Introduction

Diarrhoea is defined as “passage of abnormally liquid or unformed stools at an increased frequency”. It is characterized by the frequent evacuation of liquid /stools weighing >200gm/d accompanied by an excess loss of fluid & electrolytes (mainly Na & K). It occurs when:

• There is excessively rapid transit of intestinal contents through the small intestine.
• Decreased enzymatic digestion of foods.
• Decreased absorption of fluid & nutrients.
• Increased secretion of fluid in the G.I tract.

Dietary guidelines

• Patients suffering from diarrhoea should never be starved because in acute state digestive enzymes are functional and almost 60% digestion can take place.
• Resting the gut can be most damaging as it can bring about structural changes in the gut membrane.
• Calories can be provided through easily digestible carbohydrates. The calorie intake is increased gradually as per the tolerance of the patient. An increment of 200-300 Kcal is the feasible target. But excess sugar must be avoided to prevent fermentative effect, which can aggravate the condition.
• Requirements of proteins are increased in persistent and chronic diarrhoea. But milk is restricted as it is a high residue food or due to relative deficiency of lactase enzyme in the GI tract. Milk in the fermented form like curd, buttermilk, yogurt etc are better tolerated and help in maintaining the gut health.
• High amount of fat is restricted as its digestion and absorption is altered. Emulsified form of fat is given, which are rich in MCT.
• Simple sugars should be given instead of complex sugars during the treatment. Soluble fibre in the form stewed fruits and vegetables should be given as it helps in binding the stool and favour good environment in the gut.
• Vitamins and minerals supplementation should be done.
• Sodium and potassium is replaced to prevent loss of fluid and electrolyte by having ORS solutions.

Nutritional manipulation

Reduction or total elimination of lactose from the diet is the commonest dietary manipulation. It is quite effective since most of the patients of diarrhoea have some degree of lactose intolerance. Dietary manipulation includes:

• Low lactose diet – include curd, yoghurt or giving milk with a cereal which reduces the total intake of milk.
• Lactose free diet-include milk free diet based on staple foods with liquid consistency or semi-solid diet should be given. A formula containing rice powder, glucose, oil and egg-white can also be used.
• Lactose and sucrose free diet- include soya based or casein based diet should be given. These diets may contain glucose or glucose polymer with chicken powder or minced chicken. For vegetarians soya or milk protein hydrolysate (e.g. Protein X) can be given.

Lifestyle modification

• Don’t skip your meals as it aggravates diarrhoea.
• Try to have milk along with cereal or fruit as it helps in absorption of lactose sugar.
• Have plenty of fluids in different forms to avoid dehydration.

Diet equation for calculation of calories intake

For males:
(66.47) + (13.75 * weight in kg) + (5.0 * height in cm) – (6.78 * Age in years)

For females:
(655.10) + (9.56 * weight in kg) + (1.85 * height in cm) – (4.68 * Age in years)

Sample menu according to Indian diet

Approx total calories:
Energy 1600 Kcal, Protein 60gm, Fat 45gm, Carbohydrate 290gm