What is the relationship between dairy consumption and diarrhea. How should diet be adjusted during episodes of diarrhea. What role do fermented dairy products play in managing diarrhea. How does lactose intolerance impact diarrhea management. What are the key dietary recommendations for acute diarrhea.

Understanding Diarrhea: Causes and Common Misconceptions

Diarrhea is a prevalent condition in North America, often causing discomfort and inconvenience. Its causes can range from gastrointestinal infections like stomach flu or food poisoning to side effects of certain medications, particularly antibiotics. Chronic conditions such as food intolerances or digestive disorders may also lead to persistent diarrhea if left uncontrolled.

A common misconception surrounding diarrhea management is the belief that dairy products should be automatically eliminated from one’s diet during episodes. However, current evidence does not support this blanket approach. In fact, recent research suggests that certain fermented dairy products, like yogurt, may actually help alleviate acute episodes of diarrhea.

The Role of Diet in Managing Diarrhea

Diet plays a crucial role in managing diarrhea, but the approach varies depending on the underlying cause. The primary dietary focus during diarrhea episodes should be on proper hydration to prevent dehydration. In most cases, healthcare professionals advise returning to a normal, solid diet as soon as possible.

However, it’s important to note that certain foods may exacerbate irritation or be more challenging to digest as the digestive tract recovers. These include:

• Caffeinated beverages
• Sugary drinks
• Alcohol
• Fatty foods
• Spicy foods

The specific dietary approach to prevent or control diarrhea should be tailored to its cause and individual tolerance levels.

Dairy Consumption During Acute Diarrhea: What Does the Evidence Say?

Contrary to popular belief, evidence does not support the need to completely eliminate dairy during episodes of acute diarrhea. Instead, it is generally advised to consume milk products as tolerated, with a preference for low-fat options or those containing probiotics.

In some cases, digestive irritation may trigger a temporary shortage of the enzyme needed to properly digest lactose, leading to short-term secondary lactose intolerance. However, the body’s ability to digest lactose usually returns to normal shortly after the irritation is resolved.

Can Fermented Dairy Products Help with Diarrhea?

Emerging evidence suggests that fermented dairy products, particularly yogurt, may offer benefits in preventing or alleviating acute diarrhea. A systematic review of 31 studies exploring the health effects of probiotic foods found an association between certain probiotic milk products, such as yogurt, and a decrease in the duration of diarrhea episodes caused by either infection or antibiotics.

Furthermore, a meta-analysis including over 32,000 children revealed that probiotic yogurt was more effective than a placebo in reducing the duration of acute diarrhea in high-income countries like Canada.

Lactose Intolerance and Diarrhea Management

For individuals with lactose intolerance, managing diarrhea requires a more personalized approach. Lactose intolerant individuals can often tolerate varying levels of lactose without experiencing gastrointestinal discomfort. Factors influencing tolerance include:

• Personal sensitivity levels
• The type of food consumed
• Whether the food is consumed alone or with other foods

Understanding these factors can help lactose intolerant individuals make informed decisions about dairy consumption during diarrhea episodes.

Dietary Recommendations for Acute Diarrhea

When managing acute diarrhea, consider the following dietary recommendations:

1. Focus on proper hydration to prevent dehydration
2. Return to a normal, solid diet as soon as tolerated
3. Consume dairy products as tolerated, favoring low-fat or probiotic-rich options
4. Consider incorporating fermented dairy products like yogurt
5. Avoid caffeine, sugary drinks, alcohol, and fatty or spicy foods
6. Tailor your approach based on personal tolerance and the underlying cause of diarrhea

The Potential Benefits of Probiotic Dairy Products

Probiotic dairy products, particularly yogurt, have shown promising results in managing acute diarrhea. These benefits are attributed to the presence of beneficial bacteria that can help restore gut health and reduce the duration of diarrhea episodes.

A meta-analysis focusing on children in high-income countries found that probiotic yogurt was significantly more effective than a placebo in reducing the duration of acute diarrhea. This suggests that incorporating probiotic-rich dairy products into the diet during and after diarrhea episodes may be beneficial.

How Do Probiotics in Dairy Products Help?

Probiotics in dairy products can help manage diarrhea through several mechanisms:

• Restoring the balance of gut microbiota
• Enhancing the immune response in the gut
• Producing substances that inhibit harmful bacteria
• Improving the gut’s barrier function

These effects can contribute to faster recovery from diarrhea and may even help prevent future episodes.

Personalized Approaches for Dietary Intolerances

Individuals with dietary intolerances, such as lactose intolerance, require personalized approaches to manage diarrhea and avoid symptoms. While complete dairy elimination may not be necessary, understanding personal tolerance levels is crucial.

For lactose intolerant individuals, consider the following strategies:

• Experiment with small amounts of dairy to determine tolerance levels
• Choose lactose-free or lactose-reduced dairy products
• Opt for fermented dairy products like yogurt, which may be better tolerated
• Consider taking lactase enzyme supplements before consuming dairy
• Consume dairy products alongside other foods to slow lactose absorption

Remember that tolerance levels can vary, and what works for one person may not work for another. It’s essential to work with a healthcare professional or registered dietitian to develop a personalized plan.

The Importance of Hydration in Diarrhea Management

While discussing dietary approaches to managing diarrhea, it’s crucial to emphasize the importance of proper hydration. Diarrhea can lead to significant fluid loss, potentially resulting in dehydration if not addressed promptly.

How Can You Ensure Proper Hydration During Diarrhea?

To maintain adequate hydration during episodes of diarrhea, consider the following strategies:

• Drink plenty of clear fluids, such as water, clear broths, or electrolyte solutions
• Avoid caffeine and alcohol, which can contribute to dehydration
• Consume foods with high water content, like fruits and vegetables
• Consider oral rehydration solutions for severe cases or as recommended by a healthcare provider

Monitoring urine color can be a helpful indicator of hydration status. Pale yellow urine generally indicates good hydration, while dark yellow or amber-colored urine may suggest dehydration.

When to Seek Medical Attention for Diarrhea

While many cases of diarrhea can be managed at home with dietary adjustments and proper hydration, there are instances where medical attention is necessary. Understanding when to seek professional help is crucial for preventing complications and ensuring proper treatment.

Consider seeking medical attention if you experience any of the following:

• Diarrhea lasting more than a few days
• Signs of severe dehydration (e.g., extreme thirst, dry mouth, little or no urine output)
• Bloody or black stools
• Severe abdominal or rectal pain
• Fever above 39°C (102°F)
• Symptoms of diarrhea after returning from international travel

Healthcare professionals can provide appropriate treatment and help identify any underlying conditions that may be contributing to persistent diarrhea.

The Role of Probiotics Beyond Dairy in Diarrhea Management

While we’ve discussed the potential benefits of probiotic dairy products in managing diarrhea, it’s worth noting that probiotics can be found in other food sources and supplements as well. These non-dairy probiotic options may be particularly useful for individuals who cannot tolerate dairy or prefer alternatives.

What Are Some Non-Dairy Probiotic Sources?

Consider incorporating these non-dairy probiotic sources into your diet:

• Fermented vegetables (e.g., sauerkraut, kimchi)
• Kombucha
• Kefir (water-based varieties)
• Tempeh
• Miso
• Probiotic supplements (as recommended by a healthcare provider)

These alternatives can provide beneficial bacteria to support gut health and may help in managing diarrhea episodes. However, it’s important to introduce new foods gradually, especially during or after a bout of diarrhea, to ensure they are well-tolerated.

Long-Term Dietary Strategies for Gut Health

While managing acute diarrhea is important, adopting long-term dietary strategies to promote overall gut health can help reduce the frequency and severity of future episodes. A healthy gut microbiome plays a crucial role in digestive health and can contribute to a stronger immune system.

How Can You Promote Long-Term Gut Health Through Diet?

Consider incorporating these dietary strategies for long-term gut health:

1. Consume a diverse range of fruits and vegetables to provide various fibers and nutrients
2. Include both probiotic and prebiotic foods in your diet
3. Limit processed foods and excessive sugar intake
4. Stay hydrated by drinking plenty of water throughout the day
5. Consider fermented foods as part of your regular diet
6. Manage stress levels, as stress can impact gut health

Remember that gut health is individual, and what works best may vary from person to person. It’s advisable to work with a healthcare professional or registered dietitian to develop a personalized plan that suits your specific needs and health goals.

The Impact of Medications on Diarrhea and Dairy Tolerance

It’s important to consider the role that medications can play in both causing diarrhea and affecting an individual’s ability to tolerate dairy products. Certain medications, particularly antibiotics, can disrupt the balance of gut bacteria, potentially leading to diarrhea and temporary lactose intolerance.

How Do Antibiotics Affect Gut Health and Dairy Tolerance?

Antibiotics can impact gut health and dairy tolerance in several ways:

• Disrupting the balance of beneficial gut bacteria
• Potentially reducing the production of lactase enzyme
• Increasing susceptibility to opportunistic infections
• Altering gut motility and function

If you’re taking antibiotics and experiencing diarrhea or difficulty tolerating dairy, consider these strategies:

1. Discuss probiotic supplementation with your healthcare provider
2. Temporarily reduce dairy intake or opt for lactose-free alternatives
3. Focus on easily digestible, nutrient-dense foods
4. Stay well-hydrated to support gut health and prevent dehydration
5. Gradually reintroduce dairy products as your gut health improves

Always consult with your healthcare provider before making significant changes to your diet or medication regimen.

The Role of Dietary Fiber in Managing Diarrhea

While fiber is generally associated with promoting regular bowel movements, its role in managing diarrhea is more complex. Different types of fiber can have varying effects on diarrhea, and understanding these differences can help in developing an effective dietary strategy.

How Does Dietary Fiber Impact Diarrhea?

The impact of dietary fiber on diarrhea can be categorized as follows:

• Soluble fiber: Can help absorb excess water in the intestines, potentially reducing diarrhea
• Insoluble fiber: May exacerbate diarrhea in some cases and should be consumed cautiously during acute episodes
• Prebiotic fibers: Can support the growth of beneficial gut bacteria, potentially aiding in recovery

When managing diarrhea, consider these fiber-related strategies:

1. Focus on soluble fiber sources like bananas, applesauce, and oatmeal during acute episodes
2. Gradually increase fiber intake as symptoms improve
3. Include prebiotic-rich foods to support gut health recovery
4. Stay well-hydrated when increasing fiber intake
5. Monitor your body’s response and adjust fiber intake accordingly

As with any dietary changes, it’s advisable to consult with a healthcare professional or registered dietitian, especially if you have ongoing digestive issues or other health concerns.

The Connection Between Stress and Diarrhea

While our focus has been primarily on dietary factors, it’s crucial to acknowledge the significant role that stress can play in triggering or exacerbating diarrhea. The gut-brain connection is well-established, and stress can have a direct impact on digestive function.

How Does Stress Contribute to Diarrhea?

Stress can affect the digestive system in several ways:

• Altering gut motility and increasing intestinal permeability
• Affecting the balance of gut bacteria
• Triggering inflammation in the digestive tract
• Exacerbating existing digestive conditions

To manage stress-related diarrhea, consider these strategies:

1. Practice stress-reduction techniques like meditation or deep breathing exercises
2. Engage in regular physical activity to help manage stress levels
3. Ensure adequate sleep to support overall health and stress resilience
4. Consider cognitive-behavioral therapy or other forms of counseling if stress is chronic
5. Maintain a balanced diet to support both gut and mental health

By addressing both dietary and lifestyle factors, including stress management, you can develop a comprehensive approach to managing diarrhea and promoting overall digestive health.

The Evidence on Diarrhea and Milk

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July 01, 2021

Diet can play an important role in the management of diarrhea, but the approach will vary on its cause. There is a common belief that dairy products should automatically be eliminated during episodes of diarrhea, but current evidence does not support avoiding dairy. In fact, some research is now suggesting that certain fermented dairy products, such as yogurt, may be helpful in alleviating acute episodes of diarrhea.

In North America, diarrhea is a common condition that is often a source of discomfort and inconvenience.¹ Causes of diarrhea include gastrointestinal infections (such as the stomach flu or food poisoning), indigestion, and certain medications (such as antibiotics). ¹ Certain chronic conditions may also cause persistent diarrhea if uncontrolled, such as food intolerances or digestive disorders.¹ Prolonged or recurring episodes should be discussed with a healthcare practitioner.¹

Diet during episodes of diarrhea

Diet plays an important role in the management of diarrhea. Hydrating appropriately is a key component in the treatment of diarrhea to prevent dehydration.^2,3 In most cases, it is advised to return to a normal, solid diet as soon as possible.^2-6 However, certain foods may exacerbate irritation or be more difficult to digest as the digestive tract recovers.^5,6 Examples of such foods include caffeinated or sugary beverages, alcohol, fatty or spicy foods.^5,6 The dietary approach to prevent or control diarrhea varies depending on its cause and on personal tolerance.

In practice

• The dietary approach for treating diarrhea will vary based on its cause and on personal tolerance.
• While it is generally recommended to return to a normal diet as soon as possible, certain foods such as caffeinated or sugary beverages, alcohol, and fatty or spicy foods may be irritating to the digestive tract.
• Current evidence does not support automatically eliminating dairy during periods of acute diarrhea. Rather, favouring low-fat or fermented products is advised.
• Some research is now suggesting that certain fermented dairy products, such as yogurt, may be helpful in avoiding or alleviating acute episodes of diarrhea.

Acute diarrhea. There is a common belief that dairy products should be eliminated during episodes of diarrhea. However, evidence does not support the need to eliminate dairy completely.^4,7 Rather, it is generally advised to consume milk products as tolerated and to favour options that are low-fat or contain probiotics.^5,6 In some cases, digestive irritation may trigger a temporary shortage of the enzyme needed to properly digest lactose, causing short-term secondary lactose intolerance. ^8-10 The body’s ability to digest lactose will usually return to normal shortly after the irritation is resolved.¹⁰ 

Some evidence suggests that fermented dairy products, such as yogurt, may also yield certain benefits for preventing or alleviating acute diarrhea.^11,12 In fact, a systematic review of 31 studies that explored the health effects of probiotic foods associated certain probiotic milk products, such as yogurt, to a decrease in the duration of episodes of diarrhea that were caused by either an infection or by antibiotics.¹² Moreover, a meta-analysis including over 32 000 children found that probiotic yogurt was more effective than a placebo at reducing the duration of acute diarrhea in high-income countries, such as Canada.¹³

Dietary intolerances. Dietary intolerances require personalized approaches to avoid symptoms, such as diarrhea.^14,15 For example, lactose intolerant individuals can often tolerate varying levels of lactose without experiencing gastrointestinal discomfort. Factors include personal tolerance, the type of food consumed, and if the food is consumed alone or with other foods.^14,15  

Interested in learning more about managing lactose intolerance?

Read more here

References

1. National Institute of Diabetes and Digestive and Kidney Diseases. 2021. Diarrhea. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea. Accessed July 19, 2021.
2. UpToDate. 2021. Approach to the adult with acute diarrhea in resource-rich settings. https://www.uptodate.com/contents/approach-to-the-adult-with-acute-diarrhea-in-resource-rich-settings. Accessed July 20, 2021.
3. Grave NS. Acute Gastroenteritis. Prim Care 2013; 40: 727–741.
4. Lo Vecchio et al. Comparison of Recommendations in Clinical Practice Guidelines for Acute Gastroenteritis in Children. J Pediatr Gastroenterol Nutr 2016; 63:226–235.
5. Gouvernement du Québec. 2020. Foods to eat when you have gastroenteritis. https://www.quebec.ca/en/health/health-issues/flu-cold-and-gastroenteritis/gastroenteritis/foods-to-eat-when-you-have-gastroenteritis. Accessed July 28, 2021.
6. HealthLinkBC. 2020. Diarrhea, Age 12 and Older. https://www.healthlinkbc.ca/health-topics/diar4#hw87342. Accessed July 28, 2021.
7. Guarino A et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. Journal of pediatric gastroenterology and nutrition 2014; 59:132-152.
8. Di Costanzo M, Canani RB. Lactose intolerance: common misunderstandings. Annals of Nutrition and Metabolism 2018;73:30-37.
9. National Health Service. 2019. Lactose intolerance. https://www.nhs.uk/conditions/lactose-intolerance/. Accessed July 19, 2021.
10. American College of Gastroenterology. 2021. Lactose Intolerance in Children. https://gi.org/topics/lactose-intolerance-in-children/. Accessed July 20, 2021.
11. Savaiano DA and Hutkins RW. Yogurt, cultured fermented milk, and health: A systematic review.  Nutrition reviews 2021;79:599-614.
12. Scourboutakos MJ et al. Mismatch between probiotic benefits in trials versus food products. Nutrients 2017. doi 10.3390/nu9040400.
13. Florez ID et al. Comparative effectiveness and safety of interventions for acute diarrhea and gastroenteritis in children: a systematic review and network meta-analysis. PLoS One 2018. doi.org/10.1371/journal.pone.020770.
14. Corgneau M et al. Recent advances on lactose intolerance: Tolerance thresholds and currently available answers. Critical reviews in food science and nutrition 2017;57:3344-3356.
15. Mattar R, de Campos Mazo DF, Carrilho FJ. Lactose intolerance: diagnosis, genetic, and clinical factors. Clinical and experimental gastroenterology 2012. doi:10.2147/CEG.S32368.

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Gut Health – A Journey Inside

Lactose intolerance – Symptoms & causes

Overview

People with lactose intolerance are unable to fully digest the sugar (lactose) in milk. As a result, they have diarrhea, gas and bloating after eating or drinking dairy products. The condition, which is also called lactose malabsorption, is usually harmless, but its symptoms can be uncomfortable.

Too little of an enzyme produced in your small intestine (lactase) is usually responsible for lactose intolerance. You can have low levels of lactase and still be able to digest milk products. But if your levels are too low you become lactose intolerant, leading to symptoms after you eat or drink dairy.

Colon and small intestine

The small intestine and colon are parts of your digestive tract, which processes the foods you eat. The intestines take nutrients from the foods. What isn’t absorbed by the intestines continues along the digestive tract and is passed as stool during a bowel movement.

Most people with lactose intolerance can manage the condition without having to give up all dairy foods.

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Symptoms

The signs and symptoms of lactose intolerance usually begin from 30 minutes to two hours after eating or drinking foods that contain lactose. Common signs and symptoms include:

• Diarrhea
• Nausea, and sometimes, vomiting
• Stomach cramps
• Bloating
• Gas

When to see a doctor

Make an appointment with your doctor if you frequently have symptoms of lactose intolerance after eating dairy foods, particularly if you’re worried about getting enough calcium.

Causes

Lactose intolerance occurs when your small intestine doesn’t produce enough of an enzyme (lactase) to digest milk sugar (lactose).

Normally, lactase turns milk sugar into two simple sugars — glucose and galactose — which are absorbed into the bloodstream through the intestinal lining.

If you’re lactase deficient, lactose in your food moves into the colon instead of being processed and absorbed. In the colon, normal bacteria interact with undigested lactose, causing the signs and symptoms of lactose intolerance.

There are three types of lactose intolerance. Different factors cause the lactase deficiency underlying each type.

Primary lactose intolerance

People who develop primary lactose intolerance — the most common type — start life producing enough lactase. Infants, who get all their nutrition from milk, need lactase.

As children replace milk with other foods, the amount of lactase they produce normally drops, but usually remains high enough to digest the amount of dairy in a typical adult diet. In primary lactose intolerance, lactase production falls off sharply by adulthood, making milk products difficult to digest.

Secondary lactose intolerance

This form of lactose intolerance occurs when your small intestine decreases lactase production after an illness, injury or surgery involving your small intestine. Diseases associated with secondary lactose intolerance include intestinal infection, celiac disease, bacterial overgrowth and Crohn’s disease.

Treatment of the underlying disorder might restore lactase levels and improve signs and symptoms, though it can take time.

Congenital or developmental lactose intolerance

It’s possible, but rare, for babies to be born with lactose intolerance caused by a lack of lactase. This disorder is passed from generation to generation in a pattern of inheritance called autosomal recessive, meaning that both the mother and the father must pass on the same gene variant for a child to be affected. Premature infants can also have lactose intolerance because of an insufficient lactase level.

Risk factors

Factors that can make you or your child more prone to lactose intolerance include:

• Increasing age. Lactose intolerance usually appears in adulthood. The condition is uncommon in babies and young children.
• Ethnicity. Lactose intolerance is most common in people of African, Asian, Hispanic and American Indian descent.
• Premature birth. Infants born prematurely might have reduced levels of lactase because the small intestine doesn’t develop lactase-producing cells until late in the third trimester.
• Diseases affecting the small intestine. Small intestine problems that can cause lactose intolerance include bacterial overgrowth, celiac disease and Crohn’s disease.
• Certain cancer treatments. If you’ve had radiation therapy for cancer in your stomach or you have intestinal complications from chemotherapy, your risk of developing lactose intolerance increases.

Lactose intolerance – symptoms, signs

Lactose intolerance – symptoms, signs