An essential part of treating Clostridioides difficile (C. diff, previously known as Clostridium difficile), a bacterial infection, is maintaining a diet that helps alleviate the primarysymptom—diarrhea.
A highly contagious organism, C. diff 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.
This article covers the foods you can and can't eat with C. diff, how long to keep up a C. diff diet, side effects of the diet, and prevention strategies if you are at risk of becoming infected.
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Prevention With Probiotics
In some instances, C. diff symptoms are mild, but that's not always the case, so prevention is key.
“C. difficile has become the most common microbial cause of healthcare-associated infections in the 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, MD, MPH.
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— may reduce the risk of developing C. diff.
For people 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.”
People with C. diff or taking antibiotics 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.
C. Diff Diet Basics
A soft diet (with foods that are easy to chew and swallow) that includes soluble fiber while avoiding foods high in 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.
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 or alleviate diarrhea.
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, and that may help lessen the severity of diarrhea.Your healthcare provider and a registered dietitian will recommend the exact eating plan.
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 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.Studies show mixed evidence that specific probiotics, such as Saccharomyces and Lactobacillus species, speed up the recovery of C. diff. But be sure to consult with your healthcare provider before taking any type of supplement.
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.
Soluble/Fermentable Fiber
There are two types of fiber, soluble and insoluble.
- Insoluble fiber may worsen symptoms of diarrhea. 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.
- 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).
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.
| Foods to eat (compliant) and foods to avoid (non compliant) | |
|---|---|
| Compliant Foods | Non Compliant Foods |
| Fermented foods such as yogurt, sauerkraut, tempeh (fermented soybeans), miso (fermented soybean paste) | Fatty foods (such as mayonnaise or fatty meats) |
| Foods high in soluble fiber | Foods high In insoluble fiber |
| Vegetables (non-cruciferous) cooked into soups or mixed into smoothies (such as green beans, zucchinis, and cucumbers) | Raw vegetables |
| Cruciferous vegetables (such as cabbage, cauliflower, Brussels sprouts, broccoli), turnips, beets, carrots, and cabbage | |
| Peas (have both soluble and insoluble fiber, but may be best to avoid due to insoluble fiber content) | |
| Lean protein sources (such as turkey, chicken, and eggs) | Fried or greasy foods |
| Oats, oat bran, oatmeal, rice bran | Whole wheat, wheat bran, wheat cereals |
| Barley | Rye |
| Bananas | Prunes, prune juice, dates |
| Natural applesauce (no added sugar) | Unpeeled apples, blackberries, blueberries, and raspberries |
| Fruits such as citrus fruits, melons, peaches, cherries, strawberries, and watermelon | Spicy foods |
| Lentils, beans | Nuts and seeds (including nut butter) |
| Low-fiber cereal (such as Rice Krispies) | Sugar substitutes like sorbitol and xylitol |
| Finely ground flaxseeds (not whole) | Unnatural oils (such as margarine, Olean, or Olestra) |
| Starchy, easy to digest foods, like potatoes, noodles, crackers and white rice | Large amounts of sweet foods, such as cakes and cookies (the sugar and fat may worsen diarrhea) |
| Lots of water and liquids to replenish water loss from diarrhea (such as soup and soup broth) | Caffeine |
Cooking Tips
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) makes the 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.
Is Honey Good for C. Diff?
Some research suggests that honey may be helpful for reducing bacteria In C. diff infections. However, if you are going to eat honey, make sure you are using a product that does not contain artificial sugars, which can worsen diarrhea.
Recommended Timing
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.
Special Considerations
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 1/2 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:
- Water
- Caffeine-free drinks (such as herbal tea)
- Clear soups and broths
- Gelatin
- Sports drinks
- Popsicles
- Pedialyte
- Gatorade
Don't take salt pills and always consult with your healthcare provider to inquire about the need for potassium supplements.
Duration
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's best 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 those foods again.
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.”
Warnings and Precautions
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.
Dietary Restrictions
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
The purpose of theC. diffdiet is to help control diarrhea, restore “good” gut bacteria, and prevent or alleviate dehydration. To help maximize the impact of this diet, focus on choosing foods with a high nutritional value that are also easy on the stomach. Sometimes the diarrhea associated with aC. diffinfection may become chronic. If that is the case, your healthcare provider might recommend a multivitamin or other nutritional supplement to ensure that you remain adequately nourished while you recover.
— ALLISON HERRIES, RDN, MEDICAL EXPERT BOARD
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10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention. Nearly half a million Americans suffered from Clostridium difficile infections in a single year.
Harvard Health Publishing. Harvard Medical School. Clostridium difficile: An intestinal infection on the rise Intestinal infection known as C. diff can spread through spores and cause diarrhea.
Goldenberg JZ, Mertz D, Johnston BC. Probiotics to prevent Clostridium difficile Infection in patients receiving antibiotics. JAMA. 2018;320(5):499-500.doi:10.1001/jama.2018.9064
Oncology Nutrition. Academy of Nutrition and Dietetics.Constipation, Diarrhea and Fiber.
Oncology Nutrition. Academy of Nutrition and Dietetics. Diet and C.difficile.
C Diff Foundation.org. Foods to avoid during a C diff infection.
Na X, Kelly C. Probiotics in clostridium difficile Infection.J Clin Gastroenterol. 2011;45 Suppl(Suppl):S154-S158. doi:10.1097/MCG.0b013e31822ec787
Zheng W, Wang K, Sun Y, Kuo SM. Dietary or supplemental fermentable fiber intake reduces the presence of Clostridium XI in mouse intestinal microbiota: The importance of higher fecal bacterial load and density. PLoS ONE. 2018;13(10):e0205055. doi:10.1371/journal.pone.0205055
Wultańska D, Paterczyk B, Nowakowska J, Pituch H. The effect of selected bee products on adhesion and biofilm ofClostridioides difficilestrains belonging to different ribotypes. Molecules. 2022 Oct 30;27(21):7385. doi:10.3390/molecules27217385
UW Health. Health Facts for You. Eating hints to help with diarrhea.
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By Sherry Christiansen
Christiansen is a medical writer with a healthcare background. She has worked in the hospital setting and collaborated on Alzheimer's research.
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