What is a suitable Bengali tiffin for a 37-year-old female with non-ulcer peptic dyspepsia?

Bengali Tiffin Recommendations for Non-Ulcer Dyspepsia

A 37-year-old woman with non-ulcer dyspepsia should focus on small, frequent, low-fat meals with easily digestible Bengali foods while avoiding coffee, excess spices, and fried items, as dietary modifications targeting symptom triggers are recommended alongside medical management. 1, 2

Dietary Principles for Functional Dyspepsia

Core Dietary Modifications

• Eat frequent small meals rather than large portions to reduce gastric distension and early satiety, which are common triggers in dysmotility-like dyspepsia 2, 3
• Choose low-fat preparations as high-fat foods delay gastric emptying and worsen symptoms of fullness and bloating 2
• Minimize coffee intake as it is a recognized aggravating factor for dyspeptic symptoms 2
• Avoid overly restrictive diets that could lead to malnutrition or disordered eating patterns, as early dietitian involvement is recommended to prevent this complication 1, 4

Suitable Bengali Tiffin Options

Recommended Foods:

• Steamed preparations: Bhapa ilish (steamed hilsa), bhapa doi (steamed yogurt), or idli-style rice cakes are gentle on the stomach 2
• Plain rice-based items: Panta bhaat (soaked rice), plain rice with light dal (lentils), or soft khichuri without excess ghee 2
• Boiled or lightly cooked vegetables: Shukto with minimal oil, boiled potatoes (aloo seddho), or steamed vegetables 2
• Yogurt-based items: Plain doi (yogurt) or mishti doi in small amounts, as fermented foods may be better tolerated 2
• Soft breads: Luchi or roti in moderation, avoiding deep-fried versions 2

Foods to Avoid:

• Deep-fried items: Avoid kochuri, singara, beguni, or fried fish preparations as high-fat foods worsen symptoms 2
• Heavy spice-laden curries: Minimize use of excessive mustard oil, panch phoron, or very spicy preparations 2
• Coffee and strong tea: Replace with herbal teas or light beverages 2
• Large portions of meat: Avoid heavy meat curries; if consuming fish or chicken, choose steamed or lightly cooked preparations 2

Medical Management Context

First-Line Treatment Priorities

• Test for H. pylori infection using non-invasive methods (urea breath test or stool antigen test) and eradicate if positive, as this is the most efficacious first-line treatment 1, 4
• Start proton pump inhibitor (PPI) therapy at the lowest effective dose if H. pylori negative or if symptoms persist after eradication, particularly if epigastric pain is the predominant symptom 1, 4
• Consider prokinetic agents if bloating, fullness, and early satiety are the predominant symptoms rather than pain 4, 2
• Encourage regular aerobic exercise as this is strongly recommended for all functional dyspepsia patients 1, 4

Important Clinical Considerations

• At age 37, this patient does not require urgent endoscopy unless alarm symptoms develop (weight loss, vomiting, bleeding, anemia, dysphagia) 1, 5
• Insufficient evidence exists for specialized diets including low FODMAP diets in functional dyspepsia, so focus on avoiding individual trigger foods rather than restrictive elimination diets 1, 4
• If symptoms are refractory to first-line therapy, low-dose tricyclic antidepressants (starting at 10 mg amitriptyline once daily) are the most effective second-line treatment 1, 4

Common Pitfalls to Avoid

• Do not adopt excessively restrictive diets that eliminate entire food groups, as this increases risk of malnutrition and eating disorders like ARFID 1, 4
• Avoid NSAIDs if possible, as they can worsen dyspeptic symptoms 1
• Do not use opioids for symptom management as they cause iatrogenic harm in functional dyspepsia 1, 4