Gastro Soft (aka: High Soluble, Low Insoluble Fiber Diet) Revised: 10/11/2012

For:______Date:______

GOALS: Calories: ______Protein: ______Fluid (without diarrhea): ______

These diet guidelines are provided to prevent or reduce diarrhea. These foods are easily digested and absorbed, and are non‐irritating to the digestive tract. Initiate this diet when your treatment begins, and adjust your intake of “Foods Eaten as Tolerated” as your symptoms allow.

Remember to: 1. Maintain adequate fluid intake. 2. Chew foods well and eat slowly. 3. Include small, frequent .

Avoid: 1. Medications/herbs not prescribed by your physician. 2. Greasy, fatty or fried foods 3. Highly spiced foods 4. Extremes of temperature 5. Gas‐forming foods 6. Alcohol 7. Caffeine 8. Foods containing large amounts of lactose 9. The artificial sweeteners sorbitol, mannitol, xylitol, and maltitol 10. Foods containing the fat substitute olestra, or “Olean”

TYPE OF FOOD RECOMMENDED FOODS FOODS TO EAT AS FOODS THAT MAY CAUSE TOLERATED DISTRESS Beverages Gatorade, lemonade, Decaffeinated coffee Coffee, tea, cola caffeine‐free carbonated and tea, Kool‐Aid or beverages, beverages beverages if allowed to go fruit drinks in small containing caffeine or “flat”, lactose‐free non‐ amounts alcohol, beverages served dairy creamer in small at extreme temperatures amounts, fortified soy and (very hot or iced). Cocoa, rice milk hot chocolate, Ovaltine. Breads and Refined white, wheat or Pancakes, waffles, and Any made with whole‐ Crackers seedless rye bread. Low fat French toast prepared grain flour, cracked wheat, muffins, English muffins, with lactase‐treated bran, nuts, seeds, coconut, quick breads, rolls, biscuits. milk, fortified soymilk or raw or dried fruits, any bread. Plain, or rice milk, plain with more than 1 gram saltine and graham doughnuts, refined fiber per serving (except crackers cornbread, crescent oatmeal bread), any low‐ rolls, croissants. Breads fat or fat‐free breads containing chocolate containing olestra. Cereals Refined cooked cereals Cereals containing Any made with whole including grits, Cream of chocolate grains or whole grain flour, Wheat, Cream of Rice, bran, nuts, seeds, coconut

Page 1 TYPE OF FOOD RECOMMENDED FOODS FOODS TO EAT AS FOODS THAT MAY CAUSE TOLERATED DISTRESS , Malt‐O‐; or , granola oatmeal and oat bran; refined cold cereals, such as puffed rice, Special K, crisp rice Eggs All cooked eggs Fried eggs Raw, undercooked or (except fried) pickled eggs Fats All fats in moderation; Sour cream All highly spiced salad butter, margarine, salad oil, dressings mayonnaise, salad dressings made with allowed ingredients, plain gravy Fruits Most canned or cooked Orange or grapefruit Dried fruit, all berries, raw Limit to 2 fruits without seeds or sections without fruits with membranes and servings/day, skins, applesauce, ripe membrane, peeled fresh seeds, kiwi, melon, grapes, except for or plums, pineapple and applesauce. Fruits Apricot, peach and guava Citrus Juices containing pulp, Limit to 1 cup per nectar. Cranberry juice unless counted as a fruit day, without pulp serving. Grape, apple, prune and pear juice Meats and Meat Ground or well‐cooked, Crisp bacon Any made with whole‐ Substitutes tender beef, lamb, ham, grain ingredients, seeds or veal, pork, poultry, fish, nuts, dried beans, peas, organ meats; eggs; creamy lentils, legumes, chunky , peanut butter, fried, smoked, highly spiced, or salted meats, e.g. corned beef, deli meats, salami, bologna, hot dogs Milk and Milk Fortified soy and rice milk, Reduced‐fat or nonfat All forms of milk (whole, Products/ Milk lactose‐free non‐dairy lactase‐treated milk reduced‐fat, nonfat, Substitutes creamer, cream cheese (e.g. Lact‐Aid). evaporated, condensed, Limit milk Fermented or cultured dried) except those treated products to no milk products such as with or taken with lactase more than 2 cups acidophilus milk or enzyme. Cocoa, hot per day, in ½ cup buttermilk, plain, chocolate, Ovaltine. Cream, portions as flavored or liquid half and half. Cheese with tolerated (kefir) seeds, nuts, or pepper. containing active Yogurt containing seeds or cultures. or skins made with lactase‐treated milk. Cream made with water or lactase‐treated milk and allowed

Page 2 TYPE OF FOOD RECOMMENDED FOODS FOODS TO EAT AS FOODS THAT MAY CAUSE TOLERATED DISTRESS vegetables. ; all mild cheeses and cheese spreads except those with seeds, nuts or pepper Potato and Cooked white and sweet Whole grain and wild rice. Starches potatoes without skin; Pasta containing whole white rice; refined pasta grains. Fried potatoes, potato chips, including fat‐ free or low‐fat containing olestra. Bouillon, broth or broth‐ Cream soup made with Any other containing foods based soups made with water or lactase‐treated to avoid allowed vegetables, milk and allowed noodles, rice or flour vegetables Vegetables Most well‐cooked and Small amounts soft Sauerkraut, squash, peas Limit to 2 canned vegetables without lettuce if tolerated and corn; most raw servings/day seeds (i.e. asparagus tips, vegetables and vegetables beets, carrots, green or wax with seeds (e.g. snow beans, Italian green beans, peas). Any fried or gassy mushrooms, bean sprouts); vegetables (e.g. broccoli, strained vegetable juice; Brussels sprouts, sauce and paste; cauliflower, cabbage) Desserts and Plain cakes and cookies Lactose‐free or tofu ice Any made with whole‐ Sweets made with refined white cream as tolerated grain flour, nuts, seeds, In moderation flour, angel food cake, fruit without seeds and nuts, coconut, chocolate or dried ice, frozen pops, gelatin, plain sherbet, pie made fruit. Jam, preserves, plain hard candy, jelly, with allowed fruits. marmalade. “Sugar‐free” honey, marshmallows, candies containing molasses, sugar, and syrup artificial sweeteners (sorbitol, mannitol, xylitol, maltitol). Chewing gum. Desserts with more than 5 grams of fat per serving Miscellaneous Salt, sugar Mild spices and herbs, Nuts, coconut, seeds, vinegar, ketchup, mild popcorn, pickles, chili mustard, meat extracts sauce, horseradish, mustard (hot/spicy), relishes, pepper, chili powder, cloves, garlic, paprika, . Fried snack foods (e.g. chips)

If stools begin to increase in frequency and volume: 1. Reduce or eliminate foods in the column labeled “Foods to Eat as Tolerated”. 2. Eat six or more smaller meals per day. 3. Drink liquids between instead of with meals, and avoid extremes of temperature.

Page 3 4. Cook rice (see recipe) and begin to eat it several times per day, if possible. 5. Include a soluble fiber source with each feeding to help “gel” the stool: banana, applesauce, oatmeal, white bread, skinless potato, or refined pasta. 6. Eliminate vegetables other than strained vegetable juice. 7. Limit fat to 3 servings a day. One serving is 1 teaspoon margarine or butter, 1 tablespoon salad dressing, 1 slice bacon, 5 large olives.

Rice Congee 1 cup white rice 6 to7 cups water 1 teaspoon salt

Cook rice until soft, according to package directions. Let it sit for 15 minutes to thicken. This will be a goopy, soupy rice mixture. Eat the rice and drink the liquid with a spoon. Try making this with clear broth for added flavor. Omit the salt if using clear broth instead of water. Fish, poultry, or pieces of egg can be added for protein.

SAMPLE DAILY MENU PLAN

Breakfast Lunch Dinner 4 oz. Cranberry juice 6 oz. Rice congee 6 oz. Rice congee 1 Poached egg 2 oz. Sliced chicken on 3 oz. Roast beef au jus 1 slice White toast 2 slices White bread 2/3 c. Cooked white pasta 1 tsp. Margarine/jelly 1 Tbsp. Mayonnaise ½ c. Green beans Warm decaffeinated tea ½ c. Cooked carrots Plain dinner roll ½ c. Applesauce 1 tsp. Margarine 1 tsp. Margarine Warm decaffeinated tea Warm decaffeinated tea

Mid­Morning Mid­Afternoon Evening 1 c. Crisp rice cereal ½ c. Cottage cheese 8 oz. Peach yogurt 4 oz. Lactase‐treated reduced ½ c. Canned Angel food cake fat milk ½ English muffin 4 oz. Gatorade ½ Banana 1 tsp. Margarine/jelly

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