Management of diarrhea: BRAT DIET

During hot humid summer, diarrhea occurs more frequently than in any other season in Bangladesh. There could be so many reasons behind having diarrhea such as bacterial, viral, fungal infections, irritable bowel syndrome (IBS-D), excessive sugar intake, malnutrition, bariatric surgery, medicinal side effects, etc.

Diarrhea is a symptom of any other disease, so why it happens should be identified. Dehydration and electrolyte imbalance are to two most dangerous impacts of diarrhea which could be fatal. If not treated, diarrhea can take away one’s life as well. The first life-saving treatment for diarrhea is taking Oral Rehydration Saline (ORS). In maximum cases, diarrhea stops within 24 hours.

During diarrheal episodes, some foods should be excluded to calm down the irritated Gastrointestinal Tract (GI Tract). Hyperosmotic carbohydrates (Lactose, Fructose, Sucrose, Sugar alcohol) increase the GI Tract irritability so diarrhea cannot be reversed easily. So, the diet should be hypo-osmotic carbohydrate-rich. In this way, the gut feels cool. This is called as BRAT Diet. This diet provides a very good amount of sodium, and potassium with a boosted source of energy. At the same time, they make the stool tighter to stop diarrhea.

BRAT:

B- Banana (Unripe and ripe both types of bananas)

R- Rice (Soft bland cooked rice, puffed rice or Muri, flattened rice or Chira)

A- Apple (Raw or cooked apple, applesauce)

T- Toast (Toast biscuits, Bread toast)

What you can eat:

• During diarrheal episodes, you should choose pectin-rich banana, apple, and potato. All of them help to solidify the loose stool.
• Mashed unripe banana, ripe banana anyone you can choose. You can make cutlets with unripe bananas and chicken meats.
• Rice is a very good food at this time. But it must be in bland form. In Bangladesh, it is known as “Jau vat”. It could be prepared with mashed potato and added salt. The liquid texture of rice and pectin of potato helps to meet the energy and electrolyte requirements.
• Soaked flattened rice or puffed rice (Muri) can be easily taken as snacks. Banana can be taken also, but milk should be avoided.
• Toast biscuits and bread toasts are very useful at this time to control loose motion.
• In the BRAT diet, you can add very low oiled fish, egg, and skinless chicken with rice or toast.
• The egg can be taken as poached or boiled form.
• Coconut water is a very good juice that can balance the electrolyte imbalanced situation. But it is important to take oral saline to manage electrolyte imbalance. Coconut water can be taken as a good water source.
• The chicken clear soup is a very good source of protein, water, and electrolytes. It is a very good beverage during diarrheal episodes.
• Along with all other foods, saline and beverages, you have to take water as well.
• If you take antibiotics your beneficial gut microbes get killed. So, the guts’ normal environment becomes irregular and electrolyte absorption becomes disrupted. At this time yogurt is a beneficial food because it is a natural prebiotic. It helps to absorb electrolytes on the colonic surface.   

What to avoid:

• Dairy products and milk
• Deep-fried food
• Oily food
• Spicy food
• Packaged and processed food
• Raw vegetables and salad
• Corn
• Onion
• All types of citrus fruits except banana and apple
• Tea, coffee
• Soft drinks
• Alcohol
• Artificial sweetener (Sorbitol)
• Sardine fish
• Any food that is prepared with sugar
• Chocolate

In most diarrheal cases taking lots of liquid food, BRAT Diet, and ORS, loose motion recovers easily.

When to see a doctor:

Sometimes it is very important to see a doctor if the repeated episodes of diarrhea aren’t going to stop. You have to notice the followings-

• If diarrhea persists for more than two days.
• High fever (more than 102F)
• Severe stomach ache.
• Bloody stool.

In the case of small children, if the following symptoms are present you have to rush to your doctor.

• If the baby doesn’t feel better than before.
• If the fever goes more than 102F.
• If the baby doesn’t urinate more than 2-3 times within 24 hours or if he/she stops urinating completely.
• When the baby cries if there is no water in the eyes.
• If pinching on the skin doesn’t go back to a smooth surface immediately.

The right kind of food can help you to heal back quickly. So, you have to choose the right kind of food. You have to eat a BRAT diet for 2 to 3 days continuously and omit all other kinds of foods then you can feel better than before. But it shouldn’t be continued for long. If it is continued for long the person may face malnutrition. So, the patient must go back to his/her normal diet as soon as the diarrhea is healed.      

References:

1. Medical Nutrition Therapy

Krause’s Food And Nutrition Therapy, International Edition.

2. Diarrhea.

https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea

3. Bland Diet

Sara-Bethany S. Weir; Hossein Akhondi.

https://www.ncbi.nlm.nih.gov/books/NBK538142