This article was written by Dr JB Lim in response to an article sent by Dr Chan Boon Lye to Dr Lim for advice and comment about the use of ordinary rice water for children who frequently have diarrhoea.
Subsequently this subject was also brought up for discussion by a group of other doctors at a banquet Dr Lim and other medical doctors and scientists attended at the KLCC Convention Ballroom in Kuala Lumpur.
We thought this health issue will be of interest to people as diarrhoea is a very common problem affecting most people especially children. Dr Lim thought he should share his reply and comments to Dr Chan and to other doctors. Here’s what Dr JB Lim wrote to Dr BL Chan
Dear Dr Chan,
Thanks for your advice on the treatment of diarrhea. This is not something new to me. Even way back in the 1960’s as a postgraduate student in Nutrition at the University of London we were already taught the procedure on how to manage cases of infantile diarrhoea in developing countries like those in Africa where medical facilities were so basic and minimal.
We wanted to introduce this approach to all Government Clinics:
When I returned to Malaysia I worked at various Divisions of Rural Health, Community Medicine, Human Nutrition, etc at the Institute for Medical Research (IMR). We conducted health surveys among villages throughout the length and breadth of the country, and we found that diarrhoea was very prevalent in both urban and rural communities. So we thought we should recommend to the Ministry of Health to introduce this simple and extremely effective method of using rice water to treat all diarrhoea in all the villages and government rural clinics all over Malaysia where access to health facilities were at times difficult especially in the remote interiors of Sarawak and Sabah. Our objective was to educate doctors and nurses manning the clinics the use of rice water in managing cases of common diarrhoeas as part of our public health education to the villages.
Surprise response from the medical staff:
But before we did that, we need to conduct a survey to find out the status of how diarrhoeas were managed in government clinics. So we asked the doctors, health and medical team. We expected the doctors to tell us they use diarrhoeal agents - Loperamide (Beamodium), 400 mg of Berberine sulfate, Diphenoxylate HCl 2.5 mg + atropine sulfate 25 mcg (Dhamotil), plus various antibiotics etc, etc.
To our pleasant surprise, the doctors both in the Kuala Lumpur General Hospital (as it was called then) and the government clinics told us that they simply advised the rural folks to drink rice water or take light watery porridge with 2-3 teaspoonful of table salt added. We really didn’t expect them to give us this reply. We expected them to name us the list of anti-diarrhoeal drugs in use then. That was in the 1980’s. Later we found they already learnt of this method before they were posted to the rural clinics.
So this was not new to them nor was it to us. Even Medical Assistants and Rural Health Nurses working in some rural areas were taught this simple method on how to prevent dehydration and reduce infantile mortality in areas where diarrhoeas, malnutrition, and poor hygiene were common. The heath team has already done this even before we could even recommend to the Ministry of Health to introduce them.
Common pathogenic causes:
We know that most of these diarrhoeas in tropical countries like Malaysia are caused mainly by rotavirus, adenoviruses, parvoviruses, astroviruses, and gastroenteritis from bacterial E. coli O157:H7, Salmonella, Shigella, Campylobacter infections, as well as from protozoal infections such as from various types of pathogenic protozoa like amoebasis from amoebas such as Entamoeba histolytica, Gardia (giardiasis), etc, etc…down the list.
Infantile Diarrhoea:
We were aware that in infants persistent diarrhoeas from gastroenteritis can be fatal especially if the child is already suffering from malnutrition. We see children in some of these communities dying unnecessary due to diarrhoeas where dehydration can easily be corrected by merely what we now call it ‘rice water treatment’ There is no need even for so called ‘intravenous drips’ or oral rehydration salts (ORS) as done in a modern hospital. All that is required is to correct for fluid loss and establish electrolyte (potassium, sodium) balance. That is all that is needed.
In fact it is not just rice water or water from rice porridge which is just as good as the intravenous drip, but even any fruit or vegetable juice will do. Even coconut water is excellent.
Coconut water as IV drip:
Just to let you know that even the World Health Organization recommends the use of sterile coconut water to be used as an intravenous drip for fluid replacement and electrolyte imbalance in rural areas of poor countries where modern health facilities are hard to come by. Coconut water inside an unopened coconut is completely sterile, of the right biological electrolyte constituency with near equivalent osmotic tonicity as saline.
Imagine the entire baby coconut tree has to feed and thrive on this water which is exactly like mother’s natural milk for the baby coconut tree. So Mother Nature has prescribed the right fluid, nutrient and salts for the baby coconut inside the nut before it is washed away into the oceans to land ashore by harsh salty sea water to another place to start a new independent tree and life at another place.
So this fluid (coconut water) can never be wrong as it is given by God for a young plant to survive. Moreover, coconut water does not have foreign protein in it to trigger an anaphylactic shock even if infused many times (serial infusions) into any animal and human body. There is no built up of antibodies against any antigen (coconut water) if administered intravenously.
A Tribute to my Professors
We learnt of this from 3 of our professors even as students in England – 2 of them at London University and 1 at Cambridge. Later we found this has been in practice already for a number of years on the recommendation by the World Health Organization for poor tropical countries where young coconuts are readily available, and modern medical facilities are not readily available.
Clean, sterile and biologically just right composition:
Coconut water is absolutely clean and completely sterile, and do not have offensive proteins inside to trigger off increasing titres of antibodies against foreign protein antigen that could lead to anaphylactic events and shocks. Not only purer, cleaner and more sterile than pharmaceutical grade saline-dextrose infusion fluids for IV administration, but the electrolytes therein are of the right biological composition. We can’t beat Nature.
Simple, yet so safe and effective:
So this ‘rice water treatment’ may be used instead of using ORS. The use of coconut water as a direct IV infusion is also not something new to me. Even way back in the late 1960s we already knew about this. Both methods are simple, cheap, readily available, and extremely cost-effective.
We are light years ahead of the Internet:
I thought what you sent to me from the Internet would be something from the 21st Century which we are unaware of. I have always thought the Internet is a very powerful IT tool available only in this 21st Century where we can get lots of the latest information. But it looks like what you tell me only now in 2009 was what we already knew when we were students in the 1960’s.
As far as this piece of medical information is concerned, I think we are light years ahead of even the Internet. Thanks to my professors at London and Cambridge Universities who taught us this traditional and simple method half a century ago. No thanks to the Internet of the 21st Century. It is stale information for me.
Natural therapeutics with rice water is best:
My professional advice is, if you have diarrhoea, whether adult or children, just drink rice water, coconut water, or any fruit juice. There are a lot of water, salts, sugars, various vitamins from all these natural juices. Why go for synthetic ORS, or intravenous drips of crystalloids and colloids, dextrose, saline, Ringer’s lactate, etc as used in big hospitals?
Antibiotics therapeutic regime:
Worse still is for patients to take antibiotics for diarrhoeas which are mainly caused by rotavirus and protozoal infections in tropical countries. The problem is when we get rid of all the bacteria in the intestinal gut – beneficial as well as pathogenic forms and strains with antibiotics only make matter worse by giving opportunistic infections to antibiotic-resistant strains of pathogens to colonize there.
More medical problems than it solves:
This can cause another medical problem called dysbiosis (dysbacteriosis) which is the condition of having microbial imbalances on or within the body due to antibiotics. This is jumping from the frying pan into the fire. Instead of getting rid of all the bacteria (friendly and pathogenic) by random slaughter of all of them with antibiotics, it would be much better to flood the entire GI tract with friendly and beneficial Lactobacilli strains from yoghurt and allow them to colonize in the intestine.
The flood of friendly bacteria in the GIT naturally will outgrow and crowd out all the pathogenic strains. Many friendly strains are very useful in synthesizing many vitamins like vitamin K which are needed for normal blood clotting. Why destroy them with haphazard use of antibiotics? Unfortunately a lot of doctors prescribe unnecessary medication.
A lot of diseases are caused by doctors (iatrogenic diseases) by the unnecessary use of drugs, surgery and other invasive modalities. One example is nosocomial infections in hospitals, and the dangerous rise of MRSA (Methicillin-resistant Staphylococcus aureus) superbugs which are resistant to even the most powerful antibiotics. These are all induced by doctors using unnecessary drugs and over-prescription. Because of this random and wide-spread use of antibiotics, we just do not know how to deal with this MRSA problem anymore
What do I recommend to my patients?
Personally, I always prescribe to my patients who came to me with common diarrhoeas to take yoghurt (cultured milk) which they can easily buy in any supermarket or make their own in their kitchen. Not only yoghurt containing natural intestine-friendly bacteria like Lactobacillus acidophilus, L. bulgaricus, Bifidobacterium, etc, gets rid of all the invading harmful pathogens that caused the diarrhoeas, but they also ferment and breakdown the milk sugar (lactose) for patients who are intolerant to drinking milk (lactose-intolerant). The lack of lactase among Asian adults prevents the breakdown of lactose causing the lactose to ferment in the intestines, giving rise to gas, bloating, and causing them to have diarrhoea. This is yet another cause of having diarrhoea from lactose intolerance not just from all those viruses, bacteria, protozoa and pathogens I earlier listed above.
Even for Candidiasis:
I have also in the past suggested consumption of yoghurt and other probiotics as a prescription to my women patients suffering from vulvovaginal candidiasis (yeast candida infection of vagina) where antifungal agents and drugs like imidazole, miconazole and clotrimazole given previously by their gynecologists and doctors have failed to stopped recurrent infections.
A natural ‘drug’ like yoghurt solved all their recurrent problems. I should have complied all my cases and publish them in a medical journal, but unfortunately I have already retired from active medical research at the Institute for Medical Research.
Mechanism not understood:
Quite honestly I cannot understand the probiotic mechanism behind this therapy. The gastrointestinal tract is quite separate from the genito-urinary tracts system. How then does the Lactobacillus migrate from the anus after ingestion and travel up into the vagina and uterus? The anus and the vaginal orifices are anatomically close to each other and the bacteria could migrate from the anus up the vagina but this is not really a very good answer as it requires quite a bacterial load into the vagina to outgrow all those Candidia spp. It is not easy to get rid of these yeasts once they have established themselves. I am keen to know the probable therapeutic dynamics behind this line of management. As I said even powerful antifungals like imidazole, miconazole and clotrimazole failed to stop the growth.
If what I hypotheses is the probable answer, would it be better to insert yogurt as a cream directly into the vaginal canal instead of oral ingestion via the GI tract? Whatever the explanation is, yoghurt treatment always works for women with recurrent vaginal yeast infections where conventional antifungal preparations failed.
Not just yoghurt:
Not just yoghurt, but any probiotics supplements will do this job very well. But make sure the bacterial count from these probitics pills and dietary supplements are still there, and not destroyed due to prolonged storage, high storage temperatures, poor handling, and lack of GMP (Good Manufacturing Practice) during the production.
Other more serious aetiologies of diarrhoeas:
However, I always make sure my patient’s diarrhoea is due to a simple infections of the GI tract, and food poisoning, and not due to other causes such as osmotic diarrhea (e.g. maldigestion pancreatic disease or coeliac disease), inflammatory diarrhea caused by autoimmune disorders, tuberculosis, cancer of the colon, inflammatory bowel diseases (ulcerative colitis, Crohn's disease, etc), IBS (irritable bowel syndrome), celiac disease, food allergy, ischemic bowel disease, hormone-secreting tumors…etc, etc. A differential diagnosis is important if the diarrhoea is persistent and chronic.
Additionally, I always advise that the diarrhoea, especially if persistent, with mucous and with blood, tarry and black (melena), etc, be properly investigated and diagnosed first, albeit most of them are harmless as a normal physiological response to an irritant somewhere in the intestinal tract. Melena could be suggestive of gastric bleeding or ca (cancer) higher up the colonic tract. Medical history, description of the colour, texture, smell, frequency, signs and symptoms themselves will already give us diagnostic inference with 85 % accuracy without even invasive colonoscopy.
How do I treat myself?
If you were to ask me this question, how do I treat myself in an event of a diarrhoea? Well to tell you, I simple do nothing about it. I just let the diarrhoea run its natural course, and I am always much better after a few episodes of watery stools. If there is also vomiting, I too let the vomiting do its normal physiological job by allowing my body to let go all those causative agents I have ingested (food toxins from food poisoning, bacterial, viral invasion, etc) to throw out all of them.
I just leave it:
I don’t even take rice water, coconut water, fruit juice, ORS, and worse still take all those diarrhoeal drugs to block the food poisons and bacterial load from coming out. I take absolutely nothing, not even water to flash out the toxins. I just allow complete bowel rest by adding nothing more to my digestive system that could only add more load and problems to the digestive tract.
I have suffered from diarrhoea tens of hundreds of times in my life, but not a single time did I do anything to stop the. I knew this was a natural response of my body. If I have ingested any harmful thing in the food I just encourage my body to throw everything out – both by vomiting and stool discharge. In short, I take absolutely no medication, not even rice or coconut water. I just allow the body to do its job with bowel rest for 1-2 days.
The Body Buffering System:
A lot of doctors over treat simple diarrhoea with 5-6 different medications. This is really unnecessarily. The more they prescribe, the happier the drug companies. One of them is always an antibiotic which is always there in every prescription. Even the WHO doesn’t recommend antibiotics for diarrhoea anymore. WHO suggests correcting electrolyte imbalance with ORS and re-establish fluid replacement especially in a small child who is malnourished, and already suffering from protein-energy deficiencies (marasmus and kwashiorkor). Few realize that in an adult patient he would probably have to have 30 -40 episodes of severe diarrhoeas before the body’s homeostasis mechanisms and buffering systems give way.
Death due to diarrhoea:
According to WHO most of the infantile mortality from diarrhoea in poor malnourished communities is due not to the actual pathogens causing the gastroenteritis or food borne illness. Death is not from norovirus, rotovirus, adenovirus, astrovirus, or bacterial Salmonella, Shigella, Staphylococcus, Campylobacter jejuni, Clostridium, Escherichia coli, Yersinia, Cholera Vibrio cholera etc, but from dehydration and loss of electrolytes.
So WHO recommends just correcting the fluid and electrolytes imbalance? That is all that is needed in the management. WHO discourages the use of antibiotics to treat diarrhoea
I remember the late Dato Dr Sam Abraham, a Senior Paediatrician at the then General Hospital Kuala Lumpur with whom I was working in a research project in the late 1970-1980 told me that he has not seen even one case of a child dying because of diarrhoea and dehydration. Maybe he saw only well-nourished children from well-to-do families (he was the Consultant Paediatrician to Agong’s and Sultan’s children). Probably even in children they need to have very serve and frequent diarrhoea (maybe 20-30 episodes within 5-6 hours) before the effects of dehydration is apparent. It all depends on the nutritional status of the child at that time.
But in adults:
In adults where the body mass and normal buffering and homeostasis systems are very much better and stronger, it is not easy to suffer from potassium, sodium imbalance depletion from just 10-20 diarrhoeal events. Personally I have suffered 10-25 diarrhoeal episodes within a single night after getting food poisoning. This has happened few hundred times already in the past eating hawkers food outside. Nothing happened to me. I just did nothing about it, but just let the watery stools get out from the system.
I did not interfere with any medication to block this natural response of my body. The next day I was much, much better after all the discharge. I would be an absolute idiot if I were to interfere with the natural working of my body. I did not die of dehydration from sodium, calcium, potassium, chlorine, magnesium, and bicarbonate imbalance. I did not experience muscle twitching, tetany, cardiac arrhythmias, confusion, muscular weakness, shock, coma or any of those disturbances due to dehydration and salt imbalance.
I did not even want to take my own blood pressure, pulse rate, listen to the bowel noises of intestinal hurry through a stethoscope, or monitor my blood for blood urea nitrogen (BUN), creatinine, and glucose as normally done in a hospital. I just leave them without an iota of treatment, and yet I simply get better after having all those stools thrown out a few times.
Let Nature take her course:
The wrongs and pathogens inside the body need to be thrown out, and not silenced by drugs. I know I have done something wrong (eating contaminated foods) that have harmed my body, so my body was giving me warning by ringing the alarm bells (symptoms), and doing its part with a prescription, not prescribed by any doctor (using harsh drugs to silence the warning alarm bells within my body) but by God and Mother Nature that dictates the body to throw them all out naturally (through diarrhoea and vomiting).
As a nutritionist and doctor interested in non-invasive and non-pharmacological approaches in managing diseases, I respect God and Mother Nature with Her prescription. The body responds to rectify my wrong doings by having all the contaminated food I have taken hours previously, all thrown out from my body. Why interfere? Mother Nature and God is the Programmer and Designer of our body. He knows our body best, and He is the Best Physician in this entire Universe.
Treat the Root causes, NOT the symptoms:
The body is NOT designed and programmed to store poisons or made for the inhibition of warning signals (signs and symptoms) with harsh factory-made drugs and chemicals. Only the patients in their ignorance ask for treatment for their ‘undesirable’ symptoms silenced. They never ask the doctor to help them remove the root causes. Symptoms are NOT diseases, but just warning bells ringing. The root causes caused the problem, but drugs cannot remove root causes. Only lifestyle changes can remove root causes (like ingesting wrong foods).
The best remedy for food poisoning is to allow the body to throw them out naturally through vomiting and diarrhoea. Doctors make matter worse by giving so many medicines to block out this action to stop the vomiting and diarrhoea. But the patients ask for it.
Even when I have Spasms:
There were many times I had severe colicky pains with diarrhoea. I could have stopped the spasms by anti-spasmolytic drugs like Hyoscine butylbromide or Buscopan to get relieve from the pain of intestinal spasms, but I didn’t. I always allow time to let the intestinal spasms to relax naturally, and it always does this without fail – without any pharmacological intervention.
Interfering with Nature:
Can you imagine this scenario? We have taken something wrong for lunch or dinner, and our body is trying to get rid of them by triggering off the vomiting and bowel discharge mechanisms? Then we use powerful drugs to block off those natural physiological responses the body is trying to get rid of those offensive substances we have ingested a few hours ago. What happens next?
Both drugs and toxins now cannot get out:
Not only the food toxins cannot get out after the natural peristaltic movements of the colon is paralysed by the pharmacodynamic actions of some of the drugs the doctor gave us, but the drugs and their metabolites themselves cannot be expelled out through the normal pharmacokinetic pathways. When the food poison and the drug cannot get out through natural vomiting and diarrhoeal discharge, they will have no choice but to enter the bloodstream, into the liver (via portal vein), kidneys, and other organs to be lodged somewhere. The accumulation of these drugs if cannot be properly metabolized and excreted, will cause extensive damage to the DNA, cells, tissues, organs, and all systems – all because most patients in their absolute stupidity wants their symptoms to be abolished immediately (quick ‘cure’) using powerful pharmacological interventions the doctor gave because we ask for it. We complain of the symptoms, and not about the wrong food and the bacterial toxins we took during lunch.
Instant Relief:
In so doing, the doctor using powerful drugs do far more damage to the systems than help our discomfort. But just by the act of vomiting the offensive food out itself, would already make us feel much better within 15-20 seconds after throwing out. I think everybody has experienced this feeling of instant relief through vomiting and diarrhoea in their lives, and I need not have to describe more.
But patients are never interested in the root causes of their diarrhoeas (or any illnesses for that matter). They just only want the doctor to prescribe something (anything will do) to stop their symptoms and discomfort instead of asking the doctor how to identify the root causes, and how to treat the root causes, prevent or rid of them to enable the body to repair itself once again.
Treat the root cause first:
Patients normally just want to get rid of their symptoms such as pain and discomfort rather than going into the root causes of pain, itching, swelling discomfort etc. But signs and symptoms are not a disease per sec. Symptoms like diarrhoea is merely signals the body is trying to cry out to us that we have done something wrong to it, and want us to remove the root causes. Root causes may be anything from bad food and poor nutrition, to smoking, alcoholism, to noise pollution, drugs, chemical and environmental exposures, down to bad late nights and unnecessary stress, and negative thoughts. Any of these are extremely harmful to health, and the body reacts to them by the release of stress hormones like adrenalin, and corticosteroidal hormones, elevated blood pressure, sugars, cholesterol levels, etc. Smoking triggers off coughing, as much as certain viruses, bacteria and yeast infections may trigger off digestive upsets. They are all part of a natural response the body is trying to tell us. But unfortunately when we see a doctor about these symptoms, he uses powerful drugs to interfere and suppress these natural responses.
Let the Body heal itself, not suppress with drugs:
If we understand that something has entered the body, the body’s response is to try to get rid of them. This is the treatment prescribed by Nature. But patients only are interested in getting rid off the symptoms and warning systems using 5-6 unnecessary drugs to suppress them. They are not interested in getting rid of the causes to allow the body to heal itself naturally. But the body is specially designed to repair and heal itself naturally if any thing goes wrong, and if given time.
My advice to all doctors and patients is always to treat the root causes, never the symptoms or silence the body warning systems. But if a doctor explains, advises, and educate a patient, then he will not be able to earn a living out of the patients since consultation is the least and smallest part of his income.
Despite my years of rigorous training:
I don’t take any medicine whenever I am unwell. I just allow my body yo heal itself automatically after a few days of rest.
I realize that for every single capsule or tablet I put into my mouth, it will interfere with the body’s natural chemistry somewhere. This will do a lot of damage somewhere to the body. My training in Physiology, Pharmacology Nutrition and Medicine constantly reminds me of this inherent danger. So I am absolutely careful what I put into my mouth. The only tablets or capsules I take are all the natural health and nutritional supplements such as those produced by Diamond Interest because I know that all DI products are safe and health-protective. I take many of DI products daily after food.
But with other drugs for degenerative disorders, we will ultimately either die of the disease or chronic and accumulative drug toxicity if we depend entirely on drugs alone instead of changing the way we eat and live. I am constantly very mindful of this myself as a physician.
Neither my medical colleagues:
Most of my doctor colleagues told me they too do not dose themselves with unnecessary medication. They told me medications are meant for their patients only but they don’t take them for themselves or prescribe them for their families.
So just to make a quick summary – whenever I suffer from diarrhoea due to food poisoning, I don’t add anything more to my digestive system, whether drugs, coconut water or even rice water. I just allow my bowel to rest for a day or two. I respect Mother Nature to be my best doctor. The natural program in my body is to throw everything out, and once done with, the body heals itself naturally when the root causes are removed naturally.
If only patients know how wonderfully the body is made to protect us, they will never want to take chemicals (drugs) to interfere with the body’s chemistry since most drugs silence the body from crying out in pain or in swelling when something goes wrong.
The Power of the Body:
I only wish more doctors concentrate on physiology on how the body response to a stress, an injury, or a disease, and respect that the body can rectify and heal itself, than spending too much time on pharmacology and how to block symptoms.
Thanks for your article Dr BL Chan seeking my advice and comment. I may share your article and my comments to my medical colleagues and other doctor friends later if you don’t mind.
Regards,
Lim Ju Boo
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