Self - care : ideas & advice
In the case of acute diarrhea, irrespective of the cause, making sure to keep hydrated and getting adequate nutrition are essential first steps.1
Getting adequate hydration
Dehydration is the major consequence of acute diarrhea. Thus ensuring that the adult or child with diarrhea gets enough to drink is absolutely essential.1
In small children and infants the severity of dehydration can be assessed by weighing them. Severe dehydration can account for a greater than a 10% reduction in body weight. Some other symptoms of dehydration include thirst, lethargy, irritability, sunken eyes and decreased tear production.1
Even if dehydration is only suspected, adequate rehydration is essential and oral rehydration solutions may be helpful. These are water, sugar and salt solutions designed to replace essential electrolytes. These can be purchased from your pharmacy.
Alternatively, a simplified solution can be made at home by adding 6 level teaspoons of sugar and ½ a level teaspoon of salt dissolved in 1 litre of water, although this home - made remedy does not contain potassium salts.2 The rehydration solution should be given in small portions on request.1 It is important to provide the rehydration as soon as possible because a prolonged period of dehydration can have serious health consequences.
Eating a recovery diet
Diarrhea for any length of time robs the body of salts and nutrients. During and after a bout of diarrhea the provision of adequate nutrition not only supplies energy, but also helps promote the recovery of damaged intestinal cells. Food can be taken 4 to 5 hours after diarrhea, and breast - fed babies should continue breastfeeding. Evidence suggests that a normal diet with small portions of food, with adequate fibre and fat should be restarted after 5 hours.1
For people with an upset stomach, some doctors recommend a ‘BRAT’ diet of Bananas, Rice, Applesauce and Toast because these bland foods won’t irritate the stomach, and as they are low - fibre, they will help make the stool thicker.3 A number of simple yet comforting food recipes designed to help slow the transition of food through the gut and to add consistency to the stool can be found in the Eat well section.
Avoiding certain foods
It may be sensible to avoid certain foods, if it is suspected they cause or contribute to the diarrhea. Sweet juices with high levels of fructose, sucrose, or sorbitol should also be avoided.1
Foods with the potential to upset or aggravate an already upset stomach include:4
Fried, greasy and spicy foods
Pork, veal and sardines (meat should be grilled)
Raw vegetables, such as parsnips, beets, sauerkraut, corn, cabbage and onions
Citrus fruits such as oranges, grapefruit and pineapples
Cherries and grapes
Extremely cold or iced beverages
Coffee and alcohol
In certain particular contexts, zinc may be used in addition to oral rehydration therapy in children.1 Zinc supplements are known to reduce the duration and the severity of diarrhea. The World Health Organization recommends a dose of 20 mg per day from 6 months of age, and 10 mg per day for those under 6 months.5
Certain ‘probiotics’ (live micro - organisms) and ‘postbiotics’ (inactivated micro-organisms), given in addition to rehydration solution can help reduce the symptoms of diarrhea and restore the natural balance to the intestinal microbiota.6 For more information about the microbiota or microbiome, please refer to the Microbiota section.
Although probiotics and postbiotics are both derived from micro - organisms, they have some differences, both in terms of how they work, how well they work, and how they can be used and stored.7
Each strain is unique and has specific properties.
Postbiotics are preparations of inanimate microorganisms and/or their components that confers a health on the host.8
Postbiotics also have some practical advantages: they can be taken at the same time as antibiotics,10 they are well tolerated for the whole family and they don’t require refrigeration during transport or storage.7
When to see a doctor
Anyone suffering from diarrhea should see his doctor if the diarrhea lasts for longer than two days for adults, or longer than 24 hours for children; or if there is severe dehydration.11 Other causes for concern are if the stool is very dark or bloody, as this indicates gastrointestinal bleeding.
- Brandt KG, Castro Antunes MM, Silva GA. Acute diarrhea: evidence-based management. J Pediatr (Rio J) 2015;91:S36-43.
- Oral rehydration solutions: made at home. Rehydration Project, 2020. (Accessed August 2020, at https://rehydrate.org/solutions/homemade.htm.)
- BRAT diet: recovering from an upset stomach. American Academy of Family Physicians, 2017. (Accessed August 2020, at https://familydoctor.org/brat-diet-recovering-from-an-upset-stomach/?adfree=true.)
- BRAT diet for nausea, vomiting or diarrhea. The Oregon Clinic. (Accessed August 2020, at https://www.oregonclinic.com/diets-BRAT.)
- The treatment of diarrhoea. A manual for physicians and other senior health workers. Geneva: World Health Organization; 2005.
- Szajewska H, Guarino A, Hojsak I, et al. Use of probiotics for management of acute gastroenteritis: a position paper by the ESPGHAN Working Group for Probiotics and Prebiotics. J Pediatr Gastroenterol Nutr 2014;58:531-9.
- Piqué N, Berlanga M, Miñana-Galbis D. Health benefits of heat-killed (tyndallized) probiotics: an overview. Int J Mol Sci 2019;20.
- Salminen S, et al. The International Scientific Association of Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of postbiotics. Nat Rev Gastroenterol Hepatol. 2021. doi:10.1038/s41575-021-00440-6.
- Zorzela L, Ardestani SK, McFarland LV, Vohra S. Is there a role for modified probiotics as beneficial microbes: a systematic review of the literature. Benef Microbes 2017;8:739-54.
- Warda AK, Rea K, Fitzgerald P, et al. Heat-killed Lactobacilli alter both microbiota composition and behaviour. Behav Brain Res 2019;362:213-23.
- Diarrhea. Also called: dysentery, the runs, the trots. MedlinePlus, 2016. (Accessed August 2020, at https://medlineplus.gov/diarrhea.html.)
A number of recipes are available that use bland, stool-solidifying ingredients but still manage to be tasty, nutritious and easy to prepare…