Food Freedom Friday Edition 105 - The Shits

Diarrhea is isolating. Diarrhea is embarrassing. Diarrhea creates feelings of anxiety and paranoia. Diarrhea creates shame and secrecy – it truly is a ‘dirty little secret’! The thought of losing control of the bowels in public is something that is greatly feared. Losing control of the bowels at home is marginally (minisculely) more appealing. 

Believe it or not, these types of incidents are more common than you might think, even in regular, seemingly normal individuals. Diarrhea and loss of bowel control are silent, extremely hidden types of suffering, based on the taboo nature of the complaint.

In case this is you, or someone you know, I wanted to discuss it in a little more deptail and possibly offer a few simple strategies that may provide some relief.

For the majority of cases, chronic diarrhea is diagnosed as IBS-D (irritable bowel syndrome, diarrhea type) once inflammatory bowel diseases (Crohn’s disease, colitis, diverticulitis and the like) are ruled out. It is now universally understood that all forms of IBS have a microbial imbalance and a dysfunctional and irritated enteric nervous system. This is the system that governs the gut and is the communication pathway between the gut and the brain. These two aspects are the main targets of intervention in many of my gut healing and digestive tract intervention protocols.

This forms the foundation upon which to build and fine tune aspects with a more personalized approach. 

Types of Chronic Diarrhea

Bile acid diarrhea (BAD) is a subtype of diarrhea that occurs when too many bile acids end up in the large intestine and pull water and salt out of the body. This creates urgent, painful diarrhea. BAD can often be attributed to gallbladder removal, surgery or resection of the small intestine, small intestine bacterial overgrowth (SIBO), pancreatic insufficiency, colitis and short bowel syndrome.

Habba syndrome is a condition named after Dr. Saad Habba, a gastroenterologist who concluded that IBS-D and functional diarrhea were catch-all phrases for other differential diagnoses. In an experiment with over 300 people he found that roughly thirty percent of people that were diagnosed with IBS-D actually had some other disorder. These included but were not limited to celiac disease, microscopic colitis, lactose intolerance or fructose malabsorption.

Roughly 15-20% of his participants had what is now defined as Habba syndrome, meaning chronic diarrhea from an intact but dysfunctional gallbladder. The overzealous gallbladder pumps out too many bile acids. Habba syndrome is not considered a formal diagnosis yet, but is used by many gastroenterologists to explain to their patients the physiological basis for what may be causing their symptoms.

This means that, when struggling with chronic diarrhea, one has an overactive enteric nervous system often over stimulating the digestive process. Furthermore there is pain as a result of spasms and gas. The results are feelings of panic and a fear of leaving the ‘safety’ of one’s house.

A few simple supports:

Avoid FODMAPs

FODMAPs (Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols) are carbohydrates found in a wide variety of foods that create excess gas and can pull water into your intestine creating pain, spasm and urgency. Avoiding FODMAPs and possibly doing an elimination diet to identify your food triggers can go a long wy to easing symptoms. Grains, dairy and soy are all high on the list and are best avoided completely. Going low-FODMAP is the quickest  quickly, reduces pain and gas and can help slow you down.

Calcium Carbonate

Take 500mg calcium carbonate daily. Calcium helps to bind bile acids, making it extra-helpful in BAD, but it also reduces spasticity and decreases the sensitivity to pain.

Zinc

Take 5-10mg of zinc or zinc carnosine. Zinc helps slow diarrhea down and is a great immune booster too.

Butyrate

Take 100mg of butyrate with each meal. Butyrate is a fatty acid made by healthy, beneficial bacteria. It helps slow down fast bowels, reduces pain, decreases inflammation and acts as balancing energy for your gut. There are several compelling studies that show butyrate to be as effective as or more so than cholestyramine, a popular medication for IBS-D and BAD.

Acacia Fiber

Take 2tsp-1TB acacia fiber daily, in divided doses. Unlike other fibers which are highly fermentable and can worsen symptoms of bloating, gas and GI distress, acacia is a gentle, non-bloating fiber that helps add bulk to the stool and slow things down.

Foods that may be contributing

Nuts and Nut Flours

Too often, without even realizing, you may be consuming WAY TOO MANY nuts and nut flours. Nuts are an easy way to snack and eat quick meals.  Not only that, but there are a lot people who love to eat Paleo baked goods like pancakes, muffins, or cake on a regular basis.

Either way, the problem arises when nuts and nut flours become the bulk of your diet.  If you are unable to remember the last time you ate nut-free for a day, then I am speaking to you.  Nuts can be hard on the gut.  They are tough for people with stomach problems to break down and digest.

If you are seeing undigested nuts in your stools or you eat them regularly and still have digestive issues, it may indicate you need to test removing them from your diet.

Eggs

Eggs are fast and easy to make, especially if you are unsure of what to eat for breakfast.  Eggs are a wonderful, nutrient-dense food and can be an integral part of a nutritious diet for a healthy person.

However, if you suffer from leaky gut, the albumin protein in egg white can slip past the intestinal wall and enter your body causing a reaction.  Eating eggs every day may be the one thing making your life miserable.

Symptoms including like post-nasal drip and brain fog are common symptoms of egg reactions.  Another sign this food might need to be removed would be if you are eating eggs for breakfast every day and have immediate or mid-morning cramping, bloating, or diarrhea.  Eggs are great go-to food, except when your gut is irritated. 

Fructose

People love their morning smoothie.  They also like to eat fruit with every meal and top everything with a squeeze of honey. Eating too much sugar can promote gut dysbiosis like Small Intestinal Bacterial Overgrowth or yeast issues.  In addition, are subsets of people who do not absorb fructose very well, which can lead to increased water in the intestines and faster transit time. If you have diarrhea, gas, or cramping, take a look at how much fruit or honey you eat in a single day.  Keeping it down around two servings a day might make all the difference in the world for your GI problems.

Dairy

The casein protein in milk can slip past your intestinal lining and trigger an immune response, wreaking havoc in your body, especially if you have Leaky Gut Syndrome.  Dairy reactions can range from brain fog, post-nasal drip, and skin problems to diarrhea and constipation. If you are eating dairy, even fermented dairy, raw dairy, goat or sheep dairy and feel bad, it becomes critical to remove it and see how you feel after it is out of the system.  This food is all or nothing.  Even one bite can continue to give you symptoms.

I get a lot of satisfaction from helping people get control of their bathroom habits. To watch someone progress from being home bound with multiple episodes of fecal incontinence weekly to taking ballroom dancing lessons is something worthy of effort. Please reach out if you require more information or need a little (or a lot) of support in investigating and solving your toilet trouble mystery.