Ironman Gets a Diet

Today was the second of five weekly iron infusions. Last week it took about 15 minutes and was more of a test of how well I tolerated having iron infused into a vein. Today there was a much larger dose and the infusion lasted 90 minutes followed by a 30 minute flush.

I made the mistake of parking on the street. I didn’t expect my session to be so long. The limit at the meter is two hours and I went well past that time line. To my good fortune, I dodged a bullet; there was no ticket on the car. In future, I’ll go in one of the lots to avoid worrying about a parking violation.

While on the machine, I had a visit from Lauren, a clinical dietitian. Although unexpected, I was looking forward to getting professional advice. We’ve been working at eating healthier and have reduced processed food as much as possible. I think our diet is pretty good but today I was 81.4 kg (179.5 lbs). That’s more of a lose than I’d like so even though I think I’m eating plenty, apparently not enough. Going forward, I now have three daily goals from my dietitian:

• Consume 2,100 - 2,500 calories.
• Consume 85 - 110 grams protein.
• Consume at least 2.0 liters of fluids.

My normal eating routine is timed around breakfast, lunch, dinner and an evening snack at bedtime. Going forward, I plan to have six small meals throughout the day. The goal for each meal is:

• Consume 350 - 400 calories.
• Consume 15 - 20 grams of protein.
• Drink fluids with virtually every bite of food.

What I need to avoid is:

• Spicy food.
• Citrus products.
• Acidic foods.

Reproduced from Esophageal Soft Diet
Patient & Family Guide 2016

Ideally, my diet should be soft, moist foods and fluids. It is important to avoid food that may irritate my throat or block my esophagus. The list of diet guidelines follows:

• Eat and drink slowly. Take small bites and chew solid foods very well.
• East six small meals per day.
• Use sauces and gravies to moisten food. Cut food into small pieces. Do not swallow any hard chunks.
• Take a sip of liquid after each bite and at the end of the meal.
• Stop eating when you start to feel full.
• Avoid very hot or very cold food or drinks.
• Sit upright when eating and stay upright for at least 45 minutes. Stop eating and drinking 3 hours before bedtime.
• To avoid gas or bloating: do not use straws, chew gum, or eat hard candies, mints, or lozenges. Avoid carbonated (bubbly) drinks like pop. Chew food with your mouth closed.

I have a small booklet written for the period after my surgery has two diets:

1. Purée Diet - limited to liquids and smooth puréed foods. Our Ninja blender well be put to good use.
2. Esophageal Soft Diet - comprised of best choices and foods to avoid divided into the categories of:
   • Grain products.
   • Vegetables and fruit.
   • Milk products.
   • Meat and alternatives.

Sadly there are many things on the foods to avoid list that I like but it is more important to keep my eye on the prize. There are lots of options under best choices so all will be good.

Purée Diet

Have only liquids and smooth puréed foods such as:

• Water, juice, milk.
• Milkshakes.
• Smooth yogurts, puddings.
• Broth, strained or blended soups.
• Ice cream, sherbet, sorbet.
• Jell-O® (Soften to a liquid in your mouth before swallowing).
• Carnation Breakfast Anytime®, Ensure® or Boost® -type drinks.
• Store-bought bottled puréed meats, vegetables, and fruit (no chunks).
• Campbell’s Trepuree® frozen puréed entrees, homemade strained puréed foods.
• Foods should be the consistency of smooth applesauce or pudding with no chunks or strings.
• Limit yourself to 1 cup (250 ml) per hour for the first 1-2 days, and consume slowly.
• Include 3-4 commercial or homemade high-protein high-calorie drinks daily, such as Ensure®, Boost® or Carnation Breakfast Anytime®.
• For extra calories, choose Ensure Plus® or Boost Plus Calories®.

Esophageal Soft Diet

Grain Products

Best Choices	Foods to Avoid
- Cooked cereal and dry cereal that softens easily with milk. - Pasta and soft, moist rice in soups and sauces. - Crushed crackers and pieces of bread with crusts off, soaked in soup.	- Fresh “doughy” or crusty bread, muffins, biscuits, pancakes, waffles - Granola, Shredded Wheat - Breads and cereals containing seeds, nuts, coconut, and dried fruits.v

Vegetables and fruit

Best Choices	Foods to Avoid
- Soft, very well-cooked vegetables with skins removed, chopped fine and used in soups, sauces, and stews - Soft, moist mashed or scalloped potatoes in gravy or sauce - Canned, ground, or crushed tomatoes, tomato juice, and tomato soup -Minced yellow or green beans and minced peas in gravy or sauce - Canned and cooked fruit with peels removed - Ripe banana Applesauce, apple blends	- Raw or stir-fried vegetables, salads, coleslaw Tough or stringy cooked vegetables (such as spinach, celery, whole peas, whole green and yellow beans, Brussels sprouts, stewed and diced tomatoes, asparagus, corn) Raw fruit (bananas are Okay) Pineapple, grapes, kiwi, grapefruit, oranges, rhubarb, berries Dried or candied fruit (raisins, currants, dates)

Milk Products

Best Choices	Foods to Avoid
- Milk, smooth yogurt, pudding, ice cream, mousse, creamy cottage cheese, thin cheese slices	- Stringy cooked cheese, such as melted cheddar or mozzarella - Hard cheese - Yogurt with nuts or granola

Meat and Alternatives

Best Choices	Foods to Avoid
- Minced tender meat, poultry, or boneless fish, always in gravy, sauce, or both - Scrambled, poached, or soft-boiled eggs, chopped and topped with melted margarine or sauce - Well-cooked, tender legumes and lentils in soup or sauce (for example, soft baked beans)	- Dry, tough, or stringy meats - Bacon - Nuts and seeds - Hard-boiled and fried eggs Peanut butter (unless blended in a smoothie

Other

Best Choices	Foods to Avoid
- Nutritional beverages such as Ensure®, Boost® - Milkshakes, Carnation Breakfast Anytime® - Commercial eggnog, sherbert, Jell-O®	- Popcorn, chips, tacos - Foods containing coconut, nuts, seeds, or dried fruit - Pickles, olives - Gelatin-type candies (gum drops, jelly beans) - Cake, pie, pastry

Protein (from a clinic handout)

Your body uses protein to build and repair cells. Your body also uses protein to heal, build muscle and fight infections. The main food sources of protein include: meat, poultry, fish, eggs, dairy products, legumes and soy. Eating protein from a wide variety of food sources will also help you meet your nutrient requirements for iron, zinc, vita/min B12, calcium and vitamin D.

Food	Serving	Grams of Protein
Meat, fish, poultry	75 g / 125 ml (1/ 2 cup)	21 grams
Firm tofu	150 g / 175 ml (3/4 cup)	12 grams
Egg	1 large	6 grams
Cheese	50 g ( 1 1/2 oz)	12 grams
Cottage Cheese	125 ml (1/2 cup)	13 grams
Fortified soy beverage	250 ml (1 cup)	7-8 grams
Dried beans, peas, lentils (cooked)	175 ml (3/4 cup)	12 grams
Milk (cow’s)	250 ml (1 cup)	9 grams
Yogurt	175 ml (3/4 cup)	7 grams
Greek yogurt	175 ml (3/4 cup)	14 grams
Peanut (or other nut) butters	30 ml (2 Tbsp)	4 grams
Nuts, seeds	60 ml (1/4 cup)	3-8 grams
Bread	1 slice	4 grams
Cereal (cold)	30 g	3 grams
Cereal (hot)	175 ml (3/4 cup)	4 grams
Pasta, rice (cooked)	125 ml (1/2 cup)	3 grams
Quinoa (cooked)	125 ml (1/2 cup)	4 grams
Vegetables	125 ml (1/2 cup) or 250 ml (1 cup) of lettuce	2 grams
	250 ml (1 cup) of green peas	8 grams
Fruit	1 fruit of 125 ml (1/2 cup)	1 gram

High-Protein High-Calorie Drink Recipes

High-Protein Milk

• 1 cup (250 ml) whole milk
• ¼ cup (60 ml) skim milk powder

Add powder to milk. Mix until dissolved. Refrigerate.

• Makes 1 serving
• Energy: 260 calories
• Protein: 19 grams

Can be used:

• As a beverage, in milkshakes
• On cereal and cooked or puréed fruit.
• In soups, puddings, cream sauces and mashed potatoes.

High-Protein Milkshake

• 1 cup (250 ml) whole milk
• ½ cup (125 ml) plain ice cream or frozen yogurt
• ¼ cup (60 ml) skim milk powder
• ½ cup (125 ml) fruit (try bananas or peaches)

Place ingredients in blender. Blend ingredients together until smooth. Refrigerate.

• Makes 1 serving
• Energy: 345 calories
• Protein: 22 grams

For safe use of homemade drink

1. Keep drinks refrigerated and throw out after 24 hours.
2. Do not keep drinks at room temperature for longer than 2 hours.
3. Do not add raw eggs to blended drinks. Eggbeaters® or Naturegg Break-Free® commercial egg substitutes can be used. These are found in the cold or frozen section at your local grocery store.