Ulcers

An ulcer occurs when the surface of tissue breaks down. Different parts of the body can be affected by ulcers, including the mouth, stomach, legs or internally in the digestive tract. Some ulcers might remain small and heal quickly, but others may become persistent. That’s because ulcers develop when protective tissue barriers become weakened or irritated. 

In some cases further irritation to the tissue can happen through friction or injury. Elsewhere, inflammation, infection or poor circulation may contribute.

Healthy tissue naturally protects the body from irritation and infection. When that protective layer becomes compromised, the tissue underneath may become exposed and inflamed. This can lead to redness, tenderness, swelling and the formation of a sore.

Healing may also slow down if the area continues to experience ongoing irritation. There are also cases whereby specific underlying health conditions might affect tissue repair. More on this later.

Mouth ulcers appear inside the cheeks, lips or on the tongue. They can be a result of minor trauma or irritation. They might also be linked to nutrient deficiencies and a weak immune system. As such, if mouth ulcers occur repeatedly, it may require further examination (1). 

Digestive ulcers develop in the stomach or upper intestine when the protective lining becomes damaged by excess acid or infection (2).

Leg ulcers (and other forms of skin ulcers) tend to occur when circulation is poor and tissue struggles to repair itself properly. It is common for this to happen in cases of certain cardiovascular diseases. Examples of which include peripheral artery disease, chronic venous insufficiency, or diabetes, which disrupt healthy circulation and oxygen delivery (3). 

From a nutritional therapy perspective, ulcers are often viewed as more than isolated areas of tissue damage. Attention is typically given to factors that may influence healing, including nutrient status, inflammation and digestive health.

Please note: While some ulcers may heal with appropriate treatment and support, ulcers that develop internally can lead to serious complications if left untreated. 

Persistent pain, difficulty swallowing, unexplained weight loss, vomiting, blood in vomit, black or tarry stools, rectal bleeding, or ulcers that do not heal should never be ignored. If you suspect you have an ulcer, particularly one affecting the digestive system, you should contact your GP or GP practice promptly for assessment and the appropriate advice (4).

Nutritional therapy may provide supportive care alongside conventional treatment, but it should not replace medical evaluation, diagnosis or treatment of an ulcer where medical care is required.

For recurring mouth ulcers, low levels of key nutrients such as vitamin B12, folate, iron or zinc could be the driver (5). That’s because these nutrients play important roles in tissue repair and cell renewal. 

Alongside addressing any identified deficiencies, foods should be avoided if they are known to aggravate existing ulcers. This is usually unique to the individual, but generally speaking could look like temporarily removing foods such as highly acidic fruits, spicy foods and foods with a rough texture (6). Gentle aloe vera preparations, soothing herbal rinses and SLS-free toothpastes may also be recommended (7).

When ulcers affect the stomach the main focus is to support the stomach's protective mucus lining, a natural barrier that usually helps shield the stomach wall from the effects of digestive acid. The primary causes are thought to be H. pylori infections and NSAID painkillers (also known as non-steroidal anti-inflammatory drugs) (4,8). Alcohol, coffee, strong black tea and heavily spiced foods are commonly limited, as they can aggravate symptoms and place additional strain on the stomach's protective lining (9).

Some foods are also valued for the nutrients and plant compounds they naturally contain. Broccoli sprouts and cauliflower, for example, belong to the cruciferous vegetable family and supply sulforaphane, a naturally occurring compound that has attracted interest for its role in protecting the health of the stomach (10). 

Likewise, cabbage juice has a long history of traditional use because it provides both vitamin C and L-glutamine. To explain, L-glutamine is an amino acid, which means it acts as one of the building blocks the body uses to maintain and repair tissues, including the cells that line the digestive tract (11).

When an ulcer has started improving, agents that support digestive health and a balanced gut microbiome may form part of a nutritional plan in order to help prevent ulcers from returning. 

Here are some examples:

Probiotics promote a diverse microbiome, and crowd out harmful microbes in the digestive tract. Fermented foods such as yoghurt, kefir and miso provide beneficial bacteria that support digestive health (12). 

In addition, foods rich in flavonoids, such as apples, cranberries and onions, may help support the stomach's natural defences. Meanwhile, leafy greens and bell peppers also provide vitamins A and C, which help maintain the health of the protective tissues lining the digestive tract. Probiotics, vitamin A and vitamin C may also be taken supplementally (13).

When ulcers affect the small intestine, particular attention may be given to demulcent herbs, which are plants rich in mucilage, a gel-forming fibre that creates a soothing coating over irritated tissues. Traditionally used demulcents include slippery elm and marshmallow root, both of which help form a protective barrier along the digestive tract (14,15). Aloe vera may also be used to soothe the gut lining, while deglycyrrhizinated licorice (DGL) is valued for its ability to encourage the production of protective mucus within the digestive system (16,17). 

Identifying foods that may trigger digestive symptoms is another area that may be explored, particularly when ongoing inflammation is suspected. Fibre-rich foods including oats, apples and beans help promote healthy digestion and have been shown to be of benefit when it comes to preventing duodenal ulcers, which are ulcers affecting part of the small intestine called the duodenum (18,19). 

Large intestinal ulcers:

Ulcers affecting the large intestine, including the colon and rectum, are often associated with ongoing inflammation of the bowel. As such, soluble fibres, which dissolve in water to form a soft gel-like substance, may be used because beneficial gut bacteria can convert them into compounds that help feed and support the intestinal lining (20). An anti-inflammatory dietary approach may also be used here to help support long-term bowel health (21). 

Repairing a skin ulcer places considerable demands on the body. New tissue must be produced continuously as damaged areas are replaced, which increases the need for the nutrients involved in healing (22). 

Therefore, protein is particularly important because it provides the amino acids required to build collagen, the structural protein that gives skin strength and support. 

Beyond protein, it should be noted that healthy circulation also helps deliver oxygen and nutrients to the affected area (23), while a well-functioning immune system supports the body's response to tissue damage. 

Nutritional therapy does not replace appropriate medical care for ulcers. Instead, it aims to support the body's natural healing processes by addressing dietary factors, identifying potential nutrient gaps and creating favourable conditions for tissue repair. The most appropriate approach will depend on the location of the ulcer, and other important factors like its underlying cause and what an individual's overall health condition is.

Some ulcers heal naturally within days or weeks, although persistent sores should not be ignored. Ulcers that bleed, worsen, repeatedly return or become extremely painful may require professional assessment.

And, to reiterate the earlier disclaimer, digestive ulcers may sometimes lead to complications if left untreated, particularly when tissue damage becomes deeper.

Persistent ulcers, worsening symptoms or sores that repeatedly return should always be assessed by a medical professional to help identify the cause and support appropriate treatment.