Dr. Weyrich's Naturopathic Functional Medicine Notebook is a collection of information on topics of interest
to Dr. Weyrich that may be of interest to the world wide audience.
Due to limitations of time, not all information that Dr. Weyrich knows or would like to further research is
Dr. Weyrich welcomes financial contributions to support specific research topics, as well as copies of
non-free access journal articles for him to review on a topic.
Constructive criticism is also welcome.
Overview of Diarrhea
Diarrhea is disorder that presents with loose or watery stools
that occur more than three times in one day.
This is usually benign and self-limiting condition requiring no
treatment. The combination of diarrhea and bloody stools is called
However, severe or prolonged cases can lead to dehydration or electrolyte
imbalances that are especially dangerous to young children and the elderly,
and may indicate a more serious condition requiring medical attention.
Signs and Symptoms of Diarrhea
Loose or watery stools that occur more than three times in one day.
Cramping abdominal pain
Urgent need to use the bathroom.
Depending on cause, possibly fever, nausea, bloody stools.
Diarrhea is characterized by bowel movements that look like types 5 to 7
on the Bristol Stool Form Scale, as shown below [Lewis1997].
Paradoxically, fecal impaction can lead to a thin watery stool as small
quantities of freshly formed watery or soft stool leak around the impaction.
Treatment of Diarrhea
Diarrhea in infants or the elderly lasting more that 24 hours,
or signs of dehydration constitutes a medical emergency and merits
an emergency referral. Signs of dehydration include:
Rapid, forceless, turbulent pulse [ORWJr]
Reduced blood pressure [ORWJr]
Thirst, dry mouth and tongue
Less frequent urination, dark colored urine
Infants: No wet diapers for 3 hours or more
Skin that does not flatten when pinched and released (tenting)
Dry skin, lack of perspiration
Sunken abdomen, eyes, or cheeks
Children: No tears when crying
Fatigue, light-headedness, listlessness or irritability
Diarrhea accompanied by bloody or black tarry stools, stools containing
mucus, severe abdominal or rectal pain, lasts more than 3 days (24 hours for
children), or high temperatures requires prompt evaluation by a doctor.
In most cases, treatment is mainly supportive: replace lost fluids and
electrolytes. In mild cases, oral electrolyte solutions
(e.g. Pedialyte, Ceralyte, Infalyte, etc.)
suffice, but in severe cases intravenous (IV) solutions are required.
Antidiarrheal agents (e.g. Imodium) are generally contraindicated in
diarrhea caused by bacteria or parasites - let the body's natural reaction
flush out the infectious agent.
Antidiarrheal agents are controversial in other forms of diarrhea.
Antibiotics may be considered in cases of bacterial infections, but
beware that Herxheimer reactions (toxin release as bacteria are rapidly killed)
may exacerbate symptoms.
Antiparasitic agents may be considered in cases of parasites, but
beware that some agents may annoy the parasites and cause them to burrow into
the intestinal lining.
Be sure to identify the nutritional imbalance before taking copper or zinc supplements!
Taking the wrong supplement can be harmful!
Prevention of Diarrhea
Most cases of diarrhea arise from consuming contaminated food or water.
The following precautions will avoid most cases of diarrhea:
Never eat ground meat (hamburger) that is not cooked through to the center.
Never allow cooking utensils that have contacted raw foods to contact
cooked foods without thorough cleaning.
Never drink from mountain brooks - they may look clean, but often
harbor parasites such as Giardia.
When traveling in third-world countries, recognize that local peoples
often have developed immunity to local contaminants that can make you sick.
Do not drink, brush your teeth, or use ice made from water that
has not been boiled or comes from a sealed bottle that you open yourself.
Do not drink unpasteurized milk or dairy products.
Avoid all raw fruits and vegetables
unless they can be peeled and you peel them yourself.
Do not eat raw or rare eggs, meat or fish.
Do not eat meat or shellfish that is not hot when served to you.
Do not eat food from street vendors.
Sequelae of Diarrhea
Prolonged or severe diarrhea may deplete the body of minerals (electrolytes)
and fluids. This is particularly dangerous to young children, the elderly, and
patients having comorbid conditions that disturb fluid and electrolyte
regulation (some drugs, compromised kidney function, etc.), or that are
exacerbated by electrolyte imbalances (cardiac arrhythmias, etc.).
Pathophysiology of Diarrhea
A number of different dysbiotic bacterial overgrowths in the gut have been
associated with diarrhea, including Clostridium difficile and
Vibrio cholerae [Afghani1994].