Dietary fiber is the undigestible part of plants that maintains the structure of the plant.  Dietary fiber includes cellulose, hemicellulose, polysaccharides, pectins, gums, mucilages, and lignins.  Although they are chemically unrelated, they all resist digestion by the human body.  It is this resistance that makes these fibers important in both the normal functioning and in disorders of the large intestine or colon.

In certain medical conditions, it is important to restrict fiber.  These include acute or subacute diverticulitis, and the acute phases of certain inflammatory conditions of the bowel – ulcerative colitis or Crohn’s disease.  After some types of intestinal surgery, a low fiber/low residue diet may be used as a transition to a regular diet.  A low fiber diet may also be used for a period of time after a colostomy or ileostomy is performed.

Nutrition Facts

Depending upon individual food selection, the low fiber/low residue diet is adequate in all nutrients (National Research Council’s Recommended Dietary Allowance).  If the diet must be strict and followed over a long period of time, the intake of fruits and vegetables may not be adequate; and/or on a low residue diet, there may not be enough calcium included.  In these cases, a multivitamin supplement or liquid nutritional supplement may be needed.

Special Considerations

If a low fiber or low residue diet results in abdominal cramps or discomfort, notify the dietitian or physician immediately.

Food Groups

Group	Recommend	Avoid
Milk & Milk Products (2 or more cups daily	all milk products	Low Residue Diet – only 2 cups daily of all milk products
Vegetables (2 servings daily) 1 serving = 1/2 cup	vegetable juice without pulp; the following cooked vegetables: yellow squash (without seeds), green beans, wax beans, spinach, pumpkin, eggplant, potatoes without skin, asparagus, beets, carrots; tomato sauce and paste	vegetable juices with pulp, raw vegetables, cooked vegetables not on the Recommend list
Fruits (2-3 servings daily)     1 serving = 1/2 cup	fruit juices without pulp, canned fruit except pineapple, ripe bananas, melons, peeled and cooked apples, orange and grapefruit without the membrane	fruit juices with pulp, canned pineapple, fresh fruit except those on Recommend list, prunes, prune juice, dried fruit, jam, marmalade
Starches – Bread & Grains (4 or more servings daily)	bread and cereals made from refined flours, pasta, white rice, saltines, tapioca	whole-grain breads, cereals, rice, pasta, bran cereal, oatmeal
Meat or meat substitutes (5-6 oz daily)	meat, poultry, eggs, seafood, cottage cheese, other mildly flavored cheese	chunky peanut butter, nuts, seeds, dried beans, dried peas, tough gristly meats, hot dogs, sausage, sardines, fried meats, strongly flavored cheeses
Fats & Oils	all oils, margarine, butter	coconuts, fats used for deep frying
Sweets & Desserts (servings depend on caloric needs)	all not on Avoid list	desserts containing nuts, coconut, raisins, seeds
Miscellaneous	all not on Avoid list	popcorn, pickles, horseradish, relish

Sample Menu

Breakfast	Lunch	Dinner
orange juice 1/2 cup cornflakes 1 cup poached egg white toast 1 slice margarine 1 tsp jelly 1 Tbsp skim milk 1 cup coffee 3/4 cup sugar 1 tsp non-dairy creamer salt/pepper	fish 3 oz rice 1/2 cup cooked green beans 1/2 cup white bread 1 slice margarine 1 tsp jelly 1 Tbsp applesauce 1/2 cup coffee 3/4 cup sugar 1 tsp non-dairy creamer salt/pepper	chicken breast 3 oz noodle 1/2 cup cooked carrots 1/2 cup white bread 1 slice margarine 1 tsp jelly 1 Tbsp canned peaches 1/2 cup skim milk 1 cup coffee 3/4 cup sugar 1 tsp non-dairy creamer salt/pepper

This sample menu provides the following:

Calories…………………. 1,576                      Fat………………. 45 gm
Protein …………………. 89 gm                    Sodium………….. 2,817 mg
Carbohydrates…………. 215 gm                Potassium………. 3,510 mg

For a regular healthy diet, it is recommended that of the total calories eaten, no more than 30% should come from fat. However, certain diseases and medical conditions can make it difficult for the body to tolerate even that much fat, so a low-fat diet may help people with these conditions.

Following a low-fat diet can be helpful for many different diseases such as gallbladder disease, delayed stomach emptying (gastroparesis), diarrhea, and fatty liver disease.

In general, it is advised that all visible fat be trimmed from meats. All foods, including meat and fish, should be baked, steamed, or broiled rather than fried.

• Gallbladder Disease: Bile secreted from the gallbladder helps the body break down and absorb fats. When gallstones or gallbladder diseases are present, a low-fat diet is often used to prevent complications.
• Delayed stomach emptying (Gastroparesis) is a condition in which the stomach empties food into the intestine too slowly. This can cause bloating, nausea, and even vomiting. Normally, fat in foods delays stomach emptying, so fats make gastroparesis worse.
• Diarrhea can be caused by many conditions. When it occurs, it can be aggravated by eating fatty foods.
• Malabsorption of nutrients: Absorption is the transfer of nutrients into the bloodstream from the intestine. In some diseases of the pancreas and small intestine, patients have trouble absorbing nutrients from the diet, including fat. A low-fat diet may help to control symptoms until the cause of malabsorption can be diagnosed.

Nutrition Facts

In most cases, this diet provides all the nutrients required by the National Research Council’s Recommended Dietary Allowances (RDA). In some cases, however, the physician may prescribe supplements. Women of childbearing age and those people with malabsorption may need to take certain vitamin and/or mineral supplements.

Special Considerations

Be careful how foods are prepared. Trim all visible fat from meats. Bake, steam, or broil meats and fish instead of frying. Toppings for potatoes and pastas should contain no fat above the three allowed daily servings.This low-fat diet should be used until the underlying medical condition is controlled or corrected. The physician will give any individual instructions, and tell you when you no longer need to use the low-fat diet.

Food Groups
Group	Recommend	Avoid
Milk & milk products (2 or more cups daily)	skim milk, evaporated skim milk, skim buttermilk, nonfat sour cream, yogurt made with skim milk (3 gms fat or less/oz, maximum of 3 oz/day), fat-free cheeses, low-fat cottage cheese, part skim mozzarella cheese, part skim or skim ricotta cheese	whole milk, cream, sour cream, non-dairy creamer, whole milk cheese, cheese spreads
Bread & grains (4 or more servings daily)	whole grain and enriched breads, cold cereal, whole grain cereals (except granola), saltines, soda crackers, low-fat snack crackers, rice cakes, unbuttered popcorn, low-fat muffins, plain pasta, barley, oatmeal, home-made pancakes without fat, French toast made with egg substitute and skim milk	breads containing egg, cheese, or made with fat, biscuits, sweet rolls, pancakes, French toast, doughnuts, waffles, fritters, muffins, granola-type cereals, snack crackers, potato chips, packaged stuffing, fried rice, chow mein noodles
Vegetables (3 or more servings daily)	all vegetables (steamed, raw, boiled, or baked without added fat)	fried vegetables or those in cream, cheese, butter sauces, dips
Fruits (2 or more servings daily)	all other fruits	avocado
Meat or meat substitutes (5 to 6 oz daily)	poultry (without skin), veal, lean beef trimmed of fat (USDA good or choice cuts of round, sirloin, flank, and tenderloin), fresh, canned, cured, or boiled ham; Canadian bacon, lean pork (tenderloin, chops, cutlet), fish (fresh, frozen, canned in water), eggs (boiled, scrambled without added fat), luncheon meat at least 95% fat free	any fried, fatty, or heavily marbled meat, fish, or poultry, beef (USDA prime cuts, ribs, ground beef, corned beef), pork (spareribs, ham hocks), fish (canned in oil), eggs (fried in butter, oil, or margarine), luncheon meat less than 95% fat free
Beverages (4 to 6 cups or more daily)	decaffeinated or regular coffee or tea, cocoa made with skim milk, fruit juices, soft drinks, water	beverages made with high fat dairy products
Soups	fat-free broths, consommés, bouillon; soups made with fat-free broth, skim milk, evaporated skim milk	cream soups, soups with added oils or meat fats, soups made from stocks containing meat fat
Fats & oils (3 servings daily, each listed is one serving)	avocado 2 Tbsp or 1/8 medium, margarine 1 tsp,diet margarine 2 tsp,salad dressing 1 Tbsp,diet salad dressing 2 Tbsp, vegetable oils 1 tsp,nuts (raw or dry roasted):almonds 6, peanuts 20 small or 10 large, whole walnuts 2, whole pistachios 18, sesame seeds 1 Tbsp, sunflower seeds 1 Tbsp,saturated fats: bacon 1 strip, butter 1 tsp, dried coconut 2 Tbsp, cream cheese 1 Tbsp, sour cream 2 Tbsp, other fats: olive oil 1 tsp, peanut oil 1 tsp, large olives 10, peanut butter 2 tsp	any fat in excess
Sweets & desserts (servings depend on caloric needs)	sherbet made with skim milk, non-fat frozen yogurt, fruit ice, gelatin, angel food cake, vanilla wafers, ginger snaps, graham crackers, meringues, puddings made with skim milk, tapioca, fat-free cakes and cookies, fruit whips made with gelatin or egg whites, hard candy, jelly beans, jelly, jams, marmalades, maple syrup	ice cream, pastries, cakes, cookies, pies, doughnuts, pudding made with whole milk, cream puffs, turnovers, chocolate

Sample Menu
Breakfast	Lunch	Dinner
grapefruit 1/2dry cereal 3/4 cupbanana 1/2whole wheat toast 2 slicesmargarine 2 tspjelly or jam 1 Tbspskim milk 1 cupcoffee 3/4 cup	fat free vegetable soup 1 cuplean hamburger 2 ozmozzarella cheese made with skim milk 1 ozhamburger bunsliced tomatolettucefresh fruit salad 1/2 cupangel food cake 1 sliceskim milk 1 cupcoffee 3/4 cup	tomato juice 1/2 cupbroiled chicken breast without skin 3 ozherbed rice 1/2 cupbroccoli 1/2 cup with low fat cheese sauce 1/4 cuphard dinner rollmargarine 1 tspcarrot/raisin salad 1/2 cuplow fat frozen strawberry yogurt 1/2 cupskim milk 1 cup

This Sample Diet Provides the Following
Calories	2,060	Fat	50 gm
Protein	110 gm	Sodium	4,000 mg
Carbohydrates	299 gm	Potassium	4,245 mg

The large bowel or colon is the site of many beneficial bacteria.  However, the colon is the site for many of the symptoms in IBS patients. Since this organ is where all fiber and other food remnants arrive, it would seem logical that some parts of food we eat might play a role in the symptoms of IBS, which for the most part, are a reflection of an overly sensitive colon.

IBS is a very common disorder. Please refer to the essay Irritable Bowel Syndrome for details about this disorder. This information is directed to dietary considerations.

The large bowel or colon is the site of many beneficial bacteria.  However, the colon is the site for many of the symptoms in IBS patients. Since this organ is where all fiber and other food remnants arrive, it would seem logical that some parts of food we eat might play a role in the symptoms of IBS, which for the most part, are a reflection of an overly sensitive colon.

IBS is currently seen as falling into several major types; diarrhea predominant, constipation predominant or alternating between the two. Patients will frequently overlap their symptoms or even swing from one type to another. In each case, the diet may play an important role. So there is always some experimentation that each patient must undertake to see which dietary changes work best.

Abdominal Discomfort, Cramps, Bloating

The gut has been called the second brain because it has so many nerve cells within it. IBS patients have an increased nervous sensitivity built into their intestinal tract. This means that minor changes in the way the intestines contract can be perceived as discomfort, whereas in other people it is not. At times, there may be excessive production of colon gas resulting in bloating and discomfort. It is important that you understand how this occurs, namely that colon bacteria ferment soluble plant fibers in the food you eat and some of these bacteria will create harmless gases. You need to understand the difference between soluble fiber and insoluble fiber in your foods.

All fiber goes through the small intestine unchanged. Soluble fiber as is found in foods such as oats, beans and fruit pectins is fermented by the colon bacteria. It is used as a food by these bacteria which, in turn, provide significant health benefits. Some benign colon bacteria will create intestinal gases, mostly hydrogen, which then can move on down and become flatus. Insoluble fiber, on the other hand, is not fermented by colon bacteria and is evacuated relatively unchanged. No colon gas occurs with insoluble fiber.

Constipation Dominant

Constipation occurs when the colon just does not contract well enough or often enough. The stool within it becomes dehydrated and hard. Why does the colon become so lazy and what can be done about it? The diet may be important. Insoluble fibers such as wheat and wheat bran are not fermented by colon bacteria so they do not produce colon gas. At the same time, they retain water and create a large, bulky stool. This, in turn, often stimulates the colon to contract and provide easier evacuation. The first step then is to gradually increase the amount of insoluble fiber up to 10-15 grams a day or even more.

Soluble fibers, on the other hand, are trickier since they are used by colon bacteria as a food source and some of these bacteria make colon gas. Still, these fibers, especially the newly discovered prebiotic ones, produce many benefits within the colon. So, the IBS patient should eat enough soluble fiber to create its health benefit but not enough to produce crampy bloating and flatus.

Go to Fiber Content of Foods for the amount of fiber in each food.

Methane Constipation

Methane is just one of the gases in the colon along with hydrogen sulfide (odor), hydrogen, carbon dioxide and oxygen. There is some early research that suggests that the colon gas, methane, may promote constipation. Prebiotic plant fibers can change the acidity of the colon to an extent that these particular methane producing bacteria can’t grow. I would encourage my constipation dominant IBS patient to eat prebiotic containing foods. Or they could take prebiotics supplement powders in gradually increasing doses – 1 gram a day for a week, then 2 grams and so forth. If excessive colon gas and bloating or cramps occur before constipation improves, then the test did not work. If it did, then that amount of prebiotic food or supplement is right for you. A signal to look for is to evaluate the malodorous sulfide smell of your flatus. Like the methane producing bacteria, the bacteria that make these sulfide gases also can not grow in an acid environment. If your flatus has no or little smell, your colon may be at the right acidity and so prevent the methane producing bacteria from growing.

Diarrhea Dominant

There are many causes of diarrhea. Your physician will want to be sure there is not a correctable cause present. For instance, some patients chew sugar free gum, which is high in the sweetening agent, sorbitol. This can lead to diarrhea. Read the labels. Others may have lactose intolerance, meaning they don’t digest the milk sugar, lactose. The lactose ends up in the colon where it can promote colon gas and diarrhea. There may be chronic infections, such as the parasite, Giardia, residing in the small bowel. Celiac Disease may be present. When all of these and more are ruled out, then diarrhea dominant IBS can be diagnosed with confidence.

The next step is to consider the types of fiber in your diet. Increasing insoluble fiber in the diet or with a dietary supplement is worth a try as these can bulk up the stool which, of course, is desirable. Soluble fibers can aggravate diarrhea. However, they, along with probiotic bacteria, can also change the bacterial makeup of the colon in such a beneficial way that it may reduce the diarrhea.

Go to Fiber Content of Foods for details.

I suggest gradually increasing the insoluble fiber in the diet up to 10 grams or more a day. Following this, I would add prebiotic fibers, either in foods or a dietary supplement in very gradual increasing doses. If there were no change in symptoms, then I would add a probiotic at the direction of your physician. There is no secret here. What works for one IBS patient with diarrhea may not work for another. Judicious trial and error is recommended.

Colon Bacteria in the IBS Patient

We, in medicine, are in a new era regarding what we know about the colon and its inhabitants. What we have known for a long while is that the density and numbers of bacteria within the human colon are greater than any other place in the animal kingdom or, in fact, any place in the world. There are more bacteria within the colon by a factor of 10 than there are cells in the entire body. This is amazing! There is likely a reason and, yes, a good healthy reason for this. We have always thought that there were around 400-500 different species of colon bacteria. We were wrong. The number just discovered is closer to 1,000 different species.

A key and likely a very important fact, is that IBS patients have a significantly different colon bacterial makeup than those people without IBS. This has been a startling finding but, thinking it through, it should not have come as a great surprise. Bacteria flourish in the colon and they provide huge numbers of benefits for us. They rely on the foods we eat and what we used to call waste products for their health. However, in some way they may be a problem as well. Can changing the bacterial makeup of the colon change the symptoms in IBS patients? This is a key question. Some research studies suggest that a certain probiotic formula may reduce the symptoms of cramping and bloating in some IBS patients. We will await more research on what these interesting findings mean for the IBS patients.

Changing Colon Bacteria

This may be difficult but not impossible. A change in the foods you eat is central.

Gradually reduce animal foods – meat, poultry, fish to a more balanced diet with increasing fresh fruits and vegetables. You can go to Fiber Content of Foods to get a great deal of information of fiber of various food groups.

Add probiotics to your diet. There is no consensus yet on which are the best ones. There is still much research being done. The three types of bacteria which have been studied most are the Bifidos (Bifidobacterium), the Lactos (Lactobacillus) and streptococcus. You can get these in many low calorie dairy products and yogurt as well as over-the-counter pills.

Increase prebiotics in the diet with specific foods that contain them. The main ones are inulin and oligofructase. North Americans generally have a very low consumption of these, getting most in wheat and onions. An easy way to add prebiotics is with a dietary supplement .

Summary

There are no specific and right answers for every IBS patient. There will always be some trial and error necessary to see what is right for you. Still, there are some general principals that may apply to most patients.

1. Gradually reduce animal protein, especially red meat and increase the vegetables and fruit content proportionally. Select a balanced mix of soluble and insoluble fiber, aiming for 25-35 grams a day. Go to Fiber Content of Foods for specifics.
2. You can try adding a probiotic. The product with some evidence behind it for improving cramps and bloating is VSL#3. There are likely other healthy probiotics that work but we just don’t have the evidence for them yet. There are likely beneficial bacteria in many yogurt and dairy food preparations. The ones that have been best studied are the Bifidos (Bifidobacterium), Lactos (Lactobacillus) and certain streptococcus species. Always check with your physician before using probiotics.
3. Increase prebiotics fibers in the diet by eating specific foods (Sources of Prebiotics) and/or a supplement.  

All fiber comes from plants, bushes, vines or trees.  Of course, the ones that we eat provide us with fruits, vegetables and grains.  There are many different types of fiber but the three that are most important to the health of the body are insoluble, soluble, and prebiotic soluble. 

What is Dietary Fiber?

All fiber comes from plants, bushes, vines or trees.  Of course, the ones that we eat provide us with fruits, vegetables and grains.  There are many different types of fiber but the three that are most important to the health of the body are:

Insoluble Fiber

This fiber does not dissolve in water, nor is it fermented by the bacteria residing in the colon.  Rather, it retains water and in so doing, helps to promote a larger, bulkier and more regular bowel activity.  This, in turn, may be important in preventing disorder such as diverticulosis and hemorrhoids, and in sweeping out certain toxins and cancer causing carcinogens.  Sources of insoluble fiber are:

• whole grain wheat and other whole grains
• corn bran, including popcorn, unflavored and unsweetened
• nuts and seeds
• potatoes and the skins from most fruits from trees such as apples, bananas and avocados
• many green vegetables such as green beans, zucchini, celery and cauliflower
• some fruit plants such as tomatoes and kiwi

Soluble Fiber

These fibers are fermented or used by the colon bacteria as a food source or nourishment.  When these good bacteria grow and thrive, many health benefits occur in both the colon and the body.  Soluble fiber is present in some degree in most edible plant foods, but the ones with the most soluble fiber include:

• legumes such as peas and most beans, including soybeans
• oats, rye and barley
• many fruits such as berries, plums, apples bananas and pears
• certain vegetables such as broccoli and carrots
• most root vegetables
• psyllium husk supplement products

Prebiotic Soluble Fiber

These are relatively newly discovered soluble plant fibers.  The technical name for this fiber is inulin or fructan. When these soluble fibers are fermented by the good colon bacteria, some further significant health benefits have been shown to occur by research in many medical centers. These soluble prebiotic fibers occur in significant amounts in:

• asparagus
• yams
• onions
• garlic
• bananas
• leeks
• agave
• chicory and other root vegetables such as Jerusalem artichokes
• wheat, rye and barley (smaller amounts)

Benefits of a High Fiber Diet

The health benefits of a high fiber diet, consumed on a regular basis and reaching recommended amounts (below), are now fairly well-defined. There are some additional benefits in the early research stage with the prebiotic soluble fibers. What is now known regarding a high fiber diet include:

Bowel Regularity

A high fiber diet promotes regularity with a softer, bulkier and regular stool pattern. This decreases the chance of hemorrhoids, diverticulosis and perhaps colon cancer.

Cholesterol and Reduced Triglycerides

The soluble fibers are the ones that will reduce cholesterol levels when used on a regular basis. Psyllium husk and prebiotic soluble fiber will also reduce cholesterol. They may also reduce the incidence of coronary heart disease. Oats, flax seeds and legumes or beans are the recommended fibers.

Colon Polyps and Cancer

It is still not certain if a high fiber diet helps prevent colon cancer. Considerable research suggests that this may occur. Certainly it makes sense to increase regularity and so speed the movement of cancer causing carcinogens through the bowel. In addition, reducing a heavy meat diet reduces the bile flow from the liver in a favorable way. This, too, reduces the amount of carcinogens that reach and are manufactured in the colon. Finally, a high fiber diet, including prebiotic soluble fiber, increases the integrity and health of the wall of the colon. The risk of cancer may be reduced.

Colon Wall Integrity

A high fiber diet changes the bacterial makeup of the colon toward a more favorable balance. For instance, it is known that those people with obesity, diabetes type 2 and inflammatory bowel disease have a predominance of bad bacteria in the colon. This, in turn, may render the bowel wall weak and allow bacteria and, indeed, even toxins to seep through. A high fiber diet with a modest reduction in animal and meat products may return the bacterial makeup to a more positive balance. This, in particular, has been seen when the soluble fiber prebiotics are added to the diet.

Blood Sugar

Soluble fiber such as in legumes (beans), oats and in prebiotic fibers slows the absorption of blood sugar and so helps regulate the sugar in the blood. Insoluble fiber on a regular basis is associated with reduced risk of type 2 diabetes.

Weight Loss

High fiber diets are more filling and give a sense of fullness sooner than an animal and meat based diet does. In addition, the soluble prebiotic fibers have been shown to turn off the hunger hormones produced in the wall of the gut and to increase the hormones that give a sense of fullness. Those hormones are made in the wall of the gut.

New medical research has shown that the bacterial makeup in the colon in overweight people is abnormal to the extent that they manufacture and absorb almost twice the number of calories through the colon wall as do normals. Prebiotic fibers (below) will help change this hormonal balancein a favorable way.

Bacteria and the Function of the Colon

The colon finishes the digestive process. Hopefully, the waste products move through in a nice regular manner. Insoluble fibers help this process by retaining water and so producing a bulkier, softer stool, which is easy to pass.

The additional role of the colon is to provide a home for an enormous number of micro-organisms, mostly bacteria. Recent research has shown that there are over 1,000 species of bacteria with a total bacterial count ten times the number of cells in the body. These bacteria play a major role in keeping the colon wall itself healthy. In addition, these good bacteria produce a very strong immune system for the body. They significantly increase calcium absorption and bone density. They provide other documented benefits. It is the soluble fibers in the diet that are so effective in stimulating the growth of good colon bacteria.

How Much is Enough?

The amount of fiber in food is measured in grams.  National nutritional authorities recommend the following amounts of dietary fiber daily.
Under Age 50                Over Age 50
Men         38 grams            30 grams
Women    25 grams            21 grams

For a week or so, it is best to tally the amount of fiber you are consuming.  Boxed and packaged foods will have the amount of fiber per serving on the nutrition label.

Which Fibers and Which Foods are Best?

As noted, healthy fiber is only found in plants. The three major categories are whole grains, fruits and vegetables.

Whole Grains

Wheat, oats, barley, wild or brown rice, amaranth, buckwheat, bulgur, corn, millet, quinoa, rye, sorghum, teff and triticals. By far, wheat, oats and wild or brown rice are most common. Always buy whole grain products. White bread, baked goods and rolls almost always are made from wheat flour. Wheat flour is white because most of the fiber, vitamins and other nutrients have been removed. Try not to buy enriched grains. What this means is that simple white flour has had vitamins added to it by the manufacturer. The word, enriched, implies a good and healthy product. On the contrary, enriched means that most of the fiber has been removed and a few vitamins added.

Fruits

Fruits come from trees such as apple and pear or from bushes or vines. You should eat a wide variety of fruits, preferably with every meal. In many cases, the skin of a fruit such as apple will contain much of the insoluble fiber while the pulp contains most of the soluble fiber. To the extent possible, buy organic fruits as these will have little or no pesticides. Always wash fruit.

Vegetables

Eat a wide variety of vegetables. They should be a mainstay of lunch and dinners. Frozen vegetables retain as much nutrition and fiber as fresh vegetables. As with fruit, try to buy organic to reduce any residual pesticide ingestion. Wash fresh vegetables thoroughly.

Cruciferous vegetables such as broccoli, Brussels sprouts and cauliflower contain certain chemicals such as sulforaphane. This substance has very strong anti-cancer properties and should be eaten frequently.

Legumes, Beans, Peas and Soybeans

These vegetables have plenty of soluble fiber and should be part of a varied vegetable intake. Beans, in particular, contain a certain type of fiber that may lead to harmless gas or bloating.

Nuts and Seeds

These are rich sources of fiber and are a good substitute for sweets such as candies and baked sweet goods. While nuts and seeds are rich in fiber, they also contain vegetable fat and so can and do add calories.

Read the Labels

As noted, fresh and frozen foods are usually better.  They have good nutrition and few, if any, chemicals added to them.  When buying packaged foods and, in particular grains, look for three things:

• The first word on the label should be whole, such as whole wheat or whole grain.
• Check out the calories and the amount of fiber in a serving.
• How many and what other additives or chemicals are added.  Fewer is always better.  Do you know what each additive does?  Some are added not for the benefit of the buyer but rather for manufacturers.  These could and do include sugar, artificial flavor, chemicals to prevent oxidation and spoilage, emulsifiers to blend the product.  You have to be a detective.

Fiber Facts, Nuggets and Pearls

• For breakfast you can easily get the day started well by using a high fiber, whole grain cereal.  Check the labels.  Add fruit such as blueberries and bananas.  If you are an egg eater, use whole wheat or grain toast.  Adding wheat germ gives you a good fiber kick.
• Always use whole grain or wheat with rolls and sandwiches.  Does your fast food store not have them?  Perhaps you look elsewhere.  Eating an occasional black bean or veggie burger provides variety.
• Snacks should consist of fruit and/or nuts.  While nuts are loaded with fiber, they are an energy rich food, meaning they have a lot of calories in a small packet.
• Fruit juices should contain pulp.  Clear juices such as clear orange, pear or apple juice contain little fiber and have a lot of fructose.  Prune juice is usually high in fiber.
• Homemade soups – adding fresh or frozen vegetables to a chicken or vegetable stock is a good way to start homemade soup.
• Salads – adding cooked and then chilled vegetables provide great flavoring to almost any salad.  Remember, a cobb salad has lots of cooked corn in it.  Small slices of apples or oranges and nuts such as chopped walnuts or sliced almonds always adds taste, variety and fiber to almost any salad.
• Fruit – Try to eat fruit of some type with almost every meal.
• Rethink how you place the various foods on your dinner plate.  Reducing the portions of the meat or animal food portion to the side with equal or more portions of vegetables, legumes and fruits portion always allows for more fiber.  There was never anything magic about making the meat or animal food portion the main part of the dinner plate.  Eating from smaller plates can, over time, trick your mind and long term habit of using a dinner plate.  Again, there is nothing magic in an 11, 12, or 13 inch dinner plate.

Fiber Supplements

There are a variety of fiber supplements available on the food or pharmacy shelves.

Psyllium

This soluble plant fiber has been used in India for over 2,000 years. It is a soluble fiber with mucilage in it. This acts to retain a lot of water and also is fermented by colon bacteria. When 7 grams a day are used, it does lower cholesterol. Metamucil in various forms is psyllium.

Methyl Cellulose

All the cellulose products come from finely ground wood chips which are then treated in a variety of ways such as boiling in acids. Methyl cellulose is an insoluble fiber which does dissolve in water. It is also an emulsifier, meaning it blends oils and water. Citrucel is methyl cellulose (MC). MC may not be appropriate for Crohn’s disease or ulcerative colitis as several medical studies have shown that certain emulsifiers dissolve the mucous lining of the colon in animals prone to Crohn’s disease. This then allows bacteria to invade the underlying tissue.

Inulin

Inulin is a soluble prebiotic fiber found in many foods and which are fermented mostly in the left side of the colon. It is available in a supplement as generic inulin and in Fiber Choice.

Oligofructose

FOS

These are also prebiotic fibers. They are fermented very quickly in the right side of the colon.

Prebiotin

This product is a combination of oligofructose, which feeds the bacteria in the right side of the colon and inulin, which does the same in the left side of the colon. There seems to be a benefit for this particular formula based on medical research.

Prebiotic Soluble Fiber

These may be the healthiest of all the soluble fibers.  They grow in many plants and have had a great deal of research done on them in the last 10-15 years.  These fibers are found in asparagus, yams and other root vegetables such as chicory, garlic, onion, leeks and in smaller amounts in wheat.  This research has shown the following:

• Increase in good and decrease in bad colon bacteria
• Increase calcium absorption and enhanced bone mass
• Enhanced immune system
• Appetite and weight control by changing the hormone appetite signals to the brain
• May decrease colon cancer incidence
• Reduce or correct a leaky colon

Eating a wide variety of plant food up to the recommended amount will likely give you enough prebiotic fiber. Supplements such as Prebiotin can be added to the diet.

Short Chain Fatty Acids (SCFA)

Some rather remarkable research findings have shown that one of the benefits of ingesting a lot of soluble fiber, in particular the prebiotic ones, results in larger amounts of SCFAs in the colon.  These SCFAs are made by the good bacteria in the colon such as Bifidobacter and Lactobacillus.  These small molecules have been shown to do the following:

• Enhance the health and integrity of the colon wall
• Provide nourishment for the cells that actually line the colon
• Increases the acidity of the colon which is a very real health benefit
• Stabilize blood sugar for diabetics
• Reduce blood cholesterol and triglyceride
• Significantly enhance immunity
• May be a benefit for Crohn’s disease and ulcerative colitis patients

Fiber and Gas

Everyone has intestinal gas and that is a good thing.  It means that bacteria, hopefully the good ones, are thriving.  The normal amount of flatus passed each day depends on sex and what is eaten.  The normal number of flatus is 10-20 times a day.  When the bacteria that make intestinal gases are growing, it also means that other good bacteria are using the same fibers to grow and produce multiple health benefits, including the production of healthy short-chain fatty acids.  These substances are produced quietly in the colon and produce many health-related outcomes.

Soluble fiber should always be used in a gradual manner.  If too much is consumed at any one time, then excess, but harmless, intestinal gas can occur.  People with irritable bowel syndrome are particularly prone to bloating and cramping.  In this instance, soluble fiber in the diet or supplement should be used in small doses and increased gradually.

Finally, prebiotic fibers tend to cause the production of short-chain fatty acids which acidify the colon.  This, in turn, reduces or stops the growth of bacteria that make the smelly hydrogen sulfide gases that produce noxious flatus.  People who consume many vegetables with prebiotics or take a prebiotic fiber supplement often have non-odoriferous flatus.

Fiber and Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is one of the most common disorders of the lower digestive tract.  The symptoms of IBS can be quite varied.  They can be a mix of several symptoms such as constipation, diarrhea, crampy abdominal discomfort, bloating and gas.  An attack of IBS can be triggered by emotional tension and anxiety, poor dietary habits and certain medications.  It is now known that infections in the intestine can lead to long-term IBS symptoms.  Increased amounts of fiber in the diet can help relieve the symptoms of irritable bowel syndrome by producing soft, bulky stools.  This helps to normalize the time it takes for the stool to pass through the colon.  Recent medical research with newer techniques has shown some surprising and dramatic findings for IBS patients.  Specifically, there is a very significant and abnormal shift of bacteria from those that provide health benefits to those bad bacteria that we really do not want in the gut.  The technical name for this bad group of bacteria is called Firmicutes.  Along with this abnormal bacterial collection, there is a smoldering low-grade inflammation in the gut wall that may contribute to symptoms.  The goal for IBS patients should be to gradually increase the soluble dietary fibers in the diet so as to promote the growth of good bacteria and so suppress the bad ones along with the associated inflammation.

IBS patients need to be careful of the amount of soluble fiber they consume.  The reason for this is that, while the good colon bacteria thrive on these fibers and produce health benefits, other gas-forming bacteria may generate excessive but harmless gas and subsequent bloating.  Thus, soluble plant fibers or a dietary prebiotic supplement should be taken in small initial doses and then gradually increased to tolerance.

Fiber and Colon Polyps/Cancer

Colon cancer is a major health problem. This disease is most common in Western cultures. It is not seen very often in rural African cultures where the diet is mostly plant based. Usually, colon cancer starts out as a colon polyp, a benign mushroom-shaped growth. In time it grows, and in some people it becomes cancerous. Colon cancer is usually always curable if polyps are removed when found or if surgery is performed at an early stage. It is now known that people can inherit the risk of developing colon cancer, but diet is important, too. As noted, there is a very low rate of colon cancer in residents of countries where grains are unprocessed and retain their fiber. It seems that in the Western world, cancer-containing agents (carcinogens) remain in contact with the colon wall for a longer time and in higher concentrations. So, a large bulky stool may act to dilute these carcinogens by moving them through the bowel more quickly. Less carcinogenic exposure to the colon may mean fewer colon polyps and less cancer. A review of the entire world’s literature on the effect of fiber on colon polyps and cancer prevention has shown rather clearly that for every 10 grams of fiber added to the diet, there is a 10% reduction in incidence of colon cancer. So the recommended 30 gram fiber diet would result in a 30% less chance of getting these tumors.

There are also substances produced in the colon by the good bacteria that seem to retard certain pre-cancer factors from developing. They are called short-chain fatty acids (SCFA). See above for description of SCFAs. A high fiber diet increases these substances. So, the combination of dietary fiber and the production of short-chain fatty acids have a clear health benefit.

Fiber and Diverticulosis

Prolonged, vigorous contraction of the colon over a long period of time may result in diverticulosis.  This increased pressure causes small and, eventually, larger ballooning pockets to form.  These pockets by themselves cause no problem.  However, sometimes they become infected (diverticulitis) or even break open (perforate) causing infection or inflammation within the abdomen (peritonitis).  A high fiber diet increases the bulk in the stool and thereby reduces the pressure within the colon.  By so doing, the formation of pockets may be reduced or possibly even stopped.

In the past, many physicians were fearful that seeds as in tomatoes, nuts or berries were harmful and could get inside these pockets and rattle around, causing damage. We now know that this has never been the case and that these foods contain lots of fiber and are actually beneficial for diverticulosis patients.

Certain bulking agents such as psyllium are traditional types of bulk producing supplements.  Psyllium is a soluble fiber.  Combining it with insoluble fiber as in wheat bran or corn bran (no gluten) can enhance this bulking effect even more.  A product containing a prebiotic, psyllium and wheat bran is probably a very good combination for bowel regularity. Prebiotin Regularity/Diverticulosis is one such product.

Inflammatory Bowel Disease (IBD)

IBD means Crohn’s Disease (CD) or Ulcerative Colitis (UC).  CD is an inflammation of the lower small bowel and/or the colon.  Bacteria actually invade and cause inflammation in the entire wall of the intestine.  UC, on the other hand, is an inflammation just of the lining of the colon.  It usually starts in the rectum and left colon and may spread to the entire colon from there.  It is now known that in both CD and UC that the bacterial make up is abnormal.  This means that there are significantly more of the bad bacteria present than the good ones. These abnormal bacteria are called Firmicutes.

Fiber and Crohn’s Disease

There is now some information in the medical literature on what type of diet may be harmful and what may help Crohn’s Disease.  A reduction in red meat is likely helpful.  So is reducing the fat in the diet, including vegetable oils.  More importantly, people who had low fiber ingestion in the diet had a greater chance of getting CD.  So, a gradual increase in the amount of fiber is likely helpful in hopefully preventing CD.  This should always be done in conjunction with the physician.  It should be done gradually and should include soluble fibers which fertilize the best colon bacteria.  The good bacteria grow and push out the bad ones.  These good bacteria provide short chain fatty acids, which can help heal the bowel wall.

Fiber and Ulcerative Colitis

We still do not have strong evidence in the medical literature on what is the best diet for UC.  Eating plenty of soluble fiber, including prebiotic fibers will nourish the best colon bacteria.  It is hoped that this will result in a decrease in the bad or Firmicutes bacteria.  It is well-known that when the good bacteria proliferate that they produce lots of acid substances called short chain fatty acids (SCFA).  The SCFAs actually nourish the cells of the colon wall, the very ones that become inflamed in UC.  In addition, when the colon contents become acidic, the smelly sulfide gases are not produced and the flatus becomes less noxious and may even have no smell at all.  This may have a beneficial effect on the inflammation.   

Gluten is the protein part of wheat, rye, barley, and other related grains. Some people cannot tolerate gluten when it comes in contact with the small intestine. This condition is known as celiac disease (sometimes called non-tropical sprue or gluten enteropathy).

Gluten-Free Diet

Gluten is the protein part of wheat, rye, barley, and other related grains. Some people cannot tolerate gluten when it comes in contact with the small intestine. This condition is known as celiac disease (sometimes called non-tropical sprue or gluten enteropathy).

Celiac disease is now clearly known to be genetically determined.  In other words, if you or your close relatives have a certain gene, then it is more likely that you will get celiac disease some time in your life.  Of great concern and interest is the fact that nine out of ten people with celiac disease do not known they have it.  A simple blood test can give the physician the first clue to this disease.

In patients with celiac disease, gluten injures the lining of the small intestine. This injury can result in weight loss, bloating, diarrhea, gas, abdominal cramps, and/or vitamin and mineral deficiencies. When patients totally eliminate gluten from the diet, the lining of the intestine has a chance to heal.

Gut Bacteria

The primary area of injury in celiac disease is the smll bowel but there may be a relationship between what happens in the small bowel and the colon or large bowel.  There are very large numbers of bacteria in the colon. Most of these are beneficial and actually confer health benefits.  When these good bacteria thrive, they suppress the bad bacteria, which are present in the colon.  What has been found is that celiac patients, in fact anyone on a gluten-free diet, have an altered make-up of bacteria in the colon which favors the unwanted bacteria.

Prebiotic Plant Fiber

A prebiotic is not a probiotic, which are beneficial bacteria taken by mouth.  These probiotics are present in yogurt, other dairy products and pills.  Prebiotics, on the other hand, are the necessary plant fibers that contain both oligofructose and inulin.  These two fibers are the main nourishment for the good bacteria that reside in the gut.  These fibers are rich in chicory root, Jerusalem artichoke, leeks, asparagus and others.  Gluten containing wheat and barley also contain these prebiotics.

Health Benefits from Prebiotic Fibers

There is now ample information in the medical literature to indicate that a prebiotic rich diet leads to demonstrable health benefits.  These include:

• Increased calcium absorption
• Stronger bones and bone density
• Enhanced immunity
• Reduced allergies and asthma in infants and children
• A lower blood triglyceride level
• Appetite and weight control
• Lower cancer factors in the gut
• Other benefits, including an increased sense of well being

The Celiac Wheat-Prebiotic Dilemma

Nature has played a trick on celiac people.  Wheat and wheat products provide over 80% of the prebiotics that North Americans ingest.  Yet, celiac patients must carefully avoid wheat, barley and rye.  How do they then feed their good colon bacteria and get the health benefits, as outlined above?  They must favor the other vegetables and fruits, as listed in the prebiotic section below.  Additionally, they should consider a gluten free prebiotic supplement such as Prebiotin.

Special Considerations

Removing gluten from the diet is not easy.  Grains are used in the preparation of many foods.  It is often hard to tell by a food’s name what may be in it, so it is easy to eat gluten without even knowing it.  However, staying on a strict gluten-free diet can dramatically improve the patient’s condition.  Since it is necessary to remain on the gluten-free diet throughout life, it will be helpful to review it with a registered dietitian.

The person who prepares the patient’s food much fully understand the gluten-free diet.  Read food labels carefully:

• Do not eat anything that contains the following grains: wheat, rye and barley.
• At one time, oats were thought to contain some gluten.  It has now become apparent, however, that oats frequently were processed in facilities that also processed wheat.  Most manufacturers no longer do this, although if there are any questions, a person should get reassurance from the manufacturer by mail, email or phone.
• The following can be eaten: corn, potato, rice, soybeans, tapioca, arrowroot, carob, buckwheat, millet, amaranth and quinoa.
• Distilled white vinegar does not contain gluten.
• Malt vinegar does contain gluten.

Grains are used in the processing of many ingredients, so it will be necessary to seek out hidden gluten.  The following terms found in food labels may mean that there is gluten in the product.

• Hydrolyzed Vegetable Protein (HVP), unless made from soy or corn
• Flour or Cereal products, unless made with pure rice flour, corn flour, potato flour or soy flour
• Vegetable Protein, unless made from soy or corn
• Malt or Malt Flavoring, unless derived from corn
• Modified Starch or Modified Food Starch, unless arrowroot, corn, potato, tapioca, waxy maize or maize is used
• Vegetable Gum, unless made from carob bean, locust bean, cellulose, guar, gum arabic, gum aracia, gum tragacanth, xantham or vegetable starch
• Soy Sauce or Soy Sauce Solids, unless you know they do not contain wheat

Any of the following words on food labels often mean that a grain containing gluten has been used.

• Stabilizer
• Starch
• Flavoring
• Emulsifier
• Hydrolyzed
• Plant Protein

The following are lists of various foods that do not have gluten, may have gluten and docontain gluten.

Prebiotic Plant Fiber Oligofructose and Inulin

NO Gluten	MAY Contain Gluten	DOES Contain Gluten
Onion, garlic, leeks, Jerusalem artichokes, asparagus, chicory root, jicama, dandelion, banana, agave, jams, Prebiotin		Wheat, barley, rye

Milk and Milk Products

NO Gluten	MAY Contain Gluten	DOES Contain Gluten
Whole, low fat, skim, dry, evaporated or condensed milk; buttermilk; cream; whipping cream; Velveeta cheese food; American cheese; all aged cheese such as Cheddar, Swiss, Edam and Parmesan	Sour cream, commercial chocolate milk and drinks, non-dairy creamers, all other cheese products, yogurt	Malted drinks

Meat or Meat Substitutes

NO Gluten	MAY Contain Gluten	DOES Contain Gluten
100% meat (no grain additives); seafood; poultry (breaded with pure cornmeal, potato flour or rice flour); peanut butter; eggs; dried beans or peas; pork	Meat patties; canned meat; sausages; cold cuts; bologna; hot dogs; stew; hamburger; chili; commercial omelets, souffles, fondue; soy protein meat substitutes	Croquettes, breaded fish, chicken loaves made with bread or bread crumbs, breaded or floured meats, meatloaf, meatballs, pizza, ravioli, any meat or meat substitute, rye, barley, oats, gluten stabilizers

Breads and Grains

NO Gluten	MAY Contain Gluten	DOES Contain Gluten
Cream of rice; cornmeal; hominy; rice; wild rice; gluten-free noodles; rice wafers; pure corn tortillas; specially prepared breads made with corn, rice, potato, soybean, tapioca, arrowroot, carob, buckwheat, millet, amaranth and quinoa flour	Packaged rice mixes, cornbread, ready-to-eat cereals containing malt flavoring	Breads, buns, rolls, biscuits, muffins, crackers and cereals containing wheat, wheat germ, oats, barley, rye, bran, graham flour, malt; kasha; bulgur; Melba toast; matzo; bread crumbs; pastry; pizza dough; regular noodles, spaghetti, macaroni and other pasta; rusks; dumplings; zwieback; pretzels; prepared mixes for waffles and pancakes; bread stuffing or filling

Fats and Oils

NO Gluten	MAY Contain Gluten	DOES Contain Gluten
Butter, margarine, vegetable oil, shortening, lard	Salad dressings, non-dairy creamers, mayonnaise	Gravy and cream sauces thickened with flour

Fruits

NO Gluten	MAY Contain Gluten	DOES Contain Gluten
Plain, fresh, frozen, canned or dried fruit; all fruit juices	Pie fillings, thickened or prepared fruit, fruit fillings	None

Vegetables

NO Gluten	MAY Contain Gluten	DOES Contain Gluten
Fresh, frozen or canned vegetables; white and sweet potatoes; yams	Vegetables with sauces, commercially prepared vegetables and salads, canned baked beans, pickles, marinated vegetables, commercially seasoned vegetables	Creamed or breaded vegetables; those prepared with wheat, rye, oats, barley or gluten stabilizers

Snacks and Desserts

NO Gluten	MAY Contain Gluten	DOES Contain Gluten
Brown and white sugar, rennet, fruit whips, gelatin, jelly, jam, honey, molasses, pure cocoa, fruit ice, carob	Custards, puddings, ice cream, ices, sherbet, pie fillings, candies, chocolate, chewing gum, cocoa, potato chips, popcorn	Cakes, cookies, doughnuts, pastries, dumplings, ice cream cones, pies, prepared cake and cookie mixes, pretzels, bread pudding

Beverages

NO Gluten	MAY Contain Gluten	DOES Contain Gluten
Tea, carbonated beverages (except root beer), fruit juices, mineral and carbonated waters, wines, instant or ground coffee	Cocoa mixes, root beer, chocolate drinks, nutritional supplements, beverage mixes	Postum™, Ovaltine™, malt-containing drinks, cocomalt, beer, ale

Soups

NO Gluten	MAY Contain Gluten	DOES Contain Gluten
Those made with allowed ingredients	Commercially prepared soups, broths, soup mixes, boullion cubes	Soups thickened with wheat flour or gluten-containing grains; soup containing barley, pasta or noodles

Thickening Agents

NO Gluten	MAY Contain Gluten	DOES Contain Gluten
Gelatin, arrowroot starch; corn flour germ or bran; potato flour; potato starch flour; rice bran and flour; rice polish; soy flour; tapioca, sago	Commercially prepared soups, broths, soup mixes, boullion cubes	Wheat starch; all flours containing wheat, oats, rye, malt, barley or graham flour; all-purpose flour; white flour; wheat flour; bran; cracker meal; durham flour; wheat germ

Condiments

NO Gluten	MAY Contain Gluten	DOES Contain Gluten
Gluten-free soy sauce, distilled white vinegar, olives, pickles, relish, ketchup	Flavoring syrups (for pancakes or ice cream), mayonnaise, horseradish, salad dressings, tomato sauces, meat sauce, mustard, taco sauce, soy sauce, chip dips

Seasonings

NO Gluten	MAY Contain Gluten	DOES Contain Gluten
Salt, pepper, herbs, flavored extracts, food coloring, cloves, ginger, nutmeg, cinnamon, bicarbonate of soda, baking powder, cream of tartar, monosodium glutamate	Curry powder, seasoning mixes, meat extracts	Synthetic pepper, brewer’s yeast (unless prepared with a sugar molasses base), yeast extract (contains barley)

Prescription Products

NO Gluten	MAY Contain Gluten	DOES Contain Gluten
	All medicines – Check with pharmacist or pharmaceutical company.

Sample Menu

Breakfast	Lunch	Dinner
Cream of rice – 1/2 cup Skim milk – 1 cup Banana – 1 medium Orange juice – 1/2 cup Sugar – 1 tsp	Baked chicken – 3 oz Rice – 1/2 cup Green beans – 1/2 cup Apple juice – 1/2 cup Ice cream – 1/2 * Ice cream should be made without wheat stabilizers.	Sirloin steak – 3 oz Baked potato – 1 medium Peas – 1/2 cup Fruit gelatin – 1/2 cup Butter – 1 Tbsp Tea – 1 cup Sugar – 1 tsp

The above sample diet provides the following: 1,748 calories; 77 gm protein; 225 gm carbohydrates; 62 gm fat; 1,577 gm sodium; 2,934 potassium 

Gastroparesis is the medical term for delayed stomach emptying. During the process of digestion, the stomach must contract to empty itself of food and liquid. Normally, it contracts about three times a minute. This empties the stomach within 90-120 minutes after eating. If contractions are sluggish or less frequent, stomach emptying is delayed.

Gastroparesis is the medical term for delayed stomach emptying. During the process of digestion, the stomach must contract to empty itself of food and liquid. Normally, it contracts about three times a minute. This empties the stomach within 90-120 minutes after eating. If contractions are sluggish or less frequent, stomach emptying is delayed. This results in bothersome but sometimes serious symptoms, as well as malnutrition, because food is not being digested properly.

Gastroparesis may be caused by various conditions such as diabetes mellitus, certain disorders of the nervous system, or certain drugs. Often however, no cause can be found although a viral infection is suspected in some. The physician may prescribe medication to stimulate the stomach to contract. The purpose of the gastroparesis diet is to reduce symptoms and maintain adequate fluids and nutrition. There are three steps to the diet.

STEP 1 DIET consists of liquids, which usually leave the stomach quickly by gravity alone. Liquids prevent dehydration and keep the body supplied with vital salts and minerals.

STEP 2 DIET provides additional calories by adding a small amount of dietary fat — less than 40 gm each day. For patients with gastroparesis, fatty foods and oils should be restricted, because they delay stomach emptying. However, patients at the Step 2 level are usually able to tolerate this amount.

STEP 3 DIET is designed for long-term maintenance. Fat is limited to 50 gm per day, and fibrous foods are restricted, because many plant fibers cannot be digested.

Nutrition Facts

The STEP 1 Gastroparesis Diet is inadequate in all nutrients except sodium and potassium. It should not be continued for more than three days without additional nutritional support. STEP 2 and STEP 3 Gastroparesis Diets may be inadequate in Vitamins A and C, and the mineral iron. A multi-vitamin supplement is usually prescribed.

Special Considerations

Diets must be tailored to the individual patient. This is because the degree of gastroparesis may range from severe and long-standing to mild and easily corrected. Patients may also have various medical conditions to be considered. For example, diabetes patients with gastroparesis are allowed sugar-containing liquids on the Step 1 diet, because that is their only source of carbohydrate. On the Step 2 and Step 3 diets, these patients should avoid concentrated sweets. These are noted with an asterisk (*) on the food lists.On all of the diets, liquids and food should be eaten in small, frequent meals. This helps to maintain nutrition.

Step 1 Food Groups
Group	Recommend	Avoid
Milk & milk products	none	all
Vegetables	none	all
Fruits	none	all
Breads & grains	plain saltine crackers	all others
Meat or meat substitutes	none	all
Fats & oils	none	all
Beverages	Gatorade and soft drinks (sipped slowly throughout the day)	all others
Soups	fat-free consommé and bouillon	all others

Sample Menu Step 1
Breakfast	Lunch	Dinner
Gatorade 1/2 cupginger ale 1/2 cupbouillon 3/4 cupsaltine crackers 6	Gatorade 1/2 cupCoke 1/2 cupbouillon 3/4 cupsaltine crackers 6	Gatorade 1/2 cupSprite 1/2 cupbouillon 3/4 cupsaltine crackers 6

This Sample Diet Provides the Following
Calories	790	Fat	9 gm
Protein	11 gm	Sodium	3,531 mg
Carbohydrates	156 gm	Potassium	244 mg

Step 2 Food Groups
Group	Recommend	Avoid
Milk & milk products	skim milk, products made with skim milk, low-fat yogurt, low-fat cheeses	whole milk products, creams (sour, light, heavy, whipping), half & half
Soups	fat-free consommé & bouillon, soups made from skim milk, & fat-free broths containing pasta or noodles and allowed vegetables	soups made with cream, whole milk, or broths containing fat
Bread & grains	breads & cereals, cream of wheat, pasta, white rice, egg noodles, low-fat crackers	oatmeal, whole grain rice, cereal, bread
Meat & meat substitutes	eggs, peanut butter (maximum 2 Tbsp/day)	beef, poultry, fish, pork products, dried beans, pea, & lentils
Vegetables	vegetable juice (tomato, V-8); well-cooked vegetables without skins (acorn squash, beets, carrots, mushrooms, potatoes, spinach, summer squash, strained tomato sauce, yams)	all raw vegetables, cooked vegetables with skins, beans (green, wax, lima), broccoli, Brussels sprouts, cabbage, cauliflower, celery, corn, eggplant, onions, peas, peppers, pea pods, sauerkraut, turnips, water chestnuts, zucchini
Fruits	apple juice, cranberry juice, grape juice, pineapple, prune juice, canned fruits without skins (applesauce, peaches, pears)	citrus juices, all fresh and dried fruits, canned fruits with skins (apricots, cherries, blueberries, fruit cocktail, oranges, grapefruit, pineapple, plums, persimmons)
Fats & oils	any type of fat, but only in small amounts	none
Sweets & desserts*	hard candies, caramels, puddings & custards made from skim milk, frozen yogurt, fruit ice, gelatin, ice milk, jelly, honey, syrups	high-fat desserts (cakes, pies, cookies, pastries, ice cream), fruit preserves
Beverages	Gatorade*, soft drinks* (sipped slowly throughout the day)	all others, except allowed juices
*Concentrated sweets

Sample Menu Step 2
Breakfast	Lunch	Dinner
skim milk 1/2 cuppoached egg 1white toast sliceapple juice 1/2 cup	mozzarella cheese 2 ozsaltine crackers 6chicken noodle soup 3/4 cupGatorade 1/2 cup	peanut butter 1 Tbspsaltine crackers 6vanilla pudding 1/2 cupgrape juice 1/2 cup
Morning Snack	Afternoon Snack	Evening Snack
ginger ale 1/2 cupcanned pears 1/2 cup	skim milk 1/2 cupcornflakes 1/2 cupsugar 2 tsp	frozen yogurt 1/2 cupsaltine crackers 6

This Sample Diet Provides the Following
Calories	1,343	Fat	35 gm
Protein	52 gm	Sodium	2,639 mg
Carbohydrates	206 gm	Potassium	1,411 mg

Step 3 Food Groups
Group	Recommend	Avoid
Milk & milk products	skim milk, products made with skim milk, low-fat yogurt, low-fat cheeses	whole milk products, creams (sour, light, heavy, whipping), half & half
Soups	fat-free consommé & bouillon, soups made from skim milk, & fat-free broths containing pasta or noodles and allowed vegetables	soups made with cream, whole milk, or broths containing fat
Fruits	fruit juices, canned fruits without skins (applesauce, peaches, pears)	all fresh & dried fruits, canned fruits with skins (apricots, cherries, plums, blueberries, fruit cocktail, oranges, grapefruit, pineapple, persimmons)
Meat & meat substitutes	eggs, peanut butter (2 Tbsp/day), poultry, fish, lean ground beef	fibrous meats (steaks, roasts, chops), dried beans, peas, lentils
Fats & oils	any type of fat, but only in small amounts	none
Breads & grains	breads & cereals, cream of wheat, pasta, white rice, egg noodles, low-fat crackers	oatmeal, whole grain rice, cereal, bread
Vegetables	vegetable juices (tomato V-8), well-cooked vegetables without skins (acorn squash, beets, carrots, mushrooms, potatoes, spinach, summers quash, strained tomato sauce, yams)	all raw vegetables, cooked vegetables with skins: beans (green, wax, lima), broccoli, Brussels sprouts, cabbage, cauliflower, celery, corn, eggplant, onions, peas, peppers, pea pods, sauerkraut, turnips, water chestnuts, zucchini
Sweets & desserts*	hard candies, caramels, puddings & custards made from skim milk, frozen yogurt, fruit ice, gelatin, ice milk, jelly, honey, syrups	high-fat desserts (cakes, pies, cookies, pastries, ice cream), fruit preserves
Beverages	Gatorade*, soft drinks* (sipped slowly throughout the day), coffee, tea, water (note: non-caloric beverages should be limited if patient cannot maintain adequate caloric intake)	all others, except allowed juices
*Concentrated sweets

Sample Menu Step 3
Breakfast	Lunch	Dinner
skim milk 1/2 cupcream of wheat 1/2 cupsugar 2 tsporange juice 1/2 cupwhite toast 1 slicemargarine 1 tspjelly 1 Tbsp	tuna fish 2 ozlow-fat mayonnaise 2 Tbspwhite bread 2 slicescanned peaches 1/2 cupGatorade 1/2 cup	baked chicken 2 ozwhite rice 1/2 cupcooked beets 1/2 cupdinner roll 1skim milk 1/2 cupmargarine 2 tsp
Morning Snack	Afternoon Snack	Evening Snack
low-fat yogurt 1/2 cupSprite 1/2 cup	chocolate pudding 1/2 cupGinger ale 1/2 cup	ice milk 1/2 cuppretzels 2

This Sample Diet Provides the Following
Calories	1,822	Fat	42 gm
Protein	75 gm	Sodium	2,234 mg
Carbohydrates	286 gm	Potassium	2,467 mg

This Sample Diet Provides the Following
Calories	1822	Fat	42g
Protein	75g	Sodium	2334mg
Carbohydrates	286g	Potassium	2467mg