Diarrhea and protein loss


There is a disease called protein losing enteropathy.

In fact it's several diseases, but in each case, diarrhea is associated with losing protein.

Sometimes with hepatic effects (liver) sometimes not. This because the liver is downsteam of our intestines, receiving their products of digestion.


In a previous post, we discovered that those presenting with COVID-19 usually have (among other findings at the laboratory) low serum albumin. Albumin of course, being a protein.


One place they are losing it from is from the gut.

Not everyone has involvement of the gut, but for those that do, this becomes more important.


Here is some pertinent literature:


COVID-19 and the Digestive System.


Involvement of digestive system in COVID-19 - manifestations, pathology, management & challenges.


Protein losing enteropathy - comprehensive review of the mechanistic association with clinical and subclinical disease states


Protein Losing Enteropathy - diagnosis and management.


Mount Sinai COVID-19 autopsy experience.


Autopsy Findings in 32 Patients with COVID-19 - a single institution experience.





  • I learned about protein losing enteropathy (PTE) especially when caring for newborns in the PICU Nursery at Children's Hospital in DC. They would catch a virus, often a rotavirus, then it was off to the races trying to catch up with their fecal protein losses. If we caught up, things went well. If not, well ...
  • The last two are from the Pathologists. Always try to arrive as late as possible to your consultation with a Pathologist.  The report from Mount Sinai was sent to me by Janet Shapiro, MD. This in response to my questions about GI tract involvement. She is Director of the Medical ICU's at Mount Sinai Hospital in New York, and their affiliated hospitals. She had COVID-19, recovered and is back at work, on a positive note. We've become friends and communicate pretty often when indicated. The point here is that Pathologists have confirmed the gut as a portal of entry for this virus (as with many other viruses). Sometimes the gut is found to have been damaged, sometimes not. But the intestine (duodenum, small bowel, colon) is involved much more often than was initially thought in March/ April. And doing what the gut does (absorbing nutrients) not only supplies energy to the body eventually, it requires energy to get its work done. So the pathologists, at a microscopic level, are finding that the cells that line the intestine are pooped out (pun intended). Cells are seen to be diffusely in a low energy state (don't worry about the details of how they define that. Or if you like, look at the microscopic images at the end of the article from Janet at Mount Sinai, and form your own impression).
  • That protein loss becomes a target in those who are ill, but who don't yet need a Path Consult. Just as it was an impotant target for the rug rats I cared for at Children's.
  • Another related point. Not only did the Pathologists see with their microscopes, viral particles in the GI cells, but in addition swabs from inside of the intestine (same principle as nasal swabs for diagnosis), were invariably positive in these, ... clients.
  • Further comment and explanation possible but not necessary.




 Into practice



  • First of all, if your physicians in New York back home already covered this, go with their recommendations. If not, read on.
  • Stay well hydrated. When we had to order preparations before surgery for a procedure on the intestine (usually the colon), washing out was always accompanied by lots of liquids from above as well as the enemas from below. I'll save you the enemas as a recommendation. (Here, take a deep breath). If one drinks in a hurry, 3 to 4 liters of water or sports drinks, it will invariably prompt trips to the bathroom for watery diarrhea (as well as peeing more). The point: Make sure you are drinking more than usual. If you exaggerate with tap water, it will drop your serum sodium. So use other liquids as well. Can also ask about available salt-containing choices at the source mentioned below.
  • VERY IMPORTANT.  Even if the goal is not muscle building, now is a very good time to increase oral protein intake. Just like with the rug rats with their rotavirus infections in Pediatrics. Doing so gets better outcomes. Even after the diarrhea stops, since there is always some catching up to be done.
  • I recommend a protein source like Pete used to take in Hawaii. He can be the Team Leader for this effort.
  • I recommend taking two scoops to start with, twice a day, then working up to 2 scoops, 3 times a day for the next 2 weeks. A dose of "2 scoops" should supply about 35 to 30 grams of protein. So adjust "scoops" according to the product obtained. You'll know when you're getting into range when you notice your fingernails are gowing more rapidly.
  • Do not worry that you'll also be feeding the viruses. They don't like the stuff and never touch it, not even with their spike proteins to get a little taste. It gives them gas.
  • I suggest contacting some friends of mine on Bermuda: Kathy Lipp and her husband Gerhard. They carry an ISOPURE product that should do the trick. When you speak with them, ask for a product that is Whey ISOLATE, and not just whey. For those of us who are genetically prone to some degree of lactose intolerance, the ISOLATE form bypasses most of that problem.
  • Anticipate nevertheless that this may increase flatulaence just a bit. Of course in the current setting, you can apply this as an appropriate test for anosmia. Also making it more socially defensible: a medical emergency.
  • All three can take some. That way the small amount of added flatulence will become habitual and less noticed.


Here are the coordinates for Kathy and Gerhard at Better Health Ltd. If I recall, their store is in the central part of the island, near the Church and the Bermuda Historical Society. Perhaps on the other side of Hamilton Harbor from where you are. (That reminds me, I don't know where you are confined, I mean, ... staying).


So here is their contact information.

I'm sure you can arrange with them, a method of getting this delivered to you.


When you speak with them remember:

  • whey protein ISOLATE
  • talk over flavors with Pete. Banana, vanilla, chocolate, strawberry are commonly available. I can't stand any of them but chocolate, but do nevertheless consume what I have in stock.
  • perhaps a few bottles of a sprots drink that has salts as well as water. (These tend to be disfavored in Medicine, as of no use, unless situations are unusual. Drink plain water, and the body will adjust the needed salts is a very solid Medical principle. Nothwithstanding that truth, this may be an unusual situation). Could mix the protein with this to get both effects. Don't have to.
  • 2 or 3 shaker bottles to mix the stuff, or a fancy electrified one.
  • It will all be coming in from "outside," so appropraite precautions for 24 hours before use by the two "tested negatives" in the group. For that 3rd person who is now a pariah, he can just have at it when it arrives.


Better Health Ltd.



Monday - Friday 9 am - 5 pm
Saturday 11 am - 2 pm
Sunday Closed

Better Health Ltd.
Victoria Place, Lower Level,
Hamilton , Bermuda




And very best of wishes to you three from Christiane here in Stavelot.


Carry on. I agree that Bermuda still has advantages over "back home" given rising numbers on the mainland. As long as clinical status stays stable and leans towards improvement, I agree.


First sign of persistent degradation of that status,... get those jet engines humming.

While flying you back, but not going to a hospital once arrived, may seem like Citi participating in a nice vacation more than emergency medical transport, perhaps home would be just as effective if a few bits of added equipment are put in place. Acceptable? 



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