Peptic ulcer or acid reflux?
By Nonie DeLong, ROHP, CNP
Dear Readers,
This week’s column comes from a question I received from a neighbour from my time in Toronto. She writes:
Dear Nutritionist,
I want to know if you have solutions for acid reflux that could help me keep my need for medications down? I don’t want to be taking things when it doesn’t really get at the cause and I know nutritionists work with digestion. My problem is the reflux gets bad when I don’t eat and when I lay down at night. If I fast too long I’m feeling nauseous. I never feel comfortable anymore. I can’t take the low dose aspirin I need now because of the pain and that has me worried. Is there anything natural I can do to get this reflux more under control?
Thank you!
Susan
This is not an uncommon health condition in our culture. By middle age a lot of people deal with digestive distress of some kind, so many readers may be able to relate to Susan’s dilemma.
However, to answer this question I think we first need to be certain we know what we’re dealing with. Let’s explore this more.
Get a diagnosis
My first concern is whether this is actually an issue of acid reflux or an ulcer. I suspect we may be dealing with a peptic ulcer, not reflux. But I don’t offer diagnostic services (out of my scope) and it’s essential to be certain what the issue is, so it’s best for Susan to see her physician to get a clear diagnosis before we decide on a digestive protocol. Usually doctors will run a series of tests to determine the cause of the pain, including blood tests for H-pylori (a bacteria that causes peptic ulcers), stool tests (looking for blood, another sign of an ulcer), an endoscopy of the upper GI tract, and x rays of the upper GI to determine if there are visible changes that can confirm a diagnosis.
Just to be clear, nutritionists help people use food as medicine. We don’t diagnose disease. So Susan needs to get a clear diagnosis to direct her protocol. I will provide some advice for an ulcer.
Ulcers
“In the United States, peptic ulcer disease affects approximately 4.6 million people annually, with an estimated 10 per cent of the US population having evidence of a duodenal ulcer at some time. [20] H pylori infection accounts for 90 per cent of duodenal ulcers and 70 to 90 per cent of gastric ulcers. [21] The proportion of people with H pylori infection and peptic ulcer disease steadily increases with age.” BS Anand, MD; Medscape
Just to clarify, a peptic ulcer is in the stomach. A duodenal ulcer is in the upper intestine. As you can see, the correlation of both to H. pylori infection is very high.
It’s common for those with peptic ulcers to feel pain and nausea when they don’t eat, not because of excessive stomach acid, but because the natural, protective acid of the stomach irritates the sores in the stomach lining when it is not diluted with food. This can also cause the feeling of nausea that Susan reports.
Stomach ulcers can be precipitated by regular use of NSAIDS and aspirin, both of which damage the stomach lining over time. Once the stomach lining is damaged, the ability to create enough acid is often reduced and opportunistic hosts like H. pylori are able to take hold. You see, a healthy stomach is extremely acidic in order to kill invading bacteria.
Once H. pylori takes hold, it’s thought that irritation and sores develop and further exacerbate the ability of the stomach to create an acid enough environment to protect itself further. All kinds of imbalances can ensue, including an inability to absorb proteins, B12, zinc, and iron, as stomach acid is required for these. Being deficient in zinc and protein, in turn, slows tissue and wound healing. It’s a tricky situation.
The current standard of care for H. pylori is antibiotic treatment. There are a few problems with this approach. For one, it’s often ineffective in eradicating H. pylori. It’s thought that this is because of growing antibiotic resistance, degradation of antibiotics by the stomach acid, and/or treatment compliance issues. However, it may also be because spirochete bacteria that corkscrew into tissues are notoriously difficult to eradicate with antibiotics alone. Think Lyme and Syphilis. This is the same type of bacteria as H. pylori. They are notorious for hiding and resurfacing later when the antibiotics have been discontinued.
Additionally, oral antibiotics are indiscriminate and kill all bacteria in the body, not just the one you’d like to target. In a sense, antibiotics are like nuking your gut biome. We now understand the important role of healthy bacteria in the digestive tract. They are integral for many things in the body like strong immunity, good mental health, memory, learning, healthy weight, healthy blood sugar, and healthy hormones. These conditions are detrimentally impacted with repeated exposure to antibiotics, so if a more natural alternative exists it’s preferable.
It’s also worth noting that ample healthy bacteria in the digestive tract is thought to be protective against H. pylori. These bacteria protect the integrity of the mucosal barrier. So, a healthy, diverse gut biome is essential to ensuring an H. pylori infection does not come back. We can assume then, that when H. pylori is a factor, an imbalanced gut biome is counterproductive to healing. That would suggest antibiotics are not an optimal treatment.
But there are natural solutions!
Natural ulcer protocol
To help strengthen the body to overcome an H. pylori infection naturally we want to do a few things simultaneously. We want to add unpasteurized fermented foods to feed healthy bacteria in the gut. Remember that this is protective against H. pylori. These foods could include kombucha, kimchi, natto, miso, kefir, yogurt, sauerkraut, and fermented vegetables. Consuming at least one serving of these a day is optimal.
We also want to consume foods high in sulforaphane. Haven’t heard of it? Sulforaphane is a phytochemical (plant antioxidant) that research suggests works as an antioxidant and reduces inflammation while protecting DNA and potentially helping to protect against cancers. You can get it from cruciferous veggies like broccoli sprouts, Brussels sprouts, broccoli, cabbage, kale, turnips, watercress, cauliflower, and bok choy. It also comes as a supplement you can take to boost your dose.
Next, we want to chew mastic gum. Mastic is a resin/sap from the stem and leaves of the mastic shrub (Pistacia lentiscus), found in the Mediterranean. It’s used in both food and medicine. As reported in the New England Journal of Medicine:
“Even low doses of mastic gum — 1 mg per day for two weeks — can cure peptic ulcers very rapidly, but the mechanism responsible has not been clear. We have found that mastic is active against Helicobacter pylori, which could explain its therapeutic effect in patients with peptic ulcers.”
Next, we want to incorporate coconut oil into the diet. This should be organic and can include fresh juice and flesh or just the oil. Coconut oil has been used for wound healing and shown protective benefits against ulcers.
The next thing we use is a compound taken from the licorice herb, called DGL. We can purchase it in lozenge form from supplement dispensaries. DGL has shown protection against ulceration in animal and clinical studies and can be particularly soothing if there is pain. Licorice is known to be both antibacterial and anti-inflammatory so this is no surprise.
Lastly, it’s important to remove the NSAIDS and aspirin with our doctor’s supervision to ensure we are not continuing to wound the stomach tissues. We also want to consume small, well-chewed meals regularly to keep the acid in the stomach from irritating the ulcers until they heal and to take the DGL lozenges whenever there is pain.
Stomach ulcers can be very tricky to overcome with a conventional treatment model, but our resilience to them is increased through a more holistic approach. We also experience the relief of knowing we have not caused unwanted side effects we need to treat later.
Again, the first step is a diagnosis to be clear what we are dealing with.
As always, if you have your own nutrition and health related question, send it to me at nonienutritionista@gmail.com. Those seeking 1:1 help can find me at hopenotdope.ca.
Namaste!
Nonie Nutritionista
Nonie DeLong is a registered orthomolecular health practitioner, licensed nutritionist in both Canada and the U.S., and student of the Ontario College of Homeopathy.
Photo credit: ©Motortion via Canva.com
