Transcript Diets for GI diseases

Diets for GI diseases
Family Practice Resident
Education Series
Mary Steffensmeier, MA,RD
March, 2014
Objectives
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Increase understanding of diet guidelines
used to treat gastric or intestinal conditions
Identify diagnoses and diets that should be
referred to a Registered Dietitian
Increase awareness of teaching tools that are
available
Increase skills ordering diets
Reflux, GERD, Heartburn
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Avoid large meals
avoid food 2 hours before lying down
avoid foods that relax lower esophageal
sphincter
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alcohol
mints, garlic, onion
chocolate
high fat food
GERD continued...
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Avoid foods that can irritate damaged
esophageal mucosa
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carbonated beverages
citrus fruit and juices
coffee
tomato
pepper, chili powder
GERD continued
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Avoid obesity, smoking tight clothing, and
belts
elevate head of the bed
avoid temperature extremes in food
Reflux Diet for Inpatients
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GERD DIET, 6 small meals or snacks
add any specific restrictions to order such as
no caffeine, or carbonated beverages
add elevate head of bed to orders
*CONSULT DIETITIAN TO SEE AND MAKE
RECOMMENDATIONS.
Low Fiber
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Usually used for diverticulitis, partial bowel
obstruction, ulcerative colitis, radiation
enteritis
Restricts foods that have more than .5 grams
fiber per serving or about 3 grams per meal
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most raw fruits and vegetables
bran and whole grain breads, cereals
dried beans and peas
Low fiber continued….
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Limits high residue producing foods:
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only 2 cups milk per day,
limits course meats, peanut butter, nuts, seeds
Smaller more frequent meals
Avoid prune juice
High Fiber Diet
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Used to treat constipation, diverticulosis
10 to 13 g. fiber per 1,000 calories
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raw fruits, vegetables= 1 to 3 g. per serving
whole grain products 2 to 13 g. per serving
dried beans 2 to 5 g. per serving
Gradually increase fiber
Adequate fluids, 8 glasses water/day
High Fiber
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Limit foods have little or no fiber include
cheese, ice cream, meat, juices, and
processed foods
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Increase servings of high fiber foods: beans,
bran, vegetables
“Divertics”
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Diverticulitis-occurs in 10 to 25% of people
with diverticulosis
Diverticulosis- occurs 50% of people 60 to
80, and almost everyone over 80
Conditions started to appear in early 1900s,
same time processed foods with less fiber
were produced
Divertics/Inpatient Diet Orders
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Diverticulosis: High Fiber, avoid nuts, seeds,
hulls remains controversial
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Constipation: high fiber diet
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Diverticulitis: low fiber
Fiber Facts
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Insoluble fibers:
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Types; cellulose, hemicellulose, lignins,
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Foods: Wheat bran, wheat products, bran rice,
vegetables
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Function: Increase fecal bulk, increase transit time
More Fiber Types
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Soluble Fibers
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Types: Pectins, gums, mucilages
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Foods; oats, beans, carrots, fruits, barley
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Function: delay gastric emptying, slow glucose
absorption, lower cholesterol
Factors that Influence
Stomach Emptying
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Volume – greater volume, slower emptying
Chemical and physical property of meal
Positioning – emptying delayed due to
antigravity and duodenal compression by
spine
Medications – review med list with patients
Time of Day – satiety increases later in day
Gastric Emptying (continued)
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Fiber – slows emptying, contributes to
bezoar formations, limit to 10g./day when
gastroparesis is present
Fat – especially solid forms
Alcohol – slows emptying
Nicotine – slows emptying
Carbonated Beverages* – may aggravate
distention
*permitted on most diet sheets
Gastric Emptying (continued)
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Osmolality – may delay in test subjects but
assumed to be clinically insignificant since
clear liquid diet has an osmolarity of >1200
mOsm
Blood Glucose Levels – glucose >200
shown to delay emptying
Moderate Exercise may enhance gastric
emptying
gastroparesis
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5 to 6 small meals
limit fiber sources
limit fat to 40 to 50 grams
in diabetes may need RD/diabetes ed consult
to match meals and meds to prevent
hypoglycemia
Steps to Diet-gastroparesis
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Step 1 – Use if frequent nausea and vomiting
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Gatorade, broth, saltine crackers, in small,
frequent amount
Step 2 – Soups and starches stage, small
amounts of low-fat, low-fiber foods, fat
limited to 40 grams
Step 3 – Maintenance diet, up to 50g. fat,
small, frequent meals and snacks
Summary of Maintenance Diet
for delayed gastric emptying
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Smaller, more frequent meals
More liquid calories
Try solids in the morning
Chew food well
Sit up for one hour after meals
Reduce fat to 40 to 50g., liquids fats best
Reduce fiber from meds, medications
Gluten Free Diet
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Used to treat celiac sprue or gluten sensitivity
eliminate all sources of wheat, rye, barley
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Uncontaminated oats allowed
rice, potato, corn, peas, soy allowed
avoid any foods that have any additive that
may contain grains containing gluten
need RD consult, order gluten-free diet
Lactose Free Diet
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Used to treat lactase deficiency
all dairy foods contain some lactose
many people can tolerate 1/2 c. milk per meal
lactase enzymes available
lactose better tolerated with other foods
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example: cereal and milk
Lactose Free Diet
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Acidophilus milk not a good substitute
calcium supplements will likely be needed
can increase use of calcium fortified foods
such as orange juice
inpatient or outpatient order: lactose free diet
children may need RD consult
Fructose Restricted
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Avoid high fructose fruits
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Most fruits and juices are high fructose
Avoid products sweetened with high fructose
corn syrup
Grains, vegetables also contain some
fructose so are limited in portions
Use dextrose or sucrose to sweeten food
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Equal amounts of glucose and fructose better
absorbed
FODMAP DIET
Elimination type diet for IBS
Limits groups of carbohydrates which are
different to break down
Gradually add classes of carbohydrates back in
and monitor symptoms
Fermentable Oligo, Di and Mono Saccharides
and Polyols (beans, wheat, sugar alcohols,
lactose, fructose containing foods)
Low fat diet
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Used to treat diseases related to gallbladder,
or pancreas
Limit all sources of fat to 25 to 50 g.
May want to specify amount of fat grams
lipids ok in TPN solutions as GI system not
used
Medium chain triglycerides like coconut oil
easier to absorb
Liver related diets
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Cirrhosis-High calorie, normal protein, to
regenerate liver cells
Edema, ascites present-limit sodium to 2 g,
fluid restriction 1.5L
Hepatic encephalopathy- adequate calories,
lactulose to treat high ammonia levels
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Diet often not restricted as patients poorly
nourished
Liver Continued
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Fatty liver-restrict alcohol, lose weight,
adequate nutrition
acute hepatitis-adequate calories and protein
RD Referral
Post gastric surgery
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Order: post gastric surgery diet
goal is to reduce dumping syndrome
low in simple carbohydrates
separate liquids and solids
increase soluble fibers
Gout
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Low-fat
Limit alcohol
More water
Limit high fructose corn syrup
Low carb diets may contribute to gout
Reduce intake or high purine foods
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Organ meats
Teaching Materials
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Electronic health education sites
web sites; national digestive diseases
information clearing house
-registered dietitians
5 minute nutrition tips
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You are discharging a 63 y/o female after a 2
day hospitalization for diverticulitis. What
nutrition information do you give her?
5 minute nutrition
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You are seeing a 58 y/0 male for with GERD
who has concerns about cost of medication.
What lifestyle changes would be helpful to
encourage?