Bacteria cause most ulcers, so no special diet needed

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Q. I'm being treated by my doctor for an ulcer. Do I need to watch what I eat?

A. Generally speaking, no. "We now know that diet doesn't cause peptic ulcers, nor is it part of the treatment," says gastroenterologist David Peura, M.D., who chaired a recent National Institutes of Health panel on digestive problems.

Experts used to believe spicy food and stress caused most ulcers. But thanks to a breakthrough discovery in the 1980's by Australian scientists, a bacterium called Helicobacter pylori was nabbed as the real culprit behind at least 60%--and perhaps as many as 90%--of all ulcers. Other ulcers are caused by chronic use of aspirin and NSAIDS (non-steroidal anti-inflammatory drugs), which irritate the lining of the stomach and intestines.

We acquire H. pylori bacteria in childhood, possibly through water or fecal contact. For many people, it stays dormant, causing no problems. For others, it surfaces in adulthood, causing ulcers of the esophagus, stomach or intestines (most typically the duodenum) and possibly gastritis (inflammation of the stomach lining).

A simple blood test or breath test can determine if you're infected with H. pylori. If you are, treatment involves antacids and a course of antibiotics, which is 90% effective at curing the ulcer for good. However, you must be sure to take the medicine exactly as directed.

The milk diet--that old-fashioned treatment for ulcer--has long been discounted as unhelpful, perhaps even aggravating to ulcers, even before the real cause of ulcers was discovered. But yogurt and other fermented milk products may help fend off ulcers caused by H. pylori, according to recent research.

In a study from Sweden's Lund University, people who ate the most fermented milk products had an 18% low, er risk of peptic ulcer. Those with the highest intake of nonfermented milk products had a 17% greater risk of developing an ulcer. Researchers speculate that certain microorganisms, such as the Lactobacillus used to culture yogurt, may have antibacterial effects.

There has also been research linking infection with H. pylori to low vitamin C levels in the stomach, prompting researchers to suggest that vitamin C may help fend off ulcers.

Alcohol, coffee and pepper need be avoided only if they worsen ulcer symptoms. Though you may be certain other foods trigger ulcer-like symptoms, if they bring on burning pain at the base of the esophagus, you may actually be experiencing gastroesophageal reflux (heartburn), explains Peura. If so, you should eliminate the offending foods from your diet and see your doctor. There are new medications as well as many self-help measures that can ease reflux (see EN, July 1998).

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