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ULCERS

IT'S A DEEP, ACHING, GNAWING PAIN over your stomach that may ease a little bit right after you eat. Taking a few of the antacids you keep in your medicine cabinet helps a little, too, but the pain keeps coming back. It gets worse every time you become upset, drink a cup of coffee or have a cocktail. Could you have an ulcer?

Peptic or gastric ulcers are raw sores in the upper gastrointestinal tract - either in the stomach or in the duodenum, where the stomach connects with the small intestine. A certain amount of hydrochloric acid and the digestive enzyme pepsin are necessary for the stomach to do its work of digesting food and absorbing some nutrients. When the balance of these substances goes awry, you can get an ulcer.

A variety of factors can tip this balance the wrong way. Your body may produce excess stomach acids; smoking, alcohol, coffee and stress can aggravate such overproduction. Drugs such as aspirin, ibuprofen and other anti-inflammatories can cause ulcers. The bacterium Helicobacter pylori is found in up to 95 per cent of patients with recurrent ulcers, which is why doctors sometimes prescribe antibiotics for them. Heredity, food allergies, lack of fibre in the diet, and deficiencies of vitamins A and E may also contribute to the formation of an ulcer.

If you have blood in your stool or any long-term or recurrent upper abdominal pain, you may have an ulcer. Get a medical examination to rule out other causes.
Although drug treatment of ulcers is very effective, drugs that block the production of acid in the stomach can cause digestive problems, nutritional deficiencies and increased risk of gastrointestinal infections, including Candida, when used long-term.

Fortunately for people with ulcers, many safe, effective herbs exist that can help these wounds heal. First among them is liquorice, with a number of clinical studies confirming its usefulness in treating ulcers. In addition to liquorice, there are several anti-inflammatory, ulcer-healing, stomach-soothing herbs. All are pleasant tasting and safe for long-term use. Using them in combination can be especially helpful.

USING TINCTURES FOR ULCERS
People with ulcers are often advised to avoid alcohol. But alcohol-based tinctures are one of the easiest ways to take many of the herbs that help ulcers. If you're using tinctures rather than teas, put the recommended dose in a cup, add boiling water and allow the mixture to sit for 10 minutes. This helps evaporate some of the alcohol, which can worsen ulcers. You can also substitute glycerin extracts, known as glycerites; use the same dosages. (The best way to take ulcer herbs, however, is in a tea.)

ANTIBIOTIC ALTERNATIVES
If your ulcer is caused by the Helicobacter pylori bacterium and you prefer not to take antibiotics, preliminary scientific studies show good results using a combination treatment of liquorice, vitamin C and manuka honey. (This honey is made by a specific type of bee.You can find it in some health food stores.)

Take liquorice in the following dosage: 3 cups of tea per day (simmer 1 teaspoon of dried root in 1/4 litre of hot water for 10 minutes); or 1/8 to 1/2 teaspoon of tincture three times per day; or chew 1 or 2 tablets of deglycyrrhizinated (DGL) liquorice three times per day before meals. Add 3,000 to 10,000 milligrams of vitamin C plus 1 tablespoon of manuka honey three or four times per day. If you experience diarrhoea or burning in the stomach, reduce the dose.

Continue the treatment for two months. After that, you should be retested for the bacterium. If it is still present, go for the antibiotics.

DRUG TREATMENT

Antacids
Maalox, Rennie, Turns and others. Function: temporarily ease ulcer
pain by neutralising stomach acid. Side effects: may eventually cause production of more acid; may cause kidney stones, calcium and phosphorus depletion, headache, and coordination and concentration problems with excessive use.

Hydrochloric Acid Blockers
Cimetidine (Dyspamet, Tagamet), ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid). Function: block production of hydrochloric acid. Side effects: nausea, vomiting, headache, confusion, breast swelling, sexual dysfunction; used long-term, may cause digestive and nutritional problems, skin conditions, gastrointestinal symptoms.

Other Drugs
Omeprazole (Losec). Function: inhibits stomach acids. Side effects: interactions with other drugs; increased production of gastrin, a stomach hormone.

Misoprostol (Cytotec). Function: inhibits ulcer-causing compounds called prostaglandins. Side effects: gastrointestinal upset; may cause miscarriages in pregnant women.

Sucralfate (Antepsin). Function: forms a barrier at the base of the ulcer, inhibits pepsin and binds bile salts. Side effects: constipation, interference with absorption of other drugs, low phosphate, excess aluminium levels in the blood.

Antibiotics, often in combination with bismuth subsalicylate. Side effects: vary with antibiotic type and combination used, but all diminish healthy intestinal bacteria.

OTHER ULCER TREATMENTS
Cabbage juice is one food treatment that studies have shown may be helpful for ulcers. Cabbage juice is high in a chemical called glutamine, which may stimulate the stomach to produce more of a protective compound called mucin. To achieve this protective effect, you need to drink about four cups of juice a day in divided doses.

Other ulcer strategies:
Avoid foods that worsen symptoms.
Take supplements of vitamins A and E if you think you may not be getting enough of these vitamins. You need 10,000 IU of vitamin A (or 15,000 to 25,000 I U of beta-carotene) per day and 400 to 800 I U of vitamin E per day.
• Boost your fibre intake.
*Avoid smoking and coffee (including decaf).
Avoid aspirin, ibuprofen and other anti-inflammatory drugs.

HERBAL REMEDIES

Liquorice (Glycyrrhiza glabra)
The premier ulcer-healing herb, liquorice seems to work as well as ulcer­treating drugs, but with fewer side effects. Instead of inhibiting acid production, it strengthens the stomach's normal protective mechanisms and induces healing. It may even help eliminate H. pylori, the bacterium at fault in many ulcers. Liquorice has also been shown to decrease ulcer formation caused by drugs such as aspirin. Unlike whole liquorice, a form of the herb called DGL, or deglycyrrhizinated liquorice, can be taken by people with high blood pressure and those who take heart or blood pressure drugs.
Typical dosage: 3 cups of tea per day (simmer 1 teaspoon of dried root in 1/4 litre of hot water for 10 minutes); or 1/8 to 1/2 teaspoon of tincture three times per day; or 1 or 2 tablets of DGL liquorice chewed three times per day before meals. (Because DGL liquorice is activated by saliva, it does not work as well if you simply swallow it.) Caution: DGL liquorice may cause diarrhoea in some people. Whole liquorice should not be used if you're pregnant or breastfeeding, if you have heart disease, liver disease or diabetes, or if you are taking heart or blood pressure drugs. Limit use of whole liquorice to six weeks unless under the supervision of a qualified health practitioner.

Camomile (Matricaria recutita)
This lovely, old-fashioned herb promotes healing, decreases inflammation in the stomach, and can ease the anxiety that may be perpetuating the ulcer. Typical dosage: 3 to 6 cups of tea per day (steep 1 to 2 teaspoons of dried herb in 1/4 litre of hot water for 10 minutes); or 1/4 to 1 teaspoon of tincture or glycerite three or four times per day.

Calendula (Calendula officinalis)
These beautiful orange or yellow flowers are anti-inflammatory and wound-healing. They are also mildly astringent, which helps reduce bleeding. So if bleeding is one of your ulcer symptoms, calendula is a good choice. Typical dosage: 3 to 6 cups of tea per day (steep 1 to 2 teaspoons of dried flowers in 1/4 litre of hot water for 10 minutes); or 1/4 to 1 teaspoon of tincture or glycerite three or four times per day.

Meadowsweet (Filipendula ulmaria)
This remedy for the gastrointestinal tract contributes to ulcer healing by decreasing inflammation, protecting and soothing the stomach lining, and reducing excess acidity. It is also mildly astringent. Typical dosage: 3 to 6 cups of tea per day (steep 1 to 2 teaspoons of dried herb in 1/4 litre of hot water for 10 minutes). Caution: avoid meadowsweet if you are allergic to aspirin; it contains a chemical relative of aspirin.

Marshmallow Root (Althaea officinalis)
When water is added to this soothing root, a rich mucilage, or slippery substance, forms that helps it coat and soothe an irritated ulcer. Typical dosage: 3 to 6 cups of tea per day, sipped frequently throughout the day (steep 1 to 2 teaspoons of dried root in 1/4 litre of hot water for 10 minutes or steep the same amount in cold water overnight); or 1/4 to 1 teaspoon of tincture or glycerite three or four times per day. Caution: the mucilage in marshmallow may absorb other drugs taken at the same time, so, if you are using other drugs, ask your practitioner's advice about a dosage routine.

Slippery elm
Slippery Elm (Ulmus rubra)
The bark of this tree is another herb
that forms mucilage to protect, soothe and heal the stomach lining. Typical dosage: 3 to 6 cups of tea per day (steep 1 to 2 teaspoons of dried bark in 1/4 litre of hot water for 10 minutes or steep in cold water overnight); or 1/4 to 1 teaspoon of tincture or glycerite three or four times per day.

Common Mallow (Malva sylvestris)
Another mucilage-former, this herb can be prepared the same way as marshmallow or slippery elm. Typical dosage: 3 to 6 cups of tea per day (steep 1 to 2 teaspoons of dried bark in 1/4 litre of hot water for 10 minutes or steep the same amount in cold water overnight); or
to 1 teaspoon of tincture or glycerite three or four times per day.

Plantain (Plantago major)
A common garden weed that grows almost everywhere in the world, plantain has soothing, astringent, antibacterial and wound-healing properties. Typical dosage: 3 to 4 cups of tea per day (steep 1 to
2 teaspoons of dried leaves or 1 tablespoon of fresh herb in 1/4 litre of hot water for 10 minutes); or 1/4 to 1 teaspoon of tincture or glycerite three or four times per day.

STOMACH-SOOTHING TEA
This tea combines four stomach-soothing, ulcer-healing herbs. You can carry it with you and sip it frequently throughout the day - the more the better. It can be drunk hot or cold.
Blend equal amounts of:
dried camomile flowers
dried calendula flowers
dried meadowsweet herb
dried, chopped or powdered slippery elm bark
Combine the herbs and store the mixture in a glass jar away from heat and light.
To brew:
3-6 tablespoons tea blend
680 millilitres to 1 1/2 litres boiling water
Add the herbs to a teapot, pour boiling water (1/4 litre for every tablespoon of tea) over the herbs, and let steep for 10 minutes. Strain into a jar or vacuum­bottle. The unused tea can be refrigerated and kept for up to three days.