Gastrointestinal Diet 2

Gastrointestinal Diet 2 Guidelines

 

This diet is designed to reduce gastrointestinal "GI" discomfort (abdominal pain, nausea, vomiting, 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 can increase diarrhea or gas (for example, insoluble fibers such as whole wheat products); however, the fibers allowed in the GI 2 diet (soluble fibers such as apples, 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 and protein-rich foods are easier for your body to digest than high fat foods. Limit fatty foods to 3 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 a new food.

If your GI symptoms increase (diarrhea, nausea, vomiting, or abdominal pain), do not reorder the most recently introduced food. 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 ¼cup 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 1-2 tablespoons)
• Sour cream (if using only 1-2 level tablespoons)
• Butter
• Margarine
• Cream cheese
• Specific cheeses: cheddar, mozzarella, Swiss, parmesan, provolone, brick, 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; 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: BreathSavers® Sugar-free mints; "no sugar added" ice cream; 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®, 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 specific 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 or less grams of fat per serving. Choose crackers, chips or other snack foods with 2 or less grams of fat 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 of regular products with fat-reduced or low-fat versions. Some products differ by only 1 to 2 grams 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 (1 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 Immunosuppressed Patient Diet. Some people may not tolerate all foods listed on this diet. It is important to work with a dietitian when advancing from the Gastrointestinal 1 to the Gastrointestinal 2 diet.

 

Dairy and Supplements
Foods Recommended: (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 lowfat 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
• Lowfat yogurt (6 to 8 ounces)
• Low fat cottage cheese (non-fat 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 (1/4 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 Foods Recommended: (3 or more 3 oz servings per day or suggested portion size)

• Well-cooked, lean cuts of broiled, baked, or roasted: fish, meat, skinless poultry, ham
  
• Crab and imitation crab
• Canned, water-packed tuna and seafood
• Casseroles prepared with allowed foods
• Eggs, well-cooked
• Cooked tofu (follow Immunosuppressed Diet guidelines)
• Lean luncheon meats (such as turkey, chicken, 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 legume

Fruits and Fruit Juices
Recommended Foods: (2 or more ½ cup servings per day)

• Juices: cranberry, cran-raspberry, nectars
• ½ strength juices: apple, grape (mix equal parts of water and juice)
• Fresh fruit (peeled): apricots, bananas, melon, peaches, pears, papaya, mango, and nectarine
• 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, pineapple
• All raw fruits except those specifically allowed
• Canned or fresh: Berries, figs, oranges, grapefruit, lemons, limes, grapes, pineapple, prunes, rhubarb, cherries
• Dried Fruit: Raisins, Craisins®, dates, apricots, pineapple, prunes, 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, winter squash
• Skinless potatoes (baked, boiled, mashed, baked french cut, baked hash brown)
• Frozen potatoes: Fat-free hash browns, low fat fries (less than 4 grams fat per 3 ounces)

Foods to Avoid:

Raw or undercooked vegetables; also 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, rutabagas, 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, 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, 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, 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
• Lowfat, baked tortilla chips 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 (cracked wheat, rye, whole wheat, pumpernickel)
• Breads and cereals with raisins and 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®, 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 pie made with allowed fillings (omit spices): apple, peach, pear, cherry (use commercial filling), pumpkin (use evaporated milk treated with lactase), sweet potato
• Popsicles
• Puddings, made with lactose-free milk
• Plain cookies (such as vanilla wafers, graham crackers, 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, other omitted foods and spices
• Pastries and desserts with dried or candied fruit, coconut, nuts, raisins, 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 carbonated beverages (Check labels on carbonated beverages and choose sodas without caffeine)
• Chocolate milk or Strawberry Quik® made with lactose-free milk
• Fruit-ades: Hawaiian Punch®, Hi-C®, Tang®
• Gatorade®, 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 and strong decaffeinated
• Carbonated beverages containing caffeine
• Cola type carbonated beverages
• Peppermint tea

Fats:
Recommended Foods
Low-Fat or Non-fat Choices - No Restriction on Portion Size:

• 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 tsp)
• Cooking oil (1 tsp)
• Cool whip® (1 Tbsp)
• Margarine (1 tsp)
• Mayonnaise (1 Tbsp)
• Peanut butter (creamy) (2 tsp)
• Gravies and sauces made with lactose-free milk (¼ c)

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

• Cream cheese (1 Tbsp)
• Sour cream (2 Tbsp)
• Whipping cream (2 Tbsp)
• Half and Half (2 Tbsp)

Miscellaneous:
Recommended Foods:

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

Foods to Avoid:

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