Diarrhae

Diarrhea is characterized by loose, watery stools occurring more than three times per day. It may be acute (infection, food) or chronic (malabsorption, inflammation).


Causes of Diarrhea

  • Infections: viruses (norovirus, rotavirus), bacteria (E. coli, Salmonella), parasites (Giardia)
  • Antibiotic use (disruption of gut flora)
  • Food intolerances (lactose, FODMAPs, gluten)
  • SIBO, fungal overgrowth
  • IBD: Crohn’s disease, ulcerative colitis
  • Celiac disease
  • Hyperthyroidism
  • Bile acid malabsorption
  • GLP-1 medications (e.g., semaglutide)
  • Stress or anxiety (psychogenic diarrhea)


Conditions Associated with Chronic Diarrhea

  • Irritable Bowel Syndrome – Diarrhea type (IBS-D)
  • Inflammatory bowel diseases (IBD)
  • Microscopic colitis
  • Dumping syndrome post-surgery
  • Pancreatic insufficiency
  • HIV, immunodeficiency


Symptoms

  • Frequent loose stools
  • Cramping, bloating
  • Urgency
  • Fatigue
  • Malabsorption (fatigue, weight loss, anemia)


Testing

  • GI-MAP or GI Effects stool test
  • 3-day stool collection
  • Fecal calprotectin, lactoferrin
  • Zonulin for gut permeability
  • 5-HIAA (serotonin excess marker)
  • Food allergy/sensitivity panels
  • Blood: iron, ferritin, B12, albumin


Treatment Options Conventional:

  • Loperamide for symptom relief
  • Bile acid binders (e.g., cholestyramine)
  • Antibiotics if bacterial infection confirmed

Functional/Integrative:

  • Saccharomyces boulardii probiotic
  • Glutamine for intestinal repair
  • Curcumin or boswellia for inflammation
  • LDN for IBD or gut inflammation
  • Digestive enzymes (lipase, protease, amylase)
  • Anti-fungal herbs (oregano, berberine, caprylic acid)


Diet and Lifestyle

  • BRAT diet (short-term: bananas, rice, applesauce, toast)
  • Elimination diet for intolerances
  • Avoid alcohol, caffeine, high-fat foods
  • Rehydrate with electrolyte-rich fluids


Gut Integrity

  • Tight junction repair: zinc carnosine, butyrate, vitamin D, collagen
  • Fiber balance: soluble fibers (psyllium) help form stools


Hormonal and Brain-Gut Links

  • High serotonin or histamine may cause urgency
  • Cortisol surges (stress) impact bowel motility


Interesting Fact

 Fecal microbiota transplantation (FMT) is FDA-approved for C. difficile and under investigation for other chronic diarrhea causes.


Probiotic and Microbiome Support

  • Key strains: Saccharomyces boulardii, Bifidobacterium breve
  • Polyphenol-rich foods (berries, pomegranate) help balance gut flora


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