Download CareGroup SUMMARY OF DIETS

CareGroup SUMMARY OF DIETS©
Introduction
The CareGroup Summary of Diets is adapted from the diet section in the American
Dietetic Association's Manual of Clinical Dietetics, 6th Edition. It was developed by the
Clinical Nutrition Managers of the Food and Nutrition Departments within the
CareGroup Health System, and is copyrighted**. The purpose of the Summary is to
provide all hospital personnel access to a concise explanation of the regular and
therapeutic diets used in our institutions. For each diet there is a description, a statement
of nutritional adequacy, indications for use and diet principles. This Summary is intended
to provide a working guide for the user and is not a complete review of therapeutic
nutrition practice. For additional information, the user is referred to the Manual of
Clinical Dietetics 6th edition.
A copy of the manual is located:
New England Baptist Hospital
Medical Library
Diet Office
Revised: February 5, 2004
Approved By:
Pharmacy and Therapeutic Practices Committee,
New England Baptist Hospital, April 10, 2001
April 8, 2004
Medical Executive Committee May 17, 2004
*Manual of Clinical Dietetics developed by the Chicago Dietetic Association, The South Suburban Dietetic Association and
Dietitians of Canada-6th ed. copyright 2000, American Dietetic Association.
**The CareGroup Summary of Diets may not be reproduced in whole or part without the express written permission of
CareGroup.
1
CareGroup SUMMARY OF DIETS©
TABLE OF CONTENTS
GENERAL DIETS
House
Vegetarian
High Protein-High Calorie
Kosher
MODIFIED CONSISTENCY DIETS
Clear Liquid
Full Liquid
Surgical Progression
Mechanically Altered
Dysphasia
GASTROINTESTINAL RELATED DIETS
High Fiber
Fiber & Residue Restricted
Minimal Fiber & Residue Restricted
Lactose Restricted
Lactose Free
Bland
GERD
Post-Gastrectomy
Gluten Free (Celiac Disease)
Fat Restricted
DISEASE RELATED DIETS
Renal
Low Protein
Potassium Restricted
Sodium Restricted
Cardiac
Diabetic
No Concentrated Sweets
Reactive Hypoglycemia
TEST DIETS
Fecal Fat
Glucose Tolerance
Serotonin Test
Vanillylmandelic Acid (VMA)
OTHER DIETS
Allergy
Tyramine Controlled
Low Purine
Low Microbial
CareGroup ENTERAL FORMULARY
2
CareGroup SUMMARY
OF DIETS...
DIET TYPE:
GENERAL DIETS:
HOUSE
“Regular”, “General”
Pages: 795, 799, 800
VEGETARIAN
Pages: 159-176
HIGH PROTEIN – HIGH
CALORIE
Pages: 719-723
DESCRIPTION/
NUTRITIONAL
ADEQUACY
DESCRIPTION
All foods are allowed.
Designed to maintain or
attain optimal nutrition and
meet RDA’s. Forms the
basis for all modified diets.
This diet is nutritionally
adequate.
A regular diet in which
animal products are
excluded. Varieties of the
diet include:
 Vegan: no animal or dairy
products
 Lacto-Ovo: vegan with
milk and egg products
 Lacto: vegan diet with milk
and milk products
 Ovo: vegan with egg
products
This diet, with the possible
exception of vitamin B12 for
vegans, is nutritionally
adequate.
Provides calories and
protein in excess of normal
maintenance level. The diet
should provide at least 120%
to 150% of the RDA or RNI
for energy and protein.
Individually tailored using
house diet plus high protein,
high calorie supplements
and snacks.
INDICATIONS
PRINCIPLES
INDICATIONS
For adults not requiring
dietary modifications.
PRINCIPLES
Follows general principles of
The Dietary Guidelines for
Americans and the Food
Guide Pyramid.
Individual choice. A
vegetarian diet may be
higher in fiber and lower in
calories, total fat, saturated
fat and cholesterol, than a
diet including animal
products.
Provide a variety of foods.
For nutritional rehabilitation
of protein/calorie depleted
individual, or to prevent
weight loss and tissue
wasting where individual
requirements are increased.
Provision of small, frequent
feedings of calorie-dense
and protein-dense foods is
encouraged to increase
intake. High protein foods
include: whole milk and milk
products, peanut butter and
other nuts and seeds, beef,
chicken, fish, pork and eggs.
High calorie foods include:
butter, margarine,
mayonnaise, avocado, gravy,
oil, coconut, cream, dried
fruits, honey and sugar.
For patients who desire to
observe Jewish dietary law in
a non-kosher facility.
Individuals choose their
level of observance* of the
diet depending on the
community in which they
live, customs and personal
preference. The Kosher diet
may also be acceptable to
people of the Muslim faith.
Dairy and meat products
may never be eaten, served
or cooked together. Pareve or
neutral describes any food
product that has no meat or
dairy properties (eggs, fruits,
vegetables). They may be
used with meat or dairy
products. Kosher meats
include animals that both
chew their cud and have
split hooves; fish with skins
and scales; chicken & turkey.
Non-Kosher products are
pork, shellfish, crustaceans,
catfish, and wild birds.
This diet is more than
nutritionally adequate.
KOSHER
Pages: 785-789
*dietary restrictions of other
religions are accommodated.
Kosher refers to food and
food preparation practices
according to Jewish dietary
laws for what is fit or proper
to eat. Foods fall into two
categories: foods prohibited
under any circumstances;
and foods that are not
categorically prohibited, but
may be eaten only if
prepared a certain way.
This diet is nutritionally
adequate.
*Saturday evening meal may
need to be a cold meal, as
traditionally foods cannot be
cooked on the Sabbath.
3
Refer to page 161, Daily
Food Guide for Vegetarians
Include a food source of
vitamin B12, calcium and
iron.
CareGroup SUMMARY
OF DIETS...
DIET TYPE:
MODIFIED
CONSISTENCY DIETS:
CLEAR LIQUID
Pages: 655-657
FULL LIQUID
Pages: 659-661
SURGICAL
PROGRESSION @ NEBH
page (to be announced)
“Soft”
Refer to: Fat restricted on
page 697 and Fiber restricted
on page 703
DESCRIPTION/
NUTRITIONAL
ADEQUACY
DESCRIPTION
INDICATIONS
PRINCIPLES
INDICATIONS
PRINCIPLES
A transitional diet composed
of foods that are liquid at
body temperature and
transparent to the eye when
light is shined on them.
Nutritionally inadequate.
Should not be used for over
3 days unless supplemented.
For acute stages of illness
such as in nausea/vomiting,
diarrhea, inflammation of
the GI tract, pre and postoperative patients, and when
it is necessary to minimize
the amount of fecal material
in the colon.
Offer plain apple, cranberry,
grape juices; coffee; tea,
gelatin; broth, carbonated
sodas, fruit ice, popsicles.
A diet that consists of
liquids or foods that liquefy
at body temperature.
Nutritionally adequate
depending on individual
choice and tolerance.
Patients who have difficulty
consuming adequate fluids,
may require supplements.
Used following oral or facial
surgery; for those patients
unable to chew or swallow,
or patients with esophageal
or gastrointestinal strictures.
Includes foods allowed in
clear liquid diet. Offer all
beverages, strained cream
soups, cream of wheat, ice
cream, pudding and custard.
A transitional diet used after
surgery that eliminates foods
high in fiber and fat. The
diet obviates the need for
full liquids and restores
intake quickly.
Indicated post surgery as an
intermediate step between
clear liquids and a regular or
therapeutically modified diet.
Use short-term (3 days or
less).
Full liquid diets are not
recommended as a postsurgical transition diet.
The diet contains less than
50 grams of fat and less then
15 grams of fiber per day.
Offer all lean meats, reduced
fat dairy and low fiber
starches, canned fruits and
many well-cooked
vegetables.
Avoid most fresh fruits and
vegetables.
Avoid all regular cakes, pies,
and cookies.
Avoid regular dairy
products.
Limit total number of visible
fat servings to between 3
and 5 per day.
MECHANICALLY
ALTERED DIETS
Puree, Ground, Mechanical
Soft or Dental Soft
Pages: 663-665
A regular or modified diet
that includes foods modified
in texture, such as chopped,
ground or pureed, to
promote ease of chewing.
The foods provided are
generally moist and require
minimal chewing before
swallowing. Textures are
modified according to the
individual’s needs and
tolerance.
These diets are adequate, but
should be monitored.
For patients with limited
chewing ability, but who
tolerate a greater variety and
texture of foods than a
blenderized or liquid diet
offers. For example,
following surgery of the
head, neck and mouth areas;
cancer of these areas; those
who are edentulous or those
with ill-fitting dentures.
4
Consists of foods, which are
modified in texture, to
minimize the amount of
chewing. Foods are minced,
chopped, ground or pureed
according to the individual’s
need. Evaluate periodically
to determine if progression
to more solid foods can be
tolerated.
CareGroup SUMMARY
OF DIETS...
DIET TYPE:
DYSPHAGIA
Thickened Liquid
“Dysphagia Puree/Ground/
Mechanical Soft”
Pages: 666-693
GASTROINTESTINAL
RELATED DIETS:
HIGH FIBER
Pages: 709-717
FIBER & RESIDUE
RESTRICTED
“Low Residue”, “Reduced
Fiber”
Pages: 703-707
Minimal Fiber & Residue
DESCRIPTION/
NUTRITIONAL
ADEQUACY
Dysphagia can accompany
some chewing problems,
and increases risk of
aspiration; hence, food and
liquid consistencies need to
be altered. The risk of
aspiration is decreased with
thickened liquids. When
planning the diet, emphasis
should be placed on
adequate fluid intake. This
diet is nutritionally adequate
DESCRIPTION
INDICATIONS
PRINCIPLES
Thickened liquids and
altered consistencies are
indicated in neuro-muscular
swallowing problems, risk of
aspiration or in certain postoperative cases.
Consists of easy to swallow
foods, as noted in
mechanically altered diets ;
foods with cohesive
characteristics. Liquids
should be ordered to the
consistency that speech
therapy recommends (such
as pudding, honey or nectar
thick).
INDICATIONS
PRINCIPLES
A regular diet altered to
reduce the intake of refined
foods and to encourage
consumption of whole grain
cereals and fresh fruits and
vegetables. Goal is to
provide approximately 20-35
grams of dietary fiber daily.
This diet is nutritionally
adequate.
A diet which contains a
reduced amount of fiber. In
addition to those foods
omitted in the low fiber diet,
a low residue diet controls
total fat content and limits
milk and milk products to 2
servings per day. This diet is
nutritionally adequate.
For stimulating intestinal
motility, and to manage or
prevent: diverticular disease,
irritable bowel syndrome,
constipation, selected cases
of ulcerative colitis or
Crohn’s disease, colon and
other cancers, obesity,
diabetes, gallstones and
hypercholesterolemia.
For patients with active
diverticulitis, intermittent
partial bowel obstruction,
ulcerative colitis, or
infectious enterocolitis. Also
used in inflammatory
changes that have
progressed to stenosis of the
intestine or esophageal
lumen, or in esophageal
varices. This is also the basis
of the surgical progression
diet at NEBH.
This is a very restrictive low
fiber diet and provides less
than 5 grams of dietary fiber
daily. This diet should only
be used for a short
transitional period. No
whole fruits, vegetables,
whole grains or milk
products; only selected fruit
or vegetable juices are
included. This diet is
nutritionally inadequate in
most vitamins and calcium.
For acute inflammatory
conditions of the intestinal
tract, preparation for
intestinal procedures or
surgery, partial intestinal
obstruction, and radiation
therapy. Only short-term
use, to transition to above
diets.
5
Increase fresh fruits and
vegetables. Increase whole
grains, nuts and legumes
(beans & peas).
Fiber increases should be
gradual.
Increase fluid intake,
recommend at least eight 8ounce glasses per day.
LOW FIBER: Omit raw,
fibrous fruits and vegetables.
Omit whole grains, seeds,
legumes, nuts and prune
juice.
LOW RESIDUE: Omit as
noted above, as well as:
High fat foods and dairy
products.
MINIMAL RESIDUE:
Omit all fruits and
vegetables, whole grain
cereal products, milk
products and prune juice.
Allow only clear, strained
juices, containing no pulp,
such as apple or grape juice.
CareGroup SUMMARY
OF DIETS...
DIET TYPE:
LACTOSE RESTRICTED
“Low Lactose”
LACTOSE FREE
Refer to Lactose Intolerant
Diet on Pages: 211-217.
DESCRIPTION/
NUTRITIONAL
ADEQUACY
A diet designed to control
symptoms associated with
the ingestion of lactose. The
Lactose-Free diet eliminates
all milk, milk products and
foods containing lactose.
The Lactose Restricted diet
limits milk, milk products
and foods containing lactose
based on each individual’s
tolerance.
The diet is nutritionally
adequate. If alternate food
sources of calcium and
vitamin D are not well
accepted, supplementation
may be indicated.
BLAND
Refer to Peptic Ulcer
Disease, pages: 425-426
GERD
“Anti-reflux diet”
Pages: 401-405
POST-GASTRECTOMY
“anti-dumping diet”
Refer to Gastric Surgery,
pages: 395-400
INDICATIONS
PRINCIPLES
Indicated in the treatment of
lactase enzyme deficiency or
intolerance (congenital or
acquired, i.e. post subtotal
gastrectomy, celiac disease,
ileitis and colitis).
Avoid foods containing
milk, milk solids and lactose,
such as ice cream and
sherbet. Yogurt and cheeses
are allowed according to
individual patient tolerance.
Lactose-Free diet is ONLY
indicated with severe lactase
enzyme deficiency; the
majority of patients can be
treated with a Lactose
Restricted diet.
Read labels of all
commercially prepared food
items.
This diet is not an
appropriate treatment for a
milk protein allergy.
Refer to Micromedex
through the CareGroup
web-site for medications
containing lactose.
Avoid alcohol, spicy foods
that contain black pepper,
garlic, cloves, and chili
powder, etc..
A regular diet that limits
certain foods and beverages
to reduce and neutralize
gastric acid secretion,
maintain acid resistance of
gastrointestinal epithelial
tissue, maximize patient
comfort, and promote good
nutritional status.
This diet is nutritionally
adequate.
A regular diet that excludes
foods which cause a
decrease in lower esophageal
sphincter pressure and/or
have an irritating effect on
the esophageal mucosa.
The diet is nutritionally
adequate. If citrus fruits are
not tolerated, alternate foods
high in vitamin C should be
incorporated into the diet.
Indicated for patients with
peptic ulcer disease and
gastritis.
A diet consisting of small
meals, high in protein,
moderate in carbohydrate
and bland. Simple sugars are
avoided and fluids are
offered before or after meals
instead of during. Foods at
room temperature are
tolerated better than hot or
cold foods . This diet is
nutritionally adequate
depending on the patient’s
ability to tolerate sufficient
calories, and the nature of
the surgery.
Following gastrointestinal
surgery or for dumping
syndrome following gastric
resection.
Avoid eating close to
bedtime.
Indicated for patients with
hiatal hernia and/or gastric
reflux esophagitis.
6
Avoid irritating foods:
caffeinated or carbonated
beverages like tea, coffee,
and soda. Avoid alcohol,
mint, citrus fruits and
tomatoes. Avoid excessively
fatty foods. Eat frequent
small meals. Avoid eating 23 hours before bedtime.
Sit up during and after
meals. Achieve and maintain
ideal body weight.
Restrict total carbohydrates.
Omit concentrated sweets.
Drink liquids only between
meals. Do not skip meals,
and eat small portions,
frequently. Avoid excessively
hot or cold foods. Patients’
tolerance for certain foods
may differ.
CareGroup SUMMARY
OF DIETS...
DIET TYPE:
GLUTEN FREE/CELIAC
DISEASE
Pages: 181-185
DISEASE RELATED
DIETS:
RENAL
Pre-End Stage Renal Disease
Pages: 487-499
Dialysis
Pages: 455-473
DESCRIPTION/
NUTRITIONAL
ADEQUACY
A diet that is restricted in
gluten. Gluten is a type of
protein found in many
baked goods or grain
products. Foods containing
wheat, oats, barley, rye,
triticale and spelt should be
excluded in the diet.
This diet is nutritionally
adequate.
INDICATIONS
PRINCIPLES
Indicated for patients with
gluten sensitive enteropathy
(also called primary
idiopathic steatorrhea, celiac
sprue, and non-tropical
sprue), and dermatitis
herpetiformis. Tropical
sprue is not responsive to a
gluten free diet.
Offer plain baked or broiled
meats, plain fruits and
vegetables, potatoes, rice
and corn, free of gluten
containing additives.
DESCRIPTION
A diet that is designed to
minimize the metabolic
complications associated
with renal disorders and
possibly delay the need for
dialysis. The nutrient
content of the diet is
planned to meet the
individual need, usually low
protein, sodium and
phosphorus. Potassium is
not usually restricted unless
urine output is diminished
or the patients is taking a
potassium sparing diuretic.
INDICATIONS
Patients with pre End Stage
Renal Disease or Chronic
Renal Insufficiency.
Patients with End-Stage
Renal Disease on Dialysis,
either Hemodialysis or
Peritoneal dialysis.
A diet that is used to
minimize uremic
complications and to
maintain acceptable blood
chemistries, blood pressure
and fluid status while
meeting the need of
individuals with impaired
renal function on
maintenance dialysis.
The diet is deficient in
calcium, iron, Vitamin B12,
and zinc due to low
phosphorus and protein
intake. Diets with  60
grams of protein may be
deficient in niacin, riboflavin
and thiamin. A specific renal
multivitamin (e.g.
nephrovite, nephrocaps) is
recommended.
7
Avoid all foods containing
wheat, oats, barely, malt, rye,
triticale and spelt. Avoid
grain-based alcoholic
beverages.
Read labels of all
commercially prepared
foods.
PRINCIPLES
FOR ALL RENAL DIETS:
Offer high biological value
protein sources, such as
meat, poultry, fish and eggs
within the limits of the
protein restriction.
* DIABETIC RENAL*
GIVE GRAPE JUICE OR
APPLE JUICE FOR
LOW BLOOD SUGAR
Adjust phosphorus
allowance for lab values, &
reinforce the importance of
taking phosphorus binders
and limiting dairy products.
Supplement dietary calcium
intake.
Avoid salt and high
sodium foods, such as
bacon, sausage, luncheon
meats, regular soups, and
salted snack foods. Do not
use salt substitutes that
contain potassium, e.g.
NuSalt.
Avoid high potassium
foods like oranges, citrus,
prunes, melons, bananas,
yams, potatoes, tomatoes,
spinach, & winter squash.
Limit fluid intake, as
instructed. Offer hard
candies or chewing gum for
thirst.
CareGroup SUMMARY
OF DIETS...
DIET TYPE:
LOW PROTEIN
Refer to Liver Disease,
pages: 415-419
POTASSIUM
RESTRICTED
“Low Potassium”
Refer to Potassium Modified
Diets on Pages: 761-768
SODIUM RESTRICTED
Pages: 769-777
DESCRIPTION/
NUTRITIONAL
ADEQUACY
A regular diet which
provides a specific level of
protein according to the
individual’s needs. Fluids
and electrolytes may need to
be restricted due to
coincident metabolic
complications.
Nutritionally adequate at 60
grams of protein; below that
is deficient in protein,
calcium, folic acid, iron,
phosphorus, thiamin, niacin
and riboflavin.
A regular diet which restricts
potassium rich foods in
order to achieve and
maintain fluid and
electrolyte balance when
potassium intake exceeds the
adaptive abilities of the
body. Commonly prescribed
levels are 3000mg (77mEq),
2000mg (51mEq), and
1000mg (25mEq)- however
less than 2000mg is difficult
to achieve through diet, and
will limit most vitamins &
minerals.
A modification of the
regular diet that restricts
foods high in sodium. This
diet is nutritionally adequate
and may be ordered at the
following levels:
 3-4 gram Na (130-174
mEq) = No Added Salt Diet
 2 gram Na (87 mEq)
Only at MAH & NEBH:
 1 gram Na (43 mEq)
INDICATIONS
PRINCIPLES
For treatment of hepatic or
other disorders when normal
protein levels are not
tolerated. Also for lowering
serum ammonia levels and
to provide essential amino
acids.
Control amount of protein,
choose at least 75% from
high biological value
sources, such as eggs, meat,
fish, poultry and dairy
products.
Increase calories as
necessary by adding high
sugar and fat foods as
indicated.
Indicated in the treatment of
hyperkalemia, Renal Failure,
massive tissue destruction,
catabolic states, adrenal
insufficiency, Addison’s
Disease.
May be required for patients
taking potassium-sparing
drug therapy and some
immuno-suppressive
medications.
Indicated in the treatment of
Congestive Heart Failure,
Acute and Chronic Renal
Failure, impaired liver
function, edema, HTN,
CAD, and as an adjuvant to
adrenocorticol therapy.
Fluid restriction (1000-2000
ml) as needed.
8
Use low protein
manufactured products as
appropriate.
Limit intake of milk and
dairy products, fruits and
vegetables.
Refer to the RENAL DIET
list of high potassium foods
to avoid.
Avoid potassium containing
salt substitutes, such as
NuSalt and Morton’s Lite.
Omit salty foods and added
salt, including salt seasonings
such as garlic salt. Omit
cured foods and restrict
processed foods.
Refer to the RENAL DIET
list of salty foods.
CareGroup SUMMARY
OF DIETS...
DIET TYPE:
CARDIAC DIET
Refer to:
“Fat and Cholesterol
Controlled”, Pages: 265-288
Refer also to Cardiac
Surgery on pages 255-258.
DIABETIC diet
“ADA”, “Calorie
Controlled”
Pages: 301-336
DESCRIPTION/
NUTRITIONAL
ADEQUACY
A diet that controls overall
dietary fat, saturated fat and
cholesterol, and based on
patient’s nutritional status,
management may include
sodium, and/or fluid
restriction.
Other co-morbid conditions
(i.e. Diabetes) should be
considered when
determining appropriate diet
therapy. Fluid restriction
(1000-2000 ml) as needed.
This diet is nutritionally
adequate.
A regular diet with balanced
carbohydrate content
designed to guide the person
with diabetes in making
appropriate food choices
and behavioral changes that
will result in optimal blood
glucose and lipid levels,
improved nutritional status
and self-management of
diabetes.
INDICATIONS
PRINCIPLES
To lower elevated serum
cholesterol levels and other
serum lipid levels in the
prevention and treatment of
hyperlipidemia. For
individuals who are at risk
for developing heart disease.
 6 ounces or less per day of
lean meat, skinless poultry,
fish and meat alternatives
 Skim or 1% lowfat milk
 Low-fat or fat-free dairy
products
 6 to 8 teaspoons per day of
unsaturated fats and oils
 Limit egg yolks and regular
soups
 6 or more servings/day of
breads, cereals, rice and
pasta; whole grains for more
fiber.
 3-5 servings per day of
vegetables (fresh or frozen)
 2-4 servings per day of
fruit
 Limited modified fat
desserts
 Restrict fluids as ordered.
 Caffeine may be limited.
To control abnormal glucose
metabolism due to insulin
resistance or the lack of
insulin; as seen in Type1 & 2
Diabetes Mellitus,
Gestational Diabetes
Mellitus (GDM) and
Impaired glucose tolerance.
This diet is nutritionally
adequate.
9
*see FAT RESTRICTED &
SODIUM RESTRICTED
diet guidelines
Provide well-balanced
regularly scheduled meals.
The diet controls the
amount of carbohydrate
provided at each meal to
ensure adequate, but not
excessive portions.
Carbohydrates are found in
fruits, starches, milk and
milk products. Provide
appropriate calories for
individual needs. Encourage
regular exercise. Decrease
total fat, saturated fat and
cholesterol. Recommend
Dietitian Consult for
individual Carbohydrate
Counting Plan. Timing of
meals and medications (such
as insulin or an oral
hyperglycemic agent) may
need to be adjusted based on
individual’s treatment plan.
CareGroup SUMMARY
OF DIETS...
DIET TYPE:
NO CONCENTRATED
SWEETS
Pages: 336A
DESCRIPTION/
NUTRITIONAL
ADEQUACY
A regular diet with the
exclusion of concentrated
sources of simple
sugars/carbohydrates. The
caloric level is not specified
but individuals should
achieve and maintain their
desirable body weight.
INDICATIONS
PRINCIPLES
Non-insulin dependent
diabetes, and for patients
with medical, psychological
or socio-economic
circumstances which
interfere with compliance to
a standard meal pattern.
Achieve and maintain a
desirable body weight.
Avoid concentrated sweets,
such as regular desserts, soft
drinks, honey, jelly & sugar.
Eat well-balanced, regularly
scheduled meals. Include
high fiber foods. Control
portion size. Encourage
regular exercise. Decrease
total fat, saturated fat and
cholesterol.
For fasting or post-prandial
(reactive) hypoglycemia.
Hypoglycemia can occur
from impaired glucose
tolerance due to delayed and
excessive insulin response.
Eat small, frequent meals,
(usually 6 per day). Meals
should be appropriately
timed.
Meals should be wellbalanced, including complex
carbohydrates, protein, fat,
and fiber, which help delay
absorption of carbohydrate.
Limit alcohol and caffeine.
Refer to DIABETIC and
NO CONCENTRATED
SWEETS diets.
PRINCIPLES
Aim for between 75-100gm
of fat per day.
Keep food records of fat
intake
Not recognized by ADA.
REACTIVE
HYPOGLYCEMIA
Pages: 337-340
(refer to Chapter 20, p.301336, Diabetes Mellitus, for
more information to help
regulate carbohydrate intake)
TEST DIETS:
FECAL FAT
(100 gram fat)
page 781
GLUCOSE TOLERANCE
page 782
SEROTONIN TEST:
5-HIAA OR
5HYDROXYINDOLEACETIC ACID
page 783
VANILLYLMANDELIC
ACID (VMA)
page 783
This diet is nutritionally
adequate.
This diet minimizes rapid
elevation of blood glucose
and prevents the symptoms
of low blood glucose that
may result. Simple or refined
carbohydrates should be
avoided due to their ability
to stimulate rapid insulin
secretion. Small, frequent,
high-fiber meals should be
eaten.
DESCRIPTION
This diet provides 100 gms
of dietary fat daily for six
days, 3 days before and 3
days during the 72-hour
stool collection.
This test is designed to
provide adequate
carbohydrate. Individuals
should ingest at least 150
grams of carbohydrate daily
for three days prior to the
test and then fast for 12
hours before the test.
This diet eliminates foods
containing 5-HIAA and its
precursor, serotonin.
Ingestion of these foods
results in elevated levels of
5-HJIAA in the urine and
may give false positive
results
Depending on the laboratory
test used either a regular diet
or one eliminating coffee,
tea, cocoa, vanilla, chocolate,
bananas and citrus fruits is
appropriate.
INDICATIONS
Test for fat malabsorption,
steatorrhea or cystic fibrosis.
More than 7grams of fat in
the stool per 24 hours is
indicative of malabsorption.
To aid in the diagnosis of
diabetes mellitus and
impaired glucose tolerance
At least 150 gm of
carbohydrate daily for three
days before the test.
The patient should fast for
twelve hours before the test.
A 75 gram glucose solution
is consumed during the test.
To diagnose patients having
malignant carcinoid tumors
of the intestinal tract.
Eliminate avocado, banana,
butternuts, eggplant,
hickory nuts, kiwi fruit,
pecans, pineapples, plantain,
plums, tomatoes, walnuts
To diagnose
phenchromocytoma, a rare
tumor, in persons with
unexplained hypertension
Eliminate coffee, tea, cocoa,
vanilla, chocolate, bananas
and citrus fruits
10
CareGroup SUMMARY
OF DIETS...
DIET TYPE:
DESCRIPTION/
NUTRITIONAL
ADEQUACY
DESCRIPTION
These diets are modified to
eliminate allergenic foods
and fit the specific needs of
the patient. Nutritional
adequacy varies with
regimen.
INDICATIONS
PRINCIPLES
INDICATIONS
For individuals with
hypersensitivity to specific
foods.
PRINCIPLES
Varies with regimen but
essentially to eliminate or
restrict, according to
tolerance level, all foods
causing allergic reactions.
A regular diet omitting fruits
that show cross-reactivity
with latex
Used for individuals with
latex allergy
Eliminate avocado, banana,
coconut, chestnut
Pages 210B
A regular diet omitting
sources of foods with high
sulfite levels
Some patients with asthma
are sensitive to foods treated
with sulfites. Symptoms of
reactions include difficulty
breathing, flushing hives and
gastrointestinal symptoms.
TYRAMINE
CONTROLLED DIET
“MAOI”
Pages: 735-741
A diet that eliminates all
major sources of tyramine
and dopamine. This diet is
nutritionally adequate.
To prevent the occurence of
serious side effects from the
ingestion of monoamines,
such as tyramine, in patients
taking mono-amine oxidase
(MAO) inhibitors (a class of
anti-depressant drugs).
LOW PURINE
Pages: 731-734
A diet that eliminates foods
that are high in purine or
uric acid. This diet is
nutritionally adequate.
To help lower serum uric
acid levels in gout and in
some cases of calcium
oxalate stone formation.
Drug therapy with
allopurinol largely replaces
this diet.
LOW MICROBIAL DIET
“Neutropenic”
A regular diet omitting most
fresh fruits and all fresh
vegetables. Most cooked
foods and those that are
commercially processed and
individually packaged are
permitted.
The diet is nutritionally
adequate.
This diet is indicated for
patients who are significantly
immunocompromised, with
neutrophil counts below 500
per ml. Patients receiving
chemotherapy, immediately
post transplant operation or
on immunosuppressive
therapy may be candidates
for the diet
Eliminate foods treated with
sulfites as labeled. Sulfites
are identified as
potassium bisulfite,
potassium metabisulfite,
sodium sulfite, and
sulfur dioxide
Avoid foods containing a
high concentration of
tyramine (aged cheeses,
fermented food items,
preserved fish, soy
products). Foods containing
moderate to low amounts of
tyramine can be used in
moderation. In general, eat
only fresh food or freshly
prepared frozen foods.
Avoid aged and cured foods.
Avoid foods extremely high
in purines, such as organ
meats, sardines, anchovies,
mackerel, mussels, scallops,
shrimp, meat boullion, yeast,
meat gravies. Restrict
protein to 1 gram per kg of
ideal body weight.
Avoid large amounts of fat
which may inhibit excretion
of urate. Drink at least 8
cups of fluids per day.
Achieve and maintain ideal
body weight. Restrict alcohol
intake.
Offer cooked foods and
commercially prepared
foods in individual servings
such as single containers of
milk, juices and canned
fruits. Avoid most fresh
fruits and vegetables. Avoid
deli meats and cold cuts.
Avoid unpasteurized cheese.
OTHER DIETS:
ALLERGY
Refer to Food
Hypersensitivities
Pages: 194-210
Latex Sensitivity
Pages: 210A
Sulfite Sensitivity
Page: 840
11
CareGroup Enteral Nutrition Formularies
NEBH
Isotonic
Isotonic High Protein
Fiber Containing
Isocal HN
Fiber Containing High Protein
Elemental
Ultracal HN+
Criticare HN
Semi-Elemental
Critical Care
Peptixex
Replete
Wounds/Critical Care with Fiber
Diabetic
Pulmonary Disease
Renal Disease
Liver Disease
Replete with Fiber
Choice DM
Fluid Restricted
Deliver 2.0
Magnacal Renal
12