Symptoms Pain or discomfort in the upper central abdomen. Burning or pressing pain when the stomach is empty in the case of duodenal ulcers and after a meal in gastric ulcers. Heart burn, vomiting and subsequent loss of weight. In some patients, hemorrhages may occur and appear as black stools (Malaena) or vomiting of blood. Thus bleeding ulcers also cause anemia Treatment  is based on drug therapy, rest and diet modification. Dietetic treatment gives symptomatic relief in peptic ulcers. In the majority of uncomplicated cases, drugs play only a secondary role< Beware If you are suffering from peptic ulcers beware of the following irritating foods. Mechanically irritating foods are those which increase the peristaltic action because of their coarse, fibrous nature. For example whole grain cereals and skins and seeds of fruits and vegetables. Chemically irritating foods stimulate the flow of gastric juices and cause discomfort and pain to the patient. These foods include spices and condiments, meat extractives, fried foods and stimulating beverages like alcohol, tea, coffee, cocoa and carbonated drinks. Thermally irritating foods Thermal irritation results from eating very hot or very cold foods.  Cooking Methods The cooking method most suitable for the preparation of foods of bland diets are moist heat methods such as  Boiling  Steaming Simmering Stewing Pressure Cooking

Peptic Ulcers Peptic Ulcer is a chronic ulcer formed in regions of the gastrointestinal tract where gastric juice comes in direct contact with mucous membrane. Such ulcers usually occur in the first part of the duodenum and in the stomach. They sometimes occur in the lower Esophagus; in the jejunum after gastro-enterostomy.  Peptic Ulcers can occur at any age but the incidence is highest in middle adulthood between the ages of 45 to 55 years. Ulcers occur more often in men than in women. It may occur in combination with other diseases such as rheumatoid arthritis or other stressful illnesses or injuries.   In patients with duodenal ulcers, hyper secretion of acid is the primary causative factor while in gastric ulcers, it is the weakened mucosal resistance to acid which causes ulcers. Dietary Management The immediate objectives of dietary treatment are To provide adequate nutrition  To afford rest  To maintain continuous neutralization of gastric acid To minimize acid secretions To reduce mechanical, thermal and chemical irritation to the gastric mucosa To achieve the above objectives, the following nutrient modifications are recommended Energy  Most patients suffering from active peptic ulcers are undernourished and therefore need an increased energy intake. However, since they are confined to bed the energy needs for activity are not utilized and make up the extra needs. Proteins A high protein intake is recommended to provide essential amino acids for tissue protein synthesis and thus promote healing. Proteins are also included because of their good buffering action. They may be increased by about 50 %. However meat proteins are to be avoided because meat extractives have a stimulating effect.  Though milk protein has a good buffering action, the high calcium content of milk stimulates excess acid production. Therefore, a high milk intake has an adverse effect on the healing rate of ulcers. Thus milk should be used in moderation. Eggs and other protein foods need to be included to provide essential amino acids. Fats  Since fat delays the emptying of stomach, an increased intake is beneficial. However, fat is only moderately increased since patients suffering from peptic ulcers are generally middle aged executives who are also prone to atherosclerosis. Emulsified fats like butter, cream etc are better tolerated. Carbohydrates  Carbohydrates are included to meet the energy needs. Foods containing harsh, irritating fiber should be avoided. Vitamins  Requirements of nearly all vitamins remain normal. adequate amount of vitamin C should be provided for the healing of ulcers and better iron absorption. Minerals Care should be taken to include sources of iron and calcium in the diet. Generally, blend diets are found to be low in iron and vitamin C due to the restriction in fruits and vegetables and medicinal supplements may have to be given.

Do You Know ?  Causes of Peptic Ulcers Hereditary factors Close relatives of  patients suffering from this problem are more liable to develop peptic ulcers than relatives of normal people Occupation It is seen that some occupations predispose to ulcers. Doctors, and high ranking executives commonly suffer from ulcers. Irregular food habits and mental stress and strain may be the underlying cause. Personality type Highly nervous, emotional, ambitious and aggressive individuals are more prone to ulcers. Anxiety, worry and strain may cause hyper secretion of acid and increase motility of intestines. Irritants Excessive consumption of strong tea, coffee, spices, alcohol, tobacco and drugs like steroids and analgesics may also cause ulcers. Smoking is very strongly related to the occurrence of ulcers. Eating Habits Eating hurriedly, improper mastication of food and missing meals predispose to ulcer formation. Helicobacter pylori infection A major pathogenic factor in gastric ulcers appears to be gastritis from H. pylori infection which impairs mucosal defese making it more susceptible to ulceration. Foods to Avoid Fatty and tough meats Fried foods Sour foods like Imli Unripe citrus fruits like oranges and sweet lime Garlic Ginger Strongly flavored veggies like cabbage, cauliflower, turnip, radish, onion etc Strong spices and condiments  Chilies Pickles Strong tea and coffee Alcoholic Beverages Coriander (dhania) and cumin seeds (zeera) Natural Ulcer Therapy Cabbage is good for you Cabbage is one of the oldest folk remedies for ulcers. Researchers believe that it is possible that cabbage juice helps ulcer patients heel faster. The reason is that cabbage contains glutamine, and amino acids that increases blood flow to the stomach and helps strengthen its protective lining

DIET AND FEEDING PATTERN

Bland diets are recommended for patients suffering from peptic ulcers. Such diets are restricted in foods that are mechanically, chemically and thermally irritating to the gastro-intestinal mucosa.

The dietary modification in bland diets are therefore based on neutralizing the gastric acid and decreasing the motility.

General Dietary guidelines for peptic ulcer patients

1. Eat smaller meals more often to enable the stomach contents to be continuously diluted and neutralized. The quantity of food eaten should be small to avoid overfilling the stomach and causing distention.
2. Eat slowly and savour your food in a calm environment.
3. Easily digestible fats like fat of whole milk, egg yolk, cream and butter should be used in moderate amounts as they decrease the emptying time of the stomach and reduce matality.
4. Try to avoid caffeine beverages such as coffee, cola and tea. Also avoid alcohol.
5. Cut down on, or stop smoking cigarettes.
6. Avoid excessive spices or concentrated meat broths and extractives.
7. Avoid fibrous nature of cereals, fruits and vegetables.
8. Avoid frequent use of aspirin or other drugs that may damage the stomach lining.
9. Individual responses or tolerances to specific foods may vary. The same food may evoke different responses at different times depending on the stress factor. 

Diets for different Stages of Peptic Ulcers

Stage I Diet is prescribed during the active phase of ulcers which is characterized by severe pain
Stage II Diet is prescribed when the patient is on bed rest and their is relief from symptoms, but the ulcers are not completely healed.
Stage III Diet is what the patient has to follow throughout his life as a prophylactic measure.

Foods Recommended

Stage I & II	Stage III
Beverages like milk and fruit juice.	All foods in stage I & II
Milk products - Curd, custards, mild cheeses like cottage cheese	Weak tea and coffee
Refined cereals and their products, pastas etc	Well cooked cereal preparation
Washed pulses
Eggs - soft cooked, Minced meat	All milk, cheese and egg preparation
Soft cooked veggies and fruits	Raw fruits & veggies depending upon tolerance
Plain cakes and mildly flavored dishes

A DAYS SAMPLE DIET FOR DUODENAL ULCER

Dr Malhotra, 38 yrs old, is a cardiologist and is recovering from duodenal ulcer, but is still hospitalized and advised bed rest. He is not overweight and is non-vegetarian. A days diet is hereby planned for him 

Personal Data 

Age Sex   Weight Activity  Socio Economic Status Food Habits Pathological Condition

38 years Male Normal  Bed Rest HIG Non Vegetarian Duodenal Ulcers

Recommended Dietary Allowances

Energy	2182 kcal
Protein	75 to 90 grams
Iron	28 mg
Vitamin C	48 mg

Menu Plan

Meal	Menu	Amount
Early Morning	Milk with sugar	1 cup
Breakfast	Semolina Porridge with porridge	1 bowl
	Scrambled egg	One
	Bread with butter	2 slices
	Papaya	100 gms
Mid Morning	Blenderized Rice Pudding (Phirni)	1 bowl
Lunch	Carrot Khichri with washed pulses	Good helping
	Ghia Raita	1 bowl
Mid Afternoon	Fruit cream	1 bowl
Evening Tea	Vegetable Pulse (Dal) Puree	1 bowl
	Bread with butter
Dinner	Spinach, tender peas, carrots, beans and chicken casserole
	Baked potato
Before bed time	Caramel custard	1 bowl