The BRAT diet: Is it a good idea when your sick?

This article was originally published by our friends at Authority Nutrition.

The BRAT diet is a bland, easily digestible diet.

For decades, it has been prescribed for adults and children with gastroenteritis, an infection of the intestines commonly known as the stomach flu.

However, the BRAT diet has been criticized for being overly restrictive.

This article takes a detailed look at the BRAT diet and whether it is appropriate during recovery from digestive illness.

man-with-bunch-of-bananas-on-his-shoulder

What Is the BRAT Diet?

BRAT is an acronym for bananas, rice, applesauce and toast. These are the main foods that make up the BRAT diet.

Many people follow the BRAT diet when transitioning to normal eating after illnesses involving vomiting and diarrhea.

It is intended to be followed for up to 48 hours after active vomiting has resolved.

The BRAT diet has been prescribed for both children and adults because the foods it contains are bland, easy to digest and may be helpful for nausea.

Bottom Line: The BRAT diet contains bland, easy-to-digest foods like bananas, rice, applesauce and toast. It is often prescribed for people recovering from illnesses that involve vomiting and diarrhea.

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History of the BRAT Diet

toasted-bread

Until fairly recently, it was believed that the intestinal tract should rest during and after digestive illness.

Up until the 1980s, pediatric textbooks recommended a clear-liquid diet for the first 48 hours of illness, followed by gradual re-feeding with easy-to-digest foods (1).

The first mention of the BRAT diet was nearly a century ago, in a 1926 report. The report described the diet’s use for children with intestinal illness involving severe diarrhea and dehydration (2).

Today, many people consider the BRAT diet the best way to manage diarrhea in both children and adults.

However, despite its widespread use over the past century, there has been very little research on the BRAT diet to support its efficacy.

Bottom Line: The BRAT diet was first mentioned in a paper in 1926 as a treatment for severe diarrhea in children. It has been widely used in cases of vomiting and diarrhea, despite a lack of evidence to support its use.

Foods to Eat and Avoid on the BRAT Diet

The BRAT diet only allows a few foods and liquids, although they can be consumed in unlimited quantities based on appetite.

Foods Allowed on the BRAT Diet

  • Bananas
  • White rice
  • Applesauce
  • Toast made from white bread
  • Soda crackers
  • Clear liquids including water, weak tea, broth, juice, electrolyte-containing beverages, such as sports drinks, and soda that’s flat and caffeine-free

Foods to Avoid on the BRAT Diet

  • Meat, fish and poultry
  • Eggs
  • Dairy products
  • Fruits other than bananas and applesauce
  • Vegetables
  • Nuts and seeds
  • Whole grains
  • Beans and legumes
  • Beverages that contain caffeine
  • Carbonated beverages

Bottom Line: The BRAT diet excludes most foods other than bananas, applesauce, refined grain products and clear liquids.

Advantages of the BRAT Diet

apple-sauce-in-ramekin

The BRAT diet has certain advantages.

It consists of easy-to-digest foods that are unlikely to irritate the gut or cause nausea during digestive illness.

Although there are no studies supporting the BRAT diet’s ability to decrease diarrhea, there is research on certain foods in the diet suggesting they may help.

Bananas may act as a binding agent and provide other anti-diarrhea effects.

In a study of tube-fed, hospitalized patients, 57% of those who received banana flakes in their feedings were diarrhea-free at the end of the study, compared to 24% of patients who received medical treatment instead (3).

It appears that green or unripe bananas are particularly effective at reducing diarrhea. Green bananas contain resistant starch, which bacteria that live in your gut ferment into short-chain fatty acids.

Research suggests that these short-chain fatty acids may increase the gut’s ability to reabsorb water and nutrients, which can be very beneficial during episodes of diarrhea (4).

One researcher conducted several studies in children with diarrhea and reported that including green bananas in their diets consistently reduced the severity of diarrhea and led to faster recovery (4, 5, 6).

One of these studies looked at more than 2,900 children with acute diarrhea.

They found 80% of those who received green bananas experienced resolution of diarrhea within three days, compared to 53% of children who did not eat green bananas (6).

Rice has also been shown to provide anti-diarrheal activity. Most of these studies looked at the effects of rice-based oral rehydration solutions, which are used to treat diarrhea-related dehydration (7, 8, 9, 10).

However, a large analysis of 13 studies found that, although these rice-based solutions majorly reduced diarrhea in children and adults with cholera, they had less of an impact on those with non-cholera diarrhea (10).

Bottom Line: Studies have found that green bananas and rice-based solutions may help reduce the duration and severity of diarrhea.

Disadvantages of the BRAT Diet

bowl-of-steamed-rice

The BRAT diet’s main disadvantage is that it does not provide the appropriate nutrition that people recovering from illness need.

These individuals are already nutritionally depleted due to vomiting, diarrhea and poor appetite.

This is especially concerning for children and the frail elderly, who are more likely to become malnourished and are at greater risk of repeated illness than strong, healthy adults are.

The BRAT diet is very low in protein, fat and other nutrients that are needed for proper healing.

In one study, researchers analyzed the nutritional content of the usual diet of a two-year-old versus the nutrition of the BRAT diet. They reported the following (11):

  • Calories: 300 fewer calories on the BRAT diet
  • Protein: 70% lower on the BRAT diet
  • Fat: 80% lower on the BRAT diet

The BRAT diet was also shown to provide far less than the Reference Daily Intake (RDI) for key nutrients involved in healing:

  • Vitamin A: 12% of the RDI
  • Vitamin B12: 0% of the RDI
  • Calcium: 12% of the RDI

Although the BRAT diet is intended to be followed for no longer than two days, there have been reports of children remaining on the diet until diarrhea resolves, which may be considerably longer.

In 1998, researchers reported the case of two young children who followed the BRAT diet for two weeks and developed severe malnutrition due to insufficient protein and calorie intake (12).

The nutritional inadequacy of the BRAT diet has been acknowledged by the American Academy of Pediatrics, the European Society of Paediatric Gastroenterology Hepatology and the European Society for Paediatric Infectious Diseases.

These organizations now recommend that children resume a normal, age-appropriate diet within 24 hours of getting sick, which includes lean meat, yogurt, eggs, fruits and vegetables (13, 14).

Bottom Line: The BRAT diet does not provide enough calories, protein or key nutrients to ensure proper healing from digestive illness in children and the elderly. Extending the diet beyond a few days may lead to malnutrition.

Alternative Dietary Strategies for Digestive Illness

Here are some ideas for you to try during and after digestive illness, instead of following the BRAT diet:

  • Take probiotics or eat probiotic-rich yogurt: Certain probiotics can help reduce diarrhea, including Lactobacillus reuteri, Lactobacillus GG and Saccharomyces boulardii (15, 16, 17, 18).
  • Take prebiotic fiber: Prebiotic fiber feeds healthy gut bacteria. In one study, diarrhea resolved significantly faster in children and adults given prebiotics, compared to those given a placebo (19, 20).
  • Begin a regular diet within 24 hours of illness, as tolerated: Foods rich in protein, vitamins and minerals provide nutrition needed for proper recovery. Add small amounts of meat, fish, eggs, yogurt and cooked vegetables first.
  • Avoid foods that worsen diarrhea: These include milk, sugar, fried foods, spicy foods and caffeinated beverages. You can add them back into your diet gradually after a few days.
  • Include BRAT foods: Including bananas and rice as part of a balanced diet may help firm up loose stools. Bananas can also help replenish potassium lost in vomiting and diarrhea.
  • Drink electrolyte-rich fluids: Bone broth, chicken broth or beef broth are good options to replace water and electrolytes. For children, oral rehydration solutions like Pedialyte are recommended (21).

Bottom Line: Taking probiotics and prebiotics, consuming a balanced diet and rehydrating can help promote recovery from intestinal illness.

Take Home Message

Pediatricians and other experts now believe the BRAT diet is unnecessarily restrictive for digestive illness.

It may even hinder recovery because it doesn’t provide enough calories, protein or important nutrients.

For healthy adults, following the BRAT diet for a few days is unlikely to cause problems, but there is no evidence it will help resolve your symptoms more quickly.

For children and the elderly, resuming a normal diet as soon as possible is recommended to regain strength, ensure proper healing and prevent malnutrition.


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