Managing Diarrhea with Diet and Lifestyle Changes

You suffer from diarrhea when you have at least three loose, liquid, or watery stools in a day.

The stool becomes loose and watery because of excess water content in the stools. This excess water in stools comes from either reduced water absorption by the bowel or increased water production and elimination. 

This may occur when there is an imbalance in the absorption of various electrolytes, other substrates, and water from the intestines.

In the acute form, diarrhea may last for a few days up to two weeks. Diarrhea is considered chronic when the symptoms last two or more weeks. [1] Chronic diarrhea tends to be non-infectious.

With severe cases of diarrhea, there may be blood or mucus in the stools, fever, or weight loss.

You may experience nausea, cramps, bloating, and sometimes vomiting when suffering from diarrhea.

Causes

Acute diarrhea: The causes of acute diarrhea vary from bacterial or viral infections, contaminated water exposure from swimming pools, reactions to medicines, allergies, or food poisoning. 

In such cases, the gut epithelium becomes temporarily damaged from the toxins or infectious agents, leading to an inability of these cells to absorb water, electrolytes, etc., resulting in watery stools.

Malnutrition is also a risk factor for diarrhea incidence, duration, and severity. People with sufficient nourishment before diarrheal disease recuperate faster. [2-3]

Chronic diarrhea: The cause of chronic diarrhea often comes from other parallel diseases (Crohn’s disease, ulcerative colitis, Celiac disease, IBS, hyperthyroidism, SIBO, parasites, allergies, and intolerance such as lactose intolerance) where diarrhea is the symptom. [4]

In lactose intolerance, lactose, the sugar found in dairy products, is not broken down by the enzyme lactase due to lack or decreased amounts of this enzyme. As most people age past childhood, the enzyme lactase decreases activity and becomes absent. Lactose cannot be absorbed from dairy products, so lactose stays in the gut. Being osmotically active, lactose retains and attracts water leading to watery diarrhea. [5]

Fatty chronic diarrhea often occurs in people with allergies like celiac disease who consume gluten products and in people with pancreas inflammation. The inflamed pancreas cannot properly release the digestive enzymes necessary to break down foods, resulting in nutrient malabsorption. Symptoms include upper abdominal pain, flatulence, and pale stools due to the malabsorption of fats. [6]

Stool tests, and blood tests, can determine the cause of diarrhea.  

If left untreated, diarrhea can cause dehydration, which can be life-threatening. 

Here are ways you can manage diarrhea before it becomes severe.

1. Rehydration

Rehydration therapy is an essential aspect of managing any diarrhea. [7] Dehydration, when severe, will affect kidney function.

Drinking more water and diluted fruit juice can help replenish fluid loss. Drink 8 to 10 glasses of water a day. Other ways to replenish your fluids are by eating clear broth or low-sodium soup. 

See my article on hydration to see how much water you need depending on your weight to replenish hydration and prevent dehydration; also, when suffering from diarrhea, here. xxx

Electrolyte abnormalities can also be concerning and require monitoring for replacement needs. [1]

In fact, drinking water will not immediately help if you are dehydrated until your electrolytes are fully replenished. You must replace lost electrolytes if diarrhea persists, especially in chronic conditions. These can be taken in supplement form with an effervescent tablet to add to your water, through an electrolyte drink (caffeine free), or best yet, by drinking natural coconut water. Coconut water is naturally hydrating, has all the necessary electrolytes, and is a healthy drink rich in vitamin C for immune health [8] and potassium for heart health. [9-10]

A teaspoon of honeycomb for those not allergic can also be beneficial.

2. Prevent Infections

Prevent infectious diarrhea with proper hygiene practices such as handwashing with soap to prevent infection and the spread of disease. [11] 

Also, vaccinate children when possible, for instance, to prevent rotavirus infection, which causes severe diarrhea in children. [12] 

3. Prevent Malabsorption

The body cannot absorb nutrients and fluids properly if the transit time is high in the intestines. Nutrients such as zinc or iron may not be absorbed sufficiently, leading to more health issues. You may supplement with these nutrients in liquid form if diarrhea persists. Zinc as liquid zinc sulfate (10mg) and liquid iron (10 mg) are to be taken on an empty stomach, but never together as these contradict the absorption of each other. 

4. Avoid Sugar Alcohols (Mannitol, Sorbitol, Xylitol) 

These sugar substitutes are not always well tolerated, especially when consumed in high amounts. These may cause bloating and diarrhea in sensitive people and may lead to a microbiome imbalance, delaying recovery from diarrhea. 

5. Avoid Foods That Irritate The Bowels

Other foods to avoid include spicy foods, further irritating the bowels, processed foods, fatty meats, dairy products, fried foods, and sugary foods.

6. Follow A Bland Diet Rich In Soluble Fiber

Previously, doctors recommended the BRAT diet, which stands for Bananas, Rice, Applesauce, and Toast. However, lacking many nutrients and sufficient soluble fiber, this diet may not be the best choice. Although bananas are excellent, apples with their peel are better choices than applesauce. Oats can replace refined grain toast as they are a good source of soluble fiber, which slows digestion. Carrots, peas, beans, barley crackers, oranges, and boiled potatoes are also rich in soluble fiber and helpful for diarrhea. It’s also better to consume smaller meals throughout the day rather than three big meals, which may be hard to digest. [13]

To conclude

Rehydrate your body properly with water and electrolytes, avoid foods that contribute to diarrhea, consume foods rich in soluble fiber, replenish lost nutrients if the diarrhea is chronic, and maintain hygiene practices that prevent infections. 

Please feel free to share this article with friends you think may benefit from it.

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References 

1. Schiller LR, Pardi DS, Sellin JH. Chronic Diarrhea: Diagnosis and Management. Clin Gastroenterol Hepatol. 2017 Feb;15(2):182-193.e3.
2. National Research Council (US) Subcommittee on Nutrition and Diarrheal Diseases Control; National Research Council (US) Subcommittee on Diet, Physical Activity, and Pregnancy Outcome. Nutrition Issues in Developing Countries: Part I: Diarrheal Diseases: Part II: Diet and Activity During Pregnancy and Lactation. Washington (DC): National Academies Press (US); 1992. 3, Relationships Between Nutrition and Diarrhea.
3. Talbert A, Thuo N, Karisa J, Chesaro C, Ohuma E, Ignas J, Berkley JA, Toromo C, Atkinson S, Maitland K. Diarrhoea complicating severe acute malnutrition in Kenyan children: a prospective descriptive study of risk factors and outcome. PLoS One. 2012;7(6):e38321.
4. Wenzl HH. Diarrhea in chronic inflammatory bowel diseases. Gastroenterol Clin North Am. 2012 Sep;41(3):651-75. 
5. M Szilagyi A, Ishayek N. Lactose Intolerance, Dairy Avoidance, and Treatment Options. Nutrients. 2018 Dec 15;10(12) 
6. Nikfarjam M, Wilson JS, Smith RC., Australasian Pancreatic Club Pancreatic Enzyme Replacement Therapy Guidelines Working Group. Diagnosis and management of pancreatic exocrine insufficiency. Med J Aust. 2017 Aug 21;207(4):161-165.
7. Nemeth V, Pfleghaar N. Diarrhea. [Updated 2021 Nov 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-
8. Santos JL, Bispo VS, Filho AB, Pinto IF, Dantas LS, Vasconcelos DF, Abreu FF, Melo DA, Matos IA, Freitas FP, Gomes OF, Medeiros MH, Matos HR. Evaluation of chemical constituents and antioxidant activity of coconut water (Cocus nucifera L.) and caffeic acid in cell culture. An Acad Bras Cienc. 2013;85(4):1235-47. doi: 10.1590/0001-37652013105312. Epub 2013 Sep 27. PMID: 24141413.
9. Weaver CM. Potassium and health. Adv Nutr. 2013 May 1;4(3):368S-77S. doi: 10.3945/an.112.003533. PMID: 23674806; PMCID: PMC3650509.
10. Sandhya VG, Rajamohan T. Beneficial effects of coconut water feeding on lipid metabolism in cholesterol-fed rats. J Med Food. 2006 Fall;9(3):400-7. doi: 10.1089/jmf.2006.9.400. PMID: 17004906.
11. Null C, Stewart CP, Pickering AJ, Dentz HN, Arnold BF, Arnold CD, Benjamin-Chung J, Clasen T, Dewey KG, Fernald LCH, Hubbard AE, Kariger P, Lin A, Luby SP, Mertens A, Njenga SM, Nyambane G, Ram PK, Colford JM. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Kenya: a cluster-randomised controlled trial. Lancet Glob Health. 2018 Mar;6(3):e316-e329.
12. Fischer TK, Viboud C, Parashar U, Malek M, Steiner C, Glass R, Simonsen L. Hospitalizations and deaths from diarrhea and rotavirus among children <5 years of age in the United States, 1993-2003. J Infect Dis. 2007 Apr 15;195(8):1117-25.
13. Nakao M, Ogura Y, Satake S, Ito I, Iguchi A, Takagi K, Nabeshima T. Usefulness of soluble dietary fiber for the treatment of diarrhea during enteral nutrition in elderly patients. Nutrition. 2002 Jan;18(1):35-9. doi: 10.1016/s0899-9007(01)00715-8. PMID: 11827762.