 Now, we move on to a new area of the classes that is the therapeutic nutrition. How we can use food in treating the diseases or preventing the diseases from spoiling the health of an individual. So, let us see these therapeutic diets are nothing but we adapt the normal diet to make a therapeutic diet. Therapeutic nutrition always begins with a normal diet. It is nothing different from a normal diet, but little modifications in various ways can make it a therapeutic diet. So, it should be planned to maintain and restore good nutrition in any situation. If the person is ill, the aim of therapeutic diet is to bring him back to a normal condition without reducing the nutrient requirements of the individual. So, how to modify a normal diet to a therapeutic diet? So, you have to provide change in the consistency. When the person is very ill, you change the consistency into a pure liquid and then keep on changing the consistency as the illness is reduced, you bring it to a soft diet and then to a normal diet. Then increasing or decreasing the energy value. So, if the person is not able to tolerate high energy force, then you either increase or decrease the energy value depending upon the condition of the patient. Suppose the person has to reduce weight, then we have to decrease the energy value of the food and suppose the individual is having diarrhea, then you reduce the amount of energy that is present in the food and slowly start increasing the diet. So, and whenever the person is undernourished, you should increase the energy value. Then greater or lesser amount of more nutrients. So, we have been seeing what are the nutrients and their functions and how deficiency occurs. So, based on the type of deficiency or whatever need for the nutrient is there, you try to increase or decrease the various nutrients in the diet. Then increase or decrease the fiber in the diet. This especially comes in the case of constipation or diarrhea and the person is having constipation. You increase the fiber in the diet so that these tools become soft and it relieves the problem of constipation. Whereas in diarrhea, you start decreasing the fiber because the residue formation has to be there. So, you decrease the fiber and transit time decreases, so diarrhea will decrease. Then provide foods bland in flavor and the person is ill, he is not able to tolerate certain flavors, then you have to change the flavor of the food and provide the diet to the individual. So, these are the liquid and soft diets which can be given to the sick persons. So, mechanical soft diet, so many people they need soft diet because they have no teeth. It is the infants and the old people, so such people require only a change in the consistency. The same food which we are eating, if it is softly cooked it can be fed to the infants or to the older age group and there is no restriction for any food selection here. Then soft diet is used also in acute infection and when the person is not able to tolerate food and any gastrointestinal disturbances, so that it does not cause any irritation to the gastrointestinal system and following surgery. After surgery, the individual's gastrointestinal system becomes a little slow, so you give soft diet for easy digestion. Then this is made up of simple foods and which is easy to chew. Then you give them easily digested food, so that the gastrointestinal system is not stressed for digesting the food. Then harsh fiber and fatty or spiced foods are avoided, you better give them bland food so that it does not irritate the gastrointestinal system. But at the same time, we have to see that the soft diet is nutritionally adequate. So in that manner, we try to put all the food groups into the food and make it a soft diet. Then three meals with intermediate feedings are necessary, generally when the individual takes food, you take three meals, plan three meals, but for a sick person, we can plan five to six meals a day in small quantities so that the nutritional needs are met and the individual is recovered from the illness. So that includes some examples like soft cooked rice can be given, chapati and bread can be given by putting them in either milk or hot tea and served, then milk and milk products can be given, well cooked dal can be given, soft boiled eggs can be given and green leafy vegetables they can be given after they are cooked soft and strained so that you do not feel the fibrous thing in the mouth. And citrus fruits and juices which are non-fibrous also can be served, you see here vegetables are boiled and the liquid is given. And when you serve a sick person, the serving part also is very important because it has to be served attractively so that the appetite increases and the individual eats. Then liquid or full fluid diets, they are used for febrile states, febrile state is when the individual is suffering from fever. So you give them more of liquid and full fluid diets that the same time during fever the energy requirement is more so you should meet the nutritional requirements also. Then postoperatively also we give liquid and full fluid diets so that they are easily assimilated and whenever the patient is unable to tolerate solid food. Because vomiting the individual is not able to tolerate solid foods, vomiting and diarrhea then you give them soft or liquid or full fluid diets. And the adequacy of diet depends upon the types of liquids that are permitted. What is the type of food you are using to make the liquid, we will decide what is the nutrient content of that food. Then you have clear fluid diet there is no solid particle in the diet. So this is when the person is unable to tolerate food because either because of nausea, vomiting or gas formation, diarrhea, extreme loss of appetite the person is not able to tolerate food at all. And therefore it is restricted sometimes the person is restricted of food intake in acute infections or just before surgery and before diagnosis. When the person is supposed to not to have any food under such conditions clear fluid diet can be given. And it can also be given in acute inflammatory conditions of the intestinal tract when the intestinal tract is not able to bear the solid foods then clear liquid can be given. Surgery of colon or rectum where residue should not be formed so that there is a rest for the colon and rectum you give clear liquid diets. Then when the condition says that evacuation should not be there the bowel movement should not be there then the clear liquid is given. And to relieve the thirst whenever we feel very thirst generally we is done is we have some coconut water, coconut water is a clear fluid diet it will quench the thirst. So under such conditions you give and to supply tissues with water. When do we supply tissues with water is when the body undergoes dehydration. So first thing is to replete the body with water therefore under such conditions you give clear liquid diet. But this clear liquid diet since it does not have any solid material it is entirely inadequate it is not sufficient for the individual's nutritional needs. So it is deficient in protein, minerals, vitamins and calories. And so therefore it should not be continued for more than 48 hours it can be given for 1 or 2 days but not more than that. And amount of fluid restricted to 30 to 60 ml per hour at the beginning and slowly the amount is increased. And gradual increase in amounts as the tolerance of the patient improves and it is given at 1 to 2 hours intervals. Otherwise if you give more water what happens again it may lead to water intoxication. Next to clear fluid diet once 24 to 48 hours are over slowly the person can be shifted to full fluid diet. So this diet is a bridge between the clear fluid and the soft diet. So it bridges the gap between clear fluid and soft diet. So a person who is very ill who cannot chew or swallow the food is given full fluid diet. So it is also used for the persons who have undergone surgery then a person who has acute gastritis, acute infection and diarrhea. So slowly we have to accustom the digestive system to a solid food. So immediately after clear fluid diet we cannot give him solid food. So it has to gradually come back to the solid state so that the individual can tolerate the food. And in this diet foods are liquid which readily become liquid and upon reaching the stomach they are comfortable to the patient and the diet is made entirely adequate. You can now here you can add foods and make it nutritionally adequate and it can be used over extended time of period without any fear of deficiencies. Because you can use all the foods to make a full fluid diet. So again this is given at 2 to 4 hours interval because it is a fluid diet the quantity cannot be consumed at a time. So you give no more number of times at least once in 2 to 4 hours. Then fibrous foods and irritating spices are excluded in this full fluid diet because again it may revive the condition and the content of diet can be increased by adding protein and energy rich foods or you can add some supplements to the full fluid diet so that you meet the energy and protein requirements. So therapeutic diet is nothing but a modification of normal diet in terms of its consistency in terms of its temperature and in terms of the nutrients that are added so that the individual comes back to a normal state of health and he is able to take his normal diet. Thank you.