Problems with loose bowels are very common for many persons at end-of-life, especially in cancer patients during chemotherapy. This can rapidly increase electrolyte imbalance and dehydration if provisions are not made to replace lost fluids and minerals.

Many dietary modifications exist that can reduce the symptoms and facilitate a return to normal bowel function. The number one issue is modifying the fiber content of the diet.

Fiber - Helpful and Harmful

Dietary fiber refers to plant cell wall components that are not digestible and can only be degraded by anaerobic bacteria in the large intestine. There are two types of dietary fiber, soluble and insoluble. The greatest quantities of insoluble fiber can be found in wheat bran and flaxseed. It increases stool volume and shortens transit time or speeds up the passage of food through your digestive tract.

Soluble fiber absorbs water and forms a gel, which slows down the passage of food. It’s absorbed from the small intestines and acts like a cardiovascular broom, sweeping the blood vessels clean, thereby reducing harmful low-density lipoprotein (LDL) cholesterol and triglycerides.

Good sources of soluble fiber include:

  • Oatmeal
  • white rice
  • white flour
  • cream of wheat
  • Fruits and vegetables - particularly banannas, canned fruit, carrots, potatoes, squash, beets, avocado and okra.
  • psyllium seed (the main ingredient in many over-the-counter fiber supplements)

However, be cautious with your fiber intake. Excessive soluble fiber can result in gas, bloating and constipation. Your physician is the best source of advice on fiber supplementation for diarrhea.

Food You Can Use

Five or six small meals and snacks are easier on an unstable digestive system than three large meals. When diarrhea begins, reduce the insoluble fiber content of the diet to no more than 10 grams a day. Choose foods that contain no more than 2 grams of fiber per serving as stated on the nutrition facts label. This reduces intestinal motility which helps the gastrointestinal tract rest and promotes healing. 

A formula often prescribed for decreasing the frequency of bowel movements is the BRAT diet – bananas, rice, applesauce and toast. Once diarrhea subsides, bland foods such as chicken, fish, eggs, pudding, potatoes (without skins), pasta, rice, yogurt, cottage cheese, hot cereal, smooth peanut butter, white bread, bananas, canned fruit and cooked vegetables can be gradually introduced. A bland diet is easy on the digestive tract and is usually well tolerated.

Gut – Friendly Bugs

Probiotics are bacterial strains that promote digestive health. The gastrointestinal tract is home to billions of bacteria that perform a number of important functions including keeping the digestive system stable and functioning well.

Probiotic yeast was first isolated in 1923 by a French microbiologist, Dr. Henri Boulard. He was intrigued when he observed the natives in Indochina using a tea brewed from the skins of litchi and mangostein fruit to combat diarrhea resulting from a cholera epidemic.

Saccharomyces boulardii (S. boulardii) is a live yeast that is widely used to treat diarrhea resulting from multiple causes. It is naturally resistant to antibiotics and can accompany antibiotic therapy. It has no known interaction with pharmaceuticals except for antifungals, which will kill the organisms.

A few problematic conditions have been associated with the use of S. boulardii:

  • Persons with known allergies to baking yeast have reported itchiness and facial swelling.
  • Alcoholic beverages must be avoided, as alcohol will kill the yeast.
  • Systemic fungal infections occurred in two patients who had perforated colons. Both cases were successfully treated with antifungal agents.
  • There have been reports of opportunistic infections in patients with severely compromised immune systems and in those with indwelling vascular catheters.

This probiotic yeast is generally used for short-term gastrointestinal support of approximately three to four weeks or up to two weeks after diarrhea has been resolved. The leading brand worldwide is Florastor which can be ordered without prescription from pharmacies. It must be refrigerated to maintain potency.

Tummy Troublers

There are a number of food items that can increase distress by irritating the digestive tract. It is best to avoid the following when experiencing diarrhea:

  • Hard, raw fruits and vegetables
  • Whole grain and high fiber foods such as bran cereals, brown rice and whole wheat bread
  • Foods containing seeds such as berries and popcorn
  • Foods with skins like legumes, apples and corn
  • Stringy foods like pole beans and celery
  • Milk products if lactose intolerance is suspected
  • Caffeine, alcohol and carbonated drinks
  • Concentrated sources of sugar – sodas, candy, gum and desserts
  • Spicy and highly seasoned foods
  • Gas-forming vegetables – broccoli, cauliflower, cabbage, Brussels sprouts, collard greens, kale and beans
  • Chocolate can stimulate the bowels.

Fats and oils tend to make the bowels more sensitive, this can shorten transit time and worsen diarrhea. In addition, fat is harder to digest and this exacerbates the problem.

Seek Medical Advice

If you have persistent diarrhea and you’re concerned about the possibility of having an accident away from home, talk to your doctor. He may be able to prescribe medication that can reduce the frequency of bowel movements.

If you are wondering whether a probiotic and/or a fiber supplement could relieve your diarrhea, consult your physician. Your physician should be able to tell you whether either supplement might be helpful, recommend the most effective one, and give you guidance concerning the amount to take.

Call your doctor if you have any of the following:

  • More than six loose bowel movements per day with no improvement in two days.
  • Stools that have an unusual odor, color, or contain blood
  • Inability to urinate for 12 hours or more
  • Inability to drink fluids for more than two days
  • Weight loss due to diarrhea
  • Diarrhea after several days of constipation
  • Dizziness or passing out
  • Inability to drink more fluids than you are losing in bowel movements
  • Severe abdominal pain

For More Information:

With selective diet and supplements, diarrhea can most often be controlled if not eliminated. Additionally, there are a number of medications that can reduce symptoms and bring a large measure of relief. Here are some additional resources for more information:

Diarrhea: Cancer-related causes and how to cope. (2008) [Online]. Available: http://www.mayoclinic.com/health/diarrhea/CA00040

Saccharomyces boulardi : a probiotic now used world-wide for gastrointestinal health (2008). [Online]. Available : http://nybc.wordpress.com/2007/10/08/saccharomyces-boulardii-the-friendly-yeast/

Saccharomyces boulardi (2008). [Online]. Available : http://en.wikipedia.org/wiki/Saccharomyces_boulardii