June 17, 2008 · Updated 12:33 PM
Hey, it's official! We're better than Europe. Boeing outsold Airbus this year. But more importantly the average American has 1.5 cases of diarrhea a year, whereas the average European has only about 1.2. Ha, ha, we win! That works out to yearly total of about 450 million cases. If you figure that the average person produces 400 ccs with each trip to the toilet, five times a day for five days, then the grand total for Americans is 4.5 billion liters a year. In other words a giant lake of...a big problem. The CDC (Center for Disease Control) assesses the significance of diarrhea by using very different criteria such as the 6000 deaths each year, the billions of dollars of associated costs, and the many thousands of hospitalizations. Whatever--for me, the image of Lake Ka Ka is so much clearer, not that the lake itself is clear.
Our digestive track is essentially a series of hollow tubes attached one to the other sequentially. The mouth starts the process by grinding food into little pieces, adding water, enzymes, and antibodies to attack germs, and then passes this glop through the esophagus and into the stomach. The stomach adds more water, a few more enzymes, and enough battery-strength acid to kill just about any germ. Next the small intestine neutralizes the acid with bicarbonate and absorbs virtually everything worthwhile. What remains is a watery waste, basically diarrhea that is gifted to the large intestine. The large intestine, an unsung hero, works round the clock to absorb just the right amount of water in its quest to create the absolute, perfect poop. It's really quite emotional. An actual case of diarrhea allows us to appreciate the work of the colon. Just stand there and marvel at the contrast. It's breathtaking.
Doctors get excited about diarrhea when it is unusual, for example when it is prolonged--most cases resolve in about three days--or if it is associated with serious symptoms. Sometimes doctors get excited even when the diarrhea isn't unusual. We are just very strange people. Lots of things can cause diarrhea, but these can be grouped into just a few simple categories. There are the inflammatory causes such as Crohn's disease or infection. Of the infections, a vast majority are self-healing. Some, however, are caused by especially evil bacteria and parasites such as Campylobacter (from contaminated water or food), Vibrio (seafood), Salmonella (poultry and eggs), Shigella (water or foods), Ecoli (hamburger), and Giardia (water from streams) and can result in dysentery or other serious illnesses. Bloody stools, fever, chills, or a long course are cause for concern. Get checked out if these are present.
Another classification of diarrhea is called functional. The classic example is irritable bowel disease. People with this problem have, by every test available, normal colons. However, the colon behaves abnormally and causes diarrhea. Stress seems to be a big player. The pattern is very different from that of infectious diarrhea. It is often silent during sleep, i.e. when stress is low. In contrast, infectious diarrhea is more than happy to turn your bed into a slip and slide.
Food intolerances represent yet another group. Diarrhea and gas can be caused by foods that are not absorbed well. The trillions of bacteria in our colon are happy to make extra gas from unabsorbed food. Unabsorbed foods can also cause water to be pulled into the gut by osmosis and thus trigger diarrhea. Food elimination diets can help reveal these problems.
Most diarrheas are preventable. The simple precautions of washing your hands and keeping them out of your mouth will make a huge difference in your health and there are no side effects. Well, I suppose we would lose our lead over the Europeans.