What you need to know about BRAT diet for diarrhea in IBD, IBS and Celiac disease

Oh, the BRAT diet.

It’s been advertised as a go-to remedy for upset stomachs and diarrhea for decades.

But is it really that universally good for everybody?

The short answer is ABSOLUTELY NOT.

In fact, the BRAT diet may be very bad for people with IBS, IBD (Crohn’s disease, ulcerative colitis) and Celiac disease, especially when they’re dealing with diarrhea.

Let’s take a closer look at why.

What is BRAT diet?

First, let’s review what the BRAT diet is. It stands for Bananas, Rice, Applesauce, and Toast.

Sounds harmless enough, right? Well, not so fast.

Unfortunately, BRAT diet consists of foods that are high in FODMAPs.

What is FODMAP?

Ah, FODMAP! Sounds like a goofy term, doesn’t it?

Not quite. Let’s break it down.

FODMAP is an acronym for a group of carbohydrates and sugar alcohols that are found in various foods. It stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols.

Unsurprisingly, as the name of the first member of the group suggests, FODMAPs are known to FERMENT in your gut, causing gas, cramps, bloating, and even diarrhea.

Yes, diarrhea!

However, it may be especially harmful for people afflicted with Colitis, Crohn’s, IBS and Celiac disease.

And here is why:

Dysbiosis in Crohn’s, Colitis, IBS and Celiac disease

According to the latest studies, Crohn’s disease, ulcerative colitis, IBS, and Celiac disease have one thing in common – dysbiosis (altered gut flora or an imbalance in microbiome). (1,2,3)

According to Daren Low, Ph.D., et al, when you have dysbiosis 3 things can happen in your gut at the same time:

1. “Loss of beneficial bacteria” (4)
2. “Overgrowth of potentially pathogenic bacteria”(4)
3. “Loss of overall bacterial diversity” (4)

Altered gut flora (dysbiosis) makes digestion of FOODMAPs foods difficult. This has been proven by numerous clinical studies (see references below).

So, you can ask, are the very foods included in the BRAT diet are proven to worsen the symptoms you are trying to relieve?

Unfortunately, the answer is YES. See for yourself.

High Fructose Foods are linked to IBS-diarrhea

Foods like banana and applesauce (part of BRAT diet), are high in fructose, one of the FODMAPs.

Fructose test was abnormal in 35% of IBS patients in a recent study done by scientists from Institute for Research and Innovation in Biomedicine, Normandy University, Rouen, France. It was identified that fructose malabsorption/intolerance can trigger symptoms such as abdominal pain, bloating, gas, and diarrhea in susceptible IBS patients. (5)

Avoiding or minimizing high fructose foods has been found to reduce symptoms and improve quality of life for many IBS patients.

The doctors’ recommendation: low-fructose diet must be part of treatment strategy in patients with IBS-diarrhea.

Fructose Malabsoption & Diarrhea in Crohn’s, Colitis and Celiac disease

Fructose malabsoption was identified across multiple patients with Crohn’s, colitis  and Celiac disease in a study conducted by doctors from Department of Medicine and Gastroenterology, Monash University and Box Hill Hospital, Box Hill, Vic., Australia. Fructose malabsorption was the highest in Crohn’s disease (61%). Patients with ulcerative colitis and Celiac disease had fructose malabsorption from 33% – 44%. (6)

Conclusion: a low fructose may be beneficial for individuals with Crohn’s, colitis and Celiac disease particularly during times of active disease or when experiencing diarrhea.

Gluten can trigger diarrhea in Celiac disease

Toast in BRAT diet is usually made from traditional bread that contains gluten, which is a protein found in wheat, barley, and rye. Individuals with celiac disease must strictly avoid gluten as it triggers an immune response that damages the small intestine. Consuming gluten-containing bread can worsen symptoms and contribute to ongoing intestinal inflammation and diarrhea.

Gluten Free Diet Reduces Colitis & Crohn’s Symptoms

Scientists form University of North Carolina, Division of Gastroenterology and Hepatology conducted a study questioning 1647 patients with Crohn’s disease and ulcerative colitis. These patients ate a gluten free diet. The results of the study were shocking: 65% of all patients reported an improvement in their condition (less running to the bathroom and more energy). Only 0.6% of these patients had a diagnosis of celiac disease. This confirms that gluten free diet is extremely beneficial for IBD patients. (7)

The Bottom Line:

Now, to be absolutely clear: FODMAP foods, High Fructose Foods and Gluten containing foods are not inherently bad for everyone. They may be perfectly fine for many people to enjoy.

But for those with conditions like IBS-diarrhea, IBD-diarrhea and Celiac disease-diarrhea: ELIMINATING FODMAPs foods (read: eliminating BRAT diet), Gluten and Hight Fructose Foods can help alleviate digestive discomfort and diarrhea.

Better yet, talk to your doctor or a registered dietitian to come up with a customized plan that meets your specific needs.

Do you want to know what you should eat when you have IBS-diarrhea, IBD-diarrhea and Celiac disease-diarrhea?

Stay tuned for the next blog post.

Best of health to you, my friend.

Galina

References:

1. Khan I, Ullah N, Zha L, Bai Y, Khan A, Zhao T, Che T, Zhang C. Alteration of Gut Microbiota in Inflammatory Bowel Disease (IBD): Cause or Consequence? IBD Treatment Targeting the Gut Microbiome. Pathogens. 2019 Aug 13;8(3):126. doi: 10.3390/pathogens8030126. PMID: 31412603; PMCID: PMC6789542.
2. Girbovan A, Sur G, Samasca G, Lupan I. Dysbiosis a risk factor for celiac disease. Med Microbiol Immunol. 2017 Apr;206(2):83-91. doi: 10.1007/s00430-017-0496-z. Epub 2017 Feb 15. PMID: 28204873.
3. https://www.frontiersin.org/articles/10.3389/fmicb.2019.01136/full
4. DeGruttola AK, Low D, Mizoguchi A, Mizoguchi E. Current Understanding of Dysbiosis in Disease in Human and Animal Models. Inflamm Bowel Dis. 2016 May;22(5):1137-50. doi: 10.1097/MIB.0000000000000750. PMID: 27070911; PMCID: PMC4838534.
5. Melchior C, Douard V, Coëffier M, Gourcerol G. Fructose and irritable bowel syndrome. Nutr Res Rev. 2020 Dec;33(2):235-243. doi: 10.1017/S0954422420000025. Epub 2020 Mar 3. PMID: 32122419.
6. Comparison of the prevalence of fructose and lactose malabsorption across chronic intestinal disorders. / Barrett, Jacqueline Susanne; Irving, Peter; Shepherd, Susan Joy et al. In: Alimentary Pharmacology & Therapeutics, Vol. 30, No. 2, 2009, p. 165 – 174.
7. Herfarth HH, Martin CF, Sandler RS, Kappelman MD, Long MD. Prevalence of a gluten-free diet and improvement of clinical symptoms in patients with inflammatory bowel diseases. Inflamm Bowel Dis. 2014 Jul;20(7):1194-7. doi: 10.1097/MIB.0000000000000077. PMID: 24865778; PMCID: PMC4331053.