Peptic Ulcers

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One in every 10 Americans experiences a peptic ulcer at some point in life, and about one million new ulcers are diagnosed every year. Ulcers are no picnic: Their symptoms include abdominal discomfort, a sense of gnawing, burning, aching, and cramp-like pains, as in heartburn. They are also associated with potentially lethal complications, such as penetrations, perforations, bleeding, and obstruction.

A peptic ulcer refers to an internal sore in the lining of the stomach or duodenum, which is the first portion of the small intestine just below the stomach. These are called peptic ulcers because they develop in spots that are exposed to a digestive enzyme called pepsin. Duodenal ulcers, the most common type of peptic ulcer, occur in the duodenum. The less-common gastric ulcers usually strike the upper curve of the stomach.

Peptic ulcers develop when stomach acids damage the lining of the duodenum or stomach. Usually, the body wards off ulcers by generating mucus that lines the stomach and intestinal walls. The body also protects itself by renewing intestinal cells and releasing substances that neutralize excess stomach acid. Unfortunately, these mechanisms don’t always work. And eventually, a round or oval sore may develop where stomach acid and digestive juices have eaten away the lining of the stomach or duodenum.

Causes

Many factors are known to contribute to ulcer formation: Stress, alcohol, tobacco, coffee, and nonsteroidal anti inflammatory drugs (NSAIDs) and other medications. However, most researchers agree that a particular bacterium – Helicobacter pylori- is the real culprit in most peptic ulcers. H. pylori is implicated in 70 to 75 percent of gastric ulcers, and 90 to 100 percent of duodenal ulcers. In Natural Alternatives to Over-the-Counter and Prescription Drugs, naturopath and author Michael T. Murray, N.D., explains that H. pylori burrows itself between intestinal cells. It releases an enzyme breaks down the mucus, so it can no longer shield the intestinal lining. Indigestion, inflammation, and ulcers may result.

Who is susceptible?

Peptic ulcers can strike almost anyone, but certain populations appear to face a higher risk. According to herbalist James A. Duke, PH.D. author of The Green Pharmacy, men are four times more likely than women to develop ulcers, and the risk increases with age. Furthermore, allergies may increase ulcer risk. One study showed that 98 percent of people with peptic ulcers also experienced respiratory allergies.

Caution: H. pylori has been linked with stomach cancer. In addition, peptic ulcers may develop life-threatening complications. Because of the seriousness of this condition, professional medical care is critical. If you’re interested in self-medication, consult your doctor first.

Mainstream Treatment

Today, doctors typically treat peptic ulcers caused by H. pylori with a combination of antibiotics and bismuth or similar medications. Antacids are commonly used to relieve symptoms. However, Natural Alternatives to Over the Counter and Prescription Drugs reports that many antacid products come with adverse side effects:

• Calcium Carbonate antacids may promote alkalosis (dangerously high alkaline content) and disrupt kidney and heart function
• Aluminum-magnesium compounds may deplete calcium and phosphorous from the system. In addition, they may lead to aluminum toxicity or the buildup of aluminum in the brain.
• Bismuth, a naturally occurring mineral, is a safe and effective antacid when taken at recommended doses. However, children recovering from the flu, chicken pox, or other viral infections should not take bismuth subsalicylate. I could cover up the nausea and vomiting that characterizes Reye’s syndrome, a rare but serious condition.
• H2-receptors are another common medication used for peptic ulcers. They work by blocking the action of histamine, which reduces the production of stomach acid. Side effects of H2-receptors include nausea, constipation, diarrhea, and nutritional deficiencies. H2-receptors have also been associated with liver damage, allergic reactions, headaches, breast enlargement in men, hair loss, osteoporosis, dizziness, depression, insomnia, and impotence.

Lifestyle factors

H. pylori notwithstanding, your dietary and lifestyle choices will either decrease or increase your risk of ulcers. To help protect yourself, consider the following guidelines:

• Reduce your intake of sugar and other refined carbohydrates, such as white flour. Sugar increases stomach acid according to The Natural Pharmacy, by Skye Lininger, D.C. (editor in chief).
• Cut down on your consumption of milk and eggs. Population studies indicate that higher milk consumption heightens the risk of peptic ulcers, since milk increases the production of stomach acid (Brit Med J 293:666, 1986).
• Reduce your intake of salt. The more salt you consume, the higher your risk of gastric ulcer.
• Increase your consumption of whole grains, legumes, vegetables, and other high-fiber foods. Fiber slows down the movement of food and stomach acids to the intestines, which helps those with duodenal ulcers. In one study, people with recently healed duodenal ulcers embarked on a six month, high-fiber diet. At the conclusion of the study, researchers found that ulcer recurrence was significantly reduced (Lancet ii: 736-739, 1982).
• Avoid alcohol, aspirin and other NSAIDs, coffee (even decaffeinated), and tea. These substances increase stomach acidity.
• If you smoke, quit. Smoking delays ulcer healing.
• Find ways to reduce the stress in your life, or learn to cope with it in healthier ways. Stress is known to exacerbate ulcers. Regular exercise, meditation, progressive relaxation, and certain herbs (such as valerian or kava) can help alleviate symptoms of stress. With the help of your physician, you may choose to add some herbs to your ulcer treatment program. It’s vitally important that your keep your doctor informed about what you are taking, whether mainstream or herbal medicines.

Spotlight on Licorice

Licorice (Glycyrrhiza glabra) may be the most well known anti-ulcer herb available. It is approved as an ulcer treatment by the Commission E, Germany’s equivalent to the Food & Drug Administration (FDA) in the United States. However, the glycyrrhizic acid in licorice has been implicated in high blood pressure and water retention in some people. Fortunately, a safer version is available: deglycyrrhizinated licorice (DGL).

DGL works by stimulating the body’s normal defenses that protect against ulcers, instead of blocking the release of stomach acid, explains Dr. Michael Murray in The healing Power of Herbs. DGL amplifies both the quality and quantity of protective compounds that line the intestinal tract. It also increases the life span of the intestinal cells, and improves the blood supply to the intestinal lining.

One study compared DGL to antacids and H2-receptors in 874 patients with confirmed chronic duodenal ulcers (Irish Med J 78:153-156, 1985). Within 12 weeks, 91 percent of the ulcers had healed. Although there wasn’t much difference in the healing rate of each group, there were fewer relapses n the DGL group (8.2 percent) than in the H2-receptor (12.9 percent) or antacid (16.4 percent) groups. DGL also appears to protect the digestive lining from aspirin’s ulcer promoting effects. This herbal extract may help prevent gastric ulcers in patients using NSAIDs and/or corticosteroids.

Dr. Murray points out that while many anti ulcer drugs are associated with adverse side effects, DGL is non –toxic. It’s also more affordable. For example, while two popular H2-receptor drugs cost over $100 for a month’s supply, DGL is available for about $15 for a month’s supply. Note: DGL must be chewed and mixed with saliva in order to be effective.

Other anti-ulcer herbs

Other beneficial herbs include:

• Ginger (Zingiber officinale) contains 11 compounds with anti-ulcer activity. Ginger is an “aromatic bitter” that stimulates digestion and helps improve sluggish digestion, explains herbalist and author Donald Brown, N.D., in Herbal Prescriptions for Better Health. Ginger eases the movement of substances through the digestive tract, decreasing irritation to the intestinal walls. A study in Saudi Arabia showed that ginger protects the stomach from the damaging effects of NSAIDs and alcohol (AM J Clin Med 17:51-56, 1989). Through this action, it may reduce the risk of ulcers. New England herbalist Paul Schulick, author of Ginger: Common Spice and Wonder Drug, recommends combining ginger with honey. Both have antibacterial properties, and when used together, produce synergistic effects.
• Cabbage (Brassicaoleracea) and its juice contain glutamine and S-methylmethionine, two compounds with anti-ulcer properties. Melvyn Werbach, M.D., assistant clinical professor of psychiatry at the University of California, Los Angeles, School of Medicine, and author of Nutritional Influences on Illness, refers to a study using raw cabbage juice showed remarkable improvement within three weeks, compared with 32 percent of those taking placebo. Dr. Garnett Cheney at Stanford University’s School of Medicine, as well as other researchers in the 1950s, found that cabbage juice was particularly beneficial for peptic ulcers (Cal Med 70:10-14, 1949). One of Dr. Cheney’s favorite juice recipes includes ½ head or two cups of green cabbage, four ribs of celery, and two carrots. Cut the cabbage into long wedges and feed through the juicer, followed by the celery and carrots.
• Chamomile (Matricaria recutita) is commonly used as a digestive aid in Europe. It combines anti-inflammatory, antiseptic, antispasmodic, and stomach-soothing properties, explains Dr. James Duke in The green Pharmacy. Chamomile also contains apigenin, an important bioflavonoid shown to inhibit the growth of H. pylori (Arzneim Forsch Drug Res 45:697-700, 1995). Allergic responses are rare, but some people do have adverse reactions to chamomile. If you are allergic to the Asteraceae family – which includes ragweed, asters, and chrydsanthemums-you should avoid using chamomile.
• Yellow root (Xanthorrhiza simplicissima) is an herbal antibiotic that may block the growth of H. pylori bacteria. Yellow root contains berberine, which is reported to have anti-ulcer effects.
• Garlic (Allium sativum) is a powerful, broad-spectrum antibiotic. It exerts antibacterial, antiviral, and antifungal activity (Hosp Pharm Rep 8:27, 1993). However, because of garlic’s anti-clotting effects, people who take anti-coagulant medications should check with a nutritionally oriented doctor before using garlic. In addition, those who are scheduled for surgery should inform their surgeon if they are taking garlic supplements, according to The Natural Pharmacy.
• Red pepper/cayenne (Capsicum) may protect against peptic ulcers. Capsaicin, the substance that makes red pepper hot, has been shown to prevent ulcers in lab experiments.
• Marshmallow root (Althaea officinalis) is high in mucilage. Mucilage rich herbs relieve irritated or inflamed mucous membranes in the digestive system.
• Turmeric (Curcuma longa) is a culinary herb widely used in Indian and Asian curry dishes. It has been found to increase the mucin content of the stomach and protect against ulcers triggered by stress, alcohol, and other factors, according to The Healing Power of Herbs. In a study in Thailand, 250-mg capsules of turmeric, taken three times daily, relieved ulcer pain only half as well as pharmaceutical antacids after six weeks. On the other hand, turmeric is about eight times less expensive than the antacid, and has no side effects at the recommended dosages. However, extremely high doses (100 mg per kilogram body weight) was found to promote ulcers in rats.
• Calendula (Calendula officinalis), sometimes referred to as “pot marigold,” exerts antibacterial, antiviral, and immune-stimulating effects. Calendula has been shown to relieve chronic stomach irritation (i.e., hypersecretory gastritis), which has been linked with peptic ulcers, according to The green Pharmacy. Calendula also contains Flavonoids, which accounts for its anti-inflammatory impact (Weiss RF: Herbal Medicine. Gothenburg: John Wiley Y Sons, 113-114, 1996). The soothing effects of calendula have been used to treat peptic ulcers and inflammation.
• Gentian (Gentiana officinalis) is one of many bitter herbs used as digestive aids. The well-known “Swedish bitters” often contain gentian. Herbalist Daniel Mowrey, Ph.D., author of The Scientific Validation of Herbal Medicine and Herbal Tonci Therapies, recommends combining gentian with goldenseal, licorice, and ginger to treat peptic ulcers.
• Pineapple (Ananas comosus) provides glutamine, a compound with proven anti-ulcer activity. Pineapple also contains brome lain, an effective digestive aid.
• Bilberry (Vaccinum myrtillus) provides over 15 anthocyanosides, its most therapeutic compounds. In lab experiments, anthocyanosides have been shown to block ulcer formation. These substance help stimulate the production of mucus, thereby shielding the stomach lining from digestive acids. In one study, feeding bilberry anthocyanosides to rats helped prevent and treat gastric ulcers, without affecting gastric secretions (II Farmaco 42[2]: 29-43, 1986). This effect can be attributed in part to an increase in gastric mucus.
• Meadowsweet (Filipendulaulmaria) contains aspirin-like salicylates. While the salicylates found in aspirin can cause ulcers, whole meadowsweet helps prevent and treat them, despite its salicylates, according to British herbalist David Hoffman, author of The Herbal Handbook.

Final Thoughts

In our fast-paced world-and the prevalence of ulcer-promoting alcohol, smoking, coffee, tea, salt, and refined foods- it’s no wonder 10 percent of the American population suffers from peptic ulcers. If you or someone you care about is experiencing ulcer symptoms, keep these three points in mind:

• consult a qualified healthcare practitioner for a professional diagnosis and treatment plan;
• take the necessary lifestyle steps to reduce your risk-or to promote healing-of a peptic ulcer; and
• Use herbal medicines with the same respect you would use with mainstream medications. Make sure you understand what you are taking, and make sure you inform your healthcare provider.

Peptic ulcers are painful and potentially life threatening. However, with proper medical care, healthful lifestyle changes, and intelligent herbal supplementation, you can get rid of that ulcer-permanently.

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