1–4 cups
1–2.5 cups
Those with skins or seeds will contain more fiber.
3–10 ounce-equivalents
More than half of all grains eaten should be whole grains for extra fiber
2–3 cups
2–7 ounce-equivalents
Use sparingly
Table 10.2 Suggested Menu Plan for High Fiber Diet
| Breakfast |
| 1 small orange 1 egg ½ c. oatmeal with up to 1 Tbsp ground flaxseed 1 slice whole wheat toast 1 tsp. jelly 1 tsp. soft margarine 1 c. fat-free milk Hot beverage Sugar, pepper (optional) |
| Lunch |
| 2 oz. roasted chicken breast 3 oz. baked potato with skin ½ c. mixed vegetables with corn and peas 1 oz. whole wheat roll 2 tsp. soft margarine 1 c. fat-free milk Water |
| Supper |
| 2 oz. tuna on 2 slices whole wheat bread with 2 tsp mayonnaise 2 tomato slices 1 c. leafy greens salad 1 Tbsp. salad dressing ½ c. fruit cocktail 1 c. fat-free milk Water |
| Snack Ideas |
| 1 c. cantaloupe ½ c. carrot sticks 3 c. popcorn |
LOW FIBER DIET
Use
The Low Fiber Diet is designed for use in patients receiving radiation therapy on or near the intestine; in partial bowel obstruction; in periods of disease flares or intestinal strictures in inflammatory bowel disease (Crohn’s disease or ulcerative colitis); and diverticulitis. Long-term use of this diet is discouraged because it may contribute to constipation and diverticular disease. (1,5,6,7)
Adequacy
The suggested food plan provides foods in amounts that will provide the DRIs recommended by the National Academy of Sciences for adults.
Diet Principles
The diet includes foods that will reduce frequency and volume of stools. It is smooth in texture and is mechanically and chemically nonirritating.
Food tolerances vary greatly and patients should be encouraged to eat the most liberal diet possible and include adequate fluids.† (7)
Table 10.3 Low Fiber Diet
| Food for the Day | ||
| Recommended | Avoid | |
| Vegetables 1–cups | All vegetable juices, most well cooked or canned without seeds; mashed potatoes without skins | All raw vegetables; lettuces that have been cooked |
| Fruits 1–2.5 cups | Ripe bananas, most well cooked or canned fruits; pulp free juice | Prune juice; any juice with pulp; most fresh fruits, berries, and other fruit with seeds; dried fruit, fruit skins |
| Grains 3–10 ounce-equivalents | Enriched white bread without seeds; cornbread, biscuits, muffins, pancakes, waffles, plain sweet roll; graham crackers made with refined flours, saltines; enriched, cooked refined cereals, such as farina, grits, cornmeal; dry cereals such as puffed rice, rice flakes, cornflakes or others that are low in fiber; white pasta; white rice | Bread, crackers, or cereals containing whole grains, bran, dried fruits, nuts, or seeds; brown or wild rice |
| Dairy Products 2–3 cups | All milk and milk drinks; yogurt. If an individual does not tolerate milk to drink, choose lactose free substitutes such as soy, rice, or almond milk; mild cheese, cottage cheese | Yogurt, if flavored with fruit containing small seeds; choose lactose free milk substitutes if lactose intolerant |
| Protein Foods 2–7 ounce equivalents | Ground or well-cooked meat, poultry, or fish; eggs; smooth nut butters, if tolerated; tofu | Legumes (dried beans and peas), chunky nut butters; tough meats, soybeans |
| Oils, Solid Fats Use sparingly | Vegetable oils, fortified margarine, butter, cream, mayonnaise, mildly seasoned salad dressings | None |
| Added Sugars Use sparingly | Pudding, custard, flavored or frozen yogurt with allowed fruits, gelatin, plain sherbet, fruit ice, popsicles; plain cake and cookies; pie made with allowed fruits; honey, syrups, hard candy, marshmallows; jelly | All desserts and candy containing coconut, nuts, seeds, or dried fruit; jams and preserves; aim to keep added sugars in diet to a minimum |
| Fluids | Water and other fluids, such as milk, coffee, tea, fruit or vegetable juice, carbonated beverages | Prune juice, any juice with pulp |
| Others | Salt, pepper, ketchup, mustard, spices and herbs, vinegar | Nuts and seeds, coconut, popcorn, pickles and relish with seeds |
Table 10.4 Suggested Menu Plan for Low Fiber Diet
| Breakfast |
| ½ c. grape juice 1 egg ½ c. puffed rice cereal 1 slice enriched white toast 1 tsp. jelly 1 tsp. soft margarine 1 c. fat-free Hot beverage Sugar, salt, pepper (optional) |
| Lunch |
| 2 oz. roasted chicken breast ½ c. mashed potatoes with gravy ½ c. mixed vegetables (no peas or corn) 1 oz. enriched white roll 1 tsp. soft margarine 1 c. fat-free milk Water |
| Supper |
| 2 oz. tuna on 2 slices enriched white bread with 2 tsp mayonnaise ½ c. tomato juice ½ c. green beans, canned ½ c. peaches 1 c. fat-free milk Water |
| Snack Ideas |
| ½ c. applesauce 6 oz. yogurt, smooth 8 animal crackers |
REFERENCES
1. Eiden K. Nutritional considerations in inflammatory bowel disease. Practical Gastroenterology. 2003;33–54.
2. Marcason W. What is the latest research regarding the avoidance of nuts, seeds, corn, and popcorn in diverticular disease? J Am Dietetic Assoc. 2008;108:1956.
3. Position of the American Dietetic Association. Health implications of dietary fiber. 2008. J Am Dietetic Assoc. 2008;108:1716–31.
4. Strate L, Liu M, Syngal M, et al. Nut, corn and popcorn consumption and the incidence of diverticular disease. JAMA. 2008;300:907–14.
5. Nutrition Care Manual: www.NutritionCareManual.org.
6. Evidence Analysis Library: www.adaevidencelibrary.com.
7. Crohn’s and Colitis Foundation of America: http://www.ccfa.org/.
ADDITIONAL RESOURCES
Korzenik J. Case closed? Diverticulitis: Epidemiology and fiber. J Clin Gastroenterol. 2006;40:S112–16.
National Digestive Diseases Information (NIDDC): http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/index.htm.
Study Guide Questions
A. List at least three diseases for which a High Fiber Diet may be useful.
B. The High Fiber Diet contributes ___–___ grams of dietary fiber.
C. Fiber should be added gradually to prevent what four short-term side effects?
D. What are the potential complications of inadequate fluid intake?
E. Long term use of a Low Fiber Diet is discouraged because it can contribute to ________ and ________.
F. Modify the General menu planned in Chapter 2 to include increased fiber foods.
G. Discussion question: What are dietary interventions that can be incorporated into the diet on a routine basis to reduce the use of bowel medications?
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