General and therapeutic diets.
An individual’s diet is the sum of food and drink that he or she habitually consumes. Dieting is the practice of attempting to achieve or maintain a certain weight through diet. People’s dietary choices are often affected by a variety of factors, including ethical and religious beliefs, clinical need, or a desire to control weight.
Not all diets are considered healthy. Some people follow unhealthy diets through habit, rather than through a conscious choice to eat unhealthily. Terms applied to such eating habits include “junk food diet” and “Western diet”. Many diets are considered by clinicians to pose significant health risks and minimal long-term benefit. This is particularly true of “crash” or “fad” diets – short-term weight-loss plans that involve drastic changes to a person’s normal eating habits.
Types of Therapeutic Diets
A therapeutic diet is a meal plan that controls the intake of certain foods or nutrients. It is part of the treatment of a medical condition and are normally prescribed by a physician and planned by a dietician. A therapeutic diet is usually a modification of a regular diet. It is modified or tailored to fit the nutrition needs of a particular person.
Therapeutic diets are modified for (1) nutrients, (2) texture, and/or (3) food allergies or food intolerances.
Common reasons therapeutic diets may be ordered:
- To maintain nutritional status.
- To restore nutritional status.
- To correct nutritional status.
- To decrease calories for weight control.
- To provide extra calories for weight gain.
- To balance amounts of carbohydrates, fat and protein for control of diabetes.
- To provide a greater amount of a nutrient such as protein.
- To decrease the amount of a nutrient such as sodium.
- To exclude foods due to allergies or food intolerance.
- To provide texture modifications due to problems with chewing and/or swallowing
Common therapeutic diets include:
1. Nutrient modifications.
- No concentrated sweets diet;
- Diabetic diets;
- No added salt diet;
- Low sodium diet;
- Low fat diet and/or low cholesterol diet;
- High fiber diet;
- Renal diet.
2. Texture modification.
- Mechanical soft diet;
- Puree diet.
3. Food allergy or food intolerance modification.
- Food allergy;
- Food intolerance.
4. Tube feedings.
- Liquid tube feedings in place of meals;
- Liquid tube feedings in addition to meals.
5. Additional feedings – In addition to meal, extra nutrition may be ordered as:
- Supplements – usually ordered as liquid nutritional shakes once, twice or three times per day; given either with meals or between meals.
- Nourishments – ordered as a snack food or beverage items to be given between meals mid-morning and/or mid-afternoon.
- HS snack – ordered as a snack food or beverage items to be given at the hour of sleep.
6. The following list includes brief descriptions of common therapeutic diets:
Clear liquid diet –
- Includes minimum residue fluids that can be seen through.
- Examples are juices without pulp, broth, and Jell-O.
- Is often used as the first step to restarting oral feeding after surgery or an abdominal procedure.
- Can also be used for fluid and electrolyte replacement in people with severe diarrhea.
- Should not be used for an extended period as it does not provide enough calories and nutrients.
7. Full liquid diet.
- Includes fluids that are creamy.
- Some examples of food allowed are ice cream, pudding, thinned hot cereal, custard, strained cream soups, and juices with pulp.
- Used as the second step to restarting oral feeding once clear liquids are tolerated.
- Used for people who cannot tolerate a mechanical soft diet.
- Should not be used for extended periods.
No Concentrated Sweets (NCS) diet.
- Is considered a liberalized diet for diabetics when their weight and blood sugar levels are under control.
- It includes regular foods without the addition of sugar.
- Calories are not counted as in ADA calorie controlled diets.
Diabetic or calorie controlled diet (ADA).
- These diets control calories, carbohydrates, protein, and fat intake in balanced amounts to meet nutritional needs, control blood sugar levels, and control weight.
- Portion control is used at mealtimes as outlined in the ADA “Exchange List for Meal Planning.”
- Most commonly used calorie levels are: 1,200, 1,500, 1,800 and 2,000.
No Added Salt (NAS) diet.
- Is a regular diet with no salt packet on the tray.
- Food is seasoned as regular food.
Low Sodium (LS) diet.
- May also be called a 2 gram Sodium Diet.
- Limits salt and salty foods such as bacon, sausage, cured meats, canned soups, salty seasonings, pickled foods, salted crackers, etc.
- Is used for people who may be “holding water” (edema) or who have high blood pressure, heart disease, liver disease, or first stages of kidney disease.
Low fat/low cholesterol diet –
- Is used to reduce fat levels and/or treat medical conditions that interfere with how the body uses fat such as diseases of the liver, gallbladder, or pancreas.
- Limits fat to 50 grams or no more than 30% calories derived from fat.
- Is low in total fat and saturated fats and contains approximately 250-300 mg cholesterol.
High fiber diet.
- Is prescribed in the prevention or treatment of a number of gastrointestinal, cardiovascular, and metabolic diseases.
- Increased fiber should come from a variety of sources including fruits, legumes, vegetables, whole breads, and cereals.
- Is for renal/kidney people.
- The diet plan is individualized depending on if the person is on dialysis.
- The diet restricts sodium, potassium, fluid, and protein specified levels.
- Lab work is followed closely.
Mechanically altered or soft diet.
- Is used when there are problems with chewing and swallowing.
- Changes the consistency of the regular diet to a softer texture.
- Includes chopped or ground meats as well as chopped or ground raw fruits and vegetables.
- Is for people with poor dental conditions, missing teeth, no teeth, or a condition known as dysphasia.
- Changes the regular diet by pureeing it to a smooth liquid consistency.
- Indicated for those with wired jaws extremely poor dentition in which chewing is inadequate.
- Often thinned down so it can pass through a straw.
- Is for people with chewing or swallowing difficulties or with the condition of dysphasia.
- Foods should be pureed separately.
- Avoid nuts, seeds, raw vegetables, and raw fruits.
- Is nutritionally adequate when offering all food groups.
Food allergy modification.
- Food allergies are due to an abnormal immune response to an otherwise harmless food.
- Foods implicated with allergies are strictly eliminated from the diet.
- Appropriate substitutions are made to ensure the meal is adequate.
- The most common food allergens are milk, egg, soy, wheat, peanuts, tree nuts, fish, and shellfish.
- A gluten free diet would include the elimination of wheat, rye, and barley. Replaced with potato, corn, and rice products.
Food intolerance modification.
- The most common food intolerance is intolerance to lactose (milk sugar) because of a decreased amount of an enzyme in the body.
- Other common types of food intolerance include adverse reactions to certain products added to food to enhance taste, color, or protect against bacterial growth.
- Common symptoms involving food intolerances are vomiting, diarrhea, abdominal pain, and headaches.
Tube feedings –
- Tube feedings are used for people who cannot take adequate food or fluids by mouth.
- All or parts of nutritional needs are met through tube feedings.
- Some people may receive food by mouth if they can swallow safely and are working to be weaned off the tube feeding.
At times, due to gastro-intestinal or esophageal problems, clients need to follow a bland diet.
Ideas: Applesauce, toast, French to as cream of wheat or rice, oatmeal, simple muffins, cinnamon bread, pasta dishes such as macaroni and cheese, egg noodles with herbs or cheese, potatoes of all kinds – baked, mashed, scalloped, eggs: omelets, soft-boiled, egg salad, rice dishes, rice pudding, custards, puddings.
If the physician recommends a special diet, the physician or nurse usually provides guidelines and sample menus.