Natural Foods Merchandiser

Natural approaches to treating stomach ulcers

Consumers who are tired of antacids can choose among a number of alternative approaches for the treatment of stomach ulcers. These include zinc carnosine, gum mastic, colostrum and deglycyrrhizinated licorice extract, although not all are supported by high-quality clinical research. Similarly, raw cabbage juice and chamomile extract are popular traditional remedies for stomach ulcers, but little or no research supports their use. But in vitro studies suggest that garlic may hold some promise for the eradication of Helicobacter pylori, a bacterium implicated in the development of peptic ulcers as well as stomach cancer (see sidebar, below).

A painful problem
Peptic ulcers, among the most common conditions to affect the upper digestive tract, are characterized by a break in the mucosa (lining) of the stomach, esophagus or duodenum (upper part of the small intestine).1 A layer of mucus protects the lining of the stomach and duodenum from potentially damaging substances produced by the body, including hydrochloric acid and the digestive enzyme pepsin. When this mucus barrier breaks down, stomach acids start to destroy the cells lining the stomach and duodenum. The damage starts with the top layer of cells, called the mucosal layer, and progresses to the underlying layers, the submucosa and muscularis. Peptic ulcers can become chronic, resulting in the formation of scar tissue in place of the normal lining.2

In Americans, 90 percent of peptic ulcers occur in the duodenum.2 Duodenal ulcers are more common in men and occur most frequently between the ages of 30 and 50.1 Gastric (stomach) ulcers are more common in women, occurring most often after the age of 60. The most common symptom of peptic ulcers is recurring upper abdominal pain relieved by food or antacids,2 but some ulcers present no symptoms and are detected only through X-ray. Other symptoms include nausea, vomiting and loss of appetite. Peptic ulcers may become so advanced that they result in bleeding, which can show up in the form of black tarry stools and fatigue related to anemia.

It is now known that the underlying cause of many ulcers is infection with H. pylori bacteria, which can be detected through a blood test or urea breath test.1 Other contributing causes include lifestyle issues such as smoking, chronic alcohol abuse and use of nonsteroidal anti-inflammatory drugs, as well as overproduction of acid and pepsin by the stomach.

A typical course of conventional medical treatment for stomach ulcers may include drugs that reduce acid production (H2 blockers and proton pump inhibitors) and drugs that coat the stomach lining to prevent acid from coming into contact with the stomach wall. If H. pylori is present, doctors may prescribe antibiotics. The complete treatment regimen may include several different medicines taken throughout the day and can yield unpleasant side effects such as nausea, diarrhea, constipation, fatigue, abdominal pain and headaches. Antibiotic resistance can become a problem, especially if the person becomes reinfected with H. pylori after initial eradication.1

Zinc carnosine
Animal research suggests that a zinc carnosine product called polaprezinc holds potential both for preventing gastric mucosal lesions and promoting healing of gastric ulcers.3,8,9 Human research is also promising, although to date researchers have investigated the supplement only in terms of its ability to eradicate H. pylori infection. Most of the research has been conducted in Japan.

Polaprezinc is a proprietary substance composed of zinc and L-carnosine. Researchers believe that it exhibits anti-ulcer effects by acting directly on mucosal lesions. Zinc is a mineral essential for the cellular activities involved in tissue repair.3 Polaprezinc is thought to work by promoting mucus secretion,3 stimulating production of insulin-like growth factor3 and reducing inflammation.4 Some of these effects may be related to antioxidant activity.3,5

Though polaprezinc may be a promising mucosal protective agent, the bulk of the research has been conducted on animals or cell cultures. The evidence in humans remains weak, if only because the pace of clinical research is lagging behind that of laboratory research. The results of human research performed to date have been mixed, and no studies have examined the effects of polaprezinc on NSAID-induced peptic ulcers.

One study examined the effects of polaprezinc in combination with lansoprazole (a proton pump inhibitor), amoxycillin and clarithromycin (two antibiotics) as a treatment for H. pylori. In the study, 66 H. pylori-positive people with symptoms of indigestion were randomly assigned to one of two treatment regimens. Thirty-one people took 30 mg lansoprazole twice a day, 500 mg amoxycillin twice a day and 400 mg clarithromycin twice a day for seven days (the LAC group); the other 35 patients received the same treatment plus 150 mg polaprezinc twice a day (the LACP group). Among patients who completed the study, 24 out of 28 (86 percent) in the LAC group no longer showed evidence of infection with H. pylori. In the LACP group, all 33 patients who completed the study were negative for H. pylori post-treatment. Three patients dropped out of the study due to severe diarrhea (one in the LAC group and two in the LACP group). In this study, the addition of polaprezinc to a common treatment regimen significantly improved H. pylori eradication.6

However, a similar study comparing the effects of eight anti-ulcer drugs concluded that polyprezinc alone was ineffective in eradicating H. pylori.7 Animal research on polyprezinc is promising and suggests that the supplement may inhibit gastric mucosal oxidative inflammation and promote healing of gastric lesions,3,8,9 but more research is needed.

Gum mastic
Gum mastic, a resin obtained from the bark of the mastic tree (Pistacia lentiscus), has a history of traditional use for treating stomach upsets and ulcers.10 Results of modern research vary, however, with some studies indicating gum mastic can eradicate H. pylori11,13 and other studies demonstrating no benefit.12,13

In a small double-blind study involving 38 adults diagnosed with symptomatic duodenal ulcers, researchers compared the effects of mastic (1 g daily given to 20 participants over two weeks) with placebo (1 g lactose given to 18 participants daily over two weeks). Eighty percent (16 total) of those who took mastic reported relief of symptoms, and endoscopic examination showed healing in 70 percent of these people. These results were significant compared with placebo (p<0.01). Fifty percent (nine total) of participants who took placebo had symptomatic relief, but endoscopy demonstrated healing in only 22 percent (four total) of this group.13 These results suggest that mastic may be beneficial as a first-line treatment for duodenal ulcers.

Another study concluded that gum mastic was ineffective in eradicating H. pylori. The small study involved nine patients infected with H. pylori (determined via a urea breath test) who had no current or previous history of duodenal ulceration. One participant withdrew from the study, but the remaining eight were tested for H. pylori status after 14 days of treatment with 1 g mastic per day. All patients remained positive for H. pylori after the treatment.12 However, this study was small and very badly described, with a poor discussion of the study methodology and no indication of the age, sex or medical history of the participants. Therefore, it is difficult to judge if the negative result is due to lack of efficacy or poor study design.

Colostrum is the premilk fluid produced by a mother's mammary glands in the first few days after giving birth. Rich in immune antibodies, growth factors and nutrients, it strengthens the newborn's immune system and helps protect against various infectious microorganisms. Supplemental forms of colostrum have been marketed as health remedies for a number of ailments, and colostrum has been touted as a remedy for H. pylori infection. However, research results are mixed.

In a placebo-controlled, double-blind pilot study, researchers tested the effect of antibodies from hyperimmune bovine colostrum against H. pylori infection in 24 infants from Bangladesh. The infants were randomly assigned to receive 30 days of treatment with either hyperimmune bovine colostrum (710 mg of antibodies per day) or the same amount of bovine colostrum from nonimmunized cows; there were 12 infants in each group. Diagnosis of H. pylori was confirmed by a urea breath test before treatment and assessed again after treatment; all of the children still tested positive after the one-month treatment period ended.14 Animal studies have yielded somewhat more positive results, but much more research is needed before colostrum can be recommended as a treatment for ulcers.15

DGL and beyond
Deglycyrrhizinated licorice extract is one of the best-known and best-studied natural treatments for stomach ulcers. DGL is a special extract of licorice (Glycyrrhiza glabra) that does not contain glycyrrhizin, a compound in whole licorice extract that may elevate blood pressure.

Although the research is not new, a number of clinical studies have shown that DGL relieves pain, speeds healing of duodenal and gastric ulcers, and helps prevent ulcer relapse.16,17,18 A landmark study conducted in 1982 showed that DGL was as effective in relieving symptoms and healing ulcers as the popular drug cimetidine (marketed under the trade name Tagamet). In this single-blind study involving 100 people, those in the licorice group took 760 mg of DGL three times daily; people in the cimetidine group took three 200 mg doses daily and an additional 400 mg dose at night.16 Researchers originally attributed the healing properties of DGL to protective effects on the gastric mucosa,19 but more recent research has revealed that DGL contains flavonoid compounds that eradicate H. pylori in vitro.20

Several in vitro studies back the antibacterial activity of garlic against H. pylori.21,22,23 However, only one clinical trial has examined whether garlic will actually kill H. pylori in the human stomach. In this small pilot study, five people infected with H. pylori were given garlic oil at a dosage of 4 mg four times a day for 14 days. This dose of garlic oil did not eradicate H. pylori, but the researchers suggested that a higher dose given for a longer period of time may prove to be effective.24 Clearly, more research in humans is needed to determine whether garlic may be an effective treatment option for H. pylori infection.

Although more investigation is needed to confirm preliminary results, these and other dietary supplements may one day offer potential alternatives to antibiotic therapy for the treatment of H. pylori and peptic ulcers caused by H. pylori infection.

Marie Spano, R.D., is a food industry consultant and spokeswoman for the International Society of Sports Nutrition.

Helicobacter pylori and ulcers
In 1982, researchers J. Robin Warren and Barry Marshall proved that the bacterium Helicobacter pylori is a leading cause of both gastritis and stomach ulcers.25 Since their initial groundbreaking research, further studies have shown that 90 percent of duodenal ulcers and 70 percent of gastric ulcers are caused by H. pylori infection.2 Furthermore, H. pylori is associated with the development of stomach cancer. In fact, the World Health Organization International Agency for Research in Cancer has classified H. pylori as a class 1 carcinogen.25

H. pylori penetrates and weakens the stomach's protective mucus coat, making cells more susceptible to the damaging effects of acid and pepsin. In addition, the bacteria can attach to stomach cells, leading to localized inflammation. Even though H. pylori can be virulent, fewer than 20 percent of infected individuals develop ulcers, an indication of the wide genetic variability and number of strains associated with the bacteria.25 Therefore, even though H. pylori is a leading cause of ulcers, many infected people never actually develop ulcers.

Researchers believe H. pylori infection is acquired through direct contact with another infected person. Infection typically begins in childhood and can last throughout life. Infection is associated with problems related to low socioeconomic status, such as poor hygiene, inadequate sanitation, contaminated water supply and crowded living conditions.1 In developing nations, 70 percent to 90 percent of adults are infected with H. pylori; most acquire the infection before the age of 10. In developed countries, H. pylori is found in fewer than 10 percent of children, though a steady increase in colonization is seen with increasing age.25

Eliminating H. pylori infection is considered an important step toward healing ulcers and preventing their reccurrence.1 However, this can prove to be a difficult task. Because there are so many bacterial strains, H. pylori can easily elude immune system defenses.25 In addition, drug therapy can be costly (especially in developing countries), and can create antibiotic resistance and kill beneficial bacteria in the gut, possibly leading to additional health problems.


1. Atherton JC, Goddard AF. Gastritis, peptic ulceration and related conditions. In: Cohen J, Powderly WG, eds. Infectious Diseases, 2nd edition. Edinburgh: 2004. pp 469-476.
2. Stomach and duodenal disorders. In: The Human Body: An Illustrated Guide to its Structure, Function and Disorders. Clayman C, ed. London:1995.
3. Kato S. Effect of polaprezinc on impaired healing of chronic gastric ulcers in adjuvant-induced arthritic rats—role of insulin-like growth factors (IGF)-1. Med Sci Monit 2001;7(1):20-5.
4. Shimada T, et al. Polaprezinc down-regulates proinflammatory cytokine-induced nuclear factor-kappa B activation and interleukin-8 expression in gastric epithelial cells. J Pharmacol Exp Ther 1999; 291(1):345-52.
5. Hiraishi H, et al. Polaprezinc protects gastric mucosal cells from noxious agents through antioxidant properties in vivo. Aliment Pharmacol Ther 1999;13:261-9.
6. Kashimura H, et al. Polaprezinc, a mucosal protective agent, in combination with lansoprazole, amoxycillin and clarithromycin increases the cure rate of Helicobacter pylori infection. Aliment Pharmacol Ther 1999;13(4):483-7.
7. Murakami K. Influence of anti-ulcer drugs used in Japan on the result of 13C-urea breath test for the diagnosis of Helicobacter pylori infection. J Gastroenterol 2003;38(10):937-41.
8. Suzuki H, et al. Polaprezinc attenuates the Helicobacter pylori-induced gastric mucosal leucocyte activation in Mongolian gerbils—a study using intravital videomicroscopy. Aliment Pharmacol Ther 2001;15(5):715-25.
9. Korolkiewicz RP, et al. Polaprezinc exerts a salutary effect on impaired healing of acute gastric lesions in diabetic rats. Dig Dis Sci 2000;45(6):1200-7.
10. Al-Said MS, et al. Evaluation of mastic, a crude drug obtained from Pistacia lentiscus for gastric and duodenal anti-ulcer activity. J Ethnopharmacol 1986;15(3):271-8.
11. Huwez FU, Al-Habbal MJ. Mastic in treatment of benign gastric ulcers. Gastroenterol Jpn 1986;21:273-4.
12. Bebb JR. Mastic gum has no effect on Helicobacter pylori load in vitro. J Antimicrob Chem 2003;52:522-3.
13. Al-Habbal MJ, et al. A double-blind controlled clinical trial of mastic and placebo in the treatment of duodenal ulcer. Clin Exp Pharmacol Physiol 1984;11:541-4.
14. Casswall TH. Treatment of Helicobacter pylori infection in infants in rural Bangladesh with oral immunoglobulins from hyperimmune bovine colostrums. Aliment Pharmacol Ther 1998;12:563-8.
15. Casswall TH. Bovine anti-Helicobacter pylori antibodies for oral immunotherapy. Scan J Gastroenterol 2002;12:1380-5.
16. Morgan AG, et al. Comparison between cimetidine and Caved-S in the treatment of gastric ulceration, and subsequent maintenance therapy. Gut 1982; 23:545-51.
17. Kassir AZ. Endoscopic controlled trial of four drug regimens in the treatment of chronic duodenal ulceration. Ir Med J 1985; 78(6): 153-6.
18. Morgan AG, et al. Maintenance therapy: A two-year comparison between Caved-S and cimetidine treatment in the prevention of symptomatic gastric ulcer. Gut 26: 599-602.
19. Van Marle J, et al. Deglycyrrhizinated liquorice (DGL) and the renewal of rat stomach epithelium. Eur J Pharmacol 1981;72:219-25.
20. Fukai T, et al. Anti-helicobacter pylori flavonoids from licorice extract. Life Sci 2002; 71(12):1449-63.
21. Cellini L, et al. Inhibition of Helicobacter pylori by garlic extract (Allium sativum). FEMS Immunol Med Microbiol 1996;3(4):273-7.
22. O'Gara EA, et al. Activities of garlic oil, garlic powder, and their diallyl constituents against Helicobacter pylori. Appl Environ Microbiol 2000;66(5):2269-73.
23. Jonkers D, et al. Antibacterial effect of garlic and omeprazole on Helicobacter pylori. J Antimicrob Chemther 1999;43(6):837-9.
24. McNulty CA, et al. A pilot study to determine the effectiveness of garlic oil capsules in the treatment of dyspeptic patients with Helicobacter pylori. Helicobacter 2001;6(3):249-53.
25. Lynch NA. Helicobacter pylori and ulcers: a paradigm revised. Breakthroughs in Bioscience. Federation of American Societies for Experimental Biology.

Natural Foods Merchandiser volume XXVII/number 2/p. 38, 40, 42

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