Low-fiber/low-residue diet

A low-fiber/low-residue diet is a diet whose goal is fewer and smaller bowel movements each day. The diet may be used as part of the bowel preparation before a diagnostic procedure such as colonoscopy or as a short-term therapy for acute stages of gastrointestinal illnesses such as Crohn's disease, diverticulitis, bowel obstruction, and ulcerative colitis. In addition, a low-fiber diet is often prescribed before and/or after abdominal surgery or cancer treatments.

Dietary guidelines

Standard guidelines

Almost all low-fiber/low-residue diets make the following recommendations:[1][2][3][4][5][6][7][8][9][10][11][12]

Food type	Eat/Drink	Avoid
Grains	Breads and other baked goods made from refined white flour	Whole grain breads and baked goods
	Cold cereals made from refined flours, such as cornflakes and rice krispies	Whole grain cereals such as bran flakes
	White rice, noodles, refined pasta	Brown rice, whole wheat pasta, and other whole grain foods
Fruits	Fruit juices without pulp, except prune juice	Juices with pulp or seed, prune juice
	Soft fruits such as bananas and melons	Dried fruits, berries
	Canned or well-cooked fruit	Coconuts, popcorn
Vegetables	Vegetable juices without pulp	Juices with pulp or seed
	Potatoes without skin	Potato skins
	Canned or well-cooked vegetables
Meat, Other Protein	Well-cooked tender meat, fish, poultry, eggs	Tough meat, meat with gristle
		Beans, peas, legumes, nuts
Dairy	Milk	All dairy if lactose intolerant
	Soft, mild cheeses	Strong cheeses
	Plain yoghurt	Yoghurt or cheese containing nuts, berries, raw fruit
Oils	Vegetable oils, margarine, butter	Fried foods

Variations

Quantity of Fiber

A low-fiber diet is not a no-fiber diet. A 2015 review article recommends less than 10 grams of fiber per day.[13] Other sources recommend that a patient on a low-fiber diet eat no more than 10-15 grams of fiber per day.[5][6] Some sources recommend serving sizes that contain no more than 2 grams per serving.[6][7]

Grains

Some diets recommend limiting servings of baked goods to 2 grams per serving.[6][9] Other diets recommend limiting these servings to just 1 gram per serving.[8][10] Most diets also recommend eating warm cereals such as cream of wheat, cream of rice, grits, and farina.[3][7][9][11]

Fruits

Some diets allow additional raw fruits such as very soft apricot, canned fruit cocktail, grapes, peaches, papayas, plums, or citrus fruits without membrane,[1][2][3][4][5][6][11] but two rule out all raw fruits.[7][10] Some allow applesauce, other fruit sauces, or peeled and well-cooked apples.[1][3][6][9]

Vegetables

Many diets specifically recommend tomato sauce[1][2][3][9] and prohibit pickles.[1][2][3][4][6][9][12] Two diets actually limit the well-cooked vegetables to yellow squash without seeds, green beans, wax beans, spinach, pumpkin, eggplant, asparagus, beets, and carrots.[2][6] Two diets allow some raw vegetables: lettuce, cucumber (without seeds), and zucchini,[5][6] and one allows raw onion.[5]

Meat and other proteins

Some diets allow smooth peanut butter[6][11] or smooth nut butters.[9][7] Some diets allow tofu.[6][7][8][11]

Dairy

Some diets limit dairy to 2 cups per day.[2][5][11] One diet allows 1.5 ounces (40 g) of hard cheese.[6] Several diets allow pudding or custard,[6][8][10][12] sherbet,[3][9][7][11][12] whipped cream,[6][11] or ice cream.[3][4][9][8][10][12] A couple of diets suggest specific lactose-free products for the lactose intolerant, such as soy milk or whipped cream.[6][7] One diet prohibits whole milk, half and half, cream, sour cream, and regular ice cream.[9]

Condiments and spreads

Some diets allow mayonnaise,[3][6][9][7][10][11][12] ketchup,[3][9] sour cream,[3][8][12] cream cheese,[7] smooth sauces and salad dressings,[3][6][8][10][11][12] plain gravies,[11][12] or whipped cream.[6][11] Several diets allow jelly, honey, and syrup.[3][10][12] Many prohibit jam, marmalade, and preserves.[2][3][4][9][10][12]

Several diets prohibit highly spiced food,[1][3][4][5][6] but some allow spices, cooked herbs, and seasonings.[9][10][12]

Beverages

Several diets specifically prohibit caffeine[1][3][5][9] (two of these allow decaffeinated coffee, tea, and other drinks),[3][9] but some allow coffee, tea, and carbonated drinks.[11][12]

Nutritional quality

If the diet must be strict and followed over a long period of time, the intake of fruits and vegetables may not provide adequate amounts of vitamin C and folic acid. The quantity of calcium may also be inadequate if dairy products are restricted. In these cases, a multivitamin supplement or liquid nutritional supplement may be needed.[1][2]

Conditions that may require a low residue diet

A low-fiber diet may be used to prepare for or recover from various medical procedures:[1][2][4][6]

• Abdominal surgery
• Colonoscopy
• Internal hemorrhoid surgery

A low-fiber diet may also be used during acute stages of the following conditions, to rest the bowels:[1][2][4][6]

• Bowel inflammation
• Crohn's disease
• Diverticulitis
• Ulcerative colitis
• Radiation therapy to the pelvis and lower bowel
• Chemotherapy
• Gastroparesis

Uses

Colonoscopy

The most common preparation for a colonoscopy is a clear liquid diet accompanied by laxatives. However, this may not be the most effective preparation. A 2015 guideline issued by The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy recommends using a low-residue diet instead, also accompanied by laxatives,[14] because of evidence that it performs at least as well for bowel cleansing and is associated with better patient satisfaction.[15][16]

Crohn's Disease

Various guides to low-fiber diets suggest their use for short-term management of Crohn's disease, but there is little research to support this.[5] A 2016 review of the research found that a semi-elemental whey hydrolyzed protein (WHP) diet is superior for treatment of Crohn's disease.[17]

Diverticulitis

While a low-fiber diet is generally used for acute diverticulitis, the NIH guidelines recommend a high-fiber diet for patients with diverticulosis (a condition that may lead to diverticulitis).[18] A Mayo Clinic review from 2011 showed that a high-fiber diet can prevent diverticular disease.[19]

Aviation

In preparation for long-duration toiletless military flights, the crew is sometimes instructed to have a low-residue meal as their last meal before the flight. For example, this was the case with Blackbird pilots.[20]

Terminology

Most sources treat low-fiber and low-residue diets as identical, but some make a distinction based on the difference between fiber and residue. Dietary fiber is the indigestible part of food made from plants. Residue includes not only fiber but also other materials found in the colon after digestion. When this distinction is made, a low-fiber diet simply reduces fiber intake by eliminating or limiting high-fiber foods such as raw fruits and vegetables. A low-residue diet includes restrictions on foods such as dairy products, which do not contain fiber but do develop residue after digestion.

The American Academy of Nutrition and Dietetics’ removed the low-residue diet from its Nutrition Care Manual because there is no scientifically accepted quantitative definition of residue and there is no method to determine the residue produced by a food.[13][21][22]

See also

• Carnivore diet (zero-fiber)
• Dietary fiber
• Gastroenterology
• High residue diet

References

1. "Low Fiber/Low Residue Diet". ATLANTIC COAST GASTROENTEROLOGY ASSOCIATES. Atlantic Coast Gastroenterology. December 17, 2008. Retrieved April 29, 2017.
2. "Low Fiber/Low Residue Diet". Jackson|Siegelbaum Gastroenterology. Jackson|Siegelbaum Gastroenterology and West Shore Endoscopy Center. 2011-11-03. Retrieved April 29, 2017.
3. "Should You Try a Low-Residue Diet?". WebMD. WebMD. October 25, 2016. Retrieved April 29, 2017.
4. "Low residue diet" (PDF). Great Western Hospital. Great Western Hospital NHS Foundation Trust. May 15, 2012. Retrieved April 29, 2017.
5. "The Low-Residue Diet for Crohn's Disease". Healthline. Healthline Media. January 6, 2017. Retrieved April 30, 2017.
6. Wax, Emily; Zieve, David; Ogilvie, Isla (August 14, 2016). "Low-fiber diet". Medline Plue. ADAM Health Solutions. Retrieved May 1, 2017.
7. "Low-Fiber Nutrition Therapy". New York Presbyterian. Retrieved April 26, 2017.
8. "Diverticulitis Diet". Mayo Clinic. Mayo Foundation for Medical Education and Research. August 15, 2009. Retrieved July 5, 2012.
9. Manual of Clinical Nutrition Management (PDF). Compass Group. 2013.
10. "Low FIber Diet" (PDF). Rush University Medical Center. Rush University Medical Center. Retrieved May 3, 2017.
11. Clinical Dietitians Nutrition Service. "Low-Fiber, Low-Residue Diet" (PDF). Northwestern Memorial Hospital. Northwestern Memorial Hospital. Retrieved May 3, 2017.
12. "Low-Residue/Low-Fiber Diet". University of Pittsburgh Medical Center. UPMC. Retrieved May 3, 2017.
13. Vanhauwaert, Erika; Matthys, Christophe; Verdonck, Lies; De Preter, Vicky (November 2015). "Low-Residue and Low-Fiber Diets in Gastrointestinal Disease Management". Advances in Nutrition. 6 (6): 820–827. doi:10.3945/an.115.009688. PMC 4642427. PMID 26567203. Retrieved April 26, 2017. This narrative review focuses on defining the similarities and/or discrepancies between low-residue and low-fiber diets and on the diagnostic and therapeutic values of these diets in gastrointestinal disease management.
14. Saltzman, John R.; Cash, Brooks D.; Pasha, Shabana F.; Early, Dayna S.; Muthusamy, V. Raman; Khashab, Mouen A.; Chathadi, Krishnavel V.; Fanelli, Robert D.; Chandrasekhara, Vinay; et al. (April 2015). "Bowel preparation before colonoscopy". Gastrointestinal Endoscopy. 81 (4): 781–794. doi:10.1016/j.gie.2014.09.048. PMID 25595062. This is one of a series of documents discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this document that updates a previously issued consensus statement and a technology status evaluation report on this topic
15. Wu, Keng-Liang; Rayner, Christopher K; Chuah, Seng-Kee; Chiu, King-Wah; Lu, Chien-Chang; Chiu, Yi-Chun (2011). "Impact of low-residue diet on bowel preparation for colonoscopy". Diseases of the Colon & Rectum. 54 (1): 107–112. doi:10.1007/DCR.0b013e3181fb1e52. PMID 21160321.
16. Helwick, Caroline (May 23, 2016). "Low-Residue Diet Acceptable for Bowel Prep". Medscape. WebMD. Retrieved April 29, 2017.
17. Alexander, Dominik D; Bylsma, Lauren C; Elkayam, Laura; Nguyen, Douglas L (May 6, 2016). "Nutritional and health benefits of semi-elemental diets: A comprehensive summary of the literature". World Journal of Gastrointestinal Pharmacology and Therapeutics. 7 (2): 306–319. doi:10.4292/wjgpt.v7.i2.306. PMC 4848254. PMID 27158547.
18. Strate, Lisa L. "Diverticular Disease". NIH. National Institutes of Health. Retrieved April 30, 2017.
19. Tarleton, S; Dibaise, JK (January 17, 2017). "Invited Review: Low-residue diet in diverticular disease: Putting an end to a myth". Nutrition in Clinical Practice. 26 (2): 137–42. doi:10.1177/0884533611399774. PMID 21447765.
20. "SR-71 Pilot Interview Richard Graham Veteran Tales".
21. Alpers, David H.; Taylor, Beth E.; Bier, Dennis M.; Klein, Samuel (Jan 21, 2015). Manual of Nutritional Therapeutics. Lippincott Williams & Wilkins. Meant for quick retrieval of vital information regarding the management of nutritional issues in patients with gastroenterological problems--either primary or as the consequence of other medical disorders, such as diabetes, hyperlipidemia and obesity. The book addresses normal physiology and pathophysiology, and offers chapters on diseases that can lead to specific nutritional problems. The clinical focus is on therapeutic nutrition and dietary management.
22. Cunningham, Eleese (April 2012). "Are Low-Residue Diets Still Applicable?". Journal of the Academy of Nutrition and Dietetics. 112 (6): 960. doi:10.1016/j.jand.2012.04.005. PMID 22709819.