Previously I posted about the large number of people who are living with constipation; and the reality is that there are a whole lot of people living with chronic diarrhea. In some ways chronic diarrhea is worse because it impacts your daily life by interfering with your ability to get things done and causing anxiety about social activities. Honestly, I can’t imagine what it’s like to live with the constant fear that your bowels will betray you!
Since you deserve better than worrying about what your bowels are going to do, let’s talk about what you can do to avoid or alleviate it…
What’s the difference between acute and chronic diarrhea?
Before you start to think that diarrhea is always a bad thing, let me assure you that sometimes diarrhea is a necessary evil to protect our bodies. You see, if something gets into the digestive tract that the body recognizes as harmful, the digestive system will try to get rid of it. One option is through vomiting (if the substance is still in the stomach or the very top of the small intestine); the other option is out the back end.
Acute diarrhea is defined as three or more bowel movements per day of a decreased form (see below for more on that) lasting for less than two weeks. Chronic (or functional) diarrhea is when a person experiences loose, mushy or watery stools (types 5, 6 or 7 on the Bristol Stool Scale [aka, Meyers Scale], shown below) without pain at least 75% of the time they have a bowel movement. If you add abdominal pain or discomfort that improves with defecation to the symptoms of chronic diarrhea, the person will be diagnosed with IBS-D (irritable bowel syndrome, diarrhea predominant).
The difficult thing about distinguishing between an acute and chronic condition is that some of the causes may result in only one or two episodes of loose or watery diarrhea per incidence, which technically makes it acute diarrhea. However, if the trigger is encountered on a regular basis, then the diarrhea will show up each time the event or circumstance occurs and each of these acute episodes adds up to chronic diarrhea.
Because of this ambiguity, I am not going to distinguish between acute and chronic diarrhea from here forth except to discuss diarrhea caused by an infection. Most often truly acute diarrhea is caused by an infection (viral, bacterial or parasitic) or toxins from a microorganism (usually occurs when a bacteria in food gives off toxins and the toxins give a person food poisoning rather than the bacteria itself causing the problem). In this situation, diarrhea is a good thing because it’s trying to flush a harmful substance out of the body. The key here is to stay hydrated, which means plenty of fluids and electrolytes, until the body has had a chance to expel the toxic invader. (As an additional note here, I much prefer people to drink pure coconut water or make their own water / electrolyte beverage rather than drink Gatorade or Pedialyte which are both packed with sugar and, therefore, are not friends of your immune system.)
For the purposes of our discussion, I am going to assume that the cause of your diarrhea is not an acute digestive infection or microbial toxins (essentially food poisoning). So read on for causes and treatments…
What causes diarrhea (other than acute infection or food poisoning)?
As with most digestive issues, the potential causes of diarrhea are numerous, which can make it difficult to pin down. The following are the most common causes (listed roughly in the order of prevalence):
- Insufficient soluble fiber intake… soluble fiber slows down the transit time of matter through the intestines.
- Bacteria, yeast or parasite overgrowth in the intestine… doesn’t necessarily have to be C. difficile. Overgrowth of any microorganism may cause the intestines to try and get rid of them (although your body may not be successful as these little buggers can practically hide against the wall of the intestine).
- Food sensitivity… likely causes are wheat, gluten and dairy, but again you could be sensitive to any food. (In children, eggs and soy are often implicated as well.)
- Inability to sufficiently digest and absorb macronutrients so the body tries to get them out of the system, including:
- Lactose, fructose or sucrose
- Sugar alcohols (keep this in mind if you’re a fan of sugar free and “diabetic friendly” snacks as they often have large quantities of sugar alcohols in them)
- Fat (perhaps from lack of pancreatic digestive enzymes or insufficient bile output by the gallbladder, which is highly likely after gallbladder removal)
- Protein (likely from insufficient stomach acid, especially if you have morning diarrhea or diarrhea after heavy meals)
- Prescription medication
- Autoimmune diseases of the intestine or that affect the nervous system, including celiac disease, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), and multiple sclerosis
- Excessive intake of high fat or greasy foods (even if you can digest fat reasonably well, it is possible that too much at one time overwhelms your digestive system)
- Low fat diet, especially for children less than 3 years old
- Coffee and caffeine intake, especially in those who are sensitive to it
- Folate or vitamin B12 deficiency
- Too much serotonin (Consider this if you are taking a supplement that increases your tryptophan intake as the body converts tryptophan into serotonin. Also, this seems to be an even bigger problem in those with celiac disease or who have a gluten sensitivity, maybe because of the gluten or maybe because of a decreased tolerance to glyphosate.)
- Acquired Immunodeficiency syndrome (AIDS)
- Chemotherapy or radiation therapy
- Stress or anxiety… there is a strong brain/gut connection. Those “butterflies” in your stomach are a real thing and can lead to the digestive system moving quickly.
What can you do to stop the madness?
Interestingly, many diarrhea treatments are similar to constipation treatments. The reason is that irregular bowel movements are a non-specific symptom of a digestive system imbalance. The manifestation of that imbalance can show up as either diarrhea or constipation or sometimes I mix of both. (Alternating constipation and diarrhea is a tell-tale sign of dysbiosis.)
To get your bowels under control, do the following…
- Increase your fiber intake. (Next week’s blog post will cover fiber in detail.)
- Consider a probiotic that has bacterial strains proven to help acute diarrhea, chronic and/or IBS-D. These include Bio-Kult, Klaire Labs Saccharomyces boulardii and Culturelle with Lactobacillus GG. Note that Lactobacillus casei has been shown to help prevent episodes of acute diarrhea. Although it is not currently in any probiotic supplements that I know of, it is in Dannon DanActive yogurt (just be mindful about how much sugar is in this yogurt).
- Identify if you have a food sensitivity. If you aren’t up for doing a full elimination diet, I strongly suggest the following (listed in order of probable cause) and monitoring for symptom improvement:
- Eliminate lactose and sugar alcohols like sorbitol from your diet for at least a week. If that doesn’t help, then…
- Eliminate gluten and dairy for at least three weeks. If that doesn’t help, then…
- Eliminate sucrose and significantly reduce fructose intake for at least a week. If that doesn’t work, but there was some improvement…
- Eliminate all of the above as there may be a cumulative effect with each of the above having a small impact on their own, but a big impact when all together.
- Remove or significantly reduce your intake of coffee and caffeine.
- Reduce your intake of spicy, fatty or greasy foods, cured or smoked meats and/or alcohol, as all of these can cause diarrhea in some individuals.
- Be sure you are getting enough folate and vitamin B12. The best sources of folate include legumes, beans, green leafy vegetables, asparagus and broccoli. Most animal proteins are good sources of vitamin B12. If you are vegetarian, vegan or eat a healthy diet, but still have below optimal blood levels of these vitamins (as measured by your doctor), consider a supplement with the active form of the B vitamins.
- Seek the help of a healthcare provider who can determine if there is a physical or biochemical problem such as dysbiosis, low stomach acid (hypochlorhydria), copper deficiency or serotonin overload.
Note: If you would like to support my business and order any of the above supplements from me, follow these instructions: Nutrition QED – Supplement Ordering Instructions – NP Script. Also, if your current doctor isn’t open to discussing the root cause of your diarrhea, contact me and I can help you get to the bottom of the problem (so to speak) and/or guide you in the conversation with your doctor.
What else do you need to know about diarrhea?
If you have diarrhea, I strongly encourage you to get to the root cause because each episode is carrying important nutrients and water out of your body. In the mean time, drink plenty of water or other water-based fluid (like herbal tea or broth) and get electrolytes (including sodium, magnesium and potassium), which help maintain water balance in the body.
Also, during acute episodes, eat bland foods to prevent any additional assault on the intestines. This means following the BRAT diet (Bananas, white Rice, unsweetened Applesauce and plain Toast), with the additions of plain oatmeal, boiled or baked potatoes (avoid the skin), and skinless chicken breast. Also, avoid gut irritating foods like caffeine, alcohol, dairy, chocolate and spicy / fatty / greasy foods.
Diarrhea is irritating (literally and figuratively), but with a little investigative work, you can figure out what is causing your discomfort and resolve it for good!
— Allen S. Gastrointestinal Health from a Functional Medicine Perspective. Webinar held on February 11, 2015.
—Dannon. DanActive. Accessed March 22, 2016.
— Gaby AR. Nutritional Medicine. Concord, NH: Fritz Perlberg; 2011.
— Hawrelak J. Probiotic Advisor.
—Konoske T. Gut Health: Part 1 (GERD, SIBO, IBS, IBD). Webinar held on January 14, 2016.
— Lever DS. Acute Diarrhea. In Disease Management. August 2013. Accessed March 18, 2016.
— Rome Foundation. Appendix A: Rome III diagnostic criteria for functional gastrointestinal disorders. In Rome III Disorders and Criteria. Accessed March 15, 2016.
— WebMD, LLC. What kind of poop do I have? In Digestive Disorders Health Center. Accessed March 15, 2016.