Peptic Ulcer Diet

What to Eat and What to Avoid

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.


What Is a Stomach Ulcer?

The stomach wall is made up of three layers, explains Dr. Kaunteya Reddy, a gastroenterologist and medical director at the Redlands Community Hospital in Redlands, California. A defect in any or all of these layers results in an ulcer, which he compares to “a sore in your mouth, but instead it’s in the stomach lining.”

Olivia Vaughn, a registered dietitian at the Ohio State University Wexner Medical Center in Columbus, adds that stomach or peptic ulcers can cause stomach pain or stomach upset and lead to internal bleeding.

As with any wound, you need to be careful how you handle it; eating the right foods can help you control stomach ulcer symptoms and may even promote healing. Dr. Alaa Abousaif, a gastroenterologist and internal medicine specialist with Providence St. Joseph Hospital-Orange in California, says that because “an ulcer is an open sore in the stomach, you need to avoid anything that will irritate this.”

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What Causes Ulcers?

Stomach ulcers can develop because of the stomach acid that’s secreted to help break down food during digestion, says Dr. Roopa Vemulapalli, associate professor in gastroenterology and medical director of the digestive disease clinic at UT Southwestern Medical Center in Dallas. “This is a normal physiologic phenomenon, and the stomach lining has protective mechanisms to prevent damage from physiologic acid secretions,” she explains. Ulcers can develop, though, if those protective measures are disrupted.

Dr. Robert Lerrigo, a gastroenterologist with Santa Clara Valley Medical Center in California, adds that there are “many different causes of stomach ulcers.”

The most common causes of stomach ulcers are:

  • Helicobacter pyloriinfection. “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 H. pylori, 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 explains. Using these medications in combination with steroids also increases your risk of stomach ulcers, Reddy adds.
  • 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.

Stomach Ulcer Complications

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. It is a very serious condition that allows digestive juices and food to leak into the abdominal cavity, and it 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.

Stomach ulcer treatment often includes medications to help control symptoms and speed the 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, which tamp down the level of acid produced in the stomach that can create new ulcers or worsen an existing ulcer.

Stopping your use of NSAIDs is also a common recommendation for people with stomach ulcers, particularly if these medications are believed to have caused the problem.

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Dietary changes

In addition, your doctor may recommend making some dietary shifts to alleviate symptoms of stomach ulcers and to support healing. But what exactly should be on the menu depends on what triggers symptoms for you individually.

“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.”

Dr. Thomas R. Kelley, a family medicine physician with Orlando Health in Florida, says that when talking about the best diet for stomach ulcers and which foods to eliminate, “everybody jumps right to spicy food. But what’s interesting about that is that’s not always the case. You have to see how it affects you; if spicy food bothers your stomach, avoid that particular food. But it’s not necessarily completely off the menu, so to speak, for folks if they have a history of ulcers.”

In essence, finding the best diet for a stomach ulcer comes down to knowing what works and what doesn’t for your body. That said, commonly avoided foods and beverages include:

  • Alcohol.
  • Acidic foods like pineapple.
  • Citrus fruits.
  • Spicy foods.
  • Fatty or greasy foods.
  • Pepper, including black pepper and other types of peppers.
  • Caffeine, including caffeinated sodas.
  • Carbonated beverages.
  • Tea, including black and green varieties that contain tannins, which can increase the production of stomach acid.
  • Coffee, including decaf.
  • Peppermint.
  • Spearmint.
  • Chocolate.
  • Carbonated beverages.
  • Raw vegetables or salads.
  • Tomatoes.
  • Mint.

Reddy notes that while avoiding chocolate, coffee and citrus fruits was “thought to help reduce symptoms, there’s no scientific data to recommend this practice.” However, some individuals find that eliminating these foods can reduce symptoms.

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Finding What’s Best for You

Your own personal list of foods to include or avoid on a stomach ulcer diet will depend on you. “Consider testing foods in small amounts or a short trial of elimination to see what irritates you,” Vaughn says. “Once you know what foods cause irritation, continue to eat well-balanced, smaller and more frequent meals.”

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 acidic stomach, and going too long without eating can aggravate symptoms for those with ulcers.

It’s also 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. “A well-rounded diet is the best advice for managing a stomach ulcer to support your body overall,” says Laura Simmons, a registered dietitian at RET Physical Therapy and Healthcare Specialists in Auburn, Washington. This means “lean proteins, lots of fruits and vegetables, whole grains and plenty of water.”

Reddy agrees that “a balanced diet with fruits and vegetables helps prevent stomach ulcers.” If you’ve already got an ulcer, however, that means “your body is dealing with inflammation, so adequate intake of protein, multivitamins and micronutrients is required for faster healing,” he says. “Avoid smoking and minimize alcohol intake to help decrease acid production.”

Dana Ellis Hunnes,a senior clinical dietitian at UCLA Medical Center, assistant professor at UCLA Fielding School of Public Health and author of “Recipe For Survival,” also recommends limiting “intake of simple or processed carbohydrates, such as white bread, rice or processed cereals, as they may feed the H. pylori bacteria.”

Abousaif adds that you should include legumes, such as beans and lentils, and healthy fats, including avocado and 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 an Ulcer

One key element of your diet may be polyphenols. This area of study is still expanding, but Lerrigo points to a review of pre-clinical studies in test tubes and animals conducted in Iran that suggests “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.

Another study, published in 2020 in the journal Molecules, also suggests that flavonoids, the most abundant type of polyphenol in plant foods, might be helpful in both preventing and alleviating peptic ulcers. And, a 2023 review study in the BMJ suggests that polyphenol compounds could eradicate H. pylori infection.

Lerrigo notes several items the authors of the 2015 review paper hypothesize could have therapeutic potential for preventing or possibly even treating certain types of stomach ulcers, though they say future studies in human beings are needed. These items include:

  • Apples.
  • Grapes.
  • Pomegranates.
  • Green tea.
  • Vegetables.
  • Curcumin, a compound found in the bright orange spice turmeric.
  • The leaves of the betel vine, which come 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” because high consumption of produce, 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,” she explains. Fruits and vegetables are high in antioxidants, which can reduce inflammation, and are believed to be protective against a range of diseases.

“Fiber can also help ease constipation and decrease the acid that’s in the stomach,” Kelley says, adding that “sweet potatoes have been found to have some positive impact on stomach ulcers.”

Focusing on bland diets, however, is generally one approach you can forgo. “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.”

Vemulapalli adds that while there aren’t any specific foods that can heal stomach ulcers, “alkaline foods and foods rich in fiber and probiotics will counter the high acid levels and provide relief from symptoms caused by an ulcer.” Alkaline and high-fiber foods include:

  • Watermelon.
  • Bananas.
  • Peaches.
  • Apples.
  • Pears.
  • Broccoli.
  • Avocado.
  • Spinach.
  • Kale.
  • Potatoes.
  • Soy.
  • Green beans.
  • Lentils.
  • Whole grains.
  • Healthy fats, such as olive oil and avocado oil.
  • Nuts.
  • Fermented dairy products, such as yogurt, kefir and buttermilk.
  • Fermented foods, such as sauerkraut, miso, kimchi and plant-based yogurts with active cultures.

Fermented foods are “rich in probiotics and may help counteract the bad bacteria H. pylori,” Hunnes notes. And if you’re having difficulty eating, she recommends opting for healthy foods that are high in calories to make sure you’re meeting your energy needs. “You may hurt when you eat, you may have cramps, you may have discomfort,” she says. “It’s good to eat healthy, calorie-rich foods and small, frequent meals. Homemade shakes made with healthy ingredients such as plant-based yogurt or ice cream, fruit, bananas, peanut butter and avocado can help.”
“What food can help you with is symptom management,” Simmons adds. So, while there’s no single food that’s going to make your ulcer go away, you can manage symptoms and reduce flare-ups.

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Gut Connection

While science still doesn’t fully understand the connection between the gut microbiome and health, there’s little evidence that probiotic supplements can help. That evidence is also limited to supplements’ 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 diarrhea caused by the antibiotics used to treat H. pylori.

However, a growing body of research is showing that fermented foods, such as yogurt, kefir, sauerkraut and kimchi, might inhibit the activity of H. pylori. “Recent studies have shown probiotics inhibit colonization and burden of H. pylori infection,” Reddy says. “Hence, intake of any foods rich in probiotics, such as yogurt, help during the healing process.”

But be careful with milk, Kelley adds. “We used to think that if you have an ulcer, you should drink more milk, but that has been found to potentially have a negative impact,” he says.

Talk to Your Doctor

If you think you might have a stomach ulcer, it’s important to talk to your health care provider. “There’s a lot of misinformation on the internet and a lot of people claiming things with no research or evidence to back it up,” Simmons says. “Trust your doctors.”

Most patients start with their primary care doctor, and you may be referred to a gastroenterologist for more specialized care.

Abousaif says you should “check with your doctor if you have pain in the upper belly, especially after eating,” or other symptoms like:

  • Nausea.
  • Vomiting.
  • Bloating.
  • Feeling full quickly.
  • 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 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.”

Lastly, Kelley notes that it’s important to “see your family doctor once a year for a wellness visit.” During that visit, mention if you’ve noticed any changes in your bathroom habits or if you’ve had any symptoms that could be related to a stomach ulcer. “It’s always better to identify a problem as early as possible because delaying it isn’t going to help it get any better. It’s only going to make it more difficult to treat.”

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