Low residue diet

MANAGING DIARRHEA. Measures to manage diarrhea include a low-residue diet while the bowel rests. Electrolytes are monitored and supplemented as needed. Adequate hydration must be maintained intravenous fluids may be necessary. If diarrhea is severe, therapy may be delayed or stopped or the dose decreased. 

When nausea or vomiting is mild, a digestible low-residue diet is administered for 24 hours. 

Give dietary advice on avoiding constipation, the main cause of haemorrhoids, which often results from a low-residue diet. 

Adequate bowel preparation is essential for an accurate CTC examination. Individuals undergoing CTC should consume a low residue diet, avoiding high-fibre food such as fruit and vegetables that produce faecal residues. Residual fluid and solid residues may reduce sensitivity and specificity of CTC. Endo-luminal fluid can obscure polyps solid stool can mimic a true polyp and, if present in large quantities, obscure polyps. 

Low residue diet starting three days before the examination (no flavoured cheese, condiments, whole-grain bread, crackers, cereals, popcorn, raw fruit, mustard...)... 

Spiller GA, Chemoff MC, Hill RA, Gates JE, Nassar JJ, Shipley EA. Effect of purified cellulose, pectin, and a low-residue diet on fecal volatile fatty-adds, transit-time, and fecal weight in humans. Am J Clin Nutr. 1980 33(4) 754—759. 

The patients receive a dedicated low residue diet (Nutra Prep , E-Z-EM, Lake Success, NY, USA). This diet is provided in a box and supplies the patient with all the meals and drinks for the entire day before CT colonography (Fig. 4.2). This box contains powdered drinks with vanilla flavour, fruit drinks, soups, chips and nutrition bars. The diet reduces the fat intake and the faecal output. Patients are allowed to have breakfast (8 a.m.), lunch (noon) and dinner (5 p.m.). Breakfast consists of a tropical fruit juice, one vanilla drink and tea or coffee. At lunch patients drink another tropical fruit juice and vanilla drink and/or apple sauce, a soup and tea or coffee. At dinner they can have another soup and/or vanilla drink. Between the meals they can eat the chips and nutrition bars. The patients are allowed to drink as much additional water as they want to. 

Iannaccone et al. (2004) examined successfully 203 patients with laxative-free CT colonography. They performed faecal tagging over two days with a total of 200 ml of diatrizoate meglumine and diatrizoate sodium. The patients were also on a low residue diet for two days. They obtained very good results of polyp detection 86% for lesions >6 mm (79 lesions), 95.5% for lesions >8 mm (45 lesions), 100% for lesions >1 cm (24 lesions). 

CAUTION The elimination of certain foods, such as raw fruits and vegetables, from low residue diets makes it advisable for people following these recommendations to take mineral and vitamin supplements. Most doctors and dietitians will advise their patients regarding the products best suited to their needs. 

Symptoms of pancreatitis consist of a severe upper abdominal pain radiating into the back and stimulated by eating, tenderness above the stomach, distention, constipation, nausea, and vomiting. The basis of treatment is to limit pancreatic secretion to a minimum. Hence, during the first few days of treatment, intravenous feeding is employed, followed by a soft, bland, or low residue diet. When medical treatment is ineffective, surgery may be needed. 

Discuss the importance of maintaining nutrition by modifying the diet to include low-residue meals (low-fiber meals). 

It might be expected that EN via tubes would have been used widely before the development of parenteral nutrition (PN) however, this was not actually the case. EN via tubes inserted down the mouth or nose into the stomach and also via rectal tubes was used occasionally in the decades before the development of PN in the 1960s.1 However, modern techniques for enteral access, both the placement of the tubes themselves and the materials for making pliable, comfortable tubes, had not yet been developed. Before the PN era, the formulas delivered by the tube route often were blenderized foods. The National Aeronautics and Space Administration effort in the United States in the 1960s led to the development of low-residue (monomeric) diets for astronauts. These diets were adapted for use in sick patients requiring EN. Nonvolitional feedings in patients who cannot meet nutritional requirements by oral intake thus include EN and PN these techniques are collectively known as specialized nutrition support (SNS). 

There can be no objection to the ingestion of bulk substances for the purpose of supplementing low-residue modern diets. However, use of irritant purgatives or cathartics is not without hazards. Specifically, there is a risk of laxative dependence, i.e the inability to do without them. Chronic intake of irritant purgatives disrupts the water and electrolyte balance of the body and can thus cause symptoms of illness (e.g., cardiac arrhythmias secondary to hypokalemia). 

Domestic mminants, especially cattle, are especially sensitive to molybdenum poisoning when copper and inorganic sulfate are deficient. Cattle are adversely affected - and die if not removed - when grazing on pastures where the ratio of copper to molybdenum is <3, or if they are fed low copper diets containing molybdenum at 2.0-20.0 mg/kg diet death usually occurs when tissue residues exceed 10.0 mg Mo/kg body weight. The resistance of other species of mammals tested, including domestic livestock, small laboratory animals, and wildlife, was at least tenfold higher than that of cattle. Mule deer (Odocoileus hemionus), for example, showed no adverse effects at dietary levels of 1000.0 mg/kg. 

Fig. 4. Influence of solute output on urine flow. The subject of this study had a normal ability to dilute his urine in response to water loading. The restricted maximal rates of urine formation were a function of special low solute residue diets (Crawford, 1952).

Hence, therapeutic diets should be designed so that they are (1) very well digested and absorbed, and contain only minimal amounts of undigestible residue (2) rich in calories and protein (3) free from foods which commonly cause allergic or other digestive disturbances and (4) soft in texture and bland. These criteria are best met by elemental diets, followed by diets containing low-residue foods. 

In inflammatory bowel disease (IBD) high fiber diets have no special part to play in the management of Crohn s disease where enteral feeding (with formula low-residue, low-fiber preparations) is especially beneficial where there is acute extensive small bowel disease. In ulcerative colitis specific dietary advice is usually unnecessary though fiber supplements may be of benefit in patients whose disease is limited to proctitis (inflammation of the rectum). 

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