In contrast to those in Part 1 of this series who struggle with daily bowel movements, there are millions world wise who suffer from occasional diarrhea or even daily bouts. The consequences of chronic diarrhea can be dire and it is the second leading cause of death in children.
The causes of diarrhea are numerous, but the discomfort and reliance on the nearest available washroom can be addressed and remedied by understanding your unique physiology and understanding how one (or more) of these contribute to your elimination system. You will then be able to have an educated discussion about troubleshooting your chronic diarrhea.
- Your Microbiome
- Gut dysbiosis – This is a catch-all term for imbalanced gut bacteria. There is a delicate balance of diverse bacteria living within your digestive tract. If a certain species overgrown or is eliminated, or a colony is too large or too small, this balance can be thrown way off. There is currently no single accepted definition of the location or the exact issue with the gut bacteria when referring to dysbiosis but it can result in diarrhea which can become pervasive and persistent. It is very important to maintain a diverse gut flora that is at the right size.
- SIBO (Small Intestinal Bacterial Overgrowth) - The majority of the 100 trillion bacteria that live in your digestive tracts are located in your large intestine. Your small intestine contains way fewer as its primary function is food absorption. Many people suffering from diarrhea may have SIBO. This is an overgrowth of bacteria in the small intestine which can result in digestive distress including diarrhea (or alternately constipation). SIBO is a type of gut dysbiosis, but the difference is that there are tests for and a known location of the dysbiosis. An integrative or alternative medicine practitioner can help you determine if this is the cause of your symptoms and treat you accordingly.
- Parasites – These are organisms that feed off their hosts, causing harm and commonly diarrhea. It is a myth that people in developed areas of the world do not contract parasites. Humans can pick up parasites from pets, contaminated water, food and contact with other human waste. Common parasites that cause diarrhea include Giardia, Strongyloides, Entamoeba histolytica and Cryptosporidium. The world of parasites is complex and confusing and enlisting the support of a qualified professional is important in clearing them out of your system.
- Yeast Overgrowth - Candida is the most common yeast that overgrows, but any overgrowth of yeast is not good for gut health. Yeast is a fungus that is a normal part of your gut bacterial colonies. In healthy amounts, it aids and supports in digestion and keeps you healthy. Too much yeast can begin to damage the delicate lining of your digestive tract. Excess yeast can release harmful toxins that start to affect the gut wall and your bowel movements causing gas, bloating, and diarrhea.
- Food Intolerances
- Wheat – Wheat tastes delicious, but unfortunately, that detour off your Paleo lifestyle may be contributing to your diarrhea. Gluten is a problematic protein found in wheat and has been shown to have a toxic effect in your GI tract. It causes inflammation in the gut and can alter the structure of the gut wall. Some people are less tolerant of gluten than others, but as the research becomes clearer, we are learning that wheat and other grains contain many other compounds beyond gluten that could cause diarrhea.
- Dairy - Dairy has three components that can be common triggers of a bout of diarrhea: lactose, whey and casein. Lactose intolerance happens to some people as they age as they lose the enzyme needed to break down lactose. When this happens the lactose cannot be absorbed by the body and ends up feeding bacteria instead. This typically leads to diarrhea. Casein and whey are the two proteins in milk that can cause diarrhea for those with gut wall damage. Dairy protein intolerance is often mistaken for lactose intolerance and therefore it may be wise to cut out all dairy for a period of time if you are experiencing digestive upset.
- FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) - As gut health breaks down, almost any food can cause problems but FODMAPs can be especially problematic for those with damage. FODMAPs are a group of sugars/carbohydrates that, depending on the integrity of your gut and some genetic factors can cause diarrhea. Through a process called osmosis these undigested bits of food have an ability to draw extra fluids into the digestive tract creating a watery mixture that the body must get rid of ASAP. Often, people who are sensitive to FODMAPs typically have other underlying concerns that caused the FODMAP intolerance. As the other issues are resolved, the ability to digest FODMAP foods typically comes back.
- Emotional Stress – Your digestive tract is programmed to respond to stress. Have you ever been really nervous before an important event like a first date, public speaking event or competition event and had to run to the bathroom? Your gut is home to your Enteric Nervous System. It is often referred to as your 2nd brain and contains way more neurotransmitters than your brain. Anything that can excite the network of neurons in your gut can cause increased motility. Motility in your gut comes from a wave-like movement called peristalsis which is directly affected by nervous system signals. Stress has different effects on the different parts of your GI tract. It increases motility in the colon while simultaneously decreasing motility in the small intestine. This slowdown of food processing in the small intestine may lead to SIBO and damage to the mucous lining of the gut. Constant emotional stress this could be a contributor to your diarrhea symptoms.
- Physical Stress - Exercise is great for your health but if you are overdoing it, you could be damaging your gut. When you exercise, you generate heat in the tissues of your intestines. This can lead to inflammation and irritation of your gut. The most detrimental form of exercise for your digestive tract is long duration, medium to high intensity work outs like long distance running for marathons and triathlons. There is a further effect where blood that was directed away from your GI system during workouts rushes back in afterward and can potentially cause further gut damage. Both of these physical stresses can cause diarrhea. We know that exercise is generally more beneficial than harmful, however, part of the reason your stools may be too loose could be due to your exercise habits.
- Inflammatory Bowel Diseases (IBD) - The two main inflammatory bowel diseases are Crohn’s and Ulcerative Colitis. As the name suggests these are diseases of chronic inflammation, which creates the conditions in the intestines for diarrhea. Food may pass through the bowels too fast or slow as a result of inflamed areas of the gut. Those suffering from IBD typically have underlying reasons for the inflammation including infections, hormone imbalances and/or food intolerances. Consulting with your health care professional and following a treatment protocol can often result in full remission.
- Fat Malabsorption - Fat is necessary and vital for health. It is the building block of all hormones in the body. Some develop a condition where the body is unable to break down and absorb the fat that is eaten. Diarrhea is often the end result. The cause can be related to damage to the intestinal tract, gall bladder issues, pancreatic insufficiency and bile acid problems. Once the causes have been identified and addressed, this problem typically resolves itself. During treatment, to stop the diarrhea, it may be necessary to decrease fat intake. It is important to ensure that sufficient nutrition and energy are obtained from alternate sources.
- Traveler’s Diarrhea - You may feel you have overcome the virus or bacteria that caused the onset of diarrhea you experienced on vacation, but this may not be correct. Recent research is showing that just one experience with Traveler’s Diarrhea can significantly change your gut flora and a percentage of people end up developing SIBO and/or gut dysbiosis after such extreme infections. If you have contracted an illness or infection while traveling, it may be related to your current cause of diarrhea, especially if you used antibiotics to eliminate the infection.
Addressing the underlying cause(s) of your elimination issues is vital to re-establish your gut health Healthy elimination is a huge part of your ultimate wellness and should be approached with celebration rather than dread.
Michal Ofer is a wellness and digestion expert and nutrition coach. She is focused on assisting clients to take control of their health and happiness through the sustainable food and lifestyle choices that best support them. Through strengthening the body from the inside out, her clients are able to reach new heights of health, happiness and wellness. Michal obtained her Professional Training and Certificate from The Institute for Integrative Nutrition in New York. She has a further studied through the University of Colorado (Boulder) and Stanford University and is a Certified 21 Day Sugar Detox Coach. Michal has also received a Bachelor’s Degree in Life Sciences and a Master Life Coach Certification. For further information and to connect with Michal visit her website at www.michalofer.com