March, 2002    Vol. 1   No.3


Don’t Burn 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
ntil 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 acid production.

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

H. Pylori
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 Gastritis.
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.

1)     Fill your stomach with a plant based diet

2)     Avoid high protein foods including meat and dairy products

3)     Use garlic and thyme for spices

4)     Use pepper spices with caution – they burn, but do not cause injury

5)     Avoid beer, wine, and champagne

6)     Avoid coffee and decaffeinated coffee

7)     Keep your body healthy to avoid stomach damaging drugs

8)     Take Tylenol rather than aspirin or NSAIDs if prone to stomach trouble

9)     Take liquid or tablet antacids initially, then antacid pills for unresolved problems

10)  As a last resort, investigate and treat an H. pylori infection



1)Graham D. Spicy food and the stomach, evaluation by videoendoscopy JAMA 260:3473-75, 1988

2) Tyagi K.  Gastric mucosal morphology in tropics and influence of spices, tea, and smoking.  Nutr Metab 17:129-135, 1974. 

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 in the USA and Great BritainCirculation 21: 538, 1960.

8)  Brooks FP Effect of diet on gastric secretion. Am J Clin Nutr 1985 Nov;42(5 Suppl):1006-19. 

9)  McArthur KE Soy protein meals stimulate less gastric acid secretion and gastrin release than beef meals. Gastroenterology. 1988 Oct;95(4):920-6. 

10)  Crohn B.  Am J Med Sci. 59:70, 1920. 

11)  Elmstahl S.  Fermented milk products are associated to ulcer diseases.  Results from a cross-sectional population study.  Eur J Clin Nutr 52:668-74, 1998. 

12.  Teyssen S,.  Maleic acid and succinic acid in fermented alcoholic beverages are the stimulants of gastric acid secretion.  J Clin Invest. 1999 Mar;103(5):707-13. 

13. Larkai EN. Gastroduodenal mucosa and dyspeptic symptoms in arthritic patients during chronic nonsteroidal anti-inflammatory drug use. Am J Gastroenterol. 1987 Nov;82(11):1153-8. 

14)  Pounder R.  Helicobacter pylori and NSAIDs – the end of the debate? Lancet 358:3-4, 2002. 

15)  Dunn B.  Helicobacter pylori. Clin Microbiol Rev. 1997 Oct;10(4):720-41.

16) Clearfield H. Helicobacter pylori: aggressor or innocent bystander?
Med Clin North Am. 1991 Jul;75(4):815-29

17) Suadicani P. Genetic and life-style determinants of peptic ulcer. A study of 3387 men aged 54 to 74 years: The Copenhagen Male Study.
Scand J Gastroenterol. 1999 Jan;34(1):12-7

18) Brown LM. Helicobacter pylori: epidemiology and routes of transmission.  Epidemiol Rev. 2000;22(2):283-97.

19) Misciagna G, Diet and duodenal ulcer. Dig Liver Dis. 2000 Aug-Sep;32(6):468-72.

20)  Mahady GB,. Allixin, a phytoalexin from garlic, inhibits the growth of Helicobacter pylori in vitro.
Am J Gastroenterol
. 2001 Dec;96(12):3454-5.

21) Sivan G. Helicobacter pylori—in vitro susceptibility to garlic (Allium sativum) extract. Nutr Cancer 27:118-21, 1997.

22) Tabak, M., R. Armon, I. Potasman, and I. Neeman. 1996. In vitro inhibition of Helicobacter pylori by extracts of thyme. J. Appl. Microbiol. 80:667–672.

23) Fabry, W., P. Okemo, and R. Ansborg. 1996. Activity of East African medicinal plants against Helicobacter pylori. Chemotherapy 42:315–317.



©2002 John McDougall All Rights Reserved