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See table 3-7 for a sample low sodium diet. Bland Diets This diet may be helpful for gastritis, hyper- acidity, 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” elimi- nates only those items that have been shown scientifically 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. Decaf- feinated 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 stimulates 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 3-17


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