Natural treatments for diarrhea

• PRINCIPAL PROPOSED NATURAL TREATMENT: Probiotics

• OTHER PROPOSED NATURAL TREATMENTS: Acupuncture, bilberry, carob, chamomile, colostrum, Eleutherococcus, fiber, fructooligosaccharides (FOS), folate, food allergen identification and avoidance, goldenseal, green banana, lactase, marshmallow, pectin, red raspberry, sangre de drago, slippery elm, tormentil root (Potentilla tormentilla), witch hazel, wood creosote, zinc
• SUPPLEMENTS TO AVOID: Magnesium, vitamin C

DEFINITION: Treatment of acute and chronic loose bowel movements.

Introduction

Diarrhea can occur for many reasons. Food poisoning and infections are the most common causes of acute diarrhea. Chronic diarrhea may be caused by ongoing illnesses of the digestive tract, such as inflammatory bowel disease and irritable bowel syndrome.

Conventional treatment for diarrhea involves addressing the cause, if possible, and, in some cases, treating symptoms with medications that slow down the action of the digestive tract.

Principal Proposed Natural Treatments

Probiotics. Certain good bacteria called probiotics play a helpful role in the body in safely preventing or treating various kinds of diarrhea. Some of the most common include the yeast Saccharomyces boulardii and the bacteria Lactobacillus acidophilus, L. bulgaricus, L. reuteri (often studied in the proprietary form Lactobacillus GG), L. plantarum, L. casei, B. bifidus, S. salivarius, and Streptococcus thermophilus. Several studies and literature reviews have cited Saccharomyces boulardii probiotics as the most effective probiotic in treating and preventing diarrhea.

The digestive tract is like a rainforest ecosystem, with billions of bacteria and yeasts. Some of these internal inhabitants are more helpful to the body than others. Probiotics not only help the digestive tract function but also reduce the presence of less healthful organisms by competing with them for the limited space available. For this reason, the use of probiotics can help prevent infectious diarrhea.

Antibiotics being taken to treat an infection can disturb the balance of the inner ecosystem by killing friendly bacteria. When this occurs, harmful bacteria and yeasts can move in and flourish, leading to diarrhea. Probiotic therapy may help prevent this problem, and prevent or treat diarrhea caused by a variety of other sources.

Travelers’ diarrhea. According to some studies, the regular use of various probiotics can help prevent travelers’ diarrhea, an illness caused by eating contaminated food, usually in developing countries. One double-blind, placebo-controlled study followed 820 people traveling to southern Turkey and found that the use of a probiotic called Lactobacillus GG significantly protected against intestinal infection.

An even larger double-blind, placebo-controlled study found benefits from using the yeast product S. boulardii. This trial enrolled three thousand Austrians traveling to a variety of countries. The greatest benefits were seen in travelers who visited North Africa and Turkey. The researchers noted that the benefit depended on consistent use of the product and that a dosage of 1,000 milligrams (mg) daily was more effective than 250 mg daily.

Substances called prebiotics are thought to enhance the growth of probiotics. On this basis, prebiotics called fructooligosaccharides (FOS) have been suggested to prevent travelers’ diarrhea. However, in a 244-participant double-blind study, FOS at a dose of ten grams (g) daily offered only minimal benefits.

Infectious diarrhea. Children frequently develop diarrhea caused by infectious viruses. Probiotics may help prevent or treat this condition and may also be useful for viral diarrhea in adults. A review of the literature published in 2001 found thirteen double-blind, placebo-controlled trials on probiotics for acute infectious diarrhea in infants and children. Ten of these trials involved treatment and three involved prevention. Benefits have been seen in subsequent studies, including one involving almost one thousand infants. Overall, the evidence strongly suggests that probiotics can significantly reduce the severity and duration of diarrhea or help prevent it.

One double-blind, placebo-controlled trial of 269 children aged one month to three years with acute diarrhea found that those treated with Lactobacillus GG recovered more quickly than those given a placebo. The best results were seen among children with rotavirus infection. Rotavirus can cause severe diarrhea in children. In another double-blind, placebo-controlled study, Lactobacillus GG helped prevent diarrhea in 204 undernourished children. In addition to Lactobacillus GG, the probiotics Bifidobacterium bifidum, S. thermophilus, L. casei, L. reuteri, S. boulardii, and Escherichia coli Nisslea safe strain of E. colihave also shown promise for preventing or treating diarrhea in infants and children. However, probiotic therapy is probably not helpful for acute, severe, dehydrating diarrhea. Diarrhea in young children can be serious. If it persists for more than a couple of days or is extremely severe, the child’s physician should be consulted. In addition, a large (211-participant) double-blind, placebo-controlled study found that adults with infectious diarrhea can also benefit from probiotic treatment.

Antibiotic-related diarrhea. The results of most double-blind and open trials suggest that probiotics, especially S. boulardii and Lactobacillus GG, may help prevent or treat antibiotic-related diarrhea (including the most severe form, Clostridium difficile (diarrhea). One study found L. rhamnosus effective in children, and another study found that L. casei was effective in hospitalized patients.

Some claim it is useless to begin probiotic treatment until after the antibiotics are finished. However, evidence appears to indicate that it is better to begin treatment with probiotics at the initial use of antibiotics and continue probiotic treatment for a week or two afterward. Diarrhea that occurs in the context of antibiotics may be dangerous, so one should consult a doctor if this is the case.

Inflammatory bowel disease.Crohn’s disease and ulcerative colitis fall into the family of conditions known as inflammatory bowel disease. Chronic diarrhea is a common feature of these conditions. A double-blind trial of 116 people with ulcerative colitis compared a special probiotic treatment using E. coli to a relatively low dose of the standard drug mesalazine. The results suggest that this probiotic treatment might be as effective as low-dose mesalazine for controlling symptoms and maintaining remission. Another study found S. boulardii helpful for treating diarrhea resulting from Crohn’s disease. However, two studies failed to find benefits from Lactobacillus probiotics.

Other forms of diarrhea. Preliminary evidence suggests that probiotics may be helpful in reducing diarrhea and other gastrointestinal side effects caused by cancer treatmentradiation or chemotherapy. Another study found S. boulardii can increase the effectiveness of standard treatment for amoebic infections. Small double-blind studies suggest S. boulardii might be helpful for treating chronic diarrhea in people with human immunodeficiency virus (HIV) infection and hospitalized persons who are being tube-fed.

Premature infants weighing less than 2,500 g (5.5 pounds (lbs)) are at risk for a life-threatening intestinal condition called necrotizing enterocolitis (NEC). In a study that pooled the results of nine randomized, placebo-controlled trials involving 1,425 infants, probiotic supplementation significantly reduced the occurrence of NEC and associated death. Also, a subsequent study found similar benefits in infants with very low birth weights of less than 1,500 g (3.3 lbs).

Irritable bowel syndrome. People with irritable bowel syndrome (IBS) experience cramping digestive pain, alternating diarrhea and constipation, and other symptoms. In some people, diarrhea predominates. Although the cause of IBS is not known, one possibility is a disturbance in healthy intestinal bacteria. Based on this theory, probiotics have been tried as a treatment for IBS with diarrhea, but the results have been inconsistent. One study tested the potential effectiveness of a traditional Chinese herbal remedy for diarrhea-predominant IBS but failed to find benefit.

Other Proposed Natural Treatments

A large 255-participant, double-blind, placebo-controlled study found that the use of a product containing apple pectin and chamomile significantly improved symptoms of acute diarrhea in children aged six months to six years. A small double-blind study found that an extract of tormentil root (Potentilla tormentilla) reduced the severity and duration of rotavirus infection in children. Another study of the same herb found that it was approximately as effective as the drug loperamide for the treatment of nonspecific diarrhea in adults. The herbal extract was particularly effective in reducing symptoms of abdominal cramping.

A preliminary double-blind study found that an extract of the Amazonian herb sangre de drago might be helpful for diarrhea associated with HIV infection. The supplement medium-chain triglycerides also has shown promise for this purpose.

Wheat germ might enhance the effects of standard treatments for giardiasis. Also, a double-blind clinical trial of forty-one infants with diarrhea found that carob powderat a dose of one gram per kilogram of body weight dailysignificantly sped up resolution of diarrhea compared with a placebo.

The herb Eleutherococcus might be useful in the treatment of antibiotic-associated diarrhea. Brewer’s yeast, a bitter-tasting product recovered from the beer-making process, might also be helpful. The herb goldenseal contains berberine, a substance with antimicrobial properties. One study suggests that berberine can help with diarrhea caused by the E. coli bacterium. However, it is not clear that goldenseal itself would have the same effect. The herbs barberry and Oregon grape also contain berberine.

Allergy to milk and other foods may trigger diarrhea. Milk can also cause diarrhea in a completely different way–through lactose intolerance. This condition is the inability to digest milk sugar, and it occurs in many adults. The use of the enzyme lactase should help.

Weak and often inconsistent evidence partially supports the use of the following as treatments for various forms of diarrhea: colostrum, a special extract of egg yolk, fiber, folate, and green banana. Zinc has been shown to be beneficial for acute diarrhea in children, the most convincing evidence coming from studies done in developing countries. This suggests that zinc is most useful for this condition in the presence of a nutritional deficiency. In the literature, it reduces the length of hospital stays and improves the chances of recovery.

Other herbs suggested for diarrhea but have no meaningful supporting evidence include agrimony, bilberry, blackberry leaf, marshmallow, oak bark, red raspberry, slippery elm, and witch hazel. The supplement glutamine has been advocated for chronic diarrhea, but further research is required to confirm its utility. Some research indicates positive results from glutamine supplementation following gastrointestinal infections. Wood creosote is the principal ingredient in seirogan, a widely used traditional herbal treatment for diarrhea. It has undergone some safety testing and appears relatively safe for short-term use. Efficacy of these treatments, however, is unclear. Acupuncture has been studied for its beneficial effects on diarrhea, and for some, it has become an integral part of their treatment regimen, though scientific evidence fails to endorse its use.

It is crucial to remain hydrated when experiencing diarrhea. Pedialyte and sports beverages like Gatorade are often suggested, but research indicates that coconut water is just as effective at rehydrating the body while offering nutrients and antioxidants without artificial colors and sugar. Green tea, lemongrass tea, and chamomile tea have shown benefits for diarrhea treatment. In a systematic review of the literature, patients with cancer undergoing radiation treatment who drank green tea were found to experience less diarrhea.

Supplements to Avoid

Excessive intake of vitamin C or magnesium can cause diarrhea. Foods containing sorbitol may worsen symptoms.

Bibliography

Gao, X. W., et al. “Dose-Response Efficacy of a Proprietary Probiotic Formula of Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R for Antibiotic-Associated Diarrhea and Clostridium difficile-Associated Diarrhea Prophylaxis in Adult Patients.” American Journal of Gastroenterology, vol. 105, 2010, pp. 1636-41.

Henker, J., et al. “Placebo Versus Probiotic Escherichia coli Nissle 1917 for Treating Diarrhea of Greater than Four Days Duration in Infants and Toddlers.” Pediatric Infectious Disease Journal, vol. 27, 2008, pp. 494-99.

Huang, Rao, et al. “Efficacy of Probiotics in the Treatment of Acute Diarrhea in Children: A Systematic Review and Meta-analysis of Clinical Trials.” Translational Pediatrics, vol. 10, no. 12, 2021, pp. 3248-60. doi:10.21037/tp-21-511.

Lazzerini, M., and L. Ronfani. “Oral Zinc for Treating Diarrhoea in Children.” Cochrane Database of Systematic Reviews, 2008, p. CD005436. Available through EBSCO DynaMed Systematic Literature Surveillance at www.ebscohost.com/dynamed.

Li, Zengbin, et al. “Which Probiotic Is the Most Effective for Treating Acute Diarrhea in Children? A Bayesian Network Meta-Analysis of Randomized Controlled Trials.” Nutrients, vol. 13, no. 12, Nov. 2021, p. 4319. doi:10.3390/nu13124319.

Mao, M., et al. “Effect of a Lactose-Free Milk Formula Supplemented with Bifidobacteria and Streptococci on the Recovery from Acute Diarrhoea.” Asia Pacific Journal of Clinical Nutrition, vol. 17, 2008, pp. 30-34.

O’Brien, Brendan J., et al. “Coconut Water: A Sports Drink Alternative?” Sports, vol. 11, no. 183, 2023, p. 183, doi:10.3390/sports11090183.

Patel, Kumkum S. "How to Stop Diarrhea: Methods And Medications That Work." Verywell Health, 6 Aug. 2024, www.verywellhealth.com/how-to-make-diarrhea-go-away-1324506. Accessed 20 Sept. 2024.

Rerksuppaphol, Lakkana, and Sanguansak Rerksuppaphol. "Efficacy of Zinc Supplementation in the Management of Acute Diarrhoea: A Randomised Controlled Trial." Paediatrics and International Child Health, vol. 20, no. 2, June 2020, pp. 105-10. doi:10.1080/20469047.2019.1673548.

"Traveler's Diarrhea." Cleveland Clinic, 24 Apr. 2022, my.clevelandclinic.org/health/diseases/7315-travelers-diarrhea. Accessed 20 Sept. 2024.

Wiese, Fanny, et al. “Green Tea and Green Tea Extract in Oncological Treatment: A Systematic Review.” International Journal for Vitamin and Nutrition Research, vol. 93, no. 1, 2023, pp. 72–84, doi:10.1024/0300-9831/a000698.