Diets For Gastroenterology & Diabetes Tests

You are about to undertake a fecal fat collection. In order to be accurate, you must consume a high fat diet. If you are going to have a 72-hour fat collection, we recommend that you start the high fat diet 2 days before you are going to start collecting the stool. For those 2 days and 3 days that you are collecting the stools you should eat as follows:

1. Two eggs in the morning, two slices of toast spread with butter and a glass of whole milk.
2. For lunch have another glass of milk and all beef hamburger or equivalent.
3. For dinner you should have a beef or chicken dinner and a fatty dessert like a bowl of ice cream.

This needs to be done for 2 days prior to the stool collection and during the stool collection.

This diet provides foods which will leave minimal residue in the intestinal tract.

Food Group	Foods Allowed
Fruit Juice	Apple, White Grape and Pineapple Juice (no pulp)
Beverages	Coffee (no milk), tea, carbonated beverages like Sprite or Coca-Cola, Gatorade, Powerade (no red), Kool-Aid (no red) and Strained Lemonade
Soups	Clear broth or bouillon
Desserts/Sweets	Popsicles, Fruit Flavored Ices, Flavored Gelatin, and Hard Candy (Make sure to avoid all artificial red color)
Seasonings	Lemon juice or honey for tea, sugar for coffee

Morning	Noon	Evening
Apple Juice (no Pulp)	Pineapple Juice (No Pulp)	White Grape Juice (no Pulp)
Chicken Broth	Beef Bouillon	Vegetable Broth
Lime Gelatin	Iced Tea with lemon	Blue Gatorade
	Coffee (black)

Morning	Noon	Evening
Powerade	Sprite	Strained Lemonade
Orange Gelatin	Lime Gelatin	Orange Popsicle

***AVOID ALL FOODS NOT INCLUDED ON LIST***
***HAVE NO RED OR PURPLE COLORING***
*** IN ANY OF THE ABOVE FOODS***

 

FOR PATIENTS WHO ARE ON CLEAR LIQUIDS FOR A PROLONGED PERIOD OF TIME, REFER TO THE SECTION ON SUPPLEMENTAL FEEDINGS REGARDING INDICATIONS FOR USE OF SUPPLEMENTS ON CLEAR LIQUID DIETS.

The fat restricted diet avoids or limits foods that have a high fat content. The diet is planned with specified amounts of meat, fish, poultry, eggs, margarine and other foods containing fat. Foods are prepared without fat except for the permitted amounts of margarine, cooking oils, mayonnaise or cream.
The fat allowance should not be saved for one meal, but should be divided into three or more meals and snacks. Certain strongly flavored foods that are not necessarily high in fat may cause digestive distress in some individuals.

The suggested diet plan provides a total of 50 grams of fat each day.

• Milk - 2 – 3 cups per day

Allowed: Skim milk, buttermilk made from skim milk, non-fat instant dry milk, cocoa made from skim milk, and cocoa powder, yogurt made from skim milk.
Not Allowed: Whole, 2%, low-fat milk, evaporated or condensed milk, buttermilk made from whole milk, chocolate milk and mixes.

• Lean meat, fish, Poultry - limit to 3 oz. at lunch

Allowed: Chicken, turkey, Cornish hen or pheasant without skin. Fresh or frozen fish. Tuna or salmon packed in water (1/4 cup = 1 oz. meat) Very lean beef, ham, veal, lamb and pork. Liver, organ meats.
Not Allowed: All fried and fatty meats, fish or poultry. Fish canned in oil. Luncheon meats, sausage, frankfurters, spareribs, duck, goose, ham hocks, pig's feet, country ham, deviled ham, peanut butter.

• Eggs - Limit to one egg per day

Allowed: Prepared any way without fat, egg whites as desired
Not Allowed: Fried eggs, eggs prepared with fat.

• Cheese - No more than 1 oz. of regular cheese per day

Allowed: 1 oz of regular cheese or ¼ cup cottage cheese can be substituted for the one allowed egg or for 1 oz of allowed meat. Skim milk cheeses desired.

• Breads - As desired under allowed portion

Allowed: Whole grain or enriched bread, yeast breads, dinner rolls, English muffins, bagels and saltine crackers. All other not listed under foods are not allowed.
Not Allowed: Biscuits, waffles, pancakes, muffins, cornbread, doughnuts, sweet rolls, quick breads and snack crackers.

• Cereals - As desired

Allowed: All dried or cooked cereals except those listed under “Not allowed”.
No Allowed: Any cereal containing nuts or coconut, Granola.

• Potato or Substitute: As desired

Allowed: Potatoes, rice, noodles, spaghetti, dried beans and peas.
Not Allowed: Fried potatoes, potato chips. Any prepared with cream sauces, cheese or other added fat.

• Vegetables - As desired

Allowed: All vegetable juices. All vegetables prepared with food "allowed”.
Not Allowed: Fried vegetables. Any prepared with cream sauces, cheese or other added fat.

• Fruits - As desired

Allowed: All fruit and fruit juices.
Not Allowed: None.

• Soups - As desired

Allowed: Bouillon, consomme, fat-free broth, canned broth-base soups. Prepared with water or skim milk.
Not Allowed: Creamed or canned soups prepared with whole milk or cream.

• Fats - Limit to a total of 3 tsp. fat per meal

Allowed: Butter, margarine, cooking oils, shortening, mayonnaise or salad dressing. 1 slice bacon =1 tsp fat.
Not Allowed: Coconuts, nuts, olives or avocado, seasoning meat As salt pork, ham hocks, sweet or sour cream, whipped toppings and all non-dairy creamers.

• Dessert and Sweets - As desired

Allowed: Gelatin, angel food cake, sherbet, fruit ices, pudding made with skim milk, meringues, vanilla wafers, honey, jelly, jam, sugar, syrup, molasses, plain hard candy, gum drops.
Not Allowed: Pastries, cake (except angel), cookies, ice cream, ice milk. Any made with nuts, cream, whole milk, coconut or chocolate (cocoa may be used).

• Beverages - As desired

Allowed: Coffee, tea, decaf coffee, carbonated beverages, plain cocoa powder made with skim milk, fruit drinks.
Not Allowed: Any with added cream, whole milk, ice cream or ice milk. Cocoa mixes.

• Miscellaneous - As desired

Allowed: All spices and condiments.
Not Allowed: Rich sauces, cream sauces, gravies.

Foods Included Daily:

Skim Milk    : 2 – 3 cups
Meat, Fish or Poultry    : 6 ounces (oz) only
Eggs: 1 only
Breads/Cereals: as desired
Potato or Substitute: as desired
Vegetables: as desired
Fruits: as desired
Fats: 3 teaspoons (tsp) only
Desserts/Sweets: as desired
Beverages    : as desired
Sample Meal Pattern:

Breakfast

Fruit or juice
Cereal
Egg – only
Toast
Fat - 1 tsp Jelly, sugar
Skim milk
Beverage
Lunch and Dinner

Meat, fish or poultry – 3 ounces
Potato or Substitute
Vegetable
Bread
Fat – 1 tsp
Dessert or fruit
Skim Milk
Beverage, Sugar
Sample Meals:

Breakfast

Orange Juice
Cornflakes
1 Poached Egg
Toasted English Muffin
1 tsp. margarine
Jelly, Sugar
Skim Milk
Coffee or tea
Lunch

3 oz. Baked Chicken
Steamed Rice
Green Beans, Sliced Tomatoes
Whole Wheat Bread
1 tsp. margarine
Peach Halves
Skim Buttermilk
Iced Tea, Sugar
Dinner

3 oz Lean Roast Beef
Baked Potato
Cooked Carrots, Tossed Salad
Dinner Roll
1 tsp. Salad Dressing
Angel food Cake with fruit topping
Skim Milk
Lemonade
Fiber Supplementation

ALL IN THE MORNING

1.    Bran cereal ~ 4 oz.

2.    Apple Sauce ~ 4 oz.

3.    Prune juice or apricot nectar ~ 4 oz.

4.    Miller’s Bran One ~ tablespoon added to bran cereal

5.    Metamucil ~ one teaspoon daily

6.    Push water

7.    EXERCISE!!!!!!!!!!!!!!

The Full Liquid Diet is generally ordered for patients who are unable to tolerate solid food. The food items on this diet are liquid or semi-liquid a room and body temperature. This diet is used on a short term basis.

Nutritional Adequacy: Since this diet does not meet the recommended Dietary Allowances for all nutrients, it should be used only for a limited amount of time. If this diet must be used for an extended period of time, a nutritional supplement should be added to provide adequate nutrition.

Beverages - Coffee, tea, decaffeinated coffee, carbonated beverages, Kool Aid, Gatorade, lemonade.
Fruits and Fruit Juices - All fruit juice
Soups - Broth, bullion, consomme, strained cream soups. Made from foods allowed.
Cereals - Cooked refined cereals and gruel such as cream of wheat, grits, cream of rice, thinned oatmeal.
Dairy Products - Milk (whole, skim, buttermilk or chocolate), eggnog, milkshakes, plain yogurt.
Eggs - Soft cooked, (may be tolerated by some patients), custard.
Meats, fish, poultry, cheese - Pureed meats added to cream soups, as well as a mild cheese sauce.
Fats - Butter, margarine, vegetable oil, cream.
Vegetables & vegetable juices - All vegetable juices, pureed vegetables may be added to cream soups.
Potatoes -Thinned mashed potatoes may be tolerated, or added to cream soups.
Desserts and Sweets - Jello, sherbet, ice cream, pudding, honey, syrup, sugar, candy, jelly, popsicles, fruit ices, marshmallows.

Purpose: This diet omits foods which contain gluten. Gluten are proteins found in wheat, rye, oats and barely. These proteins may cause ill effects in individuals sensitive to them.
Principles:

Read all labels carefully on packaged, processed or prepared foods. Look for wheat, rye, oat or barely flour gluten on food labels.

Substitute (in place of the flours not allowed) cornstarch, wheat starch, tapioca, potato flour, rice flour, soybean flour, buckwheat flour or arrowroot.

Look for gluten-free products which may be available.
Gluten-Free Food Checklist

Dairy Products

Allowed: If tolerated: whole, low-fat, skim & buttermilk. Yogurt, cottage cheese, all cheeses except for those listed as not allowed. Cocoa, if no added wheat flour.
Not Allowed: Malted milk, milk drinks & mixes prepared with cereal additives, Ovaltine, chocolate milk with cereal, additives, processed cheese foods or cheese spreads.

Meat & Meat Alternate

Allowed: Any meat, fish or poultry which is not breaded or prepared with wheat flour. Processed meat products not prepared with wheat flour, peanut butter, dried beans, peas & lentils prepared without flours not allowed.
Not Allowed: Commercial meat products containing cereals not allowed such as bologna, frankfurters, liverwurst, luncheon meats, meat loaf, sausage, canned meats, canned chili.

Eggs

Allowed: Any – prepared baked, boiled, poached, scrambled or fried.
Not Allowed: Creamed eggs &soufflés if wheat flour is used.

Vegetables

Allowed: All fresh, frozen or canned except for those listed at right.
Not Allowed: Those breaded or creamed vegetables prepared with prohibited flours.

Fruits

Allowed: All fruit & fruit juices.
Not Allowed: None

Breads

Allowed: Breads, cakes, muffins, crackers & pasta products made from allowed flours (arrowroot, rice, corn, potato, tapioca, soybean), rice cakes.
Not Allowed: All those bread and pasta made form wheat, rye, oats, barely flour. Commercially prepared biscuit, bread, pancake, waffle mixes, graham flour.

Cereals

Allowed: Cereals prepared with only rice or corn. Tapioca, rice, hominy, cream rice.
Not Allowed: All cereals containing wheat, oats, rye, barley, malt, or bran.

Potato or Substitutes

Allowed: White or sweet potatoes, rice. Pasta - all made from allowed flours.
Not Allowed: Instant or creamed potatoes, macaroni, noodles, spaghetti, or bread stuffing.

Fats

Allowed: Any except for those listed as not allowed. Gravies prepared with allowed ingredients.
Not Allowed: Commercial salad dressings &gravy mixes, non-dairy whipped toppings, non-dairy creamer substitutes.

Beverages

Allowed: Plain coffee, tea and carbonated beverages.
Not Allowed: Cereal beverages such as postum. Instant coffees. Alcoholic beverages made from prohibited cereal grains.

Soups

Allowed: Broth, bouillon, broth-based meats and vegetables soups. Cream soups prepared with cream or allowed flours.
Not Allowed: Soups mad with or containing wheat, oats, rye or barley. Commercially prepared soup and soup mixes.

Desserts & Sweets

Allowed: Cakes, cookies, pies made with allowed flours. Custard, gelatin, puddings made with tapioca or cornstarch. Ice cram or sherbet prepared with allowed flours. Sugar, jam, jelly, coconut, marshmallows, pure chocolate, pure cocoa, honey.
Not Allowed: Cakes, cookies, pies, pastries and puddings prepared with prohibited ingredients.

Miscellaneous

Allowed: Catsup and mustard (check labels carefully), vinegar, herbs, extracts.
Not Allowed: Soy sauce, malt worcestershire sauce.

Sample Menu:

Morning

Fried Egg
Grits
Rice cakes
Bacon
Orange Juice
Low-fat milk
Coffee
Margarine, jelly, sugar
Noon

Tossed salad with oil and vinegar
Roast beef
Baked potato/rice bread
Peas & Carrots
Grapes
Tapioca pudding
Iced Tea
Margarine, sugar
Evening

Homemade vegetable soup
Oven-baked chicken
Green beans Almondine
Wheat starch noodles
Cornmeal muffin
Sliced pears
Low-fat milk
Margarine, honey

Patients with ileostomy will eventually be able to return to most of their pre-illness dietary habits. For six to eight weeks, they may be kept on a low residue diet which eliminates bulky and hard to digest foods. After that time, other foods my be added one at a time, with care taken to chew foods thoroughly. If a food is disagreeable, it should be deleted from the diet forever; it may be tried later as the small bowel adjusts and recovers from surgery. The patient needs to be made aware of foods that may be likely to cause blockage, odor, gas and diarrhea.

The diet meets the National Research Council’s Recommended Daily Dietary Allowances for all nutrients based on individual’s food choice.

I.    Food Blockage – may be caused by foods that are very high in bulk and are partly or totally undigested even when the large bowel is present. These foods need to be well-chewed and added to the diet one at a time: Celery, nuts, coleslaw, wild rice, popcorn, Chinese foods, (especially bamboo shoots),

Foods with seeds or kernels (corn on the cob), dried fruits, coconut (in any form), meat in casings (luncheon meats - just removed the casing), whole vegetables.

II.    Odor Causing Foods – These foods are likely to increase the odor of ileostomy drainage: Fish, eggs, asparagus, onions, garlic and some other spices.

III.    Diarrhea – These foods cause some people to have diarrhea or an increase in drainage: Green beans, broccoli, spinach, raw fruits, highly seasoned foods, beer.

Diarrhea may also be caused by flu or other illness. The following foods suggestions may help:

1.    Low residue diet.
2.    Try eating: strained bananas, boiled milk, tapioca, smooth peanut butter.
3.    Increase fluids.

IV.    Gas Forming Foods – These foods might produce excessive gas. The amount eaten at one time may be related to gas formation. Brussel Sprouts, peas, spinach, corn, cabbage, broccoli, radishes, cauliflower, turnips, string beans, dried beans, mushrooms, melons, cucumbers, onions, beer, carbonated drinks.

V.    Other Food Hints:

Red beets do not lose their color during digestion, so drainage may be red colored.

When eating corn-on-the-cob, slit the kernels with a knife before eating and eat only one cob at a meal to avoid blockage.

Eating parsley with every meal, drinking orange juice or eating an orange is said to lessen odor.

Lactose is the sugar found in milk. A lactose controlled diet avoids or limits milk and milk products or any foods prepared with milk. Some commercial products are supplemented with milk or lactose and should be omitted. It is important to read labels for ingredient content as some lactose free versions of the food are available. This diet meets the Recommended Daily Allowance for all nutrients. Be sure to consume some foods from the milk group, if at all tolerated, to ensure proper intake of calcium and riboflavin.

Food Guidelines

• Milk

Allowed: Soybean milks, nutramagen, non-dairy cream substitutes. Up to 2 cups per day or yogurt, cultured buttermilk, or sweet acidophilus milk.
Not Allowed: All regular milk (whole, low-fat, skim, dried, evaporated or condensed.

• Meat, Fish, Poultry

Allowed: Plain, beef, fish, lamb, pork, chicken, turkey, veal,shellfish. Organ meats. All meat cold cuts*and franks*, sausage*, peanut butter*.
Not Allowed: Any breaded or prepared with milk or milk products. Processed meat product containing lactose such as franks, luncheon meats and canned.

• Egg

Allowed: Prepared any way except with milk or cheese “Not Allowed”
Not Allowed: All eggs prepared with milk or cheese “Not Allowed”.

• Cheese

Allowed: Hard, ripened cheeses such as cheddar, blue, brick, colby, edam, provolone, swiss,and american.
Not Allowed: Cottage cheese, cream cheese, processed cheese foods.

• Bread (3 slices)

Allowed: Enriched, whole grain, rye, or pumpernickel breads. Quick breads such as cornbread or biscuits, made without milk. Rolls, crackers prepared without milk.
Not Allowed: Any prepared of processes with milk or milk products. commercially prepared mixes, waffles*, pancakes*, french toast, unless made without milk. Bagels.

• Potato or Substitute

Allowed: Limit potatoes, rice, noodles, macaroni, spaghetti, corn and popcorn.
Not Allowed: Any prepared with milk or milk products (cream sauces), instant potatoes.*

• Vegetables

Allowed: All plain, fresh, frozen, or canned vegetables. vegetable juices, lettuce, cum cumber, peppers, avocado, tomato, asparagus, zucchini and okra.
Not Allowed: Vegetables prepared or processed with milk or milk products. Onions, beans, celery, carrots, brussel sprouts, broccoli and cauliflower.

• Fruits

Allowed: Fresh, canned, frozen,dried fruits, and fruit juices. Cantaloupe, berries and grapes.
Not Allowed: Dietetic fruits containing lactose. Apples, citrus, fruits, bananas, apricots, prune juice.

• Soups

Allowed: Bouillon, borsht, or soups made foods "allowed". Dehydrated non-milk soup mixes.
Not Allowed: Cream soups. Commercial soups made with milk or milk products containing lactose.

• Fats

Allowed: Regular butter and margarine, cooking oils, non-dairy cram substitutes and whipped toppings,, salad dressings*, mayonnaise, bacon nuts, olives, avocado.
Not Allowed: Salad dressings with added milk, sour cream, regular whipped cream, cream cheese.

• Desserts and Sweets

Allowed: Fruit ice, gelatin, cakes*, pudding*, cookies*, made without milk or milk products, pure sugar candy. Jelly, jams, and preserves, honey, syrup.
Not Allowed: Any beverages prepared with milk or milk products.

• Beverages

Allowed: Regular, freeze dried and instant coffee, decaf coffee, regular and instant tea, carbonated beverages.
Not Allowed: Any beverages prepared with milk or milk products.

• Miscellaneous

Allowed: Salt, herbs, spices, condiments, pickles, vinegar, brown gravy, plain cocoa*, monosodium glutamate.
Not Allowed: White sauces or cream gravies, milk chocolate, cocoa mixes. Sugar substitutes with lactose, chewing gum, vanilla powder, wheat germ.

*Consult the list of ingredients or check with manufacturer. A lactose free version of food may be available.

Sample Meal Pattern:

Breakfast

Apple juice
Oatmeal
Scrambled Egg
Whole Wheat Toast
Bacon, Margarine
Jelly, Sugar
Coffee with non-dairy creamer
Lunch

Sandwich: Ham/Swiss
Cheese
Rye Bread
Mayonnaise/Mustard
Pickle
Vegetable Soup
Fresh Fruit
Lemonade
Dinner

Roast Beef au jus
Baked Potato with skin
Tossed Salad
Bread - Whole Wheat
Margarine
Oil & Vinegar Dressing
Jell-O
Iced Tea, sugar
Nutritional Suggestions

NOTE: Be sure to include some of the following foods each day to provide a good source of CALCIUM in your diet:

Allowed Cheese
Yogurt
Dark Green, Leafy Vegetables
Be sure to include a vegetable rich in Riboflavin every day:

Spinach
Asparagus
Winter Squash

This diet has been planned to be chemically and mechanically non-irritating and to reduce the residue in the lower intestinal tract after digestion. This diet is used for patients with esophageal or gastric disorders, after the acute phase of ulcerative colitis or regional enteritis.

This diet meets the National Research Council’s Recommended Daily Allowances for all nutrients except iron for women of childbearing age.

**While on low residue diet DO NOT take fiber supplements such as Metamucil**
Food Guidelines

• Cheese

Allowed: Cream cheese, cottage cheese, mild yellow cheese.
Not Allowed: Sharp cheese, aged cheese, cheese with seasonings.

• Potato or Substitute

Allowed: Baked, mashed, creamed, or boiled white potato, rice, noodles, macaroni, spaghetti.
Not Allowed: Sweet potatoes, fried potatoes, potato skins, whole grains, or wild rice.

•  Vegetables

Allowed: Cooked asparagus tips, beets, carrots, green beans, spinach, squash, mushrooms, english peas.
Not Allowed: Whole cooked or raw vegetables other than those allowed.

• Fruits

Allowed: Canned peaches, pears, applesauce, peeled apricots, Royal Anne cherries, canned peeled plums, ripe bananas, bake or peeled apples, all without skins or pits. Peeled avocado, orange, grapefruit, apple, pineapple, grape, apricot juice and all fruit juices.
Not Allowed: All other fruit and juices.

• Desserts

Allowed: Custard, Jell-o, fruit whip (made with fruits allowed), sponge cake, angel food cake, plain cookies, bread, tapioca and rice puddings, ice cream, sherbet and pie.
Not Allowed: Dessert made with nuts, coconut, spices, raisins, and unlisted fruits.

• Fats

Allowed: Butter, fortified margarine, cream, mayonnaise, vegetable oil.
Not Allowed: Lard, meat drippings, salad dressings.

• Miscellaneous

Allowed: Candy, honey, jelly, sugar, syrup, mild catsup, gravy, salt, mild spices, vinegar.
Not Allowed: Jam, candy containing dried fruits or nuts, chili sauce, coconut, garlic, horseradish, olives, pickles, popcorn, pepper.

• Beverages

Allowed: Coffee, tea, Sanka, carbonated beverages.
Not Allowed: Alcoholic beverages.

• Milk

Allowed: Milk, buttermilk, skim milk, chocolate milk, evaporated milk. Limit to one pint per day (including any item prepared with milk).
Not Allowed: None

• Bread

Allowed: White bread or rolls, saltines, ruck, melba toast, lite rye bread.
Not Allowed: Whole wheat or bran or breads containing seeds.

• Cereals

Allowed: Well-cooked, refined cereals such as cream of wheat, farina, grits and wheatena, prepared cereals made form corn, rice, or oats.
Not Allowed: Whole grain or barn cereals.

• Eggs

Allowed: Any way.
Not Allowed: None

• Soups

Allowed: Soup made with food allowed, bouillon.
Not Allowed: Soups made with food not allowed.

• Meat, Fish, Poultry

Allowed: Tender, well-cooked (broiled, baked or roasted), beef, veal, chicken, turkey, lamb, pork, fish, liver, crisp bacon, cream smoked style peanut butter.
Not Allowed: Fried meats, luncheon meats, such as pickled, salted, or spiced meats. Tough meats with large amount of connective tissue. Clam and oysters.

Suggested Meal Plan:

Breakfast

Orange juice
Cream of wheat
Egg
Toast/ Margarine
Coffee, if desired
Lunch

Roast beef
Baked potato (no skin)
Carrots - well cooked
Angel food cake
Rusk
Margarine
Milk
Dinner

Bouillon
Baked Chicken
Rice
Green Beans, well-cooked
Canned peaches
Melba toast
Milk

Excessive Gastrointestinal gas is a common problem, which may result in belching, bloating, abdominal discomfort and frequent passage of gas. These unpleasant and often embarrassing symptoms can be minimized if you follow the suggestions below. About 70% of gas in the intestinal tract comes from swallowed air. This list will help reduce the amount of gas you have.

Establish a daily route of getting adequate exercise and rest.
Make the following habit changes:

• chew food thoroughly.
• eat slowly and leisurely in a quiet atmosphere.
• avoid washing solids down with a beverage.
• avoid gulping and sipping liquids.
• avoid drinking from small-mouthed bottles or through straws.
• avoid drinking from water fountains.
• avoid carbonated beverages…beer included.
• avoid excessively hot and cold beverages.
• eliminate pipe, cigar and cigarette smoking.
• avoid gum chewing and sucking on hard candy.
• check dentures for proper fit.
• attempt to be aware of and avoid deep sighing.

Do not attempt to induce belching.
Do not Overload the stomach at any one meal. Divide daily food intake into equal amounts for each meal, and reduce intake of fats.
Avoid gaseous vegetables: legumes, cabbage, brussel sprouts, cauliflower, broccoli, turnips, cucumbers, radishes, onions, melons and excesses of raw fruits and vegetables.
Avoid foods with air whipped into them: soufflés, sponge cake, milk shakes. Avoid milk and dairy products if they cause gas for you.
Avoid long term or frequent use of medications intended for relief of cold Symptoms.
Avoid tight fitting garments, girdles, belts.
Do not lie down or sit in a slumped position immediately after eating.
Take a leisure stroll after meals.
Take only medication prescribed by your doctor.

These recommendations are intended to direct your attention to habits, which contribute to excessive gas. You may find that you will be able to reduce your gas level by following only a few of these recommendations. Persistent symptoms, however, will require more careful attention to these suggestions.

(Restricted Carbohydrate, Increased Protein, Moderately High Fat)

The Post Gastrectomy diet is used to slow the rapid passages of food from the stomach to the intestine and therefore alleviate the dumping syndrome.

Dumping syndrome occurs when the patient experiences nausea, vomiting, and / or diarrhea soon after the ingestion of a meal because the food passed through the stomach and into the upper jejunum too quickly.

Individual tolerances vary greatly, but in general the following principles apply:

Small, frequent feedings. Breakfast, mid-morning snack, lunch, mid-afternoon snack, supper, and an evening snack.
High protein and fat content for tissue growth and to increase calories. A protein food should be served with each meal.
Omission of simple sugars.
In some cases, milk and other dairy products may be restricted.
Fluids to be taken only between meals (30 minutes after a meal).
Avoid extremely hot or cold foods beverages.
Because this is a highly individualized diet, each patient will progress at his own rate. Small amounts of the “foods not allowed” may be tried gradually.
Nutritional Adequacy: This diet is nutritionally adequate according to the National Research Council’s Recommended Daily Allowances when planned by the suggested meal plan. Careful planning is necessary to meet calcium recommendation and iron recommendation for women under 51 years old.

• Dairy

Allowed: One ounce of cheese may be substituted for one ounce of meat.
Not Allowed: Milk, skim mild, buttermilk, yogurt (may or may not be restricted).

• Meats

Allowed: All baked, stewed, fried, broiled or roasted meats. Peanut butter may be used as a substitute meat.
Not Allowed: None

• Eggs

Allowed: Prepared any way.
Not Allowed: None

• Vegetables

Allowed: All as tolerated.
Not Allowed: None

• Potato or Substitute

Allowed: White or sweet potato, rice macaroni, spaghetti, noodles,corn, dried beans, peas and lima beans. Mashed potatoes without milk.
Not Allowed: None

• Fruits

Allowed: All fresh fruit, or canned,sweetened artificially or un-sweetened fruits and fruit juices. Juices only between meals.
Not Allowed: All fruits packed in syrup or candied.

• Bread

Allowed: All as tolerated except those not allowed.
Not Allowed: Breads containing dried fruits.

• Cereal

Allowed: All as tolerated accept those not allowed.
Not Allowed: Sweetened or sugar frosted.

• Fat

Allowed: Margarine, butter, vegetable, shortening, bacon.
Not Allowed: None

• Beverages

Allowed: Coffee, tea, decaffeinated coffee, artificially sweetened soft drinks. Not to be taken with meals.
Not Allowed: None with meals.

• Miscellaneous

Allowed: All condiments if tolerated, dill or sour pickles, artificial sweeteners.
Not Allowed: Sweet pickles, relishes.

• Soups

Allowed: All as tolerated.
Not Allowed: None with meals.

• Desserts/Sweets

Allowed: None, except artificially sweetened products.
Not Allowed: Candy, sugar, syrup, jam, marmalade, jelly.

Suggested Meal Plan:

Morning

1 Meat or alternate
2 Breads
2 Fats
Noon and Evening

3 Meat or alternate
1 Potato or substitute
1 Bread
1 Vegetable
1 Fruit
1 Fat
Snacks

1 Fruit or 1 Bread
1 Meat or alternate
1 Fat
Sample Menus

Morning

Scrambled Egg
Grits
Toast
Margarine
Noon and Evening

Lean Ham
Mashed Potatoes
Green Beans
Roll
Margarine
Peach Halves, unsweetened
Snacks

Roast Beef
Noodles
Broccoli
Roll
Fresh orange sections
Margarine
Morning

Apple
Cheese
Noon and Evening

½ Chicken Sandwich
Lettuce, tomato
Evening Snack

Cottage Cheese
Crackers
Applesauce, unsweetened

Purpose: Sodium is essential to the body. It is a mineral that helps the body regulate fluid balance. Under certain conditions, excess sodium can cause the body to retain too much fluid. This could be harmful for people with conditions such as high blood pressure or heart disease. These conditions are often managed by reducing sodium in the diet. For many patients, restricting the total amount of sodium to 4 grams a day is enough to reduce harmful fluid retention. However, some patients will have to restrict their total sodium intake to 2 grams a day.

Nutrition: If the patient follows the prescribed sodium limitations and chooses a variety of foods from each of the basic food groups (bread and grains, fruits, vegetables, meat alternatives, dairy products), these diets are nutritionally adequate.

Special Considerations:

Table Salt: This is a large source of sodium in the everyday diet. It is used in the kitchen in food preparation and added at the table. It is also added to many commercially canned and frozen foods. Table salt is about one – half sodium, so its use must be restricted in these diets.

Finding the Sodium in a Diet: Sodium occurs naturally in many foods, and some foods contain more sodium than others. One food labels, the sodium content is usually listed in milligrams (mg) per serving. One gram = 1000 mg. So, on a 2 gram sodium diet, a person should have no more than 2000 mg of each day; and on a 4 gram sodium diet, no more than 4000 mg a day. As a helpful guide: for the 4 gram diet, purchase products with no more than 300 mg of sodium per serving. For the 2 gram diet, purchase products with no more than 200 mg of sodium a serving.

Sodium compounds, in addition to table salt, are often added to commercially processed foods. Some of those more commonly used are baking soda, brine, monosodium glutamate (MSG), baking powder, disodium phosphate, or sodium benzoate. Read food labels on all items before purchasing or using.

Common medications: Antacids, laxatives, and cough remedies often contain sodium compounds. Check with a physician or pharmacist if there is a question about prescription or over-the-counter medications.

Fast food restaurants: Avoid them because the foods they serve tend to be very high in sodium. When dining in other restaurants, ask that no salt be used in the preparation of your meal.

Salt substitutes: Never use these unless the physician has approved it. They may replace the sodium with another mineral that could also be harmful to certain patients. Herbs and spices may be used in place of salt to add flavor and variety to meals.
Water softeners: They exchange the calcium in hard water with sodium from a salt brine. Avoid drinking home or commercially softened water. When purchasing bottled water, check the label to be sure it contains no sodium. Do not use softened water to prepare foods or beverages.
Diet Differences: A few things that are allowed on the 4 gram diet are not permitted on the 2 gram diet. Follow the guide below:

Differences Between 4 Gram and 2 Gram Diets

4 Gram Reduced Sodium Diet

Use a total of ½ teaspoon of table salt per day in cooking and food preparation. Do not add salt at the table.
Limit prepared salad dressings and condiments such as mustard or catsup to a total of 3 tablespoons per day.
Do not eat Bleu, Roquefort, Stilton, or Gorgonzola cheeses. Limit other natural or aged cheeses to 2 oz. per day.
Limit buttermilk to 8 oz. per week.
Limit regular peanut butter to 3 teaspoons per week.
2 Gram Reduced Sodium Diet

Use no table salt in cooking and food preparation. Do not add salt at the table.
Do not use commercially prepared salad dressings or condiments such as mustard or catsup.
Do not eat any natural or aged cheeses.
Do not drink buttermilk.
Do not eat regular peanut butter.
Flavoring Food Without Salt:

Onion, garlic, lemon, vinegar, black pepper, and parsley improve the flavor of many kinds of food. For gourmet-type dishes, use fruit, fruit juices, or sweet and sour sauce. Use fresh or dried herbs and spices to flavor foods. Remember that two teaspoons of chopped fresh herbs equals ½ teaspoon of the dried form. Always store dried herbs and spices in a cool, dry place in airtight containers. When flavoring, start with small amounts (1/4 tsp for four servings) and increase to taste. Don’t use more than three herbs or spices in one dish. Certain herbs and spices blend better With some foods than with others, so experiment and use the suggestions below as a guide.
Food Guidelines

• Breads

Choose: English muffin, white, wheat
pumpernickel, other types of regular or unsalted bread and rolls.
Avoid: Sweet rolls, breads or rolls with salted tops, packaged cracker or bread crumb stuffing mixes, biscuits, corn bread.

• Cereals

Choose: Regular cooked cereals such oats, cream of wheat, rice, or farina, puffed wheat, puffed rice, shredded wheat.
Avoid: Instant hot cereals, any other regular ready-to-eat cereals.

• Crackers and snack foods

Choose: All unsalted crackers and snack foods. Unsalted peanut butter.
Avoid: Salted crackers and snack items, regular peanut butter, party spreads and dips.

• Pasta, rice and potatoes

Choose: All types of Pastas such as macaroni, spaghetti, Rigatoni, ziti, potatoes, rice.
Avoid: Macaroni and cheese mix, seasoned rice, noodle, spaghetti mix, canned spaghetti, frozen lasagna, macaroni and cheese, rice, and pasta dishes, instant potatoes, seasoned potato mixes.

• Dried beans and peas:

Choose: Pinto beans, white northern beans, black-eyed peas, lima beans, lentils, split pea, etc.
Avoid: Any beans or peas prepared with ham, bacon, salt pork, or bacon grease, all canned beans.

• Meats and alternatives

Choose: Fresh or frozen meat, poultry, and fish, low sodium canned tuna and salmon, eggs.
Avoid: Salted, smoked, canned, spiced, and pickled meats, poultry and fish, bacon, ham, sausage, scrapple, regular canned tuna or salmon, cold cuts, luncheon meats, hot dogs, pre-breaded frozen meats, fish and poultry, TV dinners, meat pies.

• Fruits and vegetables

Choose: Fresh, frozen, or low-sodium canned vegetables or vegetable juices, low sodium tomato paste and sauce, fresh, canned, or frozen fruit and juices. with sodium sulfite.
Avoid: Regular canned vegetables and vegetable juices, tomato sauce and tomato paste, olives, pickles, relishes, sauerkraut or vegetables packed in brine, frozen vegetables in butter or sauces, crystallized and glazed fruit, maraschino cherries, fruit dried.

• Dairy products

Choose: Milk, cream, sour cream, non-dairy creamer, yogurt, low-sodium cottage cheese.
Avoid: Buttermilk, Dutch processed chocolate milk, processed cheese slices and spreads, regular cheese, cottage cheese.

• Fats and oils

Choose: Margarine, regular butter, or mayonnaise limit to 4 teaspoons per day, unsalted butter, margarine, cooking oils or shortenings, salt free gravies, cream sauces and salad dressings.
Avoid: Bacon grease, salt pork, commercially prepared sauces, gravies, and salad dressings.

• Soups

Choose: Salt-free soups and low- sodium bouillon cubes.
Avoid: Regular commercially canned or prepared soups, stews, broths, or bouillon, packaged and frozen soups.

• Desserts

Choose: Gelatin, sherbet, fruit ices, pudding and ice cream as part of milk allowance, angel food cake, salt-free baked goods, sugar, honey, jam, jelly, marmalade, syrup.
Avoid: Regular commercially prepared and packaged baked goods, chocolate candy.

• Beverages

Choose: Coffee, tea, soft drinks, fruit flavored drinks that do not contain sodium.
Avoid: Softened water, carbonated beverages with sodium or salt added, check with physician beverages.

• Condiments

Choose: Fresh and dried herbs, lemon juice, low-sodium mustard, Vinegar, Tabasco sauce, low-sodium or no-salt –added ketchup, extracts (almond, lemon, vanilla) baking chocolate and cocoa, seasoning blends that do not contain salt.
Avoid: Table salt, lite salt, bouillon cubes, meat extract, Worcestershire sauce, tarter sauce, ketchup, chili sauce, cooking wines, onion salt, prepared mustard garlic salt, meat flavoring, meat tenderizers, steak and barbecue sauce, seasoned salt, monosodium glutamate (MSG), Dutch processed cocoa.

Sample Menu 2 Gram Diet:

Breakfast

orange sections ½ cup
whole wheat toast 1 slice
cereal ¾ cup
unsalted margarine 2 tsp
jelly 2 tsp
skim milk 1 cup
coffee
creamer/sugar 1 tsp
Lunch

chicken noodle soup ½ cup*
lean hamburger 3oz
hamburger bun 1
sliced tomato 2 oz
lettuce
mayonnaise 1 tsp
unsalted crackers 3
vanilla wafers 3
canned peaches ½ cup
skim milk 1 cup
coffee
creamer/sugar 1 tsp
Dinner

baked chicken breast 3 oz
baked potato 1 medium
green beans 1/2cup
tossed salad
diet Italian dressing 1 tbsp
whole wheat bread 1 slice
unsalted margarine 2 tsp
angel food cake 1 slice
strawberries ½ cup
skim milk 1 cup
coffee
creamer/ sugar 1 tsp
*Low Sodium
This Sample Diet Provides the Following Calories 2090, Fat 55 gm , Protein 105 gm, Sodium 1850 mg , Carbohydrates 300 gm, Potassium 4450 mg
Sample Menu 4 Gram Diet

Breakfast

grapefruit ½
cereal ¾ cup
banana ½
whole wheat toast 2 slices
margarine 2 tsp
jelly or jam 1 tbsp
2 % milk 1 cup
coffee/tea
Lunch

vegetable soup 1 cup
lean hamburger 2 oz
swiss cheese 1 oz
hamburger bun 1
sliced tomato 2 oz
lettuce
fresh fruit salad ½ cup
oatmeal cookie 1
2% milk 1 cup
Dinner

low sodium tomato juice ½ cup
broiled chicken breast 3oz
brown rice ½ cup
broccoli spears 2
hard dinner roll 1
margarine 2 tsp
carrot/raisin salad ½ cup
frozen strawberry yogurt ½ cup
2 % milk 1 cup
coffee/tea
This Sample Diet Provides the Following Calories 2170 , Fat 69 gm, Protein 119 gm, Sodium 4040 mg , Carbohydrates 294 gm, Potassium 3950 mg.

This material does not cover all dietary information and is not intended as a substitute for professional medical care.

The purpose of this diet is to provide foods which are soft texture and moderately low in fiber.

This diet is often used as a transitional diet between the full liquid diet and the regular diet. It may be used for postoperative patients, those recovering from debilitating diseases, those who are unable to consume a regular diet, those with gastrointestinal problems, or those with poor dentition who are unable to tolerate a regular diet.

The soft diet varies from regular diet in texture and fiber content. Most raw fruits and vegetables, gas-forming foods, nuts, seeds and coarse breads and cereals are avoided.

The nutritional adequacy of this diet meets the 1989 Recommended Dietary Allowances for all nutrients when planned appropriately.

Food Guidelines

• Milk, Yogurt, and Cheese

Allowed: Milk (all types) eggnog, milkshakes, instant breakfast plain and flavored yogurt, mild flavored cheese, cream cheese, cottage cheese.
May be problematic: Cheerios with added herbs, seeds, spices, or nuts, yogurt with nuts or dried fruits.

• Meat and Substitutes

Allowed: Lean meats, poultry, fish and shellfish, eggs, creamy peanut butter, tofu.
May be problematic: Fried meats poultry, fish or shellfish, corned beef, chipped sausage, frankfurters, luncheon meats and other processed meats, dried beans and peas, crunchy peanut butter, all types of nuts.

• Potato or Substitute

Allowed: Mashed, boiled, creamed, or baked white or sweet potato, plain rice, pasta, noodles.
May be problematic: Fried potatoes, potato chips.

• Vegetables

Allowed: Tomato and mixed vegetables, juices, vegetables, rip avocados, tomatoes as tolerated.
May be problematic: Raw and fried lettuce and vegetables gas-producing. Vegetables, broccoli, brussel sprouts, cabbage, onions, leeks, cauliflower, cucumber, green peppers, rutabagas, turnips, sauerkraut.

• Fruits

Allowed: All fruit juices; canned or cooked apples (without skin), applesauce, apricots, cherries, fruit cocktail, figs, peaches, pears, purple plums, orange or grapefruit sections, fresh and ripe bananas, melons, grapes.
May be problematic: All others.

• Breads and Cereals

Allowed: White, refined wheat or light rye, enriched bread or rolls, cornbread or cornmeal, melba toast, rusk plain crackers, pancakes, waffles, biscuits, muffins, all cooked or ready to eat cereals except whole grain and bran, barley.
May be problematic: Whole grain breads, rolls or crackers with seeds, breads with nuts, raisins or dried fruits.

• Fat

Allowed: Margarine, butter, cooking fats and oils, mayonnaise, sour cream, cream and cream substitutes, gravy.
May be problematic: All others.

• Beverages

Allowed: All except alcoholic beverages.
May be problematic: Alcoholic beverages.

• Soups

Allowed: Any made with recommended meats and vegetables.
May be problematic: Those made with foods not recommended.

• Desserts

Allowed: Cakes, pies, cookies, puddings, gelatin, ice cream, sorbet, fruit ices, sherbet, and custards made with recommended foods.
May be problematic: All others.

• Sugars/Sweets

Allowed: Sugar, honey, sugar substitutes, jelly and seedless jams, clear hard candy, cocoa, chocolate, molasses, marshmallows.
May be problematic: All others.

• Seasonings

Allowed: Salt , pepper, mild flavorings and condiments as tolerated.
May be problematic: Strongly flavored seasonings and condiments (garlic, chili sauce, chili pepper, horseradish).

• Miscellaneous

May be problematic: Pickles, popcorn, nuts, coconuts, snack chips.

Sample Menu Soft Diet:

Breakfast

Orange juice – ½ cup
Rice Krispies – ¾ cup
White toast – 2 slices
Margarine – 2 teaspoons
Jelly – 2 teaspoons
2% milk – 1 cup
Coffee
Lunch

Tomato soup – 1 cup
Turkey sandwich
bread – 2 slices
turkey – 2 oz
mayonnaise – 1 tablespoon
Angel food cake – 1 slice
Fruit cocktail – ½ cup
2% milk – 1 cup
Dinner

Lean roast beef – 3oz
Parslied potatoes – ½ cup
Spinach – ½ cup cooked
Dinner roll – 1
Banana – 1 medium
Low-fat frozen
yogurt – ½ cup
2% milk – 1 cup
Approximate Nutrient Analysis of Sample Menu – Soft Diet:

Calories:    2112
Protein:    101 g
Carbohydrates:    308 g
Dietary Fiber:    13 g
Total Fat:    57 g
Saturated Fat:    21 g
Monounsaturated Fat;    19 g
Polyunsaturated Fat;    11 g
Omega 3 Fatty Acids:    0.88 g
Omega 6 Fatty Acids:    10.3 g
Cholesterol:    196 mg
Vitamin A (total):    1514 RE
Vitamin A – carotenoid:    1016 RE
Vitamin D:    10 mcg
Vitamin E:    10 mg
Vitamin C:    162mg
Thiamin:    1.6 mg
Riboflavin:    3.0 mg
Niacin:    41 mg
Vitamin B6:    3.2 mg
Vitamin B12:    7.8 mg
Folate:    356 mg
Calcium:    1626 mg
Magnesium:    389 mg
Phosphorus:    1791 mg
Iron:    15 mg
Zinc    14.8 mg
Selenium:    91 mcg
Potassium:    4257 mg
Sodium:    3862 mg

This diet consists of all foods except those which contain milk or milk products.

Food to Use:

Soups - Broth, meat base soups made without milk, chowders made without milk.

Meat and Meat Substitutes - Meat, fowl: Any prepared without milk or milk products. Eggs: coddled, deviled, hard or soft cooked, poached, fried, omelets, scrambled or soufflés if vegetable shortening replaces butter or margarine and water or vegetable liquid replaces milk.

Starches - Bread or toast: Any homemade bread or rolls without milk or milk products, bagels, Ry-Krisp; some commercial french bread and English muffins are made without milk. Read labels carefully. Cereals: Any to which mo milk product has been added during manufacture, serve without milk or cream – fruit sauce, honey or various sugars may be used. Potato or substitute: Any cooked with out milk or milk products.

Vegetables - All cooked without milk or milk products.

Fruits - All served without milk or milk products. Juices - All.

Dessert - Cakes, cookies, pie crusts, pudding and shortcake made at home without milk or milk products; angel and sponge cakes, fruit flavored and plain gelatins, fruit ices made with water, meringues.

Beverages - Milk free chocolate or cocoa made with water, coffee and tea without cream or milk, mineral and carbonated waters, mocha mix, soy milk.

Miscellaneous - Catsup, chili powders, condiments, flavorings extracts, olives, pickles, spices. Gravies, meat and other sauces made without milk or milk products. Candies made at home without milk or milk products, hard candy, jelly beans, marshmallows, jam, jelly, honey, marmalade, molasses, syrup and sugar. French dressing, mayonnaise and other salad dressings made without milk or milk products, soy margarine, vegetable oils.
Food to Avoid:

Soups - Canned, dehydrated, dried, frozen and homemade containing milk or milk products.

Meat and Meat Substitutes, Cheese - Any prepared with milk or milk products; commercially prepared meats often contain milk and milk products, for example, some frankfurters and luncheon meats.

Starches - Bread or toast: Any bread or rolls made with milk or milk products, crackers, doughnuts, muffins, pancakes, popovers, waffles, zwieback, commercial bread and rolls often contain milk or milk products. Cereals: Any to which milk or milk products have been added. Potato or potato substitute: Au gratin, creamed, escalloped, any commercial products have milk added.

Vegetables - Au gratin, creamed, escalloped, many commercial products have milk added.

Fruits - None; served without milk or milk products.

Dessert - Bavarian cream, blanc mango, custard, ice cream, junket, milk, sherbet, mousse. Cake, candy, cookies, pies and pudding made with milk or milk products.

Beverages - Any made with milk or milk chocolate, cocoa, or any preparations containing milk or milk products, Ovaltine.

Milk or Milk Products - All, including fresh, skim and whole: Buttermilk, condensed, dried, evaporated; casein, lactalbumin, curds and whey, malted and powdered milks.

Miscellaneous - Au gratin foods, rarebits, timbales, milk chocolate Breaded foods if breading contains milk or milk products. Butter, cream, half and half, margarine. Creamed and escalloped foods. Foods dipped in milk batter or fried in butter or margarine. Gravies and sauces made with milk. Prepared mixes if they contain milk or milk products. Salad dressings containing milk or milk products.