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Diarrhea

Diarrhea

16 Remedies to Deal with It

"Acute diarrhea is one of your body's best defense mechanisms," says Lynn V. McFarland, Ph.D., a research associate with the Department of Medicinal Chemistry at the University of Washington. "It's your body's way of getting something nasty out of your system."

That thought may or may not be of comfort to you right now, but it helps explain why doctors today will tell you to "tough it out" instead of automatically trying to stem the tide of this annoying, but hopefully short-lived, illness.

"It used to be that when somebody had diarrhea," Dr. McFarland explains, "doctors would quickly prescribe some type of antidiarrheal medication. Today we think the best medicine is to simply let it run its course, if you'll pardon the pun."

David A. Lieberman, M.D., associate professor of medicine at Oregon Health Sciences University School of Medicine, seconds that opinion. "I don't recommend antidiarrheal medications when a patient has acute diarrhea unless he or she has an urgent need for control—like a very important business meeting that just can't be missed. Otherwise, I think the purge is probably beneficial and helps speed recovery."

Because of that thinking, most of the tips below are designed to help you weather the discomfort of diarrhea and make a speedy recovery, rather than try to halt the course of diarrhea and risk prolonging the illness. For those who may have "an urgent need for control" while stricken, we've listed some medications to help stem the tide while you take care of other business.

Make the milk connection. "One of the leading causes of diarrhea in this country is lactose intolerance," says William Y. Chey, M.D., professor of medicine at the University of Rochester School of Medicine and Dentistry.

While few of our experts agree that lactose intolerance is the leading cause (most say viral infection), all agree that it is a major cause of diarrhea among unsuspecting adults.

"Lactose intolerance can have its onset when you're just a baby, or it can kick in suddenly during your adult years," says Dr. Chey. "You're drinking milk and the next thing you know—bam!—you have gas, pain, and diarrhea."

The cure, of course, is to avoid lactose-containing foods, which means staying away from most dairy products, with the exception of yogurt and some aged cheeses, such as cheddar. "Once you do that," says Dr. Chey, "it stops by itself."

Take the tolerance test. Given the dose-related nature of lactose intolerance, as well as its ability to kick in unexpectedly, how can you be sure whether or not milk products are responsible for your current troubles?

"What I do is have patients completely abstain from milk products for a week or two and see if that helps," says Dr. Lieberman.

If a week without milk helps, he says, "then I have them gradually add back milk products with the knowledge that at some point they may reach a level where the intolerance symptoms will return." But, Dr. Lieberman notes, once a person knows what that level is, he can avoid lactose-induced diarrhea by keeping consumption beneath it. (For more tips, see Lactose Intolerance on page 407.)

MEDICAL ALERT When Diarrhea Demands an M.D. Diarrhea should usually disappear in one or two days and leave you only slightly worse for wear. In infants, small children, elderly people, or those already sick or dehydrated from another illness, however, acute diarrhea can be particularly severe and demands prompt medical attention. Medical help is also needed if diarrhea does not subside within one or two days, or if it's accompanied by fever and severe abdominal cramps, or if it occurs with rashes, jaundice (yellowing of the skin and whites of the eyes), or extreme weakness. If blood, pus, or mucus is found in the stools, call your doctor. "The most immediate risk associated with acute diarrhea is dehydration," says Harris Clearfield, M.D. "So if an individual is having a major bout of diarrhea and isn't taking in any food or drink during that time, you're looking at a medical emergency." Seek help, he says.

Think about your medications. Our experts say there's a good possibility that the diarrhea you have now was caused by the heartburn you had earlier today. Not because of a direct connection between stomach and bowel, but because of the antacid you may have taken to soothe your burning belly.

"Antacids are the most common cause of drug-related diarrhea," says Harris Clearfield, M.D., professor of medicine and director of the Division of Gastroenterology at Hahnemann University Hospital in Philadelphia, Pennsylvania. "Maalox and Mylanta both have magnesium hydroxide in them that acts exactly like milk of magnesia does, which makes these antacids a common cause of diarrhea."

To avoid future bouts of heartburn-related diarrhea, he suggests trying antacids that contain aluminum hydroxide, with no magnesium added. "These are less likely to cause diarrhea," Dr. Clearfield says, "but they're less effective, too."

Besides antacids, antibiotics, quinidine, lactulose, and colchicine may also cause diarrhea. Consult your doctor if you suspect that these or any other medications may be causing problems for you.

Diarrhea at a Dangerous Age Diarrhea in babies and small children can be dangerous. Infants are easily dehydrated, and they lack the ability to tell you exactly how they feel. To help you treat cases of acute diarrhea in infants and young children, we consulted Loraine Stern, M.D., a private practitioner in New Hall, California. These are her recommendations. Reach for the right stuff. "Water and fruit juice really aren't the best fluids for rehydrating a baby," says Dr. Stern. What does she recommend? "Rehydration solutions are good for infants and toddlers during the acute phase of diarrhea. You can make your own rehydration solution [add 1 teaspoon of sugar and a pinch of salt to 1 quart of water], but if you make a mistake, you can overload the baby with salt. If you can afford to buy the commercially available ones (Pedialyte, ReSol, Lytren, etc.), you're much better off. These are available at drugstores without prescription." Continue feeding. "You should continue to feed a child," says Dr. Stern, "but you should probably avoid milk for a day if the diarrhea is severe. What you feed a child depends on the age of the child, but for infants I recommend rice cereal, applesauce, and bananas for a day or two. These foods tend to be a bit binding. For older children, stick with plain dry toast, plain crackers, chicken without the skin, and other bland foods." Know when to quit. "The biggest mistake most people make is in not knowing when to quit treatment," Dr. Stern says. "Children may have loose stools for quite a while after the initial illness—perhaps one or two watery stools a day for the next couple of weeks. If they are otherwise okay, it's not necessary to keep them on a restricted diet. Only do that for a couple of days." Try the carrot cure. "Some people think strained carrots are the greatest thing in the world for a child with diarrhea," she says. "You can include these in the diet if you wish," (Carrots may help enhance recovery by replacing electrolytes and minerals lost during diarrhea.) Put bacteria back in. "After the first couple of days, yogurt tends to repopulate the bowel with good bacteria," says Dr. Stern. "It isn't a bad idea to feed it to them. Three ounces a day should do it." Remember Mother's advice. "Chicken broth or beef broth is fine for a child over a year old," she says. "For some children the high salt content of broth is good because it makes them drink when they might not want to. But I wouldn't use it more than once or twice a day."

Consume a clear diet. Okay, so you didn't eat a second bowl of ice cream and you didn't travel to Mexico last week, but you've got diarrhea anyway. Now you're hungry as well as cranky and there's just one thing you need to know—is it safe to eat food? Yes, our experts say, but with a few cautions.

"Start with a 'clear-liquid' diet," says Dr. Chey. "By clear I mean chicken broth, Jell-O, or other foods and fluids you can look 'clear' through." The reason, he explains, is that the bowel needs rest during the time you have diarrhea, "and that's why you should stick with a diet like this until it subsides. You don't want to force your system to handle more than it already has to."

After you've tested the waters with broth and Jell-O, rice, bananas, applesauce, or yogurt can be introduced gradually as your symptoms improve.

Keep liquid levels high. "The type of food you eat doesn't really matter that much," says Dr. McFarland. "The most serious thing is to make sure your fluid intake is high." Though many folks don't feel like consuming large amounts of liquids during bouts of diarrhea, all our experts agree that increasing your fluid intake is vital to ward off dehydration.

Fluids that contain salt and small amounts of sugar are particularly beneficial, as they help the body replace glucose and minerals lost during diarrhea. A good "rehydration fluid" can be easily made by adding 1 teaspoon of sugar and a pinch of salt to 1 quart of water.

A more complex but tastier mix can be made by adding 1/2 teaspoon of honey or corn syrup and a pinch of table salt to 8 ounces of fruit juice. Stir well and drink often.

For those who don't feel like making anything, Gatorade comes highly recommended. It contains glucose and electrolytes in sufficient quantities to replace those being lost by your body. (Now if you can just get somebody to run to the store.)

Avoid these foods. While eating may not be as important as drinking for riding out diarrhea in the best possible shape, there are some foods that should be avoided because of their, um, well, potentially explosive nature. Obvious ones to pass up include beans, cabbage, and brussels sprouts.

Other foods containing large amounts of poorly absorbed carbohydrates can aggravate diarrhea. A short list includes bread, pasta, and other wheat products; apples, pears, peaches, and prunes; corn, oats, potatoes, and processed bran.

And, just in case you were reaching for that carton of ice cream, all our experts say you should avoid dairy products during a bout of diarrhea. Whether or not milk products caused the problem, they tend to aggravate diarrhea after you have it.

Avoid the bubble, bubble toilet trouble. "I'd suggest avoiding carbonated beverages as well," says Dr. Clearfield. "The gas they contain may add additional explosiveness to a delicate situation."

Stay out of the kitchen. While we're still on the subject of food, you or any member of your family who has diarrhea should not prepare food for other members of the household until diarrhea subsides. Also, good hand washing by you and other household members will help keep a parasitic infection from spreading. (If your job involves contact with large numbers of people or food handling, state law may require you to stay off the job until all symptoms subside.)

If you must—take something to stem the tide. Our experts insist that letting diarrhea "run its course" is the best medicine going. If, however, you absolutely must go someplace and be in control of your bodily functions while there, an over-the-counter product called Imodium, available in capsule or liquid form, is probably your best bet for slowing the flow.

"Imodium is very effective," says Dr. Clearfield. "It works by causing the bowel to tighten up, and by doing so, it prevents things from moving along."

Imodium isn't your only choice. Hydrophilic (hydro means water, and phili means love) products, such as Kaopectate and Pepto-Bismol may be useful in the treatment of mild diarrhea.

Aluminum hydroxide antacids, unlike their magnesium counterparts, have hydrophilic abilities and may be effective for reducing the symptoms of diarrhea. Amphojel and Alternagel are two to try.

Food remedies not to rely on. Such things as pectin, acidophilus tablets, carob powder, barley, bananas, Swiss cheese, and a host of exotic foods, teas, and other folk remedies have been used by some as a treatment for diarrhea. "They work to bind the bowel and slow the course of the diarrhea," says Dr. McFarland. "But that's not what you want to do. You're just increasing the time that whatever is causing the problem will stay inside you. What you want to do is get it out."

Your best bet, he says, is to let nature take its course.

PANEL OF ADVISERS

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William Y. Chey, M.D., is a professor of medicine at the University of Rochester School of Medicine and Dentistry in New York.

Harris Clearfield, M.D., is a professor of medicine and director of the Division of Gastroenterology at Hahnemann University Hospital in Philadelphia, Pennsylvania.

David A. Lieberman, M.D., is an associate professor of medicine at Oregon Health Sciences University School of Medicine in Portland.

Lynn V. McFarland, Ph.D., is a research associate with the Department of Medicinal Chemistry at the University of Washington in Seattle and director of scientific affairs of Biocodex, Inc.

Loraine Stern, M.D., is a private practitioner in New Hall, California.