Attachment A ADC Diet Manual.pdf

ARKANSAS DEPARTMENT OF CORRECTIONS

DIET MANUAL

FOREWORD

The Arkansas Department of Corrections (ADC/ACC) Diet Manual has been written for the ADC/ACC physicians, nurses, allied health professionals, and food service staff to use as a reference for normal nutrition and diet therapy.

The manual was written and/or revised using the 2020-2025 United States Dietary Guidelines and the American Dietetic Association Nutrition Care Manual as the main references.

The appendix of the manual contains educational material that may be used for inmate education.

This material may be copied from the manual.

In certain diets, the methods have been altered to fit the uniqueness and feasibility of a correctional facility. These changes in no way will affect the treatment of the individual or the outcome of the illness, as diet principles have not been changed.

Summer Patton, RDN, LD

REGULAR DIET

DESCRIPTION

The regular diet is the most liberal diet and is not considered a therapeutic or texture modified diet. It provides freedom of food choices for those that have no therapeutic restrictions. The regular diet is based on general, healthful nutrition from a variety of foods. The regular diet can be individualized to accommodate patient’s food preferences and needs. The regular diet is indicated for individuals without nutrition-related problems or those with nutrition-related problems who need a liberalized diet to allow more menu choices to improve intake. It is designed to achieve and maintain optimal nutrition levels in healthy individuals. The regular diet is planned using the 2020-2025 United States Dietary Guidelines for Americans to assure that all nutrients are provided. The regular diet is adequate as planned. It should be noted that individual food acceptance and choices would affect the adequacy of any diet. The diet will provide an average of 3,000 calories and 80 grams of protein per day when averaged over a seven-day period. If an individual’s needs are greater than what can be provided in the regular diet, the high calorie/high protein diet should be ordered. Do not order a regular diet with double portions.

SAMPLE MEAL PATTERN

BREAKFAST

1/2 cup vitamin C fortified juice 1 cup cooked cereal 2 eggs 1 oz. sausage 2 servings bread 2 tbsp. jelly 1 cup (8 oz.) milk 1 cup coffee, if desired

LUNCH

3 oz. meat, fish, poultry or 8 oz. casserole 1/2 cup dried beans/peas 1/2 cup starch (when serving casserole, omit this starch) 1 cup vegetables 1/2 cup fruit 1 serving dessert (if on menu) 2 servings bread 1 cup iced tea or fruit drink (choice)

DINNER

8 oz. casserole or 3 oz. meat, fish or poultry 1/2 cup dried beans/peas 1/2 cup starch (when serving casserole, omit this starch) 1 cup vegetables 1/2 cup fruit 2 servings bread 1 cup (8 oz.) milk 1 cup iced tea or fruit drink (choice)

SAMPLE MENU

1/2 cup orange juice 1 cup oatmeal 2 scrambled eggs 1 oz. turkey sausage 2 biscuits 2 tablespoons jelly 1 cup milk 1 cup coffee, if desired

LUNCH

3 oz. meatloaf 1/2 cup purple hull peas 1/2 cup mashed potatoes 1 cup mixed greens 2 rolls 1/2 cup apples 1 cup iced tea or fruit drink

DINNER

8 oz. chicken and rice casserole 1/2 cup pinto beans 1 cup steamed carrots 1/2 cup peaches 2 rolls 1 cup milk 1 cup iced tea or fruit drink

VEGETARIAN DIET

The vegetarian diet encompasses a variety of plant-derived foods and excludes some or all foods derived from animals. More specifically, vegetarian diets exclude all flesh foods. Individuals have a variety of reasons for choosing a vegetarian diet including religious preference, health, environmental, or ethical concerns. Within the broad category of vegetarian diets, there are several common subtypes: vegan diets, which excludes eggs and dairy products; Lacto-vegetarian diets, which include dairy products but not egg products; Lacto-ovo-vegetarian diets, which include eggs and dairy products; Ovo-vegetarian diets, which include egg products but not dairy products. The diet is planned with sufficient variety to provide adequate nutrition in healthy adults. Nutrients of concern may include protein, essential fatty acids, iron, iodine, vitamin D, and vitamin B12. Those who choose to follow a vegetarian diet should observe the United States Dietary Guidelines for Americans.

DAILY FOOD GUIDE FOR VEGETARIANS

FOOD GROUP SUGGESTED DAILY SERVING SIZE

SERVINGS

Breads, cereal, rice, and 6 or more 1/2 cup or equal to 1 oz.

Pasta

Vegetables 4 or more 1/2 cup or 1 cup raw

Fruits 3 or more 1/2 cup or 1 cup raw

Legumes and other 2 to 3 1/2 cup cooked beans, Meat Substitutes 1 oz. cheese, 2 tbsp.

Peanut butter, 2 tbsp.

Nuts or seeds

Dairy Products up to 3 1 cup milk, 1-1/2 oz.

Natural cheese, 2 oz.

Processed cheese

Eggs* 1 per day 1 whole egg, 2 egg Whites, 1/4 cup Scrambled eggs

*Individuals with elevated cholesterol should limit egg yolks to 3 per week.

VEGANS (Revised 4-08=2015)

Substitute 6 oz. tofu and 8 oz. soy milk for eggs and milk at breakfast.

Add 8 oz. soy milk and 1-1/2 cups dried beans at lunch and dinner meals.

Use a total of 8 oz. soy milk in cooked foods and cereal daily.

Soy milk should be Vitamin D fortified.

Add 8 oz. sugar free drink fortified with 100% daily value Vitamin D and 40% daily value Zinc at Lunch.

Due to the decreased intake of nutrients found in meats and dairy foods and the limited resources available in the correctional environment, a vitamin/mineral supplement is recommended to ensure that all nutrient needs are met. Any vitamin/mineral supplementation should be provided at the direction of the medical staff.

HIGH CALORIE/HIGH PROTEIN

The High Calorie/High Protein diet is intended for individuals whose nutritional needs are greater than what can be provided in a regular diet due to advanced illness, injury or trauma.

The diet is based upon the regular diet with larger portion sizes of some items. No foods are restricted. It is served as three meals provided at standard meal times and a bedtime snack.

As written, the diet will provide approximately 3,500 calories and 100 grams of protein per day and is adequate in all established nutrients according to the 2020-2025 United States Dietary Guidelines.

1 cup vitamin C fortified juice 1-1/2 cup cooked cereal 2 eggs 2 oz. meat 2 servings bread Jelly 1 cup (8 oz.) low fat milk Coffee, if desired

LUNCH

6 oz. meat, fish, poultry or 10 oz. meat casserole 1/2 cup dried beans/peas 1 cup starch (no starch if serving casserole) 1 cup vegetable 1/2 cup fruit 1 serving dessert, if on menu 2 servings bread Iced tea or fruit drink

DINNER

6 oz. meat, fish, poultry or 10 oz. meat casserole 1/2 cup dried beans/peas 1 cup starch (no starch if serving casserole) 1 cup vegetable 1/2 cup fruit 2 servings bread 1 cup low fat milk 1 cup iced tea or fruit drink

H.S. FEEDING

1 oz. meat 2 slices bread 1 cup low fat milk

1 cup grits 2 scrambled eggs 1 oz. chicken sausage 2 biscuits 2 tablespoons jelly 1 cup low fat milk 1 cup coffee, if desired

LUNCH

6 oz. meatloaf 1/2 cup pinto beans 1 cup mashed potatoes 1 cup mixed greens 1/2 cup pear halves 1 slice pound cake 2 rolls 1 cup iced tea or fruit drink

DINNER

10 oz. chicken and rice casserole 1/2 cup purple hull peas 1 cup steamed carrots 1/2 cup peaches 2 rolls 1 cup low fat milk 1 cup iced tea or fruit drink

H.S. FEEDING

1 oz. turkey salami

DIET FOR PREGNANCY

The Diet for Pregnancy provides the increased amounts of protein, vitamins, and minerals needed by the pregnant woman.

DAILY FOOD GUIDE FOR PREGNANCY

FOOD SUGGESTED DAILY SERVING SIZE

Breads, cereal, rice, and 6-11 or more 1/2 cup equal to 1 oz.

Pasta

Vegetables 3-5 or more 1/2 cup or 1 cup raw

Fruits 2-4 1/2 cup or 1 cup raw

Meat and Meat 2-3 3 oz. meat, 1 egg, 1/2 cup Substitutes cooked beans, 1 oz. cheese, 2 Tbsp. peanut butter, 2 Tbsp. nuts or seeds

Dairy Products 4-5 or more 1 cup milk, 1-1/2 oz.

Natural cheese, 2 oz.

Processed cheese

The pregnancy diet is to consist of the regular diet with milk at each meal. Also, provide a bedtime snack with 2 oz. meat, 2 slices bread, and 1 cup milk.

The pregnancy diet was planned using the 2020-2025 United States Dietary Guidelines to assure that all nutrients are provided.

CLEAR LIQUID DIET

The clear liquid diet consists of items that are liquid or will become liquid at room temperature. The diet will provide for hydration and a minimal amount of energy calories. Foods allowed in this diet primarily consist of sugar and water or water and salt.

The diet may be used for bowel preparation prior to surgery and/or diagnostic tests. It may be used post surgically to aid in hydration and to stimulate peristalsis. This diet is intended for short-term use and should be used only when necessary. The clear liquid diet is inadequate in calories, protein, minerals, and all vitamins except vitamin C (when fortified juices are served). For individuals with diabetes, blood glucose levels must be closely monitored. Medication and insulin may require adjustment while following a clear liquid diet. If the diet is served for more than 4 consecutive days or if the patient is nutritionally depleted, a suitable non-residue commercial supplement should be prescribed by the physician and provided for the patient.

Typically, the diet is served as three meals at regular meal times. However, allowed items may be served to the patient between meals. This is encouraged, as the diet is so limited. This diet was planned using the 2020-2025 American Dietetic Nutrition Care Manual as the main reference.

CLEAR LQUID DIET

1/2 cup clear juice 1 cup clear broth 1/2 cup plain, flavored gelatin Coffee Sugar

LUNCH AND DINNER

1/2 cup clear juice 6 ounces clear broth 6 ounces fruit drink 1/2 cup plain, flavored gelatin Iced tea

NOTE: Items may be served between meals

1/2 cup apple juice 6 ounces clear chicken broth 1 cup coffee 1 teaspoon sugar

LUNCH

1/2 cup grape juice 6 ounces clear beef broth 6 ounces fruit punch 1 cup tea or coffee 1 teaspoon sugar

DINNER

1/2 cup cranberry juice 6 ounces clear chicken broth 1/2 cup plain gelatin 1 cup tea or coffee 1 teaspoon sugar

FOOD DESCRIPTIONS

BEVERAGES

ALLOWED: Apple, grape, or cranapple juice, coffee or tea, carbonated beverages as tolerated, clear punch type mixes such as Kool-Aid, sports drinks such as Gatorade

AVOID: All juices not listed, nectars, milk of any kind, cream, alcohol

SOUPS

ALLOWED: Clear broth or bouillon

AVOID: All others not listed

SWEETS AND DESSERTS

ALLOWED: Clear, fruit flavored or unflavored gelatin, fruit ice made from clear fruit juice, plain hard candy, sugar, honey, sugar substitutes, popsicles

AVOID: All others not listed and any not tolerated by the patient

CONDIMENTS

ALLOWED: Sugar

AVOID: All others

FULL LIQUID DIET

The full liquid diet includes the foods allowed on the clear liquid diet plus milk and foods with minimal amount of fiber. It is used as a transition from clear liquids to solid foods, or for patients who cannot tolerate solid foods due to trauma or surgery to the head or neck. The diet is not adequate in calories or protein. It is adequate in calcium and vitamin C. However, adequacy, as with any diet, depends on consumption by the individual. Oral nutrition supplements to meet nutrient needs may be ordered for patients who require a full liquid diet for more than 3-4 days. This diet was planned using the 2020-2025 American Dietetic Nutrition Care Manual as the main reference.

1/2 cup juice without pulp 3/4 cup thinned, cooked cereal with margarine 1 cup milk 1 cup coffee

LUNCH

1/2 cup fruit juice 3/4 cup strained cream soup 1/2 cup plain, flavored gelatin 1 cup milk 1 cup iced tea

DINNER

1/2 cup fruit juice 3/4 cup strained cream soup ½ cup plain pudding

1 cup iced tea

1/2 cup orange juice (no pulp) 3/4 cup thin cream of wheat 1 cup low fat milk 1 cup coffee

LUNCH

1/2 cup apple juice 1/2 cup potato soup 1/2 cup strawberry gelatin 1 cup low fat milk 1 cup iced tea

DINNER

1/2 cup apple juice 3/4 cup tomato soup 1/2 cup plain pudding

ALLOWED: Water, Ice, Soda, Tea, Coffee, and nutritional supplements or shakes AVOID: All others.

GRAINS

ALLOWED: Thin cooked cereals such as cream of wheat AVOID: All grain foods including whole grains, processed grains such as pasta, rice, cold cereals, bread, snacks, and sweets that are flour-based.

DAIRY

ALLOWED: Milk: Nonfat, 1%, 2%, and whole; Soy milk, almond milk, rice milk, coconut milk, cashew milk, milkshakes, yogurt, custard, pudding AVOID: Hard cheese and yogurt with fruit chunks

VEGETABLES

ALLOWED: Vegetable juice with or without pulp; thin, pureed vegetable soups AVOID: whole, frozen, fresh, canned varieties

FRUITS

ALLOWED: Translucent fruit juices without pulp (apple, cranberry, grape) AVOID: whole, frozen, fresh, canned varieties

OILS

ALLOWED: Almond, avocado, canola, cashew, corn, grapeseed, olive, safflower, sesame, soybean, and sunflower; melted butter; melted margarine AVOID: Butter, coconut oil, palm oil, and lard.

OTHER

ALLOWED: Flavored gelatin (any flavor), strained cream soups, popsicles, and chicken, beef, or vegetable broth AVOID: beef and pork; chicken and turkey; fish; nuts and nut butters; eggs; meat substitutes; cold cuts or lunch meat; sausage

BLENDERIZED LIQUID DIET

(FRACTURED JAW DIET)

The diet consists of liquids and blenderized foods. The consistency of this diet ranges from that of juices to cream soup. It should go through a straw or syringe easily. Many institutions have replaced the full liquid diet with the blenderized liquid diet. The diet is adequate as served. The choices of the individual or the individual’s ability to tolerate the diet may affect adequacy. This diet was planned using the 2015 United States Dietary Guidelines for Americans to assure that all nutrients are provided.

Patients who have difficulty swallowing, head or neck trauma, or require liquids for a long period of time, can consume adequate nutrition from this diet. To increase acceptance, it can be served as three meals at regular intervals and three supplemental feedings.

1/2 cup juice 1 cup thinned, cooked cereal 1 cup milk Sugar

MID-MORNING

1 cup thinned milkshake with fruit

LUNCH

6 oz. cream soup blended with 3 oz. pureed beef 1/2 cup pureed vegetables thinned with broth 1/2 cup fruit juice 1 cup beverage

MID-AFTERNOON

1/2 cup pureed fruit thinned with fruit juice 1 cup milk

DINNER

1 cup broth blended with 1/4 cup dry bread crumbs 3 ounces pureed meat blended with broth 1/2 cup mashed potatoes thinned with milk 1/2 cup fruit juice 1 cup beverage

HS FEEDING

1/2 cup pureed fruit thinned with fruit juice

1/2 cup orange juice (no pulp) 8 oz. cream of wheat thinned with 1/4 cup milk 1 cup milk 1 cup coffee/tea

MID-MORNING

1 cup thin milk shake with 1/4 cup pureed fruit added

LUNCH

6 ounces potato soup blended with 1/4 cup dried bread crumbs 3 ounces pureed beef thinned with 1/4 cup beef broth 1/2 cup pureed vegetables thinned with 1/4 cup broth 1/2 cup fruit juice 1 cup coffee/tea

MID-AFTERNOON

1/2 cup pureed peaches thinned with 1/4 cup peach juice 1 cup milk

DINNER

1 cup beef broth blended with 1/4 cup dried bread crumbs 3 ounces pureed chicken thinned with 1/4 cup chicken broth 1/2 cup mashed potatoes thinned with 1/4 cup milk 6 ounces tomato juice 1 cup coffee/tea

HS SNACK

1/2 cup pureed fruit thinned with 1/4 cup fruit juice

ALLOWED: Milk, thinned milkshakes, all pulp free fruit juices, soft drinks, vegetable juices, fruit drinks, tea, coffee

AVOID:Thickened milk beverages, alcohol

BREAD AND CEREALS

ALLOWED: Soft breads and crackers that can be blenderized, cooked cereals thinned with milk

AVOID: All others not listed

DESSERTS

ALLOWED: Thinned custards and puddings, plain cake and pie filling that can be blended to liquid consistency with milk, thinned milkshakes, ice cream, gelatin

AVOID: All others not listed

FATS

ALLOWED: Butter or fortified margarine, cream and cream substitutes, mild gravy, whipped topping, cooking oils used in food preparation

AVOID: All others not listed

FRUITS

ALLOWED: Fruit juices without pulp, blenderized fruits without seeds, thinned fruit nectars

AVOID: All others not listed

MEAT AND MEAT SUBSTITUTES

ALLOWED: Pureed meat thinned with broth, pureed fish and poultry thinned with broth, smooth peanut butter, eggs, cheese sauce

AVOID: All others not listed

POTATOES AND POTATO SUBSTITUTES

ALLOWED: Thin, mashed creamed potatoes; blenderized thinned rice and noodles

AVOID: All others not listed

SOUPS

ALLOWED: Blenderized and strained soups, broth, bouillon

AVOID: All others not listed

SWEETS

ALLOWED: Plain jelly, honey, sugar, sugar substitutes, chocolate syrup, pancake syrup

AVOID: All others not listed

VEGETABLES

ALLOWED: Vegetable juices, cooked blenderized tender vegetables such as green beans, carrots, English peas, beets, asparagus (tips only), yellow squash

AVOID: All others not listed

MISCELLANEOUS

ALLOWED: Mild seasonings such as salt, nutmeg, cinnamon, flavoring extracts

AVOID: Hot spices, ground leaves or seeds, nuts, coconut, any spices that would not blend well

MECHANICALLY ALTERED DIET

(DENTAL SOFT OR ENDENTULOUS DIET)

The mechanically altered diet is intended to minimize the amount of chewing necessary to ingest food.

The diet is to be used when patients have limited chewing ability, but can tolerate more than liquid or blenderized foods. Foods on this diet are chopped, ground, pureed, or blended with liquid to change the consistency.

The mechanically altered diet was planned using the 2020-2025 United States Dietary Guidelines for Americans to assure that all nutrients are provided.

1/2 cup fruit juice 1/2 cup cooked cereal 1/4 cup soft scrambled egg 1 slice bread 1 tablespoon jelly 1 cup milk Coffee, if desired Salt and sugar

LUNCH

3 oz. ground meat, poultry, soft fish, or 8 oz. casserole 1/2 cup dried beans/peas 1/2 cup soft starch (no starch if casserole is served) 1 cup tender, cooked vegetable 1/2 cup soft fruit 1 serving bread 1 cup tea or fruit drink

DINNER

3 oz. ground meat, poultry, soft fish, or 8 oz. casserole 1/2 cup dried beans/peas 1/2 cup soft starch (no starch if casserole is served) 1 cup tender, cooked vegetables 1/2 cup soft fruit 1 serving bread

1 cup tea or fruit drink

1/2 cup oatmeal 1/4 cup soft scrambled egg 1 slice bread 1 teaspoon jelly 1 cup milk Coffee, if desired Salt and sugar

LUNCH

3 oz. ground beef patty with gravy 1/2 cup great northern beans 1/2 cup mashed potatoes 1 cup green beans 1/2 cup peaches 1 roll 1 cup Iced tea or fruit drink Salt and sugar

DINNER

8 oz. chicken and rice casserole 1/2 cup purple hull peas 1 cup chopped spinach 1/2 cup pear halves 1 roll 1 cup milk 1 cup Iced tea or fruit drink Salt and sugar

ALLOWED: Milk and all milk-based beverages, coffee, tea, carbonated beverages, all fruit juices, sports drinks such as Gatorade, fruit drinks, vegetable juices

AVOID: Any not listed

BREADS

ALLOWED: Soft bread and rolls, buns, pancakes, plain muffins, cinnamon rolls, waffles, bread stuffing, crackers softened in soup, soft biscuits

AVOID: Bread with seeds, bagels, taco shells, breads containing nut or dried fruit, any others not listed

CEREALS

ALLOWED: Any plain cooked cereals, refined dry cereal softened with milk

AVOID: Any cereal with seed, dried fruit or nuts, shredded wheat, granola, and other whole grain cereals, any cereal that will not soften with milk

DESSERTS

ALLOWED: Plain custard, pudding, ice cream, fruit ice, plain gelatin or gelatin with allowed fruit, yogurt, plain cakes and cookies with allowed ingredients, soft fruit crisp

AVOID: Coconut, nuts, seeds, dried fruit

FATS

ALLOWED: Butter, fortified margarine, cream, cooking oils, milk gravy, whipped toppings, crisp bacon, mayonnaise, mild salad dressings

AVOID: Any others not listed

FRUITS

ALLOWED: Applesauce, bananas, canned peaches and pears, watermelon, fruit cocktail, cantaloupe, honeydew melon, stewed prunes, Royal Anne cherries, baked apples, any fruit juice

AVOID: Citrus fruits, dried fruits, cherries, grapes, fresh peaches, fresh apples, fresh pears, pineapple, raisins, all others not listed.

MEAT AND MEAT SUBSTITUTES

ALLOWED: Any chopped or ground meat (gravy or broth may be added), soft, flaked boneless fish, casseroles from ground beef, meatloaf, smooth peanut butter, cottage cheese, cheese sauce, soft cooked eggs, egg substitutes

AVOID: Whole cuts of meat or poultry, fried fish, sausage, cold cuts

SOUPS

ALLOWED: Broth, bouillon, consommé, blended strained soups, any soup made from allowed ingredients, cream soups

AVOID: Any with whole chunks of meat and/or chunks of vegetables

SWEETS

ALLOWED: Clear jelly, sugar, sugar substitutes, honey, syrup, molasses, plain candy bars

AVOID: Any made with coconut, nuts, whole dried fruits, granola bars, chewy candy, caramel, any others not listed

VEGETABLES

ALLOWED: Well cooked, soft vegetables without husks, skins or seeds such as carrots, English peas, beets, spinach, asparagus tips, turnips, green beans, yellow squash, zucchini squash, tomato paste, tomato puree

AVOID: All other not listed

MISCELLANEOUS

ALLOWED: Salt, pepper, ground spices, catsup, smooth condiments

AVOID: Nuts, seeds, coconut, olives, pickles, dried minced vegetable spices

FIBER RESTRICTED DIET

The fiber-restricted diet comprises less than 13 g of fiber daily. A fiber-restricted diet included limited amounts of indigestible foods. A fiber-restricted diet may be indicated for individuals with acute diverticulitis, Crohn’s disease, or ulcerative colitis, or for patients recovering from gastrointestinal tract surgery. This diet should decrease the volume and bulk of the stool and cause slower movement of foods through the intestines. It may also decrease symptoms of diarrhea, abdominal pain, gas and bloating. A fiber-restricted diet may not meet the Dietary Reference Intakes (DRIs) for macronutrients and micronutrients. Fiber intake on this diet may be inadequate and other micronutrient and macronutrient deficiencies are possible because of this diet intentionally restricts intake of whole grains, fruits, and vegetables. This diet is not intended for long-term use.

FIBER-RESTRICTED DIET

1/2 cup cooked cereal 1/4 cup soft cooked eggs 1 serving bread or toast 1 tablespoon jelly 1 cup low fat milk Coffee, if desired

LUNCH

3 ounces soft cooked meat, poultry or fish 1/2 cup soft starch 1/2 cup soft, tender, cooked vegetables 1/2 cup soft fruit or dessert 1 serving bread 1 cup beverage

DINNER

3 ounces soft, cooked meat, poultry or fish 1/2 cup soft starch 1/2 cup soft, tender, cooked vegetables 1/2 cup soft fruit 1 serving bread 1 cup low fat milk

HS SNACK

1 serving bread 1/2 cup soft fruit

1/2 cup oatmeal 1 scrambled egg 1 slice bread or toast 1 tablespoon jelly 1 cup low fat milk 1 cup coffee

LUNCH

3 oz. meatloaf (made with allowed ingredients) 1/2 cup mashed potatoes 1/2 cup steamed green beans 1/2 cup peach crisp 1 roll Iced tea/fruit punch

DINNER

3 oz. baked chicken 1/2 cup steamed rice 1/2 cup steamed yellow squash 1/2 cup canned pears 1 roll 1 cup low fat milk

H.S. SNACK

1 slice bread 1/2 cup fruit cocktail

ALLOWED: Plain water, decaffeinated coffee, caffeine-free teas, and rehydration beverages AVOID: Beverages containing caffeine such as regular coffee, regular tea, soda, and energy drinks;

Limit beverages containing high-fructose corn syrup to 12 ounces per day; Beverages sweetened with sorbitol or other sugar substitutes; alcoholic beverages.

GRAINS

ALLOWED: Grain foods with less than 2 grams fiber per serving; White flour; Bread, bagels, rolls, crackers, and pasta made with white or refined flour; Cold or hot cereals made from white or refined flour such as corn flakes, crispy rice, puffed rice, cream of wheat, cream of rice or refined grits.

AVOID: Whole wheat or whole grain breads, rolls, crackers, or pasta; brown or wild rice; barley, oats, and other whole grains such as quinoa; cereals made from whole grain or bran such as shredded wheat or bran flakes; breads or cereals made with seeds or nuts; popcorn.

PROTEIN FOODS

ALLOWED: Tender, well-cooked, lean meats made without added fat: beef, fish, lamb, pork or poultry; Lean deli meats (heated to steaming); Well-cooked eggs; Tofu; Smooth nut butters: almond, peanut, or sunflower AVOID: Fried meat, poultry, or fish; luncheon meats such as bologna or salami; sausage and bacon;

hot dogs; fatty meats; dried beans and peas; hummus; nuts and seeds; crunch nut butters: peanut and almond

DAIRY

ALLOWED: buttermilk; fat-free, 1%, 2% milk; lactose-free milk; powdered milk and evaporated milk;

fortified non-dairy milks: almond, cashew, coconut, or rice; fortified pea milk and soymilk; yogurt with live active cultures; lactose-free yogurt; kefir; cheese; low-fat ice cream; lactose-free ice cream;

cottage cheese; lactose-free cottage cheese AVOID: whole milk, half-and-half, cream, sour cream, ice cream, and yogurt with fruit, granola, or nuts

VEGETABLES

ALLOWED: Well-cooked vegetables without seeds or skins; Potatoes without skin: white, red and yellow; Small amounts of sweet potatoes without skin may be added as fiber is increased in the diet;

Strained vegetable juice AVOID: All raw or fried vegetables; cooked beets, brussels sprouts, cabbage, cauliflower, collard greens, mustard greens, turnip grins, corn, dried beans, kales, lima beans, mushrooms, okra, onions, potatoes skins, and spinach

FRUITS

ALLOWED: Fruit juice, expect for prune juice; ripe bananas; melons: cantaloupe, honeydew, or watermelon; Peeled apple; a baked apple will have less fiber than a fresh apple; canned soft fruits in juice AVOID: All other fresh fruits; All dried fruits including prunes and raisins; fruit juice with pulp; canned fruit in heavy syrup; any fruits sweetened with sorbitol; prune juice

OILS

ALLOWED: Limit fats and oils to less than 8 teaspoons per day; choose oils such as olive and canola more often than solid fats AVOID: Butter

OTHERS

AVOID: Sugar alcohols such as erythritol, mannitol, sorbitol, and xylitol; sugar substitutes such as aspartame and sucralose; honey

SIX (6) FEEDING DIET

POST GASTRECTOMY

The post gastrectomy diet is designed to provide adequate nutrition for patients who have undergone surgical procedures involving the pyloric sphincter resulting in inability to regulate the normal emptying of food from the stomach into the small intestine.

The diet can be adequate if carefully planned. The extent of surgery and individual food intolerances largely determine adequacy. Vitamin and mineral supplements may be necessary to increase adequacy. This diet was planned using the 2020-2025 United States Dietary Guidelines for Americans to assure that all nutrients are provided.

General guidelines are as follows:

1. Avoid taking liquids with solid foods. Liquids should be taken 1/2 to 1 hour after a meal and limited to 1/2 to 1 cup at that time. At least 6 cups should be consumed throughout the day.

2. Small frequent meals should be provided as to avoid over distending the stomach.

3. The diet should be void of simple sugars, high in complex carbohydrates and protein and moderate in fat. Simple sugars are easily digested and leave the stomach rapidly. This increases the tendency for other foods to “dump” into the small intestine undigested.

4. Avoid milk products initially. The patient will often build tolerances to milk. Milk cooked in a product usually does not cause problems since heat breaks down the lactose that is in the milk.

5. Avoid individual food intolerances.

BREAKFAST MID-MORNING

1/2 cup soft canned fruit 1 bread ½ cup soft cooked cereal 1 oz. meat or meat substitute 1 serving bread 1 fruit 1 egg 1/2 cup low fat milk* 1/2 cup coffee

LUNCH MID-AFTERNOON

2 oz. tender meat, fish or poultry 1 bread 1/2 cup soft starch 1 oz. meat or meat substitute 1/2 cup soft vegetable 1 fat 1/2 cup unsweetened, canned fruit 1 fruit 1 serving bread 1/2 cup iced tea**

DINNER HS FEEDING

2 oz. tender meat, fish or poultry 1 oz. meat or meat substitute 1/2 cup soft starch 1 bread 1/2 cup soft vegetable 1 fruit 1/2 cup soft canned fruit 1 serving bread 1/2 cup iced tea**

*Some patients, depending on the degree of gastric resection, may experience lactose intolerance. If so, avoid milk as a beverage. Many patients are not able to tolerate foods that contain cooked milk and aged cheese. These patients should receive Vitamin D and calcium supplements to help prevent bone loss.

**Liquids should be taken 30 minutes to 1 hour before a meal. They are usually better tolerated this way as the combination of liquids and solids increases the chance of dumping in patients who may likely experience this complication.

1/2 cup canned peaches 1 tablespoon smooth 1/2 cup oatmeal peanut butter 1 scrambled egg 1 slice bread 1 teaspoon margarine 1/2 cup applesauce 1/2 cup low fat milk* 1/2 cup coffee**

LUNCH MID-AFTERNOON

3 oz. lean ground beef patty 1 slice bread 1/2 cup mashed potatoes 1 oz. lean chicken 1/2 cup steamed green beans 1 teaspoon mayonnaise 1/2 cup canned pears 1/2 cup canned peaches 1 slice bread 1/2 cup iced tea**

DINNER HS FEEDING

2 oz. baked chicken 1 tablespoon smooth 1/2 cup steamed rice peanut butter 1/2 cup steamed carrots 1 slice bread 1/2 cup canned pears 1/2 cup applesauce 1 slice bread 1/2 cup iced tea**

*See note on previous page

** See note on previous page

ALLOWED: Tea, coffee, unsweetened fruit juice without pulp, unsweetened fruit drinks

AVOID: Milk, milk-based drinks, sweetened fruit drinks, carbonated drinks

BREADS AND CEREALS

ALLOWED: Enriched, refined breads and rolls, unsweetened cooked cereals, strained oatmeal

AVOID: Breads with seeds, fruit breads, pastries, muffins, cornbread, doughnuts, whole grain breads, sugar coated cereals, wheat germ, bran, and others not listed

DESSERTS

ALLOWED: Sugar free pudding, sugar free gelatin, unsweetened pears, peaches, and applesauce, ripe bananas

AVOID: All others not listed

FATS

ALLOWED: Butter, margarine, mild salad dressings, mayonnaise, vegetable oil

AVOID: Foods fried in fat; any fat not listed

FRUITS

ALLOWED: Unsweetened applesauce, canned, unsweetened peaches and pears, ripe bananas, unsweetened fruit juice without pulp

AVOID: Any others not listed

MEAT AND MEAT SUBSTITUTES

ALLOWED: Lean tender meats, fish and poultry, eggs, smooth peanut butter, cottage cheese, mild cheese

AVOID: Any fried meats, fish, or poultry; highly seasoned meats such as sausage or corned beef, fatty cold cuts, pre-packaged meats, barbecued meats, and any others not listed

POTATOES AND POTATO SUBSTITUTES

ALLOWED: Cooked white potato without the peel, white rice, refined pasta

AVOID: All others not listed

SOUPS

ALLOWED: Bouillon, broth or cream soup make with allowed vegetables, noodles or rice

AVOID: All others not listed

VEGETABLES

ALLOWED: Soft tender well cooked vegetables such as: green beans, asparagus tips, yellow squash, carrots, English peas, beets (not pickled), tomato juice, cooked spinach

AVOID: Pickled vegetables, sauerkraut, corn, hominy, dried beans and peas, broccoli, cauliflower, celery, lettuce, radishes, okra, tomatoes, cucumbers, onions, bell peppers (and other peppers), cabbage, turnips, turnip greens, collards, mustard greens, kale, sweet potatoes, yams, and any others not listed

MISCELLANEOUS

ALLOWED: Salt, artificial sweeteners, flavoring extracts

AVOID: All others not listed

HYPOGLYCEMIA DIET

The hypoglycemia diet is used to treat disorders in carbohydrate metabolism such as reactive or functional hypoglycemia or gastric outlet surgery for peptic ulcer disease. The diet limits intake of carbohydrate rich foods that are shown to rapidly increase blood glucose. However, total carbohydrate restriction, especially complex carbohydrate, is not recommended. Often, the diet is divided into six meals.

The hypoglycemic diet contains no nutritional inadequacies. Protein content is usually increased in this diet. Care should be given not to increase the amount of saturated fat and cholesterol as well.

This diet was planned using the 2020-2025 United States Dietary Guidelines for Americans

1/2 cup canned fruit 1 bread 1/2 cup cooked cereal 1 oz. meat or meat substitute 1 serving bread 1 fruit 1 egg or 1 oz. meat 1 cup low fat milk 1/2 cup coffee

LUNCH MID-AFTERNOON

2 oz. tender meat, fish or poultry 1 bread 1/2 cup starch 1 oz. meat or meat substitute 1/2 cup vegetable 1 fat 1/2 cup unsweetened, canned fruit 1 serving bread 1 cup iced tea

DINNER HS FEEDING

2 oz. tender meat, fish or poultry 1 bread 1/2 cup starch 1 oz. meat or meat substitute 1/2 cup vegetable 1 low fat milk 1/2 cup canned fruit 1 serving bread 1 cup iced tea or low fat milk

1/2 cup canned peaches 1 tablespoon smooth peanut butter 1/2 cup oatmeal 1 slice bread 1 scrambled egg 1/2 cup applesauce 1 slice toast 1 cup low fat milk 1/2 cup coffee

LUNCH MID-AFTERNOON

2 oz. lean ground beef patty 1 slice bread 1/2 cup mashed potatoes 1 oz. lean chicken 1/2 cup steamed green beans 1 teaspoon mayonnaise 1/2 cup unsweetened canned pears 1 slice bread 1 cup iced tea

DINNER HS FEEDING

2 oz. baked chicken 1 tablespoon smooth peanut butter 1/2 cup steamed rice 1 slice bread 1/2 cup steamed carrots 1 cup milk 1/2 cup canned pears 1 slice bread 1 cup iced tea or low fat milk

CONSISTENT CARBOHYDRATE

DIABETIC DIETS

The Consistent Carbohydrate meal is used as a treatment for Diabetes Mellitus and impaired glucose tolerance to promote glycemic control. Scientific investigation suggests that careful metabolic control of blood sugar levels helps to prevent and/or delay the development of complications associated with the disease.

DIET PRINCIPLES:

• Provide consistent carbohydrate meal plans throughout the day to compliment medication and exercise regimen.

• Weight loss if applicable.

• Maintain plasma glucose as near the normal physiological range as possible.

• Meal distribution. Maintain regularity of food intake. It is important for the diabetic to space meals so that approximately the same amount of time passes between meals. This is particularly important for the insulin-dependent diabetic. Proper distribution of the meals will help prevent bouts of hypo or hyperglycemia. An h.s. feeding is provided to all diabetics.

The purpose of this is to prevent the blood sugar from dropping during sleep.

• Reduce elevated serum lipid levels that are associated with glucose intolerance and cardiovascular complications. Limit fat in the diet to less than 30% of total calories.

Approximately 1/3 of the calories from fat should come from saturated fat, 1/3 from polyunsaturated fat and 1/3 from monounsaturated fat.

• Emphasize complex carbohydrates. Increase the fiber content of the diet as tolerated. A high complex carbohydrate, high fiber diet has been demonstrated to lower insulin needs.

• The same precautions regarding the use of alcohol that apply to the general public also apply to people with diabetes. Dietary Guidelines for Americans recommends no more than two drinks per day for men and no more than one drink for women.

• Education on individualized meal planning.

CONSISTENT CARBOHYDRATE DIABETIC DIET FOOD LIST

Foods with carbohydrates include the following:

• Breads, crackers, and cereal

• Pasta, rice, and grains

• Starch vegetables, such as potatoes, corn, and peas

• Beans and legumes

• Milk, soy milk, and yogurt

• Fruits and fruit juices

• Sweets such as cakes, cookies, ice cream, jam and jelly

One carbohydrate serving is a portion of food that contains 15 g carbohydrate. You can check serving sizes with measuring cups and spoons or a food scale, or by using the nutrition facts label on the food package.

FOOD LISTS FOR CARBOHYDRATE COUNTING

1 serving = approximately 15 g carbohydrate

STARCHES

• 1 slice bread (1 oz)

• 1 tortilla (6-inch size)

• 1/4 bagel (1 oz)

• 2 taco shells (5-inch size)

• 1/2 hamburger or hot dog bun (1 oz)

• 3/4 cup ready-to-eat cereal

• 1/2 cup cooked cereal

• 1 cup broth-based soup

• 4 to 6 small crackers

• 1/3 cup pasta or rice (cooked)

• 1/2 cup beans, peas, corn, sweet potatoes, winter squash, mashed or boiled potatoes (cooked)

• 1/4 large baked potato (3 oz.)

• 3/4 oz. pretzels, potato, or tortilla chips

• 3 cups popcorn (popped)

FRUIT

• 1 small fresh fruit

• 1/2 cup canned fruit

• 1/4 cup dried fruit

• 17 small grapes (3 oz)

• 1 cup melon, berries

• 2 tablespoons raisins

• 1/2 cup fruit juice

CONSISTENT CARBOHYDRATE DIABETIC DIET FOOD LIST

MILK

• 1 cup fat-free or reduced-fat milk

• 1 cup soy milk

• 2/3 cup fat-free yogurt sweetened with sugar-free sweetener (6 oz.)

SWEET AND DESSERTS

• 2-inch square cake (unfrosted)

• 2 small cookies (2 oz. to 3 oz.)

• 1/2 cup ice cream or frozen yogurt

• 1/4 cup sherbet or sorbet

• 1 tablespoon syrup, jam, jelly, table sugar, or honey

• 2 tablespoons light syrup

OTHER FOODS

• Count 1 cup of casserole or other mixed foods as 2 carbohydrate servings

CONSISTENT CARBOHYDRATE

DIABETIC DIET

1/2 cup orange juice ( 1carbohydrate serving) 1/2 cup oatmeal (1 carbohydrate serving) 1 cup low fat milk (1 carbohydrate serving) 1 slice whole wheat bread (1 carbohydrate serving) 1 teaspoon soft margarine

LUNCH

2 oz. lean meat 1/2 cup pinto beans (1 carbohydrate serving) 2 slices whole wheat bread (2 carbohydrate servings) 1 cup carrots (.5 carbohydrate serving) 1/2 cup unsweetened fruit (1 carbohydrate serving)

DINNER

3 oz. Baked Chicken 1/2 cup mashed potatoes (1 carbohydrate serving) 1 cup green beans (.5 carbohydrate serving) 2 small whole wheat dinner rolls (2 carbohydrate servings) 1/2 cup unsweetened fruit (1 carbohydrate serving)

HS SNACK

1 slice whole wheat bread (1 carbohydrate serving) 1 cup low fat milk (1 carbohydrate serving)

Total Carbohydrate Servings: 15

CONSISTENT CARBOHYDRATE CALORIE LEVELS

LOW CALORIE LEVEL

1500-1800 Calories/Day (5-6 CHO/meal)

MEDIUM CALORIE LEVEL

2200-2400 Calories/Day (6-7 CHO/meal)

HIGH CALORIE LEVEL

2600-2800 Calories/Day (7-8 CHO/meal)

ADEQUACY

The diet is adequate in all nutrients; however, women on low calorie (1800) level may need iron supplements.

GUIDELINES FOR DETERMINING CALORIE REQUIREMENTS

FOR DIABETICS

AGE CALORIE REQUIREMENTS

18-20 years Female 13-15 kcal/lb (29-33 kcal/kg) DBW* Male 15-18 kcal/lb (33-40 kcal/kg) DBW

ADULT

Physically Active 14-16 kcal/lb (31-35 kcal/kg) DBW Moderately Active 12-14 kcal/lb (26-31 kcal/kg) DBW Sedentary 10-12 kcal/lb (22-26 kcal/kg) DBW Sedentary >55 y, obese 10 kcal/lb (22 kcal/kg) DBW and/or inactive

PREGNANCY**

1ST trimester 12-16 kcal/lb (26-35 kcal/kg) DBW 2nd & 3rd trimester 13-17 kcal/lb (29-37 kcal/kg) DBW

LACTATION 15-17 kcal/lb (33-37 kcal/kg) DBW

*DBW: Desirable Body Weight **Pregnancy: Weight gain should follow desirable gains on grid. Calories should not fall below 1,800 per day, and rarely should exceed 2,500.

EXCHANGE LIST FOR MEAL PLANNING

The exchange list for meal planning is used as the method of calculation within the ADC. It is the method of choice here since it provides accuracy and uniformity of the meals served. The lists are described as follows:

STARCH LIST

This list includes cereals, grains, pasta, breads, crackers, starch vegetables, beans, peas, lentils, and legumes. Typically, one starch is equivalent to:

▪ 1/2 cup cereal, grain pasta, or starch vegetable

▪ 1 oz. of bread product such as a slice of bread

One starch exchange equals 15 grams carbohydrate, 3 grams protein, 0-1 grams of fat, and 80 calories.

BREAD

Biscuit * (2-1/2” across) 1 Muffin*, small 1 Bread, white, whole wheat, rye 1 slice Pancake* (4” across) 2 Cornbread* (2” cube) 1 Stuffing, bread 1/3 cup Hot Dog or hamburger bun 1/2

*Count as 1 starch and 1 fat

STARCH VEGETABLES

Baked beans 1/3 cup Potato, baked or boiled 1 small Corn 1/2 cup Potato, mashed 1/2 cup Corn on cob (medium) 1 Squash (acorn, winter) 1 cup Mixed Vegetables with corn, 1 cup Yam, sweet potato, plain 1/2 cup peas or pasta Peas, green 1/2 cup

BEANS, PEAS, OR LENTILS

Beans and peas (pinto, kidney, 1/2 cup Lima Beans 2/3 cup white, black-eye, purple hull

FRUIT LIST

Fresh, frozen, canned, and dried fruits and fruit juices are on this list. All items are unsweetened. One fruit exchange equals 15 grams of carbohydrates and 60 calories. Typically, one fruit exchange is equal to:

▪ 1 small to medium fresh fruit

▪ 1/2 cup canned or fresh fruit or juice

▪ 1/4 cup dried fruit

Apple, small 1 Kiwi 1 Applesauce 1/2 cup Mandarin Oranges 3/4 cup Apples, dried 4 rings Mango 1/2 fruit Apricots, fresh 4 whole Nectarine, small 1 Apricots, dried 8 halves Orange, small 1 Apricots, canned 1/2 cup Papaya 1/2 fruit Banana, small 1 Peach, fresh 1 medium Blackberries 3/4 cup Peaches, canned 1/2 cup Blueberries 3/4 cup Pear, fresh 1/2 large Cantaloupe 1/3 melon Pineapple, Fresh 3/4 cup Cherries, sweet, fresh 12 Pineapple, canned 1/2 cup Cherries, sweet, canned 1/2 cup Plums, canned 1/2 cup Dates 3 Prunes, dried 3 Figs, fresh 1-1/2 cup Raisins 2 tbsp.

Figs, dried 1-1/2 cup Raspberries 1 cup Fruit cocktail 1/2 cup Strawberries 1-1/4 cup Grapefruit, large 1/2 Tangerine, small 2 Grapefruit, canned 3/4 cup Watermelon 1-1/4 cup Grapes, small 17 Honeydew melon 1 slice

FRUIT JUICES

Apple juice/cider 1/2 cup Grapefruit juice 1/2 cup Cranberry juice cocktail 1/3 cup Orange Juice 1/2 cup Cranberry juice cocktail, Pineapple juice ½ cup Reduced calorie 1 cup Prune Juice 1/3 cup Fruit juice blends, 100% juice 1/2 cup

MILK LIST

Different types of milk and milk products are on this list. They are placed in groups depending on the amount of fat that they contain. These groups are: skim/very low fat milk, low fat milk, and whole milk. They are counted as follows:

Carbohydrate Protein Fat Calories Skim/very low fat milk 12 g 8 g 0-3 g 90 Low fat 12 g 8 g 5 g 120 Whole milk 12 g 8 g 8 g 150

One milk exchange equals 12 g carbohydrate and 8 g protein

SKIM AND VERY LOW FAT MILK

(0-3 fat per serving)

Skim milk 1 cup Nonfat Dry Milk 1/3 cup dry 1/2 % milk 1 cup Plain Nonfat Yogurt 1/4 cup 1% milk 1 cup Nonfat and low-fat Nonfat buttermilk 1 cup Yogurt 1 cup Evaporated skim milk 1/2 cup

LOW FAT MILK WHOLE MILK

(5 g fat per serving) (8 g fat per serving)

2% milk 1 cup Whole milk 1 cup Plain low fat yogurt 1 cup Evaporated whole Milk 1 cup

VEGETABLE LIST

Typically, one vegetable exchange is equal to:

▪ 1/2 cup cooked vegetable or vegetable juice

▪ 1 cup raw vegetable

NOTE: Starchy vegetables such as corn, peas, winter squash, and potatoes contain larger amounts of carbohydrates and are listed in the Starch List.

Artichokes Eggplant Onions Artichoke Hearts Green onions Pea Pods Beans (green, wax, Italian) Greens (collard, kale, Peppers Bean Sprouts mustard, turnip) Radishes

VEGETABLE LIST CONTINUED

Beets Kohlrabi Salad greens Broccoli Mixed Vegetables Sauerkraut Brussels sprouts Mushrooms Spinach Cabbage Okra Summer squash Tomato, fresh Tomato/Vegetable juice Tomato sauce Turnips Water chestnuts Watercress Zucchini

MEAT AND MEAT SUBSTITUTE LIST

Items in this list contain protein and fat. In general, one meat exchange is equal to:

▪ 1 oz. of meat, fish, poultry, or cheese

▪ 1/2 cup beans, peas, or lentils

Based on the amount of fat they contain, meats are divided into very lean, lean, medium fat, and high fat lists. One ounce of each of these contains:

Carbohydrate (g) Protein (g) Fat (g) Calories

Very lean 0 7 0-1 35 Lean 0 7 3 55 Medium fat 0 7 5 75 High fat 0 7 8 100

Very Lean Meat and Meat Substitutes List

Poultry: Chicken, turkey without skin, Cornish hen without skin 1 oz.

Fish: Fresh or frozen cod, flounder, haddock, halibut, trout, tuna fresh or 1 oz.

canned In water Shellfish: Clams, crab, lobster, scallops, shrimp, imitation shellfish 1 oz.

Game: Duck or pheasant (no skin), venison, buffalo, ostrich 1 oz.

Cheese with 1 gram fat or less per ounce:

Non or low fat cottage cheese 1/4 cup Fat free cheese 1 oz.

Other: Processed Sandwich meats with 1 gram fat or less per ounce, such as deli thin, shave meats, chipped beef, and turkey or ham 1 oz.

Egg Whites 2 Egg substitutes, plain 1/4 cup Hot dogs with 1 gram of fat or less per ounce 1 oz.

Sausage with 1 gram of fat or less per ounce 1 oz.

Count as one very lean meat and one starch exchange:

Beans, peas, lentils (cooked) 1/2 cup

Lean Meat and Lean Meat Substitute List

Beef: USDA Select or Choice grades of lean beef trimmed of fat, such as Round, sirloin, and flank steak, tenderloin, roast (rib, chuck, rump), Steak (T-bone, porterhouse, cubed), ground round 1 oz.

Pork: Lean pork, such as fresh ham, canned, cured or boiled ham, Canadian bacon, tenderloin, center loin chops 1 oz.

Lamb: Roast, chops, leg 1 oz.

Veal: Lean chops, roast 1 oz.

Poultry: Chicken, turkey, domestic duck or goose 1 oz.

Fish: Herring (uncreamed or smoked) 1 oz.

Oysters 6 med.

Salmon (fresh or canned), catfish 1 oz.

Sardines (canned) 6 Tuna (Canned in oil, drained) 1 oz.

Game: Goose (no skin), rabbit 1 oz.

Cheese: 4.5% fat cottage cheese 1/4 cup Grated parmesan 2 T.

Cheese with 3 grams of fat or less per ounce 1 oz.

Other: Hot dogs with 3 grams of fat or less per ounce 1.5 oz.

Processed Sandwich meat with 3 grams of fat or less per ounce 1 oz.

Liver, heart (high in cholesterol) 1 oz.

Medium Fat Meat and Substitute List

Beef: Ground beef, corned beef, short ribs, prime rib 1 oz.

Pork: Top loin, chop, Boston butt, cutlet 1 oz.

Lamb: Rib roast, ground 1 oz.

Veal: Cutlet (unbreaded) 1 oz.

Poultry: Chicken (dark meat with skin), ground chicken or turkey 1 oz.

Cheese: With 5 grams of fat per ounce Feta, Mozzarella 1 oz.

Ricotta 1/4 cup OTHER: Egg (high in Cholesterol) 1 Sausage with 5 grams of fat or less per ounce 1 oz

High Fat Meat and Substitute List

Pork: Sparerib, ground pork, sausage 1 oz.

Cheese: All regular cheese such as American, cheddar, Monterey jack, Swiss 1 oz.

Other: Processed sandwich meats with 8 grams of fat or less per ounce such as bologna, pimento loaf, salami, sausage such as bratwurst, Italian, knockwurst, Polish smoked 1 oz.

Count as one high fat meat and two fat exchanges:

Peanut butter 2 T.

FAT LIST

One serving of fat contains 5 grams of fat, 0 grams of carbohydrate, 0 grams of protein, and 45 calories. This applies to all forms of fat whether it is saturated or unsaturated.

Typically, one fat exchange is equal to:

▪ 1 tsp. of regular margarine or vegetable oil

▪ 1 tsp. of regular salad dressing

Monounsaturated Fats List

Avocado, Medium 1/8 Oil (canola, olive, peanut) 1 tsp.

Olives 8 Nuts:

Almonds, Cashews 6 Mixed (50% peanuts) 6 Peanuts 10 Pecans 4 halves Peanut Butter 2 tsp.

Sesame Seeds 1 T.

Polyunsaturated Fats List

Margarine (stick, tub, or squeeze) 1 tsp.

Lower Fat 1 T Mayonnaise: regular 1 tsp.

Reduced Fat 1 T Nuts, Walnuts, English 4 halves Oil (corn, safflower, soybean) 1 tsp.

Salad Dressing: regular 1 T Reduced Fat 2 T Seeds: Pumpkin, Sunflower 1 T

Saturated Fats List

Bacon, Cooked 1 slice (20/lb) Bacon grease 1 tsp.

Butter, stick or whipped 1 tsp.

Reduced Fat 2 tsp.

Chitterlings, boiled 2 T Coconut 2 T Cream, half and half 2 T Cream cheese: regular 1 T Reduced Fat 2 T Fatback or salt pork 1 tsp.

Shortening or lard 1 tsp.

Sour cream: regular 2 T Reduced Fat 3 T

FREE FOODS LIST

A free food is any food that contains less than 20 calories per serving or less than 5 grams of carbohydrate per serving. These foods should be limited to no more than 3 servings per day and the serving size should be followed.

Fat Free or Reduced Fat Foods

Cream cheese, fat free 1 T Creamers, non dairy, liquid 1 T Creamers, non dairy, powder 2 tsp.

Mayonnaise, fat free 1 T Mayonnaise, reduced fat 1 tsp.

Margarine, fat free 4 T Margarine, reduced fat 1 tsp.

Miracle Whip, reduced fat 1 tsp.

Miracle Whip, non fat 1 T Salad Dressing, fat free 1 T Salad Dressing, fat free Italian 2 T Salsa 1/4 cup Sour Cream, fat free, reduced fat 1 T Whipped topping, regular or light 2 T

Sugar Free or Low Sugar Foods

Candy, hard, sugar free 1 pc Jam or jelly, low sugar or light 2 tsp.

Syrup, sugar free 2 T

Drinks

Bouillon, broth, consommé Bouillon or broth, low sodium Carbonated or mineral water Club Soda Cocoa powder, unsweetened 1 T Coffee Diet Soft Drinks, sugar free Drink mixes, sugar free Tea, sugar free Tonic water, sugar free

Condiments

Catsup 1 T Horseradish Lemon Juice Lime Juice

Mustard Pickles, large dill 1-1/2 Soy sauce, regular or light 1 T Taco sauce Vinegar

Seasonings

Flavoring Extracts Spices Garlic Tabasco or hot pepper sauce Herbs, fresh or dried Wine, cooking Pimento Worcestershire sauce

FAT-RESTRICTED DIET

Fat-restricted diet limits the daily total fat intake to 20% to 30% of total energy. A 2000 kcal/day menu should limit total fat to approximately 45 g to 65 g. A fat-restricted diet may be individualized based on symptoms or diagnosis. A common low-fat diet order comprised 50 g fat/day. A fat-restricted diet may be indicated if an individual is having trouble digesting or absorbing fat and may help prevent uncomfortable side effects such as diarrhea, bloating, and cramping that may occur with consumption of high-fat foods. This diet is prescribed for disorders of the pancreas, gall bladder, liver, and gastrointestinal tract.

Increased blood cholesterol increases the risk of coronary heart disease. Nutrition therapy is the cornerstone in reducing elevated blood cholesterol. Its purpose is to lower total cholesterol as well as LDL levels and should address three factors that contribute to high levels of blood cholesterol:

1. High intake of saturated fats

2. High intake of dietary cholesterol

3. Obesity

Familia hypercholesterolemia rarely responds to diet alone. Individuals should be assessed after 4 to 6 weeks of therapy and again at 3 months. After that time, cholesterol-lowering medications may be Indicated. This diet was planned using the 2020-2025 United States Dietary Guidelines for Americans to assure that all nutrients are provided.

1 cup cooked cereal 1 slice bread 1 teaspoon vegetable margarine 1 cup skim milk 1 cup coffee

LUNCH

3 ounces lean meat, fish, poultry or 6 oz. meat casserole 1/2 cup dried beans 1/2 cup fat free starch (omit starch if serving casserole) 1 cup fat free vegetables 1/2 cup fruit 1 slice bread or roll 1 cup beverage

DINNER

3 ounces lean meat, fish, poultry or 6 oz. meat casserole 1/2 cup dried beans 1/2 cup fat free starch (omit starch if serving casserole) 1 cup fat free vegetables 1/2 cup fruit 1 slice bread or roll 1 cup beverage

1 cup oatmeal 1 slice toast 1 teaspoon vegetable margarine 1 cup skim milk Coffee

LUNCH

3 oz. lean beef patty 1/2 cup fat free mashed potatoes 1 cup fat free steamed broccoli 1/2 cup canned peaches 1 yeast roll 1 cup iced tea

DINNER

3 oz. skinless baked chicken 1/2 cup fat free steamed rice 1 cup fat free green beans 1 roll ½ cup sliced pears 1 cup skim milk

DAIRY

ALLOWED: Fat-free, low-fat milk or buttermilk; Fat-free or low-fat yogurt or cottage cheese; lactose-free yogurt or lactose free cottage cheese; fat-free and low-fat cheese; fat-free, lactose-free milk and lactose-free, low-fat ice cream/frozen yogurt and sour…