personnel knowledgeable in proper eating habits. Thedietitian conducts patient interviews to learn thepatient’s eating behaviors, usual portions, preparationof foods, meal patterns, nutritional adequacy, exercise,and so forth. Individual programs should then berecommended to assist patients to attain and maintaintheir ideal weight.The Handbook of Clinical Dietetics, published bythe American Dietetic Association, lists the followingformula for determining ideal body weight. Forfemales, the basic weight for 5 feet is 100 pounds. Add5 pounds for every inch over 5 feet. For males, thebasic weight for 5 feet is 106 pounds, with 6 poundsadded for every inch over 5 feet. Adjustments must bemade for body build. Reduce desired weight by 10percent for a small frame; increase it by 10 percent for alarge frame. Total caloric requirements are based onideal body weight plus activity.Many patients on low-calorie diets experiencehunger. To satisfy this hunger or appetite, low-caloriefoods such as raw vegetables, broth, black coffee ortea, and other unsweetened or diet beverages should beprovided. Water and sodium need not be restrictedunless there are cardiac complications or edema, andthe restrictions are ordered by the physician.LOW-PROTEIN DIET.—As the name implies,the low-protein diet is made up of foods that furnishonly small amounts of protein and consist largely ofcarbohydrates and fats (e.g., foods such asmarshmallows, hard candy, and butter). This diet isused in renal diseases associated with nitrogenretention or liver disorders. Limited amounts ofprotein are sometimes advocated in certain kidneydiseases (such as chronic nephrotic edema).Low-protein diets for renal failure are usuallyrestricted in sodium and potassium, because these twoelements are not excreted properly during thiscondition. In some cases of chronic renalinsufficiency, the protein content of the diet is varied,usually between 40 and 60 g per day, so that there willbe sufficient complete protein to maintain nitrogenequilibrium.In some metabolic disturbances, such as aminoacids in the urine, protein restriction may be oftherapeutic value.HIGH-RESIDUE DIET.—The high-residue(high-bulk, high-fiber, high-roughage) diet isindicated in atonic constipation, spastic colon, irritablebowel syndrome, and diverticulosis. This dietencourages regular elimination by stimulating muscletone, creating softer and larger stools that are moreeasily propelled through the colon, thereby reducingthe pain and cramping that accompany spastic colon orirritable bowel syndrome.The patient is given a regular diet, with theinclusion of high-residue foods. The main sources offiber are whole-grain breads and cereals, bran cereals,fresh fruits, and vegetables that are raw or cooked untiltender. Whole grain breads and cereals that containwheat bran have a greater laxative effect than fruits andvegetables, because the bran acts to absorb waterwithin the colon, creating a bulk effect. Fiber intakeshould be increased gradually to minimize potentialside effects of bloating, cramps, and diarrhea. At leastone serving of 100 percent wheat bran cereal isrecommended daily. Cereals such as raisin bran, BranFlakes®, Shredded Wheat®, and oatmeal may be usedoccasionally, but they contain less than half the amountof fiber found in All-Bran® or Bran Buds®. Freshfruits and vegetables with edible skins, such as applesand grapes, are higher in fiber content than cannedfruits or vegetables and their juices.Dietary intake of refined sugars and starchesshould be decreased because they are poor sources offiber. Also, limit white flour products, refined cereals,pies, cakes, and cookies.Too little fluid in the high-residue diet may causedehydration and lead to constipation. The patient mustdrink at least eight 8-ounce glasses of water or otherfluids daily, particularly when consuming therecommended amount of bran. Drinking too muchalcohol, beverages containing caffeine (such as coffee,cola, tea, and soft drinks), however, can irritate asensitive colon and can cause dehydration. Whenpossible, use decaffeinated coffee. One or two glassesof water in the morning help to stimulate peristalsis.Excessive intake of foods like dried beans, fruits withseeds and skins, nuts, popcorn, and strong spices maycause irritability, especially during the inflammationperiod of colon disease states. These foods should beindividualized to the patient.When one is progressing from a low-residue dietafter an acute infection or diverticulitis, increase fiberin the diet gradually. Start by adding one serving of100 percent bran cereal and three servings ofwhole-grain bread to the low-residue menu pattern.Gradually increase the amount of raw vegetables andfresh fruits to at least four servings per day.LOW-RESIDUE DIET.—The low-residue diet isindicated in ulceration, inflammation, and other9-9
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