bacteria in the gut, which are the primary producers of short-chain fatty acids. These short-chain fatty acids serve as an energy source for colonocytes and improve the condition of the intestinal mucosa. Given that the gut functions as a vital immune organ, normalizing its condition helps reduce toxic manifestations and allergic tendencies.

Considering that dietary recommendations must be followed by the patient throughout their life, the food Selection and Methods of culinary preparation should not severely restrict the patient's dietary choices. Pureeing and chopping, which are traditionally recommended in clinical nutrition, apply only to cases where the patient has concomitant digestive pathology accompanied by pain and pronounced dyspeptic syndrome, and such measures are prescribed exclusively during exacerbations. Patients should not be forbidden from drinking coffee unless there are other contraindications. Coffee contains chlorogenic acid, which exhibits marked antioxidant properties. Moreover, caffeine—sharing the same MECHANISM OF ACTION as theophylline (theophylline being a specific form of caffeine)—possesses bronchodilatory properties. Coffee should not be consumed simultaneously with theophylline, as this may lead to caffeine overdose. Strong tea is beneficial for patients, as its caffeine is related to theobromine, a substance that dilates the Bronchi. Additionally, tea contains a high amount of polyphenols and possesses antioxidant properties, while the habit of consuming these beverages daily provides the body with essential antioxidants.

Thus, a wholesome, balanced diet rich in all essential components exerts various beneficial effects on all links in the Pathogenesis of bronchial asthma. Given its long-lasting effects and safety profile, dietary therapy should serve as the cornerstone of treatment for every bronchial asthma patient presenting with chronic fatigue syndrome.