“Taking up residence in the bathroom isn’t fun. My Viracept-induced diarrhea was causing serious weight loss, since all my food was ending up in the toilet,” says Walker Cunningham. “I was surprised when just changing my diet helped end the problem.”
Unfortunately, the San Francisco PWA has lots of company in the Grand Dash to the Bathroom. According to Peter Anton, MD, a gastroenterologist and researcher at UCLA School of Medicine, 50 percent to 70 percent of people with HIV will, at some point, have recurrent diarrhea. Because diarrhea is usually caused by a variety of factors working together (infections, food problems, drug side effects and/or other causes), aggressive diagnosis and treatment are crucial. (See also “Be True to Your Stool,” p. 84.)
But Anton cautions that until the diarrhea can be eliminated, good nutrition is an absolute necessity. “Doing everything to look for infectious causes diarrhea while the patient is not being supplemented nutritionally is fundamentally losing the war while you plan to win the battle,” he says. He also notes that care must be taken in choosing foods and fluids, since the wrong kinds can make diarrhea worse. Included on the problem-food list:
High-fact foods. Fat intolerance is a major cause of diarrhea; reducing fatty foods often results in substantial improvement.
Dairy products. Lactose intolerance is a frequent contributor to diarrhea and gas in PWAs.
Hot, spicy foods. They can exacerbate diarrhea.
Acidic fruits—oranges, grapefruits, pineapples and their juices. Limiting these can help reduce the stinging that makes diarrhea especially miserable.
Sugar. This sweetener will pull water from your system, the opposite of what you want with diarrhea.
Foods high in insoluble fiber. These increase the speed at which food travels through the intestines. Included are wheat bran, whole wheat products, popcorn, nuts, seeds, potato skins, corn and a high intake of raw fruits and vegetables (especially their peels).
By contrast, foods that contain soluble fiber will often bring considerable improvement. They absorb water and expand, binding together the intestine’s contents and slowing the passage of food. Included are fruits, such as peeled apples or applesauce, peeled pears, apricots, peaches, plums, grapes, berries, melons, nectarines, prunes, raisins and bananas, and such grain products as white rice, oatmeal, oat bran and barley.
White rice and white bread, although lacking the higher levels of nutrients found in their whole-food counterparts (and thus not generally recommended for a healthful diet), may be temporarily useful as sources of calories that will not irritate the intestines. Mashed skinless potatoes are also non-irritating calorie contributors.
“The right foods—especially oatmeal and white rice—practically eliminated my diarrhea,” Cunningham says. “My new motto: Soluble fiber each day keeps the run at bay.”
For those with serious diarrhea who can find little that’s tolerable, the BRAT diet may help: Every house or so, eat small servings of banana (one soft one), boiled white rice (one-half cup), applesauce (one-half cup) and dry white toast (one slice). If plain white rice becomes boring, add flavor by cooking it with a beef or chicken bouillon cube and/or with flavorful herbs like bay leaf, dill weed, basil or oregano. You could also add garlic powder or small amounts of soy or tomato sauce. Note that in some versions, the BRAT diet has an additional “T”—for tea. but since caffeine can exacerbate diarrhea, stick to a caffeine-free herbal variety.
If the BRAT diet works, try adding small amounts (a half-cup or so) of other foods that are easy on the intestines: Canned peaches or pears (without sugar), oatmeal, boiled or baked chicken, hard-cooked egg whites, mashed potatoes or sweet potatoes or carrots (without skin or butter), plain macaroni or other pasta, saltine crackers or rice cakes.
If intestinal cramping accompanies that diarrhea, try reducing intake of gas-producing food such as beans, cabbage, broccoli, cauliflower and brussels sprouts. If you do each such foods, try using digestive enzymes to decrease the gas. One product widely found to work is Beano, a vegetable enzyme sold in many supermarkets and pharmacies.
Some combination of these dietary changes has helped many PWAs solidify their efforts to get out of the bathroom and back on track.