Diarrhea prevention and treatment, natural therapy with supplements
December 19 2015 by
Ray Sahelian, M.D.
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Diarrhea is one of the most common reasons patients visit a doctor's office, particularly in pediatrics. Diarrhea is defined as loose, watery stools occurring more than three times in one day. In most cases, diarrhea lasts a day or two and goes away on its own without any special treatment. However, prolonged diarrhea can be a sign of other problems, including a serious infection or serious medical condition. People with diarrhea may pass more than a liter of stool a day.

Cause from visiting foreign countries
Travelers diarrhea affects millions of tourists each year. Most cases are caused by a variety of bacterial enteropathogens: toxigenic Escherichia coli, Campylobacter, Shigella, Salmonella, Aeromonas, Plesiomonas and non-cholera vibrios. Treatment may include antibacterial therapy with either ciprofloxacin, or azitrhomycin, or rifaximin. Viral pathogens such as norovirus usually cause short-term illness that typically resolves before travelers seek medical attention. Chronic gastrointestinal disease in returning travelers often is caused by parasitic pathogens like Giardia lamblia.

Preventing traveler's diarrhea or natural treatment
People who wash their hands properly can reduce the rate of diarrhea transmission. In rich and poor countries alike, and in schools, hospitals and elsewhere, hand washing is a simple way to reduce such infections.

Probiotic supplements, which contain "good" bacteria such as Lactobacillus may prevent bad bugs from invading the intestines. Current Sports Medicine Reports, April 2007.
J Hosp Infect. 2013. Probiotic VSL#3 prevents antibiotic-associated diarrhea in a double-blind, randomized, placebo-controlled clinical trial.

Turk J Gastroenterol. 2014. The role of Bifidobacterium lactis B94 plus inulin in the treatment of acute infectious diarrhea in children. In contrast to many other studies of probiotic species, the number of publications evaluating Bifidobacterium lactis and its combinations with prebiotics as treatments for acute infectious diarrhea is limited. We investigated the synbiotic effects of B. lactis B94 plus inulin on acute infectious diarrhea. The study was conducted on children with acute diarrhea between the ages of 2 and 60 months. The patients were administered 51010 colony-forming units (CFU) of B. lactis B94 plus 900 mg inulin or placebo, once a day for five days.  Treatment with 5 1010 CFU of B. lactis B94 plus 900 mg inulin shortened the duration of acute watery diarrhea by an average of 31 h. This decrease was most pronounced in cases of Rotavirus diarrhea.

Treatment with medication
An over-the-counter antidiarrheal drug can help reduce a bout of diarrhea, but it's important to take the medication properly.
Follow the label's instructions on how often to take the medication, and how much to take, never take more but err on the side of taking fewer pills.
Call your doctor if you have any questions or are taking other medications.
More medication does not work more effectively or quickly.
Use only one antidiarrheal medication at a time, unless directed by your doctor.

Types of diarrhea
Diarrhea is very common and usually not serious. Many people will have diarrhea once or twice each year. Diarrhea can be classified as "osmotic," "secretory" or "exudative." Osmotic diarrhea occurs when something in the bowel is drawing water from the body into the bowel. One example is the sweetener sorbitol. It is not absorbed from the intestines but attracts water into the bowel, resulting in diarrhea. Secretory diarrhea occurs when the body is releasing water into the bowel when it's not supposed to due to infections, drugs and other conditions. Exudative diarrhea happens when there is blood and pus in the stool. Exudative diarrhea occurs with inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis, and several infections.

Cause of diarrhea
There are a number of reasons why it could occur. The following are some common causes:

Viral infections. Many viruses are responsible, including rotavirus, Norwalk virus, cytomegalovirus, and viral hepatitis. Viral infection is the most common cause of diarrhea. The diarrhea usually lasts about two days and is referred to as "intestinal flu."

Bacterial infections. Several types of bacteria, consumed through contaminated food or water, can cause diarrhea. Common germs include Campylobacter, Salmonella, Shigella, and Escherichia coli. Food poisoning often occurs from a bacterial infection.

Food intolerance. Some people are unable to digest some component of food, such as lactose, the sugar found in milk. Certain allergies to foods may also cause diarrhea.

Parasites or protozoa can enter the body through food or water and settle in the digestive system. Parasites that cause diarrhea include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.

Untoward reaction to medicines, such as antibiotics, chemotherapy agents, and antacids containing magnesium. The popular class of acid reflux medication that includes Aciphex, Dexilant, Nexium, Prevacid, Prilosec, and Protonix is associated with an increased risk of diarrhea caused by the bug Clostridium difficile (C. diff).

Intestinal diseases, like inflammatory bowel disease or celiac disease.

Functional bowel disorders, such as irritable bowel syndrome, in which the intestines do not work normally. In some cases psyllium could be helpful for this.

Diarrhea associated with antibiotic use
Antibiotic associated diarrhea is a common complication when antibiotics are used and is frequent in the elderly. It has an impact on the length of hospital stay. Mostly antibiotic associated diarrhea is benign, but an infection with Clostridium difficile should always be excluded. C. difficile-enterocolitis is frequent among residents in nursing homes and in hospitalised patients. The clinical presentation varies from asymptomatic colonisation tot severe debilitating disease. A rapid diagnosis can be performed by detection of C. difficile toxin by an enzyme-linked immunoassay. Oral metronidazole and oral vancomycine are equally effective in the therapy. In relapsing infection an extended tapering regimen is sometimes necessary.

Diarrhea in seniors, the elderly, older people, age related
Gastroenterol Clin North Am. 2001. Diarrhea and malabsorption in the elderly. If diarrhea is of short duration, an infectious cause is at least as common as in the young. Institutionalized elderly are particularly prone to gastrointestinal infections, but the manifestations may not be overt. When an intestinal infection and potential medication-induced gastrointestinal disturbances have been excluded, the differential diagnosis of diarrhea in the elderly is the same as in the young. Causes include intestinal malabsorption, even though diarrhea is a less common manifestation of malabsorption in the old than in younger patients. In the elderly, micronutrient deficiency is a common presenting clinical picture; because the symptoms of malabsorption are covert, the diagnosis often is delayed, and nutritional deficiencies are more common and more severe than in the young. Because the elderly have less nutritional reserve than the young, these deficiencies are clinically much more devastating in the elderly. Although the causes of malabsorption, as a whole, are similar in older and younger patients, chronic pancreatic insufficiency of unknown cause and intestinal bacterial overgrowth without an anatomic abnormality of the small intestine are syndromes that are specific to the elderly and must be considered in any older patient with unexplained weight loss or failure to thrive. Often, therapeutic trials are necessary to establish a potential diagnosis.

Dairy foods
I'm a health reporter and am writing an article about natural remedies. I'd like to ask you about a 2003 study shows that eating dairy foods can help curb diarrhea. I think many people are under the assumption that dairy foods worsen diarrhea. Yet, the researchers suggest that calcium plays a role in preventing the overgrowth of bacteria that leads to the condition. What are your thoughts on this?
    A. Diarrhea is caused by a number of conditions from food sensitivity to infectious diseases and thus it is simplistic to put too much emphasis on the role of dairy foods as a cause or treatment for this condition, There are many, many other more crucial causes of diarrhea and the role of dairy foods is minimal.

Traveler's Diarrhea
Traveler's diarrhea is the most frequent health problem in travelers to developing countries. Traveler's diarrhea is caused by a wide range of infectious organisms, ETEC and EAEC bacteria strains being the main enteropathogens incriminated in traveler's diarrhea. Other causative bacteria are: Shigella spp., Campylobacter spp., Vibrio spp., Aeromonas spp., Salmonella spp., and Plesiomonas spp. Parasite species are also included: Cyclospora cayetanensis, Giardia lamblia, Cryptosporidium, Entamoeba histolytica, as well as viruses: rotavirus, adenovirus, Norwalk virus.
   Along with the well-known precaution of not drinking the water, traveling athletes should also avoid salads, unpasteurized dairy foods, meats and seafood that have not been well cooked, and unpeeled fruits. Food from street vendors can also be risky.

The overuse of antibiotics to treat travelers' diarrhea may contribute to the spread of drug-resistant superbugs, a new study suggests. Antibiotics should be used to treat travelers' diarrhea only in severe cases, Clinical Infectious Diseases, news release, Jan. 22, 2015.

2007 - A single-dose of the antibiotic azithromycin, sold under the trade name Zithromax, is recommended as the first therapy to use against traveler's diarrhea, particularly if it's acquired in Thailand. According to surveys of U.S. military personnel stationed in Thailand, bacteria belonging to the Campylobacter family are responsible for up to 60 percent of cases of diarrhea. More than 85 percent of these pathogens are resistant to fluoroquinolone antibiotics, such as Levaquin (levofloxacin) or Cipro (ciprofloxacin), which are frequently prescribed for traveler's diarrhea.

Diarrhea and travel - Traveler's diarrhea treatment
The Centers for Disease Control and Prevention has classified world regions based on traveler's diarrhea risk, with visitors to certain parts of Eastern Europe, the Caribbean and South Africa facing intermediate risk. Most of Asia, the Middle East, Africa and Central and South America are considered high risk areas.

Fluid replacement is the standard treatment for  traveler's diarrhea. The World Health Organization recommends an oral rehydration solution of salts and sugar along with water. Azithromycin is a good choice if an antibiotic is needed. Quinolone antibiotics should be used with care in athletes since they can increase the risk of tendon rupture.


Cruise ship passengers and diarrhea disease
The expected incidence of gastroenteritis per seven-day cruise has increased from two cases between 1990 and 2000 to three cases in between 2001 and 200. The increase seen at sea is paralleled by an increase in the prevalence of norovirus -associated gastroenteritis on land. The illness is common in Scandinavia, the UK, Europe and North America. Norovirus is a frequent cause of gastroenteritis and its symptoms -- including diarrhea and vomiting -- are unpleasant but rarely dangerous. The virus is transmitted through person-to-person contact, contaminated food or water, or by touching a contaminated surface, such as elevator buttons and stair handrails.