Therapeutic Diet
Introduction
The diet of a normal person differs from that of the person suffering from different diseases
and physiological disorders.
A patient’s appetite may be affected by various conditions/causes such as anorexia, weakness,
illness, loneliness and other factors and they may undergo malnutrition if not provided proper
type and amount of diets.
Therefore, such diets/nutrition which are modified to meet the nutritional requirements of
patient’s suffering from different diseases are known as therapeutic diets/nutrition.
OR
Diet therapy means the use of diet (foods and drinks) not only in the care of the sick but also in
the prevention of disease and the maintenance of the health.
Definition
A therapeutic diet/modified diet may be regarded as an alteration on the normal diet to treat
the disease or illness.
OR
Diet therapy means the addition or subtraction of specific nutrients and foods in specified
amounts to or from a diet, or the modification of their consistencies. such diets are called
therapeutic diets and must always be prescribed by a physician.
OR
Diet therapy means modifying or changing the patient’s normal diet to meet requirements
created by disease or injury.
OR
Therapeutic Diet is a normal diet, qualitatively and quantitatively modified as per the Patient’s
special need in line with the general principles of meal planning.
The clinical dietician is responsible for planning therapeutic diets for patients as per the
doctor’s diet prescription.
Purposes
To maintain normal nutrition and health. Example: modified diets are based on
balanced diets.
To treat deficiency diseases. example: high protein, high calorie diet in protein calorie
malnutrition.
To maintain/achieve normal or optimal nutritional status when requirements are
increased (e.g. diarrhea, fever, surgery or trauma).
To adjust nutrient intake to a level that the body can properly metabolize e.g. diabetic
diet.
To correct nutritional deficiencies that may occur e.g. anemia.
To change body weight. e.g. low calorie diet in obesity to lose weight.
To provide rest for the body or for certain organs.e.g. a low protein diet for kidney
diseases.
To prevent or restrict certain types of problems such as edema, constipation of the
patients.
Needs/Importance
Therapeutic diet raises the therapeutic effect of particular foods for specific health
conditions.
It provides preventive care for the developing disease if one is suffering from some
disease, it helps to prevent the progression.
It improves wellbeing.
It helps to increase energy level.
It helps in enhancing immunity.
It helps in improving digestive system.
It helps in stress reduction leading to improved sleeping patterns.
It aids in hormonal balance.
It improves skin conditions by removing toxins from the body.
It brings overall improvement in body function.
Classification of Modified/Therapeutic Diet
The diet is normally altered/modified in the following ways:
1. Modification in consistency
2. Modification in nutrient content
3. Modification in quantity
Modified diet
Based on consistency based on nutrient content based on quantity
Clear liquid diet High protein diet Obesity
Full liquid diet Low protein diet Vomiting
Soft diet Sodium restricted Diet
Diarrhoea
Mechanical diet Low fat diet Diabetes
Light diet High fiber diet
Pureed diet Low residue/fiber diet
Bland diet
A. Modification in Consistency
1) Clear fluid diet
A diet comprising of clear liquids without even those containing in milk which provides
fluids and electrolytes and few calories.
This diet is free from any solids, even those found in milk. The clear fluid diet is
inadequate in all nutrients and should be only used for 1-2 days.
It is high in simple sugars and need to be modified for diabetic individuals.
The amount of fluid given initially is 40-80ml/hr, which is gradually increased to 100-
200ml/hr.
Indications:
It is used for short periods when there is acute vomiting or diarrhea, when minimal
bowel residue is desired, and to test the individual’s ability to tolerate oral food.
Its purpose is to prevent dehydration and relieve thirst.
Food includes:
Fruit juices: apple, orange, grape juices.
Cereal water: barley water, arrowroot water.
Soups: fat free broth
Beverages: sugarcane juice, tea, coffee, lime juice, coconut water etc.
2) Full liquid diet
A diet comprising of Liquids and solids which liquefies at room temperature and is
generally milk based.
The full liquid diet should provide minimum requirement of proteins, calories, vitamins
and minerals.
It is given after the clear liquid diets and before starting solid foods.
Indications:
It is prescribed for individuals who are unable to chew, swallow, or tolerate solid foods.
It is mainly prescribed during acute infections, gastritis, diarrhea when milk is permitted
after surgery.
Foods includes:
Everything on clear liquid diet + strained soups and cereals
Vegetable juices, yoghurt, icecream, puddings, etc.
3) Soft Diet
It is a diet between the full liquid diet and the normal diet/ the general hospital diet.
They are similar to regular diet but these requires little chewing and should be easy to
digest.
The foods included in this diet are soft in texture and consistency, easy to chew and
digest with very little fibers, spices, and condiments.
High fiber, fatty or highly spiced foods are avoided.
Foods in these diets are generally boiled, steamed, poached, or stewed and mildly
seasoned/flavored.
Indications:
It is given during convalescence, acute infections, gastrointestinal disorders and after
surgery.
Dysphasia
Surgery involving jaw, mouth, GI tract.
Pain from newly adjusted dental braces, dental surgeries.
Pain on swallowing during chemotherapy/ radiotherapy.
Foods included:
Soft cooked rice, soft chapatti/roti and bread.
Milk, dahi(curd), buttermilk, paneer, soft cheese.
Well-cooked dals, cereals, pulses.
Boiled or poached eggs, tender meat, fish and poultry.
Tender, chopped and cooked vegetables.
Cooked fruits without skin or seeds.
Additional foods such as soups, soft desserts(kheer) etc. can be included to meet the nutritional
needs.
Sample menu: soft diet
Breakfast lunch Dinner
-milk/tea Apple/orange juice Soup, dahi or custard
-butter toast,kheer,saatu Peas and noodles Mashed potatoes
Kheer/jaulo Cooked green beans, soft
cooked rice
4) Mechanical Soft diet
It is also called a dental diet and is variation of the soft diet.
It includes foods which are easy to chew and swallow and there is no restriction on
seasoning or methods of preparations.
The texture or consistency of food may be modified by mechanical processing such as
mashing, blenderizing, or chopping.
Indications:
This type of food is prepared for those who have difficulty in chewing.
After facial surgery, or when teeth are missing or inadequate.
Foods included:
Same as soft diet but preparation includes mashing, blenderizing, chopping.
5) Light Diet/General hospital diet:
Similar to soft diet including simple salads, fruits and paneer.
6) Pureed Diet
A pureed diet means that all the food is grinded or processed into a smooth paste with a
consistency that resembles a thick pudding.
It includes all liquid and semi liquid foods which requires no chewing/mastication.
Indications:
Individuals who have difficulty in chewing and swallowing solid foods.
Foods included:
Milk and milk beverages, cream soups, lassie.
All fruits and vegetable juices.
Boiled mashed dals, oatmeal
Soft cooked cereals, soft scrambled eggs.
7) Bland Diet
This is the type of diet which includes foods which are mechanically, chemically, and
thermally non-irritating, especially foods low in fiber are recommended.
These are easily digestible and consists of soft foods that can prevent digestive
irritations or discomfort.
Indications:
This diet is prescribed for individuals suffering from GI disorders like:
Ulcers
Heartburn
Vomiting, diarrhea
Ulcerative colitis
Foods included:
Milk and other dairy products
Cooked fruits and vegetables with skin and seeds removed.
Fruit and vegetable juices,soups
All egg preparations except (fried and omelet)
Refined and cooked cereals, beans
Lean tender meat such as poultry,fish that are steamed or baked with no added fats
#Foods to be avoided in therapeutic diet (based on consistency)
Raw vegetables
Dried fruits and nuts
Coarse whole grains or cereals.
Pickles, spiced fried foods
Hard cheese
B) Modification in Nutrient Content
1) High Protein Diet:
It is a regular diet with increased protein content such as (meat, fish milk, cheese etc.) this diet
is mainly used for children and adolescence who need additional growth, pregnant or lactating
women, before and after surgery or patient with burn, fever or infections.
The average protein requirements are:
School age: 19-34gm/day
Teen age boys:52gm/day
Teenage girls:46gm/day
The protein requirement should be at least 10% of the daily calories consumption, but nor
more than 35% thus, the addition protein content in the diet than usually required is known as
high protein diet.
In case of high protein diet,
the diet usually contains about 125-150gm of protein for adults.
60-100gm for children below 10 years depending on age.
Indications:
A) Fever: since there is increased loss of tissue protein due to increased catabolism in fever,
daily intake of protein is increased up to 50%. Protein intake should be 70gm/day.
B) Burn: large amount of proteins, fluids, salts and electrolytes are lost in burn patients. So
2.2gm/kg/day protein is required with greater than 50% burn patient.
C)Tuberculosis:
Catabolism of tissue protein occurs in TB. A high protein diet should be consumed daily. It will
promote healing. Milk is important as it contains excellent protein. 1ltr of milk/day should be
consumed in any forms and eggs, cheese, fish, meat, pulses should be consumed freely.
D)Hepatitis:
Protein is required for the regeneration of the liver tissues. The recommended daily intake of
protein should be 60 – 80gm.
E) Cirrhosis:
It will help in regeneration of liver cells. The protein should be given in amount of 1.2-1.5gm/kg
body weight.
F) Nephrotic syndrome: This disease is characterized by proteinuria and thus low blood
protein. Protein requirement for nephrotic syndrome is protein 1-2gm/kg body weight.
G) Other conditions:
Geriatric individuals: 1.5gm/kg body weight.
Pregnant women:80gm/day
Malnutrition: should be twice of normal requirement. So 4-5 gm/kg body weight is
required.
Foods included:
Lean chicken, beef.
Eggs, fish, pork
Cheese, yoghurt, milk
Nuts and seeds (pumpkins, watermelon, peanuts, almonds).
2) Low Protein Diet
It is the diet in which there is reduction in intake of protein that ordinarily is
recommended.
This type of diet is especially advised for severe kidney or severe liver diseases because
their body cannot use the protein property.
In low protein diet, the amount of protein provided is 25-30gm/day.
Indications:
A) Nephritis: The intake of protein should be reduced to the minimum I.e., about 30gm/day by
excluding high protein diet, especially milk products and non-vegetarian foods.
B) Hepatic coma: since the nitrogenous products of protein metabolism cause coma because of
liver damage, no protein should be given. When patient recovers from coma, protein can be
given in small quantity i.e. 30-40gm/day which can be gradually increased to normal intake of
1gm/kg body weight.
C)Chronic renal failure: The dietary prescription for renal failure is based on the degree of renal
insufficiency, whether there is proteinuria, whether renal failure is progressive. In this
condition, glomerular filtration rate becomes less than 5ml/min. so protein intake is reduced to
0.5gm/kg body weight/day.
Foods included:
Vegetables: broccoli, mushrooms, green beans, peas, cabbage, spinach, cauliflower, raddish,
lettuce, onions, carrots, vegetable juice.
Fruits: apple, banana, orange, pears, grapes, peaches, cherries, watermelon, fruit juices.
3) Sodium/Salt restricted diet
It is the type of diet in which salt is not added or provided in very low amount.
Sodium restricted diet can be of 3 types:
A) Moderately low sodium diet: in this type of food, a limited amount of salt (1-2) gm is
consumed.
B) Low sodium diet: 0.5-1gm of salt may be prescribed in low sodium diet.
C) Very low sodium diet: less than 500mg of salt is prescribed.
Foods included:
Food cooked with little or no added salt
Fresh fruits and vegetables, rice, cereals, pulses.
Unsalted nuts, eggs, milk, yoghurt, ice-cream, fruit juices etc.
4) Low Fat/Fat free diet
The exact amount of fat contained in an average diet is difficult to determine however,
it is believed by some experts that the average diet contains 155gm of fat.
According to FDA (food and Drug Administration) fat free diet contains less than 3 gm of
fat per servings.
OR
A low fat diet must contain a maximum of 70-20gm of fat.
Indications:
Cardiovascular diseases
Pancreatitis
Obesity
Gall bladder disease (cholelithiasis, cholecystitis)
Foods included:
Fresh fruits, fresh vegetables
Lean meat, skinless chicken, eggs white.
Low fatty dairy products, skim milk
Whole grain, oatmeal, kidney beans, green peas.
5) High Fiber diet
The term roughage, residue, bulk and fiber have been used to describe the indigestible
components of food. The term fiber is used for all the indigestible polysaccharide and
lignin which remains after digestion of food.
Fiber absorbs water and produce soft, bulky stools and increases intestinal motility
hence helps in easy stool passage.
Thus, the diet which includes/contains large amount of fiber is called high fiber diet. A
high fiber diet should contain about 20-35gm of fiber/day.
Indications:
A) colon cancer: Dietary fiber helps in prevention of colon cancer. Fibers can help to reduce
40% chances of colon cancer. The recommended fibers are 25-38gm. Fiber prevents colon
cancer like as the following:
Insoluble fiber from foods such as wheat bran adds bulk to the stools and moves them through
the GI tract quickly reducing contact time with potential toxins in the colon.
Bulky stool high in water can also dilute potential carcinogens.
Fiber can also discourage growth of harmful bacteria and encourage healthy bacteria in the
colon.
B) Constipation: The diet should contain food rich in fibers like whole cereals, whole legumes,
mature vegetables and fruits as well as adequate amount of water should be taken.
C) Cardiovascular disease like atherosclerosis: An increase in fiber helps in reduction of serum
cholesterol by preventing its absorption.
Foods included:
Beans, oats, whole grains, cereals, legumes.
All fruits and vegetables with edible skins, seeds, and membranes and those which can be
consumed raw for e.g. whole oranges, apple, banana, mango.
6) Low Fiber Diet
It is the diet containing of limited or no amount of fiber. The low fiber diet/low residue diet is
intended to reduce the normal work of the intestine by reducing food residue.
It contains less than 10-15gm of fiber/day.
Indications:
A) Bowel obstruction: less than 10-15gm/day
B) Diarrhoea: 10gm/day
C) Diverticulitis: during severe diverticulitis, there is the risk of GI bleeding, perforation and
blockages so low fiber diet is recommended i.e. 2-3gm of fiber/servings.
Foods included:
Refined wheat flour, pasta, cereals
Well cooked vegetables and fruits without skin
Fruit and vegetable juice with little or no pulp.
Bibliography:
1. Davis J, Sherer K. Applied Nutrition and Diet Therapy for Nurses. 2nd ed. Philadelphia:
W.B Saunders Company; 1988.
2. Roday S. Food Science and Nutrition. New Delhi: Oxford University Press; 2007.
3. Mathur JS. Nutrients, Health and Health Management. Kathmandu: Makalu Publication
House; 2009.
4. Bansal S. Food and Nutrition. 2nd ed. India: AITBS Publishers; 2010.
5. Joshi SA. Nutrition and Dietetics. 3rd ed. New Delhi: McGraw Hill Education (p) Ltd.;
2010.
6. Oli P, Thapa S, Thapa R. Textbook on Human Nutrition. Kathmandu: Makalu Publication
House; 2010.
7. Sapkota S. Comprehensive Textbook of Food & Nutrition. 2nd ed. Kathmandu: Samiksha
Publication Pvt. Ltd.;2019.
8. Paudel R, Basaula YN. Nutrition and Dietetics. 1st ed. Kathmandu: Akshav Publication;
2021.
9. Whelan C. Diet for Jaundice: What Should I Add or Remove? [Internet]. [Place
unknown]: Healthline Media; March 7, 2019. Available from:
https://www.healthline.com/health/food-nutrition/diet-for-jaundice
