Patient Information

Dietary Education

Clear Liquid
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A clear liquid diet consists of both clear liquids and clear foods that turn to liquid at room temperature. The clear liquid diet is generally followed only for a period of 3–4 days. It generally is used before a test that requires an empty bowel, before or after bowel or stomach surgery, or with certain intestinal conditions that make digestion of regular food difficult.

Not allowed

Milk, tomato juice, fruit juices, and fruit nectars are not clear liquids. Some people are asked to avoid red foods and liquids and carbonated beverages, as well.

Allowed

The following are allowed while on this diet:

  • Water
  • Clear sodas, such as ginger ale
  • Fruit juices without pulp
  • Lemonade and limeade
  • Freezer pops without pieces of fruit in it
  • Italian ice
  • Kool-Aid®
  • Broth
  • Gelatin
  • Coffee or tea without cream (you can add sugar and lemon juice)
  • Sports drinks
  • Clear nutrition supplements, such as Ensure Clear™
  • Hard candies

Sample menu

Breakfast: 8 am 8 fl oz apple juice8 fl oz coffee or tea with 2 tsp sugar1 C Jell-O®
Snack: 10 am One bottle of Ensure Clear
Lunch: 12 pm 8 fl oz chicken broth½ C Italian ice16 fl oz Gatorade®
Snack: 2 pm One bottle of Ensure Clear
Dinner: 5 pm 8 fl oz beef broth8 fl oz ginger aleTwo twin-pop freezer pops
Snack: 8 pm One bottle of Ensure Clear

 

Contains 1295 calories, 2 g fat, 2885 mg sodium, 285 g carbohydrate, 167 g sugar, 34 g protein

C=cup, fl oz=fluid ounce, g=grams, mg=milligrams, tsp=teaspoon

 

References and recommended readings

Drugs.com. Clear liquid diet. Available at: http://www.drugs.com/cg/clear-liquid-diet.html. Accessed March 11, 2013.

MedlinePlus. Diet—clear liquid. Available at: http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000205.htm. Accessed March 11, 2013.

Full Liquid
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Diet – full liquid

A full liquid diet is made up only of fluids and foods that are normally liquid and foods that turn to liquid when they are at room temperature, like ice cream. It also includes strained creamy soups, tea, juice, Jell-O, milkshakes, pudding, and popsicles.

You can NOT eat solid foods when you are on a full liquid diet.

This diet is easier to digest than solid food. It gives you the proteins, fluids, salts, and minerals that you need for energy.

For most people on a full liquid diet, the goal is to get 1,350 to 1,500 calories and 45 grams of protein a day.

Eating only a full liquid diet gives you enough nutrition. You can stay on it for a long time. Your doctor may recommend certain vitamins and supplements. This diet is safe for people with diabetes, but only when they are followed closely by their doctor.

Why You May Need This Diet

You may need to be on a full liquid diet right before a medical test or procedure, or before certain kinds of surgery. It is important to follow the diet exactly to avoid problems with your procedure or surgery or your test results.

You also may need to be on a full liquid diet for a little while after you have had surgery on your stomach or intestine. You may also need to be on this diet if you are having trouble swallowing or chewing.

What You Can Eat and Drink

You can eat or drink only things that are liquid. You may have these foods and drinks:

  • Water
  • Fruit juices, including nectars and juices with pulp
  • Butter, margarine, oil, cream, custard, and pudding
  • Plain ice cream, frozen yogurt, and sherbet.
  • Fruit ices and popsicles
  • Sugar, honey, and syrups
  • Soup broth (bouillon, consommé, and strained cream soups — but NO solids)
  • Sodas, such as ginger ale and Sprite
  • Gelatin (Jell-O)
  • Boost, Ensure, Resource, Sustacal. and other liquid supplements
  • Tea or coffee with cream or milk and sugar or honey

Ask your doctor if you can include these foods in your full liquid diet:

  • Cooked, refined cereals, such as Cream of Wheat, cream of rice, oatmeal, grits, or farina
  • Strained meats, like the ones in baby food
  • Potatoes pureed in soup

Do NOT eat any kind of cheese, fruit (fresh, frozen, or canned), meat, and cereals that are not on your “okay” list.

Also, do NOT eat raw or cooked vegetables. And, do NOT eat ice cream or other frozen desserts that have any solids in them or on top – things like nuts, chocolate chips, and pieces of cookies.

Try having a mix of 5 to 7 of the foods you can eat for breakfast, lunch, and dinner.

Liquid foods do NOT include “mashed” foods, such as mashed potato or avocado.

Adding More Calories

If you need to be on a full liquid diet for a long time, you can do some things to get more calories. Ask your doctor if you can eat these foods together to add calories:

  • Nonfat dry milk added to your drinks
  • Instant breakfast powder added to milk, puddings, custards, and milkshakes
  • Strained meats (like the ones in baby food) added to broths
  • Butter or margarine added to hot cereal and soups
  • Sugar or syrup added to beverages
High Fiber
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What is dietary fiber?

The part of plant foods that your body cannot digest.

Where is fiber found?

Mainly in fruits, vegetables, whole grains, legumes (dried beans and peas), nuts and seeds.

What can fiber do to help me?

  • Reduce high blood cholesterol
  • Reduce high blood pressure
  • Manage body weight
  • Prevent constipation and relieve hemorrhoids
  • Improve blood sugar control
  • Reduce colon cancer risk

How much fiber do I need each day?

Men: 30 to 38 grams

Women: 21 to 25 grams

How can I increase the fiber in my diet?

  • Eat at least 3 ounce-equivalents of whole grains per day, substituting whole grain products (i.e., bread, cereal, rice, pasta) for refined grains.
  • Eat more fruits and vegetables – at least 2 cups of fruit and 2-1/2 cups of vegetables each day.
  • Choose whole (fresh, frozen or dried) vegetables and fruits over juices, which have most of the fiber removed.
  • Include legumes (i.e., dried beans and peas) with your meals regularly; increase your intake of these foods gradually to limit the gaseous side effects.
  • Include nuts and seeds several times a week, which also contain monounsaturated fats and can help control blood cholesterol levels.
  • Increase the amount of fiber in your diet gradually, using a variety of food sources. Try to include one fiber-rich food in every meal.
  • Drink plenty of water to enhance fiber’s effectiveness and to prevent constipation.

What are some other ways to “sneak” fiber into my diet?

  • Sprinkle flax meal, wheat germ, nuts and/ or seeds onto cold or hot cereal, yogurt, cottage cheese or frozen yogurt.
  • Sprinkle high fiber cereal (i.e., 100% bran) onto yogurt, fresh fruit, and frozen yogurt.
  • Liven up high fiber cereal with fresh fruits such as bananas or berries, or with dried fruits such as raisins, cranberries or apricots.
  • Substitute whole wheat flour, spelt flour or oat bran for at least 1/3 of the all-purpose flour in baked goods recipes.
  • Serve entrees like steak, chicken or fish on a “bed” or grilled zucchini and peppers, sautéed spinach or kale, sautéed onions and mushrooms, or grated carrots and slivered beets.
  • Order or make your own pizza with a whole wheat crust and with vegetable toppings such as spinach, tomatoes, broccoli, mushroom, onion, roasted red pepper and/or green pepper.
  • Snack on oat bran pretzels, whole wheat crackers, air-popped popcorn, dry-roasted nuts or seeds, whole-grain cereal, fresh or dried fruit, baked tortilla chips dipped in fresh salsa, or raw vegetables dipped in hummus.
  • Add frozen vegetables to soups, sauces, casseroles or pasta dishes.
  • Try different types of whole grains for variety – like barley, kasha, bulgur, quinoa, wild rice, and couscous. Also try other pasta varieties – like whole wheat, brown rice or quinoa pastas.
  • Choose bean soup over cream of broccoli soup, oat bran over instant cream of wheat, whole wheat bagel over croissant or white bagel, and baked potato (with skin) over French fries or mashed potatoes.

Is it difficult to eat 21-38 grams of fiber in a day?

  • 1/2 cup baked beans = 11 grams
  • 1/2 cup 100% bran ready-to-eat cereal = 8 grams
  • 1 medium orange = 2 grams
  • 1/2 cup cooked broccoli = 3 grams
  • 1 medium pear = 5 grams
  • 1 medium baked potato with skin = 5 grams
  • Grand total = 34 grams fiber

REFERENCES

Hodges LS. High Fiber Diet. The Florida Medical Nutrition Therapy Manual 2005 Edition. Florida Dietetic Association, 2005.

Position of the American Dietetic Association: Health implications of dietary fiber. J Am Diet Assoc. 2002;102:993-1000.

USDHHS and USDA Dietary Guidelines for Americans 2005. Carbohydrates. Web-site accessed April 3, 2006: http://www.health.gov/dietaryguidelines/dga2005/document/html/chapter7.htm.

Whitney EN, Cataldo CN, Rolfes SR. Understanding Normal and Clinical Nutrition, 6th ed. Brooks Cole; 2001.

GERD-Reflux
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When you swallow, food goes from your throat, down your esophagus, through the lower esophageal sphincter (LES), and into your stomach. When the LES does not close properly, the stomach contents leak back, or reflux, into the esophagus.

This backflow of acid from the stomach can irritate and sometimes damage the lining of the inside of the esophagus, causing an uncomfortable burning sensation, commonly called heartburn. Occasional heartburn is common, but if heartburn occurs more than two times per week, it is possibly gastroesophageal reflux disease (GERD).

Symptoms of GERD

  • Heartburn
  • Regurgitation of stomach acid into the mouth
  • Difficulty and/or pain when swallowing
  • Chest pain
  • Excessive clearing of the throat
  • The feeling that food is stuck in your throat
  • Burning sensation in the mouth

Factors that may contribute to GERD

  • Pregnancy
  • Overweight
  • Alcohol use
  • Smoking
  • Medications that delay emptying of the stomach or that increase the backup of acid into the esophagus

Diet and GERD

Removing some foods from the diet might help improve GERD, but it is important to know that individual reactions to foods vary. Other individuals who have GERD may not tolerate the same foods that you can tolerate, so rather than eliminating all suggested foods (see the following list), try limiting them one by one to see if your GERD improves. Avoiding entire groups of foods sometimes is not necessary and may result in nutritional deficiencies.

Foods that may have an association with reflux events include:

  • Citrus fruits:
    • Oranges
    • Grapefruit
    • Lemons
    • Limes
  • Spicy foods
  • Chocolate
  • Caffeinated beverages:
    • Tea
    • Coffee
    • Cola
  • High-fat foods:
    • Oil
    • Butter
  • Desserts
  • Fried foods
  • Raw garlic
  • Raw onions
  • Mint flavorings:
    • Peppermint oil
    • Spearmint oil
  • Tomato-based foods:
    • Spaghetti sauce
    • Pizza
    • Chili

Lifestyle changes that may help manage GERD

  • Raise the head of your bed by 6″−8″ by placing blocks of wood under the bedposts, instead of using extra pillows
  • Eat a low-fat diet
  • Avoid alcohol
  • Stop smoking, if you smoke
  • Maintain a healthy body weight—lose weight if necessary
  • Eat smaller meals
  • Wear loose-fitting clothing
  • Drink liquids between meals, instead of with meals
  • Avoid lying down, bending over, or straining after eating
  • Do no lie down for at least 3 hours after a meal
  • Chew gum after meals to help neutralize stomach acid

Other tips

  • Work with a registered dietitian to develop an eating plan that is right for you
  • Check out other sources of information, including the:

–  American Gastroenterological Association (AGA): www.gastro.org

–  American College of Gastroenterology (ACG): http://gi.org/

References and recommended readings

Cleveland Clinic. Gastroesophageal reflux disease (GERD).

Available at: http://www.clevelandclinic.org/health/health-info/docs/1600/1697.asp?index=7042. Accessed September 24, 2012.

Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012.

National Digestive Diseases Information Clearinghouse (NDDIC). Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/. Accessed September 24, 2012.

Contributed by Carol S. Casey, RD, CDN

Updated by Nutrition411.com staff

Colon Polyps & Cancer Prevention
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Cancer Risk

  • Although genes influence your risk for cancer, most of the difference in cancer risk between people is due to factors that are not inherited. Avoid tobacco products, achieve or maintain a healthy weight, stay active throughout life, and eat a healthy diet to greatly reduce your lifetime risk of developing or dying from cancer.
  • These same behaviors are also linked with a lower risk of developing heart disease and diabetes.

Eat a healthy diet, with an emphasis on plant foods

  • Choose foods and drinks in amounts that help you achieve and maintain a healthy weight.
  • Read food labels to become more aware of portion sizes and calories. Be aware that “low-fat” or “non-fat” does not necessarily mean “low-calorie.”
  • Eat smaller portions you eat high-calorie foods.
  • Choose vegetables, whole fruit, and other low-calorie foods instead of calorie-dense foods such as French fries, potato and other chips, ice cream, donuts, and sweets.
  • Limit your intake of sugar-sweetened beverages such as soft drinks, sports drinks, and fruit-flavored drinks.
  • When you eat away from home, be especially mindful to choose food low in calories, fat, and added sugar, and avoid eating large portion sizes.
  • Limit how much processed meat and red meat you eat.
    • Limit your intake of processed meats such as bacon, sausage, lunch meats, and hot dogs.
  • Choose fish, poultry, or beans instead of red meat (beef, pork, and lamb).
    •  If you eat red meat, choose lean cuts and eat smaller portions.
  • Prepare meat, poultry, and fish by baking, broiling, or poaching rather than by frying or charbroiling.
  • Eat at least 2½ cups of vegetables and fruits each day.
    • Include vegetables and fruits at every meal and for snacks.
    • Eat a variety of vegetables and fruits each day.
    • Emphasize whole fruits and vegetables
    • If you drink juice, choose 100% fruit or vegetable juice.
    • Limit your use of creamy sauces, dressings, and dips with fruits and vegetables.
  • Choose whole grains instead of refined grain products.
    • Choose whole-grain breads, pasta, and cereals (such as barley and oats) instead of breads, cereals, and pasta made from refined grains, and brown rice instead of white rice.
    • Limit your intake of refined carbohydrate foods, including pastries, candy, sugar sweetened breakfast cereals, and other high-sugar foods.
  • Studies showing that higher vegetable and fruit intake reduces cancer risk have led researchers to try to figure out which specific nutrients from these foods are responsible.
    • But many studies have not found that supplements containing certain nutrients (like vitamins) reduce cancer risk, and some have even suggested they may cause harm.
    • This is complicated because researchers must try to choose how best to give the supplement, including the exact dose, what group of people to give it to, and how long to give it for, which isn’t always known.
    • Studies of nutritional supplements to reduce cancer risk have not all been disappointing, but for the most part, research does not support their use in lowering cancer risk.
    • Foods and nutrients probably each have small effects on health that add up when consumed together, and they may interact in complex ways that are not well understood.
  • The best advice at this time is to eat whole foods as part of an overall healthy diet as outlined in this guideline, with special emphasis on controlling calorie intake to help get to and maintain a healthy weight.
  • If you drink alcohol, limit their intake to no more than 2 drinks per day for men and 1 drink per day for women.
    • The recommended limit is lower for women because of their smaller body size and slower breakdown of alcohol.

 

Original Document from:

American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention

Irritable Bowel Syndrome
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Irritable bowel syndrome (IBS) has a variety of symptoms, most commonly cramping, abdominal pain, bloating, constipation, and diarrhea. Symptoms can vary from person to person, and may alternate between diarrhea and constipation. IBS causes discomfort and often is upsetting, but it does not harm the intestines or lead to diseases such as cancer.

 

Causes of IBS

Experts do not know what causes IBS. Stress, diet, drugs, or hormones may aggravate gastrointestinal (GI) problems. The body’s immune system, which helps fight infection, also may contribute to IBS. Some researchers think that increased levels of serotonin, a normal chemical that is found in the GI tract, is involved. Other researchers believe that individuals with IBS have a large intestine that is more sensitive to certain foods or stress, which causes more of a reaction to stressors or certain foods than others. In these people, stress may trigger colon spasms.

 

Tests to diagnose IBS

Irritable bowel syndrome is diagnosed using the Rome III criteria—symptoms of recurrent abdominal pain or discomfort and a marked change in bowel habits present for at least 6 months, with symptoms experienced on at least 3 days during at least three of these months, with two or more of the following findings applying:

  • Pain is relieved by a bowel movement
  • Onset of pain is related to a change in frequency of stool
  • Onset of pain is related to a change in the appearance of stool

Other tests can help rule out other problems, with diagnosis usually based on these results and a careful review of the type and frequency of symptoms.

 

Foods to avoid with IBS

Changing your diet might help improve your IBS symptoms. Having a well-balanced diet, eating regular meals, and drinking plenty of fluids are important in order to keep your digestive system moving. Foods that might cause problems vary from person to person, but some foods might make your IBS worse.

You might find it helpful to avoid foods that cause gas or flatulence, including:

  • Fatty meats
  • Whole milk
  • Whole-milk cheeses
  • Fatty desserts
  • Broccoli
  • Brussels sprouts
  • Cabbage
  • Cauliflower
  • Corn
  • Onions

In some people, sweeteners, such as fructose or sorbitol, or use of alcohol or caffeine can make IBS symptoms worse.

Tolerance to specific foods is very individualized. Keeping a food diary can help you decide if any specific foods are causing symptoms. You do not need to completely avoid certain foods or groups of foods, unless you are able to link them with your IBS symptoms. A registered dietitian can review your food diary and help you identify foods that might make your symptoms worse.

 

Foods that can help IBS

Certain foods can possibly help those suffering from IBS. A diet high in fiber seems to help with IBS symptoms. Experts recommend 25–35 grams of fiber/day.

Good sources of fiber include:

  • Most fruits and vegetables (remember you might need to avoid the vegetables listed under Foods to avoid)
  • Dried beans, such as pinto beans and black-eyed peas
  • Whole-grain breads and cereals

 

Probiotics

Some experts think probiotics (live microorganisms found in certain foods) can help with symptoms. Probiotics are available for sale in the form of dietary supplements and foods. Examples of foods containing probiotics include yogurt, miso, tempeh, and some juices and soy drinks. Many different types of probiotics exist, and as a result, it is difficult to determine which ones, if any, are beneficial to digestive health. Not enough evidence is available to say for sure that probiotics help, but they probably will not hurt, especially when you eat foods such as yogurt.

 

FODMAPS

In recent years, patients with IBS have followed the low FODMAP™ Diet.

FODMAP is an abbreviation for:

  • Fermentable
  • Oligosaccharides (fructans and galactans)
  • Disaccharides (lactose)
  • Monosaccharides (excess fructose in a food)
  • Polyols (sugar alcohols, such as sorbitol, maltitol, mannitol, xylitol and isomalt)

 

FODMAPs are sugars (carbohydrates) in the foods that we eat that are poorly absorbed by the gut. The intestinal bacteria in the gut can react to these foods and cause abdominal pain, gas, bloating, diarrhea, and/or constipation. When foods rich in FODMAPs are removed from the diet of patients with functional gastrointestinal disorders (IBS), often symptoms of IBS are reduced.

The FODMAP Diet sometimes is complicated, requiring elimination of many foods. You should consult with a registered dietitian skilled in FODMAPS and/or elimination to learn more about this diet.

 

Medicines for IBS

Medicines often are used to help with IBS symptoms. Your doctor may suggest fiber supplements for constipation or antidiarrheal medicines for diarrhea. Sometimes an antispasmodic medicine will help reduce pain in the abdomen. Tricyclic antidepressants and selective serotonin reuptake inhibitors in low doses may help reduce abdominal pain.

 

Other treatments

If you feel stressed frequently and have IBS, stress management may help your symptoms.

 

Examples of stress management include:

  • Relaxation training and therapy
  • Counseling and support
  • Regular exercise
  • Adequate sleep
  • Removing stressful situations from your life, if possible.

 

References and recommended readings

Academy of Nutrition and Dietetics. Nutrition Care Manual®. Available to subscribers at: www.nutritioncaremanual.org. Accessed October 22, 2012.

Merck Manual for Health Care Professionals. Irritable bowel syndrome (IBS) (spastic colon). Available at: http://www.merck.com/mmpe/sec02/ch021666/ch021666a.html?qt=diagnosing%20malnutrition&alt=sh. October 22, 2012.

National Center for Complementary and Alternative Medicine. Oral probiotics: an introduction. Available at: http://www.nccam.nih.gov/health/probiotics/introduction.htm. Accessed October 22, 2012.

National Digestive Diseases Information Clearinghouse (NDDIC). Irritable bowel syndrome. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/. Accessed October 22, 2012.

University of Michigan Health System. Low FODMAPS Diet Introduction. Available at: http://www.med.umich.edu/1libr/gastro/LowFODMAPDietIntroduction.pdf. Accessed October 22, 2012.

Review Date 10/12

G-0727

Irritable Bowel Syndrome:

Potentially Bothersome Foods

The majority of research on specific foods and their effects on symptoms of irritable bowel syndrome (IBS) is not conclusive. However, some foods are more often implicated as potentially bothersome to people suffering from IBS. The following list is not a recommendation of foods that all people with IBS should avoid. It is a brief listing of foods that some people with IBS find exacerbates their condition. A careful look at diet history and continual recording of food and symptoms is recommended.

In most cases, the symptoms will occur within 3 days of eating the suspected food. In addition, you should not conclude that a food is likely to have caused symptoms unless the symptoms occur on three separate occasions following ingestion of the specific food. If you want to remove a suspected food from your diet, you should eliminate it for 2 weeks and then try to reintroduce it to your normal diet. If it is not obvious that the food is harmful when included in the diet, and if improvement is not seen when it is excluded, it is not necessary to continue to eliminate the food.

If a food does indeed seem to cause bothersome symptoms, perhaps this is not a permanent problem. You may, after 3-6 months, want to add the food back into their diet to see if symptoms still occur.

 

Potentially bothersome foods

The following foods are potentially bothersome for some people with IBS:

  • Fried foods
  • High-fat foods
  • Caffeine:
  • Coffee
  • Tea
  • Chocolate
  • Cola
  • Carbonated beverages
  • Alcohol
  • Gas-producing foods:
  • Beans
  • Brussels sprouts
  • Onions
  • Celery
  • Carrots
  • Raisins
  • Bananas
  • Prune juice
  • Apricots
  • Wheat germ
  • Bagels
  • Sugar alcohols such as sorbitol:
  • Sugarless food products
  • Some varieties of fruit*
  • Fructose:
  • Honey
  • Fruits
  • Fruit juices
  • Table sugar
  • High-fructose corn syrup*
  • Fructans:
  • Wheat
  • Onions
  • Lactose:
  • Milk
  • Dairy foods
  • Insoluble fiber:
  • Whole-wheat flour
  • Bran
  • Wheat
  • Edible seeds
  • Mature vegetables
  • High-protein foods:
  • Meat
  • Poultry
  • Corn
  • Peas
  • Bananas
  • Potatoes
  • Eggs
  • Wheat

*Note: Fruits containing both fructose and sorbitol are especially likely to cause symptoms in sensitive individuals. Examples of fruits containing both fructose and sorbitol include cherries, apples, and pears.

References and recommended readings

Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc. 2009;109:1204-1214.

Palmer S. Soothing the symptoms of IBS with diet therapy. Available at:

http://www.todaysdietitian.com/newarchives/060109p34.shtml. Accessed August 4, 2009.

Review Date 10/09

G-1130

Gastroparesis
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Gastroparesis, or delayed stomach emptying, is a disabling motility disease. It happens when nerves to the stomach are damaged or stop working. When the main nerve (vagus) is not working properly, the movement of food is slowed or stopped. This disorder may cause:

  • Nausea and vomiting
  • Heartburn
  • Bloating and belching
  • Feeling full quickly
  • Decreased appetite
  • Weight loss
  • Feeling tired
  • Blood glucose (sugar) fluctuations

Gastroparesis interferes with your ability to grind, mix, and digest your food properly. These guidelines may help reduce the side effects:

  • Consume small, frequent meals, four to six times/day
  • Limit fiber foods to 10 grams (g)/day, avoiding:
    • Foods such as cabbage and broccoli, which tend to stay in the stomach
    • High-fiber foods, when you have severe symptoms
  • Eat low-fat foods, and avoid foods high in fat—fats, including vegetable oils, naturally cause a delay in stomach emptying
  • Choose nutritional supplements with <10 g of fat/can for extra calories and protein (examples: Ensure®, Glucerna®, Carnation® Instant Breakfast®, and Slim-Fast®)
  • Chew food thoroughly; sometimes ground or pureed meats are tolerated better
  • Do not lie down for at least 1 hour after meals
  • Consume most liquids between meals
  • Try to keep a daily routine—stress can bring on or worsen symptoms
  • Pay attention to symptoms—sometimes taking a slow-paced walk can help
  • Keep a food record of foods that cause distress, and try to avoid those foods
  • Review all medications and over-the-counter products with your doctor—some medications can slow down digestion
  • Focus on meals that have little odor, if food odors trigger nausea; try foods such as:
    • Cold foods and cold sandwiches
    • Foods that are grilled outdoors
  • Avoid the following, which can irritate the lining of the stomach and result in acid reflux:
    • Smoking
    • Alcohol
    • Caffeine
    • Spicy foods
    • Mint
  • Keep your blood sugar under control, if you have diabetes, and let your doctor know if your blood sugar consistently runs higher than 200

Treatment of gastroparesis

Treating gastroparesis depends on the frequency and severity of symptoms. Four stages of treatment are outlined in this section, but work with your doctor and/or dietitian for specific recommendations.

Stage 1: Liquids

Liquids usually leave the stomach rapidly by gravity alone. Consume any tolerated liquids slowly throughout the day with plain saltine crackers.

Stage 2: Blenderized foods

You can puree Stage 3 and Stage 4 foods in your blender. You may need to add some liquid when blending solid foods.

Stage 3: Soft, low-fat and low-fiber foods

This stage starts to include a small amount of fat—<40 g/day.

Stage 4: Solid, low-fat and low-fiber foods

This is intended for long-term maintenance. Fat is limited to 50 g/day, and fibrous foods are avoided, because you can not digest many plant fibers. 

Foods for Stage 3

Food group Recommended Limit
Breads or starches Cream of Wheat®, pasta, white rice, egg noodles, and low-fat crackers Oatmeal and whole-grain rice, cereals, and breads
Fruits Canned fruits without skins, apple juice, cranberry juice, grape juice, and prune juice All fresh and dried fruits, canned fruits with skins, and citrus juices
Vegetables Vegetable juice and well-cooked vegetables without skins All raw vegetables, cooked vegetables with skins, broccoli, brussels sprouts, cabbage, cauliflower, celery, corn, onion, peas, and sauerkraut
Milk products Yogurt, low-fat cheese, skim milk, and products made with skim milk Whole milk, creams, and half-and-half
Soups Fat-free bouillon, soups made from skim milk, and broths with pasta, noodles, and allowed vegetables Soups made with heavy cream or whole milk and broths containing fat
Desserts and sweets Hard candies, caramels, pudding and custards made from skim milk, frozen yogurt, fruit ice, gelatin, ice milk, jelly, honey, and syrups High-fat desserts (cakes, pies, cookies, pastries, and ice cream) and fruit preserves
Fats and oils Any type of fat in small amounts None
Meats, eggs, and legumes Eggs, peanut butter (2 tablespoons [Tbsp]/day) Beef, poultry, pork, dried peas, beans, and lentils

 

Foods for Stage 4

Food group Recommended Limit
Breads or starches All not listed in “limit” column High-fiber, whole-grain breads and cereals
Fruits All fruits and juices not listed in “limit” column Fruits with skins, raspberries, strawberries, blackberries, coconut, and figs
Vegetables Vegetable juices, well-cooked vegetables, and raw vegetables not listed in “limit” column, chewed well Raw vegetables with skins, cabbage, broccoli, brussels sprouts, celery, and pea pods
Milk products Yogurt, low-fat cheese, skim milk, and products made with skim milk Whole milk, creams, and half-and-half
Soups Any tolerated None
Desserts and sweets Hard candies, caramels, pudding and custards made from skim milk, frozen yogurt, fruit ice, gelatin, ice milk, jelly, honey, and syrups High-fat desserts (cakes,  cookies, ice cream, pastries, and pies) and fruit preserves
Fats and oils Any tolerated, in small amounts None
Meats, eggs, and legumes Eggs, peanut butter, poultry, fish, and lean ground beef Fibrous meats (steaks, roasts, and chops), dried beans, peas, and lentils

 

Sample meal plan for Stage 4

Breakfast

1 cup (C) Cream of Wheat

One slice white toast

1 Tbsp Peanut Butter

Morning snack

6 ounces (oz) low-fat yogurt

One half of a banana

Lunch

8 fluid ounce (fl oz) nutritional drink*

½ C pasta

1 Tbsp fat-free Parmesan cheese

1 Tbsp low-fat butter

Afternoon snack

½ C canned peaches

¼ C low-fat cottage cheese

Dinner

2 oz chicken or fish

½ C cooked squash

½-1 C mashed potatoes

Evening snack

1 C low-fat pudding or frozen yogurt

Total calories: 1630

Total fiber: 10 g

Total fat: 49 g

Total protein: 71 g 

Beverages between meals

Choose from the following:

▪ Vegetable juice

▪ Crystal Light®

▪ Water mixed with fruit juice

▪ Nutritional drink supplements, if needed (examples: Ensure, Glucerna, Carnation Instant Breakfast, Slim-Fast)

References

Jackson Seigelbaum Gastroenterology. Gastroparesis diet for delayed stomach emptying. Available at: http://www.gicare.com/pated/edtgs08.htm. Accessed September 29, 2008.

National Digestive Diseases Information Clearinghouse. Gastroparesis. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/. Accessed September 29, 2008.

Parrish CR. What to eat, idiopathics: food suggestions and tips for people who have idiopathic gastroparesis or delayed emptying of the stomach. Available at: http://www.digestivedistress.com:80/main/page.php?page_id=27. Accessed September 29, 2008.

Ulcerative Colitis
Download PDF ↓

Dietary Management of Inflammatory Bowel Disease

Crohn’s disease and chronic ulcerative colitis are two diseases that are together classified as inflammatory bowel disease (IBD) and result in an inflammation of the intestines.

Symptoms

During an attack, symptoms may include:

  • Abdominal pain
  • Nausea and vomiting
  • Frequent bowel movements
  • Diarrhea
  • Weight loss
  • Dehydration
  • Anemia
  • Fever

These factors contribute to a loss of appetite in many individuals. In addition, IBD, particularly Crohn’s disease, often is associated with poor digestion and poor absorption of dietary protein, fat, carbohydrates, water, and a wide variety of vitamins and minerals. Thus, much of what a person eats may never really get into the body. Therefore, while dietary habits do not cause the disease, they do play a crucial role in managing it.

Eating plan

The same IBD diet does not necessarily work for everyone, but you can work with your registered dietitian to:

  • Develop an eating plan that will help manage symptoms during the acute phases of a flare-up
  • Help determine what types of foods may exacerbate symptoms
  • Learn how to resume a healthy eating plan that will promote recovery during remissions

In addition, the following dietary tips can help you manage IBD.

Meals

Use this advice when you eat:

  • Eat small, frequent meals and snacks, instead of just a few large meals
  • Choose adequate high-protein foods, even during a flare up, which may help relieve IBD symptoms—lean meats, fish, poultry, and eggs or egg substitutes
  • Do not skip meals, which may cause pain and bloating when you finally do eat
  • Slow down when you eat
  • Chew food well and take small bites

Meal planning

Plan your meals with these tips in mind:

  • Choose adequate high-protein foods, even during a flare-up, which may help relieve IBD symptoms:
    • Lean meats
    • Fish
    • Poultry
    • Eggs or egg substitutes
  • See if cooked vegetables are more easily tolerated than raw vegetables
  • Limit gas-producing foods, such as:
    • Cruciferous vegetables (broccoli, cabbage, cauliflower, and Brussels sprouts)
    • Dried peas, beans, legumes, and lentils
    • Onions
    • Chives
    • Peppers
    • Carbonated beverages
  • Avoid caffeine and foods that contain sorbitol (sweetener used in foods), which may cause diarrhea
  • Limit these foods in your diet, if you develop gas and diarrhea after eating fatty or greasy foods:
    • Butter
    • Margarine
    • Mayonnaise
    • Salad dressing
    • Oil
    • High-fat meats and dairy products
    • Skin of poultry
    • Fried foods
    • Etc

Fiber

Know when to use and limit high-fiber foods:

  • Try foods that are high in fiber, when IBD is under control:
    • Whole-grain breads, bagels, buns, and pasta
    • Bran cereals
    • Whole grains, such as barley, corn, brown rice, and quinoa
    • Dried fruits
    • Berries, oranges, apples, and pears (with skins)
    • Green, leafy vegetables
    • Limit high-fiber foods to help minimize symptoms during a flare-up

Lactose intolerance

If you are lactose intolerant:

  • Avoid lactose-containing (dairy) foods
  • Try soy-based alternatives, lactase enzymes, and lactase-pretreated foods

Beverages

Include liquids in your diet:

  • Drink plenty of fluids, especially water, to prevent constipation and to keep your body hydrated, which sometimes is a challenge during vomiting and diarrhea episodes
  • Use predigested nutritional drinks (elemental diet), as recommended by your registered dietitian, to give your bowels a rest and replenish lost nutrients
  • Avoid alcohol and caffeine, because these stimulate the intestines and may exacerbate IBD symptoms

Vitamins and minerals

Follow your doctor’s recommendation:

  • Take vitamin and/or mineral supplements, according to your doctor’s instructions

New nutritional therapies

The following are new nutritional therapies under consideration:

  • Fish and flaxseed oils—in the diet or as supplements
  • Prebiotics—such as psyllium (a complex carbohydrate)
  • Probiotics—lactobacillus preparations and live-culture yogurt 

References and recommended readings

Crohn’s & Colitis Foundation of America. Diet and nutrition. Available at: http://www.ccfa.org/info/diet?LMI=4.2. Accessed January 24, 2011.

National Digestive Diseases Information Clearinghouse (NDDIC). Crohn’s disease. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/index.htm. Accessed January 24, 2011.

National Digestive Diseases Information Clearinghouse (NDDIC). Inflammatory bowel disease (IBD). Available at:  http://digestive.niddk.nih.gov/ddiseases/topics/IBD.asp. Accessed January 24, 2011.

Tsang G. Inflammatory bowel disease IBD diet (Crohn’s diet). Available at: http://www.healthcastle.com/ibd-diet.shtml. Accessed January 24, 2011.

Review Date 3/11

G-1552

 

Irritable Bowel Syndrome:

Potentially Bothersome Foods

The majority of research on specific foods and their effects on symptoms of irritable bowel syndrome (IBS) is not conclusive. However, some foods are more often implicated as potentially bothersome to people suffering from IBS. The following list is not a recommendation of foods that all people with IBS should avoid. It is a brief listing of foods that some people with IBS find exacerbates their condition. A careful look at diet history and continual recording of food and symptoms is recommended.

In most cases, the symptoms will occur within 3 days of eating the suspected food. In addition, you should not conclude that a food is likely to have caused symptoms unless the symptoms occur on three separate occasions following ingestion of the specific food. If you want to remove a suspected food from your diet, you should eliminate it for 2 weeks and then try to reintroduce it to your normal diet. If it is not obvious that the food is harmful when included in the diet, and if improvement is not seen when it is excluded, it is not necessary to continue to eliminate the food.

If a food does indeed seem to cause bothersome symptoms, perhaps this is not a permanent problem. You may, after 3-6 months, want to add the food back into their diet to see if symptoms still occur.

Potentially bothersome foods

The following foods are potentially bothersome for some people with IBS:

  • Fried foods
  • High-fat foods
  • Caffeine:
    • Coffee
    • Tea
    • Chocolate
    • Cola
  • Carbonated beverages
  • Alcohol
  • Gas-producing foods:
    • Beans
    • Brussels sprouts
    • Onions
    • Celery
    • Carrots
    • Raisins
    • Bananas
    • Prune juice
    • Apricots
    • Wheat germ
    • Bagels
  • Sugar alcohols such as sorbitol:
    • Sugarless food products
    • Some varieties of fruit*
  • Fructose:
    • Honey
    • Fruits
    • Fruit juices
    • Table sugar
    • High-fructose corn syrup*
  • Fructans:
    • Wheat
    • Onions
  • Lactose:
    • Milk
    • Dairy foods
  • Insoluble fiber:
    • Whole-wheat flour
    • Bran
    • Wheat
    • Edible seeds
    • Mature vegetables
  • High-protein foods:
    • Meat
    • Poultry
  • Corn
  • Peas
  • Bananas
  • Potatoes
  • Eggs
  • Wheat

*Note: Fruits containing both fructose and sorbitol are especially likely to cause symptoms in sensitive individuals. Examples of fruits containing both fructose and sorbitol include cherries, apples, and pears.

References and recommended readings

Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc. 2009;109:1204-1214.

Palmer S. Soothing the symptoms of IBS with diet therapy. Available at:

http://www.todaysdietitian.com/newarchives/060109p34.shtml. Accessed August 4, 2009.

Review Date 10/09

G-1130

 

Irritable Bowel Syndrome: Potentially Bothersome Foods

What are the symptoms?

  • Cramping
  • Abdominal pain
  • Bloating
  • Constipation
  • Diarrhea

What aggravates it?

  • Stress
  • Diet
  • Medication
  • Hormones

How is it diagnosed?

No one knows for sure what causes irritable bowel syndrome (IBS) to develop. We do not have an easy way to diagnose it. Some tests rule out other possibilities. IBS is diagnosed if symptoms and frequency seem right.

What should I eat?

Follow these diet tips:

  • Follow a well-balanced diet
  • Eat regularly
  • Drink plenty of fluid

What foods should I avoid?

Avoiding the following gas-causing foods:

  • Fatty meats
  • Fried foods
  • Whole milk
  • Whole-milk cheeses
  • Fatty desserts
  • Broccoli
  • Brussels sprouts
  • Cabbage
  • Cauliflower
  • Corn
  • Onions
  • Beans
  • Celery
  • Carrots
  • Raisins
  • Bananas
  • Prune juice
  • Apricots
  • Wheat germ
  • Bagels

Some people have found that the following foods cause symptoms. Try these foods and see if they change your symptoms:

  • Sweeteners, such as fructose or sorbitol
  • Poultry
  • Fish
  • Alcohol
  • Caffeine
  • Carbonated beverages
  • Wheat
  • Bran
  • Seeds
  • Eggs
  • Potatoes
  • Peas
  • Cherries
  • Apples
  • Pears

What else can I do?

It is a good idea to keep a diary of the foods that you eat and your symptoms. This will help you to see patterns. Meet with a registered dietitian, who is trained to help you find associations between food and symptoms.

What about probiotics?

Probiotics (healthful bacteria) in yogurt and other fermented products also might help.

What treatment is available?

Besides dietary changes, treatment for IBS can include:

  • Relaxation training and therapy
  • Counseling and support
  • Regular exercise
  • Sleep (getting enough is important)
  • Some medications

References and recommended readings

American Dietetic Association. ADA Nutrition Care Manual. Available to subscribers at: www.nutritioncaremanual.org. Accessed October 29, 2010.

Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc. 2009;109:1204-1214.

Merck Manuals Online Medical Library. Irritable bowel syndrome (IBS) (spastic colon). Available at: http://www.merck.com/mmpe/sec02/ch021666/ch021666a.html?qt=diagnosing%20malnutrition&alt=sh. Accessed October 29, 2010.

National Center for Complementary and Alternative Medicine. An introduction to probiotics. Available at: http://nccam.nih.gov/health/probiotics/index.htm. October 29, 2010.

National Digestive Diseases Information Clearinghouse (NDDIC). Irritable bowel syndrome. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/. Accessed October 29, 2010.

Palmer S. Soothing the symptoms of IBS with diet therapy. Available at:
http://www.todaysdietitian.com/newarchives/060109p34.shtml. Accessed October 29, 2010.

Review Date 10/10

G-1414

Crohn’s Disease
Download PDF ↓

Dietary Management of Inflammatory Bowel Disease

Crohn’s disease and chronic ulcerative colitis are two diseases that are together classified as inflammatory bowel disease (IBD) and result in an inflammation of the intestines.

Symptoms

During an attack, symptoms may include:

  • Abdominal pain
  • Nausea and vomiting
  • Frequent bowel movements
  • Diarrhea
  • Weight loss
  • Dehydration
  • Anemia
  • Fever

These factors contribute to a loss of appetite in many individuals. In addition, IBD, particularly Crohn’s disease, often is associated with poor digestion and poor absorption of dietary protein, fat, carbohydrates, water, and a wide variety of vitamins and minerals. Thus, much of what a person eats may never really get into the body. Therefore, while dietary habits do not cause the disease, they do play a crucial role in managing it.

Eating plan

The same IBD diet does not necessarily work for everyone, but you can work with your registered dietitian to:

  • Develop an eating plan that will help manage symptoms during the acute phases of a flare-up
  • Help determine what types of foods may exacerbate symptoms
  • Learn how to resume a healthy eating plan that will promote recovery during remissions

In addition, the following dietary tips can help you manage IBD.

Meals

Use this advice when you eat:

  • Eat small, frequent meals and snacks, instead of just a few large meals
  • Choose adequate high-protein foods, even during a flare up, which may help relieve IBD symptoms—lean meats, fish, poultry, and eggs or egg substitutes
  • Do not skip meals, which may cause pain and bloating when you finally do eat
  • Slow down when you eat
  • Chew food well and take small bites

Meal planning

Plan your meals with these tips in mind:

  • Choose adequate high-protein foods, even during a flare-up, which may help relieve IBD symptoms:
    • Lean meats
    • Fish
    • Poultry
    • Eggs or egg substitutes
  • See if cooked vegetables are more easily tolerated than raw vegetables
  • Limit gas-producing foods, such as:
    • Cruciferous vegetables (broccoli, cabbage, cauliflower, and Brussels sprouts)
    • Dried peas, beans, legumes, and lentils
    • Onions
    • Chives
    • Peppers
    • Carbonated beverages
  • Avoid caffeine and foods that contain sorbitol (sweetener used in foods), which may cause diarrhea
  • Limit these foods in your diet, if you develop gas and diarrhea after eating fatty or greasy foods:
    • Butter
    • Margarine
    • Mayonnaise
    • Salad dressing
    • Oil
    • High-fat meats and dairy products
    • Skin of poultry
    • Fried foods
    • Etc

Fiber

Know when to use and limit high-fiber foods:

  • Try foods that are high in fiber, when IBD is under control:
    • Whole-grain breads, bagels, buns, and pasta
    • Bran cereals
    • Whole grains, such as barley, corn, brown rice, and quinoa
    • Dried fruits
    • Berries, oranges, apples, and pears (with skins)
    • Green, leafy vegetables
    • Limit high-fiber foods to help minimize symptoms during a flare-up

Lactose intolerance

If you are lactose intolerant:

  • Avoid lactose-containing (dairy) foods
  • Try soy-based alternatives, lactase enzymes, and lactase-pretreated foods

Beverages

Include liquids in your diet:

  • Drink plenty of fluids, especially water, to prevent constipation and to keep your body hydrated, which sometimes is a challenge during vomiting and diarrhea episodes
  • Use predigested nutritional drinks (elemental diet), as recommended by your registered dietitian, to give your bowels a rest and replenish lost nutrients
  • Avoid alcohol and caffeine, because these stimulate the intestines and may exacerbate IBD symptoms

Vitamins and minerals

Follow your doctor’s recommendation:

  • Take vitamin and/or mineral supplements, according to your doctor’s instructions

New nutritional therapies

The following are new nutritional therapies under consideration:

  • Fish and flaxseed oils—in the diet or as supplements
  • Prebiotics—such as psyllium (a complex carbohydrate)
  • Probiotics—lactobacillus preparations and live-culture yogurt 

References and recommended readings

Crohn’s & Colitis Foundation of America. Diet and nutrition. Available at: http://www.ccfa.org/info/diet?LMI=4.2. Accessed January 24, 2011.

National Digestive Diseases Information Clearinghouse (NDDIC). Crohn’s disease. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/index.htm. Accessed January 24, 2011.

National Digestive Diseases Information Clearinghouse (NDDIC). Inflammatory bowel disease (IBD). Available at:  http://digestive.niddk.nih.gov/ddiseases/topics/IBD.asp. Accessed January 24, 2011.

Tsang G. Inflammatory bowel disease IBD diet (Crohn’s diet). Available at: http://www.healthcastle.com/ibd-diet.shtml. Accessed January 24, 2011.

Review Date 3/11

G-1552

 

Irritable Bowel Syndrome:

Potentially Bothersome Foods

The majority of research on specific foods and their effects on symptoms of irritable bowel syndrome (IBS) is not conclusive. However, some foods are more often implicated as potentially bothersome to people suffering from IBS. The following list is not a recommendation of foods that all people with IBS should avoid. It is a brief listing of foods that some people with IBS find exacerbates their condition. A careful look at diet history and continual recording of food and symptoms is recommended.

In most cases, the symptoms will occur within 3 days of eating the suspected food. In addition, you should not conclude that a food is likely to have caused symptoms unless the symptoms occur on three separate occasions following ingestion of the specific food. If you want to remove a suspected food from your diet, you should eliminate it for 2 weeks and then try to reintroduce it to your normal diet. If it is not obvious that the food is harmful when included in the diet, and if improvement is not seen when it is excluded, it is not necessary to continue to eliminate the food.

If a food does indeed seem to cause bothersome symptoms, perhaps this is not a permanent problem. You may, after 3-6 months, want to add the food back into their diet to see if symptoms still occur.

Potentially bothersome foods

The following foods are potentially bothersome for some people with IBS:

  • Fried foods
  • High-fat foods
  • Caffeine:
    • Coffee
    • Tea
    • Chocolate
    • Cola
  • Carbonated beverages
  • Alcohol
  • Gas-producing foods:
    • Beans
    • Brussels sprouts
    • Onions
    • Celery
    • Carrots
    • Raisins
    • Bananas
    • Prune juice
    • Apricots
    • Wheat germ
    • Bagels
  • Sugar alcohols such as sorbitol:
    • Sugarless food products
    • Some varieties of fruit*
  • Fructose:
    • Honey
    • Fruits
    • Fruit juices
    • Table sugar
    • High-fructose corn syrup*
  • Fructans:
    • Wheat
    • Onions
  • Lactose:
    • Milk
    • Dairy foods
  • Insoluble fiber:
    • Whole-wheat flour
    • Bran
    • Wheat
    • Edible seeds
    • Mature vegetables
  • High-protein foods:
    • Meat
    • Poultry
  • Corn
  • Peas
  • Bananas
  • Potatoes
  • Eggs
  • Wheat

*Note: Fruits containing both fructose and sorbitol are especially likely to cause symptoms in sensitive individuals. Examples of fruits containing both fructose and sorbitol include cherries, apples, and pears.

References and recommended readings

Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc. 2009;109:1204-1214.

Palmer S. Soothing the symptoms of IBS with diet therapy. Available at:

http://www.todaysdietitian.com/newarchives/060109p34.shtml. Accessed August 4, 2009.

Review Date 10/09

G-1130

 

Irritable Bowel Syndrome: Potentially Bothersome Foods

What are the symptoms?

  • Cramping
  • Abdominal pain
  • Bloating
  • Constipation
  • Diarrhea

What aggravates it?

  • Stress
  • Diet
  • Medication
  • Hormones

How is it diagnosed?

No one knows for sure what causes irritable bowel syndrome (IBS) to develop. We do not have an easy way to diagnose it. Some tests rule out other possibilities. IBS is diagnosed if symptoms and frequency seem right.

What should I eat?

Follow these diet tips:

  • Follow a well-balanced diet
  • Eat regularly
  • Drink plenty of fluid

What foods should I avoid?

Avoiding the following gas-causing foods:

  • Fatty meats
  • Fried foods
  • Whole milk
  • Whole-milk cheeses
  • Fatty desserts
  • Broccoli
  • Brussels sprouts
  • Cabbage
  • Cauliflower
  • Corn
  • Onions
  • Beans
  • Celery
  • Carrots
  • Raisins
  • Bananas
  • Prune juice
  • Apricots
  • Wheat germ
  • Bagels

Some people have found that the following foods cause symptoms. Try these foods and see if they change your symptoms:

  • Sweeteners, such as fructose or sorbitol
  • Poultry
  • Fish
  • Alcohol
  • Caffeine
  • Carbonated beverages
  • Wheat
  • Bran
  • Seeds
  • Eggs
  • Potatoes
  • Peas
  • Cherries
  • Apples
  • Pears

What else can I do?

It is a good idea to keep a diary of the foods that you eat and your symptoms. This will help you to see patterns. Meet with a registered dietitian, who is trained to help you find associations between food and symptoms.

What about probiotics?

Probiotics (healthful bacteria) in yogurt and other fermented products also might help.

What treatment is available?

Besides dietary changes, treatment for IBS can include:

  • Relaxation training and therapy
  • Counseling and support
  • Regular exercise
  • Sleep (getting enough is important)
  • Some medications

References and recommended readings

American Dietetic Association. ADA Nutrition Care Manual. Available to subscribers at: www.nutritioncaremanual.org. Accessed October 29, 2010.

Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc. 2009;109:1204-1214.

Merck Manuals Online Medical LibraryIrritable bowel syndrome (IBS) (spastic colon). Available at: http://www.merck.com/mmpe/sec02/ch021666/ch021666a.html?qt=diagnosing%20malnutrition&alt=sh. Accessed October 29, 2010.

National Center for Complementary and Alternative Medicine. An introduction to probiotics. Available at: http://nccam.nih.gov/health/probiotics/index.htm. October 29, 2010.

National Digestive Diseases Information Clearinghouse (NDDIC). Irritable bowel syndrome. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/. Accessed October 29, 2010.

Palmer S. Soothing the symptoms of IBS with diet therapy. Available at:
http://www.todaysdietitian.com/newarchives/060109p34.shtml. Accessed October 29, 2010.

Review Date 10/10

G-1414

Dysphagia 5 Levels
Download PDF ↓

Dysphagia Level 1 Diet

(dysphagia pureed)

Sometimes patients who have trouble chewing and/or swallowing whole foods need a special diet. The National Dysphagia Diet, published in 2002, developed universal terminology for texture-modified diets. The dysphagia pureed diet (level 1) is one of three levels of texture modification that is used.

Who orders a dysphagia pureed diet?

Normally a speech therapist will recommend a dysphagia pureed diet after evaluating a patient who has problems chewing or swallowing food. In some cases, medical tests are used to determine the best texture for a patient.

What types of foods are allowed on this diet?

All foods are totally pureed to a pudding-like consistency. No coarse textures, raw fruits or vegetables, or nuts are allowed. It is important to include a variety of foods from all different food groups when providing a pureed diet, including fruits, vegetables, grains, meats and meat substitutes, and dairy foods.

Does pureed food taste bland?

Unless you have another dietary restriction, you should receive food that is flavored and seasoned like the food on a regular consistency diet. 

Are regular liquids allowed on a dysphagia pureed diet?

Possibly. Regular liquids are OK for some patients. However, depending on your condition, you might need to have thickened liquids, so you can swallow them safely

Talk to your speech and language pathologist to learn more.

What is a slurry?

A slurry is a soft, moist mixture often used for people with swallowing problems. An example is a slice of bread or a pancake moistened with milk. The moisture of the liquid makes it easier for someone with swallowing problems to swallow soft bread products. 

Food Textures for Dysphagia Pureed Diet

(dysphagia level 1)

 

Food Groups

Foods Allowed

Foods to Avoid

Meats and meat substitutes
  • · Pureed meats (pureed to pudding-like consistency)
  • · Smooth soufflés
  • · Soft, moist tofu
  • · Hummus
  • · Whole, ground, or chopped meats, fish, or poultry
  • · Legumes or lentils, unless pureed
  • · Cheese and cottage cheese, unless pureed
  • · Eggs that are not pureed
  • · Nut butters, unless pureed into other foods to correct consistency
Breads
  • · Pureed bread mixes
  • · Pregelled slurried breads, pancakes, French toast, waffles, sweet rolls, etc

 

 

  • · All other bread, rolls, crackers, biscuits, pancakes, French toast, muffins, etc
Cereals
  • · Smooth cooked cereals, such as farina-type cereals with a pudding-like consistency

 

 

  • · Dry cereals and cooked cereals with lumps, seeds, or chunks
  • · Oatmeal
Fruits
  • · Pureed fruit
  • · Well-mashed fresh bananas

 

  • · Whole fruits (fresh, frozen, canned, or dried)
Vegetables
  • · Pureed vegetables without lumps, pulp, or seeds
  • · Tomato sauce without seeds

 

  • · All other vegetables that are not pureed
Potatoes and starches
  • · Mashed potatoes and pureed potatoes with gravy, butter, margarine, or sour cream
  • · Well-cooked pasta, noodles, or pureed rice (blended to a smooth consistency)

 

  • · All other potatoes, rice, and noodles
  • · Plain mashed potatoes
  • · Cooked grains
Desserts
  • · Smooth pudding custards, yogurt, pureed desserts, and soufflés
  • · All other desserts
  • · If patient is on thickened liquids, restrict ice cream, ices, milk shakes, frozen yogurt, gelatin, and other frozen desserts, because they are thin-liquid consistency at room temperature
Beverages
  • · Any smooth, homogenous beverage without lumps, chunks, or pulp (may need to thicken to proper consistency)

 

 

References and recommended readings

American Dietetic Association. Level 1 pureed diet: patient handout. In: Nutrition Care Manual®. Available to subscribers at: www.nutritioncaremanual.org. Accessed January 10, 2011.

National Dysphagia Diet Task Force. National Dysphagia Diet: Standardization for Optimal Care. Chicago, IL: The American Dietetic Association; 2002.

 

Dysphagia Level 2 Diet

(mechanically altered) 

Sometimes patients who have trouble chewing and/or swallowing whole foods need a special diet. The National Dysphagia Diet, published in 2002, developed universal terminology for texture-modified diets. The dysphagia mechanically altered diet (level 2) is one of three levels of texture modification that is used.

Who orders a dysphagia diet?

Normally a speech and language pathologist will recommend a dysphagia mechanically altered diet after evaluating a patient who has problems chewing or swallowing food. In some cases, medical tests are used to determine the best texture for a patient.

What types of foods are allowed on this diet?

Patients on a dysphagia level 2 diet can tolerate some textures of foods, but not all. The diet  includes foods that are soft textured and moist, making them easy to swallow. Soft, well-cooked foods, well-moistened ground meats, moist and well-cooked potatoes, noodles, and dumplings are examples of foods that are the proper texture for this diet. All foods of a pureed consistency are allowed on this diet.

It is important to include a variety of foods from all different food groups when providing a mechanically altered diet, including fruits, vegetables, grains, meats and meat substitutes, and dairy foods.

Are regular liquids allowed on a mechanically altered diet?

Possibly. For some patients, regular liquids are OK. However, depending on your condition, you might need to have thickened liquids, so you can swallow them safely. Talk to your speech and language pathologist to learn more.

What is a slurry?

A slurry is a soft, moist mixture often used for people with swallowing problems. An example is a slice of bread or a pancake moistened with milk. The moisture of the liquid makes it easier for someone with swallowing problems to swallow soft bread products. 

Food Textures for Dysphagia Mechanically Altered Diet

(dysphagia level 2 diet)

 

Food Groups

Foods Allowed

Foods to Avoid

Meats and meat substitutes
  • Moistened ground or cooked meat, poultry, or fish (serve with sauces)
  • Casseroles without rice
  • Moist, well-cooked pasta
  • Moist meat loaf or meatballs
  • Poached, scrambled, or soft-cooked eggs
  • Tofu
  • Well-cooked and moist mashed legumes or beans

 

  • Dry meats, such as bacon, sausage, or hot dogs
  • Dry casseroles or casseroles with rice or large chunks
  • Cheese cubes and slices
  • Peanut butter
  • Hard-cooked or crisp fried eggs
  • Sandwiches and pizza
Breads
  • Soft, well-moistened pancakes
  • Pureed bread mixes or slurried breads

 

  • Slices of bread
  • Toast
Cereals
  • Cooked cereals with little texture, including oatmeal
  • Slightly moistened, dry cereals with little texture

 

  • Coarse cooked cereals
  • Whole-grain or coarse dry cereals
Fruits
  • Soft and drained canned or cooked fruits without seeds or skin
  • Ripe bananas

 

  • Fresh or frozen fruits
  • Cooked fruit with skin or seeds
Vegetables
  • All soft, well-cooked vegetables that are in small pieces and mashable with a fork
  • Cooked corn and peas
  • Brussels sprouts, broccoli, cabbage, asparagus, or other rubbery cooked vegetables
Potatoes and starches
  • Well-cooked and moistened boiled, baked, shredded, or mashed potatoes
  • Well-cooked pasta noodles in sauce

 

  • Potato skins and chips
  • Fried potatoes
  • Rice
Desserts
  • Puddings and custards
  • Soft fruit pies (bottom crust only)
  • Crisps and cobblers with soft topping and no seeds
  • Most canned fruits
  • Soft moist cakes with icing or slurried cakes

 

  • Dry, coarse cakes and cookies
  • Desserts with nuts, seeds, coconut, pineapple, or dried fruit
  • Rice or bread pudding
Beverages
  • All beverages with little texture or pulp

 

 

References and recommended readings

American Dietetic Association. Level 2 dysphagia diet (dysphagia mechanically altered): patient handout. In: Nutrition Care Manual®. Available to subscribers at: www.nutritioncaremanual.org. Accessed January 10, 2011.

National Dysphagia Diet Task Force. National Dysphagia Diet: Standardization for Optimal Care. Chicago IL: The American Dietetic Association; 2002.

 

Dysphagia Level 3 Diet

(dysphagia advanced)

Sometimes patients who have trouble chewing and/or swallowing whole foods need a special diet. The National Dysphagia Diet, published in 2002, developed universal terminology for texture-modified diets. The dysphagia advanced diet (level 3) is one of three levels of texture modification that is used.

Who orders a dysphagia advanced diet?

Normally a speech and language pathologist will recommend a dysphagia advanced diet after evaluating a patient who has problems chewing or swallowing food. In some cases, medical tests are used to determine the best texture for a patient.

What types of foods are allowed on this diet?

Foods that are nearly normal textures are allowed on the dysphagia advanced diet, with the exception of crunchy, sticky, or very hard foods. The diet includes bite-sized foods that are moist. Foods that are allowed on dysphagia level 1 and level 2 diets also are allowed on the dysphagia advanced diet.

It is important to include a variety of foods from all different food groups when providing a dysphagia advanced diet, including fruits, vegetables, grains, meats and meat substitutes, and dairy foods. The following table provides specific information about foods that are allowed on the dysphagia level 3 diet.

Food Textures for Dysphagia Advanced Diet

(dysphagia level 3)

 

Food Groups

Foods Allowed

Foods to Avoid

Meat and meat substitutes
  • Thin-sliced, tender, or ground meats or poultry, well-moistened
  • Fish
  • Eggs (any preparation acceptable)
  • Yogurt (no nuts or coconut)
  • Casseroles with small chunks of tender or ground meat

 

  • Tough or dry meats or poultry
  • Dry fish or fish with bones
  • Chunky peanut butter
  • Yogurt with nuts or coconut
Bread
  • Well-moistened breads, biscuits, muffins, pancakes, waffles, etc (add jelly, margarine, and other toppings to moisten well)
  • Dry bread, toast, crackers, etc
  • Tough, crusty breads, such as French bread
Cereals
  • All well-moistened cereals
  • Coarse or dry cereals
Fruits
  • All canned and cooked fruits
  • Soft, peeled, ripe fresh fruits, such as peaches, kiwi, mangos, cantaloupe, etc
  • Soft berries with small seeds, such as strawberries
  • Hard-to-chew fresh fruits, such as apples or pears
  • Stringy, pulpy fruits, such as papaya, pineapple, or mango
  • Fresh fruits with tough peels, such as grapes
  • Prunes, apricots, and other dried fruits (unless cooked)
Vegetables
  • All cooked, tender vegetables
  • Shredded lettuce
  • All raw vegetables, except shredded lettuce
  • Cooked corn
  • Rubbery cooked vegetables
Potatoes and starches
  • All, including rice and tender fried potatoes
  • Tough or crisp fried potatoes
Desserts
  • All desserts, except those on the avoid list
  • Dry cakes or cookies that are chewy
  • Anything with nuts, seeds, dry fruits, coconut, and pineapple
Beverages
  • Any beverage of recommended consistency

 

Can I drink regular liquids if I am on a dysphagia pureed diet?

Possibly. For some patients, regular liquids are OK. However, depending on your condition, you might need to have thickened liquids, so you can swallow them safely. Talk to your speech and language pathologist to learn more.

References and recommended readings

American Dietetic Association. Level 3 advanced diet: patient handout. In: Nutrition Care Manual®. Available to subscribers at: www.nutritioncaremanual.org. Accessed January 13, 2011.

National Dysphagia Diet Task Force. National Dysphagia Diet: Standardization for Optimal Care. Chicago, IL: The American Dietetic Association; 2002.

Gluten Free
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Gluten is another word for the proteins found in wheat, rye, and barley. Individuals with celiac disease must follow a gluten-free diet.

These gluten-free diet basics are important to know and follow.

Wheat, Rye, or Barley

Avoid wheat, rye, and barley. They all contain gluten.

Oats

Oats often are cross-contaminated with gluten-containing grains. Pure, uncontaminated oats, tested and labeled as gluten free, are now available and are considered safe to consume in moderation.

Wheat and wheat-containing grains

Other names for wheat or wheat-containing grains that contain gluten are:

  • Spelt
  • Kamut®
  • Einkorn
  • Emmer
  • Triticale
  • Durum
  • Farina
  • Enriched flour
  • Wheat starch
  • Wheat germ
  • Self-rising flour
  • Graham flour
  • Bulgur
  • Semolina
  • Cake flour
  • Pastry flour
  • Matzo

Wheat free does not mean gluten free. Wheat-free foods still may contain rye or barley.

Malt

Malt and malt flavorings are made from barley. They are not gluten free.

Grains and flours that are safe

The following grains and flours are safe for individuals on a gluten-free diet:

  • Rice
  • Corn
  • Quinoa
  • Amaranth
  • Arrowroot
  • Buckwheat
  • Montina™
  • Flax
  • Potato
  • Sago
  • Soy
  • Sorghum
  • Tapioca
  • Teff
  • Cornstarch
  • Any flour made from nuts, beans, tubers, or legumes

Cross contamination

Follow this advice to prevent gluten-free foods from coming in contact with foods containing gluten:

  • Store gluten-free foods separately from foods containing gluten
  • Designate certain appliances, such as a toaster, for use with gluten-free products only
  • Use clean tools for cooking, cutting, mixing, and serving gluten-free foods
    • Have separate containers of butter, peanut butter, and condiments, or institute a no-double-dipping rule
    • Do not purchase flour or cereal from open bins

Foods to choose

Stick to plain, simple foods, which are mostly found in the outer aisle of the grocery store, including:

  • All plain meats, poultry, fish, or eggs
  • Legumes and nuts in all forms
  • Corn and rice in all forms
  • Dairy products, including milk, butter, margarine, real cheese, and plain yogurt
  • All plain fruits or vegetables (fresh, frozen, or canned)
  • Vegetable oils, including canola
  • All vinegar, except malt vinegar
  • Any food that says it is gluten free

References and recommended readings

Mahan LK, Escott-Stump S. Krause’s Food and Nutrition Therapy. 12th ed. St. Louis, MO: Saunders/Elsevier; 2008.

National Digestive Diseases Information Clearinghouse (NDDIC). Celiac disease. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/. Accessed January 10, 2011.

Low Fat/Diarrhea/Gallbladder
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Diarrhea is loose, watery, and frequent stools. Diarrhea is considered chronic (long term) when you have had loose or frequent stools for more than 4 weeks. Many patients undergoing cancer treatment experience diarrhea.

Other reasons for diarrhea include:

  • Fecal impaction
  • Medications such as antibiotics
  • Partial intestinal obstruction
  • Poor diet
  • Surgery
  • Underlying infection, such as viruses, bacteria, or parasites

Identifying the cause is important in order to avoid future problems. Management is different for each individual.

 

What can you do to overcome the symptoms of diarrhea?

Liquids

Drink plenty of liquids between meals to avoid dehydration. Water, broth, gelatin, ices, and sports drinks are all good choices.

Room temperature

Some people tolerate liquids at room temperature better than those served hot or cold.

Sugar-free foods

Avoid sugar-free foods when you have diarrhea. The sugar alcohols used to sweeten these foods, such as sorbitol and xylitol, can worsen diarrhea.

Dairy products

Do not consume dairy products when symptoms are most severe. Add low-fat or fat-free milk back into your diet slowly.

Small meals

Have small meals and snacks, rather than big meals.

Bland foods

It is recommended that you choose bland foods when you have diarrhea.

Good choices include:

  • Applesauce
  • Bananas
  • Canned soft fruits
  • Cooked hot cereals
  • Crackers
  • Eggs
  • Mashed potatoes
  • Pretzels
  • Smooth nut butters
  • Soup
  • Toast
  • White rice

 

Foods to avoid

Do not choose foods that are greasy, fried, or fatty. Do not add butter, oil, or other fats to your foods.

Certain foods tend to cause discomfort for many patients, including:

  • Beets
  • Broccoli
  • Brussels sprouts
  • Cabbage
  • Carbonated beverages
  • Cauliflower
  • Corn
  • Dried beans
  • Dried fruit
  • Fried or fatty meats
  • Greens
  • High-fiber breads
  • High-fiber cereals
  • Nuts
  • Onions
  • Raw fruits (except bananas and melon)
  • Raw vegetables
  • Whole grains
  • Whole milk

Grains

Choose grains that contain less than 2 grams of fiber/serving.

Meats, chicken, and fish

Select lean meats, chicken, and fish.

Yogurt

Patients with diarrhea caused by antibiotics may benefit form adding yogurt to their diet.

 

When should you call your doctor?

Call your doctor if you:

  • Have mucus, blood, or pus in your stools
  • Have diarrhea that lasts longer than 2 to 3 days
  • Have not urinated in 12 hours
  • Have severe pain or abdominal cramping
  • Are vomiting and experiencing diarrhea at the same time
  • Have a chronic illness, such as diabetes
  • Have a high fever (more than 101º F)
  • Are pregnant
  • Experience rapid breathing, fever, or light-headedness
  • Have traveled to a foreign country and have diarrhea upon your return

Remember to:

  • Eat and drink whatever you think will work best for you
  • Wash your hands often
  • Eat and drink small portions, gradually increasing your diet as tolerated

 

References and recommended readings

Eating hints before, during, and after cancer treatment. National Institutes of Health, National Cancer Institute Web site. http://www.cancer.gov/cancertopics/coping/eatinghints/page4#diarrhea. Accessed June 5, 2013.

Mayo Clinic staff. Diarrhea. Mayo Clinic Web site. http://www.mayoclinic.com/health/diarrhea/DS00292. Accessed June 5, 2013.

US National Library of Medicine, National Institutes of Health. Diarrhea. MedlinePlus Web site. http://www.nlm.nih.gov/medlineplus/ency/article/003126.htm. Updated January 26, 2012. Accessed June 5, 2013.

National Institutes of Health, National Cancer Institute. Eating hints. http://www.cancer.gov/cancertopics/coping/insides-eating-hints.pdf. NIH No. 11-2079. Published January 2011. Accessed June 5, 2013.

Nutrition Care Manual®. Academy of Nutrition and Dietetics Web site [by subscription]. www.nutritioncaremanual.org. Accessed June 5, 2013.

Review Date 6/13

G-0513

 

Intended use

The low-fat diet is intended for use by individuals who have maldigestion or malabsorption of fat, such as small bowel resection, pancreatic disease, gastroparesis, fatty liver, or gallstones. The low-fat diet restricts fat intake to 40–60 grams (g) of fat/day by limiting high-fat food and beverage sources.

Note: This version of the low-fat diet is not intended for individuals with heart disease (access the therapeutic lifestyle changes [TLC] diet at http://circ.ahajournals.org/content/114/1/82.full.pdf). Further, this is not an optimal approach for weight loss, because calorically dense, low-fat alternatives such as sugar are not restricted.

While this diet is nutritionally adequate according to the Recommended Dietary Allowances, individuals may require supplementation of fat-soluble vitamins, minerals, or high-calorie, low-fat supplements because of the nature of their disease.

 

Reading labels

The Nutrition Facts panel lists the nutrition information about a product.  If you are unsure if a food fits into the “eat more of these” or “avoid” column, look at the “Total Fat” grams, located near the top of the panel. Make sure you adjust your serving size to the portion size listed at the top of the label.

 

Labeling terms

Term Example Definition
Fat free Skim milk, salad dressing, and pudding  <0.5 g fat
Low fat Low-fat cheese 

 

≤3 g fat
Extra lean Extra-lean pork andbeef

 

<5 g fat
Lean Pork, beef, andpoultry

 

<10 g fat
Less or reduced Less-fat or reduced-fat salad dressing  25% less than the regular equivalent
Light or lite Lite margarine or salad dressing  50% less than the regular equivalent

 

It is important to understand that while products that claim that they are lower in cholesterol, saturated fat, and trans fat are healthier selections that may positively reduce the total fat content of a meal, this is not a direct indication that these foods are acceptable on a low-fat diet.

 

Low-fat diet by food groups

Food Group Eat More of These Avoid These Foods
 Dairy

 

  • Skim or soy milk
  • ½% or 1% milk
  • Fat-free yogurt
  • Fat-free cheese

 

  • 2% or whole milk
  • Cream
  • Eggnog
  • Milk shakes

 

 Meat

 

Limit=5–6 ounces (oz)/day

 

Guide to portions:

3 oz=deck of cards

1 oz=one index finger

One serving equals:

  • 1 oz extra lean or lean meat or deli meat
  • 1 oz fish
  • 1 oz skinless poultry
  • Textured vegetable protein
  • ¼ cup (C) water-packed tuna or salmon
  • 1 egg
  • 1½ oz low-fat cheese
  • Note: Textured vegetable protein that contains <0.5 g fat/oz is considered fat free (use without restriction)

 

  • Bacon
  • Sausage
  • Luncheon meats
  • Hot dogs
  • Salami
  • Fish canned in oil
  • Fried meats
  • Convenience and fast-food meals
  • Heavily marbled meats
  • Regular cheese
  • Regular cream cheese

 

 Fruit

 

  • All are encouraged
 Vegetables

 

  • All are encouraged
  • No fried vegetables
 Grain*

 

6–11 servings/day

 

*Grain choices must contain
<3 g fat/serving

One serving equals:

  • 1 slice whole-grain bread
  • ½ English muffin, bagel, or bun
  • ½ C rice or pasta
  • ½ C hot cereal
  • ¾ C cold cereal
  • 1 oz fat-free crackers or pretzels
  • 3 C fat-free popcorn

 

  • Stuffing
  • Regular chips
  • Regular crackers
  • Regular bars
  • Biscuits
  • Muffins
  • Doughnuts
  • Baked goods
  • Grilled, fried, or cheesy breads
 Fat

 

 

Limit=3 servings/day

(includes fat added in cooking)

 

Guide to portions:

1 tablespoon (Tbsp)= thumb tip

 

 

One serving equals:

  • 1 teaspoon (tsp) regular or 2 tsp lite butter, margarine, or oil
  • 1 Tbsp regular or 2 Tbsp lite mayonnaise, cream cheese, or salad dressing
  • ⅛ avocado
  • 2 tsp peanut butter
  • 10 peanuts
  • 8 olives

 

 Miscellaneous
  • Fat-free hot chocolate
  • Carnation® Instant Breakfast® made with skim milk
  • Sugar
  • Jelly
  • Mustard
  • Ketchup
  • Sherbet
  • Jell-O®
  • Angel food cake
  • Pudding made with skim milk
  • Popsicles®

 

Discuss the use of alcohol, caffeine, and soda with your dietitian.

 

  • Ice cream
  • Cakes
  • Pies
  • Cookies
  • Regular cream-based soups

 


Sample menu

Breakfast Lunch Dinner
  • 6 fluid oz (fl oz) orange juice
  • ¾ C Cheerios®
  • 8 fl oz skim milk
  • ½ banana
  • 1 scrambled egg
  • 1 slice toast
  • 1 egg
  • 1 tsp margarine
  • Jelly
  • Coffee or tea
  • Sugar

 

  • Whole-grain sandwich with 2 oz fat-free deli meat, tomato, lettuce, onion, mustard, and fat-free mayonnaise
  • 1 C skim milk
  • 1 C broth-based soup
  • 1 apple or 1 C cut-up  fruit
  • 1½ C mixed salad greens
  • 2 Tbsp lite salad dressing
  • Coffee or tea
  • Sugar

 

  • 3 oz skinless, white meat chicken breast (baked)
  • 1 C skim milk
  • 1 piece corn on the cob
  • 1 C cooked vegetables
  • 1 whole-grain dinner roll
  • 1 tsp margarine
  • 1 C grapes or cut fruit
  • Coffee or tea
  • Sugar

 

References and recommended readings

American College of Gastroenterology. Digestive health tips. Available at: http://www.acg.gi.org/patients/healthtips.asp. Accessed October 8, 2012.

American Heart Association Nutrition Committee, Lichtenstein AH, Appel LJ, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation [serial online]. 2006;114:82-96. Available at: http://circ.ahajournals.org/content/114/1/82.full.pdf. Accessed October 8, 2012.

Andersson H, Isaksson B, S Sjögren B. Fat-reduced diet in the symptomatic treatment of small bowel disease: metabolic studies in patients with Crohn’s disease and in other patients subjected to ileal resection. Gut [serial online]. 1974;15:351-359. Available at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1412920/. Accessed October 8, 2012.

MedlinePlus. Chronic pancreatitis. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000221.htm. Accessed October 8, 2012.

National Digestive Diseases Information Clearinghouse (NDDIC). How is gastroparesis treated? Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/#5. Accessed October 8, 2012.

Contributed by Sheryl Lozicki, RD, MBA

Updated by Nutrition411.com staff

Review Date 10/12

G-1239

 

No Gastric Irritant/Ulcers/Dyspepsia
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Gastritis refers to a group of conditions, all of which cause inflammation of the stomach lining. Usually a mucous-lined barrier protects the stomach from digestive acids. In gastritis, this barrier becomes weakened, and your digestive juices damage and inflame the lining. Gastritis may have a sudden onset or may develop more slowly over a period of time.

Some people with gastritis have no symptoms. Symptoms of gastritis include:

  • Indigestion
  • Hiccups
  • Loss of appetite
  • Stomach pain
  • Nausea and vomiting
  • A sense of “fullness” after meals
  • Dark stools
  • Vomiting blood

Helicobacter pylori infection can cause chronic gastritis in some people. This is the same bacteria that cause peptic ulcers. Other infections caused by viruses, parasites, or fungus also can lead to the development of gastritis. Frequent use of certain painkillers can lead to either acute or chronic gastritis.

The risk of gastritis increases with age, as the stomach lining thins and the chances of having either an H pylori infection or an autoimmune disorder increase. Alcohol irritates and erodes the stomach lining, and excessive use can lead to acute gastritis. Severe physical stress from injury or illness can lend itself to the development of acute gastritis. Bile reflux from pyloric valve dysfunction or pyloric valve removal allows bile to enter the stomach and leads to gastritis.

Autoimmune gastritis refers to a condition in which the body attacks the cells that make up the stomach lining. Autoimmune gastritis often occurs in people with other autoimmune diseases and also is associated with vitamin B12 deficiency. People with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), Crohn’s disease, or sarcoidosis are at an increased risk for developing gastritis.

Cigarette smoking, consumption of coffee or acidic beverages, or the consumption of caustic or corrosive substances can cause irritation. Some forms of gastritis will resolve after a person quits drinking alcohol, smoking cigarettes, or taking non-steroidal anti-inflammatory medications (NSAIDs).

Avoid During Acute Episode

  • Acidic beverages – including coffee (both caffeinated and decaffeinated) carbonated beverages, and fruit juice with citric acid.
  • Alcohol
  • Caffeine – coffee, soft drinks, chocolate, and tea.
  • Fried foods
  • Processed snack foods – chips, cookies, doughnuts, cakes etc
  • Tough red meats
  • Fast foods
  • Spicy foods
  • Some raw vegetables; cruciferous vegetables
  • Consuming fluids with meals – separate your fluids from your meals by 30 minutes.
  • Possibly milk and dairy products

 

Prevention

Whole foods including lean meats, skinless poultry, fish and seafood, low fat dairy in moderation, whole grains and cereals, an abundance of fruits and vegetables.

Healthy cooking methods that avoid frying, deep frying and heavy fatty or creamy sauces.

Smaller more frequent meals as opposed to very large meals.

Flavonoids are good –  stop the growth of H pylori

    • Found in apples, celery, cranberries, onions, garlic, and tea.

 

Alternative Therapies

  • Omega-3 fatty acid supplements
  • Probiotics
  • Cranberry, capsaicin, and peppermint supplements

*Always talk to your doctor before beginning to take any supplements or herbal preparations.

 

If left untreated, gastritis can lead to peptic ulcers in the stomach or first part of the intestine and bleeding. Some forms of chronic gastritis increase the risk of stomach cancer.

Diverticulitis
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Diverticulitis is an inflammation of the diverticula or outpouches of the large intestine. The presence of these outpouches is very common. When there is no inflammation, these outpouches, also known as diverticulosis, are not painful or bothersome; they are benign abnormal pouches in the lining of the intestinal wall.

The acute or inflamed state is called diverticulitis, which is caused by fecal matter accumulating in these outpouches. Symptoms include abdominal cramping, painful muscle spasms, distention, nausea, and fever.

When inflammation occurs, bowel rest often is prescribed. Following a diet that is low in fiber gives the bowel inflammation a chance to resolve. A low-fiber diet eliminates foods that contribute to fecal bulk. By decreasing the amount of stool produced, the bowel is better able to rest and recover.

Usually a mild condition, diverticulitis responds well to medication, and only severe cases require surgical intervention. The diet for diverticulitis generally begins with a clear-liquid diet, advances to a full-liquid diet, and then progresses to a low-fiber diet. When symptoms disappear, a high-fiber diet with plenty of water generally is recommended.

Clear-liquid diet

  • Apple juice, punch, juice blends, and fruit and vegetable juices with no pulp
  • Coffee and tea
  • Broth
  • Gelatin
  • Ice pops

Full-liquid diet

  • Juice
  • Milk
  • Milk shakes
  • Broth
  • Coffee and tea
  • Carbonated beverages
  • Creamed soups
  • Liquid meal replacements
  • Yogurt
  • Pureed soups (use blender)
  • Margarine, butter, and oil
  • Pudding
  • Gelatin
  • Ice cream
  • Fruit puree
  • Custards

  Low-fiber diet

  • Refined white bread, buns, and English muffins
  • Cereal, including cornflakes, puffed rice, Kellogg’s® Special K®, and Cheerios®
  • Biscuits, including arrowroot biscuits and water crackers
  • White rice
  • Refined pasta and noodles
  • Cottage cheese
  • Cream cheese
  • Mild cheeses
  • Any fruit and vegetable juice, except prune juice
  • Melons
  • Grapes
  • Ripe banana
  • Applesauce
  • Citrus fruit sections
  • Pureed fruits
  • Canned fruit salad
  • Stone fruits (fruits with pits, such as cherries, nectarines, and plums)
  • Potatoes with no skin
  • Alfalfa sprouts
  • Beets
  • Green beans
  • Carrots
  • Celery
  • Cucumber
  • Eggplant
  • Lettuce
  • Mushrooms
  • Peppers
  • Squash
  • Zucchini
  • Pureed vegetables
  • Well-cooked meat, fish, and eggs

Foods to avoid on a low-fiber diet

  • Tough, fibrous meats
  • Raw vegetables
  • Whole-grain breads, wheat or rye bran
  • Whole-grain cereals
  • Whole-grain flours
  • Popcorn
  • Nuts
  • Seeds

After symptoms subside and a high-fiber diet is initiated, you may begin reintroducing all of the foods on the low-fiber diet. It is important to consume water with high-fiber foods to aid the fecal matter in passing through the gastrointestinal tract. Regular exercise is recommended to promote normal bowel function and to reduce pressure inside the colon.

Diverticulitis: Progressing From a Low- to High-Fiber Diet

This advice will help you progress from a low-fiber diet to a high-fiber diet following a bout of diverticulitis.

Follow your physician’s instructions

Do not advance to a high-fiber diet until your physician tells you that it is OK to do so.

Drink fluids

Make sure to drink at least 8 cups of fluid each day while increasing your fiber intake.

Start slowly

Increase your fiber intake gradually.

Mix your cereal

Mix a small amount of high-fiber cereal, such as raisin bran or oatmeal, into a lower-fiber cereal, such as corn flakes or rice puffs. Slowly increase the proportion of high-fiber cereal every few days.

Eat fresh fruits and vegetables

Start by trying to have two servings of fresh fruits and one serving of fresh vegetables each day. Slowly advance from canned fruits to eating mostly fresh fruits and vegetables by adding one serving/day every week as tolerated. You may want to mix some fresh fruit into canned fruit at the beginning.

Remember that we now know that you do not need to avoid seeds, such as those found in strawberries. Your final goal is to consume at least 2 C of fresh fruit and 2½ C of fresh vegetables each day.

Consume beans, peas, or lentils

Once you are tolerating high-fiber cereal and fresh produce, try to eat a ½ C of dried beans, peas, or lentils each day. If you cannot tolerate this, try to eat them at least two times a week and gradually increase your intake.

Add some wheat germ

Try sprinkling a small amount of wheat germ into your yogurt, cereal, or fruit salad.

Eat whole-wheat bread

Eat one slice of whole-wheat bread each day. Once you are tolerating this, progress to eating two or three slices each day.

Include nuts in your diet

Eat several small servings of nuts each week.

Go half and half with your pasta

Make half of your pasta whole grain.

Use some whole-wheat flour

Replace one third of the all-purpose flour called for in recipes with whole-wheat flour.

Consider using a psyllium-based fiber product

Once you have adjusted to the high-fiber diet, you may want to add a serving of a psyllium-based fiber product, such as Metamucil®, into your daily menu.

Prevent flares of diverticulitis

Eating a high-fiber diet when you have diverticulosis prevents flares of diverticulitits. 

Think about probiotics

Some people with diverticulosis have had positive results from consuming probiotic-enriched foods occasionally. Look for yogurt that is labeled “contains live and active cultures.”

References and recommended readings

Academy of Nutrition and Dietetics. Nutrition Care Manual®. Available to subscribers at: http://www.nutritioncaremanual.org/content.cfm?ncm_content_id=84460. Accessed October 25, 2011.

Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012:635-636.

National Digestive Diseases Information Clearinghouse (NDDIC). Diverticulosis and diverticulitis. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/. Accessed October 25, 2011.

Colon Gas & Flatus Prevention
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The body produces gas in the stomach and intestines during the normal digestion of food. Swallowed air also causes gas.

Rapid introduction of any high-fiber foods to the diet will lead to gas. If you want to begin eating a higher-fiber diet, begin slowly and make sure you drink plenty of fluids. The following foods and beverages are the ones most likely to cause gas.

Vegetables

  • Cabbage
  • Sauerkraut
  • Brussels sprouts
  • Broccoli
  • Asparagus
  • Artichokes
  • Eggplant
  • Radishes
  • Cauliflower
  • Cucumbers
  • Peas
  • Celery
  • Carrots
  • Onions
  • Rutabaga
  • Turnips
  • Apples
  • Pears
  • Melons
  • Peaches
  • Bananas
  • Apricots
  • Raisins
  • Prune juice
  • Citrus fruits
  • Fruit juices
  • Dried beans, peas, and lentils
  • Whole grains
  • Most starches, including potatoes, corn, pasta, and wheat
  • Foods containing sugar alcohols, such as sorbitol or xylitol
  • Carbonated beverages
  • Beer
  • Red wine
  • Eggs
    • High-fat diets (tend to cause more gas because the gas does not move into the small intestine for a longer period of time after eating)
  • Fructose, if a person malabsorbs fructose*
  • Lactose, if a person is lactose intolerant (common cause of gas)*

Fruits

Other foods

*If you believe you are not digesting fructose or lactose correcting, speak with your health care professional, who may request a breath test.

Foods to avoid

You do not need to avoid all of the foods just listed. Many of the foods that lead to gas formation are the healthiest foods. The best idea is to figure out which foods you started eating more of before you got excessive gas. Eliminate them from the diet, and then slowly add them back into your diet, one at a time, to help you figure out which food is the culprit. Once you have this figured out, eat small amounts, increasing the amount incrementally until you can calculate the amount that you can eat without unwanted effects.

Causes of gas

The following can cause gas:

  • Stress and anxiety
  • Swallowing too much air, which can occur when you:
    • o Eat or drink rapidly
    • o Smoke
    • o Chew gum or suck on hard candies
    • o Wear loose dentures
    • o Sip through straws or bottles with narrow mouths

Normal vs excessive gas

The average person passes gas 6-20 times a day. The following are some possible causes of excessive gas:

  • Peptic ulcer disease
  • Gastroesophageal reflux disease (GERD)
  • Gastroparesis (delayed gastric emptying)
  • Irritable bowel syndrome (IBS)
  • Celiac disease
  • Lactose intolerance
  • Fructose malabsorption
  • Crohn’s disease
  • Ulcerative colitis

Treatment

The following treatment options are used for people with excessive gas:

  • Digestive enzymes, if carbohydrate malabsorption is present (available over the counter)
  • Lactase supplements prior to eating or drinking lactose-containing foods
  • Beano®, an over-the-counter medication, which contains the enzyme necessary to break down the sugar found in vegetables and beans; has no effect on fiber or lactose
  • Exercise, which helps push gas through the digestive tract
  • Prebiotic-rich yogurt or prebiotic supplements
  • Antacids or H2 blockers, if reflux is occurring

References and recommended readings

Adams M. Gassy foods diet: gas-reducing diet. Available at: http://www.swedish.org/119563.cfm. Accessed November 7, 2009.

Davis JL. Gas, bloating: Always uncomfortable? Available at: http://www.medicinenet.com/script/main/art.asp?articlekey=52076. Accessed November 7, 2009.

National Digestive Diseases Information Clearinghouse (NDDIC). Gas in the digestive tract. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gas/. Accessed November 7, 2009.

Turcotte M. Intestinal gas and bloating: dietary causes. Available at:

http://www.thedietchannel.com/Gas-And-Bloating-Dietary-Causes.htm. Accessed November 7, 2009.

West Shore Endoscopy Center. Gas and flatulence prevention diet. Available at:

http://www.endowsec.com/pated/edtgs12.htm. Accessed November 7, 2009.

Small Intestinal Bacterial Overgrowth (SIBO)
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Small intestinal bacterial overgrowth (SIBO) occurs when excessive amounts of bacteria infiltrate the small intestine. In most people, the small intestine has fewer bacteria and varieties of bacteria than the colon. These gut bacteria aid in vitamin synthesis, improve digestion, produce vitamin K, and confer benefits for immunity. However, when these bacteria proliferate, they can lead to unpleasant gastrointestinal problems, malabsorption, and malnutrition.

Symptoms of SIBO 

  • Excess gas
  • Bloating and abdominal distension
  • Diarrhea
  • Painful cramping
  • Weight loss
  • Constipation (reported by some patients)
  • Muscle aches and pain (reported by some patients)
  • Microbes that metabolize bile salts to insoluble compounds can cause fat malabsorption and inflammation (fat malabsorption causes deficiencies of vitamins A, D, and E)
  • Vitamin B12 deficiency (common in all forms of SIBO)
  • Bacteria may synthesize folate (serum levels will reflect this elevation)
  • Bacteria that metabolize carbohydrates can lead to excessive bloating
  • Some bacteria produce toxins that damage the lining of the intestines

Causes of SIBO

SIBO most commonly results from a decrease in the secretion of gastric acid and a change in the motility of the small intestine. Normally, muscular activity sweeps food from the stomach into the small intestine and then into the colon. This same muscular activity is supposed to sweep bacteria out of the small intestine and into the colon. Unfortunately, some people do not have as much muscular activity as they should, and the bacteria get “stuck” in the small intestine.

As many as 80% of patients with irritable bowel syndrome (IBS) may have SIBO.

The following conditions may increase an individual’s chance of developing SIBO:

  • Celiac disease
  • Chronic pancreatitis
  • Crohn’s disease (the scarring can cause obstruction)
  • Diabetes (damages the nerves that control the intestinal muscles)
  • Scleroderma (damages the intestinal muscles directly)
  • Fibromyalgia
  • Interstitial cystitis
  • Renal failure
  • Diverticulosis (bacteria may multiply in the diverticuli)

SIBO sometimes is present in some cancer patients, because medications that suppress the production of gastric acid, gastric resection, frequent or long-term use of antibiotics, and surgical removal of the ileocecal valve may lead to an increased risk.

Diagnosis of SIBO

SIBO is difficult to diagnose. A direct culture is used to diagnose it, but you cannot readily access some parts of the intestines to get a sample. The lactulose breath test, which measures hydrogen and methane gas production, is used. Unfortunately, a small number of people with SIBO do not produce either hydrogen or methane gas. Slowed transit through the small intestine can elongate the time necessary for testing (up to 5 hours). The lactulose breath test is not specific for SIBO, and a positive result could indicate a number of conditions, including celiac disease, pancreatic insufficiency, or Crohn’s disease. The only way to know for sure what caused the positive test result is to treat for bacterial overgrowth and see if symptoms improve. Even then, symptoms might not improve, either because the treatment was not effective for treating the individual’s SIBO or because the individual has another, yet undiagnosed, condition.

A way to extract bacterial DNA from stool samples recently was discovered. This can help determine the type and prevalence of bacteria present. This new test may prove quite useful for diagnosing SIBO in the future.

Help for people with SIBO

Snacking

Some experts recommend avoiding snacks in-between meals to give the intestines time for cleansing.

Antibiotics

Antibiotics are commonly prescribed. Antibiotic therapy is “successful” in 40%–70% of patients. “Successful” is defined as either providing symptom relief or producing normalization of the hydrogen breath test.

Probiotics

Research is looking at probiotics as a treatment for this condition. However, because of the many different types of bacteria in the intestines, a single type of probiotic is unlikely to help all people with SIBO. Probiotics are live microorganisms, which confer a health benefit to the host when consumed in adequate amounts. They occur naturally in fermented foods, such as yogurt, buttermilk, sour poi, and miso. Commercially available probiotics are used for treating both SIBO and IBS, but their effectiveness is not known.  Bifidobacterium infantis 35624 is the only probiotic that is proven effective in the treatment of patients with IBS.

Other research

Researchers also are evaluating and treating the cause of diminished acid production or motility issues.

Fructose, sorbitol, and other sugar alcohols

Fructose, sorbitol, and other sugar alcohols often are poorly absorbed. Fructose is naturally found in fruit, fruit juices, honey, and high-fructose corn syrup. It is thought that high-fructose corn syrup might digest better than some fruit, because it contains near equal amounts of fructose and glucose. Likewise, bananas and strawberries, which contain a near equal amount of glucose and fructose, might digest better than honey, dates, and oranges, which contain more fructose than glucose. Cherries, apples, and pears contain both excess fructose and sorbitol, making them perhaps the most irritating.

Sugar alcohols include sorbitol, mannitol, xylitol, erythritol, lactitol, maltitol, isomalt, and hydrogenated starch hydrosylates. Ten grams of sorbitol, which is found in two pears or roughly five sugar-free mints, cause moderate to severe abdominal discomfort in 17% of healthy subjects.

Splenda®

Splenda may reduce beneficial gut bacteria, so you might want to eliminate its use.

Diet

It is especially important that you eat a well-balanced and healthy diet if you have SIBO. You may need to take oral supplements to correct nutrient deficiencies, such as for vitamins B12, A, D, and E.

References and recommended readings

Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc. 2009;109:1204-1214.

Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012:638-639.

Scarlata K. Small intestinal bacterial overgrowth—what to do when unwelcome microbes invade. Today’s Dietitian [serial online]. 2011;13:40. Available at: http://www.todaysdietitian.com/newarchives/040511p46.shtml. Accessed February 13, 2012.