Do you know the role of diet in peptic ulcer disease?

Peptic ulcer disease (PUD), which includes ulcer formation in the stomach or the duodenum (the first portion of the small intestine) and is the leading reason for gastrointestinal surgery. Since PUD affects your digestive tract, it makes sense that what you eat on a daily basis should impact the development of ulcer disease. However, direct associations between what many people believe to be ulcer-causing components of the diet and the development of PUD are surprisingly limited and inconsistent. Large observational studies have not established a direct link between the intake of alcohol, caffeine, or spicy foods and ulcer formation. This is true despite the fact that alcohol and caffeine are known to stimulate gastric acid secretion, which in turn makes ulcer symptoms worse and interferes with ulcer healing. Research over the past few decades has found that 80–90% of peptic ulcers are actually caused by a bacterium called Helicobacter pylori (H. pylori). So, while diet might play a role, particularly in terms of ulcer healing, H. pylori infection is the primary cause of PUD. Milk, which many people still mistakenly believe protects against or even helps to treat PUD, might actually increase its severity by causing an increase in acid secretion and masking ulcer symptoms. Masked symptoms allow the disease to progress without treatment.

 On the other hand, fermented milk products, including yogurt and cheese, have been associated with a reduction in PUD, possibly due to their antimicrobial properties. Research shows that probiotic strains, including Lactobacillus and Bifidobacterium bifidum, inhibit the growth of the H. pylori. These probiotic strains have also been shown to improve the effectiveness of treatment for H. pylori infection. In the past, fiber consumption was discouraged for patients with PUD. Current research suggests that soluble fiber might actually play a protective role. In a large prospective study, those with the highest intakes of soluble fiber, particularly fiber from legumes, including beans, tofu, peanut butter, and nuts, had a 50% lower incidence of duodenal ulcer compared to those consuming the least amount of soluble fiber. Vegetable fiber and vitamin A intake also appear to exert a protective effect. Conversely, higher intakes of refined grains (which are lower in fiber) and refined sugar have been associated with a higher risk of duodenal ulcer disease. Polyphenols, plant-based nutrients that play a role in decreasing the risk of numerous diseases, also appear to play an important role in ulcer prevention.

 Animal studies have shown that several different polyphenols help prevent PUD by increasing the formation of gut-protecting mucus; decreasing acid secretion; inhibiting the growth of H. pylori; and acting as powerful antioxidants, which help protect the lining of the gut.

 Promising research in rats has shown a potential beneficial effect of numerous polyphenol-rich plant compounds, including ginger, fennel, and olive leaf extract. Smoking has been strongly associated with the incidence of PUD through numerous mechanisms. On the other hand, physical activity has been shown to decrease the risk of duodenal ulcer. So, the adoption of a healthy lifestyle, including a diet containing a variety of fruits and vegetables, plenty of soluble fiber, and fermented dairy products with limited added sugar; not smoking; and exercising regularly can play a significant role in the prevention of ulcer disease.