How to treat diarrhea with diet. Types, causes, symptoms and dietary management of diarrhea

Diarrhea has become the most commonly occurring symptom among children in developing countries. There are about 5 billion cases of diarrhea every year. Total death from diarrhea was estimated at 1.96 million in 2013-down from 2.58 million in 1990. In 2012 it was the second most common cause of death in children younger than five. Frequent episodes of diarrhea are also a common cause of malnutrition and the most common cause in those younger than five years of age. Other long-term problems can result in stunted growth and poor intellectual development.

What is diarrhea? 

Diarrhea is characterized by the frequent evacuation of liquid stool, usually exceeding 300 ml, accompanied by an excessive loss of fluid and electrolyte, essential Sodium and potassium. It occurs when there is excessively rapid transit of intestinal content through the small intestine, decreased enzymatic digestion of food, decrease absorption of fluids and nutrients for increased secretion of fluid into the desired track.

It is said that diarrhea is a symptom and not a disease.

Now let's have a look at the type of diarrhea:- 

Diarrhea can be classified into two types based on similarity and duration.

1. Acute diarrhea:- lt generally occurs in association with infections, poisons, and drugs. It is of recent origin and is generally of short duration. In short, it is diarrhea without blood loss.

2. Chronic diarrhea:- It is generally a result of long-term diseases such as malabsorption syndromes, and deficiency of GI secretions, chronic deficiency/allergy, etc. It is of extended duration and usually, of the repeated episode in short it is diarrhea with blood loss example steatoria(diarrhea due to malabsorption of fat).

Causes of diarrhea:-

1. Viral infection rotavirus bacteria toxin Salmonella korma related to food poisoning common bacterial infection. Koli; shigella

2. Excessive eating, indigestion, malabsorption, lesions of anatomic mucosal, or enzymatic origin. Example:-Steatoria stailing of foods.

3. Allergy and food sensitivity.

4. Metabolic disorders such as diabetic neuropathy, and Addisons disorder, liver cancer, carcinoma of the small intestine, and colon.

5. Drugs (antibody, antacid, sorbitol). physiological factors like depression, anxiety, hormonal changes may lead to diabetes. Heavy metal poisoning example leads Mercury, arsenic.

Symptoms of diabetes:-

1. Weakness 

2. Dizziness 

3. Dryness of mouth

4. Anorexia 

5. Dry and loose skin 

6. Abdominal cramps 

7. Loss of excess amounts of electrolyte and water in stool leads to dehydration.

Complications of Diarrhoea:- 

1. Diarrhea

2. Loss of water and electrolytes causing dehydration

3. Drop in the extracellular fluid volume

4. Increase in pulse rate

5. Drop in blood pressure

6. Supplier of blood to extremities reduced

7. Cold extremities

8. Compromise blood supply to vital organs like brain and kidney

9. Impaired consciousness and decreased urine output

10. Disturbed acid-base balance

11. Depletion of base Reserves

12. Acidosis

13. Coma

Management: The management of diarrhea has the following general objectives: 

1. Replacement of fluid and electrolytes

2. Removal of the cause especially if the infection is present 

3. Nutrition concerns and correction of nutrient deficiencies. 

The therapy of diarrhea consists of Determining the status of dehydration by Fluid management that includes Oral Rehydration Theory (ORT)-homemade/commercial Oral Rehydration Salts(ORS).

To control diarrhea, in Indian government had launched a program known as National Diarrheal Disease Control Programme NDDCP.

National Diarrheal Disease Control Programme: NDDCP –

This program was started in 1978 by the government of India. From 1992-93 the program has become a part of the child survival and safe Motherhood program and all activities are now integrated with those of the CSSM. 

Objectives: 

1. To discover the morbidity and mortality rate due to diarrhea.

2. Improvement of knowledge related to the use of fluid available at 

home.

Target group: Children under the age of 5 years.

Program implementation: 

1. Appropriate clinical management.

2. Better MCH care practice 

3. Preventive Strategies 

4. Prevention of diarrhea epidemics

With the introduction of oral rehydration by WHO it is now firmly established that oral rehydration treatment can be safely and successfully used in treating acute diarrhea.

Composition of ORS (WHO standard formulation):

Sodium chloride- 2.6 

Glucose anhydrous- 13.5 

Potassium chloride-1.5 

Trisodium citrate dihydrate- 2.5 

Total weight- 20.5

Other than the commercial ORS, home-based ORS may also be used as an immediate measure for combating diarrhea and dehydration.

Home-based ORS preparation:

Salt- 2 pinch (the amount picked up between three fingers) or tap. 

Sugar- 4 tablespoons or the amount picked up by 4 fingers.

Sodium bicarbonate- 1 pinch 

Lemon juice- few drops 

Water boiled- 1 liter

Both the commercial and home-based oral solution has to be prepared in boiled and cooled water.

Dietary management: The diet should take into account the normal RDI and various adjustments made to the quantity and quality of the foods to be given.

1. Energy: During the acute phase of diarrhea, the calorie intake can be increased gradually as per the tolerance of the patient. An increase of 200-300 kcal is the target. Patients suffering from diarrhea should never be starved as even in acute diarrhea digestive enzymes are functional and almost 60% digestion can take place.

2. Protein: Requirements for protein are increased only in chronic diarrhea because of associated tissue depletion. An additional 10 grams of protein may be recommended above the normal requirements. Milk, though a source of good quality protein is restricted in diarrhea its fermented form that is card is beneficial.

3. Fats: Total amount of fat should be restricted as its digestion and absorption are compromised. To increase the calorie density of the diet emulsified fats or those which are rich in medium-chain triglycerides may be added in restricted amounts. Fried and fatty foods should be avoided.

4. Carbohydrates: Adequate amount of Carbohydrates that is 60-65% of the total energy should be given to the patient. Easily assimilated carbohydrates that are principally monosaccharides and some disaccharides should be preferred as well as starches. Glucose, sugar, Honey, Sago, rice, potato, refined flour, pasta can be given which tree is an item that can be given.

5. Fibre: The fiber content of the diet should be kept minimum and insoluble fiber should particularly be provided. A lower Residue / low fiber diet limits the amount of food waste that has to move through the large intestine. Soluble fiber, in the form of stewed fruits and vegetables like stewed apple, guava nectar, pomegranate juice help in binding the stool and favor a good environment in the gut. Fruits like papaya and banana have an astringent property and are beneficial.

The residue is defined medically as other solid contents that have reached the lower intestine. A low Residue diet is used in the case of diarrhea which is composed of foods, which are easily digested and readily absorbed, resulting in a minimum of residue in the intestinal tract. A high residue diet is used in case of constipation, these are the diets that are high in roughage or fiber.

6. Vitamins and minerals: loss of vitamins and minerals is very common in diarrhea and so supplements may be needed. The vitamins of importance are B complex vitamins, especially Folic acid, B12, and C. Fat-soluble vitamins should be lost if there is steatorrhoea Sodium and potassium may need to be replaced along with iron if there is bleeding.

7. Fiber: intake of adequate amount of water to minimize the risk of dehydration.

Other general guidelines : 

1. Cooking methods like boiling, steaming, baking, and pressure cooking should be encouraged.

2. Small, frequent meals are better tolerated than big meals.

3. Plenty of fluids like lemon juice, fruit juices, soups, water riddles, Lassi, coconut water, etc. should be given

4. Fruits like banana and apple should be given since they are rich in potassium.

5. Consumption of milk and dairy products should be restricted.

6. Fried foods, fast foods, vegetables should be avoided.

Some golden rules for children suffering from diarrhea:-

1. Feed the child, do not starve him.

2. Continue breastfeeding for infants.

3. Give bland, low fiber, easily digestible normal diet for older children.