Diarrhea – initial considerations

© Dr. Michael D. Jacobson, D.O. Do not reproduce this article without permission.

Editor’s note: This information was published in the December 2019 issue of Heartfelt Magazine, CHM’s monthly magazine that provides CHM membership-related tips and tricks, medical advice from doctors, testimonies from CHM members, and more. Please refer to the CHM Guidelines and applicable web pages for the most up-to-date information regarding CHM membership, sharing eligibility, and ministry news.

A member contacted me asking for advice on how to deal with her chronic diarrhea problem. A colonoscopy revealed limited diverticulitis and colitis (inflammation). Treatment with medication had only yielded minimal improvement. Though chronic or intermittent diarrhea can have a number of causes, I suggested she begin with a few of the more common considerations: food intolerance, microflora (good bacteria) disruptions, or infection.

1) Food intolerances. These are best tested through an elimination diet and “challenge” testing. In general, eliminating the suspicious food from your diet for four or five days, then adding it back into your diet (challenging), will reveal if that food group is disagreeing with your digestive system. In most cases, symptoms will significantly improve within four or five days of eliminating the offending agent. Then, after eliminating it completely for several days, symptoms will tend to be more severe and immediate when the offending food is reintroduced.

a) Dairy: The most common food intolerance is dairy, thought primarily to occur as a result of insufficient lactase. Lactase is an enzyme made by the surface (mucosal) cells of the small intestine. Lactase breaks down lactose, the sugar in cow’s milk. To determine if they’re contributing to digestive disturbance, all dairy products should be eliminated from the diet. If symptoms significantly improve after four or five days, attempt reintroduction. Many people who suffer from lactose intolerance are able to tolerate butter and cultured dairy products. Others will be able to consume limited amounts of dairy products if they supplement these foods with a lactase enzyme supplement or lactose-free dairy products. Some people must cut it out of their diet entirely.

b) Gluten: Gluten intolerance seems to be increasing in prevalence. What’s unique about gluten is that it’s a large protein with many different sub-types. Therefore, it is difficult to capture everyone with gluten intolerance through laboratory testing; it’s also difficult to fully eliminate gluten from the diet. It generally takes a full month to rid the body of gluten before a reintroduction can lead to determining if someone has an intolerance.

c) Other: Virtually any food can be a problem. If a food is suspected, try eliminating it for several days before re-introducing it into the diet as described above.

2) Disruptions in the gut microbiome. Literally trillions of bacteria reside in the small and large intestines. These bacteria are there by design and accomplish many important functions in healthy individuals, including digestion of several types of foods. They produce several key vitamins, such as vitamins B-12 and K. Some people can experience a disruption in the balance of these bacteria. One common cause is antibiotics, which can kill the target bacteria—and also the good bacteria. If this is the case, secondary pathologic (harmful or disease-causing) bacteria, yeast or parasites might flourish. To address this problem, consider supplementing your diet with probiotics (friendly bacteria).

3) Infections

a) Bacterial infections are usually associated with short-term diarrhea. An exception to this is Clostridium difficile (C. diff). Physicians typically consider C. diff the culprit in someone with chronic diarrhea, particularly if it followed antibiotics and is associated with frequent watery, foul-smelling stools. Another exception is a condition known as Small Intestine Bacterial Overgrowth (SIBO). Ironically, antibiotics are usually necessary to treat these chronic bacterial infections, even though they may have initially caused the problem.

b) Parasites can also be a problem, particularly if someone consumes contaminated water or food, often associated with international travel. Stool testing for ova and parasites, ordered by your physician, should reveal the answer.

c) Yeast or fungal infections are somewhat difficult to detect, and often not considered as the cause of chronic diarrhea. If present, these tend to get worse and are associated with gas when sugars are consumed, as yeast metabolizes sugar and produces carbon dioxide gas. If you suspect a yeast or fungal infection, ask your doctor to consider placing you on a three-week trial of either Nystatin (taken several times a day on an empty stomach), or Diflucan (can be taken once a week for three weeks, though care needs to be exercised since it can be hard on the liver).

For more information consider visiting: www.niddk.nih.gov/health-information/digestive-diseases/diarrhea.

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