What to Eat When You Have Clostridium Difficile (C. Diff)

Dietary Recommendations for Better Management

In This Article

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 primary symptom, 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. 

Benefits

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.”

Although scientists know that C. diff bacteria multiplies when the normal (good) bacteria in the gut is suppressed—such as when antibiotics are taken—and that administration of probiotics is a logical treatment modality, the studies show mixed evidence that specific probiotics, such as Saccharomyces and Lactobacillus species, speed up recovery of C. diff. However, probiotics may reduce the risk of developing 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 bacteria that causes C. diff 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 health care 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.

Duration

The C. diff diet should be implemented until your health care 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 health care 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 health care 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 health care provider and a registered dietitian will recommend the exact eating plan.

Compliant Foods

  • 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

  • Barley

  • Bananas

  • Natural applesauce (no added sugar)

  • Fruits such as citrus fruits, melons, peaches, cherries, strawberries, and watermelon

  • Lentils, beans

  • 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)

Non-Compliant Foods

  • Foods high in insoluble fiber

  • Cruciferous vegetables (such as cabbage, cauliflower, Brussels sprouts and broccoli), turnips, beets, carrots, cabbage

  • Raw vegetables

  • Fried or greasy foods

  • Fatty foods (such as mayonnaise or fatty meats)

  • Spicy foods

  • Whole wheat, wheat bran, wheat cereals

  • Rye

  • 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)

  • Caffeine

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 health care 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.

Soluble/Fermentable Fiber

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 health care 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.

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.

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) 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.

Modifications

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:

  • Drinking plenty of fluids (at least eight to 10 glasses of water per day)
  • Avoiding caffeinated beverages (which can increase dehydration) 
  • Replacing lost potassium: Eat foods high in potassium such as bananas, boiled potatoes, and more.
  • Replacing lost sodium: Drink bouillon soup, broths, tomato juice, and orange juice. Eat salty foods such as pretzels and cheese.
  • Replacing 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:

  • Water
  • Caffeine-free drinks (such as herbal tea)
  • Clear soups and broths
  • Gelatin
  • Sports drinks
  • Popsicles
  • Pedialyte
  • Gatorade

Avoid taking salt pills and always consult with your health care provider to inquire about the need for potassium supplements.

Considerations

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 health care 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 are low in lactose.
  • Select cheeses such as mozzarella, swiss, feta, and parmesan cheese.
  • Try enzymes that help with digestion of lactose (after consulting with your health care 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.  

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Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. 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. Updated July 13, 2018.

  2. Oncology Nutrition. Academy of Nutrition and Dietetics. Constipation, Diarrhea and Fiber. Updated in April, 2013.

  3. Oncology Nutrition. Academy of Nutrition and Dietetics. Diet and C.Difficile. Updated March 2019.

  4. C Diff Foundation.org. Foods to Avoid During a C Diff Infection. Updated July 5, 2013.

  5. 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

  6. UW Health. Health Facts for You. Eating Hints to Help with Diarrhea. Updated July, 2017.

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