What Is the Meaning of "Diet As Tolerated"?

Traditionally, after a surgical procedure, inpatient stay or other illness, the bowel is allowed time to rest. This means withholding all food except for sips of water. Once this stage is complete, the diet is often "advanced as tolerated." Although there is some debate as to whether patients need to remain without food after such procedures, diet as tolerated continues to be used by medical professionals.

Definition

Diet as tolerated is usually advised in relation to surgery. Once a surgical procedure is complete, individuals are given only liquids, such as water. The diet progresses to solid foods in the form of purees, chunks and finally a regular diet. Diet as tolerated is a term that indicates that the gastrointestinal tracts is tolerating food and is ready for advancement to the next stage. For example, the University of Arizona Department of Surgery recommends that once patients leave the hospital, they slowly resume a normal "diet as tolerated." Therefore, this statement is most applicably in regard to the diet after throat, abdominal or gastrointestinal surgery, signifying the patient’s tolerance of his diet.

Background

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According to DukeHealth.org, advance diet as tolerated is a way of advancing the diet in stages after surgical procedures. Your gastrointestinal tract needs time to rest after surgery. Each diet phase must be tolerated for two to four days before advancing to the next step. After bariatric surgery, the stages may take anywhere from two to six weeks before advancing to the next stage. If vomiting, nausea or increased abdominal pain occurs, the diet should not be advanced. A ‘diet as tolerated’ therefore means that a patient must be able to consume foods from one diet stage before moving to the next.

New Approach to Post Surgical Feeding

Alison Schulman and Robert Sawyer in “Have You Passed Gas Yet? Time for A New Approach to Feeding Patients Postoperatively,” explore the literature regarding early postoperative feeding. Historically, surgeons have followed a strict protocol as to when to start patients on an oral diet after major surgery, especially when the gastrointestinal tract is involved. Once bowel function is regained, a clear liquid diet is initiated. However, early feeding postoperatively has been associated with a decreased hospital length and increased patient satisfaction. Early feeding appears to not only be safe for a variety of post surgical patients, but is also beneficial in allowing patients more control over their diet. Therefore, early feeding postoperatively may be an ideal treatment strategy with potential medical costs savings.

Modern Meaning

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In “The Establishment of a Transition Diet,” Miriam Erick explains how the use of a transition diet has become more liberalized over time 3. In many cases, the postsurgical diet is now advanced faster than the traditional ‘transition diet’ system. It is based on the idea that sick and recovering patients want specific foods and amounts, and are often the best judge of individual tolerance. Factors that influence tolerance include past medical history, type and amount of oral medication before meals, age and gender, postoperative pain management and the type of anesthesia received. While the same foods are still available--clear and full liquids, soft and regular foods -- given the opportunity the patient will select the foods she perceives to be the best tolerated.

Potential Complications

In “Early Versus Delayed -- Traditional -- Oral Fluids and Foods for Reducing Complications after Major Abdominal Gynecologic Surgery,” K. Charoenkwan examines the reality of feeding on demand postoperatively versus the traditional, delayed feeding as tolerated 4. While early feeding is considered safe, this approach is associated with the increased risk of developing minor, yet often uncomfortable symptoms, such as:

• nausea
  
• diarrhea
  
• abdominal pain
  
• flatulence

Therefore, it is evident that the early feeding theory should be individualized and based on the patient’s condition and overall preferences.