The muscle tension in the area of the esophagus towards the stomach entrance prevents the stomach contents from flowing back (reflux). A minimal reflux of food especially after ingestion is normal. The frequency, the extent of reflux and the muscle tension in the lower part of the esophagus depend on the composition, the pH value and the temperature of the food.
Due to hormonal control, fat lowers the muscle tension at the lower end of the esophagus, while protein-rich food increases it. Carbohydrates have little effect on the tension of the sphincter muscle. Alcohol and nicotine have also been shown to lower tension.
Excessive reflux of stomach contents mixed with hydrochloric acid and pepsin (pepsin: protein-splitting digestive enzyme) damages the esophagus and causes the various stages of esophagitis, depending on the duration and effect. It causes a burning sensation and pain behind the breastbone (heartburn) that may radiate to the neck. After drinking alcohol, there is often a reflux of stomach contents.
Chocolate and coffee can also promote reflux, as can drinks sweetened with plenty of sugar (e.g. lemonades, cola drinks). Pronounced fat deposits in the abdominal area increase the pressure in the abdomen when lying on your back and promote the reflux of stomach contents. The same effect is produced by sumptuous meals and alcohol consumption in the evening hours.
Nutritional recommendations for inflammation of the esophagus: If you are overweight, you should try to lose weight. Avoid foods and stimulants that reduce the tension in the area of the sphincter muscle towards the stomach. These are primarily: alcohol (especially in the evening), coffee, tea, cocoa, chocolate, high-fat foods and beverages with high sugar content.
Switch to several small, high-protein but low-fat and low-sugar meals. Avoid only small meals and alcohol in the evening. In western industrialized countries, esophageal cancer accounts for only 7% of all malignant tumors.
In Asian countries this proportion is 70%. A lack of certain vitamins and the irritation of the mucous membrane by extremely hot food is discussed as the cause of this. The mucosa can also be injured and irritated by the consumption of very solid food components such as millet husks.
In western industrialized countries, chronic alcohol abuse is the decisive risk factor. The cancer-causing effect is considerably increased by cigarette smoke. The negative effects of alcohol and cigarettes can be considerably reduced by eating plenty of fruit and vegetables.
This results in a better supply of the so-called antioxidative vitamins (A, C, E). A cell protecting effect is attributed to them. Preventive, nutritional-therapeutic measures: Avoid chronic alcohol and cigarette abuse.
By eating plenty of fruit, vegetables, wholemeal products and vegetable oils, an optimal supply of antioxidants (vitamin C, E and carotenoids = precursor of vitamin A) is aimed for. We follow the recommendations of the food pyramid and the target of “5 a day” (5 portions of fruit and vegetables a day). This corresponds to the general guidelines for a healthy diet.
It is also recommended to avoid frequent irritation or injury to the mucous membrane of the oesophagus. This refers to the consumption of very hot, spicy or very hard, badly chewed food. These complaints often occur as a result of inflammatory changes (reflux of gastric juice) and associated narrowing of the esophagus.
Constrictions also occur in esophageal cancer or are caused by increased tension of the muscles in the area where they pass through the stomach. This leads to difficulty swallowing and, as the disease progresses, to the choking out of chyme. In the end, this leads to severe malnutrition.
Some patients suffer from a painful spasm of the esophagus, usually at long intervals. Very cold drinks are often the trigger for these cramps. In case of swallowing difficulties due to narrowing of the esophagus, it is recommended to chew all food well and to avoid swallowing larger pieces (such as pieces of meat).
Prefer soft food, swallow only small portions and avoid very cold drinks as a matter of principle. The following diseases of the stomach are primarily accessible to nutritional therapy:
- Gastritis (inflammation of the mucous membrane of the stomach)
- Stomach ulcer (ulcus ventriculi)
- Stomach cancer (stomach cancer)
- Dysfunctions after surgical interventions such as the complete (total) or partial (partial) removal (gastrectomy) of the stomach.
A distinction is made between acute and chronic gastritis. Acute gastritis is an inflammation of the mucous membrane without affecting its function (gastric juice production).
Triggering causes are nutritional errors such as alcohol abuse, food that is too cold or hot, certain drugs or bacteria and their toxins from spoiled food. Pain, nausea and vomiting are the result. After the trigger is removed, the symptoms quickly disappear.
In chronic gastritis, the inflammation of the stomach mucosa turns into a chronic form, the mucosa is damaged or destroyed over time. Functional disorders of the stomach are the consequence because finally the acid production comes to a standstill (anaecidity or achlorhydricity). Sometimes the production of the so-called “intrinsic factor” is also stopped.
This enzyme normally combines with vitamin B12 from food and this is the only way vitamin B12 can be absorbed. If the “intrinsic factor” is missing as a result of the destruction of the mucous membrane in the stomach, this vitamin can no longer be absorbed. This leads to a special, severe form of anaemia (pernicious anaemia) because without vitamin B12, blood formation is impaired.
Chronic gastritis is a very common clinical picture, whose causes and symptoms are very individual and different. Of great importance for its development is the effect of toxins such as alcohol over a long period of time and the colonization of the stomach with the bacterium Heliobacter pylori. This bacterium is mainly absorbed with contaminated drinking water.
In 90% of all cases, this bacterium is responsible for the development of chronic gastritis (type B) and often leads to stomach and duodenal ulcers. Type A gastritis is caused by the body’s immune cells attacking and ultimately destroying the cells of the stomach’s mucous membrane. This is called an autoimmune disease.
Nutritional recommendations for acute and chronic gastritis The nutritional therapeutic measures for acute and chronic gastritis are primarily the omission of the triggering foods. This can vary greatly from individual to individual and must be taken into account in the dietary recommendations Coffee is the most frequently poorly tolerated food in this context. In general, the principles of “light whole foods” apply.
Orientates itself towards a wholefood diet based on the food pyramid. Foods that most frequently cause intolerances: Pulses, cucumber salad, most types of cabbage, fried and fat-soaked foods, peppers, onions, fatty baked goods, potato salad, foods that are too hot and too spicy, foods and drinks that are too cold, coffee, alcohol, carbonated drinks. It is always recommended to eat slowly and chew well!
- Should be full, balanced and easily digestible.
- Basically all foods are allowed that are individually tolerated
- 5 meals per day are recommended (three main meals and two small snacks)
- Foods that are known to be poorly tolerated should be taken into account and omitted if necessary.
Until about the mid-1960s, attempts were made worldwide to treat ulcers of the stomach and duodenum with special diets. The purpose of these diets, which were often extremely one-sided, was to calm the stomach and thus promote the healing of the ulcers. All these diets, such as the slime soup diet, milk diet or passed diets have now been found to be meaningless and have no influence on the healing process.
Today, patients with gastric and duodenal ulcers are recommended to follow a balanced diet based on the light whole food described in the chapter “Gastritis”. Occurring intolerances are individually very different and should be considered in the daily diet. Recently, there has been evidence that an increased dietary fibre content does not promote the healing of an ulcer, but makes its recurrence less likely.
Pungent spices such as garlic, horseradish, paprika and mustard increase the acid production in the stomach and should therefore be avoided if possible with fresh ulcers.Also alcohol consumption stimulates the gastric acid, whereby here no effect on the occurrence or the healing of ulcers could be observed. Recommendations for the nutrition with stomach and duodenal ulcers:
- The diet should be wholesome and balanced. Only avoid foods and drinks that cause and intensify symptoms.
- Observe individual incompatibilities.
The basis is the light full diet.
- Avoid spicy food with freshly formed ulcers and avoid high coffee consumption.
- The daily diet should be rich in fiber. Therefore, prefer whole grain products and eat plenty of potatoes, fresh fruit and vegetables.
After stomach operations, the functional processes in the area of the stomach and the subsequent duodenum are considerably disturbed. The loss of the storage function of the stomach is of decisive importance here.
The delivery of small portions of chyme (at different intervals depending on its composition) is no longer possible or only incompletely possible. This leads to uncontrolled passage of chyme into the small intestine and thus to increased stretching of the intestinal wall. This is accompanied by an increased flow of fluid.
All this can cause a complex of complaints which is called “dumping syndrome”. The designation comes from the English word to dump, fall. These complaints can occur as early Dumping or postalimentäres Frühdumping briefly after the food intake or as late Dumping or postalimentäres late Dumping one to two hours after the food intake.
Patients complain of weakness, dizziness, sweating and a feeling of pressure in the upper abdomen. A further problem after stomach surgery is the lack of utilization of the food. The unusually fast passage of large quantities of food chunks and the rapid passage through the upper small intestine results in reduced stimulation of the pancreas.
Fewer digestive enzymes are formed and the fast passage prevents sufficient mixing of the chyme with digestive enzymes from the pancreas and bile. This leads to an insufficient supply of energy and a lack of vitamin D and calcium. Due to the lack of fat digestion, in some cases fat is excreted with the stool (fatty stools = steatorrhea) and the supply of energy and fat-soluble vitamins is further reduced.
During the vagotomy, the vagus nerve is severed to limit the production of gastric acid. This is intended to counteract the further development of ulcers. Only the branch of the nerve leading to the stomach is cut through, so that the nervous supply of the pancreas, gall bladder and small intestine is maintained.
Also the ability of the stomach to deliver chyme in small portions to the small intestine is not disturbed. Despite the gentle procedure, many patients develop symptoms in the first period after the operation. This is known as post-vagotomy syndrome (complaints occurring after vagotomy).
These are primarily diarrhea, weight loss, circulatory problems and often the digestion of fat is disturbed, which leads to fatty stools (steatorrhea). In the majority of cases, these syptoms subside after a few months. It is recommended to follow the principle of a light full diet.
If steatorrhea is pronounced and persists for a long time, the usual dietary fat can be partially replaced by MCT fats. These are fats that consist mainly of medium-chain triglycerides. These are more easily absorbed in the digestive tract.
The fatty stools are reduced and the energy requirement is secured. MCT-fats are available as margarine or oil in health food shops (trade name “Ceres”). Practical information on the use of MCT fats First of all, it must be taken into account that the energy content of MCT fats is somewhat lower than that of conventional fats and oils.
100 g of MCT margarine provide about 100 kcal less than conventional margarine. The exchange of both fats must take place slowly, since side effects can occur in large quantities when MCT fats are consumed suddenly. These are stomach ache, nausea, vomiting and headaches.
Dosage: Start with 10 to 20 g per day. Slowly increase to 50 to 70 g MCT margarine and 20 – 30 g MCT oil. Even larger quantities can be tolerated without complaints if evenly distributed throughout the day.In the context of this diet avoid high-fat foods such as fatty meats and sausages, fatty cheeses, cream, high-fat ready meals and desserts.
Replace spreadable and cooking fats with MCT. The content of essential fatty acids in MCT fats is much lower than in conventional vegetable fats. Therefore, if MCT is used over a long period of time, the additional administration of an oil rich in linoleic acid (rapeseed oil, olive oil, sunflower oil) is necessary.
Fat-soluble vitamin are sufficiently taken up with administration of MCT. In daily use MCT margarine should be used as a fat spread or added to warm dishes after cooking. It is not suitable for heating and is not suitable for frying, braising or grilling.
MCT oil cannot be heated as high as the usual oils. At temperatures of more than 130 degrees, smoke develops. Long warming or warming up of food with MCT avoid if possible because a bitter aftertaste can develop.
If complaints occur after vagotomy, a light full diet is recommended. No further dietary measures are necessary. In case of high fat excretion with the stool (steatorrhea, fatty stools), a part of the dietary fat can be replaced by MCT-fats.
Complaints immediately after ingestion or delayed after one to two hours. The cause of the early dumping is assumed to be a distension of the upper small intestine due to the large amount of food chyme that suddenly occurs. This chyme can contain high concentrations of certain nutrients and in order to balance the concentrations, fluid from the blood vessels flows into the small intestine.
The stretching of the intestinal wall is increased (feeling of pressure in the upper abdomen), water is withdrawn from the blood, i.e. blood pressure drops (dizziness, sweating, weakness). This complex of complaints arises primarily after the absorption of easily digestible carbohydrates, especially all kinds of sugar. The cause of late dumping, which occurs much later, is a drop in blood sugar concentration.
In this case, after the rapid passage of chyme mixed with a lot of sugar, an abnormally rapid absorption of the sugar into the bloodstream occurs. The blood sugar level rises quickly above the norm and insulin (hormone which lowers blood sugar) is released into the bloodstream in large quantities. However, since the influx of sugar from the intestine quickly comes to a standstill, there is too much insulin in the blood.
The blood sugar level falls below the norm and the symptoms of hypoglycaemia become apparent. The patient complains, for example, of lack of concentration, tiredness, drowsiness, headaches and sweating. In most patients, both early and late dumping occurs, especially soon after the operations.
Most patients become symptom-free within different time periods. Nutritional recommendations for early and late dumping syndrome: Avoid quickly digestible, water-soluble carbohydrates, primarily sugars of all kinds (including honey) or consume only small amounts after individual tolerance. Prefer wholemeal products made from cereals, plan to eat fruit and vegetables every day depending on your tolerance.
The addition of dietary fibres such as guar (e.g. guar mini tablets) or pectin (5g with meals) will slow down the rapid breakdown of carbohydrates (from all other foods such as bread or fruit) and the discomfort after ingestion can thus be reduced. In rare cases, a food intake while lying down can alleviate existing complaints. It delays the rapid passage of the food pulp into the stomach.
Example of a daily diet for dumping syndrome Breakfast 1. snack 2. snack lunch 3. snack 4. snack dinner Late meal
- Tea or coffee
- 1 wholemeal roll with 5 g butter or margarine, 40 g quark (20% fat in dry matter), 50 g fresh banana in slices
- Muesli made from 30 g whole grain oat flakes, 100 finely chopped apples, 100 g whole milk
- Season to taste with a little liquid sweetener as required.
- Tea, 1 slice of wholemeal rye bread (50 g), 5 g margarine or butter, 50 g tomato, 20 g butter cheese (45 % fat in dry matter)
- 80 g fillet of beef briefly fried in 5 g sunflower oil, 150 g potatoes, 150 g bean vegetables
- Dessert: Fresh fruit according to seasonal availability
- Tea, 50 g pumpernickel, 1 g butter or margarine, 50 g radish
- Fruit quark made from 125 g of quark (lean) and 100 g of fresh fruit.Season to taste with a little liquid sweetener as required.
- Tea, 60 g rye bread, 40 g cooked ham, 150 g beet salad
- 125 ml vegetable juice, 50 g graham bread, 20 g cream cheese
This daily example contains on average: 2200 kcal, 80 g protein, 82 g fat, 265 g carbohydrates, 35 g fiber. Nutrient ratio: 15 % protein, 35 % fat, 50 % carbohydrates. Care must be taken to drink a sufficient amount (1.5 to 2.0l daily).
Only drinks without sugar should be used and drunk in small portions throughout the day. Over the years the frequency of stomach cancer has decreased continuously. Various nutritional factors are discussed as causes for this positive trend.
Here, for example, better food preservation (canned food, frozen food) and the decrease in the consumption of salted, cured and smoked meat and fish. This reduces the absorption of carcinogenic tar components. Poor food and drinking water hygiene can lead to the absorption of the bacterium Heliobacter pylori already in adolescence.
This germ colonizes the stomach mucosa and, together with other factors (e.g. a permanently high common salt content of the food), can lead to chronic gastritis and the cessation of gastric juice production. As a result, the normally largely sterile stomach becomes bacterially colonized. These bacteria convert the nitrate ingested with food into nitrite, which combines with protein-containing substances in the stomach and can produce nitrosamines, which are considered carcinogenic.
This process is inhibited by vitamin E and C. Today’s sufficient supply of vitamin C (even in the winter months) seems to contribute to a decrease in the incidence of stomach cancer. There are clear findings that the intake of alcoholic beverages can increase the risk of stomach cancer. Stomach cancer: Prevention through the right diet Optimal supply of vitamins C and E through high vegetable and fruit consumption (5 portions of fruit and vegetables daily) and the use of high-quality vegetable oils (for example: rapeseed oil, olive oil, sunflower oil, safflower oil, etc.).
Reducing the consumption of highly salted, cured and smoked foods such as bacon, ham, smoked pork, smoked fish. Reduce the consumption of alcohol or avoid alcoholic beverages altogether.
