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Stomach bug: what to eat and drink · No Forking Nonsense - The Nutritionist UK

• 0:00
  @paulthenutritionist: Hello and welcome to another episode of No Forking Nonsense and today we are covering a question I am asked a weird amount of times. When you have a friend who is a nutritionist, I. E. Me, then often first place you reach to when you have a stomach bug is him to ask what to eat. So I cover that for you and I update loads of information for you so you're going to find it helpful because at some point in the next ten years you are probably going to have the shits this can help you.
• 0:25
  Remember if you want to update your algorithm that only shows you healthy, nutritious, positive content, then press follow, press subscribe, leave a five star review because that there will show your algorithm that you're interested in this stuff. Anyway, enjoy this episode, hope you find it helpful, Share it with someone who needs it. Ciao. Unusually, I get messages about how to eat or how to fix a stomach bug more than you would imagine. And the advice around this topic is about thirty years out of date.
• 1:01
  And there's one bit of advice that actively will make you worse. So I'm going to go into it. So next time you've got a dicky tummy, feeling sick, you've got food poisoning, things are coming out the other end, then you know what to do to at least manage those symptoms so you're feeling a little bit better and if it's not for you, it's good for your kids. So the first rule is that nobody has ever come from harm from missing meals for a day. So people are hospitalised by dehydration however.
• 1:35
  So for the first stretch, when you have a stomach bug, whatever that might be, or food poisoning, what we're talking about here, forget food entirely. Your only job and the most important thing here is to get fluid in and try and keep it there and there is a technique to that. So what you want to aim to do is to try and get small mouthful every five, maybe ten minutes because if you try to glug large volumes of fluid down then unfortunately it's not going to stay there because a full glass will stretch the stomach and then the stomach's going to object and when you haven't eaten because you exited most of it and it's evacuated, putting a lot of volume back in your stomach is not going to go down well. If you are sick after drinking, don't give up and don't wait an hour, wait five minutes then try again, just with a smaller amount. And that there, sip, wait and repeat, is what you have to just keep doing and if it comes back up, go smaller and start again.
• 2:39
  Now I've said before that I like to go on I want you to consume one litre per 25 kilograms of body weight, that's where we want to get to. However, that is going to be very hard when you keep being sick, so you just want to try and sip every five-ten minutes. Rule number two: you want to buy the right stuff and have it in your house before you need it. Water alone is probably not the best thing to drink here, and this is where I get really interesting. So you are not just losing water, are losing sodium and potassium.
• 3:17
  So you can get yourself some, can either get electrolytes, which most of you should have in your house because I am always talking about it, or dirolyte, or supermarket own brand equivalent, because what that has is a very precise ratio of salt and sugar in the water. And the ratio really matters by the way because sodium and glucose get carried across your gut wall together by the same transporter and then water kind of follows it. The sugar isn't there for energy, it's going to help us drag the salt and the water in and that's why a correctly balanced sachet gets fluid into your gut faster than plain water does. Now day to day we don't want to be having electrolytes with suvism, however in this scenario that's really important for us and dirolyte is one of the cheapest and most effective medical interventions on earth for what we are talking about here. Here's the practical bit, probably the best tip of the whole episode.
• 4:15
  Get sachets now, as in like today, when you are listening to this, go on Amazon and get them, they are so cheap. Because the moment you need them, you will not be in any fit state to drive to a pharmacy and frankly you probably shouldn't go out in public with the fear of you shitting your pants. So just get them now, they cost at worst a few quid and they will last you years. You can make a rough version at home in emergencies with sugar and salt In an emergency that's probably better than nothing, but the sachets are measured properly and getting the ratio wrong could make things worse. So just get your sachets.
• 4:52
  Here's what I don't want you to drink: Free juice, busy drinks, that's going to make your diarrhoea worse. You have very sugary drinks, that's going to pull water out of your gut rather than into it, which is precisely the opposite of what we want. Flat cola, this is the big one and half the country still believes it. The idea that flat coke settles the stomach and replaces sugar is absolutely insane. What it actually is, is far too much sugar and not enough sodium.
• 5:27
  It's the wrong drink in every respect for what we want here. So whoever told you this, I'm sure they meant well but they were wrong. The amount of sugar in it is too much, there's no sodium, there's caffeine in it, it's just an absolute shit show. Sports drinks are much better than cola, but still not quite right because they're designed for sweat loss during exercise, not for what's coming out of you now. Too much sugar, nowhere near enough salt.
• 5:55
  And then obviously alcohol and coffee, you basically don't want caffeine in this regard. So next rule, eat as soon as you can face it. So this is the outdated advice that I mentioned, starve it out, give your stomach a rest, don't eat for twenty four hours. That is guidance which has been absolutely debunked a long time ago. The evidence supports early refeeding.
• 6:17
  So once the vomiting is easing and you can get fluids down, eating small amounts can help you recover faster than continuing to fast. So your gut lining actually needs feeding to repair itself and prolonged starvation doesn't rest it, it's going to slow the repair. The rule is really simple, try and be led by your appetite, don't force it whilst you're actively being sick and don't refuse it if you're not. So there's a thing called the BRAT, and I call it the BRAT diet. I add an s on the end.
• 6:52
  But the BRAT diet is only half right. So you'll have heard of bananas, rice, applesauce and toast. And what that is, is a list of examples of gentle foods and that's fine. And they are all very reasonable things to start with. However, as a prescription to follow for several days, it's unfortunately quite outdated and probably too restricted as well.
• 7:16
  So it's quite low in protein, it's low in fat, slow in most things to be honest. And there's limited evidence that sticking rigidly to it for four days is going to kind of help you. So we can use it as a starting point but not as a rule book. Now there is an updated version, I am going to talk you through kind of what foods to eat in order and then we can revisit brats. So the things that we want to kind of get back in are plain, low fibre, low fat, low flavour really and certainly nothing spicy.
• 7:50
  So toast really good, plain rice really good, boiled potatoes really good, plain pasta really good, crackers really good, bananas really good, clear soup or broth really good. Salty things are genuinely quite helpful here. Because you have lost a lot of sodium, crackers and broth are doing two jobs at once, which is why they have kind of survived our rat's diet wisdom. You want small and often, so same principle as fluid. A few male falls every couple of hours is going to be much more helpful than the big plate of food that's going to overwhelm you and make you feel sick.
• 8:27
  What to leave until later: Fatty foods, bulk them off until you're better Fried food, get rid of them till you are better. Heavily flavoured food, spicy food, get rid of them. Large amounts of fibre, get rid of them. Just until you feel that your gut is settling. Now dairy is an interesting one because on paper we feel like we need to completely avoid all dairy.
• 8:51
  However, I'd maybe not blanket avoid it, you just want to if you've got a bad bout of stomach bug, what can happen is it temporarily strips the enzyme that digests lactose, so a lot of people who get food poison end up with a lactose intolerance and that's because the lactase has been stripped and sometimes it doesn't return in some people and that can last for a week or two after. So if milk is clearly making things worse, stop it for a few days, then bring it back. So it's temporary and it's normal, but it's not developing an intolerance. Now just going back to the BRAC style, so it stands for bananas, rice, applesauce, toast. So I've updated that to be bananas, ham bread, rice and rice cakes and crackers, apples, applesauce, I had another A there but I have forgotten what it was, and then toast and tea, because tea can be helpful, ideally decaf, but having that kind of warm fluid can be really really helpful as well.
• 9:56
  Okay, the probiotic question. You will be told to take probiotics, possibly by a pharmacist. However, in 2018, the New England Journal of Medicine published two very large trials, one American, one Canadian, testing probiotics in children with gastroenteritis. Around nine hundred children were in each study and neither found any benefit. So no shorter diarrhoea, no shorter vomiting, no fewer days off nursery, no reduction in passing it around the household, it didn't help.
• 10:29
  The American trial tested lactobacillus, which is the most commonly recommended strain that there is, and the researchers said that they tested it across every scenario they could think of and reached the same answer every time, that it didn't help. Now obviously to be fair, that's children and there is some evidence for probiotics in other situations like antibiotic associated diarrhoea. So this isn't a bland kit verde, but what I want you to think about when you're having a straightforward stomach bug is the best evidence we've got to save your money is just buy more diarrhoea. You probably don't need any probiotics. Not going to harm you but it's probably not going to help.
• 11:10
  So a word on Imodium, the anti diarrhoea. So there is one situation where you should reach for it if there is blood in your stool, or high fever alongside it. That can point to a bacterial infection and slowing everything down keeps it in you for longer. So that's probably a pharmacist or a GP conversation. For an ordinary stomach bug, where you just need to get through a train journey, I'd speak to a pharmacist.
• 11:38
  So they're free, they're right there and this is exactly what they're there for. So coming out the other side, two things nobody warned you about, your appetite will lag behind your recovery and that will absolutely fuck with your energy. The problem with having a stomach bug and not eating is that it's kind of twofold because you end up feeling like shit because you haven't got any food and no nutrients in your body and it kind of prolongs. Now it would be great if we could keep our energy topped up by consuming food at the same time but that doesn't happen. So your appetite will lag behind your recovery, you're basically, once you've kind of come out the other side, you'll probably feel fine and still not fancy food for a day or two.
• 12:17
  That is normal, so you want to keep it kind of small and frequent until it comes back on its own. Now obviously the scales are going to drop, it's fluid, gut contents and glycogen, so it will come straight back on when you rehydrate and eat properly and that regain is a good sign rather than a bad one. I mention it because I have had clients who are kind of genuinely upset about regaining four pounds after a stomach bug and that four pounds is not fat, it's just water retention. So to be honest the scale weight is irrelevant and you will put the weight back on. So two practical things from a medical perspective.
• 12:55
  I would stay off work, keep children off school until probably two days after having a stomach bug. Because what happens is like with flu and cold, you might feel good but you are probably still spitting that bacteria around. And then obviously just try and be as clean as possible. So I am obviously a nutritionist and when it comes to anything like this, I have to say the responsible thing, or my registration will get slapped away from me. So this is the disclaimer: If you are showing signs of dehydration after using rehydration sachets, If you keep being sick and you can't keep any fluid down, if there is blood in your stool or you are bleeding from your body, if diarrhoea goes past seven days or vomiting past two days, you need to get help sooner rather than later.
• 13:52
  Same if you're pregnant, if you're elderly, caring for a young child, if you're immunosuppressed, managing diabetes, kidney disease, just because the margins are much smaller. And obviously if you're vomiting blood or even vomit that looks like coffee grounds, then panic and call 999. So that's it. So what to do today if you are in this scenario? Number one buy some rehydration sachets now, ideally before you need them.
• 14:17
  Number two, when it happens, you want to have a mouthful every five to ten minutes of fluid. If you're sick, wait five minutes, go smaller again, and you basically, that's your priority. Number three: don't starve it out. You want to eat plain foods as soon as you can, small and often. Remember the BRAT's diet, the adapted BRAT's diet.
• 14:38
  No fruit juice, no fizzy drinks, no flat cola, all three are going to make things worse. And then forty eight hours after, then you can go back into the real world. And that's it! I really hope that you found this useful, it's a of a weird one isn't it? Bit of a different episode.
• 14:55
  I hope you found it useful, hope you found it helpful and I shall speak to you next time. Remember, if you want to improve your algorithm, press follow, subscribe to this episode, engage with this episode, not for me but to teach your algorithm that you are interested in factual, healthy nutrition content. Enjoy your rest of your week and I'll speak to you next time.