THERAPEUTIC DIET

Introduction

The best doctors in the world are:

“Doctor Diet, Doctor Quiet and Doctor Merryman” – Jonathan Swift.

Diet Therapy is use of appropriate foods as a tool in the recovery from illness. In
most illnesses, the patient’s diet complements the medical or surgical treatment. The
rate of recovery thus is determined by the patient’s acceptance and intake of the diet
prescribed. In certain ailments such as obesity and diabetes mellitus modified diet is
the most important input to help the patient’s recovery.
All therapeutic diets are modifications of the normal diet made in order to meet
the altered needs resulting from disease.

Therapeutic diet is planned to meet or exceed the dietary allowances of a normal

person as the aim of diet therapy is to maintain health and help the patient to regain
nutritional wellbeing.

In certain ailments it may be necessary to restrict intake of calories (as in weight

reduction diets) or sodium (as in heart ailment).

NUTRITION FOR HEALTH AND FITNESS

A. Nutrition in Weight Management

Obesity, a condition in which the natural energy reserve is increased, is a hazard
to health. It is not surprising that obese people are prone to heart disease, gallbladder
disease, diabetes, or other chronic diseases. An obese pregnant woman is more likely
to have complications than a woman of normal weight.
Reasons for Excessive Calorie Intake
1. Family patterns of rich, high-calorie foods
2. Good appetite, likes to eat
3. Ignorance of calorie value of foods
4. Skips breakfast
5. Pattern of living - sedentary occupation, riding to work
6. Emotional outlet - eats to overcome worries and problems
7. Many social events serving foods
 8. Lower metabolism with increasing age
9. Influence by advertising of many high-calorie foods

Prevention of Obesity
1. Change in the eating pattern of families
2. Children should be encouraged to get more exercise and assigned some chores
requiring daily physical activity.
3. Pre-schoolers should not be bribed or rewarded with food.

Low-Calorie Diet
Women usually lose weight satisfactorily on diets restricted to 1,000-1,50o
calories whereas men lose weight satisfactorily on diets furnishing 1,200-1,8oo calories.
Bed patients, such as those with heart disease, are often placed on diets restricted to
800-1,000 calories and sometimes less.
The daily food allowances for the 1,000- 1,2o0- and 1,500-calorie diets are
somewhat higher in protein than normal. This is desirable because it provides most
people with a feeling of satisfaction. Also, it helps correct the greater losses of muscle
tissues that occur during reducing. The extra protein is provided from the meat group,
with some restriction on the bread-cereal group.
Usually, the food allowances are divided into 3 approximately equal meals.
Skipping breakfast is not a good idea.
Meals with a low-calorie diet should be attractive and palatable. Herbs and
spices may be used to give variety to vegetable and/ or meat preparation. Meat, fish,
and poultry should be lean and prepared by boiling, broiling, roasting, and stewing.
Fresh fruits or canned unsweetened fruits are used.
Low-calorie diets should not include alcoholic beverages, Sweetened
carbonated beverages, cakes, candies, cookies, cream, trled foods, sweetened fruits,
pastries, pies, potato chips, pretzels, puddings, and others

B. Nutrition in Eating Disorder

Addictive behaviors are compulsive ways of living (eating, drinking, etc.).
Anorexia nervosa and Bulimia are addictive behaviors related to food intake, while
alcoholism is the result of addiction to alcohol and alcoholic drinks. There are no simple
causes or solutions to eating and drinking disorders.

Though eating disorders have been known since the Middle Ages, the incidence of
eating disorders is on the rise in the developed countries. One of the contributing factors
is the breakdown of social structure resulting in isolation of individuals.
 All these disorders result in the deterioration of the nutritional status of the
person; therefore nutritional rehabilitation of the patient is a very important part of
therapy.
Eating Disorders

Anorexia nervosa implies loss of appetite. It can aptly be described as denying

one’s appetite.

Bulimia means “ox-hunger” or being as hungry as an ox. The persons suffering

from bulimia go on a eating binge often and feel guilty. So they try to get rid of the food
by forced vomiting, fasting, taking diuretics or using laxatives. They keep their binge –
purge behavior a secret and hence it is difficult to identify the disorder until the stress of
these episodes results in some visible impact on the system. Even male athletes
(runners, wrestlers, swimmers, etc.) and pilots also resort to binge-purge practices.

Causes: Addictive behaviors have multiple causes – emotional, psychological,

social and biological, which result in disordered eating. Stress may have a strong
role and lack of appropriate coping mechanism is another common factor.

Symptoms of Anorexia Nervosa: The anorectic patient is often 20 to 40 per

cent below desirable weight for the age and stature and appears to be skin and bones.
Other symptoms are lowered body temperature, slower basal metabolism, decreased
heart rate (hence easy fatigue, fainting, sleepiness), iron-deficiency anemia, rough dry
scaly and cold skin from a poor nutrient intake, low white blood cell count (increasing
risk of infection and death), loss of hair, constipation (and laxative abuse), loss of
menstrual periods and deterioration of teeth due to frequent vomiting, An anorectic
person is psychologically and physically ill and needs help.

Treatment of Anorexia Nervosa: The patient is often a victim of isolation and

fear. Hence the health team must include a psychologist in addition to a physician,
dietitian and other health personnel. They should all work together to restore a sense of
balance, purpose and future with the cooperation of the patient. The first step is to help
the patient to gain weight, as a psychiatrist cannot counsel astarving person.

Nutrition Therapy: The first step is to increase the person’s food intake. This will
help to stop weight loss and may help weight gain. The next is to restore regular food
habits. The third is to ensure that the patient keeps in weekly contact with the dietitian.
In all this it is critical to allow the person to feel in control of her life in the early stage of
treatment. There should be no surprises, as these may be detrimental to progress.
Anorectics are very clever and resistant. They try to disguise weight loss or fake weight
gain by wearing many layers of clothes, putting coins in the pocket and drinking a lot of
water before weighing. One needs to gain their trust to be able to help them. The
nutritional rehabilitation is slow. The nutritional care consists of going through the stages
of liquid to soft to full diet. The mode of feeding will depend on the condition of the
patient. It is important to educate the patient and help her/his family.
Some points to note in the treatment of anorectics are:

1. Patients need to be given intravenous feedings to restore fluid and electrolyte

balance, when the patient is in a critical state and is likely to get dehydrated.
2. When patient’s nutritional state is precarious, give peripheral parenteral
nutrition to support oral intake.
3. Get patients to be partners in the efforts to restore satisfactory nutritional
status; attain normal weight and develop normal eating patterns.
2. Anorectics are intelligent patients. Educate them about their normal growth
pattern and the intake to meet the needs for their growth. This will enable
them to set goals to attain their normal growth gradually.
3. Lastly avoid food being the center point of their day. They need to take
interest in recreational activities – music, games, reading, enjoying family
company, making friends etc. to get back to enjoying normal life of which food
is an important part.

Bulimia Nervosa
An increasing number of youngsters, especially females (models, actresses, dancers,
athletes and others) go through stages of eating large amounts of foods (high fat
sweets) and then get rid of it by vomiting. This disorder is called bulimia nervosa.
Bulemics may eat 3,000 to 5,000 calories in one extended binge and then vomit to get
rid of it. With repeated episodes, they may have chloride and potassium deficiencies,
which may lead to heart damage and other complications. Bulemics suffer from low
self-esteem and depression. It is necessary to help a bulemic develop self-esteem
through understanding self worth, develop a positive attitude, learn to take pleasure in
simple activities (listening to music, reading, writing, drawing, sewing, knitting,
gardening, playing games, etc.) and avoid depressing inactivity. Most bulemics have
irregular food habits and they may be underweight and undernourished.

Diet for Bulemics

Bulemics need to understand about effects of starvation on the body, their nutrient
needs and how to meet these through planned diet modification. Bulemics need to
recognise that their primary aim is the stabilization of their body weight without having to
go through binging and purging, which disturbs and hurts the body’s well being.

Some points to note in their treatment are:

1. Help patients to understand and plan a diet which meets their normal
nutritional needs. The actual calorie expenditure needs are determined by
measuring oxygen consumption.

2. Plan the diet using basic food guide The foods thus selected meet the mineral
and vitamins needs. Hence supplements are not necessary.
 3. The patient can be helped to select a varied diet, after taking her likes and
dislikes into account.
4. Teach how to measure or weigh foods to give confidence that there will be no
over- eating.
5. Personalized meal plans (3 meals + snacks) with wide variety of foods helps
acceptance.
6. Avoid excessive bulk in the initial stages to have a third of stomach empty.
7. Gradually increase intake by 200 calories until the norm is reached.
8. Avoid fasting, skipping meals and eating inadequate amounts at a meal as it
leads to binges. Keep food record. These measures help to develop
confidence in themselves and make them self-reliant in managing their diet.

C. Nutrition Exercise and Sports

The interest in physical fitness is very high in all the age groups of populations
around the world. It may be to keep fit, healthy and thus improve the quality of life or it
can be to participate in athletics and possible competition.

Our body composition, muscular ability, respiratory and cardiovascular

capabilities are very close related to nutrition and exercise. Diet and nutrition does
influence performance.

Just as eating three meals regularly is a consistent part of daily life, so should
exercise be a consistent, regular part of daily life. In physical education in schools,
activities that are appropriate for life-long participation need to be emphasized. This will
ensure physical well-being and optimal function of the majority of students. Some of
them may become athletes.

Carbohydrates

The main role of carbohydrates in physical activity is to provide energy. For athletes, if
their diet does not contain enough carbohydrate, it is likely that their performance and
recovery will be impaired, as carbohydrate is the key fuel for the brain and for muscles
during exercise.

Protein

Protein is important in sports performance as it can boost glycogen storage, reduce

muscle soreness and promote muscle repair. For those who are active regularly, there
may be benefit from consuming a portion of protein at each mealtime and spreading
protein intake out throughout the day.
Fat

Fat is essential for the body in small amounts, but it is also high in calories. Consuming
too much fat can lead to excess calorie intake which can lead to weight gain over time,
so this is a particular concern if you’re trying to control your weight. The type of fat
consumed is also important. Studies have shown that replacing saturated fat with
unsaturated fat in the diet can reduce blood cholesterol, which can lower the risk of
heart disease and stroke. Fat-rich foods usually contain a mixture of saturated and
unsaturated fatty acids, but choosing foods that contain higher amounts of unsaturated
fat and less saturated fat, is preferable as most of us eat too much saturated fat.

Water

Water is essential for life and hydration is important for health, especially in athletes and
those who are physically active, who will likely have higher requirements. Drinking
enough fluid is essential for maximizing exercise performance and ensuring optimum
recovery. Exercising raises body temperature and so the body tries to cool down by
sweating. This causes the loss of water and salts through the skin.

The amount an individual sweats varies from person to person and depends on:

 Intensity and duration of exercise – longer and higher intensity exercise can
cause greater sweat loss.
 Environmental temperature – in hot, humid conditions sweat loss can increase.
 Clothing – the more clothing that is worn, the quicker you are likely to heat up
which may cause greater sweat loss.
 Genetics – some people sweat more than others.

Generally, the more a person sweats, the more they will need to drink. Average sweat
rates are estimated to be between 0.5–2.0 L/hour during exercise.

Supplements

Supplements are one of the most discussed aspects of nutrition for those who are
physically active. However, whilst many athletes do supplement their diet, supplements
are only a small part of a nutrition programme for training. Athletes are advised to follow
a ‘food first’ approach to avoid using supplements that aren’t needed or could result in
nutrient intakes that are too high. For most people who are active, a balanced diet can
provide all the energy and nutrients the body needs without the need for supplements.

D. Nutrition and Bone Health

 Many nutrients play a role in bone health. Some nutrients have scientifically
proven benefits, others may have benefits, but there is no research to back that up.
Some nutrients are needed in such small amounts that people are rarely deficient in
them and need not worry about getting enough. Focus on nutrients with solid scientific
evidence of need and benefit. Read food and drink labels to ensure you are meeting
your daily requirements.
With some exceptions, a balanced diet provides adequate nutrients for
most people, eliminating the need to take most supplements.

Calcium, vitamin D and magnesium are key bone health nutrients that require

special attention to ensure that you meet your daily requirement.

Although many foods contain calcium, dairy products provide the most calcium per
serving size. Calcium that has been added (fortified) to drinks may settle to the bottom,
so shake the container well before drinking. Daily requirements for calcium change with
age — people who do not eat dairy foods will need to work hard to meet them or may
need a calcium supplement.

There are food sources of vitamin D, but it is difficult to get adequate amounts from food
alone; therefore, many people benefit from a supplement.

People who consume even moderate amounts of alcohol or use proton pump inhibitors
may have increased loss of magnesium in the urine and may benefit from a supplement
(approximately 200–250 mg/day). Magnesium is found in many foods.

E. Nutrition for Oral and Dental Health

After birth, nutritional quality affects tissue synthesis as nutrients work to maintain
and repair periodontal tissues when essential. since the turnover rate of mucosal cells is
from three to seven days, some parts of the oral cavity, especially the sulcular
epithelium, can be some of the first to develop signs of poor nutritional status. This fast
cell turnover demands steady nourishment; epithelial cells have fast rates of
metabolism, differentiation, and maturation. The deficiency or abundance of some
vitamins or minerals may cause salivary gland dysfunction, sulcular epithelium
corrosion, pocket formation, hyperkeratinization of mucosa, and osteoporosis of the
alveolar bones and other bones in the body.

When the host is weak, bacteria attack periodontal tissues. The body then sends
defenders to control destructive activity and repair any damage. A thriving host
possesses nutrients to aid with bacterial attack. Healthy oral tissue is the best protection
against microbe invasion. Some nutrients influence the process of maintaining and
repairing periodontal structures more than others. Some have a singular benefit; others
offer multiple advantages. Their joint effort affects soft and hard periodontal tissues,
host susceptibility, immune response, and wound healing.
 During our lifetimes, optimal oral health depends on adequate quantities of
vitamins A, B-complex, C, D, and E; proteins; calcium, phosphorus and magnesium;
iron zine copper and some lipids, such as omega3 fatty acid.

1. Lipids perform a key role in the general health (energy, obesity, diabetes, and
hypertension) and have slight implications for the control of oral health status.
Lipids include triglycerides, phospholipids, sterols, and lipoproteins, Fat provides
a protective layer on teeth and prevents biofilm adherence. Some fatty acids
have antibacterial properties and that low levels of omega 3 fatty acids correlate
with risk for periodontitis. Clinicians should observe caution with recommending
fat intake, as excess is implicated in several chronic diseases.

2. Protein is responsible for repair and maintenance. Amino acids repair tissues and
form antibodies to help resist infection. Protein deficiencies can influence the
synthesis ot new tissue, as key amino acids are important tor maintenance and
healing. Unacceptable amounts of protein in the diet increases vulnerability to
infection, slows wound healing, and causes deterioration of periodontal
connective tissues. Excess protein can decrease calcium retention and influence
bone health. People with plant-based diets need to pay special consideration to
acquiring sufficient amounts of protein in their diets. Vitamin C is present in large
amounts in neutrophils so, when protein intake in insuffiçient, this also can
reduce the availability of vitamin C.

3. Vitamin A in adequate amounts helps sustain immune function and the integrity
of sulcular epithelium, assists with bone remodeling, and keeps the salivary
glands working efficiently. An early sign of this vitamin deficiency is a decrease in
the rate of epithelial cell differentiation. Deficiencies throughout life may cause
salivary glandatrophy, hyperkeratinization of some oral structures, compromised
periodontal tissue healing, or carotene coloration. Excess vitamin A can result in
increased catabolism of collagen and bone.

4. Vitamin D in constant amounts is important throughout life since calcified tissues

remodel. Vitamin D is vital to general health because it controls the presence of
calcium, magnesium, and phosphorus in blood plasma. The danger of vitamin D
deficiency increases with age, lack of exposure to sunlight, and poor eating
habits. Osteomalacia, osteopenia, osteoporosis, lamina dura and cementum
loss, and an even bigger risk of developing some cancers can be the result of
such deficiency. Excessive vitamin D can cause irreversible kidney and
cardiovascular tissue damage. Vitamin D and calcium levels have been linked to
periodontal problems due to their role in bone homeostasis, including attachment
and bone and tooth loss. However, it is possible for depleted bone structures to
reconstruct with vitamin D supplementation.
5. Vitamin E is a group of 10 lipid-soluble compounds that 5 include tocopherols
and tocotrienols. Vitamin E functions as an antioxidant and protects red blood
cells. Insufficient vitamin E is rare but can manifest as hemolytic anemia, Excess
amounts of vitamin E in the body can create a vitamin K deficiency, obstruction
with anticoagulant drugs, and bleeding problems.

6. Vitamin K functions as a cofactor (enzyme partner) tor the synthesis of

prothrombin. Prothrombin is essential for blood clotting and is produced by some
intestinal bacteria. Deficiencies are caused by conditions that decrease 1at
absorption or by antimicrobial medications that alter intestinal flora. Symptoms
include delayed bleeding and clotting time. High doses of vitamin K interfere with
anticoagulants, which could result in hemorrhage.

7. Vitamin B-complex is a group of coenzymes. These coenzymes work together to

sustain healthy oral tissues by forming new cells and preserving the immune
system. The risk of a vitamin B-complex deficiency increases with age, ingestion
of certain medications (phenytoin and methotrexate), eating disorders,
addictions, and in vegans, such deficiency can result in increased oral tissue
sensitivity, burning mouth syndrome, loss of taste, angular cheilosis, pernicious
anemia, gingivitis, and frequent oral lesions.

8. Vitamin C assists with collagen and connective tissue formation. It aids with
blood vessel integrity, phagocytosis, and wound healing. It is also a strong
antioxidant that facilitates calcium and iron absorption and protects vitamins A
and E. Low levels of vitamin C produce an facilitates calcium an increased
intracellular permeability of blood vessels and the sulcular epithelium, allowing
microbial penetration into deeper structures. The first symptom of vitamin c
deficiency is often exhibited as gingivitis. Enlarged magenta, hemorrhagic gingiva
along with a widened periodontal ligament is the result. Low levels of vitamin C
increase the risk of developing periodontal disease insufficient vitamin C intake
combined with smoking can result in grave consequence on periodontal tissues.
Smokers have greater metabolic turnover rate for vitamin C. Excessive vitamin C
in the diet can obstruct anticoagulants

9. Calcium, magnesium, and phosphorus deficiency in the diet can affect absorption
and create aggressive bone resorption It also increases the risk of tooth mobility,
premature tooth loss, and hemorrhage. Reduced dietary intake of calcium results
in more severe periodontal disease and low dietary Intake is a risk factor for
periodontal disease. Hypercalcemia, excess magnesium, and excess
phosphorus are almost unknown.
 10. Iron deficiency can lead to angular cheilosis, pallor, burning mouth syndrome,
glossitis, and atrophy or denudation of the filiform papillae, and candidiasis as a
result of lowered immune function. Excessive iron is rare, as most individuals
regulate the absorption of iron well.

11. Zinc is an essential mineral needed for wound healing and new tissue healing.
Zinc works along with iron and copper for wound healing. Malnourished
individuals run the risk of having low zinc levels. Zinc levels are naturally
suppressed during infection. Zinc deficiencies quickly weaken immunity and
reduce antibody activity. Even a modest insufficiency of Zinc can lead to
increased opportunistic infections. Immune status is closely linked to zinc status-
an important mineral to control periodontal disease. Zinc toxicity is uncommon.

12. Copper is an important mineral, involved in both collagen and elastin formation
and regeneration. A copper deficiency causes considerable decrease in the
tensile strength of collagen. This produces bone lesions, malformed joints, bone
fragility, and vascular lesions.

Food Sources

1. Zinc: meat, fish, poultry, eggs, nuts

2. Vitamin K: dairy, green leafy vegetables 3.

3. Vitamin E: vegetable oils, whole grains, fortified food, nuts

4. Vitamin D: sunlight, fish, fortified food and drink

5. Vitamin C: citrus fruits and juices, broccoli, strawberries, peppers 6.

6. Vitamin A: dairy, eggs, fortified food and drink 7.

7. Protein: dairy, meat, fish, poultry, legumes, seeds, nuts

8. Probiotics: yogurt, cheese, buttermilk, sauerkraut 9.

9. Phosphorus: dairy, meat, soft drinks 10.

10. Omega-3 fatty acids: fish, flaxseed, canola, soybean oils

11. Magnesium: whole grains, green leafy vegetables, nuts 12. Iron: meat, poultry,
fish, eggs, dark green vegetables

12. Folic acid: green leafy vegetables, fortified food, legumes 14. Copper: soy,
shellfish, oysters, crabs, liver, nuts
 13. Calcium: dairy, fortified food, seafood 16. Boron: fruits, vegetables, legumes,
some wines, nuts

DIETARY MODIFICATION AND DIETARY THERAPY

GENERAL DIETS

1. Regular or Full diet

 Most frequently used of all hospital diets
 Designed to maintain optimal nutritional status
 Follows the principle of good meal planning and permits the use of all
foods
 Indicated for ambulatory or bed patients whose conditions do not
necessitate a modified diet
 Food selection: all foods are allowed

2. High fiber diet

 Regular diet which include liberal amounts of foods rich in dietary fiber
 Fluids are also increased
 Indications: atonic constipation (constipation caused by failure of the colon
to respond to normal stimuli for evacuation), diverticular disease, irritable
bowel syndrome, gastric ulcers, colon cancer, cardiovascular disease,
diabetic mellitus
 Food selection: vegetables, fruits, rice or substitutes(cereals, whole grain)

3. Vegetarian diet
 Type of diet which may be preferred due to religious reasons, ecologic,
basic health principles.
 Reduce the risk of developing medical conditions such as obesity, heart
disease, hypertension, diabetic mellitus

Different types of vegetarian diet:

a. Lacto-ovo vegetarian – includes dairy and egg products
b. Ovo vegetarian – includes egg
c. Lacto vegetarian – includes dairy products
d. Vegan or pure vegetarian – eats food from plant source
e. Pesco vegetarian – includes fish but not meat
f. Pollo vegetarian – includes poultry, no meat

DIETS MODIFIED IN CONSISTENCY

1. Clear liquid diet

  A clear liquid diet is made of clear liquid foods which leave no residue in
the gastro-intestinal trace
 Provides adequate fluid/water, 500-100 kcal of simple sugars, electrolytes,
and is fiber free and fat free
 It requires minimal digestion, as there is no residue, fiber, or fat
 It is also called as “non-residue diet”
 It is recommended for short-term use (3-5 days), can be used both before
and after surgery or diagnostic procedures and during acute stages of
illness
 It consist of “see-through” foods that are liquid at body temperature-
gelatin, tea, coffee, broth, or frozen ice pops

Purposes:
a. Relieve thirst
b. Maintain water balance
c. Minimize stimulation of gastrointestinal tract
d. Serve as initial feeding after surgery of intravenous feeding

Indication of use:
a. Pre or postoperative
b. Acute diarrhea or vomiting
c. Intestinal obstruction
d. Acute phase of fever of infection
e. Inflammatory condition of the gastrointestinal tract
f. To reduce fecal material

2. Full liquid diet

 Diet consisting of liquid foods that liquefy at body temperature
 A full liquid diet provides water, calories, protein, vitamins and minerals,
and dairy products (contain lactose); because milk is allowed , it contains
residue
 It may be indicated for some clients who have difficulty chewing or
swallowing by may not be indicated for a client following CVA
 It may be considered to be a transition diet as the client progresses
postoperatively or post-procedure from liquid to solids
 It consist of all foods on a clear liquid diets, plus milk, pudding, ice cream,
soups, yogurts, and all prepared liquid formulas; is contraindicated with
sever lactose intolerance; may have increased cholesterol content

Indication for use:

a. Post-operative with minimal GI function
b. Fever and infection
c. Patients too ill to chew, fractured jaw, post oral surgery
d. Lesions in mouth
e. Transition from clear, to soft, to regular diet
3. Cold liquid diet
 Use after tonsillectomy, dental extraction, minor operation of the
mouth/throat
 All liquids are served cold or iced
 Avoid sharp, sour fruit juices which can cause pain and bleeding on
postoperative area

4. Soft diet
 Also called bland diet
 This diet includes food items that contain small amounts of seasoning and
moderate fiber content but are easy to chew, digest, and absorb
 Foods that are highly seasoned, fried, high in fiber, nuts, coconuts, and
foods that contain seeds are not included in the diet as they could cause
GI symptom upset
 It can be used as a progressive or transition diet and is a modification of a
regular diet

Food sources:
a. Well cooked vegetables
b. Ripe fruits
c. Boiled, baked or canned meat/fish
d. Desserts-cakes, puddings

5. Mechanical soft diet or mechanically altered diet

 Also called “dental soft” or “geriatric soft diet”
 This diet is used for clients who have problems with chewing; focuses on
including all foods and seasonings in a form that is easily handled by the
client
 Food with soft textures, those that are tender and chopped food items are
included in the diet
 This diet is a modification of the regular diet with attention to texture
 Foods that are touch in nature-containing seeds, nuts, raw egg- are
excluded in this diet

6. Soft bland diet

 This diet is similar to soft diet but with additional restrictions
 “NO “ hot spices like black pepper, chilis, caffeine containing beverages
like coffee, team cola drinks and alcohol

Indications for use:

a. For patients with hyperacidity
b. Peptic ulcers (when bland diet cannot be tolerated)

7. Bland diet
  Foods that do not increase gastric acid production and are non-irritating to
the gastrointestinal tract
 Indicated for patients with peptic ulcer

8. Residue restricted diet

 A low-residue diet consist of food items that minimize elimination patterns
by reducing fecal volume
 High fiber food sources are restricted in this diet along with milk and milk
products
 Erroneously called “constipating diet”

9. Low fiber diet

 This diet is one in which the choice of fruits and vegetables is limited to
those low in cellulose
 Fibrous vegetables and fruits with skin and seeds are omitted, milk is
allowed, meat with minimum tough tissue

DIETS MODIFIED IN COMPOSITION

1. Low calorie diet

 Allowance of food and drink with an energy value that is required for
maintenance in order to bring about weight reduction
 Calories are reduced by limiting carbohydrates and fats while keeping
protein at the normal level (protein should come from the low fat meat
group)
 Diet should specify calorie desired

Indications:
a. Weight reduction – in obese, hypertensive, arthritic, diabetic
b. Energy requirements – hypothyroidism, prolonged bed rest, elderly person

2. High calorie diet

 Diet which includes food and drinks with an energy value of 50 to 100%
above required for maintenance
 Food needed to supply energy/calorie are served in snacks or extra
portions at meal
 Snacks should be given in 3 exchanges + full diet + additional 50-100%
 Rice equivalents = bibingka, biko, cakes, espasol, maja

Indications for use:

a. Underweight
b. Hyperthyroidism, injury, burns, fever and infection
c. Convalescence – the period of recovery from illness or injury or surgery
3. High protein diet
 Diet with an allowance of food and drink which provides 1.5 gm of protein
or more
 The use of high-protein diet has been indicated for athletes, and so with
patients recovering from surgery or who have large wounds or pressure
sores
 Increase in protein above normal allowance to maximize the utilization of
protein, to maximize catabolism of protein as energy source
 2 exchanges of snacks + full diet + additional extra portion of protein

Indications for use:

a. Protein deficiency
b. Before and after surgery
c. Hepatitis
d. Convalescence

Food sources:
a. Soybean or lactose milk
b. Cooked sweet beans
c. Tahu with syrup
d. Nuts, peanut butter
e. Meat/fish substitutes

4. Low protein diet

 Clients who have renal disease or liver disease require some form of
protein control in dietary pattern to prevent complications from inability to
handle protein solute load
 Sufficient calories are provided for the maximum utilization of the limited
dietary protein and to prevent or minimize tissue breakdown

5. Low fat
 Foods are taken from the low-fat meat groups
 More fruits and rice exchanges
 Diets where fate is restricted are used in the management of clients who
have clinical conditions related to malabsorption, chronic pancreatitis, and
gallbladder disease
 Foods that are high in fat content are omitted, and no additional fat is used
in the cooking process
 Foods that are high in oxalates (nuts, chocolates, green leafy vegetables,
beer, tea) and avoid vitamin C supplements
 Clients who are being treated for dyslipidemia, cardiovascular disease,
congestive heart failure should be placed on low fat diet

6. Low cholesterol diet

 Diet to reduce blood levels of cholesterol particularly low density
lipoprotein cholesterol
 Indications:
a. Hypercholesterolemia
b. Coronary artery disease
c. Adults with family history of heart disease (primary prevention measure)

Foods:
a. Vegetables – avoid butter, creamed, and fried
b. Milk – only skim and non fat milk
c. Meat/fish – lean meat, chicken without skin, lean beef, avoid internal
organs and sauces

7. Low carbohydrate diet

 Allowance of food and drink in which carbohydrate should provide no
more than 50% of required for maintenance
 Complex carbohydrates are preferred (starch, cellulose, fruits and
vegetables)

Avoid foods:
a. Starchy foods
b. Condensed milk, chocolates
c. Salad dressing
d. All sweets

8. Low sodium/ sodium restricted diet

 Sodium levels are lower than the usual sodium content of a regular diet
 Various levels of restriction are available and are based on supportive
evidence that high sodium diets correlate with hypertension and
cardiovascular disease
 It is important to evaluate food labels, medications, and restaurant dietary
intake pattern for hidden sodium sources in the diet
 Sodium is often used as a preservative in many foods; it is important that
clients be taught how to read food labels to detect sodium in food products

9. Low potassium diet

 Potassium content in diets is reduced
 Indicated for clients with hyperkalemia

Avoid food:
a. Vegetables – cauliflower, celery, mushroom, green leafy vegetables
b. Fruits – fresh fruits
c. Rice – raisin bread, oatmeal
d. Meat

10. Low purine diet

  A purine-controlled died is indicated for clients who have gout, tumor lysis,
or multiple myeloma, and all who have elevated uric acid levels
 Excessive purine accumulation in the body leads to an increase in uric
acid, which is a normal end product of purine catabolism
 The diet includes the use of dairy food products and restricts foods such
as organ meats, anchovies, alcohol and seafood

Teaching and Learning

Activity:

1. Plan a menu for person suffering from Fever

2. Plan a menu for a person suffering from constipation.