Report from the LI Conference, part 7

The sensitivity of our insides means that diarrhea is a symptom of about a zillion causes. Some of them may be food related, some may be from diseases. If you go a doctor, he or she has to sort through your entire pattern of symptoms to make a proper diagnosis.

Clinical Presentation and Approach: But What if It Is Not Lactose Intolerance?
Lin Chang, M.D.
Codirector
Center for Neurobiology of Stress
Professor of Medicine
David Geffen School of Medicine
University of California, Los Angeles

Dr. Chang had a handy chart to show the common disorders that can be confused with or for lactose intolerance.

That's not six disorders. That's six entire classes of disorders that have to be sorted through.

I don't diagnose people myself, but it's apparent that many of those who write to me don't have lactose intolerance but something else entirely. It's the doctor's job to figure out what, but you can see that's not always the easiest decision to make.

Bowel Incontinence

The excellent writer Christian Nordqvist of Medical News Today seems to come up a topic every month that is of useful interest to our needs. In July it was diarrhea and in August he covered sugars and carbohydrates.

This month he covers topic that few want to think about much less talk about in public, bowel or fecal incontinence.

Bowel incontinence, also known as fecal (UK: faecal) incontinence, is an inability to control bowel movements. The person's stools (feces) leak from the rectum uncontrollably. Bowel incontinence can vary in severity from passing a small amount of feces when breaking wind, to total loss of bowel control.

Bowel incontinence is a sign or symptom of a condition or disease; it is not a condition or disease in itself. Generally, bowel incontinence is not life-threatening and does not impact negatively on the patient's health. However, the sufferer's quality of life, emotional and mental health, as well as self-esteem can be affected.

Lactose intolerance, irritable bowel syndrome, or a number of other intestinal disorders can cause this. So can a bewildering variety of diseases, disorders, syndromes, and deformities.

Because there are so many possible causes, diagnoses and corrective treatments vary just as much. I'd suggest reading Nordqvist's article to see if something there covers your problem.

And be reassured that you are not alone and this is not a rare condition. He estimates that one to two percent of the American population suffers from it, and since the elderly are more likely to have it, the condition will become more common in the future.

No Intolerance While Traveling. Why?

Every once in a while I receive an email like this one from Adam:

I have many digestion problems in the UK. Have done for a while irrespective of what I eat or cut out. Just returned from Thailand where I had absolutely perfect digestion the whole time. I found I could eat anything I wanted the whole time. I went there for the 1st time last year+ found the same thing. After returning to UK, same digestive problems started again. Mystery to me+ my doctor. Just wondered if u have ever heard of anything like this. My life is miserable in the uk because of this. Hope u can offer an answer or some advice.

This is almost the ultimate fantasy for those of use with lactose intolerance and other digestive problems. A place in which we can eat anything we want and not suffer any consequences. Why does it have to be so far from home and so temporary an ideal?

I have no answer. I have no clue. I can't think of any reason why lactose intolerance should behave differently anywhere in the world.

I had only one possible grasp at a thought that I could share with Adam. We do know that the bacteria that live in our colons are responsible for many of the symptoms of lactose intolerance and many additional ills. And we know that bacteria are local. We'll meet strange bacteria whenever we travel. That's the problem behind traveler's diarrhea.

But what if it also worked the other way? What if the local bacteria that you encounter every day in your water and food are the ones making you ill? Wouldn't you then feel better when you got so far away that your exposure was to a whole new set that didn't cause the same problems?

I'm grasping at straws here, I know. But it's the only faint shred of an answer I have. If you readers have any similar tales or ideas that might solve this mystery, please share them.

All About Diarrhea

I get excited whenever I find a good article on the Internet, one that is factually correct and contains a complete set of information, not a mere hit and run at the topic. That's becoming rare in these days when Examiner.com bloggers spew any random thoughts out at the rate of a hundred articles a month.

MedicalNewsToday.com is a higher caliber of site. They just published an article on diarrhea, written by Christian Nordqvist, that I have to restrain myself from quoting in large chunks.

I will restrict myself to one critical section.

Anybody who has had diarrhea for more than one week should see their doctor. The UK National Health Service advises parents to take their child to the doctor if:

• The child is aged 3 months to 1 year and the diarrhea has lasted over two days
• The child is over 1 year of age and the diarrhea has lasted more than five days

You should also see your doctor if you experience or witness any of the following:

• You have symptoms of dehydration - excessive thirst, very dry mouth, very little or no urination
• Your abdominal pain is severe
• You have severe rectal pain
• There is blood in the stools, the stools are black
• Your temperature is over 39C (102 F)
• A baby has not wet the diaper (UK: nappy) in over three hours
• A child/baby is very sleepy, irritable, or unresponsive
• A child/baby has a sunken abdomen
• A child/baby has sunken eyes and/or cheeks
• The child's/baby's skin does not flatten after being pinched

Prolonged diarrhea can also lead to hemorrhoids and, surprise, surprise, I found a good article on hemorrhoids there as well, also written by Nordqvist.

I recommend reading either or both articles all the way through for a thorough summary of those subjects.

Lactose-Free Milk May Help Diarrhea in Children

The British newspaper The Guardian published a health article in conjunction with the BMJ Group, the BMJ standing for nothing less than the British Medical Journal. That means the advice came with footnotes referencing the actual medical journal articles that backed up the words. Excuse me while I fan myself from the palpitations. Stuff this wonderful doesn't come across every day.

The article answered a question that most parents have to deal with at some point in their youngsters' early lives, What treatments work for diarrhoea in children?

One treatment that might work, though they hedge the answer within an inch of its life, is substituting lactose-free milk for regular milk.

There has been a lot of debate about whether babies with diarrhoea should be given formula milk that is lactose-free while they recover. Lactose-free formula milk does not have cow's milk in it. The theory is that the part of the gut that helps to digest lactose is damaged in diarrhoea so that lactose-free formula milk might be easier to digest. But lactose-free formula milk is usually recommended only in children who have had diarrhoea for a long time.

There have been some studies but the results haven't given us a clear answer about whether formula milk that is lactose-free is better than standard formula milk.

One summary of the research (a systematic review) that looked at 13 studies found that diarrhoea or dehydration was more likely to get worse in babies who had normal formula milk (about 2 in 10 babies) compared to those who had lactose-free formula milk (about 1 in 10 babies).[6] Babies on lactose-free milk got better faster (after about three and a half days) compared to those on normal formula milk (about four days).

Out of five other studies, three found that diarrhoea stopped more quickly in babies who were given lactose-free formula milk.[7] [8] [9] In the two other studies the special formula milk made no difference.[10] [11]

There don't seem to be any side effects from using lactose-free formula milk.

6. Brown KH, Peerson JM, Fontaine O. Use of nonhuman milks in the dietary management of young children with acute diarrhea: a meta-analysis of clinical trials. Pediatrics. 1994; 93: 17-27.

7. Allen UD, McLeod K, Wang EE. Cow's milk versus soy-based formula in mild and moderate diarrhea: a randomized, controlled trial. Acta Paediatrica. 1994; 83: 183-187.

8. Fayad IM, Hashem M, Husseine A, et al. Comparison of soy-based formulas with lactose and with sucrose in the treatment of acute diarrhoea in infants. Archives of Pediatrics and Adolescent Medicine. 1999; 153: 675-680.

9. Wall CR, Webster J, Quirk P, et al. The nutritional management of acute diarrhea in young infants: effect of carbohydrate ingested. Journal of Pediatric Gastroenterology and Nutrition. 1994; 19: 170-174.

10. Clemente YF, Tapia CC, Comino AL, et al. Lactose-free formula versus adapted formula in acute infantile diarrhea. Anales Espanola Pediatria. 1993; 39: 309-312.

11. Lozano JM, Cespedes JA. Lactose vs. lactose free regimen in children with acute diarrhoea: a randomized controlled trial. Archivos Latinoamericanos de Nutricion. 1994; 44: 6-11.

You should also note that:

Rehydration drinks (also called oral rehydration solutions) contain a mix of salts and sugar to help your body replace fluids and salts lost through diarrhoea. They do not stop the diarrhoea. But they can prevent your child getting dehydrated.

This is the safest treatment and it should be tried first.