Ulcer Diet
Page Updated 2/22/11

Fiber, acid and some spices can exacerbate heartburn and some kinds of ulcers.

This page focuses on ulcers that are effected by diet. Not all are.

An ulcer is a wound, or an open sore, and can be aggravated easily. Fiber and acid in food, among other things, hurt many kinds of ulcers. The chart on this page divides foods into "good" and "bad" columns based on whether or not they contain fiber or acid that would hurt an ulcer. There is nothing here about nutritional value or about any supposed medicinal effects of food. This page simply helps the reader understand where fiber and acid are in food.

This page does not deal with other things that hurt ulcers, like smoking, alcohol, aspirin, ibuprofen and other nonfood aggravators of ulcers. Neither does it address the many prescriptions that either aggravate ulcers or interact with acid-reducing drugs.

Physicians are not always the best place for advice about this. The first physician who tried to help me put me on a diet of donuts for about a month. The core of his advice was to eat things that are mushy. Some things that are mushy are bad for ulcers, like donuts.

If it is only heartburn you want to control, and you don't know for sure that the cause is an ulcer, changing your diet and/or lifestyle may or may not change your heartburn (see Stanford Study). The most common cause of heartburn is a relaxing of the esophageal sphincter that normally prevents stomach acid from flowing into the esophagus (see Chew Gum for a thought about one way to deal with that). There are other causes as well (for instance, bile reflux) and not all of them improve with changes in diet. Some ulcers can improve by changing what you eat, but if you don't know what the cause is, you are experimenting to see if the advice on this page has any effect on the kind of ulcer you might have.

To experiment with this, the first thing to try is sleeping on a bed with cement blocks under the legs of its head (the height of a brick helps no one) to give your esophagus a break so it can heal at night. That might be all you need to do no matter what is causing your problem. If it doesn't, you have learned something. Trying these things one at a time enables you to determine which of them help and which don't so that you don't live with lifestyle changes that don't make any difference. The next thing to try is eliminating from your diet vinegar, seeds, and nuts. After that perhaps stop eating anything within three hours of sleeping.  

If those don't help the problem, next eliminate citrus and tomato products. Of course, chili, barbeque and anything blackened or Cajun are problems too. As restricting as that can be, it is possible to avoid these things and still eat in Indian and Mexican restaurants. Well, sort of. Drugs might be required to get you through some escapades.

I hate to say it but being overweight is the primary cause of heartburn. Losing weight is the most important thing to try if your heartburn is not caused by an ulcer. However, if people were able to lose weight on command, they already would have done it for more important reasons than this one. I think it is unrealistic to expect most people to be able to make that change. So this page is about other things that can help.

On the chart below GOOD means low acid and/or low fiber. BAD means the opposite. That is all this chart is about, identifying where fiber and acid are and how to avoid them. For instance, when it says that sugar is good, it means only that it contains no fiber or acid that would hurt an ulcer. It does not suggest that anything else is good about sugar.

GOOD

BAD

White flour, whether it is wheat or potato or riceWhole grain flours like whole wheat flour
Salt - the literature says it's bad. I've noticed it only a few times.Pepper - black, white, or any other color
Sugar (I don't know about artificial sweeteners - if you do let me know) Herbs & Spices in general, although see below
ButterAny acid but especially vinegar, which is one of the worst things you can eat with an ulcer.
Fat and oil in general are okay, except sometimes when food is fried in it.Bell peppers are bad if someone other than you prepares them because no one else peels and seeds them. They are not so bad (in moderation) if peeled and seeded.
All cooked meat (except the skin on ham). Whether it walks, swims or flies, meat is ok unless it has been turned into meatloaf or sausage (see below)Citrus fruits like lemon, lime, orange, pineapple, and zest because they are acidic
Eggs Apples including apple juice. It's acidic.
Cheese is alkaline and actually counteracts other acids.Nuts including peanuts and peanut butter.
Cream. The literature says milk is bad, but milkshakes are soothing to me. Someone reading this page called and said that milk products help her too.Broccoli, cauliflower,
Corn starchBerries (they have acid, peels, seeds) including strawberries, raspberries, blueberries
White chocolate. It's just the cocoa butter and has no fiber. You can even make hot chocolate from white chocolate. Chocolate (it's a ground bean), although things like chocolate milkshakes often have only artificial chocolate in them, and that's ok.
Corn syrupCoffee (acidic)
Maple syrupTea (acidic - but much less so than coffee)
Most melons, like cantaloupe and honey dew and watermelon if you don't eat the seeds Tomatoes, although fresh ones, if peeled and seeded, are okay in moderation. Tomato paste and sauce are big, big problems. Reducing the sauce into a paste only concentrates its acidity.
Honey. Although if it gets really old it crystallizes and the crystals have sharp edges.Beans, peas and corn - each bean, each pea, each kernel of corn is covered with a skin that is fibrous. An ear of corn on the cob looks like a hand grenade to an ulcer.
Bell peppers of all colors if they are peeled and seededAny leaf like lettuce, cabbage, spinach, kale, basil, parsley, cilantro. The solid parts are fiber. However, the flavor and nutrition is in the juice and there are ways to get that without eating the fiber.
Squash (peeled and seeded - the fiber is in the peels and seeds) like zucchini, acorn, butternut, and spaghetti squashDill (fiber)
MangoChives (fiber)
Papaya Rosemary, dill, thyme, sage, etc, unless removed after the flavor has been imparted (see spices below)
Guava Soft drinks usually have acidic preservatives, citric acid and other acids added
BananaCandy usually has the same acids as soft drinks
PearOrange juice. Take a vitamin pill to get Vitamin C..
Peach. Although any fruit, if made into a filling or a compote for a pie or a syrup, most likely will have enough ascorbic acid or other acid added to be a problem.Most ice creams, but only because of how they are flavored. Most fruit flavors, even if artificial, are acidic. Vanilla is fine though.
Pasta, depending on the fiber content (read the side of the box). There is at least one brand that contains no fiber. When the fiber content is listed as 4% or less, you probably are okay.Raw meats like sushi or oysters, because an ulcer is an open sore providing direct access to the bloodstream for bacteria that can be found on raw meat. These bacteria do not bother other people, but in your blood stream they can make you extremely sick. (see addendum)
AvocadoOatmeal, oats in any form
White rice. Read the label. Some rice has no fiber and some has. Brown rice. Although not always. Read the label.
Cocoanut milk. Chicken cocoanut soup in a Thai restaurant is ok, partly because the lemon flavor in it comes from lemon grass which is not very acidic, and partly because the cocoanut flavor is not from shredded cocoanut but only from cocoanut milk. Cocoanut. The solid part that usually is shredded is very fibrous.
Carrots if peeled. Once again, it is only the peel that is a problem. By the way, shredded carrots can be the basis of a salad instead of lettuce. Carrots unless peeled.
Blue cheese and Roquefort cheese salad dressings are low in acidity. Pour them over shredded carrots with mushrooms and cucumber (peeled and seeded, of course) and it's a salad.Almost all salad dressings have acid of some type in them.
Mayonnaise - can substitute for salad dressing, but it bothers some people. See note at bottom of page.Rye bread is bad because there always are caraway seeds in it.
VanillaWorcester sauce, A-1 sauce, Tabasco Sauce
Asian sausage is flavored with oils and other liquids and appears to be made with parts of meat that do not contain gristle.Sausages made the American and European way. The side of the package says it has zero fiber, but they are not counting the spices they add. They also are not counting the ground gristle and oats found in some sausage.
Potatoes, but not the skin, of course.Everyone says that french fries are bad for ulcers, but it hasn't been my experience. I eat them in moderation without a problem.
McDonalds. There is almost no fiber or acid in fast food . . except for the condiments . . and the soft drinks. Oh, well.  Most condiments. Mustard, ketchup, tartar sauce, pickles (because of the brine) and such like are problems.
Teriyaki sauce isn't too bad.The breading on fried chicken has fibrous spices in it.
TofuSoy products can be fine, but some are not. Some soy milk says12% fiber.
Tempura. It's one of those instances in which, even though it is breaded and deep fried, it hasn't bothered me. Hot dogs. The skin on them is fibrous.
Seaweed appears to be a leaf that is fully digestible. (Anything you cannot digest is a fiber that can bother an ulcer.) Some exotic restaurants make salads out of seaweed. I have eaten those with success. Some normal Thai restaurants have seaweed salads, but usually they buy them pre-made with sesame seeds and acid that make them off-limit for ulcers.Chili - the beans, the spices, the tomato base.
Chinese barbeque - Test it before indulging. I haven't done the research yet to see what they make it out of, but the ones I've eaten appear not to be tomato based, have not been acidic, and have not given me a problem.American barbeque - The sauce has tomato and vinegar and spices in it. In a restaurant, if you can order the meat without the sauce, sometimes it's okay if they haven't peppered or spiced the meat too much in cooking.
  
Garlic - I'm going to have to write more about garlic, but there are ways to use it without getting the fiber. As fiber goes, it's not the worst, but it can be a problem, even when gotten through garlic salt. If something is sautéed in fresh garlic, a good deal of flavor remains after the hunks of garlic have been scrapped away. Olive oil infused with garlic is an option too. Onions - the classic round or bulb shaped things that we put into everything require moderation. Onions bother ulcers, but not as much as other things.
 Malic acid, citric acid, ascorbic acid, and even some preservatives are problems.
 Poppy seeds, sunflower seeds, almost any seeds are as bad as nuts or vinegar. If the ingredients list sesame seeds, or if you see sesame seeds on the product, it's a problem. Because sesame seeds eventually can be digested, they are not included in the fiber content rating listed on the product, but they are not digested before they reach your ulcer. So the fiber content can say that it has 0% fiber, but as far as your ulcer is concerned, it has a high degree of fiber.
Baked pastries. Cake flour and pastry flour are softer than bread flour and so they are less fibrous. Wedding cake flour might be the softest flour there is and it makes great pancakes among other things.Donuts. Something about the way they are deep fried makes them a problem.

Fiber percentage listed in nutritive value description on food packaging
It is a useful guide even though the number is revealing only what percentage of your daily fiber requirement is contained in one serving of the product. If it says zero, it probably is safe. For me personally, products with 4% or less usually are fine. Above that and I begin to have problems.

Spices
The primary problem with spices is that they are fibers that are ground up and put in food. For someone with an ulcer that is like grinding glass into a recipe. Anything woody is fibrous. But in some cases if the spice is left whole, like a cinnamon stick, so that it can be removed or avoided, then it is fine. For instance, pumpkin pie can be made by steeping the whole spices wrapped in cloth in the milk (for a chiffon pumpkin pie) to impart the flavor of the spices while allowing the removal of the fibrous element before baking. This also can be done with a tea infuser holding the spices.

This works with cloves, allspice, mace, nutmeg and such like. This even has worked with spices like fenugreek, although generally the hotter the spice the more of a problem it can be even without the fiber. Turmeric, paprika, pepper, curry mixes and such are problematic even with the fiber removed.

Herbs
These can be treated like the spices above. In many cases the juice from fresh herbs is fine, or a broth made from dried herbs. Bitter or acidic herbs are a problem, but often, as long as the fiber is not included, the essence of the herb is fine. Flavoring oils with them is one way to do get the flavor without getting the fiber. Basil Olive oil or Rosemary Olive oil or Cilantro Olive oil are non-fibrous ways of partaking of those herbs and those oils can be bought readymade.

There are many oils on the market now that add flavor to food without grinding spices. Toasted sesame oil mixed with olive oil and butter make an excellent sauce for either meat or vegetables. And peanut oil. There are two kinds of peanut oil. Most peanut oil has almost no flavor, but gourmet sections carry peanut oil that tastes like peanuts, so you can get that flavor into your life without getting the fiber.


Restaurants
French is the safest, but it still is possible to eat Indian, Mexican and Thai food. It just takes learning what is safe. Indian restaurants are among the most difficult. Some have nothing on the menu that is safe. However, Tandoori chicken and fish, even though they have been marinated in spices, can be "relatively" okay because most of the spice drains off during cooking. Not that I don't feel it after I eat it, but hey, never eat Indian food again?

Also, in Indian restaurants, plain Nan is fine. The yogurt drinks some Indian restaurants make with mango or papaya are fine. Sometimes they contain rose water as well, which is high in Vitamin C and therefore a bit acidic (some standard Vitamin tablets use rose hips as the source for their C Vitamins), but in my experience it has not been nearly as acidic as citrus products.

Unfortunately they always put caraway seeds in rice in Indian restaurants. Seeds are one of the first things that must be abandoned to combat ulcers and heartburn. And many Indian restaurants now purchase their lamb in a form that contains herbs and spices in the meat, making it inedible for people with ulcers. You need to ask about that before ordering anything made with lamb in an Indian restaurant.

Acid Reducing Drugs Effect on Nutrition
When you reduce the acid in your stomach you reduce your body's ability to absorb Vitamin B-12. Effects of too little B-12 include fatigue, muscle weakness, problems with walking, tingling in feet and hands, depression, memory loss, dementia, hallucinations, psychosis, personality changes, and a reduced ability to make gains as a result of exercise. Do a search on "pernicious anemia" if you want to read more about what happens when there is too little B-12 in your body.

Among the H2-blockers and antacids that reduce your ability to absorb B-12 are Pepcid, Tagamet, Zantac, Nexium and Tums. Some drugs, like Prevacid, can permanently alter your bodies ability to produce acid and therefore permanently reduce its ability to absorb B-12 from food.

Fortunately, to overcome the problem, prescriptions and shots are not necessary. B-12 pills are cheap and can be bought over the counter in any pharmacy. They are water soluble and nontoxic. So there is not a lot to worry about when trying B-12 to see if it helps clear up your symptoms. If it doesn't, there are other conditions that can produce similar symptoms.

The older we get, the more difficulty our bodies have absorbing B-12. Throw acid reducing drugs into the mix and it can be a problem. If you are under 40 the odds are this isn't your problem.

Ulcer
An ulcer is a wound, or an open sore, that is aggravated easily. If aggravated too much over too long a period of time it can perforate and even be fatal as bacteria in the digestive track are released into other parts of the body.

In most people the H-pylori that causes ulcers can be eradicated with drugs. In most of the rest of ulcer-sufferers, it can be controlled with Priolosec or Zantac or similar drugs. Unfortunately, those made me too stupid to function.

Articles
A helpful reader wrote in recommending these articles about how to heal ulcers:
http://www.drmirkin.com/morehealth/G123.htm
http://www.drmirkin.com/archive/6470.html
The physician who treated me originally gave up after the first course of drugs failed to heal the problem. But according to these articles, when that happens there is another course of drugs that should be tried. For me, personally, that might not be worth trying. I have ulcers because a physician mega dosed me on a prescription for six months that rotted out the lining in my digestive tract. Now that lining cannot heal in order to create the normal barrier to H-pylori, so the H-pylori comes right back. Someday I may be forced to seek a surgical solution, but from what I have seen of that, I'd rather live on pabulum. It's another one of those areas in in medicine in which the physicians who do the surgery say it's successful 98% of the time, but when you meet a few of the people they believe they treated successfully, you can see you'd be better off living with your ulcer.

Mayonnaise
Basic mayonnaise is made with oil, eggs, lemon and vinegar. Many people can tolerate it, but some can't. The principle is the same as in soap-making. Soap is made with lye. By itself lye being will dissolve the skin on your hands. But to make soap you mix it with fat. And that protects your skin.

Mayonnaise is made vinegar and lemon, which by themselves wreak havoc on ulcers. But there is so much more oil (fat) than acid that it reduces the effect of the acid. However, a reader has written to me that mayonnaise bothers him. He said he loves mayonnaise and so he found a substitute. He uses crema Salvadoreña (or Salvadoran cream). Common in Mexican cuisine, it is like a cross between sour cream and heavy cream but with a bit of a bite, which makes it perfect in sandwiches or as a sauce. We've even seen a recipe for putting it on plantain latkes. It also is a good substitute for Crème Fraîche and is the foundation of some desserts in Central and South America. It is one of the things some immigrants to the USA long for when remembering mother's cooking back home. If diary doesn't bother your ulcer, this is worth checking out even if you don't have a problem with mayonnaise.

Results of low fiber diet
There is more than one downside to a diet with no fiber in it. One is that it causes some people become constipated. To combat that many people with ulcers take a fiber pill that is not citrus-based, like Fibercon or Equate, every morning. Some doctors say to take it with food. I'm not sure why fiber pills do not bother their ulcers, but experience shows that for many it does not. And that can keep enough fiber in their bodies to prevent some of the problems that can arise from having too little fiber.

Another downside of a no-fiber diet is that fiber helps your body regulate its blood sugar. With no fiber at all in your food, your diet will tend to have more foods that are high on the glycemic index - foods that cause your blood sugar to spike. After enough years of that, your body can develop problems dealing with it. You could end up having to eat between 4 and 6 small meals per day, each one composed primarily of protein and fat, in order to aid your body in avoiding the peaks and valleys of blood sugar that can result both from eating only three large meals per day, and from eating too many carbohydrates (protein and fat digest more slowly providing a more modulated release of energy - carbs jump into your system causing spikes).

Sometimes we run out of options. It would seem that the answer to this problem would be taking a fiber pill at every meal. But that amount of fiber can damage the delicate nerves lining the colon and can cause the muscles in the colon to become weak from lack of use. That kind of long term use is considered abuse and can cause the colon to cease to function entirely. Laxatives can create and perpetuate the very problem they were intended to correct.

Internists say that taking one tablet per day is okay for long term use and it has proved to be so for me, but you should ask your own physicians to make sure it is so in your case. They can interact with other drugs you might take.


I created this page so that chefs and friends who are trying to feed me could figure out what I can eat. Since so many strangers found it and asked questions, I expanded it to answer what they asked about.

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