Causes of Chronic Diarrhea

Could It Have an Everyday Cause?

Chronic diarrhea has many causes. Malabsorption, Crohn’s disease, colitis, and pancreatic insufficiency are topics for another day. This article focuses upon those causes where a change in behavior may result in a rapid improvement in the diarrhea. Such diarrhea is usually painless and persistent, unaccompanied by signs of disease such as bleeding, anemia, weight loss or fatigue. Frequent loose stools are a daily occurrence. There may be occasional normal stools. Despite the need to stay within running distance of a toilet, the patient is manifestly well.

Very frequently the diarrhea is due to something in the diet that is taken in excess. Here, I am not speaking of an allergy to a certain fruit or vegetable (which in fact is very rare), but rather to the excess of a sugar or chemical substance. The classic examples are alcohol and caffeine. An excess of alcohol, especially beer and wine, will cause loose stools the next day. It is sometimes not an obvious cause in someone imbibing large amounts regularly. The best test is to stop alcohol completely and see if the diarrhea abates. If it does, drinking may be cautiously resumed at a more modest level.

Many people fail to recognize the laxative potential of caffeine-containing drinks. More than two or three cups of coffee or tea daily can often cause diarrhea. Here again, the test is abstinence. Decaffeinated drinks are not a perfect solution, as other chemicals not removed by the decaffeination process may also loosen the stools. Cola drinks contain caffeine as well.

Knowledge that a caffeine drink is causing the chronic diarrhea provides the individual with control. He or she may now monitor and regulate the dose of caffeine in order to control the diarrhea. A word of caution is necessary. The sudden withdrawal of caffeine can cause a headache – indeed it is an ingredient of some headache medication. If so addicted, it is best to withdraw gradually. Most people can tolerate smaller amounts well.

Some sugars can cause diarrhea. The artificial sugar sorbitol is used as a sweetener. For example, it is often used to sweeten diet gums and candies. It has no calories, but is a known laxative if taken in sufficient amount. A glance at the ingredients of many confections or sweets will reveal the offending sugar. Mannitol is another sweet substance frequently found with sorbitol.

Fructose is a natural calorie-containing sugar found in fruit. It is one reason why large amounts of fruit can cause diarrhea. It may also be found in candies, soft drinks, honey, and preservatives and in sufficient amounts can cause diarrhea. Many people notice that their bowel movements are looser and more frequent in the summer when fresh fruits and vegetables are freely available. This is seldom a big problem, but moderating intake of these otherwise commendable foods should give comfort to some.

Lactose intolerance is the cause of chronic diarrhea in some people. However, the frequency of this effect has been exaggerated. Studies show that most people who believe they are lactose intolerant are not. Even those that are, can tolerate small amounts of milk. Lactose is a sugar that is contained in cow’s milk. Its proper digestion requires the presence of an enzyme (lactase) in the wall of the small intestine. Most Europeans have this enzyme in abundance, but descendants of people who did not traditionally raise cattle have lower, but not absent, lactase levels. Even they may tolerate some milk if it is spread out through the day. Addition of the enzyme (e.g., Lactaid) to milk should permit larger amounts daily. This is an important topic. Milk is a major source of calcium. With age, there is an increasing risk of osteoporosis especially in women, so a calcium substitute should be added if milk is withdrawn.

Few people are aware of the frequent presence of laxatives in herbal medicines. Senna tea is an obvious example. But herbs with a laxative effect like senna or cascara can be found in many other popular remedies. If you’re lucky, the contents of an herbal remedy will be spelled out on the package. More often, nobody has any idea what the package includes.

Only by stopping the medicine for a trial period can one be confident that it is not the cause of chronic diarrhea. Of course, many regular medicines can have diarrhea as an unwanted side effect. A list of suspects includes: cisapride, misoprostol, antacids containing magnesium hydroxide, laxatives, stool softeners, drugs for “regularity,” alcohol, and caffeine. Furthermore, it pays to be cautious of any regularly consumed drug or “natural” remedy.

True food allergies are rare as a cause of chronic diarrhea. Persons allergic to strawberries or shellfish experience a short-lived intestinal upset, and there are usually symptoms elsewhere such as in the skin (hives) or the bronchi (wheezing). If an elimination diet is embarked upon (they are very difficult), one must take care not to end up with a nutritionally deficient diet. Supervision by your doctor is important here.

Occasionally, chronic unexplained diarrhea may be explained by an infection with the parasite giardia lambia [an intestinal parasite]. This may be detected in some cases by stool tests, or more accurately by a biopsy of the upper small intestine through a gastroscope. There are areas where this parasite is commonly found, such as St. Petersburg in Russia. It is known as “beaver fever” in the Rocky Mountains, the Appalachians, or Northern Ontario because beavers are carriers of the bug. If a doctor is suspicious he or she may try a course of the antibiotic metronidazole.

If one is suffering from chronic diarrhea, it is important to note if there have been previous intestinal operations. Removal of the lower small intestine, or extensive gastric surgery may cause diarrhea through complicated mechanisms. By letting bile spill constantly into the intestine, a gall bladder removal may also cause diarrhea. Inform your doctor of the precise nature of any previous abdominal surgery, since this type of diarrhea is often treatable.

In summary, if you have chronic diarrhea you should carefully review with your doctor all that you ingest, and your past surgical, drug and travel history. This may disclose a cause that can be remedied. In general, any excessive ingestion of items that are not natural foods should be regarded with suspicion and not acquitted until proven not to be the cause. Careful consideration of these everyday items may avoid extensive and costly tests and lead to earlier relief.