Q: I’ve always heard that the BRAT diet, with its bland foods, helps ease diarrhea and nausea from a stomach bug. Do doctors still recommend that?
Doctors once swore by a diet of bananas, rice, applesauce and toast to treat gastrointestinal ailments, a regimen often known by the acronym BRAT.
“When I was training as a pediatrician, the BRAT diet was the first thing we put anyone on when they came into the hospital with diarrhea,” said Dr. Tamara Hannon, the chair of the American Academy of Pediatrics Committee on Nutrition.
But the BRAT diet was never supported by clear evidence. By the 1990s, the American Academy of Pediatrics no longer endorsed it. Researchers said the diet did not seem to benefit their patients’ recovery and that following it for more than a day or too seemed to hamper the body’s ability to fight off illness.
On the first day of a stomach bug, there is no harm in sticking to bland foods like those included in the BRAT diet, said Dr. Shruti Gohil, an internal medicine physician and infectious disease specialist at the UCI Health in Irvine, Calif.
“If you’re having trouble keeping things down, is it good to eat what you can? Sure,” she said. But there’s no evidence that eating such a limited diet improves vomiting or diarrhea.
In a 2019 clinical trial presented at the European Society for Pediatric Gastroenterology, Hepatology and Nutrition, 95 children with diarrhea were fed either the BRAT diet or a normal diet. The study authors found no difference in the number of bowel movements or recovery time between the groups.
The cyclospora outbreak that has sickened people across the country in recent weeks has highlighted the importance of knowing how to manage gastrointestinal distress.
Here’s what doctors now know about the BRAT diet, and what foods help can help you recover from a stomach bug.
Why is the BRAT diet no longer recommended?
The BRAT diet was developed in the early 20th century for children with diarrhea. Doctors believed that eating less and sticking to bland foods would reduce the number of bowel movements and the accompanying fluid loss.
The diet’s foods reflected what was cheap, widely available at the time and palatable to people struggling to keep food down. Itquickly became a mainstay for both children and adults in households and hospitals, Dr. Hannon said.
But the BRAT diet doesn’t provide the nutrients needed over time to recover from a gastrointestinal illness, experts say. The infections that typically cause vomiting and diarrhea can damage and inflame the cells that line the gut, Dr. Gohil said,disrupting the balance of good bacteria needed to stay heathy.
After an infection, the first thing is to restore the damaged cells, said Dr. Debora Duro, a pediatric gastroenterologist and the medical director of the intestinal rehabilitation program at Nicklaus Children’s Hospital in Miami. To do that, the body requires protein, fat, vitamins and minerals — all of which are lacking in the BRAT diet.
This is especially problematic for children, whose growing bodies have stricter nutritional needs than those of adults, Dr. Duro said. She was a co-author of a 2007 review article that estimated that in a typical day of following the BRAT diet, a toddler would receive significantly lower daily amounts of calcium and vitamins A and B12 than dietary guidelines recommend.
“This diet should never be continued for more than 24 hours after the first episode of diarrhea,” Dr. Duro said.
What should you eat when recovering from a stomach bug?
Gastroenteritis impairs the digestive system’s ability to absorb water and electrolytes, so staying hydrated should be your first priority, Dr. Gohil said. But don’t forget to replenish electrolytes, which she recommends getting through the rehydration drink Pedialyte or its generic equivalent.
It’s also important to get back to a normal diet as quickly as possible, making sure to include plenty of protein to help rebuild cells and fiber to support the recovery of good bacteria, Dr. Hannon said.
If nausea and diarrhea make many foods seem unappealing, it’s fine to eat foods that go down easier, including those in the BRAT diet.
“Just make sure you add other foods as well,” Dr. Hannon said. For example, a banana cut up on toast with a light smear of peanut butter provides protein, fat and fiber.
Other foods that deliver a nutritional punch without causing too much gastrointestinal distress include poached chicken breast, eggs, bone broth, oatmeal and potatoes, Dr. Gohil said. Eggs are rich in fat and protein; bone broth is both hydrating and contains minerals; oatmeal can help bulk up watery stool; and potatoes are rich in potassium.
Dr. Hannon’s only strict guideline is to steer clear of sugary foods and drinks, including soda and juice. Sugar, she said, can promote the growth of harmful bacteria and prolong diarrhea.
Other than that, she said, go by your intuition.
“If your body doesn’t want to eat toast and it wants to eat an egg,” Dr. Hannon said, “there’s absolutely no scientific evidence of why you should choose toast over an egg.”
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