Diet & Nutrition

PURPOSE

 Gastroparesis is the medical term for delayed stomach emptying. During the process of digestion, the stomach must contract to empty itself of food and liquid. Normally, it contracts about three times a minute. This empties the stomach within 90-120 minutes after eating. If contractions are sluggish or less frequent, stomach emptying is delayed. This results in bothersome and sometimes serious symptoms, as well as malnutrition, because food is not being digested properly.

 Gastroparesis may be caused by various conditions such as diabetes mellitus, certain disorders of the nervous system, or certain drugs. Often however, no cause can be found although a viral is suspected in some. Usually, the physician prescribes medication to stimulate the stomach to contract. The purpose of the Gastroparesis Diet is to reduce symptoms and maintain fluids and nutrition. There are three steps to the diet: 

• STEP 1 DIET: Consists of liquids, which usually leave the stomach quickly by gravity alone. Liquids prevent dehydration and keep the body supplied with vital salts and minerals. 
• STEP 2 DIET: Provides additional calories by adding a small amount of dietary fat – less than 40g each day. For patients with Gastroparesis, fatty foods and oils should be restricted because they delay stomach emptying. However, patients at the Step 2 level are usually able to tolerate this amount. 
• STEP 3 DIET: Designed for long-term maintenance. Fat is limited to 50g per day, and fibrous foods are restricted because many plant fibers cannot be digested. 

NUTRITION 

The Step 1 Gastroparesis Diet is inadequate in all nutrients except sodium and potassium. It should not be continued for more than three days without additional nutritional support. Step 2 and Step 3 Gastroparesis Diets may be adequate in Vitamins A and C, and the mineral Iron. A multi-vitamin supplement is usually prescribed. 

SPECIAL CONSIDERATIONS

1. Diets must be tailored to the individual patient. This is because the degree of Gastroparesis may range from severe and long-standing to mild and easily corrected. Patients may also have various medical conditions to be considered. For example, diabetes patients with Gastroparesis are allowed sugar-containing liquids on the Step 1 Diet, because that is their only source of carbohydrate. On the Step 2 and Step 3 Diets, these patients should avoid concentrated sweets. These are noted with an asterisk (*) on the food lists. 

2. On all the diets, liquids and food should be eaten in small, frequent meals. This helps maintain nutrition.

STEP 1 FOOD GROUPS
Group	Recommend	Avoid
Milk & Milk Products	None	All
Vegetables	None	All
Fruits	None	All
Breads & Grains	Plain saltine crackers	All others
Meat & Meat Substitutes	None	All
Fats & Oils	None	All
Beverages	Gatorade and soft drinks (sipped slowly throughout the day)	All others
Soups	Fat-free consommé and bouillon	All others

SAMPLE MENU STEP 1
Breakfast  • Gatorade, ½ cup • Ginger Ale, ½ cup  • Bouillon, ¾ cup • Saltine Crackers, 6	Lunch • Gatorade, ½ cup • Coke, ½ cup • Bouillon, ¾ cup • Saltine Crackers, 6	Dinner • Gatorade, ½ cup  • Sprite, ½ cup • Bouillon, ¾ cup  • Saltine Crackers, 6

This Sample Diet Provides the Following
Calories	790	Fat	9g
Protein	11g	Sodium	3531mg
Carbohydrates	156g	Potassium	244mg

STEP 2 FOOD GROUPS
Group	Recommend	Avoid
Milk & Milk Products	Skim milk, products made with skim milk, low-fat milk, low-fat yogurt, low-fat cheeses	Whole milk products, creams (sour, light, heavy, whipping), half & half
Soups	Fat-free consommé and bouillon, soups made from skim milk and fat-free broths containing pasta or noodles and vegetables are allowed	Soups made with cream, whole milk, or broths containing fat
Breads & Grains	Breads and cereals, cream of wheat, pasta, white rice, egg noodles, low-fat crackers	Oatmeal, whole grain rice, cereal and bread
Meat & Meat Substitutes	Eggs, peanut butter (maximum 2 tbsp/day)	Beef, poultry, fish, pork products, dried beans, peas and lentils
Vegetables	Vegetable juice (tomato, V-8), well-cooked vegetables without skins (acorn squash, beets, carrots, mushrooms, potatoes, spinach, summer squash, strained tomato sauce, yams)	All raw vegetables, cooked vegetables with skins, beans (green, wax, lima), broccoli, brussels sprouts, cabbage, cauliflower, celery, corn, eggplant, onions, peas, peppers, pea pods, sauerkraut, turnips, water chestnuts, zucchini
Fruits	Apple juice, cranberry juice, grape juice, pineapple juice, prune juice, canned fruits without skins (applesauce, peaches, pears)	Citrus juices, all fresh and dried fruits, canned fruits with skins (apricots, cherries, blueberries, fruit cocktail, oranges, grapefruit, pineapple, plums, persimmons)
Fats & Oils	Any type of fat, but only in small amounts	None
Sweets & Desserts*	Hard candies, caramels, puddings and custards made from skim milk, frozen yogurt, fruit ice, gelatin, ice milk, jelly, honey, syrups	High-fat desserts (cakes, pies, cookies, pastries, ice cream), fruit preserves
Beverages	Gatorade*, soft drinks*, (sipped slowly throughout the day)	All others, except allowed juices
*Concentrated sweets

SAMPLE MENU STEP 2
Breakfast  • Skim Milk, ½ cup  • Poached Egg, 1  • White Toast, 1 slice • Apple Juice, ½ cup	Lunch  • Mozzarella Cheese, 2 oz • Saltine Crackers, 6 • Chicken Noodle Soup, ¾ cup • Gatorade, ½ cup	Dinner •Peanut Butter, 1 tbsp • Saltine Crackers, 6 • Vanilla Pudding, ½ cup • Grape Juice, ½ cup
Morning Snack  • Ginger Ale, ½ cup • Canned Pears, ½ cup	Afternoon Snack • Skim Milk, ½ cup • Cornflakes, ½ cup  • Sugar, 2 tsp	Evening Snack • Frozen Yogurt, ½ cup  • Saltine Crackers, 6

STEP 3 FOOD GROUPS
Group	Recommend	Avoid
Milk & Milk Products	Skim milk, products made with skim milk, low-fat milk, low-fat yogurt, low-fat cheeses	Whole milk products, creams (sour, light, heavy, whipping), half & half
Soups	Fat-free consommé and bouillon, soups made from skim milk and fat-free broths containing pasta or noodles and vegetables are allowed	Soups made with cream, whole milk, or broths containing fat
Breads & Grains	Breads and cereals, cream of wheat, pasta, white rice, egg noodles, low-fat crackers	Oatmeal, whole grain rice, cereal and bread
Meat & Meat Substitutes	Eggs, peanut butter (maximum 2 tbsp/day), poultry, fish, lean ground beef	Fibrous meats (steaks, roasts, chops), dried beans, peas and lentils
Vegetables	Vegetable juice (tomato, V-8), well-cooked vegetables without skins (acorn squash, beets, carrots, mushrooms, potatoes, spinach, summer squash, strained tomato sauce, yams)	All raw vegetables, cooked vegetables with skins, beans (green, wax, lima), broccoli, brussels sprouts, cabbage, cauliflower, celery, corn, eggplant, onions, peas, peppers, pea pods, sauerkraut, turnips, water chestnuts, zucchini
Fruits	Fruit juices, canned fruits without skins (applesauce, peaches, pears)	All fresh and dried fruits, canned fruits with skins (apricots, cherries, blueberries, fruit cocktail, oranges, grapefruit, pineapple, plums, persimmons)
Fats & Oils	Any type of fat, but only in small amounts	None
Sweets & Desserts*	Hard candies, caramels, puddings, and custards made from skim milk, frozen yogurt, fruit ice, gelatin, ice milk, jelly, honey, syrups	High-fat desserts (cakes, pies, cookies, pastries, ice cream), fruit preserves
Beverages	Gatorade*, soft drinks*, (sipped slowly throughout the day), coffee, tea, water (note: noncaloric beverages should be limited if patient cannot maintain adequate caloric intake)	All others, except allowed juices
*Concentrated sweets

SAMPLE MENU STEP 3
Breakfast  • Skim Milk, ½ cup  • Cream of Wheat, ½ cup • Sugar, 2 tsp • Orange Juice, ½ cup • White Toast, 1 slice  • Margarine, 1 tsp • Jelly, 1 tbsp	Lunch • Tuna Fish, 2 oz • Low-fat Mayonnaise, 2 tbsp  • White Bread, 2 slices • Canned Peaches, ½ cup  • Gatorade, ½ cup	Dinner  • Baked Chicken, 2 oz  • White Rice, ½ cup • Cooked Beets, ½ cup  • Dinner Roll, 1 • Skim Milk, ½ cup • Margarine, 2 tsp
Morning Snack • Low-fat Yogurt, ½ cup • Sprite, ½ cup	Afternoon Snack • Chocolate Pudding, ½ cup • Ginger Ale, ½ cup	Evening Snack  • Ice Milk, ½ cup  • Pretzels, 2

This Sample Diet Provides the Following
Calories	1822	Fat	42g
Protein	75g	Sodium	2334mg
Carbohydrates	286g	Potassium	2467mg

Diverticulosis is characterized by the formation of pockets in the lining of the large intestine. 

Diverticulitis is the acute stage of diverticulosis when the pockets are infected and inflamed. 

With the presence of Diverticulosis, it is best to follow a high fiber diet. This keeps pressure on the wall of the large intestine and prevents the accumulation of excess bacteria. Increase fiber gradually in your diet, as a sudden increase may cause increased formation of gas. 

If Diverticulitis does occur, it is best to switch to a low fiber diet during the acute infection period. After the infection is gone, gradually switch back to a high fiber diet.

RECOMMENDED FOODS FOR DIVERTICULOSIS
Food Group	Daily Amount	High Fiber Foods
Fresh Fruit	2 or more servings	Apples (with skin), oranges, grapefruits, bananas, peaches, pears, plums, cherries, apricots and grapes
Breads and Cereal	4 or more servings	Whole grain bread (100% whole wheat, bran, or pumpernickel), dry or cooked cereals (made from whole wheat, bran, oats, unprocessed wheat bran or oat bran), whole grain crackers, bran muffins, brown rice
Vegetables	2 or more servings	Broccoli, brussels sprouts, peas, cabbage, carrots, celery, green beans, potatoes, zucchini, tomatoes (without seeds), onions and baked beans Avoid Popcorn!

RECOMMENDED FOODS FOR DIVERTICULITIS
Food Group	Daily Amount	Low Fiber Foods
Fresh Fruit	2 or more servings	Fruit juice, fruit drinks pureed fruit, cooked fruit (without skin)
Breads and Cereal	4 or more servings	White bread, french bread, farina, cream of wheat or rice, melba toast, saltines, corn flakes, rice krispies, puffed rice, white rice and pasta
Vegetables	2 or more servings	Vegetable juice, lettuce, winter squash, tomato sauce, mashed or cooked vegetables or potato
Miscellaneous: All dairy products, meat, poultry, fish, eggs, broth, cream soup

YOU MAY HAVE ONLY THE FOLLOWING: 

Water 

Seltzer

Apple Juice 

White Grape Juice 

Sprite 

Ginger Ale 

Bouillon or Clear Broth 

Gatorade (NOT RED) 

Italian Ice (NOT RED) 

Plain Jello (NOT RED) 

Black Coffee or Tea (NO MILK OR CREAMER) 

Gum (DAY BEFORE PROCEDURE ONLY) 

THE FOLLOWING ALSO APPLIES: 

YOU MAY NOT HAVE ANY SOLID FOOD 

NO ALCOHOL 

NO LEMONADE

NO MILK OR MILK PRODUCTS

 This diet provides fluids that leaves little residue and are easily absorbed with minimal digestive activity. This diet is adequate in all essential nutrients and is recommended only if clear liquids are temporarily needed. No red or purple liquids should be consumed! 

Food Group	Foods Allowed	Foods to Avoid
Milk & Beverages No bright red or dark purple liquids	Coffee, tea (decaffeinated or regular), carbonated beverages, fruit flavored drinks	Milk, milk drinks
Meats & Meat substitutes	NONE	ALL
Vegetables	NONE	ALL
Fruits & Fruit juices	Strained fruit juices: apple, white grape, lemonade, Gatorade, crystal light, soda, water, ice tea	All fruit and fruit juices with unstrained fruit
Grains & Starches	NONE	ALL
Soups (no noodles, rice, veggies, meat)	Clear broth, consommé	All others
Desserts	Clear flavored gelatin, popsicles, Italian ices (no bright reds or dark purple flavors)	All others
Treats	NONE	ALL
Miscellaneous	Sugar, honey, syrup, clear hard candy, salt	All others

Purpose: The bland or soft diet is designed to decrease peristalsis and avoid irritation of the gastrointestinal tract.

Use: It is appropriate for people with peptic ulcer disease, chronic gastritis, reflux esophagitis or dyspepsia. It may also be used in the treatment of hiatal hernia.

A Bland Diet is a diet consisting of foods that are generally soft, low in dietary fiber, cooked rather than raw, and not spicy. Fried and fatty foods, strong cheeses, whole grains (rich in fiber) are also avoided on this diet.