What diet is recommended for patients with Clostridioides difficile (C. diff) infection?

Dietary Recommendations for Patients with C. difficile Infection

For patients with C. difficile infection (CDI), a high-fiber diet should be recommended as it reduces susceptibility to infection and supports recovery by promoting beneficial gut bacteria. 1

General Dietary Principles for CDI

Recommended Foods

• High-fiber foods: Whole grains, fruits, and vegetables (properly prepared) 1
• Fermented foods: Yogurt with live cultures, kefir, and other probiotic-rich foods 2
• Adequate hydration: Water and electrolyte-containing fluids to prevent dehydration from diarrhea 2

Foods to Limit or Avoid

• High-fat/high-protein diets: These diets (like Atkins-type diets) significantly worsen CDI outcomes and increase mortality in research models 3
• Soy protein: Associated with increased mortality in CDI models due to enhanced amino acid production that promotes C. difficile growth 4
• Sugar-sweetened beverages: These should be limited as they can worsen intestinal inflammation 2

Special Dietary Considerations

For Patients with Intestinal Strictures

• Patients with intestinal strictures should process fibrous foods to a soft consistency
• Cook vegetables thoroughly and chew food well to prevent obstruction 2
• Consider applesauce instead of raw apples as an example of appropriate texture modification 2

For Patients with Diarrhea

• Monitor fluid output and adapt fluid intake accordingly 2
• Consider reducing hypotonic fluids and increasing saline solutions 2
• Identify and eliminate food intolerances that may enhance fluid output 2

Nutritional Supplements and Therapies

Probiotics

• Specific probiotics like "VSL#3" formulation and Lactobacillus reuteri may be beneficial in managing intestinal inflammation 2
• Probiotics should be used cautiously in immunocompromised patients 2

Vitamin D Supplementation

• High-dose vitamin D supplementation may be beneficial in CDI patients as it increases beneficial gut bacteria like Bifidobacteriaceae and Christensenellaceae 5

Dietary Approaches for Specific Symptoms

For Lactose Intolerance (Common in CDI Patients)

• Temporarily reduce or remove lactose from diet 6
• Most patients can tolerate small amounts of lactose (less than 0.5 pint of milk per day) 6
• Consider lactose-free alternatives 6

For IBS-like Symptoms

• A low FODMAP diet may be beneficial for patients with overlapping IBS symptoms 6
• This should be supervised by a trained dietitian 6

Common Pitfalls to Avoid

1. Implementing overly restrictive diets: This can lead to malnutrition and further compromise immune function
2. High-fat/high-protein diets: These significantly worsen CDI outcomes 3
3. Using anti-motility agents alone: These should always be accompanied by appropriate antibiotic therapy if used at all 2
4. Ignoring individual food intolerances: These can exacerbate symptoms and should be identified and addressed 2
5. Tube feeding without assessment: Tube-fed patients should be clinically assessed due to their increased risk for CDI 2

Monitoring and Follow-up

• Regular assessment of nutritional status
• Evaluation of hydration status, particularly in patients with severe diarrhea
• Monitoring of symptoms to identify food triggers
• Adjustment of diet based on individual tolerance and response

By following these dietary recommendations, patients with CDI can support their recovery while maintaining adequate nutrition and hydration, potentially reducing the risk of recurrence and complications.