Diarrhea Diet

Definition

Origins

Description

Function

Benefits

Precautions

Risks

Research and general acceptance

Resources

Definition

A diarrhea diet is used to help alleviate diarrhea, a condition characterized by unusually frequent bowel movements and excessive evacuations of watery stools.

Origins

Diarrhea is a symptom that is not only uncomfortable, but also dangerous to health, as it is usually indicative of an underlying infection. Some causes of diarrhea include:

• Taking antibiotics. Some antibiotics have diarrhea as a side effect
• Celiac disease. Disease that damages the small intestine in people who cannot tolerate gluten, a protein found in wheat, rye, and barley
• Crohn’s disease. Inflammatory disease that usually occurs in the last section of the small intestine (ileum), causing swelling in the intestines. It can also occur in the large intestine
• Diverticulitis. Inflammation of the small pouches (diverticula) that can form in the weakened muscular wall of the large intestine
• Dysentery. Inflammation of the intestine with severe diarrhea and intestinal bleeding, resulting from drinking water containing a parasite called Entamoeba histolytica

(Illustration by GGS Information Services/Thomson Gale.)

• Food poisoning. Eating foods that are spoiled or tainted because they either contain harmful microorganisms, or toxic substances that make them unfit for consumption.
• Gardiasis. Infection of the intestine by the parasite Giardia intestinalis The parasite is one of the most common causes of waterborne disease in the United States and can be found in both drinking and recreational water.
• Infectious diarrhea. Diarrhea resulting from bacterial or viral infections. Bacterial diarrhea is most commonly caused by Campylobacter jejuni, Salmonella, Shigella, Escherichia coli O157:H7. Rotavirus is the commonest cause of viral diarrhea in the United States. Other viruses causing diarrhea include Norwalk virus, and cytomegalovirus.
• Irritable bowel syndrome (IBS). IBS, also called spastic colon, or irritable colon, is a condition in which the colon muscle contracts more readily than it should.
• Lactose intolerance. The inability to digest significant amounts of lactose, the major sugar found in milk, due to a shortage of lactase, the enzyme produced by the cells lining the small intestine. Lactase breaks down milk sugar into two simpler forms of sugar that are then absorbed into the bloodstream. If not present, lactose is not broken down.
• Malabsorption. Poor absorption of nutrients by the small intestine.
• Ulcerative colitis. Inflammation of the inner lining of the colon, characterized by open sores that appear in its mucous membrane.
• Viral gastroenteritis. Inflammation of the digestive tract, primarily of the stomach, small and large intestines. It is a mild viral infection that usually goes away on its own within a few days. It is often called “stomach flu”.
• Excessive exercise.

Description

In most diarrhea cases, treatment first seeks to prevent the body from losing too much fluid (dehydration) and the salts and minerals required by the body (electrolytes). A diarrhea diet accordingly includes drinking plenty of water. However, broths and soups that contain sodium, and fruit juices, mineral water, soft fruits, or vegetables that contain potassium, are also extremely important to restore the electrolyte levels and correct nutritional deficiencies. Until the diarrhea stops, it is also recommended to avoid caffeine, milk products, and foods that are high in fiber, or very high in simple sugars, as they tend to aggravate diarrhea. For example, soft drinks, undiluted fruit juices, and presweetened cereals should be avoided. Also, fried or fatty foods should be avoided because of their tendency to delay stomach emptying. Carbonated drinks can also affect intestinal contractions and make diarrhea worse. A heath care practitioner may also recommend the BRAT diet that includes bananas, plain rice, applesauce, and toast.

Some specific diarrheas have their own dietary requirements. For instance, avoiding dairy products in cases of lactose intolerance, or gluten in cases of malabsorption. Diarrhea caused by antibiotics can also be reduced by taking probiotic yogurt with live active cultures.

As the diarrhea improves, soft, bland foods can usually be added to the diet, supplementing bananas, plain rice, and toast with boiled potatoes, crackers, cooked carrots, and baked chicken without the skin or fat. Other recommended foods include cereals (rice, wheat, and oat cereals), and yogurt. Once the diarrhea has stopped, a person can usually return to a normal and balanced diet. The Schiffert Health Center offers the following dietary tips for the first several days after experiencing diarrhea:

• Begin eating bland, easy-to-digest foods after the first 24 hours of diarrhea.
• Slowly progress to other foods as you can tolerate them.
• Avoid food and drink that cause discomfort, cramping or gas for the first few days. Examples of food to avoid may include: spicy foods (black pepper, chili powder), caffeine, chocolate, carbonated drinks and cola drinks, alcohol, fried foods and greasy foods, acidic fruit juices (orange, grapefruit), gaseous vegetables (broccoli, cabbage, corn, cauliflower, onions).
• Initially, eat smaller meals evenly spaced throughout the day to reduce stomach acidity.
• Eat slowly and chew food well.
• A progressive bland diet may propose the following eating plan:
• Day 1: Drinking clear liquids at room temperature such as sports drinks (Powerade/Gatorade), weak tea (decaffeinated), non-caffeinated sodas;
• Day 2: Slowly adding bland foods in small amounts as can be tolerated during the day. Examples are: oatmeal or cream of wheat made with water, dry cereal (without milk), plain rice or pasta (no butter, oil, or sauces), crackers or pretzels, gingersnaps, plain toast (no butter or jelly), mashed potatoes (no skins), ripe bananas (ripe), applesauce, chicken noodle soup.
• Day 3: Gradually adding more variety of foods in small, more frequent meals evenly spaced throughout the day. Examples are: soft boiled eggs or scrambled eggs, plain baked potato, fish or chicken (no skin) well-cooked, baked or grilled (not fried), plain yogurt, cottage cheese, cooked carrots or green beans, milk (skim or low-fat after diarrhea has stopped).

Function

The primary function of a diarrhea diet is to assist the treatment seeking to correct the cause. This almost always includes preventing dehydration and replenishing lost electrolytes, especially serious in babies and young children. In serious cases, a physician may also recommend electrolyte solutions, available at drugstores. Medicines that stop diarrhea may be helpful, but they are not recommended for people whose diarrhea is caused by a bacterial infection or a parasite, because the diarrhea helps to purge the pathogen. Viral infections are either treated with medication or left to run their course, depending on the severity and type of virus.

Benefits

Certain foods are considered beneficial such as bananas because they contain potassium, required to control the body’s fluid balance, while boiled rice and toast provide low-fiber carbohydrates that do not irritate the bowel. Applesauce has a low GI and low fiber.

Precautions

For most people, any liquid that they normally drink should be adequate to bring fluid levels back to normal (rehydration). However, too much water alone, at any age, can be harmful, because water does not have any sugars or important electrolytes, such as sodium. This is why the diet must include foods and drinks that restore electrolyte levels. In this respect, mineral water is recommended. Signs of dehydration include:

• Thirst
• Dry mouth and tongue, parched throat
• Reduced need to urinate
• Dry skin and hair
• Light-headedness
• Dark urine

Very young infants also pose special problems because their risk of dehydration is much higher. They should be given a bottle frequently. A pediatrician may recommend solutions such as Pedialyte as these fluids also contain the necessary salts lost with diarrhea. Salt tablets should never be used as they may worsen diarrhea.

Diarrhea is often caused by foodborne or water-borne pathogens. The Mayo Clinic offers the following advice to prevent food contamination at home:

• Washing hands, utensils and food surfaces often to prevent cross-contamination, i.e. the transfer of harmful bacteria from one surface to another
• Keeping raw foods separate from ready-to-eat foods, also to prevent cross-contamination
• Cooking foods to kill harmful organisms (to temperatures between 140°F (60°C) and 180°F (82°C)
• Refrigerating or freezing perishable foods to avoid rapid growth of harmful bacteria
• Throwing food out when in doubt
• Drinking water only from a trusted source

Risks

There are no risks associated with a bland diet or with drinking liquids that replenish fluid levels as long as electrolytes are also provided.

Research and general acceptance

There is broad consensus among health practitioners that a bland diet combined with replenishing lost fluids and electrolytes is beneficial to treat most cases of diarrhea.

The Division of Digestive Diseases and Nutrition at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) supports basic and clinical research into gastrointestinal conditions, including diarrhea. Among other areas, NIDDK researchers are studying how the processes of absorption and secretion in the digestive tract affect the content and consistency of stool, the relationship between diarrhea and pathogenic bacteria, motility in chronic diarrhea, and chemical compounds that may be useful in treating diarrhea.

Resources

BOOKS

Dalessandro, T. M. What to Eat with IBD: A Comprehensive Nutrition and Recipe Guide for Crohn’s Disease and Ulcerative Colitis New York, NY: iUniverse (Barnes and Noble), 2006.

Wood, G. K. The Complete Guide to Digestive Health: Plain Answers About IBS, Constipation, Diarrhea, Heartburn, Ulcers, and More Peachtree City, GA: FC&A Publishing, 2006.

McDevitt, B. L. Diarrhea Frederick, MD: PublishAmerica Inc., 2005.

Ericsson, C. D., Dupont, H. L., Steffen, R. Traveller’s Diarrhea Hamilton, ON: B.C. Decker, 2003.

Berkson, D. L., Droby, S. Healthy Digestion the Natural Way: Preventing and Healing Heartburn, Constipation, Gas, Diarrhea, Inflammatory Bowel and Gallbladder Diseases, Ulcers, Irritable Bowel Syndrome, and More New York, NY: John Wiley ’sons, 2000.

Wilson, C. L., Droby, S. Microbial Food Contamination Boca Raton, FL: CRC Press, 2000.

Scala, J. The New Eating Right for a Bad Gut: The Complete Nutritional Guide to Ileitis, Colitis, Crohn’s Disease, and Inflammatory Bowel Disease London, UK: Plume Books (Penguin Group), 2000.

ORGANIZATIONS

Food and Drug Administration, Center for Food Safety and Applied Nutrition. 5100 Paint Branch Parkway, College Park, MD 20740-3835. 1-888-SAFEFOOD (1-888-723-3663). <vm.cfsan.fda.gov>

U.S. Department of Agriculture, Food Safety and Inspection Service. Meat and Poultry Hotline: 1-888-MPHotline (1-888-674-6854). <www.fsis.usda.gov>

U.S. Environmental Protection Agency. 1200 Pennsylvania Avenue, NW, Washington, DC 20460. 202-272-0167. <www.epa.gov>

Centers for Disease Control and Prevention. 1600 Clifton Road, NE, Atlanta, GA 30333. 1-800-CDC-INFO (1-800-232-4636) or 404-639-3534.<www.cdc.gov>

Crohn’s and Colitis Foundation of America. 386 Park Avenue South, 17th Floor, New York, NY 10016. 1-800-932-2423. <www.ccfa.org>

American Gastroenterological Association. 930 Del Ray Avenue, Bethesda, MD 20814. (301)654-2055. <www.gastro.org>

International Foundation for Functional Gastrointestinal Disorders Inc. P.O. Box 170864, Milwaukee, WI 532176. 11. <www.iffgd.org>

Monique Laberge, Ph.D.