Promoting liberalized diets is a great way to increase food intake, reduce malnutrition risk, and increase quality of life!
This has been an avenue that long term care Dietitian’s are trying more and more to promote in their facilities and among the older adult population.
Malnutrition alone can lead to unintentional weight loss, reduced mobility, and early mortality. With those health side effects it’s no wonder that liberalized diets is the most recent trend.
I tend to be a big advocate of person-centred care, and promoting liberalized diets falls straight into this advocacy category.
What is a Liberalized Diet?
A liberalized diet is increasing the flexibility in food options and reducing the amount of restrictions placed on an individuals food and fluid choices.
This leads to a wider variety of foods that they are allowed to eat at meals and snacks. In some cases it may mean lifting every diet restriction placed on them, in other cases it may mean only allowing certain foods back into their diet.
What is a Therapeutic Diet?
A therapeutic diet is a type of diet restriction placed on an individuals choices in order to manage some type of chronic disease, medical condition, or limit an ingredient/nutrient.
These diets can be prescribed by a Registered Dietitian, Speech-Language Pathologist or Physician in order to improve the safety measures in place for an individual.
Therapeutic diets can be prescribed in a variety of manners such as changing a diet texture for easier chewing and swallowing, limiting a certain ingredient such as gluten for Celiac Disease, or limit multiple items such as the case in Diabetes.
Here is an extensive list of all the types of therapeutic diets that you may encounter:
Therapeutic Diet Textures
|Diet Texture Name
|Reason for Diet
|Standard, Regular Diet
|Suitable for anyone that can manage no diet texture adjustments.
|Mechanical Soft Diet
|For individuals who have slight chewing/swallowing difficulty.
|Chopped or Minced Diet
|For individuals who have difficulty chewing/swallowing, typically the first step in a Dysphagia diet. Meat is usually the only item minced/chopped finely.
|Total Minced Diet
|All items on the plate will be minced to a fine texture. For ease of chewing/swallowing. No bread products are typically allowed.
|All foods are pureed. Used for individuals for significant Dysphagia.
|All food items are blended together. Typically served in a mug. For individuals with severe swallowing issues.
|Full Liquid Diet
|All foods are in a liquid form. Used for individuals with severe swallowing issues or pre-surgery preparation.
Therapeutic Diets Based on Nutrient Restrictions
|Therapeutic Diet Name
|Reason for Diet
|Diabetic Diet/ Controlled Carbohydrate Diet
|For individuals with type 1 or Type 2 Diabetes. Typically recommended for those who do not have well controlled Diabetes.
|For individuals with Kidney Disease. Typically for those who are in Stages 3-5, Dialysis, or Pre-Dialysis patients. Various levels of restrictions will occur.
|For individuals with any type of Cardiac Disease. Typically aimed at lowering saturated fat intake and sodium.
|Gluten Free Diet
|For individuals with Celiac Disease. Rarely used outside of that disease.
|Lactose Free Diet
|For individuals with lactose intolerance.
|Low Potassium Diet
|Typically used in individuals with Kidney Disease having Dialysis treatments. Can also be used in those with medications affecting Potassium levels.
|Low Phosphorous Diet
|Typically used in individuals with Kidney Disease limiting Phosphorous intake to lower levels in the blood.
|Low Residue Diet
|For individuals with Inflammatory Bowel Disease, Colonoscopy preparation, Pre-Bowel Surgery, and those with Diverticulitis flare ups.
|Low Fat Diet
|For individuals who need to reduce saturated and trans fats in the diet such as Gall Bladder Disease, Heart Disease, and may benefit Diabetes.
|High Calorie Diet
|For individuals who have increased calorie needs such as significant weight loss, pressure injuries, wounds, cancer, and malnutrition.
|High Protein Diet
|For individuals who have increased protein needs such as pressure injuries, burns, active dialysis patients, cancer, and cachexia.
|Low Iron Diet
|For individuals with iron overload such as Hemochromatosis.
|Low Sodium Diet
|For individuals with High Blood Pressure, Heart Conditions and Kidney Disease.
Therapeutic Diets Based on Medical Conditions and Other
|Therapeutic Diet Name
|Reason for Diet
|Can be used for individuals post oral surgery, head, neck or throat cancer. Includes easy to chew foods.
|For individuals that need foods easy on their digestive system, can be used post-surgery or those with difficulty with their gastrointestinal (GI) systems.
|For individuals who need help relieving constipation and regulating their bowel movements.
|Can be used for individuals with chronic inflammation such as arthritis or Inflammatory Bowel Disease (though research is mixed).
|For individuals struggling with Inflammatory Bowel Disease and other GI disorders limiting fermentable carbohydrates.
|Vegetarian or Vegan Diet
|For individuals who prefer to eliminate animal products to different extents.
|For individuals who have mild to severe swallowing disorders as prescribed by a Speech-Language Pathologist.
Why Would Someone be on a Therapeutic Diet?
Many individuals in older adults and long term care facility residents are prescribed a therapeutic diet in order to manage their chronic health diseases.
With certain chronic disease such as Kidney Disease, certain diet restrictions are necessary to keep a person alive. Having elevated levels of sodium, potassium and phosphorus can be incredibly dangerous. Therapeutic diets in these cases can benefit an individual.
With other types of diet restrictions such as Controlled Carbohydrate Diets total diet restrictions are not necessary in most circumstances.
Benefits of Liberalized Diets
A liberalized diet says that one general diet prescription does not fit everyone. In many healthcare facilities and long term care homes, a low sodium diet for example, has very specific restrictions.
An individual may no longer be able to eat the regular soup, have only low salt recipes, won’t be provided with table salt, and will be denied access to any item not on a low sodium diet list.
As long term care facilities are shifting towards person-centred care, defined as: “improving patient outcomes where patient’s are more involved in their care and decisions”.
Improving the lives of individuals regarding their nutrition care means that they get a say in the food and fluids that they want. Liberalizing diets where able can greatly benefit patient’s in the following ways:
Enhanced Quality of Life:
A liberalized diet empowers individuals to reclaim joy in eating by fostering a positive relationship with food. By breaking free from rigid restrictions, people can savor a wider variety of foods that cater to their preferences and cultural inclinations.
This newfound culinary freedom enhances mealtime experiences, strengthens social connections, and enriches overall quality of life.
The American Dietetic Association had this to say about liberalizing a diet:
“Allowing residents to participate in diet-related decisions can provide nutrient needs, allow alterations contingent on medical conditions, and simultaneously increase the desire and enjoyment of food.
Thus decreasing the risk of weight loss, undernutrition, and other potential negative effects of poor nutrition and hydration.”
Reduced Risk of Malnutrition:
One of the key advantages of liberalized diets lies in their ability to combat malnutrition, especially among older adults and individuals with specific health conditions.
Malnutrition affects anywhere from 36-90% of long term care residents (the wide range is due to different measurement techniques). If you want to know more about the negative health effects of this, check out this article.
By embracing a more diverse range of nutrient-rich foods, individuals are better equipped to meet their nutritional needs and maintain a healthy body weight. As a result, the risk of malnutrition decreases significantly, supporting optimal health and well-being.
Improved Pressure Injury Management:
For individuals with mobility challenges or those who spend prolonged periods in bed, pressure injuries can be a serious concern. A liberalized diet, with its emphasis on adequate nutrient intake, can promote tissue repair, strengthen the immune system, and facilitate faster healing of pressure injuries.
Expanded Dietary Options:
Liberalized diets offer a breath of fresh air when it comes to dietary options. By accommodating personal preferences, cultural tastes, and varying dietary needs, individuals can tailor their meals to suit their unique requirements.
This newfound flexibility makes it easier to sustain a healthy eating pattern, fostering a sense of empowerment and fulfillment.
Improved Food and Fluid Intake:
A more inclusive approach to eating ensures that individuals receive sufficient nourishment through a wider range of food choices. By removing strict limitations, people can explore diverse flavors, textures, and nutrient profiles, leading to increased appetite, improved food consumption, and enhanced hydration.
Liberalized diets go beyond culinary choices; they empower individuals to take charge of their nutritional well-being.
By allowing individuals to actively participate in decision-making and meal planning, liberalized diets promote empowerment and ownership of personal health. This engagement fosters a sense of control, dignity, and self-worth, ultimately leading to a more fulfilling and autonomous lifestyle.
With so little control of their care, food is the one area most individuals feel they still have some sense of control over.
Why Some Diets Shouldn’t Be Liberalized
Liberalized diets isn’t meant for everyone.
There are some serious health conditions that do need to be managed with a therapeutic diet. And unfortunately in some circumstances, a diet can and should not be liberalized.
In cases of:
Serious risk of adverse health conditions
Serious aspiration risk
Will progress disease rapidly
Early mortality risk
In these circumstances I recommend working with the healthcare team to see if there is any room for restriction flexibility.
There are also circumstances where an individual does not want to lift their diet restrictions. If someone has been living with a therapeutic diet for years such as a controlled carbohydrate diet, they may not be comfortable changing this.
In these circumstances they can be left without diet liberalization as this is their choice.
How Can a Dietitian Liberalize Diets?
There are many times where a Doctor is not encouraging of liberalizing a patient’s diet as they may believe it’s healthier for them to stay restricted. Though this can be difficult there are ways to deal with it.
If you need som help making the argument for diet liberalization, here are the three key talking points.
Top 3 Tips for Advocating for Liberalizing Diets
Show Your Research
If a Doctor doesn’t want to approve diet liberalization for a patient, find research articles that support your case. These may be ones I have presented here that speak to reduced frailty risk, improved malnutrition, no increased risk of chronic disease (in the specific article), improved quality of life, etc.
You want scientific facts to back up your case, and in my experience, that’s how most Doctors work.
Do Your Research
Make sure if the liberalized diet you’re speaking to is something like a Diabetic Diet that you’ve done your patient research.
For example: you want to liberalize a diabetic diet, you have looked at their nutrition related labs, their numbers are within an acceptable range, intake records, anything relevant to liberalizing their diet.
Individualize the Diet Prescription.
If it isn’t always safe to fully liberalize a diet, you should individualize the diet prescription. If we continue with the example above, let’s say for example that their A1C is above what would be best. The diet would be liberalized in areas that we are confident won’t continue to raise blood sugars.
A typical dessert in long term care is about 15-25 grams of sugar, which in combination with a protein and fibre rich meal shouldn’t in theory spike blood sugars. An intervention would be to allow regular desserts (instead of a fruit cup), but continue with diabetic juices.
You tailor the diet prescription to safely meet the nutritional and quality of life needs of your patient.
Liberalized Diet Examples
If you’re looking for some ways that you can liberalize a diet without lifting all restrictions, here are some ideas. All of these should be assessed on an individual basis.
|Controlled Carbohydrate Diet
|– Regular juice instead of diabetic juice
– Regular dessert instead of diabetic option
|Low Sodium Diet
|– Allow regular soups
– Allow deli meat sandwiches X times per week
|Lactose Free Diet
|– Allow dairy products that don’t cause GI distress. Example: Ice cream, cheese, offer lactose free milk.
|Total Minced Diet
|– Have an SLP assess permissions for diet exceptions. This may mean allowing some soft bread products.
|Mildly Thick Fluids
|– Allow thin liquids (with SLP permissions) for some fluids. Example: Regular/Thin Coffee.
|– Allow some items not on the Renal Diet (with Physician and Renal Dietitian permissions) such as bananas, milk.
Dietitian Takeaway Points
- Liberalizing diets doesn’t mean that we throw out all the usefulness of a therapeutic diet. It means that a focus on person-centred care, and develop meal plans for patients that meet their needs. These needs include emotional and preference based needs.
- Continue to use therapeutic diets when necessary, but ensure that to record diet preferences, and honour their right to choose and refuse.
- Work with your team and ensure that you are continually documenting!
If you’re looking for a great resource on how to document properly with case study examples, take a look at the eBook and Pocket Guide in our shop!
Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.