The peptic generation

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the integrative approach to total well-being Millions of Americans suffer from ulcers caused by bacteria or common painkillers. Seven natural options can help you heal

iT STARTS WITH BURNING, gnawing pain between the breastbone and navel, often late at night. For some, there's nausea, heartburn, indigestion, appetite loss, and blood in the stool. At the worst, stabbing abdominal pain and vomiting up blood indicate perforation or obstruction in the stomach.

These are the symptoms of an ulcer, and the bane of 4 million Americans with peptic ulcer disease. "A gastric ulcer is essentially a hole in the lining of your stomach," says Byron Cryer, M.D., an associate professor at the University of Texas Southwestern Medical School in Dallas. "Let's say the stomach lining looks like a carton of ice cream; when you remove a scoop, the indentation is what the ulcer is — a 'bite' in the lining of your stomach."

Pain ensues when that "bite" — full of fresh nerve endings — is exposed to stomach acid and pepsin, an enzyme that breaks down food proteins. There is a "constant seesaw balance" between enzyme-activating add and the prostaglandins, mucus, and blood vessels that protect the stomach lining, says Paul Miskovitz, M.D., a clinical professor of medicine at Weill Medical College of Cornell University in New York City and author of The Doctor's Guide to Gastrointestinal Health. When that balance gets out of whack, your insides are ripe for an ulcer.

purple pills and other drugs
THERE ARE TWO principal causes of an ulcer: Heliobacter pylori and certain painkillers. (See "What Makes an Ulcer?" at left.) And there are two principal tests for an ulcer: "The best is an endoscopy — and second best is a barium X-ray," says Anil Minocha, M.D., director of digestive diseases at the University of Mississippi Medical Center in Jackson, and author of Natural Stomach Care. If the results indicate an ulcer caused by H. pylori, a two-week regimen of antibiotics like amoxicillin, clarithromycin, tetracycline, or metronidazole will wipe out the bug in the vast majority of cases (though increased drug resistance may compromise that success in the future).

If your ulcer is the result of NSAIDs, you can switch to a noninflammatory painkiller like acetaminophen (Tylenol), prescription drugs, or treatment alternatives such as compresses, stretching, and exercise. If you must continue with NSAIDs, Miskovitz recommends taking a proton pump inhibitor before meals to reduce the risk of developing an ulcer. Such stomach-acid suppressants include omeprazoie (Prilosec), lansoprazole (Prevacid), rabeprazole (AcipHex), esomeprazole (Nexium), and pantoprozole (Protonix); as a group, they have more power than histamine blockers like cimetidine (Tagamet), nizatidine (Axid). ranitidine (Zantac), and famotidine (Pepcid), says Minocha.

Popping antacids, which neutralize acid in the stomach, is a popular way to keep ulcer pain at bay, but it should remain a shortterm strategy. "For treating ulcers, the antacids work fairly well — and in some ways that's a problem," notes Andrew Gaeddert, R.H., an herbalist at the Get Well Clinic in Oakland, Calif., and the author of Healing Digestive Disorders: Natural Treatments for Gastrointestinal Disorders. "The average American thinks, If I take this acid-blocking drug I can eat and drink whatever I want. But acid has a place in the body, and these drugs were tested for use for weeks at a time, not months and years."

the 7 alternative paths
EVEN WITH THE TWO main ulcer culprits exposed, drug treatment isn't an open-and-shut case. For one thing, as much as half the population worldwide are infected with H. pylori, and most of them will never develop an ulcer. And not everyone responds to drug therapy. "Body mechanisms have a lot to do with it — plus we know that NSAIDs and H. pylori don't explain everything," says Minocha, who notes that the incidence of ulcers increases in stressful times. That's why alternative approaches can provide useful support to traditional medicine. In fact, there are several steps you can take to help prevent or heal an ulcer.

1. Bone up on botanicals.
"Numerous studies have shown the beneficial effect of licorice against peptic ulcer disease," observes Minocha. "It appears to have an anti-inflammatory effect," along with antibacterial action. The safest form is deglycyrrhizinated licorice, or DGL, which has the properties of licorice without the harmful side effect of elevated blood pressure, says Mercedes Williams, N.D., a natuiopath in Scottsdale, Ariz. She advises taking one 380-milligram DGL tablet before breakfast and one before dinner. (Most licorice candy won't help ulcers, as it usually contains anise, not true licorice.)

In addition, slippery elm coats and soothes the lining of the gut, making it good for general GI health. Williams suggests a simple anti-ulcer recipe: Slowly add fresh, cold water to 2 tablespoons of finely powdered slippery elm bark to make a thick paste. Stir until the mixture reaches the consistency of thick porridge, and sweeten with honey to taste; consume the mixture between meals, two or three times a day.

2. Ferret out food sensitivities.
In her practice, Williams regularly sees food sensitivities and allergies that may set the stage for an ulcer, especially in someone with H. pylori or taking NSAIDs. "When we eat foods that are inflammatory to us in particular, it causes a bit of erosion to the stomach lining, exposing it more," she says. Common irritants include dairy, wheat, strawberries, citrus, nuts, shellfish, and soy; Gaeddert adds spicy foods, iced beverages, chocolate, coffee, and acidic foods to the list.

Williams uses two methods to find food sensitivities: blood tests and an elimination diet, whereby the top allergens are banished from your plate one by one for a short period. "Every three days, one of the sensitive foods is reintroduced," she explains. "If you're okay, you can rotate it back into your diet. It's the gold standard because you know definitively what's causing the problem — and it doesn't cost any money."

Meanwhile, there is indirect evidence that adding fruits, vegetables, and whole grains to your diet may protect against ulcers. Williams thinks fiber is the key: "It slows the movement of food, and therefore acid, in the stomach. It's really healing because of the fact that you're decreasing the amount of acid." Besides, adds Gaeddert, "fat is hard to digest. A healthy diet is important not just for ulcers, but for heart disease and cancer prevention."

3. Fight bad bacteria with good.
Probiotics can reduce the side effects of antibiotic treatment for H. pylori, according to reports in Alimentary Pharmacology & Therapeutics. Minocha gets his probiotics in yogurt, but you need at least 10 billion live organisms per serving, so supplements are useful. To replace the good bacteria the drugs kill off, Gaeddert suggests at least two days of post-course probiotics for every day of antibiotic use. Rotate capsules (or find a combination formula) of Lactobacillus CG, L acidophilus, B. bifidum, and L. sporogenes, and take as directed.

4. Supplement from A to zinc.
Making the most of vitamins and minerals could help usher out an ulcer. Vitamin A, for example, has been shown to strengthen the stomach wall, says Minocha. (Pregnant women, however, should not take more than 10,000 IU daily from food and/or supplements.)

Robert Pastore, Ph.D., president of Pastore Formulations, is a fan of zinc carnosine. "It's been used for years in Japan to help heal ulcers, and it's backed by scientific study," he notes. "Zinc carnosine is a combination of zinc and the amino acid L-carnosine; it helps prevent stress-induced ulcers. The best brand is PepZin GI." Pastore advises taking one capsule three or four times daily after meals.

Williams favors A and zinc, too, as well as vitamin C. "What doesn't vitamin C help with?" she observes. "It combats H. pylori, and it's really boosting to the immune system." For treating an ulcer, she suggests as much as 2 or 3 grams of C daily, taken in two or three divided doses. (If this results in loose stools, cut back immediately, she cautions.)

Both Williams and Pastore hail an amino acid called L-glutamine as one of their top choices for a stomach-friendly supplement. "L-glutamine is the primary source of fuel for cells that line the stomach and intestines — and it helps heal them," says Pastore. He recommends a pharmaceutical-grade version at a dose of 6 to 12 grams a day for four to six months.

5 Drink your • (cabbage) juice.
It wouldn't be hard to find a more appealing beverage, but cabbage juice — 1 quart a day for 10 to 14 days, advises Williams — is believed to be good for the stomach lining; she suggests sweetening it with carrot juice to make it go down easier.

A recent study from Johns Hopkins School of Medicine found that broccoli sprouts, which also contain sulforaphane, the stomach-protecting compound in cabbage, could reduce H. pylori and improve gastritis. "A diet rich in sulforaphane may be useful in chemoprevention against gastric cancer [as well]," concludes the report.

6 "Chew" on • mastic gum.
Mastic resin from the Mediterranean Pistacia lentiscus tree can help cure peptic ulcers, according to reports in The New England Journal of Medicine, among other publications. Since ulcers gain a foothold when there's an imbalance between the protective lining and stomach acid, notes Gaeddert, it can be beneficial to coat the upper GI system the way mastic gum does. Pastore recommends two 500 mg capsules three times daily after eating.

7 • De-stress.
While tension and anxiety are never the sole cause of an ulcer, they can impair healing by compromising the body's defenses. In situations where ulcers are especially hard to treat, stress reduction techniques like hypnotherapy and meditation may be helpful in facilitating healing; for patients with an NSAID-induced ulcer, these techniques are also useful in controlling pain. At the very least, less stress may protect your stomach against another ulcer down the line. And that's truly good for your gut.

For faster repair, don't smoke, and limit caffeine and alcohol intake.

WHAT MAKES AN ULCER?
In the late 1980s, after decades of pointing fingers at stress and spicy foods, researchers identified the Helicobacter pylori bacterium as the true culprit behind many ulcers. "When H. pylori hits the stomach, it elicits an inflammatory response — and inflammation in the stomach sets up a situation where you're more likely to have ulcers," explains Byron Cryer, M.D. "But once we get rid of the organism [by using antibiotics], the inflammation resolves and the likelihood of developing an ulcer falls."

It's a simple plan that successfully heals ulcers and keeps them from coming back. "Once H. pylori is eradicated, the likelihood of having an ulcer within a year is less than 5 percent," says Cryer. Without treatment, there is an 80 percent chance of recurrence.

The success rate is so high that doctors are seeing far fewer ulcer cases attributable to the bacterium. "It used to be that So percent of cases were caused by H. pylori," Cryer notes. Currently, it's around 40 percent to 50 percent.

So what can the other 2 million ulcer sufferers blame? Over-the-counter painkillers, most likely. "About half of ulcers are caused by nonsteroidal anti-inflammatory drugs like aspirin, naproxen, and ibuprofen," says Cryer. These products, known as NSAIDs, block the mucus production and prostaglandins that protect the stomach lining — and they don't waste any time making their impact. "The greatest risk of developing an ulcer occurs during the first three months of NSAID use," observes Paul Miskovrtz, M.D.

Bacterial- and drug-based peptk ulcers can develop in various parts of the gastrointestinal tract: In the stomach, they're known as gastric ulcers; in the upper small intestine, they're termed duodenal ulcers. Chronic indigestion, or dyspepsia, indicates an ulcer only about 20 percent of the time, but check such symptoms out with a physician, since they're shared by other conditions. (For example, a gastric ulcer that doesn't respond to treatment has a slight risk of being cancer.) On the other hand, some people with an ulcer, especially one caused by NSAIDs, will have no symptoms at all until they head to the ER with bleeding.

PHOTO (COLOR): THE H. PYLORI STORY: About half of all ulcers in the United States are caused by this intrepid little bug.

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By Lorie A. Parch

Illustrations by Isabelle Dervaux

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