Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
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 NICE CKS,NICE CG61.
- Advise drinking at least 8 cups of fluid per day, especially water or other non-caffeinated drinks like herbal teas NICE CKS,NICE CG61. Ensure adequate fluid intake, particularly if there is a risk of dehydration NICE CKS,NICE CKS,NICE CG49.
- 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 NICE CKS,NICE CG61.
- Suggest limiting fresh fruit to 3 portions per day (approximately 80g per portion) NICE CG61.
- Recommend reducing intake of 'resistant starch', which is often found in processed or re-cooked foods NICE CG61.
- Advise reducing or limiting foods and drinks that may exacerbate symptoms, including caffeine, alcohol, and carbonated drinks NICE CKS,NICE CG61. Specifically, restrict tea and coffee to 3 cups per day NICE CG61.
- Consider if symptoms are worsened by dairy products, which may suggest lactose intolerance NICE CKS.
- Be aware that diarrhoea can be due to consumption of food additives, such as sorbitol NICE CKS.
- Important Considerations:
- If attempting to identify potentially contributory factors, advise the patient to modify one food at a time NICE CG49.
- Encourage the use of a food and fluid diary to help establish a baseline and track symptoms NICE CG49.
- Emphasise that overall nutrient intake should remain balanced NICE CG49.
- 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 NICE CKS.