Peptic Matters

The term peptic ulcer refers to a group of ulcerative disorders of the upper gastrointestinal tract. (GIT)  A peptic ulcer is a spot in the upper GIT where the lining and the tissues beneath it, have been eroded away leaving an open wound. This may be caused by an excess of stomach acid, insufficient production of mucous to protect the stomach lining, or both. The two common types of ulcer are the duodenum and gastric; the difference between the two ulcers is their location. The duodenal ulcer occurs naturally enough in the duodenum, the narrow section of the small intestine connecting it to the stomach; while the gastric ulcers’ preferred site of irritation is the main body of the stomach.
   
Symptoms of peptic ulcer
As mentioned, a burning, gnawing pain located somewhere between the breastbone and navel is often the first symptom. This is frequently accompanied by heartburn, nausea, loss of appetite and indigestion. The usual onset of pain is between 45-60 minutes after a meal. Pain may vary from moderate to severe, and may cause the sufferer to wake up during the night. Other symptoms may include lower back pain, headache, a choking sensation, vomiting and blood in the stool. Diagnosis is normally confirmed by an X-ray or fibre-optic examination.

Causes
There are several factors which increase the secretion of stomach acid or alter the mucosal lining;
-certain drugs, namely aspirin and NSAID’s.Taken over a long period of time these drugs actually increase stomach acidity; steroids, such as those taken for arthritis also contribute to ulceration
-smoking wears away the intestinal lining; bile salt reflux induced by smoking is extremely irritating to the stomach
-antacids-the calcium carbonate antacids actually produce a rebound effect on gastric acid secretion, while the sodium bicarbonate types are believed to interfere with heart and kidney function
-stress and anxiety cause an increase in stomach acid production
-bacteria-namely Helicobacter pylori has been well established as being present in persons with ulcers (breath test will confirm). It is believed that H.pylori may be responsible for up to 90% of gastric ulcers and 70% of duodenal ulcers.
-excessive vitaminC supplementation
-food sensitivities can cause an inflammatory response which can erode the stomach lining. (As a matter of course, I always put my clients, whose blood tests reveal multiple food allergies, on a course of the amino acid l-glutamine to heal the undoubtedly eroded lining)
Treatment
Licorice root should be the herb of choice for all ulcer sufferers; it promotes healing of gastric and duodenal ulcers. Take 750-1500 milligrams of deglyrrhizinted licorice three times daily between meals for up to three months  Unlike drugs which inhibit the release of acid, licorice increases the number of mucous secreting cells, therefore enhancing the protective lining of the GIT.Please note for all licorice addicts, this does not mean increasing your consumption of licorice sweets, the herb is rarely seen in a licorice stick!

Cabbage juice-raw cabbage juice can potentially heal an ulcer within 14 days. It is believed the high levels of glutamine fond in the juice is responsible for its healing effect. Recent research suggests that cabbage also contains a phyto-nutrient capable of destroying H.pylori. Best to take 400 -500ml twice times per day before meals. Make enough for each day and keep refrigerated

Slippery elm -coats, soothes and heals gastric mucosa. Mix one tablespoon slippery elm bark with a little purified water then slowly add more water until the mixture resembles a thick milk shake. Drink twice per day between meals

Don’t laugh, the old chamomile tea-roll-around-the-floor method has sound scientific rationale behind it. Chamomile is an anti-microbial herb, as well as a gentle nervous system relaxant. Prepare a very strong cup of Chamomile tea (i.e. use at least 2 heaped teaspoons of flowers per cup, preferably organic) and drink at room temperature. Gently roll from side to side to ensure the entire stomach lining is in contact with this magnificent herb.

Eliminate food allergies. Either keep a diet diary for a week recording every morsel which enters your mouth and associated symptoms, or have a blood test to determine the presence of IgA sensitivities to foods. (Your naturopath can provide a referral).Naturally eliminate common irritants (not necessarily allergies) such as milk, alcohol, coffee, spicy foods, chocolate, citrus. Consume small frequent meals.

L-Glutamine is an amino acid with a special affinity for intestinal mucosa. It is the primary source of fuel for cells that line the stomach and intestine, and heals inflamed and ulcerated tissues. Best to take 2000mg three times per day on an empty stomach.

Zinc-is healing to gastric mucosa, stabilizing many proteins and cell membranes Steroid medication decreases zinc absorption. Take zinc as amino acid chelate, with co-factors of vitamins A, B6 and C, 15 mg three times per day or else use liquid zinc sulfate 4ml in 400ml water twice per day after meals. Do not take zinc for longer than 6 weeks at this dose (interferes with copper bioavailability).Check zinc levels with zinc tally taste test regularly.(See your naturopath).  Do not take zinc at the same time as iron as deceases zinc absorption

Aloe Vera juice- we are all familiar with the healing ability of Aloe Vera gel on an open cut or burn. The juice extract has similar restorative effects on intestinal mucosa. Take 1/3 cup twice per day on an empty stomach. Be sure to use a good quality extract with both the whole leaf and ???????????

De- stress-herbs such as verbena, chamomile, lemon balm and skullcap have a wonderfully relaxing action on the nervous system and can help soothe frayed nerves. For periods of prolonged stress, the adaptogenic group of herbs has no rival! These herbs include Siberian ginseng, Panax ginseng, Withania, and Gota Kola.Theire protective and restorative characteristics increase our resistance to stress. Look also at other stress management techniques such as mediation, or similar relaxation practices and exercise.

 Essential fatty acids (EFA’s) profoundly effect the inflammatory process (blunts the inflammatory cascade response to endotoxins) and ameliorates intestinal mucosal injury. The outer membrane protecting every cell in our body requires EFA’a on a daily basis to form healthy, flexible, tight-junction cell walls. Supplement with 5ml of flaxseed oil twice daily on food or take a combined Evening Primrose oil (EPO) and Fish oil capsule, 1000mg three times per day with meals

Anti oxidant supplementation-with hefty amount of zinc, selenium and vitamin E for healing

Bioflavanoids- part of the vitamin C complex (namely, rutin, hesperidin, quercitin, genistein) have anti-inflammatiry, anti-histamine, anti-viral properties. Several of the flavanoids can inhibit H.pylori and can prevent ulcer formation. Take 1000mg twice per day with meals.

Eat plenty of green leafy vegetables, a good source of folate and vitamin K required for healing

Befriend bananas-these wonderful fruits contain a substance that stimulates the proliferation of mucosal cells that form a protective barrier of the stomach and intestines

Avoid cow’s milk-it may neutralize stomach acid, but ultimately it worsens the condition, with the calcium and protein stimulating the production of more acid.

Probiotics. If taking a course of antibiotic treatment for H.pylori, be sure to supplement with probiotics.This will replenish the intestinal flora with beneficial bacteria, wiped out by the drug therapy. The beneficial bacteria in your probotic supplement needs to arrive safely in the large and small intestine. This is not an easy task. It is a minefield down there, and the probiotic must survive the onslaught of gastrointestinal secretions, such as hydrochloric acid, bile salts and pancreatic enzymes. The best way is to take your supplement on an empty stomach, and preferably in a capsule with an enteric coating to protect it against the rather dangerous stomach and intestinal secretions. Regular supplementation, (in other words not the stop and start “I forgot to take my supplement” approach), potentiates the growth and adhesion of friendly bacteria. To overcome a deficiency of beneficial bacteria you must also ensure your supplement has at least 25 billion organisms. (The majority of probiotic supplements range from 12 billion organisms to 25 billion organisms.) This will enable numbers to replenish rapidly.

Additional herbal medicine

 Marshmallow (Althea officinalis)-the leaves, roots and flowers of this beautiful herb contain polysaccharides which form a soothing gel that is superb in reducing stomach acidity, relieving heartburn and  forms a protective coating helping to heal areas of inflammation along the digestive tract. (Please note aerated sugary pink and white puffs of confectionary known as marshmallows are NOT therapeutic!)

 Goldenseal-Hydrastis Canadensis*-traditional use of this now endangered herb, has been for mucous membrane inflammation, peptic ulcer, dyspepsia and colitis, as well as a plethora of skin conditions..which probably goes a long way to explaining it now threatened existence. (As herbalists we try to only ever include this herb in our remedies where there is absolutely no equally effective substitute). Golden seal is anti-microbial, anti-inflammatory, anti-hemorrhagic and restorative to membrane fragility, -making it a superlative ulcer remedy. Unfortuately it is a particularly bitter and astringent herb (as is Calendula while on the topic of taste), so I generally advise all my clients taking herbal medicine containg this herb, to dilute the 5ml dose with about 10ml water or fruit juice (diluting with cabbage juice would perhaps be pushing my naturopathic luck and indeed client compliance). Swallow quickly in one go as this  reduces contact time with taste buds. For very sensitive individuals, I suggest sucking on some ice beforehand to deaden the taste buds and the olfactory nerve or chill the entire bottle of herbs by storing in the fridge.

*Do not use Goldenseal in pregnancy or lactation

Echinacea-our most valuable immune stimulating herb.Echinaeca is used to treat bacterial, viral and fungal infections of the skin and mucous membranes, and externally even treats septic sores and abrasions. (A taste test can assess the quality of your Echinacea supplement. Look out for a tongue-tingling sensation for the main active constituents-alkymides- cause this characteristic sensation.

Meadowsweet-this is my favourite digestive remedy. Meadowsweet is soothing and protective to the mucous membranes of the digestive tract, reducing stomach acidity and easing nausea; it contains compounds that help heal and prevent ulcers. Meadowsweet also contains salicylic acid, which reduces pain and inflammation, which is often part of the overall symptom picture where there is any degree of peptic ulceration

Calendula*- contains anti-inflammatory and astringent properties. We all know how healing calendula ointment can be for local burns and slow healing wounds; used internally this herb is equally as efficacious in healing ulcerated mucous membranes. Calendula is also classified by herbalists as a cholagogue, that it encourages the discharge of bile into the duodenum, thereby helping to alleviate indigestion and vague gastrointestinal complaints.
* Precautions-do not take if you have a sensitivity to the Compositae family, that is, ragweed, chrysanthemums and daisies)

An example of a typical anti-ulcer herbal tonic I would put together in the clinic looks like this;

Marshmallow root  25}
Echinacea             30}
Calendula             15}         5 ml three times per day with meals
Meadowsweet        30}

Hydrastis could be substituted for Calendula in especially acute or complex cases.

Anti-Ulcer Juice
 1/2 bunch silver beet
2 carrots
½ head cabbage
handful broccoli sprouts*
¼ cup Aloe Vera juice
1 teaspoon Slippery Elm powder (optional)

Cut the cabbage into wedges and feed through juicer, followed by the silver beet (wrap in a large leaf for easy juicing) and then the carrots.
Mix 400ml freshly squeezed juice with  30 ml good quality aloe vera juice and sip slowly twice per day before meals. For added healing, mix one teaspoon slippery elm powder to a past with a little purified water and stir into the juice.

* Broccoli sprouts have recently been found to contain the same stomach-protecting compound as cabbage, sulforaphane, which may reduce the H.pylori bacteria as well as protecting against stomach cancer.