A Lifetime of Quality Care That’s Convenient & Complete Progressive Diet Guide Robert Grimshaw MD FACP A Lifetime of Quality Care That’s Convenient & Complete

For Vomiting & Diarrhea: Every season has its risks of food poisoning and stomach viruses. In broad strokes, there are 2 types of food poisoning: 1) where you eat the toxin that has been made by germs incubating in a food and 2) where you eat the germs themselves. This guide is for viruses and for the first - not the second type of food poisoning!

A Lifetime of Quality Care That’s Convenient & Complete Before we go further, this guide presumes that: You don’t have a temperature over 100 F. The vomiting stops. There’s no blood in your stool. For any of those conditions, call!!

A Lifetime of Quality Care That’s Convenient & Complete Dietary Objective: The progressive diet is designed to keep your fluid levels up and to let your stomach and bowel “rest.” We’re aiming for at least 600 calories of intake a day also. That’s based on work by Dr. George Blackburn at Harvard with burn patients. 600 calories a day prevents muscle breakdown.

A Lifetime of Quality Care That’s Convenient & Complete The Steps Start with step 1 and go up as you feel up to it - usually meal by meal (sometimes day by day). At each level, you can use all the foods from the previous level also.

A Lifetime of Quality Care That’s Convenient & Complete 1) Clear Liquids: This means anything you can see through plus ice chips, Jell-O, and sorbets. Included are: Clear sodas: “ginger ale” (which of course has no ginger), 7-Up, Sprite and decaf colas. Clear juices are allowed: cranberry, white grape, and apple (though this may cause increased diarrhea in some). Jell-O is fine, but make it the regular, not the diet - you need the sugar! Broth is very useful, because a cup of one of the dried packets or one cube of bouillon gives you 3 grams of salt, and with vomiting or diarrhea, you are salt de- pleted. 3 cups is the same as getting one large IV bottle! Italian ices and sorbets are also allowed.

A Lifetime of Quality Care That’s Convenient & Complete 2) BRATT Bananas Rice Apple Sauce/apples Toast Tea (decaf) with sugar

A Lifetime of Quality Care That’s Convenient & Complete 3) Soft Diet - No Milk Scrambled Egg White bread toast with margarine or jelly Saltines Boiled, broiled, or baked chicken or turkey (bland) Rice, pasta, egg noodles (prepared in chicken broth) Cream of rice or wheat, no milk White potato with margarine

A Lifetime of Quality Care That’s Convenient & Complete 3) Regular Diet, No Milk, Such As: Lean hamburger Cooked, non-greasy veggies 4) Regular : once you’ve had no diarrhea for hours, gradually add milk products.

A Lifetime of Quality Care That’s Convenient & Complete Diabetics: Special Considerations: If you’re on oral agents, just hold them until you’re keeping down solid foods. You SHOULD check your sugars in the morning and 2 hours after meals during this period, and call if they’re over 250. If you’re taking insulin, cut your “baseline” dose (usually NPH) to 50-75%, and again check your sugars 4 times a day as above. If you’re on lispro (Humalog) or regular insulin before meals, hold those until you’re eating. You should get some calories in during the “clear” period - a little Jell-O or sorbet should be ok. Cover high sugars with regular or lispro. (Prepared with the help of Geri Brewster RD MPH CDN)