Gastritis and Peptic Ulcer Disease: Nutritional Considerations

 For decades, doctors have recommended dietary changes to prevent or treat gastritis and ulcers. Common suggestions have included avoiding spicy foods, coffee, and alcohol, or increasing consumption of bland foods and milk. While these suggestions have seemed reasonable, some have not stood up well in controlled trials. For example, milk ingestion tends to increase acid production. And although certain spices (black pepper, chili powder, and red pepper) may cause indigestion, they have not been shown to contribute to either gastritis or ulcers. 

The following factors have been associated with reduced risk of gastritis or ulcers in epidemiologic studies:

• High–fiber diets: A large study at the Harvard School of Public Health found that high–fiber diets were associated with reduced risk of developing ulcers. Over a six–year period, the risk was 45 percent lower for those with the highest fiber intake, compared with those with the lowest. Food sources of soluble fiber (oats, legumes, barley, certain fruits and vegetables) were especially protective, resulting in a 60 percent lower risk in this group.
  
  However, supplementation with dietary fiber in the form of wheat bran had no effect on ulcer recurrence. Similarly, high–fiber diets appeared to have no benefit on ulcer healing rates compared with diets low in fiber.
• Diets high in vitamin A: In the same Harvard study, total vitamin A intake (from food and supplements) was associated with lower risk. The risk was 54 percent lower among persons consuming the most vitamin A, compared with those consuming the least.
• Green tea: Several studies show that regular green tea consumption is associated with a 40 to 50 percent lower risk for gastritis. Cellular tests suggest that the catechins in green tea may act as antioxidants and antibacterials to suppress the H. pylori bacteria.
• Avoiding alcohol: The relationship between alcohol and gastritis and ulcers is complex and may be related to the amounts consumed. Chronic alcohol abuse favors H. pylori infection and also slows the rate of healing in existing ulcers.
  
  However, alcohol may also have antibiotic effects on H. pylori. Studies have found moderate consumption was associated with the lowest risk for infection. However, in combination with smoking, alcohol in any amount increases the risk for ulcers.

In addition, the following are under study for their role in disease management:

• Avoiding coffee: Coffee, in either its caffeinated or decaffeinated forms, stimulates acid production, and some studies have suggested a close association between coffee intake and symptoms. However, it is unclear whether coffee consumption increases or decreases the risk of H. pylori infection.
• Probiotics: Probiotics (e.g., Lactobacillus caseii) may interfere with H. pylori growth. Further, some studies have shown that probiotics also increase the effectiveness of antibiotic treatment for H. pylori and may reduce the side effects of treatment. However, further study is necessary before probiotics can be recommended for prevention or treatment of gastritis or ulcers.