Diarrhea - Nutritional Management

Medications,high dose vitamin C, food borne illness are just a few reasons people develop diarrhea. Infectious disease is a major cause.

Most importantly you will need fluid and electrolytes to replace diarrheal losses. Gatorade is a fluid and electrolyte replacement supplement used by athletes that works well for people with diarrhea. If you don't have Gatorade try diluted fruit juices, (½ water and ½ juice) and salty broth. Full strength juices make it worse. A home electrolyte replacement solution: 1 tsp. salt, 1 tsp. sugar, 2 oz. orange juice, one liter water with herb tea. You can try Infalyte, a Mead Johnson rehydration product available at the drug store.

Avoid prune juice, all caffeinated carbonated beverages (colas, Mountain Dew, Sunkist Orange, etc), coffee and chocolate. Try regular or herbal teas and non- caffeinated beverages like ginger ale or 7-up.

Milk is seldom digested when you have. There is an enzyme in the intestine called lactase that is needed to digest lactose, a milk sugar. This enzyme seems to be lacking in some gastrointestinal diseases. Even if it is still intact diarrhea causes stomach contents to pass through the gut so rapidly that there is no time for the enzyme to digest the milk. You get gassy and bloated and diarrhea gets worse.

You can try enzyme tablets or lactase treated milk like Lactaid. Soy milk and rice milk is other options. Yogurt is usually tolerated because the bacteria that ferment yogurt consume the lactose making it easy for you to digest.

Your still need protein, so rather than eating fried or fatty meats keep it simple. Broil, bake, roast and grill. White meat chicken, lean red meat and fish. Hard cooked or scrambled eggs and tofu work fine if you don't feel like eating heavier foods. Smooth peanut butter on white bread with jelly is a simple food with lots of protein.

When you have diarrhea watch out for sugary foods. When sugar hits your gut water pours in to help dilute it. Under normal conditions your body acclimates. When you have diarrhea the flood of water worsens the diarrhea. Skip the shakes and sweet desserts for now.

Fat is another culprit when you have diarrhea. It speeds movement of food through the intestine like lactose, the enzymes you need to digest fats don't respond in time. Avoid the fried foods and table fats until the diarrhea is over.

There are two kinds of fiber. One helps you battle diarrhea, the other makes it worse. Soluble fiber found in white rice, oatmeal, white and sweet potatoes, white crackers and bread may help to slow down your gastrointestinal tract. Insoluble fiber in wheat bran, brown rice, whole wheat bread and cereals will increase the transit time.

Fruits like bananas, cooked fruits and applesauce, mangos and papayas help to slow down diarrhea. They are also high in potassium, a mineral that gets depleted in bouts of watery diarrhea.

Stay away from gassy foods too like corn, broccoli, dried beans, cucumbers, melons, garlic and onions. Some people feel that gassy food makes their diarrhea worse. And the fiber in these foods is insoluble, the kind you don't want. In general, peeling and cooking food makes it easier to tolerate when you are having diarrhea. Eat well cooked foods like noodles and rice soups, baked chicken and fish, potatoes or rice, cooked carrots, canned fruits and drink plenty of fluids. Rice gruel- cook rice with twice as much water - eat and drink!

Other things you can do!

Bulk fiber supplements like Metamucil or Citrucel help to slow down diarrhea. These supplements are composed of psyllium a source of soluble fiber. Like the fiber in oatmeal and bananas.

Acidophilus ½ tsp. powder with juice or water twice a day before meals. Yogurt is not a reliable source of acidophilus.

Prebiotics are carbohydrates called FOS (fructoologosaccharides). They reach your colon undigested and feed health-promoting bacteria such as lactobacillus and Bifidobacteria. Lactobacilis is particularly important because it produces antimicrobial substances that can inhibit the growth of foodbourne pathogens such as salmonella. FOS can be found in goods such as onions, garlic and Jerusalem artichokes. As a supplement it sold as a mildly sweet powder, either loose or in capsules. Research suggests that about ¼ tsp. of FOS/day (3gm) can increase levels of good bacteria in your gut.

Probiotics are live active "good bacteria" found cultured dairy foods such as yogurt and kefir or supplements such as Culturelle or Probiata capsules

Cinnamon Tea- mix 1Tbsp dried powdered cinnamon bark into 1-cup hot water. Steep 10- 15 minutes.

Pancreatic enzymes-Two capsules prior to meals. Beware of the enzymes from the health food stores unless they are enteric coated. Ask you doctor to prescribe Ultrase MT20 paid for by most insurance plans.

Glutamine is an amino acid that gets used up GI distress. Putting it back helps to feed the gut cells and repair damage helping you with digestion and absorption. For high grade glutamine call Cambridge Neutraceuticals (800-265-2202) or visit their website Cambridge Neutraceuticals New studies are verifying the potential of glutamine to not only restore normal gut function but enhance immune function. Glutamine from Cambridge was just approved by New York Medicaid. Have your doctor write for 30 grams/day. For more information on the various glutamine products visit their website.

Shaman B or SB Normal Stool Formula is a relatively new botanical with proven efficacy in HIV related diarrhea. It is extracted from a South American plant used by natives to treat diarrhea. This was intended to be a prescription product, but the company ran out of money to complete the trials required by the FDA. In order to get it out to you the company released it as a nutritional supplement. It's a good product and my patients tell me it reduces their diarrhea, clinical trials indicate that it can half diarrhea volume and in some cases even more. To learn more about this product and where you can purchase it go to their website www.shamanbotanicals.com

These guidelines are meant to help you treat diarrhea. If you have prolonged severe diarrhea it is urgent that you call your physician, dehydration is a life threatening condition.

Updated August 2000

Donna Tinnerello, MS, RD, CD/N is a registered dietitian, living in Manhattan, with more than 10 years experience in HIV and nutrition. Her subspecialties are cardiovascular, renal, gastrointestinal disease, diabetes and weight management.
Donna is available for private consultation by referral only. Ms.Tinnerello has donated time and articles to our web site at always your choice and we sincerely appreciate her contributions.