PURPOSE

This diet helps to prevent a condition called “dumping syndrome,” which occurs in some patients who have undergone stomach surgery.  The symptoms include bloating, nausea, diarrhea, dizziness, weakness, sweating, and rapid heartbeat.  They may occur 30 to 60 minutes after eating a meal and then again, 2 to 3 hours after eating.

The early symptoms are caused when concentrated sugar passes too rapidly from the stomach into the intestine.  The body dilutes this sugar mixture by bringing fluid from body tissues into the intestine, giving a sense of fullness, cramping, and occasionally, diarrhea.  The loss of water from tissues can produce a temporary drop in blood pressure, with resulting weakness and faintness.

The later symptoms are caused by the rapid absorption of sugar into the bloodstream, which raises the amount of blood sugar.  A high level of blood sugar signals the body to produce more insulin.  The excess insulin, in turn, drives blood sugar levels down.  The low blood sugar (hypoglycemia) produces the weakness, hunger, and rapid heart rate that may occur about two to three hours after eating.  This diet is really a regular diet with frequent small meals and reduced simple sugars.

NUTRITION FACTS

Depending upon individual tolerances and food selection, the Anti-Dumping or Post-Gastrectomy Diet is adequate in all nutrients according to the National Research Council’s Recommended Dietary Allowances (RDA).  Depending on the type and extent of gastric surgery performed, poor absorption of nutrients, vitamins, and minerals may occur to a significant degree.  Some patients may become deficient in iron, calcium, folate, and B-12.  The physician may prescribe vitamin/mineral supplementation and B-12 injections.

SPECIAL CONSIDERATIONS

1. Eat six small meals daily to avoid overloading the stomach.

2. Limit fluids to 4 oz (1/2 cup) during mealtimes.  This prevents the rapid movement of food through the upper gastrointestinal tract and allows adequate absorption of nutrients.

3. Drink liquids 30 to 45 minutes before eating and 1 hour after eating, rather than with meals.

4. Rest or lie down for 15 minutes after a meal to decrease movement of food from the stomach to the small intestine.  This decreases the severity of symptoms.

5. Avoid sweets and sugars.  They aggravate the dumping syndrome.

6. Avoid very hot or cold foods or liquids, which may increase symptoms in some patients.

7. Stomach surgery is performed for different reasons, so calorie requirements may vary from patient to patient.  For example, a patient who has had surgery for severe obesity will need to be on a weight reduction program.  A very thin patient who has had ulcer or cancer surgery will need extra calories.

 

Note: the information in this section is provided as a supplement to information discussed with your healthcare provider.  It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.

 

PURPOSE

A diet of clear liquids maintains vital body fluids, salts, and minerals; and also gives some energy for patients when normal food intake must be interrupted.  Clear liquids are easily absorbed by the body.  They reduce stimulation of the digestive system, and leave no residue in the intestinal tract.  This is why a clear liquid diet is often prescribed in preparation for surgery, and is generally the first diet given by mouth after surgery.  Clear liquids are given when a person has been without food by mouth (NPO) for a long time.  This diet is also used in preparation for medical tests such as sigmoidoscopy, colonoscopy, or certain x-rays.

NUTRITION FACTS

A clear liquid diet is not adequate in calories and nutrients.  It should not be used for more than five days unless high-protein gelatin or other low-residue supplements are added.

SPECIAL CONSIDERATIONS

1.  Limitations

The physician may limit certain liquids, depending on the patient’s condition, or the surgery or test being performed.  Therefore, individual instructions should be strictly followed.

2.  What is a clear liquid?

A good rule-of-thumb is anything you can see through.  For example, apple juice is a clear liquid; milk is not.  If unsure, check with the physician or registered dietitian.

3.  After surgery and fasting

Should persistent abdominal cramps or discomfort occur with a clear liquid diet, the patient should notify the physician, nurse, or dietitian at once.

4.  Preparing for a medical test

It is important that the clear liquid diet be followed exactly.  Remember that the value of the examination will depend on getting a thoroughly clean digestive tract.

FOOD GROUPS

Group	Recommend	Avoid
.  Milk & Milk products	None	All
.  Vegetables	None	All
.  Fruits	Fruit juices without pulp	Nectars; all fresh, canned and frozen fruits
.  Bread & grains	None	All
.  Meat or meat substitutes	None	All
.  Fats & oils	None	All
.  Sweets and desserts	Gelatin, fruit ice, popsicle without pulp, clear hard candy	All others
.  Beverages	Coffee, tea, soft drinks, water, lactose-free, low residue supplements if approved by physician	All others
.  Soups	Bouillon, consommé, fat free broth	All others

SAMPLE MENU

Breakfast Lunch Dinner        Strained fruit Consommé 3/4 cup Consommé 3/4 cup        Juice 1 cup Strained fruit Strained fruit        Gelatin 1/2 cup Juice 1 cup Juice 1 cup        Hot tea with sugar & lemon Fruit ice 1/2 cup Fruit ice 1/2 cup         Gelatin 1/2 cup Gelatin 1/2 cup         Hot tea with sugar & lemon Hot tea with sugar & lemon

This Sample Diet Provides The Following

Calories ...............660.  .  .  .  .  .  .  .  Fat ................virtually none  Protein .................6 gm.  .  .  .  .  .  .  Sodium ......1500 mg  Carbohydrates ..209 gm.  .  .  .  .  Potassium ...1440 mg

 

Note: the information in this section is provided as a supplement to information discussed with your healthcare provider.  It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.

 

PURPOSE

Surgery is often needed to treat certain conditions of the colon (large bowel).  Sometimes the surgeon must make an opening on the abdominal wall through which intestinal waste (feces) can pass.  This surgery is medically known as colostomy and ileostomy.  The opening itself is called a stoma.  A lightweight, disposable bag is then worn over the stoma.  This condition is often permanent.  However, in certain cases it is a temporary detour that can be reversed at a later time.

There are two forms of this surgery where a bag may not be needed.  Sometimes a rectal pouch can be created from the small intestine, forming a reservoir for the stool behind the stoma.  A tube is put in place so the reservoir can be emptied when needed, usually once a day.  In another procedure, all of the colon is removed except for the last part of the rectum, A pouch is created from the small intestine and it is attached to the rectum so liquid stool can pass normally through the anus (opening to the outside of the body) about 3 to 7 times a day.

After all of these surgeries, the stool consistency, amount, and frequency will depend on the type and amount of foods eaten.  So, this diet is to help patients gain adequate control of their bowel movements.

NUTRITION FACTS

Generally, colostomy and ileostomy patients can easily maintain a balanced diet to provide all the vitamins, minerals and calories needed for good health.  In those cases where certain foods have to be restricted to control stool patterns or stool consistency, the physician may prescribe a vitamin-mineral supplement.

SPECIAL CONSIDERATIONS

1. Because each patient and type of surgery are different, no standard recommendations can be given for everyone.  Most patients return to a fairly normal diet.  Still, a trial and error pattern of eating is often necessary to identify those foods that may have an undesirable effect on the patient’s stool.  Then it is simply a matter of changing how much of these foods are eaten.  The lists that follow are a guideline.

2. Eat foods at a regular time each day.  Eating 4 to 6 smaller meals may help to promote a regular bowel pattern.

3. Try eating the main dinner meal at noon and a smaller meal in the evening.  This helps to reduce the stool output at night.

4. Introduce one type of food at a time to test how it affects bowel function.  If it does not produce a good result, stop eating it.  However, as the body heals and adjusts, the offending food may become easier to tolerate, so try adding it to the diet again on several occasions before giving up on it.

5. Chew foods completely to help the digestive process.  Especially avoid swallowing large pieces of leafy vegetables since they can block the stoma opening on the abdominal wall.

6. Fresh fruit may cause loose stool.

7. Drink 2 to 3 quarts of water a day.  This helps to keep the stool fluid, and it also prevents dehydration.  Normally, the colon absorbs water and electrolytes (substances such as sodium and potassium) from the stool, so people who have all or part of the colon removed will lose more water.  Because electrolytes are also lost, do not restrict salt in the diet.

8. Maintain an ideal body weight.  Extra fat in the abdominal wall can make it difficult for the stomach to function properly.

9. Colostomy patients may find that foods which caused problems before surgery continue to do so afterward.

10. During the first 4 to 6 weeks after surgery, ileostomy patients should limit foods that caused problems prior to surgery.  This will reduce the chance of stoma blockage and lower the amount of gas.

11. Certain substances can change the appearance of the stool.  Bile that cannot be reabsorbed in the intestine can cause a yellow or green stool color, especially when diarrhea or rapid bowel action occurs.  Beets make the stool appear red; it is not blood! Broccoli, asparagus, spinach, and Pepto-Bismol can darken, even blacken, the stool.

12. Certain medications such as lmodium, Lomotil, Levsin, and Bentyl can help to slow the bowel when diarrhea is a problem.

13. Foods containing large amounts of fiber and bran should be avoided for 6 to 8 weeks after surgery.  After that time, certain bulking agents such as psyllium (Metamucil), methylcellulose (Citrucel), and calcium polycarbophil (FiberCon) may help firm the stool.  Only certain patients need to have a firmer stool, so do not use these agents without the physician’s instructions.

 

Note: the information in this section is provided as a supplement to information discussed with your healthcare provider.  It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.

 

PURPOSE

The esophagus is the tube that carries food from the throat to the stomach.  However, it is not just a simple tube.  The lower esophagus has a specialized muscle around it that usually stays tightly closed, opening only to allow food and liquid into the stomach.  It is called the lower esophageal sphincter or LES.  It acts to prevent the reflux of stomach acid into the esophagus.

Symptoms occur when this specialized muscle weakens and allows stomach acid to splash up into the esophagus.  These symptoms include heartburn, chest discomfort, and buffer fluid flowing up into the mouth.  Chest discomfort can occur.  If the stomach juice trickles into the breathing tubes, hoarseness, cough, and even shortness of breath can occur.  This entire problem is called GERD (Gastroesophageal Reflux Disease).  A number of factors, including certain foods, may cause the lower esophageal muscle to relax, causing GERD.

NUTRITION FACTS

A diet designed to prevent or reduce acid reflux is usually easy to follow.  The basic food groups of cereals, vegetables, fruits, dairy products, and meats can be eaten with only a few limitations.  This diet generally meets the Dietary Reference Intakes developed by The Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences.  A vitamin C supplement may be needed if an individual does not tolerate citrus foods such as oranges, tomatoes, etc.

SPECIAL CONSIDERATIONS

The lower esophageal muscle can be weakened by factors other than food.  The following recommendations may be helpful in reducing symptoms:

1. Stop using tobacco in all forms.  Nicotine weakens the lower esophageal muscle.

2. Avoid chewing gum and hard candy.  They increase the amount of swallowed air which, in turn, leads to belching and reflux.

3. Do not lie down immediately after eating.  Avoid late evening snacks.

4. Avoid tight clothing and bending over after eating.

5. Eat small, frequent portions of food and snack if needed.

6. Lose weight if overweight.  Obesity leads to increased reflux.

7. Elevate the head of the bed six to eight inches to prevent reflux when sleeping.  Extra pillows, by themselves, are not very helpful.

8. The following foods aggravate acid reflux, and should be avoided:

• fatty or fried foods

• whole milk

• chocolates

• oils

• peppermint and spearmint

• creamed foods or soups

• most fast foods

9. The following foods irritate an inflamed lower esophagus and may need to be limited or avoided:

• citrus fruit and juices (grapefruit.  orange, pineapple, tomato)

• coffee (regular and decaffeinated)

• tea

• other caffeinated beverages caffeinated soft drinks

10. Spicy or acidic foods may not be tolerated by some individuals.

 

Note: the information in this section is provided as a supplement to information discussed with your healthcare provider.  It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.

 

PURPOSE

Gastroparesis is the medical term for delayed stomach emptying.  During the process of digestion, the stomach must contract to empty itself of food and liquid.  Normally, it contracts about three times a minute.  This empties the stomach within 90-120 minutes after eating.  If contractions are sluggish or less frequent, stomach emptying is delayed.  This results in bothersome and sometimes serious symptoms, as well as malnutrition, because food is not being digested properly.

Gastroparesis may be caused by various conditions such as diabetes mellitus, certain disorders of the nervous system, or certain drugs.  Often however; no cause can be found although a viral infection is suspected in some.  Usually, the physician prescribes medication to stimulate the stomach to contract, The purpose of the gastroparesis diet is to reduce symptoms and maintain adequate fluids and nutrition.  There are three steps to the diet.

STEP 1 DIET consists of liquids, which usually leave the stomach quickly by gravity alone, Liquids prevent dehydration and keep the body supplied with vital salts and minerals.

STEP 2 DIET provides additional calories by adding a small amount of dietary fat—less than 40 gm each day.  For patients with gastroparesis, fatty foods and oils should be restricted, because they delay stomach emptying.  However; patients at the Step 2 level are usually able to tolerate this amount.

STEP 3 DIET is designed for long-term maintenance.  Fat is limited to 50 gm per day, and fibrous foods are restricted, because many plant fibers cannot be digested.

NUTRITION FACTS

The STEP 1 Gastroparesis Diet is inadequate in all nutrients except sodium and potassium, It should not be continued for more than three days without additional nutritional support.  STEP 2 and STEP 3 Gastroparesis Diets may be inadequate in Vitamins A and C.  and the mineral iron.  A multi- vitamin supplement is usually prescribed.

SPECIAL CONSIDERATIONS

1. Diets must be tailored to the individual patient.  This is because the degree of gastroparesis may range from severe and longstanding to mild and easily corrected.  Patients may also have various medical conditions to be considered.  For example.  diabetes patients with gastroparesis are allowed sugar-containing liquids on the Step 1 diet, because that is their only source of carbohydrate.  On the Step 2 and Step 3 diets, these patients should avoid concentrated sweets.  These are noted with an asterisk (*) on the food lists.

2. On all of the diets, liquids and food should be eaten in small, frequent meals.  This helps to maintain nutrition.

Step 1 Food Groups

Group	Recommend	Avoid
.  Milk & Milk products	None	All
.  Vegetables	None	All
.  Fruits	None	All
.  Bread & grains	Plain saltine crackers	All others
.  Meat or meat substitutes	None	All
.  Fats & oils	None	All
.  Sweets and desserts	None	All
.  Beverages	Gatorade and soft drinks (sipped slowly throughout the day)	All others
.  Soups	fat free bouillon and consommé	All others

Sample Menu Step 1

Breakfast Lunch Dinner        Gatorade ½ cup Gatorade ½ cup Gatorade ½ cup        Ginger ale ½ cup Coke ½ cup Sprite ½ cup        Bouillon ¾ cup Bouillon ¾ cup Bouillon ¾ cup        Saltine crackers 6 Saltine crackers 6 Saltine crackers 6                   Morning Snack Afternoon Snack Evening Snack        Gatorade ½ cup Gatorade ½ cup Gatorade ½ cup        Saltine crackers 6 Saltine crackers 6 Saltine crackers 6

.  This Sample Diet Provides The Following

.   Calories ...............790.  .  .  .  .  .  .  .  Fat ................9 gm .   Protein .................11 gm.  .  .  .  .  .  Sodium ......3531 mg .   Carbohydrates ..156 gm.  .  .  .  .  Potassium ...244 mg

 

Step 2 Food Groups

Group	Recommend		Avoid
.  Milk & Milk products	Skim milk, products made with skim milk, low-fat yogurt, low-fat cheeses		Whole milk products, creams (sour, light, heavy, whipping), half & half
.  Vegetables	Vegetable juices (tomato, V-8); well-cooked vegetables without skins (acorn squash, beets, carrots, mushrooms, potatoes, spinach, summer squash, strained tomato sauce, yams)		All raw vegetables; cooked vegetables with skins; beans (green, wax, lima), broccoli, Brussels sprouts, cabbage, cauliflower, celery, corn, eggplant, onions, peas, peppers, pea pods, sauerkraut, turnips, water chestnuts, zucchini
.  Fruits	Apple juice, cranberry juice, grape juice, pineapple juice, prune juice, canned fruits without skins (applesauce, peaches, pears)		Citrus juices, all fresh and dried fruits, canned fruits with skins (apricots, cherries, blueberries, fruit cocktail, oranges, grapefruit, pineapple, plums persimmons)
.  Bread & grains	Breads & cereals, cream of wheat, pasta, white rice, egg noodles, low-fat crackers		Oatmeal; whole grain rice, cereal, bread
.  Meat or meat substitutes	Eggs, peanut butter (maximum 2 Tbsp/day)		Beef; poultry; fish; pork products; dried beans, peas & lentils
.  Fats & oils	Any type of fat, but only in small amounts		None
.  Sweets and desserts*	Hard candies, caramels, puddings & custards made from skim milk, frozen yogurt, fruit ice, gelatin, ice milk, jelly, honey, syrups		High-fat desserts (cakes, pies, cookies, pastries, ice cream), fruit preserves
.  Beverages	Gatorade* and soft drinks* (sipped slowly throughout the day)		All others, except allowed juices
.  Soups	Fat-free consommé & bouillon, soups made from skim milk, & fat-free broths containing pasta or noodles and allowed vegetables		Soups made with cream, whole milk, or broths containing fat
.  *Concentrated sweets

Sample Menu Step 2

Breakfast Lunch Dinner        Skim Milk ½ cup Mozzarella cheese 2 oz Peanut butter 1 Tbsp        Poached egg 1 Saltine crackers 6 Saltine crackers 6        White toast 1 slice Chicken noodle soup ¾ cup Vanilla pudding ½ cup        Apple juice ½ cup Gatorade ½ cup Grape juice ½ cup                   Morning Snack Afternoon Snack Evening Snack        Ginger ale ½ cup Skim milk ½ cup Frozen yogurt ½ cup        Canned pears ½ cup Cornflakes ½ cup, sugar 2 tsp Saltine crackers 6

.  This Sample Diet Provides The Following

.  Calories ...............1343.  .  .  .  .  .  .  .  Fat ................35 gm .  Protein .................52 gm.  .  .  .  .  .  .  Sodium ......2639 mg .  Carbohydrates ..206 gm.  .  .  .  .  Potassium ...1411 mg

 

Step 3 Food Groups

Group	Recommend		Avoid
.  Milk & Milk products	Skim milk, products made with skim milk, low-fat yogurt, low-fat cheeses		Whole milk products, creams (sour, light, heavy, whipping), half & half
.  Vegetables	Vegetable juices (tomato, V-8); well-cooked vegetables without skins (acorn squash, beets, carrots, mushrooms, potatoes, spinach, summer squash, strained tomato sauce, yams)		All raw vegetables; cooked vegetables with skins; beans (green, wax, lima), broccoli, Brussels sprouts, cabbage, cauliflower, celery, corn, eggplant, onions, peas, peppers, pea pods, sauerkraut, turnips, water chestnuts, zucchini
.  Fruits	Apple juice, cranberry juice, grape juice, pineapple juice, prune juice, canned fruits without skins (applesauce, peaches, pears)		Citrus juices, all fresh and dried fruits, canned fruits with skins (apricots, cherries, blueberries, fruit cocktail, oranges, grapefruit, pineapple, plums persimmons)
.  Bread & grains	Breads & cereals, cream of wheat, pasta, white rice, egg noodles, low-fat crackers		Oatmeal; whole grain rice, cereal, bread
.  Meat or meat substitutes	Eggs, peanut butter (maximum 2 Tbsp/day)		Beef; poultry; fish; pork products; dried beans, peas & lentils
.  Fats & oils	Any type of fat, but only in small amounts		None
.  Sweets and desserts*	Hard candies, caramels, puddings & custards made from skim milk, frozen yogurt, fruit ice, gelatin, ice milk, jelly, honey, syrups		High-fat desserts (cakes, pies, cookies, pastries, ice cream), fruit preserves
.  Beverages	Gatorade*, soft drinks* (sipped slowly throughout the day), coffee, tea, water (note: non-caloric beverages should be limited if patient cannot maintain adequate caloric intake)		All others, except allowed juices
.  Soups	Fat-free consommé & bouillon, soups made from skim milk, & fat-free broths containing pasta or noodles and allowed vegetables		Soups made with cream, whole milk, or broths containing fat
.  *Concentrated sweets

Sample Menu Step 3

Breakfast Lunch Dinner        Skim Milk ½ cup Tuna fish 2 oz Baked Chicken 2oz        Cream of wheat ½ cup Low-fat mayonnaise 2 Tbsp White rice ½ cup        Sugar 2 tsp White bread 2 slices Cooked beets ½ cup        Orange juice ½ cup Canned peaches ½ cup Dinner roll 1        White toast 1 slice Gatorade ½ cup Skim milk ½ cup        Margarine 1 tsp   Margarine 2 tsp        Jelly 1 Tbsp                       Morning Snack Afternoon Snack Evening Snack        Low-fat yogurt 1 cup Chocolate pudding ½ cup ice milk ½ cup        Sprite ½ cup Ginger ale ½ cup Pretzels 2

.  This Sample Diet Provides The Following

.  Calories ...............1822.  .  .  .  .  .  .  .  Fat ................42 gm .  Protein .................75 gm.  .  .  .  .  .  .  Sodium ......2234 mg .  Carbohydrates ..286 gm.  .  .  .  .  Potassium ...2467 mg

 

Note: the information in this section is provided as a supplement to information discussed with your healthcare provider.  It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.

 

PURPOSE

Gluten is the protein part of wheat, rye, barley, oats, and other related grains.  Some people cannot tolerate gluten when comes in contact with the small intestine.  This condition is known as celiac disease (sometimes called non-tropical sprue or gluten sensitive enteropathy).  There is also evidence that a skin disorder called dermatitis herpetiformis is associated with gluten intolerance.

In patients with celiac disease, gluten injures the lining of the small intestine.  This injury results in weight loss, bloating, diarrhea, gas.  abdominal cramps, or vitamin and mineral deficiencies.  When patients totally eliminate gluten from the diet, the lining of the intestine has a chance to heal.

Removing gluten from the diet is not easy.  Grains are used in the preparation of many foods.  It is often hard to tell by an ingredient’s name what may be in it, so it is easy to eat gluten without even knowing it.  However, staying on a strict gluten-free diet can dramatically improve the patient’s condition.  Since it is necessary to remain on the gluten-free diet throughout life, it will be helpful to review it with a registered dietitian.

NUTRITION FACTS

Depending on the foods selected, the gluten-free diet can meet the Dietary Reference Intakes of the Institute of Medicine.

SPECIAL CONSIDERATIONS

1 . The person who prepares the patient’s food must fully understand the gluten-free diet.  Read food labels carefully.

• Do not use anything that contains the following grains: wheat, rye, barley and oats.

• Can be eaten in any amount: corn, potato, rice, soybeans, tapioca, arrowroot, carob, buckwheat, millet, amaranth, and quinoa.

• Distilled white vinegar, does not contain gluten

• Malt vinegar, does contain gluten

2. Grains are used in the processing of many ingredients, so it will be necessary to seek out hidden gluten.  The following terms found in food labels may mean that there is gluten in the product.

• Hydrolyzed Vegetable Protein (HVP), unless made from soy or corn

• Flour or Cereal products, unless made with pure rice flour corn flour, potato flour, or soy flour

• Vegetable Protein unless made from soy or corn

• Malt or Malt Flavoring unless derived from corn

• Modified Starch or Modified Food Starch unless arrowroot, corn, potato, tapioca, waxy maize, or maize is used

• Vegetable Gum unless vegetable gums are carob bean gum, locust bean gum, cellulose gum.  guar gum, gum arabic, gum aracia, gum tragacanth, xanthan gum, or vegetable starch

• Soy Sauce or Soy Sauce Solids unless you know they do not contain wheat

3. Any of the following words on food labels usually means that a grain containing gluten has been used:

• stabilizer

• starch

• flavoring

• emulsifier

• hydrolyzed plant protein

4. There are now several companies that produce gluten-free products, and several support groups to provide delicious recipes and help patients adapt to the gluten-free diet.

ORGANIZED GROUPS

The Food Allergy Network

11781 Lee Jackson Hwy.  Suite, Fairfax, VA 22033-3309.  Phone: 800-929-4040

www.foodallergy.org

American Celiac Society

P.O.  Box 23455, New Orleans, LA 70183-0455.  Phone: 504-737-3293

www.americanceliacsociety.com

Celiac Sprue Association/USA, Inc.

P.O.  Box 31700, Omaha, NE 68131-0700.  Phone:(402) 558-0600 • 877-CSA-4-CSA

www.csaceliacs.org

Celiac Disease Foundation

13251 Ventura Blvd., Suite 1, Studio City, CA 91604-1838.  Phone: (818) 990-2354

www.celiac.org

Gluten Intolerance Group

31214 124 Avenue SE, Auburn, WA 98092.  Phone: (206) 246-6652

www.gluten.net

COMPANIES THAT SELL GLUTEN-FREE PRODUCTS

Ener-G Foods, Inc.

5960 1st Avenue S., P.O.  Box 84487, Seattle, WA 98124-5787.  Phone: (206) 767-6660 Toll free: 1-800-331-5222

www.ener-g.com

Gluten Free Pantry

P.O.  Box 840, Glastonbury, CT 06033.  Phone: 860-633-3826

www.glutenfree.com

The Really Great Food Company

P.O.  Box 2239, St.  James, NY 11780.  Toll free: 1-800-593-5377

www.reallygreatfoods.com

COOKBOOKS/RECIPES

The Gluten-free Gourmet More From The Gluten-free Gourmet

Bette Hagman

Gluten Freeda Online Cooking Magazine - www.glutenfreeda.com

Food Group		Do Not Contain Gluten		May Contain Gluten		Contain Gluten
.  Milk & Milk Products (2 or more cups daily)		Whole, low-fat , skim, dry, evaporated, or condensed milk; buttermilk; cream; whipping cream; Velveeta cheese food; American cheese; all aged cheeses, such as Cheddar, Swiss, Edam, and Parmesan		Sour cream, commercial chocolate milk and drinks, non-dairy creamers, all other cheese products, yogurt		Malted drinks
.  Meat or meat substitutes (5 to 6 oz. daily)		100% meat (no grain additives); seafood; poultry (breaded with pure cornmeal, potato flour, or rice flour); peanut butter; eggs; dried beans or peas; pork

 

Note: the information in this section is provided as a supplement to information discussed with your healthcare provider.  It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.

 

The High Fiber Diet

Dietary fiber is the part of a plant that cannot be digested by the body.  Just as there are many types of plants, there are also many types of fiber.  Some fibers, such as oat bran, are soluble in water and form a gelatinous bulk that can lower cholesterol.  Other fibers, such as wheat bran, are insoluble and add bulk to the stool.  Both are important and provide benefits.

The Function of the Large Intestine

The principal function of the large intestine (colon) is to remove excess water from food wastes passing into it from the small intestine.  When food passes through the large intestine too quickly, not enough water is absorbed by the intestine, and diarrhea results.  In contrast, if waste material is passed too slowly, too much water is absorbed.  This results in hard stools and constipation, often leading to straining.

The Importance of Dietary Fiber

Fiber, also called roughage or bulk, is necessary to promote the wavelike contractions that move food through the intestine.  High fiber foods expand the inside walls of the colon, easing the passage of waste.  As fiber passes through the intestine undigested, it absorbs large amounts of water, resulting in softer and bulkier stools.

Rural Africans digest and eliminate the foods they eat in one-third the time it takes people who live in Western cultures.  The rural African diet is rich in fiber, This speeds up the time required to digest food and expel wastes.  It is believed this helps sweep out harmful substances before they can cause problems in the body.  In fact, these rural people suffer less from many of the digestive tract diseases that plague Western man, and it is thought that this may be related to the nature of their diet.

A high-fiber diet causes a large, soft, bulky stool that passes through the bowel more easily and quickly.  This helps to prevent, stop, or even reverse some digestive tract disorders.  A softer, larger stool helps prevent constipation and straining, which can help avoid or relieve hemorrhoids.  More bulk means less pressure in the colon, and this is important in treating irritable bowel syndrome and diverticulosis.

Most Americans eat only 10 to 15 grams of fiber a day.  The recommended intake is 20 to 35 grams a day.  High fiber foods, such as fruits and vegetables, also tend to be low in calories, so they should not cause weight gain.  Fiber pills generally should be avoided.  They contain relatively little fiber and are expensive.  Fiber-containing foods and powdered fiber supplements are better sources.

Fiber and Irritable Bowel Syndrome

Irritable bowel syndrome, sometimes called spastic colon or IBS, is one of the most common disorders of the lower digestive tract.  There is no disease present in irritable bowel syndrome.  However, its symptoms can resemble other disorders.  The symptoms of lBS are constipation, diarrhea (or both alternately), abdominal pain, cramping and spasms.  Acute episodes can be triggered by emotional tension and anxiety, poor dietary habits, and certain medications.  Increased amounts of fiber in the diet can help relieve symptoms of irritable bowel syndrome by producing soft, bulky stools and by helping to normalize the time the stool takes to pass through the colon.  The increased bulk also reduces the pressure necessary to push food waste through the colon.  This results in less discomfort.  If irritable bowel syndrome is not treated it may lead to diverticulosis of the colon,

Fiber and Diverticulosis

Colon diverticulosis occurs when pockets or sacks bulge out from the bowel wall.  It is known that these diverticula occur gradually over time and are due to excessive pressure or spasms within the bowel.  These pockets usually cause no problem, but sometimes they can become infected (diverticulitis) or even break open, causing abscess or peritonitis.  A high-fiber diet may act to increase the bulk in the stool, which reduces pressure within the colon.  By so doing, diverticula formation may be reduced or even stopped.

Fiber and Cholesterol

As noted above, fiber generally is divided into two categories.  Insoluble fiber is found in wheat bran and in celluloses from vegetables and fruits.  Soluble fiber is commonly found in oatmeal, oat bran (the best source), guar gum, psyllium seed, fruit pectin and gum arabic.  When mixed with water, it produces a gelatinuous mucous gel.  It, too, has bowel-regulating effects.  It also acts to lower blood cholesterol by binding with the cholesterol in the intestine and carrying it away in the stool.  So, a high fiber diet should contain both types of fiber.

Fiber and Cancer

Recent evidence seems to indicate that fiber, by itself, even up to 25 grams a day, does not reduce the risk of colon or other cancers.  However, many high fiber foods are also very rich in chemicals called antioxidants.  These substances attack other chemicals known as free radicals.  Free radicals occur in the body as a natural byproduct of metabolism.  Yet, they can damage surrounding cells and seem to be related to increased risk of heart disease, macular degeneration (eye problems), and some cancers such as prostate cancer.  Hundreds of very potent antioxidants occur in many fruits and vegetables which are also high in fiber.  Nature seems to have naturally put these two substances together.  Five portions of fruits and/or vegetables are recommended each day.  Select those that are rich in color such as dark green, yellow, red, or orange.

Fiber and Whatever

What else may high fiber help? In many instances, the medical evidence is soft or fragmentary.  Yet the preponderance of evidence is so overwhelming that high fiber foods can be recommended for just about everyone.  Other diseases that are or may be benefited by high fiber foods are:

• Diabetes

• Bowel irregularity

• Constipation or diarrhea

• Macular degeneration

• Hiatus hernia

High Fiber Foods

High fiber foods can be found in most food groups.  Different types of food should be selected to get the benefits of them all.

1. Legumes—Including kidney, pinto, navy, lima and baked beans.  The bean family excels in fiber, especially the soluble, cholesterol-lowering type.

2. Whole Grains—Wheat bran and oat bran are present in a variety of cereals and breads.  The label should say that the bread contains whole wheat or whole grain.  Plain wheat bread may lack the fiber.  One cannot always tell by the color.  Some manufacturers artificially color bread brown to make it look more wholesome.

3. Whole Fresh Fruits—The valuable pectin fiber is found in the skin and pulp.  Figs, prunes and raspberries have the highest fiber content.

4. Cooked or Stewed Fruits—Prunes and applesauce are good choices.

5. Green Leafy Vegetables—Lettuce, spinach, celery, and broccoli are good examples.

6. Root Vegetables—Potatoes, turnips and carrots are all excellent sources.

Since bran can cause rumbling intestinal gas and even some mild cramping, it should be started in small amounts initially.  The amount can be increased as tolerance is acquired.  The goal should be 20 to 35 grams of fiber a day, which will usually produce 1 to 2 soft, formed stools a day.

The following are good general rules:

1.  Drink plenty of liquids, including fruit or vegetable juices and water.

2. Eat slowly and chew food thoroughly to allow the upper digestive tract (esophagus, stomach and small intestine) to work well.  This may help prevent problems from developing in the lower digestive tract.

3. Eat meals at regular intervals.  

A Dietary Fiber Supplement May Be Helpful

Some people have trouble tolerating too many high fiber foods in the diet.  Stool softening and bulking agents are available over the counter.  These products are usually plant fiber that absorbs water and produces the bulk necessary for the digestive tract to perform naturally.  Psyllium fiber is found in many commercial products such as Metamucil, Per Diem and Konsyl.  The regular product contains a fair amount of sugar, so it may be preferable to use the sugar-free products.  Most pharmacies carry a generic brand at significant cost savings.  Citrucel (hemicellulose) is another bulking agents that can be used.  These fiber supplements, in conjunction with foods, offer an easy way to reach the fiber goal of 20 to 35 grams per day.

Fiber Content of Foods

Goal — 20 to 35 grams per day

Common servings of foods containing dietary fiber are shown below.  A variety of foods should be chosen every day.  Foods that are good sources of fiber are typically low in fat and calories.

Serving Size

Grams of Dietary Fiber

BREADS

1 medium	bran muffin	3
1 slice	whole wheat bread	2
1 slice	white bread	1
1 slice	pumpernickel bread	1
1 slice	Rye bread	1
1 slice	raisin bread	<1
4 squares	saltines	0

 

CEREALS AND PASTA

1 ounce	Kellogg’s All-Bran Extra Fiber	14
1 ounce	General Mills Fiber One	12
1 ounce	Kellogg’s All-Bran	9
1 cup	whole wheat pasta	5
1 ounce	Kellogg’s Bran Flakes	4
1 ounce	Post Fruit and Fiber	4
1.4 ounces	Kellogg’s Raisin Bran	4
1 ounce	Nabisco Shredded Wheat’n Bran	4
1 ounce	oatbran	4
1 ounce	General Mills Raisin Nut Bran	3
1 ounce	General Mills Cheerios	2
1 ounce	Post Grape-Nuts	2
1 ounce	oatmeal	2
1 cup	popcorn	2
1 ounce	General Mills Total	2
1 ounce	General Mills Wheaties	2
1 cup	pasta	<1
1 ounce	Kellogg’s Corn Flakes	<1
½ cup	cooked brown rice	<1
½ cup	cooked white rice	<1
½ cup	egg noodles	0

 

LEGUMES

½ 4 cup	kidney beans	9
½ cup	baked beans	7
½ cup	navy beans	5
½ cup	pinto beans	5
½ cup	lentils	2

 

VEGETABLES

½ cup	cooked frozen peas	4
1 medium	baked potato (with skin)	4
½ cup	cooked broccoli tops	3
½ cup	cooked young carrots	3
½ cup	cooked corn	3
½ medium	fresh avocado	2
½ cup	cooked green beans	2
½ cup	Brussels sprouts	2
½ cup	cooked eggplant	2
½ medium	cooked sweet potato	2
½ cup	raw cabbage	2
½ cup	raw bean sprouts	1
½ cup	raw lettuce	1
½ cup	sliced raw mushrooms	1
1 medium	dill pickle	1
½ cup	mashed potatoes	1
10 medium	French fried potatoes	1
½	fresh tomato	1
1 stalk	raw celery	<1
6 slices	raw cucumber	<1
2 rings	green pepper	<1
½ cup	raw onion	<1

 

FRUITS and NUTS

3.5 ounces	dried figs	18
3.5 ounces	prunes	8
3.5 ounces	raspberries	7
¼ cup	almonds	5
1 medium	apple (with skin)	3
1 medium	banana	3
½ cup	blackberries	3
5	dried dates	3
1 medium	nectarine	3
1 medium	peach (with skin)	3
¼ cup	roasted peanuts	3
1 cup	strawberries	3
1	pear (with skin)	2
¼ cup	cantaloupe	2
10 medium	olives	2
1 medium	orange	2
2 tablespoons	smooth peanut butter	2
1 medium	tangerine	2
¼ cup	walnut pieces	2
1 medium	apricot	1
10 large	cherries	1
½ medium	grapefruit	1
½ cup	pineapple	1
2 tablespoons	raisins	1
2 medium	plums	<1
½ cup	orange juice	0

 

Note: the information in this section is provided as a supplement to information discussed with your healthcare provider.  It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.

 

PURPOSE

Fat is a source of energy for the body.  However it is not the body’s primary source of energy and too much fat in the diet can be harmful.  It is especially bad for the circulatory system because it raises blood cholesterol levels that can contribute to heart attack or stroke.  This diet is designed to reduce total fat, saturated fat and cholesterol to levels recommended by the National Cholesterol Education Program (NCEP), NCEP is made up of 40 private and governmental groups coordinated by the National Heart, Lung, and Blood Institute, For people at high risk or who have known cardiovascular disease, the Therapeutic Lifestyles Changes (TLC) diet has been adopted by the NCEP.  The TLC diet has the following goals:

• decrease total dietary fat, especially saturated fat and so-called trans fat

• decrease dietary cholesterol

• increase intake of soluble fiber

• adjust total calorie intake to maintain desirable body weight/prevent weight gain

• include enough moderate exercise to expend a minimum of 200 calories per day

• Decrease calories if needed to reach a healthy body weight

This diet is especially targeted to individuals with elevated [DL cholesterol, which is the bad form of cholesterol.

NUTRITION FACTS

This diet is designed to meet the National Research Council’s Recommended Dietary Allowances (RDA).  For those who require weight reduction, the RDA can be met on a daily calorie level of 1200 for women and 1500 for men.  However, if the patient requires a lower daily calorie intake, the physician may prescribe a multiple vitamin supplement.

CHOLESTEROL

The heart pumps blood through blood vessels called arteries and veins.  This blood carries vital oxygen and nutrients needed by tissues and organs throughout the body.  The heart itself is supplied with blood vessels called coronary arteries.  When cholesterol levels rise above normal limits and stay high, some cholesterol is left behind in the arteries.  Over the years, a hardened, waxy substance called cholesterol plaque builds up on the artery walls, and reduces or blocks blood flow.  Organs supplied by these arteries then become damaged because they cannot get the oxygen and nutrients they need.  For example, when blood flow to the brain is blocked, a stroke occurs.  When plaque completely blocks a coronary artery, a heart attack takes place.

Cholesterol in the body comes from two sources.  Most cholesterol is made by the liver from various nutrients and especially from saturated fats.  The liver makes just about all the cholesterol the body will ever need.  Since all animals can make their own cholesterol, some cholesterol in the human body comes directly from eating animal products.  These foods include meats, egg yolks, organ meats, whole milk and milk products.  This cholesterol is absorbed through the intestines and added to what the liver makes.  It is also known that a diet high in saturated fat seems to increase cholesterol production in the body.  Therefore, reducing dietary cholesterol and fats helps to keep blood cholesterol levels within a healthy range.

FATS IN THE DIET

Dietary fats can be saturated or unsaturated.  An easy way to remember the difference is that saturated fats solidify or remain solid at room temperature.  Unsaturated fats do not; they are liquid at room temperature.  Trans-fats are naturally occurring liquid vegetable fats that have been “transformed” into solid, unhealthy fats.  To reduce blood cholesterol levels, it is especially important to limit saturated fats. Saturated fats are found mainly in animal products and dairy products made with whole milk.

Unsaturated fats (polyunsaturated and monounsaturated) are found in plants, and are less likely to raise blood cholesterol levels.  In fact, there is evidence that monounsaturated fats (olive, peanut, or canola oils) may even help to lower blood cholesterol.  There are a few vegetable fats such as coconut oil, palm oil, and cocoa buffer (found in chocolate) that act like saturated fats in the body, so they should be avoided.

The term hydrogenated or trans fat vegetables oils appears often on food labels.  Hydrogenation is a manufacturing process for making vegetable oils solid at room temperature. The end result is a food that now contains trans fatty acids.  These oils are frequently used in baked goods, snack foods, and margarine.  Remember that all fat in the diet must be reduced, but it is especially important to avoid saturated fats and trans fatty acids.  As of January 2006, manufacturers are being required to list the grams of trans fatty acids on the nutritional label.

SPECIAL CONSIDERATIONS

1. Limit sugar and alcohol.  They provide few nutrients but many calories.  Therefore, they contribute to high cholesterol by increasing body weight.  Any alcohol use should be discussed with the physician.

2. Certain habits, such as cigarette smoking and a sedentary life, can increase the risk of heart disease.  Cigarette smokers should quit.  Regular aerobic exercise (at least 20 to 30 minutes, 3 times a week) can lower cholesterol levels and help to prevent the build-up of cholesterol plaque.  It can also reduce stress that may cause high blood pressure, another heart disease risk.

3. Fish should be eaten often, at least 2 times or more per week.  Research indicates that certain deep-sea fish—mackerel, salmon, herring, albacore tuna, lake trout—contain an oil called Omega-3 faffy acid, This oil may help to lower blood cholesterol.

4. Avoid high sodium content in foods.  Some patients with high cholesterol also have high blood pressure.  Reducing sodium or salt can help to keep blood pressure within normal limits.  Sodium is an ingredient in many commercially processed foods.  Common medications such as antacids, laxatives, and cough remedies can contain large amounts of sodium.

Read product labels and use products with no more than 250 mg of sodium per serving.  Herbs and spices can be used in place of salt to add flavor and variety to meals.  Do not use a salt substitute unless the physician has approved it.

5. Increase complex carbohydrates, (pasta, whole grains, and potatoes) in the diet.  They are an excellent source of energy without the harmful effects fats can have on the body.  But, read labels of commercially prepared baked goods, cookies, and crackers.  These products are notorious for using highly saturated fats such as coconut or palm oils and trans fatty acids.

6. Eat 10 to 25 grams of soluble dietary fiber every day.  Foods such as legumes, oats, barley, brown rice, apples, strawberries, and carrots are good to eat because they contain soluble fiber.  Research indicates that soluble fiber helps to lower blood cholesterol levels.  Supplements such as psyllium mucilloid (trade names: Konsyl, Metamucil) can lower cholesterol up to 15% when used daily.  Oat bran is another soluble fiber that has the same benefit.

7. Choose meats carefully.  Grading of meats (Prime, Choice, or Good) refers to fat content, with Prime grades having the most fat.  Marbling refers to the threads of white fat running through a cut of meat—the greater the marbling, the more fat.  Read labels and avoid any meat product with more than 3 grams of fat per ounce.

8. Eating out can be a challenge.  Avoid fast food restaurants; their foods are usually high in fats and sodium. However, many restaurants now understand the need to provide items for clients on fat or cholesterol-restricted diets.  Their menus often contain words like “heart healthy” or have items marked with the symbol V.  Ask about ingredients and how foods are prepared.  Choose foods wisely and ask for smaller portions.

 

Note: the information in this section is provided as a supplement to information discussed with your healthcare provider.  It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.

 

PURPOSE

For a regular healthy diet, if is recommended that of the total calories eaten, no more than 30% should come from fat.  However, certain diseases and medical conditions can make it difficult for the body to tolerate even that much fat, so a low-fat diet may help people with these conditions.

Gallbladder Disease: Bile secreted from the gallbladder helps the body break down and absorb fats.  When gallstones or gallbladder diseases are present, a low-fat diet is often used to prevent complications.

Delayed stomach emptying (Gastroparesis) is a condition in which the stomach empties food into the intestine too slowly.  This can cause bloating, nausea, and even vomiting.  Normally, fat in foods delays stomach emptying, so fats make gastroparesis worse.

Diarrhea can be caused by many conditions.  When it occurs, it can be aggravated by eating fatty foods.

Malabsorption of nutrients: Absorption is the transfer of nutrients into the bloodstream from the intestine.  In some diseases of the pancreas and small intestine, patients have trouble absorbing nutrients from the diet, including tat.  A low-fat diet may help to control symptoms until the cause of malabsorption can be diagnosed.

Fatty Liver: For a number of reasons, fat may accumulate in the liver.  Fat is not normally stored in the liver, and in some cases this can cause damage to the liver.  A low fat diet and weight reduction may be helpful.

NUTRITION FACTS

This diet generally meets the Dietary Reference Intakes developed by the Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences.  In some cases, however, the physician may prescribe supplements.  Women of childbearing age and those people with malabsorption may need to take certain vitamin and/or mineral supplements.

SPECIAL CONSIDERATIONS

1. Be careful how foods are prepared.  Trim all visible fat from meats.  Bake, steam, or broil meats and fish instead of frying.  Toppings for potatoes and pastas should contain no fat above the three allowed daily servings.  

2. This low-fat diet should be used until the underlying medical condition is controlled or corrected.  The physician will give any individual instructions and tell you when you no longer need to use the low-fat diet.

 

Note: the information in this section is provided as a supplement to information discussed with your healthcare provider.  It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.

 

PURPOSE

Dietary fiber is the undigestible part of plants that maintains the structure of the plant. Dietary fiber includes cellulose, hemicellulose, polysaccharides, pectins, gums, mucilages, and lignins. Although they are chemically unrelated, they all resist digestion by the human body. It is this resistance that makes these fibers important in both the normal functioning and in disorders of the large intestine or colon.

In certain medical conditions, it is important to restrict fiber. These include acute or subacute diverticulitis, and the acute phases of certain inflammatory conditions of the bowel—ulcerative colitis or Crohn’s disease. After some types of intestinal surgery, a low fiber; low residue diet may be used as a transition to a regular diet. A low fiber diet may also be used for a period of time after a colostomy or ileostomy is performed.

NUTRITION FACTS

Depending upon individual food selection, the Low Fiber, Low Residue Diet is adequate in all nutrients (National Research Council’s Recommended Dietary Allowance). If the diet must be strict and followed over a long period of time, the intake of fruits and vegetables may not be adequate; and/or on a low residue diet, there may not be enough calcium included. In these cases, a multi-vitamin supplement or liquid nutritional supplement may be needed.

SPECIAL CONSIDERATIONS

If a low fiber or low residue diet results in abdominal cramps or discomfort, notify the dietitian or physician immediately.

 

Note: the information in this section is provided as a supplement to information discussed with your healthcare provider.  It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.

 

PURPOSE

Many people will choose vegetarian diets for personal, health, or religious reasons.  On a strict vegetarian or vegan diet, only vegetables, fruits, nuts, and grains are eaten.  The lactovegetarian diet adds milk and milk products to the vegan diet, and the ovo-lactovegetarian diet adds eggs and milk products.  People who avoid meat and vegetables in their diets are called fruitarians, eating only fresh or dried fruits and nuts, honey, and olive oil.  Finally, partial or semivegetarians may eat some animal foods, but not red meats.  It is recommended that people eat less fat and more fiber for a healthy diet, and vegetarian diets have less fat and more fiber than most regular diets.

NUTRITION

Proteins, calories, vitamins, and minerals are required in the correct amounts for growth and for good health.  These elements can be found in any vegetarian diet, but it is necessary to understand how they fit together to plan a healthy diet.

SPECIAL CONSIDERATIONS

1. Proteins are made up of many small amino acids.  Some amino acids are made by the body.  Others, called essential amino acids, must come from foods that are eaten.  The proteins found in milk, eggs, meat, fish, and cheese are the most complete sources of essential amino acids.  Proteins are also found in foods from plants, but no one plant food has all of the essential amino acids in the correct amounts.  To get all the essential amino acids the body needs for growth and good health, eat a variety of foods.  The body will make its own complete protein if enough variety and calories are eaten each day.  Whole grain cereals should be used in large amounts because they give calories for energy and are a good source of iron, riboflavin, and vitamin B complex.  Include several different selections of legumes, fruits, vegetables, nuts, and seeds throughout the day.

2. Calories: Eating enough whole grains and legumes throughout the day will give the body the calories it needs for energy.

3. Vitamins and minerals are important for a vegan diet.  If the lactovegetarian and the ovo-lactovegetarian diets are planned well, they will contain all the vitamins and minerals the body needs for good health.  Vitamins and minerals that may be lacking in the vegan diet are vitamin B-12, vitamin D, riboflavin, calcium, zinc, and iron.  Soybeans and soy bean milk and dark green leafy vegetables are good sources of calcium and iron, but spinach, chard, and beet greens should be eaten in smaller amounts because they contain oxalic acid.  Oxalic acid may interfere with the absorption of calcium.  Whole grains and cereals, legumes, dates, prunes and raisins are rich in iron.  If they are eaten with foods that have ascorbic acid or vitamin C in them, the iron will be absorbed better by the body.  Leavened breads, legumes, nuts and spinach contain zinc, and the body gets vitamin D when the skin is exposed to sunlight.  Eating fruit helps to satisfy the body’s need for vitamins and minerals.

Since vitamin B-12 is not found in plants, it is necessary for strict vegetarians to get it another way.  Commercially prepared foods and meat substitutes are sometimes fortified with vitamin B-12.  Check the special foods sections of the supermarket or health food store for these items.  The health care provider may prescribe a vitamin B-12 supplement.

4. Gender, age, disease, and certain health conditions may affect the amounts of proteins, vitamins, minerals, and calories needed by the body.  For example, women who are pregnant or nursing will have different needs.  The physician or registered dietitian should be asked for advice in these cases.

HELPFUL HINTS

Avocados are a good source of protein, but they are high in fats.  There are two varieties: the California avocado, and the Florida avocado.  The Florida avocado is larger, but contains half the calories and half the fat per ounce.

Dark green leafy vegetables are a more nutritious choice for salads.  Romaine lettuce, for example, has eight times as much beta-carotene and six times as much vitamin C as iceberg lettuce.

Eat vegetables both raw and cooked.  Some yield more nutrients when cooked.  Carrots, for example, have 30% more beta-carotene after cooking.  Vitamin C can be lost in cooking.  However, only 15% may be lost when these vegetables are cooked in a microwave, while up to half may be lost in boiling.

The soybean is a world-class protein.  In the orient it is often referred to as “the meat of the fields” It is available in a variety of products: tofu.  soy milk, soy oil, miso, and soy nut snacks.  It is also a tasty substitute in recipes calling for other dried beans.  One cup of cooked, dried soybeans yields 20 grams of protein.

 

Note: the information in this section is provided as a supplement to information discussed with your healthcare provider.  It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.