Dietary management

Normal and Therapeutic Nutrition 3(2+1)
Lesson 20:Gastrointestinal diseases

Dietary management

It was customary to suggest bland diet for ulcer patients. Bland diet is a diet which is mechanically, chemically and thermally non-irritating.

Mechanically irritating foods include those with indigestible carbohydrate, such as whole grains and most raw fruits and vegetables. Foods believed to be chemically irritating because of their stimulatory effect on gastric secretion include meat extractives, caffeine, alcohol, and some spicy foods. The capsaicin present in chillies causes shedding of surface stomach cells and may cause peptic distress. Foods believed to be thermally irritating such as very hot or iced liquids may cause pain. This diet prevents irritation to the mucosa, avoids increase in acidity and aids in control of pain. Sippy's diet, Lenhartz's diet and Meulangracht diets were given in the past.

The so-called bland diets used in the past for treatment of peptic ulcer have proved to be unwarranted and ineffective. A more liberal individual approach prevails today in modern clinical practice.

  • Sound total nutrition: There must be optimal overall nutritional intake to support recovery and maintain healthy tissue, based on individual needs and food tolerance.
  • Protein foods: Milk and protein foods do have some buffering effect but they also evoke gastric secretions more than carbohydrates and fats. Milk should be included as a source of nutrient factors for healing purposes. Protein provides the necessary amino acids for synthesis of tissue protein which helps in healing ulcer.
  • Fat: Moderate amount of fat helps to suppress gastric secretion and motility through the enterogastrone mechanism. Fats such as cream, butter and. olive oil can be particularly helpful in a thin patient. Fried foods are not advised as they are difficult to digest and often aggravate the symptoms.
  • Ascorbic acid: It helps in wound healing hence citrus fruit juice and tomato juice can be given. The pH of food before ingestion has little significance.
  • No food is sufficiently acidic i.e., by itself to effect a significant change in pH or cause direct irritation on an ulcer. For majority of patients hospitalized for an active peptic ulcer some type of bland diet is commonly used.

  • Gas formers: In addition certain foods traditionally forbidden include strongly flavoured vegetables such as cabbage, cauliflower, onions turnips and fried foods. Restriction of these foods is based on subjective evidence from patients who experience distress following ingestion of these items.
  • Fibre: A regular diet, including good food sources of dietary fibre, has proved to be beneficial.
Last modified: Monday, 24 October 2011, 11:29 AM