BRAT diet

Last updated

2020-03-15 01 53 18 A single peeled banana in the Franklin Farm section of Oak Hill, Fairfax County, Virginia.jpg
2020-03-27 19 36 25 A pot of white rice after cooking in the Franklin Farm section of Oak Hill, Fairfax County, Virginia.jpg
Apple-sauce-544676.jpg
Making toasts.jpg
The BRAT diet: banana, rice, apple sauce, and toast

The BRAT diet(Bananas, Rice, Apples, Toast) is a restrictive diet that was once recommended for people, particularly children, with gastrointestinal distress like vomiting, diarrhea, or gastroenteritis. Evidence, however, does not support a benefit. [1] As of the 21st century, it is no longer recommended, as it is unnecessarily restrictive. [1] [2] The diet was first discussed in 1926. [1]

Contents

An acronym, BRAT stands for bananas, rice, apple sauce, and toast, the four food components of the diet. [1] Additionally, it is recommended that all people, regardless of age, drink plenty of fluids to prevent dehydration, along with oral rehydration solutions to replace the depleted electrolytes and avoid salt imbalance. [3] Severe, untreated salt imbalance can result in "extreme weakness, confusion, coma, or death." [4]

Nutritional analysis

The BRAT diet is no longer generally recommended. [2] 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. [5] The BRAT diet is no longer routinely recommended to those who have had stem cell transplants and have diarrhea due to graft-versus-host disease, as long-term use can lead to nutritional deficiencies.

Adding rice, bananas, or pectin to the diet while suffering from diarrhea may be beneficial, but physicians Debora Duro and Christopher Duggan point out that the 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 alleviate diarrhea and actually causes individuals to have diarrhea for longer periods, according to randomized clinical trials. [6]

Medical attention is required when on the BRAT diet if any blood or mucus is present in the diarrhea, if the diarrhea is severe, or if it lasts longer than 3 days. [7]

Alternatives

Variations include the BRATT diet, which adds tea, and the BRATTY diet, which adds tea and yogurt, to the four foods which are part of the BRAT diet. An alternative is the CRAM diet. This diet is nutritionally superior, due to having more complete protein and fat, and allows for a wider range of food options.

Medical professionals advise first aid treatment for gastroenteritis [8] by briefly limiting the diet to bland, easy-to-digest foods (similar to those of the BRAT diet or the CRAM diet) and plenty of liquids (including oral rehydration therapy, e.g. oral pediatric electrolyte solutions sold at retail). [9]

See also

Related Research Articles

<span class="mw-page-title-main">Apple sauce</span> Purée made from apples

Apple sauce is a purée made of apples. It can be made with peeled or unpeeled apples and can be spiced or sweetened. Apple sauce is inexpensive and is widely consumed in North America and some parts of Europe.

<span class="mw-page-title-main">Diarrhea</span> Loose or liquid bowel movements

Diarrhea, also spelled diarrhoea or diarrhœa in British English, is the condition of having at least three loose, liquid, or watery bowel movements in a day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.

<i>Rotavirus</i> Specific genus of RNA viruses

Rotaviruses are the most common cause of diarrhoeal disease among infants and young children. Nearly every child in the world is infected with a rotavirus at least once by the age of five. Immunity develops with each infection, so subsequent infections are less severe. Adults are rarely affected. Rotavirus is a genus of double-stranded RNA viruses in the family Reoviridae. There are nine species of the genus, referred to as A, B, C, D, F, G, H, I and J. Rotavirus A, the most common species, causes more than 90% of rotavirus infections in humans.

<span class="mw-page-title-main">Dehydration</span> Deficit of total body water

In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mild dehydration can also be caused by immersion diuresis, which may increase risk of decompression sickness in divers.

<span class="mw-page-title-main">Malnutrition</span> Medical condition

Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues and form. Malnutrition is not receiving the correct amount of nutrition. Malnutrition is increasing in children under the age of five due to providers who cannot afford or do not have access to adequate nutrition.

<span class="mw-page-title-main">Fluid replacement</span>

Fluid replacement or fluid resuscitation is the medical practice of replenishing bodily fluid lost through sweating, bleeding, fluid shifts or other pathologic processes. Fluids can be replaced with oral rehydration therapy (drinking), intravenous therapy, rectally such as with a Murphy drip, or by hypodermoclysis, the direct injection of fluid into the subcutaneous tissue. Fluids administered by the oral and hypodermic routes are absorbed more slowly than those given intravenously.

<span class="mw-page-title-main">Enteritis</span> Intestinal inflammatory disease

Enteritis is inflammation of the small intestine. It is most commonly caused by food or drink contaminated with pathogenic microbes, such as Serratia, but may have other causes such as NSAIDs, radiation therapy as well as autoimmune conditions like Crohn's disease and celiac disease. Symptoms include abdominal pain, cramping, diarrhea, dehydration, and fever. Related diseases of the gastrointestinal system involve inflammation of the stomach and large intestine.

<span class="mw-page-title-main">Gastroenteritis</span> Inflammation of the stomach and small intestine

Gastroenteritis, also known as infectious diarrhea or simply as gastro, is an inflammation of the gastrointestinal tract including the stomach and intestine. Symptoms may include diarrhea, vomiting, and abdominal pain. Fever, lack of energy, and dehydration may also occur. This typically lasts less than two weeks. Although it is not related to influenza, in the U.S. and U.K., it is sometimes called the "stomach flu".

<span class="mw-page-title-main">Electrolyte imbalance</span> Medical condition

Electrolyte imbalance, or water-electrolyte imbalance, is an abnormality in the concentration of electrolytes in the body. Electrolytes play a vital role in maintaining homeostasis in the body. They help to regulate heart and neurological function, fluid balance, oxygen delivery, acid–base balance and much more. Electrolyte imbalances can develop by consuming too little or too much electrolyte as well as excreting too little or too much electrolyte. Examples of electrolytes include calcium, chloride, magnesium, phosphate, potassium, and sodium.

<span class="mw-page-title-main">Travelers' diarrhea</span> Stomach and intestinal infection

Travelers' diarrhea (TD) is a stomach and intestinal infection. TD is defined as the passage of unformed stool while traveling. It may be accompanied by abdominal cramps, nausea, fever, headache and bloating. Occasionally bloody diarrhea may occur. Most travelers recover within three to four days with little or no treatment. About 12% of people may have symptoms for a week.

<span class="mw-page-title-main">Oral rehydration therapy</span> Type of fluid replacement used to prevent and treat dehydration

Oral rehydration therapy (ORT) is a type of fluid replacement used to prevent and treat dehydration, especially due to diarrhea. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. Oral rehydration therapy can also be given by a nasogastric tube. Therapy should routinely include the use of zinc supplements. Use of oral rehydration therapy has been estimated to decrease the risk of death from diarrhea by up to 93%.

<span class="mw-page-title-main">Ernst Moro</span>

Ernst Moro was an Austrian physician and pediatrician who was the first in western medicine to describe the infant reflex that was named after him.

Gastroenterocolitis is a condition characterized by inflammation of the stomach, small intestines, and colon.

David R. Nalin is an American physiologist, and Pollin Prize for Pediatric Research and Prince Mahidol Award, a.k.a. Mahidol Medal winner. Nalin had the key insight that oral rehydration therapy (ORT) would work if the volume of solution patients drank matched the volume of their fluid losses, and that this would drastically reduce or completely replace the only current treatment for cholera, intravenous therapy. Nalin led the trials that first demonstrated ORT works, both in cholera patients, and more significantly, also in other dehydrating diarrhea illnesses. Nalin's discoveries have been estimated to have saved over 50 million lives worldwide.

Chronic diarrheaof infancy, also called toddler's diarrhea, is a common condition typically affecting up to 1.7 billion children between ages 6–30 months worldwide every year, usually resolving by age 4. According to the World Health Organization (WHO), diarrheal disease is the second greatest cause of death in children 5 years and younger. Diarrheal disease takes the lives of 525,000 or more children per year. Diarrhea is characterized as the condition of passing of three or more loose or watery bowel movements within a day sometimes with undigested food visible. Diarrhea is separated into three clinical categories; acute diarrhea may last multiple hours or days, acute bloody diarrhea, also known as dysentery, and finally, chronic or persistent diarrhea which lasts 2–4 weeks or more. There is normal growth with no evidence of malnutrition in the child experiencing persistent diarrhea. In chronic diarrhea there is no evidence of blood in the stool and there is no sign of infection. The condition may be related to irritable bowel syndrome. There are various tests that can be performed to rule out other causes of diarrhea that don't fall under the chronic criteria, including blood test, colonoscopy, and even genetic testing. Most acute or severe cases of diarrhea have treatment guidelines revolving around prescription or non prescription medications based on the cause, but the treatment protocols for chronic diarrhea focus on replenishing the body with lost fluids and electrolytes, because there typically isn't a treatable cause.

The CRAM diet is a short term dietary treatment for diarrhea and gastroenteritis.

<span class="mw-page-title-main">Management of dehydration</span>

The management of dehydration typically involves the use of oral rehydration solution (ORS). Standard home solutions such as salted rice water, salted yogurt drinks, vegetable and chicken soups with salt can be given. Home solutions such as water in which cereal has been cooked, unsalted soup, green coconut water, weak tea (unsweetened), and unsweetened fresh fruit juices can have from half a teaspoon to full teaspoon of salt added per liter. Clean plain water can also be one of several fluids given. There are commercial solutions such as Pedialyte, and relief agencies such as UNICEF widely distribute packets of salts and sugar. The World Health Organization (WHO) describes a homemade ORS with one liter water with one teaspoon salt and six teaspoons sugar added. The WHO; however, does not generally recommend homemade solutions as how to make them is easily forgotten. Rehydration Project recommends adding the same amount of sugar but only one-half a teaspoon of salt, stating that this more dilute approach is less risky with very little loss of effectiveness. Both agree that drinks with too much sugar or salt can make dehydration worse.

<span class="mw-page-title-main">Norbert Hirschhorn</span>

Norbert Hirschhorn is an Austrian-born American public health physician. He was one of the inventors and developers of the life-saving method called oral rehydration therapy for adults and children suffering fluid loss from cholera and other infectious diarrheal illnesses. It is estimated that his work has saved around 50 million people suffering from dehydration.

Pediatric gastroenterology developed as a sub-specialty of pediatrics and gastroenterology. It is concerned with treating the gastrointestinal tract, liver and pancreas of children from infancy until age eighteen. The principal diseases it is concerned with are acute diarrhea, persistent vomiting, gastritis, and problems with the development of the gastric tract.

<span class="mw-page-title-main">Zinc sulfate (medical use)</span> Dietary supplement

Zinc sulfate is used medically as a dietary supplement. Specifically it is used to treat zinc deficiency and to prevent the condition in those at high risk. This includes use together with oral rehydration therapy for children who have diarrhea. General use is not recommended. It may be taken by mouth or by injection into a vein.

References

  1. 1 2 3 4 Mackell, S (1 December 2005). "Traveler's diarrhea in the pediatric population: etiology and impact". Clinical Infectious Diseases. 41 Suppl 8: S547-52. doi: 10.1086/432950 . PMID   16267717.
  2. 1 2 King CK, Glass R, Bresee JS, Duggan C (November 2003). "Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy". MMWR Recomm Rep. 52 (RR-16): 1–16. PMID   14627948.
  3. Duggan, C; Santosham, M; Glass, RI (16 October 1992). "The management of acute diarrhea in children: oral rehydration, maintenance, and nutritional therapy. Centers for Disease Control and Prevention". MMWR. Recommendations and Reports. 41 (RR-16): 1–20. PMID   1435668.
  4. McLaughlin, Eileen (24 July 2000). "salt imbalance". Archived from the original on 2 July 2007. Retrieved 8 April 2007.
  5. Kyle, Terri (2008). Essentials of pediatric nursing. p. 685. ISBN   978-0-7817-5115-5.
  6. Duro, Debora; Duggan, Christopher (June 2007). "The BRAT Diet for Acute Diarrhea in Children: Should It Be Used?" (PDF). Practical Gastroenterology. Retrieved 25 October 2009.
  7. "BRAT diet: What is the BRAT diet?". C. S. Mott Children's Hospital. University Of Michigan. Archived from the original on 20 February 2007. Retrieved 8 April 2007.
  8. "Gastroenteritis". MedlinePlus . United States National Library of Medicine . Retrieved 18 November 2022.
  9. Mayo Clinic Staff. "Gastroenteritis: First aid". Mayo Clinic . Retrieved 6 March 2011.