THERAPEUTIC DIET MANUAL

The diet is based on the normal diet, which has been modified as necessary for specific medical conditions. Modification of the diet may take any of the following forms:

• Include greater or lesser amounts of one or more nutrients

• Calorie Modification
• Protein Modification
• Fat Modification
• Micronutrient Modification

~ Low Salt Diet

~ High / Low Potassium Diet

~Low Purine Diet

~Low Phosphate Diet

~Low Vitamin K Diet

• Change in consistency of foods

• Clear Liquid Diet
• Slenderized Diet
• Soft Diet
• Bland Diet

• Miscellaneous and Diagnostics Test Diets

• Low Fiber Diet
• Low Residue Diet
• High Fiber Diet
• VMA Diet / Non Flavor

CALORIE MODIFIED DIET

 

DIABETIC DIET (1600kcal)

General Description

The diabetic person cannot metabolized carbohydrate in the same way as the non diabetic person due to relative or absolute insulin deficiency. Protein and fat metabolism is also affected. This necessitates a controlled diet and in many cases, the use of OAD (Oral Anti Diabetic) or insulin injections. A very important part of diabetes management is adjusting food intake to match the limited insulin response.

Diet Principles:

Involves modification of the regular diet and based on the nutritional needs of the individual. Food intake is evenly distributed throughout the day, that is 3 main meals with snacks in between so as not to overload the abnormal glucose metabolism. Spread over 4 to 6 meals (3main meals and snacks in between) depending on individual institution. In our setting, no white sugar being added for diabetic diet. The above practice also applies for patient on weight management.

Sample Menu:

Breakfast: Whole meal bread                   ±2slices + margarine                            ±1tsp @ Chicken sandwich                  ±2slices + chicken meat                       ±1tbsp + potato                                   ±1tbsp Low fat milk                            ±1cup Lunch/Dinner: Rice                                         ±1CB Chicken/beef/fish                    ±2MB Vegetable                                ±1cup Fruit                                         ±1piece Soup Afternoon Tea: Malay Kuih (no sugar)                        1piece @ Cream Cracker biscuits          3pieces Tea (no sugar)                        ±1 cup

PROTEIN MODIFIED DIET

HIGH / LOW PROTEIN DIET

General Description

 

Dietary protein restriction has been used to reduce blood urea levels and to minimize uremic symptoms, usually used in renal patient. Higher protein is indicated for individuals with increased requirement due to illness, injury and malnutrition. Relevant conditions include sepsis, major surgery, burns, and major traumatic injuries, cancer, pulmonary disease, specific conditions in liver and renal disease.

Diet Principles:

For low protein diet, sufficient calories for protein sparing are essential. Carbohydrate should be complex and fat should be from unsaturated sources. Protein should be HBV (High Biological Value) and spaced evenly over the whole day to allow for better utilization. While for high protein diet, meals are spread over 3 main meals with snacks in between and we will provide additional nutritional supplement to meet the higher requirement in the management of certain conditions. We also provide an egg during breakfast as an addition from normal diet.

Sample Menu:

High Protein Diet

Low Protein Diet

Breakfast Noodles/Bihun/Rice                ±1CB                                              @ White bread                             ±3slices +margarine                              ±1tsp Egg                                          ±1noz Tea / Coffee/Chocolate          ±1cup + sugar                                    ±2tbsp Lunch/Dinner: Rice                                         ±1CB Chicken/beef/fish                    ±2MB Vegetable                                ±1cup Fruit                                         ±1piece Soup                            Afternoon Tea: Malay Kuih                              ±1piec Tea / Coffee                            ±1cup + sugar                                    ±2tbsp

Breakfast Noodles/Bihun/Rice              ±1CB                                              @ White bread                          ± 3slices +margarine                           ±1tsp Tea / Coffee/Chocolate        ±1cup + sugar                                 ± 2tbsp Lunch/Dinner: Rice                                         ±1CB Chicken/beef/fish                    ±1MB Vegetable                                ±1cup Fruit                                         ±1piece Soup                            Afternoon Tea: Malay Kuih                           ±1piece Tea / Coffee                          ±1cup + sugar                                  ±2tbsp

FAT MODIFIED DIET

LOW FAT DIET

General Description

 

Prescribed to lower the fat intake for patient with disease of gallbladder, liver, pancreas or if disturbances in digestion and absorption of fat occur.

Diet Principles:

• Fat requirement is less than 25% total calories
• We had modified methods of cooking by baking, steaming and boiling.
• Remove skin from chicken and remove visible fat from meat.
• Substitute coconut milk and full cream milk with skim milk or low fat milk.

Sample Menu:

Breakfast: Noodle/Bihun/Rice                 ±1CB                                              @ White bread                            ±3slices +margarine                             ±1tsp             @ Chicken sandwich                  ±2slices + chicken meat                       ±1tbsp + potato                                   ±1tbsp Tea / Coffee                            ±1cup + sugar                                    ±2tbsp

Lunch/Dinner: Rice                                         ±1CB Chicken/beef/fish                    ±2MB Vegetable                                ±1cup Fruit                                         ±1piece Soup                            Afternoon Tea: Malay Kuih                              ±1piece             @ Cream Cracker biscuits          ±3pieces Tea / Coffee                            ±1cup + sugar                                    ±2tbsp

LOW CHOLESTEROL DIET

General Description

 

For  treatment of most types of hyper lipidemia and hypercholesterolemia.

Diet Principles:

• Fat requirement is within 25 to 30% of total calories and cholesterol less than 300mg per day.
• Exclude food high in cholesterol (internal organ and egg yolk)
• Limit egg yolk 2pieces a week.
• Modify methods of cooking by baking, steaming, boiling and grilling.
• Remove skin from chicken and remove visible fat from meat.
• Substitute coconut milk and full cream milk with skim milk or low fat milk.
• In principle, our hospital diet already moderately low in cholesterol.

MICRONUTRIENT MODIFIED DIET

LOW SALT DIET

General Description

Salt sources in food consist of salt or sodium occurred naturally and added into food during food preparation and processing. Low salt diet usually bland taste and without adding sodium during food preparation and during meals. Herbs and spices used to add flavor to food. This diet suitable for patient with high blood pressure, edematous, renal and heart disease.

Diet Principles:

• No salt used in cooking
• No processed food, canned or sauces used
• Naturally occurring sodium in food not more than 1000mg
• Avoid food with high sodium content, limit intake of moderate sodium content and choose more often foods with low sodium

Sodium Content in food and drink

Types	Low sodium (<120mg)			Moderate Sodium (120mg-480mg)		High Sodium(>480mg)
Beverages	Carbonated; - cream soda -isotonic sports drink	<2btl (500ml) <1 ½ btl (500ml)		Carbonated; - isotonic sport drink	1btl (1500ml)
Vegetables	Fresh vegetable			Seaweed, dried	1/2cup	-Canned vegetable -Pickled vegetable -Salted Chinese cabbage -Canned tomato soup -Salted fried peas	>1/2cp >1/2cp >1tbsp >1/2cp >1cp
Fruits & products	Fresh fruit			Tempoyak	2tbsp	Spicy pickled, mixed fruit	>1tbsp
Cereals & products	-Cooked rice, -White bread -Whole meal bread -Cream cracker -Soda, plain biscuit -Low salt cracker		1sc 1sc <7pc <3pc <12pc	Instant rice porridge Bihun Kuey Teow Laksa Noodle White bread Whole meal bread Soda, plain biscuit	1pack <2cp <2cp <2cp <2cp 2-4sc 2-3sc 3-12pc	-Instant noodle -Flavored, noodle snack (medium) -Soda, plain biscuit	>1/4pack 1 pack >12pc
Types	Low sodium (<120mg)			Moderate Sodium (120mg-480mg)		High Sodium(>480mg)
Starchy roots, tubers & product	Potato		<2whole	Potato chips (small)	1pack	Potato chip(big)	>1/2 pack
Legumes & legumes products	White soya bean Fermented soya bean cake (tempe)		<1/2cp	Fermented soya bean paste(taucu)	1tbsp	Thick soya sauce Thin soya sauce Canned baked bean	>1tbsp >1/4tbsp >3/4cp
Nut, seeds & products	Mixed nut (no salt)		<7cp	Peanut butter Dried, black  watermelon seeds	3tbsp 3cp	Mixed nuts (salted)	>1/3cp
Meat & poultry products	Chicken breast Chicken thigh Lean beef Raw lean mutton		<1cp <1cp <1/2cp <1cp	Fried chicken Chicken frankfurter Regular beef burger Beef frankfurter (12x2cm) Raw lean mutton Raw pork	1pc 2pc 1whole 2pc 1cp 1cp	-Fast-food fried chicken(140g) -Canned chicken curry -Chicken cube -Beef burger (with cheese) -Canned beef rendang -Canned mutton curry	>1pc >1can >1/3cube 1whole >1/2cp >1/2cp
Egg	Hen egg		<2pc	Salted duck egg	1pc
Fish, shellfish & products	Fresh fish other then stated in moderate column Fresh prawn Fresh cuttlefish (medium)		<2whole	Fish ball (small,2cm) Bream(Kerisi) Carp head Common carp (medium) Spanish mackerel Red snapper Fried fish cracker Dried salted prawn Prawn cracker(small) Prawn paste Dried cuttlefish(small)	5whole 1whole 1sc 1pc 1sc 1sc 5pc 1tbsp 1pack 1tbsp 1whole	-Fish ball(large) -Salted dried fish(25g) -Fish sauce(budu) -Dried anchovy (without head and entrails) -Canned sardine (small) -Fermented shrimp (cencaluk) -Shrimp paste (belacan) -Cuttlefish cracker (large)	2 ½ pc 1pc >1/4tbsp >1/4cp >1can >1/2 tbsp >1/2pc 1pack

*pc = piece, sc = slice, cp = cup, tbsp = tablespoon, btl = bottle

LOW POTASSIUM DIET

 

Same with normal diet except food or drink high in potassium should be avoided and foods or drinks low in potassium are allowed (in moderation). This diet usually use for patient at risk of high potassium level e.g renal patient.

Diet Principles:

VEGETABLE	FRUIT
Use vegetable low in potassium content Limit to 2 servings per day Raw vegetable should be avoided Vegetable cut into small pieces, soak into water for 30-60 minutes and change water few times before cooking Take vegetable without gravy	·         Limit fruit of moderate and low content of potassium to 1 to 2 servings per day ·         Skin, seed and pulp should be avoided ·         Hard fruit should be soaked to decrease potassium content, before eating ·         Dried fruit or pickles should be avoided ·         Avoid powdered spices ·         Strain fluid from canned fruit.

HIGH POTASSIUM DIET

General Description

 

Same with normal diet except foods or drinks high in potassium are encouraged.

Usually use for patient at risk of low potassium level e.g severe diarrhea, vomiting or patient on diuretic treatment.

Diet Principles:

• Increase consumption of vegetable and fruit intake
• Choose fruits and vegetables high in potassium
• Dried fruit or pickles still should be avoided

 

 

 

 

 

 

 

 

 

 

 

Potassium content in food and drink.

Types	Low potassium (<50mg/serving)		Moderate Potassium (50mg-100mg/serving)		High Potassium (>100mg/serving)
Beverages	Syrup	1cp	Barley Chinese tea Sugar cane	1cp 1cp 1cp	Canned fruit juice Cocoa/chocolate drink Coconut water Fresh fruit juice Malted drink	1cp 1cp 1cp 1cp 1cp
Types	Low potassium (<50mg/serving)		Moderate Potassium (50mg-100mg/serving)		High Potassium (>100mg/serving)
Vegetables	Bean sprout Bitter gout Leek Cucumber Kangkung Sweet potato leaf Lobak putih Ketola ular Ketola	1/2cp 1/2cp 1/2cp 1/2cp 1/2cp 1/2cp 1/2cp 1/2cp 1/2cp	All types lentil Asparagus Bamboo shoot Brinjal Capsicum Carrot Cauliflower Lettuce Pumpkin Turnip Tomato	1/2cp 1/2cp 1/2cp 1/2cp 1/2cp 1/2cp 1/2cp 1/2cp 1/2cp 1/2cp 1/2cp	Daun kelor Jantung pisang Petai Mustard leaves Spinach Brocolli Raw vegetable Cekur manis Kale Tubers	1/2cp 1/2cp 1/2cp 1/2cp 1/2cp 1/2cp 1/2cp 1/2cp 1/2cp 1cp
Fruits	Apple Pear Guava Papaya Watermelon Pineapple Star fruit(small)	1pc 1pc 1/2pc 1sc 1sc 1sc 1pc	Canned fruit (syrup) Lime Lai Lemon Grapefruit Rambutan	1/2cp 1pc 1/2cp 1pc 1pc 3pc	Banana Cempedak Ciku Durian Jackfruit Grapes Langsat Mata kucing Peach Plum	1pc 2pc 2pc 2pc 2pc 6pc 6pc 6pc 1pc 1pc
Miscellaneous					Legumes and nuts All types of spices Brown sugar Baked beans Grounded chili Food with chocolate Food with coconut milk Dried fruits Dried mushroom Salted fish Salted prawn Chicken essences Tamarind paste Tempoyak Whole meal food

*pc = piece, sc = slice, cp = cup, tbsp = tablespoon

LOW PHOSPHATE DIET

General Description

 

Same with normal diet except food or drink high in phosphate should be avoided and phosphate binder taken with meals. Usually use for patient at risk of hyperphosphatemia e.g renal patient.

Diet Principles:

• Avoid food or drink high in phosphate
• Limit food or drink contain moderate amount of phosphate
• Eat fish, crab or shrimp without bone and limit intake of shell
• Avoid intake of cartilage
• Achieve daily requirement by taking cereals and food high in complex carbohydrate in adequate amount.

Phosphate content in food and drink.

Types	Low phosphate (<40mg/serving)		Moderate Phosphate  (40mg-80mg/serving)			High Phosphate (>80mg/serving)
Cereal	Noodle Custard flour Corn flour Oats Kuay Teow Laksa Bihun Idli (60g)	1cp 2tbsp 2tbsp 2tbsp 1cp 1cp 1cp 1pc	Rice White bread Whole meal bread Barley Fried bihun (400g) Putu mayam Fish porridge(270g) Thosai		1cp 2sc 2sc 2tbsp 1plate 1sc 1bowl 1sc	Instant noodle Macaroni wet(150g) Lemang(10cm) Nasi Lemak(295g) Rawa Thosai Roti canai Capati	1pack 1cp 1pc 1plate 1pc 1pc 1pc
Milk & milk product			Ice cream		2scp	Cheese Condensed milk Full cream milk Skimmed milk Low fat milk	1sc 2tbsp 1cp 1cp 1cp
Meat, fish, chicken & legume	White egg Ground nut(fried)	1pc 2tbsp	Egg with yolk Baked chicken Baked beans Anchovy Dried prawn		1/2pc 1thigh 1/2cp 2tbsp 2tbsp	Dhal Meat, fish & chicken	1/2cp
Beverages	Syrup Chinese tea Sugar cane Creamer non milk	1cp 1cp 1cp 7g/sac	Soya bean drink Cola drink Cocoa/chocolate powder		1cp 1cp 2tbsp	Tea ‘tarik’ Coffee with milk	1cp 1cp
Vegetables	Most vegetable		Spinach Potato (small)		1/2cp 1pc	Tubers (medium) Mushroom	1pc 1/2 cp
Fruits	Most fruit
Miscellaneous	Cream cracker Kuih sago Kuih apam Fried popiah Curry puff Margarine Jam	2pc 1pc 1pc 1pc 1pc 1tsp 1tbsp	Pop corn(60g) Muffin Fish/prawn chip Fried sweet potato Chocolate biscuit	1pack 1pc 6pc 1pc 4pc		Butter cake(50g) Vada Burger Meat pau Corn Peanut butter	1pc 1pc 1pc 1pc 1pc 2tbsp

*pc = piece, sc = slice, cp = cup, tbsp = tablespoon, scp = scoop

LOW PURINE DIET

General Description

 

Food contains purine and its metabolism produced uric acid into blood. If there is disruption in purine metabolism process, high accumulation of uric acid in urine causes uric acid stone and also accumulate in joints cause gout disease. Basically, low purine diet same with normal diet except food high in purine should be avoided. Low purine diet usually use for patient with gout.

 

Diet Principles:

• Avoid food high in purine
• Quantity and frequency of intake for food high in purine taken each time will determine quantity of purine taken
• Control caloric intake if overweight
• Avoid alcoholic beverages
• Drink plenty of water
• Control fat intake
• Limit or minimize intake of food contain moderate amount of purine

Purine content in food and drink.

Low purine (0-50mg/100g)	Moderate purine (50-150mg/100g)	High purine (150-825mg/100g)
Milk Cheese Yogurt Egg Salt Chocolate Wheat Cocoa Spices Sugar Honey Jam Rice Fruit Margarine/Butter Oil Peanut butter Breakfast cereal Coffee, tea, cordial Carbonated drink Vegetable Black pepper White bread	Beef Mutton Pork Rabbit Chicken Fish Legume Animal tongue Lentils Cockle Oatmeal/whole meal Asparagus Cauliflower Spinach Mushroom Peas	Internal organ Brain Swan Wild chicken Prawn Mussel Anchovies Fish sauce (Budu) Fish egg Soup cube Sardine Yeast Minced meat Meat stock Bamboo shoot Jering Petai

LOW VITAMIN K DIET

General Description

 

Warfarin treatment given mostly to them who having cardiovascular disease. Warfarin used to prevent blood from clotting in blood. Low vitamin K diet is used to prevent function of medication disrupted due to Vitamin K is important for blood clotting. Diet is same with normal diet just food or drink high in vitamin K should be avoided.

Diet Principles:

Limit  food high in vitamin K

• Kale
• Spinach
• Broccoli
• Cabbage
• Salad
• Mustard leaves
• Soya bean
• Soya bean cake (tauhu)
• Soya bean oil
• Canola oil
• Mayonnaise
• Green tea

 

MODIFIED CONSISTENCY DIET

Clear Liquid Diet

General Description

 

A diet that includes only foods those are clear and liquid at body temperature. The diet is intended to provide an oral source of fluids and a small amount of energy and electrolyte. It is used to prevent dehydration and to reduce colonic residue to a minimum.

Diet Principle

 

A clear liquid diet is adequate only in calories. It is deficient in protein, vitamins and minerals and therefore nutritionally inadequate and not meant for prolonged use. Only foods like clear soup, strained fruit juice, tea, coffee and carbonated beverages are permitted.

Blenderized Diet

General Description

 

The diet is indicated for individuals who have difficulty in chewing and / or swallowing.

Diet Principle

 

The diet is designed to provide foods that require minimal chewing & increase the ease of swallowing example foods on soft diet that have been slenderized.

For sample meal plan, refer to soft diet.

Soft Diet

General Description

 

Soft textured food in term of types or preparation of food as to aid in eating and chewing. Usually use for patient with:

1. difficulty to chew
2. diarrhea, vomiting or sick until unable to take normal diet
3. disturbances in gastrointestinal track and need soft food
4. post operation or as transition feeding from blenderised diet to normal diet
5. problem in dentition or no teeth
6. difficulty to swallow because of neurological problem, esophagus, oral, faring or post operation.

Diet Principles:

 

• Soft food like bread, porridge, fish, tofu, chicken and soft vegetable are encouraged to be given
• Avoid meat or hard vegetable
• Food cut into smaller size or cube size
• Avoid use of spices, chili, or vinegar in cooking
• Food cooked until soft

Sample Menu Soft Diet  (Menu E) 1400kcal

Breakfast White Bread                            ± 3 pcs             + Margarine                ± 2 tsp             + Jam                          ± 1 portion             + Egg                          1 egg OR Chocolate bun                         1 pcs OR Sandwich                                ± 3 slices             + meat/sardine            ± 1 mb             + margarine                ± 2 tsp             + vegetable AND Tea / Coffee                            ±1cup + sugar                                    ±2tbsp

Lunch / Dinner Rice Porridge                          ± 2 cup             + Chicken in soup       ± 1 pc             + Oil                            ± 1 tsp             + Mix Vegetable Fruit                                         1 portion Afternoon Tea Malay Kueh                             1 pc OR Creamy Bread                                    1 pcs AND Tea / Coffee                            ±1cup + sugar                                    ±2tbsp

Bland Diet

General Description

 

A diet that eliminates foods containing caffeine, alcohol, pepper, spices, highly seasoned with strong herbs and deep fried and also other foods that are assumed to be irritating to the intestinal mucosa or that promote gastric acid secretion.

Diet Principle

 

This diet should be individualized according to food intolerances of the patient, although it usually follows the pattern of a normal full diet

MISCELLANEOUS AND DIAGNOSTICS TEST DIETS

Low Fiber Diet

General Description

 

A diet that contains a minimum of dietary fiber and connective tissue. It is not aimed at reducing the amount of fecal residue, but is aimed at reducing the amount of fibrous material in the stool.

Diet Principle

 

Foods avoided are those which contain indigestible tough connective tissues of meats and chicken, fibrous tissues of fruits and vegetables.

Purpose of the diet: To prevent the formation of an obstructing bolus of high fiber foods in patients with narrowed intestinal or esophageal lumens or to reduce the frequency of painful stools in acute phases of diverticulitis or inflammatory bowel disease.

Low Residue Diet

General Description

 

This diet is for patient with intestinal disturbances and for pre- and post operative cases. Residue refers to the volume of materials (including indigested fiber and food, bacteria, sloughed cells) remaining in the colon after the digestive system has been completed.

Diet Principles:

Diet is modified based on selection of food as given in the table below:

Food Group	Suggested	Not Suggested
Beverages	Coffee, tea, syrup, fruit juice without fiber	Fruit, vegetable, prune juice
Bread & cereals	White bread, cream cracker, muffin, biscuit without wheat meal, pancake, white rice	Bread and cereals made from whole meal flour, bran, nut, legume, dried fruit and coconut
Dessert	Cake, biscuit, pie, yogurt, custard, jelly, ice cream	Dessert made from whole meal flour, bran, nut, legume, dried fruit, seeds and coconut
Food Group	Suggested	Not Suggested
Fat	Butter, mayonnaise, margarine
Fruits	Canned fruit, Ripped fruit without skin, Ripped banana	Raw and dried fruit
Protein food	All meat, fish, chicken, duck, egg, cheese, Cooked soft offal	Though and fried  meat, nuts and legume
Vegetables	Cooked until soft vegetable, seedless vegetable	Uncooked vegetable, vegetable contains seeds and corn
Miscellaneous	Salt, white pepper, herbs, vinegar, tomato sauce	Coconut, nut, sunflower seed, pop corn.

High Fiber Diet

General Description

 

A diet that contains increased amounts of soluble dietary fiber (eg: fruits, oats, barley, legumes) and insoluble dietary fiber (e.g.: vegetables, wheat and most grains)

Diet Principle

 

The regular diet was modified with high fiber foods such as substitute white bread with whole meal bread, eat fruits together with the skin and eat two types of vegetables or one cup of vegetables during lunch and dinner.

Purpose of the diet: To increase fecal bulk and reduce intestinal transit time decreased intraluminal colonic pressure decreased risk of colon cancer decreased serum cholesterol level and decreased glucose absorption rate.

VMA (VANILLYLMANDELIC ACID TEST) Diet

General Description

 

The VMA test is used to determine the presence of pheochromocytomas or other neorogenic tumours which secret an excess of catecholamines causing hypertension. It is thought that the ingestion of certain food-stuffs results in an increase of phenolic acids in the urine which may result in a false-positive diagnosis. The test is prescribed for a 3-day period, unless specified otherwise.

Diet Principle

 

Food items to be eliminated are :
Coffee Tea Cola Caffeine-containing beverages Vanilla Vanilla containing foods	Chocolate Bananas Citrus fruits (oranges, lemon, limes, grapefruit) Biscuit	Pineapple Tomatoes Asparagus Custard Ice-cream Sweets Cake

# This food list also can be use for Non Flavour Diet