Nutrition/Diets

Patients diagnosed with celiac disease are required to follow a strict gluten free diet for life.  Gluten is a protein found in wheat, rye, barley, and derivatives of these ingredients such as malt.  Conventional oats must also be avoided due to potential for cross-contamination.

• Common gluten-containing foods include bread, cereals, pasta, crackers, baked goods, and many thickened soups and sauces
• Common gluten-free foods include fruits and vegetables; milk, yogurt, and cheese; plain meats and fish; eggs; nuts and seeds; potatoes, rice, and corn

With celiac disease, it’s especially important to eat a variety of nutrient-rich, gluten free foods to prevent nutritional deficiencies.  Consume plenty of fiber through fruits and vegetables, brown and wild rice, nuts, and unconventional whole grains such as quinoa.  Get plenty of iron with a variety of animal proteins such as meat, poultry, and fish.  A multivitamin/mineral supplement may be recommended, but ask your physician or registered dietitian.

A clear liquid diet is required for patients to prepare for a variety of procedures.  You may choose to drink any of the following liquids on this diet (be sure to avoid red, purple, or blue coloring as this may interfere with the accuracy of your procedure):

• Water
• Gatorade
• Coffee or tea (no cream)
• Apple or white grape juice
• Broth
• Gelatin
• Fruit ice without pulp
• Clear hard candy

Crohn’s disease and Ulcerative Colitis are forms of IBD (Inflammatory Bowel Disease).  No special diet is required; however, in moderate to severe cases IBD may rob the body of vital nutrients.  It is important to eat a well-balanced diet and focus on keeping weight stable.  Underweight patients will benefit from a high calorie/high protein diet.  Patients with active disease may benefit from a low residue diet to help reduce abdominal pain, calm diarrhea, and prevent further irritation in the bowel to promote healing. 

Diverticulitis results when one or more of the diverticula in the colon becomes infected or inflamed.  To promote recovery and prevent worsening of this condition, a low residue diet is recommended.  After a full recovery, you may slowly begin to resume a high fiber diet.

Dumping syndrome describes a cluster of symptoms that can occur following stomach surgery.  Symptoms result from foods passing too quickly from the stomach to the small intestine and they may include bloating, cramping, nausea, dizziness, diarrhea, weakness, sweating, and rapid heartbeat.  The following tips may help reduce your symptoms:

• Eat smaller, more frequent meals 6-8 times per day
• Avoid foods high in sugar, such as candies, desserts, and sugar-sweetened beverages
• Drink beverages between meals only (approximately one hour before and one hour after eating)
• Eat protein-rich foods first, such as meats, poultry, fish, cheese, and eggs
• Lie down for 15 minutes immediately after eating to slow the movement of food

Gas cannot be prevented completely, but people who have excessive amounts of gas may be able to reduce the severity.  Gas in the digestive tract is caused by swallowed air, normal breakdown of undigested foods, or in some cases, malabsorption of certain nutrients.  The following tips may help you reduce gas in the digestive tract:

• Eat smaller, more frequent meals 6-8 times per day
• Take your time when eating; try not to rush
• Try avoiding carbonated beverages and chewing gum
• Try eating fewer foods that are common culprits, such as beans, broccoli, Brussels sprouts, and cabbage

If the above tips do not help, consider reducing the amount of carbohydrates in your diet.  Carbohydrates are more likely to cause gas than fats and proteins.  The following foods are examples of carbohydrates:

• Starches (bread, cereals, rice, pasta)
• Fruits
• Starchy vegetables (potatoes, peas, corn)
• Dry beans
• Milk and yogurt

Gastroparesis is a condition in which the stomach empties food too slowly.  Patients who are underweight or losing weight rapidly may benefit from a high calorie/high protein diet in addition to other diet changes.  The following tips may help reduce abdominal pain, bloating, and early fullness often associated with gastroparesis:

• Eat smaller, more frequent meals 6-8 times per day
• Avoid foods with lots of roughage such as raw fruits, raw vegetables, and lettuce salads
• Avoid foods high in fat; such as fried foods, creamy sauces, fatty meats like bacon, sausage, and salami, and high-fat bakery desserts
• Choose more foods with a liquid consistency when symptoms are at their worst

Gastroesophageal Reflux (GERD) occurs when stomach acids rise up into the esophagus, the tube that carries food from the mouth to the stomach.  This is often caused by a ring of muscle called the lower esophageal sphincter (LES) that does not close properly, or remains open for a prolonged period of time.  Other common terms associated with this condition are heart burn and indigestion.  Certain factors put individuals at higher risk for developing this condition, including obesity, pregnancy, and smoking.  The following tips may help reduce symptoms associated with GERD:

• Avoid or limit foods that have a tendency to trigger symptoms such as citrus fruits and juices, chocolate, caffeinated drinks, alcohol, fatty or fried foods, garlic, onions, peppermint or spearmint, spicy foods, and tomato-based products
• Do not smoke
• If you are overweight, moderate weight loss can help relieve pressure on the esophagus
• Wear loose-fitting clothing around the midsection
• Eat smaller, more frequent meals 6-8 times per day
• Raise the head of your bed 6-9 inches using a foam wedge
• Avoid eating 3 hours prior to bedtime
• Keep a food and symptom diary to help identify potential triggers

A high calorie/high protein diet may be necessary for individuals struggling to maintain weight due to a variety of reasons.  Getting enough calories and protein can help provide much-needed energy, prevent excessive muscle loss, and promote faster healing.  The following tips can help you obtain more calories and protein:

• Aim for at least six meals and snacks each day.  If you can only eat small amounts at each meal, eat more often
• Added fats such as butter, margarine, cooking oil, and peanut butter enhance texture and provide an additional 100 calories per tablespoon
• Avoid filling up on sugar-free beverages such as water and diet drinks.  Enjoy fruit juice, milk, sports drinks, and soda
• Plan ahead to have calorie-dense foods on hand such as snack crackers, nuts, and cheese sticks
• Dress up fruits and veggies with dips and sauces
• Enjoy ice cream, milk shakes, smoothies, puddings, and custard
• Liquid nutritional supplements can provide an additional 250-350 calories per bottle

A high fiber diet is recommended for the majority of individuals to promote regular bowel movements and overall colon health; however, in certain cases this diet may not be tolerated well.  Following the tips below can help make increasing fiber more comfortable.

Soluble fiber:  forms a gel when combined with water; can help make stools softer and easier to pass.  Found in legumes (dry beans and peas), oat bran and oats, barley, and most dietary fiber supplements.

Insoluble fiber:  does not dissolve in water; adds bulk to stool and stimulates movement of the intestinal tract.  Found in wheat bran, cereals, whole wheat products, and the skins of fruits and vegetables.

The following tips may help ease the transition to a high fiber diet:

• Go slow!  Increase gradually over the course of a few weeks.  Too much too soon may result in bloating, cramping, and distension
• Increase your intake of fluids as you increase fiber.  Remember, all liquids count (except alcohol):  fruit juice, milk, broth-based soups, soda, coffee, and tea
• Physical activity stimulates intestinal muscle contraction, which can help move food through the GI tract more effectively

The following foods are excellent sources of dietary fiber:

• Fruits (especially berries) and vegetables
• Beans and peas
• Oatmeal
• Whole grain cereals
• Whole grain breads and pasta
• Brown rice
• Popcorn
• Nuts

IBS is a functional disorder of the GI tract.  In some cases, the gut moves too quickly (resulting in diarrhea), and in others the gut moves too slowly (resulting in constipation).  Some people have alternating bouts of constipation and diarrhea, as well as abdominal cramping, gas, and bloating.  No single diet exists that will treat all patients suffering from IBS; however, changes to diet and lifestyle can significantly reduce symptoms.  The following tips may help reduce symptoms associated with IBS:

• Eat smaller, more frequent meals 6-8 times per day
• Try to increase your intake of soluble fiber which can often be found in oats, beans, dried peas, legumes, and over-the-counter fiber supplements
• Avoid foods high in fat such as fried foods, creamy sauces, fatty meats (bacon, sausage, and salami), and high-fat bakery desserts (these are often a trigger)
• Foods high in certain ingredients are sometimes a trigger for IBS symptoms; including lactose, fructose, gluten, and/or simple sugars.  Ask your physician or registered dietitian if eliminating specific groupings of foods would be beneficial in your case
• Keep a food and symptom diary to help better understand your own triggers

Lactose intolerance is a condition in which the body is deficient in lactase, the enzyme responsible for digesting and breaking down lactose, the sugar found in milk.  Individuals will have varying degrees of severity.  Most people with lactose intolerance can tolerate small amounts of dairy products when combined with other foods, but others who are more sensitive cannot.  The following foods are high in lactose:

• Milk
• Buttermilk
• Cottage cheese
• Cream cheese
• Evaporated milk
• Dry milk powder or milk solids
• Sweetened condensed milk
• Ice cream

While yogurt contains lactose, it also contains beneficial bacteria that help break down that lactose.  Yogurt is a great way to obtain dietary calcium and most individuals with lactose intolerance can tolerate it quite well due to the presence of probiotics.

Cheese also contains lactose, but in much smaller amounts.  Most individuals can tolerate moderate amounts of cheese, especially cheddar, parmesan, Swiss, and American.  Softer cheeses such as blue cheese, ricotta, and cottage cheese may not be as well tolerated.

Other tips:

• Try lactose-free alternatives as a substitute for milk; examples include lactose-free milk, soy milk, almond milk, and rice milk
• Particularly sensitive individuals may need to watch out for lactose present in baked goods, cold cuts, hot dogs, creamy sauces, and some medications 

A low fat diet is appropriate to help control symptoms associated with a variety of gastrointestinal diseases.  Dietary sources of fat include butter, margarine, cooking oil, lard, nuts and nut butters, seeds, avocadoes, cheese, cream, and full-fat dairy products. The following tips can help reduce fat in your diet:

• Choose whole wheat and enriched breads, pastas, cereals, low fat crackers, brown and wild rice, or any other grains prepared without added fat
• Choose fresh, frozen, or canned fruits and vegetables
• Choose lean cuts of meat, skinless poultry, eggs, and beans
• Choose low fat or skim milk, reduced fat cheese, and low fat yogurt
• Avoid grains made with added fats such as biscuits and buttery crackers
• Avoid fried meats or fried vegetables
• Limit intake of avocado or guacamole
• Avoid fatty meats such as bacon, sausage, hot dogs, and salami

A low residue diet is appropriate for a variety of gastrointestinal disorders in which a gentler diet is indicated to promote healing.  This diet is typically low in fiber, fat, and foods that may irritate the gut.  The following tips can help you choose low residue foods:

• Avoid any food made with seeds, nuts, raw or dried fruit
• Avoid whole grain breads and cereals.  Purchase products made from refined flour
• Avoid nuts, seeds, and popcorn
• Do not eat raw fruits or vegetables.  Remove skins before cooking
• Limit fats since these can increase stool bulk
• Avoid tough, fibrous meats that are difficult to chew
• Choose foods with a soft, smooth texture
• Choose protein shakes, smoothies, or liquid nutritional supplements if extra calories and/or protein are needed