Best Foods For Peptic Ulcers

Overview of ulcers

Peptic ulcer, also called stomach ulcer, or gastric ulcer, is a sore that usually occurs in the lining of either the stomach or the upper part of the small intestine (proximal duodenum). It may involve other areas such as the lower oesophagus, distal duodenum, or jejunum. It can be characterised by a discontinuation or breakage in the inner lining of the gastrointestinal tract. This occurs when the natural defence mechanisms of the gastrointestinal mucosa fail to protect it from gastric acid and the digestive enzyme pepsin.^1,2

The main aetiologies of stomach ulcers are the chronic infection with Helicobacter pylori (H.pylori) and the use of NSAIDs. Common signs and symptoms of peptic ulcers include epigastric abdominal pain, bloating, abdominal fullness, nausea and vomiting, weight loss/ weight gain, and hematemesis (blood in vomit).¹

Diet therapy 

Diet is not one of the causes of stomach ulcers, however, it is one of the main precursors that can aggravate the peptic ulcer disease condition and symptoms.⁷ Therefore, nutritional therapy or diet therapy plays a vital role in the management and treatment of ulcers.³ It aims to prevent the hypersecretion of peptic chloride which helps to alleviate the soreness and pain in the gastric and duodenal mucosa. Moreover, it tends to promote ulcer healing including damaged tissue repair.³ Diet therapy involves identifying the appropriate diet and following it alongside the prescribed drug treatment.

The general dietary guidelines for ulcers are to limit and sometimes to avoid foods that irritate the stomach.⁷ These may differ from person to person simply because not all foods affect everyone the same way. Each person would need to identify the foods that worsen their symptoms and limit them. Normally, the patient would need to avoid acidic, spicy, or high-fat foods and try to eat fruits, vegetables, whole grains, and fat-free or low-fat dairy products.^6,7

As part of the general dietary guidelines, there are some well-established records of foods to avoid and foods to include while having an ulcer as described in the following sections.^4,5

Best foods and beverages for ulcers

Foods with probiotics

Also called fermented foods, these foods are rich sources of microbes such as bacteria, yeasts, and fungi, that can restore the balance of the gut microbiome and help fight H. pylori. Examples include yoghurt, miso, sauerkraut, kimchi, kefir, kombucha, and tempeh.

High-fibre foods

Research has shown that a fibre-rich diet might help in preventing ulcers. Fibre can lower the amount of acid in your stomach as well as ease the bloating and pain. Examples of fibre-rich foods include beans, lentils, whole wheat bread, apples, pears, and oatmeal.³

Non-acidic fruits

Examples include bananas, apples, pears, and berries. Berries are particularly helpful in reducing/ treating the Helicobacter pylori infection. For instance, blueberries contain flavonoids that help protect the stomach lining by increasing the stomach mucus halting the growth of H.pylori. Cranberries are high in nutrients and antioxidants which lower the risk of stomach ulcers and ease symptoms of any existing ulcers. Also, they are low in calories and high in vitamins A, C, and K. Other berries include raspberries, strawberries, elderberries, and bilberries.

Low-acid fruit juices

For example, apple juice or cranberry juice tends to reduce the risk of H. pylori overgrowth in the stomach, hence preventing inflammation.

Vegetables

There is evidence suggesting that vitamin A can help shrink stomach ulcers as well as help prevent them whereas vitamin C plays an important role in wound healing. Vegetables rich in vitamin A include sweet potato, leafy greens (e.g., spinach, kale), and carrots. Vegetables rich in vitamin C are broccoli and red bell peppers. Broccoli also contains sulforaphane, a phytochemical inhibiting the growth of H. Pylori.⁸ Sulforaphane is also present in cruciferous vegetables such as cauliflower, cabbage, and kale.

• Lean meat/ proteins like chicken, turkey, fish
• Whole grains like whole-wheat bread, oatmeal, brown rice, quinoa, pasta, and cereals
• Fat-free or low-fat dairy alternatives like yoghurt, almond milk, and soy-based products
• Herbs and Spices like turmeric, ginger, Aloe vera
• Honey

It is a natural antimicrobial that can lower the presence of H. pylori infection. The most potent type of honey is the Manuka and the Oak tree honey.

Olive oil

Human studies are still ongoing, however, in one of the studies, the researchers concluded that olive oil might be moderately effective in treating H. pylori infection. Olive oil is considered a healthy fat that can be used to cook and bake with and in salad dressings and dips.

• Herbal teas like chamomile and green tea, help fight off H. pylori
• Cabbage juice, which is rich in glutamine helps heal stomach ulcers

Foods and beverages to avoid

Spicy foods

Avoid foods that contain hot chiles and peppers, or are seasoned with black or red pepper, chilli powder, or mustard seed and nutmeg.

Acidic foods

Some foods are naturally acidic while others have a high dietary acid load which means they increase the production of acid in the body. Examples include citrus fruits (such as lemons, oranges, grapefruits, and lime), tomatoes and tomato-based products (such as tomato paste, tomato sauce, or tomato juice), refined carbohydrates (such as white bread, white rice, and processed cereals), and sodas.

Acidic juices

For example, orange and grapefruit juices.

Coffee and caffeinated beverages

It is advised to cut the coffee and caffeinated beverages out of the diet; however, the evidence is still not clear.

Alcohol

It is best to limit alcohol or avoid it altogether because it can make ulcers worse. Alcoholic beverages like beer, wine, and liquor can inflame and irritate the lining of the stomach.

Fried and fatty foods

Food fried in oil at high temperatures can aggravate stomach ulcers and upset the mucosal lining which is the natural layer of protection of the digestive tract. Moreover, fried foods are usually high in fat and salt. Fatty foods take longer to digest leading to belly pain and bloating.

Processed and high-sugar foods

Avoiding high-fat, salty, and sugary processed foods may help relieve stomach ulcer symptoms.

• Whole milk and dairy products made from whole milk or cream 
• It may prompt the stomach to make more acid aggravating the ulcer

Lifestyle factors 

In addition to the type of diet chosen, meal planning and portion control play an integral role in the prevention of an ulcer and in creating a balanced meal plan. Food should not be consumed for at least 2 hours before bedtime. This is to avoid the food staying in the stomach for long periods irritating the stomach mucosal lining and the food indigestion. It may also lead to acid reflux, irritating the mucosal lining of the oesophagus. 

Frequent meals are tolerated much better by the stomach than large meals. Therefore, eating smaller portions of food on a regular meal regimen is very important for the gastrointestinal tract. Some of the other important factors to be considered when managing ulcers are lifestyle factors such as stress management, smoking cessation, medication adherence, and consultation with a healthcare professional.^1,3,4

FAQ 

Can you calm an ulcer flare-up with food only and without any medication? 

No, in the case of a flare-up, antacids should be used to neutralize the existing acid and provide rapid pain relief. Examples include Gaviscon, Maalox, Pepto-Bismol, and Alka-Seltzer.

When do I seek medical help?

If the general dietary guidelines are not helping, it is better to go see your doctor to arrange a balanced meal plan that you can follow. In case of sharp stomach pain, sweating or feeling confusion, passing dark, tar-like stools, seek medical attention immediately. 

How long does it take an ulcer to heal?

With medications, most ulcers heal in a month or two. However, even after treatment ulcers can come back, therefore you should always be careful of the risk factors aggravating the GI mucosa.

Summary

This article shows the importance of having a balanced diet at all times. It also shows how following a poor diet rich in stomach irritants could lead to the development of an ulcer, provided one of the main causes was present. More research and investigations into diet therapy for the treatment of peptic ulcers are required.

The information outlined in this article is not intended as medical advice for individual conditions or treatments. You should talk to your doctor, nurse, or pharmacist before following any medical regimen to see if it is safe and effective for you. They will help in formulating a healthy diet tailored according to your circumstances.