 Welcome back to the today's class and diet therapy as we know is such an important area of study where we can modify the diets depending upon the type of disorder the body has. And a little modification in the diet will relieve the symptoms of the various diseases and last two classes we have seen the disorders of lung and also how the diet can be modified during fevers and today let us see the diet that has to be taken in gastrointestinal disorders especially we will talk about the constipation and diarrhea. So let us start with the constipation today. So generally the gastrointestinal tract functions both as a barrier to the substances from the environment and as an entry point for the nutrients and other substances. So many disorders that affect the gastrointestinal tract and its accessory organs influence the nutritional status of the subject. Now parts of the gastrointestinal tract of course we have seen in the digestive tract what are the parts. Let us revise again it has esophagus, stomach, then small intestine including the 3 parts of the small intestine that is theodinum, jegenum and idiom and large intestine including cecum, colon, rectum and anal canal. Now the digestive action also we have seen that it is a mechanical digestion and where we chew the foods and break it down into different smaller pieces and chemical digestion which involves the splitting of the complex molecules into simpler form. Now dietary factors that are associated with ailments of gastrointestinal tract are one is acidity, inadequate fiber, fat, gluten substances and lactose. Any of these can cause disorder in the gastrointestinal tract. If there is acidity the higher acidity will cause the ulcers in the parts of the stomach or it can be in the deodinum and if there is inadequate fiber then it results in constipation. Then fat also may result in fatty stools or increase in the obesity and gluten substances sometime the gluten allergy occurs in individuals who cannot tolerate gluten therefore their gastrointestinal system is irritated and they start having diarrhea and thereby the substances are not absorbed the nutrients are not absorbed and they go into various deficiency disorders of nutrients. Now lactose intolerance also occurs some children cannot tolerate milk whenever milk is given they have gastric distension that is they have bloating, diarrhea and so on. So that also causes a loss of nutrients. Now general aspects of digestion of food the foods have generally the pH of food is 5 to 7 whereas when you see the pH of HCl in the stomach I told you it is 2. So citric acid have the pH of 3.5 therefore when you compare to the 2 acidity of 2 in the stomach you see the others have little acidity that means no food is acidic enough to change the acidity of the contents of stomach. So patients suffering from acidity need not avoid foods rich in vitamin C and other foods. Protein rich foods can utilize the gastric acid and milk is the choice for treating acidity because it has enough amount of protein and the calcium and fat reduces the acid production because it can slow down the production of acid and decrease the motility of the gastrointestinal tract. Now addition of cream to milk also is used to treat the peptic ulcer. Now you can use cream in moderate amounts because if you start using excess of cream again the fat from the cream can enter into the blood and cause atherosclerosis. So to avoid creamy foods you can use creamy foods but at a moderate amounts. Then stimulants which increase the production of gastric acid should be avoided whichever food when the moment the food is enters into the stomach there are certain foods which increase the production of acid such foods should be avoided. Now one important disorder of the gastrointestinal system is constipation. So it is a decrease in the person's normal frequency of defecation. So generally there are people who have defecation once in two days that becomes a normal but if the stool defecation does not occur for more than three days then you call it as a constipation. So the stool here becomes dry, hard and it becomes very difficult to expel the stools. So this insufficient and in frequent emptying of the bowls it leads to malice, malice is there is muscle wastage and headache coated tongue you have a foul breath lack of appetite. Because there is no normal excretion of the feces the residue remains in the large intestine and it keeps on becoming the more and more water is absorbed from the residue that is in the large intestine these stools become harder and harder and they become pellet like and they cannot be expended. So you have all these symptoms when you have constipation. So once the stools are evacuated then all these symptoms will disappear. Now there are two types of constipation one is atonic constipation you know name itself says atonic there is no tone or decreased muscle tone. So this is often called as lazy bowel. So the colon becomes inactive that means there is loss of muscle tone in the intestinal walls. So this generally occurs in aged people because naturally as the aging occurs the toning of the muscles decrease. So contraction and relaxation becomes much slower and so diet for such disorder is you take 800 grams of fruits and vegetables for normal bowel. Because fruits and vegetables are rich in fiber and they contain pectin in it. So it makes the stool bulky and softer so that it evacuates. Then supplement B complex vitamins because they start becoming deficient in B complex vitamins and moderate amount of bran should be given. Bran again is a fiber which will increase the bulk of the stool. Then tea and coffee should be avoided because they start increasing the acidity and they also suppress the appetite of an individual. There is another type of constipation called spastic constipation. So this is just opposite to the atonic type. Here over stimulation of the intestinal nerve endings occur which results in irregular contractions of the bowel it is there like spasms there is no regular contraction but the contractions occur in spasms. Therefore they become irregular again there is insufficient evacuation of the bowels. This is spastic constipation. Now the causes of constipation are generally it is excessive use of cathartics. What are cathartics? They are substances which help in evacuating or they are otherwise called as laxatives. They loosen the bowels and help in evacuation of bowels. And if there is abuse of these cathartics then the person gets used to the cathartics and whenever the person does not take cathartic then they start having constipation. Then excessive use of condiments and tobacco. Then here the muscle tone is changed when you use excess of condiments and tobacco. Then eating very coarse foods because it becomes very difficult for digestion at the same time the bulk becomes so much that evacuation become difficult. And too much of coffee, alcohol and tea will cause the peristaltic movement change. Now diet should be smooth, non-irritating and it should be full of vegetables and fruit juices. So these will help in increasing the bulk as well as the softness of stool and help in evacuation. Then they should give low fiber diet. Now keys to overcome constipation so increasing the fiber in the diet, adequate amount of water has to be taken and exercising regularly and another important thing is attending to the nature's call. The moment the body gives the signal of evacuation some people have the habit of ignoring it because of some busy schedule or when there is no proper facility for evacuating. For such times again constipation results. Now medical nutrition therapy is you give adequate amount of soluble and insoluble fibers. So increase the fiber content and this will help in increasing the colonic fecal fluid. The microbial mass also will increase stool weight and frequency and rate of colonic transit will increase. So all these help in softening these tools and make them easier to pass. Now diet is the recommended amount of fiber. Generally the fiber is the most important nutrient to clear off the constipation. recommended amount of fiber is 14 grams per 1000 kilo calories and women require at least 25 grams per day and men 38 grams per day. So how do we get this fiber from the foods we generally use whole grains fruits and vegetables seeds nuts then powdered fiber supplements we get supplements which are only fiber. So when we eat them then the nutrition or the fiber is got from them. So this is how we can relieve from constipation and because constipation does not allow the person to concentrate on any work and he can also lose different nutrients the absorption power of the intestine also may change therefore go into other deficiencies. Therefore it is better to have a very good bowel evacuation every day. Thank you.