The infectious bacteria Clostridium difficile (C. diff) produces an inflammation of the colon and severe diarrhea. This highly-contagious organism primarily impacts people over age 65, particularly those who are taking antibiotics and are in the hospital or living in a facility such as a senior care center.
In some instances, C. diff symptoms are mild, but it still may be passed to others easily.The primary goal of the C diff diet is to eat foods and take supplements that help alleviate the primarysymptom, which is diarrhea.
“C. difficile has become the most common microbial cause of healthcare-associated infections in U.S. C. difficile infections cause immense suffering and death for thousands of Americans each year,” said Centers for Disease Control and Prevention (CDC) Director Tom Frieden, M.D., M.P.H.
Although there is limited research on the effectiveness of diet for alleviating symptoms of C. diff, researchers know quite a bit about foods that worsen and those that alleviate diarrhea.When it comes to those at high risk of getting C. diff due to antibiotic use, foods and supplements that have probiotics have been found to be effective.
In fact, in a 2018 study of adults and children who were taking antibiotics and co-administered a probiotic supplement, there was a lower risk of Clostridium difficile infections.The study authors concluded that “Moderate-quality evidence suggests that probiotics are associated with a lower risk of C. difficile infection.”
C. diff bacteria multiply when the normal (good) bacteria in the gut is suppressed—such as when antibiotics are taken. Probiotics may reduce the risk of developing C. diff.
Administration of probiotics is a logical treatment modality, but the studies show mixed evidence that specific probiotics, such as Saccharomyces and Lactobacillus species, speed up recovery of C. diff.
Another benefit of the C. diff diet is that it offers easy to digest foods, as well as those that have soluble fiber.There are basically two types of fiber, soluble and insoluble.Insoluble fiber may worsen symptoms of diarrhea. Soluble fiber is thought to help flush the C. diff bacteria out of the body.
Soluble fiber is contained in foods such as oats and barley (foods that absorb water and become sticky when wet).Insoluble fiber comes from foods such as celery and apple peels; when these foods are placed in water, they do not absorb the water and do not change form.
People with C. diff should consult with their healthcare provider, nutritionist, or another medical professional before taking any type of supplements, including probiotics or fiber supplements. Some digestive problems worsen with fiber supplements.
How It Works
Antibiotics are known to destroy the good "friendly" bacteria in the gut. Friendly bacteria are instrumental in fighting off infections in the colon, such as C diff. Foods that replace the good bacteria in the gut—such as fermented foods and those with probiotics and probiotic supplements—are thought to help alleviate symptoms of C. diff (such as diarrhea).
A soft diet (with foods that are easy to chew and swallow) that includes soluble fiber while avoiding foods high insoluble fiber (such as nuts and seeds) may help promote digestion. But there is a lack of definitive evidence from medical research studies to prove the best type of diet.
The C. diff diet should be implemented until your healthcare provider gives the all clear that the condition has resolved.The diet may be continued after a bout of C. diff as a prevention measure to keep the bacteria from re-growing and the condition from recurring.
Once your registered dietitian or another healthcare provider gives the order to discontinue the diet,it may be important to gradually start adding back the foods you were once accustomed to, rather than drastically changing the diet all at once. This gives your digestive system adequate time to adjust to foods that are relatively new.
It is not uncommon for those who contract C. diff to get the disease more than once, therefore, it’s important to take steps to prevent the disease once a person heals from C. diff.
According to the Academy of Nutrition and Dietetics, “The most important thing to introduce into your diet are “friendly bacteria”, often called probiotics, that will help repopulate your gut and crowd out the potential for regrowth of the C. diff bacteria.”
What to Eat
The C. diff diet is comprised of foods that help to alleviate or lessen diarrhea. Initially, your healthcare provider may recommend a diet of clear fluids, but this diet can only be implemented safely for a few days.It may take up to two weeks for a bout of C. diff to respond to treatment and for diarrhea to clear up.
In the interim, while waiting for treatment to be effective, many people with C. diff eat a diet of foods that won’t exacerbate (worsen) symptoms, but that may help lessen the severity of diarrhea.Your healthcare provider and a registered dietitian will recommend the exact eating plan.
Fermented foods such as yogurt, sauerkraut, tempeh (fermented soybeans), miso (fermented soybean paste)
Foods high in soluble fiber
Vegetables (non-cruciferous) cooked into soups or mixed into smoothies (such as green beans, zucchinis, and cucumbers)
Lean protein sources (such as turkey, chicken, and eggs)
Oats, oat bran, oatmeal, rice bran
Natural applesauce (no added sugar)
Fruits such as citrus fruits, melons, peaches, cherries, strawberries, and watermelon
Low fiber cereal (such as Rice Krispies)
Finely ground flaxseeds (not whole)
Starchy, easy to digest foods, like potatoes, noodles, crackers and white rice
Lots of water and liquids to replenish water loss from diarrhea (such as soup and soup broth)(Video) The Gut Microbiome and C. difficile
Foods high in insoluble fiber
Cruciferous vegetables (such as cabbage, cauliflower, Brussels sprouts and broccoli), turnips, beets, carrots, cabbage
Fried or greasy foods
Fatty foods (such as mayonnaise or fatty meats)
Whole wheat, wheat bran, wheat cereals
Unnatural oils (such as margarine, Olean, or Olestra)
Nuts and seeds (including nut butter)
Unpeeled apples, blackberries, blueberries, and raspberries
Prunes, prune juice, dates
Sugar substitutes like sorbitol and xylitol
Large amounts of sweet foods, such as cakes and cookies (the sugar and fat may worsen diarrhea)
Peas (have both soluble and insoluble fiber, but may be best to avoid due to insoluble fiber content)
Friendly (Good) Bacteria
It’s important to eat foods that contain probiotics to replenish the gut with good bacteria for those with C.diff, particularly if antibiotics have been taken long-term. A 2018 review study found that using probiotics helped to reduce diarrhea in those with C. diff, without any side effects.
Probiotics can be found in certain foods, such as those that are fermented, including yogurt, kefir and more.It’s important to ensure that the fermented food products do, in fact, contain live cultures. Probiotic-rich foods such as yogurt and kefir should not contain sugar—because sugar promotes the growth of bad bacteria in the gut.
An over-the-counter or prescription probiotic supplement may be beneficial.But be sure to consult with your healthcare provider before taking any type of supplements.
A combination of Lactobacillus acidophilus, Lactobacillus casei, Saccharomyces boulardii, Lactobacillus rhamnosus, and other species in a dosage of more than 10 billion colony forming units, taken each day, may be effective.
Studies have shown that eating a diet high in soluble fiber may help to eliminate C. diff. (and other types of bacterial infections in the bowel) sooner than a diet high in insoluble fiber.Foods that contain soluble fiber include oats, oat bran, oatmeal, beans, strawberries, apple pulp, and citrus fruit.
Some experts recommend taking banana flakes (available in a supplemental form) to prevent diarrhea.Bananas have pectin (a soluble fiber), which may help to slow the emptying of the gut and decrease the urgency/frequency of diarrhea.
Banana flakes can be purchased at a local pharmacy, but it’s important to consult with your healthcare provider before taking banana flakes, or any other type of natural supplements, particularly for those with C. diff.
Avoiding Insoluble Fiber
Foods that contain insoluble fiber include nuts, seeds, apple skin, wheat, wheat bran, barley, beets, carrots, cabbage, and cruciferous vegetables. These should be avoided.
Eating small amounts of foods and fluids frequently throughout the day is recommended for those on the C. diff diet.Large meals or snacks may increase diarrhea stools.
Very hot and very cold liquids and foods increase the frequency of diarrhea; drinking fluids at room temperature may help to control diarrhea.But everyone’s body is different, so experimenting with the temperature of foods and fluids may be needed to find out what works best.
Cooking vegetables until they are soft may lower the fiber content. Steaming or boiling, for example, can destroy much of the fiber content, as will deep-frying many foods.
Pureeing foods and processing them in a blender to make smoothies is not known to significantly lower the fiber content.However, using a juice extractor (which removes the pulp) will dramatically lower the fiber content in most foods.
Removing the peel from foods (such as apples) will reduce the fiber level, making foods high in insoluble fiber easier to digest and more suitable for the C. diff diet.
When cooking, it’s important to try to avoid using cooking oil whenever possible.
An excessive amount of fluid may be lost when a person has chronic diarrhea. Along with the water, some nutrients and electrolytes are lost.Examples of modifications that may need to be made on the C. diff diet include:
- Drink plenty of fluids (at least eight to 10 glasses of water per day).
- Avoid caffeinated beverages (which can increase dehydration).
- Replace lost potassium. Eat foods high in potassium such as bananas, boiled potatoes, and more.
- Replace lost sodium. Drink bouillon soup, broths, tomato juice, and orange juice. Eat salty foods such as pretzels and cheese.
- Replace lost calcium. Drink and eat plenty of dairy products if tolerated. If lactose intolerant, include almond milk, soy milk, and other milk replacements.
It’s important to drink small amounts (such as a half of a cup) of fluids frequently throughout the day instead of gulping large amounts of water).Drink fluids throughout the day; do not wait to feel thirsty.
Tips for getting extra fluids include eating/drinking plenty of:
- Caffeine-free drinks (such as herbal tea)
- Clear soups and broths
- Sports drinks
Avoid taking salt pills and always consult with your healthcare provider to inquire about the need for potassium supplements.
A long-term C. diff diet is not recommended because the foods may not supply enough of the nutrients needed on a long-term basis.Also, malabsorption of nutrients is a common side effect of C. diff.It’s important to receive close medical intervention to ensure levels of sodium, calcium, magnesium, and potassium are normal.
Look for foods high in these nutrients and follow your healthcare provider’s instructions closely on when to start back on a normal diet to ensure adequate nutritional intake.
Whole milk and whole milk products are known to cause stomach upset; a person who has C. diff is more likely to have trouble digesting lactose.Using a milk substitute (such as oat milk) may be recommended.Other tips for substituting milk products on the C. diff diet include:
- Eat/drink smaller amounts of milk products at a time.
- Eat low lactose dairy such as yogurts that contain live active cultures.
- Select cheeses such as mozzarella, swiss, feta, and parmesan cheese.
- Try enzymes that help with digestion of lactose (after consulting with your healthcare provider).
A Word From Verywell
Having a condition such as C. diff can be very challenging. Consulting with a professional registered dietitian nutritionist (RD or RDN) may be helpful. To find a registered dietitian near you, a nationwide search can be done online at the Academy of Nutrition and Dietetics’ online referral service.
Frequently Asked Questions
What foods should you avoid with a C. diff infection?
Avoid foods that can cause additional stomach upset, bloating, and diarrhea. These include:
- Milk products
- Greasy foods
- High-fat foods
- Foods high in insoluble fiber, such as apple peels and celery
- Raw vegetables
- Whole grains
- Fat-free foods with Olestra or Olean
- Spicy foods
What foods should you eat when you have a C. diff infection?
Foods that may help with managing symptoms include:
- Yogurt, kefir, and other fermented foods
- Foods with soluble fiber, such as oatmeal and barley
- Starchy foods like potatoes, crackers, and white rice
Check with your doctor or dietitian to help get the best nutrition while you're recovering.
How long should you be on a C. diff diet?(Video) MY GUT HEALTH STORY | Post-Infectious IBS & C. difficile
Your doctor or dietitian can help you decide. They may suggest you stay on it throughout your treatment to help manage symptoms. It can take up to two weeks to fully recover after starting antibiotic treatment.
Studies have shown that eating a diet high in soluble fiber may help to eliminate C. diff. (and other types of bacterial infections in the bowel) sooner than a diet high in insoluble fiber. 7 Foods that contain soluble fiber include oats, oat bran, oatmeal, beans, strawberries, apple pulp, and citrus fruit.
Some animal studies showed that using diets including soluble fiber (oat bran) helped eliminate the C-diff infection sooner than a diet with insoluble fiber (wheat bran). Foods high in soluble fiber include: oats and oat bran, oatmeal, beans, peas, carrots, barley, citrus fruits, strawberries and apple pulp.
C. difficile has been found in the intestinal tract of many types of food animals, including cattle, pigs, sheep, and poultry, as well as dogs and cats (Hensgens et al., 2012; Koene et al., 2012). Ribotypes in cattle, pigs, and poultry included those causing disease in humans. Reports of the prevalence of toxigenic C.
Curcuminoids, the major phytoconstituents of turmeric including curcumin, demethoxycurcumin, and bisdemethoxycurcumin inhibit growth of C. difficile at concentrations ranging from 4 to 32 μg/ml. Additionally, curcuminoids showed no negative effect on major populating species of the human gut.
Yogurt, which is rich in probiotics, may hold the answer to reducing life-threatening Clostridium difficile (C. diff) infections, the Wall Street Journal reports.
What are the symptoms of C. difficile associated disease? Frequent, foul smelling, watery stools characterize mild cases of C. difficile disease.
Most cases of C. diff occur when you've been taking antibiotics or not long after you've finished taking antibiotics. There are other risk factors: Being 65 or older.
The diarrhea-inducing bacterium, Clostridioides difficile (C. diff), also consumes sugars to survive in the gut.
C. difficile infections usually respond well to treatment, with most people making a full recovery in a week or two. However, the symptoms come back in around 1 in 5 cases and treatment may need to be repeated.
The most common fermented foods that naturally contain probiotics, or have probiotics added to them, include yogurt, kefir, kombucha, sauerkraut, pickles, miso, tempeh, kimchi, sourdough bread and some cheeses.
Choose fluids containing water, salt and sugar, such as diluted fruit juice, soft drinks and broths. Good nutrition. If you have watery diarrhea, eat starchy foods, such as potatoes, noodles, rice, wheat and oatmeal. Other good choices are saltine crackers, bananas, soup and boiled vegetables.
The best studied probiotic agents in CDI are Saccharomyces boulardii, Lactobacillus GG (LGG) and other lactobacilli, and probiotic mixtures.
Hospitals use special cleaning products to kill C. diff, but you can make a cleaner at home. Mix 1 part bleach to 9 parts water.
Although in about 20% of patients, CDI will resolve within two to three days of discontinuing the antibiotic to which the patient was previously exposed, CDI should usually be treated with an appropriate course (about 10 days) of treatment, including oral vancomycin or fidaxomicin.
Some types of probiotics can reduce the inflammation caused by C. difficile, some can kill the C. difficile bacteria directly, some can prevent C. difficile from attaching to your gut surface and some can destroy the toxins that cause the diarrheal symptoms.
C. difficile diarrhea may be treated with a course of antibiotics prescribed by your doctor and taken by mouth. Once you have completed treatment and diarrhea is resolved, your infection is no longer contagious and you no longer need to take any special precautions.