How does the BRAT diet manage gastrointestinal problems?
The BRAT diet - limitations and modifications
What to eat and avoid after stomach flu
When to seek medical advice
References
Further reading
The acronym BRAT stands for bananas, rice, applesauce, and toast, which is supposed to constitute a bland diet that is easy to digest.1 Although this diet has been historically recommended to children or adults with digestive issues, such as gastroenteritis and diarrhea, 21st-century clinicians no longer advocate it. Doctors have highlighted that the BRAT diet does not aid in the complete recovery of gastrointestinal issues and leads to energy deficiency and malnutrition.2
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How does the BRAT diet manage gastrointestinal problems?
Patients who persistently suffer from acid-peptic disease, excess gas formation, and gastrointestinal complaints have been typically recommended the BRAT diet. The key rationale behind this diet is that it is less acidic, easily breaks down in the digestive system, and causes fewer bowel movements. This provides sufficient rest for the gastrointestinal tract to recover.2
The key components of the BRAT diet, i.e., bananas, rice, applesauce, and toast, can be digested easily, and its fiber content helps solidify stool in patients with diarrhea.3 Fiber is an important dietary component that allows the colon to work more efficiently. An efficient bowel movement also reduces the risk of hemorrhoids or diverticulosis.4
It has been documented that bananas and rice possess antidiarrheal properties.5 Rice in the form of a soup, along with an oral rehydration solution, is beneficial for children with diarrhea.6 The low fat and protein content of the BRAT diet protects the digestive system from additional stress. Furthermore, the lack of food components that are high in flavor or strong smells reduces the risk of nausea and vomiting.
The BRAT diet - limitations and modifications
The BRAT diet is low in fiber, fat, protein, and micronutrients that play important roles in gastrointestinal tract recovery. It is also heavy in carbohydrates, which draw water into the digestive tract, potentially worsening diarrhea.7 The BRAT diet may also affect gut health and negatively influence overall health status.
The American Academy of Pediatrics currently recommends that children eat a well-balanced diet appropriate to their age within 24 hours of getting sick.8 A higher intake of gut-friendly foods, such as oatmeal, sweet potatoes, and fruits (e.g., melons and berries) is more beneficial. Both children and adults are recommended to drink plenty of fluids to avoid dehydration after being affected by stomach flu or other gastrointestinal viruses or bacteria.
In comparison to water, electrolyte replenishment is more effective in treating vomiting and diarrhea. Electrolytes contain minerals, such as potassium, sodium, and calcium, which play an important role in healthy body functions. Different oral rehydration solutions (ORS), such as high-sodium/high-osmolarity ORS and low-sodium/low-osmolarity ORS, can effectively alleviate dehydration.9
In comparison to glucose-based drinks, those containing amino acids are more effective rehydrating drinks. Commercially available drinks, such as Gatorade and Pedialyte, or homemade electrolytes containing coconut water, salt, and calcium-magnesium, have shown significant rehydrating efficacy.
Patients are also recommended to a BRATY diet that contains all components of a BRAT diet with natural yogurt. Yogurt contains probiotics like Lactobacillus acidophilus and Lactobacillus casei that improve gut health. Other foods that are high in probiotics are miso soup, fermented vegetables, and kefir.
What to eat and avoid after stomach flu
It is best to provide rest to the stomach for the first six hours after diarrhea or vomiting. Subsequently, the patients can consume clear liquids, such as water, flat soda, weak tea, or broth. On the following day, a BRAT diet, along with other bland food, such as oatmeal, porridge, and crackers, could be introduced. On the third day, soft foods such as cooked vegetables, white meat, chicken, fruits, and eggs can be consumed. Strong spices and seasonings must be avoided.
Foods that should be avoided in the first three days of stomach infection include cruciferous vegetables (e.g., broccoli and cabbage), dairy products, citrus fruits like oranges, pineapples, and grapefruits, berries, alcohol, and other caffeinated beverages. It is also not ideal to consume heavy proteins, such as pork and salmon, as proteins and fats are difficult to digest and could exert stress on the stomach. The BRAT diet also recommends avoidance of foods with high sugar and dairy content.
When to seek medical advice
Even though, in most cases, BRAT or a bland diet can effectively alleviate stomach flu symptoms, in certain cases, it is recommended to consult a doctor. For instance, if the patient develops a temperature of 102ºF or higher, diarrhea accompanied by rectal pain or bleeding, and diarrhea continues beyond two days or at a higher frequency, it is advisable to see a doctor.3,7
It is also advisable to seek medical care for dehydration symptoms, such as dry mouth and reduced urine output. Patients with persistent weakness and those who feel light-headed or dizzy must consult a doctor. In addition to the above symptoms, children or infants who experience vomiting or diarrhea for more than 24 hours, have sunken cheeks, and cannot produce tears must see a doctor.
References
- Kelly E. BRAT Diet: What Is It and Does It Work? Healthline. https://www.healthline.com/health/brat-diet. 2023; Assessed on August 15, 2024.
- Weir SBS, et al. Bland Diet. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK538142/. Assessed on August 14, 2024.
- The BRAT diet: What to eat after a stomach virus. Pieldmont. https://www.piedmont.org/living-real-change/the-brat-diet#:~:text=But%20this%20diet%20is%20helpful,stool%20if%20you%20have%20diarrhea. Assessed on August 14, 2024.
- Ho KS, et al. Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms. World J Gastroenterol. 2012;18(33):4593-6. doi: 10.3748/wjg.v18.i33.4593.
- Sarmin M, et al. Efficacy of a Green Banana-Mixed Diet in the Management of Persistent Diarrhea: Protocol for an Open-Labeled, Randomized Controlled Trial. JMIR Res Protoc. 2020;9(3):e15759. doi: 10.2196/15759.
- Kianmehr M, et al. The Effect of G-ORS Along With Rice Soup in the Treatment of Acute Diarrhea in Children: A Single-Blind Randomized Controlled Trial. Nurs Midwifery Stud. 2016;5(2):e25852. doi: 10.17795/nmsjournal25852.
- Ajmera R. What Is The BRAT Diet—And What Should You Eat With An Upset Stomach? Forbes Health. https://www.forbes.com/health/nutrition/diet/brat-diet/#:~:text=This%20is%20because%20the%20diet,%2C%20fiber%2C%20fats%20and%20micronutrients.2024; Assessed on August 14, 2024.
- Sachdev P. The BRAT Diet. WebMD. https://www.webmd.com/children/brat-diet. 2023; Assessed on August 14, 2024.
- Suh JS, Hahn WH, Cho BS. Recent Advances of Oral Rehydration Therapy (ORT). Electrolyte Blood Press. 2010;8(2):82-6. doi: 10.5049/EBP.2010.8.2.82.
Further Reading