Medically Reviewed By William C. Lloyd III, MD, FACS
— Written By Lorna Collier
Updated on September 9, 2020
Getty
The BRAT diet—consisting of bananas, rice, applesauce and toast—was created in 1926 to help children recover from bouts of diarrhea, nausea and vomiting caused by stomach flu (gastroenteritis) or other illnesses. It later was expanded to include adults. However, many medical experts and organizations, such as the American Academy of Pediatrics and World Health Organization no longer recommend this diet, especially for children. Why the change? And what foods are OK for you and your child to eat when you're sick with diarrhea and vomiting?
Why the BRAT Diet Fell Out of Favor
The BRAT diet has long been recommended by doctors, especially for parents with young children, because its foods are bland and low in fiber, which is supposed to make them easier than many other foods to digest following gastrointestinal upset. The diet also helps replace nutrients lost during vomiting and diarrhea, such as potassium, which is found in bananas.
However, the American Academy of Pediatrics, the World Health Organization, the U.S. Centers for Disease Control and Prevention (CDC) and other experts say the diet is not helpful. Their objections primarily apply to its use in children, for whom diarrhea and vomiting can be more serious than in adults. Many experts recommend adults recovering from stomach issues also choose from a range of foods and not be restricted by those in the BRAT diet.
Critics of the BRAT diet say it:
- Has not been proven to work (no large, controlled studies show it is effective)
- Does not provide enough nutrition (in the form of fiber, protein and fat) to help patients—especially children—recover, and can result in severe malnutrition if prolonged.
- May prolong symptoms, make diarrhea worse, and delay recovery
- Does not emphasize what people—especially infants and children—most need during gastroenteritis recovery: fluids, which are critical to prevent dehydration, a potentially serious complication.
The CDC says, for children, withholding food for 24 hours or longer is inappropriate, while "early feeding decreases changes in intestinal permeability caused by infection, reduces illness duration and improves nutritional outcomes." The CDC calls the BRAT diet "unnecessarily restrictive" and says it provides "suboptimal nutrition for the patient's nourishment and recovering gut."
If people use this diet, they should not do so for more than 24 to 48 hours, experts say. It also should not be used if there are indications of more serious illness, such as fever, pain or fatigue, which require medical attention. Foods like rice are "binding" and can slow down intestinal activity. This may not be appropriate for certain medical conditions, such as an inflammatory condition in the intestines or food allergies, both of which can cause symptoms of gastroenteritis.
BRAT Diet Alternatives: What to Eat and Drink Instead
Some experts recommend a diet that includes the four BRAT diet foods, but adds a variety of other bland foods. For example, the International Foundation for Gastrointestinal Disorders suggests adding potatoes, noodles, yogurt, cream of wheat, some fruits and vegetables, and small amounts of peanut butter to increase nutrient content and electrolytes.
Others say you can resume most foods in a normal, healthy diet, once vomiting has subsided.
Most experts agree—for both children and adults—to only offer fluids until vomiting has ended. Take fluids in small amounts at first (such as with a water-dropper rather than a bottle or cup for very young children or infants, or small sips from a cup for older children and adults), to ensure the fluids don't result in more vomiting or diarrhea.
However, some differences exist in recommended diets for adults vs. children. Offer a child food appropriate for their age; include many of the foods they get as part of their normal, balanced diet. You can offer these within 24 hours of getting sick.
Infants and children
Foods and drinks recommended for infants and children include:
- Drinks that contain electrolytes, such as PediaLyte, CeraLyte or Enfalyte, which can rehydrate children. Rehydration to prevent electrolyte imbalance is the top priority.
- Watered-down fruit juice, broth, Jell-O, and popsicles
- Bland foods, such as bananas, crackers, skinless chicken, pasta, and rice cereal, in small pieces
- Bananas, watermelon and applesauce, which are easily digested fruits
- Cooked vegetables, including carrots, green beans, mushrooms, beets and others
- Cooked eggs, baked or broiled beef, pork, chicken, fish or turkey
- Potatoes, white bread, white rice, pancakes and waffles made from white flour, cream of wheat, and oatmeal, to provide easily-digested carbs
- Low-fat dairy, such as milk, cheese or yogurt, so long as these items don't cause gas, bloating or additional diarrhea
Foods and drinks to avoid for infants and children:
- Full-strength fruit juices, especially apple juice, which can make diarrhea worse
- Plain water, which isn't absorbed well by many children and doesn't replace lost electrolytes
- Sugary drinks, such as many sports drinks, sodas, and Jell-O water
- Candy or other sugar-laden treats
- Full-fat dairy products like whole milk and ice cream
- Fruits and vegetables that cause gas, including broccoli, peppers, beans, peas, berries, prunes, chickpeas, green leafy vegetables, and corn
- Fatty foods, which can be hard to digest. However, the CDC argues that some fat can have a beneficial effect on the intestines.
- Foods or drinks containing caffeine; also, no carbonated drinks
- Foods with skins and seeds (remove before serving)
Yogurt sometimes is on the recommended foods list, especially types with probiotics. However, the American Gastrological Association recently advised against giving children probiotics during recovery from gastroenteritis, saying there is not enough evidence for probiotic effectiveness. There have not been enough U.S. studies to support recommending probiotics for most gastrointestinal problems, including gastroenteritis, either in children or adults.
In addition to food and liquids, some parents may consider giving their child antidiarrheal medicine. However, experts say you should never try this type of diarrhea treatment without first consulting your child's doctor.
Adults
Foods and drinks recommended for adults include:
- Ice chips to suck on (not chew) during early stages of illness; then, sips of water, clear soda, clear broths and non-caffeinated sports drinks
- Chicken soup
- Solids, such as soda crackers, pretzels, toast, gelatin, oatmeal, bananas, rice, boiled or baked potatoes (peeled first), and chicken (skin removed). Some experts recommend sticking with white rice and bread over whole-grain, high-fiber foods, which they say can aggravate diarrhea.
- Lean proteins, carbs, vegetables and fruits, as suggested above for children, are okay for adults as well.
- Fruit-flavored gelatin or ice pops, cakes, cookies or sherbet
Foods adults should avoid until feeling better:
- Dairy products, if they seem to make your diarrhea worse or cause gas and bloating
- Caffeine
- Alcohol
- Fatty foods
- Spicy or highly seasoned foods
- Fruits and vegetables that can cause gas (the same list as for children)
If your or your child's symptoms don't improve, consult with your physician or other healthcare provider. Warning signs of a more serious problem include high fever (102 degrees F or higher), persistent vomiting (more than two days), diarrhea (more than seven days in an adult, but more than 24 hours in a child), signs of dehydration (such as confusion, lack of tears, and lack of urination), and severe abdominal pain.
Always consult your healthcare provider about diarrhea or vomiting in a child less than 6 months of age.
