Fullscript Academy

Healthy bowel movements are essential for gastrointestinal integrity. Acute cases of stools that are too loose, unformed, or liquid can be potentially life-threatening depending on the root cause. According to the Global Burden of Diseases, Injuries, and Risk Factors Study in 2016, diarrhea was the eighth leading cause of death for all ages, while it was the fifth leading cause in children under the age of 5. (7) While diarrhea may be caused by different factors, sanitation, and poor water are the most common causes. (7)

Other possible causes of diarrhea can be attributed to traveling or antibiotic use. In these cases, treatment can be planned accordingly to help lessen the burden. Chronic cases can affect up to 5% of the population. (19) Anywhere from 3% to 17% of patients who had traveler’s diarrhea may experience residual chronic issues with irritable bowel syndrome. (20) 

The protocol below presents ingredients to help in both the prevention and management of loose stools and/or diarrhea.

Probiotics

2-8 billion CFU, total per day, minimum 3 months (10)(14) 

• Probiotics have been shown to decrease diarrhea in conditions like traveler’s diarrhea and antibiotic-associated diarrhea (1)(15)(8)  
• Bacillus coagulans decreased stool frequency in diarrhea-associated irritable bowel syndrome (IBS-D) (14)  
• A blend of probiotics including Lactobacillus acidophilus and Bifidobacterium bifidum, has shown to decrease daily stool frequency (10)(17) 
• Patients with moderate to severe symptomatic diarrhea-predominant IBS (IBS-D) experienced improved quality of life (QOL), decreased IBS severity scoring system by 145 points from baseline, decreased severity of abdominal pain by 69% (compared to 47% in placebo) and lowered proportion of patients with symptoms to 14% (compared to 48% in placebo) when given multi-strain probiotic Bio-Kult® for 16 weeks (10) 
• When given 2 billion CFU per day of single strain probiotic of B. coagulans MTCC 5856 for 90 days, quality of life, disease severity, and symptoms in patients with IBS-D all improved as shown by a decrease in bloating, vomiting, diarrhea, abdominal pain and stool frequency when compared to placebo (14)
• In a meta-analysis of travelers diarrhea, probiotics were found to be beneficial as a preventative measure (1)
• Meta-analysis of probiotic S. boulardii was found to be efficacious and safe in treatment of several types of diarrhea, particularly in antibiotic associated diarrhea (15)
• Systematic review and meta-analysis of 82 randomized controlled trials found that the majority of studies used single strain and multi-strain probiotics containing lactobacillus based formulas which decreased occurrences of antibiotic associated diarrhea (8)

Address soft stool with the evidence-based ingredients in this protocol. 

5.5 g, total per day, minimum 1 week (4)(9) 

• Galacto-oligosaccharide was shown to prevent the incidence of traveler’s diarrhea (4) 
• Prebiotics, specifically oligofructose, were shown to reduce relapse of diarrhea in C-difficile patients (11)
• Prebiotic galactooligosaccharide mixture (B-GOS) ameliorated abdominal pain, improved quality of life, and decreased incidence and duration of traveler’s diarrhea compared to placebo (4)
• Undergraduate students in a state of stress were given various doses of galactooligosaccharides for 8 weeks and found that treatment decreased score of GI symptoms for diarrhea; 2.5 g of galactooligosaccharides decreased stress of any level while 5.0 g was found to be effective for only lower levels of stress (9)
• Patients with C. difficile treated with prebiotic oligofructose for 30 days decreased incidence of relapse of diarrhea as shown by only 8.3% in treatment group having diarrhea relapse compared to 34.4% in placebo; additionally stool culture for treatment group demonstrated an increase in fecal bifidobacteria from 8.68 cfu/g to 9.37 cfu/g (11)

Colostrum

200-400 mg, three times per day, as needed (16)(2)

• Colostrum was effective for acute viral and bacterial diarrhea in children as demonstrated by a lower frequency of vomiting, diarrhea and vesikari score compared to placebo 48 hours after administration (2) 
• Meta-analysis of childhood infectious diarrhea found colostrum to decrease occurrence of diarrhea by 71%, and reduce stool frequency by 1.42 times per day (12)
• Adult patients given colostrum experienced decreased incidence of diarrhea, zonulin plasma levels, and plasma endotoxic concentration compared to placebo (5)
• Healthy adult participants given 1200 mg daily bovine colostrum experienced 90.9% protection, compared to placebo, when challenged with an enterotoxic E. coli strain (16)

Zinc

15 mg per day, for a minimum of five days, in children (22)

• Meta-analysis of acute diarrhea trials in children found zinc supplementation to decrease the duration of symptoms (24)
• When provided with 15 mg/day for five days, the percentage of children with diarrhea decreased at hours 72 and 96 when treated with zinc as well as decreased duration of diarrhea compared to control group (22)
• A systematic review and meta-analysis of children under age 5 with acute diarrhea showed decreased duration of diarrhea as well as incidence when given zinc compared to placebo and/or oral rehydration therapy; although risk of nausea and vomiting was higher in the zinc group (6)
• Zinc supplementation decreased frequency of stools and duration of acute and persistent diarrhea in meta-analysis of children in developing countries with acute or persistent diarrhea; when comparing zinc formulations, zinc gluconate had more incidences of vomiting compared to zinc sulfate and zinc acetate (13)
• Low dose (20 mg/day, 10-14 days) was found to be effective in treating diarrhea in children; Additionally vomiting decreased (3)

Pectin

24 g, total per day, minimum 6 weeks (21)

• Meta-analysis found that fiber (but not prebiotics) reduces the occurrence of diarrhea in patients receiving enteral nutrition (23)
• Pectin reduced stool frequency, duration of symptoms, frequency of vomiting, need for oral rehydration and need for intravenous fluid in children aged 5-12 months with persistent diarrhea (18) 
• IBS-D patients supplemented with pectin improved symptoms as shown by quality of life, composite symptom score; as well as improved immune function as shown by normalized IL-10/IL-12 ratio and improved faecal bacteria composition (increased bifidobacteria and decreased clostridium spp.) compared to placebo (21)