What Causes Chronic Diarrhea After Eating?
By Dr. Edward Barbarito
Have you ever been troubled by cramping, abdominal pain, and urgent bowel movements shortly after eating? Some people call this “da belly troubles!” Unfortunately, these incidents often have the uncanny knack of occurring at the worst possible time – when you’re out to dinner with friends, at a family function, or worse yet, when you’re at a work event. Rest assured. This common condition affects many people, and it’s usually treatable if you can determine the cause. But what causes chronic diarrhea after eating? While there are many possible contributing factors, it’s usually the particular foods we eat that are the most common culprits causing these symptoms. So let’s explore!
Before we examine the problem, it might be useful to understand how the digestive system operates under normal conditions. Usually, we all maintain an important internal messaging system called the gastro-colic reflex. This signaling process alerts the digestive tract to make space for incoming food. Specifically, when you ingest a meal, there’s a signal sent from the stomach to the large intestine (colon) to trigger a normal, controlled bowel movement within a relatively short period of time. When this system is disrupted or exaggerated, however, there is a rapid-fire signal followed by an uncomfortable rush to the bathroom. Hence, “da belly troubles!”
As the most frequent disruptor of a normal gastro-colic reflex, food is by far the most common cause of urgent bowel movements shortly after eating. Generally speaking, there are three main ways by which this unpleasant process can occur: food allergies, food sensitivities, and food intolerances. Each of these problems occurs via a unique physiologic pathway, but all result in the same common ending of gastrointestinal distress and bowel urgency. And while food allergies may be the most well-known cause, food sensitivities and food intolerances are actually more common.
The peanut allergy represents the most classic form of food allergy, and it has become seemingly more common in recent years. But peanuts aren’t the only offender; other nuts, certain fruits and vegetables, and many different types of fish and shellfish can cause problems as well. Children are often affected and usually suffer more than just gastrointestinal distress. Frequently, affected individuals develop sudden, severe rash with potentially life threatening respiratory and cardiac symptoms collectively called “anaphylaxis.” This frightening presentation is termed an immediate-type hypersensitivity reaction and is due to rapid release of antibodies and other biochemical mediators in response to the trigger food. Treatment requires immediate medical attention as well as strict future avoidance of the offending food.
Food sensitivities are less dramatic in their presentation and, while not typically life threatening, can cause significant problems just the same. Food sensitivities occur by a mechanism similar to the one that causes food allergies, but with different antibody release and with a slower, longer-lasting effect. Food sensitivities usually cause persistent symptoms such as gas, bloating, abdominal discomfort, and diarrhea following the ingestion of the culprit food. And any type of food can be responsible. Just as with food allergies, the best treatment for food sensitivities involves strict avoidance of trigger foods.
Food intolerances, on the other hand, do not involve antibody production or allergic symptoms. Rather, they often occur by way of digestive enzyme deficiency. Enzymes are active proteins our bodies make and use to digest the food we eat. There are many types of digestive enzymes, each with a specific target for food breakdown, including fats, proteins and carbohydrates, or sugars. For example, lactase is the enzyme responsible for the breakdown of lactose, or milk sugar. Lactose intolerance, the most common and most well-known food intolerance, occurs when an individual lacks a sufficient supply of this enzyme to digest milk products. The end result in such cases is rapid onset of post-meal gas, bloating, pain, and chronic diarrhea. And while lactose intolerance may be most common, many other enzyme deficiencies can result in similar circumstances.
Another example is sucrose intolerance. This condition occurs from a relative lack of sucrase, an enzyme similar to lactase, that helps us digest another commonly occurring simple sugar called sucrose. Affected individuals suffer the usual symptoms of gas and bloating with chronic diarrhea after eating. Unlike lactose, however, which is usually easily identified in the milk products we ingest, sucrose may be much harder to pin down. Sucrose can be hidden in different foods such as fruits and vegetables, as well as many baked goods and processed treats. This fact makes specific testing for sucrose intolerance that much more important.
Steps to Take
So, what can you do if you suffer from these symptoms? The first step is to create a food diary, in hopes of identifying the particular food triggers that cause symptoms. This process can be difficult, however, because our diets often change; and symptoms may be intermittent and sporadic. The next step would be visiting with your physician in order to diagnose which type of reaction is occurring, and, most importantly, to rule out anaphylactic food allergies and less severe food sensitivities through blood or skin-prick testing. Thereafter, your physician may have you undergo tests to determine which, if any, of the many different types of enzyme deficiencies that can cause common food intolerances you might have. In the vast majority of cases, the offending food trigger for chronic diarrhea can be identified and then avoided, making “da belly troubles” a thing of the past.
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