Therapeutic Diet

 

Therapeutic Diet

n Diet Therapy is the use of appropriate foods as a tool in the recovery from illness.

n The normal diet is planned to meet the recommended dietary allowances (RDA), using the basic five food groups.

n Therapeutic diets are modifications of the normal diet made in order to meet the altered needs resulting from diseases 

 

    -  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 disorders it may be necessary to restrict intake of calories (as in weight reduction diets) or sodium (as in heart failure).

    - Therapeutic diet designed to treat  diseases or metaboli  disorders

    - Therapeutic diet adapted or modified to meet special  needs of specific diseas (PKU, galactosemia)

 

        Modifications of Normal Diet

  The normal diet may be modified(depending upon the disorder):

 1. change in consistency, e.g., soft and fluid diets;

 2. Elimination of specific foods(allegy & gluten)

 3. Change in route of  delivery( Enteral & Parenteral )

 4. Increase or decrease energy content, Increase or decrease other nutrients, e.g., protein, Na, fiber, lactose, Modify the kind and amounts of nutrients such  as vitamins, minerals, fats , protein or fluid.

 

        Type of  modified diet

1.Regular(General)

2.Modifications in texture and consistency

        - General diet(pureed)

        - Liquid diet (clear liquid diet, full liquid diet)

        - Soft diet

 3. Modifications of caloric content(high calorie diet,

     low calorie diet)    

 

4. Modifications in the intakes of specific nutrients 

- CHO, fat, fiber, purine, Na restricted diet

- Gluten, lactose free diet.

- High fiber diet, high K diet.

 

       Clear Liquid Diet

n  A clear liquid diet is made up of clear liquids and foods that are liquid at room temperature.

n   Some examples of these foods or liquids are apple juice, clear broth, gelatin dessert, and weak tea.                                       

n  The clear liquid diet provides liquids, salt, and some nutrients for a few days until you can eat normal food.  

 

n   The clear liquid diet does not provide all the nutrients, vitamins, minerals, or calories that your body needs.

 

n  To keep your energy levels stable, you should aim for three meals and two to three snacks every day you're on the diet.

n  Clear liquids are easily digested (broken down) and do not put a strain on your stomach or intestines.

 

n  The goal of this diet is to provide liquids and part of 

      the calories you need until you can eat solid food.

n   Patient should not stay on the clear liquid diet for more than two or three days

n  This diet is designed to provide adequate amounts of fluid electrolytes and modest rapidly absorbed calories so as to promote a return to normal diets.

 

n  The clear liquid diet is composed of foods with low residue content which are liquid in form to minimize the load of food needing digestion in the GIT.      

 

n  This diet is used after an operation or acute inflammation of the intestinal tract. It also has application in many illnesses characterized by a high fever.

 

n  Liquid diet helps to maintain liquid and electrolyte balance, relieve thirst and stimulate the digestion system to function, after an operation or disturbance in the system due to infection. If the fluids are chosen well, the diet can provide 200-500 kcal, some sodium, potassium and ascorbic acid.

n  It does not meet the requirement of most nutrients and is given only for a day or two during a transient phase before moving on to full and soft diet.

 

n  this diet is very low in calories and will result in muscle wasting (loss) if continued indefinitely. This diet is also below the RDA in all vitamins and minerals components except vitamin C, and can promote deficiency if not supplemented with an absorbable micronutrient preparation

 

n  This diet should not be continued beyond two days without protein, calorie, vitamin, and mineral supplementation.

n   A clear liquid diet may be used before a test or

     surgery to make sure your digestive tract is empty.

    -Clear liquids do not leave any residue in the digestive system. This decreases the risk of surgical complications as well as nausea after the operation

    -Patients may also need this diet after stomach or bowel (small and large intestines) surgery, or if you have problems with eating  solid food.

 

n  A clear liquid diet is not to be confused with a full liquid diet, which allows some soft foods such as hot cereals and strained soups. Alcohol is not included on a clear liquid diet and a doctor may restrict caffeine to prevent dehydration or stomach upset.

Application

n  As preparation for endoscopic or colonoscopic evaluation;

     3days pre operation(Low residue diet; Semi liquid die; clear liquid )

n  Post operation(Clear liquid diet ;Full liquid diet ;soft diet or full diet)

n  Acute GI disturbances

n  Acute illnesses such as diverticulitis& Pancreatitis 

n  Diarrhea

n  Severe vomiting& nausea

 

  What can I eat and drink while on a clear liquid diet?

n  Beverages (drinks):

     • Clear juices (such as apple, cranberry, or grape), strained citrus           

        juices or fruit

     •  Mild tea, without cream or milk.

     • Mineral, bubbly, or plain water.

     • Clear soft drinks like ginger, lemon-lime soda, or club soda.

     • Clear sports drinks.

n  Soup:

• Clear broth, bouillon, or consommé.

n  Desserts:

• Plain popsicles. Avoid popsicles with pureed fruit or fiber in them.

• Flavored gelatin, without fruit. You may also drink gelatin as a

   warm beverage before it sets.

n  Others:

• Sugar, honey, jelly or syrup.

• Herbs, mild seasonings, or salt.

 

       What should I avoid eating and drinking while on a clear liquid diet?

n   Any beverage that you cannot see through.

n   Beverages containing alcohol.

n   Dairy products such as milk, hot cocoa, buttermilk, and cream.

n    Fruit smoothies, nectars, fruit juices with pulp and prune juice.

 

 

n Water

 -  Include mineral water, carbonated water, flavored  water or plain water.

  - Try sucking on ice chips if you have nausea or vomiting. Water provides no calories, carbohydrates, vitamins or electrolytes, but is important for hydration.

  - Adequate hydration is essential for regulating body temperature, transporting nutrients, moistening body tissues and comprising body fluids.

 

n According to the American Dietetic Association's "Manual of Clinical Dietetics." Most adults need approximately one-half oz. of fluid per lb. of body weight.

    For example, a 150-lb. person needs about 75 oz. of fluid per day.

 

n Clear Soups

  -You may include clear soups like broth, bouillon or consommé.

   -They do not provide significant calories. If you have had a fever or severe vomiting or diarrhea, soups can replace sodium losses, as well as providing fluid.

   -According to the American Dietetic Association,      

         sodium is an electrolyte that helps maintain fluid 

      balance and acid-base balance in the body

 

 - One cup broth provides five calories and about 700 mg of sodium, depending on the brand.

 - Do not include cream soups or soups that have bits of meat, vegetables, noodles or rice

n   Clear Fruit Juices

   - Choose clear fruit juices without pulp, like apple, grape and cranberry.

   - each provide about 120 calories and 30 g of carbohydrate per cup.

 

 -  Grape juice has 150 calories and 37 g of carbohydrate, while grapefruit juice provides 95 calories and 22 g of carbohydrate per cup.

 - Each of these juices is a good source of potassium and vitamin C.

 -  Potassium is another electrolyte important for maintaining fluid and acid-base balance in the body.

 - Do not drink fruit smoothies, nectars, fruit juice with pulp, prune juice, tomato juice or vegetable juice.

 

n  Clear Sodas and Sports Drinks

 - You may include clear sodas like ginger ale, which has 90 calories and 23 g of carbohydrate per cup, and lemon-lime sodas, which have105 calories and 26 g of carbohydrate per cup.

 - Do not drink cola or root beer. Sports drinks vary by brand but contain, per cup, about 65 calories, 16 g of carbohydrate and 90 mg of sodium.

 - They provide some potassium, but it is typically much less than what clear fruit juices provide.

 

n Fruit Drinks

 - Strained lemonade, strained limeade and fruit drinks are included on a clear liquid diet. Per cup, they provide 115 calories and 29 g of carbohydrate, and are a good source of vitamin C.

 -  Make sure they do not contain pulp. 

 

n  Ice Pops and Fruit Ices

 - You may include ice pops, fruit juice bars and fruit ices. Choose versions that do not contain bits of fruit or fruit pulp.

 -  A single stick ice pop contains 45 calories and 11 g of carbohydrate. A 2.5-oz. fruit juice bar provides 65 calories and 15 g of carbohydrate, and is a good vitamin C source. Fruit ice has 125 calories and 32 g of carbohydrate in a one-half cup serving.

 

 - If you have nausea or vomiting, you may tolerate sucking on an ice pop better than swallowing liquids.

n   Gelatin

 - Gelatin is allowed on a clear liquid diet because it is liquid at room temperature, and becomes a liquid again before reaching the stomach. It provides 150 calories, 3 g of protein, 34 g of carbohydrate and 180 mg of sodium per one-cup serving.

 - It should not have added fruit. You can also drink gelatin warm as a beverage before it sets.

 

n  Coffee and Tea

 - Coffee, black or green tea and herbal teas also are included.

 - Do not add cream or milk.

 - You may add sugar or sugar substitute.

 -Unsweetened beverages do not provide any energy, nutrients or electrolytes.

 - health care provider may recommend decaffeinated versions, since caffeine acts as a diuretic, increasing fluid loss.

 

n  Miscellaneous

n  Hard candy, sugar, honey, jelly, syrup and salt also are allowed. Hard candy varies significantly depending on size. A butterscotch lozenge has 20 calories and 5 g of carbohydrate. Sugar contains 16 calories and 4 g of carbohydrate per tsp. Honey provides 25 calories and 6 g of carbohydrate per teaspoon. Jelly and syrup both have about 55 calories and 14 g of carbohydrate in one tbsp. One tsp. of table salt contains 2,300 mg sodium. Do not include alcohol or dairy products on a clear liquid diet.

 

 SAMPLE MENU FOR ONE DAY   

n  Breakfast

    1 cup apple juice (strained)

    1/2 cup fruit-flavored gelatin dessert

    1/2 cup broth

     Hot, non-caloric beverage

n  Mid-Morning Snack

     1 cup fruit juice

 

n  Lunch

    1 cup orange juice (strained)

    1/2 cup fruit-flavored gelatin

    1 cup broth

n  Mid-Afternoon Snack

    1 cup fruit juice

n  Dinner

    1 cup orange juice

    1/2 cup fruit flavored gelatin dessert

 

     1/2 cup broth

    Hot, non-caloric beverage

n  Evening Snack

    1 cup fruit juice

n  Nutrient Content

    Calories: 790

    Protein: 3%

    Carbohydrate: 92%

     Fat: 5%

    Cholesterol: 20 mg

n  Fiber: 3 g

 

   A typical menu on the clear liquid diet may look like this.

n  Breakfast:
One glass fruit juice
One glass water
One cup broth
One bowl gelatin

n  Snack:
One cup coffee or tea (without cream)
One bowl gelatin

 

n  Lunch:
One glass fruit juice
One glass water
One cup broth
One bowl gelatin

n  Snack:
One ice pop (without fruit pulp)
One cup coffee or tea (without cream) or soft drink

n  Dinner:
One cup juice or water
One cup broth
One bowl gelatin
One cup coffee or tea

 

        Important Notes

  -The clear liquid diet designed to keep your stomach and intestines clear, limit strain to your digestive system, or keep your body hydrated as you recover from a medical procedure or become ready for your regular diet.

 

 - If you do not follow this diet before your test or surgery, your test or surgery may need to be scheduled for another time.

 

 - You may have to follow a clear liquid diet

    because your body cannot digest (break down) solid foods. If you do not follow this diet as ordered,   may have diarrhea (loose, watery stool), nausea and

     vomiting (throwing up), gas, or bloating.

 

n  The clear liquid diet does not provide all the nutrients you need. You should not follow this diet for more than two or three days unless your caregiver tells you to.

n  You may have to drink a clear liquid nutrition  supplement if you have to follow this diet for more than three days.  

 

 

n Because a clear liquid diet can't provide you with adequate calories and nutrients, it shouldn't be used for more than a few days. Only use the clear liquid diet until your body can comfortably digest other foods and beverages.

 

n if this diet must be adhered to for longer than three days, these supplements may be beneficial. There are high-protein gelatins and high-calorie, low-residue juice beverages, usually available at hospitals or medical centers that may be used to supplement this low-calorie diet.

.

 

References

 

1.“Nutrition in comprehensive program planning for persons with developmental disabilities.” Journal of American Dietetic Association.1997;97:189-19.

2.“Translation of diabetes nutrition recommendations for healthcare 53.institutions.” Journal of American Dietetic Association. 1997;97:52-

3.“Dietary reference intakes for energy, carbohydrates, fiber, fat, fatty acids, cholesterol, protein, and amino acids.” Journal of American Dietetic Association. 2002;102:1621-1630.

 

4. “Liberalized diets for older adults in long-term care.” Journal of American Dietetic Association. 2002;102:1316-1322.

5. www.heionline.org/docs/training/special_diets.pdf

6. http://hopkins-gi.nts.jhu.edu/files/ClearLiquidDiet.pdf

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16. http://www.dietitians.ca/