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Introduction to Gastrointestinal Diets

Gastrointestinal graft-versus-host disease (also known as GI GVHD) can cause nausea, vomiting, abdominal pain and diarrhea. Protein loss can be high, resulting in the need for a protein-rich diet.

If a patient has large amounts of diarrhea, the doctor may ask the patient not to eat or drink for several days to allow the gastrointestinal tract to rest. When eating is restarted, the patient may best tolerate a diet that is low in fat, low in lactose (milk sugar), low in insoluble fiber and low in acidic foods.

The Gastrointestinal Diet 1 and Gastrointestinal Diet 2

The Gastrointestinal Diet 1 (GI 1 diet) and Gastrointestinal Diet 2 (GI 2 diet) are designed to reduce GI discomfort (such as abdominal pain, nausea, vomiting and diarrhea) after eating. The diets are 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.

Starting the GI 1 or GI 2 Diet

The following are recommended as you start the GI diets:

  • 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.

Progressing on the GI 1 and GI 2 Diets

The GI 1 diet does not provide all of the nutrients a person needs to remain healthy. If it is to be followed for longer than one week, other nutrition support should be considered. The GI 1 diet should be used to reacquaint a patient with easily digested foods and to assess a patient's tolerance to these foods. The patient should start with the foods listed in the top table (“Foods to Try First”). Once the patient has tolerated the GI 1 beverages, cereals, starches and fruits for a few days, the foods in the second table (“If Tolerated, Try”) should be tried and tolerance of the items assessed. When the GI 1 diet has been tolerated without worsening GI symptoms, the patient may progress to the GI 2 diet.

The GI 2 diet offers a greater variety of foods. It can provide adequate nutrition and so may be continued for a long period of time.

Each person is different. What may be best for you may not be best for someone else. The rate of progressing from the GI 1 to the GI 2 diet and then to a general diet varies between people. The decision to advance the diets is based on each patient’s GI symptoms. You should work with a dietitian while progressing on the GI diets to help ensure that nutrients needs are being met. Your dietitian can give you additional guidelines based on your specific needs.

Gastrointestinal Diet 1

In this diet, all foods must be selected and prepared according to the Immunosuppressed Patient Diet.

Gastrointestinal Diet 2

This diet is designed to reduce gastrointestinal "GI" discomfort (abdominal pain, nausea, vomiting, diarrhea) after eating.