The Role of BRAT Diet in Treating Gastrointestinal Illness!

There are trillions of bacteria, fungi, viruses, and other microbes in your gut, collectively known as the gut microbiome. The composition of the gut microbiome is unique to each individual and can fluctuate due to various factors. Diet is one of the key factors that can modify the composition of microbes in your gut. Consuming a wide variety of fiber-rich and bland foods contributes to a diverse and healthy gut microbiome whereas processed foods, fried foods and spicy foods with refined sugars and saturated fats can harm your gut microbiome. For instance, eating a high-fat, low-fiber diet increases the number of bacteria that are responsible for lipid digestion whereas the bacteria that digest fiber will be deprived of nutrition and die off

Certain diets are specifically designed to address gut problems, such as the low FODMAP diet, elimination diet, and the microbiome diet. An elimination diet requires you to avoid certain foods to find out what foods you are sensitive to. The low FODMAP involves removing certain sugars from the diet to help people with intestinal disorders, such as irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO). Both these diets are similar in the sense that they work as diagnostic tools to identify foods that trigger unwanted symptoms. But there are some differences. Some foods that are allowed in the low FODMAP diet are non-compliant in the elimination diet, and vice versa.

The microbiome diet is a three-step program that begins with the elimination phase. It claims to improve gut health, reduce cravings, and boost your metabolism. Another diet that is recommended to people with stomach problems is the BRAT diet. If you have been recommended this diet by your healthcare provider or you are looking to ease a temporary digestive issue, it is important to know its protocols for the diet to be safe and effective. This article discusses the basis of this diet and its effectiveness in treating stomach issues so that it does not make your symptoms worse.

What is the BRAT diet and its origin?

The acronym BRAT stands for bananas, rice, applesauce, and toast. It originated in the 1920s and was developed with the idea that during digestive distress, you must eat something bland. Historically, most pediatrics would recommend it to children to treat loose and runny stools. The idea behind the BRAT diet is that these foods are easy on the stomach illness and also reduce the stool produced.

The diet includes foods that are low in fiber, protein, and fat. It mainly comprises simple carbohydrates for easy digestion. It allows the digestive tract to recover from digestive or stomach illnesses, such as to treat diarrhea, stomach flu, stomach bug, vomiting, and nausea. While the BRAT diet may be beneficial short-term, it is not advisable to stick to a diet so low in essential nutrients for a long period.

Benefits of the BRAT Diet

It is believed that the BRAT diet can have several benefits for people with digestive disorders. These benefits include:

• Less load on the stomach. Foods low in protein and fat don’t put a lot of stress on the digestive system or irritate your stomach. And hence are classified as easy-to-digest foods.
• Firmer stools. Starchy, low-fiber foods allow the stool to bind easily and stop runny stools.
• Reduces nausea. Since these foods don’t have strong smells or flavors, the BRAT diet foods are unlikely to cause vomiting or nausea.

Protocols of the BRAT Diet

• There are limited research-backed guidelines on the BRAT diet but there are recommendations for a 3-day diet plan. 
• You may want to avoid eating altogether within the first 6 hours of your illness.
• Allow your digestive system to wait till diarrhea or vomiting has stopped completely before eating again.
• While you wait, you can sip on water or energy/sports drinks and suck on ice chips or popsicles. This step helps to restore the electrolytes that are often lost during a stomach upset.
• Start adding liquids back into your diet within the first 24 hours of your illness. These include water, vegetable/chicken broth, or apple juice.
• If the symptoms come back, stop drinking these liquids for a couple of hours and try again.
• On the second day, you can begin the BRAT diet. Due to its restrictive nature, you don’t want to follow it longer than necessary.
• On the third day, you may start including regular foods in your diet, if you feel like it. You can have cooked vegetables and fruits, soft-cooked eggs, and white meat, such as chicken or turkey.
• The most important thing is to listen to your body. If you eat a variety of foods too soon, your symptoms are likely to return.

Studies on the BRAT Diet

While there are no scientific studies on the BRAT diet itself, there are studies on foods included in the BRAT diet and their effect on digestive problems.

A double-blind, controlled clinical trial was conducted on 62 boys (age: 5-12 months) in which the treatment group was either given rice or rice combined with either pectin or cooked green banana for seven days. The researchers analyzed the stool samples of the two groups with that of the group which received only rice. The study revealed that banana or pectin-containing diets gave much better results than rice alone. The researchers observed a reduction in stool weight and frequency of vomiting. The two groups also required fewer ORS and Intravenous fluids than the group that ate only rice ^[1].

A randomized study was conducted to evaluate the effect of rice-based ORS on 189 Mexican children diagnosed with acute diarrhea (age: 3-24 months). They were given either glucose-based ORS or rice-based ORS. The study showed that the group that received rice-based ORS required less intravenous fluids compared to the group that received glucose-based ORS. Rice-based ORS can lower the osmolarity which is also related to less stool production and less vomiting ^[2].

A study was conducted to evaluate the effect of reducing dietary fiber on 63 people suffering from constipation who were asked to follow a no-fiber diet. Thereafter, they were asked to stay on a low-fiber diet to the extent they found acceptable. The patients showed an improvement in constipation and its symptoms as well as the frequency of bowel movements ^[3].

A randomized, crossover clinical trial was conducted on 14 trained cyclists to evaluate their performance in 75 km cycling after consuming bananas vs. a 6% carbohydrate drink. They were either given bananas or a 0.2 g/kg carbohydrate drink after every 15 minutes. The study revealed that consuming bananas before and during an intensive and prolonged exercise can support athletic performance by improving fuel substrate utilization ^[4].

Foods you can eat in the BRAT Diet

You might feel eating will worsen symptoms and it will get difficult managing diarrhea, but it is your food choices that can help relieve symptoms and allow you to restore health conditions. Some experts believe that the BRAT diet is different from the bland diet, but most experts agree that you can have more than just bananas, rice, applesauce, and toast on a BRAT diet, as long as you are eating bland foods that are gentle on the stomach and are easily digested. Foods that are compliant with the BRAT diet are often known as binding foods, as they can firm up your stool and help in treating diarrhea. Other suitable BRAT Diet food list includes:

• Boiled/baked potatoes
• Cooked cereals, such as cream of wheat and oatmeal
• Apple juice/flat soda
• Popsicles
• Sherbet
• Chicken broth
• Weak tea

Foods you should AVOID in this Diet

Certain foods can cause your symptoms to return if eaten too soon. The following foods should be avoided in the first three days of the illness:

• Dairy products
• Avoid fried, spicy and greasy foods
• Sugar
• Tofu or soy
• Legumes
• Alcohol and caffeine
• Very hot or very cold drinks
• Proteins such as pork, steak, and salmon
• Acidic foods, such as lemons, limes, oranges, grapes, and berries
• Raw vegetables such as carrots, broccoli, salad greens, and cauliflower

BRAT Diet Meal Plan

• Breakfast
  Boil 1 cup rice with 2 cups water and a little bit of salt until soft. Strain the remaining water.
• Mid-day snack
  ½ cup apple sauce: Add 3 peeled, cored, and chopped apples, ½ cup water, and a pinch of cinnamon powder (optional) to a saucepan and bring to a boil. Reduce the flame and cook for 25-30 minutes. Mash the applesauce with a potato masher, fork, or blender. Add ½ Tbsp. lemon juice. Have with 250ml of tender coconut water.
• Lunch
  White toast with a small amount of jam.
• Evening snack
  ½ cup plant-based yogurt
• Dinner
  ½ cup raw oatmeal prepared with 1 cup almond/coconut milk. You may sweeten it only slightly using honey.

Key points to note:

• Whole wheat bread is generally healthier than white bread but the simple carbohydrates present in white bread make it more suitable for the BRAT diet. Avoid any kind of butter for the toast as they have high-fat content.
• Yogurt is known to reduce the duration and intensity of diarrhea and is also a good source of probiotics that can improve your gut health by encouraging the growth of beneficial bacteria.
• If purchasing jam or applesauce, make sure to get unsweetened variants as sugary foods can be difficult to digest and may worsen symptoms in some people.
• Diarrhea can cause dehydration. Therefore, it is important to stay hydrated and drink plenty of fluids to replenish the electrolytes in the body. Sip on water and electrolytic drinks throughout the day.
• Oral rehydration products can be purchased over the counter and may help people with moderate dehydration. They are available in the form of a liquid, powder, or popsicle.

Side effects of the BRAT Diet

Following the BRAT diet for a long period does not have any significant harm, but one should avoid staying on this diet long-term. The major issue with a prolonged BRAT diet is that it can cause malnutrition (nutrient and calorie deficiencies) and fatigue as it lacks enough calories and nutrients, including fiber, fat, protein, calcium, vitamin A, and vitamin B12.

In the long run, it is detrimental to your skin, hair, nails, bones, and teeth, and may prolong your illness. Due to its restrictive nature, experts don’t recommend the BRAT diet to children suffering from diarrhea as often. However, making these foods a part of the child’s normal diet can be beneficial if eaten alongside a variety of foods.

You must see a doctor if you experience:

• Diarrhea for more than 3 days
• Reduced urine
• A temperature of 102°F or higher
• Sunken cheeks
• No tear production
• Light-headedness
• Dry mouth
• Rectal pain or bleeding

Conclusion

Although it has been recommended by doctors for decades, the BRAT diet is not supported by research. But temporarily switching to foods such as bananas, rice, potatoes, and oatmeal may help treat stomach problems and allow you to recover sooner. It is important to treat these issues as they can lead to dehydration, which can have serious consequences if left untreated. Make sure to include fluids in your diet and try to include foods as soon as your body can tolerate them. Thereafter, gradually transition into having a balanced diet to restore your energy and nutritional deficiencies, as soon as you can. The BRAT diet is not designed to be used for weight loss, as it lacks proper nutrition and is not healthy for long-term use.

The BRAT diet is recommended for people suffering from digestive diseases and its symptoms, including upset stomach, heartburn, vomiting, nausea, gastritis, and after surgeries when it is beneficial to have gentle digestion. In some cases, the BRAT diet just doesn’t seem to work. If you don’t feel any better and continue to have bouts of diarrhea or vomiting, you must see your healthcare provider and may consider using a pre and probiotic supplement that are now easily available online to help treat leaky gut, IBD, SIBO, etc. Learn more about the 10 Best Leaky Gut Supplements that are natural and are way better than any taking medication!

The BRAT diet not only helps you recover from these ailments but also allows your digestive system to rest, ensuring it is in good working order. Moreover, our digestive system has to work very hard to digest the food we eat. Due to modern eating habits, digestion takes much more energy than it is supposed to. This drains the energy required for the body to heal and maintain our body. Even though the results seem promising, more research is required to determine its safety and effectiveness.

References

1. Rabbani GH, Teka T, Zaman B, Majid N, Khatun M, Fuchs GJ. Clinical studies in persistent diarrhea: dietary management with green banana or pectin in Bangladeshi children. Gastroenterology. 2001 Sep;121(3):554-60. doi: 10.1053/gast.2001.27178. PMID: 11522739.
   
2. Maulen-Radovan I, Gutierrez-Castrellón P, Hashem M, Neylan M, Baggs G, Zaldo R, Ndife LI, Pollack PF, Santosham M. Safety and efficacy of a premixed, rice-based oral rehydration solution. J Pediatr Gastroenterol Nutr. 2004 Feb;38(2):159-63. doi: 10.1097/00005176-200402000-00011. PMID: 14734877.
   
3. Ho KS, Tan CY, Mohd Daud MA, Seow-Choen F. Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms. World J Gastroenterol. 2012 Sep 7;18(33):4593-6. doi: 10.3748/wjg.v18.i33.4593. PMID: 22969234; PMCID: PMC3435786.
   
4. Nieman DC, Gillitt ND, Henson DA, Sha W, Shanely RA, Knab AM, Cialdella-Kam L, Jin F. Bananas as an energy source during exercise: a metabolomics approach. PLoS One. 2012;7(5):e37479. doi: 10.1371/journal.pone.0037479. Epub 2012 May 17. PMID: 22616015; PMCID: PMC3355124.

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