The esophagus is the tube that carries food from the throat to the stomach. However, it is not just a simple tube. The lower esophagus has a specialized muscle around it that usually stays tightly closed, opening only to allow food and liquid into the stomach. It acts to prevent the reflux of stomach acid into the esophagus.

The esophagus is the tube that carries food from the throat to the stomach. However, it is not just a simple tube. The lower esophagus has a specialized muscle around it that usually stays tightly closed, opening only to allow food and liquid into the stomach. It acts to prevent the reflux of stomach acid into the esophagus.

Symptoms occur when this specialized muscle weakens and allows stomach acid to splash up into the esophagus. These symptoms include heartburn, chest discomfort, and bitter fluid flowing up into the mouth. Chest discomfort can occur. If the stomach juice trickles into the breathing tubes, hoarseness, cough, and even shortness of breath can occur. This entire problem is called GERD (Gastroesophageal Reflux Disease). A number of factors, including certain foods, may cause the lower esophageal muscle to relax, causing GERD.

Nutrition Facts

A diet designed to prevent or reduce acid reflux is usually easy to follow. The basic food groups of cereals, vegetables, fruits, dairy products, and meats can be eaten with only a few limitations. So, this diet generally meets the Recommended Dietary Allowances (RDA) of the National Research Council. A vitamin C supplement may be needed if an individual does not tolerate citrus foods such as orange, tomato, etc.

Special Considerations

The lower esophageal muscle can be weakened by factors other than food. The following recommendations may be helpful in reducing symptoms:Stop using tobacco in all forms. Nicotine weakens the lower esophageal muscle.Avoid chewing gum and hard candy. They increase the amount of swallowed air which, in turn, leads to belching and reflux.Do not lie down immediately after eating. Avoid late evening snacks.Avoid tight clothing and bending over after eating.Eat small, frequent portions of food and snack if needed.Lose weight if overweight. Obesity leads to increased reflux.Elevate the head of the bed six to eight inches to prevent reflux when sleeping. Extra pillows, by themselves, are not very helpful.The following foods aggravate acid reflux, and should be avoided:fatty or fried foodspeppermint and spearmintwhole milkoilschocolatecreamed foods or soupsmost fast foodsThe following foods irritate an inflamed lower esophagus and may need to be limited or avoided:citrus fruits and juices (grapefruit, orange, pineapple, tomato)coffee (regular and decaffeinated)caffeinated soft drinksteaother caffeinated beveragesSpicy or acidic foods may not be tolerated by some individuals.

Food Groups
Group	Recommend	Avoid
Milk or milk products	skim, 1% or 2% low-fat milk; low-fat or fat-free yogurt	whole milk (4%), chocolate milk
Vegetables	all other vegetables	fried or creamy style vegetables*, tomatoes
Fruits	apples, berries, melons, bananas, peaches, pears	citrus*: such as oranges, grapefruit, pineapple
Breads & grains	all those made with low-fat content	any prepared with whole milk or high-fat
Meat, meat substitutes	low-fat meat, chicken, fish, turkey	cold cuts, sausage, bacon, fatty meat, chicken fat/skin
Fat, oils	none or small amounts	all animal or vegetable oils
Sweets & desserts	all items made with no or low fat (less than or equal to 3 g fat/serving)	chocolate, desserts made with oils and/or fats
Beverages	decaffeinated, non-mint herbal tea; juices (except citrus); water	alcohol, coffee (regular or decaffeinated), carbonated beverages, tea, mint tea
Soups	fat-free or low-fat based	chicken, beef, milk, or cream-based soups
*Individually determined

The full liquid diet is often used as a step between a clear liquid diet and a regular diet, for example, after surgery or fasting. It may also be used after certain procedures, such as jaw wiring. This diet may also be appropriate for patients who have swallowing and chewing problems.

The full liquid diet is often used as a step between a clear liquid diet and a regular diet, for example, after surgery or fasting. It may also be used after certain procedures, such as jaw wiring. This diet may also be appropriate for patients who have swallowing and chewing problems.

Nutrition Facts

The full liquid diet is low in iron, vitamin B12, vitamin A, and thiamine. It should not be used for a long period of time unless vitamins, iron, or liquid nutritional supplements are added. This diet has 1,800 mg of calcium, so extra calcium is not needed.

Food Groups
Group	Recommend	Avoid
Milk & milk products	milk, milkshakes, eggnog, ice cream, custard, pudding	all cheeses
Vegetables	all vegetable juices	all raw or cooked vegetables
Fruits	all juice or nectar	all fresh, frozen, or canned fruit
Breads & grains	cooked refined cereals; farina, grits, oatmeal, cream of rice, cream of wheat	all other cereals, all breads
Meat or meat substitutes	none	all
Fats & oils	butter, margarine, cream	all others
Sweets & desserts	sherbet, sugar, hard candy, plain gelatin, fruit ice, honey, syrups	all others
Beverages	all	none
Soups	broth, bouillon, strained creamed soups	all others

Sample Menu
Breakfast	Lunch & Dinner
fruit juice 1 cuphot cereal 1/2 cupeggnog 8 ozwhole milk 8 ozhot tea with sugar & lemon	strained creamed soup 3/4 cupjuice 1 cupice cream 1/2 cuppudding or custard 1/2 cupwhole milk 8 ozhot tea with sugar & lemonsalt/pepper

This Sample Diet Provides the Following
Calories	2,100	Fat	80 mg
Protein	60 gm	Sodium	2,975 mg
Carbohydrates	290 gm	Potassium	2,900 mg

One of the most common symptoms of IBS is that of abdominal bloating and distention. Distention of the gastrointestinal (GI) tract can cause abdominal pain, especially in IBS patients who already suffer from a hypersensitive GI tract. Luminal distention may also change intestinal motility. No medication is currently available to prevent luminal distention, and commonly used medications to treat bloating are often ineffective (eg. Charcoal, simethicone, smooth muscle antispasmodics).

What is the Fodmap diet and why might it help my IBS symptoms?

One of the most common symptoms of IBS is that of abdominal bloating and distention. Distention of the gastrointestinal (GI) tract can cause abdominal pain, especially in IBS patients who already suffer from a hypersensitive GI tract. Luminal distention may also change intestinal motility. No medication is currently available to prevent luminal distention, and commonly used medications to treat bloating are often ineffective (eg. Charcoal, simethicone, smooth muscle antispasmodics). Thus, researchers have recently focused their efforts on dietary factors that could contribute to abdominal bloating and distension. The FODMAP diet appears to be the most successful diet to date to improve symptoms of bloating, distention, and pain in IBS patients.

The acronym FODMAP stands for Fermentable Oligo-, Di-, and Monosaccharides and Polyols. This term is meant to group together a variety of food substances, such as short-chain carbohydrates and sugar alcohols (polyols), that have similar functional properties. The food groups covered by the FODMAP rubric include fructose, fructo-oligosaccharides (fructans), galacto-oligosaccharides (galactans), and polyols (ie. sorbitol, mannitol, xylitol, and malitol). These foods are linked by their ability to cause luminal distention because of the following:

• They are poorly absorbed in the small intestine. Although the end effect (poor absorption) is the same, there are several different mechanisms that cause this. For example, fructose, which is a monosaccharide, requires a transport mechanism for uptake from the GI tract and this transport mechanism (called GLUT) has a low capacity. Fructose is also absorbed alongside glucose. However, if fructose is present in higher concentrations than glucose, then fructose malabsorption will occur. Fructans and galactans are not well absorbed because the necessary enzymes (hydrolases) are absent from the small intestine. Finally, polyols are too large for simple diffusion.
• They are small molecules and thus osmotically active. These low molecular weight molecules exert an osmotic effect in the small intestine and thus actively draw water into the intestinal tract, increasing liquidity of the intestinal contents and accelerating GI tract motility.
• They are rapidly fermented by bacteria. The rate of fermentation of food products in the colon is determined by the length of the carbohydrate chain. The short-chain carbohydrates included in FODMAP are more rapidly fermented in the colon, thus quickly causing distention and discomfort.

What Food Groups Should Be Avoided?

• Food with excess fructose. This includes fruits such as apples, cherries, mango, pears, peaches, canned fruits in their natural fruit juice, watermelon, and large quantities of fruit juice or dried fruit. Vegetables to be avoided include asparagus, artichokes, and sugar snap peas. Honey and products with high fructose corn syrup (juices, regular soft drinks, sports/energy drinks) should also be avoided.
• Fructans (fructo-oligosaccharides), which are made up of short chains of fructose with a glucose molecule on the end. This includes grains (rye, wheat bread, crackers, biscuits, wheat pasta, and cous cous); fruits such as peaches, persimmons, plums, and watermelon; vegetables such as onions, peppers, artichokes, brussel sprouts, broccoli, cabbages, fennel, garlic, okra, leeks, and legumes (baked beans, chickpeas, lentils, and kidney beans).
• Galactans (galacto-oligosaccharides), which are short chains of sucrose with galactose (similar to the fructans list above).
• Polyols (also called sugar alcohols). This includes low calorie sweeteners such as sucralose, and also sorbitol, manitol, xylitol, and malitol (which are often used in “sugar-free” candies, gums, and mints). Fruits that contain sorbitol include apples, apricots, pears, blackberries, nectarines, and plums. Vegetables that contain mannitol include cauliflower, mushrooms, and snow peas.
  Note: lactose (which is a disaccharide, made up of glucose and galactose) is not technically considered a part of the FODMAP diet. However, if a patient is lactose deficient, then lactose cannot be broken down, and it acts similarly to fructans and galactans with regard to producing GI distress.

What Data is Available to Support This Diet in IBS Patients?

In one study of 12 patients who had ileostomies, the FODMAP diet decreased ileostomy output by 22% and also decreased the liquidity of ileostomy output.1 In a study of 15 healthy volunteers and 15 IBS patients (Rome II criteria), a diet low in FODMAPs led to significantly lower breath hydrogen levels than a diet high in FODMAPs. 2 The high FODMAP diet also caused significant GI distress and lethargy in the IBS patients, while the healthy volunteers only noted increased passage of flatus. Finally, a recently published study on 82 consecutive IBS patients attending a dietetic outpatient clinic found that a low FODMAP diet (n = 43) improved symptoms of bloating (p = 0.002), abdominal pain (p = 0.023), and flatulence (p = 0.001), compared to a standard diet (n = 39). 3 Overall compliance was high. The mean time for symptom improvement was 3.5 weeks.

What Foods Fit Within the FODMAP Diet?

•  Gluten – Free or spelt toast
• Corn or rice cereals
• Eggs
• Lean – proteins (chicken, turkey, fish, pork, lamb, red meat)
• Cheeses with no or low lactose (these are typically the hard cheeses)
• Rice cakes
• Quinoa

Fruits and vegetables not listed previously. Fruits that are generally safe include bananas, grapefruit, grapes, kiwifruit, mandarin oranges, honeydew melons, tangelos, oranges, strawberries, lemons, limes, and blueberries (in small amounts). Vegetables that are generally safe include bamboo shoots, bok choy, carrots, eggplant, green beans, lettuce, tomatoes.

Eliminate Foods Containing FODMAPs

Excess Fructose	Lactose	Fructans	Galactans	Polyols
Fruit Apples, mango, nashi, pear, tinned fruit in natural juice, watermelon	Milk Milk from cows, goats, or sheets, custard, ice cream, yogurt	Vegetables Artichoke, asparagus, beetroot, broccoli, Brussel sprouts, cabbage, fennel, garlic, leek, okra, onion (all), shallots, spring onion	Legumes Baked beans, chickpeas, kidney beans, lentils, soybeans	Fruit Apple, apricot, avocado, blackberry, cherry, longon, lychee, rashi, nectarine, peach, pear, plum, prune, watermelon
Sweeteners	Cheeses Soft, unripened cheeses, cottage, cream, mascarpone, ricotta	Cereals Wheat and rye, in large amounts of egg bread, crackers, cookies, couscous, pasta		Vegetables Cauliflower, green capsicum (bell pepper), mushroom, sweet corn
Fructose, high fructose, corn syrup		Fruit Custard apple, persimmon, watermelon		Sweeteners Sorbitol (420), Mannitol (421), Isomalt (953), Maltitol (965, Xylitol (967)
Large total fructose dose Concentrated fruit sources, large serves of fruit, dried fruit, fruit juice		Miscellaneous Chicory, dandelion, insulin pistachio
Honey Corn syrup, fruisana

 This diet provides fluids that leaves little residue and are easily absorbed with minimal digestive activity. This diet is adequate in all essential nutrients and is recommended only if clear liquids are temporarily needed. No red or purple liquids should be consumed! 

A diet of clear liquids maintains vital body fluids, salts, and minerals; and also gives some energy for patients when normal food intake must be interrupted. Clear liquids are easily absorbed by the body. They reduce stimulation of the digestive system, and leave no residue in the intestinal tract. This is why a clear liquid diet is often prescribed in preparation for surgery, and is generally the first diet given by mouth after surgery. Clear liquids are given when a person has been without food by mouth (NPO) for a long time. This diet is also used in preparation for medical tests such as sigmoidoscopy, colonoscopy, or certain x-rays.

Nutrition Facts

A clear liquid diet is not adequate in calories and nutrients. It should not be used for more than five days unless high-protein gelatin or other low-residue supplements are added.

Special Considerations

Limitations The physician may limit certain liquids, depending on the patient’s condition, or the surgery or test being performed. Therefore, individual instructions should be strictly followed.What is a clear liquid? A good rule-of-thumb is anything you can see through. For example, apple juice is a clear liquid; milk is not. If unsure, check with the physician or registered dietition.After surgery and fasting Should persistent abdominal cramps or discomfort occur with a clear liquid diet, the patient should notify the physician, nurse, or dietitian at once.Preparing for a medical test It is important that the clear liquid diet be followed exactly. Remember that the value of the examination will depend on getting a thoroughly clean digestive tract.

Food Groups
Group	Recommend	Avoid
Milk & milk products	none	all
Vegetables	none	all
Fruits	fruit juices without pulp	nectars, all fresh, canned, and frozen fruits
Breads & grains	none	all
Meat or meat substitutes	none	all
Fats & oils	none	all
Sweets & desserts	gelatin, fruit ice, popsicle without pulp, clear hard candy	all others
Beverages	coffee, tea, soft drinks, water, lactose-free, low residue supplements if approved by physician, coffee, tea, soft drinks, water, lactose-free, low residue supplements if approved by physician	all others
Soups	bouillon, consommé fat free broth	all others

Sample Menu
Breakfast	Lunch	Dinner
strained fruit juice 1 cupgelatin 1 cuphot tea with sugar & lemon	consommé 3/4 cupstrained fruit juice 1 cupfruit ice 1/2 cupgelatin 1/2 cuphot tea with sugar & lemon	consommé 3/4 cupstrained fruit juice 1 cupfruit ice 1/2 cupgelatin 1/2 cuphot tea with sugar & lemon

This Sample Diet Provides the Following
Calories	600	Fat	virtually none
Protein	6 gm	Sodium	1,500 mg
Carbohydrates	209 gm	Potassium	1,440 mg