Low-fiber/low-residue diet

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A low-residue diet is a diet intended to reduce certain constituents of the bowel, often with consequence for functional behaviour of the bowel. It may be prescribed for patients with ailments or functional gastrointestinal disorders mitigated by fewer and smaller bowel movements each day.

Contents

The diet may be used as part of the bowel preparation before a diagnostic procedure such as colonoscopy or as a short-term therapy for acute stages of gastrointestinal illnesses such as Crohn's disease, diverticulitis, bowel obstruction, and ulcerative colitis. In addition, a low-residue diet is often prescribed before and/or after abdominal surgery or cancer treatments.

A low-fiber diet is a low-residue diet eliminating dietary fiber in particular. The terms are not always distinguished, but when they are, a low-residue diet will include additional restrictions on foods such as dairy products, which do not contain fiber but do develop residue after digestion.

If the problem lies with fermentable carbohydrates instead, the patient may be directed to a low-FODMAP diet. Some monotrophic diets, such as the carnivore diet, are implicitly low-residue, but may also sacrifice nutrition.

Dietary guidelines

Standard guidelines

Almost all low-residue diets make the following recommendations: [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11]

Food typeEat/DrinkAvoid
GrainsBreads and other baked goods made from refined white flourWhole grain breads and baked goods
Cold cereals made from refined flours, such as cornflakes and rice krispiesWhole grain cereals such as bran flakes
White rice, noodles, refined pastaBrown rice, whole wheat pasta, and other whole grain foods
FruitsFruit juices without pulp, except prune juiceJuices with pulp or seed, prune juice
Soft fruits such as bananas and melonsDried fruits, berries
Canned or well-cooked fruitCoconuts, popcorn
VegetablesVegetable juices without pulpJuices with pulp or seed
Potatoes without skinPotato skins
Canned or well-cooked vegetables
Meat, Other ProteinWell-cooked tender meat, fish, poultry, eggsTough meat, meat with gristle
Beans, peas, legumes, nuts
DairyMilkAll dairy if lactose intolerant
Soft, mild cheesesStrong cheeses
Plain yoghurtYoghurt or cheese containing nuts, berries, raw fruit
OilsVegetable oils, margarine, butterFried foods

Variations

Quantity of Fiber

A low-fiber diet is not a no-fiber diet. A 2015 review article recommends less than 10 grams of fiber per day. [12] Other sources recommend that a patient on a low-fiber diet eat no more than 10–15 grams of fiber per day. [5] Some sources recommend serving sizes that contain no more than 2 grams per serving. [5] [6]

Grains

Some diets recommend limiting servings of baked goods to 2 grams per serving. [5] [8] Other diets recommend limiting these servings to just 1 gram per serving. [7] [9] Most diets also recommend eating warm cereals such as cream of wheat, cream of rice, grits, and farina. [3] [6] [8] [10]

Fruits

Some diets allow additional raw fruits such as very soft apricot, canned fruit cocktail, grapes, peaches, papayas, plums, or citrus fruits without membrane, [1] [2] [3] [4] [5] [10] but two rule out all raw fruits. [6] [9] Some allow applesauce, other fruit sauces, or peeled and well-cooked apples. [1] [3] [5] [8]

Vegetables

Many diets specifically recommend tomato sauce [1] [2] [3] [8] and prohibit pickles. [1] [2] [3] [4] [5] [8] [11] Two diets actually limit the well-cooked vegetables to yellow squash without seeds, green beans, wax beans, spinach, pumpkin, eggplant, asparagus, beets, and carrots. [2] [5] Two diets allow some raw vegetables: lettuce, cucumber (without seeds), and zucchini. [5]

Meat and other proteins

Some diets allow smooth peanut butter [5] [10] or smooth nut butters. [8] [6] Some diets allow tofu. [5] [6] [7] [10]

Dairy

Some diets limit dairy to 2 cups per day. [2] [10] One diet allows 1.5 ounces (40 g) of hard cheese. [5] Several diets allow pudding or custard, [5] [7] [9] [11] sherbet, [3] [8] [6] [10] [11] whipped cream, [5] [10] or ice cream. [3] [4] [8] [7] [9] [11] A couple of diets suggest specific lactose-free products for the lactose intolerant, such as soy milk or whipped cream. [5] [6] One diet prohibits whole milk, half and half, cream, sour cream, and regular ice cream. [8]

Condiments and spreads

Some diets allow mayonnaise, [3] [5] [8] [6] [9] [10] [11] ketchup, [3] [8] sour cream, [3] [7] [11] cream cheese, [6] smooth sauces and salad dressings, [3] [5] [7] [9] [10] [11] plain gravies, [10] [11] or whipped cream. [5] [10] Several diets allow jelly, honey, and syrup. [3] [9] [11] Many prohibit jam, marmalade, and preserves. [2] [3] [4] [8] [9] [11]

Several diets prohibit highly spiced food, [1] [3] [4] [5] but some allow spices, cooked herbs, and seasonings. [8] [9] [11]

Beverages

Several diets specifically prohibit caffeine [1] [3] [8] (two of these allow decaffeinated coffee, tea, and other drinks), [3] [8] but some allow coffee, tea, and carbonated drinks. [10] [11]

Nutritional quality

If the diet must be strict and followed over a long period of time, the intake of fruits and vegetables may not provide adequate amounts of vitamin C and folic acid. The quantity of calcium may also be inadequate if dairy products are restricted. In these cases, a multivitamin supplement or liquid nutritional supplement may be needed. [1] [2]

Conditions that may require a low-residue diet

A low-fiber diet may be used to prepare for or recover from various medical procedures: [1] [2] [4] [5]

A low-fiber diet may also be used during acute stages of the following conditions, to rest the bowels: [1] [2] [4] [5]

Uses

Colonoscopy

The most common preparation for a colonoscopy is a clear liquid diet accompanied by laxatives. However, this may not be the most effective preparation. A 2015 guideline issued by The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy recommends using a low-residue diet instead, also accompanied by laxatives, [13] because of evidence that it performs at least as well for bowel cleansing and is associated with better patient satisfaction. [14] [15]

Crohn's Disease

A 2016 review of the research found that a semi-elemental whey hydrolyzed protein (WHP) diet is superior for treatment of Crohn's disease. [16]

Diverticulitis

While a low-fiber diet is generally used for acute diverticulitis, the NIH guidelines recommend a high-fiber diet for patients with diverticulosis (a condition that may lead to diverticulitis). [17] A Mayo Clinic review from 2011 showed that a high-fiber diet can prevent diverticular disease. [18]

Aviation

In preparation for long-duration toiletless military flights, the crew is sometimes instructed to have a low-residue meal as their last meal before the flight. For example, this was the case with Blackbird pilots. [19]

Terminology

Most sources treat low-fiber and low-residue diets as identical, but some make a distinction based on the difference between fiber and residue. Dietary fiber is the indigestible part of food made from plants. Residue includes not only fiber but also other materials found in the colon after digestion. When this distinction is made, a low-fiber diet simply reduces fiber intake by eliminating or limiting high-fiber foods such as raw fruits and vegetables. A low-residue diet includes restrictions on foods such as dairy products, which do not contain fiber but do develop residue after digestion.

The American Academy of Nutrition and Dietetics' removed the low-residue diet from its Nutrition Care Manual because there is no scientifically accepted quantitative definition of residue and there is no method to determine the residue produced by a food. [12] [20] [21]

See also

Related Research Articles

<span class="mw-page-title-main">Gastroenterology</span> Branch of medicine focused on the digestive system and its disorders

Gastroenterology is the branch of medicine focused on the digestive system and its disorders. The digestive system consists of the gastrointestinal tract, sometimes referred to as the GI tract, which includes the esophagus, stomach, small intestine and large intestine as well as the accessory organs of digestion which include the pancreas, gallbladder, and liver. The digestive system functions to move material through the GI tract via peristalsis, break down that material via digestion, absorb nutrients for use throughout the body, and remove waste from the body via defecation. Physicians who specialize in the medical specialty of gastroenterology are called gastroenterologists or sometimes GI doctors. Some of the most common conditions managed by gastroenterologists include gastroesophageal reflux disease, gastrointestinal bleeding, irritable bowel syndrome, inflammatory bowel disease (IBD) which includes Crohn's disease and ulcerative colitis, peptic ulcer disease, gallbladder and biliary tract disease, hepatitis, pancreatitis, colitis, colon polyps and cancer, nutritional problems, and many more.

<span class="mw-page-title-main">Dietary fiber</span> Portion of plant-derived food that cannot be completely digested

Dietary fiber or roughage is the portion of plant-derived food that cannot be completely broken down by human digestive enzymes. Dietary fibers are diverse in chemical composition, and can be grouped generally by their solubility, viscosity, and fermentability, which affect how fibers are processed in the body. Dietary fiber has two main components: soluble fiber and insoluble fiber, which are components of plant-based foods, such as legumes, whole grains and cereals, vegetables, fruits, and nuts or seeds. A diet high in regular fiber consumption is generally associated with supporting health and lowering the risk of several diseases. Dietary fiber consists of non-starch polysaccharides and other plant components such as cellulose, resistant starch, resistant dextrins, inulin, lignins, chitins, pectins, beta-glucans, and oligosaccharides.

<span class="mw-page-title-main">Constipation</span> Bowel dysfunction

Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement. Complications from constipation may include hemorrhoids, anal fissure or fecal impaction. The normal frequency of bowel movements in adults is between three per day and three per week. Babies often have three to four bowel movements per day while young children typically have two to three per day.

<span class="mw-page-title-main">Irritable bowel syndrome</span> Functional gastrointestinal disorder

Irritable bowel syndrome (IBS) is a "disorder of gut-brain interaction" characterized by a group of symptoms that commonly include abdominal pain, abdominal bloating and changes in the consistency of bowel movements. These symptoms may occur over a long time, sometimes for years. IBS can negatively affect quality of life and may result in missed school or work or reduced productivity at work. Disorders such as anxiety, major depression, and chronic fatigue syndrome are common among people with IBS.

<span class="mw-page-title-main">Colonoscopy</span> Endoscopic examination of the bowel

Colonoscopy or coloscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It can provide a visual diagnosis and grants the opportunity for biopsy or removal of suspected colorectal cancer lesions.

<span class="mw-page-title-main">Inflammatory bowel disease</span> Medical condition

Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine, with Crohn's disease and ulcerative colitis (UC) being the principal types. Crohn's disease affects the small intestine and large intestine, as well as the mouth, esophagus, stomach and the anus, whereas ulcerative colitis primarily affects the colon and the rectum.

<span class="mw-page-title-main">Fecal occult blood</span> Medical condition

Fecal occult blood (FOB) refers to blood in the feces that is not visibly apparent. A fecal occult blood test (FOBT) checks for hidden (occult) blood in the stool (feces).

<span class="mw-page-title-main">Diverticulitis</span> Digestive disease of the large intestine

Diverticulitis, also called colonic diverticulitis, is a gastrointestinal disease characterized by inflammation of abnormal pouches—diverticula—that can develop in the wall of the large intestine. Symptoms typically include lower-abdominal pain of sudden onset, but the onset may also occur over a few days. There may also be nausea; and diarrhea or constipation. Fever or blood in the stool suggests a complication. Repeated attacks may occur.

<span class="mw-page-title-main">Diverticulosis</span> Condition of the wall of the intestine

Diverticulosis is the condition of having multiple pouches (diverticula) in the colon that are not inflamed. These are outpockets of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall. Diverticula do not cause symptoms in most people. Diverticular disease occurs when diverticula become clinically inflamed, a condition known as diverticulitis.

Abdominal bloating is a short-term disease that affects the gastrointestinal tract. Bloating is generally characterized by an excess buildup of gas, air or fluids in the stomach. A person may have feelings of tightness, pressure or fullness in the stomach; it may or may not be accompanied by a visibly distended abdomen. Bloating can affect anyone of any age range and is usually self-diagnosed, in most cases does not require serious medical attention or treatment. Although this term is usually used interchangeably with abdominal distension, these symptoms probably have different pathophysiological processes, which are not fully understood.

<span class="mw-page-title-main">Blood in stool</span> Medical condition

Blood in stool or rectal bleeding looks different depending on how early it enters the digestive tract—and thus how much digestive action it has been exposed to—and how much there is. The term can refer either to melena, with a black appearance, typically originating from upper gastrointestinal bleeding; or to hematochezia, with a red color, typically originating from lower gastrointestinal bleeding. Evaluation of the blood found in stool depends on its characteristics, in terms of color, quantity and other features, which can point to its source, however, more serious conditions can present with a mixed picture, or with the form of bleeding that is found in another section of the tract. The term "blood in stool" is usually only used to describe visible blood, and not fecal occult blood, which is found only after physical examination and chemical laboratory testing.

<span class="mw-page-title-main">Lower gastrointestinal bleeding</span> Medical condition

Lower gastrointestinal bleeding, commonly abbreviated LGIB, is any form of gastrointestinal bleeding in the lower gastrointestinal tract. LGIB is a common reason for seeking medical attention at a hospital's emergency department. LGIB accounts for 30–40% of all gastrointestinal bleeding and is less common than upper gastrointestinal bleeding (UGIB). It is estimated that UGIB accounts for 100–200 per 100,000 cases versus 20–27 per 100,000 cases for LGIB. Approximately 85% of lower gastrointestinal bleeding involves the colon, 10% are from bleeds that are actually upper gastrointestinal bleeds, and 3–5% involve the small intestine.

<span class="mw-page-title-main">Abdominal distension</span> Physical symptom

Abdominal distension occurs when substances, such as air (gas) or fluid, accumulate in the abdomen causing its expansion. It is typically a symptom of an underlying disease or dysfunction in the body, rather than an illness in its own right. People with this condition often describe it as "feeling bloated". Affected people often experience a sensation of fullness, abdominal pressure, and sometimes nausea, pain, or cramping. In the most extreme cases, upward pressure on the diaphragm and lungs can also cause shortness of breath. Through a variety of causes, bloating is most commonly due to buildup of gas in the stomach, small intestine, or colon. The pressure sensation is often relieved, or at least lessened, by belching or flatulence. Medications that settle gas in the stomach and intestines are also commonly used to treat the discomfort and lessen the abdominal distension.

The specific carbohydrate diet (SCD) is a restrictive diet originally created to manage celiac disease; it limits the use of complex carbohydrates. Monosaccharides are allowed, and various foods including fish, aged cheese and honey are included. Prohibited foods include cereal grains, potatoes and lactose-containing dairy products. It is a gluten-free diet since no grains are permitted.

<span class="mw-page-title-main">Capsule endoscopy</span> Medical imaging procedure

Capsule endoscopy is a medical procedure used to record internal images of the gastrointestinal tract for use in disease diagnosis. Newer developments are also able to take biopsies and release medication at specific locations of the entire gastrointestinal tract. Unlike the more widely used endoscope, capsule endoscopy provides the ability to see the middle portion of the small intestine. It can be applied to the detection of various gastrointestinal cancers, digestive diseases, ulcers, unexplained bleedings, and general abdominal pains. After a patient swallows the capsule, it passes along the gastrointestinal tract, taking a number of images per second which are transmitted wirelessly to an array of receivers connected to a portable recording device carried by the patient. General advantages of capsule endoscopy over standard endoscopy include the minimally invasive procedure setup, ability to visualize more of the gastrointestinal tract, and lower cost of the procedure.

A bland diet is a diet consisting of foods that are generally soft, low in dietary fiber, cooked rather than raw, and not spicy. It is an eating plan that emphasizes foods that are easy to digest. It is commonly recommended for people recovering from surgery or conditions affecting the gastrointestinal tract.

Fibre supplements are considered to be a form of a subgroup of functional dietary fibre, and in the United States are defined by the Institute of Medicine (IOM). According to the IOM, functional fibre "consists of isolated, non-digestible carbohydrates that have beneficial physiological effects in humans".

FODMAPs or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols are short-chain carbohydrates that are poorly absorbed in the small intestine and ferment in the colon. They include short-chain oligosaccharide polymers of fructose (fructans) and galactooligosaccharides, disaccharides (lactose), monosaccharides (fructose), and sugar alcohols (polyols), such as sorbitol, mannitol, xylitol, and maltitol. Most FODMAPs are naturally present in food and the human diet, but the polyols may be added artificially in commercially prepared foods and beverages.

Blair S. Lewis, M.D., F.A.C.P., F.A.C.G., is an American board-certified gastroenterologist and Clinical Professor of Medicine at the Mount Sinai School of Medicine. Lewis is a specialist in the field of gastrointestinal endoscopy and was the primary investigator for the first clinical trial of capsule endoscopy for the small intestine and also the first clinical trial of capsule endoscopy for the colon.

A low-FODMAP diet is a person's global restriction of consumption of all fermentable carbohydrates (FODMAPs), recommended only for a short time. A low-FODMAP diet is recommended for managing patients with irritable bowel syndrome (IBS) and can reduce digestive symptoms of IBS including bloating and flatulence.

References

  1. 1 2 3 4 5 6 7 8 9 10 "Low Fiber/Low Residue Diet". ATLANTIC COAST GASTROENTEROLOGY ASSOCIATES. Atlantic Coast Gastroenterology. December 17, 2008. Retrieved April 29, 2017.
  2. 1 2 3 4 5 6 7 8 9 10 "Low Fiber/Low Residue Diet". Jackson|Siegelbaum Gastroenterology. Jackson|Siegelbaum Gastroenterology and West Shore Endoscopy Center. November 3, 2011. Retrieved April 29, 2017.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 "Should You Try a Low-Residue Diet?". WebMD. October 25, 2016. Retrieved April 29, 2017.
  4. 1 2 3 4 5 6 7 8 "Low residue diet" (PDF). Great Western Hospital. Great Western Hospital NHS Foundation Trust. May 15, 2012. Retrieved April 29, 2017.
  5. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Wax, Emily; Zieve, David; Ogilvie, Isla (August 14, 2016). "Low-fiber diet". Medline Plue. ADAM Health Solutions. Retrieved May 1, 2017.
  6. 1 2 3 4 5 6 7 8 9 10 "Low-Fiber Nutrition Therapy". New York Presbyterian. Retrieved April 26, 2017.
  7. 1 2 3 4 5 6 7 "Diverticulitis Diet". Mayo Clinic. Mayo Foundation for Medical Education and Research. August 15, 2009. Retrieved July 5, 2012.
  8. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Manual of Clinical Nutrition Management (PDF). Compass Group. 2013.
  9. 1 2 3 4 5 6 7 8 9 10 "Low FIber Diet" (PDF). Rush University Medical Center. Retrieved May 3, 2017.
  10. 1 2 3 4 5 6 7 8 9 10 11 12 13 Clinical Dietitians Nutrition Service. "Low-Fiber, Low-Residue Diet" (PDF). Northwestern Memorial Hospital. Retrieved May 3, 2017.
  11. 1 2 3 4 5 6 7 8 9 10 11 12 13 "Low-Residue/Low-Fiber Diet". University of Pittsburgh Medical Center. UPMC. Retrieved May 3, 2017.
  12. 1 2 Vanhauwaert, Erika; Matthys, Christophe; Verdonck, Lies; De Preter, Vicky (November 2015). "Low-Residue and Low-Fiber Diets in Gastrointestinal Disease Management". Advances in Nutrition. 6 (6): 820–827. doi:10.3945/an.115.009688. PMC   4642427 . PMID   26567203 . Retrieved April 26, 2017. This narrative review focuses on defining the similarities and/or discrepancies between low-residue and low-fiber diets and on the diagnostic and therapeutic values of these diets in gastrointestinal disease management.
  13. ↑ Saltzman, John R.; Cash, Brooks D.; Pasha, Shabana F.; Early, Dayna S.; Muthusamy, V. Raman; Khashab, Mouen A.; Chathadi, Krishnavel V.; Fanelli, Robert D.; Chandrasekhara, Vinay; et al. (April 2015). "Bowel preparation before colonoscopy". Gastrointestinal Endoscopy. 81 (4): 781–794. doi:10.1016/j.gie.2014.09.048. PMID   25595062. This is one of a series of documents discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this document that updates a previously issued consensus statement and a technology status evaluation report on this topic
  14. ↑ Wu, Keng-Liang; Rayner, Christopher K; Chuah, Seng-Kee; Chiu, King-Wah; Lu, Chien-Chang; Chiu, Yi-Chun (2011). "Impact of low-residue diet on bowel preparation for colonoscopy". Diseases of the Colon & Rectum. 54 (1): 107–112. doi:10.1007/DCR.0b013e3181fb1e52. PMID   21160321. S2CID   25592615.
  15. ↑ Helwick, Caroline (May 23, 2016). "Low-Residue Diet Acceptable for Bowel Prep". Medscape. WebMD. Retrieved April 29, 2017.
  16. ↑ Alexander, Dominik D; Bylsma, Lauren C; Elkayam, Laura; Nguyen, Douglas L (May 6, 2016). "Nutritional and health benefits of semi-elemental diets: A comprehensive summary of the literature". World Journal of Gastrointestinal Pharmacology and Therapeutics. 7 (2): 306–319. doi: 10.4292/wjgpt.v7.i2.306 . PMC   4848254 . PMID   27158547.
  17. ↑ Strate, Lisa L. "Diverticular Disease". NIH. National Institutes of Health. Retrieved April 30, 2017.
  18. ↑ Tarleton, S; Dibaise, JK (January 17, 2017). "Invited Review: Low-residue diet in diverticular disease: Putting an end to a myth". Nutrition in Clinical Practice. 26 (2): 137–42. doi:10.1177/0884533611399774. PMID   21447765.
  19. ↑ "SR-71 Pilot Interview Richard Graham Veteran Tales". YouTube . Archived from the original on December 21, 2021.
  20. ↑ Alpers, David H.; Taylor, Beth E.; Bier, Dennis M.; Klein, Samuel (January 21, 2015). Manual of Nutritional Therapeutics. Lippincott Williams & Wilkins. Meant for quick retrieval of vital information regarding the management of nutritional issues in patients with gastroenterological problems--either primary or as the consequence of other medical disorders, such as diabetes, hyperlipidemia and obesity. The book addresses normal physiology and pathophysiology, and offers chapters on diseases that can lead to specific nutritional problems. The clinical focus is on therapeutic nutrition and dietary management.
  21. ↑ Cunningham, Eleese (April 2012). "Are Low-Residue Diets Still Applicable?". Journal of the Academy of Nutrition and Dietetics. 112 (6): 960. doi:10.1016/j.jand.2012.04.005. PMID   22709819.
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