gastric disorders (such as partial intestinal obstruction or  diverticulitis). It  is  also  used  in  certain  posto- perative states that affect any part of the GI tract, e.g., a hemorrhoidectomy.  Low-residue diets are also used in treating dysenteries of long duration. The   purpose   of   this   diet   is   to   provide   non- stimulating,   non-irritating,   and   easily   digested material   that   leaves   little   residue,   thus   avoiding mechanical   irritation   of   the   GI   tract. Various commercially   prepared   low-residue   elemental   diet supplements   may   be   given   to   provide   complete nutrition. LOW-SODIUM   DIET.—A   low-sodium   diet consists of foods containing a very small percentage of sodium,  with  no  salt  added  in  preparation  or  by  the patient. It  is  impossible  to  prepare  an  absolutely sodium-free diet. The low-sodium diet is indicated when edema is present,  in  renal  diseases,  hypertension,  and  certain cardiac conditions. The  nephrotic  patient  is  often  unable  to  excrete sodium   in   a   normal   manner   because   the   kidneys’ retention of sodium leads to edema. A low-sodium diet is   thus   indicated,   with   no   restriction   on   salt-free liquids.   Such patients should be encouraged to drink 2,000  to  3,000  milliliters  (ml)  of  low-sodium  fluids daily. The  allowance  of  sodium  in  a  strict  low-sodium diet is 250 to 1,000 mg daily. The allowance of sodium in  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 of sodium. Any   diet   in   which   the   amount   of   sodium   is drastically   reduced   has   possible   side   effects.   The patient who is on this diet regimen must be constantly observed—particularly   in   warm   climates—for lassitude,  complaints  of  weakness,  anorexia,  nausea and  vomiting,  mental  confusion,  abdominal  cramps, and aching skeletal muscles.   Electrolyte imbalances can   have   serious   consequences.   If   you   observe symptoms  such  as  those  described  above,  notify  a medical officer. BLAND DIET.—A bland diet may be helpful for gastritis, hyperacidity, hemorrhoids, peptic ulcers, and other  GI  disorders.  Dietary  management  of  patients with chronic ulcer disease has been the subject of much controversy.   Bland diets have traditionally been used for  these  patients.    However,  experiments  show  that there  is  no  significant  difference  in  the  response  of patients 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   as indicating what foods to eat, since there are individual responses   to   bland   diets.   Offer   the   following suggestions to the patient: ·   Avoid worry and emotional upsets at mealtime ·   Chew food well and eat slowly ·   Rest before and after meals ·   Avoid foods of extreme temperatures If fruits and juices between meals cause distress, try  including  them  with  meals.    Meals  must  be  kept small to reduce gastric acidity and distention.  Among foods to avoid in the bland diet are ·   fatty meats, ·   fried foods, ·   whole-grain breads and cereals, ·   dried beans and peas, ·   cabbage-family vegetables, ·   chocolate, ·   nuts and seeds, and ·   carbonated beverages, caffeine, coffee, and tea. Patients   on   a   bland   diet   may   use   spices   and condiments such as allspice, cinnamon, mace, paprika, sage,   thyme,   catsup,   cranberry   or   mint   jelly,   and extract and flavorings without chocolate or vinegar. The bland diet allows a more liberal food selection than   other   restrictive   diets. This   diet   reduces   the number of meals to three, and increases the quantity of foods given.   Individualize the diet to the patient. The  “Regular-No  Stimulants  Diet”  (also  called “liberal bland”), a type of bland diet, eliminates  only those   items   that   have   been   shown   scientifically   to irritate the gastric mucosa (i.e., alcohol, black pepper, caffeine,  chili  powder,  cocoa,  coffee,  certain  drugs, and tea). Decaffeinated  coffee  may  be  restricted  in  most types of bland diets.  Recent studies show that it causes increased   gastric   acid   secretion   and   esophageal pressure causing gastric acid reflux in the esophagus. Decaffeinated coffee is only offered on the bland diet 9-10