gastric disorders (such as partial intestinal obstructionor diverticulitis). It is also used in certain posto-perative states that affect any part of the GI tract, e.g., ahemorrhoidectomy. Low-residue diets are also used intreating dysenteries of long duration.The purpose of this diet is to provide non-stimulating, non-irritating, and easily digestedmaterial that leaves little residue, thus avoidingmechanical irritation of the GI tract. Variouscommercially prepared low-residue elemental dietsupplements may be given to provide completenutrition.LOW-SODIUM DIET.—A low-sodium dietconsists of foods containing a very small percentage ofsodium, with no salt added in preparation or by thepatient. It is impossible to prepare an absolutelysodium-free diet.The low-sodium diet is indicated when edema ispresent, in renal diseases, hypertension, and certaincardiac conditions.The nephrotic patient is often unable to excretesodium in a normal manner because the kidneys’retention of sodium leads to edema. A low-sodium dietis thus indicated, with no restriction on salt-freeliquids. Such patients should be encouraged to drink2,000 to 3,000 milliliters (ml) of low-sodium fluidsdaily.The allowance of sodium in a strict low-sodiumdiet is 250 to 1,000 mg daily. The allowance of sodiumin a moderate low-sodium diet is 2,000 mg or 2 g.Regular diets with no salt added contain 2.4 to 4.5 g ofsodium.Any diet in which the amount of sodium isdrastically reduced has possible side effects. Thepatient who is on this diet regimen must be constantlyobserved—particularly in warm climates—forlassitude, complaints of weakness, anorexia, nauseaand vomiting, mental confusion, abdominal cramps,and aching skeletal muscles. Electrolyte imbalancescan have serious consequences. If you observesymptoms such as those described above, notify amedical officer.BLAND DIET.—A bland diet may be helpful forgastritis, hyperacidity, hemorrhoids, peptic ulcers, andother GI disorders. Dietary management of patientswith chronic ulcer disease has been the subject of muchcontroversy. Bland diets have traditionally been usedfor these patients. However, experiments show thatthere is no significant difference in the response ofpatients with an active duodenal ulcer to a bland diet.Known irritants to the gastric mucosa include alcohol,black pepper, caffeine, chili powder, cocoa, coffee,certain drugs, and tea.Emphasizing how to eat is as important asindicating what foods to eat, since there are individualresponses to bland diets. Offer the followingsuggestions to the patient:Avoid worry and emotional upsets at mealtimeChew food well and eat slowlyRest before and after mealsAvoid foods of extreme temperaturesIf fruits and juices between meals cause distress,try including them with meals. Meals must be keptsmall to reduce gastric acidity and distention. Amongfoods to avoid in the bland diet arefatty meats,fried foods,whole-grain breads and cereals,dried beans and peas,cabbage-family vegetables,chocolate,nuts and seeds, andcarbonated beverages, caffeine, coffee, and tea.Patients on a bland diet may use spices andcondiments such as allspice, cinnamon, mace, paprika,sage, thyme, catsup, cranberry or mint jelly, andextract and flavorings without chocolate or vinegar.The bland diet allows a more liberal food selectionthan other restrictive diets. This diet reduces thenumber of meals to three, and increases the quantity offoods given. Individualize the diet to the patient.The “Regular-No Stimulants Diet” (also called“liberal bland”), a type of bland diet, eliminates onlythose items that have been shown scientifically toirritate the gastric mucosa (i.e., alcohol, black pepper,caffeine, chili powder, cocoa, coffee, certain drugs,and tea).Decaffeinated coffee may be restricted in mosttypes of bland diets. Recent studies show that it causesincreased gastric acid secretion and esophagealpressure causing gastric acid reflux in the esophagus.Decaffeinated coffee is only offered on the bland diet9-10
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