Announcing our new and secure web portal just for our esteemed patients!
Login NowLive Help (305) 274-7800
Gastroenterology Diets
Purpose
Dietary fiber only comes from plants and grains, never from animal foods. it helps to maintain a plant structure. Cellulose, hemicellulose, polysaccharides, pectins, gums, mucilages and lignans are all dietary fibers, mostly of interest to the plant chemist. More broadly, most fiber can be broken down into insoluble and soluble fiber. Neither of these, nor in fact any fiber, is digested by the body in the small intestine. Rather, they arrive in the colon, where they exert a profound function for the body and, indeed, our very health.
Function of the Colon
Every field of medicine has progressed enormously over the past 10-15 years. Our understanding of the colon and how if functions is no exception. What we now know about the colon and how it functions is simply staggering to us gastroenterologists who, in medical school, thought we knew all there was to know about the colon. Back then, it was viewed as a container that dehydrated liquid stool that entered it, stored it and then evacuated the stool when convenient.
But this is only a small part of what the colon does even though it is the only one that the average person will see and feel. Do I have a soft, regular bowel movement every day? If so, my colon must be functioning okay. Well, not so fast. Now we know that the colon is a hot bed of thriving community of densely-packed bacteria. We know that most of these bacteria are our friends and when they are fed purposely with the right foods and plant fibers that they need, some truly spectacular health benefits occur.
The Importance of Dietary Fiber
There are now at least 13 known, medically researched health benefits when the right types of fiber are ingested. These benefits can and do occur in the otherwise healthy person when adequate amounts of fresh vegetables, fruits, whole grains or fiber supplements are used. More specifically, most of these benefits occur when significant amounts of the newly discovered prebiotic fibers are consumed.
Prebiotic Fiber Health Benefits
- Increase probiotic growth
- Improve bowel regularity
- Increase calcium absorption
- Increase bone density
- Enhance immune system
- Reduce colon polyp/cancer factors
- Reduce triglyceride level
- Reduce cholesterol level (only psyllium fiber)
- Reduce allergies and asthma
- Control appetite and weight
- Increase good colon bacteria
- Decrease bad colon bacteria
- Decrease flatus smell
Nutrition Facts
Fiber is not digested as a calorie as it moves through the small intestine. However in the colon, under the influence of the bacteria that live there, some beneficial energy and calories are produced. However, this is a very small amount and the health benefits of dietary fiber far outweigh the few extra calories produced in the colon.
Fiber can best be understood as insoluble and soluble. Insoluble fiber does not dissolve in water and is not used by colon bacteria as a food or fuel. However, it does hand onto water avidly and so promotes regularity and a soft bowel movement.
Soluble fiber, on the other hand, does dissolve in water, and to varying degrees, is the fuel that promotes the best growth of the best colon bacteria. The soluble fibers, which by far have the most science behind them, are called prebiotics. These prebiotics, especially the ones known as inulin and oligofructose (FOS) have the most research.
You are referred to Prebiotics for further details on this key part of the fiber picture. To get a list of any foods and of the insoluble and soluble content.
Fiber in the Healthy
Eating fresh vegetables, fruits and whole grains is a mantra we have all heard forever – from our mothers, friends and the media. In the past, we didn't know why. Now we do. All plant material is a mix of soluble and insoluble fibers of many types and different percentages. When a variety of these foods are eaten on a regular basis, you are almost certain to get the right combination of insoluble, soluble and prebiotic fibers. 25-35 grams a day is the goal. When this happens and when other health parameters are followed – i.e. no smoking, adequate exercise, no stress, etc., then the best outcome and health benefits can be expected. Studies on people who consume this type of a high fiber diet as part of their overall health care plan simply live better and longer than those who do not.
Fiber in Irritable Bowel Syndrome (IBS)
IBS is a chronic disorder of the bowel, principally the colon. It is now known that there are numerous factors that contribute to IBS and its symptoms, such as genetics, diet and stress. Recent research has shown that the bacterial makeup within the colon is different in IBS people than it is in others. This means that there are different bacterial species and numbers of bacteria in the colon. We still do not know what this means. However, we do know that the bacteria within the colon rely on the foods we eat and especially the food fibers for their own health. So, changing the colon bacterial makeup may make sense for some IBS patients. This needs to be done carefully so as to avoid gas build-up.
Fiber and Colon Polyps/Cancer
A significant factor leading to colon polyps and cancer is in your genes. You can not change your genes so if anyone in your family or blood relatives has had colon polyps or cancer, you need to see your physician and get surveyed for this preventable cancer. Colon cancer can be prevented if polyps are removed before they get big. It can be cured if a colon cancer is found early. Diet is next. The regular ingestion of 25-35 grams of fresh vegetables, fruits and whole grains is the key. When significant amounts of plant fibers are ingested, particularly the newly discovered prebiotic fibers, it seems to lead to a reduction in certain carcinogenic (cancer causing) factors in the colon. This has been shown in animal and some early human studies.
Fiber, Cholesterol and Triglyceride
We have known for many years that a diet low in saturated and trans-fats, as well as high in fresh vegetables, fruits and whole grains is critical to maintaining a good cholesterol and triglyceride blood level. Other health factors such as not smoking, exercise, normal weight and lack of stress are equally important. Regarding fiber, we know that two fibers are helpful in managing and preventing heart disease and atherosclerosis.
Psyllium is a plant fiber that has long been used as a bulking agent. It comes in many dietary supplements over the counter. It has been found that when 7 grams of psyllium is ingested each day, the blood cholesterol can fall. So, if the cholesterol benefit is what you want, then you need to increase the dose. Our Prebiocil product is a mix of psyllium, prebiotics and wheat bran. The psyllium dose is 3.5 grams so you would need to add additional psyllium to get the full cholesterol benefit.
Prebiotics are the second fiber. Triglyceride levels generally fall when weight is reduced and simple carbohydrates and sugar are restricted in the diet. Prebiotics can contribute to triglyceride control.
Fiber Gas and Flatus
Most colon gas and flatus comes from the bacteria that grow in the bowel. The normal passage of flatus is 15-20 times a day, less in females and in those who just eat less food. However, there is now a great deal known about which bacteria produce the gases. Some make the odorless hydrogen and methane gases. Others make the smelly sulfide gases. Fiber can be a factor here.
Fiber and Diverticulosis
Prolonged, vigorous contractions of the colon, especially in the left side of the abdomen, may result in diverticulosis. This increased pressure causes small and eventually large ballooning pockets to form. When these pockets become infected, diverticulitis occurs, a nasty infection. In the past, physicians thought that seeds, nuts and popcorn could rattle around inside these pockets and cause damage. I, personally, never bought into this idea and had always recommended these foods because of their high fiber content. Now, science has shown that seeds, nuts and popcorn not only do not cause diverticulosis and its problems but also are good for you as a fiber source. The important consideration for patients with diverticulosis to know is that food and fiber supplements increase stool bulk and thereby reduce the colon pressure and development of diverticulitis.
Fiber and Inflammatory Bowel Disease (Crohn's Disease and Ulcerative Colitis)
In the past, there was not too much we could tell these patients about their diet. We would recommend trying almost any food and then evaluate the individual response. If the symptoms did not worsen, then it was okay to use that particular food. Now, there is considerably more known about diet in dealing with Crohn’s disease and ulcerative colitis. In particular, plant type foods such as fruits, vegetables, and whole grains, seem to be helpful. The newly discovered prebiotic plant fibers, especially, have come under scrutiny by medical researchers. In some instances, these prebiotic fibers may show benefits for patients with inflammatory bowel disease conditions.
Fiber Supplement
Most people take fiber supplements for one reason only. They want to have bowel regularity including a soft, easy-to-pass bowel movement. Beyond this, they simply don’t think too much about their lower bowel or colon. Soft regularity is a goal that every gastroenterologist wants for their patients. This occurs when enough fiber, especially the insoluble type, is ingested. This includes the fiber, psyllium, which is not available as a food but only as the fiber supplement. Psyllium contains mucilage and, along with most insoluble fibers, retains water and so promotes soft regularity. However, the soluble fibers play a role here as well. These fibers, including the newly discovered prebiotic soluble fibers, promote regularity by dramatically stimulating the growth of good colon bacteria. You add the bulk provided by the growth of good colon bacteria to that of water retaining insoluble fiber and you get the full fiber benefit.
The prebiotic soluble fibers provide a host of health benefits you cannot feel but are occurring nevertheless. These act very much like vitamins in the sense that you cannot feel them working in your body, but you know that science has shown their good health value.
Special Considerations
Select these foods for maximal fiber benefit.
- Whole grain breads and rolls so as to get the fiber along with its vitamins and minerals.
- Fresh fruits, including skin and pulp. Wash fruits thoroughly to remove any residual pesticides or buy organic.
- Dried or stewed fruits, such as prunes and apricots.
- Root vegetables such as carrots, turnips and yams, which are also rich in antioxidants.
- Cruciferous fresh vegetables such as broccoli, Brussels sprouts and cabbage. These high fiber foods also contain sulforaphone (search it on Google), a strong anti-cancer agent.
- Cereals – Many cold cereals will contain sugar, evaporated cane juice, which is nothing but sugar, or high fructose corn syrup (HFCS). I refer you to my essay on sugar and HFCS. These are added calories that are used simply because the public will usually not buy a non-sweetened cereal. Read the labels. I would recommend avoiding cereals with these sugary sweeteners or other ingredients you do not recognize.
- Finally, when 25-35 grams of total fiber a day is hard to reach, you can always use Prebiotin or Prebiocil supplements for significant amounts of fiber with both health benefits as well as soft bowel regularity.
The thriving healthy mix of bacteria within the colon does not happen without the production of some gases. Most of these gases are odorless - hydrogen, oxygen, carbon dioxide and methane. Nitrogen is also present from swallowed air, which then moves down into the colon. So, bacteria produce most of the gases that are passed as flatus. The tiny amount of the remaining gases are the sulfide ones. These are the smelly gases that are made by just a few species of bacteria specialized for this process. These rascals rely on sulfur in the water, food, beverages, and indeed, some medications we swallow to make these sulfide gases, including hydrogen sulfide.
What Is Normal?
Believe it or not, there is really a limited amount of information in the medical literature on this socially important question. Everyone will have her or his own idea of what normal is. Here is some general information that medical texts provide.
- The amount of colon gas produced per day ranges from one pint to several quarts.
- The number of flatus passages per day may be as low as 7 in females and up to 20 or more in males. An average is probably 10-13 flatus passages per day.
- Men create more colon gas than females.
- So do smokers. Don't ask why. We don't know.
- Beer drinkers have smellier flatus, probably because most beer contains significant amounts of sulfur.
Plant Fiber
There are two main types of fiber, insoluble and soluble, and almost every plant will have some of each. Insoluble fiber does not dissolve in water, is not acted on by colon bacteria and so does not create colon gas. It is an important fiber, however, in that it hangs on to water within the colon, promoting a larger, bulkier stool and improved regularity. The second type of fiber is soluble, meaning it does dissolve in water and is fermented by colon bacteria. Some of these bacteria, then, create colon gas.
Most plants have both fibers to varying degrees. As examples, the fiber in wheat is mostly insoluble while those in oats and beans are mostly soluble. A special type of recently discovered soluble fibers are the prebiotic ones, especially inulin and oligofructose. These fibers have had a great deal of research done on them lately and multiple, very significant health benefits have been found to occur with them. Still, they are soluble and, as such, do produce colon gas just like all soluble fibers will if too much is taken.
The key is to get a good balance of these fibers. The recommended total fiber intake per day is 25-35 grams, depending on your sex, age and weight. At this level, multiple health benefits occur. However, if excess colon gas and flatus is the problem, then cutting back on soluble fiber should be done first.
Insoluble Fiber
As noted, this fiber, also known as roughage and bulk, does not dissolve in water but paradoxically does hang onto water in the large bowel. This creates a larger, softer and bulkier stool. It promotes regularity and seems to be associated with reduced chance of getting colon polyps and cancer, as cancer inciting agents such as carcinogens are swept through the bowel in a more rapid manner. In addition, it may promote weight loss and enhances diabetic control. These fibers are not fermented by colon bacteria and so do not produce colon gas. Foods that are particularly high in insoluble fiber are:
|
|
Soluble Fiber
This plant fiber does dissolve in water. In the colon, it provides food for the enormous numbers of bacteria that thrive there and, in so doing, provide many health benefits. Those fibers also promote regularity by increasing the growth of the colon bacteria. However, soluble fibers are the ones that some coon bacteria metabolize and so produce some colon gas. Foods that are particularly high in soluble fiber are:
|
|
Flatus Odor and Sulfate
Sulfate is the culprit. It is also a very necessary element in the diets as our body needs it for many functions. The problem with noxious flatus odor is that certain bacteria in the colon make sulfide gases in very tiny amounts, but certainly enough to be noticeable. It is pretty simple. The more sulfate you ingest, the more of it is available for colon bacteria to make sulfide gases. So where is the sulfate we ingest?
- Drinking water - up to 20% or more may come from drinking water, depending on where yours comes from. City water is monitored so there won't be too much, but well water can vary significantly.
- Beverages - beer, red and white wine, cider, apple, grape and tomato juice, and even cow's milk have significant amounts of sulfate.
- Foods - the following have moderate amounts of sulfate
- almonds
- breads
- cruciferous vegetables - broccoli, cauliflower, Brussels sprouts, cabbage
- dates
- dried apples, apricots - dried fruits are very high in sulfate
- wheat pasta
- peanuts
- prunes
- raisins
- Animal Protein - There are only two amino acids, methionine and cystine, that contain sulfate but these are present in all animal products. The more meat, fish, and poultry you eat, the more sulfate enters your colon.
- Supplements - chondroitin sulfate, glucosamine sulfate and MSM (methylsulfonylmethane) are used by many people for bone and joint disorders. These have significant amounts of sulfate. So does carrageenan, used as a thickening agent in many prepared foods. Read the labels.
So the first step to controlling flatus smell is to moderate the amount of sulfate containing foods and supplements you take. The second step is to acidify your colon.
Colon Acidity and Prebiotics
A little known fact, even to those in the medical field, is that the sulfide producing bacteria in the colon can't grow in an acid environment. So, the trick is to acidify the colon by providing certain plant fibers that other good bacteria use to make acidic substances called short chain fatty acids. These fatty acids are a food source for the colon's own cells. The plant fibers that do this best are the prebiotics. These can and should be obtained in certain foods as listed in prebiotics. These can also be obtained in our prebiotic supplements. My own research on family and friends shows that while these prebiotic fibers will not change the amount of colon gas, they will reduce and even eliminate the malodorous flatus smell. You should use enough to reduce or stop the smell but not so much as to get too gassy. So, to reduce noxious flatus smell:
So, to reduce noxious flatus smell
- Reduce sulfates in beverages, food, dietary supplements and pills
- Use prebiotic foods or our supplement prebiotic products to acidify the colon.
Final Flatus Factoids
The following are common sense tips on flatus. They may not work for everyone but perhaps a few might.- If you have no or little flatus, then you likely are not getting an adequate amount of soluble prebiotic fiber in your diet. The good benefits of these fibers can't be obtained without a minimal amount of gas production.
- Chewing gum - When you chew gum, you swallow more often and some air goes down into your stomach with each swallow. What you don't belch up goes into the colon, where it can contribute to flatus.
- Beans contain special types of carbohydrates that some colon gas forming bacteria love. These carbs are not part of the prebiotic family that are so good for the colon and for general health. However, beans are a great source of protein and other fiber, so it can be dilemma for some people. Soaking and/or overcooking beans may help reduce gas formation. Do the experiment and see.
- Beano is an over-the-counter product touted for helping reduce flatus. It is an enzyme that works only on the carbohydrate in beans and only if it mixes with the chewed up beans in the stomach. So, you need to take the pills, and usually a lot of them, while you are eating beans. You can try taking the pills after eating but the results may not be as good.
- Gulping food or eating fast may result in more air being swallowed, which results in more of this air in the colon. So, slow down and chew your food well.
- Over-the-counter remedies - Gas-X and other similar preparations are simethicone, which is a chemical that breaks down small intestinal bubbles into big ones. I m not sure of the benefit as it does not get rid of gas. Charcoal tablets are reputed to absorb the bad sulfide smell. It has never been proven very well. Reducing sulfur in food and acidifying the colon with prebiotics foods and supplements makes more sense.
- Odor eating underwear - Yes, you can get these online. They seem a bit of a stretch and inconvenience for a physiologic event that can be controlled in other, more natural ways.
Summary
The amount of colon gas and flatus can be controlled by modifying the amount of soluble fiber in the diet. You should not eliminate soluble fiber entirely because it provides so many health benefits to the colon and body.
The smell of flatus can be controlled by reducing the amount of sulfur containing foods and beverages and by making the colon more acidic using an adequate amount of prebiotic soluble fiber.
So, it is a balance. It is recommended to use enough soluble fiber so that your colon gas and flatus is tolerable to you. When the noxious smell of flatus is gone, then that is the right dose.
IBS is a very common disorder.
The large bowel or colon is the site of many beneficial bacteria. However, the colon is the site for many of the symptoms in IBS patients. Since this organ is where all fiber and other food remnants arrive, it would seem logical that some parts of food we eat might play a role in the symptoms of IBS, which for the most part, are a reflection of an overly sensitive colon.
IBS is currently seen as falling into several major types. Patients will frequently overlap their symptoms or even swing from one type to another. In each case, the diet may play an important role. So there is always some experimentation that each patient must undertake to see which dietary changes work best.
Abdominal Discomfort, Cramps, Bloating
The gut has been called the second brain because it has so many nerve cells within it. IBS patients have an increased nervous sensitivity built into their intestinal tract. This means that minor changes in the way the intestines contract can be perceived as discomfort, whereas in other people it is not. At times, there may be excessive production of colon gas resulting in bloating and discomfort. It is important that you understand how this occurs, namely that colon bacteria ferment soluble plant fibers in the food you eat and some of these bacteria will create harmless gases. You need to understand the difference between soluble fiber and insoluble fiber in your foods.
All fiber goes through the small intestine unchanged. Soluble fiber as is found in foods such as oats, beans and fruit pectins is fermented by the colon bacteria. It is used as a food by these bacteria which, in turn, provide significant health benefits. Some benign colon bacteria will create intestinal gases, mostly hydrogen, which then can move on down and become flatus. Insoluble fiber, on the other hand, is not fermented by colon bacteria and is evacuated relatively unchanged. No colon gas occurs with insoluble fiber.
Constipation Dominant
Constipation occurs when the colon just does not contract well enough or often enough. The stool within it becomes dehydrated and hard. Why does the colon become so lazy and what can be done about it? The diet may be important. Insoluble fibers such as wheat and wheat bran are not fermented by colon bacteria so they do not produce colon gas. At the same time, they retain water and create a large, bulky stool. This, in turn, often stimulates the colon to contract and provide easier evacuation. The first step then is to gradually increase the amount of insoluble fiber up to 10-15 grams a day or even more.
Soluble fibers, on the other hand, are trickier since they are used by colon bacteria as a food source and some of these bacteria make colon gas. Still, these fibers, especially the newly discovered prebiotic ones, produce many benefits within the colon. So, the IBS patient should eat enough soluble fiber to create its health benefit but not enough to produce crampy bloating and flatus.
Methane Constipation
Methane is just one of the gases in the colon along with hydrogen sulfide (odor), hydrogen, carbon dioxide and oxygen. There is some early research that suggests that the colon gas, methane, may promote constipation. Prebiotic plant fibers can change the acidity of the colon to an extent that these particular methane producing bacteria can't grow. Were I still in practice, I would encourage my constipation dominant IBS patient to eat prebiotic containing foods. Or they could take prebiotics supplement powders in gradually increasing doses - 1 gram a day for a week, then 2 grams and so forth. If excessive colon gas and bloating or cramps occur before constipation improves, then the test did not work. If it did, then that amount of prebiotic food or supplement is right for you. A signal to look for is to evaluate the malodorous sulfide smell of your flatus. Like the methane producing bacteria, the bacteria that make these sulfide gases also can not grow in an acid environment. If your flatus has no or little smell, your colon may be at the right acidity and so prevent the methane producing bacteria from growing.
Diarrhea Dominant
There are many causes of diarrhea. Your physician will want to be sure there is not a correctible cause present. For instance, some patients chew sugar free gum, which is high in the sweetening agent, sorbitol. This can lead to diarrhea. Read the labels. Others may have lactose intolerance, meaning they don't digest the milk sugar, lactose. The lactose ends up in the colon where it can promote colon gas and diarrhea. There may be chronic infections, such as the parasite, Giardia, residing in the small bowel. Celiac sprue may be a concomitant or even the major problem. When all of these and more are ruled out, then diarrhea dominant IBS can be diagnosed with confidence.
The next step is to consider the types of fiber in your diet. Increasing insoluble fiber in the diet or with a dietary supplement is worth a try as these can bulk up the stool which, of course, is desirable. Soluble fibers can aggravate diarrhea. However, they, along with probiotic bacteria, can also change the bacterial makeup of the colon in such a beneficial way that it may reduce the diarrhea.
I suggest gradually increasing the insoluble fiber in the diet up to 10 grams or more a day. Following this, I would add prebiotic fibers, either in foods or a dietary supplement in very gradual increasing doses. If there were no change in symptoms, then I would add a probiotic at the direction of your physician. There is no secret here. What works for one IBS patient with diarrhea may not work for another. Judicious trial and error is recommended.
Colon Bacteria in the IBS Patient
We, in medicine, are in a new era regarding what we know about the colon and its inhabitants. What we have known for a long while is that the density and numbers of bacteria within the human colon are greater than any other place in the animal kingdom or, in fact, any place in the world. There are more bacteria within the colon by a factor of 10 than there are cells in the entire body. This is amazing! There is likely a reason and, yes, a good healthy reason for this. We have always thought that there were around 400-500 different species of colon bacteria. We were wrong. The number just discovered in 2007 is closer to 1,000 different species.
A key and likely a very important fact, again just discovered in 2007, is that IBS patients have a significantly different colon bacterial makeup than those people without IBS. This has been a startling finding but, thinking it through, it should not have come as a great surprise. Bacteria flourish in the colon and they provide huge numbers of benefits for us. They rely on the foods we eat and what we used to call waste products for their health. However, in some way they may be a problem as well. Can changing the bacterial makeup of the colon change the symptoms in IBS patients? This is a key question. A recent research study showed that a certain probiotic formula may reduce the symptoms of cramping and bloating in some IBS patients. We will await more research on what these interesting findings mean for the IBS patients.
Changing Colon Bacteria
This may be difficult but not impossible. A change in the foods you eat is central.
Gradually reduce animal foods - meat, poultry, fish to a more balanced diet with increasing fresh fruits and vegetables. You can
Add probiotics to your diet. There is no consensus yet on which are the best ones. There is still much research being done. The three types of bacteria which have been studied most are the Bifidos (Bifidobacterium), the Lactos (Lactobacillus) and streptococcus. You can get these in many low calorie dairy products and yogurt as well as over-the-counter pills.
Increase prebiotics in the diet with specific foods that contain them. The main ones are inulin and oligofructase. North Americans generally have a very low consumption of these, getting most in wheat and onions. An easy way to add prebiotics is with a dietary supplement .
Summary
There are no specific and right answers for every IBS patient. There will always be some trial and error necessary to see what is right for you. Still, there are some general principals that may apply to most patients.
- Gradually reduce animal protein, especially red meat and increase the vegetables and fruit content proportionally. Select a balanced mix of soluble and insoluble fiber, aiming for 25-35 grams a day.
- You can try adding a probiotic. The product with some evidence behind it for improving cramps and bloating is VSL#3. There are likely other healthy probiotics that work but we just don't have the evidence for them yet. There are likely beneficial bacteria in many yogurt and dairy food preparations. The ones that have been best studied are the Bifidos (Bifidobacterium), Lactos (Lactobacillus) and certain streptococcus species. Always check with your physician before using probiotics.
- Increase prebiotics fibers in the diet by eating specific foods (Sources of Prebiotics) and/or a supplement .
Evidence based care is something that we in medicine always seek. For medications, it means that the evidence for a benefit is firmly established and strongly outweighs any side effect. For dietary therapy of Crohn's Disease, the evidence is considered soft. This means that there is some research that a certain dietary change is beneficial but that it has not reached the level of near certainty. There are many tantalizing indications that a variety of probiotic bacteria, vitamins, minerals and even fish oil may be helpful. Prebiotics fall into this category as well.
The foods we eat and drink contain hundreds of different substances, natural chemicals if you will. Studying just one food or part of a food is very difficult. The next problem is that the colon contains over 1,000 different bacteria with a total bacteria count of many trillions of bacteria, more bacteria by a factor of 10 than there are cells in the body. So studying how foods mix and interact in this yeasty, wonderful cauldron we call our gut is not easy. But, there is emerging evidence to indicate that diet may be a much more significant factor than we realized.
So, I will present two sections. One will be the Standard Dietary Recommendations that you will find in our gastroenterology textbooks and on the web site of our prestigious organizations like Crohn's and Colitis Foundation and The Mayo Clinic.
The second section is a learned look at newer things that are emerging in the Crohn's dietary field. Considerable research has already been done. Much of it is encouraging. I call this second section, Additional Thoughts on Diet for Crohn's Disease.
Standard Dietary Recommendations
The key to good health for all Crohn's patients is to work with the physician to get the disease under control, usually with medications. Without this basic achievement, getting the full benefit of any dietary program becomes more difficult to achieve. The following are crucial dietary goals:
- Maintain a good weight by ingesting enough calories, minerals and vitamins.
- Protein - The amount of protein you need each day will depend on your weight, age, pregnancy and, especially, on the activity or seriousness of the Crohn's process. The formula for the healthy person is 0.36 grams of protein per pound of body weight. For the 150 lb person, the number is about 54 grams of protein. If you do serious exercise, if you are a large person or if your Crohn's is active, you likely need more. So, Crohn's patients with even moderate activity may need considerably more protein. Much of this protein can and should come from vegetables and fruits. Many nutritionists and physicians think we, as a nation, eat too much animal protein
- Carbohydrates - In general, you should avoid the low carb craze. The bulk of your calories should come from complex carbohydrates such as whole grain, brown rice, and fresh vegetables and fruits. Plain sugar, high fructose sweeteners, as in soft drinks, and many of the processed foods we buy have very large amounts of these simple sugars that do not have much health benefits.
- Fats - The body needs a certain amount of the right kinds of fat, especially the mono and unsaturated vegetable oils, such as olive oil. The high saturated fats in meat, creams, and all trans fat products should be used sparingly.
Vitamins
- Multiple vitamin with minerals - Many authorities recommended a daily multiple vitamin for the general population. Patients with Crohn's Disease need to discuss vitamin/mineral use with their physicians, as some patients have been found to be deficient.
- Vitamin B12 - Some Crohn's patients just don't absorb enough B12 and they may need monthly injections. The physician may want to check the blood level periodically.
- Vitamin D - Vitamin D is important for bone health. Crohn's Disease patients may be particularly susceptible to the early development of weak bones. Newer information has shown that there are vitamin D receptors or attachment points on the cells of many organs in the body including the small intestine and colon. There is likely a reason for this. Further, vitamin D deficiency has now been found to be far more common than was previously thought. So some experts are now recommending at least 800 IU and even 1200 IU per day, along with at least 1200 mg of calcium in the form of milk and/or supplements such as calcium carbonate. Check with your physician.
Minerals
- Calcium - Most adults need 1200 mg of calcium each day even if you live in the sunbelt and your skin makes lots of vitamin D from sunlight. Calcium can best be obtained from milk, other dairy products, shellfish, and, if needed, calcium supplements. If you take steroids such as prednisone, it is even more important that you get enough vitamin D and calcium, as these steroids are well known to weaken bones.
- Iron - Many Crohn's patients have low iron levels which can lead to anemia. Your physician may want to check the iron blood level periodically.
- Selenium - Some authorites believe that selenium acts like an antioxidant in the body. Certain medical studies show that selenium may be low in Crohn's Disease patients and that they do better when they take a selenium supplement. 200 mg per day is recommended. Check with your physician.
Fish, Fish Oil and Herbs
- Fish and fish oil - Fish oil has been found in some medical studies to be helpful for inflammatory bowel disease patients. Flax seed oil has the same type of oils as in fish oil. We still do not know the full benefits of fish oil. Fatty fish (blue, mackerel, salmon, and sword), fish oil capsules and flaxseed oil are recommended. They have other benefits and there are no known side effects. In some published studies, patients took up to nine capsules a day of fish oil. This is a lot and could give you a fishy regurgitation smell.
- Herbs - Herbs are dried plants that are ground into powders. Because something is labeled an herb, that does not transform it into a magical medicine. All plants contain hundreds of different chemicals, many of which are still not known to science. We cannot be sure what effect these known and unknown chemicals have on the inflammation process of Crohn's Disease. Until good data is available on the benefits of a specific herb, it is best to avoid them all.
General Advice
Here are the general recommendations that we gastroenterologists generally give to our Crohn's patients.
- Smaller, more frequent meals - The lower intestine may handle foods better when smaller portions arrive there more frequently. Your body will let you know if four or five smaller meals work better for you.
- Fluids - Adequate fluid intake is a must since diarrhea may be a significant symptom for some patients. For most people, the body tells you when you are thirsty and need fluid. Some authorities recommend eight glasses of fluid per day.
- Caffeine - Caffeine in coffee, tea, soft drinks, and power drinks stimulates the colon to contract and promotes more bowel movements. Caffeine by itself is not known to damage the intestine or colon.
- Alcohol - Alcohol can directly irritate the small intestine if too much is consumed, especially in those Crohn’s patients with extensive involvement of the small bowel.
- Allergies and food intolerance - True food allergies (hives, trouble breathing) are uncommon. Examples are shellfish and peanuts, which are potent allergens for some. Intolerance to certain foods, however, is very common andis not harmful to the body. If a certain food disagrees with you, avoid it.
- Junk food - Most fast food restaurants offer a variety of healthy choices. Dairy products, such as milk, milkshakes and yogurt are available. Pizza provides considerable protein and calcium.
- Lactose and dairy products - Milk and dairy products provide lots of good nutrition and calcium. If you think you are lactose intolerant, you may consider a simple test. Drink 16 oz. of fat free milk on a Saturday or Sunday morning and eat or drink nothing more. If symptoms of bloating, cramps or diarrhea do not occur in 3-4 hours, you likely are not lactose intolerant.
- Celiac Disease or sprue - This is a genetic disorder whereby the gluten protein in wheat and certain other grains damages the small intestine. This disorder is much more common than we have thought in the past. The symptoms may be similar to those of Crohn's disease. A simple blood test can usually screen for this disorder. Ask your physician about celiac disease.
Fiber
Fiber is a special consideration for Crohn's patients. Food fibers are healthy and should be well understood so they can be used in an effective and healthy way. All plants rely on fiber for their structure. Each plant food has both insoluble and soluble fiber. Some will be predominantly one type or the other. For instance, wheat is mostly insoluble fiber, oats is about half and half, and psyllium powder is 90% soluble. Our prebiotics powders are 100% soluble.
Insoluble fiber does not dissolve in water; it is not digested by the small bowel and is not fermented by the colon bacteria. It does, however, retain water and so produces large, bulky stools. Soluble fiber, on the other hand, does dissolve in water. It is fermented by the colon bacteria and is used as a fuel source to maintain a healthy environment in the colon. However, if too much is taken, soluble fibers may promote harmless colon gas and flatus.
Discuss your food fiber intake with your physician.
Additional Thoughts on Dietary Therapy for Crohn's Disease
Crohn's Disease, this disorder has two key and very important factors that are now known to be very important.
- There is a genetic link in Crohn's Disease. There is something in the genes that makes the local immune factors in the small intestine and colon less resistant to the normal bacteria that inhabit the colon. There is a lot of research being done in this area, but the facts remain that genes are important to resist the invasion of bacteria into the bowel wall. For now, you can't change your genes.
- The second factor is the chemistry and make-up of the microbiota of the colon. Microbiota is a fancy word that simply means the whole mix of over 1,000 different bacteria types in the colon, along with its local chemistry, nutrients, acidity and so forth. Needless to say, this is a very complex mixture. Refer to my essay, A Wonderful Colon, for more details. The problem for patients with Crohn's Disease is that these bacteria adhere to and invade the wall of the distal small bowel and colon. If there are no bacteria, there is no Crohn's Disease.
Well, you can't nor would you wish to get rid of your good colon bacteria, nor could you ever sterilize your colon. This is neither possible nor smart. But, there may be ways to trick the bacteria that are in the colon and so soften the impact on Crohn's Disease.
Probiotics
Probiotics are healthy types of bacteria that are put into yogurt, dairy products and now into various pills. One probiotic uses a healthy form of a yeast. Probiotics have been around for a long time in yogurt, and the field is advanced in Europe. In the U.S., some early studies have been performed on patients with irritable bowel syndrome, certain forms of colitis and, yes, Crohn's Disease. The results suggest there may be some benefit but it is too early to say how much.
There are several problems to consider in the probiotic field. Probiotics are considered a dietary supplement so there is no regulation by the FDA, the federal agency that oversees drugs. You can't be sure how many live bacteria are in each preparation. Further, the stomach acid is very strong and likely kills many swallowed bacteria. The make-up of existing bacteria in the colon is simply enormous, with over 1,000 different types. Adding one, two or six more may or may not make much difference. The total bacteria count in the colon is many trillions, so adding five to ten billion a day may not make much difference either. A final point. When a probiotic is stopped, the bacteria make-up of the colon resets to its previous stage within two to three weeks. If probiotics help, they would have to be taken indefinitely.
Having said all this, there are suggestive benefits with probiotics and there are few side effects, so stay in contact with your physician.
Prebiotics
I have an essay section on Prebiotics but the short version is that these are relatively newly discovered food fibers that are completely soluble and serve as a fuel source for the good bacteria within the colon. These bacteria churn out certain chemicals, one of which is called butyrate. It is a short chain fatty acid (SCFA), which means it acidifies the local environment and serves as a fuel source for the colon's own cells. These are the cells that we rely on to keep the immune factors in the colon at a high level. Further, when these SCFA are in a high concentration in this area, there seems to be less adherence to the bowel wall by the bacteria. So, the local immune factors are enhanced and the bacteria seem to be less likely to stick to the colon wall which, we assume, is the first stage in the invasion of the wall by bacteria and likely the first stage in Crohn's Disease.
Well, this sounds rather intriguing, but it should be understood that much of this work has been done in animal models and there have been very few done in patients with Crohn's Disease. Still, the cost-benefit ratio with prebiotics is very favorable. This means that these natural food fibers may produce significant benefits while having virtually no side effects. Excess colon gas is the only one if too much is taken.
As was said at the beginning, all of this information is background and general knowledge. All care, including dietary care, needs to be structured through and with your physician. Our prebiotics are not meant to prevent, treat or mitigate any disease.
Evidence based care is something we in medicine always seek. It means that each treatment we select is carefully measured with evidence to be sure that it is helpful. With medications, in particular, we insist that the benefit strongly outweigh the risk. However, there are many areas of medicine where the final data is just not there, so physicians do the best they can, using the available research as a guide and always assessing any downside risk to a particular treatment.
Diet for ulcerative colitis falls into this uncertain area because the disorder is an inflammatory one of the colon. This is where the fiber and food residue we eat ends up. Is it not possible that the foods we eat or don't eat may be part of the problem? Studying this is difficult because animal and plant food contain hundreds, no, thousands of different chemicals. When these multiple natural substances interact in our intestines with the over 1,000 different bacteria in the colon with a total bacteria count of many trillions, some very strange things may occur, both good and bad.
I present two sections. One is the standard dietary recommendations that are found in our gastroenterology textbooks and on the web site of our prestigious organizations such as Crohn's and Colitis Foundation and The Mayo Clinic.
The second section, Additional Views on Dietary Therapy for Ulcerative Colitis, is a learned look at newer things that are happening in the ulcerative colitis dietary field. Some of it is close to being evidence based. All of it has some science behind it. Very little or none of it has much risk. I view ulcerative colitis care as a partnership between the physician and the patient. The physician brings the best science and medication to the table. Patients learn and then make the necessary changes in their diet.
Standard Dietary Recommendations
The key to good health for all ulcerative colitis patients is to work with the physician to get the disease under control, usually with medications. Without this basic achievement, the full benefit of any dietary program becomes difficult to achieve. The following are crucial key goals:
- Maintain a good weight by ingesting enough calories, minerals and vitamins.
- Protein - The amount of protein you need per day will depend on your weight, age, exercise, pregnancy and, especially, on the activity or seriousness of the colitis process. The formula for the healthy person is 0.36 grams of protein per 1 lb of body weight. For the 150 lb person, the number is about 54 grams of protein.
If you do serious exercise, if you are a large person or if your ulcerative colitis is active, you may need additional protein. Much of this protein can and should come from vegetables and fruits. Many nutritionists and physicians think we, as a nation, eat too much animal protein. For ulcerative colitis patients, in particular, too much red meat may increase the odoriferous gas, hydrogen sulfide, in the colon (see below). - Carbohydrates - In general, you should avoid the low carb craze. The bulk of your calories should come from complex carbohydrates as in whole grain, brown rice, and fresh vegetables and fruits. Plain sugar, high fructose sweeteners, as in soft drinks and many of the processed foods, have large amounts of these simple sugars that do not have much health benefit.
- Fats - The body needs a certain amount of fat, especially the mono and unsaturated vegetable oils, such as olive oil. The high saturated fats in meat, creams, and all trans fat products should be used sparingly.
Vitamins
- Multiple vitamin with minerals - Many authorities recommend a daily multiple vitamin for the general population. Patients with ulcerative colitis need to discuss vitamin/mineral use with their physicians.
- Vitamin D - Vitamin D is important for bone health. Ulcerative colitis patients may be particularly susceptible to early osteoporosis, especially if they take steroids such as prednisone. Newer information has shown that there are vitamin D receptors or attachment points on the cells of many organs in the body including the colon. There is likely a reason for this. Additionally, vitamin D deficiency has been found to be much more widespread than originally thought. Some authorities are, therefore, recommending 800-1200 IU/day rather than the standard 400 IU/day. Check with your physician.
Minerals
- Calcium - Even if you live in the sunbelt and your skin make lots of vitamin D, you still need an adequate amount of calcium by mouth. Milk, dairy products, shellfish, green leafy vegetables, canned fish and, if needed, calcium supplements are the main sources. The goal is at least 1200 mg of calcium a day.
- Iron - Many ulcerative colitis patients have low iron levels which may lead to anemia. Your physician may check the iron blood level periodically.
- Selenium - Some authorities believe that selenium acts like an antioxidant in the body, providing health benefits. Certain medical studies show that selenium may be low in ulcerative colitis patients and that they do better when they take a selenium supplement. 200 mg per day is recommended. Check with your physician.
Fish, Fish Oil and Herbs
- Fish and flaxseed oil - Fish oil has been found in medical studies to be helpful for some ulcerative colitis patients. Flax seed oil has the same type of oil as in fatty fish. We still do not know the full benefits. Fatty fish (blue, mackerel, salmon, and sword), fish oil capsules and flaxseed oil can all be recommended. In some of the published studies, the patients took up to nine capsules per day of fish oil. This is a lot and could give you a fishy regurgitation smell.
- Herbs - Herbs are dried plants that are ground into powders. Because something is labeled an herb, does not transform it into a magical medicine. All plants contain hundreds of different chemicals, many of which are still not known to science. We cannot be sure what effect these known and unknown chemicals have on the inflammation process of ulcerative colitis. Until good data is available on the benefits of herbs, it is best to avoid them.
General Advice
Here are the general recommendations that we gastroenterologists generally give to our ulcerative colitis patients.
- Smaller, more frequent meals - The lower intestine may handle foods better when smaller portions arrive there more frequently. Your body will let you know if 4 or 5 smaller meals work better for you.
- Fluids - Adequate fluid intake is a must if diarrhea is a significant symptom. For most people, the body tells you when you are thirsty and need fluid. Some authorities recommend eight glasses of water per day. The evidence for the need of this much water is sketchy.
- Caffeine - Caffeine in coffee, tea, soft drinks, and,power drinks, stimulates the colon to contract and promotes more bowel movements. Caffeine by itself is not known to damage the intestine or colon.
- Alcohol - Red wine and beer contains sulfates and may contribute to the malodorous smell of flatus.
- Allergies and food intolerance - True food allergies (hives, trouble breathing) is rather uncommon. Shellfish and peanuts can induce such serious problems in the allergic person. However, intolerance to certain foods is very common. If a certain food disagrees with you, avoid it.
- Junk food - Most fast food restaurants offer a variety of healthy choices. Dairy products, such as milk, milkshakes and yogurt are available. Pizza provides considerable protein and calcium.
- Lactose and dairy products - Milk and dairy products provide lots of good nutrition and calcium. If you think you are lactose intolerant, you may consider a simple test. Drink 16 oz. of fat free milk on a Saturday or Sunday morning and eat or drink nothing more. If symptoms of bloating, cramps or diarrhea do not occur in 3-4 hours, you likely are not lactose intolerant.
- Celiac Disease or sprue - This is a disorder whereby the gluten protein in wheat and certain other grains damages the small intestine. This disorder is much more common than we have thought in the past. The symptoms may be similar to those of ulcerative colitis. A simple blood test can usually screen for this disorder. Ask you physician about Celiac Disease.
Fiber
Fiber is a special consideration for ulcerative colitis patients. Food fibers are healthy and should be well understood so they can be used in an effective and healthy way. All plants rely on fiber for their structure. Each plant food has both insoluble and soluble fiber. Some will be predominantly one type or the other. For instance, wheat is mostly insoluble fiber, oats are about half and half and psyllium powder is 90% soluble. Our prebiotics powders are 100% soluble.
Insoluble fiber does not dissolve in water; it is not digested by the small bowel and is not fermented by colon bacteria. It does, however, retain water and so produces large, bulky stools. Soluble fiber, on the other hand, does dissolve in water. It is fermented by the colon bacteria and is used as a fuel source to maintain a healthy environment in the colon. However, if too much is taken, soluble fibers will promote harmless colon gas and flatus.
Discuss your food fiber intake with your physician. Fiber Content of Food provides specific information on the amount of soluble and insoluble fiber in most foods.
Additional Views On Dietary Therapy For Ulcerative Colitis Patents
Probiotics
Probiotics are bacteria in food such as yogurt, other dairy products and now in pill form. There are some early medical studies that show that certain types of probiotics given in pill form can favorably influence the course of ulcerative colitis. However, the study of bacteria in the colon is difficult. Here are a few facts. The human colon has the most densely packed collection of bacteria anywhere in the world. There are over 1,000 different types of bacteria and the total number of bacteria in the colon are many trillions. The commercial probiotic preparations use from one up to six different bacteria and usually claim to have 5-10 billion organisms per pill. This sounds like a lot. But compared to trillions, it is small. Still, there are some favorable medical studies coming out, so stay tuned to the probiotic field. It also should be noted that the bacteria makeup of the colon returns to its previous state 2-3 weeks after probiotics are stopped. You need to stay on then long term if they are effective. People with immune deficiencies, such as HIV, AIDS and chemotherapy, should probably not take probiotics. Otherwise, probiotics seem to be safe, although ulcerative colitis patients should always discuss this with their physician.
Prebiotics
Prebiotics are the soluble food fibers that feed the healthy bacteria in the colon. The term was coined in 1995, so the field is rather new. Researchers are evaluating many prebiotics, but only inulin and oligofructose have shown consistent results. The key thing that these two prebiotics and, hopefully, others do, is to stimulate the colon's good bacteria to grow. Inulin and oligofructose cause certain bacteria to produce acidic substances called short chain fatty acids (SCFA). SCFAs are used by the colon's own cells as a fuel source. They are what make the colon's own cells, the very site of ulcerative colitis, healthy. We still don't know just how this all works but simple reasoning would say that SCFAs are likely good for ulcerative colitis patients.
For a full essay on prebiotics, please click here.
Hydrogen Sulfide (H2S) - The Gas
The H2S gas is made in the colon. It is a nasty customer. It is mostly what gives flatus its foul smell. We avoid the smell when we can and make fun of it. But, there is nothing funny about H2S. Consider these facts about H2S, all medically documented.
- Half the normal population makes H2S gas in their colon. The other half makes methane gas.
- However, 90-100% of ulcerative colitis patients make H2S. That's an interesting fact, isn't it?
- H2S is a toxic gas. In higher doses, it can irritate the eyes. In even higher concentrations, it is as damaging as hydrogen cyanide. In the normal colon, there are cells that contain an enzyme that detoxifies the H2S gas.
- There is some evidence to suggest that this enzyme is deficient in ulcerative colitis patients, so that the H2S may linger and damage the colon wall.
- Most patients have ulcerative colitis in the left side of the colon where the H2S gas is mostly made.
- Certain bacteria in the left side of the colon use sulfur in our foods, water and especially in meats, to make the H2S gas.
- The good bacteria in the colon make certain acid substances, (see SCFA above) thereby acidifying the colon contents.
- Here is a possible key point. These H2S producing bacteria do not grow in an acid environment. Keeping the colon acid may be important.
Sulfate and Sulfides
Sulfate is a necessary element in the diet as our body needs it for many of its functions. However, the H2S gas producing bacteria in the left colon rely on ingested sulfur to make the sulfide gas, H2S. The more sulfate you ingest, the more of it is available for colon bacteria to make sulfide gases. So where is the sulfate we ingest?
- Drinking water - up to 20% or more may come from drinking water, depending on the source. City water is monitored so there won't be too much, but well water can vary significantly. You need to measure sulfate in well water.
- Beverages - beer, red and white wine, cider, apple, grape and tomato juice, and even cow's milk have significant amounts of sulfate.
- Foods - the following have moderate amounts of sulfate:
- eggs
- cheese
- milk
- dates
- dried apples, apricots (dried fruits are very high in sulfate)
- almonds
- wheat pasta
- breads
- peanuts
- cruciferous vegetables (broccoli,cauliflower, Brussels sprouts, cabbage
- raisins
- prunes
- Animal Protein - There are only two amino acids, methionine and cystine, that contain sulfate. These are present in all animal products, but especially in red meat. The more meat you eat, the more sulfate enters your colon.
- Supplements - chondroitin sulfate, glucosamine sulfate and MSM (methylsulfonylmethane) are used by many people for bone and joint disorders.
These have significant amounts of sulfate. So does carrageenan, used as a thickening agent in many prepared foods. Read the labels.
Summary
Were I still in gastroenterology practice, I would recommend that ulcerative colitis patients follow the guidelines in the first part of this section. Additionally, I would consider:
- Reduce sulfur-containing foods in the diet, especially red meat, cruciferous vegetables (broccoli, cabbage, Brussels sprouts) and sulfur containing wine and beer. Check well water for sulfur.
- Increase foods that are high in inulin and oligofructose.
- Consider using a dietary supplement to get a significant dose of the beneficial prebiotics, inulin and oligofructose, into the colon every day.
The goal is to make your colon more acidic and inhospitable for the H2S gas producing bacteria. If your flatus no longer has a malodorous smell, then the H2S producing bacteria likely are not growing.
One final point. This information has some research behind it. Some of it is not conclusive, but it is at this time the best we have. Finally, check with your physician. She or he knows your case best. This information is for background use only. Prebiotic supplements are not meant to prevent, treat or mitigate any disease.
Diverticulosis, otherwise known as pockets or pouches of the colon, is very common. You can access a full description of this condition at Diverticulosis. The condition is almost certainly caused by a low fiber intake over a lifetime. This results in high pressures in the colon, which very, very slowly, over many years, cause ballooning of tiny weak points in the colon wall resulting in diverticuli. When these pockets become infected, diverticulitis occurs, a painful and, at times, serious condition. Rural Africans who consume 50 or more grams of fiber a day over a lifetime do not get diverticulosis. Yet, they do when they eat a Western diet with low fiber. Low fiber intake can result in small, thin and/or hard pellet stools, which usually means high pressure within the colon. Again, this high pressure is what causes these pockets to balloon out forming diverticuli.
These are dietary recommendations for people with diverticulosis. However, specific advice will depend on the stage of diverticulosis. Is it early diverticulosis? Is it advanced with fixed changes in the colon? Are there symptoms? Or is it acute diverticulitis where the colon is recovering from infection around these pockets?
Stages of Diverticulosis
- Diverticulitis - Diverticulitis means that one or more of these weak-walled diverticuli has become infected and inflamed. At this point, the physician will want to put the bowel and even the patient at rest. Early on, a diet consisting of clear liquids is often prescribed to ensure maximum bowel rest. As recovery proceeds, the diet is advanced to a Low Fiber Diet, progressing gradually to a High Fiber Diet when recovery is complete.
- Quiet, early and moderate diverticulosis - This is where most people are. The physician may have discovered a few or a moderate number of diverticuli on colonoscopy as an incidental finding when screening for colon cancer. Because it is just mentioned in passing, not too much importance may be attached to it. This is a mistake, as now is the time that something can really be done. Remember, it is the increased pressures that the colon can exert within itself that causes diverticulosis. A bulky stool helps prevent this. Plant fiber, especially the insoluble fiber, is the best. These are the fibers that do not produce colon gas. The easiest to take are wheat bran, amaranth, barley and others as listed in Fiber Content of Foods.
- Quiet but advanced, fixed and/or narrowed diverticulosis - In many older folks, the diverticulosis has become so severe that the colon, just above the rectum, becomes fixed, twisted or gnarled by fibrous tissue within the bowel wall. At this stage, the colon is less likely to be massaged back to its normal size. The dilemma here is that large stools can seldom be produced, as the only thing that can get through this narrowed portion of the colon is smaller, even pellet-like stool. Still, it is worth trying small doses of extra food fiber or supplements to see what can be accomplished.
Go to High Fiber Diet for full details. The goal is to increase the daily fiber to 20, 30 or even 40 grams per day. You do not want to do this all at once, and, especially with excessive amounts of soluble fiber as this fiber is the one that, if taken to excess, promotes the bacterial production of harmless colon gas and flatus.
Insoluble Fiber
This fiber, also known as roughage or bulk, does not dissolve in water but paradoxically hangs onto water in the large bowel. This creates a large, soft and bulky stool. It promotes regularity and seems to be associated with a reduced chance of getting colon polyps and colon cancer, as we believe cancer inciting agents are swept through the bowel in a more rapid manner. In addition, it may promote weight loss and it can enhance diabetic control. Foods that are high in insoluble fiber are:
- whole wheat bread and baked goods
- wheat bran
- whole grain breads
- vegetables and fruits, especially the skins
- peanuts
- Brazil nuts
- popcorn
- brown rice
The section, Fiber Content of Foods, provides detailed information on the insoluble fiber content of many foods.
Soluble Fiber
This plant fiber does dissolve in water. In the colon, it provides food for the enormous number of bacteria that thrive there and, in so doing, provides many health benefits. Soluble fibers also promote regularity by increasing growth of the colon bacteria. Foods that are high in soluble fibers are:
- oats in any form - cereal, muffins, etc.
- apples, oranges, grapefruit, peaches, concord grapes
- prunes, pears, cranberries
- beans
- beets
- carrots
- sesame seeds
- psyllium found in dietary supplements and cereals
The section, Fiber Content of Foods, provides information on the soluble fiber content of many foods.
Nuts, Seeds and Popcorn
From time immemorial, physicians have been advising patients with diverticulosis to avoid these items. Didn't it just make sense that these could get inside colon pockets, rattle around and injure the colon wall? It was just like dried seeds inside a gourd that you can hear rattling around when you shake it. I have never agreed with this. I have never heard a patient rattling after eating these things. Furthermore, all of these items become digested or totally sodden and soft by the time they reach the colon. Most important of all, they contain excellent amounts of fiber, which is exactly what the colon wants. So, I have always recommended nuts, seeds and popcorn for diverticulosis patients. Now, I have been supported in this recommendation by a 2007 study where a large number of diverticulosis patients who took these foods were matched against those who did not. You guessed it. The ones eating nuts, seeds and popcorn had less diverticulosis problems than those who did not.
Prebiotics
Prebiotics are the relatively newly discovered types of plant fiber that have been shown to promote beneficial changes in the colon. These are present in certain plant foods as well as in our prebiotic products. In diverticulosis, all the soluble fiber foods and supplements can be a healthy addition. However, if too much is taken, then excessive colon gas can occur. If it is trapped behind a narrowed diverticular colon, there may be cramps and bloating. The advice is to take these healthy fibers in small, but increasing amounts and see if symptoms develop.
Summary
Diverticulosis is a disorder of the Western diet which has occurred along with the ingestion of large amounts of animal products and small amounts of beneficial plant food and their beneficial fiber. At any stage, but particularly in the early one, increasing fiber intake will be very helpful. Reducing high pressure in the colon and a more regular, softer bowel pattern may be the observed benefit. The unseen one, in the long term, is the large number of positive health benefits that dietary fibers, especially the prebiotic ones, can confer on future health.
No one is certain which of the following points are most important. Some are easy, such as ingesting enough calcium or taking a prebiotic powder. Some are more difficult, such as getting your weight under control and reducing your consumption of red meat. Taken together, a fairly good case and set of recommendations can be made to reduce your risk. These recommendations may be appropriate for those who have never had colon cancer or polyps as well as those who have.
Red Meat
Red meat is as American as apple pie. It is hard to realize how little red meat was available hundreds of years ago when plant foods were the basis of the diet in Europe and likely the New World Indians as well. With the domestication and breeding of farm animals, the industrialization of farming, and the availability of cheap corn feed, red meat is as common and as cheap, no, cheaper than bottled water.
The adult body needs perhaps only 50 grams of protein a day. Much of it can be obtained from plant foods. But meat tastes so good. We humans are true omnivores and given a choice, most of us will pick the tasty, fat dripping, red meat every time.
But for colon cancer prevention, it is best to modify the intake. Take smaller portions, perhaps a piece of meat about the size of a deck of cards. Reduce the frequency of red meat ingestion to 3 or 4 times a week or to whatever you feel comfortable with. For the real meat lover, this is as hard a decision to make as anything else in this essay.
Prebiotics and Plant Fiber
Prebiotics are the soluble fiber which go through the gut unchanged and then are used by good colon bacteria as a fuel source for their own growth. These bacteria then make short chain fatty acids or butyrates. This substance renders the colon acidic and is a fuel source for the health of the colon's own cells. The bacteria that live in our colon rely on the prebiotic fiber we eat to make substances that maintain the health of our own colon. Scientists call this mutualism. I call it amazing.
One of the possible benefits of this process is to make the colon cells less likely to turn into precancerous and cancerous cells. So what are these prebiotic soluble plant fibers? The ones we know most about are inulin and oligofructase, which are found in:
- wheat
- onions
- garlic
- leeks
- artichokes
- bananas
Psyllium, found in bowel supplements such as Metamucil are fermented by colon bacteria. It will reduce cholesterol, but other health benefits have still not been demonstrated. There are other plant fibers that are suspected of being prebiotic fibers as well, but the science on these is still not certain.
The bottom line is that almost any plant food can be a benefit to the colon. The prebiotic foods and dietary supplement powders have the most science behind them.
Sulforaphane and Those Gassy Vegetables
Cruciferous vegetables such as cabbage, broccoli, Brussels sprouts and cauliflower are felt by many to be gassy. This is probably not true as they do not have an excessive amount of soluble fiber, which the colon's bacteria need to make colon gas. What they do have is a lot of sulfur. Sulfur is what certain other colon bacteria use to make the smelly sulfide gases in colon gas and flatus.
But, there is an extraordinary payoff here. Sulforaphane is a key ingredient in these vegetables. In broccoli sprouts, it is exceptionally high. This is a powerful anti-cancer substance. The regular ingestion of these vegetables has been found in many medical studies, to be associated with a reduced cancer risk in many organs of the body. In the laboratory and in animal testing, sulforaphane has been found to have strong anti-cancer properties. While there are still no definitive human trials on cruciferous vegetables, most nutrition experts recommend these.
Calcium and Vitamin D
Calcium is one of the most common elements in the body. Yet, we still need a regular ingestion of at least 1200 mg of calcium a day. Milk can provide much of this. The calcium in vegetables is not as readily available to the body. Colon cancer risk seems to be greater when a low amount of calcium is ingested. So, adequate calcium intake in the form of milk, dairy products, shellfish and vegetables is recommended. Many physicians are now recommending calcium carbonate supplements up to 1200 mg a day to keep calcium intake at a good level.
Vitamin D has always been associated with calcium and strong bones. However, considerable new research on this vitamin has uncovered some remarkable findings.
- Most tissues in the body, including colon cells, have receptors or attachment points for vitamin D. Hmm, that's interesting. Why should there be vitamin D receptors on so many cells in the body beyond bone cells?
- Vitamin D controls, either directly or indirectly, over 200 genes responsible for healthy cell growth. If enough vitamin D is not present, some of these cells may get a bit disorganized.
- There is now significant research to suggest an anti-cancer effect with vitamin D.
- There is recognition that vitamin D deficiency is widespread, especially in the temperate weather zones where sun exposure is variable. Sunlight makes vitamin D in the skin.
This is startling information. The blood level of vitamin D should be above 30 ng/ml. National experts are not in agreement on the amount of vitamin D needed to reach this level. Many experts think that 400 IU a day is too low and that at least 800-1200 IU a day should be taken. Toxicity from too much vitamin D is very rare. Check with your physician.
Overweight and Obesity
Obesity gets blamed for just about everything. A 2007 analysis of many published medical studies found that being overweight is a colon cancer risk factor for both men and women. The heavier you are, the higher the risk. So, for whatever other reason you might want to lose weight, decreasing the risk of colon cancer is worthwhile in and by itself.
Aspirin
In the past, it has been demonstrated that aspirin was able to reduce the risk of recurrent polyps in the colon. However, it was uncertain whether the risk of cancer was changed. Now we know that, indeed, regular aspirin, as little as two times a week, has shown a beneficial reduction in risk. Of course, aspirin should not be used unless there is concurrence with your physician as bleeding tendencies can occur with its use.
Multivitamins and Folate
There is medical research evidence that demonstrates that those people who take a multiple vitamin daily, especially with adequate amounts of the vitamin, folate, have less colon cancer.
Smoking and Excessive Alcohol
Is there any disease or disorder where smoking cigarettes and excessive alcohol are not implicated? Sad to say, the same holds true for polyps and colon cancer. Smokers and those who use excessive alcohol do have increased risk of colon cancer.
Summary
There is no one magic dietary bullet, no one simple step to take. It is very difficult for scientists to tease out an isolated lifestyle or dietary factor on any health question within a free living population. However, one thing is now rather clear. The western type of diet with large portions of animal meat, little fiber, low intake of vegetables, and possible low intake of vitamin D and calcium all seem to be major factors. The amount of solid information percolating into the medical literature has reached a point where a reasonable balanced colon cancer and polyp prevention program can be outlined.
- As hard as it is, control your weight. Overweight people have more colon cancer.
- Reduce red meat, saturated and trans-fats in the diet.
- Take 1200 mg of calcium each day using milk or calcium carbonate supplements.
- Take vitamin D at least 800 IU/day. Some experts say 1200 IU/day. Check with your physician.
- Eat cruciferous vegetables.
- Daily aspirin, but only if discussed with your physician.
- Daily multiple vitamin with adequate folate.
- No smoking or excessive alcohol.
- Prebiotics - eat these in food or take a dietary supplement, preferably ours (products).
And don't forget to get your regular colonoscopy.
Purpose
A diet of clear liquids maintains vital body fluids, salts, and minerals; and also gives some energy for patients when normal food intake must be interrupted. Clear liquids are easily absorbed by the body. They reduce stimulation of the digestive system, and leave no residue in the intestinal tract. This is why a clear liquid diet is often prescribed in preparation for surgery, and is generally the first diet given by mouth after surgery. Clear liquids are given when a person has been without food by mouth (NPO) for a long time. This diet is also used in preparation for medical tests such as sigmoidoscopy, colonoscopy, or certain x-rays.
Nutrition Facts
A clear liquid diet is not adequate in calories and nutrients. It should not be used for more than five days unless high-protein gelatin or other low-residue supplements are added.
Special Considerations |
---|
|
Food Groups |
||
---|---|---|
Group |
Recommend |
Avoid |
Milk & milk products |
none
|
all
|
Vegetables |
none |
all
|
Fruits |
fruit juices without pulp |
nectars; all fresh, canned, and frozen fruits |
Breads & grains |
none |
all |
Meat or meat substitutes |
none |
all |
Fats & oils |
none |
all |
Sweets & desserts |
gelatin, fruit ice, popsicle without pulp, clear hard candy |
all others |
Beverages |
coffee; tea; soft drinks; water; lactose-free, low residue supplements if approved by physiciancoffee; tea; soft drinks; water; lactose-free, low residue supplements if approved by physician |
all others |
Soups |
bouillon, consommé fat free broth |
all others |
Sample Menu |
||
---|---|---|
Breakfast |
Lunch |
Dinner |
|
|
|
This Sample Diet Provides the Following |
|||
---|---|---|---|
Calories |
600 |
Fat |
virtually none |
Protein |
6 gm |
Sodium |
1500 mg |
Carbohydrates |
209 gm |
Potassium |
1440 mg |
Purpose
Wilson's disease is a hereditary disorder in which the body retains too much copper. Copper is a trace mineral in the body. This means it is essential for good health, but only a tiny amount is needed. When excess copper accumulates, it is stored in the eyes, brain, kidneys, and liver. Excess copper collecting in the liver causes cirrhosis of the liver, which is a serious, life-threatening condition. However, Wilson's disease is treatable.
Copper is found in different amounts in a wide variety of foods. Therefore, dietary restriction alone is usually not enough to control Wilson's disease. Medicines such as Cuprime and Depen (generic name: D-penicillamine) and Syprine (generic name: trientine) are used to help excrete excess copper with the urine. Still, it is helpful to avoid copper-rich foods as much as possible. The dietary intake of copper should be less than 1.0 mg per day.
Nutrition Facts
A low copper diet is generally adequate in all the nutrients necessary for good health. However, patients taking D-penicillamine may develop a deficiency of vitamin B-6 (pyridoxine), and the physician may prescribe a supplement of 25 mg daily.
Special Considerations |
---|
|
Food Groups |
|||
---|---|---|---|
Eat as Desired |
6 Portions/Day |
Avoid |
|
Meat & meat substitute |
beef; eggs; white meat turkey and chicken; cold cuts and frankfurters taht do not contain pork, dark turkey, dark chicken, or organ meats; all others not listed on high or moderate list |
all fish except shellfish 3 oz, dark meat turkey and chicken 3 oz, peanut butter 2 Tbsp |
lamb; pork; pheasant quail; duck; goose; squid; salmon; organ meats including liver, heart, kidney, brain; shellfish including oysters, scallops, shrimp, lobster, clams, and crab; meat gelatin; soy protein meat substitutes; tofu; nuts and seeds |
Vegetables |
most vegetables including fresh tomatoes |
bean sprouts 1 cup; beets 1/2 cup; spinach 1/2 cup cooked, 1 cup raw; tomato juice and other tomato products 1/2 cup; broccoli 1/2 cup; asparagus 1/2 cup |
vegetable juice cocktail, mushrooms |
Fruits |
most fruits except as listed to right |
mango 1/2 cup, papaya 1/4 average, pear 1 medium, pineapple 1/2 cup |
nectarine, commercially dried fruits including raisins, dates, prunes; avocado |
Starches - breads & grains |
breads & pasta from refined flour, rice, regular oatmeal, cereals with <0.1 mg of copper per serving (check sweet potatoes, all others not listed on high or moderate list |
whole wheat bread 1 slice, Melba toast 4, whole wheat crackers 6, instant oatmeal 1/2 cup, instant Ralston™ 1/2 cup, cereals with 0.1 to 0.2 mg of copper per serving (check label), dehydrated and canned soups 1 cup, potatoes in any form 1/2 cup or small, pumpkin 3/4 cup, parsnips 2/3 cup, winter and summer squash 1/2 cup, green peas 1/2 cup |
dried beans including soy beans, lima beans, baked beans, garbanzo beans, pinto beans; dried peas; lentils; millet; barley; wheat germ; bran breads and cereals; cereals with >0.2 mg of copper per serving (check label); soy flour; soy grits; fresh sweet potatoes |
Fats, oils |
butter, cream, margarine, mayonnaise, non-dairy creamer, sour cream, oils, salad dressings (made from allowed ingredients) |
olives 2 med |
|
Milk & milk products |
Most milk products, milk flavored with carob, cheeses, cottage cheese |
all others |
chocolate milk, soy milk, cocoa |
Sweets & desserts |
most sweets; jams, jellies, and candies made with allowed ingredients; carob; flavoring extracts |
licorice 1 oz,syrups 1 oz |
desserts that contain high amounts of ingredients rich in copper; candy with nuts, chocolate, or cocoa |
Beverages, liquids, misc. |
coffee, tea, fruit juices, fruit-flavored beverages, lemonade, soups made with allowed ingredients |
Postum™ and other cereal beverages1 cup, carbonated beverages 12 oz, ketchup 2 Tbsp, dehydrated and canned soups |
instant breakfast beverages, mineral water, soy-based beverages, copper-fortified formulas, brewer's yeast, multiple vitamins with copper or minerals |
Sample Menu |
||
---|---|---|
Breakfast |
Lunch |
Dinner |
|
|
|
This Sample Diet Provides the Following |
|||
---|---|---|---|
Calories |
1520 |
Sodium |
1500 mg |
Protein |
69 gm |
Potassium |
2150 mg |
Carbohydrates |
191 gm |
Copper |
0.68 mg |
Fat |
54 gm |
Purpose
This diet helps to prevent a condition called "dumping syndrome," which occurs in some patients who have undergone stomach surgery. The symptoms include bloating, nausea, diarrhea, dizziness, weakness, sweating, and rapid heartbeat. They may occur 30 to 60 minutes after eating a meal and then again, 2 to 3 hours after eating.
The early symptoms are caused when concentrated sugar passes too rapidly from the stomach into the intestine. The body dilutes this sugar mixture by bringing fluid from body tissues into the intestine, giving a sense of fullness, cramping, and occasionally, diarrhea. The loss of water from tissues can produce a temporary drop in blood pressure, with resulting weakness and faintness.
The later symptoms are caused by the rapid absorption of sugar into the bloodstream, which raises the amount of blood sugar. A high level of blood sugar signals the body to produce more insulin. The excess insulin, in turn, drives blood sugar levels down. The low blood sugar (hypoglycemia) produces the weakness, hunger, and rapid heart rate that may occur about two to three hours after eating. This diet is really a regular diet with frequent small meals and reduced simple sugars.
Nutrition Facts
Depending upon individual tolerances and food selection, the Anti-Dumping or Post-Gastrectomy Diet is adequate in all nutrients according to the National Research Council's Recommended Dietary Allowances (RDA). Depending on the type and extent of gastric surgery performed, poor absorption of nutrients, vitamins, and minerals may occur to a significant degree. Some patients may become deficient in iron, calcium, folate, and B-12. The physician may prescribe vitamin/mineral supplementation and B-12 injections.
Special Considerations |
---|
|
Food Groups | ||
---|---|---|
Group |
Recommend |
Avoid |
Milk & milk products |
as tolerated: butter-milk; low fat, skim, or whole milk; creamed soups; low calorie pudding; plain or low-calorie, artificially sweetened yogurt; cheese |
cocoa mixes; ice cream; malted or chocolate milk; sweetened custard and pudding; sweetened, fruited, or frozen yogurt; milkshakes |
Vegetables |
all |
none |
Fruits |
fresh fruit, fruit canned in natural juice, unsweetened fruit juice |
dried fruits, canned or frozen fruits in syrup, sweetened juice |
Breads & grains |
crackers, pasta, plain breads and rolls, pretzels, rice, unsweetened cereals |
sugar-coated cereals (including granola), doughnuts, sweet rolls |
Meats & meat substitutes (5 to 6 oz daily) |
eggs, seafood, beef, poultry, pork, peanut butter |
none |
Fats & oils |
butter, margarine, oils, salad dressings |
none |
Sweets & desserts |
artificial sweeteners, low-calorie jelly, low-calorie gelatin, low-calorie popsicles |
popsicles, cakes, pies, cookies, jellies, jams, gelatin, high sugar desserts, sherbet |
Beverages |
sugar-free beverages, water |
regular soft drinks, sugared drink mixes, lemonade, Kool Aid, Gatorade, sugared ice tea, Snapple or similar drinks |
Sample Menu | ||
---|---|---|
|
|
|
Mid-Morning Snack |
Mid-Afternoon Snack |
Evening Snack |
|
|
|
This Sample Diet Provides the Following | |||
---|---|---|---|
Calories |
Fat |
||
Protein |
Sodium |
||
Carbohydrates |
Potassium |
Purpose
Dysphagia means difficulty with chewing or swallowing food or liquid. To understand how this might happen, it is important to know something about how swallowing occurs. First, food must be chewed thoroughly. Then it is moved to the back of the mouth by tightening the cheek muscles and pressing the tongue against the roof of the mouth. From this point on the process becomes automatic -- it is a reflex that people do not actively control. In "rapid- fire" succession, the soft palate closes the nasal airway to prevent food from backing into it, the airway into the lungs is closed, and the esophagus (food pipe) relaxes allowing food and liquid to enter it. The muscular esophagus then contracts in a wave-like action, sweeping the food along into the stomach. A blockage or a malfunction anywhere in this part of the body or in the nervous system controlling swallowing can result in dysphagia. There are two types:
Esophageal dysphagia occurs when food/liquid stops in the esophagus. This happens most often because of consistent stomach acid refluxing (backing up) into the esophagus. Over time, the reflux causes inflammation and a narrowing (stricture) of the esophagus. Food and eventually liquids feel like they are sticking in the middle and lower chest. There may be chest discomfort or even real pain. Fortunately, physicians can usually dilate (widen) this narrowing, and there is now treatment available to keep it from returning. Cancer, hiatus hernia, and certain muscle disorders of the esophagus are less frequent causes of esophageal dysphagia. Solid food is usually more of a problem than liquids
Oropharyngeal dysphagia involves difficulty moving food to the back of the mouth and starting the swallowing process. This type of dysphagia can result from various nerve or brain disorders such as stroke, cerebral palsy, multiple sclerosis, Parkinson's and Alzheimer's diseases, cancer of the neck or throat, a blow to the brain or neck, or even dental disorders. Depending on the cause, symptoms may include drooling, choking, coughing during or after meals, pocketing of food between the teeth and cheeks, gurgly voice quality, inability to suck from a straw, nasal regurgitation (food backing into the nasal passage), chronic respiratory infection, or weight loss. Liquids are usually more of a problem in oropharyngeal dysphagia.
The first step in treatment is to make the proper diagnosis. This involves a medical history and various tests to find the cause of the dysphagia. Often a team approach to treatment is needed. Several types of health care providers -- physicians, registered dietitian, psychologist, speech pathologist, occupational therapist -- work together to develop the best program.
An important part of the treatment is helping the patient get adequate nutrition, while protecting against complications such as pneumonia from food or liquid getting into the lungs. Obviously, this requires a specialized diet. There are five different diet levels from puréed (level 1) up through modified regular food (level 5). The diets vary in texture and consistency, and are chosen depending on which would be most effective for a specific patient.
Nutrition facts
These diets are all nutritionally adequate. However, some patients may have difficulty taking enough fluid and food to get all the energy and nutrients they need. In this case, an adjustment to diet or treatment will be required.
Liquids
Fluids are essential to maintain body functions. Usually 6 to 8 cups of liquid (48-64 oz) are needed daily. For some dysphagia patients, this may present problems because thin liquid can be more difficult to swallow. In this case, fluid can be thickened to make it easier to swallow. However, close monitoring by the dysphagia team is required for anyone drinking less than 4 cups of thickened fluid a day or anyone not progressing to thin liquids within 4 weeks.
Calories
The greater problem for some patients is eating enough calories. The whole process of eating simply becomes too difficult and too tiring. However, calorie and protein intake can be increased by fortifying the foods the patient does eat.
- Fortify milk by adding 1 cup of dry powdered milk to one quart of liquid milk. Use this protein fortified milk when making hot cooked creamed soups, sauces, milkshakes, and puddings. Also add margarine, sugar, honey, jelly, or puréed baby food to increase calories.
- Add strained baby fruit to juices, milkshakes, and cooked cereals.
- Add 1 jar of strained baby meat to soup, such as strained chicken noodle soup. Also add strained baby meats to sauces and gravies, and mix with strained vegetables.
- Add juice to prepared fruit, cereal, or milkshakes.
Special Considerations |
---|
The following are some general guidelines for safe swallowing. Remember that dysphagia patients have individual requirements, so all of these guidelines may not apply to every patient.
|
Level 1 |
|
---|---|
Foods in this group are puréed to a smooth, mashed potato-like consistency. If necessary, the puréed foods can keep their shape with the addition of a thickening agent. Meat is puréed to a smooth pasty consistency. Hot broth or hot gravy may be added to the puréed meat, approximately 1 oz of liquid per 3 oz serving of meat. CAUTION:If any food does not purée into a smooth consistency, it may make eating or swallowing more difficult. For example, zucchini seeds sometimes do not blend well. |
|
Hot Foods |
Cold Foods |
Puréed meats, poultry, & fish
|
Puréed cottage cheese |
Puréed tuna, ham, & chicken salad |
Puréed fruit |
Pureed scrambled eggs & cheese |
Thickened juices & nectars |
Baby cereals |
Thickened milk or eggnog |
Thinned cooked cereals (no lumps) |
Malts |
Puréed French toast or pancakes |
Thick milkshakes |
Mashed potatoes |
Ice cream |
Puréed parsley, au gratin, scalloped potatoes, candied sweet potatoes |
Fruit or Italian ice, sherbet |
Puréed buttered or Alfredo noodles |
Plain yogurt |
Puréed vegetables (no corn or peas) |
Smooth & drinkable yogurt |
Puréed soups & creamed soups |
Smooth pudding, mousse, custard |
Puréed scalloped apples |
Whipped gelatin |
Gravies |
Sugar, syrup, honey, jelly |
Sauces: cheese, tomato, barbecue, white, creamed |
Cream |
Decaffeinated coffee or tea |
Non-dairy creamer |
Margarine |
|
Mayonnaise |
|
Ketchup, mustard |
Sample Menu, Level 1 | ||
---|---|---|
Breakfast |
Lunch |
Dinner |
|
|
|
This Sample Diet Provides the Following | |||
---|---|---|---|
Calories | 1657 |
Fat | 61 gm |
Protein | 92 gm |
Sodium | 2590 mg |
Carbohydrates | 198 gm |
Fiber | 3163 mg |
Level 2 |
|
---|---|
Foods in this group should be minced/chopped into very small pieces (1/8 inch). The flecks of food are similar in size to sesame seeds. |
|
Hot Foods |
Cold Foods |
Minced meat, fish, poultry |
Cottage cheese |
Minced stuffed fish |
Junior baby fruit |
Flaked fish |
Semi-thickened juices |
Junior baby meats |
Nectars |
Minced soft cooked, scrambled, poached eggs |
Ripe mashed bananas |
Minced soufflé & omelets |
Minced canned fruit |
Minced soft French toast |
Pineapple sauce |
Minced soft pancakes |
Milk |
Cooked cereals |
Milkshakes |
Minced potatoes |
Custard |
Minced buttered or Alfredo noodles |
Puddings, including rice & tapioca |
Minced vegetables |
Yogurt |
Creamed soups |
Fruit ice, Italian ice, sherbet |
Puréed vegetables soup or alphabet soup |
Whipped gelatin
|
Minced scalloped apples |
Junior baby desserts |
Gravies
|
Sugar, syrup, honey, jelly |
Sauces: cheese, creamed, barbecue, tomato, white |
Cream |
Decaffeinated coffee or tea |
Margarine |
Sample Menu, Level 2 |
||
---|---|---|
Breakfast |
Lunch |
Dinner |
|
|
|
This Sample Diet Provides the Following | |||
---|---|---|---|
Calories | 2022 |
Fat | 80 gm |
Protein | 111 gm |
Sodium | 2992 mg |
Carbohydrates | 231 gm |
Potassium | 4182 mg |
Level 3
|
|
---|---|
Foods in this group should be ground/diced into 1/4-inch pieces. These pieces of food are similar in size to rice. |
|
Hot Foods |
Cold Foods |
Ground meat, fish, poultry |
Cottage cheese |
Ground meat salads (no raw eggs) |
Smooth fruited yogurt |
Ground Swedish meatballs |
Fruit juices or nectars |
Scrambled eggs or soufflés |
Ground canned fruit |
Ground poached eggs |
Crushed pineapple |
Cooked cereals |
Ripe bananas |
Ground soft French toast |
Lemonade/Limeade (no pulp) |
Ground potatoes |
Milk |
Ground noodles |
Ice cream |
Ground baked potato (no skin) |
Custard |
Ground well-cooked frozen vegetables (no corn, peas, or mixed vegetables) |
Puddings or mousse |
Ground canned vegetables |
Fruit ice, Italian ice, sherbet |
Creamed soups |
Cream |
Puréed vegetables soup or alphabet soup |
Non-dairy creamer |
Ground scalloped apples |
Margarine |
Gravies |
Mayonnaise |
Sauces: cheese, creamed, barbecue, tomato, white |
Ketchup |
Decaffeinated tea or coffee |
Mustard |
Sample Menu, Level 3 | ||
---|---|---|
Breakfast |
Lunch |
Dinner |
|
|
|
This Sample Diet Provides the Following | |||
---|---|---|---|
Calories | 2022 |
Fat | 80 gm |
Protein | 111 gm |
Sodium | 2992 mg |
Carbohydrates | 231 gm |
Potassium | 4182 mg |
Level 4 |
|
---|---|
Foods in this group should be chopped into 1/2-inch pieces. These pieces of food are similar in size to uncooked elbow macaroni or croutons (small bread cubes). |
|
Hot Foods |
Cold Foods |
Chopped meat or poultry |
Cottage cheese |
Chopped Swedish meatballs |
Yogurt |
Meat salads (ground or flaked meat) |
Milk |
Flaked fish |
Milkshakes |
Poached or scrambled eggs |
Soft, cold, dry cereal |
Soufflés and omelets |
Soft bread (if approved by speech or occupational therapy) |
Cooked cereals |
Fruit juice or nectars |
Chopped French toast or pancakes |
Chopped canned fruit |
Chopped noodles or pasta (no rice) |
Canned fruit cocktail |
Chopped cooked vegetables (no frozen peas, corn, or mixed vegetables) |
Pudding, mousse, custard |
Chopped canned small sweet peas |
Ice cream |
Creamed soup or vegetable soup |
Fruit ice, Italian ice, sherbet |
Canned chicken noodle soup |
Cream cheese |
Chopped potatoes (all kind) |
Whipped topping |
Gravies |
Whipped gelatin |
Bacon dressing |
Sugar, syrup, honey, jam, jelly |
Sauces: cheese, creamed, barbecue, tomato, white |
|
Decaffeinated tea or coffee |
Sample Menu, Level 4 | ||
---|---|---|
Breakfast |
Lunch |
Dinner |
|
|
|
This Sample Diet Provides the Following | |||
---|---|---|---|
Calories | 2097 |
Fat | 82 gm |
Protein | 113 gm |
Sodium | 3213 mg |
Carbohydrates | 243 gm |
Potassium | 4201 mg |
Level 5 Modified Regular Foods |
|
---|---|
Foods in this group are soft, moist, regularly textured foods |
|
Hot Foods |
Cold Foods |
Soft, moist meat, fish, poultry |
Soft cheeses |
Baked fish |
Cottage cheese |
Meat Salads |
Cream cheese |
Soufflés and omelets |
Yogurt |
Eggs |
Milk |
Stuffed shells |
Milkshakes |
Spaghetti with meat sauce |
Cold dry cereals (no nuts, dried fruit, coconut) |
Cooked cereal |
Crackers |
French toast or pancakes |
Soft breads (no hard rolls) |
Toast |
Fruit juices or nectars |
Noodles or pasta (no rice) |
Canned fruit |
Potatoes (all types) |
Ripe bananas |
Soft, cooked vegetables (no corn, lima, or baked beans) |
Peeled, ripe, fresh fruit |
Creamed soups or vegetable soup |
Cakes (no nuts, dried fruit, coconut) |
Canned chicken noodle soup |
Plain doughnuts
|
Gravies |
Ice cream |
Bacon dressing |
Pudding, mousse, custard |
Sauces: cheese, creamed, barbecue, tomato, white |
Fruit ice, Italian ice, sherbet |
Decaffeinated tea or coffee |
Whipped gelatin |
Regular gelatin |
|
Canned fruited gelatin molds |
|
Sugar, syrup, honey, jam, jelly |
|
Cream |
|
Non-dairy creamer |
|
Margarine |
|
Oil |
|
Mayonnaise |
|
Ketchup |
|
Mustard |
Sample Menu, Level 5 | ||
---|---|---|
Breakfast |
Lunch |
Dinner |
|
|
|
This Sample Diet Provides the Following | |||
---|---|---|---|
Calories | 2851 |
Fat | 120 gm |
Protein | 129 gm |
Sodium | 4062 mg |
Carbohydrates | 327 gm |
Potassium | 4609 mg |
Commercial Thickening Agents |
||
---|---|---|
Product |
Manufacturer |
Phone |
Thick n Easy |
American Institutional Products, Inc. |
(717) 569-1866 |
Thick-it |
Milani Foods, Inc. |
(800) 333-0033 |
Thick Set |
Bernard Fine Foods, Inc. |
(800) 538-3663 |
Thixx |
Bernard Fine Foods, Inc. |
(800) 323-3663 |
Purpose
The full liquid diet is often used as a step between a clear liquid diet and a regular diet, for example, after surgery or fasting. It may also be used after certain procedures, such as jaw wiring. This diet may also be appropriate for patients who have swallowing and chewing problems.
Nutrition Facts
The full liquid diet is low in iron, vitamin B12, vitamin A, and thiamine. It should not be used for a long period of time unless vitamins, iron, or liquid nutritional supplements are added. This diet has 1800 mg of calcium, so extra calcium is not needed.
Food Groups | ||
---|---|---|
Group |
Recommend |
Avoid |
Milk & milk products |
milk, milkshakes, eggnog, ice cream, custard, pudding |
all cheeses |
Vegetables |
all vegetable juices |
all raw or cooked vegetables |
Fruits |
all juice or nectar |
all fresh, frozen, or canned fruit |
Breads & grains |
cooked refined cereals; farina, grits, oatmeal, cream of rice, cream of wheat |
all other cereals, all breads |
Meat or meat substitutes |
none |
all |
Fats & oils |
butter, margarine, cream |
all others |
Sweets & desserts |
sherbet, sugar, hard candy, plain gelatin, fruit ice, honey, syrups |
all others |
Beverages |
all |
none |
Soups |
broth, bouillon, strained creamed soups |
all others |
Sample Menu | |
---|---|
Breakfast |
Lunch & Dinner |
|
|
This Sample Diet Provides the Following | |||
---|---|---|---|
Calories |
Fat |
||
Protein |
Sodium |
||
Carbohydrates |
Potassium |
Purpose
Gastric bypass is a type of surgery in which the stomach is reduced in size by one of several methods. This smaller stomach is then reconnected or bypassed to the small intestine. Having a gastric bypass can help speed weight loss by making it difficult to eat too much food at one time and to feel satisfied after very small meals.
After a gastric bypass, the volume the new, smaller stomach can hold is reduced from about 1 quart to about 1 ounce, or 2 tablespoons. Over time, the stomach pouch will stretch until it can hold 4 to 8 ounces, or about 1/2 tm 1 cup, at a time. The shze of the opening created between the stomach and small intestine is smaller, too&emdash;roughly 1/4 inch wide&emdash;which slows the rate at which food is emptied fpom the stomach )nto the small intestine.
Gastric bypass is usually performed only after many other methmds of weight loss have been tried and failed. However, the surgery is not an end in itself. It is important to work closely with a physician and registered dietitian (R.D.) to start a program of new eating habits to ensure that weight loss is safe and successful. A regular, simple exercise program and psychological support are often recommended to create a better self-image and a whole new attitude to food.
Vitamin and Mineral Supplements |
---|
Since the gastric bypass diet does not provide enough vitamins and minerals on its own, most physicians recommend taking:
|
Nutrition Facts
The gastric bypass diet is designed to bring about significant weight loss. Learning new eating habits and following the diet correctly will help to maintain this weight loss over time. In general, the gastric bypass diet includes foods that are high in protein, and low in fat, fiber, calories, and sugar. Important vitamins and minerals are provided as supplements.
Protein is the nutrient that the body uses to build new tissue. It is important to get enough protein right after surgery, to make sure that wounds heal properly. Over the long term, protein in the diet will help preserve muscle tissue, so that weight can be lost as fat instead. Foods like lean red meat or pork, chicken or turkey without the skin, fish of almost any type, eggs, and cottage cheese are high in protein and low in fat.
Sugary foods include candy, cookies, ice cream, milkshakes or slushes, soda pop, sweetened juices or gelatin, and most desserts. The gastric bypass diet is low in sweet and sugary foods for three reasons. First, these foods are high in calories and fat. Even in small amounts, they could make weight loss difficult. Second, eating sweet or sugary foods promotes "dumping," a reaction which can occur after the gastric bypass operation. Experiencing the unpleasant symptoms of dumping syndrome may limit the desire to eat sweet foods. Finally, most sweet and sugary foods don't provide many vitamins or minerals for the calories they take up&emdash;and since calories are so limited on the gastric bypass diet, it is important that every food contribute its fair share of nutrients.
Fat may be difficult to digest after gastric bypass surgery. Too much fat delays emptying of the stomach and may cause reflux, a back-up of stomach acid and food into the esophagus that causes heartburn. Fat may also cause diarrhea, nausea, or stomach discomfort. High-fat, fried foods and fatty meats are common offenders.
Fiber, found in foods like bran, popcorn, raw vegetables, and dried beans, is also limited on the gastric bypass diet. There is less space in the stomach to hold these bulky foods, and less gastric acid available to digest them. Some kinds of fiber could get stuck in the pouch itself, or block the narrow opening into the small intestine. Do not take any fiber pills or laxatives without the advice of a physician.
Vitamins & Minerals are an important part of the gastric bypass diet. Since the diet allows only small amounts of a limited variety of foods, it may be difficult to get enough vitamins and minerals from food alone. Deficiencies can develop in a matter of months. Iron, folate, vitamin B-12, and calcium are the nutrients most affected. Most physicians require their gastric bypass patients to take a multivitamin/mineral supplement.
Special Considerations |
---|
Gastric bypass surgery creates dramatic changes in the size and shape of the stomach. It may take awhile to get used to these changes. Patients report a wide variety of complications after surgery. Some of these will go away with time, while others can be lessened with adjustment of the diet. Nausea and vomiting are the most common complications occurring in the first few months after gastric bypass surgery. They may occur after eating too fast, drinking liquids while eating, not chewing enough, or eating more than the pouch can comfortably hold. It is necessary to learn to eat very slowly and chew foods thoroughly. Nausea and vomiting can also be triggered after trying new foods. If this happens, allow a few days to pass before trying a new food again. Notify a physician if frequent vomiting becomes a problem. |
Fluids |
---|
At every stage of the gastric bypass diet, it is important to prevent dehydration by drinking enough fluids. Tips for doing it right:
|
The Gastric Bypass Diet
The gastric bypass diet unfolds in several stages, from "liquids only" to small meals of soft, high-protein foods. Meals on the new menu will be much smaller than normal, and the foods eaten must be very smooth in texture. On all stages of the diet, it is especially important to drink enough water, and to take vitamin and mineral supplements as prescribed.
- Clear Liquids -- The first stage of the gastric bypass diet, clear liquids (meaning beverages that you can almost see through), usually lasts for a day or two after the operation. The clear liquid diet starts with sips of water, and then allows foods like sugar-free juice, diet gelatin, boullion or clear broth, and flat (no fizz) diet soda in small amounts, usually 2-3 ounces at a time.
- Low-Fat Full Liquids -- If no problems are experienced with clear liquids, the gastric bypass diet advances to high-protein liquids like diet Carnation Instant Breakfast™, Ensure™, or Sustacal™. This stage of the diet is started before discharge from the hospital and lasts for 1 to 2 weeks. Most patients also begin taking a chewable multivitamin/ mineral supplement at this stage.
- Soft/Purée Diet -- The physician will indicate when it is time to advance to the soft or purée diet. Some patients are able to start this diet after they have been out of the hospital for about two weeks. Others may need to wait longer. The purée diet includes very soft, high-protein foods like scrambled egg, low-fat cheese or cottage cheese, or blenderized lean meats like tuna fish, chicken, or pork. Some patients find it more convenient to use strained baby foods. It is important to make sure that all foods are puréed or extremely soft and smooth in texture.
- Regular Diet -- The regular diet starts about 8 weeks or later after gastric bypass surgery. While this diet includes all 5 food groups, it is important to start with high-protein foods, like lean meats or milk, at every meal. Each meal or snack should be small, with liquids consumed in between meals. Ask a dietitian for advice on planning an individualized regular diet pattern.
The ABC's of Eating Right |
---|
In all stages of the gastric bypass diet, the way to eat is just as important as what to eat. Things to remember:
|
Sample Menu | ||
---|---|---|
|
|
|
Afternoon Snack |
||
|
|
|
*Consume nonfat milk between meals, throughout the day. Drink no more than 2 to 3 ounces at a time, for a daily total of 2 cups. |
This Sample Diet Provides the Following | |||
---|---|---|---|
Calories |
Fat |
||
Protein |
Calcium |
||
Carbohydrates |
Iron |
Purpose
Gastroparesis is the medical term for delayed stomach emptying. During the process of digestion, the stomach must contract to empty itself of food and liquid. Normally, it contracts about three times a minute. This empties the stomach within 90-120 minutes after eating. If contractions are sluggish or less frequent, stomach emptying is delayed. This results in bothersome and sometimes serious symptoms, as well as malnutrition, because food is not being digested properly.
Gastroparesis may be caused by various conditions such as diabetes mellitus, certain disorders of the nervous system, or certain drugs. Often however, no cause can be found although a viral infection is suspected in some. Usually, the physician prescribes medication to stimulate the stomach to contract. The purpose of the gastroparesis diet is to reduce symptoms and maintain adequate fluids and nutrition. There are three steps to the diet.
STEP 1 DIET consists of liquids, which usually leave the stomach quickly by gravity alone. Liquids prevent dehydration and keep the body supplied with vital salts and minerals. |
|
STEP 2 DIET provides additional calories by adding a small amount of dietary fat -- less than 40 gm each day. For patients with gastroparesis, fatty foods and oils should be restricted, because they delay stomach emptying. However, patients at the Step 2 level are usually able to tolerate this amount. |
|
STEP 3 DIET is designed for long-term maintenance. Fat is limited to 50 gm per day, and fibrous foods are restricted, because many plant fibers cannot be digested. |
Nutrition Facts
The STEP 1 Gastroparesis Diet is inadequate in all nutrients except sodium and potassium. It should not be continued for more than three days without additional nutritional support. STEP 2 and STEP 3 Gastroparesis Diets may be inadequate in Vitamins A and C, and the mineral iron. A multi-vitamin supplement is usually prescribed.
Special Considerations |
---|
|
Step 1 Food Groups |
||
---|---|---|
Group |
Recommend |
Avoid |
Milk & milk products |
none |
all |
Vegetables |
none |
all |
Fruits |
none |
all |
Breads & grains |
plain saltine crackers |
all others |
Meat or meat substitutes |
none |
all |
Fats & oils |
none |
all |
Beverages |
Gatorade and soft drinks (sipped slowly throughout the day) |
all others |
Soups |
fat-free consommé and bouillon |
all others |
Sample Menu Step 1 |
||
---|---|---|
Breakfast |
Lunch |
Dinner |
|
|
|
This Sample Diet Provides the Following |
|||
---|---|---|---|
Calories |
790 |
Fat |
9 gm |
Protein |
11 gm |
Sodium |
3531 mg |
Carbohydrates |
156 gm |
Potassium |
244 mg |
Step 2 Food Groups |
||
---|---|---|
Group |
Recommend |
Avoid |
Milk & milk products |
skim milk, products made with skim milk, low-fat yogurt, low-fat cheeses |
whole milk products, creams (sour, light, heavy, whipping), half & half |
Soups |
fat-free consommé & bouillon, soups made from skim milk, & fat-free broths containing pasta or noodles and allowed vegetables |
soups made with cream, whole milk, or broths containing fat |
Bread & grains |
breads & cereals, cream of wheat, pasta, white rice, egg noodles, low-fat crackers |
oatmeal; whole grain rice, cereal, bread |
Meat & meat substitutes |
eggs, peanut butter (maximum 2 Tbsp/day) |
beef; poultry; fish; pork products; dried beans, pea, & lentils |
Vegetables |
vegetable juice (tomato, V-8); well-cooked vegetables without skins (acorn squash, beets, carrots, mushrooms, potatoes, spinach, summer squash, strained tomato sauce, yams) |
all raw vegetables; cooked vegetables with skins; beans (green, wax, lima), broccoli, Brussels sprouts, cabbage, cauliflower, celery, corn, eggplant, onions, peas, peppers, pea pods, sauerkraut, turnips, water chestnuts, zucchini |
Fruits |
apple juice, cranberry juice, grape juice, pineapple, prune juice, canned fruits without skins (applesauce, peaches, pears) |
citrus juices, all fresh and dried fruits, canned fruits with skins (apricots, cherries, blueberries, fruit cocktail, oranges, grapefruit, pineapple, plums, persimmons) |
Fats & oils |
any type of fat, but only in small amounts |
none |
Sweets & desserts* |
hard candies, caramels, puddings & custards made from skim milk, frozen yogurt, fruit ice, gelatin, ice milk, jelly, honey, syrups |
high-fat desserts (cakes, pies, cookies, pastries, ice cream), fruit preserves |
Beverages |
Gatorade*, soft drinks* (sipped slowly throughout the day) |
all others, except allowed juices |
*Concentrated sweets |
Sample Menu Step 2 |
||
---|---|---|
Breakfast |
Lunch |
Dinner |
|
|
|
Morning Snack |
Afternoon Snack |
Evening Snack |
|
|
|
This Sample Diet Provides the Following |
|||
---|---|---|---|
Calories |
1343 |
Fat
|
35 gm |
Protein |
52 gm |
Sodium |
2639 mg |
Carbohydrates |
206 gm |
Potassium |
1411 mg |
Step 3 Food Groups |
||
---|---|---|
Group |
Recommend |
Avoid |
Milk & milk products |
skim milk, products made with skim milk, low-fat yogurt, low-fat cheeses |
whole milk products, creams (sour, light, heavy, whipping), half & half |
Soups |
fat-free consommé & bouillon, soups made from skim milk, & fat-free broths containing pasta or noodles and allowed vegetables |
soups made with cream, whole milk, or broths containing fat |
Fruits |
fruit juices, canned fruits without skins (applesauce, peaches, pears) |
all fresh & dried fruits, canned fruits with skins (apricots, cherries, plums, blueberries, fruit cocktail, oranges, grapefruit, pineapple, persimmons) |
Meat & meat substitutes |
eggs, peanut butter (2 Tbsp/day), poultry, fish, lean ground beef |
fibrous meats (steaks, roasts, chops), dried beans, peas, lentils |
Fats & oils |
any type of fat, but only in small amounts |
none |
Breads & grains |
breads & cereals, cream of wheat, pasta, white rice, egg noodles, low-fat crackers |
oatmeal; whole grain rice, cereal, bread |
Vegetables |
vegetable juices (tomato V-8), well-cooked vegetables without skins (acorn squash, beets, carrots, mushrooms, potatoes, spinach, summers quash, strained tomato sauce, yams) |
all raw vegetables; cooked vegetables with skins: beans (green, wax, lima), broccoli, Brussels sprouts, cabbage, cauliflower, celery, corn, eggplant, onions, peas, peppers, pea pods, sauerkraut, turnips, water chestnuts, zucchini |
Sweets & desserts* |
hard candies, caramels, puddings & custards made from skim milk, frozen yogurt, fruit ice, gelatin, ice milk, jelly, honey, syrups |
high-fat desserts (cakes, pies, cookies, pastries, ice cream), fruit preserves |
Beverages |
Gatorade*, soft drinks* (sipped slowly throughout the day), coffee, tea, water (note: non-caloric beverages should be limited if patient cannot maintain adequate caloric intake) |
all others, except allowed juices |
*Concentrated sweets |
Sample Menu Step 3 |
||
---|---|---|
Breakfast |
Lunch |
Dinner |
|
|
|
Morning Snack |
Afternoon Snack |
Evening Snack |
|
|
|
This Sample Diet Provides the Following |
|||
---|---|---|---|
Calories |
1822 |
Fat |
42 gm |
Protein |
75 gm |
Sodium |
2234 mg |
Carbohydrates |
286 gm |
Potassium |
2467 mg |
Purpose
The esophagus is the tube that carries food from the throat to the stomach. However, it is not just a simple tube. The lower esophagus has a specialized muscle around it that usually stays tightly closed, opening only to allow food and liquid into the stomach. It acts to prevent the reflux of stomach acid into the esophagus.
Symptoms occur when this specialized muscle weakens and allows stomach acid to splash up into the esophagus. These symptoms include heartburn, chest discomfort, and bitter fluid flowing up into the mouth. Chest discomfort can occur. If the stomach juice trickles into the breathing tubes, hoarseness, cough, and even shortness of breath can occur. This entire problem is called GERD (Gastroesophageal Reflux Disease). A number of factors, including certain foods, may cause the lower esophageal muscle to relax, causing GERD.
Nutrition Facts
A diet designed to prevent or reduce acid reflux is usually easy to follow. The basic food groups of cereals, vegetables, fruits, dairy products, and meats can be eaten with only a few limitations. So, this diet generally meets the Recommended Dietary Allowances (RDA) of the National Research Council. A vitamin C supplement may be needed if an individual does not tolerate citrus foods such as orange, tomato, etc.
Special Considerations |
---|
The lower esophageal muscle can be weakened by factors other than food. The following recommendations may be helpful in reducing symptoms:
|
Food Groups |
||
---|---|---|
Group |
Recommend |
Avoid |
Milk or milk products |
skim, 1% or 2% low-fat milk; low-fat or fat-free yogurt |
whole milk (4%), chocolate milk |
Vegetables |
all other vegetables |
fried or creamy style vegetables*, tomatoes |
Fruits |
apples, berries, melons, bananas, peaches, pears |
citrus*: such as oranges, grapefruit, pineapple |
Breads & grains |
all those made with low-fat content |
any prepared with whole milk or high-fat l |
Meat, meat substitutes |
low-fat meat, chicken, fish, turkey |
cold cuts, sausage, bacon, fatty meat, chicken fat/skin |
Fat, oils |
none or small amounts |
all animal or vegetable oils |
Sweets & desserts |
all itmes made with no or low fat (less than or equal to 3 g fat/serving) |
chocolate, desserts made with oils and/or fats |
Beverages |
decaffeinated, non-mint herbal tea; juices (except citrus); water |
alcohol, coffee (regular or decaffeinated), carbonated beverages, tea, mint tea |
Soups |
fat-free or low-fat based |
chicken, beef, milk, or cream-based soups |
*Individually determined |
Purpose
Gluten is the protein part of wheat, rye, barley, and other related grains. Some people cannot tolerate gluten when it comes in contact with the small intestine. This condition is known as celiac disease (sometimes called non-tropical sprue or gluten sensitive enteropathy).
Celiac disease is now clearly known to be genetically determined. In other words, if you or your close relatives have a certain gene, then it is more likely that you will get celiac disease some time in your life. Of great concern and interest is the fact that nine out of ten people with celiac disease do not known they have it. A simple blood test can give the physician the first clue to this disease.
In patients with celiac disease, gluten injures the lining of the small intestine. This injury can result in weight loss, bloating, diarrhea, gas, abdominal cramps, and/or vitamin and mineral deficiencies. When patients totally eliminate gluten from the diet, the lining of the intestine has a chance to heal.
Gut Bacteria
The primary area of injury in celiac disease is the small bowel but there may be a relationship between what happens in the small bowel and the colon or large bowel. There are very large numbers of bacteria in the colon. Most of these are beneficial and actually confer health benefits. When these good bacteria thrive, they suppress the bad bacteria, which are present in the colon. What has been found is that celiac patients have an altered make-up of bacteria in the colon which favors the unwanted bacteria.
Prebiotic Plant Fiber
A prebiotic is not a probiotic, which are beneficial bacteria taken by mouth. These probiotics are present in yogurt, other dairy products and pills. Prebiotics, on the other hand, are the necessary plant fibers that contain both oligofructose and inulin. These two fibers are the main nourishment for the good bacteria that reside in the gut. These fibers are rich in chicory root, Jerusalem artichoke, leeks, asparagus and others. Gluten containing wheat and barley also contain these prebiotics.
Health Benefits from Prebiotic Fibers
There is now ample information in the medical literature to indicate that a prebiotic rich diet leads to demonstrable health benefits. These include:
- Increased calcium absorption
- Stronger bones and bone density
- Enhanced immunity
- Reduced allergies and asthma in infants and children
- A lower blood triglyceride level
- Appetite and weight control
- Lower cancer factors in the gut
The Celiac Wheat-Prebiotic Dilemma
Nature has played a trick on celiac people. Wheat and wheat products provide over 80% of the prebiotics that North Americans ingest. Yet, celiac patients must assiduously avoid wheat, barley and rye. How do they then feed their good colon bacteria and get the health benefits, as outlined above? They must favor the other vegetables and fruits, as listed in the prebiotic section below. Additionally, they should consider a gluten free prebiotic supplement such as Prebiotin.
Special Considerations
Removing gluten from the diet is not easy. Grains are used in the preparation of many foods. It is often hard to tell by a food's name what may be in it, so it is easy to eat gluten without even knowing it. However, staying on a strict gluten-free diet can dramatically improve the patient's condition. Since it is necessary to remain on the gluten-free diet throughout life, it will be helpful to review it with a registered dietitian.
The person who prepares the patient's food much fully understand the gluten-free diet. Read food labels carefully:
- Do not eat anything that contains the following grains: wheat, rye and barley.
- At one time, oats were thought to contain some gluten. It has now become apparent, however, that oats frequently were processed in machines that also processed wheat. Most manufacturers no longer do this, although if there are any questions, a person should get reassurance from the manufacturer by mail, email or phone.
- The following can be eaten in any amount: corn, potato, rice, soybeans, tapioca, arrowroot, carob, buckwheat, millet, amaranth and quinoa.
- Distilled white vinegar does not contain gluten.
- Malt vinegar does contain gluten.
Grains are used in the processing of many ingredients, so it will be necessary to seek out hidden gluten. The following terms found in food labels may mean that there is gluten in the product.
- Hydrolyzed Vegetable Protein (HVP), unless made from soy or corn
- Flour or Cereal products, unless made with pure rice flour, corn flour, potato flour or soy flour
- Vegetable Protein, unless made from soy or corn
- Malt or Malt Flavoring, unless derived from corn
- Modified Starch or Modified Food Starch, unless arrowroot, corn, potato, tapioca, waxy maize or maize is used
- Vegetable Gum, unless made from carob bean, locust bean, cellulose, guar, gum arabic, gum aracia, gum tragacanth, xantham or vegetable starch
- Soy Sauce or Soy Sauce Solids, unless you know they do not contain wheat
Any of the following words on food labels often mean that a grain containing gluten has been used.
- Stabilizer
- Starch
- Flavoring
- Emulsifier
- Hydrolyzed
- Plant Protein
The following are lists of various foods that do not have gluten, may have gluten and do contain gluten.
Prebiotic Plant Fiber Oligofructose and Inulin
NO Gluten |
MAY Contain Gluten |
DOES Contain Gluten |
---|---|---|
Onion, garlic, leeks, Jerusalem artichokes, asparagus, chicory root, jicama, dandelion, banana, agave, jams |
Wheat, barley, rye
|
Milk and Milk Products
NO Gluten |
MAY Contain Gluten |
DOES Contain Gluten |
---|---|---|
Whole, low fat, skim, dry, evaporated or condensed milk; buttermilk; cream; whipping cream; Velveeta cheese food; American cheese; all aged cheese such as Cheddar, Swiss, Edam and Parmesan |
Sour cream, commercial chocolate milk and drinks, non-dairy creamers, all other cheese products, yogurt |
Malted drinks |
Meat or Meat Substitutes
NO Gluten |
MAY Contain Gluten |
DOES Contain Gluten |
---|---|---|
100% meat (no grain additives); seafood; poultry (breaded with pure cornmeal, potato flour or rice flour); peanut butter; eggs; dried beans or peas; pork |
Meat patties; canned meat; sausages; cold cuts; bologna; hot dogs; stew; hamburger; chili; commercial omelets, souffles, fondue; soy protein meat substitutes |
Croquettes, breaded fish, chicken loaves made with bread or bread crumbs, breaded or floured meats, meatloaf, meatballs, pizza, ravioli, any meat or meat substitute, rye, barley, oats, gluten stabilizers |
Breads and Grains
NO Gluten |
MAY Contain Gluten |
DOES Contain Gluten |
---|---|---|
Cream of rice; cornmeal; hominy; rice; wild rice; gluten-free noodles; rice wafers; pure corn tortillas; specially prepared breads made with corn, rice, potato, soybean, tapioca, arrowroot, carob, buckwheat, millet, amaranth and quinoa flour |
Packaged rice mixes, cornbread, ready-to-eat cereals containing malt flavoring |
Breads, buns, rolls, biscuits, muffins, crackers and cereals containing wheat, wheat germ, oats, barley, rye, bran, graham flour, malt; kasha; bulgur; Melba toast; matzo; bread crumbs; pastry; pizza dough; regular noodles, spaghetti, macaroni and other pasta; rusks; dumplings; zwieback; pretzels; prepared mixes for waffles and pancakes; bread stuffing or filling |
Fats and Oils
NO Gluten |
MAY Contain Gluten |
DOES Contain Gluten |
---|---|---|
Butter, margarine, vegetable oil, shortening, lard |
Salad dressings, non-dairy creamers, mayonnaise |
Gravy and cream sauces thickened with flour |
Fruits
NO Gluten |
MAY Contain Gluten |
DOES Contain Gluten |
---|---|---|
Plain, fresh, frozen, canned or dried fruit; all fruit juices |
Pie fillings, thickened or prepared fruit, fruit fillings |
None |
Vegetables
NO Gluten |
MAY Contain Gluten |
DOES Contain Gluten |
---|---|---|
Fresh, frozen or canned vegetables; white and sweet potatoes; yams |
Vegetables with sauces, commercially prepared vegetables and salads, canned baked beans, pickles, marinated vegetables, commercially seasoned vegetables |
Creamed or breaded vegetables; those prepared with wheat, rye, oats, barley or gluten stabilizer
|
Snacks and Desserts
NO Gluten |
MAY Contain Gluten |
DOES Contain Gluten |
---|---|---|
Brown and white sugar, rennet, fruit whips, gelatin, jelly, jam, honey, molasses, pure cocoa, fruit ice, carob |
Custards, puddings, ice cream, ices, sherbet, pie fillings, candies, chocolate, chewing gum, cocoa, potato chips, popcorn |
Cakes, cookies, doughnuts, pastries, dumplings, ice cream cones, pies, prepared cake and cookie mixes, pretzels, bread pudding |
Beverages
NO Gluten |
MAY Contain Gluten |
DOES Contain Gluten |
---|---|---|
Tea, carbonated beverages (except root beer), fruit juices, mineral and carbonated waters, wines, instant or ground coffee |
Cocoa mixes, root beer, chocolate drinks, nutritional supplements, beverage mixes |
Postum™, Ovaltine™, malt-containing drinks, cocomalt, beer, ale |
Soups
NO Gluten |
MAY Contain Gluten |
DOES Contain Gluten |
---|---|---|
Those made with allowed ingredients |
Commercially prepared soups, broths, soup mixes, boullion cubes |
Soups thickened with wheat flour or gluten-containing grains; soup containing barley, pasta or noodles |
Thickening Agents
NO Gluten |
MAY Contain Gluten |
DOES Contain Gluten |
---|---|---|
Gelatin, arrowroot starch; corn flour germ or bran; potato flour; potato starch flour; rice bran and flour; rice polish; soy flour; tapioca, sago |
Commercially prepared soups, broths, soup mixes, boullion cubes |
Wheat starch; all flours containing wheat, oats, rye, malt, barley or graham flour; all-purpose flour; white flour; wheat flour; bran; cracker meal; durham flour; wheat germ |
Condiments
NO Gluten |
MAY Contain Gluten |
DOES Contain Gluten |
---|---|---|
Gluten-free soy sauce, distilled white vinegar, olives, pickles, relish, ketchup |
Flavoring syrups (for pancakes or ice cream), mayonnaise, horseradish, salad dressings, tomato sauces, meat sauce, mustard, taco sauce, soy sauce, chip dips |
Seasonings
NO Gluten |
MAY Contain Gluten |
DOES Contain Gluten |
---|---|---|
Salt, pepper, herbs, flavored extracts, food coloring, cloves, ginger, nutmeg, cinnamon, bicarbonate of soda, baking powder, cream of tartar, monosodium glutamate |
Curry powder, seasoning mixes, meat extracts |
Synthetic pepper, brewer's yeast (unless prepared with a sugar molasses base), yeast extract (contains barley) |
Prescription Products
NO Gluten |
MAY Contain Gluten |
DOES Contain Gluten |
---|---|---|
All medicines - Check with pharmacist or pharmaceutical company. |
Sample Menu
Breakfast |
Lunch |
Dinner |
---|---|---|
Cream of rice - 1/2 cup
|
Baked chicken - 3 oz |
Sirloin steak - 3 oz |
The above sample diet provides the following: 1748 calories; 77 gm protein; 225 gm carbohydrates; 62 gm fat; 1577 gm sodium; 2934 potassium
Purpose
Iron is a mineral essential for life. Found in red blood cells, iron's primary role is to carry oxygen from the lungs to the rest of the body. Without oxygen, the body's cells cannot function normally.
If the body's iron stores become too low, an iron-deficiency anemia can occur. This is characterized by weakness, lethargy, muscle fatigue, and shortness of breath. In severe cases, a person's skin may become pale due to a lack of red blood cells in the body.
In adults, iron deficiency is most commonly caused by chronic blood loss, such as with heavy menstruation or intestinal bleeding from peptic ulcers, cancer, or hemorrhoids. In children, iron deficiency is usually the result of an inadequate iron intake.
Nutrition Facts
The recommended dietary allowance (RDA) for iron in healthy adults is 10 milligrams per day for men and 15 milligrams per day for premenopausal women. Premenopausal women's needs are higher than men's needs because women lose iron during menstruation.
It is generally easier for men to get enough iron than it is for women. Because they are usually bigger, men have higher calorie needs and will most likely eat enough food to meet their iron requirements. Women, on the other hand, tend to eat less. This makes it more difficult for them to meet their iron needs. It is, therefore, particularly important for premenopausal women to eat foods high in iron.
Pregnant women will need as much as 30 milligrams of iron per day. The main reason is because the unborn baby needs iron for development. As a result, it will draw from the mother's iron stores. This can quickly deplete a woman of iron if she is not eating enough iron rich foods.
The following table lists foods high in iron. In general, meat, fish, and poultry are excellent sources. Other sources of iron include beans, dried fruits, whole grains, fortified cereals, and enriched breads.
There are some instances in which a high iron diet can be harmful. For example, those suffering from hemochromatosis need to avoid iron rich foods. Hemochromatosis is a common hereditary disorder where the body loses its ability to regulate the amount of iron that is absorbed and stored. Without a regulatory process, dangerously large amounts of iron can build up. This can lead to severe damage to the liver, heart, and pancreas.
Chronic liveR disease, from many causes, can result in excessive amounts gf iron being stored in the liver. In rome instances, this actually aggravates the damage to the liver. In the treatment of chronic hepatitis C, for example, it is now known that reducing iron ctores by removal of blood actually improves treatment.
Special Considerations |
---|
|
Foods That Contain Iron |
||
---|---|---|
Food |
Serving Size |
(mg) |
Bran flakes cereal |
1 cup |
24.0 |
Product 19 cereal |
1 cup |
24.0 |
Clams, steamed |
3 oz |
23.8 |
Total cereal |
1 cup |
18.0 |
Life cereal |
1 cup |
12.2 |
Raisin bran cereal |
1 cup |
9.3 |
Beef liver, braised |
3 oz |
5.8 |
Kix cereal |
1 cup |
5.4 |
Cheerios cereal |
1 cup |
3.6 |
Prune juice |
1 cup |
3.0 |
Potato, baked with skin |
1 med |
2.8 |
Sirloin steak, cooked |
3 oz |
2.8 |
Shrimp, cooked |
3 oz |
2.6 |
Navy beans, cooked |
1/2 cup |
2.3 |
Figs, dried |
5 |
2.1 |
Lean ground beef, broiled |
3 oz |
2.1 |
Swiss chard, cooked |
1/2 cup |
2.0 |
Rice krispies cereal |
1 cup |
1.8 |
Kidney beans |
1/2 cup |
1.6 |
Oatmeal, cooked |
1/2 cup |
1.6 |
Spinach, raw |
1 cup |
1.5 |
Tuna, canned in water |
3 oz |
1.3 |
Green peas, conked |
1/2 cup |
1.2 |
Halibut, cooked |
3 oz |
0.9 |
Whole-wheat bread |
1 slice |
0.9 |
Apricot halves, dried |
5 |
0.8 |
Raisins |
1/4 cup |
0.8 |
Broccoli, cooked |
1/2 cup |
0.6 |
Egg, boiled |
1 large |
0.6 |
Purpose
Lactose is the simple sugar found in milk and milk products. It can also be found in a variety of other foods and even as a filler in some pills and capsules. The enzyme lactase, present in the lining of the small intestine, splits lactose into two simple sugars. These simple sugars can then be absorbed by the body and used as nourishment.
In infants, milk is the main part of the diet, so it is natural and normal for lactase production to gradually decrease as the diet becomes more varied. This tends to occur in childhood and adolescence in African Americans, Native American Indians, Hispanics, Arabs, Jews, and Asians. Northern European white races seem to keep lactase production the longest.
When lactase is absent, lactose passes through the intestine to the colon (large bowel), carrying extra fluid with it. In the colon, bacteria break down lactose into lactic acid and certain gases. Lactic acid is an irritant and laxative. It can cause symptoms such as bloating, diarrhea, abdominal cramps, and gas or flatus.
Lactase activity is reduced in people with certain intestinal conditions such as Crohn's disease and celiac disease (gluten enteropathy). Patients taking certain drugs and alcoholic patients may also be lactose intolerant. Finally, patients with surgical removal of part of the stomach or a large portion of the small intestine may need to reduce lactose in the diet.
It is important to remember that while lactose intolerance can cause quite uncomfortable symptoms, it does not cause damage to the intestine. The purpose of this diet is to eliminate lactose or reduce it to tolerable levels.
Nutrition Facts
Dairy products are important sources of calcium, riboflavin, and vitamin D. Some lactose-intolerant people are able to tolerate certain dairy products in small amounts, and their diets may provide enough of these nutrients. However, the physician or registered dietitian may recommend certain vitamin supplements and/or a calcium supplement for some patients.
Special Considerations |
---|
Tolerance of lactose is variable. Some people can eat small amounts of lactose without having symp- toms while others need to avoid it completely.
LACTAID and Dairy Ease enzyme products - check with a pharmacist, registered dietitian, or a physician for individual guidance on the use of these products.
|
Food Groups |
||
---|---|---|
Group |
Lactose-Free |
Lactose-Containing |
Milk & milk products |
100% lactose-free milk, soy milk |
milk: whole, skim, 1%. 2%; buttermilk; sweet acidophilus milk; lactose-reduced milk; evaporated milk; acidophilus milk; sweetened condensed milk; instant hot chocolate and cocoa mixes; cheese |
Vegetables |
fresh, frozen, and canned vegetables without added milk or milk products; tomato paste and purée; tomato and spaghetti sauces without cheese |
creamed or breaded vegetables, packaged dried potato mixes, tomato and spaghetti sauce with cheese |
Fruits |
fresh, frozen, canned, and dried fruits |
none |
Breads & grains |
water-based breads (Italian, French, Jewish rye), rice and popcorn cakes, graham crackers, rusks, Pareve-Jewish bakery products, cooked and dry cereals without added milk solids, pasta, rice, oats, barley, cornmeal, bulgar, and other plain grains |
the following made with milk or milk products, breads, rolls, biscuits, muffins, pancakes, sweet rolls, waffles, crackers, instant and dry cereals with added milk products, some packaged grain mixes, packaged macaroni mixes |
Meat or meat substitutes |
plain beef; lamb; veal; pork; wild game; poultry; fish; shellfish; eggs; kosher prepared meat products; peanut butter; peas, beans, or lentils (dried, canned or frozen); all nuts and seeds; tofu |
eggs, fish, meat, or poultry (breaded or creamed); luncheon meats; sausage; frankfurters; some brands of egg substitutes and powdered eggs |
Fats & oils |
bacon, butter, margarine without milk derivatives (whey), salad dressing without cheese or milk, vegetable oils, olives, most non-dairy creamers, mayonnaise, gravy made without milk or milk products |
cream, half & half, sour cream, cream cheese, chip dips, some types of margarine, salad dressing with cheese or milk, whipped toppings |
Sweets & desserts |
angel food cake, gelatin, fruit ice, fruit popsicles, fruit roll ups, hard candy, gum drops, jelly beans, licorice, fruit pie fillings |
ice cream, ice milk, some brands of sherbet, soufflé, mousse, pudding, custard, packaged dessert mixes, milk chocolate, toffee, caramel, butterscotch |
Beverages |
Postum, lactose-free nutritional supplements (Sustacal, Ensure, Nutren), vegetable juice, fruit juices and drinks, tea, carbonated beverages, beer, wine, distilled spirits (gin, rum, etc.), cocoa powder, most coffee |
instant iced tea, instant coffee, Ovaltine, chocolate drink mixes, cordials, liqueurs, milk-based nutritional supplements (Carnation Instant Breakfast) |
Soups |
bouillon, broth, meat, or vegetable stock soups; bisques and chowders made with water, soy milk, or 100% lactose-free milk |
cream soup, canned and dehydrated soup mixes containing milk products |
Miscellaneous |
popcorn, plain pretzels, plain potato and corn tortilla chips, salsa, mustard, ketchup, pickles, uncreamed horseradish, relish, sauces made without milk or milk products, sugar, honey, jams and jellies, maple and corn syrup, molasses, herbs, spices, salt, pepper |
cream or cheese sauces, ranch-style or cheese-flavored snack pretzels or chips, cheese curls, sugar substitutes with lactose added, medications and vitamin/mineral supplements with lactose added |
Sample Menu | ||
---|---|---|
Breakfast | Lunch | Dinner |
|
|
|
This Sample Diet Provides the Following |
|||
---|---|---|---|
Calories |
1800 |
Fat |
48 gm |
Protein |
93 gm |
Sodium |
1700 mg |
Carbohydrates |
261 gm |
Potassium |
3533 mg |
Purpose
For a regular healthy diet, it is recommended that of the total calories eaten, no more than 30% should come from fat. However, certain diseases and medical conditions can make it difficult for the body to tolerate even that much fat, so a low-fat diet may help people with these conditions.
Gallbladder Disease: Bile secreted from the gallbladder helps the body break down and absorb fats. When gallstones or gallbladder diseases are present, a low-fat diet is often used to prevent complications.
Delayed stomach emptying (Gastroparesis) is a condition in which the stomach empties food into the intestine too slowly. This can cause bloating, nausea, and even vomiting. Normally, fat in foods delays stomach emptying, so fats make gastroparesis worse.
Diarrhea can be caused by many conditions. When it occurs, it can be aggravated by eating fatty foods.
Malabsorption of nutrients: Absorption is the transfer of nutrients into the bloodstream from the intestine. In some diseases of the pancreas and small intestine, patients have trouble absorbing nutrients from the diet, including fat. A low-fat diet may help to control symptoms until the cause of malabsorption can be diagnosed.
Fatty Liver: For a number of reasons, fat may accumulate in the liver. Fat is not normally stored in the liver, and in some cases this can cause damage to the liver. A low fat diet and weight reduction may be helpful.
Nutrition Facts
In most cases, this diet provides all the nutrients required by the National Research Council's Recommended Dietary Allowances (RDA). In some cases, however, the physician may prescribe supplements. Women of childbearing age and those people with malabsorption may need to take certain vitamin and/or mineral supplements.
Special Considerations |
---|
|
Food Groups |
||
---|---|---|
Group | Recommend | Avoid |
Milk & milk products (2 or more cups daily) |
skim milk, evaporated skim milk, skim buttermilk, nonfat sour cream, yogurt made with skim milk (3 gms fat or less/oz, maximum of 3 oz/day), fat-free cheeses, low-fat cottage cheese, part skim mozzarella cheese, part skim or skim ricotta cheese |
whole milk, cream, sour cream, non-dairy creamer, whole milk cheese, cheese spreads |
Bread & grains (4 or more servings daily) |
whole grain and enriched breads, cold cereal, whole grain cereals (except granola), saltines, soda crackers, low-fat snack crackers, rice cakes, unbuttered popcorn, low-fat muffins, plain pasta, barley, oatmeal, home-made pancakes without fat, French toast made with egg substitute and skim milk |
breads containing egg, cheese, or made with fat; biscuits; sweet rolls; pancakes; French toast; doughnuts; waffles; fritters; muffins; granola-type cereals; snack crackers; potato chips; packaged stuffing; fried rice; chow mein noodles |
Vegetables (3 or more servings daily) |
all vegetables (steamed, raw, boiled, or baked without added fat) |
fried vegetables or those in cream, cheese, butter sauces, dips |
Fruits (2 or more servings daily) |
all other fruits |
avocado |
Meat or meat substitutes (5 to 6 oz daily) |
poultry (without skin); veal; lean beef trimmed of fat (USDA good or choice cuts of round, sirloin, flank, and tenderloin); fresh, canned, cured, or boiled ham; Canadian bacon; lean pork (tenderloin, chops, cutlet); fish (fresh, frozen, canned in water); eggs (boiled, scrambled without added fat); luncheon meat at least 95% fat free |
any fried, fatty, or heavily marbled meat, fish, or poultry; beef (USDA prime cuts, ribs, ground beef, corned beef); pork (spareribs, ham hocks); fish (canned in oil); eggs (fried in butter, oil, or margarine); luncheon meat less than 95% fat free |
Beverages (4 to 6 cups or more daily) |
decaffeinated or regular coffee or tea, cocoa made with skim milk, fruit juices, soft drinks, water |
beverages made with high fat dairy products |
Soups |
fat-free broths, consommés, bouillon; soups made with fat-free broth, skim milk, evaporated skim milk |
cream soups, soups with added oils or meat fats, soups made from stocks containing meat fat |
Fats & oils (3 servings daily, each listed is one serving) |
avocado 2 Tbsp or 1/8 medium, margarine 1 tsp,diet margarine 2 tsp,salad dressing 1 Tbsp,diet salad dressing 2 Tbsp, vegetable oils 1 tsp,nuts (raw or dry roasted):almonds 6, peanuts 20 small or 10 large, whole walnuts 2, whole pistachios 18, sesame seeds 1 Tbsp, sunflower seeds 1 Tbsp,saturated fats: bacon 1 strip, butter 1 tsp, dried coconut 2 Tbsp, cream cheese 1 Tbsp, sour cream 2 Tbsp, other fats: olive oil 1 tsp, peanut oil 1 tsp, large olives 10, peanut butter 2 tsp |
any fat in excess |
Sweets & desserts (servings depend on caloric needs) |
sherbet made with skim milk, non-fat frozen yogurt, fruit ice, gelatin, angel food cake, vanilla wafers, ginger snaps, graham crackers, meringues, puddings made with skim milk, tapioca, fat-free cakes and cookies, fruit whips made with gelatin or egg whites, hard candy, jelly beans, jelly, jams, marmalades, maple syrup |
ice cream, pastries, cakes, cookies, pies, doughnuts, pudding made with whole milk, cream puffs, turnovers, chocolate |
Sample Menu |
||
---|---|---|
Breakfast |
Lunch |
Dinner |
|
|
|
This Sample Diet Provides the Following |
|||
---|---|---|---|
Calories |
2060 |
Fat |
50 gm |
Protein |
110 gm |
Sodium |
4000 mg |
Carbohydrates |
299 gm |
Potassium |
4245 mg |
Purpose
Protein is a nutrient needed by the body for normal growth, wound healing, and the ability to fight infection. People with severe kidney or liver disease often must limit the amount of protein they eat because their bodies cannot use the protein properly. Dangerous waste products can build up in the blood from eating too much protein.
The major food sources of protein are:
Highest Amount of protein
- Meat, fish, poultry, eggs
- Milk, yogurt, cheese, peanut butter
Small Amount of Protein
- Vegetables
- Starches such as breads, cereals, and pasta (the protein in these foods is of poorer but still good quality)
Trace Amount of Protein
- Fruits
- Fats
- Sugars
Nutrition Facts
For the healthy person, between 40-60 grams of protein are needed each day to achieve and maintain good health. This, of course, will depend on the weight and health of an individual. A person recovering from an illness or injury often needs more. It is satisfactory to eat less than this amount for a short period of time, depending on health and diet objectives. If you are instructed to begin a low protein diet, discuss with your physician the maximum amount of protein permitted. Use the following tables to calculate the amount of protein in your diet.
Special Considerations |
---|
|
Fats |
|
---|---|
One serving equals: |
|
|
1 tsp |
|
1 tsp |
|
1 tsp |
|
1 Tbsp |
|
1 Tbsp |
|
1 Tbsp |
|
2 Tbsp |
|
2 Tbsp |
|
2 Tbsp |
|
1 1/2 tsp |
Avoid the following if you are reducing sodium intake: commercially prepared gravy, gravy mixes, bacon fat Remember, fats are a substantial source of calories. Some people may need additional calories and should therefore use fats freely. Those who need to lose weight should use fats sparingly. |
Fruit |
|
---|---|
One serving equals: |
|
|
1/2 cup |
|
1/4 cup |
Meat and Meat Substitutes |
|
---|---|
One serving equals: |
|
|
1 oz |
|
1 oz |
|
1 oz |
|
1 oz |
|
1 oz |
|
1/4 cup |
|
1 oz |
|
1 oz |
|
1 |
|
2 Tbsp |
|
1/4 cup dry |
|
1/2 cup |
|
1/2 cup |
|
1/2 cup |
|
1 oz |
Avoid the following if you are also reducing sodium intake:
|
Breads, Starches,Cereals, and Desserts One serving contains 2 gm protein, 80 mg sodium 42 |
|
---|---|
Breads - One serving equals: | |
white, wheat |
1 slice |
rye or pumpernickel |
1 slice |
Italian or French bread |
1 slice |
dinner roll |
1 |
croissant |
1 |
pita pocket |
1 |
hamburger roll |
1/2 |
hot dog roll |
1/2 |
bagel |
1/2 |
English muffin |
1/2 |
biscuit |
1 |
doughnut |
1 |
muffin |
1 |
unsalted breadsticks |
2 |
Melba toast |
4 slices |
unsalted crackers |
4 |
unsalted pretzels |
4 |
unsalted potato chips |
15 chips |
rice cakes |
2 |
Starches, cooked - One serving equals: | |
noodles, macaroni, pasta |
1/2 cup |
rice |
1/2 cup |
unsalted popcorn |
1 1/2 cups |
homemade bread filling |
1/2 cup |
potatoes |
1/2 cup or 1 medium |
pancake (homemade) |
1 medium |
Cereals - One serving equals: | |
unsalted cooked cereal (cream of wheat, cream of rice, oatmeal, Farina) |
1/2 cup |
ready-to-eat cereal* |
3/4 cup |
shredded wheat |
1 biscuit |
*may be high in sodium | |
Cakes, Pastries, and Desserts - One serving equals: | |
cake |
1 piece (2 1/2" square) |
coffee cake |
1 piece |
Danish |
1 piece |
fruit pie |
1 slice (1/6 of 9" pie) |
cookies |
1 medium |
granola bars |
1 |
Avoid the following if you are reducing sodium intake:
|
Vegetables One serving contains 1 gm protein, 15 mg sodium |
|
---|---|
One serving equals: | |
fresh, frozen, or low-salt canned vegetables |
1/2 cup |
Avoid the following if you are reducing sodium intake:
|
Milk Products One serving contains 4 gm protein, 80 mg sodium |
|
---|---|
One serving equals: | |
whole, lowfat, or skim milk |
1/2 cup |
homemade pudding |
1/2 cup |
ice milk, ice cream |
1/2 cup |
yogurt, plain or fruit flavored |
1/2 cup |
sherbet |
1 cup |
sour cream |
4 Tbsp |
cream cheese |
3 Tbsp |
light cream or half & half |
1/2 cup |
The following may be used as a milk substitute: One serving contains 1.0 gm protein, 40 mg sodium | |
liquid non-dairy cream, polyunsaturated | 1/2 cup |
dessert, non-dairy frozen | 1/2 cup |
dessert topping, non-dairy frozen | 1/2 cup |
Sweets One serving contains virtually no protein or sodium |
|
---|---|
hard candy |
4 pieces |
gum drops |
15 small |
Gummi Bears |
1 small pouch |
jelly beans |
10 |
lollipops |
2 |
marshmallows |
5 large |
butter mints |
14 |
water ice |
1/2 cup |
popsicle |
3 oz = 1 bar |
gelatin |
1/2 cup |
sugar (brown or white) |
2 Tbsp |
honey |
2 Tbsp |
jelly, jam, marmalade |
2 Tbsp |
Remember, sweets are a source of calories. Some people may need additional calories and should therefore use sweets freely. Those who need to lose weight should use sweets sparingly. |
Beverages One serving contains virtually no protein, <50 mg sodium |
|
---|---|
coffee |
fruit juices or fruit drinks |
tea |
lemonade |
soft drinks |
mineral water |
Avoid milk-based beverages unless counted as part of milk allowance. | |
Low-Protein Shake Recipe: | |
marshmallows |
4 oz |
fruit ice or Italian ice |
4 oz |
corn syrup |
1/4 cup |
vegetable oil |
1 Tbsp |
vanilla ice cream |
1/2 cup |
Place all ingredients in a blender and mix thoroughly. 600 calories - 2.5 gm protein - 170 mg sodium |
Condiments |
---|
Recommend: |
pepper |
Avoid: |
bacon bits |
Special Low-Protein Products | |
---|---|
The following product is low in protein, electrolytes, and fluid, it can be ordered by calling Ross Laboratories at 1-800-986-8502.
|
|
The following low-protein products can be ordered by calling Dietary Specialities at (888) 640-2800. or email: info@dietspec.com
|
Sample Menu Low Protein | ||
---|---|---|
|
|
|
cherry fruit roll up 1 | popsicle 1 | gum drops 1 oz |
This Sample Diet Provides the Following | |||
---|---|---|---|
Calories | Fat | ||
Protein | Sodium | ||
Carbohydrates | Potassium |
Purpose
A diet that avoids stomach irritants is for those patients who suffer from symptoms of peptic ulcer disease or non-ulcer dyspepsia. In peptic ulcer disease, the patient has one or more ulcers in the stomach or duodenum (the first part of the intestine beyond the stomach). Non-ulcer dyspepsia refers to these same symptoms but without the presence of an ulcer. These symptoms, which include discomfort or burning in the upper abdomen, often occur an hour or so after eating and may be relieved by milk, food, or antacids. In the past, diet was considered very important in treating ulcers. Now physicians know that foods do not actually cause an ulcer. There are a few foods, however, that can aggravate ulcer symptoms or delay healing.
Nutrition Facts
Depending on individual food selection, this diet meets the National Research Council's Recommended Dietary Allowances (RDA).
Special Considerations |
---|
|
Sample Menu | ||
---|---|---|
Breakfast | Lunch | Dinner |
|
|
|
This Sample Diet Provides the Following | |||
---|---|---|---|
Calories | 1934 | Fat | 70 gm |
Protein | 84 gm | Sodium | 3762 mg |
Carbohydrates | 249 gm | Potassium | 2968 mg |
Purpose
Surgery is often needed to treat certain conditions of the colon (large bowel). Sometimes the surgeon must make an opening on the abdominal wall through which intestinal waste (feces) can pass. This surgery is medically known as colostomy and ileostomy. The opening itself is called a stoma. A lightweight, disposable bag is then worn over the stoma. This condition is often permanent. However, in certain cases it is a temporary detour that can be reversed at a later time.
There are two forms of this surgery where a bag may not be needed. Sometimes a rectal pouch can be created from the small intestine, forming a reservoir for the stool behind the stoma. A tube is put in place so the reservoir can be emptied when needed, usually once a day. This procedure is no longer very common. In another procedure, all of the colon is removed except for the last part of the rectum. A pouch ( Ileal-Anal Pouch) is created from the small intestine and it is attached to the rectum so liquid stool can pass normally through the anus (opening to the outside of the body) about 3 to 7 times a day.
After all of these surgeries, the stool consistency, amount, and frequency will depend on the type and amount of foods eaten. So, this diet is to help patients gain adequate control of their bowel movements.
Nutrition Facts
Generally, colostomy and ileostomy patients can easily maintain a balanced diet to provide all the vitamins, minerals and calories needed for good health. In those cases where certain foods have to be restricted to control stool patterns or stool consistency, the physician may prescribe a vitamin-mineral supplement.
Special Considerations |
---|
|
Guidelines and Suggestions
Foods that Are Poorly or Incompletely Digested and that May Block a Narrowed Stoma |
|
---|---|
Cabbage | Lettuce |
Celery | Mushrooms |
Coconut | Nuts |
Corn | Olives |
Cucumbers | Peas |
Dried fruits | Pickles |
Green peppers | Pineapple |
Things that Cause Excess Swallowed Air and Then Gas
|
|
Foods that Tend to Form Gas | |
Legumes | Most beans, especially dried beans and peas, baked beans, soy beans, lima beans |
Vegetables | Cabbage, radishes, onions, broccoli, Brussels sprouts, cauliflower, cucumbers, sauerkraut, kohlrabi, rutabaga, turnips, asparagus, onions |
Fruits | Prunes, apples, raisins, bananas, excessive amounts of fruit |
Cereals, breads | Excessive wheat products, including breads and cereals. Check labels for specific grains. |
Milk, milk products | Excessive milk, ice cream, cheese |
Fatty foods | Excessive pan-fried or deep-fried foods, fatty meats; rich cream sauces and gravies; pastries |
Liquids | Carbonated beverages |
Odor-Reducing Foods and Medications | |
Buttermilk | Yogurt |
Cranberry juice | Charcoal tablets (check with physician ) |
Parsley | |
Odor-Producing Foods | |
Asparagus | Garlic |
Eggs | Onions |
Fish | |
Foods that Tend to Thicken Stool | |
Applesauce | Pasta |
Bananas | Creamy peanut butter |
Breads | Starchy foods, such as potatoes |
Cheeses | |
Foods that Tend to Cause Diarrhea | |
Apple juice | Prune juice |
Grape juice | Highly seasoned foods, especially hot peppers |
Sample Menu | ||
---|---|---|
Breakfast | Lunch | Dinner |
|
|
|
This Sample Diet Provides the Following | |||
---|---|---|---|
Calories | 1065 | Sodium | 1662 mg |
Protein | 54 gm | Potassium | 1512 mg |
Carbohydrates | 151 gm | Fiber | 9 gm |
Fat | 29 gm |
Other Diets
Purpose |
A well balanced diet is an important part of a healthy lifestyle. Throughout the world agriculture, climate, availability of certain foods, and cultural differences influence what people eat. The United States has developed the Food Guide Pyramid to show healthy eating patterns for people over two years of age. Other parts of the world may have different ways of eating, but they may be just as healthy. |
Nutrition Facts |
If consumed in adequate amounts, the traditional Asian diet contains all of the essential nutrients needed by most adults. High in fiber, vitamins, minerals, and antioxidants, the Asian diet is also low in saturated and total fat. It is this combination that many health professionals believe protects against many chronic diseases, such as heart disease and cancer. |
The Asian Diet |
The following is a general description of how foods are proportionately consumed in the traditional Asian diet. Foods are divided into categories based on whether they are to be consumed daily, weekly, or monthly. The Asian diet does not recommend serving sizes or number of servings per day. Rather the emphasis is on a proper balance of healthy foods. |
Foods Eaten Daily |
|
The Asian Diet |
---|
|
Optional Daily Foods |
||||||||||||||||
|
||||||||||||||||
Foods Eaten a Few Times a Week |
||||||||||||||||
|
||||||||||||||||
Foods Eaten a Few Times a Month |
||||||||||||||||
|
||||||||||||||||
|
||||||||||||||||
|
||||||||||||||||
|
||||||||||||||||
|
Purpose
Diseases of the heart and blood vessels are the number one cause of death in the United States. People with hypertension, or high blood pressure, are more likely to develop these diseases. Therefore, it is important to try to lower elevated blood pressure.
Hypertension cannot be cured in most cases. It can be successfully managed with lifestyle changes and/or medication. Reducing the amount of sodium in the diet can help bring blood pressure levels down.
Nutrition Facts
With proper food selection, a diet for high blood pressure can be varied and adequate in all nutrients, including vitamins and minerals.
The Role of Sodium
Sodium, of course, is essential for good health. While American adults average 4,000 to 6,000 milligrams daily, the recommended daily limit for the general public is only 2,400 milligrams. Someone with high blood pressure should consult a doctor to see how much sodium should be consumed daily. As a guide, however, 2,000 to 3,000 milligrams (2 to 3 grams) is enough.
A common dietary source of sodium is salt. Sodium is one of two minerals that make up salt (the other is chloride). One teaspoon of salt contains a whopping 2,300 milligrams of sodium&emdash;an entire day's supply! But sodium is also "hidden" in the diet in other foods, mainly processed and packaged foods.
What Food Labels Mean With Regard To Sodium |
---|
The U.S. Food and Drug Administration has developed these definitions that appear on food packages to assist consumers watching their sodium intake:
|
Special Consideration |
---|
Read food labels. Most sodium in the American diet comes from processed foods. Check the nutrition facts label for sodium content. Select foods labeled low-sodium, very low sodium, or salt-free, and watch out for ingredients that indicate high sodium content. Here's a clue: any ingredient with the word sodium in it, such as disodium phosphate, monosodium glutamate (MSG), sodium benzoate, sodium hydroxide, sodium nitrite, sodium proprionate, and sodium sulfate, means that the food likely has a high sodium content. Baked goods made with baking powder or baking soda may also be high in sodium. |
Sample Menu | ||
---|---|---|
Breakfast |
Lunch |
Dinner |
|
|
|
This Sample Diet Provides the Following | |||
---|---|---|---|
Calories | 1914 Fat | Fat | 32 gm |
Protein | 76 gm | Sodium | 1027 mg |
Carbohydrates | 341 gm | Potassium | 3755 mg |
Food Groups | ||
---|---|---|
Group | Recommend | Avoid |
Meat & Meat Substitutes |
fresh or frozen lean meats, poultry, fish, shellfish, unsalted lean pork, water-packed tuna, canned salmon without added salt, unsalted nuts and seeds, low-sodium peanut butter, dried peas, beans, lentils |
cured meats, processed meats, cold cuts, smoked meats, hot dogs, sausage, bacon, Canadian bacon |
Miscellaneous |
low-sodium broth, pepper, spices, vinegar, lemon juice, low-sodium ketchup, low-sodium mustard, low-sodium pickles, hot pepper sauce, garlic and onion powders, low-sodium salsa |
garlic salt,onion salt,regular ketchup and mustard,pickles |
Purpose |
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Hypoglycemia is the term for a blood glucose level that is lower than normal. When foods are digested in the body, they are broken down into many nutrients. These nutrients are absorbed into the bloodstream to be used in performing various body functions. One of these nutrients is glucose, a sugar that provides fuel to the body. The process that regulates the amount of sugar in the blood is complex. Adrenaline is a part of this complicated process. Everyone has experienced a rush of adrenaline at some time -- that "love-at-first-sight" feeling, or the pounding heart after narrowly escaping an accident. Adrenaline is produced by the adrenal glands located on top of the kidneys. The sudden release of adrenaline is what causes the symptoms of hypoglycemia -- apprehension, hunger, sweating, rapid heartbeat, and faintness. |
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Nutrition Facts |
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Following a hypoglycemia diet gives the body all the calories, protein, minerals, and vitamins necessary to meet the Recommended Dietary Allowance (RDA) for healthy adults. |
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Purpose |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Increasing calories may be recommended for persons who are underweight, athletes who want to gain weight to enhance performance or those whose calorie needs are increased due to a poor health condition, Underweight can be caused by heredity, a serious illness, not eating ennugh, or a combination of intense ongoing ehercise and insufficient calories in the diet. Severe depression can also affect the appetite, resulting in weight loss. |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Nutrition Facts |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The nutrition considerations of a healthful diet still apply when gaining weight is desired. The goal is to increase the number of calories in the diet while making healthful choices from a variety of foods. Choose dairy products, meats, fish, poultry, eggs, legumes, nuts, fruits, vegetables, whole grain cereals, breads, rice and pasta. |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Purpose |
|||||||||||||||||||||||||||||||||||||||
Almost everyone knows someone who has had kidney stones. The kidneys filter the blood to remove excess mineral salts and other soluble (dissolvable) wastes. The kidneys also produce the urine that dissolves these wastes and excretes them through the urinary tract. Kidney stones form when the urine becomes so saturated with a certain mineral that no more of it can dissolve into the urine (like trying to dissolve too much sugar in your iced tea). The undissolved portion of the mineral forms crystals that then clump together and grow into hard stones. Kidney stones usually develop in the kidneys. However they can form anywhere in the urinary tract. This condition is medically known as urolithiasis or nephrolithiasis. When kidney stones are quite tiny, they may pass unnoticed with the urine. Often however, they grow too large to pass easily through the urinary tract, and some stones have rough or sharp edges. When these stones are passing through the urinary tract, it can be quite painful. In some cases, kidney stones cannot pass on their own, and treatment with specialized medical equipment or surgery may be necessary. For most people, kidney stones are like dandelions in the lawn; they can be eliminated, but they'll be back another year. Therefore, a major part of the treatment for this condition is aimed at preventing recurrences. There are various types of kidney stones. Because treatment for each differs, it is important for the physician to determine the stone's mineral content and to identify any medical conditions that may have contributed to stone formation. Preventive treatment may be with medications and/or changes in the diet. About 80% of all kidney stones are composed of calcium and other minerals, usually a combination of calcium and oxalate. In some cases dietary adjustments help to prevent the recurrence of these types of stones. |
|||||||||||||||||||||||||||||||||||||||
Nutrition Facts |
|||||||||||||||||||||||||||||||||||||||
Diets for managing calcium kidney stones have adequate nutrients for most healthy adults. However, the Recommended Dietary Allowance (RDA) for calcium may not be met in post-menopausal, pregnant, or breast-feeding women; or in people under 25 years of age. Calcium supplements are generally not recommended, unless approved by a physician.
|
Purpose
Fat is a major energy source for the body. However, it is not the body's only source of energy. Too much fat in the diet can be harmful. It is especially bad for the circulatory system, because it raises blood cholesterol levels that can contribute to heart attack or stroke. This diet is designed to reduce fat and cholesterol blood levels. The diet goals are:
- decrease total dietary fat, especially saturated and trans fat, also known as hydrogenated fat
- decrease dietary cholesterol
- limit sodium intake
- increase intake of fiber, especially complex carbohydrates and prebiotic fibers
- decrease calories, if needed, to reach a healthy body weight
Cholesterol in the Diet
The heart pumps blood through blood vessels called arteries. This blood carries vital oxygen and nutrients needed by tissues and organs throughout the body. The heart itself is supplied with blood vessels called coronary arteries. When cholesterol levels rise above normal limits and stay high, some cholesterol is left behind in the arteries. Over the years, waxy cholesterol plaques build up on the artery walls, and so reduce or block blood flow. When blood flow to the brain is blocked, a stroke occurs. When plaque blocks a coronary artery, angina or a heart attack may be the outcome.
Cholesterol in the body comes from two sources. Most cholesterol is made by the liver from various nutrients and especially from ingested fats. The liver makes just about all the cholesterol the body will ever need. Since all animals can make their own cholesterol, some cholesterol in the human body comes directly from eating animal foods. These foods include meats, poultry, egg yolks, organ meats, whole milk and milk products. This cholesterol is absorbed through the intestines and added to what the liver makes. It is also known that a diet high in saturated fat increases cholesterol production in the body. Therefore, reducing dietary cholesterol and fats helps to keep blood cholesterol levels within a healthy range. Most important of all is to significantly reduce the amount of animal meat, meat products and trans fat in the diet.
Facts in the Diet
Dietary fats can be saturated (bad) or unsaturated (good). An easy way to remember the difference is that saturated fats solidify or remain solid at room temperature. Unsaturated fats do not; they are soft or liquid at room temperature. To reduce blood cholesterol levels, it is especially important to limit saturated fats. Saturated fats are found mainly in meats and dairy products made with whole milk.
Unsaturated fats (polyunsaturated and monounsaturated) are found mostly in plants, and are less likely to raise blood cholesterol levels. In fact, monounsaturated fats such as olive, peanut, or canola oils may even help to lower blood cholesterol. There are a few vegetable fats such as coconut oil, palm oil, and cocoa butter (found in chocolate) that act like saturated fats in the body, so they should be avoided.
In the past, food manufacturers "hydrogenated" vegetable oils to prevent rancidity and increase shelf life. These chemically derived oils are commonly known as trans fats. They act in the body exactly as do the saturated animal fats, raising cholesterol and, especially, the bad LDL cholesterol. These trans fats should be avoided. Always read the ingredients label on foods. For example, coconut and palm oils are bad, as are saturated fats, and should be avoided. Mono- and polyunsaturated oils like olive oil, canola and cottonseed are good.
Butter and Spreads
Butter is a highly saturated fat and should be avoided. Most of the stick margarines contain trans fat. These too should be avoided. Tub spreads generally contain mono- or polyunsaturated fats, so these are suitable. However, even some of these may contain trans fats so it is important to read the label and ingredients. The tub spreads, Promise and Smart Balance, can particularly be recommended.
Gut Bacteria and Prebiotic Fibers
The human intestine, especially the colon, is home to huge numbers of bacteria. These bacteria are part of the normal physiology within the gut. There are good and bad bacteria present. When the good colon bacteria are fed healthy prebiotic plant fibers, they thrive and produce many health benefits. The fibers that do this best are the prebiotic fibers present in vegetables such as artichoke, banana, onions, garlic, asaparagus, leeks and many others. Eating 25-35 grams of varied fruits and vegetables a day will usually provide lots of these beneficial fibers.
The supplement Prebiotin™ and Prebiotin-Heart Health™ provide a very generous dose of these prebiotics.
Fiber in the Diet
Fiber in the diet is now known to be increasingly important for cholesterol control and for those with known or suspected heart disease - heart attacks and angina. These are two reasons that 30 grams of fiber a day is important. First, ingested fiber blunts hunger, gives a feeling of fullness and in so doing, helps to control weight. Secondly, certain types of food fiber actually help to reduce cholesterol and triglyceride levels.
There are two main types of fiber - insoluble and soluble. All fiber moves through the gut into the colon unchanged. Within the colon, insoluble fiber, as present in wheat and corn, is not fermented by colon bacteria but rather clings to water and helps provide a bulky stool. Solublefiber, on the other hand, is fermented by the good colon bacteria and, in so doing, helps to lower cholesterol and especially triglyceride, another nasty fat that is of concern to some heart patients.
The supplement psyllium and also oats are especially important in lowering cholesterol. Both of these fibers, along with the healthy prebiotic fibers, are present in Prebiotin-Heart Health™
Special Considerations
In the not too distant past, obtaining food and providing shelter and protection for the family were the highest priorities. Before villages developed, finding food in the wild was a difficult task. Now, food is incredibly abundant. Even very poor families can get enough calories. So, the following are some practical considerations to help you reach a heart healthy diet.
Labels
Fresh foods purchased at a local market are almost always the best. However, we usually can't avoid getting some packaged foods. Food labels provide a wealth of information. Read them. You will find:
- Serving size - Many manufacturers will have an unrealistically low serving size simply so they can artificially lower the amounts listed in the Nutrition Fact portion of the label. Be sure the serving size conforms to what you eat at a sitting.
- Nutrition Facts - Here is where you get information on calories, cholesterol, fat, fiber and sodium. It is best to avoid foods with an unrealistic low serving size and high fat content.
- Ingredients - In the very smallest print, you will find all the ingredients in the product. They have to be placed in the order of the highest to lowest amounts within the food. Packaged foods with perhaps 8 or more ingredients, many of which you do not recognize, may be packed with calories and fat in hidden ways. Be wary! An example of how one can be misled on labels is to see that there are 0 grams of trans fat in a product. The FDA allows the manufacturer to say this even when there is 0.5 gm of trans fat per serving. So, you must read the ingredients part of the label.
Packaged foods, fast food restaurants, and the ready availability of sugar and calorie laden liquids are in front of us at all times. To the extent you can, restrict your eating to those foods you and your companion have control over. It may not be as fast as packaged food and fast food restaurants, but the enjoyment of food preparation and taking control of your eating has its own rewards.
Sugar and High Fructose Corn Syrup
Nature never intended us to have so much sugar. Honey, molasses and sweet fruits were natural flavors. Now, enormous amounts of simple table sugars (sucrose) are put into many foods. The body processes these as calories, and the weight and cholesterol may both go up.
As bad as sugar has been, high fructose corn syrup (HFCS) may be worse, as our bodies were never designed to receive such large amounts of fructose, a natural fruit sugar. Again, calories, weight and cholesterol may go up. So, the advice is to limit sugar and HFCS. Together, excess sugar and HFCS may cause weight gain, metabolic syndrome and accompanying atherosclerosis. Read the labels.
Meats
The meat industry and farming has been one of the enormously successful businesses in the Western World. Not too many generations ago, meat on the dinner table was a rarity. Then, families in the US raised their own meat on farms. Finally, the meat industry, helped enormously by subsidized corn-based feed, was able to spread cuts of meat in front of us at very affordable prices. The answer for a cholesterol/weight concerned person is to cut back drastically on the frequency and the amount of meat. Remember, marbling in meat is saturated fat, and prepared and processed meats such as bacon, sausage, scrapple, bologna, etc., are very high in saturated fat. So, one should restrict the frequency of meats, where possible, trim away the fat, and select those meats with the lowest amounts of saturated fats.
Fish and Fish Oil
It is now well known that fish, and especially certain types of fish such as salmon, albacore tuna, lake trout, herring and mackerel, contain very healthy types of oils that actually lower cholesterol. The oils in these and other fish are particularly healthy for the heart patient. Fish should be consumed 3-4 times a week, preferably baked or broiled rather than sauteed or deep-fried with extra fats.
Fish oil capsules are a concentrated form of this oil and many cardiologists now recommend them for heart patients.
Whole Grains
Complex carbohydrates come from natural plants and not from processed foods. Sugar and high fructose corn syrup are simple carbohydrates and, to the extent possible, should be restricted. In particular, one should select whole wheat or grain foods. The FDA has strict requirements when this phrase is used. Almost every other term such as multigrain, 7 grain, grain plus, etc., can mean almost anything the manufacturer wants. Read the labels. In particular, avoid foods where the word "enriched" is used. What this means is that the flour has been refined down to white flour (no fiber and few complex carbohydrates) and it has been "enriched" by adding a few vitamins. It is a bit of a deceit.
Sodium and Salt
Excess sodium is quite often linked closely to high cholesterol and heart disease. It certainly is directly related to high blood pressure. Low sodium foods are now widely available. There are many other spices that can be used other than table salt. Again, read the labels and especially the salt/sodium content on the nutrition part of the label.
Restaurants
In restaurants, ask the server how items are prepared. It should be remembered that tubs of butter sit around the kitchen simply because adding butter increases flavor and is used copiously by most chefs. Tell your server you are on a low saturated fat, low butter diet.
Purpose |
|||||||||||||||||||||||||||||||
A well-planned diet plays a major role in keeping the body fit and preventing illness. In the United States, the food guide pyramid is the regular diet recommended for healthy people over two years of age. In other parts of the world, agriculture, climate, and cultural differences influence what foods people eat and how those foods are prepared. Yet, these diets may also be healthy. Prior to the 1960s, for example, in countries around the Mediterranean sea -- parts of Italy, Greece, France, Spain, Portugal, and north Africa -- chronic disease rates were low and adult life expectancy, high. However, the economies of these countries have changed in the past 30 years. Their diets have become more like the American diet, and certain disease rates have also increased, suggesting that their traditional diets were healthier. Based on extensive scientific research to identify what was healthy about those pre-1960 diets, a different type of regular diet -- the Mediterranean diet -- has been developed. |
|||||||||||||||||||||||||||||||
Nutrition Facts |
|||||||||||||||||||||||||||||||
This diet is adequate in all the nutrients needed by most healthy adults. However, the diet may need to be altered for children, people with certain medical conditions, or women during pregnancy. A physician or registered dietician should be consulted in those cases.
|
|||||||||||||||||||||||||||||||
Foods Eaten Daily |
|||||||||||||||||||||||||||||||
Foods from plant sources occupy the biggest portion of the Mediterranean diet -- potatoes and foods from grains; fruits, vegetables, beans, other legumes, and nuts. Bread is an important part of the diet, usually enjoyed without butter or margarine. Fiber is the indigestible part of plants. There are two types: Insoluble fiber, such as wheat bran, does not dissolve in water, so it helps the body to regulate bowel function by adding bulk. Soluble fiber is the type found in certain grains, beans, and in many fruits. It does dissolve in water and forms a sticky gel that may sweep harmful substances from the intestines. There is evidence that soluble fiber helps to reduce cholesterol levels, and may decrease the risk of developing certain cancers. So, it is recommended that people eat 20 to 30 grams of fiber a day, which should include both soluble and insoluble fibers. Fruits and vegetables: Choose a variety of whole fresh fruits over canned and frozen, which often contain large amounts of added sugar. Whole fruits contain more fiber than is found in fruit juice, but if choosing fruit juice, make sure it is 100% fruit juice. Nuts and Legumes (peas and beans) are good sources of fiber, vitamins, minerals, and protein, and can be used in place of meat. A half cup of cooked dried beans has many of the benefits of one ounce of meat, but none of the saturated fat found in meat. Small amounts of nuts and seeds are also good choices for calcium, zinc, and protein. They do contain more fat than legumes, but most of the fat is unsaturated fat. Coconut, however, is very high in saturated fat and should be avoided. Olive Oil and Total Fat: Olive oil is the principal fat in the Mediterranean diet. To understand why this is a healthy fat choice, it helps to know something about fats and cholesterol. Cholesterol> is a waxy, fat-like substance needed for important functions in the body. However, too much cholesterol in the blood can increase the risk of heart disease. Cholesterol is found in foods from animal sources, because animals produce cholesterol in their bodies, just as the human body does. In fact, the human body produces all the cholesterol it needs. This is why it is recommended that dietary cholesterol be limited to an average of 300 milligrams (mg) or less a day. A certain amount of fat is also needed in a healthy diet, to supply energy and a few nutrients. However, too much fat in the diet can increase the risk of heart disease and certain cancers. There are different kinds of fat in foods, and some types are worse than others. Saturated fats are found in dairy products made with whole milk and in meat. Some meats contain more saturated fat than others: beef more than chicken. Saturated fats are solid at room temperature. Some vegetable fats such as coconut, cocoa butter (found in chocolate), palm and palm kernel oils are also saturated. The liver uses certain nutrients, and especially saturated fats, as the building blocks of cholesterol. Therefore, eating too much saturated fat raises blood cholesterol, increasing the risk of heart disease. Hydrogenated oils is a term often found in food labels. Through a manufacturing process, liquid vegetable oils can be made to stay solid at room temperature. Therefore, they act as saturated fats and should be avoided in the diet. Unsaturated fats, found mostly in plants, are liquid at room temperature. They are less likely to cause heart disease. Polyunsaturated fats are found in safflower, sunflower, corn, soybean, and cottonseed oils and in some fish. Recent research shows that monounsaturated fats found in olive, peanut, and canola oils may even lower cholesterol. Dairy products: This is the smallest proportion of foods to be eaten daily. They are good sources of calcium, but are high in saturated fats. Mediterraneans use about one cup of milk per day, and this is usually used in preparing foods. Small amounts of flavorful cheeses (such as those grated over pastas) may be used everyday, but should not exceed 2 to 3 ounces per week. When using dairy products, choose low-fat varieties such as skim or 1% fat milk, low-fat yogurt, and "part skim" or low-fat cheeses. |
|||||||||||||||||||||||||||||||
Foods Eaten a Few Times a Week |
|||||||||||||||||||||||||||||||
Foods from animal sources are used very little in the Mediterranean countries. Proteins are required for growth and normal development of the body. However, as previously mentioned, protein can be obtained in lower-fat food choices than meat. Children, teenagers, and women who are pregnant or breast-feeding, should consult their physicians about protein requirements. For other adults following the Mediterranean diet, fish and poultry may be eaten a few times a week. Ocean fish and shellfish contain high concentrations of certain oils that can reduce the risk of heart disease. Fish oil supplements are not recommended; they add too many calories to the diet. Eggs: Mediterraneans traditionally eat no more than four eggs per week, including those used in baking and preparing foods. That is a good guide to follow because eggs are high in cholesterol and saturated fat. Use only one yolk per person in egg dishes, and substitute egg whites if more eggs are called for. Sweets and desserts: Mediterraneans favor fresh fruit for dessert. They eat sweets with large amounts of sugar and saturated fats only a few times a week and in small amounts. Added sugar (in processing, preparing, or at the table) increases calories without providing nutrients. Sugars include white sugar, brown sugar, raw sugar, corn syrup, honey, and molasses. Foods like soft drinks, candy, ice cream, jams, jellies, chocolate milk, and fruits canned in heavy syrups are high in sugar and should by limited in the diet. |
|||||||||||||||||||||||||||||||
Foods Eaten a Few Times a Month |
|||||||||||||||||||||||||||||||
Red Meat should be eaten only a few times a month. It may be used a little more often in very small amounts, to flavor pasta sauces or soups, for example. There is evidence that too much red meat in the diet may contribute not only to heart disease, but also to certain types of cancer. No more than 12 to 16 ounces of red meat should be eaten each month. Choose lean cuts and trim away visible fat. Broil, roast, or bake instead of pan frying. |
|||||||||||||||||||||||||||||||
Special Considerations |
|||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||
Drinking wine: |
|||||||||||||||||||||||||||||||
In some parts of the Mediterranean, wine is enjoyed in moderation, usually with a leisurely meal. Some medical studies have indicated that a glass of red wine each day may produce benefits for the cardiovascular system. Although excessive alcohol intake is the cause of many health problems, one or two glasses of wine a day for men and one glass for women may provide benefits when taken with a meal. It is always a good idea to get the advice of a physician on this matter. Furthermore, if you are a non-drinker, do not begin to use alcohol just for this uncertain benefit.
|
Purpose
Some things you never outgrow–like your need for healthful eating. Good nutrition is important at every stage of life, from infancy through late adulthood. The basics of a balanced diet remain the same but individual nutritional needs change as you grow older. No matter what your age, it is never too late to start living a healthier life.
Whether you are 50 or 85, active or homebound, your food choices will affect your overall health in the years ahead. The risk for certain diseases associated with aging such as heart disease, osteoporosis and diabetes can be reduced with a lifestyle that includes healthy eating. Good nutrition also helps in the treatment and recovery from illness. While healthy living can't turn back the clock, it can help you feel good longer.
Eating healthfully means consuming a variety of good foods each day. Food provides the energy, protein, vitamins, minerals, fiber and water you need for good health. For one reason or another your body may not be getting the right amounts of these nutrients.
There are several factors that indicate an increased risk for poor nutrition. If you have three or more of the risk factors listed below consult with a physician or registered dietitian:
- ill health
- poor eating habits
- unexpected weight gain or loss
- taking medications
- poor dental health
- economic hardship
- loneliness and lack of social contacts
- the inability to care for yourself
Nutrition Facts
Older adults need the same nutrients as younger people, but in differing amounts. As you get older, the number of calories needed is usually less than when you were younger. This is because basic body processes require less energy when there is a decline in physical activity and loss of muscles. However, contrary to popular belief, basic nutrient needs do not decrease with age. In fact, some nutrients are needed in increased amounts. The challenge is to develop an eating plan that supplies plenty of nutrients but not too many calories.
This can be done by choosing nutritious foods that are low in fat and high in fiber like whole grain breads and cereals, fruits and vegetables. Also be sure to include moderate amounts of low-fat dairy products and protein foods like meat, poultry, fish, beans and eggs. Sweets and other foods high in sugar, fat and calories can be enjoyed from time to time but the key is to eat them sparingly.
The Food Guide Pyramid is a great guide for your daily food choices. Calorie needs vary depending on age and activity level but for many older adults 1600 calories each day will meet energy needs. Chosen carefully those 1600 calories can supply a wealth of nutrients. The recommended number of daily servings from each group in the Food Guide Pyramid, with a few additions of fats, oils and sweets, will easily add up to 1600 healthful calories.
Calcium is important at any age and may need special emphasis as you grow older. Calcium is a mineral that builds strong bones and helps prevent osteoporosis. Many older adults don't eat enough calcium rich foods and the aging body is less efficient in absorbing calcium from food. In addition, many adults don't get enough weight bearing exercise like walking to help keep bones strong.
It is not too late to consume more calcium and reduce the risk of bone fractures. Eat at least 2-3 servings of calcium rich foods everyday. Low-fat milk, yogurt and cheese are good choices. Some dark green, leafy vegetables, canned salmon with edible bones, tofu made with calcium sulfate, and calcium fortified soy milk can add a significant amount of calcium to your diet. In addition, do some weight bearing exercise like walking for a total of 30 minutes each day.
The National Institutes of Health advise adults over 65 to consume 1500 mg of calcium daily. This amount may be difficult to achieve through food alone so for some people a calcium supplement is a wise choice. If you do take a supplement, take it between meals. Calcium can hinder the absorption of iron from other foods
One Serving Equals | |
---|---|
Grain |
Milk, Yogurt, and Cheese |
1 slice of gread |
1 cup milk or yogurt |
Fruits and Vegetables |
Meat, Poultry, fish, Dry Beans, Eggs and Nuts |
1 cup raw, leafy vegetables |
1-3 ounces cooked lean meat, poultry or fish |
Can Food Do It ALL? |
---|
Yes, food can provide an adequate diet and the pleasures of eating too. But for those who are unable or unwilling to eat a healthy diet a multivitamin and mineral supplement is a good way to get all the needed vitamins and minerals. The guideline is to get enough without getting too much. Look for a supplement that provides about 100% of the RDA. Physicians regularly prescribe supplements for certain health conditions. It is not a good idea to take mega-doses without first discussing it with your physician. Beware of supplements that claim to be magic or promise miracle cures. Taking unproven remedies in place of well-proven treatments could make your health worse in the long run. |
Vitamin D protects against bone disease by helping deposit calcium into bones. Known as the sunshine vitamin, it is made within the skin by exposure to the sun's ultraviolet rays. Only 20 to 30 minutes of sunlight on the hands or face two to three times per week will provide enough vitamin D. However, dark skinned people do not make vitamin D from sunlight so they must get it from food sources. Food sources of vitamin D include fortified milk and cereals. Look for it on food labels.
Vitamin C helps your body absorb iron from plant sources of food. Most people who follow the guidelines of the Food Guide Pyramid consume enough vitamin C. Poor eating habits or smoking can contribute to low levels of vitamin C. A lack of vitamin C can cause bleeding gums, delay wound healing and contribute to low levels of iron. The most effective way to increase vitamin C is to eat citrus fruits, melons, tomatoes, green peppers and berries.
Sodium is found naturally in foods such as milk, seafood and eggs. Processed foods such as tomato juice, frozen dinners, canned soups, canned fruits and canned vegetables are high in added sodium. People with high blood pressure and certain types of heart disease may be advised by their physicians to reduce the amount of sodium in their diets. For healthy adults, the American Heart Association recommends not more than three grams (3000 mg) of sodium each day. One and a half teaspoons of salt is equal to 3000 mg of sodium, so go lightly with the salt shake
Special Considerations
The ability to smell and taste may decline gradually with age. When the sense of smell becomes dulled, it affects the sense of taste and makes food less appetizing. Also, some medications may leave a bitter taste, which affects saliva, giving foods a bad flavor. Smoking reduces the ability to enjoy flavors too. Poor eating habits can result when food just doesn't taste as good as it used to.
To compensate for the loss of smell and taste, create meals that appeal to all the senses. Intensify the taste, smell, sight, sound and feel of foods. Perk up flavors with herbs, spices and lemon juice rather than relying solely on salt or sugar. Choose foods that look good and have a variety of textures and temperatures. Try new ideas. Use garlic and seasoning on foods, add a new texture like crushing crackers in soup, or change the temperature like serving applesauce warm with cinnamon
Dry mouth is another problem faced by many older adults. When it feels like your mouth is filled with cotton balls and your lips are parched and cracked, food just doesn't taste good. It can be difficult to chew and swallow because of a lack of saliva. Dry mouth is a potential side effect of many medications such as drugs to lower blood pressure or treat depression. It may also be a symptom of cancer or kidney failure.
To relieve dry mouth discomfort, watch out for spicy foods that irritate the lips and tongue. Eat soft foods that have been moistened with sauces or gravies. Try sucking on hard candies or popsicles and drink plenty of fluids. A room humidifier may help by moistening the air. It will also help to breathe through your nose–not your mouth.
Tooth loss or mouth pain can be an obstacle to good eating. Generally, people who wear poorly fitting dentures chew 75% to 85% less efficiently than those with natural teeth. Dentures should be adjusted for a proper fit. Softer foods are easier to chew. Drinking plenty of water or other fluids with meals may make swallowing easier. Good dental care (brushing, flossing, regular check-ups) will help keep teeth and gums healthy.
Many older adults say they just aren't hungry. There are many factors that influence appetite including digestive problems, certain medications, depression or loneliness. To encourage eating and appetite, keep portions small, allow plenty of time to dine, eat smaller meals more often, prepare attractive meals, play dinner music, eat meals with friends, and increase physical activity where possible. Consult a physician if the lack of appetite results in unwanted weight loss.
Constipation can be a chronic problem for many older adults. It can be caused by not getting enough fiber or fluids and by being physically inactive. To stay regular and avoid the strain of constipation engage in physical activity, drink plenty of fluids and eat fiber rich foods such as whole grain breads and cereals, legumes, vegetables and fruit. Fiber gives bulk to stools and fluids help keep stools softer making them easier to eliminate.
Some older adults have trouble digesting milk, even if it wasn't a problem in their younger years. The small intestine may no longer be producing the enzyme lactase which breaks down the natural sugar, called lactose, in milk. When the lactase enzyme is missing you may experience bloating, abdominal cramps and diarrhea. Tolerance to lactose is variable. Try eating smaller amounts of these foods, eating them during a meal instead of alone or having them less often (perhaps every other day). Lactose-reduced and -free products are now available. Look for them in your supermarket. Also, the lactase enzyme is available in tablets or drops that can be added to milk before drinking. Follow the specific directions found on the packages
Medications and older age often go together. Medications improve health and quality of life but some can profoundly affect nutritional needs. Be sure to consult with the physician or pharmacist as to specific instructions concerning food-drug interactions and directions on when and how to take medications.
Part of the pleasure of eating is in socializing with others. Many older adults who live alone may find mealtimes boring or depressing. Put some fun back into eating by getting together with friends for weekly or monthly potluck dinners. Look for a senior center in your community. This is a great way to meet old and new friends and many have programs that offer a midday meal on weekdays. Take advantage of early bird specials or senior discounts at restaurants and don't hesitate to take home a 'doggie bag'. Invite a friend to lunch at your home. Join a community service club or organization. Many of these groups plan social activities which often include getting together for meals. When home alone, make eating a special event with candles, tablecloth, music and something delicious to eat.
Look to local agencies for help for older adults who find it hard to cook their own meals or get out of the house. Meals-On-Wheels programs provide food for people who are homebound. Home health care organizations can provide aides who will shop and prepare meals for older disabled adults. Some local churches or community groups have volunteers who will help older adults with shopping and food preparation.
A Day of Good Nutrition Sample Menu | ||||||
---|---|---|---|---|---|---|
Breakfast |
Bread |
Vegetables |
Fruit |
Milk |
Meat |
Fluids |
|
|
|
|
|
|
|
1 oz. whole grain cereal |
1 |
|
|
|
|
|
1 cup 1% milk |
|
|
|
1 |
|
1 |
1 banana |
|
|
1 |
|
|
|
coffee or tea |
|
|
|
|
|
1 |
Mid Morning |
|
|
|
|
|
|
|
|
|
|
|
|
|
6 oz. tomato juice |
|
1 |
|
|
|
3/4 |
1/2 raisin bagel |
1 |
|
|
|
|
|
Lunch |
|
|
|
|
|
|
|
|
|
|
|
|
|
Sandwich |
|
|
|
|
|
|
2 oz. lean ham |
|
|
|
|
1 |
|
on whole wheat |
2 |
|
|
|
|
|
lettuce and tomato |
|
1 |
|
|
|
|
1/4 cantaloupe |
|
|
1 |
|
|
|
2 graham crackers |
1 |
|
|
|
|
|
iced tea |
|
|
|
|
|
1 |
Mid Afternoon |
|
|
|
|
|
|
|
|
|
|
|
|
|
8 oz low fat yogurt |
|
|
|
1 |
|
|
1 glass water |
|
|
|
|
|
1 |
Dinner |
|
|
|
|
|
|
|
|
|
|
|
|
|
3 oz broiled chicken breast |
|
|
|
|
1 |
|
1/2 cup rice |
1 |
|
|
|
|
|
1/2 cup cooked carrots |
|
1 |
|
|
|
|
1/2 cup cranberry sauce |
|
|
1 |
|
|
|
1/2 cup vanilla pudding (low fat milk) |
|
|
|
1 |
|
|
1 glass water |
|
|
|
|
|
1 |
cup of tea |
|
|
|
|
|
1 |
Totals |
6 |
3 |
3 |
3 |
2 |
6-7 |
- Gastroenterology
- Colonoscopy
- Balloon Enteroscopy
- Flexible Sigmoidoscopy
- ERCP/Choledochoscopy
- EUS
- Liver Biopsy
Miami Office
Address8525 SW 92nd Street, Suite C-10
Miami, FL 33156-7365
Homestead Office
Address975 Baptist Way, Suite 202
Homestead, FL 33033
Contacts for Both Offices
Telephone (305) 274-7800
Fax (305) 270-1246
Email administrationmiamigastro.org