Diet as therapeutic agent

INTRODUCTION
• A therapeutic diet is a meal plan that controls the intake of certain
foods.
• It’s a practice followed in many hospitals as part of the
treatment of a medical condition
• Are normally prescribed by a physician and planned by a
dietician.
• A therapeutic diet is usually a modification of a regular diet.
• Diets are modified for:
- Consistency,
- Nutreint and
- New methods of making regular dishes.
 Introduction….
The normal diet may be modified:

• To provide a change in the constituents of the diet.

• To maintain, restore or correct nutritional status

• To include all nutrients in the diet

• To increase or decrease the energy value of the diet

• To provide foods bland in flavor.

• To modify the intervals of feeding.

 Diet modification….

1.1 MODIFICATION IN CONSISTENCY

- These diets are used in the treatment of gastro intestinal tract.

- These diets can range from a very low residue diet to a very high fiber
diet.

- Method of feeding is oral.

 1. Diet modification in consistency

A. Diets without solids

- Liquid Diets
B. Diets with solids
- Soft and Low Fiber Diets
- Low Residue Diets
- High Fiber Diets
 Liquid Diets:
• Liquid diets consist of foods that are liquid at
room temperature and are used in:
- Febrile states (acute fever)
- post operative conditions
 Soft and Low Fiber Diets

• Soft diet is between liquid diet and normal diet.

• Soft diet includes both liquid and solid foods

• The diet can be made soft by cooking, mashing, pureeing the
foods used in a diet under normal conditions.

• This diet is soft in texture and bland to taste.

 Low Residue Diets

• The diet is made up of foods which can be completely

absorbed, leaving little or no residue for faces formation.

• This diet is low in its mineral and vitamin content.

• Foods high in fiber should be omitted.

.
• The diet is usually used in severe diarrhea, acute
diverticulitis, post operations etc.
 High Fiber Diets

• Dietary fiber plays a significant role in colonic function.

• It helps in excretion of body wastes and regulates the
cholesterol levels.

• Oats, beans, peas, and certain fruits and vegetables (oranges, pears,
and carrots) are rich sources of fiber.

Recommended in case of:

- constipation, or high cholesterol.

- This is a normal diet with fiber increased to 15–20 gms daily.

 2. MODIFICATION IN NUTRIENTS

• Modification or change in the nutrient composition of the diet to

increase or decrease the availability of nutrients.
A. High Calorie Diets
• This is a normal diet with an increase in the calorie level to 3000 or
more.
• These diets are prescribed for:
- Weight loss, Fever, Hyperthyroidism and Burns
B. Low Calorie Diet
• These diets are prescribed for reducing body weight in:
- DM, CVD, Hypertension, Gout, Gall bladder and disease Preceding
surgery
 Nutrient modification…..
C. High Protein Diet
• High protein diet of 100 – 125 g per day may be
prescribed for a variety of conditions like:
- Fever, Hyper thyroidism, Burns, after surgery, Diarrhea and
Elderly Alcoholics.
D. Low Protein Diet
➢ Such a diet is often prescribed to people with kidney or liver
disorders.
➢ Low protein diets are usually prescribed for conditions like:
kidney and liver disease.
 Nutrient modification..

E. Fat Controlled Diet

• The total calories from fats should give about 30% and 35% of the
total calories.
- saturated fat – 10%
- poly-unsaturated fats 12- 14%.
• Even the intake of cholesterol also is reduced from the average
daily intake of 600 to 300 mg.
• Usually fat controlled diets are prescribed for
- Gall bladder diseases, Celiac disease , Atherosclerosis and
Hyperlipidemisa.
 Nutrient modification…

F. Low Sodium Diet

• The mineral content of the diet may also be modified.

• Four levels of sodium restriction are used:

- 250, 500, 1000 and 2400 mgs/day

• This diet is used both to prevent and treat edema.

• It is prescribed for congestive heart failure, hypertension,
liver and renal diseases.
 Pre-Op Nutrition Guidelines

• Eat enough protein.

- At least 1 – 2 weeks before surgery 65 – 100 grams per day.
• Stock up on fruit and vegetables. vitamins C, K and
magnesium.
• Include whole grains.
- B vitamins it needs to combat stress.
• Reducing or eliminating additional sugars, caffeine, and alcohol
- Affect metabolism.
 Post-Op Nutrition Guidelines

➢ Maintaining a proper post-op diet is essential for a speedier recovery.

➢ Surgery increases the body’s need for calories, and you need more
calories to heal.
Recommendation
• Eat smaller meals
• Include fiber and eat enough protein.
• Calcium is an important component of bone.
• Vitamin C helps the body heal wounds and form bone.
• Remember to drink plenty of water. To avoid constipation, drink at
least six to eight cups of fluid a day.
 Postoperative….
The timeframes for postoperative feeding
1. The clear liquid diet (The day of your surgery)

- noncarbonated, non-caffeinated, sugar free liquids.

2. The full liquid diet (Days 2 to 14 after your surgery)

3. Soft solid foods (Starting day 15)

4. Your healthy lifestyle

Feeding babies and children born from women
who are HIV-positive

• Between 6-12 months, breast milk contributes to 50%

of the infant’s energy requirement.

• Up to 40% of babies with HIV, the infection came

from postnatal transmission of HIV through BF.
 Possible feeding options for an infant born to an
HIV-positive mother
➢ Mixed feeding
- not recommended.
➢ Exclusive replacement feeding - formula
Using commercial infant
AFASS criteria:
- Acceptable
- Feasible
- Affordable
- Sustainable
- Safe
➢ Exclusive breast feeding

- Babies who are EBF are at a lower risk of acquiring HIV infection
compared with infants who have mixed feeding.
 Nutrition of people with Diabetes Mellitus

Type 1 diabetes
- is usually diagnosed in children and adolescents.
- It is treated only with insulin
• The diet for diabetes is synonymous with a healthy diet for the general
population, with a wider variety of nutritional options
• More complex (or slowly absorbed) carbohydrate-rich foods in the
daily dietary plan is recommended.
 Type 2 diabetes

• Type 2 diabetes, formerly called ‘adult-onset diabetes’ or ‘non-

insulin dependent diabetes’, is the most common type of
diabetes.

• The onset of type 2 diabetes can be at any age – even during

childhood – and is mainly caused by obesity.
• One of the basic pieces of dietary advice for type 2 is weight loss
 Type 2 DM

• Very simply, the Glycemic Index is a scientific ranking of how the foods
we eat affect our blood sugar levels in the 2 or 3 hours after eating.

• Foods are measured against pure glucose, which has a value of 100 on
the index.

• The index ranges from 0 to 100 with:

- Low-GI = 0-55

- Medium-GI = 56-69

- High-GI = 70- 100

 Glycemic index (GI)
22
The glycemic index is a value assigned to foods based on the

speed of increasing blood glucose levels.

1. Low glycemic response (GI range is 55 or less)

- Foods have slow absorption, modest rise in blood glucose, and a

smooth return to normal. e.g. beans, whole grains, meat, egg, milk,

nut, guava, avocado, broccoli, cabbage, cauliflower, apple,

strawberry, orange, cucumber, mushrooms, peppers, tomatoes,

onions, and spinach

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2. Moderate glycemic index (GI range 56 to 69)
-Foods have moderate absorption,
23 rise in blood glucose, and
reduction of blood glucose e.g. white and sweet potatoes, corn,
white rice, macaroni, cheese, table sugar, banana, and unsweetened
juice.
3. High glycemic index (GI of 70 or higher)
-Foods have fast absorption, rapid rise in blood glucose, and
abnormal reduction of blood glucose. e.g. white bread, most
crackers, cakes, doughnuts, pasta, and dates.

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 Traditional Ethiopian foods with GI
Traditional Ethiopian foods GI
White tef enjera 35
Low Glycemic
Index Red tef enjera 39
Maize enjera 43
Barley bread 25
Qocho bread 38
Pea sauce 41
Chickpea sauce 27
Lentil sauce 17
Medium Maize bread 56
Glycemic Index
Wheat bread 57
Bulla genfo 60
High Glycemic White bread (bread from bakery) 73
Index
 Diabetes….
Importance of low GI foods
(1) Improved glycemic control in diabetic subjects,
(2) More favorable lipid profiles, and
(3) Reduced markers of inflammation, which are
associated with lower risk of metabolic syndrome and
other chronic diseases.
 DM….
• A more useful estimation of the food-blood sugar effect is
the glycemic load (GL), which has more narrow categories
of low, medium and high foods.

GL = GI x grams of carbohydrates 100

• Low : 0 to 10
• Moderate: 11 to 19
• High: 20 and above
 Dietary recommendation for DM pts

Fiber intake
• Reduce the risk of coronary heart disease and type 2 diabetes by up to
30% for each 10g increment in intake.
• Total dietary fiber intake for people with diabetes.
- 25–35g/d : for adults.
- 5g plus 1g per year of age: for children
Protein
• similar protein requirements as the general population
- 0.8–1g/kg /day.
• In diabetic nephropathy (< 0.8g/kg/day)
• Vegetable protein should be considered an alternative to animal
protein.
 Dietary recommendation for DM pts…..

Lipids
➢ Use omega 3 and omega 6 rich foods
➢ Trans fatty acids harmful to diabetic subjects
➢ Plant sterols and plant stanols.
Function of phytosterols: Lower LDL cholesterol levels.
• Can stimulate insulin secretion and may improve blood glucose control
(inhibition of glucose-6-phosphatase).
Sodium/Salt allowances:
• With diabetes + hypertension (4.6g/day to 2.3g/day).
• With diabetes and severe hypertension or nephropathy ( <2 g/day).
Physical activities:
• The WHO suggests 60–90 minutes of moderate physical activity a day.
 How can we treat hypoglycemia with diet?

Foods or food elements appropriate for the treatment of

hypoglycemia are:
- 15–20g of glucose (three glucose tablets)
- a piece of white bread
- 1 tablespoon of table sugar (dissolved in water)
- 1/2 cup of juice or regular soft drink
- 1 tbs of honey or corn syrup or two tablespoons of jam
- 1/2 cup of fat-free milk
- 1/2 tube of glucose gel
 Types of insulin to a proper diet
➢ The type of diet and the time plan of meals depend on the type of
insulin the diabetic person takes.

• A rapid-acting insulin: taken 15min before,or even just before

eating.

• Short-acting(regular)insulin: taken 30min before meals, and

• long-acting basal insulin: taken once a day at bedtime or twice,

without any match with the meals.
 Gestational diabetes

• Gestational diabetes, also known as ‘gestational diabetes

mellitus’ (GDM) or ‘diabetes during pregnancy’.

• Energy intake; 1700–1800kcal.

• Nutritional requirements during pregnancy and lactation are

similar for women with and without diabetes.
 Diabetic nephropathy.
- Provide more carbohydrates
- 90% of the total caloric intake ( from fat -30% and
CHO-60%)
- Protein - 0.75g/kg/day + 10g/day
 Nutrition of people with Hypertension
and cardiovascular
disorders
 Lifestyle Modifications to Reduce Blood
Pressure
➢ smoking cessation
➢ weight reduction
➢ moderation of alcohol consumption
➢ physical activity
➢ DASH eating plan, which include:
- reduction of salt intake
- increase in potassium intake
-Adopt a diet rich in fruits, vegetables, and low saturated fat
intake.
 nutritional approach for the prevention and
treatment of metabolic syndrome

• Metabolic syndrome is a clustering of metabolic

abnormalities and cardiovascular disease risk factors
mainly:
- Visceral obesity,
- Dyslipidaemia,
- Hypertension and
- Hyperglycemia
 Nutrition for metabolic Syndrome….

• Eat moderate-carbohydrate (45 to 55% of total energy

intake)
• high-monounsaturated fatty acid diet
• Eat dietary fiber rich foods
• Restrict alcohol intake to <30g per day and of salt intake to
<4g per day
• control of body weight
Dietary recommendations for patients with
congestive heart failure
Nutrition of people with renal disorders
 1) Nephrotic syndrome
• is the condition resulting from loss of the glomerular
barrier to protein, characterized by:
- excess albuminuria (>3.0g/24hr)
- hypoalbuminaemia
- massive peripheral oedema
- hyperlipidaemia
- hypertension.
Diet Recommendation
• protein intake of 0.8g/kg /day
• sodium restriction to less than
• low-fat, low-cholesterol, high-complex-carbohydrate
diets
 2). Diet for patients with renal stones
• Renal stones are generally generated when the concentration of
components in the urine is above the level that allows crystallisation.
• According to their chemical constituents, they are classified as:
- calcium stones
- uric acid stones
- cystine stones
- struvite stones.
Diet Recommendation
• increase their fluid intake
• sodium restriction
• reduce of dietary oxalate (spinach, chard, berries, chocolate, and
tea, sweet potatoes)
• Avoid the supplementation of Vitamin C [ (RDA)=60–95mg/day].
• Avoid purine rich protein foods (for uric acid stone)
• Avoid Alcohol drinking
 3) Acute Renal Failure (ARF)

➢ Energy needs vary greatly, depending on the

underlying cause of the ARF and any co morbidity.
• energy; 30–40kcal/kg.
• parenteral nutrition (TPN), if there is vomiting
• protein intake:
- 0.6–0.8g/kg for non-dialyzed patients
- 1.0–2.0g/kg for those undergoing dialysis.
- 0.8–1.0g/kg, as patients stabilize,
 4). Chronic kidney Disease

Energy
• 35kcal/kg for pre-dialysis renal patients.
• 30–35kcal/kg/day, for patients >60 years old or for patients with a
sedentary way of life.
• 30–35kcal/kg/day for clinically stable chronic haemodialysis patients.
Sodium
• Restriction of sodium to the level ‘no added salt’should be
implemented in patients with edema or Hypertension.
• In end-stage CKD, 2000–2300mg/day
• if the patient is dehydrated, sodium intake must be temporarily increased.
Nutrition of people with GIT
disorders
 1). Dietary protocols after undergoing gastric surgery

Right after the surgery:

- Consume nothing orally until the initiation of the intestinal movements.
- Receive fluids and electrolytes parenterally.
First stage:
- low-carbohydrate fluids.
The next stage
- provided a soft diet, rich in protein, low in carbohydrate (especially
sugars) and moderate in fat.
• Small and frequent meals
• Raw fruits and vegetables should be initiated in the diet 2–3 weeks after
surgery.
 2). Nutritional management for diarrhea

➢ Diarrhea is commonly classified in four main categories, namely :

- osmotic diarrhea
- secretary diarrhea
- inflammatory diarrhea
- Dysmotility diarrhea
➢ Diarrhea treatment is based on the treatment of the basic disease which causes the
symptom of diarrhea.

Diet recommendation
- Fluid replacement
- followed by a full liquid and then a soft diet low in fat and fibre, with easily digestible
foods (e.g. rice, potatoes, refined cereals).
- Patients with osmotic diarrhea should avoid large amounts of fructose, sucrose and
lactose.
- Treat underlying cause of diarrhea
 3).What is coeliac disease and how is it treated?
• It results from the interaction between gluten and
immune, genetic and environmental factors.

• is precipitated by the ingestion of gluten, the major storage protein

of wheat and similar grains.

• Is characterized by diarrhea, malabsorption, vomiting,

irritability, anorexia and even constipation.

• Nutritional therapy is the only accepted treatment for coeliac

disease
- lifelong elimination gluten source foods from the diet is
recommended.
 Basic dietary advice for patients with an ostomy.

• Gradual food introduction and progression from a liquid to a normal diet.

• Thorough chewing of foods such as mushrooms, corn, legumes and
peppers to prevent stoma obstruction.
• Avoid nuts, tomato skin, and the pith of oranges (block stoma).
• Increase in fluid intake.
• Avoid foods with unpleasant odors, such as onion, garlic, legumes, egg
and fish.
➢ In case a patient complains of constipation, diarrhea or distension/
flatulence
- the respective recommendations should be administered.
 THE END!
THANK YOU!
4/6/2025 48