Clinical Pearls: Chronic Diarrhea
Published 13 days ago • 2 min read
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This week's topic: Chronic Diarrhea/Loose Stools
Overview of today's email:
- Definition and overview of diarrhea
- Potential causes
- Practical clinical tips
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1. Definition and Overview of Diarrhea
Most of us already know what diarrhea is (frequent, loose, watery stools sometimes accompanied by abdominal pain), but it’s still important to review this condition/symptom in terms of types of diarrhea and duration.
Duration:
- Acute (lasts a few days, no longer than 2 weeks)
- Chronic (lasts more than 4 weeks)
Types of diarrhea:
- Osmotic (excess water drawn in to the intestines due to poor absorption of substances such as sugar or lactose)
- Secretory (bowel lining secretes excessive fluid into the lumen and damaged epithelial cells cannot reabsorb water, often due to an infectious cause)
- Fatty (stools often look greasy or float, due to malabsorption of fats often from Celiac disease or chronic pancreatitis)
- Inflammatory (stools often have mucous or blood)
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2. Potential causes
Rule out "red flags" or easy diagnoses:
- Celiac disease
- IBD (rule this out initially by testing calprotectin)
- C. Diff
- Giardia
- Gastritis or colitis
- Frequent antibiotic use
- Hyperthyroidism (or excessive intake of thyroid medication, especially T3)
- Lactose intolerance (usually cow's milk)
- Excessive sugar intake
- Excessive caffeine intake
- Excessive salt or electrolyte intake
- Alcohol
- Some medications can cause chronic diarrhea (e.g. statins)
- Supplements: Vitamin C, Digestive support (especially bile-supporting supplements like ox bile or TUDCA), oil of oregano, and magnesium citrate (e.g. mainstream practitioners recommend magnesium for headaches but aren't aware of the side effects of magnesium citrate)
Other potential causes:
- SIBO (H2S or hydrogen are more common)
- Increased acidity in the gut (often related to digestion or low SCFA)
- Histamine intolerance
- Suboptimal (< 500) or low pancreatic elastase (< 200)
- MCAS
- Bile acid diarrhea
- Fructose malabsorption
- Mycotoxin-induced illness
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3. Practical Clinical Tips
Always start with a 1-2 week supplement "holiday" (you'd be surprised by how many patients improve by doing this!)
One of the pillars I focus on in clinical practice is symptom relief (note, many treatments for this do not address the suspected root causes, and should only be used continuously for 4-6 weeks).
My top 2 treatments for symptomatic treatment:
- S. boulardii 2-3 grams daily
- Eucaloric elemental diet for at least 3 days (caution in those with history of eating disorder)
For more treatment options, I've recently moved to Substack for an extended version of these newsletters (available within 24 hours of releasing this email). I chose this platform because Substack has the benefits of being able to comment and ask questions about the posts, you're not bombarded with ads, and it's low cost!
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I hope this was clinically useful!
Would you mind filling out a one question survey to let me know which topics you have found most helpful? Thank you!
Meg
Additional resources that may be helpful:
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