Which dietary modifications should I recommend to a patient with chronic diarrhoea while awaiting further investigation?

While awaiting further investigation for chronic diarrhoea, you can recommend the following dietary modifications to the patient:

• General Eating Habits:
  • Encourage the patient to eat regular meals and take time to eat, avoiding missing meals or leaving long gaps between eating ³,⁶.
  • Advise drinking at least 8 cups of fluid per day, especially water or other non-caffeinated drinks like herbal teas ³,⁶. Ensure adequate fluid intake, particularly if there is a risk of dehydration ²,³,⁴.
• Specific Food and Drink Modifications:
  • Advise reducing the intake of insoluble fibre, such as wholemeal or high-fibre flour and breads, cereals high in bran, and whole grains like brown rice ³,⁶.
  • Suggest limiting fresh fruit to 3 portions per day (approximately 80g per portion) ⁶.
  • Recommend reducing intake of 'resistant starch', which is often found in processed or re-cooked foods ⁶.
  • Advise reducing or limiting foods and drinks that may exacerbate symptoms, including caffeine, alcohol, and carbonated drinks ³,⁶. Specifically, restrict tea and coffee to 3 cups per day ⁶.
  • Consider if symptoms are worsened by dairy products, which may suggest lactose intolerance ¹.
  • Be aware that diarrhoea can be due to consumption of food additives, such as sorbitol ¹.
• Important Considerations:
  • If attempting to identify potentially contributory factors, advise the patient to modify one food at a time ⁴.
  • Encourage the use of a food and fluid diary to help establish a baseline and track symptoms ⁴.
  • Emphasise that overall nutrient intake should remain balanced ⁴.
  • If general lifestyle and dietary advice does not help, referral to a dietitian for further dietary management, such as a low-FODMAP diet or single food avoidance, should be considered under specialist supervision to ensure a balanced and nutritious diet ³.