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digestive system
peptic ulcer disease
nutrition
dietary guidelines
»eating principles:
Frequent small meals are better tolerated
Low protein
Short alkaline fast for 3 days/Fasting
Elimination/rotation diet, rotation diet, rotation diet expanded
» duodenal ulcer:
Increasing dietary fiber delays gastric emptying time.
(Rydning, Berstad, Aadland & Odegaard. Lancet 2:736-9, 1982; Rydning & Berstad. Scand. J. Gastroenterol. 20(9):1078-82, 1985)
» therapeutic foods:
Foods high in Zinc, Vitamins A and E
Pureed lima beans, steamed carrots, rice gruel, barley water, okra, goat's milk, potato broth, coconut milk, carob, parsnips (steamed and mashed), dates and whole raw milk, pumpkin, squash, okra, tapioca, barley water, fig, kale (Airola, pp. 154-156; Ni, p. 161)
Slippery elm gruel
» fresh juices:
Cabbage (raw juice): 1 liter per day It appears that glutamine is the specific active ingredient. One study has shown it to be effective alone (may stimulate mucin production). (Zhgun AA, et al. Voen Med Zh. 1971 Apr; 4: 36-38; Dunaevskii GA, et al. Vopr Pitan. 1970 Jul; 29(4): 29-33; Vermel' EM, et al. Vrach Delo. 1966 Sep; 9: 133-135; Thaly H. Gaz Med Fr. 1965 May 10; 72(9): 1992-1993; Marz, p. 360, 1997)
Celery with a little sweet cream (Jensen, p. 50)
Spinach and grapefruit (Jensen, p. 50)
1/4 cup raw potato juice on an empty stomach 20-30 minutes before breakfast (Shefi)
Carrot (Walker, p. 156)
Carrot and spinach (Walker, p. 156)
Carrot, beet, and cucumber (Walker, p. 156)
» specific remedies:
Peptic ulcer cocktail: if you want to avoid swallowing pills or taking vitamins the following can be made into a drink:
Glutamine powder
Cabbage juice
Carrot juice (beta carotene)
Wild purslane (vitamin E)
Swiss Chard (zinc)
Cod liver oil and borage oil (vitamin A & PGE1 precursor)
The treatment plan for this cocktail is to sip this drink throughout the day so that you have local contact and you have a fresh supply of nutrients going into the gut. (Marz, p. 360, 1997)
Take several kohlrabi, peel, slice and place in a glass or ceramic container. Cover with raw honey and allow to soak for several days until kohlrabi becomes soft and the honey has soaked through. Take a piece as often as desired and chew it thoroughly (Chao-liang, Qing-rong, Bao-zhen, p. 26)
Take 250 g cabbage and boil until partly cooked, then remove from water. To the broth add a lemon that has been pickled in salt and a little honey. Simmer until the lemon is cooked and drink broth throughout the day for 15-20 days (Chao-liang, Qing-rong, Bao-zhen, p. 32)
Slice together a tomato and a pickled lemon, add honey and eat a small amount three times daily for 3 weeks (Chao-liang, Qing-rong, Bao-zhen, p. 62)
» avoid:
Avoid drugs which exacerbate condition: NSAID, aspirin, alcohol, caffeine
Avoid allergens and food intolerances, especially milk, and other irritants such as black pepper and coffee. (Ippoliti. Br. Med. J 293:666, 1986; Siegal. Ann Allergy 32:127, 1974)
Avoid smoking, stress (Person, Ahlbom & Hellers. Gut 31:1377-81, 1990)
Chili, hot and spicy foods, stimulating foods, alcohol, caffeine, acid producing foods, rich foods, fried and greasy foods, sweet foods and sugar
» drug interactions:
Phosphorous and aluminum hydroxide: aluminum binds dietary Phosporous, potentially causing depletion
Calcium and aluminum hydroxide: aluminum causes increased urinary and stool Calcium (Spencer and Kramer, 1983; 143: p. 657-658)
Cimetidine (Tagamet) and ranitidine (Zantac) inhibit gastric alcohol dehydrogenase, interfering with alcohol breakdown, and substantially increasing serum alcohol levels (DiPadova, et al., JAMA 1992; 267: 83-86)
supplements
Bismuth citrate salts form a glycoprotein-bismuth complex which acts as a local diffusion barrier to gastric acid. It does not decrease acid production by the stomach. Conventional treatment for H. pylori involves the use of bismuth, amoxicillin and metronidazole for 7 days. Serologic assays showed a marked reduction in the triple antibiotic group compared to controls.
(McKenna, Humphreys, Dooley, Bourke, et al. Gastroenterology 92:1528; 1987)
Cabbage (raw juice): 1 liter/day. It appears that glutamine is the specific active ingredient. One study has shown it to be effective alone (may stimulate mucin production).
Glutamine: 1g every four to six hours (for similar action as cabbage juice)
Glycyrrhiza glabra (Deglycyrrhinated root) 250 mg three times daily, stimulates mucus formation and secretion (Morgan AG, et al. Gut 23:545, 1982; Acta Gastroent. Bel. 46; 459, 1983; Pizzorno, Murray, VI: Ulcer P-2)
Copper: 5 mg per day
Zinc picolinate 90 mg per day; increases mucin production (Frommer. Med J. Aust. 2:793, 1975)
Vitamin A: 20,000 IU three times daily
Vitamin B12 and activated Vitamin D, if on cimetidine
Vitamin C: 1 g three times daily buffered (Marz, p. 360, 1997)
Catechin (bioflavonoid): 1g five times per day, decreases histamine levels. (Marz, p. 359, 1997)
Digestive enzymes
Essential fatty acids: both linoleic acid and GLA1-2 tbsp. safflower oil OR 4-6 caps black currant oil. PGE1 inhibits acid secretion and increases mucosal cell resistance to injury.
also:
Various botanicals: Ulmus fulva 1/2 tsp after meals, Aloe vera, unripe plantain banana. (see Botanicals).
Hydrastis canadensis & Berberis aquafolium: may be used in the treatment of Helicobacter pylori.
» drug interactions:
B12 and cimetidine (Tagamet): cimetidine reduces B12 absorption (Salom, et al.,1982; 17: 129-131)
Activated Vitamin D and cimetidine: cimetidine (Tagamet) reduces hepatic hydroxylation of vitamin D (Nutr Rev 1985; 43 (6): 184); 25(OH) cholecalciferol can be measured to determine if deficiency is present
footnotes
Dunaevskii GA, et al. Value of preserved juice of white cabbage in the complex therapy of peptic ulcer. Vopr Pitan. 1970 Jul; 29(4): 29-33.
Comparative study of carbenoloxone and cimetidine in the management of duodenal ulcer. Acta Gastroent. Bel. 46;459, 1983.
Abstract: It was found that DGL was as effective as cimetidine, but without the undesirable effects of cimetidine.
Frommer. The healing of gastric ulcers by zinc sulfate. Med J. Aust. 2:793, 1975.
Abstract: Double blind study involving 15 patients with gastric ulcers who were treated randomly with either zinc or placebo. After 3 weeks, the absolute reduction in size of the ulcer crater was 3x as great in the treated group. Zinc reduced pain markedly within 4 days in some patients. There were no side effects and pretreatment zinc levels were normal.
McKenna, Humphreys, Dooley, Bourke, et al. Campylobacter pyloritis and histological gastritis in duodenal ulcer: a controlled prospective randomized trial. Gastroenterology 92:1528; 1987.
Abstract: 64 patients with endoscopically proven duodenal ulcers were randomized to receive either cimetidine (H-2 receptor antagonist) or 120mg equivalents of bismuth salts qid for 6 weeks. In this blind & controlled study it was found that 93% of the patients who entered the study had Campylobacter pylori present. Healing rates for cimetidine and bismuth were similar, but the bismuth showed a decreased incidence of Campylobacter pyloritis from 94% to 52%. There was no change in the cimetidine treatment group. Recurrence rate in the bismuth treated group was lower.
Morgan AG, McAdam WA, Pacsoo C, Darnborough A. A comparison between cimetidine and CAVED S in the treatment of gastric ulceration and subsequent maintenance therapy. Gut 23:545, 1982.
Abstract: In a comparison with cimetidine it was found that glycyrrhiza was equally effective (88% healing rate in 12 weeks).
Person, Ahlbom & Hellers. Inflammatory bowel disease and tobacco smokea case control study. Gut 31:1377-81, 1990. Abstract: A case control study was carried out in Stockholm, Sweden between 1984-87 to evaluate the association of childhood cigarette smoking and exposure to environmental tobacco smoke and the subsequent development of irritable bowel disease. Over 500 patients were evaluated and it was found that there was a significant increase risk of developing Crohns disease later in life if the child was exposed to secondary cigarette smoke.
Rydning, Berstad, Aadland & Odegaard. Prophylactic effects of dietary fiber in duodenal ulcer disease. Lancet 2:736-9, 1982.
Rydning & Berstad. Fiber diet and antacids in the short term treatment of duodenal ulcer. Scand. J. Gastroenterol. 20(9):1078-82, 1985.
Abstract: 80 patients were treated with 1 low dose antacid four times daily. In addition they were randomly divided to receive a fiber-rich and a fiber-poor diet. A very slightly increased rate of healing was seen in the fiber-rich diet.
Thaly H. A new therapy of peptic ulcer: "the anti-ulcer factor of cabbage". Gaz Med Fr. 1965 May 10; 72(9): 1992-1993.
Vermel EM, et al. Therapeutic use of white cabbage juice. Vrach Delo. 1966 Sep; 9: 133-135.
Zhgun AA, et al. Effect of dehydrated cabbage juice on the secretory, acid- and pepsin-forming function of the stomach. Voen Med Zh. 1971 Apr; 4: 36-38.