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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | It can lead to... | Recommendations

 

In the United States, acute diarrhea is the second most commonly reported illness after respiratory infections, and worldwide, diarrhea is the leading cause of death in children less than four years of age. Diarrhea is best defined as an abnormal looseness of the stool, and may include changes in stool frequency, consistency, urgency and continence, often with the related symptoms of cramping and bloating. The symptom of diarrhea, however, is to a large extent subjective; people define it based on their own experience. Diarrhea becomes a problem when the change in bowel habits becomes annoying or distressing to the individual, or when it is associated with or causes a change in the person's well being. Acute Diarrhea
Acute diarrhea is defined as the passage of a greater number of stools of looser form than is customary, with a duration lasting no longer than 2 weeks, often with discomfort from associated gas, cramping and bloating. Severity of diarrhea may be defined as mild (no changes in activities required by the patient), moderate (change in activities required but the person is able to function), or severe (patient is disabled, often confined to bed or room). The incidence of acute diarrhea in the United States is approximately one episode per person per year, making it one of the most common medical disorders seen by primary care practitioners.

Patients with intense diarrhea and large fluid and electrolyte losses may develop dehydration that will need medical evaluation. Dehydrating illness is particularly problematic for the very young or very old. No firm conclusions can be drawn from the symptoms or the severity of the illness as to its likely cause.

The volume of the diarrhea may help to localize the disease process within the GI tract. Frequent, small volume bowel movements typically are associated with diseases of the left colon or rectum, and watery large volume movements suggest disorders of the small bowel or proximal colon. Urgency and cramping typically indicates inflammation in the rectum. Nocturnal diarrhea may be seen in infectious colitis or severe inflammatory bowel disease, and is not a feature of irritable bowel syndrome.

It is important to investigate medication use; acute diarrhea is a common side effect of a new medicine or one which contains magnesium. Antibiotic associated diarrhea is frequent, whether as a result of the medication itself or secondary to the production of a toxin by Clostridium difficile. Use of alcohol or illicit drugs (particularly methamphetamine) should be ascertained. The intake of coffee, tea or colas may lead to caffeine or methylxanthine induced diarrhea. Dietetic foods, gums or mints may contain poorly absorbed sugars such as sorbitol or mannitol which cause osmotic diarrhea.

Traveler's diarrhea, usually caused by enterotoxic Escherichia coli, is common, particularly in travelers to developing portions of the world, such as Mexico, the Mid East and India. Some more unusual infections are suggested by the site of the recent travel. For example, camping in the mountains (and drinking untreated water) raises concern for Giardia lamblia infection. With increased international and adventure travel have come more exotic pathogens that need to be considered. Infection with Cyclospora cayetanensis and Cryptosporidium parvum from travel to Nepal and St. Petersburg (Leningrad), respectively, are illustrative. Living in proximity to farm animals, or visiting petting zoos may lead to exposure to Salmonella, Brucella, or Cryptosporidia. Eating contaminated foods such as ground beef may expose a person to Escherichia coli 0157:H7, a cause of bloody diarrhea. Campylobacter infection may result from eating undercooked chicken or turkey. Health care workers are at increased risk for nosocomial infections (e.g., Clostridium difficile). Sexual practices may yield clues as to the etiology of diarrhea. Anal intercourse is a risk factor for proctitis, caused by Entamoeba histolytica, Treponema pallidum (syphilis), Neisseria gonorrhea, Chlamydia, and Herpes simplex in addition to more common bacterial pathogens. With the AIDS pandemic, one needs to be alert for opportunistic infections that may present as acute diarrheal illness.

A distended, rigid or tender abdomen may indicate a potential catastrophe, and prompt immediate, aggressive evaluation for its cause. Most episodes of acute diarrhea are managed by the affected person or by a family member with dietary modifications or with the use of available OTC medications. These can assist in reducing frequency of stools while others address symptoms of gas or bloating and newer combined formulations can do both.

In patients with mild, acute diarrhea, no immediate laboratory evaluation is needed as the results often will become available only after symptoms have subsided. Laboratory evaluation should be restricted to patients with severe diarrhea or when illness is complicated by the presence of dysentery, fever, or when the duration of illness becomes protracted. Stool cultures are not routinely indicated. They should be performed in patients with severe diarrhea and fever, dysentery, fecal leukocytes, or a prolonged (greater than 14 days) diarrheal illness.

Examination of stool for ova and parasites is indicated in patients with prolonged diarrhea, or who have particular circumstances (e.g., travel, occupation, immunocompromised status) that make them susceptible to parasitic infestation. When parasites are suspected, obtaining three fresh stool samples for immediate examination will provide better results than just one.

Conventional Treatment of Acute Diarrhea
Fluid repletion is important even for the majority of patients who have mild diarrhea. Oral replacement solutions should be used. The World Health Organization solution as well as commercially available preparations can be given both for rehydration and maintenance fluid requirements. These solutions are preferable to dilute fruit juices, uncarbonated soft drinks, or tea with sugar. Dietary modifications also may be helpful to the patient with mild, acute diarrhea. Milk and dairy products should be withheld for 24 to 48 hours, and initial refeeding may begin with cereals, starches, soups and broth.

Therapy with antidiarrheal medications is indicated for relief of the debilitating symptoms that accompany many diarrheal illnesses. Most patients can take antidiarrheal medications safely to improve their symptoms, although care must be taken not to administer antimotility agents to patients in whom a toxin producing or invasive bacteria is suspected.

Attapulgite binds water, as a result of which the stools are more formed. Attapulgite and kaolin are believed to work also by adsorbing the causative agent (bacteria or germ) and removing it from the body. It is recognized as one of the safer antidiarrheal therapies, as it exerts its effect only within the bowel lumen. Another agent, bismuth subsalicylate exerts its effect both through its antisecretory salicylate moiety and possibly also by its antimicrobial activity; it improves the symptoms of nausea and vomiting that are associated with gastroenteritis. Since bismuth subsalicylate contains non aspirin salicylate, care must be taken when it is used in patients taking medication for anticoagulation, diabetes and gout.

Most of the commonly employed antidiarrheal medications are antimotility agents that act by slowing intestinal motility, thereby increasing intraluminal fluid time and allowing for greater intestinal fluid absorption. One of the most widely used and best tolerated of these medications is loperamide. Caution must be taken when considering administration of an antimotility antidiarrheal agent in a patient with high fever or dysentery, as these medications may lead to a worsening of infectious diarrhea due to bowel stasis and increased bowel wall penetration by invasive pathogens (e.g., Shigella). The use of agents such as loperamide in acute diarrhea, and particularly in traveler's diarrhea, is usually safe in the absence of bloody diarrhea or high fever. Patients with diarrhea often have associated symptoms of nausea and bloating, and combination therapy with loperamide and simethicone is now available. Novel antisecretory compounds, which improve diarrhea through more physiologic mechanisms than do currently available agents, are in development and may become an important part of therapy in the future.

Patients in whom the use of antibiotics may be useful include those who have criteria of severe illness: high fever, signs of systemic toxicity, dysentery, or moderate to severe "traveler's diarrhea." In general, the drug of choice is a fluoroquinolone, given for one to three days. Specific therapy may be directed if stool cultures or other studies reveal a particular pathogen.

When diarrhea is more intense (for example, passage of more than 6 unformed stools per 24 hours, or associated with blood) or lasts longer than 48 hours, medical evaluation and treatment should be sought.

Chronic Diarrhea
Chronic diarrhea, especially if associated with abdominal pain or systemic symptoms, can limit activity, adversely influence quality of life, and pose diagnostic and management challenges to health care providers. Chronic diarrhea is defined as an increased stool frequency and fluidity (looseness) lasting more than two weeks. It should be distinguished from other conditions such as incontinence, which is involuntary defecation. Careful history and physical examination can determine the likely cause of most chronic diarrhea and direct subsequent diagnostic evaluation and treatment. One approach to the problem is to determine whether diarrheal stools are bloody, fatty or watery.

The most likely cause of chronic bloody diarrhea is inflammatory bowel disease (IBD), i.e. ulcerative colitis or Crohn's disease. Symptoms of tenesmus or incomplete evacuation suggest rectal inflammation. A palpable abdominal mass or tenderness, perianal fistulae, oral aphthous ulcers, sacroiliac, spinal or peripheral arthropathy, or skin changes (erythema nodosum or pyoderma gangrenosum) all suggest a diagnosis of IBD.

Less common causes of chronic bloody diarrhea include ischemia, infections (Campylobacter jejuni, Clostridium difficile, Entamoeba histolytica, Yersinia, and Cytomegalovirus), radiation or chemotherapy, and colon cancer or polyps (villous adenoma).

Maldigestion or malabsorption of fat can lead to chronic diarrhea. Fatty stools typically are bulky, greasy, and particularly malodorous. They may float because of excess gas content resulting from bacterial fermentation of unabsorbed dietary material. Individuals with maldigestion often are not systemically ill and can maintain their weight and activity in spite of massive steatorrhea because of a voracious appetite. The most frequent cause of maldigestion is pancreatic insufficiency caused by chronic pancreatitis. Those with suspected maldigestion should be asked about alcohol abuse, the most common cause of chronic pancreatitis in the United States. Severe or recurrent abdominal pain, profound weight loss, abdominal trauma or a positive family history may suggest less common causes of pancreatic insufficiency such as traumatic or hereditary pancreatitis, cystic fibrosis, congenital structural pancreatic abnormalities (pancreas divisum) or pancreatic cancer. Bile salt deficiency due to biliary tract obstruction, cholestatic liver disease, bacterial overgrowth or excessive stool losses (IBD, terminal ileal resection) also can lead to maldigestion but usually this is not associated with significant steatorrhea.

Small bowel mucosal disease or surgical resection can lead to malabsorption of fats as well as carbohydrates, proteins, vitamins and minerals, all of which can result in weight loss and various systemic signs and symptoms. Gluten sensitive enteropathy (celiac sprue) is the most common mucosal cause of malabsorption in the United States. Individuals with sprue are likely to have a positive family history, history of diabetes or skin lesions (dermatitis herpetiformis) and have manifestations of panmalabsorption dating back to childhood or adolescence. Short stature, weakness due to multifactorial anemia (iron, folate and occasional vitamin B12 deficiency), bone pain and spontaneous fractures from vitamin D and calcium malabsorption, bruising and bleeding related to vitamin K deficiency, gas and bloating due to carbohydrate malabsorption, and edema from albumin and protein loss are typical complaints of those with sprue and other small bowel mucosal diseases. Whipple's disease, tropical sprue, and Zollinger Ellison syndrome are less common mucosal conditions leading to malabsorption.

Many disorders can cause chronic watery diarrhea including carbohydrate malabsorption (lactose intolerance, sorbitol, fructose), intestinal infections or inflammation, unusual hormone secreting tumors, and irritable bowel syndrome. Careful medication history is important since such medications as NSAIDs, antacids, elixirs (containing sorbitol and fructose), antihypertensives, cholinergic agents, antibiotics, and antiarrhythmics all can cause diarrhea in some individuals. Most commonly, carbohydrate malabsorption induces an osmotic diarrhea accompanied by abdominal bloating and flatulence that is associated with meals. Such osmotic diarrhea typically abates during periods of fasting. Lactase deficiency, either ethnically acquired (more common in Asian Americans, African Americans) or secondary to acute infectious enteritis can lead to diarrhea following ingestion of milk, cheese, ice cream and other dairy products. Less commonly recognized causes of diarrhea due to carbohydrate malabsorption include ingestion of sorbitol and fructose found in certain soft drinks, juices, dried fruits, and sugar free gum or candy. A history of any relation of diarrhea to foods is important to obtain, particularly in children who seem to be more sensitive to ingested sorbitol and fructose and in older adults who may have chronic mesenteric ischemia.

Giardiasis can produce chronic symptoms, as can some opportunistic infections (e.g., microsporidiosis, cryptosporidiosis, infection with MAI or CMV) in immune suppressed individuals. Epidemics of chronic diarrhea have occurred following ingestion of unpasteurized milk but no infectious agent has been isolated in such cases. In some individuals, diarrhea may persist for months following apparent acute infectious enteritis, presumably due to secondary carbohydrate malabsorption or dysmotility from intestinal neuromuscular injury. An unusual condition, microscopic colitis, can cause chronic persistent watery diarrhea in middle aged or older individuals. While the etiology of microscopic colitis is unknown, it has been linked to gluten sensitive enteropathy, diabetes, and NSAID use, and can, in some individuals, cause nocturnal fecal incontinence.

Diabetes presumably causes chronic watery diarrhea as a result of intestinal neuropathy, bacterial overgrowth, or both. Diabetic diarrhea can occur at night, be interspersed with periods of constipation, and be associated with fecal incontinence. Individuals with diabetic diarrhea usually have severe long standing glucose intolerance associated with other diabetic complications such as retinopathy, nephropathy, and neuropathy.

Several unusual hormone producing neoplasms can cause watery diarrhea. These include carcinoid tumors and tumors producing vasoactive intestinal polypeptide and glucagon. Large volume and frequent watery stools that persist during fasting and that are associated with severe fluid and electrolyte abnormalities and dehydration characterize these endocrine neoplasms. Family history of multiple endocrine neoplastic syndrome; a history of severe ulcer disease (Zollinger Ellison syndrome); episodic hypotension, vasomotor flushing, or valvular cardiac disease (carcinoid syndrome); or the presence of a scaling, erythematous dermatitis (necrolytic migratory erythema in a patient with a glucagonoma) may offer clues to the diagnosis.

Irritable bowel syndrome (IBS) is the reason patients most commonly seek attention for chronic watery diarrhea. It is important to distinguish IBS from other conditions that cause chronic diarrhea, since in most persons with IBS, the problem is frequent defecation rather than voluminous diarrhea. Abdominal pain is the key symptom of IBS, and frequent stools often contain mucus and are accompanied by or preceded by abdominal cramps, and abdominal pain is the key symptom of IBS. Periods of loose stools can be interspersed with periods of constipation. IBS symptoms may worsen during times of emotional or physiologic stress. Those with especially severe symptoms and persistent lower abdominal pain may have been physically or sexually abused in the past. While a diagnosis of "non disease" is often difficult to make, irritable bowel syndrome is thought to be a functional disorder (dysmotility) since no anatomic or organic intestinal problems are found to explain the symptoms.

Laboratory Testing
The purposes of basic laboratory tests are: a) to assess the impact of chronic diarrhea on the patient's overall nutritional and electrolyte status, and b) to form a preliminary judgment about the characteristics of the diarrhea. A complete blood count should be obtained to look for evidence of anemia or an abnormal white blood cell count. Biochemical screening should include serum electrolytes, tests of renal function (blood urea nitrogen and creatinine) and a basic nutritional assessment, consisting of a lymphocyte count and measurements of serum calcium, phosphorus, total protein and albumin levels.

The type of diarrhea can be defined by evaluation of a random (spot) stool sample. The spot stool sample can be assessed for blood by means of a stool guaiac test (e.g., Hemoccult slide). The presence of blood suggests an inflammatory or neoplastic cause for the diarrhea, but occult blood also can be seen in celiac disease and other sprue like syndromes. The presence of pus in the stool indicates an inflammatory cause of diarrhea. This can be assessed by staining a stool smear with Wright's stain and looking for white blood cells. A latex agglutination test for the neutrophil enzyme, lactoferrin, is of proven value for detecting neutrophils in acute infectious diarrheas and in pseudomembranous colitis. Its value in chronic diarrhea has not yet been assessed.

Diarrhea that contains neither blood, pus or fat is categorized as being watery diarrhea. This usually indicates a problem with the intestinal absorption of salt and water, and can be due to secretory states or to osmotic diarrheas.

Ultrasound examination and abdominal CT scan have a limited role in the evaluation of chronic diarrhea. Endoscopy usually is more specific than Xray studies because it allows direct inspection of the mucosa, detection of superficial lesions, and the ability to biopsy the mucosa. Upper endoscopy facilitates small bowel mucosal biopsy, which is essential in establishing the diagnosis of proximal small bowel diseases, most commonly celiac sprue, but also Whipple's disease and Crohn's disease. In immune suppressed patients, the diagnosis of parasitic infestation, e.g. microsporidia, cryptosporidia, Isospora belli, as well as cytomegalovirus infection can be made by small bowel biopsy.

Giardia lamblia can cause chronic diarrhea and usually is detected in stool specimens. Occasionally, however, the organism is identified in a small bowel biopsy or by a string test. The latter examination utilizes a swallowed string to obtain a specimen of mucus from the duodenal lumen, and the mucus is subsequently examined for the presence of the organism. This test is particularly helpful in evaluation of children in whom the risks and discomforts of endoscopy may not be well tolerated.

Other blood tests that can be of use include thyroid stimulating hormone, anti-nuclear antibody, anti-gliadin and anti-endomysial antibodies for celiac disease, perinuclear antineutrophil cytoplasmic antibodies (pANCA) for IBD, HLA typing, quantization of serum immunoglobulin levels, and serum antibodies against human immunodeficiency virus and Entamoeba histolytica.

A stool pH of less than 5.3 suggests carbohydrate malabsorption, because colonic bacteria produce short chain fatty acids from malabsorbed carbohydrate. If stool pH is greater than 5.6, it is unlikely that carbohydrate malabsorption by itself explains the diarrhea. Generalized malabsorption can produce stool pH greater than 5.3, however, because of buffering by other substances. Surreptitious laxative abuse continues to be an important and underappreciated cause of chronic diarrhea. Laxative screening includes tests for magnesium, phosphate and sulfate in stool water or urine.

When a specific diagnosis is made, specific treatment often can afford a cure of chronic diarrhea. Some experts recommend that patients should receive antibiotic therapy with metronidazole or antibiotics directed against enteric pathogens before any evaluation of chronic diarrhea is started. For most patients who have been evaluated to some extent, several other options are recommended. These include use of opiate antidiarrheal drugs, the somatostatin analogue, octreotide, and intraluminal agents, such as clays, charcoal, bile acid binding resins, bismuth compounds, and fiber.

Antimotility agents and opiates are the most effective empiric therapy for diarrhea. They not only relieve symptoms of frequency and urgency, but also reduce stool weight. Many patients respond to diphenoxylate or loperamide, but patients who do not respond to these therapies should be not be denied more potent opiates, such as codeine, opium, or morphine, for fear of addiction.
 

 
 

Signs, symptoms & indicators of Diarrhea:
 
 
Symptoms - Bowel Movements  Acute diarrhea
  (Very) frequent stools or normal stool frequency
  Having very watery/having loose stools

Counter-indicators:
  Having normal stool texture or having hard stools
  Absence of acute diarrhea
 
 

Conditions that suggest Diarrhea:
 
 
Diet  Dehydration
 Diarrhea can rapidly drain your body of water, causing dehydration.

Nutrients

  Zinc Requirement
 Diarrhea causes a loss of zinc and therefore digestive diseases or gastrointestinal surgery that result in diarrhea are often associated with a deficiency.

  Hypokalemia / Potassium Need
 Diarrhea causes additional fluid loss and can result in potassium depletion.
 
 

Risk factors for Diarrhea:
 
 
Autoimmune  Microscopic Colitis (Collagenous Colitis / Lymphoc

Digestion

  Fructose malabsorption

Environment / Toxicity

  Gulf War Illness
  Mercury Toxicity / Amalgam Illness

Infections

  Clostridium Difficile
 Mild cases of C. difficile disease are characterized by frequent, foul smelling, watery stools.

  Parasite, Giardiasis Infection
 Giardia diarrhea tends to be less watery, and usually it is a mixture of watery feces, with a few semi-solid chunks mixed in.
With giardia symptoms diarrhea will continue over days, weeks and sometimes months. Typically you will feel the rumbling stomach, the belching, the gas. Then after you go to the toilet, you feel better.

  Malaria
  Parasite, Dientamoeba Fragilis

Lab Values - Chemistries

  Low CO2
  Elevated BUN

Metabolic

  Acute, Intermittent Porphoria

Nutrients

  Vitamin A Requirement

Organ Health

  Diverticular Disease

Respiratory

  SARS (Severe Acute Respiratory Syndrome)

Tumors, Malignant

  Carcinoid Cancer
 Diarrhea can occur along with facial flushing or by itself. Stools are watery and the diarrhea can be mild to severe. Episodes can occur several times each day and can interfere with daily life.
 
 

Diarrhea suggests the following may be present:
 
 
Cell Salts  Cell Salt, Nat Phos Need

Infections

  Malaria

Metabolic

  Acute, Intermittent Porphoria

Organ Health

  Diverticular Disease

Tumors, Malignant

  Carcinoid Cancer
 Diarrhea can occur along with facial flushing or by itself. Stools are watery and the diarrhea can be mild to severe. Episodes can occur several times each day and can interfere with daily life.
 
 

Diarrhea can lead to:
 
 
Diet  Dehydration
 Diarrhea can rapidly drain your body of water, causing dehydration.

Nutrients

  Hypokalemia / Potassium Need
 Diarrhea causes additional fluid loss and can result in potassium depletion.

  Zinc Requirement
 Diarrhea causes a loss of zinc and therefore digestive diseases or gastrointestinal surgery that result in diarrhea are often associated with a deficiency.
 
 

Recommendations for Diarrhea:
 
 
Animal-based  Probiotics / Fermented Foods
 A study of hospitalized children showed that a combination of Lactobacillus acidophilus and Bifidobacterium infantis was effective in treating acute diarrhea. One of the more common causes for hospitalization of infants and young children is dehydration related to acute diarrhea, especially from a rotavirus. Lactobacilli in the intestines play an important role in developing natural defenses against both intestinal bacterial and viral infections. In the study group, the frequency of diarrhea improved on the first and second day of hospitalization and the duration of diarrhea during hospitalization also decreased. The researchers concluded "Oral bacterial therapy is an effective adjuvant therapy in rotavirus positive and negative children with diarrhea and can safely be administered during an episode of acute diarrhea." [Acta Paediatr Taiwan 2001 Sep-Oct; 42(5): pp.301-5]

Probiotics appear to be effective in treating acute diarrhea, according to researchers from Johns Hopkins Bloomberg School of Public Health. They conducted a meta-analysis of 34 masked, randomized, placebo-controlled trials. One was carried out in a developing country, while the others were carried out in health-care settings in developed countries. They found that probiotics reduced:
  • Antibiotic-associated diarrhea by 52%
  • Traveler's diarrhea by 8%
  • Acute diarrhea of diverse causes by 34%
Further, risk of acute diarrhea among children and adults was reduced by 57% and 26%, respectively, when probiotics were used.

Several probiotic strains, including Saccharomyces boulardii, Lactobacillus rhamnosus GG, Lactobacillus acidophilus, Lactobacillus bulgaricus, and others, were evaluated. No significant difference was found between the different strains used, alone or in combination. [The Lancet Infectious Diseases June 2006, Vol. 6, No. 6: 374-382]

Dr. Mercola, of Internet fame, says "When treating acute infectious diarrhea, large therapeutic doses are required (typically an entire bottle over a day's time or about an eighth of a bottle every hour until the problem is resolved). Most often, the symptoms will subside within four hours."

Botanical

  Aloe Vera

Detoxification

  Bentonite Clay
 A medical study by Frederic Damrau, M.D., in 1961 (Medical Annals of the District of Columbia) established clearly that bentonite can end bouts of diarrhea. When 35 individuals (average age 51) suffering from diarrhea took two tablespoons of bentonite in distilled water daily, the diarrhea was relieved in 97% (34 of the 35 patients) in 3.8 days, regardless of the original cause of the problem (allergies, virus infection, spastic colitis, or food poisoning). According to Dr. Damrau, bentonite is “safe and highly effective” in treating acute diarrhea.

  Charcoal, Activated
 In an acute bacterial or viral infection of the GI tract, taking activated charcoal orally often stops the diarrhea. It works by adsorbing the organisms causing the infection and, since charcoal itself is not absorbed, it carries the offending organisms safely out of the body. A typical dose is 2 to 4 capsules, 4 or more times per day for up to 2 days.

Charcoal is considered one of the first aid remedies for diarrhea. When "activated charcoal" is not available, less effective regular charcoal will often work. It can be made by burning toast and scraping the charcoal from it's surface. This process is repeated until you have created as much as you need. Although not as convenient as capsules, the powder can be placed in the mouth and rinsed down with liquid. If there are no signs of improvement within the first day, medical help should be sought.

  Supplemental Fiber
 While insoluble fiber causes looser stools, soluble fiber helps hold stools together. It can be helpful for people who have diarrhea, or loose stools. This fiber works by absorbing water and forming a soft, sticky gel. As a result, stools form and hold together better when soluble fiber is included in the diet.

Diet

  Juices / Juicing
 Carrot juice and concentrated carrot oligosaccharides have been used in Europe for bacterial diarrhea for almost a century.

  Artificial Sweetener Avoidance

Drug

  Antibiotics

Extract

  Nutritional Yeast
 A thoroughly researched yeast, Saccharomyces boulardii, has been used in Europe for control of nonspecific diarrhea for several decades. Controlled studies have demonstrated its effectiveness in preventing antibiotic-associated diarrhea and Clostridium difficile colitis.

Brewer’s yeast, Saccharomyces cerevisiae, perhaps by changing the bacterial flora in the large intestine, may be helpful in the treatment of some cases of infectious diarrhea, but to a lesser degree.

Lab Tests/Rule-Outs

  Test for Microbiological Imbalance, Stool

Mineral

  Bismuth
  Colloidal Silver

Not recommended:
  Magnesium
 Too much magnesium, more than can be absorbed by the time it reaches the large intestine, can increase bowel activitiy and cause more bowel movements.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Strongly counter-indicative
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended
May have adverse consequences







GLOSSARY

Acute:  An illness or symptom of sudden onset, which generally has a short duration.

Adenoma:  An ordinarily benign growth of epithelial tissue in which the tumor cells form glands or gland-like structures that tend to exhibit glandular function.

AIDS:  Acquired Immune Deficiency Syndrome. An immune system deficiency disorder that suddenly alters the body's ability to defend itself. The AIDS virus invades the T4 helper/inducer lymphocytes and multiplies, causing a breakdown in the body's immune system, eventually leading to overwhelming infection and/or cancer, with ultimate death.

Anemia:  A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.

Antacid:  Neutralizes acid in the stomach, esophagus, or first part of the duodenum.

Antibody:  A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.

Antimicrobial:  Tending to destroy microbes, hinder their multiplication or growth.

Bacteria:  Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.

Bile:  A bitter, yellow-green secretion of the liver. Bile is stored in the gallbladder and is released when fat enters the first part of the small intestine (duodenum) in order to aid digestion.

Biopsy:  Excision of tissue from a living being for diagnosis.

Calcium:  The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. Calcium is also important to heart health, nerves, muscles and skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.

Cancer:  Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Canker Sores:  Also known as Aphthous Ulcers, these are small, painful ulcers that occur on the inside of the cheek, lip or underside of the tongue. Caused by an assortment of viruses, doctors call this condition aphthous stomatitis. Canker sores usually clear up by themselves within a week or so, but they often recur, sometimes in the form of multiple sores.

Carbohydrates:  The sugars and starches in food. Sugars are called simple carbohydrates and found in such foods as fruit and table sugar. Complex carbohydrates are composed of large numbers of sugar molecules joined together, and are found in grains, legumes, and vegetables like potatoes, squash, and corn.

Cardiac:  Pertaining to the heart, also, pertaining to the stomach area adjacent to the esophagus.

Celiac Disease:  (Gluten sensitivity) A digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten. Common symptoms include diarrhea, increased appetite, bloating, weight loss, irritability and fatigue. Gluten is found in wheat (including spelt, triticale, and kamut), rye, barley and sometimes oats.

Chemotherapy:  A treatment of disease by any chemicals. Used most often to refer to the chemical treatments used to combat cancer cells.

Chlamydia:  A sexually-transmitted disease that is often without symptoms. Some females experience a white vaginal discharge that resembles cottage cheese, a burning sensation when urinating, itching, and painful intercourse. A clear watery urethral discharge in the male probably is a chlamydia infection.

Cholestatic:  Often Cholestatic liver disorder: An arrest in the flow of bile from the liver.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Cobalamin:  Vitamin B-12. Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).

Colitis:  Inflammation of the colon.

Colon:  The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.

Constipation:  Difficult, incomplete, or infrequent evacuation of dry, hardened feces from the bowels.

Crohn's Disease:  Chronic inflammatory disease of the gastrointestinal tract. The most common symptoms are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia.

Cystic Fibrosis:  (CF) An incurable genetic disease involving a sticky buildup of mucus in the lungs (which makes breathing difficult and leads to infections), as well as pancreatic insufficiency (which leads to digestive problems). Symptoms include chronic cough producing thick mucus, excessive appetite combined with weight loss, intestinal disorders, salty sweat/skin and pneumonia. Lung-related problems are the most frequent cause of death. CF is a recessive disease, occurring only when a person inherits two mutated copies of the CF gene - one from each parent. Individuals with CF generally have a life expectancy of about 30 years.

Cytomegalovirus:  (CMV): A member of the herpes virus family which may induce the immune-deficient state or cause active illness, such as pneumonia, in a patient already immune-deficient due to chronic illness, such as cancer or organ transplantation therapy.

Cytoplasmic:  Pertaining to the contents of a cell outside the nucleus.

Dermatitis:  A general term used to refer to eruptions or rashes on the skin.

Diabetes Mellitus:  A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Diarrhea:  Excessive discharge of contents of bowel.

Duodenum:  First portion of the small intestine between the pylorus and jejunum.

Dysentery:  An inflammatory disorder of the lower intestinal tract, usually caused by a bacterial, parasitic, or protozoan infection and resulting in pain, fever, and severe diarrhea, often accompanied by the passage of blood and mucous.

Edema:  Abnormal accumulation of fluids within tissues resulting in swelling.

Electrolyte:  An element or compound that, when melted or dissolved in water or other solvent, breaks up into ions and is able to carry an electric current.

Endoscopy:  A procedure that uses an Endoscope.

Enteritis:  Sometimes Enteritis regionalis: Localized inflammation of the intestine.

Enzymes:  Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.

Erythema Nodosum:  Acute inflammation of skin with red nodules.

Fatty Acids:  Chemical chains of carbon, hydrogen, and oxygen atoms that are part of a fat (lipid) and are the major component of triglycerides. Depending on the number and arrangement of these atoms, fatty acids are classified as either saturated, polyunsaturated, or monounsaturated. They are nutritional substances found in nature which include cholesterol, prostaglandins, and stearic, palmitic, linoleic, linolenic, eicosapentanoic (EPA), and decohexanoic acids. Important nutritional lipids include lecithin, choline, gamma-linoleic acid, and inositol.

Flatulence:  Abnormal amount of gas in the stomach and intestines.

Gastroenteritis:  Gastrointestinal tract inflammation; characterized by abdominal pain, nausea, diarrhea, vomiting; which may be caused by bacteria, parasites or a virus.

Gastrointestinal:  Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.

Glucose:  A sugar that is the simplest form of carbohydrate. It is commonly referred to as blood sugar. The body breaks down carbohydrates in foods into glucose, which serves as the primary fuel for the muscles and the brain.

Gonorrhea:  A sexually-transmitted disease that is often without symptoms. If there are symptoms in the female, they include frequent and painful urination, cloudy vaginal discharge, vaginal itching, inflammation of the pelvic area, and abnormal uterine bleeding. If the male has a purulent (pus-like) urethral discharge, he should assume he has gonorrhea until proven otherwise.

Gout:  A disease characterized by an increased blood uric acid level and sudden onset of episodes of acute arthritis.

Herpes Simplex:  An infection, often recurrent, caused by herpes virus type 1 and 2. It causes cold sores around the lips and mouth, and also causes painful blisters on the genitals and in the pubic area, thighs, and buttocks.

Hormones:  Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.

Hypotension:  Low blood pressure.

Iron:  An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.

Irritable Bowel Syndrome:  (IBS) A condition that causes upset intestines for a long period of time. It is very unpleasant to the sufferer but tends to be harmless and usually does not lead to more serious complaints. The symptoms vary from person to person and from day to day. In order to be diagnosed with IBS, a person must have at least three of the following symptoms: pain in the lower abdomen; bloating; constipation; diarrhea or alternating diarrhea and constipation; nausea; loss of appetite; tummy rumbling; flatulence; mucous in stools; indigestion; constant tiredness; frequent urination; low back pain; painful intercourse for women.

Ischemia:  Localized tissue anemia due to obstruction of the inflow of arterial blood.

Lactase:  An enzyme that aids the body in converting lactose to glucose and galactose. It is also necessary for digestion of milk and milk products.

Lactose Intolerance:  A condition caused by a lack of an enzyme called lactase, which, in turn, causes the body to be unable to digest lactose, a sugar found in milk products. Common symptoms, which begin about 30 minutes to two hours after consuming foods or beverages containing lactose, may include: nausea, cramps, bloating, gas and/or diarrhea. The severity of symptoms varies depending on the amount of lactose consumed and the amount that an individual can tolerate.

Laxative:  A substance (food, herb, chemical) that stimulates evacuation of the bowels. Examples include cascara sagrada, senna, castor oil, aloe vera, bisacodyl, phenolphthalein and many others.

Leukocyte:  A white blood cell which appears 5,000 to 10,000 times in each cubic millimeter of normal human blood. Among the most important functions are destroying bacteria, fungi and viruses and rendering harmless poisonous substances that may result from allergic reactions and cell injury.

Lumen:  Space in the interior of a tubular structure.

Lymphocyte:  A type of white blood cell found in lymph, blood, and other specialized tissue such as bone marrow and tonsils, constituting between 22 and 28 percent of all white blood cells in the blood of a normal adult human being. B- and T-lymphocytes are crucial components of the immune system. The B-lymphocytes are primarily responsible for antibody production. The T-lymphocytes are involved in the direct attack against living organisms. The helper T-lymphocyte, a subtype, is the main cell infected and destroyed by the AIDS virus.

Magnesium:  An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.

Mineral:  Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.

Motility:  Capacity for spontaneous movement, frequently in reference to the intestine.

Mucosa:  Mucous tissue layer lining tubular structures (nasal passages, ear canal, etc.).

Nausea:  Symptoms resulting from an inclination to vomit.

Neuropathy:  A group of symptoms caused by abnormalities in motor or sensory nerves. Symptoms include tingling or numbness in hands or feet followed by gradual, progressive muscular weakness.

NSAID:  Non-steroidal anti-inflammatory drug.

Occult Blood:  Usually: Occult blood test. A test used in screening for blood found in the stool, sputum or urine. The most common test is for hidden blood in the stool, also known as a stool guaiac or hemoccult test, which usually indicates the presence of ulceration or cancer.

Over-The-Counter:  A drug or medication that can legally be bought without a doctor's prescription being required.

Pancreatitis:  Inflammation of the pancreas. Symptoms begin as those of acute pancreatitis: a gradual or sudden severe pain in the center part of the upper abdomen goes through to the back, perhaps becoming worse when eating and building to a persistent pain; nausea and vomiting; fever; jaundice (yellowing of the skin); shock; weight loss; symptoms of diabetes mellitus. Chronic pancreatitis occurs when the symptoms of acute pancreatitis continue to recur.

Parasite:  An organism living in or on another organism.

pH:  A measure of an environment's acidity or alkalinity. The more acidic the solution, the lower the pH. For example, a pH of 1 is very acidic; a pH of 7 is neutral; a pH of 14 is very alkaline.

Phosphorus:  The second most abundant mineral in the body found in every living cell. It is involved in the proper functioning of both muscles and nerves. It is needed for metabolic processes of all cells, to activate many other nutrients, and to form energy-storage and energy-releasing compounds. The phosphorus content of the body is approximately one percent of total body weight. Phosphorus combines with fats to form phospholipids.

Polyp:  A usually nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder or intestine, often causing obstruction.

Potassium:  A mineral that serves as an electrolyte and is involved in the balance of fluid within the body. Our bodies contain more than twice as much potassium as sodium (typically 9oz versus 4oz). About 98% of total body potassium is inside our cells. Potassium is the principal cation (positive ion) of the fluid within cells and is important in controlling the activity of the heart, muscles, nervous system and just about every cell in the body. Potassium regulates the water balance and acid-base balance in the blood and tissues. Evidence is showing that potassium is also involved in bone calcification. Potassium is a cofactor in many reactions, especially those involving energy production and muscle building.

Proctitis:  Inflammation of the mucous membranes of the rectum.

Protein:  Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.

Proximal:  Nearer to a point of reference such as an origin, a point of attachment, or the midline of the body.

Retinopathy:  An eye disorder that does not cause inflammation but results from changes in the eye (retinal) blood vessels.

Serum:  The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.

Stomach:  A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.

Syphilis:  A sexually-transmitted disease, with symptoms in the early contagious stages being a sore on the genitalia, a rash, patches of flaking tissue, fever, a sore throat, and sores in the mouth or anus.

Tenesmus:  Tenesmus is the constant feeling of the need to empty the bowel or bladder, accompanied by pain, cramping, and involuntary straining efforts.

Thyroid:  Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.

Ulcer:  Lesion on the skin or mucous membrane.

Ulcerative Colitis:  (Colitis ulcerosa): Ulceration of the colon and rectum, usually long-term and characterized by rectal bleeding or blood in the stool, frequent urgent diarrhea/bowel movements each day, abdominal pain.

Virus:  Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.

Vitamin D:  A fat-soluble vitamin essential to one's health. Regulates the amount of calcium and phosphorus in the blood by improving their absorption and utilization. Necessary for normal growth and formation of bones and teeth. For Vitamin D only, 1mcg translates to 40 IU.

Vitamin K:  Helps the blood clot when the body is injured.

White Blood Cell:  (WBC): A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. Also known as a leukocyte.

Zinc:  An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.