Diarrhea

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Diarrhea

As they say in football, the best offense is a good defense. And diarrhea is your body's best offensive defense. Whether its much-ballyhooed revenge can be blamed on Montezuma, the blue plate special, a disagreeable antibiotic, a sneaky viral infection or even stress, diarrhea is the body's painful way of saying "No, thanks!"

Sure, diarrhea lacks a certain something in elegance, but it sure makes up for it in effectiveness. A couple of trips to the toilet (okay, so maybe more than just a couple) and you're usually back on your feet.

Although it typically takes nature anywhere from two to four days to run this course, here's how to help take the kick out of the "runs."

Be clear on your diet. Most folks know that liquids are the suggested nourishment for the first 24 hours when diarrhea hits. But don't assume that any old liquid will do, "You should take only clear liquids: If you can't see through it, stay away from it," says William B. Ruderman, M.D., chairman of the Department of Gastroenterology at the Cleveland Clinic-Florida in Fort Lauderdale and an expert on diarrhea. "That means you should consume soda, tea, bouillon and applejuice. Sports drinks like Gatorade are especially good, because they replace sugars and electrolytes (potassium and sodium). But avoid acidic citrus juices, such as orange and grapefruit, and especially tomato juice." Exceptions? Beer doesn't qualify, even though you can see through it. Nor do wine, clear alcohol and mixed drinks. In fact, too much beer, wine or any other kind of alcohol can cause diarrhea.

Food-wise, the best choices after the initial 24 hours include "translucent" foods like chicken broth and Jell-O. Whatever you choose to eat at this time should be bland and easily digested.

Get cultured with yogurt. One of the few exceptions to the clear cuisine rule is yogurt, whose active cultures contain "good" bacteria your bowel loses to the "bad" bacteria that prompted the diarrhea. "Yogurt is especially effective when the diarrhea is caused by food poisoning (like traveler's diarrhea)," says Manfred Kroger, Ph.D., professor of food science at Pennsylvania State University in University Park. "And it's also effective when diarrhea is the result of stress or antibiotic or radiation treatment. Basically, yogurt's active cultures help Mother Nature speed up the process of replacing the beneficial benign bacteria, and it makes you feel a lot better faster." If yogurt isn't your thing, any acidophilus or fermented dairy product will do. Check the supermarket's dairy case.

When to See the Doctor See your doctor if your diarrhea symptoms include any of the following. A sustained fever of over 101°F Abdominal pain more severe than the "churning stomach" sensation normally associated with diarrhea No progress or a worsened condition after three or four days Blood, pus or mucus in your stool Inability to keep liquids down, lasting for more than 24 hours--or other signs of dehydration such as constant, extreme thirst, tongue dryness, sunken eyeballs and cracked or dry lips Although these may be symptoms of minor ailments, all require a doctor's attention for diagnosis.

Exercise your sweet tooth. A spoonful of sugar helps your body hold on to whatever you're drinking. "Glucose aids the absorption of water by the gut, so if you have sugar in whatever you're taking, you can absorb it more easily," says Dr. Ruderman. "If you're drinking tea or apple juice, add a teaspoonful of sugar to aid in absorption. If you're drinking soda, stick with regular sugared types and stay away from 'diet' varieties." (If you do drink soda, he adds, open the cap and let the soda go flat before you imbibe.)

Avoiding Traveler's Diarrhea Sure, you want to "experience'' a foreign country--but only to a point. So here's how travelers can stay one step ahead of the "runs" while abroad, according to William B. Ruderman, M.D., chairman of the Department of Gastroenterology at the Cleveland Clinic-Florida in Fort Lauderdale and an expert on diarrhea. "When traveling abroad, drink only bottled or canned beverages--including water. Just because you're staying in a fancy hotel, don't assume the water is safe. The hotel gets its water from the same city water supply as everyone else." Don't use ice in your drinks. "People think they're safe drinking bottled sodas, but then they use ice, get diarrhea and wonder what happened. It may not be as refreshing, but you're better off with a warm soda." Don't eat any food that is unpeeled or raw. "If you're having any local fruit, peel it--even if it's an apple or a pear. And make sure everything you eat is cooked thoroughly." Don't assume you're A-OK when traveling in the U.S.A. "I would be suspicious of the water supply in every camping area in the country that's in a backwoods, mountainous area. Take your own water supply."

Forget about high fiber--for now. Now's not the time for oat bran and other high-fiber foods or complex carbohydrates. "It's unwise to stress your system with a lot of nonabsorbable fiber," adds Dr. Ruderman. "When you have diarrhea, the blander, the better." That means choose white toast, not wheat. And go for light foods such as cooked carrots, applesauce, baked chicken (without the skin) and other things that don't cause gas. Avoid pasta, corn, oats and most fruits, particularly prunes, pears and apples. Also, have some bananas: Diarrhea can cause potassium depletion, and bananas are high in potassium.

Be anti-antacid. Yesterday's heartburn often becomes today's diarrhea, especially when you treat it with over-the-counter medications. "Antacids are the most common cause of drug-related diarrhea," says Harris Clearfield, M.D., professor of medicine and director of the Division of Gastroenterology at Hahnemann University Hospital in Philadelphia. "Maalox and Mylanta both have magnesium hydroxide in them, which acts exactly like milk of magnesia, making these antacids a common cause of diarrhea." Meanwhile, antacids with aluminum hydroxide, such as Riopan and Amphojel, can cause constipation. (True, this is the opposite effect, but it's just as unwanted.)

Keep drinking. "The more you drink, the better you'll be," says Dr. Ruderman. "Even if you're not thirsty, it's important to take in a lot of fluids, because diarrhea can cause dehydration." His advice? At least 6 to 8 ounces every two hours. "You should drink between two and three liters a day," Dr. Ruderman adds. That's the equivalent of 1 1/2-ounce bottles of soda.

Note: Drink even more if you haven't urinated in the past six hours, feel thirsty or experience sunken eyeballs. And drink a lot if your tongue feels very dry or your lips become dry and start to crack.

Don't assume you'll be in the pink with the pink stuff. If you think diarrhea is the result of something you ate and you also have a fever, don't take Pepto-Bismol. "Antidiarrheals such as Pepto-Bismol can prolong salmonella (food poisoning)," says Dr. Ruderman. The medication slows down "gut motility"--that is, the speed at which the food moves through your system--so the bad stuff stays in your body longer. (However, if you have familiar traveler's diarrhea, without fever, Pepto-Bismol may help.)