Guidelines To

Therapeutic Diet
Dr. Doaa Abdelnaby

 Na restricted diet
 DASH (Dietary Approach to Stop Hypertension) diet.
 Fat controlled diet.
 Diabetic diet.
 Uremic diet/ renal diet.
 Hepatic diet

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 Therapeutic diet
- The treatment of disease through nutritional therapy (modification of regular diet).
- May be the major treatment for disease control as in DM, HTN.
Aim

- Ensuring weight control.

- Providing nutritional requirements.
- Control blood glucose level.
- Prevent disease complication.
- Ensure effective treatment.
Importance

- Correct nutritional deficiency related to disease.

- Help to decrease certain food element from a diet that may be harmful to patient condition.
Take into consideration that each patient has his own individual nutritional needs according to

- Physiological needs
- Availability
- Presence of any associated health problems
- Patients' preference
Taking into consideration all dietary components:

- CHO (simple, complex)

- Protein (animal, plant)
- Fats (saturated, unsaturated)
- Vitamins
- Sodium and potassium.
- Water
- Snacks
Type of diet

 Regular diet (ordinary)

 Therapeutic: the patient should go on:
 Na restricted diet, (DASH)………. Hypertension, Congestive heart failure
 Fat controlled diet………….. Ischemic heart disease
 Diabetic diet………… Diabetes mellitus
 Uremic diet/ Renal diet ……… Renal failure
 Hepatic diet (low fat, low salt, low protein)…… liver disease (Liver cirrhosis)

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 Diabetic Diet Guidelines
Diabetes is a metabolic disorder caused by low or no secretion of insulin hormone. By the
deficiency of insulin glucose is not converted into glycogen leading to increase level of glucose in
blood.

Goal: Patient will repeat items of diabetic diet.

The patient should go on: diabetic diet: instruct the pt. that:

1. CHO: approximately 50%-60% of a person’s daily calories should come from carbohydrate.
 Instruct the patient to eat complex carbohydrates as (bread, white potato, rice and pasta)
and decrease intake of simple carbohydrates as (jam, honey, cake, chocolate& sweet)
as it takes more time for absorption than simple so decrease the high elevation of blood
sugar level.
 Fat: approximately <30 percent of a person’s daily calories should come from fat.
 Instruct patient to eat unsaturated fats, such as olive oil, canola oil, nuts, seeds and fish
(especially those high in omega-3 fatty acids, such as salmon, herring and sardines, and
decrease intake of foods that are high in saturated fat, such as beef, pork, lamb and high-
fat dairy products (cream cheese, whole milk) should be eaten in small amounts.
 Instruct the patient to limit intake of foods that are high in Trans fats such as fast foods,
commercially baked goods, cookies and some margarine.
 Protein: approximately 15 to 20 percent of a person’s total calories should come from protein.
 Examples of protein include fish, skinless chicken or turkey, nonfat or low fat dairy
products and legumes such as kidney beans, black beans, chick peas and lentils.
 Sodium: Moderately restricted in salt intake is less than 2400 mg/dl.
Instruct the patient to limit sodium intake.
 Fiber intake should be approximately 25-35 grams daily. Fibers can be soluble or insoluble:
 Soluble fibers: As in legumes and some fruits as oranges and apples, and vegetables as
carrots. Soluble fibers prolong stomach emptying time, so that sugar is released and
absorbed more slowly and it bind with fatty acids so it will lower total cholesterol and
LDL.
 Insoluble Fiber: As in Whole-wheat products, Corn bran, vegetables as green beans.
Insoluble fiber promotes regular bowel movement and prevents constipation.
 Snacks: diabetic patient should eat three basic meals and at least 3 snacks in between.
 Fluid intake: instruct the patient to increase fluid intake (8-12) cup/ day unless contraindicated.
 Instruct patient to:
 Eat meals and snacks at regular times every day.
 Avoid skipping meals.
 Spread carbohydrate intake evenly throughout the day.
 Include protein choices at every meal (milk, meat, cheese, peanut butter).
 Increase fiber food intake to help with blood sugar control and increase satiety.
 Avoid concentrated sweets (candy, cookies, soda) contain a lot of carbohydrate, and are
also generally high in fat and calories. For this reason, concentrated sweets should be
limited.
 When reading a food label, look at the Total Carbohydrate

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 Sodium Restricted Diet Guidelines
Sodium may need to be restricted in the diet for a variety of reasons, including congestive
heart failure, high blood pressure, and diseases associated with a fluid imbalance like kidney and
liver diseases.
Sodium Sources
The main source of sodium in the diet is salt. One teaspoon of salt contains about 2,000
milligrams (mg) of sodium.
The average diet has 4,000 to 6,000 mg sodium a day while the recommended amount is only
2,400 mg sodium a day.
The sodium found in unsalted food is adequate to meet the body’s need for sodium.
The patient should go on Na restricted diet:
A. Energy and Calories: giving foods should be reduced. Obese people are more prone to
hypertension. In any case weight should be controlled. Carbohydrates should be the main
source of calories.
B. Protein: It is advisable to cut down some amount of protein foods. For e.g. The foods which
have more sodium content.
C. Fats: It is desirable to cut down on fatty foods. High fat diets are known to increase the
incidence of atherosclerosis.
D. Minerals: The amount of sodium should be restricted.
In relation to sodium intake, instruct the patient to:
1. Prepare and eat foods without adding salt.
2. Eliminate high sodium processed foods from the diet.
3. Look for foods that are labeled salt-free, no added salt, or low sodium.
4. Avoid adding salt, sea salt, or seasoned salt at the table.
5. Decrease using salt during cooking.
6. Use unsalted seasonings, spices, fresh garlic, and herbs to make food taste better. Limit
condiments like ketchup and mustard.
7. Experiment with herbs and spices to add flavor to foods.
8. When eating out, ask for foods prepared without added salt.
9. Avoid high sodium foods like soups and foods with sauces or cheese.
10. Be aware that some medications, such as antacids, laxatives, and antibiotics, can contain
sodium.
11. Take time to read labels. Omit foods with greater than 400 mg per serving; limit foods
with 200-400 mg sodium per serving to 1-2 servings per meal.
12. Use the guidelines below to help with reading labels.
o Sodium-free: less than 5 mg per serving
o Low sodium: 140 mg or less per serving
 o Unsalted, without added salt, no salt added: no salt added during processing
13. Buy fresh and fresh frozen products, especially vegetables. Canned, processed, and
convenience foods (like store-bought meals) are high in sodium.
14. Rarely eat foods that are smoked, cured, pickled, or salted.
15. Eat out, less often. Many restaurant food items are high in sodium, like pizza and
milkshakes. Eat these rarely.
16. Increase fluids intake unless contraindicated or according to I & O chart.
17. High potassium diet in case of taking thiazids diuretics or digitalis according Dr. order. As
bananas, citrus food, green vegetables, fresh meat, carrot.

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 DASH Diet
The standard DASH diet limits salt to 2,300 milligrams (mg) a day. That's about the
amount of sodium in 1 teaspoon of table salt. A lower sodium version
of DASH restricts sodium to 1,500 mg a day.
DASH diet:

 Rich in potassium, calcium, magnesium, fiber and protein.

 Low in saturated fat.
 Low in salt.

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 Fat-Controlled Diet Guidelines
Important points to keep in mind.
 Eat small, frequent meals and snacks.
 Bake, broil, grill, poach, boil, and roast foods with little to no added fat.
 Read food labels for fat content.
 Limit fat to 45 to 55 grams per day.
Instruct the patient to:
o Limit foods of animal origin, such as meat, cheese, eggs.
o Increase intake of fruits, vegetables, and grains.
o Increase intake of whole-grain breads, enriched breads; cooked cereals, whole grain cereal
except granola type; plain corn or flour tortillas; bagels
o Intake of skim-milk, fruit ice, gelatin; skim milk pudding; fat-free commercial baked products;
nonfat ice cream, fat free cheese, dressing.
o Lean cuts of meat and remove visible fats
o Limit intake of egg yolk to 2-3 per week.
o Limit organ meats.
o Use fish, skinless chicken & turkey, and veal in most of the meat meals for the week.
o Avoid deep- fat frying and use oil that is low in saturated fats when frying is done. (Sunflower,
safflower, corn, peanut, canola).
o Instead of butter & cooking fats that are solid or completely hydrogenated, emphasize liquid
vegetable oil, as olive or sesame seed oil and soft or liquid margarines.
o Instated of whole milk & cheese made from whole milk & creams, use skim milk & skim milk
cheeses & low-fat yogurt.
o Use of plant food in place of animal foods. For example, fill up wholegrain breads and vegetable
rather than meat.
o Cooking methods that require little or no fat: - Boil Broil, Bake, Sauté, steam, microwave.
o Sodium restriction is often recommended because sodium instruction improves the effectiveness
of diuretic therapy so use of vinegar or lemon juice rather than table salt.
o Replace saturated fat with unsaturated fats.
 Saturated fats are found in animal products such as butter, cheese, whole milk, ice cream,
cream, and fatty meats.
 There are two types of unsaturated fats, polyunsaturated and monounsaturated, both of which
are liquid at room temperature. Two types of polyunsaturated fat, omega-3 and omega-6 fatty
acids cannot be produced by the human body, but play an essential role in brain
development, skin and hair growth, bone health, maintaining a healthy reproductive system
and even in regulating our metabolism. Plus, both types promote coronary health by lowering
“bad” LDL cholesterol and raising “good” HDL cholesterol.
Monounsaturated fats: Examples include olive and canola oils, Black beans, Brussels
sprouts, Cauliflower, Flax seeds, Herring, Kidney beans, Pasture-raised meats,
Salmon ,Sardines, Shrimp, Soybean oil,
Polyunsaturated fats: Examples include fish, safflower, sunflower, corn, and soybean oils,
Avocado, Cereals, Coconut, Nuts, Poultry, Soybean oil, Whole grain breads.
o Restrict dietary cholesterol intake (fruits, vegetables, grains, nuts are cholesterol free)
o Increase soluble fiber intake as oats and dried peas and beans.
o Low saturated fat sources of protein are recommended as lean meats, fish, egg white, skim milk,
and dried peas and beans.
o Liberal intake of complex CHO is recommended as they are low in fat and rich in fiber,
vitamins, and minerals.

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 Uremic diet/ Renal diet
Guidelines for therapeutic diet individuals with kidney disease:
1. Control Phosphorus Intake:
o Phosphorus is an essential mineral, but excess levels can be harmful for
kidney patients. High phosphorus levels can lead to bone and heart
problems.
o Limit foods high in phosphorus, such as dairy products, nuts, seeds,
beans, lentils, and whole grains.
o Avoid processed meats, which often contain added phosphates.
o Read food labels to identify hidden sources of phosphorus.
2. Monitor Potassium Intake:
o Potassium is important for nerve and muscle function, but too much can
be dangerous for kidney patients.
o Limit high-potassium foods, including bananas, oranges, potatoes,
tomatoes, and spinach.
o Cook vegetables to reduce their potassium content.
o Avoid salt substitutes containing potassium chloride.
3. Limit Sodium (Salt):
o Sodium can contribute to fluid retention and high blood pressure.

o Avoid processed and canned foods, as they are often high in sodium.
o Use herbs and spices to flavor food instead of salt.
o Limit high-sodium condiments like soy sauce, BBQ sauce, and
ketchup1.
4. Choose High-Quality Protein:
o Choose lean protein sources, such as chicken, fish, and eggs.

o Limit red meat and processed meats.

o Consult a dietitian to determine your protein needs.
5. Control Fluid Intake:
o Monitor fluid intake based on your individual needs and stage of kidney
disease.
o Limit beverages like sodas, energy drinks, and excessive water.

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 o Include fruits and vegetables with high water content to help manage
thirst.
6. Monitor Calcium and Vitamin D:
o Calcium is essential for bone health, but too much can be harmful.

o Discuss calcium supplements with your healthcare provider.

o Ensure adequate vitamin D to support calcium absorption.
7. Individualized Approach:
o Work with a registered dietitian who specializes in kidney disease.

o Tailor your diet to your specific needs, considering factors like stage of
kidney disease, lab results, and other health conditions.