Diarrhea Mystery: Actually Solved.

My wonderful friend Alice read my previous post and replied via email with the following:

"Because I like talking about poop too:

Though your new friends' openness about bathroom practices is admirable, there are a lot of different things that can cause bouts of diarrhea, and various reasons people who grew up in a country where the water is safe have a harder time here.

1. Some foods draw water into the bowels. Undigested lactose (in lactose intolerant people) and fructose (in people who just consumed too much fructose) are examples of this.

2. Some people's bowels are irritated by specific foods. In some cases this may be due to an allergy, though it could also just be due to eating more pungent food than usual. Sometimes undercooked spices have a strong bitter taste, so if there really are a lot of undercooked spices being used, this might irritate both your taste buds and your bowels. This should vary from person to person, and also depend on what kind of food you're used to.

3. A number of medicines can mess with your system enough to cause diarrhea.

4. Of course, the water here is often contaminated with pathogens like E. coli. People who've had more exposure to these pathogens throughout their lifetimes are less likely to get sick from a small dose than a person who's grown up with less exposure. However, it's still quite possible for people who are born in developing countries to get diarrhea, especially as children. About 8% of deaths in India are from diarheal diseases, most of which are treatable. Tests of diarrhea patients in Indian hospitals usually find evidence of intestinal pathogens in about 50% of cases, though tests may miss infections in many of the patients whose results come back negative. So, I think the main cause of diarrhea in people of all nationalities here is infection.

Anyway, this seems likely to be correct--everyone I know here (with whom I'm close enough to talk about these things) gets mild diarrhea once in a while. Yet in America, it's somewhat less common. I don't see any reason to think that Americans are more careful about fully cooking their spices, and in fact Americans probably eat more uncooked food and spices... because the water in India is less safe."

Thank you, Alice, for solving this mystery!