What is the BRAT diet and why is it unsafe?

What is the BRAT diet?

The BRAT diet stands for bananas, rice, applesauce, and toast. It was first developed in the 1920s. Until recently, it was a a popular recommendation by American doctors for treating children with upset stomachs - a general term that describes a painful or uncomfortable stomach that's often caused by indigestion - or problems with your digestive tract.

Now, experts believe that this diet is too restrictive and lacks nutrients.

But why this seemingly random combination of foods? The idea of the BRAT diet is that these foods are gentle on the stomach. "The foods in this diet were previously thought to be simple, plain and bland foods which are easy to digest," explains Kirsten Jackson, a consultant dietitian at The Food Treatment Clinic and British Dietetic Association (BDA) member.

According to the National Institutes of Health (NIH), bland foods are¹:

• Easily digestible.

• Soft in consistency.

• Low-fibre.

• Cooked.

• Non-spicy.

Experts believed that people with upset stomach illnesses could benefit from a diet consisting solely of bland BRAT diet foods that:

• Are gentle on your stomach - They are low in protein and fat, two nutrients which can be more difficult to digest when you have a stomach illness.

• Make your poo firmer - They are low in fibre and are starchy which can help runny poos to bind together more easily².

• May reduce nausea - They are relatively bland in taste and smell. Certain people, like those experiencing pregnancy sickness, may find this more tolerable.

Despite the four foods in its name, the BRAT diet can include other bland food options.

BRAT diet food list for adults and children

When would the BRAT diet be recommended?

"The BRAT diet was recommended when someone was having digestive problems or symptoms," says Jackson. This includes using this low-fibre diet for an upset stomach.

Other stomach-related issues:

• BRAT diet for stomach flu (gastroenteritis) - Despite being commonly called "stomach flu" this illness is not actually caused by the influenza virus but by various stomach bugs. This can cause pain, vomiting, and diarrhoea.

• BRAT diet for diarrhoea - Loose, frequent, and unpredictable bowel movements can have a number of causes, including stomach flu, viral infections, anxiety, and drinking too much alcohol..

• BRAT diet for acid reflux - Stomach acid rises up into the gullet (oesophagus) causing a burning sensation. This might occur when you eat too many high-fat or acidic foods or drink too much alcohol.

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Why is the BRAT diet now considered too risky?

Too restrictive

Experts no longer recommend the BRAT diet for adults and children: "It is extremely restrictive so would lead to nutritional deficiencies," says Jackson.

In other words, the range of nutrients in BRAT diet foods are too limited. Not only can this slow your recovery from stomach illness, but it might also cause other serious health issues related to malnutrition. In extreme cases, there is some evidence that the diet can even result in severe malnutrition in young children⁵.

Even though bananas and rice are healthy foods, following a diet containing only those foods can affect your body in a negative way. In fact, a lack of nutrients can make diarrhoea worse, and this illness can also make it harder to absorb nutrients in your diet.

As a result, health organisations no longer recommend the BRAT diet, including the American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC).

Contain FODMAPs

"We also now know that foods like apple, bread, and bananas contain FODMAPs," adds Jackson. "These are types of carbohydrates which are broken down in the large bowel, causing more gas to be produced and more fluid to be drawn in. In people with digestive problems, this can cause symptoms of pain, bloating, and runny poos."

Better and safer ways to recover from stomach illness

When it comes to eating during stomach problems, the current medical advice is to continue consuming a balanced diet. It's also very important that you drink enough water to prevent dehydration, especially if you have vomiting or diarrhoea symptoms.

You can usually treat stomach-related symptoms at home

Your pharmacist can suggest further treatment options if symptoms of diarrhoea continue beyond 5-7 days and vomiting beyond 1-2 days. You should also seek their advice if you notice signs of dehydration, such as urine that's dark in colour and strong in smell.

They may recommend:

• Powders that you mix with liquid that can help to rehydrate you.

• Medicine that stops diarrhoea for a few hours.

Stomach bugs and viruses that can cause common upset stomach symptoms like diarrhoea, vomiting, and pain can be very contagious. You or your child should stay at home and avoid going into work or school for 48 hours after the symptoms have cleared.

Further reading

1. Weir and Akhondi: Bland diet.

2. Ho et al: Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms.

3. Falcomer et al: Health benefits of green banana consumption: a systematic review.

4. Kianmehr 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.

5. Duro and Duggan: The BRAT diet for acute diarrhea in children: should it be used?