From the office of Robert S. Grimshaw Jr MD FACP Internal Medicine 3535 Hill Blvd Yorktown Hts NY 914 962-3180 Progressive Diet Guide Recognized Provider  “With Distinction” by the American Diabetes Association/National Committee for Quality Assurance 2/99-2/02

2000 Prepared with the help of Geri Merante RD MPH CDN

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!
Before we go further, this guide presumes that:

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You don’t have a temperature over 1000 F.

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The vomiting stops.

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There’s no blood in your stool.

For any of those conditions, call!!

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.

The Steps:
Start with step 1 and go up as you feel up to it - usually meal by meal (sometimes day be day).  At each level, you can use all the foods from the previous level also.

1) Clear Liquids: This means anything you can see through plus ice chips, Jello and sorbets.  Included are:

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Clear sodas: “ginger ale” (which of course has no ginger), 7-Up, Sprite and decaf colas.

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Clear juices are allowed: cranberry, white grape and apple (though this may cause increased diarrhea in some).

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Jello is fine, but make it the regular, not the diet - you need the sugar!

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Broth is  very useful, be-cause 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!

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Italian ices and sorbets are also allowed.

2) BRATT:

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Bananas

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Rice

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Apple Sauce/apples

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Toast

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Tea (decaf) with sugar

3) Soft Diet - No Milk

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Scrambled Egg

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White bread toast with margarine or jelly

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Saltines

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Boiled, broiled or baked chicken or turkey (bland)

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Rice, pasta, egg noodles (prepared in chicken broth)

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Cream of rice or wheat, no milk

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white potato with margarine

3) Regular Diet, No Milk
Such as:

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Lean hamburger

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Cooked, non-greasy veggies

4) Regular:
once you’ve had no diarrhea for 48-72 hours, gradually add milk products back in.

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 before meals, hold those until you’re eating. You should get some calories in during the “clear” period - a little Jello or sorbet should be ok.  Cover high sugars with regular or lispro.