Gastroenteritis and diarrhea

Gastroenteritis refers to the inflammation of the lining of the stomach and intestines, manifested by upper GI tract symptoms such as anorexia, nausea, vomiting, as well as diarrhea and abdominal pain. Gastroenteritis is a general term for these symptoms, whether the cause can be identified or not, the specific cause denoted by the descriptive term, ‘bacterial,’ or ‘viral.’ In most cases gastroenteritis is a relatively benign and self-limiting condition, but in debilitated patients and in children can be fatal due to a loss of electrolytes and the resultant dehydration.

Enterotoxins are synthesized by certain bacteria, which function to impair intestinal absorption and stimulate the secretion of electrolytes and water into the lumen of the bowel. Examples of bacteria that produce such toxins are Vibrio cholerae (cholera) and Escherichia coli. Rather than producing enterotoxin some bacteria including Shigella, Salmonella, and E. coli species actually penetrate the mucosa of the intestine, causing ulceration, bleeding, and the discharge of pus, along with the secretion of electrolytes and water. (Berkow 1992, 813; Govan et al 1990, 395)

Campylobacter jejuni is the most common bacterial cause of gastroenteritis illness in North America, primarily through infection from domesticated animals or contaminated poorly cooked food. Person-to-person transmission is especially common with gastroenteritis caused by Shigella and Escherichia coli. Salmonella infection may be acquired through contaminated food or water, contact with reptiles (e.g. frogs, turtles) or from insects (e.g. cockroaches). (Berkow 1992, 813)

Viral causes of gastroenteritis include the Norwalk virus and similar viruses, as well as rotaviruses, adenoviruses, astroviruses, and caliciviruses. Epidemics of viral diarrhea in infants, children, and adults are typically spread via contaminated water or food or via the fecal-oral route. Norwalk virus infections occur year-round and cause about 40% of outbreaks of gastroenteritis in children and adults. During the winter in temperate climates, rotaviruses are the major cause of serious gastroenteritis in young children. (Berkow 1992, 813)

A number of intestinal parasites can also cause gastroenteritis by invading the bowel mucosa. Giardia lamblia is a protozoan that inhabits the crypts in between and on the villi surface, and can cause symptoms that range from mild colic and poorly formed stools to severe cramping, diarrhea and fever. Infections can persist for a number of years, causing chronic diarrhea, flatulence, malabsorption, and weight loss. Both humans and animals are reservoirs for Giardia, and is spread by the fecal-oral route. Giardiasis or ‘beaver fever’ is common in the colder climates of North America, Europe and Asia, acquired by drinking water from contaminated creeks and streams. Another common intestinal parasite is Cryptosporidium parvum, usually acquired by drinking contaminated water. Cryptosporidosis promotes a watery diarrhea that is sometimes accompanied by abdominal cramps, nausea, and vomiting. It is usually a mild and self-limiting disease in healthy individuals, but in the immunocompromised, as well as young children and the elderly the infection can be severe, causing significant electrolyte and fluid loss. Non-infectious of causes of gastroenteritis include the ingestion of toxins found in fungi and plants (e.g. poisonous mushrooms, potato leaves), heavy-metals (e.g. arsenic, lead, mercury and cadmium) and antibiotics, the latter of which promote GI dysfunction by altering the normal gut flora. (Berkow 1992, 237)

The signs and symptoms of gastroenteritis vary to a large degree, depending on host resistance, the virulence or toxicity nature of the etiological agent, and the duration of its activity. Symptoms of gastroenteritis are often quite sudden, and can include anorexia, nausea, vomiting, borborygmi (intestinal ‘gurglings’), colic, and diarrhea with or without blood and mucus. Other symptoms may include fatigue and lethargy, muscle aches, and fever. With either vomiting or diarrhea excessive fluid loss can occur, promoting symptoms of dehydration including muscular spasm, nervous irritability, shock, vascular collapse and renal failure. (Berkow 1992, 237).

Medical treatment

The treatment of simple diarrhea is usually addressed by the use of anti-diarrheals such as loperamide hydrochloride (e.g. Imodium®), which slows intestinal motility by affecting water and electrolyte movement through the bowel, and the inhibition of peristaltic activity. Other interventions include bismuth subsalicylate, diphenoxylate, codeine phosphate, camphorated opium tincture, atropine, propantheline, psyllium, kaolin, pectin, and activated attapulgite (a clay mixture containing silicon, aluminium and iron oxides). Diarrhea however is really only a symptom, and thus measures are taken to understand the underlying etiology, which if acute, often relates to microbial infection. In this case the use of anti-diarrheals may be inadvisable, although measures to control electrolyte loss is essential and in severe diarrhea is life-saving. The following is the original electrolyte recipe recommended by the World Health Organization:

  • sodium chloride: 3.5 g
  • sodium bicarbonate: 2.5 g
  • potassium bicarbonate: 1.5 g
  • glucose: 20 g
  • water: 1 liter

There have been a number of relatively developments in the use of electrolytes, and now most formulas contain less sodium in order to prevent hypernatremia. Among the most effective agents appears to be rice starch, traditionally used in both Ayurvedic and Chinese medicine (i.e. kanji, congee). In clinical research a pre-cooked rice powder was found to be highly effective in lessening the severity of diarrhea and prevent dehydration, and in many cases is either similar to or more effective that the standard WHO-recommended oral rehydration solutions (Hossain et al 2003; Sharma et al 1998; Bhattacharya et al 1998). Specifically, rice starch appears to blocks the chloride channel, inhibiting the flow of water into the lumen (Matthews et al 1999; Goldberg et al 1996).

Although antibiotics are sometimes used in gastroenteritis, their benefit is disputed and in some cases may prolong the carrier state of certain infections such as salmonellosis.

Holistic Treatment

In addition to the usage of oral rehydration therapy, there are a great number of botanicals that can be of enormous benefit in gastroenteritis. The following outlines the basic approach taken in gastroenteritis:

1. Oral rehydration

  • using the WHO electrolyte formula, or an infusion of  mineral-rich Nettles (Urtica dioica) and Dandelion (Taraxacum officinale) leaf, one liter, taken with 2.5 g of sea salt, 2.5 g of sodium bicarbonate, and 20.0 g of table sugar

2. Decrease fecal volume

  • tannin-containing botanicals to astringe the mucosa, promote tissue healing and reduce the volume of the stool, e.g. Raspberry (Rubus idaeus) root, Chinese Cinnamon (Cinnamomum cassia) bark, Goldenseal (Hydrastis canadensis), Haritaki (Terminalia chebula) (decoction or tincture), Bayberry (Myrica cerifera), Agrimony (Agrimonia eupatoria), Cranesbill (Geranium maculatum), White Oak (Quercus alba), Mullein (Verbascum thapsus), Bearberry (Arctostaphylos uva-ursi), Walnut bark (Juglans nigra)
  • hydrophilic compounds, e.g. psyllium, pectin, activated charcoal, bentonite clay

3. Ease spasm and griping

  • aromatics, including Anise (Pimpinella anisum) Dill (Anethum graveolens) seed, Fennel (Foeniculum vulgare), Caraway (Carum carvi), Calamus (Acorus calamus), Ginger (Zingiber officinale), Prickly Ash (Zanthoxylum clavaherculis) (berries), Cardamom (Elettaria cardamomum) etc.
  • antispasmodics, including Cramp Bark (Viburnum opulus), Valerian (Valeriana officinalis), Hing (Asafoetida ferula), Wild Yam (Dioscorea villosa) etc.

4. Antimicrobial agents

  • Kutaja (Holarrhena antidysenterica), Bilwa (Aegle marmelos), Musta (Cyperus rotundus), Haritaki (Terminalia chebula, decocted fruit), Hriverum (Pavonia odorata), Kiratatiktam (Swertia chirata), Turmeric (Curcuma longa), Neem (Azadirachta indica)
  • berberine and related isoquinoline alkaloid-containing botanicals, e.g. Oregon Grape (Mahonia repens), Barberry (Beberis vulgaris), Goldenseal (Hydrastis canadensis), Huang Lian (Coptis chinensis)
  • other antimicrobial agents, e.g. Purple Coneflower (Echinacea angustifolia), Wild Indigo (Baptisia tinctoria),  Balsam fir (Abies balsamea), Yarrow (Achillea millefolium), Hing (Ferula asafoetida), Sweet Annie (Artemisia annua)

5. Probiotic remedies

  • live culture pickle brine: 1 tbsp thrice daily (as symptoms improve, graduate to eating the actual pickle)
  • yogurt water: 1 tbsp thrice daily (only if not dairy intolerant)

For chronic conditions, please review the protocol for inflammatory bowel disease.