Ulcers

Simply stated, an ulcer is an open wound. Ulcers can occur inside the mouth, on the skin, or elsewhere on the body. But when people say "ulcers," they're almost always referring to sores either in the stomach (called gastric ulcers) or at the junction of the stomach and small intestine (duodenal ulcers). Collectively, these are known as peptic ulcers-peptic meaning digestive.

The pain associated with ulcers is caused by stomach acid, which is very caustic. "If you were to put stomach acid on your skin, you'd get a very nasty burn;" says Anne Simons, M.D.

Normally, the acid doesn't burn your stomach, because the stomach cells secrete thick mucus that creates a protective barrier. The cells also produce a natural antacid that provides a chemical shield against damage.

If either of these protective mechanisms fails, the acid can easily burn your stomach cells. This is how an ulcer forms-and it also accounts for the pain that an ulcer causes.

Ulcer pain tends to be worst between meals and at night, when your stomach is empty. When your stomach is full, the acid can work on breaking down food rather than gnawing at stomach cells.

But pain isn't the only symptom of ulcers. These sores can also produce nausea, vomiting, a bloated feeling after meals, and black, tarry, foul-smelling stools.

Ulcers were one of the first conditions attributed to stress. Doctors believed that stress stimulated the release of excess stomach acid, which in turn burned holes in the stomach's mucous lining. Then in the early 1980s, two Australian doctors proposed that most ulcers result not from stress but from bacteria called Helicobacter pylori. The doctors arrived at this conclusion after noticing that the majority of people with ulcers have H. pylori in their stomach tissue.

The bacteria are able to survive inside the stomach because, just like stomach cells, they produce their own antacid. With long, swishing tails to power their progress, the bacteria burrow through the stomach's mucous lining and into the cells underneath.

"It seems H. pylori must be present for ulcers to develop," says Alan P. Brauer, M.D. "But the infection by itself isn't sufftcient to cause ulcers."

In other words, some other factor must create the conditions necessary for H. pylori to do their dirty work. Once again, the primary suspect is stress. And the stress-ulcer connection is supported by the findings of several studies, including one sponsored by the Centers for Disease Control and Prevention (CDC) in Atlanta. If you think that you have an ulcer, but you haven't been officially diagnosed, your first step is to see your doctor. Your doctor can test you for H. pylori infection using what's called a urea breath test.

For H pylori ulcers, the treatment of choice is a drug regimen that features antibiotics. But recently, many mainstream and al­ternative practitioners have begun to endorse a blended approach that uses a combination of alternative therapies, home remedies, and over-the-counter drugs to complement the prescription medications.

Best Choices

Nutrition

Be a bean counter. In 1986, Harvard researchers determined that the fiber in beans was most protective, while the fiber in fruits and vegetables was moderately protective.

But how does any fiber prevent ulcers? It slows the rate at which the contents of your stomach empty into the duodenum on their way to your small intestine. The slower your stomach empties, the lower the concentration of stomach acid in your duodenum, the place where most ulcers develop.

Fiber not only prevents ulcers but also helps treat them, says Joseph PizzornoJr., N.D. When people with ulcers increase their fiber intakes, they're less likely to get ulcers again.

To increase your fiber intake, fill your plate with whole grains, beans, fruits, and vegetables. Try to get at least 25 grams of fiber a day, the Daily Value.

Add a little heat to your meals. For a long time, mainstream physicians prescribed a bland diet for people with ulcers, believing that spicy foods aggravated the condition. As it turns out, though, hot peppers may actually help heal ulcers. Capsaicin, the compound that gives hot peppers their heat, appears to be particularly beneficial.

"Capsaicin appears to work its magic by stimulating nerves in the stomach wall," say pharmacists Joe Graedon and Teresa Graedon, Ph.D., coauthors of The People's Pharmacy books. "This dilates blood vessels and improves blood flow to the stomach wall, which supports healing." To get capsaicin, all you have to do is eat more jalapenos and other hot peppers.

Forget milk. Doctors used to tell people with ulcers to drink lots of milk to neutralize stomach acid. Now doctors know that milk's antacid effects work only briefly, says Melvyn R. Werbach, M.D., assistant clinical professor at the University of California, Los Angeles, School of Medicine. And once those effects wear off, milk actually stimulates acid secretion. While you don't have to give up milk and milk products completely, cutting back is probably a good idea.

Avoid irritating beverages. Coffee, tea, and alcohol also increase stomach acid secretion, Dr. Werbach says.

Eat dinner early. Eating early reduces nighttime stomach acidity, which can help control ulcer pain in the wee hours. In one study, 23 people ate the same breakfast at 7:00 A.M. and the same lunch at noon. Then they ate dinner at either 6:00 or 9:00 P.M. Those who ate early produced less stomach acid during the night than those who ate late.

Supplements

Reinforce the barrier. Naturopaths believe that strengthening the stomach's mucous lining can help deter H pylori from burrowing into it. Supplementation with vitamins A, C, and E and the mineral zinc can "improve stomach integrity," according to naturopath Enrico Liva, N.D., director of the Connecticut Center for Health in Middletown.

For people with ulcers, Dr. Liva recommends taking a daily multivitamin/mineral supplement. He also suggests twice-daily doses of each of the following: 25,000 international units of beta-carotene, which the body converts to vitamin A; 1,000 milligrams of buffered vitamin C; 1,000 milligrams of flaxseed oil, a source of vitamin E; and 15 milligrams of zinc. But talk to your doctor before supplementing with beta-carotene at this level. You can buy all of these supplements in health food stores and many drugstores.

Elimination Diet

Cut out the ulcer aggravators. Research has shown that the same elimination diet used to identify food intolerances can also help heal ulcers. People with ulcers tend to be most sensitive to corn, chocolate, cola, sugar, and foods made with white flour. Citrus, peanuts, soy, shellfish, and dairy products have also been linked to ulcers.

An elimination diet is best followed under the supervision of a nutrition-minded doctor.

Visualization

See your ulcer healing. At the University Hospital of South Manchester in England, researchers taught a visualization technique to people with ulcers. The researchers found visualization to be "unequivocally beneficial" in relieving ulcer pain. You can try this therapy on your own by practicing the following exercise, recommended by Gerald N. Epstein, M.D., director of the Academy of Integrative Medicine and Mental Imagery in New York City.

Close your eyes. Slowly inhale and exhale three times. As you continue this slow, relaxed breathing, envision a mermaid with flowing golden hair and a sleek, silvery body and tail. She's swimming rhythmically through your digestive tract, which is calm. Sense her there. Watch her swim to any places where you feel cramping, pain, or any other symptoms. Have her touch those areas and gently massage them until they are healed and you no longer feel discomfort. See her complete her swim through your digestive tract, making sure that everything is in order. When she's done, open your eyes. Repeat this exercise three or four times a day.

Herbal Medicine

Elude pain with licorice. When researchers began analyzing licorice for its ulcer-healing compounds, they identified glycyrrhetinic acid, a potent anti-inflammatory that heals ulcers in both animals and humans.

You can buy chewable tablets of deglycyrrhizinated licorice in health food stores. Take two to four 380-milligram tablets 20 minutes before eating or between meals, advises Seattle naturopath Michael T. Murray, N.D.

Discover a new use for ginger. You may know ginger as an effective remedy for indigestion and motion sickness. But you may not realize that the herb contains 11 compounds with scientifically verified anti­ulcer properties, says James A. Duke, Ph.D.

Home Remedies

Use pain relievers prudently. Both aspirin and ibuprofen belong to the class of medications known as nonsteroidal anti-inflammatory drugs (NSAlDs). These are the most likely to trigger or aggravate ulcers. So if you have an ulcer, you shouldn't take aspirin or ibuprofen, Dr. Simons says. If you've never had an ulcer but the condition runs in your family, you'd be wise to limit your use of these medicines-or better yet, not to use them at all.

Stop smoking. When you smoke, your stomach empties faster, which exposes your duodenum to high concentrations of stomach acid, Dr. Pizzorno says. Smoking also impairs the production of natural antacids in the stomach.

Other Good Choices

Homeopathy

Let a little medicine do a lot of good. A number of homeopathic medicines have been proven effective as ulcer treatments, according to homeopath Dana Ullman. Among the medicines he prescribes are Argentum nitricum, Arsenicum album, Hydrastis, Kali bichromicum, Kali carbonicum, Lycopodium, Mercurius, Nux vomica, Phosphorus, and Pulsatilla. To find out which of these best suits your symptoms, consult a homeopath.

Chinese Medicine

Support your Stomach and Spleen. Practitioners of Chinese medicine attribute ulcers to a weak, cold Stomach and Spleen, says Efrem Korngold, O.M.D., L.Ac. For people with ulcers, he usually prescribes the herbs coptis, which has anti-inflammatory properties, and ginger and erodia fruit, which are warming. He may also recommend a Chinese medicine called Yunnan Bai Yao.

Score points against pain. Acupuncture does such a good job of treating ulcers that it has won the endorsement of the United Nations World Health Organization. But if you prefer a self-care approach, acupressure may work just as well. Apply steady, penetrating finger pressure to each of the following points for 3 minutes.

  • Conception Vessel 12, located halfway between the end of your breastbone and your navel on the midline of your abdomen
  • Stomach 36, located four finger-widths below your kneecap and one finger-width toward the outside of your shinbone
  • Pericardium 6, located in the middle of your inner wrist, 2 1/2 finger-widths above the wrist crease

Ayurvedic Medicine

Rein in Pitta. In Ayurveda, ulcers result from an excess of Pitta dosha, explains John Douillard, D.C., a chiropractor who practices Ayurvedic medicine at the Invincible Life Spa in Boulder, Colorado. Excess Vata dosha may be a factor, too.

To treat ulcers, Dr. Douillard recommends a Pitta-pacifying diet of fresh, well­cooked vegetables and barley water tea. To make the tea, boil 2 cups of barley in 6 cups of water until only 4 cups of liquid remain. Drink three cupfuls of tea each day. Refrigerate any leftover tea and reheat as necessary.

An Ayurvedic ulcer prescription may include licorice, ginger, cloves, cinnamon, and black pepper. For dosage information, consult an Ayurvedic physician.

Over-The-Counter Drugs

Block your discomfort. The H2 blockers-a group of pharmaceuticals that includes Tagamet, Zantac, Axid, and Pepcid-reduce stomach acid secretion. The nonprescription formulations are used primarily to treat indigestion and heart­burn, but they can help relieve ulcer symptoms, too. Follow the package directions for proper dosage.

Control the acid. Antacids such as Turns and Rolaids don't cure ulcers, Dr. Simons says. But they do help neutralize stomach acid, which can temporarily relieve ulcer pain. Follow the package directions for proper dosage.

Medical Measures

Mainstream M.D.'s treat H. pylori ulcers by prescribing a combination of antibiotics; bismuth, such as Pepto-Bismol; and drugs that suppress stomach acid secretion, such as omeprazole (prilosec).

If your doctor gives you antibiotics, take the full prescription. Don't stop just because your pain subsides. The absence of pain doesn't mean that all of the bacteria have been killed. Those that survive can continue to multiply, and eventually the pain comes back. Also, these bacteria are more likely to be resistant to antibiotics, which makes them more difficult to eliminate.

Red Flags

If you have an ulcer and you experience the sudden onset of intense, unrelenting abdominal pain, call your local emergency number or have someone take you to the nearest emergency room without delay. This may be a sign that the contents of your stomach are spilling into your abdominal cavity. If so, you'll need immediate surgery.

Also, see your doctor if your stools appear black, red, or bloody or if you're vomiting what looks like blood or coffee grounds. This may mean that your ulcer is bleeding.

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