Dietary And Lifestyle Considerations
A diet rich in fruits and vegetables and fiber may reduce the risk of ulcers by 50%, and also help heal existing ulcers (Ryan-Harshman 2004; UMMC 2012).
Polyphenols, naturally occurring compounds present throughout the plant kingdom, are obtained from the diet, mostly from fruits, vegetables, spices, grains, coffee, tea, and wine (Cardona 2013). Polyphenols have considerable anti-ulcer potential. Preclinical, animal, and clinical studies have shown that polyphenols may influence ulcer formation and healing through modulation of inflammation, ulcer-healing qualities, and anti-H. pylori activity (Farzaei 2015).
Among the polyphenols that have demonstrated gastro-protective activity in preclinical studies are quercetin (found in onions, apples, and many other plant foods); curcumin (found in turmeric); epigallocatechin gallate (EGCG) and catechins (found especially in green and black tea); and anthocyanins (found especially in red grapes, grape juice, red wine, cranberries, and other red and purple produce) (Farzaei 2015; Mota 2009).
Polyphenols protect against ulcers by mechanisms including protection against free radical damage; fortifying mucosal defense by stimulating production of mucus, growth factors, and prostaglandins; diminishing stomach acid secretion; increasing mucosal blood flow; and exerting antibacterial activity against H. pylori (Farzaei 2015; Mota 2009).
Two clinical trials have found an anti-H. pylori effect of virgin olive oil (Castro 2012). In a preclinical study, polyphenols from virgin olive oil showed antibacterial activity against eight different strains of H. pylori (Romero 2007).
Extracts of the spices garlic, ginger, and turmeric have exhibited anti-ulcer activity in animal models of peptic ulcer, an effect that may result from protection of the mucosa against oxidative injury and inflammation (Choi 2014; Zaghlool 2015; Liju 2015). Ginger extract and curcumin have demonstrated anti-H. pylori activity in preclinical studies (Mahady 2003; Mahady 2002).
Dairy and Peptic Ulcers
Long before the advent of modern ulcer treatment with acid-suppressing agents and antibiotics, drinking milk was commonly recommended for ulcers (UMMC 2015). In fact, in the early 20th century, a new treatment for ulcers was introduced which consisted of hourly consumption of milk and cream along with a mixture of sodium bicarbonate (baking soda) plus a calcium-magnesium or bismuth compound. The goal of this treatment was to neutralize stomach acid in order to allow the ulcer to heal (Patel 2013; Sippy 1915). Within a couple of decades, it was discovered that this treatment led to excessive blood calcium and metabolic alkalinity, and kidney injury. This came to be called milk alkali syndrome (Medarov 2009; Cope 1936).
Interestingly, preclinical, animal, and clinical studies have shown that some milk components such as milk protein and fat have gastroprotective properties. One randomized controlled trial found that milk fermented with Bifidobacterium bifidum was superior to placebo for symptom relief (Miki 2007; Ushida 2007; Dial 1995; Dial 1987). Fermented dairy products such as yogurt and kefir appear to promote H. pylori eradication (Sachdeva 2014). However, milk has also been shown to delay the healing rate of duodenal ulcers, and is no longer recommended for ulcer patients as it likely stimulates increased stomach acid production (CCF 2017; Kumar 1986).
Smokers are at twice the risk of ulcers as non-smokers. Cigarette smoking increases the chances of developing H. pylori infection, delays healing of ulcers, and makes ulcer recurrence more likely (NIH 2013; Lee 2013). Smoking cessation provides immediate benefit for ulcer healing (Parasher 2000; Eastwood 1988).
Alcohol can cause direct physical injury to the stomach lining and increase gastric acid secretion, and, when consumed excessively, can promote ulcer development. Alcohol consumption increases the risk of bleeding in patients with peptic ulcer disease (Lee 2013; Chai 2011; Kuipers 2012). Alcohol consumption should be avoided by people who have ulcers and those at high risk for developing ulcers.
Psychological stress and tension is correlated with gastric and duodenal ulcers (Cheng 2000). In a study in 47 patients with peptic ulcer disease, an integrated stress management program involving seven one-hour sessions over four weeks was compared with listening to a relaxation tape. Over four months of follow-up, those who participated in the stress management program had greater relief of stress symptoms and better ulcer healing than those who only listened to the relaxation tapes (Han 2002). A number of techniques for reducing stress are described in the Stress Management protocol.