MODULE

Dietary
Therapy
 What is dietary therapy and why it is
important to us?

� According to Webster, it is a branch of dietetics concerned with

therapeutic uses of food and diet, to treat and prevent a specific
diseases and generally to promote wellness.

It is usually involves by having a good dietary lifestyle. For example,

in treating obesity or excess weight, exercise or having a good habit
in sports is not only the way to achieved to a healthy diet but also by
changing the personal eating habits that is needed by our body.
Regular/Full Diet
 Regular/Full Diet
� A regular diet is one that does not include any dietary restrictions. It
should include all of the characteristics of a healthy diet, which means it
should be balanced, adequate in nutrients, moderate in all foods, include
a variety of foods and be calorie controlled.
� The diet should include a healthy foundation of whole grains, fruits and
vegetables, lean proteins (including beans and legumes), low-fat daily
and sources of healthy fats, but it still allows for the occasional favorite
treat.
� We that regular diet composed of all types of foods, is well balanced and
capable of main-taining a state of good nutrition. It is intendedfor
convalescing patients who do not require a therapeutic diet.

https://www.sharecare.com/health/diet-nutrition/what-is-a-regular-diet
 Types of Therapeutic Diet
� Types of Therapeutic Diets
� A therapeutic diet is a meal plan that controls the intake of certain
foods or nutrients. It is part of the treatment of a medical condition and
are normally prescribed by a physician and planned by a dietician.

� A therapeutic diet is usually a modification of a regular diet. It is

modified or tailored to fit the nutrition needs of a particular
person.Therapeutic diets are modified for
� nutrients
� texture, and/or
� food allergies or food intolerances.
 What does regular diet mean?

� A regular diet is one that any food is included and you are
free to eat what you feel like. It may or may not be a
“healthy” diet, but all foods are included.

� Diet is a healthy meal plan that includes a variety of

healthy foods from all the food groups. A plan you do not
have any health conditions that require a special diet. A
healthy meal plan is low in unhealthy fats, salt, and added
sugar.

https://www.quora.com/What-is-a-full-regular-diet
Common reasons therapeutic diets may
be ordered:
 Regular Diet: Regular diets are planned to meet the
nutritional needs of adolescents, adults, and geriatric phases
of the life span.
� (1) The regular diet includes the basic food groups and a variety of foods. The basic
food groups include meat, milk, vegetables, fruits, bread and cereal, fats, and
sweets.
� (2) The standard menu mat, DA Form 2901-R (Regular Diet) provides approximately
3375 calories. The selective menu is developed by each individual hospital
according to patient needs, food availability, and cost. The regular diet is designed to
provide exceptionally generous amounts of all recognized nutrients and meets or
exceeds the RDA for all nutrients tabulated.
� (3) The Food Guide Pyramid is an outline of what we should eat each day (see
figure 5-1). It shows six food groups, but emphasizes foods from the five food
groups shown in the lower sections of the Pyramid. You need food from each group
for good health. Each of the food groups provides some of the nutrients you need.
Food from one group cannot replace those of another group.
https://brooksidepress.org/Products/Nursing_Fundamentals_II/lesson_5_Section_1C.htm
 Food Guide Pyramid

https://brooksidepress.org/Products/Nursing_Fundamentals_II/lesson_5_Section_1C.htm
 Common Therapeutic Diet
1.Nutrient modifications
• No concentrated sweets diet
• Diabetic diets
• No added salt diet
• Low sodium die
• Low fat diet and/or low cholesterol diet
• High fiber diet
• Renal diet
2.Texture modification
• Mechanical soft diet
• Pure diet
3.Food allergy or food intolerance modification
• Food allergy
• Food intolerance
4.Tube feedings
• Liquid tube feedings in place of meals
• Liquid tube feedings in addition to meals
5. Additional feedings – In addition to meal, extra nutrition may be ordered as:
• Supplements – usually ordered as liquid nutritional shakes once, twice or three
times per day; given either with meals or between meals
• Nourishments – ordered as a snack food or beverage items to be given between
meals mid-morning and/or mid-afternoon
• HS snack – ordered as a snack food or beverage items to be given at the hour of
sleep
 The following list includes brief descriptions of common
therapeutic diets:
� Clear liquid diet –
� Includes minimum residue fluids that can be seen through.
� Examples are juices without pulp, broth, and Jell-O.
� Is often used as the first step to restarting oral feeding after surgery or an abdominal procedure.
� Can also be used for fluid and electrolyte replacement in people with severe diarrhea.
� Should not be used for an extended period as it does not provide enough calories and nutrients.
� Full liquid diet –
� Includes fluids that are creamy.
� Some examples of food allowed are ice cream, pudding, thinned hot cereal, custard, strained
cream soups, and juices with pulp.
� Used as the second step to restarting oral feeding once clear liquids are tolerated.
� Used for people who cannot tolerate a mechanical soft diet.
� Should not be used for extended periods.
High Fiber Diet
 Definition
❑ Fibers are also known as roughage or bulk

❑They are sugars and starches (polysaccharides) from

plants. Fruits, vegestables, whole grains and
legumes, such as peas and beans.

❑Another way to get fiber is through natural

supplements such as psyllium, which is made from
the seed of a shrub-like herb.
 Dietary Fiber vs. Functional Fiber

❑Dietary fiber: consists of nondigestible

carbohydrates and lignin that are intrinsic and
intact in plants.

❑ Functional Fiber: consists of isolated,

nondigestible physiological effects in humans.
 Dietary Fiber Classifications
1. Soluble ( dissolves in water and may form a gel)
-Soluble fiber can help to lower cholesterol and regulate
glucose levels as well as promote regularity.

Ex. Oats
⮚Fruits and Vegetables
⮚Beans
⮚Barley
⮚Psyllium
2. Insoluble ( does not dissolve in water)
-Insoluble fiber adds bulks to the stool and
contributes to bowel regularity. Examples are:

Ex.
⮚ Whole-wheat flour
⮚ Wheat bran
⮚ Some vegestables
⮚ Virtually all plant foods contain soluble and insoluble
fiber.
� Fiber itself does not contribute to bone strength to calcium
metabolism, but some fiber supplements do contain calcium as an
ingredient which help with good bone health. Examples are calcium
polycarbophil in Fibercon and Metamucil Capsules Plus Calcium.

� Dietary Fiber enhances satiety( feeling full while eating) and may
prevent over eating. High Fiber diets tend to have more volume and
less calories than other types of diets.

� In addition to promoting regularity, fiber lowers the risk of developing

many life threatening diseases and conditions, such as heart disease,
certain forms of cancer, diabetes, stroke and obesity.
� Soluble fibers for instance, like those found in oat bran, oranges,
apples, carrots and dried beans, entraps cholesterol components in
the blood which can help lower cholesterol and prevent heart disease.

� And because of fiber is not digested, it keeps you feeling full for
longer, which can minimize or eliminate unnecessary snacking that
can lead to obesity and/or certain types of diabetes.

� Some studies show that a high fiber diet will prevent colon cancer.
However, the best approach to preventing colorectal cancer is to
undergo regular screening for and removal of colon polyps, along with
smoking cessation, a diet low in saturated fat, maintaining a normal
body wieght and engaging in normal physical activity.
Psyllium

�This natural fiber supplement has some

positive health benefits. Made from the
seed of a shrub-like, psyllium is high in
soluble fiber and also is a source of
insoluble fiber.
Psyllium: Dietary fibers
Functional Fiber
�Unlike protein and fat, the body does not
digest and absorb fiber. But rest assured,as
fiber passes unchanged through your
stomach and small intestine into the large
intestine (colon), it is working hard to keep
you healthy.
Benefits of Dietary Fiber
 Benefits

� Heart health
� It aids in wieght regulation
� Helps lower cholesterol
� Stabilizes blood sugar
� In fact, one-third of your daily fiber intake should be from
soluble fiber.
 Sources
� Corn niblets- Corn is good
source of fiber

� (3 gtrams per ½ cup

serving). Weather it’s fresh,
canned or frozen, corn is a
great addition to chili soups,
salads, stews or delicious
on its own.
Corn Niblets
� Dried Prunes

� This is an ideal snacks. Buy

the pitted variety so you can
add them to cereal( more
fibera) or yogurt. May savory
stews call for dried prunes to
add contrast to other flavors.
Side Effects of High Fiber Diets

�1-gas, flatulence and bloating

�2-reduce ability to absorb some vitamins
and minerals. Those nutrients include iron,
zinc, magnesium, calcium and
phosphorus.
�3-interaction with some medications.
Vegan Diet
 ⮚A vegan diet contains only plants
(such as vegetables, grains, nuts and
fruits) and foods made from plants.

⮚Vegans do not eat foods that come

from animals, including dairy products
and eggs.

https://www.nhs.uk/live-well/eat-well/the-vegan-diet
 Healthy eating as a Vegan
� eat at least 5 portions of a variety of fruit and vegetables every
day
� base meals on potatoes, bread, rice, pasta or other starchy
carbohydrates (choose wholegrain where possible)
� have some dairy alternatives, such as soya drinks and yoghurts
(choose lower-fat and lower-sugar options)
� eat some beans, pulses and other proteins
� choose unsaturated oils and spreads, and eat in small amounts
� drink plenty of fluids (the government recommends 6 to 8 cups
or glasses a day)
VEGAN SOURCES OF CALCIUM AND
VITAMIN D

� Calcium is needed to maintain healthy bones and

teeth.

� Non-vegans get most of their calcium from dairy

foods (milk, cheese and yoghurt), but vegans
can get it from other foods.
 Good sources of calcium Good sources of vitamin
for vegans include: D for vegans include:

� green, leafy vegetables – such as broccoli, � exposure to sunlight, particularly

cabbage and okra, but not spinach
� fortified unsweetened soya, rice and oat
drinks
� calcium-set tofu
� sesame seeds and tahini
� pulses
� brown and white bread (in the UK, calcium
is added to white and brown flour by law)
� dried fruit, such as raisins, prunes, figs and
dried apricots
from late March/early April to the
end of September – remember to
cover up or protect your skin before
it starts to turn red or burn (see
vitamin D and sunlight)
� fortified fat spreads, breakfast
cereals and unsweetened soya
drinks (with vitamin D added)
� Vitamin D supplements
VEGAN SOURCES OF VITAMIN B12

⮚ The body needs vitamin

Sources of vitamin B12 for
B12 to maintain healthy
vegans include:
blood and a healthy
nervous system. ▪ breakfast cereals
fortified with B12
⮚ Many people get vitamin ▪ unsweetened
B12 from animal sources, soya drinks fortified
such as meat, fish and with vitamin B12
dairy products. Sources ▪ yeast extract, such as
for vegans are limited and Marmite, which
a vitamin B12 supplement is fortified with vitamin
may be needed. B12
 VEGAN SOURCES OF OMEGA-3 FATTY
ACIDS

Sources of omega-3 fatty acids

⮚ Omega-3 fatty acids, suitable for vegans include: 
primarily those found in
oily fish, can help ▪ flaxseed (linseed) oil
maintain a healthy heart ▪ rapeseed oil
and reduce the risk of ▪ soya oil and soya-
heart disease when eaten based foods, such as
as part of a healthy diet. tofu
▪ walnuts
⮚Evidence suggests that plant sources of omega-3 fatty
acids may not have the same benefits in reducing the
risk of heart disease as those in oily fish.
⮚But if you follow a vegan diet, you can still look after
your heart by eating at least 5 portions of a variety of
fruit and vegetables every day, cutting down on food
that's high in saturated fat, and watching how
much salt you eat.
 Therapeutic Diet
� This therapeutic diet is formulated to know the nutritional
needs of the client in order to treat a variety of diseases and
disorders or to improve the eating capabilities of a patient or
client that are used by a dietitians to either maintain a healthy
lifestyle or improving health.

� In other term, it is a meal plan that controls the intake of a

certain foods and nutrients that is usually part of a treatment of
a medical condition of a person.

Source: www.pedagogyeducation.com
 NUTRITION THERAPY in ANY
CONDITIONS OR DISEASES and ITS
DIETARY TREATMENT

Source: Basic Nutrition and Diet Therapy Textbook (2nd Edition) by Maria Lourdes Cruz Caudal, RND, MEM
 CONDITION/DISEASES
⮚ Obesity- it is a condition in which the natural energy
reserved is increased, that are usually prone to heart
disease.
⮚ Diabetes Mellitus- is a metabolic disease that affects
the endocrine system of the body and the use of
carbohydrates and fats.
DIETARY TREATMENT
• Having a low-calorie diet (Women usually lose weight
satisfactorily on diets restricted to 1,000-1,500 cal.
Whereas men lose weight satisfactorily on diets
furnishing 1,200-1,800 cal.)
CHARACTERISTICS OF DIET
• Energy (overweight diabetics are initially placed on
low-calorie diets because weight lose results in better
tolerance to carbohydrates.
IN BED : 11-12 cal/lb
SEDENTART : 13-14 cal/lb
MODERATELY ACTIVE: 15-16 cal/lb
• Protein (About 1 ½ g per kg body weight (1/2-2/3 g per
lb) is usually allowed. The higher level is more typical
for patients who show a preference for protein-rich
foods.)
• Carbs and Fats (the number of grams of fat is
ordinarily about the same as the number of grams of
proteins; the amount of carbs is roughly twice the
number of grams of protein.)
 GASTROINTESTINAL TRACT
⮚ Ulcerative colitis- is an inflammatory bowel disease of the
large intestine limited to the rectum and the colon which
causes profuse and bloody diarrhea.
⮚ Peptic Ulcer- ulceration in the protective inside layer of the
lower esophagus, stomach and duodenum.
⮚ Diverticular diseases (diverticulosis and diverticulitis) –
results from the swelling of small pouches in the colon wall
and lining.
⮚ Non-tropical sprue- is a diarrheal condition in which
excessive fat is excreted in the stool (steatorrhea).
TREATMENT : Rest, Nutritional therapy, sulfonamides
DIET THERAPY
• High Protein (Protein supplements are used with food
sources to supply 120-150 rams of protein per day)
• High Calories (About 2,500-3,000 cal/day)
Increased Vitamins and Minerals (grains, fruits, vegies, protein
foods)
DIET THERAPY
• Bland diet (include foods that has bland flavor and soft
consistency, and mechanically and chemically non-
stimulating)
DIETARY TREATMENT
• A well-balanced diet with variety of foods and adequate
protein is recommended
DIET THERAPY
• High-protein diet (100g or more)
• Cereals and breads containing wheat, rye, or oats must be
omitted.
• Corn and rice cereals can be substituted.
• A low-fat fiber diet maybe better tolerated during the initial
stages.

⮚ Diarrhea- frequent loose or liquid bowel movements
that prevents complete digestion and absorption.
⮚ Lactose intolerance- caused by a deficiency of
lactase (the sugar in milk).
⮚ Constipation- condition in which person experiences
hard feces that are difficult to egest.
⮚ Intestinal Gas- increased occurrence of passage of
gas or cramping pain associated with the build-Up of
gas in the GIT.
TREATMENT : Nutritional management
DIET THERAPY
• NPO or nothing by mouth for 12 hrs. with IV fluids and
electrolytes.
• Oral fluids as conditions improve
• Liberal fluids to prevent dehydration
TREATMENT : Nutritional Management
DIET THERAPY
• Lactose Restricted-Diet (milk product)
TREATMENT : Nutritional Management, regular exercise
DIET THERAPY
• High-fiber diet (20-35g/day)
• Liberal fluid-intake
TREATMENT : Nutritional Management
DIET THERAPY
• Include food that produces gas.
• Small frequent meals, and chewing food thoroughly are
advised.

⮚ Hemorrhoids- are enlarged veins which occur in the
lower part of the rectum at the anal opening.
LIVER
⮚ Hepatitis- an inflammation of the liver.
⮚ Hepatic coma- happens where there is too much
ammonia in blood circulation.
TREATMENT : Nutritional Management
DIET THERAPY
• High-fiber Diet (25-35 g/day to relieve constipation.
• Liberal –fluids (8-10 glasses of water per day.
• Highly-seasoned foods and relishes are to be avoided.
• Low-fiber diet is recommended during flare-ups.
TREATMENT : Rest, Optimum Nutritional Therapy
DIET THERAPY
• Protein (2/3 from animal source)
• Energy (whenever the protein allowance is increased,
the caloric level of the diet must be sufficient to meet
the body’s energy needs)
• Minerals/Vitamins (The foods added to the diet foe
protein also increase the intake of calcium, iron, and
vitamin B-complex)
• Moderate Fat- (80-100 g of fat should be provided
daily)
TREATMENT: Nutritional Therapy
DIET THERAPY
• High calories about 1,500-2,000 calories to prevent
tissue catabolism and the liberation of additional
nitrogen.
 GALLBLADDER
⮚ Cholecystitis- refers to the inflammation of the
gallbladder which might result from either the formation
of gallstone blocking cystic duct or infection of the
gallbladder.
PANCREAS
⮚ Pancreatitis- is the inflammation of the pancreas due
to a decreased production of the digestive enzymes.
⮚ Cystic fibrosis- hereditary disease in which the levels
of sodium and chloride in tears and saliva, electrolytes
in sweat, and viscous secretions in the small intestine,
pancreas, bile ducts and bronchi become high.
TREATMENT : Nutritional Therapy, reduced discomfort
DIET THERAPY
• Low Fat Diet
• Plain and simple food are recommended
• Spices and high-residue foods must be avoided as they
cause distention and increase peristalsis.
TREATMENT : Depends on the severity of pancreatitis
itself
DIET THERAPY
Fluids and electrolytes given in intravenously.
TREATMENT: Improvement of nutritional status
DIET THERAPY
• Calories enough to supply demands for growth
• High-protein diet to compensate for fecal losses
• Vitamins and minerals
• Liberal fluid intake
 CARDIOVASCULAR DISEASES
⮚ Atherosclerosis- hardening of the arteries
⮚ Congestive Heart Failure (CHF)- a circulatory
congestion resulting in the hearts inability to maintain
adequate b blood supply to meet the oxygen demands.
KIDNEYS
⮚ Acute glomerulonephritis-may be a deferred
hypersensitivity reaction initiated by infectious agents
related with tonsilitis or scarlet fever or is a
consequence when an antigen-antibody complex
reaction in which some of the complexes become
ensnared in the glomeruli leads to swelling.
TREATMENT : Drugs and Diet
DIET THERAPY
• Low-Fat diet, low in saturated fat and cholesterol.
• A total of 300 mg cholesterol intake per day
• Dietary Fiber 25-30 g/day
DIET THERAPY
• Sodium restricted
-mild restriction (2-3 g Na)
-moderate restriction (1,000mg Na)
-strict restriction (500mh Na)
-severe restriction (250 mg Na)
• Calorie Control
• Caffeine should be limited.
TREATMENT : Nutritional Therapy
DIET THERAPY
• High calorie diet chiefly from carbohydrates and fat to
spare tissues from being used as an energy source.
• No sodium restriction unless edema is seen.

⮚ Nephrotic Syndrome-characterize by massive loss of
protein in the blood and edema.
⮚ Cancers- seen as an atypical growth of cells resulting
in a mass that invades and destroy normal tissue.
TREATMENT : Nutritional Therapy
DIET THERAPY
• Diet in high protein.
• High calorie intake to spare proteins for tissue
synthesis and to provide energy.
• Sodium restriction (500mg)
TREATMENT : Nutritional Management
1. Oral Nutrition -High-calorie intake, high-protein
beverages may be offered (incase of lactase
deficiency, Lactaid may be given).
2. Tube Feeding- complete products (meal replacement
that require digestion and absorption), chemically-
defined products (minimal for pancreatic cancer
patients), modular products (used in combination with
other tube feeding products to enhance calorie or
protein intake), specially products (vary in terms
specific amino acid, carbohydrate, and fat contents, for
patient with hepatic or renal failure)
3. Total Parenteral Nutrition- used when the digestive
tract is not functioning and nutrients administered
intravascularly.

⮚ Acquired Immune Deficiency syndrome (AIDS)-
caused by human immunodeficiency virus or HIV.
(transmitted by sexual intercourse, blood transfusion,
sharing contaminated needles, mother to child pregnancy,
childbirth, or breastfeeding.)
TREATMENT : Nutritional Management
• Dietary management
-energy (35-45 kcal/kg BW)
-protein (2-2.5 g/kg BW)
-fats (increase omega-3 sources and decrease
saturated fats in the diet.
-vitamins and minerals (an increase to be
recommended in case of altered metabolism)
• Alternative Management
-Common in patients with chronic or terminal illness
-May range from vitamins and mineral
supplementation.