Eating with a Duodenal Ulcer

Is a special “ulcer diet” needed?

In the past, patients with a duodenal ulcer were advised to eat mainly milk-based and boiled foods and were given special diets with long lists of prohibitions.

It is no longer accepted that there is a special diet that heals a duodenal ulcer.

The main aim of eating well is less to treat the ulcer than to avoid the foods that increase pain, burning, bloating and indigestion during treatment, and to see that the person is adequately and sensibly nourished.

Finding and treating the real cause of the ulcer matters far more.

What can be eaten?

A person with a duodenal ulcer may eat a normal, balanced diet as long as it is tolerated.

In general:

• Vegetables and fruit,
• Cereals,
• Yoghurt and other dairy products if tolerated,
• Eggs,
• Fish,
• Chicken and lean meat,
• Pulses,
• Healthy fats such as olive oil

may be eaten.

There is no special list of “ulcer foods” that holds for everyone.

If a food does not markedly increase pain or indigestion, it is usually unnecessary to forbid it simply because an ulcer is present.

Do spice and hot food cause ulcers?

No. Hot and spicy foods are not the underlying cause of duodenal ulcer.

The principal causes of the ulcer are Helicobacter pylori infection and certain painkillers of the NSAID group.

Hot or heavily spiced foods may, however, increase the pain and burning caused by an existing ulcer in some people. If such a link is noticed, it may be sensible to cut these foods down while the ulcer is healing.

If they cause no symptoms in a person, there is no need to forbid all spices.

Can coffee be drunk?

Coffee has not been shown to be an underlying cause of duodenal ulcer.

Coffee may nonetheless increase stomach symptoms in some people. If pain, burning or indigestion becomes marked after drinking coffee, intake may be reduced.

The same approach applies to tea, chocolate and fizzy drinks: personal tolerance is what matters.

Does milk heal an ulcer?

No. Milk is not a treatment for duodenal ulcer.

Some people feel brief relief on drinking milk. But it should not be used as a treatment to make the ulcer heal.

Nor does a person who can comfortably take milk and dairy products need to give them up.

Can alcohol be taken?

Because alcohol may increase stomach and duodenal symptoms, particularly while an ulcer is active, avoiding alcohol is the most suitable approach.

Excessive alcohol may also irritate the lining of the digestive tract and make treatment of the ulcer more difficult.

How should meals be arranged?

There is no strong rule that everyone must eat very frequent, small meals.

But smaller portions may be more comfortable for people whose pain, bloating or indigestion increases after large meals.

Those whose pain increases when they go hungry for a long time may arrange their meals accordingly.

The basic principle is to build a regular, balanced way of eating in which the person feels comfortable, rather than to impose unnecessary prohibitions.

Which foods should be cut down?

There is no list of prohibitions common and compulsory for everyone.

But if they increase symptoms in a person, the following may be reduced temporarily:

• Very fatty and fried foods,
• Very hot or heavily spiced foods,
• Large amounts of coffee,
• Fizzy drinks,
• Very acidic foods and drinks,
• Alcohol.

If a food causes no symptoms, removing it from the diet purely because of the ulcer is usually unnecessary.

Are yoghurt, kefir or probiotics helpful?

Yoghurt and kefir may be part of a healthy diet and may be taken if tolerated.

Whether certain probiotics reduce the diarrhoea, bloating or other side effects associated with antibiotics during H. pylori treatment is under investigation.

But yoghurt, kefir and probiotics do not take the place of H. pylori eradication treatment and do not treat the ulcer on their own.

Why smoking matters

Smoking is not merely a habit that irritates the stomach; it also matters for peptic ulcer.

Smoking may increase the risk of an ulcer developing and may adversely affect the healing of an existing one.

People with a duodenal ulcer are therefore advised to give up smoking.

What matters more than diet?

The most important thing in duodenal ulcer is to identify and remove the cause of the ulcer.

If H. pylori is found, suitable eradication treatment should be given and clearance of the bacterium confirmed afterwards.

NSAID painkillers may be the cause of the ulcer or the factor preventing it from healing. Treatment of a patient taking these drugs should be reviewed by the doctor.

Aspirin or another drug prescribed by a doctor should, however, not be stopped by the patient on their own initiative.

In brief: how should I eat with a duodenal ulcer?

You do not need to follow a special, strict ulcer diet.

Eat a balanced diet and do not needlessly forbid foods that do not trouble you. Cut down foods you notice consistently increasing your pain or burning. Avoid alcohol while the ulcer is active, and do not smoke.

Most importantly, remember that diet does not take the place of H. pylori treatment, acid-suppressing drugs or the other treatments directed at the cause of the ulcer.

Currency: This information was prepared for patients taking account of the current approach to nutrition in peptic ulcer disease.

This content is for general information. Personal advice on eating and treatment should be determined taking account of the patient’s existing conditions and medication.