It seems when it comes to bowel movements, people find themselves in the "Goldilocks Phenomenon", where the bowel movement is either too hard (aka constipation) or it is too loose (aka diarrhea.
Before looking at some of the common causes of diarrhea. it is important to review how the "Poop" factory works. The gastrointestinal tract (GI tract) includes everything from the mouth to the anus. Most of the food we eat (95%) is digested and absorbed by the time it leaves the small intestine. What remains of the food once it has been digested and absorbed will continue traveling to the colon or the large intestine (these terms are used interchangeably).
There are three important processes that occur in the large intestine: 1) the absorption of water (to help make the stool a nice, neat, brown package), 2) the absorptions of minerals and 3) the fermentation of fiber. The colon is very specific to it's job description and really doesn't like when any other job is added. In fact, when other constituents show up, the colon usually expresses it's unhappiness with the onset of "Code BROWN".
SO WHAT CAUSES CODE BROWN?
Diarrhea can have lots of contributing factors. Therefore it is important to examine some of the most common culprits (when viruses or gastrointestinal illness have been ruled out).
One factor can be medications, including antibiotics. Antibiotics are useful to treat infectious diseases/conditions in the body, but also disrupt the "good" bacteria that is found in the intestines that helps to digest food and provides anti inflammatory properties. Individuals that are on prolonged antibiotic therapy (commonly seen in patients with Staphylococcal infections can be especially at risk for such issues, even allowing for opportunistic "bad" bacteria, like C. difficile to invade the intestine, resulting in the "Mother of Code Brown" situations.
Other medications that contain sorbitol (a sugar alcohol the increases the osmolality of the intestines and causes excessive water to be shifted into the intestines) can cause diarrhea. When possible, it helps to take medications not suspended in sorbitol. Some sugar free gums can also provide a significant amount of sorbitol (for an avid gum chewer) and may also contribute to unwanted bowel behavior.
A contributing dietary factor to chronic diarrhea in some individuals is the sugar found in milk and milk products known as lactose. In normal functioning GI tract, lactose is broken down by the enzyme lactase into glucose and galactose in the small intestine and then metabolized and used for energy. Unfortunately, some people do not have the enzyme lactase (or have inadequate amounts of the enzyme) to break down lactose in the small intestine. As mentioned earlier, the large intestine has the three major functions (absorb water, absorb minerals, and ferment fibers); note that there is nothing on the list about breaking down lactose. When lactose reaches the large intestine, there is no system in place to digest or absorb it. Therefore, the colon does what it can to rid itself of the lactose-it solicits as much water into the colon to flush the lactose out, causing gas, abdominal pain, and loose, watery stools. Many times, lactose/milk intolerance is self diagnosed when adverse symptoms consistently occur after milk intake, and the food is completely avoided. Avoidance of any food group can lead to nutrient imbalances and deficiencies. There are many alternatives to regular lactose-containing cow's milk, such as Lactaid Milk (where the lactose is already broken down into galactose and glucose) or lactase enzymes are taken concurrently when consuming milk/milk products.
Occasionally, individuals may go from a highly refined diet to a diet that is high in fiber over a very short time, decreasing gastrointestinal transit time, resulting in diarrhea. Therefore, it is very important to increase fiber intake slowly in order to allow the gastrointestinal tract to adapt to the increased fiber intake.
WHAT TO DO IF THERE IS TOO MUCH NUMBER 2?
Regardless of the cause of diarrhea (including viruses and GI illness), the colon generally has something that need to "get rid of". I imagine Ray Charles in the colon playing "Hit the Road Jack" as the bouncer swiftly escorts the offending agent out of the large intestine.
Generally, slowing the process down with anti-motility agents only prolongs the time of gastrointestinal discomfort and a "crappy day". Remember, there is an offending agent in colon. One of the most effective nutritional management strategies of diarrhea includes consuming more soluble forms of fiber. I like to think of these as the types of fiber that visually absorb water. For example, if a bowl of cherrios and milk was left out all day (perhaps in the sink), the cherrios absorb a great deal of the milk and increase in size and reduce the fluid in the bowl. Soluble fibers acts in a similar fashion when the colon has a high volume of watery stool. The soluble fiber will soak up the watery stool, adding bulk to the stool, and slowing down the transit time, so that it may be excreted in a nice, neat, solid brown package. Foods that are generally well tolerated and help resolve diarrhea, include breads, cereals, apples (not the skins), bananas, and rice. It is also most important to drink lots of fluids when diarrhea is present to prevent and/or treat dehydration.
Have a HAPPY, not CRAPPY Day!
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