Far Eastern University

Institute of Nursing
Hand Outs in Nutrition
DIET THERAPY
- broad term for the practical application of nutrition as a preventive or corrective
treatment of disease.
Usually involves modification of an existing dietary lifestyle to promote optimum
health.
MEDICAL NUTRITIONAL THERAPY
Process wherein individuals with a variety of conditions and illnesses can improve
their health and quality of life by receiving appropriate diet plan and nutrition
educations based on a complete nutrition assessment.
Steps in Medical Nutritional Therapy
I. Nutritional Assessment
- is a process to identify the nutritional status of a person. Helps recognize actual
and potential nutritional problems.
- provides the foundation upon which to judge and tailor a clients nutritional care
needs including diet education.
STEPS IN NUTRITION THERAPY
I. Nutritional assessment
- is a process to identify the nutritional status of a person.
II. Nutritional Therapy
Specifies the suitable diet and nutrition education requirements for effective
management of nutritional and/or medical diagnosis.
Each client is given a nutritional care plan that includes:
Measurable goals
Diet modifications
Education
Diet Modification entails one or more of the following:
1. Changes in food consistency
2. Adjusting the amount of one or morenutrients, or fluids
3. Increasing, reducing, or eliminatingcertain foods
4.Altering the number of meals
Basis of Modified diets
Clients condition rather than the disease per se.
Considerations when giving therapeutic diet:
1. The capacity to digest and absorb nutrients
2. Psychosocial factors
Factors in Planning Modified Diet
1. Disease state, its nature, duration and intensity or severity
2. Food form or nutrient modification required by the disease
3. Patients individual food tolerances and food habits
4. Nutritional adequacy of modified diets
5. Patients physical ability and home situation
PURPOSES OF DIET MODIFICATION
1. To maintain or restore good nutritional status
2. To correct nutritional deficiency, if present
3. To afford rest to a particular part of the body that may have been affected by
illness or surgery.
4. To adjust the diet based on the digestive capability of the client

5.To adjust the diet based on the ability of the client to metabolize nutrients
6. To treat or prevent edema
7. To eliminate offending food substances
PRINCIPLES OF DISEASE MANAGEMENT THROUGH DIET
1. Liberalization
2. Individualization
3. Simplification
TYPES OF DIET
Regular diet or house diet is a diet which includes all the variety of food with no
certain restrictions.
Modified diets or therapeutic diets are diets that need to be adjusted to meet
specific health and medical condition
Test diets are diets given to a person in preparation to or as part of the diagnostic
procedure
STANDARD HOSPITAL DIETS
Also known as routine diets
Includes:
Regular diet
Liquid diet
Mechanically soft diet
Soft diet
REGULAR DIET
- Composed of all types of foods and is well balanced and capable of maintaining a
state of good nutrition.
- Intended for convalescing patients who do not require a therapeutic diet.
General viewpoint guiding the composition of a regular diet:
1. To educate the client in the principles of a good nutrition by example
2. To provide foods the client is willing to consume.
REGULAR DIET
Alternate names:
Normal diet
Standard diet
Full diet
House diet
How to attain adequate amount of Nutrient in the diet
Use the recommended amount for specific food groups based on age and sex.
Growing children and women of childbearing stage need to include a major
source of iron daily.
GUIDELINES FOR MAKING PROPER FOOD CHOICES
1. Choose a wide variety of foods daily and follow the guidelines on the
recommended amount for each food group.
2. Use the Food Guide Pyramid to help select and balance food choices.
3. Buy foods that are available, cheap and in season.
4. Include at least 2 3 servings of vegetables daily, one of which should be dark
green or yellow vegetable, a 9ood source of Vitamin A or its precursor betacarotene. ( A serving is = cup cooked or 1 cup raw).
5. Choose lean meats, poultry (without skin), fish, seafood, dried beans.
6. Include milk or milk products in the diet, otherwise, substitute other sources of

calcium like small fishes, soya beans and soy products.

Vitamin C-rich Fruits
7. Eat fruits at least 2 or 3 servings everyday; one should be rich in VitaminC
(papaya, dalanghita, guyabano, mango)..
8. Growing children and women of childbearing age should include a major
source of iron ( Iron rich foods include organ meats especially pork liver, ironfortified food products and dried fruits).
9. Use herbs and spices, seasonings, sauces, and flavorings in moderation.
10. Drink 8 10 glasses (8 oz size) of fluids daily, unless contraindicated.
HIGH-FIBER DIET
Dietary fiber is the part of a plant which is not digested by the stomach or small
intestine. Rather, it arrives unchanged in the colon.
Also known as roughage or bulk
It provides bulk or roughage and thereby helps promote regularity.
When adequate fiber is consumed, 25-35 grams per day, many amazing health
benefits occur in the colon and body.
Consumption of higher than 50 gm has no additional benefit and may cause
undesirable gastrointestinal effect.
Children: age + 5 grams of more dietary fiber is suggested.
High-fiber diets are generally low in calories and fats while packed with vitamins,
and minerals, and other protective substances.
Purpose :
To increase the weight of residue reaching the colon, to increase intestinal peristalsis,
and decrease colonic pressure.
CATEGORIES OF FIBER
I. Insoluble fiber provides texture to plant foods fruits, vegetables and cereals.
II. Soluble fiber dissolves in water to form a gel-like material.
Soluble fiber is found in all fruits, cereals , oats, legumes (peas, beans), apples, citrus
fruits, carrots, barley and psyllium.
INDICATIONS OF HIGH-FIBER DIET
1. Cancer prevention: breast, prostate, colon, bladder, rectum, uterine bleeding
2. Constipation
3. Coronary Heart Disease
4. Diabetes Mellitus
5. Diarrhea (more on soluble)
6. Diverticulosis
Contraindications
When stenosis or obstruction or norrowing of the intestinal lumen is present.
GUIDELINES FOR MAKING PROPER FOOD CHOICES
1. Eat 2 to 4 servings of fruit, 3 to 5 servings of vegetables, and 6 to 11 servings of
cereals and grains to obtain about 25 to 30 grams of fibers a day.
2. Add fiber in the diet gradually. High-fiber diet should be included in each meal.
3. As often as possible, select whole grain breads, cereals, legumes and fresh
fruits and vegetables.
4. When possible, eat vegetables raw. Use microwave or steam when cooking until
they are tender (al dente) but still firm to the bite.
5. Avoid peeling fruits and vegetables whenever possible. Eating the skin and
membranes ensures getting every bit of fiber. Whole fruits and vegetables
contain more fiber than juice.
6. Bran can be used to increase significantly the fiber content of the diet. It can be
sprinkled or added to cereals, salads

7. In labeled food products, select those with at least 10% of the daily values of the
dietary fiber.
The package that claims high in, rich in, or excellent source of, provides 20%
of daily values.
8. Add beans to soup, stew, salads; a couple of times a week, substitute legumebased dishes ( lentil soup,. Bean burritos, or rice and beans) for those made
with meat.
9. Keep fresh and dried fruit on hand for snacks.
10. Add more fluids.
11. Mix high-fiber foods with other foods:
Sprinkle raisins on salads
Sprinkle bran flakes or wheat germ on favorite foods.
Add high-fiber vegetables to dishes.
PRECAUTIONARY MEASURES
Avoid increasing fiber intake too quickly because it may result into:
1. Excessive gas formation ( flatulence) and bloating.
2. Abdominal pain and sometimes diarrhea.
3. Decrease in the absorption of Zn, Cu, Mg, Ca, CHON, and pyridoxine.
4. Water-soluble fibers (found in apples, citrus fruits, strawberries, oatmeal and dried
beans ) do not affect mineral absorption as much as cellulose and bran ( found
mainly in whole-wheat products, root vegetables, cabbage family, and mature
vegetables.
Note:
These side effects can usually be minimized by adding fiber into the diet in small
amounts with divided doses. Plenty of water is also important.
Same as the regular diet plus servings of fruits, vegetables, and substitution of refined
carbohydrates with whole grains.
VEGETARIAN DIETS
Vegans or strict vegetarians exclude all meats, fish, poultry, eggs, milk, cheeses, and all
other fruits containing animal products.
Diets are based on grains, fruits, vegetables, legumes, nuts and seeds.
Some vegetarians include one or more types of animal food sources:
1. Semi-vegetarian ( partial vegetarian) excludes only red meats. Diet is based on
grains, fruits, vegetables, legumes, nuts, seeds, eggs, dairy products, chicken and
fish.
2. Lacto-ovo-vegetarian excludes animal flesh and seafood. Diet is based on a
vegetarian diet plus dairy products.
3. Pesco-vegetarian avoids meat and poultry and their diet includes grains,
V,L,N,S, and fish ( but some eat eggs and dairy products.
4. Ovo-vegetarians excludes dairy, fish and seafood.
Extreme types of vegetarians:
Fruitarians consume only fruits and vegetables that are botanically considered
fruits that spread through their seeds are being eaten.
Zen Macrobiotic is a very limited vegetarian type followed by adherents of a set
founded by Gregorio Ohsawa. Natural and organic foods are used and fluid
restrictions maybe practiced.
Vitamins and minerals are rarely taken
NUTRITIONAL CONSIDERATIONS IN MEAL PLANNING

1. The planning of a vegetarian diet should choose a wide variety of foods and ensure
that the calorie intake is enough to meet energy needs.
2. The selection of foods for a vegetarian diet must take into consideration the daily
needs for all nine ( 10 for children) essential amino acids as well as total amount
of protein. Intake of a variety of foods over the course of a day should provide
sufficient protein.
Suggestions for complementing proteins ( they do not need to be consumed at the same
meal):
Stir-fried tofu and rice or beans and rice
Bread made with milk and cheese
Pasta with milk or cheese like Macaroni and Cheese
Rice and milk pudding or cereal and milk
Rice-cheese dishes or casseroles
Cheese and sandwiches sesame and milk or sesame seeds in bean soup

Vegetarian sources of critical nutrients:

Protein: soy-based products, legumes, seeds, nuts, grains and vegetables
Calcium: tofu processed with Calcium, dairy products dark leafy ( broccoli, kale,
bok choy), legumes, peanuts, almonds, fig, seaweeds, seeds and products
fortified with calcium such as soy beverages, breakfast cereals, and orange
juice.
Iron: legumes, dark leafy green vegetables, dried fruits, whole and enriched grains,
molasses, seeds, tofu, and iron-fortified products.
Important: Iron-rich plant foods must be consumed with foods high in vitamin C
( citrus fruits, peppers, and tomatoes.
Zinc: eggs, cheese, milk, legumes, tofu, Tempeh, miso, nuts, wheat germ, fortified
cereals and whole grains.
Riboflavin: dairy products, eggs, whole and enriched grains (if eaten daily),
brewers yeast, dark and green leafy vegetables, mushrooms, beans, nuts and
seeds.
Cobalamin (Vitamin B12): cereals fortified with vitamin B12, dairy products, eggs,
nutritional yeast, foods fortified with B12, fermented soy products, and vitamin
supplements
Vitamin D: products fortified with Vit D ( milk, soymilk, cereals, and margarine),
and exposure of skin to sunshine, supplementation maybe needed for those
who dont get enough exposure to sunlight.
Omega-3 fatty acids: canola oil, flaxseed and flaxseed oil, soy bean oil, and
walnuts.
Choose whole, unrefined foods often and minimize intake of highly sweetened,
fatty and heavy refined foods.
If animal foods such as dairy products and eggs are used, use lower fat versions of
these foods.
Limit : Cheese, High-fat dairy foods, and Eggs
Due to: 1. Saturated fat content
2. Frequent use displaces plant foods in
vegetarian diets.
VEGAN INFANTS AND CHILDREN

1. Breast-feed infants : at least 6 months and preferably

longer with careful attention with the mothers diet
2. Infants who are purely breast fed beyond 4 to 6 months of age should be
given iron supplement and Vitamin D if sunlight exposure is limited.
3. Toddlers: Fortified soy formula or milk whenever possible.
4. Older children and adolescent: should receive supplemental vitamins and
minerals if
soymilk is not used.
5. Vitamin B12 should be supplemented.
6. Reduce fiber intake to increase calcium absorption by partly replacing whole
grain cereals with lower fiber grain.
7. Avoid giving the following foods to infants and toddlers:
a. Honey and Home canned fruits and vegetables
*potential food-borne illness
b. Vegetable juices (carrots and spinach)
* High nitrate content
c. Whole nuts ( Nut butters could be used)
D. Granolas
* Potential for choking
8. Do not limit dietary fat in children younger than 2 years.
For older children, include some foods higher in unsaturated fats to help meet
nutrient and energy needs.( nuts, seeds, nut and seed butters, avocado, and
vegetable oils)
9. Keep the consumption of low-nutrient-dense foods sweets and fatty foods to
a minimum.
10. Chose whole or unrefined grains, instead of refined products or use fortified
or enriched cereal products.
11. Use a variety of fruits and vegetables, including a good food source of
ascorbic acid.
HEALTH BENEFITS OF VEGETARIAN DIET
1. Reduced risk of heart disease
2. Lower Blood Pressure
3. Less problem associated with digestion
4. Reduced risk of some cancers
5. Reduced risk of kidney disease, kidney stones and gallstones
6. Lower risk of obesity
THERAPEUTIC DIET
Modifications of the regular diet and are designed to meet specific patient needs.
These include
method of preparation (e.g., baking, boiling, or broiling),
consistency (e.g., ground or chopped),
total calories (e.g., high or low calorie),
nutrients (e.g., altering carbohydrate, protein, fat, vitamins, and minerals)
allowing only specific foods (e.g., diabetic diet)
FIBER RESTRICTED DIET
Fiber-Restricted Diet ( Low-fiber diet) limits the consumption of fiber-rich foods
by avoiding whole grain bread and cereal products, nuts, seeds, legumes, and
certain fruits and vegetables.

Total dietary fiber per day: 15 to 20 grams

Restriction depends on:
1. Clients condition
2. Goals of management
Purpose:
To reduce the total fecal size by limiting the sources of fiber and connective
tissues.
INDICATIONS OF FRD
1. For reduction of fecal output before or after surgery.
2. For acute cases of intestinal disorders: diverticulitis, inflammatory bowel
syndrome, Crohns disease , and Ulcerative Colitis
3. Reduction of gas in the intestines
4. Norrowing of the intestines: obstructions and strictures
5. Progressive diet
6. Radiation enteritis
ADEQUACY OF NUTRIENTS
When carefully planned, the diet provides all the essential nutrients except for
water-soluble vitamins particularly Vitamin C and minerals.
Supplementation is needed when used for prolonged periods.
LFD
The following foods are allowed on a low-fiber diet
white bread
White rice
Plain pasta, noodles or macaroni
Cereals with no more than 1 gram of dietary fiber per serving
Most canned or cooked fruits without skins, seeds or membranes
Raw fruit without skin or membranes
Fruit and vegetable juice with little or no pulp
Canned or well-cooked vegetables without seeds, hulls or skins, such as
carrots, string beans and peppers
Tender meat, poultry and fish
EggsSmooth (creamy) peanut butter up to 2 tablespoons a day
MilkYogurt or cheese without seeds or nuts
Fats, oils and dressings without seeds
Desserts with no seeds or nuts
While eating a low-fiber diet, limit fruits and vegetables to one to two servings a
day.
One serving is 1/2 cup or one small whole fruit.
You should also avoid:
Whole-grain breads,
cereals and pasta
Brown or wild rice
Dried fruits
Raw fruit with skin or membranes, such as oranges and grapefruit
Pears
Raw vegetables
Dried beans or peas
AVOID:

Baked beans
Luncheon meats and cheese with seeds
Chunky peanut butter
Seeds and nuts, and foods containing them
CoconutPopcorn
Eating a low-fiber diet will limit your bowel movements and help ease diarrhea or other
symptoms of abdominal conditions, such as abdominal pain. Once your digestive system
has returned to normal, you can slowly reintroduce fiber into your diet.
GUIDELINES for MAKING PROPER FOOD CHOICES
1. Eat a variety of nutritious foods and limit those high in fiber.
2. Select refined breads, cereals, rice, and pasta.
Avoid whole-wheat bread and cereals, and brown and red rice
3. Choose only tender meat, poultry, seafood and eggs.
4. remove skin, seeds, and structural fiber from fruits and vegetables. Use only
young, tender vegetables, ripe, canned or well-cooked fruits.
5.Sources of low-fiber fruits and vegetables include:
Fruits and vegetable juice
Cooked or canned, peeled apples, pineapple, peaches and bananas
Most well-cooked vegetables without seeds, or husks, lettuce, tomato paste or
puree.
6. Chew foods thoroughly, eat slowly, and avoid large meals.
7. If the goal of the diet management is to reduce gas formation, the
consumption of the following foods should be avoided on a trial basis:
Dried beans and peas
Cabbage, radishes, onions, broccoli, cauliflower, cucumber
Prunes, apples, raisins, and excessive amounts of fruits
Bran cereals, excessive amounts of wheat products
High-lactose foods such as milk, ice cream, ice milk and cream
Sorbitol, mannitol ( sugar alcohols) found in dietetic candies and sugar-free
gum
Fried food, fatty meals, rich cream sauces, gravies and pastries.
CLEAR LIQUID DIET
A temporary diet containing foods and fluids that are clear and liquid at room
temperature and without residue and is served at frequent intervals ( 1-hour to
2-hours interval).
Non-stimulating, non-gas-forming and non-irritating diet.
Given 24 to 48 hours
Rule of Thumb:
Any transparent drinkable liquid or any drinks with color but you can still see
through it ( tea, apple juice).
CLEAR LIQUID DIET
Purpose:
To provide adequate amounts of fluid and electrolytes and modest, rapidly
absorbed calories so as to promote a return to normal diets. It provides some
energy when normal food intake must be withheld.
Foods included are those that are easily absorbed and leave minimal residue
in the gastrointestinal tract (GIT).

The diet also minimizes stimulation of the GIT ( non- distending, non-irritating
and non-stimulating to peristaltic action.
Restrictions:
The type of food given may vary according to the clients acceptance and/or as dictated
by:
medical condition
diagnostic test
specific surgery the patient is undergoing
Number of food exchange list unit is not applicable in the Clear Liquid Diet.
When persistent abdominal discomfort is experienced, the patient should notify the
health care professional at once.
Preparation of medical test:
It is essential that the diet should be followed exactly. The value of the test
depends on getting a thoroughly clean digestive tract.
CONSIDERATIONS
The diet cannot meet all the calories and essential nutrients needed by the body,
mainly provides fluids (water), some electrolytes, and small amounts of energy
from simple carbohydrates.
Average clear liquid diet contains 400 800 (400 500-Peckenpaugh) kcalories
per day.
Because of inadequacy, its use must be limited to 1 or 2 days. Extended use
should be combined with high-protein gelatin or low-residue liquid supplements.
Severe vomiting and diarrhea conditions need electrolytes through parenteral
fluids.
INDICATIONS
1. As an initial feeding between intravenous fluid and a full liquid diet or a solid
diet following surgery ( postoperatively).
2. As a transition to oral feeding after tube or parenteral feeding.
3. As a dietary preparation for medical test like bowel examination.
4. As pre-diet for surgery to reduce fecal matter.
5. Acute illness and infections. As a diet when there is acute disturbance of GI
function like vomiting and diarrhea.
6. As an initial feeding for a severely weak patient including severely
malnourished patient and those with fever.
7. Temporary food intolerance/intolerance to solid food.
8. To relieve thirst.
9. For frequent feeding/1 to 2-hour feeding intervals.
GUIDELINES FOR MAKING PROPER FOOD CHOICES
1.Choose only those food items that are clear and liquid or that can be
liquefied at body temperature such as the following:
Carbonated beverages
Cereal beverages
Coffee regular or decaf
Fruit drinks( Zest-O, Hi-C, Kool-aid) and fruit ices
Fruit ices without pulp (except nectar, tomato and prune)
Clear hard candy
Sports drink
Ice
Strained fruit juice
Lemonade, Ginger ale
Sugar, honey
Plain gelatin like Jell-O
Supplements: residuePlain popsicles and sherbets
free or low-residue

Polycose9(TM)
liquid formula
Salt, salt substitute
Tea regular or decaf
Soups, clear fat-free consomm, bouillon
Note that surgical patients may not be able to tolerate carbonated
beverages and some fruit juices.
2. Avoid solid and opaque food items:
All types of breads
All meat or meat substitutes
Milk, milk products including those prepared with milk
All fresh, canned and frozen fruits
All vegetables
All fats and oils
3. All fruit juices should be clear and strained.
4. Consume allowed foods in 1 or 2 hour interval. Increase the volume of food
intake as the patient becomes better and can tolerate them.
5. Drink 5 to 8 large glasses of clear liquids a day
6. Omit food items that are prohibited by the doctor due to the presence of
diabetes or salt restrictions.
7. To make a nutritious clear liquid diet, an appropriate elemental formula like
EnsureTM can be incorporated.
FULL LIQUID DIET
Nutritionally adequate diet consisting of both clear and opaque liquid foods and some
semi solids that liquefy at body temperature. Also known as general liquid diet.
Further modification
Foods allowed may vary according to tolerance of he client and the disease
condition that may require further modification such as:
Low-fat liquid diet for fat malabsorption
Sodium-restricted liquid diet for people with hypertension
Low-calorie liquid diet for heart failure.
Many foods provided on liquid diets contain lactose, in case of lactose
intolerance, lactose-free formula may be given. Soy milk and low-lactose dairy
products could be given.
Milk may need to be eliminated if the patient produces large amount of mucus if
large amount of milk is used in the diet.
During prolonged periods of use, the diet becomes unappetizing and boring. It
should be advanced to soft or mechanical soft diet so variations in the food could
be given.
In COPD, chocolate products may not be allowed because they interfere with the
detection of blood in the sputum.
INDICATIONS OF FULL LIQUID DIET
1. As a transition between clear liquid and soft diet.
2. For clients with difficulty of chewing (including dental wiring, jaw-wiring or
swallowing).
3. For individuals who have problems digesting solid foods.
4. In conjunction with parenteral nutrition.
5. For patients who have been without food for long periods of time.
6. For persons with moderate gastrointestinal inflammations (gastritis) and mouth

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lesions.
7. For patients who are too ill to eat such as during fever or infections.
8. As a short-term diet in preparation for surgery and medical tests that require
little food in the GIT.
9. For 2 to 4-hour feeding intervals.
ADEQUACY OF THE DIET
With careful planning, it is adequate in protein, Ca, P, riboflavin and ascorbic
acid. It can be high in fats and cholesterol.
With considerable inclusion of milk and egg, the diet could be high in cholesterol
and fat. It is low in fiber, low in iron, vit B12, A, niacin, folacin and thiamine
unless food products fortified with these nutrients are used.
Average caloric composition: approx 1300 1500 kcal except when added with
nutritionally complete formula ( Ensure or Nutren).
If given for more than 2 to 3 days, liquid nutritional supplement or blenderized
food should be included to improve nutritional composition. High-protein/highcalorie supplements should be added.
CONTRAINDICATIONS
1. Post surgical patients with secondary or temporary lactose intolerance.
2. Hypercholesterolemic patients using the diet for an extended period,
appropriate modifications should be instituted.
GUIDELINES FOR MAKING PROPER FOOD CHOICES
1. Use a blender to puree or liquefy solid foods and then strain.
2. Select only those food items that are clear or opaque liquid or that can be
liquefied at body temperature such as:
All foods allowed in clear liquid list
Cheese, cottage cheese
Commercially prepared formulas
Cooked egg
Flavorings
Fat butter, cream, margarine
Lemonade
Strained fruit juices, fruit ices without fruit pieces.
All types of milk, plain yogurt, cocoa, eggnog, milkshakes
Plain custards and puddings
Plain gelatin
Plain popsicles, ice cream and sherbets
Mashed potatoes, and diluted in soups.
Refined cereals but cooked, strained and thinned with milk
Seasonings, salt, salt substitute and pepper
Soup: broth, bouillon, fat-free consomme, strained meat, vegetables, or
cream soups
Sherbet
Sugar
Tea: regular or decaf
Vegetable juices/purees, diluted in cream or soup.
3. Omit the following foods:
All forms of cheese
Fruits fresh, frozen, canned
All other fats included in the allowed list
Meat
vegetables

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4. For lactose intolerant, use lactose-free product or soya in place of regular milk.
5. When used for an indefinite period of time, canned fiber-containing product
should be incorporated in the food choices to avoid constipation due to lack of
fiber in the diet.
6. Use seasoning in moderation.
7. Distribute foods in six or more meals per day.
8. In case of other dietary requirements (low-sodium, low-fat, etc), foods must be
carefully chosen to avoid forbidden foods.
MODIFICATIONS OF FULL LIQUID DIET:
INCREASE THE PROTEIN AND CALORIE CONTENT OF LIQUID DIET

SOFT BLAND DIET

The foods on the soft/bland diet are soft in texture, easy to digest, low in residue
and lightly seasoned.
The foods should not irritate the lining of the stomach and should not cause the
production of stomach acids.
The soft/bland diet consists of foods that are easily digestible, mildly seasoned and
tender.
Fried foods, highly seasoned foods and most raw or gas-forming fruits and
vegetables are eliminated.
Purpose of the diet:
To provide foods that should not upset your stomach.
It is designed to decrease irritation of the gastrointestinal tract.

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Guidelines:
Avoid the following:
Alcohol
black, red and white pepper
broth
caffeine
Chili
powder
chocolate
cloves
corn
mustard
nutmeg
nuts
Olives
salad
dressing
tannins (tea)
Avoid the following foods:
Highly seasoned foods like soup so fried or greasy foods including fried meat
rich desserts like pastries;
sand snack chips/popcorn;
raw vegetables except lettuce;
raw fruit except ripe bananas;
gas forming foods like onions, peppers, cabbage, broccoli, cauliflower, sauerkraut,
greens, and rutabagas
Processed meats high in fat like sausage, bologna, and lunchmeat.
Eat small meals more often...six small meals per day.
Eat slowly and chew foods well.
If you have reflux, do not lie down after eating and eat your last small meal at
least two hours before bedtime.
Recommended Foods
Milk and dairy 2-3 servings each day
All milk and milk products
Plain mild cheeses
Cottage cheese
Vegetables 3-5 servings each day
Mild flavored vegetable juices
Cooked, frozen or canned vegetables as tolerated (asparagus tips, beets,
carrots, green or waxed beans, mushrooms, pumpkin, green peas, white or
sweet potato, spinach, summer or winter squashes)
Lettuce in small amounts
Salads made from allowed foods
Raw vegetables, dried peas and beans, corn
Gas forming vegetables such as broccoli, Brussels sprouts, cabbage, onions,
cauliflower, cucumber, green pepper, corn, rutabagas, turnips and sauerkraut
Fruit 2-4 servings each day
All fruit juice

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Cooked or canned fruit without skins,

seeds or tough fibers
Avocado and banana
Grapefruit and orange sections without membrane
All other fresh and dried fruit Berries and figs
Breads and grains 6-11 servings each day
White, refined wheat, seedless rye breads, plain white rolls, white melba toast, matzo,
English muffin, bagel, pita bread, tortilla
Saltine, graham, soda or plain crackers
Cooked, refined cereals such as cream of wheat, oatmeal, farina, cream of rice, dry corn
and rice cereals such as puffed rice or corn flakes
Potatoes
Enriched rice, barley, noodles, spaghetti, macaroni, and other pastas
Couscous
Whole grain and very coarse cereals such as bran
Seeds in or on breads and crackers
Bread or bread products with nuts or dried fruit
Potato chips, fried potatoes, wild rice
Meat and meat substitutes 2-3 servings each day
All lean, tender meats, poultry, fish and shellfish
Eggs, crisp bacon Smooth nut butters
Soybean curd (tofu) and other meat substitutes
Highly seasoned, cured or smoked meats, poultry or fish such as corned beef, luncheon
meats, frankfurter and other sausages, sardine anchovies, strong flavored cheeses and
chunky peanut butter
Soups
Mildly seasoned meat stock, broth bouillon or cream soups made with allowed foods
Fats and snacks (use sparingly)
Butter or fortified margarine
Mild salad dressings such as mayonnaise, French or vinegar and oil
All fats and oils
Sugar, syrup, honey, jelly, seedless jam, hard candies, plain chocolate candies,
molasses, marshmallows
Cakes, cookies, pies, puddings, custard, ice cream, sherbet and Jell-O made with
allowed foods
Highly seasoned salad dressings with seeds or pickle relish
All sweets and desserts containing nuts, coconut or unallowable fruit
Fried pastries such as doughnuts
Miscellaneous
All beverages as tolerated Herb teas, fruit drinks Iodized salt, flavorings Seedless jams,
taffy, sugar, honey, jelly Marshmallows, molasses
Mildly flavored gravies and sauces
Herbs, spices, ketchup, mustard and vinegar in moderation
Caffeine-containing beverages (coffee, tea, colas, orange soda, Dr. Pepper)
Alcoholic beverages
Strongly flavored seasonings and condiments such as garlic, barbecue sauce, chili

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sauce, chili pepper, horseradish, pepper, chili powder and other highly spiced foods
Pickles, seed spices, olives, popcorn, nuts and coconut
Aspirin and aspirin-containing medicines
LIBERAL BLAND DIETS
- highly individualized diet that is basically or regular diet with the omission of
foods known to cause gastrointestinal discomfort.
- The traditional bland diet was originally designed to eliminate those foods or
food additives known as chemically or mechanically irritating.
- Currently, now liberalized and only those foods found to clinically irritate the
stomach or esophagus are avoided.
INDICATIONS
1. As a progression step in post-operative diet advancement.
2. Esophagitis
3. Gastroesophagial Reflux Disease (GERD)
4. Peptic Ulcer Disease (PUD)
ADEQUACY OF THE DIET
It is essentially a regular diet.
GUIDELINES FOR MAKING PROPER FOOD CHOICES
1. A variety of foods may be selected similar to the regular diet.
2. According to individual differences, foods known to cause discomfort are
omitted.
3. Recommendations to minimize gastric and esophageal irritation.
Coffee ( decaffenated or regular), carbonated drinks and other caffeine-containing foods are
limited.
Most spices can be used in limited amounts but avoid any food or spice that repeatedly
causes discomfort.
Common garlic irritants: garlic, black pepper, cloves, chilli powder
Avoid alcohol
4.In case of GERD:
Do not consume large meals to avoid distending the stomach which exerts pressure on
the lower esophageal sphincter.
Have a relaxed mealtime and eat foods slowly.
Lose weight if overweight.
Avoid foods that weaken the LES: fat, alcohol, coffee (regular and decaf), citrus fruits,
chocolates, spearmint and peppermint
Quit smoking: It relaxes LES
5. In case of PUD:
Eat a variety of nutritious foods.
Avoid overeating, frequent meals, and bedtime snacks.
Avoid alcohol, non-steroidal anti-inflammatory agents, and cigarette smoking
Meal Plan
Same as regular diet but use only those foods that are permitted. If a snack is desired,
bedtime snack should be avoided.
MECHANICAL SOFT
- is a highly individualized variation of the regular diet that excludes only foods that are
difficult for a client to chew or swallow.
- got its name from the household tools like blender, and knife to make food easier to
masticate or swallow.

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Other names: geriatric diet

dental soft diet
MECHANICAL SOFT DIET
Mechanically altered diets may mean different things to different patients.
Individual tolerances determine determine if food should be given in liquid, pureed,
chopped, or tender-cooked form.
Similar to soft diet, but unlike in the soft diet, fried foods, seasonings, spices, and fibrous
foods are permitted in mechanical soft diet, unless the person can not accept such
foods.
INDICATIONS
Recommended in clients who have trouble chewing and/or swallowing whole foods
such as:
Broken jaw
Dental caries, missing or no teeth, poorly fitted dentures, and periodontal disease
Dry mouth, ulceration of the mouth or gums
Patients who are progressing from enteral or parenteral nutrition
Elderly who can not tolerate regular foods and have chewing problems
INDICATIONS
Severely debilitated patients who are unable to chew solid foods
Oral surgery, plastic surgery, or radiation therapy of the head and neck
Conditions with dysphagia or with swallowing problems: Alzheimers Disease, AIDS,
cancer, chemotherapy, congenital defects of oral cavity, Guillain Barre Syndrome,
Multiple Sclerosis, Myasthenia Gravis, Parkinsons Disease, stroke
ADEQUACY OF NUTRIENT CONTENT
1. Nutritionally adequate in all essential nutrients if:
1. foods are selected from a variety of sources
2. the patient is able to consume enough amount of food
2. Most useful when choice of foods is guided by clients tolerance.
3.Patients with poor appetite or unable to eat enough:
Diet should be supplemented with nutritional formula or snacks
4. Adequacy is also affected by coupling restrictions.
Example: Low sodium diet
GUIDELINES FOR MAKING PROPER FOOD CHOICES
1. All foods in the regular diet can be consumed except for those items, which can not be
tolerated.
Foods can be altered by cooking, mincing, mashing or chopping.
2. Milk and other dairy products like pudding, custard and smooth yogurt are generally
tolerated.
3. Choose soft rolls, bread, and biscuits instead of crusty breads and crisp rolls.
However some patients may not tolerate bread and bread products.
4. Buy or prepare foods without seeds, dried fruits, or nuts.
5. Large pieces of food are chopped, flaked or pureed.
6. Fruits and vegetables may be soft cooked or pureed. Vegetables may also be
softened in soups and sauces.
7. Blend fruits in milkshakes and yogurt.

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8. Meats, fish and poultry can be cooked, ground, moistened with sauce or gravy.
9. To boost calories, pour cheese sauce over vegetables, noodles and rice.
10. All seasonings are generally allowed except, spicy, salty, and acidic foods can be
eliminated only if the client can not tolerate them.
Relax at mealtimes and eat slowly.
12. Alterations of mechanically soft diet for patients with mouth ulcers:
Select moist, soft texture foods
Avoid spicy, salty, and acidic foods that may be painful to eat.
Avoid nuts or seeds in foods which which may become trapped in mouth ulcers and
cause discomfort.
13. Alterations of Mechanical soft diet for clients with mouth dryness:
Choose moist soft foods
Serve liquid with meals
Add sauces and gravies to baked, broiled or fried foods.
Avoid salty foods and sugary foods.
Suck on sugarless candy, sugarless chewing gum
Use drugs that stimulate the flow of saliva.
LOW RESIDUE DIET
Provides food and drinks that are easily digested and almost completely absorbed to
produce only a moderate amount of stool.
Purpose:
Makes the stool less bulky and less frequent
Decreases the rate at which the stool passes through the body
Low-fiber food but not low in residue: Milk
Milk has no fiber but produces a moderate amount of of residue.
Foods with increasing fecal output:
Proteins
Fat
Milk
Digestible carbohydrates
Carbohydrates without digestible materials
Reduce fiber content by:
Selecting young immature vegetables
Ripe canned or well cooked fruits
Raw fruits and vegetables low in fiber content.
LRD is a temporary diet, once the symptoms get better, the person can begin to eat
more.
INDICATIONS OF LRD
1. Acute diarrhea with abdominal cramping
2. Acute phases of inflammatory condition of the bowel such as ulcerative colitis, Crohns
diseas, diverticulitis, radiation enteritis ( Due to radiation therapy).
3. As an intermediate diet after intestinal or rectal surgery as a client progresses from
liquid to a regular diet.
4. Diet for patients with
Esophageal varices
ileostomy
Colostomy
norrowed intestinal lumen.
5. May be used for a short period of time for patients with

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partial intestinal obstruction,

rectal bleeding
stenosis of the esophageal and intestinal lumen
ADEQUACY OF NUTRIENTS IN LRD
In general, it is inadequate in:
Fiber
Calcium
Vitamins C and A
Riboflavin
Recommendation: Vitamins and mineral supplement
For long term use: combine LRD with residue-free liquid formula
GUIDELINES FOR MAKING PROPER FOOD CHOICES
1. Preparation: Any except frying but no much seasoning and spices.
2. In general, only vegetable juices are permitted otherwise, use only tender cooked or
canned vegetables without seeds and skin.
Omit or omit intake of potatoes.
3. All types of milk and milk products are permitted up to 2 servings ( 2 cups of milk
daily) only.
Foods to avoid:
Dairy products containing whole fruits or berries, seeds or skins.
Strongly flavored cheeses
Avoid sweet potatoes
Whole grain cereals
Those containing nuts, coconut, bran or seeds
Low-residue or residue-free nutritional supplements may be taken as advised.
4. What to buy only:
Refined breads
Refined cereals, noodles, and pasta
5. Use cooked or canned fruits without seeds and skins except pineapple and melons.
Peel off skin before cooking.
For fruit juices, use those without pulp
Avoid prune juice
6. Consume only tender and no-fry meats, poultry, internal organs, and fish, no cold cuts
and fried eggs.
7. Consume soups made from allowed ingredients.
8. Tea, coffee, fruit drinks, carbonated beverages, butter, cream, margarines,
mayonnaise are allowed in moderation, avoid peanut butter and coconut.
9. Anny dessert and sweets are permitted except those that contain whole grain, seeds,
nuts, coconut, dried fruits or other ingredients not allowed as previously mentioned.
10. Eat smaller, more frequent meals.
11. Drink plenty of fluids each day when there is diarrhea.
12. Avoid tobacco and cut down on alcohol consumption since this simulate peristalsis,
and irritates the stomach.
13. Follow the diet on a temporary basis only. Consume other foods once symptoms
disappear.

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