Editing Nutrition (section)

== Therapeutic Diets ==

=== Consistency and Texture Modifications ===

* '''Clear liquid:''' anything transparent and liquid at body temperature, such as broth, clear juice without pulp, gelatin, tea, black coffee, and popsicles. Not nutritionally adequate beyond a few days. Used pre-procedure and immediately post-op. Note that red or purple items are often avoided before colonoscopy because they mimic blood.
* '''Full liquid:''' adds milk, cream soups, ice cream, pudding, and all juices. Bridges clear liquid to soft.
* '''Mechanical soft and pureed:''' for chewing difficulty, poor dentition, or dysphagia. Texture is modified but the diet is otherwise unrestricted.
* '''Dysphagia diets and thickened liquids:''' thin liquids aspirate most easily. Liquids are thickened to nectar, honey, or pudding consistency per the speech language pathologist's recommendation. Position upright at 90 degrees, use a chin-tuck if instructed, avoid straws unless specifically ordered, allow adequate time, and check for pocketing in the cheeks after each bite. Keep the patient upright for at least 30 to 60 minutes after eating.

=== Cardiac and Hypertension Diets ===

* Sodium restriction is commonly 2 to 3 g/day for heart failure and hypertension. The largest source of dietary sodium is processed and restaurant food, not the salt shaker.
* The '''DASH''' pattern emphasizes fruits, vegetables, whole grains, low-fat dairy, poultry, fish, and nuts, and limits red meat, sweets, and sugar-sweetened beverages.
* Limit saturated fat to under 6 percent of calories, eliminate trans fat, and increase soluble fiber and omega-3 fatty acids.

'''Nursing application:''' Teach patients to read the Nutrition Facts label for sodium per serving and to check serving size. "Reduced sodium" only means 25 percent less than the original, which may still be a high-sodium food. Canned vegetables can be drained and rinsed to remove a meaningful fraction of the sodium.

=== Renal Diet ===

{| class="wikitable"
! Nutrient !! Chronic kidney disease, not on dialysis !! On hemodialysis
|-
| Protein || Restricted, roughly 0.6 to 0.8 g/kg/day || '''Increased''', roughly 1.2 g/kg/day
|-
| Sodium || Restricted, commonly 2 g/day || Restricted
|-
| Potassium || Restricted as serum level rises || Usually restricted
|-
| Phosphorus || Restricted; phosphate binders taken '''with meals''' || Restricted; binders with meals
|-
| Fluid || Usually not restricted early || Restricted, often 1000 mL/day plus urine output
|}

High-potassium foods to limit include bananas, oranges and orange juice, potatoes, tomatoes and tomato products, avocado, spinach, dried fruit, melons, and salt substitutes. Lower-potassium alternatives include apples, berries, grapes, cranberry juice, cabbage, green beans, and cauliflower. Potatoes can be leached by peeling, dicing, and soaking or double-boiling.

High-phosphorus foods to limit include dairy, nuts, seeds, legumes, whole grains, chocolate, organ meats, dark cola beverages, and processed foods with phosphate additives.

'''Nursing application:''' Phosphate binders such as calcium acetate and sevelamer must be taken '''with''' food to bind dietary phosphorus in the gut. Taken between meals, they do nothing.

=== Diabetic Diet ===

* The modern standard is '''consistent carbohydrate''' intake distributed across meals rather than a rigid "no sugar" diet. Total carbohydrate matters more than the type.
* Carbohydrate counting typically uses 15 g of carbohydrate per exchange.
* Emphasize whole grains, legumes, non-starchy vegetables, and lean protein. Limit sugar-sweetened beverages, which raise glucose fastest.
* Alcohol taken without food can cause '''delayed hypoglycemia''' because it suppresses hepatic gluconeogenesis. Patients on insulin or sulfonylureas should eat carbohydrate with alcohol.
* Treat hypoglycemia in a conscious patient with the '''rule of 15''': 15 g of fast-acting carbohydrate (4 ounces of juice or regular soda, glucose tablets, or 1 tablespoon of honey), recheck in 15 minutes, and repeat if still below 70 mg/dL. Follow with a protein and carbohydrate snack if the next meal is more than an hour away.

'''Nursing application:''' Sick-day rules matter. Patients must continue insulin during illness even if eating poorly, monitor glucose more often, check ketones, and take carbohydrate-containing liquids.

=== Gastrointestinal Diets ===

* '''Low-residue or low-fiber:''' for acute diverticulitis, active inflammatory bowel disease flares, bowel prep, and early post-operative bowel recovery. Avoid whole grains, raw fruits and vegetables, nuts, seeds, and legumes.
* '''High-fiber:''' for diverticul'''osis''' (prevention), constipation, and irritable bowel syndrome with constipation. Do not confuse this with diverticul'''itis''', which requires low fiber during the acute flare and a return to high fiber after resolution.
* '''Gluten-free (celiac disease):''' strictly eliminate wheat, rye, and barley. Safe grains include rice, corn, quinoa, buckwheat, millet, amaranth, and certified gluten-free oats. Cross-contamination from shared toasters, fryers, and cutting boards is a real cause of ongoing symptoms.
* '''Lactose-restricted:''' lactose-free milk, hard aged cheeses, and yogurt with live cultures are often tolerated. Ensure alternative calcium and vitamin D sources.
* '''GERD:''' small frequent meals, avoid eating within 3 hours of lying down, elevate the head of the bed, and limit caffeine, chocolate, peppermint, alcohol, fatty or fried food, citrus, tomato, and carbonated beverages. Weight loss and smoking cessation help most.
* '''Dumping syndrome''' (after gastrectomy or bariatric surgery): small frequent meals, high protein, moderate fat, '''low simple carbohydrate''', fluids taken between meals rather than with meals, and lying down or reclining for 20 to 30 minutes after eating.
* '''Hepatic disease:''' restrict sodium and often fluid when ascites is present. Provide adequate protein and calories; blanket protein restriction in cirrhosis is no longer standard and worsens muscle wasting. Small frequent meals with a late evening snack reduce catabolism.
* '''Pancreatitis:''' nothing by mouth during severe acute episodes, then advance to a low-fat diet. Alcohol is eliminated. Pancreatic enzyme replacement is taken with meals and snacks in chronic pancreatitis.
* '''Gout:''' limit high-purine foods such as organ meats, anchovies, sardines, shellfish, red meat, and beer. Encourage generous fluid intake.

=== Other Modified Diets ===

* '''Neutropenic or low-microbial diet:''' avoid raw or undercooked meat, fish, and eggs, unpasteurized dairy and juice, and often raw fruits and vegetables that cannot be peeled. Practices vary by institution.
* '''Bland diet:''' avoids highly seasoned, fried, and gas-forming foods.
* '''Ketogenic diet:''' high fat, adequate protein, very low carbohydrate; used for refractory pediatric epilepsy. Monitor for constipation, kidney stones, growth impairment, and hyperlipidemia.