Where hospitals differ

Compare a dozen NHS low-fibre leaflets and a pattern appears immediately. They agree completely about the extremes. Well-cooked white starch, smooth dairy and tender meat are allowed everywhere. Skins, pips, nuts, seeds, popcorn, sweetcorn, mushrooms, celery and wholegrains are restricted everywhere. Then in the middle, on perhaps a dozen foods, they contradict each other outright.

This is not carelessness. Leaflets are written locally, for local pathways, and often for a specific problem. A sheet written for bowel obstruction and a sheet written for a high-output stoma are answering different questions, and the same food can be the right answer to one and the wrong answer to the other.

The main disagreements

Herbs and spices. St George's places dried herbs and spices in the allowed tier alongside salt and vinegar. Leeds allows dried herbs and spices at stage three of its obstruction diet but lists fresh herbs as avoid, a distinction St George's does not make. East Lancashire, whose leaflet this book follows, lists herbs and spices under foods to avoid while allowing pepper in the same document.

Cauliflower and broccoli. Allowed as well-cooked florets by St George's and by the leaflet this book follows. On Leeds's avoid list even at its least restrictive stage.

Oats. On the East Lancashire and Leeds avoid lists. Classed as medium by St George's. Recommended by Milton Keynes as a thickener for a high-output stoma. The same food, in three positions, for three different reasons.

Smooth peanut butter. One of the most consistent items across the other trusts, allowed by St George's, Oxford, Milton Keynes and Leeds, and on the avoid list of the leaflet this book follows.

Tomatoes. Everyone restricts skins and seeds. St George's names tinned deseeded tomatoes and purée as allowed. Leeds allows purée and passata but wants anything else peeled and deseeded.

Milk. Treated as unrestricted in fibre-focused leaflets, which is correct, since it contains none. Radiotherapy and LARS advice can add a separate lactose restriction on top for different reasons.

What this book does

Where the leaflet this book follows takes a position, this book takes the same one, and says in the recipe where other hospitals are more relaxed. Where the leaflet is silent, the book takes the more cautious reading and says so. Every one of these is written up on its own page, and every recipe that touches one carries a line beginning "Some hospitals".

Your dietitian knows which pathway you are on. Their answer replaces anything here.