Diarrhea

By Emily Potts, MSc, and Tamsin Knox, MD

Diarrhea is an all too common problem for people with HIV. It is defined as loose or watery, and/or frequent stools. Chronic diarrhea is at least two loose stools daily for 30 days. In HIV, the main causes of diarrhea are:

  1. infection (with bacteria, parasites, or a virus);

  2. increased motility (movement through the intestine);

  3. medication side-effects; and

  4. malabsorption.

If you have diarrhea with fever, pain, blood, weakness, weight loss, low CD4 count, or if it is frequent or persistent, please get help from your doctor. A work-up for diarrhea includes keeping a diary, stool exams, and endoscopy. Treatment for diarrhea may include anti-motility or other prescription medications, but there are also many dietary measures that can help—see below:

Tips for relieving diarrhea:

  • Keep hydrated with Gatorade or diluted juices (dilute fruit juice 1:1 with water).

  • Vary the temperature to see if hot, cold, or tepid liquids are best for you.

  • Limit sodas and other sugary drinks.

  • Eat small frequent meals and snacks. Large amounts may stimulate more bowel action.

  • Eat slowly!

  • Avoid foods high in fat, such as fried foods, margarine, butter and oils.

  • Get plenty of rest. Try remaining quiet after meals.

  • Try eliminating dairy products, or use Lactaid.

  • Be sure to carefully wash or peel raw fruits and vegetables.

  • Switch to canned or well-cooked vegetables and fruits.

  • Increase foods with soluble fiber. Oatmeal, peeled pears, winter squash, zucchini, and legumes (beans) are some good examples.

  • Try the B.R.A.T. Diet—bananas, rice, applesauce, and toast. It is famous for slowing diarrhea. (It is not nutritionally complete—you need to worry about proteins after a while.)

  • Keep a diary, recording changes in bowel movements. Look for patterns. Many people have problems after eating specific foods or at certain restaurants. Be sure to take your diary to your medical appointments. It will contain a history of diarrhea episodes.

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