Holes in Your Stomach
The lining of the stomach and first part
of the small intestine, known as the duodenum, has a protective barrier
lining that keeps the powerful stomach acids and enzymes from eating
into its tissues. An ulcer develops when the defense mechanisms of the
stomach lining break down, making a “sore” or “crater” in the stomach
wall. Healing and injury are dynamic forces that are constantly acting in
the stomach. Ulcers persist when the damage exceeds the stomach’s ability
to prevent and repair the injury. Therefore, your therapeutic goals are
to minimize putting caustic substances into your stomach and to improve
the capacity of the protective barrier.
In medical school I learned that ulcers of
the stomach and duodenum, also known as peptic ulcer disease, were due to
“hurry, worry, and curry.” But current scientific evidence says this is
not the case and that the three real culprits are: acid production, drugs
(NSAIDs), and/or bacteria (H. pylori). As far as curry is concerned, the
stomach has no serious trouble from that kind of burn.
Spicy Foods Are Safe, but Hot
Spices, in particular black pepper, red pepper, and chili powder, may
produce indigestion, but they do not seem to seriously injure the stomach.
This is good news for all of us who like spice in our foods. A study of
eight men and four women on the effects of spicy food on the stomach
lining found no injury.1 The test subjects were fed four
different test meals and then an endoscopic examination was performed 12
hours later. (Endoscopy is a direct examination of the stomach lining by a
doctor through a fiberoptic scope.) A bland meal with aspirin showed
injury in 11 of the 12 subjects. In contrast, only one case of injury
each was seen with a spicy Mexican meal with an ounce of jalapeno peppers
and a meal of pepperoni pizza. No injury was seen with the control bland
meal. In a follow up test, one ounce of fresh ground jalapeno pepper was
placed directly into the stomach and yet no visible damage was seen 24
hours later.1 Other investigations have found no difference in
rates of inflammation of the stomach in heavy consumers of spice and no
difference in the rate of ulcer healing in those patients consuming large
amounts of red pepper daily.2-3 In experiments on rats, the
active ingredient in pepper, capsaicin, was found to protect the stomach
mucosa from damage caused by alcohol or aspirin.4-5
This doesn’t mean that spicy foods don’t
cause a burning sensation. In my early days as a doctor on a sugar
plantation on the Big Island of Hawaii, I saw the effects of spicy foods
every day. My Korean patients came to my office fanning their bottoms
trying to cool the burning effects of the Kim Chee they had made with
cabbage and hot chili peppers. Yes, spicy foods do burn from one end of
the intestinal tract to the other – and only time and more bland meals
wash away the uncomfortable feelings.
Three Real Causes of
Ulcers: Acid, NSAIDs, and H. pylori
Until recently the cause of peptic ulcer disease was largely a
mystery and ineffectively treated with major, often debilitating,
surgeries designed to remove acid from the stomach. Doctors believed the
excess acid was the result of emotional disturbances, like the stresses of
a busy life. Tranquilizers and special bland diets were often
prescribed. One of the popular treatments I was trained to use during my
medical residency in the early 1970s was the Sippy diet. This
regime consisted of antacids and half & half dairy creamer given
alternately every other hour. However, studies showed no improvement in
ulcer healing and some very serious drawbacks.6 As surprising
as it may be, stomach acid production is actually increased when milk is
fed to ulcer and non-ulcer patients.6 This is because both
protein and calcium stimulate stomach acid production. Furthermore,
British and American patients treated for ulcer disease with the Sippy
diet developed two to six times more heart attacks at the end of a year
compared to those treated with a non-dairy diet.7 The
saturated fat and cholesterol in the half & half were the most important
factors causing those results.
Now, at the beginning of the 21st
century, doctors do have a good idea about the cause of ulcer disease and
ways to temporarily heal it. The three main focuses are the acid
production, drugs the (NSAIDs), and the bacteria (H. pylori). However, to
really solve the ulcer problem, doctors need to focus more on the foods we
place into our stomachs and the general health of our bodies, so we can
avoid some of the toxic medications that cause ulcers.
Acid Production from Foods and Beverages:
Protein causes acid secretion,
and animal protein is more acid-producing than plant protein.8
Acid secretion measured in people was found to be 30%-40% less with soy
protein rather than with beef protein.9 Over 80 years ago
scientists reported that milk was a strong acid-producing stimulant and
was slowly emptied out of the stomach. The combination of eggs and milk
was found to be an even more powerful stimulant for stomach secretion,
producing hyperacidity and delaying emptying of the stomach.10
One large population study found peptic ulcers to be more common with
milk, meat, and bread, and also total fat, monounsaturated fats (like
olive oil) and vegetable fats (linolenic acid).11 Fermented
milk products and vegetables were associated with lower incidence.
In the 1970s the effect of various forms
of milk on gastric-acid secretion was studied in five patients with
duodenal ulcer during a period of remission and in five normal subjects. A
significant increase in acid secretion in both groups was produced by 240
ml of whole, low-fat, and nonfat milk.6 The authors concluded,
“Because milk contains both protein and calcium, and each are stimulants
of gastric-acid secretion, there is reason to question its frequent
ingestion by patients with peptic ulcer.”
Some alcoholic beverages cause indigestion
and increased acid production. Champagne has been found to be
the most upsetting followed by wine, sherry, and beer, and least
distressing is brandy and other hard spirits, such as whiskey and gin.
Substances (maleic acid and succinic acid) produced during the
fermentation upset the stomach by increasing acid production.12
These substances are removed during distilling, therefore, pure alcohol
has little effect on the stomach. Thus, nonalcoholic ingredients in beer
or wine are responsible for the distress caused by alcoholic beverages.12
In the February 2002 issue of the
McDougall Newsletter I discussed the effect of coffee and decaffeinated
coffee on stomach acid production. Both, decaf and regular, increase
production of the stomach acids by a similar amount because it is
substances in the coffee bean other than the caffeine that cause increased
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are taken by millions of people for relief of pain. About 15% of
people who frequently take NSAIDs, like Motrin and Advil, or aspirin, have
gastric or duodenal ulcers.13 Within 90 minutes of taking 300
mg or 600 mg of aspirin, nearly everyone develops acute injury consisting
of bleeding (intramucosal petechiae) and erosions. Many patients who start
NSAIDs will not be able to continue because of drug-associated pain. The
damage is due to impairment of the defenses of the stomach lining (mucosal
defenses are hindered because of the inhibition of prostaglandin
synthesis). Once injured, the stomach acid eats into the tissues. People
who take NSAIDs and are infected with H. pylori are at least 61 times more
likely to have ulcers of the stomach and/or duodenum than non-takers and
noninfected people. 14
In 1982 two physicians isolated
bacteria in the stomach tissues of patients with gastritis (chronic
inflammation of the stomach linings). Subsequently, these bacteria, known
as Helicobacter pylori or H. pylori, has been found to be involved in most
patients with stomach and duodenal ulcer disease. H. pylori can be found
in the stomachs of 70% to 90% of people in developing countries.15
In developed countries, like the USA, 25% to 50% of people are infected.
Most infections begin in childhood and spread appears to be from feces of
infected persons. The common housefly may also be an important vector.
All chronically infected persons show signs of gastritis on endoscopy
examination, but most people have no symptoms.
Despite the fact that the main cause of
duodenal ulcer incidence and recurrence is the Helicobacter pylori
bacterium, more than 80% of Helicobacter pylori-infected people never
develop an ulcer. H. pylori is probably an "innocent bystander" for most
patients, but the bacteria may sufficiently impair the defenses of the
antral and duodenal mucosa to facilitate the development and relapse of
ulcer disease in subsets of patients.16,17 Adequate nutrition,
especially frequent consumption of fruits and vegetables and of vitamin C,
appears to protect against infection with H. pylori.18,19 Of
interest, extracts of a variety of plants, such as garlic, thyme, and East
African herbal plants, inhibit the growth of H. pylori in the test
tube.20-23 Whether such extracts will prove useful in the
treatment of infected patients remains to be demonstrated.
Eradication with Antibiotics Clears the
Eradication with a triple
therapy including 2 powerful antibiotics and a powerful antacid or a
bismuth compound accelerates the healing of these ulcers. For example,
triple therapy dispensed in a blister pack consisting of bismuth
subsalicylate (two tablets; 262 mg), metronidazole (250 mg), and
tetracycline (500 mg), all taken four times daily for 14 days. The cure
rate for the bacteria is 85% to 90%. For the present time, because there
are risks and costs with antibiotics, I recommend not using them unless
there is a clear indication of benefit, such as with ulcer disease.
The Bottom Line
There is a lot of talk about antacid medications, NSAIDs, and drugs to
treat bacteria. Why? Because pharmaceuticals are highly profitable
businesses. Money drives the information. Unfortunately, other than
avoiding NSAIDs, none of the medications offers a permanent solution. The
permanent solution is to put good foods into your stomach – and these
foods are starches, vegetables and fruits. Right! A nonprofit approach,
but it is the truth.
Fill your stomach with a
plant based diet
Avoid high protein foods
including meat and dairy products
Use garlic and thyme for
Use pepper spices with
caution – they burn, but do not cause injury
Avoid beer, wine, and
Avoid coffee and
Keep your body healthy to
avoid stomach damaging drugs
Take Tylenol rather than
aspirin or NSAIDs if prone to stomach trouble
Take liquid or tablet
antacids initially, then antacid pills for unresolved problems
As a last resort,
investigate and treat an H. pylori infection
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2) Tyagi K. Gastric mucosal morphology in
tropics and influence of spices, tea, and smoking. Nutr Metab
3) Kumar N. Do chilies influence healing
of duodenal ulcer? BMJ 288:1803-4, 1984.
4) Holzer P. Intragastric capsaicin
protects against aspirin-induced lesion formation and bleeding in rat
gastric mucosa. Gastroenterlogy 1989 Jun;96(6):1425-33.
5) Holzer P. Stimulation of afferant
nerve endings by intragastric capsaicin protects against ethanol-induced
damage of gastric mucosa. Neuroscience 27:981-7, 1988.
6) Ippoliti AF The effect of various forms
of milk on gastric-acid secretion. Studies in patients with duodenal ulcer
and normal subjects. Ann Intern Med 1976 Mar;84(3):286-9.
7) Briggs R. Myocardial
infarction in patients treated with Sippy and high milk diets. An
autopsy study of fifteen hospitals
USA and Great Britain. Circulation
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Gastroenterology. 1988 Oct;95(4):920-6.
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population study. Eur J Clin Nutr 52:668-74, 1998.
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13. Larkai EN. Gastroduodenal mucosa and
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17) Suadicani P. Genetic and life-style
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Copenhagen Male Study.
Scand J Gastroenterol. 1999 Jan;34(1):12-7
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20) Mahady GB,. Allixin, a phytoalexin
from garlic, inhibits the growth of Helicobacter pylori in vitro.
Am J Gastroenterol. 2001
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susceptibility to garlic (Allium sativum)
extract. Nutr Cancer 27:118-21, 1997.
22) Tabak, M., R. Armon, I. Potasman, and
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