You know the drill–the slow burn just hours after eating. Pain so intense it can wake you out of a dead sleep. Or perhaps you don’t feel the fire. Instead you may suffer from a dull, gnawing pain between the abdomen and breastbone. Although comedians have joked about ulcers for years, these jokes aren’t funny if you’re the one afflicted.
Twenty million Americans will develop at least one ulcer sometime in their lives. That’s one in ten. Of those, more than 40,000 will resort to surgery for relief from persistent ulcers each year. Before you reach for the antacids, let’s look at what’s really going on down there.
Where ulcers begin
A peptic ulcer is a sore that forms in either the lining of the stomach or in the beginning of the small intestine, called the duodenum. Although stomach pain is the most familiar symptom of an ulcer, less common but more serious signs include loss of appetite and weight, bloody or tarry black stools, and/or vomiting of blood or a substance that looks like coffee grounds. (If you experience the sudden onset of these symptoms, make a trip to the emergency room, because they may indicate internal bleeding.)
Normally, the stomach produces hydrochloric acid and digestive enzymes such as pepsin, all of which break down and digest food. Because these gastric juices are extremely potent, the body defends itself by coating the stomach and intestines with a protective layer of mucus. Prostaglandins, hormone-like substances, form another line of defense against these acids. They keep the blood vessels in the stomach dilated–a good thing because secretions of mucus depend on blood flow to the mucosal tissue.
Ulcers develop when an imbalance occurs between the digestive juices and the body’s defense mechanisms, allowing the acid and enzymes to attack the stomach lining itself. In severe cases, the lining is eroded to the point of becoming perforated–a hole is formed in the stomach wall, enabling partially digested food, stomach acid, and bacteria to spill into the sterile abdominal cavity. That can lead to hemorrhaging from the erosion of a major blood vessel, or to obstruction of the gastrointestinal tract. Ulcers that form where the stomach and the small intestine meet can swell and scar, forming an obstruction which blocks the intestinal opening. Such an obstruction causes vomiting of the stomach contents and is an extremely serious situation which requires emergency surgery. So ulcers aren’t a condition to be taken lightly.
What causes the imbalance that begins this whole process? One of the most common causes of ulcers is a bacterium known as Helicobacter pylori. Because of its corkscrew shape, H. pylori can penetrate the stomach’s protective mucus coating and attach itself to the stomach lining. Most bacteria cannot survive the stomach’s harsh environment. But H. pylori thrives by producing the enzyme urease; urease generates ammonia, which neutralizes acid. H. pylori also produces a number of toxins that promote inflammation and damage to the stomach lining. Yet not everyone infected with the bacteria gets ulcers. Even though more than half of all adults carry H. pylori by the time they are sixty, only one in six infected with the bacterium develops an ulcer.
Genetics may also be a factor when it comes to H. pylori . Duodenal ulcers seem to be two to three times more likely in people with a family history of ulcers. Genetic abnormalities may cause high levels of acid production, weakness in the mucosal layer, or nonproductive mucus. But don’t instantly blame Dad for your ulcer–inherited ulcers are much less common than those stemming from other causes.
H. pylori was discovered in 1983 by the Australian doctor Barry Marshall, M.D., who estimated that 90 percent of duodenal ulcers and 80 percent of gastric ulcers were caused by the bacteria. The conventional medical community, including the National Institutes of Health, readily embraced the theory, and because the problem was a bug, doctors across the United States were encouraged to prescribe antibiotics to treat ulcers. However, a recent study of 276 duodenal ulcer patients by the Glostrup University Hospital in Denmark found that a quarter of these patients did not respond to the drug therapy. A different study conducted by a variety of hospitals in Spain also found that antibiotics often failed to eradicate H. pylori, leading some researchers to speculate that the original numbers were a bit too optimistic.
“We now recognize that only about 50 percent of ulcers are linked to H. pylori,” says Guy Pugh, M.D., medical director of the Marino Center for Progressive Health in Cambridge, Massachusetts.
Changes in ulcer treatment
People with ulcers who do test positive for H. pylori are usually given an antibiotic cocktail containing at least two antibiotics, such as tetracycline or amoxycillin, and an acid blocker such as Prilosec (omeprazole). But because these drugs have proven effective for fewer people than once thought, doctors are once again prescribing acid-reducing medication or performing surgery to relieve symptoms.
Another common cause of ulcers are nonsteroidal anti- inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. NSAIDs reduce pain and inflammation by blocking cyclooxygenase, an enzyme involved in the production of prostaglandins. Although these drugs might provide temporary relief from arthritis or headache pain, long-term use of NSAIDs, even of buffered varieties, can throw the stomach’s defense system out of whack, making it vulnerable to the harmful effects of acid and pepsin. Worse yet, a study of 132 patients with bleeding ulcers by the division of gastroenterology at the University Hospital in Nottingham, England, found that NSAID users infected with H. pylori had nearly double the risk of developing a bleeding ulcer compared with those not infected with the bacteria. Because NSAIDs are present in a number of over-the-counter remedies, check labels carefully before taking them if you suspect an ulcer.
Stress and ulcers
For almost a century, medical science thought stress was the primary cause of ulcers. But by 1994, the medical community was largely discounting psychological factors in favor of causes more readily identified in the lab. Today, the growing interest in mind-body medicine has led some to once again consider stress.
“Anger and hostility, as well as a feeling of helplessness, can have a big impact on the severity of an ulcer,” says Michael Grossman, M.D., whose integrative medical center in Lake Forest, California, incorporates stress reduction into treatment plans. Stress signals the stomach to temporarily close off the flow of blood. Because secretion of protective mucus depends on blood flow, it seems logical to some practitioners that severe or frequent stress would result in diminished mucus secretion, leaving the stomach’s lining more vulnerable to the acid and enzymes within.
Grossman and colleagues cite recent studies showing that people who feel stressed-out are twice as likely as their relaxed counterparts to develop an ulcer. In fact, a large, nine-year longitudinal population study by the Human Population Laboratory in Berkeley, California, found that the occurrence of ulcers was more likely in people with several stress factors. Today, although drugs and surgery continue to be used, many practitioners of integrated medicine are adding stress-reduction techniques, such as meditation, to the equation, often with good results.
Cooling an ulcer’s fire
Short of resorting to conventional medicine’s “A” team–antacids and antibiotics–there are steps you can take to ease the pain and perhaps even heal an ulcer. The first is to get an accurate diagnosis from a qualified physician. Along with prescribing a course of treatment, your doctor may also discuss lifestyle changes to help relieve symptoms. Unlike antibiotic cocktails that may have side effects, or antacids, which temporarily mask the discomfort of an ulcer, adopting healthy habits can contribute to a fertile healing environment. Among the bad habits that can bring on or exacerbate an ulcer, the three that most doctors recommend quitting are caffeine, alcohol, and tobacco.
“Caffeine stimulates gastric acid secretions,” says John Foster, M.D., of Thomas Jefferson University Hospital in Philadelphia. Tea, caffeinated soft drinks, citrus juices, and coffee may also increase susceptibility to the H. pylori bacteria. And alcohol, even in moderate amounts, intensifies the risk of bleeding.
According to a study of 4,169 subjects by researchers at the Boston University School of Medicine, the risk of gastrointestinal bleeding was highest among those who drank heavily and regularly used aspirin or ibuprofen.
“Caffeine and alcohol may not actually cause ulcers,” notes Grossman, “but they can definitely make matters worse.” And, as if cigarettes didn’t have enough going against them, smoking increases acid secretion while reducing prostaglandin and bicarbonate production. Other studies link smoking with slower healing and more frequent relapses. What’s more, a study by the University of Hong Kong found that exposure to cigarette smoke reduced the amount of stomach mucus–so those with ulcers should also avoid secondhand smoke.
Long before Tums burst onto the scene, herbalists relied on plants to treat ulcers. The most effective and well-known anti-ulcer herb was licorice (Glycyrrhiza glabra). Today, licorice is considered a first-line defense against peptic ulcers among holistic practitioners because it promotes healing and guards against recurrence. But not any licorice will do. Many practitioners believe that ordinary licorice root can raise blood pressure if used long-term. Opt instead for deglycyrrhizinated licorice (DGL) in chewable tablets, a safe and effective form of the herb. Studies show that DGL licorice may be as effective as many pharmaceuticals for treating peptic ulcers. For acute gastric or duodenal ulcers, the German Commission E recommends chewing two to four 380-mg tablets before each meal.
To soothe inflamed stomach tissue, herbalist Christopher Hobbs, L.Ac., A.H.G., recommends 3 to 4 cups of organic chamomile (Matricaria recutita) tea a day. Chamomile exerts anti-inflammatory, antipeptic, and antispasmodic activity on the stomach and duodenum. Foster agrees.
“Chamomile is a calming stomach tonic that bathes inflamed tissue,” says Foster. For best results, Hobbs advises steeping 1 oz. of chamomile in 10 oz. of boiling water for twenty to thirty minutes.
Another herb known for its ulcer-calming properties is marshmallow root (Althaea officinalis). According to the European Scientific Cooperative on Phytotherapy, taking 2 to 5 g of the dried root up to three times a day is useful for treating gastric irritations. The mucilage from marshmallow coats the mucous membranes.
Yarrow (Achillea millefolium) has anti-inflammatory properties. Long used by Native American cultures as a gastrointestinal aid, yarrow also displays antimicrobial activity against a number of bacteria. Yarrow is generally regarded as safe when 3 g of the flowers are brewed as a tea, but it should not be used by pregnant women.
Another anti-inflammatory herb that some herbalists believe may help soothe ulcer symptoms is cat’s claw (Uncaria tomentosa), a Peruvian herb traditionally used to treat gastritis. One test-tube study conducted by Louisiana State University Medical Center in New Orleans supported the widely held belief that cat’s claw has anti-inflammatory properties. However, according to the American Botanical Council, this herb is not risk-free. Because cat’s claw is used as an abortifacient in Peru, it should be avoided by pregnant or breast-feeding women. It is also not recommended for people taking insulin or other hormone therapies. And, warns Hobbs, the harvesting of cat’s claw from the Amazon may result in environmental damage to the rainforest. So save this herb as a last resort, and if you do try it, research the harvesting techniques of the manufacturer.
If you are battling H. pylori and prefer to forego antibiotics, try cinnamon (Cinnamomum verum). A recent study by Bnai Zion Medical Center in Haifa, Israel, found that cinnamon, combined with other antimicrobials, may help eradicate the bug. An earlier test-tube study found that an alcohol-based cinnamon extract alone completely inhibited the bacteria.
Another herb that may help fight H. pylori is mastic gum (Pistacia lentiscus). A resin derived from a relative of the pistachio tree, mastic gum has been used to cure gastric ailments for more than 3,000 years. Today, researchers are rediscovering its curative powers. A test-tube study of mastic gum by researchers at England’s Nottingham University found that doses as low as 1 g per day can cure peptic ulcers in just two weeks. Apparently the gum causes structural changes within the bacterium’s cell structure, causing it to weaken and die. What’s more, the study found that mastic gum protects stomach cells and inhibits acid secretions. A clinical trial is currently underway at Nottingham University to study the herb’s effect on human subjects infected with H. pylori.
New research is investigating the ulcer-healing properties in astaxanthin, a carotenoid-rich microalgae. With more antioxidant power than beta-carotene, astaxanthin has been found to boost antibody response and enhance the immune system while significantly squelching gastric inflammation. Better yet, a recent Danish study found that astaxanthin reduced bacterial load fourfold in mice infected with H. pylori. How does that translate to people? Preliminary studies have also shown this microalgae’s ability to decrease gastritis in humans.
Berberine-containing herbs such as Oregon grape root (Mahonia aquifolium) and goldenseal (Hydrastis canadensis) can also inhibit the H. pylori bug, says Hobbs, who recommends taking the herbs for a week to ten days. The German Commission E recommends 500 to 1,000 mg of goldenseal three times per day. Studies both in the United States and Japan confirm berberine’s antimicrobial properties.
Kim Erickson writes frequently on natural health and environmental issues and is the author of a book on nontoxic beauty products due for publication by Keats later this year.