Brief Answer:
Welcome to HCM. I have reviewed your question

Detailed Answer:
Oh my!

Such a sudden onset makes me wonder if you might have an infection, which should be checked by your personal physician. Bacterial overgrowth is a common source of diarrhea in resection patients.

There are a few things you can do with your diet,but I am concerned about infection, hydration, electrolytes and that this is an issue for your personal physician if this has been going on for several days with an abrupt onset.

First, eliminate all unnecessary sugars and sugar alcohols from your diet. Use stevia instead or another sweetener if any used at all. The sugar alcohols used as sugar substitutes can cause diarrhea- all of them end in -ol, like sorbitol, zylitol. Avoid sugar alcohols. Sugar can also cause diarrhea by drawing water into the intestinal track if you eat too much of it. Moderation.

Next, you are most probably lactose intolerant. Stay away from regular milk unless you break down the lactose (milk sugar) with lactaid. Other products like
cheese (preferably low-fat) do not have lactose in it so no worry. Cheese is known to be constipating. Do you enjoy cheeses?

No fried foods. Switch to lean protein. Too much fat can cause diarrhea.

Eat whole grains and avoid white, processed starches. Gradually increase fiber or it may make you gassy. Plus you need to pay attention to hydration and electrolytes with diarrhea. Do not drink sports drinks to rehydrate.

Consume small, frequent meals. You may have to drink your liquids in between meals rather than with meals.

Table salt is okay.

Take high potency, easily absorbable multi-vitamin, multi-mineral supplements.Take them 4 hours away from your medications if possible.
Your B12 injections may hide a folic acid deficiency so I would add a B-complex pill as well as mention to your physician you would like a folate test run (not a CBC with differential, but a test for your folate levels specifically). I advise a potassium level check as well. Some nutrients you should not be supplementing yourself if deficient. Potassium is one of those.

If you were my patient I would try introducing psyllium fiber (such as Metamucil like products) into your diet very slowly and see if it starts to benefit you. Drink with 4-6 oz of water with the psyllium and 4-6 0z. 20 minutes later. Be very careful and monitor symptoms.

There are other medications you and your doctor can try but some are over the counter. Oh and pancreatic enzymes may help you digest your food better which will also help with your diarrhea.

There are over the counter H2 blockers (pepsid, zantac), antimicrobials (see doctor for potential infection-), and other prescription drugs that I would prefer you discuss with your treating physician.


Regards, XXXXXXX Shattler, MS,RDN

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Brief Answer:
Good Morning XXXXXXX

Detailed Answer:
Hi there! I was referring to your onset of diarrhea after being controlled on Imodium, not the onset of your IBD. I knew that had been longstanding *you had a resection and mild Crohns, I know. My point was if the diarrhea started suddenly after being controlled on Imodium for as long as you were controlled, perhaps you had developed an infection. It is called small intestinal bacterial overgrowth, or SIBO. (just to clarify what I meant)

Metamucil can be given to regulate bowels - both constipation and diarrhea. You can try just naturally increasing your fiber if this worries you.Taken from package insert "This drug may also be used to help relieve the symptoms of irritable bowel syndrome." However, since you are nervous about this, let us just work on getting the fiber in your diet up by adding whole grains and starting slowly to try to get your fiber up. To be honest with you, I don't like psyllium fiber, it tastes terrible. Look at doing things such as having oatmeal for breakfast (fiber); switch to whole grain bread (fiber); more cooked vegies (fiber). What I am looking for is to bulk up your stools and make them less runny. However, this is not an overnight solution. I do entirely realize you are having runny stools and this is your primary problem. So, in final thought, let us just work on increasing the fiber in your diet slowly and forget Metamucil since I cannot monitor you like as a regular patient of mine.

Lactose intolerant individuals can tolerate Greek yogurt pretty well. Greek yogurt, which is thicker because much of the whey, the watery part of milk, has been strained out in processing. This also removes much of the lactose. Greek yogurt supplies less than 6.8 grams of lactose per 6-ounce serving, compared to less than 8.5 grams in whole-fat yogurt or 14 grams in non-fat yogurt. Hard cheeses such as cheddar have even less lactose, between 0 to 2 grams per ounce. Milk, in comparison, has approximately 11 grams in one cup.

You can also take lactaid orally if small amounts of lactose bother you such as in yogurt or cheese. Same as putting the lactaid pills directly into milk to break down the milk sugar, except you would take it orally. Most of my lactose intolerant people can tolerate yogurt and cheese in moderate amounts, but everyone is different.

Fruits and vegetables...avoid gassy vegies like broccoli, cabbage, cauliflower. Cooked vegies will probably be tolerated better than fresh. Fresh fruit is all tolerated differently. For some people it gives them the runs. Definitely avoid prunes and prune juice. Wash with a vegie scrub brush all fresh produce, this is how many people get infections, poorly washed produce. Sweet potatoes are good, easily digested and full of vitamins. Just try to eat some of that well scrubbed skin.

I hope this clarifies the issues you raised. I do hope I have helped. You have quite a situation to deal with. If this does not clear up soon, please see a physician to check for infection, other prescription medication to slow down your motility (these meds are available by prescription) as you will face hydration and electrolyte issues.

I truly am hoping things turn around for you soon. Remember, if this doesn't clear up soon, don't be brave, go to your personal physician so your situation does not get worse. Chronic diarrhea once it brings on electrolyte abnormalities can also cause heart problems among other things. It is a snowball effect.

My best wishes. . .

Regards, XXXXXXX Shattler, MS,RDN

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