Healing Nutrition

Diarrhea occurs when the bowels move more frequently than usual. The stools are usually soft, loose, or watery and happen 3 or more times a day—commonly accompanied by excessive gas and intestinal cramping.

 

Chemotherapy and radiation-related diarrhea can be debilitating and puts the person at risk of dehydration, malnutrition, electrolyte imbalance, and fluid depletion. Uncontrolled diarrhea may cause treatment breaks or therapy dose reduction. 

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Adequate nutrition is important during episodes of acute diarrhea to prevent losing muscle mass and dehydration. The following diet recommendations focus on decreasing the amount of work required by the entire GI system. If you do not have an appetite or have poor food tolerance, you can drink only liquids for a short period.

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Nutrition Strategies for Diarrhea

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• Eat frequent small meals and snacks every 2-3 hours.  ​

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• Drink plenty of fluids to help prevent dehydration. Try to drink these fluids between meals since liquids with a meal may speed up stomach emptying and possibly worsen diarrhea.

  • Aim for at least 8 to 10 cups (64-80 ounces) of liquids each day. ​

  • ​Add 1 cup (8 oz.) for each loose bowel movement. 

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• Beverages and foods with potassium and sodium are best for diarrhea.​

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• Beverages that are clear and at room temperature are best.

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What to Foods to Eat with Diarrhea 

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Foods used in this diet make the stools firmer. That's because the foods are considered thickening foods. They are low in insoluble fiber and high in potassium and sodium.

 

In addition, some foods have soluble dietary fiber, which acts as a thickener agent, and soft and starchy foods with smooth textures and easy-to-digest proteins.

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BRAT Diet ​

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A BRAT diet may be helpful for short periods. These foods slow down the intestines and decrease how often you have bowel movements.

• Bananas

• Rice

• Applesauce

• Toast

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Foods Low in Fiber 

• Potatoes, without skin 

• Saltine crackers 

• White bread, rolls, plan bagels, and English muffins

• White pasta

• White rice

• Hot cereals, such as oatmeal, cream of rice, cream of wheat, and farina

• Cold cereals, such as Corn Flakes®, Corn Chex™, Rice Chex™, and Rice Krispies®

• Vegetables without skins and seeds, and well cooked

• Fruit cups, without syrup

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Foods High in Protein

Getting enough protein and nutrients can help you heal faster, recover from surgery, fight infections, and repair muscles.

• Chicken

• Turkey

• Fish

• Eggs

• Smooth nut butters (like peanut butter and almond butter)

• Tofu

• Greek yogurt 

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What to Drink with Diarrhea

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​​It is essential to restore fluids with diarrhea. Otherwise, you can become dehydrated. Drinking water is the best when it comes to hydration.

 

Drinking oral rehydration with liquids that contain water, potassium, and sodium can also help rehydrate the body and restore minerals. 

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• Water

• Coconut water

• Pedialyte® 

• Gatorade®  

• Propel® 

• Powerade® 

• Soups and broths 

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Oral rehydration solutions (ORS), including standard World Health Organization ORS or commercial ORS, such as Rehydralyte and Ceralyte, may be more appropriate for people with severe diarrhea. 

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What Causes Diarrhea in Cancer

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According to the scientific literature database, diarrhea can occur in 50–80% of patients depending on the chemotherapy regimen through multiple mechanisms.

 

Chemotherapy drugs like 5-fluorouracil (5-FU) and irinotecan damage the intestinal mucosa causing diarrhea (6). Other chemotherapy agents cause gut dysmotility and alteration in gut microbiota leading to diarrhea. 

 

Chemotherapy medications such as busulfan, melphalan, oxaliplatin, azacitidine, capecitabine, hydroxyurea, mercaptopurine, pemetrexed, thioguanine, dactinomycin, mitomycin-C, daunorubicin, doxorubicin, epirubicin, idarubicin, etoposide, paclitaxel, docetaxel are associated with diarrhea (12).
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Radiation treatment to the abdominal and pelvic area also may cause radiation enteritis, which induces diarrhea. 

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Other causes of diarrhea include decreased physical performance, graft versus host disease, infections, fat or bile acid malabsorption, sorbitol or lactose intolerance, infection, food allergies, gastrointestinal diseases such as inflammatory bowel disease, and other diseases. 

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Foods and Drinks to Avoid with Diarrhea

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Insoluble Fiber 

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Insoluble fiber can draw water into the stools to soften, increasing the stool's volume and pushing everything stored in the large intestine, including water. It makes stools pass faster through the intestines, increasing the frequency of bowel movements. For this reason, insoluble fiber is contraindicated in treating diarrhea, in which the stools are already very watery. 

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• Fresh fruits, and vegetables 

• Beans, lentils, and peas 

• Whole grain and whole wheat products, such as wheat bread and brown rice

• Nuts and seeds

• Popcorn 

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Foods Containing Sorbitol

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Sorbitol intolerance appears mainly in genetically predisposed people. It is a reaction of the body against food that contains sorbitol, producing malabsorption of this nutrient, which causes digestive symptoms such as abdominal pain, gas, and diarrhea. In these cases, the treatment consists mainly in reducing the amount of sorbitol in the diet to levels that do not cause discomfort. 

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• Prunes

• Figs

• Dates

• Raisins

• Sugar-free gum

• Sugar-free candy

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Foods High in Fat and Fast Foods

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These foods are high in saturated fats, which are difficult to digest especially having an upset and sensitive stomach. Avoid foods with high-fat content until the gut function returns to normal after a severe period of diarrhea.

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Sugary Drinks and Foods

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Foods with a high sugar content can cause worsen diarrhea by pulling water into the gut making stools loose and watery. 

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Other Foods and Drinks Not to Eat

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Spicy foods, caffeine, alcohol, and carbonated drinks can overstimulate the gut and worsen diarrhea. Dairy products (except yogurt) may be difficult to digest due to lactose malabsorption. 

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• Caffeine

• Alcohol

• Carbonated drinks

• Dairy products (except yogurt)

• Spicy and over-seasoned foods

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