Myth Ulcers: Spicy Food and Stress Cause Stomach Ulcers

False. Most stomach ulcers are caused by Helicobacter pylori (H. pylori), a type of bacteria, or the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen, ibuprofen, or aspirin. In the case of H. pylori infection, antibiotics can treat the infection. Ulcers caused by NSAIDs are healed by stopping the pain medication and taking antacids and medications that reduce stomach acid. It’s a myth that spicy foods and stress cause ulcers, but it is true that they can worsen ulcer symptoms. Cancer can cause stomach ulcers, too.

Signs and symptoms of a peptic ulcer can include one or more of the following:

  • abdominal pain, classically epigastric strongly correlated to mealtimes. In case of duodenal ulcers the pain appears about three hours after taking a meal;
  • bloating and abdominal fullness;
  • waterbrash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus – although this is more associated with gastroesophageal reflux disease);
  • nausea, and copious vomiting;
  • loss of appetite and weight loss;
  • hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric ulcer, or from damage to the esophagus from severe/continuing vomiting.
  • melena (tarry, foul-smelling feces due to presence of oxidized iron from hemoglobin);
  • rarely, an ulcer can lead to a gastric or duodenal perforation, which leads to acute peritonitis, extreme, stabbing pain,[13] and requires immediate surgery.

A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain forms of medication can raise the suspicion for peptic ulcer. Medicines associated with peptic ulcer include NSAIDs (non-steroid anti-inflammatory drugs) that inhibit cyclooxygenase, and most glucocorticoids (e.g. dexamethasone and prednisolone).

In patients over 45 with more than two weeks of the above symptoms, the odds for peptic ulceration are high enough to warrant rapid investigation by esophagogastroduodenoscopy.

The timing of the symptoms in relation to the meal may differentiate between gastric and duodenal ulcers: A gastric ulcer would give epigastric pain during the meal, as gastric acid production is increased as food enters the stomach. Symptoms of duodenal ulcers would initially be relieved by a meal, as the pyloric sphincter closes to concentrate the stomach contents, therefore acid is not reaching the duodenum. Duodenal ulcer pain would manifest mostly 2–3 hours after the meal, when the stomach begins to release digested food and acid into the duodenum.

Also, the symptoms of peptic ulcers may vary with the location of the ulcer and the patient’s age. Furthermore, typical ulcers tend to heal and recur and as a result the pain may occur for few days and weeks and then wane or disappear.[14] Usually, children and the elderly do not develop any symptoms unless complications have arisen.

Burning or gnawing feeling in the stomach area lasting between 30 minutes and 3 hours commonly accompanies ulcers. This pain can be misinterpreted as hunger, indigestion or heartburn. Pain is usually caused by the ulcer but it may be aggravated by the stomach acid when it comes into contact with the ulcerated area. The pain caused by peptic ulcers can be felt anywhere from the navel up to the sternum, it may last from few minutes to several hours and it may be worse when the stomach is empty. Also, sometimes the pain may flare at night and it can commonly be temporarily relieved by eating foods that buffer stomach acid or by taking anti-acid medication.[15] However, peptic ulcer disease symptoms may be different for every sufferer.[16]

Complications

  • Gastrointestinal bleeding is the most common complication. Sudden large bleeding can be life-threatening.[17] It occurs when the ulcer erodes one of the blood vessels, such as the gastroduodenal artery.
  • Perforation (a hole in the wall of the gastrointestinal tract) often leads to catastrophic consequences if left untreated. Erosion of the gastro-intestinal wall by the ulcer leads to spillage of the stomach or intestinal content into the abdominal cavity. Perforation at the anterior surface of the stomach leads to acute peritonitis, initially chemical and later bacterial peritonitis. The first sign is often sudden intense abdominal pain; an example is Valentino’s syndrome, named after the silent-film actor who experienced this pain before his death. Posterior wall perforation leads to bleeding due to the involvement of gastroduodenal artery that lies posterior to the first part of the duodenum.
  • Penetration is a form of perforation in which the hole leads to and the ulcer continues into adjacent organs such as the liver and pancreas.[14]
  • Gastric outlet obstruction is a narrowing of the pyloric canal by scarring and swelling of the gastric antrum and duodenum due to peptic ulcers. The person often presents with severe vomiting without bile.
  • Cancer is included in the differential diagnosis (elucidated by biopsy), Helicobacter pylori as the etiological factor making it 3 to 6 times more likely to develop stomach cancer from the ulcer.[14]

Cause

H. pylori

A major causative factor (60% of gastric and up to 50–75%[18] of duodenal ulcers) is chronic inflammation due to Helicobacter pylori that colonizes the antralmucosa.[19] The immune system is unable to clear the infection, despite the appearance of antibodies. Thus, the bacterium can cause a chronic active gastritis (type B gastritis). Gastrin stimulates the production of gastric acid by parietal cells. In H. pylori colonization responses to increased gastrin, the increase in acid can contribute to the erosion of the mucosa and therefore ulcer formation.

NSAIDs

Another major cause is the use of NSAIDs, such as ibuprofen and aspirin.[20] The gastric mucosa protects itself from gastric acid with a layer of mucus, the secretion of which is stimulated by certain prostaglandins. NSAIDs block the function of cyclooxygenase 1 (COX-1), which is essential for the production of these prostaglandins. COX-2 selective anti-inflammatories (such as celecoxib or the since withdrawn rofecoxib) preferentially inhibit COX-2, which is less essential in the gastric mucosa, and roughly halve the risk of NSAID-related gastric ulceration.

Stress

Stress due to serious health problems such as those requiring treatment in an intensive care unit is well described as a cause of peptic ulcers, which are termed stress ulcers.[3]

While chronic life stress was once believed to be the main cause of ulcers, this is no longer the case.[21] It is, however, still occasionally believed to play a role.[21] This may be by increasing the risk in those with other causes such as H. pylori or NSAID use.[22]

Diet

Dietary factors such as spice consumption, were hypothesized to cause ulcers until late in the 20th century, but have been shown to be of relatively minor importance.[23] Caffeine and coffee, also commonly thought to cause or exacerbate ulcers, appear to have little effect.[24][25] Similarly, while studies have found that alcohol consumption increases risk when associated with H. pylori infection, it does not seem to independently increase risk. Even when coupled with H. pylori infection, the increase is modest in comparison to the primary risk factor.[26][27][nb 1]

Other

As of 2017 whether or not smoking increases the risk of ulcers was unclear.[28]

Gastrinomas (Zollinger–Ellison syndrome), rare gastrin-secreting tumors, also cause multiple and difficult-to-heal ulcers.

A more rational and effective approach is necessary.  The natural approach to healing ulcers is to first identify and then eliminate or reduce all factors that can contribute to their development:  food allergies, a low-fiber diet, cigarette smoking, stress, and drugs such as aspirin and other nonsteroidal analgesics.  Once these factors have been controlled or eliminated, the focus is directed at healing the ulcers and promoting tissue resistance.  This includes drinking cabbage juice, eating a healthful diet high in fiber and low in allergenic foods, and incorporating an effective stress reduction plan.

The natural approach may also involve herbs, especially a unique licorice extract known as deglycyrrhizinated licorice.  Like cabbage, deglycyrrhizinated licorice helps re-establish a healthy intestinal lining.  All of these important approaches are discussed in this article.

  • Eliminate food allergies.  Strange as it may seem, clinical and experimental evidence points to food allergy as a primary cause of ulcers.  The link between allergy and ulcers has been investigated in several studies.  In one study, 98 percent of patients with radiographic evidence of ulcers had coexisting lower and upper respiratory tract allergic disease.  In another, 25 of 43 allergic children had X-ray-diagnosed ulcers.  A diet that eliminates food allergies has been used with great success in treating and preventing recurrent ulcers.

    Food allergy is also consistent with the high recurrence rate of ulcers.  If food allergy is the cause, the ulcers will continue to recur until the offending food or foods are eliminated from the diet.  Ironically, many people with ulcers soothe themselves by drinking a lot of milk, a highly allergenic food.  (See the Allergies section of the NaturoDoc Library for information on how to control or even eliminate allergies.)

  • Increase fiber intake.  A high-fiber diet is associated with a reduced rate of duodenal ulcers.  The therapeutic use of a high-fiber diet in patients with recently healed duodenal ulcers can reduce the recurrence rate by half.  This is probably a result of fiber’s ability to promote a healthy protective layer of mucin in the stomach and intestines.

  • Stop smoking.  Another factor strongly linked to ulcers is smoking.  Increased frequency of ulcers, decreased response to therapy, and an increased mortality due to ulcers are all related to smoking.

  • Avoid aspirin.  Aspirin is a gastric irritant that damages the lining of the stomach and predisposes individuals to ulcer development when taken regularly.  The combination of aspirin and smoking is particularly harmful to the ulcer patient.

  • Reduce stress and emotional factors.  Many people consider stress an important factor in ulcer development.  However, this belief is based on uncontrolled observations.  In medical literature, the role of stress is controversial.  Men and women with ulcers seem to have distinctly different psychological profiles.  In addition, several studies show the number of stressful, life events is not significantly different between ulcer patients and ulcer-free controls.  This data suggests the individual’s response to stress, rather than the amount of stress, is the significant factor.

  • Emphasize specific nutrients.  Vitamins A and E have been shown to inhibit the development of stress ulcers in animals and are recognized as important factors in maintaining the integrity of the digestive tract lining.  According to clinical studies in humans, zinc also has a protective effect against ulcers.

A Special Licorice Extract

Glycyrrhizinic acid, a constituent of licorice, was the first compound proven to promote healing of gastric and duodenal ulcers in a clinical setting.  However, due to the known side effects of glycyrrhizinic acid (it can raise blood pressure in susceptible individuals), a procedure was developed to remove it from the plant, thereby creating deglycyrrhizinated licorice.  The result is a beneficial compound with no known side effects.

Instead of blocking stomach acid, deglycyrrhizinated licorice stimulates the body’s natural defense mechanisms that protect against ulcer formation.  This includes increasing the quantity and quality of mucosal cells in the protective lining of the gut;  increasing the life span of surface intestinal cells;  and enhancing the blood flow to the gastrointestinal tract lining.

Numerous studies indicate deglycyrrhizinated licorice is effective only when chewed and mixed with saliva.  It is generally ineffective in capsule form.  Deglycyrrhizinated licorice may promote the release of salivary compounds such as urogastrone or epithelial cell growth factors which stimulate the growth and regeneration of stomach and intestinal cells.

The recommended daily dosage for deglycyrrhizinated licorice is two to four 380 mg. tablets — chewed thoroughly — between meals or 20 minutes before eating.  This dosage should continue 8 to 16 weeks for optimum benefit.

Other herbs that may help soothe intestinal distress include American cranesbill (Geranium maculatum), marshmallow (Althaea officinalis), slippery elm (Ulmus fulva), okra (Hibiscus esculentus), echinacea or purple coneflower (Echinacea angustifolia), and goldenseal (Hydrastis canadensis).  Many of these plants have a high content of mucilage, which is very soothing to the mucous membranes, including those lining the gastrointestinal tract.

Note:  Patients with symptoms of an ulcer need competent medical care.  Ulcers are usually associated with upper abdominal pain 45 to 60 minutes after meals or during the night.  The pain is typically described as gnawing, burning, aching or cramp-like, and is relieved by food, antacids, or vomiting.  Ulcer complications such as hemorrhage, perforation, and obstruction are medical emergencies that require immediate hospitalization and care.  Patients with ulcers should be monitored by a physician even when following the natural approaches discussed here.

Therapy that’s less expensive, more effective, and safer than over-the-counter drugs

Current medical treatment of ulcers is far from ideal.  The natural approach is safer, less expensive, and just as effective as traditional drugs.  The first step is to identify and reduce or eliminate all factors implicated in the development of ulcers.  The next step is to heal the ulcers and promote tissue resistance by reducing stress and by eating a diet high in fiber and low in allergenic foods.  It’s also wise to drink fresh cabbage juice (up to one liter daily), use deglycyrrhizinated licorice preparations, and supplement the diet with nutrients such as vitamin A, vitamin E, and zinc.

Michael T. Murray, ND

Connie’s comments: Add aloe vera juice, coconut juice, goat’s milk, ginger and sulfur rich foods ( garlic,onions, yellow colored ones) in your diet.