Diets and Oral Supplements

Good Shepherd Medical Center – LongviewCreated by: Clinical Dietitians, 2013

ObjectivesParticipant will be able to identify

foods appropriate for diets offered

Participant will be able to identify oral supplements and implications for use

Participant will be able to identify goals for oral supplementation

Oral DietsALL Diets MUST have a Physician

Order and be entered into Meditech.

Verbal orders are not appropriate.

Diets served will match what is entered into Meditech.

Clear Liquid (CL)Overview – transitional diet to

promote return of normal digestion

Inadequate in protein and caloriesFoods Allowed Foods NOT Allowed

Carbonated beverages Liquids you cannot see through

Broths Orange Juice w/ Pulp

Juices – grape, cranberry, apple

Decaffeinated & Regular beverage

Full Liquid (FL)Overview – transitional diet w/

easy to consume and digest food for minimal GI tract stimulation

Inadequate in protein and calories for most patients.

Foods Allowed Foods NOT Allowed

All items allowed on a CL diet

All solid foods

All items liquid at room temperature – ice cream, yogurt, etc

Foods not liquid at room temperature

Fruit and Vegetable Juice

Oatmeal, Cream of Wheat

Creamed or Strained Soups

PureedPurpose – smooth food which

provides a modified texture for dysphasiaFoods Allowed Foods NOT Allowed

Beverages: smooth but may require thickening

Cereals & Grains: cream of wheat, grits, slurried breads

Cereals & Grains: oatmeal, dry cereals, regular rice & pasta

Fruits & Juices: applesauce, pureed fruits, mashed banana

Fruits & Juices: juices w/ pulp, non-pureed texture

Soups/Veggies/Potatoes: pureed or strained, mashed potatoes, cream or broth soup

Soups/Veggies/Potatoes: raw veggies, French fries, soups w/ food pieces

Meats/Entrees: pureed protein sources, smooth soufflés, scrambled eggs

Meats/Entrees: cottage cheese, cheese pieces, regular meats, pizza, boiled eggs

Low Fiber/Low ResidueOverview – minimizes GI

stimulationAlso known as GI soft diet

Food Allowed Foods NOT Allowed

All beverages – no pulp, limited milk

White bread/grains Whole wheat products, oatmeal

Canned/well-cooked vegetables

Raw vegetables, vegetable skins (i.e. potato)

Canned/cooked fruits Hard fruits such as apples, fruit skins

Mechanical SoftOverview – soft, simple to chew

foodsPurpose – transition from pureed

dietFoods Allowed Foods NOT Allowed

Beverages: minimal texture or pulp

Cereals & Grains: pancakes, oatmeal/cream of wheat/grits, dry cereal w/ milk, pasta w/ sauce

Cereals & Grains: no nuts, seeds or coarse grains

Fruits & Juices: soft fruits w/out skin (i.e. banana), juices w/ minimal pulp

Fruits & Juices: fresh/raw fruits

Soup/Veggies/Potatoes: soft or mashes, easy to swallow

Soup/Veggies/Potatoes: raw vegetables, soup w/ large chunks

Meats/Entrees: chopped meats, chicken/tuna salad, cottage cheese, scrambled eggs, baked beans

Meat/Entrees: dry/tough meats, pizza

RenalOverview – restricts protein,

potassium, sodium and phosphorusFoods Allowed Foods NOT Allowed

Low K+: apple (no skin), applesauce, fruit cocktail, grapes

High K+: citrus fruits, banana, potatoes, tomato products, salt substitute

Low Na: salt free seasonings, pepper, baked meats, rice

High Na: processed foods, salt

High Phos: nuts, chocolate, whole wheat products

Proteins: meat, eggs

Consistent Carbohydrate (Con CHO)

Overview – appropriate portions of CHO foods w/ fat intake modification, consistent timing of meals

PORTION SIZE is the key to success1 CHO choice = 15 gm CHO

Foods Allowed w/ Appropriate Serving Size

Food NOT Allowed

Beverages: Juice (4oz), unsweetened tea, diet sodas, water, flavored water

Regular sodas/sugar sweetened beverages such as lemonade/Gatorade/sweet tea

Desserts: SF Pudding (1/2 cup), Fruit

Regular desserts

Starches: potatoes (1/2 cup), pasta & rice (1/3 cup), bread (1 slice)

High fat foods such as fried foods

Fruit: ½ cup servings High Na foods

Large portions

RegularOverview – no restrictionsEncourage healthful foods

choices to limit fat and salt (sodium) intakes

Foods Allowed Foods NOT Allowed

All None

Encourage low salt and low fat items

BariatricClear Liquid

◦1st stage post-op; inadequate in protein, calories and micronutrients

◦Restricted to 2-4 oz per meal◦Frequent liquids throughout the day

Full Liquid◦2nd stage post-op◦Restricted to 2-4 oz per meal◦Frequent liquids throughout the day◦Protein Supplements

BariatricPureed

◦3rd Stage post-op◦3-5 oz per meal; follows Pureed diet

guidelines for consistency◦Protein Supplements

Mechanical Soft◦4th Stage post-op◦3-5 oz per meal; follows Mechanical

Soft guidelines

BariatricRegular

◦3-5 oz per meal◦6 small meals and snacks per day◦Protein Supplements PRN◦Encourage consumption of

appropriate food choices over protein supplementation

◦**Fluids should be consumed between meals without straws.

Oral SupplementsEnsure CompleteEnsure ClearGlucerna ShakeJuvenScandi Shake

◦Powdered product; mix with milkMighty ShakeOptisource

Oral SupplementsEnsure Complete

◦Commonly associated w/Regular diet◦8 oz, 350 kcal, 13 gm protein, 52 gm

CHO◦Flavors: Vanilla, Chocolate,

Strawberry

Ensure Clear◦6.7 oz, Clear Liquid Supplement◦200 kcal, 7 gm protein, 43 gm CHO◦Flavors: Apple, Mixed Berry

Oral SupplementsGlucerna Shake

◦Commonly associated w/Con CHO diet◦8 oz, 220 kcal, 10 gm protein, 29 gm

CHO◦Flavors: Chocolate, Vanilla, Strawberry,

Butter Pecan

Pediasure w/ Fiber◦8 oz, 240 kcal, 7 gm protein, 33 gm CHO◦Flavors: Vanilla

Oral SupplementsScandi Shakes

◦440 kcal, 5 gm protein, 58 gm CHO◦Flavors: Vanilla, Strawberry,

ChocolateMighty Shakes

◦4 oz, 200 kcal, 6 gm protein, 30 gm CHO

◦Flavors: Vanilla, Chocolate, Strawberry

Mighty Shakes – Sugar Free◦4 oz, 200 kcal, 8 gm protein, 20 gm

CHO◦Flavors: Vanilla

Oral or Tube SupplementsBeneprotein –mixed w/ H2O

◦25 kcal, 6 gm protein, 0 gm CHO◦Protein supplement

Juven – mixed w/ H2O◦Promotes wound healing and

maintenance of lean body mass◦80 kcal, 14 gm Amino Acids (not a

complete protein)◦Flavors: Orange, Fruit Punch,

Unflavored