The BRAT diet is, historically, a prescribed treatment for patients with gastrointestinal distress such as diarrhea, dyspepsia, and/or gastroenteritis. The BRAT diet consists of foods that are relatively bland and low in fiber. Low-fiber foods were recommended as it was thought that foods high in fiber cause gas and possibly worsen gastrointestinal upset.
BRAT is the mnemonic acronym for Bananas, Rice, Applesauce and Toast, the staples of the diet.University Of Michigan Mott Children's Hospital. "BRAT diet: What is the BRAT diet?" Extensions to the BRAT diet include BRATT (Bananas, Rice, Applesauce, Toast, and Tea) and BRATTY (Bananas, Rice, Applesauce, Toast, Tea and Yogurt).
In addition to dietary restrictions, medical professionals recommended that all patients, regardless of age, intake plenty of fluids to prevent dehydration, along with oral rehydration solutions to replace the depleted electrolytes to avoid salt imbalance. Severe, untreated salt imbalance can result in "extreme weakness, confusion, coma, or death."McLaughlin, Eileen (July 24, 2000). "salt imbalance"
Nutritional analysis
The diet is no longer recommended for most patients .King CK, Glass R, Bresee JS, Duggan C (November 2003). "Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy". MMWR Recomm Rep 52 (RR-16): 1–16. PMID 14627948 The American Academy of Pediatrics states that most children should continue a normal, age appropriate diet. The foods from the BRAT diet may be added, but should not replace normal, tolerated foods. Sugary drinks and carbonated beverages should be avoided. The BRAT diet is no longer routinely recommended by nutritionists at the Seattle Cancer Care Alliance (SCCA) to patients who have had stem cell transplants and have diarrhea due to Graft versus Host Disease as long-term use can lead to nutritional deficiencies. The foods from the BRAT diet may be added, but should not replace normal, tolerated foods. BRAT is nutritionally incomplete and may be deficient in energy, fat, protein, fiber, some vitamins and calcium. Cultured foods, rice water, coconut water and soluble fiber foods/supplements are more effective at treating ongoing diarrhea in conjunction with tolerated foods and beverages.
A well-balanced diet is best even during diarrhea. Studies have however found that incorporating foods from the BRAT diet may reduce the severity of diarrhea. Applesauce provides pectin,A. M. Godfrey Usiak, M. C. Bourne, and M. A. Rao. Blanch Temperature/Time Effects on Rheological Properties of Applesauce. Journal of Food Science. November 1995;60(6):1289 as does toast with grape jelly.
In 2007, Debora Duro and Christopher Duggan reported that bananas and rice have been shown to have a positive effect on the bowels, but recommended caution in using the diet. In vitro research has found that rice may offer anti-secretory benefits. In studies of choleric patients, rice-based oral re-hydration solutions help decrease stool volume and stop diarrhea sooner. Duro and Duggan referenced a meta-analysis that looked at thirteen studies. The banana’s high content of amylase-resistant starch has been shown to protect the gastrointestinal mucosa in animals and reduce symptoms of non-ulcer dyspepsia and peptic ulcer in people. Amylase-resistant starch is broken down into short-chain fatty acids in the colon, a process that may reduce water and electrolyte losses and benefit GI symptoms. Duro and Duggan cite one study in which adding pectin or bananas to the diet significantly decreased stool weight and stopped diarrhea much sooner, compared with a rice diet alone.
Adding rice, bananas, or pectin to the diet during diarrhea may be beneficial, but Duro and Duggan point out that the BRAT diet is not nutritionally complete and may be deficient in energy, fat, protein, fiber, vitamin A, vitamin B12, and calcium. Duro and Duggan also say that food restriction does not benefit diarrhea and actually causes individuals to suffer from diarrhea for longer periods of time, based on randomized clinical trials.Duro, Debora; Duggan, Christopher (June 2007). "The BRAT Diet for Acute Diarrhea in Children: Should It Be Used?" (PDF). Practical Gastroenterology
Contact your health care provider if the following symptoms occur:
Alternative
An alternative diet that is being researched is the CRAM diet (Cereal, Rice, Applesauce, and Milk) since it may add more complete protein and needed fat into the diet.Gail Rosenblum. "Take That, BRAT!: CRAM beats BRAT when it comes to treating diarrhea". Sesame Street Parents
Food summary
BRAT(TY) diet
Alternative: CRAM diet
Avoid
- Soft drinks
- Pre-sweetened cereals
- Grapes
- Avocado based dips
- Pretzels
- Vegetables
