Northside Hospital

DietFormulary

Gastric Bypass Stage 1

Gastric Bypass Stage 2

Gastric Bypass Stage 3

Gastric Bypass Stage 4

Full LiquidLactose Free

Surgical Low Lactose

Post-Gastrectomy

Consists of sugar free fluids, Jell-O andPopsicle. Provides broth, water, anddecaffeinated tea. No juices served. 4 ozservings provided.

The diet allows the addition of easilydigested, semi-liquid foods to beconsumed in small amounts(approximately 2 oz per meal). High-protein drinks are served betweenmeals.

The diet is comprised of soft or pureedfoods that are easy to chew and digest.Meats are ground or pureed. (2 ozservings provided at each meal). High-protein drinks are served betweenmeals.

The diet includes soft foods such ascooked vegetables and soft or groundmeats. (3 oz soft, low-fiber foods).High-protein drinks are served betweenmeals.

This diet is frequently used for GYNsurgical patients. Provides foods such asnon-cream based soups, Jell-O, juice,lactaid milk, tea and coffee.

Soft bland foods that have low fibercontent. Lactose is limited.

Low sugar, low fat, low lactose foods. Nofluids with meals. Small frequentfeedings

PG 34493

Type of Diet Description

4

Regular

Mechanical Soft(Dental Soft)

Dysphagia Puree

Dysphagia Altered

Dysphagia Advanced

Cardiac Diet

Low-Fat

No Added Salt (NAS)(4g sodium)

2 gram Sodium

This diet is served when specific dietarymodifications are not required.

This diet is indicated for the patient whohas difficulty in chewing or swallowing.

This diet is used for patients with problemschewing and swallowing or esophagealinflammation or varices. Food consistencyis blended. Liquids must be orderedseparately as regular, nectar, or honey.

Mechanically altered. Meats are ground orminced. Foods are moist, soft-textured, andeasily formed into a bolus. All vegetablesare fork-mashable. Liquids must be orderedseparately as regular, nectar, or honey.

Foods are nearly regular textures with theexception of hard, sticky, or crunchy foods.Foods are moist, bite-sized pieces. Allvegetables are fork-mashable. Liquidsmust be ordered separately as regular,nectar, or honey.

This diet provides controlled amounts ofsodium, cholesterol, saturated and total fat.

The diet provides < 30% energy from fat.

This diet provides a moderate sodiumrestriction by eliminating foods andcondiments high in sodium.

The diet is used in the treatment ofconditions characterized by edema,including the following: cirrhosis of theliver with ascites, CHF, essentialhypertension and renal disease.

PG 34493 1

Type of Diet Description

Renal (std) (80-100g)

Pre-Renal (40-60g)

GI Soft/Low Residue

Bland Diet

ConsistentCarbohydrate (definedby caloric amounts in200 increments)1200-3000 cal/day

Gestational DiabeticDiet (defined bycaloric amounts in 200increments) 1800-3000 cal/d

Hyperemesis

Small Frequent Meals

The diet provides adequate protein andlimited amounts of potassium (2g) andsodium (2g) for the dialyzed patient.

The diet provides limited amounts ofprotein (40-60g/d), potassium (2g/d), andsodium (2g/d) for the pre-dialyzed patient.

The diet limits most raw, highly-seasonedand fried foods. The diet contains onlymoderate amounts of fiber.

The diet eliminates seasoned foods andcondiments that may stimulate gastricdiscomfort and GERD.

The diet provides consistent amount ofcarbohydrate based on caloric level toallow for optimal blood glucose control.The diet provides an HS snack for allcalorie levels. (45% CHO, 25% protein,30% fat)

The diet provides consistent amount ofcarbohydrate based on caloric level toallow for optimal blood glucose control.Snacks provided between meals toprovide approximately 35-40% of Kcal from CHO.

The diet provides bland, roomtemperature or cold foods separated intosolids and liquids. Patients on this dietmay request additional foods they feelcan be tolerated. Patients are encouragedto separate their intake of food and drink.

The diet provides 6 small meals daily.

PG 34493

Type of Diet Description

2

Clear Liquid

Clear Liquid/NCS (noconcentrated sweets)

Full Liquid

Kosher

Vegetarian (Lacto-ovo)

Vegan

Neutropenic

Gluten Free

Finger Food(Cardiac Cath)

The diet is indicated for short-term usewhenever an acute illness or surgerycauses intolerance to food; or totemporarily restrict undigested materialin the GI tract. The diet is notnutritionally adequate.

Clear liquid diet providing sugar-freeproducts only. This diet provides verylimited amounts of carbohydrate and isnot recommended often.

The diet consists of foods that are liquid atbody temperature. Foods are easy to digestand provide minimal stimulation to the GItract. The diet is not nutritionally adequate.

The diet may be ordered for individuals ofthe Jewish faith if they so desire.

The diet is a variation of the regular dietexcluding most foods of animal origin(eggs and dairy provided).

The diet is a variation of the regular dietexcluding all foods of animal origin.

The diet eliminates certain foods toprovide a lower level of bacteria than ispresent in a typical hospital diet.

The diet omits foods processed withGluten. The diet is the primary means oftreatment for celiac sprue.

Indicated for patients who may notbe able to use utensils or for patientsconfined to a flat-lying position whorequire heart healthy foods.

PG 34493

Type of Diet Description

3