It’s not stress or spicy foods that causes an ulcer, though it’s generally a good idea to avoid stress and spicy foods if your body has trouble tolerating them. An ulcer is actually caused by inflammation that develops into a sore that breaks through the protective mucus layer of the stomach lining.
“Once the protective wall erodes away, a pit forms, and that’s where an ulcer is,” says Matthew Hoscheit, MD, a gastroenterologist at the Cleveland Clinic in Ohio. “Since the sore develops where the protective lining has eroded, it is constantly irritated by stomach acid, which can make eating feel very painful.”
The most common ulcers are duodenal ulcers, which are in the small intestine, followed by stomach ulcers. Collectively, these are known as peptic ulcers — named for pepsin, a digestive fluid found in the stomach and the small intestine.
Peptic ulcers affect nearly four million people around the world annually; and will affect up to 1 in every 10 people at some point in their life, according to an analysis published in August 2022 in PLoS One that looked at two decades of records from the Global Burden of Disease Study.
The most common causes of ulcers are an infection of the stomach from the bacteria Helicobacter pylori (H.Pylori), and use of nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
“H. pylori is often contracted at a young age,” says Dr. Hoscheit. “Since it thrives in an acidic environment, it will grow and divide and proliferate in the stomach. For years, people will have indigestion from it, but not know that it’s an H. pylori infection.”
He added that frequent use of NSAIDs over a long period of time can deteriorate the protective lining of the stomach, but just how much is too much varies from person to person.
What to Eat When You Have an Ulcer
Hoscheit stresses that reducing symptoms is key to dealing with ulcers, so he recommends avoiding certain medications and identifying the foods that don’t cause you problems and making sure you eat those. He often tells his patients to try a bland diet (as detailed byStatPearls),which consists of easily digestible foods that are gentle on the digestive tract.
“I often recommend my patients eat soft or moist textures to help manage symptoms,” says Suzie Finkel, RD, a GI dietitian at New York Gastroenterology Associates in New York City. She listed cooked and peeled vegetables, ripe fruits, soft starches, smoothies, and soups as some examples of the foods she recommends.
“If someone is having symptoms, I recommend small but frequent meals, for example every three to four hours,” she adds.
She noted that it’s key to stick to a consistent meal schedule for two reasons. “An empty stomach is an acidic stomach, so going too long without eating can lead to gastric acid build up,” she says. “And, proton pump inhibitors, which are often prescribed to treat peptic ulcers, work best when taken 30 minutes before a meal.”
What to Avoid When You Have an Ulcer
While there are no foods proven to harm or cause an ulcer, certain foods may irritate the stomach lining and aggravate the ulcer. “This includes very spicy foods, acidic foods, and alcohol. People with active ulcers may want to limit these foods if they cause symptoms,” says Finkel. “And when you’re eating out, the kitchen should be able to accommodate your specific needs.”
Additionally, when you have an ulcer, you should review your current medications with your doctor to see if any of them may be stomach irritants, says Hoscheit. He also cautions patients to be wary of iron supplements, which have been linked to inflammation in the stomach lining.
“Also, it’s important to stop smoking when you have an ulcer since it’s detrimental to health and prevents healing,” he adds.
