BRAT diet
Encyclopedia
The BRAT diet is a treatment historically prescribed 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.
An acronym, BRAT is a mnemonic
for banana
s, rice
, apple sauce and toast
, the staples of the diet. Extensions to the BRAT diet include BRATT (with tea
) and BRATTY (with 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 acetones to avoid salt imbalance. Severe, untreated salt imbalance can result in "extreme weakness, confusion, coma, or death."
as long-term use can lead to nutritional deficiencies. 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 not always best during diarrhea. The intestinal mucosal cells are damaged in common viral enteritis, and are not able to properly absorb nutrients until they regenerate, which requires about 48 hours. Many clinicians feel that restricting food intake during this time, especially difficult to digest substrates such as fats and proteins, helps to shorten the duration of the diarrhea (and also nausea and vomiting) that results from the enteric insult. Thus the usual recommendation for clear liquids, especially those that replace the salts lost in diarrhea and vomiting. Gatorade and bouillion are ideal for this. The brain can only use glucose as a fuel (and, normally to a lesser degree, ketones), so the sugars in gatorade and hard candy may help to ward off the mental confusion that can accompany the illness. If sugars are restricted, the body's natural mechanism is to break down muscle tissue to generate glucose, as fat cannot be broken down into glucose. Once the nausea has resolved, and hunger returns, the BRAT diet can supply carbohydrates which are easier to metabolize by the weakened intestine than are fats and proteins. The BRAT diet can also serve as a test diet, since if symptoms return or worsen that is a sign that the diet was advanced too soon. Grits or oatmeal can be substituted for the rice. Studies have found, however, that incorporating foods from the BRAT diet may reduce the severity of diarrhea. The BRAT diet was never meant to be exclusive; the need for salt replacement should always be kept in mind. It was only designed to give patients some idea of what they could try as they advance their diet, so as to avoid a relapse. Apple sauce provides pectin
, 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.
Medical attention is required when on the BRAT diet if there is any blood or mucus present in the diarrhea, if the diarrhea is severe or if it lasts longer than 3 days.
(cereal, rice, apple sauce, and milk) since it may add more complete protein
and needed fat into the diet.
Additionally, other medical professionals advise first aid treatment for gastroenteritis by briefly limiting the diet to bland, easy-to-digest foods and plenty of liquids (including oral rehydration therapy, e.g. oral pediatric electrolyte solutions sold at retail).
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
, dyspepsia
Dyspepsia
Dyspepsia , also known as upset stomach or indigestion, refers to a condition of impaired digestion. It is a medical condition characterized by chronic or recurrent pain in the upper abdomen, upper abdominal fullness and feeling full earlier than expected when eating...
, and/or gastroenteritis
Gastroenteritis
Gastroenteritis is marked by severe inflammation of the gastrointestinal tract involving both the stomach and small intestine resulting in acute diarrhea and vomiting. It can be transferred by contact with contaminated food and water...
. The BRAT diet consists of foods that are relatively bland and low in fiber
Dietary fiber
Dietary fiber, dietary fibre, or sometimes roughage is the indigestible portion of plant foods having two main components:* soluble fiber that is readily fermented in the colon into gases and physiologically active byproducts, and* insoluble fiber that is metabolically inert, absorbing water as it...
. Low-fiber foods were recommended as it was thought that foods high in fiber cause gas and possibly worsen gastrointestinal upset.
An acronym, BRAT is a mnemonic
Mnemonic
A mnemonic , or mnemonic device, is any learning technique that aids memory. To improve long term memory, mnemonic systems are used to make memorization easier. Commonly encountered mnemonics are often verbal, such as a very short poem or a special word used to help a person remember something,...
for banana
Banana
Banana is the common name for herbaceous plants of the genus Musa and for the fruit they produce. Bananas come in a variety of sizes and colors when ripe, including yellow, purple, and red....
s, rice
Rice
Rice is the seed of the monocot plants Oryza sativa or Oryza glaberrima . As a cereal grain, it is the most important staple food for a large part of the world's human population, especially in East Asia, Southeast Asia, South Asia, the Middle East, and the West Indies...
, apple sauce and toast
Toast
Toast is bread that has been browned by exposure to radiant heat. This browning reaction is known as the Maillard reaction. Toasting warms the bread and makes it firmer, so it holds toppings more securely...
, the staples of the diet. Extensions to the BRAT diet include BRATT (with tea
Tea
Tea is an aromatic beverage prepared by adding cured leaves of the Camellia sinensis plant to hot water. The term also refers to the plant itself. After water, tea is the most widely consumed beverage in the world...
) and BRATTY (with 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 acetones to avoid salt imbalance. Severe, untreated salt imbalance can result in "extreme weakness, confusion, coma, or death."
Nutritional analysis
The diet is no longer recommended for most patients . 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 diseaseGraft-versus-host disease
Graft-versus-host disease is a common complication after a stem cell transplant or bone marrow transplant from another person . Immune cells in the donated marrow or stem cells recognize the recipient as "foreign". The transplanted immune cells then attack the host's body cells...
as long-term use can lead to nutritional deficiencies. BRAT is nutritionally incomplete and may be deficient in energy, fat, protein, fiber, some vitamins and calcium. Cultured foods, rice water
Rice water
Rice water is the suspension of starch obtained by draining boiled rice or by boiling rice until it completely dissolves into the water. This may be used as a weak gruel for invalids...
, 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 not always best during diarrhea. The intestinal mucosal cells are damaged in common viral enteritis, and are not able to properly absorb nutrients until they regenerate, which requires about 48 hours. Many clinicians feel that restricting food intake during this time, especially difficult to digest substrates such as fats and proteins, helps to shorten the duration of the diarrhea (and also nausea and vomiting) that results from the enteric insult. Thus the usual recommendation for clear liquids, especially those that replace the salts lost in diarrhea and vomiting. Gatorade and bouillion are ideal for this. The brain can only use glucose as a fuel (and, normally to a lesser degree, ketones), so the sugars in gatorade and hard candy may help to ward off the mental confusion that can accompany the illness. If sugars are restricted, the body's natural mechanism is to break down muscle tissue to generate glucose, as fat cannot be broken down into glucose. Once the nausea has resolved, and hunger returns, the BRAT diet can supply carbohydrates which are easier to metabolize by the weakened intestine than are fats and proteins. The BRAT diet can also serve as a test diet, since if symptoms return or worsen that is a sign that the diet was advanced too soon. Grits or oatmeal can be substituted for the rice. Studies have found, however, that incorporating foods from the BRAT diet may reduce the severity of diarrhea. The BRAT diet was never meant to be exclusive; the need for salt replacement should always be kept in mind. It was only designed to give patients some idea of what they could try as they advance their diet, so as to avoid a relapse. Apple sauce provides pectin
Pectin
Pectin is a structural heteropolysaccharide contained in the primary cell walls of terrestrial plants. It was first isolated and described in 1825 by Henri Braconnot...
, 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.
Medical attention is required when on the BRAT diet if there is any blood or mucus present in the diarrhea, if the diarrhea is severe or if it lasts longer than 3 days.
Alternatives
An alternative diet that is being researched is the CRAM dietCRAM diet
The CRAM diet a short term dietary treatment for diarrhea and gastroenteritis. The CRAM diet has more complete protein and fat content than the BRAT diet.-Recent research:...
(cereal, rice, apple sauce, and milk) since it may add more complete protein
Protein
Proteins are biochemical compounds consisting of one or more polypeptides typically folded into a globular or fibrous form, facilitating a biological function. A polypeptide is a single linear polymer chain of amino acids bonded together by peptide bonds between the carboxyl and amino groups of...
and needed fat into the diet.
Additionally, other medical professionals advise first aid treatment for gastroenteritis by briefly limiting the diet to bland, easy-to-digest foods and plenty of liquids (including oral rehydration therapy, e.g. oral pediatric electrolyte solutions sold at retail).