For decades, doctors have recommended that adults and children suffering from diarrhea resort to the BRAT diet while recovering. BRAT is an acronym for bananas, rice, applesauce and toast, a bland diet of easy-to-digest food. Now, doctors have moved away from that recommendation. Why is that and what do they recommend instead?
The BRAT Rationale
When children or adults have diarrhea, the digestive system is in a serious state of turmoil. The original idea behind the BRAT diet was to give the bowels a rest by sticking to easily digestible foods like bananas, rice, applesauce and toast. These foods were selected because they encourage the formation of firm stools, are bland in taste and smell and are easy on the stomach.
"[The diet] was developed because it was intuitively felt to be the right thing for children with diarrhea," says Dr. George Fuchs, III, a member of the American Academy of Pediatrics (AAP) Committee on Nutrition. "There was a belief that if you gave children regular food it would worsen the diarrhea."
Rethinking the BRAT Diet
However, the AAP started moving away from the BRAT diet recommendation in the late 1990s, not because the foods weren't easy to digest, but because they were low in fiber, fat and protein. "What changed is that with more evidence about how children handle the introduction of regular food, it turns out that most children with diarrhea who get regular food do just fine," Dr. Fuchs explains, noting that the nutritional content of a regular, healthy diet is far superior to that of the BRAT diet. (The AAP affirmed these guidelines in 2016.)
The Centers for Disease Control and Prevention (CDC) agreed in a 2003 report, noting that unnecessarily restrictive diets, like the BRAT diet, don't provide the nutrition that the gut needs to recover from illness. In fact, "Severe malnutrition can occur after gastroenteritis if prolonged gut rest or clear fluids are prescribed," the report said. Most of the time this isn't much of a concern, as people tend to only stay on the BRAT diet for a couple of days.
There has also been a shift in opinion about dairy during gastrointestinal episodes. "We used to be concerned about lactose intolerance and absorption, that dairy might aggravate diarrhea," Dr. Fuchs says. "It turns out that that's the great minority of cases."
BRAT Diet Alternatives
The good news is that the newer recommendation for children with stomach issues is a lot simpler. Instead of sticking to a limited grocery list, children and adults can resume a normal diet once signs of dehydration are abated. "The recommendation is to rehydrate the child with something like Pedialyte," Dr. Fuchs says. (The AAP notes that you shouldn't try to substitute homemade salt-and-water solutions.) "Once they're no longer dehydrated let them eat. If they can tolerate it, they can eat it."
Signs of dehydration include low urine output, sunken eyes and irritability. "Once those resolve then that's an indication that they're rehydrated," he explains.
The AAP now recommends resuming a normal diet including a variety of complex carbohydrates (rice, wheat, potatoes and bread) meat, yogurt, vegetables and fruits. Dr. Fuchs says that foods with protein, such as eggs, are good choices. Certain foods, like candy, soda and sugary baked goods, are best avoided. "Some children, if they've got an upset stomach, should go easy on the high fat foods because that could aggravate [nausea]," Dr. Fuchs says.
Adults can also follow similar guidelines, first rehydrating with an electrolyte solution, followed by a normal diet, and staying away from high-sugar and high-fat foods.