diets in gastric and liver diseases.docx

Diets in Gastric Diseases

Dysphagia - difficulty in swallowing; the main focus of medical nutrition therapy for dysphagia is to provide nutrition in a form that fits specific anatomic and functional needs of the patient while maintaining or improving nutritional status and avoiding aspiration

S/sx of dysphagia:

- Collecting food under the tongue, in the cheeks, or on the hard palate- Spitting food out of the mouth, or tongue thrusting- Inability to control tongue- Excessively moving tongue- Decreasing oral transit time- Experiencing delay or absence of elevation of larynx while swallowing- Coughing before or after swallowing- Choking- Drooling- Experiencing gargled voice after eating of drinking- Regurgitating food or liquid through nose, mouth, or tracheostomy tube- Nor taking in adequate amounts of food or fluids resulting in weight loss- Increasing time required to eat- Resisting food, such as clenching teeth, pushing food away, clutching throat

Medical Nutrition Therapy:

Four-stage Dysphagia diet

Stage 1 – Pureed Diet:

Rationale: suitable for persons with severely reduced oral preparatory stage abilities, impaired lip and tongue control, delayed swallow reflex triggering oral hypersensitivity, reduced pharyngeal peristalsis, and/or cricopharyngeal dysfunction.

Description: thick homogeneous textures are emphasized, should be “spoon thick” or “pudding-like” consistency. No course textures, nuts, raw vegetables, or raw fruits allowed. Liquid or crushed medications are required and may be mixed with the pureed fruits. Liquids and water are thickened with commercial thickening agent as needed to recommended consistency.

Adequacy: intakes may be limited because of decreased appetite or increased time required to eat. Additional enteral feeding could be necessary; fluid intake should be monitored.

Stage 2 – Ground/minced Diet:

Rationale: intended for patients who can tolerate a minimum amount of easily chewed foods. May be suitable for persons with moderately impaired oral preparatory stage abilities, edentulous oral cavity, decreased pharyngeal peristalsis and/or cricopharyngeal muscle dysfunction.

Description: no course textures, nuts, raw fruits, raw vegetables (except mashed or ripe). Pureed or slurried bread, if necessary. Liquid or crushed medications may be required also. Liquids and water are thickened with commercial thickening agent as needed to recommended consistency.

Adequacy: intakes may be limited because of decreased appetite or increased time required to eat. Additional enteral feeding could be necessary; fluid intake should be monitored.

Stage 3 – Selt/easy-to-chew Diet:

Rationale: for patients who may have difficulty in chewing, manipulating, and swallowing certain foods. Based on a mechanical diet; consists of soft food items prepared without blenderizing or pureeing. May be appropriate for persons beginning to chew or with mild oral preparatory state deficits.

Description: textures are soft with no tough skins. No nuts or dry, crispy, raw, or stringy foods allowed. Meats should be minced or cut in small pieces (diced pieces should be cubes of 1cm or less). Liquid or crushed medications may still be required. Liquids and water are thickened with commercial thickening agent as needed to recommended consistency.

Adequacy: contingent on individual selection and amounts consumed, this diet is designed to provide adequate quantity of nutrients as indicated by DRI and RDA. Monitor fluid intake.

Stage 4 – Modified General Diet:

Rationale: designed for patients who chew soft textures. Based on soft diet; may be appropriate for persons with mild oral preparatory stage deficits.

Description: soft textures not requiring grinding or chopping used. No nuts or crisp, deep fried foods allowed. All liquids and medication used as tolerated. Liquid or crushed medications may still be required. Liquids and water are thickened with commercial thickening agent as needed to recommended consistency.

Adequacy: contingent on individual selection and amounts consumed, this diet is designed to provide adequate quantity of nutrients as indicated by DRI and RDA. Monitor fluid intake. Nutritional supplements may be needed.

Gastro-esophageal reflux disease (GERD) – return of gastric contents into the esophagus that results in a severe burning sensation in the sternum.

S/sx:

Adults

The most-common symptoms of GERD are:

Heartburn Regurgitation Trouble swallowing (dysphagia)

Less-common symptoms include:

Pain with swallowing (odynophagia) Increased salivation (also known as water brash) Nausea Chest pain

Several other atypical symptoms are associated with GERD, but there is good evidence for causation only when they are accompanied by esophageal injury. These symptoms are:

Chronic cough Laryngitis (hoarseness, throat clearing) Asthma Erosion of dental enamel Dentine hypersensitivity Sinusitis and damaged teeth Pharyngitis


- 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 meets the Recommended Dietary Allowances (RDA) of the National Research Council.

Special ConsiderationsThe 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 portions of food at mealtime.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 weaken the muscle valve in the lower esophagus, aggravate acid reflux, and

should be avoided:o fatty or fried foodso peppermint and spearminto whole milko oilso chocolateo creamed foods or soups

9. The following foods irritate an inflamed lower esophagus and may need to be limited or avoided:o citrus fruit and juiceso coffee (regular and decaffeinated)o grapefruit, orange, caffeinated soft drinkso pineapple, tomato

10. The following foods strengthen the muscle valve in the lower esophagus and help to prevent acid reflux.

o low-fat, high protein foodso low-fat carbohydrates (bread, cereal, pasta, crackers)o calcium, as in fat-free milk and low-fat yogurt

FOOD GROUPS

Group Recommend AvoidMilk or milk Products skim, 1% or 2% low-fat milk;

low-fat or fat-free yogurtwhole 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

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 oilsSweets & desserts all items 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

Soups fat-free or low-fat based chicken, beef, milk, or cream-based soups.

Hiatal hernia – herniation of a portion of a stomach into the chest through the esophageal hiatus of the diaphragm.

S/sx:

- dull chest pains- heart palpitations- shortness of breath


Foods to Enjoy:

- The following foods are low-acid-producing foods and should not aggravate your hiatal hernia symptoms:

Bananas and apples Green beans, peas, carrots, and broccoli Grains, like cereals (bran and oatmeal), bread, rice, pasta, and crackers Low-fat or skim milk and low-fat yogurt Egg whites and egg substitutes Fat-free cheeses, cream cheese, and fat-free sour cream Lean meat, chicken, and fish Water Pretzels, graham crackers, rice cakes, and baked potato chips Low-fat sweets (no chocolate or mint)

- You may find that some of the foods listed under "foods to avoid" may not bother you, while others on the "foods to enjoy" list may cause discomfort. Everyone tolerate food differently. To determine the best diet for you, keep a food diary for a few weeks.

Foods to Avoid:

- The following foods are highly acidic and/or may weaken the lower esophageal sphincter, making it easier for stomach acids to back up into your esophagus:

Citrus foods, such as oranges, grapefruits, and lemons, and orange juice, grapefruit juice, cranberry juice, and lemonade

Chocolate Fatty and fried foods, such as fried chicken and fatty cuts of meat Garlic and onions Spicy food Peppermint and spearmint Tomato-based foods such as spaghetti sauce, pizza, chili, salsa, and tomato juice Coffee, tea (including decaffeinated versions), and alcohol Carbonated beverages Dairy products, such as whole milk, ice cream, and creamed food. Try soy milk; it may

be a good milk substitute. Also, mild cheeses, like feta or goat, may be enjoyed in moderation, or more often if you can tolerate them

Oil and butter

Cooking Tips:

- A good way to enjoy the foods listed above is to cook them in a healthy way. Here are some heartburn-friendly cooking tips:

Choose lean meats, such as skinless chicken, meat with little visible fat, ground turkey instead of ground beef, and fish. Lean beef cuts include round, chuck, sirloin, or loin. Lean pork cuts include tenderloin or loin chop.

Bake or broil foods instead of frying. Skim off fat from meat during cooking. Go easy on seasoning. Most seasonings are OK as long as they are not spicy, but should

be used in moderation. Substitute low-fat dairy products, such as low-fat yogurt, for ice cream. Steam your vegetables using water only. Limit butter, oils, and cream sauces. Use cooking spray instead of cooking oil when

sautéing. Choose low-fat or non-fat ingredients over full-fat products. Get creative. There are all kinds of ways to modify recipes. Don't be afraid to try new

things.

Esophagitis – inflammation of the lower esophagus.


Soft foods – doctors usually prescribe acid blocking medication to reduce stomach acid production. Medicine used to gargle helps relieve pain. Avoiding hard foods, such as nuts, crackers and raw

vegetables, prevents aggravation of the esophagus until painful symptoms subside. Soft foods, such as cooked cereals, mashed potatoes, puddings and high-protein shakes are recommended.

Avoiding Triggers – making regular, long-term changes to the diet reduces or eliminates acid reflux over time. Acid reflux may occur because an esophageal muscle weakens and does not close tightly after eating, causing stomach acid backup into the esophagus to bring about heartburn and acid regurgitation. Certain foods trigger acid reflux by relaxing the esophageal muscle or increasing stomach acid secretion during digestion. They may include fried or fatty foods, tomato-based products, citrus fruits, chocolate, garlic, onions, spicy foods and drinks with caffeine or alcohol.

Protein – continue eating soft foods until the painful symptoms have disappeared. Check with your doctor to start on your diet to reduce acid reflux for the long term. Eating protein foods may help strengthen the muscle in your esophagus to prevent symptoms, according to the University of Maryland Medical Center. Protein helps repair muscle tissue. Avoid high-fat protein foods by choosing lean meats, fish and skinless poultry. Bake, broil and grill the foods instead of frying. Do not eat tough meats if you still have difficulty swallowing. Include low-fat or nonfat dairy products rather than whole-milk items in your diet for protein.

Fiber Foods – a high-fiber diet rich in fruits, vegetables and whole grains helps prevent acid reflux. However, avoid citrus fruits and tomatoes, which have acidic contents, and fried or creamy vegetables, which can trigger symptoms. Enjoy bananas, peaches, pears, apples and berries. Steam vegetables or eat them raw if you have no trouble swallowing. Whole grain foods aid digestion to avoid stomach acid buildup. Whole grains may absorb excess acid from its gel-like quality during digestion to reduce reflux. Add whole-grain bread, pasta or cereal to your dishes. Oatmeal, oat bran, brown rice, barley and air-popped popcorn provide whole-grain benefits to prevent acid reflux and protect you from esophagitis.

Avoid fatty foods Avoid spicy foods Avoid acidic foods and beverages such as citrus and tomatoes Eat smaller meals Eat soft foods that are easily digested Avoid coffee (even decaffeinated), alcohol, soda, and chocolate

Peptic Ulcer Disease – is the term to describe a break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum

S/sx:

- abdominal pain, classically epigastric with severity relating to mealtimes, after around three hours of taking a meal (duodenal ulcers are classically relieved by food, while gastric ulcers are exacerbated by it);

- bloating and abdominal fullness;- waterbrash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus -

although this is more associated with gastro-esophageal reflux disease);- nausea, and copious vomiting;- loss of appetite and weight loss;- hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric ulcer, or

from damage to the esophagus from severe/continuing vomiting.- melena (tarry, foul-smelling feces due to oxidized iron from hemoglobin);- rarely, an ulcer can lead to a gastric or duodenal perforation, which leads to acute peritonitis. This

is extremely painful and requires immediate surgery.


For some people, certain foods seem to aggravate their symptoms. For them, they need a diet that is designed to accomplish the following:

Restrict or avoid those foods that may cause irritation to the digestive system Reduce excessive acid production

Prevent unpleasant side effects, such as heartburn.

Points to Remember:

Eat 5 to 6 small meals a day instead of 3 larger meals. It is important that you avoid overeating. Frequent, smaller meals will be more comfortable and easier on the stomach than two or three large meals a day.

Eat a diet rich in fiber, especially from fruits and vegetables Rest and relax a few minutes before and after each meal, as well as remaining relaxed during

meals. Eat slowly and chew you food well Avoid eating within 3 hours before bedtime Eat foods that are low fat Avoid foods that are fried Avoid foods that are spicy Cut down on the following foods:

- Coffee- Decaffeinated coffee- Tea- Cola drinks- Carbonated beverages- Citrus fruits- Tomato-based products- Chocolate

Avoid alcohol Quit smoking

Foods that are recommended:

Breads and Grains

- Whole-grain or enriched, seedless breads and grains: Breads Tortillas English muffins Hamburger and hot dog buns Dinner rolls Pita bread Cereals Enriched rice Enriched barley Enriched noodles, spaghetti, macaroni, and other pastas French toast, muffins, pancakes, and waffles made with low-fat ingredients Low fat crackers

Vegetable

- Fresh - Frozen - Canned

Fruit

- Fresh- Frozen - Canned - Fruit juice as tolerated

Milk and Dairy Products

- Low fat and non-fat milk and milk products - Cheese with less than 5 grams of fat per ounce- Plain mild cheeses- Low-fat and non-fat yogurt- Low-fat cottage cheese

Meat and Meat Substitutes

- All lean meat: Beef Pork Lamb Veal Poultry (without the skin)

- All fresh, frozen, or canned fish packed in water - Crisp bacon- Lean ham- Eggs- Smooth peanut butter and nut butters - Soybean curd (tofu) and other meat substitutes - Dry beans and peas prepared without fat- Soups- Mildly seasoned meat stock or cream soups

Fats (use sparingly)

- Non-fat or low-fat dressings and mayonnaise- Non-fat or low fat salad dressings - Mildly flavored gravies and sauces- Light or low-fat margarine- Sugar- Syrup- Honey- Jelly- Seedless jam

Snacks (use sparingly)

- Hard candies- Marshmallows- Sherbet- Fruit ice - Gelatin- Angel food cake - Graham crackers - Pretzels (soft or hard) - Rice cakes

Misc.

- Salt- Pepper- Mild flavorings- Most herbs- Ketchup, mustard and vinegar in moderation- All beverages as tolerated

Bad foods:

Breads and Grains

- Breads and cereals prepared with high-fat ingredients: Croissants Biscuits Granola-type cereals

- Bread or bread products with nuts or dried fruit - Seeds in or on breads, and crackers - Bran cereals- Wild rice- High fat snack crackers

Vegetable

- Raw vegetables- Corn- Broccoli- Brussels sprouts- Cabbage- Onions- Cauliflower- Cucumber- Green peppers- Rutabagas- Turnips- Sauerkraut- Vegetables prepared with added fat- Tomatoes and tomato products

Fruit

- Lemons- Grapefruit- Oranges- Pineapples- Tangerines- Citrus juices such as orange, pineapple and grapefruit juice - Berries and figs

Milk and Dairy Products

- Whole milk- Chocolate milk- Buttermilk made with whole milk- Evaporated whole milk- Cream- Strong flavored cheeses

Meat and Meat Substitutes

- Highly seasoned meats Corned beef Luncheon meats Frankfurters and other sausages

- Highly seasoned poultry- Highly seasoned fish:

Sardines Anchovies

- Fried meats- Fried poultry- Fried fish- Fatty meat- Dry beans and peas prepared with fat- Chunky peanut butter- Nuts- Seeds (such as sunflower seeds)

Fats

- Gravies- Cream soups- Highly seasoned salad dressings

Snacks

- High-fat snacks: Chips Fried potatoes Buttered popcorn

- Cakes- Cookies- Pies- Pastries- Doughnuts- Coconut- Chocolate- Creamed candy- All sweets and desserts containing nuts, coconut or fruit

Misc.

- Carbonated beverages- Coffee (regular or decaffeinated)- Caffeine-containing beverages:

Coffee Tea Colas Orange soda Dr. Pepper

- Alcoholic beverages- Strongly flavored seasonings and condiments:

Garlic Barbecue sauce Chili sauce Chili pepper Chili powder Horseradish Black pepper

- Highly spiced foods- Pickles- Nicotine- Aspirin and aspirin-containing medicines- NSAIDs

Dumping Syndrome – contents from the stomach empty too rapidly into the duodenum, causing symptoms of profuse sweating, nausea, dizziness, and weakness.

S/sx:

Early signs (30-60mins after eating):

- Nausea- Vomiting- Bloating- Cramping- Diarrhea- Dizziness- Fatigue- Light-headedness- Rapid heartbeat

Late signs (happens after 1-3hrs after eating):

- Weakness- Sweating- Shakiness, dizziness, fainting, or passing out- Loss of concentration or mental confusion- Feelings of hunger- Rapid heartbeat


Foods to avoid:

- Avoid eating sugar and other sweets such as: Candy Sweet drinks Cakes Cookies Pastries Sweetened breads

- Also avoid dairy products and alcohol. And avoid eating solids and drinking liquids during the same meal. In fact, don't drink 30 minutes before and 30 minutes after meals.

Foods to eat:

- To help with symptoms, also try these tips: Use fiber supplements, such as psyllium (Metamucil or Konsyl), methylcellulose

(Citrucel), or guar gum (Benefiber). Use sugar replacements, such as Splenda, Equal, or Sweet'N Low, instead of sugar. Go for complex carbohydrates, such as vegetables and whole-wheat bread, instead of

simple carbohydrates, such as sweet rolls and ice cream. To prevent dehydration, drink more than 4 cups of water or other sugar-free,

decaffeinated, noncarbonated beverages throughout the day. To maintain or gain weight, eat extra servings of meat and fat. To lose weight, decrease servings of fat.

How to eat:

- Here are some other ways to lessen symptoms of dumping syndrome: Eat five or six small meals or snacks a day. Keep portions small, such as 1 ounce of meat or 1/4 cup of vegetables.

Cut food into very small pieces. Chew well before swallowing. Combine proteins or fats along with fruits or starches. (For example, combine fruit with

cottage cheese.) Stop eating when you first begin to feel full. Drink liquids 30 to 45 minutes after meals. Reclining after eating may help prevent light-headedness or fainting.

Celiac Disease (Gluten-sensitive enteropathy) – is a chronic autoimmune disorder in which the mucosa of the small intestine, especially the duodenum and proximal jejunum, is damaged by gluten.

S/sx:

The symptoms of celiac disease can be different from person to person. This is part of the reason why the diagnosis is not always made right away. For example, one person may have constipation, a second may have diarrhea, and a third may have no problem with stools.

Gastrointestinal symptoms include:

- Abdominal pain, bloating, gas, or indigestion- Constipation- Decreased appetite (may also be increased or unchanged)- Diarrhea, either constant or off and on- Lactose intolerance (common when the person is diagnosed, usually goes away after treatment)- Nausea and vomiting- Stools that float, are foul smelling, bloody, or “fatty”- Unexplained weight loss (although people can be overweight or of normal weight)- Because the intestines do not absorb many important vitamins, minerals, and other parts of food,

the following symptoms may start over time: Bruising easily Depression or anxiety Fatigue Growth delay in children Hair loss Itchy skin (dermatitis herpetiformis) Missed menstrual periods Mouth ulcers Muscle cramps and joint pain Nosebleeds Seizures Tingling or numbness in the hands or feet Unexplained short height

Children with celiac disease may have:

- Defects in the tooth enamel and changes in tooth color- Delayed puberty- Diarrhea, constipation, fatty or foul-smelling stools, nausea, or vomiting- Irritable and fussy behavior- Poor weight gain- Slowed growth and shorter than normal height for their age

Signs and tests:

- Albumin (may be low)- Alkaline phosphatase (high level may be a sign of bone loss)- Clotting factor abnormalities- Cholesterol (may be low)- Complete blood count (CBC - test for anemia)- Liver enzymes (transaminases)- Prothrombin time


Once the gluten is removed from the diet, symptoms gradually improve during the following weeks and months.

Food to avoid (gluten sources):

- Commercially breaded meats, fish, poultry- Meat loaf and patties, cold cuts, and other prepared meats, frozen chicken with vegetable broth,

imitation meat or fish products, cheese foods and other spreads, soy protein meat substitutes, canned baked beans, peanut butter, dry roasted nuts

- Breads, cracker, cereals, pastas, pretzels, and communion wafers made with wheat (graham flour, durum flour, pastry flour, bran or wheat germ), spelt, kamut, rye, barley or oats, malt, malt flavoring, malt extract.

- Commercially seasoned rice and potato mixes, rice crackers, some rice cakes, popped corn cakes, rice and corn cereals

- Commercially breaded vegetables- Commercially seasoned vegetables mixes, French-fried potatoes, scalloped potatoes, vegetables

with a cheese sauce.- Commercial pie fillings- Commercial gravies, white and cream sauce- Commercial salad dressing and mayonnaise- Most canned soups, dried soup mixes, soup bases and bouillon cubes made with wheat flour,

hydrolyzed wheat protein, barley, or noodles.- Commercial cakes, cookies, pastries, and ice cream cones, commercial dessert mixes, licorice- Ice cream puddings and chocolate bars- Milk beverages that contain malt, cereal beverages, beer, ale, and lager- Commercial chocolate milk, cocoa mixes, flavored and herbal teas, flavored coffees, fruit-

flavored drinks, soy or rice beverages

Lactose Intolerance – is the inability to digest and metabolize lactose, a sugar found in milk.

S/sx:

- symptoms appear thirty minutes to two hours after consumption of lactose, and typically include: abdominal bloating and cramps flatulence diarrhea nausea borborygmi (rumbling stomach) vomiting (particularly in adolescents)


Dairy:

(No Lactose: You may eat or drink these lactose free dairy foods any time.)

- Canned nutrition drinks made with soy instead of milk, such as Ensure- Lactose free milk- Non-dairy creamers (read labels to be sure)- Rice milk drinks- Soymilks

(Do not eat or drink the following dairy foods because they contain lactose.)

- Some cheeses - generally aged cheese contains less lactose, soft and processed cheeses contain higher levels of lactose

- Buttermilk- Cheese spreads and cheese foods- Cottage and ricotta cheese- Cream

- Evaporated & condensed milk- Hot chocolate mixes- Ice cream- Kefir cultured milk drink- Malted milk- Milk (Skim, 1%, 2%, whole)- Processed and natural cheeses- Reduced lactose milk- Sherbet- Sour cream- Sweet acidophilus or lactobacillus milk- Whey- Yogurt with or without live cultures

Breads & starches:

(No Lactose: You may eat or these lactose free breads and starches any time.)

- Breads made without milk, such as Italian & French breads- Cereals made without milk- Pasta, noodles, macaroni- Potatoes, rice, barley, other cooked grains- Rice cakes without cheese topping- Saltines and whole grain crackers

(Do not eat the following bread and starch foods because they contain lactose.)

- Dry cereal with milk- Frozen potato foods with milk or lactose- Instant mashed potato mixes- Prepared breads, muffins, biscuits, or rolls made with milk- Pancakes or waffles made with milk products

FATS:

(No Lactose: You may eat or drink these lactose free fats any time.)

- Margarine without butter or milk (check labels)- Non-dairy creamers (check labels)- Oils- Shortenings- Some salad dressings (check labels)

(Do not eat or drink the following fats because they contain lactose.)

- Butter- Cream cheese- Margarines with butter or milk- Party dips

Fruits & vegetables:

(No Lactose: You may eat or drink these lactose free fruits and vegetables any time.)

- All fresh fruits & vegetables- Cooked or baked fruits & vegetables made without milk products- Fruit & vegetable juices

(Do not eat or drink the following fruit and vegetable foods because they contain lactose.)

- Creamed vegetables- Fruit smoothies made with yogurt- Fruits or vegetables processed with lactose- Vegetables coated in batter

Meats & meat substitutes:

(No Lactose: You may eat these lactose free meats and meat substitutes any time.)

- All fresh cooked, plain meats, fish, & poultry- Cooked dried peas & beans- Eggs cooked without milk- Peanut butter, nuts, & seeds- Soy cheese- Soybean & tofu products

(Do not eat the following meats and meat substitutes because they contain lactose.)

- Breaded or batter-dipped meat, fish, or poultry- Main dishes with cheese such as pizza, burritos, tacos, or casseroles- Meats in cream sauces- Omelets or souffles with milk- Processed meats with milk or lactose (hot dogs, cold cuts, deli meats)

Soups, sauces, & seasonings:

(No Lactose: You may eat or drink these lactose free soups, sauces, and seasonings any time.)

- Broth, bouillon, consommé- Gravies made with water- Plain herbs & spices- Vegetable or meat soups without milk

(Do not eat the following soups, sauces, and seasonings because they contain lactose.)

- Chowders- Cream soups- Soup mixes with milk products- Whipped cream- White sauces & gravies

Sweets & desserts:

(No Lactose: You may eat or drink these lactose free sweets and desserts any time.)

- Angel food cake- Dairy-free frozen desserts made with rice or soy- Frozen pureed fruit bars- Fruit ices & sorbets- Gelatin desserts without milk or whipped cream- Honey, sugar, syrups, molasses, & powdered sweeteners- Jellies, jams, preserves- Pies, cakes, other baked foods without milk

(Do not eat or drink the following sweets & desserts because they contain lactose.)

- Cookies, cakes, pies, pastries, desserts with milk- Cream or cheese filled pastries- Fudge, coated candies, & chocolates- Pudding & custard- Sherbet, ice milk, ice cream- Toffee, butterscotch, or caramels- Whipped cream

Food ingredients that often contain lactose:

- Milk powder- Milk protein- Milk solids- Non-fat dry milk- Whey- Whey solids or protein

Inflammatory bowel Disease – refers to two idiopathic chronic inflammatory conditions – chronic ulcerative colitis (an inflammatory process confined to the mucosa of any or all of the large intestine) and crohn’s disease (an inflammatory disorder that involves all layers of the intestinal wall and may involve the small and large intestine or both; is associated with stricture formation, fistulous tracts, and abscesses)


Goals of nutrition therapy are to replace nutrients lost as a result of the inflammatory process, correct deficits, and provide adequate nutrition to achieve and maintain energy, nitrogen, fluid and electrolyte balance.

- High calorie intake- High protein intake- High fiber intake:

Excellent Sources Good Sources Fair Sources Poor SourcesAll-bran cerealBran buds cerealBran chex cerealCorn bran cerealRaisin bran cerealGrape nuts cerealFiber one cerealPear, with skinBaked beansKidney beans, cookedChick peas (garbanza)

Apple with skinPrunesRaisinsStrawberries, rawBlueberriesBroccoli, cookedGreen beans, frozenPeas, cookedPotato with skinSweet potato with skinBlack-eyed peasWhole wheat breadShredded wheat cerealBran muffinOatmeal, cookedGraham crackers

BananaPineapple, cannedCheeriosCorn, whole kernel, cannedCauliflowerCarrotsTomato, rawBrown rice

CeleryCucumberLettuce (iceberg)MushroomsOnionsGrapefruitsFruit juicesVegetable juicesCrisped rice cerealCorn flakes cerealRefined wine

- Flour products- White bread- Rolls- Bagels- Most pastas- Pizza crust- crackers

Diets in Liver Disease

Cirrhosis – is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules (lumps that occur as a result of a process in which damaged tissue is regenerated), leading to loss of liver function.


Food to avoid:

There are two things you should avoid: alcohol and high-fat foods. For people with cirrhosis, regardless of the cause, alcohol should be completely avoided. And, diets high in fat for people with

cirrhosis may cause potential digestion problems. The body digests (breaks down) fats using bile, which is a yellow-green fluid made in the liver. When the liver is damaged, the production and supply of bile may be affected.

However, it is important not to avoid fat entirely because the body requires a daily supply to remain healthy. Here, as is with much of proper nutrition, moderation and good selection is the key. For your dietary fat, choose foods like nuts, avocados, fish and plant oils.

Pancreatitis – is inflammation of the pancreas, an organ that produces several enzymes to aid in the digestion of food, as well as the hormone insulin, which controls the level of sugar (glucose) in the blood.


As the pancreas becomes inflamed, there are two consequences; either the gland loses its ability to produce digestive enzymes, a condition called exocrine failure or there is reduction in insulin production, medically known as endocrine failure. In both the cases resulting pancreas problems negatively affect the normal functioning of the body system. Thus, timely therapeutic intervention is essential to avoid worsening of this health problem. And pancreatitis diet is suggested as a part of the treatment plan. Pancreatitis foods recommendations are discussed below:

1. Limit Fat Intake – a thumb rule followed in pancreatitis diet plan is to reduce food items that require enzymes secreted by pancreas for digestion. With reference to this, the total fat content in the daily diet should be less than 30 percent. The remaining calorie should come from other nutrient sources i.e. proteins and carbohydrates. To achieve this, one needs to plan the meal menu with reference to the amount of calories yielded by fats.

2.Add Protein Rich Foods – even though there is reduced production of enzymes for digesting proteins and carbohydrates, these two nutrients cause minimal pressure to the pancreas. So, including foods that contain proteins and carbohydrates is a way to fulfill body's energy requirements in this situation. Also, incorporate foods that are rich sources of antioxidants, as they help in combating the inflammatory responses. Substituting red meat with chicken surely helps in minimizing this pancreas condition to some extent, as the former contains saturated fats.

3.Include Plant-Based Foods – incorporating plant-based foods that are low in fat content is an easy tip in planning a diet for pancreatitis. Green leafy vegetables, fresh fruits and fruit juices are healthy alternatives for people with pancreatitis condition. Some of them are also rich in proteins and carbohydrates, which are recommended for pancreatitis patients.

4.Reduce Spicy and Hot foods – pancreatitis dietary guidelines are recommended to control further inflammation of the gland and if possible, restore the normal function of the pancreas. Hence, limit intake of hot and spicy foods, which otherwise stimulate pancreas inflammation. Also, refrain from caffeine, cheese, butter, sweet desserts and foods that increase gas production in the body.

5.Stay Away from Alcohol – it is known that alcohol abuse triggers inflammation of the pancreas tissues. The same stimulation is observed with nicotine. The condition will be worse if one continues to have alcoholic beverages or nicotine in an inflamed pancreas. Thus, in order to help restore pancreas function and combat pancreatitis symptoms, refrain from alcohol and tobacco products.

Cystic Fibrosis – is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine. It is characterized by abnormal transport of chloride and sodium across epithelium, leading to thick, viscous secretions.


Caloric Requirements:

One of the major functions of food is to supply energy. The amount of energy a food provides is measured in calories, sometimes abbreviated as cals.

Most people with CF have a higher caloric requirement than other individuals of the same age and sex for these reasons:

- More energy is used in breathing.- Extra energy is used in fighting infections and during fevers.- Fewer of the energy-producing nutrients in food are properly digested and absorbed into the

body, even when treatment is optimal.

In order to meet his or her energy requirements, the typical CF child receiving enzyme therapy must consume approximately 120 to 150 percent of calories for a healthy child of the same age and sex. This figure varies considerably from person to person, and can be as high as 200 percent of a healthy child. Energy requirements are particularly high for children who are catching up on growth and development after a period of poor nutrition.

How can an individual's calorie requirements be calculated? Your child's nutritionist can do tests to establish the resting metabolic rate (the amount of energy required at rest); with that, total energy requirements can be calculated. On a more practical level, adequate caloric intake can be defined as the level that promotes normal growth and development in children, and maintenance of desirable body weight in grown individuals.

Protein Requirements:

Protein is one of the three energy-producing types of nutrients in food. The other two are carbohydrates (made up of starches and sugars) and fats. In addition to being used for energy production, protein is necessary for growth and maintenance of body tissues, proper functioning of the immune system, and a number of other critical functions.

Most people with CF have higher-than-usual protein requirements. People with CF who meet their increased caloric requirements by consuming a balanced diet usually meet their increased protein requirements at the same time.

Most high-protein foods are of animal origin, including milk and milk products, meats, poultry, fish, and eggs. Legumes, such as peas, beans, and lentils, are also good sources of protein, especially when eaten with grain products.

Fat Intake:

In the past, people with CF were told to limit intake of fats and fatty foods. This was appropriate advice for that time, because replacement enzymes were not as effective as some of those available today, and malabsorption of fat was far harder to overcome.

However, today's replacement enzymes are more effective in promoting digestion and absorption of fats. In fact, it is now recommended that people with CF consume relatively high amounts of fat, for the following reasons:

- Ounce for ounce, fat provides more than twice as many calories as protein or carbohydrate.- Conversion of fat to energy requires less oxygen than conversion of protein or carbohydrate to

energy, putting less of a burden on the respiratory system.- Generally, individuals with CF have a low blood cholesterol level and therefore do not have to

restrict the intake of saturated fat and cholesterol.

Adequate dietary fat is also required for provision of essential fatty acids, a group of nutrients which the body requires for normal functioning.

Salt Intake:

People with CF lose more salt (sodium chloride) in their sweat than other individuals. Their need for additional salt is usually met simply by increasing intake of normal foods in order to meet caloric

requirements. However, if you live in a very hot climate, your physician may advise adding extra salt to foods or increasing intake of salty foods.

Vitamin and Mineral Intake:

People with CF who meet their caloric requirements by consuming a well-balanced diet, and whose fat absorption is well-regulated, rarely develop vitamin and mineral deficiencies. However, because absorption is not optimal even at correct levels of enzyme replacement, supplementation is recommended.

Vitamins are absorbed most effectively when taken with fat-containing meals and pancreatic enzyme supplements. Infants and children up to 2 years old should take a liquid multivitamin preparation. Children ages 2 to 8 years need a standard multiple vitamin providing 100 percent of a healthy individual of the CF child's age. Older children, adolescents, and adults need 1 to 2 tablets of a standard adult multiple vitamin preparation every day.

High-potency multivitamin supplements are specially formulated to meet the needs of people with CF with poor dietary fat absorption. These supplements are indicated for use solely under medical supervision in CF people who do not obtain sufficient fat-soluble vitamins A, D, E, and K.

Additional supplementation with any vitamin or mineral beyond this level is recommended only if a specific need is recognized by your physician.

Modifying intake of regular foods:

Whenever possible, people with CF should meet their nutritional requirements by eating a balanced diet of everyday foods.

Start with a well-balanced diet for a healthy person of the same age. Then, if caloric and nutrient requirements are to be increased, modify intake by following these four steps:

1. Increase portion sizes.2. Add snacks and "mini-meals," especially at night. Good choices are:

fruit and nuts Jam or jelly with buttered toast or cheesecake, pudding, and other dessert food Cold cuts, pizza, or left-overs

3. Emphasize high-calorie, nutritious food at mealtime and snack-time. Serve as many high-protein, high-calorie foods as possible, including:

Whole-milk products, such as yogurt, cheese, custard, and pudding. Beverages made with whole milk, light cream, or undiluted evaporated milk, such as

milkshakes, malteds, cocoa, eggnog, and instant breakfast. Nuts and nut butters (especially peanut) Meat, fish, poultry, or eggs prepared with added fat (see the hints on adding fat below) or

in a mixed dish with another high-calorie, high-protein food (such as lasagna with meat and cheese).

At the same time, you may want to limit intake of foods that are filling but not very high in calories or needed nutrients. These include clear soups, tea, coffee, and low-calorie beverages.

4. Add extra fats. Remember, a little extra fat adds a lot of extra calories! Try these ideas: Put extra butter and margarine on bread products, cooked vegetables, hot cereals, pancakes,

pasta, baked and mashed potatoes, rice, and other foods at serving time. Serve whipped cream or ice cream as a topping on desserts, cocoa, waffles, and other foods. Use extra mayonnaise on sandwiches and in salads such as tuna, potato, and macaroni. Use sour cream as a topping for fruit baked potatoes, fish, chili, and other foods. Serve dips made from sour cream and mayonnaise with fresh vegetables and snack foods. Use extra salad dressing; avoid lo-cal or reduced-calorie dressings Serve generous portions of gravies and sauces. Use creamed soups instead of clear bouillon broth.

Adding extra fats is especially important because fats provide more calories per unit than carbohydrates. Proteins and fats are also essential for the body to properly absorb vitamins A, D, E, and K.

The Biliary System

The biliary system consists of the organs and ducts (bile ducts, gallbladder, and associated structures) that are involved in the production and transportation of bile. The transportation of bile follows this sequence:

1. When the liver cells secrete bile, it is collected by a system of ducts that flow from the liver through the right and left hepatic ducts.

2. These ducts ultimately drain into the common hepatic duct.3. The common hepatic duct then joins with the cystic duct from the gallbladder to form the

common bile duct, which runs from the liver to the duodenum (the first section of the small intestine).

4. However, not all bile runs directly into the duodenum. About 50 percent of the bile produced by the liver is first stored in the gallbladder, a pear-shaped organ located directly below the liver.

5. Then, when food is eaten, the gallbladder contracts and releases stored bile into the duodenum to help break down the fats.

Functions of the biliary system

The biliary system's main function includes the following:

To drain waste products from the liver into the duodenum To help in digestion with the controlled release of bile

Bile is the greenish-yellow fluid (consisting of waste products, cholesterol, and bile salts) that is secreted by the liver cells to perform two primary functions, including the following:

To carry away waste To break down fats during digestion

Bile salt is the actual component which helps break down and absorb fats. Bile, which is excreted from the body in the form of feces, is what gives feces its dark brown color.

diets in gastric and liver diseases.docx

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