What is the BRAT (Bananas, Rice, Applesauce, Toast) diet and when is it recommended for gastrointestinal issues?

BRAT Diet: Current Evidence and Recommendations

The BRAT diet (Bananas, Rice, Applesauce, Toast) is a reasonable short-term dietary intervention for acute diarrhea in children and adults, but should NOT be used for prolonged periods due to inadequate energy and protein content that can compromise nutritional recovery. 1

What is the BRAT Diet?

The BRAT diet consists of bland, low-fiber, starchy foods that are easily digestible:

• Bananas - provide potassium and pectin
• Rice - easily digestible starch
• Applesauce - provides pectin and is low in fiber
• Toast - simple carbohydrate, low in fat 1

When to Use the BRAT Diet

Acute Diarrhea (Grade 1-2)

• Use for short-term symptom management in patients with acute diarrhea, particularly viral gastroenteritis 1
• The diet is appropriate because it includes starches and fruits that are well-tolerated during gastrointestinal distress 1
• Combine with oral hydration and electrolyte replacement as the primary intervention 1
• Add antidiarrheal medications (loperamide 4 mg initially, then 2 mg after each loose stool, up to 16 mg/day) for symptomatic relief 1

Duration Limitations

Critical caveat: The BRAT diet has NO controlled trials demonstrating its efficacy 1

• Limit use to a few days maximum - prolonged use results in inadequate energy and protein content that can impair nutritional recovery 1
• This is especially important in children who need adequate nutrition for growth and development 1

When NOT to Use the BRAT Diet

Prefer Regular Diet Instead

• Older children and adults should continue a regular diet rather than restricting to BRAT foods 1
• Evidence supports introducing a full diet immediately after rehydration, which improves nutritional outcomes and may reduce stool output 1
• Recommended foods include: starches (rice, potatoes, noodles, crackers), cereals (rice, wheat, oat), soup, yogurt, vegetables, and fresh fruits 1

Foods to Avoid

• High simple sugar foods (soft drinks, undiluted apple juice, Jell-O, presweetened cereals) can exacerbate diarrhea through osmotic effects 1
• High-fat foods may not be tolerated due to delayed gastric emptying 1

Not Appropriate for Other Conditions

Irritable Bowel Syndrome (IBS)

• The BRAT diet is NOT recommended for IBS management 2
• For IBS, a low-FODMAP diet supervised by a dietitian is the most effective dietary approach for reducing symptoms, but only as second-line therapy after general dietary advice 2
• General IBS dietary recommendations include regular meals, adequate hydration (8 glasses daily), limiting caffeine to 3 cups/day, and increasing soluble fiber like psyllium 2

Chronic Diarrhea

• The BRAT diet is inadequate for chronic diarrhea management 3
• Chronic diarrhea requires identification of underlying causes and targeted dietary interventions, often requiring specialized dietitian involvement 3

Practical Algorithm for Use

For acute diarrhea in children or adults:

1. First 24-48 hours: BRAT diet is acceptable alongside oral rehydration 1
2. After 48 hours: Transition to regular age-appropriate diet to ensure adequate nutrition 1
3. If diarrhea persists beyond 48-72 hours: Investigate underlying causes rather than continuing restrictive diet 1

Key pitfall to avoid: Do not continue the BRAT diet beyond a few days, as this compromises nutritional recovery and can lead to protein-energy malnutrition, particularly in children 1