Ulcer disease is a condition in which open sores develop in the lining of the gastrointestinal tract. They can occur in the upper portion of the small intestine (duodenal ulcer), stomach (gastric ulcer), and esophagus (esophageal ulcer). Contrary to long-standing common belief, stress does not cause ulcers. Instead, the leading cause of ulcer disease is a bacterium called Helicobacter pylori (H. pylori). These bacteria damage the protective mucosal barrier of certain areas within the gastrointestinal tract, making it easier for acidic digestive fluids to injure and inflame the gut’s lining. Other causes include smoking and chronic use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen.1
The cause of your ulcer will determine the type of medical treatment that your physician recommends. If caused by NSAID use, then your doctor may discontinue prescribing NSAID medication, suggest a different pain medication, or continue NSAID use and add another medication to protect your stomach and duodenum, such as a proton pump inhibitor (PPI), which reduces production of stomach acid.
If H. pylori infection is the cause of your ulcer, then your doctor may prescribe a treatment plan to kill the infection while reducing the acid in your stomach.
Physicians often recommend lifestyle and dietary changes for persons with ulcers in addition to medications until complete healing occurs. Although in the past patients were encouraged to follow a bland diet, current research does not support this dietary modification to be beneficial. Although spicy foods are an irritant for some people with ulcers, medical professionals now place more emphasis on a high fibre diet rich in vegetables and fruits.
Dietary Fibre & Vitamin A
Research shows that a high fibre diet decreases the risk of developing ulcer disease. Although both insoluble and soluble fibres demonstrate this association, there is a stronger association between diets high in soluble fibre and a decreased risk for developing ulcers.
Foods that are high in soluble fibre include oats, psyllium husk, legumes, flax seeds, barley, nuts, and certain vegetables and fruits, such as oranges, apples, and carrots.
Findings from a prospective cohort study that included 47,806 men, showed that a diet rich in vitamin A from all sources might reduce the development of duodenal ulcer, as might diets high in fruits and vegetables, possibly due to their fibre content.2 A prospective cohort study follows, over time, a group of similar individuals (cohort) who differ with respect to certain factors under study, to determine how these factors affect rates of a certain outcome; however, more research is necessary to verify results because there are so many other factors involved with this type of study that could confound the data.
Animal studies demonstrate that vitamin A increases the production of mucus in the gastrointestinal tract. Impaired mucosal defense can allow ulcers to develop. Therefore, vitamin A may have a protective effect against the development of ulcer disease.3
Good sources of vitamin A include liver, carrots, broccoli, sweet potatoes, kale, spinach, and collard greens.
Green Tea and Flavonoid-Rich Foods
Emerging research from China shows the potential protective effects of green tea and other foods that are rich in flavonoids against chronic gastritis, H. pylori infection, and stomach cancer. Specifically, these foods seem to inhibit the growth of H. pylori.
In addition, one recent laboratory study of green, white, oolong, and black teas indicated that these teas inhibit the growth of H. pylori but cause no harm to beneficial types of bacteria normally found in the stomach, including L. acidophilus, L. plantarum, and B. lungum. However, this was an in vitro study, which means testing occurred directly between teas and bacteria in the laboratory, and we cannot draw direct conclusions as to what would happen inside the human body between these two substances. Beneficial effects in the laboratory were best when tea steeped for a full five minutes.
Flavonoid-rich foods include garlic, onions, and colourful fruits and vegetables such as cranberries, strawberries, blueberries, broccoli, carrots, and snap peas.4,5
Coffee and Alcohol
Both caffeinated and decaffeinated coffee can increase acid production and exacerbate symptoms in individuals with ulcer disease.6 Alcoholic beverages can erode the protective mucosal lining along the gastrointestinal tract and lead to further inflammation and bleeding. To minimize symptoms, individuals with ulcer disease should avoid or limit both coffee and alcohol.
Assess Your Individual Tolerance
No evidence suggests that spicy or citrus foods affect ulcer disease, although some individuals do report worsening of symptoms after eating these types of foods. It is important to find out what works for you. If you notice that your symptoms get worse after eating certain foods, then limit or avoid them so you can feel your best, making sure that you don’t eliminate an entire food group.
In summary, if you suffer from peptic ulcer disease, then aim to have a diet high in fibre and rich in vegetables, fruits, and whole grains. Try for a minimum of seven servings of vegetables and fruits each day, and a minimum of five servings of whole grains. Choose foods that are a good source of soluble fibre, vitamin A, and flavonoids. Consider adding tea to your daily list of beverages. If you drink alcohol, do so in moderation, with no more than two drinks per day, and no more than nine drinks per week for women (fourteen for men).
Cranberry Juice Cocktail
Drinking just two 250mL cups of cranberry juice cocktail per day might reduce the risk of H. pylori overgrowth in the stomach.7 Concerns about antibiotic resistance make this finding especially significant because cranberry tannins appear to block the bacteria without destroying them. When antibiotics are used to eradicate infection, the bacteria may mutate and become resistant to treatment. Cranberry helps by either not allowing the bacteria to attach itself or by disengaging it from the body once it is attached, and prevent inflammation. So drink up, cranberry juice cocktail is good for you!