Nutrition Strategies for Managing Diarrhea
Persistent or recurring diarrhea is a symptom that occurs in several digestive disorders. It can have many causes. If you have anything more than mild, short-term diarrhea, you should consult a physician to obtain a diagnosis and specific treatment.
In some people, chronic diarrhea may be controlled to some extent through diet and lifestyle factors. The good news is that making some changes to what, when, and how much a person eats and drinks, along with medications, if indicated can improve the quality of life for some.
All of the suggestions listed in this article may not work for everyone, but if there is something you may not have tried in the past, you might want to experiment to see what is most helpful for you.
The Role of Diet
If you suffer from chronic diarrhea, you have probably been advised to try the BRAT diet. This stands for: Banana, Rice, Applesauce, Toast.
These food choices may help to prevent over-stimulation of the bowel, and slow down the frequency of bowel movements. However, the BRAT diet recommendations are boring, and hardly nutritionally adequate.
As a starting point, here are some extreme nutritional strategies that are not recommended:
- Do not eliminate all fiber,
- Do not limit your diet to only liquids,
- Do not cut out all liquids (you can become dehydrated), and
- Do not exclude foods with sodium and potassium. These are electrolytes, which can become depleted if you have diarrhea.
What May Help
If you are trying to control the frequency of bowel movements, there are certain foods you may need to be cautious with. Sometimes it is the temperature of food, or portion eaten, that may increase the frequency of bowel movements. If you have chronic diarrhea, it is a good idea to keep a food diary so that you can identify problem foods, difficult times of the day, and symptoms. The following foods may contribute to loose stools.
Foods that May Produce Loose Stools
- Dried beans, corn, vegetables, and cabbage family vegetables are all high in fiber, which may worsen diarrhea
- Fruits and juices contain fructose, which can worsen diarrhea
- Caffeine-containing beverages such as coffee and tea can have a laxative effect
- Alcoholic beverages such as beer, wine and liquor can worsen diarrhea
- Fatty meats such as bacon, lunch meats, and heavily-marbled meats can worsen diarrhea
- Fried foods, pastries, and chips are high in fat which can worsen diarrhea
- Monosodium glutamate (MSG), a flavor enhancer, may exacerbate diarrhea
- NutraSweet® may be a problem for some people
- Large quantities of nuts or nut butters may worsen symptoms
- Concentrated sweets can worsen symptoms
- Dried fruits such as figs, dates, raisins, and prunes can have a laxative effect
- Prune juice can exert a laxative effect
- Sugar-free gums and mints contain the sugar alcohols sorbitol, mannitol, and/or xylitol, which can have a laxative effect
- Real black licorice (not the candy) can have a laxative effect
In addition to food choices that may be bothersome, there are several supplements which may cause more frequent bowel movements, and worsen existing diarrhea.
Supplements that can Worsen Symptoms
- Acetyl L-carnitine
- Activated charcoal
- Bee pollen
- Borage oil
- Bovine colostrum
- Chondroitin sulfate
- Flaxseed oil
- Guar gum
- Horse Chestnut seed
- Kola Nut
Foods that May Help to Control Diarrhea
- Increase fluids to prevent dehydration, but try to consume fluids between, not with, meals. (Liquids with a meal will speed up gastric emptying, potentially worsening diarrhea.)
- Consume foods/beverages with sodium and potassium:
- Broth (sodium)
- Sports drinks (sodium and potassium)
- Equalyte®, Pedialyte® (sodium and potassium)
- Bananas (potassium) or banana flakes are a good way to boost potassium, and can be added to hot cereals
- Nectars (potassium)
- Boiled or mashed potatoes ( potassium)
- Eat lower fiber foods:
- Yogurt (unless you are lactose intolerant, in which case you may need to limit consumption)
- Cream of wheat
- Grape juice
- Smooth peanut butter, a small amount at a time
- White bread
- Lean meats
- Cottage cheese
- Canned fruits in small quantities
- 1–2 Tbsp of vegetables at a time
- Drink beverages at room temperature, not hot or cold
Supplements that May Help
- Blackberry root bark (used as a tea)
Although psyllium is often used as a bulking agent for those with constipation, it can be effective in slowing down your bowel movements so that you are not going to the bathroom quite so often. Blackberry root bark contains tannins, which can also help to slow the transit time of stool through the intestinal tract.
Other supplements that may be of benefit include probiotics and pectin. Probiotics may help prevent antibiotic-associated diarrhea. They are most readily found in yogurt that contains Live Active Cultures such as lactobacillus acidophilus. Look for the term LAC on the label of yogurts in the dairy case – frozen yogurt does not contain LAC. If you are on antibiotics, you need to consume dairy products 2 to 3 hours apart from your medications.
Pectin is a form of fiber found in fruits and certain vegetables, and also sold in a powdered form in grocery stores in the aisle with pudding and gelatin. These are typically added to fruit to make preserves. To help with diarrhea, try mixing 1 tablespoon of the powder with ¼ cup of lemon water 20–30 minutes before a meal. Some of these powders are sweeter than others, so if you need to sweeten the mixture to get it down, it is fine to add a little sugar. The type of fiber in pectin may help to slow the emptying of the gut to decrease the urgency.
In addition to food choices, the number of meals is also important. Do try to eat smaller, more frequent meals through the day instead of large meals. Also, do try to rest after meals. Relaxing after eating can slow peristalsis, the rate at which food passes through the gut. Make it a point to sit for 20 to 30 minutes after a meal, or try to rearrange meal times so that you don’t need to get up and dash out as soon as your plate is empty.
The Bottom Line
To prevent complications that can result from frequent bowel movements, do try to do the following:
- Identify which foods and fluids are bothersome to you
- Drink enough fluids apart from meal times
- Make sure you include foods with sodium and potassium daily
- Eat less, more often
- Sit after you eat
Remember, generalized dietary advice does not work for everyone. The influence of diet is unique to each individual. If you have questions about your symptoms and circumstances, talk to your doctor. He or she may be able to help you identify dietary and/or other factors that might be impacting your symptoms.
Leslie Bonci is a Master of Public Health, Registered Dietician, and Licensed Dietitian/Nutritionist. She is the author of “The American Dietetic Association Guide to Better Digestion,” a user-friendly guide intended to show you how to analyze your eating habits so that you can map out a dietary plan to manage and reduce the uncomfortable symptoms of digestive disorders. The book is available in bookstores. ISBN:0471442232