Diarrhea is not a subject most people like to talk about–but I talk to people about it all the time in my practice. When people have diarrhea, it is sometimes hard for them to find useful help. Since dietary choices greatly affect diarrhea, it is important to know what food choices to focus on. Also, most people blame the food they ate right before the diarrhea started, which is not usually the culprit. Let me try and help minimize and control it with you here.
If you have diarrhea, you first need to try to figure out what is causing it and then determine what to do to control it. If it has gone on for more than a couple of days, you should see your doctor and determine if there may be a medical reason for it. If you have done that and now want to try to control it, here are the dietary modifications to try and help.
Diarrhea can be caused by many different things, including food poisoning, bacterial and viral infections, lactose intolerance, celiac disease (gluten intolerance), excessive sugar-alcohol consumption (like sorbitol and maltitol), intestinal parasites, irritable bowel syndrome, colitis, ulcerative colitis, Crohn’s disease, diverticulitis, too much thyroid medication, too much caffeine, chemotherapy, radiation treatment in the abdomen, a C. difficile infection, surgery to the intestines and other conditions including gastric bypass surgery, and other dietary factors—so make sure you have tried to identify the problem first.
- Are you lactose intolerant? A person can be newly lactose intolerant at any age. Sometimes after trauma to the gut or a long course of antibiotics, a person can become lactose intolerant. If you are, or think you are, there are lactose free milks, lactose free yogurts, lactose free ice cream, lactose free cottage cheese and lactase enzyme supplements to take when you eat lactose-containing foods.
Lactose intolerance can be a temporary problem or it can be a permanent problem. People can be slightly lactose intolerant, moderately intolerant or severely lactose intolerant. Sometimes we just need to wait it out and see how long it lasts over time.
There is a test to determine if you are lactose intolerant, however, if you are, the test will give you bad gas and diarrhea for several hours. Because of that, many people can make the diagnosis themselves, with the proper information for testing it.
- Are you eating too much fiber? Yes, too much? When people have diarrhea, they need to decrease their fiber intake to decrease stimulation to the colon. Try to eat less than 10-15 grams of fiber/day. Avoid the most laxative fibers like wheat bran, bran cereals and raw vegetables. Eat white rice, white bread, peeled fruits, peeled and cooked vegetables until you see an improvement in the diarrhea.
It may sound strange for me to tell you to eat less fiber–when you hear everyone saying people should eat more fiber. But, in the case of diarrhea, it is always best to lower your fiber intake.
Dietary fiber is actually the sum of two fibers: soluble and insoluble fiber. It is the insoluble fiber that can make diarrhea worse, like what is found in the skin of fruits and vegetables and the fiber in wheat bran.
Soluble fiber actually slows the intestines. Soluble fiber can slow stomach emptying and slow movement in the gut–most notably the soluble fiber “pectin.” Historically, pectin is part of “Kaopectate” which is an old remedy for diarrhea. Peeled apples, applesauce and a peeled potatoes have pectin in them and they do help control diarrhea. Unfortunately, food labels do not tell you how much soluble fiber is in a food–but most registered dietitians can help you get that information.
- Consider taking a calcium supplement—not for the calcium for your bones—but for the calcium that does not get absorbed. Calcium supplements are very constipating—so you can safely use that to your advantage. You may need to take 1000-1500 mg calcium/day to get help. Take calcium carbonate because it is the least absorbed form of calcium.
Many people take Tums for this–they are made from calcium carbonate. Tums have 400-1000 mg of calcium per tablet, depending on the product. Note: you do not want to take a magnesium-based antacid because magnesium has a laxative effect.
- Do not drink fruit juice or eat too much fruit. A glass of fruit juice has the equivalent of several pieces of fruit in it and is known for its laxative effect. The skin of fruit is the most laxative part of the fruit—so peel all the fruit you eat. Bananas, melons and peeled apples are the least laxative of the fruits—so eat those rather than plums, peaches, nectarines, and apricots—which are more laxative fruits. Cooking the peeled fruit also makes it easier on the gut. Eat only 1-2 servings of peeled/cooked fruit/day until the diarrhea is more controllable.
- Consider taking a probiotic—especially one that has been shown to help control diarrhea, such as Lactobacillus reuteri (or L. reuteri). Ideally, you should take it daily for several weeks to determine if it is helpful. You may want to take it every day if you have a chronic diarrhea problem. Eating yogurt is another way to get probiotics, but if you are also lactose intolerant, be sure to eat a “lactose free” yogurt product like:
- Green Valley Organics® lactose free yogurt: http://greenvalleylactosefree.com/products/yogurts.php
- Lactaid™ lactose free yogurt: http://www.lactaid.com/products-home#Nonfat_Yogurt_Strawberry
- Yoplait® lactose free yogurt: http://yoplait.com/products/yoplait-lactose-free-yogurt
Taking a probiotic will help to reestablish a more favorable type of microflora/microorganism to grow in your large intestines–one that is less likely to trigger diarrhea.
- When diet changes do not help control your diarrhea, try medication. You should not “put up” with diarrhea or “let it run its course.” There are over-the-counter and prescription drugs for controlling diarrhea, including Imodium (loperamide) and Lomotil (diphenoxylate hydrochloride and atropine sulfate)–and many others. If one drug does not work for you, don’t give up, please try another one. They all work by different methods and may affect you differently.
If you have any questions or comments about this subject, please feel free to contact me.
© 2012 Ann M. Del Tredici, MS, RD, CDE