Peptic Ulcers Diet, Lifestyle & Nutrition Discussion
Note: With the rediscovery in 1982 that ulcers were caused by the bacteria Helicobacter pylori and not by spicy meals or tension and stress, a slow shift began towards treating ulcers with simple antibiotics rather than a host of symptom supressing drugs. But it took quite a while for the information to filter down to medical providers. Nonetheless, many of the following are still relevant.
It has been reported that sugar is consumed in greater quantities by people with ulcers.1 Since it is now known that ulcers are caused by a bacteria, it could be that sugar encourages viral growth. It has also been reported that sugar consumption raises stomach acidity3 aggrevating symptoms.
Salt irritates the stomach lining and intestinal tract. Some connection has been reported between high salt consumption and higher risk of stomach ulcers (not duodenal ulcers).4 Medical professionals therefore recommend that ulcer patients lessen the amount of salt and sugar consumed.
In the 40s and 50s research demonstrated that drinking raw cabbage juice helped to heal ulcers5-8, requiring drinking up to a quart/daily for relief. There is limited modern research supporting this finding9 and many healthcare professionals recommend a quart daily for 10-14 days, with fewer symptoms after a few days. Other juices such as carrot juice can help the flavor. Cabbage has anti-bacterial qualities. Raw also cabbage contains high levels of glutamine, which is an amino acid needed for a healthy intestinal system. It also has a lot of vitamin K (needed for blood clotting), potassium, and quercetin (an antioxidant).
Fiber slows the process of food and stomach acids moving from to the intestine from the stomach, which should help duodenal ulcers.10 One study found that when patients who had recently recovered from duodenal ulcers were give a 6 month high fiber diet, recurrence was markedly lowered.11 Shorter, 4-week fiber additions made only minor improvement.12
Food allergies have been known to be tied to risk of ulcers for many years.13, 14 Repeated recurrance of peptic ulcers may be a good reason to test for food allergies.
NSAIDs and aspirin15 coffee17 (including decaf),18 alcohol,16 and tea19 can slow ulcers' healing process. Smoking also slows healing.20 Regardless of whether your ulcer is caused by bacteria or other reason, you should avoid these irritants.
Nutritional Supplement Treatment Options
Damaged tissue also employs zinc in the repair process and has provided stomach ulcer protection in animal research.23 Zinc combined with the anti-inflammatory agent, acexamic acid, is used in Europe to treat ulcers24 and another study demonstrated zinc's effacacy compared to placebo in healing gastric ulcers.25 Some medical professionals think that very high levels of zinc are not needed, and recommend 25-50mg/daily - but even so 1-3mg/daily copper are needed to avoid copper deficiency created by the extra zinc.
Animal research has demonstrated that carnosine, a zinc salt, markedly helps protect against ulcers and helps to heal existing ulcers.26 27 The degree of benefit of carnosine is not known since zinc itself is effective.28 29 Research has found that carnosine helps to deliminate the bacteria linked to both stomach cancer and peptic ulcer.30 Dosage for H. pylori eradication is 150mg twice/daily.
Glutamine is an essential amino acid that, after glucose, is the greatest provider of energy to the cells, especially those lining the stomach and small intestine. It has been known for many years that glutamine might be helpful for ulcer patients31 and it has helped prevent stress ulcers (triggered by burns).32 Research has demonstrated that it can be helpful for healing after surgery, particularly abdominal surgery.61, 62 While there is not much research for its use with ulcers, its presence in the digestive system and its ability to heal causes some medical professionals to recommend it for peptic ulcers. Dosage: 500-1,000mg 2-3 times/daily.
- Dimethyl sulfoxide has antioxidant and inflammation-reducing qualities and is used topically for a number of conditions.63, 64 Research found that as an oral supplement it lowered peptic ulcer recurrance markedly, better than either placebo or the drug cimetidine33 and that combined with cimetidine there were better results than with the drug alone.34 Supplementing with DMSO should not be done without a medical professional's supervision.
- Vitamin a has the capacity to heal mucous membranes which form the lining of the intestinal tract and stomach and such supplementation was effective in that role in one small study.21 However, the high dosage 150,000IU/daily can be toxic and can cause birth defects. Such supplementation should not be attempted without medical supervision.
- Vitamin C More research is needed regarding the effect of vitamin C. Patients with gastritis have low vitamin C levels in their stomach fluids, and it may help kill h. pylori.
Botanical Treatment Options
Licorice root is traditionally used for digestive inflammation. It may help protect the linings of the small intestine and stomacy by stimulation mucin production35 and licorice's flavonoids may slow growth of the bacteria which is responsible for ulcers.36 Most healthcare providers recommend deglycyrrhizinated licorice (DGL) which avoids some potentially serious side effects such as high blood pressure and fluid retension. In some, but not all, reports, DGL was as effective as cimetidine.37, 38 However, it was also reported that there were fewer relapses in those patients using DGL.39 In any case, in many reports it has been found to be useful for ulcers. 40, 41 Healthcare providers generally recommend 1-2 chewable 250-500mg tabs 15 minutes after meals and 1-2 hours before bed.
Two studies report that gum mastic, an extract of Pistachia lentiscus, can heal peptic ulcers42 43 and can destroy H. pylori in test tube research.44
Other Botanical Options
- Bananna Powder ayurvedic medicine traditionally recommends dried banana powder for ulcers. Banana powder is found to protect the stomach lining in animal research.45 One trial with ulcer patients also found it to be helpful; the dosage was 2 capsules 4 times daily for 8 weeks.46 It is possible that bananas can be substituted.
- Chamomile is known to sooth inflammed mucous membranes. It has lots of apigenin, a flavonoid that slowed H. pylori growth in test tubes.47 Many health professionals recommend 2-3 cups of strong chamomile tea daily. It is also available in capsules.
- Calendula also has healing and anti-inflammatory capacity. You can make a tea from the petals.
- Marshmallow is a high mucilage containing herb traditionally used for inflammation and irritation in the digestive system.
- Garlic There is controverys as to whether garlic destroys H. pylori48-51
- Corydalis extract is helpful in relieving pain and seems to be helpful for peptic ulcers.52
- Comfrey is a traditional topical treatment for skin ulcers and wounds53 54 and is used for digestive system problems but has not been adequately researched. Preparatives made from the root should be avoid.
- Plantain, like comfrey, reduces inflammation and heals wounds and could be helpful for ulcers although it has not been researched.
Discussion: Integrative Options
Stress increases production of acid in the stomach55 and is probably responsible for the connection between stress and ulcers.56-59 In Japan increased ulcers were seen after the 1995 Hanshin-awaji earthquake60 and after the 2011 earthquake and tsumani. 65 It is unknown whether techniques that reduce stress or counseling help limit ulcer development from stressful situations.
Related Health Condition: Peptic Ulcers.
60. Phenolic composition, antioxidant capacity and antibacterial activity of selected Irish Brassica vegetables, Jaiswal aK, Rajauria G, abu-Ghannam N, Gupta S., Nat Prod Commun. 2011 Sep;6(9):1299-304.
61. Morlion, B. J.; Stehle, P.; Wachtler, P.; Siedhoff, H. P.; Koller, M.; Konig, W.; Furst, P.; Puchstein, C. (1998)
62. Klimberg VS, Salloum RM, Kasper M, Plumley Da, Dolson DJ, Hautamaki RD, Mendenhall WR, Bova FC, Bland KI, Copeland EM 3rd, et al., Oral glutamine accelerates healing of the small intestine and improves outcome after whole abdominal radiation,arch Surg. 1990 aug;125(8):1040-5.
63. American Medical association. Dimethyl sulfoxide. Controversy and Current Status: 1981. JaMa 1982;248:1369-71.
64. Jimenez RaH, Willkens RF. Dimethyl sulfoxide: a perspective of its use in rheumatic diseases. J Lab Clin Med 1982;100:48-500.
65. Tomoya Sato, MD; and Shigeru Ichioka, MD, PhD, Pressure Ulcer Occurrence Following the Great East Japan Earthquake: Observations from a Disaster Medical assistance Team, Ostomy Wound Manage. 2012;58(4):70-75