13. Bland Diet For Peptic Ulcer Patients
The roots of diet therapy in the treatment of patients with peptic ulcer extend far back in medical history. As early as the first century, Celsus ordered smooth diets free of "acrid" food, and practitioners of the seventh century wrote of their belief in "special healing properties" of milk for patients with digestive disturbances. In the first half of the nineteenth century, peptic ulcer became established as a pathologic and clinical entity, and physicians generally advocated a liberal dietary regimen with frequent feedings.
However, in the later part of the nineteenth century, a radical change developed in medical opinion concerning peptic ulcer treatment. The belief spread that food was harmful to the ulcer, and only complete rest—meaning an empty stomach—would allow the stomach to heal itself. When the body is free from the irritation of the presence of food and when the digestive system is given a complete rest, healing will commence. This is the safest known method to regain health and its beneficial results can be documented by anyone who is familiar with fasting.
However, in 1915, an American physician, Bertram Sippy, broke the common practice of fasting end established the beginning principles of continuous control of gastric acidity through diet and alkaline medication. He outlined a program of milk and cream feedings with slow additions of single soft food items over a prolonged period of time, allowing little variation.
In general, Sippy's regimen is used today by many physicians and dietitions for gastric ulcer patients. This diet therapy is based on several erroneous principles. The food must be both acid neutralizing and nonirritating, according to this principle.
13.3 Acid Neutralizing
The therapy begins with milk and cream feedings every hour or so, to supposedly neutralize free acid with the milk protein, suppress gastric secretion with the cream, and generally soothe the Ulcer by coating the stomach. However, these assumptions have not been supported by research. In fact, clinical evidence proves them to be worthless.
There are gradual additions of soft bland foods over a period of time, keeping some food in the stomach at all times to mix with the acid to prevent its corrosive action on the ulcer. These bland foods are usually limited to choices of white toast or crackers, refined cereals, eggs, milk, cheeses, a few cooked pureed fruits and vegetables, and later, ground meat.
With such frequent meals, the digestive organs are never allowed to rest, and recovery is prolonged rather than assisted. In addition, many of the foods advocated are toxic and further contribute to the reason for the disease.
The therapy is concerned with eliminating chemical, mechanical, and thermal irritation.
13.5 Chemical Irritation
Any food believed to stimulate gastric secretions is prohibited. These include highly-seasoned foods, meat extractives, coffee, lea, alcohol, citrus fruit juices, dried foods, spices, and flavorings.
I could concur with this rule. The above foods are highly irritating for anyone and all except citrus juices contain toxic components that would result in sickness in a well person. For a sick individual who is already enervated, the results are just that much worse.
13.6 Mechanical Irritation
Any food believed to be abrasive in its effect upon the ulcer is prohibited. These include all raw foods, plant fiber (strained fruits and vegetables are used), coarse or rough foods, whole grains, and "gas forming," or strongly-flavored foods.
Hygienists advocate that all foods should be withheld for the gastric ulcer patient. To ensure complete return of health, a fast is in order. After the fast, a diet of the same foods that are prohibited above would be those that would be the best to maintain health. That is a diet that consists of raw foods, mostly fruit.
13.7 Thermal lrritation
Any very hot or cold food believed to irritate the lesion by its effect on surface blood vessels are prohibited. These include hot beverages and soups, frozen desserts or iced beverages.
On this point. I would concur.
13.8 The Four-Stage Pattern
After initial hourly milk and cream only, the diet is gradually increased as the ulcer heals. The routine usually, follows a progressive four-stage pattern as follows:
Stage 1 - For this initial stage of the dietary therapy, the following foods are permitted: milk, cream, butter, margarine, eggs, cooked and refined cereals, plain custard, Jell-O, rennet, plain puddings, vanilla ice cream, noodles, macaroni, spaghetti, white rice, white bread, soda crackers, cheese, jelly, honey, sugar, white potatoes, and creamed soups.
Stage 2 - During this second stage of the bland diet, strained fruit juices are allowed to a limited extent (starting with 1/2 cup). In addition to the fruit juice, the following "foods" are added to the diet: plain cake such as angel food, sponge, pound, butter cake; winter squash; strained asparagus, peas, carrots, green beans, beets, spinach; cooked, stewed fruits.
Stage 3 - At this stage, flesh foods are added to the diet. These include fowl, fish, and beef that has been ground.
Stage 4 - At this stage, certain desserts are added such as prune or apricot whip, plain cookies, plain sherbert, water ices, and fine graham crackers. Also, some additional cooked vegetables and fruits are added.
13.9 Research Studies
This entire diet is a nutritional disaster and will result only in disease. Recent research studies demonstrate the uselessness of this type of dietary therapy.
A. M. Gill reported a series of studies with chronic ulcer patients, whose ulcers healed in four to eight weeks with placebo treatment of a daily injection of one ml. of distilled water and no diet or exercise restrictions or medications. He concluded that ulcers healed not by manipulation of the various common therapies used but because, "... the man with the ulcer comes under the care of a physician who is able to transmit some of his own confidence to the patient."
Gill's studies were valuable in that he found that the orthodox dietary therapy was useless even though he arrived at some other erroneous conclusions. But his theory that no therapy is better than the bland one, is valid.
Other researchers likewise have found that bland food do not increase the rate of healing, nor was there any particular benefit from avoidance of all foods thought to be commonly irritating (such as fruits and vegetables).
It has been demonstrated that routine omission of any fiber in the diet also seems to have no benefits.
Modes of eating—wrong foods or wrong combinations of foods, improper mastication, and rapid consumption of meals are more involved as sources of irritation. Many physicians, such as Dr. H. J. Shull, contend from their experiences with individual patients that so-called coarse or rough foods; such as lettuce, raw fruits, celery, cabbage, and nuts, do not necessarily traumatize a peptic ulcer when they are properly chewed and mixed with saliva. Grinding or straining of food is needed only when teeth are poor or absent!
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