The best thing about being forced to eat a fat-free diet for chylothorax is that it is always temporary.

The worst thing about being forced to eat a fat-free diet for chylothorax is everything else.

If you are coming to this page from a web search for “chylothorax diet,” then you already know that you — or the person you’re caring for – has a leaking thoracic duct in the chest leaking a fluid called chyle, largely made up of dietary fat. If left untreated, chyle could fill the chest cavity and make it very hard to breathe. Because thoracic ducts usually heal on their own, simply waiting for that to happen is often enough treatment. While you wait, your diet has to be fat-free.

When my 8 year old daughter had to follow this diet after cardiac surgery, we were flummoxed. So many foods have a gram of fat in them — too little to be bothersome to almost any other diet, but twice as much as was allowable for her at the time. As we had before with other difficult, medically-required restrictive diets, we dug deep and did a lot of research. Here are some tips that I hope will help others manage this crummy, unpleasant, high-stakes diet.

How to Get Full

The nice thing about fat — any fat, healthy or not — is that it contributes greatly to feelings of satiety or fullness. Without fat, many foods leave us feeling unsatisfied. Lean proteins are usually the go-to items for healthy consumption of fat, but even those aren’t on the table when you’re restricted to half-a-gram of fat or less per meal.

As a vegetarian family, we found this very challenging. In the end, the best options we found for foods that packed a filling punch were:

1. Egg whites: We used these constantly and in every possible dish we could. Because they were such a crucial part of our regular diet, we bought the pre-separated cartons of egg whites. We used them to make omelets, tamagoyaki (see below), and baked goods like meringues.
2. Lentils: Thank heavens for these tiny pearls of fat-free versatility. They were already a big part of our diet — enough that I’ve dedicated an entire post to our love affair with them.

If your family eats meat, then there are some fat-free luncheon meats, hot dogs, and even some cuts of chicken that you can still eat. You’ll need to check with your doctor to be sure.

How to Snack

It’s shocking how few packaged items labeled “fat free” are actually free of fat. Many cereals that show up on lists of “fat free products” are NOT, indeed, fat free, for example — many have .7 grams of fat per serving. Even plain popcorn, air-popped with no oil, has a gram or more of fat per serving.

Even the truly fat-free items I bought were awkward for me to feed to my little girl, since they cheerfully advertised their helpfulness in aiding weight loss. Most were labeled “diet” or “fat-busting” or “slim-inspiring” or some other set of adjectives meant for their real target market. I took care not to let my daughter see those labels whenever it was possible. The last thing I wanted to do was to turn this diet into a life-long fear of fat. In the meantime, I found a few snack items that worked well for her:

1. Quaker Rice Cakes with Winona Popcorn-Butter Spray: This was a real salvation for two trips we took to the movies during my daughter’s six-week diet. The plain, salted rice cakes crumbled into bite-size pieces and sprayed with the admittedly chemical butter-flavor spray gave her the crunch of popcorn, the flavor of fat, and the experience of munching something similar to what her friends had. It wasn’t healthy, but it was tasty.
2. All the Gummy Candy: Gummy candies like gummy bears, worms, and sour patch versions are fat free. The same goes for most store-bought “fruit snax,” those marginally-more-healthy gummy chews that so easily slide into a school lunch and make your kid feel like everyone else for a few minutes. Yes, there was dental fallout from this. It was worth it.
3. Fruit and Veggies: I washed, cut, and put in snack-size containers a ton of fruit and veggies during this time. Berries, clementines, and bananas were great, as well as sliced peppers and cucumbers. Carrots and fat-free ranch dressing (read the label to be sure) also worked well.
4. Fat Free Potato Chips: We gave these to our daughter in real moderation. They’re notorious for creating upset stomachs due to the kind of non-digestible fat replacement in them.

How to Cook Dinner

The minute I realized how awful this diet was going to be, I put the word out that I was looking for fat-free recipes as quickly as people could send them. If you have a friend who participates in Weight Watchers, that friend is your best resource. They often have a lot of recipes handy that naturally are low in fat. Remove the already-scant teaspoons of olive oil or the pats of low-fat margarine, and you have a decent base from which you can work.

• Sauté vegetables in water or broth. 
• Use lots of fresh herbs.
• Try adding salsa, mustard, pickle relish, or fat free pasta sauce. (Just read the labels first.)

Excellent options for us were soups — especially ones thickened with potato or ones seasoned with lots of spices and tomatoes. You’ll find a huge list of dinner recipes at the Little Leakers site.

Staples to Keep in Your Kitchen:

• Fat Free Cheese/Cream Cheese
• Fat Free Sour Cream
• Fat Free Mayonnaise
• Fat Free Yogurt
• Skim milk
• Egg whites (purchased in quart-size containers)
• Fruit (but not avocado)
• Vegetables
• Ronzoni Smart Taste® Pasta
• White rice
• Broth — either powder, bouillon cubes, or cans of liquid
• Fresh and dried herbs
• Salsa
• Mustard
• Fat Free Bread (look carefully — there are several brands that work)
• Quaker Lightly Salted Rice Cakes
• Snackwells® Devils Food Cookie Cakes
• Lentils
• MCT Oil. A note: this is a type of fat that is processed by your body outside the thoracic ducts. Therefore, you can use this oil for cooking if you’re on a fat-free diet. However, it must be used sparingly as it can cause some significant digestive issues. We used it to maintain moisture in baking, and it worked!

Find One Great Meal

This was the saving grace of this diet for our family: we realized that we could make vegetarian sushi. The sheets of seaweed, sushi rice, and vegetables were all fat-free. We chose lots of fresh ingredients to fill the rolls (bell peppers, cucumbers, tomatoes, scallion, spinach, sweet potato) and made tamagoyaki (a special thin, rolled omelette) with egg whites. We even made several rolls with fat-free cream cheese. This meal — labor intensive and time consuming — was worth it because it was naturally fat free and already part of our family’s regular diet. We had to make very few changes to our normal preparation.

Because of all that, we opted to make every Friday night our Sushi-Movie Night. As a family, we assembled all the ingredients and rolled out each piece together, then settled into the living room for a movie. During six weeks of food that generally tasted unfulfilling and uninspired, it was one night a week of something we all loved. If you can find a meal like that, even if it requires a lot of preparation, it can really save your sanity. Here are some ideas:

• Tomato soup and toasted fat-free cheese sandwiches
• Spiced lentils and basmati rice
• Fat-free pasta with tomato sauce and steamed vegetables
• Potato soup and a big salad
• Egg white omelettes with spinach, tomatoes, and bell peppers
• Noodle soup with carrots, potatoes, and celery.

The Children’s Hospital and Clinics of Minnesota has put together a great list with even more sugestions which you can read online. If you have other ideas, please do post them in the comments below.

This is hard, but you can get through it. Good luck.

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