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Paige HarrisonKNH413April 18, 2012Diet: Low-Residue1. PurposeNutrition indicators are generally symptoms that occur as a result of GI inflammation. These can include, but are not limited to the following: diarrhea, blood in stools, abdominal pain and cramping, ulcers, reduced appetite and weight loss. (Mayo Clinic)This diet should be used for any individual suffering from GI inflammation, as a result of disease states like inflammatory bowel disease (IBD) or if there is narrowing of the bowel due to a tumor; after bowel surgery, or when treatment, such as radiation, damages or irritates the gastrointestinal tract.The rationale for the diet is that by limiting foods high in fiber, it also limits the amount of undigested materials that pass through your large intestine and lessens stool bulk. This provides relief and prevents exacerbation of symptoms caused by IBD.2. PopulationIBD causes inflammation along the GI tract, either in one specific area or in skipping patterns that occur anywhere from mouth to anus. It occurs in varying degrees, with periods of acute illness often alternating with periods of remission. (Mayo Clinic)Patients with IBD may need supplements of iron to prevent iron deficiency anemia that could result from chronic intestinal bleeding as a result of the inflammation. Vitamin B-12 shots may also be required if inflammation is occurring in the ileum, where it is normally absorbed. (Mayo Clinic)3. General GuidelinesNutrition Rx: Patients are generally prescribed a low-residue, lactose-free diet. If steatorrhea occurs, fat should be reduced with added medium chain triglycerides (MCT) to meet energy requirements. (Nelms, 2011)Adequacy of Nutrition Rx: The low-residue diet is not one that should be followed long-term, as it limits the amount of fiber a person receives to undesirably low levels. If a lactose-free diet is simultaneously followed, it is important to include milk substitutes that are fortified, to prevent vitamin D and calcium deficiencies.Goals: The goals are to decrease fiber intake to a level that minimizes physical symptoms of GI inflammation. All energy and macronutrient goals should still be followed for the specific individual.Does it meet DRI?: Should meet the DRI for every nutrient, except fiber. Nutrients found in food products that provide high fiber should be found in alternative food sources to avoid deficiencies.4. Education MaterialNutrition Therapy: Counseling on low-residue and lactose-free diets is recommended to ensure compliance. Additionally, intervention with low-fiber supplements may be advised if an individual struggles with meeting energy and macronutrient needs. An iron and/or vitamin B-12 supplement may also be considered to prevent typical deficiencies.Ideas for Compliance: Schedule appointments for monitoring and evaluating nutritional status, provide information on foods to incorporate/eliminate while following the low-residue diet, incorporate family/support systems into counseling to encourage compliance.5. Sample MenuFoods Recommended: enriched white bread/rolls/crackers (without seeds), white rice, white pasta, refined cereals, canned or cooked fruits without skin or seeds, fruit juice without pulp, canned or well-cooked vegetables without seeds, hulls, or skins, tender meat/poultry/fish, eggs, tofu, creamy peanut butter, butter, oilsFoods to Avoid: whole wheat/whole grain breads, cereals, and pastas, brown or wild rice, oats, quinoa, barley, dried fruits, prune juice, raw fruit, raw or undercooked vegetables, dried beans, peas and lentils, seeds and nuts (and foods containing them), coconut, popcornOne Day Sample Meal Plan:2 eggs, scrambled1 slice white toast with seedless grape jelly? cup canned pears1 glass skim milkTurkey sandwich (2 slices white bread, 2 oz. lean deli turkey, 1 slice iceberg lettuce, 1 T mayonnaise)1 cup applesauce? cup cooked carrotsIced tea4oz. Pork ChopBaked potato (without skin)? cup cooked green beansWhite roll with butter1 glass skim milkCanned peaches with whipped topping6. WebsitesOrganizations with websites: Mayo Clinic, Crohn’s and Colitis Foundation of AmericaGovernment websites: National Institutes of Health ()7. ReferencesEl-Salhy, M., Lilleb?, E., Reinemo, A., Salmelid, L., & Hausken, T. (2010). Effects of a health program comprising reassurance, diet management, probiotics administration and regular exercise on symptoms and quality of life in patients with irritable bowel syndrome.?Gastroenterology Insights,?2(1), 21-26. doi:10.4081/gi.2010.e6 Williams, E. A., Nai, X., & Corfe, B. M. (2011). Dietary intakes in people with irritable bowel syndrome.?BMC Gastroenterology,?11(1), 9-15. doi:10.1186/1471-230X-11-9Yoon, S. L., Grundmann, O., Koepp, L., & Farrell, L. (2011). Management of Irritable Bowel Syndrome (IBS) in Adults: Conventional and Complementary/Alternative Approaches.Alternative Medicine Review,?16(2), 134-151. ................
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