A long list of maladies can cause Diarrhea. Infections are a common cause of acute diarrhea. Accompanying symptoms often include nausea, vomiting, mild fever, cramping, and general malaise. Microbes infecting the gastrointestinal tract include viruses (rotavirus and Norwalk virus), bacteria (E. coli, Salmonella, Shigella, Campylobacter, and Vibrio cholerae), and protozoa (giardia and amoebas). Toxins produced by bacteria also make us sick.

Food allergies and intolerances (e.g., lactose intolerance) can cause gas, crampy pain, diarrhea, and vomiting. Allergic foods also cause hives and swelling of respiratory linings. Food poisoning and consumption of poisonous foods (e.g., poisonous mushrooms) usually also cause vomiting. Antibiotics disrupt the normal microbial ecosystem to cause diarrhea. Overconsumption of fruit and fruit juice loosens stools. Fear and extreme anxiety can trigger a precipitous emptying of the bowels.

Some chronic conditions are associated with recurrent diarrhea. In irritable bowel syndrome (also called spastic colon), a condition of altered bowel motility, diarrhea may alternate with constipation. Inflammatory bowel diseases, which include Crohn’s disease and ulcerative colitis, result in recurrent diarrhea (which may contain blood or pus), fatigue, fever, abdominal pain, and trouble maintaining weight. In celiac disease, consumption of gluten (a protein in certain grains) leads to an immune system attack on the intestinal lining. Hyperthyroidism speeds bowel activity, which means there isn’t enough time for water to be absorbed into the blood.

Chronic conditions require careful medical management. If allergies or intolerance upset your stomach, avoid those foods. Allergy testing, careful food diaries, and elimination diets (removing all potential culprits for several days, then slowly reintroducing them one at a time) can help pinpoint the offending foods.

Food poisoning and infectious gastroenteritis (inflammation of the stomach and intestines) usually resolve within twenty-four to seventy-two hours. During that time, it’s important to rest and replace fluid losses with clear liquids—but not simply water. You also need salt and sugar. Steer clear of apple juice and prune juice, which loosen stools. Because you may temporarily lose the ability to digest dairy, skip that food group until several days after you recover. The foods you eat should be bland, relatively low in fiber, and easy to digest.

Recipes to prevent and treat diarrhea

BRATT Diet
In pediatric practice, the diet recommended after twenty-four hours of clear liquids is the BRATT diet: bananas, cooked rice, applesauce, tea, and toast. Round it out with saltine crackers and soup. Bananas Rice Applesauce Tea Toast
Preparation and use:
Alternate these foods throughout the day. Although we generally prefer whole grains, we recommend low-fiber white rice and white bread when coping with diarrhea. Be sure to eat applesauce, not raw apples, which loosen stools.
Yield: as many applications as needed
How it works:
These low-fiber, bland foods high in carbohydrates are easy for an inflamed intestinal tract to digest. Once the diarrhea is under control after twenty-four hours of clear liquids, the BRATT diet helps the body make its way back to accepting a balanced diet including fats, proteins, and fibers. Once you can tolerate bland foods for twenty-four hours, feel free to return to fiber-rich foods.

Rehydration Drink
For the first day, stick to clear liquids. This is a variant of the recipe on page 394, adapted from the Rehydration Project. This nonprofit international group works to curb the high death rate of children in developing countries from infections. ¼ cup (60 ml) fresh orange juice 2 cups (475 ml) room-temperature water ¼ teaspoon baking soda 2 teaspoons (14 g) honey
Preparation and use:
Combine the orange juice and water in a small pitcher. Stir in the baking soda until dissolved. Stir in the honey until dissolved.
Yield: 2 servings
How it works:
The biggest risk associated with diarrhea is dehydration. Children and the elderly are most vulnerable. This drink replaces depleted water, salt, potassium, and sugar. The baking soda also helps correct losses of alkaline fluid.

Blackberry Tea 
If you have access to blackberry (or raspberry) leaves or roots, this time-honored recipe can help slow the flow. 3 cups (710 ml) water 2 tablespoons (3 g) chopped dried blackberry leaves, or 4 tablespoons (24 g) fresh honey
Preparation and use:
Boil the water. Add the leaves. Turn off the heat, cover, and steep for 15 to 20 minutes. (If you also add blackberry roots, turn the heat to low and simmer for 20 minutes.) Strain. Sweeten with honey, to taste. Yield: 3 servings 
How it works:
Blackberry tea is an astringent, which gently contracts and helps dry tissues in the intestinal tract.

Green Tea, Lemon, and Honey
1 cup (235 ml) water 2 teaspoons (4 g) loose green tea 1 teaspoon (7 g) honey 1 teaspoon (5 ml) fresh lemon juice
Preparation and use:
In a saucepan, boil the water and add the tea. Turn off the heat, cover, and steep for 1 to 3 minutes. In a cup, mix the honey and lemon juice. Strain out the tea leaves and pour the tea into the honey mixture.
Yield: 1 serving
How it works:
Green tea is astringent and it inhibits major food-borne bacteria, such as E. coli, Salmonella typhimurium, and Staphylococcus aureus. Lemon is astringent, too, and contains vitamin C and bioflavonoids, which support the immune system. The essential oils in citrus fruits also discourage bacteria such as E. coli and Salmonella. Honey is anti-inflammatory, soothing, immune system– enhancing, and antibacterial.

Barley Water 
¼ cup (46 g) uncooked barley 3 cups (710 ml) water Salt or honey (optional)
Preparation and use:
In a saucepan, combine the barley and water. Bring to a boil. Lower the heat to low. Cook the barley gently for 1 hour. Strain out the barley, filling a bowl with the water. Allow th barley water to cool. Add a pinch of salt or 1 teaspoon (7 g) of honey, as desired, before drinking.
Yield: 1 serving
How it works:
Barley and rice water restore fluids and reverse electrolyte imbalance.

Moderating Miso
¼ cup (64 g) miso paste 2 cups (475 ml) water 1 scallion, chopped 2 garlic cloves, minced
Preparation and use:
Spoon the miso paste into a bowl. Boil the water in a saucepan and lower the heat to low. Pour ¼ cup (60 ml) of boiled water into the bowl with the miso, and stir until the mixture is smooth. Add the miso mixture to the remaining water in the saucepan. Stir until fully blended. Add the scallion. Stir in the garlic just before serving (by not cooking the garlic, you maintain it’s key ingredients).
Yield: 2 servings
How it works:
Miso, which is made from fermented soybeans, contains probiotics. In research showing that probiotics shorten the course of diarrhea, volunteers received supplemental bacteria. Scientists have not yet studied miso as a remedy for diarrhea. But it will help correct loss of salty and alkaline fluid. Raw garlic inhibits a number of bacteria, viruses, protozoa, and worms.

Quickie Chickie Soup
1 cup (235 ml) water 1 chicken bouillon cube, crushed ½ cup (80 g) uncooked egg noodles 1 tablespoon (14 g) minced, precooked chicken breast Freshly ground black pepper Dried sage or thyme 1 garlic clove, minced
Preparation and use:
Bring the water to a boil and reduce the heat to low. Sprinkle the crushed bouillon cube into the water. Stir until the bouillon is fully dissolved. Stir in the egg noodles and chicken pieces. Add pepper and sage or thyme to taste. Stir in the garlic just before serving.
Yield: 1 to 2 servings
How it works:
While the broth is both nutritious and easy on the digestive system, the sodium from the bouillon helps restore electrolytes to the depleted system. The small amount of chicken helps your system begin acclimating to small amounts of protein.

The Big Apple—Sauced 
½ cup (120 ml) water 2 unpeeled apples, cored and cut into chunks ¼ teaspoon ground cinnamon 1 tablespoon (20 g) honey
Preparation and use:
Pour the water into a saucepan. Add the apples, cinnamon, and honey and stir together. Cook the mixture over medium heat for about 15 minutes or until the apples are soft. Let the apple mixture cool and mash with a fork.
Yield: 3 to 4 servings
How it works:
Apples, particularly the peels, contain pectin. If you’ve ever made jam, you known that pectin draws water to make a gel. In that way, it reduces watery diarrhea. Because raw apples are harder to digest, it’s better to consume cooked apples. If you don’t feel up to cooking, use store-bought applesauce. Cinnamon contains the antibacterial agent cinnamaldehyde. Honey is anti-inflammatory, soothing, and inhibits some bacterial species.

Skinny Oats
½ cup (40 g) rolled oats 1 cup (235 ml) water ½ teaspoon ground cinnamon 1 teaspoon (14 g) honey (optional)
Preparation and use:
Mix together the oats, water, and cinnamon in a microwave-safe dish. Heat on high for 3 minutes. (Alternatively, combine the oats and cinnamon in a dish or measuring cup. Boil the water in a small pan, and then stir in the oats and cinnamon. Lower the heat to medium-low and cook, stirring occasionally, for 5 to 8 minutes until the oats reach your desired consistency.) Add the honey, if desired. Let cool and eat.
Yield: 1 to 2 servings
How it works:
Oats are soothing to irritated linings and contain a complex carbohydrate that enhances immune function. Honey has anti-inflammatory and antibacterial properties. Cinnamon is antibacterial.

Carob Shake 
2 small or l large banana, chopped ½ cup (65 g) raspberries (optional) ½ cup (115 g) plain yogurt (Read the label to buy a yogurt with probiotic organisms.) 1 tablespoon (6.5 g) carob powder 1 tablespoon (20 g) honey
Preparation and use:
Combine the bananas and raspberries, if using, in a blender and blend until smooth. Add the yogurt, carob powder, and honey and fully blend. Serve.
Yield: 1 serving
How it works:
Carob (locust bean) contains locust bean gum, a polysaccharide that binds water. Tannins in carob have an astringent effect. Bananas are a bland, soothing food. They provide needed sugars and potassium. The probiotics, or good bacteria, in some yogurts can help relieve infectious diarrhea—the kind encountered by travelers—by fighting the bad bacteria in the intestines. Whereas many dairy products are difficult to digest during a bout of infectious diarrhea, yogurt can often be tolerated.

Soothing Carrot-Ginger Soup
2 cups (475 ml) water 1 cup (130 g) scrubbed, chopped carrot 2 tablespoons (28 g) unsalted butter 1 teaspoon (7 g) honey (optional) ½ tablespoon fresh lemon juice ¼ teaspoon ground ginger 1 vegetable bouillon cube
Preparation and use:
Bring the water to a boil in a saucepan. Add the carrot and cook about 7 minutes until tender. Meanwhile, melt the butter in a skillet over low heat and stir in the honey, if using. Mix together the lemon juice and ginger in the skillet. Strain the carrots, reserving the liquid, and stir into the skillet mixture. Pour the carrot cooking liquid back into saucepan and add the bouillon cube. Add the skillet mixture to the saucepan and cover. Simmer for about 5 minutes.
Yield: 2 servings
How it works:
Carrot soup and carrot juice are traditional remedies for diarrhea. Carrots are rich in a number of vitamins, many of which support immune health, and also minerals, including potassium, which diarrhea depletes. They also supply sugars. Cooked carrots are easier to digest than raw. Ginger is antibacterial and eases upset stomachs.

When simple Doesn’t Work
You may want to go to the pharmacy to buy an antidiarrhea medication. But note: Diarrhea represents a nonspecific defense against infectious agents and toxins. Normally, you don’t want to stop it. Don’t use an over-the-counter antidiarrhea remedy, such as Lomotil, without discussing it first with your doctor. Pepto-Bismol is okay to take (unless the sick person is under the age of eighteen, due to the small risk of a serious condition called Reye’s syndrome). The active ingredient in this over-thecounter medication is bismuth subsalicylate. It seems to soothe irritated tissues and may kill some bacteria. Probiotic supplements containing particular bacterial strains (Lactobacillus rhamnosus, Lactobacillus GG, L. ruteri, L. casei, and L. rhamnosus) have been shown to shorten the duration of diarrhea in children. A combination of Bifidobacterium bifidum with either L. acidophilus, L. bulgaricus, or streptococcus thermophilus has been shown to shorten the course of diarrhea in children and decrease the risk of traveler’s diarrhea. Probiotic supplements also reduce the odds of developing antibioticinduced diarrhea. Also, goldenseal and Oregon grape roots contain berberine, which has been shown to treat diarrhea caused by giardia and such bacteria as e. coli.

When to call the Doctor 
The following are signs that you have something other than run-of-the mill infectious diarrhea, which usually resolves within seventy-two hours.
• Diarrhea lasts more than three days. (For babies younger than six months of age, call if diarrhea lasts more than a day.)
• Signs of significant dehydration occur: urinating less than every 8 hours, lightheadedness, weakness, poor skin turgor (you pick up a pinch of skin and it stays up, rather than popping back down), sunken eyes, and dry mouth, skin, lips, and eyes (no tears with crying).
• Severe abdominal pain and/or a fever over 101°F (38.3°C) accompanies diarrhea.
• Blood or pus appears in stool.
• Prolonged or recurrent diarrhea follows recent foreign travel or a camping trip.
• Diarrhea seems to be associated, along with other symptoms, with a new medication.