Diarrhea…. When things are moving too fast… If you’re suffering from the opposite of constipation, it can cause you a lot of stress. The sudden urge to have to go to the toilet, and in the worst case sometimes not even making it to the toilet on time. That’s something no one hopes to experience. Unfortunately, if you’re suffering from diarrhea predominant irritable bowel syndrome (IBS-D) or chronic diarrhea this may be your daily life. Luckily, with IBS and gut issues there often are ways to make it better through nutrition! And I’m going to tell you exactly how.
Types of Diarrhea
Apart from acute diarrhea, which usually has a very specific cause like food poisoning, the flu or infections. The reason for chronic diarrhea is usually less clear. You can suffer from diarrhea for years, without knowing it’s cause or solution. This can be very frustrating and creates a lot of strain on your social and working life.
Research actually shows that people with IBS-D report having a significantly lower health-related quality of life, greater productivity loss at work and are missing days of work. This leads to an estimated $2485 extra costs (for the employer) for the person with IBS-D in comparison to someone without.
I personally think that the loss of quality of life is a bigger issue than the extra costs, but still, it would be great to tackle both of those!
When looking at the Bristol Stool Chart, diarrhea is shown as types 5-7. The stools are soft, easy to pass and sometimes completely liquid and hard to hold up when you feel the urge to go.
A normal stool is type 3-4. Which is what would be ideal to have most of the time.
Diagnostic Criteria for Diarrhea
According to the ROME IV criteria, you can either have diarrhea-predominant irritable bowel syndrome (IBS-D) or functional diarrhea (which sounds like it should have a function, but it really doesn’t). The criteria for IBS-D and functional diarrhea are as follows:
|Rome IV Diagnostic Criteria for IBS-D|
|IBS—Recurrent abdominal pain on average at least 1 d/wk in the last 3 mo that is associated with at least 2 of the following criteriaa:|
Related to defecation
Associated with a change in frequency of stool
Associated with a change in form (appearance) of stool,
with the IBS-D subtype identified with:
>25% Bristol stool types 6 of 7 and
<25% Bristol stool types 1 or 2
|a Criteria fulfilled for the last 3 mo, with symptom onset at least 6 mo prior to diagnosis.|
IBS-D, irritable bowel syndrome with predominant diarrhea
|Rome IV Diagnostic Criteria for Functional Diarrhea|
|Loose or watery stools, without predominant abdominal pain or bothersome bloating|
|Loose stools occur >25% of the time|
|Criteria fulfilled for the last 3 mo, with symptom onset at least 6 mo prior to diagnosis|
|Patients meeting the criteria for IBS-D should be excluded|
|IBS-D, irritable bowel syndrome with predominant diarrhea|
Of course, it is always wise to keep your eyes open for ‘red flags’. These are symptoms that indicate an underlying cause for diarrhea. Always consult your doctor if you’re worried about your symptoms or experience blood loss, fevers, waking up at night because of symptoms, family history of colon cancer or if you’re experiencing new symptoms you haven’t had before.
Causes of Diarrhea
Diarrhea can be caused by multiple factors. And often finding the source is the first step to your solution. Diarrhea is stools that are too moist, so either your intestine has not properly absorbed all the liquid out of the stools or there has been too much liquid attraction into the intestine.
Some of the most common causes of chronic diarrhea are:
| Bowels working too fast. |
If the stools move through your intestine at a high pace, your intestine will not have enough time to absorb the liquid out of the stools. Resulting in diarrhea.
|Irritable Bowel Syndrome. |
IBS is one of the most common causes of gut symptoms. For more information, read on in my article about IBS.
If you are intolerant to certain foods, your body will have difficulties breaking it down. As a result your gut bacteria will break it down for you, and they create acid and gas. This will attract liquid to your intestine and leave you with diarrhea.
Examples are FODMAP’s, Lactose, sweeteners.
|Celiac disease/gluten allergy|
If you are celiac, chances are you know it already. Most people with celiac disease have severe symptoms from a very early age. There are also cases known where the diagnosis of celiac disease has been made later in life because the symptoms aren’t as clear. So getting gluten allergy checked is not a bad idea if you experience a lot of symptoms!
Stress is a factor that influences many of our bodily functions. It actually helps speed up the movement of your intestines and this way it can promote diarrhea.
Small Intestinal Bacterial Overgrowth is where the bacteria from your large intestine have grown over to your small intestine. They are not supposed to be in your small intestine and this can cause gut problems. Read more in my article about SIBO.
| Bile acid malabsorption |
Bile acid is the juice that helps you break down the food you eat. Whenever food is coming from your stomach into your intestine the bile is added to break it down into nutrients. Usually most of the bile is absorbed in your small intestine and does not reach your large intestine. This bile is very sour and can trigger the movement of your large intestine if it’s not properly absorbed. Malabsorption of the bile acid can thus trigger diarrhea.
|Bariatric surgery. |
After bariatric surgery like a gastric bypass, your food will not be digested and absorbed properly anymore. This can lead to undigested food particles in the large intestine which in turn can cause diarrhea by attracting water to the intestine. Other caused of diarrhea after bariatric surgery can be SIBO, Bile Acid Malabsorption or Dumping Syndrome.
|Medicine use. |
Often medicine can have a side effect of causing diarrhea. If you use medication, make sure to check the leaflet of the medication on possible interactions with the gut.
Examples are antibiotics and metformin.
|Illness or parasites that can’t be fixed through nutrition. |
If you suffer from chronic diarrhea, it’s always good to have a checkup with your doctor. There could be an underlying cause to your problems, and usually, a simple blood test can either confirm or dismiss this.
Do you have diarrhea and would you like guidance from a specialized dietitian? Then schedule an online consultation at my online dietician’s practice Darm diëtist, and I will help you with all your questions!
Solutions for Diarrhea
Apart from medication, which your doctor could prescribe you, it’s valuable to try and find the solution for your symptoms the more natural way. Listed below are the most effective options to try:
Consuming Enough Fiber
This is the one I always start with in my practice and often has a great effect! Fiber is the main binding agent in the intestine, and many people don’t consume enough of it. When you don’t eat enough fiber, there will be no way to bind the moisture that is present in your intestine. Resulting in diarrhea.
The general advice is to eat at least 25 grams of fiber a day, but a lot of people don’t even reach 15 grams!
There are 2 different types of fiber present in foods that can help bind moisture in the intestine. Soluble fiber and insoluble fiber. Each one of these fibers provides a great food source for your healthy gut bacteria.
Soluble fibers are present in: fruit, vegetables, and legumes. This fiber binds moisture in the intestine without increasing the amount of stool.
Insoluble fibers are present in: grain products. This fiber increases the volume of the stool and it retains moisture.
In general, you can find fiber in the following foods:
– Vegetables; raw, baked or boiled
– Legumes, like white and brown beans, lentils and chickpeas
– Dried fruits like plums, raisins, figs, dates, and apricots
– Whole grain products like rye, muesli, whole grain bread, crackers or knäckebröd, muesli
– (Cooled down) potatoes, brown rice, wholemeal macaroni and spaghetti
– Nuts, peanuts, sesame seeds, linseed, pumpkin seeds, sunflower seeds, chia seed
Increase your intake of these foods, and soon you can start to notice your stools getting better! To get personalized advice on how much fiber you should take and on how to reach that amount, I recommend you to ask help from a dietitian nearby!
The use of psyllium fiber is actually also an effective way to increase your fiber intake. Apart from it increasing the total fiber intake, psyllium is a fiber which very effectively binds water. This can help you reduce diarrhea.
Psyllium fiber is best taken with a glass of water or juice. Mix 1 tablespoon with the water and drink it quickly. If you leave it standing too long, the fiber will start absorbing the moisture and will thicken the water, this makes it harder to drink it. You can also mix the psyllium through milk or yogurt, but it’s wise to still drink a glass of water with it.
The psyllium can make it harder for your body to properly digest medicine, so if you use medicine have a 1-2 hour gap between taking the medicine and taking the psyllium. Do consult your doctor if you have any questions about that.
The FODMAP Diet
If you are having diarrhea from the IBS-D subtype, chances are the FODMAP diet can provide a solution for you! In my article ‘The FODMAP diet’ you can read all about the diet and how it works.
In short, FODMAP’s are carbohydrates that your body can’t break down. These carbohydrates will arrive in your large intestine fully intact where your gut bacteria will start to break them down. The bacteria will produce gas and acid as a result of digestion. These acids can attract liquids to your bowel, and leave you with diarrhea. Basically, all FODMAP groups can cause diarrhea but before starting the full FODMAP diet, I would recommend checking whether or not you’re using a lot of artificial sweeteners. And this brings us to my next solution:
Eliminating Sweeteners / Polyols
Sweeteners are widely used in products nowadays. And this can pose a problem for many people. The sweeteners are not being absorbed in the small intestine and will attract moisture in the large intestine. This extra moisture can leave you with diarrhea.
Often, products that contain sweeteners have a warning on their label. You might have seen it on chewing gum for example. They warn you that the overuse of the product can cause diarrhea. And this is the same with all other products that contain sweeteners.
The biggest ‘bad guys’ are sweeteners like sorbitol, maltitol, mannitol, erythritol, isomalt, lactitol, xylitol, polyglycitol, polydextrose. As you can see, it is wise to keep an eye out for anything ending with ‘-ol’ since that usually indicates a diarrhea-causing sweetener.
Anything that lists ‘ sugar-free’ or ‘without added sugar’ is a product to watch out for. Chances are that it contains sweeteners!
If you really want to sweeten something and do not want to use sugar, then stevia is the best way to go. Although it’s best to avoid sweeteners altogether.
A lot of people in the world have lactose intolerance. Lactose is a sugar that is naturally found in dairy and milk products and people with lactose intolerance can’t digest the lactose. The lactose will attract water to the intestines, which can cause diarrhea. For more information on lactose intolerance, read on in my article.
Fructose is a fruit sugar which can be hard to digest. If you can’t digest the fructose this will attract water to the intestine to cause diarrhea. Fructose is a FODMAP and you can read more about it in my FODMAP article.
Fructose is found in fruits like mango, apple, cherries, figs and vegetables like artichoke, asparagus.
A little different from the FODMAP diet is a gluten-free diet. For the extensive explanation of the gluten-free diet, I recommend you to read my article ‘Gluten (what you need to know)’.
In short, gluten is a protein that is present in grain products. People that react to gluten can either be allergic or intolerant for gluten. The allergy is a serious health issue and is usually discovered at a young age. The intolerance, on the other hand, can start to show itself at any age and is less clearly present.
Because gluten are present in a lot of products we consume nowadays, it can be hard to pinpoint the exact culprit that is causing your problems.
If you’re suffering from diarrhea it can be smart to eliminate gluten from your diet for 1-2 weeks and see how you feel. As said, for more information read my article about gluten.
Stress has a significant effect on gut health. Studies have shown that stress alters the movement of your intestines and changes the gut bacteria. Both of these changes can result in diarrhea.
By reducing stress, the changes in your gut can be reversed. Ways to reduce stress are exercise, yoga, meditation, being active with your hobbies, spending time with loved ones or kids or anything that takes your mind off the things that worry you. Try to find what works for you, and notice your gut calming down.
When it comes to probiotics, there often is little information available as to when and how to use it. That being said there have been studies that show a positive effect of probiotics on IBS-D.
Small studies have shown Bifidobacterium Infantis to be beneficial when it comes to IBS-D. A probiotic supplement with this bacteria strain is something that is worth trying when the other solutions did not work for you. Read how to choose a good probiotic supplement in my article about probiotics.
With all probiotic strains, it can be a trial and error to find out if the supplement will work for you.
Lowering Fat Intake
A high intake of dietary fat is linked to an increase in IBS symptoms (mostly diarrhea). Lowering fat intake can help decrease these symptoms. Make sure to spread your fat intake evenly throughout the day and to use healthy fats if you do eat fat.
You can find healthy fats in nuts, seeds, avocado, olive oil, and fatty fish.
Lowering Caffeine Intake
Caffeine has a stimulating effect on your digestive system. Triggering it to move faster. This is why a lot of people have their morning poop after their cup of coffee. If you drink a lot of coffee or strong black tea. Try toning it down a little (to 2-3 cups of coffee a day or max. 5 cups of tea) for 1 week. See if your diarrhea gets better.
Especially when the diarrhea is present after a party or the weekend, chances are that it’s being triggered by alcohol. Alcohol has the tendency to leave you with loose stools the day after you drank it.
If you are a frequent alcohol user and have diarrhea issues. Try eliminating alcohol for 1 week. If the alcohol is the cause of your symptoms, you’ll see improvement soon.
And it’s a wrap! If you have chronic diarrhea try the solutions listed above after you’ve talked to your doctor and made sure the diarrhea is not caused by a disease or malfunction of the body. What solutions have worked for you? Please let me know in a comment!