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High Fiber Diet

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.

Colon Gas & Flatus Prevention

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:

  • whole wheat bread and baked goods
  • wheat bran
  • whole grain breads
  • vegetables and fruit, especially the skins
  • peanuts
  • Brazil nuts
  • popcorn
  • brown rice
 

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:

  • oats in any form - cereal, muffins, etc.
  • apples, oranges, grapefruit, peaches, concord grapes
  • prunes, pears, cranberries
  • beans
  • beets
  • carrots
  • psyllium (found in supplements and some cereals)

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.

Irritable Bowel Syndrome

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

Dietary advice for IBS patient 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.

  1. 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.
  2. 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.
  3. Increase prebiotics fibers in the diet by eating specific foods (Sources of Prebiotics) and/or a supplement .
Crohn's Disease

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.

Ulcerative Colitis

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. Functionality of lower intestine

  • 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

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.

Colon Polyps And Cancer Prevention

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.

Clear Liquid

Purpose

Soda 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
  1. Limitations
    The physician may limit certain liquids, depending on the patient's condition, or the surgery or test being performed. Therefore, individual instructions should be strictly followed.
  2. What is a clear liquid?
    A good rule-of-thumb is anything you can see through. For example, apple juice is a clear liquid; milk is not. If unsure, check with the physician or registered dietition.
  3. After surgery and fasting
    Should persistent abdominal cramps or discomfort occur with a clear liquid diet, the patient should notify the physician, nurse, or dietitian at once.
  4. Preparing for a medical test
    It is important that the clear liquid diet be followed exactly. Remember that the value of the examination will depend on getting a thoroughly clean digestive tract.


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

  • strained fruit juice 1 cup
  • gelatin 1 cup
  • hot tea with sugar & lemon
  • consommé 3/4 cup
  • strained fruit juice 1 cup
  • fruit ice 1/2 cup
  • gelatin 1/2 cup
  • hot tea with sugar & lemon
  • consommé 3/4 cup
  • strained fruit juice 1 cup
  • fruit ice 1/2 cup
  • gelatin 1/2 cup
  • hot tea with sugar & lemon


This Sample Diet Provides the Following

Calories

600

Fat

virtually none

Protein

6 gm

Sodium

1500 mg

Carbohydrates

209 gm

Potassium

1440 mg

 

Copper Restriction

Purpose

FoodWilson'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
  1. The copper content in a specific food can vary depending on a number of factors. The copper content and the location of the soil in which the food was grown, or the method used to process the food, for example, can affect how much copper is in the food when eaten. In general, the low copper diet is meant to restrict foods that are usually high in copper, especially organ meats, shellfish, dried beans, peas, whole wheat, and chocolate.
  2. Drinking water should be analyzed because it may contain too much copper. If the water contains more than 100 micrograms per liter, then bottled demineralized water should be used. This water should contain only 1 microgram of copper per liter. Demineralized water and distilled water are processed differently and may not contain the same amount of copper. Check with the physician or registered dietitian for more information.
  3. Avoid drinking alcohol. It can be harmful to the liver, and the liver may already be damaged from Wilson's disease.
  4. Read food labels; some prepared foods list the copper content. Always check the labels of vitamin/mineral supplements to see if they contain copper.
  5. For better control of copper intake, choose only average portions or serving sizes of foods. Examples of average portions are 3 to 4 oz of meat, fish, or poultry; 1/2 cup of vegetables; one slice of bread.
  6. Do not use copper cooking utensils.
  7. Patient's with Wilson's disease should have initial and periodic consultations with a registered dietitian to make sure copper in the diet is being adequately controlled.


Food Groups

 

Eat as Desired
Foods low in copper -- less
than 0.1 mg/portion.

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
Fruits dried at home are permitted

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

  • grapefruit 1/2 cup
  • scrambled egg 1
  • white toast 1 slice
  • margarine 1 tsp
  • skim milk 1/2 cup
  • coffee 1 cup
  • salt/pepper
  • white bread 2 slices
  • roast beef 2 oz
    lettuce
    tomato
    mayonnaise 1 Tbsp
  • carrot sticks 6
  • fresh orange 1
  • skim milk 1/2 cup
  • chicken breast 3 oz
  • rice 1/.2 cup
  • green beans 1/2 cup
  • margarine 1 tsp
  • white bread 1 slice
  • jelly 1 tsp
  • apple 1
  • lemonade 1 cup
  • salt/pepper


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

   
Dumping/Gastrectomy

Purpose

Fruit 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
  1. Eat six small meals daily to avoid overloading the stomach.
  2. Limit fluids to 4 oz (1/2 cup) during mealtimes. This prevents the rapid movement of food through the upper gastrointestinal tract and allows adequate absorption of nutrients.
  3. Drink liquids 30 to 45 minutes before eating and 1 hour after eating, rather than with meals.
  4. Rest or lie down for 15 minutes after a meal to decrease movement of food from the stomach to the small intestine. This decreases the severity of symptoms.
  5. Avoid sweets and sugars. They aggravate the dumping syndrome.
  6. Avoid very hot or cold foods or liquids, which may increase symptoms in some patients.
  7. Stomach surgery is performed for different reasons, so calorie requirements may vary from patient to patient. For example, a patient who has had surgery for severe obesity will need to be on a weight reduction program. A very thin patient who has had ulcer or cancer surgery will need extra calories.


Food Groups

Group

Recommend

Avoid

Milk & milk products
(2 or more cups daily)

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
(3 or more servings daily)

all

none

Fruits
(2 or more servings daily)

fresh fruit, fruit canned in natural juice, unsweetened fruit juice

dried fruits, canned or frozen fruits in syrup, sweetened juice

Breads & grains
(4 or more servings daily)

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
(servings depend on caloric needs)

butter, margarine, oils, salad dressings

none

Sweets & desserts
(servings depend on caloric needs)

artificial sweeteners, low-calorie jelly, low-calorie gelatin, low-calorie popsicles

popsicles, cakes, pies, cookies, jellies, jams, gelatin, high sugar desserts, sherbet

Beverages
(limit fluid with meals to 4 oz per meal)

sugar-free beverages, water

regular soft drinks, sugared drink mixes, lemonade, Kool Aid, Gatorade, sugared ice tea, Snapple or similar drinks



Sample Menu
Breakfast
Lunch
Dinner
  • unsweetened orange juice 1/2 cup
  • poached egg 1
  • toast 1 slice
  • margarine 1 tsp
  • low-calorie jelly 1 tsp
  • sugar substitute
  • salt/pepper
  • beef patty
    3 oz on bun
    mayonnaise or ketchup 1 Tbsp
  • broccoli 1/2 cup
  • margarine 1 tsp
  • skim milk 1/2 cup
  • salt/pepper
  • chicken breast 3 oz
  • mashed potatoes 1/2 cup
  • green beans
    1/2 cup
  • margarine 2 tsp
  • coffee 1/2 cup
  • non-dairy creamer
  • sugar substitute
  • salt/pepper

Mid-Morning Snack

Mid-Afternoon Snack

Evening Snack

  • unsweetened cereal 1/2 cup
  • skim milk 1/2 cup
  • bread 1 slice
  • turkey 1 oz
    mayonnaise
    1 Tbsp
    lettuce
  • low-calorie pudding 1./2 cup
  • cottage cheese
    1/4 cup
  • fresh peaches
    3/4 cup


This Sample Diet Provides the Following

Calories

1550

Fat

62 gm

Protein

87 gm

Sodium

2327 mg

Carbohydrates

119 gm

Potassium

2372 mg
Dysphagia 5 Levels

Purpose


Milk 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.

  • Maintain an upright position (as near 90 degrees as possible) whenever eating or drinking.
  • Take small bites -- only 1/2 to 1 teaspoon at a time.
  • Eat slowly. It may also help to eat only one food at a time.
  • Avoid talking while eating.
  • When one side of the mouth is weak, place food into the stronger side of the mouth. At the end of the meal, check the inside of the cheek for any food that may have been pocketed.
  • Try turning the head down, tucking the chin to the chest, and bending the body forward when swallowing. This often provides greater swallowing ease and helps prevent food from entering the airway.
  • Do not mix solid foods and liquids in the same mouthful and do not "wash foods down" with liquids, unless you have been instructed to do so by the therapist.
  • Eat in a relaxed atmosphere, with no distractions.
  • Following each meal, sit in an upright position (90 degree angle) for 30 to 45 minutes.


Level 1
Puréed Foods

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

  • orange juice 1/2 cup
  • cream of wheat
    1/2 cup
  • scrambled eggs with cheese 1/2 cup
  • decaffeinated tea
    1 cup
  • whole milk 1 cup
  • non-dairy creamer
    2 Tbsp
  • ketchup 1 Tbsp
  • margarine 1 tsp
  • salt 1/4 tsp
  • sugar 2 tsp
  • pineapple juice
    1/2 cup
  • puréed beef 3 oz
  • gravy 2 Tbsp
  • mashed potatoes
    1/2 cup
  • puréed fresh broccoli 1/2 cup
  • apple sauce 1/2 cup
  • decaffeinated coffee
    1 cup
  • non-dairy creamer
    2 Tbsp
  • margarine 1 tsp
  • salt 1/4 tsp
  • sugar 1 tsp
  • puréed turkey barley soup 3/4 cup
  • puréed Hawaiian chicken 3 oz
  • mashed potatoes
    1/2 cup
  • puréed spinach
    1/2 cup
  • frozen yogurt 1/2 cup
  • decaffeinated tea
    1 cup
  • non-dairy creamer
    2 Tbsp
  • margarine 1 tsp
  • salt 1/4 tsp
  • sugar 1 tsp


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
Minced Foods

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

  • orange juice 1/2 cup
  • oatmeal 1/2 cup
  • scrambled eggs with cheese 1/2 cup
  • decaffeinated tea 1 cup
  • whole milk 1 cup
  • non-dairy creamer
    2 Tbsp
  • ketchup 1 Tbsp
  • margarine 1 tsp
  • salt 1/4 tsp
  • sugar 2 tsp
  • pineapple juice 1/2 cup
  • minced beef 3 oz
  • gravy 2 Tbsp
  • mashed potatoes 1/2 cup
  • minced fresh broccoli
    1/2 cup
  • applesauce 1/2 cup
  • decaffeinated coffee
    1 cup
  • non-dairy creamer 2 Tbsp
  • margarine 1 tsp
  • salt 1/4 tsp
  • sugar 1 tsp
  • puréed turkey barley soup 3/4 cup
  • minced Hawaiian
    chicken 3 oz
  • mashed potatoes 1/2 cup
  • puréed spinach 1/2 cup
  • frozen yogurt 1/2 cup
  • decaffeinated tea 1 cup
  • non-dairy creamer 2 Tbsp
  • margarine 1 tsp
  • salt 1/4 tsp
  • sugar 1 tsp


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
Ground Foods

 

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

  • orange juice 1/2 cup
  • oatmeal 1/2 cup
  • scrambled eggs with cheese 1/2 cup
  • decaffeinated tea 1 cup
  • whole milk 1 cup
  • non-dairy creamer
    2 Tbsp
  • ketchup 1 Tbsp
  • margarine 1 tsp
  • salt 1/4 tsp
  • sugar 2 tsp
  • pineapple juice 1/2 cup
  • ground beef 3 oz
  • gravy 2 Tbsp
  • mashed potatoes 1/2 cup
  • cooked spinach 1/2 cup
  • applesauce 1/2 cup
  • decaffeinated coffee
    1 cup
  • whole milk
  • non-dairy creamer 2 Tbsp
  • margarine 1 tsp
  • salt 1/4 tsp
  • sugar 1 tsp
  • puréed turkey barley soup 3/4 cup
  • ground Hawaiian
    chicken 3 oz
  • mashed potatoes 1/2 cup
  • ground fresh broccoli
    1/2 cup
  • frozen yogurt 1/2 cup
  • decaffeinated tea 1 cup
  • non-dairy creamer 2 Tbsp
  • margarine 1 tsp
  • salt 1/4 tsp
  • sugar 1 tsp


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
Chopped Foods

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

  • orange juice 1/2 cup
  • oatmeal 1/2 cup
  • scrambled eggs with cheese 1/2 cup
  • decaffeinated tea 1 cup
  • whole milk 1 cup
  • non-dairy creamer
    2 Tbsp
  • ketchup 1 Tbsp
  • margarine 1 tsp
  • salt 1/4 tsp
  • sugar 2 tsp
  • pineapple juice 1/2 cup
  • chopped beef 3 oz
  • gravy 2 Tbsp
  • mashed potatoes 1/2 cup
  • chopped fresh broccoli
    1/2 cup
  • applesauce 1/2 cup
  • decaffeinated coffee
    1 cup
  • non-dairy creamer 2 Tbsp
  • margarine 1 tsp
  • salt 1/4 tsp
  • sugar 1 tsp
  • turkey barley soup 3/4 cup
  • chopped Hawaiian
    chicken 3 oz
  • mashed potatoes 1/2 cup
  • cooked spinach 1/2 cup
  • frozen yogurt 1/2 cup
  • decaffeinated tea 1 cup
  • non-dairy creamer 2 Tbsp
  • margarine 1 tsp
  • salt 1/4 tsp
  • sugar 1 tsp


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

  • orange juice  1/2 cup
  • oatmeal  1/2 cup
  • cheese omelet
  • toast  1 slice
  • decaffeinated tea  1 cup
  • whole milk  1 cup
  • non-dairy creamer
    2 Tbsp
  • ketchup  1 Tbsp
  • margarine  1 tsp
  • salt  1/4 tsp
  • sugar  2 tsp
  • jelly  2 tsp
  • pineapple juice  1/2 cup
  • hamburger on bun  3 oz
  • steak fries  1/2 cup
  • green beans  1/2 cup
  • applesauce  1/2 cup
  • decaffeinated coffee
    1 cup
  • whole milk  1 cup
  • non-dairy creamer  2 Tbsp
  • margarine  1 tsp
  • salt  1/4 tsp
  • sugar  1 tsp
  • ketchup  2 Tbsp
  • turkey barley soup  3/4 cup
  • Hawaiian chicken  3 oz
  • mashed potatoes  1/2 cup
  • fresh broccoli  1/2 cup
  • frozen yogurt  1/2 cup
  • decaffeinated tea  1 cup
  • non-dairy creamer  2 Tbsp
  • saltine crackers  6
  • margarine  1 tsp
  • salt  1/4 tsp
  • sugar  1 tsp


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

 

 

Full Liquid

Purpose

Milk 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

  • fruit juice 1 cup
  • hot cereal 1/2 cup
  • eggnog 8 oz
  • whole milk 8 oz
  • hot tea with sugar & lemon
  • strained creamed soup 3/4 cup
  • juice 1 cup
  • ice cream 1/2 cup
  • pudding or custard 1/2 cup
  • whole milk 8 oz
  • hot tea with sugar & lemon
  • salt/pepper


This Sample Diet Provides the Following

Calories

2100

Fat

80 mg

Protein

60 gm

Sodium

2975 mg

Carbohydrates

290 gm

Potassium

2900 mg
Gastric Bypass

Purpose

Fruit 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:

  • 1 adult or 2 children's chewable multivitamin tablets
  • Extra iron, calcium, or vitamin B-12 if needed


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.

Dehydration (loss of body fluids) is also an important concern, especially if vomiting or diarrhea is frequent. Prevent dehydration by drinking water or low-calorie beverages between meals (when there is no food in the stomach), but remember that the stomach can only hold 3-4 ounces at a time.

Dumping Syndrome occurs when food passes too quickly from the stomach into the small intestine. Symptoms may include a combination of nausea, uncomfortable fullness, cramping, and diarrhea, or weakness, sweating, and fast heart rate. Dumping can be provoked by eating very sweet or sugary foods. Reduce intake of sweets and notify a physician if these symptoms occur.

Food Intolerances, especially to red meat, milk, and high-fiber foods, are experienced by many patients. Since food intolerances vary with the individual, a dietitian can help with sorting out food choices to minimize symptoms such as stomach discomfort, nausea, or diarrhea.

Overeating -- Almost all people who require gastric bypass surgery have had problems with overeating. The causes for this are complex, involving genetics, emotions, upbringing, and even the functions of the brain. None of this changes after bypass surgery, except that the stomach is now much smaller. Eating more than the new stomach can hold may cause vomiting, expansion of the pouch, weight gain, or even rupture of the stomach. Education, counseling, group support, and certain medications can help to prevent overeating and are just as important as diet to the success of the operation.

Others: Stomach pain, ulcers, and gastritis (an inflammation of the stomach lining) are complications which may require medical attention. Notify a physician if frequent stomach pain 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:

  • Drink 1 cup of water or low-calorie beverage between each meal
  • Fluids should add up to at least 6 cups (48 ounces) each day
  • Sip slowly&emdash;make beverages last 30 minutes or more
  • Finish drinking 45-60 minutes before meals

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.

  1. 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.
  2. 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.
  3. 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.
  4. 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:

  • The new stomach can only hold 1/2 cup at a time
  • Eat 3 to 6 small meals a day
  • Chew food thoroughly and eat slowly
  • Avoid chewing gum&emdash;it could block the stomach outlet if swallowed
  • Do not overeat
  • Relax and enjoy your new life


Sample Menu
Breakfast
Lunch
Dinner
  • banana - 1/4 med
  • Scrambled egg - 1
  • toast, white -1/2 slice
  • margarine - 1 tsp
  • broiled chicken breast- 2 oz
  • carrots, boiled - 1/4 cup
  • margarine - 1 tsp
  • pasta salad - 1/4 cup
  • haddock, baked or broiled - 2 oz
  • green beans - 1/4 cup
  • dinner roll - 1/2
Morning snack

Afternoon Snack

Evening snack
  • graham crackers - 2
  • pudding, sugar-free, made with 2% fat milk - 1/2 cup
  • fruit cocktail, waterpacked - 1./2 cup
  • cheese, American - 1 oz
  • saltine crackers - 2
  • mustard - 1 tsp

*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

1011

Fat

37 gm

Protein

71 gm

Calcium

1065 mg

Carbohydrates

97 gm

Iron

6 mg
Gastroparesis

Purpose

Soda 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

  1. Diets must be tailored to the individual patient. This is because the degree of gastroparesis may range from severe and long-standing to mild and easily corrected. Patients may also have various medical conditions to be considered. For example, diabetes patients with gastroparesis are allowed sugar-containing liquids on the Step 1 diet, because that is their only source of carbohydrate. On the Step 2 and Step 3 diets, these patients should avoid concentrated sweets. These are noted with an asterisk (*) on the food lists.
  2. On all of the diets, liquids and food should be eaten in small, frequent meals. This helps to maintain nutrition.


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

  • Gatorade 1/2 cup
  • ginger ale 1/2 cup
  • bouillon 3/4 cup
  • saltine crackers 6
  • Gatorade 1/2 cup
  • Coke 1/2 cup
  • bouillon 3/4 cup
  • saltine crackers 6
  • Gatorade 1/2 cup
  • Sprite 1/2 cup
  • bouillon 3/4 cup
  • saltine crackers 6


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

  • skim milk 1/2 cup
  • poached egg 1
  • white toast slice
  • apple juice 1/2 cup 
  • mozzarella cheese
    2 oz
  • saltine crackers 6
  • chicken noodle soup 3/4 cup
  • Gatorade 1/2 cup
  • peanut butter 1 Tbsp
  • saltine crackers6
  • vanilla pudding
    1/2 cup
  • grape juice 1/2 cup 

Morning Snack

Afternoon Snack

Evening Snack

  • ginger ale 1/2 cup
  • canned pears 1/2 cup 
  • skim milk 1/2 cup
  • cornflakes1/2 cup
  • sugar 2 tsp 
  • frozen yogurt 1/2 cup
  • saltine crackers 6  


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

  • skim milk 1/2 cup
  • cream of wheat
    1/2 cup
  • sugar 2 tsp
  • orange juice 1/2 cup
  • white toast 1 slice
  • margarine 1 tsp
  • jelly 1 Tbsp  
  • tuna fish 2 oz
  • low-fat mayonnaise 2 Tbsp
  • white bread 2 slices
  • canned peaches 1/2 cup
  • Gatorade 1.2 cup
  • baked chicken 2 oz
  • white rice 1/2 cup
  • cooked beets 1/2 cup
  • dinner roll 1
  • skim milk 1/2 cup
  • margarine 2 tsp 

Morning Snack

Afternoon Snack

Evening Snack

  • low-fat yogurt
    1/2 cup
  • Sprite 1/2 cup  
  • chocolate pudding
    1/2 cup
  • gingerale 1/2 cup 
  • ice milk 1/2 cup
  • pretzels 2  


This Sample Diet Provides the Following

Calories

1822

Fat

42 gm

Protein

75 gm

Sodium

2234 mg

Carbohydrates

286 gm

Potassium

2467 mg

GERD-Reflux

Purpose

Fruit 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:

  1. Stop using tobacco in all forms. Nicotine weakens the lower esophageal muscle.
  2. Avoid chewing gum and hard candy. They increase the amount of swallowed air which, in turn, leads to belching and reflux.
  3. Do not lie down immediately after eating. Avoid late evening snacks.
  4. Avoid tight clothing and bending over after eating.
  5. Eat small, frequent portions of food and snack if needed.
  6. Lose weight if overweight. Obesity leads to increased reflux.
  7. Elevate the head of the bed six to eight inches to prevent reflux when sleeping. Extra pillows, by themselves, are not very helpful.
  8. The following foods aggravate acid reflux, and should be avoided:
    • fatty or fried foods
    • peppermint and spearmint
    • whole milk
    • oils
    • chocolate
    • creamed foods or soups
    • most fast foods
  9. The following foods irritate an inflamed lower esophagus and may need to be limited or avoided:
    • citrus fruits and juices (grapefruit, orange, pineapple, tomato)
    • coffee (regular and decaffeinated)
    • caffeinated soft drinks
    • tea
    • other caffeinated beverages
  10. Spicy or acidic foods may not be tolerated by some individuals.


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

Gluten-Free

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
Skim milk - 1 cup
Banana - 1 medium
Orange juice - 1/2 cup
Sugar - 1 tsp

Baked chicken - 3 oz
Rice - 1/2 cup
Green beans - 1/2 cup
Apple juice - 1/2 cup
Ice cream - 1/2
* Ice cream should be made
without wheat stabilizers.

Sirloin steak - 3 oz
Baked potato - 1 medium
Peas - 1/2 cup
Fruit gelatin - 1/2 cup
Butter - 1 Tbsp
Tea - 1 cup
Sugar - 1 tsp


The above sample diet provides the following: 1748 calories; 77 gm protein; 225 gm carbohydrates; 62 gm fat; 1577 gm sodium; 2934 potassium

High/Low Iron

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
  1. Heme and nonhemd iron are two forms of iron in foods. Heme iron is found in meats, poultry, and fish. NonHeme iron is found in both plant and animal foods.
    Heme iron is more easily absorbed by the body than nonheme iron. However, heme iron can also promote the absorption of non-heme iron. Therefore, eating beef and beans, for example, is good for providing adequate absorption of both types of iron.
  2. Vitamin C also promotes iron absorption. This is true for both heme and nonheme iron. It is, therefore, beneficial to consume citrus fruits or juices, which are high in vitamin C, with foods that contain iron. For example, a meal might include a lean sirloin steak (heme iron source), baked potato (nonheme iron source , broccoli (nonheme iroj source), and an orange (vitamin C source) for a good iron intake.
  3. Phytic and tannic aids are two food components that, when consumed in large amounts, prevent the abrorption of iron. Phytic acid is found in rye bread and other foods made from whole grains. Phytic acid is also found in nonherbal teas. Tannic acid is found in commercial black and pekoe teas, coffee, cola drinks, chocolate, and red wines.
  4. Iron SupplementsThere are many different kinds of iron supplements. However, iron supplemants should only be taken when there is a true deficiency of iron and only under medical supervision.
    General multivitamins often have iron and other minerals added to them in moderate amounts. If otherwise healthy, this amount of iron is probably not harmful. If iron is to be avoided, multivitamins containing iron should not be used.
    Please note that it is important to keep iron and multivita-in supplements safely away from a child's reach. If ingested, severe poisoning can occur.

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

Lactose-Free

Purpose

Fruit 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.
  • Low-lactose diet: generally eliminates only milk and milk products. However, some can tolerate milk in small amounts (2 oz) throughout the day or as part of a meal. Some can tolerate small amounts of yogurt. These patients can experiment to find a level of lactose they can tolerate. Some people can build up their level of tolerance by gradually introducing the lactose-containing foods.
  • Lactose-free diet: all lactose producst must be eliminated, including foods that are prepared with milk, both at home and in commercially packaged foods. These people may be able to use 100% lactose free milk or soy milk. Labels should always be read carefully
Lactase Digestive Aids and Products: Many people can drink milk in which the lactase has been partially or completely broken down. The following products may be available at a pharmacy or grocery store.

LACTAID and Dairy Ease enzyme products - check with a pharmacist, registered dietitian, or a physician for individual guidance on the use of these products.
  • Drops: These are added to milk. Five, 10, or 15 drops per quart of milk will generally reduces lactose content by 70%, 90%, or 99% respectively over a 24-hour period
  • Caplets/Capsules: A person chews or swallows 1 to 6 of these when starting to eat foods containing lactose
LACTAID Milk
  • Non-fat or 1% low-fat is 70% lactose reduced
  • Non-fat calcium-fortified is 70% lactose reduced and 500 mg of calcium per cup has been added
  • Non-fat LACTAID 100 is completely lactose free
DAIRY Ease Milk
  • Available in non-fat, 1%, or 2% low-fat - all are 70% lactose reduced
SOY Milk
  • Calcium-fortified soy milk has no lactose, is low in fat and is a good source of Vitamin D.
For more information about these products, call the consumer information number listed on the food label. The physician, pharmacist, or registered dietitian may also have information about these products or any newer products now available


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
  • orange juice, calcium fortified 1/2 cup
  • oatmeal 1 cup
  • Italian bread 2 slices
  • jelly 2 tsp
  • margarine 2 tsp
  • coffee 1 cup
  • sugar 1 tsp
  • nondairy creamer
  • turkey 2 oz
  • Italian bread 2 slices
  • mayonnaise 1/2 Tbsp
  • tossed green salad
    1 cup
    oil & vinegar 2 tsp
    tomato 2 slices
    carrot 1
    celery 1 stalk
  • banana 1
  • lactose-free milk
    1 cup
  • consommé 3/4 cup
  • strained fruit juice 1 cup
  • fruit ice 1/2 cup
  • gelatin 1/2 cup
  • hot tea with sugar & lemon


This Sample Diet Provides the Following

Calories

1800

Fat

48 gm

Protein

93 gm

Sodium

1700 mg

Carbohydrates

261 gm

Potassium

3533 mg

Low Fat

Purpose

Fruit 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
  1. Be careful how foods are prepared. Trim all visible fat from meats. Bake, steam, or broil meats and fish instead of frying. Toppings for potatoes and pastas should contain no fat above the three allowed daily servings.
  2. This low-fat diet should be used until the underlying medical condition is controlled or corrected. The physician will give any individual instructions, and tell you when you no longer need to use the low-fat diet.


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

  • grapefruit 1/2
  • dry cereal 3/4 cup
  • banana 1/2
  • whole wheat toast 2 slices
  • margarine 2 tsp
  • jelly or jam 1 Tbsp
  • skim milk 1 cup
  • coffee 3/4 cup
  • fat free vegetable soup 1 cup
  • lean hamburger 2 oz
  • mozzarella cheese made with skim milk 1 oz
  • hamburger bun
  • sliced tomato
  • lettuce
  • fresh fruit salad 1/2 cup
  • angel food cake 1 slice
  • skim milk 1 cup
  • coffee 3/4 cup
  • tomato juice 1/2 cup
  • broiled chicken breast without skin 3 oz
  • herbed rice 1/2 cup
  • broccoli 1/2 cup with low fat cheese sauce 1/4 cup
  • hard dinner roll
  • margarine 1 tsp
  • carrot/raisin salad 1/2 cup
  • low fat frozen strawberry yogurt 1/2 cup
  • skim milk 1 cup


This Sample Diet Provides the Following

Calories

2060

Fat

50 gm

Protein

110 gm

Sodium

4000 mg

Carbohydrates

299 gm

Potassium

4245 mg

Low Protein

Purpose

bread, fruit 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
  1. Protein is never completely eliminated from the diet. The physician and dietitian can determine how much protein the body is able to handle. However, since the amount of protein is limited, it is important to eat foods that contain high quality protein (meat, milk, fish, poultry, eggs, and peanut butter). These proteins are complete. They contain all the essential amino acids (building blocks of protein). Even though the protein in vegetables and starches is incomplete, it is still important to include these foods in a daily meal plan for a well-balanced diet.
  2. Salt and Sodium: Many people with serious kidney or liver disease may also need to limit salt or sodium intake because of high blood pressure or fluid retention. The greatest source of sodium in the diet is table salt. Therefore, the first step in reducing sodium intake is to limit the use of table salt. Certain other foods have a high sodium content and will also need to be limited.


Fats
One serving contains: virtually no protein, 55 mg sodium

One serving equals:

 

regular butter or margarine

1 tsp

mayonnaise

1 tsp

vegetable oil

1 tsp

gravy

1 Tbsp

reduced calorie margarine

1 Tbsp

reduced calorie mayonnaise

1 Tbsp

salad dressing (oil type)

2 Tbsp

low calorie salad dressing (oil type)

2 Tbsp

low calorie salad dressing (mayonnaise type)

2 Tbsp

tartar sauce

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 contains virtually no protein or sodium

One serving equals:

fresh, frozen, or canned fruit or fruit juice

1/2 cup

dried fruit

1/4 cup


Meat and Meat Substitutes
One serving contains 7 gm protein, 25 mg sodium.

One serving equals:

 

lean beef

1 oz

chicken

1 oz

fish

1 oz

lamb

1 oz

fresh pork

1 oz

low-sodium tuna

1/4 cup

turkey

1 oz

veal

1 oz

egg

1

peanut butter*

2 Tbsp

kidney beans

1/4 cup dry

soybeans

1/2 cup

garbanzo beans*

1/2 cup

lentils

1/2 cup

low-sodium cheese*

1 oz

Avoid the following if you are also reducing sodium intake:

  • bacon
  • cold cuts (bologna, salami, loaf-type luncheon meats, or processed meats)
  • corned beef
  • ham
  • sausage
  • low-salt ham or cold cuts
  • hot dogs, chicken dogs
  • turkey ham, turkey bologna
  • regular canned tuna
  • regular TV dinners (special low-sodium dinners may be acceptable -- check protein content)
  • cottage cheese
  • processed cheeses such as American, Velveeta, cheese spreads
  • canned kidney beans
*higher in sodium

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:
  • instant hot cereals
  • cornflakes, Rice Krispies, Total, Wheaties
  • salted snack crackers, pretzels, potato chips
  • packaged noodles, pasta, rice, or potato mixes
  • stuffing mixes
  • pancake mixes
  • baking mixes
  • croissants, rolls, biscuits made from commercially packaged refrigerator dough
  • waffles
Special low-protein pasta, bread, crackers, cookies, and baking mixes are available. A dietitian can discuss these with you.

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:
  • canned vegetables
  • sauerkraut
  • pickles
  • canned tomato juice or vegetable juice
  • canned or bottled tomato sauce or spaghetti sauce

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
fresh or dried herbs
flavored powders (garlic, onion, etc.)
lemon juice
vinegar
Avoid:
bacon bits
barbecue sauce
chili sauce
cooking wine
ketchup
meat tenderizers
monosodium glutamate
prepared mustard
regular salad dressings
seasoned salt (e.g., celery salt, garlic salt, onion salt)
sea salt
soy sauce
steak sauce
tartar sauce

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.
  • SUPLENA
The following low-protein products can be ordered by calling Dietary Specialities at (888) 640-2800. or email: info@dietspec.com
  • Low-Protein Bread
  • Low-Protein Crackers & Rusks
  • Low-Protein Cookies
  • Low-Protein Pasta
  • Low-Protein Baking Mix
  • Low-Protein Wheat Starch
  • Low-Protein Gelatin
  • Low-Protein Cracker Toast
  • Low-Protein Cheese Sauce Mix

Sample Menu Low Protein
Breakfast
Lunch
Dinner
  • Cheerios cereal
    3/4 cup
  • non-dairy creamer 1/2 cup
  • orange juice 1/2 cup
  • banana 1/2 med
  • white bread 2 slices
  • turkey breast 1 oz
    lettuce
  • tomato 1/2 cup
  • green beans 1/2 cup
  • mayonnaise 3 tsp
  • apple 1 med
  • fruit punch 4 oz
  • lean hamburger 2 oz
  • white rice 1/2 cup
  • broccoli 1/4 cup
  • cauliflower 1/4 cup
  • tossed salad
    ranch dressing 2 Tbsp
  • pineapple 1/2 cup
Snack
Snack
Snack
cherry fruit roll up 1 popsicle 1 gum drops 1 oz

This Sample Diet Provides the Following
Calories
1476
Fat
48 gm
Protein
39 gm
Sodium
1270 mg
Carbohydrates
237 gm
Potassium
2282 mg
No Gastric Irritants/Ulcers/Dyspepsia

Purpose

fish, bread 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
  1. Items most frequently associated with gastric discomfort include the following: black pepper, red or hot pepper, chili powder, caffeine, regular and decaffeinated coffee or tea, alcohol, cocoa, chocolate, cola beverages, citrus fruits and juices, fatty and fried foods, tomato products, and peppermint. These should be eliminated from the diet unless specifically allowed by the physician and/or dietitian. Additional adjustments may be made according to individual tolerances.
  2. Chew food thoroughly.
  3. Eat in a leisurely manner in a calm, relaxed atmosphere. Chew and swallow food slowly.
  4. Reduce or stop cigarette smoking. Smoking delays ulcer healing.
  5. Do not eat within two hours of bedtime.
  6. Omit any particular food that causes discomfort.
  7. If there is an ulcer, do not use aspirin, aspirin-containing combination medicines, or certain arthritis medications (non-steroidal anti-inflammatory drugs or NSAIDS). ibuprofen (Motrin), Advil, and Aleve are NSAIDS. These can cause ulcers and delay or prevent ulcer healing.
  8. Use antacids as needed. Keep in mind that magnesium-containing antacids can cause diarrhea.


Sample Menu
Breakfast Lunch Dinner
  • apple juice 1/2 cup
  • oatmeal 1/2 cup
  • toast 1 slice
  • skim milk 1 cup
  • margarine 1 tsp
  • sugar 1 tsp
  • jelly 1 tsp
  • salt 1/4 tsp
  • cream of potato soup 3/4 cup
  • broiled chicken patty 3 oz
  • bun
  • tossed salad
  • low-fat dressing
  • mustard 1 tsp
  • peaches 1/2 cup
  • skim milk 1 cup
  • salt 1/4 tsp
  • apricot nectar 1/2 cup
  • baked fish 3 oz
  • mashed potatoes
  • 1/2 cup
  • green beans 1/2 cup
  • bread 1 slice
  • vanilla pudding
  • 1/2 cup
  • margarine 1 tsp
  • salt 1/4 tsp


This Sample Diet Provides the Following
Calories 1934 Fat 70 gm
Protein 84 gm Sodium 3762 mg
Carbohydrates 249 gm Potassium 2968 mg
Ostomy/Pouch

Purpose

Yogurt crackers 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
  1. Because each patient and type of surgery are different, no standard recommendations can be given for everyone. Most patients return to a fairly normal diet. Still, a trial and error pattern of eating is often necessary to identify those foods that may have an undesirable effect on the patient's stool. Then it is simply a matter of changing how much of these foods are eaten. The lists that follow are a guideline.
  2. Eat foods at a regular time each day. Eating 4 to 6 smaller meals may help to promote a regular bowel pattern.
  3. Try eating the main dinner meal at noon and a smaller meal in the evening. This helps to reduce the stool output at night.
  4. Introduce one type of food at a time to test how it affects bowel function. If it does not produce a good result, stop eating it. However, as the body heals and adjusts, the offending food may become easier to tolerate, so try adding it to the diet again on several occasions before giving up on it.
  5. Chew foods completely to help the digestive process. Especially avoid swallowing large pieces of leafy vegetables since they can block the stoma opening on the abdominal wall.
  6. Fresh fruit may cause loose stool.
  7. Drink 2 to 3 quarts of water a day. This helps to keep the stool fluid, and it also prevents dehydration. Normally, the colon absorbs water and electrolytes (substances such as sodium and potassium) from the stool, so people who have all or part of the colon removed will lose more water. Because electrolytes are also lost, do not restrict salt in the diet.
  8. Maintain an ideal body weight. Extra fat in the abdominal wall can make it difficult for the stoma to function properly.
  9. Colostomy patients may find that foods which caused problems before surgery continue to do so afterward.
  10. During the first 4 to 6 weeks after surgery, ileostomy patients should limit foods that caused problems prior to surgery. This will reduce the chance of stoma blockage and lower the amount of gas.
  11. Certain substances can change the appearance of the stool. Bile that cannot be reabsorbed in the intestine can cause a yellow or green stool color, especially when diarrhea or rapid bowel action occurs. Beets make the stool appear red; it is not blood! Broccoli, asparagus, spinach, and Pepto-Bismol can darken, even blacken, the stool.
  12. Certain medications such as Imodium, Lomotil, Levsin, and Bentyl can help to slow the bowel when diarrhea is a problem.
  13. Foods containing large amounts of fiber and bran should be avoided for 6 to 8 weeks after surgery. After that time, certain bulking agents such as psyllium (Metamucil), methylcellulose (Citrucel), and calcium polycarbophil (FiberCon) may help firm the stool. Only certain patients need to have a firmer stool, so do not use these agents without the physician's instructions.


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
  • Jittery or stressed personality and excessive saliva swallowing
  • Poorly fitting dentures, smoking pipes or cigarettes, chewing gum or tobacco can cause increased salivation and swallowing
  • Eating fast and swallowing large chunks of food or large amounts of beverages
  • Using straws or drinking from a bottle or can
  • Inactivity and lying down after eating
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
  • canned peaches
    1/2 cup
  • skim milk 1/2 cup
  • white toast 1 slice
  • margarine 1 tsp
  • decaffeinated tea
    1 cup
  • lemon juice 1 tsp
  • sugar 2 tsp
  • baked chicken breast 3 oz
  • steamed white rice
    1/2 cup
  • cooked carrots
    1/2 cup
  • low-fat vanilla yogurt 1/2 cup
  • margarine 1 tsp
  • decaffeinated coffee
    1 cup
  • skim milk 1/2 cup
  • sugar 1 tsp
  • salt 1/8 tsp
  • chicken noodle soup 1/2 cup
  • saltines 2
  • sandwich 1/2
    white bread 1 slice
    creamy peanut butter 1 Tbsp
    jelly 1 Tbsp
  • applesauce 1/2 cup
  • decaffeinated tea
    1 cup
  • lemon juice 1/2 cup


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

Asian

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.

The traditional Asian diet receives a lot of attention because many of the chronic diseases, such as heart disease, diabetes, and certain cancers, are not as common in Asia as in the United States and other western nations. Researchers believe that the Asian plant-based diet provides protection against many chronic diseases. The diet is also believed to contribute to the long life spans commonly seen in Asia.

The following is a description of the traditional Asian diet as believed to be related to disease prevention and increased longevity. The dietary principles described here are based on the historical diets of rural Japan, China, and other Asian nations. Today, many fast-food restaurants and western-style eating patterns have become more common in Asia. With these recent dietary changes, heart disease, obesity, and cancer rates have also been on the rise.


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 is relatively low in meat and dairy foods. Protein and iron are obtained from nuts, seeds, and legumes. Iron is also provided through certain vegetables, such as dark leafy greens. Calcium is obtained from soy products, nuts, seeds, and green leafy vegetables.

The dietary principles of the Asian diet are meant to be for the average healthy adult. Individuals with special nutritional needs, such as children, pregnant women, or those with certain medical conditions, should consult a physician or registered dietitian to determine their appropriate dietary requirements.


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

  • Grains and Breads: Of the foods consumed on a daily basis, rice, rice products, noodles, breads, millet, corn, and other grains are consumed in the greatest amount. Potatoes and cereals are included in this food group.
  • Vegetables: Fresh vegetables are also consumed in large quantities in the traditional Asian diet. Cabbage, bok choy, scallions, dark leafy vegetables, and bean sprouts are just a few of the many different kinds of vegetables used.
  • Fruit: Fruit is another food that is enjoyed on a daily basis, with as much variety as possible. Bananas, mangos, tangerines, watermelon, grapes, and pineapple are examples of the many fruits used for desserts as well as in main courses.
  • Nuts and Legumes: Nuts and legumes are the main sources of protein in the traditional Asian diet. They are also good sources of fiber, vitamins, and minerals. Soybean is a commonly used legume in the Asian diet. It can be found in many different forms, such as tofu and soy milk. Nuts, seeds, and tofu are often used in soups, salads, noodle dishes, and main courses.
  • Vegetable Oils: Vegetable oils, which are high in unsaturated fats, are used mainly in cooking. This is one of the main differences between the historical Western style diet which uses butter, margarine and other saturated fats in cooking. Medical studies have indicated that a diet high in saturated fats may play a role in some chronic disorders, such as heart disease. Replacing saturated with unsaturated fats, particularly monounsaturated fats which are found in canola and olive oil, has been shown to decrease the risk of heart disease.

The Asian Diet


  • For the average healthy adult.
  • Not for children, pregnant women, or those with special nutritional needs.
  • Please consult a registered dietitian or physician for further guidelines.


Optional Daily Foods

  • Dairy products: Dairy foods, such as milk and cheese, are not commonly consumed in most traditional Asian diets. If used on a daily basis, choose low or nonfat products in moderate amounts.
  • Fish and Shellfish: Fish and shellfish are also considered to be an optional daily food. This is because many Asian people, such as those living in the interior regions of China, did not have access to large amounts of fish. Medical studies have found a relationship between eating fish and prevention of chronic diseases such as heart disease.

Foods Eaten a Few Times a Week

  • Sweets: Sweet desserts, that are high in fat and sugar, are consumed in moderation and on a weekly basis only. Try fresh fruit as a healthy and delicious dessert.
  • Eggs and Poultry: Eggs, chicken, or turkey are also consumed only a few times a week.

Foods Eaten a Few Times a Month

  • Red Meat: Meat is eaten monthly, or more frequently if consumed in smaller servings.
Calcium and Osteoporosis

The lack of dairy foods raises concern about calcium intake and osteoporosis. Even though Asians historically have had low rates of osteoporosis, there may be other factors involved. For example, many rural Asians traditionally spend much of their day performing vigorous activity. Regular exercise, especially weight bearing exercises, has been shown to reduce the risk of bone loss. Therefore, a diet with sufficient calcium, along with regular exercise, is suggested for decreasing the risk of osteoporosis.

Although calcium can be obtained from plant foods, it is most readily available from dairy products. As a result, low-fat or nonfat milk or milk products are recommended as important sources of calcium in the American or Western diet. Please consult a registered dietitian for further guidelines.M



 
Special Consideration

  1. Physical Activity -- Many Asians bike or walk for transportation. It is recommended that some form of regular exercise be adopted for health. Regular physical activity has been shown to help control weight, reduce stress, and prevent many chronic diseases.
  2. Tea -- Green and black tea is consumed widely in Asia. Some medical research suggests that the various beneficial antioxidants found in these teas may provide a protective effect against some chronic diseases, such as throat, stomach, lung, and breast cancer.
  3. Sodium -- Historically, Asian diets have been high in sodium, partly due to the use of soy sauce. Today, many Asians are lowering their salt consumption by switching to reduced-sodium soy sauces. They are also increasing their use of many herbs and spices for seasonings. For example, ginger, basil, lemon grass, garlic, fennel, clove, cinnamon, and fresh and dried chiles are just a few of the herbs and spices being utilized as flavor enhancers.
  4. Wine, Beer, and other Alcoholic Beverages -- Alcoholic beverages are considered optional in Asian-style diets. They should be consumed only in moderation. Many health and social factors should also be taken into consideration before determining whether alcohol should be used. For example, alcoholic beverages should be avoided during pregnancy or before operating a motor vehicle.
 
Sample Menu
Breakfast
Lunch
Dinner
  • miso soup - 1 cup
  • white rice - 1 cup
  • poached egg -1
  • orange - 1 med
  • white bread - 2 slices
  • turkey - 3 oz
  • lettuce leaf and shredded cabbage
  • tossed salad - 1 cup
  • oriental salad
  • dressing - 2 tsp
  • miso soup with tofu - 6 oz and dry seaweed - 1 tsp
  • tossed salad - 1 cup
  • oriental salad dressing 2 tsp
  • broiled fish - 6 oz
  • white rice - 1 cup
  • steamed broccoli - 1 cup with soy sauce - 1 Tbsp and mayonnaise - 1 Tbsp
 
Afternoon Snack
 
 
  • pear - 1 med
 
 
This Sample Diet Provides the Following
Calories 1796 Fat 50gm.
Protein 120gm Sodium 3772mg
Carbohydrates 214gm Calcium 657mg
High Blood Presure

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:



  • "low sodium" means the food has 140 milligrams or less of sodium per serving
  • "very low sodium" means the food has 35 milligrams or less of sodium per serving
  • "salt-free" means the food has 5 milligrams or less of sodium per serving
  • "light in sodium" means the food has at least 50% less sodium than the original version of the food
  • "reduced sodium" means the food has at least 25% less sodium than the original version of the product

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.

Limit consumption of high-sodium processed foods. These include cured and smoked meats, and some pre-packaged, frozen and canned foods, most soups, and condiments.

Remove the salt shaker from the table and make meals tasty and flavorful with herbs and spices. While cooking, experiment with fresh and dried herbs, such as onions, garlic, basil, oregano, parsley, thyme, rosemary, black and red pepper, and onion and garlic powders. These all add flavor without adding sodium.

Beware of salt substitutes. Not all salt substitutes are sodium-free. Some contain sodium, but in a lesser amount than regular table salt. Read the labels, and if you take medication for your blood pressure, consult your doctor before using a salt substitute.

Maintain a healthy body weight and exercise regularly. Maintaining a healthy body weight and exercising are both very important in controlling blood pressure. If you are overweight, just a modest weight loss can significantly improve high blood pressure. Regular exercise (with a physician's approval) is important in helping you lose weight and maintain weight loss. This helps keep blood pressure down.

Limit consumption of alcohol. In many people, drinking excessive alcohol raises blood pressure. It is recommended that people with high blood pressure limit alcohol consumption to no more than one ounce per day. That's about the amount in two ounces of 100-proof whiskey, one eight-ounce glass of wine, or two 12-ounce cans of beer.

Eat adequate amounts of potassium-rich foods. Potassium, another mineral essential to good health, works in concert with sodium to regulate blood pressure. Studies have shown that people who consume more potassium have lower blood pressures than those who consume less. Rich sources of potassium include many fruits, such as cantaloupe, bananas, watermelon, oranges and orange juice, as well as potatoes, spinach, and zucchini. (Important note: if taking medication for high blood pressure, such as diuretics, consult a doctor before using salt substitutes that contain high amounts of potassium.


Sample Menu
Breakfast
Lunch
Dinner
  • orange juice - 1/2 cup
  • oatmeal - 1 cup
  • skim milk -1 cup
  • whole-wheat toast - 2 slices
  • low sodium margarine - 1 tsp
  • sugar - 1 tsp
  • banana - 1 med
  • spaghetti with low sodium marinara sauce - 1 1/2 cups
  • green salad - 1 cup
  • low sodium dressing - 2 Tbsp
  • Italian bread - 1 slice
  • low sodium margarine - 1 tsp
  • apple - 1 med
  • grape juice - 1 cup
  • grilled chicken breast- 3 oz
  • grilled zucchini - 1/2 cup
  • pasta salad made with low sodium dressing 1/2 cup
  • whole wheat roll - 1
  • low sodium margarine - 1 tsp
  • peach cobbler - 1/2 cup
  • skim milk - 1/2 cup
  • cranberry juice - 1/2 cup

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



Hypoglycemia

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.

Hypoglycemia can occur from certain illnesses, such as liver disease and some types of tumors. These conditions cause a type of hypoglycemia called organic hypoglycemia. They usually require specific medical treatment or surgery. There is another type of hypoglycemia. In some people, the body simply responds differently to the digestion of foods. Some foods are digested and absorbed rapidly, resulting in a burst of glucose entering the bloodstream. In most people the body adjusts smoothly. It would be like two children trying to balance a see-saw. There may be a slight teetering or swinging up and down as the children shift their weight to achieve the balance. In some people, however, the response is like an actively rocking see-saw swinging up and down. The body over-reacts and sets the process in motion to reduce blood glucose. The result is a glucose level that is too low. Then the body releases adrenaline, increasing glucose in the bloodstream. This is called Reactive Hypoglycemia -- the body is simply over-reacting. It is not easy to diagnose. However, it usually occurs consistently from one to three hours after a meal and returns to normal on its own. When no known medical causes are found, the diagnosis of reactive hypoglycemia is made. The best way to manage reactive hypoglycemia is have glucose enter the bloodstream at a steady, even pace. This can be done with changes in eating habits.


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.


Special Considerations
  1. Simple carbohydrates and concentrated sweets: All carbohydrates can be broken down into glucose in the body. Some carbohydrates have a simple structure that easily breaks down into glucose. These are simple carbohydrates, commonly known as sugars. Table sugar, corn syrup, and honey are simple carbohydrates. Simple carbohydrates also occur naturally in fruits, milk, and other foods. They are digested rapidly, and this allows glucose to be absorbed into the bloodstream quickly. Therefore, meals that are high in simple carbohydrates can contribute to reactive hypoglycemia. Concentrated sweets such as candy, table sugar, soft drinks, cookies, cakes, and ice cream are mainly simple carbohydrates. Avoid these foods unless they are made with sugar substitutes. Read package labels to avoid foods containing sugars. Look for terms such as sugar, corn syrup, corn sweetener, or high fructose corn syrup.
  2. Complex carbohydrates and proteins are important in the diet. They are a basic source of energy. Complex carbohydrates are0many molecules of simple sugars linked together like beads on a string. They take longer to break down in the intestine, and this helps to keep blood glucose levels more consistent. Pasta, grains, and potatoes are complex carbohydrates. Proteins are made of amino acids that the body needs for growth and good health. Foods from animal sources contain protein, but so do legumes, nuts and seeds. Most food protein can be converted into glucose by the body, but since this process takes some time, the glucose gets into the bloodstream at a slower, more consistent pace.That is why people with reactive hypoglycemia should eat complex carbohydrates and protein for their energy needs, instead of simple carbohydrates.
  3. Choose high fiber foods. Fiber is the indigestible part of plants. Insoluble fiber, such as wheat bran, does not dissolve in water. It adds bulk to the stool and causes it to pass through the intestine more quickly. Soluble fiber does dissolve in water, forming a sticky gel. It is found in the fibrous coatings of foods such as legumes, oav products, and pectyn found in fruit. Soluble fiber delays stomach emptying, digestion, and absorption of glucose. Therefore, it helps to prevent hypoglycemia symptoms between meals. When making fruit choices, choose whole fresh fruits or those canned without added sugar instead of fruit juice. The added fiber helps to slow down the absorption of sugar.
  4. Size and frequency of meals is very important for managing hypoglycemia. The body really can't tell the difference between the glucose in a candy bar and the glucose in a whole grain roll. The object is to manage the diet so glucose is released into the bloodstream slowly and evenly. Many people skip meals, and this is certainly not good for people with reactive hypoglycemia. Start out with three well-balanced meals. Include a small mid-morning, afternoon, and evening snack. If symptoms are not relieved, it may be necessary to divide the daily food intake into five or six smaller, well-balanced meals evenly spaced throughout the day. Include an evening snack. Choose more complex carbohydrates over concentrated sweets, and try to include some insoluble fiber and protein with each meal.
  5. Fats like those in whole milk, cheese, and meats should be limited. A low-fat diet has been shown to help in treating hypoglycemia. When selecting dairy products and meats for protein; choose lean meat, skim milk products, and eggs in moderation. Use oils sparingly.
  6. Sweeteners such as sorbitol, saccharin, and aspartame (Equal® and Nutrasweet®) do not contain sugar or calories and may be used in a hypoglycemia diet. If you have questions about them, consult your physician or a registered dietitian.
  7. Alcohol is high in calories and can cause hypoglycemia all by itself. Therefore, people with reactive hypoglycemia should avoid or limit alcohol.
  8. Caffeine should be avoided. Caffeine stimulates the production of adrenaline. So does reactive hypoglycemia. Therefore, caffeine in the diet can make symptoms worse because the production of adrenaline is increased.
  9. Body Weight: Excess weight has been shown to interfere with the body functions that regulate glucose. So if you are overweight, reducing to the proper body weight could help to control reactive hypoglycemia.

Sample Menu

Breakfast

Lunch

Dinner

  • orange juice 1/2 cup
  • cornflakes 3/4 cup
  • whole wheat toast
    1 slice
  • margarine 1 tsp
  • sugar-free jelly 1 tsp
  • skim milk 1 cup
  • coffee/creamer/sugar substitute
  • lean hamburger 2 o
    hamburger bun 1
    lettuce/tmmato slice
  • cooked carrot 1/2 cup
  • tossed salad/Italian dressing 1 Tbsp
  • fresh apple 1
  • sugar-free gelatin
  • skim milk 1 cup
  • baked chicken breast 2 oz
  • baked potato
    1/2 medium
  • green beans 1/2 cup
  • sliced Strawberries
    1/2 cup
  • dinner roll 1
  • diet margarine 1 tsp
  • diet soda

Snack

Snack

Snack

  • orange 1 med
  • skim milk 1 cup
  • Graham crackers 3
  • cranberry juice
    1/3 cup
  • peanut butter 1 Tbsp
  • saltine crackers 6
 
This Sample Diet Provides the Following

Calories

1760

Fat

50 gm

Protein

90 gm

Sodium

2000 mg

Carbohydrates

232 gm

Potassium

3300 mg



Food Groups

Group

Recommend

Avoid

Meat and Meat Alternatives

all lean meat and poultry, seafood, peanut butter, nuts and seeds, limit eggs to four per week including those used in cooking

fatty and heavily marbled meats, hot dogs, salt pork, cold cuts, sausage, bacon, fried meats, or those prepared with sweetened sauces

Breads, Grains, & Potatoes*

enriched or whole grain bread and rolls; English muffins; unsweetened cereals; potatoes; rice; pasta and noodles; crackers; pretzels; popcorn; plain cakes and cookies made with allowed oils, low fat milk, and sugar substitute

presweetened cereals; sweet rolls; pastries; donuts with sugar topping, glaze, and fillings; frosted cakes; pies; cookies

Milk and Milk products

skim milk, 1% fat milk, nonfat dry milk, evaporated skim milk, plain or artificially sweetened now-fat yogurt, buttermilk, cocoa with sugar substitute, puddings made with allowed milk and sugar substitute, low-fat skim milk cheeses

whole or 2% milk, cream, chocolate milk, ice cream and ice cream products, flavored or fruited yogurt, milkshakes, sundaes, malted milk, sweetened pudding and custard, cocoa mixes, processed cheeses, cheese spreads

Vegetables*

dark green or yellow vegetables (eaten daily), all otehr raw or cooked vegetables, legumes (beans, peas, and lentils)

any glazed or sweetened

Fruits*

citrus fruit (eaten daily), raw fruit or fruit canned in natural juice or water, dried fruit

any canned in heavy syrups, candied fruit

Beverages

decaffeinated coffee, tea, and herbal teas, water; diet decaffeinated sodas; unsweetened fruit juice

sweetened frumt juice, ades andpunches; alcohol; regular and caffeinated sodac

Fats and Oils

unsaturated vegetable oils such as corn, safflower, sesame, soybean, sunflower, peanut, canola, or olive oil; salad dressings and mayonnaise made with these oils

visible fat, poultry skin, fried foods, high-fat sauces and gravies, butter, shortening, hydrogenated oils, coconut oil

Miscellaneous

jelly, jam, or gelatin with sugar substitute or unsweetened; herbs; spices; seasonings; vinegar; lemon juice; broth; unsweetened pickles; sugar substitutes; homemade soups with low-fat broth

sugar, jam, jelly, honey, syrup, molasses, candy, sweetened gelatin, dietetic chocolate candy, sherbet, fruit ice, popsicles, creamed soups

* Complete Carbohydrates (Breads, grains, and potatoes are good sources, but some fruits and vegetables also contain them.)



Some Food Sources of Fiber

Insoluble Fiter

Soluble Fiber

Whole grains; including wheat, rye, brown rice, bran, and cereals 
Cabbage, Brussels sprouts, broccoli, and cauliflower 
Root vegetables 
Dried peas and beans 
Apples

Citrus 
Strawberries 
Oatmeal 
Strawberries 
Dried beans and other legumes 
Apples



What Counts As One Serving?

Group

Amount

Breads, cereal, rice and pasta

bread, 1 slice
cooked rice or pasta, 1/2 cup
cooked cereal, 1/2 cup
ready-to-eat cereal, 1 oz

Vegetables

chopped raw or cooked vegetables, 1/2 cup leafy raw vegedables, 1 cup

Fruits

fruit or melon wedge, 1 piece
juice, 3/4 cup
canned fruid, 1/2 cup
dried fruit, 1/4 cup

Milk, yogurt, and cheese

milk or yogurt, 1 cup
natural cheese, 1 1/2 oz
process cheese, 2 oz

Meat, poultry, fish, dry beans, eggs, and nuts

cooked lean meat, pmultry, or fish, 2 1/2 or 3 oz count 1/2 cup of cooked beans, or 1 egg, or 2 Tbsp of peanut butter as 1 oz of lean meat

Fats and sweets

LIMIT CALORIES FROM THESE especially if you need to lose weight

Increasing Calories

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.

To gain body weight the number of calories consumed in the diet must exceed the number of calories the body needs to maintain its current weight. Medical problems such as depression or eating disorders must be addressed and treatment underway before weight gain will occur.


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.

Where serious underweight is a problem, weight gain can be best achieved by concentrating on foods with either a higher calorie or fat content. Ounce for ounce, fat has more than twice the calories of either carbohydrate or protein. Preferably, fat sources should primarily be from plant sources such as vegetable oils, margarines not containing trans fatty acids, and nuts or seeds. After weight gain goals are achieved a healthy but lower fat diet is recommended. 

An increase of at least 500 to 1000 calories each day will promote a one to two pound weight gain per week. It takes an extra 3500 calories to gain one pound of body weight. The chart on page 3 provides suggestions for increasing calories by 500 to 1000 each day. The Nutrition Facts panel on the food label can also help with choosing nutritious foods to supply the extra calories needed for gaining weight.


Special Considerations
  1. A basic vitamin and mineral supplement, providing 100% of the RDA may be necessary depending on current nutritional status. Ask your physician about the need for supplements.
  2. Plan for regular eating times, including three meals and several snacks throughout the day. The need to eat even when experiencing a lack of hunger can be overcome with encouragement from others.
  3. Stimulate a poor appetite by socializing and eating with friends; or by enjoying favorite foods, enticing aromas like freshly baked bread, soft dinner music, flowers on the table and relaxed, pleasant mealtime conversation.
  4. Eating larger amounts of foods at mealtimes will increase the calorie content of the meal. If larger meals are not tolerated, try increasing txe serving sizes oradually or eating small amounts more often throughouv the day.
  5. For those who drink alcoholic beverages,"a drink before meals or wine with meals can increase the appetite. Remember(that alcohol does carry "empty" calories—calories with no nutritional value. However, it is not wise to start drinking alcohol simply for this benefit.
  6. To increase calories, select higher calorie nutrient dense foods and beverages. Beware of filling up on low-calorie or no-calorie foods and beverages. Instead of diet sodas, water, coffee or tea; drink fruit juices, milk and milk shakes. Dried frui|s and ca~ned fruits packed in heavy syrup will supply more calories than0fresh fruit and are no more filling. Dry milk powder can be added to soups, casseroles and mashed potatoes to increase the calories and nutrients, espegially protmin.
  7. A ganned liquid supplement such as Ensure or Sustacal preferably taken between meals is effective when there is a lack of interest in food and eating. Many stores carry their own effective brands at a lower cost, Liquid supplemgnts are a convenient way to consume extra calories.

Weight Gain Tips
  • Eat smaller, more frequent meals
  • Fill up on food, not low-calorie beverages
  • Make mealtime pleasant-- set an attractive tablm, play soothing music
  • Get regular exercise -- check with physician first
  • Get together with friends or neighbors to share cooking duties and delights
  • Take advantage of community programs to provide ready-made meals
  • Have nutritious snacks convenient
  • Use substitutes to increase calories, try adding dry milk to fluid milk, soups, or mashed potatoes
  • Plan mealtimes around energy levels -- eat a larger breakfast if you feel better in the morning
 
Suggestions for Increasing Calories
500 calorie snack

Food

Calories

Foods

Calories

1 bagel - 3 oz

240

1 cup ready-to-eat cereal

110

2 Tbsp peanut butter

172

1 cup low-fat 1% milk

100

1 cup 1% milk

100

1 cup canned pears

190

6 dried apricot halves

66

1 oz cheddar cheese

115

Total

578

Total

515

1000 calorie snack

Foods

Calories

Foods

Calories

5 oz can vanilla pudding

220

1/4 of a 14" cheese pizza

306

4 graham crackers

120

1 cup grape juice

155

1 small banana

81

1 cup soft serve ice milk

225

1 cup pineapple juice

140

10 vanilla wafers

185

1 cup tuna salad

375

1 oz roasted peanuts

165

1 slice wheat bread

65

Total

1036

Total

1001

   
Kidney Stone

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.


Special Considerations
  1. Increase fluid intake: This is the most important preventive measure for all patients who develop kidney stones. It hinders the formation of stones by diluting the urine. For example, more sugar can be dissolved in a full glass of iced tea than in a half glass. Patients should drink enough fluid to produce two quarts or more of urine each day. As a guideline, drink 8-10 oz of fluid every hour while awake, and 8-10 oz once during the night if awakened for some reason. At least 50% of the total fluid intake should be water. In warmer climates and for physically active people, an even higher fluid intake is recommended.
  2. Calcium: Calcium from food sources is absorbed during digestion in the intestines. The body uses this mineral for many important functions. Any excess that has been absorbed is excreted or passed through the kidneys. The biggest portion of calcium in the diet comes from milk and foods made from large amounts of milk, such as cheeses and yogurt. The calcium in these foods is usually easily absorbed. Other foods, such as dark green leafy vegetables, contain significant amounts of calcium. However, they also contain other substances which prevent the body from readily absorbing the calcium. So, the amount of available calcium in green leafy vegetables is less than in milk. Certain antacids and over-the-counter medications also contain calcium that may or may not be in a form the body can absorb

    Usually the body does not absorb more calcium than is needed. However, certain conditions can cause too much calcium to be absorbed, or too much to be passed into the kidneys. Too much calcium in the urine is medically known as hypercalciuria. Only in certain cases of hypercalciuria may calcium stones be prevented controlling the amount of calcium in the diet.
    Food Sources of Calcium
    Gruyere Cheese, 1 oz.
    Mozzarella Cheese, 1 oz
    Cheddar Cheese, 1 oz.
    Yogurt, 1/2 cup
    Macaroni & Cheese, 1/2 cup
    7² Homemade Waffle, 1
    Vanilla Ice Cream, 1 cup
    Ice Milk, 1 cup
    American Cheese, 1 oz
    Ricotta Cheese, 1/4 cup
    287
    207
    204
    200
    200
    179
    176
    176
    174
    167
    Instant Oatmeal, 3/4 cup
    2% Cottage Cheese, 1 cup
    Broccoli, 1 stalk
    Pizza, 1 slice
    Milk, 1/2 cup
    Buttermilk, 1/2 cup
    Baked Custard, 1/2 cup
    Pudding, 1/2 cup
    Blackstrap Molasses, 1 T
    Instant Nonfat Dry Milk, 2 T
    163
    155
    150
    150
    150
    150
    149
    146
    137
    105

    If the physician has recommended a calcium controlled diet, the idea is to keep calcium intake within a narrow range, not too much and not too little, because the body needs a certain amount for maintaining important functions. On this diet, men are advised to limit calcium intake to 800 mg per day. Prior to menopause, women should limit calcium to 1000 mg per day; and after menopause, these women should have 1200 mg of calcium a day.

    Patients on a calcium-controlled diet should consult the physician before taking any over-the-counter medication or vitamin supplement. For examples of foods containing calcium that is easily absorbed, see the table Food Sources of Calcium.
  3. Oxalic acid or oxalate is found mostly in foods from plants. Calcium combines with oxalate in the intestines. This reduces calcium's ability to be absorbed. Sometimes oxalate or calcium oxalate stones form because there is not enough calcium in the intestines. Then, too much oxalate goes to the kidneys to be excreted. The medical term for too much oxalate in the urine is hyperoxaluria. In certain cases of oxalate or calcium oxalate stones, the physician may recommend reducing oxalate intake along with a slight increase in calcium. It is recommended that these patients have no more than 50 mg of oxalate per day in the diet. To do this, foods with high or moderate amounts of oxalate should be reduced or eliminated from the diet. 

    Although there are many foods that contain large amounts of oxalate, eight foods have been shown to be most at fault for raising urine oxalate levels. They are rhubarb, spinach, strawberries, chocolate, wheat bran, nuts, beets, and tea. For more information about the oxalate content of foods, see the table, Foods High in Oxalate on page 6.
  4. Sugar, sodium, and animal protein: It has been found that too much of these may also aggravate the development of calcium or calcium oxalate stones. Some sugars occur naturally in foods and that is not a concern. However, people who get kidney stones may benefit from avoiding packaged foods with large amounts of added sugars, and from reducing sugars added in food preparation and at the table.

    Reducing sodium in the diet appears to reduce the amount of calcium excreted in the urine. Consequently, people who develop stones containing calcium may benefit from keeping sodium intake between 2300 to 3500 mg a day. 

    A diet high in animal protein affects certain minerals in the urine that may promote the formation of kidney stones. Therefore, people who tend to develop kidney stones should avoid eating more protein than the body needs each day. The physician or registered dietitian can recommend a daily protein intake for individual patients.
  5. Insoluble fiber: Fiber is the indigestible part of plants. There are two types of fiber: soluble (dissolves in water) and insoluble. Both provide important functions in the body, but it is insoluble fiber (found in wheat, rye, barley, and rice) that may help to reduce calcium in the urine. It combines with calcium in the intestines, so the calcium is excreted with the stool instead of through the kidneys. Insoluble fiber also speeds up movement of substances through the intestine, so there will be less time for calcium to be absorbed.
  6. Vitamin C: When vitamin C is used by the body, oxalate is produced. Therefore, if the physician has recommended reducing oxalate in the diet, taking vitamin C supplements may not be a good idea. It should be discussed with the physician.


Foods High in Oxalate
(More than 10 mg per 1/2 cup serving)
Beans
string, wax
Legume types (including baked beans 
canned in tomato sauce)
Beets
Blackberries
Carob powder
Celery
Chocolate/cocoa other chocolate drink mixes
Dark leafy greens
Spinach
Swiss chard
Beet greens
Endive, escarole
Parsley
Draft beer
Fruit cake
Eggplant
Gooseberries
Grits (white corn)
Instant coffee (more than 8 oz/d)
Leeks
Nuts, nut butter
Okra
Peel: lemon, lime, orange
Rasberries (black)
Red currants
Rhubarb
Soy products (tofu)
Spinach
Strawberries
Summer squash
Sweet potatoes
Tea
Wheat bran
Wheat germ


Sample Menu For Kidney Stones
Calcium or Calcium Oxalate Stones
Breakfast Lunch Dinner
Grapefruit juice 1 cup
cereal 3/4 cup
skim milk 1 cup
scrambled eggs 1
white toast 2 slices
margarine 2 tsp
coffee 1 cup
water 1 cup
white meat chicken 2 oz
wheat bread 2 slices
oceberg lettuce 1 cup
oil/vinegar dressing 1 Tbsp
canta loupe 1 cup
lemonade 1 cup
sugar cookie 1
water 1 cup
baked haddock 3 oz
white rice 1/2 cup
peas 1/2 cup
margarine 2 tsp
dinner roll 1
apple 1
animal crackers 16
water 1 cup


This Sample Diet Provides the Following
Calories 1805 Fat 51 gm
Protein 81 gm Sodium 1821 mg
Carbohydrates 261 gm Potassium 692 gm
Low Cholesterol

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 and Fast Foods

    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.
ŸŸŸŸ
    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.

 

 

Mediterranean

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.


Some Food Sources of Fiber

Insoluble Fiber

Soluble Fiber

Whole grains; including wheat, rye, brown rice, bran, and cereals

Citrus fruits

Cabbage, Brussels sprouts, broccoli, and cauliflower

Strawberries

Root vegetables

Oatmeal

Dried peas and beans

Dried beans and other legumes

Apples

Apples



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. 

It is also very important to maintain variety and minimal processing of foods. Every meal should include choices from each daily food group. For example, a good breakfast is not just oatmeal or a piece of whole wheat toast. It should also include fruit, and perhaps nuts or low-fat yogurt. A lunch or main meal in North Africa might include a combination of couscous, vegetables, and legumes. In Italy, it might be pasta or polenta with vegetables and legumes. Nuts and seeds are often included in recipes, and dessert is usually fresh fruit. Choose seasonally fresh and locally grown fruits and vegetables when possible, and use whole grain foods. Processing of foods can remove important nutrients. For example, when grains are refined, fiber is lost.

    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. 

    Choose a wide variety of vegetables to get a balance of the nutrients they provide. Select dark green leafy vegetables over light green. Romaine lettuce, for example, has about six times as much vitamin C and eight times as much beta carotene as iceberg lettuce. Eat vegetables raw when possible, however cooked vegetables can also be nutritious. Do not over-cook. Sometimes the method of preparation helps to preserve or enhance nutrients. For example, vitamin C-rich vegetables lose half of the vitamin when boiled, but only 15% when microwaved.

    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. 

    It is recommended that a healthy diet have only 30% of the total daily calories in fat, and saturated fat should be only 1/3 of that amount. Prior to the 1960s, the Mediterranean diets averaged about 30% to 35% fat and the principal fat used was olive oil. Their rates of heart disease were as much as 90% lower than those in the U.S. So, it seems reasonable that olive oil may be a healthier fat choice in the diet. However, do not add olive oil to other sources of fat; instead use it to replace them.

    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

  1. Physical Activity: Extensive research shows that regular physical activity helps to control weight and provides other health benefits. Walking and bicycling, for example, are typical methods of getting from place to place in many parts of the Mediterranean, and some form of regular physical activity or exercise is an important part of the Mediterranean diet.
  2. Diet related lifestyle habits in the Mediterranean may contribute to good health. Mealtime is not rushed; people usually relax at the table, sharing food and conversation with family and friends. This helps to reduce stress and improve the body's ability to digest foods and absorb nutrients.

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.


Sample Menu

Breakfast

Lunch

Dinner

  • cereal 3/4 cup
  • skim milk 1/2 cup
  • banana 1
  • margarine 1 tsp
  • whole wheat toast
    1 slice
  • olive oil 1/2 tbspp
  • sliced almonds 1/2 oz
  • lentil soup 1 cup
  • hard roll 1
  • olive oil 1/2 tbsp
  • spinach 1 cup
  • romaine lettuce 1 cup
  • chopped mushrooms 1/4 cup
  • radishes 2
  • balsamic vinegar
    1/2 oz
  • pasta 1 1/2 cup
  • tomatos 1/2 cup
  • broccoli 1/2 cup
  • squash/zucchini
    1/2 cup
  • sweet peppers
    1/4 cup
  • chopped mushrooms1/4cup
  • olive oil 2 tbsp
  • parmesan cheese
    1 tbsp
  • white beans 1.2 cup
  • red wine vinegar
    1/2 oz
  • garlic 1 clove
  • whole wheat bread
    1 slice
  • grapes 1/2 cup

Snack

 

 

  • plain yogurt 1 cup
  • blueberries 1/2 cup

 

 



This Sample Diet Provides the Following

Calories

2000

Fat

73 gm

Protein

7 gm

Fiber

34 gm

Carbohydrates

284 gm

Calcium

1293 gm

Nutrition for Older Adults

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
1/2 bagel or hamburger bun
1 ounce ready-to-eat cereal
1/2 cup cooked pasta or rice
5-6 small crackers

1 cup milk or yogurt
1.5 ounces natural cheese|
2 ounces process cheese

Fruits and Vegetables

Meat, Poultry, fish, Dry Beans, Eggs and Nuts

1 cup raw, leafy vegetables
1/2 cup cooked, chopped or canned
3/4 cup joice
1 medium

1-3 ounces cooked lean meat, poultry or fish
1 ounce of meat equivalents:
1/2 cup cooked cry beans
1 egg or 2 egg whites
2 tablespoons peanut butter
1/3 cup nuts



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

 

 

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