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