Therapeutic Diet

Manual
DIRECTIVE #4311

NYS Department of Correctional and Community Supervision

NYS DOCCS Therapeutic Diet Manual – February 2021 OFFICE OF NUTRITIONAL SERVICES Page 1
February 2021
 NEW YORK STATE
DEPARTMENT OF CORRECTIONS AND COMMUNITY SUPERVISION
OFFICE OF NUTRITIONAL SERVICES
DIRECTIVE #4311

PURPOSE

Directive #4311, “Therapeutic Diet Manual,” establishes this manual as the prevailing
document in the provision of therapeutic diets within the New York State Department of
Correctional and Community Supervision. The Department provides therapeutic diets upon
written request by an approved health care provider. The purpose of the Therapeutic Diet
Manual is to:

• establish and promulgate the administrative and operation procedures

governing the provision of therapeutic diets;

• provide guidance and direction to the health care providers and food
service personnel in requesting and providing therapeutic diets.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 1

 TABLE OF CONTENTS

Page #

POLICIES AND PROCEDURES

Nutrition Professional Staff ………………………………………………................. 3
Therapeutic Diet Requests ...………………………………………………………… 4
Algorithm for Processing Therapeutic Diet Requests ……………………………... 5
Therapeutic Diet Request Review and Renewal …………………………………... 6
Therapeutic Diet Meal Attendance …………………………………………………... 7
Therapeutic Diet Change or Cancellation …………………………………………... 8
NYS DOCCS’ Statewide Menus ……………………………………………………... 9
Therapeutic Diet Summary …………………………………………………………… 10

THERAPEUTIC DIETS:

MODIFIED TEXTURE / CONSISTENCY

Clear Liquid ……………………………………………………………………………... 11
Full Liquid ………………………………………………………………………………. 12
Soft ……………………………………………………………………………............... 13

MODIFIED CONTENT (CONTROLLED A / B DIETS)

Enhanced Fiber ………………………………………………………………………… 14
Restricted Fat / Low Cholesterol ……………………………………………………… 15
Restricted Sodium ....…………………………………………………………...……… 16
Gastro-Esophageal Reflux Disease (GERD)………………………………………... 17
Pregnancy and Lactation ……………………………………………………………… 18
Diet for Infants Nine Months of Age and Older ……………………………………... 19
Food List for Infants Nine Months and Older ………………………………………... 20
Limited Carbohydrates………….……………………………………………………… 21

MODIFIED CONTENT (PRO 1, 2 & 3 DIETS)

Controlled Protein ……………………………………………………………………… 22

OTHER CONSIDERATIONS
Food Allergies, Intolerances & Aversions...…………………………………………. 23
Gluten-Free Diet ………………………………………………………………………... 24
Lactose Intolerance vs. Milk Allergy…………………………………………………... 25
Medical Nutrition Supplements, Diet Education Materials, References…………... 26

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 2

 PROFESSIONAL NUTRITION STAFF

The New York State Department of Corrections and Community Supervision employs a
Nutritional Services Administrator 2, Nutritional Services Administrator 1 items, dietitians and
dietitian technicians to provide professional skills in the delivery of nutritional care to the prison
population.

Nutritional Services Administrator 2 (NSA2)

Under the general direction of the Director of Nutritional Services, the NSA2 is
responsible for managing the clinical dietary component of Nutritional Services
through training and educating staff, maintaining the nutrient analysis program
for all ingredients, recipes and menus, menus revisions for healthier options,
review and approve new vendor products. The NSA2 also provides administrative
support to the director, assisting in policy and directive revisions.

Nutritional Services Administrator 1 (NSA1) / regional dietitians:

Under the general direction of the NSA2, the regional dietitian is responsible for
the Central Office monitoring and administration of therapeutic diet programs in
the assigned region. The regional dietitian functions as a liaison between Food
Service and Health Services at the facility level. Regular site visits are conducted,
and outcomes are addressed with facility administrators. The regional dietitian
assists with statewide nutrition policy and procedure development, diet manual
revision and other administrative tasks. The regional dietitian also oversees
medical nutrition therapy at the regional medical units (RMU) at Bedford Hills,
Fishkill and Wende Correctional Facilities, as well as Walsh at Mohawk
Correctional Facility.

Dietitians / Dietitian Technicians:

Under the direction of the NSA1, the dietitians and the dietitian technicians are
the on-site nutrition support personnel for the regional medical units. These
positions provide administrative support to the NSA1, monitor diet meal tray
accuracy and train food service staff in basic therapeutic diet requirements.

Consultant Dietitians:

Medical Nutrition Therapy is provided to the Department of Correctional and

Community Supervision dialysis units and Coxsackie RMU by consultant
dietitians on a contractual basis.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 3

 THERAPEUTIC DIET REQUESTS

POLICY

Therapeutic diets are provided with a written prescription by an authorized health care provider
in accordance with the following procedure.

PROCEDURE
1. Therapeutic diets (including allergy diets) shall be prescribed by an authorized health
care provider. For the purpose of this manual an authorized health care provider is
defined as a physician, dentist, physician’s assistant, nurse practitioner, registered
dietitian.

2. The Therapeutic Diet Request Form and Attendance Agreement, form #3273 is the
communication tool used to request the prescribed therapeutic diet (including allergy
diets) from the food service department and to apprise the incarcerated patient of the
mandatory meal attendance policy.

• The Therapeutic Diet Request Form and Attendance Agreement comprise one
document and may be ordered from the Elmira Correctional Facility Industries’
print shop, Form #3273.
• The form must be completed in full and legibly signed by an authorized health
care provider, the incarcerated individual, and a witness.
• The original remains in the incarcerated individual’s health record under
“miscellaneous” (or in the RMU the “Dietary” section.)
• The duplicate is forwarded to the food service supervisor.

3. The prescribed therapeutic diet shall be appropriate for the documented diagnosis in the
incarcerated individual’s health record.

4. The diets listed on the therapeutic diet request form are routinely available from the food
service department. Requests for diets that are not listed on this form require the prior
approval of a regional dietitian (including food allergies). Diet requests that are not in
compliance will be returned to the health care provider.

5. Incarcerated individual requests for religious diets/foods shall not be prescribed

by the health care provider. For additional information regarding policy on religious
food requests see Directive #4202, “Religious Programs & Practices,” and Directive
#4310, “Food Services Operations Manual.”

6. The food service department will begin the diet by the noon meal of the day after receipt
of the completed and signed diet request form.

7. Diet requests of an urgent nature and called to the food service department will be
initiated as soon as possible. The telephone request must be followed by a signed diet
request form within 72 hours.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 4

 ALGORITHM FOR PROCESSING THERAPEUTIC DIET REQUESTS
IN THE GENERAL POPULATION SETTING

STANDARD NON-STANDARD
(Requests for only (Any write-in diet on
the diets listed on Form 3273)
Form 3273)

Health Services staff to contact

the regional dietitian to determine
if the requested non-standard diet
order is available.

Available
The regional dietitian will send a
non-standard
written response to Health
requests
Services and instructions to Food
Service

Review the attendance

agreement with the
incarcerated individual.
Have incarcerated
Non-Standard diet requests that
individual sign it and
are not available - no
staff witness/sign it.
communication to food service
necessary

File original in the

miscellaneous section of
the medical record
(Dietary section in RMU)

SEND YELLOW COPY

TO FOOD SERVICE

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 5

 THERAPEUTIC DIET REQUEST REVIEW AND RENEWAL

POLICY

Requests for therapeutic diets shall be reviewed and approved as current at least monthly by
an authorized health care provider.

PROCEDURE

1. A current list of the therapeutic diet requests shall be maintained by food service.

2. Adjustments to the food service diet list are made based on the following criteria:

• new or changed diet requests received.

• diet cancellation by the health care provider received.
• transfer, parole, or death of the incarcerated individual.

3. At least monthly an authorized health care provider shall review and sign the updated
therapeutic diet list. This signifies that each diet request is current and remains appropriate
for the medical condition.

The updated and signed diet list shall be returned to the food service.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 6

 THERAPEUTIC DIET MEAL ATTENDANCE

POLICY

Meal attendance is mandatory for incarcerated individuals receiving a therapeutic diet.

PROCEDURE
1. An authorized health care provider prescribes a therapeutic diet using the Therapeutic
Diet Request Form and Attendance Agreement, Form 3273.

2. The incarcerated individual shall sign the attendance agreement portion of the
Therapeutic Diet Request Form and Attendance Agreement that documents
understanding of the meal attendance requirement and intention to comply. The meal
attendance agreement is obtained by the health care provider at the time the therapeutic
diet is prescribed.

3. The food service supervisor shall develop a therapeutic diet tracking form for recording
attendance at mealtime. The forms must be reviewed weekly by the food service
supervisor for compliance. These forms must be kept for three years. The attendance
form shall contain the following information:
• Name
• DIN
• Date of monitoring period
• Signature or initials of person recording attendance for each meal
• Grid for checking each meal for 7 days.

4. Missing greater than three (3) diet meals per week is a violation of the attendance policy.
After verifying the attendance record, the food service supervisor shall advise facility
health services in writing of the attendance violation. Food service or security staff may
take disciplinary action.

5. Upon notification of violation of the attendance policy, the health care provider may:
counsel the incarcerated individual or cancel the diet. Discontinuance of the therapeutic
meals by a health care provider due to non-compliance shall be documented in the
medical record.

6. Sharing / swapping of food is a violation of the therapeutic diet attendance policy.

7. An incarcerated individual may request to be placed back on the therapeutic diet meals
program through the facility’s sick call procedure. A new Therapeutic Diet Request Form
and Attendance Agreement must be completed, signed and sent to food service. A
pattern of multiple violations of the attendance policy will result in disciplinary action.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 7

 THERAPEUTIC DIET CHANGE OR CANCELLATION

POLICY

Therapeutic diet requests may be changed or canceled.

PROCEDURE

1. A therapeutic diet request is changed when a medical condition changes or a new

diagnosis is made.

A. The health care provider shall advise the incarcerated individual that a diet change
is indicated. This interaction is documented in the medical record.

B. A new Therapeutic Diet Request Form and Attendance Agreement, Form 3273, shall
be completed and sent to the food service supervisor. The new diet request should
reflect the complete diet prescription, not just the “changed” portion. The most recent
diet request form supersedes all others.

2. A therapeutic diet request is canceled under the following circumstances:

A. An incarcerated individual may refuse participation in the therapeutic diet program.

The health care provider shall advise the incarcerated individual of the negative
health consequences that may result from diet non-compliance. To adequately
document the interaction a Refusal of Medical Examination and/or Treatment Form,
form 3195, shall be completed. A Therapeutic Diet Request and Attendance
Agreement form marked “diet cancellation” shall be completed, signed by an
authorized health care provider and sent to the food service supervisor. The
incarcerated individual’s signature is not required.

B. A therapeutic diet is no longer indicated due to a change in medical condition;

supporting documentation must be in the medical record. A Therapeutic Diet
Request and Attendance Agreement form marked “diet cancellation” shall be
completed, signed by an authorized health care provider and sent to the food service
supervisor. The incarcerated individual’s signature is not required.

C. If the incarcerated individual fails to comply with the signed therapeutic diet
attendance agreement, participation in the diet meals program may be canceled by
a health care provider. A Therapeutic Diet Request Form and Attendance Agreement
marked “diet cancellation” shall be completed, signed by an authorized health care
provider and sent to the food service supervisor. The incarcerated individual’s
signature is not required.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 8

 NYS DOCCS STATEWIDE MENUS

DISCUSSION

The menus are designed to maintain or improve the nutritional health of incarcerated
individuals while incarcerated.

1. The General Confinement Menu is a cycle menu and is revised as needed. This menu
offers an average of 2,800 calories and 90 grams protein per day.

2. The Adolescent Menu is a cycle menu and is revised as needed. This menu offers an
average of 3,000 calories and 110 grams protein.

3. The Shock Incarceration Menu is a cycle menu and is revised as needed. This menu
offers an average of 3,800 calories and 125 grams protein.

4. Modified Menus are prepared according to the diet requested. The therapeutic diets
are patterned after the general confinement menu, utilizing as many of the same food
items as possible. Food items are changed when necessary for therapeutic or
production purposes. The Modified Menu is organized into menu categories entitled
Controlled A & B, PRO 1A & B, PRO 2A & B, and PRO 3A & B.

5. “Double portions” of food is not considered a therapeutic diet and is not available. Refer
to the Health Services Policy #1.46 on medical nutrition supplements for additional
calories and protein between meals. Contact the regional dietitian for assistance with
determining calorie and protein needs.

6. Religious Menus are developed jointly by the Office of Nutritional Services and the
Division of Ministerial, Family and Volunteer Services. Incarcerated individual requests
for religious diets should be directed to the facility’s ministerial services. The
Therapeutic Diet Request Form and Attendance Agreement (#3273) is not used to order
religious diets. To maintain religious integrity, Religious Menus must be strictly
followed. A request for the combination of a therapeutic and religious diet is addressed
by Central Office Nutritional Services to assure the needs in both areas are reasonably
accommodated.

Alternative and Religious Menus are also discussed in Directive #4202 and Directive
#4310.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 9

 THERAPEUTIC DIET SUMMARY

MODIFIED TEXTURE / CONSISTENCY:

Clear Liquid: Fluids and foods that are clear liquid at body temperature
- Pre-op or diagnostic GI procedures, post-op for gradual transition to a normal diet,
provide rest to GI tract (nausea, vomiting or inflammatory diseases of GI tract)
- An expiration date must be included with the diet request
Full Liquid: Nutrient dense liquids or semi-liquids at room temperature
- Acute illness, in transition to solids, chewing significantly impaired
- An expiration date must be included with the diet request
Soft: Moist texture, easy to chew and swallow
- Sore mouth, dental problems, impaired GI tract, dysphagia
- An expiration date must be included with the diet request
Pureed diets are available at RMUs only, consult the regional dietitian
MODIFIED CONTENT:
Controlled A: Enhanced fiber, restricted sodium / fat / cholesterol
- Approximately 2,300 calories, 2,400 mg sodium, 215 mg cholesterol, 33 g dietary fiber
- Constipation, cardiovascular disease, hypertension, gastroesophageal reflux
Controlled B: Same as Controlled A plus limited carbohydrates
- Approximately 2,200 calories
- Constipation, cardiovascular disease, hypertension, gastroesophageal reflux and
blood glucose control

Pro 1A: Restricted protein and sodium

- Approximately 2,100 calories, 65 g protein, <2,400 mg sodium
- Short term treatment of symptomatic encephalopathy
Pro 2A: Restricted protein, sodium, potassium, and phosphorus
- Approximately 2,100 calories, 68 g protein, <2,400 mg sodium, <3,000 mg potassium,
<1,000 mg phosphorus
- Acute Renal Failure, End Stage Renal Failure (ESRF), Nephrotic Syndrome
Pro 3A: Moderate protein, reduced sodium/potassium/phosphorus
- Approximately 2,250 calories, 91 g protein, <2,400 mg sodium, <4,000 mg potassium,
<1,000 mg phosphorus
- End stage renal disease and receiving hemodialysis or peritoneal dialysis

Protein controlled diets with comorbidity of blood glucose imbalance order the ‘B’ version
for limited carbohydrates. These diets offer an option for an evening snack.

FOOD ALLERGIES:
Confirmed food allergies require consultation with the regional dietitian in order for the proper
meal plan to be arranged with food service.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 10

 CLEAR LIQUID DIET

OBJECTIVE

✓ The objective of the diet is to provide very low residue liquids that are easily absorbed
by the gastrointestinal tract.

DISCUSSION

The clear liquid diet consists of fluids and foods that are clear liquid at body temperature. This
diet can be used for: pre-operative or diagnostic procedures of the bowel and colon, post-
operatively and to provide comfort and/or rest to the gastrointestinal tract for disturbances, such
as nausea, vomiting or inflammatory diseases of the bowel. Because of the high sugar content,
a clear liquid diet is not recommended for treatment of diarrhea.

All clear liquid diet requests must have an expiration date. The meal plan for the clear
liquid diet is nutritionally inadequate and should not be prescribed for longer than three days
without adding a nutrition supplement. Consult with the regional dietitian for information
regarding medical nutrition supplements formulated for clear liquid diets.

DIETARY PROVISIONS/PREPARATION INFORMATION

1. Foods may not contain any particles or pulp.

2. Allow water, tea, black coffee, apple juice, grape juice, fruit-flavored beverages, bouillon,
plain gelatin desserts, frozen juice bars and sugar are allowed.
3. At least two quarts (or eight cups) of clear liquid should be given daily.

Milk and dairy products are NOT clear liquids and may not be given.

NOTE: Some diagnostic procedures require caffeine restrictions. Other procedures restrict
red and purple liquids such as cranberry and grape juice, gelatin or frozen juice bars.
Nutritional Services’ personnel should make appropriate substitutions when advised by the
regional dietitian or health services personnel.

SAMPLE CLEAR LIQUID MENU:

BREAKFAST: LUNCH AND DINNER:

2 – 4oz Apple Juice 2 - 4oz Apple Juice
1 – 8oz Broth, prepared 1 – 8oz Bouillon, prepared
1 cup Flavored Gelatin 1 cup Flavored Gelatin
1 Frozen Juice Bar, if available 1 – 8oz Fruit-flavored beverage
1 – 8oz Coffee 1 – Frozen Juice Bar
2 Sugar packets 1 Tea bag and 8oz hot water
2 Sugar packets

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 11

 FULL LIQUID DIET

OBJECTIVE

✓ The objective of the diet is to provide nutrient dense liquids for individuals who cannot
tolerate solid food.

DISCUSSION

The full liquid diet consists of foods that are liquid or semi-liquid at room temperature. This diet
is indicated when solid food is not tolerated during acute illness or when chewing ability is
impaired. The meal plan for the full liquid diet is nutritionally inadequate and should not be
prescribed for longer than five days without adding a medical nutrition supplement. Consult
with the regional dietitian as to the most appropriate formula. This diet request must have an
expiration date.

DIETARY PROVISIONS/PREPARATION INFORMATION

1. At least two quarts (eight cups) of liquid should be given daily.

2. Allow all foods from the clear liquid diet.
3. Also allow milk, milk drinks, plain puddings, plain ice cream, sherbet, frozen juice bar,
yogurt, prepared bouillon.

SAMPLE FULL LIQUID MEALS:

BREAKFAST: LUNCH AND DINNER:

2 – 4oz Apple Juice 2 – 4oz Apple Juice
1 – 8oz Bouillon, prepared 1 – 8oz Bouillon, prepared
1 – ½ cup Flavored Gelatin 1 – ½ cup Flavored Gelatin
1 – 4oz Yogurt, no fruit 1 – ½ cup Pudding, chocolate or vanilla
2 – 8oz White Milk 1 – ½ cup Ice Cream, Sherbet or 1 Frozen Juice Bar
1 – 8oz Coffee 2 – 8oz White Milk
2 Sugar packets 1 Tea Bag and 8 oz. hot water
2 Sugar packets

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 12

 SOFT DIET

OBJECTIVE

✓ The objective of the diet is to provide foods of a moist texture that are easy to chew and
swallow.

DISCUSSION

This diet is indicated for individuals with sore mouth, dental problems, impaired gastrointestinal
tract, or dysphagia. This diet is often needed for short periods of time; therefore, an expiration
date is required with the diet request.

DIETARY PROVISIONS/PREPARATION INFORMATION

Either the general or modified menu can be used for soft diets with the following changes:

BREAKAST: No fresh fruit except bananas, no bagels or toast.

LUNCH & DINNER:

ENTREES: Grind all hot meats (or chop very fine), remove casing from sausage / hot dogs.
Substitute items that cannot be ground (breaded fish, burrito, Jamaican beef patty, pizza
& grilled cheese.)

STARCHES: No potato skins, potato salad or macaroni salad.

VEGETABLES: No raw vegetables.

BREADS: All are allowed.

DESSERTS/FRUIT: No fresh fruit except bananas, no cookies.

CONDIMENTS: All are allowed.

BEVERAGES: All are allowed.

Provide substitutions with foods allowed. Be sure meats are kept moist.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 13

 ENHANCED FIBER DIET

OBJECTIVE

✓ The objective of the Enhanced Fiber diet is to increase the size and bulk of the stool in
order to promote normal laxation in the individual.

DISCUSSION

This diet is generally used in the prevention and/or treatment of constipation and non-
inflammatory diseases of the colon such as diverticulosis and spastic colon.

Research has also shown a positive relationship between dietary fiber and weight control,
stabilization of blood sugar in individuals with prediabetes and diabetes mellitus.

DIETARY PROVISIONS/PREPARATION INFORMATION

An enhanced fiber diet is obtained by requesting a Controlled A diet.

The Controlled A Menu offers an average of approximately 33 grams dietary fiber per day.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 14

 RESTRICTED FAT / CHOLESTEROL DIET

OBJECTIVE

✓ The objective of the diet is to limit foods that are high in saturated fats, trans fats and
cholesterol in order to improve lipid profiles in those with cardiovascular disease.

DISCUSSION

A diet low in saturated fats, trans fats and cholesterol is recommended for treatment of
cardiovascular disease. A diet low in total fats is commonly used for disorders of the pancreas,
gall bladder, liver and gastrointestinal tract.

DIETARY PROVISIONS/PREPARATION INFORMATION

A restricted fat / cholesterol meal plan is obtained by requesting a Controlled A diet. This
meal plan consists of plainly prepared foods, 1% milk, baked fish, meat and poultry, whole
grains, vegetables, fruits and limited fat-containing condiments.

The Controlled A Menu offers an average of approximately 215 mg cholesterol per day, less
than 30% calories from fat, less than 10% calories from saturated fat and no added trans-fats.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 15

 RESTRICTED SODIUM DIET

OBJECTIVE

✓ The objective of the diet is to limit sodium intake.

DISCUSSION

Sodium is critical for maintenance of fluid balance, transmission of nerve impulses and muscle
contraction. Sodium may need to be restricted to treat hypertension, cardiovascular disease,
heart failure, kidney disease or for disorders of fluid imbalance.

DIETARY PROVISIONS/PREPARATION INFORMATION

A sodium restricted meal plan is obtained by requesting a Controlled A diet. This meal plan
consists of plainly prepared and minimally processed foods.

The Controlled A Menu offers an average of less than 2,400 mg sodium per day.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 16

 GASTROESOPHAGEAL REFLUX DISEASE (GERD)

OBJECTIVE

✓ The objective of the diet is to reduce and/or prevent symptoms associated with gastro-
esophageal reflux, or heartburn.

DISCUSSION

GERD is a condition whereby stomach acid leaks back into the lower esophagus, causing pain,
irritation and/or inflammation of the lining of the esophagus. Over time, this can narrow and/or
erode the esophagus and produce bleeding, difficulty in swallowing and increased risk for
esophageal cancer.

DIETARY PROVISION/PREPARATION INFORMATION

It is recommended that individuals with GERD be placed on the Controlled A diet. This meal
plan includes many plainly prepared lower fat foods with minimal use of spices.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 17

 PREGNANCY AND LACTATION DIET

OBJECTIVE
✓ The objective of the diet during pregnancy is to provide the growing fetus nutrients
needed for optimal growth and development.
✓ The objective of the diet for lactating mothers is to continue to nourish the infant with
ample milk for growth outside the womb.

DISCUSSION
1. Nutritional Needs of the Pregnant Woman:
• Energy: an additional 340 calories are needed during the second trimester and an extra
450 calories are needed during the third trimester.
• Protein: 71 grams of protein per day are needed throughout pregnancy.
• Carbohydrate: at least 175 grams of carbohydrate per day are needed to spare protein
from energy use and to prevent ketone formation that may damage the fetal brain.
• Fat: a moderate fat intake is recommended with emphasis on unsaturated fatty acids to
optimize fetal brain growth.
• Vitamins and Minerals: In addition to vitamins and minerals found in food, a pre-natal
supplement is offered to the pregnant women through health services.
• Dietary Fiber: Increased intake of high fiber foods, such as, vegetables, fruits and whole
grains to help prevent constipation.
• Fluids: Increased fluid intake (2-3 quarts/day) is important to aid with constipation.
• Calcium: Adequate calcium is needed for pregnant women and baby’s bones. Calcium
is found in milk (preferable low fat), yogurt and cheese.

2. Weight Gain During Pregnancy: Regardless of the current weight status of the pregnant
woman, some weight gain is advised. The following guidelines provide approximate weight
gain recommendations for pregnant women based on pre-pregnancy BMI:
• Underweight: (BMI <18.5) – 28-40 lbs.
• Healthy Weight: (BMI 18.5-24.9) – 25-35 lbs.
• Overweight: (BMI 22-29.9) – 15-25 lbs.
• Obese: (BMI >30) – 11-20 lbs.
Most weight gain should occur in the second and early third trimester (18-30 weeks). Too
much weight gain is not good for the baby.

3. Nutritional Needs of the Lactating Woman: The types and amounts of foods given during
pregnancy more than meet the caloric and nutrient needs of the lactating woman. The
Pregnancy/Lactation diet will be maintained as long as the mother is breast-feeding.

DIETARY PROVISIONS/PREPARATION INFORMATION

A meal plan for pregnancy/lactation is obtained by requesting a Controlled A diet and indicating
it is for pregnancy/lactation. An evening snack will automatically be added and substitutions
made for processed meat (bologna, salami, ham, turkey.) This meal plan provides an average
of 2,500 calories and 125 grams protein per day.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 18

 DIET FOR INFANTS NINE MONTHS OF AGE AND OLDER

OBJECTIVE

✓ The objective of the diet is to provide infants who reside within DOCCS developmentally
appropriate and nutrient dense foods that meet their nutritional and caloric needs.

DISCUSSION

Infants from birth to 4-6 months are generally fed breast milk, formula, or a combination of
the two. By about four months of age, most infants are introduced to solid foods – cereal first,
followed by fruits, vegetables, lean meats and soft grains.

The foods given during this transition stage (in addition to breast milk and/or formula) are age-
appropriate baby foods specially purchased through the nursery. However, by the time the
infant reaches nine months of age, he/she is generally ready for table food - food that is plainly
prepared, cut up and fed to the infant or picked up by the infant for self-feeding.

The meals that these older infants receive from food service provide developmentally
appropriate food items either as the sole source of nutrition or as an adjunct to the food that
the incarcerated individual mother provides. Thus, it consists of soft foods from all of the above
food groups that can be easily chewed and swallowed.

DIETARY PROVISIONS/PREPARATION INFORMATION

The foods that are provided to the infants over nine months of age are outlined on the following
page. The meals, as served, more than meet the energy and nutrient requirements of this age
group.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 19

 FOOD LIST FOR INFANTS NINE MONTHS OF AGE AND OLDER

Follow the Controlled A menu and further eliminate inappropriate foods underlined below,
(substitutions are in parenthesis.)

Diet Kidney Bean Entrée, Turkey Chow Mein, Turkey Ala King, Spicy Chicken Fiesta -
(steamed mashed kidney beans; ground or finely chopped: diced turkey, turkey patty, diet
beef patty or diced beef)
Chicken Leg drumsticks - (take meat off the bone, and grind or finely chop)
Diet Tuna Salad, Turkey Salami, Turkey Bologna - (HC Egg or plain tuna, no mayo)
Pizza - (1 slice of whole wheat bread and 1 slice of cheese)
Steamed White Rice - (elbow macaroni, chopped spaghetti or mashed potatoes)
Diet Potato Salad/Diet Macaroni Salad - (plain steamed potatoes/ plain steamed macaroni)
FPC Coleslaw, Diet Bean Salads, Tossed Salad, Carrot/Celery sticks, Beets - (any plain
steamed vegetable, except corn)
Corn or Mixed Vegetables - (any other plain steamed vegetable)
Whole Grain Bagel, Waffle - (1 slice of whole wheat bread)
Fresh Apple/Orange - (banana or canned fruit)

______________________________________________________________________

SAMPLE ONE DAY MENU

Follow the portion sizes below and use as a guide when making meals.

• Breakfast: ½ cup hot or cold cereal; 1 slice whole wheat bread/1 pancake w/1 pc syrup
/1French toast w/ 1 pc syrup; 1 pat margarine; ½ cup cut up canned fruit or 1 ripe banana
as available, 1/2c scrambled or 1 HC egg when on menu. 8oz whole milk for children 1
year and older.

• Lunch & Dinner: 2 oz. entrée; ½ cup elbow macaroni, chopped spaghetti or potato; ½
cup allowed vegetable; 1 slice whole wheat bread; 1 pat margarine; ½ cup cut up canned
fruit. Vary the entrée, starch, vegetable, and fruit from meal to meal. 8oz whole milk for
children 1 year and older.

• Snacks allowed: banana, canned fruit, yogurt, depending on availability.

Children younger than 12 months: receive the following prepared and provided by the
nursery staff: breastmilk or formula at meals and iron-fortified infant cereal at breakfast.
Children 1 year of age and older: receive the following prepared and provided by food
service; iron-fortified adult cereal per menu, and whole milk at meals.

NYS DOCCS Therapeutic Diet Manual – Revised October 2020 Page 20

 LIMITED CARBOHYDRATES DIET

OBJECTIVE

✓ The objective of the diet is to promote optimal blood glucose control.

DISCUSSION

Limiting carbohydrates is an essential component of the successful management of

prediabetes, gestational diabetes, diabetes mellitus or insulin and blood glucose imbalances.
Adherence to the diet is meant to avoid, delay, or minimize complications associated with poor
blood glucose control.

Type 1 Diabetes Mellitus: requires insulin therapy due to the body’s inability to produce
insulin. The dosage and type of insulin used, and the timing of the meals and snacks must be
coordinated. Meals (and snacks when necessary) should contain a consistent amount of
carbohydrate. Blood glucose levels should be monitored regularly, and insulin dosages
adjusted for the amount of carbohydrate eaten along with the level of exercise activity.

Type 2 Diabetes Mellitus: usually does not require insulin therapy. Typically, diet,
exercise and oral hypoglycemic agents are used to achieve blood glucose control. Insulin
therapy may become necessary. Consistency in mealtimes and carbohydrate content of meals
is important to minimize blood glucose fluctuations.

Insulin pump treatment: consult the regional dietitian for information on carbohydrate counting.

DIETARY PROVISIONS/PREPARATION INFORMATION

A diet limited in carbohydrates is obtained by requesting a Controlled B diet. The Controlled

B Menu offers an average of approximately 2,200 calories per day with approximately 55% of
the calories as carbohydrates. The addition of an evening snack may be prescribed separately
and should be determined on an individual basis.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 21

 CONTROLLED PROTEIN DIETS

OBJECTIVE

✓ The objective of the controlled protein diet is to decrease the waste produced by protein
metabolism.

DISCUSSION

There are three levels of protein-controlled diets offered, depending on the nature of the
disease and the level of restriction needed.

1. Pro 1 (restricted protein and sodium): used as short-term treatment for symptomatic
hepatic encephalopathy. An expiration date must be included with the diet request.

Protein restriction and liver disease: Studies show that protein-restricted diets can result
in the breakdown of endogenous protein in the patient with advanced liver disease. Most
patients with advanced liver disease can tolerate up to 1.5 g protein/kg body weight/day
and fare well on a restricted sodium diet using the Controlled A diet without any other dietary
restriction.

2. Pro 2 (restricted protein, sodium, potassium, and phosphorus): used to treat

individuals with acute renal failure, nephrotic syndrome, or End Stage Renal Disease
(ESRD).

3. Pro 3 (moderate protein, restricted sodium, potassium, phosphorus): used to treat

individuals with ESRD who are currently receiving hemodialysis or peritoneal dialysis.

DIETARY PROVISIONS/PREPARATION INFORMATION

A controlled protein diet is obtained by requesting one of the following diets:

• Pro 1A - offers approximately 2,100 calories, 65 g protein and <2,400 mg sodium.

• Pro 2A - offers approximately 2,100 calories, 68 g protein, and <2,400 mg sodium,

<3,000 mg potassium, and <1,000 mg phosphorus.

• Pro 3A - offers approximately 2,250 calories, 91 g protein, <2,400 mg sodium, <4,000

mg potassium and <1,000 mg phosphorus.

The Pro 1B, Pro 2B or Pro 3B diet plans are used when there is also a need to limit
carbohydrates. These diets include the option of adding an evening snack.

Consult the regional dietitian for assistance in selecting the appropriate diet or if a fluid
restriction is required.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 22

 FOOD ALLERGIES, INTOLERENCES AND AVERSIONS

OBJECTIVE

✓ The objective of the diet is to eliminate the specific food that causes an allergic reaction.

DISCUSSION

Food allergy is an abnormal reaction to a specific food by the body’s immune system. When
an offending food is eaten, the immune system produces the antibody Immunoglobin E (IgE).
Subsequent allergic reactions can range from mild to life threatening. The current treatment for
food allergy is complete avoidance of the offending food. Avoiding foods over time can result
in one or more nutrient deficiencies, therefore, it is important to confirm an allegation of food
allergy before eliminating foods from the diet permanently.

The following foods are either common allergens or are widely incorporated into the general
confinement menu: fish (cod, tuna), tomatoes, onions, corn, milk/dairy, wheat/gluten, soy, eggs
and peanuts. It is recommended that claims of allergy to any of these foods be verified by
immunoassay testing for IgE. Results indicating ‘below detectable limits’ or ‘absent’ do not
warrant dietary intervention; results greater are accepted as positive.

IgG testing is not approved by the FDA (Food & Drug Administration) for diagnosing food
allergies. Testing food group mixes with a positive result requires retesting of individual foods
to determine which food caused the reaction. For this reason, it is recommended that individual
suspected foods be tested and not food groups.

When dietary changes are needed, a Therapeutic Diet Request Form and Attendance
Agreement, form 3273, is to be completed, add the verified food allergy, then email the regional
dietitian who will coordinate the meal plan with food service staff. If symptoms continue after
accepting the allergy diet, contact the regional dietitian for consultation.

Food intolerance is often confused with a food allergy because it can have similar symptoms.
Food intolerance does not involve the immune system. The symptoms of food intolerance may
cause the individual to feel ill but are rarely dangerous or life threatening. It is important to
distinguish between food intolerance and allergy to prevent the unnecessary omission of a
food.

Food aversion is a strong dislike for a particular food.

DIETARY PROVISIONS/PREPARATION INFORMATION

Upon receipt of a completed Therapeutic Diet Request Form and Attendance Agreement (Form
#3273) indicating an allergy to one or more of the common food allergens, food service will
eliminate the offending foods with modifications made to the meal plan as necessary.

Substitutions are not made based on food intolerances or aversions.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 23

 GLUTEN-FREE DIET

OBJECTIVE

✓ The objective of the diet is to eliminate gluten, a protein found primarily in wheat, rye,
and barley. While oats do not contain gluten, they are eliminated from the diet due to
the high risk of contamination with gluten during processing.

DISCUSSION

A gluten-free diet is used in the treatment of celiac disease, gluten-sensitive enteropathy, or

dermatitis herpetiformis.

When ingested, gluten causes an immunologic reaction in the body resulting in damage to the
cells lining the walls of the small intestine. Intestinal villi are destroyed, leading to mal
absorption of nutrients, severe abdominal pain, diarrhea, constipation and/or weight loss.
Celiac disease is a lifelong condition and the only treatment is total abstinence from gluten
containing foods. Until a diagnosis is made, gluten should not be restricted, as it will likely cause
inaccurate test results.

In newly diagnosed celiac disease, a person may have trouble digesting certain foods until the
small intestine heals and absorption of nutrients returns to normal. Thus, lactose intolerance
and/or fat malabsorption may occur, necessitating further, at least temporarily, dietary
modification.

DIETARY PROVISIONS/PREPARATION INFORMATION

A gluten-free diet is obtained by adding ‘gluten-free’ on the Therapeutic Diet Request Form and
Attendance Agreement and contacting the regional dietitian.

This diet includes foods that are plainly prepared so offending foods containing wheat, barley,
rye and oats can be easily identified and eliminated. The diet may include foods that do not
occur on other DOCCS’ menus, therefore, food service will need to procure these items through
the prime source vendor.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 24

 LACTOSE INTOLERANCE vs. MILK ALLERGY

OBJECTIVE

✓ The objective for individuals with lactose intolerance is to avoid the most common
sources of lactose in the diet to alleviate symptoms associated with this intolerance.
✓ Milk allergy is less common and requires avoidance of all dairy sources. See the section
on Food Allergies for further discussion.

DISCUSSION

Lactose intolerance is an inability of the body to digest lactose, a carbohydrate found in milk
and, to a lesser extent, milk products. This intolerance to milk should not be confused with milk
allergy, which is an immune reaction to milk protein. Common symptoms of lactose intolerance
include bloating, gas, abdominal pain, diarrhea and/or nausea. The most common sources of
lactose are milk and milk products. There may also be small amounts of lactose in processed
foods.

Individuals who have been diagnosed with lactose intolerance do not necessarily have to avoid
lactose-containing foods entirely. It may be possible to enjoy such foods by following some
simple guidelines:

1. Start with small portions of milk to allow however much lactase the body makes, act on
the lactose in the milk.
2. Slowly increase the amount of milk in the diet over time until symptoms occur; the limit
of lactose in the diet has been reached.
3. Consume milk with other food, not on an empty stomach.
4. Cheese and yogurt may be a little easier to tolerate since most of the lactose is either
removed or fermented.
5. Use lactase chewable tablets along with milk and dairy products to help digest the
lactose and help avoid symptoms of intolerance.

NOTE: If milk allergy or severe lactose intolerance requires avoidance of all forms of dairy,
then calcium and vitamin D supplementation is recommended in the range of 800–1000 mg
calcium and 200–400 IU vitamin D. Contact the regional dietitian for assistance with estimating
calcium and vitamin D needs.

DIETARY PROVISIONS/PREPARATION INFORMATION

For lactose intolerance, there is no lactose-free diet. Individuals can avoid foods or quantities
they find difficult to tolerate.

For milk protein allergy, see section on food allergies.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 25

 MEDICAL NUTRITIONAL SUPPLEMENTS

DISCUSSION

Health Services Policy #1.46 outlines the procedure and criteria for ordering a nutritional
supplement.

Consult the regional dietitian, as needed, for assessing the need for a nutritional supplement
or recommending an appropriate product or dose.

DIET EDUCATION

Diet educational materials will be supplied by the regional dietitian, periodically or upon
request, in order for materials to be current.

REFERENCES

Academy of Nutrition and Dietetics. Nutrition Care Manual.

http://www.nutritioncaremanual.org. Accessed April 6, 2018.

Medical Nutrition & Disease “A Case Based Approach,” 5th Edition.

Edited by Lisa Hark, PhD, RD, Darwin Deen, MD, MS and Gail Morrison, MD.
Chapter 3, Nutrition in Pregnancy and Lactation,” by Elizabeth Horvitz West, Lisa Hark
And Darwin Deen.

When, What, and How to Introduce Solid Foods.

https://www.cdc.gov/nutrition/infantandtoddlernutrition/foods-and-drinks/index.html.
Accessed February 2020.

Guidelines for Feeding Healthy Infants.

https://wicworks.fns.usda.gov/wicworks//WIC_Learning_Online/support/job_aids/guide.
Accessed November 2019.

Early Introduction of foods to prevent food allergy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157280/. Accessed August 2020.

NYS DOCCS Therapeutic Diet Manual – February 2021 Page 26