Diet in peptic ulcer
Peptic ulcer diet today is a liberal, individualised diet: regular moderate meals, mild spices, no alcohol or strong acid stimulants, and no late-night eating.
Aim and principles of the diet
Aim: To plan, prepare and calculate a diet for a young man with a duodenal ulcer. Principles: A peptic ulcer is a sore in the lining of the stomach or duodenum, caused mainly by Helicobacter pylori infection and by painkillers such as aspirin (NSAIDs). Medicines heal the ulcer; the diet reduces irritation and acid secretion and supplies nutrients for healing. The modern diet is a liberal, individualised bland diet, not the old rigid regimens. Strong acid stimulants are avoided: alcohol, coffee (even decaffeinated), strong tea, colas, meat extracts and strong meat soups, black pepper and chilli powder. Foods that the patient finds painful are left out. Fried and very fatty foods are limited because they delay stomach emptying. Milk is not a treatment: it buffers acid briefly, but its protein and calcium then raise acid secretion (rebound), so the old Sippy regimen of hourly milk and cream is no longer used; milk and curd are taken in normal amounts. Protein, vitamin C, zinc and iron support healing, and fibre from fruits, vegetables and pulses is normal. Meals are regular and moderate in size, eaten slowly, without long gaps and without late-night eating, because food at bedtime keeps acid high during sleep. Books differ on meal frequency: Indian textbooks advise small, frequent meals so the stomach is never empty, while newer Western texts (such as Krause) note that every meal stimulates acid, that frequent feeds are no better than three regular meals, and that a bedtime snack raises night-time acid. A practical plan uses both: regular meals with small snacks, no long gaps, and nothing just before bed. Smoking is stopped. A bleeding ulcer or ulcer surgery needs a liquid-to-soft progression first.
Nutrient prescription: Mr. P, 35 y, 170 cm, 60 kg, duodenal ulcer, on treatment
| Nutrient | Prescription | Basis and source |
|---|---|---|
| Ideal body weight | 63 kg | (170 − 100) × 0.9 |
| Energy | About 1900 kcal | 30 kcal/kg × 63 = 1890 |
| Protein | About 63 g | 1.0 g/kg: enough for healing; very high protein also stimulates acid |
| Fat | 20-25% of energy; about 20 g oil | No frying; fat delays stomach emptying |
| Fibre | Normal | Fruits, vegetables and pulses are allowed |
| Meal pattern | 3 meals + 2-3 small snacks; dinner 2-3 hours before bed | Avoid long gaps and late-night eating |
Foods to include and avoid
| Food group | Include | Limit or avoid |
|---|---|---|
| Cereals | Rice, idli, dosa, chapati, upma, ragi, bread | Spicy fried snacks such as bajji and samosa |
| Pulses and protein foods | Dals and mild sambar, egg, fish, stewed chicken, paneer | Meat extracts, strong meat soups, fried meat |
| Milk | Milk, curd and buttermilk in normal amounts | Hourly milk or cream (old Sippy regimen) |
| Vegetables and fruits | Most cooked vegetables; banana, papaya, apple, guava | Any food that gives the patient pain |
| Drinks | Water, buttermilk, barley water | Alcohol, coffee (also decaffeinated), strong tea, colas, fizzy drinks |
| Spices | Mild: turmeric, cumin, coriander, a little ginger | Black pepper, chilli powder, hot pickles |
Sample one-day menu: duodenal ulcer (Mr. P)
| Time | Menu | Approx. amount (raw) |
|---|---|---|
| 7.00 am | Ragi malt | Ragi 20 g, toned milk 150 mL, sugar 10 g |
| 8.30 am | Idli (3) with mild moong dal sambar | Rice 60 g + urad dal 15 g; moong dal 15 g, vegetables 50 g, oil 3 g |
| 11.00 am | Ripe banana | 100 g |
| 1.00 pm | Soft rice, mild tur dal, carrot-beans poriyal, curd | Rice 110 g; tur dal 25 g; vegetables 100 g, oil 5 g; curd 100 g |
| 4.00 pm | Vegetable rava upma and papaya | Rava 30 g, vegetables 30 g, oil 4 g; papaya 100 g |
| 7.30 pm | Chapati (3), moong dal, mild vegetable kurma, boiled egg (or paneer) | Atta 75 g, oil 3 g; moong dal 15 g; vegetables 100 g, oil 6 g; 1 egg |
Worked calculation: Mr. P's peptic ulcer diet
Mr. P, 35 years, 170 cm, 60 kg, has a duodenal ulcer (H. pylori positive) and is on treatment. Find his IBW, energy and protein needs and check the menu.
- IBW = (170 − 100) × 0.9 = 63 kg.
- Energy = 63 kg × 30 kcal/kg = 1890, about 1900 kcal.
- Protein = 63 kg × 1.0 g/kg = 63 g: enough for healing, without the very high protein that also stimulates acid.
- Approximate values used (kcal and g protein per 100 g raw unless stated; rounded from Indian food composition tables, mainly IFCT 2017 and the older Nutritive Value of Indian Foods; a few, such as toned milk, are estimates): ragi 320 and 7; toned milk 60 and 3 per 100 mL; sugar 400; rice 355 and 8; urad dal 325 and 23; moong dal 325 and 24; mixed vegetables 30 and 1.5; oil/ghee 900; banana 100 and 1.2; tur dal 330 and 22; curd 60 and 3; rava 345 and 10.5; papaya 35 and 0.5; atta 320 and 10.5; egg 75 kcal and 6.5 g per piece.
- Cereals (ragi 20 g, rice 170 g, rava 30 g, atta 75 g): 1011.0 kcal, 26.0 g protein.
- Pulses (urad dal 15 g, moong dal 30 g, tur dal 25 g): 228.8 kcal, 16.2 g protein.
- Milk and milk products (toned milk 150 mL, curd 100 g): 150.0 kcal, 7.5 g protein.
- Egg (1 egg): 75.0 kcal, 6.5 g protein.
- Vegetables (mixed vegetables 280 g): 84.0 kcal, 4.2 g protein.
- Fruits (banana 100 g, papaya 100 g): 135.0 kcal, 1.7 g protein.
- Oil and ghee (oil/ghee 21 g): 189.0 kcal.
- Sugar (sugar 10 g): 40.0 kcal.
- Energy = 1011.0 + 228.8 + 150.0 + 75.0 + 84.0 + 135.0 + 189.0 + 40.0 = 1912.8 kcal.
- Protein = 26.0 + 16.2 + 7.5 + 6.5 + 4.2 + 1.7 = 62.1 g.
- Compare with the prescription: energy 1912.8 ÷ 1900 × 100 = 101%; protein 62.1 ÷ 63 × 100 = 99%.
- Each group is rounded to one decimal and the totals are the sums of those rounded figures; all values are approximate.
IBW 63 kg; prescription about 1900 kcal and 63 g protein. The menu gives about 1913 kcal (101%) and 62 g protein (99%) in regular, mildly spiced meals.
Preparation and serving tips, and result
- Season sambar, kurma and dal with turmeric, cumin and coriander; leave out chilli powder and pepper.
- Serve meals at the same times each day and teach the patient to eat slowly and chew well.
- Keep dinner light and at least 2-3 hours before bed; no bedtime milk.
- Offer water, buttermilk or barley water instead of coffee, tea and colas.
- Result: The ulcer diet gives about 1913 kcal and 62 g protein in regular, mildly spiced meals, meeting Mr. P's prescription of 1900 kcal and 63 g protein.
In the diet kitchen, the ulcer tray is a mild version of the normal menu: the same sambar and kurma without chilli powder or pepper, no pickle, and buttermilk instead of coffee. The kitchen should not send hourly milk; modern practice is regular, moderate meals.
Short answer: “Why is the Sippy regimen no longer used?” Hourly milk and cream buffer acid only briefly; milk protein and calcium then stimulate more acid (rebound), and the cream adds saturated fat.
Short answer: “Name four foods or drinks to avoid in peptic ulcer.” Alcohol, coffee (including decaffeinated), colas, chilli powder and black pepper, meat extracts, fried foods.
Essay: “Plan a diet for a patient with duodenal ulcer.” Aim; principles (liberal individualised bland diet, avoid acid stimulants and irritants, milk not a treatment, regular moderate meals, no late-night eating, no smoking or alcohol); prescription for IBW 63 kg: 1900 kcal, 63 g protein; foods to include and avoid; mild Indian menu; calculation; result; tips.
'No ACID': no Alcohol, no Coffee or colas, no Irritant spices (chilli, pepper), no Dinner just before bed.