From the Guidelines
For individuals with viral gastroenteritis experiencing severe watery diarrhea, I strongly recommend resuming an age-appropriate usual diet during or immediately after the rehydration process is completed, as this approach has been shown to be effective in managing the condition. This recommendation is based on the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1. The guidelines suggest that human milk feeding should be continued in infants and children throughout the diarrheal episode, and that resumption of a usual diet is recommended during or immediately after rehydration.
Some key points to consider when managing viral gastroenteritis with severe watery diarrhea include:
- Starting with clear liquids like water, diluted fruit juices, clear broths, and oral rehydration solutions to prevent dehydration
- Gradually introducing bland, easy-to-digest foods as symptoms improve
- Avoiding dairy products, fatty, spicy, or highly seasoned foods, caffeine, alcohol, and high-fiber foods that can worsen diarrhea
- Eating small, frequent meals instead of large ones
- Ensuring adequate fluid intake by drinking at least 2-3 liters of fluid daily, more if diarrhea continues
It's also important to note that while some studies suggest that certain foods or dietary approaches may be beneficial in managing diarrhea, the evidence is not always consistent. For example, a 2001 study published in Alimentary Pharmacology and Therapeutics recommends maintaining adequate fluid intake, avoiding fatty or spicy foods, and considering the use of anti-diarrheal medications like loperamide 1. However, the most recent and highest-quality evidence supports the approach of resuming a usual diet during or immediately after rehydration, as recommended by the 2017 Infectious Diseases Society of America guidelines 1.
In terms of specific foods, the BRAT diet (bananas, rice, applesauce, and toast) is often recommended for individuals with diarrhea, as these foods are gentle on the stomach and low in fiber. However, the most important thing is to listen to your body and eat foods that are easy to digest and do not exacerbate symptoms. If symptoms persist or worsen, it's always best to consult with a healthcare professional for personalized advice.
From the Research
Recommended Foods for Viral Gastroenteritis
- For individuals with viral gastroenteritis experiencing severe watery diarrhea, the World Health Organization recommends a formulation of oral rehydration salts as the intervention of choice for the treatment of acute gastroenteritis 2.
- Modifications to the original formula have been proposed to increase tolerability, shorten the duration of diarrhea, and improve parental quality of life, including low osmolarity, rice-based, glucose polymers as an alternative to glucose, the addition of probiotics, prebiotics and/or zinc, and various other ingredients 2.
- A diet containing probiotics and zinc has been shown to exert positive effects on diarrhea duration and severity in children with acute gastroenteritis 3.
- The BRAT (bananas, rice, applesauce, and toast) diet is often recommended, but current evidence suggests that a diet-containing probiotics may be more effective in managing acute diarrhea 4.
- For patients with mild, watery diarrhea, routine antibiotic use is not recommended, but antibiotics may be effective against certain bacterial infections, such as shigellosis, campylobacteriosis, and C. difficile colitis 5.
Key Considerations
- Oral rehydration solution is the mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis 6.
- Antiemetics may be used to improve tolerance of oral rehydration solution and decrease the need for intravenous fluids and hospitalization 6.
- Specific diagnostic investigation, such as stool culture and PCR, may be reserved for patients with severe dehydration, more severe illness, or suspected nosocomial infection or outbreak 5.