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Q#1: Diarrhea & Rice Water
When I was one of Jennifer's clients, she had a recipe for treating HIV-related diarrhea which I can't find on the site here. It had something to do with rice water. Could you please find that info for me? I'm having severe water diarrhea at present which is not responding to Lomotil, Paragoric, or Morphine. MediCal also won't approve and pay for Sandostatin (an injectible for severe diarrhea). I'm at my wits end on how to treat this and fearful I'll "poop" myself to death if I can't stem the tide quickly. Thanks. (November, 2000)
A: Ken Stringer, Web Site Administrator responds:
In Jennifer's Picnic Basket you'll find two articles in particular which address this issue. They are entitled Shit (Still) Happens and Hurl Not. In the former, you'll find this "recipe" for rice water:
"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!"
But I recommend you read the whole article for other issues regarding diarrhea. Jennifer also recommended commercially pre-made drinks, especially one called CeraLyte. See the Q&A Fluid Replacements for contact info on how to get CeraLyte (or other products, if you prefer).
A: Diana Peabody, RD responds:
This person might also try rice water and congee. The recipe for congee is to cook 1 cup of rice water in 6 cups of broth for 1-2 hours. Eat the rice and broth several times a day. The broth helps replace some of the sodium lost in stool.
Q#2: Diarrhea & Glutamine
I'm an RD who works in an HIV/AIDS clinic. We have been using glutamine to treat Protease Inhibitor induced diarrhea and it has been effective for some clients. But it is expensive and we wanted to know if and when to stop. How long is it necessary to keep clients on glutamine? Can they be "weaned" off it slowly? What experience have you had in stopping glutamine? Do symptoms return? (October, 2000)
A: Charlie Smigelski, RD responds:
I just start with 5 grams glutamine, twice a day. In cases where people are having 4+ episodes of diarrhea, then I might start with 10 grams, either twice or three time a day. Maintenance can be 5 to 10 grams a day. For $$$ sake, people will try to just do 5 grams every other day to squeek by. And some even try to cut down from the 5 grams a day, but find they end up needing it about every 3 days, otherwise diarrhea returns.
Back in the pre-HAART days, when crypto and micro diarrhea ruled, it would take 30 grams glutamine a day to stop the flow. Now, with PI irritation, I think 5 to 10 to start and then back off to 5 or so a day will ususally work.
For ultimate diarrhea control, I find that people end up on a combo of 2 acidophilus pills a day, Citrucil or psylium 1-2 times a day, glutamine 1-2 times a day, and 1 Immodium.... plus 3 fruits.
One of the better manufacturers of glutamine is Cambridge Nutraceuticals at 1 800 265-2202. But it is expensive. If people get glutamine by the kilo from a Buyers Club, it gets borderline reaonable in cost. Try the Boston Buyers Club or the Houston Buyers Club.
At the recent American Dietics Association convention, I tried to talk some people into 48 samples of Fibercon because I'm curious if the Calcium-polyplastic-something agent would work well. They haven't sent me any yet though.
A: Donna Tinnerello, MS, RD responds:
Glutamine is an amino acid that gets used during gastro-intestinal distress. Putting it back helps to feed the gut cells and repair damage, helping you with digestion and absorption. For high grade glutamine call Cambridge Neutraceuticals (800-265-2202) or visit their website. New studies are verifying the potential of glutamine to not only restore normal gut function but also to enhance immune function. Glutamine from Cambridge was just approved by New York Medicaid. Doctors should write for 30 grams/day.
Also, "Shaman B" or "SB Normal Stool Formula" is a relatively new botanical with proven efficacy in HIV-related diarrhea. It is extracted from a South American plant used by natives to treat diarrhea. This was intended to be a prescription product, but the company ran out of money to complete the trials required by the FDA. In order to get it out to you the company released it as a nutritional supplement. It's a good product and my patients tell me it reduces their diarrhea. Clinical trials indicate that it can halve diarrhea volume and in some cases even more. To learn more about this product and where you can purchase it go to Shaman Botanicals.
I also have a page on Diarrhea Management at Always Your Choice.
