Medical Diets 101

We often associate the word “diet” with restrictions on what you can and cannot eat with the goal of losing weight, but that’s not always the case! In the medical world, diets are just recommendations for certain food items that can be part of a treatment plan for a medical condition with the intent of decreasing negative symptoms.

These diets that are associated with medical conditions are called “therapeutic diets”. They are often prescribed and written as orders by doctors just as any medication or procedure. In many cases, they can be just as important! 

In honor of March being National Nutrition Month, we want to give an overview of the most common recommended therapeutic diets and determine what medical professionals would be the best resource if you had questions.

Reasons for Therapeutic Diets

In this article, we will discuss why a person may need a specific therapeutic diet due to one of two reasons:

• Nutritional needs. Modifications sometimes need to be made to increase or decrease the consumption of a certain nutrient. There are many, many different kinds of nutritional diets that often correspond with medical diagnoses. Some of these diets are general recommendations and some are calculated specifically for each individual person. 

• Chewing or swallowing difficulty. Modifications sometimes need to be made to the texture or consistency of a food items due to difficulty chewing and swallowing. There are 5 main textures that can be recommended which are determined specifically for each individual. 

Medical Diets for Nutritional Needs

Registered Dietitians (RDs) are largely responsible for determining the most appropriate diet for an individual based on their nutritional needs and personal goals. Some of the most common types of these therapeutic diets are:

Diabetic Diet. The diabetic diet focuses on keeping blood sugar levels in a safe range. RDs will recommend specifics for this diet based on type and intensity of diabetes, personal history, body composition, and individual nutritional needs.  

Renal diet. This diet is generally low in sodium, phosphorous, and protein for individuals with kidney disease. There also may be a fluid restriction recommended.  

DASH diet. The DASH diet stands for Dietary Approaches to Stop Hypertension and focuses on low sodium and higher potassium food items. An RD may recommend this diet for someone with high blood pressure.

Medical Diets for Chewing or Swallowing Difficulty

Individuals may require a specific therapeutic diet that modifies the texture or consistency of food items due to difficulty chewing and swallowing. These recommendations are generally made by speech language pathologists (SLPs) based on review of medical history, oral examinations, swallow assessments utilizing x-rays or scopes, and patient wishes.

The medical term for difficulty swallowing is dysphagia which can stem from physical differences in the mouth and throat such as a lack of teeth, for example. Dysphagia can also arise due to medical conditions impacting function such as a cerebral vascular accidents (strokes), dementia, Parkinson’s disease, amyotrophic lateral sclerosis (ALS), head and neck cancer, amongst many others.

Modifying textures may be necessary to decrease the risk of choking or food going into the airway, called aspiration. Both choking and aspiration can lead to more complex medical conditions or even death.

Traditionally, there were three diets recommended for dysphagia: regular, mechanical soft, and puree. Since 2019, changes were made with collaboration of RDs and SLPs as the International Dysphagia Diet Special index (IDDSI) now classifies the categories as:

Regular – As the name implies, this diet has absolutely no restrictions. Hard, crunchy, sticky, or crumbly food items are not limited.

Soft and Bite-sized – Food items are soft, tender, and moist, cut into 1.5cm bites for adults, require to be chewed but are easily broken down with pressure from the back of a fork.

Minced and moist – Food items are soft and moist, cut to be less that 4mm for adults, can be chewed without needing teeth and by only using the mouth against the roof of the mouth.

Pureed – Food items are blended smoothly resulting in no lumps, thick enough that it cannot be poured or brought through a straw, but does not require any chewing.

Liquidized – Food is brought to a liquid texture, is completely smooth, can be drunk from a cup, and is able to be swallowed directly.

How Long Do I Stay on a Diet?

Both types of therapeutic diets may be recommended for just a short period of time. It may be that being on a nutritional diet may help you reach your goals after just a few weeks or months. Similarly, being on a modified texture diet such may be necessary after a dental procedure or after a stroke for a few weeks until recovery is possible. 

However, many times diet recommendations are more long term and require staying on it for a long period of time for goals to be met. It is important to note, though, that liberalizing a diet is an option.

Diet liberalization is relaxing the original prescribed diet for quality-of-life reasons. At the end of life, for example, many patients decide to forego strict diets for enjoying things that may not be technically  “good” for them any longer. 

The complexities of therapeutic diets is why it is important to work with professionals such as RDs and SLPs for specific recommendations.

Where Do I Find an SLP or RD?

Registered dietitians and speech language pathologists both work in schools, outpatient clinics, long term care facilities, hospitals, and public health facilities. For specific recommendations for your community, ask for a referral from a primary care physician.