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DIET

One of the most common questions asked of physicians is "What kind of diet should I be on?"  Of course, this varies broadly depending on whether a person has any special illnesses or medical conditions, such as diabetes or the like. Any person who is considering a significant change in their diet should consult with their health professional before doing so.  What's being offered here is a general "healthy diet" that is consistent with US nutritional recommendations and is constructive towards maintaining good health.

The "stepped approach." Since the American diet is skewed too heavily towards fat and not enough towards high quality protein and dietary fiber, keeping in your mind a "stepped approach" to the priorities of eating can keep you on the right track. Eat the greatest amount (serving for serving) of vegetables, fruits, breads, cereals and grain foods. Seafood is also OK.. Eat more moderately of chicken or lean meat and low-fat dairy products. Eat the least amount of fats, oils, sugar, salt and alcohol. This is depicted in the well-known "Food Pyramid" provided by the USDA:

{Servings Pyramid}

Avoiding processed and "fast-eating" restaurant diets is an excellent start.  It is surprising to many that there is more fat and "empty" calories in "casual-dining" restaurants' food than there is in a fast-food quarter pound sandwich meal.  Cheese-laden soups, fried onion appetizers, fat-laden salad dressings, and heaping desserts, even on an occasional basis, are very difficult to compensate for, even by eating healthy afterwards.  Opt instead for the "heart-healthy," low fat selections at such restaurants.  Limit fast food intake.  Limit the portion sizes at such restaurants, especially if you are overweight.

As a country, we do not eat enough dietary fiber.  Dietary fiber is the part of what we eat that is not broken down by the digestive system  It comes out "the other end" virtually unaffected.  This adds bulk to our stools, can help both the colon and circulatory system, and can help prevent the formation of diverticulosis. There are two types of fiber- soluble fiber and insoluble fiber. Soluble fiber is found in oats, barley, dried or canned beans, apples and some other fruits and vegetables.  Insoluble fiber is found in wholegrain products and also in vegetables.  We need to eat both types of fiber for good digestive health. 

Fiber is found in the following:
  • Beans and peas, including canned beans
  • Wholegrain cereals and grain products such as brown rice, oats, barley, pasta
  • Breads, especially whole wheat, multigrain and high fiber types

In countries where the diet is high in fiber, conditions such as bowel cancer, diverticulitis, irritable bowel syndrome, and obesity are harder to find.  Foods which contain fiber are mostly low in fat. Also the fatty foods which make up a large part of the diet of many Americans have very little fiber.  Fiber is also very filling. This means that high fiber foods keep you from feeling hungry too soon. This is just the opposite from carbohydrates, which can spur more hunger as little as two hours after eating. Studies have shown that those who eat more fiber in the morning are satisfied with less lunch. Overweight people also lose weight more successfully if they consume more foods which are higher in fiber and lower in fat.

Saturated fat should make up less of your total diet. Check your food labels and try to limit your total fat for the day to about 30-50 grams, depending on your size and level of physical activity.  Look for low-fat dairy products, skinless chicken, lowfat salad dressings, lean meat, and products marked low-fat or fat reduced. Eat lots of fruits and vegetables, breads (avoid butter or pure margarine; use fat-reduced spreads), cereals, rice, pasta (without fatty sauces) and more seafood (not battered and fried). Avoid cakes, cookies, and pastries made with margarine or butter (CAKEFAT). Work hard to cook your own food rather than eating fatty take-out or fast foods.

Drink enough water.  An adequate amount of water is crucial to maintain the vital functions of the body.  Requirements vary, but you should drink enough water so that your urine is clear, except for first thing in the morning when it will be yellow. Most people need at least 8 glasses of water a day. Some can be in the form of soda or juice. Not too much soda, especially if you suffer from flatulence or heartburn.  If you are overweight, restrict juice to one glass a day. Of course, kidney and heart patients should always follow the advice of their physician.

Eat enough vegetables.  Try to have at least four servings of vegetables each day.  For breakfast, try slicing a banana onto cereal, or eating a sliced apple.  Add a salad and a piece of fresh fruit to lunch.  Have a salad and two vegetables at dinner, and eat that much less meat, snacks, or fried and packaged foods.

Vegetables and fruits provide vitamin C, beta carotene (which the body converts to vitamin A), folic acid, and fiber. Some vitamin C is lost in cooking, so remember to eat some raw fruits or salad vegetables each day. Cooking vegetables in a microwave, stir-frying or steaming preserves more vitamin C than boiling. The highest levels of beta-carotene are found in all brightly colored fruits and vegetables.  Green and orange vegetables provide many different antioxidants, which are thought by many to reduce the formation of free radicals which can promote cancer. Many of these substances, but not all, are also found in fruits. Antioxidants can also provide protection against heart disease, so one should try to eat an adequate quantity of both fruits and vegetables, including raw vegetables.

Get enough calcium. Low-fat cheese and yogurt are excellent sources of calcium.  Small amounts of milk will also contribute.  Calcium supplements are also available. 

Moderate intake of fatty cheeses, ice cream, and the like.  Milkfat can worsen weight and gastroesophageal reflux problems.  A small quantity of cheese can provide valuable nutrition, but don't overdo it.  Also, those with digestive problems related to not enough enzyme to break down dairy proteins (lactose intolerance) can have symptoms such as bloating, diarrhea, and excessive flatulence with an abundance of such foods. Without sufficient lactase enzyme, the lactose sugar is not digested normally in the small intestine. Instead, it passes to the large intestine where it is fermented into bacteria. These folks should especially watch out with dairy products.

Eat regular meals.  If you try to skip meals in an effort to lose weight, it is very difficult to get enough fiber to prevent constipation.  Also, a regular meal schedule, eating slowly and chewing well, helps to maximize your body's digestive machinery, making it efficient and keeping residual amounts of food in the stomach low, helping to prevent reflux.

A moderate amount of meat is needed.  Adding a small quantity of meat to your diet can actually improve the nutritional value of a vegetable meal by increasing the protein, zinc, iron and some of the B vitamins not found in vegetables.  Despite popular opinion, adding some lean meat can also fit in well with a low-fat eating pattern.  Many meats have a low-fat content, partly because many animals are now bred to have more lean tissue. The butcher also can trim meats to remove excess fat.  You can better this by trimming off any remaining fat at home.

Take care with the way you cook. Low-fat foods can easily be turned into high-fat ones during cooking. It makes sense to barbecue, grill, or broil (Some say that the char-black of barbecued foods promotes cancer; avoid this).  Stir-fry with a small amount of oil, make casserole-type dishes with minimal added fat or pan fry on a hot heavy-based non-stick pan.

Avoid excess caffeine. Too much caffeine intake daily can throw you off the path to good digestive health.  Caffeine is one of the prime offenders of gastroesophageal reflux disease.  It allows the valve between the stomach and esophagus to relax, causing stomach acid to wash back into the esophagus, causing symptoms in many.  Many commercial coffee preparations that people drink "on the way to work" each morning can also have added amounts of caffeine, making the problem even worse.  Caffeine is also present in tea just as much (if not more) than standard coffee. Caffeine is also very prevalent in sodas, including colas and Mountain Dew(R). Decaffeinated coffees are helpful, but unfortunately there are other substances in decaffeinated coffee that can make reflux worse, too!  Limit caffeine intake to that which could be found in a six-ounce cup of coffee, each day.

Chocolate, peppermint, onions, and garlic worsen reflux disease. These substances also allow the valve between the esophagus and stomach to relax, worsening reflux.  Those who suffer heartburn or more complicated reflux disease should avoid these.

Citrus can worsen stomach problems.  This is an issue of balance.  While citrus fruits and juices contain valuable vitamins and antioxidants, they can worsen symptoms of stomach inflammation, reflux, and ulcers.  Those with these conditions especially should watch intake of these foods and substitute other high quality foods in their place.