personnel knowledgeable in proper eating habits. The
dietitian conducts patient interviews to learn the
patients eating behaviors, usual portions, preparation
of foods, meal patterns, nutritional adequacy, exercise,
and so forth. Individual programs should then be
recommended to assist patients to attain and maintain
their ideal weight.
The Handbook of Clinical Dietetics, published by
the American Dietetic Association, lists the following
formula for determining ideal body weight.
females, the basic weight for 5 feet is 100 pounds. Add
5 pounds for every inch over 5 feet. For males, the
basic weight for 5 feet is 106 pounds, with 6 pounds
added for every inch over 5 feet. Adjustments must be
made for body build. Reduce desired weight by 10
percent for a small frame; increase it by 10 percent for a
large frame. Total caloric requirements are based on
ideal body weight plus activity.
Many patients on low-calorie diets experience
hunger. To satisfy this hunger or appetite, low-calorie
foods such as raw vegetables, broth, black coffee or
tea, and other unsweetened or diet beverages should be
provided. Water and sodium need not be restricted
unless there are cardiac complications or edema, and
the restrictions are ordered by the physician.
LOW-PROTEIN DIET.As the name implies,
the low-protein diet is made up of foods that furnish
only small amounts of protein and consist largely of
carbohydrates and fats (e.g., foods such as
marshmallows, hard candy, and butter). This diet is
used in renal diseases associated with nitrogen
retention or liver disorders.
Limited amounts of
protein are sometimes advocated in certain kidney
diseases (such as chronic nephrotic edema).
Low-protein diets for renal failure are usually
restricted in sodium and potassium, because these two
elements are not excreted properly during this
In some cases of chronic renal
insufficiency, the protein content of the diet is varied,
usually between 40 and 60 g per day, so that there will
be sufficient complete protein to maintain nitrogen
In some metabolic disturbances, such as amino
acids in the urine, protein restriction may be of
HIGH-RESIDUE DIET.The high-residue
(high-bulk, high-fiber, high-roughage) diet is
indicated in atonic constipation, spastic colon, irritable
bowel syndrome, and diverticulosis.
encourages regular elimination by stimulating muscle
tone, creating softer and larger stools that are more
easily propelled through the colon, thereby reducing
the pain and cramping that accompany spastic colon or
irritable bowel syndrome.
The patient is given a regular diet, with the
inclusion of high-residue foods. The main sources of
fiber are whole-grain breads and cereals, bran cereals,
fresh fruits, and vegetables that are raw or cooked until
tender. Whole grain breads and cereals that contain
wheat bran have a greater laxative effect than fruits and
vegetables, because the bran acts to absorb water
within the colon, creating a bulk effect. Fiber intake
should be increased gradually to minimize potential
side effects of bloating, cramps, and diarrhea. At least
one serving of 100 percent wheat bran cereal is
recommended daily. Cereals such as raisin bran, Bran
Flakes®, Shredded Wheat®, and oatmeal may be used
occasionally, but they contain less than half the amount
of fiber found in All-Bran® or Bran Buds®. Fresh
fruits and vegetables with edible skins, such as apples
and grapes, are higher in fiber content than canned
fruits or vegetables and their juices.
Dietary intake of refined sugars and starches
should be decreased because they are poor sources of
fiber. Also, limit white flour products, refined cereals,
pies, cakes, and cookies.
Too little fluid in the high-residue diet may cause
dehydration and lead to constipation. The patient must
drink at least eight 8-ounce glasses of water or other
fluids daily, particularly when consuming the
recommended amount of bran. Drinking too much
alcohol, beverages containing caffeine (such as coffee,
cola, tea, and soft drinks), however, can irritate a
sensitive colon and can cause dehydration. When
possible, use decaffeinated coffee. One or two glasses
of water in the morning help to stimulate peristalsis.
Excessive intake of foods like dried beans, fruits with
seeds and skins, nuts, popcorn, and strong spices may
cause irritability, especially during the inflammation
period of colon disease states. These foods should be
individualized to the patient.
When one is progressing from a low-residue diet
after an acute infection or diverticulitis, increase fiber
in the diet gradually. Start by adding one serving of
100 percent bran cereal and three servings of
whole-grain bread to the low-residue menu pattern.
Gradually increase the amount of raw vegetables and
fresh fruits to at least four servings per day.
LOW-RESIDUE DIET.The low-residue diet is
indicated in ulceration, inflammation, and other