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Your Wellbeing, LLC Gastrointestinal Guide
The following are a list of educational material available to Your Wellbeing, L...
• At first you may find it easier to eat 3-4 meals per day. Try not to skip meals. This may
cause gas production and watery ...
Lean meat, fish, and poultry
Eggs (avoid fried eggs)
FATS & SNACKS (use sparingly)
Low-fat desserts such as angel food cake...
VEGETABLES 3-5 servings each day
Mild flavored vegetable juices
Cooked, frozen or canned vegetables as
tolerated (asparagus...
FATS & SNACKS (use sparingly)
Butter or fortified margarine
Mild salad dressings such as mayonnaise,
French or vinegar and ...
• Cut down on caffeine-containing foods and beverages, citrus and tomato products, and
chocolate if these foods cause disc...
MILK & DAIRY 2-3 servings each day
Low fat and non-fat milk and milk products
Processed cheese with less than 5 grams of f...
MISC.
Salt, pepper, flavorings and most spices and
herbs
Ketchup, mustard and vinegar in moderation
All beverages as tolera...
BREADS & GRAINS 6-11 servings each
day
Refined breads, toast, rolls, biscuits,
muffins, crackers, pancakes, and waffles
Enr...
MEAT & MEAT SUBSTITUTES 2-3
servings or total of 6 oz daily
Ground or well-cooked, tender beef, lamb,
ham, veal, pork, pou...
constipation: the pressure of straining produces pouches in the colon) are tiny pea-shaped pouches of
weakness in the wall...
• Bread, pastas, pizzas, pancakes, muffins, bagels, pita bread and muffins made with
whole-grain flours
• Whole-wheat and o...
Diet Following Stomach Surgery
Purpose: This diet is used primarily after a stomach resection when solid food is tolerated...
• Take 2 chewable multivitamins with iron each day for the first month after
surgery.  Vitamin and mineral supplements may ...
• Eat slowly and stop eating when you feel full. Eating too quickly and too much may
cause you to overfill your new pouch a...
• Talk to your doctor, registered dietitian, or pharmacist about lactase enzymes in tablet
or droplet form for use with pr...
MEAT & MEAT SUBSTITUTES
All plain baked, broiled, roasted or stewed
beef fish, lamb, poultry, pork, veal, and eggs
(prepare...
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Gastrointestinal Guide

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Transcript of "Gastrointestinal Guide"

  1. 1. Your Wellbeing, LLC Gastrointestinal Guide The following are a list of educational material available to Your Wellbeing, LLC patients. This information (including diet plans) can be found on Your Wellbeing’s health portal under the Diet section tab. Please note that each educational listing is specifically designed to assist a patient’s eating habits based off the correlating condition specified in the diet. These diets may not be used by anyone and everyone. If you have other health related issues that might be affected by our diet plans please contact a doctor for further guidance. This Gastrointestinal Guide can assist patients correlated with the following: 1. Ostomy Surgery 2. Ulcer or Peptic Ulcer Disease 3. Low Irritation (residue) and Low Fiber 4. Need of High Fiber 5. Stomach By-Pass 6. Lactose Intolerance Patients OSTOMY DIET Purpose: This diet is used to prevent or limit unpleasant odor, gas, and blockage with and/or after an Ostomy placement. It is important to follow an Ostomy diet for 6-8 weeks after placement. After 6-8 weeks, add new foods one at a time to make certain the food/foods can be tolerated. Use: This diet has been designed for those people who have had an Ostomy placement. If you have an ileostomy or colostomy, you can eat a full and varied diet. Everyone is different with regard to food tolerance. You will need to experiment to find out what foods you can and cannot eat. For the first six to eight weeks after surgery, your physician may instruct you to follow a low residue diet (low fiber) to give the bowel adequate time to adjust and heal. After six to eight weeks, high fiber foods may be added to the diet, one at a time each week to allow you to determine your tolerance of each food item. If you have an ileostomy and you are experiencing a lot of output, you may need to increase your intake of foods high in potassium for the first few weeks following surgery. You may also need to increase your intake of salt and water unless your physician indicates otherwise. You should add extra salt to food and drink seven to eight cups of fluids per day. In order to improve digestion and regularity, you should attempt to adhere to the following dietary guidelines: • Eat at regular times
  2. 2. • At first you may find it easier to eat 3-4 meals per day. Try not to skip meals. This may cause gas production and watery stools • Eat more in the morning and afternoon and less later in the day to minimize filling of the Ostomy bag at night • Avoid foods that you suspect may be troublesome • Chew food thoroughly with the mouth closed to avoid excessive air swallowing • Eat in a relaxed atmosphere • Do not wash down food with water. Chew food well and then drink water if desired • Progress to a well-balanced diet containing a variety of foods from the four basic food groups: milk and milk products, meats and meat substitutes, fruits and vegetables, and breads and cereals • Skin and seeds on fruits and vegetables should be removed • Increase intake of vitamin C by consuming more citrus juices • Extra calories are not usually necessary. However, if you are underweight, you should obtain extra calories from carbohydrates such as breads, cereal, noodles, fruit juices and vegetables instead of increasing intake of fats and oils • Drink at least 8-10 cups of liquids each day to prevent dehydration and constipation. • Slowly add milk and milk products to your diet. If these foods cause uncomfortable side effects such as gas and diarrhea, omit from your diet for several days and gradually add them back in small amounts OSTOMY FOOD GUIDELINES BREADS & GRAINS 6-11 servings each day Refined cereal (cream of wheat, cream of rice, oatmeal) White bread, rolls, crackers White rice VEGETABLES 3-5 servings each day Soft, cooked green beans, carrots, beets, squash, and stewed tomatoes, Mashed, boiled, or baked potatoes without the skin Other pureed vegetables FRUIT 2-4 servings each day Applesauce, bananas, and canned fruit packed in water or juice Unsweetened citrus juices and lemon juice MILK & DAIRY 2-3 servings each day All cheeses without seeds Cottage cheese Milk and milk products as tolerated Smooth yogurts MEAT & MEAT SUBSTITUTES 2-3 servings or total of 6 oz. daily
  3. 3. Lean meat, fish, and poultry Eggs (avoid fried eggs) FATS & SNACKS (use sparingly) Low-fat desserts such as angel food cake, vanilla wafers, graham crackers Nonfat frozen dessert, and frozen yogurt MISC. Fat-free broth, bouillon, and cream soups made with skim milk and lean meats Tea and coffee ULCER COMPLICATIONS THE BLAND DIET 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. DESCRIPTION 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. Drinks containing Xanthine and alcohol should also be avoided. FOODS RECOMMENDED FOODS TO AVOID MILK & DAIRY 2-3 servings each day All milk and milk products Plain mild cheeses Cottage cheese MILK & DAIRY None    
  4. 4. 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 VEGETABLES 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 Cooked or canned fruit without skins, seeds, or tough fibers Avocado and banana Grapefruit and orange sections without membrane FRUIT All other fresh and dried fruit Berries and figs BREADS & 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 BREADS & GRAINS 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 & 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 Soups Mildly seasoned meat stock, broth bouillon, or cream soups made with allowed foods MEAT & 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
  5. 5. FATS & 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 FATS & SNACKS Highly seasoned salad dressings with seeds or pickle relish All sweets and desserts containing nuts, coconut or fruit not allowed 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 Pepper, herbs, spices, ketchup, mustard and vinegar in moderation MISCELLANEOUS Caffeine-containing beverages (coffee, tea, colas, orange soda, Dr. Pepper) Alcoholic beverages Strongly flavored seasonings and condiments such as garlic, barbecue sauce, chili 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 DIET FOR PEPTIC ULCER DISEASE Purpose: This diet is designed to restrict or avoid foods that may cause gastric irritation and excessive gastric acid secretion and help prevent uncomfortable side effects such as heartburn. Use: This diet has been designed for those people with gastroesophageal reflux disease, esophageal ulcers, esophagitis, peptic ulcer disease, dyspepsia, chronic gastritis, peptic esophageal strictures, or have other problems involving the esophagus. Dietary guidelines that may help decrease reflux and/or stomach acid: • Eat three small meals and three snacks evenly spaced throughout the day. It is important to avoid periods of hunger or overeating. • Eat slowly and chew foods well. • Be relaxed at mealtime. • Sit up while eating and for 1 hour afterward. • Avoid eating within 3 hours before bedtime. Bedtime snacks can cause gastric acid secretion during the night. • Choose foods from the low fat diet and low fat guidelines in addition to the following diet
  6. 6. • Cut down on caffeine-containing foods and beverages, citrus and tomato products, and chocolate if these foods cause discomfort. • Include a good source of protein (milk, meat, egg, cheese, etc.) at each meal and snack. • Antacids should be taken in the prescribed dose, One-hour and 3 hours after meals and prior to bedtime. This regimen is most likely to keep the acidity of the stomach at the most stable and lowest level. • Milk and cream feedings should not be used as antacid therapy. Although milk protein has an initial neutralizing effect on gastric acid, it is also a very potent stimulator. Hourly feedings of milk have been shown to produce a lower pH than three regular meals. • Caffeine-containing beverages (coffee, tea, and cola drinks) and decaffeinated coffee cause increased gastric acid production but may be taken in moderation at or near mealtime, if tolerated. There is little rationale for completely eliminating any foods from the diet unless a particular food causes you repeated discomfort. FOODS RECOMMENDED FOODS THAT MAY CAUSE DISTRESS BREADS & GRAINS 6-11 servings each day Whole-grain or enriched, seedless breads, bagels, tortillas, English muffins, hamburger/ hot dog buns, dinner rolls, pita bread, and bagels  Whole-grain or enriched cereals Enriched rice, barley, noodles, spaghetti macaroni, and other pastas French toast, muffins, pancakes, and waffles made with low-fat ingredients Low fat crackers BREADS & GRAINS Breads and cereals prepared with high-fat ingredients such as croissants, biscuits, and granola-type cereals Bread or bread products with nuts or dried fruit Seeds in or on breads, and crackers Very coarse cereals such as bran Wild rice High fat snack crackers VEGETABLES 3-5 servings each day Fresh, frozen, or canned vegetables as tolerated VEGETABLES Raw vegetables, corn Gas forming vegetables such as: broccoli, Brussels sprouts, cabbage, onions, cauliflower, cucumber, green pepper, rutabagas, turnips and sauerkraut Vegetables prepared with added fat Tomatoes and tomato products FRUIT 2-4 servings each day Fresh, frozen, and canned fruits as tolerated Fruit juice as tolerated Grapefruit and orange sections without membrane FRUIT Lemons, grapefruit, oranges, pineapples, and tangerines Citrus juices such as orange, pineapple and grapefruit juice Berries and figs
  7. 7. MILK & DAIRY 2-3 servings each day Low fat and non-fat milk and milk products Processed cheese with less than 5 grams of fat per ounce Plain mild cheeses Low-fat cottage cheese Low-fat and nonfat yogurt MILK & DAIRY Whole milk and chocolate milk Buttermilk made with whole milk Evaporated whole milk and cream Strong flavored cheeses MEAT & MEAT SUBSTITUTES 2-3 servings or total of 6 oz daily All lean, tender beef, pork, lamb, veal, and poultry (without the skin) . All fresh, frozen, or canned fish packed in water Crisp bacon; lean ham Eggs (limit to 3-4 egg yolks weekly) Smooth peanut butter and nut butters Soybean curd (tofu) and other meat substitutes Dry beans and peas prepared without fat Soups Mildly seasoned meat stock or cream soups made with allowed foods MEAT & MEAT SUBSTITUTES Highly seasoned, meats, poultry or fish such as corned beef, luncheon meats, frankfurter and other sausages, sardine anchovies All fried, fatty or heavily marbled meat, poultry, or fish Dry beans and peas prepared with fat or high-fat meat Chunky peanut butter and nuts and seeds FATS & SNACKS (use sparingly) Nonfat or low-fat dressings and mayonnaise Mild low fat salad dressings Mildly flavored gravies and sauces Butter or margarine (preferably the light or low fat brands) Sugar, syrup, honey, jelly, seedless jam, hard candies, molasses, marshmallows Sherbet, fruit ice, gelatin, angel food cake, graham crackers, and nonfat desserts Pretzels (soft or hard), rice cakes FATS & SNACKS Gravies, cream soups Highly seasoned salad dressings High-fat snacks such as chips, fried potatoes and buttered popcorn Cakes, cookies, pies, pastries, and doughnuts Coconut, chocolate, or creamed candy All sweets and desserts containing nuts, coconut or fruit not allowed
  8. 8. MISC. Salt, pepper, flavorings and most spices and herbs Ketchup, mustard and vinegar in moderation All beverages as tolerated MISC. Carbonated beverages, coffee (regular or decaffeinated) Strongly flavored seasonings and condiments such as garlic, barbecue sauce, chili sauce, chili pepper, horseradish, black pepper, chili powder and other highly spiced foods Pickles Caffeine-containing beverages (coffee, tea, colas, orange soda, Dr. Pepper) Alcoholic beverages Nicotine, aspirin and aspirin-containing medicines LOW RESIDUE (LOW FIBER DIET) Purpose: The low residue (fiber) diet is designed to avoid irritation of the gastrointestinal tract and to decrease bowel movements. Use it is used for people that are experiencing periods of diarrhea and abdominal cramping. It is used after acute phases of ulcerative colitis or regional enteritis. The low residue diet may be also be used for a short period of time for people with partial intestinal obstruction, rectal bleeding, stenosis of the esophageal or intestinal lumen, acute stages of diverticulitis, hemorrhoidectomy, post-op treatment of large bowel surgery, and during radium implant treatment for uterine and cervical cancer and acute exacerbation of Crohn's disease or ulcerative colitis. This diet may also be used postoperatively in the progression of a regular diet. DIETARY GUIDELINES • Buy breads and cereals made from refined wheat and rice. Avoid whole-grain products with added bran • Remove skin from vegetables and fruits before cooking • Marinate meats in juice or wine for added flavor • Season with spices and herbs for added flavor and variety • Avoid any food made with seeds, nuts, and raw or dried fruit • Follow this diet on a temporary basis only. Once your symptoms disappear, gradually introduce foods back into your diet once your symptoms disappear • Limit milk and milk products to 2 cups daily • Dietary fiber is reduced by using pureed or tender cooked vegetables, ripe, canned or cooked fruits without skin or seeds, and well-cooked tender meats FOODS RECOMMENDED FOODS TO AVOID
  9. 9. BREADS & GRAINS 6-11 servings each day Refined breads, toast, rolls, biscuits, muffins, crackers, pancakes, and waffles Enriched white or light rye bread or rolls Saltines, Melba Toast, Rusk crackers, Zwieback Refined ready-to-eat cereals such as puffed rice and puffed wheat Cooked refined wheat, corn or rice cereal Strained oatmeal, grits and farina Refined cold cereals made from corn, rice or oats (Rice Krispies, Cornflakes, Cheerios, puffed rice and puffed wheat) White rice and refined pasta Macaroni, noodles, white rice BREADS & GRAINS Any bread product made with whole- grain flour or graham flour, bran, seeds, nuts, coconut, or raw or dried fruit, cornbread, and graham crackers Any whole-grain, bran, or granola cereal, oatmeal, any cereal with seeds, nuts, coconut or dried fruit Bran, barley, brown and wild rice VEGETABLES 3-5 servings each day Most tender cooked and canned vegetables without seeds such as carrots, asparagus tips, beets, green or wax beans, pumpkin, spinach, squash (acorn) without seeds, potato (no skin), pureed or cooked strained lima beans, peas (no skin), potato without skin; lettuce if tolerated Strained vegetable juice VEGETABLES  Raw vegetables and vegetables with seeds, sauerkraut, winter squash, and peas FRUIT 2-4 servings each day Most canned or cooked fruits, fruit cocktail, avocado, canned applesauce, apricots, Royal Anne cherries, peaches, pears, (all without skin and seeds), pureed plums and ripe bananas and avocados Strained fruit juice FRUIT Raw or dried fruit, all berries Prune juice MILK & DAIRY 2-3 servings each day Milk, mild cheese, cottage cheese (as tolerated) Yogurt (no berries) MILK & DAIRY Highly flavored cheeses
  10. 10. MEAT & MEAT SUBSTITUTES 2-3 servings or total of 6 oz daily Ground or well-cooked, tender beef, lamb, ham, veal, pork, poultry, fish, shellfish, and organ meats Eggs Smooth peanut butter MEAT & MEAT SUBSTITUTES Tough fibrous meats with marinate meats in juice or gristle, shellfish with tough connective tissue Meat prepared with whole-grain ingredients, seeds, or nuts Fried meats and eggs Dry beans, legumes, peas, and lentils Chunky peanut butter Raw clams and oysters FATS & SNACKS (use sparingly) Margarine, butter, vegetable oils, lard, mayonnaise, cream substitutes, crisp bacon, plain gravies, and salad dressing Bouillon, broth, or strained cream soups (no corn) made with allowed ingredients Plain cakes and cookies, pie made without nuts and fruit (allowed fruits only) Plain sherbet, sorbet, pudding, fruit ice, gelatin, tapioca, angel food or sponge cake, custard, frozen fruit pops, jelly, plain hard candy, marshmallows, frozen yogurt, and ice cream FATS & SNACKS Any made with whole-grain flour, bran, seeds, nuts, coconut, or dried fruit Nuts, seeds, and popcorn Pastries, pies, potato chips Pepper, chili pepper and other hot sauces. Chocolate, raisins, seeds, seed spices, pickles, olives, nuts, mustard, spicy mustard and catsup, relish, horseradish, vinegar, rich gravies Highly spiced salad dressings Jam or marmalade with nuts and seeds MISC. Salt, soy sauce, catsup Mild spices in moderation, white sauce Sugar, honey, jelly, syrup Lemon juice, vinegar, vanilla and other flavoring extracts Decaffeinated coffee, herb tea, caffeine- free carbonated beverages, fruit drink MISC. Beverages containing caffeine should be used sparingly as caffeine is a stomach irritant) HIGH FIBER DIET FOR DIVERTICULAR DISEASE Purpose: To provide a diet with 20 to 35 grams of appropriate fiber to promote regular elimination and increases fecal excretion. Use: This diet can be used for the management of diverticulosis. The rationale for the increased fiber is that the increased bulk in the stool reduces the pressure in the colon, thus preventing further diverticula from forming. Diverticulosis (the condition) and diverticulitis (the inflammation) are also called diverticular disease (notice the difference in endings, “itis” vs “osis”). Diverticula (the underlying cause of diverticula is
  11. 11. constipation: the pressure of straining produces pouches in the colon) are tiny pea-shaped pouches of weakness in the wall of the large intestine. This condition is called diverticulosis and is usually symptom-free. Most people do not realize they have it. However, for a few people, diverticulosis results in spasms and pain. If the diverticuli become inflamed, infected or ruptured, the condition is called diverticulitis. In other words, a person with diverticulosis may get diverticulitis when waste matter is trapped in a pouch and then becomes inflamed or infected. Diverticulitis can result in fever, pain and tenderness around the left side of the lower abdomen and may require surgery. The two major signs of diverticular disease are bleeding and infection. THE HIGH FIBER DIET Studies have shown that a balanced diet containing different kinds of fiber can help regulate the bowels, aid in the prevention of heart disease and protect against a number of other health problems such as diverticulosis. Another way fiber contributes to good health is by helping to protect against cancer of the colon and rectum. Foods that contain fiber also tend to contain other cancer fighting nutrients, such as vitamin A, vitamin C, vitamin E and selenium. Dietary Guidelines • Many people have the misconception they must avoid tiny seeds, grains, lettuce, and other high fiber containing foods for fear that the particles could lodge in the diverticula and cause inflammation. This has never been proven and in fact microscopic review of surgical specimens show this to not be the case. There is no reason to avoid such foods for fear they will precipitate disaster. • Foods such as nuts, popcorn hulls, and sunflower, pumpkin, caraway, and sesame seeds should be avoided. • People differ in the amounts and types of foods they can eat. Decisions about diet should be made based on what works best for each person. • Scan food labels for bread and cereal products listing whole grain or whole wheat as the first ingredient. • Look for cooked and ready to eat cereals with at least 3 grams of fiber per serving. • Eat raw fruits and vegetables; they have more fiber than cooked or canned foods, or juice. Dried fruits (especially dried figs) are also good sources of fiber. • Increase fiber in meat dishes by adding pinto beans, kidney beans, black-eyed peas, bran, or oatmeal. • Try adding 2-3 tsp. of unprocessed wheat bran to foods such as meatloaf, casseroles, homemade breads, muffins and other baked goods. • Dairy foods provide little fiber. Increase fiber by adding fresh fruit, whole grain or bran cereals to yogurt or cottage cheese. • Chopping, peeling, cooking, pureeing, and processing may reduce fiber content • Substitute oat bran for one third of all-purpose flour in baked goods recipes • Best to eat a variety of foods and not to rely on a fiber supplement • Do it gradually—rapid fiber increase may result in gas, cramping, bloating, or diarrhea. • Drink plenty of fluids - A high-fiber diet requires lots of liquids. Fiber acts as a sponge in your large intestine - if you don't drink enough, you could become constipated. Try for at least 6 cups daily. HIGH FIBER DIET BREADS & GRAINS 6-11 servings each day
  12. 12. • Bread, pastas, pizzas, pancakes, muffins, bagels, pita bread and muffins made with whole-grain flours • Whole-wheat and other whole-grain cereal products • Buckwheat and stone-ground cornmeal • Rye bread • Whole wheat crackers or crisp breads • Whole grain or bran cereals (Excellent high fiber choices are Bran Buds and All-Bran, but 100% Bran, Raisin Bran, Most and Cracklin' Bran are also excellent sources) • Oatmeal, oat bran, or grits • Barley, dry • Wheat germ • Whole wheat pasta • Brown rice VEGETABLES 3-5 servings each day All vegetables such as asparagus, broccoli, Brussels sprouts, cabbage, carrots, Greens such as beet greens, kale, collards, Swiss chard and turnip greens, green beans, green pepper, onions, peas, potatoes with skin, Romaine, snow peas, green snap beans, pole beans, broad beans, spinach, squash, sweet potatoes, turnips The seeds in tomatoes, zucchini, cucumbers, as well as poppy seeds, are generally considered harmless FRUIT 2-4 servings each day All fruits such as apple, apricot, banana, blackberries, blueberries, cherries, dates, fig, grapefruit, nectarine, orange, peach, pear, pineapple, prune The seeds in strawberries and raspberries are generally considered harmless MILK & DAIRY 2-3 servings each day All MEAT & MEAT SUBSTITUTES 2-3 servings or total of 6 oz. daily • All beans and peas such as aduki, garbanzo beans, black beans, baked beans, kidney beans, fava, lentils, lima beans, split peas, and pinto beans • Smooth peanut butter and other smooth nut butters • All meat, poultry, fish, and eggs The seeds in poppy seeds are generally considered harmless FATS & SNACKS • Whole-wheat pretzels, baked tortilla corn chips or trail mix made with dried fruits • Cakes, breads, and cookies made with oatmeal or fruit • Bean dip
  13. 13. Diet Following Stomach Surgery Purpose: This diet is used primarily after a stomach resection when solid food is tolerated.  This diet can help prevent dumping syndrome or uncomfortable side effects such as dizziness, abdominal fullness, nausea, and diarrhea that may occur after eating.   Dumping syndrome occurs when the lower end of the small intestine (jejunum) fills too quickly with undigested food from the stomach. The partially digested food draws excess fluid from the bloodstream into the intestine to dilute the undigested food. "Early" dumping begins during or right after a meal. Symptoms of early dumping include nausea, vomiting, bloating, diarrhea, and shortness of breath. "Late" dumping happens 1 to 3 hours after eating. Symptoms of late dumping include weakness, sweating, and dizziness. Many people have both types.  Use: It is used for persons who have undergone surgical procedures that accelerate the normal emptying time of the stomach such as vagotomy, pyloroplasty, hemigastrectomy involving Billroth I and II anastomosis, esophagogastrectomy, total gastrectomy, Bariatric surgery, Whipple’s procedure, gastrojejunostomy, Roux-en-y procedure, gastric resection or gastroenterostomy. This diet is not indicated in laparotomy, pancreatectomy, cholecystectomy, or appendectomy. Dietary Guidelines You will progress through three different phases.  After the surgery the diet is divided into 3 phases to allow for gradual tolerance. Phase 1 High Protein-Liquid Diet 1 week after surgery Phase 2 High Protein-Soft Diet 2-5 weeks after surgery Phase 3 Transition to Regular Diet 6-8 weeks after surgery Phase 1- Nutritional Guidelines • Consume liquids six times daily at set times (i.e. 7am, 9am, 11am, 1pm, 4pm, 7pm) • Sip your liquid meals very slowly. Each small meal should take you 30 minutes or more. Eating too fast may lead to nausea or vomiting. • Drink small amounts.  Learn to sip. Try not to fill your entire mouth with fluid. Use a 1-ounce medicine cup to help determine a safe amount. • Mix in liquid of your choice. If you choose milk, it would be best to use skim milk or lactaid milk as lactose intolerance can occur the first few weeks after surgery. • Avoid carbonated drinks for 2 weeks • Stop drinking immediately when you are full. One more sip may lead to some very unpleasant side effects (nausea, vomiting, pain, retching, cramping…) • Avoid beverages high in sugar and fat. Foods high in sugar and fat may cause diarrhea and abdominal discomfort. This is called dumping syndrome. After gastric bypass surgery, some people feel light-heated, sweaty or faint soon after consuming sugar.
  14. 14. • Take 2 chewable multivitamins with iron each day for the first month after surgery.  Vitamin and mineral supplements may be necessary because the RDA for thiamin, riboflavin, niacin, iron, zinc and total calories may be low. Examples of full and clear liquid foods are as follows: • Broths • Blenderized or pureed soups without chunks • Tomato soup made with skim milk • Carnation Instant Breakfast (No sugar added, mixed with skim milk) • Protein Supplement Drinks • Boost®, Glucerna® • Skim milk or Lactaid milk • Light plain yogurt • Milkshakes made with skim milk, yogurt or light frozen yogurt and fruit • Sugar-free pudding • Sugar-free Jell-O • Sugar-free popsicle's or ice pops • Unsweetened applesauce • Sugar-free Kool-Aid / Crystal Light • Diet Snapple • Tea with artificial sweetener • Diluted fruit juices • Water * Protein powder can be mixed with yogurt, soups or fruit juice if blenderized Phase 2- Nutritional Guidelines  You will slowly begin adding soft, easily tolerated solid foods to your diet. Please do not begin this phase until your physician or dietitian tells you it is OK. This phase consists of foods that are soft and moist (which can be mashed, pureed, blended or chewed to a puree) and full liquids • Foods should be blended to a smooth consistency (like applesauce) in order to minimize stress on your new stomach pouch. • You should eat small and frequent meals at regular times. You should plan to eat 6 times a day (3 small meals plus 3 small snacks).  Avoid grazing, i.e. eating small amounts of foods throughout the day, with high total caloric intake. • Drink only between meals.  Consume at least 6 cups of fluid between meals over the course of the whole day. Do not drink for 15 minutes before meals, and wait 30-60 minutes after meals to drink. Drinking fluids immediately before or during meals may cause bloating, nausea or vomiting.  This is called dumping syndrome. • Avoid foods & beverages high in sugar. Foods high in sugar may cause diarrhea, abdominal discomfort or dumping syndrome. • Avoid extremes in the temperature of your foods and beverages. You may experience spasms or cramps with very hot or cold food/beverages.
  15. 15. • Eat slowly and stop eating when you feel full. Eating too quickly and too much may cause you to overfill your new pouch and cause you discomfort (i.e. nausea and vomiting). A good rule to follow is to drink approximately 4 ounces of fluid over 30 minutes. • At mealtime, start with protein-rich foods first. This is necessary to promote adequate healing and to help you maintain your lean body mass. • If you are unable to tolerate milk, it’s important to add other calcium and protein rich foods such as cottage cheese. Dry milk, protein powder, or soy powder can be added to foods for added protein (such as yogurt, soups or fruit juice if blenderized) • Read food labels; avoid desserts and foods with sugar, sucrose, or high fructose corn syrup as one of the first three ingredients. • Eat small portions of fruit and combine fruit with high a protein food such as cottage cheese, yogurt, or crackers • Try a slow cooking method to make your meat tender, such as a crock-pot, boiling or cooking at a low temperature over a long period of time. • Continue taking a chewable multi-vitamin supplement.  Vitamin and mineral supplements may be necessary because the RDA for thiamin, riboflavin, niacin, iron, zinc and total calories may be low. • To blend food: Cut foods into small pieces and place into blender or food processor.  Add liquid such as juice, milk, broth, or water and blend or puree until smooth.  Strain foods that do not blend into a completely smooth consistency. Lactose Controlled Diet Purpose: The lactose-controlled diet is designed to provide food that contains a minimal amount of lactose. This diet will help prevent uncomfortable side effects such as bloating, cramping, or diarrhea that may occur when you consume milk or milk products. The severity of symptoms depends on the quantity of lactose consumed and the extent of lactase deficiency. Use: It is used for persons who are unable to digest the milk sugar lactose because of a deficiency of lactase. It is used for those with lactose intolerance due to idiopathic lactase deficiency, as well as the lactase deficiency seen in the process of inflammatory bowel disease, post-gastrectomy syndrome, and other malabsorption disorders. Side effects should stop 3-5 days after following this diet. You will need to experiment with foods to determine your individual tolerance because there are varying degrees of lactose intolerance. The diet below describes a diet for the very sensitive patient and may be modified for others. • Heated milk products such as soup, custard, or pudding may be better tolerated than cold milk products. • Scan all product ingredient lists and check to see if they contain milk. Terms like milk solids, whey, curds, skim milk powder, and skim milk solids mean that lactose is present. • Look for cookbooks with recipes adapted for a lactose-controlled diet. • Try to include plenty of other sources of calcium in your diet. Some good sources include dark green vegetables, canned fish with fine bones (sardines and salmon), and dry beans.
  16. 16. • Talk to your doctor, registered dietitian, or pharmacist about lactase enzymes in tablet or droplet form for use with products containing milk. Strict Lactose-Free Diet: This diet is used in rare cases in which an individual cannot even tolerate small amounts of lactose.  This diet is a general diet with the elimination of milk and milk products (lactose containing foods). READ LABELS. AVOID ANY FOODS CONTAINING LACTOSE, MILK OR MILK SOLIDS. Lactate, lactalbumin, and calcium compounds are salts of lactic acid and do not contain lactose. Foods processed with small amounts of milk, milk solids or lactose may not be used. The following foods bellow marked with an * should only be avoided for those who have to follow a strict lactose-free diet. FOODS RECOMMENDED FOODS THAT MAY CAUSE DISCOMFORT BREADS & GRAINS 6-11 servings each day Whole-grain or enriched breads, cereals, rice, barley, and pastas made with milk-free ingredients Hominy, macaroni, noodles, rice, spaghetti Crackers, rusk French or Vienna bread (check labels) BREADS & GRAINS *Any bread products, muffins, biscuits, or pancakes prepared with milk, milk products, or mixes containing lactose *Homemade bread with milk *Instant Cream of Wheat *Commercial potato products *Dry cereals containing lactose or milk VEGETABLES 3-5 servings each day All vegetables and vegetables juices White and sweet potato VEGETABLES Vegetables prepared with cheese, milk or milk products FRUIT 2-4 servings each day All fruits and fruit juices FRUIT *Fruit drinks that contain lactose MILK & DAIRY 2-3 servings each day Soy milk, lactose-reduced milk, *lactose- hydrolyzed milk, and lactose-free supplements *Hard, aged, and processed cheese, if tolerated *Yogurt, if tolerated MILK & DAIRY Milk; milk products, goat's milk, and acidophilus milk Powdered milk *All cheese products
  17. 17. MEAT & MEAT SUBSTITUTES All plain baked, broiled, roasted or stewed beef fish, lamb, poultry, pork, veal, and eggs (prepared without milk) Dry peas and beans, lentils Tofu Nuts and peanut butter Plain baked, broiled roasted or stewed Soups Broth-base soups made with allowed foods MEAT & MEAT SUBSTITUTES Cold cuts, frankfurters, or other meat that contain lactose filler Creamed or breaded food Cream soups, commercial soups with milk or milk products *All creamed or breaded food *Cold cuts; wieners, or other meat with added lactose FATS & SNACKS *Butter, *margarine, lard, shortening, mayonnaise, vegetable oils, nondairy creamer, and oil-based salad dressings Cakes, cookies, pies, flavored gelatin desserts, homemade baked products and fruit ices made with milk-free ingredients or prepared without milk Popcorn Salt, pure flavorings, vinegar, spices, condiments Sugar, corn and pure maple syrup, honey, jellies, jams, and pure sugar candies Coffee, tea, carbonated beverages, cereal beverages, soy milk substitutes & beverages FATS & SNACKS Salad dressings containing milk or cheese Any desserts containing milk or milk products such as sherbet, ice cream, pudding, and some cakes, cookies, and pies Commercial desserts or mixes containing milk or milk products Instant drink mixes *Cocoa mix *Margarine with added milk or milk products *Spreads or dips containing sour cream, cream cheese, whipping cream Cocoa mixed, cream sauce, nonfat dry milk, milk chocolate Cream, caramels or chocolate candies or any candies containing milk lactose, or molasses

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