Dietary Recommendations for Peptic Ulcer Disease
No restrictive or special diet is necessary for peptic ulcer disease—patients should eat a regular, balanced diet while avoiding only foods that cause individual discomfort. 1
Core Dietary Approach
The modern management of peptic ulcers does not require bland diets or restrictive eating patterns that were historically prescribed. 1 The primary goal is simply to avoid extreme elevations of gastric acid secretion and direct irritation of the gastric mucosa. 1
What to Eat
- Regular meals: Three meals per day is as effective as frequent small feedings for chronic peptic ulcer disease. 1
- Balanced nutrition: Follow standard healthy eating guidelines with a variety of foods to meet energy and nutrient requirements. 2
- No special restrictions: The available evidence does not support placing peptic ulcer patients on restrictive diets in the era of modern acid-suppressing medications. 1
What to Avoid or Limit
Beverages that stimulate acid secretion:
- Coffee (including decaffeinated): Both regular and decaffeinated coffee are strong acid secretagogues and should be avoided. 1
- Alcohol: Particularly concentrated forms like 40% (80 proof) alcohol should be avoided as they stimulate gastric acid secretion. 1
- Caffeine-containing beverages: Tea and caffeinated soft drinks are acid secretion stimulators and should be restricted. 1
Foods that may cause individual discomfort:
- Spices: Black pepper, red pepper, and chili powder may produce dyspepsia in some patients—avoid any spice that causes personal discomfort, especially during acute exacerbations. 1
- Citric acid juices: May induce reflux and discomfort in selective patients. 1
Common Dietary Myths to Dispel
Milk is NOT recommended: Despite historical practice, frequent milk ingestion should not be encouraged. 1 Milk has only a transient buffering effect followed by significant gastric acid secretion, and the fat content does not influence these effects. 1
Bland diets are outdated: The traditional bland diet approach has no proven benefit and marked variation exists in what constitutes a "bland diet" across institutions. 3 These restrictive diets are unnecessary with modern proton pump inhibitor therapy. 1
Medical Management Takes Priority
The dietary modifications above are adjunctive only. The mainstay of treatment is:
- H. pylori eradication if infection is present (reduces ulcer risk by 50% in NSAID users). 4
- Proton pump inhibitor therapy for acid suppression. 4, 5
- Discontinuation of NSAIDs if possible, or coadministration with a PPI if NSAIDs must continue. 4, 5
Practical Implementation
- Avoid large quantities of food that cause stomach distention. 1
- Some patients report symptom relief with more frequent feedings during acute phases—this can be accommodated if helpful, though not required. 1
- Dietary fiber does not need to be restricted; some fiber-containing foods may even be protective. 1
Key Pitfall to Avoid
Do not place patients on unnecessarily restrictive diets that complicate eating patterns and may lead to nutritional deficiencies without proven benefit. 1 The psychological benefit of dietary modification should not override evidence-based practice, but individual food intolerances should be respected. 1