NUTRITION AND DIET THERAPY LABORATORY

PREPARED BY
Janet Marquez Rafael

Reference:
Medical Nutrition Therapy for Filipinos Laboratory Manual
Adela Jamorabo-Ruiz, Virginia Serraon-Claudio, 2005, Manila
Philippines
A. Learning objectives

This laboratory class is designed to provide training for students in

calculations of BMR for menu planning modified diets, nutrition
assessments, and patient counseling.
To add knowledge and information on how to sustain a healthy,
sound body, mind & spirit.

B. Concepts and Terms

1. Diet Therapy – is the modification of the daily intake of food

and drink of an individual who is suffering from a disease for
the purpose of removing or at least alleviating the result of the
disease process.
2. Diets – are defined as the daily allowance of food and drink of
an individual for a day.
3. Dietary patterns- refer to the amounts allowed per meal or per
day and will depend on the therapeutic requirements.
4. Routine diets – refer to the full, soft, full liquid or clear liquid
diets and are the basis for other therapeutic modification.
5. Therapeutic diets- are those with one or more of the
modifications given as follows;
a. A change in consistency and or flavor
b. Increase or decrease in bulk, volume or frequency of meals
c. Increase or decrease in energy value
d. Inclusion of greater or lesser amount of one or more
nutrients.
e. Inclusion or exclusion of specific foods or food components
f. Modification intervals of feeding
 g. Adjustment in the level, ratio or balance between or among
nutrient constituents
h. Change in the route or delivery of nutrients

Lesson I

A. Planning therapeutic Diets

Points to consider
1. The diet should provide enough calories to maintain
desirable body weight.
2. The diet should provide for the loss in nitrogen which may
occur as a result of the disease process, thus enough protein
should be given.
3. The diet should provide necessary nutrients to clear up any
deficiency’s concomitant with the disease.
4. The diet should only be a modification of the usual normal
diet and, must be psychologically acceptable.
5. The diet must afford rest to the organ involved in the
disease.
6. The diet must be adjusted to the body’s ability to utilize the
nutrients.

B. Problems in Planning Therapeutic Diets

1. Diet patterns vary from individual to individual

2. Nutrient contents in foods vary from food to food.
 3. Requirement for specific nutrients vary because of genetics,
environmental factors, diet patterns, the nature and severity of
the disease, and the age and sex of the patient.
4. Individual problems of patient, such as, emotional, financial,
social and others.

C. Calculating and Planning Diets

The Basis for estimating the desirable intake of an individual

1. Caloric Allowances

a. Based on basal needs and activity (BMR)

Basal needs – 1 kcal. per kg desirable body weight per
hour for male or 0.9 kcal. per kg desirable body weight
per hour for female.

Physical needs – approximate percentage increase above

basal needs

Bed rest 10-20 percent

Sedentary 30 percent
Light activity 50-60 percent
Moderately active 60-70 percent
Severely active 90-110 percent

b. Based on caloric allowance per kg. desirable body weight

Bed rest 27.5 kcal. per kg.

Very light (sedentary) 30 kcal. per kg.
 Light 35 kcal. per kg.
Moderately active 40 kcal. per kg.
Very active 45 kcal. per kg.c.

c. Based on the Recommended Energy and Nutrient Intakes

of the FNRI

Activity:

Know your present weight.

What is your desirable body weight? Record.
Look for the recommended energy allowance based on
your age, sex, and activity and your desirable body
weight.
 2. Protein Allowances

a. Based on body weight: allow 1.14 g protein per kg.

desirable body weight
b. Based on the percentage of the caloric allowances
10 -15 percent of the total energy needs for adults
15-20 percent of total energy needs for children
c. Based on the Recommended Nutrient intakes of the FNRI

3. Carbohydrate allowances

Based on percentage of the non-protein calories 60-75

percent of non-protein calories

4. Fat allowances
Based on a percentage of non-protein calories

D. Sample Calculations of a Diet

Calculating the total Energy Allowance (TER) of a woman 5’3

whose desirable body weight is 120 pounds and engages in
light activity.

1. Convert lbs to kg. weight = 120/2.2 = 55kg

2. Calculate basal needs = 0.9 × 55 × 24 = 1188 kcal.
3. Estimate physical activities = 1188 × .05 = 594 kcal.
4. Add values from 2 and 3 to get TEA
 1188 + 594 = 1782 kcal.

5. Distribute Total Energy Allowance Among Carbohydrate,

Protein, Fat as follows;

a. By using the percentage contribution of CHO, Pro Fat,

allow for protein calories afterwards
b. By calculating protein calories first by using 1.1 g/kg
body weight, multiplying with4. Allow for the desired
percentage distribution for carbohydrate from the
non-protein calories and the rests for fats.

6. To obtain the grams of CHO, Pro, Fats use the

corresponding physiological fuels values (4 kcal/g CHO or
Pro, 9 kcal/g, Fat)
7. One rule to follow in writing the diet, kilocalories are
rounded off to the nearest number exactly divisible by 25;
and CHO, Pro, Fat the nearest number exactly
divisible by 5.
Activity:
Compute your TEA
E. Using the Exchange List in Meal Planning

1. Use the table provided for meal Plans

2. Determine the amount of vegetable A and B exchanges the
patient can eat.
3. Determine the amount of fruit exchanges the patient would
like for the day.
 4. Determine the amount of milk exchanges the patient can
tolerate.
5. Determine the amount of sugar desired (only on the diets
6. when sugar is allowed)
7. Sub total the amounts of carbohydrate, protein, fats and
calories so far provided.
8. Subtract the amount of carbohydrate so far provided by the
vegetable, fruit, milk, exchanges and the sugar allowed from
the prescribed amount and divide the result by 23, which is the
amount of carbohydrate in one rice exchange necessary to fill
up the prescribe amount.
9. Sub total the amount of protein, subtract from the total
protein prescribed and divide the result by 8 to get the number
of meat exchange required.
10. Sub total the amount of fat, subtract from the total fat
prescribed and divide the result by 5 to get the number of fat
exchanges required.
11. The total number of exchanges obtained will be used for
planning the menu.

Activities:

1. Compute your basal needs and activity

2. Calculate your total Energy Allowance (TER)
3. Prepare the exchange list based on your computed TER for meal
planning.
4. Plan a full meal
 Laboratory 2
ROUTINE HOSPITAL DIETS

PURPOSE
To be able to plan and prepare the routine hospital diets;
- Full regular diet/Normal diet
- Soft diet
- Light or Liberal soft diet
- Full Liquid diet
- Clear liquid diet
- Cold liquid diet

Description of Diets
1. Regular or Normal Diet. Also called house or general or full diet, it
is the most frequently used of all hospital diets. It is planned to
provide the Recommended Energy and Nutrient Intakes (RENI) for
essential nutrients with caloric adjustment for bedridden
individuals. All foods are allowed. However, it should be carefully
planned for hospital use avoiding too much spices, gas formers
and rich, hard to digest foods.

2. Soft Diet. This follows the regular diet pattern but is modified in
consistency, free from harsh fivers and connective tissues, soft in
texture, bland in flavor allowing minimum seasonings, simply
prepared and easy to digest. It is not necessarily pureed diet,
therefore it is necessary to select foods carefully. It is a transition
diet between full liquid and regular diets. It is used in post
 operative cases when the patient cannot tolerate the normal diet.
It is also indicated for mild infections, fevers, gastrointestinal
disturbance and convalescence.

3. Liberal soft or Light Diet. This is a transition between the soft and
regular diets. It is more liberal than the usual soft diet in that
short-fibered fruits and vegetables are allowed. Moderate
seasonings are used. It should be used as tolerated.

4. Full Liquid Diet. This consist of foods that are liquid or can liquify
in the mouth or is prescribed allowance of foods which melt at
body temperature. The ingredients used should be easy to digest
and absorb. The should be high in calories and protein, hence, it
can be used for a relatively longer period of time. Feedings should
be at least six times a day; the volume and frequency of feeding
should be on case to case basis as some patients may not have
the appetite to take in more liquid foods in one setting.

Milk based foods form an important part of the diet.

Flavoring is helpful, natural or vanilla is best tolerated for long
term use. The full liquid diet easily provides adequate calories,
protein and essential fatty acids but not certain vitamins
especially vitamin C and B unless fruit juices and cereals are
routinely included.
The Full liquid diet bridges the gap between the clear liquid
and soft diets. It used in acute conditions, following surgery and
for patients too ill to eat solid foods. It is also indicated for those
who can not swallow or masticate food, such as in fractured jaws
and oral surgery or when the esophagus is narrowed and solid
foods cannot pass.
 5. Clear Liquid Diet. This diet is made up of clear liquids, (no milk and
milk drinks or opaque fluids) which do not leave any residue in the
gastro intestinal tract. It is a diet that does not irritate nor
stimulate peristalsis and therefore allows rest to the GI tract. It is
to relieve thirst and help maintain water balance. Since it is
nutritionally inadequate diet, the clear liquid diet should not be
used over 2 days or 48 hours.

It is indicated for patients of pre- and post -surgery; acute

infections and fevers acute gastrointestinal disorders, nausea and
vomiting. It is especially used for patients whose fecal material
must be reduced.
6. Cold liquid Diet. This is also called T & A diet for tonsillectomy and
adenectomy and made up of cold liquids and cold soft foods that
liquefy in body temperature given to patients after tonsillectomy,
adenectomy and other mouth and throat surgery.

LABORATORY: LESSON 2

Objective
To be able to plan and prepare the routine hospital diets
The types of Diet
1. Full, regular or normal diet
 2. Soft diet
3. Light or liberal soft diet
4. Full liquid diet
5. Clear liquid diet
6. Cold liquid diet

Description of Diets

1. Regular/normal Diet. Also called house or general /full diet, it is

the most frequently used of all hospital diets. It is planned to
provide the Recommended Energy and Nutrient Intakes (RENI) for
essential nutrients with caloric adjustment for bed ridden
individuals. It is the basis for all dietary modifications for
therapeutic purposes. Like the normal diet eaten at home, all
foods are allowed. However, it should be carefully planned for
hospital use avoiding too much spices, gas formers and rich, hard-
to-digest foods.

Activity: plan a regular/normal diet for 1 week.

2. Soft diet. This follows the regular diet pattern but is modified in
consistency, free from harsh fibers and connective tissues, soft in
texture, bland in flavor allowing minimum seasonings, simply
prepared and easy to digest. Select foods with the prescribed
characteristics, that can be serve whole, yet it is soft, this diet is a
transition of the full regular to full liquid diet. A diet for post-
operative cases when patient can not tolerate the normal diet. It
also indicated for mild infections, fevers, gastrointestinal
disturbance and convalescence.
 Activity:

1. List down foods under this category, arrange following the

basic food groups.
2. Prepare a regular soft diet for one day. To be presented in the
GC.

3. Liberal Soft or Light Diet. This is a transition between the soft and
regular diets. It is more liberal than the usual soft diet in that
short-fibered fruits and vegetables are allowed. Moderate
seasonings are used.
Activity: Plan a one-day Liberal Soft Diet

4. Full liquid diet. This consist of foods that are liquid or can liquify in
the mouth or is prescribe allowance of foods which melt at body
temperature. The ingredient used should be easy to digest and
absorb. The diet should be planned nutritionally adequate or even
high in calories and protein; hence it can be used for a relatively
longer period of time. Feedings should be at least six times a day;
the volume and frequency of feeding should be on case to case
basis.
Milk -based foods form an important part of the diet.
Natural or vanilla flavor is best tolerated for long-term use. The
Full Liquid diet easily provide adequate calories, protein and
essential fatty acids but not certain vitamins especially vitamin C
and B1 unless fruit juices and cereals are routinely included.
 The full liquid diet bridges the gap between the clear liquid
and soft diets. It is used in acute conditions, following surgery and
for patients too ill to eat solid foods, also for those who can not
swallow or masticate food, such as fractured jaws and oral
surgery or when esophagus is narrowed and solid foods cannot
pass.

Activity;
1. Prepare a one-week Full Liquid Diet.

5. Clear Liquid Diet: this diet is made up of clear liquids, (no milk
and milk drinks or opaque fluids) which do not leave any residue
in the gastro intestinal tract. It is a diet that does not leave any
residue in the gastro intestinal tract. A diet that does not irritate
nor stimulate peristalsis and therefore allows rest to the GI tract.
Its primary purpose is to relieve thirst and help maintain water
balance. Since it a nutritionally inadequate diet, the clear liquid
diet should not be used over 2 days or 48 hours. It is indicated for
patients of pre- and post- surgery, acute infections and fevers,
acute gastrointestinal disorders, nausea and vomiting. It is
especially useful for patients whose fecal material must be
reduced.

6. Cold Liquid Diet. This is also called T & A diet for tonsillectomy and
adenectomy and made up of cold liquids and cold soft foods that
liquefy in body temperature given to patients after tonsillectomy,
adenectomy and other mouth throat surgery.
CALCULATIONS AND PLANNING TABLES
1. THE NORMAL DIET

TABLE 1 & 2: DAILY FOOD PLAN FOR A NORMAL DIET

FOOD No. CH PRO FAT ENERGY

EXCHANGES of O g g kcal B L D Sn
Exch. g
I.Veg. A

Veg. B

II. Fruits

III. Milk

IV. Rice

V. Meat
VII.Sugars,etc.
TOTAL
TABLE 2 SAMPLE MENU

Breakfast Lunch Dinner

snacks
2. High Protein, Full Liquid Diet

FOOD No. CH PRO FAT ENERGY

EXCHANGES of O g g kcal B L D Sn
Exch. g
I.Veg. A

Veg. B

II. Fruits

III. Milk

IV. Rice

V. Meat
VII.Sugars,etc.
TOTAL

SAMPLE MENU
Breakfast Lunch Super

Snacks
3.High Caloric Clear Liquid Diet

FOOD No. CH PRO FAT ENERGY

EXCHANGES of O g g kcal B L D Sn
Exch. g
I.Veg. A

Veg. B

II. Fruits

III. Milk

IV. Rice

V. Meat
VII.Sugars,etc.
TOTAL

SAMPLE MENU
Breakfast Lunch Super

Snacks
 5. Food Selection

Diet Allowed Avoided

Normal

Liberal Soft

Soft

Full Liquid

Clear Liquid

Lesson 1.5
MODIFICATIONS IN CONSISTENCY
PURPOSE
 1. To be able to plan and prepare modifications in consistency
2. The types of diets to be studied are
a. Blender zed tube feedings
b. Mechanical soft diet
c. Puree diet

Descriptions of Diets
1. Blenderized Tube Feedings. These are liquid diets introduced into
the stomach by means of polyvinyl tube inserted through the
mouth or nose. It consists of liquid foods that can pass through
the tube with ease or it may be made from selected non-fibrous
foods that may be liquified or homogenized using a blender. Tube
feeding formula must be nutritionally adequate, well tolerated by
the patients, easily prepared and inexpensive.
Tube feedings are indicated for patients who are unable to
use the oral cavity. It is given in cases of esophageal obstruction,
severe burns, comatose conditions, terminal malignancy, anorexia
nervosa, acute fevers and other illnesses to augment nutrient
intake, especially for carbohydrates and protein.

2. Mechanical Soft Diet. This is also called dental soft, geriatric soft
diet, level II or III dysphagia diet because it consists of foods that
require little chewing and easy swallow. It follows the regular diet
pattern except that hard and large pieces of food are chopped,
grounded, minced or pureed. It is used for facial surgery or in
cases where minimum movement of facial muscles is required, for
poor dentures, presence of sores and lesions in the mouth and
dental surgery.
 3. Puree Diet. This diet is also called level I dysphagia diet and is
used for patients with difficulty chewing and swallowing regular
or mechanical soft foods. Foods are pureed to smooth consistency
similar to that of mashed potato.

Activity:
1. Based on the total food allowances for the normal diet, plan 2400
cc blended formula foods that can homogenized. Check the
adequacy of the formula. Describe the method for preparing the
formula.
2. Modify the normal diet into a mechanical soft diet and a puree
diet.

Laboratory 7
Modification in Flavor

Objectives
 1. To be able to plan and prepare the progressive bland diets.
2. To be able to plan and prepare salt-free and spice free diets.

Descriptions of Diets
1. Liberalized Bland Diets. Bland diets are modifications in
consistency and flavor to eliminate foods that stimulate gastric
acid secretion or those that irritate the gastric mucosa or cause
indigestion. The liberalized bland diet limits alcohol, coffee and
caffeine-containing beverages, and spices reported to cause
discomfort to the patient.

Bland diets are indicated for gastroesophageal reflux, peptic or

duodenal ulcer, gastritis; esophageal varices; gastric duodenal
and pancreatic post-surgery.

2. Salt-Free Diet. This diet is also called No Added Salt (NAS) Diet
and is similar to the regular or normal diet but is lightly salted.
Additional salt at the table and other obviously salty foods or
condiments are avoided, such as soy sauce, patis, toyo, bagoong,
salted nuts and itlog na maalat. This is equivalent to a sodium
intake of 2000mg.

It is indicated for mild cases of edema, hypertension and other

disorders where sodium intake is not quite restricted, especially
for those under drug therapy.

3. Spice-free Diet. This diet does not allow spices. The only
condiment used is salt in moderate amounts. It is usually
prescribed for gastrointestinal and kidney disorders.
4. No Sugars and concentrated sweets Diet. This diet is a liberalized
diabetic diet that does not use measurements or food exchanges.
It is prescribed for patients with mildly impaired glucose tolerance
who are maintaining an acceptable weight; those who need a
diabetic diet but have poor intake; and diabetics who cannot or
will not follow the food exchange system. “simple sugars” and
foods high in sugar need not be avoided; small amounts, up to
20% of total carbohydrate, are included in the diet. Alternative
sweeteners such as honey and fructose are also allowed.
Generous intake of fiber (30 to 50g) is recommended to improve
glycemic control.

Activity

1. Plan and calculate the total food allowances for a bland diet for
a person who has peptic ulcer disease and does not drink milk.
2. Modify the normal diet into a salt-free/spice free Diet.
3. Modify the normal diet into a no sugars and concentrated
sweets diet.

Questions
1. What foods are bland?
2. What is flavor? What causes strong flavor in foods?
3. Give a list of spices which had been found to be strongly
stimulating? Spices which have no effect on gastric secretion?
MODIFICATIONS IN TEXTURE
OBJECTIVES
To be able to plan and prepare modifications in fiber and residue.
Types of Diet
1. Fiber-modified diets (high and low fiber)
2. Residue-restricted diets
1. Fiber Modified Diets
This is a normal diet which has more dietary fiber easily supplied
by adding to the normal diet 2-3 servings of raw fruits, long
fibered vegetables, whole grain cereals, legumes and nuts skin. It
is indicated for atonic constipation in order to stimulate peristalsis
in a sluggish colon; diverticulosis, irritable bowel syndrome,
diabetes Meletus and hypercholesterolemia.
2. Fiber Restricted Diet
It contains a minimum of indigestible carbohydrates and tough
connective tissues. This is accomplished by removing gristle, using
tender cuts of meat, avoiding long-fiber vegetables and fruits,
using refined cereals, skin-less nuts and legumes and cooking food
thoroughly to soften short fibers. It is prescribed for patients with
spastic constipation, diverticulitis or inflammatory bowel disease,
diarrhea, hemorrhoids, cancer of the rectum and bowel
obstruction.
3. Minimal Residue Diet. This is similar to the liberal soft diet and
supplies the least amount of residue or fecal material. However,
unlike the fiber-restricted diet, the minimal residue diets do not
allow milk, lactose, Swiss cheese, soft-cooked egg, butter, lard,
potato and rich fatty foods. This is useful for patients whose colon
need absolute rest such as in a surgery of the colon, acute phase
of ulcerative colitis, ileitis, acute diverticulitis and right after
hemorrhoidectomy.
4. Low Residue Diet. This is mor liberal than the minimal residue
diet, it allows low fibered fruits and vegetables up to 2 servings a
day. Milk, lactose, rich fatty foods and others mentioned above
are limited. This diet is often used after initial surgery and is also
 indicated for GI inflammation, particularly the colon, dysentery,
ileitis, diverticulitis and diarrhea.
Activity:
Block A. Prepare the lunch tray for the high fiber diet
Block B. Prepare the lunch tray for the low residue
Block C. Prepare the lunch tray for low residue

Questions
1. What is the difference between fiber and residue?
2. How did you reduce the residue content of the normal diet?
3. How did you reduce the fiber content of the normal diet?

LABORATORY LESSON 7

MODIFICATIONS IN FATS

Purpose
 1. To be able to plan and prepare modifications in the amount of
fats
2. To be able to plan and prepare modifications in chain length or
fatty acids content.
The Types of Diets
1. Fat -restricted or Low-fat Diets. The level of fat intake is about half
as much as that in the normal diet. Thus, the caloric reduction is
supplied by increasing carbohydrate intake. While the average
diet supplies 50% to 60% carbohydrate-calories, 25 to 30% fat-
calories and 10 to 15% protein calories, the fat restricted diet is
calculated to provide about 15% of the total caloric needs of an
individual.
Example: an adult Filipina whose RDA requirement for energy is
2,000 kcal, her intake for a fat-restricted diet is about 30g fat per
day. The protein level is kept at a normal level and CHO intake is
increased to replace what was deducted by decreased fat intake.
This diet is indicated in obesity, pancreatitis, cholelithiasis,
hepatitis, sprue and fat malabsorption.

2. High Protein, Fat-restricted Diet. Protein intake compensates for

most of the calories deducted from restricting fat. Again, for an
adult Filipina whose RDA requirement is 2,000 kcal, 30 gram fat,
the protein intake is twice as much as the normal intake which is
calculated to be 100 g for this particular case. The remaining
calories (1,300) are supplied by 330 g carbohydrates. This regimen
is useful for portal cirrhosis, pancreatitis and obesity.
3. Fat-free Diet. This diet practically no fat. This is usually
encountered as a test diet used in the diagnosis of gallbladder
disease. The clear liquid diet is also an example of fat-free diet.
4. LCT (Long-Chain Triglyceride) – restricted Diet. This is usually
called MCT diet since it allows the use of medium chain
triglycerides, which are predominantly caprylic (C8) and capric
(C10) with some lauric acid (C12). Fats containing long chained
fatty acids like palmitic (C16), stearic (18) and the polyunsaturated
fatty acids are omitted from the diet. Most naturally occurring fats
are long chain triglycerides. MCT are not found naturally in food.
The MCT is indicated for conditions in which ordinary dietary fats
are poorly digested and absorbed. It is prescribed for the
malabsorption syndrome as in pancreatitis, post gastrectomy,
sprue, cystic fibrosis, steatorrhea and massive resection of the
small intestines.

5. High-fat Diet. The level of fat intake is twice as much as the

normal intake. In some cases, as in ketogenic diet, fat contributes
up to 80% of total energy needs and carbohydrate is restricted to
3o g or less to provide for a ketogenic; antiketogenic ratio of 2:1.
This diet is rarely prescribed. It is believed to benefit persons with
epilepsy or convulsive seizures.

Preparation

Block A
Calculate and plan a fat-restricted diet allowing half as much fat as in
the normal diet, while keeping the caloric intake the same. With
2,000 kcal
 Block B
Calculate and plan a high protein-fat-restricted diet, with at least
1750 kcal.

Block C
Calculate and plan a fat-free meal, using 1/3 of the day’s allowances,
with 1, 600 kcal.

All activities shall be presented during the google meet.

LABORATORY 8
MODIFICATIONS IN PROTEINS

PURPOSE
1. To be able to plan and prepare modifications in of protein.
2. To be able to modify the normal diet to a vegetarian diet.
Descriptions of Diets
1. High Protein Diet. For proper nutrition the normal diet must
supply 50% of the recommended intake from animal sources and
the other 50% from vegetable sources. This means that for a 60 g
protein diet, 30 g will be supplied by eggs, milk, meat/fish which is
equivalent to 4 meat exchanges; and 30 g will be supplied by
vegetables, cereals, legumes, root crops, etc. which is
approximately 2 exchanges of vegetable B and 13 exchanges of
rice, root crops and legumes.
A high protein diet is indicated for protein deficiency, burns,
fractures, liver cirrhosis, pernicious anemia, ulcerative colitis,
post-operative conditions, hemorrhaging and other cases where
regeneration of body cells or tissues needs immediate attention.

2. Protein Restricted Diet. Two levels of protein restriction:

a. Minimal – allows only 25% of the RENI for protein (0.25 g/kg/
DBW)
b. Low – (0.5g/kg DBW) of the normal RENI.
Emphasis is on high protein biologic value, which means in a
restricted protein intake (15 to 30 grams per day for an adult),
7-15 g must come from animal sources or 1-2 exchanges of
meat and the rest from vegetable sources.
It is beneficial in renal failure, hepatic coma, and
glomerulonephritis.

3. Protein Free Diet. This diet is virtually free from protein (0 to 5

g/day). The diet makes use of sugars, fats and starches. The
 butter-sugar diet is an example of a protein- free regimen. This
diet is indicated in severe anuria, hepatic coma and uremia.

4. Protein re-distribution Diet. The usual protein intake of 1 g/kg

body weight is redistributed so that only 7 to 10 g protein are
given during the day (divided between breakfast and lunch) and
the remaining protein is given after 5 pm. This diet is suggested
with Parkinson’s disease who do not respond well to levodopa.

Large neutral amino acids (LNAAs) from protein in the diet

compete with levodopa in crossing the blood-brain barrier,
making the drug less effective. By restricting the daytime protein,
the diet aims to improve the effectiveness of the drug and thus
improve daytime mobility and motor performance. However,
consuming a larger protein meal in the evening can result in
suboptimal levodopa effect with consequent increase in rigidity
and trembling at night.

5. Seven: one (7-1) Diet: a diet that aims to control the amount of
large neutral amino acids in blood to allow for better levodopa
utilization in patients with Parkinson’s disease. High blood levels
of LNAAs, components of protein in the diet compete with
levodopa for the same transport mechanism into the brain. When
blood levels of LNAA are lowered, levodopa moves across the
blood-brain barrier more effectively.

The diet consists of balancing the carbohydrates and protein in

a7:1 ratio to produce what is believed to be the most stable level
of LNAAs for optimal protein ratio is maintained.
 6. Vegetarian Diets. Three kinds of vegans:
a. Strict vegetarians – milk and eggs which originate from animal
foods are avoided.
b. Lacto -vegans - may have milk in any form and the ovo-lacto
vigans may add egg products to the list. As meat substitute,
gluten (protein complex from kneading flour) and spun
vegetable proteins (TVP or soybeans protein) have to be used
for palatability and variety. Leguminous proteins are of better
quality than other vegetable proteins.
Activities
Block A
Calculate and plan a high protein diet using an allowance of 2.2 g
protein per kg DBW, and at least 1750 kcal. use the normal diet as a
basis for the menu plan.
Block B
Calculate and plan a high calorie, protein-free Diet.
Block C
Modify the normal diet into a lacto-vegan diet.

MODIFICATIONS IN MINERAL CONTENT 9

Purpose
1. To be able to plan and prepare modifications in sodium and /or
potassium content of diets;
 2. To be able to plan a sodium and or potassium restricted diet into
a high protein intake;
3. To be able to plan a sodium and potassium restricted diet into a
low protein intake.
Descriptions of diets

1. Sodium-restricted Diets – this diet is an allowance of food and

drink in which the sodium content is limited to a special level.
Dietary sodium is limited from 2500 mg to 3000mg/day. The
normal intake of sodium ranges from 4000 to 15,000 mg per day,
depending on the amount of salt, patis, toyo, etc, used. Sodium
restricted diets are usually prescribed in terms of mg of Na and
not of NaCl, or in mEq Na, NaCl or salt is 40% Na.
Mg Na = mEq Na
23

In planning a sodium restricted diets, the sodium exchange lists

are used. The sources of foods come from two classes of foods.
a. Processed foods with added salt, (NaCL), sodium citrate,
sodium nitrate and sodium bicarbonate.
b. Foods naturally high in sodium content, such as regular milk,
egg, meats, seafoods, celery, etc. in order to achieve a 250 mg
to 500 mg or 1000 mg Na in the diet careful selection of foods
is necessary. For the 250 mg Na with high protein intake,
special low sodium food preparation, such as Lonalac (low) Na
milk) may be planned, since most foods high in protein are as
of high in sodium.
Sodium restricted diets are used in the management of
congestive heart failure for the elimination, control, and
prevention of edema, conditions of ascites, renal disorders, and
 toxemias of pregnancy. It is also beneficial in the treatment of
some cases of hypertension sensitive to sodium.

2. Potassium-restricted Diet- this diet is restricted in potassium from

1500 to 2000 mg (1.5 to 2 g) a day. It is indicated for
hyperkalemia, Addison’s disease and certain renal disorders. The
normal diet contains 2 to 6 gr potassium a day.

Just like sodium restricted diets, careful selection of foods low in

potassium is guided by the use of food lists which food and
beverages according to potassium content.

Potassium-restricted diets may be prescribed in terms of mEq

using the formula:

mg K = mEq K
39

Thus, 1500 mg K is equivalent to 38 mEq K, since fruits and

vegetables are excellent sources of potassium, vitamin-mineral
supplementation is needed particularly for ascorbic acid and
protein foods.

3. Controlled Protein, Potassium and Sodium Diet. This is an

allowance of food and drink which restricts the intake of protein,
potassium and sodium to specified levels, while permitting an
adequate caloric intake. An example of a diet prescribed in renal
failure is;
Protein 40 g
Sodium 1000 mg
 Potassium 1500 mg
Kcal 1800 – 2500

4. Calcium and Phosphorous-restricted Diet. This diet is a prescribed

allowance of food and drink to provide for a maintenance level of
calcium and phosphorus, in order to prevent calcium and
phosphorus stones. The level of calcium and phosphorus
restriction may range from 500 – 1200 mg and 700- 1000 mg
respectively.

Activities;
7:00 – 8:00
Modify the normal diet into a 500 mg Na restricted intake; 1000 mg Na
intake; 2000 mg Na intake
1:00 – 2:00
Modify the normal diet into a 2000 mg K intake
4:00 – 5:00
Calculate and plan a 500 mg Na, 2000 mg K, low protein diet.

Laboratory Lesson 10
Modification in Fat Constituents Diet
Purpose
1. To be able to plan and prepare modifications in fat constituents
Types of Diet
 1. Fat -controlled Diet (Proportioned fat Diet). Where both the
amount and kind of fata re regulated. It is indicated in weight
reduction, diseases of the gallbladder, pancreas and the
cardiovascular system.
2. High -monounsaturated fat (HMF) Diet: this Diet limits the
amount of unsaturated fat and cholesterol.
3. Low -saturated fat diet. This diet limits saturated fat intake to 8%
to 10% of calories. It is indicated for cardio vascular diseases.
4. MCT Fat Diet: this diet MCT oil.
5. Cholesterol restricted Diet: this is a regimen limiting the amount
of dietary cholesterol. It is related in hypercholesterolemia,
atherosclerosis and gallbladder.
Activity
7:00 – 8:00
Modify the normal diet into a low saturated fatty acid diet.
1:00 – 2:00
Calculate and plan a fat and cholesterol-restricted diet
4:00 – 5:00
Calculate and plan a fat-controlled diet with 30% of calories from fat
which are proportioned into 10% polyunsaturated, 10%
monounsaturated fats.
Laboratory Lesson 11
Modifications in Protein Constituents
Purpose
1. To modify the normal diet into a gluten-free diet.
 2. To be able to plan a diet modified in amino acid and purine
content.
Description of Diets
1. Gluten-Free Diet. Gliadin free denoting that the gliadin portion of
gluten is the detrimental factor. The regimen is for gluten
enteropathy.
2. Phenylalanine-restricted Diet. This diet is limited to 15mg/kg DBW
per day. This diet is prescribed for infants and children with
phenylketonuria.
3. Purine-restricted Diet. Permitting only 100 to 150 mg purine. It is
indicated for persons with high uric acid levels in the blood or for
gout.
Activities
7:00 – 8:00
Calculate and plan a diet restricted in purine and fat contents.
1:00 – 2:00
Calculate and plan a high protein, low-fat, gluten-free diet, allowing
10% of total non-protein kcal. for fat.
4:00 – 5:00
Calculate and plan a phenylalanine-restricted diet for a 12 months old
baby who weighs 7kg. allow 20 mg phenylalanine per kg body weight.
Laboratory Lesson 12
Modifications in Carbohydrates
Purpose
 1. To be able to plan and prepare a diets modified in carbohydrate
content
Description of Diets
1. High CHO Diet: this diet emphasizes easily assimilated CHO like
sugars, jellies, fruit juices and refined cereals in supplying caloric
requirement.
2. CHO-restricted Diet: this diet is for the purpose of reducing
available glucose as in diabetes mellitus and hyperinsulinism.
3. Lactose-free Diet: this diet does not allow any form of lactose.
4. Galactose-free Diet: Galactose in any form is excluded. Infants
with galactosemia problem.
Activities
7:00 – 8:00
Calculate and plan a high CHO diet allowing 80% of total caloric
requirement for CHO while maintaining caloric intake the same as for
the normal.
1:00 – 2:00
Calculate and plan a CHO-restricted diet allowing 20% of TER as CHO
while maintaining caloric intake the same as the normal diet.
4:00 – 5:00
Modify the fat-restricted diet into a lactose-free diet.