Got gastro? Here’s why eating bananas helps but drinking flat lemonade might not

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Doctors are reportedly concerned about a spike in the number of children with gastroenteritis – when abdominal infections can cause nausea, vomiting, diarrhea, fever, abdominal pain, headache and muscle aches.

Rotavirus is a common cause of gastroenteritis in children and the reported number of rotaviruses in New South Wales so far this year is five times higher than usual.

While gastroenteritis is common, the good news is that the vast majority of children will have an uneventful recovery.

Yet parents and carers receive a lot of conflicting advice about the food and drink children should consume during recovery from the disease. Let’s look at the evidence.



Read more: Gastrointestinal outbreak: How does it spread and how can we stop it? A gastroenterologist explains


Old advice: The BRAT diet

A well-known dietary recommendation in recovering from gastroenteritis is the BRAT diet. This stands for bananas, rice, applesauce and toast. These bland foods are meant to be gentle on the gut, which is important when someone is recovering from gastroenteritis.

Applesauce is a typical American food product and indeed the first mention of this diet was in 1926 in an American report on the treatment of “intestinal intoxication” in children.

The BRAT diet was traditionally recommended but has fallen out of favor in recent decades. There are no clinical studies on the diet itself, but the evidence to support it came from studies showing how each food in the BRAT diet could help with gastro-recovery.

Bananas and apples are rich in a starch called pectin that can form a gel, which helps treat diarrhea. In particular, green banana pulp and flour have been found to reduce diarrhea in children. Bananas are also a rich source of potassium, which can help replace lost potassium in diarrhea.

Rice-based oral rehydration solutions (a drink made from a mixture of water, rice, glucose, sodium and potassium salts) used to treat gastroenteritis reduce stool volume and duration of diarrhea in patients. A study from Bangladesh in infants with persistent diarrhea found that a rice-based diet containing green banana or pectin improved stool consistency and shortened its duration more than a rice-only diet.

In general, children recovering from gastroenteritis do not need a restricted diet.
Shutterstock, CC BY


Read more: Explainer: what is gastroenteritis and why can’t I get rid of it?


Magic apples

The use of apples to treat diarrhea is thought to have started in Germany, where a nurse named Sister Frieda Klimsch used the fruit to treat dysentery (a severe form of gastroenteritis) in a hospital.

Another origin story tells how a doctor in a German prison camp noticed that prisoners with dysentery who ate apples from a nearby orchard had a shorter and milder illness. The doctor started encouraging them to eat apples to treat diarrhea.

In the 1930s, eating apple peels was observed to induce vomiting in infants and so the peel was removed. Grated apple was used around the same time to treat diarrhea in children and was helpful in some cases.

Later, applesauce became the recommended form of apple for gastroenteritis recovery in the United States and features in the BRAT diet. Interestingly, giving diluted apple juice to children with mild dehydration from gastroenteritis is both safe and effective.

bowl of applesauce on counter
Applesauce is a typical American product, but grated apple works too.
Unsplash, CC BY

Why gastro-diet advice has changed

Over the past 20 years, most health professionals have come to the conclusion that the restricted BRAT diet is unhealthy in recovery from gastroenteritis because it is low in protein, fat, and energy. All of these nutrients are necessary for healing.

Studies have shown that normal eating generally does not aggravate the course of gastroenteritis. So there is no need to restrict your child’s diet. Fasting in recovery from gastroenteritis is not recommended, but it is important to be considerate of the child and facilitate the reintroduction of food.

It turns out that the absorption of fat, lactose and sucrose during diarrhea is limited – so it is wise to avoid fatty foods and foods high in simple sugars (including juices and soft drinks) for moderate to severe diarrhea as they can exacerbate symptoms.



Read more: Diarrhea, abdominal pain and nausea: The many ways COVID-19 can affect your gut


Flat soft drinks?

Flat soft drinks like colas and lemonade deserve a special mention. Some see these drinks as an option to replenish fluids and glucose lost through vomiting and diarrhea. But research has shown that this may not be a good idea.

A British study searched the medical literature dating back to the 1950s for evidence to support the use of soda for gastroenteritis. They found none.

Next, the researchers compared the contents of colas and other soft drinks with commercially available oral rehydration solutions containing electrolytes and small amounts of sugar. They found that the soft drinks not only contained very small amounts of potassium, sodium and other electrolytes, but in some cases as much as seven times the glucose recommended by the World Health Organization for rehydration.

Carbonated drinks, flat or not, are therefore not considered to provide adequate fluid or electrolytes and are not recommended.

glass of orange liquid and sachet of powder
Rehydration solutions are more effective than flat sodas and contain less sugar.
Shutterstock

So what should you eat and drink during gastroenteritis recovery?

Appropriate foods include fruits, vegetables, lean meats, yogurt, as well as complex carbohydrates such as wheat, rice, bread, potatoes, and breakfast cereals.

Parents of young children with mild gastroenteritis should keep them hydrated by encouraging fluid intake through water and milk and discouraging fruit juices and carbonated drinks.

For moderate or severe cases, the appropriate fluid for oral rehydration is a commercially available oral rehydration solution (such as Gastrolyte or Hydralyte).

A systematic review and meta-analysis of 174 studies concluded the use of a probiotic (Saccharomyces boulardii) and zinc supplementation may aid during recovery from gastroenteritis, reducing the duration of diarrhea and stool volume.

If symptoms or dehydration are severe, take your child to a doctor or go to the nearest hospital emergency room.

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