What is the CRAM diet?
The CRAM diet is a temporary, bland eating plan used to help manage acute gastrointestinal issues, most commonly diarrhea. The acronym stands for:
- Cereal
- Rice
- Applesauce
- Milk
It was developed as an evolution of the even more restrictive BRAT diet (bananas, rice, applesauce, and toast) to provide a slightly more balanced approach by including milk for added protein and fat. However, like the BRAT diet, modern medical guidance suggests that the CRAM diet is too restrictive and lacks sufficient nutrients for anything more than a very short-term use.
Origins and purpose of the CRAM diet
Historically, bland diets like BRAT were recommended for children and adults experiencing digestive upset. The principle behind these diets is that they consist of low-fiber, low-fat, and easily digestible foods that don't irritate the digestive tract. The CRAM diet was created to offer a modest improvement by adding milk, which provides protein and fat that the BRAT diet lacks. The aim is to give the stomach and intestines a rest, help solidify loose stools, and soothe the gut lining during recovery from an illness.
Why the CRAM diet is no longer widely recommended
While the logic of eating bland, gentle foods during illness seems sound, the CRAM and BRAT diets are often criticized by modern health professionals for their nutritional shortcomings. These diets are highly restrictive and are deficient in key nutrients needed for proper bodily function and recovery, such as fiber, vitamins, and minerals. Instead, a more inclusive "bland diet" that incorporates a wider variety of easy-to-digest, low-fat foods is now favored. This approach still soothes the digestive system but provides more balanced nutrition to aid in a faster, more complete recovery.
Foods to include and avoid on a bland diet
For those needing to follow a bland diet for a short time, here is a guide to what is typically recommended versus what should be avoided.
Foods to include
- Liquids: Water, oral rehydration solutions, clear broths, and diluted, clear juices.
- Starchy foods: Plain white rice, white bread or toast, saltine crackers, and cooked cereals like cream of wheat or instant oatmeal.
- Fruits: Bananas, applesauce, canned fruits packed in water, and melons.
- Vegetables: Steamed or boiled vegetables like carrots, green beans, and peeled potatoes.
- Protein: Skinless baked chicken or turkey, scrambled eggs, and tofu.
- Dairy: Low-fat milk, kefir, and yogurt (especially with probiotics).
Foods to avoid
- Fatty and fried foods: Fried foods, greasy meats, and high-fat sauces.
- Spicy foods: Anything containing hot peppers or strong spices.
- High-fiber foods: Whole grains, raw vegetables, nuts, and seeds.
- Acidic foods: Citrus fruits, tomatoes, and tomato-based products.
- Caffeine and alcohol: Both can irritate the stomach and contribute to dehydration.
- Sugary items: Candy, pastries, and sugary sodas.
Comparison of CRAM, BRAT, and Broad Bland Diets
| Feature | CRAM Diet | BRAT Diet | Broad Bland Diet |
|---|---|---|---|
| Foods Included | Cereal, rice, applesauce, milk | Bananas, rice, applesauce, toast | A wider range of soft, low-fiber, and easily digestible foods, including some lean protein, cooked vegetables, and dairy. |
| Nutritional Completeness | Minimal; better than BRAT but still restrictive. | Severely lacking in protein, fiber, and many vitamins. | More balanced, providing a broader range of nutrients for recovery. |
| Primary Use | Short-term management of diarrhea. | Historically used for diarrhea, but now considered too restrictive. | Short-term management of various GI issues (diarrhea, ulcers, GERD). |
| Duration | Up to 48 hours is typically recommended. | Up to 24-48 hours, not recommended for longer periods. | Used for a few days to a week as symptoms improve, then gradually return to a regular diet. |
How to safely use a restrictive diet for digestive issues
If you find yourself needing to rest your digestive system due to a stomach bug or food poisoning, following a restrictive diet for a day or two can be beneficial. However, it is important to reintroduce a wider variety of foods as soon as possible to avoid nutritional deficiencies.
Here are some key steps:
- Rehydrate First: Begin with small, frequent sips of clear liquids like water, clear broth, or an oral rehydration solution to replenish lost electrolytes.
- Start with Simple Foods: After a few hours without symptoms, introduce simple, bland foods like those in the CRAM diet. Eat small amounts at first to see how your stomach tolerates them.
- Expand Your Bland Diet: As you feel better, begin incorporating other easy-to-digest items, such as lean chicken, steamed vegetables, and yogurt.
- Gradual Return to Normal: Slowly reintroduce more fibrous and complex foods. Listen to your body and pull back if symptoms reappear.
Potential risks of the CRAM diet
While intended for short-term relief, adhering to a very limited diet like CRAM for too long can have negative health consequences, including:
- Nutrient Deficiencies: The diet lacks sufficient vitamins, minerals, and fiber, which can lead to malnutrition if prolonged.
- Malnutrition: For children and individuals with pre-existing conditions, a restrictive diet can lead to malnutrition and hinder recovery.
- Delayed Recovery: A lack of adequate nutrients may prolong recovery rather than expedite it.
- Ineffectiveness: The CRAM diet does not address the underlying cause of the gastrointestinal issue, which requires a diagnosis and appropriate treatment from a healthcare provider.
Conclusion
In summary, the CRAM diet is an evolution of the outdated BRAT diet, designed as a short-term, bland eating plan for acute gastrointestinal distress. While its components—cereal, rice, applesauce, and milk—are gentle on the stomach, the diet is considered too restrictive by modern medical standards for more than a brief period. A broader, more inclusive bland diet that incorporates a wider range of easy-to-digest foods is now recommended to ensure adequate nutrition for recovery. For anyone experiencing persistent digestive issues, it is always best to consult a healthcare professional to identify the root cause and determine the most appropriate course of action. For more comprehensive information on managing digestive health, consider visiting a reputable resource like the Cleveland Clinic.
