Diarrhea and diet: what foods to favor and avoid?

Diarrhea is often pasty (85% water) or even liquid (90% water) with an increase in water content (normally 80% water) and electrolytes. THE acute diarrhea evolve over a few days and rarely exceed 10 days. According to the WHO, we are talking about acute diarrhea when there are more than 3 very soft to liquid stools per day, since less than 14 days. If diarrhea persists for more than 3 weeks, it is called chronicles and are characterized by malabsorption and maldigestion diarrhea resulting from various pathologies.

Acute diarrhea mainly affects children in communities, particularly in winter during viral epidemics. The causes are almost always infectious: digestive infections (gastroenteritis) or extra-digestive (ENT and urinary pathologies). They can also be linked to food allergies, teething, and dietary errors such as eating meals too quickly and not chewing. Infantile diarrhea is a special case and must be treated by a doctor depending on the case, because the risk of dehydration can have vital consequences for the young child.

In adults, there is a tendency for acute traveler's diarrhea (tourist) and food infections. Episodes of stress and anxiety can also lead to acute diarrhea, as can taking antibiotics. In the elderly, diarrhea may require medical treatment depending on the case. Doctors regularly prescribe oral rehydration solutions to limit fluid loss.

There are two main mechanisms in acute diarrhea. First, dysenteric syndrome is caused by invasive bacteria such as salmonella. It is characterized by invasion of the rectocolic mucosa, leading to inflammatory lesions and resulting in bloody stools frequent but not very abundant. We feel fever and tenesmus (violent anorectal pain with an urgent urge to have a bowel movement). Choleriform syndrome, it is caused by enterotoxin bacteria such as cholera. It is characterized by surface colonization of the mucosa of the proximal small intestine leading to the secretion of an enterotoxin stimulating the secretion of sodium and water. This leads to copious watery fecal stools with absence of abdominal pain.

Diet plays a key role in acute diarrhea and focuses on the following areas:

• Compensate for water losses by optimizing hydration, gradually, via waters rich in mineral salts. Acute diarrhea is often watery and the main risk is dehydration. Indeed, stools have a higher water content during phases of diarrhea.

• Limit the acceleration of transit induced by diarrhea via foods based on soluble fiber. These allow a gel to form, reducing the absorption of nutrients. This is why these fibers are said to reduce cholesterol, triglyceride and glucose levels. It is also recommended to limit laxative foods such as lactose, which promote the acceleration of transit.

• Leave the transit to rest thanks to foods low in irritating fiber. Foods rich in carbohydrates and lean protein will be promoted in order to allow the intestines to rest and avoid weight loss that can be caused by reduced food intake, due to abdominal pain. They will also help attack bacteria and viruses causing diarrhea. It is also recommended to limit foods that are too fatty, too sweet, too spicy, and too rich in calories, in order to allow the digestive system to rest and limit any inflammation.

• Restore balance to the intestinal flora by bringing probiotics who contain microorganisms, most of which are bacteria similar to beneficial bacteria naturally present in the human intestine. They are used to reduce flatulence thanks to Lactobacillus acidophilus which acidifies the intestines, helping to maintain the natural balance of fermentation processes. Furthermore, it turns out that the bromelain (mixture of enzymes extracted from pineapple) counteracts certain effects of intestinal pathogens, such as Vibrio cholera and Escherichia coli, whose enterotoxin causes diarrhea in animals.

• Limit intestinal inflammation by opting for a residue-free diet and therefore poor in insoluble fiber. The latter will accelerate transit by filling themselves with water and increase the volume of stools by 20 to 30 times. It is then preferable to limit them so as not to exceed the 20 grams of fiber per day recommended by the residue-free diet. Indeed, excess fiber tends to irritate the intestinal walls.

Losses of water and mineral salts are significant in cases of diarrhea. It is essential to hydrate in a progressive and abundant manner to counter these losses. Indeed, dehydration has many harmful effects on the body such as headaches, dizziness, disturbances of consciousness such as malaise, or even a change in behavior such as agitation, apathy or severe physical and intellectual weaknesses.

We recommend you :

• to consume at least between 1.5 L and 2 L of water rich in mineral salts such as Hépar®, Courmayeur®, Contrex or Salvetat®.

• of split fluid intake throughout the day at 1 glass of water (250 mL) every 2 hours (2 Liters for 16 hours).

• to think about salty drinks like broths, for their richness in mineral salts and particularly sodium which promotes water retention.

• to favor infusions, and to limit coffee and tea rich in caffeine which stimulates transit.

• If you consume soda, stir it with a fork or spoon to remove any gas that may be present. pro-inflammatory for your intestines.

• of eliminate alcohol because it does not hydrate, but rather carries a risk of dehydration and is pro-inflammatory for the intestines.

These foods contain soluble fiber. The fibers are not not degradable by digestive enzymes, but rather by colonic bacteria. The main types of soluble fiber are pectins, gums, mucilages and certain hemicelluloses.

We recommend you :

• to consume less 5 servings of fruits and vegetables rich in soluble fiber per day such as apples, citrus fruits (oranges, lemons, grapefruit), bananas, guava, plums, or even asparagus, Brussels sprouts, carrots and onions.

• to consume foods rich in soluble fiber in the form of purees, compotes, Or well cooked, in order to eliminate excess fibers. This is the reason why ripe bananas and applesauce are known as foods that can be eaten during phases of diarrhea.

• to consume legumes 1 to 2 times a week by pureeing them (red beans, peas) and soaking them in water to promote digestion.

• to consume in snack of the psyllium powder. These foods are rich in soluble fiber. Indeed, psyllium has many benefits for your intestines, this fiber concentrate modulates intestinal peristalsis, which will affect constipation but also acute to moderate diarrhea. It also acts as a prebiotic, which helps optimize intestinal symbiosis.

• Be careful not to exceed 20 g of fiber per day, referring to the fiber contents of the foods above in Ciqual (ANSES nutritional table).

Starchy foods are rich in carbohydrates which help limit weight loss by functioning as fuel for the body. It is preferable to turn to refined cereals such as rice and pasta which have a very low fiber content unlike whole grain products. We can also move towards starchy foods like potatoes, semolina or even bulgur. We add them gradually according to your personal tolerance.

Caution : rice and refined starches are not miracle cures. The absence of residue during their digestion leaves the colon at rest. You are therefore not going to heal via rice, but rather limit breakage and eat as much as you are hungry without fearing additional pain.

We recommend you :

• to ensure a majority of starchy foods compared to vegetables in order to limit the presence of fiber and limit the loss of vitamins and minerals destroyed by pureeing or long cooking: 1/2 from the starchy plate, 1/4 of the vegetable plate.

• of limit as much as possible whole grains for their richness in irritating fiber during periods of diarrhea.

• to consume at least between 300g and 400g of starchy foods per day (100-130 g raw because they triple in volume when cooked).

Dietary proteins help limit weightloss weakening the immune system. The latter being in interaction with the muscles, weight loss leads to a loss of muscle mass and consequently a weakening of immunity.

We recommend you :

• to consume a source lean protein at each meal : 100 g of lean meat (turkey, chicken, guinea fowl, escalope and veal fillet), or 100 g of lean fish (hake, cod, whiting, saithe), or 2 eggs. Despite their sulfur content which can contribute to intestinal gas, eggs are better tolerated than legumes and oilseeds.

• to prefer lean proteins to meats red, cold cuts, meats fries and fish fat rich in fats promoting the acceleration of intestinal transit, but also legumes, certainly rich in protein, but also rich in fiber.

• to divide your diet into 4 to 6 meals to limit weight loss.

Fermented foods are rich in probiotics. High-quality studies prove the effectiveness of probiotics in acute infectious diarrhea, antibiotic-associated diarrhea, and Clostridium difficile-associated diarrhea. Also, in the context of an Escherichia coli infection, active bromelain supplementation causes certain non-stick effects, preventing bacteria from attaching to specific glycoprotein receptors. These receptors being located on the intestinal mucosa, bromelain would break down the proteins present on the receptor attachment sites, and would thus prevent the bacteria from attaching to it and damaging it.

We recommend you :

• to eat pineapple as a dessert or snack. Rest assured, this fruit is not rich in fiber (1.2 g per 100 g).

• introduce probiotics to your diet: yogurts (very rich in milk bacteria), lactose-free cheeses (see below), fermented drinks (kombucha, kefir), brewer's yeast. However, be careful with fermented vegetables, which are rich in fiber.

It is recommended to limit lactose during phases of acute diarrhea. However, a study on 80 children aged between 6 and 24 months demonstrated very beneficial effects on the consumption of natural yogurts during periods of diarrhea. This study recommends the universal consumption of yogurt in the context of acute non-bloody diarrhea. Another study was carried out on the impact of yogurt on 112 children suffering from acute watery diarrhea. The results showed that yogurt feeding was associated with a clinically relevant decrease in stool frequency and diarrhea duration in children who had reducing sugars in the stool.

We recommend you :

• to move towards lactose-free or low-lactose dairy products such as “lactose-free” cheeses or almost (a few traces per 100 g of cheese) such as cheddar, parmesan, gruyere, emmental, county, cantal, reblochon or even Beaufort, but also semi-hard cheeses (less than 1 g of lactose per 100 g) such as sheep's and goat's cheeses in logs, bricks, crottin or fresh.

• to introduce a natural yogurt every day, because these yogurts are also rich in milk bacteria to rebalance the intestinal flora.

These foods are rich in insoluble fiber. The best known insoluble fibers are resistant starches, lignin, cellulose and hemicellulose. They are mainly found in the envelope plants, and therefore in the skin of fruits, certain vegetables, whole grains, or even legumes and oilseeds.

We recommend you :

• to limit or even dELETE foods containing insoluble fiber such as wheat bran, whole wheat cereals, almonds, and peanuts. It is recommended to limit the following fruits: plums, raspberries, apples with skin and raw, pears, hard bananas, blueberries and strawberries. Finally, you must reduce the following vegetables: spinach, green beans, green peas, cauliflower, kale, red cabbage, asparagus.

• to eat fruits and vegetables well cooked or in mash potatoes to destroy as many fibers as possible.

• to limit fiber to 20 g maximum per day.

These foods overload the inflamed intestines and promote inflammation. In addition, foods that are too sweet generate an additional need for water to be digested and can thus lead to dehydration. This is why most sodas do not quench the feeling of thirst.

We recommend you :

• to avoid the insulated sockets foods that are too sweet and high in calories such as sweets.

• to avoid excesses spices in your dishes and in particular the chili peppers. because they will cause inflammation of the intestinal walls when consumed in excess.

• to limit the sauces industrial in your dishes and foods too rich in fat, to limit the digestion process and leave to rest the intestines.

• to limit to the maximum sweets, confectionery, pastries and fast foods.

Lactose is a laxative carbohydrate and accelerates intestinal transit. Therefore, it is preferable to limit foods that contain it during diarrhea. In fact, virtually all health nutrition professionals recommend a lactose-free diet in phases of diarrhea.

We recommend you :

• to limit or even dELETE lactose and particularly milk during phases of diarrhea, and to reintroduce it gradually afterwards.

• to limit fresh cheeses such as Saint-Môret and Philadelphia, and milk-based preparations such as sauces, milk chocolate and industrial dishes containing lactose in their preparation.

• to direct you towards the vegetable drinks soy, almond, or hemp, if you want to continue consuming a drink with a texture close to milk.

You have undoubtedly noticed in summer, with the high heat and the air conditioning present in stores, that this mix was not very appreciated by your digestive system. This is simply because it creates a thermal shock which disrupts the intestines and accelerates transit. This is the same phenomenon that occurs when we eat foods that are too hot or too cold. The thermal shock following this ingestion induces expansion/contraction (depending on hot or cold) blood vessels promoting the acceleration of intestinal transit.

We recommend you :

• to consume your meals at temperature ambient.

• to limit the drinks consumed very hot such as coffees, teas and herbal teas.

• to limit the ice cream if you are in a hot environment.

• Banana is a food composed of soluble fiber like many other foods. It is recommended in cases of diarrhea for its interesting composition in soluble fiber and potassium. Indeed, potassium is a mineral salt that we lose in abundance in cases of diarrhea. Promoting your potassium intake through bananas can be interesting. You can consume it provided that they are fully ripe for fiber assimilation. But be careful, despite its beneficial contributions, it’s not a miracle food! In fact, water rich in minerals and the combination of several foods that are sources of soluble fiber will be much more effective than the soluble fiber and potassium intake that bananas can offer.

• Rice water is said to be effective against diarrhea. This is because rice leaches its micronutrients into the cooking water. The latter therefore becomes rich in potassium, sodium and sodium chloride via table salt. This would allow you to hydrate with some minerals. However, no scientific consensus seems to say that rice water is really effective against diarrhea. In fact, the natural mineral waters that we find commercially are more than enough to provide the micronutrients lost during periods of diarrhea, moreover they provide them in greater quantities.

• Coke is a drink that allows you to rehydrate and provide a lot of sugar during diarrhea. Therefore, it should be consumed at room temperature to avoid thermal shock, and without bubbles to limit inflammation of the intestinal walls. These elements are true, especially since coke contains antiseptic elements. However, once again, it's not the miracle food. Optimal hydration, accompanied by starchy foods and lean meats, will much more efficient than drinking a lot of coke. In addition, Coke remains a soda, and therefore a drink rich in additives and very sweet, to be consumed occasionally.

Breakfast :

• Applesauce
• Bread toast with butter
• Bowl or cup of almond vegetable drink

Lunch :

• Turkey escalope
• Basmati rice
• Carrot puree
• County Piece

Snack :

• Linseed
• Banana compote
• Psyllium powder with compote

Dinner :

• Onion omelette
• Buttered potatoes
• Carrot soup with psyllium powder
• Emmental in pieces or grated for soup

• Limit physical activity because it tends to promote the acceleration of transit by action on the contractions of the intestinal mucosa allowing digestion (peristalsis).

• Wash one's hands frequently with soap and water, or with an alcohol-based gel, is the safest way to prevent contagion, particularly before eating, during meal preparation, and in the bathroom.

• Other hygiene rules: do not drink water from a source whose purity is unknown; always keep perishable food in the fridge to limit bacterial contamination after opening; avoid buffets where food remains at room temperature for too long; monitor and respect the expiration date of food; when traveling, drink your tea or coffee with boiled water to eliminate bacteria; and avoid ice cubes.

• Self-isolate during the illness because the virus is very contagious.

• Try exercises cardiac coherence, of relaxation like yoga, or essential oils such as lavender, bitter orange or ylang-ylang, to reduce your daily stress.