Menu planning for diarrhoea
In diarrhoea, replace fluid and salts first with ORS, keep feeding, and give soft, low-fibre, low-fat foods such as kanji, curd rice, idli and banana.
Aim and principles of the diet
Aim: To plan a menu for a young woman recovering from acute diarrhoea and calculate its energy and protein. Principles: Diarrhoea means three or more loose or watery stools a day. The biggest danger is dehydration and loss of sodium and potassium, so fluid and electrolytes come first: ORS (oral rehydration solution), tender coconut water, rice water, buttermilk with a pinch of salt and soups. In ORS, glucose helps sodium, and with it water, to be absorbed in the small intestine. Feeding is continued: starving does not rest the gut and only causes weight loss (infants continue breastfeeding; children also get zinc as prescribed). In the acute phase, food is soft, bland and low in insoluble fibre and fat: rice kanji, curd rice, idli, moong dal khichdi, ripe banana, boiled potato, stewed apple and toast. Curd and buttermilk are better tolerated than milk, because short-lived lactose intolerance often follows diarrhoea, and they add helpful bacteria. Banana and apple supply pectin, and banana and coconut water restore potassium. Avoid fried and fatty foods, raw salads and whole grains, strong spices, sugary drinks and undiluted juices (they draw water into the gut), excess tea or coffee, and alcohol. Energy and protein return to normal as the stools settle. In chronic diarrhoea, the cause is treated and energy, protein, vitamins and minerals are raised.
Nutrient prescription: Ms. D, 22 y, 160 cm, 54 kg, acute diarrhoea for 2 days, settling
| Nutrient | Prescription | Basis and source |
|---|---|---|
| Ideal body weight | 54 kg | (160 − 100) × 0.9 |
| Energy | About 1600 kcal | 30 kcal/kg × 54 = 1620; less on day 1 if appetite is poor |
| Protein | About 54 g | 1.0 g/kg from curd, dal and egg |
| Fat | Low: about 10 g oil or ghee | Fatty food can worsen loose stools |
| Fibre | Low in insoluble fibre | No bran, whole grams, skins or raw salads at first |
| Fluid | 2.5-3 L, plus ORS for losses | About 200-400 mL ORS after each loose stool (WHO Plan A figure for over-10s and adults, as given in MSF guides); adults may also drink as much as they want |
Foods to give and avoid
| Food group | Give | Avoid |
|---|---|---|
| Fluids | ORS, tender coconut water, rice water, buttermilk with a pinch of salt, clear soups | Sugary soft drinks, undiluted fruit juice, strong tea or coffee, alcohol |
| Cereals | Rice kanji, curd rice, idli, soft khichdi, toast, rice flakes soaked in curd | Bran, whole-wheat in large amounts, fried snacks |
| Pulses and protein foods | Moong dal soup or khichdi, soft-boiled egg, steamed fish | Whole grams, rajma, chana (gas-forming) |
| Milk | Curd, buttermilk | Large amounts of plain milk if it worsens stools |
| Vegetables and fruits | Boiled potato, carrot or pumpkin mash; ripe banana, stewed apple, pomegranate | Raw salads, cabbage, cauliflower, unripe or very fibrous fruit |
| Fats and spices | A little ghee or oil; mild cumin and ginger | Fried foods, rich gravies, chillies |
Sample one-day menu: recovering from acute diarrhoea (Ms. D)
| Time | Menu | Approx. amount (raw) |
|---|---|---|
| 6.00 am | ORS, sipped slowly | 200 mL |
| 7.00 am | Tender coconut water | 200 mL |
| 8.00 am | Idli (3) with curd and a soft-boiled egg | Rice 60 g + urad dal 15 g; curd 50 g; 1 egg |
| 10.00 am | Ripe banana | 100 g |
| 11.30 am | Strained rice water with a pinch of salt | 200 mL |
| 1.00 pm | Curd rice, mashed boiled potato, moong dal soup | Rice 70 g, curd 150 g; potato 100 g, oil 3 g; moong dal 25 g |
| 4.00 pm | Stewed apple with toast | Apple 100 g, sugar 10 g; bread 1 slice (25 g) |
| 7.30 pm | Moong dal khichdi with curd | Rice 50 g, moong dal 25 g, ghee or oil 5 g; curd 100 g |
| 9.00 pm | Buttermilk with a pinch of salt and roasted cumin | 200 mL |
| After each loose stool | ORS | About 200-400 mL |
Worked calculation: Ms. D's diarrhoea recovery menu
Ms. D, 22 years, 160 cm, 54 kg, has had acute watery diarrhoea for 2 days. She is mildly dehydrated, the stools are settling and she can eat. Find her IBW, energy and protein needs and check the menu.
- IBW = (160 − 100) × 0.9 = 54 kg; her weight equals her IBW.
- Energy = 54 kg × 30 kcal/kg = 1620, about 1600 kcal (less on the first day if appetite is poor).
- Protein = 54 kg × 1.0 g/kg = 54 g, from curd, moong dal and egg.
- Fluid: 2.5-3 L a day, plus ORS after every loose stool to replace what is lost.
- Approximate values used (kcal and g protein per 100 g raw unless stated; rounded from Indian food composition tables, mainly IFCT 2017 and the older Nutritive Value of Indian Foods; a few, such as toned milk, are estimates): coconut water 20 and 0.2 per 100 mL; rice 355 and 8; urad dal 325 and 23; curd 60 and 3; egg 75 kcal and 6.5 g per piece; banana 100 and 1.2; potato 85 and 1.6; oil/ghee 900; moong dal 325 and 24; apple 60 and 0.3; sugar 400; bread 260 and 8; buttermilk 15 and 0.8 per 100 mL.
- Cereals (rice 180 g, bread 25 g): 704.0 kcal, 16.4 g protein.
- Pulses (urad dal 15 g, moong dal 50 g): 211.3 kcal, 15.5 g protein.
- Milk and milk products (curd 300 g, buttermilk 200 mL): 210.0 kcal, 10.6 g protein.
- Egg (1 egg): 75.0 kcal, 6.5 g protein.
- Vegetables (potato 100 g): 85.0 kcal, 1.6 g protein.
- Fruits (coconut water 200 mL, banana 100 g, apple 100 g): 200.0 kcal, 1.9 g protein.
- Oil and ghee (oil/ghee 8 g): 72.0 kcal.
- Sugar (sugar 10 g): 40.0 kcal.
- Energy = 704.0 + 211.3 + 210.0 + 75.0 + 85.0 + 200.0 + 72.0 + 40.0 = 1597.3 kcal.
- Protein = 16.4 + 15.5 + 10.6 + 6.5 + 1.6 + 1.9 = 52.5 g.
- Compare with the prescription: energy 1597.3 ÷ 1600 × 100 = 100%; protein 52.5 ÷ 54 × 100 = 97%.
- ORS, rice water and water are extra; they add fluid and salts but very little energy.
- Each group is rounded to one decimal and the totals are the sums of those rounded figures; all values are approximate.
IBW 54 kg; prescription about 1600 kcal and 54 g protein with 2.5-3 L fluid plus ORS. The menu gives about 1597 kcal (100%) and 53 g protein (97%).
Preparation and serving tips, and result
- Make packet ORS exactly as printed (usually one packet in 1 litre of boiled, cooled water) and throw away what is left after 24 hours.
- Home-made ORS: 6 level teaspoons sugar and half a level teaspoon salt in 1 litre of clean, boiled and cooled water.
- Give fluids in small, frequent sips; if the patient vomits, wait about 10 minutes and continue more slowly.
- Wash hands, boil water and cover food; good hygiene stops diarrhoea spreading.
- Move back to the normal diet over 2-3 days as the stools become formed.
- Result: The menu gives about 1597 kcal and 53 g protein in soft, low-fibre, low-fat meals, with 2.5-3 L fluid plus ORS, meeting Ms. D's prescription.
In the diet kitchen, diarrhoea trays need fluids on every round: ORS, coconut water, rice water and salted buttermilk, besides soft meals such as curd rice and khichdi. The kitchen also guards against the cause: boiled water, washed hands and covered food stop diarrhoea spreading on the ward.
Short answer: “Give the composition of WHO low-osmolarity ORS.” Per litre: sodium chloride 2.6 g, anhydrous glucose 13.5 g, potassium chloride 1.5 g, trisodium citrate dihydrate 2.9 g; this gives sodium 75, glucose 75, chloride 65, potassium 20 and citrate 10 mmol/L, total 245 mOsm/L.
Short answer: “Why are curd and buttermilk preferred to milk in diarrhoea?” Short-lived lactose intolerance often follows diarrhoea; curd bacteria have already fermented part of the lactose and help the gut recover.
Structured question: “Write the dietary management of acute diarrhoea.” ORS and other fluids first (after every loose stool); continue feeding; soft, bland, low-fibre, low-fat foods (kanji, curd rice, idli, khichdi, banana, boiled potato, stewed apple); curd instead of milk; avoid fried and spicy food, raw salads, sugary drinks and alcohol; hygiene; back to normal diet in 2-3 days.
'ORS first, food never stops', then the soft four: banana, kanji, curd rice, khichdi.