Crohn’s disease is an inflammatory bowel disease (IBD), similar to ulcerative colitis, except that Crohn’s can cause the entire digestive tract to become inflamed. Crohn’s is considered relapsing and remitting – meaning you can go through periods when it is worse, or flaring, (relapsing) and periods when it is better, and you feel almost normal (remissions). When it relapses, one of the most common symptoms is diarrhea. The first choice of treatment for diarrhea is a diet change.
A Diarrhea Diet for Crohn’s disease is similar to what doctors recommend for people with stomach flu, often called the “BRAT” diet. BRAT” stands for bananas, rice, apple juice and toast – dry, white bread toast. Because fiber can further irritate an inflamed intestinal tract, the diarrhea diet chooses foods with low to no fiber that are easy to digest. Bananas, white rice (especially the quick-cooking kinds, such as Minute Rice TM ), apple juice (but not whole apples, especially not apple peel) and toast made from white bread, without butter or any other spread, are all low in both fiber and fat, another thing you want to exclude in a Crohn’s diarrhea diet.
You can add other non-carbonated and non-caffeinated clear liquids, such as herbal teas, to the diarrhea diet, but most soft drinks contain a great deal of acid, which can cause increased irritation. Orange juice, grapefruit juice and tomato juice also contain acids that should be avoided in a diarrhea diet; tomatoes in particular are often poorly tolerated by Crohn’s patients even when they are not having a relapse or flare. If you start doing better, you can add a low-sodium chicken rice soup to the diarrhea diet, if you can find one that doesn’t contain gluten, a wheat product that is also poorly tolerated by many Crohn’s patients. If you already know that you have trouble with gluten, you may want to replace the toast with something such as rice cakes, which are essentially little more than puffed rice, with low fiber and easy digestibility, which shouldn’t worsen the diarrhea. If you can tolerate it, a multivitamin with minerals is very important while on the diarrhea diet, as the diarrhea diet doesn’t contain all the vitamins and minerals that your body will need.
If after two days on this diet you are no better, or the diarrhea becomes worse, it may be time to switch to a liquid diet. The liquids should be clear and non-acidic. At this point you should add supplements to your diarrhea diet, especially calcium, folate and vitamin B-12; these substances are poorly digested by most Crohn’s patients, and the diarrhea just makes it harder for your system to absorb them. Doctors suggest that anti-diarrhea medications, like Lomotil (which contains diphenoxylate and atropine) and Imodium (loperamide), be used in conjunction with the diarrhea diet; they can also help stop the abdominal pain and cramping that accompanies diarrhea, and sometimes occurs in Crohn’s patients even without diarrhea.
If the diarrhea persists for more than four days, you really should see your physician. It may be time to “rest” your intestines by switching to a strictly intravenous nutrition program, or a total peripheral nutrition (TPN) and avoid a diarrhea diet altogether for awhile. The intravenous addition of nutrients to your body helps them bypass the intestinal system, and gives your intestines time to recover from the flare and the diarrhea. This is always a decision that should be made by your doctor.
If you have any questions about what you should or should not eat, and you are a Crohn’s patient experiencing a bout of diarrhea, call your doctor. You need to have a good doctor who understands your illness, and will be responsive to your questions – so find one before you have a relapse. Until you get a response from your doctor, stick to a diarrhea diet that is low in fiber, salt and acid, and is basically very bland. Avoid dairy products, including yogurt, and avoid any fresh fruits or vegetables. Keep yourself hydrated with apple juice, white grape juice, flat ginger ale and water. If your stomach is upset too, suck on ice chips – but if you are that ill, it’s time to visit either a walk-in clinic or the emergency room, if you haven’t reached your doctor. Not treating diarrhea promptly will make your relapse worse, and make it last longer. You need to be your own advocate and take charge of your health care. Part of that is knowing what foods will work for you.
