Caring for Your Gut: Dealing with Diarrhea, Nausea, and Other Stomach Problems

Submitted on Sep 15, 2023

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Table of Contents

Gut Basics

The gut includes the stomach, small bowel (small intestine), large bowel (large intestine), rectum, and anus. It is also called the gastrointestinal or GI tract.

The gut plays an important role in keeping you healthy. It is where food is dissolved, and nutrients and medications are soaked up into the blood. It is also one of the body's first immune defenses. The stomach is normally very sour, so anything you eat gets bathed in acid that kills many germs. In addition, the lining of the gut contains over half of the body's lymphocytes (a type of immune cell; for more information, see our fact sheet on Understanding the Immune System). The gut also contains many different bacteria; many of these bacteria are helpful to the body. The 'friendly' or 'good' bacteria help to fend off 'unfriendly' or 'bad' bacteria and support the immune cells that line the gut.

The gut protects you from infection by helping to get rid of dangerous germs and chemicals. Feeling like you are going to throw up, throwing up, and loose, watery poop are three ways in which the gut responds to anything that comes into your body that might be harmful.


The Gut and HIV

HIV, HIV drugs, and HIV-related conditions can all cause problems in the gut.


Even if you take HIV drugs, hidden pockets of HIV stay in the gut. HIV damages the lining of the bowels because it infects the immune cells that live there. Research has also shown that HIV changes the mix of bacteria that live in the gut. It reduces the number of 'good' or 'friendly' bacteria that help the gut's immune cells. This is why some people living with HIV take supplements that contain probiotics or eat foods containing live ('good') bacterial cultures (e.g., yogurt, kefir). Some people also drink a fermented beverage called kombucha to help with their gut problems. Supplements and kombucha may interfere with some of the 'good' bacteria, as well. It is therefore important to talk to your health care provider before taking any of these products.

HIV Medications

When you start a new drug, you may experience GI symptoms such as:

  • Diarrhea
  • Nausea
  • Vomiting
  • Loss of appetite
  • Stomach pains
  • Gas or bloating
  • Heartburn

When these symptoms occur as side effects of HIV treatment, they are usually mild, and generally go away after a few days or weeks as your gut gets used to the medicine. Occasionally, especially with protease inhibitors (PIs), diarrhea or bloating does not go away, and your health care provider may need to switch you to other HIV drugs. It is important that you not stop taking your HIV drugs until you have spoken with your provider.

HIV-Related Conditions

If you have not changed medications recently, gut problems are probably not the result of drug side effects. If they continue or get worse, it may be a sign that you have an infection, especially if you also have a fever. Some AIDS-related opportunistic infections (OIs) that affect the gut include:

  • Cryptosporidiosis
  • Microsporidiosis
  • Cytomegalovirus (CMV)
  • Mycobacterium avium complex (MAC)
  • Bacterial infections such as Shigella, Salmonella, and Campylobacter

Very bad or long-lasting gut problems can lead to serious health problems and can prevent HIV drugs from entering the system and fighting HIV. Tell your health care provider about these symptoms so he or she can determine if they are a side effect of treatment or a sign of something more serious.

Diarrhea and HIV

Diarrhea is one of the most common side effects of HIV, intestinal infections, and HIV drugs. Left untreated, diarrhea can cause a loss of water and nutrients and unintentional weight loss.

You have diarrhea if you have watery or loose poop, or if you have three or more bowel movements each day. If your diarrhea lasts for more than a few days, contains blood, or if you have a high fever or stomach pain, it is important that you contact your health care provider.

When looking for possible causes of diarrhea, your health care provider will most likely:

  • Ask about your medical history and the history of your symptoms and perform a physical exam to help determine a cause. If diarrhea persists or no clear cause is found, your provider might;

    • Test your stool to see if you have a parasite, microscopic organism, virus, or bacterium
    • Check your blood for HIV-related infections, proteins, vitamins, and other nutrients
    • Perform radiology studies and/or refer you to a specialist who can use a scope or special tool to look inside your gut

It can be difficult to diagnose the cause of diarrhea, but it is important to try since many infections will need treatment to get better.

If HIV drugs are causing your diarrhea, you may be able to switch medications. However, that option is not the best one for everyone. It is important to talk to your health care provider before you stop or change any HIV drugs.

Coping with Diarrhea

Medications and Supplements

Once your health care provider has determined that your diarrhea is not caused by an infection, there are some medications and supplements that can help. These include:

  • Over-the-counter remedies such as Imodium (loperamide), Kaopectate (bismuth subsalicylate), Pepto-Bismol (bismuth subsalicylate), or Maalox (calcium carbonate +/- magnesium +/- aluminum +/- simethicone)
  • Prescription medicine such as Lomotil (diphenoxylate and atropine) for harder-to-treat symptoms
  • Calcium, fiber, probiotics, and glutamine supplements

Drink Plenty of Fluids

Diarrhea can cause you to lose a lot of your body's water and electrolytes. If the water is not replaced, you will become dehydrated. Symptoms of dehydration include:

  • Thirst, anxiety, weakness, confusion, lightheadedness, fainting
  • Less urine that is often darker than normal
  • Dry and pale skin
  • Faster heartbeat
  • Lower blood pressure

Try to drink water before you feel dehydrated. Clear juices, such as apple, peach, or pear, are easier on the stomach than other types of juices that are high in acid (such as orange or grapefruit). However, if you have diarrhea, it is best not to drink large amounts of sweetened fruit juices. Unflavored coconut water or sports drinks can help you replace electrolytes if you have been vomiting or had diarrhea, but water is usually sufficient in adults. It is important to get medical attention if you are dehydrated.

Change Your Diet

Some foods cause diarrhea or make it worse, including:

  • Coffee and other beverages with caffeine (cola, some other soft drinks, some teas, etc.)
  • Alcohol
  • Chocolate
  • Fried, fatty, and spicy foods
  • Hard to digest fiber such as raw vegetables, potato peels, beans, and brown rice
  • Dairy products (milk and cheese)

Some foods can help to relieve diarrhea, such as the BRATT diet:

  • Bananas
  • Rice (white)
  • Apple juice or apple sauce
  • Toast (avoid whole grain, high-fiber bread)
  • Tea (herbal, non-caffeinated)

Nausea, Vomiting, and Loss of Appetite

Nausea, vomiting, and loss of appetite often occur as side effects of starting or switching HIV drugs. For many people, nausea goes away by itself after a few weeks on the new drugs. Other people need anti-nausea drugs called antiemetics. Some antiemetics interact with HIV drugs, so make sure your health care provider knows about all medications you are taking (including over-the-counter drugs, prescription medications, street drugs, herbs, and supplements), even if you only use them occasionally.

Megace (a hormone called megestrol) and Marinol (dronabinol; a manufactured version of marijuana) may increase appetite. Cannabis (marijuana, weed, pot) may be effective for loss of appetite but is not legal or available everywhere. For more information, see our fact sheets on Cannabis, HIV, and Your Health and on Cannabis, Health, and the Law in the US.

Nausea, vomiting, and loss of appetite can be a special problem for pregnant people who may be having morning sickness because of their pregnancy.

Ways to cope with nausea include:

  • Eating dry crackers
  • Drinking fluids frequently
  • Eating small meals more often
  • Sticking to bland foods that are easier to digest
  • Relaxing before meals and chewing slowly
  • Sipping peppermint tea, ginger tea, or ginger ale
  • Adding nutmeg to your food or drinks

Gas, Bloating, and Heartburn

Farting and bloating can usually be managed by not eating fatty foods or foods such as beans, broccoli, and vegetable skins. Over-the-counter or prescription drugs may also help.

Heartburn causes a burning sensation in your chest. Despite its name, it has nothing to do with your heart. Rather, heartburn occurs when stomach acid comes back up into your food pipe. To avoid heartburn, try to stop eating certain foods:

  • Spicy or fatty foods
  • Alcohol
  • Caffeine
  • Acidic juices (orange, grapefruit, lemon, and tomato)

Also, eating smaller meals, maintaining a healthy weight, quitting smoking and not laying down to sleep until 3 hours after meals can reduce or eliminate heartburn symptoms. If symptoms do not go away, it is important that you see your health care provider. Heartburn may be a symptom of gastroesophageal reflux disease, which can sometimes lead to cancer of the esophagus.

Taking Care of Yourself

HIV, other infections, and HIV drugs can cause many side effects that involve the gut. When problems in the gut are the result of drug side effects, they usually go away after a few days or weeks of adjusting to the new drug. However, for some people living with HIV, these side effects can last longer and have a serious impact on both health and quality of life.

It is best to report gut symptoms to your health care provider. He or she can determine if they are a side effect of treatment or a symptom of a different medical condition. You can also use the following tips to manage symptoms and keep your gut as healthy as possible:

  • Drink lots of water (at least eight 8-ounce glasses each day)
  • Eat high-fiber foods (whole grain rice, bread, oats, vegetables, and fresh fruits)
  • Cut down on caffeine, fried foods, sugar, and animal fat
  • See your health care provider regularly
Additional Resources


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