If you’re like a lot of people, you probably spend some time every day wondering what to eat. This question can be made more complex if you’re dealing with a digestive health issue, such as stomach ulcers.
Olivia Vaughn, a registered dietitian at the Ohio State University Wexner Medical Center who specializes in nutrition for gastroenterology, says “stomach or peptic ulcers are open sores on the lining of the stomach that can cause stomach pain or stomach upset,” and can lead to internal bleeding.
The foods you eat can impact how you feel with an ulcer, and eating the right foods can help you control symptoms and possibly may even promote healing. Dr. Alaa Abousaif, a gastroenterologist and internal medicine specialist with St. Joseph Hospital in Orange, California, says that because “an ulcer is an open sore in the stomach, you need to avoid anything that will irritate this.”
What Causes Ulcers?
Dr. Robert Lerrigo, a gastroenterologist with Santa Clara Valley Medical Center in California, says there are “many different causes of stomach ulcers.”
The most common among these are:
— Helicobacter pylori infection. “Infection with the bacteria H. pylori can directly cause inflammation in the stomach and increase acid production,” Lerrigo says. About 80% to 90% of stomach ulcers are caused by this bacterium, according to studies over several decades.
— NSAIDs. Frequent or excessive use of nonsteroidal, anti-inflammatory drugs such as aspirin, ibuprofen and naproxen “can impair the mucous lining of the stomach, leaving it susceptible to damage from stomach acid,” Lerrigo says.
— Tumors and other diseases. Less common causes of ulcers include tumors that increase acid production in the stomach and stomach cancer, which can “erode into the stomach, creating large ulcers,” Lerrigo says.
No matter the cause of your stomach ulcers, healing them is important, not just to alleviate the pain and discomfort they can cause, but also for your long-term health. Left untreated, a stomach ulcer can turn into a serious problem. Complications may include:
— Bleeding. A broken blood vessel can cause bleeding into the stomach. This may show up as dark or bloody stools.
— Obstruction. Obstructions or blockages can develop that prevent food from moving through the digestive tract properly.
— Perforations. When the ulcer creates a hole in the stomach wall, this is called a perforation and is a very serious condition that allows digestive juices and food to leak into the abdominal cavity. This can lead to a potentially life-threatening infection.
— Peritonitis. This infection of the lining of the abdominal cavity can also become a serious issue.
Surgery may be required to address these complications, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
[See: The Best Plant-Based Diets.]
Treatment of stomach ulcers often includes medications to help control symptoms and speed healing of ulcers. For example, if your stomach ulcer is caused by H. pylori, you’ll likely be prescribed an antibiotic to clear up that infection. Many people are also prescribed acid-reducing medications that tamp down the level of acid produced in the stomach that can burn new ulcers or worsen an existing ulcer.
Stopping use of NSAIDs is also a common recommendation for people with stomach ulcers, particularly if these medications are believed to have caused the problem.
In addition, your doctor may recommend making some dietary shifts to alleviate symptoms and support healing. But what exactly you should eat may end up being something of an individual question based on what tends to trigger symptoms for you.
“There is no specific diet that is recommended by the American Gastroenterological Association or American College of Gastroenterology to promote stomach ulcer healing,” Lerrigo says. “There have been several international studies suggesting certain foods may be helpful, but without larger trials in humans, one cannot definitively say for sure.”
Foods and Drinks to Avoid
While a generally healthy diet is considered best in supporting people with stomach ulcers, there tends to be a somewhat clearer list of foods to avoid. “Although certain foods and beverages can cause stomach upset or increased production of stomach acid, there is no good evidence that they cause or worsen ulcers,” Vaughn says. Nevertheless, “these foods may increase secretions of stomach acid, causing irritation of the stomach, or directly irritate the stomach wall.”
Therefore, many people with stomach ulcers find that eating these foods makes them feel worse and thus they avoid them. Commonly avoided foods and beverages include:
— Pepper, including black pepper and other types of peppers.
— Caffeine, including caffeinated sodas.
— Tea, including black and green varieties that contain tannins that can increase production of stomach acid.
— Coffee (including decaf).
Abousaif adds that some people also have difficulty with:
— Spicy foods.
— Citrus foods.
— Carbonated beverages.
— Raw vegetables or salads.
Not everyone who has a stomach ulcer has problems with any or all of these foods, though. “This is dependent on the person, so consider testing foods in small amounts or a short trial of elimination to see what irritates you,” Vaughn says.
Following an elimination diet for a while to determine exactly which foods cause you the most difficulty can help you dial in the right way of eating for you. “Once you know what foods cause irritation (if any), continue to eat well-balanced, smaller and more frequent meals,” Vaughn says.
In fact, moving away from eating three large meals a day to eating smaller meals every three hours is a key component of managing stomach ulcer symptoms for many people. An empty or hungry stomach is an acidy stomach, and when people with ulcers go too long without eating, that can aggravate symptoms.
It’s important that you continue to cover all your nutritional bases — eliminating certain foods could set you up for certain nutrient deficiencies if you’re not including enough other foods that contain those nutrients. For example, “make sure to include a protein-containing food at each meal,” Vaughn says.
Abousaif adds that you should seek to include legumes (beans, lentils) and healthy fats (avocado, olive oil) in your diet to provide good nutrition. And don’t forget to drink plenty of water. Staying well hydrated has lots of health benefits and can promote better health of the digestive tract.
What to Eat If You Have Ulcers
Lerrigo says eating a “healthy, diversified diet rich in fruits, vegetables and fiber, and devoid of harmful artificial preservatives is key to helping your body heal its wounds. It’s also important to avoid smoking cigarettes and drinking alcohol as these are risk factors for developing stomach ulcers.”
He points to a review of pre-clinical studies in test tubes and animals conducted in Iran that suggests that “antioxidant properties of dietary polyphenols” can support good gut health. Polyphenols are compounds found in fruits and vegetables that support digestion and brain health and provide other health benefits.
Specifically, Lerrigo lists several items that the authors of the review paper hypothesize could have therapeutic potential for preventing or possibly even treating certain types of stomach ulcers, and for which studies in human beings would be warranted to validate their hypothesis. These include:
— Green tea.
— Curcumin, a compound found in the bright orange spice turmeric.
— The leaves of the betel vine (a vine from a family of plants indigenous to southern Asia that includes pepper and kava).
Vaughn also recommends “eating a healthy diet with plenty of fruits, vegetables and fiber,” as this approach may decrease the risk of ulcers. She says that high consumption of fruits and vegetables, dietary fiber and vitamin A are associated with a reduced risk of ulcer disease. “This is possibly related to the protective effects of these foods,” Vaugh explains. Fruits and vegetables are high in antioxidants, which can reduce inflammation and are believed to be protective against a range of diseases.
“Many people think a bland diet is necessary,” Vaughn says, “but overall the evidence to support the use of a bland diet or dietary restrictions to prevent peptic ulcers is lacking.”
While science still doesn’t fully understand the connection between the gut microbiome and health, there’s little evidence that probiotic supplements can help, and that evidence is limited to their use when treating H. pylori bacterial infections. It’s believed that certain strains of probiotics, which promote the growth of protective gut microorganisms may reduce the diarrhea caused by the antibiotics used to treat H. pylori.
Lerrigo notes that a growing body of research is showing that fermented foods, such as yogurt, kefir, sauerkraut and kimchi, might inhibit the activity of H. pylori.
Talk to Your Doctor
If you think you might have a stomach ulcer, it’s important to talk to your health care provider. Most patients start with their primary care doctor, and you may be referred to a gastroenterologist for more specialized care.
In particular, Abousaif says you should “check with your doctor if you have pain in the upper belly, especially after eating,” or other symptoms like:
— A constant feeling of gnawing hunger. Ulcer pain can feel like hunger and is often alleviated by eating because that reduces acid levels and dulls the pain.
All of these can all be signs of stomach ulcers. In addition, if you see blood in the stool or black tarry stools, Abousaif recommends you seek medical attention, as these are also an indication of a stomach ulcer.
It’s important to seek this help, Lerrigo adds, rather than trying to doctor yourself with food. “Experimenting with a new diet is often not the best way to go,” if you have a stomach ulcer, he says. “Stomach ulcers have many different causes, and it’s important to identify the cause and treat it specifically.”
For example, “if your doctor recommends antibiotics or taking a stomach-acid blocking medicine, no amount of curcumin is going to replace those treatments, and I think it’s important for people to realize that,” Lerrigo says. “Yes, there are several studies that suggest certain foods and probiotics may help promote stomach ulcer healing, but their findings are not definitive. There is no substitute for treating the underlying cause of the stomach ulcer, and these diets should be viewed as adjuncts to treatment, not as replacements.”
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Update 07/02/21: This story was previously published on an earlier date and has been updated with new information.