Ulcers-What Really Causes Them?
Do you suffer from: acid reflux (Gastro-esophageal reflux or GERD), “over-acid” stomach, ulcer or gastritis? If so, see how many signs and symptoms that may relate to LOW stomach acid you have.
Do your fingernails chip or break easily?
Do you have distaste for meat (not a vegetarian for moral reasons)?
Are you sleepy after eating?
Do you have bad breath?
Do you experience epigastric burning or gastric reflux?
Do you have a decreased ability to taste or smell?
Have you had an anemia that was unresponsive to iron?
Does taking vitamins upset your stomach?
Do you have a sense of excessive fullness after meals? (Does food just sit there)
Do you not feel like eating breakfast in the morning?
Do you burp, belch, have gas or pain within 30 minutes of eating?
Do you have small white spots on your finger nails?
Do you consume coffee, alcohol, soft drinks, junk food or refined carbohydrates on
more than an occasional basis?
Have you had excess stress and feel anxious? (Butterflies in stomach)
Do you take any of the following medications: Birth Control pills, aspirin, ibuprofen,
acetaminophen, antacids, anti-histamines, anti-depressants or prednisone?
Do you have a low protein diet by choice?
Do you have low estrogen levels (peri-menopausal or menopausal) or have low thyroid?
Have you ever had an ulcer?
Has a family member ever had an ulcer?
Is your hair thinning?
Do you or have you suffered from any of the following: gall bladder or liver disease,
diabetes, asthma, eczema, rosacea, psoriasis, osteoporosis, hypothyroid?
The more symptoms you have, if you are taking any stomach medications, feel fuller sooner, stay fuller longer than you used to or if you burp within 30-60 minutes of eating, you certainly have stomach issues. If they aren’t improving with what your doctor has prescribed, then obviously it isn’t working. Why not? There is a real possibility that you are doing exactly the wrong thing!
Let’s begin with an “over-acid” stomach that is supposed to be the cause of ulcers and GERD. The stomach is the main location of protein digestion, which must occur in an acidic environment. One of the truly amazing feats of the body, one that is little appreciated, is that, to go from the average body pH of about 7.2 to the harsh acidic environment of the stomach, pH 1-2.5, requires that the body concentrate hydrogen ions (acid) over 3,000,000 times that of the blood! To create a liter of stomach acid requires 1,500 calories!
Chronic stomach ailments become more frequent the older we get. Now ask yourself- given that it takes a huge effort by the body, one that requires many calories and the presence of many essential nutrients to create stomach acid (HCL) and given that as we age virtually all metabolic processes slow down, does it really make sense that most stomach complaints are due to too much acid? No, it makes sense that they are due to too little acid (hypochlorhydria).
Ulcers become more frequent as we age. They are not nearly as common when we are young. Yet it is when we are young that we produce the most stomach acid. At least 50% of people over 60 years old produce too little. So there is an obvious disconnect between levels of HCL and frequency of ulcers. In fact, it is an inverse relationship. So what really causes ulcers?
One often overlooked cause of ulcers, one that is often the root cause of other problems such as hypochlorhydria (low stomach acid) and GERD, is an infection with the bacteria Helicobacter pylori. The discovery of this organism and that it is the major causative agent of stomach ulcers, serves as a typical example of how the medical profession works.
In the late 1800’s researchers from Italy and Germany separately found bacteria in the stomachs of dogs. Later, Robin Warren, an Australian pathologist, noted small curved bacteria colonizing the lower part of the stomach in about 50% of patients from which biopsies had been taken. He made the crucial observation that signs of inflammation were always present in the gastric mucosa close to where the bacteria were seen. Barry Marshall, MD became interested in Warren’s findings and together they initiated a study of biopsies from 100 patients. They were able to cultivate a previously unknown bacterial species. They found the bacteria present in almost all patients with gastric inflammation, duodenal ulcer or gastric ulcer. They proposed that Helicobacter pylori was involved in the cause of these diseases.
Of course, at the time, all MD’s knew that the cause of ulcers was stress and the resultant excess of stomach acid. They treated accordingly. Even though reducing or eliminating gastric acid production does help heal ulcers, they have a nasty habit of recurring, since H. Pylori bacteria and stomach inflammation remain. Of course, Marshall was virtually ostracized for his heretical beliefs. Instead of giving up he did the unthinkable- he drank a vial of H. Pylori! (A bad way of committing suicide). In a few days he developed nausea and vomiting. An endoscopic biopsy showed gastritis! He treated himself with antibiotics and the infection promptly resolved. Marshall, Warren and others subsequently showed that patients could be cured from their peptic ulcer disease only when the bacteria were eradicated from the stomach. It is now known that H. pylori causes more than 90% of duodenal ulcers and up to 80% of gastric ulcers. It is found in the stomach in about 50% of all humans. It has been traced back at least 58,000 years to the birthplace of humans in Africa. In countries with high socio-economic standards infection is less common than in developing countries where almost everyone is infected.
H. pylori is a highly infectious disease. It can be contracted in early childhood, by transmission from mother to child. It may remain in the stomach for the rest of the person’s life unless treated. Kissing may transmit the disease. If a family member has an ulcer, there is a higher incidence of H. pylori among family members. The severity of inflammation and its exact location is important for the resultant disease. In most individuals infection is asymptomatic, but 10-15% of infected individuals will experience peptic ulcer disease. Such ulcers are more common in the duodenum than in the stomach itself.
If H. pylori infects the corpus region of the stomach, it causes widespread inflammation that predisposes one to stomach cancer, which still ranks as number two in the world in terms of cancer deaths! Another form of cancer, MALT Lymphoma is present at higher rates in infected people. Eradicating H. pylori causes regression of the tumor. Current research indicates that other inflammatory diseases of the GI system may be linked to H. pylori and other bacteria found in the GI tract.
So after being virtually laughed out of the profession for his ridiculous ideas, Marshall was awarded the Nobel Prize for Medicine in 2005. The moral of the story is- don’t always believe everything your doctor tells you or does.
Unfortunately, 25 years after Marshall’s discovery, very few physicians seem to be testing for H. pylori. They continue giving Prevacid and other acid blockers out like candy. You can even get it over the counter! Tummy meds are still the biggest seller around. You can’t go a night without hearing a TV ad for one, which extols their virtues, but fails to tell of the dire consequences of prolonged use. Long-term use carries with it a risk of osteoporosis. Failure to eradicate the underlying cause can increase rates of MALT Lymphoma. Loss of stomach acid has major consequences for the entire GI tract, some of which were discussed in two other articles, Disorders of the Stomach and Understanding the Digestive Tract.
If you are on the acid blocker Merry-Go-Round perhaps it is time to get off. How can you tell if you have H. pylori? If you score high on the above test, have had gastritis, GERD or an ulcer or have a family member who has; it would be a good idea to be tested. There are a number of methods of testing. You can have an endoscopic biopsy, but if the area biopsied isn’t infected, it could be missed. You can have a breath test done (H. pylori produces urea which can be exhaled and measured), but if the infection isn’t currently active it can also be missed. A stool sample also has its drawbacks. An immunoassay for Immunoglobulin (Ig) A, G and M will detect past and present infection and may be the best method, but is expensive. Simple, inexpensive tests that check for IgG antibodies to H. pylori are available.