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Gastrointestinal Diet 2

This diet is designed to reduce gastrointestinal (GI) discomfort (abdominal pain, nausea, vomiting and diarrhea) after eating. The diet is based on the following guidelines:

  • Low fat: Fats are hard to digest and can increase diarrhea.
  • Low fiber: Certain fibers (insoluble fibers, such as in whole wheat products) can increase diarrhea or gas. However, the fibers allowed in the GI 2 diet (soluble fibers, such as apples and pears) help to form stools.
  • Low lactose: Dairy products contain a sugar called lactose that may be hard to digest during GI illness. Signs of poor digestion are bloating, gas, abdominal cramping and diarrhea. Lactose-free milk is available as a substitute for regular milk. Talk with your dietitian about use of oral lactase enzyme tablets with other dairy products.
  • Low acid and irritants: Foods that are high in acid or spicy can irritate the mouth, stomach or GI tract.

The following are recommended as you start the GI 2 diet:

  • Carbohydrate-rich and protein-rich foods are easier for your body to digest than high-fat foods. Limit fatty foods to three servings each day to start with.
  • Limit meal size. Smaller, more-frequent meals are easier to digest.
  • Try one new food at a time. Wait at least three hours before trying another new food.
  • If your GI symptoms (abdominal pain, nausea, vomiting or diarrhea) increase, do not eat the most recently introduced food again. Tell your dietitian, nurse or doctor about your symptoms.
  • If your GI symptoms (abdominal pain, nausea, vomiting or diarrhea) increase, do not eat the most recently introduced food again. Tell your dietitian, nurse or doctor about your symptoms.

Most importantly, each person is different. What may be best for you may not be best for someone else. Your dietitian can give you additional guidelines based on your specific needs.

Special Guidelines

New Foods
Try new foods in the morning or mid-day. Often, foods are easier to digest when you are sitting up and are not tired.

Citrus and Tomato Products
Some people develop heartburn or an upset stomach after eating or drinking acidic foods, such as orange juice, lemonade, lime juice, tomato sauce, catsup, salsa and tomato soup. Foods containing vinegar, such as salad dressing, mustard and tartar sauce, may also cause discomfort. If you want to try any of these foods, talk to your dietitian.

When you add these foods to your diet, start with small amounts, such as ¼ cup orange juice, juice diluted with an equal amount of water, or 2 teaspoons catsup. You can also try different recipes. For example, tomato soup made with lactose-free milk may be easier to digest than tomato soup made with water.

If the foods you try cause no discomfort, then you can try slightly larger amounts in the future.

Lactose
Some dairy foods have very small amounts of lactose. Your dietitian may suggest that you do not need to take lactase enzyme tablets with these items. Examples are:

  • Half-and-half (if using only 1 to 2 tablespoons)
  • Sour cream (if using only 1 to 2 tablespoons)
  • Butter
  • Margarine
  • Cream cheese
  • Certain cheeses: cheddar, mozzarella, Swiss, parmesan, provolone, brick and colby

Sorbitol
Sorbitol is a sugar that can cause diarrhea in some people. It occurs naturally in some juices. Sorbitol is sometimes used as a sweetener in candies and gums, especially sugar-free varieties.

Natural juices with sorbitol are apple juice, cherry juice, peach juice or nectar, and pear juice or nectar. If you choose a juice containing sorbitol, start with a small amount (1/4 cup). If it does not cause diarrhea, you can increase the portion size next time.

Examples of candies and gums which may contain sorbitol are BreathSavers sugar-free mints, no-sugar-added ice cream and sugar-free gum. Look for sorbitol in the ingredients list on the food label.

Gas (Flatulence)
Some foods and eating habits may cause uncomfortable gas. The following suggestions can help prevent gas:

  • Avoid carbonated beverages. (Flat soda is fine.)
  • Eat slowly.
  • Chew with your mouth closed.
  • Do not gulp food.
  • Do not drink with a straw.

Fat Substitutes
Avoid products with Olestra or Olean. These are fat substitutes found in some fat-free chips and crackers. They may cause flatulence and diarrhea.

Spices
Some people are sensitive to certain spices. The GI 2 diet excludes spices known to cause problems with digestion. Some people may have discomfort after eating other spices. You should avoid spices that seem to cause heartburn or upset stomach.

Food Labels
You can make better food selections by reading labels. Here are some things to watch for:

  • Serving sizes: What is one serving? Remember that the amount of fat, calories or protein listed on the label is based on the printed serving size.
     
  • Choose lunchmeats and cheeses with 5 grams of fat or less per serving. Choose crackers, chips or other snack foods with 2 grams of fat or less per serving. Be sure to limit your portion based on the serving size!
     
  • Look for milk, lactose, nonfat milk powder or other forms of milk or cheese in the ingredient list. Ask your dietitian if you should take lactase enzyme tablets with foods containing forms of milk or cheese.
     
  • Compare the amount of fat per serving in regular products with the amount in reduced-fat or low-fat versions. Some products differ by only 1 to 2 grams of fat per equal serving size. How much of the food will you eat at one time? If you plan to eat a larger amount of the food, it makes sense to choose the lower-fat product. If you will eat very little of the food (one serving or less), choose the product that you enjoy most.

Gastrointestinal Diet 2 and Daily Food Allowances

All foods must be selected and prepared according to the Diet for Immunosuppressed Patients. Some people may not tolerate all foods listed on this diet. It is important to work with a dietitian when advancing from the Gastrointestinal Diet 1 to the Gastrointestinal Diet 2.

Dairy and Supplements

Recommended foods (3 or more cups per day)

  • Lactose-free 2%, 1% or skim milk
  • Soy milk
  • Rice milk (Rice Dream)
  • Ensure, Ensure Plus
  • NuBasics
  • Pediasure
  • Boost, Boost Plus
  • Resource Fruit Beverage
  • Resource, Resource Plus
  • Scandishake, lactose-free, made with lactose-free low-fat milk
  • Other: ___________

Note: Chocolate flavored beverages are allowed.

Take with lactase enzyme tablet as needed (discuss with nutritionist):

  • Instant Breakfast, made with low-lactose milk
  • Buttermilk
  • Regular 2%, 1% or skim milk
  • Low-fat yogurt (6 to 8 ounces)
  • Low-fat cottage cheese (nonfat or 1%)
  • Low-fat cheeses (cheddar, monterey jack, Swiss) (1 ounce)
  • American cheese (1 ounce)
  • Cheddar cheese (1 ounce)
  • Jack cheese (1 ounce)
  • Mozzarella cheese, part skim (1 ounce)
  • Parmesan cheese, grated or canned (1 ounce)
  • Ricotta cheese, part skim (¼ cup)
  • Ricotta cheese, fat-free
  • String cheese (part-skim mozzarella) (1 ounce)
  • Swiss cheese (1 ounce)

Foods to avoid

  • Any milk or milk-based product not pre-treated or not taken with lactase enzyme

Meat or Meat Substitutes

Recommended foods (3 or more 3-ounce servings per day or suggested portion size)

  • Well-cooked, lean cuts of broiled, baked or roasted fish, meat, skinless poultry or ham
  • Crab and imitation crab
  • Canned, water-packed tuna or other seafood
  • Casseroles prepared with allowed foods
  • Eggs, well cooked
  • Cooked tofu (follow immunosuppressed diet guidelines)
  • Lean luncheon meats (such as turkey, chicken or ham)
  • Low-fat hot dogs
  • Turkey bacon

Foods to avoid

  • Luncheon meats (including Spam)
  • Hot dogs
  • Corned beef
  • Pepperoni
  • Pickled or cured meats or fish
  • Fried meats or fish
  • Beans and legumes

Fruits and Fruit Juices

Recommended foods (2 or more ½-cup servings per day) 

  • Juices: cranberry, cran-raspberry and nectars
  • Half-strength juices (mix equal parts water and juice): apple and grape
  • Fresh fruit (peeled): apricots, bananas, melons, peaches, pears, papayas, mangoes and nectarines
  • Baked and peeled: apples
  • Canned fruit (peeled): peaches, pears, plums and apricots
  • Other: applesauce (plain) and canned cranberry jelly or sauce
  • Other: ___________

Foods to avoid

  • Juices: citrus, prune, V-8, V-8 Splash, tomato and pineapple
  • All raw fruits except those specifically allowed
  • Canned or fresh: berries, figs, oranges, grapefruits, lemons, limes, grapes, pineapple, prunes, rhubarb and cherries
  • Dried fruit: raisins, Craisins, dates, apricots, pineapples, prunes and bananas

Vegetables

Recommended foods (2 or more ½-cup servings per day) 

  • Well-cooked, tender vegetables, as tolerated: asparagus tips, beets, carrots, green beans, lettuce, mushrooms, pumpkin, sweet potatoes and yams without skin, and winter squash
  • Skinless potatoes (baked, boiled, mashed, baked french cut, or baked hash browns)
  • Frozen potatoes: fat-free hash browns and low-fat fries (less than 4 grams of fat per 3-ounce serving)

Foods to avoid

  • Raw or undercooked vegetables
  • The following cooked vegetables artichokes, baked beans, bamboo shoots, bean dishes, bean sprouts, beet greens, broccoli, celery, brussel sprouts, cabbage, chives, corn, cucumbers, peas, eggplant, bell peppers, leeks, legumes, lentils, lima beans, mustard greens, parsley, rutabaga, sauerkraut, summer squash, tomatoes, turnips, spinach, collard greens, swiss chard and others not listed

Soups

Recommended foods (as desired)

  • Broth-based soups made with allowed meats and vegetables (*in moderation): beef broth, beef noodle, chicken broth, chicken noodle, chicken with rice, chicken vegetable*, scotch broth, turkey noodle, vegetable* or vegetable beef*
  • Ramen soups, without flavor packet
  • Homemade milk- and cream-based soups and chowders (made with low fat, lactose-free milk)

Foods to avoid

  • Highly seasoned soups
  • Soups with more than 2 grams of fiber per serving: bean with bacon, beef noodle with vegetables, chili, chunky varieties, green pea, Manhattan clam chowder, minestrone, onion, split pea and tomato
  • Tomato-based soups
  • Ready-to-eat cream soups

Bread and Cereal Products

Recommended foods (4 or more servings per day) 

  • Bagels, plain
  • Breads, enriched and refined: corn, white, sourdough and pita
  • Cereals with less than 2 grams of fiber per serving: Cheerios, Corn Chex, corn flakes, Cream of Rice, Cream of Wheat, Froot Loops, Kix, puffed rice, Rice Chex, Rice Krispies, Special K, Sugar Pops, Sugar Smacks, Trix, Cocoa Krispies, Captain Crunch, instant oatmeal, instant grits
  • Cornmeal
  • Cornstarch
  • Crackers: animal, graham, saltine and low-fat crackers
  • English muffins: white and sourdough
  • Macaroni, noodles, spaghetti and other refined pastas
  • Polenta
  • Pretzels
  • Rice cakes, plain
  • Rolls, white
  • Tortillas, corn or flour
  • White flour
  • White rice
  • Couscous
  • Zwieback
  • Low-fat, baked tortilla chips and baked potato chips

Take with lactase enzyme tablet as needed (discuss with nutritionist):

  • Pancakes, waffles: frozen, mix or home recipe using allowed ingredients

Foods to avoid

  • Whole-grain bagels, breads, English muffins or rolls (including cracked wheat, rye, whole wheat and pumpernickel)
  • Breads and cereals with raisins, nuts or seeds
  • Brown or wild rice
  • Bulgur
  • Cereals with more than 2 grams of fiber per serving: bran, cracked wheat, granola, Grapenuts, Nutri-Grain (all varieties), puffed wheat, Shredded Wheat, Wheaties, regular oatmeal
  • Whole-grain macaroni and noodles
  • Whole-wheat tortillas
  • Wheat germ
  • Crackers with more than 2 grams of fiber per serving

Note: Avoid products with Olestra or Olean.

Desserts

Recommended foods (as desired; read ingredient list) 

  • Cake (plain, without frosting)
  • Custard made with lactose-free milk
  • Jello
  • Homemade fruit cobbler made with allowed fruits
  • Pastries and pies made with allowed fillings (omit spices): apple, peach, pear, cherry (use commercial filling), pumpkin (use evaporated milk treated with lactase) and sweet potato
  • Popsicles
  • Pudding made with lactose-free milk
  • Plain cookies (such as vanilla wafers, graham crackers and gingersnaps)
  • Rice Krispie Treats
  • Angel food cake
  • Low-fat, non-dairy ice cream

Take with lactase enzyme tablet as needed (discuss with nutritionist):

  • Canned puddings
  • Sherbet (check labels for milk in package)
  • Sorbet (check labels for milk in package)
  • Low-fat hard-pack ice cream and frozen yogurt (less than 3 grams fat per serving)
  • Smoothies made with allowed ingredients

Foods to avoid

  • Cake with raisins, nuts, coconut or other foods and spices that are not allowed
  • Pastries and desserts with dried or candied fruit, coconut, nuts, raisins or seeds
  • High-fat cream-filled cakes and pastries
  • Premium high-fat ice creams
  • Sugar cookies, wafer cremes and other cookies not recommended

Beverages

Recommended foods (as desired) 

  • Non-cola caffeine-free (check labels) carbonated beverages
  • Chocolate milk or Strawberry Quik made with lactose-free milk
  • Fruit-ades: Hawaiian Punch, Hi-C and Tang
  • Gatorade and Powerade
  • Kool-aid
  • Tea, weak decaffeinated and herb teas, in moderation (except peppermint)

Take with lactase enzyme tablet as needed (discuss with nutritionist):

  • Cocoa

Foods to avoid

  • Alcoholic beverages
  • Coffee: regular or decaffeinated
  • Tea (including instant): regular tea, strong decaffeinated tea, peppermint tea
  • Carbonated beverages containing caffeine
  • Cola-type carbonated beverages

Fats

Recommended foods

Low-fat or non-fat choices

  • Low-calorie margarine
  • Fat-free mayonnaise
  • Fat-free non-dairy creamers
  • Low-fat gravies and sauces made with lactose-free milk or broth
  • Low-fat salad dressing
  • Other: _____________

Take with lactase enzyme tablet as needed (discuss with nutritionist):

  • Fat-free or light cream cheese
  • Fat-free sour cream
  • Low-fat whipped topping
  • Fat-free cheeses

Fats with limited portion size

  • Avocado (1/8 each)
  • Bacon, lean crisp (1 slice)
  • Butter (1 teaspoon)
  • Cooking oil (1 teaspoon)
  • Cool whip (1 tablespoon)
  • Margarine (1 teaspoon)
  • Mayonnaise (1 tablespoon)
  • Peanut butter, creamy (2 teaspoons)
  • Gravies and sauces made with lactose-free milk (¼ cup)

Take with lactase enzyme tablet as needed (discuss with nutritionist):

  • Cream cheese (1 tablespoon)
  • Sour cream (2 tablespoon)
  • Whipping cream (2 tablespoon)
  • Half-and-half (2 tablespoon)

Miscellaneous

Recommended foods

  • Gum drops, jelly beans, hard candy and gummi bears
  • For seasoning: basil, bay leaf, oregano, rosemary, thyme and cinnamon
  • Honey
  • Jelly
  • Marshmallows
  • Fruit Roll-ups
  • Ripe olives (moderate)
  • Salt
  • Sugar (any type)
  • Soy sauce
  • Syrups
  • Vinegar

Foods to avoid

  • Fried snack foods, such as corn chips, Doritos, potato chips and Cheetos
  • Jams with seeds or skin
  • Nuts, seeds, dried fruit and coconut: alone or in any food product
  • Pickles
  • Popcorn
  • Spices: cayenne, chili powder, garlic (fresh, powder or salt), mustard, onion powder or onion salt, paprika and pepper
  • Condiments: catsup, chili sauce, horseradish, jalapeno peppers, prepared mustard, steak sauce, relish and BBQ sauce
  • Salsa
  • Tabasco