Bland diet

A bland diet is a diet consisting of foods that are generally soft, low in dietary fiber, cooked rather than raw, and not spicy. It is an eating plan that emphasizes foods that are easy to digest. It is commonly recommended for people recovering from surgery, diarrhea, gastroenteritis, or other conditions affecting the gastrointestinal tract.

Fried and fatty foods, strong cheeses, whole grains (rich in fiber), and the medications aspirin and ibuprofen are avoided while on this diet. Such a diet is called bland because it is soothing to the digestive tract (it minimizes irritation of tissues). It can also be bland in the sense of "lacking flavor", but it does not always have to be so; nonirritating food can be appetizing food, depending on preparation and individual preferences.

Uses

Bland diets are often recommended following stomach or intestinal surgery, or for people with conditions such as ulcers, acid reflux (GERD), gastritis, heartburn, nausea, vomiting, diarrhea, gastroenteritis and gas. A bland diet allows the digestive tract to heal before introducing foods that are more difficult to digest.

Many milk and dairy products may be permissible on a bland diet, but there are a few exceptions. Chocolate-flavored dairy products are discouraged, as well as any strongly spiced cheeses or high fat dairy products such as heavy cream or half-and-half. Mild dairy foods may soothe irritated linings, but excessive fats, cocoa and spices can have the opposite effect.

Most canned fruits and vegetables are fine, with the exception of tomatoes. Tomato-based sauces on pasta are avoided. Bananas are good; however, higher fiber and acidic fruits should be avoided. Baked potatoes and sweet potatoes are very easily digested, but it is important to avoid high fat toppings like butter. Vinegar based foods such as pickles are to be avoided as are sour fermented foods like sauerkraut.

Perhaps, the most difficult adjustment for some to a bland diet may involve meats and proteins. In a strict bland food diet, softer protein sources such as smooth peanut butter, eggs and tofu are encouraged over any type of fibrous or seasoned meat. Certain meats such as poultry or fish are permitted, as long as they are not heavily fried, breaded or processed like sandwich meats. Steamed poultry breast served with a salt substitute would be a typical protein serving while on a bland diet.

A bland diet is designed primarily to help patients recover from gastrointestinal conditions or other medical circumstances in which improved digestion would be essential. It is not especially effective as a long-term weight loss diet, although portion sizes are strictly controlled. Many people find a bland diet to be very difficult to maintain, although some find the use of acceptable spice alternatives does make it easier. Most patients slowly return to a more normal diet once their medical issues have been resolved.

Specific bland diets

BRAT

The BRAT diet: banana, rice, apple sauce, and toast

The BRAT diet ("Bananas, Rice, Apple sauce, Toast") is a restrictive diet that was once recommended for people, particularly children, with gastrointestinal distress like vomiting, diarrhea, or gastroenteritis. Evidence, however, does not support a benefit. As of the 21st century, it is no longer recommended, as it is unnecessarily restrictive. The diet was first discussed in 1926.

An acronym, BRAT stands for bananas, rice, apple sauce, and toast, the four food components of the diet. Additionally, it is recommended that all people, regardless of age, drink plenty of fluids to prevent dehydration, along with oral rehydration solutions to replace the depleted electrolytes and avoid salt imbalance. Severe, untreated salt imbalance can result in "extreme weakness, confusion, coma, or death."

Nutritional analysis

The BRAT diet is no longer generally recommended. The American Academy of Pediatrics states that most children should continue a normal, age appropriate diet. The foods from the BRAT diet may be added, but should not replace normal, tolerated foods. Sugary drinks and carbonated beverages should be avoided. The BRAT diet is no longer routinely recommended to those who have had stem cell transplants and have diarrhea due to graft-versus-host disease, as long-term use can lead to nutritional deficiencies.

Adding rice, bananas, or pectin to the diet while suffering from diarrhea may be beneficial, but physicians Debora Duro and Christopher Duggan point out that the diet is not nutritionally complete and may be deficient in energy, fat, protein, fiber, vitamin A, vitamin B₁₂, and calcium. Duro and Duggan also say that food restriction does not alleviate diarrhea and actually causes individuals to have diarrhea for longer periods, according to randomized clinical trials.

Medical attention is required when on the BRAT diet if any blood or mucus is present in the diarrhea, if the diarrhea is severe, or if it lasts longer than 3 days.

BRATT diet

The BRATT diet consists of bananas, rice, applesauce, toast, and tea.

BRATTY diet

The BRATTY diet consists of bananas, rice, applesauce, toast, tea, and yogurt.

CRAM diet

The CRAM diet (cereal, rice, applesauce, and milk) is a short term dietary treatment for diarrhea and gastroenteritis.

Recent research

The use of cereals, rice and milk as a stop-gap eating plan for stomach upset has been validated as a more effective remedy to manage diarrhea than the BRAT diet by recent research in hospitals in South America and Asia.

According to John Snyder, M.D., professor of pediatrics at the University of California at San Francisco Medical Center and a member of the American Academy of Pediatrics subcommittee on treating acute diarrhea:

Not only does the CRAM diet seem to ease the diarrhea symptoms faster, but the milk gives the child more complete protein and needed fat, which is lacking in the BRAT diet.

Need for additional hydration

Due to severe dehydration caused by both diarrhea and gastroenteritis, the CRAM eating plan should be combined with oral rehydration therapy through the administration of liquids (e.g. Gatorade, Pedialyte) or food-based fluids (such as broth or gruels) to replace loss of fluids.

According to Snyder, it is essential to combine the CRAM diet with an electrolyte-replacement drink. Immediate medical attention is necessary if the diarrhea symptoms remain severe or if the child exhibits symptoms of dehydration, such as dry mouth, lack of urination, listlessness, or rapid heart rate.

Comparisons

The CRAM diet has more complete protein and fat content than the BRAT diet.

Controversy

Even though milk and other dairy products are permissible in a bland diet, consumption may interfere with the homeostatic processes involved in digestion; prominently for peptic ulcer patients. In an early study, milk was found to have a short-lived gastric acid neutralising effect; which may lead to milk-alkali syndrome and eventually arteriosclerotic heart disease if dietary intake is excessive and uncontrolled. Further research by McArthur, Hogan & Isenberg demonstrated a link between milk consumption and an increase in gastrin production almost equivalent to that of pentagastrin, which may be detrimental to the patients requiring a bland diet as an increased gastric acid output is induced and acts as an overcompensation to the increased (neutralised) pH.

Alternatives

Medical professionals advise first aid treatment for gastroenteritis by briefly limiting the diet to bland, easy-to-digest foods (similar to those of the BRAT diet or the CRAM diet) and plenty of liquids (including oral rehydration therapy, e.g. oral pediatric electrolyte solutions sold at retail).