"Shit happens! That is, if you're lucky. Otherwise you may have 'massive, intractable, watery, secretory diarrhea,' as your doctor might put on your medical chart." That's the first sentence of the first Nutrition Power column in our Being Alive Newsletter. The article was called "Diarrhea and What You Can Do About It" with a little nutrition power at the upper left. It was only one page in length, and I've never been so short-winded since! This month, for it's second anniversary, "Shit Happens" is reprised, updated, and enlarged -- hang in.

Two years ago this March, Fran McDonald (our wonderful Bits 'n Pieces author) called me to ask if I'd write an article about nutritional diarrhea remedies. I was and am Project Angel Food's nutritionist and since I had already made a "Big-D" handout for PAF clients, I just expanded it into an article. Well, the shit did hit the fan! I spent about two full months just answering phone calls. In all, I've received well-over 300 telephone calls about that article, it's been reprinted in at least 12 other newsletters internationally, and those calls -- that are still coming in -- they're still welcome, as always. "Shit Happens" just never stopped happening! I now think of myself as the "Diarrhea Queen" of HIV-LA. What an Honor!

At first I had some reservations on how "descriptive" I could get away with being. But I knew from prior editions that our A-list editor Jim Stoecker would amend my language if necessary, so I just did it my way. As it happens, so did Jim (thanks!). My concerns were on "esthetics" so I issued a warning about the wording which read: "Note: The language used in this article is a little 'gritty;' I personally like the non-euphemism approach to writing. 'Feces' just isn't the same as "shit!"

Over the years, reservations on the descriptive language have "wasted away," as it were, and shit has been added to my (formerly modest) WordPerfect dictionary. Thanks, guys, for continuing to publish what I write! For this edition, the "notes in quotes" are from my original 1993 article -- mostly. Here goes:

"Probably, all people living with HIV have experienced diarrhea at various stages of infection. There are many opportunistic infections (OIs) that can cause diarrhea, and a correct diagnosis of the reason is our primary medical healthcare situation: If an OI happens, and medical treatment is indicated, that comes first -- diagnosis and treatment. But without benefit of a correct diagnosis or with failed treatment strategies, as often happens, we can control diarrhea using Nutrition Power!" Update: Also, preventing the diarrhea OI using "Nutrition Power Prophylaxis" is coming up and may be more clearly understood and presented -- read on.

"When living with HIV disease, we can get pretty tired of taking pills -- especially if they don't work. It's been said that all drugs, from aspirin to morphine, carry side effects and nutrition interactions as well. When drug-nutrient and drug-drug interactions are going on all at the same time, side-effects can be worse than the original problem! Wouldn't it be nice to avoid a drug here and there? Good news! You probably can!"

Then I went off, way out on a nutritional limb, or so I thought. I advised avoiding nutritious food -- like fruits, vegetables and whole grains. I covered my suggestions by saying "Fruits, vegetables and wholegrains (brown rice/starch selections) are, of course, better nutritional choices but the fiber in those foods can and will make diarrhea worse." I've grown up; now, I just advise scraping the high-fiber foods directly from the plate into the toilet so as not to bother the intestines with pre-processing. I've become bolder and have even become an affirmed salad-basher! (Salads with green leafy vegetables have little nutritional value, few calories and lots of fiber to intensify diarrhea --- and are hard to clean.)

"Besides salads, other foods to avoid include milk and dairy, unless you know you can safely eat them. You may also need to avoid cream soups and mixed foods like lasagna, enchiladas, pizza and 'white' sauces. All of these may contain dairy -- either milk or cream, or both. And they are high in fat. Speaking of which, avoid hi-fat foods -- although you may digest them easily, you also might not." 1995 update: Find out for yourself to avoid living with unnecessary food restrictions.

As I continued, "So now that you've eliminated everything you thought was healthy, and maybe what you thought was good to eat, what to eat now? Good news! Some foods may actually help you to reverse symptoms of diarrhea. Let's look."

"Eat bananas, mangoes, papayas and applesauce. Although people may have trouble with some of these fruits, others will find that they provide some relief. They usually can help people with HIV-related diarrhea. Many other fruits, especially berries, will make diarrhea worse!" Update: So will popcorn -- if you haven't already found out!

"Eat barley. This neutral-tasting grain can slow intestinal motion which will, in turn, help to control diarrhea. For a great barley recipe, buy a can of vegetable beef & barley soup and also a package of pearl barley, which is near the pasta and rice in markets, packaged in plastic wrappers. Follow label directions to make both the soup and one cup of barley, then add the barley to the soup -- with more water if you want to make it more like soup -- and enjoy! This mixture will slow down your GI tract. (The veggies in the soup, like most canned vegetables, will be easier to digest and you should have no problem with the very few vegetables in that can anyway!)" Update: Oatmeal and oat bran are also excellent choices.

"Drink rice water: follow label directions to make white rice, but use an extra 12 cups of water. When the rice is cooked to the texture you want, drain off the extra water, chill (if you prefer), and then drink. If you need a sweetener, use a small amount of sugar or honey. This is an old Latin remedy called horchata and can be purchased ready-to-drink. It even comes in different flavors!"

"Drink Ricelyte. This wonderful product is sold in the baby food section of ordinary grocery stores. It even helps with the BAD diarrhea of cryptosporidium! Here's a story."

"A patient with crypto and CMV colitis and MAI, with over 40 'squirts' per day (ouch!) for over a year (double ouch!!), drank 3 liters of Ricelyte over one entire day and 'crapped out a long hard one' [his words] the very next day. It will probably work for you too -- and if you're living your life around your diarrhea (how did I know that?), you'll do or try just about anything to control it. Using food as medicine -- what a concept!"

"At Project Angel Food we send Ricelyte out to all diarrhea clients. They report very good results -- that is, a lot less diarrhea. Also, Jim Avedikian, a highly-respected community pharmacist/activist in Pasadena has just begun to carry it (because of my recommendation) and his patients are also reporting very good success with this product." All still true, but . . .

A lot has happened in two years. Originally, Ricelyte was hard to find, then the manufacturer, Mead Johnson, changed its name to Infalyte which made my prior efforts less helpful, maybe even insulting to adults with diarrhea -- and people still couldn't find it! The "Anti-D" agents in Ricelyte/Infalyte are rice syrup solids and here's a "very-good-news" update from Nutrition Power 1995: Best$Lyte has been born! It was designed especially for HIV-specific diarrhea. With 50% more rice solids` and less sodium, than Infalyte/Ricelyte, welcome changes, it's probably even cheaper to buy than the non-HIV products.

You can purchase "Best" now -- it's there even as you read -- at Capitol Drugs (Hollywood - (310) 289-1125 / Sherman Oaks - (818) 905-8338), Discount Pharmacy in Silverlake (213) 661-8366, and Phoenix Pharmacy in Pasadena (818) 791-7600. More retail locations will undoubtedly start to carry it soon. For now, Best's manufacturer, Med-X Integrated Health, has set up a hotline for orders and samples (800) 757-6339. Operators are waiting for your calls! Remember -- go for good bathroom-health and comfort; choose Best!

Or choose to not need Best-Lyte or any other anti-diarrheal at all -- diarrhea prevention has become sort of a "theme" throughout my articles and this one in particular deserves it more than ever! I call it Nutrition Power Prophylaxis. Cryptosporidium, Microsporidium and MAI are all water-borne diarrhea-causing opportunists. Prevent the OIs that can cause diarrhea! Although easier on paper than in life: drink only "safe water." Dedicated attention to water safety may prevent the need for the remedies in this article! Safe water is heat-treated; boiled or distilled.

Bottled water, from any source may carry bugs; regulations require only that it be as safe as municipal (tap) water. Chlorine, iodine, and most filtering systems cannot catch these very tiny bugs. Resilient though they may be, they will die if they get too hot! Boiling water does this (keep it rolling for 5 minutes). Distilled water is captured steam, so it's safe by definition.

Recently reported from a survey of water microbes indicates that there is crypto in 77% of river water, 75% of lake water, and 20% of "tap" water. Since bottled water only has to meet municipal standards, with a 20% the stated "lack-of-safety" margin, bottled water from spa-sounding sources may not meet requirements for HIV/AIDS safety standards. Any bottled water may be as risky as tap water. This water also includes soda fountain drinks served in restaurants and movie theaters where soda syrup is mixed with tap water; highly unsafe. Don't forget about ice from tap water -- freezing does not kill bugs, it just deactivates them till they thaw out; then it's business as usual which normally means reproduction (two-for-one) at 20-second intervals, 24-hours; all day, every day.

About risk, Dr. Jorge Rodriguez stated last month: "To a susceptible individual, 'just a little bit' is way too much." I say that living your life around diarrhea is a lot more inconvenient than living your life around water safety -- and it's easier on the A--. (Anatomy?) Taking precautions can be fairly easy: Take your own canned soda or other beverage with you -- always and everywhere.

Of course it's a big pain in the Anatomy to live around water safety practices; it's a bigger pain in the same Anatomy to be stuck in the bathroom with runny diarrhea ruining your life and hitting hard on dignity in the process. Distilled or boiled -- beyond bottled. Heat kills germs.

From 1993, and true again: "For the record, I do not have financial connections with any pharmaceutical company; products I recommend are chosen because they work." I also said "I've been begging Mead Johnson, maker of Ricelyte, to sponsor a clinical trial . . . frustrated with their lack of attention . . . etc." The company never did support the HIV/AIDS community in this way, and their 1995 product still has availability problems. It's hard to support a product, good though it may be, when no attention to the HIV/AIDS community has occurred. Oh, what a time to be Best! I wish this product well -- very well. Developed especially for people living with HIV/AIDS. Ah . . . respect at last!

"First do no harm. Should the advice in this column be, or seem to be, related to any adverse consequences, check with your doctor or nutritionist." (A new caveat from the CYA-department) And my sign-off is still:

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Nutrition Power is a Registered Trademark of Health and Nutrition Awareness. Copyright 1995 Jennifer Jensen, MS, MBA, RD.

All Rights Reserved.

Other versions of this article have appeared with permission in Being Alive Newsletter, Arts & Understanding Magazine,and other newsletters.