Therapeutic diet

What is a therapeutic diet?

• A therapeutic diet is a meal plan that controls the intake of certain foods or nutrients. A therapeutic
diet is sometimes called a “special diet”. It is part of the treatment of a medical condition. A therapeutic
diet is usually a modification of a Regular diet. It is modified or tailored to fit the nutrition needs of a
particular patient or resident. Therapeutic diets are modified for (1) nutrients, (2) texture and/or (3)
food allergies or food intolerances.

Who may order a Therapeutic diet?

A therapeutic diet order is made by a physician. In some cases, a physician’s assistant or a nurse
practitioner is allowed to order a therapeutic diet under a physician’s guidance. Dietitians, nurses and
speech therapists often make recommendations to physicians about therapeutic diets for residents and
patients. Once the therapeutic diet is ordered, it is filled by the foodservice department. Filling a diet
order in the foodservice department is similar to a nurse filling a medication order. It must be done with
the same importance.

Why are therapeutic diets necessary?

Common reasons therapeutic diets may be ordered include:
• To maintain nutritional status
• To restore nutritional status
• To correct nutritional status
• To decrease calories for weight control
• To provide extra calories for weight gain
• To balance amounts of carbohydrates, fat and protein for control of diabetes
• To provide a greater amount of a nutrient such as protein
• To decrease the amount of a nutrient such as sodium
• To exclude foods due to allergies or food intolerance
• To provide texture modifications due to problems with chewing and/or swallowing

What are common types of therapeutic diets?

Common therapeutic diets include:

Nutrient Modifications
No Concentrated Sweets Diet
Diabetic Diets
No Added Salt Diet
Low Sodium Diet
Low Fat Diet and/or Low Cholesterol Diet
High Fiber Diet
Renal Diet
 Texture Modification
Mechanical Soft Diet
Puree Diet

Food Allergy or Food Intolerance Modification

Food Allergy
Food Intolerance

Tube Feedings
Liquid Tube Feedings in place of Meals
Liquid Tube Feedings in addition of Meals

Additional Feedings
In addition to meal, extra nutrition may be ordered as:
Supplements– usually ordered as liquid nutritional shakes once, twice or three times per day;
given either with meals or between meals.
Nourishments– ordered as a snack food or beverage items to be given between meals midmorning
and/or mid-afternoon.
HS Snack– ordered as a snack food or beverage items to be given at the hour of sleep.

Therapeutic Diets
 Regular: There are no restrictions on this diet. It is based on healthy eating from all of the food groups.
 Cardiac: This may be ordered for patients with a heart condition. It is low fat, low cholesterol, sodium
(salt) controlled, and limited in caffeine.
 Low Fat/Low Cholesterol: This diet is designed to assist in reducing the buildup of plaque in the
arteries and improve digestion. Patients with heart disease, pancreatitis and gallbladder disease are
often on a low fat/low cholesterol diet.
 Diabetic Consistent Carbohydrates: This is used for patients with Diabetes or uncontrolled blood
sugars. This diet is based on Carbohydrate Counting to assist in maintaining normal blood sugar levels.
The amount of carbohydrates (simple and complex sugars) given per meal and snack are controlled.
 Diabetic Cardiac: Patients with diabetes may have heart disease as a result of the diabetes. This is a
combination diet that controls the amount of fat, cholesterol, salt, caffeine and carbohydrates.
 Sodium Restricted: Sodium (salt) restrictions are typically ordered for patients with high blood
pressure or a buildup of fluid in the body. The degree to which the sodium is restricted depends on the
severity of the complications resulting from excess sodium. Canned soups, luncheon meats, microwave
products and processed foods are high in sodium.
 Coumadin Guidelines: Avoid a sudden increase of foods rich in Vitamin K (deep green leafy vegetables,
broccoli, Brussels sprouts, scallions). A daily multi-vitamin with no more than 25 micrograms of
Vitamin K is okay. Avoid alcohol and large quantities of cranberry products. Check with your
pharmacist before buying any drug, supplement or herbal.
 Soft/Low Fiber: A soft or low fiber diet may be ordered due to gastrointestinal reasons. It is limited in
fiber and fried and highly seasoned foods.
 High Fiber: This diet provides bran or whole grain cereals at breakfast, and whole wheat bread and
whole fruits and vegetables throughout the day.
 Chopped/Ground: This is ordered for patients who have difficulty chewing and swallowing. Foods are
moist, soft and in small pieces which are thoroughly cooked and not dry or crumbly.
 Puree: This is ordered for patients who have difficulty chewing and swallowing. All foods are broken
down to a pudding consistency.
 Renal: This is for patients with reduced or no kidney function. It is one of the more complicated diets
due to the restrictions in sodium and potassium. The diet may be restricted in phosphorus as well. If
you are on dialysis, please continue to follow the guidelines provided by the dialysis dietitian unless
advised otherwise by your doctor.
 Fluid Restriction: Patients are placed on a fluid restriction to eliminate a buildup of fluid in the body.
These patients usually have kidney, heart (congestive heart failure) or liver disease.
 Clear Liquid: A clear liquid diet is usually a temporary diet and may be ordered before and after a test,
before and after surgery or for acute gastrointestinal upset.
 Full Liquid: A full liquid diet is usually a temporary diet and may be ordered as a step from clear liquids
to regular foods. It includes milk/milk products.
 NPO: This term means “nothing by mouth.” You will not receive a meal. This diet is usually ordered
before and after certain tests and/or surgery.
 Potassium Restricted: This diet may be ordered to assist in decreasing the amount of potassium in the
blood to normal levels. Potassium is used in regulating heart function. Excess potassium can result in
heart failure. Common foods high in potassium are potatoes, tomatoes, oranges, bananas and milk.
 Lactose Restricted: Lactose restricted diets are for patients who are not able to adequately digest milk
sugar or lactose. Lactaid is typically sent. The diet usually eliminates milk and dairy products. It does
not eliminate all the foods in which lactose may be hidden. This is because the patient can usually
tolerate lactose in small amounts.