27 April 2010

Cordain vs Campbell

I recently read what is entitled the "Protein Debate" between Loren Cordain, a paleo diet proponent, and Colin Campbell, a plant-based diet proponent. Given that I'm simply a graduate student without any specific adherence to either diet philosophy, i found the debate to be fascinating. Both had strong points to defend their positioning. In short, this is how it goes:
  • Loren Cordain argues that because nutritional science is a young, evolving science with little agreement as to what is correct in eating for the general population, they should have a "guiding paradigm" based on the diet of our hunter-gatherer ancestors. The paleolithic diet would be one that include high amounts of protein from lean meats and minimally processed foods of paleolithic resemblance.
  • Colin Campbell argues that nutritional science is not young (it's older than many other sciences) and, that, although knowledge of ancestral diets may be helpful, "biological complexity" throws out its use as a reference standard (after all, high calorie intake from meat may have increased likelihood of reproduction, but not guarded against disease). The priority should be given to searching for dietary factors that cause "collective disease and health outcomes" to guide nutritional recommendations.
You decide. They could, in fact, both be right and wrong on different levels. David

20 April 2010

What causes Autism

Any connection between autism and childhood vaccines?

I don't really "believe" in much unless backed by science. I realize that the connection of vaccines and autism is a touchy subject and that there are opposing viewpoints. Eventually, however, reason must come into the picture and, despite what our opinions are, we need to rely on evidence to guide decision making.

Just last February, The Lancet retracted the study by Dr. Andrew Wakefield that had linked vaccines with autism. The medical journal cited flaws and unethical activity in connecting autism with vaccines (1). This was the study that had launched the first wave of groups against vaccines like Jenny MccCarthy's Generation Rescue. And I think everyone needs to all get over this and continue to see vaccines for what they are, life-saving medicines.

I know that just discounting vaccines' role in autism is not enough to appease a lot of people who fear for their children. After all, according to the CDC, 1 in 110 children in the U.S. now have autism. If not vaccines, than what is making this happen?

Vitamin D Theory

I, for one (being the vitamin D nut that I am), have high hopes for what's been dubbed the "Vitamin D Theory". The theory suggests that our autism epidemic began at or around the same time as did our epidemic of vitamin D insufficiency (2). If there is a link, then it would explain why there is a higher rate of autism among blacks and there should be a higher rate among children who are not in the sun for sufficient amounts of time.

According to Dr. John Cannell writing in Vitamin D Council's January newsletter, "The 'all autism is caused from vaccinations' crowd cannot accept the Vitamin D possibility as it threatens their core beliefs. They simply cannot change their minds" (3).

Then again, there's not much yet to support the vitamin D link, but Dr. Cannell adds "...organized medicine would say you should stop the vitamin D and watch your son deteriorate, which is why slavery to evidence based medicine is fine for scientists and unethical for practitioners" (3).


1. CNN. Medical Journal retracts study linking autism to vaccine. Available at: http://www.cnn.com/2010/HEALTH/02/02/lancet.retraction.autism/index.html

2. Vitamin D Council. http://www.vitamindcouncil.org/health/autism/vit-D-theory-autism.shtml

3. Cannell J. Vitamin D Newsletter. 2010 Jan 30.

16 April 2010

Thoughts on High Fructose Corn Syrup

There are some really wacked people on the Internet who try to blame the whole obesity epidemic on HFCS, fructose or agave and are misguiding everyone. I liken it to the same misguidance that occurred in 1980s when everyone was scared of fat.

You shouldn't just cut out HCFS and replace it regular sugar or another caloric sweetener. It's really overeating, the overabundance of calories much of it from sugar, that in general contributes to this obesity problem.

What our real problem is is that our brains are wired for fats, carbs and salt that has led us into this obesity crisis now. As a whole, our species needed this wiring to seek out nutritious foods that helped us survive.

But in this modern world of aplenty, the answer to our obesity problem is to control our brains (or trick them with artificial stuff) and use simple discipline, portion control and balanced, nutritious meals.

15 April 2010

Sucralose (Splenda)

Sucralose has been on the market for about two decades now and has been touted as a quite the wonderful artificial sweetener. The safety profile of sucralose has been excellent in adults and it has already helped many with type 2 diabetes to manage blood sugar without having to give up on many of their favorite foods and beverages.

Because of increased use of Sucralose over the years, however, high concentrations of it has been popping up in the environment and there have been worries about how the artificial sweetener may influence infants, children and even animals. One big worry has been potential affects on brain growth.

Two Swedish researchers, Dr Viberg and Dr Fredriksson set out to study the possible neurotoxicity of sucralose in mice. They gave just mice an oral dose of 5-125 mg of sucralose per kilogram bodyweight per day on days 8 through 12 immediately after their birth.

Then, the researchers killed the mice and analyzed their brains. They checked for key proteins and found no alterations that would indicate a disturbance to neuronal development.

Thus, they concluded, sucralose "seems to be a safe alternative for people", and possibly even during pregnancy, as it does not affect growth and development of the brain.


Viberg H, Fredriksson A. Neonatal exposure to sucralose does not alter biochemical markers of neuronal development or adult behavior. Nutrition. 2010 Jan 27. [Epub ahead of print]

High cola intake may cut sperm count, reports Danish study

Men who drink a few too many Diet Coke or some other cola-like beverages daily may have fewer sperm, according to a new study.

The study, published in the April 15, 2010 issue of American Journal of Epidemiology (1), had examined the semen quality of more than 2,500 young Danish men who had been recruited upon was evaluated for fitness and military service.

They found that those subjects who reported on a questionnaire that they consumed high amounts of caffeine (more than 800 mg per day) or high intakes of cola (more than 14 half-liter bottles per week) had reduced sperm concentration and total sperm count. On the other hand, the consumption of only moderate amounts of caffeine (less than 800 mg per day) or low amounts of cola (less than 14 half-liter bottles per week) were not associated with any similar effect on sperm concentration or count.

There was no association established between caffeine from tea or coffee and influence on sperm count.

The Copenhagen researchers of University of Denmark of Growth and Reproduction concluded that they "cannot exclude the possibility of a threshold above which cola, and possibly caffeine, negatively affects semen quality" (1).

They added, "Alternatively, the less healthy lifestyle of these men may explain these findings" (1).

Still, if you're interested in maintaining your vitality (who isn't?), it may be better to avoid the cola!

Caffeine and Semen Quality

There have been several studies that have investigated caffeine and a possible association with semen quality, which have led to conflicting results.

Previous to this study on high intakes of cola, there had been a pregnancy cohort in 2008 on more than 5,000 males that evaluated semen quality in association with prenatal coffee and caffeine exposure (2).

The study, also from Denmark, found that although high caffeine intake didn't have any significant effect on semen quality, it did lead to increased testosterone concentrations (approximately 14 percent) in the men (2).

So, until more research is conducted, there's still no need to give up on the coffee.


1. Jensen TK, Swan SH, Skakkebaek NE, Rasmussen S, Jørgensen N. Caffeine intake and semen quality in a population of 2,554 young Danish men. Am J Epidemiol. 2010 Apr 15;171(8):883-91. Epub 2010 Mar 25.

2. Ramlau-Hansen CH, Thulstrup AM, Bonde JP, Olsen J, Bech BH. Semen quality according to prenatal coffee and present caffeine exposure: two decades of follow-up of a pregnancy cohort. Hum Reprod. 2008 Dec;23(12):2799-805. Epub 2008 Aug 28.

Luo han guo - a source of xylitol

Louo han guo is a fruit that has been recently hyped up and marketed as a natural sweetener. What is it really? It's really just a source of xylitol. Xylitol is a natural sugar alcohol, which is not digested as easily by the body lending fewer calories per gram than regular sugar. The polyol also has a slight cooling effect, which you would recognize while eating sugarless gum like Trident.

Xylitol was first discovered and isolated in Sweden from birch bark. It is also now widely used in Sweden (where it was first isolated) and used in all sorts of candies there.

Regular use of xylitol is associated with significant reduction of cavities and tooth remineralization (1). Why? Because research shows that xylitol doesn't contribute to tooth decay and, unlike other sugar alcohols like erythritol, it may even help fight cavities by a mechanism of confusing cavity-causing bacteria to eat it and basically die.


1. Mäkinen KK. Sugar alcohols, caries incidence, and remineralization of caries lesions: a literature review. Int J Dent. 2010;2010:981072. Epub 2010 Jan 5.

Summing up Low-carb

Low-carbohydrate diets may do wonders for quick weight loss (mostly from water loss) and to improve glucose and insulin levels, but they are not without their adverse effects (1-2).

The body needs carbs for energy. Without sufficient amounts, muscle catabolism and protein will result, the break down of fat stores for fuel will result in incomplete fat oxidation, and an excess of acidic ketones will be produced. Diets too low in carbs can lead to ketoacidosis (1).

However, moderately low-carb diets such as the Mediterranean diet, which includes plenty of fruits, vegetables and monounsatured oils are a good choice for long-term health (2).


1. Nix, S. (2005). Williams' Basic Nutrition & Diet Therapy. Philadelphia: Mosby.

2. Shai, I., Schwarzfuchs, D., Yaakov, H., Sahar, D.R., Witkow, S., et al. (July, 2008). Weight loss with a low-carbohydrate, Mediterranean or low-fat diet. The New England Journal of Medicine, 359:229-241.

11 April 2010

Does low-calorie dieting cause you to "yo yo" because of lowered metabolism?

This post came out of a question from someone who asked a question related to whether or not eating a very low calorie diet would lead to a "yo yo" effect caused by lowered metabolism, stoping weight loss and causing weight gain upon eating normally again.

There is no evidence suggesting that a "yo yo" effect would occur from low-calorie dieting, nor would lowering calories too far "stop" weight loss altogether. Truth is, calorie restriction does reduce metabolic rate, you would lose weight at a rate that is lower than normally expected, but if you started eating normally again, your metabolism would speed back up again.

In 2006, Heilbronn et al. studied the effects of calorie restriction (CR) on metabolism. The researchers published in JAMA the results of a six-month randomized controlled trial on CR and how it made an impact on biomarkers of metabolism as well as longevity and oxidative stress in overweight adults.

The subjects were paid and placed in one of the following groups: a control group, a CR group (25% reduction from baseline), a CR group with exercise (12.5% reduction, 12.5% increase activity), and what they called a very-calorie diet (890 kcal/d) followed by weight management at 15 percent weight reduction.

By the third month, metabolism had slowed (measured in part with plasma T3 levels) in both CR and very low-calorie diets. At six months, metabolism had slowed in the CR, CR with exercise, and very low-calorie diet groups.

Everyone lost weight in the intervention groups. Those on the very-low calorie diet lost the most, but they also lost the most muscle. From that same study, the researchers were the first to find reduced oxidative stress and DNA damage from CR in humans.

So, what do we know? We know that if you also drop even to 500-800 kcal per day that, despite slower metabolism (your body's survival mechanism), you still would lose weight albeit at a lower rate (as stated before).

What some researchers have tried to do since then to "trick" the body to not slow metabolism. They do it by staggering the calories with alternate-day CR/fasting or intermittent CR/fasting. These are interesting topics of research and may show up as new weight-loss fads of the future.

I don't recommend people drop calories or lose weight too quickly because it leads to too much loss of hard-earned muscle and, possibly, gallstones (if you're not drinking enough water and eating small meals throughout the day). In my experience, I've also seen quite a few people go lower than 800 calories per day for weeks and end up without energy, getting sick and looking pretty frail.

It's best, I think, to stick with losing only 1-2 pounds per week (by dropping calories steadily and increasing activity to keep muscle up) and then eventually keeping diet within 800-1200 kcal/d range.

Undigested meat in the colon

When you have undigested meat proteins in your colon, they will basically do what they do when thery are outside the colon: they rot. The rotting, or decay, is characterized by a release of foul-smelling chemicals.

One such chemical is cadaverine--the same that gave "cadavers" their name because of the smell they emit--which is the result of protein hydrolysis or the decarboxylation product of lysine. It's similar in structure to putrescine, putrescine itself produced from rotting activity.

Rotting flesh in the colon gives off a horrible odor and the smelly chemicals can become apparent in a person's breath, feces or urine. The person may suffer from the foul odors for a good while as the long process digestion or elimination of the meat continues.

To help speed things along, it's important to maintain a diet high in dietary fiber, specifically insoluble fiber, which helps increase rate of transit in the colon. Insoluble fiber comes from the "woody" parts of plants such as wheat bran and vegetable skins.

No one should have to put up with "the smell of death" after a meal. To avoid offensive gas and bad breath, just eat smaller portions of meat and be sure to also include some salad and extra vegetables.

Lecture notes by Albert Grazia, M.S.

Green tea EGCG in low doses boosts fat oxidation by amounts comparable to caffeine

Several studies have reported that green tea improves weight loss, which has largely been attributed to its content of caffeine. A pilot study, however, reports that green tea's main antioxidant catechin, epgallocatechin-3-gallate (EGCG), may also have thermogenic potential.

Thielecke et al of Germany report in the April issue of European Journal of Clinical Nutrition that consumption of EGCG at low doses taken after meals may contribute to increased fat oxidation similarly to caffeine (as much as 35 percent). The same effects of EGCG were not demonstrated while fasting.

The German researchers employed by DSM Nutritional Products performed a randomized, double-blind, placebo-controlled trial on 12 men that were screened for health problems, drugs and smoking. They also excluded men that had taken any dietary supplement within a week of the study.

Each male volunteer consumed an encapsulated supplement over three days (weeklong wash out in between) of either a low dose of EGCG (300mg), high dose of EGCG (600mg), caffeine (200mg), a combination of low-dose EGCG and caffeine (300mg EGCG/200mg caffeine), or a placebo.

The subjects were fed a standard meal of bread, butter, cheese, ham, tomato and cucumber according to the individual energy requiremens of each volunteer, calculated as 5 kcal/kg body weight with 50 percent enrgy from carbohydrates, 35 percent from fats, and 15 percent from proteins. They were prohibited from drinking caffeinated drinks during the study.

Fat and carbohydrate oxidation rates were calculated using a relatively new "respiratory quotient" that measures variance of oxygen consumption (VO2) and carbon dioxide production (VCO2). After three days of each treatment, the researchers took anthropometric measurements for body weight and BMI.

Here are their reported findings:

- 10 of the 12 successfully completed all five supplementation periods
- No adverse effects were reported
- There was no significant difference in fasting blood glucose and insulin from the different supplements
- Energy expenditure was not affected by EGCG
- Caffeine alone and in combination with green tea did have a pronounced effect on fat oxidation
- High dose EGCG boosted fat oxidation by a non-significant 20 percent
- Low dose EGCG surprisingly boosted fat oxidation by 33 percent after meals similarly to caffeine, but not before meals
- Low EGCG (300mg) and caffeine (200mg) maximized fat oxidation, increasing it by 49 percent, after meals

The researchers conclude: "This pilot study provides for the first time evidence that a single green tea catechin, EGCG, can increase fat oxidation in obese men, at least within 2 h after meal intake. Within this postprandial phase, EGCG is equipotent with caffeine with regard to fat oxidation."

My thoughts:

Why did the high dose EGCG not exhibit the same effects as the low EGCG? I understand that there may be a threshold point that is reached by caffeine and EGCG and its influence on fat oxidation, but I have a hard time buying that a low dose of EGCG may be more effective than a high dose. To that end, I'd like to see similar studies appear to clarify the relationship of EGCG on fat oxidation.

However, I am definitely glad to learn that we now know that EGCG does influence fat oxidation and that its effects of potentially improving weight loss have been pinned down to this mechanism instead of others such as reducing fat absorption. I am also glad to confirm that EGCG has no effect on body composition by means of influencing energy expenditure (meaning an influence on how many calories a person burns in a day).

I will continue recommending three or more cups of green tea a day, with or without the caffeine, for helping patients improve their weight loss. Despite the study, however, I think that across the board the most important reason why we continually see patients losing greatest amounts of weight while drinking green tea daily is because they are, at the same time, replacing their sugary beverages such as fountain drinks.


Thielecke F, Rahn G, Böhnke J, Adams F, Birkenfeld AL, Jordan J, Boschmann J. Epigallocatechin-3-gallate and postprandial fat oxidation in overweight/obese male volunteers: a pilot study. European Journal of Clinical Nutrition advance online publication 7 April 2010; doi:10.1038/ejcn.2010.47.

10 April 2010

Whole milk better for your heart?

Every nutritionist knows (or should know) that a DASH eating plan is incredibly effective for helping patients to lower their blood pressure. A staple on the plan are low-fat or non-fat dairy foods (think 2 percent or skim milk versus whole milk) because they are considered more heart healthy than full-fat dairy, but the results of a 16-year prospective study just published in the European Journal of Clinical Nutritianare suggesting otherwise.

Bonthuis et al are calling for more studies to assess whether or not full-fat dairy may have more cardioprotective benefits than low-fat or nonfat dairy (1). The researchers found that among more than 1,500 adult Australians regularly consuming dairy products, those with highest consumption of full-fat dairy had reduced mortality when compared with those who ate low-fat dairy (1). This was after adjusting for possible confounders such as calcium and vitamin D. Most of the deaths of the participants in the study were related to cardiovascular disease and cancer (1).

The study overall confirms that dairy deserves to continue to be part of DASH and a previously published cohort from Australia that dairy could lower all-cause mortality (2). The study also questions recommendations of avoiding full-fat dairy for long-term protection against chronic disease.

Where did the recommendation to go for the low-fat dairy come from anyway?

The recommendation appeared because of studies that found that low-fat dairy was associated with lower blood pressure, but that full-fat dairy was not. Somewhat recently, the National Heart, Lung, and Blood Institute Family Heart Study in 2006 found an inverse association between prevalent hypertension and consumption of a diet containing dairy low in saturated fat (3).

Given the newest Australian findings, the dairy and blood pressure relationship may be dependent on the fatty acid make-up of the dairy. Could there be something about Australian dairy sources that are cardioprotective? The researchers no doubt must have this data and I imagine less saturated fat and more omega-3s would be involved in their results.

So, don't go switching to whole milk yet. If you like that full-fat flavor, then consider drinking omega-3-fortified dairy.

Just last month in March, a double-blind, cross-over study confirmed that omega-3-fortified dairy foods improved lipid profiles decreasing cardiovascular risk factors (4). The dairy improved omega-3 index, lowered total cholesterol, lowered LDL cholesterol, and lowered triglycerides significantly (4).

Once again, the fact of the matter is that it is the amount of omega-3s in any food that may truly determine how cardioprotective the food really is, as well as its lack of saturated fat and trans fat. Milk is no exception to this nutritional rule.


1. Bonthuis M, Hughes MC, Ibiebele TI, Green AC, van der Pols JC. Dairy consumption and patterns of mortality of Australian adults. Eur J Clin Nutr. 2010 Apr 7. [Epub ahead of print] Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20372173.
2. van der Pols JC, Gunnell D, Williams GM, Holly JM, Bain C, Martin RM. Childhood dairy and calcium intake and cardiovascular mortality in adulthood: 65-year follow-up of the Boyd Orr cohort. Heart. 2009 Oct;95(19):1600-6. Epub 2009 Jul 29.
3. Djoussé L, Pankow JS, Hunt SC, Heiss G, Province MA, Kabagambe EK, Ellison RC. Influence of saturated fat and linolenic acid on the association between intake of dairy products and blood pressure. Hypertension. 2006;48:335.
4. Dawczynski C, Marin L, Wagneer A, Jahreis G. n-3 LC-PUFA-enriched dairy products are able to reduce cardiovascular risk factors: A double-blind, cross-over study. Clinical Nutrition. Mar 19. [Epub ahead of print]

09 April 2010

Getting to the Bottom of Hemorrhoids

When a patient has hemorrhoids (most prevalent in males over 50) then it is always important to evaluate hydration and dietary fiber intake because constipation contributes to risk (1). Sufficient regular water intake and fiber helps to encourage regular bowel movement and alleviate symptoms of constipation.

One can't get to the bottom (excuse the pun) of hemorrhoids, however, without also evaluating the patient's level of activity. A sedentary lifestyle is a major risk factor (spicy foods and alcohol intake are also risk factors) (2). Sitting too long in an office chair, an automobile, in front of the TV, or on a toilet increases pressure on veins in the anus. Exercise promotes circulation and alleviates pressure on the veins, which helps to shrink hemorrhoids and prevent them in the future.

I am also a fan of flavonoids (in particular, micronized purified flavonoids, or Daflon at 500mg) for use with hemorrhoid therapy. There has been at least a few double-blind, placebo-controlled trial that showed flavonoids relieved symptoms associated with hemorrhoids and reduced frequency and severity of hemorrhoid flare-ups (1-4). The evidence behind use of flavonoids, I realize, is limited because of methodological errors and possible bias (5), but in my experience (which I will not explain) they work well.


1. Pigot F, Siproudhis L, Allaert FA. Risk factors associated with hemorrhoidal symptoms in specialized consultation. Gastroenterol Clin Biol. 2005 Dec;29(12):1270-4. Available at http://www.em-consulte.com/article/100126.
2. Jiang ZM, Cao JD. The impact of micronized purified flavonoid fraction on the treatment of acute haemorrhoidal episodes. Curr Med Res Opin. 2006 Jun;22(6):1141-7.
3. Danielsson G, Jungbeck C, Peterson K, Norgren L. A randomised controlled trial of micronised purified flavonoid fraction vs placebo in patients with chronic venous disease. Eur J Vasc Endovasc Surg. 2002 Jan;23(1):73-6.
4. Lyseng-Williamson KA, Perry CM. Micronised purified flavonoid fraction: a review of its use in chronic venous insufficiency, venous ulcers and haemorrhoids. Drugs. 2003;63(1):71-100.
5. Struckmann JR. Clinical efficacy of micronized purified flavonoid fraction: an overview. J Vasc Res. 1999;36 Suppl 1:37-41.
6. Alonso-Coello P, Zhou Q, Martinez-Zapata MJ, Mills E, Heels-Ansdell D, Johanson JF, Guyatt G. Meta-analysis of flavonoids for the treatment of haemorrhoids. Br J Surg. 2006 Aug;93(8):909-20.

03 April 2010

Heartburn and Diet

Heartburn is an awful feeling that almost everyone has suffered from at some time in their lives. It's disheartening to hear that in the USA about 44 percent suffer every month and, worse yet, about 10 percent suffer every day (1). There's no need for the continual pain from heartburn (or taking the drugs to avoid it or treat it). With a little knowledge of what causes heartburn and change in diet, anyone can avoid heartburn for life.


Chronic heartburn, or gastroesophageal reflux disease (GERD), is a result of reflux of gastric acid and gastric contents re-entering the esophagus. Depending on the amount of acid refluxed and heartburn severity, mucosal damage can cause the esophagus to become irritated and painfully inflamed (2). Although the esophagus can heal pretty well, GERD mucosal damage can potentially leads to more serious outcomes such as increased risk for erosive esophagitis, strictures, Barret's esophagus and even adenocarcinoma (1).

Gastric acid amounts, which peak about 2-3 hours after meals, have more of a chance to reflux if a person is in a reclining position (2). Certain foods can also cause the lower esophageal sphincter to relax increasing risk of heartburn, namely alcohol, fatty foods and chocolate. Alcohol and coffee also can cause increased gastric acid secretion increasing risk. As you can imagine or may have experienced, the worst events of heartburn happens to people in the evening after eating a large fatty meal accompanied by alcohol, coffee and chocolate.

Peptic Ulcer

Heartburn can also be the result of a peptic ulcer, or duodenal ulcer that is chiefly caused by infection from Helicobacter pylori or, to a lesser degree, overuse of aspirin or NSAIDs (1). NSAID produces ulcers by blocking the production of prostaglandins in the cyclooxygenase-1 pathways (3). What H. pylori does to cause the ulcers is cause acid to be secreted at higher rates (hypersecretion), which is not good for the gut and produces the discomfort. The rate of secretion also can be corrected by eradicating the H. pylori (1). Whatever can help to modulate acid secretion is also considered therapeutic, which includes H2-receptor antagonists and proton pump inhibitors (1).

Dietary Therapy

Dietary therapy should focus on avoidance of heartburn trigger foods while encouraging healing with other foods as well as improving immune resistance to harmful bacteria such as H. pylori.

A word on low-carb diets

Although there does appear to be a few proponents of a high-protein, low-carb diet as therapeutic for both GERD and peptic ulcer disease, I was not able to find any clinical evidence to back up claims on blogs and Web sites that the diet would help with heartburn, or specifically that a low-carb diet would help eradicate bacterial infection. The interest in low-carb dieting is prevalent, however, and if nutritionists choose to recommend one such as Atkin's, then they should make patients aware of possible unwanted side effect from eating additional fatty foods that may cause increased possibility of heartburn as stated earlier.

Therapeutic Fiber and Probiotics

Dietary therapy for GERD and peptic ulcer disease should begin with a diet higher in fiber, preferably soluble fiber (1-3). According to a prospective cohort study on more than 51,000 male adults in 1986, dietary fiber from beans, tofu, peanuts, and other nuts (all rich in soluble fiber) reduced risk of peptic ulcer disease more than other foods rich in insoluble fiber (3). Dietary fiber helps to normalize gastric motility and soluble fiber can support growth of healthy gut flora (1). To best help prevent both diseases, patients should strive to eat a diet high in fruits, vegetables and legumes.

After antibiotic therapy in peptic ulcer disease, probiotic foods such as yogurt, kefir and sauerkraut can be therapeutic. Probiotics can help support GERD as well by helping to normalize symbiosis. The probiotic bacteria can help repopulate gut flora and they will thrive on prebiotics found in fruits, vegetables and legumes (1). A healthy gut flora can help normalize symbiosis and improve immune resistance to infection.

Avoiding Triggers

What a diet should not do is cause any additional stress to the patient, which include heart burn triggers. GERD patients should limit fatty foods, caffeine, alcohol, chocolate, garlic, onions and peppermint that can relax the lower esophageal sphincter (1). In addition, acidic foods such as peppers, citrus juice and tomato juice should be avoided to limit recurrence of pain from inflammation in the esophagus (1).

On the other hand, there is no evidence for avoiding spicy foods (surprising to me) or milk, alcohol or coffee as they have not been linked as causal factors for peptic ulcer disease (2). Milk, however, can exacerbate symptoms after infection (1). Those with risk of peptic ulcers should also avoid aspirin and NSAIDs with direction from a doctor.

Other advice

GERD therapies
- Avoid large meals, finish eating at least three hours before bedtime, relax, eat slowly, chew food, sleep well, keep their head up during digestion (1;2).
- Because being overweight and smoking are risk factors for GERD, a weight-loss program and quitting the cigarettes can help avoid heartburn (1).
- Try a food allergy elimination diet to determine if there's a challenge from gluten, dairy, eggs, etc (1).
- Take digestive enzymes to avoid maldigestion as necessary (1).
- Take glutamine for as it is the preferred fuel for gut lining and can help encourage faster healing (1).

Peptic ulcer therapies
- Although there is limited evidence on how much it helps, eating broccoli and brussel sprouts may help upregulate antioxidant enzymes and protect and repair gastric mucosa (1;2).
- Cook broccoli and other foods to avoid infection with H. pylori or E. coli (1).
- Drinking green tea, eat berries and drink red wine since they contain catechins, quercetin and other flavonoids that inhibit H. pylori proliferation and have anti-inflammatory effects (1).
- Take zinc-carnosine since it helps to inhibit H. pylori proliferation and shortens duration of treatment with antibiotics (1).


1. Kohlstadt I. Food and Nutrients in Disease Management. Boca Raton, FL: CRC Press, 2009.
2. Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ. Modern Nutrition in Health and Disease. Baltimore, MD: Lippincott Williams & Wilkins, 2009.
3. Ryan-Harshman M, Aldoori W. How diet and lifestyle affect duodenal ulcers. Review of the evidence. Can Fam Physician. 2004 May; 50:727-732.