Is the BRAT Diet Still the Best for Nausea?

If you or your child has ever suffered with a stomach bug, you may have tried the BRAT diet, which stands for bananas, rice, applesauce, and toast. This combination of bland, easily digestible foods is traditionally considered a safe choice to help relieve bouts of nausea, vomiting, and/or diarrhea.

For decades, physicians recommended the BRAT diet for adults and children dealing with mild to moderate stomach viruses (viral gastroenteritis). But, in 2012, the American Academy of Family Physicians published updated guidelines that specifically do not recommend this diet for children. Based on research, the BRAT diet was deemed too nutritionally restrictive, and “many studies have shown that a child’s regular diet reduces the duration of diarrhea.”

When caring for a child who is vomiting and/or experiencing diarrhea, parents and caretakers should focus on preventing dehydration, which can escalate to a medical emergency if it becomes severe.

Our nutrition expert weighs in

Veruska Gonzalez, M.S., R.D., a clinical dietitian with the University of Miami Health System, supports the academy’s findings. She says that many foods beyond bananas, rice, applesauce, and toast can help support someone with an aching belly. She adds that when you’re sick to your stomach, you may feel better after eating several smaller meals throughout the day, rather than three larger meals.

“The BRAT diet is a very restrictive diet that offers very little protein and healthy fats, which are important for growth in children,” Gonzalez says. In addition, protein builds and repairs tissues, muscles, and hormones. Healthy fats help the body absorb fat-soluble vitamins (Vitamins A, D, E, and K), provide energy, and protect organs.

“Research has also been scarce when it comes to confirming that the BRAT diet is the best for diarrhea and nausea,” she says. “Considering this, it is usually more beneficial to continue to follow a bland diet without as many restrictions.”

Gonzalez recommends starting with simple foods, such as dry cereal, oatmeal, broths, and boiled starchy vegetables, such as potato and pumpkin. As symptoms improve, you can try scrambled eggs, skinless boiled or grilled chicken breast, fruits without skins and seeds, blended vegetables with skins and seeds removed, and soups. Avoid spicy, heavily seasoned, fried, and sugary foods.

“The main difference for children experiencing nausea/vomiting with or without diarrhea is the recommended vitamins, calories, and protein they need per day — as children have different needs than adults,” Gonzalez says.

Hydration is essential

“It is crucial to maintain proper fluid intake by consuming liquids such as tea, electrolyte-rich fluids, bone broth, and water,” she says.

If you or your child simply can’t keep down any liquids, you can try an over-the-counter medication, such as a stomach-lining protectant (like Pepto-Bismol) or one that calms stomach muscle contractions (Emetrol or Nauzene). If nothing helps, your doctor or an urgent care center may prescribe a serotonin antagonist medication (ondansetron) used to treat severe nausea caused by viral illness. All of these medications are intended to ease vomiting to prevent dehydration, but they cannot address the underlying causes of nausea or diarrhea.

When symptoms aren’t improving

If stomach upset is caused by food poisoning (bacterial gastroenteritis) or a GI viral infection, symptoms should stop within three days. With bacterial infections or rotavirus, symptoms can linger for up to a week.

If nausea/vomiting and diarrhea become more severe, long-lasting, or include any of the following symptoms, talk to your health care provider:

• fever
• severe weakness
• blood in the stool
• refusal to drink liquid
• dry, sticky mouth
• infrequent urination
• extreme thirst
• no tears when crying
• in young children: sunken soft spot (fontanelle)

If you have irritable bowel syndrome (IBS) or inflammatory bowel disease (such as Crohn’s disease or Ulcerative colitis), or have had a C. diff or H. pylori bacterial infection, consult with your primary care physician or gastroenterologist about the best way to treat your ongoing GI symptoms like stomach cramps, vomiting, diarrhea, and lack of appetite.

“The dietary recommendations I mentioned can apply to adults with these conditions, but you may need additional dietary modifications long term,” she says. “GI illnesses present differently in every patient, so it’s difficult to provide an overall dietary guideline. For example, I have patients with IBD who do well with oatmeal, while others don’t. Generally, patients with chronic GI conditions are recommended to limit fried and sugary foods and consume bland diets with little seasoning.”

Dana Kantrowitz is a contributing writer for UHealth’s news service. Medically reviewed by Veruska Gonzalez, M.S., R.D., a clinical dietitian with the University of Miami Health System in 2023 and 2026.

Originally published on: October 17, 2023

Tags: BRAT diet, diarrhea, food poisoning, gastroenteritis, GI distress, nausea, stomach virus, Veruska Gonzalez, vomiting