Hole in one - treating ulcers - Abstract

Men's Fitness, Dec, 1998 by R. Daniel Foster

FORGET THE DAIRY-AND-DENIAL DIET: ULCERS CAN BE CURED

Ulcers were once considered as much a part of the office environment as telephones made by AT&T, copy machines made by Xerox, and secretaries made by middle managers. You simply weren't a player if you didn't have Milk of Magnesia in your hip flask. That burning, aching, clenching sensation - announcing the presence of an injury in the lining of your stomach, esophagus or duodenum - was an overachiever's badge of courage. Meanwhile, doctors blithely prescribed a little R&R and a lot of Malt-O-Meal.

Hold that mush. A definitive cause of ulcers was discovered by Australian scientists way back in 1982, with the medical community formally sanctioning the findings in 1994. Still, about two-thirds of Americans and a surprising number of doctors don't know that a type of bacteria known as Helicobacter pylori causes about 90 per- of ulcers. "It attaches itself to cells and causes irritation and swelling," explains Ali Karakurum, MD, a gastroenterologist at the Nassau County Medical Center in East Meadow, New York.

The bug spreads when infected fecal matter comes in contact with hands, food or water. While about half the population will become infected during their lifetimes, says Karakurum, for unknown reasons only 10 to 20 percent will develop an ulcer because of H. pylori.

Pat Callaghan was one of the unlucky minority. After being diagnosed in his early 20s, the Chicagoan endured two decades of biopsies. X-rays and "dull, boring food - so dull I don't remember the names for most of it." Finally, he found a doctor who put him on a 10-day antibiotic regimen. Sure enough, the problem - and the pain vanished, and Callaghan took himself out to dinner. A real one.

"Now I eat whatever I want," he says. "I spent almost half my life dealing with this I'm very grateful." He's also lucky: Some untreated ulcers can result in digestive-tract bleeding, a tear in intestinal or stomach walls, and a higher risk for cancer.

Remarkably, there are doctors who still don't test for the bacterium when patients complain of stomach pain. "The discovery of H. pylori has revolutionized the way we treat ulcer disease," says Jay Goldstein, MD, an associate professor of medicine at the University of Illinois at Chicago. "So it's unfortunate that some physicians have not rapidly accepted this."

There are three ways to detect H. pylori: In descending order of invasiveness, they are endoscopy, blood tests and a simple breath test. Those who test positive are usually treated with a combination of two or three antibiotics for up to two weeks. "The reinfection rate after treatment is less than I percent a year," says Karakurum. "A doctor will also prescribe some acid blockers during treatment, to keep you comfortable and reduce swelling."

Here's what else you can do to reduce discomfort and stave off ulcers. even if you've already been exposed to H. pylori:

* PUT AWAY THE PAIN PILLS. The second-largest cause of ulcers is the overuse of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, Naproxen and high-dose aspirin. "Abusing NSAIDs can inhibit an essential enzyme that produces a chemical which defends the stomach," says Goldstein. A new "ulcer-quotient risk screener" can determine whether you need to cap the caplets.

* KNOW PEPCID FROM PRILOSEC AND TUMS FROM TAGAMET. There are more over-the-counter antacids available than ever before, and they're not always interchangeable. Ask your doctor which one will work best for you.

* GO NATURAL. Studies show that deglycerrhizinated licorice is more effective than many standard anti-ulcer drugs. Aloe vera juice and vitamin E aid pain relief and healing; marshmallow root and slippery-elm tea soothe irritated mucous membranes; and pectin helps relieve duodenal ulcers by creating a protective coating in the intestines. St. John's Wort, boswellia and bromelain can sometimes be substituted for NSAIDs.

* NIX THE MARLBOROS AND MARTINIS. The toxic effects of nicotine can slow healing and may increase the risk of bleeding. Excess alcohol can aggravate ulcers by breaking down the stomach lining and stimulating acid production.

* DEEP-SIX THE DAIRY AND DENIAL. People with ulcers need a balanced diet that focuses on whole, unprocessed foods. Problems usually stem from certain foods that can trigger distress; the most common examples are caffeinated beverages, coffee (regular and decaf), chocolate, peppermint, tomatoes, vinegar, black pepper and chili powder. Fatty foods can stimulate acid release; so can milk products, even as they temporarily soothe pain.

* EAT DEFENSIVELY. Certain foods may facilitate healing. Cabbage contains glutamine, which increases blood flow to the stomach (see page 119); raw, unpasteurized honey appears to have an antibacterial effect; and bananas and plantains help produce protective mucus. Some nutritionists believe that the "friendly bacteria" in active-culture yogurt can displace H. pylori in the stomach, while new research suggests that two small cloves of raw garlic eaten daily will control the bacterium.