back to basics | restricted diets
Help! I’ve been put on a restricted diet! What do I eat?
As I’ve mentioned before, my work in nutrition services at the local medical center provides plenty of food for thought (haha—pun intended). And a huge topic of conversation with patients is what to do at home when you’ve been put on a restricted diet.
March is National Nutrition Month, and so our Back to Basics theme continues with a deeper dive into secondary foods nutrition—the value of the (whole) foods you put in your mouth. If you want to catch up on the series, you can read the previous posts here:
- Nutrition 101: what are the basic categories of nutrients?
- Macronutrients cocktail: what do the macronutrients do in and for our bodies?
- Nutrient density: what it is and why it’s important.
These blog posts cover information we all can benefit from. And they don’t really address what to eat when you’ve been told that you have to monitor certain nutrients more carefully than other people—or than you used to.
Of course, patients are visited by a Registered Dietician who attempts to explain why this is happening and outlines the food plan going forward. And the patients still call with lots of questions.
what’s a restricted diet?
In this post, I’m not talking about what many of us think of as a restricted diet—one that limits caloric intake in an effort to lose weight.
A diet restricted for medical purposes usually falls into one of the following categories. This is not a complete list—I’m just focusing on the most common ones:
- Heart healthy—for patients who have had a cardiac episode or are hurtling toward one
- Consistent carb—for patients who struggle with high blood sugar/diabetes
- Renal—for patients with kidney disease or failure
- Clear liquid—the first stage for patients who are transitioning from “no food by mouth” (usually in preparation for surgery) to eating again after a procedure
- Full liquid—the stage between clear liquids and a soft diet, one step closer to eating “real food”
- Mechanical/surgical soft—for patients who cannot chew or swallow harder foods due to surgery or poor dentition or who are moving back to solids after a procedure
- Dysphagia—for patients who might accidentally inhale food into their lungs instead of swallowing it due to functional, mechanical, or physical issues
Renal diets and dysphagia diets are very difficult to figure out at home and require close monitoring by speech and language pathologists (dysphagia) and RDs.
If you’ve ever had a colonoscopy, you’ve probably been through that nasty prep stage—which is a gradual reduction from “real food” to soft to full liquid to clear liquid to that hellishly nasty prep fluid. I find it interesting that I wasn’t told on the other side of the experience to work my way in the other direction.
I knew enough about nutrition not to eat a burger and fries right after the procedure—nor did they sound in the least appealing. And I’ve heard a lot of people say they went right back to eating solids and regretted it.
taking a restricted diet home
The most common restricted diets are the first two in the list—and they’re also the diets that we hope patients will stick to once they leave us. (Yeah, it’s pretty clear that a lot of them plan to go right back to their poor food choices the minute they’re sprung!)
So let’s talk about how you can stick to a heart healthy diet or a consistent carb diet at home. Because surely, if you’re reading this, you will try to do that rather than go back to your old ways!
This diet normally restricts three nutrients: fat, saturated fat, and sodium. These are generally held to be the nutrients that most affect cardiac health.
There is some evidence, though, that sugar—especially refined, added sugar—might be just as much (if not more) a culprit. And we’ll let the medical field catch up to that idea. Today, we’re focusing on what your MD/RD are most likely asking of you. And it wouldn’t hurt to start limiting your sugar intake. I know–more bad news, so start with a small step. Every step in the right direction makes a difference.
The standard recommendations for limiting fat, saturated fat, and sodium are:
- Keeping fat to < 30% of total calories (Ironically, it sometimes doesn’t limit the number of calories one ingests.)
- Limiting saturated fat to < 7% of total calories (Same irony.)
- Staying below 2,400 mg of sodium per day (The American Heart Association puts the ideal at 1,500 mg/day for adults. Oh, we do love our salt….)
These suggestions are slightly lower than what is recommended for a non-restricted diet.
Remember from our previous posts in this series that high-fat foods are animal proteins, dairy, nuts and seeds, avocados and coconuts. Foods high in saturated fats are animal in origin for the most part. Red meat and animal proteins with the skin on are highest in saturated fat. Tropical plants such as palm and coconut also contain saturated fats. (So eat more plants, tropical ones in moderation!)
Sodium is found in small amounts in most whole foods and is abundant in salt.
Sound complicated? It doesn’t have to be.
fat + saturated fat
If you’ve done my Label Reading 101 workshop, you might recall my “fat check” trick for processed foods:
- Take a look at the nutrition facts label.
- Divide the total calories from fat by the total number of calories per serving. You might have to multiply grams of fat by 9 to get the first number. (Yes, I’m assuming you are eating just one serving!) This number should be less that 30% (0.30). For those not on a restricted diet, this figure is usually 33% or lower.
- Divide the total calories from saturated fat by the total number of calories per serving. You might have to multiply grams of saturated fat by 9 to get the first number. (Again, I’m assuming you are eating just one serving!) This number should be less that 7% (0.07). For those not on a restricted diet, this figure is usually 10% or lower.
For measuring sodium:
- Add up all the milligrams of sodium on all the servings of foods you eat that day. Major hint: processed foods have TONS of sodium.
- That’s why I highly recommend cooking whole foods from scratch at home—you’ll know exactly how much salt you’ve added. (And don’t forget, most whole foods already have some sodium in them.) 1 tsp of table salt has about 2,325 mg of sodium—almost as much as a restricted diet and way more than the AHA ideal. Do you see where I’m going with this?
As a general rule, when I cook at home, I start with about 1/2 tsp of salt in a recipe that feeds 4. That goes up or down depending on what’s in the recipe: fat and carbs, for example, make food taste less salty.
So then we tend to add even more salt.
Think about eating 3 meals a day with 3–4 servings of various foods per meal. That’s 9–12 servings of food, each of which contain 1/8 tsp of salt per food item. Which is 1.125–1.5 tsp or 2,615–3,488 mg of sodium.
Whoa—we’re counting on you eating ONE portion of each food and only adding 1/2 tsp of salt per 4 servings. And that’s not counting snacks! Sigh. Like I said: take a small step.
Try reducing how much salt you add in the kitchen OR at the table. And if possible, don’t try to go from 5,000 mg to 1,500 mg overnight. It won’t work. (Your MD/RD might tell you to do this, in which case, listen to them.) If you have the luxury of making changes more gradually, give your palate time to adjust—it will happen.
As you reduce the salt you add, experiment with fresh and dried herbs and spices—the more flavor a dish has, the less salt it might need.
consistent carb diet
The goal behind adopting this restricted diet is to spread carbohydrate consumption evenly across the course of a day. This helps to keep blood sugar levels more, well, level! And that means insulin amounts can be more predictable.
Where I work, most patients get 75–80 g of carbs per meal and 30–32 g of carbs per snack.
You can figure out the carbs in processed food from the nutrition facts label. And the whole foods can be searched up in a number of apps. I like NutritionData—and it’s a bit too detailed for a lot of people. Try the simpler FatSecret (love the labels and search options, hate the name) if that’s you.
Remember our nutrient density lesson? There we learned that broccoli has about 6 g of carbs per cup, while that squishy white bread has about 13 g.
I’m just saying. You could eat TWO CUPS of broccoli or ONE SLICE of white bread for the same amount of carbs, and you’d be getting a whole lot more nutrition from the broccoli.
Yes, vegetables have carbs—and they come with a lot of other nutrients. So if you’re trying to reduce your carbs, focus on proteins (lean animal flesh, poultry, fish, legumes) and vegetables. Reduce the grain products (bread, pasta, cereals) and sweets and eat fruit in moderation.
make the connection
If you look back over this post, you’ll see that my principles of healthy eating apply to a restricted diet, too. Perhaps even more so to a restricted diet!
If you’ve been put on a restricted diet by your MD or RD, make sure you understand what that means in terms of nutrients you need to limit. Some professionals will help you with recipes and meal plans, others will not. And that’s where a health coach can help! Let me know if you need to adhere to a restricted diet and where your challenges lie. You’re welcome to come to my free office hours or schedule a 1:1 to discuss.