See table 3-7 for a sample low sodium
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
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
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
The RegularNo 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 RegularNo 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