Proteins
Fats
Carbohydrates
Minerals
Vitamins
Water

Objectives of Diet Therapy
Regular Diet
Modified or Therapuetic Diets

This chapter is concerned with the nutritional requirements for the healthy and for the sick, wounded, and convalescing patient. Research has proved that good health in part depends upon the availability of essential elements that the body needs throughout life. The well-nourished individual is usually mentally alert, is at a maximum of physical capability, and has a high resistance to disease. The daily basic minimum nutritional requirements must also be met and often times supplemented during periods of illness to meet changing needs of the body and its ability to use foods. Therefore, the diet is an important factor of the therapeutic plan for each patient.

Food Classification

Foods are substances from the animal, plant, and mineral kingdoms that, when taken into the body, yield heat and energy, build and renew tissues, and regulate the body processes. Nutrients are classified as proteins, fats, carbohydrates, minerals, vitamins, and water.

A. Proteins

Proteins are important nutritive elements required by man. They are found in both the animal and plant kingdoms. All proteins are composed of amino acids, some of which are absolutely essential to maintain life and are necessary for repair, growth, and body development. Proteins, which promote tissue growth and renewal, have long been recognized as the main structural unit of all living cells. Each gram (g) of protein yields 4 calories in the process of metabolism. (If sufficient carbohydrate is not supplied, the body will use protein for energy requirements. This protein may be obtained from muscle tissue to produce a "wasting effect" in some diseases or long term starvation.) Although proteins also yield energy, they are an expensive source. A constant protein source is required in the daily diet. The normal daily protein intake for adults should be .08 gram per kilogram (g/kg) (2.2 lbs) of body weight, or 12 percent of the total caloric intake, as indicated in the 1980 revision of the Recommended Daily Allowances, prepared by the Food and Nutrition Board, National Academy of Sciences, National Research Council. Pregnant women require 1.2 g of protein per kg of body weight.

Proteins play an important role in recovering from injuries of all kinds, such as fractures, burns, and infections. They are also important in healing wounds and recovering from surgical procedures. Protein intake should be increased in accordance with the severity of the above conditions. Calories must be sufficiently high in order to spare protein for tissue repair. Carbohydrates and fats can be added liberally. Ideally, the patient should receive protein by mouth; however, it is sometimes necessary to meet the minimum requirements through the parenteral route. Glucose parenteral solution, given during the acute emergency period, will prevent some loss of protein. Protein deficiency may stunt growth, promote a secondary anemia, or induce nutritional edema. Dietary sources of protein are milk, yogurt, eggs, meats, fish, cheese, poultry, peanut butter, legumes, and nuts. (Protein from plant sources is best used combined with animal protein, such as milk plus peanut butter, or if legumes are combined with grains, such as Navy beans plus rice.)

B. Fats

The chief functions of fats are to supply energy and transport fat-soluble vitamins. Each g of fat yields 9 calories. Fats provide the most concentrated source of calories (thus energy) of all the food nutrients. They are found in both the animal and vegetable kingdoms. Fatty acids and glycerol are the end products of the digestion of fats. In the normal diet, fats should contribute 30 percent of the calories. Saturated fat intake should be no more than 10 percent of the total calories. Cholesterol may be limited to 300 milligrams (mg) per day.

Many fats act as carriers for the fat-soluble vitamins A, D, E, and K; they also act both as a padding for vital organs, particularly the kidneys, and as subcutaneous tissue to help conserve body heat. Fat is stored as adipose (fatty) tissue to form a reserve supply in time of need. Fats delay gastric emptying and promote satiety. Excess calories from fat may produce obesity, the forerunner of arteriosclerosis, hypertension, gallbladder disease, and diabetes. Too little fat in the diet may lead to being underweight, having insufficient padding for the vital organs, and lowered energy. Dietary sources of fats are butter, margarine, cream cheese, fatty meats, whole milk, olives, avocados, egg yolks, nuts, and vegetable oils.

C. Carbohydrates

Carbohydrates (sugar and starches) are the most efficient sources of energy and are known as the "fuel of life." They are abundant in food. The Senate Select Committee on Nutrition and Human Needs, 1977 Dietary Goalsfor the United States, Second Edition, recommends that complex carbohydrates and naturally occurring sugars make up 48 percent of total caloric intake, and refined and processed sugars 10 percent.

Each g of carbohydrate yields 4 calories in the process of its metabolism. Carbohydrates must be reduced to glucose before they can be used by the body. Carbohydrates are stored in the liver as glycogen. The glycogen is broken down and released as glucose at the exact rate needed by the body. This mechanism is controlled largely by insulin from the pancreas. During fasting glycogen is rapidly depleted, which leads the body to use its fat for energy.

The main functions of carbohydrates are to:

furnish the main source of energy for muscular work and nutritive processes,
help maintain body temperature,
form reserve fuel,
assist in oxidation of fats, and
spare protein for growth and repair. Excess carbohydrates are converted into adipose tissue. Dietary sources of carbohydrates are fruits, honey, sweets, legumes, potatoes, grains, sugars, and grain products.

D. Minerals

Although the mineral elements constitute only a small portion of the total body weight, they enter into the activities of the body to a much greater degree than their mere weight would indicate. Table 3-1 lists the essential elements, the foods that contain them, and their functions. Certain mineral elements are essential for specific body functions. It is not known exactly how many of the mineral elements are indispensable to the body functions, but changes of concentration that may seem small can be fatal. These essential inorganic elements contribute overwhelmingly to the skeletal framework of the body and the teeth and are an essential part of many organic compounds. They form an integral part of all cell structure and circulate in body fluids. In addition, they exercise specific physiological influences on the function of body tissues. For the mineral needs to be met satisfactorily, the consumption of each element must be sufficient to cover body tissue requirements and to meet changing physiological needs. It was once believed that any diet that was adequate in other respects would also provide an adequate intake of the essential minerals. This is not true. Foods vary greatly in their mineral content. Depending on growing conditions and storing and preparation procedures, they may vary considerably in nutritional content.

E. Vitamins

Vitamins are essential substances present in food in minute quantities. Although they do not furnish energy or act as tissue building materials, they do act as catalysts in many body chemical reactions and are necessary for normal metabolic functions, growth, and health of the human body. Their absence results in malnutrition and specific deficiency diseases. Their chemistry is complex and nutritional experimentation is difficult, so our knowledge of them is being continually supplemented and revised. It is quite possible that additional vitamins will be discovered or that some of those already recognized may prove to contain more than one factor.

Vitamins are so widely distributed in food that a properly prepared normal diet usually provides an adequate amount. Some are destroyed in preparing or preserving certain foods. Some manufacturers add vitamins to their products to replace those destroyed or removed in processing. Fat-soluble vitamins A, D, E, and K can be stored in the body. It is possible to consume excessive amounts of these nutrients and cause hyper-vitaminosis; death may result in extreme cases. Water-soluble vitamins, such as B complex and ascorbic acid, are not stored to any great extent.

Vitamin supplements are usually not necessary if the diet includes a wide variety of foods. Exceptions may occur in prenatal diets in which iron is low and in patients proven to be deficient in a specific vitamin. Vitamin supplements should be taken only on a physician's or dietitian's recommendation.

F. Water

The body can survive weeks without food, but only days without water. It makes up 70 percent of the body weight and is found in every cell in the body. Water is the medium through which nutrients are transported from the digestive tract to the cells where they are needed. It is also the medium through which the by-products of cell metabolism are removed. Water also serves as the medium in which the chemical processes of life take place. Fluid needs are increased with sweating, vomiting, diarrhea, high protein diets, and hot environments. Water is normally taken into the body in beverages, soups, and in the form of solid foods. An insufficient intake may cause constipation, loss of weight, abnormal body temperature, and dehydration leading to ketosis.

II. Guide to Good Eating

Calculating therapeutic diets can be complicated and is best left to dietitians. For daily living, there is a simple, practical plan, based upon the classification of foods into groups according to the nutrient content.

It is now common practice for dietitians or dietary kitchens to select foods for diets on the basis of food groups. See figure 3-1 for the Guide to Good Eating food groups. They are classified according to their nutritional value and the number of servings that should be eaten each day. This figure can serve as a simple and effective guide in planning or evaluating diets.

Diets

The appetite of the patient requires catering to, as patients tend to be more fastidious when sick. In some disease states, such as cancer, patients experience marked taste changes. Because of the importance of the nutritional elements in feeding the sick, try to carry out the patient's wishes whenever possible. A tactful and observant hospital corpsman will be most helpful to the physician and dietitian in carrying out the dietary regimen. You must be aware of what comprises a well-balanced diet and should be able to recognize when dietary adjustments need to be made in special situations. This is important to meet the changing needs of the diseased body's ability to make use of foods.

The patient should be made to feel that the utmost cleanliness and care have been observed. The patient's face and hands should be cleaned before food is served, and the lips and teeth cleaned before and after the meal. If the mouth is dry, it should be moistened periodically.

When special or modified diets are ordered, check the contents of the tray with the written orders. An error in serving a special diet may cause discomfort, serious illness, or even death.

A. Objectives of Diet Therapy

The dietary objectives are:

To increase or decrease body weight
To rest a particular organ; e.g. to limit cholecystagogues in preventing gallbladder contraction
To adjust the diet to the body's ability to use certain foods
To produce some specific effect as a remedy; e.g. to regulate blood sugar in diabetes
To overcome deficiencies by the addition of food rich in some necessary element; e.g. to supplement the diet with iron in treating macrocytic anemia
To provide ease of digestion by omitting irritating substances, such as fiber, condiments, or fried foods

Diets used in the treatment of disease are often spoken of by names that show a special composition and often indicate the purpose for which the diet is intended.

Regular Diet

The regular diet composed of all types of foods, is well balanced and capable of maintaining a state of good nutrition. It is intended for convalescing patients who do not require a therapeutic diet.

Modified or Therapeutic Diets

These diets are modifications of the regular diet designed to meet specific patient needs. These include:

Method of preparation (boiling or broiling)
Consistency (ground or chopped)
Total calories (high or low calorie diets)
Nutrients (altering carbohydrate, protein, fat, vitamins, minerals)
Allowing only specific foods (diabetic diet)

Soft

This diet is soft in texture and consists of liquids and semisolid foods. It is indicated in certain postoperative cases, for convalescents who cannot tolerate a regular diet, in acute illnesses, and in some gastrointestinal disorders. It is an intermediate step between the liquid and regular diets. It is low in connective tissue and indigestible dietary fiber. Little or no condiments are used in its preparation.

Soft diets include all liquids in addition to wellcooked cereals, pastas, white bread and crackers, eggs, cottage cheese, tender meat, fish, poultry, and vegetables, including baked, mashed, or scalloped potatoes. Foods not allowed include fried foods, raw vegetables, and nuts. Desserts permitted are custards, gelatin puddings, soft fruits, and simple cakes and cookies. Vegetables can be pureed and meats ground for dental patients.

Liquid

This diet consists of foods that are in a liquid state at body temperature. It is indicated in some postoperative cases, in acute illnesses, and in inflammatory conditions of the gastrointestinal (GI) tract. It is important that feedings consisting of 6 to 8 ounces or more be given every 2 to 3 hours while the patient is awake. These diets are usually ordered as clear, full, or dental liquid. A clear liquid diet includes clear broths, black tea or coffee, plain gelatin, and clear fruit juices (apple, grape, and cranberry), popsicles, fruit drinks, and soft drinks. This diet is inadequate in all nutrients. A full liquid diet includes all the liquids served in a clear liquid diet, with the addition of strained soups and broths, milk and milk drinks, ice cream, sherbet, puddings, and custard. The all liquid diet is inadequate in iron, niacin, and possibly Vitamin A and thiamin. A dental liquid diet includes foods blenderized and strained in liquid form and all foods allowed on clear and full liquid diets. Vitamin and mineral supplements may be necessary with the dental liquid diet if the recommended amounts of food are not tolerated.

High Calorie

This diet is of a higher caloric value than the average patient normally requires. An increase in total calories is needed by patients who are malnourished, underweight, postsurgical, or convalescing from acute illnesses such as infections, burns, and fevers. The increase in calories is obtained by supplementing or modifying the regular diet with high calorie foods or commercial supplements, giving larger portions, or adding snacks. It is given to meet a need for energy caused by the more rapid metabolism that accompanies certain diseases, especially fever, hyperthyroidism, poliomyelitis, and tuberculosis. In the liquid or soft diet, the caloric value is increased by adding fats and carbohydrates. Proteins are added to prevent depletion of proteins in the plasma (hypoproteinemia). As the patient progresses, a more solid diet is given.

Good sources of high calorie foods are whole milk, cream, sweets, butter, margarine, fried foods, gravies, sauces, and ice cream. Between- meal feedings consisting of milk, milkshakes, cheese, cookies, or sandwiches are recommended, but they should not interfere with the patient's appetite at mealtime.

High Protein

As previously stated, protein is essential for tissue growth and regeneration. The high protein diet is indicated in almost all illnesses; for example, nephrosis, cirrhosis of the liver, infectious hepatitis, burns, radiation injury, fractures, some GI disorders, other conditions in which the protein blood level is low, and in preoperative and postoperative cases.

In some acute illnesses and disorders, such as infectious hepatitis, GI disorders, and postoperative conditions, patients may be unable to consume solid foods or the daily requirement of protein because of pain or nausea. Therefore, substitute intravenous fluids and nutrients in order for the patient to receive the required amount of protein.

Protein-calorie deficiency is a definite factor in postoperative wound disruption. This disruption can best be prevented by preemptive nutritional measures before surgery. Antibody production will be decreased if the patient receives inadequate protein.

The daily recommended intake of proteins for adult patients is at least .8 g/kg of body weight (approximately 56 g). A high protein diet should provide a minimum of 1.5 g of protein per kg of body weight (approximately 105 g). The seriously burned and radiation injury patients should receive at least 187.5 g daily.

Supplement the regular diet with high quality protein foods, such as meat, fish, fowl, cheese, milk, and eggs, as listed in table 3-2.

Low Calorie

Low calorie diets are used in the treatment of obesity, but they may also be used to control weight in medical conditions such as arthritis, hypertension, diabetes, cardiac disease, or hypothyroidism. A loss of I to 2 pounds a week is a medically acceptable reduction in weight. Low calorie diets consist of 800 to 1800 calories per day. A sample 1200 calorie diet is shown in table 3-3. Calorie levels are determined by physicians and dietitians to help meet specific individual patient weight loss goals. The daily intake of proteins should be at least .8 g/kg of standard body weight. Supplemental vitamins may be ordered if the prescribed diet is less than 1200 calories.

Patients on low calorie diets should be instructed by the dietitian (if available) or other medical personnel knowledgeable in proper eating habits. The dietitian conducts patient interviews to learn the patient's eating behavior, usual portions, preparation of foods, meal patterns, nutritional adequacy, exercise, and so forth. Individual programs should then be recommended to assist patients to attain and maintain their ideal weight.

The Handbook of Clinical Dietetics published by the American Dietetic Association, lists the formula for determining ideal body weight as follows. For females, the basic weight for 5 feet is 100 pounds. Add 5 pounds for every inch over 5 feet. For males, the basic weight for 5 feet is 106 pounds, with 6 pounds added for every inch over 5 feet. Adjustments must be made for body build. Reduce desired weight by 10 percent for a small frame; increase it by 10 percent for a large frame. Total caloric requirements are based on ideal body weight plus activity.

Many patients on low calorie diets experience hunger. To satisfy this hunger or appetite, low calorie foods such as raw vegetables, dill pickles, broth, black coffee or tea, and other unsweetened or diet beverages should be provided. Water and salt need not be restricted unless there are cardiac complications or edema and the restrictions are ordered by the physician.

Low Protein

As the name implies, this diet is made up of foods that furnish only small amounts of protein and consists largely of carbohydrates and fats. Calories should be high to spare protein. Use foods such as marshmallows, hard candy, and butter liberally. This diet is used in renal diseases associated with nitrogen retention or GI disorders when putrefaction is present. Limited amounts of protein are sometimes advocated in certain kidney diseases, such as chronic nephrotic edema. Low protein diets for renal failure are usually restricted in sodium and potassium, as they are not excreted properly. In some cases of chronic renal insufficiency, the protein content of the diet is varied, usually between 40 and 60 g per day, so that there will be sufficient complete protein to maintain nitrogen equilibrium.

In some metabolic disturbances, such as amino acids in the urine, protein restriction may be of therapeutic value. A sample low protein diet is listed in table 3-4.

High Residue

The high residue (high bulk, high fiber, high roughage) diet is indicated in atonic constipation, spastic colon, irritable bowel syndrome, and diverticulosis. This diet encourages regular elimination by stimulating muscle tone, creating softer and larger stools that are more easily propelled through the colon. This reduces the pain and cramping that accompany spastic colon or irritable bowel syndrome.

The patient is given a regular diet, with the inclusion of high residue foods. The main sources of fiber are whole grain breads and cereals, bran cerals, fresh fruits, and vegetables that are raw or cooked until tender. Whole grain breads and cereals that contain wheat bran have a greater laxative effect than fruits and vegetables, because the bran acts to absorb water within the colon creating, a bulk effect. At least one serving of 100 percent wheat bran cereal is recommended daily. Raisin Bran, Bran Flakes, Shredded Wheat, and Oatmeal may be used occasionally, but they contain less than half the amount of fiber in All Bran or Bran Buds. Fresh fruits and vegetables with edible skins, such as apples and grapes are higher in fiber content than canned fruits or vegetables and their juices.

Dietary intake of refined sugars and starches should be decreased, as they are poor sources of fiber. Limit white flour products, refined cereals, pies, cakes, and cookies.

Fluids are increased. Too little fluid in the diet may cause dehydration and lead to constipation. The patient must drink at least 8 glasses of water or other fluids daily, particularly when consuming the recommended amount of bran. Drinking too much alcohol, coffee, cola, tea, and soft drinks can irritate a sensitive colon and can cause dehydration. If possible, use decaffeinated coffee. One or 2 glasses of water in the morning helps to stimulate peristalsis.

Excessive intake of alcohol, beverages containing caffeine (coffee, tea, colas), chili powder, dried beans, fruits with seeds and skins, nuts, pepper, popcorn, and strong spices may cause irritability. These foods should be individualized to the patient.

When one is progressing from a low residue diet after an acute infection or diverticulitis, increase fiber in the diet gradually. Start by adding I serving of 100 percent bran cereal and 3 servings of whole grain bread to the low residue menu pattern. Gradually increase the amount of raw vegetables and fresh fruits to at least 4 servings per day.

Laxatives may cause decreased absorption of vitamins, loss of minerals, or inhibition of glucose uptake. A sample high residue diet is contained in table 3-5.

Low Residue

This diet is indicated in ulceration, inflammation, and other gastric disorders, such as partial intestinal obstruction or diverticulitis. It is also used in certain postoperative states that affect any part of the GI tract, e.g., a hemorrhoidectomy. Low residue diets are also used in treating dysenteries of long duration.

The purpose of this diet is to provide nonstimulating and nonirritating, easily digested material that leaves little residue to avoid mechanical irritation of the GI tract. Commercially prepared low residue elemental diet supplements, such as Vivonex by Eaton or Precision Low Residue by Doyle, may be given to provide complete nutrition.

Foods Allowed:

Beverages	Orangeade, grapeade, and lemonade; weak tea and coffee; decaffeinated coffee
Bread:	White, enriched
Cereals:	Cooked, refined corn, rice, wheat cereals, and grits (no bran)
Cheese:	Cottage, cream, and mild cheddar in cooking
Desserts:	Rice and tapioca puddings, custards, gelatin, ice cream, plain cake, and cookies. (Count desserts containing milk in the milk allowance.)
Eggs:	Soft cooked or poached (1 or 2 daily)
Fat:	Butter, margarine, and salad dressing
Fruits:	Orange juice, grapefruit juice, and strained apples, peaches, pears, and ripe bananas
Meat:	Crisp bacon and tender meat, fish, or fowl that is baked, boiled, or broiled
Milk:	Whole or skim, cream, or cocoa (2 cups daily)
Soups:	All strained, creamed, and pureed
Vegetables:	Strained vegetable juice, lettuce, cooked asparagus, beets, greenbeans, tomatoes, eggplant, acorn squash (without seeds), lima beans, or spinach (2 servings daily)

Foods to Avoid

Beverages:	Alcoholic
Bread:	Hot
Cereals:	Coarse, whole grain
Cheese:	Uncooked
Desserts:	Rich
Fruits:	Raw or dry
Meat:	Fibrous
Vegetables:	Gas-forming, such as cabbage, turnips, dry lentils, beans, or onions
Other:	Spicy seasonings or fatty, fried, very hot, or very

A sample low residue diet is contained in table 3-6.

Low Sodium

A low sodium diet consists of foods containing a very small percentage of sodium, with no salt added in preparation or by the patient. It is impossible to prepare an absolutely sodium-free diet.

The low sodium diet is indicated when edema is present, in renal diseases, in hypertension, and in certain cardiac conditions.

The nephrotic patient is often unable to excrete sodium in a normal manner. The kidneys' retention of sodium leads to edema. A low sodium diet is thus indicated, with no restriction on salt-free fluids. Such patients should be encouraged to drink 2,000 to 3,000 milliliters (ml) of low sodium fluids daily.

The allowance of sodium in a strict low sodium diet is 250 to 1000 mg daily. The allowance of sodium in a moderate low sodium diet is 2000 mg or 2 g. Regular diets with no salt added contain 2.4 to 4.5 g of sodium.

Any diet in which the amount of sodium is drastically reduced has possible side effects. The patient who is on this regimen must be constantly observed, particularly in warm climates, for lassitude, complaints of weakness, anorexia, nausea and vomiting, mental confusion, abdominal cramps, and aching skeletal muscles.

Foods Allowed

Beverages:	Milk (2 cups daily), carbonated beverages (1 cup daily), unsalted fruit juices, coffee, and tea
Bread:	Made without baking soda, baking powder, or salt. Low sodium baking soda and baking powder are allowed. Regular bread is provided on diets of 2000 mg sodium and above.
Cereals:	Cooked without salt. Puffed wheat or rice, and Shredded Wheat
Desserts:	Any desserts made without salt, baking soda, or baking powder
Fat:	Unsalted butter and margarine, shortening, cream, oil, or low sodium salad dressing
Fruits:	Any unsalted canned, cooked, fresh frozen, or raw fruit
Meat:	Meat, fish, or fowl prepared without salt or sodium compounds, such as meat tenderizers, steak sauce, and soy sauce
Soups:	Low sodium including broth
Sweets:	Pure sugar candy and jams and jellies made without sodium benzoate
Vegetables:	Salt-free raw, cooked, or canned dietetic

Foods to Avoid:

Beverages:	Coffee, cocoa, etc.
Cereals:	All instant
Desserts:	Those prepared with salt, baking soda, or baking powder
Fruits:	Jam, jelly, or dried fruit containing sodium benzoate
Meats:	Canned, salted, or smoked
Milk:	Cultured buttermilk and chocolate milk
Vegetables:	Those prepared with salt
Sauces:	Soy sauce, monosodium glutamate, and steak sauce
Other:	Instant foods; pancakes and waffles prepared with salt, baking soda or baking powder; pickles and olives; salted condiments; salted nuts; or peanut butter.

See table 3-7 for a sample low sodium diet.

Bland Diets

This diet may be helpful for gastritis, hyperacidity, hemorrhoids, peptic ulcers, and other GI disorders. Dietary management of patients with chronic ulcer disease has been the subject of much controversy. Bland diets have traditionally been used for these patients. Experiments show that there is no significant difference in the response of patients with an active duodenal ulcer to a bland diet. The American Dietetic Association states that the only known irritants to the gastric mucosa include alcohol, black pepper, caffeine, chili powder, cocoa, coffee, certain drugs, and tea.

Emphasizing how to eat is as important as indicating what foods to eat, since there are individual responses to bland diets. Offer the following suggestions to the patient:

Avoid worry and emotional upsets at mealtime
Chew food well and eat slowly
Rest before and after meals
Avoid foods of extreme temperatures

If fruits and juices between meals cause distress, try including them with meals.

The "Six Meal Bland Diet" follows the most conservative approach to the dietary treatment of active ulcer disease. Chemical, mechanical, and thermal irritants are eliminated. Meals are kept small to reduce gastric acidity and distention. Avoid fatty meats, fried foods, whole grain breads and cereals, dried beans and peas, cabbage family vegetables, bouillon, clear broths, chocolate, nuts, seeds, carbonated beverages, caffeine, coffee, decaffeinated coffee, and tea. Patients may use allspice, cinnamon, mace, paprika, sage, thyme, catsup, cranberry or mint jelly, and extract and flavorings without chocolate, salt, and vinegar.

The "Bland Diet" allows a more liberal food selection, reduces the number of meals to three, and increases the quantity of foods given. Avoid whole grain breads and cereal, bouillon, clear broths, chocolate, nuts, seeds, dried fruits, and caffeine. Individualize the diet to the patient.

The "Regular-No Stimulants Diet" eliminates only those items that have been shown cientifically to irritate the gastric mucosa-alcohol, black pepper, caffeine, chili powder, cocoa, coffee, certain drugs, and tea.

Decaffeinated coffee may be restricted as recent studies show that it causes increased gastric acid secretion and esophageal pressure causing gastric acid reflux in the esophagus. Decaffeinated coffee is only offered on the Bland Diet and the Regular-No Stimulants Diet if it is tolerated by the patient.

Chronic and excessive use of antacids to treat hyperacidity and related conditions may result in thiamin deficiency, presumably because of alkaline destruction of thiamin within the bowel lumen. Excessive intake of milk with antacids may cause systemic alkalosis and hypercalcemia. Milk may be contraindicated in patients with allergic reactions or lactase deficiency.

Sample menu patterns follow for the Six Meal Bland Diet and Bland Diet (tables 3-8 and 3-9). A sample menu pattern is not listed for the Regular-No Stimulants Diet, as it is derived from the regular diet.

Low Carbohydrate, High Protein Diet

A low carbohydrate, high protein diet is used in the treatment of hypoglycemia. This diet limits simple carbohydrates that are quickly absorbed into the blood. A marked rise in blood sugar stiumulates the pancreas to overproduce insulin, which leads to a hypoglycemic state as too much sugar is transported out of the blood.

Individualize the diet to the patient, as hypoglycemic reactions may occur at any time for various reasons. For example, meal skipping, inadequate calorie intake with excessive energy expenditure, and drinking alcohol may precipitate a low blood sugar reaction.

The foods may be divided into three to six or more small meals. Liberal amounts of protein and fat are used as they are more slowly digested and absorbed. The diet includes meats, fish, poultry, cheese, eggs, fats, low starch vegetables, and limited amounts of unsweetened fruit and juices, breads, cereals, and high starch vegetables. Because milk contains the sugar lactose, limit it to 2 cups a day for an adult.

Sweets such as candy, sugar, jams, jellies, soft drinks, and pastries should be avoided to help prevent hypoglycemic reactions. They should be consumed only to quickly increase blood sugar levels during a hypoglycemic reaction. If reactions are frequent, it is helpful to carry hard candy for quick and easy use. Handy high protein snacks to help prevent reactions may include cheese, peanut butter, milk, and hard boiled eggs.

A sample low carbohydrate, high protein menu is listed in table 3-10.

References:

NAVMED P-5125, Medical Services Diet Manual
Guthrie H: Introductory Nutrition, ed 5, St. Louis, C. V. Mosby Co., 1983.
Kerschner V: Nutrition and Diet Therapy, ed 3, Philadelphia, F. A. Davis Co., 1983.

Naval Education and Training Command: Hospital Corpsman 1 & C: August 1986

Approved for public release; Distribution is unlimited.

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Operational Medicine 2001

Health Care in Military Settings

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Operational Medicine
Health Care in Military Settings
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January 1, 2001

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Hospital Corpsman 1 & C Chapter 3: Diet Therapy

Health Care in Military Settings

Hospital Corpsman 1 & C
Chapter 3: Diet Therapy