Today’s topic is on stomach ulcers and a stomach ulcer is an open sore or wound in the upper

intestines. In discussing stomach ulcers, we’re also discussing ulcers in the duodenum.
ACtually, the duodenum which is the beginning of the small intestine, located above the belly
button and just below the rib cage - the duodenum is the more common site where an ulcer
develops. Duodenal ulcers occur approximately four times more often than an actual stomach
ulcer. But, in regular conversation, most people use the word stomach ulcer to discuss it.

A stomach happens when there has been erosion of the intestinal wall, perhaps due to acidity,
infection, or other processes. We’ll discuss that. Some good news about ulcerS: the mortality
rate from ulcers has dropped dramatically in the twentieth century due to the discovery and
identification of H Pylori. H pylori is a an abbreviation helicobacter (?) pylori, which is a
microorganism that can infect the upper GI tract and it’s been found that 90% of people with
ulcers have H Pylori infections. And that many of those ulcers resolve after a round of
antibiotics. Previously, before the discovery of H Pylori, nobody suspected that a microorganism
could have any relationship to the development of ulcers. Peptic ulcers - ulcers in the stomach -
were actually quite rare before the 1800s. This is interesting, because H pylori existed long
before the 1800s. But peptic ulcers were really rare. In other words, ulcers are a modern
disease. Duodenal ulcers were rare before the 1900s. So, duodenal ulcers were kind of unheard
100 years, but today, duodenal ulcers are 4x more common than ulcers of the stomach. So, this
is some surprising news because it tells us that our modern diet and lifestyle is implicated in the
development of ulcers.

4 million Americans have ulcers. And 350,000 people are diagnosed each year with an ulcer
according to the NIH. There are 6,000 deaths annually and the incidents of ulcers is increasing
in children. Which is also a surprise, because children tend to have very strong digestion and
digestive tracts after the age of three years old. Ulcers occur 11-14% in males and 8-11% in
females; this means that ulcers occur more often in males. There’s a genetic component; if you
have a first degree relative with an ulcer, you’re 2-3x as likely to get the disease. In the
everyday folk medical wisdom, people attribute stress as one of the causes of an ulcer and
perhaps alcohol as well. This has been unproven by western medicine - in other words, western
doctors have not been able to prove that stress and alcohol have an effect on ulcers. But that
does not deter us in Ayurveda from saying that stress and alcohol are causes. And the reason is
because of constitution.

It may be that, depending on the type of ulcer or the type of constitution you have, has more of a
relationship to the development of an ulcer due to stress and alcohol than the stress or alcohol
itself.

[4:57]Some other surprising facts is that ulcers tend not to occur in the summer. Ulcer rates are
lower in the summer. In the spring and fall, ulcer rate increase. This implicates Vata dosha -
during the seasons of change, ulcers are more likely to develop. Some of the most basic
symptoms of an ulcer include pain - that could be a burning or gnawing feeling in the stomach
area. The pain is generally mild when there is only one ulcer, or that the ulcer has not
developed any complications in relation. The pain can be above the belly button ,as high as the
sternum, or it can radiate to the lumbar region or the back. And sometimes, ulcers are confused
with heartburn or heart attack, because the symptoms occur in the same general region. The
pain of an ulcer will last between 30 minutes to three hours. If the ulcer is in the duodenum, than
the person is more likely to feel the pain at night. And 50-80% of people with a duodenal ulcer
complain that the ulcers wake them up at night, whereas with a stomach ulcer, a gastric ulcer,
only 30-40% report waking up at night due to pain from the ulcer. The pain may get worse when
the stomach is empty, when it is a gastric ulcer. A gastric ulcer can often be relieved by drinking
milk or taking an antacid.

Another interesting fact is that children and the elderly experience symptoms of the ulcer,
usually only when it’s a complicated case. When there are other complications and the ulcer has
advanced considerably.

Some other symptoms of an ulcer include bloating, belching, nausea, and vomiting. And a
hungry, sort of empty feeling in the stomach that we would refer to in Chinese medicine as a
Clamouring Stomach. In a gastric ulcer, pain increase upon eating. But in a duodenal ulcer, pain
is temporarily relieved by eating food. And that’s because the valve between the stomach and
the duodenum closes after a meal. That vale is called the pyloric valve and it closes after a meal
to concentrate the contents. And then, after the stomach has had a chance to digest the food, it
starts to release acidic food into the duodenum about 2-3 hours after the meal and that’s when a
duodenal ulcer feels painful. That is when the patient will report beginning to feel pain.

The pain in a gastric or stomach ulcer is going to be more to the left, whereas the pain in a
duodenal ulcer is going to be more central, to the midline of the body.

Abdominal examination usually discloses generalized tenderness. The patient may be guarding
the area of pain and have some rigidity, some tension in the muscles. So, you should call a
health professional or medical doctor any time you suspect that an ulcer may be present -
especially if there is blood, anemia, weight loss, any loss of appetite, or if you are over 45 years
old. And, part of the reason for that is often times a cancer of the stomach can cause an ulcer.
SO, it’s important that you get a diagnosis early.

The Ayurvedic name for an ulcer is paranomashula. I don’t expect anyone to be able to spell
that. We should discuss a little bit about the anatomy of the region. Basically, how the stomach
and the duodenum are supposed to function in the following way: that when we swallow food,
the stomach secretes acids and those acids should digest the food, but not the intestines. ANd
so, the intestines have to defend themselves against the acids and the enzymes - the acid and
pepsin - so that the digestive organs do not autodigest themselves.

[10:20] The way that the stomach protects itself from acid is through mucus. The stomach
secretes mucus in response to irritation; the duodenum releases mucus in response to
hormones and irritation. And this forms a gel-layer over the intestinal wall that is impermeable to
the acid and the pepsin. There are ion pumps that remove excess hydrogen ions. And in
general, the blood flow in the area will carry away any free hydrogen-radicals and that all helps
to reduce the damage due to acid. But, if there is damage, then healthy cells - healthy nearby
cells - will actually migrate to the area and try to repair it. Normally, in the intestines, there is a
balance between acid production and the defense system. But an ulcer results when that
defense system and the acid production are out of balance.

The main methods of diagnosis are first and foremost by symptoms. If you describe your
symptoms to a medical doctor, and those symptoms are similar to an ulcer, than the doctor may
simply just assume you have an ulcer and offer you a round of antibiotics. This might help clear
up an infectious process that is happening in the gut. Doctors also use barium contrast x-rays,
endoscopies, other tools and tricks to diagnose H Pylori. If the ulcer fails to resolve, their may
be a biopsy to rule out cancer. There may be a test for blood in the stool, a fecal blood test.
These are some of the techniques that Western medicine uses to positively diagnose an ulcer.

Some of the causes of ulcers include H Pylori, which I mentioned earlier - the bacteria that
infects the upper GI - and the use of NSAIDs (non-steroidal anti-inflammatory drugs) like aspirin
and steroids and these tend to inhibit the secretion of prostaglandins necessary for the secretion
of mucus in the stomach. So, if a person has ulcers but there are no other digestive symptoms,
then we should suspect NSAIDs. Another cause of stomach ulcers can be a lack of coordination
between the pyloric valve and the duodenum. That lack of coordination can occur when a
person overeats, or when the muscles - if they are not damaged - fails to perform in a regular
way, then we can assume there is some toxic build up in the body. 4% of ulcers are caused by
malignant tumors.

The curious thing is that - in Western Medical terms - hyperacidity generally does not cause
ulcers, but can delay healing. And, from an Ayurvedic point of view, our experience with the
matter is that depends on constitution. That hyperacidity could cause ulcers in certain
constitutions, but not every constitution.

[15:08] When the ulcer is located within 3cm of the valve between the stomach and the
duodenum, generally we assume that hyperacidity may be a factor. Salt can increase ulcers.
Smoking, from an Ayurvedic and Western medical point of view, accelerates gastric emptying
and reduces the secretion of acid buffers by the duodenum. So smoking, basically causes the
stomach to dump a lot of food into the duodenum, and that food is acidic. And then the
duodenum gets overwhelmed by these raw acids and the raw acids eat away at the intestinal
tissue.

Smoking also reduces the secretion of the acid buffer by the duodenum so that the large
quantity of acidic food is not neutralized as fast.

Western medicine has shown that alcohol increase risk of ulcers when H Pylori is present. That
they have not determined a relationship between alcohol and ulcers, when H Pylori is not
present. But generally in Ayurveda we’re going to say that anything that irritates the intestinal
tract is going to either delay healing of an ulcer or weaken the digestive tract to the point where
an H Pylori infection can actually cause an ulcer.

Western medical tests have been inconclusive about the effect of caffeine on ulcers, but coffee
in particular irritates the lining of the gastrointestinal tract and should be avoided. Physical
trauma to the body - physical stress - has been shown to increase ulcers. But western medicine
has not been able to prove that psychological stress can create ulcers. In Ayurveda, we would
say that stress aggravates the ulcer in Vata and Pitta individuals only.

The prognosis: most ulcers resolve on their own, especially since the identification of H Pylori
and the use of antibiotics, that most ulcers resolve on their own but there are complications in
1-2% of cases, and in those cases, there can be gradual erosion of stomach function as cells
sort of die close to the surface of the stomach. If the ulcer eats through the stomach wall deep
enough to reach a blood vessel, there can be hemorrhaging and bleeding. A person can vomit
blood. If there’s a lot of blood loss, there can be anemia, fatigue, and weight loss. The ulcer can
penetrate through the stomach and actually the acids could scar the liver, or pancreas, or other
nearby organs. This is rare though. Scarring and swelling from a long-term, chronic ulcer can
cause narrowing of the digestive tract and obstruction.

The pain from an ulcer can often be misinterpreted as hunger, indigestion, or heartburn. So,
we’ve already talked a little bit about the doshas that are involved in ulcers - I just mentioned it
briefly - Vata and Pitta are the two doshas that are most often behind an ulcer from an
Ayurvedic point of view. Kapha dosha rarely gets an ulcer.

[19:31]Vata-ulcers occur because the mucus membranes of the upper GI are too thin in a Vata
constitution. Vata people tend to have a lot of dryness, and so the mucus membranes - the gel
mucus layer - is not adequate enough to protect the lining of the GI tract. Stress, worry, and
anxiety stimulates the production of bile and acids while at the same time thins the mucus lining
of the digestive tract. Vata-people love to skip meals, but the stomach gets hungry on time and
around lunch time, the stomach will ask for food by secreting lots of acids. And then we get that
empty feeling in the stomach, and our body lets us know to eat food. and vata people often
ignore. Well, during that period when the stomach is empty but producing acid, the stomach is
very vulnerable to the development of an ulcer.

People with a pitta-constitution can develop ulcers when shame or anger overstimulate the solar
plexus area. IT gives people that burning feeling. Psychologically, it gives people that burning
up feeling - that sort of tight feeling, clenched fists kind of feeling, and that intense emotion can
activate digestive juices from the stomach, liver, and pancreas. And in Chinese Medicine, this
condition is called “Liver invading the Spleen.” In pitta-type ulcers, bleeding is more likely.

So, Vata-type ulcers occur when the mucus membranes are too thin and dry, and pitta-type
ulcers occur when the digestive enzymes - when we’re producing too many digestive enzymes,
too much acid, and that whole region is heating up. So vata-people benefit from a routine, from
foods that rebuild the mucus layer - basically sweet foods, gooey foods like tapioca, even milk -
we’ll discuss more about diet. Pitta-constitutions benefit more when that heat is cooled down by
either sweets, not refined sugar which is hot, but naturally sweet foods tend to be a little bit cool
in nature. Astringent foods, like a raw apple. And bitter tasting foods, like kale. And sweet,
astringent foods, and bitter foods tend to reduce acid secretions and cool the liver.

Herbs that stop bleeding can be helpful for people with a pitta-ulcer, including raspberry leaf.

SO, if you have an ulcer, you want to avoid eating or doing anything that is going to destroy the
mucus layer of your stomach. And there are several things - several types of foods - that erode
the mucus layer. Those foods include aromatic spices like cardamom and mint. And pungent,
hot spices like cayenne and black pepper. You want to avoid anything that irritates the lining of
the digestive tract, including alcohol, caffeine, and chocolate. Chili peppers. Anything that
increase acid secretions you want to avoid - spicy and sour foods increase acids. Black pepper,
cinnamon.

Avoid anything that accelerates the emptying of the stomach, so that the stomach doesn’t push
anything out too quickly into the GI tract. So overeating will push too much food into the
duodenum and aromatic spices like cardamom and mint will too. Spices that have a strong
smell accelerate the rate at which the stomach empties food. you want to avoid fasting or an
irregular eating schedule, because fasting increases acids and dries out the blood, which dries
out mucus. You want to avoid stress and anxiety, which decrease mucus and increases acids.
You want to avoid smoking, which we mentioned already.

[25:06] Foods that you want to favor: first thing, is we want to favor foods that will rebuild the
mucus layer. The first and the most important way to rebuild the mucus layer is to stay properly
hydrated. And hydration, sure, it means drinking enough water. But more importantly, it means
having balanced electrolytes, meaning sodium, potassium, magnesium, etc. One way that a
vata-person can help increase the salt in the blood - the sodium in their blood, vata people tend
to have low sodium levels - is they can drink salt water and that will help them retain water.
Kapha people do not need to retain water - you hear lots of bad reports about salt on TV,
because it increases blood pressure - that’s for people who are overweight. But for vata people,
who are underweight, they can often have a deficiency in sodium and salt helps them retain
more water. And that water retention is key to help them build a good, strong mucus layer in the
digestive tract. Sweet foods help to rebuild mucus. Sweet foods tends to have a little bit of
gooeyness in them. Rice pudding is an example. The sugar that is used should not be refined
sugar, I mentioned that already - it should be raw sugar or natural sugars. Applesauce is a bit
sweet, or gooey foods like oatmeal, milk, okra. Even fresh yogurt. Those all help. Cheese - one
way to think about cheese (and I know that this is gross, so I am going to apologize in advance)
but one way to think about cheese, is as if cheese is dried up mucus. Basically if you boiled
mucus for a really long time, it would turn into cheese. Cheese has this gooey property to it that
can help coat the digestive tract. Slightly oily foods - the best example is ghee. Ghee, when it’s
present in the duodenum, reduces acid secretions. You’ll also want to eat foods that reduce
inflammation. Foods that reduce acid production, and foods that are cool. Pomegranate juice,
coconut actually reduces the secretion of acid - coconut water, coconut flakes.

There are a number of herbs that are useful in the treatment of stomach ulcers. Some of those
herbs include amalaki, licorice root, bhringraj, shatavari, psyllium husk, rose petals, fennel, and
manjistha.

So this has been a brief introduction to some foods to avoid and some foods to favor in relation
to Ayurvedic perspectives on stomach ulcers, and also how and why stomach ulcers develop.
There’s no real conclusion on what causes a stomach ulcer - nobody really knows why the
stomach ulcers forms or Western medicine doesn’t know or has not been able to prove it. H
Pylori is implicated in many stomach ulcer cases, but only 20% of people who have H Pylori
have ever shown any symptoms. So H Pylori is widespread throughout the population - most
people who have H Pylori and most people don’t have stomach ulcers. Most people with
stomach ulcers tend to all have H Pylori or at least some form of it. So, the jury is still out on
what exactly causes an ulcer. But, this is the Ayurvedic perspective on how to speed up
resolution of an ulcer in your gut.