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Diarrhoea can be a bit of a taboo subject. It can affect not only our health but our self-confidence, interfering with everyday life and on occasions our social life. Diarrhoea is often a symptom of pre-existing health issues such as Irritable Bowel Syndrome,[i] which can be addressed in different ways.
By definition, diarrhoea refers to urgent, frequent, watery bowel movements. Usually after such disruption in the digestive process, the integrity of our gut and levels of good bacteria begin to reduce.
Underlying causes include:
Infection: bacteria, fungi, parasites or viruses can be a common cause of infectious diarrhoea. Hospital stays, travelling to exotic countries are common environments were exposure to microbes is high. The reason our bodies react this way is to flush out the pathogenic organisms after exposure, accelerating motility and drawing water into the bowel. [ii]
Intensive Exercise can be quite stressful on the digestive system by increasing oxidative stress and inflammation which irritates the delicate lining of the gut, triggering diarrhoea.[iii]
Chronic antibiotic use can severely compromise the balance of beneficial bacteria in the gut,[iv] causing maldigestion and malabsorption and a higher risk of infections.
Stress can cause the body’s systems to overreact, the speed of transit during the digestive process is again accelerated, not allowing time for enough water to be reabsorbed, causing loose stools.[v],[vi] In response to stress, some of us take anti-depressants to modulate symptoms but these can actually increase this acceleration of motility.[vii] If you are taking regular medication, the diarrhoea may be a side effect. We therefore recommend to return to your GP to discuss and review your medication.
Diet Choices: diet can also have a causative impact for diarrhoea, such as undiagnosed food intolerances, a diet low in fibre/water and high consumption of sugary foods and caffeinated drinks. Common drivers of digestive symptoms can include gluten, milk, excessive caffeine, laxatives, sugar, vitamin C, or excessive magnesium.
So what can we do about it? We can address any potential imbalances and making necessary changes through diet, lifestyle and supplementation.
Dehydration is a major side effect of diarrhoea and it is therefore extremely important to replenish electrolyte levels lost and rehydrate the cells. Drinking plenty of water with added coconut water for a natural source of electrolytes is a good way to do this, or electrolyte solution drops are available from some retailers to add to water.
You are what you eat!
Following the ‘Elimination Diet’ is often a protocol followed for identifying food allergies or intolerances. For a more direct route, food intolerance/allergy testing is also an option, which is available through your local GP/hospital or a reputable private company/health practitioner. Keeping a food diary may help to identify which foods may be aggravating symptoms. We have many apps at our disposal nowadays to help keep track of the foods we eat.
Rebalance the Gut
If infection is likely, especially after returning from a hospital stay or travelling to exotic countries, then addressing the infectious cause could be the answer. Usually it is better to let the diarrhoea run its course as this is the body’s natural mechanism to help eliminate the pathogen and its toxins. Making sure you stay well hydrated during this process is the best approach. Sources of natural anti-bacterial, anti-fungal, and anti-parasitic agents through diet and/or supplementation can be helpful, such as essential oils of oregano, clove, grapefruit and garlic alongside a good probiotic supplement.[viii]
Sources of fibre are very important for healthy stools. We can get fibre from the diet such as nuts and seeds, cauliflower, celery and some fruits including avocado and unripe bananas. Prunes in particular are rich in soluble fibre, helping with the frequency and consistency of stools. [ix] Supplementing with good quality fibre is sometimes necessary, psyllium husk for example acts as a natural cleansing and bulking agent for the bowel, allowing normal water absorption to ease motility. [x] Fructoolligosaccharides or F.O.S. is a prebiotic fibre, which supports the reduction of any possible pathogenic bacteria in the gut [xi]and levels of the ‘good’ bacteria.[xii],[xiii] This can be supplemented or incorporated into the diet by introducing dietary sources of FOS such as chicory, raw garlic, leeks and artichoke.
Relax and Replenish
Herbal extracts may be helpful ‘IBS’ type symptoms of cramping and pain. Chamomile for example can help to reduce any possible inflammation and spasming of muscles in the gut.[xiv] Peppermint is another natural muscle relaxant,[xv] as well as cardamom[xvi] and fennel. [xvii] You can take these through supplementation or any good brand of herbal teas on the market.
Bad episodes of diarrhoea can cause malabsorption of nutrients in the gut which can be problematic if levels become deficient. Toping up our nutrient levels with a good quality Multinutrient supplement is therefore recommended alongside digestive enzymes for breaking down of proteins, fats and sugars and absorption of nutrients in the diet.
Stress is a massive contributor to diarrhoea. Therefore taking the time to relax and re group is very important. Taking a yoga class, going out for a walk with the dog or sitting in the garden are really basic ways we can try and relax. Using apps for meditation can also be useful, especially for those who have a busy schedule. Try Epsom salt baths in the evening to relax the muscles and exert a calming effect on the body.
Though it is unpleasant and inconvenient, diarrhoea is almost always the consequence of infection or other underlying problems. There are some ways to ease the symptoms, however, it is important to identify the cause, in order to alleviate symptoms altogether.
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[ii] Fasano, A. Zonulin, regulation of tight junctions, and autoimmune diseases. Ann N Y Acad Sci. 2012; 1258 (1): 25-33
[iii] Van Wijck K et al. Exercise-induced splanchnic hypoperfusion results in gut dysfunction in healthy men. PLoS One. 2011; 6 (7): e22366
[iv] Brown KA et al. Meta-analysis of antibiotics and risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother. 2013; 57 (5): 2326-2332
[v] Stengel A, Tache Y. Neuroendocrine control of the gut during stress: corticotropin-releasing factor signalling pathways in the spotlight. Annu Rev Physiol. 2009; 71: 219-39
[vi] Spiller R. Role of motility in chronic diarrhoea. Neurogastroenterol Motil. 2006; 18 (12): 1045-55
[vii] Chial HJ et al. Selective effects of serotonergic psychoactive agents on gastrointestinal functions in health. Am J Physiol Gastrointest Liver Physiol. 2003; 284 (1): G130-7
[viii] Sazawal S, Hiremath G, Dhingra U, et al; Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials. Lancet Infect Dis. 2006 Jun;6(6):374-82.
[ix] Lever E, et al. Systematic review: the effect of prunes on gastrointestinal function. Aliment Pharmacol Ther. 2014 Oct;40(7):750-8.
[x] Bliss DZ, et al. Dietary fiber supplementation for fecal incontinence: a randomized clinical trial. Res Nurs Health. 2014 Oct;37(5):367-78.
[xi] Rajkumar et al. Effect of Probiotic Lactobacillus salivarius UBL S22 and Prebiotic Fructo-oligosaccharide on Serum Lipids, Inflammatory Markers, Insulin Sensitivity, and Gut Bacteria in Healthy Young Volunteers: A Randomized Controlled Single-Blind Pilot Study. J Cardiovasc Pharmacol Ther. 2015 May; 20 (3): 289-98
[xii] Bouhnik et al. Effects of fructo-oligosaccharides ingestion on fecal bifidobacteria and selected metabolic indexes of colon carcinogenesis in healthy humans. Nutr Cancer. 1996; 26 (1): 21-9
[xiii] Rajkumar et al. Effect of Probiotic Lactobacillus salivarius UBL S22 and Prebiotic Fructo-oligosaccharide on Serum Lipids, Inflammatory Markers, Insulin Sensitivity, and Gut Bacteria in Healthy Young Volunteers: A Randomized Controlled Single-Blind Pilot Study. J Cardiovasc Pharmacol Ther. 2015 May; 20 (3): 289-98
[xiv] Wang Y, Tang H, Nicholson JK, et al. A metabonomic strategy for the detection of the metabolic effects of chamomile (Matricaria recutita L.) ingestion. J Agric Food Chem 2005;53:191-6.
[xv] Grigoleit HG & Grigoleit P. Peppermint oil in irritable bowel syndrome. Phytomedicine. 2005; 12(8):601 -606
[xvi] al-Zuhair H et al Pharmacological studies of cardamom oil in animals. Pharmacol Res., Jul-Aug;34(1-2):79-82 (1996).
[xvii] Forster HB, Niklas H, Lutz S. Antispasmodic effects of some medicinal plants. Plant Med 1980;40:303–19.