Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

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Doctors have been mistaken for many decades on the cause of peptic ulcers. We have thought it to be due to excess stomach acid, drugs, stress, etc. Now the true culprit is recognized as a germ, Helicobacter pylori. For years we have been quite dogmatic in talking about the cause in terms of excess acid, etc. Now we speak a great deal more humbly. Several studies have shown that 70 to 90 percent of the ulcer patients treated with Zantac or Tagamet will have recurrences within one year. On the other hand those treated for Helicobacter have only five to ten percent recurrence. Helicobacter has been found in virtually all cases of chronic gastritis and peptic ulcers. People who have the bacterium Helicobacter pylori are three times more likely to develop stomach cancer than those who do not have the germ.

The outstanding symptom of ulcers is pain occurring in the epigastrium (just below the breast bone) often at regular times and relieved by eating. Constipation is another common symptom. Nausea, vomiting, loss of appetite, and even anemia, may occasionally occur.

Complications vary from the merely uncomfortable to rarely the serious or life-threatening ones. These serious ones include hemorrhage, which may require emergency surgery; perforation of the bowel with peritonitis; penetration of the ulcer into the pancreas; blockage of the stomach outlet due to scar tissue; and unrelenting pain. Many of these complications may require surgery. It is important to treat ulcers vigorously to avoid the complications.

‍Causes, Promoters, and Results

• Infection by Helicobacter pylori, followed by increased acid secretion.
• Failure to drink sufficient water.
• Use of aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) use.
• Almost all drugs irritate the stomach, but especially steroids are prone to cause ulcers.
• Allergies or food sensitivities: One study revealed that patients with proven peptic ulcers also suffered in 98 percent of cases from respiratory tract allergies. Ref. Annals of Allergy 32:127-30, 1974.
• The use of alcohol, tea, colas, or coffee.
• The use of tobacco.
• Excessive dietary sugar, salt, and fat.
• Insufficient intake of linoleic acid from nuts, seeds, whole grains, and beans.
• Inadequate chewing, overeating, or undereating. All food should be chewed to a cream before swallowing. Overeating and eating between meals slows gastric emptying, promotes excessive acid, and encourages ulcers.

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Treatment‍

We have had most excellent results with a program for H. pylori in which ulcers of many years duration have been cured.‍

1. Avoid antacids as they cause rebound acidity in the stomach. Fast one day, using nothing except water by mouth. Fasting also reduces acid production. Meals on the first day after the fast should be approximately half the quantity one ordinarily eats.‍
2. Avoid use of the so-called "H2 blockers," such as Zantac and Tagamet. They may have significant side effects. Also, when stomach acid is completely blocked, it allows overgrowth of bacteria in the stomach. Malabsorption of B-12 is common, along with an increase in infections—possibly an increase in stomach cancer.‍
3. Begin a simple diet consisting of not more than two food items, plus bread and spread. Never eat between meals, and avoid all irritants for the stomach such as ginger, cinnamon, nutmeg, cloves, black and red pepper.‍
4. ‍The diet should be changed to a non-irritating type, which means the total elimination of vinegar and any product containing vinegar including bread; irritating spices (ginger, cinnamon, nutmeg, cloves, black and red pepper); the brown drinks coffee, tea, colas, and chocolate; animal products of all kinds (meat, milk, eggs, and cheese); excessive quantities of salt, all baking soda or baking powder; all beverages except water and herb teas; all sweetening agents including honey: refined proteins such as soy protein isolates (watch soy milk and meat substitutes); and refined fats such as margarine, butter, mayonnaise, fried foods, cooking fats, salad oils, and nut butters.‍
5. ‍Chew food well—taking small bites and eating slowly. A well-chewed meal produces as much hydrochloric acid as a poorly chewed meal, but the well-chewed meal produces more buffer substance. This is very important.‍
6. ‍Maintain good hydration, as many people have peptic ulcers because of chronic dehydration. Under 50 years of age you may need around eight glasses each day; over 50 you probably need ten to twelve glasses.‍
7. ‍Caffeinated beverages, even when decaffeinated, prolong the stomach acid output and must be banished from the diet. Drink eight to ten, eight ounce glasses of water or herbal teas per day. Many people with peptic ulcer disease are chronically dehydrated.‍
8. ‍Do not smoke, as smoking inhibits pancreatic bicarbonate secretion and promotes backward flow of material from the duodenum to the stomach.‍
9. ‍Use a tincture of goldenseal and echinacea (obtainable from Dr. Christopher Deatherage, Rt. 5, Box 806, Ava, MO 65608, Phone: 417-683-1300), one teaspoonful every hour for six hours: then one teaspoonful every four hours for 24 hours—you must wake up at night to take it—then five teaspoons a day, until four bottles containing eight ounces have been taken.‍
10. ‍We use six drops of grapefruit seed extract (from a health food store) three times a day, diluted in at least eight ounces of water or tea. This should be taken just after meals, as it is likely to upset the stomach in some people with peptic ulcer. Goldenseal should be taken— two capsules, four times a day. Kyolic liquid garlic extract (which is more expensive than the capsules, but we think it is superior in the treatment of peptic ulcers to capsules or tablets) should be taken in the quantity of one teaspoonful three times a day. If liquid is unavailable, take two capsules or tablets four times a day.‍
11. ‍Buy large green bananas called plantain, peel, lay the slices out on a towel to dry, either in the sun or in an oven turned to the lowest possible temperature. When the plantain is entirely dry, pulverize the pieces in a blender to a powder and take two tablespoonfuls two to three times daily.‍
12. ‍Both cabbage and olives contain the "anti-gizzard erosion factor." Use four to ten olives four times a day, depending on how many calories you can afford. Juice cabbage freshly and take one glassful four times a day. When mealtime is near to dosage schedule, it is good to take the juice ten minutes before the meal. One liter per day for 30 days of concentrated cabbage juice (high in L-glutamine) has been curative in up to 92 percent of patients studied. This treatment, along with the garlic treatment (see below) for two months, may be substituted for the goldenseal, echinacea, and grapefruit seed extract, if these are unavailable, although it is not as effective a routine. Raw celery juice also contains much of the L-glutamine and may be used occasionally to give relief from the monotony of the cabbage juice.‍
13. ‍Aloe vera juice—two ounces, ten minutes before each meal, has a healing benefit. Often helpful is a heaping teaspoon of finely ground slippery elm stirred into two to four ounces of aloe juice.‍
14. ‍A paste made of carob powder and water can be taken by the teaspoonful any time there is pain or nausea. Beginning on the seventh day, take a heaping tablespoon of charcoal for pain four times daily, early morning, midmorning, midafternoon, and bedtime, avoiding mealtimes by at least half an hour on either side. No need to take carob or charcoal if there is no pain or nausea.
15. An ELIMINATION AND CHALLENGE DIET should be attempted to see what foods the patient is most sensitive to, and eliminate them until the symptoms are entirely gone. They may then be reintroduced one at a time every ten days. Millet is often soothing to the intestinal tract, especially in peptic ulcers.
16. Stress increases stomach acid production. Remember that exercise neutralizes stress, and have a regular out-of-doors program daily.‍
17. ‍For pain of peptic ulcer, an ice bag may be placed over the point of maximum pain. Cold applications to the area immediately over the stomach (epigastrium) produces an effect similar to sympathetic nerve stimulation by epinephrine with lessened muscle tone of the stomach and irregular short but deep peristaltic waves, accompanied by complete relaxation of the pylorus. When used for gastric and pyloric ulcers the pain relief can be dramatic. Applications to other areas of the body produce no such response in the stomach. This illustrates the principle that the major effect of temperature change of the skin is on the organs that lie immediately beneath the skin being treated.‍
18. ‍Another method of pain relief is that of applying heat. You may use very hot fomentations or hot wet towels, as hot as can be tolerated on the abdomen. You may prefer a hot bath instead. About half an hour before bedtime, sit in a tub of hot water, so hot that you sweat rather profusely, unless your resting heart rate (pulse rate) is more than 90 per minute, since the heart rate will increase as you sit longer in the hot water. Keep your face cool with cold compresses wrung from ice water. As soon as the hot part is over—about 20 minutes—you should take a brief cool shower for about 20 seconds. Briskly rub your skin dry with a coarse dry towel, dress for bed, and get into the bed to sweat. You should be able to fall asleep with this treatment. The treatment may be done in the daytime, if you have pain then. If your resting pulse rate is above 90, you should not do this treatment.
19. Herbal teas may be used for soothing, for pain, sedation, etc., as needed. These include white willow bark, wild lettuce, licorice, and slippery elm.‍
20. ‍Deglycyrrhizinated licorice has proven very effective in peptic ulcer. It must mix with saliva in order to be effective. It stimulates growth and regeneration of stomach and intestinal cells. The dosage is four to eight 200 mg. capsules, taken about 20 minutes before meals for two to four months. This is a treatment for resistant cases.‍
21. ‍Garlic, if tolerated, should be taken in the quantity of five cloves four times a day. The garlic can be chopped and made into a garlic sandwich, if preferred. The sandwich can consist of three to five garlic cloves taken in a sandwich twice a day. The other two times the garlic cloves may be taken blended in cabbage or celery juice. If raw garlic is irritating to the stomach, it may be steamed. Put one globe of garlic cloves in a microwave oven for one minute and ten seconds, or steam over water for ten minutes, or bake in an oven at 350 degrees for 20 minutes. The entire globe should be taken when it is cooked. The aged garlic extract such as Kyolic may be substituted as the form of garlic used. Take two capsules four to six times a day for 30 days.
22. If there is bleeding, you may use a single very, very hot compress. Hold the ends of towels folded lengthwise and twist them, as if wringing the towels out of water. Dip the mid-section into hot water. The hot compresses should be above 115 degrees, but not as hot as 120 degrees. Lift the towels from the hot water, while maintaining their twisted position, then twist really tightly and stretch them out to remove excess hot water. Quickly open up the towels, fold and apply to the abdomen over the stomach area. Allow the compress to stay on only three minutes, and by all means no more than six. This should be followed by a very cold and icy compress for one minute and a cold mitten friction to the arms, ending with a dry friction to encourage blood flow to the arms. Do not rub the abdomen after the cold compress. Keep the patient still and quiet after the treatment.‍
23. ‍We do not treat H. pylori with colloidal silver, since it is a new remedy, and ill effects may not have been defined yet. We are of the old school when silver treatments were used for syphilis, and we occasionally had a very bad result with it—a peculiar graying of the skin which never goes away!‍
24. ‍We do not give Pepto-Bismol any more, as it has been discovered that the treatment for peptic ulcers is just as good without the bismuth.
25. ‍Keep the extremities warm, as chilled extremities cause reduced blood flow to the stomach.